Protocol for electrophysiological monitoring of carotid endarterectomies.

Near zero stroke rates can be achieved in carotid endarterectomy (CEA) surgery with selective shunting and electrophysiological neuromonitoring. though false negative rates as high as 40% have been reported. We sought to determine if improved training for interpretation of the monitoring signals can advance the efficacy of selective shunting with electrophysiological monitoring across multiple centers, and determine if other factors could contribute to the differences in reports. Processed and raw beta band (12.5-30 Hz) electroencephalogram (EEG) and median and tibial nerve somatosensory evoked potentials (SSEP) were monitored in 668 CEA cases at six surgical centers. A decrease in amplitude of 50% or more in any EEG or SSEP channel was the criteria for shunting or initiating a neuroprotective protocol. A reduction of 50% or greater in the beta band of the EEG or amplitude of the SSEP was observed in 150 cases. No patient showed signs of a cerebral infarct after surgery. Selective shunting based on EEG and SSEP monitoring can reduce CEA intraoperative stroke rate to a near zero level if trained personnel adopted standardized protocols. We also found that the rapid administration of a protective stroke protocol by attending anesthesiologists was an important aspect of this success rate

The effect of the l’Aquila earthquake on labour market outcomes

Using Labour Force Survey individual-level data recently released by the Italian Institute of Statistics (ISTAT) where information is for the first time at available at provincial level, this paper looks at the short-term effects of the L’Aquila earthquake on labour market outcomes. Our estimates are based on a difference-in-differences (DiD) strategy that compares residents of L’Aquila with residents of a control area before and after the earthquake. The empirical results suggest that while the earthquake had no significant effect on the employment-population ratio, it led to a modest, but significant, reduction in labour force participation. There is also evidence of significant heterogeneous effects by gender and level of education

Socio-economic inequality and inequity in use of health care services in Kenya: evidence from the fourth Kenya household health expenditure and utilization survey

BACKGROUND: Kenya is experiencing persistently high levels of inequity in health and access to care services. In 2018, decades of sustained policy efforts to promote equitable, affordable and quality health services have culminated in the launch of a universal health coverage scheme, initially piloted in four Kenyan counties and planned for national rollout by 2022. Our study aims to contribute to monitoring and evaluation efforts alongside policy implementation, by establishing a detailed, baseline assessment of socio-economic inequality and inequity in health care utilization in Kenya shortly before the policy launch. METHODS: We use concentration curves and corrected concentration indexes to measure socio-economic inequality in care use and the horizontal inequity index as a measure of inequity in care utilization for three types of care services: outpatient care, inpatient care and preventive and promotive care. Further insights into the individual and household level characteristics that determine observed inequality are derived through decomposition analysis. RESULTS: We find significant inequality and inequity in the use of all types of care services favouring richer population groups, with particularly pronounced levels for preventive and inpatient care services. These are driven primarily by differences in living standards and educational achievement, while the region of residence is a key driver for inequality in preventive care use only. Pro-rich inequalities are particularly pronounced for care provided in privately owned facilities, while public providers serve a much larger share of individuals from lower socio-economic groups. CONCLUSIONS: Through its focus on increasing affordability of care for all Kenyans, the newly launched universal health coverage scheme represents a crucial step towards reducing disparities in health care utilization. However in order to achieve equity in health and access to care such efforts must be paralleled by multi-sectoral approaches to address all key drivers of inequity: persistent poverty, disparities in living standards and educational achievement, as well as regional differences in availability and accessibility of care

Strong H₂O and high-<i>J</i> CO emission towards the Class 0 protostar L1448-mm

The spectrum of the Class 0 source L1448-mm has been measured over the wavelength range extending from 6 to 190 μm with the Long Wavelength Spectrometer (LWS) and the Short Wavelength Spectrometer (SWS) on the Infrared Space Observatory (ISO). The far infrared spectrum is dominated by strong emission from gaseous H2O and from CO transitions with rotational quantum numbers J ≥ 14; in addition, the H2 pure rotational lines S(3), S(4) and S(5), the OH fundamental line at 119 μm, as well as emission from [O I]63 μm and [C II] 158 μm are also observed. The strong CO and water emission can be consistently explained as originating in a warm gas component at T ~ 700-1400 K and nH2~(3-50) 104cm-3 , which fills about 0.2-2% of the ~ 75" LWS field of view (corresponding, assuming a single emitting region, to a physical size of about (3-12)" or (0.5-2) 10-2 pc at d = 300 pc). We derive an H2O/CO abundance ratio ~ 5, which, assuming a standard CO/H2 abundance of 10-4, corresponds to H2O/H2 ~ 5 10-4. This value implies that water is enhanced by about a factor ~ 103 with respect to its expected abundance in the ambient gas. This is consistent with models of warm shocked regions which predict that most of the free atomic oxygen will be rapidly converted into water once the temperature of the post-shocked gas exceeds ~ 300 K. The relatively high density and compact size inferred for this emission may suggest an origin in the shocked region along the molecular jet traced by SiO and EHV CO millimeter line emission. Further support is given by the fact that the observed enhancement in H2O can be explained by shock conditions similar to those expected to produce the abundant SiO observed in the region. L1448-mm shows the largest water abundance so far observed by ISO amongst young sources displaying outflow activity; we argue that the occurrence of multiple shocks over a relatively short interval of time, like that evidenced in the surroundings of L1448-mm, could have contributed to enrich the molecular jet with a high H2O column density

Molecular line emissions from pre main sequence objects

We present some preliminary results obtained with the LWS G.T. programme on the study of young objects driving molecular outflows. In particular, we discuss the importance of molecular emission in these sources and address the role of the H20 cooling

<i>Herschel</i> observations of B1-bS and B1-bN: two first hydrostatic core candidates in the Perseus star-forming cloud

We report far-infrared Herschel observations obtained between 70 μm and 500 μm of two star-forming dusty condensations, [HKM99] B1-bS and [HKM99] B1-bN, in the B1 region of the Perseus star-forming cloud. In the western part of the Perseus cloud, B1-bS is the only source detected in all six PACS and SPIRE photometric bands, but it is not visible in the Spitzer map at 24 μm. B1-bN is clearly detected between 100 μm and 250 μm. We have fitted the spectral energy distributions of these sources to derive their physical properties, and find that a simple greybody model fails to reproduce the observed spectral energy distributions. At least a two-component model is required, consisting of a central source surrounded by a dusty envelope. The properties derived from the fit, however, suggest that the central source is not a Class 0 object. We then conclude that while B1-bS and B1-bN appear to be more evolved than a pre-stellar core, the best-fit models suggest that their central objects are younger than a Class 0 source. Hence, they may be good candidates to be examples of the first hydrostatic core phase. The projected distance between B1-bS and B1-bN is a few Jeans lengths. If their physical separation is close to this value, this pair would allow studying the mutual interactions between two forming stars at a very early stage of their evolution

The Herschel view of the on-going star formation in the Vela-C molecular cloud

As part of the Herschel guaranteed time key program 'HOBYS', we present the photometric survey of the star forming region Vela-C, one of the nearest sites of low-to-high-mass star formation in the Galactic plane. Vela-C has been observed with PACS and SPIRE in parallel mode between 70 um and 500 um over an area of about 3 square degrees. A photometric catalogue has been extracted from the detections in each band, using a threshold of 5 sigma over the local background. Out of this catalogue we have selected a robust sub-sample of 268 sources, of which 75% are cloud clumps and 25% are cores. Their Spectral Energy Distributions (SEDs) have been fitted with a modified black body function. We classify 48 sources as protostellar and 218 as starless. For two further sources, we do not provide a secure classification, but suggest they are Class 0 protostars. From SED fitting we have derived key physical parameters. Protostellar sources are in general warmer and more compact than starless sources. Both these evidences can be ascribed to the presence of an internal source(s) of moderate heating, which also causes a temperature gradient and hence a more peaked intensity distribution. Moreover, the reduced dimensions of protostellar sources may indicate that they will not fragment further. A virial analysis of the starless sources gives an upper limit of 90% for the sources gravitationally bound and therefore prestellar. We fit a power law N(logM) prop M^-1.1 to the linear portion of the mass distribution of prestellar sources. This is in between that typical of CO clumps and those of cores in nearby star-forming regions. We interpret this as a result of the inhomogeneity of our sample, which is composed of comparable fractions of clumps and cores.Comment: 9 pages, 7 figures, accepted by A&

ISO-LWS study of pre-main sequence sources

We present the results obtained with the ISO Long Wavelength Spectrometer on a sample of Pre-MS sources, where several molecular lines of CO, H2O and OH have been detected. The analysis of the CO lines indicates that gas temperatures as low as 200 K are consistent with the data. This would be in agreement with the relatively low abundance of water in the gas phase measured in most of the objects

High Temperature Neutron Diffraction Study of the La1.4Sr1.6mn2o7 Bilayered Manganite

In this paper we present the results of a high temperature (300 K<T<800 K) neutron powder diffraction study of the La1.4Sr1.6Mn2O7 bilayered manganite. An unusual trend of the /Mn-Oequatorial parameter was found: it first decreases up to 500 K and then increases up to the highest T measured. At the same time, a significant shortening of the apical Mn-O(2) bond is observed in the range where the J-T distortion is reduced. The overall data gained by this study may suggest a shift of electronic density from axial to planar eg orbitals with T. This trend is explained considering of the presence of short range magnetic interaction well above TC.Comment: 18 pages, 6 figure

The real TiO2/HTM interface of solid-state dye solar cells: role of trapped states from a multiscale modelling perspective

We present a multiscale simulation of charge transport in a solid-state dye-sensitized solar cell, where the real morphology between TiO2 and the hole transport material is included