42 research outputs found
WASOG statement on the diagnosis and management of sarcoidosis-associated pulmonary hypertension
Sarcoidosis-associated pulmonary hypertension (SAPH) is an important complication of advanced sarcoidosis. Over the past few years, there have been several studies dealing with screening, diagnosis and treatment of SAPH. This includes the results of two large SAPH-specific registries. A task force was established by the World Association of Sarcoidosis and Other Granulomatous disease (WASOG) to summarise the current level of knowledge in the area and provide guidance for the management of patients. A group of sarcoidosis and pulmonary hypertension experts participated in this task force. The committee developed a consensus regarding initial screening including who should undergo more specific testing with echocardiogram. Based on the results, the committee agreed upon who should undergo right-heart catheterisation and how to interpret the results. The committee felt there was no specific phenotype of a SAPH patient in whom pulmonary hypertension-specific therapy could be definitively recommended. They recommended that treatment decisions be made jointly with a sarcoidosis and pulmonary hypertension expert. The committee recognised that there were significant defects in the current knowledge regarding SAPH, but felt the statement would be useful in directing future studies
First patient-centred set of outcomes for pulmonary sarcoidosis: a multicentre initiative
Introduction Routine and international comparison of
clinical outcomes enabling identification of best practices
for patients with pulmonary sarcoidosis is lacking. The aim
of this study was to develop a standard set of outcome
measures for pulmonary sarcoidosis, using the valuebased healthcare principles.
Methods Six expert clinics for interstitial lung diseases in
four countries participated in a consensus-driven RANDmodified Delphi study. A mixed-method approach was
applied for the identification of an outcome measures
set and initial conditions for patients with pulmonary
sarcoidosis. The expert team consisted of multidisciplinary
professionals (n=14) from Cleveland Clinic, Cincinnati MC,
Erasmus MC, Leuven UZ, Royal Brompton and St. Antonius
Hospital. During a ranking process, participants were
instructed to rank variables on a scale from 1 to 10 based
on whether it has (1) impact of the outcome on quality of
life, (2) impact of quality of care on the outcome and (3) the
number of patients negatively affected by the outcome.
Results An outcome measures set was defined consisting
of seven outcome measures: mortality, pulmonary function,
soluble interleukin-2 receptor change as an activity
biomarker, weight gain, quality of life, osteoporosis and
clinical outcome status.
Discussion Collecting outcomes in pulmonary sarcoidosis
internationally and the use of a broadly accepted set can
enable international comparison. Differences in outcomes
can potentially be used as a starting point for quality
improvement initiatives
Fermi Large Area Telescope Constraints on the Gamma-ray Opacity of the Universe
The Extragalactic Background Light (EBL) includes photons with wavelengths
from ultraviolet to infrared, which are effective at attenuating gamma rays
with energy above ~10 GeV during propagation from sources at cosmological
distances. This results in a redshift- and energy-dependent attenuation of the
gamma-ray flux of extragalactic sources such as blazars and Gamma-Ray Bursts
(GRBs). The Large Area Telescope onboard Fermi detects a sample of gamma-ray
blazars with redshift up to z~3, and GRBs with redshift up to z~4.3. Using
photons above 10 GeV collected by Fermi over more than one year of observations
for these sources, we investigate the effect of gamma-ray flux attenuation by
the EBL. We place upper limits on the gamma-ray opacity of the Universe at
various energies and redshifts, and compare this with predictions from
well-known EBL models. We find that an EBL intensity in the optical-ultraviolet
wavelengths as great as predicted by the "baseline" model of Stecker et al.
(2006) can be ruled out with high confidence.Comment: 42 pages, 12 figures, accepted version (24 Aug.2010) for publication
in ApJ; Contact authors: A. Bouvier, A. Chen, S. Raino, S. Razzaque, A.
Reimer, L.C. Reye
Detection of High-Energy Gamma-Ray Emission from the Globular Cluster 47 Tucanae with Fermi
Gamma-Ray Pulsar Bonanza
Most of the pulsars we know about were detected through their radio emission; a few are known to pulse gamma rays but were first detected at other wavelengths (see the Perspective by
Halpern
). Using the Fermi Gamma-Ray Space Telescope,
Abdo
et al.
(p.
840
, published online 2 July; see the cover) report the detection of 16 previously unknown pulsars based on their gamma-ray emission alone. Thirteen of these coincide with previously unidentified gamma-ray sources, solving the 30-year-old mystery of their identities. Pulsars are fast-rotating neutron stars. With time they slow down and cease to radiate; however, if they are in a binary system, they can have their spin rates increased by mass transfer from their companion stars, starting a new life as millisecond pulsars. In another study,
Abdo
et al.
(p.
845
) report the detection of gamma-ray emission from the globular cluster 47 Tucanae, which is coming from an ensemble of millisecond pulsars in the cluster's core. The data imply that there are up to 60 millisecond pulsars in 47 Tucanae, twice as many as predicted by radio observations. In a further companion study,
Abdo
et al.
(p.
848
, published online 2 July) searched Fermi Large Area Telescope data for pulsations from all known millisecond pulsars outside of stellar clusters, finding gamma-ray pulsations for eight of them. Their properties resemble those of other gamma-ray pulsars, suggesting that they share the same basic emission mechanism. Indeed, both sets of pulsars favor emission models in which the gamma rays are produced in the outer magnetosphere of the neutron star
Gamma-ray and radio properties of six pulsars detected by the fermi large area telescope
We report the detection of pulsed Îł-rays for PSRs J0631+1036, J0659+1414, J0742-2822, J1420-6048, J1509-5850, and J1718-3825 using the Large Area Telescope on board the Fermi Gamma-ray Space Telescope (formerly known as GLAST). Although these six pulsars are diverse in terms of their spin parameters, they share an important feature: their Îł-ray light curves are (at least given the current count statistics) single peaked. For two pulsars, there are hints for a double-peaked structure in the light curves. The shapes of the observed light curves of this group of pulsars are discussed in the light of models for which the emission originates from high up in the magnetosphere. The observed phases of the Îł-ray light curves are, in general, consistent with those predicted by high-altitude models, although we speculate that the Îł-ray emission of PSR J0659+1414, possibly featuring the softest spectrum of all Fermi pulsars coupled with a very low efficiency, arises from relatively low down in the magnetosphere. High-quality radio polarization data are available showing that all but one have a high degree of linear polarization. This allows us to place some constraints on the viewing geometry and aids the comparison of the Îł-ray light curves with high-energy beam models