Pre-Liver Transplant: Tips Versus Distal Splenorenal Shunt

Recurrent variceal bleeding in liver transplant candidates with end-stage liver disease can complicate or even prohibit a subsequent transplant procedure (OLT). Endoscopic sclero-therapy and medical therapy are considered as first-line management with surgical shunts reserved for refractory situations. Surgical shunts can be associated with a high mortality in this population and may complicate subsequent OLT. The transjugular intrahepatic portosystemic shunt (TIPS) has been recommended in these patients as a bridge to OLT. This is a new modality that has not been compared with previously established therapies such as the distal splenorenal shunt (DSRS). In this study we report our experience with 35 liver transplant recipients who had a previous TIPS (18 patients) or DSRS (17 patients) for variceal bleeding. The TIPS group had a significantly larger proportion of critically ill and Child-Pugh C patients. Mean operating time was more prolonged in the DSRS group (P=0.014) but transfusion requirements were similar. Intraoperative portal vein blood flow measurements averaged 2132±725 ml/min in the TIPS group compared with 1120±351ml/min in the DSRS group (P<0.001). Arterial flows were similar. Mean ICU and hospital stays were similar. There were 3 hospital mortalities in the DSRS group and none in the TIPS group (P=0.1). We conclude that TIPS is a valuable tool in the management of recurrent variceal bleeding prior to liver transplantation. Intra0Perative hemodynamic measurements suggest a theoretical advantage with TIPS. In a group of patients with advanced liver disease we report an outcome that is similar to patients treated with DSRS prior to liver transplantation. The role of TIPS in the treatment of nontransplant candidates remains to be clarified

'To live and die [for] Dixie': Irish civilians and the Confederate States of America

Around 20,000 Irishmen served in the Confederate army in the Civil War. As a result, they left behind, in various Southern towns and cities, large numbers of friends, family, and community leaders. As with native-born Confederates, Irish civilian support was crucial to Irish participation in the Confederate military effort. Also, Irish civilians served in various supporting roles: in factories and hospitals, on railroads and diplomatic missions, and as boosters for the cause. They also, however, suffered in bombardments, sieges, and the blockade. Usually poorer than their native neighbours, they could not afford to become 'refugees' and move away from the centres of conflict. This essay, based on research from manuscript collections, contemporary newspapers, British Consular records, and Federal military records, will examine the role of Irish civilians in the Confederacy, and assess the role this activity had on their integration into Southern communities. It will also look at Irish civilians in the defeat of the Confederacy, particularly when they came under Union occupation. Initial research shows that Irish civilians were not as upset as other whites in the South about Union victory. They welcomed a return to normalcy, and often 'collaborated' with Union authorities. Also, Irish desertion rates in the Confederate army were particularly high, and I will attempt to gauge whether Irish civilians played a role in this. All of the research in this paper will thus be put in the context of the Drew Gilpin Faust/Gary Gallagher debate on the influence of the Confederate homefront on military performance. By studying the Irish civilian experience one can assess how strong the Confederate national experiment was. Was it a nation without a nationalism

Rapid post-glacial bedrock weathering in coastal Norway

Quantifying bedrock weathering rates under diverse climate conditions is essential to understanding timescales of landscape evolution. Yet, weathering rates are often difficult to constrain, and associating a weathered landform to a specific formative environment can be complicated by overprinting of successive processes and temporally varying climate. In this study, we investigate three sites between 59°N and 69°N along the Norwegian coast that display grussic saprolite, tafoni, and linear weathering grooves on diverse lithologies. These weathering phenomena have been invoked as examples of geomorphic archives predating Quaternary glaciations and consequently as indicators of minimal glacial erosion. Here we apply cosmogenic nuclide chronometry to assess the recent erosional history. Our results demonstrate that all three sites experienced sufficient erosion to remove most cosmogenic nuclides formed prior to the Last Glacial Maximum. This finding is inconsistent with preservation of surficial (<1–2 m) weathered landforms under non-erosive ice during the last glacial period, while simultaneously demonstrating that post-glacial weathering and erosion rates can be locally rapid (4–10 cm kyr−1) in cold temperate to subarctic coastal locations

Search for Neutral Higgs Bosons in e+e- Collisions at sqrt(s) ~189GeV

A search for neutral Higgs bosons has been performed with the OPAL detector at LEP, using approximately 170 pb-1 of e+e- collision data collected at sqrt(s)~189GeV. Searches have been performed for the Standard Model (SM) process e+e- to H0Z0 and the MSSM processes e+e- to H0Z0, A0h0. The searches are sensitive to the b b-bar and tau antitau decay modes of the Higgs bosons, and also to the MSSM decay mode h0 to A0A0. OPAL search results at lower centre-of-mass energies have been incorporated in the limits we set, which are valid at the 95% confidence level. For the SM Higgs boson, we obtain a lower mass bound of 91.0 GeV. In the MSSM, our limits are mh>74.8GeV and mA>76.5GeV, assuming tan(beta)>1, that the mixing of the scalar top quarks is either zero or maximal, and that the soft SUSY-breaking masses are 1 TeV. For the case of zero scalar top mixing, we exclude values of tan(beta) between 0.72 and 2.19.Comment: 38 pages, 15 figures, submitted Euro. Phys. J.

Bose-Einstein Correlations in e+e- to W+W- at 172 and 183 GeV

Bose-Einstein correlations between like-charge pions are studied in hadronic final states produced by e+e- annihilations at center-of-mass energies of 172 and 183 GeV. Three event samples are studied, each dominated by one of the processes W+W- to qqlnu, W+W- to qqqq, or (Z/g)* to qq. After demonstrating the existence of Bose-Einstein correlations in W decays, an attempt is made to determine Bose-Einstein correlations for pions originating from the same W boson and from different W bosons, as well as for pions from (Z/g)* to qq events. The following results are obtained for the individual chaoticity parameters lambda assuming a common source radius R: lambda_same = 0.63 +- 0.19 +- 0.14, lambda_diff = 0.22 +- 0.53 +- 0.14, lambda_Z = 0.47 +- 0.11 +- 0.08, R = 0.92 +- 0.09 +- 0.09. In each case, the first error is statistical and the second is systematic. At the current level of statistical precision it is not established whether Bose-Einstein correlations, between pions from different W bosons exist or not.Comment: 24 pages, LaTeX, including 6 eps figures, submitted to European Physical Journal

W+W- production and triple gauge boson couplings at LEP energies up to 183 GeV

A study of W-pair production in e+e- annihilations at Lep2 is presented, based on 877 W+W- candidates corresponding to an integrated luminosity of 57 pb-1 at sqrt(s) = 183 GeV. Assuming that the angular distributions of the W-pair production and decay, as well as their branching fractions, are described by the Standard Model, the W-pair production cross-section is measured to be 15.43 +- 0.61 (stat.) +- 0.26 (syst.) pb. Assuming lepton universality and combining with our results from lower centre-of-mass energies, the W branching fraction to hadrons is determined to be 67.9 +- 1.2 (stat.) +- 0.5 (syst.)%. The number of W-pair candidates and the angular distributions for each final state (qqlnu,qqqq,lnulnu) are used to determine the triple gauge boson couplings. After combining these values with our results from lower centre-of-mass energies we obtain D(kappa_g)=0.11+0.52-0.37, D(g^z_1)=0.01+0.13-0.12 and lambda=-0.10+0.13-0.12, where the errors include both statistical and systematic uncertainties and each coupling is determined setting the other two couplings to the Standard Model value. The fraction of W bosons produced with a longitudinal polarisation is measured to be 0.242+-0.091(stat.)+-0.023(syst.). All these measurements are consistent with the Standard Model expectations.Comment: 48 pages, LaTeX, including 13 eps or ps figures, submitted to European Physical Journal

Measurements of Flavour Dependent Fragmentation Functions in Z^0 -> qq(bar) Events

Fragmentation functions for charged particles in Z -> qq(bar) events have been measured for bottom (b), charm (c) and light (uds) quarks as well as for all flavours together. The results are based on data recorded between 1990 and 1995 using the OPAL detector at LEP. Event samples with different flavour compositions were formed using reconstructed D* mesons and secondary vertices. The \xi_p = ln(1/x_E) distributions and the position of their maxima \xi_max are also presented separately for uds, c and b quark events. The fragmentation function for b quarks is significantly softer than for uds quarks.Comment: 29 pages, LaTeX, 5 eps figures (and colour figs) included, submitted to Eur. Phys. J.

Lopinavir–ritonavir in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

SummaryBackground Lopinavir–ritonavir has been proposed as a treatment for COVID-19 on the basis of in vitro activity,preclinical studies, and observational studies. Here, we report the results of a randomised trial to assess whether lopinavir–ritonavir improves outcomes in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, platform trial, a range of possible treatments was compared with usual care in patients admitted to hospital with COVID-19. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients were randomly allocated to either usual standard of care alone or usual standard of care plus lopinavir–ritonavir (400 mg and 100 mg, respectively) by mouth for 10 days or until discharge (or one of the otherRECOVERY treatment groups: hydroxychloroquine, dexamethasone, or azithromycin) using web-based simple (unstratified) randomisation with allocation concealment. Randomisation to usual care was twice that of any of the active treatment groups (eg, 2:1 in favour of usual care if the patient was eligible for only one active group, 2:1:1 if the patient was eligible for two active groups). The primary outcome was 28-day all-cause mortality. Analyses weredone on an intention-to-treat basis in all randomly assigned participants. The trial is registered with ISRCTN,50189673, and ClinicalTrials.gov, NCT04381936.Findings Between March 19, 2020, and June 29, 2020, 1616 patients were randomly allocated to receive lopinavir–ritonavir and 3424 patients to receive usual care. Overall, 374 (23%) patients allocated to lopinavir–ritonavir and 767 (22%) patients allocated to usual care died within 28 days (rate ratio 1·03, 95% CI 0·91–1·17; p=0·60). Resultswere consistent across all prespecified subgroups of patients. We observed no significant difference in time until discharge alive from hospital (median 11 days [IQR 5 to >28] in both groups) or the proportion of patients discharged from hospital alive within 28 days (rate ratio 0·98, 95% CI 0·91–1·05; p=0·53). Among patients not on invasive mechanical ventilation at baseline, there was no significant difference in the proportion who met the composite endpoint of invasive mechanical ventilation or death (risk ratio 1·09, 95% CI 0·99–1·20; p=0·092).Interpretation In patients admitted to hospital with COVID-19, lopinavir–ritonavir was not associated with reductions in 28-day mortality, duration of hospital stay, or risk of progressing to invasive mechanical ventilation or death. These findings do not support the use of lopinavir–ritonavir for treatment of patients admitted to hospital with COVID-19.Funding Medical Research Council and National Institute for Health Research

Bose-Einstein Correlations of Three Charged Pions in Hadronic Z^0 Decays

Bose-Einstein Correlations (BEC) of three identical charged pions were studied in 4 x 10^6 hadronic Z^0 decays recorded with the OPAL detector at LEP. The genuine three-pion correlations, corrected for the Coulomb effect, were separated from the known two-pion correlations by a new subtraction procedure. A significant genuine three-pion BEC enhancement near threshold was observed having an emitter source radius of r_3 = 0.580 +/- 0.004 (stat.) +/- 0.029 (syst.) fm and a strength of \lambda_3 = 0.504 +/- 0.010 (stat.) +/- 0.041 (syst.). The Coulomb correction was found to increase the \lambda_3 value by \~9% and to reduce r_3 by ~6%. The measured \lambda_3 corresponds to a value of 0.707 +/- 0.014 (stat.) +/- 0.078 (syst.) when one takes into account the three-pion sample purity. A relation between the two-pion and the three-pion source parameters is discussed.Comment: 19 pages, LaTeX, 5 eps figures included, accepted by Eur. Phys. J.

Climatic and geographic predictors of life history variation in Eastern Massasauga (Sistrurus catenatus): A range-wide synthesis

Elucidating how life history traits vary geographically is important to understanding variation in population dynamics. Because many aspects of ectotherm life history are climate-dependent, geographic variation in climate is expected to have a large impact on population dynamics through effects on annual survival, body size, growth rate, age at first reproduction, size-fecundity relationship, and reproductive frequency. The Eastern Massasauga (Sistrurus catenatus) is a small, imperiled North American rattlesnake with a distribution centered on the Great Lakes region, where lake effects strongly influence local conditions. To address Eastern Massasauga life history data gaps, we compiled data from 47 study sites representing 38 counties across the range. We used multimodel inference and general linear models with geographic coordinates and annual climate normals as explanatory variables to clarify patterns of variation in life history traits. We found strong evidence for geographic variation in six of nine life history variables. Adult female snout-vent length and neonate mass increased with increasing mean annual precipitation. Litter size decreased with increasing mean temperature, and the size-fecundity relationship and growth prior to first hibernation both increased with increasing latitude. The proportion of gravid females also increased with increasing latitude, but this relationship may be the result of geographically varying detection bias. Our results provide insights into ectotherm life history variation and fill critical data gaps, which will inform Eastern Massasauga conservation efforts by improving biological realism for models of population viability and climate change