Pediatric collaborative care outcomes in a regional model

BackgroundDespite the movement toward hospital-based medical centers acquiring pediatric primary care offices, many primary care pediatricians still work in small, independent practices. To expand mental healthcare access, service delivery models must consider primary care practice needs and regionally available resources.ObjectiveThis report describes the implementation and evaluation of the Mood, Anxiety, ADHD Collaborative Care (MAACC) program over a 4 years period. MAACC. MAACC engaged 97 pediatric primary care clinicians across 39 practices in mental health training and supported the treatment of referred patients through a collaborative care model. To support psychosocial treatment needs, we built a child community therapy referral network of 213 licensed psychotherapy providers.MethodsData were collected on service delivery patterns (e.g., referrals, treatment use, and attrition) and patient outcomes. Measures included parent and children and adolescents PROMIS anxiety and depression short forms and the Parent NICHQ Vanderbilt.ResultsSix hundred ninety-six children and adolescents aged 6–18 were evaluated and provided treatment recommendations. Anxiety disorders were the most common diagnosis (45.4%), followed by ADHD (30.7%) and mood disorder (17%). For children and adolescents with an anxiety or mood disorder, significant improvement was observed from baseline to any initial follow-up and from baseline to 6, 12-, and 18 weeks on children and adolescents and parent measures of anxiety and depression. For children and adolescents with ADHD, significant improvement was observed from baseline to any initial follow-up measure and at 6 and 18 weeks on parent-reported inattentive symptoms. Significant differences in treatment outcomes were identified for children and adolescents with anxiety receiving psychotherapy alone and medication management and psychotherapy.ConclusionMAACC utilization and patient outcomes suggest that real-world collaborative care can effectively provide high-quality care while cultivating increased primary care treatment capacity and building on existing community resources

Low False-Positive Rate of Kepler Candidates Estimated From A Combination Of Spitzer And Follow-Up Observations

(Abridged) NASA's Kepler mission has provided several thousand transiting planet candidates, yet only a small subset have been confirmed as true planets. Therefore, the most fundamental question about these candidates is the fraction of bona fide planets. Estimating the rate of false positives of the overall Kepler sample is necessary to derive the planet occurrence rate. We present the results from two large observational campaigns that were conducted with the Spitzer telescope during the the Kepler mission. These observations are dedicated to estimating the false positive rate (FPR) amongst the Kepler candidates. We select a sub-sample of 51 candidates, spanning wide ranges in stellar, orbital and planetary parameter space, and we observe their transits with Spitzer at 4.5 microns. We use these observations to measures the candidate's transit depths and infrared magnitudes. A bandpass-dependent depth alerts us to the potential presence of a blending star that could be the source of the observed eclipse: a false-positive scenario. For most of the candidates (85%), the transit depths measured with Kepler are consistent with the depths measured with Spitzer as expected for planetary objects, while we find that the most discrepant measurements are due to the presence of unresolved stars that dilute the photometry. The Spitzer constraints on their own yield FPRs between 5-40%, depending on the KOIs. By considering the population of the Kepler field stars, and by combining follow-up observations (imaging) when available, we find that the overall FPR of our sample is low. The measured upper limit on the FPR of our sample is 8.8% at a confidence level of 3 sigma. This observational result, which uses the achromatic property of planetary transit signals that is not investigated by the Kepler observations, provides an independent indication that Kepler's false positive rate is low.Comment: 33 pages, 16 figures, 3 tables; accepted for publication in ApJ on February 7, 201

Transit Timing Observations from Kepler: VI. Potentially interesting candidate systems from Fourier-based statistical tests

We analyze the deviations of transit times from a linear ephemeris for the Kepler Objects of Interest (KOI) through Quarter six (Q6) of science data. We conduct two statistical tests for all KOIs and a related statistical test for all pairs of KOIs in multi-transiting systems. These tests identify several systems which show potentially interesting transit timing variations (TTVs). Strong TTV systems have been valuable for the confirmation of planets and their mass measurements. Many of the systems identified in this study should prove fruitful for detailed TTV studies.Comment: 32 pages, 6 of text and one long table, Accepted to Ap

Inhibition of HIV Fusion with Multivalent Gold Nanoparticles

The design and synthesis of a multivalent gold nanoparticle therapeutic is presented. SDC-1721, a fragment of the potent HIV inhibitor TAK-779, was synthesized and conjugated to 2.0 nm diameter gold nanoparticles. Free SDC-1721 had no inhibitory effect on HIV infection; however, the (SDC-1721)-gold nanoparticle conjugates displayed activity comparable to that of TAK-779. This result suggests that multivalent presentation of small molecules on gold nanoparticle surfaces can convert inactive drugs into potent therapeutics

Two Earth-sized planets orbiting Kepler-20

Since the discovery of the first extrasolar giant planets around Sun-like stars, evolving observational capabilities have brought us closer to the detection of true Earth analogues. The size of an exoplanet can be determined when it periodically passes in front of (transits) its parent star, causing a decrease in starlight proportional to its radius. The smallest exoplanet hitherto discovered has a radius 1.42 times that of the Earth's radius (R Earth), and hence has 2.9 times its volume. Here we report the discovery of two planets, one Earth-sized (1.03R Earth) and the other smaller than the Earth (0.87R Earth), orbiting the star Kepler-20, which is already known to host three other, larger, transiting planets. The gravitational pull of the new planets on the parent star is too small to measure with current instrumentation. We apply a statistical method to show that the likelihood of the planetary interpretation of the transit signals is more than three orders of magnitude larger than that of the alternative hypothesis that the signals result from an eclipsing binary star. Theoretical considerations imply that these planets are rocky, with a composition of iron and silicate. The outer planet could have developed a thick water vapour atmosphere.Comment: Letter to Nature; Received 8 November; accepted 13 December 2011; Published online 20 December 201

Masses, radii, and orbits of small Kepler planets : The transition from gaseous to rocky planets

We report on the masses, sizes, and orbits of the planets orbiting 22 Kepler stars. There are 49 planet candidates around these stars, including 42 detected through transits and 7 revealed by precise Doppler measurements of the host stars. Based on an analysis of the Kepler brightness measurements, along with high-resolution imaging and spectroscopy, Doppler spectroscopy, and (for 11 stars) asteroseismology, we establish low false-positive probabilities (FPPs) for all of the transiting planets (41 of 42 have an FPP under 1%), and we constrain their sizes and masses. Most of the transiting planets are smaller than three times the size of Earth. For 16 planets, the Doppler signal was securely detected, providing a direct measurement of the planet's mass. For the other 26 planets we provide either marginal mass measurements or upper limits to their masses and densities; in many cases we can rule out a rocky composition. We identify six planets with densities above 5 g cm-3, suggesting a mostly rocky interior for them. Indeed, the only planets that are compatible with a purely rocky composition are smaller than 2 R ⊕. Larger planets evidently contain a larger fraction of low-density material (H, He, and H2O).Peer reviewedFinal Accepted Versio

Transit Timing Observations from Kepler: VI. Transit Timing Variation Candidates in the First Seventeen Months from Polynomial Models

Transit timing variations provide a powerful tool for confirming and characterizing transiting planets, as well as detecting non-transiting planets. We report the results an updated TTV analysis for 1481 planet candidates (Borucki et al. 2011; Batalha et al. 2012) based on transit times measured during the first sixteen months of Kepler observations. We present 39 strong TTV candidates based on long-term trends (2.8% of suitable data sets). We present another 136 weaker TTV candidates (9.8% of suitable data sets) based on excess scatter of TTV measurements about a linear ephemeris. We anticipate that several of these planet candidates could be confirmed and perhaps characterized with more detailed TTV analyses using publicly available Kepler observations. For many others, Kepler has observed a long-term TTV trend, but an extended Kepler mission will be required to characterize the system via TTVs. We find that the occurrence rate of planet candidates that show TTVs is significantly increased (~68%) for planet candidates transiting stars with multiple transiting planet candidate when compared to planet candidates transiting stars with a single transiting planet candidate.Comment: Accepted to ApJ; 9 pages, incl. 3 B&W figures, 1 table, 2 electronic datasets available as ancillary files; Includes analyses of more planet candidates; Transit times and additional figures at http://www.astro.ufl.edu/~eford/data/kepler

The kepler-19 system: a transiting 2.2 R ⊕ planet and a second planet detected via transit timing variations

We present the discovery of the Kepler-19 planetary system, which we first identified from a 9.3day periodic transit signal in the Kepler photometry. From high-resolution spectroscopy of the star, we find a stellar effective temperature T= 5541 60K, a metallicity [Fe/H] = -0.13 0.06, and a surface gravity log(g) = 4.59 0.10. We combine the estimate of T and [Fe/H] with an estimate of the stellar density derived from the photometric light curve to deduce a stellar mass of M = 0.936 0.040 M and a stellar radius of R = 0.850 0.018 R (these errors do not include uncertainties in the stellar models). We rule out the possibility that the transits result from an astrophysical false positive by first identifying the subset of stellar blends that reproduce the precise shape of the light curve. Using the additional constraints from the measured color of the system, the absence of a secondary source in the high-resolution spectrum, and the absence of a secondary source in the adaptive optics imaging, we conclude that the planetary scenario is more than three orders of magnitude more likely than a blend. The blend scenario is independently disfavored by the achromaticity of the transit: we measure a transit depth with Spitzer at 4.5 μm of 547+113 -110 ppm, consistent with the depth measured in the Kepler optical bandpass of 567 6 ppm (corrected for stellar limb darkening). We determine a physical radius of the planet Kepler-19b of Rp = 2.209 0.048 R ⊕; the uncertainty is dominated by uncertainty in the stellar parameters. From radial velocity observations of the star, we find an upper limit on the planet mass of 20.3 M ⊕, corresponding to a maximum density of 10.4 g cm -3. We report a significant sinusoidal deviation of the transit times from a predicted linear ephemeris, which we conclude is due to an additional perturbing body in the system. We cannot uniquely determine the orbital parameters of the perturber, as various dynamical mechanisms match the amplitude, period, and shape of the transit timing signal and satisfy the host star's radial velocity limits. However, the perturber in these mechanisms has a period ≲ 160days and mass ≲ 6 M Jup, confirming its planetary nature as Kepler-19c. We place limits on the presence of transits of Kepler-19c in the available Kepler data

THE HOT-JUPITER KEPLER-17b: DISCOVERY, OBLIQUITY FROM STROBOSCOPIC STARSPOTS, AND ATMOSPHERIC CHARACTERIZATION

This paper reports the discovery and characterization of the transiting hot giant exoplanet Kepler-17b. The planet has an orbital period of 1.486 days, and radial velocity measurements from the Hobby–Eberly Telescope show a Doppler signal of 419.5+13.3−15.6 m s−1. From a transit-based estimate of the host star's mean density, combined with an estimate of the stellar effective temperature Teff = 5630 ± 100 from high-resolution spectra, we infer a stellar host mass of 1.06 ± 0.07 M☉ and a stellar radius of 1.02 ± 0.03 R☉. We estimate the planet mass and radius to be MP = 2.45 ± 0.11 MJ and RP = 1.31 ± 0.02 RJ. The host star is active, with dark spots that are frequently occulted by the planet. The continuous monitoring of the star reveals a stellar rotation period of 11.89 days, eight times the planet's orbital period; this period ratio produces stroboscopic effects on the occulted starspots. The temporal pattern of these spot-crossing events shows that the planet's orbit is prograde and the star's obliquity is smaller than 15°. We detected planetary occultations of Kepler-17b with both the Kepler and Spitzer Space Telescopes. We use these observations to constrain the eccentricity, e, and find that it is consistent with a circular orbit (e < 0.011). The brightness temperatures of the planet's infrared bandpasses are T3.6 μm = 1880  ±  100 K and T4.5 μm = 1770 ± 150 K. We measure the optical geometric albedo Ag in the Kepler bandpass and find Ag = 0.10 ± 0.02. The observations are best described by atmospheric models for which most of the incident energy is re-radiated away from the day side