Fungal abscess of the parotid gland - the value of microbiological assessment

SUMMARY

Fungal parotitis is rare and the sequela parotid abscess exceedingly so. We report our experience with Candida glabrata and Candida albicans parotid gland abscesses in critically ill HIV-positive patients and highlight the value of microbiological assessment to tailor management.

Exploring views of members of the public and policymakers on the acceptability of population level dietary and active-travel policies: a qualitative study

BACKGROUND

There is limited evidence on what shapes the acceptability of population level dietary and active-travel policies in England. This information would be useful in the decision-making process about which policies should be implemented and how to increase their effectiveness and sustainability. To fill this gap, we explored public and policymakers' views about factors that influence public acceptability of dietary and active-travel policies and how to increase public acceptability for these policies.

METHODS

We conducted online, semi-structured interviews with 20 members of the public and 20 policymakers in England. A purposive sampling frame was used to recruit members of the public via a recruitment agency, based on age, sex, socioeconomic status and ethnicity. Policymakers were recruited from existing contacts within our research collaborations and via snowball sampling. We explored different dietary and active-travel policies that varied in their scope and focus. Interviews were transcribed verbatim and analysed using thematic reflexive analysis with both inductive and deductive coding.

RESULTS

We identified four themes that informed public acceptability of dietary and active-travel policies: (1) perceived policy effectiveness, i.e., policies that included believable mechanisms of action, addressed valued co-benefits and barriers to engage in the behaviour; (2) perceived policy fairness, i.e., policies that provided everyone with an opportunity to benefit (mentioned only by the public), equally considered the needs of various population subgroups and rewarded 'healthy' behaviours rather than only penalising 'unhealthy' behaviours; (3) communication of policies, i.e., policies that were visible and had consistent and positive messages from the media (mentioned only by policymakers) and (4) how to improve policy support, with the main suggestion being an integrated strategy addressing multiple aspects of these behaviours, inclusive policies that consider everyone's needs and use of appropriate channels and messages in policy communication.

CONCLUSIONS

Our findings highlight that members' of the public and policymakers' support for dietary and active-travel policies can be shaped by the perceived effectiveness, fairness and communication of policies and provide suggestions on how to improve policy support. This information can inform the design of acceptable policies but can also be used to help communicate existing and future policies to maximise their adoption and sustainability.

16 SARS-COV-2 INFECTION AND VACCINATION PATTERNS DETERMINE LONG-TERM ANTIBODY RESPONSES IN NURSING HOME RESIDENTS: DATA FROM NH-COVAIR

Background

Older Nursing Home Residents (NHRs) are at greatest risk of morbidity and mortality from SARS-CoV-2, particularly in the context of both waning vaccine efficacy and the emergence of Variants-of-Concern (VOCs). However, the determinants of long-term vaccine-induced protective antibody responses are yet to be determined in this group.

Methods

NH-COVAIR recruited older NHRs for comprehensive clinical and frailty (NH-FRAIL) assessment. Blood samples were obtained pre-vaccination, at 6-weeks and 6-months following primary vaccination and 6-months following booster vaccination. Antibody titres were measured using both an electrochemiluminescence assay and a custom bead-based array (Luminex™) to measure antibody titre and avidity for Wuhan strain/major VOC antigens. Stepwise adjusted linear regression (log-transformed) assessed longitudinal determinants of vaccine-induced antibody responses.

Results

Of 86 participants (81.1 ± 10.8 years; 65% female), just under half (45.4%) had evidence of previous SARS-CoV-2 infection. All NHRs mounted a significant antibody-response to vaccination at 5 weeks followed by a significant decrease in antibody titre by 6 months. Previous SARS-CoV-2 infection was the strongest predictor of antibody waning at all timepoints (β: 3.59; 2.89, 4.28; P < 0.001 for 6-months). Independent of infection history, both age (β: –0.05; –0.08, –0.02; p<0.001) and frailty (β: –0.22; –0.33, –0.11; p<0.001) were associated with faster antibody waning at 6-months. Cross-reactivity and avidity were significantly lower for Beta (B.1.351) and Gamma (P.1) VOC strains (all p<0.001). Additionally, there was faster antibody waning and significantly reduced antibody avidity to Beta and Gamma VOCs in SARS-CoV-2 naïve NHRs.

Conclusion

Older NHRs are capable of mounting protective antibody responses to SARS-CoV-2 vaccination. Responses were more durable, with a greater cross-reactivity to and avidity for VOCs in those with previous SARS-CoV-2 infection. Increasing age and greater frailty in NHRs was associated with faster antibody waning. Our findings support ongoing serological surveillance and use of additional vaccine doses in older NHRs, particularly in those without previous SARS-CoV-2 exposure.

Comparing perspectives on research needs from stakeholders vs. researchers in an exposome project

Background

Exposome research looks into how combined exposures affect human health. The EU-funded Equal-Life project focuses on physical and social exposures in a child’s environment and its effects on children’s mental health and cognitive development in the life course. Perspectives and priorities on what to study in particular might differ between practitioners and researchers. Therefore, collaboration with external stakeholders from various fields is encouraged to integrate practical experience and link it to the researchers’ aims.

Methods

Two Delphi studies were conducted collecting and evaluating research questions to be studied in the project among a) the researchers within the project and b) among external stakeholders from various European countries. The exercise was to evaluate the research questions for group a) based on relevance and testability and for b) e.g. regarding practitioners’ work and options for policies. Involved stakeholders work in health care, and urban planning, among others. Prioritised questions are collated.

Findings

Within the researchers’ group, top-rated questions were mainly mechanism-directed in terms of how and to what extent certain factors affect children’s mental health and cognitive development, cumulative effects in different settings, among others. Stakeholders most value research questions on practical issues, e.g. effects of early experiences of discrimination, critical windows in children’s lives that are most sensitive regarding the impact of exposures on mental health and cognitive development, or impact of exposures in early stages of life.

Discussion

In comparing approaches of stakeholders and researchers, stakeholders’ input from the practical field can shape the approach of the research process. The second benefit is to derive implications for creating effective interventions and policies to prevent adverse effects of environmental exposures and to foster positive health in children and later on in life.

Key messages

• Bi-directional exchange between researchers and external stakeholders can make gaps visible.

• Engaging stakeholders into a research process can help sharpening the aim and outcome of a project.

Making integration foundational in population health intervention research: why we need 'Work Package Zero'

OBJECTIVES

We aimed to identify when and how integration should take place within evaluations of complex population health interventions (PHIs).

STUDY DESIGN

Descriptive analytical approach.

METHODS

We draw on conceptual insights that emerged through (1) a working group on integration and (2) a diverse range of literature on case studies, small-n evaluations and mixed methods evaluation studies.

RESULTS

We initially sought techniques to integrate analyses at the end of a complex PHI evaluation. However, this conceptualization of integration proved limiting. Instead, we found value in conceptualizing integration as a process that commences at the beginning of an evaluation and continues throughout. Many methods can be used for this type of integration, including process tracing, realist evaluation, congruence analysis, general elimination methodology/modus operandi, pattern matching and contribution analysis. Clearly signposting when integrative methods should commence within an evaluation should be of value to the PHI evaluation community, as well as to funders and related stakeholders.

CONCLUSIONS

Rather than being a tool used at the end of an evaluation, we propose that integration is more usefully conceived as a process that commences at the start of an evaluation and continues throughout. To emphasize the importance of this timing, integration can be described as comprising 'Work Package Zero' within evaluations of complex PHIs.

Extraocular Muscle Enlargement in Growth Hormone-Secreting Pituitary Adenomas

BACKGROUND AND PURPOSE

While Graves disease is the most common cause of extraocular muscle enlargement, case reports have also associated growth hormone-secretory pituitary adenomas with this same phenomenon. We investigated the prevalence and response to treatment of extraocular muscle enlargement in patients with growth hormone-secretory pituitary adenomas.

MATERIALS AND METHODS

We retrospectively reviewed extraocular muscle sizes using MR imaging in patients with growth hormone-secretory pituitary adenomas who underwent a transsphenoidal surgical resection compared with a matched control group with nonsecretory pituitary adenomas. Descriptive and comparative statistics were used to evaluate patient characteristics and extraocular muscle sizes between the 2 groups.

RESULTS

We identified 16 patients who presented with growth hormone-secreting pituitary adenomas and underwent transsphenoidal surgical resection from 2010 to 2019. The average diameter of the extraocular muscle at the time of diagnosis for the group with growth hormone-secretory pituitary adenomas was larger than that in the control group (4.7 versus 3.8 mm, P < .001). Nine patients achieved insulin-like growth factor 1 level normalization at a median of 11.5 months before their most recent MR imaging evaluation. The average size of the extraocular muscles of patients who achieved a normalized insulin-like growth factor 1 was smaller compared with those that did not (difference, 0.7 mm; 95% CI, 0.3-1.2 mm; P < .001), approaching the size of extraocular muscle in the control group.

CONCLUSIONS

We describe a high prevalence of extraocular muscle enlargement in patients with growth hormone-secreting pituitary adenomas. Additionally, we note that the size of extraocular muscles decreased with associated improvement in the biochemical control of acromegaly.

Use of cytology for canine mammary masses and perceived diagnostic utility in four European countries

OBJECTIVES

To investigate the use of cytology of canine mammary masses and its perceived diagnostic utility in four European countries.

MATERIALS AND METHODS

The link to a web-based questionnaire was sent to veterinarians of Italy, UK, Greece and Spain. The questionnaire contained basic questions regarding the respondents' background, their general use of cytology as a diagnostic tool, the incidence of canine mammary tumours within their clinics and their use of cytology for canine mammary masses. Multiple binary and ordinal logistics models were used to evaluate associations between variables.

RESULTS

Four hundred and sixty-five veterinarians completed the survey (Italy: 114; UK: 66; Greece: 55; Spain: 230). Most veterinarians working in each country used cytology as a diagnostic tool, although only 43.0%, 54.6%, 43.6% and 36.5% used cytology for the investigation of CMMs in Italy, UK, Greece and Spain respectively. Supposing the cytology were able to correctly differentiate benign versus malignant canine mammary masses, the percentage of veterinarians using this test would increase in Italy, UK and Greece (Italy: 91.2%; UK: 93.9%; Greece: 96.4%); however, this was not reflected by veterinarians working in Spain (51.7%).

CLINICAL SIGNIFICANCE

If cytology of canine mammary masses were able to differentiate between benign and malignant, most veterinarians in Italy, UK and Greece would utilise the technique, justifying further research into the diagnostic accuracy of this test. Spanish veterinarians were significantly different and further research into why these individuals would not value the ability of cytology to differentiate between benign and malignant may be of value.

Stakeholders’ involvement in identification of research and policy needs for children’s mental health

Background

The overarching aim of the Horizon 2020 Equal-Life project is to develop evidence-based guidance for policy-and decision-makers concerning child environment and long-term effects on mental health and cognitive development. Stakeholders at national and local level are crucial in improving the physical and social environments children grow up in. In this paper, we present preliminary results of a repeated survey on stakeholders' needs concerning environmental determinants of mental health and cognitive development of children and adolescents.

Methods

We invited potential stakeholders from relevant fields of expertise. Two of three rounds of the Delphi survey were performed by means of an on-line survey between November 2020 and February 2021.The questionnaire was aimed at identifying research questions, knowledge gaps and raised issues about data collection and analysis regarding improving mental health and cognitive development, policy needs related to environment and its role in children's mental health and the potential effectiveness of policy interventions.

Results and Conclusions

In the 1st survey round 34 stakeholders participated and in the 2nd survey round 51 stakeholders participated from 26 different countries and continents. Across both rounds of the survey most participants were from research institutes (21), public health organisations (8), civil society (6), national stakeholders (5) with only little involvement of local or regional authorities or child care organisations. Stakeholders identified several research priorities such as: instruments to improve children's mental health, preventive programs addressing mental health, integrated mental health care services, programs aimed at parenting skills and child care. Early life exposure to adverse social events and psychosocial stressors in the family and socioeconomic disadvantage were recognized as main factors for child development.

Key messages

The guidance from Equal-Life aims to include stakeholders in creation of intervention strategies and preventive measures for mental health and the cognitive development of children. Evidence-based policies and programmes can buffer the negative effects of adverse environments and create restorative ones, and by doing so improve mental health and cognitive development.

0187 The Effects of Nocturnal Aircraft Noise on Self-Reported Sleep

Introduction

Nocturnal traffic noise can fragment sleep through cortical arousals and induce self-reported sleep disturbance. Here we present data gathered around Atlanta International Airport in a pilot field study on the effects of aircraft noise on sleep.

Methods

N=34 subjects participated in a five night in-home study. Every night, subjects recorded noise inside their bedroom, and completed questionnaires the following morning containing items on sleep latency; number of awakenings; sleepiness (Stanford Sleepiness Scale); 11-point scales on sleep quality, tiredness, ease of falling asleep and calmness or restlessness of sleep; and a 5-point scale on sleep disturbance by noise. We analyzed the effect of both the average (LAEq,sleep) and maximum (LAS,max,sleep) aircraft noise level during a subject’s sleep period for each questionnaire outcome in repeated measures multiple regression adjusted for the number of aircraft noise events during sleep, sex, age, and if the window was open or closed.

Results

A total of 165 sleep questionnaires (97.1% of expected) were completed. Self-reported awakenings increased by n=0.051 per decibel (dB) LAS,max,sleep (p&lt;0.001). An increase in LAS,max,sleep was associated with a significant increase in tiredness (0.118/dB, p=0.005). There was a significant effect of sex on tiredness in the LAEq,sleep model, whereby men were less tired than women. There were no significant effects of LAEq,sleep on any questionnaire outcomes.

Conclusion

There was some evidence for adverse effects of aircraft noise on self-reported sleep outcomes. Effects were predominantly found for maximum rather than average noise exposure during the sleep period, stressing the importance of individual noise events for sleep. A larger-scale, adequately powered National Sleep Study will be conducted to better understand the observed effects.

Support

This research was funded by the U.S. Federal Aviation Administration Office of Environment and Energy through ASCENT, the FAA Center of Excellence for Alternative Jet Fuels and the Environment, project 017 through FAA Award Number 13-C-AJE-UPENN-011 under the supervision of Natalia Sizov. Any opinions, findings, conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the views of the FAA.

0136 Bright Light Could Be an Alternative to the Caffeine for Improving Driving Performance in Chronically Sleep-Deprived Young Drivers

Introduction

Young drivers are over-involved in sleepiness-related crashes. Daytime and nighttime exposure to light might shift the human circadian phase and alertness. The alerting effects of bright light were compared with those of caffeine in young drivers.

Methods

In a within-subjects study, 30 chronically sleep-deprived non-professional drivers (aged 18–24 years) completed two simulated daytime driving sessions per day across three consecutive days. Participants completed the first drive under a Baseline condition (non-caffeinated gum, 555 nm light, 0.3 µW/cm²), and the second drive under the randomized conditions of Light (500 nm, 230 µW/cm²), Caffeine (100 mg caffeinated gum) or the combination of Light and Caffeine. Using mixed-effects models, the alerting effects of these conditions on objective sleepiness (ECG beat-to-beat intervals), driving performance (lateral lane variability) and subjective sleepiness (scores on the Karolinska sleepiness scale; KSS) were examined.

Results

Compared to the Baseline condition, lateral lane variability decreased under the Light (P=0.011), Caffeine (P=0.0001), and the combination of Light and Caffeine (P=0.046). Lateral lane variability was lower under Caffeine when compared with the Light (P=0.009) or the combination of Light and Caffeine (P= 0.0001). Average beat-to-beat intervals increased from the Baseline condition to the Light (P=0.017), Caffeine (P=0. 0.0001), and the combination of Light and Caffeine conditions (P=0.0001). All three conditions significantly reduced subjective sleepiness compared to the Baseline condition (KSS= 4–5 vs KSS=6, P= 0.0001).

Conclusion

Bright light, either alone or combined with caffeine, improves driving performance and subjective sleepiness during daytime drives. Light might better improve objective sleepiness and other sleepiness indicators during nighttime when drivers are sleepier and have an increased sensitivity to the light. Further research would clarify how the circadian effects are aligned with the alerting effects of the light. Bright light, as an alternative to or combined with caffeine, could reduce sleep-related crashes on the road.

Support

NA

A review of the effectiveness of vegetated buffers to mitigate pesticide and nutrient transport into surface waters from agricultural areas

A relatively large number of studies have investigated the effectiveness of vegetated buffer strips at reducing the movement of pesticides and nutrients from agriculture fields. This review outlines the observed influence of different factors (e.g., buffer width, slope, runoff intensity, soil composition, plant community) that can influence the efficacy of vegetated buffers in pesticide and nutrient retention. The reported effectiveness of vegetated buffers reducing the movement of pesticides and nutrients ranged from 10 to 100% and 12-100%, respectively. Buffer width is the factor that is most frequently considered by various jurisdictions when making recommendations on vegetated buffer strip implementation. However, the literature clearly illustrates that there is a great deal of variation in pesticide or nutrient reduction for a given buffer width. This indicates that other factors play an important role in buffer efficacy (e.g., ratio of source area to buffer area, soil composition and structure, runoff intensity, plant community structure) in addition to the width of the vegetative buffer area. These factors need to be considered when making recommendations on vegetated buffer strip construction in agroecosystems. This review has also identified a number of other gaps in the understanding of the effectiveness of vegetated buffers at reducing the movement of pesticides and nutrients from the areas of application.

Overview of the OECD-NEA Working Party on International Nuclear Data Evaluation Cooperation (WPEC)

The OECD Nuclear Energy Agency (NEA) Working Party on International Nuclear Data Evaluation Cooperation (WPEC) was established in 1989 to facilitate collaboration in nuclear data activities. Over its thirty year history, different Subgroups have been created to address topics in nearly every aspect of nuclear data, including: experimental measurements, evaluation, validation, model development, quality assurance of databases and the development of software tools.

WPEC has recently completed activities on fission yield evaluation, the general nuclear database structure (GNDS) to replace the ENDF-6 format, methods to provide feedback to evaluation, studies of specific capture cross sections, new methods in thermal scattering kernel evaluation and the Collaborative International Evaluated Library Organisation (CIELO) Pilot Project. Ongoing activities in GNDS application programming interface (API) development, methods for covariance evaluation and quality assurance in nuclear data validation using the International Criticality Safety Benchmark Evaluation Project (ICSBEP) database are complemented by the work of two Expert Groups that oversee the High-Priority Request List (HPRL) for Nuclear Data and the continuous development of the GNDS. New activities on the use of integral experiments for nuclear data validation and adjustment, as well as the use of the Shielding Integral Benchmark Archive and Database (SINBAD) for validation have begun and will be coordinated alongside future Subgroups.

After three decades we will review the status of WPEC, how it integrates other collections and activities organised by the NEA and how it dovetails with the initiatives of the IAEA and other bodies to effectively coordinate international activities in nuclear data.

Academic and professional paths of narcoleptic patients: the Narcowork study

OBJECTIVE/BACKGROUND

To study educational and professional pathways of narcoleptic patients and examine demographic, disease-related and environmental factors associated with a better academic and professional prognosis.

PATIENTS/METHODS

In sum, 69 narcoleptic patients (51 narcolepsy type 1 and 18 narcolepsy type 2, age 42.5 ± 18.2 years) were enrolled in this pilot monocentric cross-sectional study with a comparison group (80 age- and sex-matched controls) between October 2017 and July 2018 in Lyon Center for Sleep Medicine. They completed questionnaires about their academic and professional trajectories and specific scales of quality of life (EuroQol quality of life scale EQ-5D-3L), depression (beck depression inventory, BDI), sleepiness (Epworth Sleepiness Scale, ESS) and narcoleptic symptoms severity (narcolepsy severity scale, NSS).

RESULTS

No difference in grade repetition or final obtained diploma was observed between patients and controls, but patients evaluated their academic curricula as more difficult (45.5% vs 16.9%, p = 0.0007), complained for more attentional deficits (75% vs 22.1%, p < 0.0001), and had needed more educational reorientation (28.6% vs 9.9%, p = 0.01). Even if no difference was observed in occupational category and professional status, patients expressed significantly less satisfaction about their work. Patients had more signs of depression [OR severe depression = 4.4 (1.6-12.6), p = 0.02] and their quality of life was significantly decreased (67.3 ± 18.4 vs 80.6 ± 13.2, p = 0.0007) as compared to controls. Multivariate analysis showed that a more favorable professional career was associated with a better quality of life.

CONCLUSIONS

Educational and professional pathways do not seem to be significantly impaired in narcoleptic patients, but their experience and quality of life are affected. These findings may allow to reassure patients and should lead to a more comprehensive management of the disease.

CLINICAL TRIAL REGISTRATION

Narcowork, https://clinicaltrials.gov/ct2/show/NCT03173378, N° NCT03173378.

High Performance Bi-2212 Round Wires Made with Recent Powders

Multifilamentary Bi₂Sr₂CaCu₂O_x (Bi-2212) wire made by the powder-in-tube technique is the only high temperature superconductor made in the round shape preferred by magnet builders. The critical current density (J _C ) of Bi-2212 round wire was improved significantly by the development of overpressure heat treatment in the past few years. Bi-2212 wire is commercially available in multiple architectures and kilometer-long pieces and a very promising conductor for very high field NMR and accelerator magnets. We studied the effects of precursor powder and heat treatment conditions on the superconducting properties and microstructure of recent Bi-2212 wires. Short samples of recent wire with optimized overpressure processing showed J _C (4.2 K, 15 T) = 6640 A/mm² and J _C (4.2 K, 30 T) = 4670 A/mm², which correspond to engineering critical current densities J _E (4.2 K, 15 T) = 1320 A/mm² and J _E (4.2 K, 30 T) = 930 A/mm².

The role of vegetated buffers in agriculture and their regulation across Canada and the United States

A vegetated buffer, barrier, or filter strip is a parcel of land that is designated to separate land used for agriculture from valued aquatic or terrestrial habitats. It exists partly with the intent to diffuse runoff and to impeded sediment, nutrients, pesticides, and other constituents from reaching off-site surface waters. Mandatory buffer implementation is regulated at various levels of government in North America - from the federal to the state and provincial levels, and by some municipalities and counties. To better understand the degree and breadth of oversight, we undertook a comprehensive search and review of vegetative buffer regulations across North America. We determined the width of buffer required, under what habitat or field conditions, for which pesticides, and application type, amongst other attributes. For ground application, margins ranged from 1 m to upwards of greater than 4000 m depending on protection goals, with some being compound specific and others being generally applied to all registered pesticides/compounds. These buffers tended to be used most often to protect surface water, groundwater (e.g. drinking water wells), and nearby sensitive crops, but the required distances are generally not consistent between jurisdictions, regardless of the stated protection goals. We recommend that a thorough science-based review take place, with input from relevant stakeholders, to harmonize vegetated buffer size for effective surface water protection where ecological, climatic, and agricultural conditions are sufficiently similar in North America.

Abstract P6-20-06: Withdrawn

This abstract was withdrawn by the authors.

Citation Format: Dann S, Chionis J, Eisele K, Zhang Q, Liu C, Yuan J, Miller N, Murray B, Xu M, Solowiej J, Wei P, Weinrich S, Sutton S, Behenna D, Ninkovic S, Hoffman R, Freeman-Cook K, Jessen B, Huser N, Zhang C, Visswanathan R, Boras B, VanArsdale T, White MA. Withdrawn [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 P6-20-06.

Fate of thiamethoxam in mesocosms and response of the zooplankton community

Thiamethoxam is a neonicotinoid insecticide that can reach wetlands in agro-ecosystems through runoff. The fate and effects of thiamethoxam on non-target organisms in shallow wetland ecosystems have not been well characterized. To this end, a mesocosm study was conducted with a focus on characterizing zooplankton community responses. A single pulse application of thiamethoxam (0, 25, 50, 100, 250, and 500 μg/L; n = 3) was applied to experimental systems and monitored for 8 weeks. The mean half-life of thiamethoxam among the different treatments was 3.7 days in the water column with concentrations of <0.8 μg/L in the majority of mesocosms by 56 days. Principal response curve analysis did not show any significant concentration-dependent differences in the zooplankton community among treatments over the course of the study. The minimum detectable difference (MDD%) values for abundance of potentially sensitive arthropod taxa (nauplius larvae, cyclopoid copepods) allowed the detections from controls as low as 42 and 59% effect, respectively. The MDD% values for total abundance of zooplankton (including the potentially less sensitive taxonomic group of Rotifera) allowed the detection from controls as low as 41% effect. There were no statistically significant differences in zooplankton abundance or diversity between control and treated mesocosms at the end of the study. There were also no statistically significant differences for individual taxa that were sustained between sampling points, or manifested as a concentration-response. We conclude that acute exposure to thiamethoxam at environmentally relevant concentrations (typically ng/L) likely does not represent a significant adverse ecological risk to wetland zooplankton community abundance and structure.

Patient and healthcare professional perceptions of colostomy-related problems and their impact on quality of life following rectal cancer surgery

Background

The perception of colostomy‐related problems and their impact on health‐related quality of life (QoL) may differ between patients and healthcare professionals. The aim of this study was to investigate this using the Colostomy Impact Score (CIS) tool.

Methods

Healthcare professionals including consultant colorectal surgeons, stoma nurses, ward nurses, trainees and medical students were recruited. An online survey was designed. From the 17 items used to develop the CIS, participants chose the seven factors they thought to confer the strongest negative impact on the QoL of patients with a colostomy. They were then asked to rank the 12 responses made by patients to the final seven factors contained in the CIS. Results were compared with the original patient rankings at the time of development of the CIS.

Results

A total of 156 healthcare professionals (50·4 per cent of the pooled professionals) from 17 countries completed the survey. Of the original seven items in the CIS, six were above the threshold for random selection. Ranking the responses, a poor match between participants and the original score was detected for 49·7 per cent of the professionals. The most under‐rated item originally present in the CIS was stool consistency, reported by 47 of the 156 professionals (30·1 per cent), whereas frequency of changing the stoma bag was the item not included in the CIS that was chosen most often by professionals (124, 79·5 per cent). Significant differences were not observed between different groups of professionals.

Conclusion

The perspective of colostomy‐related problems differs between patients with a colostomy and healthcare professionals.

Epizootics of Streptococcus agalactiae infection in captive rays from Queensland, Australia

The aim of this study was to describe two epizootics of high mortalities from infection with Streptococcus agalactiae, occurring in captive rays held in a marine display aquarium in south-east Queensland, Australia, in 2009 and 2010. Five different species of rays were affected, including mangrove whiprays (Himantura granulata), estuary rays (Dasyatis fluviorum), eastern shovelnose rays (Aptychotrema rostrata), white-spotted eagle rays (Aetobatus narinari) and blue-spotted mask rays (Neotrygon kuhlii). This report describes the history of both epizootics including collection, quarantine and husbandry of rays, the disease epizootics, clinico-pathological features of the disease, antimicrobial therapy, autogenous vaccine production, and laboratory studies including clinical and histopathology, bacteriology, PCR, molecular serotyping and sequencing of the bacterium S. agalactiae.

Changes in consumption of added sugars from age 13 to 30 years: a systematic review and meta-analysis of longitudinal studies

Added sugar intake during adolescence has been associated with weight gain and cardiometabolic risk factors. Moreover, dietary habits may persist into adulthood, increasing chronic disease risk in later life. This systematic review investigated changes in intake of added sugars between the ages of 13 and 30 years. Literature databases were searched for longitudinal studies of diet during adolescence or early adulthood. Retrieved articles were screened for studies including multiple measures of intake of sugars or sugary foods from cohort participants between the ages of 13 and 30. Data were analysed using random-effects meta-analysis, by the three main nutrient and food group categories identified (PROSPERO: CRD42015030126). Twenty-four papers reported longitudinal data on intake of added sugar or sucrose (n = 6), sugar-sweetened beverages (SSBs) (n = 20) and/or confectionery (n = 9). Meta-analysis showed a non-significant per year of age decrease in added sugar or sucrose intake (-0.15% total energy intake (95%CI -0.41; 0.12)), a decrease in confectionery consumption (-0.20 servings/week (95%CI -0.41; -0.001)) and a non-significant decrease in SSB consumption (-0.15 servings/week (95%CI -0.32; 0.02)). Taken together, the overall decrease in added sugar intake observed from adolescence to early adulthood may suggest opportunities for intervention to further improve dietary choices within this age range.