LSST: from Science Drivers to Reference Design and Anticipated Data Products

(Abridged) We describe here the most ambitious survey currently planned in the optical, the Large Synoptic Survey Telescope (LSST). A vast array of science will be enabled by a single wide-deep-fast sky survey, and LSST will have unique survey capability in the faint time domain. The LSST design is driven by four main science themes: probing dark energy and dark matter, taking an inventory of the Solar System, exploring the transient optical sky, and mapping the Milky Way. LSST will be a wide-field ground-based system sited at Cerro Pach\'{o}n in northern Chile. The telescope will have an 8.4 m (6.5 m effective) primary mirror, a 9.6 deg$^2$ field of view, and a 3.2 Gigapixel camera. The standard observing sequence will consist of pairs of 15-second exposures in a given field, with two such visits in each pointing in a given night. With these repeats, the LSST system is capable of imaging about 10,000 square degrees of sky in a single filter in three nights. The typical 5$\sigma$ point-source depth in a single visit in $r$ will be $\sim 24.5$ (AB). The project is in the construction phase and will begin regular survey operations by 2022. The survey area will be contained within 30,000 deg$^2$ with $\delta<+34.5^\circ$, and will be imaged multiple times in six bands, $ugrizy$, covering the wavelength range 320--1050 nm. About 90\% of the observing time will be devoted to a deep-wide-fast survey mode which will uniformly observe a 18,000 deg$^2$ region about 800 times (summed over all six bands) during the anticipated 10 years of operations, and yield a coadded map to $r\sim27.5$. The remaining 10\% of the observing time will be allocated to projects such as a Very Deep and Fast time domain survey. The goal is to make LSST data products, including a relational database of about 32 trillion observations of 40 billion objects, available to the public and scientists around the world.Comment: 57 pages, 32 color figures, version with high-resolution figures available from https://www.lsst.org/overvie

Genomic investigations of unexplained acute hepatitis in children

Since its first identification in Scotland, over 1,000 cases of unexplained paediatric hepatitis in children have been reported worldwide, including 278 cases in the UK1. Here we report an investigation of 38 cases, 66 age-matched immunocompetent controls and 21 immunocompromised comparator participants, using a combination of genomic, transcriptomic, proteomic and immunohistochemical methods. We detected high levels of adeno-associated virus 2 (AAV2) DNA in the liver, blood, plasma or stool from 27 of 28 cases. We found low levels of adenovirus (HAdV) and human herpesvirus 6B (HHV-6B) in 23 of 31 and 16 of 23, respectively, of the cases tested. By contrast, AAV2 was infrequently detected and at low titre in the blood or the liver from control children with HAdV, even when profoundly immunosuppressed. AAV2, HAdV and HHV-6 phylogeny excluded the emergence of novel strains in cases. Histological analyses of explanted livers showed enrichment for T cells and B lineage cells. Proteomic comparison of liver tissue from cases and healthy controls identified increased expression of HLA class 2, immunoglobulin variable regions and complement proteins. HAdV and AAV2 proteins were not detected in the livers. Instead, we identified AAV2 DNA complexes reflecting both HAdV-mediated and HHV-6B-mediated replication. We hypothesize that high levels of abnormal AAV2 replication products aided by HAdV and, in severe cases, HHV-6B may have triggered immune-mediated hepatic disease in genetically and immunologically predisposed children

Laser Interstitial Thermal Therapy Case Series: Choosing the Correct Number of Fibers Depending on Lesion Size

BACKGROUND: Laser interstitial thermal therapy (LITT) is being used for the treatment of recurrent glioblastoma multiforme (GBM). Lesions can be treated using 1 or multiple LITT fibers depending on the preference of surgeons. Usually, more fibers are needed for coverage of larger tumors. OBJECTIVE: To investigate and analyze how tumor size affected the number of LITT fibers used. METHODS: This is a retrospective review of patients undergoing treatment of recurrent GBM. Patients were treated with up to 4 LITT fibers for adequate tumor coverage. Patient demographics, tumor characteristics, length of stay, complications, and biopsy results were recorded. RESULTS: A total of 43 cases were treated using LITT, and of these cases, 31 consisted of contiguous lesions. We used more fibers to treat larger tumor volumes. On average, for each 5 cc of tumor volume, a fiber was added for proper coverage (P=.554). Complications and length of stay were similar across the groups (P=.378, P=.941). CONCLUSION: LITT can be used for the treatment of recurrent GBM. For each 5 cc of tumor volume, a LITT fiber can be added to the treatment plan

Risk, Capacity and Making Decisions about CTOs: A Report From ‘The CTO Study’

This study was commissioned by the Mental Health, Drug and Alcohol Office of NSW Health to address the question of how ‘risk’ and ‘capacity’ can be better conceptualised in the setting of decisions around CTOs in NSW

Involuntary psychiatric treatment in the community : general practitioners and the implementation of community treatment orders

Background. There are no data about general practitioners' (GPs') involvement in involuntary psychiatric community treatment orders (CTOs). We examined stakeholder perspectives on the GP's role in this area. Methods. Semi-structured interviews were conducted around CTO experiences with 38 participants: patients, carers, clinicians and Mental Health Review Tribunal members. Data were analysed using established qualitative methodologies. Results. Sixteen participants specifically spoke about GPs. The analysis identified four themes in their accounts: GPs as 'instruments' of CTOs; GPs as primary caregivers within a CTO; GPs as 'outsiders'; and practical challenges for GPs. Within these themes, participants identified the value of GPs in the provision of care for people living with severe and persistent mental illness, the challenges of coercive processes and the dangers of GPs being isolated from them

Community Treatment Orders: The Lived Experience of Consumers and Carers in NSW

Report based on the study commissioned by the Mental Health, Drug and Alcohol Office (MHDAO) of NSW Health to provide a qualitative analysis of the lived experience of consumers subject to CTOs and carers of people subject to CTOs in NSW. This study was linked to another inquiry conducted on behalf of MHDAO by the same research group examining how the concepts of ‘risk’ and ‘capacity’ could be constructed in the context of decisions around the use of CTOs. (The results of the ‘risk and capacity’ arm of the study are reported elsewhere.

Community treatment orders: the lived experience of consumers and carers in NSW

There is limited research examining the lived experiences of consumers and carers subject to community treatment orders (CTOs). Between 2009 and 2012, the Centre for Values Ethics and the Law in Medicine (VELiM) at the University of Sydney conducted a research program examining this area, on behalf of the Mental Health, Drug and Alcohol Office (MHDAO) of NSW Health. (The research was part of a larger project examining CTO decision-making, in which clinicians and Mental Health Review Tribunal members were also interviewed.) Eleven participants - five consumers and six carers - participated in the research project by taking part in in-depth interviews about their experiences. This interview data set was analysed using qualitative methodologies. The lived experience of consumers and carers of CTOs in NSW had five themes: `access', 'isolation', 'loss and trauma', 'resistance and resignation' and `vulnerability and distress'. These spoke to the experiential components of the losses and trauma associated with a severe mental illness, the compromises associated with the assumption of the sick role, and the challenges of managing the relationships and engagements necessitated by these processes. According to the theory that emerges from our analysis of the data, the experience of living under a CTO in NSW is a mixture of distress and of acknowledgement of the value of the process. This generalised across both the consumer and the carer participant groups. In a number of the narratives provided, there were both direct and indirect experiences of sub-optimal care, usually the result of excessive demands on particular health services and the overall deprivation or social injustice faced by many suffering from severe mental illness. The distress, isolation, grief and loss experienced by those affected by CTOs appeared to be a part of the experience of a severe mental illness. Putting aside instances where CTOs were implemented poorly, the kind of illness and level of disability experienced by those who needed such treatment interventions was an intrinsic source of distress. The need for a CTO emerged from that illness and, by extension, that distress. In essence, the experience of distress around a CTO seemed to be indistinguishable from the distress of the severe illness that necessitated it. All of the consumer participants and many of the carer participants described the experience of CTOs as being characterised by problems with communication and understanding. The model of the lived experience of CTOs for consumer and career participants can be distilled as one of profound ambivalence. As a part of the tragic journey taken by consumers and their carers in the course of a severe mental illness, CTOs are associated with distress and a sense of loss, isolation and disempowerment. From these data the study proposed a model of experience of being subject to a CTO in NSW is one of a core distress, emerging from the distress of the illness, communication gaps, difficultly accessing services, and the perceived benefits of CTOs. The findings of this research are in general agreement with other studies in that the loss of autonomy and constraints associated with a CTO are balanced with their clear benefits. These findings build on existing research in the field. From this research, it is evident that the distress arising from being subject to a CTO can be assuaged by those tasked with their implementation by focusing upon clearer communication about the order (including strategies to ensure consumers and their carers are aware of the specifics of the order), strategies to improve access to services for mental and physical services and other social institutions, and acknowledging that the CTO is a part of the overall distress of a severe mental illness.Mental Health, Drug and Alcohol Office (MHDAO), NSW Healt