Search for CP Violation in Neutrino and Antineutrino Oscillations by the T2K Experiment with 2.2×10^{21} Protons on Target

The T2K experiment measures muon neutrino disappearance and electron neutrino appearance in accelerator-produced neutrino and antineutrino beams. With an exposure of 14.7(7.6)×10^{20} protons on target in the neutrino (antineutrino) mode, 89 ν_{e} candidates and seven anti-ν_{e} candidates are observed, while 67.5 and 9.0 are expected for δ_{CP}=0 and normal mass ordering. The obtained 2σ confidence interval for the CP-violating phase, δ_{CP}, does not include the CP-conserving cases (δ_{CP}=0, π). The best-fit values of other parameters are sin^{2}θ_{23}=0.526_{-0.036}^{+0.032} and Δm_{32}^{2}=2.463_{-0.070}^{+0.071}×10^{-3}  eV^{2}/c^{4}.

'There is such a thing as too healthy!' The impact of minimum nutritional guidelines on school food practices in secondary schools

BACKGROUND

Pressure to improve school meals has resulted in stringent nutritional guidelines across the UK. In Wales, the 'Appetite for Life' guidelines of 2008 resulted in significant changes to the provision of food in Welsh schools. Although evaluation of these changes has focussed on nutritional quality, there is little evidence of how pupils perceive these changes and their impact on school food practices. Using a Collective Lifestyles approach, the present study reports how secondary school pupils perceive and negotiate menu changes and the implications for lunchtime practices.

METHODS

Seven focus groups (52 pupils) were undertaken in four secondary schools within one local authority in Wales. Participatory techniques were used to facilitate discussion, and the focus groups were recorded, transcribed and analysed using a framework approach. Analysis was underpinned by a Collective Lifestyles approach, which provides a framework to understand behaviour in context using three domains: (i) patterns of consumption; (ii) the construction and maintenance of identity; and (iii) power relationships.

RESULTS

Pupils reported that the new menus were unpopular in terms of content and meal type; the preference was for portable and snack style foods. In terms of power relationships, pupils' ability to negotiate within the school setting was constrained by the institutional nature of school dining. As a result, pupils tended to opt out of school food provision, accessing alternatives where possible.

CONCLUSIONS

The development of the healthy eating agenda within the school setting needs to consider the complexities of adolescent consumption preferences, identities and social networks if they are to be successful.

Acyclic and Cyclic Alkyl and Ether-Functionalised Sulfonium Ionic Liquids Based on the [TFSI]- and [FSI]- Anions as Potential Electrolytes for Electrochemical Applications

This work provides a study based on acyclic and cyclic sulfonium ionic liquids (ILs) with alkyl and ether-functionality on the cation paired with the bis{(trifluoromethyl)sulfonyl}imide, [TFSI]- , or the bis(fluorosulfonyl)imide, [FSI]- , as the counter anion. Herein, thermophysical characterisation of nine sulfonium-based ILs concerning the density, viscosity and conductivity and thermal properties including phase transition behaviour and decomposition temperature is reported. The electrochemical stability of the ILs was also measured by cyclic voltammetry at a glassy carbon macro-disk electrode. All of the ILs showed low melting point, low viscosity and good conductivity and could serve as potential electrolytes for energy storage devices.

The American Orthopaedic Association's Own the Bone® database: a national quality improvement project for the treatment of bone health in fragility fracture patients

The American Orthopaedic Association initiated the Own the Bone (OTB) quality improvement program in 2009. Herein we show that the data collected through this program is similar to that collected in other large studies. Thus, the OTB registry functions as an externally valid cohort for studying fragility fracture patients.

INTRODUCTION

The American Orthopedic Association initiated the Own the Bone (OTB) quality improvement program in 2009 to improve secondary prevention of fragility fractures. In this study, we present a summary of the data collected by the OTB program and compare it to data from other large fragility fracture registries with an aim to externally validate the OTB registry.

METHODS

The OTB registry contained 35,038 unique cases of fragility fracture as of September, 2016. We report the demographics, presenting fracture characteristics, past fracture history, and bone mineral density (BMD) data and compare these to data from large fragility fracture studies across the world.

RESULTS

Seventy-three percent of the patients in the OTB registry were female, Caucasian, and post-menopausal. In 54.4% of cases, patients had a hip fracture; spine fractures were the second most common fracture type occurring in 11.1% of patients. Thirty-four percent of the patients had a past history of fragility fracture, and the most common sites were the spine and hip. The average femoral neck T-score was - 2.06. When compared to other studies, the OTB database showed similar findings with regard to patient age, gender, race, BMI, BMD profile, prior fracture history, and family history of fragility fractures.

CONCLUSION

OTB is the first and largest multi-center voluntary fragility fracture registry in the USA. The data collected through the OTB program is comparable to that collected in international studies. Thus, the OTB registry functions as an externally valid cohort for further studies assessing the clinical characteristics, interventions, and outcomes achieved in patients who present with a fragility fracture in the USA.

Patterns of mortality in modern stroke care

Background Stroke is a leading cause of death. We looked at the causes (direct and indirect) of in-hospital mortality in a modern stroke unit over a two-year period. Methods We reviewed medical charts of stroke deaths in hospital from 2014-2015 inclusive. Data on stroke type, aetiology, age, length of stay, comorbidities, and documented cause of death were recorded. All patients were included. Results 518 patients were admitted acutely to the stroke service. Overall death rate was 7.5% (n=39). Of fatal strokes 29 (74%) were ischaemic. Average age 78.6 years. Mean survival was 26.4 days (range 1-154). 19 (49%) patients had atrial fibrillation. Forty-nine percent of deaths were due to pneumonia, and 33% were due to raised intracranial pressure. Discussion Mortality rate in our stroke service has decreased from 15% in 1997, and now appears dichotomised into early Secondary Stroke Related Cerebral Events (SSRCEs) and later infections.

Investigating a tuberculosis cluster among Filipino health care workers in a low-incidence country

SETTING

Nearly 8% of adult tuberculosis (TB) cases in England, Wales and Northern Ireland (EW&NI) occur among health care workers (HCWs), the majority of whom are from high TB incidence countries.

OBJECTIVES

To determine if a TB cluster containing multiple HCWs was due to nosocomial transmission.

METHODS

A cluster of TB cases notified in EW&NI from 2009 to 2014, with indistinguishable 24-locus mycobacterial interspersed repetitive unit-variable number of tandem repeats (MIRU-VNTR) profiles, was identified through routine national cluster review. Cases were investigated to identify epidemiological links, and occupational health (OH) information was collected for HCW cases. To further discriminate strains, typing of eight additional loci was conducted.

RESULTS

Of the 53 cases identified, 22 were HCWs. The majority (n = 43), including 21 HCWs, were born in the Philippines. Additional typing split the cluster into three subclusters and seven unique strains. No epidemiological links were identified beyond one household and a common residential area. HCWs in this cluster received no or inadequate OH assessment.

CONCLUSIONS

The MIRU-VNTR profile of this cluster probably reflects common endemic strains circulating in the Philippines, with reactivation occurring in the UK. Furthermore, 32-locus typing showed that 24-locus MIRU-VNTR failed to distinguish strain diversity. The lack of OH assessment indicates that latent tuberculous infection could have been identified and treated, thereby preventing active cases from occurring.

Abstract WP113: Evidence of Ongoing Platelet Activation in Micro-emboli Negative Recently Symptomatic versus Asymptomatic Carotid Stenosis

Introduction: Cerebral microembolic signals (MES) predict increased stroke risk in carotid stenosis however micro-emboli negative symptomatic patients also demonstrate increased risk compared to asymptomatic patients. Enhanced platelet activation may contribute to this risk disparity.

Methods: We performed a prospective, observational analytical study assessing platelet counts, platelet activation status, and the relationship between platelet activation and MES in asymptomatic versus symptomatic moderate (≥50-69%) or severe (≥70-99%) carotid stenosis. Full blood count measurements were performed, and whole-blood flow cytometry used to quantify platelet surface activation marker expression (CD62P and CD63) and circulating leucocyte-platelet complexes. Bilateral simultaneous Transcranial Doppler (TCD) ultrasound monitoring of the middle cerebral arteries was performed to classify patients’ MES status.

Results: Complete TCD data from 28 asymptomatic patients were compared with 35 symptomatic patients in the ‘early phase’ (≤4 weeks) and 30 of these patients in the ‘late phase’ (≥3 months) after TIA/ischaemic stroke. The %MES positive patients were higher in early symptomatic (31.4%; P = 0.027), but not in late symptomatic (6.7%; P = 0.996) vs. asymptomatic patients (7.1%). There were no significant differences in platelet counts, mean platelet volume, %CD62P or %CD63 expression between early/late symptomatic and asymptomatic MES negative patients (P>0.05). There were however, a significantly higher %circulating lymphocyte-platelet complexes in early symptomatic vs. asymptomatic patients (2.7% vs. 2.17%;P=0.02)

Discussion: Increased lymphocyte-platelet complex formation in recently symptomatic vs. asymptomatic MES-negative patients indicates enhanced platelet activation in this early symptomatic subgroup. Platelet biomarkers, in combination with TCD, have the potential to aid risk-stratification in carotid stenosis.

Abstract WP126: Profile of Reticulated Platelets and Red Cell Reticulocytes in Patients With Recently Symptomatic versus Asymptomatic Carotid Stenosis

Introduction: The mechanisms responsible for the disparity in stroke risk between asymptomatic and symptomatic carotid stenosis are not fully understood. Profiles of ‘reticulated platelets’ and red cell reticulocytes in carotid stenosis patients are poorly understood.

Methods: This prospective, multi-centre, observational analytical study compared full blood count parameters and platelet production/turnover biomarkers in early-phase (≤4 weeks after TIA/stroke) and late-phase (≥3 months) symptomatic versus asymptomatic moderate-severe (≥50-99%) carotid stenosis patients. Reticulated platelets were quantified by whole-blood flow cytometry and by an ‘automated assay’ (Sysmex XE-2100™). Multiple linear regression analysis controlled for the potential influence of independent variables on observed differences between groups.

Results: Data from 43 early-phase symptomatic and 37 late-phase symptomatic patients were compared with 34 asymptomatic patients. The mean platelet count in citrate-anticoagulated blood was higher in early-phase (P=0.040) and late-phase symptomatic (P=0.045) than asymptomatic patients. Mean platelet volume was higher in early symptomatic than asymptomatic patients (10.8 vs . 10.45fl; P=0.04). There were no differences in % reticulated platelets between groups using flow cytometry. However, the ‘automated assay’ revealed a higher ‘unadjusted’ reticulated-platelet fraction (%RPF) in early-phase (5.78%; P<0.001) and late-phase symptomatic (5.11%; P=0.001) vs . asymptomatic patients (3.48%). The % red cell reticulocytes was lower in early (0.92%; P=0.035) and late symptomatic (0.93%; P=0.036) than asymptomatic patients (1.07%).

Discussion: There is an ongoing stimulus to increased platelet production/secretion/reduced clearance, and an increased population of immature, potentially ‘more-reactive’ reticulated platelets in symptomatic carotid stenosis patients which may contribute to the higher risk of stroke in symptomatic vs . asymptomatic carotid stenosis.

Outcomes of endovascular treatment for acute large-vessel ischaemic stroke more than 6 h after symptom onset

BACKGROUND AND OBJECTIVES

Benefit from endovascular thrombectomy (EVT) for large-vessel occlusion (LVO) acute ischaemic stroke (AIS) is well demonstrated. Furthermore, emerging evidence supports efficacy in appropriately selected patients treated beyond current recommendations of 6 h. We evaluated clinical outcomes in patients undergoing late EVT at our institution.

METHODS

Retrospective review of prospectively collected clinical database on 355 patients who underwent EVT for LVO AIS. Data collected consisted of patient demographics, radiological findings and outcome details. Outcomes, including 90-day functional status, recanalization, symptomatic intracranial haemorrhage (sICH) and 90-day mortality, for patients undergoing EVT <6 h, >6 h, and >7.3 h, were compared.

RESULTS

A total of 355 patients underwent EVT for LVO AIS at our institution during the review period, with 74 (21%) patients treated ≥6 h from symptom onset. Successful recanalization was achieved in 285 (80%) patients, with 228 (81%) achieving a mTICI ≥2b in the <6 h group, and 57 (77%) in the >6 h group (P = 0.429). Ninety-day functional independence (mRS 0-2) was achieved in 162 (46%) patients, with 130 (46%) achieving a mRS of 0-2 in the <6 h group, and 32 (43%) in the >6 h group (P = 0.643). No significant differences were found in rates of sICH or 90-day mortality. No significant differences in functional independence, recanalization rates, sICH or mortality were identified in patients treated with EVT >7.3 h compared to <7.3 h.

CONCLUSIONS

In appropriately selected patients, EVT >6 h was associated with comparable outcomes to those treated <6 h. These data support a physiological approach to patient selection.

Establishing the feasibility of a community and primary health care intervention to raise awareness of symptoms of Type 1 Diabetes-The Early Detection of Type 1 Diabetes in Youth (EDDY) study

AIMS

To design, develop, and evaluate the feasibility of delivering a multi-component community based intervention to parents and primary health care professionals to raise awareness of the symptoms of Type 1 diabetes (T1D) in childhood in 3 adjoining borough counties of South Wales.

MATERIALS AND METHODS

Parent and primary health care advisory groups were established to design the intervention. Qualitative interviews with stakeholders and parents assessed the acceptability, feasibility and any potential impact of the intervention.

RESULTS

The parent component of the intervention developed was a re-useable shopping bag with the 4 main symptoms of T1D illustrated on the side, based on the road traffic system of red warning triangles and an octagon "stop" sign stating "Seek Medical Help". Accompanying the bag was an A5 leaflet giving further information. Both were overwrapped with clear plastic and delivered to 98% (323/329) schools, equating to 101 371 children. The primary health care professional component was a dual glucose/ketone meter, single use lancets, stickers, the A5 parent leaflet displayed as a poster and an educational visit from a Community Diabetes Liaison Nurse. 87% (73/84) of GP practices received the intervention, 100% received the materials. The intervention was delivered within Cardiff, the Vale of Glamorgan and Bridgend. Qualitative analyses suggest that the intervention raised awareness and had some impact.

CONCLUSION

This study showed that it is feasible and acceptable to design, develop and deliver a community based intervention to raise awareness of T1D. There is some suggestion of impact but a definitive evaluation of effectiveness is still required.

Antibiotic Resistance Gene Detection in the Microbiome Context

Within the past decade, microbiologists have moved from detecting single antibiotic resistance genes (ARGs) to detecting all known resistance genes within a sample due to advances in next generation sequencing. This has provided a wealth of data on the variation and relative abundances of ARGs present in a total bacterial population. However, to use these data in terms of therapy or risk to patients, they must be analyzed in the context of the background microbiome. Using a quantitative PCR ARG chip and 16S rRNA amplicon sequencing, we have sought to identify the ARGs and bacteria present in a fecal sample of a healthy adult using genomic tools. Of the 42 ARGs detected, 12 fitted into the ResCon1 category of ARGs: cfxA, cphA, bacA, sul3, aadE, bla_TEM, aphA1, aphA3, aph(2')-Id, aacA/aphd, catA1, and vanC. Therefore, we describe these 12 genes as the core resistome of this person's fecal microbiome and the remaining 30 ARGs as descriptors of the microbial population within the fecal microbiome. The dominant phyla and genera agree with those previously detected in the greatest abundances in fecal samples of healthy humans. The majority of the ARGs detected were associated with the presence of specific bacterial taxa, which were confirmed using microbiome analysis. We acknowledge the limitations of the data in the context of the limited sample set. However, the principle of combining qPCR and microbiome analysis was shown to be helpful to identify the association of the ARGs with specific taxa.

A preliminary investigation of the effect of sample collection technique on the cell and RNA content of fine-needle aspirates of five canine tumours

OBJECTIVES

To evaluate the effect of syringe size, needle size, number of needle passes and operator experience on cell yield from tumour fine-needle aspirates, and the quantity and quality of extractable RNA.

MATERIALS AND METHODS

Fine-needle aspirates were collected from canine lymphoma, cutaneous mast cell tumour, anal gland adenocarcinoma, fibrosarcoma and oral malignant melanoma using nine different techniques.

RESULTS

There was a significant difference in cell yield between fine-needle aspirate techniques for melanoma, lymphoma and anal gland adenocarcinoma. The application of suction yielded the largest number of cells. Cell numbers in lymphoma and fibrosarcoma aspirates collected by different veterinary surgeons were not significantly different. Use of a smaller gauge needle and suction increased the quantity of RNA isolated from fibrosarcoma and anal gland adenocarcinoma aspirates, but did not influence RNA integrity.

CLINICAL SIGNIFICANCE

Suction during fine-needle aspiration increases cell numbers obtained from five common canine tumours. Suction increases the quantity of RNA isolated from anal gland adenocarcinoma and fibrosarcoma aspirates without affecting RNA quality. Junior veterinary surgeons gain comparable cell numbers to senior staff.