The effect of dust obscuration in RR Tel on optical and IR long-term photometry and Fe II emission lines

Infrared and optical photometric and spectroscopic observations of the symbiotic nova RR Tel are used to study the effects and properties of dust in symbiotic binaries containing a cool Mira component, as well as showing "obscuration events" of increased absorption, which are typical for such Miras. A set of photometric observations of the symbiotic nova RR Tel in different wavelength bands - visual from 1949 to 2002 and near-infrared (JHKL) from 1975 to 2002 - are presented. The variability due to the normal Mira pulsation was removed from the JHKL data, which were then compared with the AAVSO visual light curve. The changes of the Fe II emission line fluxes during the 1996-2000 obscuration episode were studied in the optical spectra taken with the Anglo-Australian telescope. We discuss the three periods during which the Mira component was heavily obscured by dust as observed in the different wavelength bands. A change in the correlations of J with other infrared magnitudes was observed with the colour becoming redder after JD2446000. Generally, J-K was comparable, while K-L was larger than typical values for single Miras. A distance estimate of 2.5 kpc, based on the IR data, is given. A larger flux decrease for the permitted than for the forbidden Fe II lines, during the obscuration episode studied, has been found. There is no evidence for other correlations with line properties, in particular with wavelength, which suggests obscuration due to separate optically thick clouds in the outer layers.Comment: 19 pages, 11 figures, 3 table

The mysterious eruption of V838 Mon

V838 Mon is marking one of the most mysterious stellar outbursts on record. The spectral energy distribution of the progenitor resembles an under-luminous F main sequence star (at V=15.6 mag), that erupted into a cool supergiant following a complex and multi-maxima lightcurve (peaking at V=6.7 mag). The outburst spectrum show BaII, LiI and lines of several s-elements, with wide P-Cyg profiles and a moderate and retracing emission in the Balmer lines. A light-echo discovered expanding around the object helped to constrain the distance (d=790+/-30 pc), providing M_V=+4.45 in quiescence and M_V=-4.35 at optical maximum (somewhat dependent on the still uncertain E(B-V)=0.5 reddening). The general outburst trend is toward lower temperatures and larger luminosities, and continuing so at the time of writing. The object properties conflict with a classification within already existing categories: the progenitor was not on a post-AGB track and thus the similarities with the born-again AGB stars FG Sge, V605 Aql and Sakurai's object are limited to the cool giant spectrum at maximum; the cool spectrum, the moderate wind velocity (500 km/sec and progressively reducing) and the monotonic decreasing of the low ionization condition argues against a classical nova scenario. The closest similarity is with a star that erupted into an M-type supergiant discovered in M31 by Rich et al. (1989), that became however much brighter by peaking at M_V=-9.95, and with V4332 Sgr that too erupted into an M-type giant (Martini et al. 1999) and that attained a lower luminosity, closer to that of V838 Mon. M31-RedVar, V4332 Sgr and V838 Mon could be manifestations of the same and new class of astronomical objects.Comment: A&A, in pres

HST and VLT observations of the Symbiotic Star Hen 2-147

We investigate the dynamics of the nebula around the symbiotic star Hen 2-147, determine its expansion parallax, and compare it with the distance obtained via the Period-Luminosity relation for its Mira variable. The geometry of the nebula is found to be that of a knotty annulus of ionized gas inclined to the plane of sky and expanding with a velocity of ~90 km/s. A straightforward application of the expansion parallax method provides a distance of 1.5+-0.4 kpc, which is a factor of two lower than the distance of 3.0+-0.4 kpc obtained from the Period-Luminosity relationship for the Mira (which has a pulsation period of 373 days). The discrepancy is removed if, instead of expanding matter, we are observing the expansion of a shock front in the plane of the sky. This shock interpretation is further supported by the broadening of the nebular emission lines.Comment: Accepted for publication in A&A; 16 pages, 13 figure

Sex differences in stress-induced social withdrawal: role of brain derived neurotrophic factor in the bed nucleus of the stria terminalis

Depression and anxiety disorders are more common in women than men, and little is known about the neurobiological mechanisms that contribute to this disparity. Recent data suggest that stress-induced changes in neurotrophins have opposing effects on behavior by acting in different brain networks. Social defeat has been an important approach for understanding neurotrophin action, but low female aggression levels in rats and mice have limited the application of these methods primarily to males. We examined the effects of social defeat in monogamous California mice (Peromyscus californicus), a species in which both males and females defend territories. We demonstrate that defeat stress increases mature brain-derived neurotrophic factor (BDNF) protein but not mRNA in the bed nucleus of the stria terminalis (BNST) in females but not males. Changes in BDNF protein were limited to anterior subregions of the BNST, and there were no changes in the adjacent nucleus accumbens (NAc). The effects of defeat on social withdrawal behavior and BDNF were reversed by chronic, low doses of the antidepressant sertraline. However, higher doses of sertraline restored social withdrawal and elevated BDNF levels. Acute treatment with a low dose of sertraline failed to reverse the effects of defeat. Infusions of the selective tyrosine-related kinase B receptor (TrkB) antagonist ANA-12 into the anterior BNST specifically increased social interaction in stressed females but had no effect on behavior in females naïve to defeat. These results suggest that stress-induced increases in BDNF in the anterior BNST contribute to the exaggerated social withdrawal phenotype observed in females

Kualitas dan Kadar Amonia Litter Akibat Penambahan Sinbiotik dalam Ransum Ayam Broiler

Penelitian bertujuan untuk mengkaji perubahan kualitas dan kadar amonia litter pada pemeliharaan ayam broiler akibat penambahan sinbiotik dari inulin ekstrak umbi gembili dan bakteri Lactobacillus plantarum. Materi yang digunakan adalah ayam broiler day old chick (DOC) unsexed sebanyak 144 ekor dengan bobot awal 45,68 ± 1,52 g dialokasikan ke dalam rancangan acak lengkap (RAL) dengan 4 perlakuan 6 ulangan. Perlakuan yang diberikan berupa penambahan sinbiotik yaitu sebagai berikut T0 : ransum basal (tanpa penambahan sinbiotik); T1 : sinbiotik 1 ml/100g ransum; T2 : sinbiotik 2 ml/100g ransum dan T3 : sinbiotik 3 ml/100g ransum. Parameter yang diamati adalah kadar air, pH, suhu, dan amonia litter. Data yang diperoleh dianalisis dan data yang menunjukkan pengaruh perlakuan yang nyata di uji lanjut dengan uji wilayah Duncan. Hasil penelitian menunjukkan bahwa penambahan sinbiotik signifikan (P≤0,05) menurunkan kadar amonia dan pH litter, dan signifikan (P≤0,05) meningkatkan kadar air litter, sedangkan terhadap suhu litter tidak berpengaruh signifikan (P>0,05). Kesimpulan dari penelitian ini adalah penambahan sinbiotik sebanyak 2 ml/ 100g ransum dapat memperbaiki kualitas dan kadar amonia litter

(Cost-)effectiveness of an individualised risk prediction tool (PERSARC) on patient’s knowledge and decisional conflict among soft-tissue sarcomas patients:protocol for a parallel cluster randomised trial (the VALUE-PERSARC study)

Introduction Current treatment decision-making in high-grade soft-tissue sarcoma (STS) care is not informed by individualised risks for different treatment options and patients’ preferences. Risk prediction tools may provide patients and professionals insight in personalised risks and benefits for different treatment options and thereby potentially increase patients’ knowledge and reduce decisional conflict. The VALUE-PERSARC study aims to assess the (cost-)effectiveness of a personalised risk assessment tool (PERSARC) to increase patients’ knowledge about risks and benefits of treatment options and to reduce decisional conflict in comparison with usual care in high-grade extremity STS patients. Methods The VALUE-PERSARC study is a parallel cluster randomised control trial that aims to include at least 120 primarily diagnosed high-grade extremity STS patients in 6 Dutch hospitals. Eligible patients (≥18 years) are those without a treatment plan and treated with curative intent. Patients with sarcoma subtypes or treatment options not mentioned in PERSARC are unable to participate. Hospitals will be randomised between usual care (control) or care with the use of PERSARC (intervention). In the intervention condition, PERSARC will be used by STS professionals in multidisciplinary tumour boards to guide treatment advice and in patient consultations, where the oncological/ orthopaedic surgeon informs the patient about his/her diagnosis and discusses benefits and harms of all relevant treatment options. The primary outcomes are patients’ knowledge about risks and benefits of treatment options and decisional conflict (Decisional Conflict Scale) 1 week after the treatment decision has been made. Secondary outcomes will be evaluated using questionnaires, 1 week and 3, 6 and 12 months after the treatment decision. Data will be analysed following an intention-to-treat approach using a linear mixed model and taking into account clustering of patients within hospitals. Ethics and dissemination The Medical Ethical Committee Leiden-Den Haag-Delft (METC-LDD) approved this protocol (NL76563.058.21). The results of this study will be reported in a peer-review journal.</p

Reduction in use of MRI and arthroscopy among patients with degenerative knee disease in independent treatment centers versus general hospitals: a time series analysis

The use of MRI and arthroscopy are considered low-value care in most patients with degenerative knee disease. To reduce these modalities, there have been multiple efforts to increase awareness. Reductions have been shown for general hospitals (GH), but it is unclear whether this may be partly explained by a shift of patients receiving these modalities in independent treatment centers (ITCs). The aims of this study were to assess (i) whether the trend in use of MRI and arthroscopy in patients with degenerative knee disease differs between ITCs and GH, and (ii) whether the Dutch efforts to raise awareness on these recommendations were associated with a change in the trend for both types of providers. All patients insured by a Dutch healthcare insurer aged ≥50 years with a degenerative knee disease who were treated in a GH or ITC between July 2014 and December 2019 were included. Linear regression was used with the quarterly percentage of patients receiving an MRI or knee arthroscopy weighted by center volume, as the primary outcome. Interrupted time-series analysis was used to evaluate the effect of the Dutch efforts to raise awareness. A total of 14 702 patients included were treated in 90 GHs (n = 13 303, 90.5%) and 29 ITCs (n = 1399, 9.5%). Across the study period, ITCs on an average had a 16% higher MRI use (P Orthopaedics, Trauma Surgery and Rehabilitatio

Performing a knee arthroscopy among patients with degenerative knee disease:one-third is potentially low value care

PURPOSE: The purpose of this study was to assess in which proportion of patients with degenerative knee disease aged 50+ in whom a knee arthroscopy is performed, no valid surgical indication is reported in medical records, and to explore possible explanatory factors. METHODS: A retrospective study was conducted using administrative data from January to December 2016 in 13 orthopedic centers in the Netherlands. Medical records were selected from a random sample of 538 patients aged 50+ with degenerative knee disease in whom arthroscopy was performed, and reviewed on reported indications for the performed knee arthroscopy. Valid surgical indications were predefined based on clinical national guidelines and expert opinion (e.g., truly locked knee). A knee arthroscopy without a reported valid indication was considered potentially low value care. Multivariate logistic regression analysis was performed to assess whether age, diagnosis ("Arthrosis" versus "Meniscal lesion"), and type of care trajectory (initial or follow-up) were associated with performing a potentially low value knee arthroscopy. RESULTS: Of 26,991 patients with degenerative knee disease, 2556 (9.5%) underwent an arthroscopy in one of the participating orthopedic centers. Of 538 patients in whom an arthroscopy was performed, 65.1% had a valid indication reported in the medical record and 34.9% without a reported valid indication. From the patients without a valid indication, a joint patient-provider decision or patient request was reported as the main reason. Neither age [OR 1.013 (95% CI 0.984-1.043)], diagnosis [OR 0.998 (95% CI 0.886-1.124)] or type of care trajectory [OR 0.989 (95% CI 0.948-1.032)] were significantly associated with performing a potentially low value knee arthroscopy. CONCLUSIONS: In a random sample of knee arthroscopies performed in 13 orthopedic centers in 2016, 65% had valid indications reported in the medical records but 35% were performed without a reported valid indication and, therefore, potentially low value care. Patient and/or surgeons preference may play a large role in the decision to perform an arthroscopy without a valid indication. Therefore, interventions should be developed to increase adherence to clinical guidelines by surgeons that target invalid indications for a knee arthroscopy to improve care. LEVEL OF EVIDENCE: IV

(Cost-)effectiveness of an individualised risk prediction tool (PERSARC) on patient’s knowledge and decisional conflict among soft-tissue sarcomas patients:protocol for a parallel cluster randomised trial (the VALUE-PERSARC study)

Introduction Current treatment decision-making in high-grade soft-tissue sarcoma (STS) care is not informed by individualised risks for different treatment options and patients’ preferences. Risk prediction tools may provide patients and professionals insight in personalised risks and benefits for different treatment options and thereby potentially increase patients’ knowledge and reduce decisional conflict. The VALUE-PERSARC study aims to assess the (cost-)effectiveness of a personalised risk assessment tool (PERSARC) to increase patients’ knowledge about risks and benefits of treatment options and to reduce decisional conflict in comparison with usual care in high-grade extremity STS patients. Methods The VALUE-PERSARC study is a parallel cluster randomised control trial that aims to include at least 120 primarily diagnosed high-grade extremity STS patients in 6 Dutch hospitals. Eligible patients (≥18 years) are those without a treatment plan and treated with curative intent. Patients with sarcoma subtypes or treatment options not mentioned in PERSARC are unable to participate. Hospitals will be randomised between usual care (control) or care with the use of PERSARC (intervention). In the intervention condition, PERSARC will be used by STS professionals in multidisciplinary tumour boards to guide treatment advice and in patient consultations, where the oncological/ orthopaedic surgeon informs the patient about his/her diagnosis and discusses benefits and harms of all relevant treatment options. The primary outcomes are patients’ knowledge about risks and benefits of treatment options and decisional conflict (Decisional Conflict Scale) 1 week after the treatment decision has been made. Secondary outcomes will be evaluated using questionnaires, 1 week and 3, 6 and 12 months after the treatment decision. Data will be analysed following an intention-to-treat approach using a linear mixed model and taking into account clustering of patients within hospitals. Ethics and dissemination The Medical Ethical Committee Leiden-Den Haag-Delft (METC-LDD) approved this protocol (NL76563.058.21). The results of this study will be reported in a peer-review journal.</p