Outcomes of substance use and sexual power among adolescent girls and young women in Cape Town: Implications for structural and cultural differences.

Adolescent girls and young women (AGYW) in South Africa experience contextual barriers to HIV risk reduction including incomplete schooling, unintended pregnancy, substance use, and gender-based violence. A cluster randomised trial in Cape Town allocated 24 Black and Coloured communities to a gender-focused HIV risk-reduction intervention or HIV testing, with 500 AGYW total enrolled. We evaluated intervention efficacy by comparing mean differences overall, by community population group (Black and Coloured) and among those with structural barriers based on neighbourhood, education, and employment (n = 406). Both arms reported reductions in alcohol, cannabis, and condomless sex, with no intervention efficacy overall. Among AGYW with barriers, intervention participants reported fewer days of methamphetamine use at 6 months (t(210) = 2·08, p = ·04). In population group analysis, we found intervention effects on alcohol and sexual communication. Intervention participants in Black communities had fewer days of alcohol use at 12 months (t(136) = 2·10, p = ·04). Sexual discussion (t(147) = -2·47, p = ·02) and condom negotiation (t(146) = -2·51, p = ·01) increased for intervention participants at 12 months in Coloured communities. Gender-focused interventions must address population group differences and intersecting barriers to decrease substance use and increase education, skills, and sexual health protection.

Oxygen isotopes of anhydrous primary minerals show kinship between asteroid Ryugu and comet 81P/Wild2.

The extraterrestrial materials returned from asteroid (162173) Ryugu consist predominantly of low-temperature aqueously formed secondary minerals and are chemically and mineralogically similar to CI (Ivuna-type) carbonaceous chondrites. Here, we show that high-temperature anhydrous primary minerals in Ryugu and CI chondrites exhibit a bimodal distribution of oxygen isotopic compositions: 16O-rich (associated with refractory inclusions) and 16O-poor (associated with chondrules). Both the 16O-rich and 16O-poor minerals probably formed in the inner solar protoplanetary disk and were subsequently transported outward. The abundance ratios of the 16O-rich to 16O-poor minerals in Ryugu and CI chondrites are higher than in other carbonaceous chondrite groups but are similar to that of comet 81P/Wild2, suggesting that Ryugu and CI chondrites accreted in the outer Solar System closer to the accretion region of comets.

The Winchcombe meteorite, a unique and pristine witness from the outer solar system.

Direct links between carbonaceous chondrites and their parent bodies in the solar system are rare. The Winchcombe meteorite is the most accurately recorded carbonaceous chondrite fall. Its pre-atmospheric orbit and cosmic-ray exposure age confirm that it arrived on Earth shortly after ejection from a primitive asteroid. Recovered only hours after falling, the composition of the Winchcombe meteorite is largely unmodified by the terrestrial environment. It contains abundant hydrated silicates formed during fluid-rock reactions, and carbon- and nitrogen-bearing organic matter including soluble protein amino acids. The near-pristine hydrogen isotopic composition of the Winchcombe meteorite is comparable to the terrestrial hydrosphere, providing further evidence that volatile-rich carbonaceous asteroids played an important role in the origin of Earth's water.

Analytical protocols for Phobos regolith samples returned by the Martian Moons eXploration (MMX) mission.

Japan Aerospace Exploration Agency (JAXA) will launch a spacecraft in 2024 for a sample return mission from Phobos (Martian Moons eXploration: MMX). Touchdown operations are planned to be performed twice at different landing sites on the Phobos surface to collect > 10 g of the Phobos surface materials with coring and pneumatic sampling systems on board. The Sample Analysis Working Team (SAWT) of MMX is now designing analytical protocols of the returned Phobos samples to shed light on the origin of the Martian moons as well as the evolution of the Mars-moon system. Observations of petrology and mineralogy, and measurements of bulk chemical compositions and stable isotopic ratios of, e.g., O, Cr, Ti, and Zn can provide crucial information about the origin of Phobos. If Phobos is a captured asteroid composed of primitive chondritic materials, as inferred from its reflectance spectra, geochemical data including the nature of organic matter as well as bulk H and N isotopic compositions characterize the volatile materials in the samples and constrain the type of the captured asteroid. Cosmogenic and solar wind components, most pronounced in noble gas isotopic compositions, can reveal surface processes on Phobos. Long- and short-lived radionuclide chronometry such as 53Mn-53Cr and 87Rb-87Sr systematics can date pivotal events like impacts, thermal metamorphism, and aqueous alteration on Phobos. It should be noted that the Phobos regolith is expected to contain a small amount of materials delivered from Mars, which may be physically and chemically different from any Martian meteorites in our collection and thus are particularly precious. The analysis plan will be designed to detect such Martian materials, if any, from the returned samples dominated by the endogenous Phobos materials in curation procedures at JAXA before they are processed for further analyses.

The Fe/S ratio of pyrrhotite group sulfides in chondrites: An indicator of oxidation and implications for return samples from asteroids Ryugu and Bennu.

Determining compositional trends among individual minerals is key to understanding the thermodynamic conditions under which they formed and altered, and is also essential to maximizing the scientific value of small extraterrestrial samples, including returned samples and meteorites. Here we report the chemical compositions of Fe-sulfides, focusing on the pyrrhotite-group sulfides, which are ubiquitous in chondrites and are sensitive indicators of formation and alteration conditions in the protoplanetary disk and in small Solar System bodies. Our data show that while there are trends with the at.% Fe/S ratio of pyrrhotite with thermal and aqueous alteration in some meteorite groups, there is a universal trend between the Fe/S ratio and degree of oxidation. Relatively reducing conditions led to the formation of troilite during: (1) chondrule formation in the protoplanetary disk (i.e., pristine chondrites) and (2) parent body thermal alteration (i.e., LL4 to LL6, CR1, CM, and CY chondrites). Oxidizing and sulfidizing conditions led to the formation of Fe-depleted pyrrhotite with low Fe/S ratios during: (1) aqueous alteration (i.e., CM and CI chondrites), and (2) thermal alteration (i.e., CK and R chondrites). The presence of troilite in highly aqueously altered carbonaceous chondrites (e.g., CY, CR1, and some CM chondrites) indicates they were heated after aqueous alteration. The presence of troilite, Fe-depleted pyrrhotite, or pyrite in a chondrite can provide an estimate of the oxygen and sulfur fugacities at which it was formed or altered. The data reported here can be used to estimate the oxygen fugacity of formation and potentially the aqueous and/or thermal histories of sulfides in extraterrestrial samples, including those returned by the Hayabusa2 mission and due to be returned by the OSIRIS-REx mission in the near future.

Primordial formation of major silicates in a protoplanetary disc with homogeneous 26Al/27Al.

Understanding the spatial variability of initial 26Al/27Al in the solar system, i.e., (26Al/27Al)0, is of prime importance to meteorite chronology, planetary heat production, and protoplanetary disc mixing dynamics. The (26Al/27Al)0 of calcium-aluminum-rich inclusions (CAIs) in primitive meteorites (~5 × 10-5) is frequently assumed to reflect the (26Al/27Al)0 of the entire protoplanetary disc, and predicts its initial 26Mg/24Mg to be ~35 parts per million (ppm) less radiogenic than modern Earth (i.e., Δ'26Mg0 = -35 ppm). Others argue for spatially heterogeneous (26Al/27Al)0, where the source reservoirs of most primitive meteorite components have lower (26Al/27Al)0 at ~2.7 × 10-5 and Δ'26Mg0 of -16 ppm. We measured the magnesium isotope compositions of primitive meteoritic olivine, which originated outside of the CAI-forming reservoir(s), and report five grains whose Δ'26Mg0 are within uncertainty of -35 ppm. Our data thus affirm a model of a largely homogeneous protoplanetary disc with (26Al/27Al)0 of ~5 × 10-5, supporting the accuracy of the 26Al→26Mg chronometer.

The oldest magnetic record in our solar system identified using nanometric imaging and numerical modeling.

Recordings of magnetic fields, thought to be crucial to our solar system's rapid accretion, are potentially retained in unaltered nanometric low-Ni kamacite (~ metallic Fe) grains encased within dusty olivine crystals, found in the chondrules of unequilibrated chondrites. However, most of these kamacite grains are magnetically non-uniform, so their ability to retain four-billion-year-old magnetic recordings cannot be estimated by previous theories, which assume only uniform magnetization. Here, we demonstrate that non-uniformly magnetized nanometric kamacite grains are stable over solar system timescales and likely the primary carrier of remanence in dusty olivine. By performing in-situ temperature-dependent nanometric magnetic measurements using off-axis electron holography, we demonstrate the thermal stability of multi-vortex kamacite grains from the chondritic Bishunpur meteorite. Combined with numerical micromagnetic modeling, we determine the stability of the magnetization of these grains. Our study shows that dusty olivine kamacite grains are capable of retaining magnetic recordings from the accreting solar system.

An asteroidal origin for water in the Moon.

The Apollo-derived tenet of an anhydrous Moon has been contested following measurement of water in several lunar samples that require water to be present in the lunar interior. However, significant uncertainties exist regarding the flux, sources and timing of water delivery to the Moon. Here we address those fundamental issues by constraining the mass of water accreted to the Moon and modelling the relative proportions of asteroidal and cometary sources for water that are consistent with measured isotopic compositions of lunar samples. We determine that a combination of carbonaceous chondrite-type materials were responsible for the majority of water (and nitrogen) delivered to the Earth-Moon system. Crucially, we conclude that comets containing water enriched in deuterium contributed significantly <20% of the water in the Moon. Therefore, our work places important constraints on the types of objects impacting the Moon ∼4.5-4.3 billion years ago and on the origin of water in the inner Solar System.

A Predictive Model and Risk Score for Unplanned Cardiac Surgery Intensive Care Unit Readmissions.

BACKGROUND: Readmissions or "bounce back" to the intensive care unit (ICU) following cardiac surgery is associated with an increased risk of morbidity and mortality. We sought to identify clinical and system-based factors associated with ICU bounce backs in order to generate a Bounce Back After Transfer (BATS) prediction score. METHODS: We prospectively collected the clinical and financial records of all patients undergoing coronary artery bypass grafting (CABG) or surgical aortic valve replacement (AVR) between May 2013 and March 2014. Multivariable logistic regression was used to identify independent predictors of bounce backs to the ICU which served as the basis for our BATS score. RESULTS: Of the 532 patients that underwent CABG or AVR during the study period, 35 (6.6%) were readmitted to the ICU. After risk adjustment, female sex, NYHA class III/IV, urgent or emergent operative status, and postoperative renal failure were the predictors of ICU bounce backs utilized to create the BATS score. Patients in the low (<5), moderate (5-10), and high-risk (>10) score cohorts experienced bounce back rates of 3.0%, 10.4%, and 42%, respectively. After adjusting for preoperative patient risk, ICU bounce back resulted in an increase in $68,030 to a patient's total hospital charges. CONCLUSIONS: A predictive model (BATS) can determine the risk of a bounce back to the ICU after transfer to the floor. We speculate that determination of a patient's BATS upon ICU transfer would allow targeted floor care and decrease bounce back rates, along with postoperative morbidity, mortality, and cost of care.

Heterogeneity in lunar anorthosite meteorites: implications for the lunar magma ocean model.

The lunar magma ocean model is a well-established theory of the early evolution of the Moon. By this model, the Moon was initially largely molten and the anorthositic crust that now covers much of the lunar surface directly crystallized from this enormous magma source. We are undertaking a study of the geochemical characteristics of anorthosites from lunar meteorites to test this model. Rare earth and other element abundances have been measured in situ in relict anorthosite clasts from two feldspathic lunar meteorites: Dhofar 908 and Dhofar 081. The rare earth elements were present in abundances of approximately 0.1 to approximately 10× chondritic (CI) abundance. Every plagioclase exhibited a positive Eu-anomaly, with Eu abundances of up to approximately 20×CI. Calculations of the melt in equilibrium with anorthite show that it apparently crystallized from a magma that was unfractionated with respect to rare earth elements and ranged in abundance from 8 to 80×CI. Comparisons of our data with other lunar meteorites and Apollo samples suggest that there is notable heterogeneity in the trace element abundances of lunar anorthosites, suggesting these samples did not all crystallize from a common magma source. Compositional and isotopic data from other authors also suggest that lunar anorthosites are chemically heterogeneous and have a wide range of ages. These observations may support other models of crust formation on the Moon or suggest that there are complexities in the lunar magma ocean scenario to allow for multiple generations of anorthosite formation.

Bevacizumab plus ipilimumab in patients with metastatic melanoma.

Ipilimumab improves survival in advanced melanoma and can induce immune-mediated tumor vasculopathy. Besides promoting angiogenesis, vascular endothelial growth factor (VEGF) suppresses dendritic cell maturation and modulates lymphocyte endothelial trafficking. This study investigated the combination of CTLA4 blockade with ipilimumab and VEGF inhibition with bevacizumab. Patients with metastatic melanoma were treated in four dosing cohorts of ipilimumab (3 or 10 mg/kg) with four doses at 3-week intervals and then every 12 weeks, and bevacizumab (7.5 or 15 mg/kg) every 3 weeks. Forty-six patients were treated. Inflammatory events included giant cell arteritis (n = 1), hepatitis (n = 2), and uveitis (n = 2). On-treatment tumor biopsies revealed activated vessel endothelium with extensive CD8(+) and macrophage cell infiltration. Peripheral blood analyses demonstrated increases in CCR7(+/-)/CD45RO(+) cells and anti-galectin antibodies. Best overall response included 8 partial responses, 22 instances of stable disease, and a disease-control rate of 67.4%. Median survival was 25.1 months. Bevacizumab influences changes in tumor vasculature and immune responses with ipilimumab administration. The combination of bevacizumab and ipilimumab can be safely administered and reveals VEGF-A blockade influences on inflammation, lymphocyte trafficking, and immune regulation. These findings provide a basis for further investigating the dual roles of angiogenic factors in blood vessel formation and immune regulation, as well as future combinations of antiangiogenesis agents and immune checkpoint blockade.

Effective low-dose escalation of indocyanine green for near-infrared fluorescent sentinel lymph node mapping in melanoma.

BACKGROUND: Regional lymph node metastasis is the strongest prognostic factor in patients with melanoma. Published reports that used lymphoscintigraphy with radioactive colloids and blue dye demonstrated accurate sentinel lymph node (SLN) identification in inguinal nodes and axillary nodes, but decreased accuracy in cervical, popliteal, epitrochlear, and parascapular nodes. Near-infrared imaging (NIR) may utilize indocyanine green (ICG) to improve SLN identification. The safety, feasibility and optimal dose of albumin-bound ICG (ICG:HSA) was assessed by NIR to improve SLN mapping in patients with melanoma. METHODS: Twenty-five consecutive patients with biopsy-proven melanoma underwent standard SLN mapping with preoperatively administered technetium-99 m nanocolloid (Tc-99 m). Intraoperative NIR fluorescence imaging was performed after injection of 1.0 ml of 100, 250 or 500 µM of ICG:HSA in four quadrants around the primary lesion. RESULTS: NIR fluorescent imaging demonstrated accuracy of 98 % when compared with radioactive colloid. A total of 65 lymph nodes were identified (65 with Tc-99 m, 64 with ICG:HSA). Overall, successful mapping that used either technique was 96 % as one patient failed to map with either modality. As the dose of ICG was increased, the signal-to-background ratio increased from a median of 3.1 to 8.4 to 10.9 over the range of 100, 250, and 500 µM, respectively. CONCLUSIONS: SLN mapping with ICG:HSA is feasible and accurate in melanoma. ICG has the added advantage of a low cost and an intraoperative technique that does not alter the surgical field, thus allowing for easy identification of SLNs.

Surveillance for Clostridium difficile infection in nursing homes.

OBJECTIVES: To define the time of onset of Clostridium difficile infection (CDI) in the community nursing home setting. DESIGN: Retrospective. SETTING: Four community nursing homes. PARTICIPANTS: Residents with incident CDI identified from infection control surveillance records. MEASUREMENTS: Cases were divided into two groups depending on the time of onset of infection: within 30 days of admission after hospitalization or more than 30 days after admission to a nursing home after hospitalization. RESULTS: Of 75 incident CDI cases, 52 (69%) developed within 30 days of admission and 23 (31%) more than 30 days after admission. Of the 52 cases that developed within 30 days, 68% were in residents admitted for subacute care. The mean number of days ± standard deviation to CDI was 10.5 ± 2.5 in those who developed infection within 30 days; 75% of these cases developed within 15 days of admission. CONCLUSIONS: The majority of CDI in the study nursing homes developed within 30 days of admission; this group may be analogous to community-onset, hospital-associated CDI as defined in the Centers for Disease Control and Prevention (CDC) surveillance definitions. Therefore, the proposed CDC surveillance definitions may overestimate the incidence of nursing home-associated CDI.

Establishment of antitumor memory in humans using in vitro-educated CD8+ T cells.

Although advanced-stage melanoma patients have a median survival of less than a year, adoptive T cell therapy can induce durable clinical responses in some patients. Successful adoptive T cell therapy to treat cancer requires engraftment of antitumor T lymphocytes that not only retain specificity and function in vivo but also display an intrinsic capacity to survive. To date, adoptively transferred antitumor CD8(+) T lymphocytes (CTLs) have had limited life spans unless the host has been manipulated. To generate CTLs that have an intrinsic capacity to persist in vivo, we developed a human artificial antigen-presenting cell system that can educate antitumor CTLs to acquire both a central memory and an effector memory phenotype as well as the capacity to survive in culture for prolonged periods of time. We examined whether antitumor CTLs generated using this system could function and persist in patients. We showed that MART1-specific CTLs, educated and expanded using our artificial antigen-presenting cell system, could survive for prolonged periods in advanced-stage melanoma patients without previous conditioning or cytokine treatment. Moreover, these CTLs trafficked to the tumor, mediated biological and clinical responses, and established antitumor immunologic memory. Therefore, this approach may broaden the availability of adoptive cell therapy to patients both alone and in combination with other therapeutic modalities.

Severe acute gastrointestinal graft-vs-host disease: an emerging surgical dilemma in contemporary cancer care.

OBJECTIVE: To determine the natural history of and guidelines for the surgical management of severe acute gastrointestinal (GI) graft-vs-host disease (GVHD) after allogeneic hematopoietic stem cell transplantation (HSCT). DESIGN: Case series from a prospective database. SETTING: Tertiary care referral center/National Cancer Institute-designated Comprehensive Cancer Center. PATIENTS: A total of 63 of 2065 patients (3%) undergoing HSCT for hematologic malignancies from February 1997 to March 2005 diagnosed clinically with severe (stage 3 or 4) acute GI GVHD. Main Outcome Measure Percutaneous or surgical intervention. Perforation, obstruction, ischemia, hemorrhage, and abscess were considered surgically correctable problems. RESULTS: Severe acute GI GVHD was diagnosed in 63 patients (median age at HSCT, 47.6 years) at a median of 23 days after HSCT. Clinical diagnosis was confirmed histologically in 84% of patients. On computed tomography and/or magnetic resonance images, 64% had bowel wall thickening, 20% had a normal-appearing bowel, and 16% had nonspecific findings; none had evidence of perforation, obstruction, or abscess. All were initially treated with immunosuppression. Only 1 patient (1.6%) required intervention, undergoing a nontherapeutic laparotomy for worsening abdominal pain. A total of 83% of patients have died (median time to death from HSCT, 119 days; from GI GVHD diagnosis, 85 days). None who underwent an autopsy died of a surgically correctable cause. CONCLUSIONS: This series represents a large single-center experience with GI GVHD reviewed from a surgical perspective. Operative intervention was rarely required. Therefore, mature surgical judgment is necessary to confirm the absence of surgically reversible problems, thus avoiding unnecessary operations in this challenging patient population.

Comment on "ancient asteroids enriched in refractory inclusions".

Sunshine et al. (Reports, 25 April 2008, p. 514) reported that certain asteroids contain 30 +/- 10 volume percent calcium- and aluminum-rich inclusions (CAIs). We contend that the amount of CAIs in CV chondrites is two to three times as low as the 10 volume percent assumed by the authors; thus, we question whether the CAI-rich bodies they studied are indeed older than known asteroids or formed before the injection of (26)Al into the solar nebula.