We present NuSTAR observations of neutron star (NS) low-mass X-ray binaries: 4U 1636-53, GX 17+2, and 4U 1705-44. We observed 4U 1636-53 in the hard state, with an Eddington fraction, , of 0.01; GX ...17+2 and 4U 1705-44 were in the soft state with fractions of 0.57 and 0.10, respectively. Each spectrum shows evidence for a relativistically broadened Fe K line. Through accretion disk reflection modeling, we constrain the radius of the inner disk in 4U 1636-53 to be ISCO (innermost stable circular orbit), assuming a dimensionless spin parameter , and ISCO for (errors quoted at 1 ). This value proves to be model independent. For and , for example, 1.08 0.06 ISCO translates to a physical radius of km, and the NS would have to be smaller than this radius (other outcomes are possible for allowed spin parameters and masses). For GX 17+2, ISCO for and ISCO for . For and , ISCO translates to km. The inner accretion disk in 4U 1705-44 may be truncated just above the stellar surface, perhaps by a boundary layer or magnetosphere; reflection models give a radius of 1.46-1.64 ISCO for and 1.69-1.93 ISCO for . We discuss the implications our results may have on the equation of state of ultradense, cold matter and our understanding of the innermost accretion flow onto NSs with low surface magnetic fields, and systematic errors related to the reflection models and spacetime metric around less idealized NSs.
Healthcare-associated infections (HAIs) have a significant impact on patients' morbidity and mortality, and have a detrimental financial impact on the healthcare system. Various strategies exist to ...prevent HAIs, but economic evaluations are needed to determine which are most appropriate.
To present the financial impact of a nationwide project on HAI prevention in intensive care units (ICUs) using a quality improvement (QI) approach.
A health economic evaluation assessed the financial results of the QI initiative ‘Saúde em Nossas Mãos’ (SNM), implemented in Brazil between January 2018 and December 2020. Among 116 participating institutions, 13 (11.2%) fully reported the aggregate cost and stratified patients (with vs without HAIs) in the pre-intervention and post-intervention periods. Average cost (AC) was calculated for each analysed HAI: central-line-associated bloodstream infections (CLABSIs), ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infections (CAUTIs). The absorption model and time-driven activity-based costing were used for cost estimations. The numbers of infections that the project could have prevented during its implementation were estimated to demonstrate the financial impact of the SNM initiative.
The aggregated ACs calculated for each HAI from these 13 ICUs – US$8480 for CLABSIs, US$10,039 for VAP, and US$7464 for CAUTIs – were extrapolated to the total number of HAIs prevented by the project (1727 CLABSIs, 3797 VAP and 2150 CAUTIs). The overall savings of the SNM as of December 2020 were estimated at US$68.8 million, with an estimated return on investment (ROI) of 765%.
Reporting accurate financial data on HAI prevention strategies is still challenging in Brazil. These results suggest that a national QI initiative to prevent HAIs in critical care settings is a feasible and value-based approach, reducing financial waste and yielding a significant ROI for the healthcare system.
The prevalence of obesity is increasing among children in the developed world. The association of obesity and abnormal cardiac function is still debated. The reported changes may reflect the role of ...comorbidities that contribute to ventricular dysfunction. Obese children, without arterial hypertension, may be a unique clinical opportunity to evaluate the effect of obesity, per se, on myocardial function, excluding the influence of possible comorbidities. We sought to define the preclinical effects of obesity on the cardiovascular system, of healthy children with excess weight who have no other clinically appreciable cause of heart disease, using the more sensitive ultrasonic-derived strain and strain rate (SR) imaging.
We studied 300 subjects divided into two groups: (i) obese children (Group O: n=150; age, 12+/-3 years); (ii) healthy lean children comparable for age, sex, and pubertal stage (Referents: n=150; mean age, 12+/-3 years). Systolic (SBP) and diastolic blood pressure (DBP), as well as 24 h-SBP and 24 h-DBP were comparable between groups. Left ventricular (LV) mass/height(2.7) was increased (P<0.0001) in Group O (46+/-12 g/m(2.7)) when compared with Referents (31+/-14 gm(2.7)). Standard echocardiographic indices of global systolic function were similar in the two groups. Intima-media thickness measured at the common carotid artery was not significantly different (P=0.4) in obese children (0.46+/-0.09 mm) when compared with Referents (0.45+/-0.07 mm). Obese children showed regional longitudinal peak systolic myocardial deformation properties (SR=-1.4+/-0.7 s(-1)) lower (P<0.0001) than those of Referents (SR=-2.2+/-0.5) in both left and right ventricle. In multivariable analysis, average peak systolic SR was significantly correlated with homeostasis model assessment of insulin resistance (P<0.01; coefficient, 0.02; SE, 0.011), and insulin serum concentration (P<0.01; coefficient, 0.05; SE, 0.023). Average LV peak systolic strain was significantly correlated with body mass index (P=0.0001; coefficient, 0.06; SE, 0.016), LVM/H(2.7) (P=0.006; coefficient, 0.016; SE, 0.018).
Our study demonstrated that obesity, in absence of hypertension, is associated with significant reduction in systolic myocardial deformation properties already in childhood involving both right and left ventricle. Obesity not only is a risk factor for later cardiovascular disease, but also is associated with contemporaneous and significant impairment of longitudinal myocardial deformation properties.
We present new data for five underluminous Type II-plateau supernovae (SNe IIP), namely SN 1999gn, SN 2002gd, SN 2003Z, SN 2004eg and SN 2006ov. This new sample of low-luminosity SNe IIP (LL SNe IIP) ...is analysed together with similar objects studied in the past. All of them show a flat light-curve plateau lasting about 100 d, an underluminous late-time exponential tail, intrinsic colours that are unusually red, and spectra showing prominent and narrow P Cygni lines. A velocity of the ejected material below 103 km s−1 is inferred from measurements at the end of the plateau. The 56Ni masses ejected in the explosion are very small (≤10−2 M). We investigate the correlations among 56Ni mass, expansion velocity of the ejecta and absolute magnitude in the middle of the plateau, confirming the main findings of Hamuy, according to which events showing brighter plateau and larger expansion velocities are expected to produce more 56Ni. We propose that these faint objects represent the LL tail of a continuous distribution in parameters space of SNe IIP. The physical properties of the progenitors at the explosion are estimated through the hydrodynamical modelling of the observables for two representative events of this class, namely SN 2005cs and SN 2008in. We find that the majority of LL SNe IIP, and quite possibly all, originate in the core collapse of intermediate-mass stars, in the mass range 10-15 M.
We present results derived from the first multi-chord stellar occultations by the transneptunian object (50000) Quaoar, observed on 2011 May 4 and 2012 February 17, and from a single-chord ...occultation observed on 2012 October 15. If the timing of the five chords obtained in 2011 were correct, then Quaoar would possess topographic features (crater or mountain) that would be too large for a body of this mass. An alternative model consists in applying time shifts to some chords to account for possible timing errors. Satisfactory elliptical fits to the chords are then possible, yielding an equivalent radius R sub(equiv) = 555+ or -2.5 km and geometric visual albedo p sub(v) = 0.109+ or -0.007. Assuming that Quaoar is a Maclaurin spheroid with an indeterminate polar aspect angle, we derive a true oblateness of member of = 0.087 super(+0.0268) sub(-0.0175), an equatorial radius of 569 super(+24) sub(-17)km, and a density of 1.99 + or - 0.46 g cm super(-3). The orientation of our preferred solution in the plane of the sky implies that Quaoar's satellite Weywot cannot have an equatorial orbit. Finally, we detect no global atmosphere around Quaoar, considering a pressure upper limit of about 20 nbar for a pure methane atmosphere.
This essay considers sacramental character as a fundamental principle of the Christian life by comparing it with the bodily characters of the ministers of public authority mentioned in St. Thomas's ...famed article on whether it is licit to kill in self-defense '64.7.' In particular, it discusses how a spiritual character confers a power to act in a way that one could not otherwise act by uniting one to Christ as one's spiritual head. It concludes by examining why it is necessary to be deputed by a character in order to participate in the sacraments.
We report the direct measurement of the {sup 7}Be solar neutrino signal rate performed with the Borexino detector at the Laboratori Nazionali del Gran Sasso. The interaction rate of the 0.862 MeV ...{sup 7}Be neutrinos is 49{+-}3{sub stat}{+-}4{sub syst} counts/(day{center_dot}100 ton). The hypothesis of no oscillation for {sup 7}Be solar neutrinos is inconsistent with our measurement at the 4{sigma} C.L. Our result is the first direct measurement of the survival probability for solar {nu}{sub e} in the transition region between matter-enhanced and vacuum-driven oscillations. The measurement improves the experimental determination of the flux of {sup 7}Be, pp, and CNO solar {nu}{sub e}, and the limit on the effective neutrino magnetic moment using solar neutrinos.
Many membrane-based ion separation technologies require monovalent cations selectivity. However, available membranes usually show limited specific ion selectivity. In order to provide basic ...information on the membrane ion selectivity, the confinement effect on narrow pores disrupting the ion hydration is investigated in this work, with the aim to provide a new alternative to classical Cation Exchange Membranes (CEM). Starting from solvated cations structures used as templates and obtained by a quantum approach, Single-Wall Carbon Nanotubes (SWCNT) with ad-hoc designed diameters were chosen to perform in-silico experiments of single-cation permeation through CNT by means of Molecular Dynamics simulations, for which partial charges at nanotube inlets were parametrized through ab initio calculations. Cations' trajectories and energy decomposition analysis suggest that 100 % perm-selectivity towards Na+ with respect to Ca2+ and Mg2+ is virtually attainable with CNT of 1.33 nm diameter. Interestingly, the origin of this behaviour lays on thermodynamics rather than on size exclusion mechanisms. Opposite to polymeric homogeneous CEM, showing higher affinity for multivalent cations, an inverted trend was found for CNT in terms of hydration free energies, where Na+ shows more affinity up to 36 kJ/mol. Finally, total rejection of Cl− was observed in the range of CNT diameters investigated.
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•Hydrated cations DFT-COSMO optimized structures as templates for CNT diameters.•Selectivity of monovalent versus divalent cations: a proof of concept•Single cation 200 ns MD trajectories through 4 nm-long CNT models in water•Na+ 36 kJ/mol affinity vs. Mg2+ and Ca2+ total rejection with CNT 1.33 nm diameter•Total rejection of Cl− anions through zig-zag CNTs 1.33–1.96 nm diameter
Radical trachelectomy is considered a viable option for fertility preservation in patients with low-risk, early-stage cervical cancer. Standard approaches include laparotomy or minimally invasive ...surgery when performing radical trachelectomy.
To compare disease-free survival between patients with FIGO (2009) stage IA2 or IB1 (≤2cm) cervical cancer who underwent open versus minimally invasive (laparoscopic or robotic) radical trachelectomy.
We hypothesize that minimally invasive radical trachelectomy has similar oncologic outcomes to those of the open approach.
This is a collaborative, multi-institutional, international, retrospective study. Patients who underwent a radical trachelectomy and lymphadenectomy between January 1, 2005 and December 31, 2017 will be included. Institutional review board approval will be required. Each institution will be provided access to a study-specific REDCap (Research Electronic Data Capture) database maintained by MD Anderson Cancer Center and will be responsible for entering patient data.
Patients with squamous, adenocarcinoma, or adenosquamous cervical cancer FIGO (2009) stages IA2 and IB1 (≤2 cm) will be included. Surgery performed by the open approach or minimally invasive approach (laparoscopy or robotics). Tumor size ≤2 cm, by physical examination, ultrasound, MRI, CT, or positron emission tomography (at least one should confirm a tumor size ≤2 cm). Centers must contribute at least 15 cases of radical trachelectomy (open, minimally invasive, or both).
Prior neoadjuvant chemotherapy or radiotherapy to the pelvis for cervical cancer at any time, prior lymphadenectomy, or pelvic retroperitoneal surgery, pregnant patients, aborted trachelectomy (intra-operative conversion to radical hysterectomy), or vaginal approach.
The primary endpoint is disease-free survival measured as the time from surgery until recurrence or death due to disease. To evaluate the primary objective, we will compare disease-free survival among patients with FIGO (2009) stage IA2 or IB1 (≤2cm) cervical cancer who underwent open versus minimally invasive radical trachelectomy.
An estimated 535 patients will be included; 256 open and 279 minimally invasive radical trachelectomy. Previous studies have shown that recurrence rates in the open group range from 3.8% to 7.6%. Assuming that the 4.5-year disease-free survival rate for patients who underwent open surgery is 95.0%, we have 80% power to detect a 0.44 HR using α level 0.10. This corresponds to an 89.0% disease-free survival rate at 4.5 years in the minimally invasive group.
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