Demonstration of event position reconstruction based on diffusion in the NEXT-white detector.

Noble element time projection chambers are a leading technology for rare event detection in physics, such as for dark matter and neutrinoless double beta decay searches. Time projection chambers typically assign event position in the drift direction using the relative timing of prompt scintillation and delayed charge collection signals, allowing for reconstruction of an absolute position in the drift direction. In this paper, alternate methods for assigning event drift distance via quantification of electron diffusion in a pure high pressure xenon gas time projection chamber are explored. Data from the NEXT-White detector demonstrate the ability to achieve good position assignment accuracy for both high- and low-energy events. Using point-like energy deposits from 83mKr calibration electron captures (E∼45 keV), the position of origin of low-energy events is determined to 2 cm precision with bias <1mm. A convolutional neural network approach is then used to quantify diffusion for longer tracks (E≥1.5 MeV), from radiogenic electrons, yielding a precision of 3 cm on the event barycenter. The precision achieved with these methods indicates the feasibility energy calibrations of better than 1% FWHM at Qßß in pure xenon, as well as the potential for event fiducialization in large future detectors using an alternate method that does not rely on primary scintillation.

Association between parental resource depletion and parent use of specific food parenting practices: An ecological momentary assessment study.

The resource depletion model proposes that self-control is a limited resource that may become depleted after repeated use. This study aimed to improve our understanding of the correlates of resource depletion in parents, examine the association between resource depletion and use of coercive food parenting practices, and explore the relationship between resource depletion and stress. Children aged 5-9 and their parents (n = 631 dyads) were recruited from primary care clinics in a large metropolitan area in the United States in 2016-2019. Ecological momentary assessment was carried out over seven days with parents. Frequency tabulations and descriptive statistics were calculated to examine the overall, between-participant, and within-participant frequency of resource depletion, stress, and coercive food parenting practices. Resource depletion was higher among mothers (as compared to fathers) and native born participants (as compared to immigrants). Resource depletion was found to decrease significantly with each increase in household income level and perceived co-parenting support was negatively associated with resource depletion. Greater resource depletion earlier in the day was positively associated with coercive food parenting practices (e.g., food restriction, pressure-to-eat) at dinner the same night. Further, prior day resource depletion was associated with greater pressure-to-eat the next day. Parents with lower chronic stress were found to engage in pressuring when experiencing higher depletion. Clinicians and public health professionals should be aware of the role the resource depletion can play in parent's use of specific food parenting practices and seek to provide parents with the support they need to manage the cognitive load they are experiencing.

Demonstration of Single-Barium-Ion Sensitivity for Neutrinoless Double-Beta Decay Using Single-Molecule Fluorescence Imaging.

A new method to tag the barium daughter in the double-beta decay of ^{136}Xe is reported. Using the technique of single molecule fluorescent imaging (SMFI), individual barium dication (Ba^{++}) resolution at a transparent scanning surface is demonstrated. A single-step photobleach confirms the single ion interpretation. Individual ions are localized with superresolution (∼2 nm), and detected with a statistical significance of 12.9σ over backgrounds. This lays the foundation for a new and potentially background-free neutrinoless double-beta decay technology, based on SMFI coupled to high pressure xenon gas time projection chambers.

A 5-µm pitch charge-coupled device optimized for resonant inelastic soft X-ray scattering.

We have developed a charge-coupled device (CCD) with 5 µm × 45 µm pixels on high-resistivity silicon. The fully depleted 200 µm-thick silicon detector is back-illuminated through a 10 nm-thick in situ doped polysilicon window and is thus highly efficient for soft through >8 keV hard X-rays. The device described here is a 1.5 megapixel CCD with 2496 × 620 pixels. The pixel and camera geometry was optimized for Resonant Inelastic X-ray Scattering (RIXS) and is particularly advantageous for spectrometers with limited arm lengths. In this article, we describe the device architecture, construction and operation, and its performance during tests at the Advance Light Source (ALS) 8.0.1 RIXS beamline. The improved spectroscopic performance, when compared with a current standard commercial camera, is demonstrated with a ∼280 eV (CK) X-ray beam on a graphite sample. Readout noise is typically 3-6 electrons and the point spread function for soft CK X-rays in the 5 µm direction is 4.0 µm ± 0.2 µm. The measured quantum efficiency of the CCD is greater than 75% in the range from 200 eV to 1 keV.

Analysis of effectiveness and safety of a three-part triage system for the access to dermatology specialist health care.

BACKGROUND: Accessibility and waiting times pose a general problem in public financed health care systems. In Italy a three-part triage system (urgent, priority and deferrable with a corresponding maximum time target before treatment of 1, 8 and 60 days respectively) to gain faster treatment for urgent and emergent cases of dermatology outpatients has been introduced. METHODS: From February 2011 to August 2013, samples of 1526 outpatient electronic medical record cases were randomly retrieved. Diagnoses with their corresponding triage codes were recorded. Urgent visits were further analysed according to the referring physician. The appropriateness of the referral was based on the published state law diagnostic guidelines. Data were statistically analysed using the 2-tailed Pearson chi-squared test or the Fisher exact test. RESULTS: Overall, 56.5% retrieved cases were deferrable, 13.1% priority and 30.4% urgent. Frequency of diagnoses differed significantly between the three groups (P < 0.05). Appropriateness of the triage level was higher for priority than for urgent referrals (P < 0.05%). An overestimation of urgency levels was noted and urgent cases were not overseen. Triage levels were best assessed by general practitioners (75% correct allocations) followed by emergency physicians (59%) and other specialists (45%) (P < 0.01%). CONCLUSION: The triage system according to clinical need is safe. Correct allocation according to urgency occurs in <75% and leaves space for improvement. General Practitioners address patient's access significantly better than other physicians, therefore are best suited to function as gatekeepers to the access of specialist care in public funded health care systems.

Mediators involved in the relation between depressive symptoms and weight status in female adolescents and young adults.

Depression may be a risk factor for overweight status, but mechanisms involved in this relationship are unclear. This study explored behavioral factors involved in the relationship between adolescent depression symptoms and adult overweight status. A population-based cohort of female participants in Project EAT (n=1035) was followed over 10 years and reported on psychological functioning, weight status and eating and activity patterns in early/middle adolescence (1999=Time 1; T1), middle adolescence/early young adulthood (2004=Time 2; T2) and early/middle young adulthood (2009=Time 3; T3). Structural equation models were fit which included T1 depression scores predicting overweight status at T3, with T2 fruit and vegetable consumption, moderate-to-vigorous physical activity and binge eating examined as mediators. There were small but significant effects of T1 depression scores predicting an increased likelihood of T3 overweight status (standardized estimate=0.038; P=0.007), and of T2 binge eating mediating the relation between T1 depression and T3 overweight status (standardized indirect effect estimate=0.036; P=0.009). Binge eating may be one pathway to overweight among depressed females, suggesting that recognition and treatment of eating pathology in individuals with depression may help prevent overweight. Examination of other behavioral (and non-behavioral) factors explaining the relationship between depression and overweight is warranted.

Compact x-ray microradiograph for in situ imaging of solidification processes: bringing in situ x-ray micro-imaging from the synchrotron to the laboratory.

A laboratory based high resolution x-ray radiograph was developed for the investigation of solidification dynamics in alloys. It is based on a low-power microfocus x-ray tube and is potentially appropriate for x-ray diagnostics in space. The x-ray microscope offers a high spatial resolution down to approximately 5 µm. Dynamic processes can be resolved with a frequency of up to 6 Hz. In reference experiments, the setup was optimized to yield a high contrast for AlCu-alloys. With samples of about 150 µm thickness, high quality image sequences of the solidification process were obtained with high resolution in time and space.

Non-destructive and quantitative imaging of a nano-structured microchip by ptychographic hard X-ray scanning microscopy.

We used hard X-ray scanning microscopy with ptychographic coherent diffraction contrast to image a front-end processed passivated microchip fabricated in 80 nm technology. No sample preparation was needed to image buried interconnects and contact layers with a spatial resolution of slightly better than 40 nm. The phase shift in the sample is obtained quantitatively. With the additional knowledge of the elemental composition determined in parallel by X-ray fluorescence mapping, quantitative information about specific nanostructures is obtained. A significant enhancement in signal-to-noise ratio and spatial resolution is achieved compared to conventional hard X-ray scanning microscopy.

Copper suppresses hippocampus LTP in the rat, but does not alter learning or memory in the morris water maze.

The objective of our study was to determinate the effect of copper on long-term potentiation (LTP) in hippocampus slices and a learning test in the Morris Water Maze (MWM). A group of adult Wistar rats received intraperitoneal (ip) injections of 1 mg/kg of CuSO(4) dissolved in saline for 30 consecutive days (Cu.R). A group of control rats (Sal.R), received saline by the same routes and duration. After this period, every individual of both groups was submitted to learning in MWM. Once the learning was completed, the LTP was studied in slices of hippocampus of both groups. The statistical assessment shows that the rats in both groups did not show significant differences in their progressive learning, notwithstanding that group Cu.R had 14.2 times more copper in their hippocampus and 16.7 times more in the visual cortices than in those of group Sal.R. On the other hand, the neurons of CA1 in hippocampus slices of Sal.R showed a significant development of LTP, but this was not observed in group Cu.R. In a second situation, 13 rats received training in MWM. Then, a group of 6 animals were injected with copper i.p. at the dose and time previously described. The 7 other animals were administered saline. Afterward, both groups were retrained in the MWM. The results obtained in Cu.R were similar to those obtained in Sal.R. Both groups maintained the concentrations of copper in the hippocampus indicated above, nonetheless, only the hippocampus slices of Cu.R did not show LTP. The spatial learning behavior of the rats was not affected by high copper concentration.

Independent measurement of the total active 8B solar neutrino flux using an array of 3He proportional counters at the Sudbury Neutrino Observatory.

The Sudbury Neutrino Observatory (SNO) used an array of 3He proportional counters to measure the rate of neutral-current interactions in heavy water and precisely determined the total active (nu_x) 8B solar neutrino flux. This technique is independent of previous methods employed by SNO. The total flux is found to be 5.54_-0.31;+0.33(stat)-0.34+0.36(syst)x10(6) cm(-2) s(-1), in agreement with previous measurements and standard solar models. A global analysis of solar and reactor neutrino results yields Deltam2=7.59_-0.21;+0.19x10(-5) eV2 and theta=34.4_-1.2;+1.3 degrees. The uncertainty on the mixing angle has been reduced from SNO's previous results.

[How does the German DRG system differentiate and reimburse vitreoretinal surgery in diabetic patients?]. / Wie differenziert und vergütet das G-DRG-System bei vitreoretinalen Eingriffen an Diabetikern?

INTRODUCTION: The German DRG system (G-DRG system) is required to assign medical cases with similar costs correctly into a particular group, each case within the group receiving the same amount of reimbursement. At the same time the system should allow all-inclusive reimbursement, not necessarily reflecting the exact costs of each case. These opposite goals and the so far limited calculation basis raise the question of how the G-DRG system actually processes and reimburses empirically collected in-hospital treatment data. PATIENTS AND METHODS: In 2005, 112 patients were admitted to the University Eye Hospital, University of the Saarland. All patients had diabetic retinopathy and required at least one vitreoretinal procedure. Demographic and clinical data were collected by using the hospital information system and the coding software KODIP. For statistic evaluation, principal diagnoses, ancillary diagnoses and procedures were each reassigned to particular groups. Reimbursement was calculated based on the case data of the year 2005. Also, the case data were reassigned with respect to calculation of reimbursement for the years 2006 and 2007. The results were compared with federal G-DRG calculation data. RESULTS: Mean age of the patients was 65.8 +/- 11.1 years, length of stay in-hospital was 9.3 +/- 3.2 days. In the 66 patients requiring general anaesthesia the cumulative length of stay in the operation room was 148.4 +/- 39.5 minutes, the cumulative duration of surgery was 86.3 +/- 34.1 minutes. In the 50 patients requiring local anaesthesia the cumulative length of stay in the operation room was 137.8 +/- 51.8 minutes, the cumulative duration of surgery was 81.6 +/- 43.6 minutes. The patients had 1.9 +/- 0.8 principal diagnoses, 14.4 +/- 5.8 ancillary diagnoses and 3.4 +/- 1.6 procedures. Twenty-five of 112 patients (22.3 %) were assigned to DRG C 03Z (1), 82 of 112 patients (73.2 %) were assigned to DRG C 17Z (2). Five patients were assigned to other DRG. Compared with the federal calculation data, our own data for 2005, 2006 and 2007 showed more high primary clinical complexity levels and a longer duration of in-hospital stay. For each of the three years the amount of reimbursement was equal in about two thirds of the own patients. Reimbursement was only differentiated for outliers beyond the trim point of the duration of in-hospital stay. CONCLUSIONS: The demographic and clinical G-DRG data of the included patients showed substantial cost-effective inhomogeneities. These inhomogeneities were not sufficiently considered for reimbursement based upon Z-DRG. Specialised departments with higher numbers of difficult cases may be discriminated. Wrong incentives may result in the selection of "low-risk cases".

Interdisciplinary pain therapy: an innovative therapeutic but pre-DRG Economical Center of Medical Excellence.

OBJECTIVE: After the implementation of the G-DRG system in Germany, doubts arose whether and how interdisciplinary pain therapy centers should be restructured to remain profitable and maintain medical excellence for patients with a long ordeal of malaise. METHODS: To reveal structural deficits, we performed a detailed economic analysis of all patients treated at an interdisciplinary pain therapy center of a German University hospital in 2004. RESULTS: 3,672 patients were treated: 2,163 outpatients, 753 at the daycare clinic, 619 as consults and 132 inpatients. The costs for personnel were euro 736,645, consumables euro 105,061, and infrastructure euro 277,762. We calculated fixed costs of euro 236, and consumables of euro 24 per patient. The costs for surgery were euro 1,595, and for a neuroradiological examination euro 245 per patient. Overall treatment costs were euro 319 per patient. We calculated an overall loss of euro 476,752 or euro 109.19 per patient. Outpatients caused a total loss of euro 456,665.83 or euro 211 per patient, consults a total loss of euro 161 683.16 or euro 261.20 per patient, daycare patients a slight profit of euro 30,370 or euro 40 per patient and inpatients a total profit of euro 111,225 or euro 135 per day. CONCLUSION: Managerial optimization can yield considerable cost reductions in the G-DRG coding system, without any change in treatment strategies, selection of profitable patients or dismissal of personnel. Inversely, additional personnel are needed to accomplish the implementation process. Board certification was unveiled to constitute the key structural implementation that ensures the economic survival of the department and continuing medical excellence for the patients.

Search for extraterrestrial point sources of neutrinos with AMANDA-II.

We present the results of a search for point sources of high-energy neutrinos in the northern hemisphere using AMANDA-II data collected in the year 2000. Included are flux limits on several active-galactic-nuclei blazars, microquasars, magnetars, and other candidate neutrino sources. A search for excesses above a random background of cosmic-ray-induced atmospheric neutrinos and misreconstructed downgoing cosmic-ray muons reveals no statistically significant neutrino point sources. We show that AMANDA-II has achieved the sensitivity required to probe known TeV gamma-ray sources such as the blazar Markarian 501 in its 1997 flaring state at a level where neutrino and gamma-ray fluxes are equal.

Limits on diffuse fluxes of high energy extraterrestrial neutrinos with the AMANDA-B10 detector.

Data from the AMANDA-B10 detector taken during the austral winter of 1997 have been searched for a diffuse flux of high energy extraterrestrial muon neutrinos. This search yielded no excess events above those expected from background atmospheric neutrinos, leading to upper limits on the extraterrestrial neutrino flux measured at the earth. For an assumed E-2 spectrum, a 90% classical confidence level upper limit has been placed at a level E2Phi(E)=8.4 x 10(-7) cm(-2) s(-1) sr(-1) GeV (for a predominant neutrino energy range 6-1000 TeV), which is the most restrictive bound placed by any neutrino detector. Some specific predicted model spectra are excluded. Interpreting these limits in terms of the flux from a cosmological distributions of sources requires the incorporation of neutrino oscillations, typically weakening the limits by a factor of 2.

Parity violation observed in the beta decay of magnetically trapped 82Rb atoms.

Laser cooling and atomic trapping techniques have been employed to confine polarized 82Rb atoms ( T1/2 = 75 s) in a magnetic time-orbiting-potential (TOP) trap. We have observed the parity-violating correlation between the emitted positron momentum and the parent nuclear spin as a continuous function of angle and positron energy for this pure Gamow-Teller (GT) transition. These proof-of-principle measurements demonstrate the utility of exploring fundamental symmetries in a TOP trap and the steps required to improve sensitivity in the search for physics beyond the standard model.

Observation of high-energy neutrinos using Cerenkov detectors embedded deep in Antarctic ice.

Neutrinos are elementary particles that carry no electric charge and have little mass. As they interact only weakly with other particles, they can penetrate enormous amounts of matter, and therefore have the potential to directly convey astrophysical information from the edge of the Universe and from deep inside the most cataclysmic high-energy regions. The neutrino's great penetrating power, however, also makes this particle difficult to detect. Underground detectors have observed low-energy neutrinos from the Sun and a nearby supernova, as well as neutrinos generated in the Earth's atmosphere. But the very low fluxes of high-energy neutrinos from cosmic sources can be observed only by much larger, expandable detectors in, for example, deep water or ice. Here we report the detection of upwardly propagating atmospheric neutrinos by the ice-based Antarctic muon and neutrino detector array (AMANDA). These results establish a technology with which to build a kilometre-scale neutrino observatory necessary for astrophysical observations.

Health informatics.

Health informatics is the development and assessment of methods and systems for the acquisition, processing and interpretation of patient data with the help of knowledge from scientific research. This definition implies that health informatics is not tied to the application of computers but more generally to the entire management of information in healthcare. The focus is the patient and the process of care. The apparent information overload and the imperfection of medical decision making motivate the use of information systems for medical decision support. Health informatics provides tools to control processes in healthcare, acquire medical knowledge and communicate information between all people and organisations involved with healthcare. Although the development of medical information systems may often lag behind the available possibilities, the technological state of the current medical information systems is better than it is generally held to be. Health informatics should help healthcare professionals to provide better and more cost-effective care and enable healthcare systems to be more efficient and to adapt better to our patients' needs. Health informatics may reshape the way we deliver care to meet the demands of the future.

[New communication platforms in gynecology exemplified by the Professional Group for Information Processing in Gynecology and Obstetrics and the German IVF Registry]. / Neue Kommunikationsplattformen in der Frauenheilkunde am Beispiel der Arbeitsgemeinschaft für Informationsverarbeitung in der Gynäkologie und Geburtshilfe (AIG) und des Deutschen IVF-Registers (DIR).

Main reason for acceptance and distribution of the internet is the possibility to present information in a reasonable and contemporary way. Therefore the internet changed the way of decision making techniques in medicine. Two different information platforms for gynecological and reproductive topics have been created. The German Register for In-Vitro-Fertilization (DIR) collect data for quality assessment in reproductive medicine. The Work Group for Information Technologies in Gynecology and Obstetrics (AIG) will establish methods and new techniques to support treatments and science.

Gamma ray nuclear resonance absorption: an alternative method for in vivo body composition studies.

We have evaluated gamma ray nuclear resonance absorption (gamma-NRA) on nitrogen, a mature technology proposed and developed by Soreq NRC for detecting explosives, as an alternative to neutron activation for in vivo assaying of body nitrogen. The principles of the gamma-NRA method are outlined, and a test facility constructed at McMaster University's Accelerator Laboratory is described. The results of a feasibility study recently performed there on phantoms and animal tissue are presented and discussed. gamma-NRA is a full imaging technique that essentially constitutes element-specific absorptiometry--i.e., it can generate projections of the mass distribution for a specific element, along with a conventional radiograph of the patient. From the transmission profile of an individual scanned by 9.17 MeV gamma rays, local or whole body nitrogen content can be determined via the resonant attenuation undergone when the beam encounters regions of nitrogen concentration. The advantages of gamma-NRA over neutron activation are (a) radiation doses delivered to the body are at least one order of magnitude lower, thus allowing repeated measurements on individual patients and also rendering the method ethically acceptable for application to children; (b) gamma-NRA is inherently free from uncertainties related to nonuniform distributions of the element in question within the body; (c) it is applicable to patients of varying size and shape; and (d) it yields both nitrogen images and conventional radiographic images of the body.