Assessing how routes to diagnosis vary by the age of patients with cancer: a nationwide register-based cohort study in Denmark

BACKGROUND

Older patients with cancer have poorer prognosis compared to younger patients. Moreover, prognosis is related to how cancer is identified, and where in the healthcare system patients present, i.e. routes to diagnosis (RtD). We investigated whether RtD varied by patients' age.

METHODS

This population-based national cohort study used Danish registry data. Patients were categorized into age groups and eight mutually exclusive RtD. We employed multinomial logistic regressions adjusted for sex, region, diagnosis year, cohabitation, education, income, immigration status and comorbidities. Screened and non-screened patients were analysed separately.

RESULTS

The study included 137,876 patients. Both younger and older patients with cancer were less likely to get diagnosed after a cancer patient pathways referral from primary care physician compared to middle-aged patients. Older patients were more likely to get diagnosed via unplanned admission, death certificate only, and outpatient admission compared to younger patients. The patterns were similar across comorbidity levels.

CONCLUSIONS

RtD varied by age groups, and middle-aged patients were the most likely to get diagnosed after cancer patient pathways with referral from primary care. Emphasis should be put on raising clinicians' awareness of cancer being the underlying cause of symptoms in both younger patients and in older patients.

OP0037 USE OF PRIMARY HEALTHCARE AND RADIOLOGICAL IMAGING PRECEDING A DIAGNOSIS OF RHEUMATOID ARTHRITIS: A DANISH NATIONWIDE COHORT STUDY

Background

Focus on early diagnosis and treatment initiation is key in rheumatoid arthritis (RA) to prevent permanent joint damage and systemic manifestations. Increased use of healthcare services before an RA diagnosis can be seen as a proxy for symptom presentation and the actions taken by healthcare professionals, and thus indicate an opportunity for earlier diagnosis. However, little is known about where and when people use healthcare services before an RA diagnosis.

Objectives

To explore the pattern in use of healthcare services during the 12 months preceding a diagnosis of RA in Denmark.

Methods

We conducted a population-based cohort study using data from Danish national registries. For every patient diagnosed with RA in 2014-2018 we matched ten reference persons from the Danish general population without RA, listed in the same general practice and with same age and sex. Healthcare use was defined as: daytime face to face contacts to general practice, contacts to private practicing physiotherapists.

We estimated the monthly healthcare use for patients with RA and reference persons in the 12 months preceding the diagnosis, and we compared their healthcare use by incidence rate ratios (IRR) for each month, adjusted for sociodemographic characteristics and comorbidity.

Results

7,427 patients with RA and 74,270 reference persons were included in the study. The median age was 62 years (interquartile interval (IQI): 51-71), and 65% were women. Patients with RA had an average of 0.5 contacts per month in general practice from 12 months until six months prior to the diagnosis (Figure 1); this number increased from six months before the diagnosis to an average of one contact in the last month before the diagnosis. Reference persons had an average of 0.4 contacts per months throughout the entire study period. Compared to their references, patients with RA had statistically significantly more contacts during all 12 months before the diagnosis date; IRR increased from 1.25 (95% CI: 1.19-1.30) to 2.63 (2.55-2.71) during the study period.

Patients with RA also had statstistically significantly more contacts to physiotherapists compared to their references throughout the entire study period, and increasing contact rates from eight months before the diagnosis. This was primarily driven by more contacts in women with RA compared to their references.

Conclusion

Patients with RA had more contacts to general practice and physiotherapists in all 12 months preceding the RA diagnosis compared to references and these contact rates increased further the last six to eight months in patients with RA. This indicates symptom presentation for several months before the RA is diagnosed, and it indicates that a window of opportunity exists to expedite referral to specialist care and the diagnosis of RA.

Disclosure of Interests

None declared.

Distribution of natural and anthropogenic radionuclides in sediments from the Vefsnfjord, Norway

Areas in central Norway were heavily contaminated with fallout from the Chernobyl accident in 1986. In this study, we assess ¹³⁷Cs in surface sediments and sediment cores collected in the Vefsnfjord in Nordland county. Concentrations of ¹³⁷Cs in surface sediments ranged from 159 to 191 Bq kg^-1 dry weight (d.w.). Sub-surface peaks of ¹³⁷Cs were observed in all cores, with a maximum concentration of 432 Bq kg^-1 d.w. Given that little is known about the distribution of naturally occurring radionuclides in Norwegian fjords and coastal areas, a better understanding of the total burden of radioactivity is important for the Norwegian fishing and aquaculture industries. Therefore, analyses of the natural radionuclides ⁴⁰K, ²²⁶Ra, ²²⁸Ra and ²¹⁰Pb were included in the study. Analyses of total sulphur (TS), total carbon (TC), total organic carbon (TOC) and grain size distribution have been performed to provide a sedimentologic context for interpreting the radionuclide results.

Geochronology of sediment cores from the Vefsnfjord, Norway

The sedimentary environment is a repository and carrier for a variety of pollutants, and sediment transport from land to coastal areas is an important environmental process. In the present study, we use ²¹⁰Pb/²²⁶Ra and ¹³⁷Cs in sediment cores to assess sediment supply rates at four sites within the Vefsnfjord in Nordland county, Norway. This area was highly affected by fallout from the Chernobyl accident in 1986 and inventories of ¹³⁷Cs in the fjord are much higher than in many other Norwegian fjords. Sedimentation rates between 0.042 and 0.25 g cm^-2 y^-1 (0.060 and 0.38 cm y^-1) were determined using a combination of the Constant Rate of Supply (CRS) and Constant Flux:Constant Sedimentation rate (CF:CS) models. Well-defined ¹³⁷Cs concentration peaks were used as a supplementary tool to the ²¹⁰Pb dating methods.

OP0159-HPR IMPACT OF NON-PHARMACOLOGICAL INTERVENTIONS TARGETING SLEEP DISTURBANCES OR DISORDERS IN PATIENTS WITH INFLAMMATORY ARTHRITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMISED TRIALS

Background:

Patients with inflammatory arthritis (IA) often present limitations in daily life due to unpredictability, severity and chronicity of the disease, reduced functional ability and health-related quality of life. Moreover, sleep disturbances or disorders have been reported in up to 40-90% of patients with IA [1-3]. Sleep disturbances are further associated with pain, fatigue, mental well-being and disease activity [4]. As chronic us of hypnotic drugs are associated with tolerance and side effects, there is growing interest in non-pharmacological management to improve sleep.

Objectives:

With a systematic review and meta-analysis, our primary objective was to evaluate the evidence of non-pharmacological interventions targeting sleep in patients with IA. Primary outcome was sleep domains, while secondary objectives were based on the core outcome domains for IA trials and harms.

Methods:

Following protocol closure, a systematic search was undertaken in MEDLINE, CENTRAL, PsycINFO, CINAHL, ClinicalTrials.gov, ACR and EULAR in September 2020. Eligible studies were randomised trials with adults with IA and concomitant sleep disturbances or disorders, comparing a non-pharmacological intervention targeting sleep disturbances or disorders to another non-pharmacological intervention, a pharmacological intervention or standard care. Screening of titles, abstracts, and subsequent full text assessment were conducted independently by two reviewers using the Covidence tool. Randomisation, blinding, and adequacy of analyses was assessed using the Cochrane’s RoB tool and the overall quality of evidence was rated using GRADE methodology. Disagreements were resolved at consensus meetings with last authors. Effect sizes for continuous outcomes were based on the standardised mean difference (SMD), combined using standard random-effects meta-analysis (all with 95% CIs).

Results:

Six trials (308 patients) were included in the quantitative synthesis. Two trials included patients with the sleep disorder insomnia and the remaining four trials included patients with sleep disturbances. Sleep domains were measured with Pittsburgh Sleep Quality Index (PSQI) or Insomnia Severity index (ISI). Three trials reported improvement on sleep following foot reflexology, auricular plaster therapy, and exercise. The overall meta-analysis presented in the figure of forest plot for self-reported sleep suggests that non-pharmacological interventions have a potentially large effect size of -0.80 (95% CI, -1.33 to -0.28) on sleep. However, the quality of the evidence was assessed as corresponding to low, given that the body of the evidence was rated down twice, due to serious study limitations and inconsistency.

Conclusion:

Although the effect of non-pharmacological interventions targeting sleep disturbances or the sleep disorder insomnia was statistically highly significant, the implication for clinical practice is questionable because of the overall quality evidence. None of the core outcomes used in contemporary IA trials have indicated clinical benefit in favour of non-pharmacological interventions targeting sleep disturbances or disorders.

In conclusion, more rigorous research on non-pharmacological management of sleep disturbances and disorders is urgently needed, also aimed at specific sleep disorders, in order to fully reveal the clinical utility of these novel treatment options. At this point, non-pharmacological treatment of sleep disturbances or disorders is promising and potentially highly effective, and may have the potential to persistently decrease the symptom burden and increase the quality of life of patients with IA.

References:

[1]Li et al., Psychol Health Med. 2019 Sep;24(8):911-924

[2]Haugeberg et al., Arthritis Res Ther. 2020 Aug 26;22(1):198

[3]Wali et al., J Clin Sleep Med. 2020 Feb 15;16(2):259-265

[4]Løppenthin et al., Clin Rheumatol. 2015 Dec;34(12):2029-39

Disclosure of Interests:

Kristine Marie Latocha: None declared, Katrine Løppenthin: None declared, Safa Al-Bazy: None declared, Tannie Albrechtsen: None declared, Helle Jensen: None declared, Mikkel Østergaard Speakers bureau: Abbvie, Celgene, Eli-Lilly, Janssen, Novartis, Pfizer, Roche, Sanofi and UCB, Consultant of: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi and UCB, Grant/research support from: Abbvie, BMS, Merck, Celgene, Novartis, Poul Jennum: None declared, Bente Appel Esbensen: None declared, Robin Christensen: None declared

Nursing teamwork in the care of older people: A mixed methods study

Healthcare is increasingly complex and requires the ability to adapt to changing demands. Teamwork is essential to delivering high quality care and is central to nursing. The aims of this study were to identify the processes that underpin nursing teamwork and how these affect the care of older people, identify the relationship between perceived teamwork and perceived quality of care, and explore in depth the experience of working in nursing teams. The study was carried out in three older people's wards in a London teaching hospital. Nurses and healthcare assistants completed questionnaires (n = 65) on known dynamics of teamwork (using the Nursing Teamwork Survey) together with ratings of organisational quality (using an adapted AHRQ HSPS scale). A sample (n = 22; 34%) was then interviewed about their perceptions of care, teamwork and how good outcomes are delivered in everyday work. Results showed that many care difficulties were routinely encountered, and confirmed the importance of teamwork (e.g. shared mental models of tasks and team roles and responsibilities, supported by leadership) in adapting to challenges. Perceived quality of teamwork was positively related to perceived quality of care. Work system variability and the external environment influenced teamwork, and confirmed the importance of team adaptive capacity. The CARE model shows the centrality of teamwork in adapting to variable demand and capacity to deliver care processes, and the influence of broader system factors on teamworking.

P2844Novel temperature guided irrigated ablation catheter: reproducibility of procedural efficiencies and acute success to isolate the pulmonary veins from two multicenter, feasibility studies

Background/Introduction

The novel catheter with 6 thermocouples for real-time temperature monitoring during irrigated radiofrequency ablation was designed to potentially enhance safety and effectiveness of the Smart Touch Surround Flow (STSF) catheter by incorporating real-time temperature sensing. A supplementary, novel algorithm was developed to modulate power to maintain target temperature during high power/short duration ablation (90W, 4s).

Purpose

This sub-analysis was performed to examine consistency and reproducibility of the procedural efficiencies and acute success of the novel catheter with optimized temperature control and microelectrodes in treating paroxysmal atrial fibrillation (PAF) across multiple sites from two initial feasibility studies, in standard (QMODE) and high power/short duration (QMODE+) temperature-control ablation modes.

Methods

The QDOT-MICRO (QMODE, NCT02944968; N=42) and QDOT-FAST (QMODE+, NCT03459196; N=52) studies were both prospective, non-randomized multi-center, clinical investigations completed across 6 and 7 centers, respectively, in Europe. Procedural efficiencies and acute success (PVI via entrance block) was examined across sites within the study.

Results

In the QDOT-MICRO study, median procedure time (105–155 min), RF ablation time (27.7–39.5 min), and fluoroscopy times (2.2–8 min) during QMODE ablation were similar across the 6 sites. In QMODE+ ablation, median procedure time, RF ablation time, and fluoroscopy times all fall within (84–134 min), (4.8–9.7 min) and (1.1–9.6 min), respectively, across the 7 sites. Fluid delivery by the study catheter was low in both studies: QDOT-MICRO 547±278mL (mean ± SD); QDOT-FAST 382±299. mL (mean ± SD); which is 39.1 and 57.4% lower, respectively, than reported in the SMART SF trial. Esophageal temperature probe was used in the majority of patients (30/42 for QDOT MICRO and 51/52 for QDOT-FAST). Acute PVI was successful in 100% of patients in both studies with no deaths or unanticipated AEs.

Conclusion(s)

In both feasibility studies, procedural efficiencies were reproducible across study sites in both QMODE and QMODE+, with 100% acute success and good safety outcomes. Efficiencies are likely to improve with further experience. These results need to be confirmed in larger trials.

Acknowledgement/Funding

Both Studies are Company Sponsored Studies funded by Biosense Webster, Inc.

Rural-Urban Variation in Time to Diagnosis and Treatment of Colorectal or Breast Cancer in Victoria, Australia

Background: Rural-urban disparities in cancer outcomes are found in many countries, though these vary by cancer type. In Victoria, Australia, survival is poorer for rural patients with colorectal cancer, but not breast cancer. Delayed diagnosis and treatment may contribute to disparities, but previous studies have not compared the timeliness of rural and urban pathways to treatment of these common cancers. Aim: We investigated whether time to diagnosis and treatment differed for rural and urban patients with colorectal or breast cancer in Victoria, Australia. Methods: Population-based, cross-sectional surveys examining events and dates on the pathway to treatment completed by patients aged ≥ 40 and approached within six months of diagnosis, their general practitioner (GP) and specialist. Data were collected from 2013 to 2014 as part of the International Cancer Benchmarking Partnership, Module 4. Six intervals were explored: patient (symptom to presentation), primary care (presentation to referral), diagnostic (presentation/screening to diagnosis), treatment (diagnosis to treatment), health system (presentation to treatment) and total intervals (symptom/screening to treatment). Rural-urban differences were examined for each cancer using quantile regression (50th, 75th and 90th percentiles) models including age, gender, health insurance and socioeconomic status. Results: 433 colorectal (48% rural) and 489 breast (42% rural) patients, 621 GPs and 370 specialists completed surveys. Compared with urban patients, symptomatic colorectal cancer patients from rural areas had a significantly longer total interval at all percentiles: 50th (18 days longer, 95% confidence interval (CI): 9-27), 75th (53, 95% CI: 47-59) 90th (44, 95% CI: 40-48). These patients also had longer health system intervals, ranging 7-85 days longer. This appeared mostly due to longer diagnostic intervals (range: 6-54 days longer). Results were similar when including screen-detected cases. In contrast, breast cancer intervals were similar for rural and urban patients, except the patient interval, which was shorter for rural patients. Conclusion: Consistent with variation in survival, we found longer total and diagnostic intervals for rural compared with urban patients with colorectal cancer, but not breast cancer. The lack of rural-urban differences observed for breast cancer suggest that inequities in the timeliness of colorectal cancer pathways can be ameliorated, and may improve clinical outcomes. Indeed, based on previous research, delays observed in this study could result in stage progression and hence reduced survival. From our results, interventions targeting the time from presentation to colorectal cancer diagnosis in rural populations should be pursued. Countries seeking to understand cancer disparities in their local context may also consider using a pathways approach to identify possible targets for policy intervention.

Insights into the genetic architecture of morphological traits in two passerine bird species

Knowledge about the underlying genetic architecture of phenotypic traits is needed to understand and predict evolutionary dynamics. The number of causal loci, magnitude of the effects and location in the genome are, however, still largely unknown. Here, we use genome-wide single-nucleotide polymorphism (SNP) data from two large-scale data sets on house sparrows and collared flycatchers to examine the genetic architecture of different morphological traits (tarsus length, wing length, body mass, bill depth, bill length, total and visible badge size and white wing patches). Genomic heritabilities were estimated using relatedness calculated from SNPs. The proportion of variance captured by the SNPs (SNP-based heritability) was lower in house sparrows compared with collared flycatchers, as expected given marker density (6348 SNPs in house sparrows versus 38 689 SNPs in collared flycatchers). Indeed, after downsampling to similar SNP density and sample size, this estimate was no longer markedly different between species. Chromosome-partitioning analyses demonstrated that the proportion of variance explained by each chromosome was significantly positively related to the chromosome size for some traits and, generally, that larger chromosomes tended to explain proportionally more variation than smaller chromosomes. Finally, we found two genome-wide significant associations with very small-effect sizes. One SNP on chromosome 20 was associated with bill length in house sparrows and explained 1.2% of phenotypic variation (V_P), and one SNP on chromosome 4 was associated with tarsus length in collared flycatchers (3% of V_P). Although we cannot exclude the possibility of undetected large-effect loci, our results indicate a polygenic basis for morphological traits.

Assertive Interventions for First Episode Psychoses: The Danish Experience

Early Intervention services with team-based intensive case management and family involvement are superior to standard treatment in reducing psychotic and negative symptoms and comorbid substance abuse and improving social functioning and user satisfaction. The results of the OPUS-trial will be presented together with meta-analyses based on similar trials. The implementation of OPUS all over Denmark will be presented together with the Danish OPUS-fidelity study. Specialized elements are being are being developed such as inclusion of new methods in CBT for psychotic and negative symptoms, neurocognitive and social cognitive training programs, interventions for supported employment and focus on physical health. Results of long term follow-up studies indicate that the prognosis of first episode psychosis is very diverse with the extremes represented by one group being well functioning and able to quit medication without relapse; and another group having a long term chronic course of illness with a need for support to maintain daily activities. The Danish TAILOR-trial–testing dose reduction versus maintenance therapy will be presented. It will be of immense value to be able to intervene in risk groups identified in the premorbid phase, and there are few examples of ongoing trial for children of parent with schizophrenia and bipolar disorder.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Sex-linked inheritance, genetic correlations and sexual dimorphism in three melanin-based colour traits in the barn owl

Theory states that genes on the sex chromosomes have stronger effects on sexual dimorphism than genes on the autosomes. Although empirical data are not necessarily consistent with this theory, this situation may prevail because the relative role of sex-linked and autosomally inherited genes on sexual dimorphism has rarely been evaluated. We estimated the quantitative genetics of three sexually dimorphic melanin-based traits in the barn owl (Tyto alba), in which females are on average darker reddish pheomelanic and display more and larger black eumelanic feather spots than males. The plumage traits with higher sex-linked inheritance showed lower heritability and genetic correlations, but contrary to prediction, these traits showed less pronounced sexual dimorphism. Strong offspring sexual dimorphism primarily resulted from daughters not expressing malelike melanin-based traits and from sons expressing femalelike traits to similar degrees as their sisters. We conclude that in the barn owl, polymorphism at autosomal genes rather than at sex-linked genes generate variation in sexual dimorphism in melanin-based traits.

A homozygous mutation in a consanguineous family consolidates the role of ALDH1A3 in autosomal recessive microphthalmia

Anomalies of eye development can lead to the rare eye malformations microphthalmia and anophthalmia (small or absent ocular globes), which are genetically very heterogeneous. Several genes have been associated with microphthalmia and anophthalmia, and exome sequencing has contributed to the identification of new genes. Very recently, homozygous variations within ALDH1A3 have been associated with autosomal recessive microphthalmia with or without cysts or coloboma, and with variable subphenotypes of developmental delay/autism spectrum disorder in eight families. In a consanguineous family where three of the five siblings were affected with microphthalmia/coloboma, we identified a novel homozygous missense mutation in ALDH1A3 using exome sequencing. Of the three affected siblings, one had intellectual disability and one had intellectual disability and autism, while the last one presented with normal development. This study contributes further to the description of the clinical spectrum associated with ALDH1A3 mutations, and illustrates the interfamilial clinical variation observed in individuals with ALDH1A3 mutations.

Quantification of activity by alpha-camera imaging and small-scale dosimetry within ovarian carcinoma micrometastases treated with targeted alpha therapy

Targeted alpha therapy (TAT) a promising treatment for small, residual, and micrometastatic diseases has questionable efficacy against malignant lesions larger than the α-particle range, and likely requires favorable intratumoral activity distribution. Here, we characterized and quantified the activity distribution of an alpha-particle emitter radiolabelled antibody within >100-µm micrometastases in a murine ovarian carcinoma model. Nude mice bearing ovarian micrometastases were injected intra-peritoneally with 211At-MX35 (total injected activity 6 MBq, specific activity 650 MBq/mg). Animals were sacrificed at several time points, and peritoneal samples were excised and prepared for alpha-camera imaging. Spatial and temporal activity distributions within micrometastases were derived and used for small-scale dosimetry. We observed two activity distribution patterns: uniform distribution and high stable uptake (>100% IA/g at all time points) in micrometastases with no visible stromal compartment, and radial distribution (high activity on the edge and poor uptake in the core) in tumor cell lobules surrounded by fibroblasts. Activity distributions over time were characterized by a peak (140% IA/g at 4 h) in the outer tumor layer and a sharp drop beyond a depth of 50 µm. Small-scale dosimetry was performed on a multi-cellular micrometastasis model, using time-integrated activities derived from the experimental data. With injected activity of 400 kBq, tumors exhibiting uniform activity distribution received <25 Gy (EUD=13 Gy), whereas tumors presenting radial activity distribution received mean absorbed doses of <8 Gy (EUD=5 Gy). These results provide new insight into important aspects of TAT, and may explain why micrometastases >100 µm might not be effectively treated by the examined regimen.

Dietary ontogeny and niche shift to piscivory in lacustrine brown trout Salmo trutta revealed by stomach content and stable isotope analyses

The feeding ecology and ontogeny of a large size range of brown trout Salmo trutta in Lake Fyresvatnet, southern Norway, were examined by stomach content and stable isotope analyses. According to the stomach contents, the S. trutta changed their diet at c. 30 cm total length (L(T) ). The smaller size classes fed on benthic invertebrates and surface insects, whereas larger S. trutta (>30 cm) fed mainly on whitefish Coregonus lavaretus. A similar, but more gradual shift to piscivory in the size range 25-30 cm was found when using the stable isotope mixing model SIAR to reveal dietary ontogeny. The δ¹³C isotopic signature confirmed that S. trutta independent of size predominantly relied upon benthic energy sources, suggesting that the littoral zone was the primary foraging habitat for both invertebrate and piscivorous feeders. The δ¹⁵N values and trophic position increased with predator length, ranging from an average of 3·60 for small-sized S. trutta (<15 cm) to 4·15 for large-sized fish (>35 cm). The S. trutta exhibited a relatively slow growth rate during the predominant invertebrate feeding stages up to 7 years of age and 28 cm L(T) , whereas fish above this size and age displayed a rapid growth rate of 9-11 cm year⁻¹, demonstrating the profitability of piscivorous feeding.

Search for the standard model Higgs boson in the decay channel H→ZZ→4ℓ in pp collisions at √s=7 TeV

A search for a Higgs boson in the four-lepton decay channel H→ZZ, with each Z boson decaying to an electron or muon pair, is reported. The search covers Higgs boson mass hypotheses in the range of 110<m(H)<600 GeV. The analysis uses data corresponding to an integrated luminosity of 4.7 fb(-1) recorded by the CMS detector in pp collisions at √s=7 TeV from the LHC. Seventy-two events are observed with four-lepton invariant mass m(4ℓ)>100 GeV (with 13 below 160 GeV), while 67.1±6.0 (9.5±1.3) events are expected from background. The four-lepton mass distribution is consistent with the expectation of standard model background production of ZZ pairs. Upper limits at 95% confidence level exclude the standard model Higgs boson in the ranges of 134-158 GeV, 180-305 GeV, and 340-465 GeV. Small excesses of events are observed around masses of 119, 126, and 320 GeV, making the observed limits weaker than expected in the absence of a signal.

Search for signatures of extra dimensions in the diphoton mass spectrum at the large hadron collider

A search for signatures of extra spatial dimensions in the diphoton invariant-mass spectrum has been performed with the CMS detector at the LHC. No excess of events above the standard model expectation is observed using a data sample collected in proton-proton collisions at √s=7 TeV corresponding to an integrated luminosity of 2.2 fb(-1). In the context of the large-extra-dimensions model, lower limits are set on the effective Planck scale in the range of 2.3-3.8 TeV at the 95% confidence level. These limits are the most restrictive bounds on virtual-graviton exchange to date. The most restrictive lower limits to date are also set on the mass of the first graviton excitation in the Randall-Sundrum model in the range of 0.86-1.84 TeV, for values of the associated coupling parameter between 0.01 and 0.10.

Search for a vectorlike quark with charge 2/3 in t+Z events from pp collisions at √s=7 TeV

A search for pair-produced heavy vectorlike charge-2/3 quarks, T, in pp collisions at a center-of-mass energy of 7 TeV, is performed with the CMS detector at the LHC. Events consistent with the flavor-changing-neutral-current decay of a T quark to a top quark and a Z boson are selected by requiring two leptons from the Z-boson decay, as well as an additional isolated charged lepton. In a data sample corresponding to an integrated luminosity of 1.14  fb(-1), the number of observed events is found to be consistent with the standard model background prediction. Assuming a branching fraction of 100% for the decay T→tZ, a T quark with a mass less than 475  GeV/c(2) is excluded at the 95% confidence level.

Search for supersymmetry at the LHC in events with jets and missing transverse energy

A search for events with jets and missing transverse energy is performed in a data sample of pp collisions collected at √s=7 TeV by the CMS experiment at the LHC. The analyzed data sample corresponds to an integrated luminosity of 1.14 fb(-1). In this search, a kinematic variable α(T) is used as the main discriminator between events with genuine and misreconstructed missing transverse energy. No excess of events over the standard model expectation is found. Exclusion limits in the parameter space of the constrained minimal supersymmetric extension of the standard model are set. In this model, squark masses below 1.1 TeV are excluded at 95% C.L. Gluino masses below 1.1 TeV are also ruled out at 95% C.L. for values of the universal scalar mass parameter below 500 GeV.

Search for new physics with a monojet and missing transverse energy in pp collisions at √s = 7 TeV

A study of events with missing transverse energy and an energetic jet is performed using pp collision data at a center-of-mass energy of 7 TeV. The data were collected by the CMS detector at the LHC, and correspond to an integrated luminosity of 36 pb(-1). An excess of these events over standard model contributions is a signature of new physics such as large extra dimensions and unparticles. The number of observed events is in good agreement with the prediction of the standard model, and significant extension of the current limits on parameters of new physics benchmark models is achieved.

Search for B(s)(0) → μ+ μ- and B(0) → μ+ μ- decays in pp collisions at sqrt[s] = 7 TeV

A search for the rare decays B(s)(0) → μ+ μ- and B(0) → μ+ μ- is performed in pp collisions at sqrt[s] = 7 TeV, with a data sample corresponding to an integrated luminosity of 1.14 fb(-1), collected by the CMS experiment at the LHC. In both cases, the number of events observed after all selection requirements is consistent with expectations from background and standard-model signal predictions. The resulting upper limits on the branching fractions are B(B(s)(0) → μ+ μ-) < 1.9 × 10(-8) and B(B(0) → μ+ μ-)<4.6 × 10(-9), at 95% confidence level.

Measurement of the inclusive jet cross section in pp collisions at √s = 7 TeV

The inclusive jet cross section is measured in pp collisions with a center-of-mass energy of 7 TeV at the Large Hadron Collider using the CMS experiment. The data sample corresponds to an integrated luminosity of 34 pb(-1). The measurement is made for jet transverse momenta in the range 18-1100 GeV and for absolute values of rapidity less than 3. The measured cross section extends to the highest values of jet p(T) ever observed and, within the experimental and theoretical uncertainties, is generally in agreement with next-to-leading-order perturbative QCD predictions.

Search for three-jet resonances in pp collisions at square root(s)=7 TeV

A search for three-jet hadronic resonance production in pp collisions at a center-of-mass energy of 7 TeV has been conducted by the CMS Collaboration at the LHC, using a data sample corresponding to an integrated luminosity of 35  pb(-1). Events with high jet multiplicity and a large scalar sum of jet transverse momenta are analyzed using a signature-based approach. The number of expected standard model background events is found to be in good agreement with the observed events. Limits on the cross section times branching ratio are set in a model of gluino pair production with an R-parity-violating decay to three quarks, and the data rule out such particles within the mass range of 200 to 280  GeV/c2.

Measurement of the t-channel single top quark production cross section in pp collisions at √s=7 TeV

Electroweak production of the top quark is measured for the first time in pp collisions at √=7  TeV, using a data set collected with the CMS detector at the LHC and corresponding to an integrated luminosity of 36  pb⁻¹. With an event selection optimized for t-channel production, two complementary analyses are performed. The first one exploits the special angular properties of the signal, together with background estimates from the data. The second approach uses a multivariate analysis technique to probe the compatibility with signal topology expected from electroweak top-quark production. The combined measurement of the cross section is 83.6±29.8(stat+syst)±3.3(lumi)  pb, consistent with the standard model expectation.

Indications of suppression of excited Υ states in Pb-Pb collisions at √(s(NN))=2.76 TeV

A comparison of the relative yields of Υ resonances in the μ(+)μ(-) decay channel in Pb-Pb and pp collisions at a center-of-mass energy per nucleon pair of 2.76 TeV is performed with data collected with the CMS detector at the LHC. Using muons of transverse momentum above 4  GeV/c and pseudorapidity below 2.4, the double ratio of the Υ(2S) and Υ(3S) excited states to the Υ(1S) ground state in Pb-Pb and pp collisions, [Υ(2S+3S)/Υ(1S)](Pb-Pb)/[Υ(2S+3S)/Υ(1S)](pp), is found to be 0.31(-0.15)(+0.19)(stat)±0.03(syst). The probability to obtain the measured value, or lower, if the true double ratio is unity, is calculated to be less than 1%.

Measurement of the polarization of W bosons with large transverse momenta in W + jets events at the LHC

A first measurement of the polarization of W bosons with large transverse momenta in pp collisions is presented. The measurement is based on 36 pb⁻¹ of data recorded at √s = 7 TeV by the CMS detector at the LHC. The left-handed, right-handed, and longitudinal polarization fractions (f(L), f(R), and f₀, respectively) of W bosons with transverse momenta larger than 50 GeV are determined by using decays to both electrons and muons. The muon final state yields the most precise measurement: (f(L) - f(R))⁻ = 0.240 ± 0.036(stat) ± 0.031(syst) and f₀⁻ = 0.183 ± 0.087(stat) ± 0.123(syst) for negatively charged W bosons and (f(L) - f(R))⁺ = 0.310 ± 0.036(stat) ± 0.017(syst) and f₀⁺ = 0.171 ± 0.085(stat) ± 0.099(syst) for positively charged W bosons. This establishes, for the first time, that W bosons produced in pp collisions with large transverse momenta are predominantly left-handed, as expected in the standard model.

Measurement of the B0 production cross section in pp collisions at sqrt[s] = 7 TeV

Measurements of the differential production cross sections dσ/dpTB and dσ/dyB for B0 mesons produced in pp collisions at sqrt[s] = 7 TeV are presented. The data set used was collected by the CMS experiment at the LHC and corresponds to an integrated luminosity of 40 pb-1. The production cross section is measured from B0 meson decays reconstructed in the exclusive final state J/ψKS0, with the subsequent decays J/ψ → μ + μ - and KS0 → π+}π-. The total cross section for pTB>5 GeV and |yB|<2.2 is measured to be 33.2 ± 2.5 ± 3.5 μb, where the first uncertainty is statistical and the second is systematic.

Search for neutral minimal supersymmetric standard model Higgs bosons decaying to tau pairs in pp collisions at √s=7 TeV

A search for neutral minimal supersymmetric standard model (MSSM) Higgs bosons in pp collisions at the LHC at a center-of-mass energy of 7 TeV is presented. The results are based on a data sample corresponding to an integrated luminosity of 36  pb(-1) recorded by the CMS experiment. The search uses decays of the Higgs bosons to tau pairs. No excess is observed in the tau-pair invariant-mass spectrum. The resulting upper limits on the Higgs boson production cross section times branching fraction to tau pairs, as a function of the pseudoscalar Higgs boson mass, yield stringent new bounds in the MSSM parameter space.