Permissive versus restrictive temperature thresholds in critically ill children with fever and infection: A multicentre randomized clinical pilot trial

Background: Fever improves pathogen control at a significant metabolic cost. No randomized clinical trials (RCT) have compared fever treatment thresholds in critically ill children. We performed a pilot RCT to determine whether a definitive trial of a permissive approach to fever in comparison to current restrictive practice is feasible in critically ill children with suspected infection. Methods: An open, parallel-group pilot RCT with embedded mixed methods perspectives study in four UK paediatric intensive care units (PICUs) and associated retrieval services. Participants were emergency PICU admissions aged > 28 days to < 16 years receiving respiratory support and supplemental oxygen. Subjects were randomly assigned to permissive (antipyretic interventions only at ≥ 39.5 °C) or restrictive groups (antipyretic interventions at ≥ 37.5 °C) whilst on respiratory support. Parents were invited to complete a questionnaire or take part in an interview. Focus groups were conducted with staff at each unit. Outcomes were measures of feasibility: recruitment rate, protocol adherence and acceptability, between group separation of temperature and safety. Results: One hundred thirty-eight children met eligibility criteria of whom 100 (72%) were randomized (11.1 patients per month per site) without prior consent (RWPC). Consent to continue in the trial was obtained in 87 cases (87%). The mean maximum temperature (95% confidence interval) over the first 48 h was 38.4 °C (38.2-38.6) in the restrictive group and 38.8 °C (38.6-39.1) in the permissive group, a mean difference of 0.5 °C (0.2-0.8). Protocol deviations were observed in 6.8% (99/1438) of 6-h time periods and largely related to patient comfort in the recovery phase. Length of stay, duration of organ support and mortality were similar between groups. No pre-specified serious adverse events occurred. Staff (n = 48) and parents (n = 60) were supportive of the trial, including RWPC. Suggestions were made to only include invasively ventilated children for the duration of intubation. Conclusion: Uncertainty around the optimal fever threshold for antipyretic intervention is relevant to many emergency PICU admissions. A more permissive approach was associated with a modest increase in mean maximum temperature. A definitive trial should focus on the most seriously ill cases in whom antipyretics are rarely used for their analgesic effects alone. Trial registration: ISRCTN16022198. Registered on 14 August 2017

Multiplicity dependence of light (anti-)nuclei production in p–Pb collisions at sNN=5.02 TeV

The measurement of the deuteron and anti-deuteron production in the rapidity range −1 < y < 0 as a function of transverse momentum and event multiplicity in p–Pb collisions at √sNN = 5.02 TeV is presented. (Anti-)deuterons are identified via their specific energy loss dE/dx and via their time-of- flight. Their production in p–Pb collisions is compared to pp and Pb–Pb collisions and is discussed within the context of thermal and coalescence models. The ratio of integrated yields of deuterons to protons (d/p) shows a significant increase as a function of the charged-particle multiplicity of the event starting from values similar to those observed in pp collisions at low multiplicities and approaching those observed in Pb–Pb collisions at high multiplicities. The mean transverse particle momenta are extracted from the deuteron spectra and the values are similar to those obtained for p and particles. Thus, deuteron spectra do not follow mass ordering. This behaviour is in contrast to the trend observed for non-composite particles in p–Pb collisions. In addition, the production of the rare 3He and 3He nuclei has been studied. The spectrum corresponding to all non-single diffractive p-Pb collisions is obtained in the rapidity window −1 < y < 0 and the pT-integrated yield dN/dy is extracted. It is found that the yields of protons, deuterons, and 3He, normalised by the spin degeneracy factor, follow an exponential decrease with mass number

Measurement of inclusive J/ψ\psi pair production cross section in pp collisions at s=13\sqrt{s} = 13 TeV

International audienceThe production cross section of inclusive J/$\psi$ pairs in pp collisions at a centre-of-mass energy $\sqrt{s} = 13$ TeV is measured with ALICE. The measurement is performed for J/$\psi$ in the rapidity interval $2.5 0$. The production cross section of inclusive J/$\psi$ pairs is reported to be $10.3 \pm 2.3 {\rm (stat.)} \pm 1.3 {\rm (syst.)}$ nb in this kinematic interval. The contribution from non-prompt J/$\psi$ (i.e. originated from beauty-hadron decays) to the inclusive sample is evaluated. The results are discussed and compared with data

Inclusive and multiplicity dependent production of electrons from heavy-flavour hadron decays in pp and p−-Pb collisions

International audienceMeasurements of the production of electrons from heavy-flavour hadron decays in pp collisions at $\sqrt{s} = 13$ TeV at midrapidity with the ALICE detector are presented down to a transverse momentum ($p_{\rm T}$) of 0.2 GeV$/c$ and up to $p_{\rm T} = 35$ GeV$/c$, which is the largest momentum range probed for inclusive electron measurements in ALICE. In p$-$Pb collisions, the production cross section and the nuclear modification factor of electrons from heavy-flavour hadron decays are measured in the $p_{\rm T}$ range $0.5 < p_{\rm T} < 26$ GeV$/c$ at $\sqrt{s_{\rm NN}} = 8.16$ TeV. The nuclear modification factor is found to be consistent with unity within the statistical and systematic uncertainties. In both collision systems, first measurements of the yields of electrons from heavy-flavour hadron decays in different multiplicity intervals normalised to the multiplicity-integrated yield (self-normalised yield) at midrapidity are reported as a function of the self-normalised charged-particle multiplicity estimated at midrapidity. The self-normalised yields in pp and p$-$Pb collisions grow faster than linear with the self-normalised multiplicity. A strong $p_{\rm T}$ dependence is observed in pp collisions, where the yield of high-$p_{\rm T}$ electrons increases faster as a function of multiplicity than the one of low-$p_{\rm T}$ electrons. The measurement in p$-$Pb collisions shows no $p_{\rm T}$ dependence within uncertainties. The self-normalised yields in pp and p$-$Pb collisions are compared with measurements of other heavy-flavour, light-flavour, and strange particles, and with Monte Carlo simulations

Jet fragmentation transverse momentum distributions in pp and p-Pb collisions at s \sqrt{s} , sNN \sqrt{s_{\mathrm{NN}}} = 5.02 TeV

Jet fragmentation transverse momentum (j$_{T}$) distributions are measured in proton-proton (pp) and proton-lead (p-Pb) collisions at $\sqrt{s_{\mathrm{NN}}}$ = 5.02 TeV with the ALICE experiment at the LHC. Jets are reconstructed with the ALICE tracking detectors and electromagnetic calorimeter using the anti-k$_{T}$ algorithm with resolution parameter R = 0.4 in the pseudorapidity range |η| < 0.25. The j$_{T}$ values are calculated for charged particles inside a fixed cone with a radius R = 0.4 around the reconstructed jet axis. The measured j$_{T}$ distributions are compared with a variety of parton-shower models. Herwig and Pythia 8 based models describe the data well for the higher j$_{T}$ region, while they underestimate the lower j$_{T}$ region. The j$_{T}$ distributions are further characterised by fitting them with a function composed of an inverse gamma function for higher j$_{T}$ values (called the “wide component”), related to the perturbative component of the fragmentation process, and with a Gaussian for lower j$_{T}$ values (called the “narrow component”), predominantly connected to the hadronisation process. The width of the Gaussian has only a weak dependence on jet transverse momentum, while that of the inverse gamma function increases with increasing jet transverse momentum. For the narrow component, the measured trends are successfully described by all models except for Herwig. For the wide component, Herwig and PYTHIA 8 based models slightly underestimate the data for the higher jet transverse momentum region. These measurements set constraints on models of jet fragmentation and hadronisation

Production of charged pions, kaons, and (anti-)protons in Pb-Pb and inelastic pppp collisions at sNN\sqrt {s_{NN}} = 5.02 TeV

International audienceMid-rapidity production of $\pi^{\pm}$, $\rm{K}^{\pm}$ and ($\bar{\rm{p}}$)p measured by the ALICE experiment at the LHC, in Pb-Pb and inelastic pp collisions at $\sqrt{s_{\rm{NN}}}$ = 5.02 TeV, is presented. The invariant yields are measured over a wide transverse momentum ($p_{\rm{T}}$) range from hundreds of MeV/$c$ up to 20 GeV/$c$. The results in Pb-Pb collisions are presented as a function of the collision centrality, in the range 0$-$90%. The comparison of the $p_{\rm{T}}$-integrated particle ratios, i.e. proton-to-pion (p/$\pi$) and kaon-to-pion (K/$\pi$) ratios, with similar measurements in Pb-Pb collisions at $\sqrt{s_{\rm{NN}}}$ = 2.76 TeV show no significant energy dependence. Blast-wave fits of the $p_{\rm{T}}$ spectra indicate that in the most central collisions radial flow is slightly larger at 5.02 TeV with respect to 2.76 TeV. Particle ratios (p/$\pi$, K/$\pi$) as a function of $p_{\rm{T}}$ show pronounced maxima at $p_{\rm{T}}$ $\approx$ 3 GeV/$c$ in central Pb-Pb collisions. At high $p_{\rm{T}}$, particle ratios at 5.02 TeV are similar to those measured in pp collisions at the same energy and in Pb-Pb collisions at $\sqrt{s_{\rm{NN}}}$ = 2.76 TeV. Using the pp reference spectra measured at the same collision energy of 5.02 TeV, the nuclear modification factors for the different particle species are derived. Within uncertainties, the nuclear modification factor is particle species independent for high $p_{\rm{T}}$ and compatible with measurements at $\sqrt{s_{\rm{NN}}}$ = 2.76 TeV. The results are compared to state-of-the-art model calculations, which are found to describe the observed trends satisfactorily

Measurements of the groomed and ungroomed jet angularities in pp collisions at s \sqrt{s} = 5.02 TeV

International audienceThe jet angularities are a class of jet substructure observables which characterize the angular and momentum distribution of particles within jets. These observables are sensitive to momentum scales ranging from perturbative hard scatterings to nonperturbative fragmentation into final-state hadrons. We report measurements of several groomed and ungroomed jet angularities in pp collisions at $\sqrt{s}$ = 5.02 TeV with the ALICE detector. Jets are reconstructed using charged particle tracks at midrapidity (|η| < 0.9). The anti-k$_{T}$ algorithm is used with jet resolution parameters R = 0.2 and R = 0.4 for several transverse momentum {p}_{\mathrm{T}}^{\mathrm{ch}} ^{jet} intervals in the 20–100 GeV/c range. Using the jet grooming algorithm Soft Drop, the sensitivity to softer, wide-angle processes, as well as the underlying event, can be reduced in a way which is well-controlled in theoretical calculations. We report the ungroomed jet angularities, λ$_{α}$, and groomed jet angularities, λ$_{α,g}$, to investigate the interplay between perturbative and nonperturbative effects at low jet momenta. Various angular exponent parameters α = 1, 1.5, 2, and 3 are used to systematically vary the sensitivity of the observable to collinear and soft radiation. Results are compared to analytical predictions at next-to-leading-logarithmic accuracy, which provide a generally good description of the data in the perturbative regime but exhibit discrepancies in the nonperturbative regime. Moreover, these measurements serve as a baseline for future ones in heavy-ion collisions by providing new insight into the interplay between perturbative and nonperturbative effects in the angular and momentum substructure of jets. They supply crucial guidance on the selection of jet resolution parameter, jet transverse momentum, and angular scaling variable for jet quenching studies.[graphic not available: see fulltext

Neutron emission in ultraperipheral Pb-Pb collisions at sNN\sqrt {s_{NN}} = 5.02 TeV

In ultraperipheral collisions (UPCs) of relativistic nuclei without overlap of nuclear densities, the two nuclei are excited by the Lorentz-contracted Coulomb fields of their collision partners. In these UPCs, the typical nuclear excitation energy is below a few tens of MeV, and a small number of nucleons are emitted in electromagnetic dissociation (EMD) of primary nuclei, in contrast to complete nuclear fragmentation in hadronic interactions. The cross sections of emission of given numbers of neutrons in UPCs of $^{208}$Pb nuclei at $\sqrt{s_{\mathrm{NN}}}=5.02$~TeV were measured with the neutron zero degree calorimeters (ZDCs) of the ALICE detector at the LHC, exploiting a similar technique to that used in previous studies performed at $\sqrt{s_{\mathrm{NN}}}=2.76$~TeV. In addition, the cross sections for the exclusive emission of 1, 2, 3, 4 and 5 forward neutrons in the EMD, not accompanied by the emission of forward protons, and thus mostly corresponding to the production of $^{207,206,205,204,203}$Pb, respectively, were measured for the first time. The predictions from the available models describe the measured cross sections well. These cross sections can be used for evaluating the impact of secondary nuclei on the LHC components, in particular, on superconducting magnets, and also provide useful input for the design of the Future Circular Collider (FCC-hh).In ultraperipheral collisions (UPCs) of relativistic nuclei without overlap of nuclear densities, the two nuclei are excited by the Lorentz-contracted Coulomb fields of their collision partners. In these UPCs, the typical nuclear excitation energy is below a few tens of MeV, and a small number of nucleons are emitted in electromagnetic dissociation (EMD) of primary nuclei, in contrast to complete nuclear fragmentation in hadronic interactions. The cross sections of emission of given numbers of neutrons in UPCs of Pb208 nuclei at sNN=5.02 TeV were measured with the neutron zero degree calorimeters (ZDCs) of the ALICE detector at the LHC, exploiting a similar technique to that used in previous studies performed at sNN=2.76 TeV. In addition, the cross sections for the exclusive emission of one, two, three, four, and five forward neutrons in the EMD, not accompanied by the emission of forward protons, and thus mostly corresponding to the production of Pb207,206,205,204,203, respectively, were measured for the first time. The predictions from the available models describe the measured cross sections well. These cross sections can be used for evaluating the impact of secondary nuclei on the LHC components, in particular, on superconducting magnets, and also provide useful input for the design of the Future Circular Collider (FCC-hh).In ultraperipheral collisions (UPCs) of relativistic nuclei without overlap of nuclear densities, the two nuclei are excited by the Lorentz-contracted Coulomb fields of their collision partners. In these UPCs, the typical nuclear excitation energy is below a few tens of MeV, and a small number of nucleons are emitted in electromagnetic dissociation (EMD) of primary nuclei, in contrast to complete nuclear fragmentation in hadronic interactions. The cross sections of emission of given numbers of neutrons in UPCs of $^{208}$Pb nuclei at $\sqrt{s_{\mathrm{NN}}}=5.02$ TeV were measured with the neutron zero degree calorimeters (ZDCs) of the ALICE detector at the LHC, exploiting a similar technique to that used in previous studies performed at $\sqrt{s_{\mathrm{NN}}}=2.76$ TeV. In addition, the cross sections for the exclusive emission of one, two, three, four, and five forward neutrons in the EMD, not accompanied by the emission of forward protons, and thus mostly corresponding to the production of $^{207,206,205,204,203}$Pb, respectively, were measured for the first time. The predictions from the available models describe the measured cross sections well. These cross sections can be used for evaluating the impact of secondary nuclei on the LHC components, in particular, on superconducting magnets, and also provide useful input for the design of the Future Circular Collider (FCC-hh)