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

OBJECTIVES

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

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

Background

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

Methods

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

Results

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

Conclusion

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

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

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

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

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

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

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

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

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

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

Searching for high-z DSFGs with NIKA2 and NOEMA

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Introduction

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

Method

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

Result

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

Conclusion

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

Take-home message

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

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

OBJECTIVES

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

STUDY DESIGN

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

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

Cluster cosmology with the NIKA2 SZ Large Program

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

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

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

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

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

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

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

Debris disks around stars in the NIKA2 era

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

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

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

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

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

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

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

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

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

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

INTRODUCTION

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

AIM

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

STUDY DESIGN

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

RESULTS

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

DISCUSSION

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

CONCLUSION

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

Identical and Nonidentical Twins: Risk and Factors Involved in Development of Islet Autoimmunity and Type 1 Diabetes

OBJECTIVE

There are variable reports of risk of concordance for progression to islet autoantibodies and type 1 diabetes in identical twins after one twin is diagnosed. We examined development of positive autoantibodies and type 1 diabetes and the effects of genetic factors and common environment on autoantibody positivity in identical twins, nonidentical twins, and full siblings.

RESEARCH DESIGN AND METHODS

Subjects from the TrialNet Pathway to Prevention Study (N = 48,026) were screened from 2004 to 2015 for islet autoantibodies (GAD antibody [GADA], insulinoma-associated antigen 2 [IA-2A], and autoantibodies against insulin [IAA]). Of these subjects, 17,226 (157 identical twins, 283 nonidentical twins, and 16,786 full siblings) were followed for autoantibody positivity or type 1 diabetes for a median of 2.1 years.

RESULTS

At screening, identical twins were more likely to have positive GADA, IA-2A, and IAA than nonidentical twins or full siblings (all P < 0.0001). Younger age, male sex, and genetic factors were significant factors for expression of IA-2A, IAA, one or more positive autoantibodies, and two or more positive autoantibodies (all P ≤ 0.03). Initially autoantibody-positive identical twins had a 69% risk of diabetes by 3 years compared with 1.5% for initially autoantibody-negative identical twins. In nonidentical twins, type 1 diabetes risk by 3 years was 72% for initially multiple autoantibody-positive, 13% for single autoantibody-positive, and 0% for initially autoantibody-negative nonidentical twins. Full siblings had a 3-year type 1 diabetes risk of 47% for multiple autoantibody-positive, 12% for single autoantibody-positive, and 0.5% for initially autoantibody-negative subjects.

CONCLUSIONS

Risk of type 1 diabetes at 3 years is high for initially multiple and single autoantibody-positive identical twins and multiple autoantibody-positive nonidentical twins. Genetic predisposition, age, and male sex are significant risk factors for development of positive autoantibodies in twins.

Caring for Obese Children- A change in Paradigm

Childhood Obesity is a problem of epidemic proportions. The causes are complex and treatment results are variable with much research ongoing. We analysed the initial assessment forms of a group of patients attending the W82GO! Healthy Lifestyle service at The Children's University Hospital, Temple Street to look at the population and their specific needs. Our analysis revealed a high proportion of emotional and behavioural problems along with bullying. This group of patients are complex and a multi-disciplinary team approach is essential in their treatment.

Waterborne outbreak of cryptosporidiosis in the South East of Ireland: weighing up the evidence

BACKGROUND

In late Spring 2012, 12 cases of cryptosporidiosis in a town in the South East of Ireland were notified to the regional Department of Public Health.

AIM

The purpose of this paper is to describe the outbreak and the investigative process which led to the conclusion that the source was a public drinking water supply.

METHODS

Outbreak and incident control teams were convened to investigate and control the outbreak.

RESULTS

Eleven cases were speciated as Cryptosporidium parvum. GP60 analysis demonstrated that 10 were C. parvum IIaA20G3R1, indicating that the cases were linked. The public water supply was the only common risk factor identified. Increased water sampling identified Cryptosporidium muris/andersoni in the treated water at one of two water treatment plants (Water Treatment Plant, WTP A) for the supply, and on the network. C. parvum was subsequently identified in raw water from WTP A.

CONCLUSIONS

The Health Service Executive (HSE) concluded that this outbreak was "probably associated with water" produced at WTP A based on (1) descriptive epidemiological evidence suggesting water-related illness and excluding other obvious explanations; and (2) water treatment failure at WTP A. WTP A was closed to facilitate an upgrade. No boil water notice was required as a supplementary supply was available. The upgrade was completed and the incident closed in 2013.

Hopkins Verbal Learning Test- Revised: Normative data for the Latin American Spanish speaking adult population

OBJECTIVE

To generate normative data on the Hopkins Verbal Learning Test- Revised (HVLT-R) across 11 countries in Latin America, with country-specific adjustments for gender, age, and education, where appropriate.

METHOD

The sample consisted of 3,977 healthy adults who were recruited from Argentina, Bolivia, Chile, Cuba, El Salvador, Guatemala, Honduras, Mexico, Paraguay, Peru, and, Puerto Rico. Each subject was administered the HVLT-R as part of a larger neuropsychological battery. A standardized five-step statistical procedure was used to generate the norms.

RESULTS

The final multiple linear regression models explained 17- 45% of the variance in HVLT-R scores. Although t-tests showed significant differences between men and women in Guatemala on the HVLT-R, it was a small effect size. As a result, gender-adjusted norms were not generated.

CONCLUSIONS

The results from this study will have a substantial impact on the practice of neuropsychology in Latin America, as this is the first normative multicenter study to develop norms for the HVLT-R in this region.

Horn-coupled, commercially-fabricated aluminum lumped-element kinetic inductance detectors for millimeter wavelengths

We discuss the design, fabrication, and testing of prototype horn-coupled, lumped-element kinetic inductance detectors (LEKIDs) designed for cosmic microwave background studies. The LEKIDs are made from a thin aluminum film deposited on a silicon wafer and patterned using standard photolithographic techniques at STAR Cryoelectronics, a commercial device foundry. We fabricated 20-element arrays, optimized for a spectral band centered on 150 GHz, to test the sensitivity and yield of the devices as well as the multiplexing scheme. We characterized the detectors in two configurations. First, the detectors were tested in a dark environment with the horn apertures covered, and second, the horn apertures were pointed towards a beam-filling cryogenic blackbody load. These tests show that the multiplexing scheme is robust and scalable, the yield across multiple LEKID arrays is 91%, and the measured noise-equivalent temperatures for a 4 K optical load are in the range 26±6 μK√s.