Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Measurements of sensor radiation damage in the ATLAS inner detector using leakage currents

Non-ionizing energy loss causes bulk damage to the silicon sensors of the ATLAS pixel and strip detectors. This damage has important implications for data-taking operations, charged-particle track reconstruction, detector simulations, and physics analysis. This paper presents simulations and measurements of the leakage current in the ATLAS pixel detector and semiconductor tracker as a function of location in the detector and time, using data collected in Run 1 (2010–2012) and Run 2 (2015–2018) of the Large Hadron Collider. The extracted fluence shows a much stronger |z|-dependence in the innermost layers than is seen in simulation. Furthermore, the overall fluence on the second innermost layer is significantly higher than in simulation, with better agreement in layers at higher radii. These measurements are important for validating the simulation models and can be used in part to justify safety factors for future detector designs and interventions.publishedVersio

Measurements of W+W−+ ≥ 1 jet production cross-sections in pp collisions at s \sqrt{s} = 13 TeV with the ATLAS detector

Fiducial and differential cross-section measurements of W+W− production in association with at least one hadronic jet are presented. These measurements are sensitive to the properties of electroweak-boson self-interactions and provide a test of perturbative quantum chromodynamics and the electroweak theory. The analysis is performed using proton-proton collision data collected at p s = 13TeV with the ATLAS experiment, corresponding to an integrated luminosity of 139 fb−1. Events are selected with exactly one oppositely charged electron-muon pair and at least one hadronic jet with a transverse momentum of pT > 30 GeV and a pseudorapidity of |�| < 4.5. After subtracting the background contributions and correcting for detector effects, the jet-inclusive W+W−+ � 1 jet fiducial cross-section and W+W−+ jets differential cross-sections with respect to several kinematic variables are measured. These measurements include leptonic quantities, such as the lepton transverse momenta and the transverse mass of the W+W− system, as well as jet-related observables such as the leading jet transverse momentum and the jet multiplicity. Limits on anomalous triple-gauge-boson couplings are obtained in a phase space where interference between the Standard Model amplitude and the anomalous amplitude is enhanced

Configuration and performance of the ATLAS b-jet triggers in Run 2

Several improvements to the ATLAS triggers used to identify jets containing b-hadrons (b-jets) were implemented for data-taking during Run 2 of the Large Hadron Collider from 2016 to 2018. These changes include reconfiguring the b-jet trigger software to improve primary-vertex finding and allow more stable running in conditions with high pile-up, and the implementation of the functionality needed to run sophisticated taggers used by the offline reconstruction in an online environment. These improvements yielded an order of magnitude better light-flavour jet rejection for the same b-jet identification efficiency compared to the performance in Run 1 (2011–2012). The efficiency to identify b-jets in the trigger, and the conditional efficiency for b-jets that satisfy offline b-tagging requirements to pass the trigger are also measured. Correction factors are derived to calibrate the b-tagging efficiency in simulation to match that observed in data. The associated systematic uncertainties are substantially smaller than in previous measurements. In addition, b-jet triggers were operated for the first time during heavy-ion data-taking, using dedicated triggers that were developed to identify semileptonic b-hadron decays by selecting events with geometrically overlapping muons and jets

Search for a high-mass Higgs boson decaying to a W boson pair in pp collisions at root s=8TeV with the ATLAS detector

A search for a high-mass Higgs boson H is performed in the H -> WW -> l nu l nu and H -> WW -> l nu qq decay channels using pp collision data corresponding to an integrated luminosity of 20.3 fb(-1) collected at root s = 8TeV by the ATLAS detector at the Large Hadron Collider. No evidence of a high-mass Higgs boson is found. Limits on sigma(H) x BR(H -> WW) as a function of the Higgs boson mass m(H) are determined in three different scenarios: one in which the heavy Higgs boson has a narrow width compared to the experimental resolution, one for a width increasing with the boson mass and modeled by the complex-pole scheme following the same behavior as in the Standard Model, and one for intermediate widths. The upper range of the search is m(H) = 1500 GeV for the narrow-width scenario and m(H) = 1000 GeV for the other two scenarios. The lower edge of the search range is 200{300 GeV and depends on the analysis channel and search scenario. For each signal interpretation, individual and combined limits from the two WW decay channels are presented. At m(H) = 1500 GeV, the highest-mass point tested, sigma(H) x BR(H -> WW) for a narrow-width Higgs boson is constrained to be less than 22 fb and 6.6 fb at 95% CL for the gluon fusion and vector-boson fusion production modes, respectively

Combination of searches for resonant Higgs Boson pair production using pp collisions at √s = 13 TeV with the ATLAS detector

A combination of searches for a new resonance decaying into a Higgs boson pair is presented, using up to 139  fb−1 of pp collision data at √s = 13 TeV recorded with the ATLAS detector at the LHC. The combination includes searches performed in three decay channels: b ¯ b ⁢b ¯ b , b⁢ ¯ b ⁢τ+⁢τ−, and b⁢ ¯ bγγ ⁢. No excess above the expected Standard Model background is observed and upper limits are set at the 95% confidence level on the production cross section of Higgs boson pairs originating from the decay of a narrow scalar resonance with mass in the range 251 GeV–5 TeV. The observed (expected) limits are in the range 0.96–600 fb (1.2–390 fb). The limits are interpreted in the type-I two-Higgs-doublet model and the minimal supersymmetric standard model, and constrain parameter space not previously excluded by other searches

Search for heavy neutral leptons in decays of W bosons using a dilepton displaced vertex in √s = 13 TeV pp collisions with the ATLAS detector

A search for a long-lived, heavy neutral lepton ( N ) in 139     fb − 1 of √ s = 13     TeV p p collision data collected by the ATLAS detector at the Large Hadron Collider is reported. The N is produced via W → N μ or W → N e and decays into two charged leptons and a neutrino, forming a displaced vertex. The N mass is used to discriminate between signal and background. No signal is observed, and limits are set on the squared mixing parameters of the N with the left-handed neutrino states for the N mass range 3     GeV &lt; m N &lt; 15     GeV . For the first time, limits are given for both single-flavor and multiflavor mixing scenarios motivated by neutrino flavor oscillation results for both the normal and inverted neutrino-mass hierarchies

The ATLAS inner detector trigger performance in pp collisions at 13 TeV during LHC Run 2

The design and performance of the inner detector trigger for the high level trigger of the ATLAS experiment at the Large Hadron Collider during the 2016-18 data taking period is discussed. In 2016, 2017, and 2018 the ATLAS detector recorded 35.6 fb$^{-1}$, 46.9 fb$^{-1}$, and 60.6 fb$^{-1}$ respectively of proton-proton collision data at a centre-of-mass energy of 13 TeV. In order to deal with the very high interaction multiplicities per bunch crossing expected with the 13 TeV collisions the inner detector trigger was redesigned during the long shutdown of the Large Hadron Collider from 2013 until 2015. An overview of these developments is provided and the performance of the tracking in the trigger for the muon, electron, tau and $b$-jet signatures is discussed. The high performance of the inner detector trigger with these extreme interaction multiplicities demonstrates how the inner detector tracking continues to lie at the heart of the trigger performance and is essential in enabling the ATLAS physics programme