COVID-19 vaccines and adverse events of special interest: A multinational Global Vaccine Data Network (GVDN) cohort study of 99 million vaccinated individuals

BACKGROUND

The Global COVID Vaccine Safety (GCoVS) Project, established in 2021 under the multinational Global Vaccine Data Network™ (GVDN®), facilitates comprehensive assessment of vaccine safety. This study aimed to evaluate the risk of adverse events of special interest (AESI) following COVID-19 vaccination from 10 sites across eight countries.

METHODS

Using a common protocol, this observational cohort study compared observed with expected rates of 13 selected AESI across neurological, haematological, and cardiac outcomes. Expected rates were obtained by participating sites using pre-COVID-19 vaccination healthcare data stratified by age and sex. Observed rates were reported from the same healthcare datasets since COVID-19 vaccination program rollout. AESI occurring up to 42 days following vaccination with mRNA (BNT162b2 and mRNA-1273) and adenovirus-vector (ChAdOx1) vaccines were included in the primary analysis. Risks were assessed using observed versus expected (OE) ratios with 95 % confidence intervals. Prioritised potential safety signals were those with lower bound of the 95 % confidence interval (LBCI) greater than 1.5.

RESULTS

Participants included 99,068,901 vaccinated individuals. In total, 183,559,462 doses of BNT162b2, 36,178,442 doses of mRNA-1273, and 23,093,399 doses of ChAdOx1 were administered across participating sites in the study period. Risk periods following homologous vaccination schedules contributed 23,168,335 person-years of follow-up. OE ratios with LBCI > 1.5 were observed for Guillain-Barré syndrome (2.49, 95 % CI: 2.15, 2.87) and cerebral venous sinus thrombosis (3.23, 95 % CI: 2.51, 4.09) following the first dose of ChAdOx1 vaccine. Acute disseminated encephalomyelitis showed an OE ratio of 3.78 (95 % CI: 1.52, 7.78) following the first dose of mRNA-1273 vaccine. The OE ratios for myocarditis and pericarditis following BNT162b2, mRNA-1273, and ChAdOx1 were significantly increased with LBCIs > 1.5.

CONCLUSION

This multi-country analysis confirmed pre-established safety signals for myocarditis, pericarditis, Guillain-Barré syndrome, and cerebral venous sinus thrombosis. Other potential safety signals that require further investigation were identified.

"I'll meet you at our bench": adaptation, innovation and resilience among VCSE organisations who supported marginalised and minoritised communities during the Covid-19 pandemic in Northern England - a qualitative focus group study

BACKGROUND

The Covid-19 pandemic has exacerbated pre-existing inequalities and increased adversity and challenges for vulnerable and marginalised communities worldwide. In the UK, the Voluntary Community and Social Enterprise (VCSE) sector play a vital role in supporting the health and wellbeing of people who are marginalised or experiencing multiple complex needs. However, only a small number of studies have focused on the impact that Covid-19 had on the VCSE sector.

METHODS

As part of a Health Inequalities Impact Assessment (HIIA), we conducted qualitative focus groups with staff and volunteers from five organisations to examine short, medium and longer-term impacts of Covid-19 upon the VCSE sector in Northern England. Nine online focus groups were conducted between March and July 2021.

FINDINGS

Focus group transcripts were analysed using Framework Analysis and yielded three central themes: (1) exacerbation of pre-existing inequalities, adversity and challenges for vulnerable and marginalised populations; (2) the 'price' of being flexible, innovative and agile for VCSE staff and volunteers; and (3) the voluntary sector as a 'lifeline' - organisational pride and resilience.

CONCLUSIONS

While the voluntary sector 'adapted at pace' to provide support during Covid-19 and in its continued aftermath, this resilience has potentially come at the cost of workforce and volunteer wellbeing, compounded by political obstacles and chronic shortage in funding and support. The VCSE sector has a vital role to play in the post-lockdown 'levelling up' agenda. The expertise, capacity and resilience of VCSE organisations, and their ability to respond to Covid-19, should be celebrated, recognised and supported adequately to maintain its resilience. To not do so threatens the sector's sustainability and risks jeopardising attempts to involve the sector in addressing the social determinants of health.

Planning Considerations for the Primary Lung Tumor Stereotactic Body Radiation Therapy Followed by Concurrent Mediastinal Radiotherapy for Locally-Advanced Non-Small Cell Lung Cancer

PURPOSE/OBJECTIVE(S)

Phase III prospective randomized trial of primary lung tumor stereotactic body radiation therapy followed by concurrent mediastinal chemoradiation for locally-advanced non-small cell lung cancer (NRG LU-008), designed to lower the rates of radiation pneumonitis and improve the progression-free survival, is expected to become active nationally in July 2023. Due to the specific nature of the cases selected for this trial, a new approach to treatment planning had to be developed to satisfy the conditions of the trial. Levice Cancer Institute (Atrium Health, North Carolina) ran the initial Phase II trial and investigated several approaches, providing recommendations for the future dosimetry planning approach.

MATERIALS/METHODS

A total of 60 patients were selected for the initial trial and treated with a combination of SBRT treatment to the primary tumor (50-54 Gy in 3-5 fractions) and conventional IMRT treatment to 60 Gy to the involved lymph nodes for patients with stage 3 or unresectable stage II NSCLC, combined with chemotherapy. Depending on the location of the primary tumor, all cases could be subdivided into no overlap between the SBRT and IMRT targets, adjacent targets, and overlapping targets. All SBRT plans were done with a 6X-FFF beam, advanced dose calculation algorithm, and 0.1 cm grid size. IMRT targets were primarily treated with VMAT plans, though a minority of cases were planned with the DMLC technique, with a 6X beam, advanced dose calculation algorithm, and 0.25 cm grid size. Various approaches to the planning included target cropping, avoidance via adjusting optimization objectives and utilizing the base dose of the SBRT plan to optimize the dose for the IMRT nodal plan. Various geometries utilized in the plan included a variation in the number of arcs, covered arc angles, and the number of beams.

RESULTS

A significant reduction in the side effects was achieved throughout the trial, with only three patients experiencing grade 3 or higher pneumonitis, 3 patients experiencing grade 3 or higher cardiotoxicity, and 1 patient experiencing grade 3 esophagitis. For targets with no significant overlap between the primary tumor and nodal target, standard planning techniques proved to be sufficient. For the overlapping targets, the planning approach of utilizing 2 arcs, >180-degree coverage, for the SBRT plan, and using ¼ of the base SBRT dose to plan the IMRT nodal plan provided the best target coverage while achieving sufficient OAR sparing.

CONCLUSION

Planning the joint SBRT-IMRT plan in the cases of a significant target overlap requires a careful approach, but is feasible with the proposed guideline and should be achievable for any center electing to participate in the NRG LU-008 trial.

Delivery outcomes as a result of snoring as determined by standard sleep surveys

Background

Sleep-disordered breathing (SDB), is an umbrella term that encompasses obstructive sleep apnea (OSA), central sleep apnea (CSA) and hypoventilation. is common but studies in the pregnant population are limited. Data suggests relationships between OSA and preeclampsia, but the relationship between snoring and pregnancy outcomes is unknown.

Methods

A prospective study of 2224 singleton pregnancies was undertaken. Women were questioned using the Berlin Questionnaire (BQ- 2 or more categories where the score is positive.) and the Epworth Sleepiness Scale (ESS >10/24), the results compared with pregnancy outcomes with regard to hypertension in pregnancy.

Results

Women having symptoms raising the possibility of OSA defined by the BQ with a score >7 was 45.5%, and using ESS with a score >10, was 36%. The birth and neonatal outcomes for self-reported snoring and increased daytime sleepiness showed increased adverse outcomes notably increased caesarean section rates and low APGAR scores but not birth before 37 weeks of gestation.

Conclusion

Using questionnaires designed for the general population, the prevalence of possible undiagnosed OSA is high in the pregnant population. The increased adverse delivery and neonatal outcomes for self-reported snoring and increased daytime sleepiness with these tools indicated the need for further investigation of the links between snoring SDB and pregnancy outcomes.

INZ-701, a recombinant ENPP1-Fc protein, effectively treats and prevents neointimal proliferation in WT and ENPP1 Deficient mice

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Inozyme Pharma

Inactivating mutations in ENPP1, which encodes the ecto-nucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1), underlie the rare inherited disorder, generalized arterial calcification of infancy (GACI)/autosomal recessive hypophosphatemic rickets type 2 (ARHR2) also known as ENPP1 Deficiency. ENPP1 Deficiency is characterized by calcification of large and medium sized arteries and marked neointimal proliferation of arteries, leading to arterial stenosis and severe cardiovascular and skeletal complications. ENPP1 Deficiency is associated with a 50% mortality rate in the first six months of life, and there are no approved treatments.

Previous research demonstrated that INZ-701 protein prevented arterial calcification in an ENPP1 deficient mouse model (Enpp1 asj/asj). This study was designed to determine whether INZ-701 can prevent neointimal proliferation in WT and an ENPP1 deficient mouse model (ttw/ttw). Carotid ligation was performed to induce intimal proliferation in the mice.

In the preventive arm of the study, INZ-701 (10mg/kg) or vehicle was administered subcutaneously every other day starting in 6-week-old ttw/ttw-mice. Carotid ligation was performed in these mice at the age of 7 weeks and dosing continued for another 2 weeks. Carotid intimal and medial area caudal from the ligation were analyzed by histomorphometry 14 days and 21 days after carotid ligation. In the therapeutic arm of the study, INZ-701 (10 mg/kg) or vehicle was administered subcutaneously every other day starting 7 days after carotid ligation, when intimal proliferation had already developed, in 8-week-old ttw/ttw-mice. After one week of treatment, histomorphometry was performed.

Fourteen days after carotid ligation, ttw/ttw-mice preventatively treated with INZ-701 showed a significantly reduced intimal area (p<0.001) and intimal/medial (I/M) ratio (p<0.001) compared to those treated with vehicle. This effect was also observed in mice treated with INZ-701, which were treated for 28 days and were subsequently dissected 21 days after carotid ligation. Interestingly, similar effects of INZ-701 were found in WT mice in the preventative study.  In the therapeutic arm of the study, subcutaneous injection of INZ-701 beginning at 7 days post carotid ligation also led to a significant reduction in the I/M ratio (p<0.001) in the INZ-701 treated group compared to vehicle treated ttw/ttw-mice.

These findings demonstrate that INZ-701 prevents neointimal proliferation after carotid injury in a murine model of ENPP1 Deficiency. INZ-701 is hypothesized to restore circulating levels of AMP and adenosine, both potent inhibitors of intimal hyperplasia. Neointimal proliferation is a key feature in the pathophysiology of ENPP1 Deficiency and our results build on prior evidence to support the potential of INZ-701 to treat this rare and life-threatening disease.

Outcomes of rapid digital transformation of large-scale communications during the COVID-19 pandemic

Objective This study examined the content and impact of a new digital communication medium, called a VIDCAST, implemented at a large hospital and health service when the COVID-19 pandemic was announced, and the key concerns held by staff at the time when the health service was preparing for the COVID-19 pandemic to arrive in this health service. Methods A mixed-methods approach was used. Thematic analysis of 20 transcripts of daily VIDCASTS broadcast between 30 March and 24 April 2020 was undertaken, in addition to descriptive analysis of feedback from an anonymous online survey. Results Survey feedback from 322 staff indicated almost universal satisfaction with this new communication method. The VIDCASTS provided a new COVID-safe method for the Executive to connect to staff at a time of uncertainty. Thematic analysis of the content of the VIDCASTS revealed three themes: 'Accurate Information', 'Reassurance and Support' and 'Innovation'. The Executive was able to reassure staff about what the organisation was doing to safeguard the health and wellbeing of all, and enabled an effective response to the pandemic. Conclusions The digital communication channel of VIDCASTS, rapidly operationalised at a major Australian hospital and health service in March 2020, provided important information and support for staff as it prepared for the anticipated COVID-19 surge. What is known about the topic? When the COVID-19 pandemic began, traditional face-to-face staff meetings were disrupted and many hospitals and their staff were left scrambling for information, and for reassurance about their safety, as they prepared to receive increasing numbers of COVID-19 patients. What does this paper add? The implementation of a digital communication tool was able to address many of the concerns raised by hospital staff in other geographic locations dealing with surging COVID-19 cases and underpinned a globally leading COVID-19 response. What are the implications for practitioners? New digitised communication methods provided an effective vehicle to inform and support staff in the early stages of pandemic preparation.

Long-term effects of an early-life exposure of fathead minnows to sediments containing bitumen. Part I: Survival, deformities, and growth

The aim of this study was to investigate the long-term effects of a short exposure to natural sediments within the Athabasca oil sand formation to critical stages of embryo-larval development in fathead minnows (Pimephales promelas). Three different sediments were used: Ref sediment from the upper Steepbank River tested at 3 g/L (containing 12.2 ng/g ∑PAHs), and two bitumen-rich sediments tested at 1 and 3 g/L; one from the Ells River (Ells downstream, 6480 ng/g ∑PAHs) and one from the Steepbank River (Stp downstream, 4660 ng/g ∑PAHs). Eggs and larvae were exposed to sediments for 21 days, then transferred to clean water for a 5-month grow-out and recovery period. Larval fish had significantly decreased survival after exposure to 3 g/L sediment from Stp downstream, and decreased growth (length and weight at 16 days post hatch) in Ells and Stp downstream sediments at both 1 and 3 g/L. Decreased tail length was a sensitive endpoint in larval fish exposed to Ells and Stp downstream sediments for 21 days compared to Ref sediment. After the grow-out in clean water, all growth effects from the bitumen-containing sediments recovered, but adult fish from Stp downstream 3 g/L sediment had significant increases in jaw deformities. The study shows the potential for fish to recover from the decreased growth effects caused by sediments containing oil sands-related compounds, but that some effects of the early-life sediment exposure occur later on in adult fish.

Nasal mask average volume-assured pressure support in an infant with congenital central hypoventilation syndrome

Congenital central hypoventilation syndrome (CCHS) is a rare disorder characterized by alveolar hypoventilation and autonomic dysregulation secondary to mutations of the PHOX 2B genes. Treatment consists of assisted ventilation using positive pressure ventilators via tracheostomy, bi-level positive airway pressure (BPAP), negative pressure ventilators, or diaphragm pacing. Previous case reports have highlighted early use of nasal non-invasive BPAP use in infants with CCHS. We present a case of a 10-month-old infant who was successfully managed on a new feature of non-invasive ventilation called average volume assured pressure support (AVAPS) without the need for tracheostomy. The AVAPS feature enables the machine to automatically adjust the inspiratory pressures to deliver a constant targeted tidal volume. This feature enabled a better control of ventilation as indicated by a more stable transcutaneous carbon dioxide profile compared to conventional nasal non-invasive BPAP, making non-invasive ventilation a more accessible method of managing sleep hypoventilation in CCHS.

Constraining the Neutron Star Compactness: Extraction of the ^{23}Al(p,γ) Reaction Rate for the rp Process

The ^{23}Al(p,γ)^{24}Si reaction is among the most important reactions driving the energy generation in type-I x-ray bursts. However, the present reaction-rate uncertainty limits constraints on neutron star properties that can be achieved with burst model-observation comparisons. Here, we present a novel technique for constraining this important reaction by combining the GRETINA array with the neutron detector LENDA coupled to the S800 spectrograph at the National Superconducting Cyclotron Laboratory. The ^{23}Al(d,n) reaction was used to populate the astrophysically important states in ^{24}Si. This enables a measurement in complete kinematics for extracting all relevant inputs necessary to calculate the reaction rate. For the first time, a predicted close-lying doublet of a 2_{2}^{+} and (4_{1}^{+},0_{2}^{+}) state in ^{24}Si was disentangled, finally resolving conflicting results from two previous measurements. Moreover, it was possible to extract spectroscopic factors using GRETINA and LENDA simultaneously. This new technique may be used to constrain other important reaction rates for various astrophysical scenarios.

Experiences of Kidney Transplant Recipients as Patient Navigators

BACKGROUND AND OBJECTIVE

The use of trained kidney transplant recipients as patient navigators resulted in increased completion of the steps in the transplant process by dialysis patients. We sought to understand the experiences of these patient navigators.

SETTING AND PARTICIPANTS

Six kidney transplant recipients were hired and employed by transplant centers in Ohio, Kentucky, and Indiana. The transplant navigators received formal training as peer educators, met with dialysis patients on a regular basis, and provided tailored education and assistance about transplantation to each patient. They worked closely with the pretransplant coordinators and social workers to learn the details of each patient's transplant work-up.

METHODOLOGY

We queried navigators using open-ended questions to learn about their experiences. Navigator responses were coded and common themes identified. A thematic auditor reviewed and refined the coding.

RESULTS

Two primary categories of themes emerged about the navigator experience: 1. practical comments that supported programmatic or implementation observations of the navigators, and 2. affective comments that reflected a shared experience among the navigators and patients. The navigators were able to fill voids in the transplant process that were not fulfilled by other caregivers. This was accomplished by a natural bond based upon a shared experience (of dialysis and kidney failure) between the navigator and the patient. The patient and navigator became experiential partners.

CONCLUSION

Kidney transplant recipients trained as patient navigators fill the role of a nontraditional medical provider, offer support during the transplant process, and provide an added benefit to complement routine dialysis and nephrology care.

Generation rate and fate of surplus soil extracted in New York City

With increasing urgency to build earthworks projects to protect against flooding from climate change and mitigate exposure to pollutants in degraded urban soils, many cities could experience increased demand for soil of between 10 and 35 million t in coming decades. This study showed that building construction in New York City (NYC) produces an estimated 1.7 × 10⁶ t of surplus clean native soil (mostly glacial sediments) each year and could be an important source to meet future urban soil demand. This quantity of soil is sufficient to build a 3-m-high earthen levee 21-km long each year and a continuous levee along NYC's 840 km shoreline in about 40 years. Alternately, this quantity is sufficient to build a 15-cm-thick clean soil cover over 7.3 km² of degraded urban soil each year. Detailed study of the fate of 1.03 × 10⁶ t of surplus soil from 113 building construction projects showed that over 95% was exported, with average one-way soil transportation of about 72 km. Paradoxically, while >74% of soil was recycled, long transportation through a diffused network of recycling facilities caused significant environmental and economic impacts. Each year, surplus soil management from building construction in NYC requires an estimated 60,000 truck-trips and 8.7 × 10⁶ km of truck travel, combusts 4.3 × 10⁶ l of fossil fuel, emits 11,800 t of CO₂ and costs over $60 M USD. Soil banking and other programs and public policies to retain soil within cities could increase urban soil supply to meet the rising demand for earthworks projects while also reducing soil transportation and associated environmental and economic impacts and achieving circular urban materials metabolism goals.

Adolescent Perinatal Outcomes in South West Sydney, Australia

Objective

To compare perinatal outcomes, blood pressures throughout pregnancy, rates of hypertensive disorders of pregnancy, preeclampsia, gestational diabetes mellitus, and immediate obstetric outcomes in adolescents younger than 20 years at delivery and those in the 20- to 34-year age group.

Patients and Methods

Questionnaires were administered to pregnant women at Campbelltown and Liverpool hospitals within South West Sydney, Australia, as part of a broader study of sleep-disordered breathing in pregnancy between February 1, 2009, and February 28, 2013. Data collected included demographic data, blood pressure readings, pregnancy complications, delivery type, and neonatal outcomes. Adolescents were compared with older women using Student t tests and χ² statistics.

Results

A total of 103 adolescents were compared with 2291 women aged 20 to 34 years. Adolescents were more likely to be primiparous, had longer average gestations, and had lower pre-pregnancy body mass index. Adolescents had lower rates of cesarean section delivery and gestational diabetes mellitus. There was no significant difference in smoking rates, perinatal mortality rate, small for gestational age, intrauterine growth restriction, Apgar score of less than 7 at 5 minutes, admission to special care nursery, or hypertensive disorder of pregnancy rates. Adolescents had lower booking systolic and diastolic blood pressures, and their highest antenatal systolic blood pressures were lower.

Conclusion

Adolescents have birth outcomes to similar to those of their older counterparts. Adolescents had lower booking blood pressures. This may have implications for the screening and diagnosis of hypertensive disorders of pregnancy in adolescents.

Sleep disordered breathing controlled by CPAP and sFlt-1 in a pregnant patient with chronic hypertension: Case report and literature review

Background

There is recent interest exploring the possible impact of sleep disordered breathing on the mechanisms of preeclampsia. A biomarker of preeclampsia, soluble fms-like tyrosine kinase-1, has come to prominence in recent years. The aim of this study was to investigate the relationship between continuous positive airway pressure treatment, sleep disordered breathing and soluble fms-like tyrosine kinase-1 concentrations during pregnancy.

Methods

A 38-year-old G1P0 presented at 20 + 5 weeks. She had a history of chronic hypertension. Sleep studies revealed she had sleep disordered breathing with an AHI of 7.3/h. She was commenced on continuous positive airway pressure. Soluble fms-like tyrosine kinase-1 concentrations and blood pressure recordings were taken at various points during her pregnancy.

Results

She did not develop preeclampsia or require an escalation in her antihypertensives. Soluble fms-like tyrosine kinase-1 concentrations rose 16% from a low baseline. She remained compliant with her continuous positive airway pressure. She progressed to birth a well, live, term baby.

Conclusion

Continuous positive airway pressure treatment controlled sleep disordered breathing in a high risk pregnant woman with chronic hypertension with no increase in soluble fms-like tyrosine kinase-1 concentrations.

A Standardized Donor Designation Ratio to Assess the Performance of Driver's License Agencies

Evaluating Department of Motor Vehicles (DMV) locations based on the percent of patrons who register as donors does not account for individual characteristics that may influence willingness to donate. We reviewed the driver's licenses of 2997 randomly selected patients at an urban medical system to obtain donor designation, age, gender, and DMV location and linked patient addresses with census tract data on race, ethnicity, income, and education. We then developed a Standardized Donor Designation Ratio (SDDR) (ie, the observed number of donors at each DMV divided by the expected number of donors based on patient demographic characteristics). Overall, 1355 (45%) patients were designated as donors. Donor designation was independently associated with younger age, female gender, nonblack race, and higher income. Across 18 DMVs, the proportion of patients who were donors ranged from 30% to 68% and SDDRs ranged from 0.82 to 1.17. Among the 6 facilities in the lowest tertile by SDDR, 3 were in the lowest tertile by percent donation. In conclusion, there is a great deal of variation across DMVs in rates of organ donor designation. SDDRs that adjust for DMV patron characteristics are distinct measures that may more accurately describe the performance of DMVs in promoting organ donation.

Assessing the delivery of alcohol screening and brief intervention in sexual health clinics in the north east of England

Background

Risky drinking is associated with risky sexual experiences, however the relationship between alcohol and sex is complex. The aim of the study was to assess the feasibility of delivering alcohol screening and brief interventions in genitourinary medicine (GUM) clinics. The objectives were to; understand the levels of alcohol use amongst patients; report on the number of alcohol interventions delivered; and to analyse the relationship between alcohol use with demographic data as well as diagnosed sexually transmitted infections (STIs) to see if there were any associations.

Methods

All new patients attending GUM between April 2012 and March 2013 self-completed the Alcohol Use Disorder Identification Test (AUDIT) prior to their clinical consultation. Where appropriate (scoring 8+ on AUDIT) the clinician would deliver up to 2–3 min of alcohol brief intervention. Descriptive statistics, t-tests, ANOVA and logistic regression were carried out as appropriate.

Results

AUDIT scores were available for 90% of all new patients (3058/3390) with an average mean score of 7.75. Of those who drank alcohol, 44% were categorised as being AUDIT positive, including 2% who had a score indicative of probable alcohol dependence (20+). 55 % (n = 638) of patients who screened positive on the AUDIT received a brief intervention whilst 24% (n = 674) of drinkers were diagnosed with a STI. Logistic regression modelling revealed that males, younger age groups and those of ‘white’ ethnicity were more likely to score positive on AUDIT. Patients classified as non-students, living in deprivation quintiles one to four and categorised as probable alcohol dependence on the AUDIT were more likely to be diagnosed with an STI.

Conclusion

It is possible to embed alcohol screening into routine practice within sexual health services however further work is required to embed brief interventions particularly amongst increasing risk drinkers. If resources are limited, services may consider more targeted rather than universal alcohol screening to specific population groups. The study was undertaken in one GUM service in the North East of England and therefore findings may not be generalizable. The study did not assess efficacy of alcohol brief intervention in this setting.

Observation of the Isovector Giant Monopole Resonance via the ^{28}Si(^{10}Be,^{10}B^{*}[1.74 MeV]) Reaction at 100 AMeV

The (^{10}Be,^{10}B^{*}[1.74  MeV]) charge-exchange reaction at 100  AMeV is presented as a new probe for isolating the isovector (ΔT=1) nonspin-transfer (ΔS=0) response of nuclei, with ^{28}Si being the first nucleus studied. By using a secondary ^{10}Be beam produced by fast fragmentation of ^{18}O nuclei at the NSCL Coupled Cyclotron Facility, applying the dispersion-matching technique with the S800 magnetic spectrometer to determine the excitation energy in ^{28}Al, and performing high-resolution γ-ray tracking with the Gamma-Ray Energy Tracking In-beam Nuclear Array (GRETINA) to identify the 1022-keV γ ray associated with the decay from the 1.74-MeV T=1 isobaric analog state in ^{10}B, a ΔS=0 excitation-energy spectrum in ^{28}Al was extracted. Monopole and dipole contributions were determined through a multipole-decomposition analysis, and the isovector giant dipole resonance and isovector giant monopole resonance (IVGMR) were identified. The results show that this probe is a powerful tool for studying the elusive IVGMR, which is of interest for performing stringent tests of modern density functional theories at high excitation energies and for constraining the bulk properties of nuclei and nuclear matter. The extracted distributions were compared with theoretical calculations based on the normal-modes formalism and the proton-neutron relativistic time-blocking approximation. Calculated cross sections based on these strengths underestimate the data by about a factor of 2, which likely indicates deficiencies in the reaction calculations based on the distorted wave Born approximation.

Is Signature Size Associated With Organ Donor Designation on Driver's Licenses?

INTRODUCTION

Previous studies suggest that large signature size is associated with narcissistic characteristics. By contrast, organ donation is an indicator of altruism. Because altruism and narcissism may be viewed as opposites, we sought to determine if smaller signature size is associated with willingness to be an organ donor.

METHODS

Using a cross-sectional study design, we reviewed the health records of 571 randomly selected primary care patients at a large urban safety-net medical system to obtain their demographic and medical characteristics. We also examined driver's licenses that were scanned into electronic health records as part of the patient registration process. We measured signature sizes and obtained the organ donor designation from these driver's licenses.

RESULTS

Overall, 256 (45%) patients were designated as donors on their driver's licenses. Signature size averaged 113.3 mm(2) but varied greatly across patients (10th percentile 49.1 mm(2), 90th percentile 226.1 mm(2)). On multivariate analysis, donor designation was positively associated with age 18-34 years, non-black race, having private insurance, and not having any comorbid conditions. However, signature size was not associated with organ donor designation.

CONCLUSIONS

Signature size is not associated with verified organ donor designation. Further work is needed to understand the relationship between personality types and willingness to be an organ donor.

Elevated carbon dioxide has limited acute effects on Lepomis macrochirus behaviour

The current study investigated the behavioural response of Lepomis macrochirus following exposures to elevated carbon dioxide (CO₂ ). For this, L. macrochirus were held at ambient pCO₂ (160 μatm pCO₂ ) for 7 days, then exposed to elevated pCO₂ (8300 μatm pCO₂ ) for 5 days, and then returned to ambient conditions for a further 5 days to recover. At the end of each exposure period, several behavioural metrics were quantified (boldness, lateralization and activity). Data showed no change in lateralization and most metrics associated with performance and boldness. During the boldness test, however, average velocity, velocity in the thigmotaxis (outer) zone and proportion of activity in the thigmotaxis zone increased with pCO₂ exposure. During post-exposure, average velocity of L. macrochirus decreased. In addition, individual rank was repeatable during the pre-exposure and post-exposure period in three of the 17 metrics investigated (average velocity in the middle zone, average velocity near object and total shuttles to the object zone), but not during the CO₂ exposure period, suggesting that elevated pCO₂ disrupted some behavioural performances. Overall, this study found elevated pCO₂ caused disruption to behaviours of freshwater fishes such as L. macrochirus and effects do not appear to be as serious as has been shown for marine fishes.

Infectious disease models in zebrafish

In recent years, the zebrafish (Danio rerio) has developed as an important alternative to mammalian models for the study of hostpathogen interactions. Because they lack a functional adaptive immune response during the first 4-6weeks of development, zebrafish rely upon innate immune responses to protect against injuries and infections. During this early period of development, it is possible to isolate and study mechanisms of infection and inflammation arising from the innate immune response without the complications presented by the adaptive immune response. Zebrafish possess several inherent characteristics that make them an attractive option to study hostpathogen interactions, including extensive sequence and functional conservation with the human genome, optical clarity in larvae that facilitates the high-resolution visualization of host cell-microbe interactions, a fully sequenced and annotated genome, robust forward and reverse genetic tools and techniques (e.g., CRISPR-Cas9 and TALENs), and amenability to chemical studies and screens. Here, we describe methods for studying hostpathogen interactions both through systemic infections and through localized infections that allow analysis of host cell response, migration patterns, and behavior. Each of the methods described can be modified for use in downstream applications that include ecotoxicant studies and chemical screens.

Reactive Center Loop (RCL) Peptides Derived from Serpins Display Independent Coagulation and Immune Modulating Activities

Serpins regulate coagulation and inflammation, binding serine proteases in suicide-inhibitory complexes. Target proteases cleave the serpin reactive center loop scissile P1-P1' bond, resulting in serpin-protease suicide-inhibitory complexes. This inhibition requires a near full-length serpin sequence. Myxomavirus Serp-1 inhibits thrombolytic and thrombotic proteases, whereas mammalian neuroserpin (NSP) inhibits only thrombolytic proteases. Both serpins markedly reduce arterial inflammation and plaque in rodent models after single dose infusion. In contrast, Serp-1 but not NSP improves survival in a lethal murine gammaherpesvirus68 (MHV68) infection in interferon γ-receptor-deficient mice (IFNγR(-/-)). Serp-1 has also been successfully tested in a Phase 2a clinical trial. We postulated that proteolytic cleavage of the reactive center loop produces active peptide derivatives with expanded function. Eight peptides encompassing predicted protease cleavage sites for Serp-1 and NSP were synthesized and tested for inhibitory function in vitro and in vivo. In engrafted aorta, selected peptides containing Arg or Arg-Asn, not Arg-Met, with a 0 or +1 charge, significantly reduced plaque. Conversely, S-6 a hydrophobic peptide of NSP, lacking Arg or Arg-Asn with -4 charge, induced early thrombosis and mortality. S-1 and S-6 also significantly reduced CD11b(+) monocyte counts in mouse splenocytes. S-1 peptide had increased efficacy in plasminogen activator inhibitor-1 serpin-deficient transplants. Plaque reduction correlated with mononuclear cell activation. In a separate study, Serp-1 peptide S-7 improved survival in the MHV68 vasculitis model, whereas an inverse S-7 peptide was inactive. Reactive center peptides derived from Serp-1 and NSP with suitable charge and hydrophobicity have the potential to extend immunomodulatory functions of serpins.

Evolution and functional significance of derived sternal ossification patterns in ornithothoracine birds

The midline pattern of sternal ossification characteristic of the Cretaceous enantiornithine birds is unique among the Ornithodira, the group containing birds, nonavian dinosaurs and pterosaurs. This has been suggested to indicate that Enantiornithes is not the sister group of Ornithuromorpha, the clade that includes living birds and their close relatives, which would imply rampant convergence in many nonsternal features between enantiornithines and ornithuromorphs. However, detailed comparisons reveal greater similarity between neornithine (i.e. crown group bird) and enantiornithine modes of sternal ossification than previously recognized. Furthermore, a new subadult enantiornithine specimen demonstrates that sternal ossification followed a more typically ornithodiran pattern in basal members of the clade. This new specimen, referable to the Pengornithidae, indicates that the unique ossification pattern observed in other juvenile enantiornithines is derived within Enantiornithes. A similar but clearly distinct pattern appears to have evolved in parallel in the ornithuromorph lineage. The atypical mode of sternal ossification in some derived enantiornithines should be regarded as an autapomorphic condition rather than an indication that enantiornithines are not close relatives of ornithuromorphs. Based on what is known about molecular mechanisms for morphogenesis and the possible selective advantages, the parallel shifts to midline ossification that took place in derived enantiornithines and living neognathous birds appear to have been related to the development of a large ventral keel, which is only present in ornithuromorphs and enantiornithines. Midline ossification can serve to medially reinforce the sternum at a relatively early ontogenetic stage, which would have been especially beneficial during the protracted development of the superprecocial Cretaceous enantiornithines.

β+ Gamow-Teller transition strengths from 46Ti and stellar electron-capture rates

The Gamow-Teller strength in the β(+) direction to (46)Sc was extracted via the (46)Ti(t,(3)He + γ) reaction at 115  MeV/u. The γ-ray coincidences served to precisely measure the very weak Gamow-Teller transition to a final state at 991 keV. Although this transition is weak, it is crucial for accurately estimating electron-capture rates in astrophysical scenarios with relatively low stellar densities and temperatures, such as presupernova stellar evolution. Shell-model calculations with different effective interactions in the pf shell-model space do not reproduce the experimental Gamow-Teller strengths, which is likely due to sd-shell admixtures. Calculations in the quasiparticle random phase approximation that are often used in astrophysical simulations also fail to reproduce the experimental Gamow-Teller strength distribution, leading to strongly overestimated electron-capture rates. Because reliable theoretical predictions of Gamow-Teller strengths are important for providing astrophysical electron-capture reaction rates for a broad set of nuclei in the lower pf shell, we conclude that further theoretical improvements are required to match astrophysical needs.

PP162. sFlt-1 controlled by CPAP in a pregnant patient with chronic hypertension

INTRODUCTION

Preeclampsia is recognised as the leading cause of perinatal mortality and morbidity worldwide. Interest has been increasing recently as to the possible impact of sleep disordered breathing (SDB) on the mechanisms of preeclampsia, possibly by augmenting placental hypoxia during sleep. A biomarker of preeclampsia, sFlt-1, has also come to prominence in recent years and is postulated to be a good predictor of preeclampsia as well as a strong indicator of the severity of the disease.

OBJECTIVES

The aim of this study was to investigate the effect of CPAP treatment for SDB on sFlt-1 concentrations during pregnancy.

METHODS

Patients were recruited from the outpatients' clinic in Campbelltown Hospital, Campbelltown, NSW in the first half of 2011. The levels of sFlt-1 in four pregnant women, with or without hypertensive disorders of pregnancy, and with or without SDB were measured using ELISA.

RESULTS

Women with SDB and chronic hypertension or preeclampsia had higher levels of sFlt-1 and a greater percentage increase of this marker, and CPAP treatment appeared to attenuate the rise of sFlt-1 as shown in the table below.

CONCLUSION

Elevated sFlt-1 was associated with untreated SDB in those with chronic hypertension. This study provides feasibility for a larger scale study to occur, to further examine the validity of the hypothesis that CPAP treatment has a beneficial effect on sFLt-1 levels and therefore, may lower the risk and severity of preeclampsia.

PP154. Relationship between recorded and reported snoring during pregnancy: Objective measurement versus questionnaire responses

INTRODUCTION

Snoring is a common symptom of sleep disordered breathing (SDB), a condition that is present in 4% of the general population. SDB is identified by snoring and repetitive cessation of breathing during sleep accompanied by repetitive hypoxia and has been found to be associated with hypertension, stroke and heart attack. There is not depth of knowledge examining the association between SDB and pregnancy outcomes.

OBJECTIVES

To examine the prevalence of self reported snoring in pregnancy and the potential association between self reported snoring and the development of Hypertensive Disorders of Pregnancy (HDP) within a larger cohort from a prevalence of SDB in pregnancy study.

METHODS

Questionnaires were administered to pregnant women attending an outpatient's antenatal clinic. The self reported snoring is a component of the Epworth scale. Pregnancy progression and outcome data were collected on all participants and analyse by IBM SPSS v.20™ utilising Chi-square analysis, Student T test and logistic regression analysis. HDP diagnoses were in alignment with the SOMANZ (2009) diagnostic criteria.

RESULTS

Questionnaires were administered and outcomes collected on 2023 pregnancies. Snoring was reported by 49.2% of women. HDP affected 10.1% of the cohort, 3.3% of whom were preeclamptic. Of the pregnancies affected by HDP self reported snoring occurred in 57.7% in comparison to 43.3% who do not report snoring (p<0.001).

CONCLUSION

This would indicate that there is an association between self reported snoring and the development of HDP. Further analysis will be undertaken to model the effect of other potential risk factors such as maternal age, parity, pre-pregnancy BMI and other co morbidities.

Abstract P6-04-04: Hypoxia Is Associated with Somatic Loss of BRCA1 Protein and Pathway Activity in Triple Negative Breast Cancer

Background: Triple negative breast cancer (TNBC) has loss of BRCA1 activity either through germline mutation, epigenetic modification or negative transcriptional regulators. Yale investigators have demonstrated that tumor hypoxia leads to loss of critical DNA repair activities, including BRCA1, RAD-51 and γ-H2AX (Bindra RS, et al. Cancer Res 2005;65(24): 11597-604). This study was designed to explore the relationship of BRCA1 loss and hypoxia using Carbonic Anhydrase IX (CA-IX), a downstream target of hypoxia-induced factor 1a (HIF-1a), an accepted surrogate biomarker for tumor hypoxia, in TNBC. Methods: Two cohorts of breast tumors from Yale archival materials were studied. The first consisted of 660, unselected breast tumors, the second a cohort of 130 TNBC, both with long term clinical followup. Automated Quantitative Analysis (AQUA) was used to detect the intensity of BRCA1 and CAIX within specific subcellular compartments. CA-IX antibody M75 was provided by the J Zavada lab (1:10000), BRCA1 monoclonal antibody M110 (Ab-1) was purchased from Calbiochem (1:1000). The 130 TNBC cohort was also subjected to whole genome expression analysis. In brief, tissue core biopsies from tumor blocks were subjected to nucleic acid extraction using RecoverAll Total Nucleic Acid Isolation kit (Applied Biosystems) and 600ng total RNA were processed by the Keck Microarray Facility for the Illumina DASL platform. Statistical analysis of gene expression data was carried out in Bioconductor/R software. A set of relevant signatures was selected by enrichment analysis of modules identified by principal component analysis. Signature scores were computed as Pearson correlation between the signature vector of gene contributions and each sample's expression profile for these genes. Results: In the cohort of 660 specimens, 22 were found to have high CA-IX expression score (above cut-off value of 10). Cut-off was based on known positive cell lines and corresponding AQUA scores, as well as visual confirmation of positivity. A negative correlation (Rho=-0.6, p=0.0165) of BRCA1 nuclear protein with CA-IX level was found and this data was reproducible on a duplicate array. Of note, 14 out of 22 hypoxic breast tumors were from triple negative breast cancers (TNBC) (p=0.0034). In the triple negative cohort, CAIX staining was positive in 20 % of cases (n=15/75) and in these samples it was associated with the 2002 van ‘t Veer BRCA1 mutant signature (Rho=0.51). Positive CAIX staining was also associated with worse outcome (p=0.046) as was CAIX mRNA expression (p=0.02).

Conclusions: In human breast tumors BRCA1 nuclear expression is negatively correlated with tumor hypoxia, measured by CAIX. A subset of TNBC has higher levels of hypoxia and BRCA1 signatures. This data suggests that CAIX may be a useful biomarker for BRCA1 loss, and possibly for response to PARP inhibitor therapy. This will be evaluated in our recently completed trial of BSI-201+Irinotecan.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P6-04-04.

Abstract P6-15-09: Insulin-Like Growth Factor Receptor I (IGF1R) Inhibitors May Be Synergistic with Chemotherapy in Basal Breast Cancer

Background: Preclinical and clinical data show associations between basal breast cancer (BBC) and obesity, insulin resistance and metabolic syndrome suggesting a role for the insulin-like growth factor (IGF) pathway in this disease. We hypothesized that IGF1R targeted therapy will be active in BBC and would enhance the activity of chemotherapeutic agents. We evaluated AG1024, a kinase inhibitor of IGF1R, and Figitumumab, a human anti-IGF1R antibody, in BBC cell lines as monotherapy and in combination with conventional chemotherapeutic agents, doxorubicin or paclitaxel.

Materials and Methods: To evaluate the effect of AG1024, Figitumumab, doxorubicin and paclitaxel, growth assays were conducted using four BBC cell lines (MDA-MB-231, MDA-MB-468, SUM149 and BT20) and the ER positive control cell line, MCF7. Cells were harvested, resuspended in OptiMEM and plated in triplicate at optimal cell densities (50-70% confluent). AG1024 (0-µM), Figitumumab (0-0.585μM), doxorubicin (0-0µM) and paclitaxel (0-20nM) were added after 24-hour incubation. On Day 5, at 70-90% confluence, the cell proliferation Reagent WST-1 (Roche) was added, cells incubated and OD measured as directed by the manufacturer. The percent of surviving cells in each test well was calculated as follows: OD drug-treated well/untreated mean x 100. Each drug combination was assessed in triplicate. Using CalcuSyn (BioSoft), the Median Effects method described by T-C Chou and P. Talaly was used to determine whether or not drug combinations were synergistic or additive. A combination index (CI) &lt;0.90 = synergism, between 0.90 and 1.10 = additive and &gt;1.10 = antagonism. The CI values reported were observed in two or more experiments.

Results: AG1024 produced dose-dependent growth inhibition in all BBC cell lines.

Cytotoxicity of AG1024 (40uM) after a five day incubation.

The hormone-receptor positive MCF7 cell line was the least sensitive to AG1024. Figitumumab had no activity as monotherapy on BBC and control cell lines. Combination therapy with AG1024 and chemotherapy produced synergistic or additive effects in all BBC cell lines. For instance, combining 01µM doxorubicin with 1µM AG1024 produced a synergistic effect in all BBC cell lines except MDA-MB-468.

Combination Indices (CI) of combination therapy experiments.

Similarly, Figitumumab and chemotherapy produced additive or synergistic growth inhibition. Further data on IGF1R levels and phosphotyrosine activity will be presented

Conclusions: AG1024 causes a dose-dependent decrease in cell viability in BBC cell lines produced synergistic cytotoxicity with paclitaxel and doxorubicin. Figitumumab alone failed to have cytotoxic effects on BBC cell lines, however additive or synergistic effects were seen with paclitaxel or doxorubicin in combination with Figitumumab. The combination of IGF1R inhibitors with chemotherapy in BBC should be further explored.

Germination of Clostridium cylindrosporum Spores on Medium Containing Uric Acid

Clostridium cylindrosporum spores germinated rapidly under reducing conditions when bicarbonate, uric acid, and calcium were present. Germination rates on 10 mM urate increased with increasing Ca (maximum rate at 5 mM Ca or greater). Germination rates on urate (limiting Ca) increased with increasing urate concentrations to 10 mM urate. At 10 mM Ca, germination rates reached a maximum at 1 mM urate and remained constant thereafter. Cations (Na, K, Li, and Mg), purines, purine analogs, and EDTA inhibited germination at limiting calcium concentrations but not (except for 10 mM adenine) at 10 mM Ca. Methyl viologen or formate did not inhibit germination. Germination was not observed in solutions containing xanthine, hypoxanthine, caffeine, theophylline, 6,8-dihydroxypurine, adenine, allopurinol, formate, glycine, or acetate, even though some of the purines are growth substrates.