Detection of Gamma-Ray Emission from the Vela Pulsar Wind Nebula with AGILE

Pulsars are known to power winds of relativistic particles that can produce bright nebulae by interacting with the surrounding medium. These pulsar wind nebulae (PWNe) are observed in the radio, optical, x-rays and, in some cases, also at TeV energies, but the lack of information in the gamma-ray band prevents from drawing a comprehensive multiwavelength picture of their phenomenology and emission mechanisms. Using data from the AGILE satellite, we detected the Vela pulsar wind nebula in the energy range from 100 MeV to 3 GeV. This result constrains the particle population responsible for the GeV emission, probing multivavelength PWN models, and establishes a class of gamma-ray emitters that could account for a fraction of the unidentified Galactic gamma-ray sources.Comment: Accepted by Science; first published online on December 31, 2009 in Science Express. Science article and Supporting Online Material are available at http://www.sciencemag.or

Patient reported out come measures in patients with abdominal a ortic a neurysms: a systematic review p rotocol

Background: Abdominal aortic aneurysm (AAA) is a dilatation of the abdominal aorta, which is usually asymptomatic. However, rupture of the aneurysm can be fatal or require complex surgery with potential complications, leading to a poor quality of life. Patient reported outcome measures (PROMs) are becoming increasing ly important in the current era of healthcare management. PROMs are used to directly assess how patients feel or function in relation to their health condition without any interpretation . Generic, disease - specific and preference - based PROMs ca n be used to assess the quality of life (QoL), symptoms and functional limitations in patients with AAA including those under surveillance or undergoing endovascular or open surgery or screening . However, these tools vary in terms of their reliability, validity and suitability for use in patients with AAA in a clinical setting. Objectives: To identify, summarise and assess PROMs that have been administered to patients with a diagnosis of AAA including those under surveillance or undergoing endovascular or open surgery or screening . Methods: Key electronic databases and research registers will be searched including: MEDLINE and MEDLINE in Process, EMBASE, PsycINFO, PROQOLID, CINAH L, PROMS Bibliography (Oxford University), Web of Science and the Cochrane Library databases from inception. A two - stage search approach will be used. The first stage will utilise general terms for PROMs to identify studies. These will be retrieved and t he title and abstract will be examined for additional PROM terms. Stage 2 will incorporate these terms with the preliminary search strategy and a methodological search filter . Searches will be supplemented by hand - searching reference lists of relevant reviews and included studies. Study selection, data extraction and quality assessment will be performed independently by at least 2 reviewers. All English language instruments identified as PROMs for patients with AAA will be included. Data will be extracted regarding type of PROM, methods and results. Methodological quality of included studies will be assessed using the CO nsensus - based S tandards for the selection of health st atus Measurement IN struments checklist (COSMIN) and the psychometric properties of the PROMs will be assessed on criteria bas ed in published recommendations. Findings will be presented as narrative and tabular summaries. Discussion : This systematic review will identify PROMs that are used to assess QoL , symptoms and functional limitations in patients with AAA and assess their effectiveness for this population and application to clinical practice. The findings of the review will help inform a project examining the re-configuration of vascular services in the UK, and identify targets for future research

Patient-reported outcome measures in patients with peripheral artery disease: Protocol for a systematic review

Peripheral arterial disease (PAD) results in reduced health-related quality of life and significant functional impairment. Patient-reported outcome measures (PROMs) are important when considering the impact of treatments and management strategies in patients with PAD. A variety of studies have reported the use of different PROMs in patients with PAD. However, PROMs should provide valid and reliable findings to help in healthcare decision-making. The aim of this proposed systematic review is to comprehensively evaluate the psychometric properties of PROMs developed and/ or validated in patients with PAD

Effectiveness of acupuncture, special dressings and simple, low-adherence dressings for healing venous leg ulcers in primary healthcare: study protocol for a cluster-randomized open-labeled trial

<p>Abstract</p> <p>Background</p> <p>Venous leg ulcers constitute a chronic recurring complaint that affects 1.0–1.3% of the adult population at some time in life, and which corresponds to approximately 75% of all chronic ulcers of the leg. Multilayer compression bandaging is, at present, the only treatment that has been proved to be effective in treating this type of ulcer. There is no consensus, however, about the dressings that may be applied, beneath the compression, to promote the healing of this type of ulcer, as there does not seem to be any added benefit from using special dressings rather than simple, low-adherence ones. As well as analgesia, acupuncture provokes peripheral vasodilation, in skin and muscles – which has been demonstrated both experimentally and in clinical practice – probably due to the axon reflex, among other mechanisms. The aim of the present study is to measure the effectiveness and cost of compression treatment for venous leg ulcers combined with special dressings, in comparison with low-adherence ones and acupuncture.</p> <p>Methods/design</p> <p>Cluster-randomized open-labeled trial, at 15 primary healthcare clinics in the Sevilla-Sur Healthcare District, with a control group treated with compression bandaging and low-adherence dressings; the experiment will consist, on the one hand, of the compression treatment applied in combination with special dressings (Treatment 1), and on the other, the compression treatment applied in association with low-adherence dressings, together with acupuncture (Treatment 2).</p> <p>Discussion</p> <p>The results will be measured and recorded in terms of the median time elapsed until complete healing of the ulcer, and the rate of complete healing at 3 months after beginning the treatment. An economic analysis will also be made.</p> <p>This study, carried out in the context of real clinical practice, will provide information for decision-taking concerning the effectiveness of special dressings. Moreover, for the first time a high-quality study will evaluate the effectiveness of acupuncture in the process of healing venous leg ulcers.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN26438275.</p

Autonomy and Its Role in English Language Learning: Practice and Research

This chapter picks up discussion in the previous edition of this handbook of how the concept of autonomy has influenced language education and applied linguistics in recent years. It begins by discussing the philosophical and practical origins of learner autonomy in language education and particularly in English language teaching and how these have developed over the last 10 years. Key practical initiatives and research findings are reviewed to illuminate how autonomy has been interpreted in relation to learners, teachers, and the learning situation; how it has been linked or contrasted with other constructs; and how fostering autonomy has been seen as a part of pedagogy. Recent developments from the earlier edition are discussed regarding metacognition and, in particular, various contextual dimensions of learner autonomy. Other emerging topics are also reviewed, including learner autonomy in the world of digital/social media, learner autonomy in curriculum design and published materials, and the relation of learner autonomy to plurilingual perspectives. The chapter discusses issues in each of these areas, potential strategies for developing autonomy and effective learning, and possible future directions for research and practice

High-Resolution Timing Observations of Spin-Powered Pulsars with the AGILE Gamma-Ray Telescope

AGILE is a small gamma-ray astronomy satellite mission of the Italian Space Agency dedicated to high-energy astrophysics launched in 2007 April. Its 1 microsecond absolute time tagging capability coupled with a good sensitivity in the 30 MeV-30 GeV range, with simultaneous X-ray monitoring in the 18-60 keV band, makes it perfectly suited for the study of gamma-ray pulsars following up on the CGRO/EGRET heritage. In this paper we present the first AGILE timing results on the known gamma-ray pulsars Vela, Crab, Geminga and B 1706-44. The data were collected from 2007 July to 2008 April, exploiting the mission Science Verification Phase, the Instrument Timing Calibration and the early Observing Pointing Program. Thanks to its large field of view, AGILE collected a large number of gamma-ray photons from these pulsars (about 10,000 pulsed counts for Vela) in only few months of observations. The coupling of AGILE timing capabilities, simultaneous radio/X-ray monitoring and new tools aimed at precise photon phasing, exploiting also timing noise correction, unveiled new interesting features at sub-millisecond level in the pulsars' high-energy light-curves.Comment: Accepted for publication in The Astrophysical Journal. 14 pages in emulate-apj style, 2 tables, 9 figures (1 color). Replacement corrected Figure

A Second Chromatic Timing Event of Interstellar Origin toward PSR J1713+0747

The frequency dependence of radio pulse arrival times provides a probe of structures in the intervening media. Demorest et al. was the first to show a short-term (~100–200 days) reduction in the electron content along the line of sight to PSR J1713+0747 in data from 2008 (approximately MJD 54750) based on an apparent dip in the dispersion measure of the pulsar. We report on a similar event in 2016 (approximately MJD 57510), with average residual pulse-arrival times ≈−3.0, −1.3, and −0.7 μs at 820, 1400, and 2300 MHz, respectively. Timing analyses indicate possible departures from the standard ν −2 dispersive-delay dependence. We discuss and rule out a wide variety of potential interpretations. We find the likeliest scenario to be lensing of the radio emission by some structure in the interstellar medium, which causes multiple frequency-dependent pulse arrival-time delays

'Care and Prevent': rationale for investigating skin and soft tissue infections and AA amyloidosis among people who inject drugs in London.

BACKGROUND: Skin and soft tissue infections (SSTIs) are a leading cause of morbidity and mortality among people who inject drugs (PWID). International data indicate up to one third of PWID have experienced an SSTI within the past month. Complications include sepsis, endocarditis and amyloid A (AA) amyloidosis. AA amyloidosis is a serious sequela of chronic SSTI among PWID. Though there is a paucity of literature reporting on AA amyloidosis among PWID, what has been published suggests there is likely a causal relationship between AA amyloidosis and injecting-related SSTI. If left untreated, AA amyloidosis can lead to renal failure; premature mortality among diagnosed PWID is high. Early intervention may reverse disease. Despite the high societal and individual burden of SSTI among PWID, empirical evidence on the barriers and facilitators to injecting-related SSTI prevention and care or the feasibility and acceptability of AA amyloidosis screening and treatment referral are limited. This study aims to fill these gaps and assess the prevalence of AA amyloidosis among PWID. METHODS: Care and Prevent is a UK National Institute for Health Research-funded mixed-methods study. In five phases (P1-P5), we aim to assess the evidence for AA amyloidosis among PWID (P1); assess the feasibility of AA amyloidosis screening, diagnostic and treatment referral among PWID in London (P2); investigate the barriers and facilitators to AA amyloidosis care (P3); explore SSTI protection and risk (P4); and co-create harm reduction resources with the affected community (P5). This paper describes the conceptual framework, methodological design and proposed analysis for the mixed-methods multi-phase study. RESULTS: We are implementing the Care and Prevent protocol in London. The systematic review component of the study has been completed and published. Care and Prevent will generate an estimate of AA amyloidosis prevalence among community recruited PWID in London, with implications for the development of screening recommendations and intervention implementation. We aim to recruit 400 PWID from drug treatment services in London, UK. CONCLUSIONS: Care and Prevent is the first study to assess screening feasibility and the prevalence of positive proteinuria, as a marker for AA amyloidosis, among PWID accessing drug treatment services. AA amyloidosis is a serious, yet under-recognised condition for which early intervention is available but not employed

Chronic lymphocytic leukaemia Australasian consensus practice statement

Chronic lymphocytic leukaemia (CLL) is the most common haematological malignancy in Australia and New Zealand (ANZ). Considerable changes to diagnostic and management algorithms have occurred within the last decade. The availability of next-generation sequencing and measurable residual disease assessment by flow cytometry allow for advanced prognostication and response assessments. Novel therapies, including inhibitors of Bruton's tyrosine kinase (BTKi) and B-cell lymphoma 2 (BCL2) inhibitors, have transformed the treatment landscape for both treatment-naïve and relapsed/refractory disease, particularly for patients with high-risk genetic aberrations. Recommendations regarding appropriate supportive management continue to evolve, and special considerations are required for patients with CLL with respect to the global SARS-CoV-2 pandemic. The unique funding and treatment environments in Australasia highlight the need for specific local guidance with respect to the investigation and management of CLL. This consensus practice statement was developed by a broadly representative group of ANZ experts in CLL with endorsement by peak haematology bodies, with a view to providing this standardised guidance