Voices of Community Organizations: How Cancer Centers Can Support Communities in the Face of COVID-19

Purpose: As part of an ongoing effort to support the equitable delivery of cancer care to historically underserved communities in New York City (NYC), we examined the impact of COVID-19 on community outreach organizations working with an NCI-comprehensive cancer center Methods: We conducted 16 semi-structured interviews (30–90 minutes; July-September 2020) with stakeholders (SH) including patient navigators, patient advocates, faith-based leaders, community health, and non-profit organizations in NYC – the epicenter of the COVID-19 pandemic in the US. Using thematic analysis, we characterized experiences and challenges in supporting cancer care delivery during COVID-19. Results: Per SH, COVID-19 required organizations to shift priorities to address day-to-day needs exacerbated by COVID-19 (food insecurity, financial/housing instability, misinformation, emotional distress). Organizations adapted by leveraging existing partnerships, including the cancer center, and partnering with new local/state organizations to broaden their work scope (e.g., COVID-19 testing centers, food pantries, technology training), and disseminate reliable COVID-19 information to communities. All organizations transitioned to virtual platforms creating challenges for those with limited technical resources and often excluded older or isolated populations; thus, many organizations retained a socially distanced in-person component to remain visible and trustworthy within the community. Importantly, SH emphasized the importance of cancer center support via proactive involvement and communication with community members, providing a supportive infrastructure (funding, technical support, personnel), and incorporating community voices into new programs and projects during and beyond the COVID-19 pandemic. Conclusion: In addition to or in lieu of cancer care delivery efforts, community organizations are compelled to develop innovative approaches that address the more immediate needs of the community resulting from COVID-19. Cancer centers can support their community partners by being responsive and flexible to the community needs, building trust within the community, and strengthening community organizational capacity to reduce the long-term damage of COVID-19 and achieve equity.

Identification and comparison of missed nursing care in the United States of America and South Korea

AIMS AND OBJECTIVES

This study aimed to identify and compare missed nursing care types and reasons between South Korea and the United States of America.

BACKGROUND

Patient safety has become a significant task of the healthcare delivery systems worldwide. The omission of nursing care constitutes a growing concern because it threatens both patient safety and nursing care quality.

DESIGN

This study used a cross-sectional, descriptive and comparative design.

METHODS

Data were collected from registered nurses working in two university-affiliated tertiary hospitals and a general hospital in Korea and a Midwest United States tertiary hospital. In addition, the STROBE checklist was used in this study.

RESULTS

While substantial, the level of missed nursing care reported by Korean nurses was lower than that of United States nurses. Only three nursing care activities, setting up meals, patient assessment and skin/wound care, did not significantly differed between two countries. More basic nursing care types such as ambulation, feeding and mouth care were missed more than others in both countries. The reasons for missed care differed between two countries. However, both Korean and US nurses reported labour resource problems as reasons for missed care.

CONCLUSIONS

Although the types of missed nursing care differed significantly between countries, both Korean and US nurses reported labour resource problems for the top reasons for missed care. Thus, comparing missed nursing care could assist nursing administrators in developing strategies to improve care quality and patient safety.

RELEVANCE TO CLINICAL PRACTICE

The level and reasons for missed nursing care are very influential factors for patient outcomes and patient safety. Appropriate skill mix and staffing are needed to decrease extent of missed care, so that enhancing patient safety and quality of nursing care.

A241 A REVIEW OF 101 CHILDREN WITH GASTRO-JEJUNAL FEEDING TUBES INCLUDING THEIR COMPLICATIONS AT BC CHILDREN’S HOSPITAL

Background

The use of GastroJejunal Tubes (GJTs) is an increasingly common method for providing post-pyloric enteral nutrition in pediatric patients.

Aims

To describe the patients with GJT including the indication, comorbidities including by system, as well as tube related complications.

Methods

The charts of 101 patients who had a GJT over a one-year period (2019–20) were retrospectively reviewed including demographics, medical diagnoses, information about tube placement, maintenance, and complications including malposition, balloon failure, blockages, and leakages / breaks.

Results

The top indications for GJT are aspiration and GERD. 73.3% have >3 system comorbidities (ie CNS, GI, Resp). Mean age of GJT placement was 43 months. 78% remain on a PPI and 24% are on a prokinetic. 24% continue to eat some amount orally. Over this one-year period, 92% continue with a GJT (mean duration 4 years, max 15), 4% have reverted back to a G-tube, 1% had a surgical J tube placed, and 3% died (not due to the GJT). Following initial placement, these 101 patients underwent 1194 GJT related procedures, (417 urgent changes, 777 routine changes) with 98.3% technical success. Patients needed an average of one urgent repair per year (3.2/1000 GJT days) and the majority of patients required >1 emergency visit. Those with routine GJT changes seem to have fewer urgent repairs (Figure 1).

Conclusions

Children with GJT represent a growing complex patient population. GJT are being used for the longer term. Routine maintenance seems supported by our data although doesn’t prevent the need for urgent repairs or other complications. Frameworks and guidelines are needed for this essential technology to improve clinical care.

Funding Agencies

None

Risk factors for the delayed diagnosis of extrapulmonary TB

BACKGROUND: Extrapulmonary TB (EPTB) is more difficult to diagnose than pulmonary TB. The delayed management of EPTB can lead to complications and increase the socio-economic burden.METHODS: Patients newly diagnosed with EPTB were retrospectively enrolled from 11 general hospitals in South Korea from January 2017 to December 2018. The basic characteristics of patients were described. Univariable and multivariable analyses were performed between early and delayed diagnosis groups to identify risk factors for delayed diagnosis and treatment in EPTB.RESULTS: In total, 594 patients were enrolled. Lymph node TB (28.3%) was the predominant form, followed by abdominal (18.4%) and disseminated TB (14.5%). Concurrent lung involvement was 17.8%. The positivity of diagnostic tests showed no significant difference between the two groups. Acute clinical manifestations in disseminated, pericardial and meningeal TB, and immunosuppression were associated with early diagnosis. Delayed diagnosis was associated with outpatient clinic visits, delayed sample acquisition and diagnostic departments other than infection or pulmonology.CONCLUSION: The delay in diagnosis and treatment of EPTB was not related to differences in microbiological characteristics of Mycobacterium tuberculosis itself; rather, it was due to the indolent clinical manifestations that cause referral to non-TB-specialised departments in the outpatient clinic and delay the suspicion of TB and diagnostic testing.

CERKL is upregulated in cutaneous squamous cell carcinoma and maintains cellular sphingolipids and resistance to oxidative stress

BACKGROUND

Ceramide kinase-like protein (CERKL) was originally described in retinal tissue. CERKL has been shown to protect cells from oxidative stress, and mutations in CERKL underlie the inherited disease retinitis pigmentosa. CERKL expression maintains cellular sphingolipids via an unknown mechanism.

OBJECTIVES

To determine whether CERKL is expressed in epidermis and cutaneous squamous cell carcinoma (cSCC) and whether CERKL expression affects cSCC sphingolipid metabolism and susceptibility to oxidative stress.

METHODS

CERKL expression was determined by RNA-Seq, quantitative polymerase chain reaction and immunohistochemistry. CERKL was knocked down in cSCC cells using small interfering RNA. Sphingolipid content was analysed by liquid chromatography-mass spectrometry. Oxidative stress was induced by treatment with H₂ O₂ , and apoptosis was measured using flow cytometry to determine annexin V binding.

RESULTS

CERKL mRNA and protein are highly expressed in actinic keratosis and cSCC in comparison with normal epidermis. CERKL is also expressed in metabolically active epithelial cells in normal hair bulbs and sebaceous glands. CERKL knockdown in cultured cSCC cells reduces cellular sphingolipid content and enhances susceptibility to oxidative stress.

CONCLUSIONS

These findings suggest that CERKL may be important in cSCC progression and could lead to novel strategies for prevention and treatment of cSCC.

Effects of Self-Education on Patient Safety via Smartphone Application for Self-Efficacy and Safety Behaviors of Inpatients in Korea

Objectives

This study aimed to determine whether self-educational intervention on patient safety via a smartphone application could improve the level of self-efficacy and safety behaviors of patients. In addition the effect of change in self-efficacy on the improvement of safety behaviors after self-educational intervention was investigated.

Methods

A one-group pre- and post-test design and convenience sampling were implemented. Self-educational intervention via smartphone application was provided to 94 participants in a tertiary university hospital in South Korea. The smartphone application included learning contents on why the participation of patients is critical in preventing hospital-acquired infections and surgery-related adverse events during hospitalization. Paired t-tests and hierarchical regression analysis were conducted to assess the effect of self-educational intervention and self-efficacy on the improvement of safety behaviors of patients.

Results

After the intervention, the level of self-efficacy and safety behaviors significantly increased from 2.53 to 2.95 and from 2.00 to 2.62, respectively. In the hierarchical regression analysis, the change in self-efficacy accounted for 35.4% of the variance in the improvement of safety behaviors.

Conclusions

The results of this study demonstrated that self-education on patient safety via a smartphone application was an effective strategy to enhance patients’ self-efficacy and safety behaviors. This process could ultimately enhance patient safety by promoting patient involvement during hospitalization and preventing the occurrence of medical errors.

Developing a Transnational Health Record Framework with Level-Specific Interoperability Guidelines Based on a Related Literature Review

With the advent of digital healthcare without borders, enormous amounts of health information are captured and computerized. As healthcare quality largely depends on the reliability of given health information, personal health records should be accessible according to patients’ mobility, even as they travel or migrate to other countries. However, since all the health information is scattered in multiple places, it is an onerous task to carry it whenever people move to other countries. To effectively and efficiently utilize health information, interoperability, which is the ability of various healthcare information technologies to exchange, to interpret, and to use data, is needed. Hence, building a robust transnational health information infrastructure with clear interoperability guidelines considering heterogeneous aspects is necessary. For this purpose, this study proposes a Transnational Health Record framework, which enables access to personal health records anywhere. We review related literature and define level-specific interoperability guidelines, business processes, and requirements for the Transnational Health Record system framework.

Modeling the dynamic behaviors of the COPI vesicle formation regulators, the small GTPase Arf1 and its activating Sec7 guanine nucleotide exchange factor GBF1 on Golgi membranes

The components and subprocesses underlying the formation of COPI-coated vesicles at the Golgi are well understood. The coating cascade is initiated after the small GTPase Arf1 is activated by the Sec7 domain–containing guanine nucleotide exchange factor GBF1 (Golgi brefeldin A resistant guanine nucleotide exchange factor 1). This causes a conformational shift within Arf1 that facilitates stable association of Arf1 with the membrane, a process required for subsequent recruitment of the COPI coat. Although we have atomic-level knowledge of Arf1 activation by Sec7 domain–containing GEFs, our understanding of the biophysical processes regulating Arf1 and GBF1 dynamics is limited. We used fluorescence recovery after photobleaching data and kinetic Monte Carlo simulation to assess the behavior of Arf1 and GBF1 during COPI vesicle formation in live cells. Our analyses suggest that Arf1 and GBF1 associate with Golgi membranes independently, with an excess of GBF1 relative to Arf1. Furthermore, the GBF1-mediated Arf1 activation is much faster than GBF1 cycling on/off the membrane, suggesting that GBF1 is regulated by processes other than its interactions Arf1. Interestingly, modeling the behavior of the catalytically inactive GBF1/E794K mutant stabilized on the membrane is inconsistent with the formation of a stable complex between it and an endogenous Arf1 and suggests that GBF1/E794K is stabilized on the membrane independently of complex formation.

Relationship between Selected Trace Elements in Human Milk and Psychosocial Characteristics in Korean Early Postpartum Women

This study aimed to identify the relationship between selected trace elements in human milk and depression, breastfeeding self-efficacy, sleep satisfaction, and the demographic and obstetric characteristics of lactating mothers. Forty lactating mothers recovering after birth in two postpartum care centers located in Changwon, South Korea, were studied. Calcium, sodium, iron, and selenium concentrations in human milk were analyzed using inductively coupled plasma mass spectrometry at the analysis center of Kyungnam University. Data were analyzed using descriptive statistics, the Kruskal-Wallis test, the Mann-Whiney U test, and Spearman's correlation coefficients using an SPSS 23.0 program. There were no significant differences in concentration of selected trace elements (calcium, sodium, iron, and selenium) in human milk according to demographic and obstetric characteristics. Sodium concentration was negatively correlated with breastfeeding self-efficacy (r = -0.51, CI = -0.71 to -0.24). Selenium concentration was negatively correlated with calcium concentration (r = -0.34, CI = -0.58 to 0.38). Postpartum depression was negatively correlated with sleep satisfaction (r = -0.46, CI = -0.67 to -0.17) and with breastfeeding self-efficacy (r = -0.41, CI = -0.64 to -0.11). Breastfeeding self-efficacy was positively correlated with sleep satisfaction (r = 0.48, CI = 0.20 to 0.69). This study suggests that sodium concentration in human milk is associated with breastfeeding self-efficacy.

CERKL is Upregulated in Cutaneous Squamous Cell Carcinoma and Maintains Cellular Sphingolipids and Resistance to Oxidative Stress

BACKGROUND

Ceramide Kinase-Like Protein (CERKL) was originally described in retinal tissue. CERKL has been shown to protect cells from oxidative stress, and mutations in CERKL underlie the inherited disease, retinitis pigmentosa. CERKL expression maintains cellular sphingolipids via an unknown mechanism.

OBJECTIVES

To determine whether CERKL is expressed in epidermis and cutaneous squamous cell carcinoma (cSCC) and whether CERKL expression affects cSCC sphingolipid metabolism and susceptibility to oxidative stress.

METHODS

CERKL expression was determined by RNA-Seq, qPCR and immunohistochemistry. CERKL was knocked down in cSCC cells using siRNA. Sphingolipid content was analyzed by liquid chromatography-mass spectrometry (LC-MS). Oxidative stress was induced by treatment with H2 O2 , and apoptosis was measured using flow cytometry to determine annexin v binding.

RESULTS

CERKL mRNA and protein are highly expressed in actinic keratosis and cSCC in comparison with normal epidermis. CERKL also is expressed in metabolically active epithelial cells in normal hair bulbs and sebaceous glands. CERKL knockdown in cultured cSCC cells reduces cellular sphingolipid content and enhances susceptibility to oxidative stress.

CONCLUSIONS

These findings suggest that CERKL may be important in cSCC progression and could lead to novel strategies for prevention and treatment of cSCC.

A Deep Learning-Based Approach for Identifying the Medicinal Uses of Plant-Derived Natural Compounds

Medicinal plants and their extracts have been used as important sources for drug discovery. In particular, plant-derived natural compounds, including phytochemicals, antioxidants, vitamins, and minerals, are gaining attention as they promote health and prevent disease. Although several in vitro methods have been developed to confirm the biological activities of natural compounds, there is still considerable room to reduce time and cost. To overcome these limitations, several in silico methods have been proposed for conducting large-scale analysis, but they are still limited in terms of dealing with incomplete and heterogeneous natural compound data. Here, we propose a deep learning-based approach to identify the medicinal uses of natural compounds by exploiting massive and heterogeneous drug and natural compound data. The rationale behind this approach is that deep learning can effectively utilize heterogeneous features to alleviate incomplete information. Based on latent knowledge, molecular interactions, and chemical property features, we generated 686 dimensional features for 4,507 natural compounds and 2,882 approved and investigational drugs. The deep learning model was trained using the generated features and verified drug indication information. When the features of natural compounds were applied as input to the trained model, potential efficacies were successfully predicted with high accuracy, sensitivity, and specificity.

Using opportunistic screening with abdominal CT to identify osteoporosis and osteopenia in patients with diabetes

Opportunistic osteoporosis screening involves measuring the attenuation of L1 vertebrae on abdominal computed tomography (CT), which correlates with DXA T-score. We found that this approach is useful for detecting low bone mass in patients with diabetes and propose L1 attenuation ≤ 135 Hounsfield units (HU) as a threshold for which DXA should be strongly considered.

INTRODUCTION

Attenuation of the L1 vertebrae on computer tomography (CT) images done for other reasons ("Opportunistic Osteoporosis Screening") has been found to correlate well with DXA-derived T-score. However, the method and the thresholds have never been tested specifically in those with diabetes mellitus (DM), in whom the fracture risk is greater than explained by BMD.

METHODS

In a retrospective study of subjects with DM who had both abdominal CT and DXA within 6 months of each other, we compared L1 attenuation and DXA T-score to define the sensitivity and specificity of thresholds previously established in the general population.

RESULTS

There were 313 subjects among whom 18 (5.8%) had prior major osteoporotic fracture (MOF). Subjects with MOF had lower T-scores (- 2.3 ± 1.4 vs. - 0.9 ± 1.4, p < 0.001) and L1 attenuation (104 HU ± 46 vs. 149 HU ± 47, p < 0.001) than non-fracture subjects. L1 attenuation ≤ 160 HU was 91% sensitive for osteoporosis, while ≤ 110 HU was 80% specific. For a higher T-score of ≤ - 1.5, L1 attenuation ≤ 135 HU showed balanced sensitivity and specificity (65% and 69%, respectively).

CONCLUSION

Opportunistic osteoporosis screening with abdominal CT is useful in determining the need for DXA screening in subjects with diabetes. We propose L1 attenuation ≤ 135 HU as a reasonable threshold for detecting the T-score of ≤ - 1.5, which is likely associated with increased fragility in DM.

High bodyweight variability and increased risk of atrial fibrillation in patients with type 2 diabetes mellitus

Background

Bodyweight variability is a risk factor for atrial fibrillation (AF), but this has not been studied with a focus on patients with diabetes mellitus (DM).

Methods

A nationwide population-based cohort of 670,797 patients with type 2 DM from the Korean National Health Insurance Service database without a history of AF and with ≥3 measurements of body weight over a 5-year period were followed up for AF development. Intra-individual bodyweight variability was calculated using variability independent of mean (VIM), and high bodyweight variability was defined as the quintile with the highest variability with the lower four quintiles as reference.

Results

During a median of 7.0 years of follow-up, 22,019 patients (3.3%) were newly diagnosed with AF. Risk of incident AF was increased in those in the highest quintile of bodyweight variability, after adjustment for baseline body mass index (BMI), age, sex, lifestyle factors, comorbidities, number of oral anti-diabetic medication, insulin use, duration of DM, and fasting glucose (HR 1.16, 95% CI 1.12–1.20). High bodyweight variability was significantly associated with AF development regardless of baseline BMI group and direction of overall weight change. This association was stronger in subjects with lower BMI, those on insulin, and those with a DM duration of greater than 5 years.

Conclusions

High bodyweight variability was associated with AF development, independently of traditional cardiovascular risk factors and baseline BMI. This association was stronger in underweight patients and in advanced diabetic stage.

Funding Acknowledgement

Type of funding source: None

S, K.R. R, Anua S, Mastor N. Antimicrobial resistance profile of Salmonella present in organic farming in Selangor, Malaysia

Presence of Salmonella in organic farming may lead to contamination in fresh produce. This study was designed to detect Salmonella contamination in organic vegetable farm situated in Serdang and to evaluate the antibiotic susceptibility profiles of the isolates. A total of 460 samples of brinjal, cucumber, ladies’ fingers and soil were collected and examined for the presence of Salmonella. The obtained isolates were identified and confirmed by biochemical characterization and serotyping. Antibiotic sensitivity profiles of the isolates were determined by using agar disk diffusion method. Salmonella spp. was detected in brinjal (1.7%, n=2), cucumber (1.7%, n=2), ladies’ fingers (2.5%, n=3) and soil (5.0%, n=5) samples. The prevalent serovars were Salmonella enterica ser. Senftenberg, S. enterica ser. Weltevreden and S. enterica ser. Corvallis. All strains were resistance to penicillin and vancomycin, with multiple antibiotic resistance (MAR) index between 0.21 and 0.36, demonstrated here as multi-drug resistant (MDR) Salmonella. The result highlighted that organic vegetables constituted potential sources of Salmonella, informing continuous monitoring and tightened surveillance are necessary to ensure food safety.

Impact of Data Presentation on Physician Performance Utilizing Artificial Intelligence-Based Computer-Aided Diagnosis and Decision Support Systems

Ultrasound (US) is a valuable imaging modality used to detect primary breast malignancy. However, radiologists have a limited ability to distinguish between benign and malignant lesions on US, leading to false-positive and false-negative results, which limit the positive predictive value of lesions sent for biopsy (PPV3) and specificity. A recent study demonstrated that incorporating an AI-based decision support (DS) system into US image analysis could help improve US diagnostic performance. While the DS system is promising, its efficacy in terms of its impact also needs to be measured when integrated into existing clinical workflows. The current study evaluates workflow schemas for DS integration and its impact on diagnostic accuracy. The impact on two different reading methodologies, sequential and independent, was assessed. This study demonstrates significant accuracy differences between the two workflow schemas as measured by area under the receiver operating curve (AUC), as well as inter-operator variability differences as measured by Kendall’s tau-b. This evaluation has practical implications on the utilization of such technologies in diagnostic environments as compared to previous studies.

Age-related natural fertility outcomes in women over 35 years: a systematic review and individual participant data meta-analysis

STUDY QUESTION

What is the rate of natural conception leading to ongoing pregnancy or livebirth over 6–12 months for infertile women of age ≥35 years?

SUMMARY ANSWER

Natural conception rates were still clinically relevant in women aged 35 years and above and were significantly higher in women with unexplained infertility compared to those with other diagnoses.

WHAT IS KNOWN ALREADY

In recent years, increasing numbers of women have attempted to conceive at a later age, resulting in a commensurate increase in the need for ART. However, there is a lack of data on natural fertility outcomes (i.e. no interventions) in women with increasing age.

STUDY DESIGN, SIZE, DURATION

A systematic review with individual participant data (IPD) meta-analysis was carried out. PubMed, MEDLINE, EMBASE, the Cochrane Library, clinicaltrials.gov were searched until 1 July 2018 including search terms ‘fertility service’, ‘waiting list’, ‘treatment-independent’ and ‘spontaneous conception’. Language restrictions were not imposed.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Inclusion criteria were studies (at least partly) reporting on infertile couples with female partner of age ≥35 years who attended fertility services, underwent fertility workup (e.g. history, semen analysis, tubal status and ovulation status) and were exposed to natural conception (e.g. independent of treatment such as IVF, ovulation induction and tubal surgery). Studies that exclusively studied only one infertility diagnosis, without including other women presenting to infertility services for other causes of infertility, were excluded. For studies that met the inclusion criteria, study authors were contacted to provide IPD, after which fertility outcomes for women of age ≥35 years were retrieved. Time to pregnancy or livebirth and the effect of increasing age on fertility outcomes after adjustment for other prognostic factors were analysed. Quality of studies was graded with the Newcastle–Ottawa Scale (non-randomised controlled trials (RCTs)) or the Cochrane Risk of Bias tool (for RCTs).

MAIN RESULTS AND THE ROLE OF CHANCE

We included nine studies (seven cohort studies and two RCTs) (n = 4379 women of at least age 35 years), with the observed composite primary outcome of ongoing pregnancy or livebirth occurring in 429 women (9.8%) over a median follow-up of 5 months (25th to 75th percentile: 2.5–8.5 months). Studies were of moderate to high quality. The probability of natural conception significantly decreased with any diagnosis of infertility, when compared with unexplained infertility. We found non-linear effects of female age and duration of infertility on ongoing pregnancy and tabulated the predicted probabilities for unexplained infertile women aged 35–42 years with either primary or secondary infertility and with a duration of infertility from 1 to 6 years. For a 35-year-old woman with 2 years of primary unexplained infertility, the predicted probability of natural conception leading to ongoing pregnancy or livebirth was 0.15 (95% CI 0.11–0.19) after 6 months and 0.24 (95% CI 0.17–0.30) after 12 months. For a 42-year-old woman, this decreased to 0.08 (95% CI 0.04–0.11) after 6 months and 0.13 (95% CI 0.07–0.18) after 12 months.

LIMITATIONS, REASONS FOR CAUTION

In the studies selected, there were different study designs, recruitment strategies in different centres, protocols and countries and different methods of assessment of infertility. Data were limited for women above the age of 40 years.

WIDER IMPLICATIONS OF THE FINDINGS

Women attending fertility services should be encouraged to pursue natural conception while waiting for treatment to commence and after treatment if it is unsuccessful. Our results may aid in counselling women, and, in particular, for those with unexplained infertility.

STUDY FUNDING/COMPETING INTEREST(S)

S.J.C. received funding from the University of Adelaide Summer Research Scholarship. B.W.M. is supported by a NHMRC Investigator grant (GNT1176437), B.W.M. reports consultancy for ObsEva, Merck, Merck KGaA, iGenomix and Guerbet. B.W.M. reports research support by Merck and Guerbet.

PROSPERO REGISTRATION NUMBER

CRD42018096552.

An epistatic interaction between pre-natal smoke exposure and socioeconomic status has a significant impact on bronchodilator drug response in African American youth with asthma

BACKGROUND

Asthma is one of the leading chronic illnesses among children in the United States. Asthma prevalence is higher among African Americans (11.2%) compared to European Americans (7.7%). Bronchodilator medications are part of the first-line therapy, and the rescue medication, for acute asthma symptoms. Bronchodilator drug response (BDR) varies substantially among different racial/ethnic groups. Asthma prevalence in African Americans is only 3.5% higher than that of European Americans, however, asthma mortality among African Americans is four times that of European Americans; variation in BDR may play an important role in explaining this health disparity. To improve our understanding of disparate health outcomes in complex phenotypes such as BDR, it is important to consider interactions between environmental and biological variables.

RESULTS

We evaluated the impact of pairwise and three-variable interactions between environmental, social, and biological variables on BDR in 233 African American youth with asthma using Visualization of Statistical Epistasis Networks (ViSEN). ViSEN is a non-parametric entropy-based approach able to quantify interaction effects using an information-theory metric known as Information Gain (IG). We performed analyses in the full dataset and in sex-stratified subsets. Our analyses identified several interaction models significantly, and suggestively, associated with BDR. The strongest interaction significantly associated with BDR was a pairwise interaction between pre-natal smoke exposure and socioeconomic status (full dataset IG: 2.78%, p = 0.001; female IG: 7.27%, p = 0.004)). Sex-stratified analyses yielded divergent results for females and males, indicating the presence of sex-specific effects.

CONCLUSIONS

Our study identified novel interaction effects significantly, and suggestively, associated with BDR in African American children with asthma. Notably, we found that all of the interactions identified by ViSEN were "pure" interaction effects, in that they were not the result of strong main effects on BDR, highlighting the complexity of the network of biological and environmental factors impacting this phenotype. Several associations uncovered by ViSEN would not have been detected using regression-based methods, thus emphasizing the importance of employing statistical methods optimized to detect both additive and non-additive interaction effects when studying complex phenotypes such as BDR. The information gained in this study increases our understanding and appreciation of the complex nature of the interactions between environmental and health-related factors that influence BDR and will be invaluable to biomedical researchers designing future studies.

Sustaining tuberculosis preventive therapy scale-up through direct supportive supervision

Background

Tuberculosis preventive therapy (TPT) is recommended for tuberculosis (TB) prevention among people living with HIV (PLHIV) and other high-risk groups. The Nigerian Military HIV Program embarked on TPT-specific 'direct supportive supervision' (DSS) in May 2018 to increase TPT initiation and completion rates.

Methods

Interventional approaches included site visits to conduct root cause analysis, didactic teaching approach on the concepts of quality improvement and mentorship to address barriers. The DSS introduced TPT monitoring tools, sticker reminders on clients' folders, and bi-weekly data collection and review for decision making.

Results

TPT initiation increased from a monthly pre-intervention median of 323 clients to monthly medians of 2611 during the 'surge' and 1212 clients during the 'sustained' phases. Due to an isoniazid stock-out, a 'dip phase', with a median of 559 clients was recorded. Overall, 10 463 clients were started on TPT in fiscal year (FY) 2018 and 12 596 in FY2019, with an overall initiation rate of 79%. Completion rates were respectively 73% and 70% for FY2018 and FY2019.

Conclusion

With the implementation of a tailored DSS, programmatic barriers to TPT were easily identified and quickly addressed to increase initiation and completion rates.

AB0074 KRÜPPEL-LIKE FACTOR 10 IS A IMPORTANT MODULATORY FACTOR OF CHONDROCYTE HYPERTROPHY IN DEVELOPING SKELETON

Background:

To investigate the functional role of KLF10 as a modulator of chondrocyte hypertrophy in developmental skeleton, the developmental characteristics in the long bone of KLF10 knockout mice and characteristics of MSCs from KLF10 KO mice were investigated regarding chondrogenesis and osteogenesis. Delayed long bone growth and delayed formation of primary ossification center were observed in an early embryonic stage in KLF10 KO mouse along with very low Ihh expression in epiphyseal plate. While the chondrogenic potential of mMSCs appeared normal or slight decrerased in KLF10 KO mice, osteogenesis and hypertrophy were extensively suppressed. KLF10 was found to be a mediator of chondrocyte hypertrophy in developing skeleton. Suppression of KLF10 may be considered as a new strategy for preventing hypertrophy in cartilage regeneration using MSCs.

Objectives:

Investigated the functional role of KLF10 to present new insights into the transcriptional network regulating skeletal development and provide a novel strategy for preventing aberrant hypertrophic differentiation in cartilage regeneration strategies using MSCs.

Methods:

Generation of KLF10 KO mice and genotyping / Skeletal preparations, embryo heights, and mineralized bone length measurements / Histological and Fluorescent Immunohistochemical Analysis / ALP staining and activity / Alizarin red staining / Von Kossa staining and calcium salts quantification / Isolation and Establishment of Mouse Clonal MSC Lines / Chondrogenic pellet culture and differentiation of mMSCs / DNA Quantification and GAG Contents Analysis / Rq-PCR Analysis / Statistics

Results:

The overall results showed that mMSCs from KLF10 KO mice have significantly decreased osteogenic potential with very low Ihh expression while an increase in chondrogenic potential was not significant. In addition to Ihh promotor demonstrated in our previous study, KLF10 can activate Runx2 expression through its proximal-promoter region. Thus, KLF10 may indirectly stimulate Ihh expression upstream of Runx2 or directly bind to Ihh promoter and activate Ihh expression. As shown in this and out previous study, KLF10 also enhances Wnt/β-catenin signalling in MSCs. KLF10 modulates β-catenin sub-cellular localization and enhances Wnt signalling in osteoblasts.

Conclusion:

In conclusion, primary ossification in KLF10 KO mice was critically delayed during early endochondral bone development. KLF10 KO inhibited hypertrophy via reduced Ihh expression in developing skeleton. TGF-β-induced hypertrophy was inhibited during chondrogenesis of KLF10 KO mMSCs. Our findings present new insights into the transcriptional-network system of skeletal development and provide a novel strategy for suppressing hypertrophy in cartilage tissue engineering.

Figure.

Acknowledgments:

This research was supported by the National Research Foundation of Korea (NRF-2019R1H1A2039685 and 2019R1I1A1A01043778).

Disclosure of Interests:

None declared