Molecular autopsy for fetal structural anomaly: diagnostic and clinical utility of multidisciplinary team approach

OBJECTIVES

In the West Midlands Regional Genetic Service, cases of perinatal death with a possible genetic diagnosis are evaluated by the Perinatal Pathology Genetic Multidisciplinary Team (MDT). The MDT assessed autopsy findings and considered genomic assessments. The objective of this retrospective service evaluation was to determine the clinical utility of the MDT. This is the first evaluation since the introduction of whole genome and whole exome sequencing in routine clinical care.

METHOD

The outcomes for all the perinatal MDT cases from January 2021 to December 2021 were examined. All cases received a full or partial post-mortem examination (PM) and a chromosomal microarray. Demographics, phenotype, MDT recommendations, genetic testing, diagnoses, outcomes, impact of PM and impact of genetic testing were collected from patient case notes.

RESULTS

One hundred and twenty-three cases were discussed at the MDT meeting in 2021. Genetic evaluation was recommended in 84 cases and accepted in 64 cases. A range of genetic tests were requested according to indication and availability. Thirty diagnoses were identified in 29 cases from 26 unrelated families. The diagnostic yield was 24% (29/123) of all cases or 45% (29/64) of the cases with a suspected genetic diagnosis who underwent genetic testing. PM examination added clinically actionable phenotype data in 79% of cases. A genetic diagnosis enabled accurate counselling of recurrence risk and provision of appropriate follow-up, including prenatal testing and preimplantation diagnosis for patients with inherited conditions.

CONCLUSIONS

Genomic testing was a clinically useful addition to (but not a substitute for) PM examination in perinatal cases associated with structural anomalies. The MDT model helped assess cases and plan appropriate follow-up. Expedited whole genome sequencing or panel-agnostic analysis were most appropriate for heterogeneous presentations. This broad approach can also expand prenatal phenotypes and detect novel disease genes and should be a priority for future research. This article is protected by copyright. All rights reserved.

Impact of Bifidobacterium longum1714® on maternal cytokine response in peripheral blood mononuclear cells

PURPOSE

The maternal immune system is implicated in adverse pregnancy outcomes. Manipulation of maternal immune response by probiotics holds potential to reduce pregnancy complications. The MicrobeMom2 study investigates the impact of probiotic supplementation on maternal immune responses to pathogen associated molecular patterns (PAMPs) in peripheral blood mononuclear cells (PBMCs) during pregnancy.

METHODS

This double-blinded randomised-controlled trial involved oral supplementation of Bifidobacterium longum subsp. longum 1714® (B. longum 1714; daily ingestion of a minimum of 1x109 colony forming units) or placebo from 16 to 20-weeks' gestation until delivery in healthy pregnant women. The primary outcome was a change in IL-10 production, after stimulation with Lipopolysaccharide (LPS) or anti-CD3/28/2, in PBMCs isolated from blood samples taken at baseline (11-15 weeks' gestation) and late pregnancy (28-32 weeks' gestation) after 48 h incubation. 68 subjects were needed (34ineachgroup) for 80 % power at an alpha significance of 0.05 to detect differences in IL10.

RESULTS

72 women (mean ± SD age 33.17 ± 4.53 years and median (25th, 75th centile) body mass index 24.93 (21.93, 27.57 kg/m2)) were recruited with primary outcome data. Using LPS, late pregnancy fold change in IL-10 in PBMCs after 48 h incubation was median (25th, 75th centile) 88.45 (4.88, 488.78) in the intervention, 24.18 (6.36, 141.17) in the control group, p = 0.183. Using anti-CD3/28/2, values were 189.69 (425.96, 866.57),148.74 (31.67, 887.03) in intervention and control groups, respectively, p = 0.506. No significant differences were observed between the two groups.

CONCLUSION

Maternal antenatal supplementation with B. longum 1714 did not alter cytokine production by maternal PBMCs in response to PAMPs or anti-CD3/28/2.

TRIAL REGISTRATION NUMBER

ISRCTN registry ISRCTN43013285.

Pragmatic Adaptive Trial for Respiratory Infection in Children (PATRIC) Clinical Registry protocol

INTRODUCTION

Acute respiratory infections (ARI) are the most common cause of paediatric hospitalisation. There is an urgent need to address ongoing critical knowledge gaps in ARI management. The Pragmatic Adaptive Trial for Respiratory Infections in Children (PATRIC) Clinical Registry will evaluate current treatments and outcomes for ARI in a variety of paediatric patient groups. The registry will provide a platform and data to inform a number of PATRIC clinical trials, testing various interventions in ARI treatment and management to optimise paediatric ARI care.

METHODS AND ANALYSIS

The PATRIC Clinical Registry is a single-centre, prospective observational registry recruiting from a tertiary paediatric Emergency Department in Western Australia. Through characterising demographic, clinical, treatment and outcome data, the PATRIC Clinical Registry will improve our understanding of antibiotic utilisation and ARI outcomes in children.

ETHICS AND DISSEMINATION

The PATRIC Clinical Registry is conducted in accordance with the Declaration of Helsinki, and the International Council for Harmonisation (ICH) Guidelines for Good Clinical Practice (CPMP/ICH/13595) July 1996. Approval is provided by the Child and Adolescent Health Service Human Research Ethics Committee (HREC). Study results will be communicated by presentation and publication (HREC: RGS0000003078.) TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12619000903189. UTN: U1111-1231-3365.

Cross-sectional survey of compliance behaviour, knowledge and attitudes among cases and close contacts during COVID-19 pandemic

Objectives

A key public health intervention is self-isolation for cases and restriction of movement for contacts. This study aimed to identify predictors of compliance behaviour and describe knowledge and attitudes among cases and contacts identified by the national Contact Management Programme to inform the global public health response.

Study design

Secondary data analysis of anonymised cross-sectional survey data on national sample of cases and close contacts.

Methods

A sample of 1000 cases and 1000 contacts was calculated to estimate compliance within a margin of error of 3% with 95% confidence. A telephone survey administered by trained interviewers collected information on socio-demographics, compliance behaviours, knowledge, and attitudes to COVID-19 from cases and close contacts. Data analysis included chi-squared statistics and multivariable logistic regression.

Results

Most cases and contacts complied with public health guidance with similar characteristics in those who did and did not comply. Reasons for non-compliance included exercise, medical appointment, shopping, and work. Cases and contacts reported high levels of understanding about symptoms of COVID-19 and satisfaction with available information.

Conclusion

Achieving high compliance with public health guidance is feasible and requires political leadership, policy changes and practical solutions.

Geochemical controls on mobilization of metals from a 100-year-old waste rock pile and implications for selection of cover amendments

Reclamation of mine waste rock piles typically consists of constructing a cover with amendments to improve conditions for vegetation. However, cover amendments have potential to mobilize metals in waste by introducing new chemicals and altering pH and redox conditions. This study evaluates metal phases in a 100-year-old waste rock pile with high metals content (3.5% lead by weight, 0.8% zinc, and 0.75% copper) and the potential for these metals to be mobilized by several cover materials and amendments (topsoil, spent brewery grain, biochar, compost, commercial soil media, and phosphate). Laboratory testing indicates that metals have weathered from their initial metal sulfide phases (galena, sphalerite, chalcopyrite), and are now also present as sulfates, phosphates, carbonates, and phases associated with manganese/iron oxides. Sequential extraction tests demonstrated that the largest extractable fraction of metals is associated with manganese/iron oxides (37% of lead by weight, 22% of copper, and 26% of zinc), suggesting an environmental risk should geochemically reducing conditions develop and mobilize metals in the pile after cover construction. Testing of specific cover materials demonstrated that metals mobilization also occurs from low pH (as with spent brewery grain), formation of stable aqueous metal-organic complexes (as with spent brewery grain and compost), and ligand exchange (as with phosphate amendment). Results of this study demonstrate the importance of identifying metal phases present in a waste rock pile prior to selecting cover amendments.

MALDI and Trace Metal Analysis in Age-Related Macular Degeneration

Age-related macular degeneration (AMD) remains one of the most prevalent causes of blindness throughout the world. Key to prevention of AMD is furthering the understanding of its pathology. In recent years, both the proteins within the innate immune system and essential and non-essential metals have been implicated in the pathology of AMD. Herein, a multidisciplinary and multimodal methodology has been taken to further our understanding of the role of the innate immune proteins and the essential metals within mouse ocular tissue.

135 A FEASIBILITY STUDY TO EXPLORE THE ROLE OF EXERCISE AND PROTEIN SUPPLEMENTATION TO TARGET FRAILTY IN PEOPLE EXPERIENCING HOMELESSNESS

Background

People who are homeless are more likely to experience poor health with acceleration of ageing commonly reported. The concept of frailty is related to age acceleration and research has shown that appropriate exercise and nutritional supplementation strategies can delay or even reverse frailty. This has not been tested in the homeless population. The aim of this study was to explore the feasibility and preliminary efficacy of an exercise intervention with protein supplementation to target physical functioning deficits and frailty in people experiencing homelessness.

Methods

A low-threshold, 'drop-in' exercise programme with protein supplementation was delivered once weekly for 16 weeks. The main recruitment site was a day-service centre for people who are homeless and have addiction issues. A one-day programme was also delivered to a connected female-only centre to offer a more inclusive service. Primary outcome was feasibility, which included recruitment and retention of participants. Secondary outcomes included frailty and nutritional status, physical function and self-reported pain.

Results

Thirty-one participants were recruited, 13 of whom were aged over 50 years. Of these older participants, there was a 100% retention rate to the main recruitment centre, with at least one repeat visit to the exercise intervention. The majority of the older participants presented as frail (6/13) or pre-frail (3/13), with 4/13 non-frail. One of these participants was malnourished, six were at risk of malnourishment and six had normal nutritional status. The possible presence of sarcopenia (eight or less on the Short Physical Performance Battery) was noted in 3/13 of participants. The majority of participants (10/13) reported chronic pain.

Conclusion

This study highlights a high level of frailty and poor physical and nutritional health in older people experiencing homelessness. High retention indicates interest in this intervention. There is a need to establish and roll out targeted interventions to optimise outcomes for this socially excluded group.

Evaluation of the Dose-Dependent Inflammatory Response and No-Observable Adverse Effect Level of Intravitreal Endotoxin in the African Green Monkey

Purpose

To evaluate the inflammatory effects and no-observed adverse effect level (NOAEL) of intravitreal endotoxin in an African green monkey model of uveitis.

Methods

Fifteen green monkeys were administered intravitreal endotoxin ranging from 0.005 to 0.08 endotoxin unit (EU)/eye. Inflammation was evaluated by slit-lamp biomicroscopy, indirect fundoscopy, tonometry, color fundus photography, ocular coherence tomography, laser flare photometry, and histopathology, with analysis of cytokine levels in aqueous and vitreous humor. The inter-rater reliability of a refined nonhuman primate ophthalmic scoring system was evaluated.

Results

A dose-dependent inflammatory response was observed beginning at 0.02 EU/eye; no inflammatory response exceeding the vehicle was observed at 0.005 EU/eye. Retinal pathology was minimal, and posterior visualization degraded with increasing inflammation. Inflammation was observed by histopathology at 0.04 EU/eye. Inter-rater reliability of the scoring system was high, with 99.2% of individual scores differing by 1 scale unit or less and 87.2% of summary scores differing by 2 scale units or less.

Conclusions

The NOAEL for intravitreal endotoxin in the green monkey is 0.005 EU/eye, with inflammation increasing with increasing dose beginning at 0.02 EU/eye. This updated nonhuman primate ophthalmic scoring system allows for high inter-rater reliability for the quantification of mild to severe inflammation in the green monkey eye.

Translational Relevance

Validation of the ophthalmic inflammation scoring system enables application of the green monkey as a valuable translational model. Candidate therapeutics should be confirmed to have endotoxin levels below this threshold before safety testing in this species to enable interpretation of inflammation and minimize impact on animal welfare.

Evolving fetal phenotypes and clinical impact of progressive prenatal exome sequencing pathways: cohort study

OBJECTIVES

To determine (1) the diagnostic yield and turnaround time (TAT) of two consecutive prenatal exome sequencing (ES) pathways, (2) the evolution of the fetal phenotype and (3) the clinical impact of detecting causative pathogenic variants and incidental findings.

METHODS

This was a retrospective cohort analysis of prospectively collected fetal cases that underwent trio ES in the presence of a structural anomaly and normal chromosomal microarray testing in the West Midlands Regional Genetics Laboratory, Birmingham, UK. The study included two phases: (1) between July 2018 and October 2020, the clinical pathway from the Prenatal Assessment of Genomes and Exomes (PAGE) study was adopted and involved prenatal trio ES based on a panel of 1542 development disorder genes and case selection by a multidisciplinary team; (2) between October 2020 and July 2021, prenatal trio ES investigation was based on the National Health Service (NHS) England R21 pathway, with definitive inclusion criteria and a panel of 1205 prenatally relevant genes. Deep phenotyping was performed throughout pregnancy and postnatally.

RESULTS

A total of 54 cases were included. The diagnostic yield before vs after R21 pathway implementation was 28.0% (7/25) and 55.2% (16/29), respectively (P = 0.04). The respective values for mean TAT were 54.0 days (range, 14-213 days) and 14.2 days (range, 3-29 days). In cases in which a causative pathogenic variant was identified and in which the pregnancy reached the third trimester, additional anomalies were detected between the second and third trimesters in 73.3% (11/15) of cases, predominantly secondary to progressive hydropic features (3/11 (27.3%)), arthrogryposis (3/11 (27.3%)) or brain anomaly (2/11 (18.2%)). In three cases, a variant of uncertain significance was reclassified to likely pathogenic based on postnatal information. Detection of a causative pathogenic variant had a significant clinical impact in 78.3% (18/23) of cases, most frequently affecting decision-making regarding the course of the pregnancy and neonatal management (7/18 (38.9%)).

CONCLUSIONS

Prenatal ES using the NHS England R21 pathway showed great promise when applied to this cohort, allowing a genetic diagnosis to be made in over half of preselected cases with a fetal structural anomaly on ultrasound. Monitoring and real-time updating of fetal phenotype and reclassification of variants based on postnatal findings is vital to increase the clinical impact that is already evident from this emerging genomic technology. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Detection and control of an ongoing international outbreak of hepatitis A among the Irish Traveller community beginning September 2020

Hepatitis A virus (HAV) infection is a notifiable disease in Ireland, with national coverage of clinical and laboratory surveillance. In December 2020, a cluster of 11 HAV cases among the Irish Traveller community was detected. The outbreak investigation identified 61 total HAV cases from September 2020 to November 2021. Sequenced isolates were sub-genotype IA with identical genome sequence. Case-patients were predominantly aged under 18 (77%), hospitalised (46%) and lived on communal residential sites. Mass onsite HAV vaccination was employed following failure of initial ring vaccination to contain the outbreak. This is the largest outbreak of HAV described in Ireland, involving spillover to the UK and Netherlands. We recommend mass HAV vaccination and tailored communication for outbreak control in migratory subpopulations.

An overview of the establishment of a national contact tracing programme: a quality improvement approach in a time of pandemic

Background: With the onset of the coronavirus disease 2019 (COVID-19) pandemic, the Irish health system needed a contact tracing and management intervention at a national level to undertake high volume, low complexity contact tracing. This paper describes the establishment and first year of a national Contact Management Programme (CMP) in Ireland, its core components, outcomes on key measures (coverage, timeliness, and training) and learnings from the process. Methods: CMP is centred on four steps, 1) case: rapid notification to a person of a result and provision of advice, 2) contacts: rapid identification of contacts, 3) control: rapid public health management of contacts, which includes testing and 4) active follow-up of close contacts with additional testing and public health advice reminder SMS and calls. The outcome measures used in this study are: 1) The proportion of all Irish cases contact traced through the CMP (Coverage), 2) the time taken to complete the 3 types of CMP calls (timeliness), 3) number of contact tracers trained and their feedback (training). Results: 246,666 positive cases were recorded using the CMP between 17th March 2020 and 30th April 2021, with contact tracing successfully completed for 237,759 cases, representing 99% and 96%, respectively, of the 248,529 cases notified in Ireland up to the 30th of April 2021. The average time taken for contact tracing to be completed was 29.4 hours (95% CI 28.9, 29.9) and the median was 16.8 hours (approximate 95% CI 15.9, 17.7). Conclusion: Using the Quality Improvement (QI) approach, the Health Service Executive (HSE) successfully established and scaled up a Contact Management Programme that rapidly notified results to people and traced their close contacts. CMP contributed to the success of the Irish health service in managing the pandemic. CMP slowed COVID-19 transmission and lessened the impact on health services capacity.

Probing the role of magnetic fields in star-forming filaments: NIKA2-Pol commissioning results toward OMC-1

Dust polarization observations are a powerful, practical tool to probe the geometry (and to some extent, the strength) of magnetic fields in starforming regions. In particular, Planck polarization data have revealed the importance of magnetic fields on large scales in molecular clouds. However, due to insufficient resolution, Planck observations are unable to constrain the B-field geometry on prestellar and protostellar scales. The high angular resolution of 11.7 arcsec provided by NIKA2-Pol 1.15 mm polarimetric imaging, corresponding to 0.02 pc at the distance of the Orion molecular cloud (OMC), makes it possible to advance our understanding of the B-field morphology in star-forming filaments and dense cores (IRAM 30m large program B-FUN). The commissioning of the NIKA2-Pol instrument has led to several challenging issues, in particular, the instrumental polarization or intensity-to-polarization “leakage” effect. In the present paper, we illustrate how this effect can be corrected for, leading to reliable exploitable data in a structured, extended source such as OMC-1. We present a statistical comparison between NIKA2-Pol and SCUBA2-Pol2 results in the OMC-1 region. We also present tentative evidence of local pinching of the B-field lines near Orion-KL, in the form of a new small-scale hourglass pattern, in addition to the larger-scale hourglass already seen by other instruments such as Pol2.

Multi-probe analysis of the galaxy cluster CL J1226.9+3332: Hydrostatic mass and hydrostatic-to-lensing bias

We present a multi-probe analysis of the well-known galaxy cluster CL J1226.9+3332 as a proof of concept for multi-wavelength studies within the framework of the NIKA2 Sunyaev-Zel’dovich Large Program (LPSZ). CL J1226.9+3332 is a massive and high redshift (z = 0.888) cluster that has already been observed at several wavelengths. A joint analysis of the thermal SZ (tSZ) effect at millimeter wavelength with the NIKA2 camera and in X-ray with the XMM-Newton satellite permits the reconstruction of the cluster’s thermodynamical properties and mass assuming hydrostatic equilibrium. We test the robustness of our mass estimates against different definitions of the data analysis transfer function. Using convergence maps reconstructed from the data of the CLASH program we obtain estimates of the lensing mass, which we compare to the estimated hydrostatic mass. This allows us to measure the hydrostatic-to-lensing mass bias and the associated systematic effects related to the NIKA2 measurement. We obtain M500HSE = (7:65 ± 1:03) × 1014M⊙ and M500lens = (7:35 ± 0:65) × 1014M⊙, which implies a HSE-to-lensing bias consistent with 0 within 20%.

Exploring the millimetre emission in nearby galaxies: Analysis of the edge-on galaxy NGC 891

New observations of the edge-on galaxy NGC 891, at 1.15 and 2mm obtained with the IRAM 30-m telescope and the NIKA2 camera, within the framework of the IMEGIN (Interpreting the Millimetre Emission of Galaxies with IRAM and NIKA2) Large Program, are presented in this work. By using multiwavelength maps (from the mid-IR to the cm wavelengths) we perform SED fitting in order to extract the physical properties of the galaxy on both global and local (~kpc) scales. For the interpretation of the observations we make use of a state-of-the-art SED fitting code, HerBIE (HiERarchical Bayesian Inference for dust Emission). The observations indicate a galaxy morphology, at mm wavelengths, similar to that of the cold dust emission traced by submm observations and to that of the molecular gas. The contribution of the radio emission at the NIKA2 bands is very small (negligible at 1.15 mm and ~ 10% at 2 mm) while it dominates the total energy budget at longer wavelengths (beyond 5 mm). On local scales, the distribution of the free-free emission resembles that of the dust thermal emission while the distribution of the synchrotron emission shows a deficiency along the major axis of the disc of the galaxy.

The NIKA2 Sunyaev-Zeldovich Large Program: Precise galaxy cluster physics for an accurate cluster-based cosmology

The NIKA2 Guaranteed-Time SZ Large Program (LPSZ) is dedicated to the high-angular resolution SZ mapping of a representative sample of 45 SZ-selected galaxy clusters drawn from the catalogues of the Planck satellite, or of the Atacama Cosmology Telescope. The LPSZ sample spans a mass range from 3 to 11 × 1014M⊙ and a redshift range from 0:5 to 0:9, extending to higher redshift and lower mass the previous samples dedicated to the cluster mass calibration and universal properties estimation. The main goals of the LPSZ are the measurement of the average radial profile of the ICM pressure up to R500 by combining NIKA2 with Planck or ACT data, and the estimation of the scaling law between the SZ observable and the mass using NIKA2, XMM-Newton and Planck/ACT data. Furthermore, combining LPSZ data with existing or forthcoming public data in lensing, optical/NIR or radio domains, we will build a consistent picture of the cluster physics and further gain knowledge on the mass estimate as a function of the cluster morphology and dynamical state.

We give an overview of the LPSZ, present recent results and discuss the future implication for cosmology with galaxy clusters.

Searching for high-z DSFGs with NIKA2 and NOEMA

As the possible progenitors of passive galaxies at z=2-3, dusty starforming galaxies (DSFGs) at z>4 provide a unique perspective to study the formation, assembly, and early quenching of massive galaxies in the early Universe. The extreme obscuration in optical-IR makes (sub)mm spectral scans the most universal and unbiased way to confirm/exclude the high-z nature of candidate dusty star-forming galaxies. We present here the status of the NIKA2 Cosmological Legacy Survey (N2CLS), which is the deepest wide-area singledish survey in the millimeter searching for high-z DSFGs. We also introduce a joint-analysis method to effciently search for the spectroscopic redshift of high-z DSFGs with noisy spectra and photometric data and present its success in identifying the redshift of DSFGs found in NIKA2 science verification data.

Galactic star formation with NIKA2 (GASTON): Filament convergence and its link to star formation

In the past decade filaments have been recognised as a major structural element of the interstellar medium, the densest of these filaments hosting the formation of most stars. In some star-forming molecular clouds converging networks of filaments, also known as hub filament systems, can be found. These hubs are believed to be preferentially associated to massive star formation. As of today, there are no metrics that allow the systematic quantification of a filament network convergence. Here, we used the IRAM 30m NIKA2 observations of the Galactic plane from the GASTON large programme to systematically identify filaments and produce a filament convergence parameter map. We use such a map to show that: i. hub filaments represent a small fraction of the global filament population; ii. hubs host, in proportion, more massive and more luminous compact sources that non-hubs; iii. hub-hosting clumps are more evolved that non-hubs; iv. no discontinuities are observed in the properties of compact sources as a function of convergence parameter. We propose that the rapid global collapse of clumps is responsible for (re)organising filament networks into hubs and, in parallel, enhancing the mass growth of compact sources.

PSZ2 G091: A massive double cluster at z ~ 0.822 observed by the NIKA2 camera

PSZ2 G091.83+26.11 is a massive galaxy cluster with M500 = 7:43 × 1014M⊙ at z = 0:822. This object exhibits a complex morphology with a clear bimodality observed in X-rays. However, it was detected and analysed in the Planck sample as a single, spherical cluster following a universal profile [1]. This model can lead to miscalculations of thermodynamical quantities, like the pressure profile. As future multiwavelength cluster experiments will detect more and more objects at higher redshifts (where we expect the fraction of merging objects to be higher), it is crucial to quantify this systematic effect. In this work, we use high-resolution observations of PSZ2 G091.83+26.11 by the NIKA2 camera to integrate the morphological characteristics of the cluster in our modelling. This is achieved by fitting a two-halo model to the SZ image and then by reconstruction of the resulting projected pressure profile. We then compare these results with the spherical assumption.

Galactic Star Formation with NIKA2 (GASTON): Evidence of mass accretion onto dense clumps

High-mass stars (m* ≳ 8 M⊙) play a crucial role in the evolution of galaxies, and so it is imperative that we understand how they are formed. We have used the New IRAM KIDs Array 2 (NIKA2) camera on the Institut de Radio Astronomie Millimétrique (IRAM) 30-m telescope to conduct high-sensitivity continuum mapping of ~ 2 deg2 of the Galactic plane (GP) as part of the Galactic Star Formation with NIKA2 (GASTON) large program. We have identified a total of 1467 clumps within our deep 1.15 mm continuum maps and, by using overlapping continuum, molecular line, and maser parallax data, we have determined their distances and physical properties. By placing them upon an approximate evolutionary sequence based upon 8 μm Spitzer imaging, we find evidence that the most massive dense clumps accrete material from their surrounding environment during their early evolution, before dispersing as star formation advances, supporting clump-fed models of high-mass star formation.

Overdensity of SubMillimiter Galaxies in the GJ526 Field mapped with the NIKA2 Camera

Using the NIKA2 dual band millimeter camera installed on the IRAM30m telescope, we have mapped a relatively large field (~ 70 arcmin2) in the direction of the star GJ526 to investigate the nature of the sources found with the MAMBO camera at 1.2 mm ten years earlier. We have found that they must be dust-obscured galaxies (SMGs) in the background beyond the star. The new NIKA2 map at 1.15 mm reveals additional sources and, in fact, an overdensity of SMGs predominantly distributed along a filament-like structure in projection on the sky across the whole observed field. We speculate this might be a cosmic filament at high redshift as revealed in cosmological hydrodynamical simulations. Measurement of spectroscopic redshifts of the SMGs in the candidate filament is required now for a definitive confirmation of the nature of the structure.

Crab nebula at 260 GHz with the NIKA2 polarimeter: Implications for the polarization angle calibration of future CMB experiments

The quest for primordial gravitational waves enclosed in the Cosmic Microwave Background (CMB) polarization B-modes signal motivates the development of a new generation of high sensitive experiments (e.g. CMBS4, LiteBIRD), thus allowing to probe the inflationary epoch in the early Universe. However, this will be only possible by ensuring a high control of the instrumental systematic effects and an accurate absolute calibration of the polarization angle.

The Crab nebula is known to be a polarization calibrator on the sky for CMB experiments. Already used for the Planck satellite it exhibits a high polarized signal at microwave wavelengths. In this work we present Crab polarization observations obtained, in the 260 GHz frequency band, with the NIKA2 instrument. Furthermore, we discuss the accuracy needed on such a measurement to improve the constraints on the absolute angle calibration for CMB experiments.

The LPSZ-CLASH galaxy cluster sample: Combining lensing and hydrostatic mass estimates

Starting from the clusters included in the NIKA sample and in the NIKA2 Sunyaev-Zel’dovich Large Program (LPSZ) we have selected a sample of six common objects with the Cluster Lensing And Supernova survey with Hubble (CLASH) lensing data. For the LPSZ clusters we have at our disposal both high-angular resolution observations of the thermal SZ with NIKA and NIKA2 and X-ray observations with XMM-Newton from which hydrostatic mass estimates can be derived. In addition, the CLASH dataset includes lensing convergence maps that can be converted into lensing estimates of the total mass of the cluster. One-dimensional mass profiles are used to derive integrated mass estimates accounting for systematic effects (data processing, modeling, etc.). Two-dimensional analysis of the maps can reveal substructures in the cluster and, therefore, inform us about the dynamical state of each system. Moreover, we are able to study the hydrostatic mass to lensing mass bias, across different morphology and a range of redshift clusters to give more insight on the hydrostatic mass bias. The analysis presented in this proceeding follows the study discussed in [20].

Mapping the intracluster medium temperature in the era of NIKA2 and MUSTANG-2

We present preliminary results from an on-going program that aims at mapping the intracluster medium (ICM) temperature of high redshift galaxy clusters from the MaDCoWS sample using a joint analysis of shallow X-ray data obtained by Chandra and high angular resolution Sunyaev-Zel’dovich (SZ) observations realized with the NIKA2 and MUSTANG-2 cameras. We also present preliminary results from an on-going Open Time program within the NIKA2 collaboration that aims at mapping the ICM temperature of a galaxy cluster at z = 0.45 from the resolved detection of the relativistic corrections to the SZ spectrum. These studies demonstrate how high angular resolution SZ observations will play a major role in the coming decade to push the investigation of ICM dynamics and non-gravitational processes to high redshift before the next generation X-ray observatories come into play.

Dust Emission in Galaxies at Millimeter Wavelengths: Cooling of star forming regions in NGC6946

Interstellar dust plays an important role in the formation of molecular gas and the heating and cooling of the interstellar medium. The spatial distribution of the mm-wavelength dust emission from galaxies is largely unexplored. The NIKA2 Guaranteed Time Project IMEGIN (Interpreting the Millimeter Emission of Galaxies with IRAM and NIKA2) has recently mapped the mm emission in the grand design spiral galaxy NGC6946. By subtracting the contributions from the free-free, synchrotron, and CO line emission, we map the distribution of the pure dust emission at 1:15mm and 2mm. Separating the arm/interarm regions, we find a dominant 2mm emission from interarms indicating the significant role of the general interstellar radiation field in heating the cold dust. Finally, we present maps of the dust mass, temperature, and emissivity index using the Bayesian MCMC modeling of the spectral energy distribution in NGC6946.

Efficacy of Digital Health Tools for a Pediatric Patient Registry: Semistructured Interviews and Interface Usability Testing With Parents and Clinicians

Background

Acute respiratory infection (ARI) in childhood is common, but more knowledge on the burden and natural history of ARI in the community is required. A better understanding of ARI risk factors, treatment, and outcomes will help support parents to manage their sick child at home. Digital health tools are becoming more widely adopted in clinical care and research and may assist in understanding and managing common pediatric diseases, including ARI, in hospitals and in the community. We integrated 2 digital tools—a web-based discharge communication system and the REDCap (Research Electronic Data Capture) platform—into the Pragmatic Adaptive Trial for Acute Respiratory Infection in Children to enhance parent and physician engagement around ARI discharge communication and our patient registry.

Objective

The objective of this study is to determine the efficacy and usability of digital tools integrated into a pediatric patient registry for ARI.

Methods

Semistructured interviews and software interface usability testing were conducted with 11 parents and 8 emergency department physicians working at a tertiary pediatric hospital and research center in Perth, Western Australia, in 2019. Questions focused on experiences of discharge communication and clinical trial engagement. Responses were analyzed using the qualitative Framework Method. Participants were directly observed using digital interfaces as they attempted predetermined tasks that were then classified as success, failure, software failure, or not observed. Participants rated the interfaces using the System Usability Scale (SUS).

Results

Most parents (9/11, 82%) indicated that they usually received verbal discharge advice, with some (5/11, 45%) recalling receiving preprinted resources from their physician. Most (8/11, 73%) would also like to receive discharge advice electronically. Most of the physicians (7/8, 88%) described their usual practice as verbal discharge instructions, with some (3/8, 38%) reporting time pressures associated with providing discharge instructions. The digital technology option was preferred for engaging in research by most parents (8/11, 73%). For the discharge communication digital tool, parents gave a mean SUS score of 94/100 (SD 4.3; A grade) for the mobile interface and physicians gave a mean usability score of 93/100 (SD 4.7; A grade) for the desktop interface. For the research data management tool (REDCap), parents gave a mean usability score of 78/100 (SD 11.0; C grade) for the mobile interface.

Conclusions

Semistructured interviews allowed us to better understand parent and physician experiences of discharge communication and clinical research engagement. Software interface usability testing methods and use of the SUS helped us gauge the efficacy of our digital tools with both parent and physician users. This study demonstrates the feasibility of combining qualitative research methods with software industry interface usability testing methods to help determine the efficacy of digital tools in a pediatric clinical research setting.

Decreased CSF1R Signaling and the Accumulation of Reticular Pseudo-Drusen?

Adult-onset leukoencephalopathy with axonal spheroids and pigmented glia (ALSP) is caused by dominant-acting mutations in the gene colony-stimulating factor 1 receptor (CSF1R). It is an ultra-rare leukoencephalopathy that involves demyelination of white matter and early-onset dementia. It has been well validated that mutations in the kinase region of the gene cause decreased signaling of the receptor via its two cognate ligands interleukin-34 (IL-34) and colony-stimulating factor-1 (CSF-1). In this article, we report a thorough analysis of retinal integrity in a 48-year-old genetically diagnosed ALSP patient. We show that although the optic nerve, optic chiasm, and optic tracts are relatively preserved, the patient has visual field deficits likely due to optic radiation and/or cortical atrophy. Intriguingly, we report the appearance of inner retinal vascular leakage and the appearance of reticular pseudo-drusen (RPD)-like deposits. We propose that the early stages of RPD accumulation may be associated with an attenuated CSF-1 receptor signaling axis. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:666-671.].

Numbers of close contacts of individuals infected with SARS-CoV-2 and their association with government intervention strategies

Background

Contact tracing is conducted with the primary purpose of interrupting transmission from individuals who are likely to be infectious to others. Secondary analyses of data on the numbers of close contacts of confirmed cases could also: provide an early signal of increases in contact patterns that might precede larger than expected case numbers; evaluate the impact of government interventions on the number of contacts of confirmed cases; or provide data information on contact rates between age cohorts for the purpose of epidemiological modelling. We analysed data from 140,204 close contacts of 39,861 cases in Ireland from 1st May to 1st December 2020.

Results

Negative binomial regression models highlighted greater numbers of contacts within specific population demographics, after correcting for temporal associations. Separate segmented regression models of the number of cases over time and the average number of contacts per case indicated that a breakpoint indicating a rapid decrease in the number of contacts per case in October 2020 preceded a breakpoint indicating a reduction in the number of cases by 11 days.

Conclusions

We found that the number of contacts per infected case was overdispersed, the mean varied considerable over time and was temporally associated with government interventions. Analysis of the reported number of contacts per individual in contact tracing data may be a useful early indicator of changes in behaviour in response to, or indeed despite, government restrictions. This study provides useful information for triangulating assumptions regarding the contact mixing rates between different age cohorts for epidemiological modelling.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12318-y.

1324Clinical Registry for Acute Respiratory Infections in Children in Western Australia

Background

Acute respiratory infections (ARIs) are the leading cause for emergency presentation and a major driver for antibiotic use in children. In 2020, we established an ARI clinical registry to: evaluate clinical care for ARI to inform clinical guidelines; and as a platform for clinical trials assessing antimicrobial interventions.

Methods

Any child <16 years presenting to Perth Children’s Hospital Emergency Department (ED) with cough, fever, sore throat and/or difficulty breathing was eligible for enrolment. Using an automated survey sent to parents’ mobile phones, each enrolled child was followed weekly until 28 days or disease recovery (whichever occurred first). Data collected included clinical symptoms, antibiotic prescription, adherence, and duration to return to regular activity (recovery).

Results

From Feb 2020-April 2021, 448 participants were enrolled (84% <5 years). Fever and cough were the most frequently reported symptoms. Of 448, 274 (61%) ARI cases completed all surveys until recovered. The median recovery length was 9 days (IQR:6-12). The recovery days were longer, although not statistically significant (p > 0.05), in: children who received antibiotics versus those who did not (9.5 days vs. 8); children <5 years versus those over (9 days vs. 7); and children with chronic illnesses versus those without (9 days vs. 8).

Conclusions

Most children presenting to ED with ARI recover within 10 days. The length of recovery does not vary significantly by age, chronic illnesses, or antibiotic usage.

Key messages

Registry data provides baseline data to inform clinical trials assessing the role and duration of antibiotics for ARI.

Palliative care research promotion in policy and practice: a knowledge exchange process

In palliative care, as in many areas of medicine, there is a considerable amount of research conducted that makes sound recommendations but does not result consistently in improved care. For instance, though palliative care has been shown to benefit all people with a life-threatening illness, its main reach continues to be for those with cancer. Drawing on relational models of research use, we set out to engage policy-makers, educators, clinicians, commissioners and service providers in a knowledge exchange process to identify implications of research for Scottish palliative care priorities. First, we mapped the existing palliative care research evidence in Scotland. We then organised evidence review meetings and a wider stakeholder event where research producers and users came together to coproduce implications of the evidence for policy, education and practice. We used questionnaires and key stakeholder feedback meetings to explore impacts of this process on research uptake and use immediately after the events and over time. In this paper, we reflect on this knowledge exchange process and the broader context in which it was set. We found that participation fostered relationships and led to a rich and enthusiastic exploration of research evidence from multiple perspectives. Potential impacts relating to earlier identification for palliative care, education and need-based commissioning ensued. We make suggestions to guide replication.

Estimation of the serial interval and proportion of pre-symptomatic transmission events of COVID- 19 in Ireland using contact tracing data

BACKGROUND

The serial interval is the period of time between the onset of symptoms in an infector and an infectee and is an important parameter which can impact on the estimation of the reproduction number. Whilst several parameters influencing infection transmission are expected to be consistent across populations, the serial interval can vary across and within populations over time. Therefore, local estimates are preferable for use in epidemiological models developed at a regional level. We used data collected as part of the national contact tracing process in Ireland to estimate the serial interval of SARS-CoV-2 infection in the Irish population, and to estimate the proportion of transmission events that occurred prior to the onset of symptoms.

RESULTS

After data cleaning, the final dataset consisted of 471 infected close contacts from 471 primary cases. The median serial interval was 4 days, mean serial interval was 4.0 (95% confidence intervals 3.7, 4.3) days, whilst the 25th and 75th percentiles were 2 and 6 days respectively. We found that intervals were lower when the primary or secondary case were in the older age cohort (greater than 64 years). Simulating from an incubation period distribution from international literature, we estimated that 67% of transmission events had greater than 50% probability of occurring prior to the onset of symptoms in the infector.

CONCLUSIONS

Whilst our analysis was based on a large sample size, data were collected for the primary purpose of interrupting transmission chains. Similar to other studies estimating the serial interval, our analysis is restricted to transmission pairs where the infector is known with some degree of certainty. Such pairs may represent more intense contacts with infected individuals than might occur in the overall population. It is therefore possible that our analysis is biased towards shorter serial intervals than the overall population.

O79: THE ROLE OF SENTINEL LYMPH NODE BIOPSY IN BREAST CANCER PATIENTS OVER THE AGE OF 80 – HOW MUCH IS ENOUGH?

Introduction

Recent studies have suggested that sentinel lymph node biopsy (SLNB) can be omitted in newly diagnosed elderly breast cancer (BC) patients as it may not influence decisions regarding further therapeutic intervention. The aim of this study was to assess the impact of SLNB on further surgical intervention as well as adjuvant treatments in patients over the age of 80.

Method

A retrospective study was performed involving all BC patients over the age of 80 diagnosed between 2008 and 2017 who underwent SLNB as part of their initial surgery. Patient/tumour characteristics and adjuvant treatments were recorded.

Result

127 patients underwent SLNB in the study period. The median age was 82 (Range: 80-95). 91/127 (71.6%) had ductal pathology, median tumour grade was 2, and oestrogen receptor positivity was seen in 89% of patients. The median number of sentinel nodes removed was 2 (Range: 1-6). 45 patients (35.4%) had a positive sentinel node (median positive nodes = 1). Of the 45 patients, 11 proceeded to axillary lymph node dissection (ALND) (11/127; 8.6%). The median number of nodes excised during ALND was 14 (Range:7-25) and 6 patients (6/11) had further positive nodes. 9% of patients with a positive node received adjuvant chemotherapy, 87% received adjuvant radiotherapy and 79% received hormonal therapy.

Conclusion

Although SLNB positivity is still used in the elderly patients, only a few patients (<10%) proceed to ALND or receive adjuvant chemotherapy. Hence performing a SLNB should be carefully considered when treating patients over the age of 80

Take-home message

The use of SLNB in elderly patients needs to be considered in node negative patients

Epidemiology of COVID-19 and public health restrictions during the first wave of the pandemic in Ireland in 2020

BACKGROUND

We describe the epidemiological trends and report and review the public health restrictions implemented during the first wave of the COVID-19 pandemic in Ireland.

METHODS

The study reviewed confirmed cases of COVID-19 notified from 1 March to 18 July 2020. Data were obtained from the national COVID-19 Data Hub, the National Health Protection Surveillance Centre, the National Contact Management Programme and the European Centre for Disease Prevention and Control.

RESULTS

A total of 25 617 cases were notified during the study period. Weekly cases and deaths peaked in mid-April 2020 at 5701 and 316, respectively. Mean number of close contacts per case was lowest at 0.7 in April, rising to 6.6 by July. Outbreak settings shifted from travel and workplace in March, to healthcare in April. Restrictions implemented on 12 March extended to full lockdown on 27 March. Phased relaxation of restrictions commenced 18 May. Effective suppression of community transmission of COVID-19 was achieved by June 2020.

CONCLUSION

Lockdown is a crude population-level restriction effective in controlling COVID-19. Phased relaxation of restrictions in Ireland, however, led to an immediate increase in mean number of contacts per case, which facilitates viral transmission unless individual-level restrictions are adhered to. This demonstrates a limitation of lockdown as a long-term mechanism of pandemic control.

Routine testing of close contacts of confirmed COVID-19 cases - National COVID-19 Contact Management Programme, Ireland, May to August 2020

OBJECTIVES

The objective of this study was to inform public health practitioners who are designing, adapting and implementing testing and tracing strategies for Coronavirus disease (COVID-19) control.

STUDY DESIGN

The study design is monitoring and evaluation of a national public health protection programme.

METHODS

All close contacts of laboratory-confirmed cases of COVID-19 identified between the 19th May and 2nd August were included; secondary attack rates and numbers needed to test were estimated.

RESULTS

Four thousand five hundred eighty six of 7272 (63%) close contacts of cases were tested with at least one test. The secondary attack rate in close contacts who were tested was 7% (95% Confidence Interval [CI]: 6.3 - 7.8%). At the 'day 0' test, 14.6% (95% CI: 11.6-17.6%) of symptomatic close contacts tested positive compared with 5.2% (95% CI: 4.4-5.9%) of asymptomatic close contacts.

CONCLUSIONS

The application of additional symptom-based criteria for testing in this high-incidence population (close contacts) is of limited utility because of the low negative predictive value of absence of symptoms.

A proposal for changes to the European Union syphilis surveillance case definition using evidence from evaluations in Ireland

Syphilis remains a disease of public health importance, with considerable health effects if not treated. Concurrent infection with syphilis and untreated HIV facilitates HIV transmission. The incidence of syphilis in Europe has been increasing, particularly among men who have sex with men (MSM) and in MSM with HIV. However, there is heterogeneity among countries in the case definition used for syphilis and in reported syphilis notification rates. In Ireland, we have undertaken a number of refinements of the national syphilis surveillance system since 2014, including refinement of the laboratory thresholds for notification (rapid plasma reagin 1:16 and/or positive IgM). This article outlines the steps taken and some of the challenges we faced. Our current case definition now accurately reflects the epidemiology of syphilis in Ireland and our current surveillance provides timely information for action, while not reducing the sensitivity of the system too much. For countries where surveillance is driven mainly by laboratory reporting and where obtaining clinical details is challenging, these thresholds for notification may be a pragmatic solution.

GASTON: Galactic Star Formation with NIKA2 A new population of cold massive sources discovered

Understanding where and when the mass of stars is determined is one of the fundamental, mostly unsolved, questions in astronomy. Here, we present the first results of GASTON, the Galactic Star Formation with NIKA2 large programme on the IRAM 30m telescope, that aims to identify new populations of low-brightness sources to tackle the question of stellar mass determination across all masses. In this paper, we focus on the high-mass star formation part of the project, for which we map a ~ 2 deg2 region of the Galactic plane around l = 24° in both 1.2 mm and 2.0 mm continuum. Half-way through the project, we reach a sensitivity of 3.7 mJy/beam at 1.2mm. Even though larger than our target sensitivity of 2 mJy, the current sensitivity already allows the identification of a new population of cold, compact sources that remained undetected in any (sub-)mm Galactic plane survey so far. In fact, about 25% of the ~ 1600 compact sources identified in the 1.2mm GASTON image are new detections. We present a preliminary analysis of the physical properties of the GASTON sources as a function of their evolutionary stage, arguing for a potential evolution of the mass distribution of these sources with time.

Cluster cosmology with the NIKA2 SZ Large Program

The main limiting factor of cosmological analyses based on thermal Sunyaev-Zel’dovich (SZ) cluster statistics comes from the bias and systematic uncertainties that affect the estimates of the mass of galaxy clusters. High-angular resolution SZ observations at high redshift are needed to study a potential redshift or morphology dependence of both the mean pressure profile and of the mass-observable scaling relation used in SZ cosmological analyses. The NIKA2 camera is a new generation continuum instrument installed at the IRAM 30-m telescope. With a large field of view, a high angular resolution and a high-sensitivity, the NIKA2 camera has unique SZ mapping capabilities. In this paper, we present the NIKA2 SZ large program, aiming at observing a large sample of clusters at redshifts between 0.5 and 0.9, and the characterization of the first cluster oberved with NIKA2.

Mapping the gas thermodynamic properties of the massive cluster merger MOO J1142+1527 at z = 1.2

We present the results of the analysis of the very massive cluster MOO J1142+1527 at a redshift z = 1.2 based on high angular resolution NIKA2 Sunyaev-Zel’dovich (SZ) andChandraX-ray data. This multi-wavelength analysis enables us to estimate the shape of the temperature profile with unprecedented precision at this redshift and to obtain a map of the gas entropy distribution averaged along the line of sight. The comparison between the cluster morphological properties observed in the NIKA2 andChandramaps together with the analysis of the entropy map allows us to conclude that MOOJ1142+1527 is an on-going merger hosting a cool-core at the position of the X-ray peak. This work demonstrates how the addition of spatially-resolved SZ observations to low signal-to-noise X-ray data can bring valuable insights on the intracluster medium thermodynamic properties atz>1.

Observing with NIKA2Pol from the IRAM 30m telescope : Early results on the commissioning phase

The NIKA2 polarization channel at 260 GHz (1.15 mm) has been proposed primarily to observe galactic star-forming regions and probe the critical scales between 0.01-0.05 pc at which magnetic field lines may channel the matter of interstellar filaments into growing dense cores. The NIKA2 polarime-ter consists of a room temperature continuously rotating multi-mesh HWP and a cold polarizer that separates the two orthogonal polarizations onto two 260 GHz KIDs arrays. We describe in this paper the preliminary results obtained during the most recent commissioning campaign performed in December 2018. We concentrate here on the analysis of the extended sources, while the observation of compact sources is presented in a companion paper [12]. We present preliminary NIKA2 polarization maps of the Crab nebula. We find that the integrated polarization intensity flux measured by NIKA2 is consistent with expectations. In terms of polarization angle, we are still limited by systematic uncertainties that will be further investigated in the forthcoming commissioning campaigns.

Preliminary results on the instrumental polarization of NIKA2-Pol at the IRAM 30m telescope

Clarifying the role of magnetic fields in the star formation process is crucial. Observations have already shown that magnetic fields play an important role in the early stages of star formation. The high spatial resolution (∼0.01 to 0.05 pc) provided by NIKA2-Pol 1.2 mm imaging polarimetry of nearby clouds will help us clarify the geometry of the B-field within dense cores and molecular filaments as part of the IRAM 30m large program B-FUN. There are numerous challenging issues in the validation of NIKA2-Pol such as the calibration of instrumental polarization. The commissioning phase of NIKA2-Pol is underway and is helping us characterize the intensity-to-polarization “leakage” pattern of the instrument. We present a preliminary analysis of the leakage pattern and its dependence with elevation. We also present the current leakage correction made possible by the NIKA2 pipeline in polarization mode based on the NIKA2-Pol commissioning data taken in December 2018. Based on reduced Stokes I, Q, U data we find that the leakage pattern of NIKA2-Pol depends on elevation and is sensitive to the focus of the telescope.

Debris disks around stars in the NIKA2 era

The new NIKA2 camera at the IRAM 30m radiotelescope was used to observe three known debris disks in order to constrain the SED of their dust emission in the millimeter wavelength domain. We have found that the spectral index between the two NIKA2 bands (1mm and 2mm) is consistent with the Rayleigh-Jeans regime (λ-2), unlike the steeper spectra (λ-3) measured in the submillimeter-wavelength domain for two of the three disks - around the stars Vega and HD107146. We provide a succesful proof of concept to model this spectral inversion in using two populations of dust grains, those smaller and those larger than a grain radius a0 of 0.5mm. This is obtained in breaking the slope of the size distribution and the functional form of the absorption coefficient of the standard model. The third disk - around the star HR8799 - does not exhibit this spectral inversion but is also the youngest.

NIKA2 mapping and cross-instrument SED extraction of extended sources with Scanamorphos

The steps taken to tailor to NIKA2 observations the Scanamorphos algorithm (initially developed to subtract low-frequency noise from Herschel on-the-fly observations) are described, focussing on the consequences of the different instrument architecture and observation strategy. The method, making the most extensive use of the redundancy built in the multi-scan coverage with large arrays of a given region of the sky, is applicable to extended sources, while the pipeline is so far optimized for compact sources. An example of application is given. A related tool to build consistent broadband SEDs from 60 microns to 2 mm, combining Herschel and NIKA2 data, has also been developed. Its main task is to process the data least affected by low-frequency noise and coverage limitations (i.e. the Herschel data) through the same transfer function as the NIKA2 data, simulating the same scan geometry and applying the same noise and atmospheric signal as extracted from the 1mm and 2mm data.

The NIKA polarimeter on science targets: Crab nebula observations at 150 GHz and dual-band polarization images of Orion Molecular Cloud OMC-1

We present here the polarization system of the NIKA camera and give a summary of the main results obtained and performed studies on Orion and the Crab nebula. The polarization system was equipped with a room temperature continuously rotating multi-mesh half wave plate and a grid polarizer facing the NIKA cryostat window. NIKA even though less sensitive than NIKA2 had polarization capability in both 1 and 2 millimiter bands. NIKA polarization observations demonstrated the ability of such a technology in detecting the polarization of different targets, compact and extended sources like the Crab nebula and Orion Molecular Cloud region OMC-1. These measurements together with the developed techniques to deal with systematics, opened the way to the current observations of NIKA2 in polarization that will provide important advances in the studies of galactic and extra-galactic emission and magnetic fields.

NIKA: a mm camera for Sunyaev-Zel’dovich science in clusters of galaxies

Clusters of galaxies, the largest bound objects in the Universe, constitute a cosmological probe of choice, which is sensitive to both dark matter and dark energy. Within this framework, the Sunyaev-Zel’dovich (SZ) effect has opened a new window for the detection of clusters of galaxies and for the characterization of their physical properties such as mass, pressure and temperature. NIKA, a KID-based dual band camera installed at the IRAM 30-m telescope, was particularly well adapted in terms of frequency, angular resolution, field-of-view and sensitivity, for the mapping of the thermal and kinetic SZ effect in high-redshift clusters. In this paper, we present the NIKA cluster sample and a review of the main results obtained via the measurement of the SZ effect on those clusters: reconstruction of the cluster radial pressure profile, mass, temperature and velocity.

A low-mass galaxy cluster as a test-case study for the NIKA2 SZ Large Program

High-resolution mapping of the hot gas in galaxy clusters is a key tool for cluster-based cosmological analyses. Taking advantage of the NIKA2 millimeter camera operated at the IRAM 30-m telescope, the NIKA2 SZ Large Program seeks to get a high-resolution follow-up of 45 galaxy clusters covering a wide mass range at high redshift in order to re-calibrate some of the tools needed for the cosmological exploitation of SZ surveys. We present the second cluster analysis of this program, targeting one of the faintest sources of the sample in order to tackle the difficulties in data reduction for such faint, low-SNR clusters. In this study, the main challenge is the precise estimation of the contamination by sub-millimetric point sources, which greatly affects the tSZ map of the cluster. We account for this contamination by performing a joint fit of the SZ signal and of the flux density of the compact sources. A prior knowledge of these fluxes is given by the adjustment of the SED of each source using data from both NIKA2 and the Herschel satellite. The first results are very promising and demonstrate the possibility to estimate thermodynamic properties with NIKA2, even in a compact cluster heavily contaminated by point sources.

Parental experiences of their child's vulvovaginitis: a qualitative interview study

INTRODUCTION

Vulvovaginitis is described as a common self-limiting paediatric gynaecological condition. Parents' experiences of their child being diagnosed with this condition and subsequent treatment have not previously been described.

AIM

The aim of this study was to explore parents' experiences of their child's diagnosis and management of vulvovaginitis.

STUDY DESIGN

The study was conducted in the north west of England over a two-year period. Qualitative data were generated by semistructured in-depth interviews. Mothers of nine children with vulvovaginitis consented to participate. Data were analysed using thematic analysis.

RESULTS

The analysis of the data resulted in four themes: trauma and uncertainty of initial symptoms, seeking a diagnosis; an uncertain journey, managing the symptoms; a process of trial and error and managing the impact; keeping it private. Parents experienced a difficult and protracted journey to their child's diagnosis and were involved in a process of trial and error to try and monitor and manage what can be a difficult ongoing condition.

DISCUSSION

Clinical reports suggest that vulvovaginitis is a minor childhood condition; this is not necessarily the perceptions and experiences of parents, who can experience uncertainty and ongoing difficulty after their child's diagnosis.

CONCLUSION

The diagnosis of vulvovaginitis can have a major and ongoing impact on children's and their family's lives.