Objective
To determine whether laparoscopic sacrocolpopexy (LSC) or vaginal sacrospinous fixation (VSF) is the most optimal surgical treatment in patients with POP‐Q stage ≥2 vaginal vault prolapse ...(VVP).
Design
Multicentre randomised controlled trial (RCT) and prospective cohort study alongside.
Setting
Seven non‐university teaching hospitals and two university hospitals in the Netherlands.
Population
Patients with symptomatic post‐hysterectomy vaginal vault prolapse, requiring surgical treatment.
Methods
Randomisation in a 1:1 ratio to LSC or VSF. Evaluation of prolapse was done using the pelvic organ prolapse quantification (POP‐Q). All participants were asked to fill in various Dutch validated questionnaires 12 months postoperatively.
Main outcome measures
Primary outcome was disease‐specific quality of life. Secondary outcomes included composite outcome of success and anatomical failure. Furthermore, we examined peri‐operative data, complications and sexual function.
Results
A total of 179 women, 64 women randomised and 115 women, participated in a prospective cohort. Disease‐specific quality of life did not differ after 12 months between the LSC and VSF group in the RCT and the cohort (RCT: P = 0.887; cohort: P = 0.704). The composite outcomes of success for the apical compartment, in the RCT and cohort, were 89.3% and 90.3% in the LSC group and 86.2% and 87.8% in the VSF group, respectively (RCT: P = 0.810; cohort: P = 0.905). There were no differences in number of reinterventions and complications between both groups (reinterventions RCT: P = 0.934; cohort: P = 0.120; complications RCT: P = 0.395; cohort: P = 0.129).
Conclusions
LSC and VSF are both effective treatments for vaginal vault prolapse, after a follow‐up period of 12 months.
Charged particles and photons have been measured in central Pb+Pb collisions at 158 A GeV in a common (η–ϕ)-phase space region in the WA98 experiment at the CERN SPS. The measured distributions have ...been analyzed to quantify the frequency with which phase space regions of varying sizes have either small or large neutral pion fraction. The measured results are compared with VENUS model simulated events and with mixed events. Events with both large and small charged–neutral fluctuations are observed to occur more frequently than expected statistically, as deduced from mixed events, or as predicted by model simulations, with the difference becoming more prominent with decreasing size of the Δη–Δϕ region.
Transdiagnostic approaches to psychiatry have significant potential in overcoming the limitations of conventional diagnostic paradigms. However, while frameworks such as the Research Domain Criteria ...have garnered significant enthusiasm among researchers and clinicians from a theoretical angle, examples of how such an approach might translate in practice to understand the biological mechanisms underlying complex patterns of behaviors in realistic and heterogeneous populations have been sparse. In a richly phenotyped clinical sample (n = 186) specifically designed to capture the complex nature of heterogeneity and comorbidity within- and between stress- and neurodevelopmental disorders, we use exploratory factor analysis on a wide range of clinical questionnaires to identify four stable functional domains that transcend diagnosis and relate to negative valence, cognition, social functioning and inhibition/arousal before replicating them in an independent dataset (n = 188). We then use connectopic mapping to map inter-individual variation in fine-grained topographical organization of functional connectivity in the striatum-a central hub in motor, cognitive, affective and reward-related brain circuits-and use multivariate machine learning (canonical correlation analysis) to show that these individualized topographic representations predict transdiagnostic functional domains out of sample (r = 0.20, p = 0.026). We propose that investigating psychiatric symptoms across disorders is a promising path to linking them to underlying biology, and can help bridge the gap between neuroscience and clinical psychiatry.
The Radar Echo Telescope for Cosmic Rays (RET-CR) is a recently funded experiment designed to detect the englacial cascade of a cosmic ray-initiated air shower via in-ice radar, toward the goal of a ...full-scale, next-generation experiment to detect ultrahigh energy neutrinos in polar ice. For cosmic rays with a primary energy greater than 10 PeV, roughly 10% of an air shower’s energy reaches the surface of a high elevation ice sheet (≳2 ˙km) concentrated into a radius of roughly 10 cm. This penetrating shower core creates an in-ice cascade orders of magnitude more dense than the preceding in-air cascade. Additionally, this dense cascade can be detected via the radar echo technique, where transmitted radio waves are reflected from the ionization deposit left in the wake of the cascade. RET-CR will test the radar echo method in nature, with the in-ice cascade of a cosmic ray-initiated air shower serving as a test beam. In this work, we present the projected event rate and sensitivity based upon a three part simulation using corsika, geant4, and radioscatter. RET-CR expects ~1 radar echo event per day.
Charged particles and photons have been measured in central Pb + Pb collisions at 158 A GeV in a common (eta-phi)-phase space region in the WA98 experiment at the CERN SPS. The measured distributions ...have been analyzed to quantify the frequency with which phase space regions of varying sizes have either small or large neutral pion fraction. The measured results are compared with VENUS model simulated events and with mixed events. Events with both large and small charged-neutral fluctuations are observed to occur more frequently than expected statistically, as deduced from mixed events, or as predicted by model simulations, with the difference becoming more prominent with decreasing size of the A Delta eta-Delta phi region. (C) 2011 Elsevier B.V. All rights reserved.
We report on the first measurement of the astrophysical neutrino flux using particle showers (cascades) in IceCube data from 2010–2015. Assuming standard oscillations, the astrophysical neutrinos in ...this dedicated cascade sample are dominated (∼90 %) by electron and tau flavors. The flux, observed in the sensitive energy range from 16 TeV to 2.6 PeV, is consistent with a single power-law model as expected from Fermi-type acceleration of high energy particles at astrophysical sources. We find the flux spectral index to be γ = 2.53 ± 0.07 and a flux normalization for each neutrino flavor of ϕastro = 1.66+0.25 −0.27 at E0 = 100 TeV , in agreement with IceCube's complementary muon neutrino results and with all-neutrino flavor fit results. In the measured energy range we reject spectral indices γ ≤ 2.28 at ≥ 3 σ significance level. Because of high neutrino energy resolution and low atmospheric neutrino backgrounds, this analysis provides the most detailed characterization of the neutrino flux at energies below ∼100 TeV compared to previous IceCube results. Results from fits assuming more complex neutrino flux models suggest a flux softening at high energies and a flux hardening at low energies (p value ≥ 0.06). The sizable and smooth flux measured below ∼100 TeV remains a puzzle. In order to not violate the isotropic diffuse gamma-ray background as measured by the Fermi Large Area Telescope, it suggests the existence of astrophysical neutrino sources characterized by dense environments which are opaque to gamma rays.
The IceCube Neutrino Observatory has established the existence of a high-energy all-sky neutrino flux of astrophysical origin. This discovery was made using events interacting within a fiducial ...region of the detector surrounded by an active veto and with reconstructed energy above 60 TeV, commonly known as the high-energy starting event sample (HESE). We revisit the analysis of the HESE sample with an additional 4.5 years of data, newer glacial ice models, and improved systematics treatment. This paper describes the sample in detail, reports on the latest astrophysical neutrino flux measurements, and presents a source search for astrophysical neutrinos. We give the compatibility of these observations with specific isotropic flux models proposed in the literature as well as generic power-law-like scenarios. Assuming νe: νμ: ντ= 1 : 1 : 1 , and an equal flux of neutrinos and antineutrinos, we find that the astrophysical neutrino spectrum is compatible with an unbroken power law, with a preferred spectral index of 2.87−0.19+0.20 for the 68% confidence interval.
Abstract
We present a measurement of the high-energy astrophysical muon–neutrino flux with the IceCube Neutrino Observatory. The measurement uses a high-purity selection of 650k neutrino-induced muon ...tracks from the northern celestial hemisphere, corresponding to 9.5 yr of experimental data. With respect to previous publications, the measurement is improved by the increased size of the event sample and the extended model testing beyond simple power-law hypotheses. An updated treatment of systematic uncertainties and atmospheric background fluxes has been implemented based on recent models. The best-fit single power-law parameterization for the astrophysical energy spectrum results in a normalization of
ϕ
@
100
TeV
ν
μ
+
ν
¯
μ
=
1.44
−
0.26
+
0.25
×
10
−
18
GeV
−
1
cm
−
2
s
−
1
sr
−
1
and a spectral index
γ
SPL
=
2.37
−
0.09
+
0.09
, constrained in the energy range from 15 TeV to 5 PeV. The model tests include a single power law with a spectral cutoff at high energies, a log-parabola model, several source-class-specific flux predictions from the literature, and a model-independent spectral unfolding. The data are consistent with a single power-law hypothesis, however, spectra with softening above one PeV are statistically more favorable at a two-sigma level.
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