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Background: Hospitalizations for serious infections requiring long-term intravenous (IV) antimicrobials related to injection drug use have risen sharply over the last decade. At our rural tertiary care center, opportunities for treatment of underlying substance use disorders were often missed during these hospital admissions. Once medically stable, home IV antimicrobial therapy has not traditionally been offered to this patient population due to theoretical concerns about misuse of long-term IV catheters, leading to discharges with suboptimal treatment regimens, lengthy hospital stays, or care that is incongruent with patient goals and preferences. Methods: A multidisciplinary group of clinicians and patients set out to redesign and improve care for this patient population through a health care innovation process, with a focus on increasing the proportion of patients who may be discharged on home IV therapy. Baseline assessment of current experience was established through retrospective chart review and extensive stakeholder analysis. The innovation process was based in design thinking and facilitated by a health care delivery improvement incubator. Results: The components of the resulting intervention included early identification of hospitalized people who inject drugs with serious infections, a proactive psychiatry consultation service for addiction management for all patients, a multidisciplinary care conference to support decision making around treatment options for infection and substance use, and care coordination/navigation in the outpatient setting with a substance use peer recovery coach and infectious disease nurse for patients discharged on home IV antimicrobials. Patients discharged on home IV therapy followed routine outpatient parenteral antimicrobial therapy (OPAT) protocols and treatment protocols for addiction with their chosen provider. Conclusion: An intervention developed through a design-thinking-based health care redesign process improved patient-centered care for people with serious infections who inject drugs.

Landsman, through case study examples, examines the role of motherhood for mothers of children with disabilities. Mothers of disabled children often struggle with feelings of inadequacy or guilt, and these feelings often originate with the family and society.

Two-neutrino double electron capture (2 ν ECEC) is a second-order weak-interaction process with a predicted half-life that surpasses the age of the Universe by many orders of magnitude 1 . Until now, indications of 2 ν ECEC decays have only been seen for two isotopes 2 – 5 , 78 Kr and 130 Ba, and instruments with very low background levels are needed to detect them directly with high statistical significance 6 , 7 . The 2 ν ECEC half-life is an important observable for nuclear structure models 8 – 14 and its measurement represents a meaningful step in the search for neutrinoless double electron capture—the detection of which would establish the Majorana nature of the neutrino and would give access to the absolute neutrino mass 15 – 17 . Here we report the direct observation of 2 ν ECEC in 124 Xe with the XENON1T dark-matter detector. The significance of the signal is 4.4 standard deviations and the corresponding half-life of 1.8 × 10 22  years (statistical uncertainty, 0.5 × 10 22  years; systematic uncertainty, 0.1 × 10 22  years) is the longest measured directly so far. This study demonstrates that the low background and large target mass of xenon-based dark-matter detectors make them well suited for measuring rare processes and highlights the broad physics reach of larger next-generation experiments 18 – 20 . Two-neutrino double electron capture is observed experimentally in 124 Xe with the XENON1T detector, yielding a half-life of 1.8 × 10 22 years.

A low-energy electronic recoil calibration of XENON1T, a dual-phase xenon time projection chamber, with an internal$^{37}$$37 Ar source was performed. This calibration source features a 35-day half-life and provides two mono-energetic lines at 2.82 keV and 0.27 keV. The photon yield and electron yield at 2.82 keV are measured to be ($$32.3\\,\\pm \\,0.3$$32.3 ± 0.3 ) photons/keV and ($$40.6\\,\\pm \\,0.5$$40.6 ± 0.5 ) electrons/keV, respectively, in agreement with other measurements and with NEST predictions. The electron yield at 0.27 keV is also measured and it is ($$68.0^{+6.3}_{-3.7}$$68 . 0 - 3.7 + 6.3 ) electrons/keV. The$^{37}$$37 Ar calibration confirms that the detector is well-understood in the energy region close to the detection threshold, with the 2.82 keV line reconstructed at ($$2.83\\,\\pm \\,0.02$$2.83 ± 0.02 ) keV, which further validates the model used to interpret the low-energy electronic recoil excess previously reported by XENON1T. The ability to efficiently remove argon with cryogenic distillation after the calibration proves that$^{37}$$37 Ar can be considered as a regular calibration source for multi-tonne xenon detectors.

We describe the purification of xenon from traces of the radioactive noble gas radon using a cryogenic distillation column. The distillation column was integrated into the gas purification loop of the XENON100 detector for online radon removal. This enabled us to significantly reduce the constant [Formula omitted]Rn background originating from radon emanation. After inserting an auxiliary [Formula omitted]Rn emanation source in the gas loop, we determined a radon reduction factor of [Formula omitted] (95% C.L.) for the distillation column by monitoring the [Formula omitted]Rn activity concentration inside the XENON100 detector.

We correct an overestimation of the production rate of 137 Xe in the DARWIN detector operated at LNGS. This formerly dominant intrinsic background source is now at a level similar to the irreducible background from solar 8 B neutrinos, thus unproblematic at the LNGS depth. The projected half-life sensitivity for the neutrinoless double beta decay ( 0 ν β β ) of 136 Xe improves by 22 % compared to the previously reported number and is now T 1 / 2 0 ν = 3.0 × 10 27 yr (90% C.L.) after 10 years of DARWIN operation.

A low-energy electronic recoil calibration of XENON1T, a dual-phase xenon time projection chamber, with an internal 37Ar source was performed. This calibration source features a 35-day half-life and provides two mono-energetic lines at 2.82 keV and 0.27 keV. The photon yield and electron yield at 2.82 keV are measured to be (32.3±0.3) photons/keV and (40.6±0.5) electrons/keV, respectively, in agreement with other measurements and with NEST predictions. The electron yield at 0.27 keV is also measured and it is (68.0+6.3−3.7) electrons/keV. The 37Ar calibration confirms that the detector is well-understood in the energy region close to the detection threshold, with the 2.82 keV line reconstructed at (2.83±0.02) keV, which further validates the model used to interpret the low-energy electronic recoil excess previously reported by XENON1T. The ability to efficiently remove argon with cryogenic distillation after the calibration proves that 37Ar can be considered as a regular calibration source for multi-tonne xenon detectors.

We describe the purification of xenon from traces of the radioactive noble gas radon using a cryogenic distillation column. The distillation column was integrated into the gas purification loop of the XENON100 detector for online radon removal. This enabled us to significantly reduce the constant 222 Rn background originating from radon emanation. After inserting an auxiliary 222 Rn emanation source in the gas loop, we determined a radon reduction factor of R > 27 (95% C.L.) for the distillation column by monitoring the 222 Rn activity concentration inside the XENON100 detector.

Abstract The DARWIN observatory is a proposed next-generation experiment to search for particle dark matter and for the neutrinoless double beta decay of¹³⁶136 Xe. Out of its 50 t total natural xenon inventory, 40 t will be the active target of a time projection chamber which thus contains about 3.6 t of¹³⁶136 Xe. Here, we show that its projected half-life sensitivity is2.4× 10²⁷ \\hbox year2.4 × 10 27 year , using a fiducial volume of 5 t of natural xenon and 10 year of operation with a background rate of less than 0.2 events/(t⋅ · year) in the energy region of interest. This sensitivity is based on a detailed Monte Carlo simulation study of the background and event topologies in the large, homogeneous target. DARWIN will be comparable in its science reach to dedicated double beta decay experiments using xenon enriched in¹³⁶136 Xe.

Abstract The DARWIN observatory is a proposed next-generation experiment to search for particle dark matter and for the neutrinoless double beta decay of¹³⁶136 Xe. Out of its 50 t total natural xenon inventory, 40 t will be the active target of a time projection chamber which thus contains about 3.6 t of¹³⁶136 Xe. Here, we show that its projected half-life sensitivity is2.4× 10²⁷ \\hbox year2.4×1027year , using a fiducial volume of 5 t of natural xenon and 10 year of operation with a background rate of less than 0.2 events/(t  ⋅ ·  year) in the energy region of interest. This sensitivity is based on a detailed Monte Carlo simulation study of the background and event topologies in the large, homogeneous target. DARWIN will be comparable in its science reach to dedicated double beta decay experiments using xenon enriched in¹³⁶136 Xe.