Background and purpose
Trigeminal neuralgia (TN) is an extremely painful condition which can be difficult to diagnose and treat. In Europe, TN patients are managed by many different specialities. ...Therefore, there is a great need for comprehensive European guidelines for the management of TN. The European Academy of Neurology asked an expert panel to develop recommendations for a series of questions that are essential for daily clinical management of patients with TN.
Methods
A systematic review of the literature was performed and recommendations was developed based on GRADE, where feasible; if not, a good practice statement was given.
Results
The use of the most recent classification system is recommended, which diagnoses TN as primary TN, either classical or idiopathic depending on the degree of neurovascular contact, or as secondary TN caused by pathology other than neurovascular contact. Magnetic resonance imaging (MRI), using a combination of three high‐resolution sequences, should be performed as part of the work‐up in TN patients, because no clinical characteristics can exclude secondary TN. If MRI is not possible, trigeminal reflexes can be used. Neurovascular contact plays an important role in primary TN, but demonstration of a neurovascular contact should not be used to confirm the diagnosis of TN. Rather, it may help to decide if and when a patient should be referred for microvascular decompression. In acute exacerbations of pain, intravenous infusion of fosphenytoin or lidocaine can be used. For long‐term treatment, carbamazepine or oxcarbazepine are recommended as drugs of first choice. Lamotrigine, gabapentin, botulinum toxin type A, pregabalin, baclofen and phenytoin may be used either alone or as add‐on therapy. It is recommended that patients should be offered surgery if pain is not sufficiently controlled medically or if medical treatment is poorly tolerated. Microvascular decompression is recommended as first‐line surgery in patients with classical TN. No recommendation can be given for choice between any neuroablative treatments or between them and microvascular decompression in patients with idiopathic TN. Neuroablative treatments should be the preferred choice if MRI does not demonstrate any neurovascular contact. Treatment for patients with secondary TN should in general follow the same principles as for primary TN. In addition to medical and surgical management, it is recommended that patients are offered psychological and nursing support.
Conclusions
Compared with previous TN guidelines, there are important changes regarding diagnosis and imaging. These allow better characterization of patients and help in decision making regarding the planning of medical and surgical management. Recommendations on pharmacological and surgical management have been updated. There is a great need for future research on all aspects of TN, including pathophysiology and management.
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Kepler's first major discoveries are two hot (T > 10,000 K) small-radius objects orbiting stars in its field. A viable hypothesis is that these are the cores of stars that have each been eroded or ...disrupted by a companion star. The companion, which is the star monitored today, is likely to have gained mass from its now-defunct partner and can be considered to be a blue straggler. KOI-81 is almost certainly the product of stable mass transfer; KOI-74 may be as well, or it may be the first clear example of a blue straggler created through three-body interactions. We show that mass-transfer binaries are common enough that Kepler should discover ~1000 white dwarfs orbiting main-sequence stars. Most of these, like KOI-74 and KOI-81, will be discovered through transits, but many will be discovered through a combination of gravitational lensing and transits, while lensing will dominate for a subset. In fact, some events caused by white dwarfs will have the appearance of 'anti-transits'--i.e., short-lived enhancements in the amount of light received from the monitored star. Lensing and other mass-measurement methods provide a way to distinguish white dwarf binaries from planetary systems. This is important for the success of Kepler's primary mission, in light of the fact that white dwarf radii are similar to the radii of terrestrial planets, and that some white dwarfs will have orbital periods that place them in the habitable zones of their stellar companions. By identifying transiting and/or lensing white dwarfs, Kepler will conduct pioneering studies of white dwarfs and of the end states of mass transfer. It may also identify orbiting neutron stars or black holes. The calculations inspired by the discovery of KOI-74 and KOI-81 have implications for ground-based wide-field surveys as well as for future space-based surveys.
We describe the simulated data sample for the Photometric Large Synoptic Survey Telescope (LSST) Astronomical Time Series Classification Challenge (PLAsTiCC), a publicly available challenge to ...classify transient and variable events that will be observed by the LSST, a new facility expected to start in the early 2020s. The challenge was hosted by Kaggle, ran from 2018 September 28 to December 17, and included 1094 teams competing for prizes. Here we provide details of the 18 transient and variable source models, which were not revealed until after the challenge, and release the model libraries at https://doi.org/10.5281/zenodo.2612896. We describe the LSST Operations Simulator used to predict realistic observing conditions, and we describe the publicly available SNANA simulation code used to transform the models into observed fluxes and uncertainties in the LSST passbands (ugrizy). Although PLAsTiCC has finished, the publicly available models and simulation tools are being used within the astronomy community to further improve classification, and to study contamination in photometrically identified samples of SN Ia used to measure properties of dark energy. Our simulation framework will continue serving as a platform to improve the PLAsTiCC models, and to develop new models.
ABSTRACT
Close-orbit binaries consisting of two compact objects are a centre of attention because of the detection of gravitational-radiation-induced mergers. The creation of close, compact-object ...binaries involves physical processes that are not yet well understood; there are open questions about the manner in which two compact objects come to be close enough to merge within a Hubble time. Here, we explore an important, and likely common physical process: mass transfer from a third star in a wider, hierarchical orbit. Mass added to the close binary’s components can reduce the time to merger and can even change the nature of an accretor, transforming a white dwarf to a neutron star and/or a neutron star to a black hole. Some accreting WDs in close binaries may even explode as Type Ia supernovae. Given the ubiquity of higher order multiples, the evolutionary channels we lay out may be important pathways to gravitational mergers, including Type Ia supernovae. Fortunately, these pathways also lead to testable predictions.
A
bstract
We present the first complete next-to-next-to-leading order analysis of the Standard Model Higgs potential. We computed the two-loop QCD and Yukawa corrections to the relation between the ...Higgs quartic coupling (
λ
) and the Higgs mass (
M
h
), reducing the theoretical uncertainty in the determination of the critical value of
M
h
for vacuum stability to 1 GeV. While
λ
at the Planck scale is remarkably close to zero, absolute stability of the Higgs potential is excluded at 98 % C.L. for
M
h
<
126 GeV. Possible consequences of the near vanishing of
λ
at the Planck scale, including speculations about the role of the Higgs field during inflation, are discussed.
In a canonical model, the progenitors of Type Ia supernovae (SNe Ia) are accreting, nuclear-burning white dwarfs (NBWDs), which explode when the white dwarf reaches the Chandrasekhar mass, M{sub C} . ...Such massive NBWDs are hot (kT {approx} 100 eV), luminous (L {approx} 10{sup 38} erg s{sup -1}), and are potentially observable as luminous supersoft X-ray sources (SSSs). During the past several years, surveys for soft X-ray sources in external galaxies have been conducted. This paper shows that the results falsify the hypothesis that a large fraction of progenitors are NBWDs which are presently observable as SSSs. The data also place limits on sub-M{sub C} models. While SN Ia progenitors may pass through one or more phases of SSS activity, these phases are far shorter than the time needed to accrete most of the matter that brings them close to M{sub C} .
ABSTRACT Globular clusters are ancient stellar populations in compact dense ellipsoids. There is no star formation and there are no core-collapse supernovae, but several lines of evidence suggest ...that globular clusters are rich in planets. If so, and if advanced civilizations can develop there, then the distances between these civilizations and other stars would be far smaller than typical distances between stars in the Galactic disk, facilitating interstellar communication and travel. The potent combination of long-term stability and high stellar densities provides a globular cluster opportunity. Yet the very proximity that promotes interstellar travel also brings danger, as stellar interactions can destroy planetary systems. We find, however, that large portions of many globular clusters are "sweet spots," where habitable-zone planetary orbits are stable for long times. Globular clusters in our own and other galaxies are, therefore, among the best targets for searches for extraterrestrial intelligence (SETI). We use the Drake equation to compare the likelihood of advanced civilizations in globular clusters to that in the Galactic disk. We also consider free-floating planets, since wide-orbit planets can be ejected to travel through the cluster. Civilizations spawned in globular clusters may be able to establish self-sustaining outposts, reducing the probability that a single catastrophic event will destroy the civilization. Although individual civilizations may follow different evolutionary paths, or even be destroyed, the cluster may continue to host advanced civilizations once a small number have jumped across interstellar space. Civilizations residing in globular clusters could therefore, in a sense, be immortal.
In the single-degenerate scenario for Type Ia supernovae (SNe Ia), a white dwarf (WD) must gain a significant amount of matter from a companion star. Because the accreted mass carries angular ...momentum, the WD is likely to achieve fast spin periods, which can increase the critical mass, M crit, needed for explosion. When M crit is higher than the maximum mass achieved by the WD, the central regions of the WD must spin down before it can explode. This introduces super-Chandrasekhar single-degenerate explosions, and a delay between the completion of mass gain and the time of the explosion. Matter ejected from the binary during mass transfer therefore has a chance to become diffuse, and the explosion occurs in a medium with a density similar to that of typical regions of the interstellar medium. Also, either by the end of the WD's mass increase or else by the time of explosion, the donor may exhaust its stellar envelope and become a WD. This alters, generally diminishing, explosion signatures related to the donor star. Nevertheless, the spin-up/spin-down model is highly predictive. Prior to explosion, progenitors can be super-M Ch WDs in either wide binaries with WD companions or cataclysmic variables. These systems can be discovered and studied through wide-field surveys. Post-explosion, the spin-up/spin-down model predicts a population of fast-moving WDs, low-mass stars, and even brown dwarfs. In addition, the spin-up/spin-down model provides a paradigm which may be able to explain both the similarities and the diversity observed among SNe Ia.
In order for a white dwarf (WD) to achieve the Chandrasekhar mass, M{sub C} , and explode as a Type Ia supernova (SNIa), it must interact with another star, either accreting matter from or merging ...with it. The failure to identify the class or classes of binaries which produce SNeIa is the long-standing 'progenitor problem'. Its solution is required if we are to utilize the full potential of SNeIa to elucidate basic cosmological and physical principles. In single-degenerate models, a WD accretes and burns matter at high rates. Nuclear-burning white dwarfs (NBWDs) with mass close to M{sub C} are hot and luminous, potentially detectable as supersoft X-ray sources (SSSs). In previous work, we showed that >90%-99% of the required number of progenitors do not appear as SSSs during most of the crucial phase of mass increase. The obvious implication might be that double-degenerate binaries form the main class of progenitors. We show in this paper, however, that many binaries that later become double degenerates must pass through a long-lived NBWD phase during which they are potentially detectable as SSSs. The paucity of SSSs is therefore not a strong argument in favor of double-degenerate models. Those NBWDs that are the progenitors of double-degenerate binaries are likely to appear as symbiotic binaries for intervals >10{sup 6} years. In fact, symbiotic pre-double-degenerates should be common, whether or not the WDs eventually produce SNeIa. The key to solving the Type Ia progenitor problem lies in understanding the appearance of NBWDs. Most of them do not appear as SSSs most of the time. We therefore consider the evolution of NBWDs to address the question of what their appearance may be and how we can hope to detect them.
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