Multicentre randomised controlled trial of nasal diamorphine for analgesia in children and teenagers with clinical fractures.

OBJECTIVE: To compare the effectiveness of nasal diamorphine spray with intramuscular morphine for analgesia in children and teenagers with acute pain due to a clinical fracture, and to describe the safety profile of the spray. DESIGN: Multicentre randomised controlled trial. SETTING: Emergency departments in eight UK hospitals. PARTICIPANTS: Patients aged between 3 and 16 years presenting with a clinical fracture of an upper or lower limb. MAIN OUTCOME MEASURES: Patients' reported pain using the Wong Baker face pain scale, ratings of reaction to treatment of the patients and acceptability of treatment by staff and parents, and adverse events. RESULTS: 404 eligible patients completed the trial (204 patients given nasal diamorphine spray and 200 given intramuscular morphine). Onset of pain relief was faster in the spray group than in the intramuscular group, with lower pain scores in the spray group at 5, 10, and 20 minutes after treatment but no difference between the groups after 30 minutes. 80% of patients given the spray showed no obvious discomfort compared with 9% given intramuscular morphine (difference 71%, 95% confidence interval 65% to 78%). Treatment administration was judged acceptable by staff and parents, respectively, for 98% (199 of 203) and 97% (186 of 192) of patients in the spray group compared with 32% (64 of 199) and 72% (142 of 197) in the intramuscular group. No serious adverse events occurred in the spray group, and the frequencies of all adverse events were similar in both groups (spray 24.1% v intramuscular morphine 18.5%; difference 5.6%, -2.3% to 13.6%). CONCLUSION: Nasal diamorphine spray should be the preferred method of pain relief in children and teenagers presenting to emergency departments in acute pain with clinical fractures. The diamorphine spray should be used in place of intramuscular morphine

Optical Readout in a Multi-Module System Test for the ATLAS Pixel Detector

The innermost part of the ATLAS experiment at the LHC, CERN, will be a pixel detector. The command messages and the readout data of the detector are transmitted over an optical data path. The readout chain consists of many components which are produced at several locations around the world, and must work together in the pixel detector. To verify that these parts are working together as expected a system test has been built up. In this paper the system test setup and the operation of the readout chain is described. Also, some results of tests using the final pixel detector readout chain are given.Comment: 6 pages, 10 figures, Pixel 2005 proceedings preprin

Validation Studies of the ATLAS Pixel Detector Control System

The ATLAS pixel detector consists of 1744 identical silicon pixel modules arranged in three barrel layers providing coverage for the central region, and three disk layers on either side of the primary interaction point providing coverage of the forward regions. Once deployed into the experiment, the detector will employ optical data transfer, with the requisite powering being provided by a complex system of commercial and custom-made power supplies. However, during normal performance and production tests in the laboratory, only single modules are operated and electrical readout is used. In addition, standard laboratory power supplies are used. In contrast to these normal tests, the data discussed here was obtained from a multi-module assembly which was powered and read out using production items: the optical data path, the final design power supply system using close to final services, and the Detector Control System (DCS). To demonstrate the functionality of the pixel detector system a stepwise transition was made from the normal laboratory readout and power supply systems to the ones foreseen for the experiment, with validation of the data obtained at each transition.Comment: 8 pages, 8 figures, proceedings for the Pixel2005 worksho

Detection of blueshifted emission and absorption and a relativistic Iron line in the X-ray spectrum of ESO 323-G077

We report on the X-ray observation of the Seyfert 1 ESO323-G077 performed with XMM-Newton. The spectra show a complex spectrum with conspicuous absorption and emission features. The continuum emission can be modelled with a power law with an index of 1.99+/-0.02 in the whole XMM-Newton energy band, marginally consistent with typical values of Type-I objects. An absorption component with an uncommonly high equivalent Hydrogen column, n_H=5.82(+0.12/-0.11)x10^22 cm-2, is affecting the soft part of the spectrum. Additionally, two warm absorption components are also present. The lower ionised one has an ionisation parameter of Log(U)=2.14(+0.06/-0.07) and an outflowing velocity of v=3200(+600/-200) km/s. Two absorption lines located at ~6.7 and ~7.0 keV can be modelled with the highly ionised absorber. The ionisation parameter and outflowing velocity of the gas measured are Log(U)=3.26(+0.19/-0.15) and v=1700(+600/-400) km/s, respectively. Four emission lines were also detected in the soft energy band. The most likely explanation for these emission lines is that they are associated with an outflowing gas with a velocity of ~2000 km/s. The data suggest that the same gas which is causing the absorption could also being responsible of these emission features. Finally, the spectrum shows the presence of a relativistic iron emission line likely originated in the accretion disc of a Kerr BH with an inclination of ~25 deg. We propose a model to explain the observed X-ray properties which invokes the presence of a two-phase outflow with cone-like structure and a velocity of the order of 2,000-4,000 km/s. The inner layer of the cone would be less ionised, or even neutral, than the outer layer. The inclination angle would be lower than the opening angle of the outflowing cone.Comment: 11 pages, accepted in MNRA

Changing distribution of the east coast of Scotland bottlenose dolphin population and the challenges of area‐based management

MAC received funding from the Department of Energy and Climate Change (DECC) (now Department for Business, Energy and Industrial Strategy) UK, and the MASTS (Marine Alliance for Science and Technology for Scotland) pooling initiative. MASTS is funded by the Scottish Funding Council (grant reference HR09011) and contributing institutions. Annual surveys were funded by DECC, Scottish Natural Heritage (SNH), Beatrice Offshore Windfarm Ltd., Moray Offshore Renewables Ltd, Marine Scotland, The Crown Estate, Highlands and Islands Enterprise and the Universities of St Andrews and Aberdeen. All fieldwork was carried out under SNH Animal Scientific Licences to PMT and PSH. The authors have no conflict of interest to declare. We thank John Baxter for helpful discussions about the implications for conservation and management while drafting this manuscript, and Morven Carruthers for her advice on the site condition monitoring for the Moray Firth SAC. This manuscript benefited from the helpful comments of two anonymous reviewers.Peer reviewedPostprin

Subclonal TP53 copy number is associated with prognosis in multiple myeloma

Multiple myeloma (MM) is a genetically heterogeneous cancer of bone marrow plasma cells with variable outcome. To assess the prognostic relevance of clonal heterogeneity of TP53 copy number, we profiled tumors from 1777 newly diagnosed Myeloma XI trial patients with multiplex ligation-dependent probe amplification (MLPA). Subclonal TP53 deletions were independently associated with shorter overall survival, with a hazard ratio of 1.8 (95% confidence interval, 1.2-2.8; P = .01). Clonal, but not subclonal, TP53 deletions were associated with clinical markers of advanced disease, specifically lower platelet counts (P < .001) and increased lactate dehydrogenase (P < .001), as well as a higher frequency of features indicative of genomic instability, del(13q) (P = .002) or del(1p) (P = .006). Biallelic TP53 loss-of-function by mutation and deletion was rare (2.4%) and associated with advanced disease. We present a framework for identifying subclonal TP53 deletions by MLPA, to improve patient stratification in MM and tailor therapy, enabling management strategies

Measurement of the Charged Multiplicities in b, c and Light Quark Events from Z0 Decays

Average charged multiplicities have been measured separately in $b$, $c$ and light quark ($u,d,s$) events from $Z^0$ decays measured in the SLD experiment. Impact parameters of charged tracks were used to select enriched samples of $b$ and light quark events, and reconstructed charmed mesons were used to select $c$ quark events. We measured the charged multiplicities: $\bar{n}_{uds} = 20.21 \pm 0.10 (\rm{stat.})\pm 0.22(\rm{syst.})$, $\bar{n}_{c} = 21.28 \pm 0.46(\rm{stat.}) ^{+0.41}_{-0.36}(\rm{syst.})$ $\bar{n}_{b} = 23.14 \pm 0.10(\rm{stat.}) ^{+0.38}_{-0.37}(\rm{syst.})$, from which we derived the differences between the total average charged multiplicities of $c$ or $b$ quark events and light quark events: $\Delta \bar{n}_c = 1.07 \pm 0.47(\rm{stat.})^{+0.36}_{-0.30}(\rm{syst.})$ and $\Delta \bar{n}_b = 2.93 \pm 0.14(\rm{stat.})^{+0.30}_{-0.29}(\rm{syst.})$. We compared these measurements with those at lower center-of-mass energies and with perturbative QCD predictions. These combined results are in agreement with the QCD expectations and disfavor the hypothesis of flavor-independent fragmentation.Comment: 19 pages LaTex, 4 EPS figures, to appear in Physics Letters

A Search for Jet Handedness in Hadronic Z0Z^0 Decays

We have searched for signatures of polarization in hadronic jets from $Z^0 \to q \bar{q}$ decays using the ``jet handedness'' method. The polar angle asymmetry induced by the high SLC electron-beam polarization was used to separate quark jets from antiquark jets, expected to be left- and right-polarized, respectively. We find no evidence for jet handedness in our global sample or in a sample of light quark jets and we set upper limits at the 95% C.L. of 0.063 and 0.099 respectively on the magnitude of the analyzing power of the method proposed by Efremov {\it et al.}Comment: Revtex, 8 pages, 2 figure

The National Adult Inpatient Survey conducted in the English National Health Service from 2002 to 2009: how have the data been used and what do we know as a result?

<p>Abstract</p> <p>Background</p> <p>When it was initiated in 2001, England's national patient survey programme was one of the first in the world and has now been widely emulated in other healthcare systems. The aim of the survey programme was to make the National Health Service (NHS) more "patient centred" and more responsive to patient feedback. The national inpatient survey has now been running in England annually since 2002 gathering data from over 600,000 patients. The aim of this study is to investigate how the data have been used and to summarise what has been learned about patients' evaluation of care as a result.</p> <p>Methods</p> <p>Two independent researchers systematically gathered all research that included analyses of the English national adult inpatient survey data. Journals, databases and relevant websites were searched. Publications prior to 2002 were excluded. Articles were also identified following consultation with experts. All documents were then critically appraised by two co-authors both of whom have a background in statistical analysis.</p> <p>Results</p> <p>We found that the majority of the studies identified were reports produced by organisations contracted to gather the data or co-ordinate the data collection and used mainly descriptive statistics. A few articles used the survey data for evidence based reporting or linked the survey to other healthcare data. The patient's socio-demographic characteristics appeared to influence their evaluation of their care but characteristics of the workforce and the. At a national level, the results of the survey have been remarkably stable over time. Only in those areas where there have been co-ordinated government-led campaigns, targets and incentives, have improvements been shown. The main findings of the review are that while the survey data have been used for different purposes they seem to have incited little academic interest.</p> <p>Conclusions</p> <p>The national inpatient survey has been a useful resource for many authors and organisations but the full potential inherent in this large, longitudinal publicly available dataset about patients' experiences has not as yet been fully exploited.</p> <p>This review suggests that the presence of survey results alone is not enough to improve patients' experiences and further research is required to understand whether and how the survey can be best used to improve standards of care in the NHS.</p