MBGEM: a stack of borated GEM detector for high efficiency thermal neutron detection

A new position-sensitive thermal neutron detector based on boron-coated converters has been developed as an alternative to today’s standard 3He -based technology for application to thermal neutron scattering. The key elements of the development are the boron-coated GEM foils (Sauli in Nucl Instrum Methods Phys Res Sect A Accel Spectrom Detect Assoc Equip 386:531, 1997) that are used as a multi-layer neutron converter via the 10B (n, α) 7Li reaction together with an efficient collection of the produced secondary electrons. This paper reports the test performed on a 3 layers converter prototype coupled to a GEMPix detector (Murtas in Radiat Meas 138:106421, 2020), carried out in order to study the possibility to produce a large-scale multi-layer neutron detector capable to reach high detection efficiency with high spatial resolution and able to sustain the high neutron flux expected in the new neutron spallation source under development like the ESS

Anticholinergic drug burden tools/scales and adverse outcomes in different clinical settings: a systematic review of reviews

Background: Cumulative anticholinergic exposure (anticholinergic burden) has been linked to a number of adverse outcomes. To conduct research in this area, an agreed approach to describing anticholinergic burden is needed. Objective: This review set out to identify anticholinergic burden scales, to describe their rationale, the settings in which they have been used and the outcomes associated with them. Methods: A search was performed using the Healthcare Databases Advanced Search of MEDLINE, EMBASE, Cochrane, CINAHL and PsycINFO from inception to October 2016 to identify systematic reviews describing anticholinergic burden scales or tools. Abstracts and titles were reviewed to determine eligibility for review with eligible articles read in full. The final selection of reviews was critically appraised using the ROBIS tool and pre-defined data were extracted; the primary data of interest were the anticholinergic burden scales or tools used. Results: Five reviews were identified for analysis containing a total of 62 original articles. Eighteen anticholinergic burden scales or tools were identified with variation in their derivation, content and how they quantified the anticholinergic activity of medications. The Drug Burden Index was the most commonly used scale or tool in community and database studies, while the Anticholinergic Risk Scale was used more frequently in care homes and hospital settings. The association between anticholinergic burden and clinical outcomes varied by index and study. Falls and hospitalisation were consistently found to be associated with anticholinergic burden. Mortality, delirium, physical function and cognition were not consistently associated. Conclusions: Anticholinergic burden scales vary in their rationale, use and association with outcomes. This review showed that the concept of anticholinergic burden has been variably defined and inconsistently described using a number of indices with different content and scoring. The association between adverse outcomes and anticholinergic burden varies between scores and has not been conclusively established

Effect of n-acetylcysteine administration on 30-day mortality in critically ill patients with septic shock caused by carbapenem-resistant klebsiella pneumoniae and acinetobacter baumannii. A retrospective case-control study

Carbapenem-resistant Klebsiella pneumoniae (CR-Kp) and Acinetobacter baumannii (CR-Ab) represent important cause of severe infections in intensive care unit (ICU) patients. N-Acetylcysteine (NAC) is a mucolytic agent with antioxidant and anti-inflammatory properties, showing also in-vitro antibacterial activity. Aim was to evaluate the effect on 30-day mortality of the addition of intravenous NAC to antibiotics in ICU patients with CR-Kp or CR-Ab septic shock. A retrospective, observational case:control study (1:2) in patients with septic shock caused by CR-Kp or CR-Ab hospitalized in two different ICUs was conducted. Cases included patients receiving NAC plus antimicrobials, controls included patients not receiving NAC. Cases and controls were matched for age, SAPS II, causative agent and source of infection. No differences in age, sex, SAPS II score or time to initiate definitive therapy were observed between cases and controls. Pneumonia and bacteremia were the leading infections. Overall, mortality was 48.9% (33.3% vs. 56.7% in cases and controls, p = 0.05). Independent risk factors for mortality were not receiving NAC (p = 0.002) and CR-Ab (p = 0.034) whereas therapy with two in-vitro active antibiotics (p = 0.014) and time to initial definite therapy (p = 0.026) were protective. NAC plus antibiotics might reduce the 30-day mortality rate in ICU patients with CR-Kp and CR-Ab septic shock

Clinical course of Coronavirus Disease-19 in patients with haematological malignancies is characterized by a longer time to respiratory deterioration compared to non-haematological ones: results from a case-control study

Background We evaluated clinical features and risk factors for mortality in patients with haematological malignancies and COVID-19. Methods Retrospective, case-control (1:3) study in hospitalized patients with COVID-19. Cases were patients with haematological malignancies and COVID-19, controls had COVID-19 without haematological malignancies. Patients were matched for sex, age and time of hospitalization. Results Overall, 66 cases and 198 controls were included in the study. Cases had higher prior corticosteroid use, infection rates, thrombocytopenia and neutropenia and more likely received corticosteroids and antibiotics than controls. Cases had higher respiratory deterioration than controls (78.7% vs 65.5%, p = 0.04). Notably, 29% of cases developed respiratory worsening > 10 days after hospital admission, compared to only 5% in controls. Intensive Care Unit admission and mortality were higher in cases than in controls (27% vs 8%, p = 0.002, and 35% vs 10%, p < 0.001). At multivariable analysis, having haematological malignancy [OR4.76, p < 0.001], chronic corticosteroid therapy [OR3.65, p = 0.004], prior infections [OR57.7, p = 0.006], thrombocytopenia [OR3.03, p < 0.001] and neutropenia [OR31.1, p = 0.001], low albumin levels [OR3.1, p = 0.001] and >= 10 days from hospital admission to respiratory worsening [OR3.3, p = 0.002] were independently associated with mortality. In cases, neutropenia [OR3.1, p < 0.001], prior infections [OR7.7, p < 0.001], >= 10 days to respiratory worsening [OR4.1, p < 0.001], multiple myeloma [OR1.5, p = 0.044], the variation of the CT lung score during hospitalization [OR2.6, p = 0.006] and active treatment [OR 4.4, p < 0.001] all were associated with a worse outcome. Conclusion An underlying haematological malignancy was associated with a worse clinical outcome in COVID-19 patients. A prolonged clinical monitoring is needed, since respiratory worsening may occur later during hospitalization

Mechanism of and Threshold Biomechanical Conditions for Falsetto Voice Onset

The sound source of a voice is produced by the self-excited oscillation of the vocal folds. In modal voice production, a drastic increase in transglottal pressure after vocal fold closure works as a driving force that develops self-excitation. Another type of vocal fold oscillation with less pronounced glottal closure observed in falsetto voice production has been accounted for by the mucosal wave theory. The classical theory assumes a quasi-steady flow, and the expected driving force onto the vocal folds under wavelike motion is derived from the Bernoulli effect. However, wavelike motion is not always observed during falsetto voice production. More importantly, the application of the quasi-steady assumption to a falsetto voice with a fundamental frequency of several hundred hertz is unsupported by experiments. These considerations suggested that the mechanism of falsetto voice onset may be essentially different from that explained by the mucosal wave theory. In this paper, an alternative mechanism is submitted that explains how self-excitation reminiscent of the falsetto voice could be produced independent of the glottal closure and wavelike motion. This new explanation is derived through analytical procedures by employing only general unsteady equations of motion for flow and solids. The analysis demonstrated that a convective acceleration of a flow induced by rapid wall movement functions as a negative damping force, leading to the self-excitation of the vocal folds. The critical subglottal pressure and volume flow are expressed as functions of vocal fold biomechanical properties, geometry, and voice fundamental frequency. The analytically derived conditions are qualitatively and quantitatively reasonable in view of reported measurement data of the thresholds required for falsetto voice onset. Understanding of the voice onset mechanism and the explicit mathematical descriptions of thresholds would be beneficial for the diagnosis and treatment of voice diseases and the development of artificial vocal folds

Characterization of the I-phase regime at TCV

The I-phase is an H-mode confinement regime of tokamaks characterized by limit cycle oscillations, the so-called LCOs or bursts. These bursts are the manifestation of a periodic flattening of the plasma edge pressure profile. The profile flattening is caused by increased radial transport, driven by a high-frequency plasma edge mode that periodically appears. This short-living mode is intrinsically connected to each burst. It vanishes once the profiles are fully flattened, and it reestablishes during profile recovery once critical gradients are reached and a new cycle begins. In this paper, we describe for the first time the unambiguous presence of the I-phase at the tokamak `a configuration variable (TCV). As the I-phase confinement regime is found in the parameter regime between the L-mode and the fully developed H-mode, it is often confused with dithers between H-mode and L-mode. Therefore, we are highlighting the differences between these two phenomena. Furthermore, we show the two-dimensional dynamics of the I-phase mode and bursts and the associated filamentary transport, enabled by the outstanding capabilities of the 2D TCV Gas Puff Imaging diagnostics

A influência da redução do espaço nasofaringeano na morfologia facial de pré-adolescentes

A redução do espaço nasofaringeano devido à hipertrofia adenoideana leva a adaptações posturais da cabeça, mandíbula, língua e lábios, podendo causar alterações no padrão esquelético facial. Foram coletadas 98 teleradiografias em norma lateral de pré-adolescentes na faixa etária de 7 a 10 anos na Clínica de Ortodontia da F.O. Araraquara, as quais foram selecionadas levando-se em consideração a dimensão da imagem do espaço nasofaringeano (ENF) (correspondente à menor distância do dorso do palato mole à parede faringeana posterior). As radiografias foram divididas em 3 grupos: Grupo I (estreito), ENF entre 1,7 e 5,1mm; Grupo II (médio), ENF entre 5,2 e 7,6mm; Grupo III (amplo), ENF entre 7,7 e 12,9mm. Utilizamos duas medidas angulares e seis medidas lineares para caracterizar a morfologia facial. As médias e o desvio padrão de cada medida efetuada foram obtidas, e por meio de teste de análise de variância (ANOVA), verificou-se diferença não significativa entre os grupos para as variáveis: ANperp, p=0,07; PgNperp, p=0,058, comprimento mandibular, p=0,15, comprimento maxilar, p=0,06, diferença maxilomandibular, p=0,98, eixo facial, p=0,96, altura facial inferior, p=0,84 e significativa na variável plano mandibular (p<0,01). Portanto, a redução do espaço nasofaringeano está associada a alterações no plano mandibular, que apresentou valores maiores com a diminuição do espaço nasofaringeano.<br>The nasopharyngeal reduction consequent to a adenoid obstruction is reponsible to postural adaptions of the head, mandible, tongue and lips and may also lead to facial skeleton pattern alterations. Ninety-eight lateral cephalometric X-rays of 7 to 10 years old preadolescents were used considering the nasopharyngeal space width (NSW), that was correspondent to the minor distance between the soft palate and posterior nasopharyngeal wall. The radiographs were divided into 3 groups: Group I (narrow), NSW between 1.7 and 5.1mm; Group II (median), NSW between 5.2 and 7.6mm; Group III (extensive) NSW between 7.7 and 12.9mm. Two angular and six linear measurements were used to characterize the facial morphology. The means and standard deviations of each measurement were obtained and the ANOVA analysis showed no significant difference among the groups for A-Nperp, p = 0.07, Pg-Nperp, p = 0,058, mandible length, p = 0.98, facial axis, p = 0.96, lower facial height, p = 0.84 and significant difference for mandibular plane, p<0,01. So it can be concluded that the nasopharyngeal space reduction is associated with mandibular plane alterations that presented higher values when there was a nasopharyngeal space reduction