Management of patients with severe acute respiratory failure due to SARS-CoV-2 pneumonia with noninvasive ventilatory support outside Intensive Care Unit

BACKGROUND

COVID-19 has high mortality rate mainly stemming from acute respiratory distress leading to respiratory failure (ARF). Aim of the study was to evaluate the management of severe ARF due to COVID-19 pneumonia using noninvasive ventilatory support (NIVS), studying safety and effectiveness of NIVS.

METHODS

This is a retrospective, multicenter study. Primary outcomes were NIVS failure with intubation rate and hospital mortality. Secondary outcomes were hospital stay and factors related to NIVS failure and mortality. These outcomes were compared with patients intubated and admitted to ICU.

RESULTS

One hundred sixty-two patients were hospitalized because of severe respiratory failure (PaO<inf>2</inf>/FiO<inf>2</inf> ratio <250). One hundred thirty-eight patients were admitted to Respiratory Intermediate Care Unit (RICU) for a NIVS trial. One hundred patients were treated successfully with NIVS (74.5%); 38 failed NIVS trial (27.5%). In-hospital mortality was 23.18% in RICU group and 30.55% in ICU group. Patients with NIVS failure were older, had a lower number of lymphocytes, a higher IL-6, lower PaO<inf>2</inf>, PaC O<inf>2</inf>, PaO<inf>2</inf>/FiO<inf>2</inf> ratio, higher respiratory rate (RR) and heart rate at admission and lower PaO2, and PaO<inf>2</inf>/FiO<inf>2</inf> ratio and higher RR after 1-6 hours. Multivariate analysis identified higher age, C-reactive protein as well as RR after 1-6 hours and PaO<inf>2</inf>/FiO<inf>2</inf> ratio after 1-6 hours as an independent predictor mortality.

CONCLUSIONS

NIVS is a safe and effective strategy in the treatment of severe ARF due to COVID-19 related pneumonia, that reduces mortality and length of hospital stay in the carefully selected patients.

Non-invasive ventilation in the treatment of severe polymicrobial community-acquired pneumonia

Polymicrobial pneumonia may be caused by the combination of respiratory viruses, bacteria and fungi in a host. Colonization by <em>Streptococcus pneumoniae</em> was associated with increased risk of Intensive Care Unit admission or death in the setting of influenza infection, whereas the colonization by methicillin sensible <em>Staphylococcus aureus</em> co-infection was associated with severe disease and death in adults and children. The principal association of pathogens in community-acquired pneumonia (CAP) is bacteria and viral co-infection, and accounts approximately for 39% of microbiological diagnosed cases of CAP. The differential clinical diagnosis between a viral and a bacterial CAP is not easy: no clinical signs or radiological findings help the clinician to suspect to the diagnosis. Patients with polymicrobial infections are more likely to have underlying medical conditions and have more severe outcome. Severe respiratory failure and need of mechanical ventilation occur in several cases. Non invasive ventilation (NIV) use aims to avoid invasive mechanical ventilation. NIV treatment is controversial owing to high reported treatment failure. In this case series we report three cases of severe polymicrobial CAP: all of them required NIV with a good outcome.

A direct electron detector for time-resolved MeV electron microscopy

The introduction of direct electron detectors enabled the structural biology revolution of cryogenic electron microscopy. Direct electron detectors are now expected to have a similarly dramatic impact on time-resolved MeV electron microscopy, particularly by enabling both spatial and temporal jitter correction. Here we report on the commissioning of a direct electron detector for time-resolved MeV electron microscopy. The direct electron detector demonstrated MeV single electron sensitivity and is capable of recording megapixel images at 180 Hz. The detector has a 15-bit dynamic range, better than 30-μm spatial resolution and less than 20 analogue-to-digital converter count RMS pixel noise. The unique capabilities of the direct electron detector and the data analysis required to take advantage of these capabilities are presented. The technical challenges associated with generating and processing large amounts of data are also discussed.

A rare adverse reaction to ethambutol: drug-induced haemolytic anaemia

Anti-tuberculosis drugs seldom cause serious haematological side effects. However, among these drugs, isoniazid and rifampicin, especially when administered intermittently, may very rarely be linked to acute autoimmune haemolytic anaemia. Ethambutol (EMB) can cause dose-related retrobulbar neuritis. In this paper, we present the first reported case of acute fatal autoimmune haemolytic anaemia due to EMB.

Data systems for the Linac coherent light source

The data systems for X-ray free-electron laser (FEL) experiments at the Linac coherent light source (LCLS) are described. These systems are designed to acquire and to reliably transport shot-by-shot data at a peak throughput of 5 GB/s to the offline data storage where experimental data and the relevant metadata are archived and made available for user analysis. The analysis and monitoring implementation (AMI) and Photon Science ANAlysis (psana) software packages are described. Psana is open source and freely available.

Pneumomediastinum following Endobronchial Ultrasound- Guided Transbronchial Needle Aspiration: A Case Report

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an effective and safe technique associated with a very low complication rate for the sampling of lymph nodes in those presenting with mediastinal and hilar adenopathy." We report a rare case describing the development of pneumomediastinum following EBUS-TBNA in a young patient with mediastinal lymphadenopathy secondary to non-Hodgkin's lymphoma. Conservative treatment led to spontaneous resolution of the pneumomediastinum. Pneumomediastinum is a rare but possible complication of EBUS-TBNA. Careful follow-up can reduce its severity and the associated morbidity.

Data systems for the Linac Coherent Light Source

The data acquisition and data management systems for X-ray free-electron laser experiments at the Linac Coherent Light Source are described. These systems are designed to acquire and to reliably transport shot-by-shot data at a peak throughput of 5 GB s−1to the offline data storage, where experimental data and the relevant metadata are archived and made available for user analysis. A case study of a serial femtosecond crystallography pipeline is presented.

Interfacial tension of oil/water emulsions with mixed non-ionic surfactants: comparison between experiments and molecular simulations

Smaller Span molecules occupy the free spaces between bulkier Tween molecules thus lowering interfacial tension as compared to those obtained for single surfactant systems.

Phase inversion emulsification: Current understanding and applications

This review is addressed to the phase inversion process, which is not only a common, low-energy route to make stable emulsions for a variety of industrial products spanning from food to pharmaceuticals, but can also be an undesired effect in some applications, such as crude oil transportation in pipelines. Two main ways to induce phase inversion are described in the literature, i.e., phase inversion composition (PIC or catastrophic) and phase inversion temperature (PIT or transitional). In the former, starting from one phase (oil or water) with surfactants, the other phase is more or less gradually added until it reverts to the continuous phase. In PIT, phase inversion is driven by a temperature change without varying system composition. Given its industrial relevance and scientific challenge, phase inversion has been the subject of a number of papers in the literature, including extensive reviews. Due to the variety of applications and the complexity of the problem, most of the publications have been focused either on the phase behavior or the interfacial properties or the mixing process of the two phases. Although all these aspects are quite important in studying phase inversion and much progress has been done on this topic, a comprehensive picture is still lacking. In particular, the general mechanisms governing the inversion phenomenon have not been completely elucidated and quantitative predictions of the phase inversion point are limited to specific systems and experimental conditions. Here, we review the different approaches on phase inversion and highlight some related applications, including future and emerging perspectives.

Non-invasive ventilation for the treatment of acute respiratory failure following ovarian hyperstimulation syndrome: report of two cases and a brief review of the literature

The ovarian hyperstimulation syndrome (OHSS) is a serious but rarely fatal complication of medical interventions that seek to induce fertility; it is typically encountered in women who undergo controlled ovarian hyperstimulation, but there are very rare patients who have genetic defects who present with OHSS. In recent years, its pathogenesis has been elucidated; this knowledge will decrease the frequency of this syndrome. Clinical signs may include any or all of the following: rapid weight gain, ascites, oliguria, hemoconcentration, leukocytosis, along with intravascular hypovolemia, hyponatremia, and hyperkalemia. If the patient is not diagnosed early, ascites, pleural and more rarely pericardial effusions, severe respiratory failure and ARDS, hypercoagulability with tromboembolism and multiple organ system failure can occur. Due to the increased use of therapeutic strategies for infertility (particularly those using human chorionic gonadotropin), the systemic, particularly the pulmonary, complications of this syndrome must be identified early to allow appropriate diagnosis and management. We describe two cases of women with extremely severe OHSS presenting bilateral pleural effusions, and severe respiratory failure (paO2/FiO2 < 200) treated with non-invasive ventilation (NIV). The severe form of OHSS varies between 0.5% and 5%, depending on the population studied: intensive care may be required for management of tromboembolic complications, renal failure and severe respiratory failure. The diagnosis of severe OHSS was made, largely based on bedside ultrasonography showing increased ovarian size, mild ascites and bilateral pleural effusions. Owing to severe respiratory failure the patients were admitted to Respiratory Intermediate Care. Pulmonary intensive care may involve thoracentesis, oxygen supplementation and in more severe cases assisted ventilation. There are only a few studies in English that describe severe respiratory failure treated with non-invasive ventilation, but all of them have had good outcomes.

The use of non-invasive ventilation in very old patients with hypercapnic acute respiratory failure because of COPD exacerbation

AIMS

We prospectively enrolled 207 patients (121 were 75 or older and 86 younger than 75) who were admitted to three Respiratory Monitoring Units. The primary outcomes were intubation and mortality rates; the secondary outcomes were changes in arterial blood gases analysis, non-invasive ventilation (NIV) duration and length of hospital stay.

RESULTS

Hospital mortality was similar in the two groups, as were intubation rates. The proportion who died in the very old patient group was 19.8% (24/121) vs. 10.4% (9/86) in the younger group. Intubation rate was 10.7% (13/121) in the very old patient group and 11.6% (10/86) in the younger group. The presence of comorbidities, the severity of illness (SAPS II), the level of consciousness, NIV failure (intubation), absolute value of pH prior to NIV, as well as the changes in pH and paCO2 and PaO2 /FiO2 after 2 h of NIV, were the variables associated with higher mortality. Very old patients had significantly higher NIV duration than younger patients (69.0 ± 47.0 vs. 57.0 ± 27.0 h) (p ≤ 0.03) and hospital stays (11.6 ± 3.8 vs. 8.4 ± 1.4) (p ≤ 0.02).

CONCLUSIONS

The use of NIV in very old patients was effective in many cases. Endotracheal intubation after NIV failure was not efficacious in either group.

Can ultrasound guidance reduce the risk of pneumothorax following thoracentesis?

OBJECTIVE:

Thoracentesis is one of the bedside procedures most commonly associated with iatrogenic complications, particularly pneumothorax. Various risk factors for complications associated with thoracentesis have recently been identified, including an inexperienced operator; an inadequate or inexperienced support team; the lack of a standardized protocol; and the lack of ultrasound guidance. We sought to determine whether ultrasound-guided thoracentesis can reduce the risk of pneumothorax and improve outcomes (fewer procedures without fluid removal and greater volumes of fluid removed during the procedures). In our comparison of thoracentesis with and without ultrasound guidance, all procedures were performed by a team of expert pulmonologists, using the same standardized protocol in both conditions.

METHODS:

A total of 160 participants were randomly allocated to undergo thoracentesis with or without ultrasound guidance (n = 80 per group). The primary outcome was pneumothorax following thoracentesis. Secondary outcomes included the number of procedures without fluid removal and the volume of fluid drained during the procedure.

RESULTS:

Pneumothorax occurred in 1 of the 80 patients who underwent ultrasound-guided thoracentesis and in 10 of the 80 patients who underwent thoracentesis without ultrasound guidance, the difference being statistically significant (p = 0.009). Fluid was removed in 79 of the 80 procedures performed with ultrasound guidance and in 72 of the 80 procedures performed without it. The mean volume of fluid drained was larger during the former than during the latter (960 ± 500 mL vs. 770 ± 480 mL), the difference being statistically significant (p = 0.03).

CONCLUSIONS:

Ultrasound guidance increases the yield of thoracentesis and reduces the risk of post-procedure pneumothorax. (Chinese Clinical Trial Registry identifier: ChiCTR-TRC-12002174 [http://www.chictr.org/en/])

Acute respiratory failure following ovarian hyperstimulation syndrome

Ovarian hyperstimulation syndrome is a serious and potentially life-threatening physiological complication that may be encountered in patients who undergo controlled ovarian hyperstimulation cycles. The syndrome is typically associated with regimes of exogenous gonadotropins, but it can be seen, albeit rarely, when clomiphene is administered during the induction phase. Although this syndrome is widely described in scientific literature and is well known by obstetricians, the knowledge of this pathological and potentially life-threatening condition is generally less than satisfactory among physicians. The dramatic increase in therapeutic strategies to treat infertility has pushed this condition into the realm of acute care therapy. The potential complications of this syndrome, including pulmonary involvement, should be considered and identified so as to allow a more appropriate diagnosis and management. We describe a case of a woman with an extremely severe (Stage 6) ovarian hyperstimulation syndrome who presented ascites, bilateral pleural effusion and severe respiratory failure treated with non-invasive ventilation. The patient was admitted to the intensive care unit because of severe respiratory failure, ascites, and bilateral pleural effusion due to ovarian hyperstimulation syndrome. Treatment included non-invasive ventilation and three thoracentesis procedures, plus the administration of albumin, colloid solutions and high-dose furosemid. Severe form of ovarian hyperstimulation syndrome is observed in 0.5-5% of the women treated, and intensive care may be required for management of thromboembolic complications, renal failure and severe respiratory failure. Pulmonary intensive care may involve thoracentesis, oxygen supplementation and, in more severe cases, assisted ventilation. To our knowledge, there have been only two studies in English language medical literature that describe severe respiratory failure treated with non-invasive ventilation.

Desmoplastic malignant mesothelioma of the pericardium: Description of a case and review of the literature

Desmoplastic mesothelioma (DMM) is a rare and highly lethal subtype of diffuse malignant mesothelioma and is often difficult to distinguish from reactive pleural fibrosis. The term "desmoplastic" refers to the growth of fibrous or connective tissue. We report the clinical, radiological, and pathological features of a primary DMM of the pericardium and a short review of the literature. A 72-year-old man was admitted presenting shortness of breath, cough, and asthenia. Computed tomography scan showed thickenings and effusions both in the pleura and in the pericardium. Histopathological diagnosis was performed by surgical pericardial biopsy and confirmed by autopsy. The patient had a history of asbestos exposure. Primary mesothelioma of the pericardium is a rare tumor occurring in the fourth to seventh decades with nonspecific symptoms and a rapid clinical course. The diagnosis is difficult and often needing a surgical pericardial biopsy. The prognosis is poor although newer antiblastic drugs seem to prolong survival times.

Influenza A H1N1 pneumonia in a patient with hairy-cell leukemia

Severe pandemic influenza A virus (H1N1) infection is associated with risk factors such as pregnancy, obesity and immunosuppression. Immunocompromised patients are at increased risk of more severe or prolonged infection. We report a case of a hairy cell leukemia patient with H1N1 pneumonia which caused severe and prolonged illness. H1N1 virus pneumonia with meticillin-resistant Staphilococcus Aerues (MRSA) coinfection causing Acute Lung Injury (ALI) was treated with a double-dose of osentamyvir, a high dose of teicoplanin and a low dose of corticosteroids. Haematological findings included leucopenia, neutropenia, lymphopenia, reduction of gamma-globulins and natural killer (NK) cells. Reduction of NK and gamma-globulins may explain the development of severe illness and the prolonged illness Neutropenia may explain the MRSA co-infection. Lymphopenia is directly associated with virus action and is considered to be a marker of the swine influenza in adults.

Measurement of D{0}-D[-over]{0} mixing from a time-dependent amplitude analysis of D{0}-->K+pi{-}pi{0} decays

We present evidence of D{0}-D[-over ]{0} mixing using a time-dependent amplitude analysis of the decay D{0}-->K+pi{-}pi;{0} in a data sample of 384 fb{-1} collected with the BABAR detector at the PEP-II e+e{-} collider at the Stanford Linear Accelerator Center. Assuming CP conservation, we measure the mixing parameters x{Kpipi{0}}{'}=[2.61{-0.68}{+0.57}(stat)+/-0.39(syst)]%, y{Kpipi;{0}}{'}=[-0.06{-0.64}{+0.55}(stat)+/-0.34(syst)]%. This result is inconsistent with the no-mixing hypothesis with a significance of 3.2 standard deviations. We find no evidence of CP violation in mixing.

Measurement of semileptonic B decays into orbitally excited charmed mesons

We present a study of B decays into semileptonic final states containing charged and neutral D1(2420) and D_{2};{*}(2460). The analysis is based on a data sample of 208 fb;{-1} collected at the Upsilon(4S) resonance with the BABAR detector at the PEP-II asymmetric-energy B factory at SLAC. With a simultaneous fit to four different decay chains, the semileptonic branching fractions are extracted from measurements of the mass difference Deltam=m(D;{**})-m(D) distributions. Product branching fractions are determined to be B(B;{+}-->D_{1};{0}l;{+}nu_{l})xB(D_{1};{0}-->D;{*+}pi;{-})=(2.97+/-0.17+/-0.17)x10;{-3}, B(B;{+}-->D_{2};{*0}l;{+}nu_{l})xB(D_{2};{*0}-->D;{(*)+}pi;{-})=(2.29+/-0.23+/-0.21)x10;{-3}, B(B;{0}-->D_{1};{-}l;{+}nu_{l})xB(D_{1};{-}-->D;{*0}pi;{-})=(2.78+/-0.24+/-0.25)x10;{-3} and B(B;{0}-->D_{2};{*-}l;{+}nu_{l})xB(D_{2};{*-}-->D;{(*)0}pi;{-})=(1.77+/-0.26+/-0.11)x10;{-3}. In addition we measure the branching ratio Gamma(D_{2};{*}-->Dpi;{-})/Gamma(D_{2};{*}-->D;{(*)}pi;{-})=0.62+/-0.03+/-0.02.

Measurement of B-->Xgamma decays and determination of |Vtd/Vts|

Using a sample of 383 x 10;{6} BB[over ] events collected by the BABAR experiment, we measure sums of seven exclusive final states B-->X_{d(s)}gamma, where X_{d}(X_{s}) is a nonstrange (strange) charmless hadronic system in the mass range 0.6-1.8 GeV/c;{2}. After correcting for unmeasured decay modes in this mass range, we obtain a branching fraction for b-->dgamma of (7.2+/-2.7(stat)+/-2.3(syst))x10;{-6}. Taking the ratio of X_{d} to X_{s} we find Gamma(b-->dgamma)/Gamma(b-->sgamma)=0.033+/-0.013(stat)+/-0.009(syst), from which we determine |V_{td}/V_{ts}|=0.177+/-0.043.

Evidence for X(3872)-->psi(2S)gamma in B(+/-)-->X(3872)K(+/-) decays and a study of B-->cc[over ]gammaK

In a search for B-->cc[over ]gammaK decays with the BABAR detector, where cc[over ] includes J/psi and psi(2S), and K includes K(+/-), K(S)(0), and K(*)(892), we find evidence for X(3872)-->J/psigamma and X(3872)-->psi(2S)gamma with 3.6sigma and 3.5sigma significance, respectively. We measure the product of branching fractions B(B(+/-)-->X(3872)K(+/-))xB(X(3872)-->J/psigamma)=[2.8+/-0.8(stat)+/-0.1(syst)]x10(-6) and B(B(+/-)-->X(3872)K(+/-))xB(X(3872)-->psi(2S)gamma)=[9.5+/-2.7(stat)+/-0.6(syst)]x10(-6).

Direct CP, lepton flavor, and isospin asymmetries in the decays B-->K(*)l+l-

We measure branching fractions and integrated rate asymmetries for the rare decays B-->K(*)l+l-, where l+l- is either e+e- or micro+micro-, using a sample of 384x10(6) BB events collected with the BABAR detector at the PEP-II e+e- collider. We find no evidence for direct CP or lepton-flavor asymmetries. However, for dilepton masses below the J/psi resonance, we find evidence for unexpectedly large isospin asymmetries in both B-->Kl+l- and B-->K*l+l- which differ, respectively, by 3.2sigma and 2.7sigma, including systematic uncertainties, from the standard model expectations.

Measurement of the e;{+}e;{-}-->bb[over ] Cross Section between sqrt[s]=10.54 and 11.20 GeV

We report e;{+}e;{-}-->bb[over ] cross section measurements by the BABAR experiment performed during an energy scan in the range of 10.54 to 11.20 GeV at the SLAC PEP-II e;{+}e;{-} collider. A total relative error of about 5% is reached in more than 300 center-of-mass energy steps, separated by about 5 MeV. These measurements can be used to derive precise information on the parameters of the Upsilon(10860) and Upsilon(11020) resonances. In particular we show that their widths may be smaller than previously measured.

Measurement of the branching fractions of B-->D**(l) nu(l) decays in events tagged by a fully reconstructed B meson

We report a measurement of the branching fractions of B-->D**(l) nu(l), decays based on 417 fb(-1) of data collected at the Y(4S) resonance with the BABAR detector at the PEP-II e+e- storage rings. Events are selected by full reconstructing one of the B mesons in a hadronic decay mode. A fit to the invariant mass differences m(D(*) pi)- m(D(*)) is performed to extract the signal yields of the different D** states. We observe the B-->D**l(-1)nu(l) decay modes corresponding to the four D states predicted by heavy quark symmetry with a significance greater than 5 standard deviations including systematic uncertainties.

Searches for B meson decays to phiphi, phirho, phif_{0}(980), and f_{0}(980)f_{0}(980) final states

We present the results of searches for B decays to charmless final states involving varphi, f_{0}(980), and charged or neutral rho mesons. The data sample corresponds to 384x10;{6} BB[over ] pairs collected with the BABAR detector operating at the PEP-II asymmetric-energy e;{+}e;{-} collider at SLAC. We find no significant signals and determine the following 90% confidence level upper limits on the branching fractions, including systematic uncertainties: B(B;{0}-->varphivarphi)<2.0x10;{-7}, B(B;{+}-->varphirho;{+})<30x10;{-7}, B(B;{0}-->varphirho;{0})<3.3x10;{-7}, B[B;{0}-->varphif_{0}(980)]xB[f_{0}(980)-->pi;{+}pi;{-}]<3.8x10;{-7}, and B[B;{0}-->f_{0}(980)f_{0}(980)]xB[f_{0}(980)-->pi;{+}pi;{-}]xB[f_{0}(980)-->K;{+}K;{-}]<2.3x10;{-7}.

Measurement of the CP asymmetry in b-->sgamma using a sum of exclusive final states

We perform a measurement of the CP asymmetry in b-->sgamma decays using a sample of 383 x 10(6) B[over] B events collected by the BABAR detector at the SLAC PEP-II asymmetric B factory. We reconstruct 16 flavor-specific B decay modes containing a high-energy photon and a hadronic system X_(s) containing an s quark. We measure the CP asymmetry to be -0.011+/-0.030(stat)+/-0.014(syst) for a hadronic system mass between 0.6 and 2.8 GeV/c(2).

Observation and polarization measurements of B+/- -->phiK1 +/- and B +/- -->phiK2 *+/-

With the full BABAR data sample of 465 x 10(6) B(over)B pairs, we observe the decays B+/- -->phiK_(1)(1270) +/- and B +/- -->phiK*_(2)(1430)+/-. We measure the branching fractions (6.1+/-1.6+/-1.1) x 10(-6) and (8.4+/-1.8+/-1.0) x 10(-6) and the fractions of longitudinal polarization 0.46 (+0.12+0.06) _(-0.13-0.07) and 0.80(+0.09)_(-0.10)+/-0.03, respectively. We also report on the B+/- -->phiK*_(0)(1430)+/- decay branching fraction of (7.0+/-1.3+/-0.9) x 10(-6) and several parameters sensitive to CP violation and interference in the above three decays. Upper limits are placed on the B+/- decay rates to final states with phi and K_1(1400)+/-, K*(1410)+/-, K2(1770)+/-, or K_2(1820)+/-. Understanding the observed polarization pattern requires amplitude contributions from an uncertain source.

Study of B meson decays with excited eta and eta' mesons

Using 383 x 10(6) BBover pairs from the BABAR data sample, we report results for branching fractions of six charged B-meson decay modes, where a charged kaon recoils against a charmless resonance decaying to KKover* or etapipi final states with mass in the range (1.2-1.8) GeV/c2. We observe a significant enhancement at the low KKover* invariant mass which is interpreted as B+-->eta(1475)K+, find evidence for the decay B+-->eta(1295)K+, and place upper limits on the decays B+-->eta(1405)K+, B+-->f1(1285)K+, B+-->f1(1420)K+, and B+-->phi(1680)K+.

Observation of Y(3940) --> J/psiomega in B --> J/psiomegaK at BABAR

We present a study of the decays B;{0,+}-->J/psiomegaK;{0,+} using 383x10;{6} BB[over ] events obtained with the BABAR detector at PEP-II. We observe Y(3940)-->J/psiomega, with mass 3914.6_{-3.4};{+3.8}(stat)+/-2.0(syst) MeV/c;{2}, and width 34_{-8};{+12}(stat)+/-5(syst) MeV. The ratio of B0 and B+ decay to YK is 0.27_{-0.23};{+0.28}(stat)-0.01+0.04(syst), and the relevant B0 and B+ branching fractions are reported.

Measurements of B --> {pi,eta,eta;{'}}lnu_{l} branching fractions and determination of |V_{ub}| with semileptonically tagged B mesons

We report measurements of branching fractions for the decays B-->Plnu_{l}, where P are the pseudoscalar charmless mesons pi;{-}, pi;{0}, eta and eta;{'}, based on 348 fb;{-1} of data collected with the BABAR detector, using B0 and B+ mesons found in the recoil of a second B meson decaying as B-->D;{(*)}lnu_{l}. Assuming isospin symmetry, we combine pionic branching fractions to obtain B(B;{0}-->pi;{-}l;{+}nu_{l})=(1.54+/-0.17_{(stat)}+/-0.09_{(syst)})x10;{-4}; we find 3.2sigma evidence of the decay B;{+}-->etal;{+}nu_{l} and measure its branching fraction to be (0.64+/-0.20_{(stat)}+/-0.03_{(syst)})x10;{-4}, and determine B(B;{+}-->eta;{'}l;{+}nu_{l})<0.47x10;{-4} to 90% confidence level. Using partial branching fractions for the pionic decays in ranges of the momentum transfer and a variety of form factor calculation, we obtain values of the magnitude of the Cabibbo-Kobayashi-Maskawa matrix element |V_{ub}| in ranging from 3.6x10;{-3} to 4.1x10;{-3}.

Observation of the bottomonium ground state in the decay Upsilon(3S)-->gammaetab

We report the results of a search for the bottomonium ground state etab(1S) in the photon energy spectrum with a sample of (109+/-1) million of Upsilon(3S) recorded at the Upsilon(3S) energy with the BABAR detector at the PEP-II B factory at SLAC. We observe a peak in the photon energy spectrum at Egamma=921.2(-2.8)+2.1(stat)+/-2.4(syst) MeV with a significance of 10 standard deviations. We interpret the observed peak as being due to monochromatic photons from the radiative transition Upsilon(3S)-->gammaetab(1S). This photon energy corresponds to an etab(1S) mass of 9388.9(-2.3)+3.1(stat)+/-2.7(syst) MeV/c2. The hyperfine Upsilon(1S)-etab(1S) mass splitting is 71.4(-3.1)+2.3(stat)+/-2.7(syst) MeV/c2. The branching fraction for this radiative Upsilon(3S) decay is estimated to be [4.8+/-0.5(stat)+/-1.2(syst)]x10(-4).

Evidence for CP violation in B0-->J/psipi0 decays

We present measurements of the branching fraction and time-dependent CP asymmetries in B0-->J/psipi0 decays based on 466 x 10(6) Upsilon(4S)-->BB over events collected with the BABAR detector at the SLAC PEP-II asymmetric-energy B factory. We measure the CP asymmetry parameters S= -1.23+/-0.21(stat)+/-0.04(syst) and C= -0.20+/-0.19(stat)+/-0.03(syst), where the measured value of (S, C) is 4.0 standard deviations from (0, 0) including systematic uncertainties. The branching fraction is determined to be B(B0-->J/psipi0)=[1.69+/-0.14(stat)+/-0.07(syst)]x10(-5).

Measurement of the decay B(-) ---> D(*0)e(-)nu[overline](e)

Using 226 x 10(6) BB[overline] events recorded on the Upsilon(4S) resonance with the BABAR detector at the SLAC e(+)e(-) PEP-II storage rings, we reconstruct B(-) ---> D(*0)e(-)nu[overline](e) decays using the decay chain D(*0) --> D(0)pi(0) and D(0)-->K(-)pi(+). From the dependence of their differential rate on w, the dot product of the four velocities of B(-) and D(*0), and using the form factor description by Caprini et al. with the parameters F(1) and rhoA(1)(2), we obtain the results rhoA(1)(2) = 1.16+/-0.06+/-0.08, F(1)|V(cb)|=(35.9+/-0.6+/-1.4) x 10(-3), and B(B(-) --> D(*0)e(-)nu[overline](e))=(5.56+/-0.08+/-0.41)%.

Observation of tree-level B decays with ss production from gluon radiation

We report on our search for decays proceeding via a tree-level b-->c quark transition in which a gluon radiates into an ss[over ] pair. We present observations of the decays B;{-}-->D_{s};{+}K;{-}pi;{-} and B[over ];{0}-->D_{s};{+}K_{S};{0}pi;{-} and evidence for B;{-}-->D_{s};{+}K;{-}K;{-} and set upper limits on the branching fractions for B[over ];{0}-->D_{s};{+}K_{S};{0}pi;{-} and B;{-}-->D_{s};{+}K;{-}K;{-} using 383x10;{6} Upsilon(4S)-->BB[over ] events collected by the BABAR detector at SLAC. We present evidence that the invariant mass distributions of D_{s};{+}K;{-} pairs from B;{-}-->D_{s};{+}K;{-}pi;{-} decays are inconsistent with the phase-space model, suggesting the presence of charm resonances lying below the D_{s};{+}K;{-} threshold.

Measurements of partial branching fractions for B-->Xulnu and determination of |Vub|

We present partial branching fractions for inclusive charmless semileptonic B decays B[over ]-->X_{u}lnu[over ], and the determination of the Cabibbo-Kobayashi-Maskawa matrix element |V_{ub}|. The analysis is based on a sample of 383 x 10;{6} Upsilon(4S) decays into BB[over ] pairs collected with the BABAR detector at the SLAC PEP-II e;{+}e;{-} storage rings. We select events using the invariant mass M_{X} of the hadronic system, the invariant mass squared, q;{2}, of the lepton and neutrino pair, the kinematic variable P+, or one of their combinations. We then determine partial branching fractions in limited regions of phase space: DeltaB=(1.18+/-0.09_{stat}+/-0.07_{syst}+/-0.01_{theor})x10;{-3} (M_{X}<1.55 GeV/c;{2}), DeltaB=(0.95+/-0.10_{stat}+/-0.08_{syst}+/-0.01_{theor})x10;{-3} (P+<0.66 GeV/c), and DeltaB=(0.81+/-0.08_{stat}+/-0.07_{syst}+/-0.02_{theor})x10;{-3} (M_{X}<1.7 GeV/c;{2}, q;{2}>8 GeV;{2}/c;{4}). Corresponding values of |V_{ub}| are extracted using several theoretical calculations.

Measurement of the branching fractions of exclusive _B-->D(*)(pi)l-_nu l decays in events with a fully reconstructed B meson

We report a measurement of the branching fractions for _B-->D(*)(pi)l- _nu(l) decays based on 341.1 fb(-1) of data collected at the Upsilon(4S) resonance with the BABAR detector at the SLAC PEP-II e+ e- storage rings. Events are tagged by fully reconstructing one of the B mesons in a hadronic decay mode. We obtain B(B- -->D(0)l-_nu(l)=(2.33+/-0.09(stat)+/-0.09(syst)%, B(B- -->D(*0)l-_nu(l)=(5.83+/-0.15(stat) +/-0.30(syst) %, B(_B(0)-->D+l-_nu(l)=(2.21+/-0.11(stat) +/-0.12(syst)%, B(_B(0)-->D(*)l-_nu(l)=(5.49+/-0.16(stat)+/-0.25(syst)%, B(B- -->D+pi-l-_nu(l)=(0.42+/-0.06(stat)+/-0.03(syst)%, B(B- -->D(*)+pi-l-_nu(l)=(0.59+/-0.05(stat)+/-0.04(syst)%, B(_B(0)-->D(0)pi+l-_nu(l)=(0.43+/-0.08(stat)+/-0.03(syst)%, and B(_B(0)-->D(*0)pi+l-_nu(l)=(0.48+/-0.08(stat)+/-0.04(syst)%.

Search for CPT and lorentz violation in B0-B[over ]0 oscillations with dilepton events

We report results of a search for CPT and Lorentz violation in B(0)-B[over ](0) oscillations using inclusive dilepton events from 232 x 10(6) Upsilon(4S)-->BB[over ] decays recorded by the BABAR detector at the PEP-II B Factory at SLAC. We find 2.8sigma significance, compatible with no signal, for variations in the complex CPT violation parameter z at the Earth's sidereal frequency and extract values for the quantities Deltaa(micro) in the general Lorentz-violating standard-model extension. The spectral powers for variations in z over the frequency range 0.26 yr(-1) to 2.1 solar day(-1) are also compatible with no signal.

Observation of B;{0}-->K;(*0)K[over ](*0) and Search for B;(0)-->K;(*0)K;(*0)

We report the observation of the b-->d penguin-dominated decay B;{0}-->K;{*0}K[over ];{*0} with a sample of 383.2+/-4.2 million BB[over ] pairs collected with the BABAR detector at the PEP-II asymmetric-energy e;{+}e;{-} collider at the Stanford Linear Accelerator Center. The measured branching fraction is B(B;{0}-->K;{*0}K[over ];{*0})=[1.28_{-0.30};{+0.35}+/-0.11]x10;{-6} and the fraction of longitudinal polarization is f_{L}(B;{0}-->K;{*0}K[over ];{*0})=0.80_{-0.12};{+0.10}+/-0.06. The first error quoted is statistical and the second systematic. We also obtain an upper limit at the 90% confidence level on the branching fraction for B(B;{0}-->K;{*0}K;{*0})<0.41x10;{-6}.

Search for lepton flavor violating decays tau+/--->l+/-omega

A search for lepton flavor violating decays of a tau to a lighter-mass charged lepton and an omega vector meson is performed using 384.1 fb(-1) of e(+)e(-) annihilation data collected with the BABAR detector at the Stanford Linear Accelerator Center PEP-II storage ring. No signal is found, and the upper limits on the branching ratios are determined to be B(tau(+/-)-->e;{+/-}omega)<1.1 x10 (-7) and B(tau(+/-)-->micro(+/-)omega)<1.0 x 10(-7) at 90% confidence level.

Search for CP violation in the decays D0 --> K- K+ and D0 --> pi- pi+

We measure time-integrated CP-violating asymmetries of neutral charmed mesons in the modes D0 --> K(-) K(+) and D0 --> pi(-) pi(+) with the highest precision to date by using D0 --> K(-) pi(+) decays to correct detector asymmetries. An analysis of 385.8 fb(-1) of data collected with the BABAR detector yields values of a(CP)(KK)=(0.00+/-0.34(stat)+/-0.13(syst))% and a(CP)(pipi)=(-0.24+/-0.52(stat)+/-0.22(syst))%, which agree with standard model predictions.

Measurement of the absolute branching fraction of D0-->K-pi+

We measure the absolute branching fraction for D(0)-->K(-)pi(+) using partial reconstruction of B(0)-->D(*+)Xl(-)nu(l) decays, in which only the charged lepton and the pion from the decay D(*+)-->D(0)pi(+) are used. Based on a data sample of 230 x 10(6) BB pairs collected at the Upsilon(4S) resonance with the BABAR detector at the PEP-II asymmetric-energy B factory at SLAC, we obtain B(D(0)-->K(-)pi(+)) = (4.007+/-0.037+/-0.072)%, where the first uncertainty is statistical and the second is systematic.

Observation of B+-->a1+(1260)K0 and B0-->a1-(1260)K+

We present branching fraction measurements of the decays B(+)-->a(1)(+)(1260)K(0) and B(0)-->a(1)(-)(1260)K(+) with a(1)(+/-)(1260)-->pi(-/+)pi(+/-)pi(+/-). The data sample corresponds to 383 x 10(6) BB pairs produced in e(+)e(-) annihilation through the Upsilon(4S) resonance. We measure the products of the branching fractions B(B(+)-->a(1)(+)(1260)K(0)B(a(1)(+)(1260)-->pi(-)pi(+)pi(+))=(17.4+/-2.5+/-2.2) x 10(-6) and B(B(0)-->a(1)(-)(1260)K(+)B(a(1)(-)(1260)-->pi(+)pi(-)pi(-)) = (8.2+/-1.5+/-1.2) x 10(-6). We also measure the charge asymmetries A(ch)(B(+)-->a(1)(+)(1260)K(0) = 0.12+/-0.11+/-0.02 and A(ch)(B(0)-->a(1)(-)(1260)K+) = -0.16+/-0.12+/-0.01. The first uncertainty quoted is statistical and the second is systematic.

Observation of the semileptonic decays B-->D*tau-nutau and evidence for B-->Dtau-nutau

We present measurements of the semileptonic decays B--->D0tau-nutau, B--->D*0tau-nutau, B0-->D+tau-nutau, and B0-->D*+tau-nutau, which are potentially sensitive to non-standard model amplitudes. The data sample comprises 232x10(6) Upsilon(4S)-->BB decays collected with the BABAR detector. From a combined fit to B- and B0 channels, we obtain the branching fractions B(B-->Dtau-nutau)=(0.86+/-0.24+/-0.11+/-0.06)% and B(B-->D*tau-nutau)=(1.62+/-0.31+/-0.10+/-0.05)% (normalized for the B0), where the uncertainties are statistical, systematic, and normalization-mode-related.

Exclusive branching-fraction measurements of semileptonic tau decays into three charged hadrons, into phipi(-)nu tau, and into phi K(-)nu tau

Using a data sample corresponding to an integrated luminosity of 342 fb(-1) collected with the BABAR detector at the SLAC PEP-II electron-positron storage ring operating at a center-of-mass energy near 10.58 GeV, we measure B(tau(-)--> pi(-)pi(-)pi+nu(tau)(ex.K(S0))=(8.83+/-0.01+/-0.13)%, B(tau(-) -->K(-)pi(-)pi+nu tau(ex.K(S0))=(0.273+/-0.002+/-0.009)%, B(tau(-) -->K(-)pi(-)K+nu tau)=(0.1346+/-0.0010+/-0.0036)%, and B(tau(-) -->K(-)K(-)K+nu tau)=(1.58+/-0.13+/-0.12)x10;{-5}, where the uncertainties are statistical and systematic, respectively. These include significant improvements over previous measurements and a first measurement of B(tau(-) -->K(-)K(-)K+nu tau) in which no resonance structure is assumed. We also report a first measurement of B(tau(-) -->var phi(-)nu tau)=(3.42+/-0.55+/-0.25)x10(-5), a new measurement of B(tau(-) -->var phi K(-)nu tau)=(3.39+/-0.20+/-0.28)x10(-5) and a first upper limit on B(tau(-) -->K(-)K(-)K+nu tau(ex.var phi)).

Evidence for charged B meson decays to a1+/-(1260)pi0 and a1(0)(1260)pi+/-

We present measurements of the branching fractions for the decays B;{+/-}-->a_{1};{+/-}(1260)pi;{0} and B;{+/-}-->a_{1};{0}(1260)pi;{+/-} from a data sample of 232x10;{6} BB[over ] pairs produced in e;{+}e;{-} annihilation through the Upsilon(4S) resonance. We measure the branching fraction B(B;{+/-}-->a_{1};{+/-}(1260)pi;{0})xB(a_{1};{+/-}(1260)-->pi;{-}pi;{+}pi;{+/-})=(13.2+/-2.7+/-2.1)x10;{-6} with a significance of 4.2sigma, and the branching fraction B(B;{+/-}-->a_{1};{0}(1260)pi;{+/-})xB(a_{1};{0}(1260)-->pi;{-}pi;{+}pi;{0})=(20.4+/-4.7+/-3.4)x10;{-6} with a significance of 3.8sigma, where the first error quoted is statistical and the second is systematic.

Improved limits on the lepton-flavor violating decays tau{-}-->l{-}l{+}l{-}

A search for the neutrinoless, lepton-flavor violating decay of the tau lepton into three charged leptons has been performed using 376 fb{-1} of data collected at an e{+}e{-} center-of-mass energy around 10.58 GeV with the BABAR detector at the SLAC PEP-II storage rings. In all six decay modes considered, the numbers of events found in data are compatible with the background expectations. Upper limits on the branching fractions are set in the range (4-8)x10{-8} at 90% confidence level.

Measurement of CP violation parameters with a Dalitz plot analysis of B{+/-}-->D{pi{+}pi{-}pi{0}}K{+/-}

We report the results of a CP violation analysis of the decay B{+/-}-->D{pi{+}pi{-}pi;{0}}K{+/-}, where D{pi{+}pi{-}pi{0}} indicates a neutral D meson detected in the final state pi{+}pi{-}pi{0}, excluding K{S}{0}pi{0}. The analysis makes use of 324 x 10{6}e{+}e{-}-->BB[over ] events recorded by the BABAR experiment at the PEP-II e;{+}e;{-} storage ring. Analyzing the pi;{+}pi;{-}pi;{0} Dalitz plot distribution and the B{+/-}-->D{pi{+}pi{-}pi{0}}K{+/-} branching fraction and decay rate asymmetry, we find the following one-standard-deviation constraints on the amplitude ratio and on the weak and strong phases: 0.06<r{B}<0.78, -30 degrees <gamma<76 degrees , -27 degrees <delta<78 degrees . We also measure the magnitudes and phases of the components of the D{0}-->pi{+}pi{-}pi{0} decay amplitude.