We present ALMA observations of the CO(1–0) and CO(3–2) line emission tracing filaments of cold molecular gas in the central galaxy of the cluster PKS 0745−191. The total molecular gas mass of
...$4.6\pm 0.3\times 10^{9} {\rm \, M_{{\odot}}}$
, assuming a Galactic X
CO factor, is divided roughly equally between three filaments each extending radially 3-5 kpc from the galaxy centre. The emission peak is located in the SE filament ∼ 1 arcsec (2 kpc) from the nucleus. The velocities of the molecular clouds in the filaments are low, lying within
$\pm 100 {\rm \, km \rm \, s^{-1}}$
of the galaxy's systemic velocity. Their full width at half-maximum (FWHM) are less than
$150 {\rm \, km \rm \, s^{-1},}$
which is significantly below the stellar velocity dispersion. Although the molecular mass of each filament is comparable to a rich spiral galaxy, such low velocities show that the filaments are transient and the clouds would disperse on < 107 yr time-scales unless supported, likely by the indirect effect of magnetic fields. The velocity structure is inconsistent with a merger origin or gravitational free-fall of cooling gas in this massive central galaxy. If the molecular clouds originated in gas cooling even a few kpc from their current locations their velocities would exceed those observed. Instead, the projection of the N and SE filaments underneath X-ray cavities suggests they formed in the updraft behind bubbles buoyantly rising through the cluster atmosphere. Direct uplift of the dense gas by the radio bubbles appears to require an implausibly high coupling efficiency. The filaments are coincident with low temperature X-ray gas, bright optical line emission and dust lanes indicating that the molecular gas could have formed from lifted warmer gas that cooled in situ.
Since the year 2000, a concerted campaign against malaria has led to unprecedented levels of intervention coverage across sub-Saharan Africa. Understanding the effect of this control effort is vital ...to inform future control planning. However, the effect of malaria interventions across the varied epidemiological settings of Africa remains poorly understood owing to the absence of reliable surveillance data and the simplistic approaches underlying current disease estimates. Here we link a large database of malaria field surveys with detailed reconstructions of changing intervention coverage to directly evaluate trends from 2000 to 2015, and quantify the attributable effect of malaria disease control efforts. We found that Plasmodium falciparum infection prevalence in endemic Africa halved and the incidence of clinical disease fell by 40% between 2000 and 2015. We estimate that interventions have averted 663 (542-753 credible interval) million clinical cases since 2000. Insecticide-treated nets, the most widespread intervention, were by far the largest contributor (68% of cases averted). Although still below target levels, current malaria interventions have substantially reduced malaria disease incidence across the continent. Increasing access to these interventions, and maintaining their effectiveness in the face of insecticide and drug resistance, should form a cornerstone of post-2015 control strategies.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, KISLJ, NUK, PILJ, PNG, SAZU, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
We present new results on the microscopic nature of the ferroelectricity mechanisms in Ca3 Mn2O7 and Ca3Ti2O7. To the first approximation, we confirm the hybrid improper ferroelectric mechanism ...recently proposed by Benedek and Fennie for these Ruddlesden-Popper compounds. However, in Ca3Mn2O7 we find that there is a complex competition between lattice modes of different symmetry which leads to a phase coexistence over a large temperature range and the "symmetry trapping" of a soft mode. This trapping of the soft mode leads to a large uniaxial negative thermal expansion (NTE) reaching a maximum between 250 and 350 K (3.6×10^(-6) K^{-1}) representing the only sizable NTE reported for these and related perovskite materials to date. Our results suggest a systematic strategy for designing and searching for ceramics with large NTE coefficients.
OBJECTIVES:To clarify whether bowel preparation use or its individual components mechanical bowel preparation (MBP)/oral antibiotics impact specific outcomes after colorectal surgery.
...METHODS:National Surgical Quality Improvement Program–targeted colectomy data initiated in 2012 capture information on the use/type of bowel preparation and colorectal-specific complications. For patients undergoing elective colorectal resection, the impact of preoperative MBP and antibiotics (MBP+/ABX+), MBP alone (MBP+/ABX−), and no bowel preparation (no-prep) on outcomes, particularly anastomotic leak, surgical site infection (SSI), and ileus, were evaluated using unadjusted/adjusted logistic regression analysis.
RESULTS:Of 8442 patients, 2296 (27.2%) had no-prep, 3822 (45.3%) MBP+/ABX−, and 2324 (27.5%) MBP+/ABX+. Baseline characteristics were similar; however, there were marginally more patients with prior sepsis, ascites, steroid use, bleeding disorders, and disseminated cancer in no-prep. MBP with or without antibiotics was associated with reduced ileus MBP+/ABX+odds ratio (OR) = 0.57, 95% confidence interval (CI)0.48–0.68; MBP+/ABX−OR = 0.78, 95% CI0.68–0.91 and SSI MBP+/ABX+OR = 0.39, 95% CI0.32–0.48; MBP+/ABX−OR = 0.80, 95% CI0.69–0.93 versus no-prep. MBP+/ABX+ was also associated with lower anastomotic leak rate than no-prep OR = 0.45 (95% CI0.32–0.64). On multivariable analysis, MBP with antibiotics, but not without, was independently associated with reduced anastomotic leak (OR = 0.57, 95% CI0.35–0.94), SSI (OR = 0.40, 95% CI0.31–0.53), and postoperative ileus (OR = 0.71, 95% CI0.56–0.90).
CONCLUSIONS:These data clarify the near 50-year debate whether bowel preparation improves outcomes after colorectal resection. MBP with oral antibiotics reduces by nearly half, SSI, anastomotic leak, and ileus, the most common and troublesome complications after colorectal surgery.
In a trial comparing decompressive craniectomy with medical therapy in patients with traumatic brain injury and raised intracranial pressure refractory to medical therapy, decompressive craniectomy ...resulted in lower mortality and higher rates of vegetative state and severe disability.
After traumatic brain injury (TBI), intracranial pressure can be elevated owing to a mass effect from intracranial hematomas, contusions, diffuse brain swelling, or hydrocephalus.
1
Intracranial hypertension can lead to brain ischemia by reducing the cerebral perfusion pressure.
2
Intracranial hypertension after TBI is associated with an increased risk of death in most studies.
3
,
4
The monitoring of intracranial pressure and the administration of interventions to lower intracranial pressure are routinely used in patients with TBI, despite the lack of level 1 evidence.
5
Decompressive craniectomy is a surgical procedure in which a large section of the skull is removed and the underlying . . .
A review of dental implants and infection Pye, A.D; Lockhart, D.E.A; Dawson, M.P ...
The Journal of hospital infection,
06/2009, Letnik:
72, Številka:
2
Journal Article
Recenzirano
Summary Dental implants have become increasingly common for the management of tooth loss. Despite their placement in a contaminated surgical field, success rates are relatively high. This article ...reviews dental implants and highlights factors leading to infection and potential implant failure. A literature search identified studies analysing the microbial composition of peri-implant infections. The microflora of dental peri-implantitis resembles that found in chronic periodontitis, featuring predominantly anaerobic Gram-negative bacilli, in particular Porphyromonas gingivalis and Prevotella intermedia , anaerobic Gram-negative cocci such as Veillonella spp. and spirochaetes including Treponema denticola . The role of Staphylococcus aureus and coagulase-negative staphylococci that are typically encountered in orthopaedic infections is debatable, although they undoubtedly play a role when isolated from clinically infected sites. Likewise, the aetiological involvement of coliforms and Candida spp. requires further longitudinal studies. Currently, there are neither standardised antibiotic prophylactic regimens for dental implant placement nor universally accepted treatment for peri-implantitis. The treatment of infected implants is difficult and usually requires removal. In the UK there is no systematic post-surgical implant surveillance programme. Therefore, the development of such a project would be advisable and provide valuable epidemiological data.
Enterococci are organisms with a remarkable ability to adapt to the environment and acquire antibiotic resistance determinants. The evolution of antimicrobial resistance in these organisms poses ...enormous challenges for clinicians when faced with patients affected with severe infections. The increased prevalence and dissemination of multidrug-resistant Enterococcus faecium worldwide has resulted in a major decrease in therapeutic options because the majority of E. faecium isolates are now resistant to ampicillin and vancomycin, and exhibit high-level resistance to aminoglycosides, which are three of the traditionally most useful anti-enterococcal antibiotics. Newer antibiotics such as linezolid, daptomycin and tigecycline have good in vitro activity against enterococcal isolates, although their clinical use may be limited in certain clinical scenarios as a result of reduced rates of success, possible underdosing for enterococci and low serum levels, respectively, and also by the emergence of resistance. The experimental agent oritavancin may offer some hope for the treatment of vancomycin-resistant enterococci but clinical data are still lacking. Thus, optimal therapies for the treatment of multidrug-resistant enterococcal infections continue to be based on empirical observations and extrapolations from in vitro and animal data. Clinical studies evaluating new strategies, including combination therapies, to treat severe vancomycin-resistant E. faecium infections are urgently needed.
Emergency laparotomy is a common intra-abdominal procedure. Outcomes are generally recognized to be poor, but there is a paucity of hard UK data, and reports have mainly been confined to ...single-centre studies.
Clinicians were invited to join an ‘Emergency Laparotomy Network’ and to collect prospective non-risk-adjusted outcome data from a large number of NHS Trusts providing emergency surgical care. Data concerning what were considered to be key aspects of perioperative care, including thirty-day mortality, were collected over a 3 month period.
Data from 1853 patients were collected from 35 NHS hospitals. The unadjusted 30 day mortality was 14.9% for all patients and 24.4% in patients aged 80 or over. There was a wide variation between units in terms of the proportion of cases subject to key interventions that may affect outcomes. The presence of a consultant surgeon in theatre varied between 40.6% and 100% of cases, while a consultant anaesthetist was present in theatre for 25–100% of cases. Goal-directed fluid management was used in 0–63% of cases. Between 0% and 68.9% of the patients returned to the ward (level one) after surgery, and between 9.7% and 87.5% were admitted to intensive care (level three). Mortality rates varied from 3.6% to 41.7%.
This study confirms that emergency laparotomy in the UK carries a high mortality. The variation in clinical management and outcomes indicates the need for a national quality improvement programme.
The Global Burden of Disease 2015 study aims to use all available data of sufficient quality to generate reliable and valid prevalence, incidence, and disability-adjusted life year (DALY) estimates ...of oral conditions for the period of 1990 to 2015. Since death as a direct result of oral diseases is rare, DALY estimates were based on years lived with disability, which are estimated only on those persons with unmet need for dental care. We used our data to assess progress toward the Federation Dental International, World Health Organization, and International Association for Dental Research’s oral health goals of reducing the level of oral diseases and minimizing their impact by 2020. Oral health has not improved in the last 25 y, and oral conditions remained a major public health challenge all over the world in 2015. Due to demographic changes, including population growth and aging, the cumulative burden of oral conditions dramatically increased between 1990 and 2015. The number of people with untreated oral conditions rose from 2.5 billion in 1990 to 3.5 billion in 2015, with a 64% increase in DALYs due to oral conditions throughout the world. Clearly, oral diseases are highly prevalent in the globe, posing a very serious public health challenge to policy makers. Greater efforts and potentially different approaches are needed if the oral health goal of reducing the level of oral diseases and minimizing their impact is to be achieved by 2020. Despite some challenges with current measurement methodologies for oral diseases, measurable specific oral health goals should be developed to advance global public health.
The second messenger cyclic AMP (cAMP) can either stimulate or inhibit programmed cell death (apoptosis). Here, we review examples of cell types that show pro‐apoptotic or anti‐apoptotic responses to ...increases in cAMP. We also show that cells can have both such responses, although predominantly having one or the other. Protein kinase A (PKA)‐promoted changes in phosphorylation and gene expression can mediate pro‐apoptotic responses, such as in murine S49 lymphoma cells, based on evidence that mutants lacking PKA fail to undergo cAMP‐promoted, mitochondria‐dependent apoptosis. Mechanisms for the anti‐apoptotic response to cAMP likely involve Epac (Exchange protein activated by cAMP), a cAMP‐regulated effector that is a guanine nucleotide exchange factor (GEF) for the low molecular weight G‐protein, Rap1. Therapeutic approaches that activate PKA‐mediated pro‐apoptosis or block Epac‐mediated anti‐apoptotisis may provide a means to enhance cell killing, such as in certain cancers. In contrast, efforts to block PKA or stimulate Epac have the potential to be useful in diseases settings (such as heart failure) associated with cAMP‐promoted apoptosis.
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