732 research outputs found
Asthma diagnosis and treatment - 1012. The efficacy of budesonide in the treatmetn of acute asthma in children: a double-blind, randomized, controlled trial.
Background
Current evidence suggests that inhaled glucocorticoids (IGC) have a more profound topical none genomic effect on bronchial airways as compared to systemic glucocorticoids. The value of adding IGC to current therapy of acute asthma is not well established.
Methods
We conducted a double-blind, randomized, two-arm, parallel groups, controlled clinical trial to compare the addition of budesonide 1500 mcg or placebo (normal saline) to standard acute asthma treatment (albuterol and ipratropium bromide) administered in 3 divided mixed doses within 1 hour in the emergency department (ED). Children 2-12 years of age with moderate or severe acute asthma, scoring 8-15/15 on a well-validated scoring system were included. Both groups received a single dose of prednisone 2 mg/kg/day (max. 60 mg) at the beginning of therapy. The primary outcome was admission rate within 2-4 hours from starting therapy.
Results
A total of 723 children were enrolled in the study over 17 months duration, of whom 139 were allowed to re-enroll and be randomized to constitute 906 randomization assignments (458 on the treatment group and 448 on the control group); with baseline mean + SD asthma score of 10.63 + 1.73; age 5.52 + 2.76 years; 35% girls; 30.8% (16.5%) with baseline severe asthma score of ≥12 (≥ 13). Statistical Analysis plan allowed for the potential dependency in response due to reenrollments of a subset of children, using Generalized Linear Mixed Modeling (GLMM) techniques. Baseline demographic and clinical characteristics were not significantly different between the two randomized groups. Seventy-five out of 458 (16.4%) of the treatment group vs. 82/448 (18.3%) of the control group were admitted, (OR 0.85, CI: 0.59-1.23, p-value=0.39). Among the severe asthmatics with baseline score ≥13, treatment vs. placebo group, GLMM adjusted admission rate was 30% vs. 47%, indicating a 17% difference in admission rate in favor of the treatment group (adjusted OR of 0.49, CI: 0.25-0.95; p-value= 0.035) that indicated a 51% reduction in the risk of admission for the treatment vs. control group.
Conclusions
Children with baseline severe asthma score ≥13 who were treated with budesonide had a significant reduction in their admission rate
A Free-Form Lensing Grid Solution for A1689 with New Mutiple Images
Hubble Space Telescope imaging of the galaxy cluster Abell 1689 has revealed
an exceptional number of strongly lensed multiply-imaged galaxies, including
high-redshift candidates. Previous studies have used this data to obtain the
most detailed dark matter reconstructions of any galaxy cluster to date,
resolving substructures ~25 kpc across. We examine Abell 1689 (hereafter,
A1689) non-parametrically, combining strongly lensed images and weak
distortions from wider field Subaru imaging, and we incorporate member galaxies
to improve the lens solution. Strongly lensed galaxies are often locally
affected by member galaxies, however, these perturbations cannot be recovered
in grid based reconstructions because the lensing information is too sparse to
resolve member galaxies. By adding luminosity-scaled member galaxy deflections
to our smooth grid we can derive meaningful solutions with sufficient accuracy
to permit the identification of our own strongly lensed images, so our model
becomes self consistent. We identify 11 new multiply lensed system candidates
and clarify previously ambiguous cases, in the deepest optical and NIR data to
date from Hubble and Subaru. Our improved spatial resolution brings up new
features not seen when the weak and strong lensing effects are used separately,
including clumps and filamentary dark matter around the main halo. Our
treatment means we can obtain an objective mass ratio between the cluster and
galaxy components, for examining the extent of tidal stripping of the luminous
member galaxies. We find a typical mass-to-light ratios of M/L_B = 21 inside
the r<1 arcminute region that drops to M/L_B = 17 inside the r<40 arcsecond
region. Our model independence means we can objectively evaluate the
competitiveness of stacking cluster lenses for defining the geometric
lensing-distance-redshift relation in a model independent way.Comment: 23 pages with 25 figures Replced with MNRAS submitted version. Some
figures have been corrected and minor text edit
The Cluster Lensing and Supernova Survey with Hubble (CLASH): Strong Lensing Analysis of Abell 383 from 16-Band HST WFC3/ACS Imaging
We examine the inner mass distribution of the relaxed galaxy cluster Abell
383 in deep 16-band HST/ACS+WFC3 imaging taken as part of the CLASH multi-cycle
treasury program. Our program is designed to study the dark matter distribution
in 25 massive clusters, and balances depth with a wide wavelength coverage to
better identify lensed systems and generate precise photometric redshifts. This
information together with the predictive strength of our strong-lensing
analysis method identifies 13 new multiply-lensed images and candidates, so
that a total of 27 multiple-images of 9 systems are used to tightly constrain
the inner mass profile, (r<160 kpc).
We find consistency with the standard distance-redshift relation for the full
range spanned by the lensed images, 1.01<z<6.03, with the higher redshift
sources deflected through larger angles as expected. The inner mass profile
derived here is consistent with the results of our independent weak-lensing
analysis of wide-field Subaru images, with good agreement in the region of
overlap. The overall mass profile is well fitted by an NFW profile with
M_{vir}=(5.37^{+0.70}_{-0.63}\pm 0.26) x 10^{14}M_{\odot}/h and a relatively
high concentration, c_{vir}=8.77^{+0.44}_{-0.42}\pm 0.23, which lies above the
standard c-M relation similar to other well-studied clusters. The critical
radius of Abell 383 is modest by the standards of other lensing clusters,
r_{E}\simeq16\pm2\arcsec (for z_s=2.55), so the relatively large number of
lensed images uncovered here with precise photometric redshifts validates our
imaging strategy for the CLASH survey. In total we aim to provide similarly
high-quality lensing data for 25 clusters, 20 of which are X-ray selected
relaxed clusters, enabling a precise determination of the representative mass
profile free from lensing bias. (ABRIDGED)Comment: 15 pages, 14 figures, 2 tabels; V3 matches the submitted version
later published in Ap
Combined strong and weak lensing analysis of 28 clusters from the Sloan Giant Arcs Survey
We study the mass distribution of a sample of 28 galaxy clusters using strong
and weak lensing observations. The clusters are selected via their strong
lensing properties as part of the Sloan Giant Arcs Survey (SGAS) from the Sloan
Digital Sky Survey (SDSS). Mass modelling of the strong lensing information
from the giant arcs is combined with weak lensing measurements from deep
Subaru/Suprime-cam images to primarily obtain robust constraints on the
concentration parameter and the shape of the mass distribution. We find that
the concentration c_vir is a steep function of the mass, c_vir \propto
M_vir^-0.59\pm0.12, with the value roughly consistent with the
lensing-bias-corrected theoretical expectation for high mass (10^15 h^-1 M_sun)
clusters. However, the observationally inferred concentration parameters appear
to be much higher at lower masses (10^14 h^-1 M_sun), possibly a consequence of
the modification to the inner density profiles provided by baryon cooling. The
steep mass-concentration relation is also supported from direct stacking
analysis of the tangential shear profiles. In addition, we explore the
two-dimensional shape of the projected mass distribution by stacking weak
lensing shear maps of individual clusters with prior information on the
position angle from strong lens modelling, and find significant evidence for a
large mean ellipticity with the best-fit value of e = 0.47 \pm 0.06 for the
mass distribution of the stacked sample. We find that the luminous cluster
member galaxy distribution traces the overall mass distribution very well,
although the distribution of fainter cluster galaxies appears to be more
extended than the total mass.Comment: 29 pages, 15+9 figures, 7 tables, accepted for publication in MNRA
CLASH: The enhanced lensing efficiency of the highly elongated merging cluster MACS J0416.1-2403
We perform a strong-lensing analysis of the merging galaxy cluster MACS
J0416.1-2403 (M0416; z=0.42) in recent CLASH/HST observations. We identify 70
new multiple images and candidates of 23 background sources in the range
0.7<z_{phot}<6.14 including two probable high-redshift dropouts, revealing a
highly elongated lens with axis ratio ~5:1, and a major axis of ~100\arcsec
(z_{s}~2). Compared to other well-studied clusters, M0416 shows an enhanced
lensing efficiency. Although the critical area is not particularly large (~0.6
\square\arcmin; z_{s}~2), the number of multiple images, per critical area, is
anomalously high. We calculate that the observed elongation boosts the number
of multiple images, \emph{per critical area}, by a factor of ~2.5\times, due to
the increased ratio of the caustic area relative to the critical area.
Additionally, we find that the observed separation between the two main mass
components enlarges the critical area by a factor of ~2. These geometrical
effects can account for the high number (density) of multiple images observed.
We find in numerical simulations, that only ~4% of the clusters (with M_{vir}>6
x 10^{14} h^{-1}M_{\odot}) exhibit as elongated critical curves as M0416.Comment: 7 pages, 4 figures, 1 table. V2: accepted to ApJ Letters; minor
changes and updates; in Fig.3 labeling error corrected. Mass models available
online: ftp://wise-ftp.tau.ac.il/pub/adiz/M0416
Evidence for Ubiquitous, High-EW Nebular Emission in z~7 Galaxies: Towards a Clean Measurement of the Specific Star Formation Rate using a Sample of Bright, Magnified Galaxies
Growing observational evidence now indicates that nebular line emission has a
significant impact on the rest-frame optical fluxes of z~5-7 galaxies observed
with Spitzer. This line emission makes z~5-7 galaxies appear more massive, with
lower specific star formation rates. However, corrections for this line
emission have been very difficult to perform reliably due to huge uncertainties
on the overall strength of such emission at z>~5.5. Here, we present the most
direct observational evidence yet for ubiquitous high-EW [OIII]+Hbeta line
emission in Lyman-break galaxies at z~7, while also presenting a strategy for
an improved measurement of the sSFR at z~7. We accomplish this through the
selection of bright galaxies in the narrow redshift window z~6.6-7.0 where the
IRAC 4.5 micron flux provides a clean measurement of the stellar continuum
light. Observed 4.5 micron fluxes in this window contrast with the 3.6 micron
fluxes which are contaminated by the prominent [OIII]+Hbeta lines. To ensure a
high S/N for our IRAC flux measurements, we consider only the brightest
(H_{160}<26 mag) magnified galaxies we have identified in CLASH and other
programs targeting galaxy clusters. Remarkably, the mean rest-frame optical
color for our bright seven-source sample is very blue, [3.6]-[4.5]=-0.9+/-0.3.
Such blue colors cannot be explained by the stellar continuum light and require
that the rest-frame EW of [OIII]+Hbeta be greater than 637 Angstroms for the
average source. The bluest four sources from our seven-source sample require an
even more extreme EW of 1582 Angstroms. Our derived lower limit for the mean
[OIII]+Hbeta EW could underestimate the true EW by ~2x based on a simple
modeling of the redshift distribution of our sources. We can also set a robust
lower limit of >~4 Gyr^-1 on the specific star formation rates based on the
mean SED for our seven-source sample. (abridged)Comment: 9 pages, 6 figures, 1 table, submitted to the Astrophysical Journa
CLASH: A Census of Magnified Star-Forming Galaxies at z ~ 6-8
We utilize 16 band Hubble Space Telescope (HST) observations of 18 lensing
clusters obtained as part of the Cluster Lensing And Supernova survey with
Hubble (CLASH) Multi-Cycle Treasury program to search for galaxies.
We report the discovery of 204, 45, and 13 Lyman-break galaxy candidates at
, , and , respectively, identified from purely
photometric redshift selections. This large sample, representing nearly an
order of magnitude increase in the number of magnified star-forming galaxies at
presented to date, is unique in that we have observations in four
WFC3/UVIS UV, seven ACS/WFC optical, and all five WFC3/IR broadband filters,
which enable very accurate photometric redshift selections. We construct
detailed lensing models for 17 of the 18 clusters to estimate object
magnifications and to identify two new multiply lensed
candidates. The median magnifications over the 17 clusters are 4, 4, and 5 for
the , , and samples, respectively, over an average
area of 4.5 arcmin per cluster. We compare our observed number counts with
expectations based on convolving "blank" field UV luminosity functions through
our cluster lens models and find rough agreement down to mag, where we
begin to suffer significant incompleteness. In all three redshift bins, we find
a higher number density at brighter observed magnitudes than the field
predictions, empirically demonstrating for the first time the enhanced
efficiency of lensing clusters over field surveys. Our number counts also are
in general agreement with the lensed expectations from the cluster models,
especially at , where we have the best statistics.Comment: Accepted for publication in the Astrophysical Journal, 25 pages, 13
figures, 7 table
A Census of Star-Forming Galaxies in the z~9-10 Universe based on HST+Spitzer Observations Over 19 CLASH clusters: Three Candidate z~9-10 Galaxies and Improved Constraints on the Star Formation Rate Density at z~9
We utilise a two-color Lyman-Break selection criterion to search for z~9-10
galaxies over the first 19 clusters in the CLASH program. A systematic search
yields three z~9-10 candidates. While we have already reported the most robust
of these candidates, MACS1149-JD, two additional z~9 candidates are also found
and have H_{160}-band magnitudes of ~26.2-26.9. A careful assessment of various
sources of contamination suggests <~1 contaminants for our z~9-10 selection. To
determine the implications of these search results for the LF and SFR density
at z~9, we introduce a new differential approach to deriving these quantities
in lensing fields. Our procedure is to derive the evolution by comparing the
number of z~9-10 galaxy candidates found in CLASH with the number of galaxies
in a slightly lower redshift sample (after correcting for the differences in
selection volumes), here taken to be z~8. This procedure takes advantage of the
fact that the relative volumes available for the z~8 and z~9-10 selections
behind lensing clusters are not greatly dependent on the details of the lensing
models. We find that the normalization of the UV LF at z~9 is just
0.28_{-0.20}^{+0.39}\times that at z~8, ~1.4_{-0.8}^{+3.0}x lower than
extrapolating z~4-8 LF results. While consistent with the evolution in the UV
LF seen at z~4-8, these results marginally favor a more rapid evolution at z>8.
Compared to similar evolutionary findings from the HUDF, our result is less
insensitive to large-scale structure uncertainties, given our many independent
sightlines on the high-redshift universe.Comment: 22 pages, 11 figures, 5 tables, accepted for publication in the
Astrophysical Journal, updated to include the much deeper Spitzer/IRAC
observations over our three z~9-10 candidate
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