A giant planet undergoing extreme-ultraviolet irradiation by its hot massive-star host

The amount of ultraviolet irradiation and ablation experienced by a planet depends strongly on the temperature of its host star. Of the thousands of extrasolar planets now known, only six have been found that transit hot, A-type stars (with temperatures of 7,300-10,000 kelvin), and no planets are known to transit the even hotter B-type stars. For example, WASP-33 is an A-type star with a temperature of about 7,430 kelvin, which hosts the hottest known transiting planet, WASP-33b (ref. 1); the planet is itself as hot as a red dwarf star of type M (ref. 2). WASP-33b displays a large heat differential between its dayside and nightside, and is highly inflated-traits that have been linked to high insolation. However, even at the temperature of its dayside, its atmosphere probably resembles the molecule-dominated atmospheres of other planets and, given the level of ultraviolet irradiation it experiences, its atmosphere is unlikely to be substantially ablated over the lifetime of its star. Here we report observations of the bright star HD 195689 (also known as KELT-9), which reveal a close-in (orbital period of about 1.48 days) transiting giant planet, KELT-9b. At approximately 10,170 kelvin, the host star is at the dividing line between stars of type A and B, and we measure the dayside temperature of KELT-9b to be about 4,600 kelvin. This is as hot as stars of stellar type K4 (ref. 5). The molecules in K stars are entirely dissociated, and so the primary sources of opacity in the dayside atmosphere of KELT-9b are probably atomic metals. Furthermore, KELT-9b receives 700 times more extreme-ultraviolet radiation (that is, with wavelengths shorter than 91.2 nanometres) than WASP-33b, leading to a predicted range of mass-loss rates that could leave the planet largely stripped of its envelope during the main-sequence lifetime of the host star

KELT-24b: A 5M_J Planet on a 5.6 day Well-Aligned Orbit around the Young V=8.3 F-star HD 93148

We present the discovery of KELT-24 b, a massive hot Jupiter orbiting a bright (V=8.3 mag, K=7.2 mag) young F-star with a period of 5.6 days. The host star, KELT-24 (HD 93148), has a T_(eff) =6508±49 K, a mass of M∗ = 1.461^(+0.056)_(−0.060) M_⊙, radius of R∗ = 1.506±0.022 R_⊙, and an age of 0.77^(+0.61)_(−0.42) Gyr. Its planetary companion (KELT-24 b) has a radius of R_P = 1.272^(+0.021)_(−0.022) R_J, a mass of MP = 5.18^(+0.21)_(−0.22) M_J, and from Doppler tomographic observations, we find that the planet's orbit is well-aligned to its host star's projected spin axis (λ = 2.6^(+5.1)_(−3.6)). The young age estimated for KELT-24 suggests that it only recently started to evolve from the zero-age main sequence. KELT-24 is the brightest star known to host a transiting giant planet with a period between 5 and 10 days. Although the circularization timescale is much longer than the age of the system, we do not detect a large eccentricity or significant misalignment that is expected from dynamical migration. The brightness of its host star and its moderate surface gravity make KELT-24b an intriguing target for detailed atmospheric characterization through spectroscopic emission measurements since it would bridge the current literature results that have primarily focused on lower mass hot Jupiters and a few brown dwarfs

The genetic architecture of the human cerebral cortex

The cerebral cortex underlies our complex cognitive capabilities, yet little is known about the specific genetic loci that influence human cortical structure. To identify genetic variants that affect cortical structure, we conducted a genome-wide association meta-analysis of brain magnetic resonance imaging data from 51,665 individuals. We analyzed the surface area and average thickness of the whole cortex and 34 regions with known functional specializations. We identified 199 significant loci and found significant enrichment for loci influencing total surface area within regulatory elements that are active during prenatal cortical development, supporting the radial unit hypothesis. Loci that affect regional surface area cluster near genes in Wnt signaling pathways, which influence progenitor expansion and areal identity. Variation in cortical structure is genetically correlated with cognitive function, Parkinson's disease, insomnia, depression, neuroticism, and attention deficit hyperactivity disorder

17 Help wanted: identifying and addressing sexual distress in newly referred gynecologic oncology patients

Objectives: To assess predictors of help-seeking for sexual distress in a cohort of patients newly referred to a gynecologic oncology clinic Methods: We performed a cross-sectional study of new patients referred to a gynecologic oncology clinic for a known or suspected gynecologic malignancy. Our primary outcome was sexually related distress, classified as a score of 11 or above using the validated Female Sexual Distress Survey—Revised (FSDS-R). The PROMIS Female Sexual Function and Satisfaction Questionnaire (SexSF) is a validated instrument examining domains of sexual function over the past 30 days. We performed one-sided t-test and logistic regression statistical analyses using STATA version 17.0. Results: From May-Dec 2022, 105 of 126 (83%) eligible patients completed the survey. The median age of respondents was 60.5 years old (range 26–85). 48% of patients had a known cancer diagnosis at the time of their visit, with 71% percent having cancer confirmed on final pathology (25% ovarian, 49% uterine, and 19% cervical/vaginal/ vulvar). 50% of patients self-identified as non-Hispanic White, and 50% were non-White (Black, Asian, Pacific Islander, and Latinx), and 6% were LGBTQ. 37.5% reported being sexually active within the past 30 days. FSDS-R scores ranged from 0–32 with a median (IQR) of 2.5 (9.5). Overall, 23% of this cohort reported sexually related distress. This was not significantly associated with cancer diagnosis on arrival, final diagnosis, site of origin, or with sexual activity. 53% of patients agreed that physicians should routinely ask about sexual function. 37% of patients desired to speak with their gynecologic oncologist about sexual health, the majority (64%) of whom did not have sexual distress. Additionally, 27% desired referral to sexual health specialists, psychologists or counselor regarding sexual health concerns. Conclusions: Almost a quarter of new patients to gynecologic oncology clinic reported sexually related distress. A majority preferred to speak to their gynecologic oncologist regarding sexual health, regardless of personal report of sexual distress. Gynecologic oncology providers should incorporate screening for sexual symptoms into evaluation and treatment planning

Perspectives of gynecologic oncology fellowship training and preparedness for practice.

We aimed to examine the preparedness of recent gynecologic oncology fellowship graduates for independent practice.We conducted a web-based survey study using REDCap targeting Society of Gynecologic Oncology (SGO) members who graduated gynecologic oncology fellowship within the last six years. The survey included 52 items assessing fellowship training experiences, level of comfort in performing core gynecologic oncology surgical procedures and administering cancer-directed therapies. Questions also addressed factors driving participants selection of fellowship programs, educational experience, research and preparedness for independent practice. A total of 296 participants were invited to complete the survey. Response rate was 42% with n = 124 completed surveys included for analysis. The highest ranked factor for fellowship selection was fit with program 36% (n = 45). Upon completing fellowship, most were uncomfortable performing ureteral conduit formation 84% (n = 103), ureteroneocystostomy 77% (n = 94), exenteration 68% (n = 83), splenectomy 67% (n = 83) and lower anterior resection 41% (n = 51). Most were comfortable managing intraoperative complications 85% (n = 104) and standard cancer staging procedures (range: 61%-99%). Majority were comfortable providing cancer directed therapies with chemotherapy 99% (n = 123), immunotherapy 84% (n = 104), and poly ADP-ribose polymerase (PARP) inhibitors 97% (n = 120). Upon completing fellowship, 77% (n = 95) report having mentorship that met their expectations during fellowship and 94% (n = 116) felt they were ready for independent practice. Majority of fellowship graduates were prepared for independent practice and felt comfortable performing routine surgical procedures and cancer directed treatment. However, most are not comfortable with ultra-radical gynecologic oncology procedures. Maximizing surgical opportunities during fellowship training and acquiring early career mentorship may help

Perspectives of gynecologic oncology fellowship training and preparedness for practice

We aimed to examine the preparedness of recent gynecologic oncology fellowship graduates for independent practice.We conducted a web-based survey study using REDCap targeting Society of Gynecologic Oncology (SGO) members who graduated gynecologic oncology fellowship within the last six years. The survey included 52 items assessing fellowship training experiences, level of comfort in performing core gynecologic oncology surgical procedures and administering cancer-directed therapies. Questions also addressed factors driving participants’ selection of fellowship programs, educational experience, research and preparedness for independent practice. A total of 296 participants were invited to complete the survey. Response rate was 42% with n = 124 completed surveys included for analysis. The highest ranked factor for fellowship selection was fit with program 36% (n = 45). Upon completing fellowship, most were uncomfortable performing ureteral conduit formation 84% (n = 103), ureteroneocystostomy 77% (n = 94), exenteration 68% (n = 83), splenectomy 67% (n = 83) and lower anterior resection 41% (n = 51). Most were comfortable managing intraoperative complications 85% (n = 104) and standard cancer staging procedures (range: 61%–99%). Majority were comfortable providing cancer directed therapies with chemotherapy 99% (n = 123), immunotherapy 84% (n = 104), and poly ADP-ribose polymerase (PARP) inhibitors 97% (n = 120). Upon completing fellowship, 77% (n = 95) report having mentorship that met their expectations during fellowship and 94% (n = 116) felt they were ready for independent practice. Majority of fellowship graduates were prepared for independent practice and felt comfortable performing routine surgical procedures and cancer directed treatment. However, most are not comfortable with ultra-radical gynecologic oncology procedures. Maximizing surgical opportunities during fellowship training and acquiring early career mentorship may help

Evidence-based prescribing of opioids after laparotomy: A quality-improvement initiative in gynecologic oncology.

INTRODUCTION: Across specialties, surgeons over-prescribe opioids to patients after surgery. We aimed to develop and implement an evidence-based calculator to inform post-discharge opioid prescription size for gynecologic oncology patients after laparotomy. METHODS: In 2021, open surgical gynecologic oncology patients were called 2-4 weeks after surgery to ask about their home opioid use. This data was used to develop a calculator for post-discharge opioid prescription size using two factors: 1) age of the patient, 2) oral morphine equivalents (OME) used by patients the day before hospital discharge. The calculator was implemented on the inpatient service from 8/21/22 and patients were contacted 2-4 weeks after surgery to again assess their opioid use at home. RESULTS: Data from 95 surveys were used to develop the opioid prescription size calculator and are compared to 95 post-intervention surveys. There was no difference pre- to post-intervention in demographic data, surgical procedure, or immediate postoperative recovery. The median opioid prescription size decreased from 150 to 37.5 OME (p < 0.01) and self-reported use of opioids at home decreased from 22.5 to 7.5 OME (p = 0.05). The refill rate did not differ (12.6 % pre- and 11.6 % post-intervention, p = 0.82). The surplus of opioids our patients reported having at home decreased from 1264 doses of 5 mg oxycodone tabs in the pre-intervention cohort, to 490 doses in the post-intervention cohort, a 61 % reduction. CONCLUSIONS: An evidence-based approach for prescribing opioids to patients after laparotomy decreased the surplus of opioids we introduced into our patients communities without impacting refill rates

55 If you don't use it, lose it: reducing over prescription of opioids at discharge

Objectives: To decrease the median number of opioid tabs prescribed to gynecologic oncology patients after open surgery who use zero oral morphine equivalents (“0-OME”) the day before hospital discharge. Methods: At our academic institution, medical trainees are invited annually to design and implement interprofessional quality improvement (QI) projects. An evidence-based post-discharge opioid prescription size calculator was developed within our division. The data used to make the calculator found that 35% of patients after laparotomy in 2021 used 0-OME the day prior to discharge, 97% of those patients were given a prescription for a median of 10 doses of 5mg oxycodone tabs and their median at home use of opioids was zero doses, leading to an excess of opioids in the community. We identified this pattern of over-prescription as an opportunity for a QI subcomponent to the calculator project. We utilized the post-discharge opioid calculator, which recommends a discharge prescription of 1–2 tabs of 5mg oxycodone (or equivalent alternative opioid) for 0-OME patients. Our project asked our inpatient team to use the opioid calculator to determine an appropriate post-discharge prescription size for 0-OME patients. Our initial in-process metric was completion of a fellow-led educational session with each team of rotating residents in which we reviewed our project aim and the implications of opioid over-prescription. Results: Between August 2022-March 2023 there were 37 0-OME patients discharged after open surgery. These patients were prescribed a median of 2 doses of 5mg oxycodone tabs (or equivalent alternative opioid) at discharge, which was an 80% decrease compared to 2021 historical controls. The education sessions were completed for 100% of the eight rotating resident teams. In our first plan-do-study-act (PDSA) cycle we realized we did not know if providers were utilizing the opioid calculator. Thus, we added an additional in process metric to track intervention fidelity by including documentation of calculator use in the discharge summary. After this change, 85% of discharge summaries for 0-OME patients documented calculator use. Conclusions: We met our goal of reducing the median opioid prescription size for 0-OME patients. We also demonstrated the feasibility of fellow led education for implementation and through the PDSA approach, identified the need for a new in process metric tracking calculator use

Glycerate from intestinal fructose metabolism induces islet cell damage and glucose intolerance

Dietary fructose, especially in the context of a high-fat western diet, has been linked to type 2 diabetes. Although the effect of fructose on liver metabolism has been extensively studied, a significant portion of the fructose is first metabolized in the small intestine. Here, we report that dietary fat enhances intestinal fructose metabolism, which releases glycerate into the blood. Chronic high systemic glycerate levels induce glucose intolerance by slowly damaging pancreatic islet cells and reducing islet sizes. Our findings provide a link between dietary fructose and diabetes that is modulated by dietary fat