Impact of dishware size on energy intake in adult females: A randomized control trial examining effects on within-meal and post-meal energy intake

The influence dishware size has on meal energy intake is unclear and no study to date has examined the impact on total daily energy intake. In a pre-registered RCT we investigate the impact of breakfast dishware size on breakfast and post-breakfast energy intake, as well as daily energy intake and hunger/fullness. In a repeated-measures design, 50 females (aged 18-77 years) were randomised to receive smaller or larger breakfast dishware on two separate days. Energy intake was also measured during the rest of the day. The primary outcomes were breakfast and post-breakfast energy intake (kcal). Secondary outcomes were total daily energy intake (kcal), and hunger/fullness (rated from 0 to 100). We examined if results differed by socioeconomic position (SEP). Dishware did not affect energy intake at breakfast (smaller: M = 394.8 kcal; SD = 172.2 larger: M = 394.4 kcal; SD = 164.4; d = 0.003, p = 0.98), and there was no statistically significant evidence that dishware size affected energy intake after breakfast, though post-breakfast energy intake was somewhat higher after using larger breakfast dishware (smaller: M = 1974.6 kcal; SD = 475.2; larger: M = 2077.5 kcal; SD = 525.9; d = -0.27, p = 0.06). Total daily energy intake, hunger and fullness ratings did not significantly differ between dishware conditions. There was no evidence that SEP moderated the effect of dishware size on energy intake. Smaller vs. larger breakfast dishware size had no significant effect on breakfast or post-breakfast energy intake, hunger, fullness, or daily energy intake. Previous studies may have overestimated the promise of dishware size as an intervention for reducing energy intake. Alternative interventions targeting the food environment should now be prioritised.

Psychopathy and gaze cueing

BACKGROUND AND OBJECTIVES

Psychopathic traits - and especially callous affective features - have been linked to altered processing of others' emotional expressions, and to reduced attention to the eyes. Despite the importance of gaze cueing (i.e., the tendency to orient attention toward where someone else is looking) for social functioning, few studies have investigated relationships between psychopathic traits and gaze cueing, and whether facial emotional expression influence these relationships, obtaining mixed results. To address this gap, the present study aimed to evaluate associations between psychopathic traits and gaze cueing for emotional and neutral expressions.

METHODS

65 non-clinical male participants (Mage = 27.3 years) completed two self-report measures of psychopathy and performed laboratory tasks to assess gaze-cueing for emotional vs. neutral faces and an arrow-cueing task as a comparison.

RESULTS

Linear mixed models showed no significant associations of emotional (versus neutral) expressions, or psychopathy trait dimensions, with either gaze cueing or arrow cueing.

LIMITATIONS

Reliance on a convenience sample of non-clinical men, assessed with self-reports measures of psychopathy, and using static emotional stimuli limit the generalizability of our findings.

CONCLUSIONS

Findings suggest that psychopathic traits are not associated with individual differences in following others' gaze to direct attention, and that there was no advantage for affective relative to neutral expressions.

Pharmacological interventions for the management of children and adolescents living with obesity-An update of a Cochrane systematic review with meta-analyses

IMPORTANCE

The effectiveness of anti-obesity medications for children and adolescents is unclear.

OBJECTIVE

To update the evidence on the benefits and harms of anti-obesity medication.

DATA SOURCES

Cochrane CENTRAL, MEDLINE, ClinicalTrials.gov and WHO ICTRP (1/1/16-17/3/23).

STUDY SELECTION

Randomized controlled trials ≥6 months in people <19 years living with obesity.

DATA EXTRACTION AND SYNTHESIS

Screening, data extraction and quality assessment conducted in duplicate, independently.

MAIN OUTCOMES AND MEASURES

Body mass index (BMI): 95th percentile BMI, adverse events and quality of life.

RESULTS

Thirty-five trials (N = 4331), follow-up: 6-24 months; age: 8.8-16.3 years; BMI: 26.2-41.7 kg/m2. Moderate certainty evidence demonstrated a -1.71 (95% confidence interval [CI]: -2.27 to -1.14)-unit BMI reduction, ranging from -0.8 to -5.9 units between individual drugs with semaglutide producing the largest reduction of -5.88 kg/m2 (95% CI: -6.99 to -4.77, N = 201). Drug type explained ~44% of heterogeneity. Low certainty evidence demonstrated reduction in 95th percentile BMI: -11.88 percentage points (95% CI: -18.43 to -5.30, N = 668). Serious adverse events and study discontinuation due to adverse events did not differ between medications and comparators, but medication dose adjustments were higher compared to comparator (10.6% vs 1.7%; RR = 3.74 [95% CI: 1.51 to 9.26], I2 = 15%), regardless of approval status. There was a trend towards improved quality of life. Evidence gaps exist for children, psychosocial outcomes, comorbidities and weight loss maintenance.

CONCLUSIONS AND RELEVANCE

Anti-obesity medications in addition to behaviour change improve BMI but may require dose adjustment, with 1 in 100 adolescents experiencing a serious adverse event.

The extrastriate symmetry response is robust to alcohol intoxication

Visual symmetry activates a network of regions in the extrastriate cortex and generates an event-related potential (ERP) called the sustained posterior negativity (SPN). Previous work has found that the SPN is robust to experimental manipulations of task, spatial attention, and memory load. In the current study, we investigated whether the SPN is also robust to alcohol-induced changes in mental state. A pilot experiment (N = 13) found that alcohol unexpectedly increased SPN amplitude. We followed this unexpected result with two new experiments on separate groups, using an alcohol challenge paradigm. One group completed an Oddball discrimination task (N = 26). Another group completed a Regularity discrimination task (N = 26). In both groups, participants consumed a medium dose of alcohol (0.65 g/kg body weight) and a placebo drink, in separate sessions. Alcohol reduced SPN amplitude in the Oddball task (contrary to the pilot results) but had no effect on SPN amplitude in the Regularity task. In contrast, the N1 wave was consistently dampened by alcohol in all experiments. Exploratory analysis indicated that the inconsistent effect of alcohol on SPN amplitude may be partly explained by individual differences in alcohol use. Alcohol reduced the SPN in light drinkers and increased it in heavier drinkers. Despite remaining questions, the results highlight the automaticity of symmetry processing. Symmetry still produces a large SPN response, even when participants are intoxicated, and even when symmetry is not task relevant.

Point-of-choice kilocalorie labelling practices in large, out-of-home food businesses: a preobservational versus post observational study of labelling practices following implementation of The Calorie Labelling (Out of Home Sector) (England) Regulations 2021

BACKGROUND AND OBJECTIVES

On 6 April 2022, the UK government implemented mandatory kilocalorie (kcal) labelling regulations for food and drink products sold in the out-of-home food sector (OHFS) in England. Previous assessments of kcal labelling practices in the UK OHFS found a low prevalence of voluntary implementation and poor compliance with labelling recommendations. This study aimed to examine changes in labelling practices preimplementation versus post implementation of mandatory labelling regulations in 2022.

METHODS

In August-December 2021 (preimplementation) and August-November 2022 (post implementation), large OHFS businesses (250 or more employees) subject to labelling regulations were visited. At two time points, a researcher visited the same 117 food outlets (belonging to 90 unique businesses) across four local authorities in England. Outlets were rated for compliance with government regulations for whether kcal labelling was provided at any or all point of choice, provided for all eligible food and drink items, provided per portion for sharing items, if labelling was clear and legible and if kcal reference information was displayed.

RESULTS

There was a significant increase (21% preimplementation vs 80% post implementation, OR=40.98 (95% CI 8.08 to 207.74), p<0.001) in the proportion of outlets providing any kcal labelling at point-of-choice post implementation. Only 15% of outlets met all labelling compliance criteria post implementation, with a minority of outlets not presenting labelling in a clear (33%) or legible (29%) way.

CONCLUSION

The number of large businesses in the OHFS providing kcal labelling increased following the implementation of mandatory labelling regulations. However, around one-fifth of eligible outlets sampled were not providing kcal labelling 4-8 months after the regulations came into force, and the majority of businesses only partially complied with government guidance. More effective enforcement may be required to further improve kcal labelling practices in the OHFS in England.

PREREGISTRATION

Study protocol and analysis strategy preregistered on Open Science Framework (https://osf.io/pfnm6/).

The Virtual Child

SUMMARY

We are building the world's first Virtual Child-a computer model of normal and cancerous human development at the level of each individual cell. The Virtual Child will "develop cancer" that we will subject to unlimited virtual clinical trials that pinpoint, predict, and prioritize potential new treatments, bringing forward the day when no child dies of cancer, giving each one the opportunity to lead a full and healthy life.

Validity of Entrustable Professional Activities in a National Sample of General Surgery Residency Programs

BACKGROUND

The American Board of Surgery has endorsed competency-based education as vital to the assessment of surgical training. From 2018 to 2020, a national pilot study was conducted at 28 general surgery programs to evaluate feasibility of implementing entrustable professional activities (EPAs) for 5 common general surgical conditions. ACGME core competency Milestones were also rated for each resident by program clinical competency committees. This study aimed to evaluate the validity of general surgery EPAs compared with Milestones.

STUDY DESIGN

Prospectively collected, de-identified EPA Pilot Study data were analyzed. EPAs studied were EPA-1 (gallbladder), EPA-2 (inguinal hernia), EPA-3 (right lower quadrant pain), EPA-4 (trauma), and EPA-5 (consult). Variables abstracted included levels of EPA entrustment (1 to 5) and corresponding ACGME Milestone subcompetency ratings (1 to 5) for the same study cycle. Spearman's correlations were used to evaluate the relationship between summative EPA scores and corresponding Milestone ratings.

RESULTS

A total of 493 unique residents received a summative entrustment decision. EPA summative entrustment scores had moderate-to-strong positive correlation with mapped Milestone subcompetencies, with median rho value of 0.703. Among operation-focused EPAs, median rho values were similar between EPA-1 (0.688) and EPA-2 (0.661), but higher for EPA-3 (0.833). EPA-4 showed a strong positive correlation with diagnosis and communication competencies (0.724), whereas EPA-5, mapped to the most Milestone subcompetencies, had the lowest median rho value (0.455).

CONCLUSIONS

Moderate-to-strong positive correlation was noted between EPAs and patient care, medical knowledge, and communication Milestones. These findings support the validity of EPAs in general surgery and suggest that EPA assessments can be used to inform Milestone ratings by clinical competency committees.

What is new in FungiDB: a web-based bioinformatics platform for omics-scale data analysis for fungal and oomycete species

FungiDB (https://fungidb.org) serves as a valuable online resource that seamlessly integrates genomic and related large-scale data for a wide range of fungal and oomycete species. As an integral part of the VEuPathDB Bioinformatics Resource Center (https://veupathdb.org), FungiDB continually integrates both published and unpublished data addressing various aspects of fungal biology. Established in early 2011, the database has evolved to support 674 datasets. The datasets include over 300 genomes spanning various taxa (e.g. Ascomycota, Basidiomycota, Blastocladiomycota, Chytridiomycota, Mucoromycota, as well as Albuginales, Peronosporales, Pythiales, and Saprolegniales). In addition to genomic assemblies and annotation, over 300 extra datasets encompassing diverse information, such as expression and variation data, are also available. The resource also provides an intuitive web-based interface, facilitating comprehensive approaches to data mining and visualization. Users can test their hypotheses and navigate through omics-scale datasets using a built-in search strategy system. Moreover, FungiDB offers capabilities for private data analysis via the integrated VEuPathDB Galaxy platform. FungiDB also permits genome improvements by capturing expert knowledge through the User Comments system and the Apollo genome annotation editor for structural and functional gene curation. FungiDB facilitates data exploration and analysis and contributes to advancing research efforts by capturing expert knowledge for fungal and oomycete species.

Ecological patterns and processes of temporal turnover within lung infection microbiota

BACKGROUND

Chronic infection and consequent airway inflammation are the leading causes of morbidity and early mortality for people living with cystic fibrosis (CF). However, lower airway infections across a range of chronic respiratory diseases, including in CF, do not follow classical 'one microbe, one disease' concepts of infection pathogenesis. Instead, they are comprised of diverse and temporally dynamic lung infection microbiota. Consequently, temporal dynamics need to be considered when attempting to associate lung microbiota with changes in disease status. Set within an island biogeography framework, we aimed to determine the ecological patterns and processes of temporal turnover within the lung microbiota of 30 paediatric and adult CF patients prospectively sampled over a 3-year period. Moreover, we aimed to ascertain the contributions of constituent chronic and intermittent colonizers on turnover within the wider microbiota.

RESULTS

The lung microbiota within individual patients was partitioned into constituent chronic and intermittent colonizing groups using the Leeds criteria and visualised with persistence-abundance relationships. This revealed bacteria chronically infecting a patient were both persistent and common through time, whereas intermittently infecting taxa were infrequent and rare; respectively representing the resident and transient portions of the wider microbiota. It also indicated that the extent of chronic colonization was far greater than could be appreciated with microbiological culture alone. Using species-time relationships to measure temporal turnover and Vellend's rationalized ecological processes demonstrated turnover in the resident chronic infecting groups was conserved and underpinned principally by the deterministic process of homogenizing dispersal. Conversely, intermittent colonizing groups, representing newly arrived immigrants and transient species, drove turnover in the wider microbiota and were predominately underpinned by the stochastic process of drift. For adult patients, homogenizing dispersal and drift were found to be significantly associated with lung function. Where a greater frequency of homogenizing dispersal was observed with worsening lung function and conversely drift increased with better lung function.

CONCLUSIONS

Our work provides a novel ecological framework for understanding the temporal dynamics of polymicrobial infection in CF that has translational potential to guide and improve therapeutic targeting of lung microbiota in CF and across a range of chronic airway diseases. Video Abstract.

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.

Application of generative language models to orthopaedic practice

OBJECTIVE

To explore whether large language models (LLMs) Generated Pre-trained Transformer (GPT)-3 and ChatGPT can write clinical letters and predict management plans for common orthopaedic scenarios.

DESIGN

Fifteen scenarios were generated and ChatGPT and GPT-3 prompted to write clinical letters and separately generate management plans for identical scenarios with plans removed.

MAIN OUTCOME MEASURES

Letters were assessed for readability using the Readable Tool. Accuracy of letters and management plans were assessed by three independent orthopaedic surgery clinicians.

RESULTS

Both models generated complete letters for all scenarios after single prompting. Readability was compared using Flesch-Kincade Grade Level (ChatGPT: 8.77 (SD 0.918); GPT-3: 8.47 (SD 0.982)), Flesch Readability Ease (ChatGPT: 58.2 (SD 4.00); GPT-3: 59.3 (SD 6.98)), Simple Measure of Gobbledygook (SMOG) Index (ChatGPT: 11.6 (SD 0.755); GPT-3: 11.4 (SD 1.01)), and reach (ChatGPT: 81.2%; GPT-3: 80.3%). ChatGPT produced more accurate letters (8.7/10 (SD 0.60) vs 7.3/10 (SD 1.41), p=0.024) and management plans (7.9/10 (SD 0.63) vs 6.8/10 (SD 1.06), p<0.001) than GPT-3. However, both LLMs sometimes omitted key information or added additional guidance which was at worst inaccurate.

CONCLUSIONS

This study shows that LLMs are effective for generation of clinical letters. With little prompting, they are readable and mostly accurate. However, they are not consistent, and include inappropriate omissions or insertions. Furthermore, management plans produced by LLMs are generic but often accurate. In the future, a healthcare specific language model trained on accurate and secure data could provide an excellent tool for increasing the efficiency of clinicians through summarisation of large volumes of data into a single clinical letter.

SUMOylation of OsPSTOL1 is essential for regulating phosphate starvation responses in rice and Arabidopsis

Although rice is one of the main sources of calories for most of the world, nearly 60% of rice is grown in soils that are low in phosphorus especially in Asia and Africa. Given the limitations of bioavailable inorganic phosphate (Pi) in soils, it is important to develop crops tolerant to low phosphate in order to boost food security. Due to the immobile nature of Pi, plants have developed complex molecular signalling pathways that allow them to discern changes in Pi concentrations in the environment and adapt their growth and development. Recently, in rice, it was shown that a specific serine-threonine kinase known as Phosphorus-starvation tolerance 1 (PSTOL1) is important for conferring low phosphate tolerance in rice. Nonetheless, knowledge about the mechanism underpinning PSTOL1 activity in conferring low Pi tolerance is very limited in rice. Post-translation modifications (PTMs) play an important role in plants in providing a conduit to detect changes in the environment and influence molecular signalling pathways to adapt growth and development. In recent years, the PTM SUMOylation has been shown to be critical for plant growth and development. It is known that plants experience hyperSUMOylation of target proteins during phosphate starvation. Here, we demonstrate that PSTOL1 is SUMOylated in planta, and this affects its phosphorylation activity. Furthermore, we also provide new evidence for the role of SUMOylation in regulating PSTOL1 activity in plant responses to Pi starvation in rice and Arabidopsis. Our data indicated that overexpression of the non-SUMOylatable version of OsPSTOL1 negatively impacts total root length and total root surface area of rice grown under low Pi. Interestingly, our data also showed that overexpression of OsPSTOL1 in a non-cereal species, Arabidopsis, also positively impacts overall plant growth under low Pi by modulating root development. Taken together our data provide new evidence for the role of PSTOL1 SUMOylation in mediating enhanced root development for tolerating phosphate-limiting conditions.

FcγRIIB Is an Immune Checkpoint Limiting the Activity of Treg-Targeting Antibodies in the Tumor Microenvironment

Preclinical murine data indicate that fragment crystallizable (Fc)-dependent depletion of intratumoral regulatory T cells (Treg) is a major mechanism of action of anti-CTLA-4. However, the two main antibodies administered to patients (ipilimumab and tremelimumab) do not recapitulate these effects. Here, we investigate the underlying mechanisms responsible for the limited Treg depletion observed with these therapies. Using an immunocompetent murine model humanized for CTLA-4 and Fcγ receptors (FcγR), we show that ipilimumab and tremelimumab exhibit limited Treg depletion in tumors. Immune profiling of the tumor microenvironment (TME) in both humanized mice and humans revealed high expression of the inhibitory Fc receptor, FcγRIIB, which limits antibody-dependent cellular cytotoxicity/phagocytosis. Blocking FcγRIIB in humanized mice rescued the Treg-depleting capacity and antitumor activity of ipilimumab. Furthermore, Fc engineering of antibodies targeting Treg-associated targets (CTLA-4 or CCR8) to minimize FcγRIIB binding significantly enhanced Treg depletion, resulting in increased antitumor activity across various tumor models. Our results define the inhibitory FcγRIIB as an immune checkpoint limiting antibody-mediated Treg depletion in the TME, and demonstrate Fc engineering as an effective strategy to overcome this limitation and improve the efficacy of Treg-targeting antibodies.

Effect of calorie labelling in the out-of-home food sector on adult obesity prevalence, cardiovascular mortality, and social inequalities in England: a modelling study

BACKGROUND

England implemented a menu calorie labelling policy in large, out-of-home food businesses in 2022. We aimed to model the likely policy impact on population-level obesity and cardiovascular disease mortality, as well as the socioeconomic equity of estimated effects, in the adult population in England.

METHODS

For this modelling analysis, we built a comparative assessment model using two scenarios: the current implementation scenario refers to actual deployment only in large (≥250 employees), out-of-home food businesses, whereas the full implementation scenario refers to deployment in every out-of-home food business. We compared each scenario with a counterfactual: the scenario in which no intervention is implemented (ie, baseline). For both scenarios, we modelled the impact of the policy through assumed changes in energy intake due to either consumer response or product reformulation by retailers. We used data from the Office for National Statistics and the National Diet and Nutrition Survey 2009-19, and modelled the effect over 20 years (ie, 2022-41) to capture the long-term impact of the policy and provided mid-period results after 10 years. We used the Monte Carlo approach (2500 iterations) to estimate the uncertainty of model parameters. For each scenario, the model generated the change in obesity prevalence and the total number of deaths prevented or postponed.

FINDINGS

The current implementation scenario was estimated to reduce obesity prevalence by 0·31 percentage points (absolute; 95% uncertainty interval [UI] 0·10-0·35), which would prevent or postpone 730 cardiovascular disease deaths (UI 430-1300) of the 830 000 deaths (UI 600 000-1 200 000) expected over 20 years. However, the health benefits would be increased if calorie labelling was implemented in all out-of-home food businesses (2·65 percentage points reduction in obesity prevalence [UI 1·97-3·24] and 9200 cardiovascular disease deaths prevented or postponed [UI 5500-16 000]). Results were similar in the most and the least deprived socioeconomic groups.

INTERPRETATION

This study offers the first modelled estimation of the impact of the menu calorie labelling regulation on the adult population in England, although we did not include a cost-effectiveness analysis. Calorie labelling might result in a reduction in obesity prevalence and cardiovascular disease mortality without widening health inequalities. However, our results emphasise the need for the government to be more ambitious by applying this policy to all out-of-home food businesses to maximise impact.

FUNDING

European Research Council.

Self-regulatory control processes in youths: A temporal network analysis approach

Objective

This study aimed to better understand the temporal interrelationships among self-control, response inhibition, and anger (i.e., momentary state and rumination) on both the within- and between-person levels in male adolescents.

Method

We applied temporal network analyses among 62 male adolescents with a wide range of behavioral difficulties. Self-control, momentary anger, and anger rumination were mapped by self-report measures, whereas we measured response inhibition through an ambulatory Go/No-go task (two measures a day-morning and afternoon-over a 9-day period).

Results

Temporal network analysis, at the within-person level, revealed that morning measures of response inhibition, anger rumination, and self-control were related to the corresponding measure in the afternoon. More efficient response inhibition in the morning was associated with higher self-control in the afternoon. Higher anger rumination in the morning led to higher momentary anger in the afternoon. In a concurrent within-person network, higher momentary anger was reciprocally associated with lower self-control. At the between-person level, higher momentary anger was correlated to higher anger rumination, lower response inhibition, and lower self-control.

Discussion

This study provides insight into the dynamic interactions among self-control, response inhibition, and anger (momentary state and rumination) in male adolescents, advancing the understanding of self-regulatory control functioning.

Associations between anxiety, depression, and weight status during and after pregnancy: A systematic review and meta-analysis

Previous work has found adverse mental health symptomology in women living with obesity, compared with those of healthy weight, around the time of pregnancy. This meta-analysis aimed to explore the association between anxiety, depression, and weight status in women living with obesity before, during, and after pregnancy. Bibliographic databases were systematically searched, and 14 studies were included, which aimed to assess the association between excess weight and anxiety or depression outcomes in women before, during, or after pregnancy. Data were analyzed via narrative synthesis and random effects multi-level meta-analyses. Scores on mental health indices were significantly greater (indicative of worse anxiety/depression) in women with obesity compared to women of a healthy weight, around the time of pregnancy (SMD = 0.21 [95% CI: 0.11-0.31; 95% prediction intervals: 0.13-0.56], I2  = 73%, p < 0.01). Depressive symptoms were greater during and after pregnancy (SMD = 0.23 [95% CI: 0.13-0.34; 95% prediction intervals: -0.12 to 0.59], I2  = 75.0%, p < 0.01), and trait anxiety symptoms were greater during pregnancy (SMD = 0.24 [95% CI: 0.01-0.47; 95% prediction intervals: -0.25 to 0.72], I2  = 83.7%, p = 0.039) in women living with obesity, compared to those of healthy weight. Narrative evidence suggests that socioeconomic status and ethnicity may modify the relationship between obesity and mental health symptomology. The findings indicate that maternal obesity is associated with greater anxiety and depression symptoms. These findings may inform the design of maternal weight management interventions.

Reduction of cell surface attachment in experimental hydrocephalus using a novel ventricular catheter with modified tethered liquid perfluorocarbon

OBJECTIVE

Ventriculoperitoneal shunting, the most common treatment for the neurological disorder hydrocephalus, has a failure rate of up to 98% within 10 years of placement, mainly because of proximal obstruction of the ventricular catheter (VC). The authors developed a new VC design modified with tethered liquid perfluorocarbon (TLP) and tested it in a porcine model of hydrocephalus. In this study, they aimed to determine if their TLP VC design reduced cell surface attachment and consequent shunt obstruction in the pig model.

METHODS

TLP VCs were designed to reduce drainage hole obstruction using modified TLP and slightly enlarged draining holes, but their number and placement remained very similar to standard VCs. First, the authors tested the device in nonhydrocephalic rats to assess biocompatibility. After confirming safety, they implanted the VCs in hydrocephalic pigs. Hydrocephalus was induced by intracisternal kaolin injections in 30-day-old domestic juvenile pigs. Surgical implantation of the ventriculoperitoneal shunt (clinical control or TLP) was performed 10-14 days postinduction and maintained up to 30 days posttreatment. MRI was performed to measure ventricular volume before treatment and 10 and 30 days after treatment. Histological and immunohistochemical analyses of brain tissue and explanted VCs, intracranial pressure measurement, and clinical scoring were performed when the animals were euthanized.

RESULTS

TLP VCs showed a similar surgical feel, kink resistance, and stiffness to control VCs. In rats (biocompatibility assessment), TLP VCs did not show brain inflammatory reactions after 30 or 60 days of implantation. In pigs, TLP VCs demonstrated increased survival time, improved clinical outcome scores, and significantly reduced total attached cells on the VCs compared with standard clinical control VCs. TLP VCs exhibited similar, but not worse, results related to ventriculomegaly, intracranial pressure, and the local tissue response around the cortical shunt track in pigs.

CONCLUSIONS

TLP VCs may be a strong candidate to reduce proximal VC obstruction and improve hydrocephalus treatment.

Careless responding in online studies is associated with alcohol use: A mega-analysis

OBJECTIVE

The prevalence of research conducted online in the addiction field has increased rapidly over the past decade. However, little focus has been given to careless responding in these online studies, despite the issues it may cause for statistical inference and generalizability. Our aim was to examine whether alcohol use is associated with careless responses.

METHOD

Raw data were requested from online studies examining alcohol use and related problems which also addressed careless responding. We obtained 13 data sets of 12,237 participants (Mage = 42.16, SD = 15.65, 50.5% female). The sample had an average Alcohol Use Disorders Identification Test (AUDIT) score of 10.88 (SD = 7.77). Predictors included demographic information (age, gender) and AUDIT total scores. The primary outcome was whether an individual was classed as a careless responder, for example, by failing an explicit attention check question.

RESULTS

AUDIT total scores were associated with careless responding (OR = 1.07, 95% CI [1.06, 1.08], p < .001). Hazardous drinking or worse was associated with 2.21 greater odds (OR = 2.21, 95% CI [1.81, 2.71] of careless responding, whereas harmful drinking or worse was associated with 3.43 greater odds (OR = 3.43, 95% CI [2.83, 4.17]) and probable dependence was associated with 3.63 greater odds (OR = 3.63, 95% CI [2.95, 4.48]).

CONCLUSIONS

Alcohol use and related problems are positively associated with careless responding in online research. Removal of individuals identified as careless responders may lead to issues of generalizability, and more care should be taken to identify and handle careless responder data. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Experience sampling methodology study of anxiety and depression in adolescents with epilepsy: The role of metacognitive beliefs and perseverative thinking

Emotional distress is common in young people with epilepsy (YPwE). According to the Self-Regulatory Executive Function (S-REF) model, maladaptive metacognitive beliefs and perseverative thinking are fundamental in the development and maintenance of emotional distress. As emotional distress and perseverative thinking can highly fluctuate over short intervals in YPwE, it is important to account for this variability when testing the utility of psychological models. Experience sampling methodology (ESM) was therefore used to explore the momentary relationship between metacognitive beliefs, perseverative thinking, and emotional distress in YPwE. Eighteen participants diagnosed with epilepsy (aged 12-17 years) completed the 10-day ESM period. Participants were prompted to complete the ESM assessment five times daily. The ESM assessment assessed participant's momentary levels of metacognitive beliefs, perseverative thinking (i.e., worry and rumination), and emotional distress (i.e., anxiety and depression). A series of multilevel regression analyses indicated that metacognitive beliefs were significantly positively associated with worry, rumination, anxiety and depression. After controlling for worry and rumination, respectively, metacognitive beliefs did not account for additional variance in anxiety or depression. Findings provide preliminary support for the utility of the S-REF model for emotional distress in YPwE. Metacognitive therapy, which is underpinned by the S-REF model, may be an appropriate intervention for emotional distress in YPwE. Future studies should assess the mediational relationship between metacognitive beliefs, perseverative thinking, and emotional distress using time-lagged models.

Sleep apnea multi-level surgery trial: long-term observational outcomes

STUDY OBJECTIVES

The sleep apnea multi-level surgery (SAMS) randomized clinical trial showed surgery improved outcomes at 6 months compared to ongoing medical management in patients with moderate or severe obstructive sleep apnea (OSA) who failed continuous positive airway pressure therapy. This study reports the long-term outcomes of the multi-level surgery as a case series.

METHODS

Surgical participants were reassessed >2 years postoperatively with the same outcomes reported in the main SAMS trial. Primary outcomes were apnea-hypopnea index (AHI) and Epworth sleepiness scale (ESS), with secondary outcomes including other polysomnography measures, symptoms, quality of life, and adverse events. Long-term effectiveness (baseline to long-term follow-up [LTFU]) and interval changes (6 month to LTFU) were assessed using mixed effects regression models. Control participants were also reassessed for rate of subsequent surgery and outcomes.

RESULTS

36/48 (75%) of surgical participants were reevaluated (mean (standard deviation)) 3.5 (1.0) years following surgery, with 29 undergoing polysomnography. AHI was 41/h (23) at preoperative baseline and 21/h (18) at follow-up, representing persistent improvement of -24/h (95% CI -32, -17; p < 0.001). ESS was 12.3 (3.5) at baseline and 5.5 (3.9) at follow-up, representing persistent improvement of -6.8 (95% CI -8.3, -5.4; p < 0.001). Secondary outcomes were improved long term, and adverse events were minor. Interval change analysis suggests stability of outcomes. 36/43 (84%) of the control participants were reevaluated, with 25 (69%) reporting subsequent surgery, with symptom and quality of life improvements.

CONCLUSION

Multi-level upper airway surgery improves OSA burden with long-term maintenance of treatment effect in adults with moderate or severe OSA in whom conventional therapy failed.

CLINICAL TRIAL

Multi-level airway surgery in patients with moderate-severe obstructive sleep apnea (OSA) who have failed medical management to assess change in OSA events and daytime sleepiness; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366019&isReview=true; ACTRN12614000338662.

VEuPathDB: the eukaryotic pathogen, vector and host bioinformatics resource center in 2023

The Eukaryotic Pathogen, Vector and Host Informatics Resource (VEuPathDB, https://veupathdb.org) is a Bioinformatics Resource Center funded by the National Institutes of Health with additional funding from the Wellcome Trust. VEuPathDB supports >600 organisms that comprise invertebrate vectors, eukaryotic pathogens (protists and fungi) and relevant free-living or non-pathogenic species or hosts. Since 2004, VEuPathDB has analyzed omics data from the public domain using contemporary bioinformatic workflows, including orthology predictions via OrthoMCL, and integrated the analysis results with analysis tools, visualizations, and advanced search capabilities. The unique data mining platform coupled with >3000 pre-analyzed data sets facilitates the exploration of pertinent omics data in support of hypothesis driven research. Comparisons are easily made across data sets, data types and organisms. A Galaxy workspace offers the opportunity for the analysis of private large-scale datasets and for porting to VEuPathDB for comparisons with integrated data. The MapVEu tool provides a platform for exploration of spatially resolved data such as vector surveillance and insecticide resistance monitoring. To address the growing body of omics data and advances in laboratory techniques, VEuPathDB has added several new data types, searches and features, improved the Galaxy workspace environment, redesigned the MapVEu interface and updated the infrastructure to accommodate these changes.

The Power of Partnership: NYCEAL Collaborations With Health Agencies and Mobile Vaccination Vans

New York City experienced a high COVID-19 burden and striking disparities among racial and ethnic minoritized groups. The New York Community Engagement Alliance Against COVID-19 Disparities (NYCEAL) collaborated with health agencies and clinical providers to increase and facilitate COVID-19 vaccinations across New York City. NYCEAL partners and their network of hundreds of community health workers delivered vaccine education, fostered community trust, and supported vaccine uptake among low-income, limited‒English-proficient, and racial and ethnic minoritized communities. With funding from the National Institutes of Health (NIH), the objective of NYCEAL was to reduce COVID-19 disparities by increasing vaccine uptake and promoting trust in science. (Am J Public Health. 2024;114(S1):S92-S95. https://doi.org/10.2105/AJPH.2023.307455).

Understanding alcohol use and changes in drinking habits among people with a severe mental illness: a qualitative framework analysis study

Introduction

Individuals with a severe mental illness (SMI) are more likely to drink at harmful levels or abstain. While it is known that drinking patterns change over time, the reasons for this among those with a SMI are unclear. This study aimed to (i) explore the experiences with alcohol, particularly in relation to mental health symptoms, and (ii) how drinking patterns have changed over time, among individuals who have a SMI diagnosis, who either currently drink alcohol or no longer drink.

Methods

One-to-one semi-structured telephone interviews were conducted to address the study aims. Current drinkers' alcohol use was assessed using the Alcohol Use Disorder Identification Test. A framework analysis was used to address the study aims with a specific focus on the differences in the experiences with alcohol use between current and former drinkers.

Results

16 participants were interviewed, and five themes were developed. The analysis highlighted how alcohol was increasingly used to cope with (i) trauma, (ii) SMI-related symptoms, or (iii) stress. Among those with a SMI, non-drinking was facilitated through declines in SMI-related symptoms, previous negative consequences due to alcohol and changing the social environment. Current drinking habits were facilitated through changes in the reasons for drinking and adopting different alcohol moderation techniques.

Discussion

Among those with a SMI diagnosis and who either currently drink alcohol or no longer drink, our findings support the self-medication hypothesis and drinking motives model. However, our findings indicate the need for further development of drinking to cope with a focus on symptoms of a SMI and trauma. Our findings also have implications on specialist alcohol and mental health services, the need to improve individuals' understanding of SMI, and the need to identify reasons for drinking among those with a recent diagnosis of a SMI.

A systematic review and meta-analysis of the effect of digital game-based or influencer food and non-alcoholic beverage marketing on children and adolescents: Exploring hierarchy of effects outcomes

Videogame livestreaming platforms are an emerging form of digital media, popular with young people, where users watch gaming influencers play videogames. Food and non-alcoholic beverage (hereafter: food) brands have a substantial presence on these platforms, yet no studies have examined the impact of this food marketing on young people. This systematic review and meta-analysis examined the evidence (quantitative or mixed-method) for a relationship between exposure to digital game-based or influencer food marketing, and food-related (brand awareness, attitudes, preferences, purchase, and consumption), and post-consumption (weight, body mass index [BMI], and dental caries) outcomes in young people (≤18 years). Twenty-three databases were searched in March 2021. Twenty-two studies met the inclusion criteria, of which 20 were included in the quantitative synthesis. Meta-analyses indicated food marketing was associated with more positive attitudes and greater preferences (OR = 1.74, p < 0.001 [95%CI: 1.355, 2.232]), and increased consumption (SMD = 0.37, p < 0.001 [95%CI: 0.219, 0.529]). Narrative synthesis indicated that food marketing may increase brand awareness but not pester intent, although data were limited. Evidence suggests that there is a relationship between exposure to food marketing via influencers and digital gaming media, and several food-related outcomes. This is the first quantitative synthesis to demonstrate these relationships; this work has implications for food marketing policy.

Systematic evaluation of AML-associated antigens identifies anti-U5 SNRNP200 therapeutic antibodies for the treatment of acute myeloid leukemia

Despite recent advances in the treatment of acute myeloid leukemia (AML), there has been limited success in targeting surface antigens in AML, in part due to shared expression across malignant and normal cells. Here, high-density immunophenotyping of AML coupled with proteogenomics identified unique expression of a variety of antigens, including the RNA helicase U5 snRNP200, on the surface of AML cells but not on normal hematopoietic precursors and skewed Fc receptor distribution in the AML immune microenvironment. Cell membrane localization of U5 snRNP200 was linked to surface expression of the Fcγ receptor IIIA (FcγIIIA, also known as CD32A) and correlated with expression of interferon-regulated immune response genes. Anti-U5 snRNP200 antibodies engaging activating Fcγ receptors were efficacious across immunocompetent AML models and were augmented by combination with azacitidine. These data provide a roadmap of AML-associated antigens with Fc receptor distribution in AML and highlight the potential for targeting the AML cell surface using Fc-optimized therapeutics.

A cross-sectional evaluation of the current state of wound healing education in the United Kingdom's undergraduate medical curriculum

Between 2013 and 2018, there has been a 71% increase in the number of patients who have required wound care in the NHS and such large numbers has placed a significant burden on healthcare systems. However, there is currently no evidence as to whether medical students are equipped with the necessary skills to deal with an increasing number of wound care related issues that patients present with. A total of 323 medical students across 18 UK medical schools completed an anonymous questionnaire evaluating the wound education received at their medical school, encompassing the volume, content, format and efficacy of teaching. 68.4% (221/323) of respondents had received some form of wound education during their undergraduate studies. On average students received 2.25 h of structured, preclinical teaching and only 1 h of clinical based teaching in total. All students that received wound education reported undertaking teaching on the physiology of, and factors affecting wound healing, with only 32.2% (n = 104) of students receiving clinically based wound education There was very weak correlation and no significant association in student's ability to assess wounds (R2  = 0.190, p = 0.013), manage wounds (R2  = 0.060, p = 0.37), and prescribe wound care products (R2  = 0.093, p = 0.18) with their stage of training. Students strongly agreed that wound education is an important part of the undergraduate curriculum and post graduate practice, and do not feel their learning needs have been met. This is the first study to assess the provision of wound education in the United Kingdom, demonstrating a clear deficit in the provision of wound education compared to expectation of junior doctors. Wound education is largely overlooked in the medical curriculum, lacks a clinical focus and does not prepare junior doctors with the necessary clinical abilities to deal with wound related pathology. Expert opinion to direct changes to future curriculum and further evaluation of teaching methodology is required to address this deficit and ensure students have the necessary clinical skills to excel as newly graduated doctors.

Hazardous, harmful, and dependent alcohol use in healthcare professionals: a systematic review and meta-analysis

Background

Healthcare professionals work in high-pressured and demanding environments, which has been linked to the use of alcohol as a coping strategy. This international review aimed (i) to determine the pooled prevalence of hazardous, harmful, dependent, and frequent binge drinking in healthcare professionals, and (ii) to explore factors associated with variation in these outcomes.

Methods

Scopus, MEDLINE, and PsycINFO were searched from 2003 to 17th November 2022, for studies reporting a prevalence estimate for any outcome among healthcare professionals. Random-effects meta-analyses determined pooled prevalence estimates. Sub-group analyses were conducted, stratifying the meta-analyses by pandemic period vs pre-pandemic period. Meta-regressions explored factors that were associated with variation in the outcomes. PROSPERO (CRD42020173119).

Results

After screening 9,108 records, 64 studies were identified as eligible. The pooled prevalence was 19.98% [95% Confidence Intervals [CI]: 16.05-24.23%] for hazardous alcohol use (K = 52), 3.17% [95% CI: 0.95-6.58%] for harmful drinking (K = 8), 14.59% [95% CI: 7.16-25.05%] for dependent drinking (K = 7), and 17.71% [95% CI: 8.34-29.63%] for frequent binge drinking (K = 11). The prevalence of hazardous drinking was greater during the pandemic (28.19%) compared with pre-pandemic estimates (17.95%), though this was not statistically significant (p = 0.049). Studies including all hospital staff (32.04%) showed higher prevalence estimates for hazardous drinking compared with studies of doctors (16.78%) and nurses (27.02%).

Conclusion

Approximately one fifth of healthcare professionals drink to hazardous levels, with higher prevalence estimates observed during the COVID-19 pandemic. It may be that healthcare professionals used alcohol to cope with the additional trauma and stressors. Further research is needed to investigate whether this is sustained in the post-pandemic period.

The feasibility, acceptability and efficacy of an app-based intervention (the Coping Camp) in reducing stress among Chinese school adolescents: A cluster randomised controlled trial

OBJECTIVES

This study aimed to determine the efficacies of the Coping Camp app in reducing stress, depression, and anxiety and improving stress-coping behaviours and mental health wellbeing. Additionally, feasibility and acceptability of Coping Camp were evaluated.

METHODS

In this unblinded cluster RCT, 540 participants from two high schools in China were randomly assigned to the Coping Camp intervention (n = 6 classes; 275 students) or treatment as usual (n = 5 classes; 265 students) at the class level. Coping Camp was an automated self-help app, consisting of 11 sessions delivered over 11 weeks, with primary outcomes including perceived stress, depression, anxiety, stress-coping behaviours, and mental health well-being. All outcomes were assessed at baseline, post-intervention (11 weeks), and follow-up (19 weeks), with efficacy analysed using linear mixed models and feasibility/acceptability measured by a 5-point Likert scale and qualitative feedback.

RESULTS

At post-intervention and follow-up assessments, 75.4% and 81.7% of participants respectively attended. On average, participants logged in for 8.56 out of 11 sessions. Compared to the control group, the intervention group had significant reductions in levels of perceived stress (p = 0.01, d = 0.15 at T1; p < 0.001, d = 0.18 at T2), anxiety (p = 0.11; d = 0.08 at T1; p = 0.01; d = 0.13 at T2) and depression (p = 0.04, d = 0.11 at T1; p = 0.05, d = 0.10 at T2) but did not have a greater increase in stress-coping behaviours (p = 0.10 at T1; p = 0.97 at T2) or mental health wellbeing (p = 0.93 at T1; p = 0.08 at T2). The average ratings for each session were above 4, and qualitative feedback showed that most participants found the intervention to be "great," "good," and "useful."

CONCLUSIONS

The Coping Camp is feasible, acceptable and effective in stress management among Chinese school adolescents.

Aortic annulus rupture after transcatheter aortic valve replacement: successful management of a dangerous complication

OBJECTIVE

Aortic annulus rupture remains one of the most fatal complications of TAVR. While attempts have been made to describe and predict this complication, the data remains insufficient without evidence-based guidelines for management of this rare complication.

METHODS

Here we describe a series of 3 aortic annulus ruptures after TAVR which were managed successfully to hospital discharge.

RESULTS

Patient 1 suffered annulus rupture during balloon valvuloplasty prior to TAVR. The patient became hypotensive, and echocardiogram showed pericardial effusion. The patient underwent pericardiocentesis which transiently improved the blood pressure, but bleeding continued. The patient was transitioned to an open surgical aortic valve replacement due to ongoing hemorrhage. The chest was left open with delayed closure on post-op day 2. The patient was discharged on post-op day 15. Patient 2 was undergoing TAVR valve expansion. The patient became hypotensive. An echocardiogram revealed pericardial effusion. Pericardiocentesis yielded 200 mL of blood. SURGIFLO (Johnson & Johnson Wound Management, Somerville, NJ) was injected into the pericardial space. Aortic root angiography confirmed no further contrast extravasation. A pericardial drain was left in place for 2 days, and the patient was discharged on post-op day 7. Patient 3 received a TAVR valve and post-placement dilation due to paravalvular leak. The echocardiogram showed a pericardial effusion. Pericardiocentesis was performed, yielding 500 cc of blood. The patient's healthcare proxy declined emergent surgery; thus, a pericardial drain was placed. No hemostatic agents were used, and drainage reduced over several hours. The drain was removed on post-op day 3, and the patient was discharged on post-op day 8.

CONCLUSIONS

Based on the timelines in these three cases, and interventions used, the following steps may be employed in the event of annulus rupture: identification of hemodynamic instability, echocardiogram to confirm pericardial effusion, emergent pericardiocentesis, pericardial drain placement for evacuation of the pericardial space and use of hemostatic agents, repeat aortogram to rule out ongoing extravasation. If hemostasis is unable to be achieved and/or the patient becomes hemodynamically unstable at any point, rapid transition to emergent surgical management is necessary. This management strategy proved successful for this case series and warrants further investigation.

Soil carbon sequestration in global working lands as a gateway for negative emission technologies

The ongoing climate crisis merits an urgent need to devise management approaches and new technologies to reduce atmospheric greenhouse gas concentrations (GHG) in the near term. However, each year that GHG concentrations continue to rise, pressure mounts to develop and deploy atmospheric CO2 removal pathways as a complement to, and not replacement for, emissions reductions. Soil carbon sequestration (SCS) practices in working lands provide a low-tech and cost-effective means for removing CO2 from the atmosphere while also delivering co-benefits to people and ecosystems. Our model estimates suggest that, assuming additive effects, the technical potential of combined SCS practices can provide 30%-70% of the carbon removal required by the Paris Climate Agreement if applied to 25%-50% of the available global land area, respectively. Atmospheric CO2 drawdown via SCS has the potential to last decades to centuries, although more research is needed to determine the long-term viability at scale and the durability of the carbon stored. Regardless of these research needs, we argue that SCS can at least serve as a bridging technology, reducing atmospheric CO2 in the short term while energy and transportation systems adapt to a low-C economy. Soil C sequestration in working lands holds promise as a climate change mitigation tool, but the current rate of implementation remains too slow to make significant progress toward global emissions goals by 2050. Outreach and education, methodology development for C offset registries, improved access to materials and supplies, and improved research networks are needed to accelerate the rate of SCS practice implementation. Herein, we present an argument for the immediate adoption of SCS practices in working lands and recommendations for improved implementation.

A multi-country comparison of jurisdictions with and without mandatory nutrition labelling policies in restaurants: analysis of behaviours associated with menu labelling in the 2019 International Food Policy Study

OBJECTIVE

To examine differences in noticing and use of nutrition information comparing jurisdictions with and without mandatory menu labelling policies and examine differences among sociodemographic groups.

DESIGN

Cross-sectional data from the International Food Policy Study (IFPS) online survey.

SETTING

IFPS participants from Australia, Canada, Mexico, United Kingdom and USA in 2019.

PARTICIPANTS

Adults aged 18-99; n 19 393.

RESULTS

Participants in jurisdictions with mandatory policies were significantly more likely to notice and use nutrition information, order something different, eat less of their order and change restaurants compared to jurisdictions without policies. For noticed nutrition information, the differences between policy groups were greatest comparing older to younger age groups and comparing high education (difference of 10·7 %, 95 % CI 8·9, 12·6) to low education (difference of 4·1 %, 95 % CI 1·8, 6·3). For used nutrition information, differences were greatest comparing high education (difference of 4·9 %, 95 % CI 3·5, 6·4) to low education (difference of 1·8 %, 95 % CI 0·2, 3·5). Mandatory labelling was associated with an increase in ordering something different among the majority ethnicity group and a decrease among the minority ethnicity group. For changed restaurant visited, differences were greater for medium and high education compared to low education, and differences were greater for higher compared to lower income adequacy.

CONCLUSIONS

Participants living in jurisdictions with mandatory nutrition information in restaurants were more likely to report noticing and using nutrition information, as well as greater efforts to modify their consumption. However, the magnitudes of these differences were relatively small.

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.

Transcatheter aortic valve replacement 23 years after heart transplant for aortic insufficiency

BACKGROUND

Clinicians continue to expand the availability of transcatheter aortic valve replacement (TAVR) for patients who historically would have been ineligible for surgical aortic valve replacement. Historically, reoperative aortic valve surgery after transplant was immensely complicated and high risk due to the repeat sternotomy approach, and the immunosuppression in transplant patients. As heart transplant patients continue to live longer, patients are beginning to develop novo aortic pathology of the transplanted organ. In these patients, TAVR may be a valuable rescue therapy for those with de-novo aortic valve disease.

CASE PRESENTATION

Here, we present a single case of a 70-year-old man with a history of heart transplant 23 years prior complicated by severe sternal infection and subsequent removal of his sternum. Additionally, this patient had a recent history of kidney transplant due to renal cell carcinoma necessitating nephrectomy. He subsequently developed progressive symptomatic aortic insufficiency and underwent a successful TAVR to treat his new aortic disease.

CONCLUSIONS

To our knowledge, this represents only the second case report of TAVR for severe aortic insufficiency and one of the first reports of TAVR in a multiple organ recipient. TAVR may represent an important rescue therapy for post-transplant valve pathologies instead of high-risk reoperative surgical aortic valve replacement.

Implementation of Entrustable Professional Activities in General Surgery: Results of a National Pilot Study

OBJECTIVE

The ongoing complexity of general surgery training has led to an increased focus on ensuring the competence of graduating residents. Entrustable professional activities (EPAs) are units of professional practice that provide an assessment framework to drive competency-based education. The American Board of Surgery convened a group from the American College of Surgeons, Accreditation Council for Graduate Medical Education (ACGME) Surgery Review Committee, and Association of Program Directors in Surgery to develop and implement EPAs in a pilot group of residency programs across the country. The objective of this pilot study was to determine the feasibility and utility of EPAs in general surgery resident training.

METHODS

5 EPAs were chosen based on the most common procedures reported in ACGME case logs and by practicing general surgeons (right lower quadrant pain, biliary disease, inguinal hernia), along with common activities covering additional ACGME milestones (performing a consult, care of a trauma patient). Levels of entrustment assigned (1 to 5) were observation only, direct supervision, indirect supervision, unsupervised, and teaching others. Participating in site recruitment and faculty development occurred from 2017 to 2018. EPA implementation at individual residency programs began on July 1, 2018, and was completed on June 30, 2020. Each site was assigned 2 EPAs to implement and collected EPA microassessments on residents for those EPAs. The site clinical competency committees (CCC) used these microassessments to make summative entrustment decisions. Data submitted to the independent deidentified data repository every 6 months included the number of microassessments collected per resident per EPA and CCC summative entrustment decisions.

RESULTS

Twenty-eight sites were selected to participate in the program and represented geographic and size variability, community, and university-based programs. Over the course of the 2-year pilot programs reported on 14 to 180 residents. Overall, 6,272 formative microassessments were collected (range, 0 to 1144 per site). Each resident had between 0 and 184 microassessments. The mean number of microassessments per resident was 5.6 (SD = 13.4) with a median of 1 [interquartile range (IQR) = 6]. There were 1,763 summative entrustment ratings assigned to 497 unique residents. The average number of observations for entrustment was 3.24 (SD 3.61) with a median of 2 (IQR 3). In general, PGY1 residents were entrusted at the level of direct supervision and PGY5 residents were entrusted at unsupervised practice or teaching others. For each EPA other than the consult EPA, the degree of entrustment reported by the CCC increased by resident level.

CONCLUSIONS

These data provide evidence that widespread implementation of EPAs across general surgery programs is possible, but variable. They provide meaningful data that graduating chief residents are entrusted by their faculty to perform without supervision for several common general surgical procedures and highlight areas to target for the successful widespread implementation of EPAs.

"It is like a pet in a way": The self-management experiences of people with cystic fibrosis diabetes

BACKGROUND

Cystic fibrosis diabetes (CFD) is a very common co-morbidity affecting the lives of people with cystic fibrosis. Surprisingly, minimal research has been undertaken to understand the experiences of people with CFD and how they self-mange this condition.

METHODS

Using interpretative phenomenological analysis, the present study examined the self-management experiences of people with CFD. In-depth semi-structure interviews were conducted with eight people who had CFD.

RESULTS

The following three superordinate themes were identified: forming a relationship with CFD, balancing the CFD self-management triad, and the unmet need for information and support.

CONCLUSIONS

The findings suggest that the management of CFD is challenging and, although people with CFD experience many adaptation and management processes similar to people with type 1 diabetes, they struggle with the additional complexity of balancing CF and CFD. The provision of appropriate education, support and person-centred care needs to be addressed.

Differences in directives to limit treatment and discontinue mechanical ventilation between elderly and very elderly patients: a substudy of a multinational observational study

PURPOSE

The aim of this study was to characterize differences in directives to limit treatments and discontinue invasive mechanical ventilation (IMV) in elderly (65-80 years) and very elderly (> 80 years) intensive care unit (ICU) patients.

METHODS

We prospectively described new written orders to limit treatments, IMV discontinuation strategies [direct extubation, direct tracheostomy, spontaneous breathing trial (SBT), noninvasive ventilation (NIV) use], and associations between initial failed SBT and outcomes in 142 ICUs from 6 regions (Canada, India, United Kingdom, Europe, Australia/New Zealand, United States).

RESULTS

We evaluated 788 (586 elderly; 202 very elderly) patients. Very elderly (vs. elderly) patients had similar withdrawal orders but significantly more withholding orders, especially cardiopulmonary resuscitation and dialysis, after ICU admission [67 (33.2%) vs. 128 (21.9%); p = 0.002]. Orders to withhold reintubation were written sooner in very elderly (vs. elderly) patients [4 (2-8) vs. 7 (4-13) days, p = 0.02]. Very elderly and elderly patients had similar rates of direct extubation [39 (19.3%) vs. 113 (19.3%)], direct tracheostomy [10 (5%) vs. 40 (6.8%)], initial SBT [105 (52%) vs. 302 (51.5%)] and initial successful SBT [84 (80%) vs. 245 (81.1%)]. Very elderly patients experienced similar ICU outcomes (mortality, length of stay, duration of ventilation) but higher hospital mortality [26 (12.9%) vs. 38 (6.5%)]. Direct tracheostomy and initial failed SBT were associated with worse outcomes. Regional differences existed in withholding orders at ICU admission and in withholding and withdrawal orders after ICU admission.

CONCLUSIONS

Very elderly (vs. elderly) patients had more orders to withhold treatments after ICU admission and higher hospital mortality, but similar ICU outcomes and IMV discontinuation. Significant regional differences existed in withholding and withdrawal practices.

Assessing public perception and awareness of UK mandatory calorie labeling in the out-of-home sector: Using Twitter and Google trends data

Objectives

In 2021 the UK government announced a new obesity policy requiring large out-of-home food outlets to provide mandatory in-store calorie labeling on food and drink items. Public acceptability and engagement with obesity policies could influence the level of impact on wider public health particularly with population-level policies such as calorie labeling. This study aimed to examine public responses and awareness of the policy using social media (Twitter) comments and Google trends data.

Methods

This study examined responses to social media posts on Twitter (tweets) from the UK Department of Health and Social Care detailing the policy, implementation date and post-implementation information about the policy's enforcement. The sentiments of the tweets were coded and the number of likes and replies extracted. This study utilized google trends to examine public awareness of the policy by extracting weekly relative search volume for relevant phrases such as "calorie labeling."

Results

From the 276 replies/quote-tweet extracted, the majority expressed a negative sentiment toward the policy (N = 197/71.4%). There were fewer tweets expressing a positive sentiment (N = 25/8.7%) and a neutral/no sentiment (N = 54/19.6%). There was no difference in the number of "likes" or retweets between tweets expressing positive or negative sentiments. Five themes were identified expressing negative sentiments (most common being negative impacts on eating disorders). Google trends data revealed increased searches for "calorie labels/labeling" during the week of the policy enforcement compared to previous weeks in the last 5 years but no significant differences in searches for specific menu calorie labeling.

Conclusions

This analysis revealed negative sentiment toward and increased searching of calorie labeling information during the announcement and implementation of the 2021 mandatory calorie labeling policy in England. A greater understanding of public responses to calorie labeling policies may help tailor future policies and public communication strategies.

The impact of calorie labelling and proportional pricing on out of home food orders: a randomised controlled trial study using a virtual food and drink delivery app

BACKGROUND

Mandatory calorie labelling in the out-of-home food sector was introduced in England in 2022, and menu pricing strategies that ensure cost is equivalent to portion size (proportional pricing) have been proposed as a policy to reduce obesity. Food delivery app-based platforms now contribute significantly to diet, and evidence suggests that those at a socioeconomic disadvantage may have greater exposure to unhealthy options on these platforms. However, public health policies to improve nutritional quality of food ordered from food delivery apps has received limited examination.

OBJECTIVE

This experimental study assessed the impact of calorie labelling and proportional pricing on item and meal size selection, calories ordered, and money spent when selecting food and drinks from three outlet types on a virtual delivery app.

METHODS

UK adult participants (N = 1126, 49% female), stratified by gender and education level completed an online study where they ordered items from three branded food and beverage outlets (coffee shop, sandwich outlet, fast food outlet) using a virtual delivery app. Participants were presented food and beverage options with vs. without calorie labels and with value (larger portions are proportionally cheaper) vs. proportional pricing.

RESULTS

Calorie labelling did not influence portion size selection for any outlets, but significantly reduced calories ordered from the coffee shop (-18.95kcals, 95% CI -33.07 to -4.84) and fast food outlet (-54.19kcals, 95% CI -86.04 to -22.33). Proportional pricing reduced the likelihood of choosing a larger beverage from the coffee shop (OR = 0.58, 95% CI 0.45 to 0.75), but was associated with increased calories ordered from the fast food outlet (51.25kcals, 95% CI 19.59 to 82.90). No consistent interactions were observed with participant characteristics, suggesting that effects of calorie labelling and pricing on outcomes were similar across sociodemographic groups.

CONCLUSIONS

Calorie labelling on food delivery platforms may effectively reduce calories ordered. Proportional pricing may be useful in prompting consumers to select smaller portion sizes, although further research in real-world settings will now be valuable.

Mean disease alleviation between surgery and continuous positive airway pressure in matched adults with obstructive sleep apnea

STUDY OBJECTIVES

Polysomnography parameters measure treatment efficacy for obstructive sleep apnea (OSA), such as reduction in apnea-hypopnea index (AHI). However, for continuous positive airway pressure (CPAP) therapy, polysomnography measures do not factor in adherence and thus do not measure effectiveness. Mean disease alleviation (MDA) corrects polysomnography measures for CPAP adherence and was used to compare treatment effectiveness between CPAP and multilevel upper airway surgery.

METHODS

This retrospective cohort study consisted of a consecutive sample of 331 patients with OSA managed with multilevel airway surgery as second-line treatment (N = 97) or CPAP (N = 234). Therapeutic effectiveness (MDA as % change or as corrected change in AHI) was calculated as the product of therapeutic efficacy (% or absolute change in AHI) and adherence (% time on CPAP of average nightly sleep). Cardinality and propensity score matching was utilized to manage confounding variables.

RESULTS

Surgery patients achieved greater MDA % than CPAP users (67 ± 30% vs. 60 ± 28%, p = 0.04, difference 7 ± 3%, 95% confidence interval 4% to 14%) in an unmatched comparison, despite a lower therapeutic efficacy seen with surgery. Cardinality matching demonstrated comparable MDA % in surgery (64%) and CPAP (57%) groups (p = 0.14, difference 8 ± 5%, 95% confidence interval -18% to 3%). MDA measured as corrected change in AHI showed similar results.

CONCLUSIONS

In adult patients with OSA, multilevel upper airway surgery and CPAP provide comparable therapeutic effectiveness on polysomnography. For patients with inadequate CPAP use, surgery should be considered.

The labels and models used to describe problematic substance use impact discrete elements of stigma: A registered report

OBJECTIVES

Problematic substance use is one of the most stigmatized health conditions leading research to examine how the labels and models used to describe it influence public stigma. Two recent studies examine whether beliefs in a disease model of addiction influence public stigma but result in equivocal findings-in line with the mixed-blessings model, Kelly et al. (2021) found that while the label "chronically relapsing brain disease" reduced blame attribution, it decreased prognostic optimism and increased perceived danger and need for continued care; however, Rundle et al. (2021) conclude absence of evidence. This study isolates the different factors used in these two studies to assess whether health condition (drug use vs. health concern), etiological label (brain disease vs. problem), and attributional judgment (low vs. high treatment stability) influence public stigma toward problematic substance use.

METHOD

Overall, 1,613 participants were assigned randomly to one of the eight vignette conditions that manipulated these factors. They completed self-report measures of discrete and general public stigma and an indirect measure of discrimination.

RESULTS

Greater social distance, danger, and public stigma but lower blame were ascribed to drug use relative to a health concern. Greater (genetic) blame was reported when drug use was labeled as a "chronically relapsing brain disease" relative to a "problem." Findings for attributional judgment were either inconclusive or statistically equivalent.

DISCUSSION

The labels used to describe problematic substance use appear to impact discrete elements of stigma. We suggest that addiction is a functional attribution, which may explain the mixed literature on the impact of etiological labels on stigma to date. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Effects of postage on recovery of pathogens from cystic fibrosis sputum samples

BACKGROUND

Regular surveillance microbiology of sputum is used in cystic fibrosis (CF) to monitor for new pathogens and target treatments. A move to remote clinics has meant greater reliance on samples collected at home and posted back. The impact of delays and sample disruption caused by posting has not been systematically assessed but could have significant implications for CF microbiology.

METHODS

Sputum samples collected from adult CF patients were mixed, split, and either processed immediately or posted back to laboratory. Processing involved a further split into aliquots for culture-dependant and-independent microbiology (quantitative PCR [QPCR] and microbiota sequencing). We calculated retrieval by both approaches for five typical CF pathogens: Pseudomonas aeruginosa, Burkholderia cepacia complex, Achromobacter xylosoxidans, Staphylococcus aureus and Stenotrophomonas maltophilia.

RESULTS

93 paired samples were collected from 73 CF patients. Median interval between sample posting and receipt was 5 days (range 1-10). For culture, overall concordance for posted and fresh samples was 86% across the five targeted pathogens (ranging from 57 to 100% for different organisms), with no bias towards either sample type. For QPCR, overall concordance was 62% (range 39-84%), again with no bias towards fresh or posted samples. There were no significant differences in culture or QPCR for samples with short (≤3days) versus extended (≥7days) postal delays. Posting had no significant impact on pathogen abundance nor on microbiota characteristics.

CONCLUSIONS

Posted sputum samples reliably reproduced culture-based and molecular microbiology of freshly collected samples, even after prolonged delays at ambient conditions. This supports use of posted samples during remote monitoring.

Alignment of spatial genomics data using deep Gaussian processes

Spatially resolved genomic technologies have allowed us to study the physical organization of cells and tissues, and promise an understanding of local interactions between cells. However, it remains difficult to precisely align spatial observations across slices, samples, scales, individuals and technologies. Here, we propose a probabilistic model that aligns spatially-resolved samples onto a known or unknown common coordinate system (CCS) with respect to phenotypic readouts (for example, gene expression). Our method, Gaussian Process Spatial Alignment (GPSA), consists of a two-layer Gaussian process: the first layer maps observed samples' spatial locations onto a CCS, and the second layer maps from the CCS to the observed readouts. Our approach enables complex downstream spatially aware analyses that are impossible or inaccurate with unaligned data, including an analysis of variance, creation of a dense three-dimensional (3D) atlas from sparse two-dimensional (2D) slices or association tests across data modalities.

Statistics anxiety and predictions of exam performance in UK psychology students

BACKGROUND

Statistics anxiety is common among social science students. Despite much evidence examining statistics anxiety and test performance, little research has explored the role of student self-prediction on test performance in a higher education setting.

OBJECTIVE

The purpose of this study was to investigate the relationship between statistics anxiety and both students' self-prediction of their future exam performance and actual test performance on a formal statistics assessment at undergraduate level in psychology students in the UK.

METHOD

Using a cross-sectional design, two hundred and two students were required to complete Statistics Anxiety Rating Scales, the Mathematical Prerequisites for Psychometrics Scale, and provided self-predicted test performance scores. Test performance data was obtained from a formal statistics assessment.

RESULTS

As predicted, we demonstrated statistics test anxiety to be negatively associated with self-predicted performance. Additionally, we found statistics anxiety was positively associated with test performance.

CONCLUSION

The findings highlight the complex relationship between statistics anxiety and test performance, suggesting there may be an optimal level of anxiety for performance in statistics assessments.

IMPLICATIONS

The results we report have implications for psychology research methods and statistics instructors who may wish to incorporate the findings into statistics instruction modules in order to assuage high levels of statistics anxiety and foster student well-being.

Little Evidence for the Role of Disgust Sensitivity in Implicit Disgust to Images of White People Engaged in Injecting Drug Use (IDU)

Background: Previous research has shown that People Who Inject Drugs (PWID) are subject to public stigma, which affects access to, and provision and quality of, treatment and support services. Less is known about the socio-cognitive processes that support the development and maintenance of public stigma toward PWID. The present study investigated the role of disgust sensitivity in implicit disgust to injecting drug use. Methods: 126 participants took part in an online Implicit Association Task (IAT) measuring implicit disgust to pictorial stimuli of injecting drug use or medical injecting. Participants also completed The Disgust Scale Revised, Injecting Phobia Scale (Short Form), Attitudes to People Who Use Drugs (PWUD) scale and a substance use inventory. Results: Average IAT score was negative indicating significantly higher implicit disgust to injecting drug use. Hierarchical linear regression found that injecting phobia predicted implicit disgust to injecting drug use. Questionnaire measures of disgust did not predict implicit disgust. While animal reminder disgust and injecting phobia were significantly correlated with each other, animal reminder disgust did not predict implicit disgust scores. Conclusions: On the basis of our findings, stigma toward PWID may not be a result of feelings of disgust toward injecting drug use. We discuss findings in the context of the underlying cortical processes supporting implicit and explicit representations of disgust. Future research should seek to investigate neurophysiological evidence for disgust to and stigmatization of injecting drug use and the potential role of domains of disgust in this.

Estimating cancer incidence in Uganda: a feasibility study for periodic cancer surveillance research in resource limited settings

BACKGROUND

Population based cancer registries (PBCRs) are accepted as the gold standard for estimating cancer incidence in any population. However, only 15% of the world's population is covered by high quality cancer registries with coverage as low as 1.9% in settings such as Africa. This study was conducted to assess the operational feasibility of estimating cancer incidence using a retrospective "catchment population" approach in Uganda.

METHODS

A retrospective population study was conducted in 2018 to identify all newly diagnosed cancer cases between 2013 and 2017 in Mbarara district. Data were extracted from the medical records of health facilities within Mbarara and from national and regional centres that provide cancer care services. Cases were coded according to the International Classification of Diseases for Oncology (ICD-0-03). Data was analysed using CanReg5 and Excel.

RESULTS

We sought to collect data from 30 health facilities serving Mbarara district, southwestern Uganda. Twenty-eight sources (93%) provided approval within the set period of two months. Among the twenty-eight sources, two were excluded, as they did not record addresses for cancer cases, leaving 26 sources (87%) valid for data collection. While 13% of the sources charged a fee, ranging from $30 to $100, administrative clearance and approval was at no cost in most (87%) data sources. This study registered 1,258 new cancer cases in Mbarara district. Of the registered cases, 65.4% had a morphologically verified diagnosis indicating relatively good quality of data. The Age-Standardised Incidence Rates for all cancers combined were 109.9 and 91.9 per 100,000 in males and females, respectively. In males, the most commonly diagnosed cancers were prostate, oesophagus, stomach, Kaposi's sarcoma and liver. In females, the most common malignancies were cervix uteri, breast, stomach, liver and ovary. Approximately, 1 in 8 males and 1 in 10 females would develop cancer in Mbarara before the age of 75 years.

CONCLUSION

Estimating cancer incidence using a retrospective cohort design and a "catchment population approach" is feasible in Uganda. Periodic studies using this approach are potentially a precious resource for producing quality cancer data in settings where PBCRs are scarce. This could supplement PBCR data to provide a detailed and comprehensive picture of the cancer burden over time, facilitating the direction of cancer control efforts in resource-limited countries.

Fatal granulomatous amebic encephalitis initially presenting with a cutaneous lesion

We present a case of a 66-year-old man with a cutaneous Balamuthia mandrillaris lesion that progressed to fatal granulomatous amoebic encephalitis. We provide a summary of Australian cases and describe the clinical features and approach to diagnosing this rare but devastating condition, including the importance of PCR for diagnosis.

Confronting the figure of the "mad scientist" in psychedelic history: LSD's use as a correctional tool in the postwar period

Since reports about CIA-funded LSD studies came out in the 1970s, psychedelic drugs have invoked images of unethical experimentation and "mad scientists" in the public imagination. Even now, as the stigma surrounding psychedelics diminishes in the 21st century, the figure of the "mad scientist" continues to occupy a space in what Ido Hartogsohn calls the "collective set and setting," the larger framework of cultural understandings that shape how individuals experience psychedelic drugs. Scientists and humanities scholars who study these drugs have responded to this issue by drawing boundaries between those who used psychedelics carefully and those who used them ignorantly. Yet these boundaries were not always so clear in the past. Drawing on historical examples of LSD's use as a correctional tool in Canada, I show how enthusiasm about the drug's potential led several experienced and knowledgeable psychedelic therapists to use it on vulnerable populations in diverse institutional settings, such as correctional facilities. These examples reveal how the institutional context of modern industrial societies shaped the application of psychedelic therapy in the past and suggest that today's therapists need to carefully consider how this broader context impacts their work.