Measurement of CP Violation in the Decay B^{+}→K^{+}π^{0}

A measurement of CP violation in the decay B^{+}→K^{+}π^{0} is reported using data corresponding to an integrated luminosity of 5.4  fb^{-1} collected with the LHCb experiment at a center-of-mass energy of sqrt[s]=13  TeV. The CP asymmetry is measured to be 0.025±0.015±0.006±0.003, where the uncertainties are statistical, systematic, and due to an external input. This is the most precise measurement of this quantity. It confirms and significantly enhances the observed anomalous difference between the direct CP asymmetries of the B^{0}→K^{+}π^{-} and B^{+}→K^{+}π^{0} decays, known as the Kπ puzzle.

Reduction of stillbirths in England from 2008 to 2017 according to uptake of the Growth Assessment Protocol: 10-year population-based cohort study

OBJECTIVE

Antenatal detection of small-for-gestational age (SGA) can reduce significantly the risk of stillbirth. The Growth Assessment Protocol (GAP) was developed to address the problem that most SGA fetuses are missed antenatally. We set out to analyze the effect that the GAP program has had on stillbirth rates in England.

METHODS

We analyzed data from 2008 (the year before roll-out of the GAP program) to 2017 (latest available Office for National Statistics (ONS) unit-based data). The program consists of five elements: training, evidence-based guidelines for risk assessment and surveillance of fetal growth, customized charts, recording of process and outcome indicators, and audit of missed SGA cases. All maternity units in England were categorized into one of three groups according to their GAP status in 2017: (1) not in the GAP program; (2) GAP implemented partially (incomplete adoption of protocol, no monitoring and audit); and (3) GAP implemented completely. A subset of the complete-implementation group comprised the 20 units with the highest SGA detection rates. Unit-level live-birth and stillbirth data were obtained from the ONS for each of these groups.

RESULTS

Stillbirth rates declined across all groups from 2008 to 2017, and significantly more in units in which GAP was implemented completely than in the non-GAP units (P < 0.05). The steepest decline in stillbirth rate was observed in the 20 units with the highest SGA detection rates, which had a 24% lower stillbirth rate compared with the units not using GAP (P < 0.01) in 2017. This difference remained significant after mixed-effects logistic regression analysis of potential confounding, including social deprivation (odds ratio, 0.76 (95% CI, 0.64-0.90)). Assessment of the nine Bradford Hill causality criteria and associated characteristics suggested that the association between implementation of the GAP program and reduction in stillbirth rate was causal.

CONCLUSIONS

There has been an overall reduction in stillbirth rates in England that is likely to be a result of increased awareness of the importance of antenatal detection of SGA as a key risk factor for stillbirth. The decline in stillbirth rates was significantly greater in maternity units that had fully implemented the GAP program, and was most pronounced in the units with the highest antenatal SGA detection rates. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

First Observation of the Decay B_{s}^{0}→K^{-}μ^{+}ν_{μ} and a Measurement of |V_{ub}|/|V_{cb}|

The first observation of the suppressed semileptonic B_{s}^{0}→K^{-}μ^{+}ν_{μ} decay is reported. Using a data sample recorded in pp collisions in 2012 with the LHCb detector, corresponding to an integrated luminosity of 2  fb^{-1}, the branching fraction B(B_{s}^{0}→K^{-}μ^{+}ν_{μ}) is measured to be [1.06±0.05(stat)±0.08(syst)]×10^{-4}, where the first uncertainty is statistical and the second one represents the combined systematic uncertainties. The decay B_{s}^{0}→D_{s}^{-}μ^{+}ν_{μ}, where D_{s}^{-} is reconstructed in the final state K^{+}K^{-}π^{-}, is used as a normalization channel to minimize the experimental systematic uncertainty. Theoretical calculations on the form factors of the B_{s}^{0}→K^{-} and B_{s}^{0}→D_{s}^{-} transitions are employed to determine the ratio of the Cabibbo-Kobayashi-Maskawa matrix elements |V_{ub}|/|V_{cb}| at low and high B_{s}^{0}→K^{-} momentum transfer.

Allen: A High-Level Trigger on GPUs for LHCb

We describe a fully GPU-based implementation of the first level trigger for the upgrade of the LHCb detector, due to start data taking in 2021. We demonstrate that our implementation, named Allen, can process the 40 Tbit/s data rate of the upgraded LHCb detector and perform a wide variety of pattern recognition tasks. These include finding the trajectories of charged particles, finding proton-proton collision points, identifying particles as hadrons or muons, and finding the displaced decay vertices of long-lived particles. We further demonstrate that Allen can be implemented in around 500 scientific or consumer GPU cards, that it is not I/O bound, and can be operated at the full LHC collision rate of 30 MHz. Allen is the first complete high-throughput GPU trigger proposed for a HEP experiment.

High protein prescription in methylmalonic and propionic acidemia patients and its negative association with long-term outcome

BACKGROUND AND OBJECTIVE

Methylmalonic acidemia (MMA) and propionic acidemia (PA) are inborn errors of metabolism. While survival of MMA and PA patients has improved in recent decades, long-term outcome is still unsatisfactory. A protein restricted diet is the mainstay for treatment. Additional amino acid mixtures (AAM) can be prescribed if natural protein is insufficient. It is unknown if dietary treatment can have an impact on outcome.

DESIGN

We performed a nationwide retrospective cohort study and evaluated both longitudinal dietary treatment and clinical course of Dutch MMA and PA patients. Protein prescription was compared to the recommended daily allowances (RDA); the safe level of protein intake as provided by the World Health Organization. The association of longitudinal dietary treatment with long-term outcome was evaluated.

RESULTS

The cohort included 76 patients with a median retrospective follow-up period of 15 years (min-max: 0-48 years) and a total of 1063 patient years on a protein restricted diet. Natural protein prescription exceeded the RDA in 37% (470/1287) of all prescriptions and due to AAM prescription, the total protein prescription exceeded RDA in 84% (1070/1277). Higher protein prescriptions were associated with adverse outcomes in severely affected patients. In PA early onset patients a higher natural protein prescription was associated with more frequent AMD. In MMA vitamin B12 unresponsive patients, both a higher total protein prescription and AAM protein prescription were associated with more mitochondrial complications. A higher AAM protein prescription was associated with an increased frequency of cognitive impairment in the entire.

CONCLUSION

Protein intake in excess of recommendations is frequent and is associated with poor outcome.

Model-Independent Study of Structure in B^{+}→D^{+}D^{-}K^{+} Decays

The only anticipated resonant contributions to B^{+}→D^{+}D^{-}K^{+} decays are charmonium states in the D^{+}D^{-} channel. A model-independent analysis, using LHCb proton-proton collision data taken at center-of-mass energies of sqrt[s]=7, 8, and 13 TeV, corresponding to a total integrated luminosity of 9  fb^{-1}, is carried out to test this hypothesis. The description of the data assuming that resonances only manifest in decays to the D^{+}D^{-} pair is shown to be incomplete. This constitutes evidence for a new contribution to the decay, potentially one or more new charm-strange resonances in the D^{-}K^{+} channel with masses around 2.9  GeV/c^{2}.

Constraints on the K_{S}^{0}→μ^{+}μ^{-} Branching Fraction

A search for the decay K_{S}^{0}→μ^{+}μ^{-} is performed using proton-proton collision data, corresponding to an integrated luminosity of 5.6  fb^{-1} and collected with the LHCb experiment during 2016, 2017, and 2018 at a center-of-mass energy of 13 TeV. The observed signal yield is consistent with zero, yielding an upper limit of B(K_{S}^{0}→μ^{+}μ^{-})<2.2×10^{-10} at 90% C.L.. The limit reduces to B(K_{S}^{0}→μ^{+}μ^{-})<2.1×10^{-10} at 90% C.L. once combined with the result from data taken in 2011 and 2012.

Observation of Enhanced Double Parton Scattering in Proton-Lead Collisions at sqrt[s_{NN}]=8.16 TeV

A study of prompt charm-hadron pair production in proton-lead collisions at sqrt[s_{NN}]=8.16  TeV is performed using data corresponding to an integrated luminosity of about 30  nb^{-1}, collected with the LHCb experiment. Production cross sections for different pairs of charm hadrons are measured and kinematic correlations between the two charm hadrons are investigated. This is the first measurement of associated production of two charm hadrons in proton-lead collisions. The results confirm the predicted enhancement of double parton scattering production in proton-lead collisions compared to the single parton scattering production.

Genetic and nongenetic factors associated with lactation length in seasonal-calving, pasture-based dairy cows

Lactation yield estimates standardized to common lactation lengths of 270-d or 305-d equivalents are commonly used in management decision support tools and dairy cow genetic evaluations. The use of such measurements to quantify the (genetic) merit of individual cows fails to penalize cows that do not reach the standardized lactation length, or indeed reward cows that lactate for more than the standardized lactation length. The objective of the present study was to quantify the genetic and nongenetic factors associated with lactation length in seasonal-calving, pasture-based dairy cows. A total of 616,350 lactation length records from 285,598 Irish cows were used. Linear mixed models were used to quantify the associations between lactation length and calving month, parity, age at calving, previous dry period length, calving difficulty score, heterosis, recombination loss, breed, and herd size, as well as to estimate the genetic and residual variance components of lactation length. The median lactation length in the edited data set was 288 d, with 27% of cows achieving lactations of at least 305 d. Relative to cows calving in January, the lactations of cow calving in February, March, or April was, on average, 4.2, 12.7, and 21.9 d shorter, respectively. The lactation length of a first parity cow was, on average, 7.8, 8.6, and 8.4 d shorter than that of second, third, and fourth parity cows, respectively. Norwegian Red and Montbéliarde cows had, on average, a 4.7- and 1.6-d shorter lactation than Holstein-Friesian cows, respectively. The heritability estimate, coefficient of genetic variation, and repeatability estimate of lactation length were 0.02, 1.2%, and 0.04, respectively. Based on the genetic standard deviation for lactation length estimated in the present study (3.3 d), cows ranked in the top 20% for genetic merit for lactation length would be expected to have lactations 9.2 d longer than cows in the bottom 20%, demonstrating exploitable genetic variability. Given the vast array of genetic and nongenetic factors associated with lactation length, an approach which combines improved management practices and selective breeding may be an efficient and effective strategy to lengthen lactations.

Thrombus formation on bioprosthetic aortic valves

Background

18F-GP1 is a novel radiotracer with a high affinity for the platelet glycoprotein IIb/IIIa receptor. Subclinical bioprosthetic valve thrombus has been postulated as a trigger for accelerated valve degeneration.

Purpose

To determine the feasibility of 18F-GP1 positron-emission tomography-computed tomography (PET-CT) for the detection of subclinical bioprosthetic aortic valve thrombus.

Methods

(i) Explanted degenerated aortic valve prostheses underwent histology and imaging. (ii) In a prospective observational study, patients with bioprosthetic aortic valve replacement (AVR) underwent echocardiography and 18F-GP1 PET-CT. Valves were assessed for hypoattenuating leaflet thickening (HALT), hypo-attenuation affection leaflet motion (HAM) and GP1 uptake.

Results

(i) GP1 correlated with thrombus on explanted valves (Figure). (ii) The first 6 patients (Table) were asymptomatic and had normally functioning surgical bioprostheses on echocardiography. At a median of 166 (range 122–189) days post-AVR, no patients had HALT or HAM on CT. There was avid focal GP1 uptake on the leaflets of all 6 patients which appeared most prominent along the leaflet edges (Figure). Only one patient had focal uptake in the valve frame, remote from the leaflets. In a separate cohort undergoing 18F-GP1 PET-CT for other conditions, there was no uptake on normal, native aortic valves (n=8).

Conclusion

For the first time, we demonstrate that 18F-GP1 PET-CT is a highly sensitive method of assessing platelet activation on bioprosthetic aortic valves. Despite the absence of CT evidence, early thrombus appeared to be a universal finding on recently implanted valve prostheses. The biological and clinical implications of subclinical bioprosthetic aortic valve thrombus have yet to be established.

GP1 uptake in AVR

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): British Heart Foundation

Reduced orbitofrontal grey matter volume in myocardial infarction with non-obstructive coronary arteries (MINOCA)

Background

Myocardial infarction with non-obstructive coronary arteries (MINOCA) is seen in 6–10% of patients presenting acutely with suspected myocardial infarction. Cardiac magnetic resonance imaging (CMR) can identify an underlying cause in ∼80% of patients. These patients are more likely to have a history of mental health illness or an emotional or stressful precipitant.

Grey matter volume can be quantified in various anatomical regions of the brain and has been shown to be altered in common mental health conditions such as anxiety, stress and depression.

This is the first prospective study investigating the acute structural brain, cardiac and psychological changes using MRI in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) within 14 days of presentation compared to STEMI control patients.

Methods

Patients meeting the 2017 ESC definition of MINOCA were prospectively recruited with STEMI control patients from February to December 2019. All participants underwent brain and comprehensive cardiac MRI, bloods and baseline psychological evaluation. We used voxel-based morphometry (VBM) to quantify grey matter volume and changes were compared between groups.

Results

54 patients were included in this interim analysis (39 MINOCA, 15 STEMI controls). Demographics were largely similar but MINOCA patients were more likely to have a history of self-reported mental health disease (36% v 7%, p 0.03) and had significantly higher baseline anxiety (8.4 v 5.3, p 0.01) scores on the HADS questionnaire. We found that control patients have significantly greater grey matter volume in the orbitofrontal cortex (OFC) compared to MINOCA patients (pFWE-corr 0.002). The orbitofrontal cortex is involved in emotional processing and implicated in anxiety and depression. However, there was no association between grey matter volume in any brain region and anxiety, depression or perceived stress scale scores.

Conclusion

Patients with MINOCA are more likely to have a history of mental health disease and have higher anxiety scores at presentation than STEMI controls. They have less grey matter volume in the orbitofrontal cortex compared to STEMI controls.

Reduced Grey Matter Volume in the OFC

Funding Acknowledgement

Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Rosetrees Trust; James Tudor Foundation

Threats to public interest journalism: A call to action to public health

Public interest journalism is an important determinant of health, due to its roles in accountability and holding power to account, empowering communities, and contributing to health literacy. The capacity of public interest journalism to contribute to planetary health and health equity, as well as healthier people, societies, and systems of governance is under attack. Reasons include the collapse of the underpinning business model, the market power of digital platforms, neoliberalism, the rise of authoritarianism, and attacks on press freedom and safety. This paper presents an ecological analysis of the upstream determinants of a healthy and sustainable public interest journalism sector, which is informed by Aboriginal ways of knowing, being and doing, and a decolonising methodology. It also presents a case study of innovation in health-related public interest journalism in Australia, and includes clear calls to action for public health practitioners, researchers and advocates, as well as wider policy making.

Key messages

Public interest journalism is an important determinant of health. Threats to public interest journalism are a threat to public health. Collaborations strengthen public interest journalism: this presentation provides an example.

#CoveringClimateNow: A social journalism project profiling climate and health

Concerns about poor quality media reporting of climate change has led to many initiatives seeking to influence coverage. In 2019/2020, a global media collaboration was established with the aim of generating a sustained media focus on key climate-related events. This paper reports an analysis of an Australian health media organisation's contribution to the collaboration, and the opportunities this provided for public health advocates, Aboriginal and Torres Strait Islander researchers and communities, and the wider community. It presents key reflections from Croakey Health Media's contribution to the global #CoveringClimateNow collaboration, with the aim of providing practical advice to enable further such collaborations and activities in other countries. This project was run on a very small budget, and this presentation is likely to be particularly relevant for low-budget organisations and contexts.

Key messages

Poor quality media coverage of climate change has stimulated innovation. Collaboration locally and globally can convey solutions to climate change.

What are the perceptions of Indigenous organisation staff on the utility of the nKPIs?

Background

This presentation will outline the results of five Aboriginal Community Controlled Health Organisation (ACCHO) case studies which sought to understand the impact of national key performance indicators (nKPIs) at the local level. The nKPI framework attempts to collect data to assist the Commonwealth Government to monitor the Closing the Gap Framework and to aid local ACCHOs to monitor and review their service delivery. Understanding how the nKPIs have been implemented and their impact across the various sites is essential to understanding their usefulness.

Methods

A multi-case study approach with a variety of ACCHOs was used. Site recruitment was conducted using a purposive sampling framework with an expression of interest, and/or a direct approach. At each site, several semi-structured interviews were conducted, documents were reviewed, and observations made. Data analysis was conducted using the computer program NVivo.

Results

Case studies (n = 5) were conducted at the five sites between in 2017. Data collection included semi-structured interviews ACCHO staff (n = 24), nKPI site-specific documents (n = 12) and observational. A number of key themes emerged from case studies relating to: • Workforce The usefulness of the nKPIsSelf-determinationWay ForwardACCHO Governance

Conclusions

Across the case studies, it is clear there are a variety perception about the utility of the nKPIs and the barriers/enablers which impact their capacity to report, collect and utilise the nKPIs. All Case Study sites saw the value of data to measure their success and to identify emerging issues among their clients. Their attitudes to the nKPIs varied though, due to issues relating to the design and implementation. The stability and size of the service also influenced their ability to use the data. More work needs to be done by the Commonwealth Government in collaboration with ACCHOs to improve the usability and utility of the nKPIs.

Key messages

Indigenous people need to be involved in the design and implmnetation of monitoring sytems. The nKPIs only report on a small subset of services delivered by Aboriginal Community Controlled Health Organisations.

Individuals with high bone mass have increased progression of radiographic and clinical features of knee osteoarthritis

OBJECTIVE

High bone mass (HBM) is associated with an increased prevalence of radiographic knee OA (kOA), characterized by osteophytosis. We aimed to determine if progression of radiographic kOA, and its sub-phenotypes, is increased in HBM and whether observed changes are clinically relevant.

DESIGN

A cohort with and without HBM (L1 and/or total hip bone mineral density Z-score≥+3.2) had knee radiographs collected at baseline and 8-year follow-up. Sub-phenotypes were graded using the OARSI atlas. Medial/lateral tibial/femoral osteophyte and medial/lateral joint space narrowing (JSN) grades were summed and Δosteophytes, ΔJSN derived. Pain, function and stiffness were quantified using the WOMAC questionnaire. Associations between HBM status and sub-phenotype progression were determined using multivariable linear/poisson regression, adjusting for age, sex, height, baseline sub-phenotype grade, menopause, education and total body fat mass (TBFM). Generalized estimating equations accounted for individual-level clustering.

RESULTS

169 individuals had repeated radiographs, providing 330 knee images; 63% had HBM, 73% were female, mean (SD) age was 58 (12) years. Whilst HBM was not clearly associated with overall Kellgren-Lawrence measured progression (RR = 1.55 [0.56.4.32]), HBM was positively associated with both Δosteophytes and ΔJSN individually (adjusted mean differences between individuals with and without HBM 0.45 [0.01.0.89] and 0.15 [0.01.0.29], respectively). HBM individuals had higher WOMAC knee pain scores (β = 7.42 [1.17.13.66]), largely explained by adjustment for osteophyte score (58% attenuated) rather than JSN (30% attenuated) or TBFM (16% attenuated). The same pattern was observed for symptomatic stiffness and functional limitation.

CONCLUSIONS

HBM is associated with osteophyte progression, which appears to contribute to increased reported pain, stiffness and functional loss.

What are the perceptions of stakeholders on the utility of the nKPIs for Indigenous services?

Background

The Australian Commonwealth Government has introduced national key Performance Indicators, (nKPIs), for Indigenous primary health care services, including Aboriginal Community Controlled Health Organisations (ACCHOs). The nKPIs aim to assist in the monitoring of Indigenous people's health and aid ACCHOs to monitor their service delivery. The nKPI development and its ongoing implementation have involved stakeholders including the Council of Australian Governments; national and jurisdictional ACCHO peak bodies; government departments; software developers, and researchers. While high-level information is available about the nKPIs, there is very little publicly available information about how they were developed and implemented. This presentation discusses perspectives from stakeholders on the development and implementation of the nKPIs.

Methods

Stakeholder interviews (n = 15) aimed to understand the utility and appropriateness of the nKPIs and barriers/enablers to implementation. Stakeholders with knowledge of the development, management or reporting of the nKPIs were recruited. The analysis was conducted inductively and deductively and organised using NVivo.

Results

The interviews focused on the history of the nKPIs and the context within which these are collected and managed. Several key themes and sub-themes arose from the stakeholder interviews. These themes included the nKPI purpose, development, implementation, and appropriateness. Several interviewees considered the nKPI development process to be flawed, leading to poor data quality and an increased burden on ACCHOs.

Conclusions

The ACCHO sectors' needs and perspectives were mostly ignored in the development process. Numerous research papers and government documents highlight the need for active engagement of Indigenous people to be actively engaged in the design of policies, programs, and frameworks seeking to improve the health of Indigenous people.

Key messages

The nKPI implmentation issues could have been avoided had they been developed in partnership with Indigenous organisations. Indigenous policy development needs to be developed in partnership with Indigenous people.

#CroakeyGO: Walking as an act of journalism to engage not distance the public in health reporting

Health as it is reported in mainstream media is narrow and communities are often excluded, despite being where the experience of health occurs. A wide range of research indicates that it is through narratives of community members that media and health messages are best conveyed, and community members now have a range of platforms for quickly conveying information to each other and the media. However, there have been surprisingly few innovations for journalists to use this material, or to better connect with the public and report more accurately about health.

Our experience across several journalism projects demonstrates how quickly and deeply health content can be developed in collaboration with communities. One example is #CroakeyGO - an innovation in public interest journalism that gathers, walks and talks with community members together at a defined time and location about health-related matters.

#CroakeyGO brings together diverse voices from local communities - people who might otherwise not connect. This stimulates discussion about health issues beyond the individual, including system- and environmental-level issues that impact local lives. #CroakeyGO also means respecting Indigenous peoples' connection to Country on which we walk and reflecting on intergenerational inequities and solutions Indigenous knowledges offer.

To date we have published more than 40 articles from #CroakeyGO events around metropolitan and regional Australia. We have collaboratively produced social media and other editorial content with community members and stimulated enduring networks for health planning, advocacy and research. #CroakeyGO reinforces that improving health in a community requires more than just additional services, and that transformations in journalism can facilitate and support rather than hinder collective action.

Key messages

Innovations in journalism are required and possible to improve health reporting. Communities are willing to engage in health reporting.