Exclusive neutral pion production and Compton scattering at GlueX

By using data collected from Thomas Jefferson National Accelerator (JLab), I will be observing two specific reactions from the collision of linearly polarized photons with protons in a liquid hydrogen target. In this work, studies of the neutral pion reaction will be presented along with an exploratory study of the Compton scattering process. These reactions were studied by utilizing the fine-grained calorimetry of the GlueX experiment in order to aid in the understanding of meson production mechanisms in high-energy photoproduction. The separation of neutral pions and Compton events is challenging due to potential merging of the neutral pion decay photons into a single shower for large polar angles and high momentum. This merging causes neutral pion decay photons with a small opening angle to look like single Compton photon showers. As a result, electromagnetic shower shape variables are used to study these effects, and with the introduction of three new width variables, comparisons between data and Monte Carlo samples are obtained to estimate the signal purity for these two reactions. These results will provide a stepping stone to ultimately measure the sigma beam asymmetry for large angle Compton scattering events

Cost-Effectiveness Frameworks for Comparing Genome and Exome Sequencing Versus Conventional Diagnostic Pathways: A Scoping Review and Recommended Methods

PURPOSE: Methodological challenges have limited economic evaluations of genome sequencing (GS) and exome sequencing (ES). Our objective was to develop conceptual frameworks for model-based cost-effectiveness analyses (CEAs) of diagnostic GS/ES. METHODS: We conducted a scoping review of economic analyses to develop and iterate with experts a set of conceptual CEA frameworks for GS/ES for prenatal testing, early diagnosis in pediatrics, diagnosis of delayed-onset disorders in pediatrics, genetic testing in cancer, screening of newborns, and general population screening. RESULTS: Reflecting on 57 studies meeting inclusion criteria, we recommend the following considerations for each clinical scenario. For prenatal testing, performing comparative analyses of costs of ES strategies and postpartum care, as well as genetic diagnoses and pregnancy outcomes. For early diagnosis in pediatrics, modeling quality-adjusted life years (QALYs) and costs over ≥20 years for rapid turnaround GS/ES. For hereditary cancer syndrome testing, modeling cumulative costs and QALYs for the individual tested and first/second/third-degree relatives. For tumor profiling, not restricting to treatment uptake or response and including QALYs and costs of downstream outcomes. For screening, modeling lifetime costs and QALYs and considering consequences of low penetrance and GS/ES reanalysis. CONCLUSION: Our frameworks can guide the design of model-based CEAs and ultimately foster robust evidence for the economic value of GS/ES

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals <1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

Introduction: The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. Methods: In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. Findings: Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2–6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5–5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4–10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32–4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. Interpretation: After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification

DVD-Based High Intensity Interval Exercise vs. Moderate Continuous Exercise: Which Type is More Beneficial to Overall Fitness?

High intensity interval training (HIIT) has previously been shown to increase physical fitness to a greater extent than continuous moderate intensity exercise performed for the same or greater duration. However, most studies of HIIT have utilized stationary bicycles for training. This study examined HIIT using the DVD-based program “Insanity”. Participants volunteered to be in either the Insanity group (n=9) or a control group (n=7). The Insanity group completed the DVD exercise for 30 minutes, 3 times/week, while the control group completed 30 minutes of continuous moderate intensity cardiovascular activity 2 times per week along with 30 minutes of strength training 1 time per week. VO2 max, body fat percentage, vertical jump, timed push-ups and sit ups were assessed prior to and following 5.5 weeks of training. Following training there were no differences between the groups for VO2 max, body composition or sit ups. There was a trend for improved vertical jumps in both groups (Insanity pre: 22.17±1.17, post: 23.2±1.3 inches; Control pre: 17.5±1.33, post: 17.64±1.46 inches. p=0.08). There was also a significant improvement in both groups for the push-up test (Insanity pre: 44.67±15.54, post: 58.22±17.28; Control pre: 31.0±14.8, post: 37.71±12.24. p=0.000) with the Insanity group showing a greater increase in response to training compared to the control group (p=0.05). Although there were not many differences between groups, positive trends in the results suggest it is possible that a longer duration of study may yield more significant results

Exercise with incorporated expiratory manoeuvres was as effective as breathing techniques for airway clearance in children with cystic fibrosis: a randomised crossover trial

Question: Can a session of exercise with incorporated expiratory manoeuvres substitute for a session of breathing techniques for airway clearance in children with cystic fibrosis? Are children with cystic fibrosis as co-operative and satisfied with the exercise regimen as with the breathing techniques?.DesignRandomised, cross-over trial with concealed allocation and intention-to-treat analysis.Participants34 children with cystic fibrosis in a stable clinical state.InterventionsParticipants underwent two 20-min airway clearance interventions on two scheduled clinic days: one involving three bouts of various whole-body exercise modalities each followed by independent expiratory manoeuvres, and the other involving breathing control, thoracic expansions with manual expiratory compressions, and the forced expiratory technique.Outcome measuresWet weight of expectorated sputum, change in lung function, co-operation with treatment, perceived treatment quality, and satisfaction with treatment were all assessed after each intervention.ResultsThe wet weight of sputum after exercise was 0.6g higher after the exercise intervention, which was not statistically or clinically significant (95% CI –0.2 to 1.4). However, lung function and participant satisfaction with the treatment were both significantly better after the exercise intervention. Co-operation with treatment and perceived treatment quality were equally high for each intervention.ConclusionA session of various whole-body exercises interspersed with independent expiratory manoeuvres could be an acceptable substitute for a session of breathing control, thoracic expansions with manual expiratory compressions, and the forced expiratory technique in children with mild cystic fibrosis lung disease

European Society of Gynaecological Oncology Guidelines for the Management of Patients with Vulvar Cancer - Update 2023

Background As part of its mission to improve the quality of care for women with gynecological cancers across Europe, the European Society of Gynaecological Oncology (ESGO) first published in 2017 evidence-based guidelines for the management of patients with vulvar cancer. Objective To update the ESGO guidelines based on the new evidence addressing the management of vulvar cancer and to cover new topics in order to provide comprehensive guidelines on all relevant issues of diagnosis and treatment of vulvar cancer. Methods The ESGO Council nominated an international development group comprised of practicing clinicians who provide care to vulvar cancer patients and have demonstrated leadership through their expertize in clinical care and research, national and international engagement and profile as well as dedication to the topics addressed to serve on the expert panel (18 experts across Europe). To ensure that the statements were evidence-based, new data identified from a systematic search were reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the international development group. Prior to publication, the guidelines were reviewed by 206 international practitioners in cancer care delivery and patient representatives. Results The updated guidelines cover comprehensively diagnosis and referral, staging, pathology, pre-operative investigations, surgical management (local treatment, groin treatment, sentinel lymph node procedure, reconstructive surgery), (chemo)radiotherapy, systemic treatment, treatment of recurrent disease (vulvar, inguinal, pelvic, and distant recurrences), and follow-up. Management algorithms are also defined.</p

Short-term effect of different physical exercises and physiotherapy combinations on sputum expectoration, oxygen saturation, and lung function in young patients with cystic fibrosis

PURPOSE: Exercise and chest physiotherapy are integral components of cystic fibrosis (CF) care. We aimed to determine short-term effects of a combined exercise-physiotherapy intervention, using either trampoline or cycle exercises compared to billiard (sham training) on sputum production, oxygen saturation (SaO2) and short-term lung function in participants with CF. METHODS: Twelve 16- to 29-year-old individuals with CF were randomly allocated to all 3 interventions on non-consecutive days of a week with exercise and physiotherapy parts lasting 30 min and breaks of 30 min after each procedure. Sputum weight (g) and lung function were measured before and after the exercise + rest and physiotherapy + rest interventions and SaO2 was measured before and after the combined interventions. Differences in outcome measures between the different exercises and combined exercise/physiotherapy regimens were analyzed by univariate multilevel linear regression. RESULTS: Sputum expectoration during and after trampoline exercise was significantly higher than with and after billiard (P = 0.021), and tended to be higher than with and after cycling of similar cardiovascular intensity (P = 0.074). Sputum weights during and after physiotherapy were comparable among sessions, irrespective of the prior exercise or sham procedure. The increase in SaO2 was significantly higher after the combined trampoline/physiotherapy (1.7 ± 0.9%) and cycling/physiotherapy (1.8 ± 0.8%) sessions compared to billiard/physiotherapy (0.5 ± 1.8%, P = 0.011 and P = 0.007). No effects were observed on lung function. CONCLUSIONS: Exercise followed by physiotherapy has an additive effect on sputum production in participants with CF and leads to improved oxygen saturation. Exercises with increased ventilation combined with mechanical vibration seem to be most efficient