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Direct dark matter detection experiments based on a liquid xenon target are leading the search for dark matter particles with masses above ∼5 GeV/c2, but have limited sensitivity to lighter masses because of the small momentum transfer in dark matter-nucleus elastic scattering. However, there is an irreducible contribution from inelastic processes accompanying the elastic scattering, which leads to the excitation and ionization of the recoiling atom (the Migdal effect) or the emission of a bremsstrahlung photon. In this Letter, we report on a probe of low-mass dark matter with masses down to about 85 MeV/c2 by looking for electronic recoils induced by the Migdal effect and bremsstrahlung using data from the XENON1T experiment. Besides the approach of detecting both scintillation and ionization signals, we exploit an approach that uses ionization signals only, which allows for a lower detection threshold. This analysis significantly enhances the sensitivity of XENON1T to light dark matter previously beyond its reach.

In Argentina, the provision of health care is divided into three components: a highly decentralized universal public sector, funded from general taxation; a constellation of compulsory collective insurance schemes, financed by contributions withdrawn from the salaries of workers in the formal labor market; and a system of private insurance companies used primarily by the middle and upper classes. Regarding the delivery of medical services, the configuration is mixed, as the weight of public and private providers is roughly equal. This complex structure, which derives from the historical development of particular institutions, produces high costs and unequal access to care according to a person’s geographical residence, occupational status, and purchasing power.

Background: The aim of this study was to assess the long-term effects of smoking and to investigate the permanence of this damage to the oral microcirculation. Material/Methods: We recruited 75 patients and divided them into 3 groups: group 1 was composed of 25 healthy non-smokers, group 2 was composed of 25 healthy current smokers, and group 3 was composed of 25 healthy ex-smokers. Video-capillaroscopic examination was performed on all patients. The video-capillaroscopic investigation was performed on patients in sitting position, always with the same light source, at the same room temperature (23°C), in the morning, with the same operator (GAS), and was repeated many times for every area under investigation. An enlargement of 200× allowed us to explore point-bypoint all the morpho-structural characteristics of the capillaroscopic field. For non-parametric data, we evaluated the visibility of the loops and their position in relation to the surface of the mucosa. The evaluated parametric data were length of capillary loop, diameter of the loop, capillary tortuosity, and capillary density. Results: Our study clearly shows there was no remission of vascular damage, even 13 years after smoking cessation. Conclusions: Our research shows that that the effects of smoking are still visible in ex-smokers, even at 13 years after cessation and also that ex-smokers are still subject to the risk of oral pathologies in the interval of time that we considered.

This paper deals with the automatic classification of Drones using a surveillance radar signal. We show that, using state-of-the-art feature-based machine learning techniques, UAV tracks can be automatically distinguished from other object (e.g. bird, airplane, car) tracks. In fact, on a collection of real data, we measure an accuracy higher than 98%. We have also exploited the possibility of using the same features to distinguish the type of the wing of drone, between Fixed Wing and Rotary Wing, reaching an accuracy higher than 93%.

Pancoast's syndrome is caused by malignant neoplasm of superior sulcus of the lung which produces destructive lesions of thoracic inlet and comes along with the involvement of brachial plexus and stellate ganglion. Computed tomography (CT) or magnetic resonance imaging (MRI) scans can detect early lesions otherwise missed by routine radiographs and can also define the local extent or metastatic progression of the disease. Protocols involving combinations of irradiation, chemotherapy, and surgery are currently being under investigation to determine the best management.This work reviewed the current diagnostic and therapeutic approaches to Pancoast's tumors.Patients with lung superior sulcus carcinoma should be considered for surgery only after an appropriate diagnostic assessment. The perfect candidate for surgery should have a confined to the chest disease with T3N0M0 staging. Inoperable patient with severe pain after irradiation therapy may benefit from palliative surgical resection. Medical therapy plays only a secondary role in lung cancers, patients with disseminated lung cancer might require palliative treatment and medical management of paraneoplastic syndrome symptoms. Following surgery, radiation and chemotherapy may improve local and systemic control by addressing individual adverse findings.The cooperation of surgeons, clinicians and radiologists represents the gold standard today and a multidisciplinary approach is essential to achieve the best outcome possible. Further studies are advisable in order to define the best surgical approach and the real advantage of mini-invasive surgery by comparison with open surgery.

31 pags., 7 figs., The PTOLEMY project aims to develop a scalable design for a Cosmic Neutrino Background (CNB) detector, the first of its kind and the only one conceived that can look directly at the image of the Universe encoded in neutrino background produced in the first second after the Big Bang. The scope of the work for the next three years is to complete the conceptual design of this detector and to validate with direct measurements that the non-neutrino backgrounds are below the expected cosmological signal. In this paper we discuss in details the theoretical aspects of the experiment and its physics goals. In particular, we mainly address three issues. First we discuss the sensitivity of PTOLEMY to the standard neutrino mass scale. We then study the perspectives of the experiment to detect the CNB via neutrino capture on tritium as a function of the neutrino mass scale and the energy resolution of the apparatus. Finally, we consider an extra sterile neutrino with mass in the eV range, coupled to the active states via oscillations, which has been advocated in view of neutrino oscillation anomalies. This extra state would contribute to the tritium decay spectrum, and its properties, mass and mixing angle, could be studied by analyzing the features in the beta decay electron spectrum., Work supported by the Italian grant 2017W4HA7S “NAT-NET: Neutrino and Astroparticle Theory Network” (PRIN 2017) funded by the Italian Ministero dell’Istruzione, dell’Università e della Ricerca (MIUR); by the Spanish grants ENE2016-76755-R, SEV-2014-0398 and FPA2017- 85216-P (AEI/FEDER, UE), PROMETEO/2018/165 (Generalitat Valenciana), María de Maeztu Unit of Excellence CIEMAT - Particle Physics (MDM-2015-0509) and the Red Consolider MultiDark FPA2017-90566-REDC; by the Vetenskapsrådet (Swedish Research Council) through contract No. 638-2013-8993; by the Simons Foundation, USA (#377485) and John Templeton Foundation, USA (#58851); and by the European Union’s Horizon 2020 research and innovation program under the Marie Skłodowska-Curie individual Grant Agreement No. 796941.

Introduction Hepatic abscess can be defined as an encapsulated collection of suppurative material within the liver parenchyma. Hepatic abscess can be distinguished as pyogenic, amebic, or fungal. Biliary tract disease remains the most common cause of hepatic abscess today, and the most common complications range from pleural effusion, empyema, and bronchohepatic fistula to subphrenic abscess and rupture into the peritoneal cavity, stomach, colon, vena cava, or kidney. A large abscess compressing the inferior vena cava and the hepatic veins may result in Budd-Chiari syndrome. In this report, we present a rare case of hepatic abscess with an unusual evolution that was treated with a noninvasive approach. Case presentation A 79-year-old Caucasian woman underwent endoscopic bile stone extraction and laparoscopic cholecystectomy. Six months later, a hepatic abscess in association with bilateral effusion was diagnosed. The prompt imaging-guided drainage solved the case. Three years later, she came to our attention complaining of dull, diffuse abdominal pain and high body temperature (38 °C). A retroperitoneal abscess was diagnosed that was spreading to the right lateral wall of the abdomen and extending across the muscular wall to the subcutaneous layer. The fluid collection also involved the right pleural cavity, forming an empyema. Also in this case, an imaging-guided drainage was performed, and the patient’s clinical picture resolved in a few days. The retroperitoneal abscess recurred 14 months later, and it was dealt with using the same treatment. Three months from the last follow-up, the patient came back to our attention with an evident swelling of her right lumbar region. Computed tomography revealed a right inferior lumbar hernia comprising adipose tissue and the right kidney. A surgical intervention was recommended to the patient, but, owing to her poor general health, she refused any invasive approach. Conclusions Retroperitoneal abscess is an uncommon complication of biliary tract surgery and represents a potential cause of death, especially in those patients with multiple diseases. Prompt drainage is crucial to the treatment. Failure in eliminating the primary infective focus could bring complications and, in general, a weakness of lumbar muscular wall, even resulting in a rare case of lumbar hernia.

The XENON1T liquid xenon time projection chamber is the most sensitive detector built to date for the measurement of direct interactions of weakly interacting massive particles with normal matter. The data acquisition system (DAQ) is constructed from commercial, open source, and custom components to digitize signals from the detector and store them for later analysis. The system achieves an extremely low signal threshold below a tenth of a photoelectron using a parallelized readout with the global trigger deferred to a later, software stage. The event identification is based on MongoDB database queries and has over 97% efficiency at recognizing interactions at the analysis energy threshold. A readout bandwidth over 300 MB/s is reached in calibration modes and is further expandable via parallelization. This DAQ system was successfully used during three years of operation of XENON1T., 14 pages, 6 figures, submitted to JINST; Version 2 with minor updates to text

Background Vascular surgery procedural reimbursement depends on accurate procedural coding and documentation. Despite the critical importance of correct coding, there has been a paucity of research focused on the effect of direct physician involvement. We hypothesize that direct physician involvement in procedural coding will lead to improved coding accuracy, increased work relative value unit (wRVU) assignment, and increased physician reimbursement. Methods This prospective observational cohort study evaluated procedural coding accuracy of fistulograms at an academic medical institution (January-June 2014). All fistulograms were coded by institutional coders (traditional coding) and by a single vascular surgeon whose codes were verified by two institution coders (multidisciplinary coding). The coding methods were compared, and differences were translated into revenue and wRVUs using the Medicare Physician Fee Schedule. Comparison between traditional and multidisciplinary coding was performed for three discrete study periods: baseline (period 1), after a coding education session for physicians and coders (period 2), and after a coding education session with implementation of an operative dictation template (period 3). The accuracy of surgeon operative dictations during each study period was also assessed. An external validation at a second academic institution was performed during period 1 to assess and compare coding accuracy. Results During period 1, traditional coding resulted in a 4.4% ( P = .004) loss in reimbursement and a 5.4% ( P = .01) loss in wRVUs compared with multidisciplinary coding. During period 2, no significant difference was found between traditional and multidisciplinary coding in reimbursement (1.3% loss; P = .24) or wRVUs (1.8% loss; P = .20). During period 3, traditional coding yielded a higher overall reimbursement (1.3% gain; P = .26) than multidisciplinary coding. This increase, however, was due to errors by institution coders, with six inappropriately used codes resulting in a higher overall reimbursement that was subsequently corrected. Assessment of physician documentation showed improvement, with decreased documentation errors at each period (11% vs 3.1% vs 0.6%; P = .02). Overall, between period 1 and period 3, multidisciplinary coding resulted in a significant increase in additional reimbursement ($17.63 per procedure; P = .004) and wRVUs (0.50 per procedure; P = .01). External validation at a second academic institution was performed to assess coding accuracy during period 1. Similar to institution 1, traditional coding revealed an 11% loss in reimbursement ($13,178 vs $14,630; P = .007) and a 12% loss in wRVU (293 vs 329; P = .01) compared with multidisciplinary coding. Conclusions Physician involvement in the coding of endovascular procedures leads to improved procedural coding accuracy, increased wRVU assignments, and increased physician reimbursement.

Summary Suspended sediment concentrations (SSC) and yields (SSY) were measured during storm and non-storm periods from undisturbed and human-disturbed portions of a small (1.8 km 2 ), mountainous watershed that drains to a sediment-stressed coral reef. Event-wise SSY (SSY EV ) was calculated for 142 storms from measurements of water discharge ( Q ), turbidity ( T ), and SSC measured downstream of three key sediment sources: undisturbed forest, an aggregate quarry, and a village. SSC and SSY EV were significantly higher downstream of the quarry during both storm- and non-storm periods. The human-disturbed subwatershed (10.1% disturbed) accounted for an average of 87% of SSY EV from the watershed. Observed sediment yield (mass) to the coast, including human disturbed subwatersheds, was 3.9× the natural background. Specific SSY (mass/area) from the disturbed quarry area was 49× higher than from natural forest compared with 8× higher from the village area. Similar to mountainous watersheds in semi-arid and temperate climates, SSY EV from both the undisturbed and disturbed watersheds correlated closely with maximum event discharge ( Q max ), event total precipitation and event total Q , but not with the Erosivity Index. Best estimates of annual SSY varied by method, from 45 to 143 tons/km 2 /yr from the undisturbed subwatershed, 441–598 tons/km 2 /yr from the human-disturbed subwatershed, and 241–368 tons/km 2 /yr from the total watershed. Sediment yield was very sensitive to disturbance; the quarry covers 1.1% of the total watershed area, but contributed 36% of SSY EV . Given the limited access to gravel for infrastructure development, sediment disturbance from local aggregate mining may be a critical sediment source on remote islands in the Pacific and elsewhere. Identification of erosion hotspots like the quarry using rapid, event-wise measures of suspended sediment yield will help efforts to mitigate sediment stress and restore coral reefs.

Acute kidney injury (AKI) has been identified as a common complication after fenestrated and branched endovascular aneurysm repair (F/BEVAR), occurring in 5% to 29% of patients. Predictors of AKI and its impact on long-term outcomes remain unknown. We sought to identify independent predictors of AKI and its effect on long-term survival after F/BEVAR.A single-institution retrospective review of all consecutive F/BEVAR procedures was performed (November 2010-September 2018). Data were collected prospectively through an Institutional Review Board-approved registry and a physician-sponsored investigational device exemption clinical trial (G130210). AKI was defined as a decrease in estimated glomerular filtration rate by30% from baseline, within 30 days postoperatively. The cohort was stratified according to whether a patient experienced AKI. Demographics, operative details, perioperative complications, and length of stay between groups were compared. The primary outcome, long-term survival, was assessed with Kaplan-Meier analysis and Cox proportional hazards modeling. Independent predictors of AKI were identified using logistic regression.Among 219 consecutive F/BEVAR patients, AKI occurred in 41 patients (19%) and was the most common 30-day complication observed. Whereas preoperative creatinine concentration, estimated glomerular filtration rate, and target renal artery stenosis50% did not predict AKI, the occurrence of intraoperative complications did correlate with AKI (37% vs 7.3%; P .01). By 30 days, AKI resolved in 7 (17%) patients, persisted without need for dialysis in 26 (64%), and progressed to dialysis in 5 (12%); the remaining 3 (7%) patients died. Survival at 30 days was significantly lower in the AKI group (92.7% vs 98.9%; P = .047), and this difference persisted at 1 year (68% vs 87%; log-rank, P .01) and 3 years (44% vs 60%; log-rank, P = .04). On multivariable modeling, AKI increased the hazard of death nearly twofold (hazard ratio, 1.92; 95% confidence interval [CI], 1.11-3.23; P = .019). Independent predictors of AKI on multivariable logistic regression were intraoperative complications (odds ratio, 4.10; 95% CI, 1.61-10.42; P .01) and increased operating room time (odds ratio, 1.56; 95% CI, 1.22-2.00; P .01).In our 8-year experience of F/BEVAR, AKI was the most common postoperative complication observed in nearly 20% of patients. AKI after F/BEVAR is associated with decreased short- and long-term survival. Whether AKI is causative or just associated with decreased survival remains to be elucidated. Further study is needed to determine whether the independent predictors of AKI, including intraoperative complications and operating room time, are generalizable across all centers performing F/BEVAR and to investigate how we might further mitigate this common and serious complication.

Popliteal artery aneurysms (PAAs) are the most common peripheral arterial aneurysm and develop almost exclusively (>90%) in men who have a history of tobacco abuse at an average age of 65 years. Most PAAs are caused by chronic inflammation secondary to atherosclerotic disease; other non-degenerative causes of PAAs include arterial trauma, infection, Behcet's disease, medial fibromuscular dysplasia, or popliteal artery entrapment. Few case reports have been published on idiopathic congenital PAAs. We report a case of a 26-year-old man who presented with progressive claudication and subsequent acute limb ischemia due to the thrombosis of a large idiopathic PAA. Our case demonstrates that the differential diagnosis of young adult or pediatric patients presenting with signs of acute limb ischemia or claudication should include a symptomatic PAA.

The XENON experiment is dedicated to the search of dark matter particles interacting directly with ordinary matter, with particular focus on the Weakly Interacting Massive Particle (WIMP). The XENON experimental program, developed so far, consisted of three detectors, with the same conceptual design but increasing mass and so the sensitivity. All of them have been operated at the Gran Sasso underground laboratory in Italy, in different periods. XENON1T, the most recently operated detector and still in data-taking, is presently leading the field. The recent published results achieved the limit of the Spin Independent (SI) WIMP-nucleon cross section for WIMP masses above 6 GeV/c^2 of $4.1x10^{-47} cm^2 a 90% C.L. The preparation of the next phase of the XENON project is already ongoing with the construction of the XENONnT detector, which will exploit a larger mass of Xe (~8 tonnes), and will have an improved sensitivity of one order of magnitude.

Rationale: Hypercholesterolemia has been verified as an important risk factor of cardiovascular diseases. It has been shown to impair the post-ischemic arteriogenesis, the major physiological process in response to ischemic injury. As yet, the underlying mechanism is not fully illustrated. Objective: Our own data indicate that hematopoietic stem cells (HSCs) functions as a determinant in post-ischemic arteriogenesis by differentiating into vascular progenitors. However, the differentiation processes and the underlying mechanisms remain unknown. Ten eleven translocation (Tet) family are a group of enzymes initiating the demethylation of DNA. Tet1 is specifically downregulated in HSCs from hypercholesterolemic mice. Therefore, we hypothesized that Tet1 regulates the differentiation from HSCs towards vascular progenitors. Hypercholesterolemia reduces vascular specification of HSCs through a Tet1 dependent epigenetic pathway. Methods and Results: The ex vivo differentiation and in vivo transplantation experiments showed that HSC-originated Ly6C low monocytes in peripheral blood possess the greatest capacity to differentiate into vascular cells and to improve the post-ischemic arteriogenesis. Ly6C low monocyte population was specifically reduced in Tet1 -/- mice after the induction of hindlimb ischemia, consequently resulting in significant impairment of post-ischemic arteriogenesis. Tet1 deficiency caused unique expression profiles of the genes involved in the differentiation of HSCs towards monocytes. RT-PCR showed that the expression of Tet1 was specifically downregulated in HSCs isolated from ApoE -/- mice. As expected, the Ly6C low monocyte population was specifically reduced and the post-ischemic arteriogenesis was significantly impaired in ApoE -/- mice. Conclusion: Ly6C low monocytes are the major vascular progenitors originated from HSCs. Tet1 dependent epigenetic regulation is critical in the differentiation process from HSCs towards Ly6C low monocytes. Hypercholesterolemia inhibits the expression of Tet1 and subsequently impairs the differentiation from HSCs towards Ly6C low monocytes, resulting in the impairment of post-ischemic arteriogenesis.

Duplications of the alimentary tract are rare malformations, and ileum is the most involved intestinal tract. During fetal life, they are usually occasional findings and may be asymptomatic until adulthood. We present the clinical case of volvulus on ileal cystic duplication diagnosed by ultrasound during prenatal follow-up. Case report: Diagnosis of cystic ileal duplication was made by ultrasound at our center at 23 weeks of gestational age, which was confirmed with fetal MRI. During follow-up, at 36 + 4 weeks, the presence of dilated loops with reduction of peristalsis was shown by ultrasound, so that, despite stable fetal parameters, an emergency caesarean delivery was programmed for suspected volvulus. After being stabilized, the patient underwent to laparotomy that revealed ileal volvulus at 2 cm from the ileo-cecal valve on a cystic duplication. Cyst and necrotic loop (10 cm) was resected and was performed an anastomosis. Patient started feeding on VII post-operative day, and was discharged on the X day. Patient is on follow up and present good conditions. Discussion: Diagnosis of intestinal cystic mass in prenatal period requires a close follow-up because the risk of a volvulus. According to the literature, even in the presence of stable fetal parameters, the presence of dilated loops and the absence of peristalsis are signs that must suspect the presence of a mechanical occlusion for which timely treatment is necessary to reduce mortality and morbidity. Keywords: Prenatal ultrasound, Volvulus, Ileal duplication

People with type 2 diabetes mellitus (T2DM) have a 25-fold higher risk of limb loss than non-diabetics due in large part to impaired wound healing. Here, we show that the impaired wound healing phenotype found in T2D mice is recapitulated in lethally irradiated wild type recipients, whose hematopoiesis is reconstituted with hematopoietic stem cells (HSCs) from T2D mice, indicating an HSC-autonomous mechanism. This impaired wound healing phenotype of T2D mice is due to a Nox-2-dependent increase in HSC oxidant stress that decreases microRNA let-7d-3p, which, in turn, directly upregulates Dnmt1, leading to the hypermethylation of Notch1, PU.1, and Klf4. This HSC-autonomous mechanism reduces the number of wound macrophages and skews their polarization towards M1 macrophages. These findings reveal a novel inflammatory mechanism by which a metabolic disorder induces an epigenetic mechanism in HSCs, which predetermines the gene expression of terminally differentiated inflammatory cells that controls their number and function., Type 2 diabetes is associated with impaired wound healing, which can lead to limb loss. Here, the authors show that in Type 2 diabetic mouse models, Dnmt1 is upregulated in hematopoietic stem cells, leading to impaired differentiation towards macrophages, reduced macrophage infiltration in the wound and skewed M1/M2 polarization.

Background Primary headache are prevalent and debilitating disorders. Acute pain cessation is one of the key points in their treatment. Many drugs have been studied but the design of the trials is not usually homogeneous. Efficacy of the trial is determined depending on the selected primary endpoint and usually other different outcomes are measured. We aim to critically appraise which were the employed outcomes through a systematic review. Methods We conducted a systematic review of literature focusing on studies on primary headache evaluating acute relief of pain, following the PRISMA guideline. The study population included patients participating in a controlled study about symptomatic treatment. The comparator could be placebo or the standard of care. The collected information was the primary outcome of the study and all secondary outcomes. We evaluated the studied drug, the year of publication and the type of journal. We performed a search and we screened all the potential papers and reviewed them considering inclusion/exclusion criteria. Results The search showed 4288 clinical trials that were screened and 794 full articles were assessed for eligibility for a final inclusion of 495 papers. The studies were published in headache specific journals (58%), general journals (21.6%) and neuroscience journals (20.4%). Migraine was the most studied headache, in 87.8% studies, followed by tension type headache in 4.7%. Regarding the most evaluated drug, triptans represented 68.6% of all studies, followed by non-steroidal anti-inflammatories (25.1%). Only 4.6% of the papers evaluated ergots and 1.6% analyzed opioids. The most frequent primary endpoint was the relief of the headache at a determinate moment, in 54.1%. Primary endpoint was evaluated at 2-h in 69.9% of the studies. Concerning other endpoints, tolerance was the most frequently addressed (83%), followed by headache relief (71.1%), improvement of other symptoms (62.5%) and presence of relapse (54%). The number of secondary endpoints increased from 4.2 (SD = 2.0) before 1991 to 6.39 after 2013 (p = 0.001). Conclusion Headache relief has been the most employed primary endpoint but headache disappearance starts to be firmly considered. The number of secondary endpoints increases over time and other outcomes such as disability, quality of life and patients’ preference are receiving attention.

We present a measurement of the zenith angle distribution, up to θ = 75 ° , of cosmic ray muons performed in Abu Dhabi (United Arab Emirates, 24.54°N, 54.43°E), at sea level, rigidity cutoff ∼ 14 GV. The measurement has been performed by using a muon tracker based on plastic scintillator strips, wavelength shifting fibers and silicon photomultipliers for a total of 200 readout channels arranged in a compact structure. To our knowledge this is the first measurement of this kind in the Arabian gulf area.

The service line (SL) model has been proven to help shift health care toward value-based services, which is characterized by coordinated, multidisciplinary, high-quality, and cost-effective care. However, academic medical centers struggle with how to effectively set up SL structures that overcome the organizational and cultural challenges associated with simultaneously delivering the highest-value care for the patient and advancing the academic mission. In this article, the authors examine the evolution of UMass Memorial Health Care's heart and vascular service line (HVSL) from 2006 to 2011 and describe the impact on its success of multiple strategic decisions. These include key academic physician leadership recruitments and engagement via a matrixed governance and management model; development of multidisciplinary teams; empowerment of SL leadership through direct accountability and authority over programs and budgets; joint educational and training programs; incentives for academic achievement; and co-localization of faculty, personnel, and facilities. The authors also explore the barriers to success, including the need to overcome historical departmental-based silos, cultural and training differences among disciplines, confusion engendered by a matrixed reporting structure, and faculty's unfamiliarity with the financial and organizational skills required to operate a successful SL. Also described here is the impact that successful implementation of the SL has on creating high-quality services, increased profitability, and contribution to the financial stability and academic achievement of the academic medical center.

Carotid endarterectomy (CEA) for asymptomatic carotid artery stenosis is among the most common procedures performed in the United States. However, consensus is lacking regarding optimal preoperative imaging, carotid duplex ultrasound criteria, and ultimately, the threshold for surgery. We sought to characterize national variation in preoperative imaging, carotid duplex ultrasound criteria, and threshold for surgery for asymptomatic CEA.The Society for Vascular Surgery Vascular Quality Initiative (VQI) database was used to identify all CEA procedures performed for asymptomatic carotid artery stenosis between 2003 and 2014. VQI currently captures 100% of CEA procedures performed at300 centers by2000 physicians nationwide. Three analyses were performed to quantify the variation in (1) preoperative imaging, (2) carotid duplex ultrasound criteria, and (3) threshold for surgery.Of 35,695 CEA procedures in 33,488 patients, the study cohort was limited to 19,610 CEA procedures (55%) performed for asymptomatic disease. The preoperative imaging modality used before CEA varied widely, with 57% of patients receiving a single preoperative imaging study (duplex ultrasound imaging, 46%; computed tomography angiography, 7.5%; magnetic resonance angiography, 2.0%; cerebral angiography, 1.3%) and 43% of patients receiving multiple preoperative imaging studies. Of the 16,452 asymptomatic patients (89%) who underwent preoperative duplex ultrasound imaging, there was significant variability between centers in the degree of stenosis (50%-69%, 70%-79%, 80%-99%) designated for a given peak systolic velocity, end diastolic velocity, and internal carotid artery-to-common carotid artery ratio. Although 68% of CEA procedures in asymptomatic patients were performed for an 80% to 99% stenosis, 26% were performed for a 70% to 79% stenosis, and 4.1% were performed for a 50% to 69% stenosis. At the surgeon level, the range in the percentage of CEA procedures performed for a80% asymptomatic carotid artery stenosis is from 0% to 100%. Similarly, at the center level, institutions range in the percentage of CEA procedures performed for a80% asymptomatic carotid artery stenosis from 0% to 100%.Despite CEA being an extremely common procedure, there is widespread variation in the three primary determinants-preoperative imaging, carotid duplex ultrasound criteria, and threshold for surgery-of whether CEA is performed for asymptomatic carotid stenosis. Standardizing the approach to care for asymptomatic carotid artery stenosis will mitigate the significant downstream effects of this variation on health care costs.

Impact of Extreme Right Parties makes a welcome contribution to the growing scholarship that assesses the impacts of extreme right parties (ERPs) on inter-party competition, public opinion and public policy. Although it commendably avoids the pitfall of overestimating the political significance of ERPs, several criticisms of the book nevertheless can be raised. First, it is disquieting that its analysis of the impacts of ERPs within its chosen three countries covers less than a decade. Second, the reader may come away questioning its ultimate contribution to our understanding of the staying power of ERPs. Third, it is reasonable to ask if in investigating the impacts of ERPs on inter-party competition and public opinion the book is simply accumulating evidence for the much more important question of their impact on public policy. Finally, it is unfortunate that the possible effects of ERPs on partisan and party system dealignment are not considered.

In 2008, the top priority in our division's 5-year strategic plan was "to become an internationally recognized center of excellence for the endovascular treatment of complex aortic pathology extending from the aortic valve to the external iliac artery." Five components were identified as "most critical" to achieve this strategic priority: (1) training at centers of excellence in complex endovascular repair; (2) industry partnership to improve access to developing technologies; (3) a fully integrated team approach with one leader involved in all steps of all cases; (4) prospective data collection; and (5) development and implementation of a physician-sponsored investigational device exemption for juxtarenal, pararenal, and thoracoabdominal aneurysms. We have now performed 49 repairs (16 commercially manufactured devices, 33 physician-modified devices) for 3 common iliac, 20 juxtarenal, 9 pararenal, and 17 thoracoabdominal aneurysms, using 142 fenestrations, branches, and scallops. All patients had complete 30-day follow-up for calculation of 30-day events. Kaplan-Meier analysis was used to calculate 1-year events. In 5 years, we developed a successful complex endovascular aortic program that uses fenestrated/branched repair techniques. A focused team strategic planning approach to program development is an effective way for vascular surgery divisions to gain experience and expertise with new complex technologies while ensuring acceptable patient outcomes.

Objective The Agency for Healthcare Research and Quality (AHRQ) Inpatient Quality Indicator (IQI) #11, abdominal aortic aneurysm (AAA) repair mortality rate, is a measure of hospital quality that is publically reported but has not been externally validated. Because the IQI #11 overall mortality rate includes both intact and ruptured aneurysms and open and endovascular repair, we hypothesized that IQI #11 overall mortality rate does not provide accurate assessment of mortality risk after AAA repair and that AAA mortality cannot be accurately assessed by a single quality measure. Methods Using AHRQ IQI software version 4.2, we calculated observed (O) and expected (E) mortality rates for IQI #11 for all hospitals performing more than 10 AAA repairs per year in the Nationwide Inpatient Sample for the years 2007 to 2011. We used Spearman correlation coefficient to compare expected rates as determined by IQI #11 overall mortality rate risk adjustment methodology and observed rates for all AAA repairs in four cohorts stratified by aneurysm stability (ruptured vs intact) and method of repair (open vs endovascular). Results Among 187,773 AAA repairs performed at 1268 U.S. hospitals, hospitals' IQI #11 overall expected rates correlated poorly with their observed rates (E: 5.0% ± 4.4% vs O: 6.0% ± 9.8%; r = .49). For ruptured AAAs, IQI #11 overall mortality rate methodology underestimated the mortality risk of open repair (E: 34% ± 7.2% vs O: 40.1% ± 38.2%; r = 0.20) and endovascular repair (E: 24.8% ± 9% vs O: 27.3% ± 37.9%; r = 0.08). For intact AAA repair, IQI #11 overall mortality rate methodology underestimated the mortality risk of open repair (E: 4.3% ± 2.4% vs O: 6.3% ± 16.1%; r = .24) but overestimated the mortality risk of endovascular repair (E: 1.3% ± 0.8% vs O: 1.1% ± 3.7%; r = 0.25). Hospitals' observed mortality rates after intact AAA repair were not correlated with their mortality rates after ruptured AAA repair ( r = 0.03). Conclusions IQI #11 overall mortality rate fails to provide accurate assessment of inpatient mortality risk after AAA repair. Thus, it is inappropriate to use IQI #11 overall mortality rate for quality reporting. The accuracy of separate quality measures that assess mortality risk after repair of ruptured and intact AAAs, stratified by the use of open or endovascular repair, should be examined.

Despite their widespread use, the indications for the selective use of temporary inferior vena cava (IVC) filters remains uncertain with few trials supporting their use. Additionally, the risks of long-term temporary IVC filter insertion are being increasingly discussed amongst the mainstream media and through multiple class action lawsuits. Retrievable IVC filters were specifically designed to have a less secure implantation in order to facilitate retrieval. However, multiple reports have demonstrated significant filter-related complications, most commonly related to duration of implantation. Furthermore, the risk is not isolated to one manufacturer alone. The incidence of filter-related complications is linearly related to its duration of time on the market. Currently, the FDA recommends that IVC filters be removed within 25-54 days of their implantation. Unfortunately, little evidence exists to show that this recommendation is followed routinely. Recently, the PRESERVE Trial (NCT02381509) was initiated as a multicenter non-randomized open label study to determine the safety and effectiveness of commercially available IVC filters (both temporary and permanent) in individuals who require mechanical prophylaxis against pulmonary embolism. Until such evidence is developed, temporary IVC filters should be implanted based on best available evidence and routinely removed within the guidelines of the FDA of 25-54 days. A fair question at this point is whether the design features themselves that are required to manufacture a low profile removable IVC filter can achieve effective prophylaxis against pulmonary embolism at a low rate of short and long-term complications.

Postpartum hemorrhage (PPH) is one of the most frequent causes of mortality and morbidity in the obstetric population globally, causing about a quarter of maternal deaths yearly, and is the leading cause of maternal death worldwide. The management of PPH remains a topic of great debate, even in view of new diagnostic and therapeutic possibilities in recent years, for which, however, the body of evidence available thus far is still scarce, as the standard values are lacking. The protocol hereby presented was developed after a literature review and during several meetings of an Italian multidisciplinary task group of specialists adopting a modified Delphi method, and is the result of the synthesis of therapeutic operational protocols for the treatment of PPH applied by the different specialties within the team. This protocol is intended to represent a practical proposal to support clinicians in the management of a particularly complex event that requires the intervention of a multidisciplinary team and the implementation of dedicated management protocols.

CHF6001 is a new and potent PDE4 inhibitor for the treatment of human lung diseases, designed for topical administration by inhalation. In preclinical assessment CHF6001 appeared safe and devoid of emetic effect, which is typical side effect of PDE4 inhibitors in humans. CHF6001 absorption, distribution and excretion were evaluated in rats by PO and IV administration of [14C]CHF6001; additionally the role of transporters was investigated by using transfected cells expressing either human transporters or MDR1 and BCRP KO mice. [14C]CHF6001 intravenously administered as bolus distributed in all the tissues (with very low levels in brain and fetus) and it was mainly eliminated in bile. Following oral administration [14C]CHF6001 about half of the dose was absorbed through the gut. In vitro, CHF6001 was a substrate of human membrane transporters MDR1 and BCRP. In wild and BCRP KO mice CHF6001 was not detectable in brain, whereas it was measurable in Mdr1a/b KO mice. Therefore, in animal species Mdr1a/b plays a significant role in CHF6001 disposition, limiting its distribution into brain and contributing to the safety profile observed in preclinical evaluation. This behavior was confirmed by the results of the first human studies, where CHF6001 was safe and with no emetic effect at all the evaluated doses.

We describe the purification of xenon from traces of the radioactive noble gas radon using a cryogenic distillation column. The distillation column is integrated into the gas purification loop of the XENON100 detector for online radon removal. This enabled us to significantly reduce the constant $^{222}$Rn background originating from radon emanation. After inserting an auxiliary $^{222}$Rn emanation source in the gas loop, we determined a radon reduction factor of R > 27 (95% C.L.) for the distillation column by monitoring the $^{222}$Rn activity concentration inside the XENON100 detector.

In Fig. 5 of our original article, we compared measurements and predictions of the charge yield Qy. In that figure, the LUX points were misrepresented, and therefore we present here in Fig. 1 the corrected points from Ref. [1].

n our paper, we presented searches for solar axions and galactic axionlike particles (ALPs) in the data collected by the XENON100 experiment (with an exposure of 224.6 days). We recently found a bug in the code to calculate the exclusion limit for galactic ALPs. This resulted in an underestimation of the ALP expected rate, which in turn led to an overly conservative limit, compared to what it should really be. We corrected the code, and the result of the XENON100 90% C.L. exclusion limit on galactic ALPs (shown in Fig. 1) was reevaluated. The corrected limit is stronger than the one previously published by approximately a factor of 5 across all masses and sets the best published limit on the axion-electron coupling, $g_{Ae}$, in the (1–40) keV/$c^2$ mass range.

The purpose of this article is to discuss the precariousness of social media website security. While social media provides many advantages to health care providers; such as professional networking and professional education it can also pose a myriad of dangers to breaches in patient privacy and confidentially. This is particularly concerning for health care providers because health care’s providers are legally and ethically bound to maintaining the privacy and confidentially of their patients

International audience; We report on weakly interacting massive particles (WIMPs) search results in the XENON100 detector using a nonrelativistic effective field theory approach. The data from science run II (34 kg×224.6 live days) were reanalyzed, with an increased recoil energy interval compared to previous analyses, ranging from (6.6–240) keVnr. The data are found to be compatible with the background-only hypothesis. We present 90% confidence level exclusion limits on the coupling constants of WIMP-nucleon effective operators using a binned profile likelihood method. We also consider the case of inelastic WIMP scattering, where incident WIMPs may up-scatter to a higher mass state, and set exclusion limits on this model as well.

In the context of the evidence presented in both the collected scholarship under review and other select works, this article asks if and to what extent migration-related issues have been securitized in Europe and the United States. In addressing these questions it executes three tasks. First, it critically assesses the four major dimensions across which contemporary immigration purportedly is securitized: on one side, rhetorically addressing immigration-related issues through political elite discourse, public opinion, and the mass media; and on the other, the policy processes through which immigration is securitized. Second, this article identifies the strengths and weaknesses of securitization theory as it has been applied to immigration. Finally, it draws mostly negative conclusions about the veracity of the central claims of the securitization of immigration literature and, specifically, its causal story.

Background— The indications for carotid revascularization are based almost exclusively on the results of carotid duplex ultrasonography. Noninvasive vascular laboratories show large variation in the diagnostic criteria used to classify degree of carotid artery stenosis. We hypothesize that variability of these diagnostic criteria causes significant variation in stenosis classification directly affecting the number of revascularizations and associated costs. Methods and Results— The diagnostic criteria to interpret carotid duplex ultrasounds were obtained from 10 New England institutions. All carotid duplex scans performed at our institution were reviewed from 2008 to 2012. Using the diagnostic criteria from each institution, the degree of stenosis that would have been reported was classified as 70% to 99% asymptomatic, 80% to 99% asymptomatic, and 50% to 99% symptomatic. We then calculated the theoretical number of carotid revascularization procedures that this cohort would be offered using each institution’s diagnostic criteria and the costs of these procedures based on reimbursement rates. Among 10 614 patients who underwent 15 534 carotid duplex scans, 31 025 arteries were reviewed. Application of the 10 institutions’ criteria to the patients from our institution yielded marked variation in the number classified as 70% to 99% asymptomatic (range, 186–2201), 80% to 99% asymptomatic (range, 78–426), and 50% to 99% symptomatic (range, 157–781). If revascularizations were based on these results, costs would range from $2.2 to $26 million, $0.9 to $5.0 million, and $1.9 to $9.2 million, respectively. Conclusions— Differences in diagnostic criteria to interpret carotid ultrasound result in significant variation in classification of carotid artery stenosis, likely leading to differences in the number and subsequent costs of revascularizations. This theoretical model highlights the need for standardization of carotid duplex criteria.

In the context of automatic image processing, the noise nearly always represents the hardest problem to cope with. This is particularly true on images corrupted by multiplicative speckle noise, such as Synthetic Aperture Radar (SAR) images. To tackle such an issue, this paper proposes a novel anisotropic diffusion filter that manages to fulfill simultaneously two competing requirements: noise reduction on homogeneous regions and edge enhancement. To prove the capabilities of our filter, we compare it to two non-local diffusion (NLD) filters applied on Lena image corrupted by a multiplicative speckle noise and on a real SAR image acquired by the COSMO-SkyMed (CSK) satellite constellation.