The Chandra view of the Largest Quasar Lens SDSS J1029+2623

We present results from Chandra observations of the cluster lens SDSS J1029+2623 at z_l=0.58, which is a gravitationally lensed quasar with the largest known image separation. We clearly detect X-ray emission both from the lensing cluster and the three lensed quasar images. The cluster has an X-ray temperature of kT = 8.1 (+2.0, -1.2) keV and bolometric luminosity of L_X = 9.6e44 erg s^-1. Its surface brightness is centered near one of the brightest cluster galaxies, and it is elongated East-West. We identify a subpeak North-West of the main peak, which is suggestive of an ongoing merger. Even so, the X-ray mass inferred from the hydrostatic equilibrium assumption appears to be consistent with the lensing mass from the Einstein radius of the system. We find significant absorption in the soft X-ray spectrum of the faintest quasar image, which can be caused by an intervening material at either the lens or source redshift. The X-ray flux ratios between the quasar images (after correcting for absorption) are in reasonable agreement with those at optical and radio wavelengths, and all the flux ratios are inconsistent with those predicted by simple mass models. This implies that microlensing effect is not significant for this system and dark matter substructure is mainly responsible for the anomalous flux ratios.Comment: 35 pages, 8 figures. Accepted for publication in Ap

Chandra Observations of SDSS J1004+4112: Constraints on the Lensing Cluster and Anomalous X-Ray Flux Ratios of the Quadruply Imaged Quasar

We present results from Chandra observations of SDSS J1004+4112, a strongly lensed quasar system with a maximum image separation of 15". All four bright images of the quasar, as well as resolved X-ray emission originating from the lensing cluster, are clearly detected. The emission from the lensing cluster extends out to approximately 1.5 arcmin. We measure the bolometric X-ray luminosity and temperature of the lensing cluster to be 4.7e44 erg s^-1 and 6.4 keV, consistent with the luminosity-temperature relation for distant clusters. The mass estimated from the X-ray observation shows excellent agreement with the mass derived from gravitational lensing. The X-ray flux ratios of the quasar images differ markedly from the optical flux ratios, and the combined X-ray spectrum of the images possesses an unusually strong Fe Kalpha emission line, both of which are indicative of microlensing.Comment: 9 pages, 5 figures. Accepted for publication in ApJ. Version with high-quality color figures at http://cosmic.riken.jp/ota/publications/index.htm

Immunohistochemical Detection of Respiratory Syncytial Virus Infection in the Lung of Child Autopsy Cases

Viral infection in the respiratory tract is suspected in some cases of infant death; however, in most of those cases, routine postmortem examination has been unable to determine a definitive etiology. Using immunohistochemistry with a specific antibody to respiratory syncytial virus (RSV) in paraffin sections, we investigated a possible association of RSV infection with interstitial pneumonia or bronchitis in four child autopsy cases while two adult cases with cytomegalic inclusion disease, pneumocystis carinii pneumonia, or acute interstitial pneumonia were also included as negative control. Immunoreactivity for RSV was detected in one of the 4 child cases; the bronchial and bronchiolar epithelium were immunostained. No immunoreactivity was observed in the two adult cases. Retrospective microscopic examination in routinely stained slides could find no distinctive findings indicating RSV infection in this case as well as the other three cases. Although further evidence, e.g., detection of the viral nucleic acid in specimens, may be needed, the present results suggest that this antibody can be utilized for detection of RSV infection in autopsy samples

Remote home monitoring (virtual wards) for confirmed or suspected COVID-19 patients:a rapid systematic review

Background: the aim of this review was to analyze the implementation and impact of remote home monitoring models (virtual wards) for confirmed or suspected COVID-19 patients, identifying their main components, processes of implementation, target patient populations, impact on outcomes, costs and lessons learnt. Methods: we carried out a rapid systematic review on models led by primary and secondary care across seven countries (US, Australia, Canada, The Netherlands, Ireland, China, UK). The main outcomes included in the review were: impact of remote home monitoring on virtual length of stay, escalation, emergency department attendance/reattendance, admission/readmission and mortality. The search was updated on February 2021. We used the PRISMA statement and the review was registered on PROSPERO (CRD: 42020202888). Findings: the review included 27 articles. The aim of the models was to maintain patients safe in the appropriate setting. Most models were led by secondary care and confirmation of COVID-19 was not required (in most cases). Monitoring was carried via online platforms, paper-based systems with telephone calls or (less frequently) through wearable sensors. Models based on phone calls were considered more inclusive. Patient/career training was identified as a determining factor of success. We could not reach substantive conclusions regarding patient safety and the identification of early deterioration due to lack of standardized reporting and missing data. Economic analysis was not reported for most of the models and did not go beyond reporting resources used and the amount spent per patient monitored. Interpretation: future research should focus on staff and patient experiences of care and inequalities in patients' access to care. Attention needs to be paid to the cost-effectiveness of the models and their sustainability, evaluation of their impact on patient outcomes by using comparators, and the use of risk-stratification tools

Association between the examination rate of treatment-resistant schizophrenia and the clozapine prescription rate in a nationwide dissemination and implementation study

Background: The decision to initiate clozapine treatment should be made on an individual basis and may be closely related to the early detection of treatment-resistant schizophrenia (TRS), although there is evidence that the early use of clozapine results in a better response to treatment. Therefore, we investigated the relationship between the examination rate of TRS and the prescription rate of clozapine. Methods: After attending a 1-day educational program on schizophrenia based on the "Guidelines for the Pharmacological Treatment of Schizophrenia," we asked the participating facilities to submit records of whether or not TRS was evaluated for each patient. We calculated the clozapine prescription rate from the schizophrenic patients prescribed clozapine and all of the schizophrenic patients. Forty-nine facilities in 2017 were included in the study. Results: There were dichotomous distributions in the examination rate of TRS and a non-normal distribution in the prescription rate of clozapine. There was a significant correlation between the prescription rate of clozapine and the examination rate of TRS (r s = 0.531, P = 1.032 × 10−4). A significant difference was found in the prescription rate of clozapine between the three groups of facilities according to the examination rate of TRS. Conclusion: As a preliminary problem for the use of clozapine, in Japan, the examination rate of TRS varies, and there are many facilities that typically do not consider the possibility of TRS; this trend leads to a low rate of clozapine use. Clearly, further clinician training is needed for the early detection and appropriate management of TRS that includes an explanation of TRS and how to introduce clozapine therapy to patients and their families

Improvements in the degree of understanding the treatment guidelines for schizophrenia and major depressive disorder in a nationwide dissemination and implementation study

Background: To implement clinical practice guidelines (CPGs), it is necessary for psychiatrists to deepen their understanding of the CPGs. The Effectiveness of Guidelines for Dissemination and Education in Psychiatric Treatment (EGUIDE) project is a nationwide dissemination and implementation study of two sets of CPGs for schizophrenia and major depressive disorder (MDD). Methods: A total of 413 psychiatrists (n = 212 in 2016; n = 201 in 2017) learned the two CPGs in the education program of the EGUIDE project, and clinical knowledge of these CPGs was evaluated at baseline and after the programs. To improve the correct answer rate for clinical knowledge after the programs, we revised the lecture materials associated with items that had a low correct answer rate in 2016 and used the revised lecture materials with the CPGs in 2017. The rates of correct answers after the programs between the 2016 and 2017 groups were compared. Results: The correct answer rate of one item on the schizophrenia CPG and one item on the MDD CPG tended to be improved (S-D5 and D-C6) and that of one on the MDD CPG was significantly improved (D-D3, P = 0.0008) in the 2017 group compared to those in the 2016 group. Conclusions: We reported improvements in clinical knowledge of CPGs after the EGUIDE program in the 2017 group following revision of the lecture materials based on results from the 2016 group. These attempts to improve the degree of understanding of CPGs may facilitate the successful dissemination and implementation of psychiatric guidelines in everyday practice

Clozapine and Antipsychotic Monotherapy

Background: Although clozapine is effective for treatment-resistant schizophrenia (TRS), the rate of clozapine prescription is still low. Whereas antipsychotic monotherapy is recommended in clinical practice guidelines, the rate of antipsychotic polypharmacy is still high. There is little evidence on whether a clozapine prescription influences changes in the rate of monotherapy and polypharmacy, including antipsychotics and other psychotropics. We therefore hypothesized that the rate of antipsychotic monotherapy in patients with TRS who were prescribed clozapine would be higher than that in patients with schizophrenia who were not prescribed clozapine. Methods: We assessed 8306 patients with schizophrenia nationwide from 178 institutions in Japan from 2016 to 2019. We analyzed the psychotropic prescription data at discharge in patients diagnosed with TRS and with no description of TRS (ND-TRS) based on the diagnosis listed in the discharge summary. Results: The rate of antipsychotic monotherapy in the TRS with clozapine group (91.3%) was significantly higher than that in the TRS without clozapine group (45.9%; P < 2.0 × 10−16) and the ND-TRS without clozapine group (54.7%; P < 2.0 × 10−16). The rate of antipsychotic monotherapy without any other concomitant psychotropics in the TRS with clozapine group (26.5%) was significantly higher than that in the TRS without clozapine group (12.6%; P = 1.1 × 10−6) and the ND-TRS without clozapine group (17.0%; P = 5.9 × 10−6). Conclusions: Clozapine prescription could be associated with a high rate of antipsychotic monotherapy. Patients will benefit from the correct diagnosis of TRS and thus from proper clozapine prescription

Associations between the orexin (hypocretin) receptor 2 gene polymorphism Val308Ile and nicotine dependence in genome-wide and subsequent association studies

Impact of the HCRTR2 gene risk variant on schizotypal personality traits (mean ± SD). (DOC 54 kb

EGUIDE project and treatment guidelines

Background Clinical practice guidelines for schizophrenia and major depressive disorder have been published. However, these have not had sufficient penetration in clinical settings. We developed the Effectiveness of Guidelines for Dissemination and Education in Psychiatric Treatment (EGUIDE) project as a dissemination and education programme for psychiatrists. Aims The aim of this study is to assess the effectiveness of the EGUIDE project on the subjective clinical behaviour of psychiatrists in accordance with clinical practice guidelines before and 1 and 2 years after participation in the programmes. Method A total of 607 psychiatrists participated in this study during October 2016 and March 2019. They attended both 1-day educational programmes based on the clinical practice guidelines for schizophrenia and major depressive disorder, and answered web questionnaires about their clinical behaviours before and 1 and 2 years after attending the programmes. We evaluated the changes in clinical behaviours in accordance with the clinical practice guidelines between before and 2 years after the programme. Results All of the scores for clinical behaviours in accordance with clinical practice guidelines were significantly improved after 1 and 2 years compared with before attending the programmes. There were no significant changes in any of the scores between 1 and 2 years after attending. Conclusions All clinical behaviours in accordance with clinical practice guidelines improved after attending the EGUIDE programme, and were maintained for at least 2 years. The EGUIDE project could contribute to improved guideline-based clinical behaviour among psychiatrists