Business not as usual: how multisectoral collaboration can promote transformative change for health and sustainable development

Shyama Kuruvilla and colleagues present findings across 12 country case studies of multisectoral collaboration, showing how diverse sectors intentionally shape new ways of collaborating and learning, using “business not as usual” strategies to transform situations and achieve shared goals

Single Top Production at HERA and THERA

We study the single top production mediated by flavor changing neutral current via both of the $t-q-\gamma$ and $t-q-Z$ vertices (here q represents c and u quarks) in ep collisions at two colliders HERA and THERA. Contribution of the second vertex becomes even more important as the couplings take more improved values provided by the higher luminosities of colliders. In addition to these improvements if the CM energy of the collider is increased, the production will be dominated by the anomalous $t-q-Z$ vertex.Comment: 8 pages, 3 figures, RevTeX4, references adde

Temporizing management vs immediate delivery in early-onset severe preeclampsia between 28 and 34 weeks of gestation (TOTEM study): An open-label randomized controlled trial

Introduction: There is little evidence to guide the timing of delivery of women with early-onset severe preeclampsia. We hypothesize that immediate delivery is not inferior for neonatal outcome but reduces maternal complications compared with temporizing management. Material and methods: This Dutch multicenter open-label randomized clinical trial investigated non-inferiority for neonatal outcome of temporizing management as compared with immediate delivery (TOTEM NTR 2986) in women between 27+5 and 33+5 weeks of gestation admitted for early-onset severe preeclampsia with or without HELLP syndrome. In participants allocated to receive immediate delivery, either induction of labor or cesarean section was initiated at least 48 hours after admission. Primary outcomes were adverse perinatal outcome, defined as a composite of severe respiratory distress syndrome, bronchopulmonary dysplasia, culture proven sepsis, intraventricular hemorrhage grade 3 or worse, periventricular leukomalacia grade 2 or worse, necrotizing enterocolitis stage 2 or worse, and perinatal death. Major maternal complications were secondary outcomes. It was estimated 1130 women needed to be enrolled. Analysis was by intention-to-treat. Results: The trial was halted after 35 months because of slow recruitment. Between February 2011 and December 2013, a total of 56 women were randomized to immediate delivery (n = 26) or temporizing management (n = 30). Median gestational age at randomization was 30 weeks. Median prolongation of pregnancy was 2 days (interquartile range 1-3 days) in the temporizing management group. Mean birthweight was 1435 g after immediate delivery vs 1294 g after temporizing management (P =.14). The adverse perinatal outcome rate was 55% in the immediate delivery group vs 52% in the temporizing management group (relative risk 1.06; 95% confidence interval 0.67-1.70). In both groups there was one neonatal death and no maternal deaths. In the temporizing treatment group, one woman experienced pulmonary edema and one placental abruption. Analyses of only the singleton pregnancies did not result in other outcomes. Conclusions: Early termination of the trial precluded any conclusions for the main outcomes. We observed that temporizing management resulted in a modest prolongation of pregnancy without changes in perinatal and maternal outcome. Conducting a randomized study for this important research question did not prove feasible

Evidence and consensus-based recommendations for non-pharmacological treatment of fatigue, hand function loss, Raynaud's phenomenon, and digital ulcers in patients with systemic sclerosis

Objective: SSc is a complex CTD affecting mental and physical health. Fatigue, hand function loss, and RP are the most prevalent disease-specific symptoms of systemic sclerosis. This study aimed to develop consensus and evidence-based recommendations for non-pharmacological treatment of these symptoms. Methods: A multidisciplinary task force was installed comprising 20 Dutch experts. After agreeing on the method for formulating the recommendations, clinically relevant questions about patient education and treatments were inventoried. During a face-to-face task force meeting, draft recommendations were generated through a systematically structured discussion, following the nominal group technique. To support the recommendations, an extensive literature search was conducted in MEDLINE and six other databases until September 2020, and 20 key systematic reviews, randomized controlled trials, and published recommendations were selected. Moreover, 13 Dutch medical specialists were consulted on non-pharmacological advice regarding RP and digital ulcers. For each recommendation, the level of evidence and the level of agreement was determined. Results: Forty-one evidence and consensus-based recommendations were developed, and 34, concerning treatments and patient education of fatigue, hand function loss, and RP/digital ulcers-related problems, were approved by the task force. Conclusions: These 34 recommendations provide guidance on non-pharmacological treatment of three of the most frequently described symptoms in patients with systemic sclerosis. The proposed recommendations can guide referrals to health professionals, inform the content of non-pharmacological interventions, and can be used in the development of national and international postgraduate educational offerings

Clinical Practice Audit on the Management of Antineutrophil Cytoplasmic Antibody-Associated Vasculitis in the Netherlands

Introduction: Managing complex and rare systemic autoimmune diseases such as antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) can be challenging and is often accompanied by undesirable variations in clinical practice. Adequate understanding of clinical practice can help identify essential issues to improve the care for AAV patients. Therefore, we studied the real-life management and outcomes of AAV patients in the Netherlands. Methods: In this cohort study, we investigated clinical practice in university and nonuniversity teaching hospitals with respect to patients with a clinical diagnosis of AAV. We retrospectively collected clinical data encompassing clinical variables, medication details, and outcome parameters. Results: Data of 230 AAV patients were collected in 9 Dutch hospitals. Of these, 167 patients (73%) were diagnosed with granulomatosis with polyangiitis, 54 (24%) with microscopic polyangiitis and 9 (4%) with eosinophilic granulomatosis with polyangiitis. One hundred sixty-six patients (72%) had generalized disease. The median year of diagnosis was 2013 (range 1987-2018). Besides steroids, oral cyclophosphamide was the most used drug (50%) for induction therapy and azathioprine (68%) for maintenance therapy. Adverse outcomes were major infections in 35%, major relapses in 23%, malignancy in 10%, major cardiovascular events in 8%, and end-stage renal disease in 7%. Conclusion: Oral cyclophosphamide was the most frequently used induction therapy, azathioprine for maintenance therapy; over time, the use of rituximab is increasingly employed. Major infection and relapses are the most prevalent adverse outcomes. This audit resulted in important indicators for treatment of AAV patients that can be implemented for future, national audits to improve the outcomes of AAV patients

Higgs production in association with top quark pair at e+e- colliders in theories of higher dimensional gravity

The models of large extra compact dimensions, as suggested by Arkani-Hamed, Dimopoulos and Dvali, predict exciting phenomenological consequences with gravitational interactions becoming strong at the TeV scale. Such theories can be tested at the existing and future colliders. In this paper, we study the contribution of virtual Kaluza-Klein excitations in the process $e^+e^- \to t \bar t H$ at future linear collider (NLC). We find that the virtual exchange KK gravitons can modify the cross-section $\sigma(e^+e^- \to t \bar t H)$ significantly from its Standard Model value and will allow the effective string scale to be probed up to 7.9 TeV.Comment: 10 pages, Latex, 4 postscript figure

Desmopressin testing in von Willebrand disease: Lowering the burden

BACKGROUND: Individuals with von Willebrand disease (VWD) require desmopressin testing because of interindividual response differences. However, testing is burdensome, while not all patients may need extensive testing. OBJECTIVES: To provide von Willebrand factor (VWF) cutoffs that predict desmopressin nonresponse and thereby identify individuals who do not need extensive testing in a retrospective cohort. We validated these cutoffs in a prospective cohort. PATIENTS AND METHODS: We included 376 patients (Type 1 VWD with VWF activity [VWF:Act] <0.30 IU/ml: n = 112; with VWF:Act 0.30-0.50 IU/ml: n = 206; Type 2 VWD: n = 58; ages, 5-76 years) from January 2000 to July 2020. We collected VWF:Act and factor VIII activity (FVIII:C) at baseline and several time points after desmopressin (T1-T6). We defined response as VWF:Act and FVIII:C 0.50 IU/ml or greater at T1 and T4. We compared VWF:Act and FVIII:C distribution (historically lowest level, baseline, and T1) between responders and nonresponders and determined cutoffs discriminating between these groups. Results were validated in a group of 30 individuals. RESULTS: All individuals with Type 1 VWD and Type 2 VWD, respectively, with baseline VWF:Act 0.34 IU/ml or greater or 0.28 IU/ml or greater were responders. In individuals with T1 VWF:Act ≥0.89 IU/ml (Type 1 VWD) or T1 VWF:Act 1.10 IU/ml or greater (Type 2 VWD), response remained at T4. CONCLUSION: Desmopressin testing is not needed when lowest historical VWF:Act is 0.30 IU/ml or greater. In patients with Type 1 VWD who require testing, measurements after T1 are often not needed. In patients with Type 2 VWD who require testing, we advise performing T1 and T4 measurements

Difficult Scenarios for NMSSM Higgs Discovery at the LHC

We identify scenarios not ruled out by LEP data in which NMSSM Higgs detection at the LHC will be particularly challenging. We first review the `no-lose' theorem for Higgs discovery at the LHC that applies if Higgs bosons do not decay to other Higgs bosons - namely, with L=300 fb^-1, there is always one or more `standard' Higgs detection channel with at least a 5 sigma signal. However, we provide examples of no-Higgs-to-Higgs cases for which all the standard signals are no larger than 7 sigma implying that if the available L is smaller or the simulations performed by ATLAS and CMS turn out to be overly optimistic, all standard Higgs signals could fall below 5 sigma even in the no-Higgs-to-Higgs part of NMSSM parameter space. In the vast bulk of NMSSM parameter space, there will be Higgs-to-Higgs decays. We show that when such decays are present it is possible for all the standard detection channels to have very small significance. In most such cases, the only strongly produced Higgs boson is one with fairly SM-like couplings that decays to two lighter Higgs bosons (either a pair of the lightest CP-even Higgs bosons, or, in the largest part of parameter space, a pair of the lightest CP-odd Higgs bosons). A number of representative bench-mark scenarios of this type are delineated in detail and implications for Higgs discovery at various colliders are discussed.Comment: 31 pages, 5 figure

Measurement of the Gluino Mass via Cascade Decays for SPS 1a

If R-parity conserving supersymmetry is realised with masses below the TeV scale, sparticles will be produced and decay in cascades at the LHC. In the case of a neutral LSP, which will not be detected, decay chains cannot be fully reconstructed, complicating the mass determination of the new particles. In this paper we extend the method of obtaining masses from kinematical endpoints to include a gluino at the head of a five-sparticle decay chain. This represents a non-trivial extension of the corresponding method for the squark decay chain. We calculate the endpoints of the new distributions and assess their applicability by examining the theoretical distributions for a variety of mass scenarios. The precision with which the gluino mass can be determined by this method is investigated for the mSUGRA point SPS 1a. Finally we estimate the improvement obtained from adding a Linear Collider measurement of the LSP mass.Comment: 40 pages; extended discussion of error

Production and FCNC decay of supersymmetric Higgs bosons into heavy quarks in the LHC

We analyze the production and subsequent decay of the neutral MSSM Higgs bosons (h = h^0, H^0, A^0) mediated by flavor changing neutral currents (FCNC) in the LHC collider. We have computed the h-production cross-section times the FCNC branching ratio, \sigma(pp -> h -> qq') = \sigma(pp -> h) B(h -> qq'), in the LHC focusing on the strongly-interacting FCNC sector. Here qq' is an electrically neutral pair of quarks of different flavors, the dominant modes being those containing a heavy quark: tc or bs. We determine the maximum production rates for each of these modes and identify the relevant regions of the MSSM parameter space, after taking into account the severe restrictions imposed by low energy FCNC processes. The analysis of \sigma(pp -> h -> qq') singles out regions of the MSSM parameter space different from those obtained by maximizing only the branching ratio, due to non-trivial correlations between the parameters that maximize/minimize each isolated factor. The production rates for the bs channel can be huge for a FCNC process (0.1-1 pb), but its detection can be problematic. The production rates for the tc channel are more modest (10^{-3}-10^{-2} pb), but its detection should be easier due to the clear-cut top quark signature. A few thousand tc events could be collected in the highest luminosity phase of the LHC, with no counterpart in the SM.Comment: 25 pages, 9 figures, 2 tables, LaTeX 2e. Typos corrected. Version to appear in JHE