First Probe of Sub-GeV Dark Matter beyond the Cosmological Expectation with the COHERENT CsI Detector at the SNS.

The COHERENT Collaboration searched for scalar dark matter particles produced at the Spallation Neutron Source with masses between 1 and 220 MeV/c^{2} using a CsI[Na] scintillation detector sensitive to nuclear recoils above 9 keV_{nr}. No evidence for dark matter is found and we thus place limits on allowed parameter space. With this low-threshold detector, we are sensitive to coherent elastic scattering between dark matter and nuclei. The cross section for this process is orders of magnitude higher than for other processes historically used for accelerator-based direct-detection searches so that our small, 14.6 kg detector significantly improves on past constraints. At peak sensitivity, we reject the flux consistent with the cosmologically observed dark-matter concentration for all coupling constants α_{D}<0.64, assuming a scalar dark-matter particle. We also calculate the sensitivity of future COHERENT detectors to dark-matter signals which will ambitiously test multiple dark-matter spin scenarios.

Measurement of the Coherent Elastic Neutrino-Nucleus Scattering Cross Section on CsI by COHERENT.

We measured the cross section of coherent elastic neutrino-nucleus scattering (CEvNS) using a CsI[Na] scintillating crystal in a high flux of neutrinos produced at the Spallation Neutron Source at Oak Ridge National Laboratory. New data collected before detector decommissioning have more than doubled the dataset since the first observation of CEvNS, achieved with this detector. Systematic uncertainties have also been reduced with an updated quenching model, allowing for improved precision. With these analysis improvements, the COHERENT Collaboration determined the cross section to be (165_{-25}^{+30})×10^{-40} cm^{2}, consistent with the standard model, giving the most precise measurement of CEvNS yet. The timing structure of the neutrino beam has been exploited to compare the CEvNS cross section from scattering of different neutrino flavors. This result places leading constraints on neutrino nonstandard interactions while testing lepton flavor universality and measures the weak mixing angle as sin^{2}θ_{W}=0.220_{-0.026}^{+0.028} at Q^{2}≈(50 MeV)^{2}.

[Validation of Personal Factors in Breast Cancer Rehabilitation - A National Delphi Survey]. / Validierung von Personbezogenen Faktoren im Bereich der onkologischen Brustkrebsrehabilitation ­ eine Delphi-Befragung auf nationaler Ebene.

Objective: In the International Classification of Functioning, Disability and Health (ICF), data on environmental and personal factors, the so-called facilitators or barriers, can be gathered. The World Health Organization (WHO) has not classified personal factors. This is justified with the cultural differences among countries. The German society for social medicine and prevention (DGSMP) has performed pioneering work and has provided a classification draft. The aim of this study is to validate this draft in the context of oncological rehabilitation of breast cancer patients in Germany. Design: 21 experts from 8 rehabilitation centers and 2 breast cancer support groups in Germany were interviewed about personal factors in a 2-round survey using the Delphi technique. The expert group included doctors, nurses, therapists, psychologists with experience in rehabilitation of breast cancer patients and breast cancer patients. The responses of the first round were linked to the DGSMP draft. The degree of fit was calculated by means of the kappa statistic. In the second round, the focus was on the agreement of the personal factors determined in the first round. Results: The experts identified 244 factors out of which 203 (83.2%) were linked to the DGSMP draft. There are 77 categories in the DGSMP draft; 43 of them were included by the experts in the first round and 34 were not mentioned (kappa coefficient 0.776; 95% bootstrapped confidence interval 0.712-0.817). In the second round, 34 of the 43 named DGSMP categories achieved an agreement of at least 75% among the experts. Conclusions: The draft of the DGSMP working group is a comprehensive collection of facilitators and barriers in breast cancer rehabilitation and should be integrated reasonably in rehabilitation. More research on personal facilitators and barriers has to be carried out to show their concrete influence on functioning ability of breast cancer patients.

On the surface lattice of microtubules: helix starts, protofilament number, seam, and handedness.

The tubulin monomers of brain microtubules reassembled in vitro are arranged on a 3-start helix, irrespective of whether the number of protofilaments is 13 or 14. The dimer packing is that of the B-lattice described for flagellar microtubules. This implies that the tubulin core of microtubules contains at least one helical discontinuity. Neither 5-start nor 8-start helices have a physical significance and thus cannot be implicated in models of microtubule elongation, but the structure is compatible with elongation of protofilaments by dimers or protofilamentous oligomers. The inner and outer surfaces of the microtubule wall can be visualized by propane jet freezing, freeze fracturing, and metal replication, at a resolution of at least 4 nm. The 3-start helix is left-handed, in contrast to a previous study based on negative staining and shadowing. The reasons for this discrepancy are discussed.

On the ferromagnetic structure of the intermetallic borocarbide TbCo(2)B(2)C.

Based on magnetization, specific heat, magnetostriction and neutron-diffraction studies on single-crystal TbCo(2)B(2)C, it is found out that the paramagnetic properties, down to liquid nitrogen temperatures, are well described by a Curie-Weiss behavior of the Tb(3+) moments. Furthermore, below T(c) = 6.3 K, the Tb sublattice undergoes a ferromagnetic (FM) phase transition with the easy axis being along the (100) direction and, concomitantly, the unit cell undergoes a tetragonal-to-orthorhombic distortion. The manifestation of an FM state in TbCo(2)B(2)C is unique among all other isomorphous borocarbides, in particular TbNi(2)B(2)C (T(N) = 15 K, incommensurate modulated magnetic state) even though the Tb ions in both isomorphs have almost the same crystalline electric field properties. The difference among the magnetic modes of these Tb-based isomorphs is attributed to a difference in their exchange couplings which are in turn caused by a variation in their lattice parameters and in the position of their Fermi levels.

Low-temperature magnetic and transport properties of single-crystal CeCoGe.

The low-temperature properties of single-crystal CeCoGe were investigated by specific heat C(T,H), magnetoresistivity ρ(T,H), and differential susceptibility measurements χ(T,H). The zero-field low-temperature specific heat evolves as C = γT+ßT(3) = 42T+23.5T(3) mJ mol(-1) K(-1). On comparing its γ = 42 mJ mol(-1) K(-1) with that of LaCoGe (12 mJ mol(-1) K(-2)) it is inferred that both 3d (Co) and 4f (Ce) orbitals contribute to the density of states at the Fermi level. Assuming that its phonic contribution to the specific heat is similar to LaCoGe (ß = 0.5 mJ mol(-1) K(-4)), then the extra cubic term in the specific heat (23T(3) mJ mol(-1) K(-1)) must be due to magnon excitation within the antiferromagnetically ordered state, T

Case management for persons with substance use disorders.

BACKGROUND: Patients with alcohol and other drug use disorders (AOD) frequently have multiple social, physical, and mental health treatment needs, yet have difficulty accessing community services, including drug abuse treatment. One strategy for linking patients with AOD with relevant services is case management, where a single case manager is responsible for linking patients with multiple relevant services. OBJECTIVES: To conduct a systematic review of all RCTs on the use of case management for helping drug abusers in or out of treatment. Outcome criteria included successful linkage with other services, illicit drug use outcomes, and a range of related outcomes. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register (Cochrane Library, issue 4, 2006), MEDLINE (1966 - 2006), EMBASE (1980 - 2006), LILACS (1982 - 2006), PsycINFO (1973 - 2006), Biological Abstracts (1982 t- 2000). Reference searching; personal communication; conference abstracts; book chapters on case management. SELECTION CRITERIA: Randomized controlled studies that compared a specific model of case management with either treatment as usual or another treatment model, included only patients with at least one alcohol or drug related problem. DATA COLLECTION AND ANALYSIS: Two groups of reviewers extracted the data independently . Standardized mean difference was estimated. MAIN RESULTS: In total, we could extract results from 15 studies. Outcome on illicit drug use was reported from 7 studies with 2391 patients. The effect size for illicit drug use was not significant, and small (standardized mean difference (SMD)=0.12, confidence interval=-0.09,0.29, p=0.20). Substantial heterogeneity was found (I(2)=69.9%). Linkage to other treatment services was reported in 10 studies with 3132 patients. The effect size for linkage was moderate (SMD=0.42, 95% confidence interval=0.21 to 0.62, p<0.001), but substantial heterogeneity was found (I(2)=85.2%). Moderator analyses suggested that a part of the heterogeneity found in linkage studies could be explained by the presence or absence of a treatment manual for case management. A single, large trial of case management with two arms, showed that case management was superior to psychoeducation and drug counselling in reducing drug use. AUTHORS' CONCLUSIONS: There is current evidence supporting that case management can enhance linkage with other services. However, evidence that case management reduces drug use or produce other beneficial outcome is not conclusive.

Heavy-flavour and quarkonium production in the LHC era: from proton-proton to heavy-ion collisions.

This report reviews the study of open heavy-flavour and quarkonium production in high-energy hadronic collisions, as tools to investigate fundamental aspects of Quantum Chromodynamics, from the proton and nucleus structure at high energy to deconfinement and the properties of the Quark-Gluon Plasma. Emphasis is given to the lessons learnt from LHC Run 1 results, which are reviewed in a global picture with the results from SPS and RHIC at lower energies, as well as to the questions to be addressed in the future. The report covers heavy flavour and quarkonium production in proton-proton, proton-nucleus and nucleus-nucleus collisions. This includes discussion of the effects of hot and cold strongly interacting matter, quarkonium photoproduction in nucleus-nucleus collisions and perspectives on the study of heavy flavour and quarkonium with upgrades of existing experiments and new experiments. The report results from the activity of the SaporeGravis network of the I3 Hadron Physics programme of the European Union 7[Formula: see text] Framework Programme.

Hypocalcemia and skeletal disease as presenting features of celiac disease.

OBJECTIVE: To describe 15 patients examined for hypocalcemia, skeletal disease, or both in whom the diagnosis of celiac disease was subsequently made. DESIGN: Observational case series. PATIENTS: Fifteen patients (7 women and 8 men) were examined for hypocalcemia (n = 11), skeletal disease (n = 3), or both (n = 1). The diagnosis of celiac disease was subsequently made. The mean age of the patients was 62 years, and 11 patients were 60 years of age or older. RESULTS: Four patients had no gastrointestinal symptoms, 7 patients had mild or intermittent gastrointestinal symptoms, and 4 patients had persistent diarrhea. Ten patients had experienced weight loss. The serum total alkaline phosphatase level was elevated in 10 of 15 patients, the parathyroid hormone level was elevated in all patients, and the urinary calcium level was low in all 6 of the patients tested. The level of 25-hydroxyvitamin D was frankly low in 4 patients, marginal in 8 patients, and normal in 3 patients. Bone mineral density was reduced in all 8 patients in whom it was measured. CONCLUSIONS: Celiac disease should be considered in patients with unexplained metabolic bone disease or hypocalcemia, especially because gastrointestinal symptoms may be absent or mild. Advanced age does not exclude the diagnosis of celiac disease.

Bioavailability and single-dose pharmacokinetics of intramuscular phenytoin.

Comparison of phenytoin plasma concentrations in an intravenous and intramuscular crossover study in 12 healthy ambulant, male subjects indicates that phenytoin administered intramuscularly is absorbed over a period of approximately five days. A model simulating precipitation and redissolution of the drug at the injection site has been shown to satisfactorily fit observed plasma concentration data following intramuscular administration. It is proposed that this model will be useful in the selection of an appropriate dosing regimen in situations in which intramuscular administration of phenytoin is indicated.

Zinc supplementation is associated with improved neurologic recovery rate and visceral protein levels of patients with severe closed head injury.

Sixty-eight patients were entered into a randomized, prospective, double-blinded controlled trial of supplemental zinc versus standard zinc therapy to study the effects of zinc supplementation on neurologic recovery and nutritional/metabolic status after severe closed head injury. One month after injury, the mortality rates in the standard zinc group and the zinc-supplemented group were 26 and 12%, respectively. Glasgow Coma Scale (GCS) scores of the zinc-supplemented group exceeded the adjusted mean GCS score of the standard group at day 28 (p = 0.03). Mean motor GCS score levels of the zinc-supplemented group were significantly higher on days 15 and 21 than those of the control group (p = 0.005, p = 0.02). This trend continued on day 28 of the study (p = 0.09). The groups did not differ in serum zinc concentration, weight, energy expenditure, or total urinary nitrogen excretion after hospital admission. Mean 24-h urine zinc levels were significantly higher in the zinc-supplemented group at days 2 (p = 0.0001) and 10 (p = 0.01) after injury. Mean serum prealbumin concentrations were significantly higher in the zinc-supplemented group (p = 0.003) at 3 weeks after injury. A similar pattern was found for mean serum retinol binding protein level (p = 0.01). A significantly larger number of patients in the standard zinc group had craniotomies for evacuation of hematoma; thus a bias may have been present. The results of this study indicate that zinc supplementation during the immediate postinjury period is associated with improved rate of neurologic recovery and visceral protein concentrations for patients with severe closed head injury.

Vancomycin use in a university medical center: effect of a vancomycin continuation form.

OBJECTIVE: To examine the impact of a new policy to ensure appropriate use of vancomycin in a 461-bed tertiary-care hospital. DESIGN: We instituted a policy that allowed physicians to prescribe vancomycin but that required them to complete a vancomycin continuation form and document that use conformed to Hospital Infection Control Practices Advisory Committee (HICPAC) guidelines if they wished to continue the drug beyond 72 hours. Vancomycin was stopped automatically at 72 hours if use was not consistent with guidelines, if an infectious diseases consultant did not approve the drug, or if the form was not completed. A pharmacist and infectious diseases specialist monitored use of vancomycin prospectively and interacted with prescribers when indicated. Educational efforts were limited to printing the HICPAC guidelines on the form and providing information about the policy in a newsletter. Patterns of prescribing and the economic impact of the form were evaluated over a 6-month period. RESULTS: Only 29% to 48% of vancomycin orders initially met HICPAC guidelines, but 77% to 96% of use was appropriate after 72 hours when the form was used. Inappropriate surgical prophylaxis, empirical therapy of intensive-care unit and transplant patients, and therapy for inadequately documented coagulase-negative staphylococcal infections remained problems. Vancomycin use fell from a mean of 136 (+/-52) g/1,000 patient days in the 12 months before the form to 78 (+/-22) g/1,000 patient days in the 9 months after institution of the form (P<.05). Net vancomycin acquisition costs and costs of ordering vancomycin serum levels fell by $357 and $19 per 1,000 patient days, respectively (P<.05). This represented annualized saving of approximately $47,000 in drug and monitoring costs. No adverse patient outcomes were seen as a result of the program. CONCLUSIONS: A vancomycin continuation form can decrease inappropriate vancomycin use and may save money. Additional educational efforts may be required to increase compliance with HICPAC guidelines during initial prescribing.

Final inline filtration: a means of decreasing the incidence of infusion phlebitis.

Infusion phlebitis is the most common complication of intravenous therapy. Six methods of reducing the incidence of infusion phlebitis including inline final filtration, buffers, heparin, hydrocortisone, heparin-hydrocortisone combinations, and frequent set changes were tested in a two part randomized prospective double-blind study of 266 surgical patients. Patients who received filtered fluids had a significantly decreased incidence of infusion phlebitis as compared with that of controls (P = 0.0000001). Of the other methods tested, only the heparin-hydrocortisone combinations achieved any significant decrease in phlebitis (P less than 0.5). Therefore, inline filtration is a highly effective means of decreasing the incidence of infusion phlebitis and should be considered as a routine part of intravenous therapy.

Electronic flow control and roller clamp control in intravenous therapy: a clinical comparison.

In a prospective clinical study, an electronic intravenous (IV) rate controller was compared with a standard roller clamp for control of IV infusions. The electronic IV rate controller was associated with fewer complications and more accurate fluid therapy than was the roller clamp. There was also a substantial savings of nursing time and a potential for cost savings when the electronic IV rate controller was used.

Membrane filters. Additional safety for intra-arterial infusions.

The addition of a 0.45mu in-line membrane-filter to the delivery system for intra-arterial infusion therapy is a simple and inexpensive means of providing additional safety. The filter decreases particulate and microorganism infusion by removing all measurable particles and most bacterial and fungal organisms. Since air will not pass through the filter, air embolism is prevented. In addition, in the event of set disruption, the filter will prevent bleeding via red blood cells clogging the membrane.

Dopamine-phenytoin interaction. A cause of hypotension in the critically ill.

Five critically ill patients received dopamine hydrochloride intravenously to support their blood pressure. When seizures developed, intravenous phenytoin sodium therapy was begun. Coincident with the infusion of phenytoin, the blood pressure, which was stable on the dopamine infusion, declined rapidly. Analysis of these cases led to a hypothesis that the interaction of dopamine and phenytoin produced the hypotension. When this hypothesis was tested in the normovolemic dog, intravenous dopamine produced no change in the blood pressure, and the addition of a phenytoin infusion had little effect. In animals rendered hypovolemic and hypotensive by bleeding, intravenous dopamine returned the blood pressure to the prebleeding level. At this point, an infusion of phenytoin produced a sustained decrease in the blood pressure. The mechanism of this action may be related to a combination of catecholamine depletion and myocardial depression.

Comparison of epsilon aminocaproic acid and normal saline for postoperative bladder irrigation following transurethral resection of prostate.

A prospective, randomized, double-blind trial of bladder irrigation with a 0.5% solution of epsilon aminocaproic acid (EACA) versus normal saline plus placebo was undertaken in 75 patients undergoing transurethral resection of the prostate for benign or malignant disease. Systemic absorption after irrigation with EACA was not detectable. No significant advantage, however, was demonstrated for the EACA solution over normal saline irrigation in measured postoperative blood loss, irrigant volume, hours of catheterization, or length of hospital stay.

Nutritional assessment and therapy in advanced urothelial cancer.

Patients with advanced urothelial cancers often have cachexia and anorexia resulting in severe malnutrition and depressed immunologic function. Careful nutritional assessment early in their evaluation and early use of parenteral and enteral nutritional supplements play an important role in allowing these patients to withstand their therapies safely as well as in improving their prognosis.

Antimicrobial resistance in gram-positive bacteria: the myth of the MIC. Minimum inhibitory concentration.

Although much progress has occurred in the fight to treat infection, resistant bacteria increasingly are becoming problematic. The minimum inhibitory concentration is easily determined, yet its definition, clinical application, and relevance are confusing. In addition, errors can occur during in vitro susceptibility testing. The mechanism of resistance for different organisms is discussed as are the pitfalls of susceptibility testing and the prescription of antimicrobial agents.