Intermediate science knowledge predicts overconfidence

Lackner et al. found science overconfidence peaks at intermediate levels of knowledge. Those with intermediate knowledge also hold the most negative attitudes toward scientists. In doing so, they provide a novel measure of overconfidence that measures the tendency to give incorrect answers as opposed to answering, 'I don't know'.

Timely Assessment of Breathing-Related Distress in Community Palliative Care: A Multidisciplinary Collaborative Quality Improvement Project

Background: Breathlessness is a common symptom for palliative patients that can cause distress and decrease function and quality of life. Palliative care services in Australia aim to routinely assess patients for breathing-related distress, but timely reassessment is not always achieved. Objective: To improve the timeliness of breathlessness reassessment in a home-based community palliative care service in New South Wales for people with moderate-to-severe breathing-related distress. Breathing-related distress was defined as a Symptom Assessment Score for "breathing problems" of four or more. Methods: This collaborative quality improvement (QI) project between SPHERE Palliative Care CAG, Stanford University mentors, and a Sydney metropolitan specialist palliative care service included a: (1) retrospective chart audit; (2) cause and effect analyses using a fishbone diagram; (3) development and implementation of key drivers and interventions; and (4) a pre-and-post evaluation of the timeliness of reassessment of breathing-related distress and changes in Symptom Assessment Scale scores for "breathing problems." Results: Key interventions included multidisciplinary education sessions to facilitate buy-in, with nurses as case managers responsible for breathlessness reassessment and documentation of scores, access and training in electronic palliative care data entry software, fortnightly monitoring and reporting of breathing-related distress scores, and development of an educational flowchart. The proportion of patients reassessed within seven days of an initial nursing assessment of moderate-to-severe breathing-related distress increased from 34% at baseline to 92% at six months. Conclusion: A local QI project increased the proportion of patients with a timely reassessment of their breathing-related distress in a community palliative care service.

Endemic infectious cutaneous ulcers syndrome in the Oti Region of Ghana: Study of cutaneous leishmaniasis, yaws and Haemophilus ducreyi cutaneous ulcers

BACKGROUND

A recent study detected cutaneous leishmaniasis (CL) in 31.9% of persons with skin ulcers in the Oti Region of Ghana, resulting in a need to investigate other potential causes of the unexplained skin ulcers.

METHODOLOGY/PRINCIPAL FINDINGS

A community based cross-sectional study was conducted in the Oti region to investigate skin ulcers of undetermined aetiologies. To confirm a diagnosis of cutaneous leishmaniasis, Buruli ulcer, Haemophilus ducreyi ulcers, or yaws, DNA obtained from each patient skin ulcer sample was systematically subjected to polymerase chain reaction (PCR) for Leishmania spp., Mycobacterium ulcerans, Haemophilus ducreyi, and Treponema pallidum sub species pertenue. A total of 101 skin ulcer samples were obtained from 101 persons. Co-infection of more than one organism was observed in 68.3% of the samples. Forty (39.6%) participants had a positive result for Leishmania spp., 68 (67.3%) for Treponema pallidum sub. Sp. pertenue, and 74 (73.3%) for H. ducreyi. Twenty (19.8%) of the patient ulcers were simultaneously infected with Leishmania spp., Treponema pallidum sub. Sp. pertenue, and H. ducreyi. None of the patients' lesions yielded a positive result for Mycobacterium ulcerans.

CONCLUSIONS/SIGNIFICANCE

This study detected single and mixed occurrence of the causative organisms of CL, yaws, and H. ducreyi cutaneous ulcers in CL endemic communities of the Oti Region in Ghana. These findings emphasize the importance of integrating multiple skin diseases on a common research platform and calls for the development of a comprehensive guideline for diagnosing and treating tropical ulcers in the study areas.

Post-processed data and graphical tools for a CONUS-wide eddy flux evapotranspiration dataset

Large sample datasets of in situ evapotranspiration (ET) measurements with well documented data provenance and quality assurance are critical for water management and many fields of earth science research. We present a post-processed ET oriented dataset at daily and monthly timesteps, from 161 stations, including 148 eddy covariance flux towers, that were chosen based on their data quality from nearly 350 stations across the contiguous United States. In addition to ET, the data includes energy and heat fluxes, meteorological measurements, and reference ET downloaded from gridMET for each flux station. Data processing techniques were conducted in a reproducible manner using open-source software. Most data initially came from the public AmeriFlux network, however, several different networks (e.g., the USDA-Agricultural Research Service) and university partners provided data that was not yet public. Initial half-hourly energy balance data were gap-filled and aggregated to daily frequency, and turbulent fluxes were corrected for energy balance closure error using the FLUXNET2015/ONEFlux energy balance ratio approach. Metadata, diagnostics of energy balance, and interactive graphs of time series data are included for each station. Although the dataset was developed primarily to benchmark satellite-based remote sensing ET models of the OpenET initiative, there are many other potential uses, such as validation for a range of regional hydrologic and atmospheric models.

Validation of a suite of ERP and QEEG biomarkers in a pre-competitive, industry-led study in subjects with schizophrenia and healthy volunteers

OBJECTIVE

Complexity and lack of standardization have mostly limited the use of event-related potentials (ERPs) and quantitative EEG (QEEG) biomarkers in drug development to small early phase trials. We present results from a clinical study on healthy volunteers (HV) and patients with schizophrenia (SZ) that assessed test-retest, group differences, variance, and correlation with functional assessments for ERP and QEEG measures collected at clinical and commercial trial sites with standardized instrumentation and methods, and analyzed through an automated data analysis pipeline.

METHODS

81 HV and 80 SZ were tested at one of four study sites. Subjects were administered two ERP/EEG testing sessions on separate visits. Sessions included a mismatch negativity paradigm, a 40 Hz auditory steady-state response paradigm, an eyes-closed resting state EEG, and an active auditory oddball paradigm. SZ subjects were also tested on the Brief Assessment of Cognition (BAC), Positive and Negative Syndrome Scale (PANSS), and Virtual Reality Functional Capacity Assessment Tool (VRFCAT).

RESULTS

Standardized ERP/EEG instrumentation and methods ensured few test failures. The automated data analysis pipeline allowed for near real-time analysis with no human intervention. Test-retest reliability was fair-to-excellent for most of the outcome measures. SZ subjects showed significant deficits in ERP and QEEG measures consistent with published academic literature. A subset of ERP and QEEG measures correlated with functional assessments administered to the SZ subjects.

CONCLUSIONS

With standardized instrumentation and methods, complex ERP/EEG testing sessions can be reliably performed at clinical and commercial trial sites to produce high-quality data in near real-time.

Diagnosis and prevalence of canine leishmaniasis in the Atlas shepherd dog

The aim of this study was to determine the prevalence of canine leishmaniasis in the Atlas shepherd dogs from the Tiaret region of Algeria. A total of 161 dogs were included in this study and four diagnostic techniques were used, namely lymph node cytology, PCR, IFAT and ELISA. 110 out of 161 dogs were positive by at least one diagnostic technique, a percentage of 68.32% of the total number, which represent very high prevalence of canine leishmaniasis in this canine breed. 152 dogs underwent the two serological tests namely IFAT and ELISA among which 137 dogs underwent in addition the molecular examination by PCR. IFAT was positive in 9.86% of the dogs, ELISA was positive in 12.5% while 68% of the dogs proved positive by PCR. 47 dogs with lymph node enlargement underwent lymph node cytology, of which 26 dogs showed forms of amastigotes in their smears after microscopic examination, confirming the usefulness of this approach for the diagnosis of canine leishmaniasis. The clinical signs of the disease in this breed are similar to those of other canine breeds The dominant clinical signs in these dogs were onychogryphosis, poor general condition and lymph node hypertrophy. The autopsy was carried out on 7 dogs that died of canine leishmaniasis, all of which showed splenomegaly, while 5 dogs also showed hepatomegaly. Renal damage was found in 1 dog with frank jaundice. The splenic cytology was positive in all 7 dogs with the presence of amastigote forms in the smears after microscopic examination.

Artificial intelligence-guided, single-lead EKG may be a game-changer for symptom-to-balloon time reduction in ST-elevated myocardial infarction

Background

Over decades, efforts to shave off life-saving minutes from ST-Elevated Myocardial Infarction (STEMI) care centred on reducing door-to-needle and door-to-balloon times. We firmly believe that symptom-to-balloon time should prove a better focus to this end. Challenges come with this goal as it heavily relies on a patient's perception and initiative to seek care, which we deem intelligent and wearable Artificial Intelligence (AI)-driven Single Lead EKG technologies as an attractive solution in modern-day cardiology.

Purpose

To provide an accurate, accessible, and cost-effective AI-driven Single Lead STEMI detection algorithm that can be embedded into wearable devices and employed in a self-administered fashion.

Methods

Database: EKG records from Mexico, Colombia, Argentina, and Brazil from April 2014 to December 2019. Dataset: A total of 11,567 12-lead EKG records of 10[s] length with a sampling frequency of 500 Hz, including the following balanced classes: angiographically confirmed and unconfirmed STEMI, branch blocks, non-specific ST-T abnormalities, normal and abnormal (200+ CPT codes, excluding those mentioned above). Cardiologists manually checked the label of each record to ensure precision. Pre-processing: We discard the first and last 250 samples as they may contain a standardisation pulse. The study applied a digital low pass filter of order 5 with a frequency cut-off of 35 Hz. The mean was subtracted from each Lead. Classification: The determined classes were “STEMI” (Including STEMI in different locations of the myocardium – anterior, inferior, and lateral); and “Not-STEMI” (Combination of randomly sample, branch blocks, non-specific ST-T changes, and abnormal records – 25% of each). Training and Testing: A 1-D Convolutional Neural Network was trained and tested with a dataset proportion of 90/10, respectively. A different model was trained and tested for each Lead, using the central 4,500 samples of the records. The last dense layer outputs a probability for each report of being STEMI or Not-STEMI. Lead V2 showed the best overall results. The model was further tested through the same methodology using the best Lead with a subset of the previous data, excluding the unconfirmed STEMI EKG records (Total 7,230 12-lead EKG records for Confirmed Only STEMI dataset). Performance metrics were reported for each experiment and compared.

Results

Combined STEMI data: Accuracy: 91.2%; Sensitivity: 89.6%; Specificity: 92.9%. Confirmed STEMI Only dataset: Accuracy: 92.4%; Sensitivity: 93.4%; Specificity: 91.4% (Figure 1).

Conclusion

By assiduously improving the quality of the model's input, we continue to assess our algorithm's performance and reliability for future clinical validation as a potential remote monitoring and early STEMI detection device.

Funding Acknowledgement

Type of funding sources: None.

Supraglottic airway device to improve ventilation success and reduce pulmonary aspiration during cardio-pulmonary resuscitation by basic life support rescuers: a randomised cross-over human cadaver study

Objectives: Early airway management during cardiopulmonary resuscitation (CPR) prevents aspiration of gastric contents. Endotracheal intubation is the gold standard to protect airways, but supraglottic airway devices (SGA) may provide some protection with less training. Bag-mask ventilation (BMV) is the most common method used by rescuers. We hypothesized that SGA use by first rescuers during CPR could increase ventilation success rate and also decrease intragastric pressure and pulmonary aspiration.Methods: We performed a randomized cross-over experimental trial on human cadavers. Protocol A: we assessed the rate of successful ventilation (chest rise), intragastric pressure, and CPR key time metrics. Protocol B: cadaver stomachs were randomized to be filled with 300 mL of either blue or green serum saline solution through a Foley catheter. Each rescuer was randomly assigned to use SGA or BMV during a 5-minute standard CPR period. Then, in a crossover design, the stomach was filled with the second colour solution and another 5-minute CPR period was performed using the other airway method. Pulmonary aspiration, defined as the presence of coloured solution below the vocal cords, was assessed by a blinded operator using bronchoscopy. A generalized linear mixed model was used for statistical analysis.Results: Protocol A: Forty-eight rescuers performed CPR on 11 cadavers. Median ventilation success was higher with SGA than BMV: 75.0% (IQR: 59.8-87.3) vs. 34.7% (IQR: 25.0-50.0), (p = 0.003). Gastric pressure and differential (maximum minus minimum) gastric pressure were lower in the SGA group: 2.21 mmHg (IQR: 1.66; 2.68) vs. 3.02 mmHg (IQR: 2.02; 4.22) (p = 0.02) and 5.70 mmHg (IQR: 4.10; 7.60) vs. 8.05 mmHg (IQR: 5.40; 11.60) (p = 0.05). CPR key times were not different between groups. Protocol B: Ten cadavers were included with 20 CPR periods. Aspiration occurred in 2 (20%) SGA procedures and 5 (50%) BMV procedures (p = 0.44).Conclusion: Use of SGA by rescuers improved the ventilation success rate, decreased intragastric pressure, and did not affect key CPR metrics. SGA use by basic life support rescuers appears feasible and efficient.

Improving the Relationship Between Confidence and Competence: Implications for Diagnostic Radiology Training From the Psychology and Medical Literature

The focus of diagnostic radiology training is on creating competent professionals, whereas confidence and its calibration receive less attention. Appropriate confidence is critical for patient care both during and after training. Overconfidence can adversely affect patient care and underconfidence can create excessive costs. We reviewed the psychology and medical literature pertaining to confidence and competence to collect insights and best practices from the psychology and medical literature on confidence and apply them to radiology training. People are rarely accurate in assessments of their own competence. Among physicians, the correlation between perceived abilities and external assessments of those abilities is weak. Overconfidence is more prevalent than underconfidence, particularly at lower levels of competence. On the individual level, confidence can be calibrated to a more appropriate level through efforts to increase competence, including sub-specialization, and by gaining a better understanding of metacognitive processes. With feedback, high-fidelity simulation has the potential to improve both competence and metacognition. On the system level, systems that facilitate access to follow-up imaging, pathology, and clinical outcomes can help close the gap between perceived and actual performance. Appropriate matching of trainee confidence and competence should be a goal of radiology residency and fellowship training to help mitigate the adverse effects of both overconfidence and underconfidence during training and independent practice.

Leishmaniasis: A new method for confirming cure and detecting asymptomatic infection in patients receiving immunosuppressive treatment for autoimmune disease

Visceral leishmaniasis (VL) in patients receiving immunosuppressant drugs for autoimmune disease has been on the rise. It is important—but difficult—to know when cure has been achieved in these patients since the withdrawal of immunosuppressants during antileishmania treatment is commonly required, and there is a risk of relapse when immunosuppression is restored. The prevalence of asymptomatic infection among those immunosuppressed for autoimmune disease is also uncertain. The present work describes how cytokine release assays can be used to confirm the cure of VL, and to determine the prevalence of asymptomatic infection, in such patients. After collection of blood from volunteers (n = 108), SLA-stimulation of peripheral blood mononuclear cell cultures and of whole blood was found to induce the production of different combinations of cytokines that served to confirm recovery from VL, and asymptomatic Leishmania infection. Indeed, cure was confirmed in 14 patients, all of whom showed a specific Th1 immune response against Leishmania, and the prevalence of asymptomatic infection was determined as 21.27%. Cytokine profiles could be used to manage VL in patients with autoimmune disease, and to identify and better protect those with asymptomatic infection who are at risk of developing this disease.

Cytokine release assays were used to confirm the cure of visceral leishmaniasis in patients (from an area where Leishmania infantum is endemic) with autoimmune disease. They were also used to determine the prevalence of asymptomatic Leishmania infantum infection in similar patients. Some 21.27% of those with no clinical history of leishmaniasis were shown to have been contact with the parasite.

B subgroup detection in a small hospital transfusion service

The ABO blood group system includes phenotypes, or subgroups, that differ in the amount of A and B antigens present on the red blood cells (RBCs). These subgroups also differ in the A, B, or H substances present in secretions (for individuals who have the secretor phenotype). B subgroups are very rare and are less frequently reported than A subgroups. Usually, B subgroups are discovered during serologic testing when there is a discrepancy between RBC and serum grouping results. Subgroups of B are usually identified by a reference laboratory using molecular and adsorption-elution methods. This report details a case of a young, healthy, pregnant woman with a B subgroup detected by a small transfusion service using adsorption-elution methods. Serology and genotyping of the ABO gene was performed at a reference laboratory where the serology was consistent with a B subgroup, but no changes were identified in ABO gene sequencing. It is important to correctly identify B subgroups in donors and recipients to help resolve ABO discrepancies and potentially prevent ABO incompatibility in blood transfusion, thus minimizing transfusion reactions.

The ABO blood group system includes phenotypes, or subgroups, that differ in the amount of A and B antigens present on the red blood cells (RBCs). These subgroups also differ in the A, B, or H substances present in secretions (for individuals who have the secretor phenotype). B subgroups are very rare and are less frequently reported than A subgroups. Usually, B subgroups are discovered during serologic testing when there is a discrepancy between RBC and serum grouping results. Subgroups of B are usually identified by a reference laboratory using molecular and adsorption-elution methods. This report details a case of a young, healthy, pregnant woman with a B subgroup detected by a small transfusion service using adsorption-elution methods. Serology and genotyping of the ABO gene was performed at a reference laboratory where the serology was consistent with a B subgroup, but no changes were identified in ABO gene sequencing. It is important to correctly identify B subgroups in donors and recipients to help resolve ABO discrepancies and potentially prevent ABO incompatibility in blood transfusion, thus minimizing transfusion reactions.

Detection of cutaneous leishmaniasis in three communities of Oti Region, Ghana

Background

Cutaneous leishmaniasis (CL) is the most common type of leishmaniasis, a neglected tropical disease caused by parasites of the genus Leishmania. In Ghana, some studies in the Volta region have detected Leishmania parasites among persons with skin ulcers.

Methodology/Principal findings

Using a cross-sectional study design, the prevalence of CL in three communities of the Oti Region of Ghana was investigated. Demographic and epidemiological data were obtained by a structured interviewer administered questionnaire. A total of 426 (12.4%) out of 3,440 participants screened had at least one skin ulcer. Of 595 skin ulcers sampled and tested by PCR for Leishmania infection, 150 (25.2%) ulcers from 136 individuals tested positive, accounting for an overall CL prevalence of 31.9% among persons with skin ulcers. Individual community CL prevalence of 23.2%, 29.8%, and 36.8% was observed in Ashiabre, Keri, and Sibi Hilltop respectively among persons with skin ulcers.

Conclusions/Significance

Confirmation of CL in the study area suggests an active cycle of transmission of Leishmania infection. The observation of skin ulcers which tested negative to Leishmania infection suggests a need to test for additional causes of skin ulcers such as Treponema pallidum pertenue and Mycobacterium ulcerans in the study area.

Cutaneous leishmaniasis (CL) is a neglected tropical disease caused by parasites of the genus Leishmania and is transmitted by various species of female sandflies. CL usually begins as painless nodules and is usually characterized by skin ulcers which may be single or multiple. Although ulcers due to CL are often self-healing, they may become painful and result in scarring after healing. Typically, CL occurs on exposed parts of the body such as the neck, limbs, and face, which may be easily accessible to sandflies. Although cases of CL had previously been reported in some parts of the Volta region of Ghana, no previous case of CL had been reported in the Oti region. This study was initiated following reports of skin ulcers which were suggestive of CL in some communities of the Oti region. This study confirmed Leishmania infection in 150(25.5%) out of 595 skin ulcer samples obtained from 426 study participants. Given that 445(74,8%) of the skin ulcers tested negative for Leishmania parasite suggests a need for investigation of additional causes of skin ulcers such as yaws and Buruli ulcer in the study area.

Cognitive and emotional correlates of belief in political misinformation: Who endorses partisan misbeliefs?

Across two studies, we investigated how much cognitive variables and emotional dynamics anticipated endorsement of politically partisan misbeliefs. In Study 1 (n = 298), those with lower levels of cognitive ability endorsed more political misbeliefs regardless of whether those beliefs aligned with their political preferences. However, emotional investment in political parties and outcomes predicted who endorsed misbeliefs in a partisan manner. In Study 2 (n = 251), asking participants to briefly consider political misinformation as true via social consensus led them to feel dissonance, particularly for incompatible beliefs. Allowing them then to endorse or reject those misbeliefs reduced that dissonance yet maintained feelings of self-validation, particularly as participants rejected beliefs hostile to their political vies. This effect was stronger for emotionally invested participants. These findings suggest that endorsement of divisive partisan misbeliefs is associated with affective partisanship, a feature of the political landscape that is on the rise. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Jumping to conclusions: Implications for reasoning errors, false belief, knowledge corruption, and impeded learning

In schizophrenia research, patients who "jump to conclusions" in probabilistic reasoning tasks tend to display impaired decision-making and delusional belief. In five studies, we examined whether jumping to conclusions (JTC) was similarly associated with decision impairments in a nonclinical sample, such as reasoning errors, false belief, overconfidence, and diminished learning. In Studies 1a and 1b, JTC was associated with errors stimulated by automatic reasoning, oddball beliefs such as conspiracy theories, and overconfidence. We traced these deficits to an absence of controlled processing rather than to an undue impact of automatic thinking, while ruling out roles for plausible alternative individual differences. In Studies 2 and 3, JTC was associated with higher confidence despite diminished performance in a novel probabilistic learning task (i.e., diagnosing illnesses), in part because those who exhibited JTC behavior were prone to overly exuberant theorizing, with no or little data, about how to approach the task early on. In Study 4, we adapted intervention materials used in schizophrenia treatment to train participants to avoid JCT. The intervention quelled overconfidence in the probabilistic learning task. In summary, this research suggests that a fruitful crosstalk may exist between research on psychopathology and work on social cognition within the general public. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The anti-scientists bias: The role of feelings about scientists in COVID-19 attitudes and behaviors

Across three studies, we investigated who expresses concern for COVID‐19, or coronavirus, and engages in behaviors that are consistent with slowing the spread of COVID‐19. In Studies 1 and 2 (n = 415, n = 199), those with warmer feelings toward scientists were more concerned and engaged in greater COVID‐preventative behaviors, regardless of partisanship. That is, an anti‐scientists bias was related to lessened concern and toward less preventive behaviors. Furthermore, those who were the most optimistic about hydroxychloroquine, a purported but unproven treatment against the virus, were less likely to engage in behaviors designed to decrease the spread of COVID‐19. In Study 3 (n = 259), asking participants to watch a scientist discuss hydroxychloroquine on Fox News led people to greater endorsement of COVID behaviors. In short, positive feelings toward scientists, rather than political attitudes or knowledge, related to who was concerned and those willing to engage in pandemic reducing behaviors. These behaviors were not immutable and can be changed by scientific out‐reach.

TICACOS international: A multi-center, randomized, prospective controlled study comparing tight calorie control versus Liberal calorie administration study

Since the first TICACOS study, 3 additional studies have been published comparing a medical nutrition therapy guided by indirect calorimetry to a regimen prescribed on the basis of predictive equations. A recent guidelines document included a meta-analysis including these 4 papers and found a trend for improvement (OR 0.98-1.48) in favor of medical nutrition therapy guided by indirect calorimetry in terms of survival. The aim of our study was to perform a multicenter prospective, randomized, controlled non blinded study in critically patients to assess the added value for measuring daily resting energy expenditure as a guide for nutritional support. The primary objective was to decrease infectious rate of these critically ill patients.

MATERIAL AND METHODS

This phase III, multi-center, randomized, controlled non blinded study was planned to include 580 newly-admitted, adult ventilated ICU patients that were planned to stay more than 48 h in the ICU departments. The nutritional support was aimed to meet 80-100% of energy requirement measured by indirect calorimetry. The calorie needs were determined by IC in the Study group and by an equation (20-25 kcal/kg ideal body weight/day) in the Control Group. The ICU staff was trained to strive to supply 80-100% of a patient's energy requirements through artificial nutrition, preferably enteral feeding. Primary endpoint was infection rate and secondary endpoints included other morbidities and mortality during ICU, at 90 and 180 days. Comparison between the study and the control group was performed using T test for equality of means (independent samples test). Correlations were performed using the Pearson correlation test. A p level of 0.05 or below was considered as significant. Cross tabs procedure used Chi-square test for testing differences in complication rates, length of stay and length of ventilation. Correlations between energy balances and complications was also be tested using one way analysis as well as ANOVA analysis between groups and within groups. Kaplan Meir curves assessed the proportion of surviving patients in the 2 groups.

RESULTS

Seven centers with a calorimeter available participated to the study. Due to slow inclusion rate, the study was stopped after 6 years and after inclusion of 417 patients only. From the 417 intended to treat patients, 339 followed the protocol. There was no differences between control and study groups in terms of age, sex BMI, SOFA (7.1 ± 3.1 vs 7.4 ± 3.3) and APACHE II scores (22.4 ± 7.9 vs 22.2 ± 7.4). The rate of infection (40 vs 31), including pneumonia rate, need for surgery, dialysis requirement, length of ventilation, ICU length of stay, and hospital length of stay were not different between groups. Mortality (30 in the control vs 21 in the study group) was not significantly different between groups. The decreased mortality observed in the study group when added to previous studies may have a positive effect on the meta-analysis previously published.

CONCLUSION

Tight Calorie Control guided by indirect calorimetry decreased the rate of infection and mortality but not significantly. This may be explained by the not relatively small sample size. There results together with the previous 4 prospective randomized studies, may improve the results of the meta-analysis exploring the effects of IC guided nutrition on mortality.

Countdown to physician-free EKG interpretation

Background

With the introduction of electronic medical records and other digital platforms, the classification and coding of different medical entities have become a complex, cumbersome task that is prone to diagnostic inconsistencies and errors. By incorporating Artificial Intelligence (AI) to a massive database of EKG records, we have developed an innovative methodology to accurately discriminate an EKG as “normal” or “abnormal”. We firmly believe that this algorithm sets up medicine on a path of complete computer-aided EKG interpretation.

Purpose

To present a viable AI-guided filter that can accurately discriminate between normal and abnormal EKG within a cardiologist-annotated EKG database.

Methods

An observational, retrospective, case-control study. Samples: A total of 140,000 randomly sampled 12-lead ECG of 10-seconds length with a sampling frequency of 500 [Hz] from Brazil (BR) and Colombia (CO) (divided as 70,000 normal and 70,000 abnormal EKG records per country dataset) were derived from the private International Telemedical System (ITMS) database from September 2018 to July 2019. Only de-identified records were used, records with artifacts were excluded. Preprocessing: Only the first 2s of each short lead and 9s of the long lead were considered. This data includes mobile (MOB) and transtelephonic (TTP) EKGs (50/50 ratio). Limb leads I, II and III and precordial leads V1, V2, V3 and V5 were used. The mean was removed from each lead. Training Sets: Four models were trained as depicted in the figure below. Each training dataset has 25,000 Normal and 25,000 Abnormal records, where 10% of the total records were used as a validation set. The test sets included 10,000 normal, and 10,000 abnormal records each. Testing and Class Assigning: An inception convolutional neural network was implemented; Each model was tested with 5,000 normal and 5,000 abnormal records of the corresponding country and transmission type with which they were trained. “Normal” or “Abnormal” labels were assigned to each EKG record and were compared to the cardiologists' reports; performance indicators (accuracy, sensitivity, and specificity) were calculated for each model.

Results

An overall accuracy of 82.4%; sensitivity of 88.7%; and specificity of 76.2% was achieved amongst the 4 testing models (Separate results of each training set are shown below).

Conclusion(s)

AI enables the interpretation of digital EKG records to be exercised in an organized, accurate, and straightforward manner, taking into consideration the multiple potential entities that can be diagnosed through this historical triage tool. By quickly identifying the normal records, the cardiologist is able to invest efforts in treating patients in a timely manner.

Funding Acknowledgement

Type of funding source: None

AB1204 COST-EFFECTIVENESS OF ABATACEPT IN SPAIN IN SEROPOSITIVE BIOLOGIC-NAÏVE EARLY RHEUMATOID ARTHRITIS PATIENTS WITH SHARED EPITOPE

Background:

The HLA class II Shared Epitope (SE) is a known Rheumatoid Arthritis (RA) risk allele linked to autoantibody production and disease progression. The recent Early AMPLE study suggests an enhanced treatment benefit of abatacept (ABA) over adalimumab (ADA) in SE positive patients with early seropositive RA.1Economic implications beyond the trial follow-up duration are unknown.

Objectives:

To estimate the cost-effectiveness of ABA vs ADA in biologic-naive RA patients seropositive for anti-citrullinated protein antibody and rheumatoid factor based on the Early AMPLE study.

Methods:

We developed a microsimulation model to estimate clinical response, medical cost, quality of life and survival from a Spanish payer perspective. The model captures the patient’s disease and treatment journey using response outcomes and the Health Assessment Questionnaire (HAQ) score. Patients who fail to respond switch to the next treatment line. Six treatment lines are included to capture a lifetime horizon. Responding patients (ACR50 and EULAR response) achieve an improvement in their HAQ score. Patient mortality was modelled as a function of HAQ. For both the overall Early AMPLE population and SE+ patients, incremental monthly cost per response over 2 years and incremental cost per QALY over a lifetime were estimated. Costs were based on local tariffs in Spain.

Results:

Baseline characteristics for the Early AMPLE (n=80) and the SE+ (n=61) patients were well balanced between the treatment groups.2Compared to ADA, the ABA cohort had a lower cost per response and the difference was more pronounced in the SE+ population, compared to the entire Early AMPLE population for both the response criteria (Table 1). Compared with ADA, the ABA cohort showed greater quality adjusted life years (QALYs) gains, and a modest increase in cost due to a prolonged time on treatment (Table 2). The incremental cost per QALY over a lifetime fell below commonly used thresholds in Spain (25-60 thousand Euros per QALY).3

Table 1.

Cost per response results

Full Early AMPLEACR50EULARABAADAABAADACost per response (€) – 2 years25,86040,65426,99340,643Incremental monthly cost per response (€)-616-569SE positiveACR 50EULARABAADAABAADACost per response (€) – 2 years24,27240,24925,33741,425Incremental monthly cost per response (€)-666-670

All incremental results are for ABA – ADA

Table 2.

Cost-effectiveness results (discounted)

Full Early AMPLEACR50EULARABAADAABAADALYs*30.1430.0630.1130.03QALYs8.327.817.577.12Time on treatment (years)4.172.035.143.06Costs (€)75,54768,15785,12280,933Incremental LYs*0.080.08Incremental QALYs0.520.45Incremental Costs (€)7,3904,189Incremental cost per QALY (€)14,3089,275SE positiveACR50EULARABAADAABAADALYs*30.3830.2230.1630.09QALYs8.207.597.406.90Time on treatment (years)4.482.025.383.02Costs (€)78,11368,65187,58681,321Incremental LYs*0.150.06Incremental QALYs0.610.50Incremental Costs (€)9,4626,265Incremental cost per QALY (€)15,41012,503

*LY results are presented undiscounted. All incremental results are for ABA – ADA

Conclusion:

Compared with ADA, ABA is a cost-effective alternative and is associated with a lower 2 years cost per response for both populations. The economic benefit and quality of life gain is greater in a SE+ patient population.

References:

[1]Rigby W, et al. EULAR Annual Meeting, June 2019; Poster LB0008

[2]Buckner J, et al. ACR/ARP Annual Meeting, Nov 2019; Poster 1424

[3]Sacristán JA, et al.Gaceta Sanitaria2019

Disclosure of Interests:

José M. Rodríguez-Heredia: None declared, Lisanne Verburg-Baltussen Consultant of: Consultant for Bristol-Myers Squibb, Paid instructor for: Training sessions for Pharmaceutical companies, Dhanda Devender Shareholder of: BMS, Employee of: BMS, Nicholas Durno Consultant of: Consultant for Bristol-Myers Squibb, Paid instructor for: Training sessions for Pharmaceutical companies, Carlos Sanchez Shareholder of: Shareholder of Bristol-Myers Squibb, Employee of: Bristol Myers-Squibb, Neelanjana Ray Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Maarten Treur Consultant of: Consultant for Bristol-Myers Squibb, Paid instructor for: Training sessions for Pharmaceutical companies, Joe Zhuo Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb

AB0073 BOSWELLIA SERRATA EXTRACT AND CURCUMIN INCREASE GDF15 PRODUCTION BY HUMAN PRIMARY OSTEOARTHRITIS CHONDROCYTES: A NEW MECHANISM OF ACTION

Background:

Boswellia serrata extract (BSE) and curcumin are used to relief symptoms in osteoarthritis (OA).

Objectives:

This study aims to better understand the mode of action of these compounds on OA chondrocytesin vitro.

Methods:

Therapeutic plasmatic concentrations of the different components of BSE correspond to anin vitrorange from 25 to 100 µg/ml of total BSE (100 µg/ml of BSE corresponds to 9.2 µM of 11-keto-β-boswellic acid (KBA), 5.2 µM of acetylKBA, 22 µM de αBA, 34 µM de βBA, 4.4 µM de acetylαBA and 13.2 acetyl βBA), and between 2 to 10 µM for bioavaibility-increased curcumin. BSE (5-100 µg/ml) and curcumin (0.04 to 4 µg/ml corresponding to 0.1 to 10 µM) were tested separately on primary chondrocytes from 3 OA patients. Lactate Deshydrogenase LDH, nitrite (NO2), interleukin (IL)-6 and Growth Differentiation Factor (GDF)15 were quantified in 72h-treated supernatant using enzyme activity, Griess reaction and ELISAs, respectively.

Results:

No mortality was observed at the tested concentrations. BSE and curcumin both decreased concentration-dependently NO2and IL-6 production, and increased GDF15 production. For NO2production, the decrease was observed from 0.2 µg/ml of curcumin and 10 µg/ml of BSE. For IL-6 production, the decrease was observed from 1 µg/ml for curcumin and 10 µg/ml for BSE. For GDF-15, the increase was observed from 2 µg/ml for curcumin and 50 µg/ml for BSE. Maximal effect was observed at 4 µg/ml for curcumin: -67% NO2(p<0.0001), -71% IL-6 (p=0.0001) and +80% GDF15 (p<0.0001) and at 100 µg/ml for BSE: -40% NO2(p=0.0003), -70% IL-6 (p=0.0003) and +73% for GDF15 (p=0.0017).

Conclusion:

At therapeutic plasmatic concentrations, BSE and curcumin decreased the production of NO2and IL-6, two inflammatory mediators. Furthermore, BSE and curcumin enhanced GDF-15 production, an anti-inflammatory growth factor. GDF15 was first identified as Macrophage inhibitory cytokine-1 or NSAID-activated gene-1 (by a prostanoid-independent manner), and is known as a regulator of inflammatory, cell repair and apoptosis pathways. GDF-15 has pro-apoptotic and anti-tumorigenic activity in vitro and in vivo. It could represent a new pathway explaining the beneficial effects of BSE and the curcumin on synovium inflammation and cartilage degradation.

Disclosure of Interests:

christelle sanchez: None declared, Jérémie Zappia: None declared, Yvan Dierckxsens Shareholder of: Tilman SA, Employee of: Tilman SA, Jean-Pierre Delcour: None declared, Yves Henrotin Grant/research support from: HEEL, TILMAN

AB0072 A MULTICOMPONENT MEDICATION PROMOTES CHONDROGENESIS AND REDUCES MMP-13 IN PRIMARY ARTICULAR CHONDROCYTES FROM KNEE OSTEOARTHRITIS PATIENTS IN VITRO

Background:

HE-1100 is a multicomponent medicinal product. Initial preclinical data potentially suggest a preventive effect on cartilage degradation.

Objectives:

This study aims to understand the mode of action of HE-1100 on OA chondrocytesin vitro.

Methods:

Primary chondrocytes were obtained from 10 knee osteoarthritis (OA) patients undergoing knee replacement surgery. The cultures were treated with 20% (v/v) HE-1100 or placebo. Samples were collected for subsequent RNA extraction using standard methods. The reads were generated with Illumina NextSeq5000 sequencer and aligned to the human reference genome (UCSC hg19) to generate the transcriptome. Differential expression analysis between HE-1100 and placebo was made in R using the DESeq2 package to identify the differentially expressed genes in the OA-associated regulatory pathways. The protein production of the selected genes was quantified by ELISA in 10 independent human OA chondrocytes cultures.

Results:

According to the DESeq2 analysis, HE-1100 significantly modified the expression of 13 genes in OA chondrocytes by at least 10% with an adjusted p-value < 0.05: EGR1 (+93%), FOS (+87%), NR4A1 (+43%), DUSP1 (+18%), ZFP36 (+18%), ZFP36L1 (+14%), NFKBIZ (+16%) and CYR61 (+14%) were upregulated and ATF7IP (-10%), TXNIP (-11%), C10orf10 (-12%), CLEC3A (-12%) and MMP13 (-18%) were downregulated after 24h HE-1100 treatment. HE-1100 significantly increased (2.3 fold +/-1.2 after 24h, p=0.0444 and 2.3-fold +/-1.0 after 72h, p=0.0239) the CYR61 protein production by human OA chondrocytes. After 72h, HE-1100 slightly but not significantly increased aggrecan production by 14 ± 19 % (p=0.1117) and significantly increased type II collagen pro-peptide production by 27 ± 20 % (p=0.0147). For both time points CYR61 production by OA chondrocytes was positively and significantly correlated with aggrecan (r=0.66, p=0.0004) and type II collagen pro-peptide (r=0.64, p=0.0008) production. In alginate beads culture, pro-MMP-13 was significantly decreased by HE-1100 treated cultures from day 7 to day 14 (from -16 to -25 %, p<0.05) and from day 17 to 21 (-22 %, p=0.0331) in comparison to controls.

Conclusion:

HE-1100 significantly modified the expression of DUSP1, C10orf10, ZFP36/L1 and CLEC3A, which are pathway mediators involved in MMP-13 expression and activation. Further, long-term (28 days) treatment with HE-1100 significantly reduced the production of pro-MMP-13, the inactive precursor of the metalloproteinase MMP-13 involved in type II collagen degradation. HE-1100 also promoted extracellular matrix formation probably through CYR61 production, a growth factor well correlated with type II collagen and aggrecan production.

References:

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Acknowledgments:

We would like to thank the staff of the GIGA ULiège Genomic Next Generation Sequencing platform for performing the RNA sequencing and Benoit Charloteaux for his help in RNAseq data analysis.

Disclosure of Interests:

christelle sanchez: None declared, Kathrin Hemmer Employee of: Heel, Natascha Kroemmelbein Employee of: Heel, Bernd Seilheimer Employee of: Heel, Jean-Emile Dubuc: None declared, Christophe Antoine Employee of: Artialis, Yves Henrotin Grant/research support from: HEEL, TILMAN

Predictors of a good response to inhaled corticosteroids in obesity-associated asthma

INTRODUCTION

Asthma in obese subjects is poorly understood. According to GINA guidelines, pulmonologists increase ICS in case of poor asthma control but lung volume restriction may also worsen respiratory symptoms in obese asthmatics leading to overtreatment in this subpopulation.

METHODS

We conducted a retrospective study on 1217 asthmatics recruited from University Hospital of Liege. 92 patients with a BMI ≥30 came at least two times at the asthma clinic (mean interval: 335 days). In this obese population, we identified predictors of good (decrease in ACQ ≥0.5) versus poor response (rise in ACQ ≥0.5) to ICS step-up therapy.

RESULTS

Obese asthmatics had a poorer asthma control and quality of life as compared to non-obese and exhibited reduced FVC, higher levels of blood leucocytes and markers of systemic inflammation. The proportion of asthma inflammatory phenotypes was similar to that observed in a general population of asthmatics. Among uncontrolled obese asthmatics receiving ICS step-up therapy, 53% improved their asthma control while 31% had a worsening of their asthma. Uncontrolled obese asthmatics showing a good response to increase in ICS had higher ACQ, lower CRP levels, higher sputum eosinophil counts and higher FeNO levels at visit 1. Uncontrolled obese asthmatics that worsened after increasing the dose of ICS had lower FVC, lower sputum eosinophil counts and higher sputum neutrophil counts.

CONCLUSION

We observed poorer asthma control in obese asthmatics despite similar bronchial inflammation. Managing obese asthmatics according to ACQ alone seems to underestimate asthma control and the contribution of restriction to dyspnea. Increasing the dose of ICS in the absence of sputum eosinophilic inflammation or in the presence of restriction or bronchial neutrophilia led to poorer asthma control. In those patients, management of obesity should be the first choice.

Recent advances in circulating nucleic acids in oncology

Circulating cell-free DNA (cfDNA) is one of the fastest growing and most exciting areas in oncology in recent years. Its potential clinical uses cover now each phase of cancer patient management care (predictive information, detection of the minimal residual disease, early detection of resistance, treatment monitoring, recurrence surveillance, and cancer early detection/screening). This review relates the recent advances in the application of circulating DNA or RNA in oncology building on unpublished or initial findings/work presented at the 10th international symposium on circulating nucleic acids in plasma and serum held in Montpellier from the 20th to the 22nd of September 2017. This year, presenters revealed their latest data and crucial observations notably in relation to (i) the circulating cell-free (cfDNA) structure and implications regarding their optimal detection; (ii) their role in the metastatic or immunological processes; (iii) evaluation of miRNA panels for cancer patient follow up; (iv) the detection of the minimal residual disease; (v) the evaluation of a screening tests for cancer using cfDNA analysis; and (vi) elements of preanalytical guidelines. This work reviews the recent progresses in the field brought to light in the meeting, as well as in the most important reports from the literature, past and present. It proposes a broader picture of the basic research and its potential, and of the implementation and current challenges in the use of circulating nucleic acids in oncology.

Peritoneal Dialysis in Liver Disorders

The purpose of this paper is to review the specific role of peritoneal dialysis (PD) in patients with liver disorders. We will pay attention to the confluence of liver diseases and situations for which chronic dialysis treatment is required.

Hemodialysis (HD) and peritoneal membranes are safe barriers against the passage of the hepatitis C virus; consequently, while peritoneal effluent or HD ultrafiltrate drained from hepatitis S patients/carriers is infective, that from hepatitis C patients does not appear to present this risk. An important issue is horizontal transmission, which appears to occur with both viruses in HD units, and which is absent in peritoneal dialysis units. The incidence of hepatitis C among continuous ambulatory peritoneal dialysis (CAPD) patients is quite low, while it may reach almost 50% -60% of HD patients in some units. While hepatitis C transmission mechanisms are not completely understood and a vaccine is not available, PD provides some degree of protection when compared with HD, for end-stage renal disease patients.

In summary, our experience and that of others, with a total of 19 PD-treated chronic liver disease patients, supports CAPD as the treatment of choice for cirrhotic patients with ascites who require chronic dialysis. Data on peritoneal diffusion of low molecular weight substances revealed a marked increase in most patients. The ultrafiltration capacity was clearly augmented with respect to noncirrhotic patients, making the use of hypertonic bags unnecessary. Hemodynamic tolerance was excellent. Complications and death were mainly related to liver disease complications.

Spontaneous bacterial peritonitis (SSP), caused by gram-negative germs, is the most important complication directly related to ascites and may have some points in common with PD-related peritonitis. However, and in contrast to most PD peritonitis, two pathogenetic mechanisms have been suggested for SSP: (1) translocation of bacteria from the gut to the mesenteric lymph nodes, and (2) bacteremia in these patients is secondary to the general abnormal host defense mechanisms. Local factors such as intrahepatic shunting and the impairment of bactericidal activity in ascitic fluid favor the bacteria ascites. The hypothesis of a direct transmural contamination from bowel to ascitic fluid has been relegated to secondary bacterial peritonitis. Would cirrhotic patients with temporal or permanent renal function compromise benefit from peritoneal catheter placement and other PD practices to perform repetitive small ascitic drainages at home? Perhaps the time has arrived when hepatologists and PD nephrologists begin to work shoulder to shoulder in this particular field, as we have a common problem, the peritoneal cavity filled with fluid.

Novel Dual-Action Targeted Nanomedicine in Mice With Metastatic Thyroid Cancer and Pancreatic Neuroendocrine Tumors

Background

The advantages of nanomedicines include preferential delivery of the payload directly to tumor tissues. CYT-21625 is the novel, first-in-class gold nanomedicine designed to target tumor vasculature and cancer cells by specifically delivering recombinant human tumor necrosis factor alpha (rhTNF) and a paclitaxel prodrug.

Methods

We analyzed TNF receptor expression in publicly available gene expression profiling data and in thyroid tissue samples. Mice with metastatic FTC-133 and 8505C xenografts and the MEN1 conditional knock-out mice were treated weekly with CYT-21625 and gold nanoparticles with rhTNF only (CYT-6091); controls included mice treated with either paclitaxel or saline. In vivo luciferase activity was used to assess the effects on tumor growth. Computed tomography, magnetic resonance imaging, and 18F-Fludeoxyglucose positron emission tomography were used to study tumor selectivity in mice with insulin-secreting pancreatic neuroendocrine tumors (PNETs). All statistical tests were two-sided.

Results

Anaplastic thyroid cancer (ATC) expressed statistically significantly higher levels of TNF receptor superfamily 1A and 1B messenger RNA (n = 11) and protein (n = 6) than control samples (n = 45 and 13, respectively). Mice (n = 5-7 per group) with metastatic ATC (P < .009) and FTC-133 xenografts (P = .03 at week 3, but not statistically significant in week 4 owing to reduced sample size from death in non-CYT-21625 groups) treated with CYT-21625 had a statistically significantly lower tumor burden. Treatment with CYT-21625 resulted in loss of CD34 expression in intratumoral vasculature, decreased proliferating cell nuclear antigen, and increased cleaved caspase-3. Intratumoral vascular leakage occurred only in mice with PNET and ATC treated with CYT-6091 and CYT-21625. CYT-6091 and CYT-21625 preferentially deposited in PNETs and statistically significantly decreased serum insulin levels (n = 3 per group, P < .001). There were no toxicities observed in mice treated with CYT-21625.

Conclusions

CYT-21625 is effective in mice with PNETs and metastatic human thyroid cancer with no toxicities. Thus, CYT-21625 should be studied in patients with advanced PNETs and thyroid cancer.

Investigating the Robustness of the Illusory Truth Effect Across Individual Differences in Cognitive Ability, Need for Cognitive Closure, and Cognitive Style

People are more inclined to believe that information is true if they have encountered it before. Little is known about whether this illusory truth effect is influenced by individual differences in cognition. In seven studies (combined N = 2,196), using both trivia statements (Studies 1-6) and partisan news headlines (Study 7), we investigate moderation by three factors that have been shown to play a critical role in epistemic processes: cognitive ability (Studies 1, 2, 5), need for cognitive closure (Study 1), and cognitive style, that is, reliance on intuitive versus analytic thinking (Studies 1, 3-7). All studies showed a significant illusory truth effect, but there was no evidence for moderation by any of the cognitive measures across studies. These results indicate that the illusory truth effect is robust to individual differences in cognitive ability, need for cognitive closure, and cognitive style.

86-GBaud subcarrier multiplexed 16QAM signal generation using an electrical 90 degree hybrid and IQ mixers

We experimentally demonstrate an aggregate 86-GBaud (over three sub-bands and one polarization) signal generation based on subcarrier multiplexing technique using IQ mixers, an electrical 90 degree hybrid, and diplexers. The electrical hybrid allows transmitter-side digital signal processing to be simplified to pulse shaping and digital pre-emphasis. We verified the configuration by testing the performance of an 86-GBaud Nyquist-shaped 16 quadrature amplitude modulation signal with differential bit encoding. The implementation penalty assuming 7% hard-decision forward error correction is reduced to 2 dB by utilizing a 31-tap decision-directed least mean square based multiple-input multiple-output equalizer for sideband crosstalk mitigation.