P-469 Period Tracker Applications – are they giving women accurate menstrual cycle information?

Study question

Are period trackers giving women accurate information about their periods and ovulation?

Summary answer

The top 10 period trackers gave conflicting information on period dates, ovulation day and the fertile window.

What is known already

Period tracking applications allow women to track their menstrual cycles and receive a prediction for their periods. The majority of applications also provide predictions of day of ovulation and the fertile window. Previous research indicates applications are basing predictions on assuming women undergo a textbook 28-day cycle with ovulation occurring on day 14 and a fertile window between days 10 and 17.

Study design, size, duration

An audit of menstrual cycle apps was conducted on the Apple app store using menstrual cycle tracker/period tracker as the search terms. The top ten apps that followed the inclusion and exclusion criteria were analysed and used for this study. All apps had the ability to allow retrospective data entry giving future cycle predictions and fertile window, and nine of the apps predicted a day of ovulation.

Participants/materials, setting, methods

Five women’s profiles for 6 menstrual cycles were created and entered into each app. Cycle length (CL) and ovulation day (OD) for the 6th cycle were; Woman 1 – Constant 28 day CL, 0D 16, Woman 2 – Average 23 day CL, OD 13, Woman 3 – Average 28 day CL, OD 17, Woman 4 – Average 33 day CL, OD 20 and Woman 5 – Irregular, average 31 day CL, OD 14.

Main results and the role of chance

For cycle length, the apps all predicted woman 1’s cycles correctly but for women 2-5, the apps predicted 0 to 8 days shorter or longer than expected. For day of ovulation; for woman 1, no apps predicted this correctly; the apps ranged from day 13-15. For woman 2, 1 app was correct and overall the apps showed a lot of variation from day 8 to 13. For woman 3, no apps got it right, with a range of day 13-16. For woman 4, 2 apps got it right, but the apps ranged from day 13-20. For woman 5, no apps got right; the apps ranged from day 13-21. Irrespective of cycle length, 7 apps predicted a fertile window of 7 days in almost all cases; except 1 app that predicted 6 days for woman 2 and a different app which predicted 8 days for woman 4. For the remaining 3 apps, one always predicted a 10 day fertile window. One app predicted an 11 day fertile window in 4/5 women. One app predicted a 12 day fertile window in 4/5 women.

Limitations, reasons for caution

The five profiles created spanned a range of observed cycle characteristics, but many permutations are possible. A Monte Carlo type analysis could be conducted to examine these possibilities to provide more precise assessment of app performance, but as data had to be added manually into apps, this was not possible.

Wider implications of the findings

The apps do not use the same algorithm and show variation. The information given by these apps is not 100% accurate, especially for the day of ovulation and the fertile window which can only be predicted if using a marker of ovulation, such as basal body temperature or ovulation sticks.

Trial registration number

not applicable

P–469 Period Tracker Applications – are they giving women accurate menstrual cycle information?

Study question

Are period trackers giving women accurate information about their periods and ovulation?

Summary answer

The top 10 period trackers gave conflicting information on period dates, ovulation day and the fertile window.

What is known already

Period tracking applications allow women to track their menstrual cycles and receive a prediction for their periods. The majority of applications also provide predictions of day of ovulation and the fertile window. Previous research indicates applications are basing predictions on assuming women undergo a textbook 28-day cycle with ovulation occurring on day 14 and a fertile window between days 10 and 17.

Study design, size, duration

An audit of menstrual cycle apps was conducted on the Apple app store using menstrual cycle tracker/period tracker as the search terms. The top ten apps that followed the inclusion and exclusion criteria were analysed and used for this study. All apps had the ability to allow retrospective data entry giving future cycle predictions and fertile window, and nine of the apps predicted a day of ovulation.

Participants/materials, setting, methods

Five women’s profiles for 6 menstrual cycles were created and entered into each app. Cycle length (CL) and ovulation day (OD) for the 6th cycle were; Woman 1 – Constant 28 day CL, 0D 16, Woman 2 – Average 23 day CL, OD 13, Woman 3 – Average 28 day CL, OD 17, Woman 4 – Average 33 day CL, OD 20 and Woman 5 – Irregular, average 31 day CL, OD 14.

Main results and the role of chance

For cycle length, the apps all predicted woman 1’s cycles correctly but for women 2–5, the apps predicted 0 to 8 days shorter or longer than expected. For day of ovulation; for woman 1, no apps predicted this correctly; the apps ranged from day 13–15. For woman 2, 1 app was correct and overall the apps showed a lot of variation from day 8 to 13. For woman 3, no apps got it right, with a range of day 13–16. For woman 4, 2 apps got it right, but the apps ranged from day 13–20. For woman 5, no apps got right; the apps ranged from day 13–21. Irrespective of cycle length, 7 apps predicted a fertile window of 7 days in almost all cases; except 1 app that predicted 6 days for woman 2 and a different app which predicted 8 days for woman 4. For the remaining 3 apps, one always predicted a 10 day fertile window. One app predicted an 11 day fertile window in 4/5 women. One app predicted a 12 day fertile window in 4/5 women.

Limitations, reasons for caution

The five profiles created spanned a range of observed cycle characteristics, but many permutations are possible. A Monte Carlo type analysis could be conducted to examine these possibilities to provide more precise assessment of app performance, but as data had to be added manually into apps, this was not possible.

Wider implications of the findings: The apps do not use the same algorithm and show variation. The information given by these apps is not 100% accurate, especially for the day of ovulation and the fertile window which can only be predicted if using a marker of ovulation, such as basal body temperature or ovulation sticks.

Trial registration number

Not applicable

POS0840 RISK OF MALNUTRITION IN PATIENTS WITH SYSTEMIC SCLEROSIS-ASSOCIATED INTERSTITIAL LUNG DISEASE (SSC-ILD): FURTHER ANALYSES OF THE SENSCIS TRIAL

Background:

Gastrointestinal (GI) involvement is common in patients with SSc and may lead to weight loss and malnutrition. In the SENSCIS trial in patients with SSc-ILD, nintedanib reduced the rate of decline in forced vital capacity (FVC) (mL/year) over 52 weeks, with mainly GI adverse events. The Malnutrition Universal Screening Tool (MUST) was developed to identify adults who are at risk of malnutrition and has been used in studies of patients with SSc.

Objectives:

To evaluate nutritional status over 52 weeks in the SENSCIS trial based on a modified MUST score.

Methods:

The SENSCIS trial enrolled patients with SSc-ILD with first non-Raynaud symptom ≤7 years before screening, extent of fibrotic ILD ≥10% on HRCT and FVC ≥40% predicted. Patients who had taken a stable dose of mycophenolate for ≥6 months were eligible to participate. Patients were randomised to receive nintedanib 150 mg bid or placebo. Dose reductions to 100 mg bid and treatment interruptions were allowed to manage adverse events and specific recommendations were provided for the management of diarrhoea. We calculated a modified MUST score at baseline and weeks 12, 24, 36 and 52 based on (A) BMI, (B) weight loss (week 12 vs baseline; week 24 vs week 12; week 36 vs week 24; week 52 vs week 36), and (C) a surrogate for acute disease effect (if the patient had any serious adverse event that led to hospitalisation between weight assessments and received ≥1 medication from the WHO classification code for “solutions for parenteral nutrition” for ≥5 days). MUST score at baseline was based solely on BMI. With scores ranging from 0 to 6, the risk of malnutrition is defined as low (score = 0), medium (score = 1) or high (score ≥2).

Results:

Among 576 patients who received nintedanib (n=288) or placebo (n=288), mean (SD) age at baseline was 54.0 (12.2) years, weight was 69.7 (15.9) kg and BMI was 25.9 (5.0) kg/m2; median time since onset of first non-Raynaud symptom was 3.4 years; and 75.2% of patients were female. In the nintedanib and placebo groups, respectively, MUST scores suggested that 74.0% and 78.1% of patients were at low risk of malnutrition at baseline and remained at low risk at their last measurement (Table 1). At weeks 12 and 52, respectively, mean (SD) MUST scores were 0.3 (0.6) and 0.4 (0.7) in the nintedanib group and 0.2 (0.5) and 0.2 (0.6) in the placebo group. At weeks 12, 24, 36 and 52, respectively, the proportions of patients at low risk of malnutrition were 81.8%, 80.9%, 72.9% and 76.5% in the nintedanib group and 86.6%, 86.4%, 88.3% and 80.8% in the placebo group; the proportions at medium risk were 12.1%, 13.1%, 18.0% and 13.5% in the nintedanib group and 8.5%, 8.6%, 5.8% and 13.1% in the placebo group; and the proportions of patients at high risk were 6.1%, 5.6%, 8.3% and 9.6% in the nintedanib group and 4.9%, 4.3%, 4.7% and 5.4% in the placebo group.

Table 1.

Risk of malnutrition at baseline and at last assessment over 52 weeks in the SENSCIS trial.

Last assessment of riskNintedanib (n=288)Placebo (n=288)Baseline riskBaseline riskLowMediumHighTotalLowMediumHighTotalLow213 (74.0)1 (0.3)0214 (74.3)225 (78.1)7 (2.4)0232 (80.6)Medium31 (10.8)8 (2.8)039 (13.5)20 (6.9)14 (4.9)4 (1.4)38 (13.2)High13 (4.5)8 (2.8)7 (2.4)28 (9.7)3 (1.0)2 (0.7)10 (3.5)15 (5.2)Missing7 (2.4)007 (2.4)3 (1.0)003 (1.0)Total264 (91.7)17 (5.9)7 (2.4)288 (100)251 (87.2)23 (8.0)14 (4.9)288 (100)

MUST score ranges from 0 to 6. Score of 0 = low risk: score of 1 = medium risk; score of ≥2 = high risk. Baseline MUST score was based solely on BMI.

Conclusion:

In the SENSCIS trial, scores based on a modified MUST indicated that most patients treated with nintedanib were at low risk of malnutrition at baseline and remained at low risk over 52 weeks. The proportions of patients at high risk of malnutrition were low but were numerically greater in patients who received nintedanib than placebo. Management of disease manifestations and gastrointestinal adverse events that may be associated with weight loss is important to reduce the risk of malnutrition in patients with SSc-ILD treated with nintedanib.

Acknowledgements:

The SENSCIS trial was funded by Boehringer Ingelheim. Medical writing support was provided by FleishmanHillard Fishburn, London, UK. The authors meet criteria for authorship as recommended by the International Committee of Medical Journal Editors (ICMJE).

Disclosure of Interests:

Elizabeth Volkmann Consultant of: Boehringer Ingelheim, Grant/research support from: Corbus and Forbius, Zsuzsanna McMahan: None declared, Sindhu Johnson Consultant of: Boehringer Ingelheim, CSL Behring and Ikaria, Grant/research support from: Bayer, Boehringer Ingelheim, Corbus, GlaxoSmithKline, Merck and Roche, Vanessa Smith Speakers bureau: Boehringer Ingelheim and Janssen, Consultant of: Boehringer Ingelheim, Grant/research support from: Belgian Fund for Scientific Research in Rheumatic diseases (FWRO), Boehringer Ingelheim, Research Foundation - Flanders (FWO) and Janssen, Stéphane Jouneau Speakers bureau: Actelion, AIRB, AstraZeneca, Bristol-Myers Squibb, Boehringer Ingelheim, Chiesi, Genzyme, GlaxoSmithKline, LVL Mediphar, Mundipharma, Novartis, Pfizer, Roche and Sanofi, Consultant of: AIRB, Boehringer Ingelheim, Novartis and Roche, Grant/research support from: AIRB, Boehringer Ingelheim, LVL Mediphar, Novartis and Roche, Corinna Miede Employee of: Currently an employee of mainanalytics GmbH, contracted by Boehringer Ingelheim, Margarida Alves Employee of: Currently an employee of Boehringer Ingelheim, Ariane Herrick Speakers bureau: Janssen, Consultant of: Boehringer Ingelheim, Camurus, CSL Behring and Gesynta Pharma, Grant/research support from: Actelion and Gesynta Pharma

POS0050 ARE PATIENTS WITH IMMUNE MEDIATED INFLAMMATORY DISEASES (IMID) MORE LIKELY TO RECEIVE COVID-19 TESTS AND TEST POSITIVE FOR SARS-COV-2? A MATCHED POPULATION-BASED STUDY

Background:

Population-based data about the COVID-19 risk in patients with IMID remain scarce.

Objectives:

To investigate the cumulative incidence and risk factors for laboratory-confirmed COVID-19 infection and SARS-CoV2 testing in patients with IMID compared with matched non-IMID patients from the general population.

Methods:

A population-based, matched cohort study was conducted using health administrative data from adults living in Ontario, Canada from January to December 2020. Cohorts for each of the following IMID were assembled: rheumatoid arthritis (RA), psoriasis, psoriatic arthritis, ankylosing spondylitis, systemic autoimmune rheumatic diseases (including lupus, systemic sclerosis, Sjogren’s, inflammatory myositis), multiple sclerosis (MS), iritis, inflammatory bowel disease (IBD), polymyalgia rheumatica (PMR) and vasculitis. Each patient was matched with 5 non-IMID comparators based on age, sex, area of residence and living in long term care (LTC). Standardized cumulative rates of testing for SARS-CoV2, and for receiving a positive test between IMID and non-IMID were compared between IMID and non-IMID patients. Multivariable logistic regression analyses assessed sociodemographic factors associated with COVID-19 testing and positivity.

Results:

A total of 493,499 IMID patients and 2,466,946 non-IMID comparators were assessed. Significantly more IMID patients versus non-IMID were tested for SARS-CoV2 (27.4% vs. 22.7%), while the proportions of those positive for COVID-19 were identical (0.9% of all patients in both groups). Overall, IMID patients were more likely to undergo SARS-CoV2 testing (odds ratio (OR) 1.28, 95% CI 1.27, 1.29), but their overall risk of laboratory-confirmed COVID-19 was not elevated (OR 0.97 (95% CI 0.93, 1)). However, the risk of laboratory-confirmed COVID-19 infection was lower in IBD (OR 0.75), MS (OR 0.77) and psoriasis (OR 0.94) and marginally higher in RA (OR 1.07) and iritis (OR 1.13) compared with non-IMID comparators (Figure 1A). The highest standardized rates of COVID-19 infection were found in vasculitis (115 per 10,000 patients) and iritis (109 per 10,000 patients) (Figure 1B). Risk factors for COVID-19 infection included younger age, living in LTC, multimorbidity, urban living and lower income (Table 1).

Conclusion:

Patients across all IMID were more likely to be tested for COVID-19 versus non-IMID patients. IMID patients were not at higher risk for testing positive for COVID-19 as an overall group, yet risk varied across disease subgroups.

Table 1.

Factors associated with COVID-19 infection in IMID vs. Non-IMID – Multivariable Logistic Regression

VariableORCI 95%IMID vs. Non-IMID0.970.93, 1.00Age (10-year increase)0.890.89, 0.90Sex: Female vs. Males0.950.93, 0.97LTC18.6417.9, 19.42ADG score:•5-9 vs. 0-41.401.35, 1.45•10-14 vs. 0-41.731.67, 1.80•15+ vs. 0-41.181.13, 1.23Urban vs. Rural3.493.26, 3.72Income quintile•Quintile 2 vs. 10.920.89, 0.96•Quintile 3 vs. 10.900.86, 0.93•Quintile 4 vs. 10.730.70, 0.76•Quintile 5 vs. 10.600.58, 0.63

ADG - Aggregated Diagnosis Groups; IMIDs – Immune medicated inflammatory disease; LTC – long term care

Acknowledgements:

The study is supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). Parts of this material are based on data and information compiled and provided by MOHLTC and the Canadian Institute for Health Information. The opinions, results and conclusions reported in this paper are those of the authors and are independent of the funding or data sources; no endorsement is intended or should be inferred.

Disclosure of Interests:

None declared.

POS0079 PATIENTS WITH JUVENILE SYSTEMIC SCLEROSIS HAVE A DISTINCT PATTERN OF ORGAN INVOLVEMENT.RESULTS FROM THE JUVENILE SYSTEMIC SCLEROSIS INCEPTION COHORT. WWW.JUVENILE-SCLERODERMA.COM

Background:

Juvenile systemic sclerosis (jSSc) is a rare disease with a prevalence of around 3 in 1,000,000 children. To better capture the clinical manifestations of jSSc the juvenile systemic sclerosis inception cohort (jSScC) has been prospectively enrolling patients with predetermined clinical variables over the past 12 years. One of the goals is to study the demographic, clinical features, and physician and patient reported outcome differences between those with juvenile limited cutaneous (lc) compared to diffuse cutaneous (dc) disease subtypes, to determine if characteristics are similar or different between dc and lc jSSc.

Objectives:

Evaluation of the baseline clinical characteristics of jSSc patients in the jSScC. Compare clinical phenotype between diffuse (dcjSSc) and limited cutaneous (lcjSSc) subtypes.

Methods:

Demographic, physical examination, organ system evaluation, autoantibody profile, treatment, and patient and physician reported outcome variables were evaluated from the jSSc Inception cohort and summary statistics applied using chi-square test and Mann Whitney U-test comparing lcjSSc and dcjSSc subtypes.

Results:

At the time of data extraction, 175 jSSc patients were enrolled in the cohort, 81% were Caucasian and 81% female. Diffuse cutaneous jSSc subtype predominated (73%). Mean disease duration was 3.1 year (±2.7). Mean age at Raynaud´s was 10 years (+3.8) and mean age of first non-Raynaud´s was 10.2 years (±3.8). Significant differences were found between dcjSSc versus lcjSSc, regarding several clinical characteristics. Patients with diffuse cutaneous subtype had significantly higher modified Rodnan skin score (p=0.001), presence of sclerodactyly (p=0.02), presence of Gottron’s papules (p=0.003), presence of telangiectasia (p=0.001), history of digital tip ulceration (p=0.01), and frequency of elevated CK value (p=0.04). Cardiac involvement was significantly higher in limited cutaneous jSSc subtype (p=0.02). Diffuse cutaneous jSSc patients had significantly worse scores for Physician Global Assessment of disease activity (38 vs 25; p=0.002) and disease damage (34 vs 19; p=0.008).

Table 1.

Comparison of demographic data and significant differences between dcjSSc and lcjSSc at time of inclusion

Whole CohortN=175Diffuse SubtypeN=128Limited SubtypeN=47P valueFemale to Male Ratio4.3:1 (142/33)4.1:1 (103/25)4.8:1 (39/8)0.829Cutaneous subtypeDiffuse subtype73% (128)1280Limited subtype27% (47)047Mean Disease duration (years)3.1 (± 2.7)3.3 (± 2.9)2.6 (± 2.2)0.135Mean age of onset of Raynaud´s (years)10.0 (± 3.8)17 non-Raynaud9.8 (± 3.6)10 non-Raynaud10.6 (± 4.3)7 non-Raynaud0.219Mean age of onset of non-Raynaud´s (years)10.2 (± 3.9)10.0 (± 3.7)10.9 (± 4.3)0.173Disease modifying drugs88% (154)89% (114)85% (40)0.446CutaneousMean modified Rodnan skin score14.3 (0-51)17.4 (0-51)6.1 (0-24)0.001Gottron Papules27% (46/171)33% (41/124)11% (5)0.003Sclerodactyly78% (126/162)82% (98/119)65% (28/43)0.020Laboratory valuesElevated CK25% (30/122)30% (26/88)12% (4/34)0.041VascularTelangiectasia36% (56/154)44% (49/111)16% (7/43)0.001History of ulceration53% (91/173)61% (77/127)30% (14/46)0.001CardiacCardiac Involvement6% (10)2% (3)15% (7)0.002Patient Related OutcomesPhysician global disease activity(0-100) min -max35(0-90) n=14138(0-90) n=10825(0-80) n=330.002Physician global disease damage(0-100) min -max31(0-85) n=14034(0-85) n=10819(0-60) n=320.008

Conclusion:

Results from this large international cohort of jSSc patients demonstrate significant differences between dcjSSc and lcjSSc patients. According to the general organ involvement and physician global scores, the dcjSSc patients had significantly more severe disease. These observations strengthen our previous findings of the unique organ pattern of pediatric patients.

Supported by the “Joachim Herz Stiftung”

Disclosure of Interests:

None declared.

POS1304 JUVENILE SYSTEMIC SCLEROSIS (JSSC) PATIENTS WITH OVERLAP CHARACTERISTICS DO NOT HAVE MILD DISEASE. RESULTS FROM THE JSSC INCEPTION COHORT. WWW.JUVENILESCLERODERMA.COM

Background:

Juvenile systemic sclerosis (jSSc) is an orphan disease with a prevalence of around 3 in 1, 000,000 children. It is known that in pediatric jSSc cohorts, there are a significant number of patients with overlap features, such as arthritis and myositis. However, the disease burden between those with and without overlap features in jSSc has not been defined.

Objectives:

Compare the clinical phenotype between children with and without overlap features in the juvenile systemic scleroderma inception cohort (jSScC).

Methods:

A cross-sectional study was performed using baseline visit data. Demographic, organ system evaluation, autoantibody profile, treatment, and patient and physician reported outcome variables were extracted from jSScC. Comparison between patients with and without overlap features was performed using chi-square test and Mann Whitney U-test.

Results:

At the time of data extraction, 175 jSSc patients were enrolled in the cohort, 81% were Caucasian and 81% female. Mean disease duration was 3.1 year (±2.7). Mean age at Raynaud´s onset was 10 years (±3.8) and mean age of first non-Raynaud´s was 10.2 years (±3.8). Overlap features occurred 17% (n=30) of the cohort, 12.5% in the diffuse cutaneous (dc) jSSc and in 30% in the limited cutaneous (lc) jSSc. Significant differences in clinical characteristics were found between those patients with compared to without overlap characteristics. Patients with overlap features presented more frequently with Gottron papules (p=0.007), swollen joints (p=0.019), muscle weakness (p=0.003), and lung involvement documented by decreased DLCO < 80% (p=0.06) and/or abnormal high resolution computed tomography (p=0.049). Anti-PM/Scl autoantibodies were also more common in this group (p=0.001). Significantly more patients without overlap features had Raynaud´s (p=0.006). Physician Global Assessment of disease activity was significantly higher in patients with overlap features (41 vs 34; p=0.041). (Table 1.)

Table 1.

Demographic and clinical characteristics of jSSc patients with and without overlap features.

Whole CohortN=175Patients without overlapN=145Patients with overlapN=30P valueFemale to Male Ratio 4.3:1(142/33)4:1(116/29)6.5:1(26/4)0.395Cutaneous subtypeDiffuse subtype (N)73% (128)11216Limited subtype (N)27% (47)3317Mean disease duration (years)3.1 (± 2.7)3.2 (± 2.8)3.1 (± 2.2)0.291Mean age of onset of Raynaud´s (years)10.0 (± 3.8)17 non-Raynaud10.0 (± 3.8)10 non-Raynaud10.0 (± 3.7)7 non-Raynaud0.931Mean age of onset of non-Raynaud´s (years)10.2 (± 3.8)10.2 (± 3.9)9.8 (± 3.7)Disease modifying drugs (N)88% (154) 89% (129)83% (25)0.388Raynaud´s phenomenon90% (158)93% (135)77% (23)0.006Anti-PMScl18% (12/68)9% (5/53)47% (7/15)0.001Gottron Papules (N)27% (46/171)23% (33/144)48% (13/27)0.007DLCO <80% (N)44% (39/88)39% (28/71)65% (11/17)0.06Abnormal findings in HRCT (N)44% (59/133)40% (43/107)62% (16/26)0.049Proportion of patients with swollen joints 18% (32) 14% (21) 37% (11)0.019Muscle Weakness (N) 21% (31/149)16% (20/123) 42% (11/26)0.003Physician global disease activity(0-100) min -max35 (0-90) n=14134 (0-90) n=11441 (0-80) n=270.041

Conclusion:

Results from this large international cohort of jSSc patients demonstrate significant differences between patients with and without overlap features. Patients with overlap have significantly more interstitial lung disease and more physician rated disease activity and should not be considered to have more “mild disease”.

Supported by the “Joachim Herz Stiftung”

Disclosure of Interests:

None declared

OP0285 COVID-19 HOSPITALIZATIONS, ICU ADMISSION, AND DEATH AMONG PATIENTS WITH IMMUNE MEDIATED INFLAMMATORY DISEASES (IMID) – A POPULATION-BASED STUDY

Background:

It remains unclear whether patients with IMID are at greater risk for severe COVID-19.

Objectives:

To investigate the risk of COVID-19 hospitalizations and their outcomes in patients with IMID compared with matched non-IMID patents from the general population.

Methods:

A population-based, matched cohort study was conducted in adults living in Ontario, Canada using health administrative data. Ten cohorts of the following IMID were assembled: rheumatoid arthritis, psoriasis, psoriatic arthritis, ankylosing spondylitis, systemic autoimmune rheumatic diseases (SARDs, including systemic lupus, systemic sclerosis, Sjogren’s, myositis), multiple sclerosis (MS), iritis, inflammatory bowel disease, polymyalgia rheumatica (PMR), and vasculitis (including giant cell arteritis and other types of vasculitidies). Each patient was matched with 5 non-IMID comparators based on age, sex, area of residence and living in long-term care (LTC). Patients who were admitted to hospital from January 1st to July 31th, 2020 and had ICD-10 COVID-19 diagnosis codes (U07.2 or U07.1) were identified. Among those with COVID-19 hospitalizations, we determined those with admissions to intensive care unit or required mechanical ventilation or died in hospital (‘complicated hospitalization’). Age-sex-standardized rates were compared between IMID and non-IMID patients and risk factors for hospitalizations were identified by multivariable logistic regression analysis.

Results:

In total, 493,499 IMID (417 hospitalized) and 2,466,946 non-IMID patients (1,519 hospitalized) were assessed. The age-sex-standardized rate of COVID-19 hospitalization was higher in IMID (6.4 per 10,000, 95% confidence interval (CI) 5.8, 7.2) versus non-IMID patients (4.8 per 100,000, 95% CI 4.5, 5). The highest rates of hospitalizations were found in vasculitis (18/10,000), MS (16.7/10,000) and PMR (10.1/10,000). IMID diagnosis was associated with 37% higher risk of being hospitalized for COVID-19 (Odds Ratio (OR) 1.37, 95% CI 1.23, 1.53) (Figure 1). This risk was slightly attenuated after adjusting for sociodemographic factors and comorbidities but remained elevated by 23% compared to non-IMID (OR 1.23, 95% CI 1.10, 1.37). The risk for hospitalizations was increased in RA, vasculitis, SARDs, PsA, MS and iritis (Figure 1). Risk factors for COVID-19 hospitalizations included older age, male sex, lower income, multimorbidity and living in long-term care (Table 1). The risk for complicated COVID-19 hospitalizations was higher by 21% in IMID patients (OR 1.21, 95% CI 1.02, 1.43), however, this association was attenuated after adjustment for demographics and comorbidities (OR 1.08).

Table 1.

Risk Factors for COVID-19 Hospitalizations in IMIDs vs. non-IMIDs

VariableOR95% CIIMIDs vs. Non-IMID1.231.10, 1.37Age (10 yrs)1.491.44, 1.54Sex: Female0.680.62, 0.75Long term care resident8.287.32, 9.37ADG: 5-9 vs. 0-41.451.22, 1.7110-14 vs. 0-42.261.92, 2.6715+ vs. 0-43.232.73, 3.82Income (quintile) Quintile 2 vs. 10.820.73, 0.93 Quintile 3 vs. 10.760.67, 0.86 Quintile 4 vs. 10.560.48, 0.64 Quintile 5 vs. 10.460.40, 0.54Urban vs. rural4.333.32, 5.67

ADG - Aggregated Diagnosis Groups

Conclusion:

Patients with IMID were at higher risk of being hospitalized with COVID-19 and for having complicated hospitalizations. Hospitalization risk was partially independent of their comorbid conditions.

Acknowledgements:

The study is supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). Parts of this material are based on data and information compiled and provided by MOHLTC and the Canadian Institute for Health Information. The opinions, results and conclusions reported in this paper are those of the authors and are independent of the funding or data sources; no endorsement is intended or should be inferred.

Disclosure of Interests:

None declared

Assessing risk in the retail environment during the COVID-19 pandemic

The COVID-19 pandemic has caused unprecedented disruption, particularly in retail. Where essential demand cannot be fulfilled online, or where more stringent measures have been relaxed, customers must visit shop premises in person. This naturally gives rise to some risk of susceptible individuals (customers or staff) becoming infected. It is essential to minimize this risk as far as possible while retaining economic viability of the shop. We therefore explore and compare the spread of COVID-19 in different shopping situations involving person-to-person interactions: (i) free-flowing, unstructured shopping; (ii) structured shopping (e.g. a queue). We examine which of (i) or (ii) may be preferable for minimizing the spread of COVID-19 in a given shop, subject to constraints such as the geometry of the shop; compliance of the population to local guidelines; and additional safety measures which may be available to the organizers of the shop. We derive a series of conclusions, such as unidirectional free movement being preferable to bidirectional shopping, and that the number of servers should be maximized as long as they can be well protected from infection.

Fidelity to an evidence-based model for crisis resolution teams: a cross-sectional multicentre study in Norway

BACKGROUND

Crisis resolution teams (CRTs) are specialized multidisciplinary teams intended to provide assessment and short-term outpatient or home treatment as an alternative to hospital admission for people experiencing a mental health crisis. In Norway, CRTs have been established within mental health services throughout the country, but their fidelity to an evidence-based model for CRTs has been unknown.

METHODS

We assessed fidelity to the evidence-based CRT model for 28 CRTs, using the CORE Crisis Resolution Team Fidelity Scale Version 2, a tool developed and first applied in the UK to measure adherence to a model of optimal CRT practice. The assessments were completed by evaluation teams based on written information, interviews, and review of patient records during a one-day visit with each CRT.

RESULTS

The fidelity scale was applicable for assessing fidelity of Norwegian CRTs to the CRT model. On a scale 1 to 5, the mean fidelity score was low (2.75) and with a moderate variation of fidelity across the teams. The CRTs had highest scores on the content and delivery of care subscale, and lowest on the location and timing of care subscale. Scores were high on items measuring comprehensive assessment, psychological interventions, visit length, service users' choice of location, and of type of support. However, scores were low on opening hours, gatekeeping acute psychiatric beds, facilitating early hospital discharge, intensity of contact, providing medication, and providing practical support.

CONCLUSIONS

The CORE CRT Fidelity Scale was applicable and relevant to assessment of Norwegian CRTs and may be used to guide further development in clinical practice and research. Lower fidelity and differences in fidelity patterns compared to the UK teams may indicate that Norwegian teams are more focused on early interventions to a broader patient group and less on avoiding acute inpatient admissions for patients with severe mental illness.

Growth strategy determines the memory and structural properties of brain networks

The interplay between structure and function affects the emerging properties of many natural systems. Here we use an adaptive neural network model that couples activity and topological dynamics and reproduces the experimental temporal profiles of synaptic density observed in the brain. We prove that the existence of a transient period of relatively high synaptic connectivity is critical for the development of the system under noise circumstances, such that the resulting network can recover stored memories. Moreover, we show that intermediate synaptic densities provide optimal developmental paths with minimum energy consumption, and that ultimately it is the transient heterogeneity in the network that determines its evolution. These results could explain why the pruning curves observed in actual brain areas present their characteristic temporal profiles and they also suggest new design strategies to build biologically inspired neural networks with particular information processing capabilities.

A dual high-energy radiography platform with 15 μm resolution at the National Ignition Facility

To study matter at extreme densities and pressures, we need mega laser facilities such as the National Ignition Facility as well as creative methods to make observations during timescales of a billionth of a second. To facilitate this, we developed a platform and diagnostic to characterize a new point-projection radiography configuration using two micro-wires irradiated by a short pulse laser system that provides a large field of view with up to 3.6 ns separation between images. We used tungsten-carbide solid spheres as reference objects and inferred characteristics of the back-lighter source using a forward-fitting algorithm. The resolution of the system is inferred to be 15 μm (using 12.5 μm diameter wires). The bremsstrahlung temperature of the source is 70-300 keV, depending on laser energy and coupling efficiency. By adding the images recorded on multiple stacked image plates, the signal-to-noise of the system is nearly doubled. The imaging characterization technique described here can be adapted to most point-projection platforms where the resolution, spectral contrast, and signal-to-noise are important.

A health-related social needs referral program for Medicaid beneficiaries treated in an emergency department

BACKGROUND

Social determinants of health (SDH) play an important role in health outcomes. This study sought to evaluate the effectiveness of a SDH screening and health-related social needs (HRSNs) referral program in an emergency department (ED) setting with adult Medicaid beneficiaries.

METHODS

Between November 2016 and March 2017 we enrolled adult Medicaid patients in a prospective cohort study. Research assistants (RAs) completed an SDH screening survey with participants and asked them if they needed assistance with HRSNs related to medical, behavioral health, wellness, housing, food, legal and job training issues. RAs referred participants to community-based organizations (CBO) for their top three HRSNs. Patients referred to at least one CBO were phoned a month later to determine whether their HRSN was addressed and CBOs also reported their assistance rates within four months of the ED visit.

RESULTS

Of the 505 patients enrolled, 69% were female, 82% completed high school, and 57% reported working. Most participants (85%) requested assistance for at least one HRSN. Almost half (44%) received referrals to three different agencies. Help with housing (70%), medical issues (51%), and finding food (42%) were the most common. Among the 430 subjects referred to ≥1 agency, 76% completed the follow-up interview. Few patients reported receiving help from the referral agencies (5% for a wellness program to 15% for medical services). Referral agencies generally reported even lower assistance rates (0% for job training to 17% for medical services).

CONCLUSION

The majority of adult Medicaid patients treated in our ED wanted assistance with one or more HRSN. The passive referral system we implemented resulted in few patients receiving assistance from the referral agency, regardless of whether measured by self-report or by agency.

Correlation of chest radiography findings with the severity and progression of COVID-19 pneumonia

PURPOSE

Aim is to assess the temporal changes and prognostic value of chest radiograph (CXR) in COVID-19 patients.

MATERIAL AND METHODS

We performed a retrospective study of confirmed COVID-19 patients presented to the emergency between March 07-17, 2020. Clinical & radiological findings were reviewed. Clinical outcomes were classified into critical & non-critical based on severity. Two independent radiologists graded frontal view CXRs into COVID-19 pneumonia category 1 (CoV-P1) with <4 zones and CoV-P2 with ≥4 zones involvement. Interobserver agreement of CoV-P category for the CXR preceding the clinical outcome was assessed using Kendall's τ coefficient. Association between CXR findings and clinical deterioration was calculated along with temporal changes of CXR findings with disease progression.

RESULTS

Sixty-two patients were evaluated for clinical features. 56 of these (total: 325 CXRs) were evaluated for radiological findings. Common patterns were progression from lower to upper zones, peripheral to diffuse involvement, & from ground glass opacities to consolidation. Consolidations starting peripherally were noted in 76%, 93% and 48% with critical outcomes, respectively. The interobserver agreement of the CoV-P category of CXRs in the critical and non-critical outcome groups were good and excellent, respectively (τ coefficient = 0.6 & 1.0). Significant association was observed between CoV-P2 and clinical deterioration into a critical status (χ2 = 27.7, p = 0.0001) with high sensitivity (95%) and specificity (71%) within a median interval time of 2 days (range: 0-4 days).

CONCLUSION

Involvement of predominantly 4 or more zones on frontal chest radiograph can be used as predictive prognostic indicator of poorer outcome in COVID-19 patients.

Latent Class Analysis to Represent Social Determinant of Health Risk Groups in the Medicaid Cohort of the District of Columbia

OBJECTIVE

To develop distinct social risk profiles based on social determinants of health (SDH) information and to determine whether these social risk groups varied in terms of health, health care utilization, and costs.

METHODS

We prospectively enrolled 8943 beneficiaries insured by the District of Columbia Medicaid program between September 2017 and December 2018. Participants completed a SDH survey and we obtained their Medicaid claims data for a 2-year period before study enrollment. We used latent class analysis (LCA) to identify distinct social risk profiles based on their SDH responses. We assessed the relationship among different SDH as well as the relationship among the social risk classes and health, health care use and costs.

RESULTS

The majority of SDH were moderately to strongly correlated with one another. LCA yielded 4 distinct social risk groups. Group 1 reported the least social risks with the most employed. Group 2 was distinguished by financial strain and housing instability with fewer employed. Group 3 were mostly unemployed with limited car and internet access. Group 4 had the most social risks and most unemployed. The social risk groups demonstrated meaningful differences in health, acute care utilization, and health care costs with group 1 having the best health outcomes and group 4 the worst (P<0.05).

CONCLUSIONS

LCA is a practical method of aggregating correlated SDH data into a finite number of distinct social risk groups. Understanding the constellation of social challenges that patients face is critical when attempting to address their social needs and improve health outcomes.

Rapid diagnostic tests for Plasmodium vivax malaria in endemic countries

BACKGROUND

Plasmodium vivax (P vivax) is a focus of malaria elimination. It is important because P vivax and Plasmodium falciparum infection are co-endemic in some areas. There are asymptomatic carriers of P vivax, and the treatment for P vivax and Plasmodium ovale malaria differs from that used in other types of malaria. Rapid diagnostic tests (RDTs) will help distinguish P vivax from other malaria species to help treatment and elimination. There are RDTs available that detect P vivax parasitaemia through the detection of P vivax-specific lactate dehydrogenase (LDH) antigens.

OBJECTIVES

To assess the diagnostic accuracy of RDTs for detecting P vivax malaria infection in people living in malaria-endemic areas who present to ambulatory healthcare facilities with symptoms suggestive of malaria; and to identify which types and brands of commercial tests best detect P vivax malaria.

SEARCH METHODS

We undertook a comprehensive search of the following databases up to 30 July 2019: Cochrane Infectious Diseases Group Specialized Register; Central Register of Controlled Trials (CENTRAL), published in the Cochrane Library; MEDLINE (PubMed); Embase (OVID); Science Citation Index Expanded (SCI-EXPANDED) and Conference Proceedings Citation Index-Science (CPCI-S), both in the Web of Science.

SELECTION CRITERIA

Studies comparing RDTs with a reference standard (microscopy or polymerase chain reaction (PCR)) in blood samples from patients attending ambulatory health facilities with symptoms suggestive of malaria in P vivax-endemic areas.

DATA COLLECTION AND ANALYSIS

For each included study, two review authors independently extracted data using a pre-piloted data extraction form. The methodological quality of the studies were assessed using a tailored Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. We grouped studies according to commercial brand of the RDT and performed meta-analysis when appropriate. The results given by the index tests were based on the antibody affinity (referred to as the strength of the bond between an antibody and an antigen) and avidity (referred to as the strength of the overall bond between a multivalent antibody and multiple antigens). All analyses were stratified by the type of reference standard. The bivariate model was used to estimate the pooled sensitivity and specificity with 95% confidence intervals (CIs), this model was simplified when studies were few. We assessed the certainty of the evidence using the GRADE approach.

MAIN RESULTS

We included 10 studies that assessed the accuracy of six different RDT brands (CareStart Malaria Pf/Pv Combo test, Falcivax Device Rapid test, Immuno-Rapid Malaria Pf/Pv test, SD Bioline Malaria Ag Pf/Pv test, OnSite Pf/Pv test and Test Malaria Pf/Pv rapid test) for detecting P vivax malaria. One study directly compared the accuracy of two RDT brands. Of the 10 studies, six used microscopy, one used PCR, two used both microscopy and PCR separately and one used microscopy corrected by PCR as the reference standard. Four of the studies were conducted in Ethiopia, two in India, and one each in Bangladesh, Brazil, Colombia and Sudan. The studies often did not report how patients were selected. In the patient selection domain, we judged the risk of bias as unclear for nine studies. We judged all studies to be of unclear applicability concern. In the index test domain, we judged most studies to be at low risk of bias, but we judged nine studies to be of unclear applicability concern. There was poor reporting on lot testing, how the RDTs were stored, and background parasitaemia density (a key variable determining diagnostic accuracy of RDTs). Only half of the included studies were judged to be at low risk of bias in the reference standard domain, Studies often did not report whether the results of the reference standard could classify the target condition or whether investigators knew the results of the RDT when interpreting the results of the reference standard. All 10 studies were judged to be at low risk of bias in the flow and timing domain. Only two brands were evaluated by more than one study. Four studies evaluated the CareStart Malaria Pf/Pv Combo test against microscopy and two studies evaluated the Falcivax Device Rapid test against microscopy. The pooled sensitivity and specificity were 99% (95% CI 94% to 100%; 251 patients, moderate-certainty evidence) and 99% (95% CI 99% to 100%; 2147 patients, moderate-certainty evidence) for CareStart Malaria Pf/Pv Combo test. For a prevalence of 20%, about 206 people will have a positive CareStart Malaria Pf/Pv Combo test result and the remaining 794 people will have a negative result. Of the 206 people with positive results, eight will be incorrect (false positives), and of the 794 people with a negative result, two would be incorrect (false negative). For the Falcivax Device Rapid test, the pooled sensitivity was 77% (95% CI: 53% to 91%, 89 patients, low-certainty evidence) and the pooled specificity was 99% (95% CI: 98% to 100%, 621 patients, moderate-certainty evidence), respectively. For a prevalence of 20%, about 162 people will have a positive Falcivax Device Rapid test result and the remaining 838 people will have a negative result. Of the 162 people with positive results, eight will be incorrect (false positives), and of the 838 people with a negative result, 46 would be incorrect (false negative).

AUTHORS' CONCLUSIONS

The CareStart Malaria Pf/Pv Combo test was found to be highly sensitive and specific in comparison to microscopy for detecting P vivax in ambulatory healthcare in endemic settings, with moderate-certainty evidence. The number of studies included in this review was limited to 10 studies and we were able to estimate the accuracy of 2 out of 6 RDT brands included, the CareStart Malaria Pf/Pv Combo test and the Falcivax Device Rapid test. Thus, the differences in sensitivity and specificity between all the RDT brands could not be assessed. More high-quality studies in endemic field settings are needed to assess and compare the accuracy of RDTs designed to detect P vivax.

Avoiding the fatal misdiagnosis of pregnancy in a noncommunicating rudimentary horn using 3D transvaginal ultrasound

Rudimentary horn pregnancies are an increasingly recognized complication of Mullerian duct anomalies. They can lead to uterine rupture with severe maternal morbidity and mortality. We present the case of a 28-year-old woman with a prior surgical diagnosis of bicornuate uterus who was diagnosed with a 7-week pregnancy in the left horn of a bicornuate uterus by 2D ultrasound. Further investigation with 3D ultrasound revealed that the pregnancy was within a noncommunicating rudimentary horn of a unicornuate uterus. These findings were confirmed at laparotomy. This case illustrates the importance and benefits of utilizing 3D ultrasound in diagnosing suspected Mullerian anomalies.

Foam-lined hohlraum, inertial confinement fusion experiments on the National Ignition Facility

Experiments on the National Ignition Facility (NIF) to study hohlraums lined with a 20-mg/cc 400-μm-thick Ta_{2}O_{5} aerogel at full scale (hohlraum diameter = 6.72 mm) are reported. Driven with a 1.6-MJ, 450-TW laser pulse, the performance of the foam liner is diagnosed using implosion hot-spot symmetry measurements of the high-density carbon (HDC) capsule and measurement of inner beam propagation through a thin-wall 8-μm Au window in the hohlraum. Results show an improved capsule performance due to laser energy deposition further inside the hohlraum, leading to a modest increase in x-ray drive and reduced preheat due to changes in the x-ray spectrum when the foam liner is included. In addition, the outer cone bubble uniformity is improved, but the predicted improvement in inner beam propagation to improve symmetry control is not realized for this foam thickness and density.

Biomarkers of Activation and Inflammation to Track Disparity in Chronological and Physiological Age of People Living With HIV on Combination Antiretroviral Therapy

With advancement, prompt use, and increasing accessibility of antiretroviral therapy, people with HIV are living longer and have comparable lifespans to those negative for HIV. However, people living with HIV experience tradeoffs with quality of life often developing age-associated co-morbid conditions such as cancers, cardiovascular diseases, or neurodegeneration due to chronic immune activation and inflammation. This creates a discrepancy in chronological and physiological age, with HIV-infected individuals appearing older than they are, and in some contexts ART-associated toxicity exacerbates this gap. The complexity of the accelerated aging process in the context of HIV-infection highlights the need for greater understanding of biomarkers involved. In this review, we discuss markers identified in different anatomical sites of the body including periphery, brain, and gut, as well as markers related to DNA that may serve as reliable predictors of accelerated aging in HIV infected individuals as it relates to inflammatory state and immune activation.

Pneumatosis intestinalis in a patient with COVID-19

A 73-year-old man with significant medical history including renal transplantation and chronic immunosuppression presented to the hospital with acute respiratory failure. His initial treatment included steroids for concern for Pneumocystis jiroveci pneumonia, although this was later excluded as the diagnosis. The patient's illness was consistent with COVID-19; however, he was not diagnosed with the virus until late in his course. The patient was found to have pneumatosis intestinalis that was successfully managed conservatively. Despite his multiple medical comorbidities, the patient had a positive outcome following COVID-19 infection. We discuss the association of pneumatosis intestinalis and COVID-19, and we investigate the various factors, including immunosuppression, that could play a role in this patient's successful recovery from the virus.

The health promoting sports club model: An intervention planning framework

Background

Researchers and policymakers have acknowledged sports clubs (SCs) as health promoting settings. Limited research links the health promoting sports club (HPSC) concept with evidence-driven strategies to offer SCs guidance to develop health promotion interventions. As implementation science insists on theoretically grounded interventions, this work's objective was to provide SCs an evidence-driven intervention framework for planning health promotions.

Methods

A 4-step process was undertaken: 1) investigate indicators for SCs to be considered health promoting, 2) adapt the theoretical HPSC concept to create a HPSC model, 3) reformulate published evidence-driven guidelines into implementable intervention components (ICs) and 4) merge the model with the ICs to provide an intervention planning framework for SCs. During 3 workshops, researchers defined the model elements and ICs. Workshop participants classified ICs into the HSPC model. Each IC could be classified multiple times within the model.

Results

Researchers drafted 5 HPSC indicators: 1) an approach embracing all SC actions, 2) involve all SC levels in actions and decisions, 3) involve external partners, 4) promoting health is continuous and iterative and 5) base actions on needs. To create the HPSC model, elements were defined: 3 SC levels (club, management, coaches) and 4 health determinants (organizational, social, environmental, economic) per level based on the indicators. Published guidelines from literature reviews aided in developing 14 strategies with 55 ICs. Workshop classification of ICs into the model included: club (n = 79), management (n = 67) and coaches (n = 48).

Conclusions

The theoretical HPSC model and intervention planning framework act as starting points to develop and implement interventions to increase HP efforts by stakeholders in several ways: 1) SCs can apply strategies based on goals, 2) SCs can target specific levels with corresponding ICs or 3) ICs can target specific health determinants.

Key messages

A Health Promoting Sports Club model defines 4 health determinants at 3 levels (coach, management operational) of sports clubs to plan, develop and implement targeted health promotion activities. This HPSC intervention planning framework has 14 strategies with 55 intervention components targeting multiple sports club levels giving stakeholders a path to become a health promoting sports club.

Building health promoting sports clubs: A participative concept mapping approach

Background

Sports clubs offer a unique position to increase performance and physical activity but may also provide additional health promoting opportunities. Research is limited on support clubs need to increase health promotion efforts. This study took a participative approach to gather French stakeholder ideas on perceived assistance sports clubs need to increase health promotion efforts and prioritized them based on ratings of importance and feasibility.

Methods

This concept mapping study had 4-steps: 1) drafting a focus prompt to a key issue, 2) brainstorming ideas in response to the focus prompt, 3) sorting ideas into themed piles and 4) rating ideas (1-6) based on two indicators. French stakeholders (45) in sports and health organizations were invited to respond using the groupwisdom™ platform. Researchers produced visual cluster maps of themed piles and Go-Zone graphs displaying ideas perceived as important and feasible.

Results

Participants generated 62 ideas responding to the focus prompt: 'What assistance would benefit sports clubs to become health-promoting settings?'. Once researchers edited ideas, 78 were available to sort. Final sorting formed 9 clusters: Tools for health promotion, Communication tools, Stakeholder training courses, Diagnostic & Financing, Awareness & Mobilization, Advocacy, Policies & Methods, Sharing & Networking, Communication & Dissemination. Importance and feasibility ratings produced Go-Zones with 34 ideas above the mean for both indicators. Top focus areas include: increasing awareness of health promotion benefits, mobilizing actors, advocating for support and educating club actors.

Conclusions

Understanding support stakeholders need to increase health promotion efforts in sports clubs is a crucial step to plan and implement policies. Including stakeholders' perceptions helps establish effective interventions by increasing the possibility of integration into current or emerging policies and acceptance from those working in clubs.

Key messages

Generating and organizing stakeholder ideas gives insight into perceptions of what support is needed to develop and implement health promotion interventions in the sports club context. Based on importance and feasibility, sports clubs can increase health promotion efforts by focusing on: increasing awareness of health promotion benefits, mobilizing actors, advocacy and education.

How directed is a directed network?

The trophic levels of nodes in directed networks can reveal their functional properties. Moreover, the trophic coherence of a network, defined in terms of trophic levels, is related to properties such as cycle structure, stability and percolation. The standard definition of trophic levels, however, borrowed from ecology, suffers from drawbacks such as requiring basal nodes, which limit its applicability. Here we propose simple improved definitions of trophic levels and coherence that can be computed on any directed network. We demonstrate how the method can identify node function in examples including ecosystems, supply chain networks, gene expression and global language networks. We also explore how trophic levels and coherence relate to other topological properties, such as non-normality and cycle structure, and show that our method reveals the extent to which the edges in a directed network are aligned in a global direction.

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.

OP0249 LONG-TERM EXTENSION RESULTS OF RISE-SSC, A RANDOMIZED TRIAL OF RIOCIGUAT IN PATIENTS WITH EARLY DIFFUSE CUTANEOUS SYSTEMIC SCLEROSIS (DCSSC)

Background:

RISE-SSc (NCT02283762) was a multicenter Phase IIb trial of riociguat in pts with early (duration ≤18 months) dcSSc and modified Rodnan skin score (mRSS) 10−22 units. Pts were randomized double-blind to placebo or riociguat 0.5–2.5 mg t.i.d. for 52 weeks. The primary endpoint, mRSS change from baseline to Week (Wk) 52, did not reach statistical significance (p=0.08, riociguat vs placebo), but there were favorable trends in some other outcomes.

Objectives:

To present open-label long-term extension (LTE) results of RISE-SSc.

Methods:

Pts who completed Wk 52 of double-blind therapy could enter LTE on riociguat. Endpoints included mRSS, adverse events (AEs), and serious AEs (SAEs).

Results:

Of 60 pts randomized to riociguat and 61 to placebo, 42 (riociguat−riociguat group) and 45 (former placebo group), respectively, entered LTE. At LTE start, mean±SD mRSS was 16.4±3.2 and 16.3±4.2 units, and mean disease duration was 8.9±7.8 and 8.9±5.8 months, in the riociguat−riociguat and former placebo groups, respectively. Other demographics/disease characteristics were also comparable. Median duration of riociguat treatment was 1092 d in riociguat−riociguat pts and 649 d in former placebo pts. Throughout the study, mRSS decreased in both groups (Figure 1). From Wk 52 to last visit, mRSS fell by −3.02±5.51 in riociguat−riociguat patients and −3.96±5.43 in former placebo pts. Rates of mRSS regression (decrease by >5 units and ≥25% from Wk 52 to last visit) and of % declines in mRSS were similar in the two groups (Figure 2). mRSS progression (increase by >5 units and ≥25% from Wk 52 to last visit) occurred in 1 pt (2%) in each group. During the entire study, rescue therapy agents were used in 15 (36%) riociguat−riociguat pts and 17 (38%) former placebo pts. AEs were reported from Wk 52 to last visit in 82 pts (94%): 40 (95%) riociguat−riociguat and 42 (93%) former placebo. Most common AEs overall: nasopharyngitis (24%), gastroesophageal reflux disease (17%), diarrhea (15%), and hypotension (14%). AEs of special interest (dizziness, postural dizziness, or hypotension) occurred in 5 riociguat−riociguat pts (12%) and 4 former placebo pts (9%). SAEs were reported in 21 (24%) pts: 10 (24%) riociguat−riociguat pts and 11 (24%) former placebo pts, with no SAE reported in >1 patient, no SAEs of special interest, and no deaths.

Conclusion:

During LTE riociguat treatment, mRSS decreased in both groups from Wk 52 onwards and mRSS progression was uncommon. Riociguat had acceptable safety, similar to the main study, with no new safety signal.

Acknowledgments:

RISE-SSc was jointly funded by Bayer AG and Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA.

Disclosure of Interests:

Dinesh Khanna Shareholder of: Eicos, Grant/research support from: NIH NIAID, NIH NIAMS, Consultant of: Acceleron, Actelion, Bayer, BMS, Boehringer-Ingelheim, Corbus, Galapagos, Genentech/Roche, GSK, Mitsubishi Tanabi, Sanofi-Aventis/Genzyme, UCB Pharma, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB, Marco Matucci-Cerinic Grant/research support from: Actelion, MSD, Bristol-Myers Squibb, Speakers bureau: Acetelion, Lilly, Boehringer Ingelheim, Masataka Kuwana Grant/research support from: Acetelion, Consultant of: Acetelion, Bayer, Chugai, Corbus Pharmaceuticals, CSL Behring and Reata Pharmaceuticals. He was a member of the SENSCIS trial Steering Committee (Boehringer Ingelheim), Christopher Denton Grant/research support from: GlaxoSmithKline, CSL Behring, and Inventiva, Consultant of: Medscape, Roche-Genentech, Actelion, GlaxoSmithKline, Sanofi Aventis, Inventiva, CSL Behring, Boehringer Ingelheim, Corbus Pharmaceuticals, Acceleron, Curzion and Bayer, Yannick Allanore Grant/research support from: BMS, Inventiva, Roche, Sanofi, Consultant of: Actelion, Bayer AG, BMS, BI, Melanie Wosnitza Employee of: Bayer AG, Marie-Elise Truchetet: None declared, Gabriella Szücs: None declared, Wendy Stevens: None declared, Viginia Steen Grant/research support from: The associated affiliation has received grants/research from Boehringer Ingelheim, Corbus Pharmaceuticals, CSL Behring, Eicos, Galapagos, Immune Tolerance Network, Reata, Consultant of: Virginia Steen has acted as a consultant for Boehringer Ingelheim, Corbus, CSL Behring, Eicos, Forbius, Chiara Stagnaro: None declared, Vanessa Smith Grant/research support from: The affiliated company received grants from Research Foundation - Flanders (FWO), Belgian Fund for Scientific Research in Rheumatic diseases (FWRO), Boehringer Ingelheim Pharma GmbH & Co and Janssen-Cilag NV, Consultant of: Boehringer-Ingelheim Pharma GmbH & Co, Speakers bureau: Actelion Pharmaceuticals Ltd, Boehringer-Ingelheim Pharma GmbH & Co and UCB Biopharma Sprl, Richard Silver: None declared, Elena Schiopu: None declared, Valeria Riccieri: None declared, Frank Kramer Employee of: Bayer AG, Sindhu Johnson Grant/research support from: Boehringer Ingelheim, Corbus Pharmaceuticals, GlaxoSmithKline, Roche, Merck, Bayer, Consultant of: Boehringer Ingelheim, Ikaria, Osamu Ishikawa: None declared, Tomonori Ishii: None declared, Eric Hachlla: None declared, Ellen De Langhe Consultant of: member of advisory board for Boehringer, László Czirják Consultant of: Actelion, BI, Roche-Genentech, Lilly, Medac, Novartis, Pfizer, Bayer AG, Radim Bečvář Consultant of: Actelion, Roche, Tatsuya Atsumi Grant/research support from: Eli Lily Japan K.K., Alexion Pharmaceuticals, Inc., Bristol-Myers Squibb Co., AbbVie Inc., Daiichi Sankyo Co., Ltd., Pfizer Inc., Chugai Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Co., Astellas Pharma Inc., Consultant of: Gilead Sciences, Inc., Eli Lilly Japan K.K., UCB Japan Co. Ltd., AbbVie Inc., Daiichi Sankyo Co., Ltd., Pfizer Inc., Chugai Pharmaceutical Co., Ltd., Speakers bureau: Eli Lilly Japan K.K., UCB Japan Co. Ltd., Bristol-Myers Squibb Co., AbbVie Inc., Eisai Co. Ltd., Otsuka Pharmaceutical Co., Ltd., Daiichi Sankyo Co., Ltd., Pfizer Inc., Chugai Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Co., Takeda Pharmaceutical Co., Ltd., Astellas Pharma Inc., Oliver Distler Grant/research support from: Grants/Research support from Actelion, Bayer, Boehringer Ingelheim, Competitive Drug Development International Ltd. and Mitsubishi Tanabe; he also holds the issued Patent on mir-29 for the treatment of systemic sclerosis (US8247389, EP2331143)., Consultant of: Consultancy fees from Actelion, Acceleron Pharma, AnaMar, Bayer, Baecon Discovery, Blade Therapeutics, Boehringer, CSL Behring, Catenion, ChemomAb, Curzion Pharmaceuticals, Ergonex, Galapagos NV, GSK, Glenmark Pharmaceuticals, Inventiva, Italfarmaco, iQvia, medac, Medscape, Mitsubishi Tanabe Pharma, MSD, Roche, Sanofi and UCB, Speakers bureau: Speaker fees from Actelion, Bayer, Boehringer Ingelheim, Medscape, Pfizer and Roche

THU0271 PERFORMANCE OF THE EULAR/ACR 2019 CLASSIFICATION CRITERIA FOR SYSTEMIC LUPUS ERYTHEMATOSUS IN EARLY DISEASE, ACROSS SEXES AND ETHNICITIES

Background:

EULAR/ACR 2019 SLE Classification Criteria were validated in an international cohort.

Objectives:

To evaluate performance characteristics of SLE classification systems in sex, race/ethnicity, and disease duration subsets.

Methods:

Sensitivity and specificity of the EULAR/ACR 2019, SLICC 2012 and ACR 1982/1997 criteria were evaluated in the validation cohort.

Results:

The cohort consisted of female (n=1098), male (n=172), Asian (n=118), Black (n=68), Hispanic (n=124) and White (n=941) patients; and patients with an SLE duration of 1-3 years (n=196), 3-5 years (n=157), and ≥5 years (n=879). Among patients with 1-3 years disease duration, the EULAR/ACR criteria had better sensitivity than the ACR criteria (97% (95%CI 92-99%) vs 81% (95%CI 72-88%). The new criteria performed well in men (sensitivity 93%, specificity 96%) and women (sensitivity 97%, specificity 94%). The new criteria had better sensitivity than the ACR criteria in White (95% vs 83%), Hispanic (100% vs 86%) and Asian patients (97% vs 77%).

Conclusion:

The EULAR/ACR 2019 criteria perform well in patients with early disease, and across sexes and ethnicities.

Disclosure of Interests:

Sindhu Johnson Grant/research support from: Boehringer Ingelheim, Corbus Pharmaceuticals, GlaxoSmithKline, Roche, Merck, Bayer, Consultant of: Boehringer Ingelheim, Ikaria, Ralph Brinks: None declared, Karen Costenbader Grant/research support from: Merck, Consultant of: Astra-Zeneca, David Daikh: None declared, Marta Mosca: None declared, Rosalind Ramsey-Goldman: None declared, Josef S. Smolen Grant/research support from: AbbVie, Eli Lilly, Janssen, Merck Sharp & Dohme, Pfizer, Roche – grant/research support, Consultant of: AbbVie, Amgen Inc., AstraZeneca, Astro, Celgene Corporation, Celtrion, Eli Lilly, Glaxo, ILTOO, Janssen, Medimmune, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Samsung, Sanofi, UCB – consultant, Speakers bureau: AbbVie, Amgen Inc., AstraZeneca, Astro, Celgene Corporation, Celtrion, Eli Lilly, Glaxo, ILTOO, Janssen, Medimmune, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Samsung, Sanofi, UCB – speaker, David Wofsy: None declared, Dimitrios Boumpas Grant/research support from: Unrestricted grant support from various pharmaceutical companies, Diane L Kamen Consultant of: Consulted on SLE survey development for Lilly and consulted on SLE trial protocol development for EMD Serono in 2019, David Jayne Grant/research support from: ChemoCentryx, GSK, Roche/Genentech, Sanofi-Genzyme, Consultant of: Astra-Zeneca, ChemoCentryx, GSK, InflaRx, Takeda, Insmed, Chugai, Boehringer-Ingelheim, Ricard Cervera: None declared, Nathalie Costedoat-Chalumeau Grant/research support from: UCB to my institution, Betty Diamond: None declared, Dafna D Gladman Grant/research support from: AbbVie, Amgen Inc., BMS, Celgene Corporation, Janssen, Novartis, Pfizer, UCB – grant/research support, Consultant of: AbbVie, Amgen Inc., BMS, Celgene Corporation, Janssen, Novartis, Pfizer, UCB – consultant, Bevra H. Hahn Grant/research support from: Janssen Research & Development, LLC, Falk Hiepe: None declared, Soren Jacobsen: None declared, Dinesh Khanna Shareholder of: Eicos Sciences, Inc./Civi Biopharma, Inc., Grant/research support from: Dr Khanna was supported by NIH/NIAMS K24AR063120, Consultant of: Acceleron, Actelion, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Corbus Pharmaceuticals, Horizon Therapeutic, Galapagos, Roche/Genentech, GlaxoSmithKline, Mitsubishi Tanabe, Sanofi-Aventis/Genzyme, UCB, Kirsten Lerstrom: None declared, Elena Massarotti: None declared, William Joseph McCune: None declared, Guillermo Ruiz-Irastorza: None declared, Jorge Sanchez-Guerrero: None declared, Matthias Schneider: None declared, Murray B Urowitz: None declared, George Bertsias Grant/research support from: GSK, Consultant of: Novartis, Bimba F. Hoyer: None declared, Nicolai Leuchten: None declared, Chiara Tani: None declared, Sara Tedeschi: None declared, Zahi Touma: None declared, Gabriela Schmajuk Grant/research support from: Pfizer, Branimir Anic: None declared, Florence Assan: None declared, Tak Chan: None declared, Ann E Clarke: None declared, Mary K. Crow: None declared, László Czirják Consultant of: Actelion, BI, Roche-Genentech, Lilly, Medac, Novartis, Pfizer, Bayer AG, Andrea Doria Consultant of: GSK, Pfizer, Abbvie, Novartis, Ely Lilly, Speakers bureau: UCB pharma, GSK, Pfizer, Janssen, Abbvie, Novartis, Ely Lilly, BMS, Winfried Graninger: None declared, Bernadett Halda-Kiss: None declared, Sarfaraz Hasni: None declared, Peter Izmirly: None declared, Michelle Jung: None declared, Gabor Kumanovics Consultant of: Boehringer, Teva, Speakers bureau: Roche, Lilly, Novartis, Xavier Mariette: None declared, Ivan Padjen: None declared, Jose M Pego-Reigosa: None declared, Juanita Romero-Diaz Consultant of: Biogen, Iñigo Rua-Figueroa: None declared, Raphaèle Seror Consultant of: BMS, Medimmune, Novartis, Pfizer, GSK, Lilly, Georg Stummvoll: None declared, Yoshiya Tanaka Grant/research support from: Asahi-kasei, Astellas, Mitsubishi-Tanabe, Chugai, Takeda, Sanofi, Bristol-Myers, UCB, Daiichi-Sankyo, Eisai, Pfizer, and Ono, Consultant of: Abbvie, Astellas, Bristol-Myers Squibb, Eli Lilly, Pfizer, Speakers bureau: Daiichi-Sankyo, Astellas, Chugai, Eli Lilly, Pfizer, AbbVie, YL Biologics, Bristol-Myers, Takeda, Mitsubishi-Tanabe, Novartis, Eisai, Janssen, Sanofi, UCB, and Teijin, Maria Tektonidou Grant/research support from: AbbVie, MSD, Novartis and Pfizer, Consultant of: AbbVie, MSD, Novartis and Pfizer, Carlos Vasconcelos: None declared, Edward Vital Grant/research support from: AstraZeneca, Roche/Genentech, and Sandoz, Consultant of: AstraZeneca, GSK, Roche/Genentech, and Sandoz, Speakers bureau: Becton Dickinson and GSK, Daniel J Wallace: None declared, Sule Yavuz: None declared, Pier Luigi Meroni: None declared, Marvin Fritzler: None declared, Raymond Naden: None declared, Thomas Dörner Grant/research support from: Janssen, Novartis, Roche, UCB, Consultant of: Abbvie, Celgene, Eli Lilly, Roche, Janssen, EMD, Speakers bureau: Eli Lilly, Roche, Samsung, Janssen, Martin Aringer Consultant of: Boehringer Ingelheim, Roche, Speakers bureau: Boehringer Ingelheim, Roche

SAT0157 NINTEDANIB DOSE ADJUSTMENTS AND ADVERSE EVENTS IN PATIENTS WITH PROGRESSIVE AUTOIMMUNE DISEASE-RELATED INTERSTITIAL LUNG DISEASES IN THE INBUILD TRIAL

Background:

In the INBUILD trial in patients with progressive fibrosing ILDs, the adverse event (AE) profile of nintedanib was characterised predominantly by gastrointestinal AEs. Dose adjustments were used to manage AEs.

Objectives:

Assess AEs and dose adjustments in patients with autoimmune disease-related ILDs in the INBUILD trial.

Methods:

Patients with progressive fibrosing ILDs other than idiopathic pulmonary fibrosis were randomised to nintedanib 150 mg bid or placebo. Dose reductions to 100 mg bid and treatment interruptions were permitted to manage AEs. AEs over 52 weeks of treatment (or 28 days after last trial drug intake for patients who discontinued drug before week 52) were assessed in patients who received ≥1 dose of trial drug.

Results:

Of 663 patients in the INBUILD trial, 170 (82 nintedanib, 88 placebo) had autoimmune disease-related ILDs (89 RA-ILD, 39 SSc-ILD, 19 MCTD-ILD, 23 other autoimmune ILDs). In the nintedanib and placebo groups of patients with autoimmune disease-related ILDs, respectively, over 52 weeks, the proportions of patients with ≥1 dose reduction were 28.0% and 3.4%, with ≥1 treatment interruption were 31.7% and 10.2%, and with ≥1 dose reduction and/or treatment interruption were 40.2% and 12.5% (Table). Dose intensity (amount of drug administered divided by amount that would have been received had 150 mg bid been administered over 52 weeks or until permanent treatment discontinuation) was >90% in 80.5% of patients in the nintedanib group and 95.5% in the placebo group. AEs led to permanent treatment discontinuation in 17.1% and 10.2% of patients treated with nintedanib and placebo, respectively. Diarrhoea was the most common AE, reported in 63.4% and 27.3% of patients in the nintedanib and placebo groups, respectively. Diarrhoea AEs led to dose reduction, treatment interruption and permanent treatment discontinuation in 7.3%, 9.8% and 4.9% of patients in the nintedanib group, compared with 0%, 1.1% and 1.1% of patients in the placebo group, respectively. Of the nintedanib-treated patients who experienced ≥1 diarrhoea AE, 80.8% experienced 1 or 2 events and 76.9% experienced events that were mild at worst (Common Terminology Criteria for Adverse Events [CTCAE] grade 1).

Conclusion:

In the INBUILD trial, management of AEs via dose adjustments enabled most patients with autoimmune disease-related ILDs to remain on treatment for 52 weeks. Diarrhoea was the AE that most commonly led to dose adjustment.

TableNintedanib(n=82)Placebo (n=88)Patients with ≥1 dose reduction or treatment interruption33 (40.2)11 (12.5)Patients with ≥1 dose reduction23 (28.0)3 (3.4)Total number of dose reductions253Patients with ≥1 dose re-escalation after dose reduction5 (6.1)2 (2.3)Patients with ≥1 treatment interruption26 (31.7)9 (10.2)Total number of treatment interruptions3211Total duration of treatment interruptions, days, mean (SD)20.1 (15.1)19.3 (20.7)

Disclosure of Interests:

Elizabeth Volkmann Grant/research support from: Forbius, Corbus Pharmaceuticals, Consultant of: Boehringer Ingelheim, Forbius, Speakers bureau: Boehringer Ingelheim, Ivan Castellví Consultant of: Boehringer Ingelheim, Actelion, Kern Pharma, Speakers bureau: Boehringer Ingelheim, Actelion, Bristol-Myers Squibb, Roche, Sindhu Johnson Grant/research support from: Boehringer Ingelheim, Corbus Pharmaceuticals, GlaxoSmithKline, Roche, Merck, Bayer, Consultant of: Boehringer Ingelheim, Ikaria, Eric Matteson Grant/research support from: Pfizer, Consultant of: Boehringer Ingelheim, Gilead, TympoBio, Arena Pharmaceuticals, Speakers bureau: Simply Speaking, Jörg Distler Grant/research support from: Boehringer Ingelheim, Consultant of: Boehringer Ingelheim, Paid instructor for: Boehringer Ingelheim, Speakers bureau: Boehringer Ingelheim, James Seibold Shareholder of: BriaCell, Pacific Therapeutics, Consultant of: Atlantic, Blade Therapeutics, Eicos Sciences, Eiger Biopharmaceuticals, Indalo Therapeutics, Mitsubishi Tanabe Pharma, Bayer, Xenikos, Boehringer Ingelheim, Camurus, Corbus Pharmaceuticals, EMD Serono, Speakers bureau: Boehringer Ingelheim, Ulrich Costabel Consultant of: Boehringer Ingelheim, Roche, Fibrogen, Global Blood Therapeutics, Speakers bureau: Boehringer Ingelheim, Roche, AstraZeneca, Alexandra James Employee of: Employee of Boehringer Ingelheim, Carl Coeck Employee of: Employee of Boehringer Ingelheim, Manuel Quaresma Employee of: Employee of Boehringer Ingelheim, Vincent Cottin Grant/research support from: Boehringer Ingelheim, Roche, Consultant of: Boehringer Ingelheim, Roche, Actelion, Bayer, Gilead Sciences, Novartis, Promedior, Celgene, Galapagos, Galecto. He was a member of the INBUILD trial Steering Committee., Speakers bureau: Actelion, Boehringer Ingelheim, Novartis, Roche, Sanofi

FRI0575 BIOMARKER ANALYSIS FROM THE RISE-SSC STUDY OF RIOCIGUAT IN EARLY DIFFUSE CUTANEOUS SYSTEMIC SCLEROSIS (DCSSC)

Background:

RISE-SSc (NCT02283762) was a multicenter, double-blind, Phase IIb study of riociguat in early dcSSc. Primary endpoint was change in mRSS from baseline to Wk 52.

Objectives:

Exploratory, descriptive analyses of riociguat target engagement and effects on disease biomarkers in RISE-SSc and their relationship with effects on the primary endpoint. All biomarker p-values are for information only.

Methods:

Pts with dcSSc (duration ≤18 mo; modified Rodnan skin score [mRSS] 10–22 units) were randomized to riociguat 0.5−2.5 mg tid (n=60) or placebo (n=61). Biomarkers of target engagement (cGMP), inflammation and/or vascular/endothelial function (e.g. high-sensitivity C-reactive protein [hsCRP], soluble platelet endothelial cell adhesion molecule 1 [sPECAM-1], soluble E-selectin, chemokine ligand 4 [CXCL-4]), and fibrosis (e.g. alpha-smooth muscle cell actin [alphaSMA], pro-collagen mRNA expression) were measured in plasma, serum, and skin biopsies at baseline and Wk 14.

Results:

Mean±SD change from baseline in mRSS was –2.09±5.66 (n=57) with riociguat and –0.77±8.24 (n=52) with placebo (p=0.08). From baseline to Wk 14, plasma cGMP rose by mean (SD) 94% (78%) (n=52) with riociguat and 10% (39%) (n=52) with placebo (nominal p<0.001). Serum sPECAM-1 and CXCL-4 fell with riociguat vs placebo; changes in hsCRP or E-selectin differed little between groups (Fig 1). Pts with higher baseline sPECAM-1 showed larger mRSS reductions with riociguat vs placebo than pts with lower levels (nominal interaction p=0.004). In baseline skin biopsies, 34% and 31% of pts in the riociguat and placebo groups, respectively, had no alphaSMA-positive cells; other pts had +ve cells (alphaSMA counts 0.1–99.5, median 2.5), a potential indicator of higher disease activity. Pts with +ve baseline alphaSMA counts showed a reduction of mRSS with riociguat vs placebo (Fig 2). Skin collagen mRNA expression biomarkers in skin biopsies showed no differences between groups.

Conclusion:

Primary study endpoint (change in mRSS) was not met. Plasma cGMP rose with riociguat, confirming engagement with the NO-sGC-cGMP pathway. Serum sPECAM-1 (marker of endothelial activation) and CXCL-4 (marker of progressive SSc) fell with riociguat; hsCRP and E-selectin did not. Some serum and skin biomarkers of higher disease activity at baseline were associated with a greater effect of riociguat on skin fibrosis.

Acknowledgments:

RISE-SSc was jointly funded by Bayer AG and Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA.

Disclosure of Interests:

Oliver Distler Grant/research support from: Grants/Research support from Actelion, Bayer, Boehringer Ingelheim, Competitive Drug Development International Ltd. and Mitsubishi Tanabe; he also holds the issued Patent on mir-29 for the treatment of systemic sclerosis (US8247389, EP2331143)., Consultant of: Consultancy fees from Actelion, Acceleron Pharma, AnaMar, Bayer, Baecon Discovery, Blade Therapeutics, Boehringer, CSL Behring, Catenion, ChemomAb, Curzion Pharmaceuticals, Ergonex, Galapagos NV, GSK, Glenmark Pharmaceuticals, Inventiva, Italfarmaco, iQvia, medac, Medscape, Mitsubishi Tanabe Pharma, MSD, Roche, Sanofi and UCB, Speakers bureau: Speaker fees from Actelion, Bayer, Boehringer Ingelheim, Medscape, Pfizer and Roche, Frank Kramer Employee of: Bayer AG, Josef Höfler Employee of: Josef Höfler is an employee of Staburo GmbH, Munich, Germany, contracted by Bayer AG to perform the biomarker analyses, Mercedeh Ghadessi Employee of: Bayer AG, Peter Sandner Employee of: Bayer AG, Yannick Allanore Grant/research support from: BMS, Inventiva, Roche, Sanofi, Consultant of: Actelion, Bayer AG, BMS, BI, Christopher Denton Grant/research support from: GlaxoSmithKline, CSL Behring, and Inventiva, Consultant of: Medscape, Roche-Genentech, Actelion, GlaxoSmithKline, Sanofi Aventis, Inventiva, CSL Behring, Boehringer Ingelheim, Corbus Pharmaceuticals, Acceleron, Curzion and Bayer, Masataka Kuwana Grant/research support from: Acetelion, Consultant of: Acetelion, Bayer, Chugai, Corbus Pharmaceuticals, CSL Behring and Reata Pharmaceuticals. He was a member of the SENSCIS trial Steering Committee (Boehringer Ingelheim), Marco Matucci-Cerinic Grant/research support from: Actelion, MSD, Bristol-Myers Squibb, Speakers bureau: Acetelion, Lilly, Boehringer Ingelheim, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB, Tatsuya Atsumi Grant/research support from: Eli Lily Japan K.K., Alexion Pharmaceuticals, Inc., Bristol-Myers Squibb Co., AbbVie Inc., Daiichi Sankyo Co., Ltd., Pfizer Inc., Chugai Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Co., Astellas Pharma Inc., Consultant of: Gilead Sciences, Inc., Eli Lilly Japan K.K., UCB Japan Co. Ltd., AbbVie Inc., Daiichi Sankyo Co., Ltd., Pfizer Inc., Chugai Pharmaceutical Co., Ltd., Speakers bureau: Eli Lilly Japan K.K., UCB Japan Co. Ltd., Bristol-Myers Squibb Co., AbbVie Inc., Eisai Co. Ltd., Otsuka Pharmaceutical Co., Ltd., Daiichi Sankyo Co., Ltd., Pfizer Inc., Chugai Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Co., Takeda Pharmaceutical Co., Ltd., Astellas Pharma Inc., Radim Bečvář Consultant of: Actelion, Roche, László Czirják Consultant of: Actelion, BI, Roche-Genentech, Lilly, Medac, Novartis, Pfizer, Bayer AG, Ellen De Langhe Consultant of: member of advisory board for Boehringer, Eric Hachlla: None declared, Tomonori Ishii: None declared, Osamu Ishikawa: None declared, Sindhu Johnson Grant/research support from: Boehringer Ingelheim, Corbus Pharmaceuticals, GlaxoSmithKline, Roche, Merck, Bayer, Consultant of: Boehringer Ingelheim, Ikaria, Kaisa Laapas Employee of: Partly in-sourced to Bayer, Valeria Riccieri: None declared, Elena Schiopu: None declared, Richard Silver: None declared, Vanessa Smith Grant/research support from: The affiliated company received grants from Research Foundation - Flanders (FWO), Belgian Fund for Scientific Research in Rheumatic diseases (FWRO), Boehringer Ingelheim Pharma GmbH & Co and Janssen-Cilag NV, Consultant of: Boehringer-Ingelheim Pharma GmbH & Co, Speakers bureau: Actelion Pharmaceuticals Ltd, Boehringer-Ingelheim Pharma GmbH & Co and UCB Biopharma Sprl, Chiara Stagnaro: None declared, Viginia Steen Grant/research support from: The associated affiliation has received grants/research from Boehringer Ingelheim, Corbus Pharmaceuticals, CSL Behring, Eicos, Galapagos, Immune Tolerance Network, Reata, Consultant of: Virginia Steen has acted as a consultant for Boehringer Ingelheim, Corbus, CSL Behring, Eicos, Forbius, Wendy Stevens: None declared, Gabriella Szücs: None declared, Marie-Elise Truchetet: None declared, Melanie Wosnitza Employee of: Bayer AG, Dinesh Khanna Shareholder of: Eicos Sciences, Inc./Civi Biopharma, Inc., Grant/research support from: Dr Khanna was supported by NIH/NIAMS K24AR063120, Consultant of: Acceleron, Actelion, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Corbus Pharmaceuticals, Horizon Therapeutic, Galapagos, Roche/Genentech, GlaxoSmithKline, Mitsubishi Tanabe, Sanofi-Aventis/Genzyme, UCB

SAT0345 IS THERE A DIFFERENCE BETWEEN THE SEXES IN THE RATE OF PROGRESSION OF SYSTEMIC SCLEROSIS-ASSOCIATED ILD (SSC-ILD)? DATA FROM THE SENSCIS TRIAL

Background:

Previous studies suggested that male sex may be associated with a greater rate of decline in FVC in patients with SSc-ILD. In the SENSCIS trial, nintedanib reduced the rate of FVC decline over 52 weeks vs placebo.

Objectives:

Analyse the rate of decline in FVC and the efficacy and safety of nintedanib in the SENSCIS trial in subgroups by sex.

Methods:

Patients with SSc-ILD with first non-Raynaud symptom <7 years before screening and ≥10% fibrosis of the lungs on HRCT were randomised to nintedanib or placebo. We analysed the rate of decline in FVC (mL/year) and adverse events over 52 weeks in male and female patients.

Results:

Of 576 patients, 433 (75.2%) were female. Compared with males, the female subgroup included a smaller proportion of White patients (64.7% vs 74.8%), a smaller proportion on mycophenolate at baseline (46.9% vs 53.1%), a greater proportion of ATA positive patients (63.3% vs 53.1%), and had a lower mean weight at baseline (66.6 vs 79.1 kg). FVC % predicted (72.8% vs 71.7%) and mRSS (11.2 vs 10.8) were similar in females and males. The adjusted annual rate of decline in FVC in the placebo group was numerically greater in male than female patients (-126.8 [SE 29.0] vs -82.0 [16.2] mL/year). The estimated effect of nintedanib vs placebo on reducing the rate of decline in FVC was numerically more pronounced in males than females (difference: 58.6 [95% CI -18.0, 135.1] vs 34.6 [-9.3, 78.4] mL/year), but the interaction p-value did not indicate heterogeneity in the treatment effect between subgroups (p=0.59). Among nintedanib-treated patients, diarrhoea was reported in similar proportions of females and males (74.7% vs 79.1%); nausea, vomiting and liver test abnormalities were reported in greater proportions of females vs males (35.3% vs 19.4%, 28.1% vs 13.4%, and 15.4% vs 9.0%), while serious adverse events were more frequent in males (32.8% vs 21.3%). In the nintedanib and placebo groups, respectively, adverse events leading to treatment discontinuation were reported in 16.7% and 8.5% of females and 13.4% and 9.2% of males.

Conclusion:

In the SENSCIS trial in patients with SSc-ILD, the annual rate of decline in FVC in the placebo group was numerically greater in male than female patients. The rate of FVC decline was lower with nintedanib than placebo both in males and females. The safety profile of nintedanib was similar between males and females.

Disclosure of Interests:

Elizabeth Volkmann Grant/research support from: Forbius, Corbus Pharmaceuticals, Consultant of: Boehringer Ingelheim, Forbius, Speakers bureau: Boehringer Ingelheim, Serena Vettori Consultant of: Boehringer Ingelheim, John Varga Grant/research support from: John Varga is awaiting grants from Boehringer Ingelheim and has received grants from Bristol-Myers Squibb, Pfizer, Takeda, and TeneoBio, Consultant of: John Varga has acted as a consultant for Boehringer Ingelheim, Bristol-Myers Squibb, Emerald Health, and TeneoBio, Ariane Herrick: None declared, Maurizio Cutolo Grant/research support from: Bristol-Myers Squibb, Actelion, Celgene, Consultant of: Bristol-Myers Squibb, Speakers bureau: Sigma-Alpha, Ana Cordeiro Consultant of: Ana Cordeiro has acted as a consultant for Roche, Speakers bureau: Ana Cordeiro has received speaker fees from Boehringer Ingelheim, Lilly, and Vitoria, Valderilio F Azevedo Grant/research support from: Abbvie, Janssen, Bristol-Myers Squibb, Boehringer-Ingelheim, Lilly and Novartis, Consultant of: Lilly, Novartis, Janssen, Boehringer-Ingelheim, Amgen, Pfizer and Abbvie, Speakers bureau: Sandoz, Celltrion, Lilly, Novartis, Janssen, Boehringer-Ingelheim, Amgen, Pfizer and Abbvie, Sindhu Johnson Grant/research support from: Boehringer Ingelheim, Corbus Pharmaceuticals, GlaxoSmithKline, Roche, Merck, Bayer, Consultant of: Boehringer Ingelheim, Ikaria, Christian Stock Employee of: Employee of Boehringer Ingelheim, Martina Gahlemann Employee of: Employee of Boehringer Ingelheim, Lizette Moros Employee of: Lizette Moros is an employee of Boehringer Ingelheim, Margarida Alves Employee of: Employee of Boehringer Ingelheim, Maureen Mayes Grant/research support from: Maureen Mayes has received grants from Boehringer Ingelheim, Corbus, CSL Behring, Eicos, and Galapagos, Consultant of: Maureen Mayes has acted as a consultant for Boehringer Ingelheim, Eicos, and Galapagos. She was a member of the SENSCIS trial Steering Committee (Boehringer Ingelheim)

Epidemiologic trends in Clostridioides difficile isolate ribotypes in United States from 2011 to 2016

BACKGROUND

Geographic and temporal trends in the distribution of PCR ribotypes for Clostridioides difficile associated diarrheal isolates obtained in the United States (US) are changing. As part of a US national surveillance program of C. difficile susceptibility to fidaxomicin, we quantified the distribution of PCR ribotypes of stool isolates collected from 2011 to 2016.

METHODS

C. difficile isolates or C. difficile toxin + stools from patients with C. difficile infection (CDI) were submitted for testing to Tufts Medical Center from 6 geographically distinct medical centers. Following isolation and confirmation as C. difficile, approximately 35% of the isolates were randomly sampled, stratified by center, for PCR ribotyping by capillary gel electrophoresis. Toxin gene profiling was performed on all isolates.

RESULTS

939 isolates from a total of 2814 (33.4%) isolated over the 6 years were analyzed. Seventy unique ribotypes were observed, including 19 ribotypes observed 10 or more times. Sixteen ribotypes were not previously observed in our data base. Ribotype 027 declined by more than 60% over the 6 years of the survey from 35.3% to 13.1% (p < 0.001). Ribotype 106 was the most common in 2016, followed by 027 and 014-020. There were strong correlations between 027 and binary toxin with the 18 base pair deletion of tcdC and ribotype 078-126 had 100% concordance with the previously described tcdC 39 base pair deletion.

CONCLUSIONS

The frequency of ribotypes in the US has changed with a marked decline in 027. Each of the geographical areas had variations which differed from each other, but collectively, these results suggest that the changing epidemiology of C. difficile in the US is consistent with what is being seen in Europe. Continued surveillance and monitoring of changes in ribotype distributions of C. difficile are warranted.

Search for Electron Antineutrino Appearance in a Long-Baseline Muon Antineutrino Beam

Electron antineutrino appearance is measured by the T2K experiment in an accelerator-produced antineutrino beam, using additional neutrino beam operation to constrain parameters of the Pontecorvo-Maki-Nakagawa-Sakata (PMNS) mixing matrix. T2K observes 15 candidate electron antineutrino events with a background expectation of 9.3 events. Including information from the kinematic distribution of observed events, the hypothesis of no electron antineutrino appearance is disfavored with a significance of 2.40σ and no discrepancy between data and PMNS predictions is found. A complementary analysis that introduces an additional free parameter which allows non-PMNS values of electron neutrino and antineutrino appearance also finds no discrepancy between data and PMNS predictions.

Real-life insights on menstrual cycles and ovulation using big data

STUDY QUESTION

What variations underlie the menstrual cycle length and ovulation day of women trying to conceive?

SUMMARY ANSWER

Big data from a connected ovulation test revealed the extent of variation in menstrual cycle length and ovulation day in women trying to conceive.

WHAT IS KNOWN ALREADY

Timing intercourse to coincide with the fertile period of a woman maximises the chances of conception. The day of ovulation varies on an inter- and intra-individual level.

STUDY DESIGN, SIZE, DURATION

A total of 32 595 women who had purchased a connected ovulation test system contributed 75 981 cycles for analysis. Day of ovulation was determined from the fertility test results. The connected home ovulation test system enables users to identify their fertile phase. The app benefits users by enabling them to understand their personal fertility information. During each menstrual cycle, users input their perceived cycle length into an accessory application, and data on hormone levels from the tests are uploaded to the application and stored in an anonymised cloud database. This study compared users’ perceived cycle characteristics with actual cycle characteristics. The perceived and actual cycle length information was analysed to provide population ranges.

PARTICIPANTS/MATERIALS, SETTING, METHODS

This study analysed data from the at-home use of a commercially available connected home ovulation test by women across the USA and UK.

MAIN RESULTS AND THE ROLE OF CHANCE

Overall, 25.3% of users selected a 28-day cycle as their perceived cycle length; however, only 12.4% of users actually had a 28-day cycle. Most women (87%) had actual menstrual cycle lengths between 23 and 35 days, with a normal distribution centred on day 28, and over half of the users (52%) had cycles that varied by 5 days or more. There was a 10-day spread of observed ovulation days for a 28-day cycle, with the most common day of ovulation being Day 15. Similar variation was observed for all cycle lengths examined. For users who conducted a test on every day requested by the app, a luteinising hormone (LH) surge was detected in 97.9% of cycles.

LIMITATIONS, REASONS FOR CAUTION

Data were from a self-selected population of women who were prepared to purchase a commercially available product to aid conception and so may not fully represent the wider population. No corresponding demographic data were collected with the cycle information.

WIDER IMPLICATIONS OF THE FINDINGS

Using big data has provided more personalised insights into women’s fertility; this could enable women trying to conceive to better time intercourse, increasing the likelihood of conception.

STUDY FUNDING/COMPETING INTERESTS

The study was funded by SPD Development Company Ltd (Bedford, UK), a fully owned subsidiary of SPD Swiss Precision Diagnostics GmbH (Geneva, Switzerland). I.S., B.G. and S.J. are employees of the SPD Development Company Ltd.

Organisational Social Influence on Directed Hierarchical Graphs, from Tyranny to Anarchy

Coordinated human behaviour takes place within a diverse range of social organisational structures, which can be thought of as power structures with "managers" who influence "subordinates". A change in policy in one part of the organisation can cause cascades throughout the structure, which may or may not be desirable. As organisations change in size, complexity and structure, the system dynamics also change. Here, we consider majority rule dynamics on organisations modelled as hierarchical directed graphs, where the directed edges indicate influence. We utilise a topological measure called the trophic incoherence parameter, q, which effectively gauges the stratification of power structure in an organisation. We show that this measure bounds regimes of behaviour. There is fast consensus at low q (e.g. tyranny), slow consensus at mid q (e.g. democracy), and no consensus at high q (e.g. anarchy). These regimes are investigated analytically, numerically and empirically with diverse case studies in the Roman Army, US Government, and a healthcare organisation. Our work demonstrates the usefulness of the trophic incoherence parameter when considering models of social influence dynamics, with widespread consequences in the design and analysis of organisations.

Visual Immunoprecipitate Assay (VIP) for Listeria monocytogenes and Related Listeria Species Detection in Selected Foods: Collaborative Study

Six foods representing a variety of food products were analyzed by the Assurance Listeria polyclonal enzyme immunoassay (EIA) and by either the Bacteriological Analytical Manual or the U.S. Department of Agriculture culture method for detecting Listeria monocytogenes and related Listeria species. Samples of each food type, at each inoculation level, were analyzed simultaneously by both methods. A total of 19 laboratories representing federal government agencies and private industry in the United States and Canada participated. Food types were inoculated with Listeria species including L. monocytogenes, with the exception of 3 lots of green beans, which were naturally contaminated. During this study, 1764 samples and controls were analyzed and confirmed, of which 492 were positive and 947 were negative by both methods. There were 159 samples that were positive by culture method but negative by the EIA and 188 that were negative by culture method but positive by EIA. Twenty-two samples were negative by EIA and by culture method but confirmed positive when Assurance selective enrichment broths were subcultured to selective agar. The Assurance polyclonal EIA for detecting L. monocytogenes and related Listeria species in foods has been adopted first action by AOAC INTERNATIONAL.

Assurance Enzyme Immunoassay for Detection of Enterohemorrhagic Escherichia coli 0157:H7 in Selected Foods: Collaborative Study

Five foods types were analyzed by the Assurance EHEC (Escherichia coli 0157:H7) enzyme immunoassay (EIA) and by the Bacteriological Analytical Manual (BAM) culture method. Each sample of each food type at each inoculation level was simultaneously analyzed by both methods. A total of 21 laboratories representing state and federal government agencies and private industry in the United States and Canada participated. Samples were inoculated with E. coli 0157:H7, except for one lot of poultry that was naturally contaminated. A total of 1304 samples and controls were analyzed and confirmed, of which 473 were positive and 818 were negative by both methods. Thirteen samples were positive by BAM but negative by EIA. Because of the study design, it was not possible for the BAM method to produce false-negative or falsepositive results. The Assurance method for detection of E. coli OI57:H7 in selected foods has been adopted first action by AOAC INTERNATIONAL.

Visual Immunoprecipitate Assay (VIP) for Detection of Enterohemorrhagic Escherichia coli (EHEC) 0157:H7 in Selected Foods: Collaborative Study

Five foods representative of a variety of food products were analyzed by the Visual Immunoprecipitate Assay (VIP) and the Bacteriological Analytical Manual (BAM) culture method for the presence of Escherichia coli 0157: H7. A total of 21 laboratories representing state and federal government agencies, as well as private industry, in the United States and Canada participated. Food types were inoculated with strains of E. coli 0157:H7, with the exception of one lot of poultry, which was naturally contaminated. During this study, a total of 1377 samples and controls were analyzed and confirmed, of which 508 were positive and 867 were negative by both methods. Two samples were positive by BAM and negative by VIP. Because of the study design, it was not possible for the BAM method to produce false-negative or false-positive results. The VIP assay for detection of EHEC in selected foods has been adopted first action by AOAC INTERNATIONAL.

Assurance Polyclonal Enzyme Immunoassay for Detection of Listeria monocytogenes and Related Listeria Species in Selected Foods: Collaborative Study

Six foods representing a variety of food products were analyzed by the Assurance Listeria polyclonal enzyme immunoassay (EIA) and by either the Bacteriological Analytical Manual or the U.S. Department of Agriculture culture method for detecting Listeria monocytogenes and related Listeria species. Samples of each food type, at each inoculation level, were analyzed simultaneously by both methods. A total of 19 laboratories representing federal government agencies and private industry in the United States and Canada participated. Food types were inoculated with Listeria species including L. monocytogenes, with the exception of 3 lots of green beans, which were naturally contaminated. During this study, 1764 samples and controls were analyzed and confirmed, of which 492 were positive and 947 were negative by both methods. There were 159 samples that were positive by culture method but negative by the EIA and 188 that were negative by culture method but positive by EIA. Twenty-two samples were negative by EIA and by culture method but confirmed positive when Assurance selective enrichment broths were subcultured to selective agar. The Assurance polyclonal EIA for detecting L. monocytogenes and related Listeria species in foods has been adopted first action by AOAC INTERNATIONAL.

7 Pregnancy from a vitrified-warmed alpaca pre-implantation embryo

The alpaca (Vicugna pacos) is a ruminant livestock species in the South American camelid family. There are more than 9 million South American camelids globally that make important contributions to the livelihoods of rural farmers through conversion of low quality roughages to high quality food and fibre. Reproductive biotechnologies for alpacas are not well developed compared with those for other ruminant livestock species. In particular, embryo cryopreservation technologies are lacking. The objective of this study was to evaluate under field conditions a vitrification protocol originally developed for old world camels that we adapted for use in alpacas. Potential donors were evaluated for follicular development using a 7.5-MHz ultrasound probe. Hembras (sexually mature female alpacas) with ovarian follicles 7-10mm in diameter were behaviour tested to determine sexual receptivity, and receptive females were naturally mated to a proven herd sire. At the time of breeding, non-superovulated donors (n=4) received 30μg gonadorelin. Embryos were nonsurgically collected 7 days after breeding and handled at 20°C. Diameter of harvested embryos (n=4 quality grade 1 hatched expanded blastocysts) was measured using an eyepiece reticle. All recovered embryos were placed individually into 0.5-mL drops of vitrification solution (VS1: 1.4M glycerol) for 5min, 0.5-mL drops of VS2 (1.4 M glycerol + 3.6M ethylene glycol) for 5min, 0.05-mL drops of VS3 (3.4 M glycerol + 4.6M ethylene glycol) for 20s, and 0.05-mL drops of VS3 for 20s while loading into open-pulled straws (OPS). Each OPS was plunged directly into liquid nitrogen for storage for 29 days. At warming, each OPS was submerged into a 1-mL drop of warming solution 1 (WS1: 0.5M galactose) for 1min followed by 1min in WS2 (0.25 M galactose) for 5min before being incubated at 37°C in 5% CO2 in humidified air for 21h in 1mL of Syngro holding medium supplemented with 10% (vol/vol) alpaca serum. Embryos that grew during culture (n=2) were transferred individually into synchronous recipients, and embryos that did not appear to grow (n=2) were transferred together as a pair. Prior to embryo transfer, potential recipients were evaluated ultrasonographically as described previously. Hembras with ovarian follicles 7-10mm in diameter were behaviour tested, and sexually receptive females received 30μg gonadorelin 6 days before embryo transfer. Final selection of recipients (n=3) was based on presence of a corpus luteum and nonreceptive behaviour to a herd sire 24h before transfer. Pregnancy was detected ultrasonographically, and fetal heartbeat was detected 29 days post-transfer in one of the three recipients. Ultrasound at 177 days post-transfer revealed that the pregnancy, generated from a 400μm×375μm vitrified-warmed embryo that had grown in culture, was still ongoing. If this pregnancy results in the birth of a live cria (newborn alpaca), it would represent-to the best of our knowledge-the world's first cria born from a cryopreserved alpaca pre-implantation embryo. It would also demonstrate the potential utility of this protocol under field conditions.

Gang confrontation: The case of Medellin (Colombia)

Protracted conflict is one of the largest human challenges that have persistently undermined economic and social progress. In recent years, there has been increased emphasis on using statistical and physical science models to better understand both the universal patterns and the underlying mechanics of conflict. Whilst macroscopic power-law fractal patterns have been shown for death-toll in wars and self-excitation models have been shown for roadside ambush attacks, very few works deal with the challenge of complex dynamics between gangs at the intra-city scale. Here, based on contributions to the historical memory of the conflict in Colombia, Medellin’s gang-confrontation-network is presented. It is shown that socio-economic and violence indexes are moderate to highly correlated to the structure of the network. Specifically, the death-toll of conflict is strongly influenced by the leading eigenvalues of the gangs’ conflict adjacency matrix, which serves a proxy for unstable self-excitation from revenge attacks. The distribution of links based on the geographic distance between gangs in confrontation leads to the confirmation that territorial control is a main catalyst of violence and retaliation among gangs. As a first attempt to explore the time evolution of the confrontation network, the Boltzmann-Lotka-Volterra (BLV) dynamic interaction network analysis is applied to quantify the spatial embeddedness of the dynamic relationship between conflicting gangs in Medellin. However, the non-stationary character of the violence in Medellin during the observation period restricts the application of the BLV model and results suggest that more involved and comprehensive models are needed to described the dynamics of Medellin’s armed conflict.

Measuring health promotion in a sports club setting: a modified Delphi study

Background

The settings-based approach has become an increasing focus in health promotion since the World Health Organization’s 1986 Ottawa Charter. Schools and cities have implemented this approach, but development within sports clubs is limited. Thus, an internationally validated measurement of health promotion within this setting is lacking.

Methods

A modified Delphi study was completed to develop an international evaluation tool grounded in the settings-based approach. Expert panelists from academia, sports and health sectors were invited to participate in 3 online rounds. Items were generated or selected based on 3 prior Delphi-based studies and 2 nationally validated scales. Round one created a collaborative list of items, round two validated items based on relevance, importance and feasibility and the final round classified items into one of four determinants: cultural, social, environmental or economic.

Results

Panelists (69) from 13 countries participated in creating a final list of 62 items at 3 organizational levels. The sports club level included; 5 cultural, 6 social, 6 environmental and 5 economic items. The management level included; 5 cultural, 5 social, 5 environmental and 3 economic items. The coaching level included; 5 cultural, 5 social, 4 environmental and 4 economic items.

Conclusions

This study provides three important innovations; 1- it is rooted in theory through the settings-based approach, 2- the measurement tool includes three levels within sports clubs, capturing a whole club dynamic and 3- all items included in the tool have been validated by an international panel of experts.

Key messages

This 62-item measurement tool allows the comparison of perceptions from participants, coaches and management regarding how health is promoted within their sports club. This information offers insight on the capacity of sports clubs to implement and monitor policies and practices on the promotion of health beyond sports performance within their organization.

Mercury concentrations in biota in the Mediterranean Sea, a compilation of 40 years of surveys

The Mediterranean Region has a long lasting legacy of mercury mining activities and a high density of sub-marine volcanoes that has strongly contributed to its mercury budget. In the last forty years, there have been recorded increases in mercury concentrations in biota that have spurred a growing number of research activities to assess the impact of mercury pollution on human health and environment. Field investigations that quantify mercury concentrations in marine biota have led to a large amount of experimental data scattered in many peer-reviewed publications making it difficult for modelling applications and regional environmental assessments. This paper reviews existing peer-reviewed literature and datasets on mercury concentration in marine flora and fauna (Animal, Plants and Chromista Kingdoms) in the Mediterranean basin. A total of 24,465 records have been retrieved from 539 sources and included in Mercury in Mediterranean Biota (M2B). Well-defined specimens account for 24,407 observations, while a few records include generic plankton and unidentified fish species. Among all considered species, we selected Diplodus sargus, Sardina pilchardus, Thunnus thynnus and Xiphias gladius to show trends of mercury concentration against WHO and EU limits. Few notes on how M2B is intended to support the implementation of the Minamata Convention on Mercury by a user-driven Knowledge Hub are finally reported.

Measurement(s)	mercury
Technology Type(s)	digital curation
Factor Type(s)	geographic location • fishing area • species • sampling time • depth • weight • tissue
Sample Characteristic - Organism	Eukaryota
Sample Characteristic - Environment	ocean biome
Sample Characteristic - Location	Mediterranean Sea • Black Sea

Machine-accessible metadata file describing the reported data: 10.6084/m9.figshare.9886004