This document summarises proposed searches for new physics accessible in the heavy-ion mode at the CERN Large Hadron Collider (LHC), both through hadronic and ultraperipheral γγ interactions, and ...that have a competitive or, even, unique discovery potential compared to standard proton-proton collision studies. Illustrative examples include searches for new particles-such as axion-like pseudoscalars, radions, magnetic monopoles, new long-lived particles, dark photons, and sexaquarks as dark matter candidates-as well as new interactions, such as nonlinear or non-commutative QED extensions. We argue that such interesting possibilities constitute a well-justified scientific motivation, complementing standard quark-gluon-plasma physics studies, to continue running with ions at the LHC after the Run-4, i.e. beyond 2030, including light and intermediate-mass ion species, accumulating nucleon-nucleon integrated luminosities in the accessible fb−1 range per month.
Horse-related injuries account for one quarter of all paediatric sports fatalities. It is not known whether the pattern of injury spectrum and severity differ between children injured whilst mounted, ...compared with those injured unmounted around horses. We aimed to identify any distinctions between the demographic features, spectrum and severity of injuries for mounted versus unmounted patients.
Trauma registry data were reviewed for 505 consecutive paediatric patients (aged<16years) admitted to a large paediatric trauma centre with horse-related injuries over a 16-year period. Patients were classified into mounted and unmounted groups, and demographics, injury spectrum, injury severity, and helmet usage compared using odds ratios and Wilcoxon rank-sum tests.
More patients (56%) were injured in a private setting than in a sporting or supervised context (23%). Overall, head injuries were the most common horse-related injury. Mounted patients comprised 77% of the cohort. Mounted patients were more likely to sustain upper limb fractures or spinal injuries, and more likely to wear helmets. Unmounted were more likely to be younger males, and more likely to sustain facial or abdominal injuries. Strikingly, unmounted children had significantly more severe and critical Injury Severity Scores (OR 2.6; 95% CI 1.5, 4.6) and longer hospital stay (2.0days vs 1.1days; p<0.001). Unmounted patients were twice as likely to require intensive care or surgery, and eight times more likely to sustain a severe head injury.
Horse-related injuries in children are serious. Unmounted patients are distinct from mounted patients in terms of gender, age, likelihood of personal protective equipment use, severity of injuries, and requirement for intensive or invasive care. This study highlights the importance of vigilance and other safety behaviours when unmounted and around horses, and proposes specific targets for future injury prevention campaigns, both in setting of organised and private equestrian activity.
Background
Artificial intelligence (AI) has the potential to improve prenatal detection of congenital heart disease. We analysed the performance of the current national screening programme in ...detecting hypoplastic left heart syndrome (HLHS) to compare with our own AI model.
Methods
Current screening programme performance was calculated from local and national sources. AI models were trained using four‐chamber ultrasound views of the fetal heart, using a ResNet classifier.
Results
Estimated current fetal screening programme sensitivity and specificity for HLHS were 94.3% and 99.985%, respectively. Depending on calibration, AI models to detect HLHS were either highly sensitive (sensitivity 100%, specificity 94.0%) or highly specific (sensitivity 93.3%, specificity 100%). Our analysis suggests that our highly sensitive model would generate 45,134 screen positive results for a gain of 14 additional HLHS cases. Our highly specific model would be associated with two fewer detected HLHS cases, and 118 fewer false positives.
Conclusion
If used independently, our AI model performance is slightly worse than the performance level of the current screening programme in detecting HLHS, and this performance is likely to deteriorate further when used prospectively. This demonstrates that collaboration between humans and AI will be key for effective future clinical use.
Key points
What is already known on this topic?
Artificial intelligence (AI) can be used to interpret medical images and make diagnoses, including detecting fetal congenital heart disease (CHD) by ultrasound.
The sensitivity of the current English screening programme for fetal cardiac malformations is publicly available, but specificity is not reported.
What this study adds?
The current screening programme in our region is operating at a very high specificity for fetal hypoplastic left heart syndrome (HLHS).
Using a curated retrospective dataset, it is possible to train AI models to detect HLHS with a performance approaching that of the current screening programme.
Current AI models do not have high enough specificity to be used independently for screening for fetal CHD, meaning that human‐AI interaction when performing or interpreting ultrasound will be important to select cases for specialist referral.
Snow sports are popular among children but carry the potential for significant injury. Head injuries are less common than fractures and sprains but may be fatal. Helmets are recommended for all snow ...sports, and yet their effectiveness remains unknown. We aimed to evaluate the spectrum of injuries sustained at three large alpine resorts and to assess the effect of helmet usage on injury severity.
We performed a retrospective analysis of prospectively collected pediatric trauma data (2005–2015) from the three largest alpine resorts in our state. Data were analyzed using Spearman's correlation, chi-square, and odds ratio.
A total of 6299 incidents were reviewed. Skiers accounted for 3821 (60.7%) patients, while snowboarders accounted for 2422 (38.5%) patients. More than half (53.5%) of the injuries were related to falls, predominantly affecting knees in skiers and wrists in snowboarders. Overall, helmet usage decreased with age (p<0.001), though helmet uptake was positively associated with higher level of ability in both skiers and snowboarders (p<0.001). Concussions in both skiers and snowboarders were inversely correlated with the rates of helmet usage (p<0.05).
Helmet usage was associated with reduced rates of concussion. However, helmet usage decreased with age. We advocate for promotion of helmet usage, using mandatory guidelines, across all pediatric age groups.
Level II – Retrospective study.
During its Run 2 (2015–2018), the Large Hadron Collider (LHC) operated at almost twice higher energy, and provided Pb-Pb collisions with an order of magnitude higher luminosity, than in the previous ...Run 1. In consequence, the power of the secondary beams emitted from the interaction points by the bound-free pair production (BFPP) process increased by a factor∼20, while the propensity of the bending magnets to quench increased with the higher magnetic field. This beam power is about 35 times greater than that contained in the luminosity debris from hadronic interactions and is focused on specific locations that fall naturally inside superconducting magnets. The risk of quenching these magnets has long been recognized as severe and there are operational limitations due to the dynamic heat load that must be evacuated by the cryogenic system. High-luminosity operation was nevertheless possible thanks to orbit bumps that were introduced in the dispersion suppressors around the ATLAS and CMS experiments to prevent quenches by displacing and spreading out these beam losses. Further, in 2015, the BFPP beams were manipulated to induce a controlled quench, thus providing the first direct measurement of the steady-state quench level of an LHC dipole magnet. The same experiment demonstrated the need for new collimators that are being installed around the ALICE experiment to intercept the secondary beams in the future. This paper discusses the experience with BFPP at luminosities very close to the future High Luminosity LHC (HL-LHC) target, gives results on the risk reduction by orbit bumps and presents a detailed analysis of the controlled quench experiment.
The Relativistic Heavy Ion Collider at BNL has been exploring the energy frontier of nuclear physics since 2001. Its performance, flexibility and continued innovative upgrading can sustain its ...physics output for years to come. Now, the Large Hadron Collider at CERN is about to extend the frontier energy of laboratory nuclear collisions by more than an order of magnitude. In the coming years, its physics reach will evolve towards still higher energy, luminosity and varying collision species, within performance bounds set by accelerator technology and by nuclear physics itself. Complementary high-energy facilities will include fixed-target collisions at the CERN SPS, the FAIR complex at GSI and possible electron-ion colliders based on CEBAF at JLAB, RHIC at BNL or the LHC at CERN.
Objective: To report the timing of presentation and clinical profile of a cohort of fetuses with normal main cardiac connections but fetal echocardiographic signs suggestive of coarctation of the ...aorta. Design: Retrospective observational study. Setting: Tertiary fetal and paediatric cardiology centre. Patients: Between 1 January 1998 and 31 December 2002, 174 fetuses were studied, of whom 144 infants were born alive. Main outcome measures: Of the 144 liveborn infants, 43 had coarctation of the aorta, four had interruption of the aortic arch, and one was managed as having hypoplastic left heart syndrome. Hemianomalous pulmonary venous drainage was diagnosed in two infants. Three infants with coarctation presented late at 7–13 weeks of age, 6–12 weeks after closure of the arterial duct. Fetuses with cardiac asymmetry had a higher incidence of left superior vena cava than a control group. For fetuses with cardiac asymmetry, the incidence of left superior vena cava and ventricular septal defects was similar in infants who proved to have coarctation postnatally and in those who did not. The 30 day and one year surgical mortality of infants having repair of coarctation of the aorta was two of 41 (4.9%, 95% confidence interval (CI) 0.6 to 16.0). All cause mortality of liveborn infants with any abnormality of the aortic arch was five of 48 (10.4%, 95% CI 3.5 to 22.7) at 30 days and one year, which was heavily influenced by prematurity and extracardiac abnormalities. Conclusions: Precise diagnosis of coarctation of the aorta during fetal life remains difficult. Coarctation of the aorta may present several weeks after closure of the arterial duct and sequential echocardiography is recommended.
BackgroundCOVID-19 has caused significant worldwide morbidity and mortality. Congenital heart disease (CHD) is likely to increase vulnerability and understanding the predictors of adverse outcomes is ...key to optimising care.ObjectiveAscertain the impact of COVID-19 on people with CHD and define risk factors for adverse outcomes.MethodsMulticentre UK study undertaken 1 March 2020–30 June 2021 during the COVID-19 pandemic. Data were collected on CHD diagnoses, clinical presentation and outcomes. Multivariable logistic regression with multiple imputation was performed to explore predictors of death and hospitalisation.ResultsThere were 405 reported cases (127 paediatric/278 adult). In children (age <16 years), there were 5 (3.9%) deaths. Adjusted ORs (AORs) for hospitalisation in children were significantly lower with each ascending year of age (OR 0.85, 95% CI 0.75 to 0.96 (p<0.01)). In adults, there were 24 (8.6%) deaths (19 with comorbidities) and 74 (26.6%) hospital admissions. AORs for death in adults were significantly increased with each year of age (OR 1.05, 95% CI 1.01 to 1.10 (p<0.01)) and with pulmonary arterial hypertension (PAH; OR 5.99, 95% CI 1.34 to 26.91 (p=0.02)). AORs for hospitalisation in adults were significantly higher with each additional year of age (OR 1.03, 95% CI 1.00 to 1.05 (p=0.04)), additional comorbidities (OR 3.23, 95% CI 1.31 to 7.97 (p=0.01)) and genetic disease (OR 2.87, 95% CI 1.04 to 7.94 (p=0.04)).ConclusionsChildren were at low risk of death and hospitalisation secondary to COVID-19 even with severe CHD, but hospital admission rates were higher in younger children, independent of comorbidity. In adults, higher likelihood of death was associated with increasing age and PAH, and of hospitalisation with age, comorbidities and genetic disease. An individualised approach, based on age and comorbidities, should be taken to COVID-19 management in patients with CHD.
The relationship between lipid metabolism with prediabetes (impaired fasting glucose and impaired glucose tolerance) and type 2 diabetes mellitus is poorly defined. We hypothesized that a lipidomic ...analysis of plasma lipids might improve the understanding of this relationship. We performed lipidomic analysis measuring 259 individual lipid species, including sphingolipids, phospholipids, glycerolipids and cholesterol esters, on fasting plasma from 117 type 2 diabetes, 64 prediabetes and 170 normal glucose tolerant participants in the Australian Diabetes, Obesity and Lifestyle Study (AusDiab) then validated our findings on 1076 individuals from the San Antonio Family Heart Study (SAFHS). Logistic regression analysis of identified associations with type 2 diabetes (135 lipids) and prediabetes (134 lipids), after adjusting for multiple covariates. In addition to the expected associations with diacylglycerol, triacylglycerol and cholesterol esters, type 2 diabetes and prediabetes were positively associated with ceramide, and its precursor dihydroceramide, along with phosphatidylethanolamine, phosphatidylglycerol and phosphatidylinositol. Significant negative associations were observed with the ether-linked phospholipids alkylphosphatidylcholine and alkenylphosphatidylcholine. Most of the significant associations in the AusDiab cohort (90%) were subsequently validated in the SAFHS cohort. The aberration of the plasma lipidome associated with type 2 diabetes is clearly present in prediabetes, prior to the onset of type 2 diabetes. Lipid classes and species associated with type 2 diabetes provide support for a number of existing paradigms of dyslipidemia and suggest new avenues of investigation.
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