How Protostellar Outflows Help Massive Stars Form

We consider the effects of an outflow on radiation escaping from the infalling envelope around a massive protostar. Using numerical radiative transfer calculations, we show that outflows with properties comparable to those observed around massive stars lead to significant anisotropy in the stellar radiation field, which greatly reduces the radiation pressure experienced by gas in the infalling envelope. This means that radiation pressure is a much less significant barrier to massive star formation than has previously been thought.Comment: 4 pages, 2 figures, emulateapj, accepted for publication in ApJ Letter

T cell avidity and tumor recognition: implications and therapeutic strategies

In the last two decades, great advances have been made studying the immune response to human tumors. The identification of protein antigens from cancer cells and better techniques for eliciting antigen specific T cell responses in vitro and in vivo have led to improved understanding of tumor recognition by T cells. Yet, much remains to be learned about the intricate details of T cell – tumor cell interactions. Though the strength of interaction between T cell and target is thought to be a key factor influencing the T cell response, investigations of T cell avidity, T cell receptor (TCR) affinity for peptide-MHC complex, and the recognition of peptide on antigen presenting targets or tumor cells reveal complex relationships. Coincident with these investigations, therapeutic strategies have been developed to enhance tumor recognition using antigens with altered peptide structures and T cells modified by the introduction of new antigen binding receptor molecules. The profound effects of these strategies on T cell – tumor interactions and the clinical implications of these effects are of interest to both scientists and clinicians. In recent years, the focus of much of our work has been the avidity and effector characteristics of tumor reactive T cells. Here we review concepts and current results in the field, and the implications of therapeutic strategies using altered antigens and altered effector T cells

Pain Coping Skills Training for Patients Who Catastrophize About Pain Prior to Knee Arthroplasty: A Multisite Randomized Clinical Trial

BACKGROUND: Pain catastrophizing has been identified as a prognostic indicator of poor outcome following knee arthroplasty. Interventions to address pain catastrophizing, to our knowledge, have not been tested in patients undergoing knee arthroplasty. The purpose of this study was to determine whether pain coping skills training in persons with moderate to high pain catastrophizing undergoing knee arthroplasty improves outcomes 12 months postoperatively compared with usual care or arthritis education. METHODS: A multicenter, 3-arm, single-blinded, randomized comparative effectiveness trial was performed involving 5 university-based medical centers in the United States. There were 402 randomized participants. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain Scale, measured at baseline, 2 months, 6 months, and 12 months following the surgical procedure. RESULTS: Participants were recruited from January 2013 to June 2016. In 402 participants, 66% were women and the mean age of the participants (and standard deviation) was 63.2 ± 8.0 years. Three hundred and forty-six participants (90% of those who underwent a surgical procedure) completed a 12-month follow-up. All 3 treatment groups had large improvements in 12-month WOMAC pain scores with no significant differences (p > 0.05) among the 3 treatment arms. No differences were found between WOMAC pain scores at 12 months for the pain coping skills and arthritis education groups (adjusted mean difference, 0.3 [95% confidence interval (CI), -0.9 to 1.5]) or between the pain coping and usual-care groups (adjusted mean difference, 0.4 [95% CI, -0.7 to 1.5]). Secondary outcomes also showed no significant differences (p > 0.05) among the 3 groups. CONCLUSIONS: Among adults with pain catastrophizing undergoing knee arthroplasty, cognitive behaviorally based pain coping skills training did not confer pain or functional benefit beyond the large improvements achieved with usual surgical and postoperative care. Future research should develop interventions for the approximately 20% of patients undergoing knee arthroplasty who experience persistent function-limiting pain. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence

The Global Evolution of Giant Molecular Clouds II: The Role of Accretion

We present virial models for the global evolution of giant molecular clouds. Focusing on the presence of an accretion flow, and accounting for the amount of mass, momentum, and energy supplied by accretion and star formation feedback, we are able to follow the growth, evolution, and dispersal of individual giant molecular clouds. Our model clouds reproduce the scaling relations observed in both galactic and extragalactic clouds. We find that accretion and star formation contribute contribute roughly equal amounts of turbulent kinetic energy over the lifetime of the cloud. Clouds attain virial equilibrium and grow in such a way as to maintain roughly constant surface densities, with typical surface densities of order 50 - 200 Msun pc^-2, in good agreement with observations of giant molecular clouds in the Milky Way and nearby external galaxies. We find that as clouds grow, their velocity dispersion and radius must also increase, implying that the linewidth-size relation constitutes an age sequence. Lastly, we compare our models to observations of giant molecular clouds and associated young star clusters in the LMC and find good agreement between our model clouds and the observed relationship between H ii regions, young star clusters, and giant molecular clouds.Comment: 23 Pages, 9 Figures. Accepted to Ap

Analysis of lesion localisation at colonoscopy: outcomes from a multi-centre U.K. study

Background: Colonoscopy is currently the gold standard for detection of colorectal lesions, but may be limited in anatomically localising lesions. This audit aimed to determine the accuracy of colonoscopy lesion localisation, any subsequent changes in surgical management and any potentially influencing factors. Methods: Patients undergoing colonoscopy prior to elective curative surgery for colorectal lesion/s were included from 8 registered U.K. sites (2012–2014). Three sets of data were recorded: patient factors (age, sex, BMI, screener vs. symptomatic, previous abdominal surgery); colonoscopy factors (caecal intubation, scope guide used, colonoscopist accreditation) and imaging modality. Lesion localisation was standardised with intra-operative location taken as the gold standard. Changes to surgical management were recorded. Results: 364 cases were included; majority of lesions were colonic, solitary, malignant and in symptomatic referrals. 82% patients had their lesion/s correctly located at colonoscopy. Pre-operative CT visualised lesion/s in only 73% of cases with a reduction in screening patients (64 vs. 77%; p = 0.008). 5.2% incorrectly located cases at colonoscopy underwent altered surgical management, including conversion to open. Univariate analysis found colonoscopy accreditation, scope guide use, incomplete colonoscopy and previous abdominal surgery significantly influenced lesion localisation. On multi-variate analysis, caecal intubation and scope guide use remained significant (HR 0.35, 0.20–0.60 95% CI and 0.47; 0.25–0.88, respectively). Conclusion: Lesion localisation at colonoscopy is incorrect in 18% of cases leading to potentially significant surgical management alterations. As part of accreditation, colonoscopists need lesion localisation training and awareness of when inaccuracies can occur

The Dynamics of Radiation Pressure-Dominated HII Regions

We evaluate the role of radiation pressure in the dynamics of HII regions. We first determine under what conditions radiation pressure is significant in comparison to gas pressure and show that, while radiation pressure is generally unimportant for HII regions driven by a handful of massive stars, it is dominant for the larger HII regions produced by the massive star clusters found near the Galactic center and in starburst environments. We then provide a solution for the problem of how HII regions expand when radiation pressure influences their behavior. Finally, we compare radiation-dominated HII regions to other sources of stellar feedback, and argue that HII regions are probably the primary mechanism for regulating the formation of massive star clusters.Comment: 11 pages, 3 figures, emulateapj format, accepted to ApJ; minor arithmetic error in previous version correcte

Hydrodynamical simulations of the decay of high-speed molecular turbulence. I. Dense molecular regions

We present the results from three dimensional hydrodynamical simulations of decaying high-speed turbulence in dense molecular clouds. We compare our results, which include a detailed cooling function, molecular hydrogen chemistry and a limited C and O chemistry, to those previously obtained for decaying isothermal turbulence. After an initial phase of shock formation, power-law decay regimes are uncovered, as in the isothermal case. We find that the turbulence decays faster than in the isothermal case because the average Mach number remains higher, due to the radiative cooling. The total thermal energy, initially raised by the introduction of turbulence, decays only a little slower than the kinetic energy. We discover that molecule reformation, as the fast turbulence decays, is several times faster than that predicted for a non-turbulent medium. This is caused by moderate speed shocks which sweep through a large fraction of the volume, compressing the gas and dust. Through reformation, the molecular density and molecular column appear as complex patterns of filaments, clumps and some diffuse structure. In contrast, the molecular fraction has a wider distribution of highly distorted clumps and copious diffuse structure, so that density and molecular density are almost identically distributed during the reformation phase. We conclude that molecules form in swept-up clumps but effectively mix throughout via subsequent expansions and compressions.Comment: 12 pages, 12 figures; For a version of the article with higher resolution figures, see http://star.arm.ac.uk/preprints/381.p

The chronostratigraphy of Late Pleistocene glacial and periglacial aeolian activity in the Tuktoyaktuk Coastlands, NWT, Canada

Aeolian periglacial sand deposits are common in the Tuktoyaktuk Coastlands of Western Arctic Canada. Regionally extensive and thick aeolian sand-sheet deposits have been observed in two major stratigraphic settings: within a sand unit characterized by large aeolian dune deposits; and interbedded with glaciofluvial outwash from the Laurentide Ice Sheet (LIS). Small, localized sand sheets have also been observed along the tops of sandy bluffs, within sequences of drained thermokarst lakes deposits and as an involuted veneer above buried basal ice of the LIS. On the basis of radiocarbon and optically stimulated luminescence (OSL) dates from preserved periglacial aeolian sand sheets and dunes a regional chronostratigraphy is presented which indicates that both extensive dunes and sand sheets accumulated mainly between ca 30 and 13 ka. A switch to dominantly sand-sheet aggradation at ca 14–13 ka, with sand sheets forming widely until ca 8 ka, is attributed to (a) surface armouring by glacial deposits associated with the advance of the LIS; and (b) amelioration of the climate from cold aridity. An absence of OSL dates between ca 8 and 1 ka suggests that sand sheets stabilized during much of the Holocene. Local sand-sheet aggradation during recent centuries has occurred near sandy bluffs and on the floors of drained thermokarst lakes. The OSL dates constrain the maximum extent of the LIS in the Tuktoyaktuk Coastlands to Marine Isotope Stage 2

Kinetic Energy Decay Rates of Supersonic and Super-Alfvenic Turbulence in Star-Forming Clouds

We present numerical studies of compressible, decaying turbulence, with and without magnetic fields, with initial rms Alfven and Mach numbers ranging up to five, and apply the results to the question of the support of star-forming interstellar clouds of molecular gas. We find that, in 1D, magnetized turbulence actually decays faster than unmagnetized turbulence. In all the regimes that we have studied 3D turbulence-super-Alfvenic, supersonic, sub-Alfvenic, and subsonic-the kinetic energy decays as (t-t0)^(-x), with 0.85 < x < 1.2. We compared results from two entirely different algorithms in the unmagnetized case, and have performed extensive resolution studies in all cases, reaching resolutions of 256^3 zones or 350,000 particles. We conclude that the observed long lifetimes and supersonic motions in molecular clouds must be due to external driving, as undriven turbulence decays far too fast to explain the observations.Comment: Submitted to Phys. Rev. Letters, 29 Nov. 1997. 10 pages, 2 figures, also available from http://www.mpia-hd.mpg.de/theory/preprints.html#maclo