A Single-Center Comparison of Extended and Restricted THROMBOPROPHYLAXIS with LMWH after Metabolic Surgery

IntroductionMorbid obesity is an important risk factor for developing a venous thromboembolic events (VTE) after surgery. Fast-track protocols in metabolic surgery can lower the risk of VTE in the postoperative period by reducing the immobilization period. Administration of thromboprophylaxis can be a burden for patients. This study aims to compare extended to restricted thromboprophylaxis with low molecular weight heparin (LMWH) for patients undergoing metabolic surgery.MethodsIn this single center retrospective cohort study, data was collected from patients undergoing a primary Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between 2014 and 2018. Patients operated in 2014-2017 received thromboprophylaxis for two weeks. In 2018, patients only received thromboprophylaxis during hospital admission. Patients already using anticoagulants were analyzed as a separate subgroup. The primary outcome measure was the rate of clinically significant VTEs within three months. Secondary outcome measures were postoperative hemorrhage and reoperations for hemorrhage.Results3666 Patients underwent a primary RYGB or SG following the fast-track protocol. In total, two patients in the 2014-2017 cohort were diagnosed with VTE versus zero patients in the 2018 cohort. In the historic group, 34/2599 (1.3%) hemorrhages occurred and in the recent cohort 8/720 (1.1%). Postoperative hemorrhage rates did not differ between the two cohorts (multivariable analysis, p=0.475). In the subgroup of patients using anticoagulants, 21/347(6.1%) patients developed a postoperative hemorrhage. Anticoagulant use was a significant predictor of postoperative hemorrhage (

Single-vortex-induced voltage steps in Josephson-junction arrays

We have numerically and analytically studied ac+dc driven Josephson-junction arrays with a single vortex or with a single vortex-antivortex pair present. We find single-vortex steps in the voltage versus current characteristics (I-V) of the array. They correspond microscopically to a single vortex phase-locked to move a fixed number of plaquettes per period of the ac driving current. In underdamped arrays we find vortex motion period doubling on the steps. We observe subharmonic steps in both underdamped and overdamped arrays. We successfully compare these results with a phenomenological model of vortex motion with a nonlinear viscosity. The I-V of an array with a vortex-antivortex pair displays fractional voltage steps. A possible connection of these results to present day experiments is also discussed.Comment: 10 pages double sided with figures included in the text. To appear in Journal of Physics, Condensed Matte

Disseminating Policy and Environmental Change Interventions: Insights from Obesity Prevention and Tobacco Control

Evidence-based interventions are increasingly called for as a way to improve health behaviors such as tobacco use, physical inactivity, and poor diet. Numerous organizations are disseminating interventions that target individual-level behavioral change. Fewer are disseminating interventions that target the policy and environmental changes required to support healthier behaviors. This paper aims to describe the distinct features of policy and environmental change and the lessons learned by two Centers for Disease Control and Prevention-funded dissemination projects, the Center for Training and Research Translation (Center TRT) and Counter Tobacco

Critical Exponents of the Fully Frustrated 2-D Xy Model

We present a detailed study of the critical properties of the 2-D XY model with maximal frustration in a square lattice. We use extensive Monte Carlo simulations to study the thermodynamics of the spin and chiral degrees of freedom, concentrating on their correlation functions. The gauge invariant spin-spin correlation functions are calculated close to the critical point for lattice sizes up to $240\times 240$; the chiral correlation functions are studied on lattices up to $96\times 96$. We find that the critical exponents of the spin phase transition are $\nu=0.3069$, and $\eta=0.1915$, which are to be compared with the unfrustrated XY model exponents $\nu=1/2$ and $\eta=0.25$. We also find that the critical exponents of the chiral transition are $\nu_{\chi}=0.875$, $2\beta=0.1936$, $2\gamma= 1.82$, and $2\gamma\>\prime=1.025$, which are different from the expected 2-D Ising critical exponents. The spin-phase transition occurs at $T_{U(1)}=0.446$ which is about 7\% above the estimated chiral critical temperature $T_{Z_{2}}= 0.4206$. However, because of the size of the statistical errors, it is difficult to decide with certainty whether the transitions occur at the same or at slightly different temperatures. Finally, the jump in the helicity modulus in the fully frustrated system is found to be about 23\% below the unfrustrated universal value. The most important consequence of these results is that the fully frustrated XY model appears to be in a novel universality class. Recent successful comparisons of some of these results with experimental data are also briefly discussed. (TO APPEAR IN PRB)Comment: 47 pages (PHYZZX

Impact of the Cancer Prevention and Control Research Network: Accelerating the Translation of Research Into Practice

The Cancer Prevention and Control Research Network (CPCRN) is a thematic network dedicated to accelerating the adoption of evidence-based cancer prevention and control practices in communities by advancing dissemination and implementation science. Funded by the Centers for Disease Control and Prevention and National Cancer Institute, CPCRN has operated at two levels: Each participating Network Center conducts research projects with primarily local partners as well as multicenter collaborative research projects with state and national partners. Through multicenter collaboration, thematic networks leverage the expertise, resources, and partnerships of participating centers to conduct research projects collectively that might not be feasible individually. Although multicenter collaboration often is advocated, it is challenging to promote and assess. Using bibliometric network analysis and other graphical methods, this paper describes CPCRN’s multicenter publication progression from 2004 to 2014. Searching PubMed, Scopus, and Web of Science in 2014 identified 249 peer-reviewed CPCRN publications involving two or more centers out of 6,534 total. The research and public health impact of these multicenter collaborative projects initiated by CPCRN during that 10-year period were then examined. CPCRN established numerous workgroups around topics such as: 2-1-1, training and technical assistance, colorectal cancer control, federally qualified health centers, cancer survivorship, and human papillomavirus. The paper discusses the challenges that arise in promoting multicenter collaboration and the strategies that CPCRN uses to address those challenges. The lessons learned should broadly interest those seeking to promote multisite collaboration to address public health problems, such as cancer prevention and control

Dynamic ordering and frustration of confined vortex rows studied by mode-locking experiments

The flow properties of confined vortex matter driven through disordered mesoscopic channels are investigated by mode locking (ML) experiments. The observed ML effects allow to trace the evolution of both the structure and the number of confined rows and their match to the channel width as function of magnetic field. From a detailed analysis of the ML behavior for the case of 3-rows we obtain ({\it i}) the pinning frequency $f_p$, ({\it ii}) the onset frequency $f_c$ for ML ($\propto$ ordering velocity) and ({\it iii}) the fraction $L_{ML}/L$ of coherently moving 3-row regions in the channel. The field dependence of these quantities shows that, at matching, where $L_{ML}$ is maximum, the pinning strength is small and the ordering velocity is low, while at mismatch, where $L_{ML}$ is small, both the pinning force and the ordering velocity are enhanced. Further, we find that $f_c \propto f_p^2$, consistent with the dynamic ordering theory of Koshelev and Vinokur. The microscopic nature of the flow and the ordering phenomena will also be discussed.Comment: 10 pages, 7 figure, submitted to PRB. Discussion has been improved and a figure has been adde

The impact of responding to patient messages with large language model assistance

Documentation burden is a major contributor to clinician burnout, which is rising nationally and is an urgent threat to our ability to care for patients. Artificial intelligence (AI) chatbots, such as ChatGPT, could reduce clinician burden by assisting with documentation. Although many hospitals are actively integrating such systems into electronic medical record systems, AI chatbots utility and impact on clinical decision-making have not been studied for this intended use. We are the first to examine the utility of large language models in assisting clinicians draft responses to patient questions. In our two-stage cross-sectional study, 6 oncologists responded to 100 realistic synthetic cancer patient scenarios and portal messages developed to reflect common medical situations, first manually, then with AI assistance. We find AI-assisted responses were longer, less readable, but provided acceptable drafts without edits 58% of time. AI assistance improved efficiency 77% of time, with low harm risk (82% safe). However, 7.7% unedited AI responses could severely harm. In 31% cases, physicians thought AI drafts were human-written. AI assistance led to more patient education recommendations, fewer clinical actions than manual responses. Results show promise for AI to improve clinician efficiency and patient care through assisting documentation, if used judiciously. Monitoring model outputs and human-AI interaction remains crucial for safe implementation.Comment: 4 figures and tables in main, submitted for revie

Outcomes of multimodal therapy in a large series of patients with anaplastic thyroid cancer

Background The role of radiotherapy (RT) in the treatment of patients with anaplastic thyroid cancer (ATC) for local tumor control is critical because mortality often is secondary to complications of tumor volume rather than metastatic disease. Herein, the authors report the long-term outcomes of RT for patients with ATC. Methods A total of 104 patients with histologically confirmed ATC were identified who presented to the study institution between 1984 and 2017 and who received curative-intent or postoperative RT. Locoregional progression-free survival (LPFS), overall survival (OS), and distant metastasis-free survival were assessed. Results The median age of the patients was 63.5 years. The median follow-up was 5.9 months (interquartile range, 2.7-17.0 months) for the entire cohort and 10.6 months (interquartile range, 5.3-40.0 months) for surviving patients. Thirty-one patients (29.8%) had metastatic disease prior to the initiation of RT. Concurrent chemoradiation was administered in 99 patients (95.2%) and 53 patients (51.0%) received trimodal therapy. Systemic therapy included doxorubicin (73.7%), paclitaxel with or without pazopanib (24.3%), and other systemic agents (2.0%). The 1-year OS and LPFS rates were 34.4% and 74.4%, respectively. On multivariate analysis, RT >= 60 Gy was associated with improved LPFS (hazard ratio [HR], 0.135; P = .001) and improved OS (HR, 0.487; P = .004), and trimodal therapy was associated with improved LPFS (HR, 0.060; P = .017). The most commonly observed acute grade 3 adverse events included dermatitis (20%) and mucositis (13%), with no grade 4 subacute or late adverse events noted (adverse events were graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events [version 4.0]). Conclusions RT appears to demonstrate a dose-dependent, persistent LPFS and OS benefit in patients with locally advanced ATC with an acceptable toxicity profile. Aggressive RT should be strongly considered for the treatment of patients with ATC as part of a trimodal treatment approach