Molecular Hydrogen in the FUSE Translucent Lines of Sight: The Full Sample

We report total abundances and related parameters for the full sample of the FUSE survey of molecular hydrogen in 38 translucent lines of sight. New results are presented for the "second half" of the survey involving 15 lines of sight to supplement data for the first 23 lines of sight already published. We assess the correlations between molecular hydrogen and various extinction parameters in the full sample, which covers a broader range of conditions than the initial sample. In particular, we are now able to confirm that many, but not all, lines of sight with shallow far-UV extinction curves and large values of the total-to-selective extinction ratio, $R_V$ = $A_V$ / $E(B-V)$ -- characteristic of larger than average dust grains -- are associated with particularly low hydrogen molecular fractions ($f_{\rm H2}$). In the lines of sight with large $R_V$, there is in fact a wide range in molecular fractions, despite the expectation that the larger grains should lead to less H$_2$ formation. However, we see specific evidence that the molecular fractions in this sub-sample are inversely related to the estimated strength of the UV radiation field and thus the latter factor is more important in this regime. We have provided an update to previous values of the gas-to-dust ratio, $N$(H$_{\rm tot}$)/$E(B-V)$, based on direct measurements of $N$(H$_2$) and $N$(H I). Although our value is nearly identical to that found with Copernicus data, it extends the relationship by a factor of 2 in reddening. Finally, as the new lines of sight generally show low to moderate molecular fractions, we still find little evidence for single monolithic "translucent clouds" with $f_{\rm H2}$ $\sim$ 1.Comment: 35 pages, 5 tables, 7 figures, accepted for publication in The Astrophysical Journal Supplements Serie

High-Resolution Observations of Interstellar Ca I Absorption -- Implications for Depletions and Electron Densities in Diffuse Clouds

We present high-resolution (FWHM ~ 0.3-1.5 km/s) spectra of interstellar Ca I absorption toward 30 Galactic stars. Comparisons of the column densities of Ca I, Ca II, K I, and other species -- for individual components identified in the line profiles and also when integrated over entire lines of sight -- yield information on relative electron densities and depletions. There is no obvious relationship between the ratio N(Ca I)/N(Ca II) [equal to n_e/(Gamma/alpha_r) for photoionization equilibrium] and the fraction of hydrogen in molecular form f(H2) (often taken to be indicative of the local density n_H). For a smaller sample of sightlines for which the thermal pressure (n_H T) and local density can be estimated via analysis of the C I fine-structure excitation, the average electron density inferred from C, Na, and K (assuming photoionization equilibrium) seems to be independent of n_H and n_H T. While the n_e obtained from the ratio N(Ca I)/N(Ca II) is often significantly higher than the values derived from other elements, the patterns of relative n_e derived from different elements show both similarities and differences for different lines of sight -- suggesting that additional processes besides photoionization and radiative recombination commonly and significantly affect the ionization balance of heavy elements in diffuse IS clouds. Such additional processes may also contribute to the (apparently) larger than expected fractional ionizations (n_e/n_H) found for some lines of sight with independent determinations of n_H. In general, inclusion of ``grain-assisted'' recombination does reduce the inferred n_e, but it does not reconcile the n_e estimated from different elements. The depletion of calcium may have a much weaker dependence on density than was suggested by earlier comparisons with CH and CN.Comment: aastex, 70 pages, accepted to ApJ

An integrated model for developing research skills in an undergraduate medical curriculum:appraisal of an approach using student selected components

Student selected components (SSCs), at that time termed special study modules, were arguably the most innovative element in Tomorrow’s Doctors (1993), the document from the General Medical Council that initiated the modernization of medical curricula in the UK. SSCs were proposed to make up one-third of the medical curriculum and provide students with choice, whilst allowing individual schools autonomy in how SSCs were utilized. In response, at the University of Edinburgh the undergraduate medical curriculum provides an integrated and sequential development and assessment of research skill learning outcomes, for all students in the SSC programme. The curriculum contains SSCs which provide choice to students in all 5 years. There are four substantial timetabled SSCs where students develop research skills in a topic and speciality of their choice. These SSCs are fully integrated and mapped with core learning outcomes and assessment, particularly with the ‘Evidence-Based Medicine and Research’ programme theme. These research skills are developed incrementally and applied fully in a research project in the fourth year. One-third of students also perform an optional intercalated one-year honours programme between years 2 and 3, usually across a wide range of honours schools at the biomedical science interface. Student feedback is insightful and demonstrates perceived attainment of research competencies. The establishment of these competencies is discussed in the context of enabling junior graduate doctors to be effective and confident at utilizing their research skills to effectively practice evidence-based medicine. This includes examining their own practice through clinical audit, developing an insight into the complexity of the evidence base and uncertainty, and also gaining a view into a career as a clinical academic

Hematopoietic Cell Transplant and Use of Massage for Improved Symptom Management: Results from a Pilot Randomized Control Trial

Background. Pediatric hematopoietic cell transplant (HCT) is a lifesaving treatment that often results in physical and psychological discomfort. An acupressure-massage intervention may improve symptom management in this setting. Methods. This randomized controlled pilot trial compared a combined massage-acupressure intervention to usual care. Children were offered three practitioner-provided sessions per week throughout hospitalization. Parents were trained to provide additional acupressure as needed. Symptoms were assessed using nurses' reports and two questionnaires, the behavioral affective and somatic experiences scale and the Peds quality of life cancer module. Results. We enrolled 23 children, ages 5 to 18. Children receiving the intervention reported fewer days of mucositis (Hedges' g effect size ES = 0.63), lower overall symptom burden (ES = 0.26), feeling less tired and run-down (ES = 0.86), having fewer moderate/severe symptoms of pain, nausea, and fatigue (ES = 0.62), and less pain (ES = 0.42). The intervention group showed trends toward increasing contentness/serenity (ES = +0.50) and decreasing depression (ES = −0.45), but not decreased anxiety (ES = +0.42). Differences were not statistically significant. Discussion. Feasibility of studying massage-acupressure was established in children undergoing HCT. Larger studies are needed to test the efficacy of such interventions in reducing HCT-associated symptoms in children

Massage for Children Undergoing Hematopoietic Cell Transplantation: A Qualitative Report

Background. No in-depth qualitative research exists about the effects of therapeutic massage with children hospitalized to undergo hematopoietic cell transplantation (HCT). The objective of this study is to describe parent caregivers' experience of the effects of massage/acupressure for their children undergoing HCT. Methods. We conducted a qualitative analysis of open-ended interviews with 15 parents of children in the intervention arm of a massage/acupressure trial. Children received both practitioner and parent-provided massage/acupressure. Results. Parents reported that their child experienced relief from pain and nausea, relaxation, and greater ease falling asleep. They also reported increased caregiver competence and closeness with their child as a result of learning and performing massage/acupressure. Parents supported a semistandardized massage protocol. Conclusion. Massage/acupressure may support symptom relief and promote relaxation and sleep among pediatric HCT patients if administered with attention to individual patients' needs and hospital routines and may relieve stress among parents, improve caregiver competence, and enhance the sense of connection between parent and child

Low and High Ionization Absorption Properties of Mg II Absorption-Selected Galaxies at Intermediate Redshifts. I. General Properties

We present extensive metal-line absorption properties for 45 absorption systems that were selected by their Mg II absorption at redshifts between 0.4 and 1.4. For each system the properties of several chemical species are determined, including a wide range of ionization conditions. In the optical, the absorption systems have been observed at ~6 km/s resolution with HIRES/Keck, which covered Mg II, several Fe II transitions, Mg I, and in some cases (depending upon redshift), Ca II, Ti II, Mn II, and Al III. Ultraviolet, lower resolution (~230 km/s) Faint Object Spectrograph data (1600 - 3275 Ang) were obtained from the Hubble Space Telescope archive. These spectra covered Al II, Al III, Si II, Si III, Si IV, C II, C III, C IV, N V, O VI, and several Lyman series transitions, with coverage dependent upon the absorption system redshift. From these data, we infer that Mg II absorbing galaxies at intermediate redshifts have multiphase gaseous structures.Comment: Accepted: The Astrophysical Journa

Hematopoietic Cell Transplantation in Patients With Primary Immune Regulatory Disorders (PIRD): A Primary Immune Deficiency Treatment Consortium (PIDTC) Survey.

Primary Immune Regulatory Disorders (PIRD) are an expanding group of diseases caused by gene defects in several different immune pathways, such as regulatory T cell function. Patients with PIRD develop clinical manifestations associated with diminished and exaggerated immune responses. Management of these patients is complicated; oftentimes immunosuppressive therapies are insufficient, and patients may require hematopoietic cell transplant (HCT) for treatment. Analysis of HCT data in PIRD patients have previously focused on a single gene defect. This study surveyed transplanted patients with a phenotypic clinical picture consistent with PIRD treated in 33 Primary Immune Deficiency Treatment Consortium centers and European centers. Our data showed that PIRD patients often had immunodeficient and autoimmune features affecting multiple organ systems. Transplantation resulted in resolution of disease manifestations in more than half of the patients with an overall 5-years survival of 67%. This study, the first to encompass disorders across the PIRD spectrum, highlights the need for further research in PIRD management

Patient Preferences for Follow-up After Recent Excision of a Localized Melanoma

Importance The standard model of follow-up posttreatment of localized melanoma relies on clinician detection of recurrent or new melanoma, through routinely scheduled clinics (clinician-led surveillance). An alternative model is to increase reliance on patient detection of melanoma, with fewer scheduled visits and increased support for patients’ skin self-examination (SSE) (eg, using smartphone apps to instruct, prompt and record SSE, and facilitate teledermatology; patient-led surveillance). Objective To determine the proportion of adults treated for localized melanoma who prefer the standard scheduled visit frequency (as per Australian guideline recommendations) or fewer scheduled visits (adapted from the Melanoma Follow-up [MELFO] study of reduced follow-up). Design, Setting, and Participants This survey study used a telephone interview for surveillance following excision of localized melanoma at an Australian specialist center. We invited a random sample of 400 patients who had completed treatment for localized melanoma in 2014 to participate. They were asked about their preferences for scheduled follow-up, and experience of follow-up in the past 12 months. Those with a recurrent or new primary melanoma diagnosed by the time of interview (0.8-1.7 years since first diagnosis) were asked about how it was first detected and treated. SSE practices were also assessed. Main Outcomes and Measures Proportion preferring standard vs fewer scheduled clinic visits, median delay between detection and treatment of recurrent or new primary melanoma, and SSE practices. Results Of the 262 people who agreed to be interviewed, the mean (SD) age was 64.3 (14.3) years, and 93 (36%) were women. Among the 230 people who did not have a recurrent or new primary melanoma, 149 vs 81 preferred the standard vs fewer scheduled clinic visits option (70% vs 30% after adjusting for sampling frame). Factors independently associated with preferring fewer visits were a higher disease stage, melanoma on a limb, living with others, not having private health insurance, and seeing a specialist for another chronic condition. The median delay between first detection and treatment of recurrent or new primary melanoma was 7 and 3 weeks, respectively. Only 8% missed a scheduled visit, while 40% did not perform SSE or did so at greater than 3-month intervals. Conclusions and Relevance Some patients with melanoma may prefer fewer scheduled visits, if they are supported to do SSE and there is rapid clinical review of anything causing concern (patient-led surveillance)

Requirement of Bardet-Biedl syndrome proteins for leptin receptor signaling

Obesity is a major public health problem in most developed countries and a major risk factor for diabetes and cardiovascular disease. Emerging evidence indicates that ciliary dysfunction can contribute to human obesity but the underlying molecular and cellular mechanisms are unknown. Bardet-Biedl syndrome (BBS) is a genetically heterogeneous human obesity syndrome associated with ciliary dysfunction. BBS proteins are thought to play a role in cilia function and intracellular protein/vesicle trafficking. Here, we show that BBS proteins are required for leptin receptor (LepR) signaling in the hypothalamus. We found that Bbs2−/−, Bbs4−/− and Bbs6−/− mice are resistant to the action of leptin to reduce body weight and food intake regardless of serum leptin levels and obesity. In addition, activation of hypothalamic STAT3 by leptin is significantly decreased in Bbs2−/−, Bbs4−/− and Bbs6−/− mice. In contrast, downstream melanocortin receptor signaling is unaffected, indicating that LepR signaling is specifically impaired in Bbs2−/−, Bbs4−/− and Bbs6−/− mice. Impaired LepR signaling in BBS mice was associated with decreased Pomc gene expression. Furthermore, we found that BBS1 protein physically interacts with the LepR and that loss of BBS proteins perturbs LepR trafficking. Our data indicate that BBS proteins mediate LepR trafficking and that impaired LepR signaling underlies energy imbalance in BBS. These findings represent a novel mechanism for leptin resistance and obesity