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The neutron inelastic scattering of carbon-12, populating the Hoyle state, is a reaction of interest for the triple-alpha process. The inverse process (neutron upscattering) can enhance the Hoyle state’s decay rate to the bound states of 12 C, effectively increasing the overall triple-alpha reaction rate. The cross section of this reaction is impossible to measure experimentally but has been determined here at astrophysically-relevant energies using detailed balance. Using a highly-collimated monoenergetic beam, here we measure neutrons incident on the Texas Active Target Time Projection Chamber (TexAT TPC) filled with CO 2 gas, we measure the 3 α -particles (arising from the decay of the Hoyle state following inelastic scattering) and a cross section is extracted. Here we show the neutron-upscattering enhancement is observed to be much smaller than previously expected. The importance of the neutron-upscattering enhancement may therefore not be significant aside from in very particular astrophysical sites (e.g. neutron star mergers). The triple-alpha process plays a role in nucleosynthesis, in the formation of 12 C. Here, the authors discuss the rate and role of the neutron upscattering phenomenon on the triple-alpha process in a multi-step process.

X-ray bursts are among the brightest stellar objects frequently observed in the sky by space-based telescopes. A type-I X-ray burst is understood as a violent thermonuclear explosion on the surface of a neutron star, accreting matter from a companion star in a binary system. The bursts are powered by a nuclear reaction sequence known as the rapid proton capture process (rp process), which involves hundreds of exotic neutron-deficient nuclides. At so-called waiting-point nuclides, the process stalls until a slower β+ decay enables a bypass. One of the handful of rp process waiting-point nuclides is 64Ge, which plays a decisive role in matter flow and therefore the produced X-ray flux. Here we report precision measurements of the masses of 63Ge, 64,65As and 66,67Se—the relevant nuclear masses around the waiting-point 64Ge—and use them as inputs for X-ray burst model calculations. We obtain the X-ray burst light curve to constrain the neutron-star compactness, and suggest that the distance to the X-ray burster GS 1826–24 needs to be increased by about 6.5% to match astronomical observations. The nucleosynthesis results affect the thermal structure of accreting neutron stars, which will subsequently modify the calculations of associated observables.Rapid proton capture nucleosynthesis stalls at waiting-point nuclides, including 64Ge. Precision mass measurements in the vicinity of this nuclide influence state-of-the-art calculations of X-ray bursts from accreting neutron stars.

Conservation laws are deeply related to any symmetry present in a physical system 1 , 2 . Analogously to electrons in atoms exhibiting spin symmetries 3 , it is possible to consider neutrons and protons in the atomic nucleus as projections of a single fermion with an isobaric spin (isospin) of t  = 1/2 (ref.  4 ). Every nuclear state is thus characterized by a total isobaric spin T and a projection T z —two quantities that are largely conserved in nuclear reactions and decays 5 , 6 . A mirror symmetry emerges from this isobaric-spin formalism: nuclei with exchanged numbers of neutrons and protons, known as mirror nuclei, should have an identical set of states 7 , including their ground state, labelled by their total angular momentum J and parity π . Here we report evidence of mirror-symmetry violation in bound nuclear ground states within the mirror partners strontium-73 and bromine-73. We find that a J   π  = 5/2 − spin assignment is needed to explain the proton-emission pattern observed from the T  = 3/2 isobaric-analogue state in rubidium-73, which is identical to the ground state of strontium-73. Therefore the ground state of strontium-73 must differ from its J   π  = 1/2 − mirror bromine-73. This observation offers insights into charge-symmetry-breaking forces acting in atomic nuclei. Observations of the decay of 73 Sr, when compared to its mirror nucleus 73 Br, indicate that the spin assignment of their ground states differ, demonstrating mirror-symmetry violation.

The abundance and distribution of 44Ti tells us about the nature of the core-collapse supernovae explosions. There is a need to understand the nuclear reaction network creating and destroying 44Ti in order to use it as a probe for the explosive mechanism. The 44Ti(α, p)47V reaction is a very important reaction and it controls the destruction of 44Ti. Difficulties with direct measurements have led to an attempt to study this reaction indirectly. Here, the first step of the indirect study which is the identification of levels of the compound nucleus 48Cr is presented. A 100-MeV proton beam was incident on a 50Cr target. States in 48Cr were populated in the 50Cr(p, t)48Cr reaction. The tritons were momentum-analysed in the K600 Q2D magnetic spectrometer at iThemba LABS.

Policies and practices have proliferated to optimize prescribers' use of their states' prescription drug monitoring programs, which are statewide databases of controlled substances dispensed at retail pharmacies. Our study assessed the effectiveness of three such policies: comprehensive legislative mandates to use the program, laws that allow prescribers to delegate its use to office staff, and state participation in interstate data sharing. Our analysis of information from a large commercial insurance database indicated that comprehensive use mandates implemented during 2011-15 were associated with a 6-9 percent reduction in opioid prescriptions with high risk for misuse and overdose. We also found delegate laws to be associated with reductions of a similar magnitude for selected outcomes. In general, the effects of all three policies strengthened over time, especially beginning in the second year after implementation. Our findings support comprehensive use mandates and delegate laws to optimize prescribers' use of drug monitoring programs, but the results will need updates in the context of evolving state opioid policies-including the increasing integration of drug monitoring data with electronic health records.

Abstract The neutron inelastic scattering of carbon-12, populating the Hoyle state, is a reaction of interest for the triple-alpha process. The inverse process (neutron upscattering) can enhance the Hoyle state’s decay rate to the bound states of12C, effectively increasing the overall triple-alpha reaction rate. The cross section of this reaction is impossible to measure experimentally but has been determined here at astrophysically-relevant energies using detailed balance. Using a highly-collimated monoenergetic beam, here we measure neutrons incident on the Texas Active Target Time Projection Chamber (TexAT TPC) filled with CO2gas, we measure the 3α-particles (arising from the decay of the Hoyle state following inelastic scattering) and a cross section is extracted. Here we show the neutron-upscattering enhancement is observed to be much smaller than previously expected. The importance of the neutron-upscattering enhancement may therefore not be significant aside from in very particular astrophysical sites (e.g. neutron star mergers).

Objective To compare the effectiveness of shared decision making with usual care in choice of admission for observation and further cardiac testing or for referral for outpatient evaluation in patients with possible acute coronary syndrome.Design Multicenter pragmatic parallel randomized controlled trial.Setting Six emergency departments in the United States.Participants 898 adults (aged >17 years) with a primary complaint of chest pain who were being considered for admission to an observation unit for cardiac testing (451 were allocated to the decision aid and 447 to usual care), and 361 emergency clinicians (emergency physicians, nurse practitioners, and physician assistants) caring for patients with chest pain.Interventions Patients were randomly assigned (1:1) by an electronic, web based system to shared decision making facilitated by a decision aid or to usual care. The primary outcome, selected by patient and caregiver advisers, was patient knowledge of their risk for acute coronary syndrome and options for care; secondary outcomes were involvement in the decision to be admitted, proportion of patients admitted for cardiac testing, and the 30 day rate of major adverse cardiac events.Results Compared with the usual care arm, patients in the decision aid arm had greater knowledge of their risk for acute coronary syndrome and options for care (questions correct: decision aid, 4.2 v usual care, 3.6; mean difference 0.66, 95% confidence interval 0.46 to 0.86), were more involved in the decision (observing patient involvement scores: decision aid, 18.3 v usual care, 7.9; 10.3, 9.1 to 11.5), and less frequently decided with their clinician to be admitted for cardiac testing (decision aid, 37% v usual care, 52%; absolute difference 15%; P<0.001). There were no major adverse cardiac events due to the intervention.Conclusions Use of a decision aid in patients at low risk for acute coronary syndrome increased patient knowledge about their risk, increased engagement, and safely decreased the rate of admission to an observation unit for cardiac testing.Trial registration ClinicalTrials.gov NCT01969240.

The abundance and distribution of 44 Ti tells us about the nature of the core-collapse supernovae explosions. There is a need to understand the nuclear reaction network creating and destroying 44 Ti in order to use it as a probe for the explosive mechanism. The 44 Ti( α, p ) 47 V reaction is a very important reaction and it controls the destruction of 44 Ti. Difficulties with direct measurements have led to an attempt to study this reaction indirectly. Here, the first step of the indirect study which is the identification of levels of the compound nucleus 48 Cr is presented. A 100-MeV proton beam was incident on a 50 Cr target. States in 48 Cr were populated in the 50 Cr( p, t ) 48 Cr reaction. The tritons were momentum-analysed in the K600 Q2D magnetic spectrometer at iThemba LABS.

Patients were randomized to one of three arms: 1) a control group that received standard discharge instructions, 2) a narrative group that read a handout that used narrative communication techniques to discuss why the low value intervention in question had not been provided, and 3) a probabilistic group that read an analogous handout that used probabilistic communication techniques. Control group (n = 34) Probabilistic group (n = 35) Narrative group (n = 35) Sex Male 37.0% 37.0% 31.0% Female 63.0% 63.0% 69.0% Race Black 76.9% 88.5% 85.7% White 19.2% 7.7% 7.1% American Indian 3.8% 0% 7.1% Pacific Islander 0% 0% 3.6% Other 3.8% 7.7% 0% Ethnicity Hispanic 4.3% 4.0% 3.6% Table 1 Differences in observable variables between study arms (χ2 and ANOVA). Control group Probabilistic group Narrative group Mean (CI) Mean (CI) Mean (CI) Satisfaction with treatment decision 3.44 3.82 3.84 (2.99–3.89) (3.37–4.27) (3.43–4.24) Overall satisfaction at discharge 20.09 19.85 19.86 (18.61–21.58) (18.10–21.60) (18.31–21.42) Overall satisfaction at 2 week follow up 20.07 20.13 17.06 (17.74–22.39) (17.68–22.57) (14.33–19.80) Physician Trust* 47.50 46.07 42.75 (45.85–49.15) (43.19–48.95) (39.22–46.28) Table 2 Differences in outcome variables between study arms (χ2 and ANOVA).

Objectives. To compare the effectiveness of 3 approaches for communicating opioid risk during an emergency department visit for a common painful condition. Methods. This parallel, multicenter randomized controlled trial was conducted at 6 geographically disparate emergency department sites in the United States. Participants included adult patients between 18 and 70 years of age presenting with kidney stone or musculoskeletal back pain. Participants were randomly assigned to 1 of 3 risk communication strategies: (1) a personalized probabilistic risk visual aid, (2) a visual aid and a video narrative, or 3) general risk information. The primary outcomes were accuracy of risk recall, reported opioid use, and treatment preference at time of discharge. Results. A total of 1301 participants were enrolled between June 2017 and August 2019. There was no difference in risk recall at 14 days between the narrative and probabilistic groups (43.7% vs 38.8%; absolute risk reduction = 4.9%; 95% confidence interval [CI] = −2.98, 12.75). The narrative group had lower rates of preference for opioids at discharge than the general risk information group (25.9% vs 33.0%; difference = 7.1%; 95% CI = 0.64, 0.97). There were no differences in reported opioid use at 14 days between the narrative, probabilistic, and general risk groups (10.5%, 10.3%, and 13.3%, respectively; P = .44). Conclusions. An emergency medicine communication tool incorporating probabilistic risk and patient narratives was more effective than general information in mitigating preferences for opioids in the treatment of pain but was not more effective with respect to opioid use or risk recall. Trial Registration. Clinical Trials.gov identifier: NCT03134092. (Am J Public Health. 2022;112(S1):S45–S55. https://doi.org/10.2105/AJPH.2021.306511 )