Imprints of a high velocity wind on the soft x-ray spectrum of PG 1211+143

An extended XMM-Newton observation of the luminous narrow line Seyfert galaxy PG 1211+143 in 2014 has revealed a more complex high velocity wind, with components distinguished in velocity, ionization level, and column density. Here we report soft x-ray emission and absorption features from the ionized outflow, finding counterparts of both high velocity components, v ~ 0.129c and v ~ 0.066c, recently identified in the highly ionized Fe K absorption spectrum. The lower ionization of the co-moving soft x-ray absorbers imply a distribution of higher density clouds embedded in the main outflow, while much higher column densities for the same flow component in the hard x-ray spectra suggest differing sight lines to the continuum x-ray source.Comment: 8 pages, 5 figures, 4 tables; Accepted for publication in MNRA

On why the Iron K-shell absorption in AGN is not a signature of the local Warm/Hot Intergalactic Medium

We present a comparison between the 2001 XMM-Newton and 2005 Suzaku observations of the quasar, PG1211+143 at z=0.0809. Variability is observed in the 7 keV iron K-shell absorption line (at 7.6 keV in the quasar frame), which is significantly weaker in 2005 than during the 2001 XMM-Newton observation. From a recombination timescale of <4 years, this implies an absorber density n>0.004 particles/cm3, while the absorber column is 5e22<N_H <1 1e24 particles/cm2. Thus the sizescale of the absorber is too compact (pc scale) and the surface brightness of the dense gas too high (by 9-10 orders of magnitude) to arise from local hot gas, such as the local bubble, group or Warm/Hot Intergalactic Medium (WHIM), as suggested by McKernan et al. (2004, 2005). Instead the iron K-shell absorption must be associated with an AGN outflow with mildly relativistic velocities. Finally we show that the the association of the absorption in PG1211+143 with local hot gas is simply a coincidence, the comparison between the recession and iron K absorber outflow velocities in other AGN does not reveal a one to one kinematic correlation.Comment: accepted for publication in MNRAS LETTERS. 5 pages, 4 figure

Practical multimodal care for cancer cachexia

Purpose of reviewCancer cachexia is common and reduces function, treatment tolerability and quality of life. Given its multifaceted pathophysiology a multimodal approach to cachexia management is advocated for, but can be difficult to realise in practice. We use a case-based approach to highlight practical approaches to the multimodal management of cachexia for patients across the cancer trajectory.Recent findingsFour cases with lung cancer spanning surgical resection, radical chemoradiotherapy, palliative chemotherapy and no anticancer treatment are presented. We propose multimodal care approaches that incorporate nutritional support, exercise, and anti-inflammatory agents, on a background of personalized oncology care and family-centred education. Collectively, the cases reveal that multimodal care is part of everyone's remit, often focuses on supported self-management, and demands buy-in from the patient and their family. Once operationalized, multimodal care approaches can be tested pragmatically, including alongside emerging pharmacological cachexia treatments.SummaryWe demonstrate that multimodal care for cancer cachexia can be achieved using simple treatments and without a dedicated team of specialists. The sharing of advice between health professionals can help build collective confidence and expertise, moving towards a position in which every team member feels they can contribute towards multimodal care

The potentially morally injurious nature of encountering children during military deployments: A call for research

Armed forces personnel are a population at risk for exposure to potentially traumatic and morally injurious events because of the high-risk nature of military operations. One potentially morally injurious event (PMIE) could be when military personnel encounter children during deployment. These encounters may lead to acute and chronic psychological, behavioural, and social consequences, culminating in moral injury and other adverse mental health problems. According to anecdotal evidence, military personnel reported feeling torn, morally and ethically, in their decisionmaking when they encounter children in the line of duty. The decision to engage or kill a child may be difficult to reconcile with one’s moral and ethical code, and decisions may have deadly consequences for oneself and others. To date, however, no reliable data exist as to the impact that encountering children during deployment may have on psychosocial and spiritual well-being. In this article, additional research into this domain is encouraged by providing a rationale for studying encounters with children during deployment through the lens of a PMIE, as well as r

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This study evaluated the effectiveness of nondieting versus dieting treatments for overweight, bingeeating women. Participants (N = 219) were randomly assigned to 1 of 3 groups: diet treatment (DT), nondiet treatment (NDT), or wait-list control (WLC). DT received a balanced-deficit diet reinforced with behavioral strategies. NDT received therapy designed to help participants break out of their dieting cycles. Treatment in both conditions was administered in weekly groups for 6 months, followed by 26 biweekly maintenance meetings, for a total of 18 months of contact. At 6 months posttreatment, DT lost 0.6 kg while NDT gained 1.3 kg. Both treatment groups reduced their Binge Eating Scale scores significantly more than WLC. At 18-month follow-up, both treatment groups experienced weight gain but maintained similar reductions in binge eating. Results indicate that neither intervention was successful in producing short-or long-term weight loss. Therapist biases, which may have affected treatment integrity, and other methodological issues are discussed in relation to the small weight losses achieved. Estimates of binge eating among obese patients range from 20% to 50%, depending on the criteria used and the study population (Bruce &amp; Wilfiey, 1996; It is unclear whether or not binge-eating obese patients experience greater difficulty in treatment programs as a result of these liabilities. Obese binge eaters have been found to respond to weight loss programs similarly to nonbingers, and experience similar or lower attrition rates This research was supported by National Institute of Diabetes and Digestive and Kidney Diseases Grant DK43109 and by a Minority Scientist Development Award from the American Heart Association and its Puerto Rican Affiliate. Correspondence concerning this article should be addressed to G. Ken Goodrick, Behavioral Medicine Research Center, Baylor College of Medicine, 6535 Fannin, Mailstop F-700, Houston, Texas 77030. outcomes Several nondieting therapeutic approaches have been developed for the treatment of obesity The purpose of this prospective, randomized, controlled study was to evaluate the effectiveness of this nondieting approach in the treatment of obese, binge-eating women, compared with a standardized, behavioral dieting treatment and a control group. Method Participants The mean age of participants was 40 years (SD = 6.3, range = 25 to 50 years). Participants&apos; mean pretreatment weight was 88 kg (SD = 9.6, range = 66 to 110 kg). The mean body mass index (BMI) was 33 kg/m 2 (SD = 3.4), with a range of 26 to 43 kg/m 2. The ethnic-racial composition of the sample was 85% White, 8% Black, and 7% Hispanic. Of the total participants, 62% were married, 21% were single or divorced, and 17% were never married. Twenty-four percent of the participants had a college degree, 65% had some college, and 11% had a high school diploma or less. Sixty-nine percent were employed full time, and 9% part time. Procedure Female participants were recruited from Houston and the surrounding area using print and electronic media to publicize the study. Those 36

Intended Use of the National Nursing and Midwifery Digital Health Capability Framework

To realise the benefits of digital health, the health workforce needs to evolve, adapt and develop their digital proficiency. As the largest workforce in health, nurses and midwives are well positioned to lead as an agile digital healthcare workforce. The objective of this work is to describe how individual nurses and midwives, organisations and education providers could use the newly developed National Nursing and Midwifery Digital Health Capability Framework to build digital health capability. The paper concludes with an international perspective on the framework

Detection of ctDNA in plasma of patients with clinically localised prostate cancer is associated with rapid disease progression.

BACKGROUND DNA originating from degenerate tumour cells can be detected in the circulation in many tumour types, where it can be used as a marker of disease burden as well as to monitor treatment response. Although circulating tumour DNA (ctDNA) measurement has prognostic/predictive value in metastatic prostate cancer, its utility in localised disease is unknown. METHODS We performed whole-genome sequencing of tumour-normal pairs in eight patients with clinically localised disease undergoing prostatectomy, identifying high confidence genomic aberrations. A bespoke DNA capture and amplification panel against the highest prevalence, highest confidence aberrations for each individual was designed and used to interrogate ctDNA isolated from plasma prospectively obtained pre- and post- (24 h and 6 weeks) surgery. In a separate cohort (n = 189), we identified the presence of ctDNA TP53 mutations in preoperative plasma in a retrospective cohort and determined its association with biochemical- and metastasis-free survival. RESULTS Tumour variants in ctDNA were positively identified pre-treatment in two of eight patients, which in both cases remained detectable postoperatively. Patients with tumour variants in ctDNA had extremely rapid disease recurrence and progression compared to those where variants could not be detected. In terms of aberrations targeted, single nucleotide and structural variants outperformed indels and copy number aberrations. Detection of ctDNA TP53 mutations was associated with a significantly shorter metastasis-free survival (6.2 vs. 9.5 years (HR 2.4; 95% CIs 1.2-4.8, p = 0.014). CONCLUSIONS CtDNA is uncommonly detected in localised prostate cancer, but its presence portends more rapidly progressive disease

Methodology for the Development of the Australian National Nursing and Midwifery Digital Health Capability Framework.

Internationally healthcare organisations and governments are grappling with the issue of upskilling healthcare workforces in relation to digital health. Significant research has been undertaken in relation to documenting essential digital health capability requirements for the workforce. In 2019 the Australian Digital Health Agency funded work by the Australasian Institute of Digital Health to develop a National Nursing and Midwifery Digital Health Capability Framework. This paper describes the methodological approach used in the development of the Framework