First observation of PeV-energy neutrinos with IceCube

We report on the observation of two neutrino-induced events which have an estimated deposited energy in the IceCube detector of 1.04±0.16 and 1.14±0.17 PeV, respectively, the highest neutrino energies observed so far. These events are consistent with fully contained particle showers induced by neutral-current ν(e,μ,τ) (ν(e,μ,τ)) or charged-current ν(e) (ν(e)) interactions within the IceCube detector. The events were discovered in a search for ultrahigh energy neutrinos using data corresponding to 615.9 days effective live time. The expected number of atmospheric background is 0.082±0.004(stat)(-0.057)(+0.041)(syst). The probability of observing two or more candidate events under the atmospheric background-only hypothesis is 2.9×10(-3) (2.8σ) taking into account the uncertainty on the expected number of background events. These two events could be a first indication of an astrophysical neutrino flux; the moderate significance, however, does not permit a definitive conclusion at this time.

Measurement of the atmospheric νe flux in IceCube

We report the first measurement of the atmospheric electron neutrino flux in the energy range between approximately 80 GeV and 6 TeV, using data recorded during the first year of operation of IceCube's DeepCore low-energy extension. Techniques to identify neutrinos interacting within the DeepCore volume and veto muons originating outside the detector are demonstrated. A sample of 1029 events is observed in 281 days of data, of which 496±66(stat)±88(syst) are estimated to be cascade events, including both electron neutrino and neutral current events. The rest of the sample includes residual backgrounds due to atmospheric muons and charged current interactions of atmospheric muon neutrinos. The flux of the atmospheric electron neutrinos is consistent with models of atmospheric neutrinos in this energy range. This constitutes the first observation of electron neutrinos and neutral current interactions in a very large volume neutrino telescope optimized for the TeV energy range.

Search for dark matter annihilations in the sun with the 79-string IceCube detector

We have performed a search for muon neutrinos from dark matter annihilation in the center of the Sun with the 79-string configuration of the IceCube neutrino telescope. For the first time, the DeepCore subarray is included in the analysis, lowering the energy threshold and extending the search to the austral summer. The 317 days of data collected between June 2010 and May 2011 are consistent with the expected background from atmospheric muons and neutrinos. Upper limits are set on the dark matter annihilation rate, with conversions to limits on spin-dependent and spin-independent scattering cross sections of weakly interacting massive particles (WIMPs) on protons, for WIMP masses in the range 20-5000  GeV/c2. These are the most stringent spin-dependent WIMP-proton cross section limits to date above 35  GeV/c2 for most WIMP models.

A NURSE LED CENTRAL LINE INSERTION SERVICE

Advanced Nurse Practitioners (ANP) are developing their role in order to insert temporary and permanent central venous catheters to facilitate haemodialysis. Two hundred and eighty-nine central venous catheters (CVC) were inserted over a two-year period. The ANP inserted 117 CVC with 172 CVC inserted by the nephrology medical team. Using non-parametric independent two-group comparison Mann Whitney test and Chi-Squared test, the two groups were compared for specific outcomes. When comparing both groups with respect to CVC longevity, elective and non-elective removal along with infection (exit site and systemic) no statistical difference between the ANP and the nephrology medical staff could be found.

ANALYSIS OF rt-PA INFUSION IN TUNNELLED DIALYSIS CATHETERS

Urokinase and streptokinase are commonly used thrombolytic agents for obstructed central venous catheters. Although proven to be efficacious, these agents have the potential to induce fibrin breakdown and streptokinase cannot be used repeatedly due to its allergenic nature. Documented evidence suggests that urokinase is safe and effective (> 70% efficacy for catheter installation) however further evidence points to tissue-type plasminogen activator (rt-PA) achieving as much as 98% success. This study reports on the safety and efficacy of alternative catheter thrombolysis, namely rt-PA and evaluates the efficacy of rt-PA. 20 patients required 57 infusions in 38 lumens between 01/01/02 to 01/09/03. For completely blocked lines rt-PA was infused at 2 mg/hr for 4 hours achieving 85% success rate. For inadequate flow (< 250 mls/min) rt-PA was infused at 1 mg/hr for 4 hours achieving 88% success rate.

Gender differences in caregiver emotion socialization of low-income toddlers

Low-income children are at elevated risk for emotion-related problems; however, little research has examined gender and emotion socialization in low-income families. The authors describe the ways in which emotion socialization may differ for low-income versus middle-income families. They also present empirical data on low-income caregivers' responses to their toddlers' emotion displays, with findings indicating more supportive and fewer punitive responses to boys' anger than to girls', but few gender differences for sadness/anxiety. Finally, they present two models (the emotion competence model and differential emotions model) for understanding relations between emotion socialization and the development of psychopathology, particularly in low-income children.

Sustained remission of systemic lupus erythematosus related calciphylaxis

Calciphylaxis continues to present a clinical challenge for patient management. As in this case, it can be associated with connective tissue disease (CTD) such as systemic lupus erythematosus (SLE). Unlike previous reported cases, long-term remission has been attained. This provides some insight into methods of therapy as well as potential pathogenic models for this disease.

The 3q29 microdeletion syndrome: report of three new unrelated patients and in silico "RNA binding" analysis of the 3q29 region

The human 3q29 microdeletion syndrome is associated with mild facial dysmorphism, developmental delay and variable congenital malformations. We report three new unrelated patients with this syndrome. We also performed in silico RNA binding analysis in silico on the 3q29 critical region genes. Several genes within this genomic region including DLG1 and RNF168 are predicted to bind RNA. While recessive mutations in RNF168 cause RIDDLE syndrome, an immune deficiency and radiosensitivity disorder, the potential impact of heterozygous deletion of RNF168 on patients with the 3q29 deletion syndrome is still unknown.

Selective cocaine-related difficulties in emotional intelligence: relationship to stress and impulse control

Emotional Intelligence (EI) comprises the ability to perceive, use, understand, and regulate emotions and may potentially contribute to variability in risk-related factors such as stress perception and impulse control in cocaine dependent individuals. The main objective of the current study is to better define EI in cocaine dependent individuals compared with healthy controls, using the Mayer, Salovey, and Caruso Emotional Intelligence Test (MSCEIT). Secondary analysis investigates the association between EI, IQ factors, perceived stress, and impulse control in both populations. Seventy-two abstinent treatment-seeking cocaine patients and 52 healthy controls were administered the MSCEIT as well as measures of IQ, perceived stress, and impulse control. Findings showed that cocaine dependent participants demonstrated highly selective EI difficulties compared with healthy controls, specifically with regard to higher-level emotional reasoning including the understanding, management, and regulation of emotion. These EI problems were associated with increased perceived stress and impulse control difficulties. IQ was significantly associated with all MSCEIT measures in the cocaine dependent participants, but not controls. Findings indicate that specific aspects of EI may be of clinical importance to cocaine dependent populations, impacting relapse-related factors such as stress dysregulation and impulse control. 

Diel foraging behavior of gravid leatherback sea turtles in deep waters of the Caribbean Sea

It is generally assumed that leatherback turtles (Dermochelys coriacea), like other species of sea turtle, do not feed while offshore from nesting beaches, and rely instead on fat reserves to fuel reproductive activities. Recent studies, however, provide evidence that leatherbacks may forage during the internesting interval while offshore in the Western Atlantic Ocean and Caribbean Sea. Bio-logging technology was used to investigate the foraging behavior of female leatherback turtles at St Croix, US Virgin Islands. Leatherback gastrointestinal tract temperatures (TGT) were analyzed for sudden fluctuations indicative of ingestions, and laboratory ingestion simulations were used to characterize temperature fluctuations associated with ingestion of prey versus seawater. Dive patterns associated with prey ingestion were characterized and the proportion of prey ingestion during the day (05:00–18:59 h) and night (19:00–04:59 h) were compared. A combined total of 111 prey ingestions for seven leatherback turtles were documented during the internesting interval. The number of prey ingestions ranged from six to 48 for individual turtles, and the majority (87.4%) of these events occurred during the daytime. Prey ingestions were most frequently associated with V-shaped dives, and the mean (±1 s.d.) maximum dive depth with prey ingestion ranged from 154±51 to 232±101 m for individual turtles. Although leatherbacks were found to opportunistically feed during the internesting interval, the low prey ingestion rates indicate that energy reserves acquired prior to the breeding season are critical for successful reproduction by leatherbacks from the St Croix, USVI nesting population.

Controlled Integration into the Lactococcus Chromosome of the pCI829-Encoded Abortive Infection Gene from Lactococcus lactis subsp. lactis UC811

The phage insensitivity gene of lactococcal plasmid pCI829 which encodes an abortive infection defense mechanism (Abi) was inserted into the Lactococcus lactis subsp. lactis CH919 chromosome by utilizing the integration plasmid pCI194, which contains 4.2 kb of homology with the conjugative transposon Tn919. Chloramphenicol-resistant transformants expressed phage insensitivity to the prolate-headed phage c2 and the small isometric-headed phage 712, and hybridization analysis indicated that transformants contained pCI194 integrated in single copy. The level of phage insensitivity expressed by the transformants was reduced from that observed when the abi gene was located on a replicating plasmid, as determined by plaque assay and burst size analysis. Amplification of the integrated structure after growth in increased concentrations of chloramphenicol resulted in an increase in the expression of phage insensitivity. Hybridization analysis revealed that while pCI194 was stably maintained in an integrated state over 100 generations in the absence of selective pressure, the ability to express phage insensitivity was lost. Hybridization analysis also revealed that DNA flanking the abi gene contains homology to the CH919 chromosome.

Virus isolation vs RT-PCR: which method is more successful in detecting VHSV and IHNV in fish tissue sampled under field conditions?

This study compared the results of reverse transcription-polymerase chain reaction (RT-PCR) and traditional virus isolation on cell culture in detection of viral haemorrhagic septicaemia virus (VHSV) and infectious haematopoietic necrosis virus (IHNV). RT-PCR was used for 172 tissue sample pools (total of 859 fish) originating from a field survey on the occurrence of VHSV and IHNV in farmed and wild salmonids in Switzerland. These samples represented all sites with fish that were either identified as virus-positive by means of virus isolation (three sites, four positive tissue sample pools) and/or demonstrated positive anti-VHSV-antibody titres (83 sites, 121 positive blood samples) in a serum plaque neutralization test (SPNT). The RT-PCR technique confirmed the four VHSV-positive tissue sample pools detected by virus isolation and additionally identified one VHSV-positive sample that showed positive anti-VHSV-AB titres, but was negative in virus isolation. With IHNV, RT-PCR detected two positive samples not identified by virus isolation while in these fish the SPNT result had been questionable. One of the IHNV-positive samples represents the first detection of IHNV-RNA in wild brown trout in Switzerland. Compared to SPNT, the RT-PCR method detected, as with virus isolation, a much lower number of positive cases; reasons for this discrepancy are discussed. Our results indicate that RT-PCR can not only be successfully applied in field surveys, but may also be slightly more sensitive than virus isolation. However, in a titration experiment under laboratory conditions, the sensitivity of RT-PCR was not significantly higher when compared with virus isolation.

The ideal pseudo-rigid continuum

In the literature on pseudo-rigid bodies and their applications, it is generally assumed that these bodies can undergo only a restricted class of motions, without questioning how this restriction is to be strictly enforced. In 2004, I proposed in these Proceedings that such a restriction may be regarded as a ‘global constraint’ on a deformable continuum, and influenced by ideas of Antman & Marlow from the early 1990s, I assumed that the constraint is enforced by a field of reactive stresses, and I constructed a mathematical model that idealizes pseudo-rigid bodies as globally constrained continua of finite size. In a recent article in Proceedings of the Royal Society A , the validity of this model was challenged. Essentially, the controversy revolves around the issue of working definitions versus idealized mathematical models of pseudo-rigid bodies.

Comparison of European and U.S. results for cephalosporin versus penicillin treatment of group A streptococcal tonsillopharyngitis

The outcome of cephalosporin versus penicillin treatment of group A streptococcal tonsillopharyngitis may differ between Europe and the USA. In the present study, Medline, Embase, reference lists, and abstract searches were used to identify randomized, controlled trials of cephalosporin versus penicillin treatment of group A streptococcal (GAS) tonsillopharyngitis. The outcomes of interest were bacteriologic and clinical cure rates from investigations conducted in Europe versus those conducted in the USA. Forty-seven trials involving 11,426 patients were included in the meta-analyses. For the comparison of 10 days of treatment with cephalosporins versus 10 days of treatment with penicillin, there were ten European and 25 U.S. trials, all involving pediatric subjects. The overall odds ratio (OR) favored cephalosporins more strongly in bacteriologic cure rate in Europe (OR=4.27, p<0.00001) than in the USA (OR=2.70, p<0.00001). Studies of 4-5 days of cephalosporin treatment versus 10 days of penicillin treatment were also analyzed. For nine European trials, the OR significantly favored cephalosporins (OR=1.30, p=0.03) in bacteriologic cure rates, but not as strongly as in the USA, (OR=2.41, p<0.00001). When results for 4-5 days of cephalosporin treatment were divided into pediatric versus adult populations, the differences in bacteriologic eradication rates obtained with cephalosporins were more pronounced in children. The likelihood of bacteriologic and clinical failure of GAS tonsillopharyngitis treatment in both European and U.S. patients is significantly less if a 10-day course of oral cephalosporin is prescribed, and is at least similar, if not significantly less, with a 4- to 5-day course of oral cephalosporin compared with a 10-day course of oral penicillin.

Anaemia as an early predictor for diabetic renal disease? A review of the literature

Diabetes is the leading cause of end-stage renal disease in the western world and significant proportions of patients with diabetes mellitus develop renal complications. Anaemia is a key indicator of renal disease, and potentially may contribute to the pathogenesis of diabetes complications. Early correction of anaemia therefore has the potential to prevent or reverse other complications This review of the literature will examine anaemia in diabetic patients and seek to determine whether it is exclusive to diabetic nephropathy.

Guided resonances in asymmetrical GaN photonic crystal slabs observed in the visible spectrum

We demonstrate that guided resonant modes can be readily observed in asymmetrical photonic crystal slabs on high-index substrates. In spite of the high radiative loss associated with all optical modes in these cases, the guided resonant modes are found to give rise to strong high-Q features in the transmission spectra. Since these photonic crystal structures are far more robust and easier to fabricate than the free-standing photonic crystal membranes used in previous studies of guided resonant modes, detailed studies of relevant optical phenomena and the implementation of proposed applications are greatly simplified.

Ligasure trademark vs conventional diathermy haemorrhoidectomy: long-term follow-up of a randomised clinical trial

OBJECTIVE

Ligasure haemorrhoidectomy has short-term benefits over conventional diathermy haemorrhoidectomy. The current study aimed to determine the long-term efficacy of Ligasure haemorrhoidectomy.

SUBJECTS AND METHODS

Forty patients, previously randomised to Ligasure or diathermy haemorrhoidectomy in 2002, were invited to participate in the study. Haemorrhoidal symptoms and patient satisfaction were recorded. Incontinence was quantified and sphincter anatomy and function assessed by endoanal ultrasound and anorectal manometry.

RESULTS

Thirty (75%) patients participated in the study (14 Ligasure, 16 conventional). There was no difference in age, sex distribution, or length of follow-up (Ligasure : 37 months; conventional: 36 months) between the groups. Both techniques achieved good symptom control, but with a trend to less recurrent bleeding following Ligasure. Incontinence scores and patient satisfaction were similar. A significant difference was observed in internal sphincter thickness (Ligasure : 2.5 mm, 2.2-2.8 (mean, 95%CI) vs conventional: 1.88 mm, 1.7-2.1, P = 0.005) and rectal urge sensation (Ligasure : 284 mls, 211-378 vs conventional: 173 mls, 129-217, P = 0.08).

CONCLUSION

Ligasure is as effective as conventional diathermy haemorrhoidectomy in achieving long-term symptom control. Less radical haemorrhoidal excision with the Ligasure could explain the differences in internal sphincter thickness and urge sensation, and might make it the preferred method for patients with compromised sphincter function.

Restoration of flow following haemodialysis catheter thrombus. Analysis of rt-PA infusion in tunnelled dialysis catheters

PROBLEM

Urokinase and streptokinase are commonly used thrombolytic agents for obstructed central venous catheters. Although proven to be efficacious, these agents have the potential to induce fibrin breakdown and streptokinase cannot be used repeatedly because of its allergenic nature. Published evidence suggests that Urokinase is safe and effective (>70% efficacy for catheter installation) and that Tissue-type plasminogen activator (rt-PA) can achieve as much as 98% success.

OBJECTIVE

To describe our experience with and our protocol for the use of rt-PA as an alternative agent for catheter thrombolysis.

DESIGN

Investigation of a cohort of haemodialysis patients with tunnelled central venous catheter (SPCVC) placed between December 2001 to August 2003 and who developed catheter thrombus (female, n = 8: male, n = 12). Each patient was given an infusion of between 1 and 2 mg rt-PA/h for 4 h. The dose was dependent on partial or total line obstruction. The technical success of rt-PA is defined as returning catheter blood flow to >250 mL/min for a 4-h period.

FINDINGS

Twenty patients required 57 infusions in 38 lumens between 01/01/02 to 01/09/03. For completely blocked lines rt-PA was infused at 2 mg/h for 4 h achieving 85% success rate. For inadequate flow (<250 mL/min) rt-PA was infused at 1 mg/h for 4 h achieving an 88% success rate.

CONCLUSION

Rt-PA administered at 2 mg/h for blocked lines effectively restores haemodialysis catheter patency, and at 1 mg/h for sluggish lines is also effective in restoring blood flow through catheters.

Encouraging self-administration of erythropoietin

European Best Practice Guidelines of 1999 for managing anaemia in patients with kidney failure state that patients using the subcutaneous route should be encouraged to self-administer epoetin whenever possible. This article argues for and substantiates the need to develop an education programme, which should consist of group and one-to-one teaching sessions with discussion, role-play, visual aids and demonstration. Information booklets will be provided covering blood pressure monitoring, ordering and storage of medication and safe disposal of syringes. Methods to evaluate the education programme include direct observation, laboratory reports, patient care plans and feedback. The theoretical benefits of such a programme should include; improved cardiovascular function with a more compliant patient enjoying an improved quality of life. The organisation should benefit through lower costs and a structured method of audit.