Surgery for Velopharyngeal Insufficiency Following Cleft Palate Repair: An Audit of Contemporary Practice and Proposed Schema of Techniques and Variations.

Objective: Surgical treatment of velopharyngeal insufficiency (VPI) includes a wide array of procedures. The purpose of this study was to develop a classification for VPI procedures and to describe variations in how they are performed. We completed an in-depth review of the literature to develop a preliminary schema that encompassed existing VPI procedures.

Ejection of the Massive Hydrogen-rich Envelope Timed with the Collapse of the Stripped SN 2014C.

We present multi-wavelength observations of SN 2014C during the first 500 days. These observations represent the first solid detection of a young extragalactic stripped-envelope SN out to high-energy X-rays ~40 keV. SN 2014C shows ordinary explosion parameters ( ~ 1.

A luminous, blue progenitor system for the type Iax supernova 2012Z.

Type Iax supernovae are stellar explosions that are spectroscopically similar to some type Ia supernovae at the time of maximum light emission, except with lower ejecta velocities. They are also distinguished by lower luminosities. At late times, their spectroscopic properties diverge from those of other supernovae, but their composition (dominated by iron-group and intermediate-mass elements) suggests a physical connection to normal type Ia supernovae.

Slowly fading super-luminous supernovae that are not pair-instability explosions.

Super-luminous supernovae that radiate more than 10(44) ergs per second at their peak luminosity have recently been discovered in faint galaxies at redshifts of 0.1-4. Some evolve slowly, resembling models of 'pair-instability' supernovae.

Converting continuous insulin infusion to subcutaneous insulin glargine after cardiac surgery using percentage-based versus weight-based dosing: a pilot trial.

Background: Most studies report using percentage of total daily insulin (TDI) for converting therapy from continuous insulin infusion to subcutaneous insulin in cardiac surgery patients. Few studies have evaluated the efficacy of using body weight to calculate the basal insulin dose.

Objective: To compare the efficacy and safety of dosing insulin glargine by weight versus percentage of TDI in cardiac surgery patients transitioning from continuous insulin infusion to subcutaneous insulin.

An ultraviolet-optical flare from the tidal disruption of a helium-rich stellar core.

The flare of radiation from the tidal disruption and accretion of a star can be used as a marker for supermassive black holes that otherwise lie dormant and undetected in the centres of distant galaxies. Previous candidate flares have had declining light curves in good agreement with expectations, but with poor constraints on the time of disruption and the type of star disrupted, because the rising emission was not observed. Recently, two 'relativistic' candidate tidal disruption events were discovered, each of whose extreme X-ray luminosity and synchrotron radio emission were interpreted as the onset of emission from a relativistic jet.

X-ray illumination of the ejecta of supernova 1987A.

When a massive star explodes as a supernova, substantial amounts of radioactive elements--primarily (56)Ni, (57)Ni and (44)Ti--are produced. After the initial flash of light from shock heating, the fading light emitted by the supernova is due to the decay of these elements. However, after decades, the energy powering a supernova remnant comes from the shock interaction between the ejecta and the surrounding medium.

Sustained reduction in methicillin-resistant Staphylococcus aureus wound infections after cardiothoracic surgery.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) wound infections after cardiac surgery have increased in recent years and carry significant morbidity and mortality. In our hospital, MRSA accounted for 56% of postoperative infections.

Methods: Postoperative wound infection rates were compared for the 3 years before (baseline period) and after (intervention period) introduction of a comprehensive MRSA intervention program.

Observing supernova 1987A with the refurbished Hubble Space Telescope.

Observations with the Hubble Space Telescope (HST), conducted since 1990, now offer an unprecedented glimpse into fast astrophysical shocks in the young remnant of supernova 1987A. Comparing observations taken in 2010 with the use of the refurbished instruments on HST with data taken in 2004, just before the Space Telescope Imaging Spectrograph failed, we find that the Lyα and Hα lines from shock emission continue to brighten, whereas their maximum velocities continue to decrease. We observe broad, blueshifted Lyα, which we attribute to resonant scattering of photons emitted from hot spots on the equatorial ring.

A relativistic type Ibc supernova without a detected gamma-ray burst.

Long duration gamma-ray bursts (GRBs) mark the explosive death of some massive stars and are a rare sub-class of type Ibc supernovae. They are distinguished by the production of an energetic and collimated relativistic outflow powered by a central engine (an accreting black hole or neutron star). Observationally, this outflow is manifested in the pulse of gamma-rays and a long-lived radio afterglow.

A comparison of bivalirudin to heparin with protamine reversal in patients undergoing cardiac surgery with cardiopulmonary bypass: the EVOLUTION-ON study.

Objectives: Unfractionated heparin and its antidote, protamine sulfate, allow for rapid and reversible anticoagulation during cardiac surgery with cardiopulmonary bypass, yet limitations exist, including a variable dose-response, dependence on a cofactor for anticoagulant effect, and antigenic potential. This trial was performed to evaluate the safety and efficacy of bivalirudin as an alternative to heparin with protamine reversal in on-pump cardiac surgery.

Methods: We conducted a randomized, open-label, multicenter trial comparing heparin with protamine reversal to bivalirudin in patients undergoing cardiac surgery with cardiopulmonary bypass.

Hubble's diagram and cosmic expansion.

Edwin Hubble's classic article on the expanding universe appeared in PNAS in 1929 [Hubble, E. P. (1929) Proc.

Throwing light on dark energy.

Supernova observations show that the expansion of the universe has been speeding up. This unexpected acceleration is ascribed to a dark energy that pervades space. Supernova data, combined with other observations, indicate that the universe is about 14 billion years old and is composed of about 30%matter and 70%dark energy.

Supernovae, an accelerating universe and the cosmological constant.

Observations of supernova explosions halfway back to the Big Bang give plausible evidence that the expansion of the universe has been accelerating since that epoch, approximately 8 billion years ago and suggest that energy associated with the vacuum itself may be responsible for the acceleration.

The Earth's elements.

The elements that make up the earth and its inhabitants were created by earlier generations of stars.

Inflammatory aneurysm of the ascending aorta; an unreported entity.

A 69-year-old woman with an enlarging ascending aortic aneurysm is presented. At operation, the patient was noted to have extensive peri-aneurysmal fibrosis and inflammation with a 1 cm thick aneurysm wall. Pathologic examination was consistent with inflammatory aneurysm.

Spinal cord ischemia: an evaluation of pharmacologic agents in minimizing paraplegia after aortic occlusion.

Superoxide dismutase (SOD), barbiturates, and hypothermic crystalloid were evaluated for their effectiveness in minimizing ischemic damage to the spinal cord at 40 minutes of aortic occlusion. Forty-two dogs underwent proximal and distal thoracic aortic occlusion for 40 minutes with infusion of test agents into the occluded segment. The dogs were divided into six groups.

Acute aortic rupture from cross clamp injury.

We report a case of transmural disruption and perforation of the abdominal aorta secondary to clamp injury. The literature is reviewed in reference to the traumatic effects of vascular clamps. Steps are outlined to reduce the risk of this injury.

Ocular manifestations of carotid artery atheroma.

Although carotid endarterectomy (CE) is recommended in appropriate patients with bifurcation atheroma for the prevention of stroke, these patients are also at risk for visual loss, either temporary or permanent. The presentations of patients undergoing 512 consecutive CEs were reviewed to determine the preoperative frequency and risks of ocular disturbances. Visual symptoms occurred in 131 patients (25%).