Epipericardial fat necrosis – a rare cause of pleuritic chest pain: case report and review of the literature

Epipericardial fat necrosis (EPFN) is an uncommon cause of chest pain. Typically manifesting as severe acute chest pain, EPFN can be mistaken for a serious disorder, such as pulmonary embolism or myocardial infarction. We report a case of EPFN, diagnosed tentatively based on clinical and radiographic findings, with documented resolution of the lesion on chest CT. According to our literature search, this is only the second case in which chest CT alone was used to both diagnose the lesion and track its resolution. It is the first documented case diagnosed and followed as such in North America

Examining Perceptions of Participation in a Pediatric IBD Collaborative: Analyzing the Integral Features and Activities of ImproveCareNow

In 2007, pediatric gastroenterologists from ten practice sites across the U.S. created a quality improvement collaborative, now known as ImproveCareNow, to improve the quality of care provided to children with inflammatory bowel disease. Despite the face validity and great potential of quality improvement collaboratives, investigators do not fully understand how improvement happens, including the variables contributing to quality measures and the necessary components needed to sustain quality improvement. The purpose of this project was to explore perceptions of collaborative participants to identify elements of sustainability. We performed qualitative interviews with 16 ImproveCareNow participants as one method in a triangulated strategy of measuring collaborative participants’ perceptions. We selected informants from a diverse list of practice types and geographic locations, and asked open-ended questions, which we then transcribed and coded. For this master’s paper, I analyzed members’ perceptions of value of, and implementation strategies for, collaborative components like previsit planning, patient databases (population management), standardized clinic forms and algorithms, and decision support. I found that collaborative participants value many system-wide features of collaborative participation, but sites have different paths to implementation, and important features are underdeveloped or under-utilized at some sites. Respondents embraced the potential of population management reports, but noted that data entry burdened clinic flow. Previsit planning was cited as moderately successful, and one site had developed a novel modification of the planning to obviate face-to-face meetings. Standardized clinic templates and decision analysis tools met high expectations for mutual benefit from individual innovation and ingenuity. Analyzing in-depth interviews of ICN participants is the first step in understanding what health care providers perceive as the value from, benefits of, and challenges to initiating and sustaining collaborative quality improvement activitiesMaster of Public Healt

Case reportEpipericardial fat necrosis – a rare cause of pleuritic chest pain: case report and review of the literature

Epipericardial fat necrosis (EPFN) is an uncommon cause of chest pain. Typically manifesting as severe acute chest pain, EPFN can be mistaken for a serious disorder, such as pulmonary embolism or myocardial infarction. We report a case of EPFN, diagnosed tentatively based on clinical and radiographic findings, with documented resolution of the lesion on chest CT. According to our literature search, this is only the second case in which chest CT alone was used to both diagnose the lesion and track its resolution. It is the first documented case diagnosed and followed as such in North America

Cleavage of E-Cadherin Contributes to Defective Barrier Function in Neosquamous Epithelium

After ablation of Barrett’s esophagus (BE), the esophagus heals with neosquamous epithelium (NSE). Despite normal endoscopic appearance, NSE exhibits defective barrier function with similarities to defects noted in the distal esophageal epithelium in patients with gas-troesophageal reflux disease (GERD)

Epidemiology of Barrett’s Esophagus and Esophageal Adenocarcinoma

Barrett’s esophagus (BE) is a common condition, and is the precursor to esophageal adenocarcinoma, a disease with increasing burden in the western world, especially in Caucasian males. The incidence of BE increased dramatically during the late-20th century and incidence estimates continue to increase, with a prominent male:female ratio. The prevalence is between 0.5 – 2.0 percent. A number of anthropomorphic and behavioral risk factors exist for BE including obesity and tobacco smoking, but GERD is the strongest risk factor, and the risk is more pronounced with long-standing GERD. Esophageal adenocarcinoma (EAC) is the most common form of esophageal cancer in the U.S. Risk factors include GERD, tobacco smoking, and obesity, while NSAIDs and statins may be protective. A major factor predicting progression from non-dysplastic BE to EAC is the presence of dysplastic changes seen on esophageal histology, although a number of issues limit the utility of dysplasia as a marker for disease. Length of the involved BE segment is another risk for progression to high-grade dysplasia and cancer. Biomarkers have shown promise, but none are approved for clinical use

Outcomes of Esophageal Dilation in Eosinophilic Esophagitis: Safety, Efficacy and Persistence of the Fibrostenotic Phenotype

Esophageal dilation is commonly performed in eosinophilic esophagitis (EoE), but there are few long-term data. The aims of this study were to assess the safety and long-term efficacy of esophageal dilation in a large cohort of EoE cases and determine the frequency and predictors of requiring multiple dilations

The extremely narrow-caliber esophagus is a treatment-resistant subphenotype of eosinophilic esophagitis

Some patients with eosinophilic esophagitis (EoE) have an extremely narrowed esophagus, but the characteristics of this group have not been extensively described. We aimed to characterize the narrow-caliber phenotype of EoE, determine associated risk factors, and identify differences in treatment response in this sub-group of patients

Diminishing Effectiveness of Long-Term Maintenance Topical Steroid Therapy in PPI Non-Responsive Eosinophilic Esophagitis

While topical corticosteroids are first-line therapy for eosinophilic esophagitis (EoE), the data regarding long-term effectiveness are lacking. We aimed to determine long-term histologic and endoscopic outcomes of maintenance therapy in EoE steroid responders

Initial Hubble Diagram Results from the Nearby Supernova Factory

The use of Type Ia supernovae as distance indicators led to the discovery of the accelerating expansion of the universe a decade ago. Now that large second generation surveys have significantly increased the size and quality of the high-redshift sample, the cosmological constraints are limited by the currently available sample of ~50 cosmologically useful nearby supernovae. The Nearby Supernova Factory addresses this problem by discovering nearby supernovae and observing their spectrophotometric time development. Our data sample includes over 2400 spectra from spectral timeseries of 185 supernovae. This talk presents results from a portion of this sample including a Hubble diagram (relative distance vs. redshift) and a description of some analyses using this rich dataset.Comment: Short version of proceedings for ICHEP08, Philadelphia PA, July 2008; see v1 for full-length versio

Standardizing Type Ia Supernova Absolute Magnitudes Using Gaussian Process Data Regression

We present a novel class of models for Type Ia supernova time-evolving spectral energy distributions (SED) and absolute magnitudes: they are each modeled as stochastic functions described by Gaussian processes. The values of the SED and absolute magnitudes are defined through well-defined regression prescriptions, so that data directly inform the models. As a proof of concept, we implement a model for synthetic photometry built from the spectrophotometric time series from the Nearby Supernova Factory. Absolute magnitudes at peak $B$ brightness are calibrated to 0.13 mag in the $g$-band and to as low as 0.09 mag in the $z=0.25$ blueshifted $i$-band, where the dispersion includes contributions from measurement uncertainties and peculiar velocities. The methodology can be applied to spectrophotometric time series of supernovae that span a range of redshifts to simultaneously standardize supernovae together with fitting cosmological parameters.Comment: 47 pages, 15 figures, accepted for publication by Astrophysical Journa