Antibiotic prophylaxis of infective endocarditis

Links between infective endocarditis (IE) and den-tal and other invasive procedures were first identified in the1920s, and the use of antibiotic prophylaxis (AP) to prevent IEwas first recommended by the American Heart Association in1955. Recognising the weak evidence to support this practiceand the wider risks of anaphylaxis and antibiotic resistance,guidelines in the USA and Europe have been rationalised inthe last decade with restriction of AP to those patients per-ceived to be at the highest risk. In the UK, the NationalInstitute for Health and Care Excellence controversially rec-ommended the complete cessation of AP for all invasive pro-cedures in 2008 and subsequent epidemiological studies havesuggested a significant increase in cases above the baselinetrend. AP appears to be safe and is likely to be cost-effective.Until further data are available, we recommend continued ad-herence to US and European guidelines

Cooperative gas adsorption without a phase transition in metal-organic frameworks

Cooperative adsorption of gases by porous frameworks permits more efficient uptake and removal than does the more usual non-cooperative (Langmuir-type) adsorption. Cooperativity, signaled by a step-like isotherm, is usually attributed to a phase transition of the framework. However, the class of metal-organic frameworks mmen-M$_2$(dobpdc) exhibit cooperative adsorption of CO2 but show no evidence of a phase transition. Here we show how cooperativity emerges in these frameworks in the absence of a phase transition. We use a combination of quantum and statistical mechanics to show that cooperativity results from a sharp but finite increase, with pressure, of the mean length of chains of CO2 molecules that polymerize within the framework. Our study provides microscopic understanding of the emergent features of cooperative binding, including the position, slope and height of the isotherm step, and indicates how to optimize gas storage and separation in these materials.Comment: 18 pages, 11 figure

Super-Eddington Atmospheres that Don't Blow Away

We show that magnetized, radiation dominated atmospheres can support steady state patterns of density inhomogeneity that enable them to radiate at far above the Eddington limit, without suffering mass loss. The inhomogeneities consist of periodic shock fronts bounding narrow, high-density regions, interspersed with much broader regions of low density. The radiation flux avoids the regions of high density, which are therefore weighed down by gravity, while gas in the low-density regions is slammed upward into the shock fronts by radiation force. As the wave pattern moves through the atmosphere, each parcel of matter alternately experiences upward and downward forces, which balance on average. Magnetic tension shares the competing forces between regions of different densities, preventing the atmosphere from blowing apart. We calculate the density structure and phase speed of the wave pattern, and relate these to the wavelength, the density contrast, and the factor by which the net radiation flux exceeds the Eddington limit. In principle, this factor can be as large as the ratio of magnetic pressure to mean gas pressure, or the ratio of radiation pressure to gas pressure, whichever is smaller. Although the magnetic pressure must be large compared to the mean gas pressure in order to support a large density contrast, it need not be large compared to the radiation pressure. These highly inhomogeneous flows could represent the nonlinear development of the "photon bubble" instability discovered by Gammie. We briefly discuss the applicability of these solutions to astrophysical systems.Comment: 11 pages, 1 figure, accepted for publication in The Astrophysical Journa

Do patients at risk of infective endocarditis need antibiotics before dental procedures?

What you need to know: - Patients with prosthetic heart valves, previous infective endocarditis, and some types of congenital heart disease are at highest risk of infective endocarditis - Invasive dental procedures cause bacteraemia, which can be complicated by infective endocarditis in those at increased risk of the disease - Antibiotic prophylaxis reduces the incidence of bacteraemia, but high level studies confirming that this reduces the incidence of infective endocarditis are lacking - Warn high risk patients undergoing high risk dental interventions of the risk of infective endocarditis. Offer these patients antibiotic prophylaxis, and discuss with them the risks and benefits of this option - Where patients are at moderate risk, encourage preventative measures, such as maintaining good oral hygiene and infection control, and discourage tattooing or piercin

Electronic structure of warm dense copper studied by ultrafast x-ray absorption spectroscopy

We use time-resolved x-ray absorption spectroscopy to investigate the unoccupied electronic density of states of warm dense copper that is produced isochorically through the absorption of an ultrafast optical pulse. The temperature of the superheated electron-hole plasma, which ranges from 4000 to 10 000 K, was determined by comparing the measured x-ray absorption spectrum with a simulation. The electronic structure of warm dense copper is adequately described with the high temperature electronic density of state calculated by the density functional theory. The dynamics of the electron temperature is consistent with a two-temperature model, while a temperature-dependent electron-phonon coupling parameter is necessary

An Euler Solver Based on Locally Adaptive Discrete Velocities

A new discrete-velocity model is presented to solve the three-dimensional Euler equations. The velocities in the model are of an adaptive nature---both the origin of the discrete-velocity space and the magnitudes of the discrete-velocities are dependent on the local flow--- and are used in a finite volume context. The numerical implementation of the model follows the near-equilibrium flow method of Nadiga and Pullin [1] and results in a scheme which is second order in space (in the smooth regions and between first and second order at discontinuities) and second order in time. (The three-dimensional code is included.) For one choice of the scaling between the magnitude of the discrete-velocities and the local internal energy of the flow, the method reduces to a flux-splitting scheme based on characteristics. As a preliminary exercise, the result of the Sod shock-tube simulation is compared to the exact solution.Comment: 17 pages including 2 figures and CMFortran code listing. All in one postscript file (adv.ps) compressed and uuencoded (adv.uu). Name mail file `adv.uu'. Edit so that `#!/bin/csh -f' is the first line of adv.uu On a unix machine say `csh adv.uu'. On a non-unix machine: uudecode adv.uu; uncompress adv.tar.Z; tar -xvf adv.ta

Synthesis of Polycyclic Aromatic Hydrocarbons by Phenyl Addition-Dehydrocyclization: The Third Way.

Polycyclic aromatic hydrocarbons (PAHs) represent the link between resonance-stabilized free radicals and carbonaceous nanoparticles generated in incomplete combustion processes and in circumstellar envelopes of carbon rich asymptotic giant branch (AGB) stars. Although these PAHs resemble building blocks of complex carbonaceous nanostructures, their fundamental formation mechanisms have remained elusive. By exploring these reaction mechanisms of the phenyl radical with biphenyl/naphthalene theoretically and experimentally, we provide compelling evidence on a novel phenyl-addition/dehydrocyclization (PAC) pathway leading to prototype PAHs: triphenylene and fluoranthene. PAC operates efficiently at high temperatures leading through rapid molecular mass growth processes to complex aromatic structures, which are difficult to synthesize by traditional pathways such as hydrogen-abstraction/acetylene-addition. The elucidation of the fundamental reactions leading to PAHs is necessary to facilitate an understanding of the origin and evolution of the molecular universe and of carbon in our galaxy