Medicinal cannabis for the treatment of chronic refractory pain: An investigation of the adverse event profile and health-related quality of life impact of an oral formulation

Introduction: Medicinal cannabis is prescribed in Australia for patients with chronic refractory pain conditions. However, measures of safety and effectiveness of different cannabinoids are lacking. We designed an observational study to capture effectiveness, adverse events (AEs), and health-related quality of life (HRQoL) measures in patients prescribed an oral medicinal cannabis formulation at Cannabis Access Clinics through the Cannabis Access Clinics Observational study (CACOS). Objectives: We aimed to evaluate effectiveness, reported AEs, and change in patient-reported outcomes in individuals prescribed a cannabinoid oil formulation for management of chronic pain. Methods: A cross-sectional analysis was conducted on patients prescribed an oil formulation of Δ9-tetrahydrocannabinol and cannabidiol for pain symptoms of at least 3-month duration. Clinician-reported AEs were organized by system, organ, class, and frequency. Analysis of patient-reported responses to a questionnaire was conducted using published minimal clinically important differences to determine meaningful change in HRQoL over time. Results: More than half (n = 91/151, 60.3%) of the participants experienced at least one AE during the observation period (mean 133 ± 116 days). No serious AEs were reported. Patient-reported pain impact scores were significantly reduced across the cohort (p = 0.034), and pain intensity scores verged on significance (p = 0.053). The majority of patients saw meaningful improvements in sleep (49.3%) and fatigue (35.6%). Conclusion: This analysis presents real-world data collected as part of standard of care. More than one-third of patients benefited from oral medicinal cannabis, which is impactful given the refractory nature of their pain. Amelioration of the impact of pain confirms continued prescribing of this formulation and validates our observational methodology as a tool to determine the therapeutic potency of medicinal cannabinoids

Measurement of the splashback feature around SZ-selected Galaxy clusters with DES, SPT, and ACT

We present a detection of the splashback feature around galaxy clusters selected using the Sunyaev–Zel’dovich (SZ) signal. Recent measurements of the splashback feature around optically selected galaxy clusters have found that the splashback radius, rsp, is smaller than predicted by N-body simulations. A possible explanation for this discrepancy is that rsp inferred from the observed radial distribution of galaxies is affected by selection effects related to the optical cluster-finding algorithms. We test this possibility by measuring the splashback feature in clusters selected via the SZ effect in data from the South Pole Telescope SZ survey and the Atacama Cosmology Telescope Polarimeter survey. The measurement is accomplished by correlating these cluster samples with galaxies detected in the Dark Energy Survey Year 3 data. The SZ observable used to select clusters in this analysis is expected to have a tighter correlation with halo mass and to be more immune to projection effects and aperture-induced biases, potentially ameliorating causes of systematic error for optically selected clusters. We find that the measured rsp for SZ-selected clusters is consistent with the expectations from simulations, although the small number of SZ-selected clusters makes a precise comparison difficult. In agreement with previous work, when using optically selected redMaPPer clusters with similar mass and redshift distributions, rsp is ∼2σ smaller than in the simulations. These results motivate detailed investigations of selection biases in optically selected cluster catalogues and exploration of the splashback feature around larger samples of SZ-selected clusters. Additionally, we investigate trends in the galaxy profile and splashback feature as a function of galaxy colour, finding that blue galaxies have profiles close to a power law with no discernible splashback feature, which is consistent with them being on their first infall into the cluster

The SPTPoL extended cluster survey

We describe the observations and resultant galaxy cluster catalog from the 2770 deg2 SPTpol Extended Cluster Survey (SPT-ECS). Clusters are identified via the Sunyaev-Zel'dovich (SZ) effect and confirmed with a combination of archival and targeted follow-up data, making particular use of data from the Dark Energy Survey (DES). With incomplete follow-up we have confirmed as clusters 244 of 266 candidates at a detection significance ξ ≥ 5 and an additional 204 systems at 4 4 threshold, and 10% of their measured SZ flux. We associate SZ-selected clusters, from both SPT-ECS and the SPT-SZ survey, with clusters from the DES redMaPPer sample, and we find an offset distribution between the SZ center and central galaxy in general agreement with previous work, though with a larger fraction of clusters with significant offsets. Adopting a fixed Planck-like cosmology, we measure the optical richness-SZ mass (l - M) relation and find it to be 28% shallower than that from a weak-lensing analysis of the DES data-a difference significant at the 4σ level-with the relations intersecting at λ = 60. The SPT-ECS cluster sample will be particularly useful for studying the evolution of massive clusters and, in combination with DES lensing observations and the SPT-SZ cluster sample, will be an important component of future cosmological analyses

Detection of CMB-cluster lensing using polarization data from SPTpol

We report the first detection of gravitational lensing due to galaxy clusters using only the polarization of the cosmic microwave background (CMB). The lensing signal is obtained using a new estimator that extracts the lensing dipole signature from stacked images formed by rotating the cluster-centered Stokes Q U map cutouts along the direction of the locally measured background CMB polarization gradient. Using data from the SPTpol 500     deg 2 survey at the locations of roughly 18 000 clusters with richness λ ≥ 10 from the Dark Energy Survey (DES) Year-3 full galaxy cluster catalog, we detect lensing at 4.8 σ . The mean stacked mass of the selected sample is found to be ( 1.43 ± 0.40 ) × 10 14 M ⊙ which is in good agreement with optical weak lensing based estimates using DES data and CMB-lensing based estimates using SPTpol temperature data. This measurement is a key first step for cluster cosmology with future low-noise CMB surveys, like CMB-S4, for which CMB polarization will be the primary channel for cluster lensing measurements

Mass calibration of DES Year-3 clusters via SPT-3G CMB cluster lensing

We measure the stacked lensing signal in the direction of galaxy clusters in the Dark Energy Survey Year 3 (DES Y3) redMaPPer sample, using cosmic microwave background (CMB) temperature data from SPT-3G, the third-generation CMB camera on the South Pole Telescope (SPT). Here, we estimate the lensing signal using temperature maps constructed from the initial 2 years of data from the SPT-3G 'Main' survey, covering 1500 deg2 of the Southern sky. We then use this lensing signal as a proxy for the mean cluster mass of the DES sample. The thermal Sunyaev-Zel'dovich (tSZ) signal, which can contaminate the lensing signal if not addressed, is isolated and removed from the data before obtaining the mass measurement. In this work, we employ three versions of the redMaPPer catalogue: a Flux-Limited sample containing 8865 clusters, a Volume-Limited sample with 5391 clusters, and a Volume&Redshift-Limited sample with 4450 clusters. For the three samples, we detect the CMB lensing signal at a significance of 12.4σ, 10.5σ and 10.2σ and find the mean cluster masses to be M 200m = 1.66±0.13 [stat.]± 0.03 [sys.], 1.97±0.18 [stat.]± 0.05 [sys.], and 2.11±0.20 [stat.]± 0.05 [sys.]×1014 M⊙, respectively. This is a factor of ∼ 2 improvement relative to the precision of measurements with previous generations of SPT surveys and the most constraining cluster mass measurements using CMB cluster lensing to date. Overall, we find no significant tensions between our results and masses given by redMaPPer mass-richness scaling relations of previous works, which were calibrated using CMB cluster lensing, optical weak lensing, and velocity dispersion measurements from various combinations of DES, SDSS and Planck data. We then divide our sample into 3 redshift and 3 richness bins, finding no significant discrepancies with optical weak-lensing calibrated masses in these bins. We forecast a 5.7% constraint on the mean cluster mass of the DES Y3 sample with the complete SPT-3G surveys when using both temperature and polarization data and including an additional ∼ 1400 deg2 of observations from the 'Extended' SPT-3G survey

Joint analysis of Dark Energy Survey Year 3 data and CMB lensing from SPT and Planck . I. Construction of CMB lensing maps and modeling choices

Joint analyses of cross-correlations between measurements of galaxy positions, galaxy lensing, and lensing of the cosmic microwave background (CMB) offer powerful constraints on the large-scale structure of the Universe. In a forthcoming analysis, we will present cosmological constraints from the analysis of such cross-correlations measured using Year 3 data from the Dark Energy Survey (DES), and CMB data from the South Pole Telescope (SPT) and Planck. Here we present two key ingredients of this analysis: (1) an improved CMB lensing map in the SPT-SZ survey footprint and (2) the analysis methodology that will be used to extract cosmological information from the cross-correlation measurements. Relative to previous lensing maps made from the same CMB observations, we have implemented techniques to remove contamination from the thermal Sunyaev Zel’dovich effect, enabling the extraction of cosmological information from smaller angular scales of the cross-correlation measurements than in previous analyses with DES Year 1 data. We describe our model for the cross-correlations between these maps and DES data, and validate our modeling choices to demonstrate the robustness of our analysis. We then forecast the expected cosmological constraints from the galaxy survey-CMB lensing auto and cross-correlations. We find that the galaxy-CMB lensing and galaxy shear-CMB lensing correlations will on their own provide a constraint on S 8 = σ 8 √ Ω m / 0.3 at the few percent level, providing a powerful consistency check for the DES-only constraints. We explore scenarios where external priors on shear calibration are removed, finding that the joint analysis of CMB lensing cross-correlations can provide constraints on the shear calibration amplitude at the 5% to 10% level

Joint analysis of Dark Energy Survey Year 3 data and CMB lensing from SPT and Planck . II. Cross-correlation measurements and cosmological constraints

Cross-correlations of galaxy positions and galaxy shears with maps of gravitational lensing of the cosmic microwave background (CMB) are sensitive to the distribution of large-scale structure in the Universe. Such cross-correlations are also expected to be immune to some of the systematic effects that complicate correlation measurements internal to galaxy surveys. We present measurements and modeling of the cross-correlations between galaxy positions and galaxy lensing measured in the first three years of data from the Dark Energy Survey with CMB lensing maps derived from a combination of data from the 2500     deg 2 SPT-SZ survey conducted with the South Pole Telescope and full-sky data from the Planck satellite. The CMB lensing maps used in this analysis have been constructed in a way that minimizes biases from the thermal Sunyaev Zel’dovich effect, making them well suited for cross-correlation studies. The total signal-to-noise of the cross-correlation measurements is 23.9 (25.7) when using a choice of angular scales optimized for a linear (nonlinear) galaxy bias model. We use the cross-correlation measurements to obtain constraints on cosmological parameters. For our fiducial galaxy sample, which consist of four bins of magnitude-selected galaxies, we find constraints of Ω m = 0.272 + 0.032 − 0.052 and S 8 ≡ σ 8 √ Ω m / 0.3 = 0.736 + 0.032 − 0.028 ( Ω m = 0.245 + 0.026 − 0.044 and S 8 = 0.734 + 0.035 − 0.028 ) when assuming linear (nonlinear) galaxy bias in our modeling. Considering only the cross-correlation of galaxy shear with CMB lensing, we find Ω m = 0.270 + 0.043 − 0.061 and S 8 = 0.740 + 0.034 − 0.029 . Our constraints on S 8 are consistent with recent cosmic shear measurements, but lower than the values preferred by primary CMB measurements from Planck

Silent and Audible Persistent Ductus Arteriosus: An Angiographic Study.

Persistent ductus arteriosus (PDA) murmurs become silent probably due to the direction of the jet across the ductus arteriosus when entering the pulmonary artery. Out of 15 children with silent PDA, 14 demonstrated a ductal flow not contacting and away from the anterior wall of the main pulmonary artery. In 15 children with a continuous murmur caused by a PDA, 12 exhibited a ductal flow toward and reaching the anterior wall of the MPA. There was no correlation between the presence of a murmur and the size of the arterial duct in this study