Smoothed Particle Hydrodynamics Simulations of Apsidal and Nodal Superhumps

In recent years a handful of systems have been observed to show "negative" (nodal) superhumps, with periods slightly shorter than the orbital period. It has been suggested that these modes are a consequence of the slow retrograde precession of the line of nodes in a disk tilted with respect to the orbital plane. Our simulations confirm and refine this model: they suggest a roughly axisymmetric, retrogradely-precessing, tilted disk that is driven at a period slightly less than half the orbital period as the tidal field of the orbiting secondary encounters in turn the two halves of the disk above and below the midplane. Each of these passings leads to viscous dissipation on one face of an optically-thick disk -- observers on opposite sides of the disk would each observe one brightening per orbit, but 180 degrees out of phase with each other.Comment: 11 pages. Accepted for publication in The ApJ Letter

Does Access to Health Care Impact Survival Time after Diagnosis of AIDS?

Lack of access to health care is often blamed for poor health outcomes, but this effect is not supported by existing HIV/AIDS literature. The authors examined the association between access to care and survival time after progression to AIDS, using survival analysis methods. This study combined data from two CDC sponsored studies of HIV-infected persons, a cross-sectional interview study and a longitudinal medical record review study. Study subjects included 752 persons who progressed to AIDS before December 31, 1999, and were patients at either of two major HIV care facilities in Detroit, MIchigan. Separate statistical models were used to test associations between survival time after meeting the criteria for AIDS and two indicators of access to health care: (1) perceived access to health care and (2) health care utilization patterns. Perceived access was not associated with survival time after AIDS, but patterns of health care utilization were significantly associated with survival time after AIDS (HR = 2.04, p < 0.001). Individuals who received a greater proportion of their care in the ER had a worse survival prognosis than those who received more of their health care in an outpatient clinic setting. It is crucial that we provide HIV-infected populations with tools that enable them to access a regular source of health care.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63272/1/10872910252972276.pd

A Tri-Marker Proliferation Index Predicts Biochemical Recurrence after Surgery for Prostate Cancer

Prostate cancer exhibits tremendous variability in clinical behavior, ranging from indolent to lethal disease. Better prognostic markers are needed to stratify patients for appropriately aggressive therapy. By expression profiling, we can identify a proliferation signature variably expressed in prostate cancers. Here, we asked whether one or more tissue biomarkers might capture that information, and provide prognostic utility. We assayed three proliferation signature genes: MKI67 (Ki-67; also a classic proliferation biomarker), TOP2A (DNA topoisomerase II, alpha), and E2F1 (E2F transcription factor 1). Immunohistochemical staining was evaluable on 139 radical prostatectomy cases (in tissue microarray format), with a median clinical follow-up of eight years. Each of the three proliferation markers was by itself prognostic. Notably, combining the three markers together as a “proliferation index” (0 or 1, vs. 2 or 3 positive markers) provided superior prognostic performance (hazard ratio = 2.6 (95% CI: 1.4–4.9); P = 0.001). In a multivariate analysis that included preoperative serum prostate specific antigen (PSA) levels, Gleason grade and pathologic tumor stage, the composite proliferation index remained a significant predictor (P = 0.005). Analysis of receiver-operating characteristic (ROC) curves confirmed the improved prognostication afforded by incorporating the proliferation index (compared to the clinicopathologic data alone). Our findings highlight the potential value of a multi-gene signature-based diagnostic, and define a tri-marker proliferation index with possible utility for improved prognostication and treatment stratification in prostate cancer

Use of bisulfite processing to generate high-β-O-4 content water-soluble lignosulfonates

This work was supported by EPSRC grants (EP/1518175), the Industrial Biotechnology Innovation Centre (IBioIC) (DMB Ph.D. studentship) and an EPSRC Doctoral Prize Fellowship (CSL).With lignin-first biorefineries likely to become a reality, controlled depolymerization of high-quality lignin streams to high value products has become a priority. Using bisulfite chemistry, access to a high-β-O-4 content water-soluble lignosulfonate has been achieved, allowing follow-on procedures in water to be conducted. We show that phenolic β-O-4 units preferential-ly react under acidic bisulfite conditions, whilst non-phenolic β-O-4 units react much more slowly. Exploiting this improved chemical understanding and inherent selectivity, a softwood lignosulfonate has been prepared in which phenolic β-O-4 α-sulfonation has occurred leaving significant native β-O-4 content. Use of an O-benzoylation protocol with lignin coupled with advanced 2D NMR methods has allowed detailed analysis of this and other commercial and industrial lignosulfonates. Conversion of the native β-O-4 to benzylic- oxidized β-O-4 units was followed by a selective reductive cleavage to give a premium aromatic monomer in pure form.Publisher PDFPeer reviewe

Issues in the construction of wealth indices for the measurement of socio-economic position in low-income countries

BACKGROUND: Epidemiological studies often require measures of socio-economic position (SEP). The application of principal components analysis (PCA) to data on asset-ownership is one popular approach to household SEP measurement. Proponents suggest that the approach provides a rational method for weighting asset data in a single indicator, captures the most important aspect of SEP for health studies, and is based on data that are readily available and/or simple to collect. However, the use of PCA on asset data may not be the best approach to SEP measurement. There remains concern that this approach can obscure the meaning of the final index and is statistically inappropriate for use with discrete data. In addition, the choice of assets to include and the level of agreement between wealth indices and more conventional measures of SEP such as consumption expenditure remain unclear. We discuss these issues, illustrating our examples with data from the Malawi Integrated Household Survey 2004-5. METHODS: Wealth indices were constructed using the assets on which data are collected within Demographic and Health Surveys. Indices were constructed using five weighting methods: PCA, PCA using dichotomised versions of categorical variables, equal weights, weights equal to the inverse of the proportion of households owning the item, and Multiple Correspondence Analysis. Agreement between indices was assessed. Indices were compared with per capita consumption expenditure, and the difference in agreement assessed when different methods were used to adjust consumption expenditure for household size and composition. RESULTS: All indices demonstrated similarly modest agreement with consumption expenditure. The indices constructed using dichotomised data showed strong agreement with each other, as did the indices constructed using categorical data. Agreement was lower between indices using data coded in different ways. The level of agreement between wealth indices and consumption expenditure did not differ when different consumption equivalence scales were applied. CONCLUSION: This study questions the appropriateness of wealth indices as proxies for consumption expenditure. The choice of data included had a greater influence on the wealth index than the method used to weight the data. Despite the limitations of PCA, alternative methods also all had disadvantages

Photometric variability in a warm, strongly magnetic DQ white dwarf, SDSS J103655.39+652252.2

We present the discovery of photometric variability in the DQ white dwarf SDSS J103655.39+652252.2 (SDSS J1036+6522). Time-series photometry reveals a coherent monoperiodic modulation at a period of 1115.64751(67) s with an amplitude of 0.442% +/- 0.024%; no other periodic modulations are observed with amplitudes >~0.13%. The period, amplitude, and phase of this modulation are constant within errors over 16 months. The spectrum of SDSS J1036+6522 shows magnetic splitting of carbon lines, and we use Paschen-Back formalism to develop a grid of model atmospheres for mixed carbon and helium atmospheres. Our models, while reliant on several simplistic assumptions, nevertheless match the major spectral and photometric properties of the star with a self-consistent set of parameters: Teff~15,500 K, log g ~9, log(C/He)=-1.0, and a mean magnetic field strength of 3.0 +/- 0.2 MG. The temperature and abundances strongly suggest that SDSS J1036+6522 is a transition object between the hot, carbon-dominated DQs and the cool, He-dominated DQs. The variability of SDSS J1036+6522 has characteristics similar to those of the variable hot carbon-atmosphere white dwarfs (DQVs), however, its temperature is significantly cooler. The pulse profile of SDSS J1036+6522 is nearly sinusoidal, in contrast with the significantly asymmetric pulse shapes of the known magnetic DQVs. If the variability in SDSS J1036+6522 is due to the same mechanism as other DQVs, then the pulse shape is not a definitive diagnostic on the absence of a strong magnetic field in DQVs. It remains unclear whether the root cause of the variability in SDSS J1036+6522 and the other hot DQVs is the same.Comment: Accepted for publication in ApJ. 12 pages, 9 figure

Virtual patients design and its effect on clinical reasoning and student experience : a protocol for a randomised factorial multi-centre study

Background Virtual Patients (VPs) are web-based representations of realistic clinical cases. They are proposed as being an optimal method for teaching clinical reasoning skills. International standards exist which define precisely what constitutes a VP. There are multiple design possibilities for VPs, however there is little formal evidence to support individual design features. The purpose of this trial is to explore the effect of two different potentially important design features on clinical reasoning skills and the student experience. These are the branching case pathways (present or absent) and structured clinical reasoning feedback (present or absent). Methods/Design This is a multi-centre randomised 2x2 factorial design study evaluating two independent variables of VP design, branching (present or absent), and structured clinical reasoning feedback (present or absent).The study will be carried out in medical student volunteers in one year group from three university medical schools in the United Kingdom, Warwick, Keele and Birmingham. There are four core musculoskeletal topics. Each case can be designed in four different ways, equating to 16 VPs required for the research. Students will be randomised to four groups, completing the four VP topics in the same order, but with each group exposed to a different VP design sequentially. All students will be exposed to the four designs. Primary outcomes are performance for each case design in a standardized fifteen item clinical reasoning assessment, integrated into each VP, which is identical for each topic. Additionally a 15-item self-reported evaluation is completed for each VP, based on a widely used EViP tool. Student patterns of use of the VPs will be recorded. In one centre, formative clinical and examination performance will be recorded, along with a self reported pre and post-intervention reasoning score, the DTI. Our power calculations indicate a sample size of 112 is required for both primary outcomes

Discovery and analysis of p-mode and g-mode oscillations in the A-type primary of the eccentric binary HD 209295

We have discovered both intermediate-order gravity mode and low-order pressure mode pulsation in the same star, HD 209295. It is therefore both a Gamma Doradus and a Delta Scuti star, which makes it the first pulsating star to be a member of two classes. The star is a single-lined spectroscopic binary with an orbital period of 3.10575 d and an eccentricity of 0.352. Weak pulsational signals are found in both the radial velocity and line-profile variations, allowing us to show that the two highest-amplitude Gamma Doradus pulsation modes are consistent with l=1 and |m|=1. In our 280 h of BVI multi-site photometry we detected ten frequencies in the light variations, one in the Delta Scuti regime and nine in the Gamma Doradus domain. Five of the Gamma Doradus frequencies are exact integer multiples of the orbital frequency. This observation leads us to suspect they are tidally excited. Results of theoretical modeling (stability analysis, tidal excitation) were consistent with the observations. We could not detect the secondary component of the system in infrared photometry, suggesting that it may not be a main-sequence star. Archival data of HD 209295 show a strong ultraviolet excess, the origin of which is not known. The orbit of the primary is consistent with a secondary mass of M > 1.04 Msun indicative of a neutron star or a white dwarf companion.Comment: 18 pages, 18 figures, accepted for publication in MNRAS, shortened abstrac