Sustainable Approach to Justice, Equity, Diversity, and Inclusion Through Better Quality Measurement

The US health care industry has broadly adopted performance and quality measures that are extracted from electronic health records and connected to payment incentives that hope to improve declining life expectancy and health status and reduce costs. While the development of a quality measurement infrastructure based on electronic health record data was an important first step in addressing US health outcomes, these metrics, reflecting the average performance across diverse populations, do not adequately adjust for population demographic differences, social determinants of health, or ecosystem vulnerability. Like society as a whole, health care must confront the powerful impact that social determinants of health, race, ethnicity, and other demographic variations have on key health care performance indicators and quality metrics. Tools that are currently available to capture and report the health status of Americans lack the granularity, complexity, and standardization needed to improve health and address disparities at the local level. In this article, we discuss the current and future state of electronic clinical quality measures through a lens of equity.

Observation of New Isotopes in the Fragmentation of ^{198}Pt at FRIB

Five previously unknown isotopes (^{182,183}Tm, ^{186,187}Yb, ^{190}Lu) were produced, separated, and identified for the first time at the Facility for Rare Isotope Beams (FRIB) using the Advanced Rare Isotope Separator (ARIS). The new isotopes were formed through the interaction of a ^{198}Pt beam with a carbon target at an energy of 186  MeV/u and with a primary beam power of 1.5 kW. Event-by-event particle identification of A, Z, and q for the reaction products was performed by combining measurements of the energy loss, time of flight, magnetic rigidity Bρ, and total kinetic energy. The ARIS separator has a novel two-stage design with high resolving power to strongly suppress contaminant beams. This successful new isotope search was performed less than one year after FRIB operations began and demonstrates the discovery potential of the facility which will ultimately provide 400 kW of primary beam power.

Dissipative Reactions with Intermediate-Energy Beams: A Novel Approach to Populate Complex-Structure States in Rare Isotopes

A novel pathway for the formation of multiparticle-multihole excited states in rare isotopes is reported from highly energy- and momentum-dissipative inelastic-scattering events measured in reactions of an intermediate-energy beam of ^{38}Ca on a Be target. The negative-parity, complex-structure final states in ^{38}Ca are observed following the in-beam γ-ray spectroscopy of events in the ^{9}Be(^{38}Ca,^{38}Ca+γ)X reaction in which the scattered projectile loses longitudinal momentum of order Δp_{||}=700  MeV/c. The characteristics of the observed final states are discussed and found to be consistent with the formation of excited states involving the rearrangement of multiple nucleons in a single, highly energetic projectile-target collision. Unlike the far-less-dissipative, surface-grazing reactions usually exploited for the in-beam γ-ray spectroscopy of rare isotopes, these more energetic collisions appear to offer a practical pathway to nuclear-structure studies of more complex multiparticle configurations in rare isotopes-final states conventionally thought to be out of reach with high-luminosity fast-beam-induced reactions.

COVID-19 in hospitalized lung and non-lung solid organ transplant recipients: A comparative analysis from a multicenter study

Lung transplant recipients (LTR) with coronavirus disease 2019 (COVID-19) may have higher mortality than non-lung solid organ transplant recipients (SOTR), but direct comparisons are limited. Risk factors for mortality specifically in LTR have not been explored. We performed a multicenter cohort study of adult SOTR with COVID-19 to compare mortality by 28 days between hospitalized LTR and non-lung SOTR. Multivariable logistic regression models were used to assess comorbidity-adjusted mortality among LTR vs. non-lung SOTR and to determine risk factors for death in LTR. Of 1,616 SOTR with COVID-19, 1,081 (66%) were hospitalized including 120/159 (75%) LTR and 961/1457 (66%) non-lung SOTR (p = .02). Mortality was higher among LTR compared to non-lung SOTR (24% vs. 16%, respectively, p = .032), and lung transplant was independently associated with death after adjusting for age and comorbidities (aOR 1.7, 95% CI 1.0-2.6, p = .04). Among LTR, chronic lung allograft dysfunction (aOR 3.3, 95% CI 1.0-11.3, p = .05) was the only independent risk factor for mortality and age >65 years, heart failure and obesity were not independently associated with death. Among SOTR hospitalized for COVID-19, LTR had higher mortality than non-lung SOTR. In LTR, chronic allograft dysfunction was independently associated with mortality.

New ^{59}Fe Stellar Decay Rate with Implications for the ^{60}Fe Radioactivity in Massive Stars

The discrepancy between observations from γ-ray astronomy of the ^{60}Fe/^{26}Al γ-ray flux ratio and recent calculations is an unresolved puzzle in nuclear astrophysics. The stellar β-decay rate of ^{59}Fe is one of the major nuclear uncertainties impeding us from a precise prediction. The important Gamow-Teller strengths from the low-lying states in ^{59}Fe to the ^{59}Co ground state are measured for the first time using the exclusive measurement of the ^{59}Co(t,^{3}He+γ)^{59}Fe charge-exchange reaction. The new stellar decay rate of ^{59}Fe is a factor of 3.5±1.1 larger than the currently adopted rate at T=1.2  GK. Stellar evolution calculations show that the ^{60}Fe production yield of an 18 solar mass star is decreased significantly by 40% when using the new rate. Our result eliminates one of the major nuclear uncertainties in the predicted yield of ^{60}Fe and alleviates the existing discrepancy of the ^{60}Fe/^{26}Al ratio.

Exploiting Isospin Symmetry to Study the Role of Isomers in Stellar Environments

Proton capture on the excited isomeric state of ^{26}Al strongly influences the abundance of ^{26}Mg ejected in explosive astronomical events and, as such, plays a critical role in determining the initial content of radiogenic ^{26}Al in presolar grains. This reaction also affects the temperature range for thermal equilibrium between the ground and isomeric levels. We present a novel technique, which exploits the isospin symmetry of the nuclear force, to address the long-standing challenge of determining proton-capture rates on excited nuclear levels. Such a technique has in-built tests that strongly support its veracity and, for the first time, we have experimentally constrained the strengths of resonances that dominate the astrophysical ^{26m}Al(p,γ)^{27}Si reaction. These constraints demonstrate that the rate is at least a factor ∼8 lower than previously expected, indicating an increase in the stellar production of ^{26}Mg and a possible need to reinvestigate sensitivity studies involving the thermal equilibration of ^{26}Al.

Shape Changes in the N=28 Island of Inversion: Collective Structures Built on Configuration-Coexisting States in ^{43}S

The neutron-rich nuclei in the N=28 island of inversion have attracted considerable experimental and theoretical attention, providing great insight into the evolution of shell structure and nuclear shape in exotic nuclei. In this work, for the first time, quadrupole collectivity is assessed simultaneously on top of the 3/2^{-} ground state and the 7/2^{-} shape-coexisting isomer of ^{43}S, putting the unique interpretation of shape and configuration coexistence at N=27 and 28 in the sulfur isotopic chain to the test. From an analysis of the electromagnetic transition strengths and quadrupole moments predicted within the shell model, it is shown that the onset of shape coexistence and the emergence of a simple collective structure appear suddenly in ^{43}S with no indication of such patterns in the N=27 isotone ^{45}Ar.

Publisher's Note: Direct Lifetime Measurements of the Excited States in ^{72}Ni [Phys. Rev. Lett. 116, 122502 (2016)]

This corrects the article DOI: 10.1103/PhysRevLett.116.122502.

Establishing the Maximum Collectivity in Highly Deformed N=Z Nuclei

The lifetimes of the first excited 2^{+} states in the N=Z nuclei ^{80}Zr, ^{78}Y, and ^{76}Sr have been measured using the γ-ray line shape method following population via nucleon-knockout reactions from intermediate-energy rare-isotope beams. The extracted reduced electromagnetic transition strengths yield new information on where the collectivity is maximized and provide evidence for a significant, and as yet unexplained, odd-odd vs even-even staggering in the observed values. The experimental results are analyzed in the context of state-of-the-art nuclear density-functional model calculations.

Amyloid cardiomyopathy in a large integrated health care system

BACKGROUND

Light Chain (AL) and transthyretin (ATTR) amyloidosis are the most common forms of amyloid cardiomyopathy. Population based studies describing the epidemiology and clinical features of amyloid cardiomyopathy are often based in tertiary medical centers and thus may be limited by referral bias.

METHODS AND RESULTS

We performed a cohort study of 198 patients diagnosed and treated in the Kaiser Permanente Northern California health care system who had a confirmed diagnosis of cardiac amyloidosis between 2001 and 2016. Associations between demographic, clinical, laboratory and imaging data and patient outcomes were quantified using multivariable Cox proportional hazard models for both the AL and ATTR groups. The average length of follow up was 2.8 years (SD 2.9 years) and overall survival was 69.1 percent at one year and 35.4 percent at five years. In the AL group, lower left ventricular ejection fraction (HR 1.33 per 5-point decrease, P < .001), coronary artery disease (HR 3.56, P < .001), and diabetes mellitus (HR 3.19, P < .001) were associated with all-cause mortality. Increasing age at the time of diagnosis with associated with higher all-cause mortality in both the AL and ATTR groups. Higher levels of B-type natriuretic peptide were associated with all-cause mortality in both groups: Top quartile BNP HR 6.17, P < .001 for AL and HR 8.16, P = .002 for ATTR.

CONCLUSIONS

This study describes a large cohort of patients with amyloid cardiomyopathy derived from a community based, integrated healthcare system and describes demographic, clinical, and laboratory characteristics associated with mortality and heart failure hospitalization. In this population, coronary artery disease, diabetes mellitus, and high BNP levels were strongly associated with mortality.

Constraining the Neutron Star Compactness: Extraction of the ^{23}Al(p,γ) Reaction Rate for the rp Process

The ^{23}Al(p,γ)^{24}Si reaction is among the most important reactions driving the energy generation in type-I x-ray bursts. However, the present reaction-rate uncertainty limits constraints on neutron star properties that can be achieved with burst model-observation comparisons. Here, we present a novel technique for constraining this important reaction by combining the GRETINA array with the neutron detector LENDA coupled to the S800 spectrograph at the National Superconducting Cyclotron Laboratory. The ^{23}Al(d,n) reaction was used to populate the astrophysically important states in ^{24}Si. This enables a measurement in complete kinematics for extracting all relevant inputs necessary to calculate the reaction rate. For the first time, a predicted close-lying doublet of a 2_{2}^{+} and (4_{1}^{+},0_{2}^{+}) state in ^{24}Si was disentangled, finally resolving conflicting results from two previous measurements. Moreover, it was possible to extract spectroscopic factors using GRETINA and LENDA simultaneously. This new technique may be used to constrain other important reaction rates for various astrophysical scenarios.

Is the Structure of ^{42}Si Understood?

A more detailed test of the implementation of nuclear forces that drive shell evolution in the pivotal nucleus ^{42}Si-going beyond earlier comparisons of excited-state energies-is important. The two leading shell-model effective interactions, SDPF-MU and SDPF-U-Si, both of which reproduce the low-lying ^{42}Si(2_{1}^{+}) energy, but whose predictions for other observables differ significantly, are interrogated by the population of states in neutron-rich ^{42}Si with a one-proton removal reaction from ^{43}P projectiles at 81  MeV/nucleon. The measured cross sections to the individual ^{42}Si final states are compared to calculations that combine eikonal reaction dynamics with these shell-model nuclear structure overlaps. The differences in the two shell-model descriptions are examined and linked to predicted low-lying excited 0^{+} states and shape coexistence. Based on the present data, which are in better agreement with the SDPF-MU calculations, the state observed at 2150(13) keV in ^{42}Si is proposed to be the (0_{2}^{+}) level.

Enhanced Electric Dipole Strength for the Weakly Bound States in ^{27}Ne

An enhanced low-energy electric dipole (E1) strength is identified for the weakly bound excited states of the neutron-rich isotope ^{27}Ne. The Doppler-shift lifetime measurements employing a combination of the γ-ray tracking array GRETINA, the plunger device, and the S800 spectrograph determine the lower limit of 0.030  e^{2} fm^{2} or 0.052 W.u. for the 1/2^{+}→3/2^{-}  E1 transition in ^{27}Ne, representing one of the strongest E1 strengths observed among the bound discrete states in this mass region. This value is at least 30 times larger than that measured for the 3/2^{-} decay to the 3/2_{gs}^{+} ground state. A comparison of the present results to large-scale shell-model calculations points to an important role of core excitations and deformation in the observed E1 enhancement, suggesting a novel example of the electric dipole modes manifested in weakly bound deformed systems.

Localizing the Shape Transition in Neutron-Deficient Selenium

Neutron-deficient selenium isotopes are thought to undergo a rapid shape change from a prolate deformation near the line of beta stability towards oblate deformation around the line of N=Z. The point at which this shape change occurs is unknown, with inconsistent predictions from available theoretical models. A common feature in the models is the delicate nature of the point of transition, with the introduction of even a modest spin to the system sufficient to change the ordering of the prolate and oblate configurations. We present a measurement of the quadrupole moment of the first-excited state in radioactive ^{72}Se-a potential point of transition-by safe Coulomb excitation. This is the first low-energy Coulomb excitation to be performed with a rare-isotope beam at the reaccelerated beam facility at the National Superconducting Cyclotron Laboratory. By demonstrating a negative spectroscopic quadrupole moment for the first-excited 2^{+} state, it is found that any low-spin shape change in neutron-deficient selenium does not occur until ^{70}Se.

Lifetime Measurements and Triple Coexisting Band Structure in ^{43}S

Lifetime measurements of excited states in the neutron-rich nucleus ^{43}S were performed by applying the recoil-distance method on fast rare-isotope beams in conjunction with the Gamma-Ray Energy Tracking In-beam Nuclear Array. The new data based on γγ coincidences and lifetime measurements resolve a doublet of (3/2^{-}) and (5/2^{-}) states at low excitation energies. Results were compared to the π(sd)-ν(pf) shell model and antisymmetrized molecular dynamics calculations. The consistency with the theoretical calculations identifies a possible appearance of three coexisting bands near the ground state of ^{43}S: the K^{π}=1/2^{-} band built on a prolate-deformed ground state, a band built on an isomer with a 1f_{7/2}^{-1} character, and a suggested excited band built on a newly discovered doublet state. The latter further confirms the collapse of the N=28 shell closure in the neutron-rich region.

Observation of the Isovector Giant Monopole Resonance via the ^{28}Si(^{10}Be,^{10}B^{*}[1.74 MeV]) Reaction at 100 AMeV

The (^{10}Be,^{10}B^{*}[1.74  MeV]) charge-exchange reaction at 100  AMeV is presented as a new probe for isolating the isovector (ΔT=1) nonspin-transfer (ΔS=0) response of nuclei, with ^{28}Si being the first nucleus studied. By using a secondary ^{10}Be beam produced by fast fragmentation of ^{18}O nuclei at the NSCL Coupled Cyclotron Facility, applying the dispersion-matching technique with the S800 magnetic spectrometer to determine the excitation energy in ^{28}Al, and performing high-resolution γ-ray tracking with the Gamma-Ray Energy Tracking In-beam Nuclear Array (GRETINA) to identify the 1022-keV γ ray associated with the decay from the 1.74-MeV T=1 isobaric analog state in ^{10}B, a ΔS=0 excitation-energy spectrum in ^{28}Al was extracted. Monopole and dipole contributions were determined through a multipole-decomposition analysis, and the isovector giant dipole resonance and isovector giant monopole resonance (IVGMR) were identified. The results show that this probe is a powerful tool for studying the elusive IVGMR, which is of interest for performing stringent tests of modern density functional theories at high excitation energies and for constraining the bulk properties of nuclei and nuclear matter. The extracted distributions were compared with theoretical calculations based on the normal-modes formalism and the proton-neutron relativistic time-blocking approximation. Calculated cross sections based on these strengths underestimate the data by about a factor of 2, which likely indicates deficiencies in the reaction calculations based on the distorted wave Born approximation.

Isomeric Character of the Lowest Observed 4^{+} State in ^{44}S

Previous experiments observed a 4^{+} state in the N=28 nucleus ^{44}S and suggested that this state may exhibit a hindered E2-decay rate, inconsistent with being a member of the collective ground state band. We populate this state via two-proton knockout from a beam of exotic ^{46}Ar projectiles and measure its lifetime using the recoil distance method with the GRETINA γ-ray spectrometer. The result, 76(14)_{stat}(20)_{syst}  ps, implies a hindered transition of B(E2;4^{+}→2_{1}^{+})=0.61(19) single-particle or Weisskopf units strength and supports the interpretation of the 4^{+} state as a K=4 isomer, the first example of a high-K isomer in a nucleus of such low mass.

Isospin Symmetry at High Spin Studied via Nucleon Knockout from Isomeric States

One-neutron knockout reactions have been performed on a beam of radioactive ^{53}Co in a high-spin isomeric state. The analysis is shown to yield a highly selective population of high-spin states in an exotic nucleus with a significant cross section, and hence represents a technique that is applicable to the planned new generation of fragmentation-based radioactive beam facilities. Additionally, the relative cross sections among the excited states can be predicted to a high level of accuracy when reliable shell-model input is available. The work has resulted in a new level scheme, up to the 11^{+} band-termination state, of the proton-rich nucleus ^{52}Co (Z=27, N=25). This has in turn enabled a study of mirror energy differences in the A=52 odd-odd mirror nuclei, interpreted in terms of isospin-nonconserving (INC) forces in nuclei. The analysis demonstrates the importance of using a full set of J-dependent INC terms to explain the experimental observations.

Direct Lifetime Measurements of the Excited States in (72)Ni

The lifetimes of the first excited 2^{+} and 4^{+} states in ^{72}Ni were measured at the National Superconducting Cyclotron Laboratory with the recoil-distance Doppler-shift method, a model-independent probe to obtain the reduced transition probability. Excited states in ^{72}Ni were populated by the one-proton knockout reaction of an intermediate energy ^{73}Cu beam. γ-ray-recoil coincidences were detected with the γ-ray tracking array GRETINA and the S800 spectrograph. Our results provide evidence of enhanced transition probability B(E2;2^{+}→0^{+}) as compared to ^{68}Ni, but do not confirm the trend of large B(E2) values reported in the neighboring isotope ^{70}Ni obtained from Coulomb excitation measurement. The results are compared to shell model calculations. The lifetime obtained for the excited 4_{1}^{+} state is consistent with models showing decay of a seniority ν=4, 4^{+} state, which is consistent with the disappearance of the 8^{+} isomer in ^{72}Ni.

Circulating cell-free DNA enables noninvasive diagnosis of heart transplant rejection

Monitoring allograft health is an important component of posttransplant therapy. Endomyocardial biopsy is the current gold standard for cardiac allograft monitoring but is an expensive and invasive procedure. Proof of principle of a universal, noninvasive diagnostic method based on high-throughput screening of circulating cell-free donor-derived DNA (cfdDNA) was recently demonstrated in a small retrospective cohort. We present the results of a prospective cohort study (65 patients, 565 samples) that tested the utility of cfdDNA in measuring acute rejection after heart transplantation. Circulating cell-free DNA was purified from plasma and sequenced (mean depth, 1.2 giga-base pairs) to quantify the fraction of cfdDNA. Through a comparison with endomyocardial biopsy results, we demonstrate that cfdDNA enables diagnosis of acute rejection after heart transplantation, with an area under the receiver operating characteristic curve of 0.83 and sensitivity and specificity that are comparable to the intrinsic performance of the biopsy itself. This noninvasive genome transplant dynamics approach is a powerful and informative method for routine monitoring of allograft health without incurring the risk, discomfort, and expense of an invasive biopsy.

Quadrupole transition strength in the (74)Ni nucleus and core polarization effects in the neutron-rich Ni isotopes

The reduced transition probability B(E2;0(+)→2(+)) has been measured for the neutron-rich nucleus (74)Ni in an intermediate energy Coulomb excitation experiment performed at the National Superconducting Cyclotron Laboratory at Michigan State University. The obtained B(E2;0(+)→2(+))=642(-226)(+216)  e(2) fm(4) value defines a trend which is unexpectedly small if referred to (70)Ni and to a previous indirect determination of the transition strength in (74)Ni. This indicates a reduced polarization of the Z=28 core by the valence neutrons. Calculations in the pfgd model space reproduce well the experimental result indicating that the B(E2) strength predominantly corresponds to neutron excitations. The ratio of the neutron and proton multipole matrix elements supports such an interpretation.

Determining the rp-process flow through 56Ni: resonances in 57Cu(p,γ)58Zn identified with GRETINA

An approach is presented to experimentally constrain previously unreachable (p, γ) reaction rates on nuclei far from stability in the astrophysical rp process. Energies of all critical resonances in the (57)Cu(p,γ)(58)Zn reaction are deduced by populating states in (58)Zn with a (d, n) reaction in inverse kinematics at 75 MeV/u, and detecting γ-ray-recoil coincidences with the state-of-the-art γ-ray tracking array GRETINA and the S800 spectrograph at the National Superconducting Cyclotron Laboratory. The results reduce the uncertainty in the (57)Cu(p,γ) reaction rate by several orders of magnitude. The effective lifetime of (56)Ni, an important waiting point in the rp process in x-ray bursts, can now be determined entirely from experimentally constrained reaction rates.

β+ Gamow-Teller transition strengths from 46Ti and stellar electron-capture rates

The Gamow-Teller strength in the β(+) direction to (46)Sc was extracted via the (46)Ti(t,(3)He + γ) reaction at 115  MeV/u. The γ-ray coincidences served to precisely measure the very weak Gamow-Teller transition to a final state at 991 keV. Although this transition is weak, it is crucial for accurately estimating electron-capture rates in astrophysical scenarios with relatively low stellar densities and temperatures, such as presupernova stellar evolution. Shell-model calculations with different effective interactions in the pf shell-model space do not reproduce the experimental Gamow-Teller strengths, which is likely due to sd-shell admixtures. Calculations in the quasiparticle random phase approximation that are often used in astrophysical simulations also fail to reproduce the experimental Gamow-Teller strength distribution, leading to strongly overestimated electron-capture rates. Because reliable theoretical predictions of Gamow-Teller strengths are important for providing astrophysical electron-capture reaction rates for a broad set of nuclei in the lower pf shell, we conclude that further theoretical improvements are required to match astrophysical needs.

Evolution of collectivity in 72Kr: evidence for rapid shape transition

The transition rates from the yrast 2+ and 4+ states in the self-conjugate 72Kr nucleus were studied via lifetime measurements employing the GRETINA array with a novel application of the recoil-distance method. The large collectivity observed for the 4+→2+ transition suggests a prolate character of the excited states. The reduced collectivity previously reported for the 2+→0+ transition was confirmed. The irregular behavior of collectivity points to the occurrence of a rapid oblate-prolate shape transition in 72Kr, providing stringent tests for advanced theories to describe the shape coexistence and its evolution.

Nuclear structure towards N = 40 60Ca: in-beam γ-ray spectroscopy of 58,60Ti

Excited states in the neutron-rich N = 38, 36 nuclei (60)Ti and (58)Ti were populated in nucleon-removal reactions from (61)V projectiles at 90 MeV/nucleon. The γ-ray transitions from such states in these Ti isotopes were detected with the advanced γ-ray tracking array GRETINA and were corrected event by event for large Doppler shifts (v/c ∼ 0.4) using the γ-ray interaction points deduced from online signal decomposition. The new data indicate that a steep decrease in quadrupole collectivity occurs when moving from neutron-rich N = 36, 38 Fe and Cr toward the Ti and Ca isotones. In fact, (58,60)Ti provide some of the most neutron-rich benchmarks accessible today for calculations attempting to determine the structure of the potentially doubly magic nucleus (60)Ca.

Mirror energy differences at large isospin studied through direct two-nucleon knockout

The first spectroscopy of excited states in 52Ni (T(z)=-2) and 51Co (T(z)=-3/2) has been obtained using the highly selective two-neutron knockout reaction. Mirror energy differences between isobaric analogue states in these nuclei and their mirror partners are interpreted in terms of isospin nonconserving effects. A comparison between large-scale shell-model calculations and data provides the most compelling evidence to date that both electromagnetic and an additional isospin nonconserving interactions for J=2 couplings, of unknown origin, are required to obtain good agreement.

Quadrupole collectivity in neutron-rich Fe and Cr isotopes

Intermediate-energy Coulomb excitation measurements are performed on the N ≥ 40 neutron-rich nuclei (66,68)Fe and (64)Cr. The reduced transition matrix elements providing a direct measure of the quadrupole collectivity B(E2;2(1)(+) → 0(1)(+)) are determined for the first time in (68)Fe(42) and (64)Cr(40) and confirm a previous recoil distance method lifetime measurement in (66)Fe(40). The results are compared to state-of-the-art large-scale shell-model calculations within the full fpgd neutron orbital model space using the Lenzi-Nowacki-Poves-Sieja effective interaction and confirm the results of the calculations that show these nuclei are well deformed.

Correlations in intermediate energy two-proton removal reactions

We report final-state-exclusive measurements of the light charged fragments in coincidence with (26)Ne residual nuclei following the direct two-proton removal from a neutron-rich (28)Mg secondary beam. A Dalitz-plot analysis and comparisons with simulations show that a majority of the triple-coincidence events with two protons display phase-space correlations consistent with the (two-body) kinematics of a spatially correlated pair-removal mechanism. The fraction of such correlated events, 56(12)%, is consistent with the fraction of the calculated cross section, 64%, arising from spin S=0 two-proton configurations in the entrance-channel (shell-model) (28)Mg ground state wave function. This result promises access to an additional and more specific probe of the spin and spatial correlations of valence nucleon pairs in exotic nuclei produced as fast secondary beams.

Clinical and functional correlates of early microvascular dysfunction after heart transplantation

BACKGROUND

Microvascular dysfunction is emerging as a strong predictor of outcome in heart transplant recipients. At this time, the determinants and consequences of early microvascular dysfunction are not well established. The objective of the study was to determine the risk factors and functional correlates associated with early microvascular dysfunction in heart transplant recipients.

METHODS AND RESULTS

Sixty-three heart transplant recipients who had coronary physiology assessment, right heart catheterization, and echocardiography performed at the time of their first annual evaluation were included in the study. Microvascular dysfunction was assessed using the recently described index of microcirculatory resistance. The presence of microvascular dysfunction, predefined by an index of microcirculatory resistance >20, was observed in 46% of patients at 1 year. A history of acute rejection and undersized donor hearts were associated with microvascular dysfunction at 1 year, with odds ratio of 4.0 (1.3-12.8) and 3.6 (1.2-11.1), respectively. Patients with microvascular dysfunction had lower cardiac index (3.1±0.7 versus 3.5±0.7 L/min per m(2); P=0.02) and mild graft dysfunction measured by echocardiography-derived left and right myocardial performance indices ([0.54±0.09 versus 0.43±0.09; P<0.01] and [0.47±0.14 versus 0.32±0.05; P<0.01], respectively). Microvascular dysfunction was also associated with a higher likelihood of death, graft failure, or allograft vasculopathy at 5 years after transplant (hazard ratio, 2.52 [95% CI, 1.04-5.91]).

CONCLUSIONS

A history of acute rejection during the first year and smaller donor hearts were identified as risk factors for early microvascular dysfunction. Microvascular dysfunction assessed using index of microcirculatory resistances at 1 year was also associated with worse graft function and possibly worse clinical outcomes.

Quadrupole collectivity beyond N = 28: intermediate-energy Coulomb excitation of (47,48)Ar

We report on the first experimental study of quadrupole collectivity in the very neutron-rich nuclei (47,48)Ar using intermediate-energy Coulomb excitation. These nuclei are located along the path from doubly magic Ca to collective S and Si isotopes, a critical region of shell evolution and structural change. The deduced B(E2) transition strengths are confronted with large-scale shell-model calculations in the sdpf shell using the state-of-the-art SDPF-Uand EPQQM effective interactions. The comparison between experiment and theory indicates that a shell-model description of Ar isotopes around N=28 remains a challenge.

Probing configuration mixing in 12Be with Gamow-Teller transition strengths

We present a novel technique for studying the quenching of shell gaps in exotic isotopes. The method is based on extracting Gamow-Teller (ΔL=0, ΔS=1) transition strengths [B(GT)] to low-lying states from charge-exchange reactions at intermediate beam energies. These Gamow-Teller strengths are very sensitive to configuration mixing between cross-shell orbitals, and this technique thus provides an important complement to other tools currently used to study cross-shell mixing. This work focuses on the N=8 shell gap. We populated the ground and 2.24 MeV 0+ states in 12Be using the 12B(1+) (7Li, 7Be) reaction at 80  MeV/u in inverse kinematics. Using the ground-state B(GT) value from β-decay measurements (0.184±0.007) as a calibration, the B(GT) for the transition to the second 0+ state was determined to be 0.214±0.051. Comparing the extracted Gamow-Teller strengths with shell-model calculations, it was determined that the wave functions of the first and second 0+ states in 12Be are composed of 25±5% and 60±5% (0s)4(0p)8 configurations, respectively.

Exploring the low-Z shore of the island of inversion at n=19

The technique of invariant mass spectroscopy has been used to measure, for the first time, the ground state energy of neutron-unbound (28)F, determined to be a resonance in the (27)F+n continuum at 220(50) keV. States in (28)F were populated by the reactions of a 62 MeV/u (29)Ne beam impinging on a 288 mg/cm(2) beryllium target. The measured (28)F ground state energy is in good agreement with USDA/USDB shell model predictions, indicating that pf shell intruder configurations play only a small role in the ground state structure of (28)F and establishing a low-Z boundary of the island of inversion for N=19 isotones.

Lifetime measurement of the 2(1)+ state in 20C

Establishing how and when large N/Z values require modified or new theoretical tools is a major quest in nuclear physics. Here we report the first measurement of the lifetime of the 2(1)+ state in the near-dripline nucleus 20C. The deduced value of τ(2(1)+)=9.8±2.8(stat)(-1.1)(+0.5)(syst)  ps gives a reduced transition probability of B(E2; 2(1)+→0(g.s.)+)=7.5(-1.7)(+3.0)(stat)(-0.4)(+1.0)(syst)  e2  fm4 in good agreement with a shell model calculation using isospin-dependent effective charges.

Knockout reactions from p-shell nuclei: tests of ab initio structure models

Absolute cross sections have been determined following single neutron knockout reactions from 10Be and 10C at intermediate energy. Nucleon density distributions and bound-state wave function overlaps obtained from both variational Monte Carlo (VMC) and no core shell model (NCSM) ab initio calculations have been incorporated into the theoretical description of knockout reactions. Comparison to experimental cross sections demonstrates that the VMC approach, with the inclusion of 3-body forces, provides the best overall agreement while the NCSM and conventional shell-model calculations both overpredict the cross sections by 20% to 30% for 10Be and by 40% to 50% for 10C, respectively. This study gains new insight into the importance of 3-body forces and continuum effects in light nuclei and provides a sensitive technique to assess the accuracy of ab initio calculations for describing these effects.

Enhanced quadrupole collectivity at N = 40: the case of neutron-rich Fe isotopes

The transition rates for the 2(1)+ states in (62,64,66)Fe were studied using the recoil distance Doppler-shift technique applied to projectile Coulomb excitation reactions. The deduced E2 strengths illustrate the enhanced collectivity of the neutron-rich Fe isotopes up to N = 40. The results are interpreted using the generalized concept of valence proton symmetry which describes the evolution of nuclear structure around N = 40 as governed by the number of valence protons with respect to Z ≈ 30. The trend of collectivity suggested by the experimental data is described by state-of-the-art shell-model calculations with a new effective interaction developed for the fpgd valence space.

34P(7Li,7Be+γ) reaction at 100A MeV in inverse kinematics

We report on the first successful extraction of a β+ Gamow-Teller strength distribution from a radioactive isotope in an intermediate-energy charge-exchange experiment in inverse kinematics. The (7Li,7Be+γ(429  keV)) reaction at 100A  MeV was used to measure Gamow-Teller transition strengths from 34P to states in 34Si. The results show that little mixing occurs between sd and pf shell configurations for the low-lying 0+ and 2+ states even though 34Si neighbors the island of inversion and low-lying 2ℏω intruder states exist. Shell-model calculations in the sdpf model space are consistent with these findings.

In-beam gamma-ray spectroscopy of very neutron-rich nuclei: excited states in 46S and 48Ar

We report on the first in-beam gamma-ray spectroscopy study of the very neutron-rich nucleus 46S. The N=30 isotones 46S and 48Ar were produced in a novel way in two steps that both necessarily involve nucleon exchange and neutron pickup reactions 9Be(48Ca,48K)X followed by 9Be(48K,48Ar+gamma)X at 85.7 MeV/u midtarget energy and 9Be(48Ca,46Cl)X followed by 9Be(46Cl,46S+gamma)X at 87.0 MeV/u midtarget energy, respectively. The results are compared to large-scale shell-model calculations in the sd-pf shell using the SDPF-NR effective interaction and Z-dependent modifications.

Intruder configurations in the A=33 isobars: 33Mg and 33Al

The beta decay of 33Mg (N=21) presented in this Letter reveals intruder configurations in both the parent and the daughter nucleus. The lowest excited states in the N=20 daughter nucleus, 33Al, are found to have nearly 2p-2h intruder configuration, thus extending the "island of inversion" beyond Mg. The allowed direct beta-decay branch to the 5/2{+} ground state of the daughter nucleus 33Al implies positive parity for the ground state of the parent 33Mg, contrary to an earlier suggestion of negative parity from a g-factor measurement. An admixture of 1p-1h and 3p-3h configurations is proposed for the ground state of 33Mg to explain all of the experimental observables.

0(gs)+ -->2(1)+ transition strengths in 106Sn and 108Sn

The reduced transition probabilities, B(E2; 0(gs)+ -->2(1)+), have been measured in the radioactive isotopes (108,106)Sn using subbarrier Coulomb excitation at the REX-ISOLDE facility at CERN. Deexcitation gamma rays were detected by the highly segmented MINIBALL Ge-detector array. The results, B(E2;0(gs)+ -->2(1)+)=0.222(19)e2b2 for 108Sn and B(E2; 0(gs)+-->2(1)+)=0.195(39)e2b2 for 106Sn were determined relative to a stable 58Ni target. The resulting B(E2) values are approximately 30% larger than shell-model predictions and deviate from the generalized seniority model. This experimental result may point towards a weakening of the N=Z=50 shell closure.

Coulomb excitation of neutron-rich Zn isotopes: first observation of the 2(1)+ state in 80Zn

Neutron-rich, radioactive Zn isotopes were investigated at the Radioactive Ion Beam facility REX-ISOLDE (CERN) using low-energy Coulomb excitation. The energy of the 2(1)+ state in 78Zn could be firmly established and for the first time the 2+ --> 0(1)+ transition in 80Zn was observed at 1492(1) keV. B(E2,2(1)+ --> 0(1)+) values were extracted for (74,76,78,80)Zn and compared to large scale shell model calculations. With only two protons outside the Z=28 proton core, 80Zn is the lightest N=50 isotone for which spectroscopic information has been obtained to date. Two sets of advanced shell model calculations reproduce the observed B(E2) systematics. The results for N=50 isotones indicate a good N=50 shell closure and a strong Z=28 proton core polarization. The new results serve as benchmarks to establish theoretical models, predicting the nuclear properties of the doubly magic nucleus 78Ni.