The regulation of polyclonal mitogen-stimulated human gamma-interferon production

The regulation of human interferon-gamma production by peripheral blood mononuclear leukocytes, stimulated by polyclonal T-cell activators (mitogens), was investigated because of its possible importance as a regulator of the immune response and because it usually accompanies lymphocyte activation. Low density lymphocytes, enriched for large granular lymphocytes, were shown to be capable of IFN-gamma production in the absence of macrophages, unlike T-cells, but with interaction of two subsets of this low density population being required for optimal production. It is suggested that a non-T cell low density population can act as accessory cells for T-cells in the absence of macrophages. The action of both positive and negative modulators of IFN-gamma production were investigated. The importance of IL-1 production was demonstrated by the depressive effects of anti-IL-1 antibody and the ability of purified IL-1 to reverse the depressive effects of macrophage-depletion on T-cell activation. Blockade of the IL-2 receptor by monoclonal antibodies inhibits IFN-gamma production, as does treatment with prostaglandin E₂, known to inhibit IL-2 production. The receptor blockade is reversible by pure IL-2 as is the PGE₂ inhibition. IL-1 and IL-2 alone rarely induced any IFN-gamma. These data imply that for maximal IFN-gamma production the interaction of at least two other protein factors (IL-1, IL-2) with mitogen-stimulated T-cells is necessary, and that other factors may act as down-regulators. A variety of cell-surface molecules involved in MHC restriction and also the T11 antigen were also shown to have regulatory effects. Those of the T11 pathway may involve effects on calcium and IL-2 levels. T-cell activation could also be triggered by calcium ionophore plus tumour promoter. Activation of the IL-2 and IFN-gamma genes by this method was shown to be coordinate and not to require protein synthesis. Thus many regulatory effects on IFN-gamma production probably act at a post-transcriptional level

Near-Infrared Thermal Emission from the Hot Jupiter TrES-2b: Ground-Based Detection of the Secondary Eclipse

We present near-infrared Ks-band photometry bracketing the secondary eclipse of the hot Jupiter TrES-2b using the Wide-field Infrared Camera on the Canada-France-Hawaii Telescope. We detect its thermal emission with an eclipse depth of 0.062 +/- 0.012% (5-sigma). Our best-fit secondary eclipse is consistent with a circular orbit (a 3-sigma upper limit on the eccentricity, e, and argument or periastron, omega, of |ecos(omega)| < 0.0090), in agreement with mid-infrared detections of the secondary eclipse of this planet. A secondary eclipse of this depth corresponds to a day-side Ks-band brightness temperature of TB = 1636 +/- 88 K. Our thermal emission measurement when combined with the thermal emission measurements using Spitzer/IRAC from O'Donovan and collaborators suggest that this planet exhibits relatively efficient day to night-side redistribution of heat and a near isothermal dayside atmospheric temperature structure, with a spectrum that is well approximated by a blackbody. It is unclear if the atmosphere of TrES-2b requires a temperature inversion; if it does it is likely due to chemical species other than TiO/VO as the atmosphere of TrES-2b is too cool to allow TiO/VO to remain in gaseous form. Our secondary eclipse has the smallest depth of any detected from the ground at around 2 micron to date.Comment: ApJ accepted, 8 pages, 9 figures, in emulateapj format

Near-Infrared Thermal Emission from TrES-3b: A Ks-band detection and an H-band upper limit on the depth of the secondary eclipse

We present H and Ks-band photometry bracketing the secondary eclipse of the hot Jupiter TrES-3b using the Wide-field Infrared Camera on the Canada-France-Hawaii Telescope. We detect the secondary eclipse of TrES-3b with a depth of 0.133+/-0.017% in Ks-band (8-sigma) - a result in sharp contrast to the eclipse depth reported by de Mooij & Snellen. We do not detect its thermal emission in H-band, but place a 3-sigma limit on the depth of the secondary eclipse in this band of 0.051%. A secondary eclipse of this depth in Ks requires very efficient day-to-nightside redistribution of heat and nearly isotropic reradiation, conclusion that is in agreement with longer wavelength, mid-infrared Spitzer observations. Our 3-sigma upper-limit on the depth of our H-band secondary eclipse also argues for very efficient redistribution of heat and suggests that the atmospheric layer probed by these observations may be well homogenized. However, our H-band upper limit is so constraining that it suggests the possibility of a temperature inversion at depth, or an absorbing molecule, such as methane, that further depresses the emitted flux at this wavelength. The combination of our near-infrared measurements and those obtained with Spitzer suggest that TrES-3b displays a near isothermal dayside atmospheric temperature structure, whose spectrum is well approximated by a blackbody. We emphasize that our strict H-band limit is in stark disagreement with the best-fit atmospheric model that results from longer wavelength observations only, thus highlighting the importance of near-infrared observations at multiple wavelengths in addition to those returned by Spitzer in the mid-infrared to facilitate a comprehensive understanding of the energy budgets of transiting exoplanets.Comment: ApJ accepted, 8 pages, 7 figures, in EmulateApJ forma

Near-infrared Thermal Emission from WASP-12b: detections of the secondary eclipse in Ks, H & J

We present Ks, H & J-band photometry of the very highly irradiated hot Jupiter WASP-12b using the Wide-field Infrared Camera on the Canada-France-Hawaii telescope. Our photometry brackets the secondary eclipse of WASP-12b in the Ks and H-bands, and in J-band starts in mid-eclipse and continues until well after the end of the eclipse. We detect its thermal emission in all three near-infrared bands. Our secondary eclipse depths are 0.309 +/- 0.013% in Ks-band (24-sigma), 0.176 +/- 0.020% in H-band (9-sigma) and 0.131 +/- 0.028% in J-band (4-sigma). All three secondary eclipses are best-fit with a consistent phase that is compatible with a circular orbit. By combining our secondary eclipse times with others published in the literature, as well as the radial velocity and transit timing data for this system, we show that there is no evidence that WASP-12b is precessing at a detectable rate, and show that its orbital eccentricity is likely zero. Our thermal emission measurements also allow us to constrain the characteristics of the planet's atmosphere; our Ks-band eclipse depth argues in favour of inefficient day to nightside redistribution of heat and a low Bond albedo for this very highly irradiated hot Jupiter. The J and H-band brightness temperatures are slightly cooler than the Ks-band brightness temperature, and thus hint at the possibility of a modest temperature inversion deep in the atmosphere of WASP-12b; the high pressure, deep atmospheric layers probed by our J and H-band observations are likely more homogenized than the higher altitude layer. Lastly, our best-fit Ks-band eclipse has a marginally longer duration than would otherwise be expected; this may be tentative evidence for material being tidally stripped from the planet - as was predicted for this system by Li & collaborators, and for which observational confirmation was recently arguably provided by Fossati & collaborators.Comment: AJ accepted. 12 pages, 11 figures, in EmulateApJ format. Version 2 removes two figures that were added by mistak

Multiwavelength transit observations of the candidate disintegrating planetesimals orbiting WD 1145+017

We present multiwavelength, ground-based follow-up photometry of the white dwarf WD 1145+017, which has recently been suggested to be orbited by up to six or more short-period, low-mass, disintegrating planetesimals. We detect nine significant dips in flux of between 10% and 30% of the stellar flux in our ~32 hr of photometry, suggesting that WD 1145+017 is indeed being orbited by multiple, short-period objects. Through fits to the asymmetric transits that we observe, we confirm that the transit egress is usually longer than the ingress, and that the transit duration is longer than expected for a solid body at these short periods, all suggesting that these objects have cometary tails streaming behind them. The precise orbital periods of the planetesimals are unclear, but at least one object, and likely more, have orbital periods of ~4.5 hr. We are otherwise unable to confirm the specific periods that have been reported, bringing into question the long-term stability of these periods. Our high-precision photometry also displays low-amplitude variations, suggesting that dusty material is consistently passing in front of the white dwarf, either from discarded material from these disintegrating planetesimals or from the detected dusty debris disk. We compare the transit depths in the V- and R-bands of our multiwavelength photometry, and find no significant difference; therefore, for likely compositions, the radius of single-size particles in the cometary tails streaming behind the planetesimals must be ~0.15 μm or larger, or ~0.06 μm or smaller, with 2σ confidence

Rural Health Clinic Readiness for Patient-Centered Medical Home Recognition: Preparing for the Evolving Healthcare Marketplace [Working Paper]

The patient-centered medical home (PCMH) model reaffirms traditional primary care values including continuity of care, connection with an identified personal clinician, provision of same day- and after-hours access, and positions providers to participate in accountable care and other financing and delivery system models. However, little is known about the readiness of the over 4,000 Rural Health Clinics (RHCs) to meet the PCMH Recognition standards established by the National Council for Quality Assurance (NCQA). The authors present findings from a survey of RHCs that examined their capacity to meet the NCQA PCMH requirements, and discuss the implications of the findings for efforts to support RHC capacity development. Key Findings: Based on their performance on the “must pass” elements and related key factors, Rural Health Clinics (RHCs) are likely to have difficulties gaining National Center for Quality Assurance’s (NCQA) Patient-Centered Medical Home (PCMH) Recognition. RHCs perform best on standards related to recording demographic information and managing clinical activities, particularly for those using an electronic health record. RHCs perform less well on improving access to and continuity of services, supporting patient self-management skills and shared decision-making, implementing continuous quality improvement systems, and building practice teams. RHCs are likely to need substantial technical assistance targeting clinical and operational performance to gain NCQA PCMH Recognition

Adoption and Use of Electronic Health Records by Rural Health Clinics: Results of a National Survey [Working Paper]

Rural Health Clinics (RHCs) are a vital source of primary care services with more than 4,000 clinics serving rural communities. Relatively little is known about the extent to which RHCs have adopted and are using electronic health records (EHRs) to support clinical services. Because EHR adoption is an essential element for inclusion in accountable care organizations, patient centered medical homes, and health plan provider networks offered on state and national health insurance marketplaces, EHR implementation will be increasingly important to RHCs if they are to remain competitive participants in the evolving healthcare market. Key Findings: Nearly 72 percent of Rural Health Clinics (RHCs) have an operational electronic health record (EHR), with 63 percent indicating use by 90 percent or more of their staff. Slightly over 17 percent of RHCs without an EHR plan to implement one within six months, and 27 percent plan to do so within seven to twelve months. Common barriers to EHR implementation include acquisition and maintenance costs (72 percent), lack of capital (51 percent), and concerns about productivity and income loss during implementation (45 percent). RHCs continue to lag on some meaningful use measures, but perform well on measures related to clinical care and patient management. With Regional Extension Centers facing the loss of federal funding it is important to identify additional resources to assist RHCs in maximizing EHR adoption and use

Adoption and Use of Electronic Health Records by Rural Health Clinics: Results of a National Survey [Policy Brief]

Rural Health Clinics (RHCs) are a vital source of primary care services with more than 4,000 clinics serving rural communities. Relatively little is known about the extent to which RHCs have adopted and are using electronic health records (EHRs) to support clinical services. Because EHR adoption is an essential element for inclusion in accountable care organizations, patient centered medical homes, and health plan provider networks offered on state and national health insurance marketplaces, EHR implementation will be increasingly important to RHCs if they are to remain competitive participants in the evolving healthcare market. This study demonstrates that RHCs are approaching parity with other physician practices in terms EHR adoption and use, however, some RHCs, such as provider-based clinics, report lower rates of EHR adoption than other clinics. Key Findings: Nearly 72 percent of Rural Health Clinics (RHCs) have an operational electronic health record (EHR), with 63 percent indicating use by 90 percent or more of their staff. Slightly over 17 percent of RHCs without an EHR plan to implement one within six months, and 27 percent plan to do so within seven to twelve months. Common barriers to EHR implementation include acquisition and maintenance costs (72 percent), lack of capital (51 percent), and concerns about productivity and income loss during implementation (45 percent). RHCs continue to lag on some meaningful use measures, but perform well on measures related to clinical care and patient management. With Regional Extension Centers facing the loss of federal funding it is important to identify additional resources to assist RHCs in maximizing EHR adoption and use