A relativistic framework to determine the nuclear transparency from A(p,2p) reactions

A relativistic framework for computing the nuclear transparency extracted from A(p,2p) scattering processes is presented. The model accounts for the initial- and final-state interactions (IFSI) within the relativistic multiple-scattering Glauber approximation (RMSGA). For the description of color transparency, two existing models are used. The nuclear filtering mechanism is implemented as a possible explanation for the oscillatory energy dependence of the transparency. Results are presented for the target nuclei 7Li, 12C, 27Al, and 63Cu. An approximated, computationally less intensive version of the RMSGA framework is found to be sufficiently accurate for the calculation of the nuclear transparency. After including the nuclear filtering and color transparency mechanisms, our calculations are in acceptable agreement with the data.Comment: 17 pages, 4 figures, accepted for publication in Phys. Lett.

Nuclear transparencies from photoinduced pion production

We present a relativistic and cross-section factorized framework for computing nuclear transparencies extracted from A(\gamma,\pi N) reactions at intermediate energies. The proposed quantummechanical model adopts a relativistic extension to the multiple-scattering Glauber approximation to account for the final state interactions of the ejected nucleon and pion. The theoretical predictions are compared against the experimental ^4He(\gamma,p \pi^-) data from Jefferson Lab. For those data, our results show no conclusive evidence for the onset of mechanisms related to color transparency.Comment: 5 pages, 3 figure

A relativistic Glauber approach to polarization transfer in 4He(\vec{e},e'\vec{p})

Polarization-transfer components for 4He(\vec{e},e'\vec{p})3H are computed within the relativistic multiple-scattering Glauber approximation (RMSGA). The RMSGA framework adopts relativistic single-particle wave functions and electron-nucleon couplings. The predictions with free and various parametrizations for the medium-modified electromagnetic form factors are compared to the world data.Comment: 2 pages, 1 figure Proceedings of the Int. School on Nuclear Physics, 26th Course, Erice (Sicily), September 16th- 24th, 2004; To appear in Progress in Particle and Nuclear Physic

Relativistic eikonal description of A(p,pN) reactions

The authors present a relativistic and cross-section factorized framework for computing quasielastic A(p,pN) observables at intermediate and high energies. The model is based on the eikonal approximation and can accomodate both optical potentials and the Glauber method for dealing with the initial- and final-state interactions (IFSI). At lower nucleon energies, the optical-potential philosophy is preferred, whereas at higher energies the Glauber method is more natural. This versatility in dealing with the IFSI allows one to describe A(p,pN) reactions in a wide energy range. Most results presented here use optical potentials as this approach is argued to be the optimum choice for the kinematics of the experiments considered in the present paper. The properties of the IFSI factor, a function wherein the entire effect of the IFSI is contained, are studied in detail. The predictions of the presented framework are compared with two kinematically different experiments. First, differential cross sections for quasielastic proton scattering at 1 GeV off 12C, 16O, and 40Ca target nuclei are computed and compared to data from PNPI. Second, the formalism is applied to the analysis of a 4He(p,2p) experiment at 250 MeV. The optical-potential calculations are found to be in good agreement with the data from both experiments, showing the reliability of the adopted model in a wide energy range.Comment: 34 pages, 14 figures, accepted for publication in Phys. Rev.

Early treatment versus expectative management of patent ductus arteriosus in preterm infants

_Background:_ Much controversy exists about the optimal management of a patent ductus arteriosus (PDA) in preterm infants, especially in those born at a gestational age (GA) less than 28weeks. No causal relationship has been proven between a (haemodynamically significant) PDA and neonatal complications related to pulmonary hyperperfusion and/or systemic hypoperfusion. Although studies show conflicting results, a common understanding is that medical or surgical treatment of a PDA does not seem to reduce the risk of major neonatal morbidities and mortality. As the PDA might have closed spontaneously, treated children are potentially exposed to iatrogenic adverse effects. A conservative approach is gaining interest worldwide, although convincing evidence to support its use is lacking. _Methods:_ This multicentre, randomised, non-inferiority trial is conducted in neonatal intensive care units. The study population consists of preterm infants (GA1.5mm. Early treatment (between 24 and 72h postnatal age) with the cyclooxygenase inhibitor(COXi) ibuprofen (IBU) is compared with an expectative management (no intervention intended to close a PDA). The primary outcome is the composite of mortality, and/or necrotising enterocolitis (NEC) Bell stage ≥ IIa, and/or bronchopulmonary dysplasia (BPD) defined as the need for supplemental oxygen, all at a postmenstrual age (PMA) of 36weeks. Secondary outcome parameters are short term sequelae of cardiovascular failure, comorbidity and adverse events assessed during hospitalization and long-term neurodevelopmental outcome assessed at a corrected age of 2 years. Consequences regarding health economics are evaluated by cost effectiveness analysis and budget impact analysis. _Discussion:_ As a conservative approach is gaining interest, we investigate whether in preterm infants, born at a GA less than 28weeks, with a PDA an expectative management is non-inferior to early treatment with IBU regarding to the composite outcome of mortality and/or NEC and/or BPD at a PMA of 36weeks

Polarization transfer in 4He(\vec{e},e'\vec{p}) and 16O(\vec{e},e'\vec{p}) in a relativistic Glauber model

Polarization-transfer components for 4He(\vec{e},e'\vec{p})3H and 16O(\vec{e},e'\vec{p})15N are computed within the relativistic multiple-scattering Glauber approximation (RMSGA). The RMSGA framework adopts relativistic single-particle wave functions and electron-nucleon couplings. The predictions closely match those of a relativistic plane-wave model indicating the smallness of the final-state interactions for polarization-transfer components. Also short-range correlations play a modest role for the studied observables, as long as small proton missing-momenta are probed in quasi-elastic kinematics. The predictions with free and various parameterizations for the medium-modified electromagnetic form factors are compared to the world data.Comment: 24 pages, 11 figure

Diagnostic performances of the fluorescent spot test for G6PD deficiency in newborns along the Thailand-Myanmar border: A cohort study

Background: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an inherited enzymatic disorder associated with severe neonatal hyperbilirubinemia and acute haemolysis after exposure to certain drugs or infections. The disorder can be diagnosed phenotypically with a fluorescent spot test (FST), which is a simple test that requires training and basic laboratory equipment. This study aimed to assess the diagnostic performances of the FST used on umbilical cord blood by locally-trained staff and to compare test results of the neonates at birth with the results after one month of age. Methods: We conducted a cohort study on newborns at the Shoklo Malaria Research Unit, along the Thai-Myanmar border between January 2015 and May 2016. The FST was performed at birth on the umbilical cord blood by locally-trained staff and quality controlled by specialised technicians at the central laboratory. The FST was repeated after one month of age. Genotyping for common local G6PD mutations was carried out for all discrepant results. Results: FST was performed on 1521 umbilical cord blood samples. Quality control and genotyping revealed 10 misdiagnoses. After quality control, 10.7% of the males (84/786) and 1.2% of the females (9/735) were phenotypically G6PD deficient at birth. The FST repeated at one month of age or later diagnosed 8 additional G6PD deficient infants who were phenotypically normal at birth. Conclusions: This study shows the short-comings of the G6PD FST in neonatal routine screening and highlights the importance of training and quality control. A more conservative interpretation of the FST in male newborns could increase the diagnostic performances. Quantitative point-of-care tests might show higher sensitivity and specificity for diagnosis of G6PD deficiency on umbilical cord blood and should be investigated

Multi-centre, randomised non-inferiority trial of early treatment versus expectant management of patent ductus arteriosus in preterm infants (the BeNeDuctus trial):statistical analysis plan

Abstract Background Controversy exists about the optimal management of a patent ductus arteriosus (PDA) in preterm infants. A persistent PDA is associated with neonatal mortality and morbidity, but causality remains unproven. Although both pharmacological and/or surgical treatment are effective in PDA closure, this has not resulted in an improved neonatal outcome. In most preterm infants, a PDA will eventually close spontaneously, hence PDA treatment potentially increases the risk of iatrogenic adverse effects. Therefore, expectant management is gaining interest, even in the absence of convincing evidence to support this strategy. Methods/design The BeNeDuctus trial is a multicentre, randomised, non-inferiority trial assessing early pharmacological treatment (24–72 h postnatal age) with ibuprofen versus expectant management of PDA in preterm infants in Europe. Preterm infants with a gestational age of less than 28 weeks and an echocardiographic-confirmed PDA with a transductal diameter of > 1.5 mm are randomly allocated to early pharmacological treatment with ibuprofen or expectant management after parental informed consent. The primary outcome measure is the composite outcome of mortality, and/or necrotizing enterocolitis Bell stage ≥ IIa, and/or bronchopulmonary dysplasia, all established at a postmenstrual age of 36 weeks. Secondary short-term outcomes are comorbidity and adverse events assessed during hospitalization and long-term neurodevelopmental outcome assessed at a corrected age of 2 years. This statistical analysis plan focusses on the short-term outcome and is written and submitted without knowledge of the data. Trial registration ClinicalTrials.gov NTR5479. Registered on October 19, 2015, with the Dutch Trial Registry, sponsored by the United States National Library of Medicine Clinicaltrials.gov NCT02884219 (registered May 2016) and the European Clinical Trials Database EudraCT 2017-001376-28

Net Efficacy Adjusted for Risk (NEAR): A Simple Procedure for Measuring Risk:Benefit Balance

BACKGROUND: Although several mathematical models have been proposed to assess the risk:benefit of drugs in one measure, their use in practice has been rather limited. Our objective was to design a simple, easily applicable model. In this respect, measuring the proportion of patients who respond favorably to treatment without being affected by adverse drug reactions (ADR) could be a suitable endpoint. However, remarkably few published clinical trials report the data required to calculate this proportion. As an approach to the problem, we calculated the expected proportion of this type of patients. METHODOLOGY/PRINCIPAL FINDINGS: Theoretically, responders without ADR may be obtained by multiplying the total number of responders by the total number of subjects that did not suffer ADR, and dividing the product by the total number of subjects studied. When two drugs are studied, the same calculation may be repeated for the second drug. Then, by constructing a 2 x 2 table with the expected frequencies of responders with and without ADR, and non-responders with and without ADR, the odds ratio and relative risk with their confidence intervals may be easily calculated and graphically represented on a logarithmic scale. Such measures represent "net efficacy adjusted for risk" (NEAR). We assayed the model with results extracted from several published clinical trials or meta-analyses. On comparing our results with those originally reported by the authors, marked differences were found in some cases, with ADR arising as a relevant factor to balance the clinical benefit obtained. The particular features of the adverse reaction that must be weighed against benefit is discussed in the paper. CONCLUSION: NEAR representing overall risk-benefit may contribute to improving knowledge of drug clinical usefulness. As most published clinical trials tend to overestimate benefits and underestimate toxicity, our measure represents an effort to change this trend