Mass-loss rates and luminosity functions of dust-enshrouded AGB stars and red supergiants in the LMC

A radiative transfer code is used to model the spectral energy distributions of 57 mass-losing Asymptotic Giant Branch (AGB) stars and red supergiants (RSGs) in the Large Magellanic Cloud (LMC) for which ISO spectroscopic and photometric data are available. As a result we derive mass-loss rates and bolometric luminosities. A gap in the luminosity distribution around M_bol = -7.5 mag separates AGB stars from RSGs. The luminosity distributions of optically bright carbon stars, dust-enshrouded carbon stars and dust-enshrouded M-type stars have only little overlap, suggesting that the dust-enshrouded AGB stars are at the very tip of the AGB and will not evolve significantly in luminosity before mass loss ends their AGB evolution. Derived mass-loss rates span a range from Mdot about 10^-7 to 10^-3 M_sun/yr. More luminous and cooler stars are found to reach higher mass-loss rates. The highest mass-loss rates exceed the classical limit set by the momentum of the stellar radiation field, L/c, by a factor of a few due to multiple scattering of photons in the circumstellar dust envelope. Mass-loss rates are lower than the mass consumption rate by nuclear burning, Mdot_nuc, for most of the RSGs. Two RSGs have Mdot >> Mdot_nuc, however, suggesting that RSGs shed most of their stellar mantles in short phases of intense mass loss. Stars on the thermal pulsing AGB may also experience episodes of intensified mass loss, but their quiescent mass-loss rates are usually already higher than Mdot_nuc.Comment: 15 pages, 11 figures. Accepted for publication in Astronomy and Astrophysics Main Journa

IRAS04496-6958: A luminous carbon star with silicate dust in the Large Magellanic Cloud

We describe ISO observations of the obscured Asymptotic Giant Branch (AGB) star IRAS04496-6958 in the Large Magellanic Cloud (LMC). This star has been classified as a carbon star. Our new ISOCAM CVF spectra show that it is the first carbon star with silicate dust known outside of the Milky Way. The existence of this object, and the fact that it is one of the highest luminosity AGB stars in the LMC, provide important information for theoretical models of AGB evolution and understanding the origin of silicate carbon stars.Comment: 4 pages, 3 figures, accepted for publication in A&A Letter

ISO observations of obscured Asymptotic Giant Branch stars in the Large Magellanic Cloud

We present ISO photometric and spectroscopic observations of a sample of 57 bright Asymptotic Giant Branch stars and red supergiants in the Large Magellanic Cloud, selected on the basis of IRAS colours indicative of high mass-loss rates. PHOT-P and PHOT-C photometry at 12, 25 and 60 $\mu$m and CAM photometry at 12 $\mu$m are used in combination with quasi-simultaneous ground-based near-IR photometry to construct colour-colour diagrams for all stars in our sample. PHOT-S and CAM-CVF spectra in the 3 to 14 $\mu$m region are presented for 23 stars. From the colour-colour diagrams and the spectra, we establish the chemical types of the dust around 49 stars in this sample. Many stars have carbon-rich dust. The most luminous carbon star in the Magellanic Clouds has also a (minor) oxygen-rich component. OH/IR stars have silicate absorption with emission wings. The unique dataset presented here allows a detailed study of a representative sample of thermal-pulsing AGB stars with well-determined luminosities.Comment: 19 pages, 10 figures. Accepted for publication in Astronomy and Astrophysics Main Journa

A pre-post study of a multi-country scale up of resuscitation training of facility birth attendants: does Helping Babies Breathe training save lives?

Background: Whether facility-based implementation of Helping Babies Breathe (HBB) reduces neonatal mortality at a population level in low and middle income countries (LMIC) has not been studied. Therefore, we evaluated HBB implementation in this context where our study team has ongoing prospective outcome data on all pregnancies regardless of place of delivery. Methods: We compared outcomes of birth cohorts in three sites in India and Kenya pre-post implementation of a facility-based intervention, using a prospective, population-based registry in 52 geographic clusters. Our hypothesis was that HBB implementation would result in a 20 % decrease in the perinatal mortality rate (PMR) among births ≥1500 g. Results: We enrolled 70,704 births during two 12-month study periods. Births within each site did not differ prepost intervention, except for an increased proportion ofbirths; however, a post-hoc analysis stratified by birthweight documented improvement insurvival. Conclusions: Rapid scale up of HBB training of facility birth attendants in three diverse sites in India and Kenya was not associated with consistent improvements in mortality among all neonates ≥1500 g; however, differential improvements inpopulation, data collection, and ongoing quality monitoring activities. Trial registration: The study was registered at ClinicalTrials.gov: NCT0168101

Low-dose aspirin for the prevention of preterm delivery in nulliparous women with a singleton pregnancy (ASPIRIN): a randomised, double-blind, placebo-controlled trial.

BACKGROUND: Preterm birth remains a common cause of neonatal mortality, with a disproportionately high burden in low-income and middle-income countries. Meta-analyses of low-dose aspirin to prevent pre-eclampsia suggest that the incidence of preterm birth might also be decreased, particularly if initiated before 16 weeks of gestation. METHODS: ASPIRIN was a randomised, multicountry, double-masked, placebo-controlled trial of low-dose aspirin (81 mg daily) initiated between 6 weeks and 0 days of pregnancy, and 13 weeks and 6 days of pregnancy, in nulliparous women with an ultrasound confirming gestational age and a singleton viable pregnancy. Participants were enrolled at seven community sites in six countries (two sites in India and one site each in the Democratic Republic of the Congo, Guatemala, Kenya, Pakistan, and Zambia). Participants were randomly assigned (1:1, stratified by site) to receive aspirin or placebo tablets of identical appearance, via a sequence generated centrally by the data coordinating centre at Research Triangle Institute International (Research Triangle Park, NC, USA). Treatment was masked to research staff, health providers, and patients, and continued until 36 weeks and 7 days of gestation or delivery. The primary outcome of incidence of preterm birth, defined as the number of deliveries before 37 weeks\u27 gestational age, was analysed in randomly assigned women with pregnancy outcomes at or after 20 weeks, according to a modified intention-to-treat (mITT) protocol. Analyses of our binary primary outcome involved a Cochran-Mantel-Haenszel test stratified by site, and generalised linear models to obtain relative risk (RR) estimates and associated confidence intervals. Serious adverse events were assessed in all women who received at least one dose of drug or placebo. This study is registered with ClinicalTrials.gov, NCT02409680, and the Clinical Trial Registry-India, CTRI/2016/05/006970. FINDINGS: From March 23, 2016 to June 30, 2018, 14 361 women were screened for inclusion and 11 976 women aged 14-40 years were randomly assigned to receive low-dose aspirin (5990 women) or placebo (5986 women). 5780 women in the aspirin group and 5764 in the placebo group were evaluable for the primary outcome. Preterm birth before 37 weeks occurred in 668 (11·6%) of the women who took aspirin and 754 (13·1%) of those who took placebo (RR 0·89 [95% CI 0·81 to 0·98], p=0·012). In women taking aspirin, we also observed significant reductions in perinatal mortality (0·86 [0·73-1·00], p=0·048), fetal loss (infant death after 16 weeks\u27 gestation and before 7 days post partum; 0·86 [0·74-1·00], p=0·039), early preterm delivery (\u3c34 \u3eweeks; 0·75 [0·61-0·93], p=0·039), and the incidence of women who delivered before 34 weeks with hypertensive disorders of pregnancy (0·38 [0·17-0·85], p=0·015). Other adverse maternal and neonatal events were similar between the two groups. INTERPRETATION: In populations of nulliparous women with singleton pregnancies from low-income and middle-income countries, low-dose aspirin initiated between 6 weeks and 0 days of gestation and 13 weeks and 6 days of gestation resulted in a reduced incidence of preterm delivery before 37 weeks, and reduced perinatal mortality. FUNDING: Eunice Kennedy Shriver National Institute of Child Health and Human Development

BMQ

BMQ: Boston Medical Quarterly was published from 1950-1966 by the Boston University School of Medicine and the Massachusetts Memorial Hospitals

Long-Term Follow-Up of Cardiac Function and Quality of Life for Patients in NSABP Protocol B-31/NRG Oncology: A Randomized Trial Comparing the Safety and Efficacy of Doxorubicin and Cyclophosphamide (AC) Followed by Paclitaxel With AC Followed by Paclitaxel and Trastuzumab in Patients With Node-Positive Breast Cancer With Tumors Overexpressing Human Epidermal Growth Factor Receptor 2

Purpose Early cardiac toxicity is a risk associated with adjuvant chemotherapy plus trastuzumab. However, objective measures of cardiac function and health-related quality of life are lacking in long-term follow-up of patients who remain cancer free after completion of adjuvant treatment. Patients and Methods Patients in NSABP Protocol B-31 received anthracycline and taxane chemotherapy with or without trastuzumab for adjuvant treatment of node-positive, human epidermal growth factor receptor 2–positive early-stage breast cancer. A long-term follow-up assessment was undertaken for patients who were alive and disease free, which included measurement of left ventricular ejection fraction by multigated acquisition scan along with patient-reported outcomes using the Duke Activity Status Index (DASI), the Medical Outcomes Study questionnaire, and a review of current medications and comorbid conditions. Results At a median follow-up of 8.8 years among eligible participants, five (4.5%) of 110 in the control group and 10 (3.4%) of 297 in the trastuzumab group had a \u3e 10% decline in left ventricular ejection fraction from baseline to a value \u3c 50%. Lower DASI scores correlated with age and use of medications for hypertension, cardiac conditions, diabetes, and hyperlipidemia, but not with whether patients had received trastuzumab. Conclusion In patients without underlying cardiac disease at baseline, the addition of trastuzumab to adjuvant anthracycline and taxane-based chemotherapy does not result in long-term worsening of cardiac function, cardiac symptoms, or health-related quality of life. The DASI questionnaire may provide a simple and useful tool for monitoring patient-reported changes that reflect cardiac function