To Battle The Opioid Overdose Epidemic, Deploy The ‘Cascade Of Care’ Model

Similar to serologically confirmed undetectable HIV viral load, continuous abstinence from opioids can be objectively monitored with routine toxicology and serve as a biomarker for a primary outcome. Patients abstinent from opioids and on maintenance treatment with buprenorphine, methadone, or injectable naltrexone are at minimal risk for opioid overdose. Applying quality metrics informed by the Cascade of Care to treatment of opioid use disorder holds great promise to help ensure optimal returns on federal funding for areas hardest hit by overdose. Treatment programs with historically low use of MAT in the face of the worsening epidemic need compelling incentives to change practice. Identifying which patients struggle at which stages of the Cascade to help target clinical and policy interventions can help STR funding achieve its greatest impact. While the scale of the opioid crisis presents states and policymakers with a daunting and urgent task, adapting the Cascade of Care model to fit today’s crisis will help expedite and scale the programs needed to combat this epidemic

HST Images Flash Ionization of Old Ejecta by the 2011 Eruption of Recurrent Nova T Pyxidis

T Pyxidis is the only recurrent nova surrounded by knots of material ejected in previous outbursts. Following the eruption that began on 2011 April 14.29, we obtained seven epochs (from 4 to 383 days after eruption) of Hubble Space Telescope narrowband Ha images of T Pyx . The flash of radiation from the nova event had no effect on the ejecta until at least 55 days after the eruption began. Photoionization of hydrogen located north and south of the central star was seen 132 days after the beginning of the eruption. That hydrogen recombined in the following 51 days, allowing us to determine a hydrogen atom density of at least 7e5 cm^-3 - at least an order of magnitude denser than the previously detected, unresolved [NII] knots surrounding T Pyx. Material to the northwest and southeast was photoionized between 132 and 183 days after the eruption began. 99 days later that hydrogen had recombined. Both then (282 days after outburst) and 101 days later, we detected almost no trace of hydrogen emission around T Pyx. There is a large reservoir of previously unseen, cold diffuse hydrogen overlapping the previously detected, [NII] - emitting knots of T Pyx ejecta. The mass of this newly detected hydrogen is probably an order of magnitude larger than that of the [NII] knots. We also determine that there is no significant reservoir of undetected ejecta from the outer boundaries of the previously detected ejecta out to about twice that distance, near the plane of the sky. The lack of distant ejecta is consistent with the Schaefer et al (2010) scenario for T Pyx, in which the star underwent its first eruption within five years of 1866 after many millennia of quiescence, followed by the six observed recurrent nova eruptions since 1890. This lack of distant ejecta is not consistent with scenarios in which T Pyx has been erupting continuously as a recurrent nova for many centuries or millennia.Comment: 27 pages, 10 figures, submitted to the Astrophysical Journa

Glycemic Control and Cardiovascular Mortality in Hemodialysis Patients With Diabetes

Previous observational studies using differing methodologies have yielded inconsistent results regarding the association between glycemic control and outcomes in diabetic patients receiving maintenance hemodialysis (MHD). We examined mortality predictability of A1C and random serum glucose over time in a contemporary cohort of 54,757 diabetic MHD patients (age 63 ± 13 years, 51% men, 30% African Americans, 19% Hispanics). Adjusted all-cause death hazard ratio (HR) for baseline A1C increments of 8.0–8.9, 9.0–9.9, and ≥10%, compared with 7.0–7.9% (reference), was 1.06 (95% CI 1.01–1.12), 1.05 (0.99–1.12), and 1.19 (1.12–1.28), respectively, and for time-averaged A1C was 1.11 (1.05–1.16), 1.36 (1.27–1.45), and 1.59 (1.46–1.72). A symmetric increase in mortality also occurred with time-averaged A1C levels in the low range (6.0–6.9%, HR 1.05 [95% CI 1.01–1.08]; 5.0–5.9%, 1.08 [1.04–1.11], and ≤5%, 1.35 [1.29–1.42]) compared with 7.0–7.9% in fully adjusted models. Adjusted all-cause death HR for time-averaged blood glucose 175–199, 200–249, 250–299, and ≥300 mg/dL, compared with 150–175 mg/dL (reference), was 1.03 (95% CI 0.99–1.07), 1.14 (1.10–1.19), 1.30 (1.23–1.37), and 1.66 (1.56–1.76), respectively. Hence, poor glycemic control (A1C ≥8% or serum glucose ≥200 mg/dL) appears to be associated with high all-cause and cardiovascular death in MHD patients. Very low glycemic levels are also associated with high mortality risk

Can we trust “Magnitude-based inference”?

Editoria

Rest-Frame UV-Optical Selected Galaxies at 2.3 ≾ z ≾ 3.5: Searching for Dusty Star-forming and Passively Evolving Galaxies

A new set of color selection criteria (VJL) analogous with the BzK method is designed to select both star-forming galaxies (SFGs) and passively evolving galaxies (PEGs) at 2.3 ≾ z ≾ 3.5 by using rest-frame UV-optical (V – J versus J – L) colors. The criteria are thoroughly tested with theoretical stellar population synthesis models and real galaxies with spectroscopic redshifts to evaluate their efficiency and contamination. We apply the well-tested VJL criteria to the HST/WFC3 Early Release Science field and study the physical properties of selected galaxies. The redshift distribution of selected SFGs peaks at z ~ 2.7, slightly lower than that of Lyman break galaxies at z ~ 3. Comparing the observed mid-infrared fluxes of selected galaxies with the prediction of pure stellar emission, we find that our VJL method is effective at selecting massive dusty SFGs that are missed by the Lyman break technique. About half of the star formation in massive (M_(star) > 10^(10) M_☉) galaxies at 2.3 ≾ z ≾ 3.5 is contributed by dusty (extinction E(B – V) > 0.4) SFGs, which, however, only account for ~20% of the number density of massive SFGs. We also use the mid-infrared fluxes to clean our PEG sample and find that galaxy size can be used as a secondary criterion to effectively eliminate the contamination of dusty SFGs. The redshift distribution of the cleaned PEG sample peaks at z ~ 2.5. We find six PEG candidates at z > 3 and discuss possible methods to distinguish them from dusty contamination. We conclude that at least part of our candidates are real PEGs at z ~ 3, implying that these types of galaxies began to form their stars at z ≳ 5. We measure the integrated stellar mass density (ISMD) of PEGs at z ~ 2.5 and set constraints on it at z > 3. We find that the ISMD grows by at least about a factor of 10 in 1 Gyr at 3 < z <5 and by another factor of 10 in the next 3.5 Gyr (1 < z < 3)

The Murchison Widefield Array: Design Overview

The Murchison Widefield Array (MWA) is a dipole-based aperture array synthesis telescope designed to operate in the 80-300 MHz frequency range. It is capable of a wide range of science investigations, but is initially focused on three key science projects. These are detection and characterization of 3-dimensional brightness temperature fluctuations in the 21cm line of neutral hydrogen during the Epoch of Reionization (EoR) at redshifts from 6 to 10, solar imaging and remote sensing of the inner heliosphere via propagation effects on signals from distant background sources,and high-sensitivity exploration of the variable radio sky. The array design features 8192 dual-polarization broad-band active dipoles, arranged into 512 tiles comprising 16 dipoles each. The tiles are quasi-randomly distributed over an aperture 1.5km in diameter, with a small number of outliers extending to 3km. All tile-tile baselines are correlated in custom FPGA-based hardware, yielding a Nyquist-sampled instantaneous monochromatic uv coverage and unprecedented point spread function (PSF) quality. The correlated data are calibrated in real time using novel position-dependent self-calibration algorithms. The array is located in the Murchison region of outback Western Australia. This region is characterized by extremely low population density and a superbly radio-quiet environment,allowing full exploitation of the instrumental capabilities.Comment: 9 pages, 5 figures, 1 table. Accepted for publication in Proceedings of the IEE