The Alvarado score for predicting acute appendicitis: a systematic review

Background: The Alvarado score can be used to stratify patients with symptoms of suspected appendicitis; the validity of the score in certain patient groups and at different cut points is still unclear. The aim of this study was to assess the discrimination (diagnostic accuracy) and calibration performance of the Alvarado score. Methods: A systematic search of validation studies in Medline, Embase, DARE and The Cochrane library was performed up to April 2011. We assessed the diagnostic accuracy of the score at the two cut-off points: score of 5 (1 to 4 vs. 5 to 10) and score of 7 (1 to 6 vs. 7 to 10). Calibration was analysed across low (1 to 4), intermediate (5 to 6) and high (7 to 10) risk strata. The analysis focused on three sub-groups: men, women and children. Results: Forty-two studies were included in the review. In terms of diagnostic accuracy, the cut-point of 5 was good at 'ruling out' admission for appendicitis (sensitivity 99% overall, 96% men, 99% woman, 99% children). At the cut-point of 7, recommended for 'ruling in' appendicitis and progression to surgery, the score performed poorly in each subgroup (specificity overall 81%, men 57%, woman 73%, children 76%). The Alvarado score is well calibrated in men across all risk strata (low RR 1.06, 95% CI 0.87 to 1.28; intermediate 1.09, 0.86 to 1.37 and high 1.02, 0.97 to 1.08). The score over-predicts the probability of appendicitis in children in the intermediate and high risk groups and in women across all risk strata. Conclusions: The Alvarado score is a useful diagnostic 'rule out' score at a cut point of 5 for all patient groups. The score is well calibrated in men, inconsistent in children and over-predicts the probability of appendicitis in women across all strata of risk

A next-generation liquid xenon observatory for dark matter and neutrino physics

The nature of dark matter and properties of neutrinos are among the most pressing issues in contemporary particle physics. The dual-phase xenon time-projection chamber is the leading technology to cover the available parameter space for weakly interacting massive particles, while featuring extensive sensitivity to many alternative dark matter candidates. These detectors can also study neutrinos through neutrinoless double-beta decay and through a variety of astrophysical sources. A next-generation xenon-based detector will therefore be a true multi-purpose observatory to significantly advance particle physics, nuclear physics, astrophysics, solar physics, and cosmology. This review article presents the science cases for such a detector

ERS/ECDC Statement: European Union standards for tuberculosis care, 2017 update

European Respiratory Society TF-2016-1

Spectroscopy of the unbound nucleus ¹⁸Na

The unbound nucleus 18Na, the intermediate nucleus in the two-proton radioactivity of 19Mg, is studied through the resonant elastic scattering 17Ne(p,17Ne)p. The spectroscopic information obtained in this experiment is discussed and put in perspective with previous measurements and the structure of the mirror nucleus 18N. © 2011 World Scientific Publishing Company

Spectroscopy of 18^{18}Na: Bridging the two-proton radioactivity of 19^{19}Mg

The unbound nucleus $^{18}$Na, the intermediate nucleus in the two-proton radioactivity of $^{19}$Mg, was studied by the measurement of the resonant elastic scattering reaction $^{17}$Ne(p,$^{17}$Ne)p performed at 4 A.MeV. Spectroscopic properties of the low-lying states were obtained in a R-matrix analysis of the excitation function. Using these new results, we show that the lifetime of the $^{19}$Mg radioactivity can be understood assuming a sequential emission of two protons via low energy tails of $^{18}$Na resonances