ACR Appropriateness Criteria® Management of Vertebral Compression Fractures: 2022 Update

Vertebral compression fractures (VCFs) can have a variety of etiologies, including trauma, osteoporosis, or neoplastic infiltration. Osteoporosis related fractures are the most common cause of VCFs and have a high prevalence among all postmenopausal women with increasing incidence in similarly aged men. Trauma is the most common etiology in those >50 years of age. However, many cancers, such as breast, prostate, thyroid, and lung, have a propensity to metastasize to bone, which can lead to malignant VCFs. Indeed, the spine is third most common site of metastases after lung and liver. In addition, primary tumors of bone and lymphoproliferative diseases such as lymphoma and multiple myeloma can be the cause of malignant VCFs. Although patient clinical history could help raising suspicion for a particular disorder, the characterization of VCFs is usually referred to diagnostic imaging. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

NIMG-59. EVALUATION OF THE RESPONSE ASSESSMENT CRITERIA IN NEWLY DIAGNOSED AND RECURRENT GLIOBLASTOMA

BACKGROUND

We sought to compare the Response Assessment in Neuro-Oncology (RANO), modified RANO (mRANO), and immunotherapy RANO (iRANO) in a large population of patients with newly diagnosed (nGBM) and recurrent (rGBM) glioblastoma.

METHODS

Bidimensional measurements of enhancing disease and FLAIR sequence evaluation were performed by two independent readers on brain MRIs of consecutive patients with IDH-wildtype nGBM and rGBM treated at a single institution. Discrepancies were evaluated by a third reader. Dates of disease progression (PD) were identified using RANO, mRANO, iRANO, and other response assessment criteria variations. Spearman’s correlations between PFS and OS were calculated using iterative multiple imputations for censored observations.

RESULTS

526 nGBM and 580 rGBM cases were included. Spearman’s correlations were not significantly different between RANO and mRANO in nGBM (0.69 [95% CI 0.62 to 0.75] vs. 0.67 [0.60, 0.73]) and rGBM (0.48 [0.40, 0.55] vs. 0.50 [0.42, 0.57]). Evaluation of FLAIR did not improve the correlation in patients who received antiangiogenic therapy. Acquisition of confirmation scans was associated with increased correlation only when PD was identified within 12 weeks of completion of radiation in nGBM. The use of the post-radiation MRI as a baseline was associated with increased correlation compared to use of the pre-radiation MRI in nGBM (0.67 [0.60, 0.73] vs. 0.53 [0.42, 0.62]). The correlation with iRANO was similar to RANO and mRANO among 98 patients with nGBM and 175 patients with rGBM who received immunotherapy.

CONCLUSIONS

RANO and mRANO demonstrated similar correlations between PFS and OS. The evaluation of FLAIR can be omitted, while confirmation scans were only beneficial in nGBM in the first 12 weeks after completion of radiation. There was a trend in favor of the post-radiation MRI as the baseline scan in nGBM. The use of iRANO criteria did not add a significant benefit in patients who received immunotherapy.

211 ASSOCIATION OF PLASMA ANTIOXIDANTS AND COGNITIVE OUTCOMES IN NORTHERN IRISH MEN FROM PROSPECTIVE EPIDEMIOLOGICAL STUDY OF MYOCARDIAL INFARCTION (PRIME) STUDY

Background

Oxidative stress and chronic inflammation have been demonstrated to contribute to cognitive decline in older age and the development of neurodegenerative disorders. Antioxidants have been revealed to help mitigate the effects of the damage caused by oxidative stress and inflammation, but their relationship with cognitive decline is not yet fully understood. The aim of this study was to investigate the association between various plasma antioxidant levels and cognitive status in participants from the Prospective Epidemiological Study of Myocardial Infarction (PRIME) study.

Methods

10,600 men were recruited to the PRIME study between 1991-1993 and have been followed up across eleven time points. Baseline health and lifestyle characteristics were assessed, and plasma antioxidants were obtained and quantified. Baseline cognitive status was screened in 2000 using Mini-Mental State Examination (MMSE). Follow up assessment of cognitive status was performed in 2015 with MMSE and Addenbrooke’s Cognitive Examination-Revised (ACE-R) examinations.

Results

2,009 men underwent cognitive assessment in 2000 and 873 men in 2015. At both 2000 and 2015 with the use of the MMSE and ACE-R examinations to assess cognitive status, serum concentration of all the antioxidants except for gamma-tocopherol and lycopene were higher in the men with better cognitive performance at a significant level of p<0.05. Better cognitive performance was associated with more time spent in education and higher level of education achieved at a statistically significant level (p<0.01). Furthermore, those with cognitive impairment were more likely to be older. After adjustments for lifestyle variables with a linear regression model, the only significant variable associated with cognition was time spent in education (B = 0.521, p= 0.02).

Conclusion

The findings suggest that the concentration of plasma antioxidants is associated with cognitive status. Smoking and education, as well as other lifestyle factors were, demonstrated to have an impact on cognitive status.

Vascular access teams: a global outlook on challenges, benefits, opportunities, and future perspectives

BACKGROUND

Specialized vascular access training for medical professionals organized into vascular access teams (VATs) was shown to improve patient outcomes, clinical efficiency, and cost savings. Professional perspectives on VAT benefits, organization, challenges, and opportunities on a global scale remain inadequately explored. Using detailed perspectives, in this study, we explored the global VAT landscape, including challenges faced, clinical and clinico-economic impacts of VATs, with emphasis on underresearched facets of VAT initiation, data dissemination, and metrics or benchmarks for VAT success.

METHODS

Semistructured in-depth interviews of 14 VAT professionals from 9 countries and 5 continents were used to elicit qualitative and quantitative information.

RESULTS

Catheter insertions (100%) and training (86%) were the most performed VAT functions. Based on a 1-7 scale evaluating observed impacts of VATs, patient satisfaction (6.5) and institutional costs (6.2) were ranked the highest. VAT co-initiatives, advanced technology utilization (6.6), and ongoing member training (6.3) distinctly impacted VAT endeavors. Most institutions (64%) did not have routine mechanisms for recording VAT-related data; however, all participants (100%) stated the importance of sharing data to demonstrate VAT impacts. Time constraints (57%) emerged as one of the major deterrents to data collection or dissemination. The majority (64%) experienced an increased demand or workload for VAT services during the COVID-19 pandemic.

CONCLUSIONS

Despite the global variances in VATs and gaps in VAT-related data, all participants unanimously endorsed the benefits of VAT programs. Evaluating the impact of VATs, disseminating VAT-related data, and forging specialized institutional partnerships for data sharing and training are potential strategies to tackle the hurdles surrounding VAT formation and sustenance.

Evaluation of the response assessment criteria in newly diagnosed and recurrent glioblastoma

2020

Background: The Response Assessment in Neuro-Oncology (RANO) and modified RANO (mRANO) criteria are the two most widely used criteria to evaluate treatment response in glioblastoma (GBM) clinical trials. Unlike RANO, mRANO omits the evaluation of FLAIR sequence and requires a repeat scan to confirm responses. It also uses the post-radiation (RT) MRI as a baseline MRI in the newly diagnosed setting instead of the pre-RT MRI used in RANO. We sought to compare the 2 response assessment criteria and evaluate the differences between them in a large patient population. We also sought to compare them to immunotherapy RANO (iRANO) in patients who received immunotherapy. Methods: We conducted a retrospective review of consecutive patients with newly diagnosed (nGBM) and recurrent (rGBM) IDH wild-type GBM treated at Dana-Farber Cancer Institute from 2014 to 2020. Bidimensional measurements of enhancing disease and evaluation of FLAIR sequences were performed by two independent readers on patients’ brain MRIs obtained before change of treatment, and discrepancies were evaluated by a third reader. Dates of disease progression (PD) were identified using RANO, mRANO, iRANO, and other response assessment criteria variations. Spearman’s correlations between PFS and OS were calculated using an iterative multiple imputation method to account for any right-censoring. Results: 526 and 580 patients were included in the newly diagnosed and recurrent cohorts, respectively. Spearman’s correlations were not significantly different between RANO and mRANO in the nGBM (0.69 [95% CI 0.62 to 0.75] vs. 0.67 [0.60, 0.73]) and rGBM (0.45 [0.37, 0.52] vs. 0.50 [0.42, 0.57]) cohorts. Evaluation of FLAIR sequences did not improve the correlation between PFS and OS in patients who received antiangiogenic therapy. Addition of confirmation scans was associated with stronger Spearman’s correlations only when PD was identified within 12 weeks of completion of RT in the nGBM cohort, but did not affect the Spearman’s correlations in the rGBM cohort. The use of the post-RT MRI as a baseline was associated with a higher Spearman’s correlation in nGBM than the use of pre-RT MRI (0.67 [0.60, 0.73] vs. 0.53 [0.42, 0.62]). Among 98 patients with nGBM and 175 patients with rGBM who received immunotherapy, the Spearman’s correlations (nGBM and rGBM) with iRANO (0.63 [0.44, 0.76] and 0.34 [0.17, 0.49]) were similar to RANO (0.73 [0.60, 0.82] and 0.42 [0.28, 0.54]) and mRANO (0.65 [0.48, 0.77] and 0.43 [0.28, 0.56]). Conclusions: RANO and mRANO demonstrated similar correlation between PFS and OS. The evaluation of FLAIR can be omitted, while confirmation scans appear to be only beneficial in the nGBM settings during the first 12 weeks of completion of RT. There was a nonsignificant trend in favor of the use of post-RT MRI as the baseline scan in the nGBM setting. The application of iRANO criteria did not add significant benefit in patients who received immunotherapy.

809 USE OF NEW MOBILITY SCORE AND A TRANS-DISCIPLINARY APPROACH TO REDUCE HOSPITAL LOS, RETURN TO ORIGINAL RESIDENCE, AND MORTALITY

Introduction

The National Hip Fracture Database indicated Guy’s and St Thomas’ Trust ranked in the fourth quartile nationally with reference to hospital length of stay (LOS), return to original residence (ROR), and mortality in hip fracture patients in 2018. This quality improvement project aimed to improve and maintain these key factors via a two-stage process.

Methods

Stage one involved implementation of four key interventions through a trans-disciplinary focus group, comprising ortho-geriatricians, orthopaedic surgeons, physiotherapists (PT), occupational therapists (OT), nursing staff, and a transfer of care navigator (TCN). Firstly, the New Mobility Score (NMS) was employed as a tool to guide estimated length of stay. Secondly, use of preoperative OT assessment allowed early evaluation of patient expectations concerning discharge planning. Third, facilitation of the discharge process was optimised by the recruitment of a TCN. Lastly, attendance of a senior orthogeriatrician during the daily board round was established. Stage two involved education of new members of the trans-disciplinary team to ensure that the key interventions listed above were maintained on hip fracture patients.

Results

Following stage one, average acute hospital LOS and overall LOS decreased from 20.1 to 15.1 days and 22.4 to 18.3 days, respectively. Rate of ROR within 120 days of discharge improved from 72.4% to 86.9%, while mortality rates fell from 7.1 to 3.4. Following stage two, overall LOS improved to 17.1 days, while acute LOS and mortality were maintained at 15.6 and 3.9 days, respectively. While ROR fell to 82.8%, this remained higher than the national average at 69.9%.

Conclusions

Utilisation of NMS and multi-disciplinary input effectively improved ROR, while reducing length of hospital stay and mortality rates in hip fracture patients. Education of new members of the trans-disciplinary team allowed sustained improvement despite challenges faced during the COVID-19 pandemic.

NIMG-24. RANO CRITERIA DETECTS EARLY PROGRESSION SOONER THAN MODIFIED RANO CRITERIA IN PATIENTS WITH NEWLY DIAGNOSED GLIOBLASTOMA

BACKGROUND

Accurate response criteria are crucial for determining treatment efficacy. The response assessment in neuro-oncology (RANO) criteria was developed to standardize response assessment in neuro-oncology. Modified RANO (m-RANO) criteria were recently proposed to address some limitations of the initial criteria including the use of a post-radiation baseline and an additional scan to confirm progression. We sought to identify differences in the association of progression-free survival (PFS) and overall survival (OS) using RANO and m-RANO criteria.

METHODS

We conducted a retrospective review of newly diagnosed glioblastoma (GBM) patients treated at Dana-Farber Cancer Institute from January 2013 until December 2019. Patients with available clinical and imaging data obtained before initiation of treatment, after radiation completion and at intervals of 1 to 3 months were included. MRIs were evaluated by two independent readers, and PD dates determined using RANO and m-RANO criteria.

RESULTS

552 patients were included. 97.1% of the tumors were IDH wild-type. MGMT promoter was unmethylated in 51.4%, methylated in 35.1% and undetermined in 8.5%. Median OS among patients was 18.1 months. 72 patients (13%) did not have PD at the end of the study. 83 patients had treatment change while being clinically stable and without a confirmation scan and were excluded from the final analysis. PFS was 8.2 months with RANO and 8.4 months with mRANO. Difference in PD dates between RANO and m-RANO was detected in 76 patients (14%), where PFS was 3.5 months with RANO and 5.1 months with m-RANO. These patients had a worse median OS than those with identical RANO and m-RANO PD dates (15.2 vs. 22.4 months, p< 0.0001).

CONCLUSION

RANO and m-RANO criteria resulted in identical PFS for most patients. 14% of patients had discordant PD dates and a worse prognosis. These patients progressed early, and their PD was identified sooner with RANO criteria.

500 30-DAY SURVIVAL AND RECOVERY AFTER HIP FRACTURE BY MOBILISATION TIMING AND DEMENTIA: A UK DATABASE STUDY

Introduction

To compare 30-day survival and recovery of prefracture ambulation between patients mobilised early (on the day of or day after surgery) and patients mobilised late (2 days of more after surgery) in England and Wales. To determine whether the presence of dementia influences the association between mobilisation timing and 30-day survival and recovery.

Methods

Secondary analysis of the UK National Hip Fracture Database linked to hospitalisation records for 126,897 patients 60 years or older who underwent surgery for nonpathological first hip fracture in England or Wales between 2014 and 2016. We used logistic regression to regress survival and ambulation recovery at 30-days with respect to mobilisation timing, overall and by dementia, with adjustment for confounding using a propensity score for mobilisation treatment with respect to confounders.

Results

Overall, 99,667 (79%) patients mobilised early. Among those who mobilised early compared to those who mobilised late, the weighted odds ratio of survival was 1.92 (95% CI 1.80–2.05), of recovering outdoor ambulation was 1.25 (95% CI 1.03–1.51), and of recovering indoor ambulation was 1.53 (95% CI 1.32–1.78) by 30 days. Early compared with late mobilisation led to a 3.8% increase in the weighted probability of survival, 22.8% increase in weighted probability of recovering outdoor ambulation and 10.0% increase in the weighted probability of recovering indoor ambulation, by 30-days. Patients with dementia were less likely to mobilise early but increases in survival and ambulation recovery were observed both for those with and without dementia.

Conclusion

Early mobilisation led to increase probability of survival and recovery for patients (with and without dementia) after hip fracture. Early mobilisation should be incorporated as a measured indicator of quality internationally. Reasons for failure to mobilise early should also be captured to inform quality improvement initiatives.

501 DISCHARGE AFTER HIP FRACTURE SURGERY IN RELATION TO MOBILISATION TIMING BY PATIENT CHARACTERISTICS: A NATIONAL DATABASE STUDY

Introduction

Early mobilisation leads to a two-fold increase in the odds of discharge by 30-days compared to late mobilisation. Whether this association varies by identified reasons for delayed mobilisation is unknown.

Methods

Audit data linked to hospitalisation records for patients 60 years or older surgically treated for hip fracture in England/Wales 2014–2016. Adjusted proportional odds regression models tested whether the cumulative incidences of discharge differed for early compared with late mobilisation across subgroups defined by dementia, delirium, hypotension, prefracture ambulation and residence, accounting for competing risk of death.

Results

Overall, 34,253 patients presented with dementia, 9,818 with delirium, and 10,123 with hypotension. Prefracture, 100,983 were ambulant outdoors, 30,834 were ambulant indoors only, 107,144 were admitted from home, and 23,588 from residential care. 10%, 8%, 8%, 12%, and 12% fewer patients with dementia, delirium, hypotension, ambulant indoors only prefracture, or from residential care mobilised early compared to those without dementia, delirium, hypotension, with outdoor ambulation prefracture, or from home. Adjusted odds ratios of discharge by 30-days for early compared with late mobilisation were 1.71 (95% CI 1.62–1.81) for those with dementia, 2.06 (95% CI 1.98–2.15) without dementia, 1.56 (95% CI 1.41–1.73) with delirium, 2.00 (95% CI 1.93–2.07) without delirium, 1.83 (95% CI, 1.66–2.02) with hypotension, 1.95 (95% CI, 1.89–2.02) without hypotension, 2.00 (95% CI 1.92–2.08) with outdoor ambulation prefracture, 1.80 (95% CI 1.70–1.91) with indoor ambulation only prefracture, 2.30 (95% CI 2.19–2.41) from home, and 1.64 (95% CI 1.51–1.77) from residential care.

Conclusion

Irrespective of dementia, delirium, hypotension, prefracture ambulation or residence, early compared to late mobilisation increased the likelihood of discharge by 30-days. Fewer patients with these conditions, poorer prefracture ambulation, or from residential care mobilised early. There is a need reduce this care gap by ensuring sufficient resource to enable all patients to benefit from early mobilisation.

Validation of the One Broth One Plate for Salmonella Method for Detection of Salmonella Spp. in Select Food and Environmental Samples: AOAC Performance Tested MethodSM 102002

Background

One Broth One Plate for Salmonella (OBOP Salmonella) is a rapid and simple method for detection of Salmonella spp. in food and environmental samples using traditional culture methodology. The method utilizes single-step enrichment followed by plating to a selective/differential, chromogenic agar.

Objective

The purpose of the validation study was to measure the effectiveness of the OBOP Salmonella method in comparison to reference culture procedures.

Method

Performance of the OBOP Salmonella method was compared to that of the U.S. Food and Drug Administration Bacteriological Analytical Manual Chapter 5 reference method for queso fresco, smoked salmon, cantaloupe, chocolate, black pepper, chili powder, dry pet food, and sponge samples from a stainless steel surface, or to that of the U.S. Department of Agriculture Microbiology Laboratory Guidebook Chapter 4.10 method for raw ground turkey, chicken carcass rinse, and pasteurized liquid egg. Inclusivity/exclusivity, robustness, and stability/lot-to-lot consistency testing was also performed.

Results

In the matrix study, there were no statistically significant differences in performance between the OBOP Salmonella and reference methods, as determined by probability of detection analysis (P < 0.05), for any of the matrixes examined. All 104 Salmonella spp. strains produced positive results in inclusivity testing, and all 33 non-salmonellae exclusivity strains tested negative with the OBOP Salmonella method.

Conclusions

Results of the validation study show that the OBOP Salmonella method is a reliable procedure for detection of Salmonella spp. in select matrixes. The method is simple to perform, requires no specialized equipment, and produces results in as little as 37 h.

Highlights

The OBOP Salmonella method was awarded AOAC PTM^SM (#102002) for detection of Salmonella in queso fresco, smoked salmon, cantaloupe, chocolate, black pepper, chili powder, dry pet food, sponge samples on a stainless steel surface, raw ground turkey, chicken carcass rinse, and pasteurized liquid egg. The method is also approved by MicroVal^® for a broad range of foods under certification number 2019LR88.

Impacts of the San Francisco Bay Area shelter-in-place during the COVID-19 pandemic on urban heat fluxes

The purpose of this study was to make quantitative connections between changes in social and economic activities in northern California urban areas and related Earth system environmental responses to the COVID-19 pandemic in 2020. We tested the hypothesis that the absence of worker activities during Shelter-in-Place in the San Francisco Bay Area detectably altered the infrared heat flux from parking lots, highways, and large building rooftops, caused primarily by quantitative changes in the reflective properties in these different classes of urban surfaces. The Landsat satellite's thermal infrared (TIR) sensor imagery for surface temperature (ST) was quantified for all the large urban features in the Bay Area that have flat (impervious) surfaces, such parking lots, wide roadways, and rooftops. These large impervious surface features in the five-county Bay Area were first delineated and classified using sub-meter aerial imagery from the National Agriculture Imagery Program (NAIP). We then compared Landsat ST data acquired on (or near) the same dates from the three previous years (2017-2019) for all these contiguous impervious surfaces. Results showed that all the large parking lots, roadway corridors, and industrial/commercial rooftops across the entire Bay Area urban landscape were detected by Landsat ST time series as significantly cooler (by 5^o C to 8^o C) during the unprecedented Shelter-in-Place period of mid-March to late-May of 2020, compared to same months of the three previous years. The explanation for this region-wide cooling pattern in 2020 that was best supported by both remote sensing and ground-based data sets was that relatively low atmospheric aerosol lower (PM_2.5) concentrations from mid-March to late May of 2020 resulted in weaker temperature inversions over the Bay Area, higher diurnal surface mixing, and lowered urban surface temperatures, compared to the three previous years.

34 Discharge After Hip Fracture Surgery by Mobilisation Timing: Secondary Analysis of the UK National Hip Fracture Database

Background

To maximise the benefits of hip fracture surgery the National Institute for Health and Care Excellence Clinical Guideline recommends mobilisation on the day after hip fracture surgery based a low to moderate quality trial with a small sample size. There is a need to generate additional evidence to support early mobilisation as a new UK Best Practice Tariff (BPT).

Objective

To determine whether mobilisation timing was associated with the cumulative incidence of hospital discharge by 30-days after hip fracture surgery, accounting for potential confounders and the competing risk of in-hospital death.

Method

We examined data for 135,105 patients 60 years or older who underwent surgery for nonpathological first hip fracture between January 2014 and December 2016 in any hospital in England or Wales. We tested whether the cumulative incidences of discharge differed between those mobilised early (within 36 hours of surgery) and those mobilised late accounting for potential confounders and the competing risk of in-hospital death.

Results

106,722 (79%) of patients first mobilised early. The average rate of discharge was 60.1 (95% CI 59.8–60.5) per 1,000 patient days, varying from 65.2 (95% CI 64.8–65.6) among those who mobilised early to 44.5 (95% CI 43.9–45.1) among those who mobilised late, accounting for the competing risk of death. By 30-days postoperatively, the crude and adjusted odds ratios of discharge were 2.26 (95% CI 2.2–2.32) and 1.93 (95% CI 1.86–1.99) respectively among those who first mobilised early compared to those who mobilised late, accounting for the competing risk of death.

Conclusion

Early mobilisation led to a near two fold increase in the adjusted odds of discharge by 30-days postoperatively. We recommend inclusion of mobilisation within 36 hours of surgery as a new UK BPT to help reduce delays to mobilisation currently experienced by one-fifth of patients surgically treated for hip fracture.

Behaviorally-mediated trophic cascade attenuated by prey use of risky places at safe times

The mere threat of predation may incite behavioral changes in prey that lead to community-wide impacts on productivity, biodiversity, and nutrient cycling. The paucity of experimental manipulations, however, has contributed to controversy over the strength of this pathway in wide-ranging vertebrate systems. We investigated whether simulated gray wolf (Canis lupus) presence can induce behaviorally-mediated trophic cascades, specifically, whether the 'fear' of wolf olfactory cues alone can change deer foraging behavior in ways that affect plants and soils. Wolves were recently removed from the Cedar Creek Ecosystem Science Reserve (Minnesota, USA), such that consumptively mediated predator effects were negligible. At 32 experimental plots, we crossed two nested treatments: wolf urine application and herbivore exclosures. We deployed camera traps to quantify how white-tailed deer (Odocoileus virginianus) adjusted their spatiotemporal habitat use, foraging, and vigilance in response to wolf cues and how these behavioral changes affected plant productivity, plant communities, and soil nutrients. Weekly applications of wolf urine significantly altered deer behavior, but deer responses did not cascade to affect plant or soil properties. Deer substantially reduced crepuscular activity at wolf-simulated sites compared to control locations. As wolves in this area predominantly hunted during mornings and evenings, this response potentially allows deer to maximize landscape use by accessing dangerous areas when temporal threat is low. Our experiment suggests that prey may be sensitive to 'dynamic' predation risk that is structured across both space and time and, consequentially, prey use of risky areas during safe times may attenuate behaviorally-mediated trophic cascades at the predator-prey interface.

Shifts in Vegetation Cover of Southern California Deserts in Response to Recent Climate Variations

In the deserts of Southern California, air temperatures have been rising and precipitation variability has been increasing over the past several decades. These recent climate shifts may have begun to threaten the survival of certain plant and animal species in these arid ecosystems. This study was designed to quantify and characterize variations in vegetation canopy density using more than 30 consecutive years of Landsat satellite image data across the western Lower Colorado (Sonoran) and southern Mojave Desert region. Mapping of the normalized difference vegetation index (NDVI) from Landsat images (1985 to 2017), which has been closely correlated with percent cover measurements of green vegetation canopies in a variety of arid ecosystems, was used to detect periodic upslope and downslope shifts in plant cover. The change in Landsat NDVI between 1985 and 2017 within the Santa Rosa Mountains Wilderness at four elevation zones between 500 m and 2500 m showed that vegetation green cover dropped notably in below-average precipitation periods, whereas green cover increased sharply in above-average precipitation years. This same temporal pattern of shifting in NDVI was detected along steep elevation gradients in the Anza-Borrego Desert State Park and in the Little San Bernardino Mountains of Joshua Tree National Park. Although the distribution of the dominant plant species along elevation gradients may have increased by more than 60 m over several decades (prior to 2007), we found no evidence that upslope shifts in percent plant cover have yet become a permanent pattern at these mountainous desert sites.

Inequity in rehabilitation interventions after hip fracture: a systematic review

OBJECTIVE

to determine the extent to which equity factors contributed to eligibility criteria of trials of rehabilitation interventions after hip fracture. We define equity factors as those that stratify healthcare opportunities and outcomes.

DESIGN

systematic search of MEDLINE, Embase, CINHAL, PEDro, Open Grey, BASE and ClinicalTrials.gov for randomised controlled trials of rehabilitation interventions after hip fracture published between 1 January 2008 and 30 May 2018. Trials not published in English, secondary prevention or new models of service delivery (e.g. orthogeriatric care pathway) were excluded. Duplicate screening for eligibility, risk of bias (Cochrane Risk of Bias Tool) and data extraction (Cochrane's PROGRESS-Plus framework).

RESULTS

twenty-three published, eight protocol, four registered ongoing randomised controlled trials (4,449 participants) were identified. A total of 69 equity factors contributed to eligibility criteria of the 35 trials. For more than 50% of trials, potential participants were excluded based on residency in a nursing home, cognitive impairment, mobility/functional impairment, minimum age and/or non-surgical candidacy. Where reported, this equated to the exclusion of 2,383 out of 8,736 (27.3%) potential participants based on equity factors. Residency in a nursing home and cognitive impairment were the main drivers of these exclusions.

CONCLUSION

the generalisability of trial results to the underlying population of frail older adults is limited. Yet, this is the evidence base underpinning current service design. Future trials should include participants with cognitive impairment and those admitted from nursing homes. For those excluded, an evidence-informed reasoning for the exclusion should be explicitly stated.

PROSPERO

CRD42018085930.

A GAL80 Collection To Inhibit GAL4 Transgenes in Drosophila Olfactory Sensory Neurons

Fruit flies recognize hundreds of ecologically relevant odors and respond appropriately to them. The complexity, redundancy and interconnectedness of the olfactory machinery complicate efforts to pinpoint the functional contributions of any component neuron or receptor to behavior. Some contributions can only be elucidated in flies that carry multiple mutations and transgenes, but the production of such flies is currently labor-intensive and time-consuming. Here, we describe a set of transgenic flies that express the Saccharomyces cerevisiae GAL80 in specific olfactory sensory neurons (OrX-GAL80s). The GAL80s effectively and specifically subtract the activities of GAL4-driven transgenes that impart anatomical and physiological phenotypes. OrX-GAL80s can allow researchers to efficiently activate only one or a few types of functional neurons in an otherwise nonfunctional olfactory background. Such experiments will improve our understanding of the mechanistic connections between odorant inputs and behavioral outputs at the resolution of only a few functional neurons.

The KASH-containing isoform of Nesprin1 giant associates with ciliary rootlets of ependymal cells

Biallelic nonsense mutations of SYNE1 underlie a variable array of cerebellar and non-cerebellar pathologies of unknown molecular etiology. SYNE1 encodes multiple isoforms of Nesprin1 that associate with the nuclear envelope, with large cerebellar synapses and with ciliary rootlets of photoreceptors. Using two novel mouse models, we determined the expression pattern of Nesprin1 isoforms in the cerebellum whose integrity and functions are invariably affected by SYNE1 mutations. We further show that a giant isoform of Nesprin1 associates with the ciliary rootlets of ependymal cells that line brain ventricles and establish that this giant ciliary isoform of Nesprin1 harbors a KASH domain. Whereas cerebellar phenotypes are not recapitulated in Nes1g^STOP/STOP mice, these mice display a significant increase of ventricular volume. Together, these data fuel novel hypotheses about the molecular pathogenesis of SYNE1 mutations and support that KASH proteins may localize beyond the nuclear envelope in vivo.

Parental beliefs about portion size, not children's own beliefs, predict child BMI

BACKGROUND

Increases in portion size are thought by many to promote obesity in children. However, this relationship remains unclear. Here, we explore the extent to which a child's BMI is predicted both by parental beliefs about their child's ideal and maximum portion size and/or by the child's own beliefs.

METHODS

Parent-child (5-11 years) dyads (N = 217) were recruited from a randomized controlled trial (n = 69) and an interactive science centre (n = 148). For a range of main meals, parents estimated their child's 'ideal' and 'maximum tolerated' portions. Children completed the same tasks.

RESULTS

An association was found between parents' beliefs about their child's ideal (β = .34, p < .001) and maximum tolerated (β = .30, p < .001) portions, and their child's BMI. By contrast, children's self-reported ideal (β = .02, p = .718) and maximum tolerated (β = -.09, p = .214) portions did not predict their BMI. With increasing child BMI, parents' estimations aligned more closely with their child's own selected portions.

CONCLUSIONS

Our findings suggest that when a parent selects a smaller portion for their child than their child self-selects, then the child is less likely to be obese. Therefore, public health measures to prevent obesity might include instructions to parents on appropriate portions for young children.

Capturing differences in dental training using a virtual reality simulator

Virtual reality simulators are becoming increasingly popular in dental schools across the world. But to what extent do these systems reflect actual dental ability? Addressing this question of construct validity is a fundamental step that is necessary before these systems can be fully integrated into a dental school's curriculum. In this study, we examined the sensitivity of the Simodont (a haptic virtual reality dental simulator) to differences in dental training experience. Two hundred and eighty-nine participants, with 1 (n = 92), 3 (n = 79), 4 (n = 57) and 5 (n = 61) years of dental training, performed a series of tasks upon their first exposure to the simulator. We found statistically significant differences between novice (Year 1) and experienced dental trainees (operationalised as 3 or more years of training), but no differences between performance of experienced trainees with varying levels of experience. This work represents a crucial first step in understanding the value of haptic virtual reality simulators in dental education.

Ecosystem carbon emissions from 2015 forest fires in interior Alaska

BACKGROUND

In the summer of 2015, hundreds of wildfires burned across the state of Alaska, and consumed more than 1.6 million ha of boreal forest and wetlands in the Yukon-Koyukuk region. Mapping of 113 large wildfires using Landsat satellite images from before and after 2015 indicated that nearly 60% of this area was burned at moderate-to-high severity levels. Field measurements near the town of Tanana on the Yukon River were carried out in July of 2017 in both unburned and 2015 burned forested areas (nearly adjacent to one-another) to visually verify locations of different Landsat burn severity classes (low, moderate, or high; LBS, MBS, HBS).

RESULTS

Field measurements indicated that the loss of surface organic layers in boreal ecosystem fires is a major factor determining post-fire soil temperature changes, depth of thawing, and carbon losses from the mineral topsoil layer. Measurements in forest sites showed that soil temperature profiles to 30 cm depth at burned forest sites were higher by an average of 8-10 °C compared to unburned forest sites. Sampling and laboratory analysis indicated a 65% reduction in soil carbon content and a 58% reduction in soil nitrogen content in severely burned sample sites compared to soil mineral samples from nearby unburned spruce forests.

CONCLUSIONS

Combined with nearly unprecedented forest areas severely burned in the Interior region of Alaska in 2015, total ecosystem fire-related losses of carbon to the atmosphere exceeded most previous estimates for the state, owing mainly to inclusion of potential "mass wasting" and decomposition in the mineral soil carbon layer in the 2 years following these forest fires.

Modeling pesticide diuron loading from the San Joaquin watershed into the Sacramento-San Joaquin Delta using SWAT

Quantifying pesticide loading into the Sacramento-San Joaquin Delta of northern California is critical for water quality management in the region, and potentially useful for biological weed control planning. In this study, the Soil and Water Assessment Tool (SWAT) was applied to model streamflow, sediment, and pesticide diuron loading in the San Joaquin watershed, a major contributing area to the elevated pesticide levels in the downstream Delta. The Sequential Uncertainty Fitting version 2 (SUFI-2) algorithm was employed to perform calibration and uncertainty analysis. A combination of performance measures (PMs) and standardized performance evaluation criteria (PEC) was applied to evaluate model performance, while prediction uncertainty was quantified by 95% prediction uncertainty band (95PPU). Results showed that streamflow simulation was at least "satisfactory" at most stations, with more than 50% of the observed data bracketed by the 95PPU. Sediment simulation was rated as at least "satisfactory" based on two PMs, and diuron simulation was judged as "good" by all PMs. The 95PPU of sediment and diuron bracketed about 40% and 30% of the observed data, respectively. Significant correlations were observed between the diuron loads, and precipitation, streamflow, and the current and antecedent pesticide use. Results also showed that the majority (>70%) of agricultural diuron was transported during winter months, when direct exposure of biocontrol agents to diuron runoff is limited. However, exposure in the dry season could be a concern because diuron is relatively persistent in aquatic system. This study not only provides valuable information for the development of biological weed control plan in the Delta, but also serves as a foundation for the continued research on calibration, evaluation, and uncertainty analysis of spatially distributed, physically based hydrologic models.

Evaluation of modelled net primary production using MODIS and landsat satellite data fusion

BACKGROUND

To improve estimates of net primary production for terrestrial ecosystems of the continental United States, we evaluated a new image fusion technique to incorporate high resolution Landsat land cover data into a modified version of the CASA ecosystem model. The proportion of each Landsat land cover type within each 0.004 degree resolution CASA pixel was used to influence the ecosystem model result by a pure-pixel interpolation method.

RESULTS

Seventeen Ameriflux tower flux records spread across the country were combined to evaluate monthly NPP estimates from the modified CASA model. Monthly measured NPP data values plotted against the revised CASA model outputs resulted in an overall R2 of 0.72, mainly due to cropland locations where irrigation and crop rotation were not accounted for by the CASA model. When managed and disturbed locations are removed from the validation, the R2 increases to 0.82.

CONCLUSIONS

The revised CASA model with pure-pixel interpolated vegetation index performed well at tower sites where vegetation was not manipulated or managed and had not been recently disturbed. Tower locations that showed relatively low correlations with CASA-estimated NPP were regularly disturbed by either human or natural forces.

Teaching public health ethics

Teaching public health ethics has been recognised as patchy and somewhat theoretically incoherent for some years. Despite Beauchamp and Childress' work being widely known and used within health care its various principles have been criticised by a number of writers for, among other things, their inherent cultural relativism. This article suggests how a broader ethically oriented approach to the ever-changing field of public health might be pursued - so that a professional public health practitioner might be prepared for a lifelong career of ethical activism. Informed by the pedagogic philosophy of Freire it assumes the development of a module within an MPH programme. If, as is widely acknowledged, we are dealing with essentially a corpus of values, the challenge for an educator of public health ethics is how do we inculcate those values effectively and efficiently? How do we prepare students for as yet unrecognised ethical problems that they might confront? How do we assess such teaching? We know that even in clinical practice gaps appear between accepted ethical principles and actual practice. Within public health the conflicts generated by rival claimants and the contradictions of applying principles at a societal level become even clearer as action to control a situation might restrict the rights of others. This makes it even more important that students are exposed to learning experiences which will equip them adequately for a lifetime of practice. Traditional didactic approaches need to be supplemented with additional modalities such as case studies and role playing. Such case studies might encompass macro policy issues or micro operational issues. Other approaches could include citizen juries, examining international agreements and codes of practice, debates and encouraging explicit reflective practices. The importance of repetition, teachers as role models, courses which themselves demonstrate ethical practice, and a variety of methods are emphasized.

Leadership development: an applied comparison of Gibbs’ Reflective Cycle and Scharmer’s Theory U

Purpose

– The purpose of this paper is to examine two contrasting leadership development methodologies, Reflective Practice and Scharmer’s Theory U.

Design/methodology/approach

– Gibbs’ Reflective Cycle and Scharmer’s Reflecting Deeply exercise were applied to the same leadership incident on separate days.

Findings

– Reflective Practice provided helpful insights through focusing on one’s thoughts, feelings and motives during the event, as well as the actions of others and the author’s responses to them. The author found that using Scharmer’s Reflecting Deeply exercise enabled a deeper understanding of the incident to emerge, which also provided new and distinct insights.

Research limitations/implications

– The main limitation was the case study nature of this exercise; these findings are merely the result of one person’s experiences.

Practical implications

– To develop rounded leadership skills, leaders can benefit from tapping into all of their resources; these two approaches allow different aspects of one’s intelligence to be accessed, which ought to facilitate greater development.

Social implications

– Many authors cite a current crisis of leadership, not least of all a perceived failure to tackle the environmental challenges we face. By seeking to develop more intelligent and rounded leaders, leadership itself ought to improve which in turn should help society tackle pressing issues.

Originality/value

– To the author’s knowledge, a direct comparison of the leadership development methodologies used in this paper has not been previously described. This paper provides useful insights into the practical application of Reflective Practice and Scharmer’s Theory U, which will help inform others seeking to develop as leaders.

Developing public health ethics learning modules - can we learn from critical pedagogy?

Curriculum development in masters of public health programs that effectively meets the complex ethical challenges of the 21st century is an important part of public health education and requires ethical reasoning and purposively thinking. Current master programs in Public Health do not regularly include modules in public health ethics. The aim of this paper is to present background and theoretical foundation for developing a methodology and methods to develop public health ethics modules for curriculum development in public health programs. We describe ethical reasoning in medicine and in Public Health, specify pedagogical approaches and key assignments organized around the critical pedagogy.

Evaluation of a web based tool to improve health behaviours in healthcare staff

Background

A web-based tool was developed and piloted by being made available to healthcare staff in Wales from September 2012 to March 2013. This evaluation included two primary outcome measures: general health and mental well-being, and six secondary outcome measures: sickness absence, alcohol use, healthy eating, smoking, physical activity and maintaining a healthy BMI. The aim was to assess the feasibility of a web-based tool to improve health behaviours in healthcare staff.

Methods

Healthcare staff joined via a website, chose two of five challenges, and recorded their health behaviours using an online tool on a regular basis. Evaluation was undertaken by comparing baseline and follow up questionnaires.

Results

1708 individuals explored the programme’s website, of whom 1320 selected two lifestyle challenges to address. Of these 346 individuals (26.2%; 346/1320) completed the end of project evaluation questions for the main outcome and provided the basis of the evaluation. Comparing pre:post data among respondents who engaged with the programme as a whole, self-reported general health status improved in 35.3% (n = 122, p = 0.001); mental health status improved in 33% (n = 110, p = 0.02); alcohol consumption score (AUDIT-C classification) fell in 27.2% (n = 71, p = 0.001); reported fruit and vegetable consumption (7 day recall) increased (p = 0.001); average time spent on vigorous exercise increased from 40.6 minutes a week to 67.6 minutes a week (p = 0.001); and 41 individuals noted a positive change to their BMI classification category (p = 0.001).

Conclusions

Combining interactive web-based tools as part of a multi-media programme is feasible, increases health behaviours and generates interest among a proportion of the healthcare workforce. Further work is required to improve maintenance of engagement over time.

Digitization of medicine: how radiology can take advantage of the digital revolution

In the era of medical cost containment, radiologists must continually maintain their actual and perceived value to patients, payers, and referring providers. Exploitation of current and future digital technologies may be the key to defining and promoting radiology's "brand" and assure our continued relevance in providing predictive, preventive, personalized, and participatory medicine. The Association of University of Radiologists Radiology Research Alliance Digitization of Medicine Task Force was formed to explore the opportunities and challenges of the digitization of medicine that are relevant to radiologists, which include the reporting paradigm, computational biology, and imaging informatics. In addition to discussing these opportunities and challenges, we consider how change occurs in medicine, and how change may be effected in medical imaging community. This review article is a summary of the research of the task force and hopefully can be used as a stimulus for further discussions and development of action plans by radiology leaders.

Alaska ecosystem carbon fluxes estimated from MODIS satellite data inputs from 2000 to 2010

BACKGROUND

Trends in Alaska ecosystem carbon fluxes were predicted from inputs of monthly MODerate resolution Imaging Spectroradiometer (MODIS) vegetation index time-series combined with the NASA-CASA (Carnegie Ames Stanford Approach) carbon cycle simulation model over the past decade. CASA simulates monthly net ecosystem production (NEP) as the difference in carbon fluxes between net primary production (NPP) and soil microbial respiration (Rh).

RESULTS

Model results showed that NEP on a unit area basis was estimated to be highest (> +10 g C m-2 yr-1) on average over the period 2000 to 2010 within the Major Land Resource Areas (MRLAs) of the Interior Brooks Range Mountains, the Arctic Foothills, and the Western Brooks Range Mountains. The lowest (as negative land C source fluxes) mean NEP fluxes were predicted for the MLRAs of the Cook Inlet Lowlands, the Ahklun Mountains, and Bristol Bay-Northern Alaska Peninsula Lowlands. High levels of interannual variation in NEP were predicted for most MLRAs of Alaska.

CONCLUSIONS

The relatively warm and wet years of 2004 and 2007 resulted in the highest positive NEP flux totals across MLRAs in the northern and western coastal locations in the state (i.e., the Brooks Range Mountains and Arctic Foothills). The relatively cold and dry years of 2001 and 2006 were predicted with the lowest (negative) NEP flux totals for these MLRAs, and likewise across the Ahklun Mountains and the Yukon-Kuskokwim Highlands.

SHARPIN regulates uropod detachment in migrating lymphocytes

SHARPIN-deficient mice display a multiorgan chronic inflammatory phenotype suggestive of altered leukocyte migration. We therefore studied the role of SHARPIN in lymphocyte adhesion, polarization, and migration. We found that SHARPIN localizes to the trailing edges (uropods) of both mouse and human chemokine-activated lymphocytes migrating on intercellular adhesion molecule-1 (ICAM-1), which is one of the major endothelial ligands for migrating leukocytes. SHARPIN-deficient cells adhere better to ICAM-1 and show highly elongated tails when migrating. The increased tail lifetime in SHARPIN-deficient lymphocytes decreases the migration velocity. The adhesion, migration, and uropod defects in SHARPIN-deficient lymphocytes were rescued by reintroducing SHARPIN into the cells. Mechanistically, we show that SHARPIN interacts directly with lymphocyte-function-associated antigen-1 (LFA-1), a leukocyte counterreceptor for ICAM-1, and inhibits the expression of intermediate and high-affinity forms of LFA-1. Thus, SHARPIN controls lymphocyte migration by endogenously maintaining LFA-1 inactive to allow adjustable detachment of the uropods in polarized cells.

Forest production predicted from satellite image analysis for the Southeast Asia region

BACKGROUND

The objective of this study was to demonstrate a new, cost-effective method to define the sustainable amounts of harvested wood products in Southeast Asian countries case studies, while avoiding degradation (net loss) of total wood carbon stocks. Satellite remote sensing from the MODIS sensor was used in the CASA (Carnegie Ames Stanford Approach) carbon cycle model to map forest production for the Southeast Asia region from 2000 to 2010. These CASA model results have been designed to be spatially detailed enough to support carbon cycle assessments in different wooded land cover classes, e.g., open woodlands, wetlands, and forest areas.

RESULTS

The country with the highest average forest net primary production (NPP greater than 950 g C m-2 yr-1) over the period was the Philippines, followed by Malaysia and Indonesia. Myanmar and Vietnam had the lowest average forest NPP among the region's countries at less than 815 g C m-2 yr-1. Case studies from throughout the Southeast Asia region for the maximum harvested wood products amount that could be sustainably extracted per year were generated using the CASA model NPP predictions.

CONCLUSIONS

The method of using CASA model's estimated annual change in forest carbon on a yearly basis can conservatively define the upper limit for the amount of harvested wood products that can be removed and still avoid degradation (net loss) of the total wood carbon stock over that same time period.