Impact of autoimmune gastritis on chronic urticaria in paediatric patients - pathophysiological point of views

We would like to provide an updated comprehensive perspective and identify the components linked to chronic spontaneous urticaria (CSU) without specific triggers in autoimmune atrophic gastritis (AAG). AAG is an organ-specific autoimmune disease that affects the corpus-fundus gastric mucosa. Although we lack a unified explanation of the underlying pathways, when considering all paediatric patients reported in the literature, alterations result in gastric neuroendocrine enterochromaffin-like (ECL) cell proliferation and paracrine release of histamine. Several mechanisms have been proposed for the pathogenesis of CSU, with much evidence pointing towards AAG and ECL cell responses, which may be implicated as potential factors contributing to CSU. The excessive production/release of histamine into the bloodstream could cause or trigger exacerbations of CSU in AAG, independent of Helicobacter pylori; thus, the release of histamine from ECL cells may be the primary modulator.

CONCLUSION

Considering the understanding of these interactions, recognising the respective roles of AAG in the pathogenesis of CSU may strongly impact the diagnostic workup and management of unexplained/refractory CSU and may inform future research and interventions in the paediatric population.

WHAT IS KNOWN

• Autoimmune atrophic gastritis is a chronic immune-mediated inflammatory disease characterised by the destruction of the oxyntic mucosa in the gastric body and fundus, mucosal atrophy, and metaplastic changes. • Autoimmune atrophic gastritis in paediatric patients is important because of the poor outcome and risk of malignancy and possibly underestimated entities primarily reported in single-case reports.

WHAT IS NEW

• Upper gastrointestinal inflammatory disorders, independent of H. pylori, have been implicated as potential inducing factors in the development of chronic spontaneous urticaria. • If a paediatric patient presents with symptoms such as anaemia, reduced vitamin B12 levels, recurrent urticaria with no other detectable aetiology, positive anti-parietal cell antibodies, and elevated gastrin levels, autoimmune atrophic gastritis should be considered a possible cause of chronic urticaria.

Phonological deficits in dyslexia impede lexical processing of spoken words: Linking behavioural and MEG data

Phonological difficulties have been identified as a core deficit in developmental dyslexia, yet everyday speech comprehension, which relies on phonological processing, is seemingly unaffected. This raises the question as to how dyslexic readers process spoken words to achieve normal word comprehension. Here we establish a link between neural correlates of lexical and sublexical processing in auditory words and behaviourally measured phonological deficits using magnetoencephalography (MEG). Spatiotemporally resolved cortical responses to phonological and lexico-semantic information were computed with the event-related regression technique (Hauk et al., 2009) and correlated with dyslexic and non-dyslexic subjects' phonological skills. We found that phonological deficits reduced cortical responses to both phonological and lexico-semantic information (phonological neighbours and word frequency). Individuals with lower phonological skills - independent of dyslexia diagnosis - showed weaker neural responses to phonological neighbourhood information in both hemispheres 200-500 ms after word onset and reduced sensitivity to written and spoken word frequency between 200 and 650 ms. Dyslexic readers showed weaker responses to written word frequency in particular compared to the control group, pointing towards an additional effect of print exposure on auditory word processing. Source space analysis localised phonological and lexico-semantic effect peaks to the left superior temporal gyrus, a key area that has been related to core deficits in dyslexia across a range of neuroimaging studies. The results provide comprehensive evidence that phonological deficits impact both sublexical and lexical stages of spoken word processing and that these deficits cannot be fully compensated through neural re-organization of lexical-distributional information at the single word level. Theoretical and practical implications for typical readers, dyslexic readers, and readers with developmental language disorder are discussed.

A generalized approach to x-ray data modeling for high-energy-density plasma experiments

Accurate understanding of x-ray diagnostics is crucial for both interpreting high-energy-density experiments and testing simulations through quantitative comparisons. X-ray diagnostic models are complex. Past treatments of individual x-ray diagnostics on a case-by-case basis have hindered universal diagnostic understanding. Here, we derive a general formula for modeling the absolute response of non-focusing x-ray diagnostics, such as x-ray imagers, one-dimensional space-resolved spectrometers, and x-ray power diagnostics. The present model is useful for both data modeling and data processing. It naturally accounts for the x-ray crystal broadening. The new model verifies that standard approaches for a crystal response can be good approximations, but they can underestimate the total reflectivity and overestimate spectral resolving power by more than a factor of 2 in some cases near reflectivity edge features. We also find that a frequently used, simplified-crystal-response approximation for processing spectral data can introduce an absolute error of more than an order of magnitude and the relative spectral radiance error of a factor of 3. The present model is derived with straightforward geometric arguments. It is more general and is recommended for developing a unified picture and providing consistent treatment over multiple x-ray diagnostics. Such consistency is crucial for reliable multi-objective data analyses.

The Interplay of AphB and CadC to Activate Acid Resistance of Vibrio campbellii

Bacteria have evolved different systems to sense and adapt to acid stress. For example, Vibrio campbellii, a marine pathogen for invertebrates, encounters acidic conditions in the digestive glands of shrimp. The main acid resistance system of V. campbellii is the Cad system, which is activated when cells are in a low-pH, amino acid-rich environment. The Cad system consists of the pH-responsive transcriptional activator CadC, the lysine decarboxylase CadA, and the lysine/cadaverine antiporter CadB. In many Vibrio species, the LysR-type transcriptional regulator AphB is involved in the regulation of the Cad system, but its precise role is unclear. Here, we examined AphB of V. campbellii in vivo and in vitro in the context of Cad activation. At low pH, an aphB deletion mutant was less able to grow and survive compared with the wild-type because it did not excrete sufficient alkaline cadaverine to increase the extracellular pH. AphB was found to upregulate the transcription of cadC, thereby increasing its protein copy number per cell. Moreover, AphB itself was shown to be a pH-sensor, and binding to the cadC promoter increased under low pH, as shown by surface plasmon resonance spectroscopy. By monitoring the activation of the Cad system over a wide range of pH values, we found that AphB-mediated upregulation of cadC not only adjusts CadC copy numbers depending on acid stress strength, but also affects the response of individual cells and thus the degree of heterogeneous Cad system activation in the V. campbellii population. IMPORTANCE Acid resistance is an important property not only for neutralophilic enteric bacteria such as Escherichia, Yersinia, and Salmonella, but also for Vibrio. To counteract acidic threats, the marine Vibrio campbellii, a pathogen for various invertebrates, activates the acid-resistance Cad system. The transcriptional activator of the Cad system is CadC, an extracellular pH-sensor. The expression of cadC is upregulated by the transcriptional regulator AphB to achieve maximum expression of the components of the Cad system. In vitro studies demonstrate that AphB binds more tightly to the DNA under low pH. The interplay of two pH-responsive transcriptional activators allows tight control of the activity of the Cad system.

Decompression Alone in the Setting of Adult Degenerative Lumbar Scoliosis and Stenosis: A Systematic Review and Meta-Analysis

STUDY DESIGN

Systematic review and meta-analysis.OBJECTIVESSurgical decompression alone for patients with neurogenic leg pain in the setting of degenerative lumbar scoliosis (DLS) and stenosis is commonly performed, however, there is no summary of evidence for outcomes.

METHODS

A systematic search of English language medical literature databases was performed for studies describing outcomes of decompression alone in DLS, defined as Cobb angle >10˚, and 2-year minimum follow-up. Three outcomes were examined: 1) Cobb angle progression, 2) reoperation rate, and 3) ODI and overall satisfaction. Data were pooled and weighted averages were calculated to summarize available evidence.

RESULTS

Across 15 studies included in the final analysis, 586 patients were examined. Average preoperative and postoperative Cobb angles were 17.6˚ (Range: 12.7 - 25˚) and 18.0 (range 14.1 - 25˚), respectively. Average change in Cobb angle was an increase of 1.8˚. Overall rate of reoperation ranged from 3 to 33% with an average of 9.7%. Average ODI before surgery, after surgery, and change in scores were 56.4%, 27.2%, and an improvement of 29% respectively. Average from 8 studies that reported patient satisfaction was 71.2%.

CONCLUSIONS

Current literature on decompression alone in the setting of DLS is sparse and is not high quality, limited to patients with small magnitude of lumbar coronal Cobb angle, and heterogenous in the type of procedure performed. Based on available evidence, select patients with DLS who undergo decompression alone had minimal progression of Cobb angle, relatively low reoperation rate, and favorable patient-reported outcomes.

Comparison of laparoscopic and open ileocecal resection for Crohn's disease in children

PURPOSE

Ileocecal resection (ICR) is the most frequently performed surgery in paediatric Crohn's disease (CD) patients. The aim of the study was to compare laparoscopic-assisted and open ICR.

METHODS

Retrospective review of consecutive CD patients undergoing ICR between March 2014 and December 2021 was performed. The patients were divided into open (OG) and laparoscopic (LG) groups. Compared parameters included patients' demographics, clinical characteristics, surgery, duration of hospitalisation and follow-up. Complications were classified according to the Clavien-Dindo classification (CDc). Risk factors were identified using multivariable analysis.

RESULTS

Sixty-two patients (29 females, 46.7%) were included in the analysis, forty-two patients in OG. The median duration of surgery was 130 in OG versus 148 in LG (p = 0.065) minutes. Postoperative complications were reported in 4 patients (12.1%). There was no significant difference in postoperative complications according to CDc (OG 7.14 vs LG 5%, p = 1). The median length of hospitalisation was 8 in OG and 7 days in LG (p = 0.0005). The median length of follow-up was 21.5 months.

CONCLUSION

The laparoscopic-assisted approach had shorter hospital stay and was not associated with increased risk of 30-day postoperative complications. Laparoscopic surgery should be considered the preferred surgical approach for primary ICR.

Effect of Pelvic Sagittal Tilt and Axial Rotation on Functional Acetabular Orientation

Accurate and reproducible acetabular component positioning is among the most important technical factors affecting outcomes of total hip arthroplasty. Although several studies have investigated the influence of pelvic tilt and obliquity on functional acetabular anteversion, the effect of pelvic axial rotation has not yet been established. We analyzed a generic simulated pelvis created using preoperative full-body standing and sitting radiographs. A virtual acetabulum was placed in 144 different scenarios of acetabular anteversion and abduction angles. In each scenario, the effects of pelvic tilt and pelvic axial rotation on different combinations of acetabular orientations were assessed. The change in acetabular anteversion was 0.75° for each 1° of pelvic tilt and was most linear in abduction angles of 40°±45°. The change in acetabular anteversion was 0.8° for each 1° of pelvic axial rotation. Surgeons may consider adjusting acetabular anteversion in fixed axial pelvic deformities when the degree of deformity affects functional acetabular positioning, assessed from preoperative standing and sitting weight-bearing radiographs. [Orthopedics. 2023;46(1):e27-e30.].

Survey of Salmonellae occurrence in meat-producing rabbitries in Switzerland

BACKGROUND

An outbreak of salmonellosis due to Salmonella Typhimurium was detected coincidentally in a Swiss meat rabbitry, given that surveillance of Salmonella in rabbits is not mandatory in Switzerland.

METHODS

To assess the extent of potentially subclinical Salmonella carriage in meat rabbits, faecal pool samples of 50 farms (90% of Swiss commercial rabbitries) with ground covering litter and group housing were bacteriologically tested. Additionally, 236 rabbits showing clinical signs compatible with intestinal diseases, such as salmonellosis, were examined postmortem and analysed bacteriologically. Salmonella isolates were serotyped and analysed by whole genome sequencing (WGS).

RESULTS

Salmonella Typhimurium was detected in three commercial farms (6.0% of all tested farms). The affected farms were directly linked to the animal trade and Salmonella isolates were shown to be identical by WGS.

CONCLUSION

There is no increased hazard for Salmonella carriage in the animal welfare-friendly Swiss husbandry systems in general, despite risk factors such as ground covering litter.

Bacterial battle against acidity

The Earth is home to environments characterized by low pH, including the gastrointestinal tract of vertebrates and large areas of acidic soil. Most bacteria are neutralophiles, but can survive fluctuations in pH. Herein, we review how Escherichia, Salmonella, Helicobacter, Brucella, and other acid-resistant Gram-negative bacteria adapt to acidic environments. We discuss the constitutive and inducible defense mechanisms that promote survival, including proton-consuming or ammonia-producing processes, cellular remodeling affecting membranes and chaperones, and chemotaxis. We provide insights into how Gram-negative bacteria sense environmental acidity using membrane-integrated and cytosolic pH sensors. Finally, we address in more detail the powerful proton-consuming decarboxylase systems by examining the phylogeny of their regulatory components and their collective functionality in a population.

Sentinel monitoring of COVID-related daily activity in primary care practices of the canton of Vaud

Introduction

During the COVID pandemic, COVID-related data collected in family medicine were scarce. We aimed to monitor cantonal trends of COVID-related activity in family medicine and paediatric practices during the year 2021.

Methods

Family physicians and paediatricians established in the canton of Vaud were invited to join an ad hoc sentinel surveillance system. Online data collection was based on daily activity reports and monthly questionnaires. In particular, participants categorized daily counts of consultations and phone calls into predefined COVID-related categories.

Results

Thirty-seven practices contributed regularly to the system between March 20th and December 31st 2021. Out of 81'407 medical consultations, 4'950 (6.1%) were related to new COVID suspicions as defined by the Federal Office of Public Health, and 5'252 (6.4%) otherwise related to COVID. Depending on the week and the practice, between 5.6% and 26.5% of face-to-face consultations were COVID-related. In paediatrics, COVID-related activity corresponded mostly to new COVID suspicions (11.2% of on-site consultations), whereas among family physicians other COVID topics predominated (9.8% of face-to-face consultations), mainly questions about vaccination. Consultations for persisting COVID-related symptoms were stable at a low level throughout the year, and constituted less than 1% of all consultations. Most practices swabbed patients for SARS-CoV-2 tests, and an increasing proportion performed rapid antigenic tests over the year. In paediatrics, COVID-suspicions were not systematically tested.

Conclusions

Throughout 2021, COVID-related consultations constituted an important part of family medicine and paediatric practices’ activity in the canton of Vaud. Monitoring COVID-related activity in primary care during a pandemic documents how physicians translate recommendations into practice and provides health authorities with valuable information to guide public health action.

Key messages

• Throughout 2021, COVID-related consultations constituted an important part of family medicine and paediatric practices’ activity in the canton of Vaud.

• Monitoring COVID-related activity in primary care during a pandemic documents how physicians translate recommendations into daily practice.

Semantic Cues Modulate Children’s and Adults’ Processing of Audio-Visual Face Mask Speech

During the COVID-19 pandemic, questions have been raised about the impact of face masks on communication in classroom settings. However, it is unclear to what extent visual obstruction of the speaker’s mouth or changes to the acoustic signal lead to speech processing difficulties, and whether these effects can be mitigated by semantic predictability, i.e., the availability of contextual information. The present study investigated the acoustic and visual effects of face masks on speech intelligibility and processing speed under varying semantic predictability. Twenty-six children (aged 8-12) and twenty-six adults performed an internet-based cued shadowing task, in which they had to repeat aloud the last word of sentences presented in audio-visual format. The results showed that children and adults made more mistakes and responded more slowly when listening to face mask speech compared to speech produced without a face mask. Adults were only significantly affected by face mask speech when both the acoustic and the visual signal were degraded. While acoustic mask effects were similar for children, removal of visual speech cues through the face mask affected children to a lesser degree. However, high semantic predictability reduced audio-visual mask effects, leading to full compensation of the acoustically degraded mask speech in the adult group. Even though children did not fully compensate for face mask speech with high semantic predictability, overall, they still profited from semantic cues in all conditions. Therefore, in classroom settings, strategies that increase contextual information such as building on students’ prior knowledge, using keywords, and providing visual aids, are likely to help overcome any adverse face mask effects.

Age-Related Progression of Microvascular Dysfunction in Cystic Fibrosis: New Detection Ways and Clinical Outcomes

There are concerns about altered vascular functions that could play an important role in the pathogenesis and influence the severity of chronic disease, however, increased cardiovascular risk in paediatric cystic fibrosis (CF) has not been yet fully understood. Aim was to analyse vascular disease risk and investigate changes over times in CF and controls. We prospectively enrolled 22 CF subjects (a median age of 16.07 years), and 22 healthy demographically matched controls (a median age of 17.28 years) and determined endothelial function. We utilised a combined diagnostic approach by measuring the plethysmographic Reactive Hyperemia Index (RHI) as the post-to preocclusive endothelium-dependent changes of vascular tone, and biomarkers that are known to be related to endothelial dysfunction (ED): asymmetric dimethyl arginine (ADMA), high-sensitive CRP (hsCRP), VCAM-1 and E-selectin. RHI values were significantly lower in CF young adults (p<0.005). HsCRP (p<0.005), E-selectin (p<0.001) and VCAM-1 (p<0.001) were significantly increased in CF patients since childhood. The findings have provided a detailed account of the ongoing process of microvascular dysfunction with gradual progression with the age of CF patients, making them further at risk of advanced vascular disease. Elevations of biomarkers in CF children with not yet demonstrated RHI changes but with significantly reduced RHI in adulthood and lipid profile changes indicate the possible occurrence of ED with CF-related specific risk factors over time and will enable us to provide the best possible support.

Salt-concentration-dependent nucleation rates in low-metastability colloidal charged sphere melts containing small amounts of doublets

We determined bulk crystal nucleation rates in aqueous suspensions of charged spheres at low metastability. Experiments were performed in dependence on electrolyte concentration and for two different particle number densities. The time-dependent nucleation rate shows a pronounced initial peak, while postsolidification crystal size distributions are skewed towards larger crystallite sizes. At each concentration, the nucleation rate density initially drops exponentially with increasing salt concentration. The full data set, however, shows an unexpected scaling of the nucleation rate densities with metastability times the number density of particles. Parameterization of our results in terms of classical nucleation theory reveals unusually low interfacial free energies of the nucleus surfaces and nucleation barriers well below the thermal energy. We tentatively attribute our observations to the presence of doublets introduced by the employed conditioning technique. We discuss the conditions under which such small seeds may induce nucleation.

The assessment of plasma fatty acid profiles in newly diagnosed treatment-naive paediatric Crohn's disease

Fatty acid (FA) profiles as potentially relevant components of Crohn's disease (CD) have been insufficiently analysed. We sought to explore the plasma profiles of n-3 and n-6 polyunsa-turated fatty acids (PUFAs) in newly diagnosed untreated active CD. We included 26 consecutive CD pediatric patients (<19 years) and 14 healthy controls (HCs). Disease characteristics, including inflammatory markers, dietary histories, and the Pediatric Crohn's Disease Activity Index (PCDAI), were obtained. The profiles of plasma FAs in plasma lipid classes were analysed by gas chromatography with FID detection of methyl esters. The erythrocyte sedimentation rate, C-reactive protein level and fecal calprotectin level (all p<0.001) were significantly higher in CD patients than in HCs. Most changes were observed in plasma phospholipids (PLs), such as a higher content of n-3 and changes in n-6 long-chain PUFAs in the CD group. The CD group had a lower ratio of n-6/n-3 PUFAs in PLs (p<0.001) and triacylglycerols (TAGs) (p<0.01). Correlations of the FA content in plasma PLs with disease activity scores of CD were also observed, which were positive for the sum of monounsaturated fatty acids (MUFAs) as well as oleic acid (18:1n-9) (both p<0.05). The metabolism of PUFAs is significantly altered even in treatment-naive newly diagnosed active pediatric CD, and the content of major FAs in PLs correlates with disease activity and inflammatory markers, thus probably contributing to the still unclear early disease pathogenesis.

[Health, performance and use of medication in professional Swiss meat rabbit production]

INTRODUCTION

Husbandry conditions for rabbits in Switzerland are at a high animal welfare level in international comparison. Wire mesh flooring is prohibited and group housing is mandatory up to the age of eight weeks. Despite these animal-friendly husbandry standards, animal losses seem to be a significant problem, although reliable data on professional Swiss meat rabbit production is lacking to date. A herd survey was carried out in 52 rabbit farms to address this situation. At the same time, each new litter and each fattening group was documented with a standardized form focusing on animal death and the use of medication by the farmer over a one year period. In the case of increased mortality or new health problems, dead rabbits were sent to the National Reference Center for Poultry and Rabbit Diseases (Zurich) for pathological examination including bacteriological and parasitological diagnostics. Data from 32 farms were evaluated. The average mortality of young animals (birth to weaning) was 14.9% (1.0-30.0%) and of fattening rabbits (weaning to slaughter) 17.3% (4.3-31.8%). Intestinal diseases, mainly dysentery, intestinal coccidiosis and mucoid enteropathies, were the primary cause of death (68.2%). Eimeria spp., Escherichia coli and Clostridium perfringens were identified as the most frequent pathogens. Respiratory diseases were found in 18.7% of the examined rabbits, with Pasteurella multocida identified as the most common pathogen. 60.0% of the farms used antibiotics during the study period and a third (34.7%) of all the fattening animals were medicated with at least one antibiotic. The present results confirm that despite high animal welfare standards infectious diseases and mortality rates represent a considerable problem in professional Swiss meat rabbit production. Risk factors of increased morbidity and mortality should be identified to improve rabbit health, to reduce the high mortality rate and the extensive use of antibiotics in professional Swiss meat rabbit production. Practicable management improvements with specific prevention strategies should be developed.

Age-Related Progression of Microvascular Dysfunction in Cystic Fibrosis: New Detection Ways and Clinical Outcomes

There are concerns about altered vascular functions that could play an important role in the pathogenesis and influence the severity of chronic disease, however, increased cardiovascular risk in paediatric cystic fibrosis (CF) has not been yet fully understood. Aim was to analyse vascular disease risk and investigate changes over times in CF and controls. We prospectively enrolled 22 CF subjects (a median age of 16.07 years), and 22 healthy demographically matched controls (a median age of 17.28 years) and determined endothelial function. We utilised a combined diagnostic approach by measuring the plethysmographic Reactive Hyperemia Index (RHI) as the post-to preocclusive endothelium-dependent changes of vascular tone, and biomarkers that are known to be related to endothelial dysfunction (ED): asymmetric dimethyl arginine (ADMA), high-sensitive CRP (hsCRP), VCAM-1 and E-selectin. RHI values were significantly lower in CF young adults (p<0.005). HsCRP (p<0.005), E-selectin (p<0.001) and VCAM-1 (p<0.001) were significantly increased in CF patients since childhood. The findings have provided a detailed account of the ongoing process of microvascular dysfunction with gradual progression with the age of CF patients, making them further at risk of advanced vascular disease. Elevations of biomarkers in CF children with not yet demonstrated RHI changes but with significantly reduced RHI in adulthood and lipid profile changes indicate the possible occurrence of ED with CF-related specific risk factors over time and will enable us to provide the best possible support.

Growth resistance and resilience of mixed silver fir and Norway spruce forests in central Europe: Contrasting responses to mild and severe droughts

Extreme droughts are expected to increase in frequency and severity in many regions of the world, threatening multiple ecosystem services provided by forests. Effective strategies to adapt forests to such droughts require comprehensive information on the effects and importance of the factors influencing forest resistance and resilience. We used a unique combination of inventory and dendrochronological data from a long-term (>30 years) silvicultural experiment in mixed silver fir and Norway spruce mountain forests along a temperature and precipitation gradient in southwestern Germany. We aimed at examining the mechanisms and forest stand characteristics underpinning the resistance and resilience to past mild and severe droughts. We found that (i) fir benefited from mild droughts and showed higher resistance (i.e., lower growth loss during drought) and resilience (i.e., faster return to pre-drought growth levels) than spruce to all droughts; (ii) species identity determined mild drought responses while species interactions and management-related factors strongly influenced the responses to severe droughts; (iii) intraspecific and interspecific interactions had contrasting effects on the two species, with spruce being less resistant to severe droughts when exposed to interaction with fir and beech; (iv) higher values of residual stand basal area following thinning were associated with lower resistance and resilience to severe droughts; and (v) larger trees were resilient to mild drought events but highly vulnerable to severe droughts. Our study provides an analytical approach for examining the effects of different factors on individual tree- and stand-level drought response. The forests investigated here were to a certain extent resilient to mild droughts, and even benefited from such conditions, but were strongly affected by severe droughts. Lastly, negative effects of severe droughts can be reduced through modifying species composition, tree size distribution and stand density in mixed silver fir-Norway spruce forests.

Effects of Daytime Dry Fasting on Hydration, Glucose Metabolism and Circadian Phase: A Prospective Exploratory Cohort Study in Bahá'í Volunteers

Background: Religiously motivated Bahá'í fasting (BF) is a form of intermittent dry fasting celebrated by abstaining from food and drinks during daylight hours every year in March for 19 consecutive days.

Aim: To test the safety and effects of BF on hydration, metabolism, and the circadian clock.

Methods: Thirty-four healthy Bahá'í volunteers (15 women) participated in this prospective, exploratory cohort study. Laboratory examinations were carried out in four study visits: before fasting (V0), in the third week of fasting (V1) as well as 3 weeks (V3) and 3 months (V4) after fasting. Data collection included blood and urine samples, anthropometric measurements and bioelectrical impedance analysis. At V0 and V1, 24- and 12-hour urine and serum osmolality were measured. At V0–V2, alterations in the circadian clock phase were monitored in 16 participants. Our study was augmented by an additional survey with 144 healthy Bahá'í volunteers filling out questionnaires and with subgroups attending metabolic measurements (n = 11) and qualitative interviews (n = 13), the results of which will be published separately.

Results: Exploratory data analysis revealed that serum osmolality (n = 34, p < 0.001) and 24-hour urine osmolality (n = 34, p = 0.003) decreased during daytime fasting but remained largely within the physiological range and returned to pre-fasting levels during night hours. BMI (body mass index), total body fat mass, and resting metabolic rate decreased during fasting (n = 34, p < 0.001), while body cell mass and body water appeared unchanged. The circadian phase estimated by transcript biomarkers of blood monocytes advanced by 1.1 h (n = 16, p < 0.005) during fasting and returned to pre-fasting values 3 weeks after fasting. Most observed changes were not detectable anymore 3 months after fasting.

Conclusions: Results indicate that BF (Bahá'í fasting) is safe, has no negative effects on hydration, can improve fat metabolism and can cause transient phase shifts of circadian rhythms.

Trial Registration:https://www.clinicaltrials.gov/, identifier: NCT03443739.

[Expectations of patients and relatives for modern hospital care in geriatric psychiatry]

OBJECTIVE

In order to improve health care in geriatric psychiatry, users must be granted a larger role in shaping their treatment. To this aim we identify factors that are essential to psychiatric care from users' perspectives.

METHODS

Focus groups and interviews (n = 12) were conducted to identify the health care factors that were most essential to its users. In addition, patients (n = 72) and relatives (n = 62) evaluated the current health care in a questionnaire.

RESULTS

The most essential factors were longer consultations with doctors and treatment providers, comprehensive and comprehensible information, individualized procedures and therapies, having clearly defined scopes for each professional group, environmental factors and the integration of relatives into the therapy process.

CONCLUSION

The reported factors could help improve health services in geriatric psychiatry by pointing towards potential changes and room for optimization in health care on both structural and process levels.

Potential for community based surveillance of febrile diseases: Feasibility of self-administered rapid diagnostic tests in Iquitos, Peru and Phnom Penh, Cambodia

Rapid diagnostic tests (RDTs) have the potential to identify infectious diseases quickly, minimize disease transmission, and could complement and improve surveillance and control of infectious and vector-borne diseases during outbreaks. The U.S. Defense Threat Reduction Agency's Joint Science and Technology Office (DTRA-JSTO) program set out to develop novel point-of-need RDTs for infectious diseases and deploy them for home use with no training. The aim of this formative study was to address two questions: 1) could community members in Iquitos, Peru and Phnom Penh, Cambodia competently use RDTs of different levels of complexity at home with visually based instructions provided, and 2) if an RDT were provided at no cost, would it be used at home if family members displayed febrile symptoms? Test kits with written and video (Peru only) instructions were provided to community members (Peru [n = 202]; Cambodia [n = 50]) or community health workers (Cambodia [n = 45]), and trained observers evaluated the competency level for each of the several steps required to successfully operate one of two multiplex RDTs on themselves or other consenting participant (i.e., family member). In Iquitos, >80% of residents were able to perform 11/12 steps and 7/15 steps for the two- and five-pathogen test, respectively. Competency in Phnom Penh never reached 80% for any of the 12 or 15 steps for either test; the percentage of participants able to perform a step ranged from 26-76% and 23-72%, for the two- and five-pathogen tests, respectively. Commercially available NS1 dengue rapid tests were distributed, at no cost, to households with confirmed exposure to dengue or Zika virus; of 14 febrile cases reported, six used the provided RDT. Our findings support the need for further implementation research on the appropriate level of instructions or training needed for diverse devices in different settings, as well as how to best integrate RDTs into existing local public health and disease surveillance programs at a large scale.

Inter-evaluator and Intra-evaluator Reliability of a Software Program Used to Extract Kinematic Variables Obtained by an Extremity-Mounted Inertial Measurement Unit System in Sound Horses at the Trot Under Soft and Hard Ground Conditions and Treadmill Exercise

Objective: To assess the inter-evaluator and intra-evaluator reliability of a software program used to extract kinematic variables by a commercially available extremity-mounted inertial measurement unit system in sound horses at the trot under soft and hard ground conditions and treadmill exercise. Animals: Thirty adult, sound and healthy French Montagne stallions. Procedures: Data collection was performed with six IMUs strapped to the distal, metacarpal, metatarsal and tibial regions of every horse. Per surface (treadmill, soft and hard ground) 10 stallions were trotted three times. Prior to the analysis done by six evaluators (three experienced, three inexperienced) the data was blinded and copied three times. For every analysis a minimum of five strides had to be selected. To assess the intra- and inter-evaluator reliability a selection of gait variables was used to calculate intra and inter correlation coefficients (ICCs) as well as variance partitioning coefficients (VPCs). Results: All of the tested gait variables showed high levels of reliability. There was no mentionable difference considering the correlation coefficients between the intra and inter reliability as well as between the three different surfaces. VPCs showed that the factor horse is by far the most responsible for any appearing variance. The experience of the evaluator had no influence on the results. Conclusions and Clinical Relevance: The software program tested in this study has a high inter- and intra-evaluator reliability under the chosen conditions for the selected variables and acts independent of the ground situation and the experience of the evaluator. On the condition of a correct application it has the potential to become a clinically relevant and reliable gait analysis tool.

Groundwater extraction reduces tree vitality, growth and xylem hydraulic capacity in Quercus robur during and after drought events

Climate change is expected to pose major direct and indirect threats to groundwater-dependent forest ecosystems. Forests that concurrently experience increased rates of water extraction may face unprecedented exposure to droughts. Here, we examined differences in stem growth and xylem hydraulic architecture of 216 oak trees from sites with contrasting groundwater availability, including sites where groundwater extraction has led to reduced water availability for trees over several decades. We expected reduced growth and xylem hydraulic capacity for trees at groundwater extraction sites both under normal and unfavourable growing conditions. Compared to sites without extraction, trees at sites with groundwater extraction showed reduced growth and hydraulic conductivity both during periods of moderate and extremely low soil water availability. Trees of low vigour, which were more frequent at sites with groundwater extraction, were not able to recover growth and hydraulic capacity following drought, pointing to prolonged drought effects. Long-term water deficit resulting in reduced CO2 assimilation and hydraulic capacity after drought are very likely responsible for observed reductions in tree vitality at extraction sites. Our results demonstrate that groundwater access maintains tree function and resilience to drought and is therefore important for tree health in the context of climate change.

The Evolution of Anterior Total Hip Arthroplasty The Past, Present, and Future

The anterior approach has become a widely used and accepted approach for total hip arthroplasty (THA). This approach offers a number of advantages including supine positioning, improved soft tissue management, and avoidance of taking down posterior structures. The approach has evolved significantly from its introduction in the late 19th Century due to advancements in technology. Specifically, developments in the table used for the approach, safer instrumentation, and fluoroscopic guidance with overlay technologies have helped the anterior approach gain popularity. This article reviews the evolution of the usage of the anterior approach, including the use of current and emerging technologies as well as the learning curve associated with switching to the anterior THA and the future of outpatient anterior THA.

Disentangling the Photodissociation Dynamics of the HF+ Molecular Radical via Kinetic-Energy-Release-Resolved F 1s Core Excitation and Ionization

The F 1s core level photoionization of the ionic molecular radical HF⁺ has been studied using the photon-ion merged-beams technique at a synchrotron radiation source. Upon analyzing kinetic energy release (KER) dependent photoion yield spectra, complex ultrafast dissociation dynamics of the F 1s core hole excited σ* state can be revealed. By means of configuration-interaction electronic structure calculations of the excited molecular potential energy curves, this complex process can be attributed to a spin-dependent dissociation of the excited σ* biradical state.

Mixed reality for teaching catheter placement to medical students: a randomized single-blinded, prospective trial

BACKGROUND

Cost-effective methods to facilitate practical medical education are in high demand and the "mixed-reality" (MR) technology seems suitable to provide students with instructions when learning a new practical task. To evaluate a step-by-step mixed reality (MR) guidance system for instructing a practical medical procedure, we conducted a randomized, single-blinded prospective trial on medical students learning bladder catheter placement.

METHODS

We enrolled 164 medical students. Students were randomized into 2 groups and received instructions on how to perform bladder catheter placement on a male catheterization training model. One group (107 students) were given their instructions by an instructor, while the other group (57 students) were instructed via an MR guidance system using a Microsoft HoloLens. Both groups did hands on training. A standardized questionnaire covering previous knowledge, interest in modern technologies and a self-evaluation was filled out. In addition, students were asked to evaluate the system's usability. We assessed both groups's learning outcome via a standardized OSCE (objective structured clinical examination).

RESULTS

Our evaluation of the learning outcome revealed an average point value of 19.96 ± 2,42 for the control group and 21.49 ± 2.27 for the MR group - the MR group's result was significantly better (p = 0.00). The self-evaluations revealed no difference between groups, however, the control group gave higher ratings when evaluating the quality of instructions. The MR system's assessment showed less usability, with a cumulative SUS (system usability scale) score of 56.6 (lower half) as well as a cumulative score of 24.2 ± 7.3 (n = 52) out of 100 in the NASA task load index.

CONCLUSIONS

MR is a promising tool for instructing practical skills, and has the potential to enable superior learning outcomes. Advances in MR technology are necessary to improve the usability of current systems.

TRIAL REGISTRATION

German Clinical Trial Register ID: DRKS00013186.

Triptycene End-Capped Benzothienobenzothiophene and Naphthothienobenzothiophene

Previously it was demonstrated that triptycene end-capping can be used as a crystal engineering strategy to direct the packing of quinoxalinophenanthrophenazines (QPPs) towards cofacially stacked π dimers with large molecular overlap resulting in high charge transfer integrals. Remarkably, this packing motif was formed under different crystallization conditions and with a variety of derivatives bearing additional functional groups or aromatic substituents. Benzothienobenzothiophene (BTBT) and its derivatives are known as some of the best performing compounds for organic field-effect transistors. Here, the triptycene end-capping concept is introduced to this class of compounds and polymorphic crystal structures are investigated to evaluate the potential of triptycene end-caps as synthons for crystal engineering.

0460 Insomnia In 400 Women: Polysomnography, Immune Parameters, Depression and Anxiety

Introduction

Insomnia disorder has a very weak link to polysomnography (PSG) and so does sleep problems in the general population. The reason for this is not clear. One possibility is that the perception of disturbed sleep may be related to immune activation or anxiety/depression, without impairment of objective sleep.

Methods

400 women participated, constituting a representative sample of the city of Uppsala with oversampling of snorers. Insomniacs (N=41) were compared with normal sleepers in terms of polysomnography (PSG), immune parameters, anxiety and depression

Results

The results (after adjustment for age and BMI) show that C-reactive protein (CRP) reached a higher level (4.4±.5) in insomniacs (vs 2.3±.2 for normal sleepers) (p=.003) and lower subjective health (p=.000), while anxiety (p=.000) and depression (p=.000) (Hospital Anxiety and Depression Scale (HAD)) showed higher levels. PSG sleep continuity variables lacked association with insomnia, as did all sleep stage variables except for REM%, with a lower level in the insomnia group (p=.021). Interleukin 6 and Tumor Necrosis Factor alpha were not related to insomnia. CRP levels did not correlate significantly with anxiety or depression, but with subjective health (r=-.21, p=.000). A logistic regression analysis (excluding the variable subjective health) with insomnia as outcome (0/1) yielded as predictors CRP (OR=1.14, Ci= 1.05; 1.24, p=.000), depression (OR=1.21, Ci=1.06;1.38, p=.000) and anxiety (OR=1.15, Ci=1.02;1.30, p=.021).

Conclusion

It was concluded that increased CRP levels may be part of the subjective experience of insomnia.

Support

No external funding

Technology for Intraoperative Margin Assessment in Breast Cancer

BACKGROUND

As breast-conserving surgery (BCS) has become standard for treatment of breast cancer, the need for new technology to improve intraoperative margin assessment (IMA) has become clear. Close or positive margins during BCS lead to additional surgeries, treatment delay, additional stress for patients, and healthcare cost. Academia and industry have developed a diverse field of new technologies to allow surgeons to assess margins in the operating room. These technologies aim to reduce current rates of positive margins on final pathology.

METHODS

We selected recently developed IMA technologies, some of which have undergone large clinical trials and others that are still in early stage development. Technologies were categorized based on underlying methodology to differentiate malignant and normal tissue: spectroscopy, electrical properties, optical imaging and molecular imaging. Additionally, this review details clinical investigations, relevant statistical analysis as well as strengths and weaknesses of the various technologies.

CONCLUSION

Numerous technical innovations are being implemented to diminish rates of positive margins at breast tumor resection. Close collaboration among cross-disciplinary teams to further develop many of these technologies as well as completion of larger scale clinical studies are required to define an optimal approach. Development with an eye toward prioritizing sensitivity/specificity as well as healthcare cost containment has the potential to make a significant impact on this ongoing clinical need in breast cancer surgery.

Synthesis of Fulvene Vinyl Ethers by Gold Catalysis

Gold-catalyzed cyclization of 1,5-diynes with ketones as reagents and solvent provides diversely substituted vinyl ethers under mild conditions. The regioselectivity of such gold-catalyzed cyclizations is usually controlled by the scaffold of the diyne. Herein, we report the first solvent-controlled switching of regioselectivity from a 6-endo-dig- to 5-endo-dig-cyclization in these transformations, providing fulvene derivatives. With respect to the functional-group tolerance, aryl fluorides, chlorides, bromides, and ethers are tolerated. Furthermore, the mechanism and selectivity are put to scrutiny by experimental studies and a thermodynamic analysis of the product. Additionally, 6-(vinyloxy)fulvenes are a hitherto unknown class of compounds. Their reactivity is briefly evaluated, to give insights into their potential applications.

An Extensive Set of Accurate Fluoride Ion Affinities for p-Block Element Lewis Acids and Basic Design Principles for Strong Fluoride Ion Acceptors

The computed fluoride ion affinity (FIA) is a valuable descriptor to assess the Lewis acidity of a compound. Despite its widespread use, the varying accuracy of applied computational models hampers the broad comparability of literature data. Herein, we evaluate the performance of selected methods (like DLPNO‐CCSD(T)) in FIA computations against CCSD(T)/CBS data and guide for the choice of suitable density functionals that allow the treatment of larger Lewis acids. Based on the benchmarked methods, we computed an extensive set of gas‐phase and solvation corrected FIA, that is covering group 13–16 elements featuring moderate to strong electron‐withdrawing substituents (190 entries). It permits an unbiased comparison of FIA over a significant fraction of the periodic table, serves as a source of reference for future synthetic or theoretical studies, and allows to derive some simple design principles for strong fluoride ion acceptors. Finally, the manuscript includes a tutorial section for the computation of FIA with and without the consideration of solvation.

PCR Based Prevalence Study of Francisella Tularensis in Kharkiv, Dnipropetrovsk, and Mykolaiv Oblasts during 2015-2018

INTRODUCTION

Tularaemia is a zoonotic disease caused by the gram-negative bacterium Francisella tularensis, which is endemic to Ukraine. The aim of this work was to provide screening of different field samples (rodent tails, ticks, pellets, water, and hay) to obtain an actual picture of the tularaemia epizootic situation in the Kharkiv, Dnipropetrovsk, and Mykolaiv oblasts.

MATERIAL AND METHODS

Samples were collected using the flag method (for ticks) and break-back traps (for rodents). Also, hay, water and owl pellets were collected for study. The F. tularensis genetic material in samples was detected using a 16S qPCR.

RESULTS

It was found that in Kharkiv oblast, 23% of collected samples were positive for F. tularensis, in Dnipropetrovsk oblast 1.9%, and in Mykolaiv oblast 0.4%.

CONCLUSION

Among the sample types, 34.7% of ticks, 1.8% of rodents, and 36.4% of pellets were positive for F. tularensis. The most frequent carriers of F. tularensis were the D. reticulatus and I. ricinus ticks (74.2% and 29.3%, respectively, of positive results).

Improved Upper Limit on the Neutrino Mass from a Direct Kinematic Method by KATRIN

We report on the neutrino mass measurement result from the first four-week science run of the Karlsruhe Tritium Neutrino experiment KATRIN in spring 2019. Beta-decay electrons from a high-purity gaseous molecular tritium source are energy analyzed by a high-resolution MAC-E filter. A fit of the integrated electron spectrum over a narrow interval around the kinematic end point at 18.57 keV gives an effective neutrino mass square value of (-1.0_{-1.1}^{+0.9})  eV^{2}. From this, we derive an upper limit of 1.1 eV (90% confidence level) on the absolute mass scale of neutrinos. This value coincides with the KATRIN sensitivity. It improves upon previous mass limits from kinematic measurements by almost a factor of 2 and provides model-independent input to cosmological studies of structure formation.

Potential Use of Community-Based Rapid Diagnostic Tests for Febrile Illnesses: Formative Research in Peru and Cambodia

In 2012, the U.S. Defense Threat Reduction Agency Joint Science and Technology Office initiated a program to develop novel point-of-need diagnostic devices for surveillance of emerging infectious diseases including dengue, malaria, plague, and melioidosis. Prior to distribution of devices to observe their correct use among community members in Iquitos, Peru, and Phnom Penh, Cambodia, research was conducted to: 1) assess acceptability of use, including the motivation to use a rapid diagnostic test (RDT) before or instead of seeking care at a health facility, 2) explore comprehension of RDT use instructions, and 3) examine possible strategies for large scale RDT distribution and use at each site. In February 2014, 9 focus group discussions (FGD) with community members and 5 FGD with health professionals were conducted in Iquitos, and 9 FGD with community members and 9 in-depth interviews with health professionals in Phnom Penh. In both places, participants agreed to use the device themselves (involving finger prick) or could identify someone who could do so in their home or neighborhood. The main incentive to RDT use in both sites was the ability for device results to be used for care facilitation (post confirmatory tests), specifically reduced wait times to be seen or obtain a diagnosis. Comprehension of RDT use instructions was assessed in Iquitos by asking some participants to apply the device to research team members; after watching a short video, most steps were done correctly. In Phnom Penh, participants were asked to describe each step after reading the instructions; they struggled with comprehension. Health professionals’ main concerns in both sites were their community’s ability to accurately use the test, handle complicated instructions, and safety (i.e., disposal of lancets). Health system structure and ability to use home diagnostic devices varied in the two disease endemic sites, with substantial challenges in each, suggesting the need for different strategies for RDT large scale community use, and illustrating the value of formative research before deployment of novel technologies.

Development and use of devices to diagnose infectious diseases outside of health facilities (i.e., at home or in remote areas) continues to increase, providing new options for the follow up and treatment options of individuals, depending on the diseases. In this qualitative study, researchers in Iquitos, Peru, and Phnom Penh, Cambodia explored what local people thought about the possible availability of such a device to diagnose dengue and malaria in their own houses, and what would motivate them to use such a device instead of going directly to a health facility for the diagnosis. Participants reported being willing to use device on themselves and were motivated by the possibility that, by using this diagnostic device and taking the result to their health facility, they might be able to obtain quicker and more optimized attention at the health facility; for example, by obtaining a positive result to dengue or malaria on the rapid diagnostic device, they are aware they might still need confirmatory tests, but they would be able to reduce the wait time for obtaining a definitive diagnosis and starting treatment by a full day. Questions regarding accuracy of tests, complicated instructions and safety of using these devices in the community were brought up by participants—individuals living in the communities and local health professionals. Also, in this study, it was clear that if these devices were to be made available in Peru and Cambodia, different strategies for disseminating and using these in the communities would be needed to accommodate for different health infrastructure in both sites.

[Specific components for integrative and flexible care models according to § 64b SGB V]

BACKGROUND

There is a need for a theoretical model for evaluating integrative and flexible care models according to § 64b of the Social Security Statutes Book V (SGB V).

MATERIAL AND METHODS

An iterative process of data collection and analysis has been executed according to grounded theory methodology.

RESULTS

A total of 11 specific components have been identified and shown to be robust and practicable and compatible with the data from the literature.

CONCLUSION

These components can be used for implementation, quality management and evaluation of projects for treatment models according to § 64b SGB V.

Abstract P3-08-17: Evaluation of Oncotype DX testing and subsequent treatment choices in the Latin American setting

Background: The gene expression profiling assay OncotypeDx (ODx) prognosticates the risk of estrogen receptor positive (ER+) breast cancer (BC) recurrence and assesses the likely benefit from adjuvant chemotherapy in addition to endocrine therapy. Numerous clinical utility studies have shown that acknowledging the RS impacts on clinical decision making, leading to a decrease in chemotherapy (CT) use. However, the cost of the assay limits it widespread use, especially in low and middle-income countries. Our objective was to determine the patterns of use of ODx, its results and the subsequent treatment choices in a large Latin American cohort.

Methods: We retrospectively reviewed the electronic medical records of patients with early-stage ER+ BC for whom ODx recurrence score (RS) was available. Patients were diagnosed and treated at 3 specialized Peruvian cancer centers between 2007 and 2017. Descriptive results for numeric variables were presented as means with standard deviation (SD) or medians with interquartile range (IQR), depending on their distributions; otherwise, we expressed the qualitative variables as numbers with percentages. We evaluated the association between ODx RS category and treatment using the Chi-squared test.

Results: A total of 551 patients were included. Patients had a mean age of 56.2 ± 11.9 (SD) (range: 26-89). 9.6% (n=53) of patients were ≤40 years old. The size of the tumors ranged from 0.1 cm to 7.2 cm (median = 1.5 cm; IQR 1.0-2.2cm). 36 (6.5%) patients had tumors ≤ 0.5cm and 7 (1%) had tumors &gt; 5cm. A minority of patients had lymph node involvement (5.8%, n=32). ODx was ordered in 55 cases (10%) of lobular carcinoma and in 23 cases (4%) of favorable histology tumors (19 mucinous, 4 tubular). Most tumors exhibited an intermediate histological grade (71.6%, n=386). Ki67 was available in 58.8% patients (n= 324), with a median Ki67 of 20 (IQR 10-30). Using commercial cutoffs RS was distributed as follows: low (0–17) = 316 (57.4%), intermediate (18–30) = 177 (32.1%), and high (≥31) = 58 (10.5%). In general, 57.5% (n=317) of patients received endocrine therapy (ET) as their only systemic treatment and 42.5% (n=234), also received CT (ET + CT). In the low-risk category, 87.3% (n=276) of patients received ET and 12.7% (n=40), ET + CT. Within the intermediate-risk category, most patients received ET + CT (77.4%, n=137). Only one patient in the high-risk category did not receive CT. There was a significant association between the RS group and treatment choice (p&lt;0.001).

Impact of ODx RS results on treatment recommendations Oncotype risk categories  LowIntermediateHighp valueTreatmentn%n%n%&lt;0.001Endocrine therapy27687.34022.611.7 Chemotherapy + Endocrine therapy4012.713777.45798.3 

Conclusion: ODx significantly influenced treatment decisions in our cohort, however an overutilization of CT was found in low-risk patients. Further data analysis is needed to explain the higher than expected use of CT. Also, there is room for improvement in the selection of cases that undergo ODx testing.

Citation Format: Ruiz R, Morante Z, Namuche F, Urrunaga D, Aguilar A, Schwarz J, Leon M, Ziegler G, Chavez Mac Gregor M, Gomez H. Evaluation of Oncotype DX testing and subsequent treatment choices in the Latin American setting [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-08-17.

Feasibility of feeding Aedes aegypti mosquitoes on dengue virus-infected human volunteers for vector competence studies in Iquitos, Peru

BACKGROUND

Transmission of dengue virus (DENV) from humans to mosquitoes represents a critical component of dengue epidemiology. Examinations of this process have generally been hampered by a lack of methods that adequately represent natural acquisition of DENV by mosquitoes from humans. In this study, we assessed artificial and natural blood feeding methods based on rates of DENV infection and dissemination within mosquitoes for use in a field-based epidemiological cohort study in Iquitos, Peru.

METHODOLOGY/PRINCIPAL FINDINGS

Our study was implemented, stepwise, between 2011 and 2015. Participants who were 5 years and older with 5 or fewer days of fever were enrolled from ongoing clinic- and neighborhood-based studies on dengue in Iquitos. Wild type, laboratory-reared Aedes aegypti were fed directly on febrile individuals or on blood collected from participants that was either untreated or treated with EDTA. Mosquitoes were tested after approximately 14 days of extrinsic incubation for DENV infection and dissemination. A total of 58 participants, with viremias ranging from 1.3 × 10(2) to 2.9 × 10(6) focus-forming units per mL of serum, participated in one or more feeding methods. DENV infection and dissemination rates were not significantly different following direct and indirect-EDTA feeding; however, they were significantly lower for mosquitoes that fed indirectly on blood with no additive. Relative to direct feeding, infection rates showed greater variation following indirect-EDTA than indirect-no additive feeding. Dissemination rates were similar across all feeding methods. No differences were detected in DENV infection or dissemination rates in mosquitoes fed directly on participants with different dengue illness severity.

CONCLUSIONS/SIGNIFICANCE

Our study demonstrates the feasibility of using direct and indirect feeding methods for field-based studies on vector competence. Direct mosquito feeding is preferable in terms of logistical ease, biosecurity, and reliability.

Acceptability of Aedes aegypti blood feeding on dengue virus-infected human volunteers for vector competence studies in Iquitos, Peru

As part of a study to investigate drivers of dengue virus (DENV) transmission dynamics, this qualitative study explored whether DENV-infected residents of Iquitos, Peru, considered it acceptable (1) to participate in direct mosquito feeding experiments (lab-reared Aedes aegypti mosquitoes fed directly on human volunteers) and (2) to provide blood meals indirectly (Ae. aegypti fed on blood drawn from participants by venipuncture). Twelve focus group discussions (FGDs; 94 participants: 82 females and 12 males) were conducted in January 2014 to explore six themes: (1) concerns and preferences regarding direct mosquito feeds and blood draws, (2) comprehension of and misconceptions about study procedures, (3) motivating factors for participation, (4) acceptability of children's participation, (5) willingness to provide multiple samples over several days, and (6) preference for direct feedings in homes versus the study laboratory. Results of FGDs, including one with 5 of 53 past direct mosquito feed participants, indicated that mosquito feeding procedures are acceptable to Iquitos residents when they are provided with information and a few key messages are properly reinforced. FGD participants' concerns focused primarily on safety issues rather than discomfort associated with mosquito bites. A video explaining the study dramatically increased comprehension of the study procedures. The majority of participants expressed a preference for mosquito feeding over venipuncture. Adults supported child participation if the children themselves assented. For most participants, home feedings were preferred over those in a laboratory. A major impetus for participation was the idea that results would contribute to an improved understanding of DENV transmission in Iquitos. Findings from our study will support future large-scale studies that employ direct mosquito feeding, a low-risk, non-invasive procedure that is experimentally superior to artificial mosquito feeding methods.

DNA-binding directs the localization of a membrane-integrated receptor of the ToxR family

All living cells have a large number of proteins that are anchored with one transmembrane helix in the cytoplasmic membrane. Almost nothing is known about their spatiotemporal organization in whole cells. Here we report on the localization and dynamics of one representative, the pH sensor and transcriptional regulator CadC in Escherichia coli. Fluorophore-tagged CadC was detectable as distinct cluster only when the receptor was activated by external stress, which results in DNA-binding. Clusters immediately disappeared under non-stress conditions. CadC variants that mimic the active state of CadC independent of environmental stimuli corroborated the correlation between CadC clustering and binding to the DNA, as did altering the number or location of the DNA-binding site(s) in whole cells. These studies reveal a novel diffusion-and-capture mechanism to organize a membrane-integrated receptor dependent on the DNA in a rod-shaped bacterium.

Phase modulation failsafe system for multi-kJ lasers based on optical heterodyne detection

Amplification of the transverse scattered component of stimulated Brillouin scattering (SBS) can contribute to optical damage in the large aperture optics of multi-kJ lasers. Because increased laser bandwidth from optical phase modulation (PM) can suppress SBS, high energy laser amplifiers are injected with PM light. Phase modulation distributes the single-frequency spectrum of a master oscillator laser among individual PM sidebands, so a sufficiently high modulation index β can maintain the fluence for all spectral components below the SBS threshold. To avoid injection of single frequency light in the event of a PM failure, a high-speed PM failsafe system (PMFS) must be employed. Because PM is easily converted to AM, essentially all PM failsafes detect AM, with the one described here employing a novel configuration where optical heterodyne detection converts PM to AM, followed by passive AM power detection. Although the PMFS is currently configured for continuous monitoring, it can also detect PM for pulse durations ≥2 ns and could be modified to accommodate shorter pulses. This PMFS was deployed on the Z-Beamlet Laser (ZBL) at Sandia National Laboratories, as required by an energy upgrade to support programs at Sandia's Z Facility such as magnetized liner inertial fusion. Depending on the origin of a PM failure, the PMFS responds in as little as 7 ns. In the event of an instantaneous failure during initiation of a laser shot, this response time translates to a 30-50 ns margin of safety by blocking a pulse from leaving ZBL's regenerative amplifier, which prevents injection of single frequency light into the main amplification chain. The performance of the PMFS, without the need for operator interaction, conforms to the principles of engineered safety.

Polycapillary x-ray lenses for single-shot, laser-driven powder diffraction

X-ray diffraction measurements to characterize phase transitions of dynamically compressed high-Z matter at Mbar pressures require both sufficient photon energy and fluence to create data with high fidelity in a single shot. Large-scale laser systems can be used to generate x-ray sources above 10 keV utilizing line radiation of mid-Z elements. However, the laser-to-x-ray energy conversion efficiency at these energies is low, and thermal x-rays or hot electrons result in unwanted background. We employ polycapillary x-ray lenses in powder x-ray diffraction measurements using solid target x-ray emission from either the Z-Beamlet long-pulse or the Z-Petawatt (ZPW) short-pulse laser systems at Sandia National Laboratories. Polycapillary lenses allow for a 100-fold fluence increase compared to a conventional pinhole aperture while simultaneously reducing the background significantly. This enables diffraction measurements up to 16 keV at the few-photon signal level as well as diffraction experiments with ZPW at full intensity.