The contribution of different components of an air shower to the total energy deposit in the atmosphere, for different angles and primary particles, was studied using the CORSIKA air shower ...simulation code. The amount of missing energy, parameterized in terms of the calorimetric energy, was calculated. The results show that this parameterization varies less than 1% with angle or observation level. The dependence with the primary mass is less than 5% and, with the high energy hadronic interaction model, less than 2%. The systematic error introduced by the use of just one parameterization of the missing energy correction function, for an equal mixture of proton and iron at 45°, was calculated to be below 3%. We estimate the statistical error due to shower-to-shower fluctuations to be about 1%.
Science with the Cherenkov Telescope Array The Cta Consortium, The Cta Consortium
The Astrophysical journal. Supplement series,
01/2019, Letnik:
240, Številka:
2
eBook, Journal Article, Book
Recenzirano
Odprti dostop
This book summarizes the science to be carried out by the upcoming Cherenkov Telescope Array, a major ground-based gamma-ray observatory that will be constructed over the next six to eight years. The ...major scientific themes, as well as core program of key science projects, have been developed by the CTA Consortium, a collaboration of scientists from many institutions worldwide. CTA will be the major facility in high-energy and very high-energy photon astronomy over the next decade and beyond. CTA will have capabilities well beyond past and present observatories. Thus, CTA's science program is expected to be rich and broad and will complement other major multiwavelength and multimessenger facilities. This book is intended to be the primary resource for the science case for CTA and it thus will be of great interest to the broader physics and astronomy communities. The electronic version (e-book) is available in open access.
Abstract
Background
The effectiveness of catheter-directed thrombolysis (CDT) for acute pulmonary embolism (PE) has been rarely investigated in subgroups of patients at a higher risk of ...complications. Furthermore, this group of patients has been excluded from prior and ongoing phase 3 trials with CDT.
Purpose
To assess the efficacy and safety of catheter-directed thrombolysis for pulmonary embolism among specific patient subpopulations.
Material and methods
We conducted an individual patient-level analysis of patient data from 16 cohort studies and randomized trials of CDT for intermediate- and high-risk acute PE. Studies were identified on the basis of a systematic review of the literature. We focused on early clinical outcomes, including haemodynamic decompensation, intracranial bleeding, major bleeding, and death, as well as on the changes in the mean pulmonary artery pressure (mPAP) before and after CDT. We predefined three subgroups of at-risk patients: (i) older age (i.e. ≥75 years), (ii) active cancer, and (iii) surgery in the prior 4 weeks.
Results
We studied 1244 patients, of whom 586 (47.1%) were women. The median age was 61 (Q1-Q3; 50-71) years. There were 202 (16.3% of total available) patients aged 75 years or older, 101 (10%) with active cancer, and 108 (14.8%) with prior surgery. A total of 946 (89.3%) patients had intermediate-risk PE, and 113 (10.7%) were classified in the high-risk group. Patients aged ≥75 years more frequently suffered haemodynamic decompensation (7.5% vs 1.6% aged <75 years; p< 0.001), major bleeding (12.7% vs 4.5%; p<0.001), and death (9.2% vs 2.2%; p<0.001); Table 1. In a multivariable logistic regression model, age remained associated with death, major bleeding, and haemodynamic decompensation after adjustment for a key prognostic factor (high-risk PE). The same, except for decompensation, was observed after conditioning for sex, high-risk PE, and cancer status. Patients with active cancer showed a tendency to a higher 30-day case fatality when compared with patients with no active cancer, without reaching statistical significance; Table 1. Recent surgery did not appear to influence the outcome rate in this cohort. No differences were found among the three subgroups regarding the reduction of the mPAP following CDT ; Table 2.
Conclusions
Our results point to age as a strong predictor of early mortality and decompensation in patients undergoing CDT, even after adjusting for the higher rate of high-risk PE in the elderly. The clinical net benefit of CDT in the elderly when accounting for bleeding and the risk of haemodynamic decompensation remains unclear.Efficacy and safety outcomes of CDTmPAP values before and after CDT
We report a measurement of the energy spectrum of cosmic rays for energies above 2.5 × 1018 eV based on 215,030 events recorded with zenith angles below 60°. A key feature of the work is that the ...estimates of the energies are independent of assumptions about the unknown hadronic physics or of the primary mass composition. The measurement is the most precise made hitherto with the accumulated exposure being so large that the measurements of the flux are dominated by systematic uncertainties except at energies above 5 × 1019 eV. The principal conclusions are (1) The flattening of the spectrum near 5 × 1018 eV, the so-called "ankle," is confirmed. (2) The steepening of the spectrum at around 5 × 1019 eV is confirmed. (3) A new feature has been identified in the spectrum: in the region above the ankle the spectral index γ of the particle flux ( ∝ E−γ ) changes from 2.51 ± 0.03 ( stat ) ± 0.05 ( syst ) to 3.05 ± 0.05 ( stat ) ± 0.10 ( syst ) before changing sharply to 5.1 ± 0.3 ( stat ) ± 0.1 ( syst ) above 5 × 1019 eV. (4) No evidence for any dependence of the spectrum on declination has been found other than a mild excess from the Southern Hemisphere that is consistent with the anisotropy observed above 8 × 1018 eV.
We report a measurement of the energy spectrum of cosmic rays above 2.5 × 1018 eV based on 215 030 events. New results are presented: at about 1.3 × 1019 eV , the spectral index changes from 2.51 ± ...0.03 (stat) ± 0.05 (syst) to 3.05 ± 0.05 (stat) ± 0.10 (syst), evolving to 5.1 ± 0.3 (stat) ± 0.1 (syst) beyond 5 × 1019 eV, while no significant dependence of spectral features on the declination is seen in the accessible range. These features of the spectrum can be reproduced in models with energy-dependent mass composition. The energy density in cosmic rays above 5 × 1018 eV is 5.66 ± 0.03 (stat) ± 1.40 (syst) × 1053 erg Mpc−3.
Abstract
Background
Catheter-directed thrombolysis (CDT) can accelerate relief of the right ventricle overload secondary to acute pulmonary embolism (PE). The effectiveness and safety of CDT, also in ...relation to dose, duration, and different devices, are still a matter of debate.
Purpose
We conducted a systematic review and meta-analysis to assess effectiveness and safety of CDT for intermediate- and high-risk acute PE.
Methods
We systematically searched PubMed, Web of Science and CENTRAL (inception-December 2022) and selected randomized controlled trials (RCTs), observational studies, and epidemiological analysis (DRG-based, nationwide studies), focusing on standard CDT (sCDT) vs. ultrasound-assisted catheter-directed thrombolysis (USAT) for intermediate- and high-risk acute PE, according to European Society of Cardiology definition. We obtained pooled estimate rates for bleeding (intracranial and major), in-hospital/30-day fatality rate, and estimated the early improvement of several hemodynamic parameters (i.e. right/left ventricle RV/LV ratio, pulmonary artery pressure PAP) and long-term course.
Results
Overall, 58 studies with 37,496 patients (mean age 60 years) were included. The pooled intracranial bleeding rate was 0.15% (95%CI: 0-0.58%) in trials and cohort studies, and 0.87% (95%CI: 0.44-1.42%) in epidemiological studies; Fig. 1. Randomized trials comparing CDT vs. anticoagulation alone reported neither intracranial nor fatal bleeding events. In trials and cohort studies, higher rates of major bleedings were observed with longer (4.5%; 95%CI: 2.4-7.1%) vs. shorter (0.7%, 95%CI: 0-2.2%) treatment duration (p=0.01), irrespective of the dose; Fig. 2. Longer CDT regimens were associated with a high fatality rate of 2.8% (95%CI: 1.5-4.2%) vs. 0.1% (95%CI: 0-1.1%) with shorter CDT treatment (<0.01), disregarding the lytic dose; Fig. 2. All early hemodynamic and radiological outcomes assessed in available studies improve after CDT regardless of dose, duration, and type of device. However, data on the long-term course of PE after CDT has been rarely reported in literature.
Conclusions
The available evidence supports the notion that CDT strategies may represent a safe option for reversing right ventricular dysfunction due to acute PE. Overall, the reported rate of intracranial bleeding was below 1%. Patients exposed to longer CDT regimens had a higher incidence of major bleeding and fatality. Randomised trials with clinical outcomes are necessary to truly establish optimal patient selection and CDT protocol.Prevalence of intracranial bleedingOutcomes in RCTs and cohort studies
Abstract
Issue
Fragility is a major challenge that demand a comprehensive public health response, since a high rate of population is aging and becoming vulnerable.
Description of the Problem
The ...Local Health Authority of Bologna, about 850,000 inhabitants, has implemented a new qualitative and quantitative Project on fragile patients. Frailty was measured by the “Risk Profile of the Emilia-Romagna region,”, an algorithm that provides a risk index, based on patients'record, which divide population in risk categories (high/very high, moderate and low risk) of hospitalization. The 585 General Practitioners (GPs) have enrolled their fragile patients with high and very high risk (about 6% of the population). GPs and other healthcare professionals are asked to define an Individualized Care Plan (ICP) according to an integrated and multi-professional management perspective. Patients' and healthcare professionals' subjective experience was collected throughout a structured interview.
Results
From October 2018 to April 2019, 260 patients were included in the project and they received a ICP which included different interventions such as: integrated nursing care (105), nursing care in chronic ambulatory (55), community hospital care (9), social assistance (92), physiotherapy (88), specialist activities (114). Qualitative data highlighted high level of satisfaction both in patients and clinicians. The strengths of the Project are: 1) an integrated management (with a multi- professional team) of frailty population, 2) proactive and individualized treatment plan. Limitations are: 1) different approaches among clinicians in the Local Health Authority of Bologna with possible inequalities of accessibility to the treatment; 2) difficulties in the relationships among clinicians.
The early recognition and the specialistic management of the fragile population have to be considered a priority in health practice in order to provide effective medical intervention.
Key messages
Individualized Care Plan (ICP) and integrated and multi-professional management. Importance of fragility early recognition.
Abstract
Background
Measles is increasing globally, with a 300% increase in the first three months of 2019 in the WHO European Region. Measles cases recorded annually over the last decade in Italy ...have been cyclical with the last peak in 2017 with 84 cases per million inhabitants. In the same year, national coercive vaccination measures were introduced for access to educational services. Although the country is again achieving adequate vaccination coverage (VC) for the second dose of MRR (93.2% in 2018), outbreaks can still occur in communities with low VCs.
Methods
The aim of this study was to analyze measles epidemiology in Bologna Local Health Authority (LHA) from 2010 to 2018, focusing on age groups at higher risk of spread. Aggregate data on measles incidence were provided by Bologna HLA and VCs in residents were provided by the Emilia-Romagna Region (RER).
Results
The number of cases in the period of reference was 261 cases, 240 of which were laboratory confirmed (92%). The overall average age was 28.5 years (standard deviation, ds: ±14.73 years). The age group with the highest average incidence rate was 20-24 years (93 per 1.000.000 inhabitants), followed by 25-29 years (88) and 30-34 years (75). With regard to occupation at highest risk of prevalence, students represented the largest group with 22.6% of cases. VC data in residents in RER showed that in the age group 19-35 the fraction of the population not vaccinated with two doses of vaccine decreased significantly in the birth cohorts of the 1990s with a coverage of 6.9% for the 1984 birth cohort. None of the cohorts taken into consideration achieved a VC of 95% for the second dose.
Conclusions
Our results confirm the high proportion of measles cases among young adults. This highlights the need to consider catch-up actions and awareness campaign. For example, by focusing on students without previous documented vaccinations, considering that Bologna is home to tens of thousands of University students every year.
Key messages
The measles epidemiology analysis in the Local Health Authority of Bologna (Italy) over the last decade showed that the young adults (aged 20-35) have the highest average incidence rate of measles. Considering the need to focus on young adults in order to contain new cases of measles; checks on previous vaccinations, catch-up actions and improved awareness campaign are essential.
We test the predictions of hadronic interaction models regarding the depth of maximum of air-shower profiles, X max , and ground-particle signals in water-Cherenkov detectors at 1000 m from the ...shower core, S ( 1000 ) , using the data from the fluorescence and surface detectors of the Pierre Auger Observatory. The test consists of fitting the measured two-dimensional ( S ( 1000 ) , X max ) distributions using templates for simulated air showers produced with hadronic interaction models pos-, et--04, 2.3d and leaving the scales of predicted X max and the signals from hadronic component at ground as free-fit parameters. The method relies on the assumption that the mass composition remains the same at all zenith angles, while the longitudinal shower development and attenuation of ground signal depend on the mass composition in a correlated way. The analysis was applied to 2239 events detected by both the fluorescence and surface detectors of the Pierre Auger Observatory with energies between 10 18.5 eV to 10 19.0 eV and zenith angles below 60°. We found, that within the assumptions of the method, the best description of the data is achieved if the predictions of the hadronic interaction models are shifted to deeper X max values and larger hadronic signals at all zenith angles. Given the magnitude of the shifts and the data sample size, the statistical significance of the improvement of data description using the modifications considered in the paper is larger than 5 σ even for any linear combination of experimental systematic uncertainties. Published by the American Physical Society 2024
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