Exploring the ageing methylome in the model insect, Nasonia vitripennis

BACKGROUND

The ageing process is a multifaceted phenomenon marked by the gradual deterioration of cellular and organismal functions, accompanied by an elevated susceptibility to diseases. The intricate interplay between genetic and environmental factors complicates research, particularly in complex mammalian models. In this context, simple invertebrate organisms have been pivotal, but the current models lack detectable DNA methylation limiting the exploration of this critical epigenetic ageing mechanism. This study introduces Nasonia vitripennis, the jewel wasp, as an innovative invertebrate model for investigating the epigenetics of ageing. Leveraging its advantages as a model organism and possessing a functional DNA methylation system, Nasonia emerges as a valuable addition to ageing research.

RESULTS

Whole-genome bisulfite sequencing unveiled dynamic alterations in DNA methylation, with differentially methylated CpGs between distinct time points in both male and female wasps. These changes were associated with numerous genes, enriching for functions related to telomere maintenance, histone methylation, and mRNA catabolic processes. Additionally, other CpGs were found to be variably methylated at each timepoint. Sex-specific effects on epigenetic entropy were observed, indicating differential patterns in the loss of epigenetic stability over time. Constructing an epigenetic clock containing 19 CpGs revealed a robust correlation between epigenetic age and chronological age.

CONCLUSIONS

Nasonia vitripennis emerges as a promising model for investigating the epigenetics of ageing, shedding light on the intricate dynamics of DNA methylation and their implications for age-related processes. This research not only expands the repertoire of ageing models but also opens avenues for deeper exploration of epigenetic mechanisms in the context of ageing.

Mapping healthy planning frameworks

AIMS

The aim of this research was to map available healthy planning frameworks to discover the range, composition, design, and implementation of healthy planning frameworks.

METHODS

A systematic scoping review with date, location, and usability limitations was augmented by a grey literature search. Data were extracted on key details, design, outcomes considered, and implementation features of the final 61 frameworks.

RESULTS

Data extracted indicated that most frameworks tend to focus on one element of the built environment, with active mobility, active environments, and transport being the most prevalent ones (34%). Most frameworks (40) stated their intended outcomes on health in general terms, rather than targeting specific health outcomes. Very few frameworks (12%) were aimed at the public, and only 11% of frameworks included an evaluation.

CONCLUSIONS

While there are a wide variety and number of frameworks available in the field of healthy urban planning, they are generally siloed, focusing on highly specific individual urban determinants, and rarely consider health outcomes in detail. There is significantly less provision available for citizen and community use. Frameworks tend to offer limited updating mechanisms and very rarely include ongoing evaluation processes, making their success difficult to assess.

Exploring the impact of athletic identity on gender role conflict and athlete injury fear avoidance in male English professional academy football players

Men's academy football can encourage a commitment to the athletic role and masculine norms. When injured, the ability to fulfil an athletic masculine identity is threatened and athletes may experience injury fear-avoidance behaviours as part of a negative injury appraisal. The aim of the study was to explore whether higher athletic identity (AI) was associated with higher gender role conflict and injury-related fear-avoidance. Seventy-two male English academy footballers completed an Athletic Identity Measurement Scale (AIMS), Gender Role Conflict Scale (GRCS), and Athlete Fear Avoidance Questionnaire (AFAQ) based on self-reported historical injuries. Correlational analyses were conducted for all variables, and a one-way ANOVA was used to compare high, moderate, and low AI. AIMS was significantly positively correlated with two GRCS subscales: success, power, and competition (SPC) and restricted affectionate behaviour between men (RAM). AIMS exclusivity also positively correlated with SPC and AIMS negative affectivity positively correlated with GRCS total and RAM. Additionally, the current study showed that high and moderate levels of AI had significantly higher levels of total GRCS than those with low AI. No significant results were found for AIMS, GRCS, and AFAQ. Results suggest that players with higher and more exclusive AI may be susceptible to masculine role conflicts, specifically, SPC and RAM, especially when there is a risk to their athletic role. The current study informs sport and health professionals of the need to monitor AI and masculine conformity in academy-level footballers to minimise gender-role conflict and potential maladaptive rehabilitation responses when their identities are threatened.

Early Childhood Exposures to Fluorides and Child Behavioral Development and Executive Function: A Population-Based Longitudinal Study

It is important to both protect the healthy development and maintain the oral health of the child population. The study examined the effect of early childhood exposures to water fluoridation on measures of school-age executive functioning and emotional and behavioral development in a population-based sample. This longitudinal follow-up study used information from Australia's National Child Oral Health Study 2012-14. Children aged 5 to 10 y at baseline were contacted again after 7 to 8 y, before they had turned 18 y of age. Percent lifetime exposed to fluoridated water (%LEFW) from birth to the age 5 y was estimated from residential history and postcode-level fluoride levels in public tap water. Measures of children's emotional and behavioral development were assessed by the Strength and Difficulties Questionnaire (SDQ), and executive functioning was measured by the Behavior Rating Inventory of Executive Function (BRIEF). Multivariable regression models were generated to compare the associations between the exposure and the primary outcomes and controlled for covariates. An equivalence test was also conducted to compare the primary outcomes of those who had 100% LEFW against those with 0% LEFW. Sensitivity analysis was also conducted. A total of 2,682 children completed the SDQ and BRIEF, with mean scores of 7.0 (95% confidence interval, 6.6-7.4) and 45.3 (44.7-45.8), respectively. Those with lower %LEFW tended to have poorer scores of the SDQ and BRIEF. Multivariable regression models reported no association between exposure to fluoridated water and the SDQ and BRIEF scores. Low household income, identifying as Indigenous, and having a neurodevelopmental diagnosis were associated with poorer SDQ/BRIEF scores. An equivalence test confirmed that the SDQ/BRIEF scores among those with 100% LEFW were equivalent to that of those who had 0% LEFW. Exposure to fluoridated water during the first 5 y of life was not associated with altered measures of child emotional and behavioral development and executive functioning.

Assessment of Dietary Intake in Three Cohorts of Advanced Age in Two Countries: Methodology Challenges

OBJECTIVES

Dietary intake information is key to understanding nutrition-related outcomes. Intake changes with age and some older people are at increased risk of malnutrition. Application, difficulties, and advantages of the 24-hour multiple pass recall (24hr-MPR) dietary assessment method in three cohorts of advanced age in the United Kingdom (UK) and New Zealand (NZ) is described.

PARTICIPANTS

The Newcastle 85+ study (UK) recruited a single year birth cohort of people aged 85 years during 2006-7. LiLACS NZ recruited a 10-year birth cohort of Māori (indigenous New Zealanders) aged 80-90 years and a single year birth cohort of non-Māori aged 85 years in 2010.

MEASUREMENTS

Two 24hr-MPR were conducted on non-consecutive days by trained assessors. Pictorial resources and language were adapted for the New Zealand and Māori contexts. Detailed methods are described.

RESULTS

In the Newcastle 85+ study, 805 (93%) participants consented to the 24-MPR, 95% of whom completed two 24hr-MPR; in LiLACS NZ, 218 (82%) consented and 203 (76%) Māori and 353 (90%) non-Māori completed two 24hr-MPR. Mean time to complete each 24hr-MPR was 22 minutes in the Newcastle 85+ study, and 45 minutes for Māori and 39 minutes for non-Māori in LiLACS NZ. Dietary assessment of participants residing in residential care and those requiring proxy respondents were successfully included in both studies. Most participants (83-94%) felt that data captured by the 24hr-MPR reflected their usual dietary intake.

CONCLUSIONS

Dietary assessment using 24hr-MPR was successful in capturing detailed dietary data including information on portion size and time of eating for over 1300 octogenarians in the UK and New Zealand (Māori and non- Māori). The 24hr-MPR is an acceptable method of dietary assessment in this age group.

Social media and use of electronic nicotine delivery systems among school-going adolescents in a rural distressed Appalachian community

•

Social media use to discuss ENDS among youth in distressed areas is understudied.

•

Nearly 1 in 3 and 1 in 8 of youth were ever and current ENDS users, respectively.

•

Nearly 1 in 5 of the youth reported using social media to talk about ENDS.

•

Social media increased current and ever ENDS use by 4 and 3 times, respectively.

•

Social media engagement may lead to ENDS uptake among youth in distressed areas.

Electronic nicotine delivery systems (ENDS) are the most used tobacco products among middle and high schoolers in the United States (U.S.). Familial relations and access play a major role in uptake among adolescents; yet the role of social media in this phenomenon in the context of communities impacted by tobacco-related health disparities is understudied. In Spring 2019, data were collected from adolescents in 8th and 9th grades in a school located in a rural distressed county in Tennessee to assess social media’s role in ENDS uptake. Descriptive and multivariable statistical analyses were performed to delineate factors associated with ENDS use. Of a total of 399 respondents, 12.5 % reported current ENDS use and 22.1 % indicated having ever discussed ENDS on social media. Closed messaging platforms (Snapchat) and video platforms (Facebook/Instagram/You Tube) were the most reported form of social media used (8.31 % and 8.31 % respectively). Social media use was positively associated with both ever ENDS use (odds ratio [OR] = 2.9) and current ENDS use (OR = 3.98). Parental advice against ENDS use was positively associated with ever ENDS use. In conclusion, social media use was positively associated with both ever and current ENDS use, and Snapchat was the most popular platform among this population of students. The results indicate that youth social media engagement may lead to exposure that can influence ENDS uptake. Future studies are needed to further examine these associations among distressed communities.

Effectiveness of an online module: climate-change and sustainability in clinical practice

BACKGROUND

Climate change has significant implications for health, yet healthcare provision itself contributes significant greenhouse gas emission. Medical students need to be prepared to address impacts of the changing environment and fulfil a key role in climate mitigation. Here we evaluate the effectiveness of an online module on climate-change and sustainability in clinical practice designed to achieve learning objectives adapted from previously established sustainable healthcare priority learning outcomes.

METHODS

A multi-media, online module was developed, and 3^rd and 4^th year medical students at Brighton and Sussex Medical School were invited to enrol. Students completed pre- and post-module questionnaires consisting of Likert scale and white space answer questions. Quantitative and qualitative analysis of responses was performed.

RESULTS

Forty students enrolled and 33 students completed the module (83% completion rate). There was a significant increase in reported understanding of key concepts related to climate change and sustainability in clinical practice (p < 0.001), with proportion of students indicating good or excellent understanding increasing from between 2 - 21% students to between 91 - 97% students. The majority (97%) of students completed the module within 90 min. All students reported the module was relevant to their training. Thematic analysis of white space responses found students commonly reported they wanted access to more resources related to health and healthcare sustainability, as well as further guidance on how to make practical steps towards reducing the environmental impact within a clinical setting.

CONCLUSION

This is the first study to evaluate learner outcomes of an online module in the field of sustainable health and healthcare. Our results suggest that completion of the module was associated with significant improvement in self-assessed knowledge of key concepts in climate health and sustainability. We hope this approach is followed elsewhere to prepare healthcare staff for impacts of climate change and to support improving the environmental sustainability of healthcare delivery.

TRIAL REGISTRATION

Study registered with Brighton and Sussex Medical School Research Governance and Ethics Committee (BSMS RGEC). Reference: ER/BSMS3576/8, Date: 4/3/2020.

Challenges and opportunities of remote public involvement and community engagement during a pandemic: refining the MapMe childhood healthy weight intervention

AIMS

Including parents and other stakeholders in the development of interventions to address the sensitive public health issues such as childhood obesity, through public involvement is critical. However, the Covid-19 pandemic has created a challenge for public involvement and engagement activities (PICE). The aim of this paper is to describe the process and challenges of setting up, maintaining, evaluating, and recording impact of three public and stakeholder groups via remote methods in the context of the MapMe2 study during the Covid-19 pandemic. Parental reaction to result letters received as part of the National Child Measurement Programme (NCMP) informing parents of their child's overweight status is often one of hostility or disbelief. As a result, parents often do not act on these letters to address child overweight. The MapMe2 study is working in collaboration with the NCMP and local authorities, building on previous work (MapMe) and aims to support parents of primary school-aged children to recognise and maintain a healthy weight in their child. The existing MapMe Intervention includes an enhanced NCMP child weight result letter, supplemented with Body Image Scales (BIS), and an intervention website with material to support healthy eating, physical activity, and signposting supporting information. The intervention was to be refined and the evaluation informed with PICE input.

METHODS

Covid-19 restrictions meant that planned face-to-face PICE methods had to be altered with all recruitment, all correspondence, and activities taking place remotely. A Parent Involvement Panel (PIP), a child panel, and an expert panel were established. Several adaptations were made to accommodate a new way of involving the public in research.

RESULTS/CONCLUSIONS

Working remotely created many challenges and was a learning experience for all involved. However, an active group was successfully established. Using continuous assessment and evaluation methods, we were able to demonstrate successful involvement and engagement in the refinement of the MapMe2 study. Through the sharing of PICE methods practice, this paper adds to the literature, the value of partnership working.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

Real-world treatment patterns and outcomes in patients initiating lurasidone for the treatment of schizophrenia in Europe

Introduction

Lurasidone is a second-generation antipsychotic shown to have a lower risk of weight gain and a lower incidence of metabolic adverse events compared with some medications in the same class.

Objectives

To describe treatment patterns, clinical outcomes and adverse drug reactions (ADRs) over 12 months following lurasidone initiation in patients with schizophrenia.

Methods

This was a multi-centre observational study involving data collection from patients’ medical records, conducted in seven mental health centres in the United Kingdom (UK) and Switzerland. The study included patients aged ≥18 years who initiated lurasidone after 1 January 2016 for the treatment of schizophrenia. Data were collected from medical records both retrospectively and prospectively using a standardised data collection form. Data collected included patient characteristics, treatment history, lurasidone regimens, clinical outcomes and ADRs.

Results

Forty-eight patients participated in the study. The median (interquartile range [IQR]) age at lurasidone initiation was 33.5 (25.5-50.3) years and 31 (65%) patients were male. The median (range) lurasidone starting dose was 37 mg daily (9.3–148 mg). Thirty-eight (79%) patients continued lurasidone for the entire 12-month follow-up period. Among the 14 (29%) patients with documented relapse, the median (IQR) time to relapse was 3.4 (1.5–7.9) months. Five ADRs were recorded in patient notes judged as related to lurasidone: agitation, nausea, akathisia, somnolence and vomiting (one patient each).

Conclusions

In this real-world study of patients with schizophrenia in the UK and Switzerland, 79% of patients continued lurasidone for at least 12 months, and ADRs were reported rarely in patient notes.

Disclosure

This study was sponsored by CNX Therapeutics Ltd (formerly Sunovion Pharmaceuticals Europe Ltd). AJ is an employee of CNX Therapeutics. MA is an employee of OPEN HEALTH who was contracted by CNX Therapeutics for data analysis and medical writing.

Vaginal Swelling After Intercourse: A Case Report

Introduction: A vulvar hematoma is a hemorrhagic fluid collection in the female external genitalia. The majority occur as an obstetrical complication, especially during labor. Non-obstetrical vulvar hematomas are usually the result of trauma, with coitus being the most common etiology. Case Report: We present the case of a 25-year-old woman with significant vaginal pain and swelling after vigorous sexual intercourse. She exhibited tenderness and swelling of the left labia majora and minora. The differential diagnosis included bleeding, abscess, and deep venous thrombosis. Laboratory studies were normal and computed tomography of the pelvis indicated the swelling was most likely due to blood. The patient was taken to the operating room, and approximately 150 cubic centimeters of clot was evacuated. The patient had an uneventful recovery and was discharged home the next day. Conclusion: This case illustrates the unique presentation and challenges in making the diagnosis of vulvar hematoma.

The Emirates Mars Mission

The Emirates Mars Mission (EMM) was launched to Mars in the summer of 2020, and is the first interplanetary spacecraft mission undertaken by the United Arab Emirates (UAE). The mission has multiple programmatic and scientific objectives, including the return of scientifically useful information about Mars. Three science instruments on the mission's Hope Probe will make global remote sensing measurements of the Martian atmosphere from a large low-inclination orbit that will advance our understanding of atmospheric variability on daily and seasonal timescales, as well as vertical atmospheric transport and escape. The mission was conceived and developed rapidly starting in 2014, and had aggressive schedule and cost constraints that drove the design and implementation of a new spacecraft bus. A team of Emirati and American engineers worked across two continents to complete a fully functional and tested spacecraft and bring it to the launchpad in the middle of a global pandemic. EMM is being operated from the UAE and the United States (U.S.), and will make its data freely available.

Exploring the Patient's Experience of Receiving Clinical Care Which Incorporates the Use of Mobile Technology at the Bedside

OBJECTIVE

Research-based insight into patient's experiences of mobile technology at the bedside in the hospital setting remains limited. This research project aims to explore patient's experience.

METHODS

This mixed method pre and post study aimed to explore the patient experience in relation to this and also test whether introducing further bedside technology (beyond the workstation on wheels) had an effect on the patient experience. Questionnaires and interviews were conducted among inpatient samples prior to and one year post introduction of a suite of new bedside technologies.

RESULTS

Pre and post patient survey results (pre: n=82; post: n=98) suggested that mixed views and perceptions existed and that some of these were associated with primary demographics such as age. At post-test, attitudes about bedside technology were found to be more positive, and feedback about care quality was found to be unchanged, Baseline patient interview findings (n=15) highlight the social ubiquity of technology as a driver of positive attitude in the digital health context.

CONCLUSION

The addition of new bedside technology is very well received by patients and was not perceived to impact on care quality.

1174 The Reporting of Centre and Surgeon Experience in Studies of Robot Assisted Cholecystectomy: A Systematic Review

Introduction

Over 90% of cholecystectomies are performed using minimally invasive techniques. Robotic cholecystectomy (RC) has been developed to overcome technical limitations of laparoscopy, including improved range of movement and visualisation. Despite becoming increasingly widespread, the safety and efficacy of RC remain unestablished. This review aims to analyse the quality assurance reporting through centre and surgeon expertise in RC.

Method

A systematic search was conducted to identify all published studies reporting RC. Data on quality assurance measures were collected, including: centres involved, surgeons’ experience and training.

Results

Of the 1425 abstracts screened, 90 full-text papers were included. Sixty-four studies (71%) were single institutions. Of the thirty studies (33%) reporting centre type, 28 were conducted in specialist/regional/tertiary centres. Only four stated their caseload of RC. No studies described pre-specified criteria or minimum experience required for a surgeon to participate. Fifty-two (58%) reported the number of surgeons operating and 13 (14%) stated surgeons’ training grade. Two quantified previous RC experience, 7 stated prior laparoscopic experience. Only 21 (23%) described training prior to the surgeons’ first in-human procedure; animal based (n = 12), simulation (n = 12), observation (n = 4), lab-based (n = 3). Specific mentorship was reported in 8 studies, and 13 described dual operating.

Conclusions

Little information was provided about the experience and training of operating surgeons, making it difficult to ascertain whether replicable techniques were utilised which would allow development of a learning curve. This highlights the need for better transparency when reporting surgical innovation, to ensure the safe, evidence-based adoption of new technologies into clinical practice.

1498 A Ten-Year Observational Study of The Use of Two-Way Catheters Post-Transurethral Resection of The Prostate Without the Use of Post-Op Irrigation

Aim

To evaluate our practice of using two-way catheters without irrigation post-TURP and to determine impact on patient care compared to standard three-way catheterization. Our primary outcome was duration of admission, but multiple secondary outcomes were also analysed.

Method

This was a prospective observational study. Every patient undergoing TURP at our centre from 2009 to 2019 was included. Prospective patient data were collected pertaining to peri-operative factors. This data was then compared with data published in the NICE guidance pertaining to TURP.

Results

687 patients underwent TURP at our centre between 2009-2019. The average age of patients was 71.42 (±7.89). 87.17% (n = 598) had two-way catheters placed post-operatively. Average duration of admission was 1.61 (±1.35) days. TWOC was successful in 93.74% (n = 644). Complication rate was 8.73% (n = 60), reduced in comparison to other units. Furthermore, when compared to other centres, our method reduced lengths of admission and transfusion rates (1.6 days vs. 3.1 days and 0.87% vs. 2.83% respectively).

Conclusions

Our method preserves patient safety and is associated with reduced length of admission. It also has cost-saving benefits and a reduced post-operative period of catheterisation. We recommend this practice to the wider urological community.

Modified conventional gait model vs. Six degrees of freedom model: A comparison of lower limb kinematics and associated error

BACKGROUND

The conventional gait model (CGM) is commonly utilised within clinical motion analysis but has a number of inherent limitations. To overcome some of these limitations modifications have been made to the CGM and six-degrees of freedom models (6DoF) have been developed.

RESEARCH QUESTION

How comparable are lower limb kinematics calculated using modified CGM and 6DoF models and what is the error associated with the output of each model during walking?

METHODS

Ten healthy males attended two gait analysis sessions, in which they walked at a self-selected pace, while a 10-camera motion capture system recorded lower limb kinematics. Hip, knee and ankle joint kinematics in all three anatomical planes were calculated using a modified CGM, with medial anatomical markers and a three-dimensional foot added, and 6DoF. Mean absolute differences were calculated on a point-by-point basis over the walking gait cycle and interpreted relative to a 5° threshold to explore the comparability of model outputs. The standard error of the measurement (SEM) was also calculated on a point-by-point basis over the walking gait cycle for each model.

RESULTS

Mean absolute differences above 5° were reported between the two model outputs in 58-86% of the walking gait cycle at the knee in the frontal plane, and over the entire walking gait cycle at the hip and knee in the transverse plane. SEM was typically larger for the modified CGM compared to the 6DoF, with the highest SEM values reported at the knee in the frontal plane, and the hip and the knee in the transverse plane.

SIGNIFICANCE

Caution should be taken when looking to compare findings between studies utilising modified CGM and 6DoF outside of the sagittal plane, especially at the hip and knee. The reduced SEM associated with the 6DoF suggests this modelling approach may be preferable.

Surface color spectrophotometry in a murine model of steatosis: an accurate technique with potential applicability in liver procurement

Steatosis is the most important prognostic histologic feature in the setting of liver procurement. The currently utilized diagnostic methods, including gross evaluation and frozen section examination, have important shortcomings. Novel techniques that offer advantages over the current tools could be of significant practical utility. The aim of this study is to evaluate the accuracy of surface color spectrophotometry in the quantitative assessment of steatosis in a murine model of fatty liver. C57BL/6 mice were divided into a control group receiving normal chow (n = 19), and two steatosis groups receiving high-fat diets for up to 20 weeks-mild steatosis (n = 10) and moderate-to-severe steatosis (n = 19). Mouse liver surfaces were scanned with a hand-held spectrophotometer (CM-600D; Konica-Minolta, Osaka, Japan). Spectral reflectance data and color space values (L*a*b*, XYZ, L*c*h*, RBG, and CMYK) were correlated with histopathologic steatosis evaluation by visual estimate, digital image analysis (DIA), as well as biochemical tissue triglyceride measurement. Spectral reflectance and most color space values were very strongly correlated with histologic assessment of total steatosis, with the best predictor being % reflectance at 700 nm (r = 0.91 [0.88-0.94] for visual assessment, r = 0.92 [0.88-0.95] for DIA of H&E slides, r = 0.92 [0.87-0.95] for DIA of oil-red-O stains, and r = 0.78 [0.63-0.87] for biochemical tissue triglyceride measurement, p < 0.0001 for all). Several spectrophotometric parameters were also independently predictive of large droplet steatosis. In conclusion, hepatic steatosis can accurately be assessed using a portable, commercially available hand-held spectrophotometer device. If similarly accurate in human livers, this technique could be utilized as a point-of-care tool for the quantitation of steatosis, which may be especially valuable in assessing livers during deceased donor organ procurement.

POS0492 A MOLECULAR SIGNATURE RESPONSE CLASSIFIER PREDICTS THE LIKELIHOOD OF EULAR NON-RESPONSE TO TNF INHIBITOR THERAPIES IN RA: RESULTS FROM A RETROSPECTIVE COHORT ANALYSIS

Background:

Following RA treatment recommendations, most people with rheumatoid arthritis (RA) begin targeted therapy with TNF inhibitors (TNFi), even though inadequate response to TNFi therapies is widespread. Treatment changes from one medication to the next are currently fueled by disease-activity measures and eventually result in disease control for most patients; however, this “trial-and-error” approach wastes precious time on ineffective treatments. A delay in reaching treat-to-target goals has a negative effect on patient burden and, possibly, disease progression.1 Useful predictors for TNFi response have been challenging to identify but a specific molecular signature response classifier (MSRC) test was shown to be predictive for inadequate response to TNFi therapies.2 The impact of such identification has the potential to result in improved patient outcomes, but further validation would be welcome, especially for response criteria other than ACR50, and in a stringent treat-to-target setting with lower baseline disease activity.

Objectives:

To validate the predictive value of the MSRC test in identifying those patients who do not meet EULAR good response criteria after 6 months of TNFi treatment.

Methods:

Data from a prospective cohort study conducted in the Sint Maartenskliniek (Nijmegen, the Netherlands) of RA patients who started adalimumab or etanercept TNFi as their first biologic were included.3 Baseline RNA samples and clinical assessments were used to identify patients who had a molecular signature1 of non-response to TNFi therapy. Outcomes were calculated at six months using DAS28-CRP-based EULAR good response, and high and low confidence responders and non-responders were identified using Monte Carlo simulation with 2,000 repeats and 70% precision cut off. Outcome measurements were blinded for test results. Treatment switch before 6 months was imputed as non-response. Odds ratios and area under the ROC curve (AUC) assessments were used to evaluate the ability of the MSRC test to predict inadequate response at 6 months against EULAR good response criteria.

Results:

A total of 68 out of 88 RA patients were identified to have a high-confidence response status and were included in analyses (Table 1). EULAR good response was observed in 45.5% (31/68) of patients. Patients were stratified according to detection of a molecular signature of non-response with an AUC of 0.61. The odds that a patient with the molecular signature of non-response at baseline failed to achieve a EULAR good response at 6 months was four times greater than that of a patient lacking the molecular signature (odds ratio 4.0, 95% confidence interval 1.2-13.3).

Table 1.

Patient demographics

CharacteristicRA patients (N = 68)Age, median (SD)57 (11)Female, n (%)43 (63.2)CCP positive, n (%)34 (50.0)RF positive, n (%)38 (55.9)Prescribed adalimumab at baseline, n (%)11 (16.2)Prescribed etanercept at baseline, n (%)57 (83.8)

Conclusion:

In this validation study, the molecular signature of non-response identified patients who did not fulfill the EULAR good response criteria to TNFi therapies. The patient selection process for this study had limitations; additional analysis in an alternative cohort would further verify the performance of the MSRC test. Nevertheless, the test, previously validated for ACR50, now has been validated using EULAR good response in a treat-to-target setting.

References:

[1]Schipper LG et al, Time to achieve remission determines time to be in remission. Arthritis Res Ther 201

[2]Mellors T, et al. Clinical Validation of a Blood-Based Predictive Test for Stratification of Response to Tumor Necrosis Factor Inhibitor Therapies in Rheumatoid Arthritis Patients. Network and Systems Medicine 2020

[3]Tweehuysen L et al. Predictive value of ex-vivo drug-inhibited cytokine production for clinical response to biologic DMARD therapy in rheumatoid arthritis. Clin Exp Rheumatol 2019

Disclosure of Interests:

Lixia Zhang Shareholder of: Scipher Medicine Corporation, Employee of: Scipher Medicine Corporation, Celeste van der Tog: None declared, Alfons den Broeder Consultant of: Abbvie, Amgen, Cellgene, Roche, Biogen, Lilly, Novartis, Celltrion Sanofi, Gilead., Grant/research support from: Abbvie, Amgen, Cellgene, Roche, Biogen, Lilly, Novartis, Celltrion Sanofi, Gilead., Ted Mellors Shareholder of: Scipher Medicine Corporation, Employee of: Scipher Medicine Corporation, Erin Connolly-Strong Shareholder of: Scipher Medicine Corporation, Employee of: Scipher Medicine Corporation, Johanna Withers Shareholder of: Scipher Medicine Corporation, Employee of: Scipher Medicine Corporation, Alex Jones Shareholder of: Scipher Medicine Corporation, Employee of: Scipher Medicine Corporation, Viatcheslav Akmaev Shareholder of: Scipher Medicine Corporation, Employee of: Scipher Medicine Corporation

AB0140 A HIGH-CONFIDENCE DEFINITION OF THERAPEUTIC RESPONSE IN RHEUMATOID ARTHRITIS USING A MONTE CARLO SIMULATION APPROACH

Background:

Therapy choice and therapy change depend on the ability to accurately assess patients’ disease activity. The clinical assessments used to evaluate treatment response in rheumatoid arthritis have inherent variability, normally considered as measurement error, intra-observer variability or within subject variability. Each contribute to variability in deriving response status as defined by composite measures such as the ACR or EULAR criteria, particularly when a one-time observed measurement lies near the boundary defining response or non-response. To select an optimal therapeutic strategy in the burgeoning age of precision medicine in rheumatology, achieve the lowest disease activity and maximize long-term health outcomes for each patient, improved treatment response definitions are needed.

Objectives:

Develop a high-confidence definition of treatment response and non-response in rheumatoid arthritis that exceeds the expected variability of subcomponents in the composite response criteria.

Methods:

A Monte Carlo simulation approach was used to assess ACR50 and EULAR response outcomes in 100 rheumatoid arthritis patients who had been treated for 6 months with a TNF inhibitor therapy. Monte Carlo simulations were run with 2000 iterations implemented with measurement variability derived for each clinical assessment: tender joint count, swollen joint count, Health Assessment Questionnaire disability index (HAQ-DI), patient pain assessment, patient global assessment, physician global assessment, serum C-reactive protein level (CRP) and disease activity score 28-joint count with CRP.1-3 Each iteration of the Monte Carlo simulation generated one outcome with a value of 0 or 1 indicating non-responder or responder, respectively.

Results:

A fidelity score, calculated separately for ACR50 and EULAR response, was defined as an aggregated score from 2000 iterations reported as a fraction that ranges from 0 to 1. The fidelity score depicted a spectrum of response covering strong non-responders, inconclusive statuses and strong responders. A fidelity score around 0.5 typified a response status with extreme variability and inconclusive clinical response to treatment. High-fidelity scores were defined as >0.7 or <0.3 for responders and non-responders, respectively, meaning that the simulated clinical response status label among all simulations agreed at least 70% of the time. High-confidence true responders were considered as those patients with high-fidelity outcomes in both ACR50 and EULAR outcomes.

Conclusion:

A definition of response to treatment should exceed the expected variability of the clinical assessments used in the composite measure of therapeutic response. By defining high-confidence responders and non-responders, the true impact of therapeutic efficacy can be determined, thus forging a path to development of better treatment options and advanced precision medicine tools in rheumatoid arthritis.

References:

[1]Cheung, P. P., Gossec, L., Mak, A. & March, L. Reliability of joint count assessment in rheumatoid arthritis: a systematic literature review. Semin Arthritis Rheum43, 721-729, doi:10.1016/j.semarthrit.2013.11.003 (2014).

[2]Uhlig, T., Kvien, T. K. & Pincus, T. Test-retest reliability of disease activity core set measures and indices in rheumatoid arthritis. Ann Rheum Dis68, 972-975, doi:10.1136/ard.2008.097345 (2009).

[3]Maska, L., Anderson, J. & Michaud, K. Measures of functional status and quality of life in rheumatoid arthritis: Health Assessment Questionnaire Disability Index (HAQ), Modified Health Assessment Questionnaire (MHAQ), Multidimensional Health Assessment Questionnaire (MDHAQ), Health Assessment Questionnaire II (HAQ-II), Improved Health Assessment Questionnaire (Improved HAQ), and Rheumatoid Arthritis Quality of Life (RAQoL). Arthritis Care Res (Hoboken) 63 Suppl 11, S4-13, doi:10.1002/acr.20620 (2011).

Disclosure of Interests:

Vibeke Strand Consultant of: Abbvie, Amgen, Arena, BMS, Boehringer Ingelheim, Celltrion, Galapagos, Genentech/Roche, Gilead, GSK, Ichnos, Inmedix, Janssen, Kiniksa, Lilly, Merck, Novartis, Pfizer, Regeneron, Samsung, Sandoz, Sanofi, Setpoint, UCB, Stanley Cohen: None declared, Lixia Zhang Shareholder of: Scipher Medicine Corporation, Employee of: Scipher Medicine Corporation, Ted Mellors Shareholder of: Scipher Medicine Corporation, Employee of: Scipher Medicine Corporation, Alex Jones Shareholder of: Scipher Medicine Corporation, Employee of: Scipher Medicine Corporation, Johanna Withers Shareholder of: Scipher Medicine Corporation, Employee of: Scipher Medicine Corporation, Viatcheslav Akmaev Shareholder of: Scipher Medicine Corporation, Employee of: Scipher Medicine Corporation

OP0090 CLASSIFICATION OF PATIENTS WITH RELAPSING POLYCHONDRITIS BASED ON SOMATIC MUTATIONS IN UBA1

Background:

Somatic mutations in ubiquitin activating enzyme 1 (UBA1) cause a newly defined syndrome known as VEXAS. [1] More than fifty percent of patients currently identified with VEXAS meet diagnostic criteria for relapsing polychondritis (RP).

Objectives:

To determine the prevalence VEXAS within a cohort of patients with RP, to compare their clinical, laboratory, and immunologic features and to develop a clinical algorithm to inform genetic screening for VEXAS among patients with RP.

Methods:

Exome and targeted sequencing of the UBA1 gene was performed in a prospective observational cohort of patients with RP. Clinical and immunological characteristics of patients with RP were compared based on presence or absence of UBA1 mutations. Random forest was used to derive a clinical algorithm to identify patients with UBA1 mutations. Immune populations were quantified by multipanel flow cytometry. Categorical and continuous variables were compared using the chi square or Kruskal-Wallis test. P<0.05 defined statistical significance.

Results:

Seven of 92 patients with RP (7.6%) were confirmed to have UBA1 mutations (VEXAS-RP). Six additional patients with VEXAS-RP from other cohorts were included for subsequent analyses. Patients with VEXAS-RP were all male, older at disease onset, and commonly had fever, ear chondritis, skin involvement, deep vein thrombosis, and pulmonary infiltrates. Patients with RP as compared with VEXAS-RP had a significantly higher prevalence of airway chondritis, costochondritis and tenosynovitis/arthralgias. (Table). Mortality was significantly greater in VEXAS-RP than RP (27% vs 2% p=0.01). Maximum ESR, CRP, and mean corpuscular volume (MCV) values were significantly greater in VEXAS-RP. Absolute monocyte, lymphocyte, and platelet counts were significantly lower in VEXAS-RP. A decision tree based on male sex, MCV>100 fl and Platelet count<200 K/ul classified between VEXAS-RP and RP with 100% sensitivity and 96% specificity.

Table 1.

Clinical Characteristics of patients with RP vs VEXAS-RP

All Patientsn=98RPn=85VEXAS-RPn=13p valueDemographic CharacteristicsRace, White n (%)90 (92)77 (91)13 (100)0.59Sex, Male n (%)26 (27)13 (15)13 (100)<0.0001Age, Symptom onset, years, Median (IQR)38 (30-47)37 (28-43)56 (54-64)<0.0001Clinical SymptomsFever n (%)33 (34)20 (24)13 (100)<0.0001Ear chondritis n (%)61 (62)48 (56)13 (100)0.0015Nose chondritis n (%)83 (85)71 (84)12 (92)0.68Airway chondritis n (%)37 (38)37 (44)0 (0)0.0015Tenosynovitis/arthalgias n (%)83 (85)77 (91)6 (46)0.0005Skin involvement n (%)33 (34)22 (2611 (85)<0.0001Laboratory ValuesESR, mm/hr, median (IQR)12 (6-22)11 (5-19)66.5 (42-110)<0.0001CRP, mg/L, median (IQR)2.9 (0.8-9.6)1.9 (0.6-6.3)17.7 (9.6-99.5)<0.0001Platelet count (k/uL)246(201-299)258 (227-312)145 (100-169)<0.0001MCV fL93.05 (90-98)92.2 (89-95)105 (102-115)<0.0001Absolute lymphocyte count1.6 (1.1-2.3)1.78(1.4-2.4)0.92 (0.5-1.2)<0.0001CT scan abnormalitiesPulmonary infiltrates n (%)16 (16.33)6 (7.06)10 (77)<0.0001ComplicationsDeath n (%)6 (6)3 (4)3 (23)0.029Unprovoked DVT12 (12)4 (5)8 (62)<0.0001

N number; IQR = interquartile range

Conclusion:

Mutations in UBA1 are causal for disease in a subset of patients with RP. These patients are defined by disease onset in the fifth decade of life or later, male sex, ear/nose chondritis and hematologic abnormalities. Early identification is important in VEXAS given the associated high mortality rate.

References:

[1]Beck DB, Ferrada MA, Sikora KA, Ombrello AK, Collins JC, Pei W, Balanda N, Ross DL, Ospina Cardona D, Wu Z et al: Somatic Mutations in UBA1 and Severe Adult-Onset Autoinflammatory Disease. N Engl J Med 2020, 383(27):2628-2638.

Disclosure of Interests:

None declared

615 Achieving Net Zero Emission by 2050 – The Medical Education Route

Introduction

There is growing demand to reduce the environmental impact of surgery. Healthcare sustainability has recently become a mandatory GMC learning outcome for undergraduates, but expertise amongst faculty and time within the curriculum are limited. We piloted an E-module that uses surgical case studies to teach these concepts.

Method

Evidenced-based multi-media learning principles were used to develop the module. 3rd and 4th year students at Brighton and Sussex Medical School were invited to partake and complete pre- and post-module questionnaires comprising 5-point Likert scales and white-space questions. The primary outcome measures were changes in student-reported understanding of four key concepts:

Environmental impact of healthcare

Influence of climate change on health.

Principles of sustainable clinical practice.

Health co-benefits of climate change mitigation.

Results

33 students completed the E-module. Questionnaire results indicated a significant increase in understanding of all key concepts (p &lt; 0.001). Students most commonly rated improving sustainability of healthcare as ‘extremely important’. Common themes within white space responses included the importance of preventative medicine and that the module was informative, interactive, user-friendly, and engaging. The majority (81%) strongly agreed that all undergraduates should undertake this module.

Conclusions

This E-module is an effective and COVID-19-safe resource. Adapting this module for postgraduate surgical education should be explored.

138 We Tried This At Home – Safety Analysis and Outcome of Community Resource Services

Introduction

There are several data sets published for acute frailty services in hospital but there is a lack of supporting data in the emerging field of Intermediate Care. Gwent has well-established Community Resource Teams (CRT) that were set up as “Hospital at Home” services. The objective being to treat frail, acute or sub-acute medically ill patients in their own environment by a consultant-led hospital-like team using a Comprehensive Geriatric Assessment. Although “Hospital at Home” services are often preferred by the patient and are in-line with Health board strategies “Care Closer to home” and “Clinical Futures”; it is important to ask ourselves whether we are able to deliver clinical care in the community safely?

Method

One year of data from 2018 was extracted from the CRT Portal, analysed and then validated by the health board’s performance teams. From the established data set, origin of referrals and discharge outcomes were identified. Finally, at 28 days of discharge from Gwent CRTs mortality and hospital admission rates were examined.

Results

4,308 out of 5,395 referrals (85%) were accepted to Gwent CRTs of which 59.60% (2,863) referrals were from primary care and 33.54% (1,445) were from secondary care. Our admission rates to secondary care services were 15.27% (658) whilst mortality rate was 3.92% (169). After successful medical management from Gwent CRTs of 3,481 patients in their own place of residence, 28 day hospital admission rate was 13.84% (482) whilst 28 day mortality rate (expected and unexpected) was 6.89% (240).

Conclusion

Although no equivalent data is currently available for comparison, a significant number of patients can be medically managed in their own place of residence. More than 80% of patients did not require hospital admission whilst mortality rates were encouraging. Further future re-evaluation of our service performance and its value is required.