In the last 4 decades, advances in neonatology have led to a significant increase in the survival of preterm infants. One of the biggest advances was the introduction of surfactant replacement ...therapy for the treatment of respiratory distress syndrome. This is the main cause of respiratory insufficiency in preterm infants and is one of the major causes of perinatal morbidity and mortality. Surfactant replacement therapy is already a well-investigated and established therapy in neonatology. However, surfactant replacement therapy has progressed and been refined over recent decades, especially with the increasing care for preterm infants born before 26 weeks' gestational age and the recent clinical focus on avoiding mechanical ventilation. Clinical evidence is evolving on new types of surfactant, surfactant dosages, co-medication given before, with, or after surfactant replacement, and new technical advances regarding the mode of administration.
In the past decade, the observations of diffuse radio synchrotron emission toward galaxy clusters revealed cosmic-ray (CR) electrons and magnetic fields on megaparsec scales. However, their origin ...remains poorly understood to date, and several models have been discussed in the literature. CR protons are also expected to accumulate during the formation of clusters and probably contribute to the production of these high-energy electrons. In order to understand the physics of CRs in clusters, combining of observations at various wavelengths is particularly relevant. The exploitation of such data requires using a self-consistent approach including both the thermal and the nonthermal components, so that it is capable of predicting observables associated with the multiwavelength probes at play, in particular in the radio, millimeter, X-ray, and
γ
-ray bands. We develop and describe such a self-consistent modeling framework, called
MINOT
(modeling the intracluster medium (non-)thermal content and observable prediction tools) and make this tool available to the community.
MINOT
models the intracluster diffuse components of a cluster (thermal and nonthermal) as spherically symmetric. It therefore focuses on CRs associated with radio halos. The spectral properties of the cluster CRs are also modeled using various possible approaches. All the thermodynamic properties of a cluster can be computed self-consistently, and the particle physics interactions at play are processed using a framework based on the
Naima
software. The multiwavelength observables (spectra, profiles, flux, and images) are computed based on the relevant physical process, according to the cluster location (sky and redshift), and based on the sampling defined by the user. With a standard personal computer, the computing time for most cases is far shorter than one second and it can reach about one second for the most complex models. This makes
MINOT
suitable for instance for Monte Carlo analyses. We describe the implementation of
MINOT
and how to use it. We also discuss the different assumptions and approximations that are involved and provide various examples regarding the production of output products at different wavelengths. As an illustration, we model the clusters Abell 1795, Abell 2142, and Abell 2255 and compare the
MINOT
predictions to literature data. While
MINOT
was originally build to simulate and model data in the
γ
-ray band, it can be used to model the cluster thermal and nonthermal physical processes for a wide variety of datasets in the radio, millimeter, X-ray, and
γ
-ray bands, as well as the neutrino emission.
The establishment of an epidemiological overview provides valuable insights needed for the (future) dissemination of infection-prevention initiatives.
To describe the nationwide epidemiology of ...central-line-associated bloodstream infections (CLABSI) among Dutch Neonatal Intensive Care Units (NICUs).
Data from 2935 neonates born at <32 weeks' gestation and/or with a birth weight <1500 g admitted to all nine Dutch NICUs over a two-year surveillance period (2019-2020) were analysed. Variations in baseline characteristics, CLABSI incidence per 1000 central-line days, pathogen distribution and CLABSI care bundles were evaluated. Multi-variable logistic mixed-modelling was used to identify significant predictors for CLABSI.
A total of 1699 (58%) neonates received a central line, in which 160 CLABSI episodes were recorded. Coagulase-negative staphylococci were the most common infecting organisms of all CLABSI episodes (N=100, 63%). An almost six-fold difference in the CLABSI incidence between participating units was found (2.91-16.14 per 1000 line-days). Logistic mixed-modelling revealed longer central line dwell-time (adjusted odds ratio (aOR):1.08, P<0.001), umbilical lines (aOR:1.85, P=0.03) and single rooms (aOR:3.63, P=0.02) to be significant predictors of CLABSI. Variations in bundle elements included intravenous tubing care and antibiotic prophylaxis.
CLABSI remains a common problem in preterm infants in The Netherlands, with substantial variation in incidence between centres. Being the largest collection of data on the burden of neonatal CLABSI in The Netherlands, this epidemiological overview provides a solid foundation for the development of a collaborative platform for continuous surveillance, ideally leading to refinement of national evidence-based guidelines. Future efforts should focus on ensuring availability and extraction of routine patient data in aggregated formats.
High-energy gamma-ray emission from supernova remnants (SNRs) has provided a unique perspective for studies of Galactic cosmic-ray acceleration. Tycho's SNR is a particularly good target because it ...is a young, type Ia SNR that has been well-studied over a wide range of energies and located in a relatively clean environment. Since the detection of gamma-ray emission from Tycho's SNR by VERITAS and Fermi-LAT, there have been several theoretical models proposed to explain its broadband emission and high-energy morphology. We report on an update to the gamma-ray measurements of Tycho's SNR with 147 hr of VERITAS and 84 months of Fermi-LAT observations, which represent about a factor of two increase in exposure over previously published data. About half of the VERITAS data benefited from a camera upgrade, which has made it possible to extend the TeV measurements toward lower energies. The TeV spectral index measured by VERITAS is consistent with previous results, but the expanded energy range softens a straight power-law fit. At energies higher than 400 GeV, the power-law index is 2.92 0.42stat 0.20sys. It is also softer than the spectral index in the GeV energy range, 2.14 0.09stat 0.02sys, measured in this study using Fermi-LAT data. The centroid position of the gamma-ray emission is coincident with the center of the remnant, as well as with the centroid measurement of Fermi-LAT above 1 GeV. The results are consistent with an SNR shell origin of the emission, as many models assume. The updated spectrum points to a lower maximum particle energy than has been suggested previously.
Combined with measurements made by very-long-baseline interferometry, the observations of fast TeV gamma-ray flares probe the structure and emission mechanism of blazar jets. However, only a handful ...of such flares have been detected to date, and only within the last few years have these flares been observed from lower-frequency-peaked BL Lac objects and flat-spectrum radio quasars. We report on a fast TeV gamma-ray flare from the blazar BL Lacertae observed by the Very Energetic Radiation Imaging Telescope Array System (VERITAS). with a rise time of ∼2.3 hr and a decay time of ∼36 min. The peak flux above 200 GeV is (4.2 0.6) × 10−6 photon m−2 s−1 measured with a 4-minute-binned light curve, corresponding to ∼180% of the flux that is observed from the Crab Nebula above the same energy threshold. Variability contemporaneous with the TeV gamma-ray flare was observed in GeV gamma-ray, X-ray, and optical flux, as well as in optical and radio polarization. Additionally, a possible moving emission feature with superluminal apparent velocity was identified in Very Long Baseline Array observations at 43 GHz, potentially passing the radio core of the jet around the time of the gamma-ray flare. We discuss the constraints on the size, Lorentz factor, and location of the emitting region of the flare, and the interpretations with several theoretical models that invoke relativistic plasma passing stationary shocks.
On 2015 March 23, the Very Energetic Radiation Imaging Telescope Array System (VERITAS) responded to a Swift-Burst Alert Telescope (BAT) detection of a gamma-ray burst, with observations beginning ...270 s after the onset of BAT emission, and only 135 s after the main BAT emission peak. No statistically significant signal is detected above 140 GeV. The VERITAS upper limit on the fluence in a 40-minute integration corresponds to about 1% of the prompt fluence. Our limit is particularly significant because the very-high-energy (VHE) observation started only ∼2 minutes after the prompt emission peaked, and Fermi-Large Area Telescope observations of numerous other bursts have revealed that the high-energy emission is typically delayed relative to the prompt radiation and lasts significantly longer. Also, the proximity of GRB 150323A (z = 0.593) limits the attenuation by the extragalactic background light to ∼50% at 100-200 GeV. We conclude that GRB 150323A had an intrinsically very weak high-energy afterglow, or that the GeV spectrum had a turnover below ∼100 GeV. If the GRB exploded into the stellar wind of a massive progenitor, the VHE non-detection constrains the wind density parameter to be A 3 × 1011 g cm−1, consistent with a standard Wolf-Rayet progenitor. Alternatively, the VHE emission from the blast wave would be weak in a very tenuous medium such as the interstellar medium, which therefore cannot be ruled out as the environment of GRB 150323A.
We present a search for magnetically broadened gamma-ray emission around active galactic nuclei (AGNs), using VERITAS observations of seven hard-spectrum blazars. A cascade process occurs when ...multi-TeV gamma-rays from an AGN interact with extragalactic background light (EBL) photons to produce electron-positron pairs, which then interact with cosmic microwave background photons via inverse-Compton scattering to produce gamma-rays. Due to the deflection of the electron-positron pairs, a non-zero intergalactic magnetic field (IGMF) would potentially produce detectable effects on the angular distribution of the cascade emission. In particular, an angular broadening compared to the unscattered emission could occur. Through non-detection of angularly broadened emission from 1ES 1218+304, the source with the largest predicted cascade fraction, we exclude a range of IGMF strengths around 10−14 G at the 95% confidence level. The extent of the exclusion range varies with the assumptions made about the intrinsic spectrum of 1ES 1218+304 and the EBL model used in the simulation of the cascade process. All of the sources are used to set limits on the flux due to extended emission.
Wearable physiological measurement devices for ambulatory research with novel sensing technology are introduced with ever increasing frequency, requiring fast, standardized, and rigorous validation ...of the physiological signals measured by these devices and their derived parameters. At present, there is a lack of consensus on a standardized protocol or framework with which to test the validity of this new technology, leading to the use of various (often unfit) methods. This study introduces a comprehensive validity assessment protocol for physiological signals (electrodermal activity and cardiovascular activity) and investigates the validity of the E4 wearable (an example of such a new device) on the three levels proposed by the protocol: (1) the signal level, with a cross-correlation; (2) the parameter level, with Bland–Altman plots; and (3) the event level, with the detection of physiological changes due to external stressor levels via event difference plots. The results of the protocol show that the E4 wearable is valid for heart rate, RMSSD, and
SD
at the parameter and event levels, and for the total amplitude of skin conductance responses at the event level when studying strong sustained stressors. These findings are in line with the prior literature and demonstrate the applicability of the protocol. The validity assessment protocol proposed in this study provides a comprehensive, standardized, and feasible method for assessment of the quality of physiological data coming from new wearable (sensor) technology aimed at ambulatory research.
•First time low-cost vs high-end IR-camera comparison for diabetic foot assessment.•Perfect agreement between the two cameras was found through Bland-Altman and ICC.•Diagnostic accuracy of the ...low-cost smartphone thermal IR-camera was satisfactory.•The low-cost IR-camera shows excellent validity for diabetic foot assessment.
Infrared thermal imaging (IR) is not yet routinely implemented for early detection of diabetic foot ulcers (DFU), despite proven clinical effectiveness. Low-cost, smartphone-based IR-cameras are now available and may lower the threshold for implementation, but the quality of these cameras is unknown. We aim to validate a smartphone-based IR-camera against a high-end IR-camera for diabetic foot assessment.
We acquired plantar IR images of feet of 32 participants with a current or recently healed DFU with the smartphone-based FLIR-One and the high-end FLIR-SC305. Contralateral temperature differences of the entire plantar foot and nine pre-specified regions were compared for validation. Intra-class correlations coefficient (ICC(3,1)) and Bland-Altman plots were used to test agreement. Clinical validity was assessed by calculating statistical measures of diagnostic performance.
Almost perfect agreement was found for temperature measurements in both the entire plantar foot and the combined pre-specified regions, respectively, with ICC values of 0.987 and 0.981, Bland-Altman plots’ mean Δ = −0.14 and Δ = −0.06. Diagnostic accuracy showed 94% and 93% sensitivity, and 86% and 91% specificity.
The smartphone-based IR-camera shows excellent validity for diabetic foot assessment.
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