Laparoscopic sacrocolpopexy compared with open abdominal sacrocolpopexy for vault prolapse repair: a randomised controlled trial

Introduction and Hypothesis: The objective was to evaluate the functional outcome after laparoscopic sacrocolpopexy versus open sacrocolpopexy in women with vault prolapse. Methods: A multicentre randomised controlled trial was carried out at four teaching and two university hospitals in the Netherlands in women with symptomatic vault prolapse requiring surgical treatment. Participants were randomised for laparoscopic or open sacrocolpopexy. Primary outcome was disease-specific quality of life measured using the Urinary Distress Inventory (UDI) questionnaire at 12 months' follow-up. Secondary outcomes included anatomical outcome and perioperative data. We needed 74 participants to show a difference of 10 points on the prolapse domain of the UDI 12 months after surgery (power of 80%, α error 0.05). Results: Between 2007 and 2012, a total of 74 women were randomised. Follow-up after 12 months showed no significant differences in domain scores of the UDI between the two groups. After 12 months, both groups reported a UDI score of 0.0 (IQR: 0-0) for the domain "genital prolapse", which was the primary outcome. There were no significant differences between the two groups (p = 0.93). The number of severe complications was 4 in the laparoscopic group versus 7 in the open abdominal group (RR 0.57; 95% CI 0.50-2.27). There was less blood loss and a shorter hospital stay after laparoscopy; 2 (IQR 2-3) versus 4 (IQR 3-5) days, which was statistically different. There was no significant difference in anatomical outcome at 12 months. Conclusion: Our trial provides evidence to support a laparoscopic approach when performing sacrocolpopexy, as there was less blood loss and hospital stay was shorter, whereas functional and anatomical outcome were not statistically different.Anne-Lotte W.M. Coolen, Anique M.J. van Oudheusden, Ben Willem J. Mol, Hugo W.F. van Eijndhoven, Jan-Paul W.R. Roovers, Marlies Y. Bonger

On the background in the γp→ω(π0γ)p\gamma p \to \omega(\pi^0\gamma) p reaction and mixed event simulation

In this paper we evaluate sources of background for the $\gamma p \to \omega p$, with the $\omega$ detected through its $\pi^0 \gamma$ decay channel, to compare with the experiment carried out at ELSA. We find background from $\gamma p \to \pi^0 \pi^0 p$ followed by decay of a $\pi^0$ into two $\gamma$, recombining one $\pi^0$ and one $\gamma$, and from the $\gamma p \to \pi^0 \eta p$ reaction with subsequent decay of the $\eta$ into two photons. This background accounts for the data at $\pi^0 \gamma$ invariant masses beyond 700 MeV, but strength is missing at lower invariant masses which was attributed to photon misidentification events, which we simulate to get a good reproduction of the experimental background. Once this is done, we perform an event mixing simulation to reproduce the calculated background and we find that the method provides a good description of the background at low $\pi^0 \gamma$ invariant masses but fakes the background at high invariant masses, making background events at low invariant masses, which are due to $\gamma$ misidentification events, responsible for the background at high invariant masses which is due to the $\gamma p \to \pi^0 \pi^0 p$ and $\gamma p \to \pi^0 \eta p$ reactions.Comment: 10 pages, 5 figure

Search for non-relativistic Magnetic Monopoles with IceCube

The IceCube Neutrino Observatory is a large Cherenkov detector instrumenting $1\,\mathrm{km}^3$ of Antarctic ice. The detector can be used to search for signatures of particle physics beyond the Standard Model. Here, we describe the search for non-relativistic, magnetic monopoles as remnants of the GUT (Grand Unified Theory) era shortly after the Big Bang. These monopoles may catalyze the decay of nucleons via the Rubakov-Callan effect with a cross section suggested to be in the range of $10^{-27}\,\mathrm{cm^2}$ to $10^{-21}\,\mathrm{cm^2}$. In IceCube, the Cherenkov light from nucleon decays along the monopole trajectory would produce a characteristic hit pattern. This paper presents the results of an analysis of first data taken from May 2011 until May 2012 with a dedicated slow-particle trigger for DeepCore, a subdetector of IceCube. A second analysis provides better sensitivity for the brightest non-relativistic monopoles using data taken from May 2009 until May 2010. In both analyses no monopole signal was observed. For catalysis cross sections of $10^{-22}\,(10^{-24})\,\mathrm{cm^2}$ the flux of non-relativistic GUT monopoles is constrained up to a level of $\Phi_{90} \le 10^{-18}\,(10^{-17})\,\mathrm{cm^{-2}s^{-1}sr^{-1}}$ at a 90% confidence level, which is three orders of magnitude below the Parker bound. The limits assume a dominant decay of the proton into a positron and a neutral pion. These results improve the current best experimental limits by one to two orders of magnitude, for a wide range of assumed speeds and catalysis cross sections.Comment: 20 pages, 20 figure

A combined maximum-likelihood analysis of the high-energy astrophysical neutrino flux measured with IceCube

Evidence for an extraterrestrial flux of high-energy neutrinos has now been found in multiple searches with the IceCube detector. The first solid evidence was provided by a search for neutrino events with deposited energies $\gtrsim30$ TeV and interaction vertices inside the instrumented volume. Recent analyses suggest that the extraterrestrial flux extends to lower energies and is also visible with throughgoing, $\nu_\mu$-induced tracks from the Northern hemisphere. Here, we combine the results from six different IceCube searches for astrophysical neutrinos in a maximum-likelihood analysis. The combined event sample features high-statistics samples of shower-like and track-like events. The data are fit in up to three observables: energy, zenith angle and event topology. Assuming the astrophysical neutrino flux to be isotropic and to consist of equal flavors at Earth, the all-flavor spectrum with neutrino energies between 25 TeV and 2.8 PeV is well described by an unbroken power law with best-fit spectral index $-2.50\pm0.09$ and a flux at 100 TeV of $\left(6.7_{-1.2}^{+1.1}\right)\cdot10^{-18}\,\mathrm{GeV}^{-1}\mathrm{s}^{-1}\mathrm{sr}^{-1}\mathrm{cm}^{-2}$. Under the same assumptions, an unbroken power law with index $-2$ is disfavored with a significance of 3.8 $\sigma$ ($p=0.0066\%$) with respect to the best fit. This significance is reduced to 2.1 $\sigma$ ($p=1.7\%$) if instead we compare the best fit to a spectrum with index $-2$ that has an exponential cut-off at high energies. Allowing the electron neutrino flux to deviate from the other two flavors, we find a $\nu_e$ fraction of $0.18\pm0.11$ at Earth. The sole production of electron neutrinos, which would be characteristic of neutron-decay dominated sources, is rejected with a significance of 3.6 $\sigma$ ($p=0.014\%$).Comment: 16 pages, 10 figures; accepted for publication in The Astrophysical Journal; updated one referenc

Lateral Distribution of Muons in IceCube Cosmic Ray Events

In cosmic ray air showers, the muon lateral separation from the center of the shower is a measure of the transverse momentum that the muon parent acquired in the cosmic ray interaction. IceCube has observed cosmic ray interactions that produce muons laterally separated by up to 400 m from the shower core, a factor of 6 larger distance than previous measurements. These muons originate in high pT (> 2 GeV/c) interactions from the incident cosmic ray, or high-energy secondary interactions. The separation distribution shows a transition to a power law at large values, indicating the presence of a hard pT component that can be described by perturbative quantum chromodynamics. However, the rates and the zenith angle distributions of these events are not well reproduced with the cosmic ray models tested here, even those that include charm interactions. This discrepancy may be explained by a larger fraction of kaons and charmed particles than is currently incorporated in the simulations