Systemic acidemia impairs cardiac function in critically Ill patients

BACKGROUND

Acidemia, is associated with reduced cardiac function in animals, but no studies showing an effect of acidemia on cardiac function in humans are reported. In the present study, we examined the effect of acidemia on cardiac function assessed with transpulmonary thermodilution technique with integrated pulse contour analysis (Pulse Contour Cardiac Output, PiCCO™) in a large cohort of critically ill patients.

METHODS

This was a prospective multicenter observational cross-sectional study of 297 patients from 6 intensive care units in London, England selected from all patients admitted consecutively between May 2018 and March 2019. Measurements of lowest plasma pH and concurrent assessment of cardiac function were obtained.

FINDINGS

There was a significant difference between two pH categories (pH ≤ 7.28 vs. pH > 7.28) for the following variables of cardiac function: SVI (difference in means 32.7; 95% CI: 21 to 45 mL/m2; p < 0.001); GEF (18; 95% CI: 11 to 26%; p < 0.001), dPmax (-331; 95% CI: -510 to -153 mmHg/s; p = 0.001), CFI (0.7; 95% CI: 0.2 to 1.3 1/min; p = 0.01) and CPI (0.09; 95% CI: 0.03 to 0.15 W/m2; p < 0.001). However, there was no significant difference in CI (0.13; 95% CI: -0.20 to 0.47 L/min/m2; p = 0.12) between the pH categories. Also, a significant relationship was found between the quantitative pH and the following variables: SVI (132; 95% CI: 77 to 188 mL/m2; p < 0.001), GEF (74.7; 95% CI: 37.1 to 112.4%; p < 0.001), dPmax (-1587; 95% CI: -2361 to -815 mmHg/s; p < 0.001), CFI (3.5; 95% CI: 0.9 to 6.1 /min; p = 0.009), CPI (0.62; 95% CI: 0.36 to 0.88 W/m2; p < 0.001) and CI (regression coefficient 1.96; 95% CI:0.45 to 3.47 L/min/m2; p = 0.01).

INTERPRETATION

Acidemia is associated with impaired cardiac function in seriously ill patients hospitalized in the intensive care unit supporting the potential value of early diagnosis and improvement of arterial pH in these patients.

FUNDING

The study was partially supported by unrestricted funds from the UCLA School of Medicine.

A Comparison of Self-Awareness and Knowledge of Orthorexia in General Public and Nutrition Students

Objectives

Orthorexia is characterized by a fixation on healthful eating that emphasizes specific qualities of foods. The study objective was to investigate knowledge and self-awareness of orthorexia in the general public and nutrition students before and after viewing an online educational module.

Methods

De-identified online surveys created in REDCap were shared with the general public via social media groups (Facebook and Reddit) and survey exchange sites; and with nutrition students through a convenience sample obtained through nutrition departments of two universities. An educational module with an orthorexia infographic and video included pre- and post-questionnaires to assess change in knowledge of orthorexia. A validated orthorexia questionnaire (ORTO-15) was used to evaluate orthorexia behavior in these populations.

Results

Study participants who responded to the survey included 253 individuals from the general public and 77 nutrition students. Of the 253 general public respondents, 72 were from survey exchange groups on social media, 20 were from survey exchange websites and 150 were from motivational fitness groups on social media. fter reviewing the educational module, the general public's orthorexia knowledge scores increased from a mean of 3.4 (±1.0) to 4.9 (±1.3) out of a possible score of 7; whereas the nutrition students' orthorexia knowledge scores only increased from 5.2 (±1.3) to 5.7 (±0.9) pre- to post-educational module. This interaction was significant (P &lt; 0.0001). 97.7% of the general public and 93.2% of nutrition students showed an ORTO-15 score of 40 or lower from a possible total score of 60. The majority of the nutrition students (40.3%, n = 29) chose “often” whereas about 50% (n = 109) of the general public chose “sometimes” and 33% (n = 73) chose “often”, when asked about feeling guilty when transgressing on the ORTO-15 questionnaires.

Conclusions

Both populations showed an increase in knowledge about orthorexia after viewing the educational module. The evidence from this study indicates knowledge of orthorexia is low in these populations and education about the condition may be warranted for the general public and students who are in nutrition-related fields. In both populations, ORTO-15 scores showed existence of some degree of orthorexia-related behavior.

Funding Sources

No funding was used for this research.

373 A Review of Microsatellite Instability (MSI) Testing: Real World Clinical Data

Introduction

Colorectal cancers (CRC) are the second most common cause of death by cancer, in the UK. Microsatellite instability (MSI) analysis is novel yet important part of managing CRC and used as a tool for predicting prognosis, treatment and identifying lynch syndrome. Where lynch syndrome is identified, preventative screening can be utilised. Previous studies only focused tumour testing on high-risk cases.

Method

A retrospective study at Northumbria Health Care NHS Trust was performed on all new CRC patients between 2017-2020.

Results

A total of 965 patients with CRC were identified. After exclusion criteria was applied to the cohort, a total of 483 patients were identified as having undergone MSI analysis. The mean age was 73.5 years old, with the female to male ratio being 1:1.4. Patients were further grouped into MSI stable, low, and high. MSI High patients accounted for 10% of patients analysed. Further genetic testing was performed on these patients which highlighted 28 patients with BRAF positive genes who went on to screening for Lynch syndrome associated cancers.

Conclusions

MSI testing provides essential diagnostic, prognostic information and also guides treatment options. 2.9% of patients identified as high risk for familial cancers and went on to have genetic screening and surveillance.

432 What Are the Promoting and Discouraging Factors for Choosing A Career in Surgery According to Undergraduate Medical Students in A District General Hospital? A Questionnaire and Review of The Literature

Introduction

The aim was to identify which factors promote and discourage undergraduate medical students, based in a district general hospital, for choosing a career in surgery. A review of the current literature on this topic was undertaken in conjunction with the questionnaire.

Method

An online structured questionnaire was sent to all undergraduate clinical medical students based in Northumbria Specialist Emergency Care Hospital (NSECH), a teaching DGH. As well as the questionnaire, a systematic review of the literature was conducted on EMBASE, MEDLINE and Google Scholar using key search terms to review factors that influenced surgical career choices.

Results

The response rate was 46% (44/95). 75% of students rated variety of work, intellectually interesting and environment as the most important factors for their future careers. Status, financial rewards, and research opportunities were least important influences for respondents’ career decision making. A systematic literature review highlights that lifestyle factors, work-life balance were particularly important, perceived prestige and financial rewards were associated surgical career choices amongst medical students.

Conclusions

Multiple factors influence medical students career decision making and it is important to identify these factors for many reasons. Further research is recommended to further explore medical students’ perceptions on promoting and discouraging factors for surgical careers.

Vestibular rehabilitation in multiple sclerosis: study protocol for a randomised controlled trial and cost-effectiveness analysis comparing customised with booklet based vestibular rehabilitation for vestibulopathy and a 12 month observational cohort study of the symptom reduction and recurrence rate following treatment for benign paroxysmal positional vertigo

Background

Symptoms arising from vestibular system dysfunction are observed in 49–59% of people with Multiple Sclerosis (MS). Symptoms may include vertigo, dizziness and/or imbalance. These impact on functional ability, contribute to falls and significant health and social care costs. In people with MS, vestibular dysfunction can be due to peripheral pathology that may include Benign Paroxysmal Positional Vertigo (BPPV), as well as central or combined pathology. Vestibular symptoms may be treated with vestibular rehabilitation (VR), and with repositioning manoeuvres in the case of BPPV. However, there is a paucity of evidence about the rate and degree of symptom recovery with VR for people with MS and vestibulopathy. In addition, given the multiplicity of symptoms and underpinning vestibular pathologies often seen in people with MS, a customised VR approach may be more clinically appropriate and cost effective than generic booklet-based approaches. Likewise, BPPV should be identified and treated appropriately.

Methods/ design

People with MS and symptoms of vertigo, dizziness and/or imbalance will be screened for central and/or peripheral vestibulopathy and/or BPPV. Following consent, people with BPPV will be treated with re-positioning manoeuvres over 1–3 sessions and followed up at 6 and 12 months to assess for any re-occurrence of BPPV. People with central and/or peripheral vestibulopathy will be entered into a randomised controlled trial (RCT). Trial participants will be randomly allocated (1:1) to either a 12-week generic booklet-based home programme with telephone support or a 12-week VR programme consisting of customised treatment including 12 face-to-face sessions and a home exercise programme. Customised or booklet-based interventions will start 2 weeks after randomisation and all trial participants will be followed up 14 and 26 weeks from randomisation. The primary clinical outcome is the Dizziness Handicap Inventory at 26 weeks and the primary economic endpoint is quality-adjusted life-years. A range of secondary outcomes associated with vestibular function will be used.

Discussion

If customised VR is demonstrated to be clinically and cost-effective compared to generic booklet-based VR this will inform practice guidelines and the development of training packages for therapists in the diagnosis and treatment of vestibulopathy in people with MS.

Trial registration

ISRCTN Number: 27374299

Date of Registration 24/09/2018

Protocol Version 15 25/09/2019

Supplementary Information

The online version contains supplementary material available at 10.1186/s12883-020-01983-y.

Management of nystagmus in children: a review of the literature and current practice in UK specialist services

Nystagmus is an eye movement disorder characterised by abnormal, involuntary rhythmic oscillations of one or both eyes, initiated by a slow phase. It is not uncommon in the UK and regularly seen in paediatric ophthalmology and adult general/strabismus clinics. In some cases, it occurs in isolation, and in others, it occurs as part of a multisystem disorder, severe visual impairment or neurological disorder. Similarly, in some cases, visual acuity can be normal and in others can be severely degraded. Furthermore, the impact on vision goes well beyond static acuity alone, is rarely measured and may vary on a minute-to-minute, day-to-day or month-to-month basis. For these reasons, management of children with nystagmus in the UK is varied, and patients report hugely different experiences and investigations. In this review, we hope to shine a light on the current management of children with nystagmus across five specialist centres in the UK in order to present, for the first time, a consensus on investigation and clinical management.

Association of the Healthy, Hunger-Free Kids Act With Dietary Quality Among Children in the US National School Lunch Program

Importance

The Healthy, Hunger-Free Kids Act of 2010, implemented nationwide in 2012, was intended to improve the nutritional quality of meals served in the National School Lunch Program (NSLP).

Objective

To assess whether there was an association between the Healthy, Hunger-Free Kids Act of 2010 and dietary quality of lunch for students participating in the NSLP, stratified by income.

Design, Setting, Participants

Serial cross-sectional study design, using National Health and Nutrition Examination Survey (NHANES) data from 2007-2008, 2009-2010, 2013-2014, and 2015-2016, of students who were surveyed in the NHANES and were attending schools participating in the NSLP. Individuals who were aged 5 to 18 years, in kindergarten through 12th grade, enrolled in a school that served school lunch, and had a reliable weekday dietary recall were included.

Exposures

The Healthy, Hunger-Free Kids Act of 2010 (prepolicy period: 2007-2010; postpolicy period: 2013-2016), with participation in the NSLP estimated based on an algorithm.

Main Outcomes and Measures

The primary outcome was dietary quality of intake for lunch, measured by the Healthy Eating Index-2010 (HEI-2010) score (range, 0-100; 0 indicates a diet with no adherence to the 2010 Dietary Guidelines for Americans and 100 indicates a diet with complete adherence to the guidelines).

Results

Among 6389 students included in the surveys (mean age, 11.7 [95% CI, 11.6-11.9] years; 3145 [50%] female students; 1880 [56%] were non-Hispanic white), 32% were low-income, 12% were low-middle-income, and 56% were middle-high-income students. A total of 2472 (39%) were participants in the NSLP. Among low-income students, the adjusted mean prepolicy HEI-2010 score was 42.7 and the postpolicy score was 54.6 among NSLP participants and the adjusted mean prepolicy score was 34.8 and postpolicy score was 34.1 among NSLP nonparticipants (difference in differences, 12.6 [95% CI, 8.9-16.3]). Among low-middle-income students, the adjusted mean prepolicy HEI-2010 score was 40.4 and postpolicy score was 54.8 among NSLP participants and the adjusted mean prepolicy score was 34.2 and postpolicy score was 36.1 among NSLP nonparticipants (difference in differences, 12.4 [95% CI, 4.9-19.9]). Among middle-high-income students, the adjusted mean HEI-2010 prepolicy score was 42.7 and postpolicy score 55.5 for NSLP participants and the adjusted mean prepolicy score was 38.9 and prepolicy score was 43.6 for NSLP nonparticipants (difference in differences, 8.1 [95% CI, 4.2-12.0]).

Conclusions and Relevance

In a serial cross-sectional study of students, the Healthy, Hunger-Free Kids Act of 2010 was associated with better changes in dietary quality for lunch among presumed low-income, low-middle-income, and middle-high-income participants in the NSLP compared with nonparticipants.

Food Acquisition Strategies of Homeless Youth in the Greater Seattle Area: A Cross- Sectional Study

OBJECTIVES

The aims of this study were to describe how homeless youths access food in the Seattle area, and to describe the nutritional adequacy and quality of food obtained.

METHODS

This cross-sectional study was conducted between February 2018 and May 2019. Data collection took place at seven organizations in the greater Seattle area at which homeless youths typically access food. Trained research assistants verbally administered an ∼50-item survey to homeless youths aged 14 to 24 years on their general demographic characteristics, current housing situation, ability to access food, and quantity and quality of foods acquired. Each participant was given $10 at the completion of the survey.

RESULTS

Participants were 122 homeless youths with an average age of 21.6±1.94 years. During the previous week, 79.3% obtained meals from drop-in centers and 69.8% from a shelter. Most (75.2%) had not utilized a food bank during the previous month. The majority (73.6%) reported having enough food to eat, but not always the kind they wanted, and 75.4% rated the overall nutritional quality of their diet as average or below. Not having enough food or money for food contributed to skipping meals (50.4%), eating less than desired (47.1%), being hungry (45.5%), and losing weight (20.5%).

CONCLUSIONS

Information from this study can be used to identify barriers that homeless youths experience in acquiring adequate nutrition; to make suggestions for future research and program development; and to help social service organizations improve the network of nutrition services and the quality of food available to this vulnerable population through policy, community partnership, and public health action.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

How Diet Impacts Performance in Rock Climbers: A Pilot Study

Objectives

This observational, cross-sectional, pilot study was conducted to establish a nutritional profile among experienced climbers, both non-elite and elite, and to evaluate factors that influence time to exhaustion while climbing to volitional failure.

Methods

Elite (n = 10) and non-elite (n = 5) climbers, aged 18–45 years participated in the following: (1) nutritional analysis - 3-day food record and 24-hour dietary recall were analyzed using Food Processor and compared to government daily recommended intake; (2) climbing trial - after completing a climbing-related questionnaire and measuring anthropometric characteristics and hand grip strength, participants climbed a moderately difficult pre-set indoor route continuously until reaching volitional exhaustion.

Results

The major findings were significant differences for total climbing time between non-elite and elite climbers (t(13) = −2.6, p = 0.02). Additionally, protein intake from 24 hour recall (n = 15, rS = −0.53, p = 0.04) and total % water intake (n = 15, rS = −0.60, p = 0.02) were negatively correlated with climbing time.

Conclusions

These results indicate that a longer climbing time to exhaustion is related to self-reported climbing ability. In contrast, the negative association between protein intake and climbing time, suggest that carbohydrate intake may play a more important role in climbing performance than protein intake. In addition the negative association between total % water and climbing suggest that the more hydrated a person is going into a climb, the longer they can sustain a climb.

Funding Sources

This research was supported by Grant Award BUCSR-Y3–010 from the Bastyr University Center for Student Research.

Does Consumption of Nitrate Containing Beetroot Juice Affect Indoor Rowing Performance in Males and Females?

Objectives

The nitrates found in beetroot juice (BR) are known to be a precursor of nitric oxide (NO). NO is a known vasodilator which allows more oxygen to travel in the blood and may improve muscle efficiency. This study aims to measure the effect of BR supplementation on performance on 500-meter row time for trained CrossFit athletes. Many past studies have analyzed the effect of BR on male athletes, this study aimed to include both males and females.

Methods

This study used a randomized, cross-over, double-blind, placebo-controlled design to measure 500-meter row time. Thirty athletes age 18–60 consumed either a 2.7 oz shot of BR (6.5 mmol nitrate) or a placebo nitrate-free beetroot juice (PL). Two hours later, they rowed 500 meters. After at least a seven-day washout period, athletes repeated the 500-meter row with either BR or PL for comparison. This study was performed from July 2019 – January 2020 and was conducted in Mercer Island, Washington.

Results

Ten males age 18.0 to 60.3 (median 47.7) and twenty females age 26.7 to 58.3 (median 43.8), participated in this study. Row times for the 500-meter row ranged from 88.2 seconds to 150.7 seconds. Data indicate that although 60% of all participants rowed faster with BR (mean 112.83 seconds), compared to PL (mean 113.40 seconds), the difference in the means of row times (−0.563) was not significant overall (P = 0.29). However, for the 10 males, row times were significantly faster (1.02 second difference, P = 0.04) on average with BR compared to PL. For the 20 females, the difference in mean row time (−0.335 seconds) was not significant (P = 0.66). Competitive rowers were defined as those who rowed under 110 seconds (N = 15). For competitive rowers (10 males, 5 females), row times were significantly faster with BR compared to PL (difference in means −0.94, P = 0.009). However, for those rowers, the P-value of drink * group was 0.015.

Conclusions

Dietary nitrate improved indoor rowing performance in males but not in females. In addition, competitive rowers were also significantly faster with BR, however, there may be an order bias, since there was significant interaction between beverage type and testing order. Food based nitrate supplements may increase rowing performance with male rowers.

Funding Sources

Supported by Bastyr Faculty Student Research Grant.

Feasibility of Satter's How to Eat Method Using Two Delivery Modes to Improve Eating Competence Among Previous Dieters in a University Employee Wellness Program

Objectives

For a subset of dieters, the pursuit of thinness may be harmful. In contrast, eating competence is associated with positive physical and mental health outcomes. This pilot intervention study evaluated changes in eating competence and disordered eating symptoms among previous dieters who participated in the How to Eat program using two delivery modes at a major midwestern university.

Methods

Participants were adult employees of the university who self-identified as previous dieters and voluntarily enrolled in How to Eat in either individual sessions or group classes (self-selected) over a nine-year period as part of employee health promotion offerings. How to Eat, offered weekly over 10 sessions, is grounded in the validated Eating Competence model, and measured by the ecSI 2.0™, which defines eating competence as comprised of 4 domains: 1) eating attitudes; 2) food acceptance; 3) food management/contextual skills; and 4) internal regulation of eating. A total score on the ecSI 2.0™ of at least 32 (of 48 total) indicates eating competence. Symptoms of eating disorders were evaluated with the Eating Attitudes Test-26 (EAT-26). Two-factor ANOVA was used for analyses.

Results

A total of 160 employees participated in How to Eat. Those participating in individual sessions were significantly younger (M = 38.3 years) and attended a greater number of sessions (M = 9.3) than those participating in group classes (M = 48.1 years and M = 5.9 sessions). Adjusting for age and number of sessions, there was a significant interaction between intervention and session type for ecSI 2.0™ total scores [F(1, 149) = 21.424, P &lt; 0.001, ƞ2 = 0.126], all four subscale domain scores, and EAT-26 total scores [F(1, 149) = 14.035, P &lt; 0.001, ƞ2 = 0.086]. Improvements in scores were significantly greater for participants in the individual sessions than the group classes. Body weight was not significantly influenced by the intervention.

Conclusions

How to Eat is associated with improvements in measures of eating competence and symptoms of disordered eating among previous dieters, and these improvements are greater for those participating in individual sessions versus group classes in a university employee wellness setting. Further research is needed to evaluate the efficacy and additional health-related outcomes of the How to Eat method among diverse populations and other settings.

Funding Sources

None.

Feasibility of Using Satter's How to Eat Method to Improve Eating Competence Among Previous Dieters in a Metropolitan Hospital System Employee Wellness Program

Objectives

For a subset of dieters, the pursuit of thinness may be harmful. In contrast, eating competence is associated with positive physical and mental health outcomes. This single-arm, pilot intervention study evaluated changes in eating competence and symptoms of eating disorders among previous dieters employed in a metropolitan hospital system who participated in the How to Eat program.

Methods

Participants were adult employees of the hospital system who self-identified as previous dieters, and voluntarily enrolled in How to Eat on a rolling basis over a six-year period during employee health promotion offerings. How to Eat, offered weekly in a group setting over 10 sessions, is grounded in the validated Eating Competence model, and measured by the ecSI 2.0™, which defines eating competence as comprised of four domains: 1) eating attitudes; 2) food acceptance; 3) food management/contextual skills; and 4) internal regulation of eating based on hunger, appetite and satisfaction. A total score on the ecSI 2.0™ of at least 32 (of 48 possible) indicates eating competence. Symptoms of eating disorders were evaluated with the Eating Attitudes Test-26 (EAT-26). Paired t-Tests and Wilcoxon signed-rank tests were used for analyses.

Results

43 adults participated, averaged 47.5 years (SD = 10.7), 210 lbs. (SD = 30.9), and were primarily female (95.3%) and white (90.7%). From pre- to post-program, How to Eat was associated with significant changes in scores on the total ecSI 2.0™ (t(42) = 12.20, P &lt; 0.001), each of its subscales, and the EAT-26 (t(42) = 6.53, P &lt; 0.001). Pre-program, the mean ecSI 2.0™ total score was 22.8 (SD = 6.5) and 9.3% (N = 4) of participants were considered eating competent. Post-program, the mean ecSI 2.0™ total score was 34.3 (SD = 4.9) and 100% (N = 43) of participants were classified as eating competent. Mean EAT-26 total scores decreased from 10.7 (SD = 8.1) to 3.7 (SD = 2.9). Body weight was not significantly influenced by the intervention (t(21) = 0.314, P = 0.757).

Conclusions

How to Eat may be associated with improvements in measures of eating competence and eating disorder symptoms among previous dieters participating in an employee health program despite no significant change in body weight. Experimental research is needed to evaluate the efficacy and additional health-related outcomes of How to Eat among diverse populations and other settings.

Funding Sources

None.

Awareness and Perception of Carbohydrate-Controlled Diets for Management of PCOS: A Benchmark Study

Objectives

Infertility affects 6.1 million women in the United States. There is currently no recognized Medical Nutrition Therapy to optimize fertility. Despite a lack of research evidence of safety and efficacy, carbohydrate restriction (CR) and carbohydrate-controlled diets (CCD) are utilized by individuals and practitioners as a treatment for subfertility. An aim of this study was to assess awareness and perception of CR as a treatment for subfertility by Registered Dietitian Nutritionists (RDN). In addition, a secondary aim was to compare similar questions gathered from individuals who followed a CCD for fertility enhancement.

Methods

This study was a combination of two surveys open for respondents July 2019 to January 2020 via REDCap. The survey for the first aim had a restricted population of RDNs consisting of 20 questions investigating perception of CR therapy and experience with patients with subfertility. The survey was emailed via listserv through the Academy of Nutrition and Dietetics. The second survey targeted individuals who implemented CR as a fertility therapy. It consisted of 45 questions and was distributed to CCD related social media groups.

Results

The first survey had 240 RDN respondents with an average of 12 years of experience. The second survey had 203 CCD respondents of which 49% had followed a CCD for less than one year. While the remaining 51% followed a CCD for an average of 3.6 years. There was a statistically significant difference between how the two groups defined carbohydrate restriction χ,2 (3, 410) = 265.4, P &lt; 0.01. Among RDNs, 49.8% selected “Below 45% kcal from carbohydrate/day” and 32.2% selected “Below 100 g carbohydrate/day”. In contrast, 75.4% of followers of a CCD selected “Below 20 g carbohydrate/day”. A total of 41% of RDNs were familiar with research regarding the effect of carbohydrate reduction on female subfertility markers, such as PCOS and anovulation, of which 67% believe the body of evidence demonstrates “generally positive outcomes” on markers of fertility.

Conclusions

The results of this study highlight the lack of a consistent definition of CCD between providers and the public. There may be a need for educating providers that research regarding CCD and fertility exists, but effectiveness of CR as a treatment cannot be properly assessed without an agreed upon definition.

Funding Sources

N/A.

Interaction between particles with inhomogeneous surface charge distributions: Revisiting the Coulomb fission of dication molecular clusters

An analytical solution describing the electrostatic interaction between particles with inhomogeneous surface charge distributions has been developed. For particles, each carrying a single charge, the solution equates to the presence of a point charge residing on the surface, which makes it particularly suitable for investigating the Coulomb fission of doubly charged clusters close to the Rayleigh instability limit. For a series of six separate molecular dication clusters, center-of-mass kinetic energy releases have been extracted from experimental measurements of their kinetic energy spectra following Coulomb fission. These data have been compared with Coulomb energy barriers calculated from the electrostatic interaction energies given by this new solution. For systems with high dielectric permittivity, results from the point charge model provide a viable alternative to kinetic energy releases calculated on the assumption of a uniform distribution of surface charge. The equivalent physical picture for the clusters would be that of a trapped proton. For interacting particles with low dielectric permittivity, a uniform distribution of charge provides better agreement with the experimental results.

Comparison of portable blood-warming devices under simulated pre-hospital conditions: a randomised in-vitro blood circuit study

Pre-hospital transfusion of blood products is a vital component of many advanced pre-hospital systems. Portable fluid warmers may be utilised to help prevent hypothermia, but the limits defined by manufacturers often do not reflect their clinical use. The primary aim of this randomised in-vitro study was to assess the warming performance of four portable blood warming devices (Thermal Angel, Hypotherm X LG, °M Warmer, Buddy Lite) against control at different clinically-relevant flow rates. The secondary aim was to assess haemolysis rates between devices at different flow rates. We assessed each of the four devices and the control, at flow rates of 50 ml.min^-1 , 100 ml.min^-1 and 200 ml.min^-1 , using a controlled perfusion circuit with multisite temperature monitoring. Free haemoglobin concentration, a marker of haemolysis, was measured at multiple points during each initial study run with spectrophotometry. At all flow rates, the four devices provided superior warming performance compared with the control (p < 0.001). Only the °M Warmer provided a substantial change in temperature at all flow rates (mean (95%CI) temperature change of 21.1 (19.8-22.4) °C, 20.4 (19.1-21.8) °C and 19.4 (17.7-21.1) °C at 50 ml.min^-1 , 100 ml.min^-1 and 200 ml.min^-1 , respectively). There was no association between warming and haemolysis with any device (p = 0.949) or flow rate (p = 0.169). Practical issues, which may be relevant to clinical use, also emerged during testing. Our results suggest that there were significant differences in the performance of portable blood warming devices used at flow rates encountered in clinical practice.

Marie M, Stickney K, VanBuecken D, Vellek B, Webber C, Allen L, Bollyk J, Hilderman N, Ismail H, Lamola S, Sanda S, Vendettuoli H, Tridgell D, Monzavi R, Bock M, Fisher L, Halvorson M, Jeandron D, Kim M, Wood J, Geffner M, Kaufman F, Parkman R, Salazar C, Goland R, Clynes R, Cook S, Freeby M, Pat Gallagher M, Gandica R, Greenberg E, Kurland A, Pollak S, Wolk A, Chan M, Koplimae L, Levine E, Smith K, Trast J, DiMeglio L, Blum J, Evans-Molina C, Hufferd R, Jagielo B, Kruse C, Patrick V, Rigby M, Spall M, Swinney K, Terrell J, Christner L, Ford L, Lynch S, Menendez M, Merrill P, Pescovitz M, Rodriguez H, Alleyn C, Baidal D, Fay S, Gaglia J, Resnick B, Szubowicz S, Weir G, Benjamin R, Conboy D, deManbey A, Jackson R, Jalahej H, Orban T, Ricker A, Wolfsdorf J, Zhang HH, Wilson D, Aye T, Baker B, Barahona K, Buckingham B, Esrey K, Esrey T, Fathman G, Snyder R, Aneja B, Chatav M, Espinoza O, Frank E, Liu J, Perry J, Pyle R, Rigby A, Riley K, Soto A, Gitelman S, Adi S, Anderson M, Berhel A, Breen K, Fraser K, Gerard-Gonzalez A, Jossan P, Lustig R, Moassesfar S, Mugg A, Ng D, Prahalod P, Rangel-Lugo M, Sanda S, Tarkoff J, Torok C, Wesch R, Aslan I, Buchanan J, Cordier J, Hamilton C, Hawkins L, Ho T, Jain A, Ko K, Lee T, Phelps S, Rosenthal S, Sahakitrungruang T, Stehl L, Taylor L, Wertz M, Wong J, Philipson L, Briars R, Devine N, Littlejohn E, Grant T, Gottlieb P, Klingensmith G, Steck A, Alkanani A, Bautista K, Bedoy R, Blau A, Burke B, Cory L, Dang M, Fitzgerald-Miller L, Fouts A, Gage V, Garg S, Gesauldo P, Gutin R, Hayes C, Hoffman M, Ketchum K, Logsden-Sackett N, Maahs D, Messer L, Meyers L, Michels A, Peacock S, Rewers M, Rodriguez P, Sepulbeda F, Sippl R, Steck A, Taki I, Tran BK, Tran T, Wadwa RP, Zeitler P, Barker J, Barry S, Birks L, Bomsburger L, Bookert T, Briggs L, Burdick P, Cabrera R, Chase P, Cobry E, Conley A, Cook G, Daniels J, DiDomenico D, Eckert J, Ehler A, Eisenbarth G, Fain P, Fiallo-Scharer R, Frank N, Goettle H, Haarhues M, Harris S, Horton L, Hutton J, Jeffrrey J, Jenison R, Jones K, Kastelic W, King MA, Lehr D, Lungaro J, Mason K, Maurer H, Nguyen L, Proto A, Realsen J, Schmitt K, Schwartz M, Skovgaard S, Smith J, Vanderwel B, Voelmle M, Wagner R, Wallace A, Walravens P, Weiner L, Westerhoff B, Westfall E, Widmer K, Wright H, Schatz D, Abraham A, Atkinson M, Cintron M, Clare-Salzler M, Ferguson J, Haller M, Hosford J, Mancini D, Rohrs H, Silverstein J, Thomas J, Winter W, Cole G, Cook R, Coy R, Hicks E, Lewis N, Marks J, Pugliese A, Blaschke C, Matheson D, Pugliese A, Sanders-Branca N, Ray Arce LA, Cisneros M, Sabbag S, Moran A, Gibson C, Fife B, Hering B, Kwong C, Leschyshyn J, Nathan B, Pappenfus B, Street A, Boes MA, Peterson Eck S, Finney L, Albright Fischer T, Martin A, Jacqueline Muzamhindo C, Rhodes M, Smith J, Wagner J, Wood B, Becker D, Delallo K, Diaz A, Elnyczky B, Libman I, Pasek B, Riley K, Trucco M, Copemen B, Gwynn D, Toledo F, Rodriguez H, Bollepalli S, Diamond F, Eyth E, Henson D, Lenz A, Shulman D, Raskin P, Adhikari S, Dickson B, Dunnigan E, Lingvay I, Pruneda L, Ramos-Roman M, Raskin P, Rhee C, Richard J, Siegelman M, Sturges D, Sumpter K, White P, Alford M, Arthur J, Aviles-Santa ML, Cordova E, Davis R, Fernandez S, Fordan S, Hardin T, Jacobs A, Kaloyanova P, Lukacova-Zib I, Mirfakhraee S, Mohan A, Noto H, Smith O, Torres N, Wherrett D, Balmer D, Eisel L, Kovalakovska R, Mehan M, Sultan F, Ahenkorah B, Cevallos J, Razack N, Jo Ricci M, Rhode A, Srikandarajah M, Steger R, Russell WE, Black M, Brendle F, Brown A, Moore D, Pittel E, Robertson A, Shannon A, Thomas JW, Herold K, Feldman L, Sherwin R, Tamborlane W, Weinzimer S, Toppari J, Kallio T, Kärkkäinen M, Mäntymäki E, Niininen T, Nurmi B, Rajala P, Romo M, Suomenrinne S, Näntö-Salonen K, Simell O, Simell T, Bosi E, Battaglia M, Bianconi E, Bonfanti R, Grogan P, Laurenzi A, Martinenghi S, Meschi F, Pastore M, Falqui L, Teresa Muscato M, Viscardi M, Bingley P, Castleden H, Farthing N, Loud S, Matthews C, McGhee J, Morgan A, Pollitt J, Elliot-Jones R, Wheaton C, Knip M, Siljander H, Suomalainen H, Colman P, Healy F, Mesfin S, Redl L, Wentworth J, Willis J, Farley M, Harrison L, Perry C, Williams F, Mayo A, Paxton J, Thompson V, Volin L, Fenton C, Carr L, Lemon E, Swank M, Luidens M, Salgam M, Sharma V, Schade D, King C, Carano R, Heiden J, Means N, Holman L, Thomas I, Madrigal D, Muth T, Martin C, Plunkett C, Ramm C, Auchus R, Lane W, Avots E, Buford M, Hale C, Hoyle J, Lane B, Muir A, Shuler S, Raviele N, Ivie E, Jenkins M, Lindsley K, Hansen I, Fadoju D, Felner E, Bode B, Hosey R, Sax J, Jefferies C, Mannering S, Prentis R, She J, Stachura M, Hopkins D, Williams J, Steed L, Asatapova E, Nunez S, Knight S, Dixon P, Ching J, Donner T, Longnecker S, Abel K, Arcara K, Blackman S, Clark L, Cooke D, Plotnick L, Levin P, Bromberger L, Klein K, Sadurska K, Allen C, Michaud D, Snodgrass H, Burghen G, Chatha S, Clark C, Silverberg J, Wittmer C, Gardner J, LeBoeuf C, Bell P, McGlore O, Tennet H, Alba N, Carroll M, Baert L, Beaton H, Cordell E, Haynes A, Reed C, Lichter K, McCarthy P, McCarthy S, Monchamp T, Roach J, Manies S, Gunville F, Marosok L, Nelson T, Ackerman K, Rudolph J, Stewart M, McCormick K, May S, Falls T, Barrett T, Dale K, Makusha L, McTernana C, Penny-Thomas K, Sullivan K, Narendran P, Robbie J, Smith D, Christensen R, Koehler B, Royal C, Arthur T, Houser H, Renaldi J, Watsen S, Wu P, Lyons L, House B, Yu J, Holt H, Nation M, Vickers C, Watling R, Heptulla R, Trast J, Agarwal C, Newell D, Katikaneni R, Gardner C, Del A, Rio A, Logan H, Collier C, Rishton G, Whalley A, Ali S, Ramtoola T, Quattrin L, Mastrandea A, House M, Ecker C, Huang C, Gougeon J, Ho D, Pacuad D, Dunger J, May C, O’Brien C, Acerini B, Salgin A, Thankamony R, Williams J, Buse G, Fuller M, Duclos J, Tricome H, Brown D, Pittard D, Bowlby A, Blue T, Headley S, Bendre K, Lewis K, Sutphin C, Soloranzo J, Puskaric H, Madison M, Rincon M, Carlucci R, Shridharani B, Rusk E, Tessman D, Huffman H, Abrams B, Biederman M, Jones V, Leathers W, Brickman P, Petrie D, Zimmerman J, Howard L, Miller R, Alemzadeh D, Mihailescu R, Melgozza-Walker N, Abdulla C, Boucher-Berry D, Ize-Ludlow R, Levy C, Swenson, Brousell N, Crimmins D, Edler T, Weis C, Schultz D, Rogers D, Latham C, Mawhorter C, Switzer W, Spencer P, Konstantnopoulus S, Broder J, Klein L, Knight L, Szadek G, Welnick B, Thompson R, Hoffman A, Revell J, Cherko K, Carter E, Gilson J, Haines G, Arthur B, Bowen W, Zipf P, Graves R, Lozano D, Seiple K, Spicer A, Chang J, Fregosi J, Harbinson C, Paulson S, Stalters P, Wright D, Zlock A, Freeth J, Victory H, Maheshwari A, Maheshwari T, Holmstrom J, Bueno R, Arguello J, Ahern L, Noreika V, Watson S, Hourse P, Breyer C, Kissel Y, Nicholson M, Pfeifer S, Almazan J, Bajaj M, Quinn K, Funk J, McCance E, Moreno R, Veintimilla A, Wells J, Cook S, Trunnel J, Henske S, Desai K, Frizelis F, Khan R, Sjoberg K, Allen P, Manning G, Hendry B, Taylor S, Jones W, Strader M, Bencomo T, Bailey L, Bedolla C, Roldan C, Moudiotis B, Vaidya C, Anning S, Bunce S, Estcourt E, Folland E, Gordon C, Harrill J, Ireland J, Piper L, Scaife K, Sutton S, Wilkins M, Costelloe J, Palmer L, Casas C, Miller M, Burgard C, Erickson J, Hallanger-Johnson P, Clark W, Taylor A, Lafferty S, Gillett C, Nolan M, Pathak L, Sondrol T, Hjelle S, Hafner J, Kotrba R, Hendrickson A, Cemeroglu T, Symington M, Daniel Y, Appiagyei-Dankah D, Postellon M, Racine L, Kleis K, Barnes S, Godwin H, McCullough K, Shaheen G, Buck L, Noel M, Warren S, Weber S, Parker I, Gillespie B, Nelson C, Frost J, Amrhein E, Moreland A, Hayes J, Peggram J, Aisenberg M, Riordan J, Zasa E, Cummings K, Scott T, Pinto A, Mokashi K, McAssey E, Helden P, Hammond L, Dinning S, Rahman S, Ray C, Dimicri S, Guppy H, Nielsen C, Vogel C, Ariza L, Morales Y, Chang R, Gabbay L, Ambrocio L, Manley R, Nemery W, Charlton P, Smith L, Kerr B, Steindel-Kopp M, Alamaguer D, Liljenquist G, Browning T, Coughenour M, Sulk E, Tsalikan M, Tansey J, Cabbage N. Identical and Nonidentical Twins: Risk and Factors Involved in Development of Islet Autoimmunity and Type 1 Diabetes

OBJECTIVE

There are variable reports of risk of concordance for progression to islet autoantibodies and type 1 diabetes in identical twins after one twin is diagnosed. We examined development of positive autoantibodies and type 1 diabetes and the effects of genetic factors and common environment on autoantibody positivity in identical twins, nonidentical twins, and full siblings.

RESEARCH DESIGN AND METHODS

Subjects from the TrialNet Pathway to Prevention Study (N = 48,026) were screened from 2004 to 2015 for islet autoantibodies (GAD antibody [GADA], insulinoma-associated antigen 2 [IA-2A], and autoantibodies against insulin [IAA]). Of these subjects, 17,226 (157 identical twins, 283 nonidentical twins, and 16,786 full siblings) were followed for autoantibody positivity or type 1 diabetes for a median of 2.1 years.

RESULTS

At screening, identical twins were more likely to have positive GADA, IA-2A, and IAA than nonidentical twins or full siblings (all P < 0.0001). Younger age, male sex, and genetic factors were significant factors for expression of IA-2A, IAA, one or more positive autoantibodies, and two or more positive autoantibodies (all P ≤ 0.03). Initially autoantibody-positive identical twins had a 69% risk of diabetes by 3 years compared with 1.5% for initially autoantibody-negative identical twins. In nonidentical twins, type 1 diabetes risk by 3 years was 72% for initially multiple autoantibody-positive, 13% for single autoantibody-positive, and 0% for initially autoantibody-negative nonidentical twins. Full siblings had a 3-year type 1 diabetes risk of 47% for multiple autoantibody-positive, 12% for single autoantibody-positive, and 0.5% for initially autoantibody-negative subjects.

CONCLUSIONS

Risk of type 1 diabetes at 3 years is high for initially multiple and single autoantibody-positive identical twins and multiple autoantibody-positive nonidentical twins. Genetic predisposition, age, and male sex are significant risk factors for development of positive autoantibodies in twins.

A mechanistic model for thiol redox dynamics in the organogenesis stage rat conceptus

Precise control of the glutathione/glutathione disulfide (GSH/GSSG) redox balance is vital for the developing embryo, but regulatory mechanisms are poorly understood. We developed a novel, mechanistic mass-balance model for GSH metabolism in the organogenesis stage (gestational day 10.0-11.13) rat conceptus predicting the dynamics of 8 unique metabolites in 3 conceptal compartments: the visceral yolk sac (VYS), the extra-embryonic fluid (EEF) and the embryo proper (EMB). Our results show that thiol concentrations in all compartments are well predicted by the model. Protein synthesis is predicted to be a major efflux pathway for all amino acid precursors of GSH synthesis and an essential model element. Our model provides quantitative insights in the transport fluxes and enzymatic fluxes needed to maintain thiol redox balances under normal physiological conditions. This is crucial to further elucidate the mechanisms through which chemical exposure can perturb redox homeostasis, causing oxidative stress, and potentially birth defects.

A comparison of four different imaging modalities - Conventional, cross polarized, infra-red and ultra-violet in the assessment of childhood bruising

Background

It is standard practice to image concerning bruises in children. We aim to compare the clarity and measurements of bruises using cross polarized, infra-red (IR) and ultra-violet (UV) images to conventional images.

Methods

Children aged <11 years with incidental bruising were recruited. Demographics, skin and bruise details were recorded. Bruises were imaged by standard protocols in conventional, cross-polarized, IR and UV lights. Bruises were assessed in vivo for contrast, uniformity and diffuseness, and these characteristics were then compared across image modalities. Color images (conventional, cross polarized) were segmented and measured by ImageJ. Bruises of grey scale images (IR, UV) were measured by a ‘plug in’ of ImageJ. The maximum and minimum Feret's diameter, area and aspect ratio, were determined. Comparison of measurements across imaging modalities was conducted using Wilcoxon rank sum tests and modified Bland-Altman graphs. Significance was set at p < 0.05.

Results

Twenty five children had 39 bruises. Bruises that were of low contrast, i.e. difficult to distinguish from surrounding skin, were also more diffuse, and less uniformity in vivo. Low contrast bruises were best seen on conventional and cross-polarized images and less distinctive on IR and UV images. Of the 19 bruises visible in all modalities, the only significant difference was maximum and minimum Feret's diameters and area were smaller on IR compared to conventional images. Aspect ratios were not affected by the modality.

Conclusions

Conventional and cross-polarized imaging provides the most consistent bruise measurement, particularly in bruises that are not easily distinguished from surrounding skin visually.

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Diffuse bruises may be measured on conventional & cross polarized imaging.

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Infrared or ultraviolet imaging may not show bruises which are difficult to see in vivo.

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Measurements of bruises using infrared imaging may be smaller than other modalities.