Swift observations of the 2015 outburst of AG Peg -- from slow nova to classical symbiotic outburst

Symbiotic stars often contain white dwarfs with quasi-steady shell burning on their surfaces. However, in most symbiotics, the origin of this burning is unclear. In symbiotic slow novae, however, it is linked to a past thermonuclear runaway. In June 2015, the symbiotic slow nova AG Peg was seen in only its second optical outburst since 1850. This recent outburst was of much shorter duration and lower amplitude than the earlier eruption, and it contained multiple peaks -- like outbursts in classical symbiotic stars such as Z And. We report Swift X-ray and UV observations of AG Peg made between June 2015 and January 2016. The X-ray flux was markedly variable on a time scale of days, particularly during four days near optical maximum, when the X-rays became bright and soft. This strong X-ray variability continued for another month, after which the X-rays hardened as the optical flux declined. The UV flux was high throughout the outburst, consistent with quasi-steady shell burning on the white dwarf. Given that accretion disks around white dwarfs with shell burning do not generally produce detectable X-rays (due to Compton-cooling of the boundary layer), the X-rays probably originated via shocks in the ejecta. As the X-ray photo-electric absorption did not vary significantly, the X-ray variability may directly link to the properties of the shocked material. AG Peg's transition from a slow symbiotic nova (which drove the 1850 outburst) to a classical symbiotic star suggests that shell burning in at least some symbiotic stars is residual burning from prior novae.Comment: Accepted by MNRAS 23 June 2016. Manuscript submitted in original form 5 April 201

Reducing the Number of Sputum Samples Examined and Thresholds for Positivity: An Opportunity to Optimise Smear Microscopy.

SETTING: Urban health clinic, Nairobi. OBJECTIVE: To evaluate the impact on tuberculosis (TB) case detection and laboratory workload of reducing the number of sputum smears examined and thresholds for diagnosing positive smears and positive cases. DESIGN: In this prospective study, three Ziehl-Neelsen stained sputum smears from consecutive pulmonary TB suspects were examined blind. The standard approach (A), > or = 2 positive smears out of 3, using a cut-off of 10 acid-fast bacilli (AFB)/100 high-power fields (HPF), was compared with approaches B, > or = 2 positive smears (> or = 4 AFB/100 HPF) out of 3, one of which is > or = 10 AFB/100 HPF; C, > or = 2 positive smears (> or = 4 AFB/100 HPF) out of 3; D, > or = 1 positive smear (> or = 10 AFB/100 HPF) out of 2; and E, > or = 1 positive smear (> or = 4 AFB/100 HPF) out of 2. The microscopy gold standard was detection of at least one positive smear (> or = 4 AFB/100 HPF) out of 3. RESULTS: Among 644 TB suspects, the alternative approaches detected from 114 (17.7%) (approach B) to 123 cases (19.1%) (approach E) compared to 105 cases (16.3%) for approach A (P < 0.005). Sensitivity ranged between 82.0% (105/128) for A and 96.1% (123/128) for E. The single positive smear approaches reduced the number of smears by 36% compared to approach A. CONCLUSION: Reducing the number of specimens and the positivity threshold to define a positive case increased the sensitivity of microscopy and reduced laboratory workload

Added value of bleach sedimentation microscopy for diagnosis of tuberculosis: a cost-effectiveness study.

SETTING: Bleach sedimentation is a method used to increase the diagnostic yield of sputum microscopy for countries with a high prevalence of human immunodeficiency virus (HIV) infection and limited resources. OBJECTIVES: To compare the relative cost-effectiveness of different microscopy approaches in diagnosing tuberculosis (TB) in Kenya. METHODS: An analytical decision tree model including cost and effectiveness measures of 10 combinations of direct (D) and overnight bleach (B) sedimentation microscopy was constructed. Data were drawn from the evaluation of the bleach sedimentation method on two specimens (first on the spot [1] and second morning [2]) from 644 TB suspects in a peripheral health clinic. Incremental cost per smear-positive detected case was measured. Costs included human resources and materials using a micro-costing evaluation. RESULTS: All bleach-based microscopy approaches detected significantly more cases (between 23.3% for B1 and 25.9% for B1+B2) than the conventional D1+D2 approach (21.0%). Cost per tested case ranged between respectively euro 2.7 and euro 4.5 for B1 and B1+D2+B2. B1 and B1+B2 were the most cost-effective approaches. D1+B2 and D1+B1 were good alternatives to avoid using approaches exclusively based on bleach sedimentation microscopy. CONCLUSIONS: Among several effective microscopy approaches used, including sodium hypochlorite sedimentation, only some resulted in a limited increase in the laboratory workload and would be most suitable for programmatic implementation

The imprinted gene and parent-of-origin effect database now includes parental origin of de novo mutations

The imprinted gene and parent-of-origin effect database () consists of two sections. One section catalogues the current literature on imprinted genes in humans and animals. The second, and new, section catalogues current reports of parental origin of de novo mutations in humans alone. The addition of a catalogue of de novo mutations that show a parent-of-origin effect expands the scope of the database and provides a useful tool for examining parental origin trends for different types of spontaneous mutations. This new section includes >1700 mutations, found in 59 different disorders. The 85 imprinted genes are described in 152 entries from several mammalian species. In addition, >300 other entries describe a range of reported parent-of-origin effects in animals

Systematic review of antimicrobial drug prescribing in hospitals.

Prudent antibiotic prescribing to hospital inpatients has the potential to reduce the incidences of antimicrobial resistance and healthcare-associated infection. We reviewed the literature from January 1980 to November 2003 to identify rigorous evaluations of interventions to improve hospital antibiotic prescribing. We identified 66 studies with interpretable data of which 16 reported 20 microbiological outcomes: Gram negative resistant bacteria (GNRB), 10 studies; Clostridium difficile associated diarrhoea (CDAD), 5 studies; vancomycin resistant enterococci (VRE), 3 studies and methicillin resistant Staphylococcus aureus (MRSA), 2 studies. Four studies provide good evidence that the intervention changed microbial outcomes with low risk of alternative explanations, eight studies provide less convincing evidence and four studies were negative. The strongest and most consistent evidence was for CDAD but we were able to analyse only the immediate impact of interventions because of nonstandardised durations of follow up. The ability to compare results of studies could be substantially improved by standardising methodology and reporting

Maximizing Use of Extension Beef Cattle Benchmarks Data Derived from Cow Herd Appraisal Performance Software

One goal of Extension is to provide practical information that makes a difference to producers. Cow Herd Appraisal Performance Software (CHAPS) has provided beef producers with production benchmarks for 30 years, creating a large historical data set. Many such large data sets contain useful information but are underutilized. Our goal was to create a 20-year data set (CHAPS20Y) to examine trends in beef production from 1994 to 2013. In this article, we describe the CHAPS program and the process used to select herds for CHAPS20Y. We hope to publish additional related articles that will examine trends in calving distributions, reproduction, and growth and discuss implications for producers and Extension

Maximizing Use of an Extension Beef Cattle Data Set: Part 2—Reproductive Rates

Previously, we described CHAPS20Y, a historical data set, and trends in CHAPS20Y calving distributions. In this article, we describe reproductive rates, including total females exposed to bull(s), pregnancy, pregnancy loss, calving, calf death loss, weaning, culling, and replacement percentages. Yearly mean exposed females increased from 1994 through 2013, consistent with a greater replacement percentage versus culling percentage. Yearly mean reproductive percentages varied over time. Factors such as weather, body condition, temperament, nutrition, and health likely contributed to this variation. CHAPS20Y is a tool Extension professionals can use to understand beef reproductive rates and help producers set and achieve their herd management goals

Feedback from massive stars at low metallicities : MUSE observations of N44 and N180 in the Large Magellanic Cloud

Accepted for publication in MNRAS, 27 pages, 21 figuresWe present MUSE integral field data of two HII region complexes in the Large Magellanic Cloud (LMC), N44 and N180. Both regions consist of a main superbubble and a number of smaller, more compact HII regions that formed on the edge of the superbubble. For a total of 11 HII regions, we systematically analyse the radiative and mechanical feedback from the massive O-type stars on the surrounding gas. We exploit the integral field property of the data and the coverage of the HeII$\lambda$5412 line to identify and classify the feedback-driving massive stars, and from the estimated spectral types and luminosity classes we determine the stellar radiative output in terms of the ionising photon flux $Q_{0}$. We characterise the HII regions in terms of their sizes, morphologies, ionisation structure, luminosity and kinematics, and derive oxygen abundances via emission line ratios. We analyse the role of different stellar feedback mechanisms for each region by measuring the direct radiation pressure, the pressure of the ionised gas, and the pressure of the shock-heated winds. We find that stellar winds and ionised gas are the main drivers of HII region expansion in our sample, while the direct radiation pressure is up to three orders of magnitude lower than the other terms. We relate the total pressure to the star formation rate per unit area, $\Sigma_{SFR}$, for each region and find that stellar feedback has a negative effect on star formation, and sets an upper limit to $\Sigma_{SFR}$ as a function of increasing pressure.Peer reviewe

Clinical and economic evaluation of laparoscopic surgery compared with medical management for gastro-oesophageal reflux disease : 5-year follow-up of multicentre randomised trial (the REFLUX trial)

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Impact of deprivation and comorbidity on outcomes in emergency general surgery : an epidemiological study

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.Peer reviewedPublisher PD