Venous thromboembolism risk and prophylaxis prescription in surgical patients at a tertiary hospital in Eastern Cape Province, South Africa

Background. Venous thromboembolism (VTE) is a common complication during and after hospitalisation, and is regarded as the most common cause of preventable death in hospitalised patients worldwide. Despite its importance, there are few data on VTE risk and adherence to prophylaxis prescription guidelines in surgical patients from the South African (SA) public sector, especially from low-resource environments such as Eastern Cape Province.Objectives. To evaluate the risk and prescription of VTE prophylaxis to surgical patients at a tertiary government hospital in the Eastern Cape.Methods. A cross-sectional clinical audit of general surgical inpatients was performed on two dates during July and August 2017. Patients’ VTE risk was calculated by using the Caprini risk assessment model (RAM) and thromboprophylaxis prescription evaluated accordingly.Results. A total of 179 patients were included in the study, of whom 56% were male and 44% female. The average age was 45 (range 18 - 83) years. Of the total number of participants, 33% were elective cases and 67% were emergency admissions. With application of RAM, 77% of patients were at risk of VTE (Caprini score ≥2), with 81% of elective and 74% of emergency patients being at risk. The most prevalent risk factors for VTE were major surgery (34%), age 41 - 60 years (30%), age 61 - 74 years (20%) and sepsis during the previous month (27%). A contraindication to chemoprophylaxis was recorded in 30% of patients, with the most prevalent being renal dysfunction (40%), peptic ulcer disease (34%), active bleeding (17%), liver dysfunction (17%), coagulopathy (6%) and recent cerebral haemorrhage (6%). With regard to VTE risk profile and contraindications to chemoprophylaxis, the correct thromboprophylactic treatment was prescribed to 26% of at-risk patients, with 21% of elective and 27% of emergency admission patients receiving the correct therapy.Conclusions. Despite a high proportion of patients being at risk of VTE, the rate of adequate thromboprophylaxis prescription for surgical inpatients at Frere Hospital, East London, SA is very low. Increased availability of mechanical prophylaxis, as well as interventions to improve the rate of adequate prophylaxis prescription, needs to be evaluated for feasibility and effect in this hospital and other SA public hospitals

Constraints on Supersymmetric Grand Unified Theories from Cosmology

Within the context of SUSY GUTs, cosmic strings are generically formed at the end of hybrid inflation. However, the WMAP CMB measurements strongly constrain the possible cosmic strings contribution to the angular power spectrum of anisotropies. We investigate the parameter space of SUSY hybrid (F- and D- term) inflation, to get the conditions under which theoretical predictions are in agreement with data. The predictions of F-term inflation are in agreement with data, only if the superpotential coupling $\kappa$ is small. In particular, for SUSY SO(10), the upper bound is \kappa\lsim 7\times 10^{-7}. This fine tuning problem can be lifted if we employ the curvaton mechanism, in which case \kappa\lsim 8\times 10^{-3}; higher values are not allowed by the gravitino constraint. The constraint on $\kappa$ is equivalent to a constraint on the SSB mass scale $M$, namely M \lsim 2\times 10^{15} GeV. The study of D-term inflation shows that the inflaton field is of the order of the Planck scale; one should therefore consider SUGRA. We find that the cosmic strings contribution to the CMB anisotropies is not constant, but it is strongly dependent on the gauge coupling $g$ and on the superpotential coupling $\lambda$. We obtain g\lsim 2\times 10^{-2} and \lambda \lsim 3\times 10^{-5}. SUGRA corrections induce also a lower limit for $\lambda$. Equivalently, the Fayet-Iliopoulos term $\xi$ must satisfy \sqrt\xi \lsim 2\times 10^{15} GeV. This constraint holds for all allowed values of $g$.Comment: 32 pages, 7 figures. To match published versio

How generic is cosmic string formation in SUSY GUTs

We study cosmic string formation within supersymmetric grand unified theories. We consider gauge groups having a rank between 4 and 8. We examine all possible spontaneous symmetry breaking patterns from the GUT down to the standard model gauge group. Assuming standard hybrid inflation, we select all the models which can solve the GUT monopole problem, lead to baryogenesis after inflation and are consistent with proton lifetime measurements. We conclude that in all acceptable spontaneous symmetry breaking schemes, cosmic string formation is unavoidable. The strings which form at the end of inflation have a mass which is proportional to the inflationary scale. Sometimes, a second network of strings form at a lower scale. Models based on gauge groups which have rank greater than 6 can lead to more than one inflationary era; they all end by cosmic string formation.Comment: 31 pages, Latex, submitted to PR

The astrometric Gaia-FUN-SSO observation campaign of 99 942 Apophis

Astrometric observations performed by the Gaia Follow-Up Network for Solar System Objects (Gaia-FUN-SSO) play a key role in ensuring that moving objects first detected by ESA's Gaia mission remain recoverable after their discovery. An observation campaign on the potentially hazardous asteroid (99 942) Apophis was conducted during the asteroid's latest period of visibility, from 12/21/2012 to 5/2/2013, to test the coordination and evaluate the overall performance of the Gaia-FUN-SSO . The 2732 high quality astrometric observations acquired during the Gaia-FUN-SSO campaign were reduced with the Platform for Reduction of Astronomical Images Automatically (PRAIA), using the USNO CCD Astrograph Catalogue 4 (UCAC4) as a reference. The astrometric reduction process and the precision of the newly obtained measurements are discussed. We compare the residuals of astrometric observations that we obtained using this reduction process to data sets that were individually reduced by observers and accepted by the Minor Planet Center. We obtained 2103 previously unpublished astrometric positions and provide these to the scientific community. Using these data we show that our reduction of this astrometric campaign with a reliable stellar catalog substantially improves the quality of the astrometric results. We present evidence that the new data will help to reduce the orbit uncertainty of Apophis during its close approach in 2029. We show that uncertainties due to geolocations of observing stations, as well as rounding of astrometric data can introduce an unnecessary degradation in the quality of the resulting astrometric positions. Finally, we discuss the impact of our campaign reduction on the recovery process of newly discovered asteroids.Comment: Accepted for publication in A&

Shift Symmetry and Inflation in Supergravity

We consider models of inflation in supergravity with a shift symmetry. We focus on models with one moduli and one inflaton field. The presence of this symmetry guarantees the existence of a flat direction for the inflaton field. Mildly breaking the shift symmetry using a superpotential which depends not only on the moduli but also on the inflaton field allows one to lift the inflaton flat direction. Along the inflaton direction, the eta-problem is alleviated. Combining the KKLT mechanism for moduli stabilization and a shift symmetry breaking superpotential of the chaotic inflation type, we find models reminiscent of ``mutated hybrid inflation'' where the inflationary trajectory is curved in the moduli--inflaton plane. We analyze the phenomenology of these models and stress their differences with both chaotic and hybrid inflation.Comment: 29 pages, 13 figure

Black Hole Lasers Revisited

The production of Hawking radiation by a single horizon is not dependent on the high-frequency dispersion relation of the radiated field. When there are two horizons, however, Corley and Jacobson have shown that superluminal dispersion leads to an amplification of the particle production in the case of bosons. The analytic theory of this "black hole laser" process is quite complicated, so we provide some numerical results in the hope of aiding understanding of this interesting phenomenon. Specifically, we consider sonic horizons in a moving fluid. The theory of elementary excitations in a Bose-Einstein condensate provides an example of "superluminal" (Bogoliubov) dispersion, so we add Bogoliubov dispersion to Unruh's equation for sound in the fluid. A white-hole/black-hole horizon pair will then display black hole lasing. Numerical analysis of the evolution of a wave packet gives a clear picture of the amplification process. By utilizing the similarity of a radiating horizon to a parametric amplifier in quantum optics we also analyze the black hole laser as a quantum-optical network.Comment: 16 page

Acute Stress Induces Contrasting Changes in AMPA Receptor Subunit Phosphorylation within the Prefrontal Cortex, Amygdala and Hippocampus

Exposure to stress causes differential neural modifications in various limbic regions, namely the prefrontal cortex, hippocampus and amygdala. We investigated whether α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR) phosphorylation is involved with these stress effects. Using an acute inescapable stress protocol with rats, we found opposite effects on AMPA receptor phosphorylation in the medial prefrontal cortex (mPFC) and dorsal hippocampus (DH) compared to the amygdala and ventral hippocampus (VH). After stress, the phosphorylation of Ser831-GluA1 was markedly decreased in the mPFC and DH, whereas the phosphorylation of Ser845-GluA1 was increased in the amygdala and VH. Stress also modulated the GluA2 subunit with a decrease in the phosphorylation of both Tyr876-GluA2 and Ser880-GluA2 residues in the amygdala, and an increase in the phosphorylation of Ser880-GluA2 in the mPFC. These results demonstrate that exposure to acute stress causes subunit-specific and region-specific changes in glutamatergic transmission, which likely lead to the reduced synaptic efficacy in the mPFC and DH and augmented activity in the amygdala and VH. In addition, these findings suggest that modifications of glutamate receptor phosphorylation could mediate the disruptive effects of stress on cognition. They also provide a means to reconcile the contrasting effects that stress has on synaptic plasticity in these regions. Taken together, the results provide support for a brain region-oriented approach to therapeutics

Atomic scale strain relaxation in axial semiconductor III-V nanowire heterostructures

Combination of mismatched materials in semiconductor nanowire heterostructures offers a freedom of bandstructure engineering that is impossible in standard planar epitaxy. Nevertheless, the presence of strain and structural defects directly control the optoelectronic properties of these nanomaterials. Understanding with atomic accuracy how mismatched heterostructures release or accommodate strain, therefore, is highly desirable. By using atomic resolution high angle annular dark field scanning transmission electron microscopy combined with geometrical phase analyses and computer simulations, we are able to establish the relaxation mechanisms (including both elastic and plastic deformations) to release the mismatch strain in axial nanowire heterostructures. Formation of misfit dislocations, diffusion of atomic species, polarity transfer, and induced structural transformations are studied with atomic resolution at the intermediate ternary interfaces. Two nanowire heterostructure systems with promising applications (InAs/InSb and GaAs/GaSb) have been selected as key examples

Permanent 125I-seed prostate brachytherapy: early prostate specific antigen value as a predictor of PSA bounce occurrence

<p>Abstract</p> <p>Purpose</p> <p>To evaluate predictive factors for PSA bounce after ¹²⁵I permanent seed prostate brachytherapy and identify criteria that distinguish between benign bounces and biochemical relapses.</p> <p>Materials and methods</p> <p>Men treated with exclusive permanent ¹²⁵I seed brachytherapy from November 1999, with at least a 36 months follow-up were included. Bounce was defined as an increase ≥ 0.2 ng/ml above the nadir, followed by a spontaneous return to the nadir. Biochemical failure (BF) was defined using the criteria of the Phoenix conference: nadir +2 ng/ml.</p> <p>Results</p> <p>198 men were included. After a median follow-up of 63.9 months, 21 patients experienced a BF, and 35.9% had at least one bounce which occurred after a median period of 17 months after implantation (4-50). Bounce amplitude was 0.6 ng/ml (0.2-5.1), and duration was 13.6 months (4.0-44.9). In 12.5%, bounce magnitude exceeded the threshold defining BF. Age at the time of treatment and high PSA level assessed at 6 weeks were significantly correlated with bounce but not with BF. Bounce patients had a higher BF free survival than the others (100% versus 92%, p = 0,007). In case of PSA increase, PSA doubling time and velocity were not significantly different between bounce and BF patients. Bounces occurred significantly earlier than relapses and than nadir + 0.2 ng/ml in BF patients (17 vs 27.8 months, p < 0.0001).</p> <p>Conclusion</p> <p>High PSA value assessed 6 weeks after brachytherapy and young age were significantly associated to a higher risk of bounces but not to BF. Long delays between brachytherapy and PSA increase are more indicative of BF.</p

Global Carbon Budget 2018

Accurate assessment of anthropogenic carbon dioxide (CO2) emissions and their redistribution among the atmosphere, ocean, and terrestrial biosphere – the “global carbon budget” – is important to better understand the global carbon cycle, support the development of climate policies, and project future climate change. Here we describe data sets and methodology to quantify the five major components of the global carbon budget and their uncertainties. Fossil CO2 emissions (EFF) are based on energy statistics and cement production data, while emissions from land use and land-use change (ELUC), mainly deforestation, are based on land use and land-use change data and bookkeeping models. Atmospheric CO2 concentration is measured directly and its growth rate (GATM) is computed from the annual changes in concentration. The ocean CO2 sink (SOCEAN) and terrestrial CO2 sink (SLAND) are estimated with global process models constrained by observations. The resulting carbon budget imbalance (BIM), the difference between the estimated total emissions and the estimated changes in the atmosphere, ocean, and terrestrial biosphere, is a measure of imperfect data and understanding of the contemporary carbon cycle. All uncertainties are reported as ±1σ. For the last decade available (2008–2017), EFF was 9.4±0.5 GtC yr−1, ELUC 1.5±0.7 GtC yr−1, GATM 4.7±0.02 GtC yr−1, SOCEAN 2.4±0.5 GtC yr−1, and SLAND 3.2±0.8 GtC yr−1, with a budget imbalance BIM of 0.5 GtC yr−1 indicating overestimated emissions and/or underestimated sinks. For the year 2017 alone, the growth in EFF was about 1.6 % and emissions increased to 9.9±0.5 GtC yr−1. Also for 2017, ELUC was 1.4±0.7 GtC yr−1, GATM was 4.6±0.2 GtC yr−1, SOCEAN was 2.5±0.5 GtC yr−1, and SLAND was 3.8±0.8 GtC yr−1, with a BIM of 0.3 GtC. The global atmospheric CO2 concentration reached 405.0±0.1 ppm averaged over 2017. For 2018, preliminary data for the first 6–9 months indicate a renewed growth in EFF of +2.7 % (range of 1.8 % to 3.7 %) based on national emission projections for China, the US, the EU, and India and projections of gross domestic product corrected for recent changes in the carbon intensity of the economy for the rest of the world. The analysis presented here shows that the mean and trend in the five components of the global carbon budget are consistently estimated over the period of 1959–2017, but discrepancies of up to 1 GtC yr−1 persist for the representation of semi-decadal variability in CO2 fluxes. A detailed comparison among individual estimates and the introduction of a broad range of observations show (1) no consensus in the mean and trend in land-use change emissions, (2) a persistent low agreement among the different methods on the magnitude of the land CO2 flux in the northern extra-tropics, and (3) an apparent underestimation of the CO2 variability by ocean models, originating outside the tropics. This living data update documents changes in the methods and data sets used in this new global carbon budget and the progress in understanding the global carbon cycle compared with previous publications of this data set (Le Quéré et al., 2018, 2016, 2015a, b, 2014, 2013). All results presented here can be downloaded from https://doi.org/10.18160/GCP-2018