Ionized Gas Motions and the Structure of Feedback Near a Forming Globular Cluster in NGC 5253

We observed Brackett $\alpha$ 4.05$\mu$m emission towards the supernebula in NGC 5253 with NIRSPEC on Keck II in adaptive optics mode, NIRSPAO, to probe feedback from its exciting embedded super star cluster (SSC). NIRSPEC's Slit-Viewing Camera was simultaneously used to image the K-band continuum at $\sim$$0.1''$ resolution. We register the IR continuum with HST imaging, and find that the visible clusters are offset from the K-band peak, which coincides with the Br $\alpha$ peak of the supernebula and its associated molecular cloud. The spectra of the supernebula exhibit Br $\alpha$ emission with a strong, narrow core. The linewidths are 65-76 km s$^{-1}$, FWHM, comparable to those around individual ultra-compact HII regions within our Galaxy. A weak, broad (FWHM$\simeq$150-175 km s$^{-1}$) component is detected on the base of the line, which could trace a population of sources with high-velocity winds. The core velocity of Br $\alpha$ emission shifts by +13 km s$^{-1}$ from NE to SW across the supernebula, possibly indicating a bipolar outflow from an embedded object, or linked to a foreground redshifted gas filament. The results can be explained if the supernebula comprises thousands of ionized wind regions around individual massive stars, stalled in their expansion due to critical radiative cooling and unable to merge to drive a coherent cluster wind. Based on the absence of an outflow with large mass loss, we conclude that feedback is currently ineffective at dispersing gas, and the SSC retains enriched material out of which it may continue to form stars.Comment: 24 pages, 9 figure

Language and social/emotional problems identified at a universal developmental assessment at 30 months

Non peer reviewedPublisher PD

Skills-based intervention to enhance collaborative decision-making: systematic adaptation and open trial protocol for veterans with psychosis

Background: Collaborative decision-making is an innovative decision-making approach that assigns equal power and responsibility to patients and providers. Most veterans with serious mental illnesses like schizophrenia want a greater role in treatment decisions, but there are no interventions targeted for this population. A skills-based intervention is promising because it is well-aligned with the recovery model, uses similar mechanisms as other evidence-based interventions in this population, and generalizes across decisional contexts while empowering veterans to decide when to initiate collaborative decision-making. Collaborative Decision Skills Training (CDST) was developed in a civilian serious mental illness sample and may fill this gap but needs to undergo a systematic adaptation process to ensure fit for veterans. Methods: In aim 1, the IM Adapt systematic process will be used to adapt CDST for veterans with serious mental illness. Veterans and Veteran’s Affairs (VA) staff will join an Adaptation Resource Team and complete qualitative interviews to identify how elements of CDST or service delivery may need to be adapted to optimize its effectiveness or viability for veterans and the VA context. During aim 2, an open trial will be conducted with veterans in a VA Psychosocial Rehabilitation and Recovery Center (PRRC) to assess additional adaptations, feasibility, and initial evidence of effectiveness. Discussion: This study will be the first to evaluate a collaborative decision-making intervention among veterans with serious mental illness. It will also contribute to the field’s understanding of perceptions of collaborative decision-making among veterans with serious mental illness and VA clinicians, and result in a service delivery manual that may be used to understand adaptation needs generally in VA PRRCs. Trial registration: ClinicalTrials.gov Identifier: NCT0432494

Antithrombotic Treatment in Transcatheter Aortic Valve Implantation Insights for Cerebrovascular and Bleeding Events

Transcatheter aortic valve implantation (TAVI) has emerged as a therapeutic alternative for patients with symptomatic aortic stenosis at high or prohibitive surgical risk. However, patients undergoing TAVI are also at high risk for both bleeding and stroke complications, and specific mechanical aspects of the procedure itself can increase the risk of these complications. The mechanisms of periprocedural bleeding complications seem to relate mainly to vascular/access site complications (related to the use of large catheters in a very old and frail elderly population), whereas the pathophysiology of cerebrovascular events remains largely unknown. Further, although mechanical complications, especially the interaction between the valve prosthesis and the native aortic valve, may play a major role in events that occur during TAVI, post-procedural events might also be related to a prothrombotic environment or state generated by the implanted valve, the occurrence of atrial arrhythmias, and associated comorbidities. Antithrombotic therapy in the setting of TAVI has been empirically determined, and unfractionated heparin during the procedure followed by dual antiplatelet therapy with aspirin (indefinitely) and clopidogrel (1 to 6 months) is the most commonly recommended treatment. However, bleeding and cerebrovascular events are common; these may be modifiable with optimization of periprocedural and post-procedural pharmacology. Further, as the field of antiplatelet and anticoagulant therapy evolves, potential drug combinations will multiply, introducing variability in treatment. Randomized trials are the best path forward to determine the balance between the efficacy and risks of antithrombotic treatment in this high risk-population

Brief motivational enhancement intervention to prevent or reduce postpartum alcohol use: a single-blinded, randomized controlled effectiveness trial

AIMS: The aim of this study is to assess the effect of brief motivational enhancement intervention postpartum alcohol use. DESIGN: This study is a single-blinded, randomized controlled effectiveness trial in which pregnant women were assigned to receive usual care or up to 5 face-to-face brief motivational enhancement sessions lasting 10-30 minutes each and occurring at study enrollment, 4 and 8 weeks after enrollment, 32 weeks of gestation, and 6 weeks postpartum. SETTING: The setting is in a large, urban, obstetrics clinic. PARTICIPANTS: Participants were women who were \u3e/= 18 years old,gestation, and consumed alcohol during pregnancy. Of 3438 women screened, 330 eligible women were assigned to usual care (n = 165) or intervention (n=165). Due to missing data, we analyzed 125 in the intervention group and 126 in the usual care group. MEASUREMENTS: The measurements were the proportion of women with any alcohol use and the number of drinks per day, reported via follow-up telephone interviews at 4 and 8 weeks after enrollment, 32 weeks of gestation, and 6 weeks, 6 months, and 12 months postpartum. FINDINGS: In random effects models adjusted for confounders, the intervention group was less likely to use any alcohol (odds ratio 0.50; 95% confidence interval [CI], 0.23-1.09; P=0.08) and consumed fewer drinks per day (coefficient -0.11; 95% CI -0.23-0.01; P=0.07) than, the usual care group in the postpartum period but these differences were non-significant. Missing data during the prenatal period prevented us from modeling prenatal alcohol use. CONCLUSIONS: Brief motivational enhancement intervention delivered in an obstetrical outpatient setting did not conclusively decrease alcohol use during the postpartum period

International expert workshop on the analysis of the economic and public health impacts of air pollution: workshop summary.

Forty-nine experts from 18 industrial and developing countries met on 6 September 2001 in Garmisch-Partenkirchen, Germany, to discuss the economic and public health impacts of air pollution, particularly with respect to assessing the public health benefits from technologies and policies that reduce greenhouse gas (GHG) emissions. Such measures would provide immediate public health benefits, such as reduced premature mortality and chronic morbidity, through improved local air quality. These mitigation strategies also allow long-term goals--for example, reducing the buildup of GHG emissions--to be achieved alongside short-term aims, such as immediate improvements in air quality, and therefore benefits to public health. The workshop aimed to foster research partnerships by improving collaboration and communication among various agencies and researchers; providing a forum for presentations by sponsoring agencies and researchers regarding research efforts and agency activities; identifying key issues, knowledge gaps, methodological shortcomings, and research needs; and recommending activities and initiatives for research, collaboration, and communication. This workshop summary briefly describes presentations made by workshop participants and the conclusions of three separate working groups: economics, benefits transfer, and policy; indoor air quality issues and susceptible populations; and development and transfer of dose-response relationships and exposure models in developing countries. Several common themes emerged from the working group sessions and subsequent discussion. Key recommendations include the need for improved communication and extended collaboration, guidance and support for researchers, advances in methods, and resource support for data collection, assessment, and research

Origine sociale et comportement politique

Les conséquences politiques de la mobilité sociale intergénérationnelle sur les comportements et les attitudes politiques des individus ont fait l'objet, depuis une vingtaine d'années, d'une série de recherches en particulier aux Etats-Unis et en Angleterre. A la suite de ces travaux une conclusion majeure semble s'imposer : les « mobiles sociaux » adopteraient un comportement politique intermédiaire entre leur groupe d'origine et leur groupe d'arrivée. Dans cette recherche, qui se fonde sur l'analyse d'un échantillon représentatif de cadres moyens et supérieurs, l'origine sociale paraît effectivement déterminer pour partie les comportements et attitudes politiques des individus appartenant aux couches moyennes salariées. Toutefois, une étude plus précise de ce mécanisme montre que l'effet de l'origine sociale sur le comportement et les attitudes politiques n'est pas seulement fonction de la distance entre la position sociale du père et celle du fils mais se diversifie également selon la nature et les conditions du trajet social effectué par l'individu.The political consequences of intergenerational social mobility on individuals' political attitudes and behavior have been studied in a series of inquiries over the past twenty years, especially in the United States and England. As a result of this work, it seems that one major conclusion may be drawn: the "socially mobile" seem to adopt a political behavior which is intermediate to that of the group from which they started out and that into which they are arriving. In this study based on a representative sample of middle — and upper — level executives, social origin indeed seems to be in part a determining factor in the political behavior and attitudes of individuals belonging to the middle range of the wage scale. However, a closer study of this mechanism shows that the effect of social origin upon political behavior and attitudes is not only a function of the distance between the father's and the son's social positions, but also differs according to the nature and conditions of the individual's social ascension