Superalgebras of Dirac operators on manifolds with special Killing-Yano tensors

We present the properties of new Dirac-type operators generated by real or complex-valued special Killing-Yano tensors that are covariantly constant and represent roots of the metric tensor. In the real case these are just the so called complex or hyper-complex structures of the K\" ahlerian manifolds. Such a Killing-Yano tensor produces simultaneously a Dirac-type operator and the generator of a one-parameter Lie group connecting this operator with the standard Dirac one. In this way the Dirac operators are related among themselves through continuous transformations associated with specific discrete ones. We show that the group of these continuous transformations can be only U(1) or SU(2). It is pointed out that the Dirac and Dirac-type operators can form N=4 superalgebras whose automorphisms combine isometries with the SU(2) transformation generated by the Killing-Yano tensors. As an example we study the automorphisms of the superalgebras of Dirac operators on Minkowski spacetime.Comment: 35 page

The constructive use of images in medical teaching: a literature review

This literature review illustrates the various ways images are used in teaching and the evidence appertaining to it and advice regarding permissions and use. Four databases were searched, 23 papers were retained out of 135 abstracts found for the study. Images are frequently used to motivate an audience to listen to a lecture or to note key medical findings. Images can promote observation skills when linked with learning outcomes, but the timing and relevance of the images is important – it appears they must be congruent with the dialogue. Student reflection can be encouraged by asking students to actually draw their own impressions of a course as an integral part of course feedback. Careful structured use of images improve attention, cognition, reflection and possibly memory retention

The Absolute Spectra of Galactic Cosmic Rays at Solar Minimum and Their Implications for Manned Spaceflight

The radiation dose from galactic cosmic rays during a proposed mission to Mars is near the annual dose limit for the crew. Since the absolute spectra of galactic cosmic rays critically influences mission planning and spacecraft design, these spectra must be determined as accurately as possible. We have fit published measurements with solutions of the spherically symmetric diffusion equation to make accurate representations of the spectra. We report preliminary determinations on the absolute differential energy spectra at 1 AU and discuss the implications for the proposed missions to Mars

An unusual variant of choledochal cyst: a case report

<p>Abstract</p> <p>Introduction</p> <p>Choledochal cyst is an uncommon congenital disease of the biliary tract in the UK. There are five main types of choledochal cyst with several recognised sub-types. However, occasional variants do occur.</p> <p>Case presentation</p> <p>We report a case of a female infant with an antenatally diagnosed choledochal cyst. The operative cholangiogram revealed an unusual intrahepatic biliary tree. The cyst was successfully excised and the infant is well at 18-months follow up.</p> <p>Conclusion</p> <p>The anatomy should be clearly defined before surgical excision as abnormal variants can occur, which usually do not fit into the known classification types and subtypes.</p

Comparison of a New bioprosthetic Mitral Valve to Other Commercially Available Devices Under Controlled Conditions in a Porcine Mode

BACKGROUND/AIM: To evaluate three mitral bioprostheses (of comparable measured internal diameters) under controlled, stable, hemodynamic and surgical conditions by bench, echocardiographic, computerized tomography and autopsy comparisons pre‐ and postvalve implantation. METHODS: Fifteen similar‐sized Yorkshire pigs underwent preprocedural computerized tomography anatomic screening. Of these, 12 had consistent anatomic features and underwent implantation of a mitral bioprosthesis via thoracotomy on cardiopulmonary bypass (CPB). Four valves from each of three manufacturers were implanted in randomized fashion: 27‐mm Epic, 27‐mm Mosaic, and 25‐mm Mitris bioprostheses. After CPB, epicardial echocardiographic studies were performed to assess hemodynamic function and define any paravalvular leaks, followed by postoperative gated contrast computerized tomography. After euthanasia, animals underwent necropsy for anatomic evaluation. RESULTS: All 12 animals had successful valve implantation with no study deaths. Postoperative echocardiographic trans‐valve gradients varied among bioprosthesis manufacturers. The 25‐mm Mitris (5.1 ± 2.7)/(2.6 ± 1.3 torr) had the lowest peak/mean gradient and the 27‐mm Epic bioprosthesis had the highest (9.2 ± 3.7)/(4.6 ± 1.9 torr). Surgical valve opening area (SOA) varied with the 25‐mm Mitris having the largest SOA (2.4 ± 0.15 cm(2)) followed by the 27‐mm Mosaic (2.04 ± 0.23 cm(2)) and the 27‐mm Epic (1.8 ± 0.27 cm(2)) valve. Bench device orthogonal internal diameter measurements did not match manufacturer device size labeling: 25‐mm Mitris (23 × 23 mm), 27‐mm Mosaic (23 × 22 mm), 27‐mm Epic (21 × 21 mm). CONCLUSIONS: Current advertisement/packaging of commercial surgical mitral valves is not uniform. This study demonstrates marked variations in hemodynamics, valve opening area and anatomic dimensions between similar sized mitral bioprostheses. These data suggest a critical need for standardization and close scientific evaluation of surgical mitral bioprostheses to ensure optimal clinical outcomes

Hubble Space Telescope imaging of η Carinae

We present new high spatial resolution observations of the material around η Carinae obtained with the Hubble Space Telescope Wide Field/Planetary Camera. The star η Carinae is one of the most massive and luminous stars in our Galaxy, and has been episodically expelling significant quantities of gas over the last few centuries. The morphology of the bright central nebulosity (the homunculus) indicates that it is a thin shell with very well defined edges, and is clumpy on 0".2 (~10^(16)cm) scales. An extension to the northeast of the star {NN/NS using Walborn's [ApJL, 204, L17 ( 1976)] nomenclature} appears to be a stellar jet and its associated bow shock. The bow shock is notable for an intriguing series of parallel linear features across its face. The S ridge and the W arc appear to be part of a "cap" of emission located to the SW and behind the star. Together, the NE jet and the SW cap suggest that the symmetry axis for the system runs NE-SW rather than SE-NW, as previously supposed. Overall, the data indicate that the material around the star may represent an oblate shell with polar blowouts, rather than a bipolar flow

Multicentre cohort study to define and validate pathological assessment of response to neoadjuvant therapy in oesophagogastric adenocarcinoma.

BACKGROUND: This multicentre cohort study sought to define a robust pathological indicator of clinically meaningful response to neoadjuvant chemotherapy in oesophageal adenocarcinoma. METHODS: A questionnaire was distributed to 11 UK upper gastrointestinal cancer centres to determine the use of assessment of response to neoadjuvant chemotherapy. Records of consecutive patients undergoing oesophagogastric resection at seven centres between January 2000 and December 2013 were reviewed. Pathological response to neoadjuvant chemotherapy was assessed using the Mandard Tumour Regression Grade (TRG) and lymph node downstaging. RESULTS: TRG (8 of 11 centres) was the most widely used system to assess response to neoadjuvant chemotherapy, but there was discordance on how it was used in practice. Of 1392 patients, 1293 had TRG assessment; data were available for clinical and pathological nodal status (cN and pN) in 981 patients, and TRG, cN and pN in 885. There was a significant difference in survival between responders (TRG 1-2; median overall survival (OS) not reached) and non-responders (TRG 3-5; median OS 2·22 (95 per cent c.i. 1·94 to 2·51) years; P < 0·001); the hazard ratio was 2·46 (95 per cent c.i. 1·22 to 4·95; P = 0·012). Among local non-responders, the presence of lymph node downstaging was associated with significantly improved OS compared with that of patients without lymph node downstaging (median OS not reached versus 1·92 (1·68 to 2·16) years; P < 0·001). CONCLUSION: A clinically meaningful local response to neoadjuvant chemotherapy was restricted to the small minority of patients (14·8 per cent) with TRG 1-2. Among local non-responders, a subset of patients (21·3 per cent) derived benefit from neoadjuvant chemotherapy by lymph node downstaging and their survival mirrored that of local responders

Impact of Genetic Ancestry on Outcomes in ECOG-ACRIN-E5103

Purpose: Racial disparity in breast cancer outcomes exists between African American and Caucasian women in the United States. We have evaluated the impact of genetically determined ancestry on disparity in efficacy and therapy-induced toxicity for breast cancer patients in the context of a randomized, phase III adjuvant trial. Patients and Methods: This study compared outcomes between 386 patients of African ancestry (AA) and 2473 patients of European ancestry (EA) in a randomized, phase III breast cancer trial; ECOG-ACRIN-E5103. The primary efficacy endpoint, invasive disease free survival (DFS) and clinically significant toxicities were compared including: anthracycline-induced congestive heart failure (CHF), taxane-induced peripheral neuropathy (TIPN), and bevacizumab-induced hypertension. Results: Overall, AAs had significantly inferior DFS (p=0.002; HR=1.5) compared with EAs. This was significant in the estrogen receptor-positive subgroup (p=0.03); with a similar, non-significant trend for those who had triple negative breast cancer (TNBC; p=0.12). AAs also had significantly more grade 3-4 TIPN (OR=2.9; p=2.4 ×10-11) and grade 3-4 bevacizumab-induced hypertension (OR=1.6; p=0.02), with a trend for more CHF (OR=1.8; p=0.08). AAs had significantly more dose reductions for paclitaxel (p=6.6 ×10-6). In AAs, dose reductions in paclitaxel had a significant negative impact on DFS (p=0.03); whereas in EAs, dose reductions did not impact outcome (p=0.35). Conclusion: AAs had inferior DFS with more clinically important toxicities in ECOG-ACRIN-E5103. The altered risk to benefit ratio for adjuvant breast cancer chemotherapy should lead to additional research with the focus centered on the impact of genetic ancestry on both efficacy and toxicity. Strategies to minimize dose reductions for paclitaxel, especially due to TIPN, are warranted for this population

Hubble Space Telescope Planetary Camera images of R136

The Planetary Camera of the Hubble Space Telescope has been used to obtain broad and narrowband images ofR136, the core of the massive star cluster 30 Doradus in the Large Magellanic Cloud. R136a, the brightest component ofR136, is shown to have at least 12 separate components, including the eight originally identified by speckle interferometry. Three of the 12 components are previously unidentified close companions of the speckle components. The stars within R136a are found to have luminosities and colors of normal evolved (Wolf-Rayet and blue supergiants) and zero-age main-sequence (ZAMS) massive stars. A narrowband He II filter was used to investigate the Wolf-Rayet stellar population. We find that three stars in R136a are of the Wolf-Rayet type; of the two identified from ground-based data, one is now resolved into two components. We present color-magnitude diagrams and a luminosity function of the stars within the larger region (~2 pc) defined as R136. We find that the stars in R136 are similar in color and luminosity to those of cluster members that lie outside that crowded inner region. The lower end of the color-magnitude diagram corresponds to ZAMS spectral type B3. No red supergiants have been detected within R136. The luminosity per unit area in the inner 1" (0.25 pc) of R136 is ≥ 50 times that of the center of Orion for a comparable area and seven times that of the core of NGC 3603. The luminosity per unit area of all of R136 is comparable to that of Orion but is sustained over 130 times the area. An F336W surface brightness profile is constructed for R136 based on the stellar photometry. The distribution is found to be consistent with a pure power law with l(r}ɑ r^y with y=-1.72±0.06 or with a small core with r_c 5 X 10^4 M_☉ pc^(-3). The implied upper limit on the relaxation time for the cluster is much smaller than the age of 3.5 X 10^6 yrs required by the presence of Wolf-Rayet stars. This suggests that relaxation effects have been very important in determining the observed structure of the cluster unless a large population of lower mass stars is also present

Planetary camera observations of the central parsec of M32

Analysis of V band HST Planetary Camera images of the elliptical galaxy M32 shows that its nucleus is extremely dense and remains unresolved at even the HST diffraction limit. A combined approach of image deconvolution and model fitting is used to investigate the starlight distribution into limiting radii of 0".04 (0.14 pc at 700 kpc). The logarithmic slope of the brightness profile smoothly flattens from y= -1.2 at 3.4 pc to y= -0.5 at 0.34 pc; interior to this radius the profile is equally consistent with a singular µ(r)∝ r,^(-1/2) cusp or a small nonisothermal core with r_c<0.37 pc. The isophotes maintain constant ellipticity into tlle center, and there is no evidence for a central point source, disk, dust, or any other substructures. The cusp model implies central mass densities p_0 > 3 X 10^7 M_☉ pc^(-3) at the resolution limit and is consistent with a central M_• = 3 X 10^6 M_☉ black hole; the core model implies p_0≈4 X 10^6 M_☉ pc^(-3). From the viewpoint of long-term stability, we argue that a starlight cusp surrounding a central black hole is the more plausible interpretation of the observations. A core at the implied density and size without a black hole has a relaxation time of only ~7 X 10^7 yr and a short stellar oollision timescale implying wholesale stellar merging over the age of the universe. The core would be strongly vulnerable to collapse and concomitant runaway stellar merging. Collapse may lead to formation of a massive black hole in any case if it cannot be reversed by formation of a binary from high-mass merger products. Regardless of the ultimate fate of the core, however, structural evolution of the core will always be accompanied by strong evolution of the core population-the constant isophote shape and absence of a central color gradient appear to show that such evolution has not occurred. In contrast, the high velocities around a black hole imply long relaxation and stellar collision times for the cusp population compared to the age of the universe