ABSTRACT
We present Gemini-S and Spitzer-IRAC optical-through-near-IR observations in the field of the SPT2349-56 proto-cluster at z = 4.3. We detect optical/IR counterparts for only 9 of the 14 ...submillimetre galaxies (SMGs) previously identified by ALMA in the core of SPT2349-56. In addition, we detect four z ∼ 4 Lyman-break galaxies (LBGs) in the 30 arcsec-diameter region surrounding this proto-cluster core. Three of the four LBGs are new systems, while one appears to be a counterpart of one of the nine observed SMGs. We identify a candidate brightest cluster galaxy (BCG) with a stellar mass of $(3.2^{+2.3}_{-1.4})\times 10^{11}$ M⊙. The stellar masses of the eight other SMGs place them on, above, and below the main sequence of star formation at z ≈ 4.5. The cumulative stellar mass for the SPT2349-56 core is at least (12.2 ± 2.8) × 1011 M⊙, a sizeable fraction of the stellar mass in local BCGs, and close to the universal baryon fraction (0.19) relative to the virial mass of the core (1013 M⊙). As all 14 of these SMGs are destined to quickly merge, we conclude that the proto-cluster core has already developed a significant stellar mass at this early stage, comparable to z = 1 BCGs. Importantly, we also find that the SPT2349-56 core structure would be difficult to uncover in optical surveys, with none of the ALMA sources being easily identifiable or constrained through g, r, and i colour selection in deep optical surveys and only a modest overdensity of LBGs over the more extended structure. SPT2349-56 therefore represents a truly dust-obscured phase of a massive cluster core under formation.
We report results from the preliminary trials of Colibri, a dedicated fast-photometry array for the detection of small Kuiper Belt objects (KBOs) through serendipitous stellar occultations. Colibri’s ...novel data processing pipeline analyzed 4000 star hours with two overlapping-field EMCCD cameras, detecting no KBOs and one false positive occultation event in a high ecliptic latitude field. No occultations would be expected at these latitudes, allowing these results to provide a control sample for the upcoming main Colibri campaign. The empirical false positive rate found by the processing pipeline is consistent with the 0.002% simulation-determined false positive rate. We also describe Colibri’s software design, kernel sets for modeling stellar occultations, and method for retrieving occultation parameters from noisy diffraction curves. Colibri’s main campaign will begin in mid-2018, operating at a 40 Hz sampling rate.
•Hazardous alcohol use is highly prevalent among transgender populations.•There is confusion about the roles of physical sex and social gender.•We recommend ways to improve alcohol studies with ...transgender populations.
There is a recent and growing research literature on alcohol use and related harms among transgender and other gender minority populations; however, current definitions and measures of hazardous drinking do not consider the complexity of physiological sex characteristics and socially constructed gender, raising doubts regarding their validity, applicability, and use with these populations. To address this, we reviewed current research on alcohol-related outcomes in transgender populations and critically summarized key issues for consideration in future research.
We conducted a systematic review of transgender alcohol research in English language, peer-reviewed journals, published 1990–2017, and extracted key details (e.g., sample composition, alcohol measures, results).
Forty-four studies met all inclusion criteria for the review, the majority of which were conducted in the United States. The prevalence of hazardous drinking was high; however, estimates varied widely across studies. We noted frequent methodological weaknesses, including few attempts to differentiate sex and gender, poor attention to appropriate definitions of hazardous drinking, and reliance on cross-sectional study designs and non-probability sampling methods.
Given findings that suggest high need for ongoing public health attention, we offer recommendations to improve future alcohol studies with transgender and other gender minority populations, such as being explicit as to whether and how sex and/or gender are operationalized and relevant for the research question, expanding the repertoire of alcohol measures to include those not contingent on sex or gender, testing the psychometric performance of established screening instruments with transgender populations, and shifting from descriptive to analytic study designs.
Abstract Purpose To determine the safety and efficacy of enteral naloxone for the treatment of opioid-induced constipation in the medical intensive care unit (MICU). Materials and Methods This ...descriptive study included patients aged 18 to 89 years admitted to the MICU between July 1, 2007, and June 30, 2012, who received scheduled opioids and at least 1 dose of enteral naloxone. All data were obtained from electronic charting systems. Efficacy was assessed by evaluating time to bowel movement (BM), number of naloxone doses until BM, and ability to tolerate tube feeds after receipt of enteral naloxone. Safety was assessed by comparing opioid requirements, heart rates, and systolic blood pressures before and during naloxone treatment. Results Fifteen of the 16 patients included in the final analysis passed BMs during the study period. The median time to BM was 24.4 hours. The median number of naloxone doses received prior to passing a BM was 3. Seventy-eight percent of patients who were not receiving tube feeds at the time of naloxone administration received continuous tube feeds after naloxone initiation. No adverse effects associated with use of enteral naloxone were noted. Conclusions Enteral naloxone appears safe for the treatment of opioid-induced constipation in the MICU. Enteral naloxone may be effective in treating opioid-induced constipation; however, further studies are warranted.
This retrospective cohort study investigated the impact and predictive factors of methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization in 180 patients admitted to a medical intensive ...care unit between July 2009 and June 2010. No significant associations between MRSA nasal colonization and the incidence of health care–associated multidrug-resistant–related infections, intensive care unit length of stay, or inpatient mortality were found. Significant risk factors for MRSA colonization included previous medical history of diabetes mellitus and congestive heart failure.
Objective To describe rFVIIa dosing and clinical outcomes in cardiovascular surgery patients with refractory bleeding. Design Retrospective chart review of patients receiving rFVIIa from January 1, ...2004 to September 30, 2005, in the cardiovascular surgery setting. Setting Tertiary care, private teaching hospital. Participants Ninety-three patients who received rFVIIa after cardiovascular surgery for the management of refractory bleeding. Interventions None. Measures and Main Results Patients received an average of 7.6 ± 6.8 units of red blood cells (RBCs) before rFVIIa dosing (mean dose, 56.2 ± 26.5 μg/kg). Median and 25th and 75th quartile blood product consumption was significantly reduced 6 hours after rFVIIa versus 6 hours before (RBCs, −3 units, −1, −7; cryoprecipitate, −7.5 units 0, −20; platelet, −3 units −1, −4; fresh frozen plasma, −4 units −2, −7). Repeated rFVIIa dosing occurred in 10% of patients, with 8 (8.6%) and 2 (2.25%) patients receiving second and third doses, respectively. Subgroup analysis of each rFVIIa dosing quartile >30 μg/kg showed a significant reduction in RBCs; however, no significant differences were found in the magnitude of RBC reduction or percent of patients requiring massive transfusion among the quartiles. No adverse thrombotic episodes were noted, and the observed mortality (22.6%) was not attributed to rFVIIa therapy. Conclusions rFVIIa effectively reduces blood product use in cardiovascular surgery patients having massive blood loss. Although the optimal dose of rFVIIa for use in cardiovascular surgery remains undetermined, these data provide evidence that dosing regimens using <90 μg/kg are effective in this population and may provide guidance for centers establishing standardized protocols for rFVIIa use in cardiovascular surgery patients.
The issues regarding the discontinuation and reinstitution of long-term therapies, including cardiovascular agents, anticoagulants and antiplatelet agents, central nervous system agents, and herbal ...medicines, in the perioperative period are discussed.
It is estimated that one fourth of all patients undergoing a surgical procedure are taking long-term medications. The issues surrounding the decision to discontinue such medications before surgery and when to reinstitute them are complex. In the preoperative period, it is important to avoid the use of medications that may negatively interact with anesthetic agents. Postoperatively, the concern shifts toward avoiding withdrawal symptoms that may develop and possible progression of the underlying disease if the medications are not restarted in a timely fashion. The potential for decreased gastrointestinal motility in the postoperative patient, which may reduce the efficacy of oral medications, must also be considered. Antihypertensive medications may cause cardiovascular complications, such as hypotension or myocardial ischemia. Psychoactive medications may cause prolonged sedation and withdrawal symptoms may develop. Antithrombotic agents may increase the risks of bleeding during surgery. Several herbal medicines may cause a combination of these effects.
The decision to withhold and restart medications should be based on available clinical data and expert opinion. Health care professionals should exercise diligence in obtaining an accurate medication history on all preoperative patients and in reviewing the medications in the postoperative orders.
Sepsis in older adults has many challenges that affect rate of septic diagnosis, treatment, and monitoring parameters. Numerous age-related changes and comorbidities contribute to increased risk of ...infections in older adults, but also atypical symptomatology that delays diagnosis. Due to various pharmacokinetic/pharmacodynamic changes in the older adult, medications are absorbed, metabolized, and eliminated at different rates as compared to younger adults, which increases risk of adverse drug reactions due to use of drug therapy needed for sepsis management. This review provides information to aid in diagnosis and offers recommendations for monitoring and treating sepsis in the older adult population.
PDF
