Cold gas outflows from the Small Magellanic Cloud traced with ASKAP

Feedback from massive stars plays a critical role in the evolution of the Universe by driving powerful outflows from galaxies that enrich the intergalactic medium and regulate star formation. An important source of outflows may be the most numerous galaxies in the Universe: dwarf galaxies. With small gravitational potential wells, these galaxies easily lose their star-forming material in the presence of intense stellar feedback. Here, we show that the nearby dwarf galaxy, the Small Magellanic Cloud (SMC), has atomic hydrogen outflows extending at least 2 kiloparsecs (kpc) from the star-forming bar of the galaxy. The outflows are cold, $T<400~{\rm K}$, and may have formed during a period of active star formation $25 - 60$ million years (Myr) ago. The total mass of atomic gas in the outflow is $\sim 10^7$ solar masses, ${\rm M_{\odot}}$, or $\sim 3$% of the total atomic gas of the galaxy. The inferred mass flux in atomic gas alone, $\dot{M}_{HI}\sim 0.2 - 1.0~{\rm M_{\odot}~yr^{-1}}$, is up to an order of magnitude greater than the star formation rate. We suggest that most of the observed outflow will be stripped from the SMC through its interaction with its companion, the Large Magellanic Cloud (LMC), and the Milky Way, feeding the Magellanic Stream of hydrogen encircling the Milky Way.Comment: Published in Nature Astronomy, 29 October 2018, http://dx.doi.org/10.1038/s41550-018-0608-

X-ray emission from a rapidly accreting narrow-line Seyfert 1 galaxy at z=6.56

This study aims at identifying luminous quasars at $z>5.7$ among X-ray-selected sources in the eROSITA Final Equatorial-Depth Survey (eFEDS) in order to place a lower limit on black hole accretion well into the epoch of re-ionisation. We confirm the low significance detection with eROSITA of a previously known, optically faint $z=6.56$ quasar from the Subaru High-z Exploration of Low-luminosity Quasars (SHELLQs) survey. We obtained a pointed follow-up observation of the source with the Chandra X-ray telescope in order to confirm the eROSITA detection. Using new near-infrared spectroscopy, we derived the physical properties of the super-massive black hole. Finally, we used this detection to infer a lower limit on the black hole accretion density rate at $z>6$. The Chandra observation confirms the eFEDS source as the most distant blind X-ray detection to date. The derived X-ray luminosity is high with respect to the rest-frame optical emission of the quasar. With a narrow MgII line, low derived black hole mass, and high Eddington ratio, as well as its steep photon index, the source shows properties that are similar to local narrow-line Seyfert 1 galaxies, which are thought to be powered by young super-massive black holes. In combination with a previous high-redshift quasar detection in the field, we show that quasars with $L_{2-10 \, \mathrm{keV}} >10^{45} \, \mathrm{erg \, s^{-1}}$ dominate accretion onto super-massive black holes at $z\sim 6$.Comment: Accepted for publication in A&

X-ray emission from a rapidly accreting narrow-line Seyfert 1 galaxy at z = 6.56

The space density of X-ray-luminous, blindly selected active galactic nuclei (AGN) traces the population of rapidly accreting super-massive black holes through cosmic time. It is encoded in the X-ray luminosity function, whose bright end remains poorly constrained in the first billion years after the Big Bang as X-ray surveys have thus far lacked the required cosmological volume. With the eROSITA Final Equatorial-Depth Survey (eFEDS), the largest contiguous and homogeneous X-ray survey to date, X-ray AGN population studies can now be extended to new regions of the luminosity-redshift space (L2-10 keV &gt; 1045 erg s-1 and z &gt; 6). Aims. The current study aims at identifying luminous quasars at z &gt; 5:7 among X-ray-selected sources in the eFEDS field in order to place a lower limit on black hole accretion well into the epoch of re-ionisation. A secondary goal is the characterisation of the physical properties of these extreme coronal emitters at high redshifts. Methods. Cross-matching eFEDS catalogue sources to optical counterparts from the DESI Legacy Imaging Surveys, we confirm the low significance detection with eROSITA of a previously known, optically faint z = 6:56 quasar from the Subaru High-z Exploration of Low-luminosity Quasars (SHELLQs) survey. We obtained a pointed follow-up observation of the source with the Chandra X-ray telescope in order to confirm the low-significance eROSITA detection. Using new near-infrared spectroscopy, we derived the physical properties of the super-massive black hole. Finally, we used this detection to infer a lower limit on the black hole accretion density rate at z &gt; 6. Results. The Chandra observation confirms the eFEDS source as the most distant blind X-ray detection to date. The derived X-ray luminosity is high with respect to the rest-frame optical emission of the quasar.With a narrow Mgii line, low derived black hole mass, and high Eddington ratio, as well as its steep photon index, the source shows properties that are similar to local narrow-line Seyfert 1 galaxies, which are thought to be powered by young super-massive black holes. In combination with a previous high-redshift quasar detection in the field, we show that quasars with L2-10 keV &gt; 1045 erg s-1 dominate accretion onto super-massive black holes at z _ 6

IMPLEmenting a clinical practice guideline for acute low back pain evidence-based manageMENT in general practice (IMPLEMENT) : cluster randomised controlled trial study protocol

Background: Evidence generated from reliable research is not frequently implemented into clinical practice. Evidence-based clinical practice guidelines are a potential vehicle to achieve this. A recent systematic review of implementation strategies of guideline dissemination concluded that there was a lack of evidence regarding effective strategies to promote the uptake of guidelines. Recommendations from this review, and other studies, have suggested the use of interventions that are theoretically based because these may be more effective than those that are not. An evidencebased clinical practice guideline for the management of acute low back pain was recently developed in Australia. This provides an opportunity to develop and test a theory-based implementation intervention for a condition which is common, has a high burden, and for which there is an evidence-practice gap in the primary care setting. Aim: This study aims to test the effectiveness of a theory-based intervention for implementing a clinical practice guideline for acute low back pain in general practice in Victoria, Australia. Specifically, our primary objectives are to establish if the intervention is effective in reducing the percentage of patients who are referred for a plain x-ray, and improving mean level of disability for patients three months post-consultation. Methods/Design: This study protocol describes the details of a cluster randomised controlled trial. Ninety-two general practices (clusters), which include at least one consenting general practitioner, will be randomised to an intervention or control arm using restricted randomisation. Patients aged 18 years or older who visit a participating practitioner for acute non-specific low back pain of less than three months duration will be eligible for inclusion. An average of twenty-five patients per general practice will be recruited, providing a total of 2,300 patient participants. General practitioners in the control arm will receive access to the guideline using the existing dissemination strategy. Practitioners in the intervention arm will be invited to participate in facilitated face-to-face workshops that have been underpinned by behavioural theory. Investigators (not involved in the delivery of the intervention), patients, outcome assessors and the study statistician will be blinded to group allocation. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN012606000098538 (date registered 14/03/2006).The trial is funded by the NHMRC by way of a Primary Health Care Project Grant (334060). JF has 50% of her time funded by the Chief Scientist Office3/2006). of the Scottish Government Health Directorate and 50% by the University of Aberdeen. PK is supported by a NHMRC Health Professional Fellowship (384366) and RB by a NHMRC Practitioner Fellowship (334010). JG holds a Canada Research Chair in Health Knowledge Transfer and Uptake. All other authors are funded by their own institutions

Chronic non-specific low back pain - sub-groups or a single mechanism?

Copyright 2008 Wand and O'Connell; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Background: Low back pain is a substantial health problem and has subsequently attracted a considerable amount of research. Clinical trials evaluating the efficacy of a variety of interventions for chronic non-specific low back pain indicate limited effectiveness for most commonly applied interventions and approaches. Discussion: Many clinicians challenge the results of clinical trials as they feel that this lack of effectiveness is at odds with their clinical experience of managing patients with back pain. A common explanation for this discrepancy is the perceived heterogeneity of patients with chronic non-specific low back pain. It is felt that the effects of treatment may be diluted by the application of a single intervention to a complex, heterogeneous group with diverse treatment needs. This argument presupposes that current treatment is effective when applied to the correct patient. An alternative perspective is that the clinical trials are correct and current treatments have limited efficacy. Preoccupation with sub-grouping may stifle engagement with this view and it is important that the sub-grouping paradigm is closely examined. This paper argues that there are numerous problems with the sub-grouping approach and that it may not be an important reason for the disappointing results of clinical trials. We propose instead that current treatment may be ineffective because it has been misdirected. Recent evidence that demonstrates changes within the brain in chronic low back pain sufferers raises the possibility that persistent back pain may be a problem of cortical reorganisation and degeneration. This perspective offers interesting insights into the chronic low back pain experience and suggests alternative models of intervention. Summary: The disappointing results of clinical research are commonly explained by the failure of researchers to adequately attend to sub-grouping of the chronic non-specific low back pain population. Alternatively, current approaches may be ineffective and clinicians and researchers may need to radically rethink the nature of the problem and how it should best be managed

HIV and HPV infections and ocular surface squamous neoplasia: systematic review and meta-analysis.

BACKGROUND: The frequency of ocular surface squamous neoplasias (OSSNs) has been increasing in populations with a high prevalence of infection with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and infection with human papillomavirus (HPV). We aimed to quantify the association between HIV/AIDS and HPV infection and OSSN, through systematic review and meta-analysis. METHODS: The articles providing data on the association between HIV/AIDS and/or HPV infection and OSSN were identified in MEDLINE, SCOPUS and EMBASE searched up to May 2013, and through backward citation tracking. The DerSimonian and Laird method was used to compute summary relative risk (RR) estimates and 95% confidence intervals (95% CI). Heterogeneity was quantified with the I(2) statistic. RESULTS: HIV/AIDS was strongly associated with an increased risk of OSSN (summary RR=8.06, 95% CI: 5.29-12.30, I(2)=56.0%, 12 studies). The summary RR estimate for the infection with mucosal HPV subtypes was 3.13 (95% CI: 1.72-5.71, I(2)=45.6%, 16 studies). Four studies addressed the association between both cutaneous and mucosal HPV subtypes and OSSN; the summary RR estimates were 3.52 (95% CI: 1.23-10.08, I(2)=21.8%) and 1.08 (95% CI: 0.57-2.05, I(2)=0.0%), respectively. CONCLUSION: Human immunodeficiency virus infection increases the risk of OSSN by nearly eight-fold. Regarding HPV infection, only the cutaneous subtypes seem to be a risk factor

Reconstitution of Mdm2-Dependent Post-Translational Modifications of p53 in Yeast

p53 mediates cell cycle arrest or apoptosis in response to DNA damage. Its activity is subject to a tight regulation involving a multitude of post-translational modifications. The plethora of functional protein interactions of p53 at present precludes a clear understanding of regulatory principles in the p53 signaling network. To circumvent this complexity, we studied here the minimal requirements for functionally relevant p53 post-translational modifications by expressing human p53 together with its best characterized modifier Mdm2 in budding yeast. We find that expression of the human p53-Mdm2 module in yeast is sufficient to faithfully recapitulate key aspects of p53 regulation in higher eukaryotes, such as Mdm2-dependent targeting of p53 for degradation, sumoylation at lysine 386 and further regulation of this process by p14ARF. Interestingly, sumoylation is necessary for the recruitment of p53-Mdm2 complexes to yeast nuclear bodies morphologically akin to human PML bodies. These results suggest a novel role for Mdm2 as well as for p53 sumoylation in the recruitment of p53 to nuclear bodies. The reductionist yeast model that was established and validated in this study will now allow to incrementally study simplified parts of the intricate p53 network, thus helping elucidate the core mechanisms of p53 regulation as well as test novel strategies to counteract p53 malfunctions