Intensive medical student involvement in short-term surgical trips provides safe and effective patient care: a case review

<p>Abstract</p> <p>Background</p> <p>The hierarchical nature of medical education has been thought necessary for the safe care of patients. In this setting, medical students in particular have limited opportunities for experiential learning. We report on a student-faculty collaboration that has successfully operated an annual, short-term surgical intervention in Haiti for the last three years. Medical students were responsible for logistics and were overseen by faculty members for patient care. Substantial planning with local partners ensured that trip activities supplemented existing surgical services. A case review was performed hypothesizing that such trips could provide effective surgical care while also providing a suitable educational experience.</p> <p>Findings</p> <p>Over three week-long trips, 64 cases were performed without any reported complications, and no immediate perioperative morbidity or mortality. A plurality of cases were complex urological procedures that required surgical skills that were locally unavailable (43%). Surgical productivity was twice that of comparable peer institutions in the region. Student roles in patient care were greatly expanded in comparison to those at U.S. academic medical centers and appropriate supervision was maintained.</p> <p>Discussion</p> <p>This demonstration project suggests that a properly designed surgical trip model can effectively balance the surgical needs of the community with an opportunity to expose young trainees to a clinical and cross-cultural experience rarely provided at this early stage of medical education. Few formalized programs currently exist although the experience above suggests the rewarding potential for broad-based adoption.</p

Identification of carbon dioxide in an exoplanet atmosphere

Carbon dioxide (CO2) is a key chemical species that is found in a wide range of planetary atmospheres. In the context of exoplanets, CO2 is an indicator of the metal enrichment (that is, elements heavier than helium, also called ‘metallicity’)1–3, and thus the formation processes of the primary atmospheres of hot gas giants4–6. It is also one of the most promising species to detect in the secondary atmospheres of terrestrial exoplanets7–9. Previous photometric measurements of transiting planets with the Spitzer Space Telescope have given hints of the presence of CO2, but have not yielded definitive detections owing to the lack of unambiguous spectroscopic identification10–12. Here we present the detection of CO2 in the atmosphere of the gas giant exoplanet WASP-39b from transmission spectroscopy observations obtained with JWST as part of the Early Release Science programme13,14. The data used in this study span 3.0–5.5 micrometres in wavelength and show a prominent CO2 absorption feature at 4.3 micrometres (26-sigma significance). The overall spectrum is well matched by one-dimensional, ten-times solar metallicity models that assume radiative–convective–thermochemical equilibrium and have moderate cloud opacity. These models predict that the atmosphere should have water, carbon monoxide and hydrogen sulfide in addition to CO2, but little methane. Furthermore, we also tentatively detect a small absorption feature near 4.0 micrometres that is not reproduced by these models

The transiting exoplanet community early release science program for JWST

The James Webb Space Telescope (JWST) presents the opportunity to transform our understanding of planets and the origins of life by revealing the atmospheric compositions, structures, and dynamics of transiting exoplanets in unprecedented detail. However, the high-precision, time-series observations required for such investigations have unique technical challenges, and prior experience with other facilities indicates that there will be a steep learning curve when JWST becomes operational. In this paper we describe the science objectives and detailed plans of the Transiting Exoplanet Community Early Release Science (ERS) Program, which is a recently approved program for JWST observations early in Cycle 1. The goal of this project, for which the obtained data will have no exclusive access period, is to accelerate the acquisition and diffusion of technical expertise for transiting exoplanet observations with JWST, while also providing a compelling set of representative datasets that will enable immediate scientific breakthroughs. The Transiting Exoplanet Community ERS Program will exercise the time-series modes of all four JWST instruments that have been identified as the consensus highest priorities, observe the full suite of transiting planet characterization geometries (transits, eclipses, and phase curves), and target planets with host stars that span an illustrative range of brightnesses. The observations in this program were defined through an inclusive and transparent process that had participation from JWST instrument experts and international leaders in transiting exoplanet studies. Community engagement in the project will be centered on a two-phase Data Challenge that culminates with the delivery of planetary spectra, time-series instrument performance reports, and open-source data analysis toolkits in time to inform the agenda for Cycle 2 of the JWST mission

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)1.

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field

Early Release Science of the exoplanetWASP-39b with JWST NIRISS

This is the author accepted manuscript. The final version is available from Nature Research via the DOI in this recordData Availability: The raw data from this study are publicly available via the Space Science Telescope Institute's Mikulski Archive for Space Telescopes (https://archive.stsci.edu/). The data which was used to create all of the figures in this manuscript are freely available on Zenodo and GitHub (Zenodo Link;https://github.com/afeinstein20/wasp39b_niriss_paper). All additional data is available upon request.Code Availability: The following are open-source pipelines written in Python that are available either through the Python Package Index (PyPI) or GitHub that were used throughout this work: Eureka! (https://github.com/kevin218/Eureka); nirHiss (https://github.com/afeinstein20/nirhiss); supreme-SPOON (https://github.com/radicamc/supreme-spoon); transitspectroscopy (https://github.com/nespinoza/transitspectroscopy/tree/dev); iraclis (https://github.com/uclexoplanets/Iraclis); juliet (https://github.com/nespinoza/juliet); chromatic (https://github.com/zkbt/chromatic); chromatic_fitting (https://github.com/catrionamurray/chromatic_fitting); ExoTiC-LD54, 121 (https://github.com/Exo-TiC/ExoTiC-LD); ExoTETHyS122 (https://github.com/uclexoplanets/ExoTETHyS); PICASO88,89 (https://github.com/natashabatalha/picaso); Virga94, 95 (https://github.com/natashabatalha/virga); CHIMERA (https://github.com/mrline/CHIMERA); PyMultiNest (https://github.com/JohannesBuchner/PyMultiNest); MultiNest (https://github.com/JohannesBuchner/MultiNest)The Saturn-mass exoplanet WASP-39b has been the subject of extensive efforts to determine its atmospheric properties using transmission spectroscopy. However, these efforts have been hampered by modelling degeneracies between composition and cloud properties that are caused by limited data quality. Here, we present the transmission spectrum of WASP-39 b obtained using the SOSS mode of the NIRISS instrument on JWST. This spectrum spans 0.6–2.8m in wavelength and reveals multiple water absorption bands, the potassium resonance doublet, and signatures of clouds. The precision and broad wavelength coverage of NIRISS-SOSS allows us to break model degeneracies between cloud properties and the atmospheric composition of WASP-39b, favouring a heavy element enhancement (“metallicity”) of ~10–30x the solar value, a sub-solar carbon-to-oxygen (C/O) ratio, and a solar-to-super-solar potassium-to-oxygen (K/O) ratio. The observations are also best explained by wavelength-dependent, non-gray clouds with inhomogeneous coverage of the planet’s terminator.Leverhulme TrustUK Research and Innovatio

Early Release Science of the exoplanet WASP-39b with JWST NIRSpec G395H

This is the author accepted manuscript. The final version is available from Nature Research via the DOI in this recordData Availability: The data used in this paper are associated with JWST program ERS 1366 (observation #4) and are available from the Mikulski Archive for Space Telescopes (https://mast.stsci.edu). Science data processing version (SDP_VER) 2022_2a generated the uncalibrated data that we downloaded from MAST. We used JWST Calibration Pipeline software version (CAL_VER) 1.5.3 with modifications described in the text. We used calibration reference data from context (CRDS_CTX) 0916, except as noted in the text. All the data and models presented in this publication can be found at 10.5281/zenodo.7185300.Code Availability: The codes used in this publication to extract, reduce and analyze the data are as follows; STScI JWST Calibration pipeline45 (https://github.com/spacetelescope/jwst), Eureka!53 (https://eurekadocs.readthedocs.io/en/latest/), ExoTiC-JEDI47 (https://github.com/ExoTiC/ExoTiC-JEDI), juliet71 (https://juliet.readthedocs.io/en/latest/), Tiberius15,49,50, transitspectroscopy51 (https://github.com/nespinoza/transitspectroscopy). In addition, these made use of batman65 (http://lkreidberg.github.io/batman/docs/html/index.html), celerite86 (https://celerite.readthedocs.io/en/stable/), chromatic (https://zkbt.github.io/chromatic/), Dynesty72 (https://dynesty.readthedocs.io/en/stable/index.html), emcee69 (https://emcee.readthedocs.io/en/stable/), exoplanet83 (https://docs.exoplanet.codes/en/latest/), ExoTEP75–77, ExoTHETyS79 (https://github.com/ucl-exoplanets/ExoTETHyS), ExoTiCISM57 (https://github.com/Exo-TiC/ExoTiC-ISM), ExoTiC-LD58 (https://exoticld.readthedocs.io/en/latest/), george68 (https://george.readthedocs.io/en/latest/) JAX82 (https://jax.readthedocs.io/en/latest/), LMFIT70 (https://lmfit.github.io/lmfit-py/), Pylightcurve78 (https://github.com/ucl-exoplanets/pylightcurve), Pymc3138 (https://docs.pymc.io/en/v3/index.html) and Starry84 (https://starry.readthedocs.io/en/latest/), each of which use the standard python libraries astropy139,140, matplotlib141, numpy142, pandas143, scipy64 and xarray144. The atmospheric models used to fit the data can be found at ATMO[Tremblin2015,Drummond2016,Goyal2018,Goyal2020]88–91, PHOENIX92–94, PICASO98,99 (https://natashabatalha.github.io/picaso/), Virga98,107 (https://natashabatalha.github.io/virga/), and gCMCRT115 (https://github.com/ELeeAstro/gCMCRT).Measuring the abundances of carbon and oxygen in exoplanet atmospheres is considered a crucial avenue for unlocking the formation and evolution of exoplanetary systems. Access to an exoplanet’s chemical inventory requires high precision observations, often inferred from individual molecular detections with low-resolution space-based and high-resolution ground-based facilities. Here we report the medium-resolution (R≈600) transmission spectrum of an exoplanet atmosphere between 3–5 μm covering multiple absorption features for the Saturn-mass exoplanet WASP-39b, obtained with JWST NIRSpec G395H. Our observations achieve 1.46× photon precision, providing an average transit depth uncertainty of 221 ppm per spectroscopic bin, and present minimal impacts from systematic effects. We detect significant absorption from CO2 (28.5σ ) and H2O (21.5σ ), and identify SO2 as the source of absorption at 4.1 μ m (4.8σ ). Best-fit atmospheric models range between 3× and 10× solar metallicity, with sub-solar to solar C/O ratios. These results, including the detection of SO2, underscore the importance of characterising the chemistry in exoplanet atmospheres, and showcase NIRSpec G395H as an excellent mode for time series observations over this critical wavelength range.Science and Technology Facilities Council (STFC)UKR

Análisis de las Estrategias Metodológicas implementadas por el docente en el desarrollo del proceso de enseñanza- aprendizaje en la disciplina de Geografía e Historia de Nicaragua y su Didáctica en los alumnos/as de Primer año “B” del turno regular de Formación Inicial Docente en la Escuela Normal Central de Managua Alesio Blandón Juárez durante el I semestre del Curso Escolar 2016

El presente trabajo de investigación tiene como finalidad analizar la efectividad que tienen las Estrategias Metodológicas implementadas por el docente en el desarrollo del proceso de enseñanza- aprendizaje en la disciplina de Geografía de Nicaragua y su Didáctica en los alumnos/as de Primer año “B” del turno regular de Formación Inicial Docente en la Escuela Normal Central de Managua Alesio Blandón Juárez durante el I semestre del Curso Escolar 2016. Dicho trabajo de investigación tiene un enfoque naturista o cualitativo, es una vía de transformación social, a través de la cual el ser humano descubre la realidad que le rodea, determina los medios y procedimientos para actuar sobre ella y transformarla de acuerdo a una intensión social. Los procesos de investigación cualitativa, tienen como finalidad primordial la generación y construcción de conocimientos que contribuyen al desarrollo social y personal de cada uno de los miembros de una comunidad. La fase de recolección de los datos de la investigación desarrollada, se realizó de dos formas: una información que se recogió mediante la observación directa del comportamiento de los informantes claves y una información que se obtuvo mediante la interrogación de algunos informantes claves. Para ello, primeramente el investigador realizo una inmersión en el campo de trabajo, con el propósito de identificar los lugares adecuados para recoger y producir la información necesaria y requerid