Suppression of IL-1β promotes beneficial accumulation of fibroblast-like cells in atherosclerotic plaques in clonal hematopoiesis

Clonal hematopoiesis (CH) is an independent risk factor for atherosclerotic cardiovascular disease. Murine models of CH suggest a central role of inflammasomes and IL-1β in accelerated atherosclerosis and plaque destabilization. Here we show using single-cell RNA sequencing in human carotid plaques that inflammasome components are enriched in macrophages, while the receptor for IL-1β is enriched in fibroblasts and smooth muscle cells (SMCs). To address the role of inflammatory crosstalk in features of plaque destabilization, we conducted SMC fate mapping in Ldlr-/- mice modeling Jak2VF or Tet2 CH treated with IL-1β antibodies. Unexpectedly, this treatment minimally affected SMC differentiation, leading instead to a prominent expansion of fibroblast-like cells. Depletion of fibroblasts from mice treated with IL-1β antibody resulted in thinner fibrous caps. Conversely, genetic inactivation of Jak2VF during plaque regression promoted fibroblast accumulation and fibrous cap thickening. Our studies suggest that suppression of inflammasomes promotes plaque stabilization by recruiting fibroblast-like cells to the fibrous cap.

CXCL8/CXCR2 signaling mediates bone marrow fibrosis and is a therapeutic target in myelofibrosis

Proinflammatory signaling is a hallmark feature of human cancer, including in myeloproliferative neoplasms (MPNs), most notably myelofibrosis (MF). Dysregulated inflammatory signaling contributes to fibrotic progression in MF; however, the individual cytokine mediators elicited by malignant MPN cells to promote collagen-producing fibrosis and disease evolution are yet to be fully elucidated. Previously, we identified a critical role for combined constitutive JAK/STAT and aberrant NF-κB proinflammatory signaling in MF development. Using single-cell transcriptional and cytokine-secretion studies of primary cells from patients with MF and the human MPLW515L (hMPLW515L) murine model of MF, we extend our previous work and delineate the role of CXCL8/CXCR2 signaling in MF pathogenesis and bone marrow fibrosis progression. Hematopoietic stem/progenitor cells from patients with MF are enriched for a CXCL8/CXCR2 gene signature and display enhanced proliferation and fitness in response to an exogenous CXCL8 ligand in vitro. Genetic deletion of Cxcr2 in the hMPLW515L-adoptive transfer model abrogates fibrosis and extends overall survival, and pharmacologic inhibition of the CXCR1/2 pathway improves hematologic parameters, attenuates bone marrow fibrosis, and synergizes with JAK inhibitor therapy. Our mechanistic insights provide a rationale for therapeutic targeting of the CXCL8/CXCR2 pathway among patients with MF.

280 PERCEIVED NEED FOR A CLINICAL ETHICS SUPPORT SERVICE AT AN IRISH UNIVERSITY HOSPITAL

Background

Ethics are the set of moral principles that guide a person’s behaviour. Ethical issues are a key component of healthcare and frequently arise in the management of hospitalized older patients. To improve decision-making and reduce burden on individual hospital staff, Clinical Ethics Support Services (CESS) have been widely-integrated into care pathways internationally. However, the need for CESS has received little attention in Irish hospitals.

Methods

A cross-sectional analysis of the ethical situation and CESS readiness at a tertiary hospital in Ireland was collected from July-October 2021 and in February 2022 via hard copies and online collection (SurveyMonkey). Both clinical (medicine, nursing other patient care role) and non-clinical (administrative, clerical, ICT, HR, general support staff and management) staff participated. Descriptive statistics were assessed taking the valid percentages, mean 5-item Likert scores and Friedman Test mean rank for ten ranked statements.

Results

In total, 199 people (13% response rate) completed the survey. Staff were largely (76%) clinical and the majority were qualified >10 years (57%). In all, 78% reported that ethical issues arise in the role (83% clinical staff, 59% non-clinical staff). Most (63%) were unsure who to contact about ethical concerns, instead seeking informal advice from colleagues (>90%). The majority of participants were interested in additional ethical training, especially on decision-making capacity (mean interest 4.18 out of 5), strategies for working with challenging patient/family situations (4.07 out of 5) and end-of-life care (4.06 out of 5). Out of ten options assessed, participants preferenced the development of a formal clinical ethics committee over education and training or the provision of educational materials.

Conclusion

Ethical issues commonly arise when caring for older hospitalized patients. This study found a perceived need and widespread interest in additional education as well as formal approaches to develop a hospital-based CESS, centred around a formal committee structure.

A174 PERCEPTIONS OF CANNABIS USE IN WOMEN WITH INFLAMMATORY BOWEL DISEASE OF REPRODUCTIVE AGE: A CROSS-SECTIONAL STUDY

Background

Cannabis use in inflammatory bowel disease (IBD) may lead to improvement in pain and general health perception. However, its use during pregnancy may result in adverse outcomes such as preterm birth and altered fetal brain development. It remains unknown how women with IBD perceive Cannabis use during pregnancy and whether they discuss its use with their health-care providers.

Aims

To determine practices in, and perceptions of, cannabis use during pregnancy in women with IBD of reproductive age.

Methods

Women with IBD (age 18–45) were recruited at Mount Sinai Hospital and via social media platforms. Participants anonymously completed surveys on baseline demographics and IBD characteristics. They also completed a Cannabis questionnaire which asked about current use, perceived risks during pregnancy, and discussions with health-care providers. Categorical variables were reported as frequencies and compared using the chi-square test. Continuous variables were reported as medians and compared using the Mann-Whitney U test.

Results

Sixty-four women were included, 26 (40.6%) with ulcerative colitis, 37 (57.8%) with Crohn’s disease, and 1 (1.6%) with indeterminate colitis. Nineteen (29.7%) were preconception, 40 (62.5%) were pregnant, and 5 (7.8%) were post-partum. Eleven (18.0%) patients reported current Cannabis use, 4 (6.3%) during pregnancy. Cannabis users were more likely to have discussed its use with a health-care provider compared to non-users (45.5% vs. 5.7%, p<0.001) and had longer IBD duration (12.00 vs. 9.00 years, p=0.05). Twenty-five (42.4%) were unsure of the risks of Cannabis use in pregnancy, of which only two had discussed this with a health-care provider. Reasons for fear of Cannabis use included risk of fetal oxygen restriction (n=13, 20.3%), impact on brain development (n=29, 46.0%), and risk of fetal respiratory issues (n=18, 28.6%). Only eight (12.5%) patients reported having a conversation about Cannabis use during pregnancy with their health-care provider; all of whom felt its consumption was unsafe during pregnancy.

Conclusions

Many women with IBD report being unsure of risks of Cannabis use during pregnancy. With the legalization of Cannabis in Canada, it is imperative patients and health-care providers discuss the risks and benefits of its use, particularly during vulnerable times such as pregnancy.

Funding Agencies

None

Early Intervention in Psychosis services: A systematic review and narrative synthesis of the barriers and facilitators to implementation

BACKGROUND

Early intervention in psychosis (EIP) services target the early manifestation of psychosis and provide multidisciplinary care. They demonstrate effectiveness and cost-effectiveness. Implementation of EIP services is inconsistent and piecemeal. This systematic review and narrative synthesis aims to identify barriers and facilitators to EIP service implementation.

METHODS

We conducted an electronic search of databases (EMBASE, Medline, Web of Science, and PsychINFO) to detect papers reporting EIP service implementation findings and associated barriers and facilitators. The search occurred between June to August 2020, and again in January 2021. Articles meeting inclusion criteria were extracted and narratively synthesized. A quality assessment was conducted using the Mixed Methods Appraisal Tool.

RESULTS

Twenty-three studies were selected. The most common study design was descriptive accounts of implementation. Patient age ranged varied from 14 to 35 years. We identified three barrier and facilitator domains: (a) system; (b) services; and (c) staff, and a range of subdomains. The most frequent subdomains were "funding" and "strength of collaboration and communication between EIP and outside groups and services". Associations between domains and subdomains were evident, particularly between systems and services.

CONCLUSIONS

A range of barriers and facilitators to EIP implementation exist. Some of these are generic factors germane across health systems and services, while others are specific to EIP services. A thorough prior understanding of these challenges and enablers are necessary before implementation is attempted. Accounting for these issues within local and national contexts may help predict and increase the likelihood of services' success, stability, and longevity.

Prioritisation of colonoscopy services in colorectal cancer screening programmes to minimise impact of COVID-19 pandemic on predicted cancer burden: A comparative modelling study

Objectives

Colorectal cancer (CRC) screening with a faecal immunochemical test (FIT) has been disrupted in many countries during the COVID-19 pandemic. Performing catch-up of missed screens while maintaining regular screening services requires additional colonoscopy capacity that may not be available. This study aimed to compare strategies that clear the screening backlog using limited colonoscopy resources.

Methods

A range of strategies were simulated using four country-specific CRC natural-history models: Adenoma and Serrated pathway to Colorectal CAncer (ASCCA) and MIcrosimulation SCreening ANalysis for CRC (MISCAN-Colon) (both in the Netherlands), Policy1-Bowel (Australia) and OncoSim (Canada). Strategies assumed a 3-month screening disruption with varying recovery period lengths (6, 12, and 24 months) and varying FIT thresholds for diagnostic colonoscopy. Increasing the FIT threshold reduces the number of referrals to diagnostic colonoscopy. Outcomes for each strategy were colonoscopy demand and excess CRC-related deaths due to the disruption.

Results

Performing catch-up using the regular FIT threshold in 6, 12 and 24 months could prevent most excess CRC-related deaths, but required 50%, 25% and 12.5% additional colonoscopy demand, respectively. Without exceeding usual colonoscopy demand, up to 60% of excess CRC-related deaths can be prevented by increasing the FIT threshold for 12 or 24 months. Large increases in FIT threshold could lead to additional deaths rather than preventing them.

Conclusions

Clearing the screening backlog in 24 months could avert most excess CRC-related deaths due to a 3-month disruption but would require a small increase in colonoscopy demand. Increasing the FIT threshold slightly over 24 months could ease the pressure on colonoscopy resources.

A101 OPTIMIZING MATERNAL AND NEONATAL OUTCOMES IN IBD: TIGHT CONTROL MANAGEMENT OF IBD DURING PREGNANCY – PILOT STUDY

Background

Managing inflammatory bowel disease (IBD) during pregnancy is challenging as pregnancy-related symptoms may overlap with symptoms of active IBD. Fecal calprotectin (FCP) is an optimal non-invasive measure of assessing disease activity during pregnancy. However, regular FCP during pregnancy may be impractical due to collection techniques. Rather, a home point-of care rapid lateral assay FCP test such as IBDoc® and a self-reported clinical disease activity program (IBD Dashboard) may be beneficial in routine monitoring of IBD activity during pregnancy.

Aims

To assess whether tight control of objective IBD disease activity using a point-of-care FCP (IBDoc®) monitoring is concordant with self-reported clinical symptoms (IBD Dashboard) in pregnant women with IBD.

Methods

Pregnant patients, aged ≥18 years, with IBD (Crohn’s Disease (CD) or Ulcerative colitis (UC)), in the 1st trimester (<13 weeks) with a singleton pregnancy were identified and enrolled. Patients were required to have access to a smartphone and internet to use the IBDoc® and IBD Dashboard. Patients completed a IBDoc® FCP and IBD Dashboard assessment at three study time points, 1) screening/baseline in 1st trimester, 2) 2nd trimester (14 to 18 weeks), and 3) 3rd trimester (28 to 32 weeks). Clinical disease activity was assessed by the modified HBI (Harvey Bradshaw Index) for CD and partial Mayo Index (pMayo) for UC. Elevated FCP (≥250 µg/g), mHBI ≥5 or pMayo ≥2 triggered an intervention to investigate or optimize therapy if required. A 5-point Likert scale questionnaire assessed patient satisfaction and feasibility of the IBDoc® and IBD Dashboard. Median values with interquartile ranges (IQR) were calculated for all continuous variables using SPSS.

Results

29 patients (17 CD, 12 UC) were included. Median mHBI and pMayo were 2.0 (IQR 2.0) and 0.5 (IQR 1.25) respectively. A total of 17.6% (3/17) of CD patients, and 25.0% (3/12) of UC patients had active clinical disease. Median IBDoc® FCP was 73 µg/g (IQR 343) in the CD group and 267 µg/g (IQR 677) in the UC group. At baseline, disease activity was categorized into four groups: 1) clinical remission (CR) and normal FCP (n=16, no treatment Δ, 100% stayed in CR); 2) clinical disease and elevated FCP (n=5, treatment Δ in all five patients, 80% stayed in CR, 20% had a clinical flare); 3) clinical remission and elevated FCP (n=5, treatment Δ in three patients, 100% stayed in CR); 4) clinical disease and normal FCP (n=1, no treatment Δ, 100% stayed in CR). Median IBDoc® and IBD Dashboard feasibility scores were 5.0 (IQR 1.0).

Conclusions

A combination of both clinical scores and objective disease markers may better predict disease relapse compared to either clinical scores or objective markers in isolation. A home point-of-care FCP test is feasible among pregnant patients with IBD.

Funding Agencies

None

A176 THE IMPACT OF COVID-19 ON ANXIETY, DEPRESSION, AND STRESS IN WOMEN WITH INFLAMMATORY BOWEL DISEASE: A CROSS-SECTIONAL SURVEY

Background

Women with inflammatory bowel disease (IBD) are at an increased risk of mental-health illness and reduced fertility.

Aims

To determine the impact of the coronavirus disease 2019 (COVID-19) pandemic on the mental-health and pregnancy plans of women with IBD.

Methods

Women with IBD (age 18–45) were asked to anonymously complete surveys on baseline demographics, IBD characteristics, and mental health comorbidities. They were also asked to comment on prior symptoms consistent with COVID-19 and whether they were tested for the virus. Finally, patients were asked to complete three mental health surveys to reflect on anxiety (Generalized Anxiety Disorder-7 (GAD7)), depression (Patient Health Questionnaire-9 (PHQ9)), and stress (Perceived Stress Scale (PSS)) symptoms prior to and during the pandemic. Total scores were reported as continuous variables and means with standard deviations (SD) were compared using paired T-tests.

Results

Twenty-nine patients (12 UC, 17 CD) were included. 14 patients were preconception, 12 were pregnant, and 3 were post-partum. The mean age was 31.4 (SD 3.7). Fifteen of 29 (51.7%) of patients were on anti-tumor necrosis factor therapy. Twelve (41.4%) and 6 (20.7%) patients had pre-morbid anxiety and depression prior to the pandemic. COVID-19 symptoms were reported in 8 patients (27.5%). Six patients had undergone COVID-19 testing, all of whom had a negative test. Four patients indicated that COVID-19 had negatively affected their plans for pregnancy, with reasons reported including fear of the hospital (n=1), fear of COVID-19 impact on the fetus (n=2), and uncertainty on the duration of COVID-19 (n=1). During the pandemic, fourteen of 28 (50%) patients experienced symptoms of anxiety (GAD score > 5), with a majority (70%) experiencing mild symptoms (score 5–9). During the pandemic, 60.7% (17/28) and 71.4% (20/28) reported symptoms of depression (PHQ9 > 4) and at least moderate stress (PSS > 14) respectively. Furthermore, compared to pre-pandemic, 57.1% (16/28) and 67.9% (19/28) had an increase in depression and stress symptoms during the pandemic respectively. This appeared to only apply to those with CD, but not UC (Table 1). Compared to pre-pandemic, those with stricturing CD appeared to have higher stress scores whereas those with fistulizing and perianal disease appeared to have higher depression scores during the COVID-19 pandemic (Table 1). A lower house-hold income and a reduction in exercise during the COVID-19 pandemic appeared to increase the risk of stress, depression, and anxiety symptoms.

Conclusions

Over half of women with IBD indicate worsening of anxiety, depression, and stress symptoms during the COVID-19 pandemic. It remains critical that health-care professionals address these mental health concerns during these otherwise difficult times.

Funding Agencies

None

A105 RAPID INTERDISCIPLINARY IBD CLINIC RESULTS IN TIMELY IBD WAIT TIMES, IMPROVED PATIENT SATISFACTION & PATIENT REPORTED OUTCOMES

Background

Inflammatory Bowel Disease (IBD) patients often have disease flares and extraintestinal manifestations such as rashes, arthralgias & perianal fistulas that require timely assessments. We implemented a Rapid Interdisciplinary IBD program at Mount Sinai Hospital with expedited consultation by an IBD specialist and referral with clinical need to collaborative colorectal surgeon, dermatologist, rheumatologist, and/or high-risk obstetrician. The RAPID program includes an online IBD Dashboard for patients to respond to questionnaires which is closely monitored 90 days post-enrolment by the IBD nurse.

Aims

To assess the implementation of an Interdisciplinary IBD Clinic & online IBD Dashboard monitoring system on the ability to increase patient satisfaction regarding their IBD care.

Methods

Upon consent into the RAPID IBD program, patients are enrolled to the IBD Dashboard and complete a Patient Satisfaction (CACHE) questionnaire at baseline, 3, 6, 12 months follow up and clinical disease activity scores at baseline, 1, 2, 3 months post enrollment; the Modified Harvey Bradshaw Index (mHBI) for Crohn’s disease (CD); partial Mayo score and Simple Clinical Colitis Activity Index (SCCAI) for ulcerative colitis (UC) and IBD unclassified (IBDU) patients. Results were compared pre/post enrollment with changes in median and interquartile ranges (IQR).

Results

109 patients were referred to RAPID, 88 (49 CD, 33 UC, 6 IBDU) enrolled & 62 consented to IBD Dashboard monitoring. Of those enrolled, 40 patients were referred based on flaring of clinical scores, 23 with potential flare or complication, 17 with acute extraintestinal manifestations, 4 pregnant and 4 with perianal disease. Median 4 (2–7) days to first GI IBD clinic. 15 patients were referred to dermatology, 12 to colorectal surgery, 8 to rheumatology and 3 to obstetrics. 6 patients visited the ER within the first 90 days after enrollment, with 1 (1–2) ER visits. Patient satisfaction improved from baseline 73.5% (68.4%-77.4%) (n=53) to 82.3% (75.5% - 84.0%) at 3 months (n=28). Clinical responses were seen post enrollment with a decrease in mHBI of 3.0 at 2 months, 1.5 on the 6-point Mayo (SF + RB) at 1 & 3 months and patient defined significant improvement in SCCAI greater than 1.5 after 1 month.

Conclusions

Preliminary results with RAPID IBD program demonstrate a short time to be seen by an IBD specialist, improvement in patient satisfaction and clinical responses in mHBI, pMayo and SCCAI scores 1–3 months post enrollment.

Funding Agencies

AMO

A170 A NOVEL DECISION AID IMPROVES KNOWLEDGE AND QUALITY OF PREGNANCY-RELATED DECISION-MAKING IN IBD

Background

Women with inflammatory bowel disease (IBD) with poor IBD-specific reproductive knowledge experience more voluntary childlessness. Poor knowledge is associated with fear of IBD medications in pregnancy; this must be addressed as active IBD at preconception (PC) correlates with worse intrapartum disease and poor fetal outcomes. The Pregnancy IBD Decision Aid (PIDA), developed by an international multidisciplinary team following International Patient Decision Aids Standards, is an interactive online tool that offers personalised decision support on fertility, pregnancy, and medications in IBD (Fig).

Aims

To assess PIDA’s impact on knowledge and quality of decision-making among PC and pregnant patients with IBD, and to evaluate its feasibility as a tool for patients and clinicians.

Methods

PC and pregnant women aged 18–45 with IBD, recruited in Canada and Australia, completed questionnaires pre and post PIDA to assess quality of decision-making (Decisional Conflict Scale, DCS; Self-Efficacy Score, SES) and IBD in pregnancy knowledge (Crohn’s and Colitis Pregnancy Knowledge Score, CCPKnow). DCS assesses if a decision is informed, aligned with personal values, and would be implemented. SES measures belief in one’s ability to make informed decisions. Patients and clinicians (gastroenterology, obstetrics, primary care) also completed feasibility surveys. Paired t-test assessed for differences pre and post PIDA.

Results

DCS and SES were completed by 74 patients (42 Crohn’s disease, 32 ulcerative colitis); 41 PC and 33 pregnant. DCS improved significantly post PIDA (effect size 0.44, p<0.0001); this was observed in PC patients regarding pregnancy planning with IBD, and in pregnant patients regarding peripartum IBD medication management. SES of PC but not pregnant patients improved significantly post PIDA (effect size 0.32 vs 0.24, p=0.0001 vs 0.0525). In both cohorts, CCPKnow improved significantly post PIDA (n=76, effect size 0.66, p<0.0001).

Patients (n=73) assessed PIDA feasibility. Mean scores for length (3.05±0.44), readability (3.09±0.5), and content amount (2.91±0.81) were perceived as appropriate (1=limited, 5=excessive). Perceived usefulness of PIDA was high among all patients (4.09±0.93; 5=most useful). Clinicians (n=14) believed PIDA had appropriate length, readability, and content amount, and deemed PIDA useful to patients (4.6±0.8) and themselves (4.8±0.8) for clinical practice.

Conclusions

PIDA improved knowledge and quality of decision-making in PC and pregnant patients with IBD. Patients developed a strengthened belief in their ability to make informed, effective decisions, and both patients and clinicians found PIDA feasible. PIDA is an accessible tool that can empower women with IBD to make evidence-based decisions about pregnancy and may ultimately reduce voluntary childlessness.

Funding Agencies

Mount Sinai Hospital Resident Research Grant; Gastroenterological Society of Australia Rose Amarant Grant; Women and Children’s Health Research Institute (WCHRI); Clinical/Community Research Integration Support Program (CRISP); Merck Better Care, Healthy Communities Funding Program

Search for doubly charged scalar bosons decaying into same-sign W boson pairs with the ATLAS detector

A search for doubly charged scalar bosons decaying into W boson pairs is presented. It uses a data sample from proton-proton collisions corresponding to an integrated luminosity of 36.1 fb - 1 collected by the ATLAS detector at the LHC at a centre-of-mass energy of 13 TeV in 2015 and 2016. This search is guided by a model that includes an extension of the Higgs sector through a scalar triplet, leading to a rich phenomenology that includes doubly charged scalar bosons H ± ± . Those bosons are produced in pairs in proton-proton collisions and decay predominantly into electroweak gauge bosons H ± ± → W ± W ± . Experimental signatures with several leptons, missing transverse energy and jets are explored. No significant deviations from the Standard Model predictions are found. The parameter space of the benchmark model is excluded at 95% confidence level for H ± ± bosons with masses between 200 and 220 GeV.

Search for Higgs boson pair production in the γ γ W W ∗ channel using pp collision data recorded at s = 13 TeV with the ATLAS detector

Searches for non-resonant and resonant Higgs boson pair production are performed in the γ γ W W ∗ channel with the final state of γ γ ℓ ν j j using 36.1  fb - 1 of proton-proton collision data recorded at a centre-of-mass energy ofs = 13 TeV by the ATLAS detector at the Large Hadron Collider. No significant deviation from the Standard Model prediction is observed. A 95% confidence-level observed upper limit of 7.7 pb is set on the cross section for non-resonant production, while the expected limit is 5.4 pb. A search for a narrow-width resonance X decaying to a pair of Standard Model Higgs bosons HH is performed with the same set of data, and the observed upper limits on σ ( p p → X ) × B ( X → H H ) range between 40.0 and 6.1 pb for masses of the resonance between 260 and 500 GeV, while the expected limits range between 17.6 and 4.4 pb. When deriving the limits above, the Standard Model branching ratios of the H → γ γ and H → W W ∗ are assumed.

Measurement of the azimuthal anisotropy of charged particles produced in s NN = 5.02 TeV Pb+Pb collisions with the ATLAS detector

Measurements of the azimuthal anisotropy in lead-lead collisions ats NN = 5.02 TeV are presented using a data sample corresponding to 0.49nb - 1 integrated luminosity collected by the ATLAS experiment at the LHC in 2015. The recorded minimum-bias sample is enhanced by triggers for "ultra-central" collisions, providing an opportunity to perform detailed study of flow harmonics in the regime where the initial state is dominated by fluctuations. The anisotropy of the charged-particle azimuthal angle distributions is characterized by the Fourier coefficients, v 2 - v 7 , which are measured using the two-particle correlation, scalar-product and event-plane methods. The goal of the paper is to provide measurements of the differential as well as integrated flow harmonics v n over wide ranges of the transverse momentum, 0.5  < p T <  60 GeV, the pseudorapidity, | η | <  2.5, and the collision centrality 0-80%. Results from different methods are compared and discussed in the context of previous and recent measurements in Pb+Pb collisions ats NN = 2.76  TeV and 5.02  TeV . In particular, the shape of the p T dependence of elliptic or triangular flow harmonics is observed to be very similar at different centralities after scaling the v n and p T values by constant factors over the centrality interval 0-60% and the p T range 0.5  < p T <  5 GeV.

Search for electroweak production of supersymmetric particles in final states with two or three leptons at s = 13 TeV with the ATLAS detector

A search for the electroweak production of charginos, neutralinos and sleptons decaying into final states involving two or three electrons or muons is presented. The analysis is based on 36.1 fb- 1 ofs = 13  TeV proton-proton collisions recorded by the ATLAS detector at the Large Hadron Collider. Several scenarios based on simplified models are considered. These include the associated production of the next-to-lightest neutralino and the lightest chargino, followed by their decays into final states with leptons and the lightest neutralino via either sleptons or Standard Model gauge bosons; direct production of chargino pairs, which in turn decay into leptons and the lightest neutralino via intermediate sleptons; and slepton pair production, where each slepton decays directly into the lightest neutralino and a lepton. No significant deviations from the Standard Model expectation are observed and stringent limits at 95% confidence level are placed on the masses of relevant supersymmetric particles in each of these scenarios. For a massless lightest neutralino, masses up to 580 GeV are excluded for the associated production of the next-to-lightest neutralino and the lightest chargino, assuming gauge-boson mediated decays, whereas for slepton-pair production masses up to 500 GeV are excluded assuming three generations of mass-degenerate sleptons.

Operation and performance of the ATLAS Tile Calorimeter in Run 1

The Tile Calorimeter is the hadron calorimeter covering the central region of the ATLAS experiment at the Large Hadron Collider. Approximately 10,000 photomultipliers collect light from scintillating tiles acting as the active material sandwiched between slabs of steel absorber. This paper gives an overview of the calorimeter's performance during the years 2008-2012 using cosmic-ray muon events and proton-proton collision data at centre-of-mass energies of 7 and 8 TeV with a total integrated luminosity of nearly 30 fb - 1 . The signal reconstruction methods, calibration systems as well as the detector operation status are presented. The energy and time calibration methods performed excellently, resulting in good stability of the calorimeter response under varying conditions during the LHC Run 1. Finally, the Tile Calorimeter response to isolated muons and hadrons as well as to jets from proton-proton collisions is presented. The results demonstrate excellent performance in accord with specifications mentioned in the Technical Design Report.

Performance of missing transverse momentum reconstruction with the ATLAS detector using proton-proton collisions at s = 13 TeV

The performance of the missing transverse momentum ( E T miss ) reconstruction with the ATLAS detector is evaluated using data collected in proton-proton collisions at the LHC at a centre-of-mass energy of 13 TeV in 2015. To reconstruct E T miss , fully calibrated electrons, muons, photons, hadronically decaying τ -leptons , and jets reconstructed from calorimeter energy deposits and charged-particle tracks are used. These are combined with the soft hadronic activity measured by reconstructed charged-particle tracks not associated with the hard objects. Possible double counting of contributions from reconstructed charged-particle tracks from the inner detector, energy deposits in the calorimeter, and reconstructed muons from the muon spectrometer is avoided by applying a signal ambiguity resolution procedure which rejects already used signals when combining the various E T miss contributions. The individual terms as well as the overall reconstructed E T miss are evaluated with various performance metrics for scale (linearity), resolution, and sensitivity to the data-taking conditions. The method developed to determine the systematic uncertainties of the E T miss scale and resolution is discussed. Results are shown based on the full 2015 data sample corresponding to an integrated luminosity of 3.2 fb - 1 .

Measurement of colour flow using jet-pull observables in t t ¯ events with the ATLAS experiment at s = 13 TeV

Previous studies have shown that weighted angular moments derived from jet constituents encode the colour connections between partons that seed the jets. This paper presents measurements of two such distributions, the jet-pull angle and jet-pull magnitude, both of which are derived from the jet-pull angular moment. The measurement is performed in t t ¯ events with one leptonically decaying W boson and one hadronically decaying W boson, using 36.1 fb - 1 of pp collision data recorded by the ATLAS detector ats = 13 TeV delivered by the Large Hadron Collider. The observables are measured for two dijet systems, corresponding to the colour-connected daughters of the W boson and the two b-jets from the top-quark decays, which are not expected to be colour connected. To allow the comparison of the measured distributions to colour model predictions, the measured distributions are unfolded to particle level, after correcting for experimental effects introduced by the detector. While good agreement can be found for some combinations of predictions and observables, none of the predictions describes the data well across all observables.

Prompt and non-prompt J / ψ elliptic flow in Pb+Pb collisions at s NN = 5.02 Tev with the ATLAS detector

The elliptic flow of prompt and non-prompt J / ψ was measured in the dimuon decay channel in Pb+Pb collisions ats NN = 5.02   TeV with an integrated luminosity of 0.42 nb - 1 with the ATLAS detector at the LHC. The prompt and non-prompt signals are separated using a two-dimensional simultaneous fit of the invariant mass and pseudo-proper decay time of the dimuon system from the J / ψ decay. The measurement is performed in the kinematic range of dimuon transverse momentum and rapidity 9 < p T < 30   GeV , | y | < 2 , and 0-60% collision centrality. The elliptic flow coefficient, v 2 , is evaluated relative to the event plane and the results are presented as a function of transverse momentum, rapidity and centrality. It is found that prompt and non-prompt J / ψ mesons have non-zero elliptic flow. Prompt J / ψ v 2 decreases as a function of p T , while for non-prompt J / ψ it is, with limited statistical significance, consistent with a flat behaviour over the studied kinematic region. There is no observed dependence on rapidity or centrality.

Prompt and non-prompt J / ψ and ψ ( 2 S ) suppression at high transverse momentum in 5.02 TeV Pb+Pb collisions with the ATLAS experiment

A measurement of J / ψ and ψ ( 2 S ) production is presented. It is based on a data sample from Pb+Pb collisions at s NN = 5.02 TeV and pp collisions at s = 5.02 TeV recorded by the ATLAS detector at the LHC in 2015, corresponding to an integrated luminosity of 0.42 nb - 1 and 25 pb - 1 in Pb+Pb and pp, respectively. The measurements of per-event yields, nuclear modification factors, and non-prompt fractions are performed in the dimuon decay channel for 9 < p T μ μ < 40 GeV in dimuon transverse momentum, and - 2 < y μ μ < 2 in rapidity. Strong suppression is found in Pb+Pb collisions for both prompt and non-prompt J / ψ , increasing with event centrality. The suppression of prompt ψ ( 2 S ) is observed to be stronger than that of J / ψ , while the suppression of non-prompt ψ ( 2 S ) is equal to that of the non-prompt J / ψ within uncertainties, consistent with the expectation that both arise from b-quarks propagating through the medium. Despite prompt and non-prompt J / ψ arising from different mechanisms, the dependence of their nuclear modification factors on centrality is found to be quite similar.

Search for new phenomena using the invariant mass distribution of same-flavour opposite-sign dilepton pairs in events with missing transverse momentum in s=13 Tepp collisions with the ATLAS detector

A search for new phenomena in final states containing an e + e - or μ + μ - pair, jets, and large missing transverse momentum is presented. This analysis makes use of proton-proton collision data with an integrated luminosity of 36.1 fb - 1 , collected during 2015 and 2016 at a centre-of-mass energy s = 13 TeV with the ATLAS detector at the Large Hadron Collider. The search targets the pair production of supersymmetric coloured particles (squarks or gluinos) and their decays into final states containing an e + e - or μ + μ - pair and the lightest neutralino ( χ ~ 1 0 ) via one of two next-to-lightest neutralino ( χ ~ 2 0 ) decay mechanisms: χ ~ 2 0 → Z χ ~ 1 0 , where the Z boson decays leptonically leading to a peak in the dilepton invariant mass distribution around the Z boson mass; and χ ~ 2 0 → ℓ + ℓ - χ ~ 1 0 with no intermediate ℓ + ℓ - resonance, yielding a kinematic endpoint in the dilepton invariant mass spectrum. The data are found to be consistent with the Standard Model expectation. Results are interpreted using simplified models, and exclude gluinos and squarks with masses as large as 1.85 and 1.3  Te at 95% confidence level, respectively.

Search for heavy particles decaying into top-quark pairs using lepton-plus-jets events in proton-proton collisions at s = 13 TeV with the ATLAS detector

A search for new heavy particles that decay into top-quark pairs is performed using data collected from proton-proton collisions at a centre-of-mass energy of 13  TeV by the ATLAS detector at the Large Hadron Collider. The integrated luminosity of the data sample is 36.1 fb- 1 . Events consistent with top-quark pair production are selected by requiring a single isolated charged lepton, missing transverse momentum and jet activity compatible with a hadronic top-quark decay. Jets identified as likely to contain b-hadrons are required to reduce the background from other Standard Model processes. The invariant mass spectrum of the candidate top-quark pairs is examined for local excesses above the background expectation. No significant deviations from the Standard Model predictions are found. Exclusion limits are set on the production cross-section times branching ratio for hypothetical Z ' bosons, Kaluza-Kein gluons and Kaluza-Klein gravitons that decay into top-quark pairs.

Capturing the Patient's Perspective: a Review of Advances in Natural Language Processing of Health-Related Text

Background: Natural Language Processing (NLP) methods are increasingly being utilized to mine knowledge from unstructured health-related texts. Recent advances in noisy text processing techniques are enabling researchers and medical domain experts to go beyond the information encapsulated in published texts (e.g., clinical trials and systematic reviews) and structured questionnaires, and obtain perspectives from other unstructured sources such as Electronic Health Records (EHRs) and social media posts. Objectives: To review the recently published literature discussing the application of NLP techniques for mining health-related information from EHRs and social media posts. Methods: Literature review included the research published over the last five years based on searches of PubMed, conference proceedings, and the ACM Digital Library, as well as on relevant publications referenced in papers. We particularly focused on the techniques employed on EHRs and social media data. Results: A set of 62 studies involving EHRs and 87 studies involving social media matched our criteria and were included in this paper. We present the purposes of these studies, outline the key NLP contributions, and discuss the general trends observed in the field, the current state of research, and important outstanding problems. Conclusions: Over the recent years, there has been a continuing transition from lexical and rule-based systems to learning-based approaches, because of the growth of annotated data sets and advances in data science. For EHRs, publicly available annotated data is still scarce and this acts as an obstacle to research progress. On the contrary, research on social media mining has seen a rapid growth, particularly because the large amount of unlabeled data available via this resource compensates for the uncertainty inherent to the data. Effective mechanisms to filter out noise and for mapping social media expressions to standard medical concepts are crucial and latent research problems. Shared tasks and other competitive challenges have been driving factors behind the implementation of open systems, and they are likely to play an imperative role in the development of future systems.