The role of hydraulic conditions of coagulation and flocculation on the damage of cyanobacteria

Limited information exists on the damage of harmful cyanobacteria cells, such as Raphidiopsis raciborskii and Dolichospermum circinale, caused by the hydraulic conditions at water treatment plants especially when it comes to the mechanical stresses imposed by coagulation and flocculation. To close this gap, this study evaluated the impacts of rapid and slow-mixing on R. raciborskii and D. circinale cells and trichomes. The hydraulic conditions used during the experiment were selected based on AWWA, which are widely applied in the absence of specific treatability tests. Cellular integrity was evaluated by the Erythrosine B staining method and logistic regression was used to study the association between organism integrity and hydraulic conditions (i.e., velocity gradient and mixing time). Wilcoxon rank-sum test was used to verify if there was a significant reduction of the trichome length and cell integrity. Rapid-mixing (velocity gradient of 750 s^-1 for 60 s) reduced the odds of finding intact D. circinale to <50%, whereas the odds of finding intact R. raciborskii cells did not significantly decrease. The odds of finding intact cells of R. raciborskii were 124 times greater than D. circinale. Rapid-mixing also reduced the length of D. circinale trichomes by approximately 50% but did not significantly decrease R. raciborskii trichomes. Slow-mixing did not significantly affect organisms or trichomes of either species. The results indicate that AWWA recommendations for coagulation may cause damage to D. circinale but not to R. raciborskii, suggesting that the operation of water treatment plants could be adjusted according to the dominant cyanobacterium present in the reservoir to avoid cell rupture and metabolite release.

Observation of the pη^{'} Cusp in the New Precise Beam Asymmetry Σ Data for γp→pη

Data on the beam asymmetry Σ in the photoproduction of η mesons off protons are reported for tagged photon energies from 1130 to 1790 MeV (mass range from W=1748  MeV to W=2045  MeV). The data cover the full solid angle that allows for a precise moment analysis. For the first time, a strong cusp effect in a polarization observable has been observed that is an effect of a branch-point singularity at the pη^{'} threshold [E_{γ}=1447  MeV (W=1896  MeV)]. The latest BnGa partial wave analysis includes the new beam asymmetry data and yields a strong indication for the N(1895)1/2^{-} nucleon resonance, demonstrating the importance of including all singularities for a correct determination of partial waves and resonance parameters.

The anesthetist as cardiologist: a case of heart block identified in the peripartum period

We describe a case of undiagnosed heart block which was detected during the postpartum surgical repair of a vaginal tear, and the subsequent investigations that confirmed diagnosis of atrio-ventricular heart block.

Evaluation of sustainability of non-communicable diseases risk factor program in Malaysia

Background

Non-communicable diseases (NCDs) in Malaysia have risen substantially over the last two decades. We aimed to (i) evaluate the sustainability of the existing NCDs risk factor program implemented under the National Strategic Plan and (ii) identify challenges and factors impeding the sustainability of the NCDs program.

Methods

A mixed-method approach using a combination of the Program Sustainability Assessment Tool

with 40-item instrument assessing 8 domains (organizational capacity, program adaptation, program evaluation, communications, strategic planning, funding stability, environmental support and partnerships) and 5 open-ended questions were administered to 80 key managers from district directors of chronic disease programs in Malaysia. The mean score for each of the 8 sustainability domains and the overall mean sustainability score were determined. Data analysis was performed using Statistical Package for the Social Sciences (SPSS) version 25.

Results

Seven domains scored a mean of ≥ 4. The domains of communications (cross-site mean, 4.5 on a scale of 1-7) and organizational capacity (mean, 4.4) had the highest ratings. Funding stability had the lowest rating (mean, 3.8). The overall mean sustainability score was 4.2. Open-ended responses revealed challenges by program leaders, including implementation difficulties, factors impede planning for NCDs sustainability program, lack of financial, staff support and staff training which are largely consistent with the scaled domains.

Conclusions

Capacity issues affecting the sustainability of NCDs program in Malaysia are qualitatively similar to other countries. Future work should aim at improving funding stability and integrating evidence-based public health strategies to sustain implemented NCDs program.

Key messages

Researchers could utilize this tool to assess program design and strategies promoting sustainability during implementation process for long term program sustainment. Investments in leadership support for integrating program evaluation into implementation and greater funding flexibility may enhance sustainability of evidence-based public health program for NCDs.

A-47 Resting-State Functional Connectivity Associated with Contact Level in Female Varsity Athletes

Objective

The effects of participation in contact sports on brain functioning is a growing area of concern in the athlete population. This pilot study examined differences in resting-state functional connectivity (rsFC) associated with level of contact in female varsity student athletes.

Method

Resting-state functional magnetic resonance imaging (fMRI) scans were collected from 29 female university athletes. Level of contact was characterized by active participation in collision sports (n = 13) and contact sports (n = 16). Athletes completed baseline testing including self-reported psychological measures. RsFC was compared between groups using Independent Component Analysis (ICA) within the default mode (DMN), frontoparietal (FPN), dorsal attention (DAN), salience (SN), and sensorimotor (SMN) networks.

Results

Collision sport athletes reported younger age at first sport (M = 4.7, SD = 1.2) and fewer past concussions (Md = 0, Range = 0–3) compared to contact sport athletes (M = 7.5, SD = 3.4; Md = 7.5, Range = 0–6; ps &lt; .05). Collision sport athletes also reported fewer symptoms of depression on the Patient Health Questionnaire-9 (p = 0.03). Collision sport athletes had decreased rsFC between the SMN and the left inferior frontal gyrus (T = −5.6, pFDR = 0.008) compared to the contact sport athletes. This difference in rsFC was not associated with age at first sport or prior concussion history.

Conclusions

Consistent with prior studies of varsity athletes, altered patterns of rsFC were observed in areas supporting somatomotor function in female athletes with suspected greater contact exposure. Further research is necessary to examine whether these neural changes are attributable to greater exposure to sub-concussive hits or other factors, such as differences in visuomotor abilities.

Survival of children and adolescents with intellectual disability following gastrostomy insertion

BACKGROUND

Positive health outcomes have been observed following gastrostomy insertion in children with intellectual disability, which is being increasingly used at younger ages to improve nutritional intake. This study investigated the effect of gastrostomy insertion on survival of children with severe intellectual disability.

METHODS

We used linked disability and health data of children and adolescents who were born in Western Australia between 1983 and 2009 to compare survival of individuals with severe intellectual disability by exposure to gastrostomy status. For those born in 2000-2009, we employed propensity score matching to adjust for confounding by indication. Effect of gastrostomy insertion on survival was compared by pertinent health and sociodemographic risk factors.

RESULTS

Compared with children born in the 1980s-1990s, probability of survival following first gastrostomy insertion for those born in 2000-2009 was higher (2 years: 94% vs. 83%). Mortality risk was higher in cases than that in their matched controls (hazard ratio 2.9, 95% confidence interval 1.1, 7.3). The relative risk of mortality (gastrostomy vs. non-gastrostomy) may have differed by sex, birthweight and time at first gastrostomy insertion. Respiratory conditions were a common immediate or underlying cause of death among all children, particularly among those undergoing gastrostomy insertion.

CONCLUSIONS

Whilst gastrostomy insertion was associated with lower survival rates than children without gastrostomy, survival improved with time, and gastrostomy afforded some protection for the more vulnerable groups, and earlier use appears beneficial to survival. Specific clinical data that may be used to prioritise the need for gastrostomy insertion may be responsible for the survival differences observed.

Scatterometry and diffractometry techniques to monitor surfaces textured by rapid ultra-short pulse laser

The overall aim of the PROMETHEUS project is to develop high power ultra-short pulse lasers and the associated optics to enable the precise periodic texturing of surfaces to impart a range of surface functionalities at unprecedented processing speeds. The project focusses upon the industrial application of ultra-short pulse lasers for manufacturing and on the development of high power ultra-short pulse laser technologies in the range of 700 ps – 10 ns. In summary, new textures will be manufactured to achieve functional surfaces utilising fewer raw materials, less energy and less waste; improve accuracy, power and control over existing technologies; increase achievable precision and minimize heat impact on sensitive materials. This article will provide the outcomes of the first results achieved from the monitoring solutions being used to assess surface textures with micrometer resolution.

The Gut Microbiome and Xenobiotics: Identifying Knowledge Gaps

There is an increasing awareness that the gut microbiome plays a critical role in human health and disease, but mechanistic insights are often lacking. In June 2018, the Health and Environmental Sciences Institute (HESI) held a workshop, "The Gut Microbiome: Markers of Human Health, Drug Efficacy and Xenobiotic Toxicity" (https://hesiglobal.org/event/the-gut-microbiome-workshop) to identify data gaps in determining how gut microbiome alterations may affect human health. Speakers and stakeholders from academia, government, and industry addressed multiple topics including the current science on the gut microbiome, endogenous and exogenous metabolites, biomarkers, and model systems. The workshop presentations and breakout group discussions formed the basis for identifying data gaps and research needs. Two critical issues that emerged were defining the microbial composition and function related to health and developing standards for models, methods and analysis in order to increase the ability to compare and replicate studies. A series of key recommendations were formulated to focus efforts to further understand host-microbiome interactions and the consequences of exposure to xenobiotics as well as identifying biomarkers of microbiome-associated disease and toxicity.

Citizens' juries give verdict on whether private practice veterinarians should attend unvaccinated Hendra virus suspect horses

BACKGROUND

Hendra virus (HeV) is endemic in Australian flying foxes, posing a threat to equine and human health. Equine vaccination remains the most effective risk mitigation strategy. Many horses remain unvaccinated - even in higher-risk regions. Debate surrounding the vaccine's use is characterised by conflicting perspectives, misunderstanding and mistrust. Private veterinary practitioners are critical to early identification of public health risk through recognition, sampling and management of suspect-equine-HeV-cases. However, managing such cases can be burdensome, with some veterinarians opting not to attend unvaccinated horses or to abandon equine practice because of risk posed by HeV disease and liability.

OBJECTIVE

Ascertain the perspectives of informed citizens on what obligations (if any) private veterinarians have to attend unvaccinated horses with HeV or HeV-like disease.

METHODS

Three citizens' juries were tasked with considering approaches to managing HeV risk in Australia, including (reported here) roles and obligations of private veterinarians in responding to HeV-suspect-cases.

RESULTS

Jurors acknowledged that HeV management posed an important challenge for private veterinarians. A clear majority (27 of 31 jurors) voted that veterinarians should not be obliged to attend unvaccinated horses. All recognised that greater support for veterinarians should be a priority.

CONCLUSIONS

When informed of HeV risks and strategies for control and management, citizens appreciated the need to support veterinarians performing this critical 'One Health' role for public benefit. The current governance framework within which zoonotic disease recognition and response operates limits the contingency and scope for increasing support and efficacy of these important veterinary public health practices.

A231 UNDERSTANDING THE IMPACT OF TNF-ALPHA ANTAGONISTS ON THE SEVERITY OF NON-MELANOMA SKIN CANCER IN INFLAMMATORY BOWEL DISEASE AND THE CONSEQUENCES FOR THERAPY

Background

Non-melanoma skin cancer (NMSC) accounts for at least 40% of all new cancer diagnoses in Canada annually and presents a significant cost to the health care system due to the volume of cases. The incidence of NMSC in patients with Inflammatory Bowel Disease (IBD) is higher when compared to the general population. Generally, in a non-IBD population, the risk of further NMSC progression is low, however, little data exists that highlights differences in clinical course of patients diagnosed with NMSC who have IBD and are TNF-α antagonist exposed. It is unclear if TNF-α antagonist therapy should be discontinued in this patient population.

Aims

Our goal is to determine whether TNF-α antagonist exposure in IBD is associated with a high risk NMSC presentation at diagnosis, as defined by the National Comprehensive Cancer Network (NCCN) stratification. Our secondary objectives include presence of positive margins following resection, presence of metastatic disease on initial presentation, requirement of additional therapy to treat NMSC, number of patients who had TNF-α antagonist therapy discontinued following diagnosis of NMSC and number of individuals with recurrent NMSC.

Methods

Four hundred and twenty-four IBD patients seen at London Health Sciences Centre were reviewed. We have identified 22 patients who were diagnosed with NMSC. Twelve patients had a pre-NMSC TNF-α antagonist exposure while 10 patients who developed an NMSC and had no TNF-α antagonist exposure prior to NMSC diagnosis.

Results

Preliminary results of the primary outcome demonstrate that fifty-percent (6/12) of patients who have been exposed to TNF antagonist therapy presented with a high risk NMSC lesion at diagnosis compared to 40% (4/10) who were not exposed (OR 5.16, 95%CI 0.47–57.00; p = 0.181). Preliminary results of the secondary outcomes suggest that 25% (3/12) of patients exposed to TNF-α antagonist had positive margins compared with 0% (0/10) of patients who were not exposed. No patients in either group presented with metastatic disease. Twenty-five percent (3/12) of patients in the exposed group received more advanced treatment compared with 0% (0/10) in the non-exposed group. Eight percent (1/12) of patients in the TNF-α antagonist group had their IBD therapy changed from a TNF-α antagonist to an alternative biologic class, and 17% of patients (2/12) in the TNF-α antagonist group had recurrent NMSC lesions.

Conclusions

In conclusion, preliminary results suggest that TNF-α antagonist exposure may be associated with higher risk NMSC lesion at presentation. Further expansion of the sample size is required to explore these hypotheses further.

Funding Agencies

None

A214 GENETIC VARIATION IN THE FARNESOID X RECEPTOR PREDICTS CROHN’S DISEASE SEVERITY IN FEMALE PATIENTS

Background

Crohn’s disease (CD) is an immune-mediated inflammatory bowel disease defined by episodes of intestinal inflammation. There is now an increasing appreciation of the bile acid-sensing nuclear receptor, FXR, as an important regulator of intestinal inflammation, intestinal permeability and response to bacterial overgrowth. Many of these processes are dysregulated in CD. It is unclear how genetic variation in FXR impacts on CD severity. FXR deficiency is rare. Loss of function mutations in FXR as contributors to CD are unlikely; however, partial loss of function of FXR may contribute to CD progression or severity. Our group demonstrated that FXR-1G&gt;T, a SNV adjacent to the ATG start codon, is linked to reduced transactivation of FXR gene targets. We hypothesized that changes in the intestinal barrier as a result of reduced FXR expression among those who harbor the FXR-1T allele are more likely to exhibit a severe CD phenotype compared to G (reference) allele carriers, and thereby experience a more rapid progression to surgery. Alterations in FXR activity may in part be secondary to genetic variation in the FXR gene.

Aims

To evaluate FXR-1G&gt;T as a genomic biomarker of severity in CD and propose a plausible molecular mechanism.

Methods

A retrospective study (n=542) was conducted in a Canadian cohort of CD patients. Blood samples were obtained for genotypic analysis (FXR-1G&gt;T), as well as determination of the FXR downstream product, fibroblast growth factor (FGF) 19. Primary outcomes included risk and time to first CD-related surgery. To better elucidate a potential molecular basis for the observed effect of FXR-1G&gt;T genotype on CD prognosis (more frequent and early surgery) in female CD patients, we explored a connection between the estrogen receptor (ER)-mediated pathway and genetic variation in FXR using a cell-based model. .

Results

The FXR-1GT genotype was associated with the risk of (odds ratio, OR=3.34, 95%CI=1.58–7.05, p=0.002) and early progression to surgery (hazard ratio, HR=3.00, 95%CI=1.86–4.83, p&lt;0.0001) in CD. Female carriers of the FXR-1GT genotype had the greatest risk of surgery (OR=14.87 95%CI=4.22–52.38, p&lt;0.0001) and early progression to surgery (HR=6.28, 95%CI=3.62–10.90, p&lt;0.0001). Furthermore, women carriers of FXR-1GT polymorphism had a nearly three-fold lower FGF19 plasma concentration compared to women with wildtype FXR-1GG genotype (p&lt;0.0001). In HepG2 cells cotransfected with estrogen receptors (ERα and β) and FXR, presence of estradiol further attenuated variant FXR activity.

Conclusions

FXR-1GT is deleterious to women with CD through ER-mediated attenuation of FXR activation. Female CD FXR-1GT carriers should be considered for more aggressive medical management.

Funding Agencies

CAG, CCC, CIHR

A208 HLA-DQA1*05 GENOTYPE PREDICTS ANTI-DRUG ANTIBODY FORMATION AND LOSS OF RESPONSE DURING INFLIXIMAB THERAPY FOR INFLAMMATORY BOWEL DISEASE

Background

The underlying mechanism for immunogenicity in anti-TNFa-exposed patients with inflammatory bowel disease is poorly understood. Anti-drug antibodies are a leading contributor to infliximab loss of response and adverse drug events. Currently, it is not feasible to identify patients at risk of antibody formation prior to initiating infliximab. The genetic variation HLADQA1*05(rs2097432) has been linked to infliximab antibody formation in a cohort of patients with Crohn’s disease.

Aims

Due to the wide variation in the frequency of HLADQA1* 05 across ethnic groups, we aim to independently evaluate the association between HLADQA1*05and infliximab antibody formation, infliximab loss of response, treatment discontinuation and adverse drug events, in a Canadian inflammatory bowel disease cohort.

Methods

In a retrospective cohort study, infliximab-exposed patients with inflammatory bowel disease (n=262) were screened for the genetic variation, HLADQA1*05A&gt;G(rs2097432). The risk of infliximab anti-drug antibody formation, infliximab loss of response, adverse events, and discontinuation were assessed in wild type (GG) and variant-carrying (AG or AA) individuals.

Results

Forty percent of all participants were HLADQA1*05A&gt;Gvariant carriers, with 79% of participants with infliximab antibodies carrying at least one variant allele. The risk of infliximab antibody formation was higher in HLADQA1*05A&gt;Gvariant carriers in an IBD population (adjusted HR=7.29, 95%CI=2.97–17.191, p=1.46x10-5) independent of age, sex, weight, dose and co-immunosuppression with an immunomodulator. Variant carrier status was associated with an increased risk of infliximab loss of response (adjusted HR=2.34, 95%CI=1.41–3.88, p=0.001) and discontinuation (adjusted HR=2.27, 95%CI=1.46–3.43, p=2.53x10-4) though not with infliximab-associated adverse drug events.

Conclusions

HLADQA1*05 is independently associated with a high risk of infliximab antibody formation in addition to infliximab loss of response and treatment discontinuation. As a result, we propose that pre-emptive genetic screening for the HLADQA1* 05A&gt;Gvariant would be useful in order to predict individuals at risk of developing immunogenicity. There may be a role for genotype-guided application of combination therapy in inflammatory bowel disease.

Funding Agencies

NoneWolfe Medical Research Chair in Pharmacogenomics (MOP-89753 to RBK), the Academic Medical Organization of Southwestern Ontario (INN18-005 to RBK and AW; S17-004 to AW), and Lawson Health Research Institute (IRF-05-19 to AW)

Nitrogen oxidation consortia dynamics influence the performance of full-scale rotating biological contactors

Ammonia oxidising microorganisms (AOM) play an important role in ammonia removal in wastewater treatment works (WWTW) including rotating biological contactors (RBCs). Environmental factors within RBCs are known to impact the performance of key AOM, such that only some operational RBCs have shown ability for elevated ammonia removal. In this work, long-term treatment performance of seven full-scale RBC systems along with the structure and abundance of the ammonia oxidising bacteria (AOB) and archaea (AOA) communities within microbial biofilms were examined. Long term data showed the dominance of AOB in most RBCs, although two RBCs had demonstrable shift toward an AOA dominated AOM community. Next Generation Sequencing of the 16S rRNA gene revealed diverse evolutionary ancestry of AOB from RBC biofilms while nitrite-oxidising bacteria (NOBs) were similar to reference databases. AOA were more abundant in the biofilms subject to lower organic loading and higher oxygen concentration found at the distal end of RBC systems. Modelling revealed a distinct nitrogen cycling community present within high performing RBCs, linked to efficient control of RBC process variables (retention time, organic loading and oxygen concentration). We present a novel template for enhancing the resilience of RBC systems through microbial community analysis which can guide future strategies for more effective ammonia removal. To best of the author's knowledge, this is the first comparative study reporting the use of next generation sequencing data on microbial biofilms from RBCs to inform effluent quality of small WWTW.

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.