ATCA and Spitzer Observations of the Binary Protostellar Systems CG30 and BHR71

We present interferometric observations with resolution of ~3 arcsecs of the isolated, low-mass protostellar double cores CG30 and BHR71 in the N2$H+(1-0) line and at 3mm dust continuum, using the Australian Telescope Compact Array (ATCA). The results are complemented by infrared data from the Spitzer Space Telescope. In CG30, the 3mm dust continuum images resolve two compact sources with a separation of ~21.7 arcsecs (~8700 AU). In BHR71, strong dust continuum emission is detected at the position of the mid-infrared source IRS1, while only weak emission is detected from the secondary mid-infrared source IRS2. Assuming optically thin 3mm dust continuum emission, we derive hydrogen gas masses of 0.05--2.1$M_\odot$for the four sub-cores. N2H+(1-0) line emission is detected in both CG30 and BHR71, and is spatially associated with the thermal dust continuum emission. We derive the velocity fields and find symmetric velocity gradients in both sources. Assuming that these gradients are due to core rotation, we estimate the specific angular momenta and ratios of rotational energy to gravitational energy for all cores. We also find that the N2H+ emission is strongly affected by the outflows, both in terms of entrainment and molecule destruction.$Spitzer$images show the mid-infrared emission from all four sub-cores. All four sources appear to drive their own outflows. Based on the ATCA and$Spitzer$ observations, we construct spectral energy distributions (SEDs) and derive temperatures and luminosities for all cores. Based on the morphology and velocity structure, we suggest that the sub-cores in CG30 were formed by initial fragmentation of a filamentary prestellar core, while those in BHR71 could originate from rotational fragmentation of a single collapsing protostellar core.Comment: 31 pages, 10 figures, to be published by ApJ in Sep. 200

Can Electronic Health Records Systems Support New Payment Methods for Health Centers?

This study assessed the feasibility and usefulness of combining electronic health record (EHR) data with federal cost report data for the purposes of: 1) quantifying the provision of enabling services; and 2) for use as the basis of community health center payment rate-setting. The study used EHR data derived from the Center for Primary Care Informatics to isolate enabling services and perform the end-to-end analysis that might be required to develop or evaluate reimbursement rates. The study revealed that data extracted from federal cost reports combined with data from the EHR fall short of providing the information required to reasonably develop new rate setting approaches or evaluate existing rates as they might be applied to community health centers. Specifically, key findings include: Use of internal, center-specific codes (for example, in CPT fields) complicates the translation into relative value units (RVUs) and the aggregation of comparable data across health centers. Enabling services are difficult to quantify. Vague and inconsistent position titles lead to potential inaccuracies in the allocation of expenses. The current funding environment deters capture of new information. This study raises fundamental questions about how to quantify (let alone how to reimburse) the true value associated with the community health center model of care. The study recommends tailoring EHR products to better capture the unique services provided by health centers and their effective management of high-risk patients. Fully moving to value-based reimbursement models will likely require that health centers adapt workflow to ensure that additional critical information (e.g., social determinants of health) is properly entered as structured data and not merely as scanned notes and other documentatio

Palmoplantar keratoderma along with neuromuscular and metabolic phenotypes in Slurp1-deficient mice.

Mutations in SLURP1 cause mal de Meleda, a rare palmoplantar keratoderma (PPK). SLURP1 is a secreted protein that is expressed highly in keratinocytes but has also been identified elsewhere (e.g., spinal cord neurons). Here, we examined Slurp1-deficient mice (Slurp1(-/-)) created by replacing exon 2 with β-gal and neo cassettes. Slurp1(-/-) mice developed severe PPK characterized by increased keratinocyte proliferation, an accumulation of lipid droplets in the stratum corneum, and a water barrier defect. In addition, Slurp1(-/-) mice exhibited reduced adiposity, protection from obesity on a high-fat diet, low plasma lipid levels, and a neuromuscular abnormality (hind-limb clasping). Initially, it was unclear whether the metabolic and neuromuscular phenotypes were due to Slurp1 deficiency, because we found that the targeted Slurp1 mutation reduced the expression of several neighboring genes (e.g., Slurp2, Lypd2). We therefore created a new line of knockout mice (Slurp1X(-/-) mice) with a simple nonsense mutation in exon 2. The Slurp1X mutation did not reduce the expression of adjacent genes, but Slurp1X(-/-) mice exhibited all of the phenotypes observed in the original line of knockout mice. Thus, Slurp1 deficiency in mice elicits metabolic and neuromuscular abnormalities in addition to PPK

Auxiliary particle theory of threshold singularities in photoemission and X-ray absorption spectra: Test of a conserving T-matrix approximation

We calculate the exponents of the threshold singularities in the photoemission spectrum of a deep core hole and its X-ray absorption spectrum in the framework of a systematic many-body theory of slave bosons and pseudofermions (for the empty and occupied core level). In this representation, photoemission and X-ray absorption can be understood on the same footing; no distinction between orthogonality catastrophe and excitonic effects is necessary. We apply the conserving slave particle T-matrix approximation (CTMA), recently developed to describe both Fermi and non-Fermi liquid behavior systems with strong local correlations, to the X-ray problem as a test case. The numerical results for both photoemission and X-ray absorption are found to be in agreement with the exact infrared powerlaw behavior in the weak as well as in the strong coupling regions. We point out a close relation of the CTMA with the parquet equation approach of Nozi{\`e}res et al.Comment: 10 pages, 9 figures, published versio

High-Mass Cloud Cores in the eta Carinae Giant Molecular Cloud

We carried out an unbiased survey for massive dense cores in the giant molecular cloud associated with eta Carinae with the NANTEN telescope in 12CO, 13CO, and C18O 1-0 emission lines. We identified 15 C18O cores. Two of the 15 cores are associated with IRAS point sources whose luminosities are larger than 10^4 Lo, which indicates that massive star formation is occuring within these cores. Five cores including the two with IRAS sources are associated with MSX point sources. We detected H13CO+ (1-0) emission toward 4 C18O cores, one of which is associated with neither IRAS nor MSX point sources. This core shows the presence of a bipolar molecular outflow in 12CO (2-1), which indicates that star formation is also occuring in the core. In total, six C18O cores out of 15 are experienced star formation, and at least 2 of 15 are massive-star forming cores in the eta Car GMC. We found that massive star formation occurs preferentially in cores with larger column density, mass, number density, and smaller ratio of virial mass to LTE mass Mvir/M. We also found that the cores in the eta Car GMC are characterized by large line width and Mvir/M on average compared to the cores in other GMCs. We investigated the origin of a large amount of turbulence in the eta Car GMC. We propose the possibility that the large turbulence was pre-existing when the GMC was formed, and is now dissipating. Mechanisms such as multiple supernova explosions in the Carina flare supershell may have contributed to form a GMC with a large amount of turbulence.Comment: 41 pages, including 11 fugures and 9 tables. Accepted by ApJ. Author changed. Paper with high resolution figures is available at http://astrol.cias.osakafu-u.ac.jp/~yonekura/work/paper/etaCar

Transoral incisionless fundoplication effective in eliminating GERD symptoms in partial responders to proton pump inhibitor therapy at 6 months: The TEMPO randomized clinical trial

Background. Incomplete control of troublesome regurgitation and extraesophageal manifestations of chronic gastroesophageal reflux disease (GERD) is a known limitation of proton pump inhibitor (PPI) therapy. This multicenter randomized study compared the efficacy of transoral incisionless fundoplication (TIF) against PPIs in controlling these symptoms in patients with small hiatal hernias. Methods. Between June and August 2012, 63 patients were randomized at 7 US community hospitals. Patients in the PPI group were placed on maximum standard dose (MSD). Patients in the TIF group underwent esophagogastric fundoplication using the EsophyX2 device. Primary outcome was elimination of daily troublesome regurgitation or extraesophageal symptoms. Secondary outcomes were normalization of esophageal acid exposure (EAE), PPI usage and healing of esophagitis. Results. Of 63 randomized patients (40 TIF and 23 PPI), 3 were lost to follow-up leaving 39 TIF and 21 PPI patients for analysis. At 6-month follow-up, troublesome regurgitation was eliminated in 97% of TIF patients versus 50% of PPI patients, relative risk (RR) = 1.9, 95% confidence interval (CI) = 1.2-3.11 (P = .006). Globally, 62% of TIF patients experienced elimination of regurgitation and extraesophageal symptoms versus 5% of PPI patients, RR = 12.9, 95% CI = 1.9-88.9 (P = .009). EAE was normalized in 54% of TIF patients (off PPIs) versus 52% of PPI patients (on MSD), RR = 1.0, 95% CI = 0.6-1.7 (P = .914). Ninety percent of TIF patients were off PPIs. Conclusion. At 6-month follow-up, TIF was more effective than MSD PPI therapy in eliminating troublesome regurgitation and extraesophageal symptoms of GERD

The Millimeter Astronomy Legacy Team 90 GHz (MALT90) Pilot Survey

We describe a pilot survey conducted with the Mopra 22-m radio telescope in preparation for the Millimeter Astronomy Legacy Team Survey at 90 GHz (MALT90). We identified 182 candidate dense molecular clumps using six different selection criteria and mapped each source simultaneously in 16 different lines near 90 GHz. We present a summary of the data and describe how the results of the pilot survey shaped the design of the larger MALT90 survey. We motivate our selection of target sources for the main survey based on the pilot detection rates and demonstrate the value of mapping in multiple lines simultaneously at high spectral resolution.Comment: Accepted to ApJS. 23 pages and 16 figures. Full resolution version with an appendix showing all the data (12.1 MB) is available at http://malt90.bu.edu/publications/Foster_2011_Malt90Pilot.pd

Commissioning and quality assurance for VMAT delivery systems: An efficient time-resolved system using real-time EPID imaging.

PURPOSE: An ideal commissioning and quality assurance (QA) program for Volumetric Modulated Arc Therapy (VMAT) delivery systems should assess the performance of each individual dynamic component as a function of gantry angle. Procedures within such a program should also be time-efficient, independent of the delivery system and be sensitive to all types of errors. The purpose of this work is to develop a system for automated time-resolved commissioning and QA of VMAT control systems which meets these criteria. METHODS: The procedures developed within this work rely solely on images obtained, using an electronic portal imaging device (EPID) without the presence of a phantom. During the delivery of specially designed VMAT test plans, EPID frames were acquired at 9.5 Hz, using a frame grabber. The set of test plans was developed to individually assess the performance of the dose delivery and multileaf collimator (MLC) control systems under varying levels of delivery complexities. An in-house software tool was developed to automatically extract features from the EPID images and evaluate the following characteristics as a function of gantry angle: dose delivery accuracy, dose rate constancy, beam profile constancy, gantry speed constancy, dynamic MLC positioning accuracy, MLC speed and acceleration constancy, and synchronization between gantry angle, MLC positioning and dose rate. Machine log files were also acquired during each delivery and subsequently compared to information extracted from EPID image frames. RESULTS: The largest difference between measured and planned dose at any gantry angle was 0.8% which correlated with rapid changes in dose rate and gantry speed. For all other test plans, the dose delivered was within 0.25% of the planned dose for all gantry angles. Profile constancy was not found to vary with gantry angle for tests where gantry speed and dose rate were constant, however, for tests with varying dose rate and gantry speed, segments with lower dose rate and higher gantry speed exhibited less profile stability. MLC positional accuracy was not observed to be dependent on the degree of interdigitation. MLC speed was measured for each individual leaf and slower leaf speeds were shown to be compensated for by lower dose rates. The test procedures were found to be sensitive to 1 mm systematic MLC errors, 1 mm random MLC errors, 0.4 mm MLC gap errors and synchronization errors between the MLC, dose rate and gantry angle controls systems of 1°. In general, parameters measured by both EPID and log files agreed with the plan, however, a greater average departure from the plan was evidenced by the EPID measurements. CONCLUSION: QA test plans and analysis methods have been developed to assess the performance of each dynamic component of VMAT deliveries individually and as a function of gantry angle. This methodology relies solely on time-resolved EPID imaging without the presence of a phantom and has been shown to be sensitive to a range of delivery errors. The procedures developed in this work are both comprehensive and time-efficient and can be used for streamlined commissioning and QA of VMAT delivery systems

Chronic Obstructive Pulmonary Disease: Effects beyond the Lungs

Peter Barnes discusses the growing epidemic of chronic obstructive pulmonary disease (COPD), especially in developing countries and among nonsmokers