Precise measurement of the neutrino mixing parameter θ23 from muon neutrino disappearance in an off-axis beam

New data from the T2K neutrino oscillation experiment produce the most precise measurement of the neutrino mixing parameter θ23. Using an off-axis neutrino beam with a peak energy of 0.6 GeV and a data set corresponding to 6.57×10(20) protons on target, T2K has fit the energy-dependent νμ oscillation probability to determine oscillation parameters. The 68% confidence limit on sin(2)(θ23) is 0.514(-0.056)(+0.055) (0.511±0.055), assuming normal (inverted) mass hierarchy. The best-fit mass-squared splitting for normal hierarchy is Δm32(2)=(2.51±0.10)×10(-3)  eV(2)/c(4) (inverted hierarchy: Δm13(2)=(2.48±0.10)×10(-3)  eV(2)/c(4)). Adding a model of multinucleon interactions that affect neutrino energy reconstruction is found to produce only small biases in neutrino oscillation parameter extraction at current levels of statistical uncertainty.

Observation of electron neutrino appearance in a muon neutrino beam

The T2K experiment has observed electron neutrino appearance in a muon neutrino beam produced 295 km from the Super-Kamiokande detector with a peak energy of 0.6 GeV. A total of 28 electron neutrino events were detected with an energy distribution consistent with an appearance signal, corresponding to a significance of 7.3σ when compared to 4.92±0.55 expected background events. In the Pontecorvo-Maki-Nakagawa-Sakata mixing model, the electron neutrino appearance signal depends on several parameters including three mixing angles θ12, θ23, θ13, a mass difference Δm(32)(2) and a CP violating phase δ(CP). In this neutrino oscillation scenario, assuming |Δm(32)(2)|=2.4×10(-3)  eV(2), sin(2)θ(23)=0.5, and Δm322>0 (Δm(32)(2)<0), a best-fit value of sin(2)2θ(13)=0.140(-0.032)(+0.038) (0.170(-0.037)(+0.045)) is obtained at δ(CP)=0. When combining the result with the current best knowledge of oscillation parameters including the world average value of θ(13) from reactor experiments, some values of δ(CP) are disfavored at the 90% C.L.

An unusual case of mesenteric ischaemia

We describe an unusual cause of diarrhoea and segmental colitis in a previous well adult man. Mesenteric inflammatory veno-occlusive disease is a rare cause of gastrointestinal tract ischaemia of unknown aetiology. We review the literature of this condition and other mesenteric venous pathologies.

A DFT + U computational study on stoichiometric and oxygen deficient M–CeO2 systems (M = Pd1, Rh1, Rh10, Pd10 and Rh4Pd6)

Molecular and dissociative adsorption processes of ethanol on stoichiometric and O-defected CeO₂(111) surfaces alone as well as in the presence of one metal atom (Pd or Rh) are studied using spin-polarized density functional theory (DFT) with the GGA + U method (U_eff = 5.0 eV).

The Kuwait-Scotland eHealth Innovation Network (KSeHIN): a sustainable approach to quality improvement in healthcare

BACKGROUND

The rising prevalence of obesity and diabetes in Kuwait represents a significant challenge for the country's healthcare system. Diabetes care in Scotland has improved by adopting a system of managed clinical networks supported by a national informatics platform. In 2010, a Kuwait-Dundee collaboration was established with a view to transforming diabetes care in Kuwait. This paper describes the significant progress that has been made to date.

METHODS

The Kuwait-Scotland eHealth Innovation Network (KSeHIN) is a partnership among health, education, industry and government. KSeHIN aims to deliver a package of clinical service development, education (including a formal postgraduate programme and continuing professional development) and research underpinned by a comprehensive informatics system.

RESULTS

The informatics system includes a disease registry for children and adults with diabetes. At the patient level, the system provides an overview of clinical and operational data. At the population level, users view key performance indicators based on national standards of diabetes care established by KSeHIN. The national childhood registry (CODeR) accumulates approximately 300 children a year. The adult registry (KHN), implemented in four primary healthcare centres in 2013, has approximately 4000 registered patients, most of whom are not yet meeting national clinical targets. A credit-bearing postgraduate educational programme provides module-based teaching and workplace-based projects. In addition, a new clinical skills centre provides simulator-based training. Over 150 masters students from throughout Kuwait are enrolled and over 400 work-based projects have been completed to date.

CONCLUSION

KSeHIN represents a successful collaboration between multiple stakeholders working across traditional boundaries. It is targeting patient outcomes, system performance and professional development to provide a sustainable transformation in the quality of diabetes healthcare for the growing population of Kuwaitis with diabetes in Kuwait.

Randomized controlled trial of the effect of depth of anaesthesia on postoperative pain

BACKGROUND

Our hypothesis was that deep anaesthesia, as estimated by a low target bispectral index (BIS) of 30-40, would result in less postoperative pain than that achieved at a conventional depth of anaesthesia.

METHODS

We undertook a randomized double-blind controlled study at two tertiary teaching hospitals in New Zealand (2010-1) recruiting 135 adult patients ASA I-II presenting for non-emergent surgery under general anaesthesia requiring tracheal intubation. Anaesthesia was maintained with desflurane and a multimodal analgesia regimen comprising fentanyl infusion, i.v. paracetamol, and parecoxib. Patients were randomly assigned to either a low BIS (30-40) group or a high BIS (45-60) group. Desflurane concentrations were titrated to achieve these targets. Postoperative pain was assessed by: the pain on awakening (0-10, verbal rating scale, VRS(awake)) in the post-anaesthetic care unit; pain on activity at 20-24 h after operation (VRS(d1A)); and the rate of morphine patient-controlled analgesia (PCA) usage over the first 24 h.

RESULTS

There was no statistically significant difference between the two groups for any of the pain scores. The median [inter-quartile range (IQR)] VRS(awake) was 4.0 (0-8) for the low and 4.0 (0-8) for the high BIS groups (P=0.56). The median (IQR) VRS(d1A) was 3.0 (1-5) for the low and 3.0 (1.5-4.5) for the high BIS groups (P=0.83). The median PCA morphine consumption in the low BIS group was 0.61 mg h(-1) (0.04-1.5) vs 0.43 mg h(-1) (0-1.59) in the high BIS group (P=0.98).

CONCLUSIONS

We conclude that there is no clinically useful analgesic effect of a deep anaesthesia regimen.

Measurement of neutrino oscillation parameters from muon neutrino disappearance with an off-axis beam

The T2K Collaboration reports a precision measurement of muon neutrino disappearance with an off-axis neutrino beam with a peak energy of 0.6 GeV. Near detector measurements are used to constrain the neutrino flux and cross section parameters. The Super-Kamiokande far detector, which is 295 km downstream of the neutrino production target, collected data corresponding to 3.01×10(20) protons on target. In the absence of neutrino oscillations, 205±17 (syst) events are expected to be detected while only 58 muon neutrino event candidates are observed. A fit to the neutrino rate and energy spectrum, assuming three neutrino flavors and normal mass hierarchy yields a best-fit mixing angle sin2(θ23)=0.514±0.082 and mass splitting |Δm(32)(2)|=2.44(-0.15)(+0.17)×10(-3) eV2/c4. Our result corresponds to the maximal oscillation disappearance probability.

Statistics: more regression models

In a previous article, we tackled the question "How are we related?" for the simple case of one explanatory variable or covariate. Now we can move onto a natural extension, with still only one response variable, but more than one explanatory variable.

The validity of commonly used adipose tissue body composition equations relative to dual energy X-ray absorptiometry (DXA) in gaelic games players

Dual-energy X-ray absorptiometry (DXA) and adipose tissue percentage estimates (AT%) derived from regression based skinfold equations were compared. 35 Gaelic games players [20.9 ± 1.7 years; 78.1 ± 8.6 kg; 179.5 ± 5.7 cm] underwent whole body fan beam DXA scans following a standardised protocol and assessment of skinfold thickness at 8 sites. Adipose tissue% from the sum of skinfolds and/or via body density were calculated for general and athlete specific equations (SKf-AT %). The relationship, i. e., proportional bias, fixed bias and random error (SEE) between DXA-AT % and AT % derived from the 6 skinfold equations were determined using least squares regression analysis. Skinfold AT% estimates were underestimated relative to DXA-AT % across all skinfold equations except that of Durnin and Wormersley [9] (D&W-∑(4AT %)) (16.7 ± 3.4 vs. 16.6 ± 4.0 %). All equations demonstrated 95 % prediction intervals ranges exceeding ~10 %. Each equation failed to predict AT% relative to DXA within an accepted ± 3.5 % anthropometric error rate. It is recommended that the conversion of absolute skinfold thickness to an AT % is avoided and that the skinfold equations assessed herein are not utilised in Gaelic games players. Alternate 'sum of skinfold' approaches should be considered.

Interactions of Saccharomyces cerevisiae fermentation product and in-feed antibiotic on gastrointestinal and immunological responses in piglets challenged with Escherichia coli K88+

Interactive effects between in-feed antibiotics (PC; 0.04% chlortetracycline + 0.004% Denagard) and a Saccharomyces cerevisiae fermentation product (XPC) were investigated. Five pens of 3 pigs/pen were randomly allotted to one of six diets consisting of control (NC; no additives), XPC alone (0.2%), PC alone, or PC plus one of three levels of XPC (0.1, 0.2, or 0.4%). On day 7, all pigs were bled for baseline serum and then orally inoculated with a 6-mL dose of 2 x 10(9) cfu/mL of ciprofloxacin-resistant Escherichia coli K88(+) (ETEC). Severity of diarrhea, using fecal score (FS), was assessed on days 8, 9, and 10. On day 10, pigs were bled and 1 pig/pen was killed to obtain gastrointestinal (GIT) samples. Remaining pigs were monitored for another 4 d and then killed to obtain GIT samples. Pigs fed PC and XPC in combination of PC had a lower (P = 0.02) FS than NC. The PC pigs had lower (P = 0.02) serum interleukin-6 and XPC pigs had higher (P < 0.01) serum tumor necrosis factor-α than NC pigs. Ileal mucosal ETEC count was lower on day 10 (P = 0.04) and day 14 (P < 0.01) when additives were fed in combination. Microbiome analysis of day 10 digesta using pyrosequencing showed that pigs fed the PC with XPC had enriched (P = 0.01) Streptococcaceae family than PC fed alone. On day 10, pigs fed PC alone and in combination with XPC at a lower dose had shallower (P = 0.01) crypt depth than those fed higher doses of XPC, XPC alone, or NC. Pigs fed XPC had a thicker colon wall on day 10 (P < 0.01) compared to those fed non-XPC diets. Ileal and colonic digesta NH(3) concentration was lower (P < 0.05) for pigs fed additives-containing diets on days 10 and 14. Feeding PC or XPC reduced diarrhea and the number of ETEC attached to the ileal mucosa; however, responses suggest independent and interactive effects that might be associated with the nature of these additives.

Detailed molecular characterisation of acute myeloid leukaemia with a normal karyotype using targeted DNA capture

Advances in sequencing technologies are giving unprecedented insights into the spectrum of somatic mutations underlying acute myeloid leukaemia with a normal karyotype (AML-NK). It is clear that the prognosis of individual patients is strongly influenced by the combination of mutations in their leukaemia and that many leukaemias are composed of multiple subclones, with differential susceptibilities to treatment. Here, we describe a method, employing targeted capture coupled with next-generation sequencing and tailored bioinformatic analysis, for the simultaneous study of 24 genes recurrently mutated in AML-NK. Mutational analysis was performed using open source software and an in-house script (Mutation Identification and Analysis Software), which identified dominant clone mutations with 100% specificity. In each of seven cases of AML-NK studied, we identified and verified mutations in 2-4 genes in the main leukaemic clone. Additionally, high sequencing depth enabled us to identify putative subclonal mutations and detect leukaemia-specific mutations in DNA from remission marrow. Finally, we used normalised read depths to detect copy number changes and identified and subsequently verified a tandem duplication of exons 2-9 of MLL and at least one deletion involving PTEN. This methodology reliably detects sequence and copy number mutations, and can thus greatly facilitate the classification, clinical research, diagnosis and management of AML-NK.

Effects of 11β-hydroxysteroid dehydrogenase-1 inhibition on hepatic glycogenolysis and gluconeogenesis

The aim of this study was to determine the effect of prolonged 11β-hydroxysteroid dehydrogenase-1 (11β-HSD1) inhibition on basal and hormone-stimulated glucose metabolism in fasted conscious dogs. For 7 days prior to study, either an 11β-HSD1 inhibitor (HSD1-I; n = 6) or placebo (PBO; n = 6) was administered. After the basal period, a 4-h metabolic challenge followed, where glucagon (3×-basal), epinephrine (5×-basal), and insulin (2×-basal) concentrations were increased. Hepatic glucose fluxes did not differ between groups during the basal period. In response to the metabolic challenge, hepatic glucose production was stimulated in PBO, resulting in hyperglycemia such that exogenous glucose was required in HSD-I (P < 0.05) to match the glycemia between groups. Net hepatic glucose output and endogenous glucose production were decreased by 11β-HSD1 inhibition (P < 0.05) due to a reduction in net hepatic glycogenolysis (P < 0.05), with no effect on gluconeogenic flux compared with PBO. In addition, glucose utilization (P < 0.05) and the suppression of lipolysis were increased (P < 0.05) in HSD-I compared with PBO. These data suggest that inhibition of 11β-HSD1 may be of therapeutic value in the treatment of diseases characterized by insulin resistance and excessive hepatic glucose production.

Trends in cutaneous sensitization in the first 18 years of life: results from the 1989 Isle of Wight birth cohort study

BACKGROUND

Skin prick testing (SPT) is fundamental to the practice of clinical allergy identifying relevant allergens and predicting the clinical expression of disease. There are only limited data on the natural history of SPT results over childhood and adolescence.

OBJECTIVE

We aimed to describe the natural history of SPT and patterns of sensitization over childhood and adolescence.

METHODS

The 1989 Isle of Wight birth cohort (1456 participants) was followed up at 1, 2, 4, 10 and 18 years. SPT was undertaken from 4 years.

RESULTS

SPT was performed on 980 (80%), 1036 (75%) and 853 (65%) of participants at 4, 10 and 18 years. The prevalence of sensitization to any allergen at these time-points was 19.7%, 26.9% and 41.3% respectively. At each time-point, boys were significantly more likely to be sensitized (P < 0.016) and sensitization significantly increased over childhood and adolescence (average annual increase of 7%). Some children outgrew their sensitization. The rate of sensitization to most individual allergens increased over childhood and adolescence. A configural frequency analysis showed that whether an individual was sensitizated was relatively fixed over childhood and adolescence. Cluster analysis at 4 years demonstrated four major groups of individuals with similar co-sensitization to specific allergens. Children who were sensitized at age 4 years generally went onto become sensitized to additional allergens at 10 and 18 years.

CONCLUSIONS AND CLINICAL RELEVANCE

Allergic sensitization continues to increase over childhood into adolescence although the majority of children who were not sensitized at 4 years remain non-sensitized throughout childhood and adolescence. The presence of sensitization at 4 years predicted later sensitization to additional allergens.

Statistics: dealing with categorical data

This, the fifth of our series of articles on statistics in veterinary medicine, moves onto modelling categorical data, in particular assessing associations between variables. Some of the questions we shall consider are widely discussed in many clinical research publications, and we will use the ideas of hypothesis tests and confidence intervals to answer those questions.

Statistics: how many?

The fourth in our series of articles on statistics for clinicians focuses on how we determine the appropriate number of subjects to include in an experimental study to provide sufficient statistical "power".

Integrated, home-based treatment for MDR-TB and HIV in rural South Africa: an alternate model of care

SETTING

Treatment outcomes for multidrug-resistant tuberculosis (MDR-TB) in South Africa have suffered as centralized, in-patient treatment programs struggle to cope with rising prevalence and human immunodeficiency virus (HIV) co-infection rates. A new treatment model is needed to expand treatment capacity and improve MDR-TB and HIV outcomes.

OBJECTIVE

To describe the design and preliminary results of an integrated, home-based MDR-TB-HIV treatment program created in rural KwaZulu-Natal.

METHOD

In 2008, a decentralized center was established to provide out-patient MDR-TB and HIV treatment. Nurses, community health workers and family supporters have been trained to administer injections, provide adherence support and monitor adverse reactions in patients' homes. Physicians assess clinical response, adherence and the severity of adverse reactions to MDR-TB and HIV treatment at monthly follow-up visits. Treatment outcomes are assessed by monthly cultures and CD4 and viral load every 6 months.

RESULTS

Of 80 patients initiating MDR-TB treatment from February 2008 to April 2010, 66 were HIV-co-infected. Retention has been high (only 5% defaults, 93% of visits attended), and preliminary outcomes have been favorable (77% cured/still on treatment, 82% undetectable viral load). Few patients have required escalation of care (9%), had severe adverse events (8%) or died (6%).

CONCLUSION

Integrated, home-based treatment for MDR-TB and HIV is a promising treatment model to expand capacity and achieve improved outcomes in rural, resource-poor and high HIV prevalent settings.

Gamow-Teller transition strengths from 56Ni

A new technique to measure (p,n) charge-exchange reactions in inverse kinematics at intermediate energies on unstable isotopes was successfully developed and used to study the (56)Ni(p,n) reaction at 110 MeV/u. Gamow-Teller transition strengths from (56)Ni leading to (56)Cu were obtained and compared with shell-model predictions in the pf shell using the KB3G and GXPF1A interactions. The calculations with the GXPF1A interaction reproduce the experimental strength distribution much better than the calculations that employed the KB3G interaction, indicating deficiencies in the spin-orbit and proton-neutron residual potentials for the latter. The results are important for improving the description of electron-capture rates on nuclei in the iron region, which are important for modeling the late evolution of core-collapse and thermonuclear supernovae.

Indication of electron neutrino appearance from an accelerator-produced off-axis muon neutrino beam

The T2K experiment observes indications of ν(μ) → ν(e) appearance in data accumulated with 1.43×10(20) protons on target. Six events pass all selection criteria at the far detector. In a three-flavor neutrino oscillation scenario with |Δm(23)(2)| = 2.4×10(-3)  eV(2), sin(2)2θ(23) = 1 and sin(2)2θ(13) = 0, the expected number of such events is 1.5±0.3(syst). Under this hypothesis, the probability to observe six or more candidate events is 7×10(-3), equivalent to 2.5σ significance. At 90% C.L., the data are consistent with 0.03(0.04) < sin(2)2θ(13) < 0.28(0.34) for δ(CP) = 0 and a normal (inverted) hierarchy.

Hydrogen Production from Ethanol. Comparing Thermal Catalytic Reactions to Photo-catalytic Reactions

Hydrogen production from renewables such as bio-ethanol is one of the most promising processes for energy carriers in a sustainable way. In this work we review and compare two catalytic systems: one based on thermal activation over bimetallic catalysts (Rh-Pd/CeO2) and the other over photo-excited semiconductor catalysts (Au/TiO2 anatine, rutile and anatase/rutile). It is found that the hydrogen yield is far higher on the thermally activated catalysts (at 773K) when compared to that of the photo-exited catalysts (at room temperature); about 60 times. However, the photo-excited catalysts are a promising way to create a fully sustainable system for future applications if the complete removal of hydrogen atoms from water and ethanol are obtained at room temperature.