An economic evaluation of vagus nerve stimulation as an adjunctive treatment to anti-seizure medications for the treatment of drug-resistant epilepsy in England.

INTRODUCTION: Anti-seizure medications (ASMs) are commonly used to prevent recurring epileptic seizures, but around a third of people with epilepsy fail to achieve an adequate response. Vagus nerve stimulation (VNS) is clinically recommended for people with drug-resistant epilepsy (DRE) who are not suitable for surgery, but the cost-effectiveness of the intervention has not recently been evaluated. The study objective is to estimate costs and quality-adjusted life-years (QALYs) associated with using VNS as an adjunct to ongoing ASM therapy, compared to the strategy of using only ASMs in the treatment of people with DRE, from an English National Health Service perspective. METHODS: A cohort state transition model was developed in Microsoft Excel to simulate costs and QALYs of the VNS + ASM and ASM only strategies. Patients could transition between five health states, using a 3-month cycle length. Health states were defined by an expected percentage reduction in seizure frequency, derived from randomized control trial data. Costs included the VNS device as well as its installation, setup, and removal; ASM therapy; adverse events associated with VNS (dyspnea, hoarseness, and cough); and health-state costs associated with epilepsy including hospitalizations, emergency department visits, neurologist visits, and primary care visits. A range of sensitivity analyses, including probabilistic sensitivity analysis, were run to assess the impact of parameter and structural uncertainty. RESULTS: In the base case, VNS + ASM had an estimated incremental cost-effectiveness ratio (ICER) of £17,771 per QALY gained compared to ASMs alone. The cost-effective ICER was driven by relative reductions in expected seizure frequency and the differences in health care resource use associated therewith. Sensitivity analyses found that the amount of resource use per epilepsy-related health state was a key driver of the cost component. CONCLUSIONS: VNS is expected to be a cost-effective intervention in the treatment of DRE in the English National Health Service

A bulk superconducting MgB2 cylinder for holding transversely polarized targets

An innovative solution is being pursued for the challenging magnetic problem of producing an internal transverse field around a polarized target, while shielding out an external longitudinal field from a detector. A hollow bulk superconductor can trap a transverse field that is present when cooled through its transition temperature, and also shield its interior from any subsequent field changes. A feasibility study with a prototype bulk MgB2 superconducting cylinder is described. Promising measurements taken of the interior field retention and exterior field exclusion, together with the corresponding long-term stability performance, are reported. In the context of an electron scattering experiment, such a solution minimizes beam deflection and the energy loss of reaction products, while also eliminating the heat load to the target cryostat from current leads that would be used with conventional electromagnets

Test of the CLAS12 RICH large scale prototype in the direct proximity focusing configuration

A large area ring-imaging Cherenkov detector has been designed to provide clean hadron identification capability in the momentum range from 3 GeV/c up to 8 GeV/c for the CLAS12 experiments at the upgraded 12 GeV continuous electron beam accelerator facility of Jefferson Laboratory. The adopted solution foresees a novel hybrid optics design based on aerogel radiator, composite mirrors and high-packed and high-segmented photon detectors. Cherenkov light will either be imaged directly (forward tracks) or after two mirror reflections (large angle tracks). We report here the results of the tests of a large scale prototype of the RICH detector performed with the hadron beam of the CERN T9 experimental hall for the direct detection configuration. The tests demonstrated that the proposed design provides the required pion-to-kaon rejection factor of 1:500 in the whole momentum range.Comment: 15 pages, 23 figures, to appear on EPJ

Spin tune mapping as a novel tool to probe the spin dynamics in storage rings

Precision experiments, such as the search for electric dipole moments of charged particles using storage rings, demand for an understanding of the spin dynamics with unprecedented accuracy. The ultimate aim is to measure the electric dipole moments with a sensitivity up to 15 orders in magnitude better than the magnetic dipole moment of the stored particles. This formidable task requires an understanding of the background to the signal of the electric dipole from rotations of the spins in the spurious magnetic fields of a storage ring. One of the observables, especially sensitive to the imperfection magnetic fields in the ring is the angular orientation of stable spin axis. Up to now, the stable spin axis has never been determined experimentally, and in addition, the JEDI collaboration for the first time succeeded to quantify the background signals that stem from false rotations of the magnetic dipole moments in the horizontal and longitudinal imperfection magnetic fields of the storage ring. To this end, we developed a new method based on the spin tune response of a machine to artificially applied longitudinal magnetic fields. This novel technique, called \textit{spin tune mapping}, emerges as a very powerful tool to probe the spin dynamics in storage rings. The technique was experimentally tested in 2014 at the cooler synchrotron COSY, and for the first time, the angular orientation of the stable spin axis at two different locations in the ring has been determined to an unprecedented accuracy of better than $2.8\mu$rad.Comment: 32 pages, 15 figures, 7 table

Phase Measurement for Driven Spin Oscillations in a Storage Ring

This paper reports the first simultaneous measurement of the horizontal and vertical components of the polarization vector in a storage ring under the influence of a radio frequency (rf) solenoid. The experiments were performed at the Cooler Synchrotron COSY in J\"ulich using a vector polarized, bunched $0.97\,\textrm{GeV/c}$ deuteron beam. Using the new spin feedback system, we set the initial phase difference between the solenoid field and the precession of the polarization vector to a predefined value. The feedback system was then switched off, allowing the phase difference to change over time, and the solenoid was switched on to rotate the polarization vector. We observed an oscillation of the vertical polarization component and the phase difference. The oscillations can be described using an analytical model. The results of this experiment also apply to other rf devices with horizontal magnetic fields, such as Wien filters. The precise manipulation of particle spins in storage rings is a prerequisite for measuring the electric dipole moment (EDM) of charged particles

Dark matter search in a Beam-Dump eXperiment (BDX) at Jefferson Lab

MeV-GeV dark matter (DM) is theoretically well motivated but remarkably unexplored. This Letter of Intent presents the MeV-GeV DM discovery potential for a 1 m$^3$ segmented plastic scintillator detector placed downstream of the beam-dump at one of the high intensity JLab experimental Halls, receiving up to 10$^{22}$ electrons-on-target (EOT) in a one-year period. This experiment (Beam-Dump eXperiment or BDX) is sensitive to DM-nucleon elastic scattering at the level of a thousand counts per year, with very low threshold recoil energies ($\sim$1 MeV), and limited only by reducible cosmogenic backgrounds. Sensitivity to DM-electron elastic scattering and/or inelastic DM would be below 10 counts per year after requiring all electromagnetic showers in the detector to exceed a few-hundred MeV, which dramatically reduces or altogether eliminates all backgrounds. Detailed Monte Carlo simulations are in progress to finalize the detector design and experimental set up. An existing 0.036 m$^3$ prototype based on the same technology will be used to validate simulations with background rate estimates, driving the necessary R$\&$D towards an optimized detector. The final detector design and experimental set up will be presented in a full proposal to be submitted to the next JLab PAC. A fully realized experiment would be sensitive to large regions of DM parameter space, exceeding the discovery potential of existing and planned experiments by two orders of magnitude in the MeV-GeV DM mass range.Comment: 28 pages, 17 figures, submitted to JLab PAC 4

Phase locking the spin precession in a storage ring

This letter reports the successful use of feedback from a spin polarization measurement to the revolution frequency of a 0.97 GeV/$c$ bunched and polarized deuteron beam in the Cooler Synchrotron (COSY) storage ring in order to control both the precession rate ($\approx 121$ kHz) and the phase of the horizontal polarization component. Real time synchronization with a radio frequency (rf) solenoid made possible the rotation of the polarization out of the horizontal plane, yielding a demonstration of the feedback method to manipulate the polarization. In particular, the rotation rate shows a sinusoidal function of the horizontal polarization phase (relative to the rf solenoid), which was controlled to within a one standard deviation range of $\sigma = 0.21$ rad. The minimum possible adjustment was 3.7 mHz out of a revolution frequency of 753 kHz, which changes the precession rate by 26 mrad/s. Such a capability meets a requirement for the use of storage rings to look for an intrinsic electric dipole moment of charged particles

Exclusive ⁻ Electroproduction Off The Neutron In Deuterium In The Resonance Region

New results for the exclusive and quasifree cross sections off neutrons bound in deuterium vn(p) → pπ− (p) are presented over a wide final state hadron angle range with a kinematic coverage of the invariant mass (W) up to 1.825 GeV and the four-momentum transfer squared (Q2) from 0.4 to 1.0 GeV2. The exclusive structure functions were extracted and their Legendre moments were obtained. Final-state-interaction contributions have been kinematically separated from the extracted quasifree cross sections off bound neutrons solely based on the analysis of the experimental data. These new results will serve as long-awaited input for phenomenological analyses to extract the Q2 evolution of previously unavailable n → N∗ electroexcitation amplitudes and to improve state-of-the-art models of neutrino scattering off nuclei by augmenting the already available results from free protons

Toward polarized antiprotons: Machine development for spin-filtering experiments

The paper describes the commissioning of the experimental equipment and the machine studies required for the first spin-filtering experiment with protons at a beam kinetic energy of $49.3\,$MeV in COSY. The implementation of a low-$\beta$ insertion made it possible to achieve beam lifetimes of $\tau_{\rm{b}}=8000\,$s in the presence of a dense polarized hydrogen storage-cell target of areal density $d_{\rm t}=(5.5\pm 0.2)\times 10^{13}\,\mathrm{atoms/cm^{2}}$. The developed techniques can be directly applied to antiproton machines and allow for the determination of the spin-dependent $\bar{p}p$ cross sections via spin filtering

Measurement of the Spin-Dependence of the pbar-p Interaction at the AD-Ring

We propose to use an internal polarized hydrogen storage cell gas target in the AD ring to determine for the first time the two total spin-dependent pbar-p cross sections sigma_1 and sigma_2 at antiproton beam energies in the range from 50 to 450 MeV. The data obtained are of interest by themselves for the general theory of pbar-p interactions since they will provide a first experimental constraint of the spin-spin dependence of the nucleon-antinucleon potential in the energy range of interest. In addition, measurements of the polarization buildup of stored antiprotons are required to define the optimum parameters of a future, dedicated Antiproton Polarizer Ring (APR), intended to feed a double-polarized asymmetric pbar-p collider with polarized antiprotons. Such a machine has recently been proposed by the PAX collaboration for the new Facility for Antiproton and Ion Research (FAIR) at GSI in Darmstadt, Germany. The availability of an intense stored beam of polarized antiprotons will provide access to a wealth of single- and double-spin observables, thereby opening a new window on QCD spin physics.Comment: 51 pages, 23 figures, proposal submitted to the SPS committee of CER