SNO+ is a large liquid scintillator-based experiment located 2 km underground at SNOLAB, Sudbury, Canada. It reuses the Sudbury Neutrino Observatory detector, consisting of a 12 m diameter acrylic ...vessel which will be filled with about 780 tonnes of ultra-pure liquid scintillator. Designed as a multipurpose neutrino experiment, the primary goal of SNO+ is a search for the neutrinoless double-beta decay (0νββ) of 130Te. In Phase I, the detector will be loaded with 0.3% natural tellurium, corresponding to nearly 800 kg of 130Te, with an expected effective Majorana neutrino mass sensitivity in the region of 55–133 meV, just above the inverted mass hierarchy. Recently, the possibility of deploying up to ten times more natural tellurium has been investigated, which would enable SNO+ to achieve sensitivity deep into the parameter space for the inverted neutrino mass hierarchy in the future. Additionally, SNO+ aims to measure reactor antineutrino oscillations, low energy solar neutrinos, and geoneutrinos, to be sensitive to supernova neutrinos, and to search for exotic physics. A first phase with the detector filled with water will begin soon, with the scintillator phase expected to start after a few months of water data taking. The 0νββ Phase I is foreseen for 2017.
Background
The aim was to describe the management of benign gallbladder disease and identify characteristics associated with all‐cause 30‐day readmissions and complications in a prospective ...population‐based cohort.
Methods
Data were collected on consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing all‐cause 30‐day readmissions and complications were analysed by means of multilevel, multivariable logistic regression modelling using a two‐level hierarchical structure with patients (level 1) nested within hospitals (level 2).
Results
Data were collected on 8909 patients undergoing cholecystectomy from 167 hospitals. Some 1451 cholecystectomies (16·3 per cent) were performed as an emergency, 4165 (46·8 per cent) as elective operations, and 3293 patients (37·0 per cent) had had at least one previous emergency admission, but had surgery on a delayed basis. The readmission and complication rates at 30 days were 7·1 per cent (633 of 8909) and 10·8 per cent (962 of 8909) respectively. Both readmissions and complications were independently associated with increasing ASA fitness grade, duration of surgery, and increasing numbers of emergency admissions with gallbladder disease before cholecystectomy. No identifiable hospital characteristics were linked to readmissions and complications.
Conclusion
Readmissions and complications following cholecystectomy are common and associated with patient and disease characteristics.
Emergency rather than delayed cholecystectomy
The production and analysis of distributed sources of
24Na and
222Rn in the Sudbury Neutrino Observatory (SNO) are described. These unique sources provided accurate calibrations of the response to ...neutrons, produced through photodisintegration of the deuterons in the heavy water target, and to low energy betas and gammas. The application of these sources in determining the neutron detection efficiency and response of the
3He proportional counter array, and the characteristics of background Cherenkov light from trace amounts of natural radioactivity is described.
Four methods for determining the composition of low-level uranium- and thorium-chain surface contamination are presented. One method is the observation of Cherenkov light production in water. In two ...additional methods a position-sensitive proportional counter surrounding the surface is used to make both a measurement of the energy spectrum of alpha particle emissions and also coincidence measurements to derive the thorium-chain content based on the presence of short-lived isotopes in that decay chain. The fourth method is a radiochemical technique in which the surface is eluted with a weak acid, the eluate is concentrated, added to liquid scintillator and assayed by recording beta–alpha coincidences. These methods were used to characterize two ‘hotspots’ on the outer surface of one of the 3He proportional counters in the Neutral Current Detection array of the Sudbury Neutrino Observatory experiment. The methods have similar sensitivities, of order tens of ng, to both thorium- and uranium-chain contamination.
Observations of neutral-current nu interactions on deuterium in the Sudbury Neutrino Observatory are reported. Using the neutral current (NC), elastic scattering, and charged current reactions and ...assuming the standard 8B shape, the nu(e) component of the 8B solar flux is phis(e) = 1.76(+0.05)(-0.05)(stat)(+0.09)(-0.09)(syst) x 10(6) cm(-2) s(-1) for a kinetic energy threshold of 5 MeV. The non-nu(e) component is phi(mu)(tau) = 3.41(+0.45)(-0.45)(stat)(+0.48)(-0.45)(syst) x 10(6) cm(-2) s(-1), 5.3sigma greater than zero, providing strong evidence for solar nu(e) flavor transformation. The total flux measured with the NC reaction is phi(NC) = 5.09(+0.44)(-0.43)(stat)(+0.46)(-0.43)(syst) x 10(6) cm(-2) s(-1), consistent with solar models.
The Sudbury Neutrino Observatory (SNO) has measured day and night solar neutrino energy spectra and rates. For charged current events, assuming an undistorted 8B spectrum, the night minus day rate is ...14.0%+/-6.3%(+1.5%)(-1.4%) of the average rate. If the total flux of active neutrinos is additionally constrained to have no asymmetry, the nu(e) asymmetry is found to be 7.0%+/-4.9%(+1.3%)(-1.2%). A global solar neutrino analysis in terms of matter-enhanced oscillations of two active flavors strongly favors the large mixing angle solution.
Background
The optimal timing of cholecystectomy for patients admitted with acute gallbladder pathology is unclear. Some studies have shown that emergency cholecystectomy during the index admission ...can reduce length of hospital stay with similar rates of conversion to open surgery, complications and mortality compared with a ‘delayed’ operation following discharge. Others have reported that cholecystectomy during the index acute admission results in higher morbidity, extended length of stay and increased costs. This study examined the cost‐effectiveness of emergency versus delayed cholecystectomy for acute benign gallbladder disease.
Methods
Using data from a prospective population‐based cohort study examining the outcomes of cholecystectomy in the UK and Ireland, a model‐based cost–utility analysis was conducted from the perspective of the UK National Health Service, with a 1‐year time horizon for costs and outcomes. Probabilistic sensitivity analysis was used to investigate the impact of parameter uncertainty on the results obtained from the model.
Results
Emergency cholecystectomy was found to be less costly (£4570 versus £4720; €5484 versus €5664) and more effective (0·8868 versus 0·8662 QALYs) than delayed cholecystectomy. Probabilistic sensitivity analysis showed that the emergency strategy is more than 60 per cent likely to be cost‐effective across willingness‐to‐pay values for the QALY from £0 to £100 000 (€0–120 000).
Conclusion
Emergency cholecystectomy is less costly and more effective than delayed cholecystectomy. This approach is likely to be beneficial to patients in terms of improved health outcomes and to the healthcare provider owing to the reduced costs.
Emergency cholecystectomy is cheaper and more effective
Background
The aims of this prospective population‐based cohort study were to identify the patient and hospital characteristics associated with emergency cholecystectomy, and the influences of these ...in determining variations between hospitals.
Methods
Data were collected for consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing the performance of emergency cholecystectomy were analysed by means of multilevel, multivariable logistic regression modelling using a two‐level hierarchical structure with patients (level 1) nested within hospitals (level 2).
Results
Data were collected on 4744 cholecystectomies from 165 hospitals. Increasing age, lower ASA fitness grade, biliary colic, the need for further imaging (magnetic retrograde cholangiopancreatography), endoscopic interventions (endoscopic retrograde cholangiopancreatography) and admission to a non‐biliary centre significantly reduced the likelihood of an emergency cholecystectomy being performed. The multilevel model was used to calculate the probability of receiving an emergency cholecystectomy for a woman aged 40 years or over with an ASA grade of I or II and a BMI of at least 25·0 kg/m2, who presented with acute cholecystitis with an ultrasound scan showing a thick‐walled gallbladder and a normal common bile duct. The mean predicted probability of receiving an emergency cholecystectomy was 0·52 (95 per cent c.i. 0·45 to 0·57). The predicted probabilities ranged from 0·02 to 0·95 across the 165 hospitals, demonstrating significant variation between hospitals.
Conclusion
Patients with similar characteristics presenting to different hospitals with acute gallbladder pathology do not receive comparable care.
Similar patients, not similar care
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