Patients’ preferences for nutrition-related health outcomes in liver disease : a preliminary study using an electronic questionnaire

Background: Patients with liver disease frequently have nutritional problems but intervening to improve these is challenging. Healthcare interventions that respond to patients’ needs are associated with better health outcomes but no studies investigating patients’ preferences for nutrition-related outcomes in liver disease have been published. The aim of this study was to identify nutrition-related health outcomes that are important to patients with liver disease. Methodology: An electronic questionnaire was devised and reviewed by patients and dietitians with relevant experience. It comprised Likert scale and open questions focussing on six domains considered pertinent to patients with liver disease. An invitation to participate was posted on the website of a national liver charity and sent to liver patient support groups. Results: Fifty-one patients participated (22 men / 29 women). Responses indicated a wide range of preferred nutrition-related outcomes with those identified as very important most frequently focussing on gaining knowledge about which foods to eat more or less of, and on understanding why nutrition is important in liver disease. Women tended to score outcomes as more important than men. Participants who considered themselves overweight scored outcomes on body size and shape as more important than those with other nutritional problems. Additional outcomes were identified and included increased knowledge of healthy eating, interactions between medication and food, and supplementation. Conclusions: The study identified a wide range of nutrition-related outcomes that were important to this small sample of patients with liver disease and these may be useful to guide the direction of future nutrition-related management.Peer reviewedFinal Accepted Versio

Diffusive propagation of cosmic rays from supernova remnants in the Galaxy. I: spectrum and chemical composition

In this paper we investigate the effect of stochasticity in the spatial and temporal distribution of supernova remnants on the spectrum and chemical composition of cosmic rays observed at Earth. The calculations are carried out for different choices of the diffusion coefficient D(E) experienced by cosmic rays during propagation in the Galaxy. In particular, at high energies we assume that D(E)\sim E^{\delta}, with $\delta=1/3$ and $\delta=0.6$ being the reference scenarios. The large scale distribution of supernova remnants in the Galaxy is modeled following the distribution of pulsars, with and without accounting for the spiral structure of the Galaxy. We find that the stochastic fluctuations induced by the spatial and temporal distribution of supernovae, together with the effect of spallation of nuclei, lead to mild but sensible violations of the simple, leaky-box-inspired rule that the spectrum observed at Earth is $N(E)\propto E^{-\alpha}$ with $\alpha=\gamma+\delta$, where $\gamma$ is the slope of the cosmic ray injection spectrum at the sources. Spallation of nuclei, even with the small rates appropriate for He, may account for slight differences in spectral slopes between different nuclei, providing a possible explanation for the recent CREAM observations. For $\delta=1/3$ we find that the slope of the proton and helium spectra are $\sim 2.67$ and $\sim 2.6$ respectively at energies above 1 TeV (to be compared with the measured values of $2.66\pm 0.02$ and $2.58\pm 0.02$). For $\delta=0.6$ the hardening of the He spectra is not observed. We also comment on the effect of time dependence of the escape of cosmic rays from supernova remnants, and of a possible clustering of the sources in superbubbles. In a second paper we will discuss the implications of these different scenarios for the anisotropy of cosmic rays.Comment: 28 pages, To appear in JCA

A Deep HST Search for Escaping Lyman Continuum Flux at z~1.3: Evidence for an Evolving Ionizing Emissivity

We have obtained deep Hubble Space Telescope far-UV images of 15 starburst galaxies at z~1.3 in the GOODS fields to search for escaping Lyman continuum photons. These are the deepest far-UV images m_{AB}=28.7, 3\sigma, 1" diameter) over this large an area (4.83 arcmin^2) and provide the best escape fraction constraints for any galaxy at any redshift. We do not detect any individual galaxies, with 3\sigma limits to the Lyman Continuum (~700 \AA) flux 50--149 times fainter (in f_nu) than the rest-frame UV (1500 \AA) continuum fluxes. Correcting for the mean IGM attenuation (factor ~2), as well as an intrinsic stellar Lyman Break (~3), these limits translate to relative escape fraction limits of f_{esc,rel}<[0.03,0.21]. The stacked limit is f_{esc,rel}(3\sigma)<0.02. We use a Monte Carlo simulation to properly account for the expected distribution of IGM opacities. When including constraints from previous surveys at z~1.3 we find that, at the 95% confidence level, no more than 8% of star--forming galaxies at z~1.3 can have relative escape fractions greater than 0.50. Alternatively, if the majority of galaxies have low, but non-zero, escaping Lyman Continuum, the escape fraction can not be more than 0.04. Both the stacked limits, and the limits from the Monte Carlo simulation suggest that the average ionizing emissivity (relative to non-ionizing UV emissivity) at z~1.3 is significantly lower than has been observed in Lyman Break Galaxies (LBGs) at z~3. If the ionizing emissivity of star-forming galaxies is in fact increasing with redshift, it would help to explain the high photoionization rates seen in the IGM at z>4 and reionization of the intergalactic medium at z>6. [Abridged]Comment: Submitted to ApJ (Nov. 6) Comments Welcome. 11 pages, 8 figure

Search for Pairs of Isolated Radio Pulsars - Components in Disrupted Binary Systems

We have developed a method for analyzing the kinematic association of isolated relativistic objects - possible remnants of disrupted close binary systems. We investigate pairs of fairly young radio pulsars with known proper motions and estimated distances (dispersion measures) that are spaced no more than 2-3 kpc apart. Using a specified radial velocity distribution for these objects, we have constructed 100-300 thousand trajectories of their possible motion in the Galactic gravitational field on a time scale of several million years. The probabilities of their close encounters at epochs consistent with the age of the younger pulsar in the pair are analyzed. When these probabilities exceed considerably their reference values obtained by assuming a purely random encounter between the pulsars under consideration, we conclude that the objects may have been gravitationally bound in the past. As a result, we have detected six pulsar pairs (J0543+2329/J0528+2200, J1453-6413/J1430-6623, J2354+6155/J2321+6024, J1915+1009/J1909+1102, J1832-0827/J1836-1008, and J1917+1353/J1926+1648) that are companions in disrupted binary systems with a high probability. Estimates of their kinematic ages and velocities at binary disruption and at the present epoch are provided

Observations and Modelling of Relativistic Spin Precession in PSR J1141-6545

Observations of the binary pulsar PSR J1141-6545 using the Parkes radio telescope over 9.3 years show clear time-variations in pulse width, shape and polarization. We interpret these variations in terms of relativistic precession of the pulsar spin axis about the total angular momentum vector of the system. Over the nine years, the pulse width at the 50% level has changed by more than a factor of three. Large variations have also been observed in the 1400-MHz mean flux density. The pulse polarization has been monitored since 2004 April using digital filterbank systems and also shows large and systematic variations in both linear and circular polarization. Position angle variations, both across the pulse profile and over the data span, are complex, with major differences between the central and outer parts of the pulse profile. Modelling of the observed position angle variations by relativistic precession of the pulsar spin axis shows that the spin-orbit misalignment angle is about 110 deg and that the precessional phase has passed through 180 deg during the course of our observations. At the start of our observations, the line-of-sight impact parameter was about 4 deg in magnitude and it reached a minimum very close to 0 deg around early 2007, consistent with the observed pulse width variations. We have therefore mapped approximately one half of the emission beam, showing that it is very asymmetric with respect to the magnetic axis. The derived precessional parameters imply that the pre-supernova star had a mass of about 2 Msun and that the supernova recoil kick velocity was relatively small. With the reversal in the rate of change of the impact parameter, we predict that over the next decade we will see a reversed "replay" of the variations observed in the past decade.Comment: 45 pages, 19 figures, 6 tables, accepted by Astrophysical Journa

Observational Diagnostics of Gas Flows: Insights from Cosmological Simulations

Galactic accretion interacts in complex ways with gaseous halos, including galactic winds. As a result, observational diagnostics typically probe a range of intertwined physical phenomena. Because of this complexity, cosmological hydrodynamic simulations have played a key role in developing observational diagnostics of galactic accretion. In this chapter, we review the status of different observational diagnostics of circumgalactic gas flows, in both absorption (galaxy pair and down-the-barrel observations in neutral hydrogen and metals; kinematic and azimuthal angle diagnostics; the cosmological column density distribution; and metallicity) and emission (Lya; UV metal lines; and diffuse X-rays). We conclude that there is no simple and robust way to identify galactic accretion in individual measurements. Rather, progress in testing galactic accretion models is likely to come from systematic, statistical comparisons of simulation predictions with observations. We discuss specific areas where progress is likely to be particularly fruitful over the next few years.Comment: Invited review to appear in Gas Accretion onto Galaxies, Astrophysics and Space Science Library, eds. A. J. Fox & R. Dave, to be published by Springer. Typos correcte

The Circumgalactic Medium in Massive Halos

This chapter presents a review of the current state of knowledge on the cool (T ~ 1e4 K) halo gas content around massive galaxies at z ~ 0.2-2. Over the last decade, significant progress has been made in characterizing the cool circumgalactic gas in massive halos of Mh ~ 1e12-1e14 Msun at intermediate redshifts using absorption spectroscopy. Systematic studies of halo gas around massive galaxies beyond the nearby universe are made possible by large spectroscopic samples of galaxies and quasars in public archives. In addition to accurate and precise constraints for the incidence of cool gas in massive halos, detailed characterizations of gas kinematics and chemical compositions around massive quiescent galaxies at z ~ 0.5 have also been obtained. Combining all available measurements shows that infalling clouds from external sources are likely the primary source of cool gas detected at d >~ 100 kpc from massive quiescent galaxies. The origin of the gas closer in is currently less certain, but SNe Ia driven winds appear to contribute significantly to cool gas found at d < 100 kpc. In contrast, cool gas observed at d <~ 200 kpc from luminous quasars appears to be intimately connected to quasar activities on parsec scales. The observed strong correlation between cool gas covering fraction in quasar host halos and quasar bolometric luminosity remains a puzzle. Combining absorption-line studies with spatially-resolved emission measurements of both gas and galaxies is the necessary next step to address remaining questions.Comment: 29 pages, 7 figures, invited review to appear in "Gas Accretion onto Galaxies", Astrophysics and Space Science Library, eds. A. Fox & R. Dave, to be published by Springe

The Evolution of Compact Binary Star Systems

We review the formation and evolution of compact binary stars consisting of white dwarfs (WDs), neutron stars (NSs), and black holes (BHs). Binary NSs and BHs are thought to be the primary astrophysical sources of gravitational waves (GWs) within the frequency band of ground-based detectors, while compact binaries of WDs are important sources of GWs at lower frequencies to be covered by space interferometers (LISA). Major uncertainties in the current understanding of properties of NSs and BHs most relevant to the GW studies are discussed, including the treatment of the natal kicks which compact stellar remnants acquire during the core collapse of massive stars and the common envelope phase of binary evolution. We discuss the coalescence rates of binary NSs and BHs and prospects for their detections, the formation and evolution of binary WDs and their observational manifestations. Special attention is given to AM CVn-stars -- compact binaries in which the Roche lobe is filled by another WD or a low-mass partially degenerate helium-star, as these stars are thought to be the best LISA verification binary GW sources.Comment: 105 pages, 18 figure

Looking inside the black box: results of a theory-based process evaluation exploring the results of a randomized controlled trial of printed educational messages to increase primary care physicians' diabetic retinopathy referrals [Trial registration number ISRCTN72772651]

Background: Theory-based process evaluations conducted alongside randomized controlled trials provide the opportunity to investigate hypothesized mechanisms of action of interventions, helping to build a cumulative knowledge base and to inform the interpretation of individual trial outcomes. Our objective was to identify the underlying causal mechanisms in a cluster randomized trial of the effectiveness of printed educational materials (PEMs) to increase referral for diabetic retinopathy screening. We hypothesized that the PEMs would increase physicians’ intention to refer patients for retinal screening by strengthening their attitude and subjective norm, but not their perceived behavioral control. Methods: Design: A theory based process evaluation alongside the Ontario Printed Educational Material (OPEM) cluster randomized trial. Postal surveys based on the Theory of Planned Behavior were sent to a random sample of trial participants two months before and six months after they received the intervention. Setting: Family physicians in Ontario, Canada. Participants: 1,512 family physicians (252 per intervention group) from the OPEM trial were invited to participate, and 31.3% (473/1512) responded at time one and time two. The final sample comprised 437 family physicians fully completing questionnaires at both time points. Main outcome measures: Primary: behavioral intention related to referring patient for retinopathy screening; secondary: attitude, subjective norm, perceived behavioral control. Results: At baseline, family physicians reported positive intention, attitude, subjective norm, and perceived behavioral control to advise patients about retinopathy screening suggesting limited opportunities for improvement in these constructs. There were no significant differences on intention, attitude, subjective norm, and perceived behavioral control following the intervention. Respondents also reported additional physician- and patient-related factors perceived to influence whether patients received retinopathy screening. Conclusions: Lack of change in the primary and secondary theory-based outcomes provides an explanation for the lack of observed effect of the main OPEM trial. High baseline levels of intention to advise patients to attend retinopathy screening suggest that post-intentional and other factors may explain gaps in care. Process evaluations based on behavioral theory can provide replicable and generalizable insights to aid interpretation of randomized controlled trials of complex interventions to change health professional behavior