Recent activity of the Be/X-ray binary system SAX J2103.5+4545

Aims. We present a multiwavelength study of the Be/X-ray binary system SAX J2103.5+4545 with the goal of better characterizing the transient behaviour of this source. Methods. SAX J2103.5+4545 was observed by Swift-XRT four times in 2007 from April 25 to May 5, and during quiescence in 2012 August 31. In addition, this source has been monitored from the ground-based astronomical observatories of El Teide (Tenerife, Spain), Roque de los Muchachos (La Palma, Spain) and Sierra Nevada (Granada, Spain) since 2011 August, and from the TUBITAK National Observatory (Antalya, Turkey) since 2009 June. We have performed spectral and photometric temporal analyses in order to investigate the different states exhibited by SAX J2103.5+4545. Results. In X-rays, an absorbed power law model provided the best fit for all the XRT spectra. An iron-line feature at ~6.42 keV was present in all the observations except for that taken during quiescence in 2012. The photon indexes are consistent with previous studies of SAX J2103.5+4545 in high/low luminosity states. Pulsations were found in all the XRT data from 2007 (2.839(2) mHz; MJD 54222.02), but not during quiescence. Both optical outbursts in 2010 and 2012 lasted for about 8/9 months (as the one in 2007 probably did and the current one in 2014 might do) and were most probably caused by mass ejection events from the Be star that eventually fed the circumstellar disc. All of these outbursts started about 3 months before the triggering of the X-ray activity, and about the same period before the maximum of the H_alpha line equivalent width (in emission) was reached at only ~ -5 \AA. In this work we found that the global correlation between the BV variability and the X-ray intensity was also observed at longer wavelengths in the IR domain.Comment: 11 pages, 7 figures, and online material (2 tables). Submitted to A&A in 2014 Januar

A 0535+26: an X-ray/Optical Tour

We compiled X-ray and Optical observations of the accreting X-ray binary system A 0535+262 since its discovery in 1975, that will allow us to shed light on the unpredictable behavior of this binary system. We present the data in terms of the Be-disk interaction with the neutron star companion. In addition, we show recent results from the continuous monitoring of this source by the Gamma-ray Burst Monitor(GBM), on board the Fermi observatory, since its launch in 2008 June 11.Comment: 4 pages, 5 figures, Conference proceeding of "Astrophysics of Neutron Stars 2010 - a conference in honor of M. Ali Alpar", 2-6 August 2010, Cesme, Izmir, Turke

Developing a tool for mapping adult mental health care provision in Europe: the REMAST research protocol and its contribution to better integrated care

Introduction: Mental health care is a critical area to better understand integrated care and to pilot the different components of the integrated care model. However, there is an urgent need for better tools to compare and understand the context of integrated mental health care in Europe. Method: The REMAST tool (REFINEMENT MApping Services Tool) combines a series of standardised health service research instruments and geographical information systems (GIS) to develop local atlases of mental health care from the perspective of horizontal and vertical integrated care. It contains five main sections: (a) Population Data; (b) the Verona Socio-economic Status (SES) Index; (c) the Mental Health System Checklist; (d) the Mental Health Services Inventory using the DESDE-LTC instrument; and (e) Geographical Data. Expected results: The REMAST tool facilitates context analysis in mental health by providing the comparative rates of mental health service provision according to the availability of main types of care; care placement capacity; workforce capacity; and geographical accessibility to services in the local areas in eight study areas in Austria, England, Finland, France, Italy, Norway, Romania and Spain. Discussion: The outcomes of this project will facilitate cooperative work and knowledge transfer on mental health care to the different agencies involved in mental health planning and provision. This project would improve the information to users and society on the available resources for mental health care and system thinking at the local level by the different stakeholders. The techniques used in this project and the knowledge generated could eventually be transferred to the mapping of other fields of integrated care

Spanish medical students’ attitudes and views towards Mental Health and Psychiatry: a multicentric cross-sectional study.

Objective The aim of this study is to investigate the attitudes towards mental illness and psychiatry among fifth year Spanish medical students. Methods The study included 171 students from three medical schools located in different areas of Spain: Cádiz; UCA (n= 113), Madrid; San Pablo-CEU (n=22), and Barcelona; UAB (n=36). They responded, prior to their undergraduate medical course in psychiatry, to the AMI questionnaire to measure the attitudes towards mental illness and to Balon’s adapted questionnaire to investigate their view towards psychiatry. Results The students (93.4 %) had a positive attitude towards mental illness (AMI). Attitudes towards psychiatry were fairly positive with a few negative views, specifically regarding the role of psychiatrists (items 11 and 13) and the prestige of the specialty (item 16). There were some statistically significant differences between the three medical schools in the perception of psychiatry as a medical discipline. A better attitude towards mental illness was associated with a better view of the overall merits of psychiatry. Conclusions Findings suggest that Spanish medical students do not have a negative attitude towards mental illness and they have a good perception of psychiatry, although there are still some misconceptions about this specialty. These student’s attitudes could favor an appropriate management of patients suffering from mental illness

X-Ray and Optical Observations of A 0535+26

We present recent contemporaneous X-ray and optical observations of the Be/X-ray binary system A\,0535+26 with the \textit{Fermi}/Gamma-ray Burst Monitor (GBM) and several ground-based observatories. These new observations are put into the context of the rich historical data (since $\sim$1978) and discussed in terms of the neutron star Be-disk interaction. The Be circumstellar disk was exceptionally large just before the 2009 December giant outburst, which may explain the origin of the unusual recent X-ray activity of this source. We found a peculiar evolution of the pulse profile during this giant outburst, with the two main components evolving in opposite ways with energy. A hard 30-70 mHz X-ray QPO was detected with GBM during this 2009 December giant outburst. It becomes stronger with increasing energy and disappears at energies below 25\,keV. In the long-term a strong optical/X-ray correlation was found for this system, however in the medium-term the H$_\alpha$ EW and the V-band brightness showed an anti-correlation after $\sim$2002 Agust. Each giant X-ray outburst occurred during a decline phase of the optical brightness, while the H$_\alpha$ showed a strong emission. In late 2010 and before the 2011 February outburst, rapid V/R variations are observed in the strength of the two peaks of the H$_\alpha$ line. These had a period of $\sim$\,25 days and we suggest the presence of a global one-armed oscillation to explain this scenario. A general pattern might be inferred, where the disk becomes weaker and shows V/R variability beginning $\sim$\,6 months following a giant outburst.Comment: 18, 11 figures, 1 tabl

Response to Novel Drugs before and after Allogeneic Stem Cell Transplantation in Patients with Relapsed Multiple Myeloma

Multiple myeloma (MM) remains as an incurable disease and, although allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potentially curative approach, most patients ultimately relapse, and their treatment remains challenging. Because allo-HSCT can modify not only the biology of the disease, but also the immune system and the microenvironment, it can potentially enhance the response to rescue therapies. Information on the efficacy and safety of novel drugs in patients relapsing after allo-HSCT is lacking, however. The objectives of this study were to evaluate the efficacy and toxicity of rescue therapies in patients with MM who relapsed after allo-HSCT, as well as to compare their efficacy before and after allo-HSCT. This retrospective multicenter study included 126 consecutive patients with MM who underwent allo-HSCT between 2000 and 2013 at 8 Spanish centers. All patients engrafted. The incidence of grade II-IV acute graft-versus-host disease (GVHD) was 47%, and nonrelapse mortality within the first 100 days post-transplantation was 13%. After a median follow-up of 92 months, overall survival (OS) was 51% at 2 years and 43% at 5 years. The median progression-free survival after allo-HSCT was 7 months, whereas the median OS after relapse was 33 months. Patients relapsing in the first 6 months after transplantation had a dismal prognosis compared with those who relapsed later (median OS, 11 months versus 120 months; P <.001). The absence of chronic GVHD was associated with reduced OS after relapse (hazard ratio, 3.44; P <.001). Most patients responded to rescue therapies, including proteasome inhibitors (PIs; 62%) and immunomodulatory drugs (IMiDs; 77%), with a good toxicity profile. An in-depth evaluation, including the type and intensity of PI- and IMiD-based combinations used before and after allo-HSCT, showed that the overall response rate and duration of response after allo-HSCT were similar to those seen in the pretransplantation period. Patients with MM who relapse after allo-HSCT should be considered candidates for therapy with new drugs, which can achieve similar response rates with similar durability as seen in the pretransplantation period. This pattern does not follow the usual course of the disease outside the transplantation setting, where response rates and time to progression decreases with each consecutive line of treatment

The adjusted International Prognostic Index and beta-2-microglobulin predict the outcome after autologous stem cell transplantation in relapsing/refractory peripheral T-cell lymphoma

BACKGROUND AND OBJECTIVES: Preliminary data on the use of autologous stem cell transplantation (ASCT) as a salvage therapy for peripheral T-cell lymphoma (PTCL) indicate that the results are similar to those obtained in aggressive B-cell lymphomas. The aim of our study was to analyze outcomes of a large series of patients with PTCL with a prolonged follow-up who received ASCT as salvage therapy. DESIGN AND METHODS: Between 1990 and 2004, 123 patients in this situation were registered in the GELTAMO database. The median age at transplantation was 43.5 years; in 91% of patients the disease was chemosensitive. RESULTS: Seventy-three percent of the patients achieved complete remission, 11% partial remission and the procedure failed in 16%. At a median follow-up of 61 months, the 5-year overall and progression-free survival rates were 45% and 34%, respectively. The presence of more than one factor of the adjusted International Prognostic Index (a-IPI) and a high beta2-microglobulin at transplantation were identified as adverse prognostic factors for both overall and progression-free survival and allowed the population to be stratified into three distinct risk groups. INTERPRETATION AND CONCLUSIONS: Our data show that approximately one third of patients with PTCL in the salvage setting may enjoy prolonged survival following ASCT, provided they are transplanted in a chemosensitive disease state. The a-IPI and beta2-microglobulin level predict the outcome after ASCT in relapsing/refractory PTCL

Response-adapted treatment with rituximab, bendamustine, mitoxantrone, and dexamethasone followed by rituximab maintenance in patients with relapsed or refractory follicular lymphoma after first-line immunochemotherapy: Results of the RBMDGELTAMO08 phase II trial

Background Consensus is lacking regarding the optimal salvage therapy for patients with follicular lymphoma who relapse after or are refractory to immunochemotherapy. Methods This phase II trial evaluated the efficacy and safety of response-adapted therapy with rituximab, bendamustine, mitoxantrone, and dexamethasone (RBMD) in follicular lymphoma patients who relapsed after or were refractory to first-line immunochemotherapy. Sixty patients received three treatment cycles, and depending on their response received an additional one (complete/unconfirmed complete response) or three (partial response) cycles. Patients who responded to induction received rituximab maintenance therapy for 2 years. Results Thirty-three (55%) and 42 (70%) patients achieved complete/unconfirmed complete response after three cycles and on completing induction therapy (4-6 cycles), respectively (final overall response rate, 88.3%). Median progression-free survival was 56.4 months (median follow-up, 28.3 months; 95% CI, 15.6-51.2). Overall survival was not reached. Progression-free survival did not differ between patients who received four vs six cycles (P = .6665), nor between patients who did/did not receive rituximab maintenance after first-line therapy (P = .5790). Median progression-free survival in the 10 refractory patients was 25.5 months (95% CI, 0.6-N/A) and was longer in patients who had shown progression of disease after 24 months of first-line therapy (median, 56.4 months; 95% CI, 19.8-56.4) than in those who showed early progression (median, 42.31 months; 95% CI, 24.41-NA) (P = .4258). Thirty-six (60%) patients had grade 3/4 neutropenia. Grade 3/4 febrile neutropenia and infection were recorded during induction (4/60 [6.7%] and 5/60 [8.3%] patients, respectively) and maintenance (2/43 [4.5%] and 4/43 [9.1%] patients, respectively). Conclusions This response-adapted treatment with RBMD followed by rituximab maintenance is an effective and well-tolerated salvage treatment for relapsed/refractory follicular lymphoma following first-line immunochemotherapy