Decision for reconstructive interventions of the upper limb in individuals with tetraplegia: the effect of treatment characteristics

Objective: To determine the effect of treatment characteristics on the\ud decision for reconstructive interventions for the upper extremities (UE) in\ud subjects with tetraplegia. - \ud Setting: Seven specialized spinal cord injury centres in the Netherlands. - \ud Method: Treatment characteristics for UE reconstructive interventions were\ud determined. Conjoint analysis (CA) was used to determine the contribution\ud and the relative importance of the treatment characteristics on the decision\ud for therapy. Therefore, a number of different treatment scenarios using these\ud characteristics were established. Different pairs of scenarios were presented\ud to subjects who were asked to choose the preferred scenario of each set. - \ud Results: forty nine subjects with tetraplegia with a stable C5, C6 or C7\ud lesion were selected. All treatment characteristics significantly influenced\ud the choice for treatment. Relative importance of treatment characteristics\ud were: intervention type (surgery or surgery with FES implant) 13%, number\ud of operations 15%, in patient rehabilitation period 22%, ambulant\ud rehabilitation period 9%, complication rate 15%, improvement of elbow\ud function 10%, improvement of hand function 15%. In deciding for therapy\ud 40% of the subjects focused on one characteristic. - \ud Conclusion: CA is applicable in Spinal Cord Injury medicine to study the\ud effect of health outcomes and non-health outcomes on the decision for\ud treatment. Non-health outcomes which relate to the intensity of treatment\ud are equally important or even more important than functional outcome in the\ud decision for reconstructive UE surgery in subjects with tetraplegia

Arrival Directions of Cosmic Rays above 32 EeV from Phase One of the Pierre Auger Observatory

A promising energy range to look for angular correlations between cosmic rays of extragalactic origin and their sources is at the highest energies, above a few tens of EeV (1 EeV equivalent to 10^(18) eV). Despite the flux of these particles being extremely low, the area of similar to 3000 km^(2) covered at the Pierre Auger Observatory, and the 17 yr data-taking period of the Phase 1 of its operations, have enabled us to measure the arrival directions of more than 2600 ultra-high-energy cosmic rays above 32 EeV. We publish this data set, the largest available at such energies from an integrated exposure of 122,000 km^(2) sr yr, and search it for anisotropies over the 3.4 pi steradians covered with the Observatory. Evidence for a deviation in excess of isotropy at intermediate angular scales, with similar to 15 degrees Gaussian spread or similar to 25 degrees top-hat radius, is obtained at the 4 sigma significance level for cosmic-ray energies above similar to 40 EeV

Search for Ultra-high-energy Photons from Gravitational Wave Sources with the Pierre Auger Observatory

A search for time-directional coincidences of ultra-high-energy (UHE) photons above 10 EeV with gravitational wave (GW) events from the LIGO/Virgo runs O1 to O3 is conducted with the Pierre Auger Observatory. Due to the distinctive properties of photon interactions and to the background expected from hadronic showers, a subset of the most interesting GW events is selected based on their localization quality and distance. Time periods of 1000 s around and 1 day after the GW events are analyzed. No coincidences are observed. Upper limits on the UHE photon fluence from a GW event are derived that are typically at & SIM;7 MeV cm(-2) (time period 1000 s) and & SIM;35 MeV cm(-2) (time period 1 day). Due to the proximity of the binary neutron star merger GW170817, the energy of the source transferred into UHE photons above 40 EeV is constrained to be less than 20% of its total GW energy. These are the first limits on UHE photons from GW sources

Searches for Ultra-High-Energy Photons at the Pierre Auger Observatory

The Pierre Auger Observatory, which is the largest air-shower experiment in the world, offers unprecedented exposure to neutral particles at the highest energies. Since the start of data collection more than 18 years ago, various searches for ultra-high-energy (UHE, E greater than or similar to 10^(17) eV) photons have been performed, either for a diffuse flux of UHE photons, for point sources of UHE photons or for UHE photons associated with transient events such as gravitational wave events. In the present paper, we summarize these searches and review the current results obtained using the wealth of data collected by the Pierre Auger Observatory

Multi-messenger observations of a binary neutron star merger

On 2017 August 17 a binary neutron star coalescence candidate (later designated GW170817) with merger time 12:41:04 UTC was observed through gravitational waves by the Advanced LIGO and Advanced Virgo detectors. The Fermi Gamma-ray Burst Monitor independently detected a gamma-ray burst (GRB 170817A) with a time delay of ~1.7 s with respect to the merger time. From the gravitational-wave signal, the source was initially localized to a sky region of 31 deg2 at a luminosity distance of 40+8-8 Mpc and with component masses consistent with neutron stars. The component masses were later measured to be in the range 0.86 to 2.26 Mo. An extensive observing campaign was launched across the electromagnetic spectrum leading to the discovery of a bright optical transient (SSS17a, now with the IAU identification of AT 2017gfo) in NGC 4993 (at ~40 Mpc) less than 11 hours after the merger by the One- Meter, Two Hemisphere (1M2H) team using the 1 m Swope Telescope. The optical transient was independently detected by multiple teams within an hour. Subsequent observations targeted the object and its environment. Early ultraviolet observations revealed a blue transient that faded within 48 hours. Optical and infrared observations showed a redward evolution over ~10 days. Following early non-detections, X-ray and radio emission were discovered at the transient’s position ~9 and ~16 days, respectively, after the merger. Both the X-ray and radio emission likely arise from a physical process that is distinct from the one that generates the UV/optical/near-infrared emission. No ultra-high-energy gamma-rays and no neutrino candidates consistent with the source were found in follow-up searches. These observations support the hypothesis that GW170817 was produced by the merger of two neutron stars in NGC4993 followed by a short gamma-ray burst (GRB 170817A) and a kilonova/macronova powered by the radioactive decay of r-process nuclei synthesized in the ejecta

Active and passive spectroscopic imaging in the DIII-D tokamak

Wide-angle, 2D imaging of Doppler-shifted, Balmer alpha (D α) emission from high energy injected neutrals, charge exchange recombination (CER) emission from neutral beam interaction with thermal ions and fully stripped impurity ions and visible bremsstrahlung (VB) from the core of DIII-D plasmas has been carried out. Narrowband interference filters were used to isolate the specific wavelength ranges of visible radiation for detection by a tangentially viewing, fast-framing camera. Measurements of the Dα emission from fast neutrals injected into the plasma from the low field side reveal the vertical distribution of the beam, its divergence and the variation in its radial penetration with density. Modeling of this emission using both a full Monte Carlo collisional radiative code as well as a simple beam attenuation code coupled to Atomic Data and Analysis Structure emissivity lookup tables yields qualitative agreement, however the absolute magnitudes of the emissivities in the predicted distribution are larger than those measured. Active measurements of carbon CER brightness are in agreement with those made independently along the beam midplane using DIII-D's multichordal, CER spectrometer system, confirming the potential of this technique for obtaining 2D profiles of impurity density. Passive imaging of VB, which can be inverted to obtain local emissivity profiles, is compared with measurements from both a calibrated filter/photomultiplier array and the standard multichordal CER spectrometer system. © 2010 IOP Publishing Ltd

Microbial mediation of benthic biogenic silica dissolution

Pore water profiles from 24 stations in the South Atlantic (located in the Guinea, Angola, Cape, Guyana, and Argentine basins) show good correlations of oxygen and silicon, suggesting microbially mediated dissolution of biogenic silica. We used simple analytical transport and reaction models to show the tight coupling of the reconstructed process kinetics of aerobic respiration and silicon regeneration. A generic transport and reaction model successfully reproduced the majority of Si pore water profiles from aerobic respiration rates, confirming that the dissolution of biogenic silica (BSi) occurs proportionally to O 2 consumption. Possibly limited to well-oxygenated sediments poor in BSi, benthic Si fluxes can be inferred from O 2 uptake with satisfactory accuracy. Compared to aerobic respiration kinetics, the solubility of BSi emerged as a less influential parameter for silicon regeneration. Understanding the role of bacteria for silicon regeneration requires further investigations, some of which are outlined. The proposed aerobic respiration control of benthic silicon cycling is suitable for benthic–pelagic models. The empirical relation of BSi dissolution to aerobic respiration can be used for regionalization assessments and estimates of the silicon budget to increase the understanding of global primary and export production patterns

Fast-ion transport in q min > 2, high- β steady-state scenarios on DIII-D

Results from experiments on DIII-D [J. L. Luxon, Fusion Sci. Technol. 48, 828 (2005)] aimed at developing high β steady-state operating scenarios with high- q min confirm that fast-ion transport is a critical issue for advanced tokamak development using neutral beam injection current drive. In DIII-D, greater than 11 MW of neutral beam heating power is applied with the intent of maximizing β N and the noninductive current drive. However, in scenarios with q min > 2 that target the typical range of q 95 = 5-7 used in next-step steady-state reactor models, Alfvén eigenmodes cause greater fast-ion transport than classical models predict. This enhanced transport reduces the absorbed neutral beam heating power and current drive and limits the achievable βN. In contrast, similar plasmas except with q min just above 1 have approximately classical fast-ion transport. Experiments that take q min > 3 plasmas to higher β P with q 95 = 11-12 for testing long pulse operation exhibit regimes of better than expected thermal confinement. Compared to the standard high- q min scenario, the high β P cases have shorter slowing-down time and lower ∇ β fast, and this reduces the drive for Alfvénic modes, yielding nearly classical fast-ion transport, high values of normalized confinement, β N, and noninductive current fraction. These results suggest DIII-D might obtain better performance in lower- q 95, high- q min plasmas using broader neutral beam heating profiles and increased direct electron heating power to lower the drive for Alfvén eigenmodes