Bilateral Pneumothoraces Following Central Venous Cannulation

We report the occurrence of a bilateral pneumothoraces after unilateral central venous catheterization of the right subclavian vein in a 70-year-old patient. The patient had no history of pulmonary or pleural disease and no history of cardiothoracic surgery. Two days earlier, she had a median laparotomy under general and epidural anaesthesia. Prior to the procedure, the patient was hemodynamically stable and her transcutaneous oxygen saturation was 97% in room air. We punctured the right pleural space before cannulation of the right subclavian vein. After the procedure, the patient slowly became hemodynamically instable with respiratory distress. A chest radiograph revealed a complete left-side pneumothorax and a mild right-side pneumothorax. The right-side pneumothorax became under tension after left chest tube insertion. The symptoms finally resolved after insertion of a right chest tube. After a diagnostic work-up, we suspect a congenital “Buffalo chests” explaining bilateral pneumothoraces and a secondary tension pneumothorax

Case Report Bilateral Pneumothoraces Following Central Venous Cannulation

We report the occurrence of a bilateral pneumothoraces after unilateral central venous catheterization of the right subclavian vein in a 70-year-old patient. The patient had no history of pulmonary or pleural disease and no history of cardiothoracic surgery. Two days earlier, she had a median laparotomy under general and epidural anaesthesia. Prior to the procedure, the patient was hemodynamically stable and her transcutaneous oxygen saturation was 97% in room air. We punctured the right pleural space before cannulation of the right subclavian vein. After the procedure, the patient slowly became hemodynamically instable with respiratory distress. A chest radiograph revealed a complete left-side pneumothorax and a mild right-side pneumothorax. The right-side pneumothorax became under tension after left chest tube insertion. The symptoms finally resolved after insertion of a right chest tube. After a diagnostic work-up, we suspect a congenital "Buffalo chests" explaining bilateral pneumothoraces and a secondary tension pneumothorax

Limits to Quantum Gravity Effects from Observations of TeV Flares in Active Galaxies

We have used data from the TeV gamma-ray flare associated with the active galaxy Markarian 421 observed on 15 May 1996 to place bounds on the possible energy-dependence of the speed of light in the context of an effective quantum gravitational energy scale. The possibility of an observable time dispersion in high energy radiation has recently received attention in the literature, with some suggestions that the relevant energy scale could be less than the Planck mass and perhaps as low as 10^16 GeV. The limits derived here indicate this energy scale to be in excess of 4x10^16 GeV at the 95% confidence level. To the best of our knowledge, this constitutes the first convincing limit on such phenomena in this energy regime.Comment: 6 pages, including 2 figure

An occupational therapy intervention for residents with stroke related disabilities in UK care homes (OTCH): cluster randomised controlled trial

Objective To evaluate the clinical efficacy of an established programme of occupational therapy in maintaining functional activity and reducing further health risks from inactivity in care home residents living with stroke sequelae. Design Pragmatic, parallel group, cluster randomised controlled trial. Setting 228 care homes (>10 beds each), both with and without the provision of nursing care, local to 11 trial administrative centres across the United Kingdom. Participants 1042 care home residents with a history of stroke or transient ischaemic attack, including those with language and cognitive impairments, not receiving end of life care. 114 homes (n=568 residents, 64% from homes providing nursing care) were allocated to the intervention arm and 114 homes (n=474 residents, 65% from homes providing nursing care) to standard care (control arm). Participating care homes were randomised between May 2010 and March 2012. Intervention Targeted three month programme of occupational therapy, delivered by qualified occupational therapists and assistants, involving patient centred goal setting, education of care home staff, and adaptations to the environment. Main outcome measures Primary outcome at the participant level: scores on the Barthel index of activities of daily living at three months post-randomisation. Secondary outcome measures at the participant level: Barthel index scores at six and 12 months post-randomisation, and scores on the Rivermead mobility index, geriatric depression scale-15, and EuroQol EQ-5D-3L questionnaire, at all time points. Results 64% of the participants were women and 93% were white, with a mean age of 82.9 years. Baseline characteristics were similar between groups for all measures, personal characteristics, and diagnostic tests. Overall, 2538 occupational therapy visits were made to 498 participants in the intervention arm (mean 5.1 visits per participant). No adverse events attributable to the intervention were recorded. 162 (11%) died before the primary outcome time point, and 313 (30%) died over the 12 months of the trial. The primary outcome measure did not differ significantly between the treatment arms. The adjusted mean difference in Barthel index score at three months was 0.19 points higher in the intervention arm (95% confidence interval −0.33 to 0.70, P=0.48). Secondary outcome measures also showed no significant differences at all time points. Conclusions This large phase III study provided no evidence of benefit for the provision of a routine occupational therapy service, including staff training, for care home residents living with stroke related disabilities. The established three month individualised course of occupational therapy targeting stroke related disabilities did not have an impact on measures of functional activity, mobility, mood, or health related quality of life, at all observational time points. Providing and targeting ameliorative care in this clinically complex population requires alternative strategies

Achieving EU Standards in Recreational Waters

Please note that Dr Raymond Chawla's name was mistakenly omitted from the front cover. Dr Chawla's name appears on the title page and should be included in all citations.In the interest of public health and amenity, the quality of bathing waters is controlled by the European Union Bathing Water Directive (1976); the well-known Blue Flag scheme is associated with this. The Directive regulates — among other parameters — the numbers of “indicator bacteria” permitted in the water; these microorganisms themselves are not an apparently significant risk to health, but they act as indicators that sewage-derived pathogenic organisms that cause illness may be present. Coastal and freshwater bathing areas are monitored regularly during the bathing season for compliance with the Directive, and the published annual reports attract much public and news-media attention. Substantial high-cost improvements to sewerage management infrastructure have been made by Local Authorities both in Ireland and Wales aimed at achieving better compliance with bathing water standards. Nevertheless, there have been continuing episodic failures to meet the indicator-bacteria standards. Recent research in the United Kingdom has indicated that substantial quantities of the offending indicator bacteria may be conveyed in surface water runoff from the catchments of rivers and small streams in response to rainfall events. There have been indications too that the use to which land in a catchment is put (pasture, forestry, urban, and so on) is reflected in the levels of indicator bacteria contributed by the land to water. Two principal questions arise: 1. Are failures to meet microbial water-quality standards for bathing areas due to rainfall-related runoff from adjacent catchments? 2. If so, is this effect related to land uses in the catchments? This report gives an account of work addressing these issues conducted in the Afon Rheidol and Afon Ystwyth catchments in north Ceredigion, Wales and in the Dargle catchment in north Co. Wicklow, Ireland. The catchments in both areas drain to the sea through harbour outlets close to bathing beaches, and the beaches have had imperfect compliance with the Bathing Water Directive in the past.Funder: European Unio

Charge-Symmetry Violation in Pion Scattering from Three-Body Nuclei

We discuss the experimental and theoretical status of charge-symmetry violation (CSV) in the elastic scattering of pi+ and pi- on 3H and 3He. Analysis of the experimental data for the ratios r1, r2, and R at Tpi = 142, 180, 220, and 256 MeV provides evidence for the presence of CSV. We describe pion scattering from the three-nucleon system in terms of single- and double-scattering amplitudes. External and internal Coulomb interactions as well as the Delta-mass splitting are taken into account as sources of CSV. Reasonable agreement between our theoretical calculations and the experimental data is obtained for Tpi = 180, 220, and 256 MeV. For these energies, it is found that the Delta-mass splitting and the internal Coulomb interaction are the most important contributions for CSV in the three-nucleon system. The CSV effects are rather sensitive to the choice of pion-nuclear scattering mechanisms, but at the same time, our theoretical predictions are much less sensitive to the choice of the nuclear wave function. It is found, however, that data for r2 and R at Tpi = 142 MeV do not agree with the predictions of our model, which may indicate that there are additional mechanisms for CSV which are important only at lower energies.Comment: 26 pages of RevTeX, 16 postscript figure

First detection of a VHE gamma-ray spectral maximum from a Cosmic source: H.E.S.S. discovery of the Vela X nebula

The Vela supernova remnant (SNR) is a complex region containing a number of sources of non-thermal radiation. The inner section of this SNR, within 2 degrees of the pulsar PSR B0833-45, has been observed by the H.E.S.S. gamma-ray atmospheric Cherenkov detector in 2004 and 2005. A strong signal is seen from an extended region to the south of the pulsar, within an integration region of radius 0.8 deg. around the position (RA = 08h 35m 00s, dec = -45 deg. 36' J2000.0). The excess coincides with a region of hard X-ray emission seen by the ROSAT and ASCA satellites. The observed energy spectrum of the source between 550 GeV and 65 TeV is well fit by a power law function with photon index = 1.45 +/- 0.09(stat) +/- 0.2(sys) and an exponential cutoff at an energy of 13.8 +/- 2.3(stat) +/- 4.1(sys) TeV. The integral flux above 1 TeV is (1.28 +/- 0.17 (stat) +/- 0.38(sys)) x 10^{-11} cm^{-2} s^{-1}. This result is the first clear measurement of a peak in the spectral energy distribution from a VHE gamma-ray source, likely related to inverse Compton emission. A fit of an Inverse Compton model to the H.E.S.S. spectral energy distribution gives a total energy in non-thermal electrons of ~2 x 10^{45} erg between 5 TeV and 100 TeV, assuming a distance of 290 parsec to the pulsar. The best fit electron power law index is 2.0, with a spectral break at 67 TeV.Comment: 5 pages, 4 figures, accepted for publication in Astronomy and Astrophysics letter

Detection of the BL Lac object 1ES1426+428 in the Very High Energy gamma-ray band by the CAT Telescope from 1998-2000

The BL Lac Object 1ES 1426+428, at a red-shift of z=0.129, has been monitored by the CAT telescope from February 1998 to June 2000. The accumulation of 26 hours of observations shows a gamma-ray signal of 321 events above 250 GeV at 5.2 standard deviations, determined using data analysis cuts adapted to a weak, steep-spectrum source. The source emission has an average flux of Phi_diff(400 GeV) = 6.73 +/- 1.27stat +/- 1.45syst x 10^-11 /cm^-2/s/TeV, and a very steep spectrum, with a differential spectral index of gamma = -3.60 +/- 0.57 which can be refined to gamma = -3.66 +/- 0.41 using a higher flux data subset. If, as expected from its broad-band properties, the Very High Energy emission is hard at the source, these observations support a strong absorption effect of gamma-rays by the Intergalactic Infrared field.Comment: 4 pages, 3 figures, accepted for publication in A&A Letter

Nonextensive thermal sources of cosmic rays?

The energy spectrum of cosmic rays (CR) exhibits power-like behavior with a very characteristic "knee" structure. We consider a possibility that such a spectrum could be generated by some specific nonstatistical temperature fluctuations in the source of CR with the "knee" structure reflecting an abrupt change of the pattern of such fluctuations. This would result in a generalized nonextensive statistical model for the production of CR. The possible physical mechanisms leading to these effects are discussed together with the resulting chemical composition of the CR, which follows the experimentally observed abundance of nuclei.Comment: 16 pages, 3 figures, rewritten and updated version, to be published in Centr. Eur. J. Phy

Discovery of VHE gamma-rays from the high-frequency-peaked BL Lac object RGB J0152+017

Aims: The BL Lac object RGB J0152+017 (z=0.080) was predicted to be a very high-energy (VHE; > 100 GeV) gamma-ray source, due to its high X-ray and radio fluxes. Our aim is to understand the radiative processes by investigating the observed emission and its production mechanism using the High Energy Stereoscopic System (H.E.S.S.) experiment. Methods: We report recent observations of the BL Lac source RGB J0152+017 made in late October and November 2007 with the H.E.S.S. array consisting of four imaging atmospheric Cherenkov telescopes. Contemporaneous observations were made in X-rays by the Swift and RXTE satellites, in the optical band with the ATOM telescope, and in the radio band with the Nancay Radio Telescope. Results: A signal of 173 gamma-ray photons corresponding to a statistical significance of 6.6 sigma was found in the data. The energy spectrum of the source can be described by a powerlaw with a spectral index of 2.95+/-0.36stat+/-0.20syst. The integral flux above 300 GeV corresponds to ~2% of the flux of the Crab nebula. The source spectral energy distribution (SED) can be described using a two-component non-thermal synchrotron self-Compton (SSC) leptonic model, except in the optical band, which is dominated by a thermal host galaxy component. The parameters that are found are very close to those found in similar SSC studies in TeV blazars. Conclusions: RGB J0152+017 is discovered as a source of VHE gamma-rays by H.E.S.S. The location of its synchrotron peak, as derived from the SED in Swift data, allows clearly classification it as a high-frequency-peaked BL Lac (HBL).Comment: Accepted for publication in A&A Letters (5 pages, 4 figures