On the local birth place of Geminga

Using estimates of the distance and proper motion of Geminga and the constraints on its radial velocity posed by the shape of its bow shock, we investigate its birth place by tracing its space motion backwards in time. Our results exclude the lambda Ori association as the origin site because of the large distance between both objects at any time. Our simulations place the birth region at approximately 90-240 pc from the Sun, between 197 degrees and 199 degrees in Galactic longitude and -16 degrees and -8 degrees in latitude, most probably inside the Cas-Tau OB association or the Ori OB1a association. We discard the possibility of the progenitor being a massive field star. The association of Geminga with either stellar association implies an upper limit of M = 15 Msun for the mass of its progenitor. We also propose new members for the Cas-Tau and Ori OB1 associations.Comment: 6 pages, 5 figures. Accepted for publication in Astronomy & Astrophysic

Proposed New Test of Spin Effects in General Relativity

The recent discovery of a double-pulsar PSR J0737-3039A/B provides an opportunity of unequivocally observing, for the first time, spin effects in general relativity. Existing efforts involve detection of the precession of the spinning body itself. However, for a close binary system, spin effects on the orbit may also be discernable. Not only do they add to the advance of the periastron (by an amount which is small compared to the conventional contribution) but they also give rise to a precession of the orbit about the spin direction. The measurement of such an effect would also give information on the moment of inertia of pulsars

Long-term placement of continuous popliteal nerve block catheter for management of a wounded patient in a combat field environment: A case report

Continuous peripheral nerve block is a relevant part of multimodal treatment of postoperative pain. In this context the continuous popliteal nerve block is described as an option for postoperative pain management for surgical procedures on the leg, and particularly on the ankle and foot. We applied continuous popliteal nerve block for different types of anesthesia and postoperative pain management via the same catheter. No clear evidence of this specific use has been described in the literature. A 38 year-old patient wounded in combat with a displaced fracture of left tibia and extensive loss of substance needed orthopedic surgeries as well as several reconstructive procedures. A continuous popliteal nerve block was applied via ultrasound-guided catheter for anesthesia at different times, and postoperative pain control for all surgical procedures. The continuous popliteal nerve block and its long-term positioning, of non-common evidence in literature, was utilized to treat a poly-traumatized patient, thereby avoiding repeated general anesthesia and opioid use and their adverse effects. This technique, within a complicated combat field environment, was demonstrated to be clinically effective with high patient satisfaction

Thoracic ultrasound for pleural effusion in the intensive care unit: A narrative review from diagnosis to treatment

Pleural effusion (PLEFF), mostly caused by volume overload, congestive heart failure, and pleuropulmonary infection, is a common condition in critical care patients. Thoracic ultrasound (TUS) helps clinicians not only to visualize pleural effusion, but also to distinguish between the different types. Furthermore, TUS is essential during thoracentesis and chest tube drainage as it increases safety and decreases life-threatening complications. It is crucial not only during needle or tube drainage insertion, but also to monitor the volume of the drained PLEFF. Moreover, TUS can help diagnose co-existing lung diseases, often with a higher specificity and sensitivity than chest radiography and without the need for X-ray exposure. We review data regarding the diagnosis and management of pleural effusion, paying particular attention to the impact of ultrasound. Technical data concerning thoracentesis and chest tube drainage are also provided

Retrieval and analysis of land surface microwave emissivity from SSM/I data

The retrieval of land surface emissivity from microwave radiometric measurements is useful for monitoring the surface properties without being affected by the contribution of the atmosphere, which can be significant at higher frequencies. It is based on the inversion of the radiative transfer equation, assuming the absence of scattering phenomena. In this work, a method to improve the accuracy of the emissivity estimates through the removal of the effects of the atmosphere from the radiometric data and through the consideration of the surface elevation information is proposed. We have used the Special Sensor Microwave/Imager (SSM/I) observations over Italy throughout 1995. The atmospheric parameters have been derived from the NCEP vertical profiles, whilst the presence of clouds has been detected through METEOSAT images co-located with the SSM/I ones. The data provided by a digital elevation model (DEM) have been also exploited. Monthly average maps of microwave emissivity relative to a geographical area including Italy have been produced to assess the whole estimation procedure, as well as to give examples of monitoring the seasonal trend of this parameter in a mountainous zone (Alps) and in a flat area (Po Plain)

Discovery of a Hard X-Ray Source, SAX J0635+0533, in the Error Box of the Gamma-Ray Source 2EG 0635+0521

We have discovered an x-ray source, SAX J0635+0533, with a hard spectrum within the error box of the GeV gamma-ray source in Monoceros, 2EG J0635+0521. The unabsorbed x-ray flux is 1.2*10^-11 erg cm^-2 s^-1 in the 2-10 keV band. The x-ray spectrum is consistent with a simple powerlaw model with absorption. The photon index is 1.50 +/- 0.08 and we detect emission out to 40 keV. Optical observations identify a counterpart with a V-magnitude of 12.8. The counterpart has broad emission lines and the colors of an early B type star. If the identification of the x-ray/optical source with the gamma-ray source is correct, then the source would be a gamma-ray emitting x-ray binary.Comment: Accepted to the Astrophysical Journal, 8 page

Multiparametric Analysis of Factors Associated With Eosinophilic Chronic Rhinosinusitis With Nasal Polyps

Introduction: Previous studies have reported a diverse range of threshold values for blood eosinophilia. In addition, a single predictive biomarker for eosinophilic chronic rhinosinusitis (CRS) with nasal polyps (ECRSwNP) has not yet been identified. Objectives: The aim of this study is to compare the clinical characteristics of ECRSwNP and non-ECRSwNP to evaluate the preoperative risk of tissue eosinophilia of chronic rhinosinusitis with nasal polyps (CRSwNP) through a multiparametric statistical analysis. Methods: One hundred ten patients with evidence of chronic polypoid rhinosinusitis were included in this study and clinical records were retrospectively reviewed. Eosinophilic CRSwNP was diagnosed based on the presence of at least 10 eosinophils per high-power field. The demographic and clinical features of ECRSwNP and non-ECRSwNP are described. The values of blood eosinophilia as predictors of tissue eosinophilia have been identified using receiver operating characteristic curves. As the predictive value of the identified cutoff through regression analysis was low, we evaluated whether other risk factors could be statistically associated with ECRSwNP, and from this, a new predictive model was proposed for the identification of eosinophilic nasal polyps before surgery. Results: We found that the best method for predicting ECRSwNP is based on a model having asthma, blood eosinophil percentage, posterior ethmoid value in Lund-Mackay score, and modified Lund-Kennedy score as explanatory variables. Conclusions: This study provides new data for a better understanding of the polypoid CRS endotypes, and the proposed model allows the endotype to be identified preoperatively

Could the use of bedside lung ultrasound reduce the number of chest x-rays in the intensive care unit?

Background: Lung ultrasound can be used as an alternative to chest radiography (CXR) for the diagnosis and follow-up of various lung diseases in the intensive care unit (ICU). Our aim was to evaluate the influence that introducing a routine daily use of lung ultrasound in critically ill patients may have on the number of CXRs and as a consequence, on medical costs and radiation exposure. Methods: Data were collected by conducting a retrospective evaluation of the medical records of adult patients who needed thoracic imaging and were admitted to our academic polyvalent ICU. We compared the number of CXRs and relative costs before and after the introduction of lung ultrasound in our ICU. Results: A total of 4134 medical records were collected from January 2010 to December 2014. We divided our population into two groups, before (Group A, 1869 patients) and after (Group B, 2265 patients) the introduction of a routine use of LUS in July 2012. Group A performed a higher number of CXRs compared to Group B (1810 vs 961, P = 0.012), at an average of 0.97 vs 0.42 exams per patient. The estimated reduction of costs between Groups A and B obtained after the introduction of LUS, was 57%. No statistically significant difference between the outcome parameters of the two groups was observed. Conclusions: Lung ultrasound was effective in reducing the number of CXRs and relative medical costs and radiation exposure in ICU, without affecting patient outcome

Burnout in cardiac anesthesiologists. results from a national survey in italy

Objective: There is increasing burnout incidence among medical disciplines, and physicians working in emergency settings seem at higher risk. Cardiac anesthesiology is a stressful anesthesiology subspecialty dealing with high-risk patients. The authors hypothesized a high risk of burnout in cardiac anesthesiologists. Design: National survey conducted on burnout Setting: Italian cardiac centers. Participants: Cardiac anesthesiologists. Interventions: The authors administered via email an anonymous questionnaire divided into 3 parts. The first 2 parts evaluated workload and private life. The third part consisted of the Maslach Burnout Inventory test with its 3 constituents: high emotional exhaustion, high depersonalization, and low personal accomplishment. Measurements and Main Results: The authors measured the prevalence and risk of burnout through the Maslach Burnout Inventory questionnaire and analyzed factors influencing burnout. Among 670 contacts from 71 centers, 382 cardiac anesthesiologists completed the survey (57%). The authors found the following mean Maslach Burnout Inventory values: 14.5 ± 9.7 (emotional exhaustion), 9.1 ± 7.1 (depersonalization), and 33.7 ± 8.9 (personal accomplishment). A rate of 34%, 54%, and 66% of respondents scored in “high” or “moderate-high” risk of burnout (emotional exhaustion, depersonalization, and personal accomplishment, respectively). The authors found that, if offered to change subspecialty, 76% of respondents would prefer to remain in cardiac anesthesiology. This preference and parenthood were the only 2 investigated factors with a protective effect against all components of burnout. Significantly lower burnout scores were found in more experienced anesthesiologists. Conclusion: A relatively high incidence of burnout was found in cardiac anesthesiologists, especially regarding high depersonalization and low personal accomplishment. Nonetheless, most of the respondents would choose to remain in cardiac anesthesiology

Optical spectroscopy of the microquasar GRS 1758-258: a possible intermediate mass system?

Context. GRS 1758-258 is one of two prototypical microquasars towards the Galactic Center direction discovered almost a quarter of a century ago. The system remains poorly studied in the optical domain due to its counterpart being a very faint and absorbed target in a crowded region of the sky. Aims. Our aim is to investigate GRS 1758-258 in order to shed light on the nature of the stellar binary components. In particular, the main physical parameters of the donor star, such as the mass or the spectral type, are not yet well constrained. Methods. GRS 1758-258 has remained so far elusive to optical spectroscopy owing to its observational difficulties. Here, we use this traditional tool of stellar astronomy at low spectral resolution with a 10 m class telescope and a long slit spectrograph. Results. An improved spectrum is obtained as compared to previous work. The quality of the data does not allow the detection of emission or absorption features but, nevertheless, we manage to partially achieve our aims comparing the de-reddened continuum with the spectral energy distribution expected from an irradiated disc model and different donor star templates. Conclusions. We tentatively propose that GRS 1758-258 does not host a giant star companion. Instead, a main sequence star with mid-A spectral type appears to better agree with our data. The main impacts of this finding are the possibility that we are dealing with an intermediate mass system and, in this case, the prediction of an orbital period significantly shorter than previously proposed.Comment: 5 pages, 6 figures, accepted for publication in A&