Bubble, Bubble, Flow and Hubble: Large Scale Galaxy Flow from Cosmological Bubble Collisions

We study large scale structure in the cosmology of Coleman-de Luccia bubble collisions. Within a set of controlled approximations we calculate the effects on galaxy motion seen from inside a bubble which has undergone such a collision. We find that generically bubble collisions lead to a coherent bulk flow of galaxies on some part of our sky, the details of which depend on the initial conditions of the collision and redshift to the galaxy in question. With other parameters held fixed the effects weaken as the amount of inflation inside our bubble grows, but can produce measurable flows past the number of efolds required to solve the flatness and horizon problems.Comment: 30 pages, 8 figures, pdftex, minor corrections and references adde

Polarizing Bubble Collisions

We predict the polarization of cosmic microwave background (CMB) photons that results from a cosmic bubble collision. The polarization is purely E-mode, symmetric around the axis pointing towards the collision bubble, and has several salient features in its radial dependence that can help distinguish it from a more conventional explanation for unusually cold or hot features in the CMB sky. The anomalous "cold spot" detected by the Wilkinson Microwave Anisotropy Probe (WMAP) satellite is a candidate for a feature produced by such a collision, and the Planck satellite and other proposed surveys will measure the polarization on it in the near future. The detection of such a collision would provide compelling evidence for the string theory landscape.Comment: Published version. 15 pages, 8 figure

Typicality versus thermality: An analytic distinction

In systems with a large degeneracy of states such as black holes, one expects that the average value of probe correlation functions will be well approximated by the thermal ensemble. To understand how correlation functions in individual microstates differ from the canonical ensemble average and from each other, we study the variances in correlators. Using general statistical considerations, we show that the variance between microstates will be exponentially suppressed in the entropy. However, by exploiting the analytic properties of correlation functions we argue that these variances are amplified in imaginary time, thereby distinguishing pure states from the thermal density matrix. We demonstrate our general results in specific examples and argue that our results apply to the microstates of black holes.Comment: 22 pages + appendices, 3 eps figure

Hydrocortisone therapy for patients with septic shock

Background Hydrocortisone is widely used in patients with septic shock even though a survival benefit has been reported only in patients who remained hypotensive after fluid and vasopressor resuscitation and whose plasma cortisol levels did not rise appropriately after the administration of corticotropin. Methods In this multicenter, randomized, double-blind, placebo-controlled trial, we assigned 251 patients to receive 50 mg of intravenous hydrocortisone and 248 patients to receive placebo every 6 hours for 5 days; the dose was then tapered during a 6-day period. At 28 days, the primary outcome was death among patients who did not have a response to a corticotropin test. Results Of the 499 patients in the study, 233 (46.7%) did not have a response to corticotropin (125 in the hydrocortisone group and 108 in the placebo group). At 28 days, there was no significant difference in mortality between patients in the two study groups who did not have a response to corticotropin (39.2% in the hydrocortisone group and 36.1% in the placebo group, P=0.69) or between those who had a response to corticotropin (28.8% in the hydrocortisone group and 28.7% in the placebo group, P=1.00). At 28 days, 86 of 251 patients in the hydrocortisone group (34.3%) and 78 of 248 patients in the placebo group (31.5%) had died (P=0.51). In the hydrocortisone group, shock was reversed more quickly than in the placebo group. However, there were more episodes of superinfection, including new sepsis and septic shock. Conclusions Hydrocortisone did not improve survival or reversal of shock in patients with septic shock, either overall or in patients who did not have a response to corticotropin, although hydrocortisone hastened reversal of shock in patients in whom shock was reversed. (ClinicalTrials.gov number, NCT00147004 [ClinicalTrials.gov] .)Peer reviewedPublisher PD

Safety and clinical outcomes of rituximab therapy in patients with different autoimmune diseases: experience from a national registry (GRAID)

Introduction: Evidence from a number of open-label, uncontrolled studies has suggested that rituximab may benefit patients with autoimmune diseases who are refractory to standard-of-care. The objective of this study was to evaluate the safety and clinical outcomes of rituximab in several standard-of-care-refractory autoimmune diseases (within rheumatology, nephrology, dermatology and neurology) other than rheumatoid arthritis or non-Hodgkin's lymphoma in a real-life clinical setting. Methods: Patients who received rituximab having shown an inadequate response to standard-of-care had their safety and clinical outcomes data retrospectively analysed as part of the German Registry of Autoimmune Diseases. The main outcome measures were safety and clinical response, as judged at the discretion of the investigators. Results: A total of 370 patients (299 patient-years) with various autoimmune diseases (23.0% with systemic lupus erythematosus, 15.7% antineutrophil cytoplasmic antibody-associated granulomatous vasculitides, 15.1% multiple sclerosis and 10.0% pemphigus) from 42 centres received a mean dose of 2,440 mg of rituximab over a median (range) of 194 (180 to 1,407) days. The overall rate of serious infections was 5.3 per 100 patient-years during rituximab therapy. Opportunistic infections were infrequent across the whole study population, and mostly occurred in patients with systemic lupus erythematosus. There were 11 deaths (3.0% of patients) after rituximab treatment (mean 11.6 months after first infusion, range 0.8 to 31.3 months), with most of the deaths caused by infections. Overall (n = 293), 13.3% of patients showed no response, 45.1% showed a partial response and 41.6% showed a complete response. Responses were also reflected by reduced use of glucocorticoids and various immunosuppressives during rituximab therapy and follow-up compared with before rituximab. Rituximab generally had a positive effect on patient well-being (physician's visual analogue scale; mean improvement from baseline of 12.1 mm). Conclusions: Data from this registry indicate that rituximab is a commonly employed, well-tolerated therapy with potential beneficial effects in standard of care-refractory autoimmune diseases, and support the results from other open-label, uncontrolled studies

Etomidate versus Ketamine (response to Andrade and Pallin)

info:eu-repo/semantics/publishe

Reply to Andrade and Pallin

This reply refers to the comments available at: doi: 10.1007/s00134-010-1878-5 and 10.1007/s00134-010-1880-y

Systemic sclerosis - dermatological aspects. Part 1: Pathogenesis, epidemiology, clinical findings

Systemic sclerosis is a chronic inflammatory multiorgan disease belonging to the group of collagen-vascular disorders. With a prevalence of 10/100,000 inhabitants it may be regarded a rather rare disease. Its etiology and pathogenesis have still not been elucidated in detail, especially with regard to the differential involvement of skin and the cause of the clinically heterogeneous disease courses. Various components of the vasculature, connective tissue as well as the immune system are involved in a yet unknown sequence and significance. Patients need to be cared for in an interdisciplinary fashion depending on the individual organ involvement. Apart from the skin, the heart, kidneys and lungs are mainly affected in addition to frequent gastrointestinal and musculoskeletal symptoms. Clinically two distinct subsets may be separated, acral (also termed limited) and diffuse scleroderma, which are characterized by anti-centromere and anti-Scl-70/topoisomerase-1 antibodies, respectively. Recent data demonstrate a poor prognosis even in limited disease when pulmonary arterial hypertension develops at an early stage. In diffuse disease sudden and rapid onset will result in a sclerosis of major internal organs and early death in many cases

The effects of etomidate on adrenal responsiveness and mortality in patients with septic shock.

Use of etomidate in the critically ill is controversial due to its links with an inadequate response to corticotropin and potential for excess mortality. In a septic shock population, we tested the hypotheses that etomidate administration induces more non-responders to corticotropin and increases mortality and that hydrocortisone treatment decreases mortality in patients receiving etomidate.Journal ArticleMulticenter StudyRandomized Controlled TrialResearch Support, Non-U.S. Gov'tSCOPUS: ar.jinfo:eu-repo/semantics/publishe