Outbreak of Invasive Serratia marcescens among Persons Incarcerated in a State Prison, California, USA, March 2020-December 2022

Serratia marcescens is an environmental gram-negative bacterium that causes invasive disease in rare cases. During 2020-2022, an outbreak of 21 invasive Serratia infections occurred in a prison in California, USA. Most (95%) patients had a history of recent injection drug use (IDU). We performed whole-genome sequencing and found isolates from 8 patients and 2 pieces of IDU equipment were closely related. We also identified social interactions among patients. We recovered S. marcescens from multiple environmental samples throughout the prison, including personal containers storing Cell Block 64 (CB64), a quaternary ammonium disinfectant solution. CB64 preparation and storage conditions were suboptimal for S. marcescens disinfection. The outbreak was likely caused by contaminated CB64 and propagated by shared IDU equipment and social connections. Ensuring appropriate preparation, storage, and availability of disinfectants and enacting interventions to counteract disease spread through IDU can reduce risks for invasive Serratia infections in California prisons.

Serratia marcescens Outbreak at a Correctional Facility: Environmental Sampling, Laboratory Analyses and Genomic Characterization to Assess Sources and Persistence

Serratia marcescens is an environmental bacterium and clinical pathogen that can cause an array of infections. We describe an environmental sampling and comparative genomics approach used to investigate a multi-year outbreak of S. marcescens at a correctional facility. Whole genome sequencing analysis revealed a predominant cluster of clonally related S. marcescens from nine patient cases and items associated with illicit drug use. Closely related strains found among items associated with case-patient cells and diluted Cell Block 64 (CB64), a quaternary ammonium disinfectant, and Break Out (BO), a multipurpose cleaner, highlighted their role as environmental reservoirs for S. marcescens in this outbreak. Comparative genomic analysis suggested outbreak strains were both persistent (identical strains found over long periods and in multiple locations of the correctional facility) and diverse (strains clustered with multiple global samples from NCBI database). No correlation was found between antimicrobial resistance (AMR) genes of outbreak strains; NCBI strains have more AMR genes. Principal component analysis (PCA) of virulence factors associated with persistence and infectivity indicated variation based on phylogroups, including the predominant cluster; identifiable variations among environmental versus clinical strains were not observed. Identification of multiple distinct genetic groups highlights the importance of putting epidemiological genomic studies in a proper genetic context.

Integrating wearables and modelling for monitoring rehabilitation following total knee joint replacement

BACKGROUND AND OBJECTIVE

Wearable inertial devices integrated with modelling and cloud computing have been widely adopted in the sports sector, however, their use in the health and medical field has yet to be fully realised. To date, there have been no reported studies concerning the use of wearables as a surrogate tool to monitor knee joint loading during recovery following a total knee joint replacement. The objective of this study is to firstly evaluate if peak tibial acceleration from wearables during gait is a good surrogate metric for computer modelling predicted functional knee loading; and secondly evaluate if traditional clinical patient related outcomes measures are consistent with wearable predictions.

METHODS

Following ethical approval, four healthy participants were used to establish the relationship between computer modelling predicted knee joint loading and wearable measured tibial acceleration. Following this, ten patients who had total knee joint replacements were then followed during their 6-week rehabilitation. Gait analysis, wearable acceleration, computer models of knee joint loading, and patient related outcomes measures including the Oxford knee score and range of motion were recorded.

RESULTS

A linear correlation (R² of 0.7-0.97) was observed between peak tibial acceleration (from wearables) and musculoskeletal model predicted knee joint loading during gait in healthy participants first. Whilst patient related outcome measures (Oxford knee score and patient range of motion) were observed to improve consistently during rehabilitation, this was not consistent with all patient's tibial acceleration. Only those patients that exhibited increasing peak tibial acceleration over 6-weeks rehabilitation were positively correlated with the Oxford knee score (R² of 0.51 to 0.97). Wearable predicted tibial acceleration revealed three patients with a consistent knee loading, five patients with improving knee loading, and two patients with declining knee loading during recovery. Hence, 20% of patients did not present with satisfactory joint loading following total knee joint replacement and this was not detected with current patient related outcome measures.

CONCLUSIONS

The use of inertial measurement units or wearables in this study provided additional insight into patients who were not exhibiting functional improvements in joint loading, and offers clinicians an 'off-site' early warning metric to identify potential complications during recovery and provide the opportunity for early intervention. This study has important implications for improving patient outcomes, equity, and for those who live in rural regions.

862 Process Mapping of 3D Printing for Complex Limb Problems

Introduction

Difficult limb problems such as complex trauma or re-presentation following orthopaedic revision surgeries can present substantial planning and technical challenges. 3D-printed models built from patient-specific CT scans facilitate creative thinking, problem solving and decision making to find better operative solutions. This quality improvement project aims to map the process of using 3D printers to solve orthopaedic problems.

Method

Stakeholders, including a Consultant Trauma & Orthopaedic surgeon and the Medical Physics team were interviewed to formalise the full structure of their role from start to end, with the support of the Trust's Improvement Team and Innovation Team. A visual representation of the process map was produced using SmartDraw software. Feedback was received from stakeholders and a second cycle of process mapping was completed.

Results

The process map included the chronological steps of the project, the interaction between different roles and the stages of 3D printing. A database template was produced as a shared OneNote, allowing the tracking of each model production. Stakeholders found the map useful for anticipating problems and considering the future process and providing a framework of implementing innovation within the NHS.

Discussion

Unique implants cost the NHS significantly more money than batch-made products. Introduction of 3D models into pre-operative planning allow surgeons to utilise readily available solutions instead of custom, single-use implants, which can be cost saving and prevents unnecessary wastage. The project trialled operations on models, facilitated patient explanations and provided an educational tool. Future aims include roll-out to other specialties and Trusts, encouraging collaboration towards a sustainable internal economy.

414 Informed Consent for Neck of Femur Fracture Surgery During the Covid-19 Pandemic: An Evidence-Based Approach

Background

Surgical intervention for neck of femur fractures continues to be prioritised during the Covid-19 pandemic. However, there remains a lack of clarity for clinicians during the consent process. This study quantifies additional perioperative risks for Covid-19 positive patients undergoing neck of femur fracture surgery and establishes an evidence-based framework for facilitating informed consent during the Covid-19 pandemic.

Method

259 patients undergoing neck of femur fracture surgery in four hospitals at the epicentre of the United Kingdom’s first wave of Covid-19 were recruited. 51 patients were positive for Covid-19. Predefined outcomes were recorded in a 30-day postoperative period.

Results

Odds of intensive care admission were 4.64 times higher (95% CI 1.59-13.50, p = 0.005) and odds of 30-day mortality were 3 times higher (95% CI 1.22-7.40, p = 0.02) in Covid-19 positive patients. 74.5% of Covid-19 positive patients suffered post-operative complications. 35.3% of Covid-19 positive patients developed lower respiratory tract infection with 13.7% progressing to acute respiratory distress syndrome. 9.8% of Covid-19 positive patients experienced symptomatic thromboembolic events with a 3.9% incidence of pulmonary emboli.

Conclusions

The implications of Covid-19 on the informed consent process for neck of femur fracture surgery are profound. Covid-19 positive patients should be consented for increased risk of postoperative complications (including lower respiratory tract infection, acute respiratory distress syndrome and thromboembolic events), longer inpatient stay, increased frequency of intensive care admission and higher risk of mortality.

Improvements in beam's eye view fiducial tracking using a novel multilayer imager

Purpose.Electronic portal image devices (EPIDs) have been investigated previously for beams-eye view (BEV) applications such as tumor tracking but are limited by low contrast-to-noise ratio and detective quantum efficiency. A novel multilayer imager (MLI), consisting of four stacked flat-panels was used to measure improvements in fiducial tracking during liver stereotactic body radiation therapy (SBRT) procedures compared to a single layer EPID.Methods.The prototype MLI was installed on a clinical TrueBeam linac in place of the conventional DMI single-layer EPID. The panel was extended during volumetric modulated arc therapy SBRT treatments in order to passively acquire data during therapy. Images were acquired for six patients receiving SBRT to liver metastases over two fractions each, one with the MLI using all 4 layers and one with the MLI using the top layer only, representing a standard EPID. The acquired frames were processed by a previously published tracking algorithm modified to identify implanted radiopaque fiducials. Truth data was determined using respiratory traces combined with partial manual tracking. Results for 4- and 1-layer mode were compared against truth data for tracking accuracy and efficiency. Tracking and noise improvements as a function of gantry angle were determined.Results. Tracking efficiency with 4-layers improved to 82.8% versus 58.4% for the 1-layer mode, a relative improvement of 41.7%. Fiducial tracking with 1-layer returned a root mean square error (RMSE) of 2.1 mm compared to 4-layer RMSE of 1.5 mm, a statistically significant (p < 0.001) improvement of 0.6 mm. The reduction in noise correlated with an increase in successfully tracked frames (r = 0.913) and with increased tracking accuracy (0.927).Conclusion. Increases in MV photon detection efficiency by utilization of a MLI results in improved fiducial tracking for liver SBRT treatments. Future clinical applications utilizing BEV imaging may be enhanced by including similar noise reduction strategies.

Transmission, infectivity, and neutralization of a spike L452R SARS-CoV-2 variant

We identified an emerging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant by viral whole-genome sequencing of 2,172 nasal/nasopharyngeal swab samples from 44 counties in California, a state in the western United States. Named B.1.427/B.1.429 to denote its two lineages, the variant emerged in May 2020 and increased from 0% to >50% of sequenced cases from September 2020 to January 2021, showing 18.6%-24% increased transmissibility relative to wild-type circulating strains. The variant carries three mutations in the spike protein, including an L452R substitution. We found 2-fold increased B.1.427/B.1.429 viral shedding in vivo and increased L452R pseudovirus infection of cell cultures and lung organoids, albeit decreased relative to pseudoviruses carrying the N501Y mutation common to variants B.1.1.7, B.1.351, and P.1. Antibody neutralization assays revealed 4.0- to 6.7-fold and 2.0-fold decreases in neutralizing titers from convalescent patients and vaccine recipients, respectively. The increased prevalence of a more transmissible variant in California exhibiting decreased antibody neutralization warrants further investigation.

Transmission, infectivity, and antibody neutralization of an emerging SARS-CoV-2 variant in California carrying a L452R spike protein mutation

We identified a novel SARS-CoV-2 variant by viral whole-genome sequencing of 2,172 nasal/nasopharyngeal swab samples from 44 counties in California. Named B.1.427/B.1.429 to denote its 2 lineages, the variant emerged around May 2020 and increased from 0% to >50% of sequenced cases from September 1, 2020 to January 29, 2021, exhibiting an 18.6-24% increase in transmissibility relative to wild-type circulating strains. The variant carries 3 mutations in the spike protein, including an L452R substitution. Our analyses revealed 2-fold increased B.1.427/B.1.429 viral shedding in vivo and increased L452R pseudovirus infection of cell cultures and lung organoids, albeit decreased relative to pseudoviruses carrying the N501Y mutation found in the B.1.1.7, B.1.351, and P.1 variants. Antibody neutralization assays showed 4.0 to 6.7-fold and 2.0-fold decreases in neutralizing titers from convalescent patients and vaccine recipients, respectively. The increased prevalence of a more transmissible variant in California associated with decreased antibody neutralization warrants further investigation.

Clinical translation of a new flat-panel detector for beam's-eye-view imaging

Electronic portal imaging devices (EPIDs) lend themselves to beams-eye view clinical applications, such as tumor tracking, but are limited by low contrast and detective quantum efficiency (DQE). We characterize a novel EPID prototype consisting of multiple layers and investigate its suitability for use under clinical conditions. A prototype multi-layer imager (MLI) was constructed utilizing four conventional EPID layers, each consisting of a copper plate, a Gd2O2S:Tb phosphor scintillator, and an amorphous silicon flat panel array detector. We measured the detector's response to a 6 MV photon beam with regards to modulation transfer function, noise power spectrum, DQE, contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR), and the linearity of the detector's response to dose. Additionally, we compared MLI performance to the single top layer of the MLI and the standard Varian AS-1200 detector. Pre-clinical imaging was done on an anthropomorphic phantom, and the detector's CNR, SNR and spatial resolution were assessed in a clinical environment. Images obtained from spine and liver patient treatment deliveries were analyzed to verify CNR and SNR improvements. The MLI has a DQE(0) of 9.7%, about 5.7 times the reference AS-1200 detector. Improved noise performance largely drives the increase. CNR and SNR of clinical images improved three-fold compared to reference. A novel MLI was characterized and prepared for clinical translation. The MLI substantially improved DQE and CNR performance while maintaining the same resolution. Pre-clinical tests on an anthropomorphic phantom demonstrated improved performance as predicted theoretically. Preliminary patient data were analyzed, confirming improved CNR and SNR. Clinical applications are anticipated to include more accurate soft tissue tracking.

Automated MV markerless tumor tracking for VMAT

Tumor tracking during radiotherapy treatment can improve dose accuracy, conformity and sparing of healthy tissue. Many methods have been introduced to tackle this challenge utilizing multiple imaging modalities, including a template matching based approach using the megavoltage (MV) on-board portal imager demonstrated on 3D conformal treatments. However, the complexity of treatments is evolving with the introduction of VMAT and IMRT, and successful motion management is becoming more important due to a trend towards hypofractionation. We have developed a markerless lung tumor tracking algorithm, utilizing the electronic portal imager (EPID) of the treatment machine. The algorithm has been specifically adapted to track during complex treatment deliveries with gantry and MLC motion. The core of the algorithm is an adaptive template matching method that relies on template stability metrics and local relative orientations to perform multiple feature tracking simultaneously. Only a single image is required to initialize the algorithm and features are automatically added, modified or removed in response to the input images. This algorithm was evaluated against images collected during VMAT arcs of a dynamic thorax phantom. Dynamic phantom images were collected during radiation delivery for multiple lung SBRT breathing traces and an example patient data set. The tracking error was 1.34 mm for the phantom data and 0.68 mm for the patient data. A multi-region, markerless tracking algorithm has been developed, capable of tracking multiple features simultaneously without requiring any other a priori information. This novel approach delivers robust target localization during complex treatment delivery. The reported tracking error is similar to previous reports for 3D conformal treatments.

P5354Echocardiographic findings in pregnant indigenous Australians: under utilised?

Background

The Indigenous population of Australia has one of the highest prevalence of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) globally. RHD is more common in females and the incidence peaks in the 3rd to 4th decade of life, corresponding with child-bearing age. It is the number one cause of cardiac complications in pregnancy globally. Signs and symptoms of normal pregnancy may overlap with those of cardiac pathology. Significant valvular disease can complicate pregnancy and delivery. Current practice sees pregnant women referred for echocardiography if there are signs or symptoms of possible cardiac pathology or a history of RHD.

Aim

To assess the current practice of echocardiography in pregnant women in a region with a high prevalence of rheumatic heart disease.

Method

A retrospective study of all echocardiograms requested for an indication relating to pregnancy over a three-year period were reviewed in the Northern Territory of Australia. Data collected included patient demographics, echocardiography indication, history of RHD, ARF or other cardiac disease, echocardiographic parameters, location of delivery, peri-partum morbidity and mortality.

Results

The total number of patients reviewed were 257. The 158 Indigenous Australian women had a mean age of 25 years and the 99 non-indigenous women had a mean age of 30 years. The Indigenous women had a higher rate of abnormal echocardiograms, 36.1% compared with 9.1% for non-indigenous women. Table 1 outlines echocardiography indications and outcomes. Indigenous women had extremely high rates of ARF or RHD representing 37% of echocardiography referrals, with 17.1% (27/158) having moderate or severe valve lesions. 5 cases (3.2%) had a history of prior valve surgery. 10 (6.3%) Indigenous patients required transfer to a tertiary centre with valve intervention services available for delivery. There was one maternal death, one post-partum stroke and one foetal death in utero.

Echocardiogram indications and outcomes Incidental murmur Cardiac symptoms Other cardiac disease History of RHD and/or ARF Normal study Rheumatic heart disease Congenital heart disease Other heart disease Indigenous (n=158) 60 (38%) 15 (9.4%) 24 (15%) 59 (37.3%) 101 (63.9%) 47 (29.7%) 7 (4.4%) 3 (1.9%) Non-indigenous (n=99) 44 (44.4%) 24 (24.2%) 31 (31.3%) 0 90 (91%) 2 (2%) 3 (3%) 4 (4%)

Conclusion

In the Top End of Australia, Indigenous patients have a very high rate of abnormal echocardiograms during pregnancy compared with their non-indigenous counterparts, mainly as a result of RHD. Data suggests that pregnant Indigenous women are being under serviced by the current medical model and referral practices. Guidelines are urgently needed in relation to echocardiography and pregnancy in populations that are burdened by RHD.

Mortality and morbidity rounds (MMR) in pathology: relative contribution of cognitive bias vs. systems failures to diagnostic error

Background Heuristics and cognitive biases are thought to play an important role in diagnostic medical error. How to systematically determine and capture these kinds of errors remains unclear. Morbidity and mortality rounds (MMRs) are generally focused on reducing medical error by identifying and correcting systems failures. However, they may also provide an educational platform for recognizing and raising awareness on cognitive errors. Methods A total of 49 MMR cases spanning the period 2008-2015 in our pathology department were examined for the presence of cognitive errors and/or systems failures by eight study participant raters who were trained on a subset of 16 of these MMR cases (excluded from the main study analysis) to identify such errors. The Delphi method was used to obtain group consensus on error classification on the remaining 33 study cases. Cases with <75% inter-rater agreement were subjected to subsequent rounds of Delphi analysis. Inter-rater agreement at each round was determined by Fleiss' kappa values. Results Thirty-six percent of the cases presented at our pathology MMRs over an 8-year period were found to contain errors likely due to cognitive bias. Conclusions These data suggest that the errors identified in our pathology MMRs represent not only systems failures but may also be composed of a significant proportion of cognitive errors. Teaching trainees and health professionals to correctly identify different types of cognitive errors may present an opportunity for quality improvement interventions in the interests of patient safety.

Early or delayed anterior cruciate ligament reconstruction: Is one superior? A systematic review and meta-analysis

Background

Anterior cruciate ligament (ACL) reconstruction is a rapidly developing orthopaedic field and an area of notable clinical equipoise. The optimal timing of surgery in an acute (< 3 weeks) or delayed (≥ 3 weeks) time frame remains unresolved with a 2010 meta-analysis concluding no difference between these two groups across multiple outcomes. In an era of evidence-based medicine, surgeons are still basing their decisions on when to operate on little more than anecdotal evidence and personal preference. Clear guidance is required to determine whether the timing of surgery can optimise outcomes in this largely young and active patient cohort.

Methods

A systematic literature search was performed in January 2018 of Embase, Medline and OpenGrey in accordance with (PRISMA) guidelines. A total of 658 articles were retrieved, with 6 suitable for inclusion, covering 576 ACL reconstructions. Four meta-analyses were performed assessing subjective measures of Tegner activity scale and Lysholm score, and objective measures of arthroscopically identified meniscal and chondral injury. Additional relevant outcome measures underwent narrative review. Study bias was assessed and reported using the Downs and Black checklist.

Results

A statistically significant difference of 0.39 points was found on the Tegner activity scale in favour of early surgery within 3 weeks (RR 0.39, CI 0.10, 0.67, p = 0.008). No statistically difference was found between groups for the patient-reported Lysholm score (RR − 0.18, CI − 2.40, 2.05, p = 0.17). There was no statistically significant difference between groups for intra-operative findings of meniscal lesions (RR 0.84, CI 0.66, 1.08, p = 0.17). A trend towards significance was observed for the incidence of chondral lesions in the early surgery group (RR 0.56, CI 0.31, 1.02, p = 0.06). All the studies were rated either fair or good on the Downs and Black checklist with no study excluded due to bias.

Conclusions

Although there was a statistically significant result for the Tegner activity scale in favour of early surgery, the magnitude of the effect is unlikely to translate into any clinically meaningful difference. At present, there remains no clear evidence to determine superiority of acute/early or delayed reconstruction of a ruptured anterior cruciate ligament. Further research through methodologically robust randomised controlled trials or through the UK National Ligament Registry  may help to provide clearer guidance.

Canadian Stroke Best Practice Recommendations for Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care, 6th Edition, Update 2018

The 2018 update of the Canadian Stroke Best Practice Recommendations for Acute Stroke Management, 6th edition, is a comprehensive summary of current evidence-based recommendations, appropriate for use by healthcare providers and system planners caring for persons with very recent symptoms of acute stroke or transient ischemic attack. The recommendations are intended for use by a interdisciplinary team of clinicians across a wide range of settings and highlight key elements involved in prehospital and Emergency Department care, acute treatments for ischemic stroke, and acute inpatient care. The most notable changes included in this 6th edition are the renaming of the module and its integration of the formerly separate modules on prehospital and emergency care and acute inpatient stroke care. The new module, Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care is now a single, comprehensive module addressing the most important aspects of acute stroke care delivery. Other notable changes include the removal of two sections related to the emergency management of intracerebral hemorrhage and subarachnoid hemorrhage. These topics are covered in a new, dedicated module, to be released later this year. The most significant recommendation updates are for neuroimaging; the extension of the time window for endovascular thrombectomy treatment out to 24 h; considerations for treating a highly selected group of people with stroke of unknown time of onset; and recommendations for dual antiplatelet therapy for a limited duration after acute minor ischemic stroke and transient ischemic attack. This module also emphasizes the need for increased public and healthcare provider’s recognition of the signs of stroke and immediate actions to take; the important expanding role of paramedics and all emergency medical services personnel; arriving at a stroke-enabled Emergency Department without delay; and launching local healthcare institution code stroke protocols. Revisions have also been made to the recommendations for the triage and assessment of risk of recurrent stroke after transient ischemic attack/minor stroke and suggested urgency levels for investigations and initiation of management strategies. The goal of this updated guideline is to optimize stroke care across Canada, by reducing practice variations and reducing the gap between current knowledge and clinical practice.

Amplitude Analysis of the Decay B[over ¯]^{0}→K_{S}^{0}π^{+}π^{-} and First Observation of the CP Asymmetry in B[over ¯]^{0}→K^{*}(892)^{-}π^{+}

The time-integrated untagged Dalitz plot of the three-body hadronic charmless decay B[over ¯]^{0}→K_{S}^{0}π^{+}π^{-} is studied using a pp collision data sample recorded with the LHCb detector, corresponding to an integrated luminosity of 3.0  fb^{-1}. The decay amplitude is described with an isobar model. Relative contributions of the isobar amplitudes to the B[over ¯]^{0}→K_{S}^{0}π^{+}π^{-} decay branching fraction and CP asymmetries of the flavor-specific amplitudes are measured. The CP asymmetry between the conjugate B[over ¯]^{0}→K^{*}(892)^{-}π^{+} and B^{0}→K^{*}(892)^{+}π^{-} decay rates is determined to be -0.308±0.062.

Studies of the resonance structure in D 0 → K ∓ π ± π ± π ∓ decays

Amplitude models are constructed to describe the resonance structure of D 0 → K - π + π + π - and D 0 → K + π - π - π + decays using pp collision data collected at centre-of-mass energies of 7 and 8 TeV with the LHCb experiment, corresponding to an integrated luminosity of 3.0  f b - 1 . The largest contributions to both decay amplitudes are found to come from axial resonances, with decay modes D 0 → a 1 ( 1260 ) + K - and D 0 → K 1 ( 1270 / 1400 ) + π - being prominent in D 0 → K - π + π + π - and D 0 → K + π - π - π + , respectively. Precise measurements of the lineshape parameters and couplings of the a 1 ( 1260 ) + , K 1 ( 1270 ) - and K ( 1460 ) - resonances are made, and a quasi model-independent study of the K ( 1460 ) - resonance is performed. The coherence factor of the decays is calculated from the amplitude models to be R K 3 π = 0.459 ± 0.010 ( stat ) ± 0.012 ( syst ) ± 0.020 ( model ) , which is consistent with direct measurements. These models will be useful in future measurements of the unitary-triangle angle γ and studies of charm mixing and C P violation.

Evidence for the Rare Decay Σ^{+}→pμ^{+}μ^{-}

A search for the rare decay Σ^{+}→pμ^{+}μ^{-} is performed using pp collision data recorded by the LHCb experiment at center-of-mass energies sqrt[s]=7 and 8 TeV, corresponding to an integrated luminosity of 3  fb^{-1}. An excess of events is observed with respect to the background expectation, with a signal significance of 4.1 standard deviations. No significant structure is observed in the dimuon invariant mass distribution, in contrast with a previous result from the HyperCP experiment. The measured Σ^{+}→pμ^{+}μ^{-} branching fraction is (2.2_{-1.3}^{+1.8})×10^{-8}, where statistical and systematic uncertainties are included, which is consistent with the standard model prediction.

Measurement of the Ratio of the B^{0}→D^{*-}τ^{+}ν_{τ} and B^{0}→D^{*-}μ^{+}ν_{μ} Branching Fractions Using Three-Prong τ-Lepton Decays

The ratio of branching fractions R(D^{*-})≡B(B^{0}→D^{*-}τ^{+}ν_{τ})/B(B^{0}→D^{*-}μ^{+}ν_{μ}) is measured using a data sample of proton-proton collisions collected with the LHCb detector at center-of-mass energies of 7 and 8 TeV, corresponding to an integrated luminosity of 3  fb^{-1}. For the first time, R(D^{*-}) is determined using the τ-lepton decays with three charged pions in the final state. The B^{0}→D^{*-}τ^{+}ν_{τ} yield is normalized to that of the B^{0}→D^{*-}π^{+}π^{-}π^{+} mode, providing a measurement of B(B^{0}→D^{*-}τ^{+}ν_{τ})/B(B^{0}→D^{*-}π^{+}π^{-}π^{+})=1.97±0.13±0.18, where the first uncertainty is statistical and the second systematic. The value of B(B^{0}→D^{*-}τ^{+}ν_{τ})=(1.42±0.094±0.129±0.054)% is obtained, where the third uncertainty is due to the limited knowledge of the branching fraction of the normalization mode. Using the well-measured branching fraction of the B^{0}→D^{*-}μ^{+}ν_{μ} decay, a value of R(D^{*-})=0.291±0.019±0.026±0.013 is established, where the third uncertainty is due to the limited knowledge of the branching fractions of the normalization and B^{0}→D^{*-}μ^{+}ν_{μ} modes. This measurement is in agreement with the standard model prediction and with previous results.

Measurement of the Ratio of Branching Fractions B(B_{c}^{+}→J/ψτ^{+}ν_{τ})/B(B_{c}^{+}→J/ψμ^{+}ν_{μ})

A measurement is reported of the ratio of branching fractions R(J/ψ)=B(B_{c}^{+}→J/ψτ^{+}ν_{τ})/B(B_{c}^{+}→J/ψμ^{+}ν_{μ}), where the τ^{+} lepton is identified in the decay mode τ^{+}→μ^{+}ν_{μ}ν[over ¯]_{τ}. This analysis uses a sample of proton-proton collision data corresponding to 3.0  fb^{-1} of integrated luminosity recorded with the LHCb experiment at center-of-mass energies of 7 and 8 TeV. A signal is found for the decay B_{c}^{+}→J/ψτ^{+}ν_{τ} at a significance of 3 standard deviations corrected for systematic uncertainty, and the ratio of the branching fractions is measured to be R(J/ψ)=0.71±0.17(stat)±0.18(syst). This result lies within 2 standard deviations above the range of central values currently predicted by the standard model.

Search for Dark Photons Produced in 13 TeV pp Collisions

Searches are performed for both promptlike and long-lived dark photons, A^{'}, produced in proton-proton collisions at a center-of-mass energy of 13 TeV, using A^{'}→μ^{+}μ^{-} decays and a data sample corresponding to an integrated luminosity of 1.6  fb^{-1} collected with the LHCb detector. The promptlike A^{'} search covers the mass range from near the dimuon threshold up to 70 GeV, while the long-lived A^{'} search is restricted to the low-mass region 214<m(A^{'})<350  MeV. No evidence for a signal is found, and 90% confidence level exclusion limits are placed on the γ-A^{'} kinetic-mixing strength. The constraints placed on promptlike dark photons are the most stringent to date for the mass range 10.6<m(A^{'})<70  GeV, and are comparable to the best existing limits for m(A^{'})<0.5  GeV. The search for long-lived dark photons is the first to achieve sensitivity using a displaced-vertex signature.

First Observation of the Rare Purely Baryonic Decay B^{0}→pp[over ¯]

The first observation of the decay of a B^{0} meson to a purely baryonic final state, B^{0}→pp[over ¯], is reported. The proton-proton collision data sample used was collected with the LHCb experiment at center-of-mass energies of 7 and 8 TeV and corresponds to an integrated luminosity of 3.0  fb^{-1}. The branching fraction is determined to be B(B^{0}→pp[over ¯])=(1.25±0.27±0.18)×10^{-8}, where the first uncertainty is statistical and the second systematic. The decay mode B^{0}→pp[over ¯] is the rarest decay of the B^{0} meson observed to date. The decay B_{s}^{0}→pp[over ¯] is also investigated. No signal is seen and the upper limit B(B_{s}^{0}→pp[over ¯])<1.5×10^{-8} at 90% confidence level is set on the branching fraction.

χ_{c1} and χ_{c2} Resonance Parameters with the Decays χ_{c1,c2}→J/ψμ^{+}μ^{-}

The decays χ_{c1}→J/ψμ^{+}μ^{-} and χ_{c2}→J/ψμ^{+}μ^{-} are observed and used to study the resonance parameters of the χ_{c1} and χ_{c2} mesons. The masses of these states are measured to be m(χ_{c1})=3510.71±0.04(stat)±0.09(syst)  MeV and m(χ_{c2})=3556.10±0.06(stat)±0.11(syst)  MeV, where the knowledge of the momentum scale for charged particles dominates the systematic uncertainty. The momentum-scale uncertainties largely cancel in the mass difference m(χ_{c2})-m(χ_{c1})=45.39±0.07(stat)±0.03(syst)  MeV. The natural width of the χ_{c2} meson is measured to be Γ(χ_{c2})=2.10±0.20(stat)±0.02(syst)  MeV. These results are in good agreement with and have comparable precision to the current world averages.

Updated search for long-lived particles decaying to jet pairs

A search is presented for long-lived particles with a mass between 25 and 50 GeV / c 2 and a lifetime between 2 and 500 ps, using proton-proton collision data corresponding to an integrated luminosity of 2.0 fb - 1 , collected by the LHCb detector at centre-of-mass energies of 7 and 8 TeV. The particles are assumed to be pair-produced in the decay of a 125 GeV / c 2 Standard-Model-like Higgs boson. The experimental signature is a single long-lived particle, identified by a displaced vertex with two associated jets. No excess above background is observed and limits are set on the production cross-section as a function of the mass and lifetime of the long-lived particle.

Observation of D^{0} Meson Decays to π^{+}π^{-}μ^{+}μ^{-} and K^{+}K^{-}μ^{+}μ^{-} Final States

The first observation of the D^{0}→π^{+}π^{-}μ^{+}μ^{-} and D^{0}→K^{+}K^{-}μ^{+}μ^{-} decays is reported using a sample of proton-proton collisions collected by LHCb at a center-of-mass energy of 8 TeV, and corresponding to 2  fb^{-1} of integrated luminosity. The corresponding branching fractions are measured using as normalization the decay D^{0}→K^{-}π^{+}[μ^{+}μ^{-}]_{ρ^{0}/ω}, where the two muons are consistent with coming from the decay of a ρ^{0} or ω meson. The results are B(D^{0}→π^{+}π^{-}μ^{+}μ^{-})=(9.64±0.48±0.51±0.97)×10^{-7} and B(D^{0}→K^{+}K^{-}μ^{+}μ^{-})=(1.54±0.27±0.09±0.16)×10^{-7}, where the uncertainties are statistical, systematic, and due to the limited knowledge of the normalization branching fraction. The dependence of the branching fraction on the dimuon mass is also investigated.

Search for Baryon-Number Violating Ξ_{b}^{0} Oscillations

A search for baryon-number violating Ξ_{b}^{0} oscillations is performed with a sample of pp collision data recorded by the LHCb experiment, corresponding to an integrated luminosity of 3  fb^{-1}. The baryon number at the moment of production is identified by requiring that the Ξ_{b}^{0} come from the decay of a resonance Ξ_{b}^{*-}→Ξ_{b}^{0}π^{-} or Ξ_{b}^{'-}→Ξ_{b}^{0}π^{-}, and the baryon number at the moment of decay is identified from the final state using the decays Ξ_{b}^{0}→Ξ_{c}^{+}π^{-},Ξ_{c}^{+}→pK^{-}π^{+}. No evidence of baryon-number violation is found, and an upper limit at the 95% confidence level is set on the oscillation rate of ω<0.08  ps^{-1}, where ω is the associated angular frequency.

Improved limit on the branching fraction of the rare decay K S 0 → μ + μ -

A search for the decay K S 0 → μ + μ - is performed, based on a data sample of proton-proton collisions corresponding to an integrated luminosity of 3 fb - 1 , collected by the LHCb experiment at centre-of-mass energies of 7 and 8 TeV . The observed yield is consistent with the background-only hypothesis, yielding a limit on the branching fraction of B ( K S 0 → μ + μ - ) < 0.8 ( 1.0 ) × 10 - 9 at 90 % ( 95 % ) confidence level. This result improves the previous upper limit on the branching fraction by an order of magnitude.

Observation of the Doubly Charmed Baryon Ξ_{cc}^{++}

A highly significant structure is observed in the Λ_{c}^{+}K^{-}π^{+}π^{+} mass spectrum, where the Λ_{c}^{+} baryon is reconstructed in the decay mode pK^{-}π^{+}. The structure is consistent with originating from a weakly decaying particle, identified as the doubly charmed baryon Ξ_{cc}^{++}. The difference between the masses of the Ξ_{cc}^{++} and Λ_{c}^{+} states is measured to be 1334.94±0.72(stat.)±0.27(syst.)  MeV/c^{2}, and the Ξ_{cc}^{++} mass is then determined to be 3621.40±0.72(stat.)±0.27(syst.)±0.14(Λ_{c}^{+})  MeV/c^{2}, where the last uncertainty is due to the limited knowledge of the Λ_{c}^{+} mass. The state is observed in a sample of proton-proton collision data collected by the LHCb experiment at a center-of-mass energy of 13 TeV, corresponding to an integrated luminosity of 1.7  fb^{-1}, and confirmed in an additional sample of data collected at 8 TeV.

Study of charmonium production in b -hadron decays and first evidence for the decay B s 0 → ϕ ϕ ϕ

Using decays to ϕ -meson pairs, the inclusive production of charmonium states in b -hadron decays is studied with pp collision data corresponding to an integrated luminosity of 3.0 fb - 1 , collected by the LHCb experiment at centre-of-mass energies of 7 and 8 TeV. Denoting by B C ≡ B ( b → C X ) × B ( C → ϕ ϕ ) the inclusive branching fraction of a b hadron to a charmonium state C that decays into a pair of ϕ mesons, ratios R C 2 C 1 ≡ B C 1 / B C 2 are determined as R η c ( 1 S ) χ c 0 = 0.147 ± 0.023 ± 0.011 , R η c ( 1 S ) χ c 1 = 0.073 ± 0.016 ± 0.006 , R η c ( 1 S ) χ c 2 = 0.081 ± 0.013 ± 0.005 , R χ c 0 χ c 1 = 0.50 ± 0.11 ± 0.01 , R χ c 0 χ c 2 = 0.56 ± 0.10 ± 0.01 and R η c ( 1 S ) η c ( 2 S ) = 0.040 ± 0.011 ± 0.004 . Here and below the first uncertainties are statistical and the second systematic. Upper limits at 90% confidence level for the inclusive production of X(3872), X(3915) and χ c 2 ( 2 P ) states are obtained as R χ c 1 X ( 3872 ) < 0.34 , R χ c 0 X ( 3915 ) < 0.12 and R χ c 2 χ c 2 ( 2 P ) < 0.16 . Differential cross-sections as a function of transverse momentum are measured for the η c ( 1 S ) and χ c states. The branching fraction of the decay B s 0 → ϕ ϕ ϕ is measured for the first time, B ( B s 0 → ϕ ϕ ϕ ) = ( 2.15 ± 0.54 ± 0.28 ± 0 . 21 B ) × 10 - 6 . Here the third uncertainty is due to the branching fraction of the decay B s 0 → ϕ ϕ , which is used for normalization. No evidence for intermediate resonances is seen. A preferentially transverse ϕ polarization is observed. The measurements allow the determination of the ratio of the branching fractions for the η c ( 1 S ) decays to ϕ ϕ and p p ¯ as B ( η c ( 1 S ) → ϕ ϕ ) / B ( η c ( 1 S ) → p p ¯ ) = 1.79 ± 0.14 ± 0.32 .

Measurement of B_{s}^{0} and D_{s}^{-} Meson Lifetimes

We report on a measurement of the flavor-specific B_{s}^{0} lifetime and of the D_{s}^{-} lifetime using proton-proton collisions at center-of-mass energies of 7 and 8 TeV, collected by the LHCb experiment and corresponding to 3.0  fb^{-1} of integrated luminosity. Approximately 407 000 B_{s}^{0}→D_{s}^{(*)-}μ^{+}ν_{μ} decays are partially reconstructed in the K^{+}K^{-}π^{-}μ^{+} final state. The B_{s}^{0} and D_{s}^{-} natural widths are determined using, as a reference, kinematically similar B^{0}→D^{(*)-}μ^{+}ν_{μ} decays reconstructed in the same final state. The resulting differences between widths of B_{s}^{0} and B^{0} mesons and of D_{s}^{-} and D^{-} mesons are Δ_{Γ}(B)=-0.0115±0.0053(stat)±0.0041(syst)  ps^{-1} and Δ_{Γ}(D)=1.0131±0.0117(stat)±0.0065(syst)  ps^{-1}, respectively. Combined with the known B^{0} and D^{-} lifetimes, these yield the flavor-specific B_{s}^{0} lifetime, τ_{B_{s}^{0}}^{fs}=1.547±0.013(stat)±0.010(syst)±0.004(τ_{B})  ps and the D_{s}^{-} lifetime, τ_{D_{s}^{-}}=0.5064±0.0030(stat)±0.0017(syst)±0.0017(τ_{D})  ps. The last uncertainties originate from the limited knowledge of the B^{0} and D^{-} lifetimes. The results improve upon current determinations.

Observation of the Decays Λ_{b}^{0}→χ_{c1}pK^{-} and Λ_{b}^{0}→χ_{c2}pK^{-}

The first observation of the decays Λ_{b}^{0}→χ_{c1}pK^{-} and Λ_{b}^{0}→χ_{c2}pK^{-} is reported using a data sample corresponding to an integrated luminosity of 3.0  fb^{-1}, collected by the LHCb experiment in pp collisions at center-of-mass energies of 7 and 8 TeV. The following ratios of branching fractions are measured: B(Λ_{b}^{0}→χ_{c1}pK^{-})/B(Λ_{b}^{0}→J/ψpK^{-})=0.242±0.014±0.013±0.009,B(Λ_{b}^{0}→χ_{c2}pK^{-})/B(Λ_{b}^{0}→J/ψpK^{-})=0.248±0.020±0.014±0.009,B(Λ_{b}^{0}→χ_{c2}pK^{-})/B(Λ_{b}^{0}→χ_{c1}pK^{-})=1.02±0.10±0.02±0.05,where the first uncertainty is statistical, the second systematic, and the third due to the uncertainty on the branching fractions of the χ_{c1}→J/ψγ and χ_{c2}→J/ψγ decays. Using both decay modes, the mass of the Λ_{b}^{0} baryon is also measured to be m_{Λ_{b}^{0}}=5619.44±0.28±0.26  MeV/c^{2}, where the first and second uncertainties are statistical and systematic, respectively.

First Observation of a Baryonic B_{s}^{0} Decay

We report the first observation of a baryonic B_{s}^{0} decay, B_{s}^{0}→pΛ[over ¯]K^{-}, using proton-proton collision data recorded by the LHCb experiment at center-of-mass energies of 7 and 8 TeV, corresponding to an integrated luminosity of 3.0  fb^{-1}. The branching fraction is measured to be B(B_{s}^{0}→pΛ[over ¯]K^{-})+B(B_{s}^{0}→p[over ¯]ΛK^{+})=[5.46±0.61±0.57±0.50(B)±0.32(f_{s}/f_{d})]×10^{-6}, where the first uncertainty is statistical and the second systematic, the third uncertainty accounts for the experimental uncertainty on the branching fraction of the B^{0}→pΛ[over ¯]π^{-} decay used for normalization, and the fourth uncertainty relates to the knowledge of the ratio of b-quark hadronization probabilities f_{s}/f_{d}.

Measurement of the CP Violation Parameter A_{Γ} in D^{0}→K^{+}K^{-} and D^{0}→π^{+}π^{-} Decays

Asymmetries in the time-dependent rates of D^{0}→K^{+}K^{-} and D^{0}→π^{+}π^{-} decays are measured in a pp collision data sample collected with the LHCb detector during LHC Run 1, corresponding to an integrated luminosity of 3  fb^{-1}. The asymmetries in effective decay widths between D^{0} and D[over ¯]^{0} decays, sensitive to indirect CP violation, are measured to be A_{Γ}(K^{+}K^{-})=(-0.30±0.32±0.10)×10^{-3} and A_{Γ}(π^{+}π^{-})=(0.46±0.58±0.12)×10^{-3}, where the first uncertainty is statistical and the second systematic. These measurements show no evidence for CP violation and improve on the precision of the previous best measurements by nearly a factor of two.

Search for the Decays B_{s}^{0}→τ^{+}τ^{-} and B^{0}→τ^{+}τ^{-}

A search for the rare decays B_{s}^{0}→τ^{+}τ^{-} and B^{0}→τ^{+}τ^{-} is performed using proton-proton collision data collected with the LHCb detector. The data sample corresponds to an integrated luminosity of 3  fb^{-1} collected in 2011 and 2012. The τ leptons are reconstructed through the decay τ^{-}→π^{-}π^{+}π^{-}ν_{τ}. Assuming no contribution from B^{0}→τ^{+}τ^{-} decays, an upper limit is set on the branching fraction B(B_{s}^{0}→τ^{+}τ^{-})<6.8×10^{-3} at the 95% confidence level. If instead no contribution from B_{s}^{0}→τ^{+}τ^{-} decays is assumed, the limit is B(B^{0}→τ^{+}τ^{-})<2.1×10^{-3} at the 95% confidence level. These results correspond to the first direct limit on B(B_{s}^{0}→τ^{+}τ^{-}) and the world's best limit on B(B^{0}→τ^{+}τ^{-}).