Associations between daily step count trajectories and clinical outcomes among adults with comorbid obesity and depression

Purpose

To examine the relationship between features of daily measured step count trajectories and clinical outcomes among people with comorbid obesity and depression in the ENGAGE-2 Trial.

Methods

This post hoc analysis used data from the ENGAGE-2 trial where adults (n=106) with comorbid obesity (BMI ≥30.0 or 27.0 if Asian) and depressive symptoms (Patient Health Questionnaire-9 score ≥10) were randomized (2:1) to receive the experimental intervention or usual care. Daily step count trajectories over the first 60 days (Fitbit Alta HR) were characterized using functional principal component analyses. 7-day and 30-day trajectories were also explored. Functional principal component scores that described features of step count trajectories were entered into linear mixed models to predict weight (kg), depression (Symptom Checklist-20), and anxiety (Generalized Anxiety Disorder Questionnaire-7) at 2-months (2M) and 6-months (6M).

Results

Features of 60-day step count trajectories were interpreted as overall sustained high, continuous decline, and disrupted decline. Overall sustained high step count was associated with low anxiety (2M, β=-0.78, p<.05; 6M, β=-0.80, p<.05) and low depressive symptoms (6M, β=-0.15, p<.05). Continuous decline in step count was associated with high weight (2M, β=0.58, p<.05). Disrupted decline was not associated with clinical outcomes at 2M or 6M. Features of 30-day step count trajectories were also associated with weight (2M, 6M), depression (6M), and anxiety (2M, 6M); Features of 7-day step count trajectories were not associated with weight, depression, or anxiety at 2M or 6M.

Conclusions

Features of step count trajectories identified using functional principal component analysis were associated with depression, anxiety, and weight outcomes among adults with comorbid obesity and depression. Functional principal component analysis may be a useful analytic method that leverages daily measured physical activity levels to allow for precise tailoring of future behavioral interventions.

Hospital admissions in infants with Down syndrome: a record-linked population-based cohort study in Wales

BACKGROUND

Despite recent advances, mortality in children with Down syndrome remains five times higher than in the general population. This study aims to describe the burden, patterns and causes of hospital admissions in infants with Down syndrome, and compare this with infants without Down syndrome in a population-based cohort.

METHODS

This study used data from the Wales Electronic Cohort for Children, a cohort of all children born in Wales between 1990 and 2012. The cohort was generated from routine administrative data, linked to create an anonymised data set within the Secure Anonymised Information Linkage databank. This analysis is based on all infants born between January 2003 and January 2012 who were followed to their first birthday, a move out of Wales, death, or until 31 October 2012 (end of follow-up). Infants with Down syndrome were identified using the Congenital Anomaly Register and Information Service in Wales. Multivariable Cox regression was used to compare the time to first hospital admission. Admission codes were used to identify the commonest indications for hospitalisation and to determine the presence of other congenital anomalies.

RESULTS

We included 324 060 children, 356 of whom had Down syndrome. Of infants with Down syndrome, 80.3% had at least one hospital inpatient admission during the first year of life, compared with 32.9% of infants without Down syndrome. These first admissions were earlier [median of 6 days interquartile range (IQR) (3, 72) compared with 45 days [IQR 6, 166)] and longer [median of 4 days (IQR 1, 15) compared with 1 day (IQR 0, 3)] than in infants without Down syndrome. The most common causes of admissions were congenital abnormalities, respiratory diseases, conditions originating in the perinatal period and infectious diseases. The presence of other congenital abnormalities increased hospitalisations in all infants, but more so in infants with Down syndrome who spent a median of 21 days in hospital (IQR 11, 47) during their first year of life.

CONCLUSION

Infants with Down syndrome are at high risk for early, more frequent and longer hospital admissions. Congenital heart disease and respiratory infections remain a major burden in this population. More research is needed to understand how to better manage these conditions particularly in the first month of life when most admissions occur.

Linking a European cohort of children born with congenital anomalies to vital statistics and mortality records: A EUROlinkCAT study

EUROCAT is a European network of population-based congenital anomaly (CA) registries. Twenty-one registries agreed to participate in the EUROlinkCAT study to determine if reliable information on the survival of children born with a major CA between 1995 and 2014 can be obtained through linkage to national vital statistics or mortality records. Live birth children with a CA could be linked using personal identifiers to either their national vital statistics (including birth records, death records, hospital records) or to mortality records only, depending on the data available within each region. In total, 18 of 21 registries with data on 192,862 children born with congenital anomalies participated in the study. One registry was unable to get ethical approval to participate and linkage was not possible for two registries due to local reasons. Eleven registries linked to vital statistics and seven registries linked to mortality records only; one of the latter only had identification numbers for 78% of cases, hence it was excluded from further analysis. For registries linking to vital statistics: six linked over 95% of their cases for all years and five were unable to link at least 85% of all live born CA children in the earlier years of the study. No estimate of linkage success could be calculated for registries linking to mortality records. Irrespective of linkage method, deaths that occurred during the first week of life were over three times less likely to be linked compared to deaths occurring after the first week of life. Linkage to vital statistics can provide accurate estimates of survival of children with CAs in some European countries. Bias arises when linkage is not successful, as early neonatal deaths were less likely to be linked. Linkage to mortality records only cannot be recommended, as linkage quality, and hence bias, cannot be assessed.

Identifying children with Cystic Fibrosis in population-scale routinely collected data in Wales: A Retrospective Review

INTRODUCTION

The challenges in identifying a cohort of people with a rare condition can be addressed by routinely collected, population-scale electronic health record (EHR) data, which provide large volumes of data at a national level. This paper describes the challenges of accurately identifying a cohort of children with Cystic Fibrosis (CF) using EHR and their validation against the UK CF Registry.

OBJECTIVES

To establish a proof of principle and provide insight into the merits of linked data in CF research; to identify the benefits of access to multiple data sources, in particular the UK CF Registry data, and to demonstrate the opportunity it represents as a resource for future CF research.

METHODS

Three EHR data sources were used to identify children with CF born in Wales between 1st January 1998 and 31st August 2015 within the Secure Anonymised Information Linkage (SAIL) Databank. The UK CF Registry was later acquired by SAIL and linked to the EHR cohort to validate the cases and explore the reasons for misclassifications.

RESULTS

We identified 352 children with CF in the three EHR data sources. This was greater than expected based on historical incidence rates in Wales. Subsequent validation using the UK CF Registry found that 257 (73%) of these were true cases. Approximately 98.7% (156/158) of individuals identified as CF cases in all three EHR data sources were confirmed as true cases; but this was only the case for 19.8% (20/101) of all those identified in just a single data source.

CONCLUSION

Identifying health conditions in EHR data can be challenging, so data quality assurance and validation is important or the merit of the research is undermined. This retrospective review identifies some of the challenges in identifying CF cases and demonstrates the benefits of linking cases across multiple data sources to improve quality.

AB0076 SPATIAL VARIATIONS OF BONE MICROARCHITECTURE AND MINERALIZATION IN HIP OSTEOARTHRITIS AND OSTEOPOROSIS

Background:

The pattern of changes in bone microarchitecture and mineralisation are distinctly different in osteoarthritis (OA) and osteoporosis (OP). However, the pathogenesis of OA is closely related with OP, making subchondral bone a promising target for OA treatment [1]. A detailed comparison of subchondral bone in OA and OP may help understand the relationship of the two diseases.

Objectives:

To carry out a comprehensive analysis of regional and compartmental variations in subchondral bone architecture and mineralisation in OA and OP.

Methods:

Femoral heads were collected from patients undergoing hip arthroplasty surgeries for hip OA (N=16) or osteoporotic fracture (N=7). For OP group, osteochondral plugs were collected from fixed sites: anterior, posterior and superior. For OA group, an optimised sampling procedure, based on a new macroscopic grading method and modified OARSI microscopic grading system, was used to collect plugs from regions with varying severity of cartilage degradation. Plugs were scanned by micro CT (voxel size 4.88µm). Regions of interest for cortical plate (Ct) and trabecular bone (Tb) were segmented from reconstructed images using semi-automatic approach. Densitometric (tissue and bone mineral density: TMD and BMD) and architectural parameters (cortical plate thickness (Ct.Th), trabecular bone volume fraction (BV/TV), trabecular thickness (Tb.Th), etc.) were measured using commercially available software. Unmatched inter-group regional comparisons were made between OA microscopic grades (1 to 4) and OP. Matched intra-sample regional analysis was made between ‘mild’ (Grade 1 and/or 2) and ‘severe’ (Grade 3 and/or 4) OA. TMD was also subjected to paired comparison between cortical (Ct.TMD) and trabecular (Tb.TMD) compartments. Correlations between densitometric and architectural parameters were also explored.

Results:

Regional analysis showed that Tb.TMD in OA Grade 3 and 4 was significantly lower than in OP and Grade 1 and 2, while Tb.TMD in OP was not significantly different from OA Grade 1 and 2 (Fig 1A, F). Ct.TMD in OA Grade 4 was significantly lower than in OP, but no difference was found in other comparisons (Fig 1B, G). For BMD of trabecular bone (Tb.BMD) and architectural parameters including BV/TV and Ct.Th, values for OA Grade 3 and/or 4 were significantly higher than OP and Grade 1 and/or 2, but the difference between OP and Grade 1 and 2 was not significant (Fig 1C-E, H-J). Compartmental analysis showed that Ct.TMD was significantly lower than Tb.TMD in all groups (Table I). Tb.TMD was inversely correlated with Tb.BMD and BV/TV in both OA and OP; Ct.TMD and Tb.TMD were inversely associated with Ct.Th and Tb.Th respectively in OA (Table II).

Conclusion:

In both OA and OP, material density (TMD) of cortical plate was lower than trabecular bone. In hip OA, densitometric and architectural changes of subchondral cortical and trabecular bone were related to severity of cartilage degradation. In OA trabecular bone, the decrease in material density was compensated by increased bone volume, leading to higher apparent density (BMD); while in OP, loss of bone volume was correlated with, but not compensated by increased mineralisation, leading to lower apparent density.

References:

[1]Castaneda, S., et al. Biochem. Pharmacol., 2012

Table 1.

Compartmental comparison of TMD

OPOA Grade1234Ct.TMD1.19±0.071.18±0.091.15±0.061.16±0.061.12±0.07Tb.TMD1.34±0.06****1.37±0.10****1.33±0.07****1.22±0.06*1.19±0.09*Table 2.

Correlation analysis

OPOAPR2SlopePR2SlopeTb.TMD - BV/TV< 0.00010.69-0.01< 0.00010.84-0.01Tb.BMD - BV/TV< 0.00010.950.02< 0.00010.960.01Tb.BMD - Tb.TMD< 0.00010.60-1.25< 0.00010.81-1.37Ct.TMD - Ct.Thns0.00090.19-0.33Tb.TMD - Tb.Thns< 0.00010.55-1.97

Acknowledgments:

China Scholarship Council

Disclosure of Interests:

None declared

Group-works: exploring multiplex networks, leadership and group performance

Purpose

The purpose of this paper is to explore the effect of “multiplex” (multiple overlapping) networks and leadership on group performance in a higher education setting.

Design/methodology/approach

Using a combination of social network analysis and interviews, the authors employ a case study approach to map the connections between academic group members. This paper analyses the relationship between this mapping and academic performance.

Findings

The authors identified two dimensions which influence group effectiveness: multiplex networks and distributed–coordinated leadership. Where networks are built across tasks, inter-relationships develop that lead to greater group performance.

Practical implications

Where group members create a dense hive of interconnectivity and are active across all group tasks, and also informally, this increases the opportunity for knowledge sharing. When this is similarly experienced by a majority of group members, there is positive reinforcement, resulting in greater group effectiveness.

Originality/value

This paper highlights the importance of the richness of formal ties in knowledge-intensive settings. This paper is the first to differentiate between formal connections between colleagues related to different tasks within their role. This suggests that dense configurations of informal ties are insufficient; they must be coupled with strong ties around formal activity and demonstrative leadership.

Evaluation of Beef Steak Exudate Differing in Quality Grade and Post-Mortem Aging Time

ObjectivesEvaluate absorbance and metabolite differences of beef exudate from raw beef steaks differing in quality grade and post-mortem aging time.Materials and MethodsUSDA Select (SE; n = 18) and USDA Choice (CH; n = 18) beef strip loins were aged for 7d, cut into 2.54 cm thick steaks, and randomly assigned a post-mortem aging duration of either 10 or 20d post-mortem (n = 72 total). Steaks were individually packaged on d7 and frozen on the assigned day at –20°C until time for analysis. Steaks were thawed for 24h at 4°C before 2 mL of exudate was collected from each bag on removal of the steak. The exudate was frozen at –80°C until further analysis. For analysis of absorbance, 0.5 mL of thawed exudate was diluted with 4.5 mL ultra-pure water and centrifuged. Then, 200 μL of the dilution was pipetted in triplicated onto a 96 well plate. Absorbance was read at a range of 350–700nm wavelengths. A dilution of 1:20 beef exudate: ultra-pure water was filtered and used for metabolite analysis. Using a HILIC column, 5 μL were injected into an organic mobile phase gradient and analyzed using an Agilent 6545 LC/MS-QTOF in positive mode. Data were analyzed using a two-factorial design with quality grade and post-mortem day of aging as fixed effects with an α of 0.05. Loin was included as a random effect. Least squares means, correlations, and principal component analysis were used to discriminate data.ResultsCH exudate had greater (P < 0.05) absorbance than SE at wavelength ranges of 350–404, 423–467, and 491–508 nm. For the range of 350–598nm, CH exudate tended (P < 0.10) to have a greater absorbance than SE exudate. No differences (P > 0.05) were detected at all other wavelengths analyzed between quality grade. Post-mortem aging had no effect (P > 0.05) on wavelength absorbance. Of the total metabolites present (n = 33) in the samples, no differences (P > 0.05) were observed among fixed effects. Only three metabolites exhibited a twofold change in expression, observed as a downregulation from SE to CH exudate. With age, nearly two-thirds of the metabolites (n = 19) tended to increase in intensity. Tritriacontyl octacosanoate was unique to SE exudates.ConclusionBeef exudate tends to be influenced by quality grade more than post-mortem aging duration. Accordingly, exudate samples from raw steaks may be classified by quality grade no matter the duration of aging time.

Prevention of neural tube defects in the UK: a missed opportunity

OBJECTIVE

In 1991, the Medical Research Council (MRC) Vitamin Study demonstrated that folic acid taken before pregnancy and in early pregnancy reduced the risk of a neural tube defect (NTD). We aimed to estimate the number of NTD pregnancies that would have been prevented if flour had been fortified with folic acid in the UK from 1998 as it had been in the USA.

DESIGN

Estimates of NTD prevalence, the preventive effect of folic acid and the proportion of women taking folic acid supplements before pregnancy were used to predict the number of NTD pregnancies that would have been prevented if folic acid fortification had been implemented.

SETTING

Eight congenital anomaly registers in England and Wales.

MAIN OUTCOME MEASURES

The prevalence of pregnancies with an NTD in the UK and the number of these pregnancies that would have been prevented if folic acid fortification had been implemented.

RESULTS

From 1991 to 2012, the prevalence of NTD pregnancies was 1.28 (95% CI 1.24 to 1.31) per 1000 total births (19% live births, 81% terminations and 0.5% stillbirths and fetal deaths ≥20 weeks' gestation). If the USA levels of folic acid fortification from 1998 onwards had been adopted in the UK, an estimated 2014 fewer NTD pregnancies would have occurred.

CONCLUSIONS

Failure to implement folic acid fortification in the UK has caused, and continues to cause, avoidable terminations of pregnancy, stillbirths, neonatal deaths and permanent serious disability in surviving children.

Risk of congenital anomalies after exposure to asthma medication in the first trimester of pregnancy - a cohort linkage study

Objective

To examine the effect of maternal exposure to asthma medications on the risk of congenital anomalies.

Design

Meta‐analysis of aggregated data from three cohort studies.

Setting

Linkage between healthcare databases and EUROCAT congenital anomaly registries.

Population

519 242 pregnancies in Norway (2004–2010), Wales (2000–2010) and Funen, Denmark (2000–2010).

Methods

Exposure defined as having at least one prescription for asthma medications issued (Wales) or dispensed (Norway, Denmark) from 91 days before to 91 days after the pregnancy start date. Odds ratios (ORs) were estimated separately for each register and combined in meta‐analyses.

Main outcome measures

ORs for all congenital anomalies and specific congenital anomalies.

Results

Overall exposure prevalence was 3.76%. For exposure to asthma medication in general, the adjusted OR (adjOR) for a major congenital anomaly was 1.21 (99% CI 1.09–1.34) after adjustment for maternal age and socioeconomic position. The OR of anal atresia was significantly increased in pregnancies exposed to inhaled corticosteroids (3.40; 99% CI 1.15–10.04). For severe congenital heart defects, an increased OR (1.97; 1.12–3.49) was associated with exposure to combination treatment with inhaled corticosteroids and long‐acting beta‐2‐agonists. Associations with renal dysplasia were driven by exposure to short‐acting beta‐2‐agonists (2.37; 1.20–4.67).

Conclusion

The increased risk of congenital anomalies for women taking asthma medication is small with little confounding by maternal age or socioeconomic status. The study confirmed the association of inhaled corticosteroids with anal atresia found in earlier research and found potential new associations with combination treatment. The potential new associations should be interpreted with caution due to the large number of comparisons undertaken.

Tweetable abstract

This cohort study found a small increased risk of congenital anomalies for women taking asthma medication.

This cohort study found a small increased risk of congenital anomalies for women taking asthma medication.

Abstract LB-088: Ptch1 heterozygosity predisposes mice to developing IR-induced BCCs

Basal cells nevus syndrome (BCNS, Gorlin syndrome) patients carry heterozygous germline mutations in PATCHED1 (PTCH1) gene, which encodes a receptor of hedgehog (HH) ligands and represses HH signaling in the absence of ligands. Mutated PTCH1 leads to aberrant activation of the HH signaling pathway, which is the pivotal driver underlying BCC carcinogenesis in both sporadic and BCNS BCCs. BCNS (PTCH1+/-) individuals are very susceptible to developing more BCCs at an earlier age but the mechanism for this genetic predisposition to BCCs remains elusive. In this study, we assessed how heterozygosity of the murine Ptch1 gene contributes to IR-induced BCC carcinogenesis.

Specifically, we treated Ptch1fl/+ K14CreER2 mice with tamoxifen either at age 4 weeks (group A) or at 9 weeks (group B) to delete one copy of Ptch1 in K14-expressing keratinocytes. We irradiated both groups of mice with IR at mouse age 8 weeks so that at the time of IR, keratinocytes in group A mice, like those in BCNS patients, were Ptch1+/-, and mice in group B remained Ptch1+/+ but subsequent to recovery from acute damage all mice had Ptch1+/- keratinocytes. We found that mice in both groups developed similar amounts of microscopic BCCs at age either 7- or 9-months. However, only mice of group A (3 out of 13 mice) developed visible BCCs; none of the mice of group B (n = 30) developed visible BCCs by age 18-months, the longest time point monitored based on our studies of Ptch1+/- mice. The difference is statistically significant (p = 0.03). Histologically, these visible BCCs closely resemble human BCCs. This finding indicates (i) that heterozygosity of the Ptch1 gene limited to keratinocytes (without gene deletion in stromal cells) is sufficient to produce susceptibility to IR-induced visible BCC development and (ii) surprisingly that heterozygosity of the Ptch1 gene during acute mutagenic damage dramatically increases eventual conversion of microscopic to visible BCCs, probably by affecting acute repair of this damage. To gain further insights into this possible mechanism, we are culturing keratinocytes from these mice and performing cell cycle and apoptosis analysis upon IR treatment in vitro.

Citation Format: Grace Y. Wang, Eileen Libove, Danielle Tucker, Ervin Epstein. Ptch1 heterozygosity predisposes mice to developing IR-induced BCCs. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr LB-088. doi:10.1158/1538-7445.AM2015-LB-088

Wide-Field Lensing Mass Maps from Dark Energy Survey Science Verification Data

We present a mass map reconstructed from weak gravitational lensing shear measurements over 139  deg2 from the Dark Energy Survey science verification data. The mass map probes both luminous and dark matter, thus providing a tool for studying cosmology. We find good agreement between the mass map and the distribution of massive galaxy clusters identified using a red-sequence cluster finder. Potential candidates for superclusters and voids are identified using these maps. We measure the cross-correlation between the mass map and a magnitude-limited foreground galaxy sample and find a detection at the 6.8σ level with 20 arc min smoothing. These measurements are consistent with simulated galaxy catalogs based on N-body simulations from a cold dark matter model with a cosmological constant. This suggests low systematics uncertainties in the map. We summarize our key findings in this Letter; the detailed methodology and tests for systematics are presented in a companion paper.

Implications of targeted versus universal admission screening for meticillin-resistant Staphylococcus aureus carriage in a London hospital

Universal admission screening for meticillin-resistant Staphylococcus aureus (MRSA) has been performed in England since 2010. We evaluated the predictive performance of a regression model derived from the first year of universal screening for detecting MRSA at hospital admission. If we had used our previous targeted screening policy, 75% fewer patients (21,699 per year) would have been screened. However, this would have identified only ~55% of all MRSA carriers, 65% of healthcare-associated MRSA strains, and 40% of community-associated strains. Failing to identify ~45% of patients (262 per year) carrying MRSA at hospital admission may have implications for MRSA control.

One cancer destroys another: short report of a myeloid sarcoma causing ischaemic necrosis of an adenocarcinoma

We present a highly unusual case and histological images of a patient who underwent complete resection of a perforated caecal adenocarcinoma caused by angiodestruction of the proximal vasculature by a distinct acute myeloid infiltrate. Both tumours were removed in their entirety at one visit to theatre and the patient remains well and in remission 18 months later.

Trends in the prevalence, risk and pregnancy outcome of multiple births with congenital anomaly: a registry-based study in 14 European countries 1984-2007

OBJECTIVE

To assess the public health consequences of the rise in multiple births with respect to congenital anomalies.

DESIGN

Descriptive epidemiological analysis of data from population-based congenital anomaly registries.

SETTING

Fourteen European countries.

POPULATION

A total of 5.4 million births 1984-2007, of which 3% were multiple births.

METHODS

Cases of congenital anomaly included live births, fetal deaths from 20 weeks of gestation and terminations of pregnancy for fetal anomaly.

MAIN OUTCOME MEASURES

Prevalence rates per 10,000 births and relative risk of congenital anomaly in multiple versus singleton births (1984-2007); proportion prenatally diagnosed, proportion by pregnancy outcome (2000-07). Proportion of pairs where both co-twins were cases.

RESULTS

Prevalence of congenital anomalies from multiple births increased from 5.9 (1984-87) to 10.7 per 10,000 births (2004-07). Relative risk of nonchromosomal anomaly in multiple births was 1.35 (95% CI 1.31-1.39), increasing over time, and of chromosomal anomalies was 0.72 (95% CI 0.65-0.80), decreasing over time. In 11.4% of affected twin pairs both babies had congenital anomalies (2000-07). The prenatal diagnosis rate was similar for multiple and singleton pregnancies. Cases from multiple pregnancies were less likely to be terminations of pregnancy for fetal anomaly, odds ratio 0.41 (95% CI 0.35-0.48) and more likely to be stillbirths and neonatal deaths.

CONCLUSIONS

The increase in babies who are both from a multiple pregnancy and affected by a congenital anomaly has implications for prenatal and postnatal service provision. The contribution of assisted reproductive technologies to the increase in risk needs further research. The deficit of chromosomal anomalies among multiple births has relevance for prenatal risk counselling.