Very High Energy Gamma-Ray Emission from the Blazar Markarian 421

Very high energy gamma-ray emission from the BL Lac object Markarian 421 has been detected over three observing seasons on 59 nights between April 1992 and June 1994 with the Whipple 10-meter imaging Cherenkov telescope. During its initial detection in 1992, its flux above 500 GeV was 1.6$\times$10$^{-11}$photons cm$^{-2}$ s$^{-1}$. Observations in 1993 confirmed this level of emission. For observations made between December 1993 and April 1994, its intensity was a factor of 2.2$\pm$0.5 lower. Observations on 14 and 15 May, 1994 showed an increase over this quiescent level by a factor of $\sim$10 (Kerrick et al. 1995). This strong outburst suggests that 4 episodes of increased flux measurements on similar time scales in 1992 and 1994 may be attributed to somewhat weaker outbursts. The variability of the TeV gamma-ray emission from Markarian 421 stands in contrast to EGRET observations (Lin et al. 1994) which show no evidence for variability.Comment: gzip compressed tar file including LaTeX text and 4 postscript figures (14 pages total incl. 4 tables), accepted for publication in the Astrophysical Journal. Contact address is [email protected]

New Limits to the Infrared Background: Bounds on Radiative Neutrino Decay and on Contributions of Very Massive Objects to the Dark Matter Problem

From considering the effect of γ-γ interactions on recently observed TeV gamma-ray spectra, improved limits are set to the density of extragalactic infrared photons which are robust and essentially model independent. The resulting limits are more than an order of magnitude more restrictive than direct observations in the 0.025–0.3 eV regime. These limits are used to improve constraints on radiative neutrino decay in the mass range above 0.05 eV and to rule out very massive objects as providing the dark matter needed to explain galaxy rotation curves. Lower bounds on the maximum distance which TeV gamma rays may probe are also derived

Cross-over study of novice intubators performing endotracheal intubation in an upright versus supine position

There are a number of potential physical advantages to performing orotracheal intubation in an upright position. The objective of this study was to measure the success of intubation of a simulated patient in an upright versus supine position by novice intubators after brief training. This was a cross-over design study in which learners (medical students, physician assistant students, and paramedic students) intubated mannequins in both a supine (head of the bed at 0°) and upright (head of bed elevated at 45°) position. The primary outcome of interest was successful intubation of the trachea. Secondary outcomes included log time to intubation, Cormack–Lehane view obtained, Percent of Glottic Opening score, provider assessment of difficulty, and overall provider satisfaction with the position. There were a total of 126 participants: 34 medical students, 84 physician assistant students, and 8 paramedic students. Successful tracheal intubation was achieved in 114 supine attempts (90.5 %) and 123 upright attempts (97.6 %; P = 0.283). Upright positioning was associated with significantly faster log time to intubation, higher likelihood of achieving Grade I Cormack–Lehane view, higher Percent of Glottic Opening score, lower perceived difficulty, and higher provider satisfaction. A subset of 74 participants had no previous intubation training or experience. For these providers, there was a non-significant trend toward improved intubation success with upright positioning vs supine positioning (98.6 % vs. 87.8 %, P = 0.283). For all secondary outcomes in this group, upright positioning significantly outperformed supine positioning

Feasibility of upright patient positioning and intubation success rates at two academic emergency departments

Objectives Endotracheal intubation is most commonly taught and performed in the supine position. Recent literature suggests that elevating the patient's head to a more upright position may decrease peri-intubation complications. However, there is little data on the feasibility of upright intubation in the emergency department. The goal of this study was to measure the success rate of emergency medicine residents performing intubation in supine and non-supine, including upright positions. Methods This was a prospective observational study. Residents performing intubation recorded the angle of the head of the bed. The number of attempts required for successful intubation was recorded by faculty and espiratory therapists. The primary outcome of first past success was calculated with respect to three groups: 0–10° (supine), 11–44° (inclined), and ≥ 45° (upright); first past success was also analyzed in 5 degree angle increments. Results A total of 231 intubations performed by 58 residents were analyzed. First pass success was 65.8% for the supine group, 77.9% for the inclined group, and 85.6% for the upright group (p = 0.024). For every 5 degree increase in angle, there was increased likelihood of first pass success (AOR = 1.11; 95% CI = 1.01–1.22, p = 0.043). Conclusions In our study emergency medicine residents had a high rate of success intubating in the upright position. While this does not demonstrate causation, it correlates with recent literature challenging the traditional supine approach to intubation and indicates that further investigation into optimal positioning during emergency department intubations is warranted