A contemporary assessment of devices for Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA): resource-specific options per level of care

Purpose: Use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) as adjunct for temporary hemorrhage control in patients with exsanguinating torso hemorrhage is increasing. Characteristics of aortic occlusion balloons (AOB) are diverse and evolving as efforts are made to improve the technology. It is important to select a device that fits the requirements of the medical situation to minimize the risk of failure and complications. The aim of this study is to appraise guidance in the choice of an AOB in a specific situation. Methods: We assessed 29 AOB for differences and outline possible advantages and disadvantages of each. Bending stiffness was measured with a three-point bending device. Results: Diameter of the AOB ranged from 6 (ER-REBOA™) to 10 (Coda®-46) French. However, some need large-bore access sheaths up to 22 French (Fogarty®-45 and LeMaitre®-45) or even insertion via cut-down (Equalizer™-40). Bending stiffness varied from 0.08 N/mm (± 0.008 SD; Coda®-32) to 0.72 N/mm (± 0.024 SD; Russian prototype). Rescue Balloon™ showed kinking of the shaft at low bending pressures. The only non-compliant AOB is REBOA Balloon®. ER-REBOA™, Fogarty®, LeMaitre®, REBOA Balloon®, and Rescue Balloon™ are provided with external length marks to assist blind positioning. Conclusion: In resource-limited settings, a guidewire- and fluoroscopy-free, rather stiff device, such as ER-REBOA™, Fogarty®, and LeMaitre®, is warranted. Of these devices, ER-REBOA™ is the only catheter compatible with seven French sheaths and specifically designed for emergency hemorrhage control. Of the over-the-wire devices, Q50® has several features that facilitate use and reduce the risk of malplacement or vessel damage

Presupernova Evolution of Differentially Rotating Massive Stars Including Magnetic Fields

As a massive star evolves through multiple stages of nuclear burning on its way to becoming a supernova, a complex, differentially rotating structure is set up. Angular momentum is transported by a variety of classic instabilities, and also by magnetic torques from fields generated by the differential rotation. We present the first stellar evolution calculations to follow the evolution of rotating massive stars including, at least approximately, all these effects, magnetic and non-magnetic, from the zero-age main sequence until the onset of iron-core collapse. The evolution and action of the magnetic fields is as described by Spruit 2002 and a range of uncertain parameters is explored. In general, we find that magnetic torques decrease the final rotation rate of the collapsing iron core by about a factor of 30 to 50 when compared with the non-magnetic counterparts. Angular momentum in that part of the presupernova star destined to become a neutron star is an increasing function of main sequence mass. That is, pulsars derived from more massive stars will rotate faster and rotation will play a more dominant role in the star's explosion. The final angular momentum of the core is determined - to within a factor of two - by the time the star ignites carbon burning. For the lighter stars studied, around 15 solar masses, we predict pulsar periods at birth near 15 ms, though a factor of two range is easily tolerated by the uncertainties. Several mechanisms for additional braking in a young neutron star, especially by fall back, are also explored.Comment: 32 pages, 3 figures (8 eps files), submitted to Ap

A New Formation Channel for Double Neutron Stars Without Recycling: Implications for Gravitational Wave Detection

We report on a new evolutionary path leading to the formation of close double neutron stars (NS), with the unique characteristic that none of the two NS ever had the chance to be recycled by accretion. The existence of this channel stems from the evolution of helium-rich stars (cores of massive NS progenitors), which has been neglected in most previous studies of double compact object formation. We find that these non-recycled NS-NS binaries are formed from bare carbon-oxygen cores in tight orbits, with formation rates comparable to or maybe even higher than those of recycled NS-NS binaries. On the other hand, their detection probability as binary pulsars is greatly reduced (by about 1000) relative to recycled pulsars, because of their short lifetimes. We conclude that, in the context of gravitational-wave detection of NS-NS inspiral events, this new type of binaries calls for an increase of the rate estimates derived from the observed NS-NS with recycled pulsars, typically by factors of 1.5-3 or even higher.Comment: Accepted for publication in ApJ Letters; 5 pages, 1 figure, 2 tables. Two new paragraphs and one formula adde

Binary Population Synthesis: Methods, Normalization, and Surprises

In this paper we present a brief overview of population synthesis methods with a discussion of their main advantages and disadvantages. In the second part, we present some recent results from synthesis models of close binary compact objects with emphasis on the predicted rates, their uncertainties, and the model input parameters the rates are most sensitive to. We also report on a new evolutionary path leading to the formation of close double neutron stars (NS), with the unique characteristic that none of the two NS ever had the chance to be recycled by accretion. Their formation rates turn out to be comparable to or maybe even higher than those of recycled NS-NS binaries (like the ones observed), but their detection probability as binary pulsars is much smaller because of their short lifetimes. We discuss the implications of such a population for gravitational-wave detection of NS-NS inspiral events, and possibly for gamma-ray bursts and their host galaxies.Comment: 15 pages, 1 figure, to appear in the proceedings ``The influence of binaries on stellar population studies'', Brussels, August 2000 (Kluwer Academic Publishers), ed. D.Vanbevere

Discovery of magnetic fields in the very young, massive stars W601 (NGC 6611) and OI 201 (NGC 2244)

Context: Recent spectropolarimetric observations of Herbig Ae/Be stars have yielded new arguments in favour of a fossil origin for the magnetic fields of intermediate mass stars. Aims: To study the evolution of these magnetic fields, and their impact on the evolution of the angular momentum of these stars during the pre-main sequence phase, we observed Herbig Ae/Be members of young open clusters of various ages. Methods: We obtained high-resolution spectropolarimetric observations of Herbig Ae/Be stars belonging to the young open clusters NGC 6611 (< 6 Myr), NGC 2244 (~1.9 Myr), and NGC 2264 (~8 Myr), using ESPaDOnS at theCanada-France-Hawaii Telescope. Results: Here we report the discovery of strong magnetic fields in two massive pre-main sequence cluster stars. We detected, for the first time, a magnetic field in a pre-main sequence rapid rotator: the 10.2 Msun Herbig B1.5e star W601 (NGC 6611; v sin i ~ 190 km/s). Our spectropolarimetric observations yield a longitudinal magnetic field larger than 1 kG, and imply a rotational period shorter than 1.7 days. The spectrum of this very young object (age ~ 0.017 Myr) shows strong and variable lines of He and Si. We also detected a magnetic field in the 12.1 Msun B1 star OI 201 (NGC 2244; v sin i = 23.5 km/s). The Stokes V profile of this star does not vary over 5 days, suggesting a long rotational period, a pole-on orientation, or aligned magnetic and rotation axes. OI 201 is situtated near the Zero-Age Main Sequence on the HR diagram, and exhibits normal chemical abundances and no spectrum variability.Comment: Accepted for publication as a letter in A&

Health-related quality of life (HRQoL) after different axillary treatments in women with breast cancer:a 1-year longitudinal cohort study

Purpose: As life expectancy continues to rise, post-treatment health-related quality of life (HRQoL) of breast cancer patients becomes increasingly important. This study examined the one-year longitudinal relation between axillary treatments and physical, psychosocial, and sexual wellbeing and arm symptoms. Methods: Women diagnosed with breast cancer who received different axillary treatments being axilla preserving surgery (APS) with or without axillary radiotherapy or full axillary lymph node dissection (ALND) with or without axillary radiotherapy were included. HRQoL was assessed at baseline, 6- and 12-months postoperatively using the BREAST-Q and the European Organization for Research and Treatment of Cancer QoL Questionnaire Breast Cancer Module (EORTC QLQ-BR23). Mixed regression models were constructed to assess the impact of axillary treatment on HRQoL. HRQoL at baseline was compared to HRQoL at 6- and at 12-months postoperatively. Results: In total, 552 patients were included in the mixed regressions models. Except for ALND with axillary radiotherapy, no significant differences in physical and psychosocial wellbeing were found. Physical wellbeing decreased significantly between baseline and 6- and 12-months postoperatively (p &lt; 0.001, p = 0.035) and psychosocial wellbeing decreased significantly between baseline and 12 months postoperatively (p = 0.028) for ALND with axillary radiotherapy compared to APS alone. Arm symptoms increased significantly between baseline and 6 months and between baseline and 12 months postoperatively for APS with radiotherapy (12.71, 13.73) and for ALND with radiotherapy (13.93, 16.14), with the lowest increase in arm symptoms for ALND without radiotherapy (6.85, 7.66), compared to APS alone (p &lt; 0.05). Conclusion: Physical and psychosocial wellbeing decreased significantly for ALND with radiotherapy compared to APS alone. Shared decision making and expectation management pre-treatment could be strengthened by discussing arm symptoms per axillary treatment with the patient.</p

Proof of concept of high-rate decentralized pre-composting of kitchen waste : optimizing design and operation of a novel drum reactor

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Wartenberg’s migrant sensory neuritis: a prospective follow-up study

Migrant sensory neuropathy (Wartenberg’s migrant sensory neuritis) is characterized by sudden numbness in the distribution of one or multiple cutaneous nerves. To study disease course and outcome, we prospectively followed 12 patients who presented to our tertiary referral neuromuscular outpatient clinic between January 2003 and January 2004. Medical history, neurological, laboratory and electrophysiological examinations were obtained from all patients. All patients were reviewed a second time in 2007, and five had a follow-up electrophysiological examination. At the first visit, 50% described an episode of stretching preceding the sensory complaints. All but three described pain in the affected area before or concomitant with sensory loss. At clinical examination a median of six skin areas were affected, and in 75% this could be confirmed by nerve conduction studies in at least one nerve. Forty-two percent had involvement of the trigeminal nerve. After a mean disease duration of 7.5 years, three patients reported a complete disappearance of sensory complaints and five that the pain had disappeared, but numbness remained. Three patients still had both painful and numb sensory deficits. One patient developed a distal symmetric sensory polyneuropathy. In conclusion, Wartenberg’s sensory neuritis is a distinct, exclusively sensory, neuropathy, marked by pain preceding numbness in affected nerves. An episode of stretching preceding pain is not necessary for the diagnosis. Wartenberg’s sensory neuritis often retains its spotty, exclusively sensory characteristics after long term follow-up

Expressiveness modulo Bisimilarity of Regular Expressions with Parallel Composition (Extended Abstract)

The languages accepted by finite automata are precisely the languages denoted by regular expressions. In contrast, finite automata may exhibit behaviours that cannot be described by regular expressions up to bisimilarity. In this paper, we consider extensions of the theory of regular expressions with various forms of parallel composition and study the effect on expressiveness. First we prove that adding pure interleaving to the theory of regular expressions strictly increases its expressiveness up to bisimilarity. Then, we prove that replacing the operation for pure interleaving by ACP-style parallel composition gives a further increase in expressiveness. Finally, we prove that the theory of regular expressions with ACP-style parallel composition and encapsulation is expressive enough to express all finite automata up to bisimilarity. Our results extend the expressiveness results obtained by Bergstra, Bethke and Ponse for process algebras with (the binary variant of) Kleene's star operation.Comment: In Proceedings EXPRESS'10, arXiv:1011.601