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Objectives This systematic review with meta-analyses of randomised trials evaluated the preventive effects of vitamin A supplements versus placebo or no intervention on clinically important outcomes, in people of any age.Methods We searched different electronic databases and other resources for randomised clinical trials that had compared vitamin A supplements versus placebo or no intervention (last search 16 April 2024). We used Cochrane methodology. We used the random-effects model to calculate risk ratios (RRs), with 95% CIs. We analysed individually and cluster randomised trials separately. Our primary outcomes were mortality, adverse events and quality of life. We assessed risks of bias in the trials and used Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) to assess the certainty of the evidence.Results We included 120 randomised trials (1 671 672 participants); 105 trials allocated individuals and 15 allocated clusters. 92 trials included children (78 individually; 14 cluster randomised) and 28 adults (27 individually; 1 cluster randomised). 14/105 individually randomised trials (13%) and none of the cluster randomised trials were at overall low risk of bias. Vitamin A did not reduce mortality in individually randomised trials (RR 0.99, 95% CI 0.93 to 1.05; I²=32%; p=0.19; 105 trials; moderate certainty), and this effect was not affected by the risk of bias. In individually randomised trials, vitamin A had no effect on mortality in children (RR 0.96, 95% CI 0.88 to 1.04; I²=24%; p=0.28; 78 trials, 178 094 participants) nor in adults (RR 1.04, 95% CI 0.97 to 1.13; I²=24%; p=0.27; 27 trials, 61 880 participants). Vitamin A reduced mortality in the cluster randomised trials (0.84, 95% CI 0.76 to 0.93; I²=66%; p=0.0008; 15 trials, 14 in children and 1 in adults; 364 343 participants; very low certainty). No trial reported serious adverse events or quality of life. Vitamin A slightly increased bulging fontanelle of neonates and infants. We are uncertain whether vitamin A influences blindness under the conditions examined.Conclusions Based on moderate certainty of evidence, vitamin A had no effect on mortality in the individually randomised trials. Very low certainty evidence obtained from cluster randomised trials suggested a beneficial effect of vitamin A on mortality. If preventive vitamin A programmes are to be continued, supporting evidence should come from randomised trials allocating individuals and assessing patient-meaningful outcomes.PROSPERO registration number CRD42018104347.

The origin of the large α particle production and incomplete fusion in reactions involving weakly-bound α+x cluster nuclei still remains unresolved. While the (two-step) process of breakup followed by capture of the “free” complementary fragment (x) is widely believed to be responsible, a few recent studies suggest the dominant role of (direct) cluster stripping. To achieve an unambiguous experimental discrimination between these two processes, a coincidence measurement between the outgoing α particles and γ rays from the heavy residues has been performed for the 7Li(α+triton)+93Nb system. Proper choice of kinematical conditions allowed for the first time a significant population of the region accessible only to the direct triton stripping process and not to breakup followed by the capture of the “free” triton (from the three-body continuum). This result, also supported by a cluster-transfer calculation, clearly establishes the dominance of the direct cluster-stripping mechanism in the large alpha production.

Employing the Argonne Fragment Mass Analyzer and the implantation-decay-decay correlation technique, a weak 0.50(21)% proton decay branch was identified in 108I for the first time. The 108I proton-decay width is consistent with a hindered l=2 emission, suggesting a d52 origin. Using the extracted 108I proton-decay Q value of 597(13) keV, and the Qα values of the 108I and 107Te isotopes, a proton-decay Q value of 510(20) keV for 104Sb was deduced. Similarly to the 112,113Cs proton-emitter pair, the Qp(I108) value is lower than that for the less-exotic neighbor 109I, possibly due to enhanced proton-neutron interactions in N≈Z nuclei. In contrast, the present Qp(Sb104) is higher than that of 105Sb, suggesting a weaker interaction energy. For the present Qp(Sb104) value, network calculations with the one-zone X-ray burst model Mazzocchi et al. (2007) [18] predict no significant branching into the Sn-Sb-Te cycle at 103Sn. Keywords: α decay, Proton decay, Astrophysical rp process, 104Sb, 107Te, 108I

The second-phonon (nω=2) wobbling band has been established in the nucleus 135Pr. Conclusive evidence for its wobbling nature comes from the ΔI=1, E2 character of the transitions between the new band and the previously identified transverse wobbler band (nω=1) in this nucleus. Theoretical calculations in the framework of the quasiparticle triaxial rotor and triaxial projected shell models are found to be in good agreement with the experimental results.

The High-spin states in 195Tl, populated through the 185,187Re(13C, xn) fusion evaporation reaction at the beam energy of 75 MeV, were studied using the Indian National Gamma Array (INGA). More than 50 new γ transitions have been placed in the proposed level scheme which is extended up to the excitation energy of ≈ 5.6 MeV and spin=22.5ħ. Two pairs of degenerate bands based on two different quasi-particle configurations have been identified in this nucleus indicating the first observation of such bands in an odd-A nucleus in A∼190 region and signify the first evidence of multiple chiral bands in a nucleus in this region. The total Routhian surface calculations predict triaxial shapes for both the configurations and thereby, support the experimental observation. The importance of multiple neutron holes in the i13/2 orbital and the stability of shapes for these two configurations have been discussed. Keywords: Nuclear Structure, γ-ray spectroscopy, Doubly degenerate bands, TRS calculation

The structure of 71Zn was investigated by one-neutron transfer and heavy-ion induced complex (deep-inelastic) reactions using the GRETINA-CHICO2 and the Gammasphere setups, respectively. The observed inversion between the 9/2+ and 1/2â states is explained in terms of the role of neutron pairing correlations. Non-collective sequences of levels were delineated above the 9/2+ isomeric state. These are interpreted as being associated with a modest oblate deformation in the framework of Monte-Carlo shell-model calculations carried out with the A3DA-m Hamiltonian in the pfg9/2d5/2 valence space. Similarities with the structure of Ni402868 were observed and the shape-coexistence mechanism in the N=40 region of neutron-rich nuclei is discussed in terms of the so-called Type-II shell evolution, with an emphasis on protonâneutron correlations between valence nucleons, especially those involving the shape-driving g9/2 neutron orbital.

Abstract Background Atrial fibrillation is the most common arrhythmia of the heart with a prevalence of approximately 2% in the western world. Atrial flutter, another arrhythmia, occurs less often with an incidence of approximately 200,000 new patients per year in the USA. Patients with atrial fibrillation and atrial flutter have an increased risk of death and morbidities. In the management of atrial fibrillation and atrial flutter, it is often necessary to use medical interventions to lower the heart rate. Lowering the heart rate may theoretically prevent the development of heart failure and tachycardia-mediated cardiomyopathy. The evidence on the benefits and harms of digoxin compared with placebo or with other medical interventions is unclear. This protocol for a systematic review aims at identifying the beneficial and harmful effects of digoxin compared with placebo, no intervention, or with other medical interventions for atrial fibrillation and atrial flutter. Methods This protocol for a systematic review was conducted following the recommendations of Cochrane and the eight-step assessment procedure suggested by Jakobsen and colleagues. We plan to include all relevant randomised clinical trials comparing digoxin with placebo, no intervention, or with other medical interventions. We plan to search the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, LILACS, Science Citation Index Expanded on Web of Science, and BIOSIS to identify relevant trials. Any eligible trial will be assessed and classified as either at high risk of bias or low risk of bias, and our primary conclusions will be based on trials with low risk of bias. We will perform our meta-analyses of the extracted data using Review Manager 5.3 and Trial Sequential Analysis ver. 0.9.5.5 beta. For both our primary and secondary outcomes, we will create a ‘Summary of Findings’ table based on GRADE assessments of the quality of the evidence. Discussion The results of this systematic review have the potential to benefit millions of patients worldwide as well as healthcare economy. Systematic review registration PROSPERO CRD42016052935

Two opposite parity dipole sequences (DB I and DB II) in 142Eu have been investigated using the Indian National Gamma Array (INGA), and heavy-ion induced fusion-evaporation reaction, 116Cd(31P, 5n) at ELab = 148 MeV. The Configurations of these bands are assigned on the basis of tilted axis cranking covariant density functional theory (TAC-CDFT) calculations. The measured B(M1) and B(E2) rates of the DB I and DB II, have been well reproduced within the shears mechanism with the principal axis cranking model (SPAC) calculations leading to the conclusion that these bands have been based on the shears mechanism. The large B(E1) transition rates between DB I and DB II indicate the existence of octupole correlation in 142Eu that has also been corroborated through microscopic multidimensionally-constrained covariant density functional theory (MDC-CDFT) calculations. Thus, the present investigation leads to the novel observation of the presence of octupole correlation between two shears band. Keywords: Lifetime measurement, Tilted axis rotation, Principal axis rotation, Octupole correlation, 142Eu

Lifetimes of the states in the quadrupole structure in 143Eu have been measured using the Doppler shift attenuation method and the parity of the states in the sequence has been firmly identified from polarization measurements using the Indian National Gamma Array. The decreasing trends of the deduced quadrupole transition strength B(E2) with spin, along with increasing J(2)/B(E2) values before the band crossing, conclusively establish the origin of these states as arising from antimagnetic rotation. The abrupt increase in the B(E2) values after the band crossing in the quadrupole band, a novel feature observed in the present experiment, may possibly indicate the crossing of different shears configurations resulting in the re-opening of a shears structure. The results are reproduced well by numerical calculations within the framework of a semi-classical geometric model.

During recent years, systematic reviews of observational studies have compared digoxin to no digoxin in patients with atrial fibrillation or atrial flutter, and the results of these reviews suggested that digoxin seems to increase the risk of all-cause mortality regardless of concomitant heart failure. Our objective was to assess the benefits and harms of digoxin for atrial fibrillation and atrial flutter based on randomized clinical trials.We searched CENTRAL, MEDLINE, Embase, LILACS, SCI-Expanded, BIOSIS for eligible trials comparing digoxin versus placebo, no intervention, or other medical interventions in patients with atrial fibrillation or atrial flutter in October 2016. Our primary outcomes were all-cause mortality, serious adverse events, and quality of life. Our secondary outcomes were heart failure, stroke, heart rate control, and conversion to sinus rhythm. We performed both random-effects and fixed-effect meta-analyses and chose the more conservative result as our primary result. We used Trial Sequential Analysis (TSA) to control for random errors. We used GRADE to assess the quality of the body of evidence.28 trials (n = 2223 participants) were included. All were at high risk of bias and reported only short-term follow-up. When digoxin was compared with all control interventions in one analysis, we found no evidence of a difference on all-cause mortality (risk ratio (RR), 0.82; TSA-adjusted confidence interval (CI), 0.02 to 31.2; I2 = 0%); serious adverse events (RR, 1.65; TSA-adjusted CI, 0.24 to 11.5; I2 = 0%); quality of life; heart failure (RR, 1.05; TSA-adjusted CI, 0.00 to 1141.8; I2 = 51%); and stroke (RR, 2.27; TSA-adjusted CI, 0.00 to 7887.3; I2 = 17%). Our analyses on acute heart rate control (within 6 hours of treatment onset) showed firm evidence of digoxin being superior compared with placebo (mean difference (MD), -12.0 beats per minute (bpm); TSA-adjusted CI, -17.2 to -6.76; I2 = 0%) and inferior compared with beta blockers (MD, 20.7 bpm; TSA-adjusted CI, 14.2 to 27.2; I2 = 0%). Meta-analyses on acute heart rate control showed that digoxin was inferior compared with both calcium antagonists (MD, 21.0 bpm; TSA-adjusted CI, -30.3 to 72.3) and with amiodarone (MD, 14.7 bpm; TSA-adjusted CI, -0.58 to 30.0; I2 = 42%), but in both comparisons TSAs showed that we lacked information. Meta-analysis on acute conversion to sinus rhythm showed that digoxin compared with amiodarone reduced the probability of converting atrial fibrillation to sinus rhythm, but TSA showed that we lacked information (RR, 0.54; TSA-adjusted CI, 0.13 to 2.21; I2 = 0%).The clinical effects of digoxin on all-cause mortality, serious adverse events, quality of life, heart failure, and stroke are unclear based on current evidence. Digoxin seems to be superior compared with placebo in reducing the heart rate, but inferior compared with beta blockers. The long-term effect of digoxin is unclear, as no trials reported long-term follow-up. More trials at low risk of bias and low risk of random errors assessing the clinical effects of digoxin are needed.PROSPERO CRD42016052935.

A high-spin study of the shape transitional nucleus 188Pt reveals the unusual coexistence of both shape- and K-isomeric states. Reduced B(E2) transition probabilities for decays from these states inferred from the data clearly establish their hindered character. In addition to other excited structures, a rotational band built upon the K isomer is identified, and its configuration has been assigned through an analysis of alignments and branching ratios. The shape evolution with spin in this nucleus has been inferred from both experimental observables and cranking calculations. The yrast positive parity structure appears to evolve from a near-prolate deformed shape through triaxial at intermediate excitation, and eventually to oblate at the highest spins. Keywords: Shape coexistence, High-spin states, High-K isomer, Shape phase transition, Shape isomer