Simulated patients to demonstrate common stroke syndromes: accurate and convincing

Introduction Stroke detection in the preclinical setting is challenging, resulting in more than 1/3 of missed strokes by EMS personnel. Recently, prehospital identification of anterior large vessel occlusion (LVO) stroke has come into focus. Cortical signs have a high predictive value for the presence of LVO stroke but are often missed. Simulated patients (SPs) could be an excellent tool to train EMS personnel in the evaluation of stroke syndromes with cortical symptoms but it has not been studied whether they can simulate these important signs convincingly. The main objective of this study was thus to examine whether SPs can simulate stroke syndromes and symptoms so that stroke experts can identify them correctly and reliably, applying the NIH stroke scale (NIHSS). Methods Lay actors were trained to simulate one of 8 stroke syndromes either typical of a lacunary stroke or of an anterior LVO stroke and then videotaped during an examination according to the NIHSS. Stroke experts were asked to rate each item of the NIHSS based on the videos, determine which stroke syndrome was being demonstrated, and rate the quality of the simulation. The primary outcome was the correct identification of the target stroke syndrome by the expert raters. Secondary outcomes were the agreement of the rating of the NIHSS score with the target NIHSS score and the expert raters' assessment of the quality of the simulation. Results Seven of eight syndromes were rated correctly by at least twelve of fifteen raters and the mean rated NIHSS score was within one point of the target score for six of eight syndromes. The mean rating for the quality of simulation was between 3.54 and 3.98 (as rated on a scale from 1 to 4) for each syndrome. Discussion/Conclusion SPs are capable of simulating acute stroke symptoms and syndromes accurately and convincingly. They thus represent a great resource to improve educational interventions that improve stroke recognition.

[Reconstruction of a metadiaphyseal bone defect after open comminuted fracture of the proximal femur using a modified Masquelet technique]

The reconstruction of segmental bone defects after surgical treatment of infected delayed unions as well as nonunions, places the highest demands on the surgical technical implementation. After treating the fracture-related infection, guaranteeing biomechanical stability is crucial for the success of the treatment. The presented case describes the successful treatment of an infected delayed union after an open metadiaphyseal comminuted fracture of the proximal femur using a modified Masquelet technique. A solid allogeneic bone graft in combination with autologous cancellous bone were inserted into a 7 cm subtrochanteric defect zone and stabilized with a combined plate and nail osteosynthesis.

Improved upper limb function in non-ambulant children with SMA type 2 and 3 during nusinersen treatment: a prospective 3-years SMArtCARE registry study

Background

The development and approval of disease modifying treatments have dramatically changed disease progression in patients with spinal muscular atrophy (SMA). Nusinersen was approved in Europe in 2017 for the treatment of SMA patients irrespective of age and disease severity. Most data on therapeutic efficacy are available for the infantile-onset SMA. For patients with SMA type 2 and type 3, there is still a lack of sufficient evidence and long-term experience for nusinersen treatment. Here, we report data from the SMArtCARE registry of non-ambulant children with SMA type 2 and typen 3 under nusinersen treatment with a follow-up period of up to 38 months.

Methods

SMArtCARE is a disease-specific registry with data on patients with SMA irrespective of age, treatment regime or disease severity. Data are collected during routine patient visits as real-world outcome data. This analysis included all non-ambulant patients with SMA type 2 or 3 below 18 years of age before initiation of treatment. Primary outcomes were changes in motor function evaluated with the Hammersmith Functional Motor Scale Expanded (HFMSE) and the Revised Upper Limb Module (RULM).

Results

Data from 256 non-ambulant, pediatric patients with SMA were included in the data analysis. Improvements in motor function were more prominent in upper limb: 32.4% of patients experienced clinically meaningful improvements in RULM and 24.6% in HFMSE. 8.6% of patients gained a new motor milestone, whereas no motor milestones were lost. Only 4.3% of patients showed a clinically meaningful worsening in HFMSE and 1.2% in RULM score.

Conclusion

Our results demonstrate clinically meaningful improvements or stabilization of disease progression in non-ambulant, pediatric patients with SMA under nusinersen treatment. Changes were most evident in upper limb function and were observed continuously over the follow-up period. Our data confirm clinical trial data, while providing longer follow-up, an increased number of treated patients, and a wider range of age and disease severity.

Fully automatic AI-based valve motion parameter extraction on long axis CINE images - application on N=11000 patient datasets

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Research support from Siemens Healthineers GmbH.

Background

Mitral valve (MV) motion parameters, assessable using CMR [1, 2], have been shown to help the diagnosis of cardiac dysfunction. To extract valve motion parameters, we propose a fully automatic AI-based prototype system that tracks annulus and apex landmarks by the registration network on time-resolved two- and four-chamber CMR cine views. Parameters such as displacements, velocities, mitral annular plane systolic excursion (MAPSE), or longitudinal shortening (LS) are automatically extracted and evaluated on a large CMR dataset (N=11000).

Methods

The system consists of two sequential neural networks with a processing step in between (Fig. 1a) [3]. Initially, a 2D UNet is applied to localize both MV annulus insertion points as well as the apex. Based on these points, the image processing step consists of rotating, cropping, and interpolating the images, allowing a standardized image impression for both long axis views. Finally, the registration network (VoxelMorph framework [4]) is applied to the processed series and tracks the MV annulus insertion points and apex over the cardiac cycle by the deformation fields obtained by the network. The system was trained on (N=166) multivendor, multi-field strength, ground-truth annotated datasets [5].

A total of 11000 datasets, acquired on a 1.5T scanner (MAGNETOM Aera, Siemens Healthcare, Erlangen, Germany) from January 2016 to September 2017 [6], were used for parameter extraction. 200 of these datasets were additionally annotated semi-automatically for the performance evaluation of the system.

Five motion parameters were automatically derived by the system that are defined as follows (Fig. 1b): (1) The atrioventricular plane displacement (AVPD) as the distance of the plane spanned by the MV annulus points relative to the first frame, (2) the atrioventricular plane velocity (AVPV) as the discrete temporal derivate of the AVPD, (3) the diameter of the annulus as the maximum distance between the MV annulus points, (4) the lateral/inferior and septal/superior MAPSE, as the maximum MV points’ excursion, and (5) the LS as the percentage size difference of the distance between the mid valvular point and the apex point at end-systole and end-diastole.

Results

The accuracy of the system resulted in deviations on the annotated dataset of 1.02 ± 0.87 mm, 0.01 ± 0.02 mm/s, 1.54 ± 1.21 mm, 2.30 ± 1.35 mm, 2.1 ± 1.8 mm for AVPD, AVPV, diameter, MAPSE, and LS respectively. Initial statistics on all datasets (Fig. 2) revealed a mean lateral/inferior, septal/superior MAPSE and LS of 8.7 ± 2.7 mm, 10.5 ± 3.2 mm and 16.3 ± 4.2 % for two-chamber and 9.6 ± 2.6 mm, 8.7 ± 2.6 mm and 15.5 ± 3.9 % for four-chamber views, respectively.

Conclusions

The results demonstrate the versatility of the proposed system for automatic extraction of various MV motion parameters. The proposed system enables automatic extraction of clinically relevant parameters and can improve the automation of MV-based analyses. System overview & Parameter of interestsAnalysis of the extracted parameters

Shape variability of the central sulcus in the developing brain: a longitudinal descriptive and predictive study in preterm infants

Despite growing evidence of links between sulcation and function in the adult brain, the folding dynamics, occurring mostly before normal-term-birth, is vastly unknown. Looking into the development of cortical sulci in infants can give us keys to address fundamental questions: what is the sulcal shape variability in the developing brain? When are the shape features encoded? How are these morphological parameters related to further functional development? In this study, we aimed to investigate the shape variability of the developing central sulcus, which is the frontier between the primary somatosensory and motor cortices. We studied a cohort of 71 extremely preterm infants scanned twice using MRI - once around 30 weeks post-menstrual age (w PMA) and once at term-equivalent age, around 40w PMA -, in order to quantify the sulcus's shape variability using manifold learning, regardless of age-group or hemisphere. We then used these shape descriptors to evaluate the sulcus's variability at both ages and to assess hemispheric and age-group specificities. This led us to propose a description of ten shape features capturing the variability in the central sulcus of preterm infants. Our results suggested that most of these features (8/10) are encoded as early as 30w PMA. We unprecedentedly observed hemispheric asymmetries at both ages, and the one captured at term-equivalent age seems to correspond with the asymmetry pattern previously reported in adults. We further trained classifiers in order to explore the predictive value of these shape features on manual performance at 5 years of age (handedness and fine motor outcome). The central sulcus's shape alone showed a limited but relevant predictive capacity in both cases. The study of sulcal shape features during early neurodevelopment may participate to a better comprehension of the complex links between morphological and functional organization of the developing brain.

[Reprint of: Severe pre-eclampsia: guidelines for clinical practice from the French Society of anesthesiology and intensive care (SFAR) and the French College of gynaecologists and obstetricians (CNGOF)]

OBJECTIVE

To provide national guidelines for the management of women with severe preeclampsia.

DESIGN

A consensus committee of 26 experts was formed. A formal conflict of interest (COI) policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independently of any industrial funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized.

METHODS

The last SFAR and CNGOF guidelines on the management of women with severe preeclampsia was published in 2009. The literature is now sufficient for an update. The aim of this expert panel guidelines is to evaluate the impact of different aspects of the management of women with severe preeclampsia on maternal and neonatal morbidities separately. The experts studied questions within 7 domains. Each question was formulated according to the PICO (Patients Intervention Comparison Outcome) model and the evidence profiles were produced. An extensive literature review and recommendations were carried out and analyzed according to the GRADE® methodology.

RESULTS

The SFAR/CNGOF experts panel provided 25 recommendations: 8 have a high level of evidence (GRADE 1±), 9 have a moderate level of evidence (GRADE 2±), and for 7 recommendations, the GRADE method could not be applied, resulting in expert opinions. No recommendation was provided for 3 questions. After one scoring round, strong agreement was reached between the experts for all the recommendations.

CONCLUSIONS

There was strong agreement among experts who made 25 recommendations to improve practices for the management of women with severe preeclampsia.

Genome sequences of Tropheus moorii and Petrochromis trewavasae, two eco-morphologically divergent cichlid fishes endemic to Lake Tanganyika

With more than 1000 species, East African cichlid fishes represent the fastest and most species-rich vertebrate radiation known, providing an ideal model to tackle molecular mechanisms underlying recurrent adaptive diversification. We add high-quality genome reconstructions for two phylogenetic key species of a lineage that diverged about ~ 3-9 million years ago (mya), representing the earliest split of the so-called modern haplochromines that seeded additional radiations such as those in Lake Malawi and Victoria. Along with the annotated genomes we analysed discriminating genomic features of the study species, each representing an extreme trophic morphology, one being an algae browser and the other an algae grazer. The genomes of Tropheus moorii (TM) and Petrochromis trewavasae (PT) comprise 911 and 918 Mbp with 40,300 and 39,600 predicted genes, respectively. Our DNA sequence data are based on 5 and 6 individuals of TM and PT, and the transcriptomic sequences of one individual per species and sex, respectively. Concerning variation, on average we observed 1 variant per 220 bp (interspecific), and 1 variant per 2540 bp (PT vs PT)/1561 bp (TM vs TM) (intraspecific). GO enrichment analysis of gene regions affected by variants revealed several candidates which may influence phenotype modifications related to facial and jaw morphology, such as genes belonging to the Hedgehog pathway (SHH, SMO, WNT9A) and the BMP and GLI families.

Vaccine-induced CD8 T cells are redirected with peptide-MHC class I-IgG antibody fusion proteins to eliminate tumor cells in vivo

Simulating a viral infection in tumor cells is an attractive concept to eliminate tumor cells. We previously reported the molecular design and the in vitro potency of recombinant monoclonal antibodies fused to a virus-derived peptide MHC class I complex that bypass the peptide processing and MHC loading pathway and directly displays a viral peptide in an MHC class I complex on the tumor cell surface. Here, we show that a vaccination-induced single peptide-specific CD8 T cell response was sufficient to eliminate B16 melanoma tumor cells in vivo in a fully immunocompetent, syngeneic mouse tumor model when mice were treated with mouse pMHCI-IgGs fusion proteins targeting the mouse fibroblast activation protein. Tumor growth of small, established B16 lung metastases could be controlled. The pMHCI-IgG had similar potency as an analogous pan-CD3 T-cell bispecific antibody. In contrast to growth control of small tumors, none of the compounds controlled larger solid tumors of MC38 cancer cells, despite penetration of pMHCI-IgGs into the tumor tissue and clear attraction and activation of antigen-specific CD8 T cells inside the tumor. pMHCI-IgG can have a similar potency as classical pan-T-cell recruiting molecules. The results also highlight the need to better understand immune suppression in advanced solid tumors.

Correlating the phase settling behavior of aqueous-organic solvent systems in a centrifugal partition chromatograph

The prediction of the performance of a Centrifugal Partition Chromatography (CPC) is a difficult but desirable task. The partitioning of the sample, as well as the fluid dynamical phenomena dispersion, coalescence, and stationary phase retention have to be individually understood. Therefore, the phase settling behavior of different aqueous-organic solvent systems and with this, the dependency of the stationary phase retention in CPC was investigated in this study. On the one hand, batch settling experiments were performed, and the settling velocity of aqueous-organic solvent systems was investigated. With this it was possible to correlate the stationary phase retention in CPC in both operating modes. For descending mode operation a high settling velocity of the lower phase and for ascending mode a high settling velocity of the upper phase is needed for a stable operation and a high stationary phase retention. On the other hand, the dimensionless numbers Capillary number (Ca) and Morton number (Mo) were used to generate a universally applicable correlation for the stationary phase retention in ascending mode. It was shown, that a high stationary phase retention correlates with low values of Ca and Mo, whereas the influence of Mo is neglectable in the parameter space investigated. Within this correlation, the individual influence of each influencing parameter on the stationary phase retention was included. Moreover, this correlation was compared to descriptions for descending mode given in literature. With this it was shown that the minimal stationary phase retention is correlatable to the point of phase inversion.

Characterization and correlation of mobile phase dispersion of aqueous-organic solvent systems in centrifugal partition chromatography

To reach a high separation efficiency using Centrifugal Partition Chromatography (CPC), the fluid dynamical behavior of the liquid-liquid two-phase systems must be clearly understood. The fluid dynamics, namely the dispersion, the coalescence, and the stationary phase retention, have a high impact on a separation. Especially the mobile phase dispersion influences the mass transfer during a separation. In this study, the mobile phase dispersion of different aqueous-organic solvent systems was characterized for ascending and descending mode via video analysis. Thereby the influence of the physical properties of the solvent systems, the operating parameters, and the geometry of the chamber inlet was investigated systematically using dimensional analysis. With the help of the dimensionless numbers Ohnesorge number (Oh_CPC), Eötvös number (Eo_CPC), and Weber number (We_CPC) the impact of the solvent system, the plant parameters, and the operating parameters on the mobile phase dispersion could be described. Inside the three dimensional area, spanned by the dimensionless numbers, each state of mobile phase dispersion (undispersed, low dispersed, highly dispersed, and atomized) could be allocated to an individual region for both operating modes. Moreover, differences in mobile phase deflection depending on the operating mode and a possible reason for these were described.

Free-ranging wild boar (Sus scrofa) in Switzerland: casual observations and model-based projections during open and closed season for hunting

INTRODUCTION

Wild boar (i.e., Sus scrofa) are susceptible to a range of diseases that can be transmitted to domestic pigs. Assessing the potential risk of transmission-related events involves identifying where wild boar occur in Switzerland and where they still can colonize. It also involves identifying zones where piggeries are dense. In the work presented here, the distribution of wild boar in Switzerland was projected from grid data as probabilities of presence using an approach based on statistical modeling, separately for closed and open season for hunting. The predicted probabilities of wild boar presence were related to the density of piggeries in the six agricultural zones. The resulting maps show how the potential risk of transmission-related events, as a proxy for disease transmission, is distributed in Switzerland. Wild boar presence data consisted of hunting data and casual observations recorded from September 2011 to February 2018 at the coordinate level. They were obtained from all 16 Swiss cantons maintaining a license hunting system plus Solothurn (for 2017) and Zurich, as well as from info fauna. The probability of wild boar occurrence was high (> 0.7) in Jura, the valleys of the Southern Alps, the Rhone Valley down the river from Martigny, and the Rhine Valley down the river from Bündner Herrschaft; it was fair (0.5-0.7) in the Swiss Plateau. These regions broadly overlap agricultural zones with a high density of piggeries. Patches of perennially suitable, but currently not colonized habitat were found in the cantons of Berne, Obwalden, Uri, Schwyz, Glarus, and Grisons. The probability of wild boar occurrence across the entire study area, including the Alps, increased by 12% during closed season for hunting. The results were discussed with reference to similar studies.

FC10-04 - Efficacy of auditory stimulation programs for the treatment of depression, dysthymia and symptoms of burnout - RCT results

Depression is a prevalent, often chronic and disabling disease. Current psychosocial and antidepressant treatments result in similar response rates with mostly symptom reduction, but not complete remission. Poor treatment adherence complicates depression management and prevention of recurrent episodes. Therefore, new therapies must be developed urgently, that alone or combined with present treatments, can significantly improve therapy outcomes.

Depression is potentially associated with decreased heart rate variability (HRV). Based on our previous studies' results which demonstrated HRV increase following auditory stimulation, we developed two interventions based on specifically for depression treatment composed and arranged music and tested the efficacy in a waiting list and placebo controlled double-blind study with depressed outpatients.

Depression status was assessed at the beginning of T1 and T2 using the Hamilton Rating Scale for Depression (HAM-D), Beck Depression Inventory (BDI), Hospital Anxiety and Depression Scale (HADS-D) and by a composite (COMP) scale based on HAM-D, BDI and HADS-D z-scores. Changes in depressive symptoms between T1 and T2 (5 week period) were assessed based on COMP and on HAM-D, BDI and HADS-D scores alone. Compared to the control arm, a significant, positive effect in COMP was observed for MT1 at T2. Both MT1 and MT2 were associated with significant positive effects (HAM-D and HADS-D scores). MT2 resulted in positive effects on BDI scores. No significant change in any depression score was detected in the placebo arm. Treatment continuation was associated with an effect increase (mean HAM-D score reduction of 60%) after 10 to 15 weeks of treatment.

Assessing forest availability for wood supply in Europe

The quantification of forests available for wood supply (FAWS) is essential for decision-making with regard to the maintenance and enhancement of forest resources and their contribution to the global carbon cycle. The provision of harmonized forest statistics is necessary for the development of forest associated policies and to support decision-making. Based on the National Forest Inventory (NFI) data from 13 European countries, we quantify and compare the areas and aboveground dry biomass (AGB) of FAWS and forest not available for wood supply (FNAWS) according to national and reference definitions by determining the restrictions and associated thresholds considered at country level to classify forests as FAWS or FNAWS. FAWS represent between 75 and 95 % of forest area and AGB for most of the countries in this study. Economic restrictions are the main factor limiting the availability of forests for wood supply, accounting for 67 % of the total FNAWS area and 56 % of the total FNAWS AGB, followed by environmental restrictions. Profitability, slope and accessibility as economic restrictions, and protected areas as environmental restrictions are the factors most frequently considered to distinguish between FAWS and FNAWS. With respect to the area of FNAWS associated with each type of restriction, an overlap among the restrictions of 13.7 % was identified. For most countries, the differences in the FNAWS areas and AGB estimates between national and reference definitions ranged from 0 to 5 %. These results highlight the applicability and reliability of a FAWS reference definition for most of the European countries studied, thereby facilitating a consistent approach to assess forests available for supply for the purpose of international reporting.

Observation of Electroweak Production of a Same-Sign W Boson Pair in Association with Two Jets in pp Collisions at sqrt[s]=13 TeV with the ATLAS Detector

This Letter presents the observation and measurement of electroweak production of a same-sign W boson pair in association with two jets using 36.1  fb^{-1} of proton-proton collision data recorded at a center-of-mass energy of sqrt[s]=13  TeV by the ATLAS detector at the Large Hadron Collider. The analysis is performed in the detector fiducial phase-space region, defined by the presence of two same-sign leptons, electron or muon, and at least two jets with a large invariant mass and rapidity difference. A total of 122 candidate events are observed for a background expectation of 69±7 events, corresponding to an observed signal significance of 6.5 standard deviations. The measured fiducial signal cross section is σ^{fid}=2.89_{-0.48}^{+0.51}(stat)_{-0.28}^{+0.29}(syst)  fb.

Comparison of Fragmentation Functions for Jets Dominated by Light Quarks and Gluons from pp and Pb+Pb Collisions in ATLAS

Charged-particle fragmentation functions for jets azimuthally balanced by a high-transverse-momentum, prompt, isolated photon are measured in 25  pb^{-1} of pp and 0.49  nb^{-1} of Pb+Pb collision data at 5.02 TeV per nucleon pair recorded with the ATLAS detector at the Large Hadron Collider. The measurements are compared to predictions of Monte Carlo generators and to measurements of inclusively selected jets. In pp collisions, a different jet fragmentation function in photon-tagged events from that in inclusive jet events arises from the difference in fragmentation between light quarks and gluons. The ratios of the fragmentation functions in Pb+Pb events to that in pp events are used to explore the parton color-charge dependence of jet quenching in the hot medium. In relatively peripheral collisions, fragmentation functions exhibit a similar modification pattern for photon-tagged and inclusive jets. However, photon-tagged jets are observed to have larger modifications than inclusive jets in central Pb+Pb events.

Combination of Searches for Invisible Higgs Boson Decays with the ATLAS Experiment

Dark matter particles, if sufficiently light, may be produced in decays of the Higgs boson. This Letter presents a statistical combination of searches for H→invisible decays where H is produced according to the standard model via vector boson fusion, Z(ℓℓ)H, and W/Z(had)H, all performed with the ATLAS detector using 36.1  fb^{-1} of pp collisions at a center-of-mass energy of sqrt[s]=13  TeV at the LHC. In combination with the results at sqrt[s]=7 and 8 TeV, an exclusion limit on the H→invisible branching ratio of 0.26(0.17_{-0.05}^{+0.07}) at 95% confidence level is observed (expected).

Search for the Production of a Long-Lived Neutral Particle Decaying within the ATLAS Hadronic Calorimeter in Association with a Z Boson from pp Collisions at sqrt[s]=13 TeV

This Letter presents a search for the production of a long-lived neutral particle (Z_{d}) decaying within the ATLAS hadronic calorimeter, in association with a standard model (SM) Z boson produced via an intermediate scalar boson, where Z→ℓ^{+}ℓ^{-} (ℓ=e, μ). The data used were collected by the ATLAS detector during 2015 and 2016 pp collisions with a center-of-mass energy of sqrt[s]=13  TeV at the Large Hadron Collider and correspond to an integrated luminosity of 36.1±0.8  fb^{-1}. No significant excess of events is observed above the expected background. Limits on the production cross section of the scalar boson times its decay branching fraction into the long-lived neutral particle are derived as a function of the mass of the intermediate scalar boson, the mass of the long-lived neutral particle, and its cτ from a few centimeters to one hundred meters. In the case that the intermediate scalar boson is the SM Higgs boson, its decay branching fraction to a long-lived neutral particle with a cτ approximately between 0.1 and 7 m is excluded with a 95% confidence level up to 10% for m_{Z_{d}} between 5 and 15 GeV.

Search for doubly charged scalar bosons decaying into same-sign W boson pairs with the ATLAS detector

A search for doubly charged scalar bosons decaying into W boson pairs is presented. It uses a data sample from proton-proton collisions corresponding to an integrated luminosity of 36.1 fb - 1 collected by the ATLAS detector at the LHC at a centre-of-mass energy of 13 TeV in 2015 and 2016. This search is guided by a model that includes an extension of the Higgs sector through a scalar triplet, leading to a rich phenomenology that includes doubly charged scalar bosons H ± ± . Those bosons are produced in pairs in proton-proton collisions and decay predominantly into electroweak gauge bosons H ± ± → W ± W ± . Experimental signatures with several leptons, missing transverse energy and jets are explored. No significant deviations from the Standard Model predictions are found. The parameter space of the benchmark model is excluded at 95% confidence level for H ± ± bosons with masses between 200 and 220 GeV.

[ARENA-Project atrial fibrillation in the Rhein-Neckar region]

Atrial fibrillation (AF) is the most common form of cardiac tachyarrhythmia. It is estimated that in the Rhein-Neckar region approximately 40,000-50,000 out of 2 million people are affected. Due to demographic changes in the near future there will be a significant increase in the prevalence of AF within the next decades. The ARENA project was initiated by the Foundation Institute for Cardiac Infarction Research (IHF) Ludwigshafen in cooperation with cardiological and neurological departments of neighboring hospitals, resident doctors and pharmacies to improve the awareness and care of patients with AF. The particular aim is the prevention of stroke as one of the most dreaded complications. The project focusses on the following three subtopics: interventions, medication, migration. The aim of the intervention project is to raise awareness of AF as a risk factor for stroke and to improve the diagnostic work-up and care for patients with diagnosed or unknown AF. The subproject medication focusses on the adherence of patients with AF to the prescribed antithrombotic medication. To evaluate differences concerning patients with and without a migration background the subproject migration was initiated.

Erratum to: Measurement of the W boson polarisation in t t ¯ events from pp collisions at s = 8 TeV in the lepton + jets channel with ATLAS

[This corrects the article DOI: 10.1140/epjc/s10052-017-4819-4.].

Search for Higgs boson pair production in the γ γ W W ∗ channel using pp collision data recorded at s = 13 TeV with the ATLAS detector

Searches for non-resonant and resonant Higgs boson pair production are performed in the γ γ W W ∗ channel with the final state of γ γ ℓ ν j j using 36.1  fb - 1 of proton-proton collision data recorded at a centre-of-mass energy ofs = 13 TeV by the ATLAS detector at the Large Hadron Collider. No significant deviation from the Standard Model prediction is observed. A 95% confidence-level observed upper limit of 7.7 pb is set on the cross section for non-resonant production, while the expected limit is 5.4 pb. A search for a narrow-width resonance X decaying to a pair of Standard Model Higgs bosons HH is performed with the same set of data, and the observed upper limits on σ ( p p → X ) × B ( X → H H ) range between 40.0 and 6.1 pb for masses of the resonance between 260 and 500 GeV, while the expected limits range between 17.6 and 4.4 pb. When deriving the limits above, the Standard Model branching ratios of the H → γ γ and H → W W ∗ are assumed.

Measurement of the azimuthal anisotropy of charged particles produced in s NN = 5.02 TeV Pb+Pb collisions with the ATLAS detector

Measurements of the azimuthal anisotropy in lead-lead collisions ats NN = 5.02 TeV are presented using a data sample corresponding to 0.49nb - 1 integrated luminosity collected by the ATLAS experiment at the LHC in 2015. The recorded minimum-bias sample is enhanced by triggers for "ultra-central" collisions, providing an opportunity to perform detailed study of flow harmonics in the regime where the initial state is dominated by fluctuations. The anisotropy of the charged-particle azimuthal angle distributions is characterized by the Fourier coefficients, v 2 - v 7 , which are measured using the two-particle correlation, scalar-product and event-plane methods. The goal of the paper is to provide measurements of the differential as well as integrated flow harmonics v n over wide ranges of the transverse momentum, 0.5  < p T <  60 GeV, the pseudorapidity, | η | <  2.5, and the collision centrality 0-80%. Results from different methods are compared and discussed in the context of previous and recent measurements in Pb+Pb collisions ats NN = 2.76  TeV and 5.02  TeV . In particular, the shape of the p T dependence of elliptic or triangular flow harmonics is observed to be very similar at different centralities after scaling the v n and p T values by constant factors over the centrality interval 0-60% and the p T range 0.5  < p T <  5 GeV.

Search for electroweak production of supersymmetric particles in final states with two or three leptons at s = 13 TeV with the ATLAS detector

A search for the electroweak production of charginos, neutralinos and sleptons decaying into final states involving two or three electrons or muons is presented. The analysis is based on 36.1 fb- 1 ofs = 13  TeV proton-proton collisions recorded by the ATLAS detector at the Large Hadron Collider. Several scenarios based on simplified models are considered. These include the associated production of the next-to-lightest neutralino and the lightest chargino, followed by their decays into final states with leptons and the lightest neutralino via either sleptons or Standard Model gauge bosons; direct production of chargino pairs, which in turn decay into leptons and the lightest neutralino via intermediate sleptons; and slepton pair production, where each slepton decays directly into the lightest neutralino and a lepton. No significant deviations from the Standard Model expectation are observed and stringent limits at 95% confidence level are placed on the masses of relevant supersymmetric particles in each of these scenarios. For a massless lightest neutralino, masses up to 580 GeV are excluded for the associated production of the next-to-lightest neutralino and the lightest chargino, assuming gauge-boson mediated decays, whereas for slepton-pair production masses up to 500 GeV are excluded assuming three generations of mass-degenerate sleptons.

Operation and performance of the ATLAS Tile Calorimeter in Run 1

The Tile Calorimeter is the hadron calorimeter covering the central region of the ATLAS experiment at the Large Hadron Collider. Approximately 10,000 photomultipliers collect light from scintillating tiles acting as the active material sandwiched between slabs of steel absorber. This paper gives an overview of the calorimeter's performance during the years 2008-2012 using cosmic-ray muon events and proton-proton collision data at centre-of-mass energies of 7 and 8 TeV with a total integrated luminosity of nearly 30 fb - 1 . The signal reconstruction methods, calibration systems as well as the detector operation status are presented. The energy and time calibration methods performed excellently, resulting in good stability of the calorimeter response under varying conditions during the LHC Run 1. Finally, the Tile Calorimeter response to isolated muons and hadrons as well as to jets from proton-proton collisions is presented. The results demonstrate excellent performance in accord with specifications mentioned in the Technical Design Report.

Combination of the Searches for Pair-Produced Vectorlike Partners of the Third-Generation Quarks at sqrt[s]=13 TeV with the ATLAS Detector

A combination of the searches for pair-produced vectorlike partners of the top and bottom quarks in various decay channels (T→Zt/Wb/Ht, B→Zb/Wt/Hb) is performed using 36.1  fb^{-1} of pp collision data at sqrt[s]=13  TeV with the ATLAS detector at the Large Hadron Collider. The observed data are found to be in good agreement with the standard model background prediction in all individual searches. Therefore, combined 95% confidence-level upper limits are set on the production cross section for a range of vectorlike quark scenarios, significantly improving upon the reach of the individual searches. Model-independent limits are set assuming the vectorlike quarks decay to standard model particles. A singlet T is excluded for masses below 1.31 TeV and a singlet B is excluded for masses below 1.22 TeV. Assuming a weak isospin (T,B) doublet and |V_{Tb}|≪|V_{tB}|, T and B masses below 1.37 TeV are excluded.

Observation of Centrality-Dependent Acoplanarity for Muon Pairs Produced via Two-Photon Scattering in Pb+Pb Collisions at sqrt[s_{NN}]=5.02 TeV with the ATLAS Detector

This Letter presents a measurement of γγ→μ^{+}μ^{-} production in Pb+Pb collisions recorded by the ATLAS detector at the Large Hadron Collider at sqrt[s_{NN}]=5.02  TeV with an integrated luminosity of 0.49  nb^{-1}. The azimuthal angle and transverse momentum correlations between the muons are measured as a function of collision centrality. The muon pairs are produced from γγ through the interaction of the large electromagnetic fields of the nuclei. The contribution from background sources of muon pairs is removed using a template fit method. In peripheral collisions, the muons exhibit a strong back-to-back correlation consistent with previous measurements of muon pair production in ultraperipheral collisions. The angular correlations are observed to broaden significantly in central collisions. The modifications are qualitatively consistent with rescattering of the muons while passing through the hot matter produced in the collision.

Search for Resonant and Nonresonant Higgs Boson Pair Production in the bb[over ¯]τ^{+}τ^{-} Decay Channel in pp Collisions at sqrt[s]=13 TeV with the ATLAS Detector

A search for resonant and nonresonant pair production of Higgs bosons in the bb[over ¯]τ^{+}τ^{-} final state is presented. The search uses 36.1  fb^{-1} of pp collision data with sqrt[s]=13  TeV recorded by the ATLAS experiment at the LHC in 2015 and 2016. Decays of the τ-lepton pairs with at least one τ lepton decaying to final states with hadrons and a neutrino are considered. No significant excess above the expected background is observed in the data. The cross-section times branching ratio for nonresonant Higgs boson pair production is constrained to be less than 30.9 fb, 12.7 times the standard model expectation, at 95% confidence level. The data are also analyzed to probe resonant Higgs boson pair production, constraining a model with an extended Higgs sector based on two doublets and a Randall-Sundrum bulk graviton model. Upper limits are placed on the resonant Higgs boson pair production cross-section times branching ratio, excluding resonances X in the mass range 305  GeV<m_{X}<402  GeV in the simplified hMSSM minimal supersymmetric model for tanβ=2 and excluding bulk Randall-Sundrum gravitons G_{KK} in the mass range 325  GeV<m_{G_{KK}}<885  GeV for k/M[over ¯]_{Pl}=1.

Performance of missing transverse momentum reconstruction with the ATLAS detector using proton-proton collisions at s = 13 TeV

The performance of the missing transverse momentum ( E T miss ) reconstruction with the ATLAS detector is evaluated using data collected in proton-proton collisions at the LHC at a centre-of-mass energy of 13 TeV in 2015. To reconstruct E T miss , fully calibrated electrons, muons, photons, hadronically decaying τ -leptons , and jets reconstructed from calorimeter energy deposits and charged-particle tracks are used. These are combined with the soft hadronic activity measured by reconstructed charged-particle tracks not associated with the hard objects. Possible double counting of contributions from reconstructed charged-particle tracks from the inner detector, energy deposits in the calorimeter, and reconstructed muons from the muon spectrometer is avoided by applying a signal ambiguity resolution procedure which rejects already used signals when combining the various E T miss contributions. The individual terms as well as the overall reconstructed E T miss are evaluated with various performance metrics for scale (linearity), resolution, and sensitivity to the data-taking conditions. The method developed to determine the systematic uncertainties of the E T miss scale and resolution is discussed. Results are shown based on the full 2015 data sample corresponding to an integrated luminosity of 3.2 fb - 1 .

Measurement of colour flow using jet-pull observables in t t ¯ events with the ATLAS experiment at s = 13 TeV

Previous studies have shown that weighted angular moments derived from jet constituents encode the colour connections between partons that seed the jets. This paper presents measurements of two such distributions, the jet-pull angle and jet-pull magnitude, both of which are derived from the jet-pull angular moment. The measurement is performed in t t ¯ events with one leptonically decaying W boson and one hadronically decaying W boson, using 36.1 fb - 1 of pp collision data recorded by the ATLAS detector ats = 13 TeV delivered by the Large Hadron Collider. The observables are measured for two dijet systems, corresponding to the colour-connected daughters of the W boson and the two b-jets from the top-quark decays, which are not expected to be colour connected. To allow the comparison of the measured distributions to colour model predictions, the measured distributions are unfolded to particle level, after correcting for experimental effects introduced by the detector. While good agreement can be found for some combinations of predictions and observables, none of the predictions describes the data well across all observables.

Probing the Quantum Interference between Singly and Doubly Resonant Top-Quark Production in pp Collisions at sqrt[s]=13 TeV with the ATLAS Detector

This Letter presents a normalized differential cross-section measurement in a fiducial phase-space region where interference effects between top-quark pair production and associated production of a single top quark with a W boson and a b-quark are significant. Events with exactly two leptons (ee, μμ, or eμ) and two b-tagged jets that satisfy a multiparticle invariant mass requirement are selected from 36.1  fb^{-1} of proton-proton collision data taken at sqrt[s]=13  TeV with the ATLAS detector at the LHC in 2015 and 2016. The results are compared with predictions from simulations using various strategies for the interference. The standard prescriptions for interference modeling are significantly different from each other but are within 2σ of the data. State-of-the-art predictions that naturally incorporate interference effects provide the best description of the data in the measured region of phase space most sensitive to these effects. These results provide an important constraint on interference models and will guide future model development and tuning.

Prompt and non-prompt J / ψ elliptic flow in Pb+Pb collisions at s NN = 5.02 Tev with the ATLAS detector

The elliptic flow of prompt and non-prompt J / ψ was measured in the dimuon decay channel in Pb+Pb collisions ats NN = 5.02   TeV with an integrated luminosity of 0.42 nb - 1 with the ATLAS detector at the LHC. The prompt and non-prompt signals are separated using a two-dimensional simultaneous fit of the invariant mass and pseudo-proper decay time of the dimuon system from the J / ψ decay. The measurement is performed in the kinematic range of dimuon transverse momentum and rapidity 9 < p T < 30   GeV , | y | < 2 , and 0-60% collision centrality. The elliptic flow coefficient, v 2 , is evaluated relative to the event plane and the results are presented as a function of transverse momentum, rapidity and centrality. It is found that prompt and non-prompt J / ψ mesons have non-zero elliptic flow. Prompt J / ψ v 2 decreases as a function of p T , while for non-prompt J / ψ it is, with limited statistical significance, consistent with a flat behaviour over the studied kinematic region. There is no observed dependence on rapidity or centrality.

Prompt and non-prompt J / ψ and ψ ( 2 S ) suppression at high transverse momentum in 5.02 TeV Pb+Pb collisions with the ATLAS experiment

A measurement of J / ψ and ψ ( 2 S ) production is presented. It is based on a data sample from Pb+Pb collisions at s NN = 5.02 TeV and pp collisions at s = 5.02 TeV recorded by the ATLAS detector at the LHC in 2015, corresponding to an integrated luminosity of 0.42 nb - 1 and 25 pb - 1 in Pb+Pb and pp, respectively. The measurements of per-event yields, nuclear modification factors, and non-prompt fractions are performed in the dimuon decay channel for 9 < p T μ μ < 40 GeV in dimuon transverse momentum, and - 2 < y μ μ < 2 in rapidity. Strong suppression is found in Pb+Pb collisions for both prompt and non-prompt J / ψ , increasing with event centrality. The suppression of prompt ψ ( 2 S ) is observed to be stronger than that of J / ψ , while the suppression of non-prompt ψ ( 2 S ) is equal to that of the non-prompt J / ψ within uncertainties, consistent with the expectation that both arise from b-quarks propagating through the medium. Despite prompt and non-prompt J / ψ arising from different mechanisms, the dependence of their nuclear modification factors on centrality is found to be quite similar.

Measurement of the Soft-Drop Jet Mass in pp Collisions at sqrt[s]=13 TeV with the ATLAS Detector

Jet substructure observables have significantly extended the search program for physics beyond the standard model at the Large Hadron Collider. The state-of-the-art tools have been motivated by theoretical calculations, but there has never been a direct comparison between data and calculations of jet substructure observables that are accurate beyond leading-logarithm approximation. Such observables are significant not only for probing the collinear regime of QCD that is largely unexplored at a hadron collider, but also for improving the understanding of jet substructure properties that are used in many studies at the Large Hadron Collider. This Letter documents a measurement of the first jet substructure quantity at a hadron collider to be calculated at next-to-next-to-leading-logarithm accuracy. The normalized, differential cross section is measured as a function of log_{10}ρ^{2}, where ρ is the ratio of the soft-drop mass to the ungroomed jet transverse momentum. This quantity is measured in dijet events from 32.9  fb^{-1} of sqrt[s]=13  TeV proton-proton collisions recorded by the ATLAS detector. The data are unfolded to correct for detector effects and compared to precise QCD calculations and leading-logarithm particle-level Monte Carlo simulations.

Search for Low-Mass Dijet Resonances Using Trigger-Level Jets with the ATLAS Detector in pp Collisions at sqrt[s]=13 TeV

Searches for dijet resonances with sub-TeV masses using the ATLAS detector at the Large Hadron Collider can be statistically limited by the bandwidth available to inclusive single-jet triggers, whose data-collection rates at low transverse momentum are much lower than the rate from standard model multijet production. This Letter describes a new search for dijet resonances where this limitation is overcome by recording only the event information calculated by the jet trigger algorithms, thereby allowing much higher event rates with reduced storage needs. The search targets low-mass dijet resonances in the range 450-1800 GeV. The analyzed data set has an integrated luminosity of up to 29.3  fb^{-1} and was recorded at a center-of-mass energy of 13 TeV. No excesses are found; limits are set on Gaussian-shaped contributions to the dijet mass distribution from new particles and on a model of dark-matter particles with axial-vector couplings to quarks.

Search for new phenomena using the invariant mass distribution of same-flavour opposite-sign dilepton pairs in events with missing transverse momentum in s=13 Tepp collisions with the ATLAS detector

A search for new phenomena in final states containing an e + e - or μ + μ - pair, jets, and large missing transverse momentum is presented. This analysis makes use of proton-proton collision data with an integrated luminosity of 36.1 fb - 1 , collected during 2015 and 2016 at a centre-of-mass energy s = 13 TeV with the ATLAS detector at the Large Hadron Collider. The search targets the pair production of supersymmetric coloured particles (squarks or gluinos) and their decays into final states containing an e + e - or μ + μ - pair and the lightest neutralino ( χ ~ 1 0 ) via one of two next-to-lightest neutralino ( χ ~ 2 0 ) decay mechanisms: χ ~ 2 0 → Z χ ~ 1 0 , where the Z boson decays leptonically leading to a peak in the dilepton invariant mass distribution around the Z boson mass; and χ ~ 2 0 → ℓ + ℓ - χ ~ 1 0 with no intermediate ℓ + ℓ - resonance, yielding a kinematic endpoint in the dilepton invariant mass spectrum. The data are found to be consistent with the Standard Model expectation. Results are interpreted using simplified models, and exclude gluinos and squarks with masses as large as 1.85 and 1.3  Te at 95% confidence level, respectively.

Search for heavy particles decaying into top-quark pairs using lepton-plus-jets events in proton-proton collisions at s = 13 TeV with the ATLAS detector

A search for new heavy particles that decay into top-quark pairs is performed using data collected from proton-proton collisions at a centre-of-mass energy of 13  TeV by the ATLAS detector at the Large Hadron Collider. The integrated luminosity of the data sample is 36.1 fb- 1 . Events consistent with top-quark pair production are selected by requiring a single isolated charged lepton, missing transverse momentum and jet activity compatible with a hadronic top-quark decay. Jets identified as likely to contain b-hadrons are required to reduce the background from other Standard Model processes. The invariant mass spectrum of the candidate top-quark pairs is examined for local excesses above the background expectation. No significant deviations from the Standard Model predictions are found. Exclusion limits are set on the production cross-section times branching ratio for hypothetical Z ' bosons, Kaluza-Kein gluons and Kaluza-Klein gravitons that decay into top-quark pairs.