Search

The shortest-period binary star system known to date, RX J0806.3+1527 (HM Cancri), has now been observed in the optical for more than two decades. Although it is thought to be a double degenerate binary undergoing mass transfer, an early surprise was that its orbital frequency, $f_0$, is currently increasing as the result of gravitational wave radiation. This is unusual since it was expected that the mass donor was degenerate and would expand on mass loss, leading to a decreasing $f_0$. We exploit two decades of high-speed photometry to precisely quantify the trajectory of HM Cancri, allowing us to find that $\ddot f_0$ is negative, where $\ddot f_0~=~(-5.38\pm2.10)\times10^{-27}$ Hz s$^{-2}$. Coupled with our positive frequency derivative, we show that mass transfer is counteracting gravitational-wave dominated orbital decay and that HM Cancri will turn around within $2100\pm800\,$yrs from now. We present Hubble Space Telescope ultra-violet spectra which display Lyman-$\alpha$ absorption, indicative of the presence of hydrogen accreted from the donor star. We use these pieces of information to explore a grid of permitted donor and accretor masses with the Modules for Experiments in Stellar Astrophysics suite, finding models in good accordance with many of the observed properties for a cool and initially hydrogen-rich extremely-low-mass white dwarf ($\approx0.17\,$M$_\odot$) coupled with a high accretor mass white dwarf ($\approx 1.0\,$M$_\odot$). Our measurements and models affirm that HM~Cancri is still one of the brightest verification binaries for the Laser Interferometer Space Antenna spacecraft., Comment: 12 pages (+5 pages appendix), 9 figures, 6 tables. Accepted for publication in MNRAS

Genotype-phenotype correlations add value to the management of families with hereditary hearing loss (HL), where age-related typical audiograms (ARTAs) are generated from cross-sectional regression equations and used to predict the audiogram phenotype across the lifespan. A seven-generation kindred with autosomal dominant sensorineural HL (ADSNHL) was recruited and a novel pathogenic variant in POU4F3 (c.37del) was identified by combining linkage analysis with whole exome sequencing (WES). POU4F3 is noted for large intrafamilial variation including the age of onset of HL, audiogram configuration and presence of vestibular impairment. Sequential audiograms and longitudinal analyses reveal highly variable audiogram features among POU4F3 (c.37del) carriers, limiting the utility of ARTAs for clinical prognosis and management of HL. Furthermore, a comparison of ARTAs against three previously published families (1 Israeli Jewish, 2 Dutch) reveals significant interfamilial differences, with earlier onset and slower deterioration. This is the first published report of a North American family with ADSNHL due to POU4F3, the first report of the pathogenic c.37del variant, and the first study to conduct longitudinal analysis, extending the phenotypic spectrum of DFNA15.

Purpose The COVID-19 pandemic may have exacerbated ethnic health inequalities, particularly in people with multiple long-term health conditions, the interplay with mental health is unclear. This study investigates the impact of the pandemic on the association of ethnicity and multimorbidity with mortality/service use among adults, in people living with severe mental illnesses (SMI). Methods This study will utilise secondary mental healthcare records via the Clinical Record Interactive Search (CRIS) and nationally representative primary care records through the Clinical Practice Interactive Research Database (CPRD). Quasi-experimental designs will be employed to quantify the impact of COVID-19 on mental health service use and excess mortality by ethnicity, in people living with severe mental health conditions. Up to 50 qualitative interviews will also be conducted, co-produced with peer researchers; findings will be synthesised with quantitative insights to provide in-depth understanding of observed associations. Results 81,483 people in CRIS with schizophrenia spectrum, bipolar or affective disorder diagnoses, were alive from 1st January 2019. Psychiatric multimorbidities in the CRIS sample were comorbid somatoform disorders (30%), substance use disorders (14%) and personality disorders (12%). In CPRD, of 678,842 individuals with a prior probable diagnosis of COVID-19, 1.1% (N = 7493) had an SMI diagnosis. People in the SMI group were more likely to die (9% versus 2% in the non-SMI sample) and were more likely to have mental and physical multimorbidities. Conclusion The effect of COVID-19 on people from minority ethnic backgrounds with SMI and multimorbidities remains under-studied. The present mixed methods study aims to address this gap.

Background and ObjectivesStudies describing gaps in care for youth with congenital heart disease (CHD), focus on those who have returned to care, but rarely those actively missing from care. Our objective was to determine barriers for young adults with CHD actively missing from cardiac care and to re-engage them in care.MethodsRetrospective single-center cohort study of cardiology clinic patients ages 15-21 years with CHD between 2012-2019 for patients actively missing from care (≥12 months beyond requested clinic follow-up). We conducted prospective interviews, offered clinic scheduling information and recorded cardiac follow-up. Data was analyzed using descriptive statistics, univariable, and multivariable logistic regression.ResultsOf 1053 CHD patients, 33% (n=349) were actively missing. Of those missing, 58% were male and median age was 17 yrs (IQR 16-19). Forty-six percent were Non-Hispanic White, 33% Hispanic, and 9% Black. Moderately complex CHD was in 71%, and 62% had private insurance. Patients with simple CHD, older age at last encounter (18-21), and scheduled follow-up >12 months from last encounter were more likely to be actively missing. Interviews were completed by 125 patients/parents (36%). Lack of cardiac care was reported in 52%, and common barriers included: insurance (33%), appointment scheduling (26%), and unknown ACHD center care (15%). Roughly half (55%) accepted appointment information, yet only 3% successfully returned.ConclusionsMany patients require assistance beyond CHD knowledge to maintain and re-engage in care. Future interventions should include scheduling assistance, focused insurance maintenance, understanding where to obtain ACHD care, and educating on need for lifelong care.Article SummaryThere is a growing population of youth with congenital heart disease leaving cardiology care; we investigate patients actively missing from care and target their re-engagement.What’s Known on This Subject?Maintaining cardiac care is a problem for many patients with congenital heart disease, especially teens and young adults, and characteristics of both patients and their healthcare environment contribute to the maintenance and ability to continue appropriate cardiac care.What This Study AddsThis study uniquely investigates patients with congenital heart disease that are actively missing from care, and investigates if a simple intervention of contacting them while they are missing to re-engage them in care impacts their re-entry into cardiac care.Contributors’ Statement PageJudson Moore conceptualized and designed the study, designed data collection instruments, collected data, drafted the initial manuscript, and completed necessary revisions to final manuscript.Keila Lopez conceptualized and designed the study, designed data collection instruments, critically reviewed data, revised manuscript drafts, and provided content expertise.Shreya Sheth conceptualized and designed the study, critically reviewed data, and revised the manuscript.Wilson Lam contributed to study design, critically reviewed data for intellectual content, and revised the manuscript.Alexander Alexander, Andre Espaillat, and John Shabosky designed data collection instruments, collected data, and reviewed/revised the manuscript.Karla Dyer performed data extraction, data cleaning, and reviewed/revised the manuscript.Nicole Broussard and Donna Lovick provided expert knowledge for interpretation of data and reviewed/revised the manuscript.All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Wide-field time-domain photometric sky surveys are now finding hundreds of eclipsing white dwarf plus M dwarf binaries, a population encompassing a wealth of information and potential insight into white dwarf and close binary astrophysics. Precise follow-up observations are essential in order to fully constrain these systems and capitalise on the power of this sample. We present the first results from our program of high-speed, multi-band photometric follow-up. We develop a method to measure temperatures, (model-dependent) masses, and radii for both components from the eclipse photometry alone and characterize 34 white dwarf binaries, finding general agreement with independent estimates using an alternative approach while achieving around a factor of two increase in parameter precision. In addition to these parameter estimates, we discover a number of interesting systems -- finding four with sub-stellar secondaries, doubling the number of eclipsing examples, and at least six where we find the white dwarf to be strongly magnetic, making these the first eclipsing examples of such systems and key to investigating the mechanism of magnetic field generation in white dwarfs. We also discover the first two pulsating white dwarfs in detached and eclipsing post-common-envelope binaries -- one with a low-mass, likely helium core, and one with a relatively high mass, towards the upper end of the known sample of ZZ Cetis. Our results demonstrate the power of eclipse photometry, not only as a method of characterising the population, but as a way of discovering important systems that would have otherwise been missed by spectroscopic follow-up., Comment: 12 pages with a 5 page appendix and 14 figures. Accepted for publication in MNRAS

Introduction Non-muscle-invasive bladder cancer (NMIBC) patients often require multiple invasive procedures during follow-up. Surveillance guidelines do not adjust for increasing frailty or competing comorbidity. We aim to evaluate the influence of these factors on the natural history of NMIBC and whether this may have implications for appropriate follow-up schedules. Methods NMIBC patients who died in a 3-year period while on cystoscopic surveillance were identified. Frailty was assessed using the Rockwood Clinical Frailty Scale (CFS): 1–3, no frailty; 4, vulnerable; 5–9, mild/severe frailty. Similarly, three-tier categorisations were performed for comorbidity (Charlson Comorbidity Index) and for anaesthetic risk (American Society of Anesthesiologists’ [ASA] score). Results Of the 69 patients, 26 were categorised as no frailty, 20 as vulnerable and 13 as frail. There was no difference in the proportions of those with higher risk NMIBC between the categories. Increasing frailty was associated with reduced overall survival (median 59, 29 and 13 months; p < 0.05) but not recurrence-free survival (p = 0.98) or progression-free survival (p = 0.58). Similar results were obtained using the Charlson Comorbidity Index or ASA score. No frail patients with low/intermediate-risk NMIBC had clinically significant disease progression prior to death. Frail patients with CFS ≥ 4 were found to have similar complications due to bladder cancer itself (p = 0.48) yet almost three times as many complications following cystoscopic procedures during follow-up (p < 0.05). Conclusions For frail patients with low risk of progression, protocol-driven cystoscopic surveillance may not improve survival and watchful waiting may be more appropriate. Further investigation is required to determine the feasibility of this approach.

Accreting magnetic white dwarfs offer an opportunity to understand the interplay between spin-up and spin-down torques in binary systems. Monitoring of the white dwarf spin may reveal whether the white dwarf spin is currently in a state of near-equilibrium, or of uni-directional evolution towards longer or shorter periods, reflecting the recent history of the system and providing constraints for evolutionary models. This makes the monitoring of the spin history of magnetic white dwarfs of high interest. In this paper we report the results of a campaign of follow-up optical photometry to detect and track the 39 sec white dwarf spin pulses recently discovered in Hubble Space Telescope data of the cataclysmic variable V1460 Her. We find the spin pulsations to be present in g-band photometry at a typical amplitude of 0.4%. Under favourable observing conditions, the spin signal is detectable using 2-meter class telescopes. We measured pulse-arrival times for all our observations, which allowed us to derive a precise ephemeris for the white dwarf spin. We have also derived an orbital modulation correction that can be applied to the measurements. With our limited baseline of just over four years, we detect no evidence yet for spin-up or spin-down of the white dwarf, obtaining a lower limit of |P/Pdot|> 4e7 years, which is already 4 to 8 times longer than the timescales measured in two other cataclysmic variable systems containing rapidly rotating white dwarfs, AE Aqr and AR Sco., 8 pages, 6 figures. Accepted for publication in MNRAS

AR Scorpii (AR Sco) is the only radio-pulsing white dwarf known to date. It shows a broad-band spectrum extending from radio to X-rays whose luminosity cannot be explained by thermal emission from the system components alone, and is instead explained through synchrotron emission powered by the spin-down of the white dwarf. We analysed NTT/ULTRACAM, TNT/ULTRASPEC, and GTC/HiPERCAM high-speed photometric data for AR Sco spanning almost seven years and obtained a precise estimate of the spin frequency derivative, now confirmed with 50-sigma significance. Using archival photometry, we show that the spin down rate of P/Pdot = 5.6e6 years has remained constant since 2005. As well as employing the method of pulse-arrival time fitting used for previous estimates, we also found a consistent value via traditional Fourier analysis for the first time. In addition, we obtained optical time-resolved spectra with WHT/ISIS and VLT/X-shooter. We performed modulated Doppler tomography for the first time for the system, finding evidence of emission modulated on the orbital period. We have also estimated the projected rotational velocity of the M-dwarf as a function of orbital period and found that it must be close to Roche lobe filling. Our findings provide further constraints for modelling this unique system., 15 pages, 18 figures. Accepted for publication in MNRAS

Objective The COVID-19 pandemic restricted in-person appointments and prompted an increase in remote healthcare delivery. Our goal was to assess access to remote care for complex pediatric cardiology patients. Methods We performed a retrospective chart review of Texas Children’s Hospital (TCH) pediatric cardiology outpatient appointments from March 2020 to December 2020 for established congenital heart disease (CHD) patients 1 to 17 yo. Primary outcome variables were remote care use of telemedicine and patient portal activation. Primary predictor variables were age, sex, insurance, race/ethnicity, language, and location. Descriptive statistics were used to analyze patient demographics. Multivariate logistic regression determined associations with remote care use (p

Large-scale sky surveys have played a transformative role in our understanding of astrophysical transients, only made possible by increasingly powerful machine learning-based filtering to accurately sift through the vast quantities of incoming data generated. In this paper, we present a new real-bogus classifier based on a Bayesian convolutional neural network that provides nuanced, uncertainty-aware classification of transient candidates in difference imaging, and demonstrate its application to the datastream from the GOTO wide-field optical survey. Not only are candidates assigned a well-calibrated probability of being real, but also an associated confidence that can be used to prioritise human vetting efforts and inform future model optimisation via active learning. To fully realise the potential of this architecture, we present a fully-automated training set generation method which requires no human labelling, incorporating a novel data-driven augmentation method to significantly improve the recovery of faint and nuclear transient sources. We achieve competitive classification accuracy (FPR and FNR both below 1%) compared against classifiers trained with fully human-labelled datasets, whilst being significantly quicker and less labour-intensive to build. This data-driven approach is uniquely scalable to the upcoming challenges and data needs of next-generation transient surveys. We make our data generation and model training codes available to the community., 17 pages, 12 figures, resubmitted to MNRAS following reviewer comments

In plants, long-distance dispersal is both attenuated and directed by specific movement vectors, including animals, wind, and/or water. Hence, movement vectors partly shape metapopulation genetic patterns that are, however, also influenced by other life-history traits such as clonal growth. We studied the relationship between area, isolation, plant-species richness, reproduction, and dispersal mechanisms with genetic diversity and divergence in 4 widespread wetland plant-species in a total of 20 island-like kettle-hole habitats surrounded by an intensive agricultural landscape. Our results showed that genetic parameters reflect the reproduction strategies with the highest genetic diversity being observed in the non-clonal, outcrossing Oenanthe aquatica compared to the clonal Lycopus europaeus, Typha latifolia, and Phragmites australis. Lycopus showed a positive relationship between genetic diversity and kettle-hole area, but a negative relationship with the number of neighboring kettle holes (less isolation). Genetic diversity increased with plant-species richness in the clonal species Phragmites and Lycopus; while it decreased in the non-clonal Oenanthe. Finally, genetic divergence and, therefore, connectivity differed between alternative dispersal strategies, where wind-dispersed Typha and Phragmites had a higher gene flow between the analyzed kettle holes compared with the insect-pollinated, hydrochorous Lycopus and Oenanthe. Our study provides information on genetic patterns related to reproduction and dispersal mechanisms of 4 common wetland species contributing to the understanding of the functioning of plant metacommunities occurring in kettle holes embedded in agricultural landscapes.

Gravitational-wave (GW) data contains non-Gaussian noise transients called "glitches". During the third LIGO-Virgo observing run about 24% of all gravitational-wave candidates were in the vicinity of a glitch, while even more events could be affected in future observing runs due to increasing detector sensitivity. This poses a problem since glitches can affect the estimation of GW source parameters, including sky localisation, which is crucial to identify an electromagnetic (EM) counterpart. In this paper we present a study that estimates how much sky localisation is affected by a nearby glitch in low latency. We injected binary black hole (BBH), binary neutron star (BNS) and neutron star-black hole (NSBH) signals into data containing three different classes of glitches: blips, thunderstorms and fast scatterings. The impact of these glitches was assessed by estimating the number of tile pointings that a telescope would need to search over until the true sky location of an event is observed. We found that blip glitches affect the localisation of BBH mergers the most; in the most extreme cases a BBH event is completely missed even by a 20 deg$^2$ field-of-view (FOV) telescope. Thunderstorm glitches have the biggest impact on BBH and NSBH events, especially if there is no third interferometer, while BNS events appear to be not affected. Fast scattering glitches impact low latency localisation only for NSBH signals. For two-interferometer network small (FOV=1 deg$^2$) and large (FOV=20 deg$^2$) telescopes are affected, whereas three-interferometer localisation bias is small enough not to affect large (FOV=20 deg$^2$) telescopes., Comment: 16 pages, 7 figures, 3 tables. Accepted to PRD

Environmental water management is increasingly used to restore riverine, wetland and floodplain ecosystems and requires an understanding of what the flow regime or restoration objectives are, why these objectives are being targeted and how outcomes will be evaluated. This perspective paper focuses on non-woody vegetation, an important component of river-floodplain ecosystems and a targeted outcome for many environmental flow management programs, such as the Basin wide environmental watering strategy for the Murray-Darling Basin in Australia. Effective management of non-woody vegetation using environmental water requires identifying a suite of measurable condition outcomes (the “what”), understanding how these relate to broader functions and values (the “why”) and developing clear cause-and-effect relationships between management and outcomes (the “how”). A critical component of this process is to characterise what constitutes management success, which requires reimagining current definitions of condition to better incorporate dynamic functions and diverse values. We identify the need to characterise condition in a structured framework using both ecological data and societal values. This approach will not only help inform the development of benchmarks, watering objectives and monitoring metrics, but will also facilitate engagement by a broader spectrum of the community with the management and outcomes of environmental watering.

With the prevalence of wide-field, time-domain photometric sky surveys, the number of eclipsing white dwarf systems being discovered is increasing dramatically. An efficient method to follow these up will be key to determining any population trends and finding any particularly interesting examples. We demonstrate that multi-band eclipse photometry of binaries containing a white dwarf and an M~dwarf can be used to determine the masses and temperatures of the white dwarfs to better than 5 per cent. For the M~dwarfs we measure their parameters to a precision of better than 6 per cent with the uncertainty dominated by the intrinsic scatter of the M~dwarf mass-radius relationship. This precision is better than what can typically be achieved with low-resolution spectroscopy. The nature of this method means that it will be applicable to LSST data in the future, enabling direct characterisation without follow-up spectroscopy. Additionally, we characterise three new post-common-envelope binaries from their eclipse photometry, finding two systems containing hot helium-core white dwarfs with low-mass companions (one near the brown dwarf transition regime) and a possible detached cataclysmic variable at the lower edge of the period gap., Comment: 10 pages (and appendix), 5 figures, accepted to MNRAS

The COVID-19 pandemic may have exacerbated ethnic health inequalities, particularly in people with multiple long-term health conditions, the interplay with mental health is unclear. This study investigates the impact of the pandemic on the association of ethnicity and multimorbidity with mortality/service use among adults, in people living with severe mental illnesses (SMI).This study will utilise secondary mental healthcare records via the Clinical Record Interactive Search (CRIS) and nationally representative primary care records through the Clinical Practice Interactive Research Database (CPRD). Quasi-experimental designs will be employed to quantify the impact of COVID-19 on mental health service use and excess mortality by ethnicity, in people living with severe mental health conditions. Up to 50 qualitative interviews will also be conducted, co-produced with peer researchers; findings will be synthesised with quantitative insights to provide in-depth understanding of observed associations.81,483 people in CRIS with schizophrenia spectrum, bipolar or affective disorder diagnoses, were alive from 1st January 2019. Psychiatric multimorbidities in the CRIS sample were comorbid somatoform disorders (30%), substance use disorders (14%) and personality disorders (12%). In CPRD, of 678,842 individuals with a prior probable diagnosis of COVID-19, 1.1% (N = 7493) had an SMI diagnosis. People in the SMI group were more likely to die (9% versus 2% in the non-SMI sample) and were more likely to have mental and physical multimorbidities.The effect of COVID-19 on people from minority ethnic backgrounds with SMI and multimorbidities remains under-studied. The present mixed methods study aims to address this gap.

The typical detection rate of $\sim1$ gamma-ray burst (GRB) per day by the \emph{Fermi} Gamma-ray Burst Monitor (GBM) provides a valuable opportunity to further our understanding of GRB physics. However, the large uncertainty of the \emph{Fermi} localization typically prevents rapid identification of multi-wavelength counterparts. We report the follow-up of 93 \emph{Fermi} GRBs with the Gravitational-wave Optical Transient Observer (GOTO) prototype on La Palma. We selected 53 events (based on favourable observing conditions) for detailed analysis, and to demonstrate our strategy of searching for optical counterparts. We apply a filtering process consisting of both automated and manual steps to 60\,085 candidates initially, rejecting all but 29, arising from 15 events. With $\approx3$ GRB afterglows expected to be detectable with GOTO from our sample, most of the candidates are unlikely to be related to the GRBs. Since we did not have multiple observations for those candidates, we cannot confidently confirm the association between the transients and the GRBs. Our results show that GOTO can effectively search for GRB optical counterparts thanks to its large field of view of $\approx40$ square degrees and its depth of $\approx20$ mag. We also detail several methods to improve our overall performance for future follow-up programs of \emph{Fermi} GRBs.

The Gravitational-wave Optical Transient Observer (GOTO) is an array of wide-field optical telescopes, designed to exploit new discoveries from the next generation of gravitational wave detectors (LIGO, Virgo, KAGRA), study rapidly evolving transients, and exploit multi-messenger opportunities arising from neutrino and very high energy gamma-ray triggers. In addition to a rapid response mode, the array will also perform a sensitive, all-sky transient survey with few day cadence. The facility features a novel, modular design with multiple 40-cm wide-field reflectors on a single mount. In June 2017 the GOTO collaboration deployed the initial project prototype, with 4 telescope units, at the Roque de los Muchachos Observatory (ORM), La Palma, Canary Islands. Here we describe the deployment, commissioning, and performance of the prototype hardware, and discuss the impact of these findings on the final GOTO design. We also offer an initial assessment of the science prospects for the full GOTO facility that employs 32 telescope units across two sites., 19 pages, 16 Figures, accepted for publication in Monthly Notices of the Royal Astronomical Society

The advent of wide-field sky surveys has led to the growth of transient and variable source discoveries. The data deluge produced by these surveys has necessitated the use of machine learning (ML) and deep learning (DL) algorithms to sift through the vast incoming data stream. A problem that arises in real-world applications of learning algorithms for classification is imbalanced data, where a class of objects within the data is underrepresented, leading to a bias for over-represented classes in the ML and DL classifiers. We present a recurrent neural network (RNN) classifier that takes in photometric time-series data and additional contextual information (such as distance to nearby galaxies and on-sky position) to produce real-time classification of objects observed by the Gravitational-wave Optical Transient Observer (GOTO), and use an algorithm-level approach for handling imbalance with a focal loss function. The classifier is able to achieve an Area Under the Curve (AUC) score of 0.972 when using all available photometric observations to classify variable stars, supernovae, and active galactic nuclei. The RNN architecture allows us to classify incomplete light curves, and measure how performance improves as more observations are included. We also investigate the role that contextual information plays in producing reliable object classification., Comment: 16 pages, 12 figures, to be published in Monthly Notices of the Royal Astronomical Society

The affiliation of author Kerrie A.Wilson was incorrect in the original publication and this has been corrected. Correct affiliation is Queensland University of Technology, Brisbane, Queensland 4000, Australia.

Habitat fragmentation affects landscape connectivity, the extent of which is influenced by the movement capacity of the vectors of seed and pollen dispersal for plants. Negative impacts of reduced connectivity can include reduced fecundity, increased inbreeding, genetic erosion and decreased long-term viability. These are issues for not only old (remnant) populations, but also new (restored) populations. We assessed reproductive and connective functionality within and among remnant and restored populations of a common tree, Banksia menziesii R.Br. (Proteaceae), in a fragmented urban landscape, utilising a genetic and graph theoretical approach. Adult trees and seed cohorts from five remnants and two restored populations were genotyped using microsatellite markers. Genetic variation and pollen dispersal were assessed using direct (paternity assignment) and indirect (pollination graphs and mating system characterisation) methods. Restored populations had greater allelic diversity (Ar = 8.08; 8.34) than remnant populations (Ar range = 6.49–7.41). Genetic differentiation was greater between restored and adjacent remnants (FST = 0.03 and 0.10) than all other pairwise comparisons of remnant populations (mean FST = 0.01 ± 0.01; n = 16 P = 0.001). All populations displayed low correlated paternity (rp = 0.06–0.16) with wide-ranging realised pollen dispersal distances (

Left ventricular assist devices (LVADs) have become an important advancement for patients with end-stage heart failure. Left ventricular assist devices come with the risk of stroke and pump thrombosis, and to mitigate these risks, anticoagulation is given to these patients. With anticoagulation comes increased bleeding risk, and urgent reversal may be necessary. Reports have shown that the risk of thrombosis with prothrombin complex concentrate (PCC) does exist, especially in patients with baseline risk factors for thrombosis. We describe two cases of warfarin reversal with low-dose 4-factor PCC (4F-PCC) in two different LVAD patient scenarios. Low-dose 4F-PCC was administered to one patient with a Heart Mate II (HM II) LVAD, international normalized ratio (INR) of 4.7 on admission and in need of an urgent procedure. He received approximately 16 units/kg of 4F-PCC with reversal of his INR to 2.3 within 45 minutes. The second patient also had a HM II LVAD and presented with a right occipital intraparenchymal hemorrhage and subdural hematoma with an INR of 3.7. He received approximately 11 units/kg of 4F-PCC with INR reversal to 1.6 within 1 hour. Both of these patients had no thrombotic complications and successful reversal of their INR with low-dose 4F-PCC. Further investigation into low-dose 4F-PCC dosing strategies is warranted.

The continental shelf in the southwestern Atlantic Ocean is among the six richest marine regions for biodiversity in the Southern Hemisphere, and its subtropical region is one of the fastest-warming hotspots. Thus, climate change could profoundly affect future species distributions. We investigated future climate-induced changes in fish larvae and harvested fish taxa in the subtropical southwestern Atlantic Ocean using a community-based modelling technique (gradient forest). This approach integrates information on multiple species rather than treating each species individually, as is typical in many species distribution approaches. We addressed two primary questions: how might climate change affect fish larval communities, and will communities of harvested fish (juveniles and adults) taxa respond similarly. Using two climate change scenarios (moderate RCP 4.5 and ‘business as usual’ 8.5), we found that fish larvae and harvested taxa are influenced differently by environmental variables, with differences in both the level and shape of the response to environmental drivers. Chlorophyll a and sea surface temperature were the most important predictors for fish larvae communities, while depth and sea surface salinity best predicted the harvested community. However, both communities are expected to move southwards in response to climate change, with greater changes in community composition predicted in the southern portion of the study area for both fish larvae and harvested taxa. To our knowledge, this is the first study to investigate the effect of future climate change on a suite of taxa of fish larvae and adults. We also suggest that modelling the integrated response of a suite of species to environmental predictors using community-modelling approaches such as gradient forest could provide robust projections and novel insights into community changes.

Researchers report increasing trends in psychotropic medication use to treat problem behavior in individuals with intellectual and developmental disability, despite some controversy regarding its application and treatment efficacy. A substantial evidence base exists supporting behavioral intervention efficacy, however research evaluating separate and combined intervention (i.e., concurrent application of behavioral and psychopharmacological interventions) effects remains scarce. This article demonstrates how a series of analyses on clinical data collected during treatment (i.e., four case studies) may be used to retrospectively explore separate and combined intervention effects on severe problem behavior. First, we calculated individual effect sizes and corresponding confidence intervals. The results indicated larger problem behavior decreases may have coincided more often with behavioral intervention adjustments compared to medication adjustments. Second, a conditional rates analysis indicated surges in problem behavior did not reliably coincide with medication reductions. Spearman correlation analyses indicated a negative relationship between behavioral intervention phase progress and weekly episodes of problem behavior compared to a positive relationship between total medication dosage and weekly episodes of problem behavior. However, a nonparametric partial correlation analyses indicated individualized, complex relationships may exist among total medication dosage, behavioral intervention, and weekly episodes of problem behavior. We discuss potential clinical implications and encourage behavioral researchers and practitioners to consider applying creative analytic strategies to evaluate separate and combined intervention effects on problem behavior to further explore this extremely understudied topic. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40614-020-00279-3.

Full list of authors: Dhillon, V. S.; Bezawada, N.; Black, M.; Dixon, S. D.; Gamble, T.; Gao, X.; Henry, D. M.; Kerry, P.; Littlefair, S. P.; Lunney, D. W.; Marsh, T. R.; Miller, C.; Parsons, S. G.; Ashley, R. P.; Breedt, E.; Brown, A.; Dyer, M. J.; Green, M. J.; Pelisoli, I.; Sahman, D. I. Wild, J.; Ives, D. J.; Mehrgan, L.; Stegmeier, J.; Dubbeldam, C. M.; Morris, T. J.; Osborn, J.; Wilson, R. W.; Casares, J.; Muñoz-Darias, T.; Pallé, E.; Rodríguez-Gil, P.; Shahbaz, T.; Torres, M. A. P.; de Ugarte Postigo, A.; Cabrera-Lavers, A.; Corradi, R. L. M.; Domínguez, R. D.; García-Alvarez, D., HiPERCAM is a portable, quintuple-beam optical imager that saw first light on the 10.4-m Gran Telescopio Canarias (GTC) in 2018. The instrument uses re-imaging optics and four dichroic beamsplitters to record us, gs, rs, is, zs (320-1060 nm) images simultaneously on its five CCD cameras, each of 3.1-arcmin (diagonal) field of view. The detectors in HiPERCAM are frame-transfer devices cooled thermo-electrically to 183 K, thereby allowing both long-exposure, deep imaging of faint targets, as well as high-speed (over 1000 windowed frames per second) imaging of rapidly varying targets. A comparison-star pick-off system in the telescope focal plane increases the effective field of view to 6.7 arcmin for differential photometry. Combining HiPERCAM with the world's largest optical telescope enables the detection of astronomical sources to gs ∼23 in 1 s and gs ∼28 in 1 h. In this paper, we describe the scientific motivation behind HiPERCAM, present its design, report on its measured performance, and outline some planned enhancements. © 2021 The Author(s) Published by Oxford University Press on behalf of Royal Astronomical Society., HiPERCAM was funded by the European Research Council under the European Union's Seventh Framework Programme (FP/20072013) under ERC-2013-ADG GrantAgreement no. 340040 (HiPERCAM), with additional funding for operations and enhancements provided by the Science and Technology Facilities Council (STFC). This paper is based on observations made with the Gran Telescopio Canarias, installed at the Spanish Observatorio del Roque de los Muchachos of the Instituto de Astrofísica de Canarias, on the island of La Palma. SGP acknowledges the support of an STFC Ernest Rutherford Fellowship. PR-G and TMD acknowledge support from the State Research Agency (AEI) of the Spanish Ministry of Science, Innovation and Universities (MCIU), and the European Regional Development Fund (FEDER) under grant AYA2017-83383-P. MAPT and TM-D acknowledge support via Ram ' on y Cajal Fellowships RYC-2015-17854 and RYC-201518148., With funding from the Spanish government through the Severo Ochoa Centre of Excellence accreditation SEV-2017-0709.

We present results of our analysis of up to 15 years of photometric data from eight AM CVn systems with orbital periods between 22.5 and 26.8 min. Our data has been collected from the GOTO, ZTF, Pan-STARRS, ASAS-SN and Catalina all-sky surveys and amateur observations collated by the AAVSO. We find evidence that these interacting ultra-compact binaries show a similar diversity of long term optical properties as the hydrogen accreting dwarf novae. We found that AM CVn systems in the previously identified accretion disc instability region are not a homogenous group. Various members of the analysed sample exhibit behaviour reminiscent of Z Cam systems with long super outbursts and standstills, SU UMa systems with regular, shorter super outbursts, and nova-like systems which appear only in a high state. The addition of TESS full frame images of one of these systems, KL Dra, reveals the first evidence for normal outbursts appearing as a precursor to super outbursts in an AM CVn system. Our results will inform theoretical modelling of the outbursts of hydrogen deficient systems., Comment: 11 Pages, 7 Figures, 2 Tables. Accepted for publication in MNRAS. Author's final submitted version