Role of the community matron in advance care planning and ‘do not attempt CPR’ decision-making: a qualitative study

The community matron (CM) is often the key worker caring for patients with chronic, life-limiting, long-term conditions, but these patients are not always recognised as palliative cases. This study explored the experiences of CMs with regard to advance care planning (ACP) and ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) decision-making to understand whether or not they felt adequately prepared for this aspect of their role, and why. Qualitative data were generated from six CMs using a broad interpretive phenomenological approach. Face-to-face recorded interviews were analysed using template analysis. The study found that although participants faced complex ethical situations around ACP and DNACPR almost on a daily basis, none had received any formal training despite the emphasis on training in national and local guidelines. Participants often struggled to get their patients accepted on to the Gold Standards Framework. The research found variability and complexity of cases to be the main barriers to clear identification of the palliative phase

On continuum driven winds from rotating stars

We study the dynamics of continuum driven winds from rotating stars, and develop an approximate analytical model. We then discuss the evolution of stellar angular momentum, and show that just above the Eddington limit, the winds are sufficiently concentrated towards the poles to spin up the star. A twin-lobe structure of the ejected nebula is seen to be a generic consequence of critical rotation. We find that if the pressure in such stars is sufficiently dominated by radiation, an equatorial ejection of mass will occur during eruptions. These results are then applied to {\eta}-Carinae. We show that if it began its life with a high enough angular momentum, the present day wind could have driven the star towards critical rotation, if it is the dominant mode of mass loss. We find that the shape and size of the Homunculus nebula, as given by our model, agree with recent observations. Moreover, the contraction expected due to the sudden increase in luminosity at the onset of the Great Eruption explains the equatorial "skirt" as well.Comment: 8 pages, 4 figure

Protein structure and phenotypic analysis of pathogenic and population missense variants in STXBP1

Background: Syntaxin-binding protein 1, encoded by STXBP1, is highly expressed in the brain and involved in fusing synaptic vesicles with the plasma membrane. Studies have shown that pathogenic loss-of-function variants in this gene result in various types of epilepsies, mostly beginning early in life. We were interested to model pathogenic missense variants on the protein structure to investigate the mechanism of pathogenicity and genotype–phenotype correlations. Methods: We report 11 patients with pathogenic de novo mutations in STXBP1 identified in the first 4293 trios of the Deciphering Developmental Disorder (DDD) study, including six missense variants. We analyzed the structural locations of the pathogenic missense variants from this study and the literature, as well as population missense variants extracted from Exome Aggregation Consortium (ExAC). Results: Pathogenic variants are significantly more likely to occur at highly conserved locations than population variants, and be buried inside the protein domain. Pathogenic mutations are also more likely to destabilize the domain structure compared with population variants, increasing the proportion of (partially) unfolded domains that are prone to aggregation or degradation. We were unable to detect any genotype–phenotype correlation, but unlike previously reported cases, most of the DDD patients with STXBP1 pathogenic variants did not present with very early-onset or severe epilepsy and encephalopathy, though all have developmental delay with intellectual disability and most display behavioral problems and suffered seizures in later childhood. Conclusion: Variants across STXBP1 that cause loss of function can result in severe intellectual disability with or without seizures, consistent with a haploinsufficiency mechanism. Pathogenic missense mutations act through destabilization of the protein domain, making it prone to aggregation or degradation. The presence or absence of early seizures may reflect ascertainment bias in the literature as well as the broad recruitment strategy of the DDD study

SN 2007od: A Type IIP SN with Circumstellar Interaction

SN 2007od exhibits characteristics that have rarely been seen in a Type IIP supernova (SN). Optical V band photometry reveals a very steep brightness decline between the plateau and nebular phases of ~4.5 mag, likely due to SN 2007od containing a low mass of 56Ni. The optical spectra show an evolution from normal Type IIP with broad Halpha emission, to a complex, four component Halpha emission profile exhibiting asymmetries caused by dust extinction after day 232. This is similar to the spectral evolution of the Type IIn SN 1998S, although no early-time narrow (~200 km s-1) Halpha component was present in SN 2007od. In both SNe, the intermediate-width Halpha emission components are thought to arise in the interaction between the ejecta and its circumstellar medium (CSM). SN 2007od also shows a mid-IR excess due to new dust. The evolution of the Halpha profile and the presence of the mid-IR excess provide strong evidence that SN 2007od formed new dust before day 232. Late-time observations reveal a flattening of the visible lightcurve. This flattening is a strong indication of the presence of a light echo, which likely accounts for much of the broad, underlying Halpha component seen at late-times. We believe the multi-peaked Halpha emission is consistent with the interaction of the ejecta with a circumstellar ring or torus (for the inner components at \pm1500 km s-1), and a single blob or cloud of circumstellar material out of the plane of the CSM ring (for the outer component at -5000 km s-1). The most probable location for the formation of new dust is in the cool dense shell created by the interaction between the expanding ejecta and its CSM. Monte Carlo radiative transfer modeling of the dust emission from SN 2007od implies that up to 4x 10-4Msun of new dust has formed. This is similar to the amounts of dust formed in other CCSNe such as SNe 1999em, 2004et, and 2006jc.Comment: 35 pages, 6 figures. Accepted for publication in Ap

Evidence for Pre-Existing Dust in the Bright Type IIn SN 2010jl

SN 2010jl was an extremely bright, Type IIn SNe which showed a significant IR excess no later than 90 days after explosion. We have obtained Spitzer 3.6 and 4.5 \mum and JHK observations of SN 2010jl \sim90 days post explosion. Little to no reddening in the host galaxy indicated that the circumstellar material lost from the progenitor must lie in a torus inclined out of the plane of the sky. The likely cause of the high mid-IR flux is the reprocessing of the initial flash of the SN by pre-existing circumstellar dust. Using a 3D Monte Carlo Radiative Transfer code, we have estimated that between 0.03-0.35 Msun of dust exists in a circumstellar torus around the SN located 6 \times 10 ^17 cm away from the SN and inclined between 60-80\cdot to the plane of the sky. On day 90, we are only seeing the illumination of approximately 5% of this torus, and expect to see an elevated IR flux from this material up until day \sim 450. It is likely this dust was created in an LBV-like mass loss event of more than 3 Msun, which is large but consistent with other LBV progenitors such as {\eta} Carinae.Comment: Accepted in A

Optical and Infrared Analysis of Type II SN 2006BC

We present nebular phase optical imaging and spectroscopy and near/mid-IR imaging of the Type II SN 2006bc. Observations reveal the central wavelength of the symmetric H$\alpha$ line profile to be red-shifted with respect to the host galaxy H$\alpha$ emission by day 325. Such an phenomenon has been argued to result from an asymmetric explosion in the iron-peak elements resulting in a larger mass of $^{56}$Ni and higher excitation of hydrogen on the far side of the SN explosion. We also observe a gradual blue-shifting of this H$\alpha$ peak which is indicative of dust formation in the ejecta. Although showing a normal peak brightness, V $\sim$ -17.2, for a core-collapse SN, 2006bc fades by $\sim$6 mag during the first 400 days suggesting either a relatively low $^{56}$Ni yield, an increase in extinction due to new dust, or both. A short duration flattening of the light curve is observed from day 416 to day 541 suggesting an optical light echo. Based on the narrow time window of this echo, we discuss implications on the location and geometry of the reflecting ISM. With our radiative transfer models, we find an upper limit of 2 x 10$^{-3}$ M$_{\odot}$ of dust around SN 2006bc. In the event that all of this dust were formed during the SN explosion, this quantity of dust is still several orders of magnitude lower than that needed to explain the large quantities of dust observed in the early universe.Comment: 6 pages, 10 figures, accepted for publication in Ap

Reddening law and interstellar dust properties along Magellanic sight-lines

This study establishes that SMC, LMC and Milky Way extinction curves obey the same extinction law which depends on the 2200A bump size and one parameter, and generalizes the Cardelli, Clayton and Mathis (1989) relationship. This suggests that extinction in all three galaxies is of the same nature. The role of linear reddening laws over all the visible/UV wavelength range, particularly important in the SMC but also present in the LMC and in the Milky Way, is also highlighted and discussed.Comment: accepted for publication in Astrophysics and Space Science. 16 pages, 12 figures. Some figures are colour plot

A three dimensional model of the photosynthetic membranes of Ectothiorhodospira halochloris

The three dimensional organization of the complete photosynthetic apparatus of the extremely halophilic, bacteriochlorophyll b containing Ectothiorhodospira halochloris has been elaborated by several techniques of electron microscopy. Essentially all thylakoidal sacs are disc shaped and connected to the cytoplasmic membrane by small membraneous ldquobridgesrdquo. In sum, the lumina of all thylakoids (intrathylakoidal space) form one common periplasmic space. Thin sections confirm a paracrystalline arrangement of the photosynthetic complexes in situ. The ontogenic development of the photosynthetic apparatus is discussed based on a structural model derived from serial thin sections

Spitzer Space Telescope Infrared Imaging and Spectroscopy of the Crab Nebula

We present 3.6, 4.5, 5.8, 8.0, 24, and 70 micron images of the Crab Nebula obtained with the Spitzer Space Telescope IRAC and MIPS cameras, Low- and High-resolution Spitzer IRS spectra of selected positions within the nebula, and a near-infrared ground-based image made in the light of [Fe II]1.644 micron. The 8.0 micron image, made with a bandpass that includes [Ar II]7.0 micron, resembles the general morphology of visible H-alpha and near-IR [Fe II] line emission, while the 3.6 and 4.5 micron images are dominated by continuum synchrotron emission. The 24 micron and 70 micron images show enhanced emission that may be due to line emission or the presence of a small amount of warm dust in the nebula on the order of less than 1% of a solar mass. The ratio of the 3.6 and 4.5 micron images reveals a spatial variation in the synchrotron power law index ranging from approximately 0.3 to 0.8 across the nebula. Combining this information with optical and X-ray synchrotron images, we derive a broadband spectrum that reflects the superposition of the flatter spectrum jet and torus with the steeper diffuse nebula, and suggestions of the expected pileup of relativistic electrons just before the exponential cutoff in the X-ray. The pulsar, and the associated equatorial toroid and polar jet structures seen in Chandra and HST images (Hester et al. 2002) can be identified in all of the IRAC images. We present the IR photometry of the pulsar. The forbidden lines identified in the high resolution IR spectra are all double due to Doppler shifts from the front and back of the expanding nebula and give an expansion velocity of approximately 1264 km/s.Comment: 21 pages, 4 tables, 16 figure

Dust Production and Particle Acceleration in Supernova 1987A Revealed with ALMA

Supernova (SN) explosions are crucial engines driving the evolution of galaxies by shock heating gas, increasing the metallicity, creating dust, and accelerating energetic particles. In 2012 we used the Atacama Large Millimeter/Submillimeter Array to observe SN 1987A, one of the best-observed supernovae since the invention of the telescope. We present spatially resolved images at 450um, 870um, 1.4mm, and 2.8mm, an important transition wavelength range. Longer wavelength emission is dominated by synchrotron radiation from shock-accelerated particles, shorter wavelengths by emission from the largest mass of dust measured in a supernova remnant (>0.2Msun). For the first time we show unambiguously that this dust has formed in the inner ejecta (the cold remnants of the exploded star's core). The dust emission is concentrated to the center of the remnant, so the dust has not yet been affected by the shocks. If a significant fraction survives, and if SN 1987A is typical, supernovae are important cosmological dust producers.Comment: ApJL accepte