The first orbital solution for the massive colliding-wind binary HD 93162 (≡WR 25)

Context. Since the discovery, with the EINSTEIN satellite, of strong X-ray emission associated with HD 93162 (≡WR 25), this object has been predicted to be a colliding-wind binary system. However, radial-velocity variations that would prove the suspected binary nature have yet to be found. Aims. We spectroscopically monitored this object to investigate its possible variability to address this discordance. Methods. We compiled the largest available radial-velocity data set for this star to look for variations that might be due to binary motion. We derived radial velocities from spectroscopic data acquired mainly between 1994 and 2006, and searched these radial velocities for periodicities using different numerical methods. Results. For the first time, periodic radial-velocity variations are detected. Our analysis definitively shows that the Wolf-Rayet star WR 25 is an eccentric binary system with a probable period of about 208 days.Facultad de Ciencias Astronómicas y Geofísica

The first orbital solution for the massive colliding-wind binary HD 93162 (≡WR 25)

Context. Since the discovery, with the EINSTEIN satellite, of strong X-ray emission associated with HD 93162 (≡WR 25), this object has been predicted to be a colliding-wind binary system. However, radial-velocity variations that would prove the suspected binary nature have yet to be found. Aims. We spectroscopically monitored this object to investigate its possible variability to address this discordance. Methods. We compiled the largest available radial-velocity data set for this star to look for variations that might be due to binary motion. We derived radial velocities from spectroscopic data acquired mainly between 1994 and 2006, and searched these radial velocities for periodicities using different numerical methods. Results. For the first time, periodic radial-velocity variations are detected. Our analysis definitively shows that the Wolf-Rayet star WR 25 is an eccentric binary system with a probable period of about 208 days.Facultad de Ciencias Astronómicas y Geofísica

Mal-positioned nasogastric feeding tubes : are medical students safe to identify them?

OBJECTIVES: Nasogastric tube (NGT) placement is listed against Clinical Imaging in the upcoming Medical Licensing Assessment-compulsory for every graduating UK medical student from 2025. This study aims to establish the ability of medical students to correctly identify the position of an NGT on Chest X-ray (CXR) and to evaluate a learning tool to improve student outcome in this area. METHODS: Fourth-year (MB4) and fifth-year (MB5) medical students were invited to view 20 CXRs with 14 correctly sited and 6 mal-positioned NGT. MB5 students (Intervention) were exposed to an online interactive learning tool, with MB4 students kept as control. One week later, both groups of students were invited to view 20 more CXRs for NGT placement. RESULTS: Only 12 (4.8%) of 249 MB5 students and 5 (3.1%) of 161 MB4 students correctly identified all the NGTs on CXRs. The number of students misidentifying 1 or more mal-positioned NGT as "safe to feed" was 129 (51.8%) for MB5 and 76 (47.2%) for MB4 students. This improved significantly (P < .001) following exposure to the learning tool with 58% scoring all CXRs correctly, while 28% scored 1 or more mal-positioned NGT incorrectly. Students struggled to determine if the NGT tip had adequately passed into the stomach. However, they failed to identify an NG tube in the lung ("never event") in just one out of 1,108 opportunities. CONCLUSION: Medical students' ability to determine if the NGT was in the stomach remains suboptimal despite exposure to over 60 CXRs. Feeding NGT should be formally reported before use. ADVANCES IN KNOWLEDGE: This is the first attempt at quantifying graduating medical students', and by inference junior doctors', competence in safely identifying misplaced nasogastric feeding tubes. An online, experiential learning resource significantly improved their ability

Broad Balmer Wings in BA Hyper/Supergiants Distorted by Diffuse Interstellar Bands: Five Examples in the 30 Doradus Region from the VLT-FLAMES Tarantula Survey

Extremely broad emission wings at Hβ and Hα have been found in VLT-FLAMES Tarantula Survey data for five very luminous BA supergiants in or near 30 Doradus in the Large Magellanic Cloud. The profiles of both lines are extremely asymmetrical, which we have found to be caused by very broad diffuse interstellar bands (DIBs) in the longward wing of Hβ and the shortward wing of Hα. These DIBs are well known to interstellar but not to many stellar specialists, so that the asymmetries may be mistaken for intrinsic features. The broad emission wings are generally ascribed to electron scattering, although we note difficulties for that interpretation in some objects. Such profiles are known in some Galactic hyper/supergiants and are also seen in both active and quiescent Luminous Blue Variables (LBVs). No prior or current LBV activity is known in these 30 Dor stars, although a generic relationship to LBVs is not excluded; subject to further observational and theoretical investigation, it is possible that these very luminous supergiants are approaching the LBV stage for the first time. Their locations in the HRD and presumed evolutionary tracks are consistent with that possibility. The available evidence for spectroscopic variations of these objects is reviewed, while recent photometric monitoring does not reveal variability. A search for circumstellar nebulae has been conducted, with an indeterminate result for one of them

The first orbital solution for the massive colliding-wind binary HD 93162 (≡WR 25)

Context. Since the discovery, with the EINSTEIN satellite, of strong X-ray emission associated with HD 93162 (≡WR 25), this object has been predicted to be a colliding-wind binary system. However, radial-velocity variations that would prove the suspected binary nature have yet to be found. Aims. We spectroscopically monitored this object to investigate its possible variability to address this discordance. Methods. We compiled the largest available radial-velocity data set for this star to look for variations that might be due to binary motion. We derived radial velocities from spectroscopic data acquired mainly between 1994 and 2006, and searched these radial velocities for periodicities using different numerical methods. Results. For the first time, periodic radial-velocity variations are detected. Our analysis definitively shows that the Wolf-Rayet star WR 25 is an eccentric binary system with a probable period of about 208 days.Facultad de Ciencias Astronómicas y Geofísica

Predictive modelling framework on the basis of artificial neural network: A case of nano-powder mixed electric discharge machining

In this modern era where Industry 4.0, plays a crucial role in enhancing productivity, quality, and resource utilization by digitalizing and providing smart operation to industrial systems. Therefore, there is a need to establish a framework that enhances productivity and quality of work to achieve the net-zero from industry. In this study, a comprehensive and generic analytical framework has been established to mitigate or lessen the research and technological gap in the manufacturing sector. In addition to that, the key stages involved in artificial intelligence (AI) based modelling and optimization analysis for manufacturing systems have also been incorporated. To assess the proposed AI framework, electric discharge machining (EDM) as a case study has been selected. The focus enlightens the emergence of optimizing the material removal rate (MRR) and surface roughness (SR) for Inconel 617 (IN617) material. A full factorial design of the experiment was carried out for experimentation. After that, an artificial neural network (ANN) as a modelling framework is selected, and fine-tuning of hyperparameters during training has been carried out. To validate the predictive performance of the trained models, an external validation (Valext) test has been conducted. Through sensitivity analysis (SA) on the developed AI framework, the most influential factors affecting MRR and SR in EDM have been identified. Specifically, powder concentration (Cp) contributes the most to the percentage significance, accounting for 79.00 % towards MRR, followed by treatment (16.35 %) and 4.67 % surfactant concentration (Sc). However, the highest % significance in SR is given by Sc (36.86 %), followed by Cp (33.23 %), and then treatment (29.90 %), respectively. Furthermore, a parametric optimization has been performed using the framework and found that MRR and SR are 93.75 % and 58.90 % better than experimental data. This successful performance optimization proposed by the framework has the potential for application to other manufacturing systems

Cardiac myosin activation with omecamtiv mecarbil in systolic heart failure

BACKGROUND The selective cardiac myosin activator omecamtiv mecarbil has been shown to improve cardiac function in patients with heart failure with a reduced ejection fraction. Its effect on cardiovascular outcomes is unknown. METHODS We randomly assigned 8256 patients (inpatients and outpatients) with symptomatic chronic heart failure and an ejection fraction of 35% or less to receive omecamtiv mecarbil (using pharmacokinetic-guided doses of 25 mg, 37.5 mg, or 50 mg twice daily) or placebo, in addition to standard heart-failure therapy. The primary outcome was a composite of a first heart-failure event (hospitalization or urgent visit for heart failure) or death from cardiovascular causes. RESULTS During a median of 21.8 months, a primary-outcome event occurred in 1523 of 4120 patients (37.0%) in the omecamtiv mecarbil group and in 1607 of 4112 patients (39.1%) in the placebo group (hazard ratio, 0.92; 95% confidence interval [CI], 0.86 to 0.99; P = 0.03). A total of 808 patients (19.6%) and 798 patients (19.4%), respectively, died from cardiovascular causes (hazard ratio, 1.01; 95% CI, 0.92 to 1.11). There was no significant difference between groups in the change from baseline on the Kansas City Cardiomyopathy Questionnaire total symptom score. At week 24, the change from baseline for the median N-terminal pro-B-type natriuretic peptide level was 10% lower in the omecamtiv mecarbil group than in the placebo group; the median cardiac troponin I level was 4 ng per liter higher. The frequency of cardiac ischemic and ventricular arrhythmia events was similar in the two groups. CONCLUSIONS Among patients with heart failure and a reduced ejection, those who received omecamtiv mecarbil had a lower incidence of a composite of a heart-failure event or death from cardiovascular causes than those who received placebo. (Funded by Amgen and others; GALACTIC-HF ClinicalTrials.gov number, NCT02929329; EudraCT number, 2016 -002299-28.)

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)