We report the INTernational Gamma-ray Astrophysics Laboratory (INTEGRAL) detection of the short gamma-ray burst GRB 170817A (discovered by Fermi-GBM) with a signal-to-noise ratio of 4.6, and, for the ...first time, its association with the gravitational waves (GWs) from binary neutron star (BNS) merging event GW170817 detected by the LIGO and Virgo observatories. The significance of association between the gamma-ray burst observed by INTEGRAL and GW170817 is 3.2 , while the association between the Fermi-GBM and INTEGRAL detections is 4.2 . GRB 170817A was detected by the SPI-ACS instrument about 2 s after the end of the GW event. We measure a fluence of (1.4 0.4 0.6) × 10−7 erg cm−2 (75-2000 keV), where, respectively, the statistical error is given at the 1 confidence level, and the systematic error corresponds to the uncertainty in the spectral model and instrument response. We also report on the pointed follow-up observations carried out by INTEGRAL, starting 19.5 hr after the event, and lasting for 5.4 days. We provide a stringent upper limit on any electromagnetic signal in a very broad energy range, from 3 keV to 8 MeV, constraining the soft gamma-ray afterglow flux to <7.1 × 10−11 erg cm−2 s−1 (80-300 keV). Exploiting the unique capabilities of INTEGRAL, we constrained the gamma-ray line emission from radioactive decays that are expected to be the principal source of the energy behind a kilonova event following a BNS coalescence. Finally, we put a stringent upper limit on any delayed bursting activity, for example, from a newly formed magnetar.
We report on International Gamma-Ray Astrophysics Laboratory (INTEGRAL) observations of the soft γ-ray repeater SGR 1935+2154 performed between 2020 April 28 and May 3. Several short bursts with ...fluence of erg cm−2 were detected by the Imager on-board INTEGRAL (IBIS) instrument in the 20-200 keV range. The burst with the hardest spectrum, discovered and localized in real time by the INTEGRAL Burst Alert System, was spatially and temporally coincident with a short and very bright radio burst detected by the Canadian Hydrogen Intensity Mapping Experiment (CHIME) and Survey for Transient Astronomical Radio Emission 2 (STARE2) radio telescopes at 400-800 MHz and 1.4 GHz, respectively. Its lightcurve shows three narrow peaks separated by ∼29 ms time intervals, superimposed on a broad pulse lasting ∼0.6 s. The brightest peak had a delay of 6.5 1.0 ms with respect to the 1.4 GHz radio pulse (that coincides with the second and brightest component seen at lower frequencies). The burst spectrum, an exponentially cutoff power law with photon index and peak energy , is harder than those of the bursts usually observed from this and other magnetars. By the analysis of an expanding dust-scattering ring seen in X-rays with the Neil Gehrels Swift Observatory X-ray Telescope (XRT) instrument, we derived a distance of kpc for SGR 1935+2154, independent of its possible association with the supernova remnant G57.2+0.8. At this distance, the burst 20-200 keV fluence of erg cm−2 corresponds to an isotropic emitted energy of erg. This is the first burst with a radio counterpart observed from a soft γ-ray repeater and it strongly supports models based on magnetars that have been proposed for extragalactic fast radio bursts.
In this study, continuous positive airway pressure plus weight loss was no better than either one alone in reducing C-reactive protein levels in patients with obstructive sleep apnea, but ...improvements were seen in insulin resistance, triglyceride levels, and blood pressure.
Available clinical data derived largely from observational studies link obstructive sleep apnea
1
to proatherosclerotic risk factors, including insulin resistance,
2
dyslipidemia, hypertension,
3
and inflammation.
4
Obesity and obstructive sleep apnea are strongly associated.
5
–
8
Like obstructive sleep apnea, obesity is linked to insulin resistance,
6
dyslipidemia,
9
hypertension,
9
,
10
and inflammation.
10
However, the relative causal roles that obstructive sleep apnea and obesity play in these abnormalities is unclear.
6
,
11
,
12
The interrelationships between obesity and obstructive sleep apnea are complex and bidirectional, and they cannot be confidently discerned in observational studies. Randomized trials have shown the beneficial effects of weight loss on cardiovascular risk . . .
Standard therapy for an enhancing renal mass is surgical. However, operative treatment may not be plausible in all clinical circumstances. Data on the natural history of untreated enhancing renal ...lesions is limited but could serve as a decision making resource for patients and physicians. We examined available data on the natural history of observed solid renal masses.
A Medline review of the literature was performed from 1966 to the present regarding untreated, observed, localized solid renal masses. To these data we added our institutional experience with a total of 61 lesions observed in 49 patients for a minimum of 1 year. Variables examined were initial lesion size at presentation, growth rate, duration of followup, pathological findings and progression to metastatic disease. Overall weighted mean estimates were calculated for lesion size at presentation, growth rate and followup based upon combining single institutional series with complete information.
We identified 10 reports from 9 single institutional series in the world literature regarding the natural history of untreated solid localized renal lesions. The series included 6 to 40 patients (mean 25) with a mean followup of 30 months (range 25 to 39). When combined with our institutional data, a total of 286 lesions were analyzed, of which 234 could be included in the meta-analysis. Mean lesion size at presentation was 2.60 cm (median 2.48, range 1.73 to 4.08). Meta-analysis revealed a mean growth rate of 0.28 cm yearly (median 0.28, range 0.09 to 0.86) at a mean followup of 34 months (median 32, range 26 to 39) in all series combined. Pathological confirmation was available in 46% of the cases (131 of 286) and it confirmed 92% (120 of 131) as RCC variants. Evaluable data in this subset of confirmed RCC demonstrated a mean growth rate of 0.40 cm yearly (median 0.35, range 0.42 to 1.6). Lesion size at presentation did not predict the overall growth rate (p = 0.46). Progression to metastatic disease was identified in only 1% of lesions (3 of 286) during followup.
The majority of small enhancing renal masses grow at a slow rate when observed. Although metastatic and cancer specific death are low, serial radiographic data alone are insufficient to predict the true natural history of these lesions. Therefore, physicians and patients assume a calculated risk when following these tumors. Basic biological data are needed to assess the natural history of untreated renal masses.
The role of microglia in the pathophysiology of injury to the developing brain has been extensively studied. In children under the age of 4 who have sustained a traumatic brain injury (TBI), markers ...of microglial/macrophage activation were increased in the cerebrospinal fluid and were associated with worse neurologic outcome. Minocycline is an antibiotic that decreases microglial/macrophage activation following hypoxic-ischemia in neonatal rodents and TBI in adult rodents thereby reducing neurodegeneration and behavioral deficits. In study 1, 11-day-old rats received an impact to the intact skull and were treated for 3days with minocycline. Immediately following termination of minocycline administration, microglial reactivity was reduced in the cortex and hippocampus (p<0.001) and was accompanied by an increase in the number of fluoro-Jade B profiles (p<0.001) suggestive of a reduced clearance of degenerating cells; however, this effect was not sustained at 7days post-injury. Although microglial reactivity was reduced in the white matter tracts (p<0.001), minocycline treatment did not reduce axonal injury or degeneration. In the thalamus, minocycline treatment did not affect microglial reactivity, axonal injury and degeneration, and neurodegeneration. Injury-induced spatial learning and memory deficits were also not affected by minocycline. In study 2, to test whether extended dosing of minocycline may be necessary to reduce the ongoing pathologic alterations, a separate group of animals received minocycline for 9days. Immediately following termination of treatment, microglial reactivity and neurodegeneration in all regions examined were exacerbated in minocycline-treated brain-injured animals compared to brain-injured animals that received vehicle (p<0.001), an effect that was only sustained in the cortex and hippocampus up to 15days post-injury (p<0.001). Whereas injury-induced spatial learning deficits remained unaffected by minocycline treatment, memory deficits appeared to be significantly worse (p<0.05). Sex had minimal effects on either injury-induced alterations or the efficacy of minocycline treatment. Collectively, these data demonstrate the differential effects of minocycline in the immature brain following impact trauma and suggest that minocycline may not be an effective therapeutic strategy for TBI in the immature brain.
•Minocycline administration for 3d after TBI in the neonate rat reduced microglial activation but exacerbated neurodegeneration•Minocycline administration for 3d after TBI failed to attenuate spatial learning and memory deficits•Minocycline administration for 10d after TBI worsened microglial activation and neurodegeneration•Minocycline administration for 10d after TBI did not attenuate spatial learning deficits and exacerbated memory deficits•The effects of minocycline administration was not influenced by the sex of the brain-injured animal
Background
To study national trends in the mastectomy rate for treatment of early stage breast cancer.
Methods
We analyzed data from the Surveillance, Epidemiology, and End Results database, ...including 256,081 women diagnosed with T1–2 N0–3 M0 breast cancer from 2000 to 2008. We evaluated therapeutic mastectomy rates by the year of diagnosis and performed a multivariable logistic regression analyses to determine predictors of mastectomy as the treatment choice.
Results
The proportion of women treated with mastectomy decreased from 40.1 to 35.6 % between 2000 and 2005. Subsequently, the mastectomy rate increased to 38.4 % in 2008 (
p
< 0.0001). Simple logistic regression models demonstrated that mastectomy rates between 2005 and 2008 were moderated by age (
p
< 0.0001), marital status (
p
= 0.0230), and geographic location (
p
< 0.0001). Multivariate logistic regression analysis found that age, race, marital status, geographic location, involvement of multiple regions of the breast, lobular histology, increasing T stage, lymph node positivity, increasing grade, and negative hormone receptor status were independent predictors of mastectomy. Additionally, multivariate analysis confirmed that women diagnosed in 2008 were more likely to undergo mastectomy than women diagnosed in 2005 (odds ratio 1.17, 95 % confidence interval 1.13 to 1.21,
p
< 0.0001).
Conclusions
There is evidence of a reversal in the previously declining national mastectomy rates, with the mastectomy rate reaching a nadir in 2005 and subsequently rising. Further follow-up to confirm this trend and investigation to determine the underlying cause of this trend and its effect on outcomes may be warranted.
The Laser Interferometer Gravitational Wave Observatory (LIGO) and Virgo Collaboration’s Observing Run 3 has demanded the development of widely-applicable tools for gravitational wave follow-up. ...These tools must address the main challenges of the multi-messenger era, namely covering large localisation regions and quickly identifying decaying transients. To address these challenges, we present a public web interface to assist astronomers in conducting galaxy-targeted follow-up of gravitational wave events by offering a fast and public list of targets post-gravitational wave trigger. After a gravitational wave trigger, the back-end galaxy retrieval algorithm identifies and scores galaxies based on the LIGO and Virgo computed probabilities and properties of the galaxies taken from the Galaxy List for the Advanced Detector Era V2 galaxy catalogue. Within minutes, the user can retrieve, download, and limit ranked galaxy lists from the web application. The algorithm and website have been tested on past gravitational wave events, and execution times have been analysed. The algorithm is being triggered automatically during Observing Run 3 and its features will be extended if needed. The web application was developed using the Python based
Flask
web framework.
Rural disparities in age-adjusted mortality are growing in the United States. While socioeconomic variables have been found to explain significant variation in life expectancy across US counties, ...previous research has not examined the role of socioeconomic variables in explaining rural mortality disparities. The purpose of this study was to quantify the rural mortality disparity after controlling for socioeconomic variables.
Recursive partitioning, or tree regression, was used to fit models predicting premature mortality across counties in the United States, adjusted for age, median income, and percent in poverty in 4 time periods (from 2004 to 2012) with and without inclusion of an urban-rural variable.
We found median income and percent in poverty explained about 50% of the variation in age-adjusted premature mortality rates across US counties in each of the four time periods. After controlling for these socioeconomic variables, rural mortality disparities largely disappeared, explaining less than 2% of the variance in premature mortality.
Addressing poverty and other socioeconomic issues should be a priority to improve health in rural communities. Interventions designed to target social determinants of health in rural areas are needed to address the growing rural mortality disparity that is largely explained by measures of poverty and income. Researchers examining rural health disparities should routinely include socioeconomic variables in their analyses.
ABSTRACT Using observations of the INTErnational Gamma-Ray Astrophysics Laboratory (INTEGRAL), we place upper limits on the gamma-ray and hard X-ray prompt emission associated with the gravitational ...wave event GW150914, which was discovered by the LIGO/Virgo Collaboration. The omnidirectional view of the INTEGRAL/SPI-ACS has allowed us to constrain the fraction of energy emitted in the hard X-ray electromagnetic component for the full high-probability sky region of LIGO triggers. Our upper limits on the hard X-ray fluence at the time of the event range from erg cm−2 to erg cm−2 in the 75 keV-2 MeV energy range for typical spectral models. Our results constrain the ratio of the energy promptly released in gamma-rays in the direction of the observer to the gravitational wave energy E E . We discuss the implication of gamma-ray limits for the characteristics of the gravitational wave source, based on the available predictions for prompt electromagnetic emission.
To determine the relationship, in patients with adenocarcinoma of the colon, between survival and the number of lymph nodes analyzed from surgical specimens.
Intergroup Trial INT-0089 is a mature ...trial of adjuvant chemotherapy for high-risk patients with stage II and stage III colon cancer. We performed a secondary analysis of this group with overall survival (OS) as the main end point. Cause-specific survival (CSS) and disease-free survival were secondary end points. Rates for these outcome measures were estimated using Kaplan-Meier methodology. Log-rank test was used to compare overall curves, and Cox proportional hazards regression was used to multivariately assess predictors of outcome.
The median number of lymph nodes removed at colectomy was 11 (range, one to 87). Of the 3411 assessable patients, 648 had no evidence of lymph node metastasis. Multivariate analyses were performed on the node-positive and node-negative groups separately to ascertain the effect of lymph node removal. Survival decreased with increasing number of lymph node involvement (P =.0001 for all three survival end points). After controlling for the number of nodes involved, survival increased as more nodes were analyzed (P =.0001 for all three end points). Even when no nodes were involved, OS and CSS improved as more lymph nodes were analyzed (P =.0005 and P =.007, respectively).
The number of lymph nodes analyzed for staging colon cancers is, itself, a prognostic variable on outcome. The impact of this variable is such that it may be an important variable to include in evaluating future trials.
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