Exertional sickling: Questions and controversy

Sickle cell trait (SCT) occurs in about 8% of African-Americans and is often described to be of little clinical consequence. Over time, a number of risks have emerged, and among these are rare but catastrophic episodes of sudden death in athletes and other individuals associated with physical activities which is often described as exercise collapse associated with sickle trait (ECAST). Despite an epidemiologic link between SCT and sudden death as well as numerous case reports in both medical literature and lay press, no clear understanding of the key pathophysiologic events has been identified. Strategies for identification of individuals at risk and prevention of ECAST have been both elusive and controversial. Stakeholders have advocated for different approaches to this issue particularly with regard to screening for hemoglobin S. Furthermore, the recommendations and guidelines that are in place for the early recognition of ECAST and the prevention and treatment of the illness are not well defined and remain fragmented. Among the cases identified, those in collegiate football players in the United States are often highlighted. This manuscript examines these case studies and the current recommendations to identify areas of consensus and controversy regarding recommendations for prevention, recognition and treatment of ECAST

Molecular line study of the very young protostar IRAM 04191 in Taurus: Infall, rotation, and outflow

We present a detailed millimeter line study of the circumstellar environment of the low-luminosity Class 0 protostar IRAM 04191+1522 in the Taurus molecular cloud. New line observations demonstrate that the ~14000 AU radius protostellar envelope is undergoing both extended infall and fast, differential rotation. Radiative transfer modeling of multitransition CS and C34S maps indicate an infall velocity v_inf ~ 0.15 km/s at r ~ 1500 AU and v_inf ~ 0.1 km/s up to r ~ 11000 AU, as well as a rotational angular velocity Omega ~ 3.9 x 10^{-13} rad/s, strongly decreasing with radius beyond 3500 AU down to a value Omega ~ 1.5-3 x 10^{-14} rad/s at ~ 11000 AU. Two distinct regions, which differ in both their infall and their rotation properties, therefore seem to stand out: the inner part of the envelope (r ~< 2000-4000 AU) is rapidly collapsing and rotating, while the outer part undergoes only moderate infall/contraction and slower rotation. These contrasted features suggest that angular momentum is conserved in the collapsing inner region but efficiently dissipated due to magnetic braking in the slowly contracting outer region. We propose that the inner envelope is in the process of decoupling from the ambient cloud and corresponds to the effective mass reservoir (~0.5 M_sun) from which the central star is being built. Comparison with the rotational properties of other objects in Taurus suggests that IRAM 04191 is at a pivotal stage between a prestellar regime of constant angular velocity enforced by magnetic braking and a dynamical, protostellar regime of nearly conserved angular momentum. The rotation velocity profile we derive for the inner IRAM 04191 envelope should thus set some constraints on the distribution of angular momentum on the scale of the outer Solar system at the onset of protostar/disk formation.Comment: 23 pages, 16 figures, 1 table, Accepted by Astronomy & Astrophysic

Existence of a Semiclassical Approximation in Loop Quantum Gravity

We consider a spherical symmetric black hole in the Schwarzschild metric and apply Bohr-Sommerfeld quantization to determine the energy levels. The canonical partition function is then computed and we show that the entropy coincides with the Bekenstein-Hawking formula when the maximal number of states for the black hole is the same as computed in loop quantum gravity, proving in this case the existence of a semiclassical limit and obtaining an independent derivation of the Barbero-Immirzi parameter.Comment: 6 pages, no figures. Final version accepted for publication in General Relativity and Gravitatio

Inconsistency in Fermi's probability of the quantum states

We point out an important hidden inconsistency in Fermi's probability of the quantum states that engendered inconsistent/inaccurate equations-of-state extensively used in the literature to model nonideal plasma systems. The importance of this amendment goes beyond rectifying our comprehension and foundation of an important physical problem to influencing contemporary research results.Comment: Accepted for Publicatio

Successful orthotopic liver transplantation in an adult patient with sickle cell disease and review of the literature

Sickle cell disease can lead to hepatic complications ranging from acute hepatic crises to chronic liver disease including intrahepatic cholestasis, and iron overload. Although uncommon, intrahepatic cholestasis may be severe and medical treatment of this complication is often ineffective. We report a case of a 37 year-old male patient with sickle cell anemia, who developed liver failure and underwent successful orthotopic liver transplantation. Both pre and post-operatively, he was maintained on red cell transfusions. He remains stable with improved liver function 42 months post transplant. The role for orthotopic liver transplantation is not well defined in patients with sickle cell disease, and the experience remains limited. Although considerable challenges of post-transplant graft complications remain, orthotopic liver transplantation should be considered as a treatment option for sickle cell disease patients with end-stage liver disease who have progressed despite conventional medical therapy. An extended period of red cell transfusion support may lessen the post-operative complications

Quantum-critical spin dynamics in quasi-one-dimensional antiferromagnets

By means of nuclear spin-lattice relaxation rate 1/T1, we follow the spin dynamics as a function of the applied magnetic field in two gapped one-dimensional quantum antiferromagnets: the anisotropic spin-chain system NiCl2-4SC(NH2)2 and the spin-ladder system (C5H12N)2CuBr4. In both systems, spin excitations are confirmed to evolve from magnons in the gapped state to spinons in the gapples Tomonaga-Luttinger-liquid state. In between, 1/T1 exhibits a pronounced, continuous variation, which is shown to scale in accordance with quantum criticality. We extract the critical exponent for 1/T1, compare it to the theory, and show that this behavior is identical in both studied systems, thus demonstrating the universality of quantum critical behavior

Antibiotic resistance peculiarities of S. aureus isolates, obtained from nasal and throat mucosa of outpatients, Chernivtsi city

The purpose of this study was to determine the specificity of sensitivity to antibiotics of S. aureus strains isolated from nasal mucous membranes and tonsils, as well as to identify the factors of antibiotic resistance. Materials and methods. The pure culture method was used to study smears of the palatine tonsils, the nose and the secret of the external auditory canal of 561, 56 and 15 cultures, respectively. Identification of isolated cultures was carried out according to morphological, tinctorial, physiological and biochemical characteristics. The sensitivity of S. aureus strains to antibiotics was studied and analyzed, 211 of which were isolated from the mucous of the palatine tonsils and 18 - from the nasal mucous. All the isolated strains of S. aureus were determined for the presence of antibiotic resistance factors (FA) -ß-lactamases (BL) and penicillin-binding protein (PВPs). Results. High percentage of strains resistant to ß-lactam antibiotics and macrolides was found in both groups of studied cultures. However, the number of resistant forms to these antibiotics was higher among nasal strains. At the same time, none of the resistant strain to aminoglycosides, fluoroquinolones, lincosamides, tetracyclines, and vancomycin was detected among them. 9.57 % of the strains isolated from the tonsillar mucosa were resistant to the last one. BL and PВPs antibiotic resistance factors of isolated S. aureus strains were more frequent among nasal isolates (BL – 83.3 %, PВPs – 66.7 %) than in strains isolated from the palatine tonsils (BL – 66.3 %, PВPs – 38.6 %), P < 0.05. Sensitivity to antibiotics of S. aureus strains having both FA simultaneously (30 strains) and strains having none of them (26 strains) turned out to be different. Among the strains having both FA, 100 % were resistant to penicillin, 93.3 % to oxacillin, and 36.7 % to vancomycin. Whereas there were 3.9 %, 0.0 %, and 7.7 % strains without FA resistant to these antibiotics, respectively. Resistance to azithromycin was greater in the group of strains with FA: 26.7 % versus 7.7 % in the group without FA. The strains of both groups were highly sensitive with an insignificant difference to other studied antibiotics (aminoglycosides, fluoroquinolones, macrolides, lincosamides and tetracyclines). Conclusions. S. aureus strains isolated from the mucous membranes of the nose and tonsils differ in sensitivity to antibiotics and the presence of FA. The nasal strains of S. aureus are more likely to be resistant to ß-lactam antibiotics and macrolides. Vancomycin resistant strains of S. aureus are significantly more common among strains with FA

Services, Offshoring and Wages: Evidence from Micro Data

This paper investigates the effects of services offshoring on wages using individual level data combined with industry information on offshoring. Our results show that services ofsshoring affects the real wage of low and medium skilled individuals negatively. By contrast, skilled workers benefit from services offshoring in terms of higher real wages. Hence, offshoring has contributed to a widening of the wage gap between skilled and less skilled workers. This result is obtained while controlling for individual and sectoral observed and unobserved heterogeneity. In particular, our empirical model also controls for the impact of technological change and offshoring materials