Multi-Symptom Management in Hospice Patients during End-of-Life Transition

The purpose of this quality improvement project is to compare the provider’s perception following an educational model of using single symptom management versus multi-symptom management during the end-of-life transition in adult patients for improved quality of life outcomes. The appraised evidence indicates that it is critical to have anticipatory medications at the patient’s residence to manage multiple symptoms rather than focusing exclusively on a single symptom management such as pain management. In February 2016, the author conducted an educational model among hospice providers for increasing knowledge and awareness of multi-symptom management. Thirty (n = 30) Clinical Nursing Directors, Licensed Practical Nurses, Medical Directors, and Registered Nurse Case Managers from hospice organizations located in South Carolina were surveyed pre and post intervention regarding their perception of symptoms, the most prominent distressful symptoms that are experienced by hospice patients, and the pharmaceutical preference to manage distressful symptoms. With a response rate of 77%; (n=23) participants pre-test responses indicated that pain (35%) was the most prominent symptom among patients; Dyspnea/SOB (44%) was identified as the most distressful symptom for patients; and anxiety/restlessness and increased respiratory secretions received (35%) as the most distressful symptoms for patients’ families and/ or caregivers witnessed during a patient’s last two weeks of life. Hospice provider’s post-test responses indicated that the most prominent symptom was dyspnea/SOB (30%) followed by pain (22%). Additionally, the presence of anxiety/restlessness had increased by almost (10%) in the post-test results (26%). Healthcare providers reported the most distressful symptom for the patient was dyspnea/SOB (44%) with the same response rate both pre-test and post-test. However, the prevalence of pain as the most distressful symptom’s response rate decreased from pre-test (17%) to post-test (9%). The presence of perceived increased respiratory secretions response rate increased from pre-test (13%) to post-test (22%). This project was consistent with the evidence that multi-symptom management is critical in end of life transitions and care providers must focus on multi-symptoms rather than single symptom

Baryonic Tully-Fisher Relation for Extremely Low Mass Galaxies

We study Tully-Fisher relations for a sample that combines extremely faint (M_B > -14.0) galaxies along with bright (i.e. L_*) galaxies. Accurate (~ 10%) distances, I band photometry, and B-V colors are known for the majority of the galaxies in our sample. The faint galaxies are drawn from the Faint Irregular Galaxy GMRT survey (FIGGS), and we have HI rotation velocities derived from aperture synthesis observations for all of them. For the faint galaxies, we find that even though the median HI and stellar masses are comparable, the HI mass correlates significantly better with the circular velocity indicators than the stellar mass. We also find that W$_{20}$ correlates better with mass than the rotation velocity, although the difference is not statistically significant. The faint galaxies lie systematically below the I band TF relation defined by bright galaxies, and also show significantly more intrinsic scatter. This implies that the integrated star formation in these galaxies has been both less efficient and also less regulated than in large galaxies. We find that while the faint end deviation is greatly reduced in Baryonic Tully-Fisher (BTF) relations, the existence of a break at the faint end of the BTF is subject to systematics such as the assumed stellar mass to light ratio. If we assume that there is an intrinsic BTF and try to determine the baryonic mass by searching for prescriptions that lead to the tightest BTF, we find that scaling the HI mass leads to a much more significant tightening than scaling the stellar mass to light ratio. The most significant tightening that we find however, is if we scale the entire baryonic mass of the faint (but not the bright) galaxies. Such a scenario would be consistent with models where dwarf (but not large) galaxies have a large fraction of dark or ``missing'' baryons (Slightly abridged)Comment: 7 pages, 7 figures. Accepted for publication in MNRA

An HST/ACS View of the Inhomogeneous Outer Halo of M31

We present a high precision photometric view of the stellar populations in the outer halo of M31, using data taken with the Hubble Space Telescope Advanced Camera for Surveys (HST/ACS). We analyse the field populations adjacent to 11 luminous globular clusters which sample the galactocentric radial range 18 < R < 100 kpc and reach a photometric depth of ~2.5 magnitudes below the horizontal branch (m_F814W ~27 mag). The colour-magnitude diagrams (CMDs) are well populated out to ~60 kpc and exhibit relatively metal-rich red giant branches, with the densest fields also showing evidence for prominent red clumps. We use the Dartmouth isochrones to construct metallicity distribution functions (MDFs) which confirm the presence of dominant populations with = -0.6 to -1.0 dex and considerable metallicity dispersions of 0.2 to 0.3 dex (assuming a 10 Gyr population and scaled-Solar abundances). The average metallicity over the range 30 - 60 kpc is [Fe/H] = -0.8 +/- 0.14 dex, with no evidence for a significant radial gradient. Metal-poor stars ([Fe/H] <= -1.3) typically account for < 10-20 % of the population in each field, irrespective of radius. Assuming our fields are unbiased probes of the dominant stellar populations in these parts, we find that the M31 outer halo remains considerably more metal-rich than that of the Milky Way out to at least 60 kpc.Comment: Accepted for publication in MNRAS. 10 pages, 6 figure

JWST/NIRSpec Observations of the Planetary Mass Companion TWA 27B

We present 1-5um spectroscopy of the young planetary mass companion TWA 27B (2M1207B) performed with NIRSpec on board the James Webb Space Telescope. In these data, the fundamental band of CH_4 is absent and the fundamental band of CO is weak. The nondetection of CH_4 reinforces a previously observed trend of weaker CH_4 with younger ages among L dwarfs, which has been attributed to enhanced non-equilibrium chemistry among young objects. The weakness of CO may reflect an additional atmospheric property that varies with age, such as the temperature gradient or cloud thickness. We are able to reproduce the broad shape of the spectrum with an ATMO cloudless model that has T=1300 K, non-equilibrium chemistry, and a temperature gradient reduction caused by fingering convection. However, the fundamental bands of CH_4 and CO are somewhat stronger in the model. In addition, the model temperature of 1300 K is higher than expected from evolutionary models given the luminosity and age of TWA 27B (T=1200 K). Previous models of young L-type objects suggest that the inclusion of clouds could potentially resolve these issues; it remains to be seen whether cloudy models can provide a good fit to the 1-5um data from NIRSpec. TWA 27B exhibits emission in Paschen transitions and the He I triplet at 1.083um, which are signatures of accretion that provide the first evidence of a circumstellar disk. We have used the NIRSpec data to estimate the bolometric luminosity of TWA 27B (log L/L_sun=-4.466+/-0.014), which implies a mass of 5-6 MJup according to evolutionary models.Comment: Astrophysical Journal Letters, in pres

Advanced Camera for Surveys Observations of Young Star Clusters in the Interacting Galaxy UGC 10214

We present the first Advanced Camera for Surveys (ACS) observations of young star clusters in the colliding/merging galaxy UGC 10214. The observations were made as part of the Early Release Observation (ERO) program for the newly installed ACS during service mission SM3B for the Hubble Space Telescope (HST). Many young star clusters can be identified in the tails of UGC 10214, with ages ranging from ~3 Myr to 10 Myr. The extreme blue V-I (F606W-F814W) colors of the star clusters found in the tail of UGC 10214 can only be explained if strong emission lines are included with a young stellar population. This has been confirmed by our Keck spectroscopy of some of these bright blue stellar knots. The most luminous and largest of these blue knots has an absolute magnitude of M_V = -14.45, with a half-light radius of 161 pc, and if it is a single star cluster, would qualify as a super star cluster (SSC). Alternatively, it could be a superposition of multiple scaled OB associations or clusters. With an estimated age of ~ 4-5 Myr, its derived mass is < 1.3 x 10^6 solar masses. Thus the young stellar knot is unbound and will not evolve into a normal globular cluster. The bright blue clusters and associations are much younger than the dynamical age of the tail, providing strong evidence that star formation occurs in the tail long after it was ejected. UGC 10214 provides a nearby example of processes that contributed to the formation of halos and intra-cluster media in the distant and younger Universe.Comment: 6 pages with embedded figures, ApJ in pres

Star formation in 30 Doradus

Using observations obtained with the Wide Field Camera 3 (WFC3) on board the Hubble Space Telescope (HST), we have studied the properties of the stellar populations in the central regions of 30 Dor, in the Large Magellanic Cloud. The observations clearly reveal the presence of considerable differential extinction across the field. We characterise and quantify this effect using young massive main sequence stars to derive a statistical reddening correction for most objects in the field. We then search for pre-main sequence (PMS) stars by looking for objects with a strong (> 4 sigma) Halpha excess emission and find about 1150 of them over the entire field. Comparison of their location in the Hertzsprung-Russell diagram with theoretical PMS evolutionary tracks for the appropriate metallicity reveals that about one third of these objects are younger than ~4Myr, compatible with the age of the massive stars in the central ionising cluster R136, whereas the rest have ages up to ~30Myr, with a median age of ~12Myr. This indicates that star formation has proceeded over an extended period of time, although we cannot discriminate between an extended episode and a series of short and frequent bursts that are not resolved in time. While the younger PMS population preferentially occupies the central regions of the cluster, older PMS objects are more uniformly distributed across the field and are remarkably few at the very centre of the cluster. We attribute this latter effect to photoevaporation of the older circumstellar discs caused by the massive ionising members of R136.Comment: 15 pages, 12 figures. Accepted for publication in The Astrophysical Journa

Discovery of Globular Clusters in the Proto-Spiral NGC2915: Implications for Hierarchical Galaxy Evolution

We have discovered three globular clusters beyond the Holmberg radius in Hubble Space Telescope Advanced Camera for Surveys images of the gas-rich dark matter dominated blue compact dwarf galaxy NGC2915. The clusters, all of which start to resolve into stars, have M_{V606} = -8.9 to -9.8 mag, significantly brighter than the peak of the luminosity function of Milky Way globular clusters. Their colors suggest a metallicity [Fe/H] ~ -1.9 dex, typical of metal-poor Galactic globular clusters. The specific frequency of clusters is at a minimum normal, compared to spiral galaxies. However, since only a small portion of the system has been surveyed it is more likely that the luminosity and mass normalized cluster content is higher, like that seen in elliptical galaxies and galaxy clusters. This suggests that NGC2915 resembles a key phase in the early hierarchical assembly of galaxies - the epoch when much of the old stellar population has formed, but little of the stellar disk. Depending on the subsequent interaction history, such systems could go on to build-up larger elliptical galaxies, evolve into normal spirals, or in rare circumstances remain suspended in their development to become systems like NGC2915.Comment: ApJ Letters accepted; 6 pages, 2 figures, 3 table

Evolution in the Cluster Early-type Galaxy Size-Surface Brightness Relation at z =~ 1

We investigate the evolution in the distribution of surface brightness, as a function of size, for elliptical and S0 galaxies in the two clusters RDCS J1252.9-2927, z=1.237 and RX J0152.7-1357, z=0.837. We use multi-color imaging with the Advanced Camera for Surveys on the Hubble Space Telescope to determine these sizes and surface brightnesses. Using three different estimates of the surface brightnesses, we find that we reliably estimate the surface brightness for the galaxies in our sample with a scatter of < 0.2 mag and with systematic shifts of \lesssim 0.05 mag. We construct samples of galaxies with early-type morphologies in both clusters. For each cluster, we use a magnitude limit in a band which closely corresponds to the rest-frame B, to magnitude limit of M_B = -18.8 at z=0, and select only those galaxies within the color-magnitude sequence of the cluster or by using our spectroscopic redshifts. We measure evolution in the rest-frame B surface brightness, and find -1.41 \+/- 0.14 mag from the Coma cluster of galaxies for RDCS J1252.9-2927 and -0.90 \+/- 0.12 mag of evolution for RX J0152.7-1357, or an average evolution of (-1.13 \+/- 0.15) z mag. Our statistical errors are dominated by the observed scatter in the size-surface brightness relation, sigma = 0.42 \+/- 0.05 mag for RX J0152.7-1357 and sigma = 0.76 \+/- 0.10 mag for RDCS J1252.9-2927. We find no statistically significant evolution in this scatter, though an increase in the scatter could be expected. Overall, the pace of luminosity evolution we measure agrees with that of the Fundamental Plane of early-type galaxies, implying that the majority of massive early-type galaxies observed at z =~ 1 formed at high redshifts.Comment: Accepted in ApJ, 16 pages in emulateapj format with 15 eps figures, 6 in colo

The XMM-Newton serendipitous ultraviolet source survey catalogue

The XMM-Newton Serendipitous Ultraviolet Source Survey (XMM-SUSS) is a catalogue of ultraviolet (UV) sources detected serendipitously by the Optical Monitor (XMM-OM) on-board the XMM-Newton observatory. The catalogue contains ultraviolet-detected sources collected from 2,417 XMM-OM observations in 1-6 broad band UV and optical filters, made between 24 February 2000 and 29 March 2007. The primary contents of the catalogue are source positions, magnitudes and fluxes in 1 to 6 passbands, and these are accompanied by profile diagnostics and variability statistics. The XMM-SUSS is populated by 753,578 UV source detections above a 3 sigma signal-to-noise threshold limit which relate to 624,049 unique objects. Taking account of substantial overlaps between observations, the net sky area covered is 29-54 square degrees, depending on UV filter. The magnitude distributions peak at 20.2, 20.9 and 21.2 in UVW2, UVM2 and UVW1 respectively. More than 10 per cent of sources have been visited more than once using the same filter during XMM-Newton operation, and > 20 per cent of sources are observed more than once per filter during an individual visit. Consequently, the scope for science based on temporal source variability on timescales of hours to years is broad. By comparison with other astrophysical catalogues we test the accuracy of the source measurements and define the nature of the serendipitous UV XMM-OM source sample. The distributions of source colours in the UV and optical filters are shown together with the expected loci of stars and galaxies, and indicate that sources which are detected in multiple UV bands are predominantly star-forming galaxies and stars of type G or earlier.Comment: Accepted for publication in MNRA