643 research outputs found
Light echoes reveal an unexpectedly cool Eta Carinae during its 19th-century Great Eruption
Eta Carinae (Eta Car) is one of the most massive binary stars in the Milky
Way. It became the second-brightest star in the sky during its mid-19th century
"Great Eruption," but then faded from view (with only naked-eye estimates of
brightness). Its eruption is unique among known astronomical transients in that
it exceeded the Eddington luminosity limit for 10 years. Because it is only 2.3
kpc away, spatially resolved studies of the nebula have constrained the ejected
mass and velocity, indicating that in its 19th century eruption, Eta Car
ejected more than 10 M_solar in an event that had 10% of the energy of a
typical core-collapse supernova without destroying the star. Here we report the
discovery of light echoes of Eta Carinae which appear to be from the 1838-1858
Great Eruption. Spectra of these light echoes show only absorption lines, which
are blueshifted by -210 km/s, in good agreement with predicted expansion
speeds. The light-echo spectra correlate best with those of G2-G5 supergiant
spectra, which have effective temperatures of ~5000 K. In contrast to the class
of extragalactic outbursts assumed to be analogs of Eta Car's Great Eruption,
the effective temperature of its outburst is significantly cooler than allowed
by standard opaque wind models. This indicates that other physical mechanisms
like an energetic blast wave may have triggered and influenced the eruption.Comment: Accepted for publication by Nature; 4 pages, 4 figures, SI: 6 pages,
3 figures, 5 table
Anaesthetic considerations of adults with Morquio's syndrome - a case report
<p>Abstract</p> <p>Background</p> <p>The anaesthetic management of patients with Morquio syndrome is complicated by a number of factors including odontoid hypoplasia, atlantoaxial instability, thoracic kyphosis, and deposition of mucopolysaccharides in the soft tissue of the oropharnyx.</p> <p>Case presentation</p> <p>Herein we describe the anaesthetic considerations and management of a 26 year old adult with Morquio syndrome, who presented for an elective hip replacement.</p> <p>Conclusion</p> <p>This report details an awake fiberoptic intubation in an adult with Morquio syndrome. We recommend that this approach be considered in patients with Morquio syndrome undergoing general anaesthesia.</p
Does minimally invasive lumbar disc surgery result in less muscle injury than conventional surgery? A randomized controlled trial
The concept of minimally invasive lumbar disc surgery comprises reduced muscle injury. The aim of this study was to evaluate creatine phosphokinase (CPK) in serum and the cross-sectional area (CSA) of the multifidus muscle on magnetic resonance imaging as indicators of muscle injury. We present the results of a double-blind randomized trial on patients with lumbar disc herniation, in which tubular discectomy and conventional microdiscectomy were compared. In 216 patients, CPK was measured before surgery and at day 1 after surgery. In 140 patients, the CSA of the multifidus muscle was measured at the affected disc level before surgery and at 1 year after surgery. The ratios (i.e. post surgery/pre surgery) of CPK and CSA were used as outcome measures. The multifidus atrophy was classified into three grades ranging from 0 (normal) to 3 (severe atrophy), and the difference between post and pre surgery was used as an outcome. Patients’ low-back pain scores on the visual analogue scale (VAS) were documented before surgery and at various moments during follow-up. Tubular discectomy compared with conventional microdiscectomy resulted in a nonsignificant difference in CPK ratio, although the CSA ratio was significantly lower in tubular discectomy. At 1 year, there was no difference in atrophy grade between both groups nor in the percentage of patients showing an increased atrophy grade (14% tubular vs. 18% conventional). The postoperative low-back pain scores on the VAS improved in both groups, although the 1-year between-group mean difference of improvement was 3.5 mm (95% CI; 1.4–5.7 mm) in favour of conventional microdiscectomy. In conclusion, tubular discectomy compared with conventional microdiscectomy did not result in reduced muscle injury. Postoperative evaluation of CPK and the multifidus muscle showed similar results in both groups, although patients who underwent tubular discectomy reported more low-back pain during the first year after surgery
GRIPS - Gamma-Ray Imaging, Polarimetry and Spectroscopy
We propose to perform a continuously scanning all-sky survey from 200 keV to
80 MeV achieving a sensitivity which is better by a factor of 40 or more
compared to the previous missions in this energy range. The Gamma-Ray Imaging,
Polarimetry and Spectroscopy (GRIPS) mission addresses fundamental questions in
ESA's Cosmic Vision plan. Among the major themes of the strategic plan, GRIPS
has its focus on the evolving, violent Universe, exploring a unique energy
window. We propose to investigate -ray bursts and blazars, the
mechanisms behind supernova explosions, nucleosynthesis and spallation, the
enigmatic origin of positrons in our Galaxy, and the nature of radiation
processes and particle acceleration in extreme cosmic sources including pulsars
and magnetars. The natural energy scale for these non-thermal processes is of
the order of MeV. Although they can be partially and indirectly studied using
other methods, only the proposed GRIPS measurements will provide direct access
to their primary photons. GRIPS will be a driver for the study of transient
sources in the era of neutrino and gravitational wave observatories such as
IceCUBE and LISA, establishing a new type of diagnostics in relativistic and
nuclear astrophysics. This will support extrapolations to investigate star
formation, galaxy evolution, and black hole formation at high redshifts.Comment: to appear in Exp. Astron., special vol. on M3-Call of ESA's Cosmic
Vision 2010; 25 p., 25 figs; see also www.grips-mission.e
A Blast Wave from the 1843 Eruption of Eta Carinae
Very massive stars shed much of their mass in violent precursor eruptions as
luminous blue variables (LBVs) before reaching their most likely end as
supernovae, but the cause of LBV eruptions is unknown. The 19th century
eruption of Eta Carinae, the prototype of these events, ejected about 12 solar
masses at speeds of 650 km/s, with a kinetic energy of almost 10^50 ergs. Some
faster material with speeds up to 1000-2000 km/s had previously been reported
but its full distribution was unknown. Here I report observations of much
faster material with speeds up to 3500-6000 km/s, reaching farther from the
star than the fastest material in earlier reports. This fast material roughly
doubles the kinetic energy of the 19th century event, and suggests that it
released a blast wave now propagating ahead of the massive ejecta. Thus, Eta
Car's outer shell now mimics a low-energy supernova remnant. The eruption has
usually been discussed in terms of an extreme wind driven by the star's
luminosity, but fast material reported here suggests that it was powered by a
deep-seated explosion rivalling a supernova, perhaps triggered by the
pulsational pair instability. This may alter interpretations of similar events
seen in other galaxies.Comment: 10 pages, 3 color figs, supplementary information. Accepted by Natur
Comparative mortality of hemodialysis patients at for-profit and not-for-profit dialysis facilities in the United States, 1998 to 2003: A retrospective analysis
<p>Abstract</p> <p>Background</p> <p>Concern lingers that dialysis therapy at for-profit (versus not-for-profit) hemodialysis facilities in the United States may be associated with higher mortality, even though 4 of every 5 contemporary dialysis patients receive therapy in such a setting.</p> <p>Methods</p> <p>Our primary objective was to compare the mortality hazards of patients initiating hemodialysis at for-profit and not-for-profit centers in the United States between 1998 and 2003. For-profit status of dialysis facilities was determined after subjects received 6 months of dialysis therapy, and mean follow-up was 1.7 years.</p> <p>Results</p> <p>Of the study population (<it>N </it>= 205,076), 79.9% were dialyzed in for-profit facilities after 6 months of dialysis therapy. Dialysis at for-profit facilities was associated with higher urea reduction ratios, hemoglobin levels (including levels above 12 and 13 g/dL [120 and 130 g/L]), epoetin doses, and use of intravenous iron, and less use of blood transfusions and lower proportions of patients on the transplant waiting-list (<it>P </it>< 0.05). Patients dialyzed at for-profit and at not-for-profit facilities had similar mortality risks (adjusted hazards ratio 1.02, 95% CI 0.99–1.06, <it>P </it>= 0.143).</p> <p>Conclusion</p> <p>While hemodialysis treatment at for-profit and not-for-profit dialysis facilities is associated with different patterns of clinical benchmark achievement, mortality rates are similar.</p
Gastrointestinal Hyperplasia with Altered Expression of DNA Polymerase β
Background: Altered expression of DNA polymerase β (Pol β) has been documented in a large percentage of human tumors. However, tumor prevalence or predisposition resulting from Pol β over-expression has not yet been evaluated in a mouse model. Methodology/Principal Findings: We have recently developed a novel transgenic mouse model that over-expresses Pol β. These mice present with an elevated incidence of spontaneous histologic lesions, including cataracts, hyperplasia of Brunner's gland and mucosal hyperplasia in the duodenum. In addition, osteogenic tumors in mice tails, such as osteoma and osteosarcoma were detected. This is the first report of elevated tumor incidence in a mouse model of Pol β over-expression. These findings prompted an evaluation of human gastrointestinal tumors with regard to Pol β expression. We observed elevated expression of Pol β in stomach adenomas and thyroid follicular carcinomas, but reduced Pol β expression in esophageal adenocarcinomas and squamous carcinomas. Conclusions/Significance: These data support the hypothesis that balanced and proficient base excision repair protein expression and base excision repair capacity is required for genome stability and protection from hyperplasia and tumor formation
Reasons of general practitioners for not prescribing lipid-lowering medication to patients with diabetes: a qualitative study
Background: Lipid-lowering medication remains underused, even in high-risk populations. The objective of this study was to determine factors underlying general practitioners' decisions not to prescribe such drugs to patients with type 2 diabetes. Methods: A qualitative study with semi-structured interviews using real cases was conducted to explore reasons for not prescribing lipid-lowering medication after a guideline was distributed that recommended the use of statins in most patients with type 2 diabetes. Seven interviews were conducted with general practitioners (GPs) in The Netherlands, and analysed using an analytic inductive approach. Results: Reasons for not-prescribing could be divided into patient and physician-attributed factors. According to the GPs, some patients do not follow-up on agreed medication and others object to taking lipid-lowering medication, partly for legitimate reasons such as expected or perceived side effects. Furthermore, the GPs themselves perceived reservations for prescribing lipid-lowering medication in patients with short life expectancy, expected compliance problems or near goal lipid levels. GPs sometimes postponed the start of treatment because of other priorities. Finally, barriers were seen in the GPs' practice organisation, and at the primary-secondary care interface. Conclusion: Some of the barriers mentioned by GPs seem to be valid reasons, showing that guideline non-adherence can be quite rational. On the other hand, treatment quality could improve by addressing issues, such as lack of knowledge or motivation of both the patient and the GP. More structured management in general practice may also lead to better treatment
Timing and minimal access surgery for sciatica: a summary of two randomized trials
Scientific Assessment and Innovation in Neurosurgical Treatment Strategie
Differing myocardial response to a single session of hemodialysis in end-stage renal disease with and without type 2 diabetes mellitus and coronary artery disease
BACKGROUND: Though hemodialysis (HD) acutely improves cardiac function, the impact of background diseases like coronary artery disease (CAD) and Type 2 diabetes (DM) in the setting of end-stage renal disease (ESRD) is not known. Tissue velocity echocardiography (TVE) offers a fast choice to follow changes in myocardial function after HD in ESRD with concomitant DM and /or CAD. METHODS: 46 subjects (17 with ESRD, Group 1; 15 with DM, Group 2; 14 with DM+CAD, Group 3) underwent standard and TVE prior to and shortly after HD. Besides standard Doppler variables, regional myocardial systolic and diastolic velocities, as well as systolic strain rate were post processed. RESULTS: Compared with pre-HD, post-HD body weight (kg) significantly decreased in all the three groups (51 ± 9 vs. 48 ± 8, 62 ± 10 vs.59 ± 10, and 61 ± 9 vs. 58 ± 9 respectively; all p < 0.01). Left ventricular end diastolic dimensions (mm) also decreased post- HD (46 ± 5 vs. 42 ± 7, 53 ± 7 vs. 50 ± 7, 51 ± 7 vs. 47 ± 8 respectively; all p < 0.01). Regional longitudinal peak systolic velocity in septum (cm/s) significantly increased post-HD in Group 1(5.7 ± 1.6 vs. 7.2 ± 2.3; p < 0.001) while remained unchanged in the other two groups. Similar trends were noted in other left ventricular walls. When the myocardial velocities (cm/s) were computed globally, the improvement was seen only in Group 1 (6.3 ± 1.5 vs. 7.9 ± 2.0; p < 0.001). Global early regional diastolic velocity (cm/s) improved in Group 1, remained unchanged in Group 2, while significantly decreased in Group 3(-5.9 ± 1.3 vs. -4.1 ± 1.8; p < 0.01). Global systolic strain rate (1/sec) increased in the first 2 Groups but remained unchanged (-0.87 ± 0.4 vs. -0.94 ± 0.3; p = ns) in Group 3. CONCLUSION: A single HD session improves LV function only in ESRD without coexistent DM and/or CAD. The present data suggest that not only dialysis-dependent changes in loading conditions but also co-existent background diseases determine the myocardial response to HD
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