Does disparity in educational material contributing to melanoma mortality?

The lack of diversity in the medical fraternity among physicians and educators is quite notable across America, but even more notable is the lack of diversity within the educational material being used to educate medical professionals. In a medical school in an urban setting where African Americans and Hispanic population predominates, it was noticeable that the educational material, both textbooks and lecture slides, were not representative of the population that the school serves. Even in a school that has a demonstrated track record for committing to community service. The school is most recognized for encouraging its student to engage in community activities that promotes the wellbeing of the population it serves. This institution also demonstrates it’s commitment to community service by requiring their medical student be active in direct patient care at their student operated community clinic as early as their first year of medical school. However, as will be presented in this pilot study, exposure to patients without proper educational exposure does not guarantee the best outcome for the patients. Cutaneous melanoma is the most commonly fatal cancer among all the cancers affecting the skin. This highly fatal skin cancer is also increasing in incidence more than other forms of cancer that are of a preventable nature. The current SEERS data trend ranks melanoma of the skin as 6th in incidence and 6th in death in 2016. In 1990 the worldwide age-adjusted incidence of melanoma in men and women were 2.3 and 2.2 per 100,000 people respectively. Between 2009 and 2013 the incidence had increased significantly to 21.8 men and women per 100,000 people according to the SEERS database. In 2016 the SEERS database estimates the number of new cases of melanoma to be 76,380 representing 4.5% of all new cases of cancer in the United States. The estimated death rate from melanoma in 2016 is set at 10,130 cases, representing 1.7% of death by cancer. For melanoma of the skin, 83.8% are diagnosed at the local stage (confined to the primary site), 9% are diagnosed at the regional stage (spread to regional lymph nodes) and distant metastasis is diagnosed in 4% of cases. The five year survival rate for those diagnosed with cutaneous melanoma is significantly dependent on the stage of the disease at the time of diagnosis, with survival rates declining dramatically as the tumor thickens and the stage of the disease increases. The five year survival for tumors diagnosed at the localized stage is 98.4%. The survival rate declines significantly to 62.4% for tumors diagnosed at the regional stage and even worse for those diagnosed with distant metastasis, 17.9%

Spatially Resolved Spitzer-IRS Spectroscopy of the Central Region of M82

We present high spatial resolution (~ 35 parsec) 5-38 um spectra of the central region of M82, taken with the Spitzer Infrared Spectrograph. From these spectra we determined the fluxes and equivalent widths of key diagnostic features, such as the [NeII]12.8um, [NeIII]15.5um, and H_2 S(1)17.03um lines, and the broad mid-IR polycyclic aromatic hydrocarbon (PAH) emission features in six representative regions and analysed the spatial distribution of these lines and their ratios across the central region. We find a good correlation of the dust extinction with the CO 1-0 emission. The PAH emission follows closely the ionization structure along the galactic disk. The observed variations of the diagnostic PAH ratios across M82 can be explained by extinction effects, within systematic uncertainties. The 16-18um PAH complex is very prominent, and its equivalent width is enhanced outwards from the galactic plane. We interpret this as a consequence of the variation of the UV radiation field. The EWs of the 11.3um PAH feature and the H_2 S(1) line correlate closely, and we conclude that shocks in the outflow regions have no measurable influence on the H_2 emission. The [NeIII]/[NeII] ratio is on average low at ~0.18, and shows little variations across the plane, indicating that the dominant stellar population is evolved (5 - 6 Myr) and well distributed. There is a slight increase of the ratio with distance from the galactic plane of M82 which we attribute to a decrease in gas density. Our observations indicate that the star formation rate has decreased significantly in the last 5 Myr. The quantities of dust and molecular gas in the central area of the galaxy argue against starvation and for negative feedback processes, observable through the strong extra-planar outflows.Comment: 15 pages, 12 figures, 3 tables, ApJ, emulateap

The Energetics of Molecular Gas in NGC 891 from H2 and FIR Spectroscopy

We have studied the molecular hydrogen energetics of the edge-on spiral galaxy NGC\,891, using a 34-position map in the lowest three pure rotational H$_2$ lines observed with the Spitzer Infrared Spectrograph. The S(0), S(1), and S(2) lines are bright with an extinction corrected total luminosity of $\sim2.8 \times 10^{7}$ L$_{\odot}$, or 0.09\% of the total-infrared luminosity of NGC\,891. The H$_2$ line ratios are nearly constant along the plane of the galaxy -- we do not observe the previously reported strong drop-off in the S(1)/S(0) line intensity ratio in the outer regions of the galaxy, so we find no evidence for the very massive cold CO-free molecular clouds invoked to explain the past observations. The H$_2$ level excitation temperatures increase monotonically indicating more than one component to the emitting gas. More than 99\% of the mass is in the lowest excitation (T$_{ex}$ $\sim$125 K) ``warm'' component. In the inner galaxy, the warm H$_2$ emitting gas is $\sim$15\% of the CO(1-0)-traced cool molecular gas, while in the outer regions the fraction is twice as high. This large mass of warm gas is heated by a combination of the far-UV photons from stars in photo-dissociation regions (PDRs) and the dissipation of turbulent kinetic energy. Including the observed far-infrared [OI] and [CII] fine-structure line emission and far-infrared continuum emission in a self-consistent manner to constrain the PDR models, we find essentially all of the S(0) and most (70\%) of the S(1) line arises from low excitation PDRs, while most (80\%) of the S(2) and the remainder of the S(1) line emission arises from low velocity microturbulent dissipation.Comment: Accepted for publication in The Astrophysical Journal. Figure 10 available at http://www.physics.uoc.gr/~vassilis/papers/ngc891.pd

Far-Infrared Properties of Spitzer-selected Luminous Starbursts

We present SHARC-2 350 micron data on 20 luminous z ~ 2 starbursts with S(1.2mm) > 2 mJy from the Spitzer-selected samples of Lonsdale et al. and Fiolet et al. All the sources were detected, with S(350um) > 25 mJy for 18 of them. With the data, we determine precise dust temperatures and luminosities for these galaxies using both single-temperature fits and models with power-law mass--temperature distributions. We derive appropriate formulae to use when optical depths are non-negligible. Our models provide an excellent fit to the 6um--2mm measurements of local starbursts. We find characteristic single-component temperatures T1 ~ 35.5+-2.2 K and integrated infrared (IR) luminosities around 10^(12.9+-0.1) Lsun for the SWIRE-selected sources. Molecular gas masses are estimated at 4 x 10^(10) Msun, assuming kappa(850um)=0.15 m^2/kg and a submillimeter-selected galaxy (SMG)-like gas-to-dust mass ratio. The best-fit models imply >~2 kpc emission scales. We also note a tight correlation between rest-frame 1.4 GHz radio and IR luminosities confirming star formation as the predominant power source. The far-IR properties of our sample are indistinguishable from the purely submillimeter-selected populations from current surveys. We therefore conclude that our original selection criteria, based on mid-IR colors and 24 um flux densities, provides an effective means for the study of SMGs at z ~ 1.5--2.5.Comment: 13 pages, 4 figures, edited to match published version in ApJ 717, 29-39 (2010

Educating a syndrome? Seeking a balance between identifying a learning profile and delivering inclusive education

This article summarizes research related to pedagogical approaches to special education, and characteristics of teacher's attitudes and beliefs that supports effective inclusion practices. Additionally, the author summarizes factors that may both enable and disable children with DS's progress, and notes speech and language characteristics from research to date

Enhanced dust heating in the bulges of early-type spiral galaxies

Stellar density and bar strength should affect the temperatures of the cool (T ~ 20-30 K) dust component in the inner regions of galaxies, which implies that the ratio of temperatures in the circumnuclear regions to the disk should depend on Hubble type. We investigate the differences between cool dust temperatures in the central 3 kpc and disk of 13 nearby galaxies by fitting models to measurements between 70 and 500 microns. We attempt to quantify temperature trends in nearby disk galaxies, with archival data from Spitzer/MIPS and new observations with Herschel/SPIRE, which were acquired during the first phases of the Herschel observations for the KINGFISH (key insights in nearby galaxies: a far-infrared survey with Herschel) sample. We fit single-temperature modified blackbodies to far-infrared and submillimeter measurements of the central and disk regions of galaxies to determine the temperature of the component(s) emitting at those wavelengths. We present the ratio of central-region-to-disk-temperatures of the cool dust component of 13 nearby galaxies as a function of morphological type. We find a significant temperature gradient in the cool dust component in all galaxies, with a mean center-to-disk temperature ratio of 1.15 +/- 0.03. The cool dust temperatures in the central ~3 kpc of nearby galaxies are 23(+/-3)% hotter for morphological types earlier than Sc, and only 9(+/-3)% hotter for later types. The temperature ratio is also correlated with bar strength, with only strongly barred galaxies having a ratio over 1.2. The strong radiation field in the high stellar density of a galactic bulge tends to heat the cool dust component to higher temperatures, at least in early-type spirals with relatively large bulges, especially when paired with a strong bar.Comment: Accepted for publication on the A&A Herschel Special Issu

Optical Imaging and Spectroscopy of the Edge-On Sbc Galaxy UGC10043: Evidence for a Galactic Wind and a Peculiar Triaxial Bulge

We present new optical imaging and spectroscopy of the peculiar, edge-on Sbc galaxy UGC10043. B & R imaging reveals that the inner bulge of UGC10043 is elongated perpendicular to the major axis. At larger r, the bulge isophotes twist to become oblate and nearly circular, suggesting the bulge is triaxial. Based on stellar and ionized gas kinematics, the bulge shows no clear evidence for rotation about either its major or minor axis. The southwestern quadrant of the bulge is girdled by a narrow dust lane parallel to the minor axis that may be part of an inner polar ring. The stellar disk of UGC10043 has a low optical surface brightness, a small scale height, a mild integral sign warp, and a dusty, inner region that appears tilted relative to the outlying disk. The HA and [NII] emission lines in UGC10043 resolve into multiple velocity components, indicating the presence of a large-scale galactic wind with an outflow velocity of ~104 km/s. HA+[NII] imaging reaffirms this picture by revealing ionized gas extended to |z|~3.5kpc in a biconical structure. The [NII]/HA line intensity ratio increases with increasing distance from the plane, reaching values as high as 1.7. Unlike most galaxies with large-scale winds, UGC10043 has only a modest global star formation rate (~1M_sun/yr), implying the wind is powered by a rather feeble central starburst. We discuss evolutionary scenarios that could account for both the structural complexities of UGC10043 and its large-scale wind. [Abridged]Comment: accepted to the Astronomical Journal (July 2004); version with full-resolution and color figures available at http://cfa-www.harvard.edu/~lmatthe

Obscured Activity: AGN, Quasars, Starbursts and ULIGs observed by the Infrared Space Observatory

Some of the most active galaxies in the Universe are obscured by large quantities of dust and emit a substantial fraction of their bolometric luminosity in the infrared. Observations of these infrared luminous galaxies with the Infrared Space Observatory (ISO) have provided a relatively unabsorbed view to the sources fuelling this active emission. The improved sensitivity, spatial resolution and spectroscopic capability of ISO over its predecessor Infrared Astronomical Satellite (IRAS), has enabled significant advances in the understanding of the infrared properties of active galaxies. ISO surveyed a wide range of active galaxies which, in the context of this review, includes those powered by intense bursts of star-formation as well as those containing a dominant active galactic nucleus (AGN). Mid infrared imaging resolved for the first time the dust enshrouded nuclei in many nearby galaxies, while a new era in infrared spectroscopy was opened by probing a wealth of atomic, ionic and molecular lines as well as broad band features in the mid and far infrared. This was particularly useful since it resulted in the understanding of the power production, excitation and fuelling mechanisms in the nuclei of active galaxies including the intriguing but so far elusive ultraluminous infrared galaxies. Detailed studies of various classes of AGN and quasars greatly improved our understanding of the unification scenario. Far-infrared imaging and photometry also revealed the presence of a new very cold dust component in galaxies and furthered our knowledge of the far-infrared properties of faint starbursts, ULIGs and quasars. We summarise almost nine years of key results based upon ISO data spanning the full range of luminosity and type of active galaxies.Comment: Accepted for publication in 'ISO science legacy - a compact review of ISO major achievements', Space Science Reviews - dedicated ISO issue. To be published by Springer in 2005. 62 pages (low resolution figures version). Higher resolution PDFs available from http://users.physics.uoc.gr/~vassilis/papers/VermaA.pdf or http://www.iso.vilspa.esa.es/science/SSR/Verma.pd

BHPR research: qualitative1. Complex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis

Background: Foot surgery is common in patients with RA but research into surgical outcomes is limited and conceptually flawed as current outcome measures lack face validity: to date no one has asked patients what is important to them. This study aimed to determine which factors are important to patients when evaluating the success of foot surgery in RA Methods: Semi structured interviews of RA patients who had undergone foot surgery were conducted and transcribed verbatim. Thematic analysis of interviews was conducted to explore issues that were important to patients. Results: 11 RA patients (9 ♂, mean age 59, dis dur = 22yrs, mean of 3 yrs post op) with mixed experiences of foot surgery were interviewed. Patients interpreted outcome in respect to a multitude of factors, frequently positive change in one aspect contrasted with negative opinions about another. Overall, four major themes emerged. Function: Functional ability & participation in valued activities were very important to patients. Walking ability was a key concern but patients interpreted levels of activity in light of other aspects of their disease, reflecting on change in functional ability more than overall level. Positive feelings of improved mobility were often moderated by negative self perception ("I mean, I still walk like a waddling duck”). Appearance: Appearance was important to almost all patients but perhaps the most complex theme of all. Physical appearance, foot shape, and footwear were closely interlinked, yet patients saw these as distinct separate concepts. Patients need to legitimize these feelings was clear and they frequently entered into a defensive repertoire ("it's not cosmetic surgery; it's something that's more important than that, you know?”). Clinician opinion: Surgeons' post operative evaluation of the procedure was very influential. The impact of this appraisal continued to affect patients' lasting impression irrespective of how the outcome compared to their initial goals ("when he'd done it ... he said that hasn't worked as good as he'd wanted to ... but the pain has gone”). Pain: Whilst pain was important to almost all patients, it appeared to be less important than the other themes. Pain was predominately raised when it influenced other themes, such as function; many still felt the need to legitimize their foot pain in order for health professionals to take it seriously ("in the end I went to my GP because it had happened a few times and I went to an orthopaedic surgeon who was quite dismissive of it, it was like what are you complaining about”). Conclusions: Patients interpret the outcome of foot surgery using a multitude of interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than other factors in the overall outcome of the surgery. Future research into foot surgery should incorporate the complexity of how patients determine their outcome Disclosure statement: All authors have declared no conflicts of interes