C, N, O Abundances in the Most Metal-Poor Damped Lyman alpha Systems

This study focuses on some of the most metal-poor damped Lyman alpha absorbers known in the spectra of high redshift QSOs, using new and archival observations obtained with UV-sensitive echelle spectrographs on the Keck and VLT telescopes. The weakness and simple velocity structure of the absorption lines in these systems allows us to measure the abundances of several elements, and in particular those of C, N, and O, a group that is difficult to study in DLAs of more typical metallicities. We find that when the oxygen abundance is less than about 1/100 of solar, the C/O ratio in high redshift DLAs and sub-DLAs matches that of halo stars of similar metallicity and shows higher values than expected from galactic chemical evolution models based on conventional stellar yields. Furthermore, there are indications that at these low metallicities the N/O ratio may also be above simple expectations and may exhibit a minimum value, as proposed by Centurion and her collaborators in 2003. Both results can be interpreted as evidence for enhanced production of C and N by massive stars in the first few episodes of star formation, in our Galaxy and in the distant proto-galaxies seen as QSO absorbers. The higher stellar yields implied may have an origin in stellar rotation which promotes mixing in the stars' interiors, as considered in some recent model calculations. We briefly discuss the relevance of these results to current ideas on the origin of metals in the intergalactic medium and the universality of the stellar initial mass function.Comment: 17 pages, 9 Figures, Accepted for publication in Monthly Notices of the Royal Astronomical Societ

Combination therapy versus monotherapy: a randomised pilot study on the evolution of inflammatory parameters after ventilator associated pneumonia [ISRCTN31976779]

INTRODUCTION: Combination antibiotic therapy for ventilator associated pneumonia (VAP) is often used to broaden the spectrum of activity of empirical treatment. The relevance of such synergy is commonly supposed but poorly supported. The aim of the present study was to compare the clinical outcome and the course of biological variables in patients treated for a VAP, using a monotherapy with a beta-lactam versus a combination therapy. METHODS: Patients with VAP were prospectively randomised to receive either cefepime alone or cefepime in association with amikacin or levofloxacin. Clinical and inflammatory parameters were measured on the day of inclusion and thereafter. RESULTS: Seventy-four mechanically ventilated patients meeting clinical criteria for VAP were enrolled in the study. VAP was microbiologically confirmed in 59 patients (84%). Patients were randomised to receive cefepime (C group, 20 patients), cefepime with amikacin (C-A group, 19 patients) or cefepime with levofloxacin (C-L group, 20 patients). No significant difference was observed regarding the time course of temperature, leukocytosis or C-reactive protein level. There were no differences between length of stay in the intensive care unit after infection, nor in ventilator free days within 28 days after infection. No difference in mortality was observed. CONCLUSION: Antibiotic combination using a fourth generation cephalosporin with either an aminoside or a fluoroquinolone is not associated with a clinical or biological benefit when compared to cephalosporin monotherapy against common susceptible pathogens causing VAP

An Imaging and Spectroscopic Study of the z=3.38639 Damped Lyman Alpha System in Q0201+1120: Clues to Star Formation Rate at High Redshift

We present the results of a series of imaging and spectroscopic observations aimed at identifying and studying the galaxy responsible for the z = 3.38639 damped lya system in the z = 3.61 QSO Q0201+1120. We find that the DLA is part of a concentration of matter which includes at least four galaxies (probably many more) over linear comoving dimensions, greater than 5h^-1Mpc. The absorber may be a 0.7 L* galaxy at an impact parameter of 15 h^-1 kpc, but follow-up spectroscopy is still required for positive identification. The gas is turbulent, with many absorption components distributed over approximately 270 km/s and a large spin temperature, T_s greater than 4000K. The metallicity is relatively high for this redshift, Z(DLA) approximately 1/20 Z(solar). From consideration of the relative ratios of elements which have different nucleosynthetic timescales, it would appear that the last major episode of star formation in this DLA occurred at z greater than 4.3, more than approximately 500 Myr prior to the time when we observe it.Comment: Accepted for publication in Ap

Unfair Trading Practice Regulation and Voluntary Agreements targeting food waste: A policy assessment in select EU Member States

This report provides a qualitative assessment of Voluntary Agreements (VAs) and Unfair Trading Practices (UTPs) as two typologies of policy interventions having an impact on food loss and waste. To carry out this assessment, two sets of country-based comparative case studies were developed, namely in the UK and Italy for regulations against UTPs, and in the UK and the Netherlands for VAs. The report found that, for both VAs and regulations against UTPs, a preliminary assessment of underlying food supply chain market structure is important to identify the most appropriate policy measures for a specific EU MS (e.g. the size and number of actors at each level of the food supply chain, the level of market concentration and power imbalance among actors, etc.). Specifically concerning UTPs, the following was identified: - Food supply chains are particularly susceptible to UTPs in MS where market power is concentrated within a few large retailers interacting with many suppliers. Perishable products, such as fresh fruits and vegetables supplied direct from primary producers to retailers are particularly at risk due to the time constraints in finding alternate outlets; - It is important to identify solutions for food surplus generated by UTPs (ex: redistributing surplus that results from order cancellations linked to UTPs or ensuring that the \u201cwrongdoer\u201d assumes the responsibility of the food product resulting from the UTPs); - To tackle UTPs, it was found that an effective approach would be the creation of an independent authority to investigate any infringement of good trading practices, (ex: through an industry code of practice, and, if needed, the introduction of sanctions on actors who are found to have not met the standard required by the industry code; - Other recommendations identified include adopting a common EU-level definition of UTPs in relation to grocery supply to avoid unequal treatment of comparable situations across EU, and to allow the judgement of cases based on the principle of equity. Furthermore, indirect and foreign suppliers also need to be protected against UTPs. Specifically concerning VAs the following was identified: - The level and the nature of funding has a significant impact on their lifetime and agendas (a mix of public and private is optimal); - To ensure a VA\u2019s relevance, signatories must benefit from their participating, either financially or in terms of heightened visibility; - VAs should establish ambitious yet realistic targets, achievable by their signatories, and robustness and transparency of data reporting should be forefront to ensure the credibility of the initiatives; - VAs can be implemented alongside compulsory legislation or provide an alternative to it. An advantage of them, compared to legislation, is that they can be designed and adapted relatively quickly depending on political goals related to food waste; - The role of a third party is crucial in managing a VA, notably to facilitate actor accession to it, ensure confidentiality of data, supervise and eventually nudge compliance with the agreement. The report ultimately shows that VAs and UTPs interlinked as VAs can be an effective tool to explore the effects of regulation against UTPs and assess actors\u2019 readiness to avoid market power abuse

Nutrition During Critical Care: An Audit on Actual Energy and Protein Intakes

peer reviewedIntroduction: Oral nutrition is delivered frequently in intensive care units (ICUs) but rarely studied. The primary objective of this study was to quantify nutrition intakes in patients exclusively orally fed (OF) and in those receiving medical nutrition solutions or both. Methods: Adults who stayed in a mixed ICU for ≥3 days were studied. Nutrition deficits were calculated as the difference between estimated energy or protein targets (determined by weight-based formulas) and actual intakes (recorded on a daily basis by nurses). Total volumes of enteral or parenteral nutrition solutions, propofol, and glucose infused over 24 hours were collected and energy and protein amounts were calculated. In OF patients, food intake at each meal (breakfast, lunch, and dinner) was estimated using the "one-quarter portion" method. Results: Among the 289 included patients aged 67 (57-75.5) years, 253 were fed and received, on average, 14.3 (7.8-19) kcal/kg/d and 0.53 (0.27-0.8) g/kg/d protein. In OF patients (n = 126), intakes were 9.7 (5.8-19) kcal/kg/d and 0.35 (0.17-0.57) g/kg/d protein. In the subset of OF patients with ICU stay ≥ 7 days (n = 37), respectively, 51% and 94% never received ≥80% of their energy and protein targets. Conclusion: Nutrition intakes were lower by oral feeding compared with other exclusive or combined medical nutrition. Compared with the prescribed amounts, the deficit was larger for proteins than for energ

Randomized controlled trial of deutetrabenazine for tardive dyskinesia: The ARM-TD study

OBJECTIVE: To determine the efficacy and safety of deutetrabenazine as a treatment for tardive dyskinesia (TD). METHODS: One hundred seventeen patients with moderate to severe TD received deutetrabenazine or placebo in this randomized, double-blind, multicenter trial. Eligibility criteria included an Abnormal Involuntary Movement Scale (AIMS) score of ≥6 assessed by blinded central video rating, stable psychiatric illness, and stable psychoactive medication treatment. Primary endpoint was the change in AIMS score from baseline to week 12. Secondary endpoints included treatment success at week 12 on the Clinical Global Impression of Change (CGIC) and Patient Global Impression of Change. RESULTS: For the primary endpoint, deutetrabenazine significantly reduced AIMS scores from baseline to week 12 vs placebo (least-squares mean [standard error] -3.0 [0.45] vs -1.6 [0.46], p = 0.019). Treatment success on CGIC (48.2% vs 40.4%) favored deutetrabenazine but was not significant. Deutetrabenazine and placebo groups showed low rates of psychiatric adverse events: anxiety (3.4% vs 6.8%), depressed mood/depression (1.7% vs 1.7%), and suicidal ideation (0% vs 1.7%, respectively). In addition, no worsening in parkinsonism, as measured by the Unified Parkinson's Disease Rating Scale motor subscale, was noted from baseline to week 12 in either group. CONCLUSIONS: In patients with TD, deutetrabenazine was well tolerated and significantly reduced abnormal movements. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that in patients with TD, deutetrabenazine reduces AIMS scores

A Carbon-enhanced Metal-poor Damped Lyman alpha System: Probing Gas from Population III Nucleosynthesis?

We present high resolution observations of an extremely metal-poor damped Lyman-alpha system, at z_abs = 2.3400972 in the spectrum of the QSO J0035-0918, exhibiting an abundance pattern consistent with model predictions for the supernova yields of Population III stars. Specifically, this DLA has [Fe/H] = -3.04, shows a clear `odd-even' effect, and is C-rich with [C/Fe] = +1.53, a factor of about 20 greater than reported in any other damped Lyman-alpha system. In analogy to the carbon-enhanced metal-poor stars in the Galactic halo (with [C/Fe] > +1.0), this is the first reported case of a carbon-enhanced damped Lyman-alpha system. We determine an upper limit to the mass of 12C, M(12C) < 200 solar masses, which depends on the unknown gas density n(H); if n(H) > 1 atom per cubic cm (which is quite likely for this DLA given its low velocity dispersion), then M(12C) < 2 solar masses, consistent with pollution by only a few prior supernovae. We speculate that DLAs such as the one reported here may represent the `missing link' between the yields of Pop III stars and their later incorporation in the class of carbon-enhanced metal-poor stars which show no enhancement of neutron-capture elements (CEMP-no stars).Comment: 13 pages, 7 Figures, Accepted for publication in Monthly Notices of the Royal Astronomical Societ