Screening, brief intervention, and referral to treatment for tobacco consumption, alcohol misuse, and physical inactivity: an equity-informed rapid review

OBJECTIVE

This rapid review systematically synthesizes evidence of the effectiveness of the Screening, Brief Intervention, and Referral (SBIR/T) approach for tobacco use, alcohol misuse, and physical inactivity.

STUDY DESIGN

This was a rapid review.

METHODS

We searched primary studies between 2012 and 2022 in seven electronic databases. The search strategy used concepts related to alcohol-related disorders, intoxication, cigarette, nicotine, physical activity, exercise, sedentary, screening, therapy, and referral. We reviewed both title/abstract and full-text using a priori set inclusion and exclusion criteria to identify the eligible studies. We appraised study quality, extracted data, and summarized the characteristics of the included studies. We applied health equity lenses in the synthesis.

RESULTS

Of the 44 included studies, most focused on alcohol misuse. SBIR/T improved patients' attitudes toward alcohol behavior change, improved readiness and referral initiation for change, and effectively reduced alcohol consumption. Few studies pertained to smoking and physical inactivity. Most studies on smoking demonstrated effectiveness pertaining to patients' acceptance of referral recommendations, improved readiness and attempts to quitting smoking, and reduced or cessation of smoking. Findings were mixed about the effectiveness of SBIR/T in improving physical activity. Minimal studies exist on the impacts of SBIR/T for these three risk factors on healthcare resource use or costs. Studies considering diverse population characteristics in the design and effectiveness assessment of the SBIR/T intervention are lacking.

CONCLUSIONS

More research on the impacts of SBIR/T on tobacco use, alcohol misuse, and physical inactivity is required to inform the planning and delivery of SBIR/T for general and disadvantaged populations.

Structure guided mutagenesis of Henipavirus Receptor Binding Proteins reveals molecular determinants of receptor usage and antibody binding epitopes

Nipah virus (NiV) is a highly lethal, zoonotic henipavirus (HNV) that causes respiratory and neurological signs and symptoms in humans. Similar to other paramyxoviruses, HNVs mediate entry into host cells through the concerted actions of two surface glycoproteins: a receptor binding protein (RBP) that mediates attachment and a fusion glycoprotein (F) that triggers fusion in an RBP-dependent manner. NiV uses ephrin-B2 (EFNB2) and ephrin-B3 (EFNB3) as entry receptors. Ghana virus (GhV), a novel HNV identified in a Ghanaian bat, use EFNB2 but not EFNB3. In this study, we employ a structure-informed approach to identify receptor interfacing residues and systematically introduce GhV-RBP residues into a NiV-RBP backbone to uncover the molecular determinants of EFNB3 usage. We reveal two regions that severely impair EFNB3 binding by NiV-RBP and EFNB3-mediated entry by NiV pseudotyped viral particles. Further analyses uncovered two point mutations (NiVN557SGhV and NiVY581TGhV) pivotal for this phenotype. Moreover, we identify NiV interaction with Y120 of EFNB3 as important for usage of this receptor. Beyond these EFNB3-related findings, we reveal two domains that restrict GhV binding of EFNB2, identify the HNV-head as an immunodominant target for polyclonal and monoclonal antibodies, and describe putative epitopes for GhV and NiV-specific monoclonal antibodies. Cumulatively, the work presented here generates useful reagents and tools that shed insight to residues important for NiV usage of EFNB3, reveals regions critical for GhV binding of EFNB2, and describes putative HNV antibody binding epitopes.

Integrating a Tool to Automatically Determine Necessity of Online Adaptive Replanning

PURPOSE/OBJECTIVE(S)

As online adaptive replanning (OLAR) is labor-intensive and time-consuming, it's desirable to determine when OLAR is necessary before OLAR is initiated. We have previously reported a novel method to automatically determine the necessity of OLAR using machine leaning algorithms based on the structural similarity maps (SSIM) and wavelet texture maps (WMT) extracted from the daily MRI during MR-guided adaptive radiation therapy (MRgART). This study aims to integrate this method into a commercial software platform that has been used during our routine MRgART.

MATERIALS/METHODS

The method of automatically determining the necessity of OLAR based on daily MRI was implemented and integrated into the software platform through a specifically developed workflow. The obtained workflow was tested using 25 daily MRI sets acquired from 5 patients with pancreatic cancer in the following procedure: 1) rigidly registering the daily and reference MRIs, 2) identifying the region enclosed by the 50-100% iso-dose surfaces on the daily MRI by transferring the iso-dose surfaces from the reference to the daily MRIs, 3) launching our in-house codes to calculate significant changes in textures extracted from SSIM and WMT maps, 4) inputting the feature values into the pre-trained classifier models for SSIM and WMT, and 5) outputting results considering the WMT based prediction as the primary indicator and the SSIM-based as the secondary (validation) indicator on whether OLAR is needed for the daily MRI.

RESULTS

The execution of the developed workflow was fast and can be used to streamline the process. It provides the ability to scroll through the images for better decision making while providing quantitative prediction within 30-38 seconds. Eighty percent of the daily MRIs required OLAR. The SSIM map displayed was able to successfully captured the areas of similarity between the reference and daily MRIs and the WMT prediction agreed with the prediction class.

CONCLUSION

The integration of the prediction method for automatically determining the necessity of OLAR based on two independent machine learning classifiers into a commercially available software is feasible and can be used to streamline the process of MRgART. With larger verification studies, this workflow-based tool may be developed into a generalized tool that assist in OLAR using different platforms.

Evaluation of a retinol containing topical treatment to improve signs of neck aging

BACKGROUND

The neck region is an area that can be indicative of signs of skin aging. A novel topical product that combines multiple active ingredients including retinol, tripeptide and glaucine was formulated to specifically target neck aging correction and complement post-procedure as part of an integrated skincare regimen.

OBJECTIVES

To evaluate the efficacy of a topical neck treatment through clinical subject evaluation, in addition to ultrasound and biopsy assessment.

METHODS

Evaluation for the efficacy of this novel topical product on improving the aging signs of neck skin was performed in multiple clinical trials. The first trial focused on clinical efficacy and included clinical assessment, subject questionnaires, ultrasound imaging and digital photographs. The second trial focused on biomarker analysis through skin biopsy.

RESULTS

Data from the clinical trials showed that aging signs on the neck were significantly improved after 12 or 16 weeks of product usage. Changes were readily observed by clinical evaluators and participants. They were documented with digital photos, ultrasound images, and biomarker expression in the skin which clearly display the improvements.

CONCLUSIONS

This novel topical product is effective in treating the aging signs on the neck skin and has been shown to provide statistically significant improvement on a myriad of neck aging attributes including fine lines/wrinkles, crepiness, laxity, and texture.

An eco-friendly system for stabilization of retinol: A step towards attending performance with improved environmental respect

OBJECTIVE

Retinol (Vitamin A) is one of the most effective molecules for the treatment of skin aging. However, it degrades rapidly under the influence of light, oxygen, metal ions, and oxidizing agents. To prevent this, stabilizing systems are used commonly. Notably, butylated hydroxytoluene (2,6-di-tert-butyl-p-cresol) (BHT) and ethylenediaminetetraacetic acid (EDTA) salts exhibit excellent antioxidant and metal-chelating properties but are not eco-friendly. In this study, our goal was to develop a new eco-friendly stabilization system for retinol-based formulations such that the system does not interfere with retinol skin absorption, nor its clinical efficacy.

METHODS

An evaluation tool called the Sustainable Product Optimization Tool (SPOT) was used to assess the environmental performance of formulations containing retinol and the various stabilizers investigated. Accelerated stability tests were performed on formulations stored for 2 months at 4 and 45°C (ISO/TR Standard 18811 2018 directives). Long-term stability evaluation was done on formulations stored for 24-months at room temperature. Retinol skin absorption was assessed by the Franz cell method using human skin explants (OECD guideline 428). Finally, a clinical study was performed to evaluate the cosmetic performance of a 0.3% stabilized retinol formulation.

RESULTS

N,N'-ethylenediamine disuccinic acid ([S,S]-EDDS isomer) and pentaerythritol tetrakis(3,5-di-tert-butyl-4-hydroxyhydrocinnamate) (PBHC) showed higher biodegradability and a reduced water footprint compared with those of BHT and EDTA. The SPOT simulation gave [S,S]-EDDS + PBHC a score of 10 versus 8.84 for EDTA + BHT. Moreover, [S,S]-EDDS + PBHC better controlled the chemical degradation of retinol compared with EDTA + BHT. Retinol skin absorption was also achieved in the case of a formulation containing [S,S]-EDDS + PBHC, and several skin attributes improved significantly after 12 weeks of product use, with over 75% of the panel perceiving benefits.

CONCLUSION

Regarding retinol stabilization, the PBHC + [S,S]-EDDS combination is an eco-friendlier and more effective alternative to BHT + EDTA.

Uncertainty in phosphorus fluxes and budgets across the U.S. long-term agroecosystem research network

Phosphorus (P) budgets can be useful tools for understanding nutrient cycling and quantifying the effectiveness of nutrient management planning and policies; however, uncertainties in agricultural nutrient budgets are not often quantitatively assessed. The objective of this study was to evaluate uncertainty in P fluxes (fertilizer/manure application, atmospheric deposition, irrigation, crop removal, surface runoff, leachate) and the propagation of these uncertainties to annual P budgets. Data from 56 cropping systems in the P-FLUX database, which spans diverse rotations and landscapes across the U.S. and Canada, were evaluated. Results showed that across cropping systems, average annual P budget was 22.4 kg P ha^-1 (range = -32.7 to 340.6 kg P ha^-1 ), with an average uncertainty of 13.1 kg P ha^-1 (range = 1.0 to 87.1 kg P ha^-1 ). Fertilizer/manure application and crop removal were the largest P fluxes across cropping systems and, as a result, accounted for the largest fraction of uncertainty in annual budgets (61 and 37%, respectively). Remaining fluxes individually accounted for <2% of the budget uncertainty. Uncertainties were large enough that determining whether P was increasing, decreasing, or not changing was inconclusive in 39% of the budgets evaluated. Findings indicate that more careful and/or direct measurements of inputs, outputs, and stocks are needed. Recommendations for minimizing uncertainty in P budgets based on the results of the study were developed. Quantifying, communicating, and constraining uncertainty in budgets among production systems and multiple geographies is critical for engaging stakeholders, developing local and national strategies for P reduction, and informing policy. This article is protected by copyright. All rights reserved.

Initial phase establishment of an in vitro method for developmental neurotoxicity test using Ki-67 in human neural progenitor cells

Building a precise alternative neurotoxicological test is of great importance to respond to societal and ethical requirements. In this study, a new developmental neurotoxicity test (DNT) was established with the human neural progenitor cell line. ReNcell CX cells were exposed to neurotoxic chemicals (aphidicolin, hydroxyurea, cytosine arabinoside, 5-fluorouracil, and ochratoxin A) or non-neurotoxic chemicals (sodium gluconate, sodium bicarbonate, penicillin G, and saccharin). Propidium iodide (PI) was used to evaluate cell viability. BrdU and Ki-76 were employed to determine cell proliferation. Based on the cell viability and proliferation, mathematical models were built by linear discriminant analysis. Furthermore, the neurotoxic-considered chemicals inhibited cell cycle progression at the protein level, supporting the biomolecular rationale for the predictive model. Overall, these results show that the new test method can be used to determine the potential developmental neurotoxicants or new drug candidates.

Integrating EM and Patch-seq data: Synaptic connectivity and target specificity of predicted Sst transcriptomic types

Neural circuit function is shaped both by the cell types that comprise the circuit and the connections between those cell types ¹ . Neural cell types have previously been defined by morphology ^{2, 3} , electrophysiology ^{4, 5} , transcriptomic expression ^6-8 , connectivity ^9-13 , or even a combination of such modalities ^14-16 . More recently, the Patch-seq technique has enabled the characterization of morphology (M), electrophysiology (E), and transcriptomic (T) properties from individual cells ^17-20 . Using this technique, these properties were integrated to define 28, inhibitory multimodal, MET-types in mouse primary visual cortex ²¹ . It is unknown how these MET-types connect within the broader cortical circuitry however. Here we show that we can predict the MET-type identity of inhibitory cells within a large-scale electron microscopy (EM) dataset and these MET-types have distinct ultrastructural features and synapse connectivity patterns. We found that EM Martinotti cells, a well defined morphological cell type ^{22, 23} known to be Somatostatin positive (Sst+) ^{24, 25} , were successfully predicted to belong to Sst+ MET-types. Each identified MET-type had distinct axon myelination patterns and synapsed onto specific excitatory targets. Our results demonstrate that morphological features can be used to link cell type identities across imaging modalities, which enables further comparison of connectivity in relation to transcriptomic or electrophysiological properties. Furthermore, our results show that MET-types have distinct connectivity patterns, supporting the use of MET-types and connectivity to meaningfully define cell types.

Sensitivity to orthographic vs. phonological constraints on word recognition: An ERP study with deaf and hearing readers

The role of phonology in word recognition has previously been investigated using a masked lexical decision task and transposed letter (TL) nonwords that were either pronounceable (barve) or unpronounceable (brvae). We used event-related potentials (ERPs) to investigate these effects in skilled deaf readers, who may be more sensitive to orthotactic than phonotactic constraints, which are conflated in English. Twenty deaf and twenty hearing adults completed a masked lexical decision task while ERPs were recorded. The groups were matched in reading skill and IQ, but deaf readers had poorer phonological ability. Deaf readers were faster and more accurate at rejecting TL nonwords than hearing readers. Neither group exhibited an effect of nonword pronounceability in RTs or accuracy. For both groups, the N250 and N400 components were modulated by lexicality (more negative for nonwords). The N250 was not modulated by nonword pronounceability, but pronounceable nonwords elicited a larger amplitude N400 than unpronounceable nonwords. Because pronounceable nonwords are more word-like, they may incite activation that is unresolved when no lexical entry is found, leading to a larger N400 amplitude. Similar N400 pronounceability effects for deaf and hearing readers, despite differences in phonological sensitivity, suggest these TL effects arise from sensitivity to lexical-level orthotactic constraints. Deaf readers may have an advantage in processing TL nonwords because of enhanced early visual attention and/or tight orthographic-to-semantic connections, bypassing the phonologically mediated route to word recognition.

Fingerspelling and Its Role in Translanguaging

Fingerspelling is a critical component of many sign languages. This manual representation of orthographic code is one key way in which signers engage in translanguaging, drawing from all of their linguistic and semiotic resources to support communication. Translanguaging in bimodal bilinguals is unique because it involves drawing from languages in different modalities, namely a signed language like American Sign Language and a spoken language like English (or its written form). Fingerspelling can be seen as a unique product of the unified linguistic system that translanguaging theories purport, as it blends features of both sign and print. The goals of this paper are twofold: to integrate existing research on fingerspelling in order to characterize it as a cognitive-linguistic phenomenon and to discuss the role of fingerspelling in translanguaging and communication. We will first review and synthesize research from linguistics and cognitive neuroscience to summarize our current understanding of fingerspelling, its production, comprehension, and acquisition. We will then discuss how fingerspelling relates to translanguaging theories and how it can be incorporated into translanguaging practices to support literacy and other communication goals.

Stent expansion evaluated by optical coherence tomography and subsequent outcomes

Background

Regarding stent expansion indexes, previous optical coherence tomography (OCT) studies have shown minimal stent area (MSA) to be most predictive of adverse events.

Purpose

We sought to evaluate the impact of various stent expansion indexes by post-stent OCT on long-term clinical outcomes, and hence to find OCT-defined optimal stent expansion criteria.

Methods

Of the patients registered in the Yonsei OCT registry, a total of 1071 patients with 1123 native coronary artery lesions treated with new-generation drug-eluting stents under the OCT guidance and analyzable final post-stent OCT were included. Stent expansion indexes and different suboptimal stent expansion criteria were evaluated for their association with device-oriented clinical endpoints (DoCE) including cardiac death, target vessel-related myocardial infarction (TVMI) or stent thrombosis, and target lesion revascularization. Major safety events (MSE) included cardiac death, TVMI or stent thrombosis.

Results

The median follow-up period was 40.6 (interquartile range 22.0–50.0) months. As a continuous variable, MSA, adaptive volumetric stent expansion (stent volume/adaptive reference lumen volume) and overall volumetric stent expansion (stent volume/post-stent lumen volume) were significantly predictive of DoCE. As a categorical criteria, MSA &lt;5.0 mm2 (hazard ratio [HR] 3.80; 95% confidence interval [CI] 1.53–9.45), MSA/distal reference lumen area &lt;90% (HR 2.13; 95% CI 1.10–4.14), and overall volumetric stent expansion ≥96.6% (HR 2.38; 95% CI 1.09–5.22) were independently associated with DoCE after adjusting for confounders, and a total malapposition volume ≥7.0 mm3 (HR 3.38; 95% CI 1.05–10.93) was linked to MSE.

Conclusions

This OCT study highlights that sufficient stent expansion to achieve adequate absolute MSA and relative MSA by distal reference lumen area and alleviate significant malapposition is important to improve clinical outcome, but overall stent overexpansion may have deleterious effect.

Funding Acknowledgement

Type of funding sources: None.

Atrial fibrillation detection in ambulatory patients using a smart ring powered by deep learning analysis of continuous photoplethysmography monitoring

Background

Atrial fibrillation (AF) detection could be effective with photoplethysmography (PPG) signal monitoring by a wearable device.

Purpose

We aimed to validate the performance of AF detection among ambulatory patients who underwent electrical cardioversion for AF using a smart ring capable of continuous PPG monitoring and deep learning analysis.

Methods

In this prospective single-arm study, participants who underwent successful electrical cardioversion for AF were enrolled. The participants equipped a smart ring (CardioTracker, Sky Labs Inc., Seongnam, Republic of Korea) after the electrical cardioversion. The smart ring then continuously monitored PPG over 14 days to detect AF recurrence. The smart ring alarmed AF episodes based on deep learning analysis of PPG. The participants were asked to measure at least three daily ECGs using the smart ring to validate AF recurrence detected by PPG. All ECG snapshots were recorded along with lead I and saved with simultaneous PPG. ECG data were examined by the three cardiologists independently (SK, SRL, and EKC). The monitoring time, analyzable proportions of monitored signals, detection rates of AF episodes, and the diagnostic performance of PPG-based deep learning were evaluated. At the end of the monitoring, a survey on the use of the smart ring was performed.

Results

A total of 35 participants (mean age 58.9 years, male 74.3%) were enrolled. Figure 1 illustrates an example of PPG monitoring and PPG-ECG snapshots by the smart ring. The study participation period was a median of 14 days and the wearing time of the smart ring was a median of 9.2 days (IQR 7.1–11.5 days). Signal artifacts during daily activity decreased the analyzable proportions of monitored PPG by 68.5%. Irregular pulse episodes were detected by the smart ring in 29 (82.9%) participants after a median of 1 day from the cardioversion (Figure 2). A total of 2532 PPG-ECG snapshots were acquired and 1623 (64.1%) were interpretable by both the cardiologists (using ECG) and the deep learning analysis (using PPG). Comparing PPG by simultaneous ECG, the performance of AF detection by the smart ring was 98.7% for sensitivity, 97.8% for specificity, 2.2% for false positives, and 1.3% for false negatives (Figure 2). After using the smart ring, 76.9% of the participants responded that they had no discomfort in using the smart ring in daily activity and another 76.9% responded that it was helpful to monitor their disease.

Conclusion

Despite the signal artifacts during daily activity, AF detection with PPG monitoring by a smart ring could be effective for AF screening among ambulatory patients.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): This work was supported by Sky Labs Inc, Seongnam, Republic of Korea, and by the grant No. 0320202040 from the Seoul National University Hospital Research Fund.

POS0763 A MULTIMODAL MAGNETIC RESONANCE IMAGING STUDY OF COGNITIVE FUNCTION IN SYSTEMIC LUPUS ERYTHEMATOSUS: A MACHINE LEARNING APPROACH

Background

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder that can affect the central nervous system. Cognitive dysfuncion is the most common neuropsyhiatric event in SLE patients, yet it is also one of the hardest to diagnose.

Objectives

To investigate if multimodal imaging to assess anatomical magnetic resonance imaging (MRI) abnormalities in the brains of SLE patients can predict cognitive function.

Methods

Subjects underwent voxel-based morphometry (VBM), magnetization transfer imaging (MTI), and dynamic contrast-enhanced (DCE) MRI. Automated Neuropsychological Assessment Metrics (ANAM) was used to assess cognitive function in this cross-sectional study and the primary measure was the total throughput score (TTS). TTS is the total of the throughput scores for each of the 8 ANAM subtests: (i) code substitution learning (CSL); (ii) code substitution immediate (CSI); (iii) code substitution delayed (CSD); (iv) spatial processing (SP); (v) matching to sample (MSP); (vi) running memory continuous performance test (CPT); (vii) mathematical processing (MTH) and (viii) memory search (MS). Olfactory assessment was done using the University of Pennsylvania Smell Identification Test. We used a machine learning-based model (i.e. GLMnet) to predict TTS. Subjects with active SLE disease or above 40 years old were excluded.

Results

Thirty SLE patients [26 female, 32.0 (26.8-37.0) years] without clinically overt neuropsychiatric manifestations and 10 healthy controls (HCs) [9 females, 27.0 (23.0-31.5) years] were enrolled in this study. Both groups had comparable cognitive and olfactory functions. No significant differences were observed in VBM, MTR, olfactory blub and tract (OBT) volume in SLE patients compared to HCs. We observed increased blood-brain barrier (BBB) permeability parameters (Ktrans and PS) in several regions of SLE patients. DCE-MRI perfusion parameters such as perfusion (F) and vp but not permeability measures were associated with TTS. In particular, F right amygdala correlated with TTS in SLE patients (r = 0.636, FDR p < 0.05) (Table 1). Using GLMnet, we trained a multimodal MRI model comprising of VBM, MTR, DCE-MRI and OBT volume parameters to predict TTS in SLE patients (r = 0.998, p < 0.0005) (Figure 1).

Figure 1.

Machine learning-based models to predict cognitive function.

Table 1.

Correlation between ANAM tests with perfusion (F) in SLE patients, ranked in descending order of statistical significance for TTS.

VariableTTSCSLCSICSDSPMSPCPTMTHMSF right amygdala0.636‡*0.520‡0.3370.437†0.559‡0.3230.633‡0.412†0.598‡F left entorhinal0.504‡0.422†0.3660.416†0.3050.1850.530‡0.1860.416†F left amygdale0.495‡0.400†0.1890.378†0.3300.2370.491‡0.376†0.449†F choroid0.469†0.384†0.2160.413†0.458†0.2020.456†0.3400.406†plexusF right rostal anterior cingulate0.453†0.3010.1180.2960.393†0.2140.547‡0.420†0.383†F right entorhinal0.448†0.368†0.2320.3120.376†0.1560.438†0.2710.407†F cerebellum white matter0.427†0.3580.2010.370†0.2730.0780.449†0.2900.297F left hippocampus0.427†0.3550.1340.390†0.3560.2030.511‡0.3360.332F brain stem0.407†0.2980.1380.2750.2940.1530.478‡0.3080.369†F right insula0.407†0.3080.0740.3000.3240.1760.437†0.3230.347F left parietal0.400†0.2630.0920.2540.2940.2240.487‡0.2740.332F ventricles0.396†0.3030.0830.3210.370†0.1920.477‡0.2860.361F right temporal0.395†0.2800.1130.2810.2880.1670.477‡0.3220.331F right hippocampus0.395†0.3070.0770.3250.3560.1900.486‡0.3570.339F right parietal0.376†0.2490.0820.2740.2830.1390.460†0.2550.311F right parahippocampal gyrus0.375†0.3530.1190.3020.3410.2410.3530.2080.273

† p < 0.05, ‡ p < 0.01, *FDR p < 0.05

Conclusion

These findings suggest that the BBB may be affected early in the course of cognitive dysfunction, even preceding detectable changes in other MRI sequences and machine learning algorithms can be used to predict TTS measures, even in asymptomatic SLE patients.

References

Nil.

Disclosure of Interests

Sen Hee Tay: None declared, Mary Stephenson: None declared, Nur Azizah Allameen: None declared, Sriram Narayanan: None declared, Bernett Lee: None declared, Anselm Mak Speakers bureau: JnJ Apr 2019 and GSK Jan 2022, Grant/research support from: GSK - The Supported Studies Programme

P-FLUX: A phosphorus budget dataset spanning diverse agricultural production systems in the United States and Canada

Quantifying spatial and temporal fluxes of phosphorus (P) within and among agricultural production systems is critical for sustaining agricultural production while minimizing environmental impacts. To better understand P fluxes in agricultural landscapes, P-FLUX, a detailed and harmonized dataset of P inputs, outputs, and budgets, as well as estimated uncertainties for each P flux and budget, was developed. Data were collected from 24 research sites and 61 production systems through the Long-term Agroecosystem Research (LTAR) network and partner organizations spanning 22 U.S. states and 2 Canadian provinces. The objectives of this paper are to (a) present and provide a description of the P-FLUX dataset, (b) provide summary analyses of the agricultural production systems included in the dataset and the variability in P inputs and outputs across systems, and (c) provide details for accessing the dataset, dataset limitations, and an example of future use. P-FLUX includes information on select site characteristics (area, soil series), crop rotation, P inputs (P application rate, source, timing, placement, P in irrigation water, atmospheric deposition), P outputs (crop removal, hydrologic losses), P budgets (agronomic budget, overall budget), uncertainties associated with each flux and budget, and data sources. Phosphorus fluxes and budgets vary across agricultural production systems and are useful resources to improve P use efficiency and develop management strategies to mitigate environmental impacts of agricultural systems. P-FLUX is available for download through the USDA Ag Data Commons (https://doi.org/10.15482/USDA.ADC/1523365).

Pediatric Emergency Medicine Didactics and Simulation (PEMDAS) Telesimulation Series: Hyperleukocytosis

INTRODUCTION

Hyperleukocytosis, an infrequent presentation of new-onset leukemia, is a medical emergency requiring prompt recognition and treatment. It can include altered mental status, fever, critical electrolyte derangements, and coagulopathies. Due to the COVID-19 pandemic, this simulation was created as a telesimulation in order to adhere to mandatory physical distancing guidelines while addressing learning objectives.

METHODS

This simulation was designed for pediatric emergency medicine fellows and featured a pediatric patient presenting with fever, altered mental status, and respiratory distress. After an initial assessment and appropriate workup, the patient developed tumor lysis syndrome, coagulopathies, and new-onset neurologic changes requiring appropriate interventions. A debriefing guide and participant evaluation form were utilized.

RESULTS

This telesimulation was implemented at five different institutions, with evaluation surveys completed by 22 pediatric emergency medicine fellows. The scenario was rated on a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree) and was generally well received, with participants rating the simulation as effective in teaching the recognition (M = 4.8) and management (M = 4.6) of hyperleukocytosis. Participants felt that virtual telesimulation was effective compared to other distance learning methods (M = 3.9).

DISCUSSION

This simulation-based curriculum allows learners to practice identifying and managing hyperleukocytosis. We found that it was well received in both in-person and virtual formats.

Are form priming effects phonological or perceptual? Electrophysiological evidence from American Sign Language

Form priming has been used to identify and demarcate the processes that underlie word and sign recognition. The facilitation that results from the prime and target being related in form is typically interpreted in terms of pre-activation of linguistic representations, with little to no consideration for the potential contributions of increased perceptual overlap between related pairs. Indeed, isolating the contribution of perceptual similarity is impossible in spoken languages; there are no listeners who can perceive speech but have not acquired a sound-based phonological system. Here, we compared the electrophysiological indices of form priming effects in American Sign Language between hearing non-signers (i.e., who had no visual-manual phonological system) and deaf signers. We reasoned that similarities in priming effects between groups would most likely be perceptual in nature, whereas priming effects that are specific to the signer group would reflect pre-activation of phonological representations. Behavior in the go/no-go repetition detection task was remarkably similar between groups. Priming in a pre-N400 window was also largely similar across groups, consistent with an early effect of perceptual similarity. However, priming effects diverged between groups during the subsequent N400 and post-N400 windows. Signers had more typical form priming effects and were especially attuned to handshape overlap, whereas non-signers did not exhibit an N400 component and were more sensitive to location overlap. We attribute this pattern to an interplay between perceptual similarity and phonological knowledge. Perceptual similarity contributes to early phonological priming effects, while phonological knowledge tunes sensitivity to linguistically relevant dimensions of perceptual similarity.

Initial experience of TAS-102 chemotherapy in Australian patients with Chemo-refractory metastatic colorectal cancer

For patients with refractory metastatic colorectal cancer (mCRC) treatment with Trifluridine/Tipiracil, also known as TAS-102, improves overall survival. This study aims to investigate the efficacy and safety of TAS-102 in a real-world population from Victoria, Australia. A retrospective analysis of prospectively collected data from the Treatment of Recurrent and Advanced Colorectal Cancer (TRACC) registry was undertaken. The characteristics and outcomes of patients receiving TAS-102 were assessed and compared to those enrolled in the registration study (RECOURSE). Across 13 sites, 107 patients were treated with TAS-102. The median age was 60 years (range: 31-83), compared to 63 for RECOURSE. Comparing registry TAS-102-treated and RECOURSE patients, 75% vs 100% were ECOG performance status 0-1, 74% vs 79% had initiated treatment more than 18 months from diagnosis of metastatic disease and 36% vs 49% were RAS wild-type. Median time on treatment was 10.4 weeks (range: 1.7-32). Median progression-free survival (PFS) was 3.3 months compared to 2 months in RECOURSE, while median overall survival was the same at 7.1 months. Two patients (2.3%) had febrile neutropenia and there were no treatment-related deaths, where TAS-102 dose at treatment initiation was at clinician discretion.TRACC registry patients treated with TAS-102 were younger than those from the RECOURSE trial, with similar overall survival observed. Less strict application of RECIST criteria and less frequent imaging may have contributed to an apparently longer PFS.

Alterations of a serum marker of collagen X in growing children with osteogenesis imperfecta

Abnormalities in the structure and/or processing of type I collagen cause osteogenesis imperfecta and result in bone fragility, abnormal bone growth and short stature. Type I collagen is expressed in the growth plate but the mechanisms by which abnormalities in collagen I contribute to growth plate dysfunction and growth retardation are unknown. The non-collagenous domain (NC1) of type X collagen (CXM) is released from the hypertrophic zone of active growth plates and is a marker for new endochondral bone formation. Serum CXM levels are strongly correlated with the rate of growth in healthy children. We hypothesized that CXM levels in children with OI would be abnormal when compared to normally growing children. Using participants from the Brittle Bone Disease Consortium Natural History Study we analyzed the distribution of CXM over the ages of 8 months to 40 years in 187 subjects with OI (89 type I and 98 types III/IV) as well as analyzed the relationship between growth velocity and CXM levels in a subset of 100 children <16 years old with OI (44 type I and 56 types III/IV). CXM levels in both control and OI children demonstrated a similar pattern of variation by age with higher levels in early life and puberty followed by a post-pubertal drop. However, there was greater variability within the OI cohort and the relationship with growth velocity was weaker. The ratio of CXM level to growth velocity was elevated in children with type III/IV OI compared to controls. These results suggest that the relationship between hypertrophic zone function and the end point of skeletal growth is disrupted in OI.

The organization of the American Sign Language lexicon: Comparing one- and two-parameter ERP phonological priming effects across tasks

We used phonological priming and ERPs to investigate the organization of the lexicon in American Sign Language. Across go/no-go repetition detection and semantic categorization tasks, targets in related pairs that shared handshape and location elicited smaller N400s than targets in unrelated pairs, indicative of facilitated processing. Handshape-related targets also elicited smaller N400s than unrelated targets, but only in the repetition task. The location priming effect reversed direction across tasks, with slightlylargeramplitude N400s for targets in related versus unrelated pairs in the semantic task, indicative of interference. These patterns imply that handshape and location play different roles during sign recognition and that there is a hierarchical organization for the sign lexicon. Similar to interactive-activation models of word recognition, we argue for differentiation between sublexical facilitation and lexical competition. Lexical competition is primarily driven by the location parameter and is more engaged when identification of single lexico-semantic entries is required.

Critical view of robotic-assisted transverse abdominal release (r-TAR)

INTRODUCTION

Establishing straightforward and reproducible steps to describe the technique performed with the aid of the robotic system for complex hernia surgery is key for good outcomes. Even using the description of open surgery as a parameter for performing the robotic technique, it is important to stress the particularities of this access. To describe the steps to perform robotic-assisted TAR (r-TAR) in a standardized technique, with a critical and safe view of all the anatomical structures.

DESCRIPTION OF THE TECHNIQUE

We defined 8 landmarks for the critical view of safety in r-TAR which include: (1) patient position, trocar and docking; (2) posterior rectus sheath mobilization; (3) transversus abdominis release (TAR)-Top-down technique; (4) transversus abdominis release (TAR)-bottom-up technique and mesh insertion; (5) contralateral trocar insertion and redocking, 6) posterior sheath closure; (7) final mesh positioning; and (8) anterior defect closure and drains.

DISCUSSION

Complex hernia surgery using a robotic-assisted posterior component separation requires well-established steps so the procedure can be reproducible and achieve better results.

The neurocognitive basis of skilled reading in prelingually and profoundly deaf adults

Deaf individuals have unique sensory and linguistic experiences that influence how they read and become skilled readers. This review presents our current understanding of the neurocognitive underpinnings of reading skill in deaf adults. Key behavioural and neuroimaging studies are integrated to build a profile of skilled adult deaf readers and to examine how changes in visual attention and reduced access to auditory input and phonology shape how they read both words and sentences. Crucially, the behaviours, processes, and neural circuity of deaf readers are compared to those of hearing readers with similar reading ability to help identify alternative pathways to reading success. Overall, sensitivity to orthographic and semantic information is comparable for skilled deaf and hearing readers, but deaf readers rely less on phonology and show greater engagement of the right hemisphere in visual word processing. During sentence reading, deaf readers process visual word forms more efficiently and may have a greater reliance on and altered connectivity to semantic information compared to their hearing peers. These findings highlight the plasticity of the reading system and point to alternative pathways to reading success.

Macrophage function in the elderly and impact on injury repair and cancer

Older age is associated with deteriorating health, including escalating risk of diseases such as cancer, and a diminished ability to repair following injury. This rise in age-related diseases/co-morbidities is associated with changes to immune function, including in myeloid cells, and is related to immunosenescence. Immunosenescence reflects age-related changes associated with immune dysfunction and is accompanied by low-grade chronic inflammation or inflammageing. This is characterised by increased levels of circulating pro-inflammatory cytokines such as tumor necrosis factor (TNF), interleukin (IL)-1β and IL-6. However, in healthy ageing, there is a concomitant age-related escalation in anti-inflammatory cytokines such as transforming growth factor-β1 (TGF-β1) and IL-10, which may overcompensate to regulate the pro-inflammatory state. Key inflammatory cells, macrophages, play a role in cancer development and injury repair in young hosts, and we propose that their role in ageing in these scenarios may be more profound. Imbalanced pro- and anti-inflammatory factors during ageing may also have a significant influence on macrophage function and further impact the severity of age-related diseases in which macrophages are known to play a key role. In this brief review we summarise studies describing changes to inflammatory function of macrophages (from various tissues and across sexes) during healthy ageing. We also describe age-related diseases/co-morbidities where macrophages are known to play a key role, focussed on injury repair processes and cancer, plus comment briefly on strategies to correct for these age-related changes.

Financial toxicity in lung cancer: an assessment of magnitude, perception, and impact on quality of life

BACKGROUND

Advances in lung cancer therapy have resulted in improved clinical outcomes. Unfortunately, advances can come at a financial cost to patients and their families that poses a significant risk to overall quality of life (QoL). Financial distress has been shown to be associated with increased symptom burden and decreased treatment compliance but the magnitude of financial distress is not well characterized in lung cancer populations.

PATIENTS AND METHODS

Patients with stage II-IV newly diagnosed lung cancer and starting first-line therapy were recruited at a tertiary academic institution between July 2018 and April 2019. The comprehensive score for financial toxicity (COST) was used to assess financial toxicity and the Functional Assessment of Cancer Therapy-Lung (FACT-L) was used to assess QoL. Associations between financial toxicity and baseline variables were assessed using multivariable linear regression and correlations were assessed using the Pearson correlation.

RESULTS

In this study, 143 consecutive patients were approached and 91.6% agreed to participate (N = 131). The median age was 65 years (35-90); 52.7% were male (n = 69), and 75.6% were white (n = 99). The inability to afford basic necessities and having <1 month of savings was associated with increased financial toxicity (P < 0.001) after adjusting for other factors such as age, race, insurance, and income. There was also a trend toward increased financial toxicity among those who were employed but on sick leave (P = 0.06). Increased financial toxicity was correlated with a decrease in QoL (correlation coefficient 0.41, P < 0.001). Patients' anticipated out-of-pocket (OOP) expenses for the upcoming 6 months ranged from $0 to $50 000 (median $2150). However, there was no correlation between anticipated OOP expenses and either financial toxicity or QoL.

CONCLUSIONS

These data identify key factors for identifying at-risk patients and builds a framework for exploring the benefit of financial counseling interventions, which may improve QoL and oncologic outcomes.

Cross-linguistic metaphor priming in ASL-English bilinguals: Effects of the Double Mapping Constraint

Meir's (2010) Double Mapping Constraint (DMC) states the use of iconic signs in metaphors is restricted to signs that preserve the structural correspondence between the articulators and the concrete source domain and between the concrete and metaphorical domains. We investigated ASL signers' comprehension of English metaphors whose translations complied with the DMC (Communication collapsed during the meeting) or violated the DMC (The acid ate the metal). Metaphors were preceded by the ASL translation of the English verb, an unrelated sign, or a still video. Participants made sensibility judgments. Response times (RTs) were faster for DMC-compliant sentences with verb primes compared to unrelated primes or the still baseline. RTs for DMC-violation sentences were longer when preceded by verb primes. We propose the structured iconicity of the ASL verbs primed the semantic features involved in the iconic mapping and these primed semantic features facilitated comprehension of DMC-compliant metaphors and slowed comprehension of DMC-violation metaphors.