Factors affecting pharmacology learning in integrated PBL in diverse medical students: a mixed methods study

INTRODUCTION

Problem-based learning (PBL) was introduced to address passive teaching limitations. However, it is not fully characterised as a teaching modality in pharmacology. The present study investigated the factors affecting pharmacology learning in an integrated PBL-based curriculum in diverse learners.

METHODS

Year 1 undergraduate medical students from two cohorts at St. George's University of London and University of Nicosia, participated. Statistical analysis of pharmacology knowledge scores, at the beginning (pre-test) and end of the academic year (post-test), investigated readiness to benefit from PBL based on diverse student characteristics (educational background, age, gender, country of origin, ethnicity, native language, PBL experience). Focus groups/interviews and a survey investigated aspects of integrated PBL impacting learning in depth.

RESULTS

Pre- and post-test scores were positively correlated. Students with biomedical sciences degrees performed better at the pharmacology pre- and post-tests, while post-graduate degree holders performed better only at the pre-test. Effect size was of moderate magnitude. However, progress in learning (post-test performance after controlling for pre-test scores) was unaffected. Qualitative analysis revealed three major themes: 1) PBL as a learning environment; 2) PBL as a learning environment in pharmacology; and 3) PBL as a learning environment and confidence in prescribing. Under theme one, skill development, knowledge acquisition through collaboration and self-directed learning, group dynamics and preferred teaching methods were discussed. Under theme two, contextual learning, depth of knowledge and material correctness were raised. Under theme 3, students expressed variability in prescribing confidence. They perceived that learning could be improved by better integration, further references earlier on, more lectures and PBL facilitators with greater content expertise. The survey findings were consistent with those from focus groups/interviews.

CONCLUSION

Pharmacology learning in a PBL-based curriculum is facilitated by constructive, collaborative and contextual learning. While baseline pharmacology knowledge may be advantageous, the other aforementioned characteristics studied may not affect readiness to benefit from PBL. However, further instructional scaffolding is needed, for example through further resources, lectures and self-assessment. The results from our study can inform evidence-based curriculum reform to support student learning further. Addressing learning needs could ultimately contribute to reducing medication errors through effective training of future prescribers.

The association between depression and quality of life in the elderly

Background

Depression is the most common cause of emotional disorder in older adults causing functional impairment and leading to lower quality of life (QOL). The aim of the study was to investigate the prevalence of depression, measure the perceived QOL and evaluate the impact of depression on life quality of older people in the community.

Methods

We conducted a cross-sectional study in older people, enrolled in open day care centers and other healthcare facilities. To all participants the Greek validated version of the Geriatric Depression Scale (GDS-15) was applied to screen for depressive symptoms and the EQ-5D-5L scale to estimate their self-reported health status.

Results

A total of 634 seniors participated in the study, 53% were females, mean age 78 years. 45.6% of the participants showed moderate to severe depression. Those who suffered from at least two chronic diseases (75.6%) were more likely to develop moderate or severe depressive symptoms compared to those with only one (19.3%) or none (2.2%) chronic disease. Increased risk of depression was observed in people with Parkinson’s disease (56.5%), mental illness (47.1%), respiratory disease (40%) and stroke (35.1%). Regarding the EQ-5D-5L scale, 72% reported slight to extreme anxiety or depression, 68.2% slight to extreme pain or discomfort, 59.8% slight to extreme problems in performing usual activities, 59.8% in mobility and 40.1% in self-care, respectively. Significant differences were found between people with or without depression. Specifically, participants who reported slight to severe problems in all five domains of the EQ-5D-5L, showed higher levels of depression in the GDS-15.

Conclusions

Our results revealed that elderly with depressive symptoms have a lower quality of life. Given the mutual relationship between chronic diseases, lower life quality and depression, assessment of depressive symptoms are needed in elderly population, mainly in people with multiple chronic diseases.

Key messages

• Depression can be a predictor of poorer quality of life in older population.

Global left ventricular myocardial work efficiency in left bundle branch pacing versus right ventricular septal pacing: preliminary results of a randomized trial

Background

Recently, the concept of left bundle branch pacing (LBBP) has emerged in clinical practice, in an attempt to prevent the deteriorating effects of right ventricular pacing (Vp).

Purpose

The aim of this study is to compare the effect of Vp on left ventricular (LV) dyssynchrony in patients with atrioventricular block (AVB) and preserved ejection fraction (EF), subjected to either LBBP or right ventricular septal pacing (RVSP).

Methods

Patients with AVB are randomized 1:1 to LBBP or RVSP. The effect of Vp is evaluated by echocardiographic indices of dyssynchrony, such as global myocardial work efficiency (GWE) and peak systolic dispersion (PSD). GWE represents the ratio of constructive work divided by the sum of constructive and wasted work [1]. Successful LBBP is defined by the presence of right bundle branch block paced QRS morphology in lead V1 and stim to LV activation time <75 msec [2]. No back-up right Vp lead was used in LBBP group.

Results

We conducted a preliminary analysis of the first 20 patients. Enrollment is still ongoing and total follow-up period is one year. We sought to investigate the acute effect of Vp on LV dyssynchrony 24 hours post procedure. Patients' baseline characteristics were similar in both groups and are presented in Table 1.

One crossover was noted from LBBP to RVSP group, due to high ventricular capture threshold during implant. Implantation time was increased in LBBP arm (130±17.4 min in LBBP versus 47.7±4.5 min in RVSP group, p=0.004). Left bundle branch potential was recorded in 3 out of 10 LBBP patients. No statistically significant difference was demonstrated in GWE between the two groups (91.3% in LBBP versus 87.4% in RVSP group, p=0.052). PSD was numerically shorter in LBBP (53.3 msec) versus in RVSP (63.6 msec), p=0.114. There were no complications during both the acute perioperative phase and the running period of the follow-up. Moreover, no acute ventricular threshold capture rise, or lead dislodgement has been observed in neither group.

The increased implantation time may be attributed to the more demanding technique, or the learning curve period required in the arm of LBBP. In the present analysis, a remarkable difference regarding GWE in favor of the LBBP group was demonstrated, although statistically not significant. However, even in this initial phase of the study, there is a trend of better LV synchrony and less wasted myocardial work in the LBBP group. The final difference of these indices will be assessed at the end of the one-year follow-up, when comparative results will be available.

Conclusion

LBBP is a novel, safe pacing method. Despite the longer procedural time and the risk of crossover, LBBP seems to offer better – without however statistical significance – LV synchrony even in the acute postoperative phase compared to RVSP. Longer follow-up studies are required to test whether LBBP compared to RVSP confers substantial clinical benefit.

Funding Acknowledgement

Type of funding sources: None.

Nutrient Status in Patients with Frequent Episodic Tension-Type Headache: A Case-Control Study

OBJECTIVE

To investigate the relationship between frequent episodic tension-type headache (FE-TTH) and 25-hydroxyvitamin-D (25(OH)D), folate, vitamin B12, and magnesium.

DESIGN-METHODS

A prospective case-control study involving adults with FETTH and age-sex matched healthy controls (HC) was performed. Individuals under the responsibility of the three provincial Health Centres of the prefecture of Trikala (Central Greece) were recruited during their regular check-up visits. The relationship between FETTH and serum levels of 25(OH)D, vitamin B12, folate, and magnesium was investigated (primary outcomes). Demographics, daily habits, somatometrics, psychometric and sleep quality measurements, laboratory indices, cardiovascular comorbidities and medications taken were also recorded and compared (secondary outcomes). Potential associations of the above-listed parameters with headache parameters (headache frequency, severity and analgesic consumption) were also examined (secondary outcomes).

RESULTS

Between September and December 2020, 30 patients with FETTH and 30 HC were successfully recruited. Demographics, comorbidities, regular medications, smoking habits, alcohol and coffee consumption, body mass index measurements, markers of systemic inflammation, folate and vitamin B12 levels were similar between the two groups (P>0.05). Lower serum 25(OH)D was both univariately (P<0.001) and multivariately [OR= 0.72, 95%CI=(0.55, 0.94) per 1ng/ml increase] associated with FETTH, while serum magnesium was found lower in FETTH only according to the univariate approach (P=0.036). Higher levels of depression (P=0.050) and anxiety (P=0.020), as well as poor quality of sleep (P=0.008), were univariately associated with FETTH. Only the effect of anxiety remained significant following the multivariate logistic regression [OR=7.90, 95%CI=(1.00, 62.47)]. Headache parameters were not associated with any one of the assessed variables.

DISCUSSION

Lower serum 25(OH)D was related to the presence of FETTH. This finding could imply a potential role for vitamin D in the pathophysiology of TTH.

P6602Plasma signature of apoptotic microparticles in acute coronary syndromes is associated with endothelial dysfunction and plaque rupture

Background

Circulating microparticles (MP) are surrogate biomarkers of atherosclerosis and are elevated in acute coronary syndromes (ACS) but its exact biological role remains unknown.

Purpose

To explore the diagnostic and biological significance of circulating apoptotic MP signature in patients with ACS.

Methods

We enrolled 122 ACS patients: n=38 with unstable angina (UA), n=49 with STEMI, 35 with NSTEMI. Flow cytometry analysis was used to quantify circulating apoptotic (annexin+) endothelial cell (EMP), red blood cell (RMP) and platelet (PMP) derived microparticles. Endothelial function was estimated with flow mediated dilation (FMD), and inflammatory status with C-reactive protein (hsCRP).

Results

The association between EMP, RMP and PMP is shown on a cloud plot (A). Using an unbiased approach, we performed hierarchical clustering (A) of the total population of patients with ACS by using the circulating levels of EMP, RMP and PMP (B). Hierachical clustering identified two discreet clusters of patients (Cluster A and B) without any differences in the presence of traditional risk factors (not shown), but significant differences in the distribution of ACS type (C). STEMI subtype (a surrogate for definite plaque rupture) was significantly increased in Cluster B, which also had significantly decreased FMD (D), but not hsCRP (p=NS).

Conclusions

Apoptotic MP are involved in the pathogenesis of acute coronary syndromes via promotion of endothelial dysfunction and plaque rupture. The diagnostic and/or predictive value of microparticles' profiling for plaque vulnerability should be explored in future studies.

Characterization of dissolved organic carbon in rainwater of an urban/coastal site in Mediterranean area

Concentration and optical characteristics of dissolved organic matter were studied in rainwater in the urban/coastal city of Thessaloniki, Northern Greece for 2-yr sampling period (2014-2016). The concentration of DOC ranged from 0.33-24.5mg/L with higher values measured in spring-summer period. Higher aromaticity and fluorescence intensity was observed in winter. Chromophoric organic matter represents a significant fraction of DOC that is highly correlated with fluorescence during cold period. Three factor spectral profiles of fluorescence were elucidated, with peaks at protein-like and humic-like area at different intensities. Fluorophores at shorter wavelengths are more susceptible to changes. DOC showed negative relationship with precipitation height, particularly during autumn and spring suggesting washout effect. NMR spectra showed the dominance of aliphatic protons in rainwater. Levoglucosan, sucrose and arabitol were determined in rainwater at concentrations <0.07-2.2μg/L, <0.03-5.1μg/L and <0.03-2.1μg/L, respectively showing impact of biomass combustion and biogenic emissions.

Incidence and factors predisposing to retinopathy of prematurity in inborn infants less than 32 weeks of gestation

PURPOSE

Retinopathy of prematurity (ROP) is a visual-impairing disorder of the developing retinal vasculature in premature infants. Recent advances in neonatal care have led to an increase in the vulnerable premature population. The aim of this retrospective study was to assess the incidence of ROP and its risk factors according to degree of prematurity.

METHODS

Data from a sequence of 1,562 infants <32 weeks of gestational age, admitted to the Jewish General Hospital Neonatal Intensive Care Unit, a tertiary care perinatal center in Montreal, Canada, were reviewed to determine the incidence and risk factors of ROP. Perinatal risk factors for ROP were analyzed using univariate and multivariate analyses in four consecutive gestational age (GA) groups (24-25^+6/7weeks, 26-27^+6/7 weeks, 28-29^+6/7 weeks and 30-31^+6/7 weeks).

RESULTS

The overall incidence in our study was 15.6 %. Severe ROP, defined as stage 3 or plus disease was detected in 5.2 % of the neonates screened. In the univariate analyses, many risk factors in each GA group were found to have a significant association with ROP. On subsequent multivariate logistic regression analysis, birth weight, small for gestational age, the presence of patent ductus arteriosus (PDA), sepsis, necrotizing enterocolitis (NEC), and mechanical ventilation >7 days were independently associated with the development of ROP. Birth weight was consistently an independent risk factor for ROP in all GA groups.

CONCLUSION

Our study confirmed the importance of birth weight as an independent ROP risk factor. Sepsis, NEC, PDA, and prolonged mechanical ventilation have been shown to be independent risk factors in the different gestational age groups. Hippokratia 2016, 20(2): 121-126.

Fate of natural organic matter at a full-scale Drinking Water Treatment Plant in Greece

The aim of this study was to investigate the fate of natural organic matter (NOM) and subsequent changes during the various treatment processes at a full-scale Drinking Water Treatment Plant (DWTP). Monthly sampling campaigns were conducted for 1 year at six sites along DWTP of Thessaloniki, Northern Greece including raw water from the Aliakmonas River that supplies DWTP and samples from various treatment processes (pre-ozonation, coagulation, sand filtration, ozonation, and granular activated carbon (GAC) filtration). The concentration of NOM and its characteristics as well as the removal efficiency of various treatment processes on the basis of dissolved organic carbon, UV absorbance, specific ultra-violet absorbance, fluorescence intensity, hydrophobicity, biodegradable dissolved organic carbon, and formation potential of chlorination by-products trihalomethanes (THMs) and haloacetic acids (HAAs) were studied. The concentration of dissolved organic carbon (DOC) in reservoir of the Aliakmonas River ranged from 1.46 to 1.84 mg/L, exhibiting variations regarding UV, fluorescence, and hydrophobic character through the year. Along DWTP, a significant reduction of aromatic, fluorophoric, and hydrophobic character of NOM was observed resulting in significant elimination of THM (63%) and HAAs (75%) precursors.

Carbonyl compounds and dissolved organic carbon in rainwater of an urban atmosphere

This study investigates the occurrence of carbonyl compounds in rainwater at the city of Thessaloniki, Northern Greece. The concentrations of carbonyl compounds (as sum of 14 compounds) ranged from 21.8 to 592 μg/L, mean concentration 119 μg/L. Formaldehyde, acetaldehyde, hexanal, glyoxal, and methylglyoxal were the dominant compounds. DOC concentrations in rainwater ranged from 0.46 to 21.3 mg/L. UV-Vis and fluorescence spectra characteristics showed variation among rain events. Carbonyl compounds were negatively correlated with temperature exhibited relatively higher concentrations in cold season. They also influenced by storm origin with higher concentrations under terrestrial air masses. Calm conditions enhance the concentrations of DOC. Wash out is an effective removal mechanism of DOC.

The ethics and practice of neonatal resuscitation at the limits of viability: an international perspective

Premature infants at the limits of viability raise difficult ethical, legal, social and economic questions. Neonatologists attending an international Collegium were surveyed about delivery room behaviour, and the approach taken by selected countries practicing 'modern' medicine was explored.

CONCLUSION

There were strong preferences for comfort care at 22 weeks and full resuscitation at 24 weeks. Resuscitation was a grey area at 23 weeks. Cultural, social and legal factors also had a considerable impact on decision-making.

Occurrence and fate of ozonation by-products at a full-scale drinking water treatment plant

The occurrence and fate of carbonyl compounds as ozonation by-products at a full scale drinking water treatment plant (DWTP) were studied for one year. Raw water and samples after the main treatment processes (pre-ozonation, coagulation/flocculation, sand filtration, main ozonation, filtration through granular activated carbon and chlorination) were collected on a monthly basis. Pre-ozonation led to the formation of carbonyl compounds at concentrations of 67.3 ± 43.3 μg/l as sum of 14 carbonyl compounds whereas lower concentrations were determined after the main ozonation process, 32.8 ± 22.3 μg/l. The dominant compounds were formaldehyde, acetaldehyde, glyoxal and methyl glyoxal contributing to 65% of total carbonyl content. The DOC reactivity in formation of carbonyl compounds varied through the year exhibiting the higher values in spring. Coagulation/flocculation and sand filtration significantly removed (64-80%) the carbonyl compounds formed at the pre-ozonation step. The removal efficiency of filtration through granular activated carbon showed great variation ranging from 15 to 62%. Finally, the concentrations of carbonyl compounds in finished water were low, close to detection limits, revealing the efficiency of DWTP in the removal of this class of ozonation by-products.

Review of the antenatal and postnatal use of steroids

Antenatal and postnatal corticosteroids play an extremely important role in the management of premature infants. The antenatal administration of steroids has been universally implemented. They have not only been shown to reduce the incidence and severity of respiratory distress syndrome (RDS), but also have an impact on the incidence of intraventricular hemorrhage (IVH), patent ductus arteriosus (PDA), necrotizing enterocolitis (NEC), and possibly retinopathy of prematurity (ROP) by reducing the need for supplemental oxygen due to improved lung function. The postnatal use of dexamethasone in ventilated infants has been adopted with caution, as there have been several reports of long-term neurodevelopmental complications with this therapy. Hence, changes in dosage and indications and the search for alternative therapies has emerged. Hydrocortisone appears to be a good alternative, with reassuring long-term evaluations thus far.

Obesity rather than regional fat depots marks the metabolomic pattern of adipose tissue: an untargeted metabolomic approach

OBJECTIVE

This study compares the patterns of visceral (VIS) and subcutaneous (SC) adipose tissue (AT)-derived metabolites from non-obese (BMI 24-26 kg/m2) and obese subjects (BMI > 40 kg/m2) with no major metabolic risk factors other than BMI.

METHODS

SC- and VIS- AT obtained from obese (Ob) and non-obese (NOb) subjects during surgery were incubated to obtain their metabolites. Differences related to obesity or anatomical provenances of AT were assessed using an untargeted metabolomics approach based on gas chromatography-mass spectrometry.

RESULTS

The overall effect of obesity on the metabolite profile resulted more remarkable than the effect of regional AT. Only the depletion of 2-ketoisocaproic (2-KIC) acid reached statistical significance for the SC-AT alone, although it was observed in both depots. Obesity induced more significant changes in several amino acids levels of the VIS-AT metabolites. On the one hand, higher released levels of glutamine and alanine were detected in the VIS- obese AT, whereas on the other, the VIS- obese AT presented a diminished uptake of essential amino acids (methionine, threonine, lysine), BCAAs, leucine, and serine.

CONCLUSION

This study shows that obesity markedly affects the amino acid metabolic signature of the AT before the clinical onset of other significant metabolic alterations aside from BMI.

Inclusive search for supersymmetry using razor variables in pp collisions at √s=7 TeV

An inclusive search is presented for new heavy particle pairs produced in √s=7 TeV proton-proton collisions at the LHC using 4.7±0.1 fb(-1) of integrated luminosity. The selected events are analyzed in the 2D razor space of M(R), an event-by-event indicator of the heavy particle mass scale, and R, a dimensionless variable related to the missing transverse energy. The third-generation sector is probed using the event heavy-flavor content. The search is sensitive to generic supersymmetry models with minimal assumptions about the superpartner decay chains. No excess is observed in the number of events beyond that predicted by the standard model. Exclusion limits are derived in the CMSSM framework as well as for simplified models. Within the CMSSM parameter space considered, gluino masses up to 800 GeV and squark masses up to 1.35 TeV are excluded at 95% confidence level depending on the model parameters. The direct production of pairs of top or bottom squarks is excluded for masses as high as 400 GeV.

Search for physics beyond the standard model in events with τ leptons, jets, and large transverse momentum imbalance in pp collisions at [Formula: see text]

A search for physics beyond the standard model is performed with events having one or more hadronically decaying τ leptons, highly energetic jets, and large transverse momentum imbalance. The data sample corresponds to an integrated luminosity of 4.98 fb-1 of proton-proton collisions at [Formula: see text] collected with the CMS detector at the LHC in 2011. The number of observed events is consistent with predictions for standard model processes. Lower limits on the mass of the gluino in supersymmetric models are determined.

Search for supersymmetry in pp collisions at [Formula: see text] TeV in events with a single lepton, jets, and missing transverse momentum

Results are reported from a search for new physics processes in events containing a single isolated high-transverse-momentum lepton (electron or muon), energetic jets, and large missing transverse momentum. The analysis is based on a 4.98 fb-1 sample of proton-proton collisions at a center-of-mass energy of 7 TeV, obtained with the CMS detector at the LHC. Three separate background estimation methods, each relying primarily on control samples in the data, are applied to a range of signal regions, providing complementary approaches for estimating the background yields. The observed yields are consistent with the predicted standard model backgrounds. The results are interpreted in terms of limits on the parameter space for the constrained minimal supersymmetric extension of the standard model, as well as on cross sections for simplified models, which provide a generic description of the production and decay of new particles in specific, topology based final states.

ELECTRONIC SUPPLEMENTARY MATERIAL

The online version of this article (doi:10.1140/epjc/s10052-013-2404-z) contains supplementary material, which is available to authorized users.

Are antenatal steroids beneficial to severely growth restricted fetuses?

Antenatal steroids (AS) have been shown to enhance fetal maturation in preterms and to improve outcome. The aim of this study was to evaluate the efficacy of AS in premature severely intrauterine growth restricted infants. The electronic data of 149 inborn, single infants born 24 to 31 6/7 weeks of GA and with a BW ≤ 3rd percentile were reviewed. Infants with congenital anomalies and syndromes were excluded. We compared the outcome of those who received 2 doses of AS (group A, 87 infants) with those who did not receive AS (group B, 62 infants). Sixty-eight infants in group A and 53 in group B were discharged home alive. AS did not improve the neonatal outcome, with the exception of a better cord pH and 5-min Apgar and we did not observe a significant difference in the Griffith's test at 2 years of corrected age, although there was a trend to a higher incidence of severe global delay in the steroid group. In view of the potential cerebral and CVS risks associated with high circulating steroids, the indications for AS in such a population need to be re-evaluated.

Search for pair production of third-generation leptoquarks and top squarks in pp collisions at sqrt[s] = 7 TeV

Results are presented from a search for the pair production of third-generation scalar and vector leptoquarks, as well as for top squarks in R-parity-violating supersymmetric models. In either scenario, the new, heavy particle decays into a τ lepton and a b quark. The search is based on a data sample of pp collisions at sqrt[s] = 7 TeV, which is collected by the CMS detector at the LHC and corresponds to an integrated luminosity of 4.8 fb(-1). The number of observed events is found to be in agreement with the standard model prediction, and exclusion limits on mass parameters are obtained at the 95% confidence level. Vector leptoquarks with masses below 760 GeV are excluded and, if the branching fraction of the scalar leptoquark decay to a τ lepton and a b quark is assumed to be unity, third-generation scalar leptoquarks with masses below 525 GeV are ruled out. Top squarks with masses below 453 GeV are excluded for a typical benchmark scenario, and limits on the coupling between the top squark, τ lepton, and b quark, λ(333)(') are obtained. These results are the most stringent for these scenarios to date.

Measurement of the Υ1S, Υ2S, and Υ3S polarizations in pp collisions at sqrt[s] = 7 TeV

The polarizations of the Υ(1S), Υ(2S), and Υ(3S) mesons are measured in proton-proton collisions at sqrt[s] = 7 TeV, using a data sample of Υ(nS) → μ +μ- decays collected by the CMS experiment, corresponding to an integrated luminosity of 4.9 fb(-1). The dimuon decay angular distributions are analyzed in three different polarization frames. The polarization parameters λ[symbol see text], λ(φ), and λ([symbol see text]φ), as well as the frame-invariant quantity λ, are presented as a function of the Υ(nS) transverse momentum between 10 and 50 GeV, in the rapidity ranges |y|<0.6 and 0.6<|y|<1.2. No evidence of large transverse or longitudinal polarizations is seen in the explored kinematic region.

Measurement of the sum of WW and WZ production with W+dijet events in pp collisions at [Formula: see text]

A measurement of the inclusive WW+WZ diboson production cross section in proton-proton collisions is reported, based on events containing a leptonically decaying W boson and exactly two jets. The data sample, collected at [Formula: see text] with the CMS detector at the LHC, corresponds to an integrated luminosity of 5.0 fb-1. The measured value of the sum of the inclusive WW and WZ cross sections is σ(pp→WW+WZ)=68.9±8.7 (stat.)±9.7 (syst.)±1.5 (lum.) pb, consistent with the standard model prediction of 65.6±2.2 pb. This is the first measurement of WW+WZ production in pp collisions using this signature. No evidence for anomalous triple gauge couplings is found and upper limits are set on their magnitudes.

Measurement of the azimuthal anisotropy of neutral pions in Pb-Pb collisions at sqrt[s](NN)] = 2.76 TeV

First measurements of the azimuthal anisotropy of neutral pions produced in Pb-Pb collisions at a center-of-mass energy of sqrt[s(NN)] = 2.76 TeV are presented. The amplitudes of the second Fourier component (v(2)) of the π(0) azimuthal distributions are extracted using an event-plane technique. The values of v(2) are studied as a function of the neutral pion transverse momentum (p(T)) for different classes of collision centrality in the kinematic range 1.6<p(T) <8.0 GeV/c, within the pseudorapidity interval |η|<0.8. The CMS measurements of v(2) (p(T)) are similar to previously reported π(0) azimuthal anisotropy results from sqrt[s(NN)] = 200 GeV Au-Au collisions at RHIC, despite a factor of ∼ 14 increase in the center-of-mass energy. In the momentum range 2.5<p(T)<5.0 GeV/c, the neutral pion anisotropies are found to be smaller than those observed by CMS for inclusive charged particles.

Evidence for associated production of a single top quark and W boson in pp collisions at sqrt[s]=7 TeV

Evidence is presented for the associated production of a single top quark and W boson in pp collisions at sqrt[s]=7  TeV with the CMS experiment at the LHC. The analyzed data correspond to an integrated luminosity of 4.9  fb(-1). The measurement is performed using events with two leptons and a jet originated from a b quark. A multivariate analysis based on kinematic properties is utilized to separate the tt background from the signal. The observed signal has a significance of 4.0σ and corresponds to a cross section of 16(-4)(+5)  pb, in agreement with the standard model expectation of 15.6±0.4(-1.2)(+1.0)  pb.

Search for heavy neutrinos and W(R) bosons with right-handed couplings in a left-right symmetric model in pp collisions at sqrt[s]=7 TeV

Results are presented from a search for heavy, right-handed muon neutrinos, N(μ), and right-handed W(R) bosons, which arise in the left-right symmetric extensions of the standard model. The analysis is based on a 5.0  fb(-1) sample of proton-proton collisions at a center-of-mass energy of 7 TeV, collected by the CMS detector at the Large Hadron Collider. No evidence is observed for an excess of events over the standard model expectation. For models with exact left-right symmetry, heavy right-handed neutrinos are excluded at 95% confidence level for a range of neutrino masses below the W(R) mass, dependent on the value of M(W(R)). The excluded region in the two-dimensional (M(W(R)), M(N(μ)) mass plane extends to M(W(R))=2.5  TeV.

Study of the Dijet mass spectrum in pp → W+jets events at sqrt[s] = 7 TeV

We report an investigation of the invariant mass spectrum of the two jets with highest transverse momentum in pp → W+2-jet and W+3-jet events to look for resonant enhancement. The data sample corresponds to an integrated luminosity of 5.0 fb(-1) collected with the CMS detector at sqrt[s] = 7 TeV. We find no evidence for the anomalous structure reported by the CDF Collaboration, and establish an upper limit of 5.0 pb at 95% confidence level on the production cross section for a generic Gaussian signal with mass near 150 GeV. Additionally, we exclude two theoretical models that predict a CDF-like dijet resonance near 150 GeV.

Measurement of the relative prompt production rate of χc2 and χc1 in pp collisions at [Formula: see text]

A measurement is presented of the relative prompt production rate of χc2 and χc1 with 4.6 fb-1 of data collected by the CMS experiment at the LHC in pp collisions at [Formula: see text]. The two states are measured via their radiative decays χc→J/ψ+γ, with the photon converting into an e+e- pair for J/ψ rapidity |y(J/ψ)|<1.0 and photon transverse momentum pT(γ)>0.5 GeV/c. The measurement is given for six intervals of pT(J/ψ) between 7 and 25 GeV/c. The results are compared to theoretical predictions.

Observation of sequential Υ suppression in PbPb collisions

The suppression of the individual Υ(nS) states in PbPb collisions with respect to their yields in pp data has been measured. The PbPb and pp data sets used in the analysis correspond to integrated luminosities of 150 μb(-1) and 230 nb(-1), respectively, collected in 2011 by the CMS experiment at the LHC, at a center-of-mass energy per nucleon pair of 2.76 TeV. The Υ(nS) yields are measured from the dimuon invariant mass spectra. The suppression of the Υ(nS) yields in PbPb relative to the yields in pp, scaled by the number of nucleon-nucleon collisions, R(AA), is measured as a function of the collision centrality. Integrated over centrality, the R(AA) values are 0.56±0.08(stat)±0.07(syst), 0.12±0.04(stat)±0.02(syst), and lower than 0.10 (at 95% confidence level), for the Υ(1S), Υ(2S), and Υ(3S) states, respectively. The results demonstrate the sequential suppression of the Υ(nS) states in PbPb collisions at LHC energies.

Search for new physics in the multijet and missing transverse momentum final state in proton-proton collisions at √s = 7 TeV

A search for physics beyond the standard model is performed in events with at least three jets and large missing transverse momentum produced in proton-proton collisions at a center-of-mass energy of √s=7 TeV. No significant excess of events above the expected backgrounds is observed in 4.98 fb(-1) of data collected with the CMS detector at the Large Hadron Collider. The results are presented in the context of the constrained minimal supersymmetric extension of the standard model and more generically for simplified models. For the simplified models of gluino-gluino and squark-squark production, gluino masses below 1.0 TeV and squark masses below 0.76 TeV are excluded in case the lightest supersymmetric particle mass is below 200 GeV. These results significantly extend previous searches.

Measurement of the pseudorapidity and centrality dependence of the transverse energy density in Pb-Pb collisions at √(s(NN))=2.76 TeV

The transverse energy (E(T)) in Pb-Pb collisions at 2.76 TeV nucleon-nucleon center-of-mass energy (√(s(NN)) has been measured over a broad range of pseudorapidity (η) and collision centrality by using the CMS detector at the LHC. The transverse energy density per unit pseudorapidity (dE(T)/dη) increases faster with collision energy than the charged particle multiplicity. This implies that the mean energy per particle is increasing with collision energy. At all pseudorapidities, the transverse energy per participating nucleon increases with the centrality of the collision. The ratio of transverse energy per unit pseudorapidity in peripheral to central collisions varies significantly as the pseudorapidity increases from η=0 to |η|=5.0. For the 5% most central collisions, the energy density per unit volume is estimated to be about 14 GeV/fm(3) at a time of 1 fm/c after the collision. This is about 100 times larger than normal nuclear matter density and a factor of 2.6 times higher than the energy density reported at √(s(NN))=200 GeV at the Relativistic Heavy Ion Collider.

Search for a W' or techni-ρ decaying into WZ in pp Collisions at sqrt[s] = 7 TeV

A search is performed in pp collisions at sqrt[s]=7  TeV for exotic particles decaying via WZ to final states with electrons and muons. The data sample corresponds to an integrated luminosity of approximately 5  fb(-1). No significant excess is observed in the data above the expected standard model background. Upper bounds at 95% confidence level are set on the production cross section of the W' boson described by the sequential standard model and on the W' WZ coupling. W' bosons with masses below 1143 GeV are excluded. Limits are also set in the context of low-scale technicolor models, under a range of assumptions concerning the model parameters.

Search for a light pseudoscalar Higgs boson in the dimuon decay channel in pp collisions at √s = 7 TeV

The dimuon invariant mass spectrum is searched in the range between 5.5 and 14 GeV for a light pseudoscalar Higgs boson a, predicted in a number of new physics models, including the next-to-minimal supersymmetric standard model. The data sample used in the search corresponds to an integrated luminosity of 1.3 fb(-1) collected in pp collisions at √s = 7 TeV with the CMS detector at the LHC. No excess is observed above the background predictions and upper limits are set on the cross section times branching fraction σ × B(pp→a→μ(+)μ(-)) in the range of 1.5-7.5 pb. These results improve on existing bounds on the abb coupling for m(a) < m(Υ(1S)) and are the first significant limits for m(a) > m(Υ(3S)). Constraints on the supersymmetric parameter space are presented in the context of the next-to-minimal model.

Measurement of the electron charge asymmetry in inclusive W production in pp collisions at sqrt[s]=7 TeV

A measurement of the electron charge asymmetry in inclusive pp→W+X→eν+X production at sqrt[s]=7  TeV is presented based on data recorded by the CMS detector at the LHC and corresponding to an integrated luminosity of 840  pb(-1). The electron charge asymmetry reflects the unequal production of W(+) and W(-) bosons in pp collisions. The electron charge asymmetry is measured in bins of the absolute value of electron pseudorapidity in the range of |η|<2.4. The asymmetry rises from about 0.1 to 0.2 as a function of the pseudorapidity and is measured with a relative precision better than 7%. This measurement provides new stringent constraints for parton distribution functions.

Search for new physics with same-sign isolated dilepton events with jets and missing transverse energy

A search for new physics is performed in events with two same-sign isolated leptons, hadronic jets, and missing transverse energy in the final state. The analysis is based on a data sample corresponding to an integrated luminosity of 4.98 fb(-1) produced in pp collisions at a center-of-mass energy of 7 TeV collected by the CMS experiment at the LHC. This constitutes a factor of 140 increase in integrated luminosity over previously published results. The observed yields agree with the standard model predictions and thus no evidence for new physics is found. The observations are used to set upper limits on possible new physics contributions and to constrain supersymmetric models. To facilitate the interpretation of the data in a broader range of new physics scenarios, information on the event selection, detector response, and efficiencies is provided.

Azimuthal anisotropy of charged particles at high transverse momenta in Pb-Pb collisions at sqrt[s(NN)] = 2.76 TeV

The azimuthal anisotropy of charged particles in Pb-Pb collisions at sqrt[s(NN)]=2.76  TeV is measured with the CMS detector at the LHC over an extended transverse momentum (p(T)) range up to approximately 60  GeV/c. The data cover both the low-p(T) region associated with hydrodynamic flow phenomena and the high-p(T) region where the anisotropies may reflect the path-length dependence of parton energy loss in the created medium. The anisotropy parameter (v2) of the particles is extracted by correlating charged tracks with respect to the event-plane reconstructed by using the energy deposited in forward-angle calorimeters. For the six bins of collision centrality studied, spanning the range of 0-60% most-central events, the observed v2 values are found to first increase with p(T), reaching a maximum around p(T)=3  GeV/c, and then to gradually decrease to almost zero, with the decline persisting up to at least pp(T)=40  GeV/c over the full centrality range measured.

Prevalence of thrombophilic mutations in patients with unprovoked thromboembolic disease. A comparative analysis regarding arterial and venous disease

BACKGROUND

Thromboembolic disease (TED) represents one of the main reasons of morbitity and mortality in Western World. Venous and arterial thrombotic disorders have long been viewed as separate pathophysiological entities. However, in recent times the separate nature of arterial and venous thrombotic events has been challenged. Although inherited thrombophilia's predominant clinical manifestation is venous thrombosis, its contribution to arterial thrombosis remains controversial. Purpose  of  the  study  was  to  evaluate  the  prevalence  of  the  most common  thrombophilic  mutations, FV Leiden G1691A-FVL and FII G20210A-PTM and to assess  the  differences between venous, arterial and mixed thrombotic events. Testing  for polymorphism MTHFR C677T and  antithrombin,  protein  C  and  protein  S was also performed. Correlations with  dyslipidemia, smoking, obesity, homocysteine and antiphospholipid antibodies were made.

METHODS

515 patients with unprovoked TED, 263 males, median age 44 years, were studied. Patients were divided into three groups: 258 with venous thrombosis (group A), 239 with arterial (group B) and 18 with mixed episodes (group C). All patients were interviewed regarding family history of TED, origin, smoking and dyslipidemia. Body mass index (BMI) had been calculated. Molecular assessment of the FVL, PTM and MTHFR C677T was performed. Antithrombin, protein C, protein S, APCR, homocysteine, antiphospholipid antibodies and lipid profile were also measured.

RESULTS

The population studied was homogenous among three groups as regards age (p=0.943), lipid profile (p=0.271), BMI (p=0.506), homocysteine (p=0.177), antiphospholipid antibodies (p=0.576), and positive family history (p=0.099). There was no difference in the prevalence of FVL between venous and arterial disease (p=0.440). Significant correlation of PTM with venous TED was found (p=0.001). The number of positive and negative for MTHFR presented statistically significant difference with a support in arterial disease (p=0.05). Moreover, a 2-fold increase in the risk of venous thrombosis in FVL positive patients (odds ratio: 2.153) and a positive correlation of homocysteine levels with MTHFR C677T (p<0.001) was found.

CONCLUSIONS

Correlation of PTM with venous thrombosis was established. Analysis showed no difference in prevalence of FVL between venous and arterial thrombosis, indicating that FVL might be a predisposing factor for arterial disease. A significant increase in MTHFR C677T prevalence in arterial disease was found. In conclusion, young patients with unprovoked arterial disease should undergo evaluation for thrombophilic genes. Identification of these mutations is important in the overall assessment and management of patients at high risk. Findings will influence the decisions of stratified approaches for antithrombotic therapy either primary or secondary thromboprophylaxis, the duration of therapy, the potential for avoiding clinical thrombosis by risk factor modification and the genetic counselling of family members. However, further studies are needed to clarify the nature of the association regarding venous and arterial thrombotic events.