Cardiogenic Shock

80% of people developing shock after myocardial infarction die. This essay is concerned to ask why they die and what can be done about it.Accordingly it consists of two parts: the one concerned with the definition and some relevant aspects of the pathogenesis of cardiogenic shock; the other concerned with therapy, its difficulties and its future

Post impact evaluation of an E-learning cross-infection control CD-ROM provided to all general dental practitioners in England

Aim To carry out a post-impact evaluation of a cross-infection control CD-ROM, developed for NHS dental teams as a continuing professional development e-learning tool. The program was commissioned by the Department of Health and developed by a project team through the UK Committee of Postgraduate Dental Deans. The Dental Practice Boardhad originally sent one copy of the CD-ROM to each dental practice in England in 2004. Method A quantitative statistical analysis of the results of 326 online respondents to the learning package and a survey of 118 dental practitioners drawn from the Dental Practice Board database. Results Practitioners felt the CD-ROM in this instance was well designed and appropriate for their needs. It is inclusive and accessible to a wide range of dental professionals including nurses and hygienists. Conclusions This form of continuing professional development is popular with dental practitioners, although it should not be the only form of continuing professional development available. However, whilst the project was generally regarded as successful, there were problems with the distribution of the CD-ROM. This suggests that anonline resource should be made available in the future

Spitzer characterisation of dust in an anomalous emission region: the Perseus cloud

Anomalous microwave emission is known to exist in the Perseus cloud. One of the most promising candidates to explain this excess of emission is electric dipole radiation from rapidly rotating very small dust grains, commonly referred to as spinning dust. Photometric data obtained with the Spitzer Space Telescope have been reprocessed and used in conjunction with the dust emission model DUSTEM to characterise the properties of the dust within the cloud. This analysis has allowed us to constrain spatial variations in the strength of the interstellar radiation field ($\chi_\mathrm{ISRF}$), the mass abundances of the PAHs and VSGs relative to the BGs (Y$_\mathrm{PAH}$ and Y$_\mathrm{VSG}$), the column density of hydrogen (N$_\mathrm{H}$) and the equilibrium dust temperature (T$_\mathrm{dust}$). The parameter maps of Y$_\mathrm{PAH}$, Y$_\mathrm{VSG}$ and $\chi_\mathrm{ISRF}$ are the first of their kind to be produced for the Perseus cloud, and we used these maps to investigate the physical conditions in which anomalous emission is observed. We find that in regions of anomalous emission the strength of the ISRF, and consequently the equilibrium temperature of the dust, is enhanced while there is no significant variation in the abundances of the PAHs and the VSGs or the column density of hydrogen. We interpret these results as an indication that the enhancement in $\chi_\mathrm{ISRF}$ might be affecting the properties of the small stochastically heated dust grains resulting in an increase in the spinning dust emission observed at 33 GHz. This is the first time that such an investigation has been performed, and we believe that this type of analysis creates a new perspective in the field of anomalous emission studies, and represents a powerful new tool for constraining spinning dust models.Comment: 13 pages, 9 figures, accepted for publication in MNRA

The Spiral Structure of the Milky Way, Cosmic Rays, and Ice Age Epochs on Earth

The short term variability of the Galactic cosmic ray flux (CRF) reaching Earth has been previously associated with variations in the global low altitude cloud cover. This CRF variability arises from changes in the solar wind strength. However, cosmic ray variability also arises intrinsically from variable activity of and motion through the Milky Way. Thus, if indeed the CRF climate connection is real, the increased CRF witnessed while crossing the spiral arms could be responsible for a larger global cloud cover and a reduced temperature, thereby facilitating the occurrences of ice ages. This picture has been recently shown to be supported by various data (Shaviv, 2001). In particular, the variable CRF recorded in Iron meteorites appears to vary synchronously with the appearance ice ages. Here we expand upon the original treatment with a more thorough analysis and more supporting evidence. In particular, we discuss the cosmic ray diffusion model which considers the motion of the Galactic spiral arms. We also elaborate on the structure and dynamics of the Milky Way's spiral arms. In particular, we bring forth new argumentation using HI observations which imply that the galactic spiral arm pattern speed appears to be that which fits the glaciation period and the cosmic-ray flux record extracted from Iron meteorites. In addition, we show that apparent peaks in the star formation rate history, as deduced by several authors, coincides with particularly icy epochs, while the long period of 1 to 2 Gyr before present, during which no glaciations are known to have occurred, coincides with a significant paucity in the past star formation rate.Comment: 33 pages, 11 figures. To Appear in New Astronom

Developing Risk Management as a Competitive Capability

At the level of the firm, three major parameters are found to influence the ability of SMEs to develop risk management competencies; these are enterprise risk management, internal control, and risk culture

Angular Power Spectra of the Millimeter Wavelength Background Light from Dusty Star-forming Galaxies with the South Pole Telescope

We use data from the first 100 square-degree field observed by the South Pole Telescope (SPT) in 2008 to measure the angular power spectrum of temperature anisotropies contributed by the background of dusty star-forming galaxies (DSFGs) at millimeter wavelengths. From the auto and cross-correlation of 150 and 220 GHz SPT maps, we significantly detect both Poisson distributed and, for the first time at millimeter wavelengths, clustered components of power from a background of DSFGs. The spectral indices between 150 and 220 GHz of the Poisson and clustered components are found to be 3.86 +- 0.23 and 3.8 +- 1.3 respectively, implying a steep scaling of the dust emissivity index beta ~ 2. The Poisson and clustered power detected in SPT, BLAST (at 600, 860, and 1200 GHz), and Spitzer (1900 GHz) data can be understood in the context of a simple model in which all galaxies have the same graybody spectrum with dust emissivity index of beta = 2 and dust temperature T_d = 34 K. In this model, half of the 150 GHz background light comes from redshifts greater than 3.2. We also use the SPT data to place an upper limit on the amplitude of the kinetic Sunyaev-Zel'dovich power spectrum at l = 3000 of 13 uK^2 at 95% confidence.Comment: 18 pages, 9 figure

What does inflation really predict?

If the inflaton potential has multiple minima, as may be expected in, e.g., the string theory "landscape", inflation predicts a probability distribution for the cosmological parameters describing spatial curvature (Omega_tot), dark energy (rho_Lambda, w, etc.), the primordial density fluctuations (Omega_tot, dark energy (rho_Lambda, w, etc.). We compute this multivariate probability distribution for various classes of single-field slow-roll models, exploring its dependence on the characteristic inflationary energy scales, the shape of the potential V and and the choice of measure underlying the calculation. We find that unless the characteristic scale Delta-phi on which V varies happens to be near the Planck scale, the only aspect of V that matters observationally is the statistical distribution of its peaks and troughs. For all energy scales and plausible measures considered, we obtain the predictions Omega_tot ~ 1+-0.00001, w=-1 and rho_Lambda in the observed ballpark but uncomfortably high. The high energy limit predicts n_s ~ 0.96, dn_s/dlnk ~ -0.0006, r ~ 0.15 and n_t ~ -0.02, consistent with observational data and indistinguishable from eternal phi^2-inflation. The low-energy limit predicts 5 parameters but prefers larger Q and redder n_s than observed. We discuss the coolness problem, the smoothness problem and the pothole paradox, which severely limit the viable class of models and measures. Our findings bode well for detecting an inflationary gravitational wave signature with future CMB polarization experiments, with the arguably best-motivated single-field models favoring the detectable level r ~ 0.03. (Abridged)Comment: Replaced to match accepted JCAP version. Improved discussion, references. 42 pages, 17 fig

A roadmap for global synthesis of the plant tree of life

Providing science and society with an integrated, up-to-date, high quality, open, reproducible and sustainable plant tree of life would be a huge service that is now coming within reach. However, synthesizing the growing body of DNA sequence data in the public domain and disseminating the trees to a diverse audience are often not straightforward due to numerous informatics barriers. While big synthetic plant phylogenies are being built, they remain static and become quickly outdated as new data are published and tree-building methods improve. Moreover, the body of existing phylogenetic evidence is hard to navigate and access for non-experts. We propose that our community of botanists, tree builders, and informaticians should converge on a modular framework for data integration and phylogenetic analysis, allowing easy collaboration, updating, data sourcing and flexible analyses. With support from major institutions, this pipeline should be re-run at regular intervals, storing trees and their metadata long-term. Providing the trees to a diverse global audience through user-friendly front ends and application development interfaces should also be a priority. Interactive interfaces could be used to solicit user feedback and thus improve data quality and to coordinate the generation of new data. We conclude by outlining a number of steps that we suggest the scientific community should take to achieve global phylogenetic synthesis

Character, Incidence, and Predictors of Knee Pain and Activity after Infrapatellar Intramedullary Nailing of an Isolated Tibia Fracture

© Copyright 2015 Wolters Kluwer Health, Inc. All rights reserved. Objective: To study the activity and incidence of knee pain after sustaining an isolated tibia fracture treated with an infrapatellar intramedullary nail at 1 year. Design: Retrospective review of prospective cohort. Setting: Multicenter Academic and Community hospitals. Patients: Four hundred thirty-seven patients with an isolated tibia fracture completed a 12-month assessment on pain and self-reported activity. Intervention: Infrapatellar intramedullary nail. Outcomes: Demographic information, comorbid conditions, injury characteristics, and surgical technique were recorded. Knee pain was defined on a 1-7 scale with 1 being no pain and 7 being a very great deal of pain. Knee pain \u3e4 was considered clinically significant. Patients reported if they were able, able with difficulty, or unable to perform the following activities: kneel, run, climb stairs, and walk prolonged. Variables were tested in multilevel multivariable regression analyses. Results: In knee pain, 11% of patients reported a good deal to a very great deal of pain (\u3e4), and 52% of patients reported no or very little pain at 12 months. In activity at 12 months, 26% and 29% of patients were unable to kneel or run, respectively, and 31% and 35% of patients, respectively, stated they were able with difficulty or unable to use stairs or walk. Conclusions: Clinically significant knee pain (\u3e4/7) was present in 11% of patients 1 year after a tibia fracture. Of note, 31%-71% of patients had difficulty performing or were unable to perform routine daily activities of kneeling, running, and stair climbing, or walking prolonged distances