The next generation magnetic spectrometer in space, AMS-100, is designed to have a geometrical acceptance of 100 m 2 sr and to be operated for at least ten years at the Sun–Earth Lagrange Point 2. ...Compared to existing experiments, it will improve the sensitivity for the observation of new phenomena in cosmic rays, and in particular in cosmic antimatter, by at least a factor of 1000. The magnet design is based on high temperature superconductor tapes, which allow the construction of a thin solenoid with a homogeneous magnetic field of 1 Tesla inside. The inner volume is instrumented with a silicon tracker reaching a maximum detectable rigidity of 100 TV and a calorimeter system that is 70 radiation lengths deep, equivalent to four nuclear interaction lengths, which extends the energy reach for cosmic-ray nuclei up to the PeV scale, i.e. beyond the cosmic-ray knee. Covering most of the sky continuously, AMS-100 will detect high-energy gamma-rays in the calorimeter system and by pair conversion in the thin solenoid, reconstructed with excellent angular resolution in the silicon tracker.
Objective
To investigate the safety and effects of a restrictive red blood cell (RBC) transfusion strategy in pediatric cardiac surgery patients.
Design
Randomized controlled trial.
Setting
Pediatric ...ICU in an academic tertiary care center, Leiden University Medical Center, Leiden, The Netherlands.
Patients
One hundred seven patients with non-cyanotic congenital heart defects between 6 weeks and 6 years of age. One hundred three patients underwent corrective surgery on cardiopulmonary bypass.
Interventions
Prior to surgery patients were randomly assigned to one of two groups with specific RBC transfusion thresholds: Hb 10.8 g/dl (6.8 mmol/l) and Hb 8.0 g/dl (5.0 mmol/l).
Measurements
Length of stay in hospital (primary outcome), length of stay in PICU, duration of ventilation (secondary outcome), incidence of adverse events and complications related to randomization (intention to treat analysis).
Results
In the restrictive transfusion group, mean volume of transfused RBC was 186 (±70) ml per patient and in the liberal transfusion group 258 (±87) ml per patient, (95 % CI 40.6–104.6),
p
< 0.001. Length of hospital stay was shorter in patients with a restrictive RBC transfusion strategy: median 8 (IQR 7–11) vs. 9 (IQR 7–14) days,
p
= 0.047. All other outcome measures and incidence of adverse effects were equal in both RBC transfusion groups. Cost of blood products for the liberal transfusion group was 438.35 (±203.39) vs. 316.27 (±189.96) euros (95 % CI 46.61–197.51) per patient in the restrictive transfusion group,
p
= 0.002.
Conclusions
For patients with a non-cyanotic congenital heart defect undergoing elective cardiac surgery, a restrictive RBC transfusion policy (threshold of Hb 8.0 g/dl) during the entire perioperative period is safe, leads to a shorter hospital stay and is less expensive.
The Mental Health Parity and Addiction Equity Act of 2008 prohibits commercial group health plans from imposing spending and visit limitations for mental health and substance abuse services that are ...not imposed on medical-surgical services. The act also restricts the use of managed care tools that apply to behavioral health benefits in ways that differ from how they apply to medical-surgical benefits. The only precedent for this approach is Oregon's state parity law, which was implemented in 2007. The goal of this study was to estimate the effect of Oregon's parity law on expenditures for mental health and substance abuse treatment services.
The authors compared expenditures for commercially insured individuals in four Oregon health plans from 2005 through 2008 and a matched group of commercially insured individuals in Oregon who were exempt from parity. Using a difference-in-differences analysis, the authors analyzed the effect of comprehensive parity on spending for mental health and substance abuse services.
Increases in spending on mental health and substance abuse services after implementation of Oregon's parity law were almost entirely the result of a general trend observed among individuals with and without parity. Expenditures per enrollee for mental health and substance abuse services attributable to parity were positive, but they did not differ significantly from zero in any of the four plans.
Behavioral health insurance parity rules that place restrictions on how plans manage mental health and substance abuse services can improve insurance protections without substantial increases in total costs.
The Earth’s atmosphere is an integral part of the detector in ground-based imaging atmospheric Cherenkov telescope (IACT) experiments and has to be taken into account in the calibration. Atmospheric ...and hardware-related deviations from simulated conditions can result in the mis-reconstruction of primary particle energies and therefore of source spectra. During the eight years of observations with the High Energy Stereoscopic System (H.E.S.S.) in Namibia, the overall yield in Cherenkov photons has varied strongly with time due to gradual hardware aging, together with adjustments of the hardware components, and natural, as well as anthropogenic, variations of the atmospheric transparency. Here we present robust data selection criteria that minimize these effects over the full data set of the H.E.S.S. experiment and introduce the Cherenkov transparency coefficient as a new atmospheric monitoring quantity. The influence of atmospheric transparency, as quantified by this coefficient, on energy reconstruction and spectral parameters is examined and its correlation with the aerosol optical depth (AOD) of independent MISR satellite measurements and local measurements of atmospheric clarity is investigated.
Purpose
Clinical applications of quantitative computed tomography (qCT) in patients with pulmonary opacifications are hindered by the radiation exposure and by the arduous manual image processing. We ...hypothesized that extrapolation from only ten thoracic CT sections will provide reliable information on the aeration of the entire lung.
Methods
CTs of 72 patients with normal and 85 patients with opacified lungs were studied retrospectively. Volumes and masses of the lung and its differently aerated compartments were obtained from all CT sections. Then only the most cranial and caudal sections and a further eight evenly spaced sections between them were selected. The results from these ten sections were extrapolated to the entire lung. The agreement between both methods was assessed with Bland–Altman plots.
Results
Median (range) total lung volume and mass were 3,738 (1,311–6,768) ml and 957 (545–3,019) g, the corresponding bias (limits of agreement) were 26 (−42 to 95) ml and 8 (−21 to 38) g, respectively. The median volumes (range) of differently aerated compartments (percentage of total lung volume) were 1 (0–54)% for the nonaerated, 5 (1–44)% for the poorly aerated, 85 (28–98)% for the normally aerated, and 4 (0–48)% for the hyperaerated subvolume. The agreement between the extrapolated results and those from all CT sections was excellent. All bias values were below 1% of the total lung volume or mass, the limits of agreement never exceeded ±2%.
Conclusion
The extrapolation method can reduce radiation exposure and shorten the time required for qCT analysis of lung aeration.
We present prototype modules for a tracking detector consisting of multiple layers of 0.25
mm diameter scintillating fibers that are read out by linear arrays of silicon photomultipliers. The module ...production process is described and measurements of the key properties for both the fibers and the readout devices are shown. Five modules have been subjected to a 12
GeV/
c proton/pion testbeam at CERN. A spatial resolution of
50
μ
m
and light yields exceeding 20 detected photons per minimum ionizing particle have been achieved, at a tracking efficiency of more than 98.5%. Possible techniques for further improvement of the spatial resolution are discussed.
The gastrointestinal tract of the premature newborn functions suboptimally with regard to digestion, absorption, and feeding tolerance. Human milk contains trophic factors, such as insulin-like ...growth factor-1 (IGF-1), that are believed to stimulate gut growth and function. The objective of this double blind, randomized, controlled trial was to assess the effects of enteral IGF-1 supplementation on whole body growth measured by weight gain (in grams per kilogram per day), days to regain birth weight, and anthropometrical characteristics, and gut maturation and permeability (measured by sugar absorption tests).
The study included 60 premature infants (birth weight 750-1250 g) during the first month of life. Patients received either standard infant formula or standard infant formula supplemented with IGF-1 in a concentration twice that of human colostrum (10 microg/100 mL of formula). Primary endpoints were days to full enteral feeding, days to regain birth weight, and growth rate. Sugar absorption tests were performed weekly to assess the secondary endpoints gut permeability and maturation.
None of the primary endpoints differed to statistical significance between groups at any point. However, gut permeability was significantly lower in the IGF-1 supplement group on day 14 compared with the control group. At day 21, lactulose/mannitol excretion ratios were (again) comparable between the groups.
Although gut permeability showed a faster decrease in the IGF-1 supplement group, our data do not support IGF-1 supplementation to infant formula.
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