Fatigue as a key factor for testing knee stability with single leg drop landing for injury prevention and return to play tests

Objectives

Fatigue can decrease knee stability and increase the injury risk. However, fatigue is rarely being applied throughout movement analysis. The aim of this study was to investigate if the knee stability throughout SLDLs differ between cyclic and acyclic sports, before and after fatigue in general, and between the dominant and non-dominant leg of soccer players.

Methods

A total of 43 active male (n = 34) and female (n = 9) athletes (age: 26.5 ± 7.2) participated in this study with a pre-post-design. Subjects performed a single leg drop landing (SLDL) from a plyobox. For each leg, the two-dimensional frontal plane projection angle (FPPA) was analyzed. After pretesting the shuttle run test was performed until exhaustion, before repeating the measurements.

Results

ANOVA with repeated measures was applied and identified no significance difference for the FPPA between cyclic and acyclic sports (F = 0.98, p = 0.33), a significant difference before and after fatigue (F = 12.49, p = 0.002) and no significant difference between the dominant and non dominant leg of soccer players (F = 4.35, p = 0.26).

Discussion

Fatigue seems to be able to have a significant influence on knee stability in the frontal axis. Therefore, fatigue should be included in motion analysis for injury prevention and return to play tests because during this physical state most injuries happen.

Body metrics are associated with clinical, free-living, and self-report measures of mobility in a cohort of adults with obesity and multiple sclerosis

BACKGROUND

Obesity is associated with multiple sclerosis (MS) onset and may contribute to more rapid disability accumulation. Whether obesity impacts mobility in MS is uncertain. Some studies find that obesity in MS is associated with poorer mobility; other studies find no relationship. Discrepant findings may be due to differences in measurement and methodology. In the present study, we employ a comprehensive battery of anthropometric and mobility measures in a sample of people with MS and obesity.

METHODS

Participants with MS (N = 74) completed a battery of adiposity measurements (weight, height, waist circumference, and full body dual-energy x-ray absorptiometry [DXA] scans). They also completed validated clinical, free-living (accelerometry), and self-report measures of mobility. Spearman's Rho correlations were used to examine the associations between mobility and obesity measures with Benjamini and Hochberg correction for multiple comparisons. Multiple linear regression was used to examine if adiposity predicted mobility outcomes in people with MS when controlling for age and disease duration.

RESULTS

The majority of participants (n = 70) were diagnosed with relapsing-remitting MS and reported mild MS-related disability on the Patient Determined Disease Steps (M = 0.77, SD = 1.1). Median BMI was 35.8 (SD = 5.4). Higher percentage body fat (measured via DXA) was associated with poorer self-reported physical functioning (rs = -0.52, p <0.001), less moderate-to-vigorous physical activity (rs = -0.24, p = 0.04), and worse performance on the Six Minute Walk Test (6MWT; rs = -0.44, p <0.001), the Timed 25 Foot Walk (T25FW; rs = 0.45, p <0.001), and the Timed Up and Go test (TUG; rs = 0.35, p = .003). Higher BMI and waist-to-height ratio (WtHR) were associated with worse outcomes on the 6MWT (BMI; rs = -0.35, p <0.01, WtHR; rs = -0.43, p <0.001), T25FW (BMI; rs = 0.32, p <0.01, WtHR; rs = 0.38, p <0.001), and the SF-36 (BMI; rs = -0.29, p <0.005, WtHR; rs = -0.31, p <0.05). Percentage body fat accounted for an additional 17 % of the variance in the T25FW and 6MWT performance, after controlling for age and disease duration.

CONCLUSION

Higher BMI, WtHR, and percentage body fat were associated with lower levels of mobility (T25FW and 6MWT) in people with MS who have class I, class II, and class III obesity. Higher percentage body fat was associated with significantly worse performance on clinical, free-living, and self-report measures of mobility in people with MS even when accounting for participant age and disease duration. These findings suggest that people with MS and obesity may show improved mobility with weight loss.

A stable isotope assay with 13C-labeled polyethylene to investigate plastic mineralization mediated by Rhodococcus ruber

Methods that unambiguously prove microbial plastic degradation and allow for quantification of degradation rates are necessary to constrain the influence of microbial degradation on the marine plastic budget. We developed an assay based on stable isotope tracer techniques to determine microbial plastic mineralization rates in liquid medium on a lab scale. For the experiments, ¹³C-labeled polyethylene (¹³C-PE) particles (irradiated with UV-light to mimic exposure of floating plastic to sunlight) were incubated in liquid medium with Rhodococcus ruber as a model organism for proof of principle. The transfer of ¹³C from ¹³C-PE into the gaseous and dissolved CO₂ pools translated to microbially mediated mineralization rates of up to 1.2 % yr^-1 of the added PE. After incubation, we also found highly ¹³C-enriched membrane fatty acids of R. ruber including compounds involved in cellular stress responses. We demonstrated that isotope tracer techniques are a valuable tool to detect and quantify microbial plastic degradation.

Postoperative IL-6 levels cannot predict early onset periprosthetic hip/knee infections: an analysis of 7,661 patients at a single institution

Prior studies have outlined C-reactive protein (CRP) within the first 5 d following total hip arthroplasty (THA) as an inappropriate indicator of an early periprosthetic joint infection (PJI). Recently, interleukin-6 (IL-6), as a potential inflammatory marker following total joint arthroplasty (TJA), has gained increasing interest, particularly due to its considerably shorter half-life. The aim of the present study was to assess IL-6 measured on postoperative day 3 following TJA as a prediction marker of early onset PJI. 7,661 patients, who underwent total hip or knee arthroplasty (THA, TKA) at a single institution between 2016 and 2019, were evaluated. Serum IL-6 values were measured on postoperative day 3 and compared between patients, with and without early onset PJI in the postoperative follow-up, matched for age, gender, Surgical Site Infection Risk Score and Charlson comorbidity index. Overall (n = 7,661), there was no statistically significant difference in serum IL-6 levels comparing patients with and without early onset PJI following THA [38.9 pg/ mL vs. 32.0 pg/mL, p = 0.116] and TKA [30.6 pg/mL vs. 28.2 pg/mL, p = 0.718]. Male gender and high body mass index were associated with an increased risk of early onset PJI following THA (p = 0.027, p = 0.002). Matched cohort analysis (n = 86) showed no statistically significant difference in serum IL-6 levels between patients with and without early onset PJI following THA (p = 0.680) and TKA (p = 0.910). Serum IL-6 values on postoperative day 3 following THA or TKA could not predict early onset PJIs.

Impact of the COVID-19 Pandemic on a Cancer Fast-Track Programme

Introduction

The COVID-19 pandemic has disrupted many aspects of clinical practice in oncology, particularly regarding early cancer diagnosis, sparking public health concerns that possible delays could increase the proportion of patients diagnosed at advanced stages. In 2009, a cancer fast-track program (CFP) was implemented at the Clinico-Malvarrosa Health Department in Valencia, Spain with the aim of shortening waiting times between suspected cancer symptoms, diagnosis and therapy initiation.

Objectives

The study aimed to explore the effects of the COVID-19 pandemic on our cancer diagnosis fast-track program.

Methods

The program workflow (patients included and time periods) was analysed from the beginning of the state of alarm on March 16th, 2020 until March 15th, 2021. Data was compared with data from the same period of time from the year before (2019).

Results

During the pandemic year, 975 suspected cancer cases were submitted to the CFP. The number of submissions only decreased during times of highest COVID-19 incidence and stricter lockdown, and overall, referrals were slightly higher than in the previous 2 years. Cancer diagnosis was confirmed in 197 (24.1%) cases, among which 33% were urological, 23% breast, 16% gastrointestinal and 9% lung cancer. The median time from referral to specialist appointment was 13 days and diagnosis was reached at a median of 18 days. In confirmed cancer cases, treatment was started at around 30 days from time of diagnosis. In total, 61% of cancer disease was detected at early stage, 20% at locally advanced stage, and 19% at advanced stage, displaying time frames and case proportions similar to pre-pandemic years.

Conclusions

Our program has been able to maintain normal flow and efficacy despite the challenges of the current pandemic, and has proven a reliable tool to help primary care physicians referring suspected cancer patients.

Economic consequences of the overuse of short-acting beta-adrenergic agonists (SABA) in the treatment of asthma in Spain

BACKGROUND

To determine the relationship between short-acting beta-adrenergic agonist (SABA) overuse and healthcare resource use and costs in asthma patients in routine clinical practice.

MATERIAL AND METHODS

A longitudinal retrospective study in Spanish primary and specialized care using the BIG-PAC® Medical Records Database was conducted. Asthma patients ≥12 years of age who attended ≥ 2 consultations during 2017 and had 1-year follow-up data available were included. Main outcomes were demographics, comorbidities, medication, clinical and healthcare resource use and costs. The relationship between SABA overuseand healthcare costs, and between asthma severity and healthcare costs was determined.

RESULTS

This SABA use IN Asthma (SABINA) study included 39,555 patients, mean (standard deviation, SD) age 49.8 (20.7) years; 64.2% were female. Charlson comorbidity index was 0.7 (1.0). SABA overuse (≥ 3 canisters/year) was 28.7% (95% CI: 27.7-29.7), with an overall mean number of 3.3 (3.6) canisters/year. Overall, 5.1% of patients were prescribed ≥12 canisters/year. SABA overuse was correlated with healthcare costs (ρ = 0.621; p < 0.001).The adjusted mean annual cost/patient, according to the Global Initiative for Asthma (GINA 2019) classification of asthma severity, was €2,231, €2,345, €2,735, €3,473, and €4,243,for GINA steps 1-5, respectively (p < 0.001). Regardless of asthma severity, SABA overuse yielded a significant increase in healthcare costs per patient and year (€5,702 vs. €1,917, p < 0.001) compared with recommended use (< 2 canisters/year).

CONCLUSIONS

SABA overuse yields greater costs for the Spanish National Health System. Costs increased according to asthma severity.

ASSESSMENT OF LYMPHEDEMA WITH LYMPHOSCINTIGRAPHY: CAN NODAL QUANTIFICATION HELP?

Lymphoscintigraphy with combined qualitative and quantitative analysis is reported to be a more sensitive approach to diagnose lymphedema in comparison with the conventional clinical analysis. Our study seeks to evaluate the diagnostic performance of lower limb lymphoscintigraphy with amalgamation of qualitative and quantitative analysis by measuring the ilio-inguinal nodal uptake. This prospective observational study was comprised of 86 patients (172 limbs) diagnosed with lower limb lymphedema. After a thorough clinical grading of edema, radionuclide lymphoscintigraphy was performed as per a dedicated institutional protocol. Ilio-inguinal nodal quantification of tracer uptake was computed along with the visual study of the scans. Additionally, the corresponding mean nodal uptake percentage for each grade of lymphedema was assessed and a cut off nodal uptake percentage to differentiate between normal and abnormal limbs was defined. Although quantitative analysis with nodal uptake percentage provides objective criteria to diagnose lymphedema, it can only act as an adjunct to qualitative method without replacing it. Finally, standardization of procedure for quantitative lymphoscintigraphy is needed including the potential for combining both rate of clearance of tracer from injection site and nodal uptake for quantification.

South Indian zebu dwarf cattle show higher natural resistance to tick infestation compared to crossbreds: preliminary observations

The present study aimed to evaluate the influence of various factors on the host resistance of cattle against tick infestation in Kerala State, South India. The number of naturally infested semi-engorged female ticks present on the cattle was counted on a sample cattle population across the four regions of Kerala. Then, the animals were grouped based on the tick count. The chi-square test and Fisher exact test were used to identify the effects of genetic and non-genetic factors on tick burden in cattle. It was found that the Holstein Friesian crossbred and Jersey crossbred cattle had a significantly higher level of tick infestation than the indigenous Vechur breed (Bos indicus). No tick infestation was observed in indigenous Kasaragod Dwarf cattle (B. indicus). Tick infestation was more in heifers and dry animals than lactating animals. However, the sex of the animal and the stage of lactation did not influence the tick load. Tick infestation was also influenced by parity, grazing, and region.

Luminescent lanthanide nanoparticle-based imaging enables ultra-sensitive, quantitative and multiplexed in vitro lateral flow immunoassays

Lateral Flow Assays (LFAs) have been extensively used on-site to rapidly detect analytes, possibly in complex media. However, standard gold nanoparticle-based LFAs lack sensitivity and cannot provide quantitative measurements with high accuracy. To overcome these limitations, we image lanthanide-doped nanoparticles (YVO₄:Eu 40%) as new luminescent LFA probes, using a homemade reader coupled to a smartphone and propose an original image analysis allowing strip quantification regardless of the shape of the test band signal. This method is demonstrated for the detection of staphylococcal enterotoxins SEA, SEG, SEH, and SEI. A systematic comparison to state-of-the-art gold nanoparticle-based LFA revealed an analytical sensitivity enhancement of at least one order of magnitude. We furthermore provided measurements of absolute toxin concentration over two orders of magnitude and demonstrated simultaneous quantitative detection of multiple toxins with unaltered sensitivity. In particular, we reached concentrations 100 times lower than the ones reported in the literature for on-site multiplexed LFA targeting enterotoxins. Altogether, these results highlight that our luminescent nanoparticle-based method provides a powerful and versatile on-site framework to detect multiple biomolecules with sensitivity approaching that obtained by ELISA. This paves the way to a change of paradigm in the field of analytical immunoassays by providing fast in situ quantitative high sensitivity detection of biomarkers or pathogens.

[Prioritization of intensive medical treatment places - Concept proposal]

In the situation of a shortage of ventilation beds, ethically justifiable, transparent and comprehensible decisions must be made. This concept proposes that all patients are first intubated depending on necessity and then assessed by a triage team afterwards. In this situation newly admitted COVID patients compete with newly admitted Non-COVID patients as well as patients already treated in intensive care units for a ventilator. The combination of short-term and long-term prognoses should enable the interprofessional triage team to make comprehensible decisions. The aim of the prioritization concept is to save as many human lives as possible and to relieve the treatment team of the difficult decision on prioritization.

Ten-year assessment of a cancer fast-track programme to connect primary care with oncology: reducing time from initial symptoms to diagnosis and treatment initiation

Background

Cancer is the second leading cause of mortality worldwide. Integrating different levels of care by implementing screening programmes, extending diagnostic tools and applying therapeutic advances may increase survival. We implemented a cancer fast-track programme (CFP) to shorten the time between suspected cancer symptoms, diagnosis and therapy initiation.

Patients and methods

Descriptive data were collected from the 10 years since the CFP was implemented (2009-2019) at the Clinico-Malvarrosa Health Department in Valencia, Spain. General practitioners (GPs), an oncology coordinator and 11 specialists designed guidelines for GP patient referral to the CFP, including criteria for breast, digestive, gynaecological, lung, urological, dermatological, head and neck, and soft tissue cancers. Patients with enlarged lymph nodes and constitutional symptoms were also considered. On identifying patients with suspected cancer, GPs sent a case proposal to the oncology coordinator. If criteria were met, an appointment was quickly made with the patient. We analysed the timeline of each stage of the process.

Results

A total of 4493 suspected cancer cases were submitted to the CFP, of whom 4019 were seen by the corresponding specialist. Cancer was confirmed in 1098 (27.3%) patients: breast cancer in 33%, urological cancers in 22%, gastrointestinal cancer in 19% and lung cancer in 15%. The median time from submission to cancer testing was 11 days, and diagnosis was reached in a median of 19 days. Treatment was started at a median of 34 days from diagnosis.

Conclusions

The findings of this study show that the interval from GP patient referral to specialist testing, cancer diagnosis and start of therapy can be reduced. Implementation of the CFP enabled most patients to begin curative intended treatment, and required only minimal resources in our setting.

•

Our CFP easily connects GPs and hospital specialists.

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Our CFP shortens assessment time in patients with suspected cancer, adding to quality care.

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Our CFP decreases emotional stress in patients without cancer.

Assessment of lymphedema with lymphoscintigraphy: Can nodal quantification help?

Lymphoscintigraphy with combined qualitative and quantitative analysis is reported to be a more sensitive approach to diagnose lymphedema in comparison with the conventional clinical analysis. Our study seeks to evaluate the diagnostic performance of lower limb lymphoscintigraphy with amalgamation of qualitative and quantitative analysis by measuring the ilio-inguinal nodal uptake. This prospective observational study was comprised of 86 patients (172 limbs) diagnosed with lower limb lymphedema. After a thorough clinical grading of edema, radionuclide lymphoscintigraphy was performed as per a dedicated institutional protocol. Ilio-inguinal nodal quantification of tracer uptake was computed along with the visual study of the scans. Additionally, the corresponding mean nodal uptake percentage for each grade of lymphedema was assessed and a cut off nodal uptake percentage to differentiate between normal and abnormal limbs was defined. Although quantitative analysis with nodal uptake percentage provides objective criteria to diagnose lymphedema, it can only act as an adjunct to qualitative method without replacing it. Finally, standardization of procedure for quantitative lymphoscintigraphy is needed including the potential for combining both rate of clearance of tracer from injection site and nodal uptake for quantification.

Changing trends in the management of condylar fractures

Our aim was to evaluate the functional outcomes and complications of mandibular condylar fractures managed surgically and non-surgically. Patients were identified retrospectively from audit data and clinical records from 2005-2018, and functional outcomes were evaluated based on the development of complications at clinical follow up. Patients were categorised into three treatment groups: conservative (management with soft diet, analgesia, and monitoring), closed (management with intermaxillary fixation), and open reduction and internal fixation (ORIF). A total of 358 patients were included with a median age of 33 years (mean 38), and a male:female ratio of 2.7:1. A total of 72 patients (20%) were treated conservatively, 177 (49%) were treated with closed management, and 109 (31%) with ORIF. The ORIF group demonstrated better outcomes than the closed group in terms of reduced protrusive and lateral excursive movements, and temporomandibular joint (TMJ) pain; and in terms of occlusal derangement when compared with the conservative group. The ORIF group had poorer outcomes than both the closed and conservative groups in terms of maximum mouth opening, and temporary facial nerve injury occurred in 5/109 (5%) and condylar resorption in 2/109 (2%) of patients in the ORIF group. There was no incidence of permanent facial nerve injury, Frey syndrome, or paraesthesia of the auricular nerve. The trend that favours ORIF can be justified, as it offers improved functional outcomes in severe or displaced condylar fractures. However, this must be evaluated against the risk of potential surgical complications. Careful case selection is therefore necessary to optimise management of these injuries.

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.

Proposta de sequenciamento das projeções mielográficas na identificação de compressão da medula espinhal em cães com doença do disco intervertebral cervical

RESUMO O objetivo deste trabalho foi verificar em quais projeções foi possível identificar compressão da medula espinhal em cães com doença do disco intervertebral (DDIV) cervical e propor um sequenciamento das projeções a ser realizado no exame mielográfico dessa região. Foram avaliadas quatro projeções mielográficas (lateral, ventrodorsal e oblíquas esquerda e direita) de 41 pacientes diagnosticados com DDIV cervical. Em 40 pacientes (97,5%), foi possível identificar compressão da medula espinhal na projeção lateral; em 22 (53,6%), nas oblíquas; e em 11 (26,8%), na ventrodorsal (P<0,05). Havia lateralização da compressão em 22 (53,6%) pacientes; 100% delas (n=22) foram detectadas pelas projeções oblíquas e 50% (n=11) pela ventrodorsal. Em 10 (24,4%) cães, foi observado mais que um local de compressão, tendo as projeções ventrodorsal e oblíquas auxiliado na definição do local de compressão em 50% e 70%, respectivamente. Pode-se concluir que todas as projeções mielográficas estudadas permitem identificar compressão na medula espinhal em cães com DDIV cervical, sendo a incidência lateral a que mais a revelou, seguida das oblíquas e da ventrodorsal, estabelecendo-se, assim, uma proposta de sequenciamento das projeções mielográficas a serem realizadas para essa região.

International Nosocomial Infection Control Consortium (INICC) report, data summary of 45 countries for 2012-2017: Device-associated module

BACKGROUND

We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2012 to December 2017 in 523 intensive care units (ICUs) in 45 countries from Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific.

METHODS

During the 6-year study period, prospective data from 532,483 ICU patients hospitalized in 242 hospitals, for an aggregate of 2,197,304 patient days, were collected through the INICC Surveillance Online System (ISOS). The Centers for Disease Control and Prevention-National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI) were applied.

RESULTS

Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the medical-surgical ICUs, the pooled central line-associated bloodstream infection rate was higher (5.05 vs 0.8 per 1,000 central line-days); the ventilator-associated pneumonia rate was also higher (14.1 vs 0.9 per 1,000 ventilator-days,), as well as the rate of catheter-associated urinary tract infection (5.1 vs 1.7 per 1,000 catheter-days). From blood cultures samples, frequencies of resistance, such as of Pseudomonas aeruginosa to piperacillin-tazobactam (33.0% vs 18.3%), were also higher.

CONCLUSIONS

Despite a significant trend toward the reduction in INICC ICUs, DA-HAI rates are still much higher compared with CDC-NHSN's ICUs representing the developed world. It is INICC's main goal to provide basic and cost-effective resources, through the INICC Surveillance Online System to tackle the burden of DA-HAIs effectively.

Extraction and validation of a new set of CMS pythia8 tunes from underlying-event measurements

New sets of CMS underlying-event parameters ("tunes") are presented for the pythia8 event generator. These tunes use the NNPDF3.1 parton distribution functions (PDFs) at leading (LO), next-to-leading (NLO), or next-to-next-to-leading (NNLO) orders in perturbative quantum chromodynamics, and the strong coupling evolution at LO or NLO. Measurements of charged-particle multiplicity and transverse momentum densities at various hadron collision energies are fit simultaneously to determine the parameters of the tunes. Comparisons of the predictions of the new tunes are provided for observables sensitive to the event shapes at LEP, global underlying event, soft multiparton interactions, and double-parton scattering contributions. In addition, comparisons are made for observables measured in various specific processes, such as multijet, Drell-Yan, and top quark-antiquark pair production including jet substructure observables. The simulation of the underlying event provided by the new tunes is interfaced to a higher-order matrix-element calculation. For the first time, predictions from pythia8 obtained with tunes based on NLO or NNLO PDFs are shown to reliably describe minimum-bias and underlying-event data with a similar level of agreement to predictions from tunes using LO PDF sets.

A religiously-tailored, multilevel intervention in African American churches to increase HIV testing: Rationale and design of the Taking It to the Pews cluster randomized trial

HIV continues to disproportionately impact African American (AA) communities. Due to delayed HIV diagnosis, AAs tend to enter HIV treatment at advanced stages. There is great need for increased access to regular HIV testing and linkage to care services for AAs. AA faith institutions are highly influential and have potential to increase the reach of HIV testing in AA communities. However, well-controlled full-scale trials have not been conducted in the AA church context. We describe the rationale and design of a 2-arm cluster randomized trial to test a religiously-tailored HIV testing intervention (Taking It to the Pews [TIPS]) against a standard information arm on HIV testing rates among AA church members and community members they serve. Using a community-engaged approach, TIPS intervention components are delivered by trained church leaders via existing multilevel church outlets using religiously-tailored HIV Tool Kit materials and activities (e.g., sermons, responsive readings, video/print testimonials, HIV educational games, text messages) to encourage testing. Church-based HIV testing events and linkage to care services are conducted by health agency partners. Control churches receive standard, non-tailored HIV information via multilevel church outlets. Secondarily, HIV risk/protective behaviors and process measures on feasibility, fidelity, and dose/exposure are assessed. This novel study is the first to fully test an HIV testing intervention in AA churches - a setting with great reach and influence in AA communities. It could provide a faith-community engagement model for delivering scalable, wide-reaching HIV prevention interventions by supporting AA faith leaders with religiously-appropriate HIV toolkits and health agency partners.

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.

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.

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.

Search for a heavy pseudoscalar boson decaying to a Z and a Higgs boson at s = 13 Te

A search is presented for a heavy pseudoscalar boson A decaying to a Z  boson and a Higgs boson with mass of 125GeV . In the final state considered, the Higgs boson decays to a bottom quark and antiquark, and the Z  boson decays either into a pair of electrons, muons, or neutrinos. The analysis is performed using a data sample corresponding to an integrated luminosity of 35.9fb - 1 collected in 2016 by the CMS experiment at the LHC from proton-proton collisions at a center-of-mass energy of 13Te . The data are found to be consistent with the background expectations. Exclusion limits are set in the context of two-Higgs-doublet models in the A boson mass range between 225 and 1000GeV .

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.

Management of deep caries and the exposed pulp

Caries prevalence remains high throughout the world, with the burden of disease increasingly affecting older and socially disadvantaged groups in Western cultures. If left untreated, caries will advance through dentine stimulating pulpitis and eventually pulp infection and necrosis; however, if conservatively managed, pulpal recovery occurs even in deep carious lesions. Traditionally, deep caries management was destructive with nonselective (complete) removal of all carious dentine; however, the promotion of minimally invasive biologically based treatment strategies has been advocated for selective (partial) caries removal and a reduced risk of pulp exposure. Selective caries removal strategies can be one-visit as indirect pulp treatment or two-visit using a stepwise approach. Management strategies for the treatment of the cariously exposed pulp are also shifting with avoidance of pulpectomy and the re-emergence of vital pulp treatment (VPT) techniques such as partial and complete pulpotomy. These changes stem from an improved understanding of the pulp-dentine complex's defensive and reparative response to irritation, with harnessing the release of bioactive dentine matrix components and careful handling of the damaged tissue considered critical. Notably, the development of new pulp capping materials such as mineral trioxide aggregate, which although not an ideal material, has resulted in more predictable treatments from both a histological and a clinical perspective. Unfortunately, the changes in management are only supported by relatively weak evidence with case series, cohort studies and preliminary studies containing low patient numbers forming the bulk of the evidence. As a result, critical questions related to the superiority of one caries removal technique over another, the best pulp capping biomaterial or whether pulp exposure is a negative prognostic factor remain unanswered. There is an urgent need to promote minimally invasive treatment strategies in Operative Dentistry and Endodontology; however, the development of accurate diagnostic tools, evidence-based management strategies and education in management of the exposed pulp are critical in the future.

Search for vector-like quarks in events with two oppositely charged leptons and jets in proton-proton collisions at s = 13 Te

A search for the pair production of heavy vector-like partners T and B of the top and bottom quarks has been performed by the CMS experiment at the CERN LHC using proton-proton collisions ats = 13 Te . The data sample was collected in 2016 and corresponds to an integrated luminosity of 35.9fb - 1 . Final states studied for T T ¯ production include those where one of the T quarks decays via T → t Z and the other via T → b W , t Z , or t H , where H is a Higgs boson. For the B B ¯ case, final states include those where one of the B quarks decays via B → b Z and the other B → t W , b Z , or b H . Events with two oppositely charged electrons or muons, consistent with coming from the decay of a Z boson, and jets are investigated. The number of observed events is consistent with standard model background estimations. Lower limits at 95% confidence level are placed on the masses of the T and B quarks for a range of branching fractions. Assuming 100% branching fractions for T → t Z , and B → b Z , T and B quark mass values below 1280 and 1130Ge , respectively, are excluded.

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.

Search for resonant production of second-generation sleptons with same-sign dimuon events in proton-proton collisions at s = 13 TeV

A search is presented for resonant production of second-generation sleptons (μ ~ L ,ν ~ μ ) via the R-parity-violating coupling λ 211 ' to quarks, in events with two same-sign muons and at least two jets in the final state. The smuon (muon sneutrino) is expected to decay into a muon and a neutralino (chargino), which will then decay into a second muon and at least two jets. The analysis is based on the 2016 data set of proton-proton collisions ats = 13 TeV recorded with the CMS detector at the LHC, corresponding to an integrated luminosity of 35.9fb - 1 . No significant deviation is observed with respect to standard model expectations. Upper limits on cross sections, ranging from 0.24 to 730fb , are derived in the context of two simplified models representing the dominant signal contributions leading to a same-sign muon pair. The cross section limits are translated into coupling limits for a modified constrained minimal supersymmetric model with λ 211 ' as the only nonzero R-parity violating coupling. The results significantly extend restrictions of the parameter space compared with previous searches for similar models.