Unresolved Gamma-Ray Sky through its Angular Power Spectrum.

The gamma-ray sky has been observed with unprecedented accuracy in the last decade by the Fermi -large area telescope (LAT), allowing us to resolve and understand the high-energy Universe. The nature of the remaining unresolved emission [unresolved gamma-ray background (UGRB)] below the LAT source detection threshold can be uncovered by characterizing the amplitude and angular scale of the UGRB fluctuation field. This Letter presents a measurement of the UGRB autocorrelation angular power spectrum based on eight years of Fermi-LAT Pass 8 data products. The analysis is designed to be robust against contamination from resolved sources and noise systematics. The sensitivity to subthreshold sources is greatly enhanced with respect to previous measurements. We find evidence (with ∼3.7σ significance) that the scenario in which two classes of sources contribute to the UGRB signal is favored over a single class. A double power law with exponential cutoff can explain the anisotropy energy spectrum well, with photon indices of the two populations being 2.55±0.23 and 1.86±0.15.

Investigating the Nature of Late-Time High-Energy GRB Emission Through Joint Fermi /Swift Observations.

We use joint observations by the Neil Gehrels Swift X-ray Telescope (XRT) and the Fermi Large Area Telescope (LAT) of gamma-ray burst (GRB) afterglows to investigate the nature of the long-lived high-energy emission observed by Fermi LAT. Joint broadband spectral modeling of XRT and LAT data reveal that LAT non-detections of bright X-ray afterglows are consistent with a cooling break in the inferred electron synchrotron spectrum below the LAT and/or XRT energy ranges. Such a break is sufficient to suppress the high-energy emission so as to be below the LAT detection threshold. By contrast, LAT-detected bursts are best fit by a synchrotron spectrum with a cooling break that lies either between or above the XRT and LAT energy ranges. We speculate that the primary difference between GRBs with LAT afterglow detections and the non-detected population may be in the type of circumstellar environment in which these bursts occur, with late-time LAT detections preferentially selecting GRBs that occur in low wind-like circumburst density profiles. Furthermore, we find no evidence of high-energy emission in the LAT-detected population significantly in excess of the flux expected from the electron synchrotron spectrum fit to the observed X-ray emission. The lack of excess emission at high energies could be due to a shocked external medium in which the energy density in the magnetic field is stronger than or comparable to that of the relativistic electrons behind the shock, precluding the production of a dominant synchrotron self-Compton (SSC) component in the LAT energy range. Alternatively, the peak of the SSC emission could be beyond the 0.1-100 GeV energy range considered for this analysis.

Clcn7F318L/+ as a new mouse model of Albers-Schönberg disease.

Dominant negative mutations in CLCN7, which encodes a homodimeric chloride channel needed for matrix acidification by osteoclasts, cause Albers-Schönberg disease (also known as autosomal dominant osteopetrosis type 2). More than 25 different CLCN7 mutations have been identified in patients affected with Albers-Schönberg disease, but only one mutation (Clcn7G213R) has been introduced in mice to create an animal model of this disease. Here we describe a mouse with a different osteopetrosis-causing mutation (Clcn7F318L). Compared to Clcn7+/+ mice, 12-week-old Clcn7F318L/+ mice have significantly increased trabecular bone volume, consistent with Clcn7F318L acting as a dominant negative mutation. Clcn7F318L/F318L and Clcn7F318L/G213R mice die by 1month of age and resemble Clcn7 knockout mice, which indicate that p.F318L mutant protein is non-functional and p.F318L and p.G213R mutant proteins do not complement one another. Since it has been reported that treatment with interferon gamma (IFN-G) improves bone properties in Clcn7G213R/+ mice, we treated Clcn7F318L/+ mice with IFN-G and observed a decrease in osteoclast number and mineral apposition rate, but no overall improvement in bone properties. Our results suggest that the benefits of IFN-G therapy in patients with Albers-Schönberg disease may be mutation-specific.

Search for Spectral Irregularities due to Photon-Axionlike-Particle Oscillations with the Fermi Large Area Telescope.

We report on the search for spectral irregularities induced by oscillations between photons and axionlike-particles (ALPs) in the γ-ray spectrum of NGC 1275, the central galaxy of the Perseus cluster. Using 6 years of Fermi Large Area Telescope data, we find no evidence for ALPs and exclude couplings above 5×10^{-12} GeV^{-1} for ALP masses 0.5≲m_{a}≲5 neV at 95% confidence. The limits are competitive with the sensitivity of planned laboratory experiments, and, together with other bounds, strongly constrain the possibility that ALPs can reduce the γ-ray opacity of the Universe.

Radio imaging of the very-high-energy gamma-ray emission region in the central engine of a radio galaxy.

The accretion of matter onto a massive black hole is believed to feed the relativistic plasma jets found in many active galactic nuclei (AGN). Although some AGN accelerate particles to energies exceeding 10(12) electron volts and are bright sources of very-high-energy (VHE) gamma-ray emission, it is not yet known where the VHE emission originates. Here we report on radio and VHE observations of the radio galaxy Messier 87, revealing a period of extremely strong VHE gamma-ray flares accompanied by a strong increase of the radio flux from its nucleus. These results imply that charged particles are accelerated to very high energies in the immediate vicinity of the black hole.

Childhood sexual abuse and preterm labor in adulthood: an endocrinological hypothesis.

Anecdotal reports link adverse pregnancy outcomes, such as preterm delivery, to women with histories of childhood sexual abuse. Although little research has been conducted on this subject, we provide an overview of known health effects of violence against women and posit a biological explanation for adverse pregnancy outcomes among this population. Specifically, we hypothesize that early traumatic experiences of childhood sexual abuse may activate corticotropin releasing hormone (CRH) gene expression in the brain, and a vulnerability to elevated CRH gene expression in the placenta. Those traumatized by early abuse may be more susceptible to stress vís a vís CRH dysregulation during a major psychosocial stressor, such as pregnancy. Elevated CRH has been associated with preterm labor.

How to select counsel and participate in your own defense. The plaintiff's perspective.

The most important initial step a physician can take in a malpractice case is to secure the best possible representation for his or her defense. This article enumerates the criteria for obtaining quality representation. Among other points, the author cautions the physician to consider the motivation of those who are defending him or her and explains how to determine if an attorney has one's best interests in mind.

The expert witness.

The worst mistake any attorney or physician involved in a case of medical negligence can make is to underestimate the opponent. The expert witness may know a lot more about a certain field than the physician, or at least a lot more about what the basic standard of care is for a particular case. This article discusses the importance of the deposition and delineates four aspects of the deposition that are of utmost importance in a medical negligence case.

Trials, settlements, and arbitration. The plaintiff's perspective.

From a plaintiff's perspective, a jury trial and verdict are prepared for in every case. Experienced trial lawyers know, however, that it is preferable for both sides to reach an equitable compromise as to the value of a case, rather than risk the unknowns involved in a jury determination of a verdict. There are legal elements that require an independent analysis to determine whether a trial, settlement, or some form of arbitration is the appropriate strategy for a plaintiff to pursue.

Response of obstetrics and gynecology program directors to a domestic violence lecture module.

OBJECTIVE: Our goal was to determine the use by obstetrics and gynecology residency program directors of The American College of Obstetricians and Gynecologists' domestic violence slide lecture module and the opinions of the directors regarding its efficacy. STUDY DESIGN: A 6-question survey was mailed to 289 directors of accredited obstetrics and gynecology programs in the United States and Canada 9 and 13 months after a learning module on domestic violence was mailed to these same persons. The questions related to receipt and use of the module in the curriculum, target audiences, future plans for integration of the module into curricula, and recommendations for future supplemental topics in the same format. RESULTS: The return rate for the survey was 57% (164/289). The responses represented university-affiliated, community- and military-based programs with representation from all geographic areas of the country. Fourteen directors who had no recollection of receiving the package were sent a second set. The lecture had been presented by 72% of the respondents' departments to audiences of residents (89%), medical students (55%), practicing physicians (41%), and the lay public (11%). Two thirds of the nonusers and 87% of the users intended to use the module as a formal lecture in the curriculum of both residents and medical students in the coming school year. Recommendations for future supplemental lecture packages included abuse during pregnancy, screening women with different cultural backgrounds, and how to ask tough questions. CONCLUSION: The majority of obstetrics and gynecology resident program directors who responded to the survey integrated or will integrate an American College of Obstetricians and Gynecologists-created learning module on domestic violence into their residents' and medical students' formal curricula.

Assessment and management of the woman with lymphedema after breast cancer.

Lymphedema is a life-long potential complication of breast and axillary node surgery and radiation. The primary care provider plays a key role in the prevention, assessment, and treatment of this potentially debilitating condition. Through ongoing educational reinforcement, the condition may be prevented or minimized.

Domestic violence screening practices of obstetrician-gynecologists.

OBJECTIVE: To ascertain the current knowledge base and screening practices of obstetrician-gynecologists in the area of domestic violence. METHODS: We mailed a survey to 189 ACOG Fellows who are members of the Collaborative Ambulatory Research Network. Questionnaires were also mailed to a random sample of 1250 nonmember Fellows. RESULTS: Obstetrician-gynecologists are aware of the nature of domestic violence and are familiar with common symptomatology that may be associated with domestic violence. For pregnant patients, 39% of respondents routinely screen at the first prenatal visit; 27% of respondents routinely screen nonpregnant patients at the initial visit. Screening is most likely to occur when the obstetrician-gynecologist suspects a patient is being abused, both during pregnancy (68%) and when the patient is not pregnant (72%). Only 30% of obstetrician-gynecologists received training on domestic violence during medical school; 37% received such instruction during residency training. The majority (67%) have received continuing education on the subject. Years since training and personal experiences with intimate-partner violence were associated with increased screening practices. CONCLUSION: Routine screening of all women for domestic violence has been recommended by ACOG for more than a decade. The majority of obstetrician-gynecologists screen both pregnant and nonpregnant patients when they suspect abuse. However, with universal screening, more female victims of violence can be identified and can receive needed services.

The American College of Obstetricians and Gynecologists: a decade of responding to violence against women.

Violence against women is a common phenomenon worldwide. Effects can be severe and life-long. As physicians who treat women exclusively, the obstetrician-gynecologist has a medical and ethical obligation to recognize and intervene on behalf of their abused patients. At the same time, because of the special nature of the patient-physician relationship, the obstetrician-gynecologist is in a unique position to provide such assistance. This article presents an overview of violence against women and its consequences, highlights responses to the problem, and details the activities of the American College of Obstetricians and Gynecologists to educate its members on domestic violence. ACOG activities may serve as a model of response to domestic violence for similar organizations.

The clementine mission to the moon: scientific overview.

In the course of 71 days in lunar orbit, from 19 February to 3 May 1994, the Clementine spacecraft acquired just under two million digital images of the moon at visible and infrared wavelengths. These data are enabling the global mapping of the rock types of the lunar crust and the first detailed investigation of the geology of the lunar polar regions and the lunar far side. In addition, laser-ranging measurements provided the first view of the global topographic figure of the moon. The topography of many ancient impact basins has been measured, and a global map of the thickness of the lunar crust has been derived from the topography and gravity.

Tissue expansion: past, present, and future.

The history of tissue expansion, technique, indications, and complications are reviewed. A detailed review of delayed tissue expansion's histologic, biochemical, biomechanical, and physiologic changes in the skin is given. There is a net gain in epidermal tissue during delayed expansion. Recent experimental and clinical experience suggests that expansion for 1 to 2 weeks is just as effective as longer delayed expansion for 6 to 8 weeks. A new deviation from standard technique, intraoperative tissue expansion, may have significant implications for dermatologic surgery. Intraoperative tissue expansion is explored in relation to other commonly used techniques of intraoperative load cycling.

Role of preoperative topical 5-fluorouracil in preparation for Mohs micrographic surgery of extramammary Paget's disease.

The true extent of the skin affected in extramammary Paget's disease is frequently well beyond its clinical borders. A case of extramammary Paget's disease of the scrotum was treated with Mohs micrographic surgery. Prior to surgery, 5-fluorouracil was applied topically for 10 days. This resulted in a sharply delineated, erythematous patch of biopsy-proved extramammary Paget's disease well beyond the original clinical borders. This increased the visible area of disease by 60%. Mohs micrographic surgery detected microscopic extramammary Paget's disease approximately 1 cm beyond the erythematous borders. The location of disease farthest from the margins was in the direction toward which this erythema was most advanced when the application of 5-fluorouracil was discontinued. At the time of writing, 3.5 years after treatment, the patient was free of disease. Topical 5-fluorouracil may have a role as an adjunct to surgery by highlighting subclinical areas of extramammary Paget's disease. It may also be useful postoperatively to detect early disease recurrence.