Mass and Angular Momentum Transfer in the Massive Algol Binary RY Persei

We present an investigation of H-alpha emission line variations observed in the massive Algol binary, RY Per. We give new radial velocity data for the secondary based upon our optical spectra and for the primary based upon high dispersion UV spectra. We present revised orbital elements and an estimate of the primary's projected rotational velocity (which indicates that the primary is rotating 7 times faster than synchronous). We use a Doppler tomography algorithm to reconstruct the individual primary and secondary spectra in the region of H-alpha, and we subtract the latter from each of our observations to obtain profiles of the primary and its disk alone. Our H-alpha observations of RY Per show that the mass gaining primary is surrounded by a persistent but time variable accretion disk. The profile that is observed outside-of-eclipse has weak, double-peaked emission flanking a deep central absorption, and we find that these properties can be reproduced by a disk model that includes the absorption of photospheric light by the band of the disk seen in projection against the face of the star. We developed a new method to reconstruct the disk surface density distribution from the ensemble of H-alpha profiles observed around the orbit, and this method accounts for the effects of disk occultation by the stellar components, the obscuration of the primary by the disk, and flux contributions from optically thick disk elements. The resulting surface density distribution is elongated along the axis joining the stars, in the same way as seen in hydrodynamical simulations of gas flows that strike the mass gainer near trailing edge of the star. This type of gas stream configuration is optimal for the transfer of angular momentum, and we show that rapid rotation is found in other Algols that have passed through a similar stage.Comment: 39 pages, 12 figures, ApJ in press, 2004 June 20 issu

The SCARE Statement: Consensus-based surgical case report guidelines

Introduction: Case reports have been a long held tradition within the surgical literature. Reporting guidelines can improve transparency and reporting quality. However, recent consensus-based guidelines for case reports (CARE) are not surgically focused. Our objective was to develop surgical case report guidelines. Methods: The CARE statement was used as the basis for a Delphi consensus. The Delphi questionnaire was administered via Google Forms and conducted using standard Delphi methodology. A multidisciplinary group of surgeons and others with expertise in the reporting of case reports were invited to participate. In round one, participants stated how each item of the CARE statement should be changed and what additional items were needed. Revised and additional items from round one were put forward into a further round, where participants voted on the extent of their agreement with each item, using a nine-point Likert scale, as proposed by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) working group. Results: In round one, there was a 64% (38/59) response rate. Following adjustment of the guideline with the incorporation of recommended changes, round two commenced and there was an 83% (49/59) response rate. All but one of the items were approved by the participants, with Likert scores 7–9 awarded by >70% of respondents. The final guideline consists of a 14-item checklist. Conclusion: We present the SCARE Guideline, consisting of a 14-item checklist that will improve the reporting quality of surgical case reports

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Semi-parametric risk prediction models for recurrent cardiovascular events in the LIPID study

Background: Traditional methods for analyzing clinical and epidemiological cohort study data have been focused on the first occurrence of a health outcome. However, in many situations, recurrent event data are frequently observed. It is inefficient to use methods for the analysis of first events to analyse recurrent event data

Efficient land water management practice and cropping system for increasing water and crop productivity in semi‐arid tropics

In Indian semi-arid tropics (SATs), low water and crop productivity in Vertisols and associated soils are mainly due to poor land management and erratic and low rainfall occurrence. This study was conducted from 2014 to 2016 at the ICRISAT in India to test the effect of broad bed furrows (BBF) as land water management against conventional flatbed planting for improving soil water content (SWC) and water and crop productivity of three cropping systems: sorghum [Sorghum bicolor (L.) Moench]–chickpea (Cicer arientinum L.) and maize (Zea mays)–groundnut (Arachis hypogaea L.) as sequential and pearl millet [Pennisetum glaucum (L.)] + pigeonpea [Cajanus cajan (L.) Millsp.] as intercropping, grown under different nutrients management involving macronutrients (N, P, and K) only and combined application of macro- and micronutrients. The results stated that the SWC in BBF was higher over flatbed by 9.35–10.44% in 0- to 0.3-m, 4.56–9.30% in 0.3- to 0.6-m and 3.85–5.26% in 0.6- to 1.05-m soil depths during the cropping season. Moreover, depletion of the soil water through plant uptake was higher in BBF than in flatbed. Among the cropping systems, sorghum–chickpea was the best in bringing highest system equivalent yield and water productivity with the combined application of macro- and micronutrients. The BBF minimized water stress at critical crop growth stages leading to increase crop yield and water productivity in SATs. Thus, BBF along with the application of macro- and micronutrients could be an adaptation strategy to mitigate erratic rainfall due to climate change in SATs

Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF.

AIMS: The relationship between outcomes and time after diagnosis for patients with non-valvular atrial fibrillation (NVAF) is poorly defined, especially beyond the first year. METHODS AND RESULTS: GARFIELD-AF is an ongoing, global observational study of adults with newly diagnosed NVAF. Two-year outcomes of 17 162 patients prospectively enrolled in GARFIELD-AF were analysed in light of baseline characteristics, risk profiles for stroke/systemic embolism (SE), and antithrombotic therapy. The mean (standard deviation) age was 69.8 (11.4) years, 43.8% were women, and the mean CHA2DS2-VASc score was 3.3 (1.6); 60.8% of patients were prescribed anticoagulant therapy with/without antiplatelet (AP) therapy, 27.4% AP monotherapy, and 11.8% no antithrombotic therapy. At 2-year follow-up, all-cause mortality, stroke/SE, and major bleeding had occurred at a rate (95% confidence interval) of 3.83 (3.62; 4.05), 1.25 (1.13; 1.38), and 0.70 (0.62; 0.81) per 100 person-years, respectively. Rates for all three major events were highest during the first 4 months. Congestive heart failure, acute coronary syndromes, sudden/unwitnessed death, malignancy, respiratory failure, and infection/sepsis accounted for 65% of all known causes of death and strokes for <10%. Anticoagulant treatment was associated with a 35% lower risk of death. CONCLUSION: The most frequent of the three major outcome measures was death, whose most common causes are not known to be significantly influenced by anticoagulation. This suggests that a more comprehensive approach to the management of NVAF may be needed to improve outcome. This could include, in addition to anticoagulation, interventions targeting modifiable, cause-specific risk factors for death. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov. Unique identifier: NCT01090362