A New Population of Planetary Nebulae Discovered in the Large Magellanic Cloud (III): The Luminosity Function

Our previous identification and spectroscopic confirmation of 431 faint, new planetary nebulae in the central 25 deg^2 region of the LMC permits us to now examine the shape of the LMC Planetary Nebula Luminosity Function (PNLF) through an unprecedented 10 magnitude range. The majority of our newly discovered and previously known PNe were observed using the 2dF, multi-object fibre spectroscopy system on the 3.9-m Anglo-Australian Telescope and the FLAMES multi-object spectrograph on the 8-m VLT. We present reliable [OIII]5007 and H-beta flux estimates based on calibrations to well established PN fluxes from previous surveys and spectroscopic standard stars. The bright cutoff (M*) of the PNLF is found by fitting a truncated exponential curve to the bright end of the PNLF over a 3.4 magnitude range. This cutoff is used to estimate a new distance modulus of 18.46 to the LMC, in close agreement with previous PNLF studies and the best estimates by other indicators. The bright end cutoff is robust to small samples of bright PNe since significantly increased PN samples do not change this fiducial. We then fit a truncated exponential curve directly to the bright end of the function over a 6 magnitude range and test the curve's ability to indicate the position of M*. Because of the significant increase in the number of LMC PN, the shape of the PNLF is now examined in greater detail than has previously been possible. Through cumulative functions, the new LMC PNLF is compared to those from the SMC and a new deep local Galactic sample revealing the effects of incompleteness. The new [OIII]5007 LMC PNLF is then compared to our new H-beta LMC PNLF using calibrated and measured fluxes for the same objects, revealing the effects of metallicity on the [OIII]5007 line.Comment: 28 pages, 24 figures. Accepted MNRA

Hierarchical structures in the Large and Small Magellanic Clouds

We investigate the degree of spatial correlation among extended structures in the LMC and SMC. To this purpose we work with sub-samples characterised by different properties such as age and size, taken from the updated catalogue of Bica et al. or gathered in the present work. The structures are classified as star clusters or non-clusters (basically, nebular complexes and their stellar associations). The radius distribution functions follow power-laws ($dN/dR\propto R^{-\alpha}$) with slopes and maximum radius ($R_{max}$) that depend on object class (and age). Non-clusters are characterised by $\alpha\approx1.9$ and R_{max}\la472 pc, while young clusters (age \la10 Myr) have $\alpha\approx3.6$ and R_{max}\la15 pc, and old ones (age \ga600 Myr) have $\alpha\approx2.5$ and R_{max}\la40 pc. Young clusters present a high degree of spatial self-correlation and, especially, correlate with star-forming structures, which does not occur with the old ones. This is consistent with the old clusters having been heavily mixed up, since their ages correspond to several LMC and SMC crossing times. On the other hand, with ages corresponding to fractions of the respective crossing times, the young clusters still trace most of their birthplace structural pattern. Also, small clusters ($R<10$ pc), as well as small non-clusters ($R<100$ pc), are spatially self-correlated, while their large counterparts of both classes are not. The above results are consistent with a hierarchical star-formation scenario for the LMC and SMC.Comment: Accepted by MNRA

Post-intervention Status in Patients With Refractory Myasthenia Gravis Treated With Eculizumab During REGAIN and Its Open-Label Extension

OBJECTIVE: To evaluate whether eculizumab helps patients with anti-acetylcholine receptor-positive (AChR+) refractory generalized myasthenia gravis (gMG) achieve the Myasthenia Gravis Foundation of America (MGFA) post-intervention status of minimal manifestations (MM), we assessed patients' status throughout REGAIN (Safety and Efficacy of Eculizumab in AChR+ Refractory Generalized Myasthenia Gravis) and its open-label extension. METHODS: Patients who completed the REGAIN randomized controlled trial and continued into the open-label extension were included in this tertiary endpoint analysis. Patients were assessed for the MGFA post-intervention status of improved, unchanged, worse, MM, and pharmacologic remission at defined time points during REGAIN and through week 130 of the open-label study. RESULTS: A total of 117 patients completed REGAIN and continued into the open-label study (eculizumab/eculizumab: 56; placebo/eculizumab: 61). At week 26 of REGAIN, more eculizumab-treated patients than placebo-treated patients achieved a status of improved (60.7% vs 41.7%) or MM (25.0% vs 13.3%; common OR: 2.3; 95% CI: 1.1-4.5). After 130 weeks of eculizumab treatment, 88.0% of patients achieved improved status and 57.3% of patients achieved MM status. The safety profile of eculizumab was consistent with its known profile and no new safety signals were detected. CONCLUSION: Eculizumab led to rapid and sustained achievement of MM in patients with AChR+ refractory gMG. These findings support the use of eculizumab in this previously difficult-to-treat patient population. CLINICALTRIALSGOV IDENTIFIER: REGAIN, NCT01997229; REGAIN open-label extension, NCT02301624. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that, after 26 weeks of eculizumab treatment, 25.0% of adults with AChR+ refractory gMG achieved MM, compared with 13.3% who received placebo

Minimal Symptom Expression' in Patients With Acetylcholine Receptor Antibody-Positive Refractory Generalized Myasthenia Gravis Treated With Eculizumab

The efficacy and tolerability of eculizumab were assessed in REGAIN, a 26-week, phase 3, randomized, double-blind, placebo-controlled study in anti-acetylcholine receptor antibody-positive (AChR+) refractory generalized myasthenia gravis (gMG), and its open-label extension

Self-management practices associated with quality of life for adults with epilepsy.

Epilepsy self-management practices enhance a patient\u27s competence and confidence in managing their chronic condition, which is assumed to lead to an improved quality of life (QoL). We analyzed the relationship between the Epilepsy Self-Management Scale (ESMS) responses and the Quality of Life in Epilepsy (QOLIE-31) scores. Baseline questionnaires from HOBSCOTCH, a self-management program for cognitive problems, were administered in four New England epilepsy centers on adults (n = 100) with epilepsy and subjective memory complaints. There was no correlation between overall self-management scores and overall quality-of-life scores; however, subscale analyses indicated that certain self-management practices were strongly correlated with the overall QOLIE-31 score. Specifically, improved ESMS lifestyle management was associated with an increased quality-of-life score (adjusted p \u3c 0.01), while enhanced ESMS safety management practices were associated with a decreased overall quality-of-life score (adjusted p \u3c 0.01). Our item-level analysis highlighted specific items within the ESMS safety management, ESMS lifestyle management, and ESMS information management subdomains that were significant predictors for QoL. Depression was also shown to be significantly correlated with the QOLIE-31 (p \u3c 0.01). Our study suggests that an overemphasis on safety practices may negatively affect quality of life, while enhanced lifestyle management has positive effects. Furthermore, our finding that quality of life is greatly dependent on depressive symptoms underscores the importance of treating depression in epilepsy

Effectiveness of a Self-Management Program to Improve Cognition and Quality of Life in Epilepsy: A Pragmatic, Randomized, Multicenter Trial

OBJECTIVE: To determine the effectiveness of HOBSCOTCH (Home-based self-management and cognitive training changes lives) in a real-world setting, and to assess feasibility of a virtual intervention, we conducted a multi-site, pragmatic replication trial at four New England epilepsy centers. METHODS: HOBSCOTCH is an 8-session intervention addressing cognitive impairment and quality of life (QOL) for people with epilepsy (PWE). Participants were recruited from epilepsy centers in four states and block-randomized into the following groups: in-person HOBSCOTCH (H-IP), virtual HOBSCOTCH (H-V), and waitlist control. Outcome measures were assessed for all groups at baseline, 3-months, and 6-months; intervention groups received long-term follow-up at 9- and 12-months. RESULTS: A total of 108 participants were recruited, of which 85 were included in this analysis (age at baseline 47.5 ± 11.5 years; 68% female). Participants completing the in-person intervention (H-IP) had a 12.4-point improvement in QOL score compared to controls ( \u3c 0.001). Pairwise comparisons found a 6.2-point treatment effect for subjective cognition in the H-IP group ( \u3c 0.001). There were no meaningful group differences in objective cognition or healthcare utilization at any timepoints, and the treatment effect for QOL diminished by 6-months. The virtual intervention demonstrated feasibility, but did not significantly improve outcomes compared to controls. Within-group analysis found improvements in QOL for both H-V and H-IP. CONCLUSIONS: This study replicated the effectiveness of the HOBSCOTCH program in improving QOL for PWE. The study was conducted prior to the COVID-19 pandemic, but the distance-delivered intervention may be particularly well-suited for the current environment. Future research will explore modifications designed to improve the efficacy of H-V and the sustainability of HOBSCOTCH\u27s treatment effect. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that in-person HOBSCOTCH delivery improved subjective measures of cognition in persons with epilepsy.The study was registered and listed on ClinicalTrials.gov (NCT02394509)