Tracing Tomorrow: young people's preferences and values related to use of personal sensing to predict mental health, using a digital game methodology

BACKGROUND

Use of personal sensing to predict mental health risk has sparked interest in adolescent psychiatry, offering a potential tool for targeted early intervention.

OBJECTIVES

We investigated the preferences and values of UK adolescents with regard to use of digital sensing information, including social media and internet searching behaviour. We also investigated the impact of risk information on adolescents' self-understanding.

METHODS

Following a Design Bioethics approach, we created and disseminated a purpose-built digital game (www.tracingtomorrow.org) that immersed the player-character in a fictional scenario in which they received a risk assessment for depression Data were collected through game choices across relevant scenarios, with decision-making supported through clickable information points.

FINDINGS

The game was played by 7337 UK adolescents aged 16-18 years. Most participants were willing to personally communicate mental health risk information to their parents or best friend. The acceptability of school involvement in risk predictions based on digital traces was mixed, due mainly to privacy concerns. Most participants indicated that risk information could negatively impact their academic self-understanding. Participants overwhelmingly preferred individual face-to-face over digital options for support.

CONCLUSIONS

The potential of digital phenotyping in supporting early intervention in mental health can only be fulfilled if data are collected, communicated and actioned in ways that are trustworthy, relevant and acceptable to young people.

CLINICAL IMPLICATIONS

To minimise the risk of ethical harms in real-world applications of preventive psychiatric technologies, it is essential to investigate young people's values and preferences as part of design and implementation processes.

UK medical students' self-reported knowledge and harm assessment of psychedelics and their application in clinical research: a cross-sectional study

OBJECTIVE

To capture UK medical students' self-reported knowledge and harm assessment of psychedelics and to explore the factors associated with support for changing the legal status of psychedelics to facilitate further clinical research.

DESIGN

Cross-sectional, anonymous online survey of UK medical students using a non-random sampling method.

SETTING

UK medical schools recognised by the General Medical Council.

PARTICIPANTS

132 medical students who had spent an average of 3.8 years (SD=1.4; range: 1-6) in medical school.

RESULTS

Most students (83%) reported that they were aware of psychedelic research and only four participants (3%) said that they were not interested in learning more about this type of research. Although medical students' harm assessment of psychedelics closely aligned with that of experts, only 17% of students felt well-educated on psychedelic research. Teachings on psychedelics were only rarely encountered in their curriculum (psilocybin: 14.1 (SD=19.9), scale: 0 (never) to 100 (very often)). Time spent at medical schools was not associated with more knowledge about psychedelics (r=0.12, p=0.129). On average, this sample of medical students showed strong support for changing the legal status of psychedelics to facilitate further research into their potential clinical applications (psilocybin: 80.2 (SD=24.8), scale: 0 (strongly oppose) to 100 (strongly support)). Regression modelling indicated that greater knowledge of psychedelics (p<0.001), lower estimated harm scores (p<0.001), more time spent in medical school (p=0.024) and lower perceived effectiveness of non-pharmacological mental health treatments (p=0.044) were associated with greater support for legal status change.

CONCLUSIONS

Our findings reveal a significant interest among UK medical students to learn more about psychedelic research and a strong support for further psychedelic research. Future studies are needed to examine how medical education could be refined to adequately prepare medical students for a changing healthcare landscape in which psychedelic-assisted therapy could soon be implemented in clinical practice.

Surgeon reported treatment choices for AO type B and C thoracolumbar fractures without neurological deficits: An expert survey

INTRODUCTION

Less invasive spine surgery (LISS) has become well-established for thoracolumbar burst fractures without neurological deficits. However, notable controversy persists regarding the adequacy of LISS for more unstable AO type B and C injuries, as it does not allow for formal open fusion.

MATERIALS AND METHODS

In this cross-sectional survey experienced spine surgeons of the Dutch Spine Society were invited to participate (56 participants). They were asked to indicate the most appropriate treatment for AO type B1, B2 (L1: A1 and L1: A3), B3 and C (L1: A4) injuries at level Th12-L1. Taking into account: age, AO N0-N1, or polytrauma. Specific agreement between participants was obtained applying Variation Ratio (VR).

RESULTS

A significant level of overall agreement was observed for AO type-B1 injuries with 73.8% of participants opting for percutaneous short-segment fixation (VR 0.775). For AO type-B3 injuries, 79.4% of participants favored percutaneous long-segment fixation (VR 0.794). for AO type-B2 injuries, there was less overall agreement (VR 0.571-0.657). Nonetheless, when considering all AO type-B injuries combined, percutaneous fixation emerged as the most preferred treatment option with substantial agreement (VR 0.871-0.923). Conversely, for AO type-C injuries, there was less agreement among the participants (VI 0.411), 26.5% of them chose additional open spinal fusion.

CONCLUSION

For all AO type-B injuries there was substantial agreement to treat these fractures with percutaneous techniques. For AO type-C injuries, the survey results do not support a consensus. Nevertheless, the responses raise important questions about the necessity of spinal fusion for such injuries.

When the Trial Ends: The Case for Post-Trial Provisions in Clinical Psychedelic Research

The ethical value-and to some scholars, necessity-of providing trial patients with post-trial access (PTA) to an investigational drug has been subject to significant attention in the field of research ethics. Although no consensus has emerged, it seems clear that, in some trial contexts, various factors make PTA particularly appropriate. We outline the atypical aspects of psychedelic clinical trials that support the case for introducing the provision of PTA within research in this field, including the broader legal status of psychedelics, the nature of the researcher-therapist/participant relationship, and the extended time-frame of the full therapeutic process. As is increasingly understood, the efficacy of psychedelic-assisted psychotherapy is driven as much by extrapharmacological elements and the cultural therapeutic container as by the drug itself. As such, we also advocate for a refocusing of attention from post-trial access to a broader concept encompassing other elements of post-trial care. We provide an overview of some of the potential post-trial care provisions that may be appropriate in psychedelic clinical trials. Although the World Medical Association's Declaration of Helsinki calls on researchers, sponsors, and governments to make provisions for post-trial access, such provision may feel impracticable or out-of-reach within psychedelic trials that are already constrained by a high resource demand and significant bureaucratic burden. We show how conceiving of post-trial provision as an integral site of the research process, and an appropriate destination for research funding, will serve to develop the infrastructure necessary for the post-legalisation psychedelic medicine ecosystem.

Transformative experience and informed consent to psychedelic-assisted psychotherapy

Just as psychedelic-assisted psychotherapy (PAP) represents a clinical innovation that may need to be accommodated with corresponding theoretical and methodological innovations, there is growing awareness that the tools, normative frameworks, and standard practices of our clinical ethics may also need to be adapted, renewed, or replaced to accommodate its unusual features. Drawing on L. A. Paul's work on "Transformative Experience," I argue that the acute and long-term effects that are repeatedly reported following the administration of psychedelic drugs, including in clinical contexts, are epistemically inaccessible at the point of deciding to take them. By virtue of both the so-called "mystical" experiences that frequently arise during PAP, and the long-term shifts to outlooks, values, and priorities that can follow treatment, the processes of decision-making that are normatively expected of patients run aground. If this framing is correct, then prospective patients cannot meet the requirement of understanding that is one of the principal analytic components of informed consent. The role of understanding in supporting two functions of informed consent-avoiding unauthorized trespass against patients and supporting values-aligned decision-making-is explored, and I argue that, while the normative standard for the first function may be met by extant suggestions for enhancing the consenting process for PAP, the latter function remains unattainable. In light of this, the consequences for the ethical preparation of prospective patients are considered.

Testing Design Bioethics Methods: Comparing a Digital Game with a Vignette Survey for Neuroethics Research with Young People

BACKGROUND

Over the last decades, the neurosciences, behavioral sciences, and the social sciences have all seen a rapid development of innovative research methods. The field of bioethics, however, has trailed behind in methodological innovation. Despite the so-called "empirical turn" in bioethics, research methodology for project development, data collection and analysis, and dissemination has remained largely restricted to surveys, interviews, and research papers. We have previously argued for a "Design Bioethics" approach to empirical bioethics methodology, which develops purpose-built methods for investigation of bioethical concerns. In this paper we compare a research tool created using a design bioethics approach to a "methods-as-usual" approach in empirical bioethics.

METHODS

Our study compared dimensions of engagement with a digital game we created, called "Tracing Tomorrow," to a standard vignette survey. The two tools investigated the same subject matter, digital phenotyping for mental health, in a sample of 301 UK adolescents.

RESULTS

Participants who played the game reported a greater sense of presence, emotional engagement, cognitive absorption, and mental health ethics insight, compared to participants who completed the vignette survey. Perceived authenticity and curiosity/motivation to learn more was equivalent for both methods.

CONCLUSION

The results of this study highlights the importance of purpose-built methodology for empirical bioethics research.

The impact of the COVID-19 pandemic on healthcare access and utilisation in South Sudan: a cross-sectional mixed methods study

BACKGROUND

Indirect effects of the COVID-19 pandemic on communities in fragile and conflict-affected settings may be severe due to reduced access and use of healthcare, as happened during the 2015 Ebola Virus Disease outbreak. Achieving a balance between short-term emergency response and addressing long-term health needs is particularly challenging in fragile and conflict-affected settings such as South Sudan, given the already significant barriers to accessing healthcare for the population. This study sought to characterise the effect of COVID-19 on healthcare access and South Sudan's healthcare response. This can inform efforts to mitigate the potential impacts of COVID-19 or other epidemiological threats, and contribute to understanding how these may be balanced for greater health system resilience in fragile contexts.

METHODS

We conducted a mixed methods study in three of South Sudan's states, combining data from a cross-sectional quantitative household survey with qualitative interviews and Focus Group Discussions.

RESULTS

Even though some fears related to COVID-19 were reported, we found these did not greatly dissuade people from seeking care and do not yield significant consequences for health system programming in South Sudan. The pillars of the response focused on risk communication and community engagement were effective in reaching communities through different channels. Respondents and participants reported behaviour changes that were in line with public health advice. We also found that the implementation of COVID-19 response activities sometimes created frictions between the national government and international health actors, and that COVID-19 caused a greater reliance on, and increased responsibility for, international donors for health planning.

CONCLUSIONS

Given the fact that global priorities on COVID-19 are greatly shifting, power dynamics between international health agencies and the national government may be useful to consider in further COVID-19 planning, particularly for the vaccine roll-out. South Sudan must now navigate a period of transition where COVID-19 vaccine roll-out continues and other domestic health burdens are re-prioritised.

977 Breaking Out of Tradition: Designing Escape Rooms as Novel Simulation

Aim

The emerging field of gamification, the addition of game play elements to non-game settings, is widely used in business and is increasingly being used in education. Successful methods have included live leader boards and a web-based game solving a protein folding conundrum.

Method

We designed an escape room (ER), incorporating gaming elements, focussing on communication in a surgical environment. A cross over study was delivered to 4th year medical students, comparing traditional simulation. The ER included logic puzzles, hidden clues, padlocked boxes, and surgical skills appropriate to their level. Self-reported engagement and teamwork were recorded, as was observed teamwork and communication skills.

Results

Self-reported engagement was very high for the students compared to more traditional simulation, including better understanding of effective communication strategies. The ER group were less likely to self-identify learning points but structured debrief mitigated this difference.

Conclusions

Gamification techniques can be integrated with good engagement and educational outcomes and should be considered as an adjunct to existing simulation strategy.

971 Gamification of Education; Can Playable Education Result in Better Learning Outcomes?

Aim

Combining traditional simulation (TS) and the emerging field of gamification, to create medical Escape Rooms (ERS) has been used in Nursing to good results but is yet to be widely adopted in medical education. We conducted a pilot study to create ERS for undergraduates to assess their educational value.

Method

Existing Simulation themes of sepsis, post-operative bleeding, trauma, burns and communication in the theatre environment were developed into Escape Rooms by a multidisciplinary team. A cross over study for 4th year students was carried out. Questionnaires were used to evaluate the experience, learning assessed by pre and post quiz and observational tools for teamwork, communication and leadership were utilised.

Results

Qualitative data demonstrated overall good feedback on enjoyment an engagement. Quantitative data collected as pre- and post-exposure learning demonstrated equivocal benefit. Self-assessed teamwork showed equal in all domains and improved in contribution of knowledge and maintaining team focus on the ER group.

Conclusions

Participants find ER enjoyable have similar educational benefits of traditional simulation with the benefits on enhancing non-technical skills amongst a novice group. Escape rooms may be useful as an adjunct to TS particularly at developing non-technical skills.

Resistance to local anaesthetics administered via epidural, intrathecal and pudendal injections

A primigravida presented to our institution in established labour. Her past medical history included joint hypermobility, postural orthostatic tachycardia syndrome, Raynaud's syndrome, fibromyalgia and gastroparesis. Two technically uneventful lumbar epidurals with bupivacaine and fentanyl provided no analgesia. The spinal element of a planned combined spinal and epidural was also ineffective, so alternative analgesia was offered. While this was being prepared, the obstetric team recommended an instrumental delivery. An attempted pudendal nerve block with lidocaine had no effect, and general anaesthesia was therefore provided for a lower segment caesarean delivery. We believe this is the first report of local anaesthetic resistance via three distinct routes of administration in a single patient. Resistance to local anaesthetics is unusual and is more common in patients with hypermobility spectrum disorders. This case demonstrates the unique experience of a patient with a hypermobility condition who had failed epidural, spinal and pudendal local anaesthetic. We suggest that patients with a hypermobility condition should be specifically assessed for local anaesthetic resistance as part of anaesthetic pre-assessment, to enable early planning.

A framework for mapping and monitoring human-ocean interactions in near real-time during COVID-19 and beyond

The human response to the COVID-19 pandemic set in motion an unprecedented shift in human activity with unknown long-term effects. The impacts in marine systems are expected to be highly dynamic at local and global scales. However, in comparison to terrestrial ecosystems, we are not well-prepared to document these changes in marine and coastal environments. The problems are two-fold: 1) manual and siloed data collection and processing, and 2) reliance on marine professionals for observation and analysis. These problems are relevant beyond the pandemic and are a barrier to understanding rapidly evolving blue economies, the impacts of climate change, and the many other changes our modern-day oceans are undergoing. The "Our Ocean in COVID-19″ project, which aims to track human-ocean interactions throughout the pandemic, uses the new eOceans platform (eOceans.app) to overcome these barriers. Working at local scales, a global network of ocean scientists and citizen scientists are collaborating to monitor the ocean in near real-time. The purpose of this paper is to bring this project to the attention of the marine conservation community, researchers, and the public wanting to track changes in their area. As our team continues to grow, this project will provide important baselines and temporal patterns for ocean conservation, policy, and innovation as society transitions towards a new normal. It may also provide a proof-of-concept for real-time, collaborative ocean monitoring that breaks down silos between academia, government, and at-sea stakeholders to create a stronger and more democratic blue economy with communities more resilient to ocean and global change.

Neuroenhancements in the Military: A Mixed-Method Pilot Study on Attitudes of Staff Officers to Ethics and Rules

Utilising science and technology to maximize human performance is often an essential feature of military activity. This can often be focused on mission success rather than just the welfare of the individuals involved. This tension has the potential to threaten the autonomy of soldiers and military physicians around the taking or administering of enhancement neurotechnologies (e.g., pills, neural implants, and neuroprostheses). The Hybrid Framework was proposed by academic researchers working in the U.S. context and comprises “rules” for military neuroenhancement (e.g., ensuring transparency and maintaining dignity of the warfighter). Integrating traditional bioethical perspectives with the unique requirements of the military environment, it has been referenced by military/government agencies tasked with writing official ethical frameworks. Our two-part investigation explored the ethical dimensions of military neuroenhancements with military officers – those most likely to be making decisions in this area in the future. In three workshops, structured around the Hybrid Framework, we explored what they thought about the ethical issues of enhancement neurotechnologies. From these findings, we conducted a survey (N = 332) to probe the extent of rule endorsement. Results show high levels of endorsement for a warfighter’s decision-making autonomy, but lower support for the view that enhanced warfighters would pose a danger to society after service. By examining the endorsement of concrete decision-making guidelines, we provide an overview of how military officers might, in practice, resolve tensions between competing values or higher-level principles. Our results suggest that the military context demands a recontextualisation of the relationship between military and civilian ethics.

How to build a game for empirical bioethics research: The case of 'Tracing Tomorrow'

It is becoming increasingly clear that the field of empirical bioethics requires methodological innovations that can keep up with the scale and pace of contemporary research in health and medicine. With that in mind, we have recently argued for Design Bioethics-the use of purpose-built, engineered research tools that allow researchers to investigate moral decision-making in ways that are embodied and contextualized. In this paper, we outline the development, testing and implementation of a novel prototype tool in the Design Bioethics Workshop-with each step illustrated with collected data. Titled 'Tracing Tomorrow' (www.tracingtomorrow.org), the tool is a narrative game to investigate young people's values and preferences in the context of digital phenotyping for mental health. The process involved (1) Working with young people to discover, validate and define the morally relevant cases or problems, (2) Building and testing the game concept in collaboration with relevant groups and game developers, (3) Developing prototypes that were tested and iterated in partnership with groups of young people and game developers and (4) Disseminating the game to young people to collect data to investigate research questions. We argue that Design Bioethics yields tools that are relevant, representative and meaningful to target populations and provide improved data for bioethics analysis. PATIENT OR PUBLIC CONTRIBUTION: In planning and conducting this study, we consulted with young people from a diverse range of backgrounds, including the NeurOX Young People's Advisory Group, the What Lies Ahead Junior Researchers Team, Censuswide youth participants and young people from the Livity Youth Network.

Puff-resolved analysis and selected quantification of chemicals in the gas phase of E-Cigarettes, Heat-not-Burn devices and conventional cigarettes using single photon ionization time-of-flight mass spectrometry (SPI-TOFMS): A comparative study

INTRODUCTION

A wide array of alternative nicotine delivery devices (ANDD) has been developed and they are often described as less harmful than combustible cigarettes. This work compares the chemical emissions of three ANDD in comparison to cigarette smoke. All the tested ANDD are characterized by not involving combustion of tobacco.

METHOD

Single photon ionization time-of-flight mass spectrometry (SPI-TOFMS) is coupled to a linear smoking machine, which allows a comprehensive, online analysis of the gaseous phase of the ANDD aerosol and the conventional cigarette smoke (CC). The following devices were investigated in this study: a tobacco cigarette with a glowing piece of coal as a heating source, an electric device for heating tobacco and a first-generation electronic cigarette. Data obtained from a standard 2R4F research cigarette are taken as a reference.

RESULTS

The puff-by-puff profile of all products was recorded. The ANDD show a substantial reduction or complete absence of known harmful and potentially harmful substances compared to the CC. In addition, tar substances (i.e. semivolatile and low volatile aromatic and phenolic compounds) are formed to a much lower extent. Nicotine, however, is supplied in comparable amounts except for the investigated electronic cigarette.

CONCLUSIONS

The data shows that consumers switching from CC to ANDD are exposed to lower concentrations of harmful and potentially harmful substances. However, toxicological and epidemiological studies must deliver conclusive results if these reduced exposures are beneficial for users.

IMPLICATION

The comparison of puff-resolved profiles of emissions from different tobacco products, traditional and alternative, may help users switch to lower emission products. Puff-resolved comparison overcomes technical changes, use modes between products and may help in their regulation.

Age at diagnosis of Type 2 diabetes in Germany: a nationwide analysis based on claims data from 69 million people

AIM

For many European countries, including Germany, no valid estimates are available on age at diagnosis of Type 2 diabetes. Thus, we aimed to estimate the age at diagnosis in Germany.

METHODS

Age at diagnosis of Type 2 diabetes in Germany was estimated based on Type 2 diabetes prevalence and incidence and the age distribution of the German population. Age- and sex-specific incidence and prevalence in 2014/2015, based on claims data from statutory health insurance (n= 69 000 000, ~85% of the German population), and the age pyramid for Germany in 2015 were used for the calculation. Age at Type 2 diabetes diagnosis was stratified by sex. CIs were estimated using bootstrap methods. In addition, the age range in which 50% of the population received a diagnosis of Type 2 diabetes was calculated (the interquartile range).

RESULTS

The mean ± sd age at Type 2 diabetes diagnosis in 2015 was 61.0 ± 13.4 years (95% CI 60.9-61.0) in men. Women were diagnosed ~2 years later than men (mean age 63.4 ± 14.9 years; 95% CI 63.4-63.5). The age range in which 50% of the population was diagnosed with diabetes was 53-72 years for men and 54-76 years for women.

CONCLUSIONS

The sex differences are mainly attributable to a higher incidence of Type 2 diabetes in men than women during middle age and the higher absolute number of women in the older ages. The early age at diabetes diagnosis compared to average life expectancy means that the risk of diabetes-related complications is increased.

Sexual dimorphism of physical activity on cognitive aging: Role of immune functioning

OBJECTIVE

Exercise is one of the most potent strategies available to support cognitive health with age, yet substantial variability exists. Sexual dimorphism is evident for brain and immune functioning, the latter being implicated as important pathway for exercise. We examined the moderating role of sex on the relationship between physical activity and systemic inflammatory and brain health outcomes in support of more personalized approaches to behavioral interventions.

METHODS

Our discovery cohort included 45 typically aging women matched on age (±5y) and education (±2y) to 45 men (mean age = 72.5; Clinical Dementia Rating = 0) who completed self-reported current physical activity (Physical Activity Scale for Elderly), blood draw, neuropsychological evaluation, and brain MRI. An independent sample of 45 typically aging women and 36 men who completed the same measures comprised a replication cohort. Plasma was analyzed for 11 proinflammatory cytokine and chemokine markers via MesoScale Discovery.

RESULTS

Discovery cohort: Reported physical activity did not differ between sexes (150 vs. 157, p = 0.72). There was a significant interaction between sex and physical activity on chemokine markers MDC, MIP-1b, MCP-4, and eotaxin-3 (ps < 0.03), with a similar trend for MCP-1 and INFγ (ps < 0.09). Men who reported greater activity demonstrated lower inflammatory markers, an effect attenuated-to-absent in women. An interaction between sex and physical activity was also observed for parahippocampal volumes (p = 0.02) and cognition (processing speed and visual memory; ps < 0.04). Again, the beneficial effect of physical activity on outcomes was present in men, but not women. Replication cohort analyses conferred a consistent effect of sex on the relationship between physical activity and immune markers; models examining neurobehavioral outcomes did not strongly replicate. Across cohorts, post-hoc models demonstrated an interaction between sex and activity-related inflammatory markers on total gray matter volume and visual memory. Men with higher inflammatory markers demonstrated poorer brain structure and function, whereas inflammatory markers did not strongly relate to neurobehavioral outcomes in women.

CONCLUSIONS

Greater physical activity was associated with lower markers of inflammation in clinically normal older men, but not women - an effect consistently replicated across cohorts. Additionally, men appeared disproportionately vulnerable to the adverse effects of peripheral inflammatory markers on brain structure and function compared to women. Immune activation may be a male-specific pathway through which exercise confers neurobehavioral benefit.

A potential role for psilocybin in the treatment of obsessive-compulsive disorder

The recent revivification of interest in the therapeutic use of psychedelics has had a particular focus on mood disorders and addiction, although there is reason to think these drugs may be effective more widely. After outlining pertinent aspects of psilocybin and obsessive-compulsive disorder (OCD), the current review summarizes the evidence indicating that there may be a role for psilocybin in the treatment of OCD, as well as highlighting a range of potential therapeutic mechanisms that reflect the action of psilocybin on brain function. Although the current evidence is limited, that multiple signals point in directions consistent with treatment potential, alongside the psychological and physiological safety of clinically administered psilocybin, support the expansion of research, both in animal models and in further randomized controlled trials, to properly investigate this potential.

Hepcidin-regulating Iron-metabolism Genes and Pancreatic Ductal Adenocarcinoma: A Pathway Analysis of Genome-wide Association Studies

Pancreatic ductal adenocarcinoma (PDAC) is a highly lethal cancer, and epidemiological studies have suggested positive associations with iron and red meat intake. Rare mutations in genes involved in the hepcidin-regulating pathway are known to cause iron overload and hemochromatosis. We hypothesize that the hepcidin-regulating pathway as characterized by common variants from genome-wide association studies will be associated with PDAC. Methods: We conducted a large pathway-based meta-analysis of the hepcidin-regulating genes using the summary based adaptive rank truncated product (sARTP) method in 9,253 PDAC cases and 12,525 controls of European descent from the Pancreatic Cancer Cohort (PanScan) and the Pancreatic Cancer Case-Control (PANC4) consortia. Our analysis included 11 hepcidin-regulating genes (BMP2, BMP6, FTH1, FTL, HAMP, HFE, HJV, NRF2, SLC40A1, TFR1, TFR2) and adjacent genomic regions (20 kb upstream and downstream) with a total of 412 single-nucleotide polymorphisms (SNPs). We also conducted the sARTP with four iron status biomarkers (serum iron, transferrin, transferrin saturation, and ferritin, n = 23,986) using summary statistics from previous GWAS studies (Benyamin, et al. 2014) to examine if the hepcidin-regulating genes were also associated with these iron traits. The sARTP method combines SNP-level associations across variants in a gene or a pathway. Signals from up to five of the most associated SNPs for each gene studied were accumulated. Results: The hepcidin-regulating pathway was significantly associated with PDAC (P-value = 0.002) with the HJV, TFR2, and TFR1 genes contributing the most to the association (gene level P-values = 0.001, 0.014, and 0.019, respectively). The pathway associations were more significant in women than men. This pathway was also significantly associated with the four biomarkers of iron metabolism (P-values &lt;1.5 × 10–7). Conclusions: Our results support that genetic susceptibility related to the hepcidin-regulating pathway is associated with PDAC and a potential role of iron metabolism in pancreatic carcinogenesis. Further studies are needed to evaluate the modifying effect of iron-rich foods and genetic susceptibility of this pathway and PDAC risk.

Performance of Gem Premier blood gas/electrolyte analyzer evaluated

We evaluated a new analyzer designed for point-of-care testing of blood gases, sodium, potassium, ionized calcium, and hematocrit. The Gem Premier (Mallinckrodt) system has two components: the analyzer and a disposable cartridge. Analysis takes place in the cartridge, which contains the electrochemical sensors, the calibrants, the reagents, the sampling stylus, and the waste container. The system was evaluated for imprecision and accuracy. With aqueous control materials, total imprecision (CV) was: pH, 0.10-0.18%; PCO2, 3.16-5.78%; PO2, 2.92-4.85%; sodium, 0.82-1.44%; potassium, 1.35-1.48%; ionized calcium, 0.75-1.45%; and hematocrit, 1.13-1.83%. Accuracy of the system was assessed by split-sample comparison with the Radiometer ABL 330 blood gas analyzer for pH and blood gases, the Nova Stat Profile 5 for whole-blood electrolyte and hematocrit analysis, and the IL Phoenix for plasma electrolyte analysis. After outlier correction, regression statistics were excellent for all analytes except sodium, which demonstrated Sy[x values between 1.80 and 2.30 mmol/L and 0.85 &lt; or = r &lt; 0.90.

Prevalence and molecular diversity of invasive Streptococcus dysgalactiae and Streptococcus pyogenes in a German tertiary care medical centre

Prevalence of invasive ß-haemolytic streptococci (BHS) at a tertiary care hospital and molecular diversity of S. pyogenes and S. dysgalactiae was studied. Between 2012 and 2016, all blood culture sets (n = 55,839), CSF (n = 8413) and soft tissue (n = 20,926) samples were analysed for BHS positivity using HYBASE software. Molecular profiles of 99 S. pyogenes and S. dysgalactiae were identified by sequencing of M protein genes (emm types) and multiplex PCR typing of 20 other virulence determinants. Streptococci contributed to 6.2% of blood, 10.7% of CSF and 14.5% of soft tissue isolates, being among the most common invasive isolates. The overall rates of invasive S. pyogenes, S. agalactiae, S. dysgalactiae and S. pneumoniae were 2.4, 4.4, 2.1, and 5.3%. Whereas S. pneumoniae was 1.5% more common in CSF samples, BHS isolates were 2-fold and 11-fold higher in bacteraemia and invasive soft tissue infections. Genetic BHS typing revealed wide molecular diversity of invasive and noninvasive group A and group G BHS, whereas one emm-type (stG62647.0) and no other virulence determinants except scpA were detected in invasive group C BHS. BHS were important invasive pathogens, outpacing S. pneumoniae in bacteraemia and invasive soft tissue infections. The incidence of S. dysgalactiae infections was comparable to that of S. pyogenes even with less diversity of molecular virulence. The results of this study emphasise the need for awareness of BHS invasiveness in humans and the need to develop BHS prevention strategies.

Healthcare costs of Type 2 diabetes in Germany

AIM

To describe for the first time the direct costs of Type 2 diabetes treatment by analysing nationwide routine data from statutory health insurance in Germany.

METHODS

This cost-of-illness-study was based on a 6.8% random sample of all German people with statutory health insurance (4.3 out of 70 million people). The healthcare expenses show direct per capita costs from the payer perspective. Healthcare expenses for physicians, dentists, pharmacies, hospitals, sick benefits and other healthcare costs were considered. Per capita costs, cost ratios for people with Type 2 diabetes and without diabetes as well as diabetes-attributable costs were calculated.

RESULTS

Per capita costs for people with Type 2 diabetes amounted to €4,957 in 2009 and €5,146 in 2010. People with Type 2 diabetes had 1.7-fold higher health expenses than people without diabetes. The largest differences in health expenses were found for prescribed medication from pharmacies (cost ratio diabetes/no diabetes: 2.2) and inpatient treatment (1.8). Ten percent of the total statutory health insurance expense, in total €16.1 billion, was attributable to the medical care of people with Type 2 diabetes.

CONCLUSIONS

This nationwide study indicates that one in 10 Euros of healthcare expenses is spent on people with Type 2 diabetes in Germany. In the future, national statutory health insurance data can be used to quantify time trends of costs in the healthcare system.

Psychiatric sequelae following surgical treatment of breast cancer

Breast cancer has been the most carefully studied site of tumor from a psychological point of view. A range of interventions have been developed to assist the woman and her family in the emotional adjustment to breast cancer and its treatment. Many of these have been developed 'by women for women' and by their insistence that the medical community give more attention to this aspect of medical care. Rehabilitation now centers far more on breast reconstruction then previously. The psychologic understanding of problems posed by breast cancer has been used to develop rational and appropriate psychosocial interventions to reduce emotional distress. This model for development of support in breast cancer should be applied to psychologic management of patients with cancers of other sites, particularly those that carry high emotional distress and that place extensive demand on an individual's adaptive capacities.

The prevalence of burnout among oncology professionals: oncologists are at risk of developing burnout

OBJECTIVE

International research shows that oncology staff suffers more from burnout than other healthcare professionals. Burnout is common among oncologists. The prevalence of emotional exhaustion, depersonalization, and low personal accomplishment appears to be significantly higher among physicians. Detecting burnout is highly relevant, because it affects the personal well-being and quality of life of the healthcare professional. A national study on the prevalence of burnout in oncology was never conducted in Flanders (Dutch-speaking part of Belgium).

METHODS

The Cédric Hèle institute spread anonymous questionnaires among 923 healthcare workers in oncology (physicians, social workers, psychologists, nurses, and specialist-nurses) in Flanders. The questionnaire consisted of two parts. The first part contained questions concerning demographic and job features. The second part included the Dutch version of the Maslach Burnout Inventory.

RESULTS

Five hundred and fifty subjects participated in the survey (response rate of 59.5%). Of the medical oncologists, 51.2% suffered from emotional exhaustion, 31.8% from depersonalization, and 6.8% from a lack of personal accomplishment. Multivariate analysis of variance suggested a significantly elevated level of emotional exhaustion and depersonalization in oncologists compared with other professionals. Logistic regression indicated that the following variables have predictive value on risk of burnout: gender, profession, and combining work in a university hospital with work in a private hospital.

CONCLUSION

The CHi research showed a significantly increased level of burnout-components in professionals working in oncology, especially in medical oncologists. These results should have an impact on the daily clinic of oncology, and could be guidance for further research.

Observation of low- and high-energy Gamow-Teller phonon excitations in nuclei

Gamow-Teller (GT) transitions in atomic nuclei are sensitive to both nuclear shell structure and effective residual interactions. The nuclear GT excitations were studied for the mass number A = 42, 46, 50, and 54 "f-shell" nuclei in ((3)He, t) charge-exchange reactions. In the (42)Ca → (42)Sc reaction, most of the GT strength is concentrated in the lowest excited state at 0.6 MeV, suggesting the existence of a low-energy GT phonon excitation. As A increases, a high-energy GT phonon excitation develops in the 6-11 MeV region. In the (54)Fe → (54)Co reaction, the high-energy GT phonon excitation mainly carries the GT strength. The existence of these two GT phonon excitations are attributed to the 2 fermionic degrees of freedom in nuclei.

Positive regulatory elements involved in urea amidolyase and urea uptake induction in Saccharomyces cerevisiae

Urea amidolyase and the high affinity urea uptake system are induced by allophanate. durM (-) and durL (-) recessive mutations, which are easily obtained, totally prevent this induction. They are not linked to each other nor to the concerned structural genes. Despite an intensive hunt, no mutation of repressor or classical operator type has been selected. We conclude that urea amidolyase and urea uptake induction involves at least two positive elements coded for by the durM and durL genes.

Concepts of diabetes self-management in Mexican American and African American low-income patients with diabetes

The goal of the study was to explore low-income minority patients' concepts of diabetes self-management and assess the extent to which patient beliefs correspond to evidence-based recommendations. African American and Mexican American patients with type 2 diabetes were recruited from safety net clinics that serve the uninsured and under-insured in Chicago and San Francisco to participate in focus group discussions. Grounded theory was used to identify themes related to diabetes self-management. Strategies participants mentioned for diabetes self-care were medication use, diet, weight loss and exercise. Eating more fruit and vegetables and consuming smaller portions were the most commonly mentioned dietary behaviors to control diabetes. African Americans expressed skepticism about taking medications. Mexican Americans discussed barriers to acquiring medications and use of herbal remedies. Mexican Americans frequently mentioned intentional exercise of long duration as a management strategy, whereas African Americans more frequently described exercise as regular activities of daily living. Blood glucose self-monitoring and reducing risks of diabetes complications were rarely mentioned as diabetes self-management behaviors. African American and Mexican American patients have different concepts of diabetes self-management, especially with regard to medication use and physical activity. Consideration of these differences may facilitate design of effective self-management interventions for these high-risk populations.

Abstract LB-337: Synergistic effects of twelve common genetic polymorphisms and smoking habits on absolute risk of bladder cancer

Smoking is the strongest established risk factor for bladder cancer and recent studies have identified multiple common susceptibility loci for this disease. Evaluation of gene-smoking interactions on absolute risk of bladder cancer could be important for understanding both the public health and biological significance of the combined effect of these factors. However, previous studies of gene-environment interactions focused on relative rather than absolute risk measures and thus did not address this important question. The aim of our analyses was to estimate absolute risk of bladder cancer in relation to smoking habits and 12 known susceptibility variants for this disease, and to evaluate if smoking risk differences (RD) vary by levels of a polygenic risk score derived from these variants, using additive tests for interaction. Analyses were based on data from 4,098 cases and 5,995 controls of European background in eight studies participating in the NCI bladder cancer genome-wide association study (GWAS). Absolute risks were estimated based on US incidence and mortality data. The main outcome measures were 30-year cumulative absolute risk of bladder cancer and RDs for males aged 50 years in relation to smoking habits and the polygenic risk score. RDs for ever compared to never smokers were significantly larger (P-additive interaction &lt; 0.05) for subjects carrying risk alleles for seven out of 12 known susceptibility variants. Polymorphisms in two detoxification enzymes, NAT2 and UGT1A6, provided the strongest evidence of additive interactions (P-additive interaction of 0.0002 and 0.0003, respectively), supporting the presence of biological interactions between smoking and these variants. The 30-year risk of bladder cancer in never, former and current smokers was 0.7%, 1.6% and 3.7%, respectively, for subjects in the bottom quartile of the polygenic risk score, compared to 2.0%, 5.1% and 8.0% for subjects in the top quartile. This translates into a significantly larger number of projected cases, which could be avoided by smoking prevention in subjects at higher compared to lower genetic risk (P-additive (2df)=4.6x10-9 for top to bottom quartile of the polygenic risk score). In conclusion, our analyses provide strong evidence for synergistic effects of smoking and known susceptibility loci for bladder cancer on the absolute risk of the disease. This indicates that targeting intense smoking prevention efforts to individuals at elevated genetic risk for bladder cancer could improve the public health impact of such efforts. However, genetic susceptibility for other smoking-related diseases, as well as practical and ethical considerations, would need to be taken into account before any recommendations could be made. (MGC, NR are Co-first authors; N.C. and DTS are Co-last authors)

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr LB-337. doi:1538-7445.AM2012-LB-337

Retroperitoneal, mesenteric and multifocal fibrosis: review of their aetiopathogenesis. A possible role of adipocytes as in Crohn's disease?

First observed during an autopsy by Simpson in 1867 as a cause of hydronephrosis, retroperitoneal fibrosis became a medical topic after the detailed report of two cases by Ormond in 1948. Initially considered to be chiefly an urological disease, it appeared progressively that it could possibly be a systemic disease because of its occasional association with inflammatory fibrosing processes in other sites of the body or with clinical and biological manifestations of hypersensitivity or autoimmunity. Mesenteric panniculitis and mesenteric fibrosis may occur independently or, occasionally, in association with retroperitoneal fibrosis. One third of the cases of retroperitoneal fibrosis can be attributed to specific causes. That the other cases (idiopathic retroperitoneal fibrosis) could be manifestations of an immunological (systemic) process with vasculitis is generally accepted. The authors present a survey of the various possible morphological aspects of the disease and a review of its aetiopathogenesis. Idiopathic retroperitoneal fibrosis is usually characterized by an overproduction of fibro-inflammatory tissue; however in few cases as well as in mesenteric panniculitis, extensive development of fatty tissue may also occur. The authors suggest that an initial proliferation of adipocytes, considered to account for the fat hyperplasia adjacent to Crohn's ileitis, could also play a role in the pathogenesis of the inflammatory fibrosing process in some cases of mesenteric and retroperitoneal fibrosis.

Occurrence of macrolide-resistant Mycoplasma pneumoniae strains in Germany

In a total of 167 respiratory tract specimens from adult outpatients with confirmed Mycoplasma pneumoniae pneumonia, sampled between 2003 and 2008, and a further 99 isolates obtained from patients between 1991 and 2009 in Germany, M. pneumoniae was tested for macrolide resistance. Using PCR, real-time PCR and sequencing of the 23S rRNA gene, 1.2% of M. pneumoniae in the respiratory tract samples and 3.0% of the isolates were found to be resistant. The results indicate a limited but not negligible importance of macrolide-resistant M. pneumoniae in the population investigated, which requires the monitoring of macrolide susceptibility of isolates or the testing of respiratory samples by molecular methods.