A Randomized, Double-Blinded, Placebo-Controlled, Cross Over Study Evaluating the Efficacy and Safety of Timolol Ophthalmic Solution as an Acute Treatment of Migraine

Introduction. Daily oral beta-adrenoreceptor antagonist has been shown to be effective in preventing migraine headaches. Timolol 0.5% ophthalmic solution is a non-selective beta-adrenoreceptor antago- nist, where the primary use is for glaucoma. There have been case reports that timolol is effective in aborting or improving an acute migraine headache. The objective of this study was to assess the efficacy (decrease of ≥ 50% in pain scale at 120 minutes) of timolol 0.5% ophthalmic solution compared to placebo in acute treatment of migraine headache. Methods.We performed a randomized, double-blind, crossover, placebo-controlled, study. Study entry criteria required subjects to have one to eight migraine episodes per month. The primary outcome was comparison of the change in a visual analog pain scale (VAS) at 120 minutes after taking the study medication. Study subjects were given a pain scale with a range of 1 (no pain) to 10 (most severe pain) to complete after onset of migraine but before administration of study drops and 120 minutes after administration of study drops. Improve- ment was defined as a ≥ 50% decrease in pain scale. Results. Nineteen subjects completed the study and were used for analysis. The primary outcome changes in pain scale, 120 minutes after dose, showed a similar decrease for placebo and drug with a slightly wider 95% CI for placebo. Six subjects in each arm experi- enced a ≥ 50% decrease in pain scale. Conclusion. These results support that timolol 0.5% ophthalmic solution is not an efficacious treatment for acute migraine headache

The 55 Cancri Planetary System: Fully Self-Consistent N-body Constraints and a Dynamical Analysis

We present an updated study of the planets known to orbit 55 Cancri A using 1,418 high-precision radial velocity observations from four observatories (Lick, Keck, Hobby-Eberly Telescope, Harlan J. Smith Telescope) and transit time/durations for the inner-most planet, 55 Cancri "e" (Winn et al. 2011). We provide the first posterior sample for the masses and orbital parameters based on self-consistent n-body orbital solutions for the 55 Cancri planets, all of which are dynamically stable (for at least $10^8$ years). We apply a GPU version of Radial velocity Using N-body Differential evolution Markov Chain Monte Carlo (RUN DMC; B. Nelson et al. 2014) to perform a Bayesian analysis of the radial velocity and transit observations. Each of the planets in this remarkable system has unique characteristics. Our investigation of high-cadence radial velocities and priors based on space-based photometry yields an updated mass estimate for planet "e" ($8.09\pm0.26$ M$_\oplus$), which affects its density ($5.51\pm^{1.32}_{1.00}$ g cm$^{-3}$) and inferred bulk composition. Dynamical stability dictates that the orbital plane of planet "e" must be aligned to within $60^o$ of the orbital plane of the outer planets (which we assume to be coplanar). The mutual interactions between the planets "b" and "c" may develop an apsidal lock about $180^o$. We find 36-45% of all our model systems librate about the anti-aligned configuration with an amplitude of $51^o\pm^{6^o}_{10^o}$. Other cases showed short-term perturbations in the libration of $\varpi_b-\varpi_c$, circulation, and nodding, but we find the planets are not in a 3:1 mean-motion resonance. A revised orbital period and eccentricity for planet "d" pushes it further toward the closest known Jupiter analog in the exoplanet population.Comment: 12 pages, 5 figures, 4 tables, accepted to MNRAS. Figure 2 (left) is updated from published version. Posterior samples available at http://www.personal.psu.edu/ben125/Downloads.htm

A new physical interpretation of optical and infrared variability in quasars

Changing-look quasars are a recently identified class of active galaxies in which the strong UV continuum and/or broad optical hydrogen emission lines associated with unobscured quasars either appear or disappear on timescales of months to years. The physical processes responsible for this behaviour are still debated, but changes in the black hole accretion rate or accretion disk structure appear more likely than changes in obscuration. Here we report on four epochs of spectroscopy of SDSS J110057.70-005304.5, a quasar at a redshift of $z=0.378$ whose UV continuum and broad hydrogen emission lines have faded, and then returned over the past $\approx$20 years. The change in this quasar was initially identified in the infrared, and an archival spectrum from 2010 shows an intermediate phase of the transition during which the flux below rest-frame $\approx$3400\AA\ has decreased by close to an order of magnitude. This combination is unique compared to previously published examples of changing-look quasars, and is best explained by dramatic changes in the innermost regions of the accretion disk. The optical continuum has been rising since mid-2016, leading to a prediction of a rise in hydrogen emission line flux in the next year. Increases in the infrared flux are beginning to follow, delayed by a $\sim$3 year observed timescale. If our model is confirmed, the physics of changing-look quasars are governed by processes at the innermost stable circular orbit (ISCO) around the black hole, and the structure of the innermost disk. The easily identifiable and monitored changing-look quasars would then provide a new probe and laboratory of the nuclear central engine.Comment: 13 pages, 4 figures, 3 tables. Published in MNRAS. All code and data links on GitHub, https://github.com/d80b2t/WISE_L

Accretion onto the Supermassive Black Hole in M87

Chandra X-ray observations of the giant elliptical galaxy M87 resolve the thermal state of the hot interstellar medium into the accretion (Bondi) radius of its central 3 10^9 Msun black hole. We measure the X-ray gas temperature and density profiles and calculate the Bondi accretion rate, Mdot_Bondi \sim 0.1 Msun/yr. The X-ray luminosity of the active nucleus of M87 observed with Chandra is L_{x, 0.5-7 \keV} \sim 7 \times 10^{40}erg/s. This value is much less than the predicted nuclear luminosity, L_{Bondi} \sim 5 \times 10^{44} erg/s, for accretion at the Bondi rate with a canonical accretion radiative efficiency of 10%. If the black hole in M87 accretes at this rate it must do so at a much lower radiative efficiency than the canonical value. The multiwavelength spectrum of the nucleus is consistent with that predicted by an advection-dominated flow. However, as is likely, the X-ray nucleus is dominated by jet emission then the properties of flow must be modified, possibly by outflows. We show that the overall energetics of the system are just consistent with the predicted Bondi nuclear power. This suggests that either most of the accretion energy is released in the relativistic jet or that the central engine of M87 undergoes on-off activity cycles. We show that, at present, the energy dumped into the ISM by the jet may reduce the accretion rate onto the black hole by a factor \propto (v_j/c_s)^{-2}, where v_j is the jet velocity and c_s the ISM sound speed, and that this is sufficient to account for the low nuclear luminosity.Comment: emulateapj.sty, revised version, accepted by Ap

Outcomes of elective induction of labour compared with expectant management: population based study

Objective To determine neonatal outcomes (perinatal mortality and special care unit admission) and maternal outcomes (mode of delivery, delivery complications) of elective induction of labour compared with expectant management

ERC Re-Certification Training

A 1 hour and 50 minute course designed to provide updates on the LPA Program and more advanced knowledge to an experienced, recertifying ERC. Topics covered: recent updates to the LPA Guidance Document, Change Orders, and Utility Coordination. This course satisfies ERC requirements for one year following completion