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.

Genetic and nongenetic factors associated with lactation length in seasonal-calving, pasture-based dairy cows

Lactation yield estimates standardized to common lactation lengths of 270-d or 305-d equivalents are commonly used in management decision support tools and dairy cow genetic evaluations. The use of such measurements to quantify the (genetic) merit of individual cows fails to penalize cows that do not reach the standardized lactation length, or indeed reward cows that lactate for more than the standardized lactation length. The objective of the present study was to quantify the genetic and nongenetic factors associated with lactation length in seasonal-calving, pasture-based dairy cows. A total of 616,350 lactation length records from 285,598 Irish cows were used. Linear mixed models were used to quantify the associations between lactation length and calving month, parity, age at calving, previous dry period length, calving difficulty score, heterosis, recombination loss, breed, and herd size, as well as to estimate the genetic and residual variance components of lactation length. The median lactation length in the edited data set was 288 d, with 27% of cows achieving lactations of at least 305 d. Relative to cows calving in January, the lactations of cow calving in February, March, or April was, on average, 4.2, 12.7, and 21.9 d shorter, respectively. The lactation length of a first parity cow was, on average, 7.8, 8.6, and 8.4 d shorter than that of second, third, and fourth parity cows, respectively. Norwegian Red and Montbéliarde cows had, on average, a 4.7- and 1.6-d shorter lactation than Holstein-Friesian cows, respectively. The heritability estimate, coefficient of genetic variation, and repeatability estimate of lactation length were 0.02, 1.2%, and 0.04, respectively. Based on the genetic standard deviation for lactation length estimated in the present study (3.3 d), cows ranked in the top 20% for genetic merit for lactation length would be expected to have lactations 9.2 d longer than cows in the bottom 20%, demonstrating exploitable genetic variability. Given the vast array of genetic and nongenetic factors associated with lactation length, an approach which combines improved management practices and selective breeding may be an efficient and effective strategy to lengthen lactations.

Thrombus formation on bioprosthetic aortic valves

Background

18F-GP1 is a novel radiotracer with a high affinity for the platelet glycoprotein IIb/IIIa receptor. Subclinical bioprosthetic valve thrombus has been postulated as a trigger for accelerated valve degeneration.

Purpose

To determine the feasibility of 18F-GP1 positron-emission tomography-computed tomography (PET-CT) for the detection of subclinical bioprosthetic aortic valve thrombus.

Methods

(i) Explanted degenerated aortic valve prostheses underwent histology and imaging. (ii) In a prospective observational study, patients with bioprosthetic aortic valve replacement (AVR) underwent echocardiography and 18F-GP1 PET-CT. Valves were assessed for hypoattenuating leaflet thickening (HALT), hypo-attenuation affection leaflet motion (HAM) and GP1 uptake.

Results

(i) GP1 correlated with thrombus on explanted valves (Figure). (ii) The first 6 patients (Table) were asymptomatic and had normally functioning surgical bioprostheses on echocardiography. At a median of 166 (range 122–189) days post-AVR, no patients had HALT or HAM on CT. There was avid focal GP1 uptake on the leaflets of all 6 patients which appeared most prominent along the leaflet edges (Figure). Only one patient had focal uptake in the valve frame, remote from the leaflets. In a separate cohort undergoing 18F-GP1 PET-CT for other conditions, there was no uptake on normal, native aortic valves (n=8).

Conclusion

For the first time, we demonstrate that 18F-GP1 PET-CT is a highly sensitive method of assessing platelet activation on bioprosthetic aortic valves. Despite the absence of CT evidence, early thrombus appeared to be a universal finding on recently implanted valve prostheses. The biological and clinical implications of subclinical bioprosthetic aortic valve thrombus have yet to be established.

GP1 uptake in AVR

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): British Heart Foundation

Reduced orbitofrontal grey matter volume in myocardial infarction with non-obstructive coronary arteries (MINOCA)

Background

Myocardial infarction with non-obstructive coronary arteries (MINOCA) is seen in 6–10% of patients presenting acutely with suspected myocardial infarction. Cardiac magnetic resonance imaging (CMR) can identify an underlying cause in ∼80% of patients. These patients are more likely to have a history of mental health illness or an emotional or stressful precipitant.

Grey matter volume can be quantified in various anatomical regions of the brain and has been shown to be altered in common mental health conditions such as anxiety, stress and depression.

This is the first prospective study investigating the acute structural brain, cardiac and psychological changes using MRI in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) within 14 days of presentation compared to STEMI control patients.

Methods

Patients meeting the 2017 ESC definition of MINOCA were prospectively recruited with STEMI control patients from February to December 2019. All participants underwent brain and comprehensive cardiac MRI, bloods and baseline psychological evaluation. We used voxel-based morphometry (VBM) to quantify grey matter volume and changes were compared between groups.

Results

54 patients were included in this interim analysis (39 MINOCA, 15 STEMI controls). Demographics were largely similar but MINOCA patients were more likely to have a history of self-reported mental health disease (36% v 7%, p 0.03) and had significantly higher baseline anxiety (8.4 v 5.3, p 0.01) scores on the HADS questionnaire. We found that control patients have significantly greater grey matter volume in the orbitofrontal cortex (OFC) compared to MINOCA patients (pFWE-corr 0.002). The orbitofrontal cortex is involved in emotional processing and implicated in anxiety and depression. However, there was no association between grey matter volume in any brain region and anxiety, depression or perceived stress scale scores.

Conclusion

Patients with MINOCA are more likely to have a history of mental health disease and have higher anxiety scores at presentation than STEMI controls. They have less grey matter volume in the orbitofrontal cortex compared to STEMI controls.

Reduced Grey Matter Volume in the OFC

Funding Acknowledgement

Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Rosetrees Trust; James Tudor Foundation

Threats to public interest journalism: A call to action to public health

Public interest journalism is an important determinant of health, due to its roles in accountability and holding power to account, empowering communities, and contributing to health literacy. The capacity of public interest journalism to contribute to planetary health and health equity, as well as healthier people, societies, and systems of governance is under attack. Reasons include the collapse of the underpinning business model, the market power of digital platforms, neoliberalism, the rise of authoritarianism, and attacks on press freedom and safety. This paper presents an ecological analysis of the upstream determinants of a healthy and sustainable public interest journalism sector, which is informed by Aboriginal ways of knowing, being and doing, and a decolonising methodology. It also presents a case study of innovation in health-related public interest journalism in Australia, and includes clear calls to action for public health practitioners, researchers and advocates, as well as wider policy making.

Key messages

Public interest journalism is an important determinant of health. Threats to public interest journalism are a threat to public health. Collaborations strengthen public interest journalism: this presentation provides an example.

#CoveringClimateNow: A social journalism project profiling climate and health

Concerns about poor quality media reporting of climate change has led to many initiatives seeking to influence coverage. In 2019/2020, a global media collaboration was established with the aim of generating a sustained media focus on key climate-related events. This paper reports an analysis of an Australian health media organisation's contribution to the collaboration, and the opportunities this provided for public health advocates, Aboriginal and Torres Strait Islander researchers and communities, and the wider community. It presents key reflections from Croakey Health Media's contribution to the global #CoveringClimateNow collaboration, with the aim of providing practical advice to enable further such collaborations and activities in other countries. This project was run on a very small budget, and this presentation is likely to be particularly relevant for low-budget organisations and contexts.

Key messages

Poor quality media coverage of climate change has stimulated innovation. Collaboration locally and globally can convey solutions to climate change.

What are the perceptions of Indigenous organisation staff on the utility of the nKPIs?

Background

This presentation will outline the results of five Aboriginal Community Controlled Health Organisation (ACCHO) case studies which sought to understand the impact of national key performance indicators (nKPIs) at the local level. The nKPI framework attempts to collect data to assist the Commonwealth Government to monitor the Closing the Gap Framework and to aid local ACCHOs to monitor and review their service delivery. Understanding how the nKPIs have been implemented and their impact across the various sites is essential to understanding their usefulness.

Methods

A multi-case study approach with a variety of ACCHOs was used. Site recruitment was conducted using a purposive sampling framework with an expression of interest, and/or a direct approach. At each site, several semi-structured interviews were conducted, documents were reviewed, and observations made. Data analysis was conducted using the computer program NVivo.

Results

Case studies (n = 5) were conducted at the five sites between in 2017. Data collection included semi-structured interviews ACCHO staff (n = 24), nKPI site-specific documents (n = 12) and observational. A number of key themes emerged from case studies relating to: • Workforce The usefulness of the nKPIsSelf-determinationWay ForwardACCHO Governance

Conclusions

Across the case studies, it is clear there are a variety perception about the utility of the nKPIs and the barriers/enablers which impact their capacity to report, collect and utilise the nKPIs. All Case Study sites saw the value of data to measure their success and to identify emerging issues among their clients. Their attitudes to the nKPIs varied though, due to issues relating to the design and implementation. The stability and size of the service also influenced their ability to use the data. More work needs to be done by the Commonwealth Government in collaboration with ACCHOs to improve the usability and utility of the nKPIs.

Key messages

Indigenous people need to be involved in the design and implmnetation of monitoring sytems. The nKPIs only report on a small subset of services delivered by Aboriginal Community Controlled Health Organisations.

Individuals with high bone mass have increased progression of radiographic and clinical features of knee osteoarthritis

OBJECTIVE

High bone mass (HBM) is associated with an increased prevalence of radiographic knee OA (kOA), characterized by osteophytosis. We aimed to determine if progression of radiographic kOA, and its sub-phenotypes, is increased in HBM and whether observed changes are clinically relevant.

DESIGN

A cohort with and without HBM (L1 and/or total hip bone mineral density Z-score≥+3.2) had knee radiographs collected at baseline and 8-year follow-up. Sub-phenotypes were graded using the OARSI atlas. Medial/lateral tibial/femoral osteophyte and medial/lateral joint space narrowing (JSN) grades were summed and Δosteophytes, ΔJSN derived. Pain, function and stiffness were quantified using the WOMAC questionnaire. Associations between HBM status and sub-phenotype progression were determined using multivariable linear/poisson regression, adjusting for age, sex, height, baseline sub-phenotype grade, menopause, education and total body fat mass (TBFM). Generalized estimating equations accounted for individual-level clustering.

RESULTS

169 individuals had repeated radiographs, providing 330 knee images; 63% had HBM, 73% were female, mean (SD) age was 58 (12) years. Whilst HBM was not clearly associated with overall Kellgren-Lawrence measured progression (RR = 1.55 [0.56.4.32]), HBM was positively associated with both Δosteophytes and ΔJSN individually (adjusted mean differences between individuals with and without HBM 0.45 [0.01.0.89] and 0.15 [0.01.0.29], respectively). HBM individuals had higher WOMAC knee pain scores (β = 7.42 [1.17.13.66]), largely explained by adjustment for osteophyte score (58% attenuated) rather than JSN (30% attenuated) or TBFM (16% attenuated). The same pattern was observed for symptomatic stiffness and functional limitation.

CONCLUSIONS

HBM is associated with osteophyte progression, which appears to contribute to increased reported pain, stiffness and functional loss.

What are the perceptions of stakeholders on the utility of the nKPIs for Indigenous services?

Background

The Australian Commonwealth Government has introduced national key Performance Indicators, (nKPIs), for Indigenous primary health care services, including Aboriginal Community Controlled Health Organisations (ACCHOs). The nKPIs aim to assist in the monitoring of Indigenous people's health and aid ACCHOs to monitor their service delivery. The nKPI development and its ongoing implementation have involved stakeholders including the Council of Australian Governments; national and jurisdictional ACCHO peak bodies; government departments; software developers, and researchers. While high-level information is available about the nKPIs, there is very little publicly available information about how they were developed and implemented. This presentation discusses perspectives from stakeholders on the development and implementation of the nKPIs.

Methods

Stakeholder interviews (n = 15) aimed to understand the utility and appropriateness of the nKPIs and barriers/enablers to implementation. Stakeholders with knowledge of the development, management or reporting of the nKPIs were recruited. The analysis was conducted inductively and deductively and organised using NVivo.

Results

The interviews focused on the history of the nKPIs and the context within which these are collected and managed. Several key themes and sub-themes arose from the stakeholder interviews. These themes included the nKPI purpose, development, implementation, and appropriateness. Several interviewees considered the nKPI development process to be flawed, leading to poor data quality and an increased burden on ACCHOs.

Conclusions

The ACCHO sectors' needs and perspectives were mostly ignored in the development process. Numerous research papers and government documents highlight the need for active engagement of Indigenous people to be actively engaged in the design of policies, programs, and frameworks seeking to improve the health of Indigenous people.

Key messages

The nKPI implmentation issues could have been avoided had they been developed in partnership with Indigenous organisations. Indigenous policy development needs to be developed in partnership with Indigenous people.

#CroakeyGO: Walking as an act of journalism to engage not distance the public in health reporting

Health as it is reported in mainstream media is narrow and communities are often excluded, despite being where the experience of health occurs. A wide range of research indicates that it is through narratives of community members that media and health messages are best conveyed, and community members now have a range of platforms for quickly conveying information to each other and the media. However, there have been surprisingly few innovations for journalists to use this material, or to better connect with the public and report more accurately about health.

Our experience across several journalism projects demonstrates how quickly and deeply health content can be developed in collaboration with communities. One example is #CroakeyGO - an innovation in public interest journalism that gathers, walks and talks with community members together at a defined time and location about health-related matters.

#CroakeyGO brings together diverse voices from local communities - people who might otherwise not connect. This stimulates discussion about health issues beyond the individual, including system- and environmental-level issues that impact local lives. #CroakeyGO also means respecting Indigenous peoples' connection to Country on which we walk and reflecting on intergenerational inequities and solutions Indigenous knowledges offer.

To date we have published more than 40 articles from #CroakeyGO events around metropolitan and regional Australia. We have collaboratively produced social media and other editorial content with community members and stimulated enduring networks for health planning, advocacy and research. #CroakeyGO reinforces that improving health in a community requires more than just additional services, and that transformations in journalism can facilitate and support rather than hinder collective action.

Key messages

Innovations in journalism are required and possible to improve health reporting. Communities are willing to engage in health reporting.

Collateral damage: the impact on outcomes from cancer surgery of the COVID-19 pandemic

BACKGROUND

Cancer diagnostics and surgery have been disrupted by the response of health care services to the coronavirus disease 2019 (COVID-19) pandemic. Progression of cancers during delay will impact on patients' long-term survival.

PATIENTS AND METHODS

We generated per-day hazard ratios of cancer progression from observational studies and applied these to age-specific, stage-specific cancer survival for England 2013-2017. We modelled per-patient delay of 3 and 6 months and periods of disruption of 1 and 2 years. Using health care resource costing, we contextualise attributable lives saved and life-years gained (LYGs) from cancer surgery to equivalent volumes of COVID-19 hospitalisations.

RESULTS

Per year, 94 912 resections for major cancers result in 80 406 long-term survivors and 1 717 051 LYGs. Per-patient delay of 3/6 months would cause attributable death of 4755/10 760 of these individuals with loss of 92 214/208 275 life-years, respectively. For cancer surgery, average LYGs per patient are 18.1 under standard conditions and 17.1/15.9 with a delay of 3/6 months (an average loss of 0.97/2.19 LYGs per patient), respectively. Taking into account health care resource units (HCRUs), surgery results on average per patient in 2.25 resource-adjusted life-years gained (RALYGs) under standard conditions and 2.12/1.97 RALYGs following delay of 3/6 months. For 94 912 hospital COVID-19 admissions, there are 482 022 LYGs requiring 1 052 949 HCRUs. Hospitalisation of community-acquired COVID-19 patients yields on average per patient 5.08 LYG and 0.46 RALYGs.

CONCLUSIONS

Modest delays in surgery for cancer incur significant impact on survival. Delay of 3/6 months in surgery for incident cancers would mitigate 19%/43% of LYGs, respectively, by hospitalisation of an equivalent volume of admissions for community-acquired COVID-19. This rises to 26%/59%, respectively, when considering RALYGs. To avoid a downstream public health crisis of avoidable cancer deaths, cancer diagnostic and surgical pathways must be maintained at normal throughput, with rapid attention to any backlog already accrued.

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.