Natural history of asymptomatic pancreatic cystic neoplasms

AbstractBackgroundThe management of asymptomatic pancreatic cysts is controversial and indications for excision are based on pathology and natural history.ObjectivesThis study aimed to examine outcomes of asymptomatic lesions using a protocol based on size and cyst fluid analysis.MethodsAsymptomatic cysts were identified from a prospectively maintained database. Sequential cross‐sectional imaging studies were assessed, and results of endoscopic ultrasound‐guided aspiration were co‐analysed.ResultsA total of 338 asymptomatic patients underwent evaluation. Overall, 84 cysts were <1.5 cm and 254 were ≥1.5 cm in diameter. Median patient follow‐up was 5.1 years [interquartile range (IQR): 4.1–6.9 years]. In the group in which cysts measured <1.5 cm in diameter, median cyst size was 1.0 cm (IQR: 0.6–1.2 cm) at presentation and increased to 1.2 cm (IQR: 0.7–1.6 cm) during follow‐up. Five (6.0%) patients underwent resection, all within 2 months of presentation. In the group in which cysts measured ≥1.5 cm in diameter, median cyst size was 2.5 cm (IQR: 2.0–3.4 cm) at presentation and increased to 2.7 cm (IQR: 3.0–4.2 cm). A total of 63 (24.8%) patients underwent resection. Surgery was performed with 2 months in 53 (84.1%) patients, within 12 months in four (6.3%) patients and at >12 months post‐presentation in six (9.5%) patients. A total of 70.6% of resected specimens were identified as malignancies or mucinous lesions.conclusionsAsymptomatic cysts of <1.5 cm in diameter can safely be followed by imaging and are expected to undergo little change. A quarter of all asymptomatic cysts measuring ≥1.5 cm are appropriately resected based on imaging and cyst fluid analysis

Preparing students to be doctors: introduction of a sub-internship program.

Preparing graduates for the transformation from medical student to doctor provides medical schools with a real challenge. Medical educators advocate a process of graduated delegation of responsibility in the clinical years of medical school. This is best exemplified in the North American system of sub-internship programmes; an educational approach which European medical schools have been slow to adopt. This study reports on the introduction of an intensive two-week surgical sub-internship for final medical year students. \u22Sub-interns\u22 were asked to complete pre and post sub-internship online questionnaires assessing their readiness to perform clinical and practical skills, attitudes towards the program, and how well it prepared students for internship. Forty-nine students completed a questionnaire pre sub-internship and 47 completed the post-questionnaire. Student confidence towards practical and clinical skills and their first day at work increased over the two weeks. Mean Iikert scores for all 6 practical and clinical skills improved post sub-internship. The introduction of a surgical sub-internship is timely and welcomed by medical students. Its development helps bridge the gap in responsibilities between medical student and doctor

Multiscale variation in drought controlled historical forest fire activity in the boreal forests of eastern Fennoscandia

Forest fires are a key disturbance in boreal forests, and characteristics of fire regimes are among the most important factors explaining the variation in forest structure and species composition. The occurrence of fire is connected with climate, but earlier, mostly local-scale studies in the northern European boreal forests have provided little insight into fire-climate relationship before the modern fire suppression period. Here, we compiled annually resolved fire history, temperature, and precipitation reconstructions from eastern Fennoscandia from the mid-16th century to the end of the 19th century, a period of strong human influence on fires. We used synchrony of fires over the network of 25 fire history reconstructions as a measure of climatic forcing on fires. We examined the relationship between fire occurrence and climate (summer temperature, precipitation, and a drought index summarizing the influence of variability in temperature and precipitation) across temporal scales, using a scale space multiresolution correlation approach and Bayesian inference that accounts for the annually varying uncertainties in climate reconstructions. At the annual scale, fires were synchronized during summers with low precipitation, and most clearly during drought summers. A scale-derivative analysis revealed that fire synchrony and climate varied at similar, roughly decadal scales. Climatic variables and fire synchrony showed varying correlation strength and credibility, depending on the climate variable and the time period. In particular, precipitation emerged as a credible determinant of fire synchrony also at these time scales, despite the large uncertainties in precipitation reconstruction. The findings explain why fire occurrence can be high during cold periods (such as from the mid-17th to early-18th century), and stresses the notion that future fire frequency will likely depend to a greater extent on changes in precipitation than temperature alone. We showed, for the first time, the importance of climate as a decadal-scale driver of forest fires in the European boreal forests, discernible even during a period of strong human influence on fire occurrence. The fire regime responded both to anomalously dry summers, but also to decadal-scale climate changes, demonstrating how climatic variability has shaped the disturbance regimes in the northern European boreal forests over various time scales.Peer reviewe

Spirit, mind and body: the archaeology of monastic healing

Archaeology and material culture are used in this chapter to consider how monastic experience responded to illness, ageing and disability. The approach taken is influenced by the material study of religion, which interrogates how bodies and things engage to construct the sensory experience of religion, and by practice-based approaches in archaeology, which examine the active role of space and material culture in shaping religious agency and embodiment. The archaeology of monastic healing focuses on the full spectrum of healing technologies, from managing the body in order to prevent illness, through to the treatment of the sick and preparation of the corpse for burial

Three Warm Jupiters around Solar-analog Stars Detected with TESS*

We report the discovery and characterization of three giant exoplanets orbiting solar-analog stars, detected by the TESS space mission and confirmed through ground-based photometry and radial velocity measurements taken at La Silla observatory with FEROS. TOI-2373 b is a warm Jupiter orbiting its host star every ∼13.3 days, and is one of the most massive known exoplanet with a precisely determined mass and radius around a star similar to the Sun, with an estimated mass of m _p = ${9.3}_{-0.2}^{+0.2}\,{M}_{\mathrm{jup}}$ and a radius of r _p = ${0.93}_{-0.2}^{+0.2}\,{R}_{\mathrm{jup}}$ . With a mean density of $\rho ={14.4}_{-1.0}^{+0.9}\,{\rm{g}}\,{\mathrm{cm}}^{-3}$ , TOI-2373 b is among the densest planets discovered so far. TOI-2416 b orbits its host star on a moderately eccentric orbit with a period of ∼8.3 days and an eccentricity of e = ${0.32}_{-0.02}^{+0.02}$ . TOI-2416 b is more massive than Jupiter with m _p = ${3.0}_{-0.09}^{+0.10}\,{M}_{\mathrm{jup}}$ , however is significantly smaller with a radius of r _p = ${0.88}_{-0.02}^{+0.02},{R}_{\mathrm{jup}}$ , leading to a high mean density of $\rho ={5.4}_{-0.3}^{+0.3}\,{\rm{g}}\,{\mathrm{cm}}^{-3}$ . TOI-2524 b is a warm Jupiter near the hot Jupiter transition region, orbiting its star every ∼7.2 days on a circular orbit. It is less massive than Jupiter with a mass of m _p = ${0.64}_{-0.04}^{+0.04}\,{M}_{\mathrm{jup}}$ , and is consistent with an inflated radius of r _p = ${1.00}_{-0.03}^{+0.02}\,{R}_{\mathrm{jup}}$ , leading to a low mean density of $\rho ={0.79}_{-0.08}^{+0.08}\,{\rm{g}}\,{\mathrm{cm}}^{-3}$ . The newly discovered exoplanets TOI-2373 b, TOI-2416 b, and TOI-2524 b have estimated equilibrium temperatures of ${860}_{-10}^{+10}$ K, ${1080}_{-10}^{+10}$ K, and ${1100}_{-20}^{+20}$ K, respectively, placing them in the sparsely populated transition zone between hot and warm Jupiters

The Long-Baseline Neutrino Experiment: Exploring Fundamental Symmetries of the Universe

The preponderance of matter over antimatter in the early Universe, the dynamics of the supernova bursts that produced the heavy elements necessary for life and whether protons eventually decay --- these mysteries at the forefront of particle physics and astrophysics are key to understanding the early evolution of our Universe, its current state and its eventual fate. The Long-Baseline Neutrino Experiment (LBNE) represents an extensively developed plan for a world-class experiment dedicated to addressing these questions. LBNE is conceived around three central components: (1) a new, high-intensity neutrino source generated from a megawatt-class proton accelerator at Fermi National Accelerator Laboratory, (2) a near neutrino detector just downstream of the source, and (3) a massive liquid argon time-projection chamber deployed as a far detector deep underground at the Sanford Underground Research Facility. This facility, located at the site of the former Homestake Mine in Lead, South Dakota, is approximately 1,300 km from the neutrino source at Fermilab -- a distance (baseline) that delivers optimal sensitivity to neutrino charge-parity symmetry violation and mass ordering effects. This ambitious yet cost-effective design incorporates scalability and flexibility and can accommodate a variety of upgrades and contributions. With its exceptional combination of experimental configuration, technical capabilities, and potential for transformative discoveries, LBNE promises to be a vital facility for the field of particle physics worldwide, providing physicists from around the globe with opportunities to collaborate in a twenty to thirty year program of exciting science. In this document we provide a comprehensive overview of LBNE's scientific objectives, its place in the landscape of neutrino physics worldwide, the technologies it will incorporate and the capabilities it will possess.Comment: Major update of previous version. This is the reference document for LBNE science program and current status. Chapters 1, 3, and 9 provide a comprehensive overview of LBNE's scientific objectives, its place in the landscape of neutrino physics worldwide, the technologies it will incorporate and the capabilities it will possess. 288 pages, 116 figure

Conserving plants within and beyond protected areas - still problematic and future uncertain

Against a background of continuing loss of biodiversity, it is argued that for the successful conservation of threatened plant species we need to ensure the more effective integration of the various conservation actions employed, clarify the wording of the CBD targets and provide clearer operational guidance as to how they are to be implemented and their implementation monitored. The role and effectiveness of protected areas in conserving biodiversity and in particular plant species are discussed as are recent proposals for a massive increase of their extent. The need for much greater effort and investment in the conservation or protection of threatened species outside protected areas where most plant diversity occurs is highlighted. The difficulties involved in implementing effective conservation of plant diversity both at an area- and species/population-based level are discussed. The widespread neglect of species recovery for plants is noted and the desirability of making a clearer distinction between species recovery and reintroduction is emphasized. Key messages from a global overview of species recovery are outlined and recommendations made, including the desirability of each country preparing a national species recovery strategy. The projected impacts of global change on protected areas and on species conservation and recovery, and ways of addressing them are discussed

QCD and strongly coupled gauge theories : challenges and perspectives

We highlight the progress, current status, and open challenges of QCD-driven physics, in theory and in experiment. We discuss how the strong interaction is intimately connected to a broad sweep of physical problems, in settings ranging from astrophysics and cosmology to strongly coupled, complex systems in particle and condensed-matter physics, as well as to searches for physics beyond the Standard Model. We also discuss how success in describing the strong interaction impacts other fields, and, in turn, how such subjects can impact studies of the strong interaction. In the course of the work we offer a perspective on the many research streams which flow into and out of QCD, as well as a vision for future developments.Peer reviewe

Mitochondrial physiology

As the knowledge base and importance of mitochondrial physiology to evolution, health and disease expands, the necessity for harmonizing the terminology concerning mitochondrial respiratory states and rates has become increasingly apparent. The chemiosmotic theory establishes the mechanism of energy transformation and coupling in oxidative phosphorylation. The unifying concept of the protonmotive force provides the framework for developing a consistent theoretical foundation of mitochondrial physiology and bioenergetics. We follow the latest SI guidelines and those of the International Union of Pure and Applied Chemistry (IUPAC) on terminology in physical chemistry, extended by considerations of open systems and thermodynamics of irreversible processes. The concept-driven constructive terminology incorporates the meaning of each quantity and aligns concepts and symbols with the nomenclature of classical bioenergetics. We endeavour to provide a balanced view of mitochondrial respiratory control and a critical discussion on reporting data of mitochondrial respiration in terms of metabolic flows and fluxes. Uniform standards for evaluation of respiratory states and rates will ultimately contribute to reproducibility between laboratories and thus support the development of data repositories of mitochondrial respiratory function in species, tissues, and cells. Clarity of concept and consistency of nomenclature facilitate effective transdisciplinary communication, education, and ultimately further discovery