Kinematic Sunyaev-Zel'dovich Effect with Projected Fields: A Novel Probe of the Baryon Distribution with Planck, WMAP, and WISE Data

The kinematic Sunyaev-Zel'dovich (KSZ) effect-the Doppler boosting of cosmic microwave background (CMB) photons due to Compton scattering off free electrons with nonzero bulk velocity-probes the abundance and the distribution of baryons in the Universe. All KSZ measurements to date have explicitly required spectroscopic redshifts. Here, we implement a novel estimator for the KSZ-large-scale structure cross-correlation based on projected fields: it does not require redshift estimates for individual objects, allowing KSZ measurements from large-scale imaging surveys. We apply this estimator to cleaned CMB temperature maps constructed from Planck and WMAP data and a galaxy sample from the Wide-field Infrared Survey Explorer (WISE). We measure the KSZ effect at 3.8σ-4.5σ significance, depending on the use of additional WISE galaxy bias constraints. We verify that our measurements are robust to possible dust emission from the WISE galaxies. Assuming the standard Λ cold dark matter cosmology, we directly constrain (f_{b}/0.158)(f_{free}/1.0)=1.48±0.19 (statistical error only) at redshift z≈0.4, where f_{b} is the fraction of matter in baryonic form and f_{free} is the free electron fraction. This is the tightest KSZ-derived constraint reported to date on these parameters. Astronomers have long known that baryons do not trace dark matter on ∼ kiloparsec scales and there has been strong evidence that galaxies are baryon poor. The consistency between the f_{b} value found here and the values inferred from analyses of the primordial CMB and big bang nucleosynthesis verifies that baryons approximately trace the dark matter distribution down to ∼ megaparsec scales. While our projected-field estimator is already competitive with other KSZ approaches when applied to current data sets (because we are able to use the full-sky WISE photometric survey), it will yield enormous signal-to-noise ratios when applied to upcoming high-resolution, multifrequency CMB surveys.

Taking the Universe's Temperature with Spectral Distortions of the Cosmic Microwave Background

The cosmic microwave background (CMB) energy spectrum is a near-perfect blackbody. The standard model of cosmology predicts small spectral distortions to this form, but no such distortion of the sky-averaged CMB spectrum has yet been measured. We calculate the largest expected distortion, which arises from the inverse Compton scattering of CMB photons off hot, free electrons, known as the thermal Sunyaev-Zel'dovich (TSZ) effect. We show that the predicted signal is roughly one order of magnitude below the current bound from the COBE-FIRAS experiment, but it can be detected at enormous significance (≳1000σ) by the proposed Primordial Inflation Explorer (PIXIE). Although cosmic variance reduces the effective signal-to-noise ratio to 230σ, this measurement will still yield a subpercent constraint on the total thermal energy of electrons in the observable Universe. Furthermore, we show that PIXIE can detect subtle relativistic effects in the sky-averaged TSZ signal at 30σ, which directly probe moments of the optical depth-weighted intracluster medium electron temperature distribution. These effects break the degeneracy between the electron density and the temperature in the mean TSZ signal, allowing a direct inference of the mean baryon density at low redshift. Future spectral distortion probes will thus determine the global thermodynamic properties of ionized gas in the Universe with unprecedented precision. These measurements will impose a fundamental "integral constraint" on models of galaxy formation and the injection of feedback energy over cosmic time.

Evidence of lensing of the cosmic microwave background by dark matter halos

We present evidence of the gravitational lensing of the cosmic microwave background by 10(13) solar mass dark matter halos. Lensing convergence maps from the Atacama Cosmology Telescope Polarimeter (ACTPol) are stacked at the positions of around 12 000 optically selected CMASS galaxies from the SDSS-III/BOSS survey. The mean lensing signal is consistent with simulated dark matter halo profiles and is favored over a null signal at 3.2σ significance. This result demonstrates the potential of microwave background lensing to probe the dark matter distribution in galaxy group and galaxy cluster halos.

Evidence of galaxy cluster motions with the kinematic Sunyaev-Zel'dovich effect

Using high-resolution microwave sky maps made by the Atacama Cosmology Telescope, we for the first time present strong evidence for motions of galaxy clusters and groups via microwave background temperature distortions due to the kinematic Sunyaev-Zel'dovich effect. Galaxy clusters are identified by their constituent luminous galaxies observed by the Baryon Oscillation Spectroscopic Survey, part of the Sloan Digital Sky Survey III. We measure the mean pairwise momentum of clusters, with a probability of the signal being due to random errors of 0.002, and the signal is consistent with the growth of cosmic structure in the standard model of cosmology.

Retroperitoneoscopic lumbar sympathectomy for nonreconstructable arterial occlusive disease

AIM

The aim of this study was to present our experience with video-assisted lumbar sympathectomy for non-reconstructive arterial occlusive disease in a series of 23 consecutive patients whose predominant symptoms were unilateral rest pain, limited skin ulcerations or gangrene of the toes.

METHODS

All the procedures were performed with retroperitoneal approach, dorsal position of the patient and simple digital dissection of the retroperitoneal space.

RESULTS

The operations were successfully performed in all patients except for 2, who immediately underwent open conversion. A urinoma caused by ureteral lesion was the only severe complication in this series. The mean operative time of the procedure was 55 min and the hospital stay was 2 or 3 days. No parenteral analgesics were administered postoperatively. At 1 month from operation, 20 patients out of 23 had significant relief of rest pain and improvement of ischemic lesions. After a median follow-up of 36 months, 2 patients had died, 4 underwent some type of distal amputation, 1 had recurrent rest pain and the other 16 reported persistent improvement of pain or dystrophic changes.

CONCLUSIONS

Retro-peritoneoscopic technique appears the modern and less invasive version of the lumbar surgical sympathectomy.

Improving emergency medical services for children with special health care needs: does training make a difference?

This study evaluated the impact of a paramedic training program on emergency medical services (EMS) responses for children with special health care needs. EMS responses for children with a congenital or acquired condition or a chronic physical or mental illness, were reviewed. Responses, related to the child's special health care need, involving paramedics who had completed our training program were compared with responses with paramedics not participating in the training. There was significantly more advanced life support treatment for responses with paramedics completing the training program compared with other responses. However, there was no significant difference in transport to a hospital or in-hospital admission between these 2 groups. This finding suggests that existing EMS protocols may play a more important role in emergency treatment and transport of children with special health care needs than specialized training of already certified paramedics.

Emergency medical services assessment and treatment of children with special health care needs before and after specialized paramedic training

INTRODUCTION

This study evaluates whether a continuing education program for paramedics, focusing on Children with Special Health Care Needs, improved paramedics' assessment and management.

METHODS

Emergency Medical Services responses for children, 21 years of age or younger, with a congenital or acquired condition or a chronic physical or mental illness, were identified. The responses before and after the specialized education program were reviewed by a multidisciplinary team to evaluate assessment and management of the children. Interreviewer agreement between the nurses on the team and between the physicians on the team was assessed. We also evaluated whether there was an improvement in assessment and care by paramedics completing our education program.

RESULTS

Significant improvement was seen in appropriate assessment and overall care by paramedics who completed our specialized education program. Reviewers also noted an appropriate rating for the initial assessment category more often for responses involving paramedics who had the training. Agreement on whether assessment and treatment was appropriate for all five reviewers varied considerably, ranging from 32% to 93%. Overall there was a high percentage of agreement (>70%) between the nurses and between the physicians on most items. However, kappa statistics did not generally reflect good agreement except for most of the focused assessment items and some treatment and procedure items.

CONCLUSION

Most of the documentation on the EMS records indicated appropriate assessment and treatment during all responses for Children with Special Health Care Needs. Nevertheless, the results indicate that paramedics may improve their assessment and management of these children after specialized continuing education.

Increasing paramedics' comfort and knowledge about children with special health care needs

This study evaluated a continuing education program for paramedics about children with special health care needs (CSHCN). Pretraining, posttraining, and follow-up surveys containing two scales (comfort with CSHCN management skills and comfort with Pediatric Advanced Life Support [PALS] skills) were administered. Objective measures of knowledge were obtained from pre- and posttraining tests. Differences in average scores were assessed using t-tests. Response rates for paramedics completing the program ranged from 94% for the posttraining survey, 81% for the initial comfort survey, 56% for the knowledge pretest, and 56% for the follow-up survey. PALS comfort scores were significantly higher than CSHCN comfort scores both before and after training, both P < .01. Posttraining surveys showed an increase in CSHCN comfort, P < .01. The follow-up surveys showed a significant decline in CSHCN comfort, P = .05. Scores on the tests showed a similar pattern, with a significant increase in knowledge from pre- to posttraining (P = .02) and a significant decrease in knowledge from posttraining to follow-up (P < .01). Comfort was significantly higher for standard pediatric skills than for specialized management skills. Completion of the self-study program was associated with an increase in comfort and knowledge, but there was some decay over time.

Training paramedics: emergency care for children with special health care needs

OBJECTIVE

To enhance knowledge and comfort related to the emergency care of children with special health care needs (CSHCN) through an innovative continuing education program for paramedics.

METHODS

A self-study program presenting in-depth information about common problems that affect the assessment and management of a child's airway, breathing, circulation, disability, and environment (ABCDEs), regardless of the child's diagnosis, was developed. This program used a manual, a video, practice mannequins, and skills evaluations to teach skills to paramedics employed at a municipal fire department.

RESULTS

Pre- and posttraining surveys found that the paramedics were significantly more comfortable with the assessment and management of CSHCN after the completion of the self-study program, with a pretraining average of 2.83 and posttraining average of 4.20 on a five-point Likert-type scale, t(37) = 12.87, p < 0.001. A skills evaluation showed that skills performance varied widely across 21 skills, ranging from skills mastery to low skills knowledge. On the posttraining survey, between 74% and 94% of the paramedics rated each topic (tracheostomies, indwelling central venous catheters, cerebrospinal fluid shunts, gastrostomies, child abuse, and latex allergy) as applicable to their practices as paramedics.

CONCLUSION

Given the growing population of CSHCN, it is important to provide specialized education to increase an EMS provider's preparedness to respond to emergency situations involving children with special health care needs.

Use of emergency medical services by children with special health care needs

OBJECTIVE

This study describes emergency medical services (EMS) responses for children with special health care needs (CSHCN) in an urban area over a one-year period.

METHODS

A prospective surveillance system was established to identify EMS responses for children, 21 years of age or younger, with a congenital or acquired condition or a chronic physical or mental illness. Responses related to the special health care needs of the child were compared with unrelated responses.

RESULTS

During a one-year period, 924 responses were identified. Fewer than half of the responses were related to the child's special health care need. Younger children were significantly more likely to have a response related to their special needs than older children. Among related responses, seizure disorder was the most common diagnosis, while asthma was more common for unrelated responses. Almost 58% of the responses resulted in transport of the child to a hospital.

CONCLUSIONS

Emergency medical services responses related to a child's special health care needs differ from unrelated responses. The most common special health care needs of children did not require treatment beyond the prehospital care provider's usual standard of care. These results are relevant for communities providing EMS services for CSHCN.