Modelling the structure and kinematics of the Firework nebula: The nature of the GK Persei nova shell and its jet-like feature

Aims. The shaping mechanisms of old nova remnants are probes for several important and unexplained processes, such as dust formation and the structure of evolved star nebulae. To gain a more complete understanding of the dynamics of the GK Per (1901) remnant, an examination of symmetry of the nova shell is explored, followed by a kinematical analysis of the previously detected jet-like feature in the context of the surrounding fossil planetary nebula. Methods. Faint-object high-resolution echelle spectroscopic observations and imaging were undertaken covering the knots which comprise the nova shell and the surrounding nebulosity. New imaging from the Aristarchos telescope in Greece and long-slit spectra from the Manchester Echelle Spectrometer instrument at the San Pedro Martir observatory in Mexico were obtained, supplemented with archival observations from several other optical telescopes. Position-velocity arrays are produced of the shell, and also individual knots, and are then used for morpho-kinematic modelling with the shape code. The overall structure of the old knotty nova shell of GK Per and the planetary nebula in which it is embedded is then analysed. Results. Evidence is found for the interaction of knots with each other and with a wind component, most likely the periodic fast wind emanating from the central binary system. We find that a cylindrical shell with a lower velocity polar structure gives the best model fit to the spectroscopy and imaging. We show in this work that the previously seen jet-like feature is of low velocity. Conclusions. The individual knots have irregular tail shapes; we propose here that they emanate from episodic winds from ongoing dwarf nova outbursts by the central system. The nova shell is cylindrical, not spherical, and the symmetry axis relates to the inclination of the central binary system. Furthermore, the cylinder axis is aligned with the long axis of the bipolar planetary nebula in which it is embedded. Thus, the central binary system is responsible for the bipolarity of the planetary nebula and the cylindrical nova shell. The gradual planetary nebula ejecta versus sudden nova ejecta is the reason for the different degrees of bipolarity. We propose that the “jet” feature is an illuminated lobe of the fossil planetary nebula that surrounds the nova shell

Polarimetry and Spectroscopy of the `Oxygen Flaring' DQ Herculis-like nova: V5668 Sagittarii (2015)

Classical novae are eruptions on the surface of a white dwarf in a binary system. The material ejected from the white dwarf surface generally forms an axisymmetric shell of gas and dust around the system. The three-dimensional structure of these shells is difficult to untangle when viewed on the plane of the sky. In this work a geometrical model is developed to explain new observations of the 2015 nova V5668 Sagittarii. To understand the ionisation structure in terms of the nova shell morphology and estimate the emission distribution directly following the light-curve's dust-dip. High-cadence optical polarimetry and spectroscopy observations of a nova are presented. The ejecta is modelled in terms of morpho-kinematics and photoionisation structure. Initially observational results are presented, including broadband polarimetry and spectroscopy of V5668 Sgr nova during eruption. Variability over these observations provides clues towards the evolving structure of the nova shell. The position angle of the shell is derived from polarimetry, which is attributed to scattering from small dust grains. Shocks in the nova outflow are suggested in the photometry and the effect of these on the nova shell are illustrated with various physical diagnostics. Changes in density and temperature as the super soft source phase of the nova began are discussed. Gas densities are found to be of the order of 10$^{9}$ cm$^{-3}$ for the nova in its auroral phase. The blackbody temperature of the central stellar system is estimated to be around $2.2\times10^{5}$ K at times coincident with the super soft source turn-on. It was found that the blend around 4640 $\rm{\AA}$ commonly called `nitrogen flaring' is more naturally explained as flaring of the O~{\sc ii} multiplet (V1) from 4638 - 4696 $\rm{\AA}$, i.e. `oxygen flaring'

Two New Nova Shells associated with V4362 Sagittarii and DO Aquilae

A classical nova is an eruption on the surface of a white dwarf in an accreting binary system. The material ejected from the white dwarf surface generally forms an axisymmetric shell. The shaping mechanisms of nova shells are probes of the processes that take place at energy scales between planetary nebulae and supernova remnants. We report on the discovery of nova shells surrounding the post-nova systems V4362 Sagittarii (1994) and more limited observations of DO Aquilae (1925). Distance measurements of 0.5p/m1.4 kpc for V4362 Sgr and 6.7 p/m 3.5 kpc -0.2 for DO Aql are found based on the expansion parallax method. The growth rates are measured to be 0.07``/year for DO Aql and 0.32``/year for V4362 Sgr. A preliminary investigation into the ionisation structure of the nova shell associated with V4362 Sgr is presented. The observed ionisation structure of nova shells depends strongly on their morphology and the orientation of the central component towards the observer. X-ray, IR and UV observations as well as optical integral field unit spectroscopy are required to better understand these interesting objects

Hemobilia and pancreatitis as complications of a percutaneous transhepatic cholangiogram

Percutaneous transhepatic cholangiography (PTC) was performed on a 23-year-old male because of an atypical progression of hepatitis B antigen-negative hepatitis. No bile duct was entered and the procedure was uneventful. However, celiac angiography the day following PTC revealed abnormal liver vessels in the target area and the patient developed hemobilia and clinical pancreatitis, causing common duct obstruction. Symptomatology persisted until celiotomy 32 days after PTC. Clots were found obstructing the common bile duct.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44383/1/10620_2005_Article_BF01071178.pd

Shock shaping? Nebular spectroscopy of nova V906 Carinae

V906 Carinae was one of the best observed novae of recent times. It was a prolific dust producer and harboured shocks in the early evolving ejecta outflow. Here, we take a close look at the consequences of these early interactions through study of high-resolution Ultraviolet and Visual Echelle spectrograph spectroscopy of the nebular stage and extrapolate backwards to investigate how the final structure may have formed. A study of ejecta geometry and shaping history of the structure of the shell is undertaken following a spectral line $\rm {\small SHAPE}$ model fit. A search for spectral tracers of shocks in the nova ejecta is undertaken and an analysis of the ionized environment. Temperature, density, and abundance analyses of the evolving nova shell are presented

Part-time and full-time medical specialists, are there differences in allocation of time?

BACKGROUND: An increasing number of medical specialists prefer to work part-time. This development can be found worldwide. Problems to be faced in the realization of part-time work in medicine include the division of night and weekend shifts, as well as communication between physicians and continuity of care. People tend to think that physicians working part-time are less devoted to their work, implying that full-time physicians complete a greater number of tasks. The central question in this article is whether part-time medical specialists allocate their time differently to their tasks than full-time medical specialists. METHODS: A questionnaire was sent by mail to all internists (N = 817), surgeons (N = 693) and radiologists (N = 621) working in general hospitals in the Netherlands. Questions were asked about the actual situation, such as hours worked and night and weekend shifts. The response was 53% (n = 411) for internists, 52% (n = 359) for surgeons, and 36% (n = 213) for radiologists. Due to non-response on specific questions there were 367 internists, 316 surgeons, and 71 radiologists included in the analyses. Multilevel analyses were used to analyze the data. RESULTS: Part-time medical specialists do not spend proportionally more time on direct patient care. With respect to night and weekend shifts, part-time medical specialists account for proportionally more or an equal share of these shifts. The number of hours worked per FTE is higher for part-time than for full-time medical specialists, although this difference is only significant for surgeons. CONCLUSION: In general, part-time medical specialists do their share of the job. However, we focussed on input only. Besides input, output like the numbers of services provided deserves attention as well. The trend in medicine towards more part-time work has an important consequence: more medical specialists are needed to get the work done. Therefore, a greater number of medical specialists have to be trained. Part-time work is not only a female concern; there are also (international) trends for male medical specialists that show a decline in the number of hours worked. This indicates an overall change in attitudes towards the number of hours medical specialists should work

How does study quality affect the results of a diagnostic meta-analysis?

Background: The use of systematic literature review to inform evidence based practice in diagnostics is rapidly expanding. Although the primary diagnostic literature is extensive, studies are often of low methodological quality or poorly reported. There has been no rigorously evaluated, evidence based tool to assess the methodological quality of diagnostic studies. The primary objective of this study was to determine the extent to which variations in the quality of primary studies impact the results of a diagnostic meta-analysis and whether this differs with diagnostic test type. A secondary objective was to contribute to the evaluation of QUADAS, an evidence-based tool for the assessment of quality in diagnostic accuracy studies. Methods: This study was conducted as part of large systematic review of tests used in the diagnosis and further investigation of urinary tract infection (UTI) in children. All studies included in this review were assessed using QUADAS, an evidence-based tool for the assessment of quality in systematic reviews of diagnostic accuracy studies. The impact of individual components of QUADAS on a summary measure of diagnostic accuracy was investigated using regression analysis. The review divided the diagnosis and further investigation of UTI into the following three clinical stages: diagnosis of UTI, localisation of infection, and further investigation of the UTI. Each stage used different types of diagnostic test, which were considered to involve different quality concerns. Results: Many of the studies included in our review were poorly reported. The proportion of QUADAS items fulfilled was similar for studies in different sections of the review. However, as might be expected, the individual items fulfilled differed between the three clinical stages. Regression analysis found that different items showed a strong association with test performance for the different tests evaluated. These differences were observed both within and between the three clinical stages assessed by the review. The results of regression analyses were also affected by whether or not a weighting (by sample size) was applied. Our analysis was severely limited by the completeness of reporting and the differences between the index tests evaluated and the reference standards used to confirm diagnoses in the primary studies. Few tests were evaluated by sufficient studies to allow meaningful use of meta-analytic pooling and investigation of heterogeneity. This meant that further analysis to investigate heterogeneity could only be undertaken using a subset of studies, and that the findings are open to various interpretations. Conclusion: Further work is needed to investigate the influence of methodological quality on the results of diagnostic meta-analyses. Large data sets of well-reported primary studies are needed to address this question. Without significant improvements in the completeness of reporting of primary studies, progress in this area will be limited

Validity of Resting Energy Expenditure Predictive Equations before and after an Energy-Restricted Diet Intervention in Obese Women

Background We investigated the validity of REE predictive equations before and after 12-week energy-restricted diet intervention in Spanish obese (30 kg/m2>BMI<40 kg/m2) women. Methods We measured REE (indirect calorimetry), body weight, height, and fat mass (FM) and fat free mass (FFM, dual X-ray absorptiometry) in 86 obese Caucasian premenopausal women aged 36.7±7.2 y, before and after (n = 78 women) the intervention. We investigated the accuracy of ten REE predictive equations using weight, height, age, FFM and FM. Results At baseline, the most accurate equation was the Mifflin et al. (Am J Clin Nutr 1990; 51: 241–247) when using weight (bias:−0.2%, P = 0.982), 74% of accurate predictions. This level of accuracy was not reached after the diet intervention (24% accurate prediction). After the intervention, the lowest bias was found with the Owen et al. (Am J Clin Nutr 1986; 44: 1–19) equation when using weight (bias:−1.7%, P = 0.044), 81% accurate prediction, yet it provided 53% accurate predictions at baseline. Conclusions There is a wide variation in the accuracy of REE predictive equations before and after weight loss in non-morbid obese women. The results acquire especial relevance in the context of the challenging weight regain phenomenon for the overweight/obese population.The present study was supported by the University of the Basque Country (UPV 05/80), Social Foundation of the Caja Vital- Kutxa and by the Department of Health of the Government of the Basque Country (2008/111062), and by the Spanish Ministry of Science and Innovation (RYC-2010-05957)

Rapid copper acquisition by developing murine mesothelioma: Decreasing bioavailable copper slows tumor growth, normalizes vessels and promotes T cell infiltration

Copper, an essential trace element acquired through nutrition, is an important co-factor for pro-angiogenic factors including vascular endothelial growth factor (VEGF). Decreasing bioavailable copper has been used as an antiangiogenic and anti-cancer strategy with promising results. However, the role of copper and its potential as a therapy in mesothelioma is not yet well understood. Therefore, we monitored copper levels in progressing murine mesothelioma tumors and analyzed the effects of lowering bioavailable copper. Copper levels in tumors and organs were assayed using atomic absorption spectrophotometry. Mesothelioma tumors rapidly sequestered copper at early stages of development, the copper was then dispersed throughout growing tumor tissues. These data imply that copper uptake may play an important role in early tumor development. Lowering bioavailable copper using the copper chelators, penicillamine, trientine or tetrathiomolybdate, slowed in vivo mesothelioma growth but did not provide any cures similar to using cisplatin chemotherapy or anti-VEGF receptor antibody therapy. The impact of copper lowering on tumor blood vessels and tumor infiltrating T cells was measured using flow cytometry and confocal microscopy. Copper lowering was associated with reduced tumor vessel diameter, reduced endothelial cell proliferation (reduced Ki67 expression) and lower surface ICAM/CD54 expression implying reduced endothelial cell activation, in a process similar to endothelial normalization. Copper lowering was also associated with a CD4+ T cell infiltrate. In conclusion, these data suggest copper lowering is a potentially useful anti-mesothelioma treatment strategy that slows tumor growth to provide a window of opportunity for inclusion of other treatment modalities to improve patient outcomes