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To report the introduction and impact of non-medical prescribing, initiated to improve patient pathways for those presenting with dizziness and balance disorders.
The Southport and Ormskirk physiotherapy-led vestibular clinic sees and treats all patients with dizziness and balance disorders referred to the ENT department. Letters are triaged by an audiologist, who also performs an otological examination and hearing test; this is followed by an assessment with the independent prescriber physiotherapist. An ENT consultant is nearby if joint consultation is needed. Diagnoses, treatments and patient satisfaction were studied, with an analysis of the impact of medication management (stopping or starting medicines) on patients and service.
In 12 months, 413 new patients with dizziness and balance disorders had appointments. The most common diagnoses were benign paroxysmal positional vertigo and vestibular migraine. Eighty-four per cent of patients required self-management strategies, 50 per cent exercise therapy, 48 per cent medication management and 24 per cent a particle repositioning manoeuvre. Patient satisfaction was high (99 per cent).
Having an independent prescriber physiotherapist leading the balance clinic has reduced the number of hospital visits and onward referrals. Nearly half of all patients required medication management as part of their dizziness or balance treatment.
The extension of the Quaternary glaciations has been studied in the semi-arid Andes of north-central Chile, where the glacial modelling is striking. In the Elqui valley (lat. 30°S.), two glacial advances were identified reaching down to 3 100 m (Laguna glaciation) and 2 500 m (Tapado glaciation). In the Aconcagua valley (lat. 33°S.), moraines from three major glacial advances were found, at 2 800 m (Portillo glaciation), 1 600 m (Guardia Vieja glaciation) and 1 300 m (Salto del Soldado glaciation).
The Quaternary glaciations were linked with a decrease of temperature, but more significantly with a marked increase of precipitation probably related to an equatorward shift of 5–6 degrees of the austral polar front. The results obtained in the semi-arid Chilean Andes are correlated with those recently reported from other sectors of the southern Andes.
The integration of new knowledge into clinical practice continues to lag behind discovery. The use of Free Open Access Medical education (FOAM) has disrupted communication between emergency physicians, making it easy for practicing clinicians to interact with colleagues from around the world to discuss the latest and highest impact research. FOAM has the potential to decrease the knowledge translation gap, but the concerns raised about its growing influence are 1) research that is translated too quickly may cause harm if its findings are incorrect; 2) there is little editorial oversight of online material; and 3) eminent online individuals may develop an outsized influence on clinical practice. We propose that new types of scholars are emerging to moderate the changing landscape of knowledge translation: 1) critical clinicians who critically appraise research in the same way that lay reviewers critique restaurants; 2) translational teachers adept with these new technologies who will work with researchers to disseminate their findings effectively; and 3) interactive investigators who engage with clinicians to ensure that their findings resonate and are applied at the bedside. The development of these scholars could build on the promise of evidence-based medicine by enhancing the appraisal and translation of research in practice.
A clear excess in the Fermi-LAT data is present at energies around a few GeV. The spectrum of this so-called ’GeV excess’ is remarkably similar to the expected annihilation signal of WIMP dark matter. However, a large bulge population of millisecond pulsars living below the Fermi–LAT detection threshold could also explain the excess spectrum. In a recent work we optimized the search for sub-threshold sources, by applying a wavelet transform to the Fermi–LAT gamma-ray data. In the Inner-Galaxy the wavelet signal is significantly enhanced, providing supportive evidence for the point source interpretation of the excess. In these proceedings we will extent our previous work with a spectral analysis and elaborate on the potential contamination from substructures in the gas.
By performing a global magnetohydrodynamical (MHD) simulation for the Milky Way with an axisymmetric gravitational potential, we propose that spatially dependent amplification of magnetic fields possibly explains the observed noncircular motion of the gas in the Galactic centre (GC) region. The radial distribution of the rotation frequency in the bulge region is not monotonic in general. The amplification of the magnetic field is enhanced in regions with stronger differential rotation, because magnetorotational instability and field-line stretching are more effective. The strength of the amplified magnetic field reaches ≳ 0.5 mG, and radial flows of the gas are excited by the inhomogeneous transport of angular momentum through turbulent magnetic field that is amplified in a spatially dependent manner. As a result, the simulated position-velocity diagram exhibits a time-dependent asymmetric parallelogram-shape owing to the intermittency of the magnetic turbulence; the present model provides a viable alternative to the bar-potential-driven model for the parallelogram shape of the central molecular zone. In addition, Parker instability (magnetic buoyancy) creates vertical magnetic structure, which would correspond to observed molecular loops, and frequently excited vertical flows. Furthermore, the time-averaged net gas flow is directed outward, whereas the flows are highly time dependent, which would contribute to the outflow from the bulge.
SWAG (“Survey of Water and Ammonia in the Galactic Center”) is a multi-line interferometric survey toward the Center of the Milky Way conducted with the Australia Telescope Compact Array. The survey region spans the entire ~400 pc Central Molecular Zone and comprises ~42 spectral lines at pc spatial and sub-km/s spectral resolution. In addition, we deeply map continuum intensity, spectral index, and polarization at the frequencies where synchrotron, free-free, and thermal dust sources emit. The observed spectral lines include many transitions of ammonia, which we use to construct maps of molecular gas temperature, opacity and gas formation temperature (see poster by Nico Krieger et al., this volume). Water masers pinpoint the sites of active star formation and other lines are good tracers for density, radiation field, shocks, and ionization. This extremely rich survey forms a perfect basis to construct maps of the physical parameters of the gas in this extreme environment.
A peculiar source in the Galactic center known as the Dusty S-cluster Object (DSO/G2) moves on a highly eccentric orbit around the supermassive black hole with the pericenter passage in the spring of 2014. Its nature has been uncertain mainly because of the lack of any information about its intrinsic geometry. For the first time, we use near-infrared polarimetric imaging data to obtain constraints about the geometrical properties of the DSO. We find out that DSO is an intrinsically polarized source, based on the significance analysis of polarization parameters, with the degree of the polarization of ~30% and an alternating polarization angle as it approaches the position of Sgr A*. Since the DSO exhibits a near-infrared excess of Ks-L′ > 3 and remains rather compact in emission-line maps, its main characteristics may be explained with the model of a pre-main-sequence star embedded in a non-spherical dusty envelope.
Because of the unique observational challenges -extreme crowding and extinction- any existing large-scale near-infrared (NIR) imaging data on the Galactic Center (GC) are limited by either one, or a combination, of the following: saturation, lack of sensitivity, too low angular resolution, or lack of multi-wavelength coverage. To overcome this situation, we are currently carrying out a sensitive, 0.2” resolution JHK imaging survey of the Galactic Centre with HAWK-I/VLT. Thanks to holographic imaging, we achieve a similar resolution than with HST/WFC, but can cover also the long NIR, beyond 2 micrometers, which is essential to deal with extinction. Our survey is supported by an ESO Large Programme and will provide photometrically accurate (few percent uncertainty for H < 18 stars), high-angular resolution, NIR data for an area of several 1000 pc2, a more than ten-fold increase compared to the current state of affairs. Here we present an overview and first results.
We present NH3 and H64α+H63α VLA observations of the Radio Arc region, including the M0.20 – 0.033 and G0.10 – 0.08 molecular clouds. These observations suggest the two velocity components of M0.20 – 0.033 are physically connected in the south. Additional ATCA observations suggest this connection is due to an expanding shell in the molecular gas, with the centroid located near the Quintuplet cluster. The G0.10 – 0.08 molecular cloud has little radio continuum, strong molecular emission, and abundant CH3OH masers, similar to a nearby molecular cloud with no star formation: M0.25+0.01. These features detected in G0.10 – 0.08 suggest dense molecular gas with no signs of current star formation.
The nature and origin of the Fermi bubbles detected in the inner Galaxy remain elusive. In this paper, we briefly discuss some recent theoretical and observational developments, with a focus on the AGN jet model. Analogous to radio lobes observed in massive galaxies, the Fermi bubbles could be naturally produced by a pair of opposing jets emanating nearly along the Galaxy’s rotation axis from the Galactic center. Our two-fluid hydrodynamic simulations reproduce quite well the bubble location and shape, and interface instabilities at the bubble surface could be effectively suppressed by shear viscosity. We briefly comment on some potential issues related to our model, which may lead to future progress.
The environment within the inner few hundred parsecs of the Milky Way, known as the “Central Molecular Zone” (CMZ), harbours densities and pressures orders of magnitude higher than the Galactic Disc; akin to that at the peak of cosmic star formation (Kruijssen & Longmore 2013). Previous studies have shown that current theoretical star-formation models under-predict the observed level of star-formation (SF) in the CMZ by an order of magnitude given the large reservoir of dense gas it contains. Here we explore potential reasons for this apparent dearth of star formation activity.
Sagittarius A* is the closest example of a supermassive black hole and our proximity allows us to detect emission from its accretion flow in the radio, submillimeter, near IR, and X-ray regimes. Ambitious monitoring campaigns have yielded rich multi-wavelength, time-resolved data that have the power to probe the physical processes underlying Sgr A*’s quiescent and flare emission. Here, I review the status of Sgr A* X-ray monitoring campaigns from the Chandra X-ray Observatory (also XMM Newton, and Swift), and efforts to coordinate these with observations across the electromagnetic spectrum. I also discuss how these observations constrain models for Sgr A*’s variability, which range from tidal disruption of asteroids to gravitational lensing to collimated outflows to magnetic reconnection.
Various observations show peculiar features in the Galactic Center region, such as loops and filamentary structure. It is still unclear how such characteristic features are formed. Magnetic field is believed to play very important roles in the dynamics of gas in the Galaxy Center. Suzuki et al. (2015) performed a global magneto-hydrodynamical simulation focusing on the Galactic Center with an axisymmetric gravitational potential and claimed that non-radial motion is excited by magnetic activity. We further analyzed their simulation data and found that vertical motion is also excited by magnetic activity. In particular, fast down flows with speed of ~100 km/s are triggered near the footpoint of magnetic loops that are buoyantly risen by Parker instability. These downward flows are accelerated by the vertical component of the gravity, falling along inclined field lines. As a result, the azimuthal and radial components of the velocity are also excited, which are observed as high velocity features in a simulated position-velocity diagram. Depending on the viewing angle, these fast flows will show a huge variety of characteristic features in the position-velocity diagram.
Quasi-periodic oscillations (QPOs) are believed to be indirect evidence for black holes. Several authors have reported detections of QPOs from Sgr A*, the nucleus of our Galaxy, in infrared and X-ray wavelength during flare-ups. Miyoshi et al. (2011) reported a tentative detection of QPOs in the 43 GHz light curve of Sgr A* obtained with the Very Long Baseline Array (VLBA). To confirm their detection, we reanalysed their VLBA data very conservatively. The 43 GHz flux was calculated for every 15 seconds by assuming a two-dimensional Gaussian-shape spatial structure. The Lomb-Scargle periodogram of the 43 GHz flux just after a millimeter wave flare of Sgr A*, shows three apparent peaks at 10.2, 14.6 and 32.1 min. Two of them are barely consistent with the previously reported QPOs. Using the resonant oscillation model, we estimated the spin parameter of the Sgr A* black hole to be 0.56 assuming the mass of 4.3 × 106M⊙.
Atomic carbon (C0) is one of the most abundant carbon-bearing species in the interstellar molecular gas, and its submillimeter lines are good tracers of low-density molecular clouds which are often dark in CO rotational lines. We present a new map of the central 150 pc region of the Milky Way in the 500 GHz [CI] line, which has been recently obtained with the ASTE 10-m telescope. The [CI] emission is brightest toward the central 5-pc region, where massive GMCs are absent. This [CI]-bright region is approximately centered toward Sgr A*, covering the entire circum-nuclear ring (CND) and the western part of the 50-km/s cloud. The C0/CO abundance ratio is 0.5–2 there, and the highest ratio is observed toward the CND but just outside of the 2-pc ring of dense gas. This discovery may suggest that the CO-dark component occupies a significant fraction of the molecular gas in the circumnuclear region.
We study the evolution of G2 in a Compact Source Scenario, where G2 is the outflow from a low-mass central star moving on the observed orbit. This is done through 3D AMR simulations of the hydrodynamic interaction of G2 with the surrounding hot accretion flow. A comparison with observations is done by means of mock position-velocity (PV) diagrams. We found that a massive (Ṁw = 5× 10−7M⊙ yr−1) and slow (vw = 50 km s−1) outflow can reproduce G2’s properties. A faster outflow (vw = 400 km s−1) might also be able to explain the material that seems to follow G2 on the same orbit.
The center of our Galaxy hosts a Super-Massive Black Hole (SMBH) of about 4 × 106 M⊙. Since it has been argued that the SMBH might accelerate particles up to very high energies, its current and past activity could contribute to the population of Galactic cosmic-rays (CRs). Additionally, the condition in the Galactic Center (GC) are often compared with the one of a starburst system. The high supernovae (SN) rate associated with the strong massive star formation in the region must create a sustained CR injection in the GC via the shocks produced at the time of their explosion.
The presence of an excess of very high energy (VHE) cosmic rays in the inner 100 pc of the Galaxy in close correlation with the massive gas complex known as the central molecular zone (CMZ) has been revealed in 2006 by the H.E.S.S. collaboration. Recently, by analysing 10 years of H.E.S.S. data, the H.E.S.S. collaboration confirmed the presence of this extended VHE diffuse emission and deduced a CR density peaked toward the GC. The origin of the CR over-abundance in the GC still remains mysterious: Is it due to a single accelerator at the center or to multiple accelerators filling the region?
In order to investigate the presence of these multiple CR accelerators, and in particular the impact of their spatial distribution on the VHE emission morphology, we build a 3D model of CR injection and diffusive propagation with a realistic 3D gas distribution. We discuss the CR injection in the region by a spectral and morphological comparison with H.E.S.S. data.
We show that a peaked γ-ray profile towards the GC center is obtained using a realistic SN spatial distribution taking into account the central massive star clusters. The contribution of theses sources cannot be neglected in particular at high longitudes. In order to fit the very central excess observed with H.E.S.S., another central VHE component is probably necessary.
The Galactic Center (GC) is one of the more extreme environments in the Galaxy. The so call Bubble of the GC presents structures that do not match with the general behavior of the inner Central Molecular Zone (CMZ). In this work we study the molecular emission related to the observable ionized gas emitted by this Bubble. We find dense pockets of gas and bubble like structures in the velocity domain.
A radio survey of red giant SiO sources in the inner Galaxy and bulge is not hindered by extinction. Accurate stellar velocities (<1 km/s) are obtained with minimal observing time (<1 min) per source. Detecting over 20,000 SiO maser sources yields data comparable to optical surveys with the additional strength of a much more thorough coverage of the highly obscured inner Galaxy. Modeling of such a large sample would reveal dynamical structures and minority populations; the velocity structure can be compared to kinematic structures seen in molecular gas, complex orbit structure in the bar, or stellar streams resulting from recently infallen systems. Our Bulge Asymmetries and Dynamic Evolution (BAaDE) survey yields bright SiO masers suitable for follow-up Galactic orbit and parallax determination using VLBI.
Here we outline our early VLA observations at 43 GHz in the northern bulge and Galactic plane (0<l°<250), and ALMA observations at 86 GHz in the southern bulge (250<l°<360). We report a preliminary overall 70% detection rate in our color-selected MSX sources.