Development and Utility of Quality Metrics for Ambulatory Pediatric Cardiology in Kawasaki Disease.

The Adult Congenital and Pediatric Cardiology (ACPC) Section of the American College of Cardiology sought to develop quality indicators/metrics for ambulatory pediatric cardiology practice. The objective of this study was to report the creation of metrics for patients with Kawasaki disease. Over a period of 5 months, 12 pediatric cardiologists developed 24 quality metrics based on the most relevant statements, guidelines, and research studies pertaining to Kawasaki disease. Of the 24 metrics, the 8 metrics deemed the most important, feasible, and valid were sent on to the ACPC for consideration. Seven of the 8 metrics were approved using the RAND method by an expert panel. All 7 metrics approved by the ACPC council were accepted by ACPC membership after an "open comments" process. They have been disseminated to the pediatric cardiology community for implementation by the ACPC Quality Network

Radiocarbon dating of methane and carbon dioxide evaded from a temperate peatland stream

Streams draining peatlands export large quantities of carbon in different chemical forms and are an important part of the carbon cycle. Radiocarbon (14C) analysis/dating provides unique information on the source and rate that carbon is cycled through ecosystems, as has recently been demonstrated at the air-water interface through analysis of carbon dioxide (CO2) lost from peatland streams by evasion (degassing). Peatland streams also have the potential to release large amounts of methane (CH4) and, though 14C analysis of CH4 emitted by ebullition (bubbling) has been previously reported, diffusive emissions have not. We describe methods that enable the 14C analysis of CH4 evaded from peatland streams. Using these methods, we investigated the 14C age and stable carbon isotope composition of both CH4 and CO2 evaded from a small peatland stream draining a temperate raised mire. Methane was aged between 1617-1987 years BP, and was much older than CO2 which had an age range of 303-521 years BP. Isotope mass balance modelling of the results indicated that the CO2 and CH4 evaded from the stream were derived from different source areas, with most evaded CO2 originating from younger layers located nearer the peat surface compared to CH4. The study demonstrates the insight that can be gained into peatland carbon cycling from a methodological development which enables dual isotope (14C and 13C) analysis of both CH4 and CO2 collected at the same time and in the same way

Estimating the number needed to treat from continuous outcomes in randomised controlled trials: methodological challenges and worked example using data from the UK Back Pain Exercise and Manipulation (BEAM) trial

Background Reporting numbers needed to treat (NNT) improves interpretability of trial results. It is unusual that continuous outcomes are converted to numbers of individual responders to treatment (i.e., those who reach a particular threshold of change); and deteriorations prevented are only rarely considered. We consider how numbers needed to treat can be derived from continuous outcomes; illustrated with a worked example showing the methods and challenges. Methods We used data from the UK BEAM trial (n = 1, 334) of physical treatments for back pain; originally reported as showing, at best, small to moderate benefits. Participants were randomised to receive 'best care' in general practice, the comparator treatment, or one of three manual and/or exercise treatments: 'best care' plus manipulation, exercise, or manipulation followed by exercise. We used established consensus thresholds for improvement in Roland-Morris disability questionnaire scores at three and twelve months to derive NNTs for improvements and for benefits (improvements gained+deteriorations prevented). Results At three months, NNT estimates ranged from 5.1 (95% CI 3.4 to 10.7) to 9.0 (5.0 to 45.5) for exercise, 5.0 (3.4 to 9.8) to 5.4 (3.8 to 9.9) for manipulation, and 3.3 (2.5 to 4.9) to 4.8 (3.5 to 7.8) for manipulation followed by exercise. Corresponding between-group mean differences in the Roland-Morris disability questionnaire were 1.6 (0.8 to 2.3), 1.4 (0.6 to 2.1), and 1.9 (1.2 to 2.6) points. Conclusion In contrast to small mean differences originally reported, NNTs were small and could be attractive to clinicians, patients, and purchasers. NNTs can aid the interpretation of results of trials using continuous outcomes. Where possible, these should be reported alongside mean differences. Challenges remain in calculating NNTs for some continuous outcomes

An X-ray survey of low-mass stars in Trumpler 16 with Chandra

We identify and characterize low-mass stars in the ~3 Myr old Trumpler 16 (Tr16) region by means of a deep Chandra X-ray observation, and study their optical and near-IR properties. We compare X-ray activity of Tr16 stars with known characteristics of Orion and Cygnus OB2 stars. We analyzed a 88.4 ksec Chandra ACIS-I observation pointed at the center of Tr16. Because of diffuse X-ray emission, source detection was performed using the PWDetect code for two different energy ranges: 0.5-8.0 keV and 0.9-8.0 keV. Results were merged into a single final list. We positionally correlate X-ray sources with optical and 2MASS catalogues. Source events were extracted with the IDL-based routine ACIS-Extract. X-ray variability was characterized using the Kolmogorov-Smirnov test and spectra were fitted by using XSPEC. X-ray spectra of early-type, massive stars were analyzed individually. Our list of X-ray sources consists of 1035 entries, 660 of which have near-IR counterparts and are probably associated with Tr16 members. From near-IR color-color and color-magnitudes diagrams we compute individual masses of stars and their Av values. About 15% of the near-IR counterparts show disk-induced excesses. X-ray variability is found in 77 sources. X-ray emission from OB stars appear softer than the low-mass stars. The Tr16 region has a very rich population of low-mass X-ray emitting stars. An important fraction of its circumstellar disks survive the intense radiation field of its massive stars. Stars with masses 1.5-2.5 Mo display X-ray activity similar to that of stars in Cyg OB2 but much less intense than observed for Orion Nebula Cluster members.Comment: 19 pages, 3 ellectronic tables and 19 figures. Accepted for publication at the A&

Spiralling out of control: 3D hydrodynamical modelling of the colliding winds in η \eta\thinspaceCarinae

Three dimensional (3D) adaptive-mesh refinement (AMR) hydrodynamical simulations of the wind-wind collision between the enigmatic super-massive star \etacar and its mysterious companion star are presented which include radiative driving of the stellar winds, gravity, optically-thin radiative cooling, and orbital motion. Simulations with static stars with a periastron passage separation reveal that the preshock companion star's wind speed is sufficiently reduced that radiative cooling in the postshock gas becomes important, permitting the runaway growth of non-linear thin shell (NTSI) instabilities which massively distort the WCR. However, large-scale simulations which include the orbital motion of the stars, show that orbital motion reduces the impact of radiative inhibition, and thus increases the acquired preshock velocities. As such, the postshock gas temperature and cooling time see a commensurate increase, and sufficient gas pressure is preserved to stabilize the WCR against catastrophic instability growth. We then compute synthetic X-ray spectra and lightcurves and find that, compared to previous models, the X-ray spectra agree much better with {\it XMM-Newton} observations just prior to periastron. The narrow width of the 2009 X-ray minimum can also be reproduced. However, the models fail to reproduce the extended X-ray mimimum from previous cycles. We conclude that the key to explaining the extended X-ray minimum is the rate of cooling of the companion star's postshock wind. If cooling is rapid then powerful NTSIs will heavily disrupt the WCR. Radiative inhibition of the companion star's preshock wind, albeit with a stronger radiation-wind coupling than explored in this work, could be an effective trigger.Comment: 25 pages, 20 figures, accepted for publication in Ap

Report of Second Meeting for the Purpose of Obtaining the Views of the Three Affiliated Tribes of the Fort Berthold Reservation on the Lieu Lands Offered by the Secretary of War, 1946

Report of the second meeting held in the office of Assistant Secretary of the Interior C. Girard Davidson for the purpose of obtaining the views of the Three Affiliated Tribes of the Fort Berthold Reservation of the lieu lands offered by the Secretary of War. Includes a list of attendees and a transcript of the meeting discussing the Three Affiliated Tribes\u27 rejection of the offer of lieu lands made by the Secretary of Interior and Department of War to the Fort Berthold Reservation. See also: Report of Meeting for the Purpose of Obtaining the Views of the Three Affiliated Tribes of the Fort Berthold Reservation on the Lieu Lands Offered by the Secretary of War, 1946https://commons.und.edu/langer-papers/1147/thumbnail.jp

X-ray variation statistics and wind clumping in Vela X-1

We investigate the structure of the wind in the neutron star X-ray binary system Vela X-1 by analyzing its flaring behavior. Vela X-1 shows constant flaring, with some flares reaching fluxes of more than 3.0 Crab between 20-60 keV for several 100 seconds, while the average flux is around 250 mCrab. We analyzed all archival INTEGRAL data, calculating the brightness distribution in the 20-60 keV band, which, as we show, closely follows a log-normal distribution. Orbital resolved analysis shows that the structure is strongly variable, explainable by shocks and a fluctuating accretion wake. Analysis of RXTE ASM data suggests a strong orbital change of N_H. Accreted clump masses derived from the INTEGRAL data are on the order of 5 x 10^19 -10^21 g. We show that the lightcurve can be described with a model of multiplicative random numbers. In the course of the simulation we calculate the power spectral density of the system in the 20-100 keV energy band and show that it follows a red-noise power law. We suggest that a mixture of a clumpy wind, shocks, and turbulence can explain the measured mass distribution. As the recently discovered class of supergiant fast X-ray transients (SFXT) seems to show the same parameters for the wind, the link between persistent HMXB like Vela X-1 and SFXT is further strengthened.Comment: 8 pages, 6 figures, accepted for publication in A&

Neutrinoless double-beta decay and seesaw mechanism

From the standard seesaw mechanism of neutrino mass generation, which is based on the assumption that the lepton number is violated at a large (~10exp(+15) GeV) scale, follows that the neutrinoless double-beta decay is ruled by the Majorana neutrino mass mechanism. Within this notion, for the inverted neutrino-mass hierarchy we derive allowed ranges of half-lives of the neutrinoless double-beta decay for nuclei of experimental interest with different sets of nuclear matrix elements. The present-day results of the calculation of the neutrinoless double-beta decay nuclear matrix elements are briefly discussed. We argue that if neutrinoless double-beta decay will be observed in future experiments sensitive to the effective Majorana mass in the inverted mass hierarchy region, a comparison of the derived ranges with measured half-lives will allow us to probe the standard seesaw mechanism assuming that future cosmological data will establish the sum of neutrino masses to be about 0.2 eV.Comment: Some changes in sections I, II, IV, and V; two new figures; additional reference

Exploring the Partonic Structure of Hadrons through the Drell-Yan Process

The Drell-Yan process is a standard tool for probing the partonic structure of hadrons. Since the process proceeds through a quark-antiquark annihilation, Drell-Yan scattering possesses a unique ability to selectively probe sea distributions. This review examines the application of Drell-Yan scattering to elucidating the flavor asymmetry of the nucleon's sea and nuclear modifications to the sea quark distributions in unpolarized scattering. Polarized beams and targets add an exciting new dimension to Drell-Yan scattering. In particular, the two initial-state hadrons give Drell-Yan sensitivity to chirally-odd transversity distributions.Comment: 23 pages, 9 figures, to appear in J. Phys. G, resubmission corrects typographical error