Catching Element Formation In The Act

Gamma-ray astronomy explores the most energetic photons in nature to address some of the most pressing puzzles in contemporary astrophysics. It encompasses a wide range of objects and phenomena: stars, supernovae, novae, neutron stars, stellar-mass black holes, nucleosynthesis, the interstellar medium, cosmic rays and relativistic-particle acceleration, and the evolution of galaxies. MeV gamma-rays provide a unique probe of nuclear processes in astronomy, directly measuring radioactive decay, nuclear de-excitation, and positron annihilation. The substantial information carried by gamma-ray photons allows us to see deeper into these objects, the bulk of the power is often emitted at gamma-ray energies, and radioactivity provides a natural physical clock that adds unique information. New science will be driven by time-domain population studies at gamma-ray energies. This science is enabled by next-generation gamma-ray instruments with one to two orders of magnitude better sensitivity, larger sky coverage, and faster cadence than all previous gamma-ray instruments. This transformative capability permits: (a) the accurate identification of the gamma-ray emitting objects and correlations with observations taken at other wavelengths and with other messengers; (b) construction of new gamma-ray maps of the Milky Way and other nearby galaxies where extended regions are distinguished from point sources; and (c) considerable serendipitous science of scarce events -- nearby neutron star mergers, for example. Advances in technology push the performance of new gamma-ray instruments to address a wide set of astrophysical questions.Comment: 14 pages including 3 figure

Pre-Procedural Atorvastatin Mobilizes Endothelial Progenitor Cells: Clues to the Salutary Effects of Statins on Healing of Stented Human Arteries

OBJECTIVES: Recent clinical trials suggest an LDL-independent superiority of intensive statin therapy in reducing target vessel revascularization and peri-procedural myocardial infarctions in patients who undergo percutaneous coronary interventions (PCI). While animal studies demonstrate that statins mobilize endothelial progenitor cells (EPCs) which can enhance arterial repair and attenuate neointimal formation, the precise explanation for the clinical PCI benefits of high dose statin therapy remain elusive. Thus we serially assessed patients undergoing PCI to test the hypothesis that high dose Atorvastatin therapy initiated prior to PCI mobilizes EPCs that may be capable of enhancing arterial repair. METHODS AND RESULTS: Statin naïve male patients undergoing angiography for stent placement were randomized to standard therapy without Atorvastatin (n = 10) or treatment with Atorvastatin 80 mg (n = 10) beginning three days prior to stent implantation. EPCs were defined by flow cytometry (e.g., surface marker profile of CD45dim/34+/133+/117+). As well, we also enumerated cultured angiogenic cells (CACs) by standard in vitro culture assay. While EPC levels did not fluctuate over time for the patients free of Atorvastatin, there was a 3.5-fold increase in EPC levels with high dose Atorvastatin beginning within 3 days of the first dose (and immediately pre-PCI) which persisted at 4 and 24 hours post-PCI (p<0.05). There was a similar rise in CAC levels as assessed by in vitro culture. CACs cultured in the presence of Atorvastatin failed to show augmented survival or VEGF secretion but displayed a 2-fold increase in adhesion to stent struts (p<0.05). CONCLUSIONS: High dose Atorvastatin therapy pre-PCI improves EPC number and CAC number and function in humans which may in part explain the benefit in clinical outcomes seen in patients undergoing coronary interventions

Decreasing Frontal Electroencephalogram Alpha Power and Increasing Sensitivity to Volatile Anesthetics Over 3 Surgeries Within 7 Months: A Case Report.

Depth of anesthesia (DoA) monitors are widely used during general anesthesia to guide individualized dosing of hypnotics. Other than age and specific drugs, there are few reports on which comorbidities may influence the brain and the resultant electroencephalogram (EEG) of patients undergoing general anesthesia. We present a case of a patient undergoing 3 cardiac operations within 7 months with severe illness and comorbidity, leading to pronounced physical frailty and significant changes of frontal alpha power in the EEG and increased sensitivity to volatile anesthetics. These findings may have important clinical implications and should trigger further investigations on this topic

Acute and mixed alcohol intoxications in asylum seekers presenting to an urban emergency department in Switzerland

BackgroundPrevious studies have reported an increase in alcohol-and-mixed intoxication (AAMI)-related emergency department (ED) admissions, but less is known about the incidence and characteristics of AAMI admissions to EDs among asylum-seeking patients. Asylum seeking patients may be at higher risk for AAMI due stressors associated with forced migration. The aim of this study was to determine the proportional incidence, population characteristics, and predictors of ED admissions due to AAMI among patients with a residency status of asylum seeker as compared to those with a residency status of Swiss-national.MethodsThis retrospective analysis included all medical consultations from a large, adult ED in Switzerland between January 1, 2013 to December 31, 2016. The residency status of consultations was established if possible, and AAMI was determined utilizing a two-step screening procedure, blinded for residency status. A multivariable logistic regression was performed to determine the odds of AAMI in asylum-seeking patient consultations compared to consultations for Swiss-national patients. In addition, patient characteristics among asylum seekers admitted for AAMI were compared to patients with Swiss-national residency status for AAMI.ResultsIn total, 117,716 eligible consultations (Swiss-national patient consultations: n=115,226 and asylum-seeker consultations: n=2490) were included in this study. The proportional incidence of AAMI among asylum seekers was 3.7% (n=92) compared to 1.6% (n=1841) among the Swiss-national patients. AAMI in asylum seekers was associated with higher levels of trauma (37.0% vs. 23.5%, p=0.003), and hospital admission (35.4% vs. 14.1%, p<0.001), but a smaller proportion of chronic alcohol consumption (13.0% vs. 43.5%, p<0.001), and psychiatric referrals (26.1% vs. 49.0%, p<0.001). Multivariable analysis controlling for age, sex, triage category, weekend admission, year of admission, and multiple visits showed a 1.6 times higher odds (95% CI: 1.3, 2.0; p<0.001) for an AAMI-related ED consultation in asylum seeking patients.ConclusionsThese findings show that individuals seeking asylum in a high-income country may be at greater risk for AAMI-related admission than the local population. Given the observed association between AAMI-related ED admissions and trauma, suicidality, and psychiatric referrals among this subpopulation, the data also suggests that co-morbid mental health disorders associated with forced displacement may contribute to hazardous alcohol use

Predictors of High Resource Consumption in Alcohol Intoxicated Patients in the Emergency Department

Background: previous studies have reported that the incidence of alcohol-related visits to emergency departments (ED) has increased, but little is known about how the necessary resources per visit have changed, or about the predictors and reasons for resource consumption. Methods: a retrospective analysis was performed of all consultations with a primary or secondary diagnosis of acute alcohol intoxication admitted to the ED of Bern University Hospital, Switzerland, between 1 June 2012, and 31 May 2017. Clinical characteristics and resource consumption were extracted and analysed over time. Results: in all, 196,045 ED consultations included 2586 acute alcohol intoxications, corresponding to 1.3% of the total. The incidences of acute alcohol intoxications have tended to increase over the last five years, and a growing number of visits have consumed high resources (consultations above the 75th percentile for total resource consumption). High resource consumption was associated with greater age and the male gender (p < 0.001). The main predictors of resource consumption were fractures (Odds ratio (OR): 3.9, 95% CI 2.8-5.3, p < 0.001), dislocations (OR 3.7, 95%: 1.5-9.1, p < 0.001), and traumatic brain injury (3.5, 2.5-5.1, p < 0.001). Consultations consuming high resources mostly required radiology resources (45%); consultations consuming low or normal resources mostly required physicians' work (45%) or nurses' work (27%). Conclusions: the number of alcohol intoxications consuming high resources has increased over the last five years. Acute alcohol intoxication associated with trauma is resource intensive, especially with regard to radiology resources. This underlines the need for further efforts to prevent alcohol-related traffic accidents, for examples

Hyperoxia-induced deterioration of diastolic function in anaesthetised patients with coronary artery disease – Randomised crossover trial

Background: There are no current recommendations for oxygen titration in patients with stable coronary artery disease. This study investigates the effect of iatrogenic hyperoxia on cardiac function in patients with coronary artery disease undergoing general anaesthesia. Methods: Patients scheduled for elective coronary artery bypass graft surgery were prospectively recruited into this randomised crossover clinical trial. All patients were exposed to inspired oxygen fractions of 0.3 (normoxaemia) and 0.8 (hyperoxia) in randomised order. A transoesophageal echocardiographic imaging protocol was performed during each exposure. Primary analysis investigated changes in 3D peak strain, whereas secondary analyses investigated other systolic and diastolic responses. Results: There was no statistical difference in systolic function between normoxaemia and hyperoxia. However, the response in systolic function to hyperoxia was dependent on ventricular function at normoxaemia. Patients with a normoxaemic left ventricular (LV) global longitudinal strain (GLS) poorer than the derived cut-off (>–15.4%) improved with hyperoxia (P<0.01), whereas in patients with normoxaemic LV-GLS <–15.4%, LV-GLS worsened with transition to hyperoxia (P<0.01). The same was seen for right ventricular GLS with a cut-off at –24.1%. Diastolic function worsened during hyperoxia indicated by a significant increase of averaged E/e′ (8.6 [2.6]. vs 8.2 [2.4], P=0.01) and E/A ratio (1.4 (0.4) vs 1.3 (0.4), P=0.01). Conclusions: Although the response of biventricular systolic variables is dependent on systolic function at normoxaemia, diastolic function consistently worsens under hyperoxia. In coronary artery disease, intraoperative strain analysis may offer guidance for oxygen titration. Clinical trial registration: NCT04424433