Porcine Bioprosthetic Aortic Valve Endocarditis with Ring Abscess and Aortic Stenosis

Porcine bioprosthetic valve endocarditis is an infrequent but serious complication of valve replacement surgery. Ring (or annular) abscess is a frequent finding in mechanical valve endocarditis. In contrast, porcine valve endocarditis most often involves the cusps, and annular infection is uncommon. Porcine valvular dysfunction secondary to endocarditis usually takes the form of incompetence, whereas stenosis is less frequent. We report a case of a 76-year-old female who developed endocarditis wilh Staphylococcus epidermidis nine months after placement of a Carpenter-Edwards porcine aortic valve. Her initial presentation included complete heart block and moderate aortic stenosis. Transesophageal echocardiography aided the diagnosis by demonstrating large vegetations, while transthoracic echocardiography showed only slight thickening of the valve leaflets. At operation, there was a circumferential abscess around the sewing ring causing valve dehiscence and virtual discontinuity of the aorta from the left ventricle. Valve degeneration and organisms within the cusps were observed on microscopy. This case illustrates two infrequent complications of porcine aortic valve endocarditis, namely massive annular abscess with invasion of the conducting system and aortic stenosis. It also demonstrates the utility and limitations of transesophageal echocardiography in the diagnosis of this disorder

Beyond words: Aesthetic knowledge and knowing in design

Aesthetic knowledge comes from practitioners understanding the look, feel, smell, taste and sound of things. It is vital to work in many organizational contexts. In this paper, we explore aesthetic knowledge and knowing in organizations through detailed observation of design work in the architectural practice Edward Cullinan Architects. Through our research, we explore aesthetic knowledge in the context of architectural work, we unpack what it is, how it is generated, and how it is applied in design projects, shared between practitioners and developed at the level of the organization. Our analysis suggests that aesthetic knowledge plays an important part in organizational practice, not only as the symbolic context for work, but as an integral part of the work that people do. It suggests that aesthetic reflexivity, which involves an opening up and questioning of what is known, is experienced as part of practice as well as a `time out' from practice

Additional experimental evidence for a solar influence on nuclear decay rates

Additional experimental evidence is presented in support of the recent hypothesis that a possible solar influence could explain fluctuations observed in the measured decay rates of some isotopes. These data were obtained during routine weekly calibrations of an instrument used for radiological safety at The Ohio State University Research Reactor using Cl-36. The detector system used was based on a Geiger-Mueller gas detector, which is a robust detector system with very low susceptibility to environmental changes. A clear annual variation is evident in the data, with a maximum relative count rate observed in January/February, and a minimum relative count rate observed in July/August, for seven successive years from July 2005 to June 2011. This annual variation is not likely to have arisen from changes in the detector surroundings, as we show here.Comment: 8 pages, 6 figure

Type Ia Supernova Rate Measurements To Redshift 2.5 From CANDELS: Searching For Prompt Explosions In The Early Universe

dThe Cosmic Assembly Near-infrared Deep Extragalactic Legacy Survey (CANDELS) was a multi-cycle treasury program on the Hubble Space Telescope (HST) that surveyed a total area of -0.25 deg2 with -900 HST orbits spread across five fields over three years. Within these survey images we discovered 65 supernovae (SNe) of all types, out to z 2.5. We classify -24 of these as Type Ia SNe (SNe Ia) based on host galaxy redshifts and SN photometry (supplemented by grism spectroscopy of six SNe). Here we present a measurement of the volumetric SN Ia rate as a function of redshift, reaching for the first time beyond z =- 2 and putting new constraints on SN Ia progenitor models. Our highest redshift bin includes detections of SNe that exploded when the universe was only -3 Gyr old and near the peak of the cosmic star formation history. This gives the CANDELS high redshift sample unique leverage for evaluating the fraction of SNe Ia that explode promptly after formation ( 40 Myr. However, mild tension is apparent between ground-based low-z surveys and space-based high-z surveys. In both CANDELS and the sister HST program CLASH (Cluster Lensing And Supernova Survey with Hubble), we find a low rate of SNe Ia at z > 1. This could be a hint that prompt progenitors are in fact relatively rare, accounting for only 20% of all SN Ia explosions-though further analysis and larger samples will be needed to examine that suggestion. Key words: infrared: general - supernovae:Astronom

The XMM deep survey in the CDF-S II. a 9-20 keV selection of heavily obscured active galaxies at z>1.7

We present results on a search of heavily obscured active galaxies z>1.7 using the rest-frame 9-20 keV excess for X-ray sources detected in the deep XMM-CDFS survey. Out of 176 sources selected with the conservative detection criteria (>8 sigma) in the first source catalogue of Ranalli et al., 46 objects lie in the redshift range of interest with the median redshift z~2.5. Their typical rest-frame 10-20 keV luminosity is 1e+44 erg/s, as observed. Among optically faint objects that lack spectroscopic redshift, four were found to be strongly absorbed X-ray sources, and the enhanced Fe K emission or absorption features in their X-ray spectra were used to obtain X-ray spectroscopic redshifts. Using the X-ray colour-colour diagram based on the rest-frame 3-5 keV, 5-9 keV, and 9-20 keV bands, seven objects were selected for their 9-20 keV excess and were found to be strongly absorbed X-ray sources with column density of nH > 0.6e+24 cm-2, including two possible Compton thick sources. While they are emitting at quasar luminosity, ~3/4 of the sample objects are found to be absorbed by nH > 1e+22 cm-2. A comparison with local AGN at the matched luminosity suggests an increasing trend of the absorbed source fraction for high-luminosity AGN towards high redshifts.Comment: 9 pages, 7 figures. Accepted for publication in A&

Black hole accretion and host galaxies of obscured quasars in XMM-COSMOS

We explore the connection between black hole growth at the center of obscured quasars selected from the XMM-COSMOS survey and the physical properties of their host galaxies. We study a bolometric regime ( 8 x 10^45 erg/s) where several theoretical models invoke major galaxy mergers as the main fueling channel for black hole accretion. We confirm that obscured quasars mainly reside in massive galaxies (Mstar>10^10 Msun) and that the fraction of galaxies hosting such powerful quasars monotonically increases with the stellar mass. We stress the limitation of the use of rest-frame color-magnitude diagrams as a diagnostic tool for studying galaxy evolution and inferring the influence that AGN activity can have on such a process. We instead use the correlation between star-formation rate and stellar mass found for star-forming galaxies to discuss the physical properties of the hosts. We find that at z ~1, ~62% of Type-2 QSOs hosts are actively forming stars and that their rates are comparable to those measured for normal star-forming galaxies. The fraction of star-forming hosts increases with redshift: ~71% at z ~2, and 100% at z ~3. We also find that the the evolution from z ~1 to z ~3 of the specific star-formation rate of the Type-2 QSO hosts is in excellent agreement with that measured for star-forming galaxies. From the morphological analysis, we conclude that most of the objects are bulge-dominated galaxies, and that only a few of them exhibit signs of recent mergers or disks. Finally, bulge-dominated galaxies tend to host Type-2 QSOs with low Eddington ratios (lambda<0.1), while disk-dominated or merging galaxies have at their centers BHs accreting at high Eddington ratios (lambda > 0.1).Comment: Accepted by A&A. 20 pages, 16 figures, 2 tables. A version with higher resolution figures and SED fits of Appendix A is available at http://www.eso.org/~vmainier/QSO2/qso2.pd

The central energy source of 70micron-selected galaxies: Starburst or AGN?

We present the first AGN census in a sample of 61 galaxies selected at 70microns, a wavelength which should strongly favour the detection of star-forming systems. For the purpose of this study we take advantage of deep Chandra X-ray and Spitzer infrared (3.6-160micron) data, as well as optical spectroscopy and photometry from the Deep Extragalactic Evolutionary Probe 2 (DEEP2) survey for the Extended Groth Strip (EGS) field. We investigate spectral line diagnostics ([OIII]/Hbeta and [NeIII]/[OII] ratios, Hdelta Balmer absorption line equivalent widths and the strength of the 4000Ang break), X-ray luminosities and spectral energy distributions (SEDs). We find that the 70micron sources are undergoing starburst episodes and are therefore characterised by a predominance of young stars. In addition, 13 per cent of the sources show AGN signatures and hence potentially host an AGN. When the sample is split into starbursts (SBs, 10^10<L_IR<10^11 L_solar), Luminous InfraRed Galaxies (LIRGs, 10^11<L_IR<10^12 L_solar) and UltraLuminous InfraRed Galaxies (ULIRGs,10^12<L_IR<10^13 L_solar), the AGN fraction becomes 0, 11 and 23 per cent respectively, showing an increase with total infrared luminosity. However, by examining the sources' panchromatic SEDs, we conclude that although the AGN is energetically important in 1 out of 61 objects, all 70micron-selected galaxies are primarily powered by star-formation.Comment: 20 pages, 14 figures, accepted for publication in MNRA

Professional approaches in clinical judgements among senior and junior doctors: implications for medical education

<p>Abstract</p> <p>Background</p> <p>Clinical experience has traditionally been highly valued in medical education and clinical healthcare. On account of its multi-faceted nature, clinical experience is mostly difficult to articulate, and is mainly expressed in clinical situations as professional approaches. Due to retirement, hospitals in Scandinavia will soon face a substantial decrease in the number of senior specialist doctors, and it has been discussed whether healthcare will suffer an immense loss of experienced-based knowledge when this senior group leaves the organization. Both senior specialists and junior colleagues are often involved in clinical education, but the way in which these two groups vary in professional approaches and contributions to clinical education has not been so well described. Cognitive psychology has contributed to the understanding of how experience may influence professional approaches, but such studies have not included the effect of differences in position and responsibilities that junior and senior doctors hold in clinical healthcare. In the light of the discussion above, it is essential to describe the professional approaches of senior doctors in relation to those of their junior colleagues. This study therefore aims to describe and compare the professional approaches of junior and senior doctors when making clinical judgements.</p> <p>Methods</p> <p>Critical incident technique was used in interviews with nine senior doctors and nine junior doctors in internal medicine. The interviews were subjected to qualitative content analysis.</p> <p>Result</p> <p>Senior and junior doctors expressed a variety of professional approaches in clinical judgement as follows: use of theoretical knowledge, use of prior experience of cases and courses of events, use of ethical and moral values, meeting and communicating with the patient, focusing on available information, relying on their own ability, getting support and guidance from others and being directed by the organization.</p> <p>Conclusion</p> <p>The most prominent varieties of professional approaches were seen in use of knowledge and work-related experience. Senior doctors know how the organization has worked in the past and have acquired techniques with respect to long-term decisions and their consequences. Junior doctors, on the other hand, have developed techniques and expertise for making decisions based on a restricted amount of information, in relation to patients' wellbeing as well as organizational opportunities and constraints. This study contributes to medical education by elucidating the variation in professional approaches among junior and senior doctors, which can be used as a basis for discussion about clinical judgement, in both pre-clinical and clinical education. Further research is required to explain how these professional approaches are expressed and used in clinical education.</p