The complex circumstellar environment of supernova 2023ixf.

The early evolution of a supernova (SN) can reveal information about the environment and the progenitor star. When a star explodes in vacuum, the first photons to escape from its surface appear as a brief, hours-long shock-breakout flare1,2, followed by a cooling phase of emission. However, for stars exploding within a distribution of dense, optically thick circumstellar material (CSM), the first photons escape from the material beyond the stellar edge and the duration of the initial flare can extend to several days, during which the escaping emission indicates photospheric heating3. Early serendipitous observations2,4 that lacked ultraviolet (UV) data were unable to determine whether the early emission is heating or cooling and hence the nature of the early explosion event. Here we report UV spectra of the nearby SN 2023ixf in the galaxy Messier 101 (M101). Using the UV data as well as a comprehensive set of further multiwavelength observations, we temporally resolve the emergence of the explosion shock from a thick medium heated by the SN emission. We derive a reliable bolometric light curve that indicates that the shock breaks out from a dense layer with a radius substantially larger than typical supergiants.

Intermittent explosive disorder subtypes in the general population: association with comorbidity, impairment and suicidality.

AIMS: Intermittent explosive disorder (IED) is characterised by impulsive anger attacks that vary greatly across individuals in severity and consequence. Understanding IED subtypes has been limited by lack of large, general population datasets including assessment of IED. Using the 17-country World Mental Health surveys dataset, this study examined whether behavioural subtypes of IED are associated with differing patterns of comorbidity, suicidality and functional impairment. METHODS: IED was assessed using the Composite International Diagnostic Interview in the World Mental Health surveys (n = 45 266). Five behavioural subtypes were created based on type of anger attack. Logistic regression assessed association of these subtypes with lifetime comorbidity, lifetime suicidality and 12-month functional impairment. RESULTS: The lifetime prevalence of IED in all countries was 0.8% (s.e.: 0.0). The two subtypes involving anger attacks that harmed people ('hurt people only' and 'destroy property and hurt people'), collectively comprising 73% of those with IED, were characterised by high rates of externalising comorbid disorders. The remaining three subtypes involving anger attacks that destroyed property only, destroyed property and threatened people, and threatened people only, were characterised by higher rates of internalising than externalising comorbid disorders. Suicidal behaviour did not vary across the five behavioural subtypes but was higher among those with (v. those without) comorbid disorders, and among those who perpetrated more violent assaults. CONCLUSIONS: The most common IED behavioural subtypes in these general population samples are associated with high rates of externalising disorders. This contrasts with the findings from clinical studies of IED, which observe a preponderance of internalising disorder comorbidity. This disparity in findings across population and clinical studies, together with the marked heterogeneity that characterises the diagnostic entity of IED, suggests that it is a disorder that requires much greater research.

Associations between neighborhood-level violence and individual mental disorders: Results from the World Mental Health surveys in five Latin American cities.

Rapidly urbanizing areas of Latin America experience elevated but unevenly distributed levels of violence. Extensive research suggests that individual exposure to violence is associated with higher odds of both internalizing (anxiety and mood) and externalizing (substance and intermittent explosive) mental disorders. Less research, however, has focused on how neighborhood-level violence, as an indicator of broader neighborhood contexts, might relate to the mental health of residents, independently of an individual's personal exposure. We used multilevel analyses to examine associations of neighborhood-level violence with individual-level past-year mental disorders, controlling for individual-level violence exposure. We used data from 7,251 adults nested in 83 neighborhoods within five large Latin American cities as part of the WHO World Mental Health Surveys. Accounting for individual-level violence exposure, living in neighborhoods with more violence was associated with significantly elevated odds of individual-level internalizing disorders, but not externalizing disorders. Caution should be exercised when making causal inferences regarding the effects of neighborhood-level violence in the absence of experimental interventions. Nevertheless, neighborhood context, including violence, should be considered in the study of mental disorders. These findings are particularly relevant for rapidly urbanizing areas with high levels of violence, such as Latin America.

Twelve-month mental health service use in six countries of the Americas: A regional report from the World Mental Health Surveys.

AIMS: To provide cross-national data for selected countries of the Americas on service utilization for psychiatric and substance use disorders, the distribution of these services among treatment sectors, treatment adequacy and factors associated with mental health treatment and adequacy of treatment. METHODS: Data come from data collected from 6710 adults with 12 month mental disorder surveys across seven surveys in six countries in North (USA), Central (Mexico) and South (Argentina, Brazil, Colombia, Peru) America who were interviewed 2001-2015 as part of the World Health Organization (WHO) World Mental Health (WMH) Surveys. DSM-IV diagnoses were made with the WHO Composite International Diagnostic Interview (CIDI). Interviews also assessed service utilization by the treatment sector, adequacy of treatment received and socio-demographic correlates of treatment. RESULTS: Little over one in four of respondents with any 12 month DSM-IV/CIDI disorder received any treatment. Although the vast majority (87.1%) of this treatment was minimally adequate, only 35.3% of cases received treatment that met acceptable quality guidelines. Indicators of social-advantage (high education and income) were associated with higher rates of service use and adequacy, but a number of other correlates varied across survey sites. CONCLUSIONS: These results shed light on an enormous public health problem involving under-treatment of common mental disorders, although the problem is most extreme among people with social disadvantage. Promoting services that are more accessible, especially for those with few resources, is urgently needed.

Delays in making initial treatment contact after the first onset of mental health disorders in the Argentinean Study of Mental Health Epidemiology.

AIMS: While there are effective treatments for psychiatric disorders, many individuals with such disorders do not receive treatment and those that do often take years to get into treatment. Information regarding treatment contact failure and delay in Argentina is needed to guide public health policy and planning. Therefore, this study aimed to provide data on prompt treatment contact, lifetime treatment contact, median duration of treatment delays and socio-demographic predictors of treatment contact after the first onset of a mental disorder. METHODS: The Argentinean Study of Mental Health Epidemiology (EAESM) is a multistage probability sample representative of adults (aged 18+) living in large urban areas of Argentina. A total of 2116 participants were evaluated with the World Mental Health Composite International Diagnostic Interview to assess psychiatric diagnosis, treatment contact and delay. RESULTS: Projections of cases that will make treatment contact by 50 years taken from a survival curve suggest that the majority of individuals with a mood (100%) or anxiety disorder (72.5%) in Argentina whose disorder persist for a sufficient period of time eventually make treatment contact while fewer with a substance disorder do so (41.6%). Timely treatment in the year of onset is rare (2.6% for a substance disorder, 14.6% for an anxiety disorder and 31.3% of those with a mood disorder) with mean delays between 8 years for mood disorders and 21 years for anxiety disorders. Younger cohorts are more likely to make treatment contact than older cohorts, whereas those with earlier ages of disorder onset are least likely to make treatment contact. Those with anxiety disorders and major depressive disorder are more likely to make treatment contact when they have comorbid disorders, whereas those with substance use disorders are less likely. CONCLUSIONS: Argentina needs to implement strategies to get individuals with substance use disorders into treatment, and to reduce treatment delays for all, but particularly to target early detection and treatment among children and adolescents.

A kilonova as the electromagnetic counterpart to a gravitational-wave source.

Gravitational waves were discovered with the detection of binary black-hole mergers and they should also be detectable from lower-mass neutron-star mergers. These are predicted to eject material rich in heavy radioactive isotopes that can power an electromagnetic signal. This signal is luminous at optical and infrared wavelengths and is called a kilonova. The gravitational-wave source GW170817 arose from a binary neutron-star merger in the nearby Universe with a relatively well confined sky position and distance estimate. Here we report observations and physical modelling of a rapidly fading electromagnetic transient in the galaxy NGC 4993, which is spatially coincident with GW170817 and with a weak, short γ-ray burst. The transient has physical parameters that broadly match the theoretical predictions of blue kilonovae from neutron-star mergers. The emitted electromagnetic radiation can be explained with an ejected mass of 0.04 ± 0.01 solar masses, with an opacity of less than 0.5 square centimetres per gram, at a velocity of 0.2 ± 0.1 times light speed. The power source is constrained to have a power-law slope of -1.2 ± 0.3, consistent with radioactive powering from r-process nuclides. (The r-process is a series of neutron capture reactions that synthesise many of the elements heavier than iron.) We identify line features in the spectra that are consistent with light r-process elements (atomic masses of 90-140). As it fades, the transient rapidly becomes red, and a higher-opacity, lanthanide-rich ejecta component may contribute to the emission. This indicates that neutron-star mergers produce gravitational waves and radioactively powered kilonovae, and are a nucleosynthetic source of the r-process elements.

A Wolf-Rayet-like progenitor of SN 2013cu from spectral observations of a stellar wind.

The explosive fate of massive Wolf-Rayet stars (WRSs) is a key open question in stellar physics. An appealing option is that hydrogen-deficient WRSs are the progenitors of some hydrogen-poor supernova explosions of types IIb, Ib and Ic (ref. 2). A blue object, having luminosity and colours consistent with those of some WRSs, has recently been identified in pre-explosion images at the location of a supernova of type Ib (ref. 3), but has not yet been conclusively determined to have been the progenitor. Similar work has so far only resulted in non-detections. Comparison of early photometric observations of type Ic supernovae with theoretical models suggests that the progenitor stars had radii of less than 10(12) centimetres, as expected for some WRSs. The signature of WRSs, their emission line spectra, cannot be probed by such studies. Here we report the detection of strong emission lines in a spectrum of type IIb supernova 2013cu (iPTF13ast) obtained approximately 15.5 hours after explosion (by 'flash spectroscopy', which captures the effects of the supernova explosion shock breakout flash on material surrounding the progenitor star). We identify Wolf-Rayet-like wind signatures, suggesting a progenitor of the WN(h) subclass (those WRSs with winds dominated by helium and nitrogen, with traces of hydrogen). The extent of this dense wind may indicate increased mass loss from the progenitor shortly before its explosion, consistent with recent theoretical predictions.

Análisis de la variabilidad de la presión arterial mediante la automedida de la presión arterial en Navarra / Analysis of the variability of blood pressure by self-measurement of blood pressure in Navarra

Objetivos. Dada la gran utilización del método diagnóstico que es la automedida de presión arterial (AMPA) y existiendo escasa clarificación sobre la variabilidad diurna y sobre el número de determinaciones de PA a realizar mediante AMPA se realizó este estudio. Método. Se seleccionó una muestra de 1.136 personas (población total, 2.084), aleatoria y estratificada por edad y sexo, de 25 a 64 años. Se excluyeron a los diagnosticados de hipertensión arterial (HTA). En la recogida de datos en consulta (C) se determinó la PA tres veces mediante el esfigmomanómetro de mercurio (Hg) en las dos primeras y mediante el aparato automático Omron 705 CP (ap autom) en la tercera. Se registró la frecuencia cardíaca (FC), la talla y el peso. Para la recogida de datos en el domicilio (D) se les instruyó en el manejo del ap autom y se les pidió que obtuviesen 9 mediciones de PA, tres por la mañana (M), tres por la tarde (T) y tres por la noche (N) durante tres días laborables (L) y uno festivo (F). Se aplicó la "t" de Student de medias pareadas y ANOVA monofactorial. Resultados. Las mediciones de PA (mmHg) en C y D se obtuvieron en 734 participantes. De ellos, 185 con una PA en C >= 140/90. Las medias de presión sistólica/presión diastólica (PS/PD) en C con el Hg fueron: 123,5 ± 15,1/76,4 ± 10,3 y 122,4 ± 14,4/75,5 ± 10 y con el ap autom de 123 ± 16,1/73,7 ± 10,3. La media de PS/PD en el D de toda la muestra fue: 115 ± 14,3/69,2 ± 9 y en el grupo con PA en C < 140/90, la media de PS fue 111 ± 12,2 y de PD 66,8 ± 7,6. La media de FC en la C fue de 70,3 ± 10,4 (pulsaciones/minuto). La media de FC en el D de toda la muestra fue 67,9 ± 9,7 y en el grupo con PA < 140/90 en C fue de 67 ± 9,6. Al comparar la PA de la C y del D existieron diferencias significativas entre las determinaciones en C en relación con las del D (M, T o N) en los días L y F (p < 0,05); siendo superior la PA en C. La FC fue también diferente en la C y en el D, siendo superior en C que en el D. Al analizar las tres tomas de la M de cada día se observó que existía una diferencia significativa de la PA tanto en la primera toma que se realizaba por la M, por la T y por la N del primer día en relación con la segunda y la tercera tomas del mismo día (p < 0,05). Respecto a la FC se observaron diferencias significativas entre la primera toma de la M en comparación con la segunda y la tercera tomas de la M del primer día (p < 0,05). Al comparar la PA de la M, la T y la N de los días L se observó que existían diferencias significativas entre las tomas de la M y la N (p < 0,05). Al comparar el día L y el F no existieron diferencias significativas de PS entre las M (p = 0,998) y las T (p = 0,934) del día L y F, pero sí existieron diferencias entre PS de las N (p < 0,05). La PD no presentó diferencias significativas por las T (p = 0,268), pero sí entre las M y las N (p < 0,05). Conclusiones. 1) Se demuestra una gran variabilidad entre las diferentes tomas de PA y se mantiene el ritmo circadiano, y 2) se recomienda realizar tres determinaciones por la M, tres por la T y tres por la N durante tres días, debiendo eliminar sólo la primera determinación del primer día

Objectives. This study was conducted given the great use of the diagnostic method that is the self-measurements of blood pressure (SMBP) and there being scarce clarification on the daytime variability and the number of BP determinations to be conducted by SMBP. Method. A sample of 1,136 persons (total population, 2,084) was chosen. It was randomized and stratified by age and gender, from 25 to 64 years. Those diagnosed of HBP were excluded. PB was determined three times in the consultation (C) data collection. This was done by mercury sphygmomanometer (Hg) in the first two and by automatic Omron 705 CP apparatus (ap autom) in the third. Heart rate (HR), height and weight were recorded. For home (H) data collection, they were instructed in the management of the ap autom and were asked to obtain 9 BP measurements, three in the morning (M), three in the afternoon (A) and three at night (NO) for three work (W) days and one holiday (H). The Student's "t" test of paired means and monofactorial ANOVA were administered. Results. The blood pressure measurements (mmHg) in C and H were obtained in 734 participants. Of them, 185 had a BP C >= 140/90. SP/DP means in the C with the Hg were 123.5 ± 15.1/76.4 ± 10.3 and 122.4 ± 14.4/75.5 ± 10 and with the ap autom, 123 ± 16.1/73.7 ± 10.3. The mean SP /DP at H of all the sample was 115 ± 14.3/69.2 ± 9 and in the group with BP at C < 140/90, the mean SP was 111 ± 12.2 and DP, 66.8 ± 7.6. Mean HR in the C was 70.3 ± 10.4 (beats/minute). Mean HR at H of all the sample was 67.9 ± 9.7 and in the group with BP < 140/90 in C it was 67 ± 9.6. When the BP of the C was compared with that of the H, there were significant differences between the measurements in C in relationship with those in H (M, A or N) on the days of W and H (p < 0.05); the BP being greater in C. The HR was also different in the C and H, it being greater in the C than in the H. When the three measurements of the M of each day were analyzed, it was observed that there was a significant different of BP both in the first done in the M, the A and N of the first day in relationship with the 2nd and 3rd measurements of the same day (p < 0.05). Regarding the HR, significant differences were observed between the 1st measurement of the M in comparison with the 2nd and 3rd measurements of the M of the first day (p < 0.05). When the BP of the M, A and N of the W days were compared, it was observed that there were significant differences between the measurements of the M and N (p < 0.05). When the W and H day were compared, there were no significant differences of SP between M (p = 0.998) and A (p = 0.934) of the W and H day. However, there were differences between SP of the N (p < 0.05). The DP did not have significant differences in the A (p = 0.268), but did between the M and N (p < 0.05). Conclusions. 1) A large variability is shown between the different BP measurements and the circadian rhythm is maintained, and 2) it is recommended to make three measurements in the M, three in the A and three at N for three days, and only the 1st measurement of the first day should be eliminated

[Use of cryotherapy in the Rochapea Health Centre]. / Utilización de crioterapia en el Centro de Salud de Rochapea.

An analysis is made of the results obtained with the application of cryotherapy to 128 lesions: 86 common warts and 42 flat papillomas, of the 203 diagnosed in the Rochapea Health Centre in the period between October 1996 and June 30th 1997. 55.28% corresponded to warts located on the upper extremities, 34.78% were located on the head and neck, 8.07% on the lower extremities and 1.24% on the thorax. The percentage of flat papillomas was 20.68%. 2.96 sessions were needed to cure each lesion, with an average length of treatment of 42 days. No cases of postcryotherapy infection were registered and there was only one retarded complication, which was the appearance of a keloid scar. We conclude from the present study that cryotherapy is a good treatment for common warts and flat papillomas.