Pion and proton showers in the CALICE scintillator-steel analogue hadron calorimeter

Showers produced by positive hadrons in the highly granular CALICE scintillator-steel analogue hadron calorimeter were studied. The experimental data were collected at CERN and FNAL for single particles with initial momenta from 10 to 80 GeV/c. The calorimeter response and resolution and spatial characteristics of shower development for proton- and pion-induced showers for test beam data and simulations using Geant4 version 9.6 are compared.Comment: 26 pages, 16 figures, JINST style, changes in the author list, typos corrected, new section added, figures regrouped. Accepted for publication in JINS

Testing Hadronic Interaction Models using a Highly Granular Silicon-Tungsten Calorimeter

A detailed study of hadronic interactions is presented using data recorded with the highly granular CALICE silicon-tungsten electromagnetic calorimeter. Approximately 350,000 selected negatively charged pion events at energies between 2 and 10 GeV have been studied. The predictions of several physics models available within the Geant4 simulation tool kit are compared to this data. A reasonable overall description of the data is observed; the Monte Carlo predictions are within 20% of the data, and for many observables much closer. The largest quantitative discrepancies are found in the longitudinal and transverse distributions of reconstructed energy.Comment: 28 pages, 24 figures, accepted for publication in NIM

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure < 100 mmHg (n = 1127), estimated glomerular filtration rate < 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

Early responses of three medical colleges following the implementation of new diversity LCME accreditation standards

To enhance diversity in medical education, the Liaison Committee on Medical Education (LCME) introduced new diversity accreditation standards for United States medical schools that grant the Doctor of Medicine (MD) degree. Added in 2009, the two standards related to diversity, identified as MS-8 and IS-16, went into effect with the 2009-2010 accreditation cycle. Their intent is to boost access and graduation rates for underrepresented individuals in medical schools and to enhance diversity in the medical school faculty as well. The long-range goal is to prepare physicians to provide culturally competent care for an increasingly pluralistic society and to address issues related to healthcare disparities. Thus far, numerous medical schools have fallen short of these standards, putting their accreditation status at risk with resulting citations that may contribute to probationary status. Inherent in the process is the perception from the field that these new standards are highly interpretative and not sensitive to the operational and regional challenges of medical schools in their unique environment. This study focused on how local actors interpret and implement the diversity accreditation policy demands that are made on them. This qualitative case study of three American medical schools examined the attitudes, challenges, and lessons learned regarding the implementation of these new diversity accreditation standards. The schools selected for the study were stratified by various stages of LCME accreditation (full, provisional, and probationary) and represent varied geographic regions of the United States. The participants were medical school leaders, faculty, medical students, and LCME accreditation surveyors. This study sought to determine stakeholders\u27 attitudes and perceptions of the standards and their importance, along with perceived barriers and facilitators to their implementation. This study concluded that the LCME diversity accreditation standards are powerful policy levers to stimulate diversity program development. Study findings suggest that medical schools and field surveyors need enhanced education on the application of these standards. Additionally, a number of faculty, staff and students lack a full appreciation of the need for these standards, which necessitates leadership involvement and education. Medical curricula related to diversity, inclusion, and healthcare disparities may need enhancement and implementation in order for schools to achieve their goals related to diversity. Preliminary evidence demonstrates that diversity programs focusing on meeting the standards for the sake of compliance are not as robust and sustainable as diversity programs that align their missions to achieve diversity. The policy implementation procedures and outcomes associated with compliance or non-compliance with these new diversity standards are important learning opportunities for organizations seeking accreditation and for the accrediting bodies themselves

Early responses of three medical colleges following the implementation of new diversity LCME accreditation standards

To enhance diversity in medical education, the Liaison Committee on Medical Education (LCME) introduced new diversity accreditation standards for United States medical schools that grant the Doctor of Medicine (MD) degree. Added in 2009, the two standards related to diversity, identified as MS-8 and IS-16, went into effect with the 2009-2010 accreditation cycle. Their intent is to boost access and graduation rates for underrepresented individuals in medical schools and to enhance diversity in the medical school faculty as well. The long-range goal is to prepare physicians to provide culturally competent care for an increasingly pluralistic society and to address issues related to healthcare disparities. Thus far, numerous medical schools have fallen short of these standards, putting their accreditation status at risk with resulting citations that may contribute to probationary status. Inherent in the process is the perception from the field that these new standards are highly interpretative and not sensitive to the operational and regional challenges of medical schools in their unique environment. This study focused on how local actors interpret and implement the diversity accreditation policy demands that are made on them. This qualitative case study of three American medical schools examined the attitudes, challenges, and lessons learned regarding the implementation of these new diversity accreditation standards. The schools selected for the study were stratified by various stages of LCME accreditation (full, provisional, and probationary) and represent varied geographic regions of the United States. The participants were medical school leaders, faculty, medical students, and LCME accreditation surveyors. This study sought to determine stakeholders\u27 attitudes and perceptions of the standards and their importance, along with perceived barriers and facilitators to their implementation. This study concluded that the LCME diversity accreditation standards are powerful policy levers to stimulate diversity program development. Study findings suggest that medical schools and field surveyors need enhanced education on the application of these standards. Additionally, a number of faculty, staff and students lack a full appreciation of the need for these standards, which necessitates leadership involvement and education. Medical curricula related to diversity, inclusion, and healthcare disparities may need enhancement and implementation in order for schools to achieve their goals related to diversity. Preliminary evidence demonstrates that diversity programs focusing on meeting the standards for the sake of compliance are not as robust and sustainable as diversity programs that align their missions to achieve diversity. The policy implementation procedures and outcomes associated with compliance or non-compliance with these new diversity standards are important learning opportunities for organizations seeking accreditation and for the accrediting bodies themselves