Early Release Science of the exoplanet WASP-39b with JWST NIRCam.

Measuring the metallicity and carbon-to-oxygen (C/O) ratio in exoplanet atmospheres is a fundamental step towards constraining the dominant chemical processes at work and, if in equilibrium, revealing planet formation histories. Transmission spectroscopy (for example, refs. 1,2) provides the necessary means by constraining the abundances of oxygen- and carbon-bearing species; however, this requires broad wavelength coverage, moderate spectral resolution and high precision, which, together, are not achievable with previous observatories. Now that JWST has commenced science operations, we are able to observe exoplanets at previously uncharted wavelengths and spectral resolutions. Here we report time-series observations of the transiting exoplanet WASP-39b using JWST's Near InfraRed Camera (NIRCam). The long-wavelength spectroscopic and short-wavelength photometric light curves span 2.0-4.0 micrometres, exhibit minimal systematics and reveal well defined molecular absorption features in the planet's spectrum. Specifically, we detect gaseous water in the atmosphere and place an upper limit on the abundance of methane. The otherwise prominent carbon dioxide feature at 2.8 micrometres is largely masked by water. The best-fit chemical equilibrium models favour an atmospheric metallicity of 1-100-times solar (that is, an enrichment of elements heavier than helium relative to the Sun) and a substellar C/O ratio. The inferred high metallicity and low C/O ratio may indicate significant accretion of solid materials during planet formation (for example, refs. 3,4,) or disequilibrium processes in the upper atmosphere (for example, refs. 5,6).

A broadband thermal emission spectrum of the ultra-hot Jupiter WASP-18b.

Close-in giant exoplanets with temperatures greater than 2,000 K ('ultra-hot Jupiters') have been the subject of extensive efforts to determine their atmospheric properties using thermal emission measurements from the Hubble Space Telescope (HST) and Spitzer Space Telescope1-3. However, previous studies have yielded inconsistent results because the small sizes of the spectral features and the limited information content of the data resulted in high sensitivity to the varying assumptions made in the treatment of instrument systematics and the atmospheric retrieval analysis3-12. Here we present a dayside thermal emission spectrum of the ultra-hot Jupiter WASP-18b obtained with the NIRISS13 instrument on the JWST. The data span 0.85 to 2.85 µm in wavelength at an average resolving power of 400 and exhibit minimal systematics. The spectrum shows three water emission features (at >6σ confidence) and evidence for optical opacity, possibly attributable to H-, TiO and VO (combined significance of 3.8σ). Models that fit the data require a thermal inversion, molecular dissociation as predicted by chemical equilibrium, a solar heavy-element abundance ('metallicity', [Formula: see text] times solar) and a carbon-to-oxygen (C/O) ratio less than unity. The data also yield a dayside brightness temperature map, which shows a peak in temperature near the substellar point that decreases steeply and symmetrically with longitude towards the terminators.

Coherent anti-Stokes Raman scattering microspectroscopy: an emerging technique for non-invasive optical assessment of a local bio-nano-environment.

Raman spectroscopy provides a non-invasive, chemically-specific optical imaging of biological objects without relying on endogenous labels. Nonlinear Raman spectroscopy allows non-invasive imaging at much faster speed with an improved spatial resolution and axial sectioning capability. In this report we propose a novel use of nonlinear Raman spectroscopy as a sensor of local nano-environment. Time-resolved coherent anti-Stokes Raman spectrograms are found to be sensitive to small variations of local structural changes, which are not normally observed using conventional Raman spectroscopy.

A high C/O ratio and weak thermal inversion in the atmosphere of exoplanet WASP-12b.

The carbon-to-oxygen ratio (C/O) in a planet provides critical information about its primordial origins and subsequent evolution. A primordial C/O greater than 0.8 causes a carbide-dominated interior, as opposed to the silicate-dominated composition found on Earth; the atmosphere can also differ from those in the Solar System. The solar C/O is 0.54 (ref. 3). Here we report an analysis of dayside multi-wavelength photometry of the transiting hot-Jupiter WASP-12b (ref. 6) that reveals C/O ≥ 1 in its atmosphere. The atmosphere is abundant in CO. It is depleted in water vapour and enhanced in methane, each by more than two orders of magnitude compared to a solar-abundance chemical-equilibrium model at the expected temperatures. We also find that the extremely irradiated atmosphere (T > 2,500 K) of WASP-12b lacks a prominent thermal inversion (or stratosphere) and has very efficient day-night energy circulation. The absence of a strong thermal inversion is in stark contrast to theoretical predictions for the most highly irradiated hot-Jupiter atmospheres.

Possible thermochemical disequilibrium in the atmosphere of the exoplanet GJ 436b.

The nearby extrasolar planet GJ 436b-which has been labelled as a 'hot Neptune'-reveals itself by the dimming of light as it crosses in front of and behind its parent star as seen from Earth. Respectively known as the primary transit and secondary eclipse, the former constrains the planet's radius and mass, and the latter constrains the planet's temperature and, with measurements at multiple wavelengths, its atmospheric composition. Previous work using transmission spectroscopy failed to detect the 1.4-mum water vapour band, leaving the planet's atmospheric composition poorly constrained. Here we report the detection of planetary thermal emission from the dayside of GJ 436b at multiple infrared wavelengths during the secondary eclipse. The best-fit compositional models contain a high CO abundance and a substantial methane (CH(4)) deficiency relative to thermochemical equilibrium models for the predicted hydrogen-dominated atmosphere. Moreover, we report the presence of some H(2)O and traces of CO(2). Because CH(4) is expected to be the dominant carbon-bearing species, disequilibrium processes such as vertical mixing and polymerization of methane into substances such as ethylene may be required to explain the hot Neptune's small CH(4)-to-CO ratio, which is at least 10(5) times smaller than predicted.

Plantar Kinetics During Wheeled Knee Walker Use Compared to Different Assistive Walking Devices in Persons With Type 2 Diabetes Mellitus.

Background: Diabetic patients with foot ulcers are commonly prescribed assistive walking devices to unload the affected foot and promote tissue healing. However, the effect on shear loads to the contralateral foot is unknown. This study investigated the effect of a wheeled knee walker (WKW), compared to common devices, on compressive and shear plantar forces carried by the propulsive foot during walking in patients with type 2 diabetes mellitus. A secondary objective investigated plantar forces' correlations with body weight unloaded (BWU). Methods: Participants walked a maximum of 200 m per condition during normal walking or when using crutches, a standard walker, and a WKW in randomized order. Plantar forces were measured with force plates, and wireless force-sensitive pads measured BWU through the hands. The WKW was instrumented to measure BWU onto the seat and handlebars. Three-dimensional motion capture confirmed gait events. Results: The WKW produced the lowest vertical, braking, propulsive, and medial shear forces but the highest lateral shear force among all conditions. Using crutches or a walker had negligible medial and lateral shear (mean = -6.69 N and -7.80 N), with normal walking producing the highest medial shear. There was a poor relationship between BWU and assistive walking devices and shear force values. Conclusion: A WKW could be the preferred assistive device for unloading a diabetic foot ulcer. The magnitude of lateral force would need further investigation to determine ulceration risk, given patient susceptibility and neuropathy. Clinical Relevance: Understanding shear forces on the propulsive foot is important for minimizing contralateral limb tissue damage risk while treating an ulcer. Different assistive walking devices change walking patterns and affect shear forces on the plantar surface of the foot. Although the WKW minimizes several loading metrics, a clinical trial investigating assistive walking device compliance and wound healing in diabetic foot ulcer patients across devices is needed.

The hottest planet.

Of the over 200 known extrasolar planets, just 14 pass in front of and behind their parent stars as seen from Earth. This fortuitous geometry allows direct determination of many planetary properties. Previous reports of planetary thermal emission give fluxes that are roughly consistent with predictions based on thermal equilibrium with the planets' received radiation, assuming a Bond albedo of approximately 0.3. Here we report direct detection of thermal emission from the smallest known transiting planet, HD 149026b, that indicates a brightness temperature (an expression of flux) of 2,300 +/- 200 K at 8 microm. The planet's predicted temperature for uniform, spherical, blackbody emission and zero albedo (unprecedented for planets) is 1,741 K. As models with non-zero albedo are cooler, this essentially eliminates uniform blackbody models, and may also require an albedo lower than any measured for a planet, very strong 8 microm emission, strong temporal variability, or a heat source other than stellar radiation. On the other hand, an instantaneous re-emission blackbody model, in which each patch of surface area instantly re-emits all received light, matches the data. This planet is known to be enriched in heavy elements, which may give rise to novel atmospheric properties yet to be investigated.

A spectrum of an extrasolar planet.

Of the over 200 known extrasolar planets, 14 exhibit transits in front of their parent stars as seen from Earth. Spectroscopic observations of the transiting planets can probe the physical conditions of their atmospheres. One such technique can be used to derive the planetary spectrum by subtracting the stellar spectrum measured during eclipse (planet hidden behind star) from the combined-light spectrum measured outside eclipse (star + planet). Although several attempts have been made from Earth-based observatories, no spectrum has yet been measured for any of the established extrasolar planets. Here we report a measurement of the infrared spectrum (7.5-13.2 microm) of the transiting extrasolar planet HD 209458b. Our observations reveal a hot thermal continuum for the planetary spectrum, with an approximately constant ratio to the stellar flux over this wavelength range. Superposed on this continuum is a broad emission peak centred near 9.65 microm that we attribute to emission by silicate clouds. We also find a narrow, unidentified emission feature at 7.78 microm. Models of these 'hot Jupiter' planets predict a flux peak near 10 microm, where thermal emission from the deep atmosphere emerges relatively unimpeded by water absorption, but models dominated by water fit the observed spectrum poorly.

Engaging Chicago hospitals in the baby-friendly hospital initiative.

Breastfeeding is now widely recognized as a vital obesity prevention strategy and hospitals play a primary role in promoting, supporting and helping mothers to initiate and maintain breastfeeding. The Baby-Friendly Hospital Initiative (BFHI) provides an evidence-based model that hospitals can use to plan and implement breastfeeding quality improvement (QI) projects. Funding under Communities Putting Prevention to Work (CPPW), administered by the CDC, brought together key Chicago partners to provide individualized support and technical assistance with breastfeeding QI projects to the 19 maternity hospitals in Chicago. A community organizing approach was taken to mobilize hospital interest in breastfeeding QI projects, leading to successes, e.g. 12/19 (63 %) Chicago hospitals registered with Baby-Friendly USA, Inc. (BFUSA) to pursue official Baby-Friendly designation. Key factors that fostered this success included: involving all levels of hospital staff, financial incentives, and ongoing tailored technical assistance. To assist other communities in similar work, this article discusses the approach the project took to mobilize hospitals to improve breastfeeding support practices based on the BFHI, as well as successes and lessons learned.

Muscle activation and rating of perceived exertion of typically developing children during DRY and aquatic treadmill walking.

Aquatic treadmill gait training is a poorly understood rehabilitation method that alters bodyweight support, increases lower limb resistance, and assists with postural stability. This training could be an attractive tool for clinical populations with balance control issues or limited weight-bearing prescriptions for the lower limb. As a first step, the purpose of this study was to quantify differences in mean muscle activity of the tibialis anterior, rectus femoris, medial gastrocnemius, and semitendinosus, and perceived exertion (RPE) in typically developing children (7:8 M:F, age = 11.3 ± 4.1 years, 1.46 ± 0.18 m, and 44.2 ± 16.8 kg) during dry and aquatic treadmill walking at 75 %, 100 %, and 125 % self-selected speed. We hypothesized that the greatest mean muscle activity, normalized to percent maximum voluntary contraction and averaged across all strides, would be observed during 125 % dry treadmill walking and that aquatic treadmill walking would produce lower RPE. Overall, aquatic treadmill walking reduced mean medial gastrocnemius activity by 50.2 % (padj < 0.001), increased mean rectus femoris activity at least 32.8 % (padj < 0.006), and produced 78.0 % (padj = 0.007) greater RPE compared to dry treadmill walking. This study provides normative pediatric data for future aquatic treadmill walking studies in clinical populations to help inform gait rehabilitation protocols.

Hand loading, rates of perceived exertion, and usability during assisted walking in patients with type 2 diabetes mellitus.

BACKGROUND: Patients suffering from a diabetic foot ulcer often receive a non-weight bearing prescription of the affected limb to promote healing. Total unilalteral offloading of the affected foot necessitates walking aids that require loading at the hands during ambulation. Excessive loading at the hands can increase of the risk of crutch palsy. In addition, certain walking aids can also be more strenuous and less comfortable to use than others, resulting in lower prescription compliance. This study aimed to investigate hand loading, rates of perceived exertion, and usability of typically prescribed walking aids in patients with Type 2 Diabetes. METHODS: Twenty patients (12 F | 8 M, 61.0 ± 10.36 yrs., 90.54 ± 13.34 kg, 1.71 ± 0.08 m) walked as much as 200 m without assistance and with crutches, walkers, and a wheeled knee walker instrumented with flexible force-sensing pads on walking aid handles. Patients rated exertion using a Modified Borg Scale and completed a System Usability Scale questionnaire after each walking condition with or without walking aids. FINDINGS: Results show that using a wheeled knee walker required 94% less hand loading than crutches and walkers. Patients reported 45% lower exertion with the WKW compared to crutches and walkers, and scored the usability of the wheeled knee walker 106% higher than crutches and walkers. INTERPRETATION: The wheeled knee walker could be the preferred walking aid for total unilateral offloading because of the reduced loading demand at the hands, lower exertion during use, and greater usability compared to crutches and walkers.

Stakeholder engagement infrastructure to support multicenter research networks: Advances from the clinical research networks participating in PCORnet.

Background: The evidence based on the inclusion of patients and other stakeholders as partners in the clinical research process has grown substantially. However, little has been reported on how stakeholders are engaged in the governance of large-scale clinical research networks and the infrastructure used by research networks to support engagement in network-affiliated activities. Objectives: The objective was to document engagement activities and practices emerging from Clinical Research Networks (CRNs) participating in PCORnet, the National Patient-Centered Clinical Research Network, specifically regarding governance and engagement infrastructure. Methods: We conducted an environmental scan of PCORnet CRN engagement structures, assets, and services, focusing on network oversight structures for policy development and strategic decision-making. The scan included assets and services for supporting patient/stakeholder engagement. Data were collected by searching web-based literature and tool repositories, review of CRN Engagement Plans, analysis of previously collected key informant interviews, and CRN-based iterative review of structured worksheets. Results: We identified 87 discrete engagement structures, assets, and services across nine CRNs. All CRNs engage patients/stakeholders in their governance, maintain workgroups and/or staff dedicated to overseeing engagement strategies, and offer one or more services to non-CRN researchers to enhance conducting engaged clinical research. Conclusions: This work provides an important resource for the research community to explore engagement across peers, reflect on progress, consider opportunities to leverage existing infrastructure, and identify new collaborators. It also serves to highlight PCORnet as a resource for non-CRN researchers seeking to efficiently conduct engaged clinical research and a venue for advancing the science of engagement.

Deconstructing the Minimum Clinically Important Difference (MCID).

PURPOSE: The minimal clinically important difference (MCID) is a way of dichotomizing data for assessment of success or failure based on clinically meaningful changes. The magnitude of the MCID is often misunderstood to be a singular quantity applicable across studies. However, substantial differences have been reported among MCIDs for the same outcome measures usually based upon differences extrinsic to the calculation. This study explores the effects of variabilities intrinsic to the calculation of the MCID. METHODS: The MCIDs for two knee replacement patient-reported outcomes measures of pain and function were calculated at 1 year postoperative with an integrative anchor and distribution-based method using external anchor questions and receiver operator characteristic (ROC) curves. The effects upon the magnitude and precision of the MCIDs of varying the anchor questions, the thresholds for success/failure, and the sample sizes were examined. RESULTS: Wide variabilities were observed in both the magnitudes and precision of the MCIDs. The threshold for success had the largest effect on magnitude of pain scores, while the sample size had the largest effect on precision. For function scores, the sample size had the largest effect on magnitude, and the anchor question had the largest effect on precision. CONCLUSION: Comparisons among MCIDs are difficult to interpret if elements of the calculations are different and influence the results. While factors extrinsic to the calculations, e.g., study population, trial design, methods of calculation, etc., are known to produce differences in the magnitude of MCIDs, this study shows that more subtle and less obvious factors intrinsic to the calculations have profound effects on both the magnitude and precision of MCIDs. Comparisons among MCIDs should be made with caution and call for greater transparency in reporting intrinsic methods. It is probably advisable for individual studies to calculate their own MCIDs and not rely on published values.

Alterations to plantar loading and ankle range of motion of the contralateral foot during assisted walking in patients with Type 2 Diabetes Mellitus.

AIMS: Patients with diabetic foot ulcers are instructed to be non-weight bearing on the affected limb to promote healing. Therefore, the aim of this study was to investigate the effect of different assistive devices on whole foot plantar loading, peak forefoot force, ankle range of motion, and locomotion speed during gait in patients with Type 2 Diabetes Mellitus. METHODS: Participants walked normally, with crutches, a walker, and a wheeled knee walker (WKW) in randomized order. Force sensitive insoles and 3D motion capture were used to record plantar normal force and ankle kinematics. Force sensitive pads were wrapped around handles of the crutches and walker to measure bodyweight offloaded onto the assistive device. An instrumented WKW was used to measure bodyweight offloaded onto the handlebars and knee cushion. RESULTS: Locomotion with the WKW produced the lowest whole foot plantar loading and peak forefoot force in the propulsive limb, while also producing the greatest ankle range of motion and locomotion speed amongst assistive devices. CONCLUSIONS: This pre-clinical study found that the WKW could be the preferred assistive device for total unilateral offloading of diabetic foot ulcers as it reduced propulsive limb whole foot and forefoot plantar loading while retaining ankle range of motion and locomotion speed.

Infrared radiation from an extrasolar planet.

A class of extrasolar giant planets--the so-called 'hot Jupiters' (ref. 1)--orbit within 0.05 au of their primary stars (1 au is the Sun-Earth distance). These planets should be hot and so emit detectable infrared radiation. The planet HD 209458b (refs 3, 4) is an ideal candidate for the detection and characterization of this infrared light because it is eclipsed by the star. This planet has an anomalously large radius (1.35 times that of Jupiter), which may be the result of ongoing tidal dissipation, but this explanation requires a non-zero orbital eccentricity (approximately 0.03; refs 6, 7), maintained by interaction with a hypothetical second planet. Here we report detection of infrared (24 microm) radiation from HD 209458b, by observing the decrement in flux during secondary eclipse, when the planet passes behind the star. The planet's 24-microm flux is 55 +/- 10 microJy (1sigma), with a brightness temperature of 1,130 +/- 150 K, confirming the predicted heating by stellar irradiation. The secondary eclipse occurs at the midpoint between transits of the planet in front of the star (to within +/- 7 min, 1sigma), which means that a dynamically significant orbital eccentricity is unlikely.

Engaging patients, clinicians, and the community in a Clinical Data Research Network: Lessons learned from the CAPriCORN CDRN.

Engaging patients, clinicians, and community members in the development of a research network creates opportunities and challenges beyond engagement in discrete learning activities. This paper describes our experiences establishing and maintaining a stakeholder engagement infrastructure for the Chicago Area Patient-Centered Outcomes Research Network (CAPriCORN) and highlights important lessons learned over the first 4 years. During this time, the CAPriCORN Patient and Community Advisory Committee (PCAC) appointed patient, clinician, and community representatives to governance and advisory groups throughout the network, developed a process and criteria for patient- and clinician-centered review of research proposals, and evolved from a large, diverse group to a smaller yet still diverse, more actively engaged group with connections to the broader community. Key challenges faced by the PCAC have included determining the optimal size and composition of the group, understanding the complex structure of the network as a whole, coordinating with other network entities and functions, and integrating the patient and community voice into the research review process. Efforts to engage stakeholders in clinical data research networks should anticipate and develop solutions to address these challenges.

3-Chloro-4-(dichloromethyl)-5-hydroxy-2(5H)-furanone (MX) and mutagenic activity in Massachusetts drinking water.

There is limited information on the prevalence of the potent mutagen 3-chloro-4-(dichloromethyl)-5-hydroxy-2(5H)-furanone (MX) in U.S. water supplies. We measured MX concentrations and mutagenic activity in tap water samples from 36 surface water systems throughout Massachusetts. We found MX levels much higher (up to 80 ng/L) than previously reported in the United States. We also evaluated the role of water treatment on mutagenic activity and disinfection by-product formation. After adjusting for other covariates, chloramination and filtration were the most important treatment options for reducing mutagenic activity and disinfection by-product formation. Multiple chlorine application (before and after filtration) was associated with increased mutagenicity. Chlorine dose, pH, and total organic carbon were also associated with mutagenicity, MX, and total trihalomethane (TTHM) concentration. Seasonal variation was evident for MX and mutagenic activity, with higher levels occurring in the spring compared to the fall. In contrast, TTHM concentrations were greater in the fall.

Stockpiling anti-viral drugs for a pandemic: the role of Manufacturer Reserve Programs.

To promote stockpiling of anti-viral drugs by non-government organizations such as hospitals, drug manufacturers have introduced Manufacturer Reserve Programs which, for an annual fee, provide the right to buy in the event of a severe outbreak of influenza. We show that these programs enhance drug manufacturer profits but could either increase or decrease the amount of pre-pandemic stockpiling of anti-viral drugs.

Handedness and earnings.

We examine whether handedness is related to performance in the labour market and, in particular, to earnings. We find a significant wage effect for left-handed men with high levels of education. This positive wage effect is strongest among those who have lower than average earnings relative to those of similar high education. This effect is not found among women.