Organizational and social justice paradoxes in EDI

This perspective article positions social justice as an addition to the aims of organizational justice, and core to diversity, equality, and inclusion (DEI). It problematizes simplistic DEI rhetoric and positions paradoxes within DEI, as experienced by employers, based on an explanation of key justice concepts and the introduction of fairness, equality, desert, and need. The paper broadens perspective-taking beyond a sole focus on beneficiaries of DEI, towards tensions that employers experience in working towards the aims of workplace justice, including the embeddedness of social justice within both organizations and social systems. The paper concludes with avenues for future research and a call to carefully examine simplistic notions of organizational justice in effecting DEI, suggesting a paradoxical lens on embracing, rather than avoiding, multiple and often conflicting workplace justice imperatives.

ESMO Expert Consensus Statements on the management of breast cancer during pregnancy (PrBC)

The management of breast cancer during pregnancy (PrBC) is a relatively rare indication and an area where no or little evidence is available since randomized controlled trials cannot be conducted. In general, advances related to breast cancer (BC) treatment outside pregnancy cannot always be translated to PrBC, because both the interests of the mother and of the unborn should be considered. Evidence remains limited and/or conflicting in some specific areas where the optimal approach remains controversial. In 2022, the European Society for Medical Oncology (ESMO) held a virtual consensus-building process on this topic to gain insights from a multidisciplinary group of experts and develop statements on controversial topics that cannot be adequately addressed in the current evidence-based ESMO Clinical Practice Guideline. The aim of this consensus-building process was to discuss controversial issues relating to the management of patients with PrBC. The virtual meeting included a multidisciplinary panel of 24 leading experts from 13 countries and was chaired by S. Loibl and F. Amant. All experts were allocated to one of four different working groups. Each working group covered a specific subject area with two chairs appointed: Planning, preparation and execution of the consensus process was conducted according to the ESMO standard operating procedures.

Impact of COVID-19 & Response Measures on HIV-HCV Prevention Services and Social Determinants in People Who Inject Drugs in 13 Sites with Recent HIV Outbreaks in Europe, North America and Israel

HIV/HCV prevention among people who inject drugs (PWID) is of key public health importance. We aimed to assess the impact of COVID-19 and associated response measures on HIV/HCV prevention services and socio-economic status of PWID in high-HIV-risk sites. Sites with recent (2011-2019) HIV outbreaks among PWID in Europe North America and Israel, that had been previously identified, were contacted early May 2020. Out of 17 sites invited to participate, 13 accepted. Semi-structured qualitative site reports were prepared covering data from March to May 2020, analyzed/coded and confirmed with a structured questionnaire, in which all sites explicitly responded to all 103 issues reported in the qualitative reports. Opioid maintenance treatment, needle/syringe programs and antiretroviral treatment /hepatitis C treatment continued, but with important reductions and operational changes. Increases in overdoses, widespread difficulties with food and hygiene needs, disruptions in drug supply, and increased homelessness were reported. Service programs rapidly reformed long established, and politically entrenched, restrictive service delivery policies. Future epidemic control measures should include mitigation of negative side-effects on service provision and socio-economic determinants in PWID.

Changes in training activity post COVID-19 infection in recreational runners and cyclists

Background

Anecdotal evidence suggests that athletes struggle to return to exercise post COVID-19 infection. However, studies evaluating the effect of COVID-19 on athletes' exercise activity are limited.

Objectives

The objectives of this study were: (i) to describe the perceptions of recreational runners and cyclists recovering from COVID-19 on their training activity and general well-being, (ii) to compare device-measured training data in runners and cyclists pre- and post COVID-19, with non-infected controls that had a training interruption.

Methods

Participants who were recruited via social media completed an online questionnaire (n=61), including demographic, health and COVID-19 descriptive data. In a sub-sample, device-measured training data (heart rate, time, distance and speed, n=27) were obtained from GPS devices for four weeks before infection and on resumption of training. Similar data were collected for the control group (n=9) whose training had been interrupted but by factors excluding COVID-19.

Results

Most participants experienced a mild to moderate illness (91%) that was associated with a training interruption time of two-four weeks. Decreases in heart rate, relative exercise intensity, speed, time and distance were observed during the first week of returning to training for both groups, followed by an increase from Week two onwards.

Discussion

Results failed to support a 'COVID-19 effect' on exercise activity as reductions in training variables occurred in both the COVID-19 and control groups. A possible explanation for the reductions observed is a deliberate gradual return to training by athletes post-COVID-19.

Conclusion

More research is needed using device-measured training data prior to and post COVID-19 infection to better understand the impact of the SARS-CoV-2 virus on the exercise activity of athletes.

PCSK-9-inhibitor therapy improves endothelial function in high-risk patients with cardiovascular disease

Background

Impaired endothelial function predicts cardiovascular events. The aim of this study was to analyse the effect of evolocumab on endothelial function in patients with cardiovascular disease and on obligatory statin therapy.

Methods

This was a prospective, double-blinded, randomized, controlled, single center study including patients with cardiovascular disease (diagnosis of coronary artery disease, non-hemorrhagic stroke, transient ischemic attack or symptomatic peripheral artery disease) and treated with statins, similar to the inclusion criteria of the FOURIER study. Patients were consecutively randomized (1:1) to either evolocumab treatment (420mg was administrated in monthly intervals, twice during the study) or placebo. All patients underwent examination of endothelial function at baseline, and after 1, 4 and 8 weeks of treatment by a semi-automatic high-resolution ultrasound system (UNEX EF 18G; Unex Co., Nagoya, Japan). Endothelial function parameter such as flow-mediated vasodilation (FMD; vasodilator responsiveness), low flow-mediated vasocontriction (L-FMC; vasoconstrictor responsiveness) and vasoactive range (VAR; total vasomotor responsiveness) were measured.

Results

103 patients with a mean age of 66.2 (±7.7) years and a mean LDL-cholesterol of 98.2 (±19.1) mg/dl completed the study. 83.5% of the study population was known to have coronary artery disease. Endothelial function parameter (VAR) increased after 8 weeks of treatment with evolocumab compared to baseline (p=0.034), whereas there was no significant change at 1 and 4 weeks after treatment. Moreover, an improvement in VAR from baseline at week 8 was found with evolocumab compared to placebo (p=0.045).

In a subgroup analysis, in patients with age ≤67 years, lower systolic blood pressure (≤125 mmHg) or higher baseline LDL-cholesterol (>95 mg/dl), significant evolocumab treatment effect was found in VAR improvement (p=0.006, p=0.049 and p=0.042, respectively) from baseline at week 8. No serious adverse event related to study medication occurred during the study.

Conclusion

Our data indicate that endothelial function could be improved with evolocumab treatment in high-risk patients with preexisting cardiovascular disease and on statin therapy. Our results contribute to the mechanistic explanation why lower incidence of the cardiovascular composite endpoint has been demonstrated in the FOURIER study.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): AMGEN GmbH

P-594 mRNA COVID-19 vaccine does not influence performance during oocyte donation cycles

Study question

What is the effect of mRNA SARS-CoV-2 vaccines on oocyte donors regarding oocyte quality, embryo development and clinical outcomes?

Summary answer

Oocyte quality, fertilization, blastocyst formation, embryo quality and pregnancy rates were similar following donors' mRNA SARS-CoV-2 vaccination compared to previous oocyte donation cycles.

What is known already

The severe acute respiratory syndrome Coronavirus 2 (SARS–CoV-2) infection, urged scientists to develop safe and effective vaccines. During the ongoing pandemic, the scientific community has promoted vaccination programs to reduce morbidity and mortality.

While it has been suggested that SARS–CoV-2 infection might impact fertility, limited evidence shows that vaccination has no influence on sperm parameters, follicular steroidogenesis, or oocyte quality and only one study reported no effects on fertilization or top-quality embryos rate in vaccinated patients undergoing IVF. There is a paucity of evidence with regards to younger population undergoing ovarian stimulation.

Study design, size, duration

This prospective, multicentre cohort study evaluated 32 oocyte donors with two controlled and similar ovarian stimulation, before and after complete SARS-CoV-2 vaccination, between November 2020 and January 2022. A total of 64 oocyte recipient cycles were analysed equally separately into these two groups. Severe male factor was excluded.

Participants/materials, setting, methods

Complete SARS-CoV-2 vaccination of the oocyte donor made the difference between the two groups of recipients analysed. The time frame between the previous ovarian stimulation and the vaccination was lower than 8 months. We evaluated and compared the rates of matured eggs (metaphase II, MII), the fertilization and blastocyst formation rates, blastocyst quality (A/B ASEBIR categories), positive pregnancy test and clinical pregnancy rates in both groups of recipients. The statistical analysis was performed using SPSS.

Main results and the role of chance

The average number of MII collected were similar before and following vaccination (12.23 vs 12.91, p = 0.198, respectively). In recipients, the outcomes with regards to fertilization rate (81.4% vs 77.3% p = 0.210), blastocyst formation rate (60.2% vs 61.5%, p = 0.771) and high-quality blastocysts (quality A: 31.1% vs 36.4% and quality B: 29.0% vs 25.1%, p = 0.430) did not differ statistically between the control group (n = 32, pre-vaccination) and the study group (n = 32, post-vaccination), respectively.

Furthermore, regarding clinical outcomes, there were not statistically differences in pregnancy rates (64.0% vs 77.4%, p = 0.269) or clinical pregnancy rates (60.0% vs 64.5%, p = 0.729) before and after vaccination respectively.

Limitations, reasons for caution

Our encouraging results should be interpreted with caution due to the small sample size and the short period of follow-up. Larger controlled trials are needed to corroborate our findings as the countries continue making forward with the vaccination campaign.

Wider implications of the findings

The present study suggests no influence of mRNA SARS-CoV2 vaccines on donor oocyte cycles, reflecting no detrimental effects on the assisted reproduction outcomes. The safety of SARS-CoV-2 vaccination concerning IVF cycles is encouraging for the medical community and the health of our patients.

Trial registration number

Not Applicable

AAV-mediated expression of secreted and transmembrane αKlotho isoforms rescues relevant aging hallmarks in senescent SAMP8 mice

Senescence represents a stage in life associated with elevated incidence of morbidity and increased risk of mortality due to the accumulation of molecular alterations and tissue dysfunction, promoting a decrease in the organism's protective systems. Thus, aging presents molecular and biological hallmarks, which include chronic inflammation, epigenetic alterations, neuronal dysfunction, and worsening of physical status. In this context, we explored the AAV9-mediated expression of the two main isoforms of the aging-protective factor Klotho (KL) as a strategy to prevent these general age-related features using the senescence-accelerated mouse prone 8 (SAMP8) model. Both secreted and transmembrane KL isoforms improved cognitive performance, physical state parameters, and different molecular variables associated with aging. Epigenetic landscape was recovered for the analyzed global markers DNA methylation (5-mC), hydroxymethylation (5-hmC), and restoration occurred in the acetylation levels of H3 and H4. Gene expression of pro- and anti-inflammatory mediators in central nervous system such as TNF-α and IL-10, respectively, had improved levels, which were comparable to the senescence-accelerated-mouse resistant 1 (SAMR1) healthy control. Additionally, this improvement in neuroinflammation was supported by changes in the histological markers Iba1, GFAP, and SA β-gal. Furthermore, bone tissue structural variables, especially altered during senescence, recovered in SAMP8 mice to SAMR1 control values after treatment with both KL isoforms. This work presents evidence of the beneficial pleiotropic role of Klotho as an anti-aging therapy as well as new specific functions of the KL isoforms for the epigenetic regulation and aged bone structure alteration in an aging mouse model.

Efficacy of AAV serotypes to target Schwann cells after intrathecal and intravenous delivery

To optimize gene delivery to myelinating Schwann cells we compared clinically relevant AAV serotypes and injection routes. AAV9 and AAVrh10 vectors expressing either EGFP or the neuropathy-associated gene GJB1/Connexin32 (Cx32) under a myelin specific promoter were injected intrathecally or intravenously in wild type and Gjb1-null mice, respectively. Vector biodistribution in lumbar roots and sciatic nerves was higher in AAVrh10 injected mice while EGFP and Cx32 expression rates and levels were similar between the two serotypes. A gradient of biodistribution away from the injection site was seen with both intrathecal and intravenous delivery, while similar expression rates were achieved despite higher vector amounts injected intravenously. Quantified immune cells in relevant tissues were similar to non-injected littermates. Overall, AAV9 and AAVrh10 efficiently transduce Schwann cells throughout the peripheral nervous system with both clinically relevant routes of administration, although AAV9 and intrathecal injection may offer a more efficient approach for treating demyelinating neuropathies.

Effect of empagliflozin on ketone bodies in patients with stable chronic heart failure

Background

Recent studies indicated that sodium glucose cotransporter (SGLT)2 inhibition increases levels of ketone bodies in the blood in patients with type 1 and 2 diabetes. Other studies suggested that in patients with chronic heart failure (CHF), increased myocardial oxygen demand can be provided by ketone bodies as a fuel substrate. Experimental studies reported that ketone bodies, specifically beta-hydroxybutyrate (β-OHB) may increase blood pressure (BP) by impairing endothelium-dependant relaxation, thereby leading to increased vascular stiffness. In our study we assessed whether the SGLT 2 inhibition with empagliflozin increases ketone bodies in patients with stable CHF and whether such an increase impairs BP and vascular function.

Methods

In a prospective, double blind, placebo controlled, parallel-group single centre study 75 patients with CHF (left ventricular ejection fraction 39.0 ± 8.2%) were randomised (2:1) to the SGLT-2 inhibitor empagliflozin 10 mg orally once daily or to placebo, 72 patients completed the study. After a run-in phase we evaluated at baseline BP by 24 h ambulatory blood pressure (ABP) monitoring, vascular stiffness parameters by the SphygmoCor system (AtCor Medical, Sydney, NSW, Australia) and fasting metabolic parameters, including β-OHB by an enzymatic assay (Beckman Coulter DxC 700 AU). The same measurements were repeated 12 weeks after treatment. In 19 of the 72 patients serum levels of β-OHB were beneath the lower border of our assay (< 0.05 mmol/l) therefore being excluded from the subsequent analysis.

Results

In patients with stable CHF, treatment with empagliflozin (n = 36) was followed by an increase of β-OHB by 33.39% (p = 0.017), reduction in 24 h systolic (p = 0.038) and diastolic (p = 0.085) ABP, weight loss (p = 0.003) and decrease of central systolic BP (p = 0.008) and central pulse pressure (p = 0.008). The increase in β-OHB was related to an attenuated decrease of empagliflozin-induced 24 h systolic (r = 0.321, p = 0.069) and diastolic (r = 0.516, p = 0.002) ABP and less reduction of central systolic BP (r = 0.470, p = 0.009) and central pulse pressure (r = 0.391, p = 0.033). No significant changes were seen in any of these parameters after 12 weeks of treatment in the placebo group (n = 17).

Conclusion

In patients with stable CHF ketone bodies as assessed by β-OHB increased after treatment with empagliflozin. This increase led to an attenuation of the beneficial effects of empagliflozin on BP and vascular parameters.

Trial registration The study was registered at http://www.clinicaltrials.gov (NCT03128528).

Reduced tissue sodium content is related to improvement of vascular function in patients with chronic heart failure treated with the SGLT2 inhibitor empagliflozin

Background

Large randomized controlled trials have demonstrated that SGLT2 inhibitors produce cardiovascular benefits beyond their metabolic effects. One of the assumed underlying mechanisms is the reduction of the left ventricular afterload. Factors aggravating the afterload are impaired vascular function (ventricular-arterial coupling) as well as high tissue sodium content, which exerts enhanced hypertrophic stimuli and exaggerated response to vasoconstrictors.

Purpose

We hypothesized that the SGLT2 inhibitor empagliflozin leads to afterload reduction in patients with chronic heart failure (CHF) by reducing tissue sodium content and improving vascular function and that these changes are related to each other.

Methods

In a randomized (2:1), investigator initiated, double-blind, placebo controlled, parallel-group, prospective clinical study, patients with CHF NYHA II-III and an ejection fraction of 49% or less were randomized to empagliflozin 10mg once daily or placebo. In each patient, we assessed vascular parameters under resting conditions (Sphygmocor) and 24-hour daily life conditions (Mobilograph), including central systolic pressure (cSBP) and central pulse pressure (cPP) among others. In parallel, we measured tissue (skin and muscle) sodium content of the lower leg by Sodium-MRI, at baseline and after 1 month of therapy.

Results

A total of 74 patients (men: n=62), aged 66±9 years, with a mean ejection fraction of 39±9% were included. Only 24% of the patients had type 2 diabetes. After 1 month treatment with empagliflozin, a decrease of skin sodium content was observed (22.8±6.1 vs. 21.6±6.0 mmol/l, p=0.039), while there was no significant change in muscle sodium and muscle water content. A decrease of cSBP (117.1±14.5 vs. 110.7±11.3 mmHg, p&lt;0.001) and cPP (41.4±8.8 vs. 38.4±8.5 mmHg, p=0.004) under resting conditions was observed after 1 month treatment with empagliflozin, while changes in the placebo group were not significant for cSBP (117.0±18.1 vs. 116.3±15.0 mmHg, p=0.759) and cPP (40.6±9.1 vs. 39.4±8.6 mmHg, p=0.422). Similarly, there was a decrease of cSBP and cPP in patients with empagliflozin treatment under ambulatory conditions, but not in the placebo group. In the whole group, we observed a significant correlation between change in skin sodium content and change in vascular parameters such as cSBP (r=0.364, p=0.004) and cPP (r=0.250, p=0.054) after 1 month of treatment with empagliflozin or placebo.

Conclusion(s)

Significant changes in skin sodium content induced by empagliflozin and a significant correlation between changes in skin sodium content and vascular function suggest that a reduction of tissue sodium content may be one of the mechanisms underlying the beneficial effects of SGLT2 inhibitors in heart failure.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Boehringer Ingelheim International GmbH.

Séroprévalence SARS-Cov-2 chez les professionnels de santé : étude multicentrique avec analyse des facteurs de risque professionnels et extraprofessionnels

Introduction

L’objectif de notre étude était d’évaluer la séroprévalence SARS-Cov-2 chez les professionnels de santé, après la première vague Covid-19, et d’analyser les facteurs professionnels et extraprofessionnels modifiant cette prévalence.

Matériels et méthodes

Suite aux instructions gouvernementales proposant de réaliser une sérologie Covid-19 à tout professionnel de santé après la première vague, nous avons réalisé une étude transversale, multicentrique. Tous les professionnels volontaires des quatre centres participants étaient invités à réaliser une sérologie et à remplir un questionnaire concernant leurs données démographiques, leurs caractéristiques professionnelles, l’utilisation des équipements de protection individuelle et l’exposition extra professionnelle au Covid-19. Nous avons calculé la prévalence SARS-Cov-2 et utilisé une régression logistique en appliquant un effet centre.

Résultats

Un total de 3454 professionnels ont participé à l’étude dont 83,4 % de femmes. L’âge moyen était de 40,6 ans [31,8–50,3]. En médiane, la prévalence sérologique SARS-Cov-2 était de 5 % (95 % IC, 4,3 %–5,8 %). Les facteurs associés à une plus forte séroprévalence étaient : l’âge < 30 ans (aOR = 1,59, (95 % IC, 1,06–2,37)), le statut d’étudiant (aOR = 3,38, (95 % IC, 1,62–7,05)) avec une séroprévalence de 16,9 % dans cette catégorie. L’unité de travail, y compris le fait d’avoir travaillé en unité Covid ou en réanimation, ainsi que l’exposition à des patients (quel que soit leur statut infectieux) n’étaient pas associé à une augmentation de la séroprévalence. Par contre les professionnels rapportant un contact avec un patient Covid, sans protection adaptée, ou ayant pratiqué des taches aérosolisantes, y compris avec un masque FFP2, avaient un surrisque d’infection Covid-19 (respectivement aOR à 1,66 et 1,7). Enfin, l’exposition à un collègue infecté ou à un cas familial était également associée à une augmentation de la prévalence sérologique.

Conclusion

Les mesures mises en place pour limiter la transmission du SARS-Cov-2 des patients aux professionnels de santé semblent efficaces. En complément de la vaccination, l’éviction systématique des professionnels infectés, la formation des étudiants et le rappel des mesures d’hygiène durant les temps de pause pourraient limiter la contamination des professionnels de santé.

Intrathecal AAVrh10 corrects biochemical and histological hallmarks of mucopolysaccharidosis VII mice and improves behavior and survival

Mucopolysaccharidosis (MPS) type VII is a lysosomal storage disease caused by ß-glucuronidase deficiency, prompting glycosaminoglycan accumulation in enlarged vesicles, leading to peripheral and neuronal dysfunction. Here, we present a gene therapy strategy using lumbar puncture of AAVrh10 encoding human β-glucuronidase (AAVrh10-GUSB) to adult MPS VII mice. This minimally invasive technique efficiently delivers the recombinant vector to the cerebrospinal fluid (CSF) with a single intrathecal injection. We show that AAVrh10 delivery to the CSF allows global, stable transduction of CNS structures. In addition, drainage of AAVrh10-GUSB from the CSF to the bloodstream resulted in the transduction of somatic organs such as liver, which provided a systemic β-glucuronidase source sufficient to achieve serum enzyme activity comparable to wild type mice. ß-glucuronidase levels were enough to correct biochemical and histopathological hallmarks of the disease in the CNS and somatic organs at short and long term. Moreover, the progression of the bone pathology was also reduced. Importantly, the biochemical correction led to a significant improvement in the physical, cognitive and emotional characteristics of MPS VII mice, and doubling their life span. Our strategy may have implications for gene therapy in patients with lysosomal storage diseases.

Gender pay transparency mechanisms: Future directions for South Africa

The gender pay gap – that is, the difference in wages between men and women for the same or substantially the same work, or work of equal value – still features prominently as a stumbling block in achieving South African gender equality. If South Africa is to dislodge its stagnant gender pay gap, especially for women in the middle and upper levels of the wage distribution, pay transparency – making gender differences in wages known to employees, government and the public – can compel employers to remunerate fairly and equally. We undertook a comparison between the global and national mechanisms of gender pay transparency to propose a way forward to increase transparency in gender pay for South Africa. In addition to a discussion of existing mechanisms, a summary of the gender pay transparency mechanisms of 16 countries is provided as supplementary material to the article. We found that South Africa could strengthen legislated transparency mechanisms, especially with regard to pay reporting and pay audits, provided that sanctions are attached to non-delivery of these duties. Reigniting the debate on strengthening and improving South African legislation and interpretation of existing governance codes in relation to the implementation, monitoring and enforcement of gender pay transparency mechanisms could strengthen the existing collective bargaining framework and provide the impetus to demonstrate that South Africa sees gender equality as an achievable reality, not an improbable ideology.

Gender pay transparency mechanisms: Future directions for South Africa

The gender pay gap – that is, the difference in wages between men and women for the same or substantially the same work, or work of equal value – still features prominently as a stumbling block in achieving South African gender equality. If South Africa is to dislodge its stagnant gender pay gap, especially for women in the middle and upper levels of the wage distribution, pay transparency – making gender differences in wages known to employees, government and the public – can compel employers to remunerate fairly and equally. We undertook a comparison between the global and national mechanisms of gender pay transparency to propose a way forward to increase transparency in gender pay for South Africa. In addition to a discussion of existing mechanisms, a summary of the gender pay transparency mechanisms of 16 countries is provided as supplementary material to the article. We found that South Africa could strengthen legislated transparency mechanisms, especially with regard to pay reporting and pay audits, provided that sanctions are attached to non-delivery of these duties. Reigniting the debate on strengthening and improving South African legislation and interpretation of existing governance codes in relation to the implementation, monitoring and enforcement of gender pay transparency mechanisms could strengthen the existing collective bargaining framework and provide the impetus to demonstrate that South Africa sees gender equality as an achievable reality, not an improbable ideology.

1416Combined therapy of empagliflozin and linagliptin is superior to metformin and insulin glargine in improving blood pressure and vascular function in type 2 diabetes

Background and purpose

The optimal choice of antidiabetic medication in patients that need combined therapy is under debate. The aim of this study was to analyze whether beyond glucose control the combination of empagliflozin (E) and linagliptin (L) improves blood pressure (BP) and vascular function in patients with type 2 diabetes (T2DM) as opposed to the combination of metformin (M) and insulin glargine (I).

Methods

This was a prospective, randomized, controlled, single center study including 101 patients with T2DM, who were randomized 1:1 to E 10–25mg combined with L 5mg once daily or M 850 or 1000mg twice daily combined with I once daily. All patients underwent BP measurement and vascular function analysis by validated systems at baseline and after 12 weeks of treatment.

Results

In comparison to baseline, office, 24-hour ambulatory BP as well as central blood and pulse pressure (PP) values decreased significantly after 12 weeks of treatment with E+L, whereas there was no change in the M+I group (see table). Twenty-four-hour peripheral systolic (mean difference: −5.2±1.5mmHg, p=0.004) and diastolic BP (−1.9±1.0mmHg, p=0.036), central clinical systolic BP (−5.56±1.9mmHg, p=0.009), forward pressure pulse height (−2.0±0.9mmHg, p=0.028), 24-h central systolic BP (−3.6±1.4mmHg, p=0.045) and 24-h pulse wave velocity (−0.14±0.05m/s, p=0.043) were reduced to a greater extent in the E+L than in the M+I group.

Empagliflozin+Linagliptin Metformin+Insulin Baseline 12 weeks p value Baseline 12 weeks p value Peripheral ambulatory BP values   24-h SBP [mmHg] 131.0±10.9 127.0±8.8 <0.001 131.0±9.7 131.0±8.6 0.438   24-h DBP [mmHg] 81.5±7.1 79.7±7.0 0.013 81.0±7.1 81.0±7.5 0.976 Clinical (laboratory) central vascular parameters   Central SBP [mmHg] 123.0±9.6 117.0±10.4 <0.001 121.0±9.9 121.0±8.3 0.944   Central PP [mmHg] 44.4±8.0 41.4±6.6 0.004 43.5±8.6 42.8±7.5 0.471   Forward pressure pulse height [mmHg] 33.0±5.7 30.2±4.6 <0.001 32.5±5.6 31.8±4.5 0.216   Central office PWV [m/s] 8.2±1.6 8.0±1.5 0.039 8.4±1.3 8.3±1.2 0.400 24-h ambulatory central vascular parameters   Central 24-h SBP [mmHg] 120.5±9.3 117.3±7.9 0.007 121.0±9.1 121.0±8.0 0.608   Central 24-h DBP [mmHg] 83.2±7.3 81.1±6.9 0.016 82.4±7.1 82.4±7.7 0.928   Central 24-h PWV [m/s] 8.9±1.3 8.8±1.3 0.010 9.0±1.4 9.0±1.3 0.349 SBP, systolic blood pressure; DBP, diastolic blood pressure; PP, pulse pressure; PWV, pulse wave velocity.

Conclusion

The combination of E+L significantly improves BP and vascular function in contrast to the combination of M+I.

Acknowledgement/Funding

This IIS was supported by a research grant from Boehringer Ingelheim International GmBH

Gender traits in relation to work versus career salience

Orientation: The concepts of work- and career-role salience are used interchangeably, yet work focuses on the short-term aspect and career on the long-term aspect.Research purpose: We utilised gender traits, that is, masculinity, femininity and psychological androgyny, to find greater nuances in the salience of work versus career roles. We also set out to confirm the adapted factor structure of the revised Bem Sex Role Inventory (BSRI).Motivation for the study: Generally, self-reported sex is used to determine differences in role salience between men and women, as opposed to considering the gender roles people associate with.Research approach/design and method: A sample of 395 South African employees was used. Structural equation modelling and t-tests were applied.Main findings: We confirmed work- and career-role salience as distinct constructs. The factor structure of the revised BSRI holds for this study. With regard to gender traits, femininity decreased work-role salience, while psychological androgyny increased work-role salience. Masculinity had a direct effect on work-role salience while indirectly influencing career-role salience through work-role salience. Women were found to be significantly more feminine and psychologically androgynous than men.Practical/managerial implications: Utilising gender traits may have greater career guidance relevance for individuals than traditional approaches utilising differences between the sexes.Contribution/value-add: This study confirmed that work and career roles are to be viewed as separate constructs and that people may view the importance placed on work- and career-role salience differently. The study further contributes by including gender traits as a significant contributor to role salience.

A Rasch Adapted Version of the 30-Item Bem Sex Role Inventory (BSRI)

As a foundational instrument in the measurement of gender, the study investigated the psychometric properties of the item scores on the 30-item Bem Sex Roles Inventory (BSRI) to address concerns raised in previous studies and to determine possible differential item functioning (DIF) by applying a Rasch measurement model on a multicultural South African sample. A quantitative cross-sectional research design with 55.3% women and 44.4% men was used. Overall, we found support for the reliability and validity of BSRI item scores, consistent with findings in North American and European contexts. The results supported the use of a 6-point response format as opposed to the original 7-point response format. The items "aggressive" (masculinity) and "loves children" (femininity) were removed. The Neutral dimension fit the data well. No DIF for the groupings of man/woman, race, and language (the latter 2 as measures of culture) were found. This study makes contributions by applying a Rasch measurement model to the BSRI, scores which have previously only been validated through classical test theory and often excludes the validation of the neutral dimension scores.

A practical approach to tuberculosis diagnosis and treatment in liver transplant recipients in a low-prevalence area

Solid organ transplant candidates/recipients are at risk of mycobacterial infections. Although guidelines on the management of latent tuberculosis infection and active tuberculosis are available for solid organ transplant recipients, limited guidance focuses on end-stage liver disease or liver transplant recipients who require management in a referral center. Therapeutic challenges arise from direct antituberculosis drug-related hepatotoxicity, and substantial metabolic interactions between immunosuppressive and antituberculosis drugs. Another issue is the optimal timing of therapy with regards to the time of transplantation. This review focuses on the importance of tuberculosis screening with immunological tests, challenges in the diagnosis, management, and treatment of latent tuberculosis infection and active tuberculosis, as well as risk assessment for active tuberculosis in the critical peri-liver transplantation period. We detail therapeutic adjustments required for the management of antituberculosis drugs in latent tuberculosis infection and active tuberculosis, particularly when concomitantly using rifampicin and immunosuppressive drugs.

Persistence of Hepatitis A Virus in Fresh Produce and Production Environments, and the Effect of Disinfection Procedures: A Review

Although information is limited, it is evident that prolonged persistence of infectious Hepatitis A virus (HAV) is a factor in the transmission of the virus via fresh produce. Consequently, data on persistence of the virus on produce, and in environments relevant to production, such as soils, water and surfaces, are required to fully understand the dynamics of transmission of HAV via foods. Furthermore, information on effective disinfection procedures is necessary to implement effective post-harvest control measures. This review summarises current information on HAV persistence in fresh produce and on relevant disinfection procedures. On vegetables, HAV can remain infectious for several days; on frozen berries, it can persist for several months. HAV can remain infectious on surfaces for months, depending on temperature and relative humidity, and can survive desiccation. It can survive for several hours on hands. Washing hands can remove the virus, but further data are required on the appropriate procedure. Chlorination is effective in water, but not when HAV is associated with foodstuffs. Bleach and other sodium hypochlorite disinfectants at high concentrations can reduce HAV on surfaces, but are not suitable for use on fresh produce. There is only limited information on the effects of heating regimes used in the food industry on HAV. HAV is resistant to mild pasteurisation. Some food components, e.g. fats and sugars, can increase the virus' resistance to higher temperatures. HAV is completely eliminated by boiling. Quantitative prevalence data are needed to allow the setting of appropriate disinfection log reduction targets for fresh produce.

Abstract OT3-06-03: ABC-SE, Advanced Breast Cancer – Statins and Endocrine treatment

Full Title: A randomized, open-label, multi-center, phase II study to compare the efficacy and tolerability of atorvastatin 40 mg in addition to endocrine treatment in patients with estrogen receptor (ER) positive advanced breast cancer with focus on mechanisms of resistance.

Background: The majority of metastatic breast cancer patients progress during endocrine therapy and eventually become resistant to treatment. Understanding how metastatic cancer cells adapt to different therapies is key for the development of improved treatment regimens. The effectiveness of endocrine therapy in ER+ tumors may be influenced by cholesterol through the cholesterol metabolite oxysterol 27-hydroxycholesterol, which acts as an ER ligand, harboring the ability to regulate ER-dependent tumor growth. Statin-mediated inhibition of the cholesterol pathway has been demonstrated to induce anti-neoplastic effects in both breast cancer cells and human breast cancer. Hence the goal of this study is to both understand the mechanisms of resistance to endocrine treatment and test the hypothesis that addition of statins will enhance the efficacy of endocrine treatment.

Trial Design: A multi-center randomized, open-labelled, phase II trial in the first and second line metastatic treatment setting, comparing standard endocrine treatment (letrozole) with letrozole +/- atorvastatin (1:1). Upon progression in the first line setting, and as part of the translational studies of mechanisms of resistance to endocrine therapy, the patients receive second line endocrine treatment using fulvestrant.

Eligibility criteria: 1) Patients diagnosed with ER positive/HER2 negative metastatic breast cancer, including locally advanced stage IV disease, requiring systemic endocrine treatment. 2) No Previous treatment for metastatic breast cancer, unless being considered for direct entry to the second part of the study with fulvestrant.

Specific aims: To test the clinical efficacy of adding statins to endocrine treatment in advanced breast cancer. Primary endpoint: Clinical benefit rate, defined as the proportion of all randomly assigned patients who have the best overall response; complete response, partial response, or stable disease for at least 24 weeks following first-line letrozole treatment alone or in combination with atorvastatin. Translational endpoint: To elucidate mechanisms of resistance to endocrine treatment alone or in combination with statins in ER+ metastatic breast cancer.

Statistical Methods:The primary endpoint of clinical benefit rate will be compared in the two groups using a logistic regression model where the odds ratios and associated 95% CIs and p-values will be reported. The secondary endpoint, progression-free-survival, will be analyzed in crude analysis using the Kaplan-Meier and Log-Rank test as well as the Cox regression hazards analysis with the latter allowing for confounder-controlled multivariate analysis.

Present accrual and target accrual: The trial started recruiting as of October 10, 2016. The target accrual is 126 patients, whereof 17 are presently included in the trial.

Contact information for people with a specific interest in the trial:

Signe.Borgquist@med.lu.se

Citation Format: Borgquist S, Ekholm M, Feldt M, Schyman T, Zackrisson S, Bosch A. ABC-SE, Advanced Breast Cancer – Statins and Endocrine treatment [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT3-06-03.

SGLT-2-inhibition with dapagliflozin reduces tissue sodium content: a randomised controlled trial

Background and aims

Sodium tissue content by ²³Na magnetic resonance imaging (Na-MRI) has been validated in experimental and human studies. SGLT-2 inhibition blocks the reabsorption of glucose and of sodium in the proximal tubular cells in a 1:1 fashion. We hypothesized that SGLT-2 inhibition in patients with type 2 diabetes characterized by sodium retention leads to decreased tissue sodium content due to its pharmacological action.

Materials and methods

In a prospective double blind, placebo controlled, cross-over trial 59 patients (61 ± 7.6 years) with type 2 diabetes were randomized to either dapagliflozin 10 mg or placebo once daily for 6 weeks each. In addition to metabolic parameters and ambulatory blood pressure (BP) we analysed the sodium content in the skin and muscles of the lower leg by Na-MRI.

Results

Compared to baseline 6 weeks treatment with the SGLT-2 inhibitor dapagliflozin decreased fasting (132 ± 28 vs. 114 ± 19 mg/dl, p < 0.001), postprandial blood glucose (178 ± 66 mg/dl vs. 153 ± 46 mg/dl, p < 0.001), body weight (87.6 vs. 86.6 kg, p < 0.001) and systolic (129 ± 12 vs. 126 ± 11 mmHg, p = 0.010), and diastolic (77.4 ± 9 vs. 75.6 ± 8 mmHg, p = 0.024), 24-h ambulatory BP. Tissue sodium content in the skin was reduced after 6 weeks treatment with dapagliflozin compared to baseline [24.1 ± 6.6 vs. 22.7 ± 6.4 A.U.(arbitrary unit) p = 0.013]. No significant reduction of tissue sodium content was observed in the muscle (M. triceps surae: 20.5 ± 3.5 vs. 20.4 ± 3.7 A.U. p = 0.801). No clear significant difference in tissue water content of muscle and skin was observed after 6 weeks of treatment with dapagliflozin, compared to baseline.

Conclusion

SGLT-2 inhibition with dapagliflozin resulted in a significant decrease in tissue sodium content of the skin after 6 weeks. This observation point to a decrease of total sodium content in patients with type 2 diabetes prone to cardiovascular complications, that might be mitigated by SGLT-2 inhibition.

Trial registration The study was registered at http://www.clinicaltrials.gov (NCT02383238) retrospectively registered

Analytical techniques for deoxynivalenol detection and quantification in wheat destined for the manufacture of commercial products

The concern regarding toxicity from the presence of deoxynivalenol (DON) in wheat that affects both economy and public health leads to the need to find appropriate detection methods for determining the degree of DON contamination in terms of the equipment available and the speed required for obtaining the incidence. The objective of this study was to compare the performance of two alternative analytical techniques for DON quantification for use in the food industry with a reference technique. Samples of wheat and the commercial by-products were analysed by high-performance liquid chromatography (HPLC) with an ultraviolet detector as the reference method and the results compared with those obtained from a rapid lateral-flow immunochromatographic device (Reveal Q+) and of a Fourier-transform-infrared (FTIR) spectroscopy technique. Pearson’s correlation coefficient between the HPLC and Reveal-Q+ data (0.45), although significant (P<0.0003), was lower than that obtained between HPLC and the FTIR method (0.94, P<0.0001). Both methods were considered efficient in quantifying DON levels in wheat-flour samples. This study was aimed at assisting the producers in choosing an appropriate tool for the purpose of analysis and upon consideration of the available equipment.

What makes representation of executive women in business happen?

Purpose

The purpose of this paper is to identify the underlying organisational features, according to the gendered organisation theory, that have contributed to high levels of representation of women executives, contrary to the trend in the South African financial services industry.

Design/methodology/approach

A critical realist approach was employed, using semi-structured interviews, based on a theoretical framework of the gendered organisation. Data were aligned to the theoretical levels of critical realism.

Findings

The research found that the pool from which the successful candidates were appointed was influenced by two features. The first was the perceived attractiveness of the organisation as an employer, composed of organisational prestige, opportunity for altruism, and the sex of the CEO. The second was the role of the CEO as gatekeeper, most notably the CEO’s network and the impact of the similar-to-me paradigm during selection.

Originality/value

The utilisation of critical realism as an approach allowed for organisational features embedded in the theory of the gendered organisation to be identified and gives an indication of how the number of women at executive management level may be increased. The salient factors are the role the woman CEO played in the inclusion of more women at the executive level by virtue of her being a woman, and the attractiveness of the organisation to women employees. Organisational features identified were gendered towards the feminine.

An analysis of Comrades marathon records: A 2008 update

An analysis of Comrades marathon records: A 2008 update

Abstract P3-04-27: Delineating novel molecular pathways driving endocrine resistance in breast cancer

Background

Estrogen receptor (ER) is a main driver of tumor progression in ER+ metastatic breast cancer (MBC). The use of endocrine therapy can effectively control the disease in a large proportion of patients. However, the majority of MBC eventually become resistant and progress. To elucidate the mechanisms of acquired resistance to endocrine treatment is key in order to better select therapeutic partners and delay disease progression.

Methods

A panel of ER+ breast cancer cell lines initially sensitive to the selective estrogen receptor degrader (SERD) fulvestrant was exposed to increasing concentrations of this drug over several months to induce resistance. Cell proliferation was determined with the xCELLigence system. Protein expression was measured by phospho-kinase array and western blotting. RNA expression was evaluated by gene expression microarray analysis (Illumina) and validated by RT-qPCR. Cell cycle distribution was analyzed by flow cytometry.

Results

Using an unbiased approach to identify pathways that drive endocrine resistance, both the parental and the resistant cell models were studied. As expected, fulvestrant treatment resulted in G1-cell cycle arrest in the parental cell lines.

In stark contrast, resistant cells bypassed fulvestrant-induced proliferation block despite a lower expression of genes driving mitotic progression compared to untreated parental cells. This gene expression pattern was coupled with a reduction of ER protein level in the resistant cells, which was in line with a significant decrease in the expression of ER-target genes. Our phospho-screen analysis showed a genotype specific down-modulation of p53 and up-regulation of several signaling components of mitogenic pathways in resistant cells compared to parental cells.

Conclusions

Our results suggest that acquired endocrine resistance is driven by multiple cell-specific mechanisms rather than a common molecular underpinning. Strikingly, there is one unique feature in our models, which is a cellular switch towards an ER-independent gene expression program. Ongoing in vitro and in vivo studies, aimed at further characterizing these cellular models, will provide valuable insights into the heterogeneity underlying the response to endocrine treatment observed in MBC patients.

Citation Format: Bosch A, Staaf J, Akrap N, Kaminska KK, Borgquist S, Borg Å, Honeth G. Delineating novel molecular pathways driving endocrine resistance in breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-04-27.

Development of a Toughened Epoxy Resin Matrix for Use in Advanced Composites

A series of high performance, toughened epoxy resins has been developed as matrices for advanced composites. The resin systems possess excellent processability with a wide processing window. Preimpregnated fiber ( prepreg) exhibits good tack and drape. Carbon fiber composite laminates possess an excellent balance of mechanical properties, particularly with intermediate modulus fibers. Toughness, as measured by post impact compression strength, is extremely high. With an impact energy of 1500 in. Ib/in. ( 6.7 J/mm) compression strength values of up to 48 ksi ( 328 MPa) have been achieved.

An organisational coherence model to maintain employee contributions during organisational crises

Orientation: Crises that threaten an organisation’s continued existence cannot be seen in isolation when considering the perception of threats to individual job security. These threats often go hand in hand with employee panic.Research purpose: The aim of this study was to establish a model to assist organisations in managing employee emotionality and panic during times of crisis.Motivation for the study: Environmental crises threaten organisations’ existence, threatening employees’ livelihood and resulting in employee panic. Panic reduces employees’ contributions. Organisations that are successful harness employee contributions at all times.Research design, approach, and method: A modernist qualitative research methodology was adopted, which included a case study as research strategy, purposive sampling to select 12 research participants, semi-structured interviews for data gathering, focus groups for data verification, and the use of grounded theory for data analysis.Main findings: An organisation’s ability to manage employee panic depends on the relationship between the foundational elements of authentic leadership, crisis readiness, resilience practices, versatile and committed talent, strategic management, quality management, and coherence actions taken during the crisis, which include crisis leadership, ongoing visible communication, mindfulness, work flexibility, and decisions based on the greatest financial need and social support.Practical/managerial implications: The study provides a best-practice option for managing emotionality during crises for the case organisation and other organisations within the vehicle components and other manufacturing industries.Contribution/value-add: The Coherence Hexagons Model is presented as a tool to manage employee panic during crisis.Keywords: crisis management; employee emotionality; employee panic; authentic leadership; talent management

Retention of women accountants: The interaction of job demands and job resources

Orientation: Most CEOs in South Africa are chartered accountants (CAs). Retaining women CAs might therefore lead to an increase in women in leadership. The Job Demands-Resources model presents a framework to investigate organisational job-related factors that promote or deter voluntary turnover of women CAs.Research purpose: The primary objective was to investigate which organisational factors promote or reduce the risk of turnover intentions for South African women CAs. The secondary objective was to investigate the moderating potential of job resources on the relationship between job demands and turnover intentions.Motivation for the study: There is a fair amount of research on the problems associated with the retention of women CAs in public practice but very little is known about how those problems interact with each other, and whether there are factors that could buffer them.Research design, approach, and method: The study consisted of a sample (n = 851) of women CAs in public practice firms nationally in South Africa. We used structural equation modelling together with moderated regression analysis.Main findings: Job demands promote turnover intentions, whereas job resources have a negative effect on turnover intentions. Counter-intuitively a negative direct effect was found between job insecurity and turnover intentions. Statistical support was found for the moderating role of all job resources, except financial advancement, on the relationship between work–family conflict and turnover intentions; and growth opportunities, on the relationship between job insecurity and turnover intentions.Practical/managerial implications: No job resource measured could buffer the impact of job overload on turnover intentions.Contribution: This is the first study to investigate factors that may retain women CAs in public practice audit, tax, and advisory firms (Big Four Accountancy Firms) using the JD-R model. Few studies have investigated the buffering effect of job resources on the relationship between job demands and turnover intentions in general.Keywords: gender; auditing; voluntary turnover; female; moderate; JD-R model

An analysis of Comrades marathon records: A 2008 update

An analysis of Comrades marathon records: A 2008 update

Direct ultrafiltration performance and membrane integrity monitoring by microbiological analysis

The feasibility of substituting a conventional pre-treatment, consisting of dioxi-chlorination, coagulation/flocculation, settling and sand filtration, of a drinking water treatment plant (DWTP) by direct ultrafiltration (UF) has been assessed from a microbiological standpoint. Bacterial indicators, viral indicators and human viruses have been monitored in raw river, ultrafiltered and conventionally pre-treated water samples during two years. Direct UF has proven to remove bacterial indicators quite efficiently and to a greater extent than the conventional process does. Nevertheless, the removal of small viruses such as some small bacteriophages and human viruses (e.g. enteroviruses and noroviruses) is lower than the current conventional pre-treatment. Membrane integrity has been assessed during two years by means of tailored tests based on bacteriophages with different properties (MS-2, GA and PDR-1) and bacterial spores (Bacillus spores). Membrane integrity has not been compromised despite the challenging conditions faced by directly treating raw river water. Bacteriophage PDR-1 appears as a suitable microbe to test membrane integrity, as its size is slightly larger than the considered membrane pore size. However, its implementation at full scale plant is still challenging due to difficulties in obtaining enough phages for its seeding.

Graduate identity development in South Africa

Purpose

– The purpose of this paper is to focus on the misunderstandings that hamper the graduate identity development process of black South African graduates in the first year of work. The authors introduce the role of an independent mediator in supporting identity development in a graduate development programme (GDP). The independent mediator mediates between graduate and manager when misunderstandings occur that inhibit the warranting process during professional identity development.

Design/methodology/approach

– In seeking to understand the graduate transition from student to professional, the authors used identity studies as the foundation from which to track a group of 21 graduates on a year-long GDP, in a financial institution in Johannesburg, South Africa. A model of emergent graduate identity was utilised to gain insight into the warranting process and associated behaviours that graduates employ in their interactions with others in the workplace.

Findings

– As warranting is based on people’s own assumptions and beliefs about a particular situation or role, misunderstandings can occur during the warranting process when graduates are determining their professional identity, and managers are either affirming of disaffirming this identity. These misunderstandings were exacerbated by the fact that the graduates were often South African multi-cultural, first-generation professionals who lacked insight into and experience of corporate dynamics, this impacted on how they found their place in the organisation. Both graduates and managers were often not equipped to deal with cultural, racial, and other differences. When the graduate programme manager stepped in to play the additional role of independent mediator, helping to mediate misinterpretations during the identity formation process, the negative impact of misunderstandings was lessened, and graduates transitioned to a professional identity with greater ease. Managers also learned about managing multi-cultural individuals and their own, often limiting, experiences and worldviews.

Practical implications

– This highlights the value of a third-party intervention in graduate identity transitions, particularly in contexts where the graduate has little or no experience of what it means to be professional, and where managers are not equipped to deal with people who come from backgrounds that differ vastly from their own.

Originality/value

– The role of a third-party in shaping the identities of graduates during the identity warranting process, referred to as the independent mediator in this paper, has not been presented in research before. Studies of this nature would give us insight into how best to support graduate identity development and improve the design of GDPs.