Pulse Profiles, Accretion Column Dips and a Flare in GX 1+4 During a Faint State

The Rossi X-ray Timing Explorer (RXTE) spacecraft observed the X-ray pulsar GX 1+4 for a period of 34 hours on July 19/20 1996. The source faded from an intensity of ~20 mCrab to a minimum of <~0.7 mCrab and then partially recovered towards the end of the observation. This extended minimum lasted ~40,000 seconds. Phase folded light curves at a barycentric rotation period of 124.36568 +/- 0.00020 seconds show that near the center of the extended minimum the source stopped pulsing in the traditional sense but retained a weak dip feature at the rotation period. Away from the extended minimum the dips are progressively narrower at higher energies and may be interpreted as obscurations or eclipses of the hot spot by the accretion column. The pulse profile changed from leading-edge bright before the extended minimum to trailing-edge bright after it. Data from the Burst and Transient Source Experiment (BATSE) show that a torque reversal occurred <10 days after our observation. Our data indicate that the observed rotation departs from a constant period with a Pdot/P value of ~-1.5% per year at a 4.5 sigma significance. We infer that we may have serendipitously obtained data, with high sensitivity and temporal resolution about the time of an accretion disk spin reversal. We also observed a rapid flare which had some precursor activity, close to the center of the extended minimum.Comment: 19 pages, 6 figures, accepted for publication in Astrophysical Journal (tentatively scheduled for vol. 529 #1, 20 Jan 2000

Physical Conditions of Accreting Gas in T Tauri Star Systems

We present results from a low resolution (R~300) near-infrared spectroscopic variability survey of actively accreting T Tauri stars (TTS) in the Taurus-Auriga star forming region. Paschen and Brackett series H I recombination lines were detected in 73 spectra of 15 classical T Tauri systems. The values of the Pan/PaB, Brn/BrG, and BrG/Pan H I line ratios for all observations exhibit a scatter of < 20% about the weighted mean, not only from source to source, but also for epoch-to-epoch variations in the same source. A representative or `global' value was determined for each ratio in both the Paschen and Brackett series as well as the BrG/Pan line ratios. A comparison of observed line ratio values was made to those predicted by the temperature and electron density dependent models of Case B hydrogen recombination line theory. The measured line ratios are statistically well-fit by a tightly constrained range of temperatures (T < 2000 K) and electron densities 1e9 < n_e < 1e10 cm^-3. A comparison of the observed line ratio values to the values predicted by the optically thick and thin local thermodynamic equilibrium cases rules out these conditions for the emitting H I gas. Therefore, the emission is consistent with having an origin in a non-LTE recombining gas. While the range of electron densities is consistent with the gas densities predicted by existing magnetospheric accretion models, the temperature range constrained by the Case B comparison is considerably lower than that expected for accreting gas. The cooler gas temperatures will require a non-thermal excitation process (e.g., coronal/accretion-related X-rays and UV photons) to power the observed line emission.Comment: 12 pages, emulateapj format, Accepted for publication in Ap

High-resolution absorption spectroscopy of the OH 2Pi 3/2 ground state line

The chemical composition of the interstellar medium is determined by gas phase chemistry, assisted by grain surface reactions, and by shock chemistry. The aim of this study is to measure the abundance of the hydroxyl radical (OH) in diffuse spiral arm clouds as a contribution to our understanding of the underlying network of chemical reactions. Owing to their high critical density, the ground states of light hydrides provide a tool to directly estimate column densities by means of absorption spectroscopy against bright background sources. We observed onboard the SOFIA observatory the 2Pi3/2, J = 5/2 3/2 2.5 THz line of ground-state OH in the diffuse clouds of the Carina-Sagittarius spiral arm. OH column densities in the spiral arm clouds along the sightlines to W49N, W51 and G34.26+0.15 were found to be of the order of 10^14 cm^-2, which corresponds to a fractional abundance of 10^-7 to 10^-8, which is comparable to that of H_2O. The absorption spectra of both species have similar velocity components, and the ratio of the derived H_2O to OH column densities ranges from 0.3 to 1.0. In W49N we also detected the corresponding line of ^18OH

Early switch from intravenous to oral antibiotic therapy in patients with cancer who have low-risk neutropenic sepsis: the EASI-SWITCH RCT

Background: Neutropenic sepsis is a common complication of systemic anticancer treatment. There is variation in practice in timing of switch to oral antibiotics after commencement of empirical intravenous antibiotic therapy. Objectives: To establish the clinical and cost effectiveness of early switch to oral antibiotics in patients with neutropenic sepsis at low risk of infective complications. Design: A randomised, multicentre, open-label, allocation concealed, non-inferiority trial to establish the clinical and cost effectiveness of early oral switch in comparison to standard care. Setting: Nineteen UK oncology centres. Participants: Patients aged 16 years and over receiving systemic anticancer therapy with fever (≥ 38\ub0C), or symptoms and signs of sepsis, and neutropenia (≤ 1.0 7 109/l) within 24 hours of randomisation, with a Multinational Association for Supportive Care in Cancer score of ≥ 21 and receiving intravenous piperacillin/tazobactam or meropenem for &lt; 24 hours were eligible. Patients with acute leukaemia or stem cell transplant were excluded. Intervention: Early switch to oral ciprofloxacin (750 mg twice daily) and co-amoxiclav (625 mg three times daily) within 12-24 hours of starting intravenous antibiotics to complete 5 days treatment in total. Control was standard care, that is, continuation of intravenous antibiotics for at least 48 hours with ongoing treatment at physician discretion. Main outcome measures: Treatment failure, a composite measure assessed at day 14 based on the following criteria: fever persistence or recurrence within 72 hours of starting intravenous antibiotics; escalation from protocolised antibiotics; critical care support or death. Results: The study was closed early due to under-recruitment with 129 patients recruited; hence, a definitive conclusion regarding non-inferiority cannot be made. Sixty-five patients were randomised to the early switch arm and 64 to the standard care arm with subsequent intention-to-treat and per-protocol analyses including 125 (intervention n = 61 and control n = 64) and 113 (intervention n = 53 and control n = 60) patients, respectively. In the intention-to-treat population the treatment failure rates were 14.1% in the control group and 24.6% in the intervention group, difference = 10.5% (95% confidence interval 0.11 to 0.22). In the per-protocol population the treatment failure rates were 13.3% and 17.7% in control and intervention groups, respectively; difference = 3.7% (95% confidence interval 0.04 to 0.148). Treatment failure predominantly consisted of persistence or recurrence of fever and/or physician-directed escalation from protocolised antibiotics with no critical care admissions or deaths. The median length of stay was shorter in the intervention group and adverse events reported were similar in both groups. Patients, particularly those with care-giving responsibilities, expressed a preference for early switch. However, differences in health-related quality of life and health resource use were small and not statistically significant. Conclusions: Non-inferiority for early oral switch could not be proven due to trial under-recruitment. The findings suggest this may be an acceptable treatment strategy for some patients who can adhere to such a treatment regimen and would prefer a potentially reduced duration of hospitalisation while accepting increased risk of treatment failure resulting in re-admission. Further research should explore tools for patient stratification for low-risk de-escalation or ambulatory pathways including use of biomarkers and/or point-of-care rapid microbiological testing as an adjunct to clinical decision-making tools. This could include application to shorter-duration antimicrobial therapy in line with other antimicrobial stewardship studies. Trial registration: This trial is registered as ISRCTN84288963. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 13/140/05) and is published in full in Health Technology Assessment; Vol. 28, No. 14. See the NIHR Funding and Awards website for further award information.Neutropenic sepsis, or infection with a low white blood cell count, can occur following cancer treatment. Usually patients receive treatment with intravenous antibiotics (antibiotics delivered into a vein) for two or more days. Patients at low risk of complications from their infection may be able to have a shorter period of intravenous antibiotics benefitting both patients and the NHS. The trial compared whether changing from intravenous to oral antibiotics (antibiotics taken by mouth as tablets or liquid) 12–24 hours after starting antibiotic treatment (‘early switch’) is as effective as usual care. Patients could take part if they had started intravenous antibiotics for low-risk neutropenic sepsis. Patients were randomly allocated to ‘early switch’ or to usual care. The main outcome measured was treatment failure. Treatment failure happened if fever persisted or recurred despite antibiotics, if patients needed to change antibiotics, if they needed to be re-admitted to hospital or needed to be admitted to intensive care within 14 days or died. We had originally intended that 628 patients would take part, but after review of the design of the study the number needed to take part was revised to 230. We were not able to complete the trial as planned as unfortunately only 129 patients took part. As the trial was smaller than expected we were not able to draw conclusions as to whether ‘early switch’ is no less effective than usual care. Our findings suggest that ‘early switch’ might result in a shorter time in hospital initially; however, treatment failure was more likely to occur, meaning some patients had to return to hospital for further antibiotics. There were no differences in side effects and no serious complications from treatment or treatment failure (such as intensive care admission or death) among the 65 patients in the ‘early switch’ group. Patients were satisfied with ‘early switch’. Early switch may be a treatment option for some patients with low-risk neutropenic sepsis who would prefer a shorter duration of hospital admission but accept a risk of needing hospital re-admission

Late presentation of superior mesenteric artery syndrome following scoliosis surgery: a case report

<p>Abstract</p> <p>Introduction</p> <p>Obstruction of the third part of the duodenum by the superior mesenteric artery (SMA) can occur following surgical correction of scoliosis. The condition most commonly occurs in significantly underweight patients with severe deformities during the first few days to a week following spinal surgery.</p> <p>Case presentation</p> <p>We present the atypical case of a patient with normal body habitus and a 50° adolescent idiopathic thoracolumbar scoliosis who underwent anterior spinal arthrodesis with instrumentation and developed SMA syndrome due to progressive weight loss several weeks postoperatively. The condition manifested with recurrent vomiting, abdominal distension, marked dehydration, and severe electrolyte disorder. Prolonged nasogastric decompression and nasojejunal feeding resulted in resolution of the symptoms with no recurrence at follow-up. The spinal instrumentation was retained and a solid spinal fusion was achieved with good spinal balance in both the coronal and sagittal planes.</p> <p>Conclusion</p> <p>SMA syndrome can occur much later than previously reported and with potentially life-threatening symptoms following scoliosis correction. Early recognition of the condition and institution of appropriate conservative measures is critical to prevent the development of severe complications including the risk of death.</p

The geographies of access to enterprise finance: the case of the West Midlands, UK

The geographies of access to enterprise finance: the case of the West Midlands, UK, Regional Studies. Whilst there is a long history of credit rationing to small and medium-sized enterprises (SMEs) in the UK, the financial crisis has seen banks retreat further from lending to viable SMEs due to a reassessment of risk and lack of available capital. In so doing, the credit crunch is thought to be creating new geographies of financial exclusion. This paper explores the financial inclusion of enterprise through community development finance institutions (CDFIs) which provide loan finance to firms at the commercial margins in the West Midlands, UK. The paper concludes that CDFIs could partially address the financial exclusion of enterprise as an additional, alternative source of finance to that of mainstream banks

Eureka and beyond: mining's impact on African urbanisation

This collection brings separate literatures on mining and urbanisation together at a time when both artisanal and large-scale mining are expanding in many African economies. While much has been written about contestation over land and mineral rights, the impact of mining on settlement, notably its catalytic and fluctuating effects on migration and urban growth, has been largely ignored. African nation-states’ urbanisation trends have shown considerable variation over the past half century. The current surge in ‘new’ mining countries and the slow-down in ‘old’ mining countries are generating some remarkable settlement patterns and welfare outcomes. Presently, the African continent is a laboratory of national mining experiences. This special issue on African mining and urbanisation encompasses a wide cross-section of country case studies: beginning with the historical experiences of mining in Southern Africa (South Africa, Zambia, Zimbabwe), followed by more recent mineralizing trends in comparatively new mineral-producing countries (Tanzania) and an established West African gold producer (Ghana), before turning to the influence of conflict minerals (Angola, the Democratic Republic of Congo and Sierra Leone)

Near-Infrared Spectroscopy of Photodissociation Regions: The Orion Bar and Orion S

To test the PDR model spectra under the physical conditions present in Orion, we have obtained moderate-resolution (R=3000) J-, H-, and K-band long-slit spectra of the Orion bar and Orion S regions These observations provide conclusive evidence for the PDR origin (rather than shocks) of the H_2 emission in each of these regions and demonstrate significant departures in the observed chemical structure from that predicted by models of homogeneous PDRs.Comment: Accepted to Astrophysical Journa

A statistical framework for integrating two microarray data sets in differential expression analysis

<p>Abstract</p> <p>Background</p> <p>Different microarray data sets can be collected for studying the same or similar diseases. We expect to achieve a more efficient analysis of differential expression if an efficient statistical method can be developed for integrating different microarray data sets. Although many statistical methods have been proposed for data integration, the genome-wide concordance of different data sets has not been well considered in the analysis.</p> <p>Results</p> <p>Before considering data integration, it is necessary to evaluate the genome-wide concordance so that misleading results can be avoided. Based on the test results, different subsequent actions are suggested. The evaluation of genome-wide concordance and the data integration can be achieved based on the normal distribution based mixture models.</p> <p>Conclusion</p> <p>The results from our simulation study suggest that misleading results can be generated if the genome-wide concordance issue is not appropriately considered. Our method provides a rigorous parametric solution. The results also show that our method is robust to certain model misspecification and is practically useful for the integrative analysis of differential expression.</p