A study on Head Injury patients with GCS 15

In our study we have analyzed the risk factor which are statistically significant in predicting positive CT brain in head injury patients with admission GCS 15. Incidence of positive CT in our consecutive, non-selective population of 3536 patients with admission GCS of 15 was 12.8%. which indicate that mTBI patients with GCS 15 may still have a significant CT finding and the line of management can change. 1. Operative neurosurgical intervention was required in 1% of our study population. 2. The following risk factors which were statistically significant in our study were: Headache, Loss of consciousness, ENT bleed, CSF leak, Vomiting, Mode of injury, Alcohol influence, External injuries They predict the possibility of an abnormal CT findings in head injury patients with GCS 15. 3. Patients with a. Admission GCS of 15 b. Normal neurological examination c. Normal CT can be safely discharged without need for admission or observation. . mTBI patients with GCS score of 15 and normal CT Brain can be discharged safely from the emergency rooms, and there with the hospital care cost and manpower utilization can be significantly reduced especially in Government institutions where the resources are limited. 5. The medico legal implications of a positive CT scan are as follows; a positive CT scan can convert a simple injury in to a grievous one; discharging a patient without subjecting to CT scanning and if that patient is found to have positive CT scan subsequently may result in risk of litigation, especially in this consumer era. Routine CT scan of brain in mTBI patients saves the patients from complications and also doctors from the medico legal litigations

A Sample of Intermediate-Mass Star-Forming Regions: Making Stars at Mass Column Densities <1 g/cm^2

In an effort to understand the factors that govern the transition from low- to high-mass star formation, we identify for the first time a sample of intermediate-mass star-forming regions (IM SFRs) where stars up to - but not exceeding - 8 solar masses are being produced. We use IRAS colors and Spitzer Space Telescope mid-IR images, in conjunction with millimeter continuum and CO maps, to compile a sample of 50 IM SFRs in the inner Galaxy. These are likely to be precursors to Herbig AeBe stars and their associated clusters of low-mass stars. IM SFRs constitute embedded clusters at an early evolutionary stage akin to compact HII regions, but they lack the massive ionizing central star(s). The photodissociation regions that demarcate IM SFRs have typical diameters of ~1 pc and luminosities of ~10^4 solar luminosities, making them an order of magnitude less luminous than (ultra)compact HII regions. IM SFRs coincide with molecular clumps of mass ~10^3 solar masses which, in turn, lie within larger molecular clouds spanning the lower end of the giant molecular cloud mass range, 10^4-10^5 solar masses. The IR luminosity and associated molecular mass of IM SFRs are correlated, consistent with the known luminosity-mass relationship of compact HII regions. Peak mass column densities within IM SFRs are ~0.1-0.5 g/cm^2, a factor of several lower than ultra-compact HII regions, supporting the proposition that there is a threshold for massive star formation at ~1 g/cm^2.Comment: 61 pages, 6 tables, 20 figures. Accepted for publication in the Astronomical Journa

What is the initiation step of the Grubbs-Hoveyda olefin metathesis catalyst?

Density function theory calculations reveal that the Grubbs-Hoveyda olefin metathesis pre-catalyst is activated by the formation of a complex in which the incoming alkene substrate and outgoing alkoxy ligand are both clearly associated with the ruthenium centre. The computed energies for reaction are in good agreement with the experimental values, reported here

European VLBI Network observations of 6.7 GHz methanol masers in clusters of massive young stellar objects

Context. Methanol masers at 6.7 GHz are associated with high-mass star-forming regions (HMSFRs) and often have mid-infrared (MIR) counterparts characterized by extended emission at 4.5 μm, which likely traces outflows from massive young stellar objects (MYSOs). Aims. Our objectives are to determine the milliarcsecond (mas) morphology of the maser emission and to examine if it comes from one or several candidate MIR counterparts in the clusters of MYSOs. Methods. The European VLBI Network (EVN) was used to image the 6.7 GHz maser line with ∼2.1' field of view toward 14 maser sites from the Torun catalog. Quasi-simultaneous observations were carried out with the Torun 32 m telescope. Results. We obtained maps with mas angular resolution that showed diversity of methanol emission morphology: a linear distribution (e.g., G37.753−00.189), a ring-like (G40.425+00.700), and a complex one (e.g., G45.467+00.053). The maser emission is usually associated with the strongest MIR counterpart in the clusters; no maser emission was detected from other MIR sources in the fields of view of 2.1' in diameter. The maser source luminosity seems to correlate with the total luminosity of the central MYSO. Although the Very Long Baseline Interferometry (VLBI) technique resolves a significant part of the maser emission, the morphology is still well determined. This indicates that the majority of maser components have compact cores

Variable Radio Sources in the Galactic Plane

Using three epochs of VLA observations of the Galactic Plane in the first quadrant taken ~15 years apart, we have conducted a search for a population of variable Galactic radio emitters in the flux density range 1-100 mJy at 6 cm. We find 39 variable sources in a total survey area of 23.2 sq deg. Correcting for various selection effects and for the extragalactic variable population of active galactic nuclei, we conclude there are ~1.6 Galactic sources per sq deg which vary by more than 50% on a time scale of years (or shorter). We show that these sources are much more highly variable than extragalactic objects; more than 50% show variability by a factor >2 compared to <10% for extragalactic objects in the same flux density range. We also show that the fraction of variable sources increases toward the Galactic center (another indication that this is a Galactic population), and that the spectral indices of many of these sources are flat or inverted. A small number of the variables are coincident with mid-IR sources and two are coincident with X-ray emitters, but most have no known counterparts at other wavelengths. Intriguingly, one lies at the center of a supernova remnant, while another appears to be a very compact planetary nebula; several are likely to represent activity associated with star formation regions. We discuss the possible source classes which could contribute to the variable cohort and followup observations which could clarify the nature of these sources.Comment: 11 pages, 7 figures; to be published in the Astronomical Journal; data available on MAGPIS website at http://third.ucllnl.org/gps

Characterizing star formation activity in infrared dark cloud MSXDC G048.65-00.29

Infrared Dark Clouds (IRDCs), condensed regions of the ISM with high column densities, low temperatures and high masses, are suspected sites of star formation. Thousands of IRDCs have already been identified. To date, it has not been resolved whether IRDCs always show star formation activity and, if so, if massive star formation (> 8 solar masses) is the rule or the exception in IRDCs. Previous analysis of sub-millimeter cores in the cloud MSXDC G048.65-00.29 (G48.65) indicates embedded star formation activity. To characterize this activity in detail, mid-infrared photometry (3-30 micron) has been obtained with the Spitzer Space Telescope. This paper analyzes the point sources seen in the 24 micron band, combined with counterparts or upper limits at shorter and longer wavelengths. Data points in wavelength bands ranging from 1 up to 850 micron are used to compare each 24 micron source to a set of Spectral Energy Distributions of Young Stellar Object (YSO) models. By assessing the models that fit the data, an attempt is made to identify YSOs as such and determine their evolutionary stages and stellar masses. A total of 17 sources are investigated, 13 of which are classified as YSOs, primarily - but not exclusively - in an early embedded phase of star formation. The modeled masses of the central stellar objects range from sub-solar to ~8 solar masses. Every YSO is at less than 1 pc projected distance from its nearest YSO neighbor. We conclude that IRDC G48.65 is a region of active star formation. We find YSOs in various evolutionary phases, indicating that the star formation in this cloud is not an instantaneous process. The inferred masses of the central objects suggest that this IRDC hosts only low to intermediate mass YSOs and none with masses exceeding ~8 solar masses.Comment: 10 pages, 6 figures; v2: minor editorial changes to match published versio

Novel positioning sensor with real-time feedback for improved postoperative positioning: pilot study in control subjects

Introduction: Repair of retinal detachment frequently requires use of intraocular gas. Patients are instructed to position themselves postoperatively to appose the intraocular bubble to the retinal break(s). We developed a novel wearable wireless positioning sensor, which provides real-time audiovisual feedback on the accuracy of positioning. Methods: Eight healthy volunteers wore the wireless sensor for 3 hours while instructed to maintain their head tilted toward the 2 o’clock meridian with no audiovisual feedback. Positioning accuracy was recorded. The subjects repeated the experiment for 3 hours with the audiovisual feedback enabled. Results: With no audiovisual feedback, the percentage of time greater than 10° out of position varied from 8.9% to 93.9%. With audiovisual feedback enabled, these percentages ranged from 9.4% to 65%. Three subjects showed significant improvement in their time out of position (P<0.01, Fisher’s exact test). Four subjects demonstrated a nonsignificant improvement, and one subject had a significant increase in time out of position with feedback (P<0.01). When pooled, all subjects demonstrated a statistically significant decrease in degrees out of position (P<0.001, Wilcoxon test) and a statistically significant improvement in total time out of position (P<0.001). Conclusion: The novel positioning sensor showed improved positioning compliance in half of the healthy volunteers during our short pilot study. Other subjects derived little benefit from the feedback. The causes for this observation are unclear. However, given the significant improvement as a group, this new technology could be beneficial to patients who struggle with postoperative positioning

Left Ventricular Outflow Tract Obstruction Defined by Active Three-Dimensional Echocardiography Using Rotational Transthoracic Acquisition

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75675/1/j.1540-8175.1994.tb01105.x.pd

Cluster-randomized, crossover trial of head positioning in acute stroke

The role of supine positioning after acute stroke in improving cerebral blood flow and the countervailing risk of aspiration pneumonia have led to variation in head positioning in clinical practice. We wanted to determine whether outcomes in patients with acute ischemic stroke could be improved by positioning the patient to be lying flat (i.e., fully supine with the back horizontal and the face upwards) during treatment to increase cerebral perfusion. METHODS In a pragmatic, cluster-randomized, crossover trial conducted in nine countries, we assigned 11,093 patients with acute stroke (85% of the strokes were ischemic) to receive care in either a lying-flat position or a sitting-up position with the head elevated to at least 30 degrees, according to the randomization assignment of the hospital to which they were admitted; the designated position was initiated soon after hospital admission and was maintained for 24 hours. The primary outcome was degree of disability at 90 days, as assessed with the use of the modified Rankin scale (scores range from 0 to 6, with higher scores indicating greater disability and a score of 6 indicating death). RESULTS The median interval between the onset of stroke symptoms and the initiation of the assigned position was 14 hours (interquartile range, 5 to 35). Patients in the lying-flat group were less likely than patients in the sitting-up group to maintain the position for 24 hours (87% vs. 95%, P\u3c0.001). In a proportional-odds model, there was no significant shift in the distribution of 90-day disability outcomes on the global modified Rankin scale between patients in the lying-flat group and patients in the sitting-up group (unadjusted odds ratio for a difference in the distribution of scores on the modified Rankin scale in the lying-flat group, 1.01; 95% confidence interval, 0.92 to 1.10; P = 0.84). Mortality within 90 days was 7.3% among the patients in the lying-flat group and 7.4% among the patients in the sitting-up group (P = 0.83). There were no significant betweengroup differences in the rates of serious adverse events, including pneumonia. CONCLUSIONS Disability outcomes after acute stroke did not differ significantly between patients assigned to a lying-flat position for 24 hours and patients assigned to a sitting-up position with the head elevated to at least 30 degrees for 24 hours

Infall, outflow, and rotation in the G19.61-0.23 hot molecular core

Aims: The main goal of this study is to perform a sub-arcsecond resolution analysis of the high-mass star formation region G19.61-0.23, both in the continuum and molecular line emission. While the centimeter continuum images will be discussed in detail in a forthcoming paper, here we focus on the (sub)mm emission, devoting special attention to the hot molecular core. Results: Our observations resolve the HMC into three cores whose masses are on the order of 10^1-10^3 Msun. No submm core presents detectable free-free emission in the centimeter regime, but they appear to be associated with masers and thermal line emission from complex organic molecules. Towards the most massive core, SMA1, the CH3CN (18_K-17_K) lines reveal hints of rotation about the axis of a jet/outflow traced by H2O maser and H13CO+ (1--0) line emission. Inverse P-Cygni profiles of the 13CO (3--2) and C18O (3--2) lines seen towards SMA1 indicate that the central high-mass (proto)star(s) is (are) still gaining mass with an accretion rate $ge 3 ~10^{-3}$ Msun/yr. Due to the linear scales and the large values of the accretion rate, we hypothesize that we are observing an accretion flow towards a cluster in the making, rather than towards a single massive star.Comment: A&A accepted; 18 pages; Preprint with full-resolution figures is available at http://subarutelescope.org/staff/rsf/publication.htm