Dependence of direct detection signals on the WIMP velocity distribution

The signals expected in WIMP direct detection experiments depend on the ultra-local dark matter distribution. Observations probe the local density, circular speed and escape speed, while simulations find velocity distributions that deviate significantly from the standard Maxwellian distribution. We calculate the energy, time and direction dependence of the event rate for a range of velocity distributions motivated by recent observations and simulations, and also investigate the uncertainty in the determination of WIMP parameters. The dominant uncertainties are the systematic error in the local circular speed and whether or not the MW has a high density dark disc. In both cases there are substantial changes in the mean differential event rate and the annual modulation signal, and hence exclusion limits and determinations of the WIMP mass. The uncertainty in the shape of the halo velocity distribution is less important, however it leads to a 5% systematic error in the WIMP mass. The detailed direction dependence of the event rate is sensitive to the velocity distribution. However the numbers of events required to detect anisotropy and confirm the median recoil direction do not change substantially.Comment: 21 pages, 7 figures, v2 version to appear in JCAP, minor change

High rate of autonomic neuropathy in Cornelia de Lange Syndrome

Background: Cornelia de Lange Syndrome (CdLS) is a rare congenital disorder characterized by typical facial features, growth failure, limb abnormalities, and gastroesophageal dysfunction that may be caused by mutations in several genes that disrupt gene regulation early in development. Symptoms in individuals with CdLS suggest that the peripheral nervous system (PNS) is involved, yet there is little direct evidence. Method: Somatic nervous system was evaluated by conventional motor and sensory nerve conduction studies and autonomic nervous system by heart rate variability, sympathetic skin response and sudomotor testing. CdLS Clinical Score and genetic studies were also obtained. Results: Sympathetic skin response and sudomotor test were pathological in 35% and 34% of the individuals with CdLS, respectively. Nevertheless, normal values in large fiber nerve function studies. Conclusions: Autonomic nervous system (ANS) dysfunction is found in many individuals with Cornelia de Lange Syndrome, and could be related to premature aging

A novel determination of the local dark matter density

We present a novel study on the problem of constructing mass models for the Milky Way, concentrating on features regarding the dark matter halo component. We have considered a variegated sample of dynamical observables for the Galaxy, including several results which have appeared recently, and studied a 7- or 8-dimensional parameter space - defining the Galaxy model - by implementing a Bayesian approach to the parameter estimation based on a Markov Chain Monte Carlo method. The main result of this analysis is a novel determination of the local dark matter halo density which, assuming spherical symmetry and either an Einasto or an NFW density profile is found to be around 0.39 GeV cm$^{-3}$ with a 1-$\sigma$ error bar of about 7%; more precisely we find a $\rho_{DM}(R_0) = 0.385 \pm 0.027 \rm GeV cm^{-3}$ for the Einasto profile and $\rho_{DM}(R_0) = 0.389 \pm 0.025 \rm GeV cm^{-3}$ for the NFW. This is in contrast to the standard assumption that $\rho_{DM}(R_0)$ is about 0.3 GeV cm$^{-3}$ with an uncertainty of a factor of 2 to 3. A very precise determination of the local halo density is very important for interpreting direct dark matter detection experiments. Indeed the results we produced, together with the recent accurate determination of the local circular velocity, should be very useful to considerably narrow astrophysical uncertainties on direct dark matter detection.Comment: 31 pages,11 figures; minor changes in the text; two figures adde

Comparative effectiveness and safety of low-strength and high-strength direct oral anticoagulants compared with warfarin: a sequential cohort study

OBJECTIVES:The aim of this study was to compare effectiveness and safety of low-strength and high-strength direct oral anticoagulants (DOACs) with warfarin in the Australian Veteran population. DESIGN:Sequential cohort study using inverse probability of treatment weighting (IPTW) and propensity score matching. Initiators of high-strength (apixaban 5 mg, dabigatran 150 mg, rivaroxaban 20 mg) and low-strength DOACS (apixaban 2.5 mg, dabigatran 110 mg, rivaroxaban 15 mg) were compared with warfarin initiators. SETTING:Australian Government Department of Veterans' Affairs claims database. PARTICIPANTS:4836 patients who initiated oral anticoagulants (45.8%, 26.0% and 28.2% on low-strength, high-strength DOACs and warfarin, respectively) between August 2013 and March 2015. Mean age was 85, 75 and 83 years for low-strength, high-strength DOACs and warfarin initiators, respectively. MAIN OUTCOME MEASURES:One-year risk of hospitalisation for ischaemic stroke, any bleeding event or haemorrhagic stroke. Secondary outcomes were 1-year risk of hospitalisation for myocardial infarction and death. RESULTS:Using the IPTW method, no difference in risk of ischaemic stroke or bleeding was found with low-strength DOACs compared with warfarin. As a class, no increased risk of myocardial infarction was found for low-strength DOACs, however, risk was elevated for apixaban (HR 2.25, 95% CI 1.23 to 4.13). For high-strength DOACs, no difference was found for ischaemic stroke compared with warfarin, however, there was a significant reduction in risk of bleeding events (HR 0.63, 95% CI 0.44 to 0.89) and death (HR 0.40, 95% CI 0.28 to 0.58). Propensity score matching showed no difference in risk of ischaemic stroke or bleeding. CONCLUSION:We found that in the practice setting both DOAC formulations were similar to warfarin with regard to effectiveness and had no increased risk of bleeding.Nicole L Pratt, Emmae Ramsay, Lisa M Kalisch Ellett, Katherine Duszynski, Sepehr Shakib, Mhairi Kerr, Gillian Caughey, Elizabeth Ellen Roughea

Why decision support systems are important for medical education

During the last decades the inclusion of digital tools in health education has rapidly lead to a continuously enlarging digital era. All the online interactions between learners and tutors, the description, creation, reuse and sharing of educational digital resources and the interlinkage between them in conjunction with cheap storage technology has led to an enormous amount of educational data. Medical education is a unique type of education due to accuracy of information needed, continuous changing competences required and alternative methods of education used. Nowadays medical education standards provide the ground for organizing the educational data and the paradata. Analysis of such education data through education data mining techniques is in its infancy, but decision support systems for medical education need further research. To the best of our knowledge, there is a gap and a clear need for identifying the challenges for decision support systems in medical education in the era of medical education standards. Thus, in this paper the role and the attributes of such a decision support system for medical education are delineated and the challenges and vision for future actions are identified

Domain Wall Spacetimes: Instability of Cosmological Event and Cauchy Horizons

The stability of cosmological event and Cauchy horizons of spacetimes associated with plane symmetric domain walls are studied. It is found that both horizons are not stable against perturbations of null fluids and massless scalar fields; they are turned into curvature singularities. These singularities are light-like and strong in the sense that both the tidal forces and distortions acting on test particles become unbounded when theses singularities are approached.Comment: Latex, 3 figures not included in the text but available upon reques

Bringing onco-innovation to Europe’s healthcare systems: the potential of biomarker testing, real world evidence, tumour agnostic therapies to empower personalised medicine

International audienceRapid and continuing advances in biomarker testing are not being matched by uptake in health systems, and this is hampering both patient care and innovation. It also risks costing health systems the opportunity to make their services more efficient and, over time, more economical. The potential that genomics has brought to biomarker testing in diagnosis, prediction and research is being realised, pre-eminently in many cancers, but also in an ever-wider range of conditions—notably BRCA1/2 testing in ovarian, breast, pancreatic and prostate cancers. Nevertheless, the implementation of genetic testing in clinical routine setting is still challenging. Development is impeded by country-related heterogeneity, data deficiencies, and lack of policy alignment on standards, approval—and the role of real-world evidence in the process—and reimbursement. The acute nature of the problem is compellingly illustrated by the particular challenges facing the development and use of tumour agnostic therapies, where the gaps in preparedness for taking advantage of this innovative approach to cancer therapy are sharply exposed. Europe should already have in place a guarantee of universal access to a minimum suite of biomarker tests and should be planning for an optimum testing scenario with a wider range of biomarker tests integrated into a more sophisticated health system articulated around personalised medicine. Improving healthcare and winning advantages for Europe’s industrial competitiveness and innovation require an appropriate policy framework—starting with an update to outdated recommendations. We show herein the main issues and proposals that emerged during the previous advisory boards organised by the European Alliance for Personalized Medicine which mainly focus on possible scenarios of harmonisation of both oncogenetic testing and management of cancer patients

Current assessment of the Red Rectangle band problem

In this paper we discuss our insights into several key problems in the identification of the Red Rectangle Bands (RRBs). We have combined three independent sets of observations in order to try to define the constraints guiding the bands. We provide a summary of the general behavior of the bands and review the evidence for a molecular origin of the bands. The extent, composition, and possible absorption effects of the bands are discussed. Comparison spectra of the strongest band obtained at three different spectral resolutions suggests that an intrinsic line width of individual rotational lines can be deduced. Spectroscopic models of several relatively simple molecules were examined in order to investigate where the current data are weak. Suggestions are made for future studies to enhance our understanding of these enigmatic bands

Dialysis initiation, modality choice, access, and prescription: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Globally, the number of patients undergoing maintenance dialysis is increasing, yet throughout the world there is significant variability in the practice of initiating dialysis. Factors such as availability of resources, reasons for starting dialysis, timing of dialysis initiation, patient education and preparedness, dialysis modality and access, as well as varied \u201ccountry-specific\u201d factors significantly affect patient experiences and outcomes. As the burden of end-stage kidney disease (ESKD) has increased globally, there has also been a growing recognition of the importance of patient involvement in determining the goals of care and decisions regarding treatment. In January 2018, KDIGO (Kidney Disease: Improving Global Outcomes) convened a Controversies Conference focused on dialysis initiation, including modality choice, access, and prescription. Here we present a summary of the conference discussions, including identified knowledge gaps, areas of controversy, and priorities for research. A major novel theme represented during the conference was the need to move away from a \u201cone-size-fits-all\u201d approach to dialysis and provide more individualized care that incorporates patient goals and preferences while still maintaining best practices for quality and safety. Identifying and including patient-centered goals that can be validated as quality indicators in the context of diverse health care systems to achieve equity of outcomes will require alignment of goals and incentives between patients, providers, regulators, and payers that will vary across health care jurisdictions