Cold indoor temperatures and their association with health and well-being: a systematic literature review

OBJECTIVE

The study aimed to identify, appraise and update evidence on the association between cold temperatures (i.e. <18°C) within homes (i.e. dwellings) and health and well-being outcomes.

STUDY DESIGN

This study was a systematic review.

METHODS

Seven databases (MEDLINE, Embase, Cochrane Database of Systematic Reviews, CINAHL, APA PsycInfo, Applied Social Sciences Index and Abstracts, Coronavirus Research Database) were searched for studies published between 2014 and 2022, which explored the association between cold indoor temperatures and health and well-being outcomes. Studies were limited to those conducted in temperate and colder climates due to the increased risk of morbidity and mortality during winter in those climatic zones. Studies were independently quality assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.

RESULTS

Of 1209 studies, 20 were included for review. Study outcomes included cardiovascular (blood pressure, electrocardiogram abnormalities, blood platelet count), respiratory (chronic obstructive pulmonary disease symptoms, respiratory viral infection), sleep, physical performance and general health. Seventeen studies found exposure to cold indoor temperatures was associated with negative effects on health outcomes studied. Older individuals and those with chronic health problems were found to be more vulnerable to negative health outcomes.

CONCLUSION

Evidence suggests that indoor temperatures <18°C are associated with negative health effects. However, the evidence is insufficient to allow clear conclusions regarding outcomes from specific temperature thresholds for different population groups. Significant gaps in the current evidence base are identified, including research on the impacts of cold indoor temperatures on mental health and well-being, studies involving young children, and the long-term health effects of cold indoor temperatures.

The Blunt Liver and Spleen Trauma (BLAST) audit: national survey and prospective audit of children with blunt liver and spleen trauma in major trauma centres

PURPOSE

To compare the reported and observed management of UK children with blunt liver or spleen injury (BLSI) to the American Pediatric Surgical Association (APSA) 2019 BLSI guidance.

METHODS

UK Paediatric Major Trauma Centres (pMTCs) undertook 1 year of prospective data collection on children admitted to or discussed with those centres with BLSI and an online questionnaire was distributed to all consultants who care for children with BLSI in those centres.

RESULTS

All 21/21 (100%) pMTCs participated; 131 patients were included and 100/152 (65%) consultants responded to the survey. ICU care was reported and observed to be primarily determined using haemodynamic status or concomitant injuries rather than injury grade, in accordance with APSA guidance. Bed rest was reported to be determined by grade of injury by 63% of survey respondents and observed in a similar proportion of patients. Contrary to APSA guidance, follow-up radiological assessment of the injured spleen or liver was undertaken in 44% of patients before discharge and 32% after discharge, the majority of whom were asymptomatic.

CONCLUSIONS

UK management of BLSI differs from many aspects of APSA guidance. A shift towards using clinical features to determine ICU admission and readiness for discharge is demonstrated, in line with a strong evidence base. However, routine bed rest and re-imaging after BLSI is common, contrary to APSA guidance. This disparity may exist due to concern that evidence around the incidence, presentation and natural history of complications after conservatively managed BLSI, particularly bleeding from pseudoaneurysms, is weak.

O-181 4D ultrasound guided embryo transfers statistically improve live birth rates - A randomised controlled trial

Study question

Does the use of 4D ultrasound to guide embryo transfers improve live birth rates in comparison to the clinical touch technique?

Summary answer

4D ultrasound guided embryo transfers (4DUS) result in significantly higher live birth rates (LBR) in comparison to those performed using the clinical touch technique (CTT)(41%vs28%).

What is known already

A previous Cochrane review showed ultrasound guided embryo transfers (ET) improve pregnancy outcomes in comparison to CTT; however there was a large degree of heterogeneity between the studies and the largest study in the review showed no difference between ultrasound guidance and CTT. A further study demonstrated no difference in ongoing pregnancy rates between 2D vs 3D ultrasound guided embryo transfers, however this study did not use LBR as an endpoint and did not report on procedure duration/difficultly, both of which are known to impact ET success rates.

Study design, size, duration

This was a prospective, open labelled randomised controlled trial comparing superiority between two techniques for ET (4DUS vs CTT). A total of 320 (n = 160/group) patients were recruited using computer generated randomisation that were centrally distributed in consecutive sealed opaque envelopes between July 2018 to December 2019. Main outcomes were clinical pregnancy rate (CPR) and LBR. Following the procedure, participants completed a survey based on their comfort and satisfaction.

Participants/materials, setting, methods

Inclusion criteria included single blastocyst transfer and a normal uterine cavity. Participants were recruited and randomized on the day of ET. Those allocated to the CTT group, had their embryo transferred without ultrasound, depositing the embryo 6cm from the external os. Those in the 4DUS group had their ET using transvaginal 4D ultrasonography and had their embryos deposited at the maximal implantation point (MIP).

Main results and the role of chance

Results were available from a total of 295 women (8% attrition rate, CTT n = 153; 4DUS n = 142)).

No demographic differences between the two groups (CTT and 4DUS) were noted including age (p = 0.05), BMI (p = 0.29), duration of infertility (p = 0.94), type of infertility (p = 0.68) or embryo quality (p = 0.89). All the 4DUS and 95% of the CTT group were performed by the same practitioner.

The 4DUS resulted in significantly higher CPR (50% vs 36% p = 0.015, OR 1.78 (1.12-2.84)) and LBR (41%vs 28%, p = 0.021, OR 1.77 (1.09-2.87)).

There were no statistically significant differences between miscarriage (p = 0.494), pregnancy of unknown location (p = 0.141) or ectopic pregnancy rates (p = 0.958) between the two groups. The 4DUS process took significantly longer time compared with the CTT procedure (15.7 vs 10.2 minutes respectively, p &lt; 0.01). The results of the survey showed no statistical difference between patient comfort (p = 0.17) or satisfaction (p = 0.08) between the groups however there were significantly more positive comments in the 4DUS (p &lt; 0.01). In the 4DUS group there was no difference in mean endometrial thickness (P = 0.186) or endometrial volume (p = 0.836) between pregnant and non-pregnant patients.

Limitations, reasons for caution

Due to the nature of this trial we were unable to blind the participants due to the obvious differences between the methods. Wallace catheters were used for the CTT and Kitazato catheters for the 4DUS, whilst a methodological weakness; previous meta-analysis has not shown any difference between different soft catheters.

Wider implications of the findings

LBRs, when utilizing 4DUS, are significantly higher than the current UK average (41%vs22-23%) and significantly higher than CTT. 4DUS allows for superior imaging of the uterine cavity, tailoring the embryo deposition point specifically to the patient. Further RCTs are required to confirm that 4DUS is the superior technique for ET.

Trial registration number

ISRCTN79955797 ,IRAS 202857

POS0606 DISEASE ACTIVITY AND PATIENTS-REPORTED OUTCOMES AFTER SWITCHING BETWEEN IL-6 RECEPTOR INHIBITORS AND JAK INHIBITORS: AN ANALYSIS FROM THE CORRONA REGISTRY

Background:

Rheumatoid arthritis (RA) patients who fail therapy may be switched to any of the five classes of biological disease-modifying antirheumatic drugs (DMARDs) and targeted synthetic DMARDs, to meet treatment goals. Physicians may hesitate to switch between Janus Kinase inhibitors (JAKi) and interleukin-6 receptor inhibitors (IL-6Ri) since they both impact IL-6 signalling and due to limited data on switching between the two classes.

Objectives:

This retrospective, observational study based on the real-world Corrona RA registry aimed to describe the response in RA patients switching between IL-6Ri and JAKi.

Methods:

Adult RA patients who initiated either IL-6Ri or JAKi after November 2012 and had a six-month post-initiation follow-up visit were eligible. Patients in ‘Cohort A’ initiated an IL-6Ri following discontinuation of a JAKi and those in ‘Cohort B’ initiated a JAKi following discontinuation of an IL-6Ri. Disease activity measures and patient-reported outcomes (PROs) were evaluated at baseline and at six-month follow-up. Within each group, change from baseline was assessed for Clinical Disease Activity Index (CDAI), Health Assessment Questionnaire (HAQ), pain, fatigue, tender joint count (TJC), swollen joint count (SJC), physician global assessment (MDGA), patient global assessment (PtGA) and morning stiffness duration. Proportion of patients achieving CDAI low disease activity (LDA), CDAI remission and minimal clinically important difference (MCID) for HAQ, pain, fatigue, MDGA, PtGA were assessed. Adjusted linear and logistic regression models were performed for between-group comparisons (Cohort A vs Cohort B) excluding initiators who switched therapy prior to six-month visit.

Results:

Cohorts A and B included 122 and 144 initiators, respectively. Patients who switched to

IL-6Ri (vs JAKi) were younger (mean [SD] age, 56.2 [11.3] vs 58.9 [12.6] years), had higher baseline CDAI (23.2 [12.9] vs 20.2 [12.8]), had higher prior use of ≥2 csDMARDs (75% vs 65%), and were less likely to initiate therapy as monotherapy (44% vs 50%).

In Cohort A, significant changes from baseline were observed for all continuous outcomes except HAQ and fatigue. In Cohort B, a significant improvement was observed only for patient-reported pain (Table 1).

Table 1.

Unadjusted Within-Group Change from Baseline to Six Months, Mean (95% CI), n

OutcomesCohort A, N = 122Cohort B, N = 144CDAI-4.7 (-7.6, -1.9), 109-2.4 (-5.2, 0.4), 116HAQ-0.0 (-0.1, 0.1), 105-0.1 (-0.1, 0.0), 118Patient-reported pain-8.2 (-13.4, -3.0), 109-5.9 (-11.5, -0.2), 120Patient-reported fatigue-4.4 (-9.0, 0.2), 109-1.7 (-6.6, 3.3), 117TJC-1.6 (-3.0, -0.1), 112-1.2 (-2.6, 0.3), 117SJC-1.5 (-2.5, -0.4), 112-0.4 (-1.3, 0.6),117MDGA-10.9 (-15.6, -6.3), 112-4.3 (-8.7, 0.2), 117PtGA-6.0 (-11.2, -0.8), 109-4.8 (-10.5, 0.8), 120Morning stiffness durationa-1.3 (-2.2, -0.5), 109-0.1 (-1.1, 0.8), 118

aAmong those reporting morning stiffness at baseline.

In the adjusted between-group comparison (data not shown) of change from baseline, there were no significant differences in clinical outcomes between Cohorts A and B.

In both cohorts, patients achieved CDAI LDA, CDAI remission, and MCIDs across other PROs (Figure 1). In the adjusted between-group comparison (data not shown), the results were similar with the exception of achievement of CDAI LDA among patients with moderate to high disease activity at baseline.

Figure 1.

Rates of CDAI LDA, CDAI Remission, and MCID for PROsa at Six Months

Conclusion:

In general, in both cohorts a substantial proportion of patients achieved CDAI LDA and MCID across PROs. Despite some overlap of JAKi and IL-6Ri therapies’ on the IL-6 pathway, there are some distinct mechanisms of action which may result in meaningful improvements for a subset of patients.

Acknowledgements:

Amy Praestgaard (Sanofi) contributed to the interpretation of the statistical analysis for this abstract. Medical writing support for this abstract was provided by Nupur Chaubey (Sanofi).

Disclosure of Interests:

Anisha Dua Speakers bureau: AbbVie, Consultant of: Consulting/advisory board for AbbVie, Novartis, and Chemocentryx, Employee of: Board member of Vasculitis foundation and Chicago Rheumatism Society, Kerri Ford Shareholder of: Sanofi, Employee of: Sanofi, Stefano Fiore Shareholder of: Sanofi, Employee of: Sanofi. In addition, Stefano Fiore has a patent EP 19306553.9; USPTO #s 62/799,698; 62/851,474; 62/935,395 issued, Dimitrios A Pappas Shareholder of: Corrona LLC, Consultant of: Sanofi, AbbVie, Gtech, Roche Hellas, and Novartis, Employee of: Corrona LLC. Board of directors, Corrona Research Foundation, Judson Janak: None declared, Taylor Blachley: None declared, Carla Roberts-Toler: None declared, Kelechi Emeanuru: None declared, Joel Kremer Consultant of: AbbVie, Lilly, Novartis, Pfizer, BMS, Genentech, Regeneron, Sanofi, and Corrona, Grant/research support from: AbbVie, Lilly, Novartis, and Pfizer, Alan Kivitz Shareholder of: Pfizer, Sanofi, GlaxoSmithKline, Gilead Sciences, Inc., and Novartis, Speakers bureau: Celgene, Merck, Lilly, Novartis, Pfizer, Sanofi, Flexion, and AbbVie, Consultant of: AbbVie, Boehringer Ingelheim, Flexion, Janssen, Pfizer, Sanofi, Regeneron, SUN Pharma Advanced Research, Gilead Sciences, Inc. In addition, Alan Kivitz reports other from Altoona Center for Clinical Research, PC, during the conduct of the study.

POS0594 MEANINGFUL IMPROVEMENT AND WORSENING IN PATIENTS WHO DO NOT ACHIEVE LDA AND SWITCH THERAPY TO A NEW BIOLOGIC OR TARGETED THERAPY: RESULTS FROM THE CORRONA REGISTRY

Background:

Guidelines recommend adjusting therapy in patients with rheumatoid arthritis (RA) who fail to reach and sustain low disease activity (LDA) or remission (disease control). Many factors can affect the decision to change therapy, including the potential for improvement as well as the fear of potential worsening or loss of improvement already achieved. Although data exist on response to treatment in patients who switch therapy, data addressing the likelihood of worsening are limited.

Objectives:

The aim of this analysis was to describe the demographic, clinical characteristics, and change in clinical outcomes in patients on biologic/targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) who had some improvement in clinical disease activity index (CDAI) but did not achieve LDA after ~ 6-12 months of treatment and then switched to a different b/tsDMARD.

Methods:

This study included adult inadequately responding RA patients from the CORRONA registry who: (1) started a biologic or Janus kinase inhibitor (JAKi) between January 2010 to November 2020 (V1), (2) had any CDAI improvement (i.e., decrease ≥1 unit) but were not in LDA or remission at a subsequent visit (baseline [BL]) occurring 3 to 15 months after V1; (3) had a third visit (follow-up [F/U]) 6 (±3) months after BL with a valid CDAI measure; (4) switched therapy at the BL or between BL and F/U, with the switch occurring at least 3 months prior to the F/U. CDAI >10 and ≤22 was defined as moderate disease activity (MDA) and CDAI >22 was defined as high disease activity (HDA). Two thresholds of change in CDAI (≥6 and ≥12 units) were used to define meaningful improvement and meaningful worsening after the switch. If there was no meaningful improvement or meaningful worsening, this was considered as no meaningful change (-5 to +5 for 6 units change and -11 to +11 for 12 units change). These thresholds for meaningful change were set for all switchers regardless of their pre-switch CDAI value. Descriptive statistics were generated for demographic and clinical characteristics for the switchers at BL, and the change of clinical outcomes was evaluated from BL to F/U.

Results:

Of the 1,224 patients fulfilling the inclusion criteria, 93 (7.6%) switched therapy and 1,131 (92.4%) did not switch therampy after not achieving an adequate response on the initial b/tsDMARD. At BL, 42.5% and 70.0% of patients had no meaningful improvement to their prior therapy based on ≥6 and ≥12-unit change, respectively; mean (SD) age was 53.1 (14.0) years; duration of RA 10.7 (10.4) years; CDAI 22.2 (10.8); 81.7% were female; 64.5% had MDA, 35.5% had HDA; 21.5 % reported being disabled, 24.7% were current smokers, and 50% were obese. In terms of prior biologic use 57.0%, 22.6%, and 20.4% had been on 1, 2, and 3+, respectively. From BL to F/U, meaningful worsening occurred in 30.1% and 12.9% using a threshold of 6 and 12, respectively, with the remaining patients experiencing meaningful improvement or no meaningful change (Figure 1).

Figure 1.

Meaningful Worsening, Meaningful Improvement, and No Meaningful Change Based on CDAI Change Thresholds of ≥6 and ≥12 From BL to F/U (N=93)

Conclusion:

In our analysis, a large proportion of patients who initiated a biologic/JAKi and experienced some improvement but failed to attain LDA or remission, did not switch therapy within approximately a year. This analysis consisted of many patients who did not have a meaningful response to their prior biologic/JAKi, patients who had received multiple prior biologics, and a large portion of patients with poor prognostic factors. Despite this, the proportion of patients with meaningful worsening was low compared with most patients who had either meaningful improvement or no meaningful change. Additional research is warranted to understand the reasons for not switching and whether the likelihood of a meaningful change correlates with prior response, poor prognosis, or other factors.

Acknowledgements:

Amy Praestgaard (Sanofi) contributed to the statistical analysis for this abstract. Medical writing support for this abstract was provided by Krishna Kammari (Sanofi).

Disclosure of Interests:

Jeffrey Curtis Grant/research support from: and personal fees from AbbVie, Amgen, BMS, CORRONA, Eli Lily, Janssen, Myriad, Pfizer, Roche, Regeneron, Radius, UCB, outside the submitted work, Stefano Fiore Shareholder of: Sanofi, Employee of: Sanofi. In addition, he has a patent EP 19306553.9; USPTO #s 62/799,698; 62/851,474; 62/935,395 issued, Kerri Ford Shareholder of: Sanofi, Employee of: Sanofi, Judson Janak: None declared, Hong Chang: None declared, Dimitrios A Pappas Employee of: CORRONA LLC. He has previously acted as a consultant for Sanofi, Abbvie, Gtech Roche Hellas, and Novartis. He has an equity interest in CORRONA LLC. and is on the Board of directors of the CORRONA research foundation, Taylor Blachley: None declared, Kelechi Emeanuru: None declared, Vivian Bykerk Grant/research support from: reports grants from Amgen, BMS, UCB, and Novartis were given to institution, that grants from the NIH, PCORI, and CIHR were given to institutions which whom she is affiliated, and that she has received personal fees from Amgen, Gilead, BMS, Pfizer, Sanofi Aventis, Roche, UCB and Regeneron, outside the submitted work.

POS0638 DISEASE SEVERITY AND OUTCOMES AMONG PATIENTS WITH RHEUMATOID ARTHRITIS WHO RECEIVE A NEWLY APPROVED BIOLOGIC: REAL-WORLD US EXPERIENCE WITH SARILUMAB FROM THE ACR RISE REGISTRY

Background:

Patients with rheumatoid arthritis (RA) who have received multiple biologics or targeted therapies over time tend to have more refractory and more severe disease, which may lead to worse clinical response to treatment.

Objectives:

We used data from the ACR RISE registry to assess whether disease severity was greater in those who received sarilumab shortly after its FDA approval (May 2017) than in subsequent time periods and to evaluate the effectiveness of sarilumab in populations with various degrees of disease severity.

Methods:

Patients with RA who initiated sarilumab treatment in the period 2017-2020 were identified in the ACR RISE registry and divided into Cohort 1 (2017, year of the FDA approval) and the calendar year-based Cohorts 2-4 (2018-2020). Patient demographics, RA-related features, and comorbidities were determined using data prior to sarilumab initiation. The cohorts were compared using chi-square test (categorical variables) and a nonparametric test (continuous variables). Sarilumab effectiveness was assessed using 3 cohorts assembled based on progressively restrictive criteria: Active Disease cohort (Clinical Disease Activity Index [CDAI] >10 or Routine Assessment of Patient Index Data 3 [RAPID3] >6, and C-reactive protein, if measured, ≥8 mg/L), TARGET Eligibility cohort (patients who satisfied enrolment criteria for TARGET,1 a Phase 3 sarilumab trial in patients with RA and an inadequate response to TNF inhibitors), and TARGET Baseline cohort (patients from TARGET Eligibility cohort with characteristics weighted to match those from the TARGET trial baseline,1 using the matching-adjusted indirect comparison method2). In all 3 effectiveness cohorts, mean changes in CDAI and RAPID3 at 6 and 12 months post-initiation of sarilumab were evaluated using a model adjusted for baseline score, age, sex, race, calendar year, and seropositivity.

Results:

A total of 2949 patients, treated by 585 rheumatologists, initiated sarilumab treatment in the period 2017–2020. The 4 yearly cohorts were relatively similar in terms of patients’ age, sex, race, and most clinical characteristics. However, patients receiving sarilumab shortly after FDA approval (Cohort 1) had more ambulatory visits, a greater number of previously used non-TNFi biologics (particularly tocilizumab), and a higher comorbidity burden, and were more likely to be current users of glucocorticoids or opioids than sarilumab initiators in the subsequent 3 years. In the 3 cohorts used to assess sarilumab effectiveness, the greatest improvement was observed in the TARGET Baseline cohort, which also had the greatest mean baseline CDAI score (43), compared with the other two (24 both).

Conclusion:

In this real-world cohort, we observed modest evidence for channeling of patients with greater RA severity and greater prior exposure to non-TNFi biologics to sarilumab shortly after its FDA approval. This cohort effect did not diminish the effectiveness of sarilumab. All cohorts showed improvement, with the greatest clinical improvement observed in the cohort with the highest baseline CDAI score who most closely resembled those enrolled in a phase 3 trial of patients with an inadequate response to TNF inhibitors.

References:

[1]Fleischmann R, et al. Arthritis Rheumatol 2017;69:277-290.

[2]Signorovitch JE et al. Value Health 2012;15:940-7.

Figure 1.

Adjusted improvements in CDAI and RAPID3

Acknowledgements:

This study was sponsored by Sanofi. Medical writing support was provided by Vojislav Pejović, PhD (Eloquent Medical Affairs, division of Envision Pharma Group) and funded by Sanofi.

Disclosure of Interests:

Stefano Fiore Employee of: Sanofi, Lang Chen: None declared, Cassie Clinton Consultant of: Information available in profile, Huifeng Yun Grant/research support from: Research support for Pfizer, Amy Praestgaard Employee of: Sanofi, Kerri Ford Employee of: Sanofi, Jeffrey Curtis Consultant of: Received consulting and research grants from AbbVie, Amgen, BMS, Lilly, Gilead, GSK, Janssen, Myriad, Pfizer, Roche, Samsung, Sandoz, Sanofi, UCB, Grant/research support from: Received consulting and research grants from AbbVie, Amgen, BMS, Lilly, Gilead, GSK, Janssen, Myriad, Pfizer, Roche, Samsung, Sandoz, Sanofi, UCB

Investigating Wilms' Tumours Worldwide: A Report of the OxPLORE Collaboration-A Cross-Sectional Observational Study

BACKGROUND

Childhood cancer is neglected within global health. Oxford Pediatrics Linking Oncology Research with Electives describes early outcomes following collaboration between low- and high-income paediatric surgery and oncology centres. The aim of this paper is twofold: to describe the development of a medical student-led research collaboration; and to report on the experience of Wilms' tumour (WT).

METHODS

This cross-sectional observational study is reported as per STROBE guidelines. Collaborating centres included three tertiary hospitals in Tanzania, Rwanda and the UK. Data were submitted by medical students following retrospective patient note review of 2 years using a standardised data collection tool. Primary outcome was survival (point of discharge/death).

RESULTS

There were 104 patients with WT reported across all centres over the study period (Tanzania n = 71, Rwanda n = 26, UK n = 7). Survival was higher in the high-income institution [87% in Tanzania, 92% in Rwanda, 100% in the UK (X² 36.19, p < 0.0001)]. Given the short-term follow-up and retrospective study design, this likely underestimates the true discrepancy. Age at presentation was comparable at the two African sites but lower in the UK (one-way ANOVA, F = 0.2997, p = 0.74). Disease was more advanced in Tanzania at presentation (84% stage III-IV cf. 60% and 57% in Rwanda and UK, respectively, X² 7.57, p = 0.02). All patients had pre-operative chemotherapy, and a majority had nephrectomy. Post-operative morbidity was higher in lower resourced settings (X² 33.72, p < 0.0001). Methodology involving medical students and junior doctors proved time- and cost-effective. This collaboration was a valuable learning experience for students about global research networks.

CONCLUSIONS

This study demonstrates novel research methodology involving medical students collaborating across the global south and global north. The comparison of outcomes advocates, on an institutional level, for development in access to services and multidisciplinary treatment of WT.

SAT0102 NONINFLAMMATORY PAIN IS A FREQUENT PHENOMENON IN RHEUMATOID ARTHRITIS AND RESPONDS WELL TO TREATMENT WITH SARILUMAB

Background:

Inflammation is clearly a key driver of pain in rheumatoid arthritis (RA). However, in some patients the level of pain exceeds what would be expected based on the amount of synovitis observed, which may indicate the presence of noninflammatory pain (NIP). Interleukin-6 (IL-6) has been shown in animal models to increase sensitization to pain and may play a role in NIP.

Objectives:

To assess the effect of sarilumab, a human IL-6 receptor inhibitor approved for the treatment of adults with moderate to severely active RA, on NIP and disease activity, stratified by baseline (BL) NIP status.

Methods:

The analysis included data from three Phase 3 studies of sarilumab: MOBILITY (NCT01061736), MONARCH (NCT02332590), and TARGET (NCT01709578). Patients received double-blind placebo or sarilumab 150 mg or 200 mg subcutaneously (SC) every 2 weeks (q2w), plus weekly csDMARD (MOBILITY and TARGET), or adalimumab 40 mg or sarilumab 200 mg SC q2w as monotherapy (MONARCH).

NIP was defined using an established formula: tender 28-joint count (TJC) – swollen 28-joint count (SJC) ≥7.1,2Patients were assessed for NIP at study BL and for change in NIP status at Weeks 12 and 24. The proportion of patients achieving ACR20/50/70, Clinical Disease Activity Index (CDAI) ≤10, and DAS28-CRP <3.2 at Week 24 was assessed in patients with and without BL NIP. No inferential statistics were performed.

Results:

Of 2112 patients in the analysis, 490 (23%) met the criteria for NIP at study BL: MOBILITY, n = 294/1197 (25%); MONARCH, n = 90/369 (24%); TARGET, n = 106/546 (19%). BL demographics were similar for patients with or without BL NIP: mean age (SD) was 52.6 (10.7) versus 51.2 (12.3) years, and 85% versus 81% were female. Patients with BL NIP had higher CDAI, DAS28-CRP, pain Visual Analog Scale (VAS), and TJC at BL versus patients without NIP (Table). Of patients with NIP at BL, those who received sarilumab were more likely to have no NIP at Weeks 12 and 24 versus patients who received placebo or adalimumab (Figure 1). The percentage of patients achieving improvements in disease activity at Week 24 was greater for sarilumab versus adalimumab among both patients with and without BL NIP, and these differences were larger among patients with BL NIP for all assessments except ACR50 (Figure 2).

Table.

Baseline characteristics

Patients with TJC – SCJ ≥7Mean (SD)Yes (n = 490)No (n = 1622)Duration of RA, years9.1 (8.6)9.7 (8.4)TJC, 0–2821.7 (4.7)14.3 (6.2)SJC, 0–2810.7 (4.3)13.1 (6.0)CRP, mg/L22.7 (27.0)22.9 (24.0)HAQ-DI, 0–31.8 (0.6)1.7 (0.6)DAS28-CRP6.4 (0.7)5.9 (0.9)CDAI46.0 (9.4)40.4 (13.0)Pain VAS72.3 (18.2)67.0 (20.7)

Conclusion:

NIP was prevalent at BL in the patient populations assessed. Among patients with BL NIP, a lower proportion continued to have NIP at Weeks 12 and 24 when treated with sarilumab versus placebo or adalimumab. Patients with and without BL NIP had greater improvements in pain when treated with sarilumab versus adalimumab. The difference in clinical improvement was greater among patients with BL NIP versus without BL NIP for most measures. These trends support the emerging concept that mechanisms other than direct inflammation may contribute to pain in RA, potentially mediated via IL-6 signaling.

References:

[1]Durán J et al.Rheumatology. 2015;54:2166–70

[2]Pollard LC et al.Rheumatology. 2010;49:924–8

Acknowledgments:

Study funding and medical writing support (Joseph Hodgson, PhD, Adelphi Communications Ltd, Macclesfield, UK) provided by Sanofi Genzyme (Cambridge, MA, USA) and Regeneron Pharmaceuticals, Inc. (Tarrytown, NJ, USA) in accordance with GPP3 guidelines.

Disclosure of Interests:

Ernest Choy Grant/research support from: Amgen, Bio-Cancer, Chugai Pharma, Ferring Pharmaceuticals, Novimmune, Pfizer, Roche, UCB, Consultant of: AbbVie, Amgen, AstraZeneca, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Chelsea Therapeutics, Chugai Pharma, Daiichi Sankyo, Eli Lilly, Ferring Pharmaceuticals, GlaxoSmithKline, Hospita, Ionis, Janssen, Jazz Pharmaceuticals, MedImmune, Merck Sharp & Dohme, Merrimack Pharmaceutical, Napp, Novartis, Novimmune, ObsEva, Pfizer, R-Pharm, Regeneron Pharmaceuticals, Inc., Roche, SynAct Pharma, Sanofi Genzyme, Tonix, UCB, Speakers bureau: Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Chugai Pharma, Eli Lilly, Hospira, Merck Sharp & Dohme, Novartis, Pfizer, Regeneron Pharmaceuticals, Inc., Roche, Sanofi-Aventis, UCB, Vivian Bykerk: None declared, Yvonne Lee Shareholder of: Cigna-Express Scripts, Grant/research support from: Pfizer, Consultant of: Highland Instruments, Inc., Gregory St John Shareholder of: Regeneron Pharmaceuticals, Inc., Employee of: Regeneron Pharmaceuticals, Inc., Hubert van Hoogstraten Shareholder of: Sanofi, Employee of: Sanofi, Kerri Ford Shareholder of: Sanofi Genzyme, Employee of: Sanofi Genzyme, Amy Praestgaard Employee of: Sanofi Genzyme, Anthony Sebba Consultant of: Genentech, Gilead, Lilly, Regeneron Pharmaceuticals Inc., Sanofi, Speakers bureau: Lilly, Roche, Sanofi

FRI0108 ASSOCIATION BETWEEN CHANGES IN C-REACTIVE PROTEIN AT WEEK 12 AND PATIENT-REPORTED OUTCOMES AT WEEK 24 WITH SARILUMAB THERAPY ACROSS THREE PIVOTAL PHASE 3 STUDIES

Background:

Evaluation of early response to rheumatoid arthritis (RA) therapy at 12 weeks after initiation is recommended in treatment guidelines. C-reactive protein (CRP) response at 12 weeks on therapy may indicate favorable longer-term patient-reported outcomes (PROs).

Objectives:

To describe the association between CRP response at Week 12 and PROs at Week 24 with sarilumab therapy across three pivotal studies.

Methods:

The analysis included patients with RA who took part in MOBILITY (NCT01061736), TARGET (NCT01709578), or MONARCH (NCT02332590) and were treated with sarilumab 200 mg every 2 weeks (q2w) or adalimumab 40 mg q2w (MONARCH only). Patients who achieved a CRP response at Week 12 (defined as serum CRP ≤3 mg/L) were evaluated for PROs at Week 24. Response for PROs was defined as change from baseline visual analog scale score ≥10 for pain, sleep, and morning stiffness and an increase of ≥4 for FACIT-Fatigue score. Odds ratios (ORs) and 95% confidence intervals (CIs) were generated for the likelihood of achieving PRO responses at Week 24.

Results:

The proportions of patients achieving a CRP response at Week 12 were 78% (MOBILITY), 74% (TARGET), 80% (MONARCH, sarilumab), and 36% (MONARCH, adalimumab). Of these, 71.4% (MOBILITY; OR 3.78, 95% CI 2.31–6.18), 71.5% (TARGET; OR 2.86, 95% CI 1.44–5.65), 79.7% (MONARCH, sarilumab; OR 4.40, 95% CI 2.04–9.47), and 79.7% (MONARCH, adalimumab; OR 2.76, 95% CI 1.36–5.61) reported pain score responses at Week 24. Fatigue responses at Week 24 among Week 12 CRP responders were 66.6% (MOBILITY; OR 2.74, 95% CI 1.69–4.45), 59.9% (TARGET; OR 3.18, 95% CI 1.58–6.42), 73.0% (MONARCH, sarilumab; OR 4.78, 95% CI 2.21–10.33), and 64.1% (MONARCH, adalimumab; OR 1.64, 95% CI 0.88–3.06). Sleep was evaluated in MOBILITY only, and 58.2% of those achieving Week 12 CRP responses reported sleep score responses at Week 24 (OR 3.51, 95% CI 2.10–5.87). Morning stiffness responses (evaluated in TARGET and MONARCH only) at Week 24 among patients with Week 12 CRP responses were 71.5% (TARGET; OR 3.70, 95% CI 1.86–7.39), 81.1% (MONARCH, sarilumab; OR 5.36, 95% CI 2.47–11.63), and 75.0% (MONARCH, adalimumab; OR 2.42, 95% CI 1.24–4.72).

Conclusion:

Achievement of a CRP response at Week 12 in patients with RA treated with sarilumab 200 mg q2w or adalimumab 40 mg q2w was associated with improvements at Week 24 in PROs for pain, fatigue, sleep, and morning stiffness. Among patients with RA, CRP responses at 12 weeks on treatment predict favorable longer-term PRO improvements.

Acknowledgments:

Study funding was provided by Sanofi Genzyme (Cambridge, USA) and Regeneron Pharmaceuticals, Inc. (Tarrytown, USA). Medical writing support (Tracey Lonergan, Adelphi Communications Ltd, Macclesfield, UK) was provided by Sanofi Genzyme and Regeneron Pharmaceuticals, Inc. in accordance with Good Publication Practice (GPP3) guidelines.

Disclosure of Interests:

John Tesser Consultant of: Sanofi/Regeneron, Speakers bureau: Sanofi/Regeneron, Grace C. Wright Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Exagen, Eli Lilly, Myriad Autoimmune, Novartis, Pfizer, Regeneron Pharmaceuticals, Inc., Sanofi Genzyme, UCB, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Exagen, Eli Lilly, Myriad Autoimmune, Novartis, Regeneron Pharmaceuticals, Inc., Sanofi Genzyme, UCB, Vibeke Strand Consultant of: AbbVie, Amgen, Biogen, Celltrion, Consortium of Rheumatology Researchers of North America, Crescendo Bioscience, Eli Lilly, Genentech/Roche, GlaxoSmithKline, Hospira, Janssen, Merck, Novartis, Pfizer, Regeneron Pharmaceuticals, Inc., Sanofi, UCB, Jeff Kaine Speakers bureau: Eli Lilly, Merck, Regeneron Pharmaceuticals, Inc., Sanofi, Karina Maslova Shareholder of: Sanofi Genzyme, Employee of: Sanofi Genzyme, Gregory St John Shareholder of: Regeneron Pharmaceuticals, Inc., Employee of: Regeneron Pharmaceuticals, Inc., Kerri Ford Shareholder of: Sanofi Genzyme, Employee of: Sanofi Genzyme, Amy Praestgaard Employee of: Sanofi Genzyme, Ernest Choy Grant/research support from: Amgen, Bio-Cancer, Chugai Pharma, Ferring Pharmaceuticals, Novimmune, Pfizer, Roche, UCB, Consultant of: AbbVie, Amgen, AstraZeneca, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Chelsea Therapeutics, Chugai Pharma, Daiichi Sankyo, Eli Lilly, Ferring Pharmaceuticals, GlaxoSmithKline, Hospita, Ionis, Janssen, Jazz Pharmaceuticals, MedImmune, Merck Sharp & Dohme, Merrimack Pharmaceutical, Napp, Novartis, Novimmune, ObsEva, Pfizer, R-Pharm, Regeneron Pharmaceuticals, Inc., Roche, SynAct Pharma, Sanofi Genzyme, Tonix, UCB, Speakers bureau: Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Chugai Pharma, Eli Lilly, Hospira, Merck Sharp & Dohme, Novartis, Pfizer, Regeneron Pharmaceuticals, Inc., Roche, Sanofi-Aventis, UCB

Low-fidelity Paediatric Surgical Simulation: Description of Models in Low-Resource Settings

BACKGROUND

Surgical simulation is an important aspect of competency-based training. Recent trends in paediatric surgical simulations have migrated towards high-fidelity simulation with advanced technology resulting in models which are expensive and largely inaccessible in low- and middle-income countries.

METHODS

This article describes four wet simulation models of common surgical procedures in paediatric population created with animal tissue from local abattoir. The models are designed to provide a framework for others to make the models and benefit from the training opportunity they provide especially in low-middle-income countries.

RESULTS

The models created in the wet laboratory are neonatal bowel anastomosis, duodenoduodenostomy for discrepancy anastomosis, gastrostomy and pyeloplasty. These models are easily reproducible in resource-challenged healthcare setting as they are low cost, utilise locally available resources and require only a basic set of surgical instruments with which to perform the procedures.

CONCLUSION

These models provide locally accessible material for sustainable training programmes which are fundamental in developing safe and affordable surgical care worldwide.

Measuring the relationships between adverse childhood experiences and educational and employment success in England and Wales: findings from a retrospective study

OBJECTIVES

Educational and employment outcomes are critical elements in determining the life course of individuals, yet through health and other mechanisms, those who suffer adverse childhood experiences (ACEs) may experience barriers to achieve in these domains. This study examines the association between ACEs and poor educational outcomes, before considering the impact of ACEs and education on employment in adulthood.

STUDY DESIGN

Retrospective cross-sectional surveys were conducted in England and Wales using a random stratified sampling methodology.

METHODS

During face-to-face household interviews (n = 2881), data were collected on demographic factors, ACEs, self-rated childhood affluence, the highest qualification level attained and the current employment status.

RESULTS

While respondents with ≥4 ACEs were significantly more likely to have no formal qualifications (adjusted odds ratio [AOR] = 2.18; P < 0.001), among those who did achieve secondary level qualifications, the presence of ACEs did not further impact subsequent likelihood of going on to attain college or higher qualifications. However, results suggest a persisting independent impact of high (≥4) ACEs, which were found to be significantly associated with both current unemployment (AOR = 2.52, P < 0.001) and long-term sickness and disability (AOR = 3.94, P < 0.001). Modelled levels of not being in employment ranged from as little as 3% among those with 0 or 1 ACE and higher qualifications to 62% among those with no qualifications and ≥4 ACEs (adjusted for age, gender and childhood affluence effects).

CONCLUSIONS

Compulsory education may play a pivotal role in mitigating the effects of adversity, supporting the case for approaches within schools that build resilience and tackle educational inequalities. However, adults with ACEs should not be overlooked and efforts should be considered to support them in achieving meaningful employment.

The United Kingdom Primary Immune Deficiency (UKPID) Registry: report of the first 4 years' activity 2008-2012

This report summarizes the establishment of the first national online registry of primary immune deficency in the United Kingdom, the United Kingdom Primary Immunodeficiency (UKPID Registry). This UKPID Registry is based on the European Society for Immune Deficiency (ESID) registry platform, hosted on servers at the Royal Free site of University College, London. It is accessible to users through the website of the United Kingdom Primary Immunodeficiency Network (www.ukpin.org.uk). Twenty-seven centres in the United Kingdom are actively contributing data, with an additional nine centres completing their ethical and governance approvals to participate. This indicates that 36 of 38 (95%) of recognized centres in the United Kingdom have engaged with this project. To date, 2229 patients have been enrolled, with a notable increasing rate of recruitment in the past 12 months. Data are presented on the range of diagnoses recorded, estimated minimum disease prevalence, geographical distribution of patients across the United Kingdom, age at presentation, diagnostic delay, treatment modalities used and evidence of their monitoring and effectiveness.

Soil radon measurements in the Canadian cities

Radon has been identified as the second leading cause of lung cancer after tobacco smoking. Information on indoor radon concentrations is required to assess the lung cancer burden due to radon exposure. Since radon in soil is believed to be the main source of radon in homes, measurements of soil gas radon concentrations can be used to estimate variations in radon potential of indoor environments. This study reports surveys of natural background variation in soil radon levels in four cities, Montreal, Gatineau, Kingston and the largest Canadian city of Toronto. A total of 212 sites were surveyed. The average soil gas radon concentrations varied significantly from site to site, and ranged from below detection limit to 157 kBq m(-3). For each site, the soil radon potential (SRP) index was determined with the average soil radon concentration and average soil permeability measured. The average SRP indexes are 20±16, 12±11, 8±9 and 12±10 for Montreal, Gatineau, Kingston and Toronto, respectively. The results provide additional data for the validation of an association between indoor and soil radon potentials and for the development of radon potential map of Canada.

Dopamine receptor expression and distribution dynamically change in the rat nucleus accumbens after withdrawal from cocaine self-administration

Dopamine receptors (DARs) in the nucleus accumbens (NAc) are critical for cocaine's actions but the nature of adaptations in DAR function after repeated cocaine exposure remains controversial. This may be due in part to the fact that different methods used in previous studies measured different DAR pools. In the present study, we used a protein crosslinking assay to make the first measurements of DAR surface expression in the NAc of cocaine-experienced rats. Intracellular and total receptor levels were also quantified. Rats self-administered saline or cocaine for 10 days. The entire NAc, or core and shell subregions, were collected one or 45 days later, when rats are known to exhibit low and high levels of cue-induced drug seeking, respectively. We found increased cell surface D1 DARs in the NAc shell on the first day after discontinuing cocaine self-administration (designated withdrawal day 1, or WD1) but this normalized by WD45. Decreased intracellular and surface D2 DAR levels were observed in the cocaine group. In shell, both measures decreased on WD1 and WD45. In core, decreased D2 DAR surface expression was only observed on WD45. Similarly, WD45 but not WD1 was associated with increased D3 DAR surface expression in the core. Taking into account many other studies, we suggest that decreased D2 DAR and increased D3 DAR surface expression on WD45 may contribute to enhanced cocaine-seeking after prolonged withdrawal, although this is likely to be a modulatory effect, in light of the mediating effect previously demonstrated for AMPA-type glutamate receptors.

Drink a little; take a few drugs: do nurses have knowledge to identify and manage in-patients at risk of drugs and alcohol?

INTRODUCTION AND AIMS

The widespread use of alcohol and other drugs poses particular problems during hospitalisation. Although nurses have been identified as an appropriate group to screen patients and provide acute and ongoing management to people with drug and alcohol-related problems, rates of screening are low. The aims of this study were to identify current practices for screening by nurses working in medical and surgical wards, determine their knowledge relating to problems associated with substance use and identify their self-reported skills in managing patients with drug- and alcohol-related problems.

DESIGN AND METHODS

A chart audit of medical records was completed and a survey was distributed to nurses working in the study wards.

RESULTS

Screening for alcohol and drug use was documented on only 22/79 medical records, and detailed information about quantity and duration of use was recorded in only nine. Overall, the nurses reported that they had little knowledge about substance use problems, and felt that they lacked skills to care adequately for these patients.

DISCUSSION AND CONCLUSIONS

The results of this study suggest a need for a comprehensive training and education to ensure that nurses are familiar with policies and protocols for management of patients and to assist nurses to provide evidence-based care and make appropriate referrals to specialist services.

HIV testing experience of drug users in Bali, Indonesia

Recently, large increases have been noted in injection drug use and HIV prevalence among drug users in Indonesia. The objective of this study was to examine the experience of drug users with HIV testing in Bali, Indonesia. In-depth interviews were conducted with a sample of 40 drug users who had injected heroin in the Denpasar, Bali area. The users' experience with testing highlighted the importance of pre- and post-test counselling that provides clear information, confidentiality and assistance in developing social support.

Study of the decay B0(B- 0)-->rho+rho-, and constraints on the Cabibbo-Kobayashi-Maskawa angle alpha

Using a data sample of 89 x 10(6) Upsilon(4S)-->BB decays collected with the BABAR detector at the PEP-II asymmetric B Factory at SLAC, we measure the B0(B (0))-->rho(+)rho(-) branching fraction as [30+/-4(stat)+/-5(syst)]x10(-6) and a longitudinal polarization fraction of f(L)=0.99+/-0.03(stat)+0.04-0.03(syst). We measure the time-dependent-asymmetry parameters of the longitudinally polarized component of this decay as C(L)=-0.17+/-0.27(stat)+/-0.14(syst) and S(L)=-0.42+/-0.42(stat)+/-0.14(syst). We exclude values of alpha between 19 degrees and 71 degrees (90% C.L.).

Search for B+/--->[K(-/+)pi(+/-)](D)K+/- and upper limit on the b-->u amplitude in B+/--->DK+/-

We search for B+/--->[K(-/+)pi(+/-)](D)K+/- decays, where [K(-/+)pi(+/-)](D) indicates that the K-/+pi(+/-) pair originates from the decay of a D0 or D (0). Results are based on 120x10(6) Upsilon(4S)-->BB decays collected with the BABAR detector at SLAC. We set an upper limit on the ratio R(Kpi) identical with[Gamma(B+-->[K(-)pi(+)](D)K+)+Gamma(B--->[K(+)pi(-)](D)K-)][Gamma(B+-->[K(+)pi(-)](D) / K+)+Gamma(B--->[K(-)pi(+)](D)K-)]<0.026 (90% C.L.). This constrains the amplitude ratio r(B) identical with|A(B--->D 0K-)/A(B--->D0K-)|<0.22 (90% C.L.), consistent with expectations. The small value of r(B) favored by our analysis suggests that the determination of the Cabibbo-Kobayashi-Maskawa phase gamma from B-->DK will be difficult.

Measurements of CP-violating asymmetries in B0-->K(0)(s)pi(0) decays

We present a measurement of the time-dependent CP-violating (CPV) asymmetries in B0-->K(0)(S)pi(0) decays based on 124x10(6) Upsilon(4S)-->BB decays collected with the BABAR detector at the PEP-II asymmetric-energy B factory at SLAC. In a sample containing 122+/-16 signal decays, we obtain the magnitudes of the direct CPV asymmetry CK(0)(S)(pi(0))=0.40(+0.27)(-0.28)+/-0.09 and of the CPV asymmetry in the interference between mixing and decay SK(0)(S)(pi(0))=0.48(+0.38)(-0.47)+/-0.06 where the first error is statistical and the second systematic.

Measurement of the B-->Xsl+l- branching fraction with a sum over exclusive modes

We measure the branching fraction for the flavor-changing neutral-current process B-->X(s)l(+)l(-) with a sample of 89x10(6) Upsilon(4S)-->BBmacr; events recorded with the BABAR detector at the PEP-II e(+)e(-) storage ring. The final state is reconstructed from e(+)e(-) or micro(+)micro(-) pairs and a hadronic system X(s) consisting of one K+/- or K(0)(S) and up to two pions, with at most one pi(0). We observe a signal of 40+/-10(stat)+/-2(syst) events and extract the inclusive branching fraction B(B-->X(s)l(+)l(-))=(5.6+/-1.5(stat)+/-0.6(exp syst)+/-1.1(model syst))x10(-6) for ml(+)(l(-))>0.2 GeV/c(2).

Measurement of the time-dependent CP asymmetry in the B0-->phiK0 decay

We present a measurement of the time-dependent CP asymmetry for the neutral B-meson decay B0-->phiK0. We use a sample of approximately 114 x 10(6) B-meson pairs taken at the Upsilon(4S) resonance with the BABAR detector at the PEP-II B-meson factory at SLAC. We reconstruct the CP eigenstates phiK0S and phiK0L, where phi-->K+K-, K0S-->pi+pi-, and K0L is observed via its hadronic interactions. The other B meson in the event is tagged as either a B0 or Bbar0 from its decay products. The values of the CP-violation parameters are SphiK=0.47+/-0.34(stat)+0.08-0.06(syst) and CphiK=0.01+/-0.33(stat)+/-0.10(syst).

Study of high momentum eta' production in B --> eta'Xs

We measure the branching fraction for the charmless semi-inclusive process B --> eta'Xs, where the eta' meson has a momentum in the range 2.0 to 2.7 GeV/c in the upsilon4S center-of-mass frame and Xs represents a system comprising a kaon and zero to four pions. We find B(B --> eta'Xs) = [3.9 +/- 0.8(stat) +/- 0.5(syst) +/- 0.8(model)] x 10(-4). We also obtain the Xs mass spectrum and find that it fits models predicting high masses.

Measurement of branching fractions and charge asymmetries in B+/--->rho+/-pi0 and B+/--->rho0pi+/- decays, and search for B0-->rho0pi0

We present measurements of branching fractions and charge asymmetries in B-meson decays to rho(+)pi(0), rho(0)pi(+), and rho(0)pi(0). The data sample comprises 89x10(6) Upsilon(4S)-->BBmacr; decays collected with the BABAR detector at the PEP-II asymmetric-energy B Factory at SLAC. We find the charge-averaged branching fractions B(B+-->rho(+)pi(0))=[10.9+/-1.9(stat)+/-1.9(syst)]x10(-6) and B(B+-->rho(0)pi(+))=(9.5+/-1.1+/-0.9)x10(-6), and we set a 90% confidence-level upper limit B(B0-->rho(0)pi(0))<2.9x10(-6). We measure the charge asymmetries ACP(pi(0))(rho(+))=0.24+/-0.16+/-0.06 and ACP(pi(+))(rho(0))=-0.19+/-0.11+/-0.02.

Observation of the decay B-->J/psietaK and search for X(3872)-->J/psieta

We report the observation of the B meson decay B+/- -->J/psietaK+/- and evidence for the decay B0-->J/psietaK0S, using 90 x 10(6) BB; events collected at the Upsilon(4S) resonance with the BABAR detector at the SLAC PEP-II e+e- asymmetric-energy storage ring. We obtain branching fractions of B(B+/- -->J/psietaK+/-) = [10.8 +/- 2.3(stat) +/- 2.4(syst)] x 10(-5) and B(B0-->J/psietaK0S) = [8.4 +/- 2.6(stat) +/- 2.7(syst)] x 10(-5). We search for the new narrow mass state, the X(3872), recently reported by the Belle Collaboration, in the decay B+/- -->X(3872)K+/-,X(3872)-->J/psieta and determine an upper limit of B[B +/- -->X(3872)K+/- -->J/psietaK+/-] < 7.7 x 10(-6) at 90% confidence level.

Measurement of the direct CP asymmetry in b-->s gamma Decays

We describe a measurement of the direct CP asymmetry between inclusive b-->s gamma and b-->s gamma decays. This asymmetry is expected to be less than 0.01 in the standard model, but could be enhanced up to about 0.10 by new physics contributions. We use a sample of 89 x 10(6) BB pairs recorded with the BABAR detector at SLAC PEP-II, from which we reconstruct a set of 12 exclusive b-->s gamma final states containing one charged or neutral kaon and one to three pions. We measure an asymmetry of A(CP)(b-->s gamma)=0.025+/-0.050(stat)+/-0.015(syst), corresponding to an allowed range of -0.06<A(CP)(b-->s gamma)<+0.11 at 90% confidence level.

The National Immunization Information Hotline

The National Immunization Information Hotline (NIIH) has been providing information regarding immunizations to the public and to health care professionals since March 1997. We describe the operations of the NIIH, its experience over the first two and a half years of operation and lessons learned for other immunization hotlines. From 1998-2000, the hotline answered 246,859 calls. Calls concerning immunization information requests totaled 175,367; data about the calls were collected from 35,102. Approximately a third of the 35,102 calls were from health care providers. Of the remaining calls from the public, the greatest number of calls concerned childhood immunizations. Immunization schedule queries from the public increased 323.0% from 1998 to 2000. While the major goal of the NIIH is to provide accurate and reliable information to the public and to health care providers, data from the hotline can be used to monitor changes over time in calls concerning inquiries about the immunization schedule in addition to other variables of interest.

Measurement of time-dependent CP asymmetries and constraints on sin(2beta+gamma) with partial reconstruction of B0-->D*-/+pi+/- decays

We present a measurement of time-dependent CP-violating asymmetries in decays of neutral B mesons to the final states D(*-/+)pi(+/-), using approximately 82x10(6) BBmacr; events recorded by the BABAR experiment at the PEP-II e(+)e(-) storage ring. Events containing these decays are selected with a partial reconstruction technique, in which only the high-momentum pi(+/-) from the B decay and the low-momentum pi(-/+) from the D(*-/+) decay are used. We measure the amplitude of the asymmetry to be -0.063+/-0.024(stat)+/-0.014(syst) and compute bounds on |sin((2beta+gamma)|.

Measurement of time-dependent CP asymmetries in B0-->D(*)+/-pi-/+ decays and constraints on sin(2beta+gamma)

We present a measurement of CP-violating asymmetries in fully reconstructed B0-->D(*)+/-pi-/+ decays in approximately 88 x 10(6) upsilon(4S)-->BBmacr; decays collected with the BABAR detector at the PEP-II asymmetric-energy B factory at SLAC. From a time-dependent maximum-likelihood fit we obtain the following for the CP-violating parameters: a=-0.022+/-0.038 (stat)+/-0.020 (syst), a*=-0.068+/-0.038 (stat)+/-0.020 (syst), c(lep)=+0.025+/-0.068 (stat)+/-0.033 (syst), and c*(lep)=+0.031+/-0.070 (stat)+/-0.033 (syst). Using other measurements and theoretical assumptions we interpret the results in terms of the angles of the Cabibbo-Kobayashi-Maskawa unitarity triangle, and find |sin((2beta+gamma)|>0.69 at 68% confidence level. We exclude the hypothesis of no CP violation [sin(2beta+gamma)=0] at 83% confidence level.

Study of B+/ --> J/psi pi+/- and B+/ -->J/psi K+/- decays: measurement of the ratio of branching fractions and search for direct CP violation

We study B+/ --> J/psi pi(+/-) and B+/ --> J/psi K+/- decays in a sample of about 89 x 10(6) BB pairs collected with the BABAR detector at the PEP-II asymmetric B factory at SLAC. We observe a signal of 244+/-20 B+/ --> J/psi pi(+/-) events and determine the ratio B(B+/ --> J/psi pi(+/-))/B(B+/ --> J/psi K+/-) to be [5.37+/-0.45(stat)+/-0.11(syst)]%. The charge asymmetries for the B+/ --> J/psi pi(+/-) and B+/ --> J/psi K+/- decays are determined to be A(pi)=0.123+/-0.085(stat)+/-0.004(syst) and A(K)=0.030+/-0.015(stat)+/-0.006(syst), respectively.

Search for the rare leptonic decay B+-->mu(+)nu(mu)

We have performed a search for the rare leptonic decay B+-->mu(+)nu(mu) with data collected at the Upsilon(4S) resonance by the BABAR experiment at the PEP-II storage ring. In a sample of 88.4 x 10(6) BB pairs, we find no significant evidence for a signal and set an upper limit on the branching fraction B(B+-->my(+)nu(my))< 6.6 x 10(-6) at the 90% confidence level.

Measurement of the branching fractions and CP asymmetry of B--->D(0)((CP))K- decays with the BABAR detector

We present a study of B--->D(0)(CP)K- decays, where D(0)(CP) is reconstructed in CP-even channels, based on a sample of 88.8 x 10(6) Upsilon(4S)-->BB decays collected with the BABAR detector at the PEP-II e(+)e(-) storage ring. We measure the ratio of Cabibbo-suppressed to Cabibbo-favored branching fractions B(B--->D(0)(CP)K-)/B(B--->D(0)(CP)pi(-))=[8.8+/-1.6(stat)+/-0.5(syst)]x10(-2) and the CP asymmetry A(CP)=0.07+/-0.17(stat)+/-0.06(syst). We also measure B(B--->D0K-)/B(B--->D0pi(-))=[8.31+/-0.35(stat)+/-0.20(syst)]x10(-2) using a sample of 61.0 x 10(6) BB pairs.

Measurements of branching fractions and CP-violating asymmetries in B meson decays to charmless two-body states containing a K(0)

We present measurements of branching fractions and CP-violating asymmetries in decays of B mesons to two-body final states containing a K0. The results are based on a data sample of approximately 88 x 10(6) Upsilon(4S)-->BB decays collected with the BABAR detector at the PEP-II asymmetric-energy B Factory at SLAC. We measure B(B+-->K(0)pi(+))=(22.3+/-1.7+/-1.1)x10(-6), B(B0-->K(0)pi(0)=(11.4+/-1.7+/-0.8)x10(-6), B(B+-->K(0)K+)<2.5 x 10(-6), and B(B0-->K(0)K(0)<1.8 x 10(-6), where the first uncertainty is statistical and the second is systematic, and the upper limits are at the 90% confidence level. In addition, the following CP-violating asymmetries have been measured: A(CP)(B+-->K(0)pi(+))=-0.05+/-0.08+/-0.01 and A(CP)(B0-->K(0)pi(0)=0.03+/-0.36+/-0.11.

Limits on the decay-rate difference of neutral B mesons and on CP, T, and CPT violation in B(0-0)B oscillations

Using events in which one of two neutral B mesons from the decay of an Upsilon(4S) meson is fully reconstructed, we determine parameters governing decay (DeltaGamma(d)/Gamma(d)), CP, and T violation (|q/p|), and CP and CPT violation (Re z,Im z). The results, obtained from an analysis of 88 x 10(6) Upsilon(4S) decays recorded by BABAR, are sgn(Re lambda(CP))DeltaGamma(d)/Gamma(d)=-0.008+/-0.037(stat)+/-0.018(syst)[-0.084,0.068],|q/p|=1.029+/-0.013(stat)+/-0.011(syst)[1.001,1.057],(Re lambda(CP)/|lambda(CP)|) Re z=0.014+/-0.035(stat)+/-0.034(syst)[-0.072,0.101],Im z=0.038+/-0.029(stat)+/-0.025(syst)[-0.028,0.104]. The values inside the square brackets indicate the 90% confidence-level intervals. These results are consistent with standard model expectations.

Measurement of the branching fraction and polarization for the decay B--->D*0K*-

We present a study of the decay B--->D(*0)K(*-) based on a sample of 86 x 10(6) Upsilon(4S)-->BBmacr; decays collected with the BABAR detector at the PEP-II asymmetric-energy B Factory at SLAC. We measure the branching fraction B(B--->D(*0)K(*-))=(8.3+/-1.1(stat)+/-1.0(syst)) x 10(-4), and the fraction of longitudinal polarization in this decay to be Gamma(L)/Gamma=0.86+/-0.06(stat)+/-0.03(syst).

Measurements of the mass and width of the eta(c) meson and of an eta(c)(2S) candidate

The mass m(eta(c)) and total width Gamma(eta(c))(tot) of the eta(c) meson have been measured in two-photon interactions at the SLAC e(+)e(-) asymmetric B Factory with the BABAR detector. With a sample of approximately 2500 reconstructed eta(c)-->K(0)(S)K+/-pi(-/+) decays in 88 fb(-1) of data, the results are m(eta(c))=2982.5+/-1.1(stat)+/-0.9(syst) MeV/c(2) and Gamma(eta(c))(tot)=34.3+/-2.3(stat)+/-0.9(syst) MeV/c(2). Using the same decay mode, a second resonance with 112+/-24 events is observed with a mass of 3630.8+/-3.4(stat)+/-1.0(syst) MeV/c(2) and width of 17.0+/-8.3(stat)+/-2.5(syst) MeV/c(2). This observation is consistent with expectations for the eta(c)(2S) state.

Search for lepton-flavor violation in the decay tau- --> l- l+ l-

A search for the lepton-flavor-violating decay of the tau into three charged leptons has been performed using 91.5 fb(-1) of data collected at an e(+)e(-)center-of-mass energy around 10.58 GeV with the BABAR detector at the SLAC storage ring PEP-II. In all six decay modes considered, the numbers of events found in data are compatible with the background expectations. Upper limits on the branching fractions are set in the range (1-3)x10(-7) at 90% confidence level.