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Background: Atrial fibrillation is the most common complication after cardiac surgery and is associated with extended in-hospital stay and increased adverse outcomes, including death and stroke. Pericardial effusion is common after cardiac surgery and can trigger atrial fibrillation. We tested the hypothesis that posterior left pericardiotomy, a surgical manoeuvre that drains the pericardial space into the left pleural cavity, might reduce the incidence of atrial fibrillation after cardiac surgery. Methods: In this adaptive, randomised, controlled trial, we recruited adult patients (aged ≥18 years) undergoing elective interventions on the coronary arteries, aortic valve, or ascending aorta, or a combination of these, performed by members of the Department of Cardiothoracic Surgery from Weill Cornell Medicine at the New York Presbyterian Hospital in New York, NY, USA. Patients were eligible if they had no history of atrial fibrillation or other arrhythmias or contraindications to the experimental intervention. Eligible patients were randomly assigned (1:1), stratified by CHA2DS2-VASc score and using a mixed-block randomisation approach (block sizes of 4, 6, and 8), to posterior left pericardiotomy or no intervention. Patients and assessors were blinded to treatment assignment. Patients were followed up until 30 days after hospital discharge. The primary outcome was the incidence of atrial fibrillation during postoperative in-hospital stay, which was assessed in the intention-to-treat (ITT) population. Safety was assessed in the as-treated population. This study is registered with ClinicalTrials.gov, NCT02875405, and is now complete. Findings: Between Sept 18, 2017, and Aug 2, 2021, 3601 patients were screened and 420 were included and randomly assigned to the posterior left pericardiotomy group (n=212) or the no intervention group (n=208; ITT population). The median age was 61·0 years (IQR 53·0–70·0), 102 (24%) patients were female, and 318 (76%) were male, with a me

Long-period variability in luminous red giants has several promising applications, all of which require models able to accurately predict pulsation periods. Linear pulsation models have proven successful in reproducing the observed periods of overtone modes in evolved red giants, but they fail to accurately predict their fundamental mode (FM) periods. Here, we use a 1D hydrodynamic code to investigate the long-period variability of M-type asymptotic giant branch stars in the non-linear regime. We examine the period and stability of low-order radial pulsation modes as a function of mass and radius, and find overtone mode periods in complete agreement with predictions from linear pulsation models. In contrast, non-linear models predict an earlier onset of dominant FM pulsation, and shorter periods at large radii. Both features lead to a substantially better agreement with observations that we verify against OGLE and Gaia data for the Magellanic Clouds. We provide simple analytical relations describing the non-linear FM period-mass-radius relation. Differences with respect to linear predictions originate from the readjustment of the envelope structure induced by large-amplitude pulsation. We investigate the impact of turbulent viscosity on linear and non-linear pulsation, and probe possible effects of varying metallicity and carbon abundance.

We present a technique to fit the stellar components of the Galaxy by comparing Hess Diagrams (HDs) generated from TRILEGAL models to real data. We apply this technique, which we call MWFITTING, to photometric data from the first 3 yr of the Dark Energy Survey (DES). After removing regions containing known resolved stellar systems such as globular clusters, dwarf galaxies, nearby galaxies, the Large Magellanic Cloud, and the Sagittarius Stream, our main sample spans a total area of ~2300 deg2. We further explore a smaller subset (~1300 deg2) that excludes all regions with known stellar streams and stellar overdensities. Validation tests on synthetic data possessing similar properties to the DES data show that the method is able to recover input parameters with a precision better than 3 per cent. We fit the DES data with an exponential thick disc model and an oblate double power-law halo model. We find that the best-fitting thick disc model has radial and vertical scale heights of 2.67 ± 0.09 kpc and 925 ± 40 pc, respectively. The stellar halo is fit with a broken power-law density profile with an oblateness of 0.75 ± 0.01, an inner index of 1.82 ± 0.08, an outer index of 4.14 ± 0.05, and a break at 18.52 ± 0.27 kpc from the Galactic centre. Several previously discovered stellar overdensities are recovered in the residual stellar density map, showing the reliability of MWFITTING in determining the Galactic components. Simulations made with the best-fitting parameters are a promising way to predict Milky Way star counts for surveys such as the LSST and Euclid.

Importance: Changes in evidence-based practice and guideline recommendations depend on high-quality randomized clinical trials (RCTs). Commercial device and pharmaceutical manufacturers are frequently involved in the funding, design, conduct, and reporting of trials, the implications of which have not been recently analyzed. Objective: To evaluate the design, outcomes, and reporting of contemporary randomized clinical trials of invasive cardiovascular interventions and their association with the funding source. Design, Setting, and Participants: This cross-sectional study analyzed published RCTs between January 1, 2008, to May 31, 2019. The trials included those involving coronary, vascular and structural interventional cardiology, and vascular and cardiac surgical procedures. Main Outcomes and Measures: We assessed (1) trial characteristics, (2) finding of a statistically significant difference in the primary end point favoring the experimental intervention, (3) reporting of implied treatment advantage in trials without significant differences in primary end point, (4) existence of major discrepancies between registered and published primary outcomes, (5) number of patients whose outcomes would need to switch from a nonevent to an event to convert a significant difference in primary end point to nonsignificant, and (6) association with funding source. Results: Of the 216 RCTs analyzed, 115 (53.2%) reported having commercial sponsorship. Most trials had 80% power to detect an estimated treatment effect of 30%, and 128 trials (59.3%) used composite primary end points. The median (interquartile range [IQR]) sample size was 502 (204-1702) patients, and the median (IQR) follow-up duration was 12 (1.0-14.4) months. Overall, 123 trials (57.0%) reported a statistically significant difference in the primary outcome favoring the experimental intervention; reporting strategies that implied an advantage were identified in 55 (65.5%) of 84 trials that reported nonsignificant di

Analyses of data from spectroscopic and astrometric surveys have led to conflicting results concerning the vertical characteristics of the Milky Way. Ages are often used to provide clarity, but typical uncertainties of >40 per cent from photometry restrict the validity of the inferences made. Using the Kepler APOKASC sample for context, we explore the global population trends of two K2 campaign fields (3 and 6), which extend further vertically out of the Galactic plane than APOKASC. We analyse the properties of red giant stars utilizing three asteroseismic data analysis methods to cross-check and validate detections. The Bayesian inference tool PARAM is used to determine the stellar masses, radii, and ages. Evidence of a pronounced red giant branch bump and an [a/Fe] dependence on the position of the red clump is observed from the K2 fields radius distribution. Two peaks in the age distribution centred at similar to 5 and similar to 12 Gyr are found using a sample with sigma(age) < 35 per cent. In comparison with Kepler, we find the older peak to be more prominent for K2. This age bimodality is also observed based on a chemical selection of low-[alpha/Fe] (<= 0.1) and high-[alpha/Fe] (>0.1) stars. As a function of vertical distance from the Galactic mid-plane (|Z|), the age distribution shows a transition from a young to old stellar population with increasing |Z| for the K2 fields. Further coverage of campaign targets with high-resolution spectroscopy is required to increase the yield of precise ages achievable with asteroseismology.

The thermally pulsing asymptotic giant branch (TP-AGB) experienced by low- and intermediate-mass stars is one of the most uncertain phases of stellar evolution and the models need to be calibrated with the aid of observations. To this purpose, we couple high-quality observations of resolved stars in the Small Magellanic Cloud (SMC) with detailed stellar population synthesis simulations computed with the TRILEGAL code. The strength of our approach relies on the detailed spatially resolved star formation history of the SMC, derived from the deep near-infrared photometry of the VISTA survey of the Magellanic Clouds, as well as on the capability to quickly and accurately explore a wide variety of parameters and effects with the COLIBRI code for the TP-AGB evolution. Adopting a well-characterized set of observations - star counts and luminosity functions - we set up a calibration cycle along which we iteratively change a few key parameters of the TP-AGB models until we eventually reach a good fit to the observations. Our work leads to identify two best-fitting models that mainly differ in the efficiencies of the third dredge-up and mass-loss in TP-AGB stars with initial masses larger than about 3 M⊙. On the basis of these calibrated models, we provide a full characterization of the TP-AGB stellar population in the SMC in terms of stellar parameters (initial masses, C/O ratios, carbon excess, mass-loss rates). Extensive tables of isochrones including these improved models are publicly available.