Diagnostic Accuracy of Spanish Language Depression-Screening Instruments

PURPOSE To make decisions about implementing systematic depression screening, primary care physicians who serve Spanish-speaking populations need to know whether Spanish language depression-screening instruments are accurate. We aimed to review systematically the evidence regarding diagnostic accuracy of depression-screening instruments in Spanish-speaking primary care populations

Giant Lya nebulae associated with high redshift radio galaxies

We report deep Keck narrow-band Lya images of the luminous z > 3 radio galaxies 4C 41.17, 4C 60.07, and B2 0902+34. The images show giant, 100-200 kpc scale emission line nebulae, centered on these galaxies, which exhibit a wealth of morphological structure, including extended low surface brightness emission in the outer regions, radially directed filaments, cone-shaped structures and (indirect) evidence for extended Lya absorption. We discuss these features within a general scenario where the nebular gas cools gravitationally in large Cold Dark Matter (CDM) halos, forming stars and multiple stellar systems. Merging of these ``building'' blocks triggers large scale starbursts, forming the stellar bulges of massive radio galaxy hosts, and feeds super-massive black holes which produce the powerful radio jets and lobes. The radio sources, starburst superwinds and AGN radiation then disrupt the accretion process limiting galaxy and black hole growth, and imprint the observed filamentary and cone-shaped structures of the Lya nebulae.Comment: 36 Pages, including 8 Postscript figures. Accepted for publication in the Astrophysical Journa

Development and evaluation of the Measure of Drug Self-Management

BackgroundCurrent adherence scales often fail to assess the full spectrum of behaviors associated with safe and appropriate drug use and may be unsuitable for patients with limited health literacy. We sought to develop and evaluate a comprehensive yet brief Measure of Drug Self-Management (MeDS) for use in research and clinical settings among diverse patient groups.MethodsExpert opinion, literature reviews, and interviews with patients and providers were utilized to create and revise potential items. Item performance testing was then conducted among 193 adult English-speaking patients with hypertension and diabetes. Factor analysis was used to inform item selection. Reliability was assessed via calculations of internal consistency. To assess construct and predictive validity, MeDS scores were compared with scores from the 8-item Morisky Medication Adherence Scale and relevant clinical measures (HbA1c, blood pressure, and low-density lipoprotein cholesterol).ResultsThe MeDS demonstrated adequate internal consistency with a Cronbach’s α of 0.72. The MeDS was significantly correlated with the Morisky Medication Adherence Scale (r= −0.62; P<0.001). The MeDS was also associated with clinical measures, with statistically significant correlations found between MeDS scores and low-density lipoprotein cholesterol (r= −0.27, P≤0.001) and diastolic blood pressure (r= −0.18, P=0.01).ConclusionThe MeDS seems to be a valid and reliable tool that can be used to assess medication self-management skills among diverse patients, including those with limited literacy skills. Future studies are needed to test the tool in actual use and explore clinical applications

CO emission and associated HI absorption from a massive gas reservoir surrounding the z=3 radio galaxy B3 J2330+3927

We present results of a comprehensive multi-frequency study of the radio galaxy B3 J2330+3927. The 1.9" wide radio source, consisting of 3 components, is bracketed by 2 objects in our Keck K-band image. Optical and near-IR Keck spectroscopy of these two objects yield z=3.087+-0.004. The brightest (K=18.8) object has a standard type II AGN spectrum, and is the most likely location of the AGN, which implies a one-sided jet radio morphology. Deep 113 GHz observations with the IRAM Plateau de Bure Interferometer reveal CO J=4-3 emission, which peaks at the position of the AGN. The CO line is offset by 500 km/s from the systemic redshift of the AGN, but corresponds very closely to the velocity shift of an associated HI absorber seen in Lya. This strongly suggests that both originate from the same gas reservoir surrounding the AGN host galaxy. Simultaneous 230 GHz interferometer observations find a ~3x lower integrated flux density when compared to single dish 250 GHz observations with MAMBO at the IRAM 30m telescope. This can be interpreted as spatially resolved thermal dust emission at scales of 0.5" to 6". Finally, we present a tau <1.3% limit to the HI 21 cm absorption against the radio source, which represents the seventh non-detection out of 8 z>2 radio galaxies observed to date with the WSRT. We present mass estimates for the atomic, neutral, and ionized hydrogen, and for the dust, ranging from M(HI)=2x10^7 M_Sun derived from the associated HI absorber in Lya up to M(H_2)=7x10^{10} M_Sun derived from the CO emission. This indicates that the host galaxy is surrounded by a massive reservoir of gas and dust. The K-band companion objects may be concentrations within this reservoir, which will eventually merge with the central galaxy hosting the AGN.Comment: 16 Pages, including 11 PostScript figures. Accepted for publication in Astronomy & Astrophysic

Gas Accretion and Giant Lyman-alpha Nebulae

Several decades of observations and discoveries have shown that high-redshift AGN and massive galaxies are often surrounded by giant Lyman-alpha nebulae extending in some cases up to 500 kpc in size. In this review, I discuss the properties of the such nebulae discovered at z>2 and their connection with gas flows in and around the galaxies and their halos. In particular, I show how current observations are used to constrain the physical properties and origin of the emitting gas in terms of the Lyman-alpha photon production processes and kinematical signatures. These studies suggest that recombination radiation is the most viable scenario to explain the observed Lyman-alpha luminosities and Surface Brightness for the large majority of the nebulae and imply that a significant amount of dense, ionized and cold clumps should be present within and around the halos of massive galaxies. Spectroscopic studies suggest that, among the giant Lyman-alpha nebulae, the one associated with radio-loud AGN should have kinematics dominated by strong, ionized outflows within at least the inner 30-50 kpc. Radio-quiet nebulae instead present more quiescent kinematics compatible with stationary situation and, in some cases, suggestive of rotating structures. However, definitive evidences for accretion onto galaxies of the gas associated with the giant Lyman-alpha emission are not unambiguously detected yet. Deep surveys currently ongoing using other bright, non-resonant lines such as Hydrogen H-alpha and HeII1640 will be crucial to search for clearer signatures of cosmological gas accretion onto galaxies and AGN.Comment: Invited review to appear in Gas Accretion onto Galaxies, Astrophysics and Space Science Library, eds. A. J. Fox & R. Dave', to be published by Springe

Mid-Infrared Spectra of High Redshift (z>2) Radio Galaxies

We present the first mid-infrared Spitzer/Infrared Spectrograph (IRS) observations of powerful radio galaxies at z>2. These radio galaxies, 4C +23.56 (z=2.48) and 6C J1908+7220 (z=3.53), both show strong mid-infrared continua, but with 6C J1908+7220 also showing strong PAH emission at rest-frame 6.2 and 7.7um. In 4C+23.56 we see no obvious PAH features above the continuum. The PAH emission in 6C J1908+7220 is the amongst the most distant observed to date and implies that there is a large instantaneous star formation rate (SFR). This is consistent with the strong detection of 6C J1908+7220 at far-IR and sub-mm wavelengths, indicative of large amounts of cold dust, ~10^9Msun. Powerful radio galaxies at lower redshifts tend to have weak or undetectable PAH features and typically have lower far-IR luminosities. In addition, 4C 23.56 shows moderate silicate absorption as seen in less luminous radio galaxies, indicating tau_{9.7um}=0.3+/-0.05. This feature is shifted out of the observed wavelength range for 6C J1908+7220. The correlation of strong PAH features with large amounts of cold dust, despite the presence of a powerful AGN, is in agreement with other recent results and implies that star formation at high redshift is, in some cases at least, associated with powerful, obscured AGN.Comment: 6 pages, 3 figures, includes emulateapj.cls, in press ApJ

Metal enriched gaseous halos around distant radio galaxies: Clues to feedback in galaxy formation

We present the results of an optical and near-IR spectroscopic study of giant nebular emission line halos associated with three z &gt; 3 radio galaxies, 4C 41.17, 4C 60.07 and B2 0902+34. Previous deep narrow band Ly{alpha} imaging had revealed complex morphologies with sizes up to 100 kpc, possibly connected to outflows and AGN feedback from the central regions. The outer regions of these halos show quiet kinematics with typical velocity dispersions of a few hundred km s{sup -1}, and velocity shears that can mostly be interpreted as being due to rotation. The inner regions show shocked cocoons of gas closely associated with the radio lobes. These display disturbed kinematics and have expansion velocities and/or velocity dispersions &gt;1000 km s{sup -1}. The core region is chemically evolved, and we also find spectroscopic evidence for the ejection of enriched material in 4C 41.17 up to a distance of {approx} 60 kpc along the radio-axis. The dynamical structures traced in the Ly{alpha} line are, in most cases, closely echoed in the Carbon and Oxygen lines. This shows that the Ly{alpha} line is produced in a highly clumped medium of small filling factor, and can therefore be used as a tracer of the dynamics of HzRGs. We conclude that these HzRGs are undergoing a final jet-induced phase of star formation with ejection of most of their interstellar medium before becoming 'red and dead' Elliptical galaxies

Do Physicians with Self-Reported Non-English Fluency Practice in Linguistically Disadvantaged Communities?

BackgroundLanguage concordance between physicians and patients may reduce barriers to care faced by patients with limited English proficiency (LEP). It is unclear whether physicians with fluency in non-English languages practice in areas with high concentrations of people with LEP.ObjectiveTo investigate whether physician non-English language fluency is associated with practicing in areas with high concentrations of people with LEP.DesignCross-sectional cohort study.ParticipantsA total of 61,138 practicing physicians no longer in training who participated in the California Medical Board Physician Licensure Survey from 2001-2007.MeasuresSelf-reported language fluency in Spanish and Asian languages. Physician practice ZIP code corresponding to: (1) high concentration of people with LEP and (2) high concentration of linguistically isolated households.MethodsPractice location ZIP code was geocoded with geographic medical service study designations. We examined the unadjusted relationships between physician self-reported fluency in Spanish and selected Asian languages and practice location, stratified by race-ethnicity. We used staged logistic multiple variable regression models to isolate the effect of self-reported language fluency on practice location controlling for age, gender, race-ethnicity, medical specialty, and international medical graduate status.ResultsPhysicians with self-reported fluency in Spanish or an Asian language were more likely to practice in linguistically designated areas in these respective languages compared to those without fluency. Physician fluency in an Asian language [adjusted odds ratio (AOR) = 1.77; 95% confidence intervals (CI): 1.63-1.92] was independently associated with practicing in areas with a high number of LEP Asian speakers. A similar pattern was found for Spanish language fluency (AOR = 1.77; 95% CI: 1.43-1.82) and areas with high numbers of LEP Spanish-speakers. Latino and Asian race-ethnicity had the strongest effect on corresponding practice location, and this association was attenuated by language fluency.ConclusionsPhysicians who are fluent in Spanish or an Asian language are more likely to practice in geographic areas where their potential patients speak the corresponding language

Black hole accretion and host galaxies of obscured quasars in XMM-COSMOS

We explore the connection between black hole growth at the center of obscured quasars selected from the XMM-COSMOS survey and the physical properties of their host galaxies. We study a bolometric regime ( 8 x 10^45 erg/s) where several theoretical models invoke major galaxy mergers as the main fueling channel for black hole accretion. We confirm that obscured quasars mainly reside in massive galaxies (Mstar>10^10 Msun) and that the fraction of galaxies hosting such powerful quasars monotonically increases with the stellar mass. We stress the limitation of the use of rest-frame color-magnitude diagrams as a diagnostic tool for studying galaxy evolution and inferring the influence that AGN activity can have on such a process. We instead use the correlation between star-formation rate and stellar mass found for star-forming galaxies to discuss the physical properties of the hosts. We find that at z ~1, ~62% of Type-2 QSOs hosts are actively forming stars and that their rates are comparable to those measured for normal star-forming galaxies. The fraction of star-forming hosts increases with redshift: ~71% at z ~2, and 100% at z ~3. We also find that the the evolution from z ~1 to z ~3 of the specific star-formation rate of the Type-2 QSO hosts is in excellent agreement with that measured for star-forming galaxies. From the morphological analysis, we conclude that most of the objects are bulge-dominated galaxies, and that only a few of them exhibit signs of recent mergers or disks. Finally, bulge-dominated galaxies tend to host Type-2 QSOs with low Eddington ratios (lambda<0.1), while disk-dominated or merging galaxies have at their centers BHs accreting at high Eddington ratios (lambda > 0.1).Comment: Accepted by A&A. 20 pages, 16 figures, 2 tables. A version with higher resolution figures and SED fits of Appendix A is available at http://www.eso.org/~vmainier/QSO2/qso2.pd