Variation in the clinical management of self-harm by area-level socio-economic deprivation: findings from the multicenter study of self-harm in England

BACKGROUND

We investigated disparities in the clinical management of self-harm following hospital presentation with self-harm according to level of socio-economic deprivation (SED) in England.

METHODS

108 092 presentations to hospitals (by 57 306 individuals) after self-harm in the Multicenter Study of Self-harm spanning 17 years. Area-level SED was based on the English Index of Multiple Deprivation. Information about indicators of clinical care was obtained from each hospital's self-harm monitoring systems. We assessed the associations of SED with indicators of care using mixed effect models.

RESULTS

Controlling for confounders, psychosocial assessment and admission to a general medical ward were less likely for presentations by patients living in more deprived areas relative to presentations by patients from the least deprived areas. Referral for outpatient mental health care was less likely for presentations by patients from the two most deprived localities (most deprived: adjusted odd ratio [aOR] 0.77, 95% CI 0.71-0.83, p < 0.0001; 2nd most deprived: aOR 0.80, 95% CI 0.74-0.87, p < 0.0001). Referral to substance use services and 'other' services increased with increased SED. Overall, referral for aftercare was less likely following presentations by patients living in the two most deprived areas (most deprived: aOR 0.85, 95% CI 0.78-0.92, p < 0.0001; 2nd most deprived: aOR 0.86, 95% CI 0.79-0.94, p = 0.001).

CONCLUSIONS

SED is associated with differential care for patients who self-harm in England. Inequalities in care may exacerbate the risk of adverse outcomes in this disadvantaged population. Further work is needed to understand the reasons for these differences and ways of providing more equitable care.

Diagnosing the origin and impact of low-mode asymmetries in ignition experiments at the National Ignition Facility

Inertial confinement fusion ignition requires high inflight shell velocity, good energy coupling between the hotspot and shell, and high areal density at peak compression. Three-dimensional asymmetries caused by imperfections in the drive symmetry or target can grow and damage the coupling and confinement. Recent high-yield experiments have shown that low-mode asymmetries are a key degradation mechanism and contribute to variability. We show the experimental signatures and impacts of asymmetry change with increasing implosion yield given the same initial cause. This letter has implications for improving robustness to a key degradation in ignition experiments.

Infectious syphilis in women and heterosexual men in major Australian cities: sentinel surveillance data, 2011-2019

OBJECTIVES

To examine changes in the positive infectious syphilis test rate among women and heterosexual men in major Australian cities, and rate differences by social, biomedical, and behavioural determinants of health.

DESIGN, SETTING

Analysis of data extracted from de-identified patient records from 34 sexual health clinics participating in the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance of Sexually Transmissible Infections and Blood Borne Viruses (ACCESS).

PARTICIPANTS

First tests during calendar year for women and heterosexual men aged 15 years or more in major cities who attended ACCESS sexual health clinics during 2011-2019.

MAIN OUTCOME MEASURES

Positive infectious syphilis test rate; change in annual positive test rate.

RESULTS

180 of 52 221 tested women (0.34%) and 239 of 36 341 heterosexual men (0.66%) were diagnosed with infectious syphilis. The positive test rate for women was 1.8 (95% confidence interval [CI], 0.9-3.2) per 1000 tests in 2011, 3.0 (95% CI, 2.0-4.2) per 1000 tests in 2019 (change per year: rate ratio [RR], 1.12; 95% CI, 1.01-1.25); for heterosexual men it was 6.1 (95% CI, 3.8-9.2) per 1000 tests in 2011 and 7.6 (95% CI, 5.6-10) per 1000 tests in 2019 (RR, 1.10; 95% CI, 1.03-1.17). In multivariable analyses, the positive test rate was higher for women (adjusted RR [aRR], 1.85; 95% CI, 1.34-2.55) and heterosexual men (aRR, 2.39; 95% CI, 1.53-3.74) in areas of greatest socio-economic disadvantage than for those in areas of least socio-economic disadvantage. It was also higher for Indigenous women (aRR, 2.39; 95% CI, 1.22-4.70) and for women who reported recent injection drug use (aRR, 4.87; 95% CI, 2.18-10.9) than for other women; it was lower for bisexual than heterosexual women (aRR, 0.48; 95% CI, 0.29-0.81) and for women who reported recent sex work (aRR, 0.35; 95% CI, 0.29-0.44). The positive test rate was higher for heterosexual men aged 40-49 years (aRR, 2.11; 95% CI, 1.42-3.12) or more than 50 years (aRR, 2.36; 95% CI, 1.53-3.65) than for those aged 15-29 years.

CONCLUSION

The positive test rate among both urban women and heterosexual men tested was higher in 2019 than in 2011. People who attend reproductive health or alcohol and drug services should be routinely screened for syphilis.

Measurement of Dark Ice-Ablator Mix in Inertial Confinement Fusion

We present measurements of ice-ablator mix at stagnation of inertially confined, cryogenically layered capsule implosions. An ice layer thickness scan with layers significantly thinner than used in ignition experiments enables us to investigate mix near the inner ablator interface. Our experiments reveal for the first time that the majority of atomically mixed ablator material is "dark" mix. It is seeded by the ice-ablator interface instability and located in the relatively cooler, denser region of the fuel assembly surrounding the fusion hot spot. The amount of dark mix is an important quantity as it is thought to affect both fusion fuel compression and burn propagation when it turns into hot mix as the burn wave propagates through the initially colder fuel region surrounding an igniting hot spot. We demonstrate a significant reduction in ice-ablator mix in the hot-spot boundary region when we increase the initial ice layer thickness.

Protocol for a feasibility study of a cancer symptom awareness campaign to support the rapid diagnostic centre referral pathway in a socioeconomically deprived area: Targeted Intensive Community-based campaign To Optimise Cancer awareness (TIC-TOC)

INTRODUCTION

Rapid diagnostic centres (RDCs) are being implemented across the UK to accelerate the assessment of vague suspected cancer symptoms. Targeted behavioural interventions are needed to augment RDCs that serve socioeconomically deprived populations who are disproportionately affected by cancer, have lower cancer symptom awareness and are less likely to seek help for cancer symptoms. The aim of this study is to assess the feasibility and acceptability of delivering and evaluating a community-based vague cancer symptom awareness intervention in an area of high socioeconomic deprivation.

METHODS AND ANALYSIS

Intervention materials and messages were coproduced with local stakeholders in Cwm Taf Morgannwg, Wales. Cancer champions will be trained to deliver intervention messages and distribute intervention materials using broadcast media (eg, local radio), printed media (eg, branded pharmacy bags, posters, leaflets), social media (eg, Facebook) and attending local community events. A cross-sectional questionnaire will include self-reported patient interval (time between noticing symptoms to contacting the general practitioner), cancer symptom recognition, cancer beliefs and barriers to presentation, awareness of campaign messages, healthcare resource use, generic quality of life and individual and area-level deprivation indicators. Consent rates and proportion of missing data for patient questionnaires (n=189) attending RDCs will be measured. Qualitative interviews and focus groups will assess intervention acceptability and barriers/facilitators to delivery.

ETHICS AND DISSEMINATION

Ethical approval for this study was given by the London-West London & GTAC Research Ethics (21/LO/0402). This project will inform a potential future controlled study to assess intervention effectiveness in reducing the patient interval for vague cancer symptoms. The results will be critical to informing national policy and practice regarding behavioural interventions to support RDCs in highly deprived populations.

Cost-effectiveness of psychosocial assessment for individuals who present to hospital following self-harm in England: a model-based retrospective analysis

Background

Guidance in England recommends psychosocial assessment when presenting to hospital following self-harm but adherence is variable. There is some evidence suggesting that psychosocial assessment is associated with lower risk of subsequent presentation to hospital for self-harm, but the potential cost-effectiveness of psychosocial assessment for hospital-presenting self-harm is unknown.

Methods

A three-state four-cycle Markov model was used to assess cost-effectiveness of psychosocial assessment after self-harm compared with no assessment over 2 years. Data on risk of subsequent self-harm and hospital costs of treating self-harm were drawn from the Multicentre Study of Self-Harm in England, while estimates of effectiveness of psychosocial assessment on risk of self-harm, quality of life, and other costs were drawn from literature. Incremental cost-effectiveness ratios (ICERs) for cost per Quality Adjusted Life Year (QALY) gained were estimated. Parameter uncertainty was addressed in univariate and probabilistic sensitivity analyses.

Results

Cost per QALY gained from psychosocial assessment was £10,962 (95% uncertainty interval [UI] £15,538–£9,219) from the National Health Service (NHS) perspective and £9,980 (95% UI £14,538–£6,938) from the societal perspective. Results were generally robust to changes in model assumptions. The probability of the ICER being below £20,000 per QALY gained was 78%, rising to 91% with a £30,000 threshold.

Conclusions

Psychosocial assessment as implemented in the English NHS is likely to be cost-effective. This evidence could support adherence to NICE guidelines. However, further evidence is needed about the precise impacts of psychosocial assessment on self-harm repetition and costs to individuals and their families beyond immediate hospital stay.

Recurrent asthma exacerbations: co-existing asthma and common variable immunodeficiency

Common variable immunodeficiency is characterized by impaired B-cell differentiation and defective immunoglobulin production manifesting as recurrent respiratory tract infections. While the condition can masquerade as asthma, late diagnosis of CVID in known asthmatic is rarely reported.

We present the case of a 43-year-old lady with recurrent episodes of wheeze, cough, sinusitis and multiple lower respiratory tract infections. Transiently responsive to antibiotics and steroids. These episodes had been occurring for many years and she had a longstanding clinical diagnosis of asthma.

As part of her work up for recurrent respiratory tract infections a CT thorax was performed and demonstrated bronchiectasis. Further tests including Immunoglobulin levels revealed critically low IgG, IgM, and IgA levels. Immunoglobulin replacement therapy was commenced with a reduction in exacerbation frequency and severity, and objective improvement of asthma control. Subsequent lung function tests demonstrated reversible airflow limitation (obstructive lung function with 13% reversibility in FEV₁ post-bronchodilator) consistent with asthma.

Our case illustrates the importance of searching for alternate and co-existent diagnoses in patients diagnosed with asthma who are unresponsive to conventional therapy. We believe that serum immunoglobulin measurement should form a component of such a workup.

Roadmap to recovery: Reporting on a research taskforce supporting Indigenous responses to COVID-19 in Australia

In April 2020 a Group of Eight Taskforce was convened, consisting of over 100 researchers, to provide independent, research-based recommendations to the Commonwealth Government on a "Roadmap to Recovery" from COVID-19. The report covered issues ranging from pandemic control and relaxation of social distancing measures, to well-being and special considerations for vulnerable populations. Our work focused on the critical needs of Aboriginal and Torres Strait Islander communities; this paper presents an overview of our recommendations to the Roadmap report. In addressing the global challenges posed by pandemics for citizens around the world, Indigenous people are recognised as highly vulnerable. At the time of writing Australia's First Nations Peoples have been largely spared from COVID-19 in comparison to other Indigenous populations globally. Our recommendations emphasise self-determination and equitable needs-based funding to support Indigenous communities to recover from COVID-19, addressing persistent overcrowded housing, and a focus on workforce, especially for regional and remote communities. These latter two issues have been highlighted as major issues of risk for Indigenous communities in Australia It remains to be seen how governments across Australia take up these recommendations to support Indigenous peoples' health and healing journey through yet another, potentially catastrophic, health crisis.

Improving Outcomes Among Young Adults with type 1 diabetes: The D1 Now Randomised Pilot Study Protocol

BACKGROUND

Young adults (18-25 years old) living with type 1 diabetes mellitus often have sub-optimal glycaemic levels which can increase their risk of long term diabetes complications. Informed by health psychology theory and using a (public and patient involvement) young adult-centred approach, we have developed a complex intervention, entitled D1 Now, to improve outcomes in this target group. The D1 Now intervention includes three components; 1) a support-worker, 2) an interactive messaging system and 3) an agenda setting tool for use during clinic consultations.

AIMS

The aim of the D1 Now pilot study is to gather and analyse acceptability and feasibility data to allow us to (1) refine the D1 Now intervention, and (2) determine the feasibility of a definitive Randomised Control Trial (RCT) of the intervention.

METHODS

Diabetes clinics on the island of Ireland will be recruited and randomised to a D1 Now intervention arm or a usual care control arm. For a participant to be eligible they should be 18-25 years old and living with type 1 diabetes for at least 12 months. Participant outcomes (influenced by a Core Outcome Set) include change in HbA1c, clinic attendance, number of episodes of severe hypoglycaemia and of diabetic ketoacidosis, diabetes distress, self-management, quality of life and perceived level of control over diabetes; these will be will be measured at baseline and after 12 months follow-up for descriptive statistics only. An assessment of treatment fidelity, a health economic analysis and a qualitative sub-study will also be incorporated into the pilot study. ISRCTN (ref: ISRCTN74114336).

The effectiveness of Reslizumab in severe asthma treatment: a real-world experience

Background

Increased numbers of blood and sputum eosinophils are associated with higher exacerbation frequency and increased asthma severity. In clinical trials, targeting Interleukin-5 has been shown to be a useful therapeutic strategy for patients with severe eosinophilic asthma.

Methods

Twenty-six patients have been commenced on Reslizumab in our institution since early 2017. Safety and clinical efficacy parameters were recorded at regular intervals.

Results

Mean ACQ-6 score at the start of treatment was 3.5. The average number of exacerbations in the year preceding treatment was 8.3 per person. 30% of patients had been admitted to hospital at least once over the 12 months preceding therapy. 54% of our patients were on long term oral steroid.

Our data showed sustained improvement of Asthma control (Mean improvement in ACQ-6 was 1.7 at 1 year, and 2.0 at 2 years, P = 0.0001). Of the patients who were on long term systemic steroids, 35.7% discontinued steroids completely, with a mean reduction of prednisolone dose of 5.2 mg at 1 year. There was a 79% reduction in the annual exacerbation frequency at 1 year, and 88% at 2 years (P = < 0.0001). Modest, albeit statistically significant increases in creatine kinase which seemed to plateau by 1 year were noted.

Conclusions

Overall, Reslizumab was well tolerated with discontinuation of treatment due to side effects recorded in only one patient. Our data confirm the utility of anti-IL5 therapy in a carefully selected phenotype of severe asthma with evidence of eosinophilic airway inflammation.

Fusion Energy Output Greater than the Kinetic Energy of an Imploding Shell at the National Ignition Facility

A series of cryogenic, layered deuterium-tritium (DT) implosions have produced, for the first time, fusion energy output twice the peak kinetic energy of the imploding shell. These experiments at the National Ignition Facility utilized high density carbon ablators with a three-shock laser pulse (1.5 MJ in 7.5 ns) to irradiate low gas-filled (0.3  mg/cc of helium) bare depleted uranium hohlraums, resulting in a peak hohlraum radiative temperature ∼290  eV. The imploding shell, composed of the nonablated high density carbon and the DT cryogenic layer, is, thus, driven to velocity on the order of 380  km/s resulting in a peak kinetic energy of ∼21  kJ, which once stagnated produced a total DT neutron yield of 1.9×10^{16} (shot N170827) corresponding to an output fusion energy of 54 kJ. Time dependent low mode asymmetries that limited further progress of implosions have now been controlled, leading to an increased compression of the hot spot. It resulted in hot spot areal density (ρr∼0.3  g/cm^{2}) and stagnation pressure (∼360  Gbar) never before achieved in a laboratory experiment.

"Hitting the spot": Developing individuals with lived-experience of health and social care as facilitators to deliver a course to enhance public involvement in research - a Welsh perspective

PLAIN ENGLISH SUMMARY

Public involvement in research has become an important and integral part of the research process in health and social care, from the early stages of research prioritisation and development to the later stages of research conduct and dissemination. Learning and development opportunities, including training, can assist the public and researchers in working together in the research process, and a training schedule exists in Wales for this purpose. One of the key components of this training schedule in Wales is the course Involving the Public in the Design and Conduct of Research: Building Research Partnerships. Building on the existing successes of this UK-wide course, first developed by Macmillan Cancer Support, a project was established between Health and Care Research Wales and Macmillan Cancer Support to develop three members of the Involving People Network into trained facilitators. Once trained, the aim was for the three facilitators to deliver the course in Wales. Macmillan Cancer Support and Health and Care Research Wales selected, through a competitive process, three members of the Involving People Network to use their lived experience of Involvement in research projects, as well as any lived experience of a physical or mental health condition or illness, to become facilitators of the course in the unique context of public involvement in research in Wales. Through this process many benefits were realised, including developing the course content and its delivery in Wales, as well as building the skills and confidence of the individuals themselves as facilitators. This has contributed to a continuing commitment to the sustainable delivery of the Involving the Public in the Design and Conduct of Research: Building Research Partnerships course in Wales and a combined approach to addressing any challenges and obstacles which presented.

ABSTRACT

Health and Care Research Wales has a strategic aim to Ensure public involvement and engagement is central to what we do and visible in all elements of it. As part of the ongoing development of the Health and Care Research Wales Training Programme a project was initiated to develop members of the public as facilitators to deliver a public involvement in research course. The project was undertaken in collaboration with Macmillan Cancer Support and was advertised via the Involving People Network in Wales. Three trainee facilitators were recruited, from 14 people that applied, to deliver a public involvement in research training course, the Building Research Partnerships course, as it was known then, originally developed for and by Macmillan Cancer Support. As members of the Involving People Network, the trainees were given training, mentorship, financial and administrative support to develop their role as facilitators over a two year period. This has been reciprocated with incredible commitment, ongoing course delivery in Wales, excellent course evaluations, course review and involvement in future planning. Through this project several benefits were realised, including developing the course content and its delivery and building the skills and confidence of the individual facilitators themselves. Additionally, and importantly, the project team found that patients and members of the public who are given appropriate training and support can greatly enhance a research training programme and act as highly effective ambassadors to further the cause of public involvement in research.

Genetic improvement and dissemination for the global commercial swine industry

Commercial swine production has become an increasingly globalised industry, with global meat trade demanding that all regions compete on cost and differentiation of pork products. The utilisation of continually improving genetic populations can be one input that helps maintain, or increases, the competitiveness of an individual producer or regional industry. So as to deliver these improving genetic populations, genetic providers of today must focus on developing and implementing best science that delivers improvement on traits affecting commercial profitability. Providers must also efficiently multiply and disseminate the improved merit to the commercial hog production level. The swine-genetics industry has made considerable progress in driving a faster genetic gain over the past 30 years by systematically combining ever-changing computing power, accurate data capture and emerging genomics information. The combination of these technologies today has resulted in hundreds of thousands of animals being genotyped for tens of thousands of markers, and this information is being combined with extensive phenotypic data to deliver rates of genetic gain nearly double what we were able to achieve 20 years ago. As importantly, this scientific advancement can then be combined with the ability to continue to understand and evaluate emerging traits related to animal robustness, well-being and consumer demand, resulting in the most comprehensive definition of selection targets in the history of modern animal improvement. Finally, managing the dissemination of these genes through boar stud and multiplication systems helps ensure that the commercial level minimises lag and utilises the highest-merit genetics available.

Conceptual design of the gamma-to-electron magnetic spectrometer for the National Ignition Facility

The Gamma-to-Electron Magnetic Spectrometer (GEMS) diagnostic is designed to measure the prompt γ-ray energy spectrum during high yield deuterium-tritium (DT) implosions at the National Ignition Facility (NIF). The prompt γ-ray spectrum will provide "burn-averaged" observables, including total DT fusion yield, total areal density (ρR), ablator ρR, and fuel ρR. These burn-averaged observables are unique because they are essentially averaged over 4π, providing a global reference for the line-of-sight-specific measurements typical of x-ray and neutron diagnostics. The GEMS conceptual design meets the physics-based requirements: ΔE/E = 3%-5% can be achieved in the range of 2-25 MeV γ-ray energy. Minimum DT neutron yields required for 15% measurement uncertainty at low-resolution mode are: 5 × 10(14) DT-n for ablator ρR (at 0.2 g/cm(2)); 2 × 10(15) DT-n for total DT yield (at 4.2 × 10(-5) γ/n); and 1 × 10(16) DT-n for fuel ρR (at 1 g/cm(2)).

Observation of a reflected shock in an indirectly driven spherical implosion at the national ignition facility

A 200  μm radius hot spot at more than 2 keV temperature, 1  g/cm^{3} density has been achieved on the National Ignition Facility using a near vacuum hohlraum. The implosion exhibits ideal one-dimensional behavior and 99% laser-to-hohlraum coupling. The low opacity of the remaining shell at bang time allows for a measurement of the x-ray emission of the reflected central shock in a deuterium plasma. Comparison with 1D hydrodynamic simulations puts constraints on electron-ion collisions and heat conduction. Results are consistent with classical (Spitzer-Harm) heat flux.

Supporting mentors in clinical practice

Students who entered training as of September 2007 are required to have a 'sign-off mentor' in their final clinical placement to register with the Nursing and Midwifery Council. The sign-off mentor status is mandatory for confirming that, on completion of the final clinical placement, the student has met all the requirements of the pre-registration clinical assessment criteria and can register as a qualified nurse. This article describes the role of the clinical teacher in preparing and supporting mentors in one area of Wales.

Understanding physical activity facilitators and barriers during and following a supervised exercise programme in Type 2 diabetes: a qualitative study

AIMS

To assess barriers and facilitators of participation in a supervised exercise programme, and adherence to exercise after programme completion.

METHODS

Focus group discussions addressed factors which could facilitate attendance, current engagement in exercise, reasons for continuing or discontinuing regular exercise and ways to integrate exercise into daily life. Three focus groups, with a total of 16 participants, were led by a trained moderator; audiotapes were transcribed verbatim; transcripts were coded and themes were identified. Themes that recurred across all three focus groups were considered to have achieved saturation.

RESULTS

Motivation was the most critical factor in exercising both during and following the programme. Participants appreciated the monitoring, encouragement and accountability provided by programme staff. They voiced a need for better transition to post-programme realities of less support and supervision. Co-morbid conditions were apt to derail them from a regular exercise routine. They viewed the optimal programme as having even greater scheduling flexibility and being closer to them geographically. Post-programme, walking emerged as the most frequent form of physical activity.

CONCLUSIONS

Adults with Type 2 diabetes require long-term monitoring and support for physical activity and exercise.

Surveillance of insecticide resistance in head lice using biochemical and molecular methods

Treatment of head louse infection is primarily through topical insecticides. However, there is growing evidence of resistance. A representative population sample was tested using biochemical and molecular methods; it was shown that, in Wales, treatments containing pyrethroids are likely to be less effective in controlling head louse infection than those containing organophosphates.

Measurement of dijet azimuthal decorrelations at central rapidities in pp collisions at sqrt s =1.96 TeV

Correlations in the azimuthal angle between the two largest transverse momentum jets have been measured using the D0 detector in p (-)p collisions at a center-of-mass energy sqrt[s]=1.96 TeV. The analysis is based on an inclusive dijet event sample in the central rapidity region corresponding to an integrated luminosity of 150 pb(-1). Azimuthal correlations are stronger at larger transverse momenta. These are well described in perturbative QCD at next-to-leading order in the strong coupling constant, except at large azimuthal differences where contributions with low transverse momentum are significant.

Search for supersymmetry with gauge-mediated breaking in diphoton events at D0

We report the results of a search for supersymmetry (SUSY) with gauge-mediated breaking in the missing transverse energy distribution of inclusive diphoton events using 263 pb(-1) of data collected by the D0 experiment at the Fermilab Tevatron Collider in 2002-2004. No excess is observed above the background expected from standard model processes, and lower limits on the masses of the lightest neutralino and chargino of about 108 and 195 GeV, respectively, are set at the 95% confidence level. These are the most stringent limits to date for models with gauge-mediated SUSY breaking with a short-lived neutralino as the next-to-lightest SUSY particle.

Measurement of the B0s lifetime in the exclusive decay channel B0s-->J/psiphi

Using the exclusive decay B0s-->J/psi(mu+mu-)phi(K+K-), we report the most precise single measurement of the B0s lifetime. The data sample corresponds to an integrated luminosity of approximately 220 pb(-1) collected with the D0 detector at the Fermilab Tevatron Collider in 2002-2004. We reconstruct 337 signal candidates, from which we extract the B0s lifetime, tau(B0s)=1.444(+0.098)(-0.090)(stat)+/-0.020(sys) ps. We also report a measurement for the lifetime of the B0 meson using the exclusive decay B0-->J/psi(mu+mu-)K*0(892)(K+pi-). We reconstruct 1370 signal candidates, obtaining tau(B0)=1.473(+0.052)(-0.050)(stat)+/-0.023(sys) ps, and the ratio of lifetimes, tau(B0s)/tau(B0)=0.980(+0.076)(-0.071)(stat)+/-0.003(sys).

Observation and properties of the X(3872) decaying to J/psipi(+)pi(-) in pp collisions at sqrt[s]=1.96 TeV

We report the observation of the X(3872) in the J/psipi(+)pi(-) channel, with J/psi decaying to mu(+)mu(-), in pp collisions at sqrt[s]=1.96 TeV. Using approximately 230 pb(-1) of data collected with the Run II D0 detector, we observe 522+/-100 X(3872) candidates. The mass difference between the X(3872) state and the J/psi is measured to be 774.9+/-3.1(stat)+/-3.0(syst) MeV/c(2). We have investigated the production and decay characteristics of the X(3872) and find them to be similar to those of the psi(2S) state.

Search for doubly charged higgs boson pair production in the decay to mu(+)mu(+)mu(-)mu(-) in pp collisions at sqrt[s]=1.96 TeV

A search for pair production of doubly charged Higgs bosons in the process pp -->H(++)H(--) -->mu(+)mu(+)mu(-)mu(-) is performed with the D0 run II detector at the Fermilab Tevatron. The analysis is based on a sample of inclusive dimuon data collected at an energy of sqrt[s]=1.96 TeV, corresponding to an integrated luminosity of 113 pb(-1). In the absence of a signal, 95% confidence level mass limits of M(H(+/-+/-)(L))>118.4 GeV/c(2) and M(H(+/-+/-)(R))>98.2 GeV/c(2) are set for left-handed and right-handed doubly charged Higgs bosons, respectively, assuming 100% branching into muon pairs.

A precision measurement of the mass of the top quark

The standard model of particle physics contains parameters--such as particle masses--whose origins are still unknown and which cannot be predicted, but whose values are constrained through their interactions. In particular, the masses of the top quark (M(t)) and W boson (M(W)) constrain the mass of the long-hypothesized, but thus far not observed, Higgs boson. A precise measurement of M(t) can therefore indicate where to look for the Higgs, and indeed whether the hypothesis of a standard model Higgs is consistent with experimental data. As top quarks are produced in pairs and decay in only about 10(-24) s into various final states, reconstructing their masses from their decay products is very challenging. Here we report a technique that extracts more information from each top-quark event and yields a greatly improved precision (of +/- 5.3 GeV/c2) when compared to previous measurements. When our new result is combined with our published measurement in a complementary decay mode and with the only other measurements available, the new world average for M(t) becomes 178.0 +/- 4.3 GeV/c2. As a result, the most likely Higgs mass increases from the experimentally excluded value of 96 to 117 GeV/c2, which is beyond current experimental sensitivity. The upper limit on the Higgs mass at the 95% confidence level is raised from 219 to 251 GeV/c2.

Search for narrow tt resonances in pp collisions at square root of (s)=1.8 TeV

A search for narrow resonances that decay into tt pairs has been performed using 130 pb(-1) of data in the lepton + jets channel collected by the Dphi detector in pp collisions at square root of (s)=1.8 TeV. There is no significant deviation observed from the standard-model predictions at a top-quark mass of 175 GeV/c2. We therefore present upper limits at the 95% confidence level on the product of the production cross section and branching fraction to tt for narrow resonances as a function of the resonance mass MX. These limits are used to exclude the existence of a leptophobic top-color particle with mass MX<560 GeV/c2, using a theoretical cross section for a width GammaX=0.012MX.

Comparative responses of molluscs and fish to environmental estrogens and an estrogenic effluent

It is now well established that there is a diverse array of chemical discharged into the environment that can mimic or antagonise the action of hormones. These endocrine-disrupting chemicals (EDCs) can thus interact with physiological systems and cause alterations in development, growth and reproduction in wildlife that are exposed to them. As yet, however, there is little information on the relative sensitivities of different wild life groups to these chemicals and/or mixtures of them (e.g. estrogenic effluents) and hence, there are fundamental shortfalls in our knowledge of the ecological chemicals (17alpha-ethinylestradiol; EE2, bisphenol-A, and 4-tert octylphenol) and a mixture containing these chemicals (treated sewage effluent) on embryo production in the prosobranch mollusc, Potamopyrgus antipodarum, were studied and compared with the effects of EE2 and the same estrogenic effluent on vitellogenin induction and/or egg production in various species of freshwater fish (fathead minnow; Pimaphales promelas, rainbow trout (Oncorhynchus mykiss); Cyprinus carpio, carp; Cyprinus carpio). The lab-based studies demonstrated that all of the tested chemicals (known to be estrogenic and to cause reproductive effects in fish) also affected embryo production in P. antipodarum. Furthermore, exposure to EE2 induced similar reproductive responses in the snails as in the fathead minnow (Pimephales promelas), stimulating egg/embryo production at low doses (up to 1 ng/l in the minnow and 25 ng/l in the snail) and causing inhibitory effects at higher doses. A similar pattern of embryo production occurred in P. antipodarum when it was exposed to a graded concentration of treated sewage effluent containing mixtures of estrogenic EDCs and hence, the total number of new embryos produced by the snails increased steadily over the 9 week exposure period in treated snails. Plasma vitellogenin concentrations in two species of male fish (the rainbow trout and the carp) also increased over the same time period. These data indicate that both the nature of the response and the relative sensitivities to environmental estrogens in P. antipodarum and three different fish species fish are comparable. P. andtipodarum is thus, potentially a sensitive test organism for assessing estrogenicity of chemicals with a relevance to their activity in vertebrates.

Comparative responses of molluscs and fish to environmental estrogens and an estrogenic effluent

It is now well established that there is a diverse array of chemicals discharged into the environment that can mimic or antagonise the action of hormones. These endocrine-disrupting chemicals (EDCs) can thus interact with physiological systems and cause alterations in development, growth and reproduction in wildlife that are exposed to them. As yet, however, there is little information on the relative sensitivities of different wildlife groups to these chemicals and/or mixtures of them (e.g. estrogenic effluents) and hence, there are fundamental shortfalls in our knowledge of the ecological importance of endocrine disruption in wildlife. In this study, the effects of exposure to individual estrogenic chemicals (17alpha-ethinylestradiol; EE2, bisphenol-A, and 4-tert octylphenol) and a mixture containing these chemicals (treated sewage effluent) on embryo production in the prosobranch mollusc, Potamopyrgus antipodarum, were studied and compared with the effects of EE2 and the same estrogenic effluent on vitellogenin induction and/or egg production in various species of freshwater fish (fathead minnow; Pimaphales promelas, rainbow trout (Oncorhynchus mykiss); Cyprinus carpio, carp; Cyprinus carpio). The lab-based studies demonstrated that all of the tested chemicals (known to be estrogenic and to cause reproductive effects in fish) also affected embryo production in P. antipodarum. Furthermore, exposure to EE2 induced similar reproductive responses in the snails as in the fathead minnow (Pimephales promelas), stimulating egg/embryo production at low doses (up to 1 ng/l in the minnow and 25 ng/l in the snail) and causing inhibitory effects at higher doses. A similar pattern of embryo production occurred in P. antipodarum when it was exposed to a graded concentration of treated sewage effluent containing mixtures of estrogenic EDCs and hence, the total number of new embryos produced by the snails increased steadily over the 9 weeks exposure period in treated snails. Plasma vitellogenin concentrations in two species of male fish (the rainbow trout and the carp) also increased over the same time period. These data indicate that both the nature of the response and the relative sensitivities to environmental estrogens in P. antipodarum and three different fish species fish are comparable. P. antipodarum is thus, potentially a sensitive test organism for assessing estrogenicity of chemicals with a relevance to their activity in vertebrates.

Search for large extra dimensions in the monojet+E(T) channel with the DØ detector

We present a search for large extra dimensions (ED) in pp collisions at a center-of-mass energy of 1.8 TeV using data collected by the DØ detector at the Fermilab Tevatron in 1994-1996. Data corresponding to 78.8+/-3.9 pb(-1) are examined for events with large missing transverse energy, one high-p(T) jet, and no isolated muons. There is no excess observed beyond expectation from the standard model, and we place lower limits on the fundamental Planck scale of 1.0 and 0.6 TeV for 2 and 7 ED, respectively.

Search for the production of single sleptons through R-parity violation in pp; collisions at square root (s) =1.8 TeV

We report the first search for supersymmetric particles via s-channel production and decay of smuons or muon sneutrinos at hadronic colliders. The data for the two-muon and two-jets final states were collected by the D0 experiment and correspond to an integrated luminosity of 94+/-5 pb(-1). Assuming that R parity is violated via the single coupling lambda'211, the number of candidate events is in agreement with expectation from the standard model. Exclusion contours are given in the (m(0),m(1/2)) and (m(x),m(v)) planes for lambda(')(211)=0.09, 0.08, and 0.07.

Search for R-parity violating supersymmetry in two-muon and four-jet topologies

We present results of a search for R-parity-violating decay of the neutralino chi;01, taken as the lightest supersymmetric particle, to a muon and two jets. The decay proceeds through a lepton-number violating coupling lambda(')(2jk) (j=1,2; k=1,2,3), with R-parity conservation in all other production and decay processes. In the absence of candidate events from 77.5+/-3.9 pb(-1) of data collected by the D0 experiment at the Fermilab Tevatron in pp collisions at sqrt[s]=1.8 TeV, and with an expected background of 0.18+/-0.03+/-0.02 events, we set limits on squark and gluino masses within the framework of the minimal low-energy supergravity-supersymmetry model.

Hepatitis B: how many patients are counselled on transmission prevention and how many contacts are offered vaccination?

The proportion of cases of hepatitis B who receive counselling on how to prevent transmission and for whom at-risk contacts are offered vaccination is low. A centralised arrangement under the management of the local CCDC can provide a comprehensive contract tracing service.

Search for leptoquark pairs decaying into nunu+jets in pp collisions at square root[s] = 1.8 TeV

We present the results of a search for leptoquark (LQ) pairs in (85.2+/-3.7) pb(-1) of pp* collider data collected by the D0 experiment at the Fermilab Tevatron. We observe no evidence for leptoquark production and set a limit on sigma(pp*-->LQLQ-->nunu+jets) as a function of the mass of the leptoquark (m(LQ)). Assuming the decay LQ-->nuq, we exclude scalar leptoquarks for m(LQ) < 98 GeV/c(2), and vector leptoquarks for m(LQ) < 200 GeV/c(2) and coupling which produces the minimum cross section, at a 95% confidence level.

Search for the scalar top quark in pp collisions at square root[s] = 1.8 TeV

We have performed a search for scalar top quark (stop) pair production in the inclusive electron-muon-missing transverse energy final state, using a sample of pp events corresponding to 108.3 pb(-1) of data collected with the D0 detector at Fermilab. The search is done in the framework of the minimal supersymmetric standard model assuming that the sneutrino is the lightest supersymmetric particle. For the dominant decays of the lightest stop, t-->b chi+1 and t-->blnu, no evidence for signal is found. We derive cross-section limits as a function of stop ( t ), chargino ( chi+1), and sneutrino ( nu) masses.

Direct search for charged higgs bosons in decays of top quarks

We present a search for charged Higgs bosons in decays of pair-produced top quarks in pp collisions at sqrt[s] = 1.8 TeV recorded by the D0 detector at the Fermilab Tevatron collider. With no evidence for signal, we exclude most regions of the ( M(H+/-),tan(beta)) parameter space where the decay t--> H(+)b has a branching fraction >0.36 and B(H+/--->tau(nu)(tau)) is large.

Ratio of isolated photon cross sections in pp macro collisions at square root of s = 630 and 1800 GeV

The inclusive cross section for production of isolated photons has been measured in pp macro collisions at square root of s = 630 GeV with the D0 detector at the Fermilab Tevatron Collider. The photons span a transverse energy (E(T)) range from 7-49 GeV and have pseudorapidity absolute value of eta < 2.5. This measurement is combined with the previous D0 result at square root of s = 1800 GeV to form a ratio of the cross sections. Comparison of next-to-leading-order QCD with the measured cross section at 630 GeV and the ratio of cross sections show satisfactory agreement in most of the E(T) range.

Search for new physics using QUAERO: a general interface to D0 event data

We describe QUAERO, a method that (i) enables the automatic optimization of searches for physics beyond the standard model, and (ii) provides a mechanism for making high energy collider data generally available. We apply QUAERO to searches for standard model WW, ZZ, and t t macro production, to searches for these objects produced through a new heavy resonance, and to the first direct search for W'-->WZ. Through this interface, we make three data sets collected by the D0 experiment at square root of [s] = 1.8 TeV publicly available.

Search for heavy particles decaying into electron-positron pairs in pp collisions

We present results of searches for technirho (rho(T)), techniomega (omega(T)), and Z' particles, using the decay channels rho(T),omega(T),Z'-->e(+)e(-). The search is based on 124.8 pb(-1) of data collected by the D0 detector at the Fermilab Tevatron during 1992-1996. In the absence of a signal, we set 95% C.L. upper limits on the cross sections for the processes pp-->rho(T),omega(T),Z'-->e(+)e(-) as a function of the mass of the decaying particle. For certain model parameters, we exclude the existence of degenerate rho(T) and omega(T) states with masses below about 200 GeV. We exclude a Z' with mass below 670 GeV, assuming that it has the same couplings to fermions as the Z boson.

Quasi-model-independent search for new high p(T) physics at D0

We apply a quasi-model-independent strategy ("Sleuth") to search for new high p(T) physics in approximately 100 pb(-1) of pp collisions at square root of (s) = 1.8 TeV collected by the D0 experiment during 1992-1996 at the Fermilab Tevatron. We systematically analyze many exclusive final states and demonstrate sensitivity to a variety of models predicting new phenomena at the electroweak scale. No evidence of new high p(T) physics is observed.

Ratio of jet cross sections at square root of s = 630 GeV and 1800 GeV

The D0 Collaboration has measured the inclusive jet cross section in barpp collisions at square root of s = 630 GeV. The results for pseudorapidities (eta)<0.5 are combined with our previous results at square root of s = 1800 GeV to form a ratio of cross sections with smaller uncertainties than either individual measurement. Next-to-leading-order QCD predictions show excellent agreement with the measurement at 630 GeV; agreement is also satisfactory for the ratio. Specifically, despite a 10% to 15% difference in the absolute magnitude, the dependence of the ratio on jet transverse momentum is very similar for data and theory.