Comparison of distal radial access versus standard transradial access in patients with smaller diameter radial Arteries(The distal radial versus transradial access in small transradial ArteriesStudy: D.A.T.A - S.T.A.R study).

AIMS: To evaluate safety and efficacy of distal right radial access (DRRA) compared to right radial access (RRA), for coronary procedures, in patients with smaller diameter radial arteries (SDRA) (radial artery diameter (RAD) < 2.1 mm). METHODS AND RESULTS: This is a retrospective analysis of safety and efficacy of DRRA Vs. RRA in patients undergoing coronary procedures at our cardiac catheterization laboratories over a 10- month period between September 2017 and June, 2018 (first 5 calendar months with RRA-first; next 5 calendar months with DRRA-first). All patients underwent pre-procedure ultrasound of arm arteries. All patients had RAD<2.1 mm (mean RAD 1.63 ± 0.27 mm; RAD≤1.6 mm in 73.5%). Baseline characteristics were similar between groups. Primary end-point of puncture success was significantly lower in DRRA vs RRA group [79.5% vs 98.5%, p < 0.0001]. Puncture success was also lower in the subgroup of patients with RAD <1.6 mm Vs. ≥ 1.6 mm in the DRRA group (p < 0.0001). The secondary end-point of puncture time was significantly higher (2.1 ± 1.4 min vs. 1.0 ± 0.45 min, p < 0.00001) in the DRRA Vs. RRA group. The occurrence of vascular access site complications (including access site hematomas), radial artery occlusion (RAO) and distal RAO at day 1 and day 30 were similar between RRA and DRRA groups.Non-vascular access-site complication was seen only in the DRRA group. CONCLUSION: DRRA is a safe and effective access for coronary procedures; though technically challenging in patients with SDRA (RAD<2.1 mm; mean RAD 1.63 ± 0.27 mm), with lower puncture success and higher puncture time compared to RRA

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality. Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children &lt;18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months. Results All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3-11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p&lt;0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p&lt;0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p&lt;0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality. Conclusions Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer

Search for neutrinos in coincidence with gravitational wave events from the LIGO–Virgo O3a observing run with the Super-Kamiokande detector

The Super-Kamiokande detector can be used to search for neutrinos in time coincidence with gravitational waves detected by the LIGO–Virgo Collaboration (LVC). Both low-energy (7–100 MeV) and high-energy (0.1–105 GeV) samples were analyzed in order to cover a very wide neutrino spectrum. Follow-ups of 36 (out of 39) gravitational waves reported in the GWTC-2 catalog were examined; no significant excess above the background was observed, with 10 (24) observed neutrinos compared with 4.8 (25.0) expected events in the high-energy (low-energy) samples. A statistical approach was used to compute the significance of potential coincidences. For each observation, p-values were estimated using neutrino direction and LVC sky map; the most significant event (GW190602_175927) is associated with a post-trial p-value of 7.8% (1.4σ). Additionally, flux limits were computed independently for each sample and by combining the samples. The energy emitted as neutrinos by the identified gravitational wave sources was constrained, both for given flavors and for all flavors assuming equipartition between the different flavors, independently for each trigger and by combining sources of the same nature

Diffuse supernova neutrino background search at Super-Kamiokande

A new search for the diffuse supernova neutrino background (DSNB) flux has been conducted at Super-Kamiokande (SK), with a $22.5\times2970$-kton$\cdot$day exposure from its fourth operational phase IV. The new analysis improves on the existing background reduction techniques and systematic uncertainties and takes advantage of an improved neutron tagging algorithm to lower the energy threshold compared to the previous phases of SK. This allows for setting the world's most stringent upper limit on the extraterrestrial $\bar{\nu}_e$ flux, for neutrino energies below 31.3 MeV. The SK-IV results are combined with the ones from the first three phases of SK to perform a joint analysis using $22.5\times5823$ kton$\cdot$days of data. This analysis has the world's best sensitivity to the DSNB $\bar{\nu}_e$ flux, comparable to the predictions from various models. For neutrino energies larger than 17.3 MeV, the new combined $90\%$ C.L. upper limits on the DSNB $\bar{\nu}_e$ flux lie around $2.7$ cm$^{-2}$$\cdot$$\text{sec}^{-1}$, strongly disfavoring the most optimistic predictions. Finally, potentialities of the gadolinium phase of SK and the future Hyper-Kamiokande experiment are discussed.Comment: 42 pages, 37 figures, 14 table

Searching for supernova bursts in Super-Kamiokande IV

Super-Kamiokande has been searching for neutrino bursts characteristic of core-collapse supernovae continuously, in real time, since the start of operations in 1996. The present work focuses on detecting more distant supernovae whose event rate may be too small to trigger in real time, but may be identified using an offline approach. The analysis of data collected from 2008 to 2018 found no evidence of distant supernovae bursts. This establishes an upper limit of 0.29 yr−1 on the rate of core-collapse supernovae out to 100 kpc at 90% C.L. For supernovae that fail to explode and collapse directly to black holes the limit reaches to 300 kpc

Indirect search for dark matter from the Galactic Center and halo with the Super-Kamiokande detector

We present a search for an excess of neutrino interactions due to dark matter in the form of weakly interacting massive particles (WIMPs) annihilating in the Galactic center or halo based on the data set of Super-Kamiokande-I, -II, -III and -IV taken from 1996 to 2016. We model the neutrino flux, energy, and flavor distributions assuming WIMP self-annihilation is dominant to ν ¯ ν , μ + μ − , b ¯ b , or W + W − . The excess is in comparison to atmospheric neutrino interactions which are modeled in detail and fit to data. Limits on the self-annihilation cross section ⟨ σ A V ⟩ are derived for WIMP masses in the range 1 GeV to 10 TeV, reaching as low as 9.6 × 10 − 23     cm 3   s − 1 for 5 GeV WIMPs in b ¯ b mode and 1.2 × 10 − 24     cm 3   s − 1 for 1 GeV WIMPs in ν ¯ ν mode. The obtained sensitivity of the Super-Kamiokande detector to WIMP masses below several tens of GeV is the best among similar indirect searches to date

On the effectiveness of top-down strategy for forecasting autoregressive demands

We investigate the relative effectiveness of top-down versus bottom-up strategies for forecasting the demand of an item that belongs to a product family. The demand for each item in the family is assumed to follow a first-order univariate autoregressive process. Under the top-down strategy, the aggregate demand is forecasted by using the historical data of the family demand. The demand forecast for the items is then derived by proportional allocation of the aggregate forecast. Under the bottom-up strategy, the demand forecast for each item is directly obtained by using the historical demand data of the particular item. In both strategies, the forecasting technique used is exponential smoothing. We analytically evaluate the condition under which one forecasting strategy is preferred over the other when the lag-1 autocorrelation of the demand time series for all the items is identical. We show that when the lag-1 autocorrelation is smaller than or equal to 1/3, the maximum difference in the performance of the two forecasting strategies is only 1%. However, if the lag-1 autocorrelation of the demand for at least one of the items is greater than 1/3, then the bottom-up strategy consistently outperforms the top-down strategy, irrespective of the items' proportion in the family and the coefficient of correlation between the item demands. A simulation study reveals that the analytical findings hold even when the lag-1 autocorrelation of the demand processes is not identical

A new two-bin policy for inventory systems with differentiated demand classes

We consider an inventory system under continuous review with two demand classes that are different in terms of service level required (or penalty cost incurred for backordering of demand). Prior literature has proposed the critical level rationing (CLR) policy under which the demand from the lower priority class is backordered once inventory falls below the critical level. While this reduces the penalty cost for the higher demand class, the fill rate achieved for the lower priority demand class gets compromised. In this study, we propose a new class of two-bin (2B) policy for the problem. The proposed 2B policy assigns separate bins of inventory for the two demand classes. The demand for each class is fulfilled from its assigned bin. However, when the bin intended for the higher demand class is empty, the demand from the higher class can still be fulfilled with the inventory from the other bin. The advantage of the 2B policy is that better fill rates are achieved, especially for the lower demand class. Computational results show that the proposed policy is able to provide a much higher service level for the lower priority class demand without increasing the total cost too much and without affecting the service level for the higher priority class. When a service level constrained optimization problem is considered, the 2B policy dominates the CLR policy when the service level difference for the two classes is not too high or the service levels required for both the classes are relatively lower.Accepted versio