Determining the clinical and cost-effectiveness of nasal sprays and a physical activity and stress management intervention to reduce respiratory tract infections in primary care: A protocol for the 'Immune Defence' randomised controlled trial

BACKGROUND

Most adults in the UK experience at least one viral respiratory tract infection (RTI) per year. Individuals with comorbidities and those with recurrent RTIs are at higher risk of infections. This can lead to more severe illness, worse quality of life and more days off work. There is promising evidence that using common nasal sprays or improving immune function through increasing physical activity and managing stress, may reduce the incidence and severity of RTIs.

METHODS AND DESIGN

Immune Defence is an open, parallel group, randomised controlled trial. Up to 15000 adults from UK general practices, with a comorbidity or risk factor for infection and/or recurrent infections (3 or more infections per year) will be randomly allocated to i) a gel-based nasal spray designed to inhibit viral respiratory infections; ii) a saline nasal spray, iii) a digital intervention promoting physical activity and stress management, or iv) usual care with brief advice for managing infections, for 12 months. Participants will complete monthly questionnaires online. The primary outcome is the total number of days of illness due to RTIs over 6 months. Key secondary outcomes include: days with symptoms moderately bad or worse; days where work/normal activities were impaired; incidence of RTI; incidence of COVID-19; health service contacts; antibiotic usage; beliefs about antibiotics; intention to consult; number of days of illness in total due to respiratory tract infections over 12 months. Economic evaluation from an NHS perspective will compare the interventions, expressed as incremental cost effectiveness ratios. A nested mixed methods process evaluation will examine uptake and engagement with the interventions and trial procedures.

TRIAL STATUS

Recruitment commenced in December 2020 and the last participant is expected to complete the trial in April 2024.

DISCUSSION

Common nasal sprays and digital interventions to promote physical activity and stress management are low cost, accessible interventions applicable to primary care. If effective, they have the potential to reduce the individual and societal impact of RTIs.

TRIAL REGISTRATION

Prospectively registered with ISRCTN registry (17936080) on 30/10/2020.

SPONSOR

This RCT is sponsored by University of Southampton. The sponsors had no role in the study design, decision to publish, or preparation of the manuscript.

Bendamustine is safe and effective for lymphodepletion before tisagenlecleucel in patients with refractory or relapsed large B-cell lymphomas

BACKGROUND

Anti-CD19 chimeric antigen receptor T-cell immunotherapy (CAR-T) is now a standard treatment of relapsed or refractory B-cell non-Hodgkin lymphomas; however, a significant portion of patients do not respond to CAR-T and/or experience toxicities. Lymphodepleting chemotherapy is a critical component of CAR-T that enhances CAR-T-cell engraftment, expansion, cytotoxicity, and persistence. We hypothesized that the lymphodepletion regimen might affect the safety and efficacy of CAR-T.

PATIENTS AND METHODS

We compared the safety and efficacy of lymphodepletion using either fludarabine/cyclophosphamide (n = 42) or bendamustine (n = 90) before tisagenlecleucel in two cohorts of patients with relapsed or refractory large B-cell lymphomas treated consecutively at three academic institutions in the United States (University of Pennsylvania, n = 90; Oregon Health & Science University, n = 35) and Europe (University of Vienna, n = 7). Response was assessed using the Lugano 2014 criteria and toxicities were assessed by the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 and, when possible, the American Society for Transplantation and Cellular Therapy (ASTCT) consensus grading.

RESULTS

Fludarabine/cyclophosphamide led to more profound lymphocytopenia after tisagenlecleucel infusion compared with bendamustine, although the efficacy of tisagenlecleucel was similar between the two groups. We observed significant differences, however, in the frequency and severity of adverse events. In particular, patients treated with bendamustine had lower rates of cytokine release syndrome and neurotoxicity. In addition, higher rates of hematological toxicities were observed in patients receiving fludarabine/cyclophosphamide. Bendamustine-treated patients had higher nadir neutrophil counts, hemoglobin levels, and platelet counts, as well as a shorter time to blood count recovery, and received fewer platelet and red cell transfusions. Fewer episodes of infection, neutropenic fever, and post-infusion hospitalization were observed in the bendamustine cohort compared with patients receiving fludarabine/cyclophosphamide.

CONCLUSIONS

Bendamustine for lymphodepletion before tisagenlecleucel has efficacy similar to fludarabine/cyclophosphamide with reduced toxicities, including cytokine release syndrome, neurotoxicity, infectious and hematological toxicities, as well as reduced hospital utilization.

Using nasal sprays to prevent respiratory tract infections: a qualitative study of online consumer reviews and primary care patient interviews

OBJECTIVES

Nasal sprays could be a promising approach to preventing respiratory tract infections (RTIs). This study explored lay people's perceptions and experiences of using nasal sprays to prevent RTIs to identify barriers and facilitators to their adoption and continued use.

DESIGN

Qualitative research. Study 1 thematically analysed online consumer reviews of an RTI prevention nasal spray. Study 2 interviewed patients about their reactions to and experiences of a digital intervention that promotes and supports nasal spray use for RTI prevention (reactively: at 'first signs' of infection and preventatively: following possible/probable exposure to infection). Interview transcripts were analysed using thematic analysis.

SETTING

Primary care, UK.

PARTICIPANTS

407 online customer reviews. 13 purposively recruited primary care patients who had experienced recurrent infections and/or had risk factors for severe infections.

RESULTS

Both studies identified various factors that might influence nasal spray use including: high motivation to avoid RTIs, particularly during the COVID-19 pandemic; fatalistic views about RTIs; beliefs about alternative prevention methods; the importance of personal recommendation; perceived complexity and familiarity of nasal sprays; personal experiences of spray success or failure; tolerable and off-putting side effects; concerns about medicines; and the nose as unpleasant and unhygienic.

CONCLUSIONS

People who suffer disruptive, frequent or severe RTIs or who are vulnerable to RTIs are interested in using a nasal spray for prevention. They also have doubts and concerns and may encounter problems. Some of these may be reduced or eliminated by providing nasal spray users with information and advice that addresses these concerns or helps people overcome difficulties.

Patient perceptions of vulnerability to recurrent respiratory tract infections and prevention strategies: a qualitative study

OBJECTIVES

Respiratory tract infections (RTIs) are extremely common, usually self-limiting, but responsible for considerable work sickness absence, reduced quality of life, inappropriate antibiotic prescribing and healthcare costs. Patients who experience recurrent RTIs and those with certain comorbid conditions have higher personal impact and healthcare costs and may be more likely to suffer disease exacerbations, hospitalisation and death. We explored how these patients experience and perceive their RTIs to understand how best to engage them in prevention behaviours.

DESIGN

A qualitative interview study.

SETTING

Primary care, UK.

METHODS

23 participants who reported recurrent RTIs and/or had relevant comorbid health conditions were interviewed about their experiences of RTIs. Interviews took place as the COVID-19 pandemic began. Data were analysed using inductive thematic analysis.

RESULTS

Three themes were developed: Understanding causes and vulnerability, Attempting to prevent RTIs, Uncertainty and ambivalence about prevention, along with an overarching theme; Changing experiences because of COVID-19. Participants' understandings of their susceptibility to RTIs were multifactorial and included both transmission via others and personal vulnerabilities. They engaged in various approaches to try to prevent infections or alter their progression yet perceived they had limited personal control. The COVID-19 pandemic had improved their understanding of transmission, heightened their concern and motivation to avoid RTIs and extended their repertoire of protective behaviours.

CONCLUSIONS

Patients who experience frequent or severe RTIs are likely to welcome and benefit from advice and support regarding RTI prevention. To engage people effectively, those developing interventions or delivering health services must consider their beliefs and concerns about susceptibility and prevention.

Factors associated with attendance at screening for breast cancer: a systematic review and meta-analysis

OBJECTIVE

Attendance at population-based breast cancer (mammographic) screening varies. This comprehensive systematic review and meta-analysis assesses all identified patient-level factors associated with routine population breast screening attendance.

DESIGN

CINAHL, Cochrane Library, Embase, Medline, OVID, PsycINFO and Web of Science were searched for studies of any design, published January 1987-June 2019, and reporting attendance in relation to at least one patient-level factor.

DATA SYNTHESIS

Independent reviewers performed screening, data extraction and quality appraisal. OR and 95% CIs were calculated for attendance for each factor and random-effects meta-analysis was undertaken where possible.

RESULTS

Of 19 776 studies, 335 were assessed at full text and 66 studies (n=22 150 922) were included. Risk of bias was generally low. In meta-analysis, increased attendance was associated with higher socioeconomic status (SES) (n=11 studies; OR 1.45, 95% CI: 1.20 to 1.75); higher income (n=5 studies; OR 1.96, 95% CI: 1.68 to 2.29); home ownership (n=3 studies; OR 2.16, 95% CI: 2.08 to 2.23); being non-immigrant (n=7 studies; OR 2.23, 95% CI: 2.00 to 2.48); being married/cohabiting (n=7 studies; OR 1.86, 95% CI: 1.58 to 2.19) and medium (vs low) level of education (n=6 studies; OR 1.24, 95% CI: 1.09 to 1.41). Women with previous false-positive results were less likely to reattend (n=6 studies; OR 0.77, 95% CI: 0.68 to 0.88). There were no differences by age group or by rural versus urban residence.

CONCLUSIONS

Attendance was lower in women with lower SES, those who were immigrants, non-homeowners and those with previous false-positive results. Variations in service delivery, screening programmes and study populations may influence findings. Our findings are of univariable associations. Underlying causes of lower uptake such as practical, physical, psychological or financial barriers should be investigated.

TRIAL REGISTRATION NUMBER

CRD42016051597.

Case of renal cell carcinoma with immunotherapy effect mimicking xanthogranulomatous pyelonephritis

Introduction/Objective

The histologic features of renal cell carcinoma (RCC) after immunotherapy are not fully established. We report the pathologic findings of one case of clear cell RCC after treatment with pembrolizumab which is a humanized monoclonal anti-PD1 antibody.

Methods/Case Report

46-year-old man completed three cycles of pembrolizumab for recurrent basal cell carcinoma. A 5.0 cm mass was incidentally found within left kidney during staging CT scan. He subsequently had left radical nephrectomy. Pathologic examination of nephrectomy specimen identified one 5.0 cm, well-circumscribed, solid mass in the upper pole, confined to the kidney with predominantly hemorrhagic, focally golden-yellow soft cut surface. The remaining parenchyma appears unremarkable. The pelvicalyceal system is not dilated. Sections of tumor show predominance of foamy histiocytes, lymphoplasmacytic infiltrate, and scattered cells having pale or eosinophilic cytoplasm, conspicuous nucleoli and low nuclear: cytoplasm ratio. Cholesterol clefts and hemosiderin deposits are noted. The immunostaining profile highlights areas suspicious for viable tumor cells by using pan-keratin, CK8/18, EMA, CA9 and CD10. Focal positivity in the same area is noted by the stains of PAX 8 and AMACR. However, with numerous histiocytes, it is difficult to determine if the tumor cells are positive for Vimentin. Moreover CD 117 is negative in the tumor cells.

Results (if a Case Study enter NA)

NA

Conclusion

Differential diagnosis includes renal cell carcinoma and xanthogranulomatous pyelonephritis. The overall findings support a clear cell RCC affected by the immunotherapy. With immunotherapy-based combinations becoming standard of care in advanced malignancies, it makes the pathological diagnosis more challenging and difficult, especially for incidental tumors.

Studies of Charm Quark Diffusion inside Jets Using Pb-Pb and pp Collisions at sqrt[s_{NN}]=5.02 TeV

The first study of charm quark diffusion with respect to the jet axis in heavy ion collisions is presented. The measurement is performed using jets with p_{T}^{jet}>60  GeV/c and D^{0} mesons with p_{T}^{D}>4  GeV/c in lead-lead (Pb-Pb) and proton-proton (pp) collisions at a nucleon-nucleon center-of-mass energy of sqrt[s_{NN}]=5.02  TeV, recorded by the CMS detector at the LHC. The radial distribution of D^{0} mesons with respect to the jet axis is sensitive to the production mechanisms of the meson, as well as to the energy loss and diffusion processes undergone by its parent parton inside the strongly interacting medium produced in Pb-Pb collisions. When compared to Monte Carlo event generators, the radial distribution in pp collisions is found to be well described by pythia, while the slope of the distribution predicted by sherpa is steeper than that of the data. In Pb-Pb collisions, compared to the pp results, the D^{0} meson distribution for 4<p_{T}^{D}<20  GeV/c hints at a larger distance on average with respect to the jet axis, reflecting a diffusion of charm quarks in the medium created in heavy ion collisions. At higher p_{T}^{D}, the Pb-Pb and pp radial distributions are found to be similar.

Azimuthal separation in nearly back-to-back jet topologies in inclusive 2- and 3-jet events in pp collisions at s = 13 Te

A measurement for inclusive 2- and 3-jet events of the azimuthal correlation between the two jets with the largest transverse momenta, Δ ϕ 12 , is presented. The measurement considers events where the two leading jets are nearly collinear ("back-to-back") in the transverse plane and is performed for several ranges of the leading jet transverse momentum. Proton-proton collision data collected with the CMS experiment at a center-of-mass energy of 13 Te and corresponding to an integrated luminosity of 35.9 fb - 1 are used. Predictions based on calculations using matrix elements at leading-order and next-to-leading-order accuracy in perturbative quantum chromodynamics supplemented with leading-log parton showers and hadronization are generally in agreement with the measurements. Discrepancies between the measurement and theoretical predictions are as large as 15%, mainly in the region177 ∘ < Δ ϕ 12 < 180 ∘ . The 2- and 3-jet measurements are not simultaneously described by any of models.

Innovative playgrounds: use, physical activity, and implications for health

OBJECTIVES

The aim of the study is to assess the use and levels of moderate-to-vigorous physical activity (MVPA) occurring in innovative playgrounds in London vs. traditional playgrounds in the US in neighborhoods with a similar population density.

STUDY DESIGN

This is a cross-sectional observational study.

METHODS

We selected a sample of London playgrounds based on their innovative design. One group of eight playgrounds was matched to the US playgrounds by size and population density; a second group of very large London playgrounds was matched only by population density. Playground use and person-hours of MVPA were measured using direct observation at similar times of the day and days of the week in all locations.

RESULTS

The number of playground visit hours was 58% higher in London than in the US (394 vs 249). The matched London playgrounds had 37.8% more children and 129% more adults who were, respectively, engaging in 90% and 116% more MVPA. While the London playgrounds were nearly 8.5 times larger than the US ones, they attracted a total of 5.8 times more visitors (1399 vs 243, P < .0001), and this included 10 times as many adults (679 vs. 66, P < .0001) and 7.5 times more seniors (23 vs. 3). The London playgrounds included more amenities targeting adults.

CONCLUSIONS

The design of an innovative playground was associated with the amount of MVPA in similar-sized playgrounds, but the size of the playground was more strongly associated with the number of visitors. It is as important to design playgrounds for adults as it is for children to increase visit hours.

Measurement of exclusive ρ 770 0 photoproduction in ultraperipheral pPb collisions at s NN = 5.02 Te

Exclusiveρ 770 0 photoproduction is measured for the first time in ultraperipheral pPb collisions ats NN = 5.02 Te with the CMS detector. The cross section σ ( γ p → ρ 770 0 p ) is 11.0 ± 1.4 (stat) ± 1.0 (syst) μ b at ⟨ W γ p ⟩ = 92.6 Ge for photon-proton centre-of-mass energies W γ p between 29 and 213 Ge . The differential cross section d σ / d | t | is measured in the interval0.025 < | t | < 1 Ge 2 as a function of W γ p , where t is the squared four-momentum transfer at the proton vertex. The results are compared with previous measurements and theoretical predictions. The measured cross section σ ( γ p → ρ 770 0 p ) has a power-law dependence on the photon-proton centre-of-mass, consistent with electron-proton collision measurements performed at HERA. The W γ p dependence of the exponential slope of the differential cross section d σ / d | t | is also measured.

Atopic dermatitis in the elderly: a review of clinical and pathophysiological hallmarks

BACKGROUND

Atopic dermatitis (AD) is a multifactorial and complex disease, characterized by an impaired skin barrier function and abnormal immune response. Many elderly patients present with pruritus and xerosis to dermatology, allergy and primary care clinics, and there is a lack of information available to clinicians regarding the proper diagnosis and management of these patients. Although the elderly are described as having a distinct presentation of AD and important comorbidities, most investigations and clinical care guidelines pertaining to AD do not include patients aged 60 years and older as a separate group from younger adults.

OBJECTIVES

To summarize current information on pathophysiology, diagnosis and management of AD in the elderly population and identify areas of insufficient information to be explored in future investigations.

METHODS

We carried out a systematic review of published literature, which assessed changes in the skin barrier and immune function with ageing and current information available for physicians to use in the diagnosis and treatment of AD in elderly patients.

RESULTS

Many age-related changes overlap with key hallmarks observed in AD, most notably a decline in skin barrier function, dysregulation of the innate immune system, and skewing of adaptive immunity to a type-2 T helper cell response, in addition to increased Staphylococcus aureus infection.

CONCLUSIONS

While general physiological alterations with ageing overlap with key features of AD, a research gap exists regarding specific ageing-related changes in AD disease development. More knowledge about AD in the elderly is needed to establish firm diagnostic and treatment methodologies. What's already known about this topic? Atopic dermatitis (AD) is a common inflammatory skin disease that causes significant burden worldwide. Recently, elderly patients have been considered a subgroup of patients with distinct AD manifestation. Limited studies have characterized the clinical presentation and role of IgE-mediated allergy in elderly patients with AD. What does this study add? This review offers a summary of age-related skin and immune alterations that correspond to pathogenic changes noted in patients with AD. The role of itch, environmental factors and skin microbiota in AD disease presentation in ageing patients is explored.

Studies of Beauty Suppression via Nonprompt D^{0} Mesons in Pb-Pb Collisions at sqrt[s_{NN}]=5.02 TeV

The transverse momentum spectra of D^{0} mesons from b hadron decays are measured at midrapidity (|y|<1) in pp and Pb-Pb collisions at a nucleon-nucleon center of mass energy of 5.02 TeV with the CMS detector at the LHC. The D^{0} mesons from b hadron decays are distinguished from prompt D^{0} mesons by their decay topologies. In Pb-Pb collisions, the B→D^{0} yield is found to be suppressed in the measured p_{T} range from 2 to 100  GeV/c as compared to pp collisions. The suppression is weaker than that of prompt D^{0} mesons and charged hadrons for p_{T} around 10  GeV/c. While theoretical calculations incorporating partonic energy loss in the quark-gluon plasma can successfully describe the measured B→D^{0} suppression at higher p_{T}, the data show an indication of larger suppression than the model predictions in the range of 2<p_{T}<5  GeV/c.

Combined measurements of Higgs boson couplings in proton-proton collisions at s = 13 Te

Combined measurements of the production and decay rates of the Higgs boson, as well as its couplings to vector bosons and fermions, are presented. The analysis uses the LHC proton-proton collision data set recorded with the CMS detector in 2016 ats = 13 Te , corresponding to an integrated luminosity of 35.9fb - 1 . The combination is based on analyses targeting the five main Higgs boson production mechanisms (gluon fusion, vector boson fusion, and associated production with a W or Z boson, or a top quark-antiquark pair) and the following decay modes: H → γ γ , Z Z , W W , τ τ , b b , and μ μ . Searches for invisible Higgs boson decays are also considered. The best-fit ratio of the signal yield to the standard model expectation is measured to be μ = 1.17 ± 0.10 , assuming a Higgs boson mass of 125.09 Ge . Additional results are given for various assumptions on the scaling behavior of the production and decay modes, including generic parametrizations based on ratios of cross sections and branching fractions or couplings. The results are compatible with the standard model predictions in all parametrizations considered. In addition, constraints are placed on various two Higgs doublet models.

Jet Shapes of Isolated Photon-Tagged Jets in Pb-Pb and pp Collisions at sqrt[s_{NN}]=5.02 TeV

The modification of jet shapes in Pb-Pb collisions, relative to those in pp collisions, is studied for jets associated with an isolated photon. The data were collected with the CMS detector at the LHC at a nucleon-nucleon center-of-mass energy of 5.02 TeV. Jet shapes are constructed from charged particles with track transverse momenta (p_{T}) above 1  GeV/c in annuli around the axes of jets with p_{T}^{jet}>30  GeV/c associated with an isolated photon with p_{T}^{γ}>60  GeV/c. The jet shape distributions are consistent between peripheral Pb-Pb and pp collisions, but are modified for more central Pb-Pb collisions. In these central Pb-Pb events, a larger fraction of the jet momentum is observed at larger distances from the jet axis compared to pp, reflecting the interaction between the partonic medium created in heavy ion collisions and the traversing partons.

Measurement of exclusive Υ photoproduction from protons in p Pb collisions at s NN = 5.02 TeV

The exclusive photoproduction of Υ ( nS ) meson states from protons, γ p → Υ ( nS ) p (with n = 1 , 2 , 3 ), is studied in ultraperipheral p Pb collisions at a centre-of-mass energy per nucleon pair ofs NN = 5.02 TeV . The measurement is performed using the Υ ( nS ) → μ + μ - decay mode, with data collected by the CMS experiment corresponding to an integrated luminosity of 32.6nb - 1 . Differential cross sections as functions of the Υ ( nS ) transverse momentum squared p T 2 , and rapidity y, are presented. The Υ ( 1 S ) photoproduction cross section is extracted in the rapidity range | y | < 2.2 , which corresponds to photon-proton centre-of-mass energies in the range 91 < W γ p < 826 GeV . The data are compared to theoretical predictions based on perturbative quantum chromodynamics and to previous measurements.

Measurement of associated production of a W boson and a charm quark in proton-proton collisions at s = 13 Te

Measurements are presented of associated production of a W boson and a charm quark ( W + c ) in proton-proton collisions at a center-of-mass energy of 13Te . The data correspond to an integrated luminosity of 35.7fb - 1 collected by the CMS experiment at the CERN LHC. The W bosons are identified by their decay into a muon and a neutrino. The charm quarks are tagged via the full reconstruction ofD ∗ ( 2010 ) ± mesons that decay viaD ∗ ( 2010 ) ± → D 0 + π ± → K ∓ + π ± + π ± . A cross section is measured in the fiducial region defined by the muon transverse momentump T μ > 26 Ge , muon pseudorapidity| η μ | < 2.4 , and charm quark transverse momentump T c > 5 Ge . The inclusive cross section for this kinematic range is σ ( W + c ) = 1026 ± 31 (stat) + 76 - 72 (syst) pb . The cross section is also measured differentially as a function of the pseudorapidity of the muon from the W boson decay. These measurements are compared with theoretical predictions and are used to probe the strange quark content of the proton.

Search for Narrow Hγ Resonances in Proton-Proton Collisions at sqrt[s]=13 TeV

A search for heavy, narrow resonances decaying to a Higgs boson and a photon (Hγ) has been performed in proton-proton collision data at a center-of-mass energy of 13 TeV, corresponding to an integrated luminosity of 35.9  fb^{-1} collected with the CMS detector at the LHC in 2016. Events containing a photon and a Lorentz-boosted hadronically decaying Higgs boson reconstructed as a single, large-radius jet are considered, and the γ+jet invariant mass spectrum is analyzed for the presence of narrow resonances. To increase the sensitivity of the search, events are categorized depending on whether or not the large-radius jet can be identified as a result of the merging of two jets originating from b quarks. Results in both categories are found to agree with the predictions of the standard model. Upper limits on the production rate of Hγ resonances are set as a function of their mass in the range of 720-3250 GeV, representing the most stringent constraints to date.

Study of the underlying event in top quark pair production in p p collisions at 13 Te

Measurements of normalized differential cross sections as functions of the multiplicity and kinematic variables of charged-particle tracks from the underlying event in top quark and antiquark pair production are presented. The measurements are performed in proton-proton collisions at a center-of-mass energy of 13 Te , and are based on data collected by the CMS experiment at the LHC in 2016 corresponding to an integrated luminosity of 35.9 fb - 1 . Events containing one electron, one muon, and two jets from the hadronization and fragmentation of b quarks are used. These measurements characterize, for the first time, properties of the underlying event in top quark pair production and show no deviation from the universality hypothesis at energy scales typically above twice the top quark mass.

Search for rare decays of Z and Higgs bosons to J / ψ and a photon in proton-proton collisions at s = 13 TeV

A search is presented for decays of Z and Higgs bosons to a J / ψ meson and a photon, with the subsequent decay of the J / ψ toμ + μ - . The analysis uses data from proton-proton collisions with an integrated luminosity of 35.9fb - 1 ats = 13 TeV collected with the CMS detector at the LHC. The observed limit on the Z → J / ψ γ decay branching fraction, assuming that the J / ψ meson is produced unpolarized, is 1.4 × 10 - 6 at 95% confidence level, which corresponds to a rate higher than expected in the standard model by a factor of 15. For extreme-polarization scenarios, the observed limit changes from - 13.6 to + 8.6 % with respect to the unpolarized scenario. The observed upper limit on the branching fraction for H → J / ψ γ where the J / ψ meson is assumed to be transversely polarized is 7.6 × 10 - 4 , a factor of 260 larger than the standard model prediction. The results for the Higgs boson are combined with previous data from proton-proton collisions ats = 8 TeV to produce an observed upper limit on the branching fraction for H → J / ψ γ that is a factor of 220 larger than the standard model value.

Search for the Higgs Boson Decaying to Two Muons in Proton-Proton Collisions at sqrt[s]=13 TeV

A search for the Higgs boson decaying to two oppositely charged muons is presented using data recorded by the CMS experiment at the CERN LHC in 2016 at a center-of-mass energy sqrt[s]=13  TeV, corresponding to an integrated luminosity of 35.9  fb^{-1}. Data are found to be compatible with the predicted background. For a Higgs boson with a mass of 125.09 GeV, the 95% confidence level observed (background-only expected) upper limit on the production cross section times the branching fraction to a pair of muons is found to be 3.0 (2.5) times the standard model expectation. In combination with data recorded at center-of-mass energies sqrt[s]=7 and 8 TeV, the background-only expected upper limit improves to 2.2 times the standard model value with a standard model expected significance of 1.0 standard deviation. The corresponding observed upper limit is 2.9 with an observed significance of 0.9 standard deviation. This corresponds to an observed upper limit on the standard model Higgs boson branching fraction to muons of 6.4×10^{-4} and to an observed signal strength of 1.0±1.0(stat)±0.1(syst).

Search for Dark Matter Particles Produced in Association with a Top Quark Pair at sqrt[s]=13 TeV

A search is performed for dark matter particles produced in association with a top quark pair in proton-proton collisions at sqrt[s]=13  TeV. The data correspond to an integrated luminosity of 35.9  fb^{-1} recorded by the CMS detector at the LHC. No significant excess over the standard model expectation is observed. The results are interpreted using simplified models of dark matter production via spin-0 mediators that couple to dark matter particles and to standard model quarks, providing constraints on the coupling strength between the mediator and the quarks. These are the most stringent collider limits to date for scalar mediators, and the most stringent for pseudoscalar mediators at low masses.

Measurement of differential cross sections for inclusive isolated-photon and photon+jet production in proton-proton collisions at s = 13 TeV

Measurements of inclusive isolated-photon and photon+jet production in proton-proton collisions ats = 13 TeV are presented. The analysis uses data collected by the CMS experiment in 2015, corresponding to an integrated luminosity of 2.26fb - 1 . The cross section for inclusive isolated photon production is measured as a function of the photon transverse energy in a fiducial region. The cross section for photon+jet production is measured as a function of the photon transverse energy in the same fiducial region with identical photon requirements and with the highest transverse momentum jet. All measurements are in agreement with predictions from next-to-leading-order perturbative QCD.

Observation of Medium-Induced Modifications of Jet Fragmentation in Pb-Pb Collisions at sqrt[s_{NN}]=5.02 TeV Using Isolated Photon-Tagged Jets

Measurements of fragmentation functions for jets associated with an isolated photon are presented for the first time in pp and Pb-Pb collisions. The analysis uses data collected with the CMS detector at the CERN LHC at a nucleon-nucleon center-of-mass energy of 5.02 TeV. Fragmentation functions are obtained for jets with p_{T}^{jet}>30  GeV/c in events containing an isolated photon with p_{T}^{γ}>60  GeV/c, using charged tracks with transverse momentum p_{T}^{trk}>1  GeV/c in a cone around the jet axis. The association with an isolated photon constrains the initial p_{T} and azimuthal angle of the parton whose shower produced the jet. For central Pb-Pb collisions, modifications of the jet fragmentation functions are observed when compared to those measured in pp collisions, while no significant differences are found in the 50% most peripheral collisions. Jets in central Pb-Pb events show an excess (depletion) of low (high) p_{T} particles, with a transition around 3  GeV/c. This measurement shows for the first time the in-medium shower modifications of partons (quark dominated) with well-defined initial kinematics. It constitutes a new well-controlled reference for testing theoretical models of the parton passage through the quark-gluon plasma.

Search for Leptoquarks Coupled to Third-Generation Quarks in Proton-Proton Collisions at sqrt[s]=13 TeV

Three of the most significant measured deviations from standard model predictions, the enhanced decay rate for B→D^{(*)}τν, hints of lepton universality violation in B→K^{(*)}ℓℓ decays, and the anomalous magnetic moment of the muon, can be explained by the existence of leptoquarks (LQs) with large couplings to third-generation quarks and masses at the TeV scale. The existence of these states can be probed at the LHC in high energy proton-proton collisions. A novel search is presented for pair production of LQs coupled to a top quark and a muon using data at a center-of-mass energy of 13 TeV, corresponding to an integrated luminosity of 35.9  fb^{-1}, recorded by the CMS experiment. No deviation from the standard model prediction has been observed and scalar LQs decaying exclusively into tμ are excluded up to masses of 1420 GeV. The results of this search are combined with those from previous searches for LQ decays into tτ and bν, which excluded scalar LQs below masses of 900 and 1080 GeV. Vector LQs are excluded up to masses of 1190 GeV for all possible combinations of branching fractions to tμ, tτ and bν. With this analysis, all relevant couplings of LQs with an electric charge of -1/3 to third-generation quarks are probed for the first time.

Evidence for the Associated Production of a Single Top Quark and a Photon in Proton-Proton Collisions at sqrt[s]=13 TeV

The first evidence of events consistent with the production of a single top quark in association with a photon is reported. The analysis is based on proton-proton collisions at sqrt[s]=13  TeV and recorded by the CMS experiment in 2016, corresponding to an integrated luminosity of 35.9  fb^{-1}. Events are selected by requiring the presence of a muon (μ), a photon (γ), an imbalance in transverse momentum from an undetected neutrino (ν), and at least two jets (j) of which exactly one is identified as associated with the hadronization of a b quark. A multivariate discriminant based on topological and kinematic event properties is employed to separate signal from background processes. An excess above the background-only hypothesis is observed, with a significance of 4.4 standard deviations. A fiducial cross section is measured for isolated photons with transverse momentum greater than 25 GeV in the central region of the detector. The measured product of the cross section and branching fraction is σ(pp→tγj)B(t→μνb)=115±17(stat)±30(syst)  fb, which is consistent with the standard model prediction.

Measurement of differential cross sections for Z boson production in association with jets in proton-proton collisions at s = 13 TeV

The production of a Z boson, decaying to two charged leptons, in association with jets in proton-proton collisions at a centre-of-mass energy of 13TeV is measured. Data recorded with the CMS detector at the LHC are used that correspond to an integrated luminosity of 2.19fb -1 . The cross section is measured as a function of the jet multiplicity and its dependence on the transverse momentum of the Z boson, the jet kinematic variables (transverse momentum and rapidity), the scalar sum of the jet momenta, which quantifies the hadronic activity, and the balance in transverse momentum between the reconstructed jet recoil and the Z boson. The measurements are compared with predictions from four different calculations. The first two merge matrix elements with different parton multiplicities in the final state and parton showering, one of which includes one-loop corrections. The third is a fixed-order calculation with next-to-next-to-leading order accuracy for the process with a Z boson and one parton in the final state. The fourth combines the fully differential next-to-next-to-leading order calculation of the process with no parton in the final state with next-to-next-to-leading logarithm resummation and parton showering.

Studies of B s 2 ∗ ( 5840 ) 0 and B s 1 ( 5830 ) 0 mesons including the observation of the B s 2 ∗ ( 5840 ) 0 → B 0 K S 0 decay in proton-proton collisions at s = 8 TeV

Measurements ofB s 2 ∗ ( 5840 ) 0 andB s 1 ( 5830 ) 0 mesons are performed using a data sample of proton-proton collisions corresponding to an integrated luminosity of , collected with the CMS detector at the LHC at a centre-of-mass energy of 8 TeV . The analysis studies P-waveB s 0 meson decays intoB ( ∗ ) + K - andB ( ∗ ) 0 K S 0 , where theB + andB 0 mesons are identified using the decaysB + → J / ψ K + andB 0 → J / ψ K ∗ ( 892 ) 0 . The masses of the P-waveB s 0 meson states are measured and the natural width of theB s 2 ∗ ( 5840 ) 0 state is determined. The first measurement of the mass difference between the charged and neutralB ∗ mesons is also presented. TheB s 2 ∗ ( 5840 ) 0 decay toB 0 K S 0 is observed, together with a measurement of its branching fraction relative to theB s 2 ∗ ( 5840 ) 0 → B + K - decay.

Measurement of the top quark mass with lepton+jets final states using p p collisions at s = 13 TeV

The mass of the top quark is measured using a sample of t t ¯ events collected by the CMS detector using proton-proton collisions ats = 13 TeV at the CERN LHC. Events are selected with one isolated muon or electron and at least four jets from data corresponding to an integrated luminosity of 35.9fb - 1 . For each event the mass is reconstructed from a kinematic fit of the decay products to a t t ¯ hypothesis. Using the ideogram method, the top quark mass is determined simultaneously with an overall jet energy scale factor (JSF), constrained by the mass of the W boson in q q ¯ ' decays. The measurement is calibrated on samples simulated at next-to-leading order matched to a leading-order parton shower. The top quark mass is found to be 172.25 ± 0.08 (stat+JSF) ± 0.62 (syst) GeV . The dependence of this result on the kinematic properties of the event is studied and compared to predictions of different models of t t ¯ production, and no indications of a bias in the measurements are observed.

Observation of the Z→ψℓ^{+}ℓ^{-} Decay in pp Collisions at sqrt[s]=13 TeV

This Letter presents the observation of the rare Z boson decay Z→ψℓ^{+}ℓ^{-}. Here, ψ represents contributions from direct J/ψ and ψ(2S)→J/ψX, ℓ^{+}ℓ^{-} is a pair of electrons or muons, and the J/ψ meson is detected via its decay to μ^{+}μ^{-}. The sample of proton-proton collision data, collected by the CMS experiment at the LHC at a center-of-mass energy of 13 TeV, corresponds to an integrated luminosity of 35.9  fb^{-1}. The signal is observed with a significance in excess of 5 standard deviations. After subtraction of the ψ(2S)→J/ψX contribution, the ratio of the branching fraction of the exclusive decay Z→J/ψℓ^{+}ℓ^{-} to the decay Z→μ^{+}μ^{-}μ^{+}μ^{-} within a fiducial phase space is measured to be B(Z→J/ψℓ^{+}ℓ^{-})/B(Z→μ^{+}μ^{-}μ^{+}μ^{-})=0.67±0.18(stat)±0.05(syst).

Search for Pair-Produced Resonances Each Decaying into at Least Four Quarks in Proton-Proton Collisions at sqrt[s]=13 TeV

This Letter presents the results of a search for pair-produced particles of masses above 100 GeV that each decay into at least four quarks. Using data collected by the CMS experiment at the LHC in 2015-2016, corresponding to an integrated luminosity of 38.2  fb^{-1}, reconstructed particles are clustered into two large jets of similar mass, each consistent with four-parton substructure. No statistically significant excess of data over the background prediction is observed in the distribution of average jet mass. Pair-produced squarks with dominant hadronic R-parity-violating decays into four quarks and with masses between 0.10 and 0.72 TeV are excluded at 95% confidence level. Similarly, pair-produced gluinos that decay into five quarks are also excluded with masses between 0.10 and 1.41 TeV at 95% confidence level. These are the first constraints that have been placed on pair-produced particles with masses below 400 GeV that decay into four or five quarks, bridging a significant gap in the coverage of R-parity-violating supersymmetry parameter space.

Search for new physics in dijet angular distributions using proton-proton collisions at s = 13 TeV and constraints on dark matter and other models

A search is presented for physics beyond the standard model, based on measurements of dijet angular distributions in proton-proton collisions ats = 13 TeV . The data collected with the CMS detector at the LHC correspond to an integrated luminosity of 35.9fb - 1 . The observed distributions, corrected to particle level, are found to be in agreement with predictions from perturbative quantum chromodynamics that include electroweak corrections. Constraints are placed on models containing quark contact interactions, extra spatial dimensions, quantum black holes, or dark matter, using the detector-level distributions. In a benchmark model where only left-handed quarks participate, contact interactions are excluded at the 95% confidence level up to a scale of 12.8 or 17.5TeV, for destructive or constructive interference, respectively. The most stringent lower limits to date are set on the ultraviolet cutoff in the Arkani-Hamed-Dimopoulos-Dvali model of extra dimensions. In the Giudice-Rattazzi-Wells convention, the cutoff scale is excluded up to 10.1TeV. The production of quantum black holes is excluded for masses below 5.9 and 8.2TeV, depending on the model. For the first time, lower limits between 2.0 and 4.6TeVare set on the mass of a dark matter mediator for (axial-)vector mediators, for the universal quark couplingg q = 1.0 .

Measurement of the Z / γ ∗ → τ τ cross section in pp collisions at s = 13 TeV and validation of τ lepton analysis techniques

A measurement is presented of the Z / γ ∗ → τ τ cross section in pp collisions ats = 13 TeV , using data recorded by the CMS experiment at the LHC, corresponding to an integrated luminosity of 2.3 fb - 1 . The product of the inclusive cross section and branching fraction is measured to be σ ( pp → Z / γ ∗ +X ) B ( Z / γ ∗ → τ τ ) = 1848 ± 12 ( stat ) ± 67 (syst \,+\,lumi) pb , in agreement with the standard model expectation, computed at next-to-next-to-leading order accuracy in perturbative quantum chromodynamics. The measurement is used to validate new analysis techniques relevant for future measurements of τ lepton production. The measurement also provides the reconstruction efficiency and energy scale for τ decays to hadrons+ ν τ final states, determined with respective relative uncertainties of 2.2 and 0.9%.

Search for third-generation scalar leptoquarks decaying to a top quark and a τ lepton at s = 13 Te

A search for pair production of heavy scalar leptoquarks (LQs), each decaying into a top quark and a τ lepton, is presented. The search considers final states with an electron or a muon, one or two τ leptons that decayed to hadrons, and additional jets. The data were collected in 2016 in proton-proton collisions ats = 13 Te with the CMS detector at the LHC, and correspond to an integrated luminosity of 35.9fb - 1 . No evidence for pair production of LQs is found. Assuming a branching fraction of unity for the decay LQ → t τ , upper limits on the production cross section are set as a function of LQ mass, excluding masses below 900Ge at 95% confidence level. These results provide the most stringent limits to date on the production of scalar LQs that decay to a top quark and a τ lepton.

Measurement of the weak mixing angle using the forward-backward asymmetry of Drell-Yan events in p p collisions at 8 TeV

A measurement is presented of the effective leptonic weak mixing angle ( sin 2 θ eff ℓ ) using the forward-backward asymmetry of Drell-Yan lepton pairs ( μ μ and e e ) produced in proton-proton collisions at s = 8 TeV at the CMS experiment of the LHC. The data correspond to integrated luminosities of 18.8 and 19.6 fb - 1 in the dimuon and dielectron channels, respectively, containing 8.2 million dimuon and 4.9 million dielectron events. With more events and new analysis techniques, including constraints obtained on the parton distribution functions from the measured forward-backward asymmetry, the statistical and systematic uncertainties are significantly reduced relative to previous CMS measurements. The extracted value of sin 2 θ eff ℓ from the combined dilepton data is sin 2 θ eff ℓ = 0.23101 ± 0.00036 (stat) ± 0.00018 (syst) ± 0.00016 (theo) ± 0.00031 (parton distributions in proton) = 0.23101 ± 0.00053 .

Observation of the χ_{b1}(3P) and χ_{b2}(3P) and Measurement of their Masses

The χ_{b1}(3P) and χ_{b2}(3P) states are observed through their ϒ(3S)γ decays, using an event sample of proton-proton collisions collected by the CMS experiment at the CERN LHC. The data were collected at a center-of-mass energy of 13 TeV and correspond to an integrated luminosity of 80.0  fb^{-1}. The ϒ(3S) mesons are identified through their dimuon decay channel, while the low-energy photons are detected after converting to e^{+}e^{-} pairs in the silicon tracker, leading to a χ_{b}(3P) mass resolution of 2.2 MeV. This is the first time that the J=1 and 2 states are well resolved and their masses individually measured: 10513.42±0.41(stat)±0.18(syst)  MeV and 10524.02±0.57(stat)±0.18(syst)  MeV; they are determined with respect to the world-average value of the ϒ(3S) mass, which has an uncertainty of 0.5 MeV. The mass splitting is measured to be 10.60±0.64(stat)±0.17(syst)  MeV.

Measurement of charged particle spectra in minimum-bias events from proton-proton collisions at s = 13 TeV

Pseudorapidity, transverse momentum, and multiplicity distributions are measured in the pseudorapidity range | η | < 2.4 for charged particles with transverse momenta satisfyingp T > 0.5 GeV in proton-proton collisions at a center-of-mass energy ofs = 13 TeV . Measurements are presented in three different event categories. The most inclusive of the categories corresponds to an inelastic p p data set, while the other two categories are exclusive subsets of the inelastic sample that are either enhanced or depleted in single diffractive dissociation events. The measurements are compared to predictions from Monte Carlo event generators used to describe high-energy hadronic interactions in collider and cosmic-ray physics.

Elliptic Flow of Charm and Strange Hadrons in High-Multiplicity p+Pb Collisions at sqrt[s_{NN}]=8.16 TeV

The elliptic azimuthal anisotropy coefficient (v_{2}) is measured for charm (D^{0}) and strange (K_{S}^{0}, Λ, Ξ^{-}, and Ω^{-}) hadrons, using a data sample of p+Pb collisions collected by the CMS experiment, at a nucleon-nucleon center-of-mass energy of sqrt[s_{NN}]=8.16  TeV. A significant positive v_{2} signal from long-range azimuthal correlations is observed for all particle species in high-multiplicity p+Pb collisions. The measurement represents the first observation of possible long-range collectivity for open heavy flavor hadrons in small systems. The results suggest that charm quarks have a smaller v_{2} than the lighter quarks, probably reflecting a weaker collective behavior. This effect is not seen in the larger PbPb collision system at sqrt[s_{NN}]=5.02  TeV, also presented.

Constraining Gluon Distributions in Nuclei Using Dijets in Proton-Proton and Proton-Lead Collisions at sqrt[s_{NN}]=5.02 TeV

The pseudorapidity distributions of dijets as functions of their average transverse momentum (p_{T}^{ave}) are measured in proton-lead (pPb) and proton-proton (pp) collisions. The data samples were collected by the CMS experiment at the CERN LHC, at a nucleon-nucleon center-of-mass energy of 5.02 TeV. A significant modification of the pPb spectra with respect to the pp spectra is observed in all p_{T}^{ave} intervals investigated. The ratios of the pPb and pp distributions are compared to next-to-leading order perturbative quantum chromodynamics calculations with unbound nucleon and nuclear parton distribution functions (PDFs). These results give the first evidence that the gluon PDF at large Bjorken x in lead ions is strongly suppressed with respect to the PDF in unbound nucleons.

Measurement of prompt and nonprompt charmonium suppression in PbPb collisions at 5.02 TeV

The nuclear modification factors of J / ψ and ψ (2S) mesons are measured in PbPb collisions at a centre-of-mass energy per nucleon pair of s NN = 5.02 TeV . The analysis is based on PbPb and p p data samples collected by CMS at the LHC in 2015, corresponding to integrated luminosities of 464 μ b - 1 and 28 pb -1 , respectively. The measurements are performed in the dimuon rapidity range of | y | < 2.4 as a function of centrality, rapidity, and transverse momentum ( p T ) from p T = 3 GeV / c in the most forward region and up to 50 GeV / c . Both prompt and nonprompt (coming from b hadron decays) J / ψ mesons are observed to be increasingly suppressed with centrality, with a magnitude similar to the one observed at s NN = 2.76 TeV for the two J / ψ meson components. No dependence on rapidity is observed for either prompt or nonprompt J / ψ mesons. An indication of a lower prompt J / ψ meson suppression at p T > 25 GeV / c is seen with respect to that observed at intermediate p T . The prompt ψ (2S) meson yield is found to be more suppressed than that of the prompt J / ψ mesons in the entire p T range.

Search for Physics Beyond the Standard Model in Events with High-Momentum Higgs Bosons and Missing Transverse Momentum in Proton-Proton Collisions at 13 TeV

A search for physics beyond the standard model in events with one or more high-momentum Higgs bosons, H, decaying to pairs of b quarks in association with missing transverse momentum is presented. The data, corresponding to an integrated luminosity of 35.9  fb^{-1}, were collected with the CMS detector at the LHC in proton-proton collisions at the center-of-mass energy sqrt[s]=13  TeV. The analysis utilizes a new b quark tagging technique based on jet substructure to identify jets from H→bb[over ¯]. Events are categorized by the multiplicity of H-tagged jets, jet mass, and the missing transverse momentum. No significant deviation from standard model expectations is observed. In the context of supersymmetry (SUSY), limits on the cross sections of pair-produced gluinos are set, assuming that gluinos decay to quark pairs, H (or Z), and the lightest SUSY particle, LSP, through an intermediate next-to-lightest SUSY particle, NLSP. With large mass splitting between the NLSP and LSP, and 100% NLSP branching fraction to H, the lower limit on the gluino mass is found to be 2010 GeV.

Observation of tt[over ¯]H Production

The observation of Higgs boson production in association with a top quark-antiquark pair is reported, based on a combined analysis of proton-proton collision data at center-of-mass energies of sqrt[s]=7, 8, and 13 TeV, corresponding to integrated luminosities of up to 5.1, 19.7, and 35.9  fb^{-1}, respectively. The data were collected with the CMS detector at the CERN LHC. The results of statistically independent searches for Higgs bosons produced in conjunction with a top quark-antiquark pair and decaying to pairs of W bosons, Z bosons, photons, τ leptons, or bottom quark jets are combined to maximize sensitivity. An excess of events is observed, with a significance of 5.2 standard deviations, over the expectation from the background-only hypothesis. The corresponding expected significance from the standard model for a Higgs boson mass of 125.09 GeV is 4.2 standard deviations. The combined best fit signal strength normalized to the standard model prediction is 1.26_{-0.26}^{+0.31}.

Measurement of b hadron lifetimes in pp collisions at s = 8 TeV

Measurements are presented of the lifetimes of theB 0 ,B s 0 , Λ b 0 , and B c + hadrons using the decay channelsB 0 → J / ψ K ∗ ( 892 ) 0 ,B 0 → J / ψ K S 0 ,B s 0 → J / ψ π + π - ,B s 0 → J / ψ ϕ ( 1020 ) ,Λ b 0 → J / ψ Λ 0 , andB c + → J / ψ π + . The data sample, corresponding to an integrated luminosity of 19.7fb -1 , was collected by the CMS detector at the LHC in proton-proton collisions ats = 8 TeV . TheB 0 lifetime is measured to be 453.0 ± 1.6 (stat) ± 1.8 (syst) μ m in J / ψ K ∗ ( 892 ) 0 and 457.8 ± 2.7 (stat) ± 2.8 (syst) μ m in J / ψ K S 0 , which results in a combined measurement of c τ B 0 = 454.1 ± 1.4 (stat) ± 1.7 (syst) μ m . The effective lifetime of theB s 0 meson is measured in two decay modes, with contributions from different amounts of the heavy and light eigenstates. This results in two different measured lifetimes: c τ B s 0 → J / ψ π + π - = 502.7 ± 10.2 (stat) ± 3.4 (syst) μ m and c τ B s 0 → J / ψ ϕ ( 1020 ) = 443.9 ± 2.0 (stat) ± 1.5 (syst) μ m . The Λ b 0 lifetime is found to be 442.9 ± 8.2 (stat) ± 2.8 (syst) μ m . The precision from each of these channels is as good as or better than previous measurements. The B c + lifetime, measured with respect to theB + to reduce the systematic uncertainty, is 162.3 ± 7.8 (stat) ± 4.2 (syst) ± 0.1 ( τ B + ) μ m . All results are in agreement with current world-average values.