Prospects for detecting the 21cm forest from the diffuse intergalactic medium with LOFAR

We discuss the feasibility of the detection of the 21cm forest in the diffuse IGM with the radio telescope LOFAR. The optical depth to the 21cm line has been derived using simulations of reionization which include detailed radiative transfer of ionizing photons. We find that the spectra from reionization models with similar total comoving hydrogen ionizing emissivity but different frequency distribution look remarkably similar. Thus, unless the reionization histories are very different from each other (e.g. a predominance of UV vs. x-ray heating) we do not expect to distinguish them by means of observations of the 21cm forest. Because the presence of a strong x-ray background would make the detection of 21cm line absorption impossible, the lack of absorption could be used as a probe of the presence/intensity of the x-ray background and the thermal history of the universe. Along a random line of sight LOFAR could detect a global suppression of the spectrum from z>12, when the IGM is still mostly neutral and cold, in contrast with the more well-defined, albeit broad, absorption features visible at lower redshift. Sharp, strong absorption features associated with rare, high density pockets of gas could be detected also at z~7 along preferential lines of sight.Comment: 12 pages, 13 figures. MNRAS, in pres

Foregrounds for observations of the cosmological 21 cm line: II. Westerbork observations of the fields around 3C196 and the North Celestial Pole

In the coming years a new insight into galaxy formation and the thermal history of the Universe is expected to come from the detection of the highly redshifted cosmological 21 cm line. The cosmological 21 cm line signal is buried under Galactic and extragalactic foregrounds which are likely to be a few orders of magnitude brighter. Strategies and techniques for effective subtraction of these foreground sources require a detailed knowledge of their structure in both intensity and polarization on the relevant angular scales of 1-30 arcmin. We present results from observations conducted with the Westerbork telescope in the 140-160 MHz range with 2 arcmin resolution in two fields located at intermediate Galactic latitude, centred around the bright quasar 3C196 and the North Celestial Pole. They were observed with the purpose of characterizing the foreground properties in sky areas where actual observations of the cosmological 21 cm line could be carried out. The polarization data were analysed through the rotation measure synthesis technique. We have computed total intensity and polarization angular power spectra. Total intensity maps were carefully calibrated, reaching a high dynamic range, 150000:1 in the case of the 3C196 field. [abridged]Comment: 20 pages, 22 figures, accepted for publication in A&A. A version with full resolution figures is available at http://www.astro.rug.nl/~bernardi/NCP_3C196/bernardi.pd

Systematic review and meta-analysis of the diagnostic accuracy of ultrasonography for deep vein thrombosis

Background Ultrasound (US) has largely replaced contrast venography as the definitive diagnostic test for deep vein thrombosis (DVT). We aimed to derive a definitive estimate of the diagnostic accuracy of US for clinically suspected DVT and identify study-level factors that might predict accuracy. Methods We undertook a systematic review, meta-analysis and meta-regression of diagnostic cohort studies that compared US to contrast venography in patients with suspected DVT. We searched Medline, EMBASE, CINAHL, Web of Science, Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, Database of Reviews of Effectiveness, the ACP Journal Club, and citation lists (1966 to April 2004). Random effects meta-analysis was used to derive pooled estimates of sensitivity and specificity. Random effects meta-regression was used to identify study-level covariates that predicted diagnostic performance. Results We identified 100 cohorts comparing US to venography in patients with suspected DVT. Overall sensitivity for proximal DVT (95% confidence interval) was 94.2% (93.2 to 95.0), for distal DVT was 63.5% (59.8 to 67.0), and specificity was 93.8% (93.1 to 94.4). Duplex US had pooled sensitivity of 96.5% (95.1 to 97.6) for proximal DVT, 71.2% (64.6 to 77.2) for distal DVT and specificity of 94.0% (92.8 to 95.1). Triplex US had pooled sensitivity of 96.4% (94.4 to 97.1%) for proximal DVT, 75.2% (67.7 to 81.6) for distal DVT and specificity of 94.3% (92.5 to 95.8). Compression US alone had pooled sensitivity of 93.8 % (92.0 to 95.3%) for proximal DVT, 56.8% (49.0 to 66.4) for distal DVT and specificity of 97.8% (97.0 to 98.4). Sensitivity was higher in more recently published studies and in cohorts with higher prevalence of DVT and more proximal DVT, and was lower in cohorts that reported interpretation by a radiologist. Specificity was higher in cohorts that excluded patients with previous DVT. No studies were identified that compared repeat US to venography in all patients. Repeat US appears to have a positive yield of 1.3%, with 89% of these being confirmed by venography. Conclusion Combined colour-doppler US techniques have optimal sensitivity, while compression US has optimal specificity for DVT. However, all estimates are subject to substantial unexplained heterogeneity. The role of repeat scanning is very uncertain and based upon limited data

Foregrounds for observations of the cosmological 21 cm line: I. First Westerbork measurements of Galactic emission at 150 MHz in a low latitude field

We present the first results from a series of observations conducted with the Westerbork telescope in the 140--160 MHz range with a 2 arcmin resolution aimed at characterizing the properties of the foregrounds for epoch of reionization experiments. For the first time we have detected fluctuations in the Galactic diffuse emission on scales greater than 13 arcmin at 150 MHz, in the low Galactic latitude area known as Fan region. Those fluctuations have an $rms$ of 14 K. The total intensity power spectrum shows a power--law behaviour down to $\ell \sim 900$ with slope $\beta^I_\ell = -2.2 \pm 0.3$. The detection of diffuse emission at smaller angular scales is limited by residual point sources. We measured an $rms$ confusion noise of $\sim$3 mJy beam$^{-1}$. Diffuse polarized emission was also detected for the first time at this frequency. The polarized signal shows complex structure both spatially and along the line of sight. The polarization power spectrum shows a power--law behaviour down to $\ell \sim 2700$ with slope $\beta^P_\ell = -1.65 \pm 0.15$. The $rms$ of polarization fluctuations is 7.2 K on 4 arcmin scales. By extrapolating the measured spectrum of total intensity emission, we find a contamination on the cosmological signal of $\delta T= \sqrt{\ell (\ell+1) C^I_\ell / 2\pi} \sim 5.7$ K on 5 arcmin scales and a corresponding $rms$ value of $\sim$18.3 K at the same angular scale. The level of the polarization power spectrum is $\delta T \sim 3.3$ K on 5 arcmin scales. Given its exceptionally bright polarized signal, the Fan region is likely to represent an upper limit on the sky brightness at moderate and high Galactic latitude.Comment: Minor corrections made to match the final version printed on A&A. A version with high resolution figures is available at http://www.astro.rug.nl/~bernardi/FAN/fan.pd

Foreground simulations for the LOFAR - Epoch of Reionization Experiment

Future high redshift 21-cm experiments will suffer from a high degree of contamination, due both to astrophysical foregrounds and to non-astrophysical and instrumental effects. In order to reliably extract the cosmological signal from the observed data, it is essential to understand very well all data components and their influence on the extracted signal. Here we present simulated astrophysical foregrounds datacubes and discuss their possible statistical effects on the data. The foreground maps are produced assuming 5 deg x 5 deg windows that match those expected to be observed by the LOFAR Epoch-of-Reionization (EoR) key science project. We show that with the expected LOFAR-EoR sky and receiver noise levels, which amount to ~52 mK at 150 MHz after 300 hours of total observing time, a simple polynomial fit allows a statistical reconstruction of the signal. We also show that the polynomial fitting will work for maps with realistic yet idealised instrument response, i.e., a response that includes only a uniform uv coverage as a function of frequency and ignores many other uncertainties. Polarized galactic synchrotron maps that include internal polarization and a number of Faraday screens along the line of sight are also simulated. The importance of these stems from the fact that the LOFAR instrument, in common with all current interferometric EoR experiments has an instrumentally polarized response.Comment: 18 figures, 3 tables, accepted to be published in MNRA

Non-invasive management of peripheral arterial disease.

BACKGROUND: Peripheral arterial disease (PAD) is common and symptoms can be debilitating and lethal. Risk management, exercise, radiological and surgical intervention are all valuable therapies, but morbidity and mortality rates from this disease are increasing. Circulatory enhancement can be achieved using simple medical electronic devices, with claims of minimal adverse side effects. The evidence for these is variable, prompting a review of the available literature. METHODS: Embase and Medline were interrogated for full text articles in humans and written in English. Any external medical devices used in the management of peripheral arterial disease were included if they had objective outcome data. RESULTS: Thirty-one papers met inclusion criteria, but protocols were heterogenous. The medical devices reported were intermittent pneumatic compression (IPC), electronic nerve (NMES) or muscle stimulators (EMS), and galvanic electrical dressings. In patients with intermittent claudication, IPC devices increase popliteal artery velocity (49-70 %) and flow (49-84 %). Gastrocnemius EMS increased superficial femoral artery flow by 140 %. Over 4.5-6 months IPC increased intermittent claudication distance (ICD) (97-150 %) and absolute walking distance (AWD) (84-112 %), with an associated increase in quality of life. NMES of the calf increased ICD and AWD by 82 % and 61-150 % at 4 weeks, and 26 % and 34 % at 8 weeks. In patients with critical limb ischaemia IPC reduced rest pain in 40-100 % and was associated with ulcer healing rates of 26 %. IPC had an early limb salvage rate of 58-83 % at 1-3 months, and 58-94 % at 1.5-3.5 years. No studies have reported the use of EMS or NMES in the management of CLI. CONCLUSION: There is evidence to support the use of IPC in the management of claudication and CLI. There is a building body of literature to support the use of electrical stimulators in PAD, but this is low level to date. Devices may be of special benefit to those with limited exercise capacity, and in non-reconstructable critical limb ischaemia. Galvanic stimulation is not recommended

Real-time ultrasound-guided catheterisation of the internal jugular vein: a prospective comparison with the landmark technique in critical care patients

INTRODUCTION: Central venous cannulation is crucial in the management of the critical care patient. This study was designed to evaluate whether real-time ultrasound-guided cannulation of the internal jugular vein is superior to the standard landmark method. METHODS: In this randomised study, 450 critical care patients who underwent real-time ultrasound-guided cannulation of the internal jugular vein were prospectively compared with 450 critical care patients in whom the landmark technique was used. Randomisation was performed by means of a computer-generated random-numbers table, and patients were stratified with regard to age, gender, and body mass index. RESULTS: There were no significant differences in gender, age, body mass index, or side of cannulation (left or right) or in the presence of risk factors for difficult venous cannulation such as prior catheterisation, limited sites for access attempts, previous difficulties during catheterisation, previous mechanical complication, known vascular abnormality, untreated coagulopathy, skeletal deformity, and cannulation during cardiac arrest between the two groups of patients. Furthermore, the physicians who performed the procedures had comparable experience in the placement of central venous catheters (p = non-significant). Cannulation of the internal jugular vein was achieved in all patients by using ultrasound and in 425 of the patients (94.4%) by using the landmark technique (p < 0.001). Average access time (skin to vein) and number of attempts were significantly reduced in the ultrasound group of patients compared with the landmark group (p < 0.001). In the landmark group, puncture of the carotid artery occurred in 10.6% of patients, haematoma in 8.4%, haemothorax in 1.7%, pneumothorax in 2.4%, and central venous catheter-associated blood stream infection in 16%, which were all significantly increased compared with the ultrasound group (p < 0.001). CONCLUSION: The present data suggest that ultrasound-guided catheterisation of the internal jugular vein in critical care patients is superior to the landmark technique and therefore should be the method of choice in these patients