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Introduction: The aim of this systematic review was to investigate whether viscoelastic haemostatic assays (VHAs) offer comparative diagnostic ability of acute traumatic coagulopathy (ATC) compared to the standard laboratory coagulation tests (SLCT). ATC is a complication of major trauma characterized by dysfunctional blood clotting, leading to an increased bleeding risk. Additionally, we aimed to analyse the association of VHA with blood product use and health outcomes. Methods: The search protocol was pre-published and completed on December 2, 2020, assessing manuscripts from 2000 until the present. We searched MEDLINE, Embase, Cochrane Central, BIOSIS, Emcare, CINAHL, and additional online resources and referenced lists. Included were manuscripts that quantitatively reported the detection of ATC using VHAs and SLCTs. A meta-analysis was undertaken including observational studies that reported on patients with injuries to all body regions and results analysed using a random-effects model and reported using pooled odds ratio with 95% confidence intervals (CI). Results: There were 14 observational studies and one randomized control trial involving 2,715 participants that satisfied inclusion criteria. We observed significant heterogeneity in the definitions of ATC, study design, setting, and patient population. Among observational studies that reported on patients with injuries to all body regions, VHAs were associated with higher odds of diagnosing ATC compared to SLCT (pooled OR 2.4; 95% CI: 1.4–4.1). There was inadequate evidence to suggest VHAs were associated with reduced blood product usage or lower mortality. Conclusion: VHAs detected more patients with ATC compared to SLCTs. However, the clinical significance and applicability of this finding remains unknown as translation to management was not adequately reported.

To describe the outcome and complications associated with the use of caudal superficial epigastric axial pattern flaps in dogs and cats.Multicentre retrospective review and descriptive study of clinical records of dogs and cats having undergone caudal superficial epigastric axial pattern flaps between 2007 and 2020. Data retrieved included signalment, aetiology of surgical defect, tumour type, presence/absence of clean surgical margins, presence/absence of post-operative wound infection, use of peri- and post-operative antibiotics, duration of anaesthesia, duration of surgery, presence and duration of hypothermia, presence and duration of hypotension, presence/absence of post-operative surgical drain and length of caudal superficial epigastric axial pattern flap. The incidence of complications and outcomes were documented.Seventy cases met the inclusion criteria; 51 dogs and 19 cats. In dogs, 67% of cases developed complications (59% minor, 8% major) and 33% had uneventful wound healing. In cats, 53% of cases developed complications, (47% minor, 5% major) and 47% had uneventful wound healing. In dogs, the percentage of cases experiencing dehiscence, necrosis, seroma, oedema and post-operative infection was 31%, 29%, 26%, 26% and 16% respectively. In cats, this was 26%, 16%, 11%, 0% and 5% respectively. A good overall outcome was seen in 77% of dogs and 79% of cats. A poor overall outcome was seen in 4% of dogs and 0% of cats.Caudal superficial epigastric axial pattern flaps are traditionally thought more robust than other flaps, yet complication rates remain high, despite a high overall success rate.

Tilletia caries and T. laevis, which are the causal agents of common bunt, as well as T. controversa, which causes dwarf bunt of wheat, threaten especially organic wheat farming. The three closely related fungal species differ in their teliospore morphology and partially in their physiology and infection biology. The gene content as well as intraspecies variation in these species and the genetic basis of their separation is unknown. We sequenced the genome of four T. caries, five T. controversa, and two T. laevis and extended this dataset with five publicly available ones. The genomes of the three species displayed microsynteny with up to 94.3% pairwise aligned regions excluding repetitive regions. The majority of functionally characterized genes involved in pathogenicity, life cycle, and infection of corn smut, Ustilago maydis, were found to be absent or poorly conserved in the draft genomes and the biosynthetic pathway for trimethylamine in Tilletia spp. could be different from bacteria. Overall, 75% of the identified protein-coding genes comprising 84% of the total predicted carbohydrate utilizing enzymes, 72.5% putatively secreted proteins, and 47.4% of effector-like proteins were conserved and shared across all 16 isolates. We predicted nine highly identical secondary metabolite biosynthesis gene clusters comprising in total 62 genes in all species and none were species-specific. Less than 0.1% of the protein-coding genes were species-specific and their function remained mostly unknown. Tilletia controversa had the highest intraspecies genetic variation, followed by T. caries and the lowest in T. laevis. Although the genomes of the three species are very similar, employing 241 single copy genes T. controversa was phylogenetically distinct from T. caries and T. laevis, however these two could not be resolved as individual monophyletic groups. This was in line with the genome-wide number of single nucleotide polymorphisms and small insertions and deletions. Despite the conspicuously different teliospore ornamentation of T. caries and T. laevis, a high degree of genomic identity and scarcity of species-specific genes indicate that the two species could be conspecific.

SS433 is the only Galactic binary system known to persistently accrete at highly super-critical (or hyper-critical) rates, similar to those in tidal disruption events, and likely needed to explain the rapid growth of those very high redshift quasars containing massive SMBHs. Probing the inner regions of SS433 in the X-rays is crucial to understanding this system, and super-critical accretion in general, but is highly challenging due to obscuration by the surrounding wind, driven from the accretion flow. NuSTAR observed SS433 in the hard X-ray band across multiple phases of its 162 day super-orbital precession period. Spectral-timing tools allow us to infer that the hard X-ray emission from the inner regions is likely being scattered towards us by the walls of the wind-cone. By comparing to numerical models, we determine an intrinsic X-ray luminosity of $\ge$ 2$\times$10$^{37}$ erg/s and that, if viewed face on, we would infer an apparent luminosity of $>$ 1$\times$10$^{39}$ erg/s, confirming SS433's long-suspected nature as an ultraluminous X-ray source (ULX). We present the discovery of a narrow, $\sim 100$s lag due to atomic processes occurring in outflowing material travelling at least 0.14-0.29c, which matches absorption lines seen in ULXs and -- in the future -- will allow us to map a super-critical outflow for the first time., 14 pages, 10 figures, accepted for publication in MNRAS

OBJECTIVES: To describe the clinical presentation, management and outcome of cases presenting with intrathoracic wooden skewers originating from the abdominal gastrointestinal tract.MATERIALS AND METHODS: Clinical records of dogs presented and treated for an intrathoracic wooden skewer were reviewed from June to August 2020. Data included signalment, clinical presentation, duration of clinical signs, haematological and biochemical abnormalities, diagnostic imaging findings, surgical procedure, postoperative complications and outcome.RESULTS: Eleven dogs were included in the study. In all cases, the foreign body was identified as a wooden skewer. The most common clinical signs were anorexia/hyporexia (n=7), vomiting/regurgitation (n=7), lethargy (n=6), pyrexia (n=4) and gait abnormalities/lameness (n=3). CT correctly identified a wooden skewer in all cases when performed (n=7). A coeliotomy combined with transdiaphragmatic thoracotomy was performed in six of 11 cases (55%), a coeliotomy combined with median sternotomy in four of 11 cases (36%) and a median sternotomy alone was performed in one case. Foreign bodies penetrated from the stomach (n=10) or the duodenum (n=1). Intrathoracic trauma was most commonly identified to the lungs (n=3) and pericardium (n=3). Complications occurred in three of 11 cases (27%), two minor and one resulting in death. Ten of the 11 cases (91%) survived to discharge. Long-term outcome was available for seven of 11 cases (66%), all of them excellent.CLINICAL SIGNIFICANCE: Despite the challenges of managing wooden skewers penetrating the thoracic cavity from the abdominal gastrointestinal tract, the majority of the patients are stable to undergo diagnostic procedures, surgical exploration and management with low morbidity and excellent short- and long-term prognosis.

Objectives Although physical activity is linked to multiple health outcomes, a majority of Americans do not meet physical activity guidelines, often with precipitous declines among older adults. Marital quality is a less-explored, but important, factor that may influence physical activity, as spouses often influence each other’s health behaviors. Methods We use nationally representative panel data to investigate whether positive and negative dimensions of marital quality influence physical activity, and whether age and gender moderate these relationships. Results We find that both marital support and strain are related to higher odds of more frequent active exercise and walking, pointing to the complex influence of marital quality. Marital support became increasingly important to higher levels of walking frequency as men aged. Discussion This study provides new information on the ways in which both positive and negative dimensions of marital quality may contribute to trajectories of physical activity across the life course.

We discuss the phenomenology of no-scale supergravity (SUGRA), in which the universal scalar mass is zero at the high scale, focussing on the recently updated muon g-2 measurement, and including dark matter and the correct Higgs boson mass. Such no-scale supergravity scenarios arise naturally from string theory and are also inspired by the successful Starobinsky inflation, with a class of minimal models leading to a strict upper bound on the gravitino mass m3/2 < 103 TeV. We perform a Monte Carlo scan over the allowed parameter space, assuming a mixture of pure gravity mediated and universal gaugino masses, using the SPheno package linked to FeynHiggs, MicrOmegas and CheckMate, displaying the results in terms of a Likelihood function. We present results for zero and non-zero trilinear soft parameters, and for different signs of gaugino masses, giving a representative set of benchmark points for each viable region of parameter space. We find that, while no-scale SUGRA can readily satisfy the dark matter and Higgs boson mass requirements, consistent with all other phenomenological constraints, the muon g- 2 measurement may be accommodated only in certain regions of parameter space, close to the LHC excluded regions for light sleptons and charginos., 46 pages 18 figures 16 tables

Abstract The fungal genus Tilletia includes a large number of plant pathogens of Poaceae. Only a few of those cause bunt of wheat, but these species can lead to significant yield losses in crop production worldwide. Due to quarantine regulations and specific disease control using appropriate seed treatments for the different disease agents, it is of high importance to distinguish Tilletia caries and Tilletia laevis as causal agents of common bunt accurately from Tilletia controversa, the causal agent of the dwarf bunt. Several studies have shown that matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS) is a useful tool to differentiate closely related fungal species. The aim of this study was to assess whether MALDI-TOF MS analysis is able to distinguish specimens of the three closely related pathogens T. caries, T. laevis, and T. controversa and whether it may constitute an alternative method to the morphology-based identification or germination tests. Spectral data are available via ProteomeXchange with identifier PXD030401. Spectra-based hierarchical cluster analysis (HCA) and discriminant analysis of principal components (DAPC) of the obtained mass spectra showed two main clusters. One cluster included specimens of T. controversa, whereas the second cluster comprised T. laevis and T. caries specimens. Even though main spectral profiles (MSPs) for species identification are missing, MALDI-TOF MS has proven to be a useful method for distinguishing between T. controversa and the two causal agents of common bunt, using direct analysis of teliospores, but was unable to separate T. caries and T. laevis species. Key points • MALDI-TOF MS was developed to classify Tilletia species causing bunt of wheat. • Best results were achieved when combining HCA and DAPC analysis. • The method resulted in an accuracy of 98.51% testing 67 Tilletia specimens. Graphical abstract

Purpose: To investigate the effect of prophylactic use of SafeSkin films strips applied to the inframammary fold during whole breast or reconstructed breast irradiation to avoid moist desquamation to the inframammary fold. Materials and Methods: Between November 15, 2016 and April 17, 2018, a total of 30 patients were recruited, with 29 patients contributing to analysis, and one patient with bilateral breast cancer. Areas of the breast treatment field not covered by the film were treated with physician's choice of cream, (80% Jean's Cream, 13% Aquafor, and 7% with no topical therapy). The treatment field was photographed weekly. SkinSafe strips were reapplied as needed, but were not applied if erythema was already observed in the inframammary fold. Severity of skin reaction was assessed using the RTOG scale. Results: There was only one treatment interruption, against medical advice, due to axillary discomfort. One patient refused further trial participation after the first day. No short or long term side effects of film use were noted. Inframammary desquamation developed in only one patient, who tried to replicate the increased comfort of her inframammary tape with adhesive bandages when her tape came off. There was no moist desquamation under the SkinSafe film in the inframammary field in any patient. Axillary moist desquamation, where no film, but rather physician's choice of topical cream was applied, remained at 35%. Areas of skin adjacent to the SkinSafe film showed desquamation in 9.7% of patients, 0.5-1 cm in maximal diameter, all of which had resolved at time of completion. Conclusions: Prophylactic use of SkinSafe film strips applied to the inframammary fold substantially reduces or eliminates the risk of inframammary desquamation during breast radiation. Citation Format: Garren D, Le B, Vasireddy R, Flynn L, Forster K, Malina L, Dorfman Y. Prophylactic application of SkinSafe film strips to the inframammary fold prevents moist desquamation during irradiation for breast cancer in a prospective trial [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-12-11.

Tilletia controversa causing dwarf bunt of wheat is a quarantine pathogen in several countries. Therefore, its specific detection is of great phytosanitary importance. Genomic regions routinely used for phylogenetic inferences lack suitable polymorphisms for the development of species-specific markers. We therefore compared 21 genomes of six Tilletia species to identify DNA regions that were unique and conserved in all T. controversa isolates and had no or limited homology to other Tilletia species. A loop-mediated isothermal amplification (LAMP) assay for T. controversa was developed based on one of these DNA regions. The specificity of the assay was verified using 223 fungal samples comprising 43 fungal species including 11 Tilletia species, in particular 39 specimens of T. controversa, 92 of T. caries and 40 of T. laevis, respectively. The assay specifically amplified genomic DNA of T. controversa from pure cultures and teliospores. Only Tilletia trabutii generated false positive signals. The detection limit of the LAMP assay was 5 pg of genomic DNA per reaction. A test performance study that included five laboratories in Germany resulted in 100% sensitivity and 97.7% specificity of the assay. Genomic regions, specific to common bunt (Tilletia caries and Tilletia laevis together) are also provided.

Purpose: To identify interventional factors associated with improved visual results and faster time to resolution for patients with Pseudomonas scleritis.Methods: Retrospective study analyzing inci...

NATO burden sharing has become an especially timely issue in the past several years as a result of a number of factors, including Russian annexation of Crimea and destabilization of eastern Ukraine in 2014. This article argues that alliance unity among the great democracies of Europe and North America is indispensable to peace and stability on the Eurasian continent. A fractured NATO, and especially, a large divide in purposes or commitments as between the United States and its European security partners, invites aggression and the possibility of inadvertent escalation. Past successes and failures in US-involved multinational peace and stability operations, within and outside of Europe, show that mission accomplishment requires give and take, including the occasional acceptance of unequal costs and benefits among the members, in order to achieve peace and security objectives.

PurposeTo compare the amount of myopia induced by same-size donor-to-host penetrating keratoplasty with that of the amount of myopia induced by over-sized donor-to-host penetrating keratoplasty.SettingTertiary referral academic center.DesignRetrospective cohort study.MethodsCharts from patients who underwent penetrating keratoplasty by the same technique at Bascom Palmer Eye Institute between Nov 1, 2002, and January 1, 2006, were reviewed. The patients underwent optical penetrating keratoplasty using 12 interrupted 10-0 nylon sutures and a 12-bite continuous 10-0 nylon suture by a single surgeon (R.K.F.). The surgical technique used would be considered standard of care at most institutions. The Institutional Review Board, University of Miami Human Subjects Research Office, approved the study protocol. The donor graft was over-sized by 0.25mm in eyes when the intended final refractive target was greater than -1.00 diopters spherical equivalent (SE). The same-size donor graft was used when the intended final refractive target was less than -1.00 diopters SE. The selection of donor graft size was entirely based upon clinical parameters, meaning that the intended final refractive target was determined per each patient's fellow eye refraction, with the intention of reducing anisometropia. All patients received postoperative refraction and corneal topography. These measurements were performed at 6-8 weeks when the initial removal of sutures commenced, then at 6 months, then after completion of selective suture removal, then again at 12 months.ResultsAt 12 months, the over-sized group resulted in -1.35 diopters (SD = 2.25) SE of refraction, and the same-size group resulted in -0.14 diopters (SD = 2.42) SE. This approached statistical significance (p = 0.052) in comparison to -1.00 diopters spherical equivalent.ConclusionsUsing a donor graft that is over-sized by 0.25mm results in refraction of -1.00 diopters SE or more of myopia. Using a same-size donor-graft results in refraction of less than -1.00 diopters SE. Therefore, careful graft-size selection can result in a more favorable clinical outcome-namely, reduction in anisometropia-in patients undergoing penetrating keratoplasty.

A partir de casos da Corte Interamericana de Direitos Humanos (CIDH) e da Corte Europeia de Direitos Humanos (CEDH), o presente trabalho traz uma reflexão acerca do princípio da imparcialidade na figura do juiz natural e do mediador. Como princípio concretizador da segurança jurídica, deve ser garantido ao cidadão ser julgado por um juiz constitucionalmente competente, imparcial, constituído in abstrato por lei para o pleno desempenho da função jurisdicional, e por um mediador igualmente imparcial, facilitador do diálogo entre as partes no processo de mediação. O objetivo é compreender as implicações de discussões que se vêm construindo em torno das intersecções do princípio da imparcialidade na prática da mediação e nas práticas judiciais.

To assess the postoperative outcomes of limbal dermoid excision with corneoscleral graft transplantation. The charts of 8 consecutive patients (mean age: 13.0y) who had undergone limbal dermoid excision with lamellar corneoscleral graft transplantation by a single surgeon were retrospectively reviewed. Mean dermoid size was 7.75 mm (6.0-12.0 mm). Mean visual acuities (in logMAR units) before and after surgery were 1.8 and 1.7, respectively (P=0.29). Spherical equivalents were 1.3 diopter (D) before surgery and 0.7 D after surgery (P=0.40). The mean astigmatism measurements before and after surgery were 2.4 D and 1.5 D, respectively (P=0.17). Vector analysis revealed a mild change in astigmatism with a mean “d” of 3.2 (0.56-6.89). No intra- or post-operative complications occurred. Lamellar keratoplasty for limbal dermoids is safe and offers good cosmesis and tectonic stability. A significant decrease in the amount of astigmatism is not expected following surgery.

AimTo investigate the relationships between corneal suture bacteriology, biofilm and the clinical setting using culture studies and scanning electron microscopy (SEM).MethodsThis is a prospective, observational study of patients with a history of penetrating keratoplasty presenting to a tertiary cornea clinic for routine or symptoms-related corneal suture removal. We documented for each patient the suture clinical setting (quiescent, exposed and keratitis-related), retention time, antimicrobial therapy, bacterial growth on culture studies, and bacterial presence and biofilm coverage on SEM.ResultsThere were significantly different culture positivity rates between the quiescent (8%), exposed (12%) and keratitis-related (60%) suture groups (p=0.039). As expected, keratitis-related sutures had the longest retention time compared with quiescent and exposed ones (p=0.02). The biofilm coverage score was higher for sutures from the keratitis-related and exposed groups, although this trend was not statistically significant (p=0.90). Higher biofilm scores were seen in samples that also yielded a positive culture result (p=0.36) and in samples with bacterial presence on SEM images (p=0.16 and p=0.73). Both of these were important trends but not statistically significant.ConclusionsEvidence for active bacterial and biofilm presence on corneal sutures was found. Corneal sutures should be considered for removal sooner, before becoming exposed and/or keratitis-related. Traditional culture studies and SEM imaging are helpful in investigating biofilm and its clinical importance. More studies of the spectrum of bacterial growth on embedded biomedical devices such as corneal sutures are needed.

Research in cross-cultural contexts has remained largely unexplored due to the complexities and complications that arise during such studies. While many cross-cultural studies have been conducted in a variety of contexts, little has been published with regard to caveats, practicalities, and potential impediments. This paper presents a practical lessons learned approach derived from a recent cross-cultural team cognition study executed at a large eastern United States university and a comparable institution in the United Kingdom. While seeking to carry out cross-cultural research, we encountered issues with communication, coordination, and practical requirements that had a strong impact on experimental design and ultimately, on outcomes. This paper presents several of the lessons learned from this cross-site, cross-cultural research project with particular focus on the underlying aspects of designing, preparing, and implementing cross-cultural research.

Emergency crisis management is a highly dynamic and complex domain. It challenges performance and increases reliance on information, technology, people and context. Crisis events are something to which all nations must respond, however processes, policies, and responses to those events may be culturally defined. Culture, described as a set of characteristics, values and behaviors manifested within a group of people and shaped by historical experiences means that cognition can no longer be thought of as being universally the same across populations. To explore the role of culture within decision-making and distributed cognition, an initial collaborative pilot study was undertaken with the University of Manchester. The goals were to collect case data on the strength of cognitive and behavioral variables related to culture as it is operationalized within the NeoCITIES emergency response simulation. The study purported to test the influence of a naturalistic culture (U.S. and U.K.), hidden knowledge, and time stress on team performance to provide an initial understanding of how culture impacts cognition within an emergency crisis management setting. This initial study was a successful proof of concept that NeoCITIES could be used in an international comparative experiment. Although we did not achieve results with our initial pilot study, several significant lessons were learned in carrying out this cross-cultural research.

Purpose To report historically evolving strategies (then and now) in prevention and management of endophthalmitis. Design A perspective on relevant topics in the prophylaxis and management of endophthalmitis. Methods This is an author-selected review of studies leading to changes in strategies for endophthalmitis management over the last 100 years. Results The current perspective discusses the trends and strategies over the past century. Historically, 3 endophthalmitis time-periods have existed and include the pre-antimicrobial era, the predominantly systemic antimicrobial era, and the current intravitreal antimicrobial era. The management of endophthalmitis from different etiologies, including endogenous, postinjection, post–cataract surgery, and other anterior segment–related (eg, post–penetrating keratoplasty), bleb-associated, glaucoma drainage device–associated, and open globe injury–associated, are discussed. Specific etiologies may predict most common microbial causes and may guide differing management strategies. Pars plana vitrectomy offers theoretical advantages but is generally reserved for patients with more advanced disease. Conclusions Despite advances over the past 100 years, endophthalmitis is an important sight-threatening complication. Timely management with the appropriate use of antimicrobial agents may optimize visual outcomes.

PURPOSE: To identify interventional factors associated with improved visual results and faster time to resolution for patients with pseudomonas scleritis. METHODS: Retrospective study analyzing inciting factors, therapeutic modalities, and outcomes of patients with pseudomonas scleritis. RESULTS: Twenty-four patients were analyzed; 22 were treated as outpatients. All had resolution of infection and 58% (n=14) maintained ≥20/200 vision. Medical therapy included topical and oral antibiotics; 7 received additional subconjunctival injections; 2 were admitted for IV antibiotics. Patients presenting with ≥20/200 vision were more likely to maintain this level of vision (n=8, 80%) compared to those presenting with severe vision loss (n=5, 36%), (p=0.04). A similar proportion of patients who received (n=8, 61%) and did not receive (n=5, 39%) oral steroids achieved 20/200 vision or better once infection resolved, p=1.0. CONCLUSIONS: Pseudomonas scleritis can be successfully managed in the outpatient setting. Oral steroids do not appear harmful in the treatment of this disease.

The Nuclear Spectroscopic Telescope Array (NuSTAR) launched in June 2012, flies two conical approximation Wolter-I mirrors at the end of a 10.15-m mast. The optics are coated with multilayers of Pt/C and W/Si that operate from 3 to 80 keV. Since the optical path is not shrouded, aperture stops are used to limit the field of view (FoV) from background and sources outside the FoV. However, there is still a sliver of sky (∼1.0 deg to 4.0 deg) where photons may bypass the optics altogether and fall directly on the detector array. We term these photons stray light. Additionally, there are also photons that do not undergo the focused double reflections in the optics, and we term these ghost rays. We present detailed analysis and characterization of these two components and discuss how they impact observations. Finally, we discuss how they could have been prevented and should be in future observatories.

The presence of energetically low-lying triplet states is a hallmark of organic semiconductors. Even though they present a wealth of interesting photophysical properties, these optically dark states significantly limit optoelectronic device performance. Recent advances in emissive charge-transfer molecules have pioneered routes to reduce the energy gap between triplets and "bright" singlets, allowing thermal population exchange between them and eliminating a significant loss channel in devices. In conjugated polymers, this gap has proved resistant to modification. Here, we introduce a general approach to reduce the singlet-triplet energy gap in fully conjugated polymers, using a donor-orthogonal acceptor motif to spatially separate electron and hole wave functions. This new generation of conjugated polymers allows for a greatly reduced exchange energy, enhancing triplet formation and enabling thermally activated delayed fluorescence. We find that the mechanisms of both processes are driven by excited-state mixing between π-π*and charge-transfer states, affording new insight into reverse intersystem crossing.

We present first results from a series of $NuSTAR$ observations of the black hole X-ray binary V404 Cyg obtained during its summer 2015 outburst, primarily focusing on observations during the height of this outburst activity. The $NuSTAR$ data show extreme variability in both the flux and spectral properties of the source. This is partly driven by strong and variable line-of-sight absorption, similar to previous outbursts. The latter stages of this observation are dominated by strong flares, reaching luminosities close to Eddington. During these flares, the central source appears to be relatively unobscured and the data show clear evidence for a strong contribution from relativistic reflection, providing a means to probe the geometry of the innermost accretion flow. Based on the flare properties, analogy with other Galactic black hole binaries, and also the simultaneous onset of radio activity, we argue that this intense X-ray flaring is related to transient jet activity during which the ejected plasma is the primary source of illumination for the accretion disk. If this is the case, then our reflection modelling implies that these jets are launched in close proximity to the black hole (as close as a few gravitational radii), consistent with expectations for jet launching models that tap either the spin of the central black hole, or the very innermost accretion disk. Our analysis also allows us to place the first constraints on the black hole spin for this source, which we find to be $a^* > 0.92$ (99% statistical uncertainty, based on an idealized lamppost geometry)., 23 pages, 16 figures, accepted for publication in ApJ

Asymmetry is required by most numerical simulations of stellar core-collapse explosions, but the form it takes differs significantly among models. The spatial distribution of radioactive 44Ti, synthesized in an exploding star near the boundary between material falling back onto the collapsing core and that ejected into the surrounding medium, directly probes the explosion asymmetries. CassiopeiaA is a young, nearby, core-collapse remnant from which 44Ti emission has previously been detected but not imaged. Asymmetries in the explosion have been indirectly inferred from a high ratio of observed 44Ti emission to estimated 56Ni emission, from optical light echoes, and from jet-like features seen in the X-ray and optical ejecta. Here we report spatial maps and spectral properties of the 44Ti in Cassiopeia A. This may explain the unexpected lack of correlation between the 44Ti and iron X-ray emission, the latter being visible only in shock-heated material. The observed spatial distribution rules out symmetric explosions even with a high level of convective mixing, as well as highly asymmetric bipolar explosions resulting from a fast-rotating progenitor. Instead, these observations provide strong evidence for the development of low-mode convective instabilities in core-collapse supernovae., Comment: 32 pages, Figures Embedded

We present the first full catalog and science results for the NuSTAR serendipitous survey. The catalog incorporates data taken during the first 40 months of NuSTAR operation, which provide ~20Ms of effective exposure time over 331 fields, with an areal coverage of 13 sq deg, and 497 sources detected in total over the 3-24 keV energy range. There are 276 sources with spectroscopic redshifts and classifications, largely resulting from our extensive campaign of ground-based spectroscopic followup. We characterize the overall sample in terms of the X-ray, optical, and infrared source properties. The sample is primarily comprised of active galactic nuclei (AGNs), detected over a large range in redshift from z = 0.002 - 3.4 (median of = 0.56), but also includes 16 spectroscopically confirmed Galactic sources. There is a large range in X-ray flux, from log( f_3-24keV / erg s^-1 cm^-2 ) ~ -14 to -11, and in rest-frame 10-40 keV luminosity, from log( L_10-40keV / erg s^-1 ) ~ 39 to 46, with a median of 44.1. Approximately 79% of the NuSTAR sources have lower energy ( 10^44 erg s^-1) to ~80% at the lowest luminosities (Lx < 10^43 erg s^-1). Our optical spectroscopic analysis finds that the observed fraction of optically obscured AGNs (i.e., the Type 2 fraction) is F_Type2 = 53(+14-15)%, for a well-defined subset of the 8-24 keV selected sample. This is higher, albeit at a low significance level, than the Type 2 fraction measured for redshift- and luminosity-matched AGNs selected by, 49 pages, 23 figures, 8 tables. Accepted for publication in ApJ

Purpose To describe the epidemiology of patients with infectious scleritis and identify factors associated with poor visual prognosis. Methods Retrospective review of inciting factors, causative organisms, and visual outcomes of patients with infectious scleritis. Results Fifty-five patients (56 eyes) with confirmed infectious scleritis were included. The median time from inciting event to scleritis symptoms was 1.9 months. Eyes with a history of pterygium surgery had a longer time from surgery to development of scleritis (median 49 months, range 0-183) compared to those with a history of glaucoma, cataract, and retina surgery (median 1.0-1.6 months; P = 0.001). Fungal, nocardial, and mycobacterial infections (median 17-45 days) had a longer interval between symptoms and diagnosis than eyes with non-acid-fast gram-positive and gram-negative bacteria (median 7 days; P = 0.04). Patients were followed for a median of 11.1 months (0.5-47 months). Approximately 50% of eyes lost functional vision (worse than 20/200). Presenting VA of worse than 20/200 and concomitant keratitis or endophthalmitis were associated with poorer VA outcomes. Conclusions Infectious scleritis can occur days to years after ocular surgery, with infection occurring after a longer interval in eyes with a history of pterygium surgery. Approximately 50% of eyes lost functional VA after infection with poor presenting VA being the strongest predictor for subsequent severe vision loss.

SummaryObjectives: To survey the current management of cranial cruciate ligament rupture in small dogs (Methods: A questionnaire was distributed to veterinarians attending the British Veterinary Orthopaedic Association Spring meeting and British Small Animal Veterinary Association Annual Congress which took place in April 2010. Respondents were surveyed on their management of small dogs with cranial cruciate ligament ruptureResults: Immediate surgical management was chosen by 15.5% of the respondents. Following that, 77.6% of respondents suggested that case management would depend on severity of lameness (81%), age (72.6%), bodyweight (70.4%), degree of instability (64.8%), and duration of lameness (64.0%). Conservative management included non- steroidal antiinflammatory drugs (91.1%), short leash walks (91.1%), weight loss (89.0%), hydrotherapy (53.6%), physiotherapy (41.9%), and cage rest (24.2%). Where surgical management was chosen, 71.4% would perform the procedure rather than refer it to another practice. Surgical techniques included extra-capsular stabilisation (63.4%), corrective osteotomies (32.9%), and intra-articular stabilisation (6.8%). The demographic characteristics of the responding veterinarians had no effect on their initial management of the case. General practice veterinarians were less likely to perform a corrective osteotomy than to refer the case, but were no less likely to perform an extracapsular technique.Clinical significance: Conservative management is still widely used for treatment of cranial cruciate ligament rupture in dogs weighing less than 15 kg; this is in agreement with previous publications on the management of this condition in small dogs.

Purpose To describe the incidence, microbiology, associated factors, and clinical outcomes of patients with infectious keratitis progressing to endophthalmitis. Design Nonrandomized, retrospective, consecutive case series. Participants All patients treated for culture-proven keratitis and endophthalmitis between January 1, 1995 and December 31, 2009, at the Bascom Palmer Eye Institute. Methods Ocular microbiology and medical records were reviewed on all patients with positive corneal and intraocular cultures over the period of the study. Univariate analysis was performed to obtain P values described in the study. Main Outcome Measures Microbial isolates, treatment strategies, and visual acuity (VA) outcomes. Results A total of 9934 corneal cultures were performed for suspected infectious keratitis. Only 49 eyes (0.5%) progressed to culture-proven endophthalmitis. Fungi (n = 26) were the most common responsible organism followed by gram-positive bacteria (n = 13) and gram-negative bacteria (n = 10). Topical steroid use (37/49 [76%]) was the most common associated factor identified in the current study, followed by previous surgery (30/49 [61%]), corneal perforation (17/49 [35%]), dry eye (15/49 [31%]), relative immune compromise (10/49 [20%]), organic matter trauma (9/49 [18%]), and contact lens wear (3/49 [6%]). There were 27 patients in whom a primary infectious keratitis developed into endophthalmitis, and 22 patients in whom an infectious keratitis adjacent to a previous surgical wound progressed into endophthalmitis. Patients in the primary keratitis group were more likely to be male (22/27 [81%] vs 8/22 [36%]; P = 0.001), have history of organic matter trauma (8/27 [30%] vs 1/22 [5%]); P = 0.030), and have fungal etiology (21/27 [78%] vs 5/22 [23%]; P P = 0.024). A VA of ≥20/50 was achieved in 7 of 49 patients (14%), but was Conclusions Progression of infectious keratitis to endophthalmitis is relatively uncommon. The current study suggests that patients at higher risk for progression to endophthalmitis include patients using topical corticosteroids, patients with fungal keratitis, patients with corneal perforation, and patients with infectious keratitis developing adjacent to a previous surgical wound. Patients with sequential keratitis and endophthalmitis have generally poor visual outcomes. Financial Disclosure(s) Proprietary or commercial disclosure may be found after the references.