Strong Lensing Model of SPT-CLJ0356-5337, a Major Merger Candidate at Redshift 1.0359

We present an analysis of the mass distribution inferred from strong lensing by SPT-CL J0356-5337, a cluster of galaxies at redshift z = 1.0359 revealed in the follow-up of the SPT-SZ clusters. The cluster has an Einstein radius of Erad=14 for a source at z = 3 and a mass within 500 kpc of M_500kpc = 4.0+-0.8x10^14Msol. Our spectroscopic identification of three multiply-imaged systems (z = 2.363, z = 2.364, and z = 3.048), combined with HST F606W-band imaging allows us to build a strong lensing model for this cluster with an rms of <0.3'' between the predicted and measured positions of the multiple images. Our modeling reveals a two-component mass distribution in the cluster. One mass component is dominated by the brightest cluster galaxy and the other component, separated by ~170 kpc, contains a group of eight red elliptical galaxies confined in a ~9'' (~70 kpc) diameter circle. We estimate the mass ratio between the two components to be between 1:1.25 and 1:1.58. In addition, spectroscopic data reveal that these two near-equal mass cores have only a small velocity difference of 300 km/s between the two components. This small radial velocity difference suggests that most of the relative velocity takes place in the plane of the sky, and implies that SPT-CL J0356-5337 is a major merger with a small impact parameter seen face-on. We also assess the relative contributions of galaxy-scale halos to the overall mass of the core of the cluster and find that within 800 kpc from the brightest cluster galaxy about 27% of the total mass can be attributed to visible and dark matter associated with galaxies, whereas only 73% of the total mass in the core comes from cluster-scale dark matter halos.Comment: 19 pages, 11 figures. Submitted to Ap

Update of Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS)) : Part B

In 2014 the International Endohernia Society (IEHS) published the first international "Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias". Guidelines reflect the currently best available evidence in diagnostics and therapy and give recommendations to help surgeons to standardize their techniques and to improve their results. However, science is a dynamic field which is continuously developing. Therefore, guidelines require regular updates to keep pace with the evolving literature. Methods For the development of the original guidelines all relevant literature published up to year 2012 was analyzed using the ranking of the Oxford Centre for Evidence-Based-Medicine. For the present update all of the previous authors were asked to evaluate the literature published during the recent years from 2012 to 2017 and revise their statements and recommendations given in the initial guidelines accordingly. In two Consensus Conferences (October 2017 Beijing, March 2018 Cologne) the updates were presented, discussed, and confirmed. To avoid redundancy, only new statements or recommendations are included in this paper. Therefore, for full understanding both of the guidelines, the original and the current, must be read. In addition, the new developments in repair of abdominal wall hernias like surgical techniques within the abdominal wall, release operations (transversus muscle release, component separation), Botox application, and robot-assisted repair methods were included. Results Due to an increase of the number of patients and further development of surgical techniques, repair of primary and secondary abdominal wall hernias attracts increasing interests of many surgeons. Whereas up to three decades ago hernia-related publications did not exceed 20 per year, currently this number is about 10-fold higher. Recent years are characterized by the advent of new techniques-minimal invasive techniques using robotics and laparoscopy, totally extraperitoneal repairs, novel myofascial release techniques for optimal closure of large defects, and Botox for relaxing the abdominal wall. Furthermore, a concomitant rectus diastasis was recognized as a significant risk factor for recurrence. Despite still insufficient evidence with respect to these new techniques it seemed to us necessary to include them in the update to stimulate surgeons to do research in these fields. Conclusion Guidelines are recommendations based on best available evidence intended to help the surgeon to improve the quality of his daily work. However, science is a continuously evolving process, and as such guidelines should be updated about every 3 years. For a comprehensive reference, however, it is suggested to read both the initially guidelines published in 2014 together with the update. Moreover, the presented update includes also techniques which were not known 3 years before

Family-led rehabilitation after stroke in India (ATTEND): a randomised controlled trial

Background: Most people with stroke in India have no access to organised rehabilitation services. The effectiveness of training family members to provide stroke rehabilitation is uncertain. Our primary objective was to determine whether family-led stroke rehabilitation, initiated in hospital and continued at home, would be superior to usual care in a low-resource setting. Methods: The Family-led Rehabilitation after Stroke in India (ATTEND) trial was a prospectively randomised open trial with blinded endpoint done across 14 hospitals in India. Patients aged 18 years or older who had had a stroke within the past month, had residual disability and reasonable expectation of survival, and who had an informal family-nominated caregiver were randomly assigned to intervention or usual care by site coordinators using a secure web-based system with minimisation by site and stroke severity. The family members of participants in the intervention group received additional structured rehabilitation training—including information provision, joint goal setting, carer training, and task-specific training—that was started in hospital and continued at home for up to 2 months. The primary outcome was death or dependency at 6 months, defined by scores 3–6 on the modified Rankin scale (range, 0 [no symptoms] to 6 [death]) as assessed by masked observers. Analyses were by intention to treat. This trial is registered with Clinical Trials Registry-India (CTRI/2013/04/003557), Australian New Zealand Clinical Trials Registry (ACTRN12613000078752), and Universal Trial Number (U1111-1138-6707). Findings: Between Jan 13, 2014, and Feb 12, 2016, 1250 patients were randomly assigned to intervention (n=623) or control (n=627) groups. 33 patients were lost to follow-up (14 intervention, 19 control) and five patients withdrew (two intervention, three control). At 6 months, 285 (47%) of 607 patients in the intervention group and 287 (47%) of 605 controls were dead or dependent (odds ratio 0·98, 95% CI 0·78–1·23, p=0·87). 72 (12%) patients in the intervention group and 86 (14%) in the control group died (p=0·27), and we observed no difference in rehospitalisation (89 [14%]patients in the intervention group vs 82 [13%] in the control group; p=0·56). We also found no difference in total non-fatal events (112 events in 82 [13%] intervention patients vs 110 events in 79 [13%] control patients; p=0·80). Interpretation: Although task shifting is an attractive solution for health-care sustainability, our results do not support investment in new stroke rehabilitation services that shift tasks to family caregivers, unless new evidence emerges. A future avenue of research should be to investigate the effects of task shifting to health-care assistants or team-based community care. Funding: The National Health and Medical Research Council of Australia

Increased Systemic Th17 Cytokines Are Associated with Diastolic Dysfunction in Children and Adolescents with Diabetic Ketoacidosis

Diastolic dysfunction suggestive of diabetic cardiomyopathy is established in children with T1DM, but its pathogenesis is not well understood. We studied the relationships of systemic inflammatory cytokines/chemokines and cardiac function in 17 children with T1DM during and after correction of diabetic ketoacidosis (DKA). Twenty seven of the 39 measured cytokines/chemokines were elevated at 6–12 hours into treatment of DKA compared to values after DKA resolution. Eight patients displayed at least one parameter of diastolic abnormality (DA) during acute DKA. Significant associations were present between nine of the cytokine/chemokine levels and the DA over time. Interestingly, four of these nine interactive cytokines (GM-CSF, G-CSF, IL-12p40, IL-17) are associated with a Th17 mediated cell response. Both the DA and CCL7 and IL-12p40, had independent associations with African American patients. Thus, we report occurrence of a systemic inflammatory response and the presence of cardiac diastolic dysfunction in a subset of young T1DM patients during acute DKA

Evaluation of sesamum gum as an excipient in matrix tablets

In developing countries modern medicines are often beyond the affordability of the majority of the population. This is due to the reliance on expensive imported raw materials despite the abundance of natural resources which could provide an equivalent or even an improved function. The aim of this study was to investigate the potential of sesamum gum (SG) extracted from the leaves of Sesamum radiatum (readily cultivated in sub-Saharan Africa) as a matrix former. Directly compressed matrix tablets were prepared from the extract and compared with similar matrices of HPMC (K4M) using theophylline as a model water soluble drug. The compaction, swelling, erosion and drug release from the matrices were studied in deionized water, 0.1 N HCl (pH 1.2) and phosphate buffer (pH 6.8) using USP apparatus II. The data from the swelling, erosion and drug release studies were also fitted into the respective mathematical models. Results showed that the matrices underwent a combination of swelling and erosion, with the swelling action being controlled by the rate of hydration in the medium. SG also controlled the release of theophylline similar to the HPMC and therefore may have use as an alternative excipient in regions where Sesamum radiatum can be easily cultivated

Inferring More from Less: Prospector as a Photometric Redshift Engine in the Era of JWST

The advent of the James Webb Space Telescope (JWST) signals a new era in exploring galaxies in the high-$z$ universe. Current and upcoming JWST imaging will potentially detect galaxies out to $z \sim 20$, creating a new urgency in the quest to infer accurate photometric redshifts (photo-$z$) for individual galaxies from their spectral energy distributions, as well as masses, ages and star formation rates. Here we illustrate the utility of informed priors encoding previous observations of galaxies across cosmic time in achieving these goals. We construct three joint priors encoding empirical constraints of redshifts, masses, and star formation histories in the galaxy population within the \prospector\ Bayesian inference framework. In contrast with uniform priors, our model breaks an age-mass-redshift degeneracy, and thus reduces the mean bias error in masses from 0.3 to 0.1 dex, and in ages from 0.6 to 0.2 dex in tests done on mock JWST observations. Notably, our model recovers redshifts at least as accurately as the state-of-the-art photo-$z$ code \eazy\ in deep JWST fields, but with two advantages: tailoring a model based on a particular survey renders mostly unnecessary given well-motivated priors; obtaining joint posteriors describing stellar, active galactic nuclei, gas, and dust contributions becomes possible. We can now confidently use the joint distribution to propagate full non-Gaussian redshift uncertainties into inferred properties of the galaxy population. This model, ``\prospector-$\beta$'', is intended for fitting galaxy photometry where the redshift is unknown, and will be instrumental in ensuring the maximum science return from forthcoming photometric surveys with JWST. The code is made publicly available online as a part of \prospector.Comment: Accepted for publication in ApJL. 13 pages, 6 figures, 2 tables. The code is made publicly available online as a part of Prospector; the version used in this work corresponds to the state of the Git repository at commit 820ad7

Manual versus automatic bladder wall thickness measurements: a method comparison study

Purpose To compare repeatability and agreement of conventional ultrasound bladder wall thickness (BWT) measurements with automatically obtained BWT measurements by the BVM 6500 device. Methods Adult patients with lower urinary tract symptoms, urinary incontinence, or postvoid residual urine were urodynamically assessed. During two subsequent cystometry sessions the infusion pump was temporarily stopped at 150 and 250 ml bladder filling to measure BWT with conventional ultrasound and the BVM 6500 device. For each method and each bladder filling, repeatability and variation was assessed by the method of Bland and Altman. Results Fifty unselected patients (30 men, 20 women) aged 21–86 years (median 62.5 years) were prospectively evaluated. Invalid BWT measurements were encountered in 2.1–14% of patients when using the BVM 6500 versus 0% with conventional ultrasound (significant only during the second measurement at 150 ml bladder filling). Mean difference in BWT values between the measurements of one technique was -0.1 to +0.01 mm. Measurement variation between replicate measurements was smaller for conventional ultrasound and the smallest for 250 ml bladder filling. Mean difference between the two techniques was 0.11–0.23 mm and did not differ significantly. The BVM 6500 device was not able to correctly measure BWTs above 4 mm. Conclusions Both BWT measurements are repeatable and agree with each other. However, conventional ultrasound measurements have a smaller measurement variance, can measure BWT in all patients, and BWTs above 4 mm

The incorporation of focused history in checklist for early recognition and treatment of acute illness and injury

BACKGROUND: Diagnostic error and delay are critical impediments to the safety of critically ill patients. Checklist for early recognition and treatment of acute illness and injury (CERTAIN) has been developed as a tool that facilitates timely and error-free evaluation of critically ill patients. While the focused history is an essential part of the CERTAIN framework, it is not clear how best to choreograph this step in the process of evaluation and treatment of the acutely decompensating patient. METHODS: An un-blinded crossover clinical simulation study was designed in which volunteer critical care clinicians (fellows and attendings) were randomly assigned to start with either obtaining a focused history choreographed in series (after) or in parallel to the primary survey. A focused history was obtained using the standardized SAMPLE model that is incorporated into American College of Trauma Life Support (ATLS) and Pediatric Advanced Life Support (PALS). Clinicians were asked to assess six acutely decompensating patients using pre – determined clinical scenarios (three in series choreography, three in parallel). Once the initial choreography was completed the clinician would crossover to the alternative choreography. The primary outcome was the cognitive burden assessed through the NASA task load index. Secondary outcome was time to completion of a focused history. RESULTS: A total of 84 simulated cases (42 in parallel, 42 in series) were tested on 14 clinicians. Both the overall cognitive load and time to completion improved with each successive practice scenario, however no difference was observed between the series versus parallel choreographies. The median (IQR) overall NASA TLX task load index for series was 39 (17 – 58) and for parallel 43 (27 – 52), p = 0.57. The median (IQR) time to completion of the tasks in series was 125 (112 – 158) seconds and in parallel 122 (108 – 158) seconds, p = 0.92. CONCLUSION: In this clinical simulation study assessing the incorporation of a focused history into the primary survey of a non-trauma critically ill patient, there was no difference in cognitive burden or time to task completion when using series choreography (after the exam) compared to parallel choreography (concurrent with the primary survey physical exam). However, with repetition of the task both overall task load and time to completion improved in each of the choreographies. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12873-016-0099-9) contains supplementary material, which is available to authorized users

TEMPLATES: A Robust Outlier Rejection Method for JWST/NIRSpec Integral Field Spectroscopy

We describe a custom outlier rejection algorithm for JWST/NIRSpec integral field spectroscopy. This method uses a layered sigma clipping approach that adapts clipping thresholds based upon the spatial profile of the science target. We find that this algorithm produces a robust outlier rejection while simultaneously preserving the signal of the science target. Originally developed as a response to unsatisfactory initial performance of the jwst pipeline outlier detection step, this method works either as a standalone solution, or as a supplement to the current pipeline software. Comparing leftover (i.e., not flagged) artifacts with the current pipeline's outlier detection step, we find that our method results in one fifth as many residual artifacts as the jwst pipeline. However, we find a combination of both methods removes nearly all artifacts -- an approach that takes advantage of both our algorithm's robust outlier rejection and the pipeline's use of individual dithers. This combined approach is what the TEMPLATES Early Release Science team has converged upon for our NIRSpec observations. Finally, we publicly release the code and Jupyter notebooks for the custom outlier rejection algorithm.Comment: 10 pages, including 5 figures. Submitted to the Publications of the Astronomical Society of the Pacific (PASP). Code associated with paper released at https://github.com/aibhleog/baryon-swee