We report on the observations of an electron vortex magnetic hole corresponding to a new type of coherent structure in the turbulent magnetosheath plasma using the Magnetospheric Multiscale mission ...data. The magnetic hole is characterized by a magnetic depression, a density peak, a total electron temperature increase (with a parallel temperature decrease but a perpendicular temperature increase), and strong currents carried by the electrons. The current has a dip in the core region and a peak in the outer region of the magnetic hole. The estimated size of the magnetic hole is about 0.23 i (∼30 e) in the quasi-circular cross-section perpendicular to its axis, where i and e are respectively the proton and electron gyroradius. There are no clear enhancements seen in high-energy electron fluxes. However, there is an enhancement in the perpendicular electron fluxes at 90° pitch angle inside the magnetic hole, implying that the electrons are trapped within it. The variations of the electron velocity components Vem and Ven suggest that an electron vortex is formed by trapping electrons inside the magnetic hole in the cross-section in the M-N plane. These observations demonstrate the existence of a new type of coherent structures behaving as an electron vortex magnetic hole in turbulent space plasmas as predicted by recent kinetic simulations.
Purpose
Adolescent and young adult (AYA) cancer survivors are more likely to have multiple chronic conditions compared to AYAs without history of cancer. The financial hardship of chronic conditions ...associated with cancer can substantially impact cancer survivors. We aim to assess health risk behaviors and health care access factors associated with increased medical expenses in AYA cancer survivors.
Methods
We utilized 2011–2016 Medical Expenditure Panel Survey (MEPS) data to identify the prevalence of chronic conditions, health risk behaviors, and health care access in 2326 AYA cancer survivors. The association between health risk behaviors, health care access factors, and chronic conditions with medical expenditures was assessed using multivariable regression with gamma distribution and log link. Analyses were adjusted for age, sex, race/ethnicity, education, and marital status. Expenses were adjusted for inflation to 2016 dollars.
Results
Most AYA cancer survivors had ≥1 chronic condition (74%) and were diagnosed with cancer ≥10 years prior to the survey (76%). AYA cancer survivors with chronic conditions spent an additional $2777 (95% CI, $480 to $5958) annually compared to survivors with no chronic conditions. Additional annual expenses also were associated with physical inactivity ($3558; 95% CI, $2200 to $4606) and being unable to get care when needed ($1291; 95% CI, $198 to 3335).
Conclusions
Chronic conditions are associated with a substantial increase in medical expenses well after cancer diagnosis in AYA cancer survivors.
Implication for Cancer Survivors
Getting care when needed and adopting healthy behaviors, particularly exercise, may reduce medical expenses associated with chronic conditions in AYAs.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, VSZLJ, ZAGLJ
Kinetic-size magnetic holes (KSMHs) in the terrestrial magnetotail plasma sheet are statistically investigated using the observations from the Magnetospheric Multiscale mission. The scales of KSMHs ...are found to be smaller than one ion gyroradius or tens of electron gyroradii. The occurrence distributions of KSMHs have dawn-dusk asymmetry (duskside preference) in the magnetotail, which may be caused by the Hall effect. Most events of KSMHs (71.7%) are accompanied by a substorm, implying that substorms may provide favorable conditions for the excitation of KSMHs. However, there is a weak correlation between KSMHs and magnetic reconnection. The statistical results reveal that for most of the events, the electron total temperature and perpendicular temperature increase while the electron parallel temperature decreases inside the KSMHs. The electron temperature anisotropy (Te / ) is observed in 72% of KSMHs. Whistler-mode waves are frequently observed inside the KSMHs, and most (92%) KSMHs associated with whistler waves have enhancements of electron perpendicular distributions and satisfy the unstable condition of whistler instability. This suggests that the observed electron-scale whistler waves, locally generated by the electron temperature anisotropy, could couple with the electron-scale KSMHs. The observed features of KSMHs and their coupling to electron-scale whistlers are similar to the ones in the turbulent magnetosheath, implying that they are ubiquitous in the space plasmas. The generation of KSMHs in the plasma sheet could be explained by an electron vortex magnetic hole, magnetosonic solitons, and/or ballooning/interchange instabilities.
Abstract Background Sociodemographic and clinical factors associated with diagnostic delays in pediatric, adolescent, and young adult cancers are poorly understood. Methods Using the Optum Labs Data ...Warehouse's de‐identified claims data for commercial health plan enrollees, we identified children (0–14 years) and adolescents/young adults (AYAs) (15–39 years) diagnosed with one of 10 common cancers from 2001 to 2017, who were continuously enrolled for 6 months preceding diagnosis. Time to diagnosis was calculated as days between first medical encounter with possible cancer symptoms and cancer diagnosis date. Median times from first symptom to diagnosis were compared using Wilcoxon rank sum test. Multivariable unconditional logistic regression identified sociodemographic factors associated with longer time (>3 months) to cancer diagnosis (from symptom onset). Results Of 47,296 patients, 87% presented prior to diagnosis with symptoms. Patients with central nervous system (CNS) tumors were most likely to present with symptoms (93%), whereas patients with cervical cancer were least likely (70%). Symptoms varied by malignancy. Of patients with symptoms, thyroid (105 days range: 50–154) and cervical (104 days range: 41–151) cancer had the longest median time to diagnosis. Females and patients at either end of the age spectrum were more likely to experience diagnosis delays of more than 3 months. Conclusion In a commercially insured population, time to diagnosis varies by cancer type, age, and sex. Further work is needed to understand the patient, provider, and health system‐level factors contributing to time from symptom onset to diagnosis, specifically in the very young children and the young adult patient population going forward.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
► In this study we observed and modelled the Asteroid (216) Kleopatra through different technics. ► The work revealed two moonlets orbiting Kleopatra. ► From these observations we derived the ...equivalent radius of Kleopatra and its macroscopic bulk density.
To take full advantage of the September 2008 opposition passage of the M-type Asteroid (216) Kleopatra, we have used near-infrared adaptive optics (AO) imaging with the W.M. Keck II telescope to capture unprecedented high resolution images of this unusual asteroid. Our AO observations with the W.M. Keck II telescope, combined with Spitzer/IRS spectroscopic observations and past stellar occultations, confirm the value of its IRAS radiometric radius of 67.5
km as well as its dog-bone shape suggested by earlier radar observations. Our Keck AO observations revealed the presence of two small satellites in orbit about Kleopatra (see Marchis, F. et al. 2008a. (3749) Balam. In: Green, D.W.E. (Ed.), IAU Circ. 8928; Marchis, F., Descamps, P., Berthier, J., Emery, J.P. 2008b. S/2008 ((216)) 1 and S/2008 ((216)) 2. In: Green, D.W.E. (Ed.), IAU Circ. 8980). Accurate measurements of the satellite orbits over a full month enabled us to determine the total mass of the system to be 4.64
±
0.02
×
10
18
kg. This translates into a bulk density of 3.6
±
0.4
g/cm
3, which implies a macroscopic porosity for Kleopatra of ∼30–50%, typical of a rubble-pile asteroid. From these physical characteristics we measured its specific angular momentum, very close to that of a spinning equilibrium dumbbell.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Background
Despite efforts to increase participation of adolescents and young adults (AYAs; 15–39 years) in cancer clinical trials (CTs), enrollment remains very low. Even when provided access to ...CTs, AYAs are less likely to participate than children and older adults. A better understanding of oncologist‐ and AYA survivor‐reported barriers, facilitators, and potential areas for CT enrollment improvement is needed.
Procedures
From December 2019 to August 2020, we conducted 43 semi‐structured interviews with oncologists (n = 17) and AYA cancer survivors (n = 26) who were offered and/or participated in CTs at cancer centers in California and Utah. Thematic analyses were used to interpret the findings.
Results
Oncologists identified a lack of available CTs, strict eligibility criteria, lack of awareness of open CTs, and poor communication between pediatric and adult oncologists as major barriers to enrollment. AYA cancer survivors identified financial and psychosocial barriers, and a poor understanding of what a CT means and its potential benefits as barriers to enrollment. Areas for improvement identified by oncologists and AYAs include educational, financial, and psychosocial support to AYAs. Oncologists also emphasized the need to increase CT availability, improve awareness of open CTs, and better communication between both pediatric and adult oncologists and oncologists and AYAs.
Conclusions
For AYAs with cancer, a lack of CT eligibility and physician awareness of open CTs likely factor into their lower CT enrollment. Potential strategies to improve AYA enrollment in CTs require comprehensive collaboration between pediatric and adult institutions, as well as educational, psychosocial, and financial support to AYAs.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
The International Olympic Committee (IOC) recently published a framework on fairness, inclusion, and nondiscrimination on the basis of gender identity and sex variations. Although we appreciate the ...IOC's recognition of the role of sports science and medicine in policy development, we disagree with the assertion that the IOC framework is consistent with existing scientific and medical evidence and question its recommendations for implementation. Testosterone exposure during male development results in physical differences between male and female bodies; this process underpins male athletic advantage in muscle mass, strength and power, and endurance and aerobic capacity. The IOC's “no presumption of advantage” principle disregards this reality. Studies show that transgender women (male‐born individuals who identify as women) with suppressed testosterone retain muscle mass, strength, and other physical advantages compared to females; male performance advantage cannot be eliminated with testosterone suppression. The IOC's concept of “meaningful competition” is flawed because fairness of category does not hinge on closely matched performances. The female category ensures fair competition for female athletes by excluding male advantages. Case‐by‐case testing for transgender women may lead to stigmatization and cannot be robustly managed in practice. We argue that eligibility criteria for female competition must consider male development rather than relying on current testosterone levels. Female athletes should be recognized as the key stakeholders in the consultation and decision‐making processes. We urge the IOC to reevaluate the recommendations of their Framework to include a comprehensive understanding of the biological advantages of male development to ensure fairness and safety in female sports.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
1 Departments of Veterinary Biomedical Sciences and Medical
Physiology, and Dalton Cardiovascular Research Center, University of
Missouri Columbia, Missouri 65211; and 2 Vascular Biology
Center, ...Medical College of Georgia, Augusta, Georgia 30912
Exercise training produces enhanced
nitric oxide (NO)-dependent, endothelium-mediated vasodilator responses
of porcine coronary arterioles but not conduit coronary arteries. The
purpose of this study was to test the hypothesis that exercise training
increases the amount of endothelial NO synthase (eNOS) in the coronary
arterial microcirculation but not in the conduit coronary arteries.
Miniature swine were either exercise trained or remained sedentary for
16-20 wk. Exercise-trained pigs exhibited increased skeletal
muscle oxidative capacity, exercise tolerance, and heart weight-to-body weight ratios. Content of eNOS protein was determined with immunoblot analysis in conduit coronary arteries (2- to 3-mm ID), small arteries (301- to 1,000-µm ID), resistance arteries (151- to 300-µm ID), and
three sizes of coronary arterioles large (101- to 150-µm ID),
intermediate (51- to 100-µm ID), and small (<50-µm ID). Immunoblots revealed increased eNOS protein in some sizes of coronary arteries and arterioles but not in others. Content of eNOS was increased by 60-80% in small and large arterioles, resistance arteries, and small arteries; was increased by 10-20% in
intermediate-sized arterioles; and was not changed or decreased in
conduit arteries. Immunohistochemistry revealed that eNOS was located
in the endothelial cells in all sizes of coronary artery. We conclude
that exercise training increases eNOS protein expression in a
nonuniform manner throughout the coronary arterial tree. Regional
differences in shear stress and intraluminal pressures during exercise
training bouts may be responsible for the distribution of increased
eNOS protein content in the coronary arterial tree.
arteries; blood flow; coronary disease; endothelium; endothelial-derived factors; exercise; nitric oxide synthase
Engagement of patients in their care can lead to better health outcomes, especially for adolescent and young adult (AYA) cancer survivors who experience mental and physical illnesses more often than ...noncancer adults. We examined how patient engagement in care influences health care expenses and use.
AYA cancer survivors (
= 1162) and a comparison group of matched adults with no history of cancer (
= 2954) were identified from the 2011 to 2016 Medical Expenditure Panel Survey (MEPS) data. Medical expenditures and health care utilization associated with shared decision-making (SDM) measured by a self-administered questionnaire adapted from the Consumer Assessment of Healthcare Providers and Systems Clinician and Group (CAHPS-CG) survey were evaluated using multivariable regression models.
AYA cancer survivors were more likely to report poor SDM compared with adults with no history of cancer (odds ratio = 1.31, 95% confidence interval CI): 1.06 to 1.62). AYA cancer survivors with poor SDM were more likely to report poor mental and physical health compared with AYAs with good SDM. AYA cancer survivors with poor SDM had $3037 (CI: $110 to $7032) in additional annual medical expenses and 4.86 (CI: 2.00 to 8.52) in additional office visits compared with AYA cancer survivors with optimal SDM, even after adjusting for chronic conditions and psychological distress.
Our results highlight the substantial economic burden associated with poor SDM in AYA cancer survivors. Our research suggests that interventions to improve SDM in AYA cancer survivors may contribute to patients' positive perception of their health and result in AYAs seeking fewer medical services resulting in lower medical expenses.
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