NICER and Fermi GBM Observations of the First Galactic Ultraluminous X-Ray Pulsar Swift J0243.6+6124

Swift J0243.6+6124 is a newly discovered Galactic Be/X-ray binary, revealed in late 2017 September in a giant outburst with a peak luminosity of 2 × 10[superscript 39](d/7 kpc)[superscript 2] erg s[superscript -1] (0.1-10 keV), with no formerly reported activity. At this luminosity, Swift J0243.6+6124 is the first known galactic ultraluminous X-ray pulsar. We describe Neutron star Interior Composition Explorer (NICER) and Fermi Gamma-ray Burst Monitor (GBM) timing and spectral analyses for this source. A new orbital ephemeris is obtained for the binary system using spin frequencies measured with GBM and 15-50 keV fluxes measured with the Neil Gehrels Swift Observatory Burst Alert Telescope to model the system's intrinsic spin-up. Power spectra measured with NICER show considerable evolution with luminosity, including a quasi-periodic oscillation near 50 mHz that is omnipresent at low luminosity and has an evolving central frequency. Pulse profiles measured over the combined 0.2-100 keV range show complex evolution that is both luminosity and energy dependent. Near the critical luminosity of L ∼ 10[superscript 38] erg s[superscript -1], the pulse profiles transition from single peaked to double peaked, the pulsed fraction reaches a minimum in all energy bands, and the hardness ratios in both NICER and GBM show a turnover to softening as the intensity increases. This behavior repeats as the outburst rises and fades, indicating two distinct accretion regimes. These two regimes are suggestive of the accretion structure on the neutron star surface transitioning from a Coulomb collisional stopping mechanism at lower luminosities to a radiation-dominated stopping mechanism at higher luminosities. This is the highest observed (to date) value of the critical luminosity, suggesting a magnetic field of B ∼ 10[superscript 13] G.United States. National Aeronautics and Space Administratio

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

An ethnographic investigation of maternity healthcare experience of immigrants in rural and urban Alberta, Canada

Background: Canada is among the top immigrant-receiving nations in the world. Immigrant populations may face structural and individual barriers in the access to and navigation of healthcare services in a new country. The aims of the study were to (1) generate new understanding of the processes that perpetuate immigrant disadvantages in maternity healthcare, and (2) devise potential interventions that might improve maternity experiences and outcomes for immigrant women in Canada. Methods: The study utilized a qualitative research approach that focused on ethnographic research design and data analysis contextualized within theories of organizational behaviour and critical realism. Data were collected over 2.5 years using focus groups and in-depth semistructured interviews with immigrant women (n = 34), healthcare providers (n = 29), and social service providers (n = 23) in a Canadian province. Purposive samples of each subgroup were generated, and recruitment and data collection – including interpretation and verification of translations – were facilitated through the hiring of community researchers and collaborations with key informants. Results: The findings indicate that (a) communication difficulties, (b) lack of information, (c) lack of social support (isolation), (d) cultural beliefs, e) inadequate healthcare services, and (f) cost of medicine/services represent potential barriers to the access to and navigation of maternity services by immigrant women in Canada. Having successfully accessed and navigated services, immigrant women often face additional challenges that influence their level of satisfaction and quality of care, such as lack of understanding of the informed consent process, lack of regard by professionals for confidential patient information, short consultation times, short hospital stays, perceived discrimination/stereotyping, and culture shock. Conclusions: Although health service organizations and policies strive for universality and equality in service provision, personal and organizational barriers can limit care access, adequacy, and acceptability for immigrant women. A holistic healthcare approach must include health informational packages available in different languages/media. Health care professionals who care for diverse populations must be provided with training in cultural competence, and monitoring and evaluation programs to ameliorate personal and systemic discrimination

Radiological case of the month : battered child syndrome

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