Statistical quantification of hip radiograph assessment using Shenton line femur neck length ratio

INTRODUCTION

Identification of a poorly positioned hip radiograph often requires a subjective assessment by the radiographer, which, due to the observer dependency of this method, may have conflicting opinions between radiographers. A quantitative approach may be a better personnel independent approach for assessing an optimally positioned hip radiograph. A Shenton line length femur neck length ratio (SLFLR) could be used to achieve this, which is the aim of this study.

METHODS

Seventy-three (48 digital and 25 analog) optimally positioned non-pathological hip radiographs of asymptomatic patients aged between 20 and 59 years and reported by the consultant radiologist as normal were conveniently selected. Three different radiographers, each blinded to the results of the other two, measured the Shenton line length and the femur neck length with the aid of flexible and straight meter rules for the analog images and inbuilt electronic calipers for the digital images. Bland-Altman method of agreement was used to assess for reproducibility and reliability of the measurements while the 5th, 25th, 75th, and 95th percentiles of the SLFLR were computed.

RESULTS

The mean ± SD SLFLR for both genders were 1.07 ± 0.08 cm (females: 1.06 ± 0.09 and males: 1.08 ± 1.07 cm). The measurements demonstrated high reproducibility and reliability between (interclass correlation coefficient: 0.993) and within (intraclass correlation coefficient: 0.998) radiographers. The 5th, 25th, 75th, and 95th percentile values of the SLFLR are 0.90, 1.03, 1.12, and 1.18.

CONCLUSION

For a hip radiograph to be reported as optimal for patients aged 20-59 years, the SLFLR should be between 0.90 and 1.18. This method is highly reproducible and repeatable and could be adopted for quantitative assessment of radiographs.

IMPLICATIONS FOR PRACTICE

The SLFLR could be used as an additional tool by the radiographer to quantitatively assess for a well-positioned hip radiograph.

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.

[Nocebo, informed consent and doctor-patient communication]

Negative previous experiences (conditioning), observational learning and expectations can trigger nocebo effects. They are responsible for a substantial proportion of the side effects of medical treatment, and are induced primarily by risk information for informed consent. This has been demonstrated in studies on patient groups with or without modified medical information. Drug trials in the field of neurology and psychiatry have regularly revealed side effects and drop-out also in placebo groups. The underlying neurobiological mechanisms were experimentally investigated especially for nocebo-induced hyperalgesia, whereby the specifically involved regions of the brain could be identified by functional imaging as well as changes in the dopamine, endorphin and cholecystokinin systems. Nocebo effects are specific, i.e. they are closely related to patient information and can induce or aggravate exactly the symptoms addressed. Nevertheless, informed consent is an essential part of doctor-patient communication; however, information on risks can be markedly less damaging when unnecessary repetitions are avoided, misunderstandings are recognized or resolved and several different options are given. In addition, risks should always be named together with positive aspects, such as the advantages of the appropriate treatment, the prophylactic measures applied or the early detection and treatment of developing side effects. The best protection against harm caused by information on risks is a trustful doctor-patient relationship. Poor knowledge of nocebo effects or lack of countermeasures constitute a serious threat to patients and according to the current state of knowledge could be rated as medical malpractice.

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.

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.

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.

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.

Exploring Kernberg's Model of Personality Functioning as a Moderator of Traits: Focus on DSM-5's Section III Alternative Model of Personality Disorder

A current trend emphasizes simplified models of traits and personality functioning that would reduce individuals to as few as five potential traits and one dimension of personality functioning. However, the evidence behind those models is based on linear methods of analysis that authors from Cattell to Kernberg (2016) believe do not capture the potential moderating interaction effects of personality. Using models of traits and functioning from the DSM-5, this study demonstrates not only that traits and functioning interact, but that they do so in a rich and meaningful way that points up the dangers of collapsing these concepts. Without taking the interaction into account, satisfaction in romantic or work relationships often could not be predicted or understood. If we cannot predict satisfaction in these relationships with precision, honest confusion arises over how to guide others toward these goals. Low Detachment depends on high levels of Self-Definition, just as low Antagonism relies on high levels of Empathy to be successful. Most interestingly, negative traits and low functioning can actually lead to individual satisfaction, suggesting not only that interaction is key but that nonlinear effects may also be present.

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^{∓}).

Observation of New Resonances in the Λ_{b}^{0}π^{+}π^{-} System

We report the observation of a new structure in the Λ_{b}^{0}π^{+}π^{-} spectrum using the full LHCb data set of pp collisions, corresponding to an integrated luminosity of 9  fb^{-1}, collected at sqrt[s]=7, 8, and 13 TeV. A study of the structure suggests its interpretation as a superposition of two almost degenerate narrow states. The masses and widths of these states are measured to be m_{Λ_{b}(6146)^{0}}=6146.17±0.33±0.22±0.16  MeV,m_{Λ_{b}(6152)^{0}}=6152.51±0.26±0.22±0.16  MeV,Γ_{Λ_{b}(6146)^{0}}=2.9±1.3±0.3  MeV,Γ_{Λ_{b}(6152)^{0}}=2.1±0.8±0.3  MeV,with a mass splitting of Δm=6.34±0.32±0.02  MeV, where the first uncertainty is statistical, the second systematic. The third uncertainty for the mass measurements derives from the knowledge of the mass of the Λ_{b}^{0} baryon. The measured masses and widths of these new excited states suggest their possible interpretation as a doublet of Λ_{b}(1D)^{0} states.

Measurement of CP-Violating and Mixing-Induced Observables in B_{s}^{0}→ϕγ Decays

A time-dependent analysis of the B_{s}^{0}→ϕγ decay rate is performed to determine the CP -violating observables S_{ϕγ} and C_{ϕγ} and the mixing-induced observable A_{ϕγ}^{Δ}. The measurement is based on a sample of pp collision data recorded with the LHCb detector, corresponding to an integrated luminosity of 3  fb^{-1} at center-of-mass energies of 7 and 8 TeV. The measured values are S_{ϕγ}=0.43±0.30±0.11, C_{ϕγ}=0.11±0.29±0.11, and A_{ϕγ}^{Δ}=-0.67_{-0.41}^{+0.37}±0.17, where the first uncertainty is statistical and the second systematic. This is the first measurement of the observables S and C in radiative B_{s}^{0} decays. The results are consistent with the standard model predictions.

First Observation of the Radiative Decay Λ_{b}^{0}→Λγ

The radiative decay Λ_{b}^{0}→Λγ is observed for the first time using a data sample of proton-proton collisions corresponding to an integrated luminosity of 1.7  fb^{-1} collected by the LHCb experiment at a center-of-mass energy of 13 TeV. Its branching fraction is measured exploiting the B^{0}→K^{*0}γ decay as a normalization mode and is found to be B(Λ_{b}^{0}→Λγ)=(7.1±1.5±0.6±0.7)×10^{-6}, where the quoted uncertainties are statistical, systematic, and systematic from external inputs, respectively. This is the first observation of a radiative decay of a beauty baryon.

Observation of an Excited B_{c}^{+} State

Using pp collision data corresponding to an integrated luminosity of 8.5  fb^{-1} recorded by the LHCb experiment at center-of-mass energies of sqrt[s]=7, 8, and 13 TeV, the observation of an excited B_{c}^{+} state in the B_{c}^{+}π^{+}π^{-} invariant-mass spectrum is reported. The observed peak has a mass of 6841.2±0.6(stat)±0.1(syst)±0.8(B_{c}^{+})  MeV/c^{2}, where the last uncertainty is due to the limited knowledge of the B_{c}^{+} mass. It is consistent with expectations of the B_{c}^{*}(2^{3}S_{1})^{+} state reconstructed without the low-energy photon from the B_{c}^{*}(1^{3}S_{1})^{+}→B_{c}^{+}γ decay following B_{c}^{*}(2^{3}S_{1})^{+}→B_{c}^{*}(1^{3}S_{1})^{+}π^{+}π^{-}. A second state is seen with a global (local) statistical significance of 2.2σ (3.2σ) and a mass of 6872.1±1.3(stat)±0.1(syst)±0.8(B_{c}^{+})  MeV/c^{2}, and is consistent with the B_{c}(2^{1}S_{0})^{+} state. These mass measurements are the most precise to date.

Measurement of the Mass Difference Between Neutral Charm-Meson Eigenstates

We report a measurement of the mass difference between neutral charm-meson eigenstates using a novel approach that enhances sensitivity to this parameter. We use 2.3×10^{6} D^{0}→K_{S}^{0}π^{+}π^{-} decays reconstructed in proton-proton collisions collected by the LHCb experiment in 2011 and 2012. Allowing for CP violation in mixing and in the interference between mixing and decay, we measure the CP-averaged normalized mass difference x_{CP}=[2.7±1.6(stat)±0.4(syst)]×10^{-3} and the CP-violating parameter Δx=[-0.53±0.70(stat)±0.22(syst)]×10^{-3}. The results are consistent with CP symmetry. These determinations are the most precise from a single experiment and, combined with current world-average results, yield the first evidence that the masses of the neutral charm-meson eigenstates differ.

Observation of a Narrow Pentaquark State, P_{c}(4312)^{+}, and of the Two-Peak Structure of the P_{c}(4450)^{+}

A narrow pentaquark state, P_{c}(4312)^{+}, decaying to J/ψp, is discovered with a statistical significance of 7.3σ in a data sample of Λ_{b}^{0}→J/ψpK^{-} decays, which is an order of magnitude larger than that previously analyzed by the LHCb Collaboration. The P_{c}(4450)^{+} pentaquark structure formerly reported by LHCb is confirmed and observed to consist of two narrow overlapping peaks, P_{c}(4440)^{+} and P_{c}(4457)^{+}, where the statistical significance of this two-peak interpretation is 5.4σ. The proximity of the Σ_{c}^{+}D[over ¯]^{0} and Σ_{c}^{+}D[over ¯]^{*0} thresholds to the observed narrow peaks suggests that they play an important role in the dynamics of these states.

Observation of CP Violation in Charm Decays

A search for charge-parity (CP) violation in D^{0}→K^{-}K^{+} and D^{0}→π^{-}π^{+} decays is reported, using pp collision data corresponding to an integrated luminosity of 5.9  fb^{-1} collected at a center-of-mass energy of 13 TeV with the LHCb detector. The flavor of the charm meson is inferred from the charge of the pion in D^{*}(2010)^{+}→D^{0}π^{+} decays or from the charge of the muon in B[over ¯]→D^{0}μ^{-}ν[over ¯]_{μ}X decays. The difference between the CP asymmetries in D^{0}→K^{-}K^{+} and D^{0}→π^{-}π^{+} decays is measured to be ΔA_{CP}=[-18.2±3.2(stat)±0.9(syst)]×10^{-4} for π-tagged and ΔA_{CP}=[-9±8(stat)±5(syst)]×10^{-4} for μ-tagged D^{0} mesons. Combining these with previous LHCb results leads to ΔA_{CP}=(-15.4±2.9)×10^{-4}, where the uncertainty includes both statistical and systematic contributions. The measured value differs from zero by more than 5 standard deviations. This is the first observation of CP violation in the decay of charm hadrons.

Search for CP Violation in D_{s}^{+}→K_{S}^{0}π^{+}, D^{+}→K_{S}^{0}K^{+}, and D^{+}→ϕπ^{+} Decays

A search for charge-parity (CP) violation in Cabibbo-suppressed D_{s}^{+}→K_{S}^{0}π^{+}, D^{+}→K_{S}^{0}K^{+}, and D^{+}→ϕπ^{+} decays is reported using proton-proton collision data, corresponding to an integrated luminosity of 3.8  fb^{-1}, collected at a center-of-mass energy of 13 TeV with the LHCb detector. High-yield samples of kinematically and topologically similar Cabibbo-favored D_{(s)}^{+} decays are analyzed to subtract nuisance asymmetries due to production and detection effects, including those induced by CP violation in the neutral kaon system. The results areA_{CP}(D_{s}^{+}→K_{S}^{0}π^{+})=(1.3±1.9±0.5)×10^{-3},A_{CP}(D^{+}→K_{S}^{0}K^{+})=(-0.09±0.65±0.48)×10^{-3},A_{CP}(D^{+}→ϕπ^{+})=(0.05±0.42±0.29)×10^{-3},where the first uncertainties are statistical and the second systematic. They are the most precise measurements of these quantities to date, and are consistent with CP symmetry. A combination with previous LHCb measurements, based on data collected at 7 and 8 TeV, is also reported.

Observation of B_{(s)}^{0}→J/ψpp[over ¯] Decays and Precision Measurements of the B_{(s)}^{0} Masses

The first observation of the decays B_{(s)}^{0}→J/ψpp[over ¯] is reported, using proton-proton collision data corresponding to an integrated luminosity of 5.2  fb^{-1}, collected with the LHCb detector. These decays are suppressed due to limited available phase space, as well as due to Okubo-Zweig-Iizuka or Cabibbo suppression. The measured branching fractions are B(B^{0}→J/ψpp[over ¯])=[4.51±0.40(stat)±0.44(syst)]×10^{-7}, B(B_{s}^{0}→J/ψpp[over ¯])=[3.58±0.19(stat)±0.39(syst)]×10^{-6}. For the B_{s}^{0} meson, the result is much higher than the expected value of O(10^{-9}). The small available phase space in these decays also allows for the most precise single measurement of both the B^{0} mass as 5279.74±0.30(stat)±0.10(syst)  MeV and the B_{s}^{0} mass as 5366.85±0.19(stat)±0.13(syst)  MeV.

Search for Lepton-Universality Violation in B^{+}→K^{+}ℓ^{+}ℓ^{-} Decays

A measurement of the ratio of branching fractions of the decays B^{+}→K^{+}μ^{+}μ^{-} and B^{+}→K^{+}e^{+}e^{-} is presented. The proton-proton collision data used correspond to an integrated luminosity of 5.0  fb^{-1} recorded with the LHCb experiment at center-of-mass energies of 7, 8, and 13 TeV. For the dilepton mass-squared range 1.1<q^{2}<6.0  GeV^{2}/c^{4} the ratio of branching fractions is measured to be R_{K}=0.846_{-0.054}^{+0.060}_{-0.014}^{+0.016}, where the first uncertainty is statistical and the second systematic. This is the most precise measurement of R_{K} to date and is compatible with the standard model at the level of 2.5 standard deviations.

Model-Independent Observation of Exotic Contributions to B^{0}→J/ψK^{+}π^{-} Decays

An angular analysis of B^{0}→J/ψK^{+}π^{-} decays is performed, using proton-proton collision data corresponding to an integrated luminosity of 3  fb^{-1} collected with the LHCb detector. The m(K^{+}π^{-}) spectrum is divided into fine bins. In each m(K^{+}π^{-}) bin, the hypothesis that the three-dimensional angular distribution can be described by structures induced only by K^{*} resonances is examined, making minimal assumptions about the K^{+}π^{-} system. The data reject the K^{*}-only hypothesis with a large significance, implying the observation of exotic contributions in a model-independent fashion. Inspection of the m(J/ψπ^{-}) vs m(K^{+}π^{-}) plane suggests structures near m(J/ψπ^{-})=4200 and 4600 MeV.

First Measurement of Charm Production in its Fixed-Target Configuration at the LHC

The first measurement of heavy-flavor production by the LHCb experiment in its fixed-target mode is presented. The production of J/ψ and D^{0} mesons is studied with beams of protons of different energies colliding with gaseous targets of helium and argon with nucleon-nucleon center-of-mass energies of sqrt[s_{NN}]=86.6 and 110.4 GeV, respectively. The J/ψ and D^{0} production cross sections in pHe collisions in the rapidity range [2, 4.6] are found to be σ_{J/ψ}=652±33(stat)±42(syst)   nb/nucleon and σ_{D^{0}}=80.8±2.4(stat)±6.3(syst)  μb/nucleon, where the first uncertainty is statistical and the second is systematic. No evidence for a substantial intrinsic charm content of the nucleon is observed in the large Bjorken-x region.

Measurement of the Charm-Mixing Parameter y_{CP}

A measurement of the charm-mixing parameter y_{CP} using D^{0}→K^{+}K^{-}, D^{0}→π^{+}π^{-}, and D^{0}→K^{-}π^{+} decays is reported. The D^{0} mesons are required to originate from semimuonic decays of B^{-} and B[over ¯]^{0} mesons. These decays are partially reconstructed in a data set of proton-proton collisions at center-of-mass energies of 7 and 8 TeV collected with the LHCb experiment and corresponding to an integrated luminosity of 3  fb^{-1}. The y_{CP} parameter is measured to be (0.57±0.13(stat)±0.09(syst))%, in agreement with, and as precise as, the current world-average value.

Observation of Two Resonances in the Λ_{b}^{0}π^{±} Systems and Precise Measurement of Σ_{b}^{±} and Σ_{b}^{*±} Properties

The first observation of two structures consistent with resonances in the final states Λ_{b}^{0}π^{-} and Λ_{b}^{0}π^{+} is reported using samples of pp collision data collected by the LHCb experiment at sqrt[s]=7 and 8 TeV, corresponding to an integrated luminosity of 3  fb^{-1}. The ground states Σ_{b}^{±} and Σ_{b}^{*±} are also confirmed and their masses and widths are precisely measured.

Evidence for an η c ( 1 S ) π - resonance in B 0 → η c ( 1 S ) K + π - decays

A Dalitz plot analysis of B 0 → η c ( 1 S ) K + π - decays is performed using data samples of pp collisions collected with the LHCb detector at centre-of-mass energies of s = 7 , 8 and 13 Te V , corresponding to a total integrated luminosity of 4.7 fb - 1 . A satisfactory description of the data is obtained when including a contribution representing an exotic η c ( 1 S ) π - resonant state. The significance of this exotic resonance is more than three standard deviations, while its mass and width are 4096 ± 20 - 22 + 18 Me V and 152 ± 58 - 35 + 60 Me V , respectively. The spin-parity assignments J P = 0 + and J P = 1 - are both consistent with the data. In addition, the first measurement of the B 0 → η c ( 1 S ) K + π - branching fraction is performed and gives B ( B 0 → η c ( 1 S ) K + π - ) = ( 5.73 ± 0.24 ± 0.13 ± 0.66 ) × 10 - 4 , where the first uncertainty is statistical, the second systematic, and the third is due to limited knowledge of external branching fractions.

Search for lepton-flavour-violating decays of Higgs-like bosons

A search is presented for a Higgs-like boson with mass in the range 45 to 195 GeV / c 2 decaying into a muon and a tau lepton. The dataset consists of proton-proton interactions at a centre-of-mass energy of 8 TeV , collected by the LHCb experiment, corresponding to an integrated luminosity of 2 fb - 1 . The tau leptons are reconstructed in both leptonic and hadronic decay channels. An upper limit on the production cross-section multiplied by the branching fraction at 95% confidence level is set and ranges from 22 pb for a boson mass of 45 GeV / c 2 to 4 pb for a mass of 195 GeV / c 2 .

Measurement of Antiproton Production in p-He Collisions at sqrt[s_{NN}]=110 GeV

The cross section for prompt antiproton production in collisions of protons with an energy of 6.5 TeV incident on helium nuclei at rest is measured with the LHCb experiment from a data set corresponding to an integrated luminosity of 0.5  nb^{-1}. The target is provided by injecting helium gas into the LHC beam line at the LHCb interaction point. The reported results, covering antiproton momenta between 12 and 110  GeV/c, represent the first direct determination of the antiproton production cross section in p-He collisions, and impact the interpretation of recent results on antiproton cosmic rays from space-borne experiments.

First Observation of the Doubly Charmed Baryon Decay Ξ_{cc}^{++}→Ξ_{c}^{+}π^{+}

The doubly charmed baryon decay Ξ_{cc}^{++}→Ξ_{c}^{+}π^{+} is observed for the first time, with a statistical significance of 5.9σ, confirming a recent observation of the baryon in the Λ_{c}^{+}K^{-}π^{+}π^{+} final state. The data sample used corresponds to an integrated luminosity of 1.7  fb^{-1}, collected by the LHCb experiment in pp collisions at a center-of-mass energy of 13 TeV. The Ξ_{cc}^{++} mass is measured to be 3620.6±1.5(stat)±0.4(syst)±0.3(Ξ_{c}^{+})  MeV/c^{2} and is consistent with the previous result. The ratio of branching fractions between the decay modes is measured to be [B(Ξ_{cc}^{++}→Ξ_{c}^{+}π^{+})×B(Ξ_{c}^{+}→pK^{-}π^{+})]/[B(Ξ_{cc}^{++}→Λ_{c}^{+}K^{-}π^{+}π^{+})×B(Λ_{c}^{+}→pK^{-}π^{+})]=0.035±0.009(stat)±0.003(syst).

Measurement of Angular and CP Asymmetries in D^{0}→π^{+}π^{-}μ^{+}μ^{-} and D^{0}→K^{+}K^{-}μ^{+}μ^{-} Decays

The first measurements of the forward-backward asymmetry of the dimuon pair (A_{FB}), the triple-product asymmetry (A_{2ϕ}), and the charge-parity-conjugation asymmetry (A_{CP}), in D^{0}→π^{+}π^{-}μ^{+}μ^{-} and D^{0}→K^{+}K^{-}μ^{+}μ^{-} decays are reported. They are performed using data from proton-proton collisions collected with the LHCb experiment from 2011 to 2016, corresponding to a total integrated luminosity of 5  fb^{-1}. The asymmetries are measured to be A_{FB}(D^{0}→π^{+}π^{-}μ^{+}μ^{-})=(3.3±3.7±0.6)%, A_{2ϕ}(D^{0}→π^{+}π^{-}μ^{+}μ^{-})=(-0.6±3.7±0.6)%, A_{CP}(D^{0}→π^{+}π^{-}μ^{+}μ^{-})=(4.9±3.8±0.7)%, A_{FB}(D^{0}→K^{+}K^{-}μ^{+}μ^{-})=(0±11±2)%, A_{2ϕ}(D^{0}→K^{+}K^{-}μ^{+}μ^{-})=(9±11±1)%, A_{CP}(D^{0}→K^{+}K^{-}μ^{+}μ^{-})=(0±11±2)%, where the first uncertainty is statistical and the second systematic. The asymmetries are also measured as a function of the dimuon invariant mass. The results are consistent with the standard model predictions.

Measurement of the Ω_{c}^{0} Baryon Lifetime

We report a measurement of the lifetime of the Ω_{c}^{0} baryon using proton-proton collision data at center-of-mass energies of 7 and 8 TeV, corresponding to an integrated luminosity of 3.0  fb^{-1} collected by the LHCb experiment. The sample consists of about 1000  Ω_{b}^{-}→Ω_{c}^{0}μ^{-}ν[over ¯]_{μ}X signal decays, where the Ω_{c}^{0} baryon is detected in the pK^{-}K^{-}π^{+} final state and X represents possible additional undetected particles in the decay. The Ω_{c}^{0} lifetime is measured to be τ_{Ω_{c}^{0}}=268±24±10±2  fs, where the uncertainties are statistical, systematic, and from the uncertainty in the D^{+} lifetime, respectively. This value is nearly four times larger than, and inconsistent with, the current world-average value.

Observation of a New Ξ_{b}^{-} Resonance

From samples of pp collision data collected by the LHCb experiment at sqrt[s]=7, 8 and 13 TeV, corresponding to integrated luminosities of 1.0, 2.0 and 1.5  fb^{-1}, respectively, a peak in both the Λ_{b}^{0}K^{-} and Ξ_{b}^{0}π^{-} invariant mass spectra is observed. In the quark model, radially and orbitally excited Ξ_{b}^{-} resonances with quark content bds are expected. Referring to this peak as Ξ_{b}(6227)^{-}, the mass and natural width are measured to be m_{Ξ_{b}(6227)^{-}}=6226.9±2.0±0.3±0.2  MeV/c^{2} and Γ_{Ξ_{b}(6227)^{-}}=18.1±5.4±1.8  MeV/c^{2}, where the first uncertainty is statistical, the second is systematic, and the third, on m_{Ξ_{b}(6227)^{-}}, is due to the knowledge of the Λ_{b}^{0} baryon mass. Relative production rates of the Ξ_{b}(6227)^{-}→Λ_{b}^{0}K^{-} and Ξ_{b}(6227)^{-}→Ξ_{b}^{0}π^{-} decays are also reported.

Measurement of the Lifetime of the Doubly Charmed Baryon Ξ_{cc}^{++}

The first measurement of the lifetime of the doubly charmed baryon Ξ_{cc}^{++} is presented, with the signal reconstructed in the final state Λ_{c}^{+}K^{-}π^{+}π^{+}. The data sample used corresponds to an integrated luminosity of 1.7  fb^{-1}, collected by the LHCb experiment in proton-proton collisions at a center-of-mass energy of 13 TeV. The Ξ_{cc}^{++} lifetime is measured to be 0.256_{-0.022}^{+0.024}(stat)±0.014(syst)  ps.

Psychiatric Disorders, Antiretroviral Medication Adherence and Viremia in a Cohort of Perinatally HIV-Infected Adolescents and Young Adults

BACKGROUND

Perinatally HIV-infected (PHIV+) adolescents and young adults (AYA) are at risk for suboptimal antiretroviral therapy (ART) adherence and mental health and substance use problems that, in HIV-infected adults, predict nonadherence. Studies on the relationship between psychiatric and substance use disorders (SUD) and adherence among PHIV+ AYA are limited, but may be important for informing evidence-based interventions to promote adherence.

METHODS

Data were analyzed from 3 annual follow-up interviews (FU2-FU4, N = 179) in a longitudinal study of PHIV+ AYA. Psychiatric disorders (anxiety, disruptive behavior, mood and SUD) were assessed with the Diagnostic Interview Schedule for Children. Adherence was self-reported missed ART doses within the past week. Viral load (VL) results were abstracted from medical charts. Multiple logistic regression analyzed cross-sectional associations between psychiatric disorders and (1) missed ART dose and (2) VL > 1000 copies/mL. Multiple linear regression assessed associations between psychiatric disorders and proportion of VL values >1000 copies/mL over time.

RESULTS

At FU2, 53% of PHIV+ AYA had any psychiatric disorder, 35% missed an ART dose in the past week and 47% had a VL > 1000 copies/mL. At FU2, behavioral disorders were associated with missed dose (P = 0.009) and VL > 1000 (P = 0.019), and mood disorders were associated with missed dose (P = 0.041). At FU4, behavioral disorders were associated with missed dose (P = 0.009). Behavioral disorders (P = 0.041), SUD (P = 0.016) and any disorder (P = 0.008) at FU2 were associated with higher proportion of VLs >1000 across FU2-FU4.

CONCLUSIONS

Addressing psychiatric disorder and SUD among PHIV+ AYA may improve ART adherence outcomes in this population. Targeted interventions should be developed and tested.

Association Between Psychiatric Disorders, Substance Use, and Sexual Risk Behaviors in Perinatally HIV-Exposed Youth

As youth with perinatally acquired HIV infection age, there is a need for studies that identify predictors and correlates of sexual risk behaviors. We examined the association between psychiatric disorders and substance use disorders (SUD) with sexual risk behaviors in youth with perinatally acquired HIV infection and perinatally HIV-exposed but uninfected youth. Participants were recruited from four medical centers in New York City. The Diagnostic Interview Schedule for Children and the Adolescent Sexual Behavior Assessment were administered to assess psychiatric disorders and sexual behaviors, respectively. SUD and behavior disorders were correlated with either ever having had penetrative sex or recent condomless sex for participants with perinatally acquired HIV infection only. Results suggest that clinicians should screen and treat patients for SUD and behavioral disorders to reduce sexual risk behaviors in youth with perinatally acquired HIV infection.

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.

Use of Unannounced Telephone Pill Counts to Measure Medication Adherence Among Adolescents and Young Adults Living With Perinatal HIV Infection

Objective

To examine unannounced telephone pill counts as a measure of adherence to antiretroviral therapy among adolescents and young adults living with perinatal HIV infection.

Methods

Participants were recruited from an ongoing longitudinal study to complete four monthly, unannounced telephone pill counts. Detailed notes concerning participants' medication habits surrounding adherence were recorded.

Results

Two-thirds of 102 eligible participants aged 18-27 years participated; 57% were female, 69% were Black. Blacks and participants with viral loads >40 and >1,000 copies/ml were less likely to participate. Average adherence across calls was 77%. Those who completed all calls averaged significantly higher adherence scores than those who did not. Calls revealed adherence barriers at individual (e.g., medication disorganization), social (e.g., limited support), and system (e.g., pharmacy problems) levels.

Conclusions

Despite challenges, this procedure can be implemented with this population and can help identify adherence barriers important for interventions that address medication-taking behaviors.

The PARACELSUS score: a novel diagnostic tool for pyoderma gangrenosum

BACKGROUND

The lack of objective diagnostic criteria renders pyoderma gangrenosum (PG) a diagnosis of exclusion. The diagnostic approaches proposed to date have not been systematically evaluated. Thus, PG remains a challenging and frequently misdiagnosed disorder.

OBJECTIVES

To develop and assess a comprehensive, yet clinically practicable, sensitive diagnostic scoring system for PG.

METHODS

Clinical history and images of a total of 60 participants with previously confirmed PG located on the lower extremity and a control cohort of 50 patients with venous leg ulcers were retrospectively evaluated by expert teams at two tertiary dermatological centres specializing in wound care using a newly developed diagnostic scoring system composed of 10 criteria.

RESULTS

The three major diagnostic criteria are rapidly progressing disease, assessment of relevant differential diagnoses and a reddish-violaceous wound border (prevalent in 98% of patients with PG). Minor criteria (evident in 61-95% of patients with PG) include amelioration by immunosuppressant drugs, characteristically irregular shape of ulceration, extreme pain > 4/10 on a visual analogue scale and localization of lesion at the site of the trauma. Three additional criteria (observed in up to 60% of patients with PG) encompass suppurative inflammation in histopathology, undermined wound borders and systemic disease associated. A total score value of 10 points or higher indicates a high likelihood of PG and differentiates PG from venous leg ulcers. The initial letters of the above-listed criteria form the acronym PARACELSUS.

CONCLUSIONS

The PARACELSUS score represents a novel, easily implementable, effective and sensitive diagnostic tool for PG.