Measuring the clinical learning environment in anaesthesia

The learning environment describes the way that trainees perceive the culture of their workplace. We audited the learning environment for trainees throughout Australia and New Zealand in the early stages of curriculum reform. A questionnaire was developed and sent electronically to a large random sample of Australian and New Zealand College of Anaesthetists trainees, with a 26% final response rate. This new instrument demonstrated good psychometric properties, with Cronbach's α ranging from 0.81 to 0.91 for each domain. The median score was equivalent to 78%, with the majority of trainees giving scores in the medium range. Introductory respondents scored their learning environment more highly than all other levels of respondents (P=0.001 for almost all comparisons). We present a simple questionnaire instrument that can be used to determine characteristics of the anaesthesia learning environment. The instrument can be used to help assess curricular change over time, alignment of the formal and informal curricula and strengths and weaknesses of individual departments.

Search for the lepton-flavor-violating decays B(s)0→e(±)μ(∓) and B0→e(±)μ(∓)

A search for the lepton-flavor-violating decays B(s)0→e(±)μ(∓) and B0→e(±)μ(∓) is performed with a data sample, corresponding to an integrated luminosity of 1.0 fb(-1) of pp collisions at √s=7 TeV, collected by the LHCb experiment. The observed number of B(s)0→e(±)μ(∓) and B0→e(±)μ(∓) candidates is consistent with background expectations. Upper limits on the branching fractions of both decays are determined to be B(B(s)0→e(±)μ(∓))<1.1(1.4)×10(-8) and B(B0→e(±)μ(∓))<2.8(3.7)×10(-9) at 90% (95%) confidence level (C.L.). These limits are a factor of 20 lower than those set by previous experiments. Lower bounds on the Pati-Salam leptoquark masses are also calculated, M(LQ)(B(s)0→e(±)μ(∓))>101 TeV/c(2) and M(LQ)(B0→e(±)μ(∓))>126 TeV/c(2) at 95% C.L., and are a factor of 2 higher than the previous bounds.

Measurement of CP violation in the phase space of B±→K± π+ π- and B±→K± K+ K- decays

The charmless decays B±→K± π+ π- and B±→K± K+ K- are reconstructed using data, corresponding to an integrated luminosity of 1.0  fb(-1), collected by LHCb in 2011. The inclusive charge asymmetries of these modes are measured as ACP(B±→K± π+ π-)=0.032±0.008 (stat)±0.004 (syst)±0.007(J/ψK±) and ACP(B±→K± K+ K-)=-0.043±0.009 (stat)±0.003 (syst)±0.007(J/ψK±), where the third uncertainty is due to the CP asymmetry of the B±→J/ψK± reference mode. The significance of ACP(B±→K± K+ K-) exceeds three standard deviations and is the first evidence of an inclusive CP asymmetry in charmless three-body B decays. In addition to the inclusive CP asymmetries, larger asymmetries are observed in localized regions of phase space.

Full-Length Hairpin RNA Accumulates at High Levels in Yeast but Not in Bacteria and Plants

Hairpin-structured (hp) RNA has been widely used to induce RNA interference (RNAi) in plants and animals, and an in vivo expression system for hpRNA is important for large-scale RNAi applications. Bacterial expression systems have so far been developed for in vivo expression of hpRNA or double-stranded (ds) RNA, but the structure of the resulting RNAi molecules has remained unclear. Here we report that long hpRNAs expressed in the bacteria Escherichia coli and Sinorhizobium meliloti were largely processed into shorter dsRNA fragments with no or few full-length molecules being present. A loss-of-function mutation in the dsRNA-processing enzyme RNase III, in the widely used E. coli HT115 strain, did not prevent the processing of hpRNA. Consistent with previous observations in plants, the loop sequence of long hpRNA expressed in Agrobacterium-infiltrated Nicotiana benthamiana leaves was excised, leaving no detectable levels of full-length hpRNA molecule. In contrast to bacteria and plants, long hpRNAs expressed in the budding yeast Saccharomyces cerevisiae accumulated as intact, full-length molecules. RNA extracted from hpRNA-expressing yeast cells was shown to be capable of inducing RNAi against a β-glucuronidase (GUS) reporter gene in tobacco leaves when applied topically on leaf surfaces. Our results indicate that yeast can potentially be used to express full-length hpRNA molecules for RNAi and perhaps other structured RNAs that are important in biological applications.

Evidence for CP violation in B+ → ppK+ decays

Three-body B+ → ppK+ and B(+) → ppπ(+) decays are studied using a data sample corresponding to an integrated luminosity of 3.0 fb(-1) collected by the LHCb experiment in proton-proton collisions at center-of-mass energies of 7 and 8 TeV. Evidence of CP violation in the B(+) → ppK(+) decay is found in regions of the phase space, representing the first measurement of this kind for a final state containing baryons. Measurements of the forward-backward asymmetry of the light meson in the pp rest frame yield A(FB)(ppK(+),m(pp)<2.85 GeV/c(2)) = 0.495 ± 0.012 (stat) ± 0.007 (syst) and A(FB)(ppπ(+),m(pp) <2.85 GeV/c(2)) = -0.409 ± 0.033 (stat) ± 0.006 (syst). In addition, the branching fraction of the decay B(+) → Λ(1520)p is measured to be B(B(+) → Λ(1520)p) = (3.15 ± 0.48 (stat) ± 0.07 (syst) ± 0.26 (BF)) × 10(-7), where BF denotes the uncertainty on secondary branching fractions.

Biochemical assessment of pancreatic disease in human immunodeficiency virus infected men

AIM

To determine the usefulness of measuring amylase activity as an indicator of pancreatic disease in human immunodeficiency virus (HIV) positive patients.

METHODS

A prospective study of 129 ambulant HIV positive males. Total amylase, pancreatic amylase, and lipase activities were assayed using commercial test kits on an automated analyser. Samples with raised amylase were examined for the presence of macroamylasaemia using cellulose acetate electrophoresis.

RESULTS

Thirty six (28%) of the subjects had raised total amylase activities compared with healthy, age matched blood donors. However, almost half of these were because of an increase of the salivary fraction. Four subjects were found to have macroamylasaemia. Pancreatic amylase and lipase assays, more specific indicators of pancreatic disease, produced significantly fewer abnormal results. There was no association between abdominal symptoms and elevated enzyme levels.

CONCLUSIONS

Total amylase is a poor indicator of pancreatic disease in HIV infected outpatients. Specific assays for pancreatic amylase offer advantages over the traditional total amylase assay. The lipase assay produced the least number of abnormal results and its use could improve the biochemical identification of patients with possible pancreatic disease and allow a more selective investigation of these cases.

Precision measurement of the Λb(0) baryon lifetime

The ratio of the Λb(0) baryon lifetime to that of the B(0) meson is measured using 1.0  fb(-1) of integrated luminosity in 7 TeV center-of-mass energy pp collisions at the LHC. The Λb(0) baryon is observed for the first time in the decay mode Λb(0)→J/ψpK-, while the B(0) meson decay used is the well known B(0)→J/ψπ+ K- mode, where the π+ K- mass is consistent with that of the K(*0)(892) meson. The ratio of lifetimes is measured to be 0.976±0.012±0.006, in agreement with theoretical expectations based on the heavy quark expansion. Using previous determinations of the B(0) meson lifetime, the Λb(0) lifetime is found to be 1.482±0.018±0.012  ps. In both cases, the first uncertainty is statistical and the second systematic.

Measurement of D0-D0 mixing parameters and search for CP violation using D0 → K+ π- decays

Measurements of charm mixing parameters from the decay-time-dependent ratio of D0 → K+ π- to D0 → K- π+ rates and the charge-conjugate ratio are reported. The analysis uses data, corresponding to 3  fb(-1) of integrated luminosity, from proton-proton collisions at 7 and 8 TeV center-of-mass energies recorded by the LHCb experiment. In the limit of charge-parity (CP ) symmetry, the mixing parameters are determined to be x'2=(5.5±4.9)×10(-5), y'=(4.8±1.0)×10(-3), and RD=(3.568±0.066)×10(-3). Allowing for CP violation, the measurement is performed separately for D0 and D0 mesons yielding AD=(-0.7±1.9)%, for the direct CP-violating asymmetry, and 0.75<|q/p|<1.24 at the 68.3% confidence level, for the parameter describing CP violation in mixing. This is the most precise determination of these parameters from a single experiment and shows no evidence for CP violation.

Measurement of CP violation in the phase space of B± → K+ K- π± and B± → π+ π- π± decays

The charmless decays B± → K+ K- π± and B± → π+ π- π± are reconstructed in a data set of pp collisions with an integrated luminosity of 1.0  fb(-1) and center-of-mass energy of 7 TeV, collected by LHCb in 2011. The inclusive charge asymmetries of these modes are measured to be A(CP)(B± → K+ K- π±) = -0.141±0.040  (stat)±0.018 (syst)±0.007(J/ψ K±) and A(CP)(B± → π+ π- π±) = 0.117±0.021 (stat)±0.009 (syst)±0.007(J/ψ K±), where the third uncertainty is due to the CP asymmetry of the B± → J/ψK± reference mode. In addition to the inclusive CP asymmetries, larger asymmetries are observed in localized regions of phase space.

Search for Majorana neutrinos in B- → π+ μ- μ- decays

A search for heavy Majorana neutrinos produced in the B- → π+ μ- μ- decay mode is performed using 3  fb(-1) of integrated luminosity collected with the LHCb detector in pp collisions at center-of-mass energies of 7 and 8 TeV at the LHC. Neutrinos with masses in the range 250 to 5000 MeV and lifetimes from zero to 1000 ps are probed. In the absence of a signal, upper limits are set on the branching fraction B(B- → π+ μ- μ-) as functions of neutrino mass and lifetime. These limits are on the order of 10(-9) for short neutrino lifetimes of 1 ps or less. Limits are also set on the coupling between the muon and a possible fourth-generation neutrino.

First evidence of direct CP violation in charmless two-body decays of Bs0 mesons

Using a data sample corresponding to an integrated luminosity of 0.35  fb-1 collected by LHCb in 2011, we report the first evidence of CP violation in the decays of Bs0} mesons to K±π∓ pairs, ACP(Bs0→Kπ)=0.27±0.08(stat)±0.02(syst), with a significance of 3.3σ. Furthermore, we report the most precise measurement of CP violation in the decays of B0 mesons to K±π∓ pairs, ACP(B0→Kπ)=-0.088±0.011(stat)±0.008(syst), with a significance exceeding 6σ.

Differential branching fraction and angular analysis of the decay B0 → K*0 μ+ μ-

The angular distributions and the partial branching fraction of the decay B0 → K*0 μ+ μ- are studied by using an integrated luminosity of 0.37  fb(-1) of data collected with the LHCb detector. The forward-backward asymmetry of the muons, A(FB), the fraction of longitudinal polarization, F(L), and the partial branching fraction dB/dq2 are determined as a function of the dimuon invariant mass. The measurements are in good agreement with the standard model predictions and are the most precise to date. In the dimuon invariant mass squared range 1.00-6.00  GeV2/c4, the results are A(FB)=-0.06(-0.14)(+0.13)±0.04, F(L)=0.55±0.10±0.03, and dB/dq2=(0.42±0.06±0.03)×10(-7)  c4/GeV2. In each case, the first error is statistical and the second systematic.

Precision measurement of the mass and lifetime of the Ξ(b)(0) baryon

Using a proton-proton collision data sample corresponding to an integrated luminosity of 3 fb(-1) collected by LHCb at center-of-mass energies of 7 and 8 TeV, about 3800 Ξ(b)(0) → Ξ(c)(+)π(-), Ξ(c)(+)) → pK(-)π(+) signal decays are reconstructed. From this sample, the first measurement of the Ξ(b)(0) baryon lifetime is made, relative to that of the Λ(b)(0) baryon. The mass differences M(Ξ(b)(0))-M(Λ(b)(0)) and M(Ξ(c)(+))-M(Λ(c)(+)) are also measured with precision more than 4 times better than the current world averages. The resulting values are τ(Ξ(b)(0))/τ(Λ)(b)(0)) = 1.006 ± 0.018 ± 0.010,M(Ξ(b)(0))-M(Λ(b)(0)) = 172.44 ± 0.39 ± 0.17 MeV/c(2),M(Ξ(c)(+))-M(Λ(c)(+)) = 181.51 ± 0.14 ± 0.10 MeV/c(2),where the first uncertainty is statistical and the second is systematic. The relative rate of Ξ(b)(0) to Λ(b)(0) baryon production is measured to be f(Ξ)(b)(0))/f(Λ)(b)(0))B(Ξ(b)(0) → Ξ(c)(+)π(-))/B(Λ(b)(0) → Λ(c)(+)π(-))B(Ξ(c)(+) → pK(-)π(+))/B(Λ(c)(+) → pK(-)}π(+)) = (1.88 ± 0.04 ± 0.03) × 10(-2),where the first factor is the ratio of fragmentation fractions, b → Ξ(b)(0) relative to b → Λ(b)(0). Relative production rates as functions of transverse momentum and pseudorapidity are also presented.

Root-Specific Expression of a Jacalin Lectin Family Protein Gene Requires a Transposable Element Sequence in the Promoter

Transposable elements (TEs) are widespread in the plant genome and can impact on the expression of neighbouring genes. Our previous studies have identified a number of DNA demethylase-regulated defence-related genes that contain TE sequences in the promoter and show tissue-specific expression in Arabidopsis. In this study we investigated the role of the promoter TE insertions in the root-specific expression of a DNA demethylase-regulated gene, AT5G38550, encoding a Jacalin lectin family protein. Using a promoter:GUS fusion reporter gene approach, we first demonstrated that the full-length promoter fragment, carrying four TE sequences, contained the essential regulatory information required for root-specific expression and DNA demethylase regulation in Arabidopsis. By successive deletion of the four TE sequences, we showed that one of the four TE insertions, a 201-bp TE fragment of the hAT DNA transposon family, was required for root-specific expression: Deletion of this TE, but not the first two TE sequences, converted the root-specific expression pattern to a constitutive expression pattern in Arabidopsis plants. Our study provides an example indicating an important role of TE insertions in tissue-specific expression of plant defence-related genes.

MRI of the brain in HIV-positive patients: what is the value of routine intravenous contrast medium?

Our purpose was to assess the value of routine administration of intravenous gadolinium-DTPA (Gd-DTPA) for cranial MR in a series of human immunodeficiency virus (HIV)-positive patients. Two radiologists retrospectively reviewed 150 consecutive examinations of 104 patients. All patients underwent unenhanced and contrast-enhanced images. Each radiologist independently assessed first the unenhanced images alone and then the pre- and postinjection images together. Then both reviewed the complete study and produced a consensus report. The history, investigations and management were collated separately and were unknown to the radiologists. Contrast-enhanced T1-weighted images showed new focal abnormalities, not seen on the T2-weighted or unenhanced images in 15 (14 %) patients, but almost always in the context of abnormal unenhanced images. In only 2 patients (2 %) did contrast medium reveal abnormalities when the unenhanced study had been considered normal. In only 1 of these (1 %) was the new finding, cytomegalovirus diffuse ependymal enhancement, of clinical importance, although the diagnosis of encephalitis was made on routine examination of cerebrospinal-fluid. The other revealed a toxoplasma lesion in a patient known to have resolving disease. Meningeal disease not suspected on the unenhanced images was shown in 2 patients (2 %). In these case the unenhanced images were abnormal in other respects. Intravenous Gd-DTPA was helpful to the radiologist in making a radiological diagnosis in 11 patients (11 %), usually by improving characterisation of a lesion seen on the unenhanced images. The contribution of intravenous Gd-DTPA in this series does not warrant recommending its use in every case.

A case of angioimmunoblastic lymphadenopathy associated with a long spontaneous remission, retrobulbar neuritis, a clonal rearrangement of the T-cell receptor gamma chain gene and an unusual marrow infiltration

A man with angioimmunoblastic lymphadenopathy entered a spontaneous remission that lasted 18 yr, ending in retrobulbar neuritis followed by a generalized relapse. After another remission was induced by prednisolone he developed marrow infiltration with a lymphoid cell of novel surface-marker phenotype. His lymph node cells demonstrated a clonal rearrangement of the T-cell receptor gamma chain (TcR gamma) genes whereas the TcR beta genes were heterogeneously rearranged. The marrow cells did not contain the rearranged TcR gamma gene. He died of pulmonary emboli 21 yr after his original presentation. We propose a model whereby the original event was the development of a lymphoid stem cell clone with no TcR gene rearrangement. Subsequently, a sub-clone bearing the TcR gamma gene rearrangement proliferated in the lymph nodes and further heterogeneous rearrangement of the TcR beta genes occurred within this subclone. Proliferation in the marrow of the original clone finally supervened.

Measurement of Bc+ Production in Proton-Proton Collisions at √[s]=8 TeV

Production of Bc+ mesons in proton-proton collisions at a center-of-mass energy of 8 TeV is studied with data corresponding to an integrated luminosity of 2.0  fb-1 recorded by the LHCb experiment. The ratio of production cross sections times branching fractions between the Bc+→J/ψπ+ and B+→J/ψK+ decays is measured as a function of transverse momentum and rapidity in the regions 0<pT<20  GeV/c and 2.0<y<4.5. The ratio in this kinematic range is measured to be (0.683±0.018±0.009)%, where the first uncertainty is statistical and the second systematic.

Observation of a resonance in B+ → K+ μ+ μ- decays at low recoil

A broad peaking structure is observed in the dimuon spectrum of B+ → K+ μ+ μ- decays in the kinematic region where the kaon has a low recoil against the dimuon system. The structure is consistent with interference between the B+ → K+ μ+ μ- decay and a resonance and has a statistical significance exceeding six standard deviations. The mean and width of the resonance are measured to be 4191(-8)(+9)  MeV/c2 and 65(-16)(+22)  MeV/c2, respectively, where the uncertainties include statistical and systematic contributions. These measurements are compatible with the properties of the ψ(4160) meson. First observations of both the decay B+ → ψ(4160)K+ and the subsequent decay ψ(4160) → μ+ μ- are reported. The resonant decay and the interference contribution make up 20% of the yield for dimuon masses above 3770  MeV/c2. This contribution is larger than theoretical estimates.

Precision measurement of the mass and lifetime of the Ξb⁻ baryon

We report on measurements of the mass and lifetime of the Ξ(b)⁻ baryon using about 1800 Ξ(b)⁻ decays reconstructed in a proton-proton collision data set corresponding to an integrated luminosity of 3.0  fb⁻¹ collected by the LHCb experiment. The decays are reconstructed in the Ξ(b)⁻→Ξ(c)⁰π⁻, Ξ(c)⁰→pK⁻K⁻π⁺ channel and the mass and lifetime are measured using the Λ(b)⁰→Λ(c)⁺π⁻ mode as a reference. We measure M(Ξ(b)⁻)-M(Λ(b)⁰)=178.36±0.46±0.16  MeV/c², (τ(Ξ(b)⁻)/τ(Λ(b)⁰)=1.089±0.026±0.011, where the uncertainties are statistical and systematic, respectively. These results lead to a factor of 2 better precision on the Ξ(b)⁻ mass and lifetime compared to previous best measurements, and are consistent with theoretical expectations.

First measurement of the CP-violating phase in Bs(0) → ϕϕ decays

A first flavor-tagged measurement of the time-dependent CP-violating asymmetry in B(s)(0) → ϕϕ decays is presented. In this decay channel, the CP-violating weak phase arises due to CP violation in the interference between B(s)(0)-B(s)(0) mixing and the b → sss gluonic penguin decay amplitude. Using a sample of pp collision data corresponding to an integrated luminosity of 1.0 fb(-1) and collected at a center-of-mass energy of 7 TeV with the LHCb detector, 880 B(s)(0) → ϕϕ signal decays are obtained. The CP-violating phase is measured to be in the interval [-2.46,-0.76] rad at a 68% confidence level. The p value of the standard model prediction is 16%.

Lateral epicondylitis in a hospital phlebotomist--an ergonomic solution

This report outlines a case of lateral epicondylitis in a hospital phlebotomist thought to be due to the forceful gripping, and repetitive twisting, involved in breaking the seals on green vacutainer needles. An ergonomic solution in the form of a device to aid breaking of the vacutainer seals is presented. The importance of seeking ergonomic solutions with manufacturers is highlighted.

An audit of inadequate cervical cytology in a genitourinary medicine clinic

The taking of inadequate cervical cytological smears leads to patient anxiety, an increased burden on medical and laboratory staff and potentially misses cervical abnormalities. It has been suggested that screening programmes should collect information about the proportion of smears considered unfit for diagnostic purposes. We present an audit of the rate of inadequate smears in our unit and the factors contributing to their taking. The largest single factor in the taking of inadequate smears was the individual performing the test. Measures have been introduced to retrain these staff whilst an ongoing programme of training and evaluation has been implemented for all staff.