American Society of Hematology 2020 guidelines for sickle cell disease: Prevention, diagnosis, and treatment of cerebrovascular disease in children and adults

BACKGROUND: Central nervous system (CNS) complications are among the most common, devastating sequelae of sickle cell disease (SCD) occurring throughout the lifespan.OBJECTIVE: These evidence-based guidelines of the American Society of Hematology are intended to support the SCD community in decisions about prevention, diagnosis, and treatment of the most common neurological morbidities in SCD.METHODS: The Mayo Evidence-Based Practice Research Program supported the guideline development process, including updating or performing systematic evidence reviews. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, including GRADE evidence-to-decision frameworks, to assess evidence and make recommendations.RESULTS: The panel placed a higher value on maintaining cognitive function than on being alive with significantly less than baseline cognitive function. The panel developed 19 recommendations with evidence-based strategies to prevent, diagnose, and treat CNS complications of SCD in low-middle- and high-income settings.CONCLUSIONS: Three of 19 recommendations immediately impact clinical care. These recommendations include: use of transcranial Doppler ultrasound screening and hydroxyurea for primary stroke prevention in children with hemoglobin SS (HbSS) and hemoglobin Sβ0 (HbSβ0) thalassemia living in low-middle-income settings; surveillance for developmental delay, cognitive impairments, and neurodevelopmental disorders in children; and use of magnetic resonance imaging of the brain without sedation to detect silent cerebral infarcts at least once in early-school-age children and once in adults with HbSS or HbSβ0 thalassemia. Individuals with SCD, their family members, and clinicians should become aware of and implement these recommendations to reduce the burden of CNS complications in children and adults with SCD.</p

Towards a New Standard Model for Black Hole Accretion

We briefly review recent developments in black hole accretion disk theory, emphasizing the vital role played by magnetohydrodynamic (MHD) stresses in transporting angular momentum. The apparent universality of accretion-related outflow phenomena is a strong indicator that large-scale MHD torques facilitate vertical transport of angular momentum. This leads to an enhanced overall rate of angular momentum transport and allows accretion of matter to proceed at an interesting rate. Furthermore, we argue that when vertical transport is important, the radial structure of the accretion disk is modified at small radii and this affects the disk emission spectrum. We present a simple model demonstrating how energetic, magnetically-driven outflows modify the emergent disk emission spectrum with respect to that predicted by standard accretion disk theory. A comparison of the predicted spectra against observations of quasar spectral energy distributions suggests that mass accretion rates inferred using the standard disk model may severely underestimate their true values.Comment: To appear in the Fifth Stromlo Symposium Proceedings special issue of ApS

Active Galaxies in the UV

In this article we present different aspects of AGN studies demonstrating the importance of the UV spectral range. Most important diagnostic lines for studying the general physical conditions as well as the metalicities in the central broad line region in AGN are emitted in the UV. The UV/FUV continuum in AGN excites not only the emission lines in the immediate surrounding but it is responsible for the ionization of the intergalactic medium in the early stages of the universe. Variability studies of the emission line profiles of AGN in the UV give us information on the structure and kinematics of the immediate surrounding of the central supermassive black hole as well as on its mass itself.Comment: 29 pages, 13 figures, Ap&SS in pres