Although pulmonary aspiration complicating operative general anaesthesia has been extensively studied, little is known regarding aspiration during procedural sedation.
We performed a comprehensive, ...systematic review to identify and catalogue published instances of aspiration involving procedural sedation in patients of all ages. We sought to report descriptively the circumstances, nature, and outcomes of these events.
Of 1249 records identified by our search, we found 35 articles describing one or more occurrences of pulmonary aspiration during procedural sedation. Of the 292 occurrences during gastrointestinal endoscopy, there were eight deaths. Of the 34 unique occurrences for procedures other than endoscopy, there was a single death in a moribund patient, full recovery in 31, and unknown recovery status in two. We found no occurrences of aspiration in non-fasted patients receiving procedures other than endoscopy.
This first systematic review of pulmonary aspiration during procedural sedation identified few occurrences outside of gastrointestinal endoscopy, with full recovery typical. Although diligent caution remains warranted, our data indicate that aspiration during procedural sedation appears rare, idiosyncratic, and typically benign.
A
bstract
We investigate the non-relativistic reduction of simplified models for spin 1 dark matter (DM) with the aim of identifying features in the phenomenology of DM-quark interactions which are ...specific to vector DM. In the case of DM-quark interactions mediated by a spin 1 particle, we find two DM-nucleon interaction operators arising from the non-relativistic reduction of simplified models for spin 1 DM that are specific to spin 1 DM, and which were not considered in previous studies. They are quadratic in the momentum transfer, linear in a symmetric combination of polarisation vectors for the DM particle, and arise from simplified models which do not generate momentum transfer independent operators as leading interactions in the non-relativistic expansion of DM-nucleon scattering amplitudes. Within these simplified models, the new operators cannot be neglected when computing DM signals at direct detection experiments. For example, we find that nuclear recoil energy spectra computed by including or neglecting the new operators can differ by up to one order of magnitude for nuclear recoil energies larger than about 20 keV and DM masses below 50 GeV. Furthermore, the shape of the expected nuclear recoil spectra depends significantly on whether the new operators are taken into account or not. Finally, neglecting the contribution to DM direct detection signals from the new operators leads to inaccurate conclusions when assessing the compatibility of a future direct detection signal with CMB constraints on the DM relic density, especially when the number of signal events is small, e.g.
O
(1).
A
bstract
It is well-known that dark matter (DM) direct detection experiments and the LHC are complementary, since they probe physical processes occurring at different energy scales. And yet, there ...are aspects of this complementarity which are still not fully understood, or exploited. For example, what is the impact that the discovery of DM at XENONnT would have on present and future searches for DM in LHC final states involving a pair of hadronic jets? In this work we investigate the impact of a XENONnT signal on the interpretation of current dijet searches at the LHC, and on the prospects for dijet signal discovery at the High-Luminosity (HL) LHC in the framework of simplified models. Specifically, we focus on a general class of simplified models where DM can have spin 0, 1/2 or 1, and interacts with quarks through the exchange of a scalar, pseudo-scalar, vector, or pseudo-vector mediator. We find that exclusion limits on the mediator’s mass and its coupling to quarks from dijet searches at the LHC are significantly affected by a signal at XENONnT, and that
O
(100) signal events at XENONnT would drastically narrow the region in the parameter space of simplified models where a dijet signal can be discovered at 5
σ
C.L. at the HL-LHC.
Summary
The multidisciplinary International Committee for the Advancement of Procedural Sedation presents the first fasting and aspiration prevention recommendations specific to procedural sedation, ...based on an extensive review of the literature. These were developed using Delphi methodology and assessment of the robustness of the available evidence. The literature evidence is clear that fasting, as currently practiced, often substantially exceeds recommended time thresholds and has known adverse consequences, for example, irritability, dehydration and hypoglycaemia. Fasting does not guarantee an empty stomach, and there is no observed association between aspiration and compliance with common fasting guidelines. The probability of clinically important aspiration during procedural sedation is negligible. In the post‐1984 literature there are no published reports of aspiration‐associated mortality in children, no reports of death in healthy adults (ASA physical status 1 or 2) and just nine reported deaths in adults of ASA physical status 3 or above. Current concerns about aspiration are out of proportion to the actual risk. Given the lower observed frequency of aspiration and mortality than during general anaesthesia, and the theoretical basis for assuming a lesser risk, fasting strategies in procedural sedation can reasonably be less restrictive. We present a consensus‐derived algorithm in which each patient is first risk‐stratified during their pre‐sedation assessment, using evidence‐based factors relating to patient characteristics, comorbidities, the nature of the procedure and the nature of the anticipated sedation technique. Graded fasting precautions for liquids and solids are then recommended for elective procedures based upon this categorisation of negligible, mild or moderate aspiration risk. This consensus statement can serve as a resource to practitioners and policymakers who perform and oversee procedural sedation in patients of all ages, worldwide.
Dark matter from the vector of SO(10) Boucenna, Sofiane M.; Krauss, Martin B.; Nardi, Enrico
Physics letters. B,
04/2016, Letnik:
755
Journal Article
Recenzirano
Odprti dostop
SO(10) grand unified theories can ensure the stability of new particles in terms of the gauge group structure itself, and in this respect are well suited to accommodate dark matter (DM) candidates in ...the form of new stable massive particles. We introduce new fermions in two vector 10 representations. When SO(10) is broken into the standard model by a minimal 45+126‾+10 scalar sector with SU(3)C⊗SU(2)L⊗SU(2)R⊗U(1)B−L as intermediate symmetry group, the resulting lightest new states are two Dirac fermions corresponding to combinations of the neutral members of the SU(2)L doublets in the 10s, which get split in mass by loop corrections involving WR. The resulting lighter mass eigenstate is stable, and has only non-diagonal ZL,R neutral current couplings to the heavier neutral state. Direct detection searches are evaded if the mass splitting is sufficiently large to suppress kinematically inelastic light-to-heavy scatterings. By requiring that this condition is satisfied, we obtain the upper limit MWR≲25 TeV.
Ton-scale direct dark matter search experiments should be sensitive to neutrino-induced recoil events from either 8B solar neutrinos or the brief but intense flux from a core collapse supernova in ...the Milky Way. These low-threshold detectors are sensitive to the very low recoil energies, of order 10 keV, deposited via coherent elastic scatters between supernova neutrinos and target nuclei. Large superheated fluid detectors like PICO-500, a bubble chamber to be initially filled with an active target of 1 t of C3F8, should see multiple-bubble events from CEνNS if the detector is live during a neutrino burst from a supernova at a distance up to 10 kpc. This paper discusses conditions under which bubble chambers could be used as an independent measurement in the event of a supernova similar to SN 1987A, with particular sensitivity to the currently less-constrained heavy-lepton νx channel.
Detection of underlying tumor in patients with unknown-origin acute ICH may be difficult because acute hematoma may mask enhancement of tumor on postcontrast CT. We intended to investigate the ...clinical utility of DECT in differentiating tumor bleeding from pure ICH.
Using a dual-source CT scanner, we obtained TNC single-energy and postcontrast DECT scans for 56 patients with unknown-origin spontaneous ICH. From the 2 sets of postcontrast DECT images obtained with different tube energy, EA (equivalent to conventional postcontrast CT), VNC, color-coded iodine overlay, fusion images of iodine overlay and VNC images were produced. The diagnostic performances of fusion, EA, and combined EA and TNC images for detecting underlying tumors were compared.
Of the 56 patients, 17 had primary or metastatic tumors (18 lesions) and 39 had nontumorous ICH. The sensitivities of fusion, EA, and combined EA and TNC images for detecting brain tumors were 94.4%, 61.1%, and 66.7%, respectively, and their specificities were 97.4%, 92.3%, and 89.7%, respectively. The areas under the ROC curves were 0.964, 0.786, and 0.842, respectively. Overall, the diagnostic performance of fusion images was significantly superior to EA (P = .006) and combined EA and TNC (P = .011) images.
DECT may be useful in detecting underlying tumors in patients with unknown-origin ICH.
The interactions of dark matter (DM) with the visible sector are often phenomenologically described in the framework of simplified models, where the couplings of quarks to the new particles are ...generally assumed to be universal or have a simple structure motivated by observational benchmarks. They should, however, a priori be treated as free parameters. In this work, we discuss one particular realization of the structure of DM couplings based on an S4 × Z5 flavor symmetry, which has been shown to account reasonably well for fermion masses and mixing, and compare their effect on observational signals to universal as well as Yukawa-like couplings, which are motivated by a minimal flavor violation. We will also comment on how these structures could be constrained in UV complete theories of DM and how DM observables, such as, e.g., relic density and direct detection, can potentially be used as a smoking gun for the underlying flavor symmetries.
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