The decline and fall of GRS 1915+105: the end is nigh?

The Galactic microquasar GRS 1915+105 has been in a continuous state of outburst since 1992, over 20 times longer than any other black hole X-ray transient. Assuming that the outburst is powered via accretion of an irradiated gaseous disc, we calculate how the predicted outburst duration varies according to the efficiency of the self-irradiation mechanism. At least one current model leads to the conclusion that the end of the outburst is imminent. The timing of the decline of GRS 1915+105, whenever it arrives, will be an excellent discriminator of the self-irradiation mechanism in X-ray transients, allowing us to infer the fraction of the disc that is heated by the incident X-rays and the magnitude of the mass loss rate in the form of a wind

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

On the nature of superoutbursts in dwarf novae

We present the first detailed hydrodynamic simulation of a superoutburst to incorporate the full tidal potential of a binary system. A two-dimensional smoothed particle hydrodynamics code is used to simulate a superoutburst in a binary with the parameters of the SU UMa system Z Chamaeleontis. The simulated light curves shows all the features observed in such systems. Analysis of the mass flux through the disc and the growth rate of the superhumps and disc eccentricity show that the superoutburst–superhump phenomenon is a direct result of tidal instability. No enhanced mass transfer from the secondary is required to initiate or sustain these phenomena. Comparisons of superoutbursts with normal outbursts are made and we show that the model can be reconciled with the behaviour of U Geminorum-type dwarf novae, which show no superoutbursts

Propeller-activated resonances and the fate of short-period cataclysmic variables

We show that the combination of a weak magnetic propeller and accretion disc resonances can effectively halt accretion in short-period cataclysmic variables (CVs) for large fractions of their lifetimes. This may help to explain the discrepancy between the observed and predicted orbital period distributions of CVs at short periods. Orbital resonances cause the disc to become eccentric, allowing material to fall back on to the donor star or out of the system. A weak magnetic field on a rapidly spinning primary star propels disc material outwards, allowing it to access these resonances. Numerical and analytic calculations show that this state can be long lived (1011 yr). This is because the magnetic propeller is required only to maintain access to the resonances, and not to push matter out of the Roche lobe, so that the spin-down time-scale is much longer than that for a classical propeller model

The outbursts of dwarf novae

We present a numerical scheme for the evolution of an accretion disc through a dwarf nova outburst. We introduce a time-varying artificial viscosity into an existing smoothed particle hydrodynamics code optimized for two- and three-dimensional simulations of accretion discs. The technique gives rise to coherent outbursts and can easily be adapted to include a complete treatment of thermodynamics. We apply a two-dimensional isothermal scheme to the system SS Cygni, and present a wide range of observationally testable results

DNA damage-induced expression of p53 suppresses mitotic checkpoint kinase hMps1: the lack of this suppression in p53mut cells contributes to apoptosis

DNA damage induced by the topoisomerase I inhibitor irinotecan (CPT-11) triggers in p53WT colorectal carcinoma cells a long term cell cycle arrest and in p53MUT cells a transient arrest followed by apoptosis (Magrini, R., Bhonde, M. R., Hanski, M. L., Notter, M., Scherübl, H., Boland, C. R., Zeitz, M., and Hanski, C. (2002) Int. J. Cancer 101, 23-31; Bhonde, M. R., Hanski, M. L., Notter, M., Gillissen, B. F., Daniel, P. T., Zeitz, M., and Hanski, C. (2006) Oncogene 25, 165-175). The mechanism of the p53-independent apoptosis still remains largely unclear. Here we used five p53WT and five p53MUT established colon carcinoma cell lines to identify gene expression alterations associated with apoptosis in p53MUT cells after treatment with SN-38, the irinotecan metabolite. After treatment, 16 mitosis-related genes were found to be expressed at least 2-fold stronger in the apoptosis-executing p53MUT cells than in the cell cycle-arrested p53WT cells by oligonucleotide microarray analysis. One of the genes whose strong post-treatment expression was associated with apoptosis was the mitotic checkpoint kinase hMps1 (human ortholog of the yeast monopolar spindle 1 kinase). hMps1 mRNA and protein expression were suppressed by the treatment-induced and by the exogenous adenovirus-coded p53 protein. The direct suppression of hMps1 on RNA level or inhibition of its activity by a dominant-negative hMps1 partly suppressed apoptosis. Together, these data indicate that the high expression of mitotic genes in p53 MUT cells after SN-38 treatment contributes to DNA damage-induced apoptosis, whereas their suppression in p53WT cells acts as a safeguard mechanism preventing mitosis initiation and the subsequent apoptosis. hMps1 kinase is one of the mitotic checkpoint proteins whose expression after DNA damage in p53 MUT cells activates the checkpoint and contributes to apoptosis. © 2006 by The American Society for Biochemistry and Molecular Biology, Inc

Body mass index and complications following major gastrointestinal surgery: A prospective, international cohort study and meta-analysis

Aim Previous studies reported conflicting evidence on the effects of obesity on outcomes after gastrointestinal surgery. The aims of this study were to explore the relationship of obesity with major postoperative complications in an international cohort and to present a metaanalysis of all available prospective data. Methods This prospective, multicentre study included adults undergoing both elective and emergency gastrointestinal resection, reversal of stoma or formation of stoma. The primary end-point was 30-day major complications (Clavien–Dindo Grades III–V). A systematic search was undertaken for studies assessing the relationship between obesity and major complications after gastrointestinal surgery. Individual patient meta-analysis was used to analyse pooled results. Results This study included 2519 patients across 127 centres, of whom 560 (22.2%) were obese. Unadjusted major complication rates were lower in obese vs normal weight patients (13.0% vs 16.2%, respectively), but this did not reach statistical significance (P = 0.863) on multivariate analysis for patients having surgery for either malignant or benign conditions. Individual patient meta-analysis demonstrated that obese patients undergoing surgery formalignancy were at increased risk of major complications (OR 2.10, 95% CI 1.49–2.96, P < 0.001), whereas obese patients undergoing surgery for benign indications were at decreased risk (OR 0.59, 95% CI 0.46–0.75, P < 0.001) compared to normal weight patients. Conclusions In our international data, obesity was not found to be associated with major complications following gastrointestinal surgery. Meta-analysis of available prospective data made a novel finding of obesity being associated with different outcomes depending on whether patients were undergoing surgery for benign or malignant disease