The FCC-ee Interaction Region Magnet Design

The design of the region close to the interaction point of the FCC-ee experiments is especially challenging. The beams collide at an angle (+-15 mrad) in the high-field region of the detector solenoid. Moreover, the very low vertical beta_y* of the machine necessitates that the final focusing quadrupoles have a distance from the IP (L*) of around 2 m and therefore are inside the main detector solenoid. The beams should be screened from the effect of the detector magnetic field, and the emittance blow-up due to vertical dispersion in the interaction region should be minimized, while leaving enough space for detector components. Crosstalk between the two final focus quadrupoles, only about 6 cm apart at the tip, should also be minimized.Comment: Poster presented at IPAC16, May 8-13, Busan, Kore

Facial-muscle weakness, speech disorders and dysphagia are common in patients with classic infantile Pompe disease treated with enzyme therapy

Classic infantile Pompe disease is an inherited generalized glycogen storage disorder caused by deficiency of lysosomal acid α-glucosidase. If left untreated, patients die before one year of age. Although enzyme-replacement therapy (ERT) has significantly prolonged lifespan, it has also revealed new aspects of the disease. For up to 11 years, we investigated the frequency and consequences of facial-muscle weakness, speech disorders and dysphagia in long-term survivors. Sequential photographs were used to determine the timing and severity of facial-muscle weakness. Using standardized articulation tests and fibreoptic endoscopic evaluation of swallowing, we investigated speech and swallowing function in a subset of patients. This study included 11 patients with classic infantile Pompe disease. Median age at the start of ERT was 2.4 months (range 0.1-8.3 months), and median age at the end of the study was 4.3 years (range 7.7 months −12.2 years). All patients developed facial-muscle weakness before the age of 15 months. Speech was studied in four patients. Articulation was disordered, with hypernasal resonance and reduced speech intelligibility in all four. Swallowing function was studied in six patients, the most important findings being ineffective swallowing with residues of food (5/6), penetration or aspiration (3/6), and reduced pharyngeal and/or laryngeal sensibility (2/6). We conclude that facial-muscle weakness, speech disorders and dysphagia are common in long-term survivors receiving ERT for classic infantile Pompe disease. To improve speech and reduce the risk for aspiration, early treatment by a speech therapist and regular swallowing assessments are recommended

Resource Quantity Affects Benthic Microbial Community Structure and Growth Efficiency in a Temperate Intertidal Mudflat

Estuaries cover <1% of marine habitats, but the carbon dioxide (CO2) effluxes from these net heterotrophic systems contribute significantly to the global carbon cycle. Anthropogenic eutrophication of estuarine waterways increases the supply of labile substrates to the underlying sediments. How such changes affect the form and functioning of the resident microbial communities remains unclear. We employed a carbon-13 pulse-chase experiment to investigate how a temperate estuarine benthic microbial community at 6.5°C responded to additions of marine diatom-derived organic carbon equivalent to 4.16, 41.60 and 416.00 mmol C m−2. The quantities of carbon mineralized and incorporated into bacterial biomass both increased significantly, albeit differentially, with resource supply. This resulted in bacterial growth efficiency increasing from 0.40±0.02 to 0.55±0.04 as substrates became more available. The proportions of diatom-derived carbon incorporated into individual microbial membrane fatty acids also varied with resource supply. Future increases in labile organic substrate supply have the potential to increase both the proportion of organic carbon being retained within the benthic compartment of estuaries and also the absolute quantity of CO2 outgassing from these environments

German evidence-based guidelines for the treatment of Psoriasis vulgaris (short version)

Psoriasis vulgaris is a common and chronic inflammatory skin disease which has the potential to significantly reduce the quality of life in severely affected patients. The incidence of psoriasis in Western industrialized countries ranges from 1.5 to 2%. Despite the large variety of treatment options available, patient surveys have revealed insufficient satisfaction with the efficacy of available treatments and a high rate of medication non-compliance. To optimize the treatment of psoriasis in Germany, the Deutsche Dermatologische Gesellschaft and the Berufsverband Deutscher Dermatologen (BVDD) have initiated a project to develop evidence-based guidelines for the management of psoriasis. The guidelines focus on induction therapy in cases of mild, moderate, and severe plaque-type psoriasis in adults. The short version of the guidelines reported here consist of a series of therapeutic recommendations that are based on a systematic literature search and subsequent discussion with experts in the field; they have been approved by a team of dermatology experts. In addition to the therapeutic recommendations provided in this short version, the full version of the guidelines includes information on contraindications, adverse events, drug interactions, practicality, and costs as well as detailed information on how best to apply the treatments described (for full version, please see Nast et al., JDDG, Suppl 2:S1–S126, 2006; or http://www.psoriasis-leitlinie.de)

Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.

Student compliance with indications for intravenous cannulation during clinical learning

Background. Intravenous (IV) cannulation is a commonly performed procedure that is taught to a  number of health science students. As with most invasive medical interventions, there is a possibility of unintended adverse effects. Therefore, IV cannulation should only be performed for a clearly established need.Objective. To assess the extent to which emergency medical care students, during the course of their clinical learning, establish IV access in patients without a clearly documented indication.Methods. A retrospective analysis of historical data from a clinical learning database was done to  investigate whether patients seen by students over a 2-year period received IV cannulation in line with indications taught to students.Results. Of the 5 893 cases reviewed, 1 862 (32%) were cannulated intravenously. Of these, 426 (23%) did not have a clearly documented indication that had been taught for the procedure. Therefore, these  patients may potentially have been ‘overtreated’.Conclusion. This study demonstrates that a high number of IV lines were established by students, with no clearly documented indication. This potential overtreatment may in part be attributed to pressures placed on students to achieve the minimum prescribed number of skills. Such practices remain common in medical education and may be detrimental to the patient. Medical educators need to ensure that  students value the patient rather than the procedure. Further research needs to be conducted to  investigate and identify other possible reasons for overtreatment of patients by medical students

Student compliance with indications for intravenous cannulation during clinical learning

Background. Intravenous (IV) cannulation is a commonly performed procedure that is taught to a number of health science students. As with most invasive medical interventions, there is a possibility of unintended adverse effects. Therefore, IV cannulation should only be performed for a clearly established need. Objective. To assess the extent to which emergency medical care students, during the course of their clinical learning, establish IV access in patients without a clearly documented indication. Methods. A retrospective analysis of historical data from a clinical learning database was done to investigate whether patients seen by students over a 2-year period received IV cannulation in line with indications taught to students. Results. Of the 5 893 cases reviewed, 1 862 (32%) were cannulated intravenously. Of these, 426 (23%) did not have a clearly documented indication that had been taught for the procedure. Therefore, these patients may potentially have been ‘overtreated’. Conclusion. This study demonstrates that a high number of IV lines were established by students, with no clearly documented indication. This potential overtreatment may in part be attributed to pressures placed on students to achieve the minimum prescribed number of skills. Such practices remain common in medical education and may be detrimental to the patient. Medical educators need to ensure that students value the patient rather than the procedure. Further research needs to be conducted to investigate and identify other possible reasons for overtreatment of patients by medical students