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Sökning: WFRF:(Halpern H.)

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1.
  • Ruilope, LM, et al. (författare)
  • Design and Baseline Characteristics of the Finerenone in Reducing Cardiovascular Mortality and Morbidity in Diabetic Kidney Disease Trial
  • 2019
  • Ingår i: American journal of nephrology. - : S. Karger AG. - 1421-9670 .- 0250-8095. ; 50:5, s. 345-356
  • Tidskriftsartikel (refereegranskat)abstract
    • <b><i>Background:</i></b> Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. <b><i>Patients and</i></b> <b><i>Methods:</i></b> The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate ≥25 mL/min/1.73 m<sup>2</sup> and albuminuria (urinary albumin-to-creatinine ratio ≥30 to ≤5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level α = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. <b><i>Conclusions:</i></b> FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049.
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2.
  • Fenstermacher, M.E., et al. (författare)
  • DIII-D research advancing the physics basis for optimizing the tokamak approach to fusion energy
  • 2022
  • Ingår i: Nuclear Fusion. - : IOP Publishing. - 0029-5515 .- 1741-4326. ; 62:4
  • Tidskriftsartikel (refereegranskat)abstract
    • DIII-D physics research addresses critical challenges for the operation of ITER and the next generation of fusion energy devices. This is done through a focus on innovations to provide solutions for high performance long pulse operation, coupled with fundamental plasma physics understanding and model validation, to drive scenario development by integrating high performance core and boundary plasmas. Substantial increases in off-axis current drive efficiency from an innovative top launch system for EC power, and in pressure broadening for Alfven eigenmode control from a co-/counter-I p steerable off-axis neutral beam, all improve the prospects for optimization of future long pulse/steady state high performance tokamak operation. Fundamental studies into the modes that drive the evolution of the pedestal pressure profile and electron vs ion heat flux validate predictive models of pedestal recovery after ELMs. Understanding the physics mechanisms of ELM control and density pumpout by 3D magnetic perturbation fields leads to confident predictions for ITER and future devices. Validated modeling of high-Z shattered pellet injection for disruption mitigation, runaway electron dissipation, and techniques for disruption prediction and avoidance including machine learning, give confidence in handling disruptivity for future devices. For the non-nuclear phase of ITER, two actuators are identified to lower the L-H threshold power in hydrogen plasmas. With this physics understanding and suite of capabilities, a high poloidal beta optimized-core scenario with an internal transport barrier that projects nearly to Q = 10 in ITER at ∼8 MA was coupled to a detached divertor, and a near super H-mode optimized-pedestal scenario with co-I p beam injection was coupled to a radiative divertor. The hybrid core scenario was achieved directly, without the need for anomalous current diffusion, using off-axis current drive actuators. Also, a controller to assess proximity to stability limits and regulate β N in the ITER baseline scenario, based on plasma response to probing 3D fields, was demonstrated. Finally, innovative tokamak operation using a negative triangularity shape showed many attractive features for future pilot plant operation.
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4.
  • Abdo, A. A., et al. (författare)
  • FERMI LARGE AREA TELESCOPE DETECTION OF PULSED gamma-RAYS FROM THE VELA-LIKE PULSARS PSR J1048-5832 AND PSR J2229+6114
  • 2009
  • Ingår i: Astrophysical Journal. - 0004-637X .- 1538-4357. ; 706:2, s. 1331-1340
  • Tidskriftsartikel (refereegranskat)abstract
    • We report the detection of gamma-ray pulsations (>= 0.1GeV) from PSR J2229+ 6114 and PSR J1048-5832, the latter having been detected as a low-significance pulsar by EGRET. Data in the gamma-ray band were acquired by the Large Area Telescope (LAT) aboard the Fermi Gamma-ray Space Telescope, while the radio rotational ephemerides used to fold the gamma-ray light curves were obtained using the Green Bank Telescope, the Lovell telescope at Jodrell Bank, and the Parkes Telescope. The two young radio pulsars, located within the error circles of the previously unidentified EGRET sources 3EG J1048-5840 and 3EG J2227+6122, present spin-down characteristics similar to the Vela pulsar. PSR J1048-5832 shows two sharp peaks at phases 0.15 +/- 0.01 and 0.57 +/- 0.01 relative to the radio pulse confirming the EGRET light curve, while PSR J2229+ 6114 presents a very broad peak at phase 0.49 +/- 0.01. The gamma-ray spectra above 0.1 GeV of both pulsars are fit with power laws having exponential cutoffs near 3 GeV, leading to integral photon fluxes of (2.19 +/- 0.22 +/- 0.32) x 10(-7) cm(-2) s(-1) for PSR J1048-5832 and (3.77 +/- 0.22 +/- 0.44) x 10(-7) cm(-2) s(-1) for PSR J2229+6114. The first uncertainty is statistical and the second is systematic. PSR J1048-5832 is one of the two LAT sources whichwere entangled together as 3EG J1048-5840. These detections add to the growing number of young gamma-ray pulsars that make up the dominant population of GeV gamma-ray sources in the Galactic plane.
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5.
  • Abdo, A. A., et al. (författare)
  • Fermi Large Area Telescope Detection of Pulsed γ-rays from the Vela-like Pulsars PSR J1048–5832 and PSR J2229+6114
  • 2009
  • Ingår i: Astrophysical Journal. - 0004-637X .- 1538-4357. ; 706:2, s. 1331-1340
  • Tidskriftsartikel (refereegranskat)abstract
    • We report the detection of γ-ray pulsations (>=0.1 GeV) from PSR J2229+6114 and PSR J1048–5832, the latter having been detected as a low-significance pulsar by EGRET. Data in the γ-ray band were acquired by the Large Area Telescope (LAT) aboard the Fermi Gamma-ray Space Telescope, while the radio rotational ephemerides used to fold the γ-ray light curves were obtained using the Green Bank Telescope, the Lovell telescope at Jodrell Bank, and the Parkes Telescope. The two young radio pulsars, located within the error circles of the previously unidentified EGRET sources 3EG J1048–5840 and 3EG J2227+6122, present spin-down characteristics similar to the Vela pulsar. PSR J1048–5832 shows two sharp peaks at phases 0.15 ± 0.01 and 0.57 ± 0.01 relative to the radio pulse confirming the EGRET light curve, while PSR J2229+6114 presents a very broad peak at phase 0.49 ± 0.01. The γ-ray spectra above 0.1 GeV of both pulsars are fit with power laws having exponential cutoffs near 3 GeV, leading to integral photon fluxes of (2.19 ± 0.22 ± 0.32) × 10–7 cm–2 s–1 for PSR J1048–5832 and (3.77 ± 0.22 ± 0.44) × 10–7 cm–2 s–1 for PSR J2229+6114. The first uncertainty is statistical and the second is systematic. PSR J1048–5832 is one of the two LAT sources which were entangled together as 3EG J1048–5840. These detections add to the growing number of young γ-ray pulsars that make up the dominant population of GeV γ-ray sources in the Galactic plane.
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7.
  • Amiri, M., et al. (författare)
  • Periodic activity from a fast radio burst source
  • 2020
  • Ingår i: Nature. - : Springer Science and Business Media LLC. - 0028-0836 .- 1476-4687. ; 582:7812, s. 351-355
  • Tidskriftsartikel (refereegranskat)abstract
    • Fast radio bursts (FRBs) are bright, millisecond-duration radio transients originating from sources at extragalactic distances1, the origin of which is unknown. Some FRB sources emit repeat bursts, ruling out cataclysmic origins for those events2–4. Despite searches for periodicity in repeat burst arrival times on timescales from milliseconds to many days2,5–7, these bursts have hitherto been observed to appear sporadically and—although clustered8—without a regular pattern. Here we report observations of a 16.35 ± 0.15 day periodicity (or possibly a higher-frequency alias of that periodicity) from the repeating FRB 180916.J0158+65 detected by the Canadian Hydrogen Intensity Mapping Experiment Fast Radio Burst Project4,9. In 38 bursts recorded from 16 September 2018 to 4 February 2020 utc, we find that all bursts arrive in a five-day phase window, and 50 per cent of the bursts arrive in a 0.6-day phase window. Our results suggest a mechanism for periodic modulation either of the burst emission itself or through external amplification or absorption, and disfavour models invoking purely sporadic processes.
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8.
  • Archambault, S., et al. (författare)
  • Discovery of a New TeV Gamma-Ray Source : VER J0521+211
  • 2013
  • Ingår i: Astrophysical Journal. - 0004-637X .- 1538-4357. ; 776:2
  • Tidskriftsartikel (refereegranskat)abstract
    • We report the detection of a new TeV gamma-ray source, VER J0521+211, based on observations made with the VERITAS imaging atmospheric Cherenkov Telescope Array. These observations were motivated by the discovery of a cluster of >30 GeV photons in the first year of Fermi Large Area Telescope observations. VER J0521+211 is relatively bright at TeV energies, with a mean photon flux of (1.93 ± 0.13stat ± 0.78sys) × 10–11 cm–2 s–1 above 0.2 TeV during the period of the VERITAS observations. The source is strongly variable on a daily timescale across all wavebands, from optical to TeV, with a peak flux corresponding to ~0.3 times the steady Crab Nebula flux at TeV energies. Follow-up observations in the optical and X-ray bands classify the newly discovered TeV source as a BL Lac-type blazar with uncertain redshift, although recent measurements suggest z = 0.108. VER J0521+211 exhibits all the defining properties of blazars in radio, optical, X-ray, and gamma-ray wavelengths.
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9.
  • Clark, Andrew G., et al. (författare)
  • Evolution of genes and genomes on the Drosophila phylogeny
  • 2007
  • Ingår i: Nature. - : Springer Science and Business Media LLC. - 0028-0836 .- 1476-4687. ; 450:7167, s. 203-218
  • Tidskriftsartikel (refereegranskat)abstract
    • Comparative analysis of multiple genomes in a phylogenetic framework dramatically improves the precision and sensitivity of evolutionary inference, producing more robust results than single-genome analyses can provide. The genomes of 12 Drosophila species, ten of which are presented here for the first time (sechellia, simulans, yakuba, erecta, ananassae, persimilis, willistoni, mojavensis, virilis and grimshawi), illustrate how rates and patterns of sequence divergence across taxa can illuminate evolutionary processes on a genomic scale. These genome sequences augment the formidable genetic tools that have made Drosophila melanogaster a pre-eminent model for animal genetics, and will further catalyse fundamental research on mechanisms of development, cell biology, genetics, disease, neurobiology, behaviour, physiology and evolution. Despite remarkable similarities among these Drosophila species, we identified many putatively non-neutral changes in protein-coding genes, non-coding RNA genes, and cis-regulatory regions. These may prove to underlie differences in the ecology and behaviour of these diverse species.
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10.
  • Clavel, J., et al. (författare)
  • Steps toward determination of the size and structure of the broad-line region in active galactic nuclei. I. An 8 month campaign of monitoring NGC 5548 with IUE
  • 1991
  • Ingår i: Astrophysical Journal. - : American Astronomical Society. - 0004-637X .- 1538-4357. ; 366:1, s. 64-8181
  • Tidskriftsartikel (refereegranskat)abstract
    • The authors present emission-line and ultraviolet continuum observations of a type I Seyfert galaxy in which the time resolution is adequate for describing the character of variability. Using the IUE satellite, the nucleus of NGC 5548 was observed every 4 days for a period of 8 months. Its mean properties-continuum shape, line ratios-are not unusual for type I Seyfert galaxies, but it was found to be strongly variable. The ultraviolet continuum flux and broad emission line fluxes varied significantly, going through three large maxima and three deep minima. The great majority of all variations were well resolved in time. The data lend qualitative support to the view that photoionization by the nuclear continuum is responsible for driving the emission lines
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13.
  • Gephart, Jessica A., et al. (författare)
  • Scenarios for Global Aquaculture and Its Role in Human Nutrition
  • 2021
  • Ingår i: Reviews in Fisheries Science & Aquaculture. - : Informa UK Limited. - 2330-8249 .- 2330-8257. ; 29:1, s. 122-138
  • Forskningsöversikt (refereegranskat)abstract
    • Global demand for freshwater and marine foods (i.e., seafood) is rising and an increasing proportion is farmed. Aquaculture encompasses a range of species and cultivation methods, resulting in diverse social, economic, nutritional, and environmental outcomes. As a result, how aquaculture develops will influence human wellbeing and environmental health outcomes. Recognition of this has spurred a push for nutrition-sensitive aquaculture, which aims to benefit public health through the production of diverse, nutrient-rich seafood and enabling equitable access. This article explores plausible aquaculture futures and their role in nutrition security using a qualitative scenario approach. Two dimensions of economic development - the degree of globalization and the predominant economic development philosophy - bound four scenarios representing systems that are either localized or globalized, and orientated toward maximizing sectoral economic growth or to meeting environmental and equity dimensions of sustainability. The potential contribution of aquaculture in improving nutrition security is then evaluated within each scenario. While aquaculture could be nutrition-sensitive under any of the scenarios, its contribution to addressing health inequities is more likely in the economic and political context of a more globally harmonized trade environment and where economic policies are oriented toward social equity and environmental sustainability.
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14.
  • Tschandl, P., et al. (författare)
  • Comparison of the accuracy of human readers versus machine-learning algorithms for pigmented skin lesion classification: an open, web-based, international, diagnostic study
  • 2019
  • Ingår i: The Lancet Oncology. - 1470-2045 .- 1474-5488. ; 20:7, s. 938-947
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Whether machine-learning algorithms can diagnose all pigmented skin lesions as accurately as human experts is unclear. The aim of this study was to compare the diagnostic accuracy of state-of-the-art machine-learning algorithms with human readers for all clinically relevant types of benign and malignant pigmented skin lesions. Methods: For this open, web-based, international, diagnostic study, human readers were asked to diagnose dermatoscopic images selected randomly in 30-image batches from a test set of 1511 images. The diagnoses from human readers were compared with those of 139 algorithms created by 77 machine-learning labs, who participated in the International Skin Imaging Collaboration 2018 challenge and received a training set of 10 015 images in advance. The ground truth of each lesion fell into one of seven predefined disease categories: intraepithelial carcinoma including actinic keratoses and Bowen's disease; basal cell carcinoma; benign keratinocytic lesions including solar lentigo, seborrheic keratosis and lichen planus-like keratosis; dermatofibroma; melanoma; melanocytic nevus; and vascular lesions. The two main outcomes were the differences in the number of correct specific diagnoses per batch between all human readers and the top three algorithms, and between human experts and the top three algorithms. Findings: Between Aug 4, 2018, and Sept 30, 2018, 511 human readers from 63 countries had at least one attempt in the reader study. 283 (55·4%) of 511 human readers were board-certified dermatologists, 118 (23·1%) were dermatology residents, and 83 (16·2%) were general practitioners. When comparing all human readers with all machine-learning algorithms, the algorithms achieved a mean of 2·01 (95% CI 1·97 to 2·04; p<0·0001) more correct diagnoses (17·91 [SD 3·42] vs 19·92 [4·27]). 27 human experts with more than 10 years of experience achieved a mean of 18·78 (SD 3·15) correct answers, compared with 25·43 (1·95) correct answers for the top three machine algorithms (mean difference 6·65, 95% CI 6·06–7·25; p<0·0001). The difference between human experts and the top three algorithms was significantly lower for images in the test set that were collected from sources not included in the training set (human underperformance of 11·4%, 95% CI 9·9–12·9 vs 3·6%, 0·8–6·3; p<0·0001). Interpretation: State-of-the-art machine-learning classifiers outperformed human experts in the diagnosis of pigmented skin lesions and should have a more important role in clinical practice. However, a possible limitation of these algorithms is their decreased performance for out-of-distribution images, which should be addressed in future research. Funding: None. © 2019 Elsevier Ltd
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15.
  • Ade, P. A. R., et al. (författare)
  • A Constraint on Primordial B-modes from the First Flight of the Spider Balloon-borne Telescope
  • 2022
  • Ingår i: Astrophysical Journal. - : American Astronomical Society. - 0004-637X .- 1538-4357. ; 927:2
  • Tidskriftsartikel (refereegranskat)abstract
    • We present the first linear polarization measurements from the 2015 long-duration balloon flight of SPIDER, which is an experiment that is designed to map the polarization of the cosmic microwave background (CMB) on degree angular scales. The results from these measurements include maps and angular power spectra from observations of 4.8% of the sky at 95 and 150 GHz, along with the results of internal consistency tests on these data. While the polarized CMB anisotropy from primordial density perturbations is the dominant signal in this region of sky, Galactic dust emission is also detected with high significance. Galactic synchrotron emission is found to be negligible in the SPIDER bands. We employ two independent foreground-removal techniques to explore the sensitivity of the cosmological result to the assumptions made by each. The primary method uses a dust template derived from Planck data to subtract the Galactic dust signal. A second approach, which constitutes a joint analysis of SPIDER and Planck data in the harmonic domain, assumes a modified-blackbody model for the spectral energy distribution of the dust with no constraint on its spatial morphology. Using a likelihood that jointly samples the template amplitude and r parameter space, we derive 95% upper limits on the primordial tensor-to-scalar ratio from Feldman-Cousins and Bayesian constructions, finding r < 0.11 and r < 0.19, respectively. Roughly half the uncertainty in r derives from noise associated with the template subtraction. New data at 280 GHz from SPIDER´s second flight will complement the Planck polarization maps, providing powerful measurements of the polarized Galactic dust emission.
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16.
  • Bergman, A. S., et al. (författare)
  • 280 GHz Focal Plane Unit Design and Characterization for the SPIDER-2 Suborbital Polarimeter
  • 2018
  • Ingår i: Journal of Low Temperature Physics. - : Springer Science and Business Media LLC. - 0022-2291 .- 1573-7357. ; 193:5-6, s. 1075-1084
  • Tidskriftsartikel (refereegranskat)abstract
    • We describe the construction and characterization of the 280 GHz bolometric focal plane units (FPUs) to be deployed on the second flight of the balloon-borne SPIDER instrument. These FPUs are vital to SPIDER's primary science goal of detecting or placing an upper limit on the amplitude of the primordial gravitational wave signature in the cosmic microwave background (CMB) by constraining the B-mode contamination in the CMB from Galactic dust emission. Each 280 GHz focal plane contains a 16 x 16 grid of corrugated silicon feedhorns coupled to an array of aluminum-manganese transition-edge sensor (TES) bolometers fabricated on 150 mm diameter substrates. In total, the three 280 GHz FPUs contain 1530 polarization-sensitive bolometers (765 spatial pixels) optimized for the low loading environment in flight and read out by time-division SQUID multiplexing. In this paper, we describe the mechanical, thermal, and magnetic shielding architecture of the focal planes and present cryogenic measurements which characterize yield and the uniformity of several bolometer parameters. The assembled FPUs have high yields, with one array as high as 95% including defects from wiring and readout. We demonstrate high uniformity in device parameters, finding the median saturation power for each TES array to be similar to 3 pW at 300 mK with a less than 6% variation across each array at 1 sigma. These focal planes will be deployed alongside the 95 and 150 GHz telescopes in the SPIDER-2 instrument, slated to fly from McMurdo Station in Antarctica in December 2018.
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17.
  • Crona, Beatrice, et al. (författare)
  • Four ways blue foods can help achieve food system ambitions across nations
  • 2023
  • Ingår i: Nature. - : Springer Science and Business Media LLC. - 0028-0836 .- 1476-4687. ; 616:7955, s. 104-112
  • Tidskriftsartikel (refereegranskat)abstract
    • Blue foods, sourced in aquatic environments, are important for the economies, livelihoods, nutritional security and cultures of people in many nations. They are often nutrient rich1, generate lower emissions and impacts on land and water than many terrestrial meats2, and contribute to the health3, wellbeing and livelihoods of many rural communities4. The Blue Food Assessment recently evaluated nutritional, environmental, economic and justice dimensions of blue foods globally. Here we integrate these findings and translate them into four policy objectives to help realize the contributions that blue foods can make to national food systems around the world: ensuring supplies of critical nutrients, providing healthy alternatives to terrestrial meat, reducing dietary environmental footprints and safeguarding blue food contributions to nutrition, just economies and livelihoods under a changing climate. To account for how context-specific environmental, socio-economic and cultural aspects affect this contribution, we assess the relevance of each policy objective for individual countries, and examine associated co-benefits and trade-offs at national and international scales. We find that in many African and South American nations, facilitating consumption of culturally relevant blue food, especially among nutritionally vulnerable population segments, could address vitamin B12 and omega-3 deficiencies. Meanwhile, in many global North nations, cardiovascular disease rates and large greenhouse gas footprints from ruminant meat intake could be lowered through moderate consumption of seafood with low environmental impact. The analytical framework we provide also identifies countries with high future risk, for whom climate adaptation of blue food systems will be particularly important. Overall the framework helps decision makers to assess the blue food policy objectives most relevant to their geographies, and to compare and contrast the benefits and trade-offs associated with pursuing these objectives.
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18.
  • Filippini, J. P., et al. (författare)
  • In-Flight Gain Monitoring of SPIDER's Transition-Edge Sensor Arrays
  • 2022
  • Ingår i: Journal of Low Temperature Physics. - : Springer Science and Business Media LLC. - 0022-2291 .- 1573-7357. ; 209:3-4, s. 649-657
  • Tidskriftsartikel (refereegranskat)abstract
    • Experiments deploying large arrays of transition-edge sensors (TESs) often require a robust method to monitor gain variations with minimal loss of observing time. We propose a sensitive and non-intrusive method for monitoring variations in TES responsivity using small square waves applied to the TES bias. We construct an estimator for a TES's small-signal power response from its electrical response that is exact in the limit of strong electrothermal feedback. We discuss the application and validation of this method using flight data from SPIDER, a balloon-borne telescope that observes the polarization of the cosmic microwave background with more than 2000 TESs. This method may prove useful for future balloon- and space-based instruments, where observing time and ground control bandwidth are limited.
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19.
  • Gambrel, A. E., et al. (författare)
  • The XFaster Power Spectrum and Likelihood Estimator for the Analysis of Cosmic Microwave Background Maps
  • 2021
  • Ingår i: Astrophysical Journal. - : American Astronomical Society. - 0004-637X .- 1538-4357. ; 922:2
  • Tidskriftsartikel (refereegranskat)abstract
    • We present the XFaster analysis package, a fast, iterative angular power spectrum estimator based on a diagonal approximation to the quadratic Fisher matrix estimator. It uses Monte Carlo simulations to compute noise biases and filter transfer functions and is thus a hybrid of both Monte Carlo and quadratic estimator methods. In contrast to conventional pseudo-Cℓ–based methods, the algorithm described here requires a minimal number of simulations and does not require them to be precisely representative of the data to estimate accurate covariance matrices for the bandpowers. The formalism works with polarization-sensitive observations and also data sets with identical, partially overlapping, or independent survey regions. The method was first implemented for the analysis of BOOMERanG data and also used as part of the Planck analysis. Here we describe the full, publicly available analysis package, written in Python, as developed for the analysis of data from the 2015 flight of the Spider instrument. The package includes extensions for self-consistently estimating null spectra and estimating fits for Galactic foreground contributions. We show results from the extensive validation of XFaster using simulations and its application to the Spider data set.
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20.
  • Gualtieri, R., et al. (författare)
  • SPIDER : CMB Polarimetry from the Edge of Space
  • 2018
  • Ingår i: Journal of Low Temperature Physics. - : Springer Science and Business Media LLC. - 0022-2291 .- 1573-7357. ; 193:5-6, s. 1112-1121
  • Tidskriftsartikel (refereegranskat)abstract
    • SPIDER is a balloon-borne instrument designed to map the polarization of the millimeter-wave sky at large angular scales. Spider targets the B-mode signature of primordial gravitational waves in the cosmic microwave background (CMB), with a focus on mapping a large sky area with high fidelity at multiple frequencies. SPIDER's first long-duration balloon (LDB) flight in January 2015 deployed a total of 2400 antenna-coupled transition-edge sensors (TESs) at 90 GHz and 150 GHz. In this work we review the design and in-flight performance of the SPIDER instrument, with a particular focus on the measured performance of the detectors and instrument in a space-like loading and radiation environment. SPIDER's second flight in December 2018 will incorporate payload upgrades and new receivers to map the sky at 285 GHz, providing valuable information for cleaning polarized dust emission from CMB maps.
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21.
  • Leung, J. S.-Y., et al. (författare)
  • A Simulation-based Method for Correcting Mode Coupling in CMB Angular Power Spectra
  • 2022
  • Ingår i: Astrophysical Journal. - : American Astronomical Society. - 0004-637X .- 1538-4357. ; 928:2
  • Tidskriftsartikel (refereegranskat)abstract
    • Modern cosmic microwave background (CMB) analysis pipelines regularly employ complex time-domain filters, beam models, masking, and other techniques during the production of sky maps and their corresponding angular power spectra. However, these processes can generate couplings between multipoles from the same spectrum and from different spectra, in addition to the typical power attenuation. Within the context of pseudo-C-l based, MASTER-style analyses, the net effect of the time-domain filtering is commonly approximated by a multiplicative transfer function, F-l , that can fail to capture mode mixing and is dependent on the spectrum of the signal. To address these shortcomings, we have developed a simulation-based spectral correction approach that constructs a two-dimensional transfer matrix, J(ll'), which contains information about mode mixing in addition to mode attenuation. We demonstrate the application of this approach on data from the first flight of the Spider balloon-borne CMB experiment.
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22.
  • Nagy, J. M., et al. (författare)
  • A New Limit on CMB Circular Polarization from SPIDER
  • 2017
  • Ingår i: Astrophysical Journal. - : American Astronomical Society. - 0004-637X .- 1538-4357. ; 844:2
  • Tidskriftsartikel (refereegranskat)abstract
    • We present a new upper limit on cosmic microwave background (CMB) circular polarization from the 2015 flight of SPIDER, a balloon-borne telescope designed to search for B-mode linear polarization from cosmic inflation. Although the level of circular polarization in the CMB is predicted to be very small, experimental limits provide a valuable test of the underlying models. By exploiting the nonzero circular-to-linear polarization coupling of the half-wave plate polarization modulators, data from SPIDER's 2015 Antarctic flight provide a constraint on Stokes V at 95 and 150 GHz in the range 33 < l < 307. No other limits exist over this full range of angular scales, and SPIDER improves on the previous limit by several orders of magnitude, providing 95% C.L. constraints on l (l + 1)C-l(VV) /(2 pi) ranging from 141 to 255 mu K-2 at 150 GHz for a thermal CMB spectrum. As linear CMB polarization experiments become increasingly sensitive, the techniques described in this paper can be applied to obtain even stronger constraints on circular polarization.
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24.
  • Short, Rebecca E., et al. (författare)
  • Harnessing the diversity of small-scale actors is key to the future of aquatic food systems
  • 2021
  • Ingår i: Nature Food. - : Springer Science and Business Media LLC. - 2662-1355. ; 2:9, s. 733-741
  • Tidskriftsartikel (refereegranskat)abstract
    • Small-scale fisheries and aquaculture (SSFA) provide livelihoods for over 100 million people and sustenance for -1 billion people, particularly in the Global South. Aquatic foods are distributed through diverse supply chains, with the potential to be highly adaptable to stresses and shocks, but face a growing range of threats and adaptive challenges. Contemporary governance assumes homogeneity in SSFA despite the diverse nature of this sector. Here we use SSFA actor profiles to capture the key dimensions and dynamism of SSFA diversity, reviewing contemporary threats and exploring opportunities for the SSFA sector. The heuristic framework can inform adaptive governance actions supporting the diversity and vital roles of SSFA in food systems, and in the health and livelihoods of nutritionally vulnerable people-supporting their viability through appropriate policies whilst fostering equitable and sustainable food systems.
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25.
  • Sumaila, U. Rashid, et al. (författare)
  • WTO must ban harmful fisheries subsidies
  • 2021
  • Ingår i: Science. - : American Association for the Advancement of Science (AAAS). - 0036-8075 .- 1095-9203. ; 374:6567, s. 544-544
  • Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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26.
  • Tigchelaar, Michelle, et al. (författare)
  • The vital roles of blue foods in the global food system
  • 2022
  • Ingår i: Global Food Security. - : Elsevier BV. - 2211-9124. ; 33
  • Tidskriftsartikel (refereegranskat)abstract
    • Blue foods play a central role in food and nutrition security for billions of people and are a cornerstone of the livelihoods, economies, and cultures of many coastal and riparian communities. Blue foods are extraordinarily diverse, are often rich in essential micronutrients and fatty acids, and can often be produced in ways that are more environmentally sustainable than terrestrial animal-source foods. Capture fisheries constitute the largest wild-food resource for human extraction that would be challenging to replace. Yet, despite their unique value, blue foods have often been left out of food system analyses, policies, and investments. Here, we focus on three imperatives for realizing the potential of blue foods: (1) Bring blue foods into the heart of food system decision-making; (2) Protect and develop the potential of blue foods to help end malnutrition; and (3) Support the central role of small-scale actors in fisheries and aquaculture. Recognition of the importance of blue foods for food and nutrition security constitutes a critical justification to preserve the integrity and diversity of aquatic species and ecosystems.
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27.
  • Tschandl, P., et al. (författare)
  • Human-computer collaboration for skin cancer recognition
  • 2020
  • Ingår i: Nature Medicine. - : Springer Science and Business Media LLC. - 1078-8956 .- 1546-170X. ; 26, s. 1229-1234
  • Tidskriftsartikel (refereegranskat)abstract
    • The rapid increase in telemedicine coupled with recent advances in diagnostic artificial intelligence (AI) create the imperative to consider the opportunities and risks of inserting AI-based support into new paradigms of care. Here we build on recent achievements in the accuracy of image-based AI for skin cancer diagnosis to address the effects of varied representations of AI-based support across different levels of clinical expertise and multiple clinical workflows. We find that good quality AI-based support of clinical decision-making improves diagnostic accuracy over that of either AI or physicians alone, and that the least experienced clinicians gain the most from AI-based support. We further find that AI-based multiclass probabilities outperformed content-based image retrieval (CBIR) representations of AI in the mobile technology environment, and AI-based support had utility in simulations of second opinions and of telemedicine triage. In addition to demonstrating the potential benefits associated with good quality AI in the hands of non-expert clinicians, we find that faulty AI can mislead the entire spectrum of clinicians, including experts. Lastly, we show that insights derived from AI class-activation maps can inform improvements in human diagnosis. Together, our approach and findings offer a framework for future studies across the spectrum of image-based diagnostics to improve human-computer collaboration in clinical practice. A systematic evaluation of the value of AI-based decision support in skin tumor diagnosis demonstrates the superiority of human-computer collaboration over each individual approach and supports the potential of automated approaches in diagnostic medicine.
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28.
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29.
  • Abazajian, Kevork, et al. (författare)
  • CMB-S4 : Forecasting Constraints on Primordial Gravitational Waves
  • 2022
  • Ingår i: Astrophysical Journal. - : American Astronomical Society. - 0004-637X .- 1538-4357. ; 926:1
  • Tidskriftsartikel (refereegranskat)abstract
    • CMB-S4—the next-generation ground-based cosmic microwave background (CMB) experiment—is set to significantly advance the sensitivity of CMB measurements and enhance our understanding of the origin and evolution of the universe. Among the science cases pursued with CMB-S4, the quest for detecting primordial gravitational waves is a central driver of the experimental design. This work details the development of a forecasting framework that includes a power-spectrum-based semianalytic projection tool, targeted explicitly toward optimizing constraints on the tensor-to-scalar ratio, r, in the presence of Galactic foregrounds and gravitational lensing of the CMB. This framework is unique in its direct use of information from the achieved performance of current Stage 2–3 CMB experiments to robustly forecast the science reach of upcoming CMB-polarization endeavors. The methodology allows for rapid iteration over experimental configurations and offers a flexible way to optimize the design of future experiments, given a desired scientific goal. To form a closed-loop process, we couple this semianalytic tool with map-based validation studies, which allow for the injection of additional complexity and verification of our forecasts with several independent analysis methods. We document multiple rounds of forecasts for CMB-S4 using this process and the resulting establishment of the current reference design of the primordial gravitational-wave component of the Stage-4 experiment, optimized to achieve our science goals of detecting primordial gravitational waves for r > 0.003 at greater than 5σ, or in the absence of a detection, of reaching an upper limit of r < 0.001 at 95% CL.
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30.
  • Baron, J. S., et al. (författare)
  • Synthesis Centers as Critical Research Infrastructure
  • 2017
  • Ingår i: Bioscience. - : Oxford University Press (OUP). - 0006-3568 .- 1525-3244. ; 67:8, s. 750-759
  • Tidskriftsartikel (refereegranskat)abstract
    • Synthesis centers offer a unique amalgam of culture, infrastructure, leadership, and support that facilitates creative discovery on issues crucial to science and society. The combination of logistical support, postdoctoral or senior fellowships, complex data management, informatics and computing capability or expertise, and most of all, opportunity for group discussion and reflection lowers the "activation energy" necessary to promote creativity and the cross-fertilization of ideas. Synthesis centers are explicitly created and operated as community-oriented infrastructure, with scholarly directions driven by the ever-changing interests and needs of an open and inclusive scientific community. The last decade has seen a rise in the number of synthesis centers globally but also the end of core federal funding for several, challenging the sustainability of the infrastructure for this key research strategy. Here, we present the history and rationale for supporting synthesis centers, integrate insights arising from two decades of experience, and explore the challenges and opportunities for long-term sustainability.
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31.
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32.
  • Blenckner, Thorsten, et al. (författare)
  • The Baltic Health Index (BHI): Assessing the social-ecological status of the Baltic Sea
  • 2021
  • Ingår i: People and Nature. - : Wiley. - 2575-8314. ; 3:2, s. 359-375
  • Tidskriftsartikel (refereegranskat)abstract
    • Improving the health of coastal and open sea marine ecosystems represents a substantial challenge for sustainable marine resource management, since it requires balancing human benefits and impacts on the ocean. This challenge is often exacerbated by incomplete knowledge and lack of tools that measure ocean and coastal ecosystem health in a way that allows consistent monitoring of progress towards predefined management targets. The lack of such tools often limits capabilities to enact and enforce effective governance. We introduce the Baltic Health Index (BHI) as a transparent, collaborative and repeatable assessment tool. The Index complements existing, more ecological-oriented, approaches by including a human dimension on the status of the Baltic Sea, an ecosystem impacted by multiple anthropogenic pressures and governed by a multitude of comprehensive national and international policies. Using a large amount of social-ecological data available, we assessed the health of the Baltic Sea for nine goals that represent the status towards set targets, for example, clean waters, biodiversity, food provision, natural products extraction and tourism. Our results indicate that the overall health of the Baltic Sea is suboptimal (a score of 76 out of 100), and a substantial effort is required to reach the management objectives and associated targets. Subregionally, the lowest BHI scores were measured for carbon storage, contaminants and lasting special places (i.e. marine protected areas), albeit with large spatial variation. Overall, the likely future status of all goals in the BHI averaged for the entire Baltic Sea is better than the present status, indicating a positive trend towards a healthier Baltic Sea. However, in some Baltic Sea basins, the trend for specific goals was decreasing, highlighting locations and issues that should be the focus of management priorities. The BHI outcomes can be used to identify both pan-Baltic and subregional scale management priorities and to illustrate the interconnectedness between goals linked by cumulative pressures. Hence, the information provided by the BHI tool and its further development will contribute towards the fulfilment of the UN Agenda 2030 and its Sustainability Development Goals. A free Plain Language Summary can be found within the Supporting Information of this article. A free Plain Language Summary can be found within the Supporting Information of this article.
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33.
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34.
  • Cohen, R. V., et al. (författare)
  • Effect of Gastric Bypass vs Best Medical Treatment on Early-Stage Chronic Kidney Disease in Patients With Type 2 Diabetes and Obesity A Randomized Clinical Trial
  • 2020
  • Ingår i: Jama Surgery. - : American Medical Association (AMA). - 2168-6254. ; 155:8
  • Tidskriftsartikel (refereegranskat)abstract
    • IMPORTANCE Early-stage chronic kidney disease (CKD) characterized by microalbuminuria is associated with future cardiovascular events, progression toward end-stage renal disease, and early mortality in patients with type 2 diabetes. OBJECTIVE To compare the albuminuria-lowering effects of Roux-en-Y gastric bypass (RYGB) surgery vs best medical treatment in patients with early-stage CKD, type 2 diabetes, and obesity. DESIGN, SETTING, AND PARTICIPANTS For this randomized clinical trial, patients with established type 2 diabetes and microalbuminuria were recruited from a single center from April 1, 2013, through March 31, 2016, with a 5-year follow-up, including prespecified intermediate analysis at 24-month follow-up. INTERVENTION A total of 100 patients with type 2 diabetes, obesity (body mass indexes of 30 to 35 [calculated as weight in kilograms divided by height in meters squared]), and stage G1 to G3 and A2 to A3 CKD (urinary albumin-creatinine ratio [uACR] >30 mg/g and estimated glomerular filtration rate >30 mL/min) were randomized 1:1 to receive best medical treatment (n = 49) or RYGB (n = 51). MAIN OUTCOMES AND MEASURES The primary outcome was remission of albuminuria (uACR <30 mg/g). Secondary outcomes were CKD remission rate, absolute change in uACR, metabolic control, other microvascular complications, quality of life, and safety. RESULTS A total of 100 patients (mean [SD] age, 51.4 [7.6] years; 55 [55%] male) were randomized: 51 to RYGB and 49 to best medical care. Remission of albuminuria occurred in 55% of patients (95% CI, 39%-70%) after best medical treatment and 82% of patients (95% CI, 72%-93%) after RYGB (P = .006), resulting in CKD remission rates of 48% (95% CI, 32%-64%) after best medical treatment and 82% (95% CI, 72%-92%) after RYGB (P = .002). The geometric mean uACRs were 55% lower after RYGB (10.7 mg/g of creatinine) than after best medical treatment (23.6 mg/g of creatinine) (P < .001). No difference in the rate of serious adverse events was observed. CONCLUSIONS AND RELEVANCE After 24 months, RYGB was more effective than best medical treatment for achieving remission of albuminuria and stage G1 to G3 and A2 to A3 CKD in patients with type 2 diabetes and obesity.
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35.
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36.
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37.
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38.
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39.
  • Kritz, A.H., et al. (författare)
  • PTRANSP: Predictive Integrated Tokamak Modeling
  • 2009
  • Ingår i: 36th European Physical Society Conference on Plasma Physics 2009, EPS 2009; Sofia; Bulgaria; 29 June 2009 through 3 July 2009. - 9781622763368 ; 33E, s. 905-908
  • Konferensbidrag (refereegranskat)
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40.
  • Liopyris, Konstantinos, et al. (författare)
  • Expert agreement on the presence and spatial localization of melanocytic features in dermoscopy.
  • 2023
  • Ingår i: The Journal of investigative dermatology. - 1523-1747. ; 144:3
  • Tidskriftsartikel (refereegranskat)abstract
    • Dermoscopy aids in melanoma detection; however, agreement on dermoscopic features, including those of high clinical relevance, remains poor. Herein we attempted to evaluate agreement among experts on 'exemplar images' not only for the presence of melanocytic-specific features but also for spatial localization. This was a cross-sectional, multicenter, observational study. Dermoscopy images exhibiting at least one of 31 melanocytic-specific features were submitted by 25 world experts as 'exemplars'. Using a web-based platform that allows for image mark-up of specific contrast-defined regions (superpixels), 20 expert readers annotated 248 dermoscopic images in collections of 62 images. Each collection was reviewed by five independent readers. A total of 4,507 feature observations were performed. Good-to-excellent agreement was found for 14 of 31 features (45.2%), with 8 achieving excellent agreement (Gwet's AC >0.75) and 7 of them being melanoma-specific features. These features were: 'Peppering /Granularity' (0.91); 'Shiny White Streaks' (0.89); 'Typical Pigment network' (0.83); 'Blotch Irregular' (0.82); 'Negative Network' (0.81); 'Irregular Globules' (0.78); 'Dotted Vessels' (0.77) and 'Blue Whitish Veil' (0.76). By utilizing an exemplar dataset, good-to-excellent agreement was found for 14 features that have previously been shown useful in discriminating nevi from melanoma. All images are public (www.isic-archive.com) and can be used for education, scientific communication and machine learning experiments.
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41.
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42.
  • Ogishi, M, et al. (författare)
  • Impaired IL-23-dependent induction of IFN-γ underlies mycobacterial disease in patients with inherited TYK2 deficiency
  • 2022
  • Ingår i: The Journal of experimental medicine. - : Rockefeller University Press. - 1540-9538 .- 0022-1007. ; 219:10
  • Tidskriftsartikel (refereegranskat)abstract
    • Human cells homozygous for rare loss-of-expression (LOE) TYK2 alleles have impaired, but not abolished, cellular responses to IFN-α/β (underlying viral diseases in the patients) and to IL-12 and IL-23 (underlying mycobacterial diseases). Cells homozygous for the common P1104A TYK2 allele have selectively impaired responses to IL-23 (underlying isolated mycobacterial disease). We report three new forms of TYK2 deficiency in six patients from five families homozygous for rare TYK2 alleles (R864C, G996R, G634E, or G1010D) or compound heterozygous for P1104A and a rare allele (A928V). All these missense alleles encode detectable proteins. The R864C and G1010D alleles are hypomorphic and loss-of-function (LOF), respectively, across signaling pathways. By contrast, hypomorphic G996R, G634E, and A928V mutations selectively impair responses to IL-23, like P1104A. Impairment of the IL-23–dependent induction of IFN-γ is the only mechanism of mycobacterial disease common to patients with complete TYK2 deficiency with or without TYK2 expression, partial TYK2 deficiency across signaling pathways, or rare or common partial TYK2 deficiency specific for IL-23 signaling.
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43.
  • Osherson, B., et al. (författare)
  • Particle Response of Antenna-Coupled TES Arrays : Results from SPIDER and the Laboratory
  • 2020
  • Ingår i: Journal of Low Temperature Physics. - : Springer Science and Business Media LLC. - 0022-2291 .- 1573-7357. ; 199:3-4, s. 1127-1136
  • Tidskriftsartikel (refereegranskat)abstract
    • Future mm-wave and sub-mm space missions will employ large arrays of multiplexed transition-edge-sensor (TES) bolometers. Such instruments must contend with the high flux of cosmic rays beyond our atmosphere that induce 'glitches' in bolometer data, which posed a challenge to data analysis from the Planck bolometers. Future instruments will face the additional challenges of shared substrate wafers and multiplexed readout wiring. In this work, we explore the susceptibility of modern TES arrays to the cosmic ray environment of space using two data sets: the 2015 long-duration balloon flight of the SPIDER cosmic microwave background polarimeter, and a laboratory exposure of SPIDER flight hardware to radioactive sources. We find manageable glitch rates and short glitch durations, leading to minimal effect on SPIDER analysis. We constrain energy propagation within the substrate through a study of multi-detector coincidences and give a preliminary look at pulse shapes in laboratory data.
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44.
  • Pittman, S. J., et al. (författare)
  • Seascape ecology : identifying research priorities for an emerging ocean sustainability science
  • 2021
  • Ingår i: Marine Ecology Progress Series. - : INTER-RESEARCH. - 0171-8630 .- 1616-1599. ; 663, s. 1-29
  • Tidskriftsartikel (refereegranskat)abstract
    • Seascape ecology, the marine-centric counterpart to landscape ecology, is rapidly emerging as an interdisciplinary and spatially explicit ecological science with relevance to marine management, bio-diversity conservation, and restoration. While important progress in this field has been made in the past decade, there has been no coherent prioritisation of key research questions to help set the future research agenda for seascape ecology. We used a 2-stage modified Delphi method to solicit applied research questions from academic experts in seascape ecology and then asked respondents to identify priority questions across 9 interrelated research themes using 2 rounds of selection. We also invited senior management/conservation practitioners to prioritise the same research questions. Analyses highlighted congruence and discrepancies in perceived priorities for applied research. Themes related to both ecological concepts and management practice, and those identified as priorities include seascape change, seascape connectivity, spatial and temporal scale, ecosystem-based management, and emerging technologies and metrics. Highest-priority questions (upper tercile) received 50% agreement between respondent groups, and lowest priorities (lower tercile) received 58% agreement. Across all 3 priority tiers, 36 of the 55 questions were within a +/- 10% band of agreement. We present the most important applied research questions as determined by the proportion of votes received. For each theme, we provide a synthesis of the research challenges and the potential role of seascape ecology. These priority questions and themes serve as a roadmap for advancing applied seascape ecology during, and beyond, the UN Decade of Ocean Science for Sustainable Development (2021-2030).
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45.
  • Russo, Teresa, et al. (författare)
  • Indications for Digital Monitoring of Patients With Multiple Nevi: Recommendations from the International Dermoscopy Society
  • 2022
  • Ingår i: Dermatology Practical and Conceptual. - : Mattioli1885. - 2160-9381. ; 12
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: In patients with multiple nevi, sequential imaging using total body skin photography (TBSP) coupled with digital dermoscopy (DD) documentation reduces unnecessary excisions and improves the early detection of melanoma. Correct patient selection is essential for optimizing the efficacy of this diagnostic approach. Objectives: The purpose of the study was to identify, via expert consensus, the best indications for TBSP and DD follow-up. Methods: This study was performed on behalf of the International Dermoscopy Society (IDS). We attained consensus by using an e-Delphi methodology. The panel of participants included international experts in dermoscopy. In each Delphi round, experts were asked to select from a list of indications for TBSP and DD. Results: Expert consensus was attained after 3 rounds of Delphi. Participants considered a total nevus count of 60 or more nevi or the presence of a CDKN2A mutation sufficient to refer the patient for digital monitoring. Patients with more than 40 nevi were only considered an indication in case of personal history of melanoma or red hair and/or a MC1R mutation or history of organ transplantation. Conclusions: Our recommendations support clinicians in choosing appropriate follow-up regimens for patients with multiple nevi and in applying the time-consuming procedure of sequential imaging more efficiently. Further studies and real-life data are needed to confirm the usefulness of this list of indications in clinical practice.
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46.
  • Tigchelaar, Michelle, et al. (författare)
  • Compound climate risks threaten aquatic food system benefits
  • 2021
  • Ingår i: Nature Food. - : Springer Science and Business Media LLC. - 2662-1355. ; 2:9, s. 673-682
  • Tidskriftsartikel (refereegranskat)abstract
    • The nutritional, economic and livelihood contributions provided by aquatic food systems are threatened by climate change. Building climate resilience requires systemic interventions that reduce social vulnerabilities. Aquatic foods from marine and freshwater systems are critical to the nutrition, health, livelihoods, economies and cultures of billions of people worldwide, but climate-related hazards may compromise their ability to provide these benefits. Here, we estimate national-level aquatic food system climate risk using an integrative food systems approach that connects climate hazards impacting marine and freshwater capture fisheries and aquaculture to their contributions to sustainable food system outcomes. We show that without mitigation, climate hazards pose high risks to nutritional, social, economic and environmental outcomes worldwide-especially for wild-capture fisheries in Africa, South and Southeast Asia, and Small Island Developing States. For countries projected to experience compound climate risks, reducing societal vulnerabilities can lower climate risk by margins similar to meeting Paris Agreement mitigation targets. System-level interventions addressing dimensions such as governance, gender equity and poverty are needed to enhance aquatic and terrestrial food system resilience and provide investments with large co-benefits towards meeting the Sustainable Development Goals.
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47.
  • Wu, Hemmings, et al. (författare)
  • Deep brain stimulation for refractory obsessive-compulsive disorder (OCD) : emerging or established therapy?
  • 2021
  • Ingår i: Molecular Psychiatry. - : Springer Nature. - 1359-4184 .- 1476-5578. ; 26, s. 60-65
  • Tidskriftsartikel (refereegranskat)abstract
    • A consensus has yet to emerge whether deep brain stimulation (DBS) for treatment-refractory obsessive-compulsive disorder (OCD) can be considered an established therapy. In 2014, the World Society for Stereotactic and Functional Neurosurgery (WSSFN) published consensus guidelines stating that a therapy becomes established when "at least two blinded randomized controlled clinical trials from two different groups of researchers are published, both reporting an acceptable risk-benefit ratio, at least comparable with other existing therapies. The clinical trials should be on the same brain area for the same psychiatric indication." The authors have now compiled the available evidence to make a clear statement on whether DBS for OCD is established therapy. Two blinded randomized controlled trials have been published, one with level I evidence (Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score improved 37% during stimulation on), the other with level II evidence (25% improvement). A clinical cohort study (N = 70) showed 40% Y-BOCS score improvement during DBS, and a prospective international multi-center study 42% improvement (N = 30). The WSSFN states that electrical stimulation for otherwise treatment refractory OCD using a multipolar electrode implanted in the ventral anterior capsule region (including bed nucleus of stria terminalis and nucleus accumbens) remains investigational. It represents an emerging, but not yet established therapy. A multidisciplinary team involving psychiatrists and neurosurgeons is a prerequisite for such therapy, and the future of surgical treatment of psychiatric patients remains in the realm of the psychiatrist.
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