Paying for treatments? Influences on negotiating clinical need and decision-making for dental implant treatment

Background The aim of this study is to examine how clinicians and patients negotiate clinical need and treatment decisions within a context of finite resources. Dental implant treatment is an effective treatment for missing teeth, but is only available via the NHS in some specific clinical circumstances. The majority of people who receive this treatment therefore pay privately, often at substantial cost to themselves. People are used to paying towards dental treatment costs. However, dental implant treatment is much more expensive than existing treatments – such as removable dentures. We know very little about how dentists make decisions about whether to offer such treatments, or what patients consider when deciding whether or not to pay for them. Methods/Design Mixed methods will be employed to provide insight and understanding into how clinical need is determined, and what influences people's decision making processes when deciding whether or not to pursue a dental implant treatment. Phase 1 will use a structured scoping questionnaire with all the General dental practitioners (GDPs) in three Primary Care Trust areas (n = 300) to provide base-line data about existing practice in relation to dental implant treatment, and to provide data to develop a systematic sampling procedure for Phase 2. Phases 2 (GDPs) and 3 (patients) use qualitative focused one to one interviews with a sample of these practitioners (up to 30) and their patients (up to 60) to examine their views and experiences of decision making in relation to dental implant treatment. Purposive sampling for phases 2 and 3 will be carried out to ensure participants represent a range of socio-economic circumstances, and choices made. Discussion Most dental implant treatment is conducted in primary care. Very little information was available prior to this study about the quantity and type of treatment carried out privately. It became apparent during phase 2 that ISOD treatment was an unusual treatment in primary care. We thus extended our sample criteria for Phase 3 to include people who had had other implant supported restorations, although not single tooth replacements

Particulate air pollutants, APOE alleles and their contributions to cognitive impairment in older women and to amyloidogenesis in experimental models

Exposure to particulate matter (PM) in the ambient air and its interactions with APOE alleles may contribute to the acceleration of brain aging and the pathogenesis of Alzheimer's disease (AD). Neurodegenerative effects of particulate air pollutants were examined in a US-wide cohort of older women from the Women's Health Initiative Memory Study (WHIMS) and in experimental mouse models. Residing in places with fine PM exceeding EPA standards increased the risks for global cognitive decline and all-cause dementia respectively by 81 and 92%, with stronger adverse effects in APOE ɛ4/4 carriers. Female EFAD transgenic mice (5xFAD+/−/human APOE ɛ3 or ɛ4+/+) with 225 h exposure to urban nanosized PM (nPM) over 15 weeks showed increased cerebral β-amyloid by thioflavin S for fibrillary amyloid and by immunocytochemistry for Aβ deposits, both exacerbated by APOE ɛ4. Moreover, nPM exposure increased Aβ oligomers, caused selective atrophy of hippocampal CA1 neurites, and decreased the glutamate GluR1 subunit. Wildtype C57BL/6 female mice also showed nPM-induced CA1 atrophy and GluR1 decrease. In vitro nPM exposure of neuroblastoma cells (N2a-APP/swe) increased the pro-amyloidogenic processing of the amyloid precursor protein (APP). We suggest that airborne PM exposure promotes pathological brain aging in older women, with potentially a greater impact in ɛ4 carriers. The underlying mechanisms may involve increased cerebral Aβ production and selective changes in hippocampal CA1 neurons and glutamate receptor subunits

J/ψ polarization in p+p collisions at s=200 GeV in STAR

AbstractWe report on a polarization measurement of inclusive J/ψ mesons in the di-electron decay channel at mid-rapidity at 2<pT<6 GeV/c in p+p collisions at s=200 GeV. Data were taken with the STAR detector at RHIC. The J/ψ polarization measurement should help to distinguish between different models of the J/ψ production mechanism since they predict different pT dependences of the J/ψ polarization. In this analysis, J/ψ polarization is studied in the helicity frame. The polarization parameter λθ measured at RHIC becomes smaller towards high pT, indicating more longitudinal J/ψ polarization as pT increases. The result is compared with predictions of presently available models

A novel formulation of inhaled sodium cromoglicate (PA101) in idiopathic pulmonary fibrosis and chronic cough: a randomised, double-blind, proof-of-concept, phase 2 trial

Background Cough can be a debilitating symptom of idiopathic pulmonary fibrosis (IPF) and is difficult to treat. PA101 is a novel formulation of sodium cromoglicate delivered via a high-efficiency eFlow nebuliser that achieves significantly higher drug deposition in the lung compared with the existing formulations. We aimed to test the efficacy and safety of inhaled PA101 in patients with IPF and chronic cough and, to explore the antitussive mechanism of PA101, patients with chronic idiopathic cough (CIC) were also studied. Methods This pilot, proof-of-concept study consisted of a randomised, double-blind, placebo-controlled trial in patients with IPF and chronic cough and a parallel study of similar design in patients with CIC. Participants with IPF and chronic cough recruited from seven centres in the UK and the Netherlands were randomly assigned (1:1, using a computer-generated randomisation schedule) by site staff to receive PA101 (40 mg) or matching placebo three times a day via oral inhalation for 2 weeks, followed by a 2 week washout, and then crossed over to the other arm. Study participants, investigators, study staff, and the sponsor were masked to group assignment until all participants had completed the study. The primary efficacy endpoint was change from baseline in objective daytime cough frequency (from 24 h acoustic recording, Leicester Cough Monitor). The primary efficacy analysis included all participants who received at least one dose of study drug and had at least one post-baseline efficacy measurement. Safety analysis included all those who took at least one dose of study drug. In the second cohort, participants with CIC were randomly assigned in a study across four centres with similar design and endpoints. The study was registered with ClinicalTrials.gov (NCT02412020) and the EU Clinical Trials Register (EudraCT Number 2014-004025-40) and both cohorts are closed to new participants. Findings Between Feb 13, 2015, and Feb 2, 2016, 24 participants with IPF were randomly assigned to treatment groups. 28 participants with CIC were enrolled during the same period and 27 received study treatment. In patients with IPF, PA101 reduced daytime cough frequency by 31·1% at day 14 compared with placebo; daytime cough frequency decreased from a mean 55 (SD 55) coughs per h at baseline to 39 (29) coughs per h at day 14 following treatment with PA101, versus 51 (37) coughs per h at baseline to 52 (40) cough per h following placebo treatment (ratio of least-squares [LS] means 0·67, 95% CI 0·48–0·94, p=0·0241). By contrast, no treatment benefit for PA101 was observed in the CIC cohort; mean reduction of daytime cough frequency at day 14 for PA101 adjusted for placebo was 6·2% (ratio of LS means 1·27, 0·78–2·06, p=0·31). PA101 was well tolerated in both cohorts. The incidence of adverse events was similar between PA101 and placebo treatments, most adverse events were mild in severity, and no severe adverse events or serious adverse events were reported. Interpretation This study suggests that the mechanism of cough in IPF might be disease specific. Inhaled PA101 could be a treatment option for chronic cough in patients with IPF and warrants further investigation

Post-acute COVID-19 neuropsychiatric symptoms are not associated with ongoing nervous system injury

A proportion of patients infected with severe acute respiratory syndrome coronavirus 2 experience a range of neuropsychiatric symptoms months after infection, including cognitive deficits, depression and anxiety. The mechanisms underpinning such symptoms remain elusive. Recent research has demonstrated that nervous system injury can occur during COVID-19. Whether ongoing neural injury in the months after COVID-19 accounts for the ongoing or emergent neuropsychiatric symptoms is unclear. Within a large prospective cohort study of adult survivors who were hospitalized for severe acute respiratory syndrome coronavirus 2 infection, we analysed plasma markers of nervous system injury and astrocytic activation, measured 6 months post-infection: neurofilament light, glial fibrillary acidic protein and total tau protein. We assessed whether these markers were associated with the severity of the acute COVID-19 illness and with post-acute neuropsychiatric symptoms (as measured by the Patient Health Questionnaire for depression, the General Anxiety Disorder assessment for anxiety, the Montreal Cognitive Assessment for objective cognitive deficit and the cognitive items of the Patient Symptom Questionnaire for subjective cognitive deficit) at 6 months and 1 year post-hospital discharge from COVID-19. No robust associations were found between markers of nervous system injury and severity of acute COVID-19 (except for an association of small effect size between duration of admission and neurofilament light) nor with post-acute neuropsychiatric symptoms. These results suggest that ongoing neuropsychiatric symptoms are not due to ongoing neural injury

Dielectron Azimuthal Anisotropy At Mid-rapidity In Au+au Collisions At Snn =200 Gev

We report on the first measurement of the azimuthal anisotropy (v2) of dielectrons (e+e- pairs) at mid-rapidity from sNN=200 GeV Au+Au collisions with the STAR detector at the Relativistic Heavy Ion Collider (RHIC), presented as a function of transverse momentum (pT) for different invariant-mass regions. In the mass region Mee<1.1 GeV/c2 the dielectron v2 measurements are found to be consistent with expectations from π0,η,ω, and φ decay contributions. In the mass region 1.1<Mee<2.9GeV/c2, the measured dielectron v2 is consistent, within experimental uncertainties, with that from the cc¯ contributions.906Adams, J., (2005) Nucl. Phys. A, 757, p. 102. , NUPABL 0375-9474Arsene, I., (2005) Nucl. Phys. A, 757, p. 1. , NUPABL 0375-9474Adcox, K., (2005) Nucl. Phys. A, 757, p. 184. , NUPABL 0375-9474Back, B.B., (2005) Nucl. Phys. A, 757, p. 28. , NUPABL 0375-9474Rapp, R., Wambach, J., (2002) Adv. Nucl. Phys., 25, p. 1. , 0065-2970David, G., Rapp, R., Xu, Z., (2008) Phys. Rep., 462, p. 176. , PRPLCM 0370-1573Agakichiev, G., (2005) Eur. Phys. J. C, 41, p. 475. , EPCFFB 1434-6044Arnaldi, R., (2006) Phys. Rev. Lett., 96, p. 162302. , PRLTAO 0031-9007Brown, G.E., Rho, M., (1996) Phys. Rep., 269, p. 333. , PRPLCM 0370-1573Rapp, R., Wambach, J., (1999) Eur. Phys. J. A, 6, p. 415. , EPJAFV 1434-6001Dusling, K., Teaney, D., Zahed, I., (2007) Phys. Rev. C, 75, p. 024908. , PRVCAN 0556-2813Van Hees, H., Rapp, R., (2008) Nucl. Phys. A, 806, p. 339. , NUPABL 0375-9474Renk, T., Ruppert, J., (2008) Phys. Rev. C, 77, p. 024907. , PRVCAN 0556-2813Adare, A., (2010) Phys. Rev. C, 81, p. 034911. , PRVCAN 0556-2813Adamczyk, L., (2014) Phys. Rev. Lett., 113, p. 022301. , a longer version (unpublished). PRLTAO 0031-9007Rapp, R., Wambach, J., Van Hees, H., (2010) Relativistic Heavy-Ion Physics, , in, edited by R. Stock, Landolt Börnstein New Series I/23A (Springer, Berlin), Chap. 4-1Linnyk, O., Cassing, W., Manninen, J., Bratkovskaya, E.L., Ko, C.M., (2012) Phys. Rev. C, 85, p. 024910. , PRVCAN 0556-2813Xu, J.-H., Chen, H.F., Dong, X., Wang, Q., Zhang, Y.F., (2012) Phys. Rev. C, 85, p. 024906. , PRVCAN 0556-2813Adare, A., (2010) Phys. Rev. Lett., 104, p. 132301. , PRLTAO 0031-9007Poskanzer, A.M., Voloshin, S.A., (1998) Phys. Rev. C, 58, p. 1671. , PRVCAN 0556-2813Adare, A., (2012) Phys. Rev. Lett., 109, p. 122302. , PRLTAO 0031-9007Van Hees, H., Gale, C., Rapp, R., (2011) Phys. Rev. C, 84, p. 054906. , PRVCAN 0556-2813Chatterjee, R., Srivastava, D.K., Heinz, U., Gale, C., (2007) Phys. Rev. C, 75, p. 054909. , PRVCAN 0556-2813Adare, A., (2009) Phys. Lett. B, 670, p. 313. , PYLBAJ 0370-2693Bonner, B., (2003) Nucl. Instrum. Methods A, 508, p. 181. , NIMAER 0168-9002Shao, M., (2002) Nucl. Instrum. Methods A, 492, p. 344Wu, J., (2005) Nucl. Instrum. Methods A, 538, p. 243. , NIMAER 0168-9002Landgraf, J.M., (2003) Nucl. Instrum. Methods A, 499, p. 762. , NIMAER 0168-9002Ackermann, K.H., (2003) Nucl. Instrum. Methods A, 499, p. 624. , NIMAER 0168-9002Anderson, M., (2003) Nucl. Instrum. Methods A, 499, p. 659. , NIMAER 0168-9002Bichsel, H., (2006) Nucl. Instrum. Methods A, 562, p. 154. , NIMAER 0168-9002Xu, Y., (2010) Nucl. Instrum. Methods A, 614, p. 28. , NIMAER 0168-9002Shao, M., (2006) Nucl. Instrum. Methods A, 558, p. 419. , NIMAER 0168-9002Adams, J., (2005) Phys. Lett. B, 616, p. 8. , PYLBAJ 0370-2693Ruan, L., Ph.D. thesis, University of Science and Technology of China, 2005, arXiv:nucl-ex/0503018 (unpublished)Llope, W.J., (2004) Nucl. Instrum. Methods A, 522, p. 252. , NIMAER 0168-9002Adler, C., (2002) Phys. Rev. Lett., 89, p. 202301. , PRLTAO 0031-9007Adams, J., (2005) Phys. Rev. Lett., 94, p. 062301. , PRLTAO 0031-9007Adamczyk, L., (2012) Phys. Rev. C, 86, p. 024906. , PRVCAN 0556-2813Zhao, J., (2013), https://drupal.star.bnl.gov/STAR/theses/phd-32, Ph.D. thesis, Shanghai Institute of Applied Physics, (unpublished)Voloshin, S.A., Poskanzer, A.M., Snellings, R., (2010) Relativistic Heavy Ion Physics, pp. 5-54. , in, Landolt-Börnstein Vol. 1/23 (Springer-Verlag, Berlin), ppAdamczyk, L., (2013) Phys. Rev. C, 88, p. 014902. , PRVCAN 0556-2813Abelev, B.I., (2008) Phys. Rev. C, 77, p. 054901. , PRVCAN 0556-2813Abelev, B.I., (2006) Phys. Rev. Lett., 97, p. 152301. , PRLTAO 0031-9007Abelev, B.I., (2009) Phys. Rev. C, 79, p. 034909. , PRVCAN 0556-2813Abelev, B.I., (2009) Phys. Rev. C, 79, p. 064903. , PRVCAN 0556-2813Adams, J., (2005) Phys. Lett. B, 612, p. 181. , PYLBAJ 0370-2693Adler, S.S., (2007) Phys. Rev. C, 75, p. 024909. , PRVCAN 0556-2813Tang, Z., Xu, Y., Ruan, L., Van Buren, G., Wang, F., Xu, Z., (2009) Phys. Rev. C, 79, p. 051901. , (R) () PRVCAN 0556-2813Shao, M., Yi, L., Tang, Z., Chen, H., Li, C., Xu, Z., (2010) J. Phys. G, 37, p. 085104. , JPGPED 0954-3899Afanasiev, S., (2009) Phys. Rev. C, 80, p. 054907. , PRVCAN 0556-2813Adams, J., (2005) Phys. Rev. C, 72, p. 014904. , PRVCAN 0556-2813Abelev, B.I., (2007) Phys. Rev. Lett., 99, p. 112301. , PRLTAO 0031-9007Kroll, N.M., Wada, W., (1955) Phys. Rev., 98, p. 1355. , PHRVAO 0031-899XRuan, L., (2011) Nucl. Phys. A, 855, p. 269. , NUPABL 0375-9474Huang, B., (2011), Ph.D. thesis, University of Science and Technology of China, (unpublished)Sjöstrand, T., (2001) Comput. Phys. Commun., 135, p. 238. , CPHCBZ 0010-4655Adamczyk, L., (2012) Phys. Rev. D, 86, p. 072013. , PRVDAQ 1550-7998Agakishiev, H., (2011) Phys. Rev. D, 83, p. 052006. , PRVDAQ 1550-7998Adare, A., (2011) Phys. Rev. C, 84, p. 044905. , PRVCAN 0556-2813Adare, A., (2012) Phys. Rev. C, 85, p. 064914. , PRVCAN 0556-2813Adare, A., (2007) Phys. Rev. Lett., 98, p. 162301. , PRLTAO 0031-9007Adams, J., (2004) Phys. Rev. Lett., 92, p. 052302. , PRLTAO 0031-9007Vujanovic, G., Young, C., Schenke, B., Jeon, S., Rapp, R., Gale, C., (2013) Nucl. Phys. A, 904-905, p. 557c. , NUPABL 0375-9474Vujanovic, G., Young, C., Schenke, B., Jeon, S., Rapp, R., Gale, C., (2014) Phys. Rev. C, 89, p. 034904. , PRVCAN 0556-281

Beam-energy Dependence Of Charge Separation Along The Magnetic Field In Au+au Collisions At Rhic

Local parity-odd domains are theorized to form inside a quark-gluon plasma which has been produced in high-energy heavy-ion collisions. The local parity-odd domains manifest themselves as charge separation along the magnetic field axis via the chiral magnetic effect. The experimental observation of charge separation has previously been reported for heavy-ion collisions at the top RHIC energies. In this Letter, we present the results of the beam-energy dependence of the charge correlations in Au+Au collisions at midrapidity for center-of-mass energies of 7.7, 11.5, 19.6, 27, 39, and 62.4 GeV from the STAR experiment. After background subtraction, the signal gradually reduces with decreased beam energy and tends to vanish by 7.7 GeV. This implies the dominance of hadronic interactions over partonic ones at lower collision energies. © 2014 American Physical Society.1135DOE; National Research Foundation; CNRS/IN2P3; NSF; National Research Foundation; NRF-2012004024; National Research FoundationVafa, C., Witten, E., (1984) Phys. Rev. Lett., 53, p. 535. , PRLTAO 0031-9007 10.1103/PhysRevLett.53.535Lee, D.T., (1973) Phys. Rev. D, 8, p. 1226. , PRVDAQ 0556-2821 10.1103/PhysRevD.8.1226Lee, T.D., Wick, G.C., (1974) Phys. Rev. D, 9, p. 2291. , PRVDAQ 0556-2821 10.1103/PhysRevD.9.2291Kharzeev, D.E., McLerran, L.D., Warringa, H.J., (2008) Nucl. Phys., A803, p. 227. , NUPBBO 0375-9474 10.1016/j.nuclphysa.2008.02.298Kharzeev, D., (2006) Phys. Lett. B, 633, p. 260. , PYLBAJ 0370-2693 10.1016/j.physletb.2005.11.075Kharzeev, D., Zhitnitsky, A., (2007) Nucl. Phys., A797, p. 67. , NUPBBO 0375-9474 10.1016/j.nuclphysa.2007.10.001Fukushima, K., Kharzeev, D.E., Warringa, H.J., (2008) Phys. Rev. D, 78, p. 074033. , PRVDAQ 1550-7998 10.1103/PhysRevD.78.074033Kharzeev, E.D., (2010) Ann. Phys. (Amsterdam), 325, p. 205. , APNYA6 0003-4916 10.1016/j.aop.2009.11.002Gatto, R., Ruggieri, M., (2012) Phys. Rev. D, 85, p. 054013. , PRVDAQ 1550-7998 10.1103/PhysRevD.85.054013Abelev, B.I., (2009) Phys. Rev. Lett., 103, p. 251601. , (STAR Collaboration),. PRLTAO 0031-9007 10.1103/PhysRevLett.103.251601Abelev, B.I., (2010) Phys. Rev. C, 81, p. 054908. , (STAR Collaboration),. PRVCAN 0556-2813 10.1103/PhysRevC.81.054908Adamczyk, L., (2013) Phys. Rev. C, 88, p. 064911. , (STAR Collaboration),. PRVCAN 0556-2813 10.1103/PhysRevC.88.064911Adamczyk, L., (2014) Phys. Rev. C, 89, p. 044908. , (STAR Collaboration),. PRVCAN 0556-2813 10.1103/PhysRevC.89.044908Ajitanand, N.N., Esumi, S., Lacey, R.A., Proceedings of the RBRC Workshops, 2010, 96. , http://www.bnl.gov/isd/documents/74466.pdf, (PHENIX Collaboration), in, Vol.Ajitanand, N.N., Lacey, R.A., Taranenko, A., Alexander, J.M., (2011) Phys. Rev. C, 83, p. 011901. , PRVCAN 0556-2813 10.1103/PhysRevC.83.011901Abelev, B.I., (2013) Phys. Rev. Lett., 110, p. 012301. , (ALICE Collaboration),. PRLTAO 0031-9007 10.1103/PhysRevLett.110.012301Bzdak, A., Koch, V., Liao, J., (2010) Phys. Rev. C, 81, p. 031901. , PRVCAN 0556-2813 10.1103/PhysRevC.81.031901Liao, J., Koch, V., Bzdak, A., (2010) Phys. Rev. C, 82, p. 054902. , PRVCAN 0556-2813 10.1103/PhysRevC.82.054902Kharzeev, D.E., Son, D.T., (2011) Phys. Rev. Lett., 106, p. 062301. , PRLTAO 0031-9007 10.1103/PhysRevLett.106.062301Voloshin, A.S., (2004) Phys. Rev. C, 70, p. 057901. , PRVCAN 0556-2813 10.1103/PhysRevC.70.057901Anderson, M., (2003) Nucl. Instrum. Methods Phys. Res., Sect. A, 499, p. 659. , NIMAER 0168-9002 10.1016/S0168-9002(02)01964-2Adams, J., (2005) Phys. Rev. C, 72, p. 014904. , (STAR Collaboration), ()PRVCAN 0556-2813 10.1103/PhysRevC.72.014904Agakishiev, G., (2012) Phys. Rev. C, 86, p. 014904. , (STAR Collaboration), ()PRVCAN 0556-2813 10.1103/PhysRevC.86.014904Adamczyk, L., (2012) Phys. Rev. C, 86, p. 054908. , (STAR Collaboration),. PRVCAN 0556-2813 10.1103/PhysRevC.86.054908Poskanzer, A.M., Voloshin, S.A., (1998) Phys. Rev. C, 58, p. 1671. , PRVCAN 0556-2813 10.1103/PhysRevC.58.1671Barrette, J., (1997) Phys. Rev. C, 56, p. 3254. , PRVCAN 0556-2813 10.1103/PhysRevC.56.3254Ollitrault, J.-Y., Poskanzer, A.M., Voloshin, S.A., (2009) Phys. Rev. C, 80, p. 014904. , PRVCAN 0556-2813 10.1103/PhysRevC.80.014904Abelev, B.I., (2008) Phys. Rev. Lett., 101, p. 252301. , (STAR Collaboration), () and references therein. PRLTAO 0031-9007 10.1103/PhysRevLett.101.252301Bzdak, A., Koch, V., Liao, J., (2011) Phys. Rev. C, 83, p. 014905. , PRVCAN 0556-2813 10.1103/PhysRevC.83.014905Ray, R.L., Longacre, R.S., arXiv:nucl-ex/0008009;Ray, R.L., Longacre, R.S., (private communication)Bass, S.A., (1998) Prog. Part. Nucl. Phys., 41, p. 255. , PPNPDB 0146-6410 10.1016/S0146-6410(98)00058-1Bleicher, M., (1999) J. Phys. G, 25, p. 1859. , JPGPED 0954-3899 10.1088/0954-3899/25/9/308Ma, G.-L., Zhang, B., (2011) Phys. Lett. B, 700, p. 39. , PYLBAJ 0370-2693 10.1016/j.physletb.2011.04.057Okorokov, A.V., (2013) Int. J. Mod. Phys. e, 22, p. 1350041. , IMPEER 0218-3013 10.1142/S0218301313500419Bzdak, A., Koch, V., Liao, J., (2013) Lect. Notes Phys., 871, p. 503. , LNPHA4 0075-8450 10.1007/978-3-642-37305-

Fluctuations Of Charge Separation Perpendicular To The Event Plane And Local Parity Violation In S Nn = 200 Gev Au + Au Collisions At The Bnl Relativistic Heavy Ion Collider

Previous experimental results based on data (∼15×106 events) collected by the STAR detector at the BNL Relativistic Heavy Ion Collider suggest event-by-event charge-separation fluctuations perpendicular to the event plane in noncentral heavy-ion collisions. Here we present the correlator previously used split into its two component parts to reveal correlations parallel and perpendicular to the event plane. The results are from a high-statistics 200-GeV Au + Au collisions data set (57×106 events) collected by the STAR experiment. We explicitly count units of charge separation from which we find clear evidence for more charge-separation fluctuations perpendicular than parallel to the event plane. We also employ a modified correlator to study the possible P-even background in same- and opposite-charge correlations, and find that the P-even background may largely be explained by momentum conservation and collective motion. © 2013 American Physical Society.886NRF-2012004024; National Research FoundationLee, T.D., Yang, C.N., (1956) Phys. Rev., 104. , 1, 254. 0031-899X PHRVAO 10.1103/PhysRev.104.254Vafa, C., Witten, E., (1984) Phys. Rev. Lett., 53. , 2, 535. 0031-9007 PRLTAO 10.1103/PhysRevLett.53.535Lee, T.D., (1973) Phys. Rev. D, 8. , 3, 1226. 0556-2821 10.1103/PhysRevD.8.1226Lee, T.D., Wick, G.C., (1974) Phys. Rev. D, 9. , 4, 2291. 0556-2821 10.1103/PhysRevD.9.2291Kharzeev, D., Parity violation in hot QCD: Why it can happen, and how to look for it (2006) Physics Letters, Section B: Nuclear, Elementary Particle and High-Energy Physics, 633 (2-3), pp. 260-264. , DOI 10.1016/j.physletb.2005.11.075, PII S0370269305017430Kharzeev, D., Zhitnitsky, A., (2007) Nucl. Phys. A, 797. , 6, 67. 0375-9474 NUPABL 10.1016/j.nuclphysa.2007.10.001Kharzeev, D., McLerran, L.D., Warringa, H.J., (2008) Nucl. Phys. A, 803. , 7, 227. 0375-9474 NUPABL 10.1016/j.nuclphysa.2008.02.298Fukushima, K., Kharzeev, D.E., Warringa, H.J., (2008) Phys. Rev. D, 78. , 8, 074033. 1550-7998 PRVDAQ 10.1103/PhysRevD.78.074033Abelev, B.I., (2009) Phys. Rev. Lett., 103. , 9 (STAR Collaboration), 251601. 0031-9007 PRLTAO 10.1103/PhysRevLett.103. 251601Abelev, B.I., (2010) Phys. Rev. C, 81. , 10 (STAR Collaboration), 054908. 0556-2813 PRVCAN 10.1103/PhysRevC.81. 054908Abelev, B.I., (2013) Phys. Rev. Lett., 110. , 11 (ALICE Collaboration), 012301. 0031-9007 PRLTAO 10.1103/PhysRevLett. 110.012301Ackermann, K.H., Adams, N., Adler, C., Ahammed, Z., Ahmad, S., Allgower, C., Amonett, J., Harris, J.W., STAR detector overview (2003) Nuclear Instruments and Methods in Physics Research, Section A: Accelerators, Spectrometers, Detectors and Associated Equipment, 499 (2-3), pp. 624-632. , DOI 10.1016/S0168-9002(02)01960-5Adams, J., Aggarwal, M.M., Ahammed, Z., Amonett, J., Anderson, B.D., Arkhipkin, D., Averichev, G.S., Bai, Y., Directed flow in Au+Au collisions at sNN=62.4 GeV (2006) Physical Review C - Nuclear Physics, 73 (3), pp. 1-7. , http://oai.aps.org/oai?verb=GetRecord&Identifier=oai:aps.org: PhysRevC.73.034903&metadataPrefix=oai_apsmeta_2, DOI 10.1103/PhysRevC.73.034903, 034903Adamczyk, L., (2012) Phys. Rev. Lett., 108. , 14 (STAR Collaboration), 202301. 0031-9007 PRLTAO 10.1103/PhysRevLett. 108.202301Voloshin, S.A., Parity violation in hot QCD: How to detect it (2004) Physical Review C - Nuclear Physics, 70 (5), pp. 0579011-0579012. , DOI 10.1103/PhysRevC.70.057901, 057901Poskanzer, A.M., Voloshin, S.A., Methods for analyzing anisotropic flow in relativistic nuclear collisions (1998) Physical Review C - Nuclear Physics, 58 (3), pp. 1671-1678. , DOI 10.1103/PhysRevC.58.1671Ollitrault, J.-Y., Poskanzer, A.M., Voloshin, S.A., (2009) Phys. Rev. C, 80. , 17, 014904. 0556-2813 PRVCAN 10.1103/PhysRevC.80.014904Pratt, S., Schlichting, S., Gavin, S., (2011) Phys. Rev. C, 84. , 18, 024909. 0556-2813 PRVCAN 10.1103/PhysRevC.84.024909Schlichting, S., Pratt, S., (2011) Phys. Rev. C, 83. , 19, 014913. 0556-2813 PRVCAN 10.1103/PhysRevC.83.014913Selyuzhenkov, I., Voloshin, S., (2008) Phys. Rev. C, 77. , 20, 034904. 0556-2813 PRVCAN 10.1103/PhysRevC.77.034904Kisiel, A., (2006) Comput. Phys. Commun., 174. , 21, 669. 0010-4655 CPHCBZ 10.1016/j.cpc.2005.11.010Bzdak, A., Koch, V., Liao, J., (2011) Phys. Rev. C, 83. , 22, 014905. 0556-2813 PRVCAN 10.1103/PhysRevC.83.014905Adams, J., Aggarwal, M.M., Ahammed, Z., Amonett, J., Anderson, B.D., Arkhipkin, D., Averichev, G.S., Grebenyuk, O., Azimuthal anisotropy in Au+Au collisions at sNN=200GeV (2005) Physical Review C - Nuclear Physics, 72 (1), pp. 1-23. , http://oai.aps.org/oai/?verb=ListRecords&metadataPrefix= oai_apsmeta_2&set=journal:PRC:72, DOI 10.1103/PhysRevC.72.014904, 014904Ray, R.L., Longacre, R.S., 24, arXiv:nucl-ex/0008009 and private communicationKopylov, G.I., Podgoretsky, M.I., Kopylov, G.I., Podgoretsky, M.I., (1972) Sov. J. Nucl. Phys., 15. , 25a, 219 ()25b, Phys. Lett. B. 50, 472 (1974) 0370-2693 PYLBAJ 10.1016/0370-2693(74)90263-925c, Sov. J. Part. Nucl. 20, 266 (1989)Goldhaber, G., Goldhaber, S., Lee, W., Pais, A., (1960) Phys. Rev., 120. , 26, 325. 0031-899X PHRVAO 10.1103/PhysRev.120.32

Effects of sleep disturbance on dyspnoea and impaired lung function following hospital admission due to COVID-19 in the UK: a prospective multicentre cohort study

Background: Sleep disturbance is common following hospital admission both for COVID-19 and other causes. The clinical associations of this for recovery after hospital admission are poorly understood despite sleep disturbance contributing to morbidity in other scenarios. We aimed to investigate the prevalence and nature of sleep disturbance after discharge following hospital admission for COVID-19 and to assess whether this was associated with dyspnoea. Methods: CircCOVID was a prospective multicentre cohort substudy designed to investigate the effects of circadian disruption and sleep disturbance on recovery after COVID-19 in a cohort of participants aged 18 years or older, admitted to hospital for COVID-19 in the UK, and discharged between March, 2020, and October, 2021. Participants were recruited from the Post-hospitalisation COVID-19 study (PHOSP-COVID). Follow-up data were collected at two timepoints: an early time point 2–7 months after hospital discharge and a later time point 10–14 months after hospital discharge. Sleep quality was assessed subjectively using the Pittsburgh Sleep Quality Index questionnaire and a numerical rating scale. Sleep quality was also assessed with an accelerometer worn on the wrist (actigraphy) for 14 days. Participants were also clinically phenotyped, including assessment of symptoms (ie, anxiety [Generalised Anxiety Disorder 7-item scale questionnaire], muscle function [SARC-F questionnaire], dyspnoea [Dyspnoea-12 questionnaire] and measurement of lung function), at the early timepoint after discharge. Actigraphy results were also compared to a matched UK Biobank cohort (non-hospitalised individuals and recently hospitalised individuals). Multivariable linear regression was used to define associations of sleep disturbance with the primary outcome of breathlessness and the other clinical symptoms. PHOSP-COVID is registered on the ISRCTN Registry (ISRCTN10980107). Findings: 2320 of 2468 participants in the PHOSP-COVID study attended an early timepoint research visit a median of 5 months (IQR 4–6) following discharge from 83 hospitals in the UK. Data for sleep quality were assessed by subjective measures (the Pittsburgh Sleep Quality Index questionnaire and the numerical rating scale) for 638 participants at the early time point. Sleep quality was also assessed using device-based measures (actigraphy) a median of 7 months (IQR 5–8 months) after discharge from hospital for 729 participants. After discharge from hospital, the majority (396 [62%] of 638) of participants who had been admitted to hospital for COVID-19 reported poor sleep quality in response to the Pittsburgh Sleep Quality Index questionnaire. A comparable proportion (338 [53%] of 638) of participants felt their sleep quality had deteriorated following discharge after COVID-19 admission, as assessed by the numerical rating scale. Device-based measurements were compared to an age-matched, sex-matched, BMI-matched, and time from discharge-matched UK Biobank cohort who had recently been admitted to hospital. Compared to the recently hospitalised matched UK Biobank cohort, participants in our study slept on average 65 min (95% CI 59 to 71) longer, had a lower sleep regularity index (–19%; 95% CI –20 to –16), and a lower sleep efficiency (3·83 percentage points; 95% CI 3·40 to 4·26). Similar results were obtained when comparisons were made with the non-hospitalised UK Biobank cohort. Overall sleep quality (unadjusted effect estimate 3·94; 95% CI 2·78 to 5·10), deterioration in sleep quality following hospital admission (3·00; 1·82 to 4·28), and sleep regularity (4·38; 2·10 to 6·65) were associated with higher dyspnoea scores. Poor sleep quality, deterioration in sleep quality, and sleep regularity were also associated with impaired lung function, as assessed by forced vital capacity. Depending on the sleep metric, anxiety mediated 18–39% of the effect of sleep disturbance on dyspnoea, while muscle weakness mediated 27–41% of this effect. Interpretation: Sleep disturbance following hospital admission for COVID-19 is associated with dyspnoea, anxiety, and muscle weakness. Due to the association with multiple symptoms, targeting sleep disturbance might be beneficial in treating the post-COVID-19 condition. Funding: UK Research and Innovation, National Institute for Health Research, and Engineering and Physical Sciences Research Council