Utilizing Co-Creative Principles to Develop an E-Learning Platform for Interprofessional Training on Tinnitus: The Erasmus+ Project Tin-TRAC

Tinnitus treatment, diagnosis and management across Europe varies significantly. The lack of national clinical guidelines for tinnitus management in most European countries and the absence of a common language across all disciplines involved is reflected in the diversification of healthcare practices. Interprofessional Training for Tinnitus Researchers and Clinicians (Tin-TRAC) is an Erasmus+ project that aims to develop common educational ground in the form of an e-Learning platform, co-created by patients, researchers and clinicians, which is able to unify tinnitus diagnosis and treatment strategies across Europe. A pan-European thematic educational platform integrating the best practices and latest research achievements with regard to tinnitus diagnosis and management has the potential to act as a facilitator of the reduction of interdisciplinary and interregional practice diversification. A detailed analysis of the educational needs of clinicians and researchers across disciplines will be followed by the co-creative development of the curriculum. Reusable learning objects will incorporate the training contents and will be integrated in an open e-Learning platform. Tin-TRAC envisions that its output will answer the need to create a common language across the clinicians and researchers of different disciplines that are involved in tinnitus management, and reduce patients’ prolonged suffering, non-adherence and endless referral trajectories

A survey-based assessment of attitudes and needs regarding tinnitus healthcare among patients and healthcare professionals in Europe

Despite good agreement of national guidelines for the assessment and treatment of tinnitus, there is still substantial variation regarding tinnitus-related healthcare across Europe. In contrast to previous work, which has mainly focussed on the perspective of healthcare professionals, we here report the results of separate web-based surveys conducted with clinicians and researchers as well as tinnitus patients. These surveys were devised to obtain information about their respective attitudes and needs with respect to tinnitus healthcare, and to reveal possible interdisciplinary inconsistencies among clinicians and researchers. We mainly targeted participants from Germany, Cyprus, and Greece, the countries in which the institutions of the researchers involved in this project are based. Results showed, firstly, that the treatment satisfaction of the patients was overall more negative than that of the clinicians and researchers, and that the patients' treatment satisfaction did not depend on the number of different treatments they had received. Secondly, patients as well as clinicians and researchers indicated that they were interested in learning more about a variety of tinnitus-related topics, especially treatment strategies, with no marked differences between clinicians from different professional disciplines. This suggests similar tinnitus-specific educational needs in patients and healthcare professionals

Monitoring quality of care in hepatocellular carcinoma: A modified delphi consensus

Although there are several established international guidelines on the management of hepatocellular carcinoma (HCC), there is limited information detailing specific indicators of good quality care. The aim of this study was to develop a core set of quality indicators (QIs) to underpin the management of HCC. We undertook a modified, two-round, Delphi consensus study comprising a working group and experts involved in the management of HCC as well as consumer representatives. QIs were derived from an extensive review of the literature. The role of the participants was to identify the most important and measurable QIs for inclusion in an HCC clinical quality registry. From an initial 94 QIs, 40 were proposed to the participants. Of these, 23 QIs ultimately met the inclusion criteria and were included in the final set. This included (a) nine related to the initial diagnosis and staging, including timing to diagnosis, required baseline clinical and laboratory assessments, prior surveillance for HCC, diagnostic imaging and pathology, tumor staging, and multidisciplinary care; (b) thirteen related to treatment and management, including role of antiviral therapy, timing to treatment, localized ablation and locoregional therapy, surgery, transplantation, systemic therapy, method of response assessment, and supportive care; and (c) one outcome assessment related to surgical mortality. Conclusion: We identified a core set of nationally agreed measurable QIs for the diagnosis, staging, and management of HCC. The adherence to these best practice QIs may lead to system-level improvement in quality of care and, ultimately, improvement in patient outcomes, including survival

Measurement of differential cross sections for Z bosons produced in association with charm jets in pp collisions at root s=13 TeV

Measurements are presented of differential cross sections for the production of Z bosons in association with at least one jet initiated by a charm quark in pp collisions at root s = 13 TeV. The data recorded by the CMS experiment at the LHC correspond to an integrated luminosity of 35.9 fb(-1). The final states contain a pair of electrons or muons that are the decay products of a Z boson, and a jet consistent with being initiated by a charm quark produced in the hard interaction. Differential cross sections as a function of the transverse momentum p(T) of the Z boson and p(T) of the charm jet are compared with predictions from Monte Carlo event generators. The inclusive production cross section 405.4 +/- 5.6 (stat) +/- 24.3 (exp) +/- 3.7 (theo) pb, is measured in a fiducial region requiring both leptons to have pseudorapidity |eta| 10 GeV, at least one lepton with p(T)> 26 GeV, and a mass of the pair in the range 71-111 GeV, while the charm jet is required to have p(T)> 30 GeV and |eta| < 2.4. These are the first measurements of these cross sections in proton-proton collisions at 13 TeV.Peer reviewe

Measurement of the Z boson differential production cross section using its invisible decay mode (Z -> nu(nu)over-bar) in proton-proton collisions at root s=13 TeV

Measurements of the total and differential fiducial cross sections for the Z boson decaying into two neutrinos are presented at the LHC in proton-proton collisions at a center-of-mass energy of 13TeV. The data were collected by the CMS detector in 2016 and correspond to an integrated luminosity of 35.9 fb(-1). In these measurements, events are selected containing an imbalance in transverse momentum and one or more energetic jets. The fiducial differential cross section is measured as a function of the Z boson transverse momentum. The results are combined with a previous measurement of charged-lepton decays of the Z boson. The measured total fiducial cross section for events with Z boson transverse momentum greater than 200 GeV is 3000(-170)(+180) fb.Peer reviewe

Study of Drell-Yan dimuon production in proton-lead collisions at root s(NN )=8.16 TeV

Differential cross sections for the Drell-Yan process, including Z boson production, using the dimuon decay channel are measured in proton-lead (pPb) collisions at a nucleon-nucleon centre-of-mass energy of 8.16 TeV. A data sample recorded with the CMS detector at the LHC is used, corresponding to an integrated luminosity of 173 nb(-1). The differential cross section as a function of the dimuon mass is measured in the range 15-600 GeV, for the first time in proton-nucleus collisions. It is also reported as a function of dimuon rapidity over the mass ranges 15-60 GeV and 60-120 GeV, and ratios for the p-going over the Pb-going beam directions are built. In both mass ranges, the differential cross sections as functions of the dimuon transverse momentum p(T), and of a geometric variable phi* are measured, where phi* highly correlates with p(T), but is determined with higher precision. In the Z mass region, the rapidity dependence of the data indicate a modification of the distribution of partons within a lead nucleus as compared to the proton case. The data are more precise than predictions based upon current models of parton distributions.Peer reviewe

Inclusive nonresonant multilepton probes of new phenomena at s\sqrt{s}= 13 TeV

An inclusive search for nonresonant signatures of beyond the standard model (SM) phenomena in events with three or more charged leptons, including hadronically decaying τ leptons, is presented. The analysis is based on a data sample corresponding to an integrated luminosity of 138 fb$^{-1}$ of proton-proton collisions at $\sqrt{s}$= 13 TeV collected by the CMS experiment at the LHC in 2016–2018. Events are categorized based on the lepton and b-tagged jet multiplicities and various kinematic variables. Three scenarios of physics beyond the SM are probed, and signal-specific boosted decision trees are used for enhancing sensitivity. No significant deviations from the background expectations are observed. Lower limits are set at 95% confidence level on the mass of type-III seesaw heavy fermions in the range 845–1065 GeV for various decay branching fraction combinations to SM leptons. Doublet and singlet vectorlike τ lepton extensions of the SM are excluded for masses below 1045 GeV and in the mass range 125–150 GeV, respectively. Scalar leptoquarks decaying exclusively to a top quark and a lepton are excluded below 1.12–1.42 TeV, depending on the lepton flavor. For the type-III seesaw as well as the vectorlike doublet model, these constraints are the most stringent to date. For the vectorlike singlet model, these are the first constraints from the LHC experiments. Detailed results are also presented to facilitate alternative theoretical interpretations

Inclusive nonresonant multilepton probes of new phenomena at s\sqrt{s}= 13 TeV

An inclusive search for nonresonant signatures of beyond the standard model (SM) phenomena in events with three or more charged leptons, including hadronically decaying τ leptons, is presented. The analysis is based on a data sample corresponding to an integrated luminosity of 138 fb$^{-1}$ of proton-proton collisions at $\sqrt{s}$= 13 TeV collected by the CMS experiment at the LHC in 2016–2018. Events are categorized based on the lepton and b-tagged jet multiplicities and various kinematic variables. Three scenarios of physics beyond the SM are probed, and signal-specific boosted decision trees are used for enhancing sensitivity. No significant deviations from the background expectations are observed. Lower limits are set at 95% confidence level on the mass of type-III seesaw heavy fermions in the range 845–1065 GeV for various decay branching fraction combinations to SM leptons. Doublet and singlet vectorlike τ lepton extensions of the SM are excluded for masses below 1045 GeV and in the mass range 125–150 GeV, respectively. Scalar leptoquarks decaying exclusively to a top quark and a lepton are excluded below 1.12–1.42 TeV, depending on the lepton flavor. For the type-III seesaw as well as the vectorlike doublet model, these constraints are the most stringent to date. For the vectorlike singlet model, these are the first constraints from the LHC experiments. Detailed results are also presented to facilitate alternative theoretical interpretations

Angular analysis of the decay B+ -> K+mu(+)mu(-) in proton-proton collisions at root s=8 TeV

The angular distribution of the flavor-changing neutral current decay B+ -> K+mu(+)mu(-) is studied in proton-proton collisions at a center-of-mass energy of 8 TeV. The analysis is based on data collected with the CMS detector at the LHC, corresponding to an integrated luminosity of 20.5 fb(-1). The forward-backward asymmetry A(FB) of the dimuon system and the contribution F-H from the pseudoscalar, scalar, and tensor amplitudes to the decay width are measured as a function of the dimuon mass squared. The measurements are consistent with the standard model expectations.Peer reviewe

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life