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For the first time, the FRagment Separator (FRS) and the Multiple-Reflection Time-Of-Flight Mass-Spectrometer (MR-TOF-MS) particle identification (PID) systems at GSI have been coupled. This new approach adds to the standard FRS PID an additional unambiguous identification of the fragments and the possibility to identify and count long-lived isomeric states (>ms). For this purpose, single-event timestamp information given by a common clock was used to correlate both systems. Two methods were implemented to improve the signal-to-background ratio by more than a factor 2 in the high resolution mass spectrum obtained with the MR-TOF-MS for the 109In isotope. Moreover, the coupling of the systems allows an improvement in the on-line monitoring of the FRS-Ion Catcher (IC) efficiency and extraction time. In addition, range calculations were implemented in the on-line monitoring; a powerful tool for real-time optimization of stopped beam experiments. [ABSTRACT FROM AUTHOR]

Here we report the isolation and characterization of three metagenome-derived clones that interfere with bacterial quorum sensing and degrade N-(3-oxooctanoyl)-L-homoserine lactone (3-oxo-C[sub8]-HSL). By using a tral-lacZ gene fusion, the metagenome-derived clones were identified from a soil DNA library and analyzed. The open reading frames linked to the 3-oxo-C[sub8]-HSL-degrading activities were designated bpiB01, bpiB04, and bpiB07. While the BpiB07 protein was similar to a known lactonase, no significant similarities were observed for the BpiB01 and BpiB04 proteins or the deduced amino acid sequences. High-performance liquid chromatography-mass spectrometry analyses confirmed that the identified genes encode novel lactone-hydrolyzing enzymes. The original metagenome-derived clones were expressed in Pseudomonas aeruginosa and employed in motility and biofilm assays. All clones were able to reproducibly inhibit motility in P. aeruginosa. Furthermore, these genes clearly inhibited biofllm formation in P. aeruginosa when expressed in P. aeruginosa PAO1. Thus, this is the first study in which metagenome-derived proteins have been expressed in P. aeruginosa to successfully inhibit biofilm formation. [ABSTRACT FROM AUTHOR]

Background: Understanding of data-reporting methods is imperative for correct interpretation of the medical literature as well as for proper performance of future clinical research. Recent developments in biostatistics have greatly changed the types of statistical analyses used and the minimum quality standards that must be maintained. Method: Different types of review are described, including systematic review with and without meta-analysis. Minimum reporting standards, sources of bias, both quantitative and qualitative, and references are discussed. Results and Conclusion: Meta-analysis has become a clearly defined technique, with reporting standards for both randomized controlled trials and observational studies. It is assuming a wider role in the surgical literature. Although many sources of bias exist, there are clear reporting standards and readers should be aware of these when studying the literature. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

A fast and reliable range monitoring method is required to take full advantage of the high linear energy transfer provided by therapeutic ion beams like carbon and oxygen while minimizing damage to healthy tissue due to range uncertainties. Quasi-real-time range monitoring using in-beam positron emission tomography (PET) with therapeutic beams of positron-emitters of carbon and oxygen is a promising approach. The number of implanted ions and the time required for an unambiguous range verification are decisive factors for choosing a candidate isotope. An experimental study was performed at the FRS fragment-separator of GSI Helmholtzzentrum für Schwerionenforschung GmbH, Germany, to investigate the evolution of positron annihilation activity profiles during the implantation of 14 O and 15 O ion beams in a PMMA phantom. The positron activity profile was imaged by a dual-panel version of a Siemens Biograph mCT PET scanner. Results from a similar experiment using ion beams of carbon positron-emitters 11 C and 10 C performed at the same experimental setup were used for comparison. Owing to their shorter half-lives, the number of implanted ions required for a precise positron annihilation activity peak determination is lower for 10 C compared to 11 C and likewise for 14 O compared to 15 O, but their lower production cross-sections make it difficult to produce them at therapeutically relevant intensities. With a similar production cross-section and a 10 times shorter half-life than 11 C, 15 O provides a faster conclusive positron annihilation activity peak position determination for a lower number of implanted ions compared to 11 C. A figure of merit formulation was developed for the quantitative comparison of therapy-relevant positron-emitting beams in the context of quasi-real-time beam monitoring. In conclusion, this study demonstrates that among the positron emitters of carbon and oxygen, 15 O is the most feasible candidate for quasi-real-time range monitoring by in-beam PET that can be produced at therapeutically relevant intensities. Additionally, this study demonstrated that the in-flight production and separation method can produce beams of therapeutic quality, in terms of purity, energy, and energy spread. [ABSTRACT FROM AUTHOR]

Objective. Beams of stable ions have been a well-established tool for radiotherapy for many decades. In the case of ion beam therapy with stable 12C ions, the positron emitters 10,11C are produced via projectile and target fragmentation, and their decays enable visualization of the beam via positron emission tomography (PET). However, the PET activity peak matches the Bragg peak only roughly and PET counting statistics is low. These issues can be mitigated by using a short-lived positron emitter as a therapeutic beam. Approach. An experiment studying the precision of the measurement of ranges of positron-emitting carbon isotopes by means of PET has been performed at the FRS fragment-separator facility of GSI Helmholtzzentrum für Schwerionenforschung GmbH, Germany. The PET scanner used in the experiment is a dual-panel version of a Siemens Biograph mCT PET scanner. Main results. High-quality in-beam PET images and activity distributions have been measured from the in-flight produced positron emitting isotopes 11C and 10C implanted into homogeneous PMMA phantoms. Taking advantage of the high statistics obtained in this experiment, we investigated the time evolution of the uncertainty of the range determined by means of PET during the course of irradiation, and show that the uncertainty improves with the inverse square root of the number of PET counts. The uncertainty is thus fully determined by the PET counting statistics. During the delivery of 1.6 × 107 ions in 4 spills for a total duration of 19.2 s, the PET activity range uncertainty for 10C, 11C and 12C is 0.04 mm, 0.7 mm and 1.3 mm, respectively. The gain in precision related to the PET counting statistics is thus much larger when going from 11C to 10C than when going from 12C to 11C. The much better precision for 10C is due to its much shorter half-life, which, contrary to the case of 11C, also enables to include the in-spill data in the image formation. Significance. Our results can be used to estimate the contribution from PET counting statistics to the precision of range determination in a particular carbon therapy situation, taking into account the irradiation scenario, the required dose and the PET scanner characteristics. [ABSTRACT FROM AUTHOR]

An abstract of the article "Care Coordination by Paraprofessionals: Impact on the Functional Status of Rural Elderly" by C. A. Hornung and colleagues is presented.

An abstract of the article "The Sociologic Reality of Advance Directives" by D. List and colleagues is presented.

The FRagment Separator FRS at GSI is a versatile spectrometer and separator for experiments with relativistic in-flight separated short-lived exotic beams. One branch of the FRS is connected to the target hall where the bio-medical cave (Cave M) is located. Recently a joint activity between the experimental groups of the FRS and the biophysics at the GSI and Department of physics at LMU was started to perform biomedical experiments relevant for hadron therapy with positron emitting carbon and oxygen beams. This paper presents the new ion-optical mode and commissioning results of the FRS-Cave M branch where positron emitting 15O-ions were provided to the medical cave for the first time. An overall conversion efficiency of 2. 9 ± 0. 2 × 1 0 − 4 15O fragments per primary 16O ion accelerated in the synchrotron SIS18 was reached. [ABSTRACT FROM AUTHOR]

A novel system has been developed to detect simultaneous double-alpha emission from purified and weightless sources. The system includes the collection of 224Ra low-energy recoils in purified helium buffer gas from the decay of 228Th. The recoil products are thermalized and collected in a cryogenic buffer gas cell and extracted into an RF-ion guide for mass selection. The mass-separated ions are implanted at low kinetic energy into a thin carbon foil placed between two large-area double-sided silicon strip detectors to observe correlated alpha-particle emission. The apparatus is described in detail, including insights into its experimental performance. [ABSTRACT FROM AUTHOR]

The multinucleon transfer (MNT) reaction approach was successfully employed for the first time to measure the isomeric ratios (IRs) of 211Po isomer (25/2+) and its ground state (9/2+) at the IGISOL facility using a 945 MeV 136Xe beam impinged on 209Bi and natPb targets. The dominant production of isomers compared to the corresponding ground states was consistently revealed in the α -decay spectra. Deduced IR of 211Po populated through the 136Xe+natPb reaction was found to have an enhancement of ≈1.8-times than that observed for the 136Xe+209Bi. State-of-the-art Langevin-type model calculations have been utilized to estimate the spin distribution of an MNT residue. The computations qualitatively corroborate with the considerable increase in the IRs of 211Po produced from 136Xe+natPb compared to 136Xe+209Bi. Theoretical investigations indicate a weak dependence of target spin on the IRs. The enhancement of the 211Po isomer in the 136Xe+natPb over 136Xe+209Bi can be attributed to the different proton (p)-transfer production routes. Estimations demonstrate an increment in the angular momentum transfer, favorable for isomer production, with increasing projectile energy. Comparative analysis reveals the two entrance channel parameters, projectile mass and p -transfer channels, strongly influencing the population of the high-spin isomer of 211Po (25/2+). This letter reports the first experimental and theoretical study on the IRs of nuclei formed from two different p -transfer channels via two independent MNT reactions. [ABSTRACT FROM AUTHOR]

Abstract: The N-acyl-homoserine lactones (N-AHLs) play an important role in bacterial cell–cell signaling. Up to date, however, only a few different experimentally proven classes of N-AHL ring-cleaving enzymes are known. Here we report on the isolation and biochemical characterization of a novel hydrolase derived from the soil metagenome and acting on N-AHLs. The identified protein designated BpiB05 is weakly similar to hypothetical proteins from Bacteroides fragilis, the draft genomes of two Burkholderia species as well as a marine metagenomic ORF but is otherwise not similar to any known protein. BpiB05 was overexpressed in Escherichia coli as a 10× His-tagged fusion protein. The recombinant protein revealed a molecular weight of about 70kDa and was tested for its quorum quenching (QQ) activities using a lacZ-bioassay. Additional HPLC–MS analyses confirmed the lactonolytic activity of the purified protein in the presence of Ca2+. Further tests suggested that BpiB05 strongly reduces motility in Pseudomonas aeruginosa, pyocyanin synthesis and biofilm formation in this microbe. Because BpiB05 is not distantly related to any of the currently known hydrolases it forms probably a novel group within the growing number of proteins acting on N-AHLs. [Copyright &y& Elsevier]

The article examines the extent of publication bias for the surgeon scientist. The researchers described the qualitative and quantitative methods of detecting publication bias such as their advantages and disadvantages. Based on the results, they concluded that surgeon scientist should take steps to minimize publication bias such as using both qualitative and quantitative assessment methods.

Nuclear mass is a key property of atomic nuclei. The accurate determination of nuclear masses provides information for the nuclear shell structure and nuclear deformations. The FRS Ion Catcher experimental setup at GSI, Darmstadt was used to perform mass measurements of 252Cf fragments using a multiple-reflection time-of-flight mass spectrometer. The reported results are compared to previous measurements and their implication in the estimation of two-neutron separation energy is discussed. [ABSTRACT FROM AUTHOR]

The use of multi-nucleon transfer (MNT) reactions to produce neutronrich nuclei in the heavy region has received an increased attention in the last decade. The feasibility of employing such reactions at the FRS Ion Catcher facility at GSI and the IGISOL facility at JYFL is studied using a combination of theoretical calculations and experiment simulations. The reactions are computed within a Langevin-type model, and the Geant program is used to simulate the transport of the resulting products within the experimental setups of the above-mentioned facilities. The angular distribution of ion release, possible target choices and target-to-beam-dump distances are discussed. [ABSTRACT FROM AUTHOR]

Determination of the constituents of the radioactive ion beam (RIB) is crucial for successful experiments at low-energy RIB facilities and as such decides the fate of many experiments. Here we present the role of TITAN's Multiple-Reflection Time-Of-Flight Mass Separator (MR-TOF-MS) and how it complements the present capabilities at ISAC-TRIUMF for yield determinations and beam delivery. This non-scanning, broadband, high-resolution mass spectrometer allows for real-time identification and quantification of all species, ranging from radionuclides with half-lives as low as a few ms to stable isotopes and molecules. In this manner it can be efficiently used to optimize RIB delivery through the ISAC mass separator for rate of the species of interest or its ratio to contamination. We present an example of this optimization approach, where the purity of secondary beams of neutron-rich titanium was improved by more than one order of magnitude based on the diagnostics capabilities of the new MR-TOF-MS and thus, allowed for high-precision mass measurements at TITAN. [ABSTRACT FROM AUTHOR]

We plan to conduct an experimental search for η'-mesic nuclei in order to investigate in-medium properties of the η' meson. A 2.5 GeV proton beam is employed to produce η'-mesic 11C nuclei with the 12C(p,d)η' 11C reaction. Simultaneous measurements of the forward ejected deuterons and decay protons from η'-mesic nuclei will allow us to achieve high experimental sensitivity. The experiment will be performed at GSI by making full use of the fragment separator FRS and the WASA detector system. The plan of this proposed experiment is described. [ABSTRACT FROM AUTHOR]

At the FRS Ion Catcher (FRS-IC), projectile and fission fragments are produced at relativistic energies, separated in-flight, energy-bunched, slowed down, and thermalized in the ultra-pure helium gas-filled cryogenic stopping cell (CSC). Thermalized nuclei are extracted from the CSC using a combination of DC and RF electric fields and gas flow. This CSC also serves as the prototype for the CSC of the Super-FRS, where exotic nuclei will be produced at unprecedented rates making it possible to go towards the extremes of the nuclear chart. Therefore, it is essential to efficiently extract thermalized exotic nuclei from the CSC under high beam rate conditions, in order to use the rare exotic nuclei, which come as cocktail beams. The dependence of the extraction efficiency on the intensity of the impinging beam into the CSC was studied with a primary beam of 238U and its fragments. Tests were done with two different versions of the DC electrode structure inside the cryogenic chamber, the standard 1 m long and a short 0.5 m long DC electrode systems. In contrast to the rate capability of 10 4 ions/s with the long DC electrode system, results show no extraction efficiency loss up to the rate of 2 × 10 5 ions/s with the new short DC electrode. This order of magnitude increase of the rate capability paves the way for new experiments at the FRS-IC, including studies of exotic nuclei with in-cell multi-nucleon transfer reactions. The results further validate the design concept of the CSC of the Super-FRS, which was developed to effectively manage beams of even higher intensities. [ABSTRACT FROM AUTHOR]

In this paper, the major upgrades and technical improvements of the buffer gas handling system for the cryogenic stopping cell of the FRS Ion Catcher at GSI/FAIR (in Darmstadt, Germany) are described. The upgrades include implementation of new gas lines and gas purifiers to achieve a higher buffer gas cleanliness for a more efficient extraction of reactive ions as well as suppression of the molecular background ionized in the stopping cell. Furthermore, additional techniques have been implemented for improved monitoring and quantification of the purity of the helium buffer gas. [ABSTRACT FROM AUTHOR]

A new probability distribution function (PDF) called hyper-Exponentially Modified Gaussian (hyper-EMG) is introduced for the analysis of high-resolution spectra from multiple-reflection time-of-flight mass spectrometers. The hyper-EMG consists of a central Gaussian distribution modified by multiple exponential tails with different strengths at one or both sides. The basic statistical properties of the new PDF are given and the analysis of mass spectra containing separated and overlapping peaks is presented. The main requirement is to accurately determine the positions and areas of the individual mass peaks. From the distances of positions the mass values can be determined, from the areas the population of different ground and isomeric states can be obtained. The hyper-EMG has been applied to high-resolution time and mass spectra characterized by mass resolving powers of 140,000 and 520,000 obtained with Cs + 133 and K + 39 ions, respectively. From the measured mass distribution of K + 39 ions, an overlapping distribution of two peaks with an area ratio of 1:10 and a mass difference of 2.6 ppm (parts-per-million) is generated and analyzed. The results reveal significant advantages of the new PDF for the evaluation of overlapping distributions for accurate mass and area determinations compared with commonly used PDFs which are more than one order of magnitude less accurate. It is obvious that the hyper-EMG can be favorably applied also to other fields. [ABSTRACT FROM AUTHOR]

We performed a missing-mass spectroscopy experiment of the 12C(p,d) reaction in order to search for η′-mesic nuclei. Excitation spectrum of 11C around the η′-meson production threshold was successfully obtained with a high-statistical sensitivity and sufficiently good energy resolution. Since no peak structure associated with the formation of η′-mesic nuclei was observed, we set constraints on the formation cross sections of η′-mesic states and on the η′-nucleus interaction. [ABSTRACT FROM AUTHOR]

At the Low-Energy Branch (LEB) of the Super-FRS at FAIR, projectile and fission fragments will be produced at relativistic energies, separated in-flight, energy-bunched, slowed down and thermalized in a cryogenic stopping cell (CSC) filled with ultra-pure He gas. The fragments are extracted from the stopping cell using a combination of DC and RF electric fields and gas flow. A prototype CSC for the LEB has been developed and successfully commissioned at the FRS Ion Catcher at GSI. Ionization of He buffer gas atoms during the stopping of energetic ions creates a region of high space charge in the stopping cell. The space charge decreases the extraction efficiency of stopping cells since the high amount of charge distorts the applied DC electric drag fields. Thus the understanding of space charge effects is of great importance to make full use of the high yields at future RIB facilities such as the Super-FRS at FAIR. For this purpose a detailed study of space charge effects in the CSC was performed using experiments and simulations. The dependence of the extraction efficiency, the extraction time and the temporal ion extraction profile on the intensity of the impinging beam and the electric field strength was studied for two different 238 U projectile fragments produced at 1000 MeV/u and separated with the FRS. Good agreement between experiments and simulations was found. [ABSTRACT FROM AUTHOR]

In deep inelastic multinucleon transfer reactions of 48 Ca + 248 Cm we observed about 100 residual nuclei with proton numbers between Z = 82 and Z = 100 . Among them, there are five new neutron-deficient isotopes: 216 U, 219 Np, 223 Am, 229 Am and 233 Bk. As separator for the transfer products we used the velocity filter SHIP of GSI while the isotope identification was performed via the α decay chains of the nuclei. These first results reveal that multinucleon transfer reactions together with here applied fast and sensitive separation and detection techniques are promising for the synthesis of new isotopes in the region of heaviest nuclei. [ABSTRACT FROM AUTHOR]

The possible existence of η′-nucleus bound states has been put forward through theoretical and experimental studies. It is strongly related to the η′ mass at finite density, which is expected to be reduced because of the interplay between the U(1) anomaly and partial restoration of chiral symmetry. The investigation of the C( p, d) reaction at GSI and FAIR, as well as an overview of the experimental program at GSI and future plans at FAIR are discussed. [ABSTRACT FROM AUTHOR]

211 Po ions in the ground and isomeric states were produced via 238 U projectile fragmentation at 1000 MeV/u. The 211 Po ions were spatially separated in flight from the primary beam and other reaction products by the fragment separator FRS. The ions were energy-bunched, slowed-down and thermalized in a gas-filled cryogenic stopping cell (CSC). They were then extracted from the CSC and injected into a high-resolution multiple-reflection time-of-flight mass spectrometer (MR-TOF-MS). The excitation energy of the isomer and, for the first time, the isomeric-to-ground state ratio were determined from the measured mass spectrum. In the subsequent experimental step, the isomers were spatially separated from the ions in the ground state by an ion deflector and finally collected with a silicon detector for decay spectroscopy. This pioneering experimental result opens up unique perspectives for isomer-resolved studies. With this versatile experimental method new isomers with half-lives longer than a few milliseconds can be discovered and their decay properties can be measured with highest sensitivity and selectivity. These experiments can be extended to studies with isomeric beams in nuclear reactions. [ABSTRACT FROM AUTHOR]

The mass of the η' meson is theoretically expected to be reduced at finite density, which indicates the existence of η'-nucleus bound states. To investigate these states, we perform missing-mass spectroscopy for the (p; d) reaction near the η' production threshold. The overview of the experimental situation is given and the current status is discussed. [ABSTRACT FROM AUTHOR]

The FRS Ion Catcher setup at GSI is used for high precision measurements of slowed down exotic nuclei. The current setup consists of a gas-filled stopping cell, working at cryogenic temperatures for improved gas purity, coupled to a radio-frequency quadrupole beamline for bunching and pre-selection and a multiple-reflection time-of-flight mass spectrometer for precise mass measurements. The setup with all its components is controlled by various control systems. The development of a new slow control system for monitoring, control, and logging of all components of this setup is presented. The slow control is based on the LabVIEW Actor Framework enhanced by the Control System++ libraries, a highly scalable and extendable platform which is a powerful tool to create complex messaging schemes from custom events. The implementation and testing of the control system at the FRS Ion Catcher setup is discussed. [ABSTRACT FROM AUTHOR]

TRIUMF's Ion Trap for Atomic and Nuclear science (TITAN) has specialized in fast Penning Trap mass spectrometry of very short-lived radioactive isotopes. The facility has been upgraded with a Multiple-Reflection Time-of-Flight Mass Spectrometer (MR-TOF-MS) to continue its quest towards more exotic nuclides, which are critical for our understanding of nuclear structure effects far from the valley of beta stability and for the nucleosynthesis of heavy elements in explosive astrophysical environments. In this publication, we discuss the implementation, operation and performance of TITAN's MR-TOF-MS as a stand-alone high-precision mass spectrometer and as an isobar separator. By using the novel mass-selective re-trapping technique for the isobar separation, the MR-TOF-MS can consecutively perform separation and mass measurement of the same ion population, acting as its own isobar separator. The device boosts the dynamic range and reach of the TITAN facility by several orders of magnitude. The MR-TOF-MS reaches a high mass resolving power (m / Δ m ∼ 400 000), high precision and mass accuracy (δ m / m < 1 0 − 7 ), is fast (common cycle time 20 ms), shows high sensitivity and very large dynamic range (ion of interest to contaminant ratios of up to 1 to 1 0 6 ). [ABSTRACT FROM AUTHOR]

Background Despite numerous guidelines recommending prophylactic antibiotics prior to percutaneous endoscopic gastrostomy, their use remains controversial. Aim To conduct a systematic literature review and performed meta-analyses to determine the benefit of antibiotic prophylaxis for percutaneous endoscopic gastrostomy placement. Methods We performed a systematic literature review by searching healthcare databases and grey literature for randomized-controlled trials of antibiotic prophylaxis against wound infection after percutaneous endoscopic gastrostomy. Relative risks were calculated for individual trials and data pooled using fixed-effects model. Relative risk reduction, absolute risk reduction and number needed to treat were calculated and are reported with 95% confidence intervals. Results Ten randomized-controlled trials met the inclusion criteria and 1059 cases were pooled. Overall findings indicated that antibiotic prophylaxis resulted in a relative risk reduction of 64% and an absolute risk reduction of 15%. Number needed to treat to prevent one wound infection was 8. Cephalosporin prophylaxis was associated with a relative risk reduction of 64%, absolute risk reduction of 10% and number needed to treat of 10, whereas penicillin-based prophylaxis was associated with a relative risk reduction of 62%, absolute risk reduction of 13% and number needed to treat of 8. Conclusions Antibiotic prophylaxis prior to percutaneous endoscopic gastrostomy is effective in reducing the incidence of percutaneous endoscopic gastrostomy site wound infection. Based on sensitivity analyses, penicillin-based prophylaxis should be the prophylaxis of choice. [ABSTRACT FROM AUTHOR]

Obesity in children is a rapidly growing problem and may be underrecognized by pediatricians. We reviewed 473 consecutive well child visits to assess frequency of correctly identifying overweight children. Of children with a body mass index greater than the 95th percentile for gender and age, only 27 (29%) were diagnosed as overweight by the physician. Our results suggest that the frequency of diagnosing children as overweight at well child visits is critically low. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate the quality of the medical evidence available to the clinician in the practice of hematology/oncology.Methods: We selected 14 neoplastic hematologic disorders and identified 154 clinically important patient management decision/interventions, ranging from initial treatment decisions to those made for the treatment of recurrent or refractory disease. We also performed a search of the scientific literature for the years 1966 through 1996 to identify all randomized controlled trials in hematology/oncology.Results: We identified 783 randomized controlled trials (level 1 evidence) pertaining to 37 (24%) of the decision/interventions. An additional 32 (21%) of the decision/interventions were supported by evidence from single arm prospective studies (level 2 evidence). However, only retrospective or anecdotal evidence (level 3 evidence) was available to support 55% of the identified decision/interventions. In a retrospective review of the decision/interventions made in the management of 255 consecutive patients, 78% of the initial decision/interventions in the management of newly diagnosed hematologic/oncologic disorders could have been based on level 1 evidence. However, more than half (52%) of all the decision/interventions made in the management of these 255 patients were supported only by level 2 or 3 evidence.Conclusions: We conclude that level 1 evidence to support the development of practice guidelines is available primarily for initial decision/interventions of newly diagnosed diseases. Level 1 evidence to develop guidelines for the management of relapsed or refractory malignant diseases is currently lacking. [ABSTRACT FROM AUTHOR]

Excitation spectra of 11C are measured in the 12C(p,d) reaction near the ή emission threshold. A proton beam extracted from the synchrotron SIS-18 at GSI with an incident energy of 2.5 GeV impinges on a carbon target. The momenta of deuterons emitted at 0° are precisely measured with the fragment separator (FRS) operated as a spectrometer. In contrast to theoretical predictions on the possible existence of deeply bound ή-mesic states in carbon nuclei, no distinct structures are observed associated with the formation of bound states. The spectra are analyzed to set stringent constraints on the formation cross section and on the hitherto barely known ή-nucleus interaction. [ABSTRACT FROM AUTHOR]