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Objective: Liver stiffness measurement (LSM) is a tool used to screen for significant fibrosis and portal hypertension. The aim of this retrospective multicentre study was to develop an easy tool using LSM for clinical outcomes in advanced chronic liver disease (ACLD) patients.
Design: This international multicentre cohort study included a derivation ACLD patient cohort with valid two-dimensional shear wave elastography (2D-SWE) results. Clinical and laboratory parameters at baseline and during follow-up were recorded. LSM by transient elastography (TE) was also recorded if available. The primary outcome was overall mortality. The secondary outcome was the development of first/further decompensation.
Results: After screening 2148 patients (16 centres), 1827 patients (55 years, 62.4% men) were included in the 2D-SWE cohort, with median liver SWE (L-SWE) 11.8 kPa and a model for end stage liver disease (MELD) score of 8. Combination of MELD score and L-SWE predict independently of mortality (AUC 0.8). L-SWE cut-off at ≥20 kPa combined with MELD ≥10 could stratify the risk of mortality and first/further decompensation in ACLD patients. The 2-year mortality and decompensation rates were 36.9% and 61.8%, respectively, in the 305 (18.3%) high-risk patients (with L-SWE ≥20 kPa and MELD ≥10), while in the 944 (56.6%) low-risk patients, these were 1.1% and 3.5%, respectively. Importantly, this M10LS20 algorithm was validated by TE-based LSM and in an additional cohort of 119 patients with valid point shear SWE-LSM.
Conclusion: The M10LS20 algorithm allows risk stratification of patients with ACLD. Patients with L-SWE ≥20 kPa and MELD ≥10 should be followed closely and receive intensified care, while patients with low risk may be managed at longer intervals.
The STAR collaboration presents jet substructure measurements related to both the momentum fraction and the opening angle within jets in p+p and Au+Au collisions at sNN−−−√=200 GeV. The substructure observables include SoftDrop groomed momentum fraction (zg), groomed jet radius (Rg), and subjet momentum fraction ((zSJ)) and opening angle ((θSJ)). The latter observable is introduced for the first time. Fully corrected subjet measurements are presented for p+p collisions and are compared to leading order Monte Carlo models. The subjet θSJ distributions reflect the jets leading opening angle and are utilized as a proxy for the resolution scale of the medium in Au+Au collisions. We compare data from Au+Au collisions to those from p+p which are embedded in minimum-bias Au+Au events in order to include the effects of detector smearing and the heavy-ion collision underlying event. The subjet observables are shown to be more robust to the background than zg and (Rg).
We observe no significant modifications of the subjet observables within the two highest-energy, back-to-back jets, resulting in a distribution of opening angles and the splittings that are vacuum-like. We also report measurements of the differential di-jet momentum imbalance (AJ) for jets of varying θg. We find no qualitative differences in energy loss signatures for varying angular scales in the range 0.1<θSJ<0.3, leading to the possible interpretation that energy loss in this population of high momentum di-jet pairs, is due to soft medium-induced gluon radiation from a single color-charge as it traverses the medium.
We report measurements of the longitudinal double-spin asymmetry, ALL, for inclusive jet and dijet production in polarized proton-proton collisions at midrapidity and center-of-mass energy s√ = 510 GeV, using the high luminosity data sample collected by the STAR experiment in 2013. These measurements complement and improve the precision of previous STAR measurements at the same center-of-mass energy that probe the polarized gluon distribution function at partonic momentum fraction 0.015 ≲x≲ 0.25. The dijet asymmetries are separated into four jet-pair topologies, which provide further constraints on the x dependence of the polarized gluon distribution function. These measurements are in agreement with previous STAR measurements and with predictions from current next-to-leading order global analyses. They provide more precise data at low dijet invariant mass that will better constraint the shape of the polarized gluon distribution function of the proton.
Measurement of cold nuclear matter effects for inclusive J/ψ in p+Au collisions at √sNN = 200 GeV
(2021)
Measurement by the STAR experiment at RHIC of the cold nuclear matter (CNM) effects experienced by inclusive J/ψ at mid-rapidity in p+Au collisions at sNN−−−√ = 200 GeV is presented. Such effects are quantified utilizing the nuclear modification factor, RpAu, obtained by taking a ratio of J/ψ yield in p+Au collisions to that in p+p collisions scaled by the number of binary nucleon-nucleon collisions. The differential J/ψ yield in both p+p and p+Au collisions is measured through the dimuon decay channel, taking advantage of the trigger capability provided by the Muon Telescope Detector in the RHIC 2015 run. Consequently, the J/ψ RpAu is derived within the transverse momentum (pT) range of 0 to 10 GeV/c. A suppression of approximately 30% is observed for pT<2 GeV/c, while J/ψ RpAu becomes compatible with unity for pT greater than 3 GeV/c, indicating the J/ψ yield is minimally affected by the CNM effects at high pT. Comparison to a similar measurement from 0-20% central Au+Au collisions reveals that the observed strong J/ψ suppression above 3 Gev/c is mostly due to the hot medium effects, providing strong evidence for the formation of the quark-gluon plasma in these collisions. Several model calculations show qualitative agreement with the measured J/ψ RpAu, while their agreement with the J/ψ yield in p+p and p+Au collisions is worse.
We report precision measurements of hypernuclei 3ΛH and 4ΛH lifetimes obtained from Au+Au collisions at \snn = 3.0\,GeV and 7.2\,GeV collected by the STAR experiment at RHIC, and the first measurement of 3ΛH and 4ΛH mid-rapidity yields in Au+Au collisions at \snn = 3.0\,GeV. The lifetimes are measured to be 221±15(stat.)±19(syst.)\,ps for 3ΛH and 218±6(stat.)±13(syst.)\,ps for 4ΛH. The pT-integrated yields of 3ΛH and 4ΛH are presented in different centrality and rapidity intervals. It is observed that the shape of the rapidity distribution of 4ΛH is different for 0--10\% and 10--50\% centrality collisions. Thermal model calculations, using the canonical ensemble for strangeness, describes the 3ΛH yield well, while underestimating the 4ΛH yield. Transport models, combining baryonic mean-field and coalescence (JAM) or utilizing dynamical cluster formation via baryonic interactions (PHQMD) for light nuclei and hypernuclei production, approximately describe the measured 3ΛH and 4ΛH yields.
Einleitung : Eine sinnvolle Einbindung von Pflegefachpersonen mit Hochschulabschluss in die Versorgungsabläufe wird international häufig mit besseren Behandlungsergebnissen bei den Patient*innen assoziiert. In Deutschland fehlt es derzeit noch an verlässlichen Zahlen über Absolvent*innen und deren Aufgabenfeldern. Ziel dieser Erhebung war daher, durch Wiederholung einer früheren Erhebung erneut den Anteil von Pflegefachpersonen mit Bachelor- oder Masterabschlüssen in der direkten Patient*innenversorgung zu ermitteln.
Methode: In einer Querschnittserhebung wurden die Pflegedirektor*innen der Universitätskliniken und Medizinischen Hochschulen (UK) Deutschlands mittels einer standardisierten Befragung nach der Anzahl der Pflegefachpersonen mit Hochschulabschlüssen (Bachelor, Master und Doktor) gefragt. Weitere Fragen betrafen deren Aufgabengebiete und Integrationsmaßnahmen. Die Daten wurden mittels deskriptiver Statistik ausgewertet.
Ergebnisse: Insgesamt konnten n = 29 gültige Fragebögen aus 35 UK in die Analyse eingeschlossen werden, daraus ergibt sich eine Rücklaufquote von 82,85%. Für insgesamt 18 UK konnte eine Steigerung der hochschulisch qualifizierten Pflegefachpersonen um n = 786, von 2015 (n = 593) auf 2018 (n = 1379) erreicht werden. Der Anteil an Pflegefachpersonen mit Hochschulabschluss in den teilnehmenden UK liegt bei 3,16% (SD = 1,66; Min - Max = 1,09 - 6,69; Q1 - Q3 = 1,49 - 4,04; 95% KI = 2,30 – 3,95). In der direkten Versorgung beträgt der Anteil 2,11% (SD = 1,40; Min – Max = 0,47 - 5,42; Q1 – Q3 = 0,87 – 3,16; 95% KI 1,36 - 2,76). Die Aufgabenschwerpunkte liegen im Bereich der Regelversorgung und Patient*innenedukation (Bachelorabsolvent*innen), der evidenzbasierten Pflegepraxisentwicklung (Masterabsolvent*innen) und Forschung (promovierte Absolvent*innen).
Diskussion: Im Vergleich zu 2015 ist der Anteil hochschulisch qualifizierter Pflegefachpersonen zwar angestiegen, doch er liegt immer noch auf einem sehr niedrigen Niveau. Die Hochschulabsolvent*innen nehmen versorgungs- und entwicklungsrelevante Aufgaben wahr, doch besteht hinsichtlich ihrer Aufgabengebiete Bedarf an kompetenzorientierter Differenzierung.
We present the first inclusive measurements of the invariant and SoftDrop jet mass in proton-proton collisions at s√=200 GeV at STAR. The measurements are fully corrected for detector effects, and reported differentially in both the jet transverse momentum and jet radius parameter. We compare the measurements to established leading-order Monte Carlo event generators and find that STAR-tuned PYTHIA-6 reproduces the data, while LHC tunes of PYTHIA-8 and HERWIG-7 do not agree with the data, providing further constraints on parameter tuning. Finally, we observe that SoftDrop grooming, for which the contribution of wide-angle non-perturbative radiation is suppressed, shifts the jet mass distributions into closer agreement with the partonic jet mass as determined by both PYTHIA-8 and a next-to-leading-logarithmic accuracy perturbative QCD calculation. These measurements complement recent LHC measurements in a different kinematic region, as well as establish a baseline for future jet mass measurements in heavy-ion collisions at RHIC.
Glecaprevir/pibrentasvir, a pangenotypic, direct-acting antiviral combination approved for chronic hepatitis C virus treatment, has limited real-world evidence supporting 8-week therapy in compensated cirrhosis. We investigated effectiveness and safety of 187 hepatitis C virus-infected, treatment-naïve, patients with compensated cirrhosis receiving 8-week glecaprevir/pibrentasvir therapy in the German Hepatitis C-Registry between 2 August 2017 and 1 January 2020. Sustained virologic response was 98.4% (127/129) in the per-protocol analysis (excluding patients lost to follow-up or who discontinued treatment due to compliance) and was 85.8% (127/148) in patients with data available in an intention-to-treat analysis. Nineteen patients were lost to follow-up; nine genotype 3 patients, nine nongenotype 3 patients and one mixed genotype patient. One patient relapsed, and one died, unrelated to treatment. Adverse events (>5%) were fatigue and headache. Two serious adverse events occurred; no adverse events resulted in drug discontinuation. An 8-week glecaprevir/pibrentasvir therapy was effective and well-tolerated in this real-world analysis.
We report a new measurement of the production cross section for inclusive electrons from open heavy-flavor hadron decays as a function of transverse momentum (pT) at mid-rapidity (|y|< 0.7) in p+p collisions at s√=200 GeV. The result is presented for 2.5 <pT< 10 GeV/c with an improved precision at high pT with respect to the previous measurements, and thus provides a better constraint on perturbative QCD calculations. Moreover, this measurement also provides a high-precision reference for measurements of nuclear modification factors for inclusive electrons from open-charm and -bottom hadron decays in heavy-ion collisions.
In high-energy heavy-ion collisions, partonic collectivity is evidenced by the constituent quark number scaling of elliptic flow anisotropy for identified hadrons. A breaking of this scaling and dominance of baryonic interactions is found for identified hadron collective flow measurements in sNN−−−√ = 3 GeV Au+Au collisions. In this paper, we report measurements of the first-order and second-order azimuthal anisotropic parameters, v1 and v2, of light nuclei (d, t, 3He, 4He) produced in sNN−−−√ = 3 GeV Au+Au collisions at the STAR experiment. An atomic mass number scaling is found in the measured v1 slopes of light nuclei at mid-rapidity. For the measured v2 magnitude, a strong rapidity dependence is observed. Unlike v2 at higher collision energies, the v2 values at mid-rapidity for all light nuclei are negative and no scaling is observed with the atomic mass number. Calculations by the Jet AA Microscopic Transport Model (JAM), with baryonic mean-field plus nucleon coalescence, are in good agreement with our observations, implying baryonic interactions dominate the collective dynamics in 3 GeV Au+Au collisions at RHIC.
We report a systematic measurement of cumulants, Cn, for net-proton, proton and antiproton multiplicity distributions, and correlation functions, κn, for proton and antiproton multiplicity distributions up to the fourth order in Au+Au collisions at sNN−−−√ = 7.7, 11.5, 14.5, 19.6, 27, 39, 54.4, 62.4 and 200 GeV. The Cn and κn are presented as a function of collision energy, centrality and kinematic acceptance in rapidity, y, and transverse momentum, pT. The data were taken during the first phase of the Beam Energy Scan (BES) program (2010 -- 2017) at the BNL Relativistic Heavy Ion Collider (RHIC) facility. The measurements are carried out at midrapidity (|y|< 0.5) and transverse momentum 0.4 < pT < 2.0 GeV/c, using the STAR detector at RHIC. We observe a non-monotonic energy dependence (sNN−−−√ = 7.7 -- 62.4 GeV) of the net-proton C4/C2 with the significance of 3.1σ for the 0-5\% central Au+Au collisions. This is consistent with the expectations of critical fluctuations in a QCD-inspired model. Thermal and transport model calculations show a monotonic variation with sNN−−−√. For the multiparticle correlation functions, we observe significant negative values for a two-particle correlation function, κ2, of protons and antiprotons, which are mainly due to the effects of baryon number conservation. Furthermore, it is found that the four-particle correlation function, κ4, of protons plays a role in determining the energy dependence of proton C4/C1 below 19.6 GeV, which cannot be understood by the effect of baryon number conservation.
We report a systematic measurement of cumulants, Cn, for net-proton, proton and antiproton, and correlation functions, κn, for proton and antiproton multiplicity distributions up to the fourth order in Au+Au collisions at sNN−−−√ = 7.7, 11.5, 14.5, 19.6, 27, 39, 54.4, 62.4 and 200 GeV. The Cn and κn are presented as a function of collision energy, centrality and kinematic acceptance in rapidity, y, and transverse momentum, pT. The data were taken during the first phase of the Beam Energy Scan (BES) program (2010 -- 2017) at the Relativistic Heavy Ion Collider (RHIC) facility. The measurements are carried out at midrapidity (|y|< 0.5) and transverse momentum 0.4 < pT < 2.0 GeV/c, using the STAR detector at RHIC. We observe a non-monotonic energy dependence (sNN−−−√ = 7.7 -- 62.4 GeV) of the net-proton C4/C2 with the significance of 3.1σ for the 0-5\% central Au+Au collisions. This is consistent with the expectations of critical fluctuations in a QCD-inspired model. Thermal and transport model calculations show a monotonic variation with sNN−−−√. For the multiparticle correlation functions, we observe significant negative values for a two-particle correlation function, κ2, of protons and antiprotons, which are mainly due to the effects of baryon number conservation. Furthermore, it is found that the four-particle correlation function, κ4, of protons plays a role in determining the energy dependence of proton C4/C1 below 19.6 GeV, which cannot be solely understood by the negative values of κ2 for protons.
We report on the first multi-differential measurement of ϕ meson and Ξ− hyperon production as well as the ϕ/K− and ϕ/Ξ− ratio in Au+Au collisions at sNN−−−√=3GeV with the STAR experiment under its fixed targ et configuration at RHIC. ϕ mesons and Ξ− hyperons are measured through their hadronic decay channels, ϕ→K+K− and Ξ−→Λπ−. The transverse kinetic energy spectra of K−, ϕ and Ξ− are presented in different centrality and rapidity intervals. The total production yields and the ratios within a 4π coverage are calculated and compared to thermal model predictions. A calculation within the grand canonical ensemble framework shows a clear discrepancy from our measurement. Our data favor the canonical ensemble approach employing local strangeness conservation with a small strangeness correlation length (rc≤4.2 fm) in 0--10\% central Au+Au collisions at sNN−−−√=3GeV.
We report the first multi-differential measurements of strange hadrons of K−, ϕ and Ξ− yields as well as the ratios of ϕ/K− and ϕ/Ξ− in Au+Au collisions at sNN−−−√=3GeV with the STAR experiment fixed target configuration at RHIC. The ϕ mesons and Ξ− hyperons are measured through hadronic decay channels, ϕ→K+K− and Ξ−→Λπ−. Collision centrality and rapidity dependence of the transverse spectra for these strange hadrons are presented. The 4π yields and ratios are compared to thermal model and hadronic transport model predictions. At the collision energy, thermal model with grand canonical ensemble (GCE) under-predicts the ϕ/K− ratio while the result of canonical ensemble (CE) calculations reproduce well the ratios of ϕ/K−, with the correlation length rc∼2.7\,fm, and ϕ/Ξ−, rc∼4.2\,fm, for the 0-10\% central collisions. Hadronic transport models including high mass resonance decays could also describe the ratios. While thermal calculations with GCE work well for strangeness production in high energy collisions, the change to CE at 3GeV implies a rather different medium property at high baryon density.
We report the first multi-differential measurements of strange hadrons of K−, ϕ and Ξ− yields as well as the ratios of ϕ/K− and ϕ/Ξ− in Au+Au collisions at sNN−−−√=3GeV with the STAR experiment fixed target configuration at RHIC. The ϕ mesons and Ξ− hyperons are measured through hadronic decay channels, ϕ→K+K− and Ξ−→Λπ−. Collision centrality and rapidity dependence of the transverse momentum spectra for these strange hadrons are presented. The 4π yields and ratios are compared to thermal model and hadronic transport model predictions. At this collision energy, thermal model with grand canonical ensemble (GCE) under-predicts the ϕ/K− ratio while the result of canonical ensemble (CE) calculations reproduce well the ratios of ϕ/K−, with the correlation length rc∼2.7\,fm, and ϕ/Ξ−, rc∼4.2\,fm, for the 0-10\% central collisions. Hadronic transport models including high mass resonance decays could also describe the ratios. While thermal calculations with GCE work well for strangeness production in high energy collisions, the change to CE at 3GeV implies a rather different medium property at high baryon density.
The chiral magnetic effect (CME) is predicted to occur as a consequence of a local violation of P and CP symmetries of the strong interaction amidst a strong electro-magnetic field generated in relativistic heavy-ion collisions. Experimental manifestation of the CME involves a separation of positively and negatively charged hadrons along the direction of the magnetic field. Previous measurements of the CME-sensitive charge-separation observables remain inconclusive because of large background contributions. In order to better control the influence of signal and backgrounds, the STAR Collaboration performed a blind analysis of a large data sample of approximately 3.8 billion isobar collisions of 9644Ru+9644Ru and 9640Zr+9640Zr at sNN−−−√=200 GeV. Prior to the blind analysis, the CME signatures are predefined as a significant excess of the CME-sensitive observables in Ru+Ru collisions over those in Zr+Zr collisions, owing to a larger magnetic field in the former. A precision down to 0.4% is achieved, as anticipated, in the relative magnitudes of the pertinent observables between the two isobar systems. Observed differences in the multiplicity and flow harmonics at the matching centrality indicate that the magnitude of the CME background is different between the two species. No CME signature that satisfies the predefined criteria has been observed in isobar collisions in this blind analysis.
Understanding gluon density distributions and how they are modified in nuclei are among the most important goals in nuclear physics. In recent years, diffractive vector meson production measured in ultra-peripheral collisions (UPCs) at heavy-ion colliders has provided a new tool for probing the gluon density. In this Letter, we report the first measurement of J/ψ photoproduction off the deuteron in UPCs at the center-of-mass energy sNN−−−√=200 GeV in d+Au collisions. The differential cross section as a function of momentum transfer −t is measured. In addition, data with a neutron tagged in the deuteron-going Zero-Degree Calorimeter is investigated for the first time, which is found to be consistent with the expectation of incoherent diffractive scattering at low momentum transfer. Theoretical predictions based on the Color Glass Condensate saturation model and the gluon shadowing model are compared with the data quantitatively. A better agreement with the saturation model has been observed. With the current measurement, the results are found to be directly sensitive to the gluon density distribution of the deuteron and the deuteron breakup, which provides insights into the nuclear gluonic structure.
The STAR Collaboration reports measurements of back-to-back azimuthal correlations of di-π0s produced at forward pseudorapidities (2.6<η<4.0) in p+p, p+Al, and p+Au collisions at a center-of-mass energy of 200 GeV. We observe a clear suppression of the correlated yields of back-to-back π0 pairs in p+Al and p+Au collisions compared to the p+p data. The observed suppression of back-to-back pairs as a function of event activity and transverse momentum suggests nonlinear gluon dynamics arising at high parton densities. The larger suppression found in p+Au relative to p+Al collisions exhibits a dependence of the saturation scale, Q2s, on the mass number, A. The suppression in high-activity p+Au collisions is consistent with theoretical predictions including gluon saturation effects.
Partons traversing the strongly interacting medium produced in heavy-ion collisions are expected to lose energy depending on their color charge and mass. We measure the nuclear modification factors for charm- and bottom-decay electrons, defined as the ratio of yields, scaled by the number of binary nucleon-nucleon collisions, in sNN−−−√ = 200 GeV Au+Au collisions to p+p collisions (RAA), or in central to peripheral Au+Au collisions (RCP). We find the bottom-decay electron RAA and RCP to be significantly higher than that of charm-decay electrons. Model calculations including mass-dependent parton energy loss in a strongly coupled medium are consistent with the measured data. These observations provide clear evidence of mass ordering of charm and bottom quark energy loss when traversing through the strongly coupled medium created in heavy-ion collisions.
Understanding how epigenetic variation in non-coding regions is involved in distal gene-expression regulation is an important problem. Regulatory regions can be associated to genes using large-scale datasets of epigenetic and expression data. However, for regions of complex epigenomic signals and enhancers that regulate many genes, it is difficult to understand these associations. We present StitchIt, an approach to dissect epigenetic variation in a gene-specific manner for the detection of regulatory elements (REMs) without relying on peak calls in individual samples. StitchIt segments epigenetic signal tracks over many samples to generate the location and the target genes of a REM simultaneously. We show that this approach leads to a more accurate and refined REM detection compared to standard methods even on heterogeneous datasets, which are challenging to model. Also, StitchIt REMs are highly enriched in experimentally determined chromatin interactions and expression quantitative trait loci. We validated several newly predicted REMs using CRISPR-Cas9 experiments, thereby demonstrating the reliability of StitchIt. StitchIt is able to dissect regulation in superenhancers and predicts thousands of putative REMs that go unnoticed using peak-based approaches suggesting that a large part of the regulome might be uncharted water.