BACKGROUND: Low literacy skills are common and associated with a variety of poor health outcomes. This may be particularly important in patients with chronic illnesses such as chronic obstructive pulmonary disease (COPD) that require appropriate inhaler technique to maintain quality of life and avoid exacerbations. OBJECTIVE: To explore the impact of a literacy-sensitive self-management intervention on inhaler technique scores in COPD patients and to determine if effects differ by literacy. DESIGN: Randomized controlled trial. PARTICIPANTS: Ninety-nine patients with COPD. INTERVENTION: Patients were randomly assigned to a one-on-one self-management educational intervention or usual care. The intervention focused on inhaler technique, smoking cessation, and using a COPD action plan. MAIN MEASURES: At baseline, an inhaler technique assessment, literacy assessment, health-related quality of life questionnaires, and pulmonary function tests were completed. Inhaler technique was re-evaluated after two to eight weeks. KEY RESULTS: Mean age 63, 65% female, 69% Caucasian, moderate COPD severity on average, 36% with low literacy, moderately impaired health-related quality of life, and similar baseline metered dose inhaler technique scores. Patients in the intervention group had greater mean improvement from baseline in metered dose inhaler technique score compared to those in the usual care group (difference in mean change 2.1, 95% CI 1.1, 3.0). The patients in the intervention group also had greater mean improvements in metered dose inhaler technique score than those in the usual care group whether they had low health literacy (difference in mean change 2.8, 95% CI 0.6, 4.9) or higher health literacy (1.8, 95% CI 0.7, 2.9).CONCLUSIONS: A literacy-sensitive self-management intervention can lead to improvements in inhaler technique, with benefits for patients with both low and higher health literacy.KEY WORDS: COPD; inhaler technique; health literacy; selfmanagement; randomized controlled trial.

The first collider search for dark matter arising from a strongly coupled hidden sector is presented and uses a data sample corresponding to 138 fb−1, collected with the CMS detector at the CERN LHC, at $$ \sqrt{s} $$ s = 13 TeV. The hidden sector is hypothesized to couple to the standard model (SM) via a heavy leptophobic Z′ mediator produced as a resonance in proton-proton collisions. The mediator decay results in two “semivisible” jets, containing both visible matter and invisible dark matter. The final state therefore includes moderate missing energy aligned with one of the jets, a signature ignored by most dark matter searches. No structure in the dijet transverse mass spectra compatible with the signal is observed. Assuming the Z′ boson has a universal coupling of 0.25 to the SM quarks, an inclusive search, relevant to any model that exhibits this kinematic behavior, excludes mediator masses of 1.5–4.0 TeV at 95% confidence level, depending on the other signal model parameters. To enhance the sensitivity of the search for this particular class of hidden sector models, a boosted decision tree (BDT) is trained using jet substructure variables to distinguish between semivisible jets and SM jets from background processes. When the BDT is employed to identify each jet in the dijet system as semivisible, the mediator mass exclusion increases to 5.1 TeV, for wider ranges of the other signal model parameters. These limits exclude a wide range of strongly coupled hidden sector models for the first time.

A search is presented for new particles produced at the LHC in proton-proton collisions at $$ \sqrt{s} $$ s = 13 TeV, using events with energetic jets and large missing transverse momentum. The analysis is based on a data sample corresponding to an integrated luminosity of 101 fb−1, collected in 2017–2018 with the CMS detector. Machine learning techniques are used to define separate categories for events with narrow jets from initial-state radiation and events with large-radius jets consistent with a hadronic decay of a W or Z boson. A statistical combination is made with an earlier search based on a data sample of 36 fb−1, collected in 2016. No significant excess of events is observed with respect to the standard model background expectation determined from control samples in data. The results are interpreted in terms of limits on the branching fraction of an invisible decay of the Higgs boson, as well as constraints on simplified models of dark matter, on first-generation scalar leptoquarks decaying to quarks and neutrinos, and on models with large extra dimensions. Several of the new limits, specifically for spin-1 dark matter mediators, pseudoscalar mediators, colored mediators, and leptoquarks, are the most restrictive to date.

Measurements of jet substructure describing the composition of quark- and gluon-initiated jets are presented. Proton-proton (pp) collision data at $$ \sqrt{s} $$ s = 13 TeV collected with the CMS detector are used, corresponding to an integrated luminosity of 35.9 fb−1. Generalized angularities are measured that characterize the jet substructure and distinguish quark- and gluon-initiated jets. These observables are sensitive to the distributions of transverse momenta and angular distances within a jet. The analysis is performed using a data sample of dijet events enriched in gluon-initiated jets, and, for the first time, a Z+jet event sample enriched in quark-initiated jets. The observables are measured in bins of jet transverse momentum, and as a function of the jet radius parameter. Each measurement is repeated applying a “soft drop” grooming procedure that removes soft and large angle radiation from the jet. Using these measurements, the ability of various models to describe jet substructure is assessed, showing a clear need for improvements in Monte Carlo generators.

A search for heavy neutral leptons (HNLs), the right-handed Dirac or Majorana neutrinos, is performed in final states with three charged leptons (electrons or muons) using proton-proton collision data collected by the CMS experiment at $$ \sqrt{s} $$ s = 13 TeV at the CERN LHC. The data correspond to an integrated luminosity of 138 fb−1. The HNLs could be produced through mixing with standard model neutrinos ν. For small values of the HNL mass (<20 GeV) and the square of the HNL-ν mixing parameter (10−7–10−2), the decay length of these particles can be large enough so that the secondary vertex of the HNL decay can be resolved with the CMS silicon tracker. The selected final state consists of one lepton emerging from the primary proton-proton collision vertex, and two leptons forming a displaced, secondary vertex. No significant deviations from the standard model expectations are observed, and constraints are obtained on the HNL mass and coupling strength parameters, excluding previously unexplored regions of parameter space in the mass range 1–20 GeV and squared mixing parameter values as low as 10−7.