Abstract
Background
It is nearly impossible to overestimate the burden of chronic pain, which is associated with enormous personal and socioeconomic costs. Chronic pain is the leading cause of ...disability in the world, is associated with multiple psychiatric comorbidities, and has been causally linked to the opioid crisis. Access to pain treatment has been called a fundamental human right by numerous organizations. The current COVID-19 pandemic has strained medical resources, creating a dilemma for physicians charged with the responsibility to limit spread of the contagion and to treat the patients they are entrusted to care for.
Methods
To address these issues, an expert panel was convened that included pain management experts from the military, Veterans Health Administration, and academia. Endorsement from stakeholder societies was sought upon completion of the document within a one-week period.
Results
In these guidelines, we provide a framework for pain practitioners and institutions to balance the often-conflicting goals of risk mitigation for health care providers, risk mitigation for patients, conservation of resources, and access to pain management services. Specific issues discussed include general and intervention-specific risk mitigation, patient flow issues and staffing plans, telemedicine options, triaging recommendations, strategies to reduce psychological sequelae in health care providers, and resource utilization.
Conclusions
The COVID-19 public health crisis has strained health care systems, creating a conundrum for patients, pain medicine practitioners, hospital leaders, and regulatory officials. Although this document provides a framework for pain management services, systems-wide and individual decisions must take into account clinical considerations, regional health conditions, government and hospital directives, resource availability, and the welfare of health care providers.
We describe the catalogs assembled and the algorithms used to populate the revised TESS Input Catalog (TIC), based on the incorporation of the Gaia second data release. We also describe a revised ...ranking system for prioritizing stars for 2 minute cadence observations, and we assemble a revised Candidate Target List (CTL) using that ranking. The TIC is available on the Mikulski Archive for Space Telescopes server, and an enhanced CTL is available through the Filtergraph data visualization portal system at http://filtergraph.vanderbilt.edu/tess_ctl.
The detection and characterization of young planetary systems offer a direct path to study the processes that shape planet evolution. We report on the discovery of a sub-Neptune-sized planet orbiting ...the young star HD 110082 (TOI-1098). Transit events we initially detected during TESS Cycle 1 are validated with time-series photometry from Spitzer. High-contrast imaging and high-resolution, optical spectra are also obtained to characterize the stellar host and confirm the planetary nature of the transits. The host star is a late-F dwarf (M⁎ = 1.2Mꙩ) with a low-mass, M dwarf binary companion (M⁎ = 0.26Mꙩ) separated by nearly one arcminute (∼6200 au). Based on its rapid rotation and Lithium absorption, HD 110082 is young, but is not a member of any known group of young stars (despite proximity to the Octans association). To measure the age of the system, we search for coeval, phase-space neighbors and compile a sample of candidate siblings to compare with the empirical sequences of young clusters and to apply quantitative age-dating techniques. In doing so, we find that HD 110082 resides in a new young stellar association we designate MELANGE-1, with an age of 250(+50, -70) Myr. Jointly modeling the TESS and Spitzer light curves, we measure a planetary orbital period of 10.1827 days and radius of R(p) = 3.2 ± 0.1Rꚛ. HD 110082 b’s radius falls in the largest 12% of field-age systems with similar host-star mass and orbital period. This finding supports previous studies indicating that young planets have larger radii than their field-age counterparts.
Occipital neuralgia (ON) is characterized by lancinating pain and tenderness overlying the occipital nerves. Both steroid injections and pulsed radiofrequency (PRF) are used to treat ON, but few ...clinical trials have evaluated efficacy, and no study has compared treatments. We performed a multicenter, randomized, double-blind, comparative-effectiveness study in 81 participants with ON or migraine with occipital nerve tenderness whose aim was to determine which treatment is superior. Forty-two participants were randomized to receive local anesthetic and saline, and three 120 second cycles of PRF per targeted nerve, and 39 were randomized to receive local anesthetic mixed with deposteroid and 3 rounds of sham PRF. Patients, treating physicians, and evaluators were blinded to interventions. The PRF group experienced a greater reduction in the primary outcome measure, average occipital pain at 6 weeks (mean change from baseline -2.743 ± 2.487 vs -1.377 ± 1.970; P < 0.001), than the steroid group, which persisted through the 6-month follow-up. Comparable benefits favoring PRF were obtained for worst occipital pain through 3 months (mean change from baseline -1.925 ± 3.204 vs -0.541 ± 2.644; P = 0.043), and average overall headache pain through 6 weeks (mean change from baseline -2.738 ± 2.753 vs -1.120 ± 2.1; P = 0.037). Adverse events were similar between groups, and few significant differences were noted for nonpain outcomes. We conclude that although PRF can provide greater pain relief for ON and migraine with occipital nerve tenderness than steroid injections, the superior analgesia may not be accompanied by comparable improvement on other outcome measures.
ABSTRACT We present a new catalog of absolute proper motions and updated positions derived from the same Space Telescope Science Institute digitized Schmidt survey plates utilized for the ...construction of Guide Star Catalog II. As special attention was devoted to the absolutization process and the removal of position, magnitude, and color dependent systematic errors through the use of both stars and galaxies, this release is solely based on plate data outside the galactic plane, i.e., . The resulting global zero point error is less than 0.6 mas yr−1, and the precision is better than 4.0 mas yr−1 for objects brighter than RF = 18.5, rising to 9.0 mas yr−1 for objects with magnitudes in the range 18.5 < RF < 20.0. The catalog covers 22,525 square degrees and lists 100,774,153 objects to the limiting magnitude of RF ∼ 20.8. Alignment with the International Celestial Reference System was made using 1288 objects common to the second realization of the International Celestial Reference Frame (ICRF2) at radio wavelengths. As a result, the coordinate axes realized by our astrometric data are believed to be aligned with the extragalactic radio frame to within 0.2 mas at the reference epoch J2000.0. This makes our compilation one of the deepest and densest ICRF-registered astrometric catalogs outside the galactic plane. Although the Gaia mission is poised to set the new standard in catalog astronomy and will in many ways supersede this catalog, the methods and procedures reported here will prove useful to remove astrometric magnitude- and color-dependent systematic errors from the next generation of ground-based surveys reaching significantly deeper than the Gaia catalog.
Abstract
We present a validation of a long-period (
91.68278
−
0.00041
+
0.00032
days) transiting sub-Neptune planet,
TOI-1221 b
(TIC 349095149.01), around a Sun-like (
m
V
= 10.5) star. This is one ...of the few known exoplanets with a period >50 days, and belongs to the even smaller subset of which have bright enough hosts for detailed spectroscopic follow-up. We combine Transiting Exoplanet Survey Satellite light curves and ground-based time-series photometry from the Perth Exoplanet Survey Telescope (0.3 m) and Las Cumbres Observatory global telescope network (1.0 m) to analyze the transit signals and rule out nearby stars as potential false-positive sources. High-contrast imaging from the Southern Astrophysical Research Telescope and Gemini/Zorro rule out nearby stellar contaminants. Reconnaissance spectroscopy from CHIRON sets a planetary scale upper mass limit on the transiting object (1.1 and 3.5
M
Jup
at 1
σ
and 3
σ
, respectively) and shows no sign of a spectroscopic binary companion. We determine a planetary radius of
R
p
=
2.91
−
0.12
+
0.13
R
⊕
, placing it in the sub-Neptune regime. With a stellar insolation of
S
=
6.06
−
0.77
+
0.85
S
⊕
, we calculate a moderate equilibrium temperature of
T
eq
= 440 K, assuming no albedo and perfect heat redistribution. We find a false-positive probability from the
TRICERATOPS
tool of FPP = 0.0014 ± 0.0003 as well as other qualitative and quantitative evidence to support the statistical validation of TOI-1221 b. We find significant evidence (>5
σ
) of oscillatory transit timing variations, likely indicative of an additional nontransiting planet.
•A search for satellites of Ceres was conducted as part of NASA's Dawn mission.•The search is complete to a distance of 15 Ceres radii.•No satellites larger than 12–323 m were found, assuming Ceres' ...geometric albedo of 0.11.•Internal properties of Ceres and of other asteroids without satellites may explain their absence.
Upon its approach to orbit the dwarf planet Ceres in early 2015, optical navigation and dedicated satellite search images were acquired with the Dawn mission's framing camera 2. A team of searchers individually processed and examined the images for evidence of objects moving with Ceres. Completeness of search with respect to the space searched was calculated as a function of distance to Ceres and found to be complete down to 15 Ceres radii (Ceres' mean radius is 470 km). Upper limits of detectable magnitude were determined for each observed set of images and an upper limit in size was calculated assuming for the putative objects, Ceres' geometric albedo of 0.11. Nothing was found associated with Ceres down to a radius of 12 m for the most sensitive search, and down to a radius of 323 m for the least sensitive search circumstances. Examination of the physical properties of the 41 largest and most massive main belt asteroids suggests that large asteroids without satellites are intact and their interiors have internal strength. This is consistent with results from the Dawn mission at both Vesta and Ceres. Ceres' volatile-rich composition also is a likely contributor to both the absence of satellites at Ceres and of Ceres meteorites at Earth. These results suggest that collisional disruption creating rubble pile structure is a necessary condition for formation of satellites around main belt asteroids.
Chronic, non-surgical, non-specific anterior knee pain is a common source of functionally limiting chronic ailment, especially in a young athletic and active-duty military population. The ...infrapatellar branch of the saphenous is becoming a common therapeutic target for the diagnosis and treatment of anterior knee pain. It is a nerve commonly injured during knee surgeries and trauma, resulting in neuroma formation and chronic neuropathic pain states, and it can also transmit nociceptive input from patients with non-surgical anterior knee pain of multiple etiologies. Several methods have been employed to treat this condition. After the diagnosis of infrapatellar saphenous neuralgia, the nerve is safely ablated using radiofrequency ablation, neurolytic solutions, and, most recently, cryoablation using the handheld iovera® cryoablation system (Myoscience, Inc. Fremont, CA). Cryoablation is an attractive technique because it is minimally invasive, not permanent, and well tolerated by the patient with only local anesthesia. We have previously described a technique using a non-invasive peripheral nerve stimulator to identify and treat the exact location of the nerve more precisely, thereby optimizing treatment success and procedural simplicity. This case series illustrates our initial use and success with this technique. Further follow-up and randomized sham-controlled trials are also planned.
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