85 research outputs found
Prospective multicentre multifaceted before-after implementation study of ICU delirium guidelines: a process evaluation
Objective We aimed to explore: the exposure
of healthcare workers to a delirium guidelines
implementation programme; effects on guideline
adherence at intensive care unit (ICU) level; impact
on knowledge and barriers, and experiences with the
implementation.
Design A mixed-methods process evaluation of a
prospective multicentre implementation study.
Setting Six ICUs.
Participants 4449 adult ICU patients and 500 ICU
professionals approximately.
Intervention A tailored implementation programme.
Main outcome measure Adherence to delirium
guidelines recommendations at ICU level before, during
and after implementation; knowledge and perceived
barriers; and experiences with the implementation.
Results Five of six ICUs were exposed to all
implementation strategies as planned. More than 85%
followed the required e-learnings; 92% of the nurses
attended the clinical classroom lessons; five ICUs used
all available implementation strategies and perceived
to have implemented all guideline recommendations
(>90%). Adherence to predefined performance indicators
(PIs) at ICU level was only above the preset target
(>85%) for delirium screening. For all other PIs, the
inter-ICU variability was between 34% and 72%. The
implementation of delirium guidelines was feasible and
successful in resolving the majority of barriers found
before the implementation. The improvement was well
sustained 6months after full guideline implementation.
Knowledge about delirium was improved (from 61% to
65%). The implementation programme was experienced as
very successful.
Conclusions Multifaceted implementation can improve
and sustain adherence to delirium guidelines, is feasible
and can largely be performed as planned. However,
variability in delirium guideline adherence at individual
ICUs remains a challenge, indicating the need for more
tailoring at centre level
Search for sterile neutrino mixing in the MINOS long-baseline experiment
A search for depletion of the combined flux of active neutrino species over a 735 km baseline is reported using neutral-current interaction data recorded by the MINOS detectors in the NuMI neutrino beam. Such a depletion is not expected according to conventional interpretations of neutrino oscillation data involving the three known neutrino flavors. A depletion would be a signature of oscillations or decay to postulated noninteracting sterile neutrinos, scenarios not ruled out by existing data. From an exposure of 3.18×1020 protons on target in which neutrinos of energies between ~500¿¿MeV and 120 GeV are produced predominantly as ¿µ, the visible energy spectrum of candidate neutral-current reactions in the MINOS far detector is reconstructed. Comparison of this spectrum to that inferred from a similarly selected near-detector sample shows that of the portion of the ¿µ flux observed to disappear in charged-current interaction data, the fraction that could be converting to a sterile state is less than 52% at 90% confidence level (C.L.). The hypothesis that active neutrinos mix with a single sterile neutrino via oscillations is tested by fitting the data to various models. In the particular four-neutrino models considered, the mixing angles ¿24 and ¿34 are constrained to be less than 11° and 56° at 90% C.L., respectively. The possibility that active neutrinos may decay to sterile neutrinos is also investigated. Pure neutrino decay without oscillations is ruled out at 5.4 standard deviations. For the scenario in which active neutrinos decay into sterile states concurrently with neutrino oscillations, a lower limit is established for the neutrino decay lifetime t3/m3>2.1×10-12¿¿s/eV at 90% C.L
Neutrino and Antineutrino Inclusive Charged-current Cross Section Measurements with the MINOS Near Detector
The energy dependence of the neutrino-iron and antineutrino-iron inclusive
charged-current cross sections and their ratio have been measured using a
high-statistics sample with the MINOS Near Detector exposed to the NuMI beam
from the Main Injector at Fermilab. Neutrino and antineutrino fluxes were
determined using a low hadronic energy subsample of charged-current events. We
report measurements of neutrino-Fe (antineutrinoFe) cross section in the energy
range 3-50 GeV (5-50 GeV) with precision of 2-8% (3-9%) and their ratio which
is measured with precision 2-8%. The data set spans the region from low energy,
where accurate measurements are sparse, up to the high-energy scaling region
where the cross section is well understood.Comment: accepted by PR
Recommended from our members
Search for sterile neutrino mixing in the MINOS long-baseline experiment
A search for depletion of the combined flux of active neutrino species over a 735 km baseline is reported using neutral-current interaction data recorded by the MINOS detectors in the NuMI neutrino beam. Such a depletion is not expected according to conventional interpretations of neutrino oscillation data involving the three known neutrino flavors. A depletion would be a signature of oscillations or decay to postulated noninteracting sterile neutrinos, scenarios not ruled out by existing data. From an exposure of 3.18×10^(20) protons on target in which neutrinos of energies between ∼500 MeV and 120 GeV are produced predominantly as ν_μ, the visible energy spectrum of candidate neutral-current reactions in the MINOS far detector is reconstructed. Comparison of this spectrum to that inferred from a similarly selected near-detector sample shows that of the portion of the ν_μ flux observed to disappear in charged-current interaction data, the fraction that could be converting to a sterile state is less than 52% at 90% confidence level (C.L.). The hypothesis that active neutrinos mix with a single sterile neutrino via oscillations is tested by fitting the data to various models. In the particular four-neutrino models considered, the mixing angles θ_(24) and θ_(34) are constrained to be less than 11° and 56° at 90% C.L., respectively. The possibility that active neutrinos may decay to sterile neutrinos is also investigated. Pure neutrino decay without oscillations is ruled out at 5.4 standard deviations. For the scenario in which active neutrinos decay into sterile states concurrently with neutrino oscillations, a lower limit is established for the neutrino decay lifetime τ_3/m_3>2.1×10^(-12) s/eV at 90% C.L
A Study of Muon Neutrino Disappearance Using the Fermilab Main Injector Neutrino Beam
We report the results of a search for muon-neutrino disappearance by the Main
Injector Neutrino Oscillation Search. The experiment uses two detectors
separated by 734 km to observe a beam of neutrinos created by the Neutrinos at
the Main Injector facility at Fermi National Accelerator Laboratory. The data
were collected in the first 282 days of beam operations and correspond to an
exposure of 1.27e20 protons on target. Based on measurements in the Near
Detector, in the absence of neutrino oscillations we expected 336 +/- 14
muon-neutrino charged-current interactions at the Far Detector but observed
215. This deficit of events corresponds to a significance of 5.2 standard
deviations. The deficit is energy dependent and is consistent with two-flavor
neutrino oscillations according to delta m-squared = 2.74e-3 +0.44/-0.26e-3
eV^2 and sin^2(2 theta) > 0.87 at 68% confidence level.Comment: In submission to Phys. Rev.
Measurement of the Atmospheric Muon Charge Ratio at TeV Energies with MINOS
The 5.4 kton MINOS far detector has been taking charge-separated cosmic ray
muon data since the beginning of August, 2003 at a depth of 2070
meters-water-equivalent in the Soudan Underground Laboratory, Minnesota, USA.
The data with both forward and reversed magnetic field running configurations
were combined to minimize systematic errors in the determination of the
underground muon charge ratio. When averaged, two independent analyses find the
charge ratio underground to be 1.374 +/- 0.004 (stat.) +0.012 -0.010(sys.).
Using the map of the Soudan rock overburden, the muon momenta as measured
underground were projected to the corresponding values at the surface in the
energy range 1-7 TeV. Within this range of energies at the surface, the MINOS
data are consistent with the charge ratio being energy independent at the two
standard deviation level. When the MINOS results are compared with measurements
at lower energies, a clear rise in the charge ratio in the energy range 0.3 --
1.0 TeV is apparent. A qualitative model shows that the rise is consistent with
an increasing contribution of kaon decays to the muon charge ratio.Comment: 16 pages, 17 figure
Measurement of neutrino velocity with the MINOS detectors and NuMI neutrino beam
The velocity of a ~3 GeV neutrino beam is measured by comparing detection times at the near and far detectors of the MINOS experiment, separated by 734 km. A total of 473 far detector neutrino events was used to measure (v-c)/c=5.12.910-5 (at 68% C.L.). By correlating the measured energies of 258 charged-current neutrino events to their arrival times at the far detector, a limit is imposed on the neutrino mass of mnu<50 MeV/c2 (99% C.L.)
First observations of separated atmospheric nu_mu and bar{nu-mu} events in the MINOS detector
The complete 5.4 kton MINOS far detector has been taking data since the beginning of August 2003 at a depth of 2070 meters water-equivalent in the Soudan mine, Minnesota. This paper presents the first MINOS observations of nuµ and [overline nu ]µ charged-current atmospheric neutrino interactions based on an exposure of 418 days. The ratio of upward- to downward-going events in the data is compared to the Monte Carlo expectation in the absence of neutrino oscillations, giving Rup/downdata/Rup/downMC=0.62-0.14+0.19(stat.)±0.02(sys.). An extended maximum likelihood analysis of the observed L/E distributions excludes the null hypothesis of no neutrino oscillations at the 98% confidence level. Using the curvature of the observed muons in the 1.3 T MINOS magnetic field nuµ and [overline nu ]µ interactions are separated. The ratio of [overline nu ]µ to nuµ events in the data is compared to the Monte Carlo expectation assuming neutrinos and antineutrinos oscillate in the same manner, giving R[overline nu ][sub mu]/nu[sub mu]data/R[overline nu ][sub mu]/nu[sub mu]MC=0.96-0.27+0.38(stat.)±0.15(sys.), where the errors are the statistical and systematic uncertainties. Although the statistics are limited, this is the first direct observation of atmospheric neutrino interactions separately for nuµ and [overline nu ]µ
Antibodies against viral nucleo-, phospho-, and X protein contribute to serological diagnosis of fatal Borna disease virus 1 infections
Borna disease virus 1 (BoDV-1) causes rare but often fatal encephalitis in humans. Late diagnosis prohibits an experimental therapeutic approach. Here, we report a recent case of fatal BoDV-1 infection diagnosed on day 12 after hospitalization by detection of BoDV-1 RNA in the cerebrospinal fluid. In a retrospective analysis, we detect BoDV-1 RNA 1 day after hospital admission when the cell count in the cerebrospinal fluid is still normal. We develop a new ELISA using recombinant BoDV-1 nucleoprotein, phosphoprotein, and accessory protein X to detect seroconversion on day 12. Antibody responses are also shown in seven previously confirmed cases. The individual BoDV-1 antibody profiles show variability, but the usage of three different BoDV-1 antigens results in a more sensitive diagnostic tool. Our findings demonstrate that early detection of BoDV-1 RNA in cerebrospinal fluid and the presence of antibodies against at least two different viral antigens contribute to BoDV-1 diagnosis. Physicians in endemic regions should consider BoDV-1 infection in cases of unclear encephalopathy and initiate appropriate diagnostics at an early stage
Fine-mapping of lipid regions in global populations discovers ethnic-specific signals and refines previously identified lipid loci
Genome-wide association studies have identified over 150 loci associated with lipid traits, however, no large-scale studies exist for Hispanics and other minority populations. Additionally, the genetic architecture of lipid-influencing loci remains largely unknown. We performed one of the most racially/ethnically diverse fine-mapping genetic studies of HDL-C, LDL-C, and triglycerides to-date using SNPs on the MetaboChip array on 54,119 individuals: 21,304 African Americans, 19,829 Hispanic Americans, 12,456 Asians, and 530 American Indians. The majority of signals found in these groups generalize to European Americans. While we uncovered signals unique to racial/ethnic populations, we also observed systematically consistent lipid associations across these groups. In African Americans, we identified three novel signals associated with HDL-C (LPL, APOA5, LCAT) and two associated with LDL-C (ABCG8, DHODH). In addition, using this population, we refined the location for 16 out of the 58 known MetaboChip lipid loci. These results can guide tailored screening efforts, reveal population-specific responses to lipid-lowering medications, and aid in the development of new targeted drug therapies
- …