HST Images and Spectra of the Remnant of SN 1885 in M31

Near UV HST images of the remnant of SN 1885 (S And) in M31 show a 0"70 +- 0"05 diameter absorption disk silhouetted against M31's central bulge, at SN 1885's historically reported position. The disk's size corresponds to a linear diameter of 2.5 +- 0.4 pc at a distance of 725 +- 70 kpc, implying an average expansion velocity of 11000 +- 2000 km/s over 110 years. Low-dispersion FOS spectra over 3200-4800 A; reveal that the absorption arises principally from Ca II H & K (equivalent width ~215 A;) with weaker absorption features of Ca I 4227 A; and Fe I 3720 A;. The flux at Ca II line center indicates a foreground starlight fraction of 0.21, which places SNR 1885 some 64 pc to the near side of the midpoint of the M31 bulge, comparable to its projected 55 pc distance from the nucleus. The absorption line profiles suggest an approximately spherically symmetric, bell-shaped density distribution of supernova ejecta freely expanding at up to 13100 +- 1500 km/s. We estimate Ca I, Ca II, and Fe I masses of 2.9(+2.4,-0.6) x 10^-4 M_o, 0.005(+0.016,-0.002) M_o, and 0.013(+0.010,-0.005) M_o respectively. If the ionization state of iron is similar to the observed ionization state of calcium, M_CaII/M_CaI = 16(+42,-5), then the mass of Fe II is 0.21(+0.74,-0.08) M_o, consistent with that expected for either normal or subluminous SN Ia.Comment: 8 pages, including 4 embedded EPS figures, emulateapj.sty style file. Color image at http://casa.colorado.edu/~mcl/sand.shtml . Submitted to Ap

Cost-effectiveness of malaria diagnosis using rapid diagnostic tests compared to microscopy or clinical symptoms alone in Afghanistan

Background Improving access to parasitological diagnosis of malaria is a central strategy for control and elimination of the disease. Malaria rapid diagnostic tests (RDTs) are relatively easy to perform and could be used in primary level clinics to increase coverage of diagnostics and improve treatment of malaria.<p></p> Methods A cost-effectiveness analysis was undertaken of RDT-based diagnosis in public health sector facilities in Afghanistan comparing the societal and health sector costs of RDTs versus microscopy and RDTs versus clinical diagnosis in low and moderate transmission areas. The effect measure was ‘appropriate treatment for malaria’ defined using a reference diagnosis. Effects were obtained from a recent trial of RDTs in 22 public health centres with cost data collected directly from health centres and from patients enrolled in the trial. Decision models were used to compare the cost of RDT diagnosis versus the current diagnostic method in use at the clinic per appropriately treated case (incremental cost-effectiveness ratio, ICER).<p></p> Results RDT diagnosis of Plasmodium vivax and Plasmodium falciparum malaria in patients with uncomplicated febrile illness had higher effectiveness and lower cost compared to microscopy and was cost-effective across the moderate and low transmission settings. RDTs remained cost-effective when microscopy was used for other clinical purposes. In the low transmission setting, RDTs were much more effective than clinical diagnosis (65.2% (212/325) vs 12.5% (40/321)) but at an additional cost (ICER) of US$4.5 per appropriately treated patient including a health sector cost (ICER) of US$2.5 and household cost of US$2.0. Sensitivity analysis, which varied drug costs, indicated that RDTs would remain cost-effective if artemisinin combination therapy was used for treating both P. vivax and P. falciparum. Cost-effectiveness of microscopy relative to RDT is further reduced if the former is used exclusively for malaria diagnosis. In the health service setting of Afghanistan, RDTs are a cost-effective intervention compared to microscopy.<p></p> Conclusions RDTs remain cost-effective across a range of drug costs and if microscopy is used for a range of diagnostic services. RDTs have significant advantages over clinical diagnosis with minor increases in the cost of service provision.<p></p&gt

Physical and mental quality of life in patients with end-stage liver disease and their informal caregivers

Background & Aims Management of end-stage liver disease (ESLD) has implications for not only patients’ quality of life (QOL), but also their caregivers’. We aimed to identify characteristics of patients with ESLD and their caregivers that are associated with QOL. Methods We obtained cross-sectional baseline data from patients and their caregivers (132 dyads; 62% were married or partners), recruited from outpatient hepatology clinics within 2 healthcare centers. Patients were included if their model for end-stage liver disease score was 15 or more; caregivers were identified by the patient as the primary informal caregiver. QOL was measured by the SF-36 and relationship quality using the mutuality scale. We measured uncertainty using the uncertainty in illness scales for patients and caregivers. Multilevel modeling was used to analyze the data. Results Refractory ascites was associated with worse physical QOL for patients (unstandardized beta [B], –9.19; standard error [SE], 2.28) and caregivers (B, –5.41; SE, 2.33); history of hepatic encephalopathy was associated with worse patient physical QOL (B, –3.86; SE, 1.65). High levels of uncertainty were associated with worse physical and mental QOL for both members of the dyads; relationship quality was significantly associated with patient mental QOL (B, 2.73; SE, 1.19). Conclusions Clinicians and researchers should consider the effects of ESLD on caregivers as well as their patients to optimize the QOL for both

Treatment compliance and effectiveness of a cognitive behavioural intervention for low back pain : a complier average causal effect approach to the BeST data set

Background: Group cognitive behavioural intervention (CBI) is effective in reducing low-back pain and disability in comparison to advice in primary care. The aim of this analysis was to investigate the impact of compliance on estimates of treatment effect and to identify factors associated with compliance. Methods: In this multicentre trial, 701 adults with troublesome sub-acute or chronic low-back pain were recruited from 56 general practices. Participants were randomised to advice (control n = 233) or advice plus CBI (n = 468). Compliance was specified a priori as attending a minimum of three group sessions and the individual assessment. We estimated the complier average causal effect (CACE) of treatment. Results: Comparison of the CACE estimate of the mean treatment difference to the intention-to-treat (ITT) estimate at 12 months showed a greater benefit of CBI amongst participants compliant with treatment on the Roland Morris Questionnaire (CACE: 1.6 points, 95% CI 0.51 to 2.74; ITT: 1.3 points, 95% CI 0.55 to 2.07), the Modified Von Korff disability score (CACE: 12.1 points, 95% CI 6.07 to 18.17; ITT: 8.6 points, 95% CI 4.58 to 12.64) and the Modified von Korff pain score (CACE: 10.4 points, 95% CI 4.64 to 16.10; ITT: 7.0 points, 95% CI 3.26 to 10.74). People who were non-compliant were younger and had higher pain scores at randomisation. Conclusions: Treatment compliance is important in the effectiveness of group CBI. Younger people and those with more pain are at greater risk of non-compliance

Supplemental Brief for Appellees

Supplemental brief for appellees, written by appellees in support of plaintiffs-appellees in AMP v. Myriad Genetics (No. 2010-1406)

Hubble Space Telescope Near-Ultraviolet Spectroscopy of Bright CEMP-s Stars

We present an elemental-abundance analysis, in the near-ultraviolet (NUV) spectral range, for the bright carbon-enhanced metal-poor (CEMP) stars HD196944 (V = 8.40, [Fe/H] = -2.41) and HD201626 (V = 8.16, [Fe/H] = -1.51), based on data acquired with the Space Telescope Imaging Spectrograph (STIS) on the Hubble Space Telescope. Both of these stars belong to the sub-class CEMP-s, and exhibit clear over-abundances of heavy elements associated with production by the slow neutron-capture process. HD196944 has been well-studied in the optical region, but we are able to add abundance results for six species (Ge, Nb, Mo, Lu, Pt, and Au) that are only accessible in the NUV. In addition, we provide the first determination of its orbital period, P=1325 days. HD201626 has only a limited number of abundance results based on previous optical work -- here we add five new species from the NUV, including Pb. We compare these results with models of binary-system evolution and s-process element production in stars on the asymptotic giant branch, aiming to explain their origin and evolution. Our best-fitting models for HD 196944 (M1,i = 0.9Mo, M2,i = 0.86Mo, for [Fe/H]=-2.2), and HD 201626 (M1,i = 0.9Mo , M2,i = 0.76Mo , for [Fe/H]=-2.2; M1,i = 1.6Mo , M2,i = 0.59Mo, for [Fe/H]=-1.5) are consistent with the current accepted scenario for the formation of CEMP-s stars.Comment: 25 pages, 13 figures; accepted for publication in Ap