Progressive cervical tumour in an HIV-patient: giant pseudoaneurysm of the carotid artery: a case report

Background Aneurysms of the extracranial carotid artery are a rare entity and correspond to <1% of all arterial aneurysms. Case summary A 58-year-old male with known human immunodeficiency virus (HIV) infection presented in the emergency department with a massive cervical tumour on the right side of the neck and a severe occipital pain. Contrast computed tomography demonstrated a pseudoaneurysm of the proximal right internal carotid artery (ICA). Open surgery of the ICA was performed with reconstruction of the posterior vessel wall, embolectomy of the ICA, and anterior pericardial patch reconstruction. After an uneventful postoperative course, the patient was readmitted 4 weeks later with a right retrobulbous haematoma caused by a carotid cavernous fistula. Therefore a coil-embolization of the fistula and finally of the distal right carotid artery was performed. Discussion In patients with a proven HIV infection, the occurrence of a vasculopathy in the extra- or intracranial carotid artery is significantly increased and the second most common site after the lower extremities. In patients with progredient neck swelling it should be considered in the differential. Surgical therapy is the preferred treatment strategy in the extracranial aneurysm type, especially in this patient collective

Optical properties and composition of viscous organic particles found in the Southern Great Plains

Atmospheric high-viscosity organic particles (HVOPs) were observed in samples of ambient aerosols collected in April and May 2016 in the Southern Great Plains of the United States. These particles were apportioned as either airborne soil organic particles (ASOPs) or tar balls (TBs) from biomass burning based on spetro-microscopic imaging and assessments of meteorological records of smoke and precipitation data. Regardless of their apportionment, the number fractions of HVOPs were positively correlated (R2=0.85) with increased values of absorption Ångström exponent (AAE) measured in situ for ambient aerosol at the site. Extending this correlation to 100 % HVOPs yields an AAE of 2.6, similar to previous literature reports of the class of light-absorbing organic particles known as brown carbon (BrC). One out of the three samples investigated had a significant number of ASOPs, while the other two samples contained TBs. Although there are chemical similarities between ASOPs and TBs, they can be distinguished based on composition inferred from near-edge absorption X-ray fine structure (NEXAFS) spectroscopy. ASOPs were distinguished from TBs based on their average − COOH/C = C and − COOH/COH peak ratios, with ASOPs having lower ratios. NEXAFS spectra of filtered soil organic brine particles nebulized from field samples of standing water deposited after rain were consistent with ASOPs when laboratory particles were generated by bubble bursting at the air–organic brine interface. However, particles generated by nebulizing the bulk volume of soil organic brine had a particle composition different from ASOPs. These observations are consistent with the raindrop generation mechanism responsible for ASOP emissions in the area of study. In contrast, nebulized samples carry with them higher fractions of soil inorganics dissolved in the bulk volume of soil brine, which are not aerosolized by the raindrop mechanism. Our results support the bubble bursting mechanism of particle generation during rainfall resulting in the ejection of soil organics into the atmosphere. In addition, our results show that ASOPs may only be atmospherically relevant during times when suitable emission conditions are met

Elemental Mixing State of Aerosol Particles Collected in Central Amazonia during GoAmazon2014/15

Two complementary techniques, Scanning Transmission X-ray Microscopy/Near Edge Fine Structure spectroscopy (STXM/NEXAFS) and Scanning Electron Microscopy/Energy Dispersive X-ray spectroscopy (SEM/EDX), have been quantitatively combined to characterize individual atmospheric particles. This pair of techniques was applied to particle samples at three sampling sites (ATTO, ZF2, and T3) in the Amazon basin as part of the Observations and Modeling of the Green Ocean Amazon (GoAmazon2014/5) field campaign during the dry season of 2014. The combined data was subjected to k-means clustering using mass fractions of the following elements: C, N, O, Na, Mg, P, S, Cl, K, Ca, Mn, Fe, Ni, and Zn. Cluster analysis identified 12 particle types across different sampling sites and particle sizes. Samples from the remote Amazon Tall Tower Observatory (ATTO, also T0a) exhibited less cluster variety and fewer anthropogenic clusters than samples collected at the sites nearer to the Manaus metropolitan region, ZF2 (also T0t) or T3. Samples from the ZF2 site contained aged/anthropogenic clusters not readily explained by transport from ATTO or Manaus, possibly suggesting the effects of long range atmospheric transport or other local aerosol sources present during sampling. In addition, this data set allowed for recently established diversity parameters to be calculated. All sample periods had high mixing state indices (χ) that were \u3e0.8. Two individual particle diversity (Di) populations were observed, with particles \u3c0.5 µm having a Di of ~2.4 and \u3e0.5 µm particles having a Di of ~3.6, which likely correspond to fresh and aged aerosols, respectively. The diversity parameters determined by the quantitative method presented here will serve to aid in the accurate representation of aerosol mixing state, source apportionment, and aging in both less polluted and more developed environments in the Amazon Basin

The primordial nucleus of comet 67P/Churyumov-Gerasimenko

Context. We investigate the formation and evolution of comet nuclei and other trans-Neptunian objects (TNOs) in the solar nebula and primordial disk prior to the giant planet orbit instability foreseen by the Nice model. Aims. Our goal is to determine whether most observed comet nuclei are primordial rubble-pile survivors that formed in the solar nebula and young primordial disk or collisional rubble piles formed later in the aftermath of catastrophic disruptions of larger parent bodies. We also propose a concurrent comet and TNO formation scenario that is consistent with observations. Methods. We used observations of comet 67P/Churyumov-Gerasimenko by the ESA Rosetta spacecraft, particularly by the OSIRIS camera system, combined with data from the NASA Stardust sample-return mission to comet 81P/Wild 2 and from meteoritics; we also used existing observations from ground or from spacecraft of irregular satellites of the giant planets, Centaurs, and TNOs. We performed modeling of thermophysics, hydrostatics, orbit evolution, and collision physics. Results. We find that thermal processing due to short-lived radionuclides, combined with collisional processing during accretion in the primordial disk, creates a population of medium-sized bodies that are comparably dense, compacted, strong, heavily depleted in supervolatiles like CO and CO2; they contain little to no amorphous water ice, and have experienced extensive metasomatism and aqueous alteration due to liquid water. Irregular satellites Phoebe and Himalia are potential representatives of this population. Collisional rubble piles inherit these properties from their parents. Contrarily, comet nuclei have low density, high porosity, weak strength, are rich in supervolatiles, may contain amorphous water ice, and do not display convincing evidence of in situ metasomatism or aqueous alteration. We outline a comet formation scenario that starts in the solar nebula and ends in the primordial disk, that reproduces these observed properties, and additionally explains the presence of extensive layering on 67P/Churyumov-Gerasimenko (and on 9P/Tempel 1 observed by Deep Impact), its bi-lobed shape, the extremely slow growth of comet nuclei as evidenced by recent radiometric dating, and the low collision probability that allows primordial nuclei to survive the age of the solar system. Conclusions. We conclude that observed comet nuclei are primordial rubble piles, and not collisional rubble piles. We argue that TNOs formed as a result of streaming instabilities at sizes below ∼400 km and that ∼350 of these grew slowly in a low-mass primordial disk to the size of Triton, Pluto, and Eris, causing little viscous stirring during growth. We thus propose a dynamically cold primordial disk, which prevented medium-sized TNOs from breaking into collisional rubble piles and allowed the survival of primordial rubble-pile comets. We argue that comets formed by hierarchical agglomeration out of material that remained after TNO formation, and that this slow growth was a necessity to avoid thermal processing by short-lived radionuclides that would lead to loss of supervolatiles, and that allowed comet nuclei to incorporate ∼3 Myr old material from the inner solar system

Large-scale dust jets in the coma of 67P/Churyumov-Gerasimenko as seen by the OSIRIS instrument onboard Rosetta

During the most recent perihelion passage in 2009 of comet 67P/Churyumov-Gerasimenko (67P), ground-based observations showed an anisotropic dust coma where jet-like features were detected at ~ 1.3 AU from the Sun. The current perihelion passage is exceptional as the Rosetta spacecraft is monitoring the nucleus activity since March 2014, when a clear dust coma was already surrounding the nucleus at 4.3 AU from the Sun. Subsequently, the OSIRIS camera also witnessed an outburst in activity between April 27 and 30, and since mid-July, the dust coma at rh ~ 3.7-3.6 AU preperihelion is clearly non-isotropic, pointing to the existence of dust jet-like features. We aim to ascertain on the nucleus surface the origin of the dust jet-like features detected as early as in mid-July 2014. This will help to establish how the localized comet nucleus activity compares with that seen in previous apparitions and will also help following its evolution as the comet approaches its perihelion, at which phase most of the jets were detected from ground-based observations. Determining these areas also allows locating them in regions on the nucleus with spectroscopic or geomorphological distinct characteristics. Methods. Three series of dust images of comet 67P obtained with the Wide Angle Camera (WAC) of the OSIRIS instrument onboard the Rosetta spacecraft were processed with different enhancement techniques. This was made to clearly show the existence of jet-like features in the dust coma, whose appearance toward the observer changed as a result of the rotation of the comet nucleus and of the changing observing geometry from the spacecraft. The position angles of these features in the coma together with information on the observing geometry, nucleus shape, and rotation, allowed us to determine the most likely locations on the nucleus surface where the jets originate from. Results. Geometrical tracing of jet sources indicates that the activity of the nucleus of 67P gave rise during July and August 2014 to large-scale jet-like features from the Hapi, Hathor, Anuket, and Aten regions, confirming that active regions may be present on the nucleus localized at 60° northern latitude as deduced from previous comet apparitions. There are also hints that large-scale jets observed from the ground are possibly composed, at their place of origin on the nucleus surface, of numerous small-scale features

Thermophysics of fractures on comet 67P/Churyumov-Gerasimenko

Context. The camera OSIRIS on board Rosetta obtained high-resolution images of the nucleus of comet 67P/Churyumov-Gerasimenko (67P). Great parts of the nucleus surface are composed of fractured terrain. Aims. Fracture formation, evolution, and their potential relationship to physical processes that drive activity are not yet fully understood. Observed temperatures and gas production rates can be explained or interpreted with the presence of fractures by applying appropriate modelling methods. Methods. We followed a transient thermophysical model approach that includes radiative, conductive, and water-ice sublimation fluxes by considering a variety of heliocentric distances, illumination conditions, and thermophysical properties for a set of characteristic fracture geometries on the nucleus of 67P. We computed diurnal temperatures, heat fluxes, and outgassing behaviour in order to derive and distinguish the influence of the mentioned parameters on fractured terrain. Results. Our analysis confirms that fractures, as already indicated by former studies about concavities, deviate from flat-terrain topographies with equivalent properties, mostly through the effect of self-heating. Compared to flat terrain, illuminated cometary fractures are generally warmer, with smaller diurnal temperature fluctuations. Maximum sublimation rates reach higher peaks, and dust mantle quenching effects on sublimation rates are weaker. Consequently, the rough structure of the fractured terrain leads to significantly higher inferred surface thermal inertia values than for flat areas with identical physical properties, which might explain the range of measured thermal inertia on 67P. Conclusions. At 3.5 AU heliocentric distance, sublimation heat sinks in fractures converge to maximum values &gt;50 W / m2 and trigger dust activity that can be related mainly to H2O. Fractures are likely to grow through the erosive interplay of alternating sublimation and thermal fatigue

Influenza vaccination for immunocompromised patients: systematic review and meta-analysis from a public health policy perspective.

Immunocompromised patients are vulnerable to severe or complicated influenza infection. Vaccination is widely recommended for this group. This systematic review and meta-analysis assesses influenza vaccination for immunocompromised patients in terms of preventing influenza-like illness and laboratory confirmed influenza, serological response and adverse events

The primordial nucleus of comet 67P/Churyumov-Gerasimenko

Context. We investigate the formation and evolution of comet nuclei and other trans-Neptunian objects (TNOs) in the solar nebula and primordial disk prior to the giant planet orbit instability foreseen by the Nice model. Aims: Our goal is to determine whether most observed comet nuclei are primordial rubble-pile survivors that formed in the solar nebula and young primordial disk or collisional rubble piles formed later in the aftermath of catastrophic disruptions of larger parent bodies. We also propose a concurrent comet and TNO formation scenario that is consistent with observations. Methods: We used observations of comet 67P/Churyumov-Gerasimenko by the ESA Rosetta spacecraft, particularly by the OSIRIS camera system, combined with data from the NASA Stardust sample-return mission to comet 81P/Wild 2 and from meteoritics; we also used existing observations from ground or from spacecraft of irregular satellites of the giant planets, Centaurs, and TNOs. We performed modeling of thermophysics, hydrostatics, orbit evolution, and collision physics. Results: We find that thermal processing due to short-lived radionuclides, combined with collisional processing during accretion in the primordial disk, creates a population of medium-sized bodies that are comparably dense, compacted, strong, heavily depleted in supervolatiles like CO and CO2; they contain little to no amorphous water ice, and have experienced extensive metasomatism and aqueous alteration due to liquid water. Irregular satellites Phoebe and Himalia are potential representatives of this population. Collisional rubble piles inherit these properties from their parents. Contrarily, comet nuclei have low density, high porosity, weak strength, are rich in supervolatiles, may contain amorphous water ice, and do not display convincing evidence of in situ metasomatism or aqueous alteration. We outline a comet formation scenario that starts in the solar nebula and ends in the primordial disk, that reproduces these observed properties, and additionally explains the presence of extensive layering on 67P/Churyumov-Gerasimenko (and on 9P/Tempel 1 observed by Deep Impact), its bi-lobed shape, the extremely slow growth of comet nuclei as evidenced by recent radiometric dating, and the low collision probability that allows primordial nuclei to survive the age of the solar system. Conclusions: We conclude that observed comet nuclei are primordial rubble piles, and not collisional rubble piles. We argue that TNOs formed as a result of streaming instabilities at sizes below ~400 km and that ~350 of these grew slowly in a low-mass primordial disk to the size of Triton, Pluto, and Eris, causing little viscous stirring during growth. We thus propose a dynamically cold primordial disk, which prevented medium-sized TNOs from breaking into collisional rubble piles and allowed the survival of primordial rubble-pile comets. We argue that comets formed by hierarchical agglomeration out of material that remained after TNO formation, and that this slow growth was a necessity to avoid thermal processing by short-lived radionuclides that would lead to loss of supervolatiles, and that allowed comet nuclei to incorporate ~3 Myr old material from the inner solar system

2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease

The recommendations listed in this document are, whenever possible, evidence based. An extensive evidence review was conducted as the document was compiled through December 2008. Repeated literature searches were performed by the guideline development staff and writing committee members as new issues were considered. New clinical trials published in peer-reviewed journals and articles through December 2011 were also reviewed and incorporated when relevant. Furthermore, because of the extended development time period for this guideline, peer review comments indicated that the sections focused on imaging technologies required additional updating, which occurred during 2011. Therefore, the evidence review for the imaging sections includes published literature through December 2011

The Rosetta Mission - Where no Spacecraft has gone before

This Talk will provide an overview on the Scientific Highlights of the Rosetta Mission. After travelling through the Solar System for nearly 10 years Rosetta arrived at its main target, Comet 67/P Churyumov-Gerasimenko, in August 2014. Following an initial characterisation of the Comet, the lander unit Philae touched down on the partly active Nucleus on November 12 of the same year. The data acquired from the numerous instruments onboard the Spacecraft provides a unique insight into the properties of the Comets. While most of the measurements and processing of the data are still ongoing, the results from the Mission provide continuous surprises to the scientific community. While the Lander has been reactivated with some difficulties after a few months of inactivity due to low insolation levels, the Orbiter is pursuing its main mission objectives until the end of its extended Mission in Autumn 2016. During the long journey, the Spacecraft had encountered Earth, Mars and two Asteroids ( 2867 Šteins and 21 Lutetia) and even performed some Astronomical observations