Should all acutely ill children in primary care be tested with point-of-care CRP: A cluster randomised trial

Background: Point-of-care blood C-reactive protein (CRP) testing has diagnostic value in helping clinicians rule out the possibility of serious infection. We investigated whether it should be offered to all acutely ill children in primary care or restricted to those identified as at risk on clinical assessment. Methods: Cluster randomised controlled trial involving acutely ill children presenting to 133 general practitioners (GPs) at 78 GP practices in Belgium. Practices were randomised to undertake point-of-care CRP testing in all children (1730 episodes) or restricted to children identified as at clinical risk (1417 episodes). Clinical risk was assessed by a validated clinical decision rule (presence of one of breathlessness, temperature ≥ 40 °C, diarrhoea and age 12-30 months, or clinician concern). The main trial outcome was hospital admission with serious infection within 5 days. No specific guidance was given to GPs on interpreting CRP levels but diagnostic performance is reported at 5, 20, 80 and 200 mg/L. Results: Restricting CRP testing to those identified as at clinical risk substantially reduced the number of children tested by 79.9 % (95 % CI, 77.8-82.0 %). There was no significant difference between arms in the number of children with serious infection who were referred to hospital immediately (0.16 % vs. 0.14 %, P = 0.88). Only one child with a CRP < 5 mg/L had an illness requiring admission (a child with viral gastroenteritis admitted for rehydration). However, of the 80 children referred to hospital to rule out serious infection, 24 (30.7 %, 95 % CI, 19.6-45.6 %) had a CRP < 5 mg/L. Conclusions: CRP testing should be restricted to children at higher risk after clinical assessment. A CRP < 5 mg/L rules out serious infection and could be used by GPs to avoid unnecessary hospital referrals

Mrk 421, Mrk 501, and 1ES 1426+428 at 100 GeV with the CELESTE Cherenkov Telescope

We have measured the gamma-ray fluxes of the blazars Mrk 421 and Mrk 501 in the energy range between 50 and 350 GeV (1.2 to 8.3 x 10^25 Hz). The detector, called CELESTE, used first 40, then 53 heliostats of the former solar facility "Themis" in the French Pyrenees to collect Cherenkov light generated in atmospheric particle cascades. The signal from Mrk 421 is often strong. We compare its flux with previously published multi-wavelength studies and infer that we are straddling the high energy peak of the spectral energy distribution. The signal from Mrk 501 in 2000 was weak (3.4 sigma). We obtain an upper limit on the flux from 1ES 1426+428 of less than half that of the Crab flux near 100 GeV. The data analysis and understanding of systematic biases have improved compared to previous work, increasing the detector's sensitivity.Comment: 15 pages, 14 figures, accepted to A&A (July 2006) August 19 -- corrected error in author lis

Modélisation 3D des transports de sel et de chaleur au cours des 248 Ma d’évolution du bassin de Paris : implications diagénétiques

Un modèle de bassin 3D a été développé sur le bassin de Paris, reconstituant ses 248 Ma d’histoire géologique depuis le Trias jusqu’à l’actuel. Cette modélisation s’appuie sur une base de données stratigraphique et lithologique détaillée constituée d’environ 1100 forages pétroliers. Ce modèle, d’échelle régionale, couvre un domaine de 700 000 km2, plus vaste que l’extension actuelle du bassin, afin de prendre en compte l’évolution paléogéographique de la plaque européenne. Cette histoire géologique est simulée à l’aide du modèle numérique NEWBAS de l’Ecole des Mines de Paris. Le modèle simule la sédimentation, l’érosion, la compaction, les écoulements de fluides et les processus de transport de solutés et de chaleur. L’objet du présent article est de montrer l’intérêt d’une telle modélisation pour l’estimation et la quantification de l’importance des circulations de fluides dans les processus géologiques. Les études sur les ciments diagénétiques des réservoirs Dogger et Keuper du bassin de Paris ont souvent conduit leurs auteurs à invoquer des circulations de fluides régionales. Ces études, qui fournissent des estimations de paléotempératures et de paléosalinités, apportent des contraintes à la modélisation, mais en retour la modélisation peut apporter un calage dans le temps de ces événements et une estimation des processus pertinents. La reconstitution des transports de chaleur et de sel proposée dans cet article permet ainsi de cerner l’influence de l’hydrodynamique sur ces processus. L’histoire thermique et saline du bassin est présentée à différentes étapes sur une coupe NW-SE représentative d’une ligne d’écoulement actuelle également valable au cours du Tertiaire. On montre l’importance de la paléotopographie pour expliquer les fortes salinités dans les réservoirs et le rôle de la faille de Bray pour l’évolution de la salinité dans le Dogger. Le basculement et l’érosion de la base tertiaire crée un écoulement gravitaire qui se substitue au régime d’écoulement en compaction, permettant ainsi la migration de saumures depuis la formation salifère à l’est du bassin vers les réservoirs du Keuper à l’ouest. La recharge des aquifères aux affleurements et la mise en charge des systèmes permet une migration ascendante des eaux salées depuis le Keuper vers le Dogger en considérant une perméabilité plus importante au niveau de la faille de Bray. Bien que dominé par la composante conductive, le transport de chaleur est également influencé par l’hydrodynamique avec un effet de refroidissement convectif possible lors de la mise en charge des aquifères à la fin de l’érosion tertiaire, pouvant expliquer une partie de l’excès de température déduit des inclusions fluides du Keuper entre l’état thermique à la fin du dépôt de la craie et l’actuel. D’après nos simulations, la base du Tertiaire est la période la plus compatible avec les observations diagénétiques, pour des raisons thermiques (maximum d’enfouissement et effet de refroidissement convectif) et chimique (topographie favorable aux migrations de saumures dans le Keuper et le Dogger)

Search for Early Gamma-ray Production in Supernovae Located in a Dense Circumstellar Medium with the Fermi LAT

Supernovae (SNe) exploding in a dense circumstellar medium (CSM) are hypothesized to accelerate cosmic rays in collisionless shocks and emit GeV gamma rays and TeV neutrinos on a time scale of several months. We perform the first systematic search for gamma-ray emission in Fermi LAT data in the energy range from 100 MeV to 300 GeV from the ensemble of 147 SNe Type IIn exploding in dense CSM. We search for a gamma-ray excess at each SNe location in a one year time window. In order to enhance a possible weak signal, we simultaneously study the closest and optically brightest sources of our sample in a joint-likelihood analysis in three different time windows (1 year, 6 months and 3 months). For the most promising source of the sample, SN 2010jl (PTF10aaxf), we repeat the analysis with an extended time window lasting 4.5 years. We do not find a significant excess in gamma rays for any individual source nor for the combined sources and provide model-independent flux upper limits for both cases. In addition, we derive limits on the gamma-ray luminosity and the ratio of gamma-ray-to-optical luminosity ratio as a function of the index of the proton injection spectrum assuming a generic gamma-ray production model. Furthermore, we present detailed flux predictions based on multi-wavelength observations and the corresponding flux upper limit at 95% confidence level (CL) for the source SN 2010jl (PTF10aaxf).Comment: Accepted for publication in ApJ. Corresponding author: A. Franckowiak ([email protected]), updated author list and acknowledgement

Gamma-ray flares from the Crab Nebula

A young and energetic pulsar powers the well-known Crab Nebula. Here we describe two separate gamma-ray (photon energy >100 MeV) flares from this source detected by the Large Area Telescope on board the Fermi Gamma-ray Space Telescope. The first flare occurred in February 2009 and lasted approximately 16 days. The second flare was detected in September 2010 and lasted approximately 4 days. During these outbursts the gamma-ray flux from the nebula increased by factors of four and six, respectively. The brevity of the flares implies that the gamma rays were emitted via synchrotron radiation from PeV (10^15 eV) electrons in a region smaller than 1.4 10^-2 pc. These are the highest energy particles that can be associated with a discrete astronomical source, and they pose challenges to particle acceleration theory.Comment: Contact authors: Rolf Buehler,[email protected]; Stefan Funk,[email protected]; Roger Blandford,rdb3@stanford ; 16 pages,2 figure

Multiwavelength Evidence for Quasi-periodic Modulation in the Gamma-ray Blazar PG 1553+113

We report for the first time a gamma-ray and multi-wavelength nearly-periodic oscillation in an active galactic nucleus. Using the Fermi Large Area Telescope (LAT) we have discovered an apparent quasi-periodicity in the gamma-ray flux (E >100 MeV) from the GeV/TeV BL Lac object PG 1553+113. The marginal significance of the 2.18 +/-0.08 year-period gamma-ray cycle is strengthened by correlated oscillations observed in radio and optical fluxes, through data collected in the OVRO, Tuorla, KAIT, and CSS monitoring programs and Swift UVOT. The optical cycle appearing in ~10 years of data has a similar period, while the 15 GHz oscillation is less regular than seen in the other bands. Further long-term multi-wavelength monitoring of this blazar may discriminate among the possible explanations for this quasi-periodicity.Comment: 8 pages, 5 figures. Accepted to The Astrophysical Journal Letters. Corresponding authors: S. Ciprini (ASDC/INFN), S. Cutini (ASDC/INFN), S. Larsson (Stockholm Univ/KTH), A. Stamerra (INAF/SNS), D. J. Thompson (NASA GSFC

Detection of 16 Gamma-Ray Pulsars Through Blind Frequency Searches Using the Fermi LAT

Pulsars are rapidly-rotating, highly-magnetized neutron stars emitting radiation across the electromagnetic spectrum. Although there are more than 1800 known radio pulsars, until recently, only seven were observed to pulse in gamma rays and these were all discovered at other wavelengths. The Fermi Large Area Telescope makes it possible to pinpoint neutron stars through their gamma-ray pulsations. We report the detection of 16 gamma-ray pulsars in blind frequency searches using the LAT. Most of these pulsars are coincident with previously unidentified gamma-ray sources, and many are associated with supernova remnants. Direct detection of gamma-ray pulsars enables studies of emission mechanisms, population statistics and the energetics of pulsar wind nebulae and supernova remnants.Comment: Corresponding authors: Michael Dormody, Paul S. Ray, Pablo M. Saz Parkinson, Marcus Ziegle

Search for extended gamma-ray emission from the Virgo galaxy cluster with Fermi-LAT

Galaxy clusters are one of the prime sites to search for dark matter (DM) annihilation signals. Depending on the substructure of the DM halo of a galaxy cluster and the cross sections for DM annihilation channels, these signals might be detectable by the latest generation of $\gamma$-ray telescopes. Here we use three years of Fermi Large Area Telescope (LAT) data, which are the most suitable for searching for very extended emission in the vicinity of nearby Virgo galaxy cluster. Our analysis reveals statistically significant extended emission which can be well characterized by a uniformly emitting disk profile with a radius of 3\deg that moreover is offset from the cluster center. We demonstrate that the significance of this extended emission strongly depends on the adopted interstellar emission model (IEM) and is most likely an artifact of our incomplete description of the IEM in this region. We also search for and find new point source candidates in the region. We then derive conservative upper limits on the velocity-averaged DM pair annihilation cross section from Virgo. We take into account the potential $\gamma$-ray flux enhancement due to DM sub-halos and its complex morphology as a merging cluster. For DM annihilating into $b\overline{b}$, assuming a conservative sub-halo model setup, we find limits that are between 1 and 1.5 orders of magnitude above the expectation from the thermal cross section for $m_{\mathrm{DM}}\lesssim100\,\mathrm{GeV}$. In a more optimistic scenario, we exclude $\langle \sigma v \rangle\sim3\times10^{-26}\,\mathrm{cm^{3}\,s^{-1}}$ for $m_{\mathrm{DM}}\lesssim40\,\mathrm{GeV}$ for the same channel. Finally, we derive upper limits on the $\gamma$-ray-flux produced by hadronic cosmic-ray interactions in the inter cluster medium. We find that the volume-averaged cosmic-ray-to-thermal pressure ratio is less than $\sim6\%$.Comment: 15 pages, 11 figures, 4 tables, accepted for publication in ApJ; corresponding authors: T. Jogler, S. Zimmer & A. Pinzk