Constraining the neutron-matter equation of state with gravitational waves

We show how observations of gravitational waves from binary neutron star (BNS) mergers over the next few years can be combined with insights from nuclear physics to obtain useful constraints on the equation of state (EoS) of dense matter, in particular, constraining the neutron-matter EoS to within 20% between one and two times the nuclear saturation density $n_0\approx 0.16\ {\text{fm}^{-3}}$. Using Fisher information methods, we combine observational constraints from simulated BNS merger events drawn from various population models with independent measurements of the neutron star radii expected from x-ray astronomy (the Neutron Star Interior Composition Explorer (NICER) observations in particular) to directly constrain nuclear physics parameters. To parameterize the nuclear EoS, we use a different approach, expanding from pure nuclear matter rather than from symmetric nuclear matter to make use of recent quantum Monte Carlo (QMC) calculations. This method eschews the need to invoke the so-called parabolic approximation to extrapolate from symmetric nuclear matter, allowing us to directly constrain the neutron-matter EoS. Using a principal component analysis, we identify the combination of parameters most tightly constrained by observational data. We discuss sensitivity to various effects such as different component masses through population-model sensitivity, phase transitions in the core EoS, and large deviations from the central parameter values.Comment: 13 pages, 9 figures + supplement 11 page

The Clinical Rationale for the Sentry Bioconvertible Inferior Vena Cava Filter for the Prevention of Pulmonary Embolism

The Sentry inferior vena cava (IVC) filter is designed to provide temporary protection against pulmonary embolism (PE) during transient high-risk periods and then to bioconvert after 60 days after implantation. At the time of bioconversion, the device's nitinol arms retract from the filtering position into the caval wall. Subsequently, the stable stent-like nitinol frame is endothelialized. The Sentry bioconvertible IVC filter has been evaluated in a multicenter investigational-device-exemption pivotal trial (NCT01975090) of 129 patients with documented deep vein thrombosis (DVT) or PE, or at temporary risk of developing DVT or PE, and with contraindications to anticoagulation. Successful filter conversion was observed in 95.7% of patients at 6 months (110/115) and 96.4% at 12 months (106/110). Through 12 months, there were no cases of symptomatic PE. The rationale for development of the Sentry bioconvertible device includes the following considerations: (1) the period of highest risk of PE for the vast majority of patients occurs within the first 60 days after an index event, with most of the PEs occurring in the first 30 days; (2) the design of retrievable IVC filters to support their removal after a transitory high-PE-risk period has, in practice, been associated with insecure filter dynamics and time-dependent complications including tilting, fracture, embolization, migration, and IVC perforation; (3) most retrievable IVC filters are placed for temporary protection, but for a variety of reasons they are not removed in any more than half of implanted patients, and when removal is attempted, the procedure is not always successful even with advanced techniques; and (4) analysis of Medicare hospital data suggests that payment for the retrieval procedure does not routinely compensate for expense. The Sentry device is not intended for removal after bioconversion. In initial clinical use, complications have been limited. Long-term results for the Sentry bioconvertible IVC filter are anticipated soon

Flight Deck Information Automation: A Human-in-the-Loop In-Trail Procedure Simulation Study

Information automation systems are generally intended to support pilot tasks and improve flightcrew awareness and decision making, but not to directly control the aircraft or its systems. As a result these systems do not include cases where automation decisions and actions directly affect the aircraft performance, flight path or systems. Next Generation Air Transportation System (NextGen) operational concepts and technologies will dramatically affect both the types and amount of information available on flight decks. Much of that information will be produced by flight deck information automation systems that collect, process, and present that information to the flightcrew. It is therefore important to understand the human factors characteristics of information automation systems and identify human factors issues specifically related to information automation. This paper presents an investigation of two information automation characteristics (functional complexity and automation visibility) using prototype oceanic In-Trail Procedures (ITP) display systems. The outcome will be used to develop and iterate recommendations for design and evaluation of information automation systems that will mitigate the identified human factors issues

Characterization of Information Automation on the Flight Deck

This paper summarizes the results of analyses to identify characteristics of flight deck information automation systems which can lead to potential human factors issues. Information automation systems are responsible for the collection, processing, analysis, and presentation of information to the flightcrew. Information automation systems can pose human factors issues and challenges particular to this type of automation. This paper presents a formal definition of information automation and identifies characteristics and associated human factors issues in the domain of aircraft flight deck systems. A method was developed to identify a set of consistent and independent characteristics of information automation. Characteristics, a set of properties or attributes which describe its operation or behavior, can be used to identify and assess potential human factors issues. This effort lays the groundwork for providing data to support the development of recommendations specific to different characteristics of information automation

Complicated acute type B aortic dissection: Midterm results of emergency endovascular stent–grafting

ObjectiveThis study assessed midterm results of emergency endovascular stent–grafting for patients with life-threatening complications of acute type B aortic dissection.MethodsBetween November 1996 and June 2004, 16 patients with complicated acute type B aortic dissections (mean age 57 years, range 16–88 years) underwent endovascular stent–grafting within 48 hours of presentation. Complications included contained rupture, hemothorax, refractory chest pain, and severe visceral or lower limb ischemia. Stent–graft types included custom-made first-generation endografts and second-generation commercial stent–grafts (Gore Excluder or TAG; W. L. Gore & Associates, Inc, Flagstaff, Ariz.). Follow-up was 100% complete, averaged 36 ± 36 months, and included postprocedural surveillance computed tomographic scans.ResultsEarly mortality was 25% ± 11% (70% confidence limit), with no late deaths. No new neurologic complications occurred. According to the latest scan, 4 patients (25%) had complete thrombosis of the false lumen; the lumen was partially thrombosed in 6 patients (38%). Distal aortic diameter was increased in only 1 patient. Actuarial survival at 1 and 5 years was 73% ± 11%; freedom from treatment failure (including aortic rupture, device fault, reintervention, aortic death, or sudden, unexplained late death) was 67% ± 14% at 5 years.ConclusionWith follow-up to 9 years, endovascular stent–grafting for patients with complicated acute type B aortic dissection conferred benefit. Consideration of emergency stent–grafting may improve the dismal outlook for these patients; future refinements in stent–graft design and technology and earlier diagnosis and intervention should be associated with improved results

Aortic dissection: Percutaneous management of ischemic complications with endovascular stents and balloon fenestration

AbstractPurpose: The purpose of this study was to evaluate endovascular stenting (EVS) and balloon fenestration (BF) of intimal flaps for the management of lower extremity, renal, and visceral ischemia in acute or chronic aortic dissection.Methods: Twenty-two patients (16 male, 6 female) with a median age of 53 years (range 35 to 77 years) underwent percutaneous treatment for peripheral ischemic complications of 12 type A (five acute, seven chronic) and 10 type B (nine acute, one chronic) aortic dissections.Results: Ten patients had leg ischemia, 13 had renal ischemia, and 6 had visceral ischemia. Sixteen patients were treated with EVS including 11 with renal, 6 with lower extremity, 2 with superior mesenteric artery, and 2 with aortic stents. Three patients had BF of the intimal flap, and three had BF in combination with EVS. Revascularization with clinical success was achieved in all 22 patients. Two patients died 3 days and 13.4 months after the procedure was performed, respectively. Of the remaining 20 patients, 1 is lost to follow-up, and 19 have persistent relief of clinical symptoms. Mean follow-up time is 13.7 months (range 1.1 to 46.5 months). One case was complicated by guidewire-induced perinephric hematoma.Conclusion: EVS and BF provide a safe and effective percutaneous method for managing peripheral ischemic complications of aortic dissection. (J VASC SURG 1996;23:241-53.

Chronic cerebrospinal venous insufficiency in multiple sclerosis: a historical perspective

Chronic cerebrospinal venous insufficiency (CCSVI) is a term used to describe impaired venous drainage from the central nervous system (CNS) caused by abnormalities in anatomy and flow affecting the extracranial veins. Recently, it has been proposed that CCSVI may contribute to the pathogenesis of multiple sclerosis (MS). It is hypothesized that venous obstruction results in abnormal flow that promotes inflammation at the blood-brain barrier and that this triggers a process marked by a disturbance of homeostasis within the CNS that leads to demyelination and neurodegeneration. The venous abnormalities of CCSVI are often diagnosed by ultrasound or magnetic resonance venography, however the prevalence of CCSVI detailed in groups of MS patients and patients without MS varies widely in published reports. Increased standardization of diagnostic studies to evaluate both anatomical and physiological findings associated with CCSVI is needed. The purpose of this article is to provide a background to understand the development of the theory of CCSVI and to frame the relevant issues regarding its diagnosis and relationship to the pathogenesis of MS

Multiaxial pulsatile dynamics of the thoracic aorta and impact of thoracic endovascular repair

Purpose: The thoracic aorta is a highly mobile organ whose dynamics are altered by thoracic endovascular aorta repair (TEVAR). The aim of this study was to quantify cardiac pulsatility-induced multi-axial deformation of the thoracic aorta before and after descending aortic TEVAR. Methods: Eleven TEVAR patients (8 males and 3 females, age 57–89) underwent retrospective cardiac-gated CT angiography before and after TEVAR. 3D geometric models of the thoracic aorta were constructed, and lumen centerlines, inner and outer surface curves, and cross-sections were extracted to measure aortic arclength, centerline, inner surface, and outer surface longitudinal curvatures, as well as cross-sectional effective diameter and eccentricity for the ascending and stented aortic portions. Results: From pre- to post-TEVAR, arclength deformation was increased at the ascending aorta from 5.9 \ub1 3.1 % to 8.8 \ub1 4.4 % (P < 0.05), and decreased at the stented aorta from 7.5 \ub1 5.1 % to 2.7 \ub1 2.5 % (P < 0.05). Longitudinal curvature and diametric deformations were reduced at the stented aorta. Centerline curvature, inner surface curvature, and cross-sectional eccentricity deformations were increased at the distal ascending aorta. Conclusions: Deformations were reduced in the stented thoracic aorta after TEVAR, but increased in the ascending aorta near the aortic arch, possibly as a compensatory mechanism to maintain overall thoracic compliance in the presence of reduced deformation in the stiffened stented aorta

Influence of Thoracic Endovascular Aortic Repair on True Lumen Helical Morphology for Stanford Type B Dissections

Objective: Thoracic endovascular aortic repair (TEVAR) can change the morphology of the flow lumen in aortic dissections, which may affect aortic hemodynamics and function. This study characterizes how the helical morphology of the true lumen in type B aortic dissections is altered by TEVAR. Methods: Patients with type B aortic dissection who underwent computed tomography angiography before and after TEVAR were retrospectively reviewed. Images were used to construct three-dimensional stereolithographic surface models of the true lumen and whole aorta using custom software. Stereolithographic models were segmented and co-registered to determine helical morphology of the true lumen with respect to the whole aorta. The true lumen region covered by the endograft was defined based on fiducial markers before and after TEVAR. The helical angle, average helical twist, peak helical twist, and cross-sectional eccentricity, area, and circumference were quantified in this region for pre- and post-TEVAR geometries. Results: Sixteen patients (61.3 \ub1 8.0 years; 12.5% female) were treated successfully for type B dissection (5 acute and 11 chronic) with TEVAR and scans before and after TEVAR were retrospectively obtained (follow-up interval 52 \ub1 91 days). From before to after TEVAR, the true lumen helical angle (–70.0 \ub1 71.1 to –64.9 \ub1 75.4\ub0; P =.782), average helical twist (–4.1 \ub1 4.0 to –3.7 \ub1 3.8\ub0/cm; P =.674), and peak helical twist (–13.2 \ub1 15.2 to –15.4 \ub1 14.2\ub0/cm; P =.629) did not change. However, the true lumen helical radius (1.4 \ub1 0.5 to 1.0 \ub1 0.6 cm; P <.05) and eccentricity (0.9 \ub1 0.1 to 0.7 \ub1 0.1; P <.05) decreased, and the cross-sectional area (3.0 \ub1 1.1 to 5.0 \ub1 2.0 cm2; P <.05) and circumference (7.1 \ub1 1.0 to 8.0 \ub1 1.4 cm; P <.05) increased significantly from before to after TEVAR. The distinct bimodal distribution of chiral and achiral native dissections disappeared after TEVAR, and subgroup analyses showed that the true lumen circumference of acute dissections increased with TEVAR, although it did not for chronic dissections. Conclusions: The unchanged helical angle and average and peak helical twists as a result of TEVAR suggest that the angular positions of the true lumen are constrained and that the endografts were helically conformable in the angular direction. The decrease of helical radius indicated a straightening of the corkscrew shape of the true lumen, and in combination with more circular and expanded lumen cross-sections, TEVAR produced luminal morphology that theoretically allows for lower flow resistance through the endografted portion. The impact of TEVAR on dissection flow lumen morphology and the interaction between endografts and aortic tissue can provide insight for improving device design, implantation technique, and long-term clinical outcomes