Background
Central nervous system (CNS) medication use is common among older adults, yet the impact of hospitalizations on use remains unclear. This study details CNS medication use, ...discontinuations, and user profiles during hospitalization periods.
Methods
Retrospective cohort study using electronic health records on patients ≥65 years, from three hospitals (2018–2020), and prescribed a CNS medication around hospitalization (90 days prior to 90 days after). Latent class transitions analysis (LCTA) examined profiles of CNS medication class users across four time points (90 days prior, admission, discharge, 90 days after hospitalization).
Results
Among 4666 patients (mean age 74.3 ± 9.3 years; 63% female; 70% White; mean length of stay 4.6 ± 5.6 days (median 3.0 2.0, 6.0), the most commonly prescribed CNS medications were antidepressants (56%) and opioids (49%). Overall, 74% (n = 3446) of patients were persistent users of a CNS medication across all four time points; 7% (n = 388) had discontinuations during hospitalization, but of these, 64% (216/388) had new starts or restarts within 90 days after hospitalization. LCTA identified three profile groups: (1) low CNS medication users, 54%–60% of patients; (2) mental health medication users, 30%–36%; and (3) acute/chronic pain medication users, 9%–10%. Probability of staying in same group across the four time points was high (0.88–1.00). Transitioning to the low CNS medication use group was highest from admission to discharge (probability of 9% for pain medication users, 5% for mental health medication users). Female gender increased (OR 2.4, 95% CI 1.3–4.3), while chronic kidney disease lowered (OR 0.5, 0.2–0.9) the odds of transitioning to the low CNS medication use profile between admission and discharge.
Conclusions
CNS medication use stays consistent around hospitalization, with discontinuation more likely between admission and discharge, especially among pain medication users. Further research on patient outcomes is needed to understand the benefits and harms of hospital deprescribing, particularly for medications requiring gradual tapering.
ABSTRACT
To date, thousands of planets have been discovered, but there are regions of the orbital parameter space that are still bare. An example is the short period and intermediate mass/radius ...space known as the ‘Neptunian desert’, where planets should be easy to find but discoveries remain few. This suggests unusual formation and evolution processes are responsible for the planets residing here. We present the discovery of TOI-332 b, a planet with an ultra-short period of 0.78 d that sits firmly within the desert. It orbits a K0 dwarf with an effective temperature of 5251 ± 71 K. TOI-332 b has a radius of $3.20^{+0.16}_{-0.12}$ R⊕, smaller than that of Neptune, but an unusually large mass of 57.2 ± 1.6 M⊕. It has one of the highest densities of any Neptune-sized planet discovered thus far at $9.6^{+1.1}_{-1.3}$ g cm−3. A 4-layer internal structure model indicates it likely has a negligible hydrogen-helium envelope, something only found for a small handful of planets this massive, and so TOI-332 b presents an interesting challenge to planetary formation theories. We find that photoevaporation cannot account for the mass-loss required to strip this planet of the Jupiter-like envelope it would have been expected to accrete. We need to look towards other scenarios, such as high-eccentricity migration, giant impacts, or gap opening in the protoplanetary disc, to try and explain this unusual discovery.
Abstract
Planets around young stars trace the early evolution of planetary systems. We report the discovery and validation of two planetary systems with ages ≲300 Myr from observations by the ...Transiting Exoplanet Survey Satellite (TESS). The
Myr old G star TOI-251 hosts a
mini-Neptune with a
day period. The
Myr old K star TOI-942 hosts a system of inflated Neptune-sized planets, with TOI-942b orbiting in a period of
days with a radius of
and TOI-942c orbiting in a period of
days with a radius of
. Though we cannot place either host star into a known stellar association or cluster, we can estimate their ages via their photometric and spectroscopic properties. Both stars exhibit significant photometric variability due to spot modulation, with measured rotation periods of ∼3.5 days. These stars also exhibit significant chromospheric activity, with age estimates from the chromospheric calcium emission lines and X-ray fluxes matching that estimated from gyrochronology. Both stars also exhibit significant lithium absorption, similar in equivalent width to well-characterized young cluster members. TESS has the potential to deliver a population of young planet-bearing field stars, contributing significantly to tracing the properties of planets as a function of their age.
The amount of ultraviolet irradiation and ablation experienced by a planet depends strongly on the temperature of its host star. Of the thousands of extrasolar planets now known, only six have been ...found that transit hot, A-type stars (with temperatures of 7,300-10,000 kelvin), and no planets are known to transit the even hotter B-type stars. For example, WASP-33 is an A-type star with a temperature of about 7,430 kelvin, which hosts the hottest known transiting planet, WASP-33b (ref. 1); the planet is itself as hot as a red dwarf star of type M (ref. 2). WASP-33b displays a large heat differential between its dayside and nightside, and is highly inflated-traits that have been linked to high insolation. However, even at the temperature of its dayside, its atmosphere probably resembles the molecule-dominated atmospheres of other planets and, given the level of ultraviolet irradiation it experiences, its atmosphere is unlikely to be substantially ablated over the lifetime of its star. Here we report observations of the bright star HD 195689 (also known as KELT-9), which reveal a close-in (orbital period of about 1.48 days) transiting giant planet, KELT-9b. At approximately 10,170 kelvin, the host star is at the dividing line between stars of type A and B, and we measure the dayside temperature of KELT-9b to be about 4,600 kelvin. This is as hot as stars of stellar type K4 (ref. 5). The molecules in K stars are entirely dissociated, and so the primary sources of opacity in the dayside atmosphere of KELT-9b are probably atomic metals. Furthermore, KELT-9b receives 700 times more extreme-ultraviolet radiation (that is, with wavelengths shorter than 91.2 nanometres) than WASP-33b, leading to a predicted range of mass-loss rates that could leave the planet largely stripped of its envelope during the main-sequence lifetime of the host star.
Background & Aims: The revised Bethesda guidelines for Lynch syndrome recommend microsatellite instability (MSI) testing all colorectal cancers in patients diagnosed before age 50 years and ...colorectal cancers diagnosed in patients between ages 50 and 59 years with particular pathology features. Our aim was to identify pathology and other features that independently predict high MSI (MSI-H). Methods: Archival tissue from 1098 population-based colorectal cancers diagnosed before age 60 years was tested for MSI. Pathology features, site, and age at diagnosis were obtained. Multiple logistic regression was performed to determine the predictive value of each feature, as measured by an odds ratio (OR), from which a scoring system (MsPath) was developed to estimate the probability a colorectal cancer is MSI-H. Results: Fifteen percent of tumors (162) were MSI-H. Independent predictors were tumor-infiltrating lymphocytes (OR, 9.1; 95% confidence interval CI, 5.9–14.1), proximal subsite (OR, 4.7; 95% CI, 3.1–7.3), mucinous histology (OR, 2.8; 95% CI, 1.7–4.8), poor differentiation (OR, 1.9; 95% CI, 1.2–3.1), Crohn’s-like reaction (OR, 1.9; 95% CI, 1.2–2.9), and diagnosis before age 50 years (OR, 1.9; 95% CI, 1.3–2.9). MsPath score ≥1.0 had a sensitivity of 93% and a specificity of 55% for MSI-H. Conclusions: The probability an individual colorectal cancer is MSI-H is predicted well by the MsPath score. There is little value in testing for DNA mismatch repair loss in tumors, or for germline mismatch repair mutations, for colorectal cancers diagnosed in patients before age 60 years with an MSPath score <1 (approximately 50%). Pathology can identify almost all MSI-H colorectal cancers diagnosed before age 60 years.
We present the discovery of the giant planet KELT-19Ab, which transits the moderately bright ( ) A8V star TYC 764-1494-1 with an orbital period of 4.61 days. We confirm the planetary nature of the ...companion via a combination of radial velocities, which limit the mass to ( ), and a clear Doppler tomography signal, which indicates a retrograde projected spin-orbit misalignment of degrees. Global modeling indicates that the K host star has and . The planet has a radius of and receives a stellar insolation flux of , leading to an inferred equilibrium temperature of K assuming zero albedo and complete heat redistribution. With a , the host is relatively slowly rotating compared to other stars with similar effective temperatures, and it appears to be enhanced in metallic elements but deficient in calcium, suggesting that it is likely an Am star. KELT-19A would be the first detection of an Am host of a transiting planet of which we are aware. Adaptive optics observations of the system reveal the existence of a companion with late-G9V/early-K1V spectral type at a projected separation of . Radial velocity measurements indicate that this companion is bound. Most Am stars are known to have stellar companions, which are often invoked to explain the relatively slow rotation of the primary. In this case, the stellar companion is unlikely to have caused the tidal braking of the primary. However, it may have emplaced the transiting planetary companion via the Kozai-Lidov mechanism.
In the United States, colorectal cancer (CRC) is the third most common cancer diagnosed among men and women and the second leading cause of death from cancer. CRC largely can be prevented by the ...detection and removal of adenomatous polyps, and survival is significantly better when CRC is diagnosed while still localized. In 2006 to 2007, the American Cancer Society, the US Multi Society Task Force on Colorectal Cancer, and the American College of Radiology came together to develop consensus guidelines for the detection of adenomatous polyps and CRC in asymptomatic average‐risk adults. In this update of each organization's guidelines, screening tests are grouped into those that primarily detect cancer early and those that can detect cancer early and also can detect adenomatous polyps, thus providing a greater potential for prevention through polypectomy. When possible, clinicians should make patients aware of the full range of screening options, but at a minimum they should be prepared to offer patients a choice between a screening test that is effective at both early cancer detection and cancer prevention through the detection and removal of polyps and a screening test that primarily is effective at early cancer detection. It is the strong opinion of these 3 organizations that colon cancer prevention should be the primary goal of screening.
We report the discovery of five transiting companions near the hydrogen-burning mass limit in close orbits around main sequence stars originally identified by the Transiting Exoplanet Survey ...Satellite (TESS) as TESS objects of interest (TOIs): TOI-148, TOI-587, TOI-681, TOI-746, and TOI-1213. Using TESS and ground-based photometry as well as radial velocities from the CORALIE, CHIRON, TRES, and FEROS spectrographs, we found the companions have orbital periods between 4.8 and 27.2 days, masses between 77 and 98 MJup , and radii between 0.81 and 1.66 RJup . These targets have masses near the uncertain lower limit of hydrogen core fusion (~73-96 MJup ), which separates brown dwarfs and low-mass stars. We constrained young ages for TOI-587 (0.2 ± 0.1 Gyr) and TOI-681 (0.17 ± 0.03 Gyr) and found them to have relatively larger radii compared to other transiting companions of a similar mass. Conversely we estimated older ages for TOI-148 and TOI-746 and found them to have relatively smaller companion radii. With an effective temperature of 9800 ± 200 K, TOI-587 is the hottest known main-sequence star to host a transiting brown dwarf or very low-mass star. We found evidence of spin-orbit synchronization for TOI-148 and TOI-746 as well as tidal circularization for TOI-148. These companions add to the population of brown dwarfs and very low-mass stars with well measured parameters ideal to test formation models of these rare objects, the origin of the brown dwarf desert, and the distinction between brown dwarfs and hydrogen-burning main sequence stars.
We report the discovery of KELT-20b, a hot Jupiter transiting a early A star, HD 185603, with an orbital period of days. Archival and follow-up photometry, Gaia parallax, radial velocities, Doppler ...tomography, and AO imaging were used to confirm the planetary nature of KELT-20b and characterize the system. From global modeling we infer that KELT-20 is a rapidly rotating ( ) A2V star with an effective temperature of K, mass of , radius of , surface gravity of , and age of . The planetary companion has a radius of , a semimajor axis of au, and a linear ephemeris of . We place a upper limit of on the mass of the planet. Doppler tomographic measurements indicate that the planetary orbit normal is well aligned with the projected spin axis of the star ( ). The inclination of the star is constrained to , implying a three-dimensional spin-orbit alignment of . KELT-20b receives an insolation flux of , implying an equilibrium temperature of of ∼2250 K, assuming zero albedo and complete heat redistribution. Due to the high stellar , KELT-20b also receives an ultraviolet (wavelength nm) insolation flux of , possibly indicating significant atmospheric ablation. Together with WASP-33, Kepler-13 A, HAT-P-57, KELT-17, and KELT-9, KELT-20 is the sixth A star host of a transiting giant planet, and the third-brightest host (in V) of a transiting planet.
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