Trends and area variations in Potentially Preventable Admissions for COPD in Spain (2002-2013): A significant decline and convergence between areas

Background: Potentially Preventable Hospitalizations (PPH) are hospital admissions for conditions which are preventable with timely and appropriate outpatient care being Chronic Obstructive Pulmonary Disease (COPD) admissions one of the most relevant PPH. We estimate the population age-sex standardized relative risk of admission for COPD-PPH by year and area of residence in the Spanish National Health System (sNHS) during the period 2002–2013. Methods: The study was conducted in the 203 Hospital Service Areas of the sNHS, using the 2002 to 2013 hospital admissions for a COPD-PPH condition of patients aged 20 and over. We use conventional small area variation statistics and a Bayesian hierarchical approach to model the different risk structures of dependence in both space and time. Results: COPD-PPH admissions declined from 24.5 to 15.5 per 10, 000 persons-year (Men: from 40.6 to 25.1; Women: from 9.1 to 6.4). The relative risk declined from 1.19 (19 % above 2002–2013 average) in 2002 to 0.77 (30 % below average) in 2013. Both the starting point and the slope were different for the different regions. Variation among admission rates between extreme areas dropped from 6.7 times higher in 2002 to 4.6 times higher in 2013. Conclusions: COPD-PPH conditions in Spain have undergone a strong decline and a reduction in geographical variation in the last 12 years, suggesting a general improvement in health policies and health care over time. Variability among areas still remains, with a substantial room for improvement

Pulmonary long-term consequences of COVID-19 infections after hospital discharge

Objectives: COVID-19 survivors are reporting residual abnormalities after discharge from the hospital. Limited information is available about this stage of recovery or the lingering effects of the virus on pulmonary function and inflammation. The aim of this study was to describe lung function and to identify biomarkers in serum and induced sputum samples from patients recovering from COVID-19 hospitalisation. Methods: Patients admitted to Spanish hospitals with laboratory-confirmed COVID-19 infection by a real-time PCR (RT-PCR) assay for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were recruited for this study. Each hospital screened their lists of discharged patients at least 45 days after symptom onset. SARS-CoV-2-infected patients were divided into mild/moderate and severe disease groups according to the severity of their symptoms during hospitalisation. Patients’ epidemiological and medical histories, comorbidities, chronic treatments, and laboratory parameters were evaluated. Pulmonary function tests, the standardised 6-minute walk test (6 MWT) and chest computed tomography (CT) were also performed. The levels of proteases, their inhibitors, and shed receptors were measured in serum and induced sputum samples. Results: A total of 100 patients with respiratory function tests were included in this study. The median number of days after the onset of symptoms was 104 (IQR 89.25, 126.75). COVID-19 was severe in 47% (47/100) of patients. CT was normal in 48% (48/100) of patients. Lung function was normal (FEV1 ≥80%, FVC ≥80%, FEV1/FVC ≥0.7, and diffusing capacity for carbon monoxide [DLCO] ≥80%) in 92% (92/100), 94% (94/100), 100% (100/100) and 48% (48/100) of patients, respectively. Multivariate analysis showed that a DLCO <80% (OR 5.92; 95%CI 2.28-15.37; p <0.0001) and a lower serum LDH level (OR 0.98; 95%CI 0.97-0.99) were associated with the severe disease group of SARS-CoV-2 during hospital stay. Conclusions: A diffusion deficit (DLCO <80%) was still present after hospital discharge and was associated with the most severe SARS-CoV-2 cases

Nutrient flux and budget in the Ebro estuary

The Ebro river flows to the Mediterranean coast of Spain. During its final stretch, the Ebro behaves in a similar way to a highly stratified estuary. This paper describes the transport of nutrients to the Ebro estuary, evaluates the general movement of nutrients in the estuarine region, using a mass balance approach, and estimates the amounts of nutrients discharged to the coastal environment. Given the strong saline stratification, this study only includes the surface layer that contains the continental freshwater. The annual nutrient budget for the Ebro estuary shows a net excess for nitrogen and phosphorus, while silicate almost attains equilibrium between addition and removal. There are several reasons for gains in nitrogen and phosphorous: a contribution of dissolved and particulate compounds in the freshwater (some of which are mineralized); a lower uptake of phytoplankton indicated by chlorophyll reduction in the estuary; an entrainment of the nutrient-rich upper part of the salt wedge; and, to a lesser extent, the impact of wastewater and agricultural water use. The biggest load discharged into the Mediterranean Sea by the Ebro is nitrogen, followed by silicate with over 10 000 tons of each deposited annually. Phosphorus is discharged at relatively low concentrations and with an annual load of about 200 t yr¿1.This project was funded by the European Union in the framework of the MAST-III research project: "Preparation and Integration of Analysis Tools towards Operational Forecast of Nutrients in Estuaries of European Rivers (PIONEER)", Reference No. MAS3-CT98-0170.Falco Giaccaglia, SL.; Niencheski, L.; Rodilla Alamá, M.; Romero Gil, I.; González Del Rio Rams, J.; Sierra, J.; Mösso, C. (2010). Nutrient flux and budget in the Ebro estuary. Estuarine, Coastal and Shelf Science. 87(1):92-102. doi:10.1016/j.ecss.2009.12.020S9210287

Definite and indeterminate nonalcoholic steatohepatitis share similar clinical features and prognosis: A longitudinal study of 1893 biopsy-proven nonalcoholic fatty liver disease subjects

[Background and Aim] Histological score systems may not fully capture the essential nonalcoholic steatohepatitis (NASH) features, which is one of the leading causes of screening failure in clinical trials. We assessed the NASH distribution and its components across the fibrosis stages and their impact on the prognosis and their relationship with the concept of metabolic-associated fatty liver disease (MAFLD).[Methods] Spanish multicenter study including 1893 biopsy-proven nonalcoholic fatty liver disease (NAFLD) patients from HEPAmet registry. NASH was diagnosed by NAS score ≥4 (including steatosis, ballooning and lobular inflammation) and fibrosis by Kleiner score. The presence of MAFLD was determined. Progression to cirrhosis, first episode of decompensated cirrhosis and death were collected during the follow-up (4.7 ± 3.8 years).[Results] Fibrosis was F0 34.3% (649/1893), F1 27% (511/1893), F2 16.5% (312/1893), F3 15% (284/1893) and F4 7.2% (137/1893). NASH diagnosis 51.9% (982/1893), and its individual components (severe steatosis, ballooning and lobular inflammation), increased from F0 (33.6%) to F2 (68.6%), and decreased significantly in F4 patients (51.8%) (P = .0001). More than 70% of non-NASH patients showed some inflammatory activity (ballooning or lobular inflammation), showing a similar MAFLD rate than NASH (96.2% [945/982] vs. 95.2% [535/562]) and significantly higher than nonalcoholic fatty liver (NAFL) subjects (89.1% [311/349]) (P < .0001). Progression to cirrhosis was similar between NASH (9.5% [51/539]) and indeterminate NASH (7.9% [25/316]), and higher than steatosis (5% [14/263]) (logRank 8.417; P = .015). Death and decompensated cirrhosis were similar between these.[Conclusions] The prevalence of steatohepatitis decreased in advanced liver disease. However, most of these patients showed some inflammatory activity histologically and had metabolic disturbances. These findings should be considered in clinical trials whose main aim is to prevent cirrhosis progression and complications, liver transplant and death.This project has been partially funded by the ‘Consejería de Salud de la Junta de Andalucía’ (PI-0075-2014) and the ‘Spanish Ministry of Economy, Innovation and Competition, Instituto de Salud Carlos III’ (PI19/01404, PI16/01842, PI17/00535 and GLD19/00100).Peer reviewe

Constraints on Higgs boson production with large transverse momentum using H →b b ¯ decays in the ATLAS detector

This paper reports constraints on Higgs boson production with transverse momentum above 1 TeV. The analyzed data from proton-proton collisions at a center-of-mass energy of 13 TeV were recorded with the ATLAS detector at the Large Hadron Collider from 2015 to 2018 and correspond to an integrated luminosity of 136 fb-1. Higgs bosons decaying into bb¯ are reconstructed as single large-radius jets recoiling against a hadronic system and are identified by the experimental signature of two b-hadron decays. The experimental techniques are validated in the same kinematic regime using the Z→bb¯ process. The 95% confidence-level upper limit on the cross section for Higgs boson production with transverse momentum above 450 GeV is 115 fb, and above 1 TeV it is 9.6 fb. The Standard Model cross section predictions for a Higgs boson with a mass of 125 GeV in the same kinematic regions are 18.4 fb and 0.13 fb, respectively

Study of Bc+→J/ψDs+ and Bc+→J/ψDs∗+ decays in pp collisions at √s = 13 TeV with the ATLAS detector

A study of Bc+→J/ψDs+ and Bc+→J/ψDs∗+ decays using 139 fb of integrated luminosity collected with the ATLAS detector from s = 13 TeV pp collisions at the LHC is presented. The ratios of the branching fractions of the two decays to the branching fraction of the Bc+→ J/ψπ decay are measured: B(Bc+→J/ψDs+)/B(Bc+→J/ψπ+) = 2.76 ± 0.47 and B(Bc+→J/ψDs∗+)/B(Bc+→J/ψπ+) = 5.33 ± 0.96. The ratio of the branching fractions of the two decays is found to be B(Bc+→J/ψDs∗+)/B(Bc+→J/ψDs∗+) = 1.93 ± 0.26. For the Bc+→J/ψDs∗+ decay, the transverse polarization fraction, Γ/Γ, is measured to be 0.70 ± 0.11. The reported uncertainties include both the statistical and systematic components added in quadrature. The precision of the measurements exceeds that in all previous studies of these decays. These results supersede those obtained in the earlier ATLAS study of the same decays with s = 7 and 8 TeV pp collision data. A comparison with available theoretical predictions for the measured quantities is presented. [Figure not available: see fulltext.]

A search for an unexpected asymmetry in the production of e(+)mu(-) and e(-)mu(+) pairs in proton-proton collisions recorded by the ATLAS detector at root s=13 TeV

This search, a type not previously performed at ATLAS, uses a comparison of the production cross sections for e(+)mu(-) and e(-)mu(+) pairs to constrain physics processes beyond the Standard Model. It uses 139 fb(-1) of proton-proton collision data recorded at root s = 13 TeV at the LHC. Targeting sources of new physics which prefer final states containing e(+)mu(-) and e(-)mu(+), the search contains two broad signal regions which are used to provide model-independent constraints on the ratio of cross sections at the 2% level. The search also has two special selections targeting supersymmetric models and leptoquark signatures. Observations using one of these selections are able to exclude, at 95% confidence level, singly produced smuons with masses up to 640 GeV in a model in which the only other light sparticle is a neutralino when the R-parity-violating coupling lambda(23)(1)' is close to unity. Observations using the other selection exclude scalar leptoquarks with masses below 1880 GeV when g(1R)(eu) = g(1R)(mu c) = 1, at 95% confidence level. The limit on the coupling reduces to g(1R)(eu) = g(1R)(mu c) = 0.46 for a mass of 1420 GeV

Search for light long-lived neutral particles that decay to collimated pairs of leptons or light hadrons in pp collisions at √s = 13 TeV with the ATLAS detector

A search for light long-lived neutral particles with masses in the O(MeV–GeV) range is presented. The analysis targets the production of long-lived dark photons in the decay of a Higgs boson produced via gluon–gluon fusion or in association with a W boson. Events that contain displaced collimated Standard Model fermions reconstructed in the calorimeter or muon spectrometer are selected in 139 fb of s = 13 TeV pp collision data collected by the ATLAS detector at the LHC. Background estimates for contributions from Standard Model processes and instrumental effects are extracted from data. The observed event yields are consistent with the expected background. Exclusion limits are reported on the production cross-section times branching fraction as a function of the mean proper decay length cτ of the dark photon, or as a function of the dark-photon mass and kinetic mixing parameter that quantifies the coupling between the Standard Model and potential hidden (dark) sectors. A Higgs boson branching fraction above 1% is excluded at 95% CL for a Higgs boson decaying into two dark photons for dark-photon mean proper decay lengths between 10 mm and 250 mm and dark photons with masses between 0.4 GeV and 2 GeV. [Figure not available: see fulltext.]

Search for a light charged Higgs boson in t -> H±b decays, with H± -> cb, in the lepton plus jets final state in proton-proton collisions at root s=13 TeV with the ATLAS detector

A search for a charged Higgs boson, H-+/-, produced in top-quark decays, t -> H(+/-)b, is presented. The search targets H-+/- decays into a bottom and a charm quark, H-+/- -> cb. The analysis focuses on a selection enriched in top-quark pair production, where one top quark decays into a leptonically decaying W boson and a bottom quark, and the other top quark decays into a charged Higgs boson and a bottom quark. This topology leads to a lepton-plus-jets final state, characterised by an isolated electron or muon and at least four jets. The search exploits the high multiplicity of jets containing b-hadrons, and deploys a neural network classifier that uses the kinematic differences between the signal and the background. The search uses a dataset of proton-proton collisions collected at a centre-of-mass energy root s = 13TeV between 2015 and 2018 with the ATLAS detector at CERN's Large Hadron Collider, amounting to an integrated luminosity of 139 fb(-1). Observed (expected) 95% confidence-level upper limits between 0.15% (0.09%) and 0.42% (0.25%) are derived for the product of branching fractions B( t -> H-+/- b) x B( H +/- -> cb) for charged Higgs boson masses between 60 and 160 GeV, assuming the SM production of the top-quark pairs