Respiratory Syncytial Virus Infection in Homeless Populations, Washington, USA

Homelessness has not previously been identified as a risk factor for respiratory syncytial virus (RSV) infection. We conducted an observational study at an urban safety-net hospital in Washington, USA, during 2012–2017. Hospitalized adults with RSV were more likely to be homeless, and several clinical outcome measures were worse with RSV than with influenza.

Measuring early childhood development in multiple contexts: the internal factor structure and reliability of the early Human Capability Index in seven low and middle income countries

BACKGROUND

The fourth year of the Sustainable Development Agenda era calls for countries to continue to invest not only in interventions and policies that will promote global equity and sustainability, but also in the monitoring systems required to track progress against these targets. A more pragmatic solution to measuring children's early development in low and middle income countries in particular, is required. This study explores the psychometric properties of the early Human Capability Index (eHCI), a population measure of holistic development for children aged 3-5 years, designed with the vision of being flexible and feasible for use in low resource and capacity settings.

METHODS

Utilizing data from seven low and middle income countries: Brazil (n = 1810), China (n = 11,421), Kiribati (n = 8339), Lao People's Democratic Republic (n = 7493), Samoa (n = 12,191), Tonga (n = 6214), and Tuvalu (n = 549), analyses explored the internal factor structure and reliability of scores produced by the tool within each country.

RESULTS

Confirmatory factor analyses and internal consistency coefficients demonstrated that after local adaptation, translation, and different implementation methods across countries, the eHCI maintained the same factor structure of nine theoretically-based developmental domains: Physical Health, Verbal Communication, Cultural Knowledge, Social and Emotional Skills, Perseverance, Approaches to Learning, Numeracy, Reading, and Writing.

CONCLUSIONS

Findings support the aims of the eHCI in being adaptable and applicable for use within a range of low and middle income countries to facilitate measurement and monitoring of children's early development, as is required for the tracking of progress towards the Sustainable Development Agenda.

Caesarean section and risk of type 1 diabetes: whole-of-population study

AIM

A hypothesized mechanism for increased type 1 diabetes risk among caesarean births is lack of exposure to the vaginal microbiota. Children born by prelabour caesarean are not exposed to the vaginal microbiota, whereas caesarean births during labour (intrapartum) may be exposed. The aim of this study was to estimate type 1 diabetes risk among children born by caesarean compared with normal vaginal delivery.

METHODS

This whole-of-population study linked routinely collected, de-identified administrative data from the South Australian Early Childhood Data Project for all births from 1999 to 2013. Type 1 diabetes cases were identified using inpatient hospitalizations from 2001 to 2014 (ICD-10-AM codes E10-E109). Type 1 diabetes risk for caesarean was assessed by Cox regression using two models: (i) caesarean vs. vaginal and (ii) prelabour or intrapartum caesarean vs. vaginal. Analyses were adjusted for confounding and multiple imputation was used to address missing data.

RESULTS

A total of 286 058 children born between 1999 and 2013 contributed to 2 200 252 person-years, of which 557 had type 1 diabetes. Of all births, 90 546 (31.7%) were caesarean, and of these 53.1% were prelabour and 46.9% intrapartum caesarean. Compared with vaginal delivery, the adjusted hazard ratio for type 1 diabetes was 1.05 [95% confidence interval (CI) 0.86-1.28) for caesarean, 1.02 (95% CI 0.79-1.32) for prelabour caesarean and 1.08 (95% CI 0.82-1.41) for intrapartum caesarean.

CONCLUSION

There may be a small increased type 1 diabetes risk following caesarean, but confidence intervals included the null. The lower estimate for prelabour compared with intrapartum caesarean, and the potential for unmeasured confounding suggest that neonatal vaginal microbiota might not be involved in type 1 diabetes.

Role of maternal age at birth in child development among Indigenous and non-Indigenous Australian children in their first school year: a population-based cohort study

BACKGROUND

Indigenous Australian children are twice as likely to score poorly on developmental outcomes at age 5 years than their non-Indigenous peers. Indigenous children are also more likely to be born to younger mothers. We aimed to quantify the relationship between maternal age at childbirth and early childhood development outcomes in Indigenous and non-Indigenous children.

METHODS

In this population-based, retrospective cohort study, we used data from the Australian Early Development Census (AEDC) that were probabilistically linked by the New South Wales (NSW) Centre for Health Record Linkage to several NSW administrative datasets, including the Perinatal Data Collection, the Register of Births, Deaths and Marriages (for birth registrations), the Admitted Patient Data Collection, and public school enrolment records, as part of the Seeding Success study. The resulting data resource comprises a cohort of 166 278 children born in NSW whose first year of school was reported in a 2009 or 2012 AEDC record (which were the years of AEDC data available at the time of data linkage). The primary outcome was the aggregate outcome of developmental vulnerability (scores in the bottom decile, according to the 2009 benchmark, on one or more of the five AEDC domains, which include physical, social, emotional, language and cognitive, and communication development). This outcome was measured in singleton children without special needs recorded on the AEDC, in those with available developmental data. As a secondary outcome analysis, we also repeated the main analyses on the outcome of developmental vulnerability on the individual domains. We estimated the absolute risk of developmental vulnerability by maternal age in Indigenous and non-Indigenous populations, and we also estimated the risk difference and relative risk between Indigenous and non-Indigenous children by use of modified Poisson regression.

FINDINGS

Of 166 278 children in the cohort, 107 666 (64·8%) children were enrolled in a public school in NSW in 2009 or 2012, of whom 7994 (7·4%) children were Indigenous (ie, they, or either parent, were recorded as Aboriginal or Torres Strait Islander on one or more birth records) and 99 672 (92·6%) children were not Indigenous. After exclusions, the final study population included 99 530 children (7206 [7·2%] Indigenous and 92 324 [92·8%] non-Indigenous). Of those for whom developmental outcome data were available, 2581 (35·9%) of 7180 Indigenous children and 18 071 (19·7%) of 91 835 non-Indigenous children were developmentally vulnerable on one domain or more. The risk of developmental vulnerability decreased with maternal ages between 15 and 39 years, but the decrease in risk with maternal age was significantly steeper in non-Indigenous than Indigenous children.

INTERPRETATION

Developmental vulnerability is most common in Indigenous and non-Indigenous children born to young mothers; however, Indigenous children have an increased risk of this outcome across most of the maternal age range. Policies that improve the socioeconomic circumstances of Indigenous children and families could promote better developmental outcomes among Indigenous children. Culturally appropriate support for Indigenous children, including those born to young mothers and disadvantaged families, could also reduce early childhood developmental inequalities.

FUNDING

The Australian National Health and Medical Research Council, Manitoba Centre for Health Policy.

Outcome Study of the Pipeline Embolization Device with Shield Technology in Unruptured Aneurysms (PEDSU)

BACKGROUND AND PURPOSE

The recently introduced Pipeline Flex Embolization Device with Shield Technology (Pipeline Shield) is the third generation of Pipeline flow-diverter devices. It has a new stent-surface modification, which reduces thrombogenicity. We aimed to evaluate clinical and radiographic (safety and efficacy) outcomes of the Pipeline Shield.

MATERIALS AND METHODS

The 30-day and 1-year mortality and morbidity rates and the 6- and 18-month radiographic aneurysm occlusion outcomes for procedures performed between March 2016 and January 2018 were analyzed. 3D-TOF-MRA was used for follow-up.

RESULTS

Forty-four attempted Pipeline Shield procedures were performed for 41 patients with 44 target aneurysms (total of 52 aneurysms treated). A total of 88.5% of devices were inserted in the anterior circulation, and 11.5%, in the posterior circulation; 49/52 (94.2%) aneurysms were saccular; and 1/52 (1.9%) was fusiform. One (1.9%) aneurysm was an iatrogenic pseudoaneurysm, and 1 (1.9%) was a dissecting aneurysm. Seventy-one percent (35/49) of the saccular aneurysms were wide-neck (neck, >4 mm), 34.6% (18/52) were large (≥10 mm), and 3.8% (2/52) were giant (≥25 mm). The mean aneurysm sac maximal diameter was 9.0 mm, and the mean neck width was 5.0 mm. The cumulative mortality and morbidity rates were 2.3% and 6.8% at 1 year, respectively. The adequate occlusion rate was 78.8% at 6 months and 90.3% at 18 months.

CONCLUSIONS

In this pragmatic and non-industry-sponsored study, the occlusion rates and safety outcomes were similar to those seen in previously published studies with flow-diverter devices and earlier generation Pipeline Embolization Devices.

Busting the myth of the ‘greedy elderly’

Background

The politics of ageing are both personal, involving judgements about specific family members as well as broad social groups. This chapter evaluates the argument that governments implement packages of policies that are favorable to the elderly, but that are societally sub-optimal, because of political pressure from the elderly. It begins by laying out the core premises of the “greedy geezer” narrative: because pension transfers, high-cost medical care, and policies that protect transferable assets like housing are highly salient to the elderly and their advocates, intense preferences for these types of policies communicated to politicians and policy-makers will eventually crowd out other, more societally-optimal policies.

Methods

Looking at public opinion data on ageing, intergenerational transfers, and the welfare state this chapter wants to understand both how different publics understand and frame ageing and health as well as what priorities these publics identify, and why?

Results

The elderly and their organized representatives (e.g. pensioner parties, pensioner unions, and advocacy groups) in some contexts do push for policies that are “greedy” in the sense of being beneficial for the elderly or their own children, but not for society as a whole. However, this phenomenon is far from universal: It is especially pronounced in the US and the UK, but much less so in other national contexts. Moreover, the policy packages adopted by national governments are generally motivated by concerns other than appeasing the elderly.

Conclusions

Characterizing the elderly as uniformly “greedy” obscures the fact that inequality among the elderly means that many need more support than they actually receive.

Which time investments in the first 5 years of life matter most for children’s language and behavioural outcomes at school entry?

Background

The ways children spend their time is one of the most valuable inputs for healthy child development. It is unknown which time investment yields the greatest return for children’s language and behavioural outcomes at school entry.

Methods

We used data from the first three waves (2004, 2006, 2008) of the Longitudinal Study of Australian Children (n = 4253). At every wave, parents completed 24-h time-use diaries on one randomly selected week and one weekend day. The amount of time children spent on 11 activities at ages 0–1, 2–3 and 4–5 years was analysed. Receptive vocabulary was assessed using the Peabody Picture Vocabulary Test, and externalizing behaviours were measured by the Strengths and Difficulties Questionnaire, completed by parents and teachers at 4–5 years. To identify which time investment in the first 5 years of life mattered most for children’s outcomes, a new production function was developed. This production function was estimated using a log–log linear regression model.

Results

Relative to other time investments, time spent on educational activities at 2–3 years of age was the most important time investment for receptive vocabulary and behavioural outcomes at school entry. After adjusting for confounding, every 1 h invested in educational activities at 2–3 years was associated with a 0.95% [95% CI (confidence interval): 0.62, 1.28] increase in receptive vocabulary, and a −5.72% (95% CI: −7.71, −3.73) and −9.23% (95% CI: −12.26, −6.20) reduction in parent- and teacher-reported externalizing problem behaviours. Time invested in play was also important to both receptive vocabulary and behaviour. One hour invested in play at 2–3 and 4–5 years was associated with a 0.68% (95% CI: 0.38, 0.98) and 0.71% (95% CI: 0.39, 1.03) increase in children’s receptive vocabulary at school entry. In addition, time invested in play at 2–3 and 4–5 years was associated with reduced problem behaviours at school entry. In contrast, screen time at all ages was associated with poorer parent- and teacher-reported externalizing problem behaviours.

Conclusions

These results suggest that time invested in educational activities at 2–3 years of age yield the greatest return for children’s receptive vocabulary and behaviour at school entry.

Harmonizing Clinical Sequencing and Interpretation for the eMERGE III Network

The advancement of precision medicine requires new methods to coordinate and deliver genetic data from heterogeneous sources to physicians and patients. The eMERGE III Network enrolled >25,000 participants from biobank and prospective cohorts of predominantly healthy individuals for clinical genetic testing to determine clinically actionable findings. The network developed protocols linking together the 11 participant collection sites and 2 clinical genetic testing laboratories. DNA capture panels targeting 109 genes were used for testing of DNA and sample collection, data generation, interpretation, reporting, delivery, and storage were each harmonized. A compliant and secure network enabled ongoing review and reconciliation of clinical interpretations, while maintaining communication and data sharing between clinicians and investigators. A total of 202 individuals had positive diagnostic findings relevant to the indication for testing and 1,294 had additional/secondary findings of medical significance deemed to be returnable, establishing data return rates for other testing endeavors. This study accomplished integration of structured genomic results into multiple electronic health record (EHR) systems, setting the stage for clinical decision support to enable genomic medicine. Further, the established processes enable different sequencing sites to harmonize technical and interpretive aspects of sequencing tests, a critical achievement toward global standardization of genomic testing. The eMERGE protocols and tools are available for widespread dissemination.

Improved calculation of warming-equivalent emissions for short-lived climate pollutants

Anthropogenic global warming at a given time is largely determined by the cumulative total emissions (or stock) of long-lived climate pollutants (LLCPs), predominantly carbon dioxide (CO₂), and the emission rates (or flow) of short-lived climate pollutants (SLCPs) immediately prior to that time. Under the United Nations Framework Convention on Climate Change (UNFCCC), reporting of greenhouse gas emissions has been standardised in terms of CO₂-equivalent (CO₂-e) emissions using Global Warming Potentials (GWP) over 100-years, but the conventional usage of GWP does not adequately capture the different behaviours of LLCPs and SLCPs, or their impact on global mean surface temperature. An alternative usage of GWP, denoted GWP*, overcomes this problem by equating an increase in the emission rate of an SLCP with a one-off "pulse" emission of CO₂. We show that this approach, while an improvement on the conventional usage, slightly underestimates the impact of recent increases in SLCP emissions on current rates of warming because the climate does not respond instantaneously to radiative forcing. We resolve this with a modification of the GWP* definition, which incorporates a term for each of the short-timescale and long-timescale climate responses to changes in radiative forcing. The amended version allows "CO₂-warming-equivalent" (CO₂-we) emissions to be calculated directly from reported emissions. Thus SLCPs can be incorporated directly into carbon budgets consistent with long-term temperature goals, because every unit of CO₂-we emitted generates approximately the same amount of warming, whether it is emitted as a SLCP or a LLCP. This is not the case for conventionally derived CO₂-e.

From smartphone to bed-side: exploring the use of social media to disseminate recommendations from the National Tracheostomy Safety Project to front-line clinical staff

Traditional methods used to disseminate educational resources to front-line healthcare staff have several limitations. Social media may increase the visibility of these resources among targeted groups and communities. Our project aimed to disseminate key clinical messages from the National Tracheostomy Safety Project to those caring for patients with tracheostomies or laryngectomies. We commissioned an external media company to design educational material and devise a marketing strategy. We developed videos to communicate recommendations from the safety project and used Facebook, Twitter, YouTube and LinkedIn to deliver these to our target users. We recorded 629,270 impressions over a paid 12-week campaign. Our YouTube channel registered more than a five-fold increase in views and watch time during the campaign as compared with the previous year. Around two-thirds of views across all platforms were from peer-to-peer sharing. We spent £4140 on social media advertising, with each view and click costing £0.02 and £0.67, respectively. This intelligence-led approach using social media is an effective and efficient method to disseminate knowledge on the principles of safe tracheostomy care to front-line clinical staff. Similar strategies may be effective for other patient safety topics, especially when targeting groups that do not use medical journals or other traditional means of dissemination.

An internet-delivered cognitive behavioural therapy pain management programme for spinal cord injury pain: A randomized controlled trial

BACKGROUND

Chronic pain is common after spinal cord injury (SCI) and dedicated SCI cognitive behavioural therapy pain management programmes (CBT-PMPs) have a growing evidence base to support their uptake clinically. The development of internet-delivered treatment options may overcome barriers to the access and uptake of centre-based programmes. This study examines such an approach on quality of lie (QoL), pain, mood and sleep.

METHODS

Adults with SCI pain (>3 months) were recruited and randomly assigned to the intervention or control group. The intervention comprised a six module CBT-PMP delivered once weekly. A blinded assessor determined changes in self-reported outcome measures post-intervention and at 3 months. Linear mixed models and effect sizes based on changes between groups were reported. Significance was set p < 0.05.

RESULTS

The recruitment rate was 32% (intervention n = 35, control n = 34), and the drop-out rate at 3 months was 26%. On average, participants accessed three (SD 2.1) of six modules. While no difference in QoL was reported, a significant group*time interaction was found for NRS of current pain (χ²  = 8.22, p = 0.016), worst pain (χ²  = 11.20, p = 0.004), and Brief Pain Inventory (interference) (χ²  = 6.924, p = 0.031). Moderate to large effect sizes favouring the intervention were demonstrated at each time point for the pain metrics (Cohen's d: 0.38-0.84). At 3-month follow-up, 48% of the intervention group rated themselves improved or very much improved (p < 0.05).

CONCLUSIONS

This study demonstrates the potential of an internet-delivered SCI specific CBT-PMP in reporting significant statistical and clinical benefit in pain intensity and interference. Strategies to improve engagement are needed.

The Effectiveness of an App-Based Nurse-Moderated Program for New Mothers With Depression and Parenting Problems (eMums Plus): Pragmatic Randomized Controlled Trial

Background

Postnatal depression and caregiving difficulties adversely affect mothers, infants, and later childhood development. In many countries, resources to help mothers and infants are limited. Online group–based nurse-led interventions have the potential to help address this problem by providing large numbers of mothers with access to professional and peer support during the postnatal period.

Objective

This study tested the effectiveness of a 4-month online group–based nurse-led intervention delivered when infants were aged 2 to 6 months as compared with standard care outcomes.

Methods

The study was a block randomized control trial. Mothers were recruited at the time they were contacted for the postnatal health check offered to all mothers in South Australia. Those who agreed to participate were randomly assigned to the intervention or standard care. The overall response rate was 63.3% (133/210). Primary outcomes were the level of maternal depressive symptoms assessed with the Edinburgh Postnatal Depression Scale (EPDS) and quality of maternal caregiving assessed using the Parenting Stress Index (PSI; competence and attachment subscales), the Parenting Sense of Competence Scale (PSCS), and the Nursing Child Assessment Satellite Training Scale. Assessments were completed at baseline (mean child age 4.9 weeks [SD 1.4]) and again when infants were aged 8 and 12 months.

Results

Outcomes were evaluated using linear generalized estimating equations adjusting for postrandomization group differences in demographic characteristics and the outcome score at baseline. There were no significant differences in the intervention and standard care groups in scores on the PSI competence subscale (P=.69) nor in the PSCS (P=.11). Although the group by time interaction suggested there were differences over time between the EPDS and PSI attachment subscale scores in the intervention and standard care groups (P=.001 and P=.04, respectively), these arose largely because the intervention group had stable scores over time whereas the standard care group showed some improvements between baseline and 12 months. Mothers engaged well with the intervention with at least 60% (43/72) of mothers logging-in once per week during the first 11 weeks of the intervention. The majority of mothers also rated the intervention as helpful and user-friendly.

Conclusions

Mothers reported that the intervention was helpful, and the app was described as easy to use. As such, it appears that support for mothers during the postnatal period, provided using mobile phone technology, has the potential to be an important addition to existing services. Possible explanations for the lack of differences in outcomes for the 2 groups in this study are the failure of many mothers to use key components of the intervention and residual differences between the intervention and standard care groups post randomization.

Trial Registration

Australian New Zealand Clinical Trials Registry ACTRN12616001732471; http://www.ANZCTR.org.au/ACTRN12616001732471.aspx (archived on WebCite as http://www.webcitation.org/77zo30GDw)

Anesthetic Management of Jael Syndrome With Impacted Blade in Close Proximity to the Internal Carotid Artery: A Case Report

A patient presented with a stab injury caused by a knife penetrating the orbital floor and maxillary sinus along the skull base with the tip situated adjacent to the left internal carotid artery. A flexible fiberoptic bronchoscope loaded with an endotracheal tube was initially positioned superior to the vocal cords and advanced into the trachea immediately following induction. The blade was removed after occluding endovascular balloons were positioned distal and proximal to the potential internal carotid artery injury site. Therefore, contralateral nasal fiberoptic intubation might be safely performed in patients with unilateral maxillofacial trauma, no intracranial penetration, and minimal bleeding.

Ivermectin treatment failure on four Irish dairy farms

We report on the use of the faecal egg count reduction test to evaluate the performance of ivermectin in treating gastrointestinal nematode infections in first grazing season (FGS) calves on four dairy farms in Co. Kilkenny, Ireland. On each farm, FGS calves were injected subcutaneously with ivermectin in accordance with their live weight (day 0). Calves were individually faecal sampled on both day 0 and day 14. Faecal egg counts were determined using the Mini-FLOTAC technique. Composite faecal cultures for each farm were performed on each sampling occasion. The faecal egg count reductions (mode) ranged from 17.3–80.2% with the lower 95% confidence limit ranging from 3.1–72.3% on the four farms, respectively. Ivermectin-resistant nematodes were detected on all farms, with evidence of Ostertagia resistance on one farm. This study highlights the urgent need for Irish producers to reappraise their parasite control practices.

Availability of disaggregated greenhouse gas emissions from beef cattle production: a systematic review

Agriculture is a significant source of anthropogenic greenhouse gas (GHG) emissions, and beef cattle are particularly emissions intensive. GHG emissions are typically expressed as a carbon dioxide equivalent (CO₂e) 'carbon footprint' per unit output. The 100-year Global Warming Potential (GWP₁₀₀) is the most commonly used CO₂e metric, but others have also been proposed, and there is no universal reason to prefer GWP₁₀₀ over alternative metrics. The weightings assigned to non-CO₂ GHGs can differ significantly depending on the metric used, and relying upon a single metric can obscure important differences in the climate impacts of different GHGs. This loss of detail is especially relevant to beef production systems, as the majority of GHG emissions (as conventionally reported) are in the form of methane (CH₄) and nitrous oxide (N₂O), rather than CO₂. This paper presents a systematic literature review of harmonised cradle to farm-gate beef carbon footprints from bottom-up studies on individual or representative systems, collecting the emissions data for each separate GHG, rather than a single CO₂e value. Disaggregated GHG emissions could not be obtained for the majority of studies, highlighting the loss of information resulting from the standard reporting of total GWP₁₀₀ CO₂e alone. Where individual GHG compositions were available, significant variation was found for all gases. A comparison of grass fed and non-grass fed beef production systems was used to illustrate dynamics that are not sufficiently captured through a single CO₂e footprint. Few clear trends emerged between the two dietary groups, but there was a non-significant indication that under GWP₁₀₀ non-grass fed systems generally appear more emissions efficient, but under an alternative metric, the 100-year global temperature potential (GTP₁₀₀), grass-fed beef had lower footprints. Despite recent focus on agricultural emissions, this review concludes there are insufficient data available to fully address important questions regarding the climate impacts of agricultural production, and calls for researchers to include separate GHG emissions in addition to aggregated CO₂e footprints.

Temporal effects of maternal psychological distress on child mental health problems at ages 3, 5, 7 and 11: analysis from the UK Millennium Cohort Study

BACKGROUND

Psychological distress is common among women of childbearing age, and limited longitudinal research suggests prolonged exposure to maternal distress is linked to child mental health problems. Estimating effects of maternal distress over time is difficult due to potential influences of child mental health problems on maternal distress and time-varying confounding by family circumstances.

METHODS

We analysed the UK Millennium Cohort Study, a nationally representative sample with data collected throughout childhood. Adopting a marginal structural modelling framework, we investigated effects of exposure to medium/high levels of maternal psychological distress (Kessler-6 score 8+) on child mental health problems (Strengths and Difficulties Questionnaire borderline/abnormal behaviour cut-off) using maternal and child mental health data at 3, 5, 7 and 11 years, accounting for the influence of child mental health on subsequent maternal distress, and baseline and time-varying confounding.

RESULTS

Prior and concurrent exposures to maternal distress were associated with higher levels of child mental health problems at ages 3, 5, 7 and 11 years. For example, elevated risks of child mental health problems at 11 years were associated with exposure to maternal distress from 3 years [risk ratio (RR) 1.27 (95% confidence interval (CI) 1.08-1.49)] to 11 years [RR 2.15 (95% CI 1.89-2.45)]. Prolonged exposure to maternal distress at ages 3, 5, 7 and 11 resulted in an almost fivefold increased risk of child mental health problems.

CONCLUSIONS

Prior, concurrent and, particularly, prolonged exposure to maternal distress raises risks for child mental health problems. Greater support for mothers experiencing distress is likely to benefit the mental health of their children.

Climate impacts of cultured meat and beef cattle

Improved greenhouse gas (GHG) emission efficiency of production has been proposed as one of the biggest potential advantages of cultured meat over conventional livestock production systems. Comparisons with beef are typically highlighted, as it is a highly emissions intensive food product. In this study we present a more rigorous comparison of the potential climate impacts of cultured meat and cattle production than has previously been made. Warming impacts are evaluated using a simple climate model that simulates the different behaviours of carbon dioxide (CO₂), methane (CH₄) and nitrous oxide (N₂O), rather than relying on carbon dioxide equivalent (CO₂e) metrics. We compare the temperature impact of beef cattle and cultured meat production at all times to 1000 years in the future, using four synthetic meat GHG footprints currently available in the literature and three different beef production systems studied in an earlier climate modelling paper. Cattle systems are associated with the production of all three GHGs above, including significant emissions of CH₄, while cultured meat emissions are almost entirely CO₂ from energy generation. Under continuous high global consumption, cultured meat results in less warming than cattle initially, but this gap narrows in the long term and in some cases cattle production causes far less warming, as CH₄ emissions do not accumulate, unlike CO₂. We then model a decline in meat consumption to more sustainable levels following high consumption, and show that although cattle systems generally result in greater peak warming than cultured meat, the warming effect declines and stabilises under the new emission rates of cattle systems, while the CO₂ based warming from cultured meat persists and accumulates even under reduced consumption, again overtaking cattle production in some scenarios. We conclude that cultured meat is not prima facie climatically superior to cattle production; its relative impact instead depends on the availability of decarbonised energy generation and the specific production systems that are realised.

Health related quality of life (HRQoL) among Aboriginal South Australians: a perspective using survey-based health utility estimates

Background

Australian health surveys occasionally include health utility measures in describing health related quality of life (HRQoL) across the general population. However, the HRQoL of specific population groups, such as Aboriginal and Torres Strait Islander (respectfully referred to as Aboriginal), are poorly understood. Our analysis describes HRQoL utility among Aboriginal South Australians by examining the characteristics of respondents completing HRQoL questioning, the relationship between HRQoL and respondent characteristics, then considers reported HRQoL utility in the wider population context.

Methods

Population weighted and self-reported HRQoL was measured using SF-6D, as derived from the SF-12 version 2, in the South Australian Aboriginal Health Survey’s face to face interviews with 399 respondents aged 15 or more in 2010/11.

Results

Mean HRQoL utility was 0.77 (95% CIs 0.76–0.79) with marked variations by gender (females 0.03, 95% CIs 0.00–0.06 lower than males), age (with ages 55 or more 0.08, 95% CIs 0.02–0.14 lower than 15–35 years) and number of chronic health conditions (3 or more conditions 0.14, 95% CIs 0.09–0.19 lower than those with 0 conditions). A pattern of response to HRQoL questions was also evident. Response was less likely among respondents speaking Aboriginal languages at home, living in non-urban settings, and experiencing multiple chronic health conditions.

Conclusions

The SF-6D provides useful information on the HRQoL of Aboriginal South Australians. However, non-completion was pronounced among respondents speaking traditional languages and experiencing more chronic health conditions. Improved participation of vulnerable and health compromised respondents through culturally safe and relevant self-reporting HRQoL utility instruments is needed.

Abstract WP550: Pathophysiology of Acute, Subacute and Chronic Lesions in Stroke: A Radiological-Pathological Analysis

Introduction: The imaging characteristics of ischemic lesions seen on MRI aid in the interpretation of the lesion pathogenesis. Early ischemic lesions are seen on diffusion weighted imaging (DWI) with low apparent diffusion coefficient (ADC), later evolve on T2-FLAIR, develop elevated ADC, then disappear on DWI. Chronic white matter lesions (WML) seen on T2-FLAIR but not DWI may or may not be of ischemic origin. Here we present an MRI targeted pathology approach to better describe in-vivo MRI based on cellular changes.

Methods: The brain of a patient was obtained for pathological evaluation early after stroke recurrence. As part of clinical care and study procedures, 3T MRI was obtained at baseline (within 2-hours), multiple follow-up visits, and during second admission. Radiological-pathological methods previously validated in trauma was employed. Whole brain 7T MRI was performed after formalin fixation, and MRI targeted pathology was performed, co-localizing three lesions of different ages based on history and presumed imaging characteristics; i) acute, ii) subacute, and iii) chronic vs WML. Homologous contralateral tissue was used as control.

Results: Lesions seen in-vivo were observed in post mortem MRI, and reconfirmed in histology. An example of in-vivo and post-mortem MRI, along with corresponding tissue sections and H&E are shown in figure. Qualitative delineation of the boundaries of the chronic lesion on H&E was challenging. A large number of small vessels with enlarged perivascular spaces dominated. The subacute lesion, was characterized by loss of white mater, infiltration of macrophages, and astrocytosis. The acute lesion had a text-book appearance.

Conclusion: Dramatic differences are seen in the volume fraction of free water, which likely a major contributor to the appearance on DWI/ADC and T2 FLAIR. Work continues with immunohistochemistry to better delineate the boundaries of the lesions and cellular morphology relevant to in-vivo MRI.