Incorporating Reflective Writing into the Clerkship

During the last decade, medical schools have turned to writing exercises as a means for encouraging students to reflect on their learning experiences during clinical clerkships. The reasons for the increased popularity of reflective writing are broad. Approaches to encouraging reflective writing are quite varied. Recently, three internal medicine clerkships (University of Chicago Pritzker School of Medicine, University of Florida College of Medicine, and University of Massachusetts Medical School) independently implemented reflective writing activities in the clerkship curriculum

Improved Orbital Parameters And Transit Monitoring For HD 156846b

HD 156846b is a Jovian planet in a highly eccentric orbit (e = 0.85) with a period of 359.55 days. The pericenter passage at a distance of 0.16 AU is nearly aligned to our line of sight, offering an enhanced transit probability of 5.4% and a potentially rich probe of the dynamics of a cool planetary atmosphere impulsively heated during close approach to a bright star (V = 6.5). We present new radial velocity (RV) and photometric measurements of this star as part of the Transit Ephemeris Refinement and Monitoring Survey. The RV measurements from the Keck-High Resolution Echelle Spectrometer reduce the predicted transit time uncertainty to 20 minutes, an order of magnitude improvement over the ephemeris from the discovery paper. We photometrically monitored a predicted transit window under relatively poor photometric conditions, from which our non-detection does not rule out a transiting geometry. We also present photometry that demonstrates stability at the millimagnitude level over its rotational timescale

Host Star Properties And Transit Exclusion For The HD 38529 Planetary System

The transit signature of exoplanets provides an avenue through which characterization of exoplanetary properties may be undertaken, such as studies of mean density, structure, and atmospheric composition. The Transit Ephemeris Refinement and Monitoring Survey is a program to expand the catalog of transiting planets around bright host stars by refining the orbits of known planets discovered with the radial velocity technique. Here we present results for the HD 38529 system. We determine fundamental properties of the host star through direct interferometric measurements of the radius and through spectroscopic analysis. We provide new radial velocity measurements that are used to improve the Keplerian solution for the two known planets, and we find no evidence for a previously postulated third planet. We also present 12 years of precision robotic photometry of HD 38529 that demonstrate the inner planet does not transit and the host star exhibits cyclic variations in seasonal mean brightness with a timescale of approximately six years

Ten New and Updated Multi-planet Systems, and a Survey of Exoplanetary Systems

We present the latest velocities for 10 multi-planet systems, including a re-analysis of archival Keck and Lick data, resulting in improved velocities that supersede our previously published measurements. We derive updated orbital fits for ten Lick and Keck systems, including two systems (HD 11964, HD 183263) for which we provide confirmation of second planets only tentatively identified elsewhere, and two others (HD 187123, and HD 217107) for which we provide a major revision of the outer planet's orbit. We compile orbital elements from the literature to generate a catalog of the 28 published multiple-planet systems around stars within 200 pc. From this catalog we find several intriguing patterns emerging: - Including those systems with long-term radial velocity trends, at least 28% of known planetary systems appear to contain multiple planets. - Planets in multiple-planet systems have somewhat smaller eccentricities than single planets. - The distribution of orbital distances of planets in multi-planet systems and single planets are inconsistent: single-planet systems show a pile-up at P ~ 3 days and a jump near 1 AU, while multi-planet systems show a more uniform distribution in log-period. In addition, among all planetary systems we find: - There may be an emerging, positive correlation between stellar mass and giant-planet semi-major axis. - Exoplanets more massive than Jupiter have eccentricities broadly distributed across 0 < e < 0.5, while lower-mass exoplanets exhibit a distribution peaked near e = 0.Comment: ApJ accepted. v.2 makes minor corrections to author list, citations, and provides a stable set of orbital parameters for HD 183263 in Table 1. v.3 makes preprint consistent with ApJ version, minor changes to wording, orbital parameters of HD 217107 and HD 187123c in Table

Effectiveness of postoperative radiotherapy after radical cystectomy for locally advanced bladder cancer

BACKGROUND: Local-regional failure (LF) for locally advanced bladder cancer (LABC) after radical cystectomy (RC) is common even with chemotherapy and is associated with high morbidity/mortality. Postoperative radiotherapy (PORT) can reduce LF and may enhance overall survival (OS) but has no defined role. We hypothesized that the addition of PORT would improve OS in LABC in a large nationwide oncology database. METHODS: We identified ≥ pT3pN0-3M0 LABC patients in the National Cancer Database diagnosed 2004-2014 who underwent RC ± PORT. OS was calculated using Kaplan-Meier and Cox proportional hazards regression modeling was used to identify predictors of OS. Propensity matching was performed to match RC patients who received PORT vs those who did not. RESULTS: 15,124 RC patients were identified with 512 (3.3%) receiving PORT. Median OS was 20.0 months (95% CI, 18.2-21.8) for PORT vs 20.8 months (95% CI, 20.3-21.3) for no PORT (P = 0.178). In multivariable analysis, PORT was independently associated with improved OS: hazard ratio 0.87 (95% CI, 0.78-0.97); P = 0.008. A one-to-three propensity match yielded 1,858 patients (24.9% receiving PORT and 75.1% without). In the propensity-matched cohort, median OS was 19.8 months (95% CI, 18.0-21.6) for PORT vs 16.9 months (95% CI, 15.6-18.1) for no PORT (P = 0.030). In the propensity-matched cohort of urothelial carcinoma patients (N = 1,460), PORT was associated with improved OS for pT4, pN+, and positive margins (P \u3c 0.01 all). CONCLUSION: In this observational cohort, PORT was associated with improved OS in LABC. While the data should be interpreted cautiously, these results lend support to the use of PORT in selected patients with LABC, regardless of histology. Prospective trials of PORT are warranted

Acoustic Imaging Evaluation of Juvenile Salmonid Behavior in the Immediate Forebay of the Water Temperature Control Tower at Cougar Dam, 2010

This report presents the results of an evaluation of juvenile Chinook salmon (Oncorhynchus tshawytscha) behavior at Cougar Dam on the south fork of the McKenzie River in Oregon in 2010. The study was conducted by the Pacific Northwest National Laboratory for the U.S. Army Corps of Engineers (USACE). The overall goal of the study was to characterize juvenile salmonid behavior and movement patterns in the immediate forebay of the Water Temperature Control (WTC) tower of the dam for USACE and fisheries resource managers use in making decisions about bioengineering designs for long-term structures and/or operations to facilitate safe downstream passage for juvenile salmonids. We collected acoustic imaging (Dual-Frequency Identification Sonar; DIDSON) data from March 1, 2010, through January 31, 2011. Juvenile salmonids (hereafter, called 'fish') were present in the immediate forebay of the WTC tower throughout the study. Fish abundance index was low in early spring (&lt;200 fish per sample-day), increased in late April, and peaked on May 19 (6,039 fish). A second peak was observed on June 6 (2904 fish). Fish abundance index decreased in early June and remained low in the summer months (&lt;100 fish per sample-day). During the fall and winter, fish numbers varied with a peak on November 10 (1881 fish) and a minimum on December 7 (12 fish). A second, smaller, peak occurred on December 22 (607 fish). A univariate statistical analysis indicated fish abundance index (log10-transformed) was significantly (P&lt;0.05) positively correlated with forebay elevation, velocity over the WTC tower intake gate weirs, and river flows into the reservoir. A subsequent multiple regression analysis resulted in a model (R2=0.70) predicting fish abundance (log-transformed index values) using two independent variables of mean forebay elevation and the log10 of the forebay elevation range. From the approximate fish length measurements made using the DIDSON imaging software, the average fish length during early spring 2010 was 214 {+-} 86 mm (standard deviation). From May through early November, the average fish length remained relatively consistent (132 {+-} 54 mm), after which average lengths increased to 295 {+-} 148 mm for mid-November though early December. From mid-December through January the average fish length decreased to 151 {+-} 76 mm. Milling in front of the WTC tower was the most common fish behavior observed throughout the study period. Traversing along the front of the tower, east-to-west and west-to-east, was the next common behavior. The percentage of fish events showing movement from the forebay to the tower or from the tower to the forebay was generally low throughout the spring, summer, and early fall (0 to 30% for both directions combined, March through early November). From mid-November 2010 through the end of the study (January 31, 2011), the combined percentages of fish moving into and out of the tower were higher (25 to 70%) than during previous months of the study. Schooling behavior was most distinct in the spring. Schooling events were present in 30 to 96% of the fish events during that period, with a peak on May 19. Schooling events were also present in the summer, but at lower numbers. With the exception of some schooling in mid-December, few to no schooling events were observed in the fall and winter months. Diel distributions for schooling fish during spring and fall months indicate schooling was concentrated during daylight hours and no schooling was observed at night. However, in December, schooling occurred at night, after midnight, and during daylight hours. Predator activity, most likely bull trout or rainbow trout according to a USACE biologist, was observed during late spring, when fish abundance index and schooling were highest for the year, and again in the fall months when fish events increased from a summer low. No predator activity was observed in the summer, and little activity occurred during the winter months

Re-Analysis of Hydroacoustic Fish-Passage Data from Bonneville Dam after Spill-Discharge Corrections

The U.S. Army Corps of Engineers - Portland District asked Pacific Northwest National Laboratory to re-analyze four years of fixed-aspect hydroacoustic data after the District made adjustments to spill discharge estimates. In this report, we present new estimates of all major fish-passage metrics for study years 2000, 2001, 2002, and 2004, as well as estimates for 2005. This study supports the Portland District and its effort to maximize survival of juvenile salmon passing Bonneville Dam. Major passage routes through Bonneville Dam include 10 turbines and a sluiceway at Powerhouse 1 (B1), an 18-bay spillway, and eight turbines at Powerhouse 2 (B2) and a sluiceway including the B2 Corner Collector. The original reports and all associated results, discussion, and conclusions for non flow-related metrics remain valid and useful, but effectiveness measures for study years 2000, 2001, 2002, and 2004 as reported in previous reports by Ploskey et al. should be superseded with the new estimates reported here. The fish-passage metrics that changed the most were related to effectiveness. Re-analysis produced spill effectiveness estimates that ranged from 12% to 21% higher than previous estimates in spring and 16.7% to 27.5% higher in summer, but the mean spill effectiveness over all years was only slightly above 1:1 (1.17 for spring and 1.29 for summer). Conversely surface-passage effectiveness decreased in the years this metric was measured (by 10.1% in spring and 10.7% in summer of 2002 and 9.5% in spring and 10.2% in summer of 2004). The smallest changes in the re-analysis were in project fish passage efficiency (0%-1%) and spill efficiency (0.9%-3.0%)

Functional regulation of the DNA damage-recognition factor DDB2 by ubiquitination and interaction with xeroderma pigmentosum group C protein

In mammalian nucleotide excision repair, the DDB1-DDB2 complex recognizes UV-induced DNA photolesions and facilitates recruitment of the XPC complex. Upon binding to damaged DNA, the Cullin 4 ubiquitin ligase associated with DDB1-DDB2 is activated and ubiquitinates DDB2 and XPC. The structurally disordered N-terminal tail of DDB2 contains seven lysines identified as major sites for ubiquitination that target the protein for proteasomal degradation; however, the precise biological functions of these modifications remained unknown. By exogenous expression of mutant DDB2 proteins in normal human fibroblasts, here we show that the N-terminal tail of DDB2 is involved in regulation of cellular responses to UV. By striking contrast with behaviors of exogenous DDB2, the endogenous DDB2 protein was stabilized even after UV irradiation as a function of the XPC expression level. Furthermore, XPC competitively suppressed ubiquitination of DDB2 in vitro, and this effect was significantly promoted by centrin-2, which augments the DNA damage-recognition activity of XPC. Based on these findings, we propose that in cells exposed to UV, DDB2 is protected by XPC from ubiquitination and degradation in a stochastic manner; thus XPC allows DDB2 to initiate multiple rounds of repair events, thereby contributing to the persistence of cellular DNA repair capacit