Nuclear and nucleon transitions of the H di-baryon

We consider 3 types of processes pertinent to the phenomenology of an H di-baryon: conversion of two $\Lambda$'s in a doubly-strange hypernucleus to an H, decay of the H to two baryons, and -- if the H is light enough -- conversion of two nucleons in a nucleus to an H. We compute the spatial wavefunction overlap using the Isgur-Karl and Bethe-Goldstone wavefunctions, and treat the weak interactions phenomenologically. The observation of $\Lambda$ decays from doubly-strange hypernuclei puts a constraint on the H wavefunction which is plausibly satisfied. In this case the H is very long-lived as we calculate. An absolutely stable H is not excluded at present. SuperK can provide valuable limits

Quantifying interictal intracranial EEG to predict focal epilepsy

Intracranial EEG (IEEG) is used for 2 main purposes, to determine: (1) if epileptic networks are amenable to focal treatment and (2) where to intervene. Currently these questions are answered qualitatively and sometimes differently across centers. There is a need for objective, standardized methods to guide surgical decision making and to enable large scale data analysis across centers and prospective clinical trials. We analyzed interictal data from 101 patients with drug resistant epilepsy who underwent presurgical evaluation with IEEG. We chose interictal data because of its potential to reduce the morbidity and cost associated with ictal recording. 65 patients had unifocal seizure onset on IEEG, and 36 were non-focal or multi-focal. We quantified the spatial dispersion of implanted electrodes and interictal IEEG abnormalities for each patient. We compared these measures against the 5 Sense Score (5SS), a pre-implant estimate of the likelihood of focal seizure onset, and assessed their ability to predict the clinicians choice of therapeutic intervention and the patient outcome. The spatial dispersion of IEEG electrodes predicted network focality with precision similar to the 5SS (AUC = 0.67), indicating that electrode placement accurately reflected pre-implant information. A cross-validated model combining the 5SS and the spatial dispersion of interictal IEEG abnormalities significantly improved this prediction (AUC = 0.79; p<0.05). The combined model predicted ultimate treatment strategy (surgery vs. device) with an AUC of 0.81 and post-surgical outcome at 2 years with an AUC of 0.70. The 5SS, interictal IEEG, and electrode placement were not correlated and provided complementary information. Quantitative, interictal IEEG significantly improved upon pre-implant estimates of network focality and predicted treatment with precision approaching that of clinical experts.Comment: 25 pages, 4 Figures, 1 tabl

Closing in on Asymmetric Dark Matter I: Model independent limits for interactions with quarks

It is argued that experimental constraints on theories of asymmetric dark matter (ADM) almost certainly require that the DM be part of a richer hidden sector of interacting states of comparable mass or lighter. A general requisite of models of ADM is that the vast majority of the symmetric component of the DM number density must be removed in order to explain the observed relationship $\Omega_B\sim\Omega_{DM}$ via the DM asymmetry. Demanding the efficient annihilation of the symmetric component leads to a tension with experimental limits if the annihilation is directly to Standard Model (SM) degrees of freedom. A comprehensive effective operator analysis of the model independent constraints on ADM from direct detection experiments and LHC monojet searches is presented. Notably, the limits obtained essentially exclude models of ADM with mass 1GeV$\lesssim m_{DM} \lesssim$ 100GeV annihilating to SM quarks via heavy mediator states. This motivates the study of portal interactions between the dark and SM sectors mediated by light states. Resonances and threshold effects involving the new light states are shown to be important for determining the exclusion limits.Comment: 18+6 pages, 18 figures. v2: version accepted for publicatio

Testing the Dark Matter Interpretation of the DAMA/LIBRA Result with Super-Kamiokande

We consider the prospects for testing the dark matter interpretation of the DAMA/LIBRA signal with the Super-Kamiokande experiment. The DAMA/LIBRA signal favors dark matter with low mass and high scattering cross section. We show that these characteristics imply that the scattering cross section that enters the DAMA/LIBRA event rate determines the annihilation rate probed by Super-Kamiokande. Current limits from Super-Kamiokande through-going events do not test the DAMA/LIBRA favored region. We show, however, that upcoming analyses including fully-contained events with sensitivity to dark matter masses from 5 to 10 GeV may corroborate the DAMA/LIBRA signal. We conclude by considering three specific dark matter candidates, neutralinos, WIMPless dark matter, and mirror dark matter, which illustrate the various model-dependent assumptions entering our analysis.Comment: 10 pages, 1 figure; v2: projected super-K sensitivity corrected and strengthened, references added; v3: published versio

Sharing clinical information across care settings: the birth of an integrated assessment system

Background: Population ageing, the emergence of chronic illness, and the shift away from institutional care challenge conventional approaches to assessment systems which traditionally are problem and setting specific

Updated Nucleosynthesis Constraints on Unstable Relic Particles

We revisit the upper limits on the abundance of unstable massive relic particles provided by the success of Big-Bang Nucleosynthesis calculations. We use the cosmic microwave background data to constrain the baryon-to-photon ratio, and incorporate an extensively updated compilation of cross sections into a new calculation of the network of reactions induced by electromagnetic showers that create and destroy the light elements deuterium, he3, he4, li6 and li7. We derive analytic approximations that complement and check the full numerical calculations. Considerations of the abundances of he4 and li6 exclude exceptional regions of parameter space that would otherwise have been permitted by deuterium alone. We illustrate our results by applying them to massive gravitinos. If they weigh ~100 GeV, their primordial abundance should have been below about 10^{-13} of the total entropy. This would imply an upper limit on the reheating temperature of a few times 10^7 GeV, which could be a potential difficulty for some models of inflation. We discuss possible ways of evading this problem.Comment: 40 pages LaTeX, 18 eps figure

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely