Search

Background Ex Utero Intrapartum Treatment (EXIT) is utilized for safe delivery when a baby has a compromised airway. The purpose of this retrospective study was to examine the indications and outcomes of 11 children presenting with airway occluding oropharyngeal and cervical teratomas. Methods Study of all children with an airway occluding teratoma delivered via EXIT (2001-2018) in our unit. Primary outcomes included survival and tracheostomy at discharge. Data are reported using descriptive statistics as median [range] and rate (%). Results We performed 45 EXIT procedure performed between January 2001 and April 2018. Of these, eleven were for cervical and/or upper airway teratoma. Ten (91%) cases had associated polyhydramnios, two (18%) developed nonimmune hydrops, and eight (72%) delivered preterm. Six (45.5%) were performed as an emergency. Estimated blood loss was 1000 mL (500, 1000). The neonatal mortality rate was 18% (2/11) and 33% (3/9) of the survivors were discharged with a tracheostomy. Conclusion EXIT is a reasonable option for delivery of babies with an occlusive upper airway mass. Neonatal survival depends on individualized factors but may be as high as 82% in those with teratoma. This article is protected by copyright. All rights reserved.

We report here the results of an Effective Field Theory (EFT) WIMP search analysis using LUX data. We build upon previous LUX analyses by extending the search window to include nuclear recoil energies up to $\sim$180 keV$_{nr}$, requiring a reassessment of data quality cuts and background models. In order to use a binned Profile Likelihood statistical framework, the development of new analysis techniques to account for higher-energy backgrounds was required. With a 3.14$\times10^4$ kg$\cdot$day exposure using data collected between 2014 and 2016, we set 90\% C.L. exclusion limits on non-relativistic EFT WIMP couplings to neutrons and protons, providing the most stringent constraints on a significant fraction of the possible EFT WIMP interactions. Additionally, we report world-leading exclusion limits on inelastic EFT WIMP-nucleon recoils., 19 Pages, 10 Figures, 4 Table

Background: There is significant perinatal morbidity and mortality of opioid use disorder. Objective: As YouTube becomes an increasingly prevalent source for medical education among the patient population, this project aims to evaluate the utility of YouTube as a source of education on opioid use disorder (OUD). Study Design: The first 100 YouTube videos for each of the following search terms were evaluated based on a variety of descriptive characteristics and by a scale developed from the American College of Obstetrics and Gynecology patient education resource (Table 1): “How to quit opioids during pregnancy”, “opioid addiction treatment during pregnancy,” and “opioid detox during pregnancy.” Results: The average views for videos targeting the general public were 20,456 views. Of these videos, the average utility score was 4.03. Conclusion: This study not only highlights the shortcomings of current YouTube resources regarding this topic, but also emphasizes the need for further resource investment by the medical community utilizing YouTube as a resource for improving health literacy.

In nutrition, epidemiology, and other public health fields, composite scores are a common tool used to assess a health behaviour. These composite scores compare an individual's health behaviour to an idealized standard and provide a number, often between 0 and 100, to indicate their compliance to a health behaviour. Crucially, this measure of health behaviour is applied across populations (gender, smoking status, etc.) and health outcomes (colon cancer, breast cancer, etc.) to create a single interpretable score. One such composite score is the 2005 Healthy Eating Index that breaks diet into 12 components and evaluates nutritional intake by adherence to these components. We provide a general method that can be used to reassess the importance of these 12 components using flexible non-linear models, across populations and diseases, based on an asymptotic least squares approximation. We establish oracle properties of this variable selection technique in our context, which is different from the usual one population and one disease context. Although our methods are motivated by the Healthy Eating Index, they are broad enough to be applied to any composite score and a broad range of non-linear models.

The EXO-200 experiment searched for neutrinoless double-beta decay of $^{136}$Xe with a single-phase liquid xenon detector. It used an active mass of 110 kg of 80.6%-enriched liquid xenon in an ultra-low background time projection chamber with ionization and scintillation detection and readout. This paper describes the design and performance of the various support systems necessary for detector operation, including cryogenics, xenon handling, and controls. Novel features of the system were driven by the need to protect the thin-walled detector chamber containing the liquid xenon, to achieve high chemical purity of the Xe, and to maintain thermal uniformity across the detector., Manuscript updated in response to JINST reviewer comments

Background/purpose The ex-utero intrapartum treatment (EXIT) procedure is used to secure effective gas exchange prior to postnatal life. We describe the obstetrical course and maternal outcomes of a series of patients who underwent EXIT. Methods This is a review of all pregnancies in which fetuses were delivered by EXIT from January 2001 to April 2018. Outcome variables included estimated gestational age (EGA) at delivery, need for emergency EXIT, maternal estimated blood loss (EBL), need for maternal blood transfusion, and maternal postoperative length of hospital stay. Data were tested for normality and reported as median [range] and n (%). Results A total of 45 patients were delivered by EXIT procedure. Sixteen (35.6%) of the EXIT procedures were performed emergently. Median maternal EBL was 800 (500-2000) mL; 6 (13.3%) patients received blood transfusion. Median maternal postoperative length of hospital stay was four [3-7] days. Conclusion Our data highlight the complexity of the obstetrical management in the EXIT procedure as evidenced by an approximately 36% chance of emergency delivery. Despite having an experienced multidisciplinary team, 13.3% of our subjects underwent maternal blood transfusion. This information can be used in counseling EXIT candidates regarding the risks and benefits of this procedure.

Author(s): Chambers, C; Walton, T; Fairbank, D; Craycraft, A; Yahne, DR; Todd, J; Iverson, A; Fairbank, W; Alamare, A; Albert, JB; Anton, G; Arnquist, IJ; Badhrees, I; Barbeau, PS; Beck, D; Belov, V; Bhatta, T; Bourque, F; Brodsky, JP; Brown, E; Brunner, T; Burenkov, A; Cao, GF; Cao, L; Cen, WR; Charlebois, SA; Chiu, M; Cleveland, B; Coon, M; Cree, W; Cote, M; Dalmasson, J; Daniels, T; Darroch, L; Daugherty, SJ; Daughhetee, J; Delaquis, S; Mesrobian-Kabakian, A Der; DeVoe, R; Dilling, J; Ding, YY; Dolinski, MJ; Dragone, A; Echevers, J; Fabris, L; Farine, J; Feyzbakhsh, S; Fontaine, R; Fudenberg, D; Giacomini, G; Gornea, R; Gratta, G; Hansen, EV; Heffner, M; Hoppe, EW; Hosl, J; House, A; Hufschmidt, P; Hughes, M; Ito, Y; Jamil, A; Jessiman, C; Jewell, MJ; Jiang, XS; Karelin, A; Kaufman, LJ; Kodroff, D; Koffas, T; Kravitz, S; Krucken, R; Kuchenkov, A; Kumar, KS; Lan, Y; Larson, A; Leonard, DS; Li, G; Li, S; Li, Z; Licciardi, C; Lin, YH; Lv, P; MacLellan, R; Michel, T; Mong, B; Moore, DC | Abstract: The search for neutrinoless double beta decay probes the fundamental properties of neutrinos, including whether or not the neutrino and antineutrino are distinct. Double beta detectors are large and expensive, so background reduction is essential for extracting the highest sensitivity. The identification, or 'tagging', of the $^{136}$Ba daughter atom from double beta decay of $^{136}$Xe provides a technique for eliminating backgrounds in the nEXO neutrinoless double beta decay experiment. The tagging scheme studied in this work utilizes a cryogenic probe to trap the barium atom in solid xenon, where the barium atom is tagged via fluorescence imaging in the solid xenon matrix. Here we demonstrate imaging and counting of individual atoms of barium in solid xenon by scanning a focused laser across a solid xenon matrix deposited on a sapphire window. When the laser sits on an individual atom, the fluorescence persists for $\sim$30~s before dropping abruptly to the background level, a clear confirmation of one-atom imaging. No barium fluorescence persists following evaporation of a barium deposit to a limit of $\leq$0.16\%. This is the first time that single atoms have been imaged in solid noble element. It establishes the basic principle of a barium tagging technique for nEXO.

We present a comprehensive analysis of electronic recoil vs. nuclear recoil discrimination in liquid/gas xenon time projection chambers, using calibration data from the 2013 and 2014-16 runs of the Large Underground Xenon (LUX) experiment. We observe strong charge-to-light discrimination enhancement with increased event energy. For events with S1 = 120 detected photons, i.e. equivalent to a nuclear recoil energy of $\sim$100 keV, we observe an electronic recoil background acceptance of $, 29 pages, 33 figures; minor typos corrected, references updated

LUX-ZEPLIN (LZ) is a second-generation direct dark matter experiment with spin-independent WIMP-nucleon scattering sensitivity above $1.4 \times 10^{-48}$ cm$^{2}$ for a WIMP mass of 40 GeV/c$^{2}$ and a 1000 d exposure. LZ achieves this sensitivity through a combination of a large 5.6 t fiducial volume, active inner and outer veto systems, and radio-pure construction using materials with inherently low radioactivity content. The LZ collaboration performed an extensive radioassay campaign over a period of six years to inform material selection for construction and provide an input to the experimental background model against which any possible signal excess may be evaluated. The campaign and its results are described in this paper. We present assays of dust and radon daughters depositing on the surface of components as well as cleanliness controls necessary to maintain background expectations through detector construction and assembly. Finally, examples from the campaign to highlight fixed contaminant radioassays for the LZ photomultiplier tubes, quality control and quality assurance procedures through fabrication, radon emanation measurements of major sub-systems, and bespoke detector systems to assay scintillator are presented., Comment: 45 pages (79 inc. tables), 7 figures, 9 tables

Two-neutrino double electron capture is a process allowed in the Standard Model of Particle Physics. This rare decay has been observed in $^{78}$Kr, $^{130}$Ba and more recently in $^{124}$Xe. In this publication we report on the search for this process in $^{124}$Xe and $^{126}$Xe using the full exposure of the Large Underground Xenon (LUX) experiment, in a total of of 27769.5~kg-days. No evidence of a signal was observed, allowing us to set 90\% C.L. lower limits for the half-lives of these decays of $2.0\times10^{21}$~years for $^{124}$Xe and $1.9\times10^{21}$~years for $^{126}$Xe., 8 pages, 3 figures

Author(s): Akerib, DS; Akerlof, CW; Alqahtani, A; Alsum, SK; Anderson, TJ; Angelides, N; Araujo, HM; Armstrong, JE; Arthurs, M; Bai, X; Balajthy, J; Balashov, S; Bang, J; Baxter, A; Bensinger, J; Bernard, EP; Bernstein, A; Bhatti, A; Biekert, A; Biesiadzinski, TP; Birch, HJ; Boast, KE; Boxer, B; Bras, P; Buckley, JH; Bugaev, VV; Burdin, S; Busenitz, JK; Cabrita, R; Carels, C; Carlsmith, DL; Carmona-Benitez, MC; Cascella, M; Chan, C; Chott, NI; Cole, A; Cottle, A; Cutter, JE; Dahl, CE; De Viveiros, L; Dobson, JEY; Druszkiewicz, E; Edberg, TK; Eriksen, SR; Fan, A; Fiorucci, S; Flaecher, H; Fraser, ED; Fruth, T; Gaitskell, RJ; Genovesi, J; Ghag, C; Gibson, E; Gilchriese, MGD; Gokhale, S; Van Der Grinten, MGD; Hall, CR; Harrison, A; Haselschwardt, SJ; Hertel, SA; Hor, JYK; Horn, M; Huang, DQ; Ignarra, CM; Jahangir, O; Ji, W; Johnson, J; Kaboth, AC; Kamaha, AC; Kamdin, K; Kazkaz, K; Khaitan, D; Khazov, A; Khurana, I; Kocher, CD; Korley, L; Korolkova, EV; Kras, J; Kraus, H; Kravitz, S; Kreczko, L; Krikler, B; Kudryavtsev, VA; Leason, EA; Lee, J | Abstract: The LUX-ZEPLIN (LZ) experiment will enable a neutrinoless double β decay search in parallel to the main science goal of discovering dark matter particle interactions. We report the expected LZ sensitivity to Xe136 neutrinoless double β decay, taking advantage of the significant (g600 kg) Xe136 mass contained within the active volume of LZ without isotopic enrichment. After 1000 live-days, the median exclusion sensitivity to the half-life of Xe136 is projected to be 1.06×1026 years (90% confidence level), similar to existing constraints. We also report the expected sensitivity of a possible subsequent dedicated exposure using 90% enrichment with Xe136 at 1.06×1027 years.

Dual-phase xenon detectors, as currently used in direct detection dark matter experiments, have observed elevated rates of background electron events in the low energy region. While this background negatively impacts detector performance in various ways, its origins have only been partially studied. In this paper we report a systematic investigation of the electron pathologies observed in the LUX dark matter experiment. We characterize different electron populations based on their emission intensities and their correlations with preceding energy depositions in the detector. By studying the background under different experimental conditions, we identified the leading emission mechanisms, including photoionization and the photoelectric effect induced by the xenon luminescence, delayed emission of electrons trapped under the liquid surface, capture and release of drifting electrons by impurities, and grid electron emission. We discuss how these backgrounds can be mitigated in LUX and future xenon-based dark matter experiments., 17 pages, 13 figures

Deep underground environments are ideal for low background searches due to the attenuation of cosmic rays by passage through the earth. However, they are affected by backgrounds from $\gamma$-rays emitted by $^{40}$K and the $^{238}$U and $^{232}$Th decay chains in the surrounding rock. The LUX-ZEPLIN (LZ) experiment will search for dark matter particle interactions with a liquid xenon TPC located within the Davis campus at the Sanford Underground Research Facility, Lead, South Dakota, at the 4,850-foot level. In order to characterise the cavern background, in-situ $\gamma$-ray measurements were taken with a sodium iodide detector in various locations and with lead shielding. The integral count rates (0--3300~keV) varied from 596~Hz to 1355~Hz for unshielded measurements, corresponding to a total flux in the cavern of $1.9\pm0.4$~$\gamma~$cm$^{-2}$s$^{-1}$. The resulting activity in the walls of the cavern can be characterised as $220\pm60$~Bq/kg of $^{40}$K, $29\pm15$~Bq/kg of $^{238}$U, and $13\pm3$~Bq/kg of $^{232}$Th., Comment: 11 pages, 9 figures

Humanitarian medicine addresses the human consequence of crises such as conflict, disaster, or displacement, and serves to assist those whose lives and health are impacted by such events. It is practised in challenging settings where resources are limited and environments unstable, and requires a clinical skillset which is both near limitlessly broad and context specific. The humanitarian sector has expanded significantly during the last two decades as a result of climate-related crises and increasing complex humanitarian emergencies due to protracted and multifaceted conflicts. The picture today is evolving rapidly to address expanding humanitarian demands and a changing global sociopolitical reality.

Liquid xenon particle detectors rely on excellent light collection efficiency for their performance. This depends on the high reflectivity of polytetrafluoroethylene (PTFE) at the xenon scintillation wavelength of 178 nm, but the angular dependence of this reflectivity is not well-understood. IBEX is designed to directly measure the angular distribution of xenon scintillation light reflected off PTFE in liquid xenon. These measurements are fully described by a microphysical reflectivity model with few free parameters. Dependence on PTFE type, surface finish, xenon pressure, and wavelength of incident light is explored. Total internal reflection is observed, which results in the dominance of specular over diffuse reflection and a reflectivity near 100% for high angles of incidence., 21 pages, 10 figures

The LUX-ZEPLIN dark matter search aims to achieve a sensitivity to the WIMP-nucleon spin-independent cross-section down to (1--2)$\times10^{-12}$\,pb at a WIMP mass of 40 GeV/$c^2$. This paper describes the simulations framework that, along with radioactivity measurements, was used to support this projection, and also to provide mock data for validating reconstruction and analysis software. Of particular note are the event generators, which allow us to model the background radiation, and the detector response physics used in the production of raw signals, which can be converted into digitized waveforms similar to data from the operational detector. Inclusion of the detector response allows us to process simulated data using the same analysis routines as developed to process the experimental data., Comment: 24 pages, 19 figures; Corresponding Authors: A. Cottle, V. Kudryavtsev, D. Woodward

BackgroundMycoplasma genitalium is a sexually transmitted infection (STI) pathogen. There have been no published studies concerning symptomatology, prevalence data, antibiotic resistance profiling or reports of co-infection with other STI in pregnant women.ObjectiveTo describe these characteristics among pregnant women attending prenatal clinics in a large tertiary care centre.DesignRemnant genital samples collected from pregnant women between August 2018 and November 2019 were tested for M. genitalium and Trichomonas vaginalis by the transcription-mediated amplification technique. Specimens with detectable M. genitalium RNA were sequenced for 23S rRNA mutations associated with azithromycin resistance and parC and gyrA mutations associated with resistance to moxifloxacin. Demographic, obstetric and STI co-infection data were recorded.ResultsOf the 719 samples, 41 (5.7 %) were positive for M. genitalium. M. genitalium infection was associated with black race, Hispanic ethnicity and young age (p=0.003, p=0.008 and p=0.004, respectively). M. genitalium infection was also associated with T. vaginalis co-infection and Streptococcus agalactiae (group B Streptococcus) colonisation (p≤0.001 and p=0.002, respectively). Of the 41 positive samples, 26 (63.4%) underwent successful sequencing. Eight (30.8%) had 23S rRNA mutations related to azithromycin resistance. One of 26 (3.8%) positive samples with sequencing results had the gyrA gene mutation and 1 of 18 sequenced samples (5.6%) had the parC gene mutation associated with moxifloxacin resistance.ConclusionsPrevalence rates of M. genitalium in pregnant women was 5.7%. M. genitalium infection disproportionately affects young black women co-infected with T. vaginalis. Pregnant women remain at risk for persistent infection with M. genitalium due to decreased azithromycin susceptibility.

© 2017 American Statistical Association. We consider a problem motivated by issues in nutritional epidemiology, across diseases and populations. In this area, it is becoming increasingly common for diseases to be modeled by a single diet score, such as the Healthy Eating Index, the Mediterranean Diet Score, etc. For each disease and for each population, a partially linear single-index model is fit. The partially linear aspect of the problem is allowed to differ in each population and disease. However, and crucially, the single-index itself, having to do with the diet score, is common to all diseases and populations, and the nonparametrically estimated functions of the single-index are the same up to a scale parameter. Using B-splines with an increasing number of knots, we develop a method to solve the problem, and display its asymptotic theory. An application to the NIH-AARP Study of Diet and Health is described, where we show the advantages of using multiple diseases and populations simultaneously rather than one at a time in understanding the effect of increased Milk consumption. Simulations illustrate the properties of the methods. Supplementary materials for this article are available online.

Background: Information and social support for women at risk for and surviving breast cancer are essential components of comprehensive clinical and public health practice in breast cancer prevention, control, and treatment. Jewish women in the US are a population of special concern due to their increased hereditary breast cancer risk for carrying BRCA1/2 gene mutations, and the dearth of culturally-relevant resources for breast cancer education and counseling. As part of a CDC initiative, Sharsheret (a non-profit breast cancer support and advocacy organization) is scaling-up its programs and services for women of all Jewish backgrounds to better meet these needs, guided by program evaluation data on client engagement practices. This abstract describes these practices and survey results. Methods: Evaluation surveys were individually-administered via e-mail using a secure online platform. Survey invitations were sent to participants ~30 days following their utilization of Sharsheret program services. Evaluation domains included program engagement and satisfaction, health-related quality of life, and resource needs. Results: The survey response rate was >65% (N=111), and a majority of respondents reported that they were Jewish (75%), married (76%), either or 35-45 years old (35%) or 46-64 years old (48%), and from the northeast region of the US (56%). Most respondents (88%) reported a previous breast or ovarian cancer diagnosis, and 7% indicated they carried a genetic mutation known to increase breast cancer risk. Based on the CDC's 'Health Days' measures, respondents reported a higher number unhealthy days (M=12 days per month) relative to general population averages for adult women (M=6.9 days). Respondents rated their experience with the organization highly (M=4.7 out of 5) for overall satisfaction with the quality of services utilized. There was also strong agreement among respondents (M =4.6 out of 5) about the availability and utility of patient navigation services, and the survivorship program garnered the highest level of engagement (71%) as it was utilized most often by respondents for its healthy living and nutrition resources. Conclusion: Nonprofit organizations devoted to cancer support and advocacy fill important roles in educating and counseling women about breast cancer prevention, control, and treatment. In an era of precision medicine and discussion of population-based screening for hereditary breast cancer risk, these organizations must scale-up their information and support services. This is necessary to be available for a greater number of women, and can be expected to perform even more important and essential roles, especially for Jewish women at risk for and surviving breast cancer. Citation Format: Fleischmann A, Silber E, Dubitsky S, Stahl S, Kravitz S, Johnson A, Murphy S, Tercyak KP. Breast cancer education, counseling, and support for Jewish women: Preliminary results of a CDC program evaluation [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-13-03.

We describe the design and assembly of the LUX-ZEPLIN experiment, a direct detection search for cosmic WIMP dark matter particles. The centerpiece of the experiment is a large liquid xenon time projection chamber sensitive to low energy nuclear recoils. Rejection of backgrounds is enhanced by a Xe skin veto detector and by a liquid scintillator Outer Detector loaded with gadolinium for efficient neutron capture and tagging. LZ is located in the Davis Cavern at the 4850' level of the Sanford Underground Research Facility in Lead, South Dakota, USA. We describe the major subsystems of the experiment and its key design features and requirements. info:eu-repo/semantics/publishedVersion

© Lippincott Williams & Wilkins. Purpose Interest in a variety of physical behaviors (e.g., exercise, sitting time, sleep) in relation to health outcomes creates a need for new statistical approaches to analyze the joint effects of these distinct but inter-related physical behaviors. We developed and tested an integrated physical behavior score (PBS). Methods National Institutes of Health-American Association of Retired Persons Diet and Health Study participants (N = 163,016) completed a questionnaire (2004-2006) asking about time spent in five exercise and nonexercise physical activities, two sedentary behaviors (television and nontelevision), and sleep. In half of the sample, we used shape-constrained additive regression to model the relationship between each behavior and survival. Maximum logit scores from each of the eight behavior-survival functions were summed to produce a PBS that was proportionally rescaled to range from 0 to 100. We examined predictive validity of the PBS in the other half-sample using Cox Proportional Hazards models after adjustment for covariates for all-cause and cause-specific mortality. Results In the testing sample, over an average of 6.6 yr of follow-up, 8732 deaths occurred. We found a strong graded decline in risk of all-cause mortality across quintiles of PBS (Q5 vs Q1 hazard ratio [95% CI] = 0.53 [0.49, 0.57]). Risk estimates for the PBS were higher than any of the components in isolation. Results were similar but stronger for cardiovascular disease (Q5 vs Q1 = 0.42 [0.39, 0.48]) and other mortality (Q5 vs Q1 = 0.42 [0.36, 0.48]). The relationship between PBS and mortality was observed in stratified analyses by median age, sex, body mass index, and health status. Conclusions We developed a novel statistical method generated a composite physical behavior that is predictive of mortality outcomes. Future research is needed to test this approach in an independent sample.

OBJECTIVE: In a 2015 Maternal-Fetal Medicine Units Network study, only half of placenta accreta spectrum cases were suspected before delivery, and the outcomes in the anticipated cases were paradoxically poorer than in unanticipated placenta accreta spectrum cases. This was possibly because the antenatally suspected cases were of greater severity. We sought to compare the outcomes of expected vs unexpected placenta accreta spectrum in a single large US center with multidisciplinary management protocol. STUDY DESIGN: This was a retrospective cohort study carried out between Jan. 1, 2011, and June 30, 2018, of all histology-proven placenta accreta spectrum deliveries in an academic referral center. Patients diagnosed at the time of delivery were cases (unexpected placenta accreta spectrum), and those who were antentally diagnosed were controls (expected placenta accreta spectrume). The primary and secondary outcomes were the estimated blood loss and the number of red blood cell units transfused, respectively. Variables are reported as median and interquartile range or number (percentage). Analyses were made using appropriate parametric and nonparametric tests. RESULTS: Fifty-four of the 243 patients (22.2%) were in the unexpected placenta accreta spectrum group. Patients in the expected placenta accreta spectrum group had a higher rate of previous cesarean delivery (170 of 189 [89.9%] vs 35 of 54 [64.8%]; P < .001) and placenta previa (135 [74.6%] vs 19 [37.3%]; P < .001). There was a higher proportion of increta/percreta in expected placenta accreta spectrum vs unexpected placenta accreta spectrum (125 [66.1%] vs 9 [16.7%], P < .001). Both primary outcomes were higher in the unexpected placenta accreta spectrum group (estimated blood loss, 2.4 L [1.4–3] vs 1.7 L [1.2–3], P = .04; red blood cell units, 4 [1–6] vs 2 [0–5], P = .03). CONCLUSION: Our data contradict the Maternal-Fetal Medicine Units results and instead show better outcomes in the expected placenta accreta spectrum group, despite a high proportion of women with more severe placental invasion. We attribute this to our multidisciplinary approach and ongoing process improvement in the management of expected cases. The presence of an experienced team appears to be a more important determinant of maternal morbidity in placenta accreta spectrum than the depth of placental invasion.

The scattering of dark matter (DM) particles with sub-GeV masses off nuclei is difficult to detect using liquid xenon-based DM search instruments because the energy transfer during nuclear recoils is smaller than the typical detector threshold. However, the tree-level DM-nucleus scattering diagram can be accompanied by simultaneous emission of a Bremsstrahlung photon or a so-called "Migdal" electron. These provide an electron recoil component to the experimental signature at higher energies than the corresponding nuclear recoil. The presence of this signature allows liquid xenon detectors to use both the scintillation and the ionization signals in the analysis where the nuclear recoil signal would not be otherwise visible. We report constraints on spin-independent DM-nucleon scattering for DM particles with masses of 0.4-5 GeV/c$^2$ using 1.4$\times10^4$ kg$\cdot$day of search exposure from the 2013 data from the Large Underground Xenon (LUX) experiment for four different classes of mediators. This analysis extends the reach of liquid xenon-based DM search instruments to lower DM masses than has been achieved previously.

This chapter introduces the concept of humanitarian medicine and the specifics which differentiate this from other disciplines. It highlights the impetus for the development of the Oxford Handbook of Humanitarian Medicine including recognition of the complexity of the sector, the changing contexts of humanitarian emergencies, and the challenges of promoting best practices. It also covers the historical origins and foundations of humanitarian principles, and outlines the key developments in humanitarian responses, including coordination, standardization, evidence-based approaches, and security.

Once a circumferential force is delivered to a limb by a compression device, assuming the tension within the device remains constant, any change in the total force is dependent upon a change in circumference of the limb, with the rate of change (excluding fabric creep) being dependent on the stress strain curve of the device. This article addresses the pre-conceived and well-accepted principle that interface compression delivered by a compression device substantially increases with the position of the limb, based on the positions of sitting (non-weight bearing) to standing and/or during muscle activity (ankle dorsiflexion). Using engineering parameters and clinical measurements, the authors demonstrate that changes in interface pressure are minimal if any, and that the current concept should be modified accordingly. Declaration of interest: This study was sponsored by Carolon. L. Reid, and S. Kravitz are employees of Carolon. M. Hegarty-Craver has received monetary compensation as a researcher for Carolon.

The Large Underground Xenon experiment (LUX) searches for dark matter using a dual-phase xenon detector. LUX uses a custom-developed trigger system for event selection. In this paper, the trigger efficiency, which is defined as the probability that an event of interest is selected for offline analysis, is studied using raw data obtained from both electron recoil (ER) and nuclear recoil (NR) calibrations. The measured efficiency exceeds 98\% at a pulse area of 90 detected photons, which is well below the WIMP analysis threshold on the S2 pulse area. The efficiency also exceeds 98\% at recoil energies of \mbox{0.2 keV} and above for ER, and \mbox{1.3 keV} and above for NR. The measured trigger efficiency varies between 99\% and 100\% over the fiducial volume of the detector., Comment: 31 pages, 14 figures

We present a suite of new climate model experiment designs for the Geoengineering Model Intercomparison Project (GeoMIP). This set of experiments, named GeoMIP6 (to be consistent with the Coupled Model Intercomparison Project Phase 6), builds on the previous GeoMIP project simulations, and has been expanded to address several further important topics, including key uncertainties in extreme events, the use of geoengineering as part of a portfolio of responses to climate change, and the relatively new idea of cirrus cloud thinning to allow more longwave radiation to escape to space. We discuss experiment designs, as well as the rationale for those designs, showing preliminary results from individual models when available. We also introduce a new feature, called the GeoMIP Testbed, which provides a platform for simulations that will be performed with a few models and subsequently assessed to determine whether the proposed experiment designs will be adopted as core (Tier 1) GeoMIP experiments. This is meant to encourage various stakeholders to propose new targeted experiments that address their key open science questions, with the goal of making GeoMIP more relevant to a broader set of communities.

Various dark matter models predict annual and diurnal modulations of dark matter interaction rates in Earth-based experiments as a result of the Earth's motion in the halo. Observation of such features can provide generic evidence for detection of dark matter interactions. This paper reports a search for both annual and diurnal rate modulations in the LUX dark matter experiment using over 20 calendar months of data acquired between 2013 and 2016. This search focuses on electron recoil events at low energies, where leptophilic dark matter interactions are expected to occur and where the DAMA experiment has observed a strong rate modulation for over two decades. By using the innermost volume of the LUX detector and developing robust cuts and corrections, we obtained a stable event rate of 2.3$\pm$0.2~cpd/keV$_{\text{ee}}$/tonne, which is among the lowest in all dark matter experiments. No statistically significant annual modulation was observed in energy windows up to 26~keV$_{\text{ee}}$. Between 2 and 6~keV$_{\text{ee}}$, this analysis demonstrates the most sensitive annual modulation search up to date, with 9.2$\sigma$ tension with the DAMA/LIBRA result. We also report no observation of diurnal modulations above 0.2~cpd/keV$_{\text{ee}}$/tonne amplitude between 2 and 6~keV$_{\text{ee}}$., Comment: 12 pages, 9 figures

Author(s): Tvrznikova, L; Bernard, EP; Kravitz, S; O'Sullivan, K; Richardson, G; Riffard, Q; Waldron, WL; Watson, J; McKinsey, DN | Abstract: As noble liquid time projection chambers grow in size their high voltage requirements increase, and detailed, reproducible studies of dielectric breakdown and the onset of electroluminescence are needed to inform their design. The Xenon Breakdown Apparatus (XeBrA) is a 5-liter cryogenic chamber built to characterize the DC high voltage breakdown behavior of liquid xenon and liquid argon. Electrodes with areas up to 33 cm2 were tested while varying the cathode-anode separation from 1 to 6 mm with a voltage difference up to 75 kV. A power-law relationship between breakdown field and electrode area was observed. The breakdown behavior of liquid argon and liquid xenon within the same experimental apparatus was comparable.

We apply deep neural networks (DNN) to data from the EXO-200 experiment. In the studied cases, the DNN is able to reconstruct the relevant parameters - total energy and position - directly from raw digitized waveforms, with minimal exceptions. For the first time, the developed algorithms are evaluated on real detector calibration data. The accuracy of reconstruction either reaches or exceeds what was achieved by the conventional approaches developed by EXO-200 over the course of the experiment. Most existing DNN approaches to event reconstruction and classification in particle physics are trained on Monte Carlo simulated events. Such algorithms are inherently limited by the accuracy of the simulation. We describe a unique approach that, in an experiment such as EXO-200, allows to successfully perform certain reconstruction and analysis tasks by training the network on waveforms from experimental data, either reducing or eliminating the reliance on the Monte Carlo., Accepted version. 33 pages, 28 figures

A search for instability of nucleons bound in Xe136 nuclei is reported with 223 kg·yr exposure of Xe136 in the EXO-200 experiment. Lifetime limits of 3.3×1023 and 1.9×1023 yr are established for nucleon decay to Sb133 and Te133, respectively. These are the most stringent to date, exceeding the prior decay limits by a factor of 9 and 7, respectively.

We discuss a novel paradigm in the optical readout of scintillation radiation detectors. In one common configuration, such detectors are homogeneous and the scintillation light is collected and recorded by external photodetectors. It is usually assumed that imaging in such a photon-starved and large-emittance regime is not possible. Here we show that the appropriate optics, matched with highly segmented photodetector coverage and dedicated reconstruction software, can be used to produce images of the radiation-induced events. In particular, such a 'distributed imaging' system can discriminate between events produced as a single cluster and those resulting from more delocalized energy depositions. This is crucial in discriminating many common backgrounds at MeV energies. With the use of simulation, we demonstrate the performance of a detector augmented with a practical, if preliminary, set of optics. Finally, we remark that this new technique lends itself to be adapted to different detector sizes and briefly discuss the implications for a number of common applications in science and technology., Comment: 9 pages, 7 figures

Future tonne-scale liquefied noble gas detectors depend on efficient light detection in the VUV range. In the past years Silicon Photomultipliers (SiPMs) have emerged as a valid alternative to standard photomultiplier tubes or large area avalanche photodiodes. The next generation double beta decay experiment, nEXO, with a 5 tonne liquid xenon time projection chamber, will use SiPMs for detecting the $178\,\text{nm}$ xenon scintillation light, in order to achieve an energy resolution of $\sigma / Q_{\beta\beta} = 1\, \%$. This paper presents recent measurements of the VUV-HD generation SiPMs from Fondazione Bruno Kessler in two complementary setups. It includes measurements of the photon detection efficiency with gaseous xenon scintillation light in a vacuum setup and dark measurements in a dry nitrogen gas setup. We report improved photon detection efficiency at $175\,\text{nm}$ compared to previous generation devices, that would meet the criteria of nEXO. Furthermore, we present the projected nEXO detector light collection and energy resolution that could be achieved by using these SiPMs., Comment: 11 pages, 13 figures, 2 tables

Objective: The objective of this paper was to investigate the pressure applied to the lower leg by multilayer, multicomponent wrap systems, in different positions Method: The stretch profiles of five multilayer, multicomponent wrap systems were tested, three 2-layer and two 4-layer systems. These were quantified in the laboratory using a tensile testing device. The circumference of the lower leg was measured on healthy participants in three locations (ankle, B1 level, and calf) in three different postures (rest, dorsiflexion, and standing). Results: The largest changes in circumference were used to simulate the pressure changes under the multilayer, multicomponent products using Laplace's Law. While the pressure differences were large for the zinc plaster product, pressure changes ranged from 5–10mmHg for the other, more elastic products. Additionally, it was noted that the leg decreased in circumference at the B1 level and calf for the majority of participants when transitioning from sitting to standing. This decrease in size results in a decrease in bandage tension and applied pressure. Conclusion: These results show that the sub-bandage pressure is not significantly affected by changes in posture when used as intended, within the therapeutic range. Declaration of interest: This study was sponsored by Carolon. L. Reid, and S. Kravitz are employees of Carolon and E. Grant is a Member of the Board. M. Hegarty-Craver and C. Kwon have received monetary compensation as researchers for Carolon.

We evaluate the effectiveness and the regional inequalities of solar radiation management (SRM) in compensating for simultaneous changes in temperature and precipitation caused by increased greenhouse gas concentrations. We analyze the results from Earth System Models under four Geoengineering Model Intercomparison Project (GeoMIP) experiments with a modified form of the Residual Climate Response approach. Each experiment produces 50 model yrs of simulations: 13 models completed experiment G1 (offsetting 4 × CO 2 via solar reduction); 12 models completed experiment G2 (offsetting CO 2 that increased by 1% per year); 3 models completed experiment G3 (offsetting increasing radiative forcing under RCP4.5 with increasing stratospheric aerosol); and 7 models completed experiment G4 (injection of 5 Tg SO 2 a − 1 into the stratosphere). The regional inequalities in temperature and precipitation compensation for experiments G1 , G3 and G4 are significantly different from their corresponding noise backgrounds for most models, but for G2 they are not significantly different from noise. Differences in the regional inequalities and the actual effectiveness among the four SRM scenarios are not significant for many models. However, in more than half of the models, the effectiveness for temperature in the solar dimming geoengineering scenarios ( G1 and G2 ) is significantly higher than that in the SO 2 geoengineering scenarios ( G3 and G4 ). The effectiveness of the four SRM experiments in compensating for temperature change is considerably higher than for precipitation. The methodology used highlights that a large across-model variation in the treatment of key geoengineering processes (such as stratospheric aerosols) and the quantification of damage caused by climate change creates significant uncertainties in any strategies to achieve optimal compensation effectiveness across different regions.

nEXO is a 5-ton liquid enriched-xenon time projection chamber (TPC) to search for neutrinoless double-beta decay, designed to have the sensitivity to completely probe the inverted mass hierarchy of Majorana neutrinos. The detector will accommodate—as a background reduction technique—a system to recover and identify the barium decay product. This upgrade will allow a background-free measurement of neutrinoless double-beta decay and increase the half-life sensitivity of the experiment by at least one order of magnitude. Ongoing research and development includes a system to test barium extraction from liquid xenon using surface adsorption and Resonance Ionization Spectroscopy (RIS).

A new Geoengineering Model Intercomparison Project (GeoMIP) experiment "G4 specified stratospheric aerosols" (short name: G4SSA) is proposed to investigate the impact of stratospheric aerosol geoengineering on atmosphere, chemistry, dynamics, climate, and the environment. In contrast to the earlier G4 GeoMIP experiment, which requires an emission of sulfur dioxide (SO2) into the model, a prescribed aerosol forcing file is provided to the community, to be consistently applied to future model experiments between 2020 and 2100. This stratospheric aerosol distribution, with a total burden of about 2 Tg S has been derived using the ECHAM5-HAM microphysical model, based on a continuous annual tropical emission of 8 Tg SO2 yr−1. A ramp-up of geoengineering in 2020 and a ramp-down in 2070 over a period of 2 years are included in the distribution, while a background aerosol burden should be used for the last 3 decades of the experiment. The performance of this experiment using climate and chemistry models in a multi-model comparison framework will allow us to better understand the impact of geoengineering and its abrupt termination after 50 years in a changing environment. The zonal and monthly mean stratospheric aerosol input data set is available at https://www2.acd.ucar.edu/gcm/geomip-g4-specified-stratospheric-aerosol-data-set.