Abstract
Dark matter is a key piece of the current cosmological scenario, with weakly interacting massive particles (WIMPs) a leading dark matter candidate. WIMPs have not been detected in their ...conventional parameter space (100 GeV ≲
M
χ
≲ 100 TeV), a mass range accessible with current Imaging Atmospheric Cherenkov Telescopes. As ultraheavy dark matter (UHDM;
M
χ
≳ 100 TeV) has been suggested as an underexplored alternative to the WIMP paradigm, we search for an indirect dark matter annihilation signal in a higher mass range (up to 30 PeV) with the VERITAS
γ
-ray observatory. With 216 hr of observations of four dwarf spheroidal galaxies, we perform an unbinned likelihood analysis. We find no evidence of a
γ
-ray signal from UHDM annihilation above the background fluctuation for any individual dwarf galaxy nor for a joint-fit analysis, and consequently constrain the velocity-weighted annihilation cross section of UHDM for dark matter particle masses between 1 TeV and 30 PeV. We additionally set constraints on the allowed radius of a composite UHDM particle.
A survey was conducted in UK regional children's hospitals with paediatric intensive care and paediatric infectious disease (PID) departments to describe the characteristics of paediatric ...antimicrobial stewardship (PAS) programmes. A structured questionnaire was sent to PAS coordinators. ‘Audit and feedback’ was implemented in 13 out of 17 centres. Microbiology-led services were more likely to implement antimicrobial restriction (75% vs 33% in PID-led services), to focus on broad-spectrum antibiotics, and to review patients with positive blood cultures. PID-led services were more likely to identify patients from e-prescribing or drug charts and review all antimicrobials. A PAS network has been established.
The spatial structure of turbulence in atmospheric boundary layer flows is highly relevant to wind energy. In particular, wind turbine control strategies based on inflow preview measurements require ...knowledge of the longitudinal evolution of turbulent flow as it approaches the rotor. These upstream measurements are usually obtained with nacelle-mounted wind lidars. In contrast to traditional in situ anemometry, lidars collect measurements within a probe volume which varies in size depending on the technology of the commercial system being used. Here, we address two issues related to the use of wind lidar to measure the incoming flow to a wind turbine: (i) whether existing longitudinal coherence models can be used to predict flow at the rotor, based on measurements performed at a distance away from the rotor; and (ii) what effect probe-volume averaging has on the inflow predictions. These two questions are critical to the design and implementation of robust wind turbine control strategies. To address these questions, we perform field measurements and large-eddy simulations to determine which incoming flow structures can be readily predicted with existing coherence models, and which require additional corrections to account for lidar volumetric averaging effects. Results reveal that the wind turbine induction zone has a negligible impact on the longitudinal coherence and first-order turbulence quantities, such as the standard deviation of velocity fluctuations. However, the phase of the signal, from which advection time periods of the turbulent structures are derived, is affected by the rotor blockage effect.
Abstract Recent experimental and numerical evidence has shown that the cumulative wake generated from the overlapping of multiple wakes within a wind farm could reduce power performance and enhance ...fatigue loads of wind turbines installed in neighboring downstream wind farms and may also extend up to distances one order of magnitude larger than those typically considered for intra-farm wake interactions. Similar to individual wind turbine wakes, wind farm wakes have a velocity deficit and added turbulence intensity, both affected by the turbine rotor thrust forces and the incoming turbulence intensity. Therefore, the evolution of wind farm wakes will vary for different operational and atmospheric conditions. In this paper, lidar measurements collected during the American WAKE experimeNt (AWAKEN) and wind tunnel tests of wind farms reproduced by porous disks are leveraged to investigate wind farm wakes.
On 2017 September 22, the IceCube Neutrino Observatory reported the detection of the high-energy neutrino event IC 170922A, of potential astrophysical origin. It was soon determined that the neutrino ...direction was consistent with the location of the gamma-ray blazar TXS 0506+056 (3FGL J0509.4+0541), which was in an elevated gamma-ray emission state as measured by the Fermi satellite. Very Energetic Radiation Imaging Telescope Array System (VERITAS) observations of the neutrino/blazar region started on 2017 September 23 in response to the neutrino alert and continued through 2018 February 6. While no significant very-high-energy (VHE; E > 100 GeV) emission was observed from the blazar by VERITAS in the two-week period immediately following the IceCube alert, TXS 0506+056 was detected by VERITAS with a significance of 5.8 standard deviations ( ) in the full 35 hr data set. The average photon flux of the source during this period was (8.9 1.6) × 10−12 cm−2 s−1, or 1.6% of the Crab Nebula flux, above an energy threshold of 110 GeV, with a soft spectral index of 4.8 1.3.
Abstract
Background
Morning report is a fundamental component of internal medicine training and often represents the most significant teaching responsibility of Chief Residents. We sought to define ...Chief Resident behaviors essential to leading a successful morning report.
Methods
In 2016, we conducted a multi-site qualitative study using key informant interviews of morning report stakeholders. 49 residents, Chief Residents, and faculty from 4 Internal Medicine programs participated. Interviews were analyzed and coded by 3 authors using inductive reasoning and thematic analysis. A preliminary code structure was developed and expanded in an iterative process concurrent with data collection until thematic sufficiency was reached and a final structure was established. This final structure was used to recode all transcripts.
Results
We identified four themes of Chief Resident behaviors that lead to a successful morning report: report preparation, delivery skills, pedagogical approaches, and faculty participation. Preparation domains include thoughtful case selection, learning objective development, content editing, and report organization. Delivery domains include effective presentation skills, appropriate utilization of technology, and time management. Pedagogical approach domains include learner facilitation techniques that encourage clinical reasoning while nurturing a safe learning environment, as well as innovative teaching strategies. Moderating the involvement of faculty was identified as the final key to morning report effectiveness. Specific behavior examples are provided.
Conclusion
Consideration of content preparation, delivery, pedagogical approaches, and moderation of faculty participation are key components to Chief Resident-led morning reports. Results from this study could be used to enhance faculty development for Chief Residents.
Abstract We use the Very Energetic Radiation Imaging telescope Array System (VERITAS) imaging air Cherenkov telescope array to obtain the first measured angular diameter of β UMa at visual ...wavelengths using stellar intensity interferometry (SII) and independently constrain the limb-darkened angular diameter. The age of the Ursa Major moving group has been assessed from the ages of its members, including nuclear member Merak ( β UMa), an A1-type subgiant, by comparing effective temperature and luminosity constraints to model stellar evolution tracks. Previous interferometric limb-darkened angular-diameter measurements of β UMa in the near-infrared (Center for High Angular Resolution Astronomy (CHARA) Array, 1.149 ± 0.014 mas) and mid-infrared (Keck Nuller, 1.08 ± 0.07 mas), together with the measured parallax and bolometric flux, have constrained the effective temperature. This paper presents current VERITAS-SII observation and analysis procedures to derive squared visibilities from correlation functions. We fit the resulting squared visibilities to find a limb-darkened angular diameter of 1.07 ± 0.04 (stat) ± 0.05 (sys) mas, using synthetic visibilities from a stellar atmosphere model that provides a good match to the spectrum of β UMa in the optical wave band. The VERITAS-SII limb-darkened angular diameter yields an effective temperature of 9700 ± 200 ± 200 K, consistent with ultraviolet spectrophotometry, and an age of 390 ± 29 ± 32 Myr, using MESA Isochrones and Stellar Tracks. This age is consistent with 408 ± 6 Myr from the CHARA Array angular diameter.
The purpose of this study was to examine additional diagnostic workup and costs generated by addition of a single molecular breast imaging (MBI) examination to screening mammography for women with ...dense breasts.
Women with mammographically dense breasts presenting for screening mammography underwent adjunct MBI performed with 300 MBq (99m)Tc-sestamibi and a direct-conversion cadmium-zinc-telluride dual-head gamma camera. All subsequent imaging tests and biopsies were tracked for a minimum of 1 year. The positive predictive value of biopsies performed (PPV3), benign biopsy rate, cost per patient screened, and cost per cancer detected were determined.
A total of 1651 women enrolled in the study. Among the 1585 participants with complete reference standard, screening mammography alone prompted diagnostic workup of 175 (11.0%) patients and biopsy of 20 (1.3%) and yielded five malignancies (PPV3, 25%). Results of combined screening mammography plus MBI prompted diagnostic workup of 279 patients (17.6%) and biopsy of 67 (4.2%) and yielded 19 malignancies (PPV3, 28.4%). The benign biopsy rates were 0.9% (15 of 1585) for screening mammography alone and 3.0% (48 of 1585) for the combination (p < 0.001). The addition of MBI increased the cost per patient screened from $176 for mammography alone to $571 for the combination. However, cost per cancer detected was lower for the combination ($47,597) than for mammography alone ($55,851).
The addition of MBI to screening mammography of women with dense breasts increased the overall costs and benign biopsy rate but also increased the cancer detection rate, which resulted in a lower cost per cancer detected than with screening mammography alone.
Abstract
Flat-spectrum radio quasars (FSRQs) are the most luminous blazars at GeV energies but only rarely emit detectable fluxes of TeV gamma rays, typically during bright GeV flares. We explore the ...gamma-ray variability and spectral characteristics of three FSRQs that have been observed at GeV and TeV energies by Fermi-LAT and VERITAS, making use of almost 100 hr of VERITAS observations spread over 10 yr: 3C 279, PKS 1222+216, and Ton 599. We explain the GeV flux distributions of the sources in terms of a model derived from a stochastic differential equation describing fluctuations in the magnetic field in the accretion disk and estimate the timescales of magnetic flux accumulation and stochastic instabilities in their accretion disks. We identify distinct flares using a procedure based on Bayesian blocks and analyze their daily and subdaily variability and gamma-ray energy spectra. Using observations from VERITAS, as well as Fermi, Swift, and the Steward Observatory, we model the broadband spectral energy distributions of PKS 1222+216 and Ton 599 during very high energy (VHE)–detected flares in 2014 and 2017, respectively, strongly constraining the jet Doppler factors and gamma-ray emission region locations during these events. Finally, we place theoretical constraints on the potential production of PeV-scale neutrinos during these VHE flares.
The potential economic benefit in terms of reduced healthcare costs when patients quit smoking after hospital discharge has not been directly measured. The aim of this study was to compare the costs ...for hospital admission and six-month follow-up for a cohort of patients who self-reported abstinence from cigarettes at 6 months after hospital discharge and a matched group of patients who reported continued smoking.
This was a secondary analysis of a recent population-based clinical trial cohort (ClinicalTrials.gov ID: NCT01575145), with cohort membership determined by self-reported 7 day point prevalence abstinence at 6 months after the index hospital discharge. Participants were admitted to Mayo Clinic Hospital, Rochester, MN, between May 5, 2012 and August 10, 2014 for any indication and lived in the areas covered by postal codes included in Olmsted County, MN. Propensity score matching was used to control for differences between groups other than smoking status, and any residual imbalance was adjusted through generalized linear model with gamma distribution for cost and log-link transformation.
Of 600 patients enrolled in the clinical trial, 144 could be contacted and self-reported 7 day point prevalence abstinence at 6 months after hospital discharge. Of these patients, 99 were successfully matched for this analysis. The cost for the index hospitalization was significantly greater in patients who abstained compared to those that did not abstain (mean difference of $3042, higher for abstainers, 95% CI $170 to $5913, P = 0.038). However, there was no difference between mean 6-month follow-up costs, number of inpatient hospitalizations, or number of emergency room visits for abstainers versus non-abstainers.
There was no evidence to support the hypothesis that abstinence at 6 months after hospital discharge is associated with a decrease in health care costs or utilization over the first 6 months after hospital discharge.
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