Lumbar puncture for the generalist

The safe and successful performance of a lumbar puncture demands a working and yet specific knowledge as well as competency in performance. This review aims to aid understanding of the knowledge framework, the pitfalls and complications of lumbar puncture. It includes special reference to three dimensional relationships, functional anatomy, imaging anatomy, normal variation and living anatomy. A lumbar puncture is a commonly performed procedure for diagnostic and therapeutic purposes. Epidural and spinal anaesthesia, for example, are common in obstetric practice and involve the same technique as a lumbar puncture except for the endpoint of the needle being in the epidural space and subarachnoid space respectively. The procedure is by no means innocuous and some anatomical pitfalls include inability to find the correct entry site for placement of the lumbar puncture needle and lack of awareness of structures in relation to the advancing needle. Headache is the most common complication and it is important to avoid traumatic and dry taps, herniation syndromes and injury to the terminal end of the spinal cord. With a thorough knowledge of the contraindications, the regional anatomy and rationale of the technique and adequate prior skills practice, a lumbar puncture can be performed safely and successfully

A GBT Survey for HI 21 cm Absorption in the Disks and Halos of Low-Redshift Galaxies

We present an HI 21 cm absorption survey with the Green Bank Telescope (GBT) of galaxy-quasar pairs selected by combining data from the Sloan Digital Sky Survey (SDSS) and the Faint Images of the Radio Sky at Twenty-Centimeters (FIRST) survey. Our sample consists of 23 sightlines through 15 low-redshift foreground galaxy - background quasar pairs with impact parameters ranging from 1.7 kpc up to 86.7 kpc. We detected one absorber in the GBT survey from the foreground dwarf galaxy, GQ1042+0747, at an impact parameter of 1.7 kpc and another possible absorber in our follow-up Very Large Array (VLA) imaging of the nearby foreground galaxy, UGC 7408. Both of the absorbers are narrow (FWHM of 3.6 and 4.8 km/s), have sub Damped Lyman alpha column densities, and most likely originate in the disk gas of the foreground galaxies. We also detected H I emission from three foreground galaxies, including UGC 7408. Although our sample contains both blue and red galaxies, the two H I absorbers as well as the H I emissions are associated with blue galaxies. We discuss the physical conditions in the 21 cm absorbers and some drawbacks of the large GBT beam for this type of survey.Comment: 15 pages, 6 figures, 3 table

What are the communication skills and needs of doctors when communicating a poor prognosis to patients and their families? A qualitative study from South Africa

Background. Thousands of South Africans are diagnosed with life-threatening illness every year. Research shows that, globally, of the 20 million people who need palliative care at the end of life every year, <10% receive it.Objectives. To explore communication skills and practices of medical practitioners when conveying a poor prognosis to patients and families, and to identify their communication skills, needs and understanding of palliative care.Methods. This was an exploratory qualitative study of practising doctors, using a grounded theory approach. The study was conducted at a government-funded public hospital in Cape Town, South Africa, which is a referral centre for various illnesses, including cancer. Face-toface, one-on-one interviews using a semistructured interview guide were conducted, using audio recording.Results. The emerging theory from this study is that doctors who understand the principles of palliative care and who have an established working relationship with a palliative care team feel supported and express low levels of emotional anxiety when conveying a poor prognosis.Conclusion. Having hospital-based palliative care teams in all public hospitals will provide support for patients and doctors handling difficult conversations. All healthcare professionals should be trained in palliative care so that they can effectively communicate concerns related to poor prognosis with patients and their families. Communication, loss and grief issues should be part of the curriculum in all disciplines and throughout training in medical school

Metal abundances at z<1.5: new measurements in sub-Damped Lyman-alpha Absorbers

Damped Lyman-alpha systems (DLAs) and sub-DLAs seen toward background quasars provide the most detailed probes of elemental abundances. Somewhat paradoxically these measurements are more difficult at lower redshifts due to the atmospheric cut-off, and so a few years ago our group began a programme to study abundances at z < 1.5 in quasar absorbers. In this paper, we present new UVES observations of six additional quasar absorption line systems at z < 1.5, five of which are sub-DLAs. We find solar or above solar metallicity, as measured by the abundance of zinc, assumed not to be affected by dust, in two sub-DLAs: one, towards Q0138-0005 with [Zn/H]=+0.28 +/- 0.16; the other towards Q2335+1501 with [Zn/H]=+0.07 +/- 0.34. Relatively high metallicity was observed in another system: Q0123-0058 with [Zn/H]=-0.45 +/- 0.20. Only for the one DLA in our sample, in Q0449-1645, do we find a low metallicity, [Zn/H]=-0.96 +/- 0.08. We also note that in some of these systems large relative abundance variations from component to component are observed in Si, Mn, Cr and Zn.Comment: 7 figures and 10 tables. Accepted for publication in MNRA

An apocalyptic agenda for mission in our time

Addressing the interest in missional theology and responding to the recent coronavirus disease 2019 (COVID-19) pandemic, this research developed an apocalyptic missional theology for our time. Whilst the Second World War inspired an exploration of the eschatological dimensions of mission, it was argued that apocalyptic theology adds a much needed perspective on mission. In addition to replying to the pandemic, apocalyptic missiology proved to be well suited to speak about the challenges for the Church in South Africa, and introduces African modes of thinking to missiology. This study comprised a qualitative literature research method that traced the history of eschatology and apocalyptic in missional thinking (summarised apocalyptic theology), demonstrated that apocalyptic theology contributes to current missiology, and finally developed an apocalyptic agenda for the mission. The research found that apocalyptic offers new ways of speaking about God that challenges contemporary powers and power structures, and presents prophetic and ethical ways for the church to participate in the Missio Dei. Apocalyptic extends a more universal future that includes all peoples and creation, and it provides believers with a new identity and comfort in our time. In conclusion, apocalyptic theology was found to enrich missional thinking, contributing hope and joy to the Christian message. INTRADISCIPLINARY AND/OR INTERDISCIPLINARY IMPLICATIONS : This article suggested that apocalyptic theology adds new dimensions to missional theology, enriching the traditional discourse. It used the insights of biblical and religious studies, and applied it to missiology, as well as to systematic and practical theology.http://www.ve.org.zaam2021Science of Religion and Missiolog

Dynamic modeling of practice effects across the healthy aging-Alzheimer’s disease continuum

Standardized tests of learning and memory are sensitive to changes associated with both aging and superimposed neurodegenerative diseases. Unfortunately, repeated behavioral test administration can be confounded by practice effects (PE), which may obscure declines in level of abilities and contribute to misdiagnoses. Growing evidence, however, suggests PE over successive longitudinal measurements may differentially predict cognitive status and risk for progressive decline associated with aging, mild cognitive impairment (MCI), and dementia. Thus, when viewed as a reflection of neurocognitive plasticity, PE may reveal residual abilities that can add to our understanding of age- and disease-related changes in learning and memory. The present study sought to evaluate differences in PE and verbal recall in a clinically characterized aging cohort assessed on multiple occasions over 3 years. Participants included 256 older adults recently diagnosed as cognitively unimpaired (CU; n = 126), or with MCI of amnestic (n = 65) or non-amnestic MCI (n = 2085), and multi-domain amnestic dementia of the Alzheimer’s type (DAT; n = 45). We applied a continuous time structural equation modeling (ctsem) approach to verbal recall performance on the Hopkins Verbal Learning Test in order to distinguish PE from individual occasion performance, coupled random changes, age trends, and differing measurement quality. Diagnoses of MCI and dementia were associated with lower recall performance on all trials, reduced PE gain per occasion, and differences in non-linear dynamic parameters. Practice self-feedback is a dynamic measure of the decay or acceleration in PE process changes over longitudinal occasions. As with PE and mean recall, estimated practice self-feedback followed a gradient from positive in CU participants to null in participants with diagnosed MCI and negative for those with dementia diagnoses. Evaluation of sensitivity models showed this pattern of variation in PE was largely unmodified by differences in age, sex, or educational attainment. These results show dynamic modeling of PE from longitudinal performance on standardized learning and memory tests can capture multiple aspects of behavioral changes in MCI and dementia. The present study provides a new perspective for modeling longitudinal change in verbal learning in clinical and cognitive aging research

Evidence for Cold Accretion: Primitive Gas Flowing onto a Galaxy at z~0.274

We present UV and optical observations from the Cosmic Origins Spectrograph on the Hubble Space Telescope and Keck of a z= 0.27395 Lyman limit system (LLS) seen in absorption against the QSO PG1630+377. We detect H I absorption with log N(HI)=17.06\pm0.05 as well as Mg II, C III, Si III, and O VI in this system. The column densities are readily explained if this is a multi-phase system, with the intermediate and low ions arising in a very low metallicity ([Mg/ H] =-1.71 \pm 0.06) photoionized gas. We identify via Keck spectroscopy and Large Binocular Telescope imaging a 0.3 L_* star-forming galaxy projected 37 kpc from the QSO at nearly identical redshift (z=0.27406, \Delta v = -26 \kms) with near solar metallicity ([O/ H]=-0.20 \pm 0.15). The presence of very low metallicity gas in the proximity of a near-solar metallicity, sub-L_* galaxy strongly suggests that the LLS probes gas infalling onto the galaxy. A search of the literature reveals that such low metallicity LLSs are not uncommon. We found that 50% (4/8) of the well-studied z < 1 LLSs have metallicities similar to the present system and show sub-L_* galaxies with rho < 100 kpc in those fields where redshifts have been surveyed. We argue that the properties of these primitive LLSs and their host galaxies are consistent with those of cold mode accretion streams seen in galaxy simulations.Comment: Accepted for publication in the Astrophysical Journa

The Large, Oxygen-Rich Halos of Star-Forming Galaxies Are A Major Reservoir of Galactic Metals

The circumgalactic medium (CGM) is fed by galaxy outflows and accretion of intergalactic gas, but its mass, heavy element enrichment, and relation to galaxy properties are poorly constrained by observations. In a survey of the outskirts of 42 galaxies with the Cosmic Origins Spectrograph onboard the Hubble Space Telescope, we detected ubiquitous, large (150 kiloparsec) halos of ionized oxygen surrounding star-forming galaxies, but we find much less ionized oxygen around galaxies with little or no star formation. This ionized CGM contains a substantial mass of heavy elements and gas, perhaps far exceeding the reservoirs of gas in the galaxies themselves. It is a basic component of nearly all star-forming galaxies that is removed or transformed during the quenching of star formation and the transition to passive evolution.Comment: This paper is part of a set of three papers on circumgalactic gas observed with the Cosmic Origins Spectrograph on HST, to be published in Science, together with related papers by Tripp et al. and Lehner & Howk, in the November 18, 2011 edition. This version has not undergone final copyediting. Please see Science online for the final printed versio

Complete homochirality induced by the nonlinear autocatalysis and recycling

A nonlinear autocatalysis of a chiral substance is shown to achieve homochirality in a closed system, if the back-reaction is included. Asymmetry in the concentration of two enantiomers or the enantiometric excess increases due to the nonlinear autocatalysis. Furthermore, when the back-reaction is taken into account, the reactant supplied by the decomposition of the enantiomers is recycled to produce more and more the dominant one, and eventually the homochirality is established.Comment: 4 pages, 2 figure

Multiphase Gas In Galaxy Halos: The OVI Lyman-limit System toward J1009+0713

We have serendipitously detected a strong O VI-bearing Lyman limit system at z_abs = 0.3558 toward the QSO J1009+0713 (z_em = 0.456) in our survey of low-redshift galaxy halos with the Hubble Space Telescope's Cosmic Origins Spectrograph. Its rest-frame equivalent width of W_r = 835 +/- 49 mA is the highest for an intervening absorber yet detected in any low-redshift QSO sightline, with absorption spanning 400 km s^-1 in its rest frame. HST/WFC3 images of the galaxy field show that the absorber is associated with two galaxies lying at 14 and 46 kpc from the QSO line of sight. The bulk of the absorbing gas traced by H I resides in two strong, blended component groups that possess a total logN(HI) = 18 - 18.8. The ion ratios and column densities of C, N, O, Mg, Si, S, and Fe, except the O VI, can be accommodated into a simple photoionization model in which diffuse, low-metallicity halo gas is exposed to a photoionizing field from stars in the nearby galaxies that propagates into the halo at 10% efficiency. We constrain the metallicity firmly within the range 0.1 - 1 Zsun, and photoionization modeling indirectly indicates a subsolar metallicity of 0.05 - 0.5 Zsun. The appearance of strong O VI and nine Mg II components and our review of similar systems in the literature support the "interface" picture of high-velocity O VI: the total strength of the O VI shows a positive correlation with the number of detected components in the low-ionization gas, however the total O VI column densities still far exceed the values expected from interface models for the number of detected clouds.Comment: 20 pages, 11 figures, accepted for publication in Ap