Transcriptomic and developmental effects of persistent organic pollutants in sentinel fishes collected near an arctic formerly used defense site

Alaska contains over 600 formerly used defense (FUD) sites, many of which serve as point sources of pollution. These sites are often co-located with rural communities that depend upon traditional subsistence foods, especially lipid-rich animals that bioaccumulate and biomagnify persistent organic pollutants (POPs). Many POPs are carcinogenic and endocrine-disrupting compounds that are associated with adverse health outcomes. Therefore, elevated exposure to POPs from point sources of pollution may contribute to disproportionate incidence of disease in arctic communities. We investigated PCB concentrations and the health implications of POP exposure in sentinel fishes collected near the Northeast Cape FUD site on Sivuqaq (St. Lawrence Island), Alaska. Sivuqaq residents are almost exclusively Yupik and rely on subsistence foods. At the request of the Sivuqaq community, we examined differential gene expression and developmental pathologies associated with exposure to POPs originating at the Northeast Cape FUD site. We found significantly higher levels of PCBs in Alaska blackfish (Dallia pectoralis) collected from contaminated sites downstream of the FUD site compared to fish collected from upstream reference sites. We compared transcriptomic profiles and histopathologies of these same blackfish. Blackfish from contaminated sites overexpressed genes involved in ribosomal and FoxO signaling pathways compared to blackfish from reference sites. Contaminated blackfish also had significantly fewer thyroid follicles and smaller pigmented macrophage aggregates. Conversely, we found that ninespine stickleback (Pungitius pungitius) from contaminated sites exhibited thyroid follicle hyperplasia. Despite our previous research reporting transcriptomic and endocrine differences in stickleback from contaminated vs. reference sites, we did not find significant differences in kidney or gonadal histomorphologies. Our results demonstrate that contaminants from the Northeast Cape FUD site are associated with altered gene expression and thyroid development in native fishes. These results are consistent with our prior work demonstrating disruption of the thyroid hormone axis in Sivuqaq residents.

Implementation of Video Blood Pressure Visits in the Veterans Health Administration

Introduction: Almost half of veterans (44.6%) seen in the U.S. Department of Veterans Affairs outpatient setting are diagnosed with hypertension (HTN). Because of the widespread nature of HTN, use of virtual visits has the potential to improve blood pressure (BP) management. This evaluation assessed the effectiveness of video blood pressure visits (VBPVs) in the management of HTN in veterans enrolled in Veterans Health Administration primary care. Methods: The program was implemented within the existing veteran-centered medical home. VBPVs are scheduled where the nurse observes veterans taking their BP and provides teaching or counseling. A national training curriculum was delivered to local nurse champions through Microsoft Teams. We analyzed improvement in BP over a 2-year period. We also captured actions taken by nurses during the VBPV by searching the electronic notes. Ratings of training and comments were summarized using feedback forms completed after training. Results: In total, 81,476 veterans participated in VBPVs over 2 years. Of those, 44,682 veterans had an existing ICD-10 code related to HTN. Of the 18,078 veterans who had a pre- and post-VBPV BP, the average change to systolic measurement was -10.6 mm Hg (range -82 to 78). Average change to diastolic measurement was -4.61 mm Hg (range -59 to 55). Most interventions addressed medication management (77%). Nurses' evaluations of the program were positive. Conclusions: Video visits provide reliable and convenient veteran-centered care. Such visits enable care when unanticipated interruptions occur such as the coronavirus disease 2019 pandemic. In addition to medication management, nurse-led interventions such as counseling on lifestyle changes can be effective in HTN management.

Improved adherence to hip fracture standards reduces mortality after hip fractures

BACKGROUND

Hip fractures are increasing in incidence due to increasing life expectancy. Mortality continues to improve but it is important to explore which factors are responsible for driving improvements.

METHODS

A cohort of hip fracture patients predating SARS-CoV-2 was examined to determine the predictors of adherence to the six Irish Hip Fracture Standards (IHFS) and the impact of adherence on short (30 day) and long term (1 year) mortality. Our primary aim was assess the impact of a single HFS and cumulative number of HFS on mortality after hip fracture. Our secondary aim was to determine the impact of the HFS which are intrinsically linked to specialist Geriatric care.

RESULTS

Across 962 patients, over 5 years, the factors which were associated with adherence to HFS were female gender, increasing ASA grade and being nursed on an orthopaedic ward. Patients with increasing ASA were more likely to have met HFS 4-6 (Geriatrician review HFS4, bone health HFS5 & specialist falls assessment HFS6), less likely to have surgery within 48 h are more likely to develop a pressure ulcer. If the patient was not nursed on an orthopaedic ward all HFS were less likely to be met. At 30 days HFS 4-6 were associated with a statistically significant odds ratio (OR) of being alive, while at one year HFS 1 (admitted to an orthopaedic ward within 4 h), 5 and 6 were associated with a statistically significant OR of being alive. As increasing numbers of hip fracture standards were met patients were more likely to be alive at 30 days and one year.

CONCLUSION

This study has identified that improved adherence to hip fracture standards are associated with improved mortality at 30 days and one year.

Differential gene expression and developmental pathologies associated with persistent organic pollutants in sentinel fish in Troutman Lake, Sivuqaq, Alaska

Persistent organic pollutants (POPs) are lipophilic compounds that bioaccumulate in animals and biomagnify within food webs. Many POPs are endocrine disrupting compounds that impact vertebrate development. POPs accumulate in the Arctic via global distillation and thereby impact high trophic level vertebrates as well as people who live a subsistence lifestyle. The Arctic also contains thousands of point sources of pollution, such as formerly used defense (FUD) sites. Sivuqaq (St. Lawrence Island), Alaska was used by the U.S. military during the Cold War and FUD sites on the island remain point sources of POP contamination. We examined the effects of POP exposure on ninespine stickleback (Pungitius pungitius) collected from Troutman Lake in the village of Gambell as a model for human exposure and disease. During the Cold War, Troutman Lake was used as a dump site by the U.S. military. We found that PCB concentrations in stickleback exceeded the U.S. Environmental Protection Agency's guideline for unlimited consumption despite these fish being low trophic level organisms. We examined effects at three levels of biological organization: gene expression, endocrinology, and histomorphology. We found that ninespine stickleback from Troutman Lake exhibited suppressed gonadal development compared to threespine stickleback (Gasterosteus aculeatus) studied elsewhere. Troutman Lake stickleback also displayed two distinct hepatic phenotypes, one with lipid accumulation and one with glycogen-type vacuolation. We compared the transcriptomic profiles of these liver phenotypes using RNA sequencing and found significant upregulation of genes involved in ribosomal and metabolic pathways in the lipid accumulation group. Additionally, stickleback displaying liver lipid accumulation had significantly fewer thyroid follicles than the vacuolated phenotype. Our study and previous work highlight health concerns for people and wildlife due to pollution hotspots in the Arctic, and the need for health-protective remediation.

Diffusive fluxes of persistent organic pollutants between Arctic atmosphere, surface waters and sediments

Arctic communities are disproportionately exposed to pollutants from sources including global atmospheric transport and formerly used defense sites (FUDS). The effects of climate change and increasing development in the Arctic have the potential to exacerbate this problem. Yupik People of Sivuqaq, or St Lawrence Island, Alaska are one such community with documented exposures to pollutants from FUDS, and their traditional lipid-rich foods such as blubber and rendered oils of marine mammals. Troutman Lake, adjacent to the Yupik community of Gambell, Alaska, was used as a disposal site during the decommission of the adjacent FUDS, leading to community concern about exposure to military pollution and intrusion from historic local dump sites. In collaboration with a local community group, this study utilized passive sampling devices deployed in Troutman Lake. Air, water and sediment deployed samplers were analyzed for unsubstituted and alkylated polycyclic aromatic hydrocarbons (PAHs), brominated and organophosphate flame retardants and polychlorinated biphenyls (PCBs). PAH concentrations were low and comparable to other remote/rural locations. PAHs were generally in deposition from the overlying atmosphere into Troutman Lake. Of the flame retardants, brominated diphenyl ether-47 was detected in all surface water samplers while triphenyl phosphate was detected in all environmental compartments. Both were at concentrations equivalent or lower than other remote locations. Of particular interest, we measured higher atmospheric concentrations of tris(2-chloroethyl) phosphate (TCEP) (0.75-2.8 ng/m3) than previously reported in the literature for remote Arctic sites (<0.017-0.56 ng/m3). TCEP was found to be in deposition to Troutman Lake at magnitudes from 290 to 1300 ng/m2/day. No PCBs were detected in this study. Our findings demonstrate the relevance of both modern and legacy chemicals from local and global sources. These results help us to understand the fate of anthropogenic contaminants in dynamic Arctic systems providing valuable data for communities, policy makers and scientists.

Effect of swab pooling on the Accula point-of-care RT-PCR for SARS-CoV-2 detection

Introduction

Swab pooling may allow for more efficient use of point-of-care assays for SARS-CoV-2 detection in settings where widespread testing is warranted, but the effects of pooling on assay performance are not well described.

Methods

We tested the Thermo-Fisher Accula rapid point-of-care RT-PCR platform with contrived pooled nasal swab specimens.

Results

We observed a higher limit of detection of 3,750 copies/swab in pooled specimens compared to 2,250 copies/swab in individual specimens. Assay performance appeared worse in a specimen with visible nasal mucous and debris, although performance was improved when using a standard laboratory mechanical pipette compared to the transfer pipette included in the assay kit.

Conclusion

Clinicians and public health officials overseeing mass testing efforts must understand limitations and benefits of swab or sample pooling, including reduced assay performance from pooled specimens. We conclude that the Accula RT-PCR platform remains an attractive candidate assay for pooling strategies owing to the superior analytical sensitivity compared to most home use and point-of-care tests despite the inhibitory effects of pooled specimens we characterized.

Monitoring plasma nucleosome concentrations to measure disease response and progression in dogs with hematopoietic malignancies

BACKGROUND

Hematopoietic malignancies are extremely common in pet dogs and represent nearly 30% of the malignancies diagnosed in this population each year. Clinicians commonly use existing tools such as physical exam findings, radiographs, ultrasound and baseline blood work to monitor these patients for treatment response and remission. Circulating biomarkers, such as prostate specific antigen or carcinoembryonic antigen, can be useful tools for monitoring treatment response and remission status in human cancer patients. To date, there has a been a lack of useful circulating biomarkers available to veterinary oncology patients.

METHODS

Circulating plasma nucleosome concentrations were evaluated at diagnosis, throughout treatment and during remission monitoring for 40 dogs with lymphoma, acute myelogenous leukemia and multiple myeloma. Additionally, C-reactive protein and thymidine kinase-1 levels were recorded.

RESULTS

Plasma nucleosome concentrations were significantly higher at diagnosis and progressive disease than they were when dogs were in remission. All but two dogs had plasma nucleosome concentrations that returned to the low range during treatment. These two dogs had the shortest progression free and overall survival times. Dogs with the highest plasma nucleosome concentrations had a significantly shorter first progression free survival than dogs with lower plasma nucleosome concentrations at diagnosis. Plasma nucleosome concentrations correlated better with disease response and progression than either thymidine kinase or C reactive protein.

CONCLUSIONS

Plasma nucleosome concentrations can be a useful tool for treatment monitoring and disease progression in dogs with hematopoietic malignancies.

Temperature-controlled Laminar Airflow (TLA) in symptomatic severe asthma – a post hoc analysis of severe exacerbations, quality of life and health economics

Purpose

Uncontrolled severe asthma constitutes a major economic burden to society. Add-ons to standard inhaled treatments include inexpensive oral corticosteroids and expensive biologics. Nocturnal treatment with Temperature-controlled Laminar Airflow (TLA; Airsonett®) could be an effective, safe and cheaper alternative. The potential of TLA in reducing severe asthma exacerbations was addressed in a recent randomised placebo-controlled trial (RCT) in patients with severe asthma (Global Initiative for Asthma (GINA) step 4/5), but the results were inconclusive. We re-analysed the RCT with severe exacerbations stratified by the level of baseline asthma symptoms and Quality of Life.

Methods

More uncontrolled patients, defined by Asthma Control Questionnaire 7 (ACQ7) > 3, EuroQoL 5-Dimension Questionnaire Visual Analogue Scale (EQ5D-VAS) ≤ 65 and Asthma Quality of Life Questionnaire (AQLQ) ≤ 4 were selected for re-analysis. The rates of severe asthma exacerbations, changes in QoL and health-economics were analysed and compared between TLA and placebo.

Results

The study population included 226 patients (113 TLA / 113 placebo.) The rates of severe asthma exacerbations were reduced by 33, 31 and 25% (p = 0.083, 0.073, 0.180) for TLA compared to placebo, dependent on selected control measures (ACQ7, EQ5D-VAS, AQLQ, respectively). For patients with less control defined by AQLQ≤4, the difference in mean AQLQ0-12M between TLA and placebo was 0.31, 0.33, 0.26 (p = 0.085, 0.034, 0.150), dependent on selected covariate (AQLQ, EQ5D-VAS, ACQ7, respectively). For patients with poor control defined by ACQ7 > 3, the difference in EQ5D-5 L utility scores between TLA and placebo was significant at 9 and 12 months with a cost-effective ICER. The results from the original study did not demonstrate these differences.

Conclusion

This post hoc analysis demonstrated an effect of TLA over placebo on severe exacerbations, asthma control and health economics in a subgroup of patients with more symptomatic severe allergic asthma. The results are consistent with the present recommendations for TLA. However, these differences were not demonstrated in the full study. Several explanations for the different outcomes have been outlined, which should be addressed in future studies.

Funding

NIHR Health Technology Assessment Programme and Portsmouth Hospitals NHS Trust.

PFAS and PBDEs in traditional subsistence foods from Sivuqaq, Alaska

The Arctic is a hemispheric sink for both legacy and current use persistent organic pollutants (POPs). Once in the Arctic, POPs biomagnify in food webs, potentially reaching concentrations in high trophic level animals that pose a health concern for people who subsist on those animals. Indigenous Peoples of the Arctic may be highly exposed to POPs through their traditional diets. The objective of this study was to assess concentrations of polybrominated diphenyl ethers (PBDEs) and per- and polyfluoroalkyl substances (PFAS) in tissues of traditionally harvested foods from Sivuqaq (St. Lawrence Island), Alaska. Community health researchers identified volunteer households and local hunters to donate tissues from traditionally harvested animals. Target species included bowhead whale (Balaena mysticetus), Pacific walrus (Odobenus rosmarus), ringed seal (Pusa hispida), bearded seal (Erignathus barbatus), ribbon seal (Histriophoca fasciata), spotted seal (Phoca largha), and reindeer (Rangifer tarandus). PBDEs were frequently detected in all species and tissues. PBDE concentrations tended to be highest in lipid-rich tissues of seals. PFAS were infrequently detected and did not show obvious patterns among species or tissues. This and other studies demonstrate that POPs such as PBDEs are present in tissues of traditional food animals from Sivuqaq, as they are throughout the Arctic, and consumption of these animals likely contributes to exposure among Arctic Indigenous Peoples.

147 ESTABLISHING A PERI-OPERATIVE MEDICAL SERVICE (POMS) FOR OLDER PEOPLE IN UROLOGY

Background

Older adults account for approximately 65% of patients undergoing urological procedures therefore as the population ages the demand is anticipated to rise. The benefits of Comprehensive Geriatric Assessment (CGA) have been proven in ortho-geriatrics and a number of surgical specialties but evidence in urology is lacking. The aim of this study was to assess the impact of a Peri-Operative Medical Service for older people (POMS) on patient outcomes in a urology inpatient population.

Methods

This was a single-centre retrospective study of patients ≥50 years with length of stay (LOS) &gt;1 day admitted over two four month periods in 2018 (Pre-intervention) and 2019 (Intervention). Group differences in LOS and complications were examined using univariate regressions and then adjusted for sex, emergency admission, severity of procedure and Charlson Co-morbidity Index which also accounts for age. Secondary outcomes were to record undiagnosed medical conditions identified and the interventions made by the POMS.

Results

There were a total of 218 admissions from 211 patients with equal numbers of admissions in both the pre-intervention and intervention groups. No significant differences were detected for LOS (median 3 vs 4 days, p=0.11) or complications (32(29%) vs 40(37%), p=0.23) between pre-intervention and intervention groups. A new medical diagnosis was made in 13 (12%) of the pre-intervention v 43(39%) of the intervention group (p&lt;0.001). The POMS recommended a change to management in 102 admissions (94%). The most common intervention was medication review: 64(59%) v 19(17%) (p&lt;0.001).

Conclusion

The Peri-Operative Medical Service for older people can improve patient management by identifying and managing medical issues, complications and geriatric syndromes that may otherwise have been missed.

Developing a novel co-produced methodology to understand 'real-world' help-seeking in online peer-peer communities by young people experiencing emotional abuse and neglect

BACKGROUND

Recent systematic reviews suggest mediating factors (barriers and facilitators) of help-seeking for children and young people (CYP) with a range of mental health problems but highlight the need for a more robust methodology underpinned by theoretical frameworks. Emotional abuse and neglect is the most prevalent and pervasive form of abuse, with many CYP remaining unknown to professional services. These CYP are underrepresented in help-seeking research yet seek help from their peers via anonymous online publicly available message communities.

OBJECTIVES

To sensitively co-develop qualitative methodology to explore 'real-world' data to inform our understanding of help-seeking for these CYP, and define potential mediators (barriers and facilitators) and mechanisms of change associated with online peer support.

METHODS

Co-production with 10 young co-researchers (YCoR; aged 14-18 years) from the NeurOX Young People's Advisory Group (YPAG) included co-development and triangulation to apply different research methods (i.e., interpretative phenomenological, thematic and conversation analyses) to analyse rich ethnographic material from 20 publicly available online message conversations between help-seekers experiencing or questioning emotional abuse and neglect. A theoretical model of adolescent help-seeking proposed by Rickwood et al. was used as a conceptual framework to guide methodological development.

RESULTS

The methodological approach facilitated the identification of barriers and facilitators of help-seeking contextualized to the lives of these CYP: understanding and validating of abuse, emotional competence, fears and uncertainties around disclosure, knowledge, motivational factors and connection/trusted relationships. Notably, positive changes in expressed or perceived 'psychological state' and/or intention to seek help were noticed in 9 of 10 message threads that included a 'conversation' (≥3 posts). Themes associated with change related to connection with supportive peers; compassionate responding and the safeness of the online community. The existing adolescent help-seeking model was found to be too simplistic to account for help-seeking associated with emotional abuse and neglect.

CONCLUSION

The novel methodological approach offers a meaningful way to explore 'real-world' data with YCoR, for a population underrepresented in help-seeking research. Proposed relational mechanisms involve connection, compassion and online communities. Further research coproduced with YCoR with diverse care experiences and characteristics is required to upscale the methodology and further validate and extend the findings.

PUBLIC CONTRIBUTION

The core study was co-produced with 10 YCoRs from the NeurOX YPAG who have been involved in over 135 h on and offline work. Their roles involved co-deciding the direction of the study, evolving methodology, detailed co-analysis and reflective processes throughout all aspects of the study, interpretation, presentation and discussion of the findings with the NSPCC and Childline, and involvement in all communications. Additional consultation and involvement included further interested members of the NeurOX YPAG for the final online workshop and dissemination outputs.

Evaluation of plasma nucleosome concentrations in dogs with a variety of common cancers and in healthy dogs

Background

Cell free DNA, in the form of nucleosomes, is released into circulation during apoptosis and necrosis in a variety of diseases. They are small fragments of chromosomes that are composed of DNA wrapped around a histone core made of four duplicate histone proteins forming an octamer. The nucleosome compartment is a relatively uninvestigated area of circulating tumor biomarkers in dogs. The objectives of this study were to quantify and better characterize nucleosome concentrations in 528 dogs with various common malignancies and compare them to 134 healthy dogs.

Results

The sensitivity of increased circulating nucleosome concentrations for the detection of cancer in all dogs was 49.8% with a specificity of 97% with an area under the curve of 68.74%. The top 4 malignancies detected by the test included lymphoma, hemangiosarcoma, histiocytic sarcoma and malignant melanoma. The malignancies least likely to be detected were soft tissue sarcomas, osteosarcoma and mast cell tumors.

Conclusions

A variety of tumor types may cause increased nucleosome concentrations in dogs. Tumors of hematopoietic origin are most likely to cause elevations and local tumors such as soft tissue sarcomas are least likely to cause elevations in plasma nucleosome concentrations.

PFAS in drinking water and serum of the people of a southeast Alaska community: A pilot study

Per- and polyfluoroalkyl substances (PFAS) have become a target of rigorous scientific research due to their ubiquitous nature and adverse health effects. However, there are still gaps in knowledge about their environmental fate and health implications. More attention is needed for remote locations with source exposures. This study focuses on assessing PFAS exposure in Gustavus, a small Alaska community, located near a significant PFAS source from airport operations and fire training sites. Residential water (n = 25) and serum (n = 40) samples were collected from Gustavus residents and analyzed for 39 PFAS compounds. In addition, two water samples were collected from the previously identified PFAS source near the community. Fourteen distinct PFAS were detected in Gustavus water samples, including 6 perfluorinated carboxylic acids (PFCAs), 7 perfluorosulfonic acids (PFSAs), and 1 fluorotelomer sulfonate (FTS). ΣPFAS concentrations in residential drinking water ranged from not detected to 120 ng/L. High ΣPFAS levels were detected in two source samples collected from the Gustavus Department of Transportation (14,600 ng/L) and the Gustavus Airport (228 ng/L), confirming these two locations as a nearby major source of PFAS contamination. Seventeen PFAS were detected in serum and ΣPFAS concentrations ranged from 0.0170 to 13.1 ng/mL (median 0.0823 ng/mL). Perfluorooctanesulfonic acid (PFOS) and perfluorohexanesulfonic acid (PFHxS) were the most abundant PFAS in both water and serum samples and comprised up to 70% of ΣPFAS concentrations in these samples. Spearman's correlation analysis revealed PFAS concentrations in water and sera were significantly and positively correlated (r = 0.495; p = 0.0192). Our results confirm a presence of a significant PFAS source near Gustavus, Alaska and suggest that contaminated drinking water from private wells contributes to the overall PFAS body burden in Gustavus residents.

Elevated mercury and PCB concentrations in Dolly Varden (Salvelinus malma) collected near a formerly used defense site on Sivuqaq, Alaska

Environmental pollution causes adverse health effects in many organisms and contributes to health disparities for Arctic communities that depend on subsistence foods, including the Yupik residents of Sivuqaq (St. Lawrence Island), Alaska. Sivuqaq's proximity to Russia made it a strategic location for U.S. military defense sites during the Cold War. Two radar surveillance stations were installed on Sivuqaq, including at the Northeast Cape. High levels of persistent organic pollutants and toxic metals continue to leach from the Northeast Cape formerly used defense (FUD) site despite remediation efforts. We quantified total mercury (Hg) and polychlorinated biphenyl (PCB) concentrations, and carbon and nitrogen stable isotope signatures, in skin and muscle samples from Dolly Varden (Salvelinus malma), an important subsistence species. We found that Hg and PCB concentrations significantly differed across locations, with the highest concentrations found in fish collected near the FUD site. We found that 89% of fish collected from near the FUD site had Hg concentrations that exceeded the U.S. Environmental Protection Agency's (EPA) unlimited Hg-contaminated fish consumption screening level for subsistence fishers (0.049 μg/g). All fish sampled near the FUD site exceeded the EPA's PCB guidelines for cancer risk for unrestricted human consumption (0.0015 μg/g ww). Both Hg and PCB concentrations had a significant negative correlation with δ¹³C when sites receiving input from the FUD site were included in the analysis, but these relationships were insignificant when input sites were excluded. δ¹⁵N had a significant negative correlation with Hg concentration, but not with PCB concentration. These results suggest that the Northeast Cape FUD site remains a point source of Hg and PCB pollution and contributes to higher concentrations in resident fish, including subsistence species. Moreover, elevated Hg and PCB levels in fish near the FUD site may pose a health risk for Sivuqaq residents.

OP0297 EFFICACY AND SAFETY OF ROMOSOZUMAB AMONG POSTMENOPAUSAL WOMEN WITH OSTEOPOROSIS AND MILD-TO-MODERATE CHRONIC KIDNEY DISEASE

Background:

Osteoporosis and renal insufficiency are coexisting disease states in a substantial proportion of postmenopausal women. Since bisphosphonates are generally contraindicated in patients with estimated glomerular filtration rate (eGFR) <35 mL/min, it is important to evaluate other osteoporosis treatments in this setting.

Objectives:

To determine if baseline renal function affects the efficacy and safety of romosozumab.

Methods:

We performed post hoc analyses of two clinical trials of romosozumab in postmenopausal women with osteoporosis. In ARCH (NCT01631214), 4,093 patients were randomised 1:1 to romosozumab 210 mg monthly or alendronate 70 mg weekly for 12 months (mean age: 74.3 years; 96.1% with prevalent vertebral fractures [VFx]). In FRAME (NCT01575834), 7,180 patients were randomised 1:1 to romosozumab 210 mg or placebo monthly for 12 months (mean age: 70.9 years; 18.3% with prevalent VFx). For these analyses, patients were categorised by baseline eGFR (mL/min/1.73m2): normal renal function (eGFR ≥90), mild renal insufficiency (eGFR 60–89), or moderate renal insufficiency (eGFR 30–59). Least squares mean (LSM) percent change from baseline in bone mineral density (BMD) at the lumbar spine, total hip, and femoral neck; incidence of new VFx and adverse events (AEs); and changes in renal function were assessed for each eGFR category at Month 12 of the double-blind treatment period.

Results:

At baseline, most patients had mild/moderate renal insufficiency: 84% in ARCH, 88% in FRAME. In both studies, change from baseline in BMD was significantly higher in the romosozumab group across baseline eGFR categories (Figure). There was an interaction between BMD increase and renal function, and although BMD increase was not as large in women with impaired renal function, differences between romosozumab and control groups remained significant (Figure). In ARCH, among patients with eGFR ≥90, 60–89, and 30–59, the incidence of new VFx (romosozumab vs alendronate) at Month 12 was 3.3% vs 7.3%, 3.2% vs 3.9%, and 3.4% vs 6.2% in ARCH. In FRAME, the incidence of new VFx (romosozumab vs placebo) at Month 12 was 0.5% vs 3.0%, 0.4% vs 1.5%, and 0.6% vs 2.1%.

In both studies, the incidences of AEs and serious AEs were similar in both treatment groups within and across eGFR categories. AEs of mild-to-moderate hypocalcaemia (investigator reported) occurred in two patients in ARCH (one romosozumab [eGFR 60–89] and one alendronate [eGFR ≥90]), and one patient in FRAME (romosozumab [eGFR 60–89]). Five patients in ARCH (all in the alendronate group) and 19 patients in FRAME (14 romosozumab, 5 placebo) had decreases in serum Ca levels (albumin adjusted); in the romosozumab group all were mild (<LLN–8.0 mg/dL) or moderate (<8.0–7.0 mg/dL). A similar percentage of patients in each group had changes in renal function over 12 months of treatment.

Conclusion:

The efficacy and safety of romosozumab vs alendronate or placebo was similar among postmenopausal women with osteoporosis and different levels of renal function.

Acknowledgments:

This study was funded by Amgen, Astellas and UCB Pharma. Editorial services were provided by Costello Medical.

Disclosure of Interests:

Paul Miller Grant/research support from: Amgen, Radius Health, Ultragenyx, Consultant of: Amgen, Radius Health, Jonathan Adachi Consultant of: Amgen, Speakers bureau: Amgen, Ben-Hur Albergaria Consultant of: Amgen Inc., Eli Lilly, Speakers bureau: Amgen Inc., Eli Lilly, Angela M Cheung Consultant of: Amgen, Eli Lilly, Arkadi Chines Shareholder of: Amgen Inc., Employee of: Amgen Inc., Evelien Gielen Consultant of: Amgen Inc., Takeda, Sandoz and UCB Pharma, Speakers bureau: Amgen Inc., Takeda, Sandoz and UCB Pharma, Bente Langdahl Grant/research support from: Amgen, NovoNordisk, Consultant of: Amgen Inc., Eli Lilly, UCB Pharma, Akimitsu Miyauchi Consultant of: Amgen Inc., Astellas BioPharma K.K., Teijin Pharma, Mary Oates Shareholder of: Amgen Inc., Employee of: Amgen Inc., Ian Reid Consultant of: Amgen Inc., Eli Lilly, Speakers bureau: Amgen Inc., Eli Lilly, Norma Ruiz Santiago Shareholder of: Amgen Inc., Employee of: Amgen Inc., Mark Vanderkelen Employee of: UCB Pharma, Wenjing Yang Shareholder of: Amgen Inc., Employee of: Amgen Inc., Zhigang Yu Shareholder of: Amgen Inc., Employee of: Amgen Inc.

Legacy and emerging semi-volatile organic compounds in sentinel fish from an arctic formerly used defense site in Alaska

The Arctic is subject to long-range atmospheric deposition of globally-distilled semi-volatile organic compounds (SVOCs) that bioaccumulate and biomagnify in lipid-rich food webs. In addition, locally contaminated sites may also contribute SVOCs to the arctic environment. Specifically, Alaska has hundreds of formerly used defense (FUD) sites, many of which are co-located with Alaska Native villages in remote parts of the state. The purpose of this study was to investigate the extent of SVOC contamination on Alaska's St. Lawrence Island through the analysis of sentinel fish, the ninespine stickleback (Pungitius pungitius), collected from Troutman Lake located within the watershed of an FUD site and adjacent to the Yupik community of Gambell. We measured the concentrations of legacy and emerging SVOCs in 303 fish samples (81 composites), including polychlorinated biphenyls (PCBs), polybrominated diphenyl ethers (PBDEs), organophosphate esters (OPEs) and their diester metabolites, and per- and poly-fluoroalkyl substances (PFAS). PBDEs and PCBs were the most abundant SVOC groups found in stickleback with ΣPBDE and ΣPCB median concentrations of 25.8 and 10.9 ng/g ww, respectively, followed by PFAS (median ΣPFAS 7.22 ng/g ww). ΣOPE and ΣOPE metabolite concentrations were lower with median concentrations of 4.97 and 1.18 ng/g ww, respectively. Chemical patterns and distributions based on correlations and comparison with SVOC concentrations in stickleback from other parts of the island suggest strong local sources of PCBs, PBDEs, and PFAS on St. Lawrence Island.

Sapphire advanced mitigation process: wet etch to expose sub-surface damage and increase laser damage resistance and mechanical strength

A novel, to the best of our knowledge, method of wet chemical etching of sapphire workpieces (such as optics, wafers, windows, and cones), called the sapphire advanced mitigation process (or sapphire AMP), has been developed that exposes sub-surface mechanical damage created during the optical fabrication process and significantly enhances the surface laser damage resistance ($ \gt {2{\times}}$>2×) and mechanical strength (up to $\sim{2.6{\times}}$∼2.6×). Sapphire AMP involves first treating the workpiece with a mixture of sulfuric and phosphoric acid $([{\rm H_{2}{\rm SO_{4}}}]:[{\rm H_{3}{\rm PO_{4}}}]=1:3)$([H₂SO₄]:[H₃PO₄]=1:3) at 220°C, followed with phosphoric acid at 160°C, then with sodium hydroxide base (NaOH) and surfactant at 40°C, and finally with a high-pressure deionized water spray rinse. Sapphire AMP has been demonstrated on both A- and C-plane sapphire workpieces. The mechanism of this etch process involves the reaction of the sapphire $({\rm Al_{2}}{\rm O_{3}})$(Al₂O₃) surface with sulfuric acid $({\rm H_{2}}{\rm SO_{4}})$(H₂SO₄) forming aluminum sulfate $[{{\rm Al}_2}{({{\rm SO}_4})_3}]$[Al₂(SO₄)₃], which has low solubility. The high phosphoric acid content in the first and second steps of sapphire AMP results in the efficient conversion of ${{\rm Al}_2}{({{\rm SO}_4})_3}$Al₂(SO₄)₃ to aluminum phosphate $({\rm AlPO_{4}})$(AlPO₄), which is very soluble, greatly reducing reaction product redeposition on the workpiece surface. Sapphire AMP is shown to expose sub-surface mechanical damage on the sapphire surface created during the grinding and polishing processes, whose etched morphology has either isotropic or anisotropic evolution depending on the nature of the initial surface damage. Sapphire AMP was also designed to remove the key known surface, laser absorbing precursors (namely, foreign chemical impurities, the fracture surface layer of preexisting sub-surface damage, and reaction product or foreign species redeposition or precipitation). Static and sliding indention induced surface microfractures on sapphire are shown after sapphire AMP to have a significant decrease in the fast photoluminescence intensity (a known metric for measuring the degree of laser damaging absorbing precursors). In addition, the onset of laser damage (at 351 nm 3 ns) on sapphire AMP treated workpieces was shown to increase in fluence from $\sim{4}$∼4 to $ \gt {9}.{5}\;{{\rm J/cm}^2}$>9.5J/cm². Finally, biaxial ball-on-ring mechanical tests on sapphire disks showed an increase in the failure stress from 340 MPa (with pre-existing 28 µm flaws) to $\sim{900}\;{\rm MPa}$∼900MPa after sapphire AMP, which is attributed to the blunting of the surface microfractures.

Perinatal mental health and risk of child maltreatment: A systematic review and meta-analysis

BACKGROUND

Mental health problems in parents have been identified as a risk factor for child maltreatment. The perinatal period (from conception to 1 year) is a critical period but it is unclear whether perinatal mental health problems are also associated with increased risk.

OBJECTIVE

To review evidence on perinatal mental health and risk of child maltreatment.

METHODS

Searches were conducted on six databases and 24 studies reported in 30 papers identified. Studies were conducted in seven countries, mainly the USA (n = 14). Sample sizes ranged from 48-14,893 and most examined mothers (n = 17). Studies were conducted in community (n = 17) or high-risk (n = 7) samples.

RESULTS

The majority of studies found a relationship between parental perinatal mental health problems and risk of child maltreatment, but inconsistent findings were observed between and within studies. The few studies that examined fathers (n = 6) all found a relationship between fathers' mental health and risk of child maltreatment. Meta-analysis of 17 studies (n = 22,042) showed perinatal mental health problems increased risk of child maltreatment by OR 3.04 (95% CI 2.29-4.03). This relationship was moderated by type of sample, with larger effects for risk of child maltreatment in high-risk samples. The relationship was not moderated by type of mental illness, child maltreatment; methodological or measurement factors.

CONCLUSION

The association between perinatal mental health and risk of child maltreatment is similar to that observed at other times during childhood. Methodological heterogeneity and inconsistent findings mean conclusions are tentative and need to be considered alongside other individual, family and social/cultural risk factors.

Suicide risk and social support in Australian resource sector employees: A cross-sectional study

This study examines the association between suicide risk and social support in Australian resource sector employees. We included 150 participants, who completed the Beck Hopelessness Scale and MOS-Social Support Survey. Data were analyzed using smallest space analysis and multidimensional scalogram analysis. The analysis identified four distinct regions, which were conceptualized as "confiding," "affection," "companionship," and "practical help." All of these components of social support were associated with hopelessness, which has important clinical implications as hopelessness is related to suicide risk. The results of this study also demonstrated that lower levels of social support, and greater sense of perceived hopelessness tended to lead to Australian resource workers seeking assistance from mental health professionals in the previous year. Attention should turn towards providing interventions that promote social support for employees in Australian resource industry.