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We report the detection of ammonia masers in the non-metastable (6, 3), (7, 5) and (6, 5) transitions, the latter is the first unambiguous maser detection of that transition ever made. Our observations include the first VLBI detection of ammonia maser emission, which allowed effective constrain of the (6, 5) maser brightness temperature. The masers were detected towards G358.931-0.030, a site of 6.7-GHz class~II methanol maser emission that was recently reported to be undergoing a period of flaring activity. These ammonia masers appear to be flaring contemporaneously with the class~II methanol masers during the accretion burst event of G358.931-0.030. This newly detected site of ammonia maser emission is only the twelfth such site discovered in the Milky Way. We also report the results of an investigation into the maser pumping conditions, for all three detected masing transitions, through radiative transfer calculations constrained by our observational data. These calculations support the hypothesis that the ammonia (6, 5) maser transition is excited through high colour temperature infrared emission, with the (6, 5) and (7, 5) transition line-ratio implying dust temperatures >400K. Additionally, we detect significant linearly polarised emission from the ammonia (6, 3) maser line. Alongside our observational and radiative transfer calculation results, we also report newly derived rest frequencies for the ammonia (6, 3) and (6, 5) transitions., Accepted into MNRAS 2023 April 24. 13 pages, 5 figures, 3 tables

High-mass protostars (M$_{\star} >$ 8 M$_{\odot}$) are thought to gain the majority of their mass via short, intense bursts of growth. This episodic accretion is thought to be facilitated by gravitationally unstable and subsequently inhomogeneous accretion disks. Limitations of observational capabilities, paired with a lack of observed accretion burst events has withheld affirmative confirmation of the association between disk accretion, instability and the accretion burst phenomenon in high-mass protostars. Following its 2019 accretion burst, a heat-wave driven by a burst of radiation propagated outward from the high-mass protostar G358.93-0.03-MM1. Six VLBI (very long baseline interferometry) observations of the raditively pumped 6.7 GHz methanol maser were conducted during this period, tracing ever increasing disk radii as the heat-wave propagated outward. Concatenating the VLBI maps provided a sparsely sampled, milliarcsecond view of the spatio-kinematics of the accretion disk covering a physical range of $\sim$ 50 - 900 AU. We term this observational approach `heat-wave mapping'. We report the discovery of a Keplerian accretion disk with a spatially resolved four-arm spiral pattern around G358.93-0.03-MM1. This result positively implicates disk accretion and spiral arm instabilities into the episodic accretion high-mass star formation paradigm., Published in Nature Astronomy in 2023

A new tool to identify possible Zeeman pairs is presented here: the right circularly polarized (RCP) and left circularly polarized (LCP) components of a pair with velocity drift at the same rate. Long-term monitoring of hydroxyl transitions towards NGC 6334I-MM3 has resulted in the identification of three possible Zeeman pairs, one each at the 1.667, 6.030, and 6.035 GHz transitions, where the rate of drift of the RCP feature equals that of the LCP component. Historical observations suggest that their drift has been occurring over 40 yr. A fourth pair in the 1.720 GHz OH transition may indicate magnetic field variation over 50 yr.

We examine the long-term history of the optical spectrum of the extremely variable Active Galactic Nucleus (AGN) MKN 110. By combining various archival data with new data, we cover an unprecedented long period of $\sim$30 years (1987 - 2019). We find that the He II $\lambda 4686$ emission line changes by a factor of forty and varies more strongly than the optical continuum. Following Ferland et al. (2020), we take He II $\lambda 4686$ as a proxy for the FUV continuum and compare the flux of several other line species against it. This comparison reveals a clear pattern, whereby lines respond close to linearly at low FUV fluxes, and saturate at high FUV fluxes. The saturation level of the response appears to depend on the excitation energy of the line species. In addition to this global pattern, we note changes among observational epochs, indicating a structural evolution in the broad line region (BLR). The line profiles in our spectra show an offset between the narrow and broad components of the He II $\lambda 4686$ and H$\beta$ lines. This offset shows a significant negative correlation with the FUV flux and a positive correlation with the line velocity width. Our analysis reveals a complex BLR response to a changing continuum. The clear presence of a non-responsive component of the broad lines indicates the existence of multiple contributions to the line emission. We find there are several kinematic models of the BLR and inner regions of the AGN that match our data., Comment: 19 pages, 11 figures, 6 tables

Figure S1: HMC1.2 cell line has constitutively actived NFAT2, NFAT2 and NFAT4 species; Figure S2: RT-PCR of transcripts modulated by 24 hour treatment with CSA; Figure S3: CNPIs do not modulate KIT signaling and KIT inhibitors do not affect NFAT localization; Figure S4: Combination therapy does not enhance the effect of KIT inhibitors on KIT or downstream signaling; Table S1: Summary of KIT-mutant mast cell characteristics; Table S2: Summary of antibodies used in immunoblotting experiments; Table S3: qRT-PCR analysis of NFAT expression in KIT-mutant mast cell lines.

Resistant KIT mutations have hindered the development of KIT kinase inhibitors for treatment of patients with systemic mastocytosis. The goal of this research was to characterize the synergistic effects of a novel combination therapy involving inhibition of KIT and calcineurin phosphatase, a nuclear factor of activated T cells (NFAT) regulator, using a panel of KIT-mutant mast cell lines. The effects of monotherapy or combination therapy on the cellular viability/survival of KIT-mutant mast cells were evaluated. In addition, NFAT-dependent transcriptional activity was monitored in a representative cell line to evaluate the mechanisms responsible for the efficacy of combination therapy. Finally, shRNA was used to stably knockdown calcineurin expression to confirm the role of calcineurin in the observed synergy. The combination of a KIT inhibitor and a calcineurin phosphatase inhibitor (CNPI) synergized to reduce cell viability and induce apoptosis in six distinct KIT-mutant mast cell lines. Both KIT inhibitors and CNPIs were found to decrease NFAT-dependent transcriptional activity. NFAT-specific inhibitors induced similar synergistic apoptosis induction as CNPIs when combined with a KIT inhibitor. Notably, NFAT was constitutively active in each KIT-mutant cell line tested. Knockdown of calcineurin subunit PPP3R1 sensitized cells to KIT inhibition and increased NFAT phosphorylation and cytoplasmic localization. Constitutive activation of NFAT appears to represent a novel and targetable characteristic of KIT-mutant mast cell disease. Our studies suggest that combining KIT inhibition with NFAT inhibition might represent a new treatment strategy for mast cell disease. Mol Cancer Ther; 13(12); 2840–51. ©2014 AACR.

Figure and table legends for supplemental figures 1-4 and supplemental tables 1-3.

High-mass stars are thought to accumulate much of their mass via short, infrequent bursts of disk-aided accretion. Such accretion events are rare and difficult to observe directly but are known to drive enhanced maser emission. In this Letter we report high-resolution, multi-epoch methanol maser observations toward G358.93-0.03 which reveal an interesting phenomenon; the sub-luminal propagation of a thermal radiation "heat-wave" emanating from an accreting high-mass proto-star. The extreme transformation of the maser emission implies a sudden intensification of thermal infrared radiation from within the inner (40 mas, 270 au) region. Subsequently, methanol masers trace the radial passage of thermal radiation through the environment at $\geq$ 4-8\% the speed of light. Such a high translocation rate contrasts with the $\leq$ 10 km s$^{-1}$ physical gas motions of methanol masers typically observed using very long baseline interferometry (VLBI). The observed scenario can readily be attributed to an accretion event in the high-mass proto-star G358.93-0.03-MM1. While being the third case in its class, G358.93-0.03-MM1 exhibits unique attributes hinting at a possible `zoo' of accretion burst types. These results promote the advantages of maser observations in understanding high-mass star formation, both through single-dish maser monitoring campaigns and via their international cooperation as VLBI arrays., Comment: Published in Nature Astronomy in 2020

We report the results of ongoing monitoring of the 6.7 GHz CH$_3$OH masers associated with G188.95+0.89. In these observations five features are periodically varying and at least two exhibit evidence of velocity drifts. It is not clear the cause of these velocity drifts. The spectra have varied significantly since detection in 1991. The 11.45 km s$^1$ feature has decreased exponentially from 2003. Complementary ALMA 1.3 mm continuum and line observational results are also presented. Eight continuum cores (MM1 - MM8) were detected in G188.95+0.89. We derived the masses of the detected cores. G188.95+0.89 MM2 was resolved into 2 continuum cores (separated by 0.1 arcsec) in ALMA band 7 observations. Also CH$_3$OH (4$_{(2,2)}$-3$_{(1,2)})$ thermal emission associated with MM2 is double peaked. We propose the presence of multiple (at least binary) young stellar objects in MM2. SiO emission exhibit a bow-shock morphology in MM2 while strong emission of $^{12}$CO at the east and west of MM2 suggest the presence of an east-west bipolar outflow., 6 pages, 11 figures

Introduction:Our urology residency program transitioned to a night float system, where dedicated residents cover nights and are off duty during the day. Junior residents previously covered ...

Seaweed cultivation is gaining interest world-wide for both food and non-food applications. Global seaweed aquaculture production currently exceeds 32 Mt WW per annum but is dominated (86% of total) by Asian countries. To meet future demand for seaweed products, regions beyond Asia with aquaculture production potential are being explored. The goal of this study was to assess the suitability of the native kelp Macrocystis pyrifera (Phaeophyceae, Laminariales), for aquaculture in Tasmania, south-eastern Australia. M. pyrifera was cultivated on seeded twine on loops (1 – 5 m depth) along 100-m longlines at two sites (Okehampton Bay and Great Taylor Bay) from April-November 2020. Temporal and spatial variability in (1) yield (kg m-1, WW), (2) biofouling (% coverage), and (3) biochemical composition (including proximate composition, fatty acids, dietary minerals, heavy metal profiling, C, N, H, S concentrations and C:N ratio, antioxidants (phenolic compounds), and pigments (Chl-a, Chl-c, fucoxanthin)) was compared amongst the two cultivation sites, at two depths (1 and 5 m) from harvests between July – November 2020. Yield (kg m-1, WW) did not significantly change across harvest times, but was greater at a depth of 1 m compared to 5 m. Biofouling on the kelp blades increased significantly in early spring (September). The biochemical composition of the cultured biomass varied over time, between sites and with depth for most of the compounds analysed. Higher lipid, protein and ash content was reported for cultures cultivated at Okehampton Bay compared to Great Taylor Bay and at 5 m compared to 1 m depth, and levels of these macronutrients decreased during the harvest period. The iodine content was slightly above the tolerable content for dried seaweed products in Australia and New Zealand. The combined results of yield, biofouling, and biochemical composition suggest that, for an April deployment at the sites investigated, M. pyrifera should be harvested in July-August (mid to late winter) to optimise yield and quality of the cultured kelp biomass. These findings provide a better understanding of the variation in growth and quality of cultivated M. pyrifera biomass in the region, and inform future management and development of kelp aquaculture in south-eastern Australia and in a global context.

The first confirmed periodically varying 6.031 and 6.035 GHz hydroxyl masers are reported here. They vary contemporaneously with the 6.7 GHz methanol masers in G323.459–0.079. The 1.665 GHz hydroxyl and 12.2 GHz methanol masers associated with G323.459–0.079 are also periodic. Evidence for periodicity is seen in all features in all transitions save a single 1.665 GHz hydroxyl maser feature. Historical excited-state hydroxyl maser observations set a stricter upper limit on the epoch in which a significant accretion event occurred. The associated burst in 6.7 GHz methanol maser activity has subsided significantly while the hydroxyl transitions are brightening possibly the result of changing physical conditions in the masing cloudlets. Time lags in methanol are confirmed and may be the result of the periodic flaring propagating outward from the central region of maser activity. A possible magnetic field reversal occurred during the accretion event.

The source G9.62+0.20E surprises again! Several of the associated 6.7- and 12.2-GHz methanol masers are experiencing contemporaneous and systematic velocity drifts. Both 6.7- and 12.2-GHz methanol features blueward of v = +1.2 km s−1 are blue shifting while those redward are red shifting. A best-fitting rotating Keplerian disc with a central mass of ∼12 M⊙, radii Rinner = 5 au and Router = 5000 au, and at an inclination angle of 22○ either precessing and/or experiencing infall explains these systematic velocity drifts. Also three more distinct 6.7-GHz methanol maser features are found to vary periodically; two very weak and one obviously periodic only after 2003. Evidence of periodicity is seen as early as 1992. Time lags are confirmed but the cause is unclear. It is possible this source will surprise again.

Objective:The Cognition Battery of the National Institute of Health (NIH) Toolbox for Assessment of Neurological and Behavioural Function is a computerised neuropsychological battery recommended for clinical practice, neurological research and clinical trials. We investigated the utility of the NIH Toolbox Cognition Battery (NIHTB-CB) for people with concussion.Methods:In this small qualitative study, semi-structured interviews were conducted with five adults with concussion who were participating in a larger study using the NIHTB-CB. Three clinician participants and two cultural advisors familiar with the tool were also interviewed. Interview transcripts were analysed using a general thematic approach and qualitative description.Results:Participants described both positive and negative experiences with the NIHTB-CB and using qualitative description, their experiences were organised into three broad themes: (1) using technology for cognitive testing made sense, (2) there were some cultural relevance questions and (3) cognitive testing after concussion could have challenges. They were positive about the computerised format and range of domains assessed for the concussion context but identified the contextual relevance of some content as having potential to impact on performances.Conclusion:This was a small study examining the experiences of a select group of participants, but nevertheless does suggest a need for future research validating the NIHTB-CB for use in different cultural and clinical contexts.

There are multiple indications for luminal imaging of the colon. From assessment of known disease, to diagnosing new pathology; intra-luminal visualisation is the mainstay of gastrointestinal diagnosis. Colonoscopy and radiological imaging are currently the most frequently deployed diagnostic methods. However, both have an associated risk profile, have significant resource pressures and are not universally tolerated. Colon capsule endoscopy (CCE) offers an adjunct to these diagnostic options. In this narrative review the utility of CCE is described. Its current uses, potential benefits and future developments are also discussed.

Numerical simulations have predicted that substructures such as spiral arms can be produced through a gravitationally unstable disk around high-mass young stellar objects (HMYSOs). Recent high-resolution observations from the Atacama Large Millimeter/submillimeter Array have investigated these substructures at a spatial resolution of ∼100 au. An accretion burst, which is a manifestation of an increase in the accretion rate caused by a gravitational instability in the disk, can result in luminosity outbursting phenomena - as has been seen in several HMYSOs. However, no clear relationship between the accretion bursts and disk substructures has been established. Here we report the detections of three new molecular maser species, HDO, HNCO and 13CH3OH, from the direction of the HMYSO G358.93-0.03 during a 6.7 GHz methanol maser flaring event. High-quality imaging of the three new maser species exhibits consistent observational evidence that these masers closely trace the spiral-arm substructures around this HMYSO. The rapid decay of the spectral lines emitted from these molecules suggests that these are transient phenomena (for only ∼1 month), probably associated with rapid changes in radiation field due to an accretion burst. Therefore, these new maser species provide evidence linking the spiral-arm substructure with an accretion burst, both expected from massive disk instabilities.

Background Multiparametric magnetic resonance imaging (mpMRI) may improve prostate cancer risk stratification and decrease the need for repeat biopsies in men on prostate cancer active surveillance (AS). However, the impact of mpMRI on AS-related healthcare spending has not been established. Objective To characterize the impact of mpMRI on AS-related Medicare expenditures. Design, setting, and participants Using Surveillance, Epidemiology, and End Results (SEER)-Medicare files, we identified men ≥66 yr old with localized prostate cancer diagnosed during 2008–2013. Outcome measures and statistical analysis With a validated algorithm, we classified men into AS with and without mpMRI groups. We then determined Medicare spending on AS in each group using inflation-adjusted, price-standardized Medicare payments for AS-related procedures (ie, prostate-specific antigen [PSA] tests, prostate biopsies, biopsy complications, and mpMRI). Multivariable median regression compared Medicare spending on AS for men who received mpMRI and those who did not. Results and limitations We identified 9081 men on AS with a median follow-up of 45 mo (interquartile range 29–64 mo). Thirteen percent (N = 1225) received mpMRI. On multivariable median regression, receipt of mpMRI was associated with an additional $447 (95% confidence interval $409–487) in Medicare spending per year. We observed greater frequency of AS-related procedures and higher spending for identical procedures (eg, PSA or prostate biopsy) in the mpMRI group than in the non-mpMRI group (all p Conclusions Among Medicare beneficiaries on AS, mpMRI is associated with additional annual Medicare spending. Future studies are needed to determine optimal use of mpMRI during AS to maximize value. Patient summary Prostate magnetic resonance imaging (MRI) helps physicians determine which prostate cancers are aggressive and which can be monitored safely. We studied whether using MRI during prostate cancer monitoring (also called active surveillance) resulted in increased healthcare spending. There was a modest increase in spending, but this may be worthwhile if the use of MRI allows physicians to monitor prostate cancer more accurately.

Background Colon capsule endoscopy (CCE) is a non-invasive alternative to colonoscopy. The reported sensitivity and specificity of CCE for the detection of clinically significant colonic neoplasia is high. To date, there have been no reported cases of colorectal cancer (CRC) missed by CCE which were located in segments adequately visualised by the capsule. Case presentation We present the case of a 71-year-old female, who underwent CCE for new lower gastrointestinal symptoms. The CCE reported 17 polyps (largest size 10 mm) and angiodysplasia. A 40 mm caecal pole tumour, not detected by the CCE, was identified at follow up colonoscopy. Surgical resection was performed, and the pathology sample was reported as moderately differentiated adenocarcinoma, pT2 pN0 (0/19) M0, with no evidence of EMVI. The patient made an uneventful recovery. The caecal pole tumour was not definitively identified on retrospective review of the CCE images. Conclusion To date, this is the first published case of a CRC missed entirely by CCE. Further research is required to allow calculation of the post CCE interval CRC rate to allow comparison with colonoscopy and CT colonogram.

Generally, in film theory, when a writer tackles such mainstream or popular artists like director, writer, and producer John Hughes, the essay or book gets bogged down by complicated wording, postm...

Aim Diverticulitis is a common cause for acute surgical admissions. UK guidance recommends uncomplicated diverticulitis is managed with antibiotics, and follow-up outpatient lower gastrointestinal (LGI) endoscopy (flexible sigmoidoscopy or colonoscopy) arranged 6-8 weeks after discharge. This audit aimed to assess compliance to national guidance and assess adenoma detection rate. Method Retrospective analysis of discharge summaries coded ‘diverticulitis’ from January 2017 – April 2020 at University Hospital Bristol(UHB). Results 426 patients presented with uncomplicated diverticulitis, mean age 60.5 years (22-92 years). 42% (179/426) of patients underwent LGI endoscopy as an inpatient or on discharge. Median time to outpatient endoscopy was 70 days (6-287 days). 23% (99/426) had LGI endoscopy within the 8-week target. Histology showed: 21% (37/179) polyp; 5% (9/179) tubular adenoma; and one patient had high grade dysplasia. The histology for the remaining 28 patients with polyps showed: hyperplasia; granulation tissue; inflammation; or samples were not sent for histology. No cases of malignancy were detected. Conclusions 58% of patients admitted with acute uncomplicated diverticulitis did not have a follow-up LGI endoscopy and only 23% had LGI endoscopy within the 8-week target. 21% had a polyp with a 5% rate of tubular adenoma and no cases of malignancy. UHB needs to improve compliance with national guidance for the arrangement of follow-up LGI endoscopy, however the absence of detection of malignancy raises the question of whether we need to re-consider its necessity for patients with uncomplicated diverticulitis.

We report the earliest detection of the 19.967-GHz [transition 21–30E (t = 0)] methanol maser associated with the massive star-forming region G358.93–0.03. The flare was detectable from 2019 January 23 to March 5, for only 44 d. It turned out to be the most powerful 19.967-GHz maser in the Galaxy in the entire history of observations, taking into account the 104-Jy flux from it on the Earth’s surface and the distance to the source, 6.75 kpc. The 19.967-GHz maser flared contemporaneously with the first of two flares detected in associated 20.971-GHz methanol masers. We estimated that the ratio of flux densities between these two transitions is F20.971/F19.967 = 14 ± 4, increasing to >520 in the second flare. We discuss the differences between the two flares in the 20.971-GHz methanol masers and the consequence thereof.

Regionalization of complex surgical care results in increasing need for patients to travel for complex oncologic procedures such as cystectomy in bladder cancer. We examined the association between travel distance to a cystectomy center, readmission, and survival.Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data, we identified bladder cancer patients undergoing radical cystectomy during 2004-2011. Patients were grouped into quartiles of distance to cystectomy center in miles (6 [close], 6-16.9 [moderately close], 17-47.9 [moderately far], ≥ 48 [far]). Multivariable logistic regression, accounting for clustering within hospitals, was used to assess the association between travel distance and readmission. A secondary analysis examined the association between travel distance and survival using multivariable proportional hazard regression.Among 4556 patients who underwent cystectomy, 1857 (41%) were readmitted, and 1251 (67%) of readmissions were to the index hospital. With increasing travel distance there was no significant difference in the overall rate of 90-day readmission. However, the farther a patient traveled, the lower the odds of being readmitted to the index hospital (adjusted odds ratio [95% confidence interval] as follows: moderately close, 0.43 miles [0.29-0.63]; moderately far, 0.14 miles [0.10-0.19]; and far, 0.07 [0.05-0.11]). Increasing travel distance was associated with improved survival.With greater distance traveled to a cystectomy center, rates of readmission to nonindex centers increased. Survival differences may be explained by the impact of travel burden on processes of care and case mix. Future efforts should focus on improving care coordination between index and nonindex hospitals and ensuring equitable access to cystectomy and other critical cancer services.

Objective To model the risk of radiation-induced malignancy from computed tomography urography (CTU) in evaluation of gross hematuria and contrast this with the benefits of urinary tract cancer detection when compared to renal ultrasound. Methods A PUBMED-based literature search was performed to identify model inputs. Estimates of radiation-induced malignancy rates were obtained from the Biological Effects of Ionizing Radiation VII report with dose extrapolation using the linear no-threshold model. Results Male gender and age over 50 years were associated with a relative risk of upper tract malignancy of 2.04 and 2.95, respectively. The risk of upper tract malignancy missed by renal ultrasound ranged from 0.055% in females under 50 to 0.51% in males over 50. Risk of CTU-induced malignancy with associated loss of life expectancy ranged from 0.25% and 0.027 years in females under 50 to 0.08% and 0.0054 years in males over 50. For CTU to be superior to renal ultrasound, an undiagnosed upper tract malignancy would have to carry a loss of life expectancy of 49.2 years in females under 50, 13.4 years in males under 50, 2.6 years in females over 50, and 1.1 years in males over 50. Conclusion In low-risk patients, CTU for evaluation of gross hematuria may carry a significant risk of radiation-induced secondary malignancy relative to the diagnostic benefit offered over renal ultrasound

We have investigated the methanol CH3OH lines at frequencies of 19.967 GHz [21-30 E(vt = 0) transition] and 20.971 GHz [101-112 E+(vt = 1) transition] toward the massive region of active star formation G358.931-0.030 with the RT-22 (Simeiz) and RT-26 (HartRAO) radio telescopes. Two new flares have been detected. One of the flares (at 20.971 GHz) is extremely powerful in the frequency range 192-26 GHz. We present our monitoring of the flaring events detected at 19.967 and 20.971 GHz. The time dependence of the flare amplitude reflects the complex structure of the maser emission regions. The velocity structure of the flares is considered.

We report the detection of new 12.178, 12.229, 20.347, and 23.121 GHz methanol masers in the massive star-forming region G358.93-0.03, which are flaring on similarly short timescales (days) as the 6.668 GHz methanol masers also associated with this source. The brightest 12.178 GHz channel increased by a factor of over 700 in just 50 d. The masers found in the 12.229 and 20.347 GHz methanol transitions are the first ever reported and this is only the fourth object to exhibit associated 23.121 GHz methanol masers. The 12.178 GHz methanol maser emission appears to have a higher flux density than that of the 6.668 GHz emission, which is unusual. No associated near-infrared flare counterpart was found, suggesting that the energy source of the flare is deeply embedded., 9 pages, 3 figures, 2 tables, Published in MNRAS

The prostate biopsy pathology report represents a critical document used for decision-making in patients diagnosed with prostate cancer, yet the content exceeds the health literacy of most patients. We sought to create and compare the effectiveness of a patient-centered prostate biopsy report compared with standard reports. Using a modified Delphi approach, prostate cancer experts identified critical components of a prostate biopsy report. Patient focus groups provided input for syntax and formatting of patient-centered pathology reports. Ninety-four patients with recent prostate biopsies were block randomized to the standard report with or without the patient-centered report. We evaluated patient activation, self-efficacy, provider communication skills, and prostate cancer knowledge. Experts selected primary and secondary Gleason score and the number of positive scores as the most important elements of the report. Patients prioritized a narrative design, non-threatening language and information on risk classification. Initial assessments were completed by 87% (40/46) in the standard report group and 81% (39/48) in the patient-centered report group. There were no differences in patient activation, self-efficacy, or provider communication skills between groups. Patients who received the patient-centered report had significantly improved ability to recall their Gleason score (100% vs. 85%, p = 0.026) and number of positive cores (90% vs. 65%, p = 0.014). In total, 86% of patients who received the patient-centered report felt that it helped them better understand their results and should always be provided. Patient-centered pathology reports are associated with significantly higher knowledge about a prostate cancer diagnosis. These important health information documents may improve patient-provider communication and help facilitate shared decision-making among patients diagnosed with prostate cancer.

OBJECTIVE: To characterize the use of multiparametric magnetic resonance imaging (mpMRI) in male Medicare beneficiaries electing active surveillance for prostate cancer. Multi-parametric resonance imaging (mpMRI) has emerged as a tool that may improve risk-stratification and decrease repeated biopsies in men electing active surveillance. However, the extent to which mpMRI has been implemented in active surveillance has not been established. METHODS: Using Surveillance, Epidemiology, and End Results (SEER) registry data linked to Medicare claims data, we identified men with localized prostate cancer diagnosed between 2008–2013 and managed with active surveillance. We classified men into two treatment groups: active surveillance without mpMRI and active surveillance with mpMRI. We then fit a multivariable logistic regression models to examine changing mpMRI utilization over time, and factors associated with the receipt of mpMRI. RESULTS: We identified 9,467 men on active surveillance. Of these, 8,178 (86%) did not receive mpMRI and 1,289 (14%) received mpMRI. The likelihood of receiving mpMRI over the entire study period increased by 3.7% (p=0.004). On multivariable logistic regression, patients who were younger, white, had lower comorbidity burden, lived in the northeast and west, had higher incomes and lived in more urban areas had greater odds of receiving mpMRI (all p

Highlights • A novel dual route vaccination using the MERS-CoV RBD sub-unit has been developed. • Murine antisera induced to the RBD protein , were neutralising in vitro. • MERS-CoV susceptibility was induced in naïve mice with Ad5hDPP4. • Passive transfer of anti-RBD sera protected susceptible mice. • Protected mice had a significantly reduced viral titre (P = 0.02) in their lungs., Murine antisera with neutralising activity for the coronavirus causative of Middle East respiratory syndrome (MERS) were induced by immunisation of Balb/c mice with the receptor binding domain (RBD) of the viral Spike protein. The murine antisera induced were fully-neutralising in vitro for two separate clinical strains of the MERS coronavirus (MERS-CoV). To test the neutralising capacity of these antisera in vivo, susceptibility to MERS-CoV was induced in naive recipient Balb/c mice by the administration of an adenovirus vector expressing the human DPP4 receptor (Ad5-hDPP4) for MERS-CoV, prior to the passive transfer of the RBD-specific murine antisera to the transduced mice. Subsequent challenge of the recipient transduced mice by the intra-nasal route with a clinical isolate of the MERS-CoV resulted in a significantly reduced viral load in their lungs, compared with transduced mice receiving a negative control antibody. The murine antisera used were derived from mice which had been primed sub-cutaneously with a recombinant fusion of RBD with a human IgG Fc tag (RBD-Fc), adsorbed to calcium phosphate microcrystals and then boosted by the oral route with the same fusion protein in reverse micelles. The data gained indicate that this dual-route vaccination with novel formulations of the RBD-Fc, induced systemic and mucosal anti-viral immunity with demonstrated in vitro and in vivo neutralisation capacity for clinical strains of MERS-CoV.

—Powerful flares in Galactic kilomasers are closely associated with regions of intense star formation. They contribute to the elucidation of physical processes occurring in these structures. We have recorded a superpowerful flare in the high-velocity −81 km s−1 line in the Galactic maser source W49N. As a result of our monitoring at the RT-22 (Simeiz), RT-32 (Torun), RT-100 (Effelsberg), and RT-32 (Medicina) radio telescopes in the period from September 2017 to November 2018, we have obtained the shape of the spectral flux density variations in the source with time. At the peak the flux density reached P ≈ 5 × 10^4 Jy. The flare has a double pattern and different durations of its components. The pattern of spectral flux density variations for the first flare with a considerably shorter duration is apparently related to a sharp increase in the density of the medium and the photon flux and to a significant rise in the temperature to hundreds of kelvins. We propose a mechanism of primary energy release related to the existence of close massive multiple systems in star-forming regions. A powerful gravitational perturbation at the system’s periastron can lead to a partial ejection of the envelope of the central massive star in a direction close to the major axis of the ellipse of the companion’s orbit. This explains the significant asymmetry of high-velocity lines in W49N. The ejected envelope is an energy source more significant than the stellar wind and can explain the giant flares in the object. Further comprehensive studies in this direction, including monitoring VLBI studies, are needed to confirm this assumption.

Objectives To describe the rate and determinants of palliative care use amongst Medicare beneficiaries with bladder cancer and encourage a national dialogue on improving coordinated urological, oncological, and palliative care in patients with genitourinary malignancies. Patients and methods Using Surveillance, Epidemiology, and End Results-Medicare data, we identified patients diagnosed with muscle-invasive bladder cancer (MIBC) between 2008 and 2013. Our primary outcome was receipt of palliative care, defined as the presence of a claim submitted by a Hospice and Palliative Medicine subspecialist. We examined determinants of palliative care use using logistic regression analysis. Results Over the study period, 7303 patients were diagnosed with MIBC and 262 (3.6%) received palliative care. Of 2185 patients with advanced bladder cancer, defined as either T4, N+ , or M+ disease, 90 (4.1%) received palliative care. Most patients that received palliative care (>80%, >210/262) did so within 24 months of diagnosis. On multivariable analysis, patients receiving palliative care were more likely to be younger, female, have greater comorbidity, live in the central USA, and have undergone radical cystectomy as opposed to a bladder-sparing approach. The adjusted probability of receiving palliative care did not significantly change over time. Conclusions Palliative care provides a host of benefits for patients with cancer, including improved spirituality, decrease in disease-specific symptoms, and better functional status. However, despite strong evidence for incorporating palliative care into standard oncological care, use in patients with bladder cancer is low at 4%. This study provides a conservative baseline estimate of current palliative care use and should serve as a foundation to further investigate physician-, patient-, and system-level barriers to this care.