Patient interest in and clinician reservations on polygenic embryo screening: a qualitative study of stakeholder perspectives

PURPOSE

We explored and compared perspectives of reproductive endocrinology and infertility specialists (REIs) and in vitro fertilization (IVF) patients regarding polygenic embryo screening (PES), a new type of preimplantation screening that estimates the genetic chances of developing polygenic conditions and traits in the future.

METHODS

Qualitative thematic analysis of semi-structured interviews with US-based REIs and IVF patients.

RESULTS

Clinicians and patients often held favorable views of screening embryos for physical or psychiatric conditions, though clinicians tended to temper their positive attitudes with specific caveats. Clinicians also expressed negative views about screening embryos for traits more frequently than patients, who generally held more positive views. Most clinicians were either unwilling to discuss or offer PES to patients or were willing to do so only under certain circumstances, while many patients expressed interest in PES. Both stakeholder groups envisioned multiple potential benefits or uses of PES and raised multiple potential, interrelated concerns about PES.

CONCLUSION

A gap exists between clinician and patient attitudes toward PES; clinicians generally maintained reservations about such screening and patients indicated interest in it. Clinicians and patients sometimes imagined using PES to prepare for the birth of a predisposed or "affected" individual-a rationale that is often associated with prenatal testing. Many clinicians and patients held different attitudes depending on what is specifically screened, despite the sometimes blurry distinction between conditions and traits. Considerations raised by clinicians and patients may help guide professional societies in developing guidelines to navigate the uncertain terrain of PES.

Divergence Between Clinician and Patient Perspectives on Polygenic Embryo Screening: A Qualitative Study

Objective

To explore and compare the perspectives of clinicians and patients on polygenic embryo screening.

Design

Qualitative.

Subjects

Fifty-three participants: 27 reproductive endocrinology and infertility specialists and 26 patients currently undergoing in vitro fertilization or had done so within the last five years.

Main Outcome Measures

Qualitative thematic analysis of interview transcripts.

Results

Both clinicians and patients often held favorable views of screening embryos for physical or psychiatric conditions, though clinicians tended to temper their positive attitudes with specific caveats. Clinicians also expressed negative views about screening embryos for traits more often than patients, who generally held more positive views. Most clinicians were either unwilling to discuss or offer polygenic embryo screening to patients or were willing to do so only under certain circumstances, while many patients expressed interest in polygenic embryo screening. Both sets of stakeholders envisioned multiple potential benefits or uses of polygenic embryo screening; the most common included selection and/or prioritization of embryos, receipt of more information about embryos, and preparation for the birth of a predisposed or "affected" child. Both sets of stakeholders also raised multiple potential, interrelated concerns about polygenic embryo screening. The most common concerns among both sets of stakeholders included the potential for different types of "biases" - most often in relation to selection of embryos with preferred genetic chances of traits -, the probabilistic nature of polygenic embryo screening that can complicate patient counseling and/or lead to excessive cycles of in vitro fertilization, and a lack of data from long-term prospective studies supporting the clinical use of polygenic embryo screening.

Conclusion

Despite patients' interest in polygenic embryo screening, clinicians feel such screening is premature for clinical application. Though now embryos can be screened for their genetic chances of developing polygenic conditions and traits, many clinicians and patients maintain different attitudes depending on what is specifically screened, despite the blurry distinction between conditions and traits. Considerations raised by these stakeholders may help guide professional societies as they consider developing guidelines to navigate the uncertain terrain of polygenic embryo screening, which is already commercially available.

1242 CO-MORBIDITY, FRAILTY AND EJECTION FRACTION IN OLDER HEART FAILURE INPATIENTS

Introduction

Co-morbidities and frailty are common in older heart failure patients. The aim of this study is to explore the relationship between co-morbidity, frailty and ejection fraction (EF) in older heart failure inpatients

Methods

A cross-sectional, observational, retrospective analysis of consecutive patients aged 60 years and over who were admitted with heart failure in a UK hospital. Patients with incomplete data were excluded. The Carlson’s comorbidity index (CCI) was used to compute comorbidity and the Rockwood Clinical Frailty Scale (CFS) was used to measure frailty. The EF was calculated as the midpoint of the ranges measured by echocardiography. IBM SPSS 28 software was used for statistical analysis. Descriptive statistics were used to measure baseline characteristics and Pearson’s correlation coefficient and linear regression were used to calculate correlation.

Results and discussion

101 patients were analysed; 48 males and 53 females. Mean age was 81.2 years(SD 9.98). Mean CCI was 6.97(SD 1.63) and mean CFS was 5.09(SD 1.14). There was statistically significant positive correlation between CCI and CFS (r= 0.232; p= .01). There was statistically significant inverse correlation between CCI and EF (r= -.277; p=. 005). When taking into account the level of frailty the correlation between CCI and EF was much stronger in non-frail than in frail patients (r= -.612; p=. 035 and r= -.216; p= .047 respectively). There was no correlation between CFS and EF (r= .095; p=.26). This was not surprising as HFpEF is the most common type of HF in the elderly. HFpEF patients are more likely to have more comorbidities and to be more frail compared to HFrEF patients.

Conclusion

There was a positive correlation between multi-morbidity and frailty in older inpatients admitted with heart failure. There was statistically significant inverse correlation between CCI and ejection fraction but there was no correlation between frailty and ejection.

Cardiovascular magnetic resonance in autoimmune rheumatic diseases: a clinical consensus document by the European Association of Cardiovascular Imaging

Autoimmune rheumatic diseases (ARDs) involve multiple organs including the heart and vasculature. Despite novel treatments, patients with ARDs still experience a reduced life expectancy, partly caused by the higher prevalence of cardiovascular disease (CVD). This includes CV inflammation, rhythm disturbances, perfusion abnormalities (ischaemia/infarction), dysregulation of vasoreactivity, myocardial fibrosis, coagulation abnormalities, pulmonary hypertension, valvular disease, and side-effects of immunomodulatory therapy. Currently, the evaluation of CV involvement in patients with ARDs is based on the assessment of cardiac symptoms, coupled with electrocardiography, blood testing, and echocardiography. However, CVD may not become overt until late in the course of the disease, thus potentially limiting the therapeutic window for intervention. More recently, cardiovascular magnetic resonance (CMR) has allowed for the early identification of pathophysiologic structural/functional alterations that take place before the onset of clinically overt CVD. CMR allows for detailed evaluation of biventricular function together with tissue characterization of vessels/myocardium in the same examination, yielding a reliable assessment of disease activity that might not be mirrored by blood biomarkers and other imaging modalities. Therefore, CMR provides diagnostic information that enables timely clinical decision-making and facilitates the tailoring of treatment to individual patients. Here we review the role of CMR in the early and accurate diagnosis of CVD in patients with ARDs compared with other non-invasive imaging modalities. Furthermore, we present a consensus-based decision algorithm for when a CMR study could be considered in patients with ARDs, together with a standardized study protocol. Lastly, we discuss the clinical implications of findings from a CMR examination.

Medicalizing risk: How experts and consumers manage uncertainty in genetic health testing

Given increased prevalence of direct-to-consumer (DTC) genetic health tests in recent years, this paper delves into discourses among researchers at professional genomics conferences and lay DTC genetic test users on popular discussion website Reddit to understand the contested value of genetic knowledge and its direct implications for health management. Harnessing ethnographic observations at five conferences and a text -analysis of 52 Reddit threads, we find both experts and lay patient-consumers navigate their own versions of “productive uncertainty.” Experts develop genetic technologies to legitimize unsettled genomics as medical knowledge and mobilize resources and products, while lay patient-consumers turn to Internet forums to gain clarity on knowledge gaps that help better manage their genetic risk states. By showing how the uncertain nature of genomics serves as a productive force placing both parties within a mutually cooperative cycle, we argue that experts and patient-consumers co-produce a form of relational medicalization that concretizes “risk” itself as a disease state.

Polygenic embryo screening: four clinical considerations warrant further attention

Recent advances in developing polygenic scores have made it possible to screen embryos for common, complex conditions and traits. Polygenic embryo screening (PES) is currently offered commercially, and though there has been much recent media and academic coverage, reproductive specialists' points of view have not yet been prominent in these discussions. We convened a roundtable of multidisciplinary experts, including reproductive specialists to discuss PES and its implications. In this Opinion, we describe four clinically relevant issues associated with the use of PES that have not yet been discussed in the literature and warrant consideration.

Clinical profile and predictors of therapeutic outcome with azithromycin in pediatric scrub typhus: A study from Eastern India

In this prospective study, children from 1-month to 12-years, admitted with positive IgM ELISA testing for scrub typhus, were enrolled over 1-year and administered an empirical single dose of azithromycin (10 mg/kg). All 189 (median age 4.84-years) children had fever with median duration of 8 days at admission. Shortness of breath, altered sensorium, headache, lymphadenopathy, hepatosplenomegaly, pallor, oedema and hypotension were the most prominent symptoms/signs. About 46% of children developed complications, among them hepatic, neurological and cardiovascular were most common. Our study showed a remarkable response to azithromycin, with mean defervescence of 32 h and no mortality. The presence of shortness of breath, headache, altered sensorium, hepatosplenomegaly, meningeal signs, severe anemia, leucocytosis, hyponatremia along with/without any of above mentioned three systemic complications were independent predictors for delayed treatment response by multivariate logistic regression analysis. Hepatic, neurological and cardiovascular complications are an emerging trend. Empiric azithromycin based on clinical suspicion of scrub typhus can be lifesaving.

Introduction of Module-based Training on Communication Skills among Interns in a Tertiary Care Teaching Hospital of Kolkata, India

Introduction: Many of the problems in Indian healthcare settings resulting in mistrust, violence, allegations and litigations against doctors can be solved by effective communication between doctors and patients or their relatives. Interaction of the students as a community physician needs training in communication skills. A structured module-based training on communication skills during internship will help the interns to communicate effectively with patients and their relatives. Aim: To develop, introduce and evaluate a structured, validated module on communication skills for interns in a Tertiary Care Teaching Hospital of Kolkata, India. Materials and Methods: A quasi-experimental, prospective, non randomised educational intervention study was conducted in the Department of Community Medicine at Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India, from January 2020 to December 2020. A structured and validated module for teaching communication skills to interns was used to train one batch of interns posted (n=40) in the department, over two days. To establish the content validity of the module, the items on content validation were rated on a scale of 1-4 by 10 experts. The validators were asked about their responses favoring face validity of the module and the average of their responses were calculated. Post-training their knowledge, skills and self-reported efficacy were assessed. Feedback from the faculty (n=6), and the interns (n=40) were collected using structured survey forms with likert scale ratings and open-ended questions. The trained cohort of interns was also assessed on communication using the SEGUE (Set the stage, Elicit information, Give information, Understand the patient's perspective, and End the encounter) Framework during patient encounter. Results: Post-training knowledge score (16.68±2.5) was significantly higher than the pre-training score (15.45±2.9). Also, there was significant increase in self-assessed knowledge (11.08±3.7 and 17.23±3.3) and skills (9.60±4.6 and 16±2.9) before and after the training. All the interns had positive attitude towards communication skill on the Communication Skills Assessment Scale (CSAS). The mean score of interns on assessment using the SEGUE framework was 16.6±3.59. The satisfaction index of the items on the feedback survey obtained from interns ranged from 82.5% to 93%. There was 100% agreement by the faculty on the relevance, usefulness and use of the module by other departments for communication skill training. More faculty involvement and more such sessions were suggested by both groups as evident from thematic analysis of open-ended responses to the feedback questsions. Conclusions: The development and delivery of a structured training module on communication skills for interns improved the knowledge and skills of the interns. Both the faculty and the interns were satisfied with the module.

Determinants of Non Communicable Diseases: A Mixed-method Study on Its Prevalence and Perceptions among Rural Population of Muchisa, West Bengal

Introduction: Most people with Non Communicable Diseases (NCDs) are unaware of the problem because it usually does not have any signs or symptoms in the initial stages. The measures for prevention of NCDs are not well known to the rural population which results in a huge burden on the health system. Aim: To estimate the burden of NCDs, and its risk factors among the rural population residing in a village of Budge Budge II block, West Bengal. Also to explore their perceptions regarding determinants, complications and prevention of NCDs, and to look for the association of NCDs with the risk factors and sociodemographic characteristics. Materials and Methods: An observational study, with crosssectional design using mixed methods approach, was conducted on 160 residents of Muchisa, from December 2020 to March 2021. A predesigned, pretested and structured schedule, prepared on the basis of World Health Organization (WHO) STEPS framework, was used to assess the presence NCD and associated risk factors in the study population. Focused group discussion guide was employed to inquire about their perceptions. The participants were selected through cluster random sampling. The data were explored using Pearson’s Chi-square test, logistic regression and thematic analysis. A p-value of <0.05 was considered significant. Results: Mean age of the participants was 45.0±16.8 years, and 69.4% participants were females. Total 75% of the participants suffered from at least one NCD. All the participants had at least one risk factor for NCD. Age group of 40-59 years (p-value <0.001) and 60 years or above (p-value=0.002), female gender (p-valu=0.009), and preschool education or below (p-value=0.006) were associated with a higher risk of NCD. Qualitative data analysis revealed that lifestyle modification was not perceived to be effective against NCDs. Conclusion: Socio-demographic factors, like age, gender and education have a bearing on the risk of developing NCD. Lack of awareness about the prevention of NCDs is the challenge in addressing the problem.

Loneliness and Social Support Experienced by COVID-19 Patients Attending a Telemedicine Centre of a Tertiary Care Hospital in Kolkata: A Cross-sectional Study

Introduction: Telemedicine acted as one of the biggest medium in treating Coronavirus Disease-2019 (COVID-19) patients during the second wave of the still ongoing pandemic. Although the symptoms were taken care of and treated through teleconsultation, the loneliness and social support system of these patients went largely unrecognised. The morbidity pattern, effect of self-isolation and quarantine, uncertainties in social support were major contributors to loneliness among patients suffering from COVID-19. Aim: To estimate the proportion of loneliness and level of social support experienced by COVID-19 patients seeking advice from a telemedicine centre of Kolkata and to find out their socioclinical profile and the associated relationship. Materials and Methods: An observational study with crosssectional design was conducted on 403 COVID-19 patients who had taken advice from the telemedicine centre of Institute of Post Graduate Medical Education and Research (IPGME and R), Kolkata for a period of 12 weeks (May-July 2021). Loneliness was assessed by the 11-item De Jong Gierveld Loneliness scale, whereas social support was assessed using 12-item Multidimensional Scale of Perceived Social Support scale through telephonic interview. Data were tabulated in the Microsoft Office Excel 2019 (Microsoft Corp, Redmond, WA, USA) and the analysis was performed using Statistical Package for the Social Sciences (IBM, New York City, USA) version 25.0. Results: Out of 403, more than half of the study population, 194 (48.2%) belonged to 18-35 years of age. Of the total, 235 (58.3%) were males, 319 (79.2%) were currently married and 300 (74.4%) were Hindus. About 142 (35.2%) respondents had experienced severe loneliness, while 297 (73.7%) had experienced high social support. There was a significant negative correlation found between loneliness and social support (r=-0.495, p-value <0.01). It was found that being male, belonging to nuclear family, education upto higher secondary level, being addicted, loneliness due to physical distancing, and those who had socialised frequently had higher odds of loneliness, whereas unemployed, unskilled, semiskilled and skilled occupation, having one chronic disease had lower odds of social support. Conclusion: About 338 (84%) patients had experienced loneliness which was strikingly high. This shows a deeper aspect into the actual picture of how COVID-19 impacts mental health of those who are affected. Future interventions are needed to address loneliness and develop social support system along with addressing healthcare needs of COVID-19 patients.

Morbidity Pattern With Treatment Outcome and Predictors of Mortality of Children Admitted to Pediatric Intensive Care Unit in a Peripheral Medical College in India

To capture lapses in management, active surveillance of pediatric intensive care unit (PICU) admissions should consider as an essential tool to bring a better outcome with available resources, while there is a scarcity of data from comparatively newly set up peripheral PICU in developing countries. An observational record-based cross-sectional study was conducted in a peripheral medical college PICU over one year to evaluate morbidity pattern, outcome, and predictors of mortality. Binomial logistic regression (SPSS version-25) was used for analysis. The confidence interval (CI) of Odd’s ratio was used to report the strength of association between dependent and independent variables. Pneumonia was the major cause of admission (27%), followed by septicemia (25.5%), congenital heart diseases (12.2%), bronchiolitis (6.6%), seizure disorders (8.6%), encephalitis (5%), and meningitis (4%). 51.7% were discharged, 14.6 %were referred, 3.2% were left against medical advice, and 30.4% were expired. Pneumonia (46.44%) was the most common cause of death, followed by sepsis (42.07%), congenital heart disease (15.3%), and bronchiolitis (6.01%). The mean duration of stay in PICU was five days (range 1-31 days). Patients who required ventilation (40%) or Inotropes (55.6%) had increased risk of mortality by 14 and 8 times, respectively. Age below one year, presence of bronchiolitis, pneumonia, ARDS, encephalitis, anemia, sepsis, dyselectrolytemia, and requirement of inotropes or ventilation were statistically significant risk factors for mortality (P<0.05). These predictors of morality will help to identify severe cases, prioritize resources and focus on the preventable methods in the public such as a vaccine, creating awareness about diseases, and proper referral.

Observation of New Resonances Decaying to J/ψK^{+} and J/ψϕ

The first observation of exotic states with a new quark content cc[over ¯]us[over ¯] decaying to the J/ψK^{+} final state is reported with high significance from an amplitude analysis of the B^{+}→J/ψϕK^{+} decay. The analysis is carried out using proton-proton collision data corresponding to a total integrated luminosity of 9  fb^{-1} collected by the LHCb experiment at center-of-mass energies of 7, 8, and 13 TeV. The most significant state, Z_{cs}(4000)^{+}, has a mass of 4003±6_{-14}^{+4}  MeV, a width of 131±15±26  MeV, and spin parity J^{P}=1^{+}, where the quoted uncertainties are statistical and systematic, respectively. A new 1^{+}  X(4685) state decaying to the J/ψϕ final state is also observed with high significance. In addition, the four previously reported J/ψϕ states are confirmed and two more exotic states, Z_{cs}(4220)^{+} and X(4630), are observed with significance exceeding 5 standard deviations.

Angular Analysis of the B^{+}→K^{*+}μ^{+}μ^{-} Decay

We present an angular analysis of the B^{+}→K^{*+}(→K_{S}^{0}π^{+})μ^{+}μ^{-} decay using 9  fb^{-1} of pp collision data collected with the LHCb experiment. For the first time, the full set of CP-averaged angular observables is measured in intervals of the dimuon invariant mass squared. Local deviations from standard model predictions are observed, similar to those in previous LHCb analyses of the isospin-partner B^{0}→K^{*0}μ^{+}μ^{-} decay. The global tension is dependent on which effective couplings are considered and on the choice of theory nuisance parameters.

Observation of a New Excited D_{s}^{+} Meson in B^{0}→D^{-}D^{+}K^{+}π^{-} Decays

Using pp collision data corresponding to an integrated luminosity of 5.4  fb^{-1} collected with the LHCb detector at a center-of-mass energy of 13 TeV, the B^{0}→D^{-}D^{+}K^{+}π^{-} decay is studied. A new excited D_{s}^{+} meson is observed decaying into the D^{+}K^{+}π^{-} final state with large statistical significance. The pole mass and width, and the spin parity of the new state are measured with an amplitude analysis to be m_{R}=2591±6±7  MeV, Γ_{R}=89±16±12  MeV, and J^{P}=0^{-}, where the first uncertainty is statistical and the second systematic. Fit fractions for all components in the amplitude analysis are also reported. The new resonance, denoted as D_{s0}(2590)^{+}, is a strong candidate to be the D_{s}(2^{1}S_{0})^{+} state, the radial excitation of the pseudoscalar ground-state D_{s}^{+} meson.

Observation of Multiplicity Dependent Prompt χ_{c1}(3872) and ψ(2S) Production in pp Collisions

The production of χ_{c1}(3872) and ψ(2S) hadrons is studied as a function of charged particle multiplicity in pp collisions at a center-of-mass energy of 8 TeV, corresponding to an integrated luminosity of 2  fb^{-1}. For both states, the fraction that is produced promptly at the collision vertex is found to decrease as charged particle multiplicity increases. The ratio of χ_{c1}(3872) to ψ(2S) cross sections for promptly produced particles is also found to decrease with multiplicity, while no significant dependence on multiplicity is observed for the equivalent ratio of particles produced away from the collision vertex in b-hadron decays. This behavior is consistent with a calculation that models the χ_{c1}(3872) structure as a compact tetraquark. Comparisons with model calculations and implications for the binding energy of the χ_{c1}(3872) state are discussed.

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

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

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

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

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

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

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

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

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

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

Measurement of CP-Averaged Observables in the B^{0}→K^{*0}μ^{+}μ^{-} Decay

An angular analysis of the B^{0}→K^{*0}(→K^{+}π^{-})μ^{+}μ^{-} decay is presented using a dataset corresponding to an integrated luminosity of 4.7  fb^{-1} of pp collision data collected with the LHCb experiment. The full set of CP-averaged observables are determined in bins of the invariant mass squared of the dimuon system. Contamination from decays with the K^{+}π^{-} system in an S-wave configuration is taken into account. The tension seen between the previous LHCb results and the standard model predictions persists with the new data. The precise value of the significance of this tension depends on the choice of theory nuisance parameters.

Exacerbations of Severe Asthma While on Anti-IL-5 Biologics

Anti-interleukin 5 (IL-5) and anti-IL-5 receptor α monoclonal antibodies markedly decrease airway and peripheral blood eosinophil numbers and are thus highly effective in reducing asthma exacerbations. Nonetheless, these biologics do not completely resolve exacerbations. There is very little information on the cellular nature of exacerbations during treatment with biologics. Using illustrative clinical case scenarios, we highlight the importance of carefully characterizing asthmatics at the time of exacerbation and recognizing neutrophilic causes of exacerbations to ensure optimal management. While an eosinophilic exacerbation may improve with more corticosteroids or by switching to another anti-IL-5 monoclonal antibody, a noneosinophilic exacerbation will likely not. An infective exacerbation needs to be recognized, and the pathogen must be identified and treated with the appropriate antimicrobial agent.

Observation of New Ξ_{c}^{0} Baryons Decaying to Λ_{c}^{+}K^{-}

The Λ_{c}^{+}K^{-} mass spectrum is studied with a data sample of pp collisions at a center-of-mass energy of 13 TeV corresponding to an integrated luminosity of 5.6  fb^{-1} collected by the LHCb experiment. Three Ξ_{c}^{0} states are observed with a large significance and their masses and natural widths are measured to be m[Ξ_{c}(2923)^{0}]=2923.04±0.25±0.20±0.14  MeV, Γ[Ξ_{c}(2923)^{0}]=7.1±0.8±1.8  MeV, m[Ξ_{c}(2939)^{0}]=2938.55±0.21±0.17±0.14  MeV, Γ[Ξ_{c}(2939)^{0}]=10.2±0.8±1.1  MeV, m[Ξ_{c}(2965)^{0}]=2964.88±0.26±0.14±0.14  MeV, Γ[Ξ_{c}(2965)^{0}]=14.1±0.9±1.3  MeV, where the uncertainties are statistical, systematic, and due to the limited knowledge of the Λ_{c}^{+} mass. The Ξ_{c}(2923)^{0} and Ξ_{c}(2939)^{0} baryons are new states. The Ξ_{c}(2965)^{0} state is in the vicinity of the known Ξ_{c}(2970)^{0} baryon; however, their masses and natural widths differ significantly.

THU0355 PARAMETRIC CARDIAC MAGNETIC RESONANCE IMAGING IDENTIFIES ARRHYTHMOGENIC SUBSTRATES IN SYSTEMIC SCLEROSIS PATIENTS

Background:

Cardiac involvement in systemic sclerosis (SSc) accounts for 26-36% of deaths. This most frequently manifests as ventricular rhythm disturbances (VRDs), eventually culminating in sudden cardiac death. However, no specific guidelines exist for implantation of cardioverter defibrillators (ICD) in SSc patients. Parametric cardiovascular magnetic resonance (CMR) indices of myocardial oedema and fibrosis like native T1/T2 mapping have been shown to be associated with prognosis in SSc patients with acute cardiac events and normal echocardiograms. However, their relationship with arrhythmogenicity per se has not been previously investigated in SSc.

Objectives:

To investigate the relationship between parametric CMR indices and arrhythmogenicity in SSc patients.

Methods:

84 consecutive SSc patients (80% diffuse-cutaneous SSc) from eight European centers presenting with cardiac symptoms were examined using a 1.5 T CMR system. 24h Holter recordings were obtained within a month of the CMR scan. The presence of VRDs was defined as any type of premature ventricular contraction (PVC) in couples, triplets, bigeminism, trigeminism, quadrigeminism and non-sustained ventricular tachycardia, as well as having >30 PVCs per hour. Logistic regression analysis was used to evaluate the relationship between VRD occurrence and native T1/T2 mapping as well as myocardial extracellular volume fraction (ECV).

Results:

Mean age in the cohort was 55 (13) years and 78 (93%) patients were female. Of these, 67 (80%) experienced at least one type of VRDs. Each 10 ms increase of native T1-mapping was associated with a higher occurrence of VRDs [odds ratio (95% confidence interval): 1.21 (1.08-1.36), p=0.001]. Similarly, a 1% increase in ECV conferred an increased probability of experiencing VRDs [1.25 (1.01-1.53), p=0.037]. Lastly, a 1ms unit increase in T2-mapping also led to increased probability of having experienced VRDs [1.09 (1.01-1.19), p=0.035].

Conclusion:

Parametric CMR indices are associated with arrhythmogenicity in SSc patients with cardiac symptoms and should be investigated further in larger studies for their clinical utility in selecting high-risk SSc patients for ICD implantation.

Disclosure of Interests:

Sophie I. Mavrogeni: None declared, Luna Gargani: None declared, Alessia Pepe: None declared, Lorenzo Monti: None declared, George Markousis-Mavrogenis: None declared, Maria De Santis: None declared, Antonella Meloni: None declared, Loukia Koutsogeorgopoulou: None declared, Georgia Karabela: None declared, Efthymios Stavropoulos: None declared, Gkikas Katsifis Grant/research support from: UCB Pharma, Janssen, Abbvie, Novartis, MSD, Aenorasis, Genesis Pharma, Pfizer, Roche, Consultant of: UCB Pharma, Janssen, Abbvie, Novartis, MSD, Aenorasis, Genesis Pharma, Pfizer, Roche, Speakers bureau: UCB Pharma, Janssen, Abbvie, Novartis, MSD, Aenorasis, Genesis Pharma, Pfizer, Roche, Konstantinos Bratis: None declared, Silvia Bellando Randone: None declared, Serena Guiducci: None declared, Cosimo Bruni: None declared, Alberto Moggi-Pignone: None declared, Theodoros Dimitroulas: None declared, Paraskevi Voulgari: None declared, Genovefa Kolovou: None declared, Vasiliki-Kalliopi Bournia Grant/research support from: Travel Grant from Boehringer Ingelheim, Monica Mukherjee: None declared, Joao Lima: None declared, George D. Kitas: None declared, Petros Sfikakis Grant/research support from: Grant/research support from Abvie, Novartis, MSD, Actelion, Amgen, Pfizer, Janssen Pharmaceutical, UCB, Marco Matucci-Cerinic Grant/research support from: Actelion, MSD, Bristol-Myers Squibb, Speakers bureau: Acetelion, Lilly, Boehringer Ingelheim

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

A search for the decays B_{s}^{0}→e^{+}e^{-} and B^{0}→e^{+}e^{-} is performed using data collected with the LHCb experiment in proton-proton collisions at center-of-mass energies of 7, 8, and 13 TeV, corresponding to integrated luminosities of 1, 2, and 2  fb^{-1}, respectively. No signal is observed. Assuming no contribution from B^{0}→e^{+}e^{-} decays, an upper limit on the branching fraction B(B_{s}^{0}→e^{+}e^{-})<9.4(11.2)×10^{-9} is obtained at 90(95)% confidence level. If no B_{s}^{0}→e^{+}e^{-} contribution is assumed, a limit of B(B^{0}→e^{+}e^{-})<2.5(3.0)×10^{-9} is determined at 90(95)% confidence level. These upper limits are more than one order of magnitude lower than the previous values.

Measurement of f_{s}/f_{u} Variation with Proton-Proton Collision Energy and B-Meson Kinematics

The ratio of the B_{s}^{0} and B^{+} fragmentation fractions f_{s} and f_{u} is studied with B_{s}^{0}→J/ψϕ and B^{+}→J/ψK^{+} decays using data collected by the LHCb experiment in proton-proton collisions at 7, 8, and 13 TeV center-of-mass energies. The analysis is performed in bins of B-meson momentum, longitudinal momentum, transverse momentum, pseudorapidity, and rapidity. The fragmentation-fraction ratio f_{s}/f_{u} is observed to depend on the B-meson transverse momentum with a significance of 6.0σ. This dependency is driven by the 13 TeV sample (8.7σ), while the results for the other collision energies are not significant when considered separately. Furthermore, the results show a 4.8σ evidence for an increase of f_{s}/f_{u} as a function of collision energy.

Isospin Amplitudes in Λ_{b}^{0}→J/ψΛ(Σ^{0}) and Ξ_{b}^{0}→J/ψΞ^{0}(Λ) Decays

Ratios of isospin amplitudes in hadron decays are a useful probe of the interplay between weak and strong interactions and allow searches for physics beyond the standard model. We present the first results on isospin amplitudes in b-baryon decays, using data corresponding to an integrated luminosity of 8.5  fb^{-1}, collected with the LHCb detector in pp collisions at center of mass energies of 7, 8, and 13 TeV. The isospin amplitude ratio |A_{1}(Λ_{b}^{0}→J/ψΣ^{0})/A_{0}(Λ_{b}^{0}→J/ψΛ)|, where the subscript on A indicates the final-state isospin, is measured to be less than 1/21.8 at 95% confidence level. The Cabibbo suppressed Ξ_{b}^{0}→J/ψΛ decay is observed for the first time, allowing for the measurement |A_{0}(Ξ_{b}^{0}→J/ψΛ)/A_{1/2}(Ξ_{b}^{0}→J/ψΞ^{0})|=0.37±0.06±0.02, where the uncertainties are statistical and systematic, respectively.

First Observation of Excited Ω_{b}^{-} States

We report four narrow peaks in the Ξ_{b}^{0}K^{-} mass spectrum obtained using pp collisions at center-of-mass energies of 7, 8, and 13 TeV, corresponding to a total integrated luminosity of 9  fb^{-1} recorded by the LHCb experiment. Referring to these states by their mass, the mass values are m[Ω_{b}(6316)^{-}]=6315.64±0.31±0.07±0.50  MeV, m[Ω_{b}(6330)^{-}]=6330.30±0.28±0.07±0.50  MeV, m[Ω_{b}(6340)^{-}]=6339.71±0.26±0.05±0.50  MeV, m[Ω_{b}(6350)^{-}]=6349.88±0.35±0.05±0.50  MeV, where the uncertainties are statistical, systematic, and the last is due to the knowledge of the Ξ_{b}^{0} mass. The natural widths of the three lower mass states are consistent with zero, and the 90% confidence-level upper limits are determined to be Γ[Ω_{b}(6316)^{-}]<2.8  MeV, Γ[Ω_{b}(6330)^{-}]<3.1  MeV and Γ[Ω_{b}(6340)^{-}]<1.5  MeV. The natural width of the Ω_{b}(6350)^{-} peak is 1.4_{-0.8}^{+1.0}±0.1  MeV, which is 2.5σ from zero and corresponds to an upper limit of 2.8 MeV. The peaks have local significances ranging from 3.6σ to 7.2σ. After accounting for the look-elsewhere effect, the significances of the Ω_{b}(6316)^{-} and Ω_{b}(6330)^{-} peaks are reduced to 2.1σ and 2.6σ, respectively, while the two higher mass peaks exceed 5σ. The observed peaks are consistent with expectations for excited Ω_{b}^{-} resonances.

Search for A^{'}→μ^{+}μ^{-} Decays

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. These searches look for A^{'}→μ^{+}μ^{-} decays using a data sample corresponding to an integrated luminosity of 5.5  fb^{-1} collected with the LHCb detector. Neither search finds evidence for a signal, and 90% confidence-level exclusion limits are placed on the γ-A^{'} kinetic mixing strength. The promptlike A^{'} search explores the mass region from near the dimuon threshold up to 70 GeV and places the most stringent constraints to date on dark photons with 214<m(A^{'})≲740  MeV and 10.6<m(A^{'})≲30  GeV. The search for long-lived A^{'}→μ^{+}μ^{-} decays places world-leading constraints on low-mass dark photons with lifetimes O(1)  ps.

Observation of Several Sources of CP Violation in B^{+}→π^{+}π^{+}π^{-} Decays

Observations are reported of different sources of CP violation from an amplitude analysis of B^{+}→π^{+}π^{+}π^{-} decays, based on a data sample corresponding to an integrated luminosity of 3  fb^{-1} of pp collisions recorded with the LHCb detector. A large CP asymmetry is observed in the decay amplitude involving the tensor f_{2}(1270) resonance, and in addition significant CP violation is found in the π^{+}π^{-}S wave at low invariant mass. The presence of CP violation related to interference between the π^{+}π^{-}S wave and the P wave B^{+}→ρ(770)^{0}π^{+} amplitude is also established; this causes large local asymmetries but cancels when integrated over the phase space of the decay. The results provide both qualitative and quantitative new insights into CP -violation effects in hadronic B decays.

The Management of Unequal Patient Status in Fertility Medicine: Donors' and Intended Parents' Experiences of Participatory and Imposed Enrollment

This paper explores the micro-dynamics of medicalization and unequal patient statuses across donors and intended parents in assisted fertility practices. Based on twelve months of fieldwork in a fertility clinic, including direct observations of 108 patient-medical expert consultations and interviews with donors, I develop an "epistemic-orientation (EO) continuum" to examine the emergence and differing consequences of unequal patient status. Patients who experience practices closer to the "participatory" epistemic orientation end of the continuum enjoy joint decision-making, personal and emotional recognition, and incorporation of their personal values in interactions with medical experts in the clinic. Patients whose experiences align more closely to the "imposed" epistemic orientation end of the continuum experience top-down instruction, neglected personhood, and medical objectification. I find that medical experts rely upon their professional authority to enroll intended parents in participatory epistemic orientations, while donors more likely experience imposed epistemic orientations. Blended orientations also occur within each patient group, often based on individuals' prior fertility experiences. The EO continuum approach carries implications for future research to note how patients of various social identities (i.e. race, class, gender) and patient groups are positioned along the continuum, as well as practical interventions into micro-dynamics of social inequalities in healthcare.

Status of pesticide residues in water, sediment, and fishes of Chilika Lake, India

Chilika Lake is the largest coastal lagoon in Asia and the second largest in the world covering an area of 1100 km² and spread over three districts of Odisha state of India. It is the first Indian wetland designated as a wetland of international importance under the Ramsar Convention in 1981. The lake ecosystem sustains large and diversified resources of plants and animals including fisheries. Pollution of the ecosystem caused by residues of pesticides originating from different sources was assessed through multiple sampling from 2012 to 2016 from three potential sites of contamination, viz., Palur Bridge, Daya River Estuary, and Makara River. Incidence of organochlorinated (OC) pesticide residues was noticed in about 25% water samples. HCH (α, γ&δ), DDD (op^|), DDE (op^|&pp.^|) and heptachlor were the OCs detected in concentration varying from 0.025 to 23.4 μg/l. None of the eight targeted synthetic pyrethroid (SP) pesticides was found in water, but among the organophosphates (OP), chlorpyrifos (0.019-2.73 μg/l), and dichlorvos (0.647 μg/l) were recorded. In sediment samples, residues of OC or OP pesticides were not present, but one SP pesticide was recorded. Fish samples were contaminated to the extent of 55%, mostly with residues of OCs and OPs and less with SPs. However, their concentrations were below the permissible limit, so there was no direct threat of health hazards to humans.

Search for Lepton-Flavor Violating Decays B^{+}→K^{+}μ^{±}e^{∓}

A search for the lepton-flavor violating decays B^{+}→K^{+}μ^{±}e^{∓} is performed using a sample of proton-proton collision data, collected with the LHCb experiment at center-of-mass energies of 7 and 8 TeV and corresponding to an integrated luminosity of 3  fb^{-1}. No significant signal is observed, and upper limits on the branching fractions are set as B(B^{+}→K^{+}μ^{-}e^{+})<7.0(9.5)×10^{-9} and B(B^{+}→K^{+}μ^{+}e^{-})<6.4(8.8)×10^{-9} at 90% (95)% confidence level. The results improve the current best limits on these decays by more than one order of magnitude.

Measurement of Charged Hadron Production in Z-Tagged Jets in Proton-Proton Collisions at sqrt[s]=8 TeV

The production of charged hadrons within jets recoiling against a Z boson is measured in proton-proton collision data at sqrt[s]=8  TeV recorded by the LHCb experiment. The charged-hadron structure of the jet is studied longitudinally and transverse to the jet axis for jets with transverse momentum p_{T}>20  GeV and in the pseudorapidity range 2.5<η<4. These are the first measurements of jet hadronization at these forward rapidities and also the first where the jet is produced in association with a Z boson. In contrast to previous hadronization measurements at the Large Hadron Collider, which are dominated by gluon jets, these measurements probe predominantly light-quark jets which are found to be more longitudinally and transversely collimated with respect to the jet axis when compared to the previous gluon dominated measurements. Therefore, these results provide valuable information on differences between quarks and gluons regarding nonperturbative hadronization dynamics.

Amplitude Analysis of B^{±}→π^{±}K^{+}K^{-} Decays

The first amplitude analysis of the B^{±}→π^{±}K^{+}K^{-} decay is reported based on a data sample corresponding to an integrated luminosity of 3.0  fb^{-1} of pp collisions recorded in 2011 and 2012 with the LHCb detector. The data are found to be best described by a coherent sum of five resonant structures plus a nonresonant component and a contribution from ππ↔KK S-wave rescattering. The dominant contributions in the π^{±} K^{∓} and K^{+} K^{-} systems are the nonresonant and the B^{±}→ρ(1450)^{0}π^{±} amplitudes, respectively, with fit fractions around 30%. For the rescattering contribution, a sizable fit fraction is observed. This component has the largest CP asymmetry reported to date for a single amplitude of (-66±4±2)%, where the first uncertainty is statistical and the second systematic. No significant CP violation is observed in the other contributions.

Search for the Lepton-Flavor-Violating Decays B_{s}^{0}→τ^{±}μ^{∓} and B^{0}→τ^{±}μ^{∓}

Results are reported from a search for the rare decays B_{s}^{0}→τ^{±}μ^{∓} and B^{0}→τ^{±}μ^{∓}, where the τ lepton is reconstructed in the channel τ^{-}→π^{-}π^{+}π^{-}ν_{τ}. These processes are effectively forbidden in the standard model, but they can potentially occur at detectable rates in models of new physics that can induce lepton-flavor-violating decays. The search is based on a data sample corresponding to 3  fb^{-1} of proton-proton collisions recorded by the LHCb experiment in 2011 and 2012. The event yields observed in the signal regions for both processes are consistent with the expected standard model backgrounds. Because of the limited mass resolution arising from the undetected τ neutrino, the B_{s}^{0} and B^{0} signal regions are highly overlapping. Assuming no contribution from B^{0}→τ^{±}μ^{∓}, the upper limit B(B_{s}^{0}→τ^{±}μ^{∓})<4.2×10^{-5} is obtained at 95% confidence level. If no contribution from B_{s}^{0}→τ^{±}μ^{∓} is assumed, a limit of B(B^{0}→τ^{±}μ^{∓})<1.4×10^{-5} is obtained at 95% confidence level. These results represent the first limit on B(B_{s}^{0}→τ^{±}μ^{∓}) and the most stringent limit on B(B^{0}→τ^{±}μ^{∓}).