46 research outputs found
Gamma-Ray Bursts: The Underlying Model
A pedagogical derivation is presented of the ``fireball'' model of gamma-ray
bursts, according to which the observable effects are due to the dissipation of
the kinetic energy of a relativistically expanding wind, a ``fireball.'' The
main open questions are emphasized, and key afterglow observations, that
provide support for this model, are briefly discussed. The relativistic outflow
is, most likely, driven by the accretion of a fraction of a solar mass onto a
newly born (few) solar mass black hole. The observed radiation is produced once
the plasma has expanded to a scale much larger than that of the underlying
``engine,'' and is therefore largely independent of the details of the
progenitor, whose gravitational collapse leads to fireball formation. Several
progenitor scenarios, and the prospects for discrimination among them using
future observations, are discussed. The production in gamma- ray burst
fireballs of high energy protons and neutrinos, and the implications of burst
neutrino detection by kilometer-scale telescopes under construction, are
briefly discussed.Comment: In "Supernovae and Gamma Ray Bursters", ed. K. W. Weiler, Lecture
Notes in Physics, Springer-Verlag (in press); 26 pages, 2 figure
Hospital Performance, the Local Economy, and the Local Workforce: Findings from a US National Longitudinal Study
Blustein and colleagues examine the associations between changes in hospital performance and their local economic resources. Locationally disadvantaged hospitals perform poorly on key indicators, raising concerns that pay-for-performance models may not reduce inequality
No short-cut in assessing trial quality: a case study
Assessing the quality of included trials is a central part of a systematic review. Many check-list type of instruments for doing this exist. Using a trial of antibiotic treatment for acute otitis media, Burke et al., BMJ, 1991, as the case study, this paper illustrates some limitations of the check-list approach to trial quality assessment. The general verdict from the check list type evaluations in nine relevant systematic reviews was that Burke et al. (1991) is a good quality trial. All relevant meta-analyses extensively used its data to formulate therapeutic evidence. My comprehensive evaluation, on the other hand, brought to the surface a series of serious problems in the design, conduct, analysis and report of this trial that were missed by the earlier evaluations. A check-list or instrument based approach, if used as a short-cut, may at times rate deeply flawed trials as good quality trials. Check lists are crucial but they need to be augmented with an in-depth review, and where possible, a scrutiny of the protocol, trial records, and original data. The extent and severity of the problems I uncovered for this particular trial warrant an independent audit before it is included in a systematic review
Diffuse intrinsic pontine glioma: current insights and future directions
Abstract
Diffuse intrinsic pontine glioma (DIPG) is a lethal pediatric brain tumor and the leading cause of brain tumor–related death in children. As several clinical trials over the past few decades have led to no significant improvements in outcome, the current standard of care remains fractionated focal radiation. Due to the recent increase in stereotactic biopsies, tumor tissue availabilities have enabled our advancement of the genomic and molecular characterization of this lethal cancer. Several groups have identified key histone gene mutations, genetic drivers, and methylation changes in DIPG, providing us with new insights into DIPG tumorigenesis. Subsequently, there has been increased development of in vitro and in vivo models of DIPG which have the capacity to unveil novel therapies and strategies for drug delivery. This review outlines the clinical characteristics, genetic landscape, models, and current treatments and hopes to shed light on novel therapeutic avenues and challenges that remain