Physiologically based pharmacokinetic modeling of arterial – antecubital vein concentration difference

BACKGROUND: Modeling of pharmacokinetic parameters and pharmacodynamic actions requires knowledge of the arterial blood concentration. In most cases, experimental measurements are only available for a peripheral vein (usually antecubital) whose concentration may differ significantly from both arterial and central vein concentration. METHODS: A physiologically based pharmacokinetic (PBPK) model for the tissues drained by the antecubital vein (referred to as "arm") is developed. It is assumed that the "arm" is composed of tissues with identical properties (partition coefficient, blood flow/gm) as the whole body tissues plus a new "tissue" representing skin arteriovenous shunts. The antecubital vein concentration depends on the following parameters: the fraction of "arm" blood flow contributed by muscle, skin, adipose, connective tissue and arteriovenous shunts, and the flow per gram of the arteriovenous shunt. The value of these parameters was investigated using simultaneous experimental measurements of arterial and antecubital concentrations for eight solutes: ethanol, thiopental, (99)Tc(m)-diethylene triamine pentaacetate (DTPA), ketamine, D(2)O, acetone, methylene chloride and toluene. A new procedure is described that can be used to determine the arterial concentration for an arbitrary solute by deconvolution of the antecubital concentration. These procedures are implemented in PKQuest, a general PBPK program that is freely distributed . RESULTS: One set of "standard arm" parameters provides an adequate description of the arterial/antecubital vein concentration for ethanol, DTPA, thiopental and ketamine. A significantly different set of "arm" parameters was required to describe the data for D(2)O, acetone, methylene chloride and toluene – probably because the "arm" is in a different physiological state. CONCLUSIONS: Using the set of "standard arm" parameters, the antecubital vein concentration can be used to determine the whole body PBPK model parameters for an arbitrary solute without any additional adjustable parameters. Also, the antecubital vein concentration can be used to estimate the arterial concentration for an arbitrary input for solutes for which no arterial concentration data is available

Consensus standards of healthcare for adults and children with inflammatory bowel disease in the UK

Objective Symptoms and clinical course during inflammatory bowel disease (IBD) vary among individuals. Personalised care is therefore essential to effective management, delivered by a strong patient-centred multidisciplinary team, working within a well-designed service. This study aimed to fully rewrite the UK Standards for the healthcare of adults and children with IBD, and to develop an IBD Service Benchmarking Tool to support current and future personalised care models. Design Led by IBD UK, a national multidisciplinary alliance of patients and nominated representatives from all major stakeholders in IBD care, Standards requirements were defined by survey data collated from 689 patients and 151 healthcare professionals. Standards were drafted and refined over three rounds of modified electronic-Delphi. Results Consensus was achieved for 59 Standards covering seven clinical domains; (1) design and delivery of the multidisciplinary IBD service; (2) prediagnostic referral pathways, protocols and timeframes; (3) holistic care of the newly diagnosed patient; (4) flare management to support patient empowerment, self-management and access to specialists where required; (5) surgery including appropriate expertise, preoperative information, psychological support and postoperative care; (6) inpatient medical care delivery (7) and ongoing long-term care in the outpatient department and primary care setting including shared care. Using these patient-centred Standards and informed by the IBD Quality Improvement Project (IBDQIP), this paper presents a national benchmarking framework. Conclusions The Standards and Benchmarking Tool provide a framework for healthcare providers and patients to rate the quality of their service. This will recognise excellent care, and promote quality improvement, audit and service development in IBD

Mucopolysaccharidosis VI

Mucopolysaccharidosis VI (MPS VI) is a lysosomal storage disease with progressive multisystem involvement, associated with a deficiency of arylsulfatase B leading to the accumulation of dermatan sulfate. Birth prevalence is between 1 in 43,261 and 1 in 1,505,160 live births. The disorder shows a wide spectrum of symptoms from slowly to rapidly progressing forms. The characteristic skeletal dysplasia includes short stature, dysostosis multiplex and degenerative joint disease. Rapidly progressing forms may have onset from birth, elevated urinary glycosaminoglycans (generally >100 μg/mg creatinine), severe dysostosis multiplex, short stature, and death before the 2nd or 3rd decades. A more slowly progressing form has been described as having later onset, mildly elevated glycosaminoglycans (generally <100 μg/mg creatinine), mild dysostosis multiplex, with death in the 4th or 5th decades. Other clinical findings may include cardiac valve disease, reduced pulmonary function, hepatosplenomegaly, sinusitis, otitis media, hearing loss, sleep apnea, corneal clouding, carpal tunnel disease, and inguinal or umbilical hernia. Although intellectual deficit is generally absent in MPS VI, central nervous system findings may include cervical cord compression caused by cervical spinal instability, meningeal thickening and/or bony stenosis, communicating hydrocephalus, optic nerve atrophy and blindness. The disorder is transmitted in an autosomal recessive manner and is caused by mutations in the ARSB gene, located in chromosome 5 (5q13-5q14). Over 130 ARSB mutations have been reported, causing absent or reduced arylsulfatase B (N-acetylgalactosamine 4-sulfatase) activity and interrupted dermatan sulfate and chondroitin sulfate degradation. Diagnosis generally requires evidence of clinical phenotype, arylsulfatase B enzyme activity <10% of the lower limit of normal in cultured fibroblasts or isolated leukocytes, and demonstration of a normal activity of a different sulfatase enzyme (to exclude multiple sulfatase deficiency). The finding of elevated urinary dermatan sulfate with the absence of heparan sulfate is supportive. In addition to multiple sulfatase deficiency, the differential diagnosis should also include other forms of MPS (MPS I, II IVA, VII), sialidosis and mucolipidosis. Before enzyme replacement therapy (ERT) with galsulfase (Naglazyme®), clinical management was limited to supportive care and hematopoietic stem cell transplantation. Galsulfase is now widely available and is a specific therapy providing improved endurance with an acceptable safety profile. Prognosis is variable depending on the age of onset, rate of disease progression, age at initiation of ERT and on the quality of the medical care provided

Search for additional heavy neutral Higgs and gauge bosons in the ditau final state produced in 36 fb−1 of pp collisions at √s=13 TeV with the ATLAS detector

A search for heavy neutral Higgs bosons and Z′ bosons is performed using a data sample corresponding to an integrated luminosity of 36.1 fb−1 from proton-proton collisions at √s=13 TeV recorded by the ATLAS detector at the LHC during 2015 and 2016. The heavy resonance is assumed to decay to τ+τ− with at least one tau lepton decaying to final states with hadrons and a neutrino. The search is performed in the mass range of 0.2-2.25 TeV for Higgs bosons and 0.2-4.0 TeV for Z′ bosons. The data are in good agreement with the background predicted by the Standard Model. The results are interpreted in benchmark scenarios. In the context of the hMSSM scenario, the data exclude tan β > 1.0 for mA= 0.25 TeV and tan β > 42 for mA=1.5 TeV at the 95% confidence level. For the Sequential Standard Model, ZSSM′ with mZ′< 2.42 TeV is excluded at 95% confidence level, while Z NU′ with mZ ′ < 2.25 TeV is excluded for the non-universal G(221) model that exhibits enhanced couplings to third-generation fermions

Measurement of detector-corrected observables sensitive to the anomalous production of events with jets and large missing transverse momentum in pp collisions at √s=13 TeV using the ATLAS detector

Observables sensitive to the anomalous production of events containing hadronic jets and missing momentum in the plane transverse to the proton beams at the Large Hadron Collider are presented. The observables are defined as a ratio of cross sections, for events containing jets and large missing transverse momentum to events containing jets and a pair of charged leptons from the decay of a Z/γ ∗ boson. This definition minimises experimental and theoretical systematic uncertainties in the measurements. This ratio is measured differentially with respect to a number of kinematic properties of the hadronic system in two phase-space regions; one inclusive single-jet region and one region sensitive to vectorboson- fusion topologies. The data are found to be in agreement with the Standard Model predictions and used to constrain a variety of theoretical models for dark-matter production, including simplified models, effective field theory models, and invisible decays of the Higgs boson. The measurements use 3.2 fb−1 of proton–proton collision data recorded by the ATLAS experiment at a centre-of-mass energy of 13TeV and are fully corrected for detector effects, meaning that the data can be used to constrain new-physics models beyond those shown in this paper

Search for supersymmetry in final states with two same-sign or three leptons and jets using 36 fb⁻¹ of √s=13 TeV pp collision data with the ATLAS detector

A search for strongly produced supersymmetric particles using signatures involving multiple energetic jets and either two isolated same-sign leptons (e or μ), or at least three isolated leptons, is presented. The analysis relies on the identification of b-jets and high missing transverse momentum to achieve good sensitivity. A data sample of proton-proton collisions at s=13 TeV recorded with the ATLAS detector at the Large Hadron Collider in 2015 and 2016, corresponding to a total integrated luminosity of 36.1 fb −1 , is used for the search. No significant excess over the Standard Model prediction is observed. The results are interpreted in several simplified supersymmetric models featuring R-parity conservation or R-parity violation, extending the exclusion limits from previous searches. In models considering gluino pair production, gluino masses are excluded up to 1.87 TeV at 95% confidence level. When bottom squarks are pair-produced and decay to a chargino and a top quark, models with bottom squark masses below 700 GeV and light neutralinos are excluded at 95% confidence level. In addition, model-independent limits are set on a possible contribution of new phenomena to the signal region yields.[Figure not available: see fulltext.]

Measurement of τ polarisation in Z/γ∗ → ττ decays in proton–proton collisions at √s = 8 TeV with the ATLAS detector

This paper presents a measurement of the polarisation of τ leptons produced in Z/γ ∗ → ττ decays which is performed with a dataset of proton—proton collisions at √s = 8 TeV, corresponding to an integrated luminosity of 20.2 fb−1 recorded with the ATLAS detector at the LHC in 2012. The Z/γ∗ → ττ decays are reconstructed from a hadronically decaying τ lepton with a single charged particle in the final state, accompanied by a τ lepton that decays leptonically. The τ polarisation is inferred from the relative fraction of energy carried by charged and neutral hadrons in the hadronic τ decays. The polarisation is measured in a fiducial region that corresponds to the kinematic region accessible to this analysis. The τ polarisation extracted over the full phase space within the Z/γ∗ mass range of 66 < mZ/γ∗ < 116GeV is found to be Pτ = −0.14±0.02(stat)±0.04(syst). It is in agreement with the Standard Model prediction of Pτ = −0.1517 ± 0.0019, which is obtained from the ALPGEN event generator interfaced with the PYTHIA 6 parton shower modelling and the TAUOLA τ decay library

Measurement of the Higgs boson coupling properties in the H → ZZ* → 4 decay channel at √s = 13 TeV with the ATLAS detector

The coupling properties of the Higgs boson are studied in the four-lepton (e, μ) decay channel using 36.1 fb−1 of pp collision data from the LHC at a centre-of-mass energy of 13 TeV collected by the ATLAS detector. Cross sections are measured for the main production modes in several exclusive regions of the Higgs boson production phase space and are interpreted in terms of coupling modifiers. The inclusive cross section times branching ratio for H → ZZ∗ decay and for a Higgs boson absolute rapidity below 2.5 is measured to be 1. 73 − 0.23 + 0.24 (stat.) − 0.08 + 0.10 (exp.) ± 0.04(th.) pb compared to the Standard Model prediction of 1.34±0.09 pb. In addition, the tensor structure of the Higgs boson couplings is studied using an effective Lagrangian approach for the description of interactions beyond the Standard Model. Constraints are placed on the non-Standard-Model CP-even and CP-odd couplings to Z bosons and on the CP-odd coupling to gluons

Search for supersymmetry in events with b-tagged jets and missing transverse momentum in pp collisions at √s = 13 TeV with the ATLAS detector

A search for the supersymmetric partners of the Standard Model bottom and top quarks is presented. The search uses 36.1 fb−1 of pp collision data at √s = 13 TeV collected by the ATLAS experiment at the Large Hadron Collider. Direct production of pairs of bottom and top squarks (b˜1 and t˜1) is searched for in final states with b-tagged jets and missing transverse momentum. Distinctive selections are defined with either no charged leptons (electrons or muons) in the final state, or one charged lepton. The zero-lepton selection targets models in which the b˜1 is the lightest squark and decays via b˜1 → bχ˜01 , where ˜χ01 is the lightest neutralino. The one-lepton final state targets models where bottom or top squarks are produced and can decay into multiple channels, b˜1 → bχ˜01 and b˜1 → tχ˜±1, or t˜1 → tχ˜01 and t˜1→ bχ˜±1, where ˜χ±1 is the lightest chargino and the mass difference mχ˜±1 − mχ˜01 is set to 1 GeV. No excess above the expected Standard Model background is observed. Exclusion limits at 95% confidence level on the mass of third-generation squarks are derived in various supersymmetry-inspired simplified models

Search for long-lived charginos based on a disappearing-track signature in pp collisions at s √ =13 s=13 TeV with the ATLAS detector

This paper presents a search for direct electroweak gaugino or gluino pair production with a chargino nearly mass-degenerate with a stable neutralino. It is based on an integrated luminosity of 36.1 fb−1 of pp collisions at s √ =13 s=13 TeV collected by the ATLAS experiment at the LHC. The final state of interest is a disappearing track accompanied by at least one jet with high transverse momentum from initial-state radiation or by four jets from the gluino decay chain. The use of short track segments reconstructed from the innermost tracking layers significantly improves the sensitivity to short chargino lifetimes. The results are found to be consistent with Standard Model predictions. Exclusion limits are set at 95% confidence level on the mass of charginos and gluinos for different chargino lifetimes. For a pure wino with a lifetime of about 0.2 ns, chargino masses up to 460 GeV are excluded. For the strong production channel, gluino masses up to 1.65 TeV are excluded assuming a chargino mass of 460 GeV and lifetime of 0.2 ns