Using high‐spectral and ‐spatial resolution Moon Mineralogy Mapper data, we investigate compositional variations across the central peak structures of four impact craters within the South Pole‐Aitken ...Basin (SPA). Two distinct causes of spectral diversity are observed. Spectral variations across the central peaks of Bhabha, Finsen, and Lyman are dominated by soil development, including the effects of space weathering and mixing with local materials. For these craters, the central peak structure is homogeneous in composition, although small compositional differences between the craters are observed. This group of craters is located within the estimated transient cavity of SPA, and their central uplifts exhibit similar mafic abundances. Therefore, it is plausible that they have all uplifted material associated with melts of the lower crust or upper mantle produced during the SPA impact. Compositional differences observed between the peaks of these craters reflect heterogeneities in the SPA subsurface, although the origin of this heterogeneity is uncertain. In contrast to these craters, Leeuwenhoek exhibits compositional heterogeneity across its central peak structure. The peak is areally dominated by feldspathic materials, interspersed with several smaller exposures exhibiting a mafic spectral signature. Leeuwenhoek is the largest crater included in the study and is located in a region of complex stratigraphy involving both crustal (feldspathic) and SPA (mafic melt and ejecta) materials. The compositional diversity observed in Leeuwenhoek's central peak indicates that kilometer‐scale heterogeneities persist to depths of more than 10 km in this region.
Key Points
M3 data resolve spectral variation across individual central peak structures
Variations due to composition and soil development are observed
Diversity in mafic composition and abundance is observed in SPA central peaks
Introduction: Cigarette smoking is the strongest modifiable risk factor for developing thyroid-associated ophthalmopathy (TAO), and the severity of TAO is related to the current number of cigarettes ...smoked per day. We aimed to establish the effects of cigarette smoke extract (CSE) on an in vitro model of TAO.
Methods: Orbital tissue was taken during surgery from 10 patients with TAO and nine control subjects. Orbital fibroblasts were cultured and exposed to CSE, and intercellular adhesion molecule 1 (ICAM1) expression was measured by flow cytometry. Glycosaminoglycan production was measured by hyaluronic acid ELISA. Orbital fibroblasts were grown in adipogenic media with or without CSE and/or IL-1, and the degree of adipogenesis was quantified.
Results: Fibroblasts from patients with TAO and controls showed similar responses. ICAM1 expression was not affected by CSE. Hyaluronic acid production was stimulated by CSE in a dose-dependent manner (correlation coefficient, 0.978; P = 0.022), with 5% CSE causing an increase of 44% (P = 0.001). CSE increased adipogenesis in a dose-related manner, as did IL-1. The effects of CSE and IL-1 on adipogenesis were synergistic, with the degree of adipogenesis in the well containing both 5% CSE and 0.1 ng/ml IL-1 being double the magnitude of the sum of the values obtained from either stimulus alone (P < 0.001). Addition of an anti-IL-1 antibody to the well containing both 5% CSE and 0.1 ng/ml IL-1 reduced the degree of adipogenesis by 82% (P < 0.001).
Conclusion: These findings may help explain how cigarette smoking has a detrimental effect in TAO and suggests that IL-1 may be an attractive therapeutic target in TAO.
Purpose Despite benefits in functional renal outcome and the similar oncological efficacy of partial nephrectomy for renal cell carcinoma, previous studies show marked underuse of partial ...nephrectomy. We describe national trends in partial and radical nephrectomy using a contemporary, population based cohort. Materials and Methods Using the 2003 to 2008 Nationwide Inpatient Sample we identified 188,702 patients treated with partial or radical nephrectomy for renal cell carcinoma at a total of 1,755 hospitals. Multivariate logistic regression was used to assess the independent associations of patient and hospital characteristics with partial nephrectomy. Post-estimations from multivariate logistic regression were done to ascertain the annual predicted probability of partial nephrectomy by hospital feature. Results Overall 149,636 (79.3%) and 39,066 patients (20.7%) underwent radical and partial nephrectomy for renal cell carcinoma, respectively. Partial nephrectomy use increased each year from 16.8% in 2003 to 25.1% in 2008 (p for trend <0.001). On multivariate analysis patients were more likely to undergo partial nephrectomy at teaching (OR 1.31, p <0.001) and urban (OR 1.13, p = 0.05) hospitals compared to nonteaching and rural hospitals, respectively. Each quartile of higher nephrectomy annual volume was associated with higher odds of partial nephrectomy compared to the lowest quartile (OR 1.21, p <0.001). Although annual predicted partial nephrectomy use increased across all hospitals, differences in annual partial nephrectomy use by teaching status, site (urban vs rural) and case volume persisted with time. Conclusions Although the use of partial nephrectomy for renal cell carcinoma is increasing nationally across all hospitals, academic and urban hospitals as well as those with higher nephrectomy volume continue to show higher partial nephrectomy use for renal cell carcinoma.
The lunar south pole is a region of focused scientific and exploration interest, with several crewed and robotic missions to this region planned within the next decade. Understanding the mineralogy ...of the region is essential to inform landing site characterization and selection and provides the key context for interpreting samples and in situ observations. At high latitudes, extreme illumination conditions (high phase angles) can negatively impact the data quality of orbital instruments. This is especially true for passive near‐infrared spectrometers such as the Moon Mineralogy Mapper (M3) and the Kaguya Spectral Profiler, which measure the spectral properties of the surface using reflected sunlight. Using Moon Mineralogy Mapper data, we observed that the south polar region is associated with a detectable mafic signature consistent with the presence of pyroxenes. The strongest mafic signatures are associated with the South Pole—Aitken Basin, suggesting that impact melt and basin ejecta from the lower crust and upper mantle are present within this region. This observation is validated in several ways: (a) comparisons between M3 data acquired during different mission phases, (b) comparisons between multiple spectral parameters sensitive to the presence of mafic minerals, (c) comparisons between the north and south lunar polar regions, and (d) comparisons with publicly available Kaguya polar mineralogy maps and Lunar Prospector elemental abundances. We also investigate the nature of an anomalous high‐albedo region within 2–3° of the south pole observed in Lunar Orbiter Laser Altimeter reflectance data exhibiting a spatially conflicting apparent FeO abundance pattern between several data sets.
Plain Language Summary
The lunar south pole region is a region of focused scientific and exploration interest, with several crewed and robotic missions to this region currently planned within the next decade and beyond. The rocks and minerals at the lunar south pole are very different from those encountered during the Apollo missions and will provide insight into a wide range of important science questions. It is important to understand the abundance and distribution of these different materials to effectively choose landing sites and plan surface science experiments and sampling targets. We combine several data sets from orbital satellites to determine the types and distribution of rocks across the south polar region. We see evidence for the presence of lower crust and upper mantle materials excavated by a nearby giant impact basin.
Key Points
Moon Mineralogy Mapper data shows that the south polar region exhibits a mafic signature consistent with the presence of pyroxenes
Mafic signatures are spatially correlated with ejecta from the South Pole—Aitken Basin, which may be sampled by Artemis astronauts
An anomalous high‐albedo region within ∼3° of the south pole exhibits spatially conflicting apparent FeO abundance patterns between several data products
Closing of the Boston Floating Hospital Moriarty, Kevin P.
Journal of pediatric surgery,
July 2022, 2022-Jul, 2022-07-00, 20220701, Letnik:
57, Številka:
7
Journal Article
A survey was conducted in UK regional children's hospitals with paediatric intensive care and paediatric infectious disease (PID) departments to describe the characteristics of paediatric ...antimicrobial stewardship (PAS) programmes. A structured questionnaire was sent to PAS coordinators. ‘Audit and feedback’ was implemented in 13 out of 17 centres. Microbiology-led services were more likely to implement antimicrobial restriction (75% vs 33% in PID-led services), to focus on broad-spectrum antibiotics, and to review patients with positive blood cultures. PID-led services were more likely to identify patients from e-prescribing or drug charts and review all antimicrobials. A PAS network has been established.
The spatial structure of turbulence in atmospheric boundary layer flows is highly relevant to wind energy. In particular, wind turbine control strategies based on inflow preview measurements require ...knowledge of the longitudinal evolution of turbulent flow as it approaches the rotor. These upstream measurements are usually obtained with nacelle-mounted wind lidars. In contrast to traditional in situ anemometry, lidars collect measurements within a probe volume which varies in size depending on the technology of the commercial system being used. Here, we address two issues related to the use of wind lidar to measure the incoming flow to a wind turbine: (i) whether existing longitudinal coherence models can be used to predict flow at the rotor, based on measurements performed at a distance away from the rotor; and (ii) what effect probe-volume averaging has on the inflow predictions. These two questions are critical to the design and implementation of robust wind turbine control strategies. To address these questions, we perform field measurements and large-eddy simulations to determine which incoming flow structures can be readily predicted with existing coherence models, and which require additional corrections to account for lidar volumetric averaging effects. Results reveal that the wind turbine induction zone has a negligible impact on the longitudinal coherence and first-order turbulence quantities, such as the standard deviation of velocity fluctuations. However, the phase of the signal, from which advection time periods of the turbulent structures are derived, is affected by the rotor blockage effect.
On 2017 September 22, the IceCube Neutrino Observatory reported the detection of the high-energy neutrino event IC 170922A, of potential astrophysical origin. It was soon determined that the neutrino ...direction was consistent with the location of the gamma-ray blazar TXS 0506+056 (3FGL J0509.4+0541), which was in an elevated gamma-ray emission state as measured by the Fermi satellite. Very Energetic Radiation Imaging Telescope Array System (VERITAS) observations of the neutrino/blazar region started on 2017 September 23 in response to the neutrino alert and continued through 2018 February 6. While no significant very-high-energy (VHE; E > 100 GeV) emission was observed from the blazar by VERITAS in the two-week period immediately following the IceCube alert, TXS 0506+056 was detected by VERITAS with a significance of 5.8 standard deviations ( ) in the full 35 hr data set. The average photon flux of the source during this period was (8.9 1.6) × 10−12 cm−2 s−1, or 1.6% of the Crab Nebula flux, above an energy threshold of 110 GeV, with a soft spectral index of 4.8 1.3.
Abstract
G106.3+2.7, commonly considered to be a composite supernova remnant (SNR), is characterized by a boomerang-shaped pulsar wind nebula (PWN) and two distinct (“head” and “tail”) regions in the ...radio band. A discovery of very-high-energy gamma-ray emission (
E
γ
> 100 GeV) followed by the recent detection of ultrahigh-energy gamma-ray emission (
E
γ
> 100 TeV) from the tail region suggests that G106.3+2.7 is a PeVatron candidate. We present a comprehensive multiwavelength study of the Boomerang PWN (100″ around PSR J2229+6114) using archival radio and Chandra data obtained two decades ago, a new NuSTAR X-ray observation from 2020, and upper limits on gamma-ray fluxes obtained by Fermi-LAT and VERITAS observatories. The NuSTAR observation allowed us to detect a 51.67 ms spin period from the pulsar PSR J2229+6114 and the PWN emission characterized by a power-law model with Γ = 1.52 ± 0.06 up to 20 keV. Contrary to the previous radio study by Kothes et al., we prefer a much lower PWN
B
-field (
B
∼ 3
μ
G) and larger distance (
d
∼ 8 kpc) based on (1) the nonvarying X-ray flux over the last two decades, (2) the energy-dependent X-ray size of the PWN resulting from synchrotron burn-off, and (3) the multiwavelength spectral energy distribution (SED) data. Our SED model suggests that the PWN is currently re-expanding after being compressed by the SNR reverse shock ∼1000 yr ago. In this case, the head region should be formed by GeV–TeV electrons injected earlier by the pulsar propagating into the low-density environment.
Abstract
Background
Morning report is a fundamental component of internal medicine training and often represents the most significant teaching responsibility of Chief Residents. We sought to define ...Chief Resident behaviors essential to leading a successful morning report.
Methods
In 2016, we conducted a multi-site qualitative study using key informant interviews of morning report stakeholders. 49 residents, Chief Residents, and faculty from 4 Internal Medicine programs participated. Interviews were analyzed and coded by 3 authors using inductive reasoning and thematic analysis. A preliminary code structure was developed and expanded in an iterative process concurrent with data collection until thematic sufficiency was reached and a final structure was established. This final structure was used to recode all transcripts.
Results
We identified four themes of Chief Resident behaviors that lead to a successful morning report: report preparation, delivery skills, pedagogical approaches, and faculty participation. Preparation domains include thoughtful case selection, learning objective development, content editing, and report organization. Delivery domains include effective presentation skills, appropriate utilization of technology, and time management. Pedagogical approach domains include learner facilitation techniques that encourage clinical reasoning while nurturing a safe learning environment, as well as innovative teaching strategies. Moderating the involvement of faculty was identified as the final key to morning report effectiveness. Specific behavior examples are provided.
Conclusion
Consideration of content preparation, delivery, pedagogical approaches, and moderation of faculty participation are key components to Chief Resident-led morning reports. Results from this study could be used to enhance faculty development for Chief Residents.
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