Interaction of Infall and Winds in Young Stellar Objects

The interaction of a stellar or disk wind with a collapsing environment holds promise for explaining a variety of outflow phenomena observed around young stars. In this paper we present the first simulations of these interactions. The focus here is on exploring how ram pressure balance between wind and ambient gas and post-shock cooling affects the shape of the resulting outflows. In our models we explore the role of ram pressure and cooling by holding the wind speed constant and adjusting the ratio of the inflow mass flux to the wind mass flux (Mdot_a/Mdot_w) Assuming non-spherical cloud collapse, we find that relatively strong winds can carve out wide, conical outflow cavities and that relatively weak winds can be strongly collimated into jet-like structures. If the winds become weak enough, they can be cut off entirely by the infalling environment. We identify discrepancies between results from standard snowplow models and those presented here that have important implications for molecular outflows. We also present mass vs. velocity curves for comparison with observations.Comment: 35 pages, 11 figures (PNG and EPS

The interactions of winds from massive young stellar objects: X-ray emission, dynamics, and cavity evolution

2D axis-symmetric hydrodynamical simulations are presented which explore the interaction of stellar and disk winds with surrounding infalling cloud material. The star, and its accompanying disk, blow winds inside a cavity cleared out by an earlier jet. The collision of the winds with their surroundings generates shock heated plasma which reaches temperatures up to ~10^8 K. Attenuated X-ray spectra are calculated from solving the equation of radiative transfer along lines-of-sight. This process is repeated at various epochs throughout the simulations to examine the evolution of the intrinsic and attenuated flux. We find that the dynamic nature of the wind-cavity interaction fuels intrinsic variability in the observed emission on timescales of several hundred years. This is principally due to variations in the position of the reverse shock which is influenced by changes in the shape of the cavity wall. The collision of the winds with the cavity wall can cause clumps of cloud material to be stripped away. Mixing of these clumps into the winds mass-loads the flow and enhances the X-ray emission measure. The position and shape of the reverse shock plays a key role in determining the strength and hardness of the X-ray emission. In some models the reverse shock is oblique to much of the stellar and disk outflows, whereas in others it is closely normal over a wide range of polar angles. For reasonable stellar and disk wind parameters the integrated count rate and spatial extent of the intensity peak for X-ray emission agree with \textit{Chandra} observations of the deeply embedded MYSOs S106 IRS4, Mon R2 IRS3 A, and AFGL 2591.(abridged)Comment: 19 pages, 14 figures, accepted for publication in MNRA

Numerical heat conduction in hydrodynamical models of colliding hypersonic flows

Hydrodynamical models of colliding hypersonic flows are presented which explore the dependence of the resulting dynamics and the characteristics of the derived X-ray emission on numerical conduction and viscosity. For the purpose of our investigation we present models of colliding flow with plane-parallel and cylindrical divergence. Numerical conduction causes erroneous heating of gas across the contact discontinuity which has implications for the rate at which the gas cools. We find that the dynamics of the shocked gas and the resulting X-ray emission are strongly dependent on the contrast in the density and temperature either side of the contact discontinuity, these effects being strongest where the postshock gas of one flow behaves quasi-adiabatically while the postshock gas of the other flow is strongly radiative. Introducing additional numerical viscosity into the simulations has the effect of damping the growth of instabilities, which in some cases act to increase the volume of shocked gas and can re-heat gas via sub-shocks as it flows downstream. The resulting reduction in the surface area between adjacent flows, and therefore of the amount of numerical conduction, leads to a commensurate reduction in spurious X-ray emission, though the dynamics of the collision are compromised. The simulation resolution also affects the degree of numerical conduction. A finer resolution better resolves the interfaces of high density and temperature contrast and although numerical conduction still exists the volume of affected gas is considerably reduced. However, since it is not always practical to increase the resolution, it is imperative that the degree of numerical conduction is understood so that inaccurate interpretations can be avoided. This work has implications for the dynamics and emission from astrophysical phenomena which involve high Mach number shocks.Comment: 14 pages, 10 figures, accepted for publication in MNRA

Total disc replacement surgery for symptomatic degenerative lumbar disc disease: a systematic review of the literature

The objective of this study is to evaluate the effectiveness and safety of total disc replacement surgery compared with spinal fusion in patients with symptomatic lumbar disc degeneration. Low back pain (LBP), a major health problem in Western countries, can be caused by a variety of pathologies, one of which is degenerative disc disease (DDD). When conservative treatment fails, surgery might be considered. For a long time, lumbar fusion has been the “gold standard” of surgical treatment for DDD. Total disc replacement (TDR) has increased in popularity as an alternative for lumbar fusion. A comprehensive systematic literature search was performed up to October 2008. Two reviewers independently checked all retrieved titles and abstracts, and relevant full text articles for inclusion. Two reviewers independently assessed the risk of bias of included studies and extracted relevant data and outcomes. Three randomized controlled trials and 16 prospective cohort studies were identified. In all three trials, the total disc replacement was compared with lumbar fusion techniques. The Charité trial (designed as a non-inferiority trail) was considered to have a low risk of bias for the 2-year follow up, but a high risk of bias for the 5-year follow up. The Charité artificial disc was non-inferior to the BAK® Interbody Fusion System on a composite outcome of “clinical success” (57.1 vs. 46.5%, for the 2-year follow up; 57.8 vs. 51.2% for the 5-year follow up). There were no statistically significant differences in mean pain and physical function scores. The Prodisc artificial disc (also designed as a non-inferiority trail) was found to be statistically significant more effective when compared with the lumbar circumferential fusion on the composite outcome of “clinical success” (53.4 vs. 40.8%), but the risk of bias of this study was high. Moreover, there were no statistically significant differences in mean pain and physical function scores. The Flexicore trial, with a high risk of bias, found no clinical relevant differences on pain and physical function when compared with circumferential spinal fusion at 2-year follow up. Because these are preliminary results, in addition to the high risk of bias, no conclusions can be drawn based on this study. In general, these results suggest that no clinical relevant differences between the total disc replacement and fusion techniques. The overall success rates in both treatment groups were small. Complications related to the surgical approach ranged from 2.1 to 18.7%, prosthesis related complications from 2.0 to 39.3%, treatment related complications from 1.9 to 62.0% and general complications from 1.0 to 14.0%. Reoperation at the index level was reported in 1.0 to 28.6% of the patients. In the three trials published, overall complication rates ranged from 7.3 to 29.1% in the TDR group and from 6.3 to 50.2% in the fusion group. The overall reoperation rate at index-level ranged from 3.7 to 11.4% in the TDR group and from 5.4 to 26.1% in the fusion group. In conclusion, there is low quality evidence that the Charité is non-inferior to the BAK cage at the 2-year follow up on the primary outcome measures. For the 5-year follow up, the same conclusion is supported only by very low quality evidence. For the ProDisc, there is very low quality evidence for contradictory results on the primary outcome measures when compared with anterior lumbar circumferential fusion. High quality randomized controlled trials with relevant control group and long-term follow-up is needed to evaluate the effectiveness and safety of TDR

Early versus Delayed Decompression for Traumatic Cervical Spinal Cord Injury: Results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS)

BACKGROUND:There is convincing preclinical evidence that early decompression in the setting of spinal cord injury (SCI) improves neurologic outcomes. However, the effect of early surgical decompression in patients with acute SCI remains uncertain. Our objective was to evaluate the relative effectiveness of early (<24 hours after injury) versus late (≥ 24 hours after injury) decompressive surgery after traumatic cervical SCI. METHODS:We performed a multicenter, international, prospective cohort study (Surgical Timing In Acute Spinal Cord Injury Study: STASCIS) in adults aged 16-80 with cervical SCI. Enrolment occurred between 2002 and 2009 at 6 North American centers. The primary outcome was ordinal change in ASIA Impairment Scale (AIS) grade at 6 months follow-up. Secondary outcomes included assessments of complications rates and mortality. FINDINGS:A total of 313 patients with acute cervical SCI were enrolled. Of these, 182 underwent early surgery, at a mean of 14.2(± 5.4) hours, with the remaining 131 having late surgery, at a mean of 48.3(± 29.3) hours. Of the 222 patients with follow-up available at 6 months post injury, 19.8% of patients undergoing early surgery showed a ≥ 2 grade improvement in AIS compared to 8.8% in the late decompression group (OR = 2.57, 95% CI:1.11,5.97). In the multivariate analysis, adjusted for preoperative neurological status and steroid administration, the odds of at least a 2 grade AIS improvement were 2.8 times higher amongst those who underwent early surgery as compared to those who underwent late surgery (OR = 2.83, 95% CI:1.10,7.28). During the 30 day post injury period, there was 1 mortality in both of the surgical groups. Complications occurred in 24.2% of early surgery patients and 30.5% of late surgery patients (p = 0.21). CONCLUSION:Decompression prior to 24 hours after SCI can be performed safely and is associated with improved neurologic outcome, defined as at least a 2 grade AIS improvement at 6 months follow-up

The efficacy of surgical decompression before 24 hours versus 24 to 72 hours in patients with spinal cord injury from T1 to L1 – with specific consideration on ethics: a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>There is no clear evidence that early decompression following spinal cord injury (SCI) improves neurologic outcome. Such information must be obtained from randomized controlled trials (RCTs). To date no large scale RCT has been performed evaluating the timing of surgical decompression in the setting of thoracolumbar spinal cord injury. A concern for many is the ethical dilemma that a delay in surgery may adversely effect neurologic recovery although this has never been conclusively proven. The purpose of this study is to compare the efficacy of early (before 24 hours) verse late (24–72 hours) surgical decompression in terms of neurological improvement in the setting of traumatic thoracolumbar spinal cord injury in a randomized format by independent, trained and blinded examiners.</p> <p>Methods</p> <p>In this prospective, randomized clinical trial, 328 selected spinal cord injury patients with traumatic thoracolumbar spinal cord injury are to be randomly assigned to: 1) early surgery (before 24 hours); or 2) late surgery (24–72 hours). A rapid response team and set up is prepared to assist the early treatment for the early decompressive group. Supportive care, i.e. pressure support, immobilization, will be provided on admission to the late decompression group. Patients will be followed for at least 12 months posttrauma.</p> <p>Discussion</p> <p>This study will hopefully assist in contributing to the question of the efficacy of the timing of surgery in traumatic thoracolumbar SCI.</p> <p>Trial Registration</p> <p><b>RCT registration number: ISRCTN61263382</b></p

Research strategies for organizational history:a dialogue between historical theory and organization theory

If history matters for organization theory, then we need greater reflexivity regarding the epistemological problem of representing the past; otherwise, history might be seen as merely a repository of ready-made data. To facilitate this reflexivity, we set out three epistemological dualisms derived from historical theory to explain the relationship between history and organization theory: (1) in the dualism of explanation, historians are preoccupied with narrative construction, whereas organization theorists subordinate narrative to analysis; (2) in the dualism of evidence, historians use verifiable documentary sources, whereas organization theorists prefer constructed data; and (3) in the dualism of temporality, historians construct their own periodization, whereas organization theorists treat time as constant for chronology. These three dualisms underpin our explication of four alternative research strategies for organizational history: corporate history, consisting of a holistic, objectivist narrative of a corporate entity; analytically structured history, narrating theoretically conceptualized structures and events; serial history, using replicable techniques to analyze repeatable facts; and ethnographic history, reading documentary sources "against the grain." Ultimately, we argue that our epistemological dualisms will enable organization theorists to justify their theoretical stance in relation to a range of strategies in organizational history, including narratives constructed from documentary sources found in organizational archives. Copyright of the Academy of Management, all rights reserved

Pathogenesis, diagnosis and management of pneumorrhachis

Pneumorrhachis (PR), the presence of intraspinal air, is an exceptional but eminent radiographic finding, accompanied by different aetiologies and possible pathways of air entry into the spinal canal. By reviewing the literature and analysing a personal case of traumatic cervical PR after head injury, we present current data regarding the pathoanatomy, clinical and radiological presentation, diagnosis and differential diagnosis and treatment modalities of patients with PR and associated pathologies to highlight this uncommon phenomenon and outline aetiology-based guidelines for the practical management of PR. Air within the spinal canal can be divided into primary and secondary PR, descriptively classified into extra- or intradural PR and aetiologically subsumed into iatrogenic, traumatic and nontraumatic PR. Intraspinal air is usually found isolated not only in the cervical, thoracic and, less frequently, the lumbosacral regions but can also be located in the entire spinal canal. PR is almost exceptional associated with further air distributions in the body. The pathogenesis and aetiologies of PR are multifold and can be a diagnostic challenge. The diagnostic procedure should include spinal CT, the imaging tool of choice. PR has to be differentiated from free intraspinal gas collections and the coexistence of air and gas within the spinal canal has to be considered differential diagnostically. PR usually represents an asymptomatic epiphenomenon but can also be symptomatic by itself as well as by its underlying pathology. The latter, although often severe, might be concealed and has to be examined carefully to enable adequate patient treatment. The management of PR has to be individualized and frequently requires a multidisciplinary regime