The incidence and outcome of septic shock patients in the absence of early-goal directed therapy

INTRODUCTION: The purpose of the present study was to measure the incidence and outcome of septic patients presenting at the emergency department (ED) with criteria for early goal-directed therapy (EGDT). METHOD: This hospital-based, retrospective, observational study using prospectively collected electronic databases was based in a teaching hospital in Melbourne, Australia. We conducted outcome-blinded electronic screening of patients with infection admitted via the ED from 1 January 2000 to 30 June 2003. We obtained data on demographics, laboratory and clinical features on admission. We used paper records to confirm electronic identification of candidates for EGDT and to study their treatment. We followed up all patients until hospital discharge or death. RESULTS: Of 4,784 ED patients with an infectious disease diagnosis, only 50 fulfilled published clinical inclusion criteria for EGDT (EGDT candidates). Of these patients, 37 (74%) survived their hospital admission, two (4%) died in the ED, eight (16%) died in the intensive care unit and three (6%) died in the ward. After review of all ward cardiac arrests and non-NFR ('not for resuscitation') ward deaths, we identified a further two potential candidates for EGDT for an overall mortality of 28.8% (15 out of 52 patients). Analysis of treatment showed that twice as many (70%) of the EGDT candidates received vasopressor therapy in the ED, and their initial mean central venous pressure (10.8 mmHg) was almost twice that in patients from the EGDT study conducted by Rivers and coworkers. CONCLUSION: In an Australian teaching hospital candidates for EGDT were uncommon and, in the absence of an EGDT protocol, their mortality was lower than that reported with EGDT

Revealing the Superfluid Lambda Transition in the Universal Thermodynamics of a Unitary Fermi Gas

We have observed the superfluid phase transition in a strongly interacting Fermi gas via high-precision measurements of the local compressibility, density and pressure down to near-zero entropy. Our data completely determine the universal thermodynamics of strongly interacting fermions without any fit or external thermometer. The onset of superfluidity is observed in the compressibility, the chemical potential, the entropy, and the heat capacity. In particular, the heat capacity displays a characteristic lambda-like feature at the critical temperature of $T_c/T_F = 0.167(13)$. This is the first clear thermodynamic signature of the superfluid transition in a spin-balanced atomic Fermi gas. Our measurements provide a benchmark for many-body theories on strongly interacting fermions, relevant for problems ranging from high-temperature superconductivity to the equation of state of neutron stars.Comment: 11 pages, 8 figure

There is variability in the attainment of developmental milestones in the CDKL5 disorder

Background: Individuals with the CDKL5 disorder have been described as having severely impaired development. A few individuals have been reported having attained more milestones including walking and running. Our aim was to investigate variation in attainment of developmental milestones and associations with underlying genotype. Methods: Data was sourced from the International CDKL5 Disorder Database, and individuals were included if they had a pathogenic or probably pathogenic CDKL5 mutation and information on early development. Kaplan-Meier time-to-event analyses investigated the occurrence of developmental milestones. Mutations were grouped by their structural/functional consequence, and Cox regression was used to investigate the relationship between genotype and milestone attainment. Results: The study included 109 females and 18 males. By 5 years of age, only 75% of the females had attained independent sitting and 25% independent walking whilst a quarter of the males could sit independently by 1 year 3 months. Only one boy could walk independently. No clear relationship between mutation group and milestone attainment was present, although females with a late truncating mutation attained the most milestones. Conclusion: Attainment of developmental milestones is severely impaired in the CDKL5 disorder, with the majority who did attain skills attaining them at a late age. It appears as though males are more severely impaired than the females. Larger studies are needed to further investigate the role of genotype on clinical variability

Cold gas in elliptical galaxies

We explore the evolution of the cold gas (molecular and neutral hydrogen) of elliptical galaxies and merger remnants ordered into a time sequence on the basis of spectroscopic age estimates. We find that the fraction of cold gas in early merger remnants decreases significantly for ~1-2 Gyr, but subsequent evolution toward evolved elliptical systems sees very little change. This trend can be attributed to an initial gas depletion by strong star-formation which subsequently declines to quiescent rates. This explanation is consistent with the merger picture for the formation of elliptical galaxies. We also explore the relation between HI-to-H2 mass ratio and spectroscopic galaxy age, but find no evidence for a statistically significant trend. This suggests little net HI to H2 conversion for the systems in the present sample.Comment: 11 pages, 6 figures, accepted for publication by MNRA

An optical/NIR survey of globular clusters in early-type galaxies. I. Introduction and data reduction procedures

Context: The combination of optical and near-infrared (NIR) colours has the potential to break the age/metallicity degeneracy and offers a better metallicity sensitivity than optical colours alone. Previous studies of extragalactic globular clusters (GCs) with this colour combination, however, have suffered from small samples or have been restricted to a few galaxies. Aims: We compile a homogeneous and representative sample of GC systems with multi-band photometry to be used in subsequent papers where ages and metallicity distributions will be studied. Methods: We acquired deep K-band images of 14 bright nearby early-type galaxies. The images were obtained with the LIRIS near-infrared spectrograph and imager at the William Herschel Telescope (WHT) and combined with optical ACS g and z images from the Hubble Space Telescope public archive. Results: For the first time GC photometry of 14 galaxies are observed and reduced homogeneously in this wavelength regime. We achieved a limiting magnitude of K~20-21. For the majority of the galaxies we detect about 70 GCs each. NGC4486 and NGC4649, the cluster-richest galaxies in the sample contain 301 and 167 GCs, respectively. We present tables containing coordinates, photometry and sizes of the GCs available.Comment: A&A accepted, 18 pages, 13 figure

The Breakdown of Preformed Peritoneal Advanced Glycation End Products by Intraperitoneal Alagebrium

It has been demonstrated that inhibitors of advanced glycation end products (AGE), such as aminoguanidine, can suppress peritoneal AGE in rats on peritoneal dialysis (PD). However, it is unknown whether late administration of a putative cross-link breaker, alagebrium, could reverse peritoneal AGE. We therefore compared alagebrium with aminoguanidine in their ability to reverse peritoneal AGE in rats on PD. Male Sprague-Dawley rats were randomly divided into 3 groups: group I dialyzed with 4.25% glucose solution for all exchanges; group II dialyzed with 4.25% glucose solution containing aminoguanidine, and group III dialyzed with 4.25% glucose solution containing alagebrium for last 8 weeks of 12-week dialysis period. Dialysis exchanges were performed 2 times a day for 12 weeks. Immunohistochemistry was performed using a monoclonal anti-AGE antibody. One-hour PET was performed for comparison of transport characteristics. The immunolabelling of AGE in peritoneal membrane was markedly decreased in the alagebrium group. Consistent with this, the alagebrium group exhibited significantly higher D/Do glucose and lower D/P urea, suggesting low peritoneal membrane transport. But there were no significant differences between the control and the aminoguanidine group. These results suggest that the alagebrium may be the optimal therapeutic approach, compared with treatment with inhibitors of AGE formation, in rats on PD

Constraints on mass loss and self-enrichment scenarios for the globular clusters of the Fornax dSph

Recently, high-dispersion spectroscopy has demonstrated conclusively that four of the five globular clusters (GCs) in the Fornax dwarf spheroidal galaxy are very metal-poor with [Fe/H]<-2. The remaining cluster, Fornax 4, has [Fe/H]=-1.4. This is in stark contrast to the field star metallicity distribution which shows a broad peak around [Fe/H]=-1 with only a few percent of the stars having [Fe/H]<-2. If we only consider stars and clusters with [Fe/H]<-2 we thus find an extremely high GC specific frequency, SN=400, implying by far the highest ratio of GCs to field stars known anywhere. We estimate that about 1/5-1/4 of all stars in the Fornax dSph with [Fe/H]<-2 belong to the four most metal-poor GCs. These GCs could, therefore, at most have been a factor of 4-5 more massive initially. Yet, the Fornax GCs appear to share the same anomalous chemical abundance patterns known from Milky Way GCs, commonly attributed to the presence of multiple stellar generations within the clusters. The extreme ratio of metal-poor GC- versus field stars in the Fornax dSph is difficult to reconcile with scenarios for self-enrichment and early evolution of GCs in which a large fraction (90%-95%) of the first-generation stars have been lost. It also suggests that the GCs may not have formed as part of a larger population of now disrupted clusters with an initial power-law mass distribution. The Fornax dSph may be a rosetta stone for constraining theories of the formation, self-enrichment and early dynamical evolution of star clusters.Comment: 4 pages, 2 figures, accepted for A&A Letter

Central Structural Parameters of Early-Type Galaxies as Viewed with HST/NICMOS

We present surface photometry for the central regions of a sample of 33 early-type (E, S0, and S0/a) galaxies observed at 1.6 microns (H band) using the Hubble Space Telescope (HST). We employ a new technique of two-dimensional fitting to extract quantitative parameters for the bulge light distribution and nuclear point sources, taking into consideration the effects of the point-spread function. Parameterizing the bulge profile with a ``Nuker'' law, we confirm that the central surface-brightness distributions largely fall into two categories, each of which correlates with the global properties of the galaxies. ``Core'' galaxies tend to be luminous ellipticals with boxy or pure elliptical isophotes, whereas ``power-law'' galaxies are preferentially lower luminosity systems with disky isophotes. Unlike most previous studies, however, we do not find a clear gap in the distribution of inner cusp slopes; several objects have inner cusp slopes (0.3 < gamma < 0.5) which straddle the regimes conventionally defined for core and power-law type galaxies. The nature of these intermediate objects is unclear. We draw attention to two objects in the sample which appear to be promising cases of galaxies with isothermal cores that are not the brightest members of a cluster. Unresolved nuclear point sources are found in about 50% of the sample galaxies, roughly independent of profile type, with magnitudes in the range m^{nuc}_H = 12.8 to 17.4 mag, which correspond to M_H^{nuc} = -12.8 to -18.4 mag. (Abridged)Comment: To appear in The Astronomical Journal. Latex, 24 pages and 17 JPEG image

A Magnetohydrodynamic Model for the Formation of Episodic Jets

Episodic ejection of plasma blobs have been observed in many black hole systems. While steady, continuous jets are believed to be associated with large-scale open magnetic fields, what causes the episodic ejection of blobs remains unclear. Here by analogy with the coronal mass ejection on the Sun, we propose a magnetohydrodynamical model for episodic ejections from black holes associated with the closed magnetic fields in an accretion flow. Shear and turbulence of the accretion flow deform the field and result in the formation of a flux rope in the disk corona. Energy and helicity are accumulated and stored until a threshold is reached. The system then loses its equilibrium and the flux rope is thrust outward by the magnetic compression force in a catastrophic way. Our calculations show that for parameters appropriate for the black hole in our Galactic center, the plasmoid can attain relativistic speeds in about 35 minutes.Comment: 8 pages, 2 figures; the finalized version to appear in MNRA

Plasmoids in Reconnecting Current Sheets: Solar and Terrestrial Contexts Compared

Magnetic reconnection plays a crucial role in violent energy conversion occurring in the environments of high electrical conductivity, such as the solar atmosphere, magnetosphere, and fusion devices. We focus on the morphological features of the process in two different environments, the solar atmosphere and the geomagnetic tail. In addition to indirect evidence that indicates reconnection in progress or having just taken place, such as auroral manifestations in the magnetosphere and the flare loop system in the solar atmosphere, more direct evidence of reconnection in the solar and terrestrial environments is being collected. Such evidence includes the reconnection inflow near the reconnecting current sheet, and the outflow along the sheet characterized by a sequence of plasmoids. Both turbulent and unsteady Petschek-type reconnection processes could account for the observations. We also discuss other relevant observational consequences of both mechanisms in these two settings. While on face value, these are two completely different physical environments, there emerge many commonalities, for example, an Alfven speed of the same order of magnitude, a key parameter determining the reconnection rate. This comparative study is meant as a contribution to current efforts aimed at isolating similarities in processes occurring in very different contexts in the heliosphere, and even in the universe.Comment: 21 pages, 9 figures, in press at J. Geophys. Res. (Space Physics), for the special NESSC section on Comparative Aspects of Magnetic Reconnectio