Semi-crystalline materials for pharmaceutical fused filament fabrication: Dissolution and porosity

A better understanding of crystallization kinetics and the effect on drug product quality characteristics is needed to exploit the use of semi-crystalline polymers in pharmaceutical fused filament fabrication. Filaments were prepared from polycaprolactone or polyethylene oxide loaded with a crystallization inhibitor or inducer, which was either 10% (w/w) ibuprofen or theophylline. A design-of-experiments approach was conducted to investigate the effect of nozzle temperature, bed temperature and print speed on the printed tablets' microstructure and dissolution kinetics. Helium pycnometry derived porosity proved an ideal technique to capture significant distortions in the tablets' microstructure. On the other hand, terahertz time domain spectroscopy (THz-TDS) analysis proved valuable to investigate additional enclosed pores of the tablets' microstructure. The surface roughness was analyzed using optical coherence tomography, showing the importance of extensional viscosity for printed drug products. Drug release occurred via erosion for tablets consisting of polyethylene oxide, which partly reduced the effect of the inner microstructure on the drug release kinetics. An initial burst release effect was noted for polycaprolactone tablets, after which drug release continued via diffusion. Both the pore and crystalline microstructure were deemed essential to steer drug release. In conclusion, this research provided guidelines for material and process choice when a specific microstructure has to be constructed from semi-crystalline materials. In addition, non-destructive tests for the characterization of printed products were evaluated.

The impact of prenatal alcohol, synthetic cannabinoid and co-exposure on behavioral adaptations in adolescent offspring and alcohol self-administration in adulthood

Prenatal exposure to alcohol or cannabinoids can produce enduring neurobiological, cognitive, and behavioral changes in the offspring. Furthermore, prenatal co-exposure to alcohol and cannabinoids induces malformations in brain regions associated with reward and stress-related circuitry. This study examined the effects of co-exposure to alcohol and the synthetic cannabinoid (SCB) CP55,940 throughout gastrulation and neurulation in rats on basal corticosterone levels and a battery of behavioral tests during adolescence and alcohol self-administration in adulthood. Importantly, we find that prenatal alcohol exposure (PAE) caused lower baseline corticosterone levels in adolescent males and females. Co-exposure to alcohol + CP produced hyperactivity during open field test in males, but not females. During the two-bottle choice alcohol-drinking procedure, prenatal cannabinoid exposed male and female adolescent rats drank more alcohol than their vehicle-exposed controls. In adulthood, female rats treated with prenatal cannabinoid exposure (PCE), showed an overall total increase in alcohol intake during alcohol self-administration; but this was not found in males. When the reinforcer was changed to a 1% sucrose solution, male rats exposed to PCE, showed a reduced self-administration compared to vehicle-exposed males, potentially indicative of an anhedonic response. This lower self-administration persisted when 20% alcohol was reintroduced to the sucrose solution. Lastly, following an abstinence period, there were no changes due to prenatal drug exposure in either males or females. Overall, these data suggest lasting consequences of prenatal alcohol and cannabinoid exposure during adolescence and adulthood in male and female rats.

Validity of common physical function tests performed online for older adults

BACKGROUND

Objectively measured physical function tests are important predictors of institutionalization, disability, and premature mortality. Although physical function was usually assessed in person prior to the COVID-19 pandemic, there is a need to investigate whether physical function tests performed online are valid.

OBJECTIVE

The purpose of this study was to determine the validity of common physical function tests conducted online compared to in-person testing in older adults.

METHODS

Physical functions included gait speed, one leg stance balance, 30-second chair stands, and the 2-minute steps were tested online and in-person using a random order for community dwellers aged 65 years and above. Using an alpha two way mixed model, average intraclass correlation coefficients (ICC) were calculated between the two settings and one sample T-test performed on the difference between the results of each test between the two settings. Finally, Bland-Altman plots were created, and proportional biases tested via linear regressions.

RESULTS

Besides the one-leg stance balance with eyes closed, for which the ICC was 0.47 (0.23-0.74) the average ICC's were excellent ranging from 0.87 to 0.94. No proportional biases were observed based on Bland-Altman graphs.

CONCLUSION

For older adults living in the community, common physical function tests can be performed online.

The impact of prenatal alcohol and synthetic cannabinoid exposure on behavioral adaptations in adolescent offspring and alcohol self-administration in adulthood

Prenatal exposure to alcohol or cannabinoids can produce enduring neurobiological, cognitive, and behavioral changes in the offspring. Furthermore, prenatal co-exposure to alcohol and cannabinoids induces malformations in brain regions associated with reward and stress-related circuitry. This study examined the effects of co-exposure to alcohol and the synthetic cannabinoid (SCB) CP55,940 throughout gastrulation and neurulation in rats on basal corticosterone levels and a battery of behavioral tests during adolescence and alcohol self-administration in adulthood. Importantly, we find that prenatal alcohol exposure (PAE) caused lower baseline corticosterone levels in adolescent males and females. Co-exposure to alcohol + CP produced hyperactivity during open field test in males, but not females. During the two-bottle choice alcohol-drinking procedure, prenatal cannabinoid exposed male and female adolescent rats drank more alcohol than their vehicle-exposed controls. In adulthood, female rats treated with prenatal cannabinoid exposure (PCE), showed an overall total increase in alcohol intake during alcohol self-administration; but this was not found in males. When the reinforcer was changed to a 1% sucrose solution, male rats exposed to PCE, showed a reduced self-administration compared to vehicle-exposed males, potentially indicative of an anhedonic response. This lower self-administration persisted when 20% alcohol was reintroduced to the sucrose solution. Lastly, following an abstinence period, there were no changes due to prenatal drug exposure in either males or females. Overall, these data suggest lasting consequences of prenatal alcohol and cannabinoid exposure during adolescence and adulthood in male and female rats.

The Multifaceted Effects of Osteocytic TGFβ Signaling on the Skeletal and Extraskeletal Functions of Bone

PURPOSE OF REVIEW

To summarize the fundamental role of transforming growth factor beta (TGFβ) signaling in osteocytes and highlight the physiological and pathophysiological conditions stemming from the deregulation of this pathway in osteocytes.

RECENT FINDINGS

Osteocytes perform a myriad of skeletal and extraskeletal functions, including mechanosensing, coordinating bone remodeling, local bone matrix turnover, and maintaining systemic mineral homeostasis and global energy balance. Transforming growth factor-beta (TGFβ) signaling, which is crucial for embryonic and postnatal bone development and maintenance, has been found to be essential for several osteocyte functions. There is some evidence that TGFβ might be accomplishing these functions through crosstalk with the Wnt, PTH, and YAP/TAZ pathways in osteocytes, and a better understanding of this complex molecular network can help identify the pivotal convergence points responsible for distinct osteocyte functions. This review provides recent updates on the interwoven signaling cascades coordinated by TGFβ signaling within osteocytes to support their skeletal and extraskeletal functions and highlights physiological and pathophysiological conditions implicating the role of TGFβ signaling in osteocytes.

A14 TRANSABDOMINAL BOWEL ULTRASOUND AND CLINICAL OUTCOMES OVER ONE YEAR IN CHILDREN WITH NEWLY DIAGNOSED CROHN’S DISEASE

Background

Transabdominal bowel ultrasound (TABUS) is an emerging non-invasive tool for monitoring inflammatory bowel disease (IBD). Its use is particularly increasing in pediatric IBD, given the need for anesthesia during endoscopy. The assessment of TABUS in pediatric IBD has been limited to small numbers of patients with no long-term follow-up.

Purpose

To describe TABUS findings and its relationship with clinical, biochemical, and endoscopic assessments in pediatric patients with Crohn’s disease up to one year post-diagnosis.

Method

Patients (0-18 years) with suspected IBD were prospectively enrolled through the Edmonton Pediatric IBD Clinic. Those with Crohn’s disease were included. Patients underwent repeated TABUS, clinical assessments, blood work, fecal calprotectin (FCP) (baseline, 1-, 3-, 6-, 12-months), and endoscopy (baseline and 6-12 months). The weighted Pediatric Crohn’s Disease Activity Index (wPCDAI), Simple Endoscopic Score for Crohn’s Disease (SES-CD; rectum excluded), and Simple Ultrasound Activity Score for Crohn’s Disease (SUS-CD; rectum excluded) were used. Remission was defined as FCP<250mg/kg, CRP<4mg/L, wPCDAI<12, no upcoming surgery, and SES-CD score ≤2 for any bowel segment.

Result(s)

Fifty-six patients (68% male), median age 12.5 years (range 6-17), were followed for 6 months. Forty (71%) were followed up to 12 months. Median TABUS bowel wall thickness (BWT) and SUS-CD total scores improved in all bowel segments over time. SUS-CD total scores significantly correlated with SES-CD (baseline, 6-, 12-months), wPCDAI (baseline, 1-, 6-, 12-months), CRP (baseline, 1-, 3-, 6-months), ESR (baseline, 1-, 3-, 6-, 12-months), and FCP (baseline, 1-, 6-, 12-months) (rho ranged 0.302-0.732, p<0.05). Patients in remission had sustained significantly thinner BWT of their most affected bowel segment (Figure 1) starting at 1-month (median 3.1mm (IQR 2.7-3.7) vs. 4.1mm (IQR 2.9-5.6; p<0.05), and sustained significantly lower SUS-CD total scores starting at 6 months (median 0 (IQR 0-1) vs. median 2 (IQR 1-3); p<0.05). Seven patients had surgery (n=7/7 ileocecal, n=2/7 jejunal resection). All 7 patients had complex TI disease (n=6 strictures, n=1 long-segment disease >25cm) and proximal small bowel disease (n=2/2) on TABUS. Those with baseline ultrasound findings of a stricture with upstream bowel dilatation (n=7/56) had increased odds (OR=288, p<0.01) and relative risk (RR=42, p<0.01) of needing surgery (n=6/7 with baseline obstructive findings, n=1/49 without) within the first year.

Image

Conclusion(s)

TABUS had significant correlations with clinical, biochemical, and endoscopic markers of Crohn’s disease activity in pediatric patients over one year. Bowel wall thickness of the most affected bowel segment is a helpful measurement, becoming significantly thinner as soon as 1-month post-diagnosis in those who obtain remission. Baseline findings of bowel narrowing and upstream dilation increase the odds and relative risk of needing surgery in the first year.

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None

Disclosure of Interest

None Declared

A187 DIETARY FIBERS ELICIT GUT IMMUNE AND EPITHELIAL BARRIER MODIFYING EFFECTS IN INFLAMMATORY BOWEL DISEASES BASED ON FOOD SOURCE AND FIBER CHEMICAL FEATURES

Background

Dietary fibers are not digested in the bowel; they are fermented by microbes, typically promoting gut health. However, IBD patients experience sensitivity to consumption of fibers. Our previous findings offered the first mechanistic evidence demonstrating that unfermented dietary β-fructans (inulin and oligofructose) can induce pro-inflammatory cytokines and altered epithelial barrier integrity in a subset of pediatric IBD colonic biopsies cultured ex vivo, and in the SYNERGY-1 (β-fructan) clinical study of adult remission UC patients. Fermentation of β-fructan by whole-microbiota intestinal washes from non-IBD or remission IBD patients (but not non-IBD microbes) reduced pro-inflammatory responses.

Purpose

Here we aimed to expand our findings to uncover the physiologically relevant gut immune and epithelial responses to over 50 unfermented and partially fermented dietary fibers (arabinoxylans, β-glucans, β-mannans, galatooligosaccharides, inulins, oligofructoses, pectins, raffinooligosaccharides, xyloglucans) sourced from commonly consumed fruits, grains, and vegetables to better understand which foods are safe for IBD patients, and in which disease state settings.

Method

Colonic biopsies cultured ex vivo, peripheral blood mononuclear cells (PBMCs), colonic organoids, and cell lines were incubated with individual dietary fibers or mixture of fibers extracted from commonly consumed fruits, grains, and vegetables. Epithelial barrier integrity (TEER, microscopy, FITC-dextran) and immune responses (cytokine secretion [ELISA/MSD] and expression [qPCR]) were assessed. Structural features of the different fibers (e.g., degree of polymerization, phenolic/phytic content, branching, sugar content) were measured by HPLC and gas chromatography and correlated to host cell responses.

Result(s)

Most significantly unfermented inulin, oligofructose, and arabinoxylan induced pro-inflammatory responses, particularly in myeloid cells. Pectin and galatooligosaccharides were either non-inflammatory or anti-inflammatory depending on the food source. The epithelial barrier response to select dietary fibers correlated more significantly with the chemical properties of the fibers; longer fibers (greater degree of polymerization; e.g., inulin) displayed improved barrier integrity while shorter dietary fibers with higher phenolic content displayed reduced barrier integrity. Fiber structural properties varied significantly between different fiber subtypes along with the same fiber subtype sourced from different foods.

Conclusion(s)

Our findings suggest that intolerance and avoidance of fibers in select IBD patients occurs in patients whose gut microbiota do not support fermentation of fibers resulting in increased presence of unfermented dietary fibers in the gut. Here we show which specific dietary fibers from specific food items can elicit gut barrier damage and inflammation in the gut dependent on fiber structural features, suggesting mechanisms underlying IBD patient avoidance of specific high-fiber foods.

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Other

Please indicate your source of funding;

Weston Family Foundation, MMSF, NSERC, CRC

Disclosure of Interest

None Declared

A94 EXPLORING THE SOCIOECONOMIC BURDEN OF PEDIATRIC INFLAMMATORY BOWEL DISEASE: A SURVEY OF FAMILIES AND PEDIATRIC PROVIDERS

Background

Rates of pediatric inflammatory bowel disease (IBD) have been increasing significantly over recent decades, contributing to the rising chronic disease burden across pediatrics. Currently, there is very limited literature exploring the financial burden on families of children with IBD. In fact, there is only one Canadian study in this area despite Canada having one of the highest rates of pediatric IBD in the world.

Purpose

The goal of this study is to better understand the socioeconomic burden of pediatric IBD at our institution and compare institutional practices across the country.

Method

The study took place at a large, tertiary care pediatric centre in Edmonton, Alberta, Canada between October 2022 and January 2023. Two separate electronic surveys were developed and distributed to all families of children with IBD at our institution (N= ~400) and pediatric IBD providers across the country (N= ~45) respectively. Surveys explored demographic information, financial impacts of IBD diagnosis and perceptions around pediatric IBD care and financial support.

Result(s)

Interim results (N=3) indicate dietary therapy costs, missed time off work and school and time off for IBD treatment as considerable burdens on families. Across the country, initial provider data (N=6) suggests significant variability in clinical practice, allied health support and financial support for families. There is overwhelming agreement among providers that the socioeconomic burdens on families is significant. Further data and regression analysis is ongoing.

Conclusion(s)

This is the first study in Canada to directly explore the socioeconomic burden on families of children with IBD. Results indicate good correlation between provider awareness and the increased financial burden on families but also considerable variation in practice across the country. Data suggest further research and advocacy is required to better support patients, however various quality improvement opportunities exist both locally and beyond.

Please acknowledge all funding agencies by checking the applicable boxes below

None

Disclosure of Interest

None Declared

Random mucosal rotating flaps for rostral to mid maxillary defect reconstruction: 26 dogs (2000-2019)

OBJECTIVES

To evaluate the feasibility and the complications following single or double random mucosal rotating (transposition or interpolation) flaps for the closure of rostral to mid maxillary defects in dogs.

MATERIALS AND METHODS

Medical records of dogs treated with single or double random mucosal rotating flaps after maxillectomy for oral lesions or traumatic loss of tissue, were evaluated. Clinical findings, surgery performed, outcome and postoperative complications (major and minor) were extracted.

RESULTS

Twenty-six client-owned dogs were retrospectively included. Dogs underwent maxillectomy for canine acanthomatous ameloblastomas (9), oral squamous cell carcinomas (4), peripheral odontogenic fibromas (4), oral melanomas (3), oral fibrosarcomas (2), dentigerous cysts (2) and oral osteosarcoma (1) and trauma resulting in an oronasal fistula (1). Twenty-three dogs underwent a single transposition or interpolation flap and three dogs were treated with a double transposition flap. Postoperative complications, including dehiscence or flap necrosis, occurred in six dogs.

CLINICAL SIGNIFICANCE

Random mucosal rotating (transposition or interpolation) flaps are versatile when used to close rostral maxillary defects in dogs. Postoperative complications appear to be more likely when these flaps are used to close mid maxillary defects.

Integrated structure-based protein interface prediction

Background

Identifying protein interfaces can inform how proteins interact with their binding partners, uncover the regulatory mechanisms that control biological functions and guide the development of novel therapeutic agents. A variety of computational approaches have been developed for predicting a protein’s interfacial residues from its known sequence and structure. Methods using the known three-dimensional structures of proteins can be template-based or template-free. Template-based methods have limited success in predicting interfaces when homologues with known complex structures are not available to use as templates. The prediction performance of template-free methods that only rely only upon proteins’ intrinsic properties is limited by the amount of biologically relevant features that can be included in an interface prediction model.

Results

We describe the development of an integrated method for protein interface prediction (ISPIP) to explore the hypothesis that the efficacy of a computational prediction method of protein binding sites can be enhanced by using a combination of methods that rely on orthogonal structure-based properties of a query protein, combining and balancing both template-free and template-based features. ISPIP is a method that integrates these approaches through simple linear or logistic regression models and more complex decision tree models. On a diverse test set of 156 query proteins, ISPIP outperforms each of its individual classifiers in identifying protein binding interfaces.

Conclusions

The integrated method captures the best performance of individual classifiers and delivers an improved interface prediction. The method is robust and performs well even when one of the individual classifiers performs poorly on a particular query protein. This work demonstrates that integrating orthogonal methods that depend on different structural properties of proteins performs better at interface prediction than any individual classifier alone.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12859-022-04852-2.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

P-191 Differences in morphokinetic patterns and clinical outcomes between fresh and frozen oocytes; a retrospective analysis

Study question

Is there a difference in morphokinetics and clinical outcomes between embryos from fresh and vitrified oocytes?

Summary answer

Embryos from vitrified versus fresh oocytes showed a delay at the cellular stage, but no impact on time to blastulation or clinical outcomes was evident.

What is known already

Oocyte vitrification has greatly impacted assisted reproduction, with the number of treatments cycles using frozen oocytes more than doubling in the UK since 2013. Studies of thawed vitrified oocytes have shown similar success rates and outcomes compared to fresh, allowing the technique to be considered safe and effective. However, vitrification and thawing subjects the oocyte to stress and osmotic changes that may be evident in alterations in the timing of their morphological events. Analysis of morphokinetic markers using time-lapse incubators was performed to investigate this.

Study design, size, duration

Matched cohort study. A total of 823 embryos were analysed, 414 embryos from fresh oocytes and 409 from vitrified. The embryos were from the 288 ICSI treatment cycles performed at LWC in 2019. Fresh oocytes were from women less than 35 years old undergoing fertility treatment and vitrified oocytes were from egg donors under 35.

Participants/materials, setting, methods

Embryos graded AA, BB, BA, AB, were selected and annotated retrospectively on the Embryoscope for the following events: pronuclei appearance (tPNa) and disappearance (tPNf), time until two (t2), four (t4) and eight cells (t8), compaction initiation (tSC), the start of blastulation (tSB) and time to expanded blastocyst (tEB). PN duration, second and third embryo cell cycle (ECC), compaction and blastulation duration were also calculated as well as differences in clinical outcomes.

Main results and the role of chance

Embryos derived from vitrified oocytes (EVO) were observed to have a statistically significant delay in 4/8 morphokinetic events studied: t4 (p = 0.03), t8 (p < 0.01), tSC (p < 0.01) and tSB (p = 0.01). A mean delay of 1h50min was observed when compared to embryos from fresh oocytes (EFO). ECC duration showed a statistically significant difference with a delay of 48 minutes in the vitrified group. However, compaction occurred on average just 84min faster in this group, meaning no differences were observed in the time needed to achieve a full expanded blastocyst.

Regression analysis revealed a correlation between the age of the oocyte and morphokinetic timings. Oocytes from older women demonstrated slower development, with age having a statistically significant impact in the following categories: tPNa, tPNf, t2 and t4.

No differences found between fresh and vitrified groups in fertilization rate (80% EFO vs 79% EVO) (p = 0.841), embryo utilization rate (60% EFO and 61% EVO) (p = 0.432), implantation rate (54% EFO vs 52% EVO) (p = 0.837) and clinical pregnancy rates (49% EFO vs 42% EVO) (p = 0.502).

Limitations, reasons for caution

Limitations of the present study include the retrospective analysis, small sample size and the lack of adjustment for potential contributory/confounding factors such as semen quality, body mass index (BMI), antimüllerian hormone (AMH) levels, type of ovarian stimulation or type of infertility which are known possible influencers of embryo morphokinetics.

Wider implications of the findings

The delay observed at the cellular stage by EVO had no impact on the time the embryos needed to achieve full expansion. While vitrification affects embryo morphokinetics, it does not seem to impact the ability of the oocyte to be fertilized, activated, or to produce a viable blastocyst and pregnancy.

Trial registration number

Not applicable

P-038 Comparison of three methods of semen analysis: A novel at-home sperm test kit, a computer-assisted assessment and an embryologist

Study question

How does computer-assisted semen analysis (CASA) (Lenshooke, LOGIXX) and at-home sperm testing (ExSeed) compare with manual methodology assessment of male fertility based on WHO criteria (5thEdition); a three-method comparison study.

Summary answer

All methods showed good agreement for concentration and limited agreement for motility highlighting the need for further development of alternatives to manual assessment.

What is known already

Several studies have shown good correlation between CASA systems and laboratory-based manual semen analysis, but only a few have carried out a three-way comparison study. One of which showed positive correlation with motility and concentration between a smartphone-based semen analysis and laboratory-based CASA system and positive correlation between concentration and motility between the smartphone-based CASA system and microscopic-based results. The at-home sperm test kit may play a role in motivating infertile males to visit clinics for early diagnosis and also reducing the need for multiple visits to the fertility clinic for repeat semen analyses.

Study design, size, duration

Fifty patients (between 29 and 56 years) attending a fertility clinic were included in the study between September 2021 to December 2021. Semen samples were split into 3 aliquots and evaluated using manual semen assessment (MSA) according to the WHO 5th Edition (2010) guidelines, the ExSeed Home Sperm Test (HST) and the LensHooke® X1 PRO Semen Quality Analyzer (CASA).

Participants/materials, setting, methods

The semen samples were collected from fifty participants at CARE Fertility Tunbridge Wells. The samples were placed in an incubator at 37°C for 30 minutes to liquefy. After liquefaction, sperm concentration, total motility, total motile sperm count (TMSC) and normal morphology were evaluated. Spearman’s Rank correlations (>0.7) and Chi-squared tests were used and the p-value < 0.05 was considered as statistically significant.

Main results and the role of chance

All variables were highly significantly (p < 0.0002) positively correlated between all 3 methods.

The greatest correlations were obtained for sperm concentration (CASA/HST: r = 0.826; MSA/HST: r = 0.870; MSA/CASA: r = 0.871) and TMSC (MSA/CASA: p = 0.792; CASA/HST: r = 0.800; MSA/HST: r = 0.854). Correlations for motility were markedly lower (MSA/HST: r = 0.611; CASA/HST: r = 0.717; MSA/LCASA: r = 0.750). The lowest correlation was found for morphology (MSA/CASA: r = 0.500). The HST device does not determine morphology.

As compared to MSA, using the HST device agreement for normal or low sperm concentration (≥15 × 106/mL or < 15 × 106/mL respectively) was identified in 84.3% of the cases, whereas 94.0% with CASA. The agreement between CASA and HST was 82.0%. For total motility ≥ or < 40%, the agreements were 68.0% (CASA/HST), 56.9% (MSA/HST) and 82.0% (MSA/CASA), respectively.

For the identification of patients with normal morphology >4%, the agreement between MSA and CASA was 30%.

Limitations, reasons for caution

The small sample size was 50 cases. The home testing device does not assess morphology. Furthermore, it is difficult to ascertain whether a consumer would carry out the analysis with this device with the same accuracy as an embryologist.

Wider implications of the findings

The need for repeated semen analyses, the effect of the COVID-19 pandemic and the discomfort some patients feel in a clinical setting, necessitate the need for evaluation of novel semen analysis approaches. These emerging technologies have potential to be more patient friendly, convenient and efficient than standard semen assessment methods.

Trial registration number

not applicable

Longitudinal Associations between Low Serum Bicarbonate and Linear Growth in Children with CKD

Background

Poor linear growth is a consequence of chronic kidney disease (CKD) that has been linked to adverse outcomes. Metabolic acidosis (MA) has been identified as a risk factor for growth failure. We investigated the longitudinal relationship between MA and linear growth in children with CKD and examined whether treatment of MA modified linear growth.

Methods

To describe longitudinal associations between MA and linear growth, we used serum bicarbonate levels, height measurements, and standard deviation (z scores) of children enrolled in the prospective cohort study Chronic Kidney Disease in Children. Analyses were adjusted for covariates recognized as correlating with poor growth, including demographic characteristics, glomerular filtration rate (GFR), proteinuria, calcium, phosphate, parathyroid hormone, and CKD duration. CKD diagnoses were analyzed by disease categories, nonglomerular or glomerular.

Results

The study population included 1082 children with CKD: 808 with nonglomerular etiologies and 274 with glomerular etiologies. Baseline serum bicarbonate levels ≤22 mEq/L were associated with worse height z scores in all children. Longitudinally, serum bicarbonate levels ≤18 and 19-22 mEq/L were associated with worse height z scores in children with nonglomerular CKD causes, with adjusted mean values of -0.39 (95% CI, -0.58 to -0.2) and -0.17 (95% CI, -0.28 to -0.05), respectively. Children with nonglomerular disease and more severe GFR impairment had a higher risk for worse height z score. A significant association was not found in children with glomerular diseases. We also investigated the potential effect of treatment of MA on height in children with a history of alkali therapy use, finding that only persistent users had a significant positive association between their height z score and higher serum bicarbonate levels.

Conclusions

We observed a longitudinal association between MA and lower height z score. Additionally, persistent alkali therapy use was associated with better height z scores. Future clinical trials of alkali therapy need to evaluate this relationship prospectively.

Cyclohexanone Exposure in Children on Extracorporeal Membrane Oxygenation Support

The aim of this study was to determine if plasma cyclohexanone and metabolites are associated with clinical outcomes of children on extracorporeal membrane oxygenation (ECMO) support. We performed a secondary analysis of a prospective observational study of children on ECMO support at two academic centers between July 2010 and June 2015. We measured plasma cyclohexanone and metabolites on the first and last days of ECMO support. Unfavorable outcome was defined as in-hospital death or discharge Pediatric Cerebral Performance Category score > 2 or decline ≥ 1 from baseline. Among 90 children included, 49 (54%) had unfavorable outcome at discharge. Cyclohexanediol, a cyclohexanone metabolite, was detected in all samples and at both time points; concentrations on the first ECMO day were significantly higher in those with unfavorable versus favorable outcome at hospital discharge (median, 5.7 ng/µl; interquartile range [IQR], 3.3-10.6 ng/µl vs. median, 4.2 ng/µl; IQR, 1.7-7.3 ng/µl; p = 0.04). Twofold higher cyclohexanediol concentrations on the first ECMO day were associated with increased risk of unfavorable outcome at hospital discharge (multivariable-adjusted hazard ratio [HR], 1.24 [95% CI, 1.05-1.48]). Higher cyclohexanediol concentrations on the first ECMO day were not significantly associated with new abnormal neuroimaging or 1-year Vineland Adaptive Behavior Scales-II score < 85 or death among survivors.

Phenotypic Variation in Paediatric Inflammatory Bowel Disease by Age: A Multicentre Prospective Inception Cohort Study of the Canadian Children IBD Network

BACKGROUND AND AIMS

Incidence of paediatric inflammatory bowel disease [IBD] in Canada is among the highest worldwide, and age of onset may be decreasing. In a multicentre nationwide inception cohort study, we examined variation in phenotype of IBD throughout the paediatric age spectrum.

METHODS

Children aged ≥2 years [y] and <17y [A1 age at diagnosis], with new onset IBD, were systematically evaluated at sites of the Canadian Children IBD Network. Prospectively recorded phenotypic data were compared between age groups.

RESULTS

Among 1092 children (70% Caucasian; 64% Crohn's disease [CD], 36% ulcerative colitis/inflammatory bowel disease unclassified [UC/IBD-U]; median age 13 y, interquartile range [IQR] 11-15 y), 210 [19%] were diagnosed before the age of age 10 y [Paris A1a] and 43 [4%] before age 6 y (very-early-onset [VEO-IBD]). CD was less common in younger children [42%, 56%, 66%, respectively, of VEO-IBD, A1a; A1b]. Colon-only IBD [UC/IBDU or CD-colon] was present in 81% of VEO-IBD and 65% of A1a; ileal disease increased progressively, reaching plateau at age 10 y. CD location was ileocolonic [L3] in 53% overall. Ileitis [L1] increased with age [6% of VEO-IBD; 13% of A1a; 21% of A1b], as did stricturing/penetrating CD [4% of A1a; 11% of A1b]. At all ages UC was extensive [E3/E4] in >85%, and disease activity moderate to severe according to Physician's Global Assessment [PGA] and weighted Paediatric Crohn's Disease Activity Index/Paediatric Ulcerative Colitis Activity Index [wPCDAI/PUCAI] in >70%. Heights were modestly reduced in CD [mean height z score -0.30 ± 1.23], but normal in UC/IBD-U.

CONCLUSIONS

Paris classification of age at diagnosis is supported by age-related increases in ileal disease until age 10 years. Other phenotypic features, including severity, are similar across all ages. Linear growth is less impaired in CD than in historical cohorts, reflecting earlier diagnosis.

Quality and Publication of Emergency Medicine Trials Registered in ClinicalTrials.gov

Introduction

Promoting emergency medicine (EM) clinical trials research remains a priority. To characterize the status of clinical EM research, this study assessed trial quality, funding source, and publication of EM clinical trials and compared EM and non-EM trials on these key metrics. We also examined the volume of EM trials and their subspecialty areas.

Methods

We abstracted data from ClinicalTrials.gov (February 2000 – September 2013) and used individual study National Clinical Trial numbers to identify published trials (January 2007 – September 2016). We used descriptive statistics and chi-square tests to examine study characteristics by EM and non-EM status, and Kaplan-Meier curves and log-rank tests to compare time to publication of completed EM and non-EM studies.

Results

We found 638 interventional EM trials and 59,512 non-EM interventional trials conducted in the United States between February 2000 and September 2013, registered on ClinicalTrials.gov. EM studies were significantly less likely than non-EM studies to be National Institutes of Health-funded or to evaluate a drug or biologic. However, EM studies had significantly larger sample sizes, and were significantly more likely to use randomization and blinding. Overall, 34.3% of EM and 26.0% of non-EM studies were published in peer-reviewed journals. By subspecialty, more EM trials concerned medical/surgical and psychiatric/neurological conditions than trauma.

Conclusion

Although EM studies were less likely to have received federal or industry funding, and the EM portfolio consisted of only 638 trials over the 14-year study period, the quality of EM trials surpassed that of non-EM trials, based on indices such as randomization and blinding. This novel finding bodes well for the future of clinical EM research, as does the higher proportion of published EM than non-EM trials. Our study also revealed that trauma studies were under-represented among EM studies. Periodic assessment of EM trials with the metrics used here could provide an informative and valuable longitudinal view of progress in clinical EM research.

Longitudinal Changes in the Genital Hiatus Preceding the Development of Pelvic Organ Prolapse

We aimed to explore relationships between changes in genital hiatus (GH) and development of pelvic organ prolapse using data from the Mothers’ Outcomes After Delivery (MOAD) Study, a Baltimore, Maryland, cohort study of parous women who underwent annual assessments during 2008–2018. Prolapse was defined as any vaginal segment protrusion beyond the hymen or reported prolapse surgery. For each case, 5 controls (matched on birth type and interval from first delivery to study enrollment) were selected using incidence sampling methods. We used a mixed model whose fixed effects described the initial size and slope of the GH as a function of prolapse status (case vs. control) and with nested (women within matched sets) random effects. Among 1,198 women followed for 1.0–7.3 years, 153 (13%) developed prolapse; 754 controls were matched to those women, yielding 3,664 visits for analysis. GH was 20% larger among the cases at enrollment (3.16 cm in cases vs. 2.62 cm in controls; P < 0.001), and the mean rate of increase in the size of the GH was more than 3 times greater (0.56 cm per 5-year period vs. 0.15 cm per 5-year period in controls; P < 0.001). Thus, to identify women at highest risk for developing prolapse, health-care providers could evaluate not simply the size of the GH but also changes in the GH over time.

Identical and Nonidentical Twins: Risk and Factors Involved in Development of Islet Autoimmunity and Type 1 Diabetes

OBJECTIVE

There are variable reports of risk of concordance for progression to islet autoantibodies and type 1 diabetes in identical twins after one twin is diagnosed. We examined development of positive autoantibodies and type 1 diabetes and the effects of genetic factors and common environment on autoantibody positivity in identical twins, nonidentical twins, and full siblings.

RESEARCH DESIGN AND METHODS

Subjects from the TrialNet Pathway to Prevention Study (N = 48,026) were screened from 2004 to 2015 for islet autoantibodies (GAD antibody [GADA], insulinoma-associated antigen 2 [IA-2A], and autoantibodies against insulin [IAA]). Of these subjects, 17,226 (157 identical twins, 283 nonidentical twins, and 16,786 full siblings) were followed for autoantibody positivity or type 1 diabetes for a median of 2.1 years.

RESULTS

At screening, identical twins were more likely to have positive GADA, IA-2A, and IAA than nonidentical twins or full siblings (all P < 0.0001). Younger age, male sex, and genetic factors were significant factors for expression of IA-2A, IAA, one or more positive autoantibodies, and two or more positive autoantibodies (all P ≤ 0.03). Initially autoantibody-positive identical twins had a 69% risk of diabetes by 3 years compared with 1.5% for initially autoantibody-negative identical twins. In nonidentical twins, type 1 diabetes risk by 3 years was 72% for initially multiple autoantibody-positive, 13% for single autoantibody-positive, and 0% for initially autoantibody-negative nonidentical twins. Full siblings had a 3-year type 1 diabetes risk of 47% for multiple autoantibody-positive, 12% for single autoantibody-positive, and 0.5% for initially autoantibody-negative subjects.

CONCLUSIONS

Risk of type 1 diabetes at 3 years is high for initially multiple and single autoantibody-positive identical twins and multiple autoantibody-positive nonidentical twins. Genetic predisposition, age, and male sex are significant risk factors for development of positive autoantibodies in twins.

Association of Delivery Mode With Pelvic Floor Disorders After Childbirth

IMPORTANCE

Pelvic floor disorders (eg, urinary incontinence), which affect approximately 25% of women in the United States, are associated with childbirth. However, little is known about the course and progression of pelvic floor disorders over time.

OBJECTIVE

To describe the incidence of pelvic floor disorders after childbirth and identify maternal and obstetrical characteristics associated with patterns of incidence 1 to 2 decades after delivery.

DESIGN, SETTING, AND PARTICIPANTS

Women were recruited from a community hospital for this cohort study 5 to 10 years after their first delivery and followed up annually for up to 9 years. Recruitment was based on mode of delivery; delivery groups were matched for age and years since first delivery. Of 4072 eligible women, 1528 enrolled between October 2008 and December 2013. Annual follow-up continued through April 2017.

EXPOSURES

Participants were categorized into the following mode of delivery groups: cesarean birth (cesarean deliveries only), spontaneous vaginal birth (≥1 spontaneous vaginal delivery and no operative vaginal deliveries), or operative vaginal birth (≥1 operative vaginal delivery).

MAIN OUTCOMES AND MEASURES

Stress urinary incontinence (SUI), overactive bladder (OAB), and anal incontinence (AI), defined using validated threshold scores from the Epidemiology of Prolapse and Incontinence Questionnaire, and pelvic organ prolapse (POP), measured using the Pelvic Organ Prolapse Quantification Examination. Cumulative incidences, by delivery group, were estimated using parametric methods. Hazard ratios, by exposure, were estimated using semiparametric models.

RESULTS

Among 1528 women (778 in the cesarean birth group, 565 in the spontaneous vaginal birth group, and 185 in the operative vaginal birth group), the median age at first delivery was 30.6 years, 1092 women (72%) were multiparous at enrollment (2887 total deliveries), and the median age at enrollment was 38.3 years. During a median follow-up of 5.1 years (7804 person-visits), there were 138 cases of SUI, 117 cases of OAB, 168 cases of AI, and 153 cases of POP. For spontaneous vaginal delivery (reference), the 15-year cumulative incidences of pelvic floor disorders after first delivery were as follows: SUI, 34.3% (95% CI, 29.9%-38.6%); OAB, 21.8% (95% CI, 17.8%-25.7%); AI, 30.6% (95% CI, 26.4%-34.9%), and POP, 30.0% (95% CI, 25.1%-34.9%). Compared with spontaneous vaginal delivery, cesarean delivery was associated with significantly lower hazard of SUI (adjusted hazard ratio [aHR], 0.46 [95% CI, 0.32-0.67]), OAB (aHR, 0.51 [95% CI, 0.34-0.76]), and POP (aHR, 0.28 [95% CI, 0.19-0.42]), while operative vaginal delivery was associated with significantly higher hazard of AI (aHR, 1.75 [95% CI, 1.14-2.68]) and POP (aHR, 1.88 [95% CI, 1.28-2.78]). Stratifying by delivery mode, the hazard ratios for POP, relative to a genital hiatus size less than or equal to 2.5 cm, were 3.0 (95% CI, 1.7-5.3) for a genital hiatus size of 3 cm and 9.0 (95% CI, 5.5-14.8) for a genital hiatus size greater than or equal to 3.5 cm.

CONCLUSIONS AND RELEVANCE

Compared with spontaneous vaginal delivery, cesarean delivery was associated with significantly lower hazard for stress urinary incontinence, overactive bladder, and pelvic organ prolapse, while operative vaginal delivery was associated with significantly higher hazard of anal incontinence and pelvic organ prolapse. A larger genital hiatus was associated with increased risk of pelvic organ prolapse independent of delivery mode.

The European Virus Archive goes global: A growing resource for research

The European Virus Archive (EVA) was created in 2008 with funding from the FP7-EU Infrastructure Programme, in response to the need for a coordinated and readily accessible collection of viruses that could be made available to academia, public health organisations and industry. Within three years, it developed from a consortium of nine European laboratories to encompass associated partners in Africa, Russia, China, Turkey, Germany and Italy. In 2014, the H2020 Research and Innovation Framework Programme (INFRAS projects) provided support for the transformation of the EVA from a European to a global organization (EVAg). The EVAg now operates as a non-profit consortium, with 26 partners and 20 associated partners from 21 EU and non-EU countries. In this paper, we outline the structure, management and goals of the EVAg, to bring to the attention of researchers the wealth of products it can provide and to illustrate how end-users can gain access to these resources. Organisations or individuals who would like to be considered as contributors are invited to contact the EVAg coordinator, Jean-Louis Romette, at jean-louis.romette@univmed.fr.

Abstract P392: Ambulatory Arterial Stiffness Index Among Children With Chronic Kidney Disease

The ambulatory arterial stiffness index (AASI) is a non-invasive measure of arterial stiffness derived from ambulatory blood pressure monitoring (ABPM) data. Studies in children have shown higher AASI is associated with obesity and hypertension, but there are no data examining AASI in children with chronic kidney disease (CKD). We used data from the Chronic Kidney Disease in Children (CKiD) Cohort Study to evaluate the association between AASI and hypertensive status on ABPM, and to identify predictors of AASI, including BMI, proteinuria, mineral metabolism and BP parameters from ABPM. Of 639 CKiD participants at their first successful ABPM visit, the mean age was 12 years, 60% (382/639) were male, 15% (96/639) were obese and the mean eGFR was 52 ml/min/1.73m 2 . Approximately two-thirds reported antihypertensive therapy use (66%, 422/639) yet 58% (368/639) met criteria for abnormal ABPM (elevated mean awake/sleep DBP/SBP or awake/sleep load >25%). Participants who met criteria for abnormal ambulatory BP had a higher mean AASI than those with a normal ambulatory BP (0.337 and 0.307, respectively, p=0.008). Masked hypertension (MH) was common (42.4%, 284/639) and those subjects had a significantly higher AASI compared to normotensive children (Table). Male sex, age and BMI category were all positively associated with AASI, but presence of proteinuria, abnormal serum calcium or phosphate were not. AASI is associated with hypertensive status and BMI in children with CKD and may be a useful non-invasive measure of vascular stiffness in this population. The relationship of AASI to other measures of vascular stiffness such as pulse wave velocity requires further study.

A Type 1 Diabetes Genetic Risk Score Predicts Progression of Islet Autoimmunity and Development of Type 1 Diabetes in Individuals at Risk

OBJECTIVE

We tested the ability of a type 1 diabetes (T1D) genetic risk score (GRS) to predict progression of islet autoimmunity and T1D in at-risk individuals.

RESEARCH DESIGN AND METHODS

We studied the 1,244 TrialNet Pathway to Prevention study participants (T1D patients' relatives without diabetes and with one or more positive autoantibodies) who were genotyped with Illumina ImmunoChip (median [range] age at initial autoantibody determination 11.1 years [1.2-51.8], 48% male, 80.5% non-Hispanic white, median follow-up 5.4 years). Of 291 participants with a single positive autoantibody at screening, 157 converted to multiple autoantibody positivity and 55 developed diabetes. Of 953 participants with multiple positive autoantibodies at screening, 419 developed diabetes. We calculated the T1D GRS from 30 T1D-associated single nucleotide polymorphisms. We used multivariable Cox regression models, time-dependent receiver operating characteristic curves, and area under the curve (AUC) measures to evaluate prognostic utility of T1D GRS, age, sex, Diabetes Prevention Trial-Type 1 (DPT-1) Risk Score, positive autoantibody number or type, HLA DR3/DR4-DQ8 status, and race/ethnicity. We used recursive partitioning analyses to identify cut points in continuous variables.

RESULTS

Higher T1D GRS significantly increased the rate of progression to T1D adjusting for DPT-1 Risk Score, age, number of positive autoantibodies, sex, and ethnicity (hazard ratio [HR] 1.29 for a 0.05 increase, 95% CI 1.06-1.6; P = 0.011). Progression to T1D was best predicted by a combined model with GRS, number of positive autoantibodies, DPT-1 Risk Score, and age (7-year time-integrated AUC = 0.79, 5-year AUC = 0.73). Higher GRS was significantly associated with increased progression rate from single to multiple positive autoantibodies after adjusting for age, autoantibody type, ethnicity, and sex (HR 2.27 for GRS >0.295, 95% CI 1.47-3.51; P = 0.0002).

CONCLUSIONS

The T1D GRS independently predicts progression to T1D and improves prediction along T1D stages in autoantibody-positive relatives.

Genomic and epidemiological monitoring of yellow fever virus transmission potential

The yellow fever virus (YFV) epidemic in Brazil is the largest in decades. The recent discovery of YFV in Brazilian Aedes species mosquitos highlights a need to monitor the risk of reestablishment of urban YFV transmission in the Americas. We use a suite of epidemiological, spatial, and genomic approaches to characterize YFV transmission. We show that the age and sex distribution of human cases is characteristic of sylvatic transmission. Analysis of YFV cases combined with genomes generated locally reveals an early phase of sylvatic YFV transmission and spatial expansion toward previously YFV-free areas, followed by a rise in viral spillover to humans in late 2016. Our results establish a framework for monitoring YFV transmission in real time that will contribute to a global strategy to eliminate future YFV epidemics.

Incidence and risk factors for mortality after release from prison in Australia: a prospective cohort study

AIMS

To estimate the incidence and identify risk factors for mortality in adults released from prisons in the state of Queensland, Australia.

DESIGN

Prospective cohort study, linking baseline survey data with a national death register.

SETTING

Selected prisons within Queensland, Australia.

PARTICIPANTS

Adults (n = 1320) recruited in Queensland prisons within 6 weeks of expected release, between August 2008 and July 2010, followed for up to 4.7 years in the community.

MEASUREMENTS

Participants completed a comprehensive baseline survey covering psychosocial circumstances, physical and mental health, substance use and health risk behaviours. Clinical data were abstracted from prison medical records and obtained through probabilistic linkage with state-based, community health records. Dates of prison release and reincarceration were obtained from correctional records. Deaths were identified through probabilistic linkage with the National Death Index. Adjusted hazard ratios (AHR) were calculated using proportional hazards regression models. Standardized mortality ratios (SMR) were calculated using the population of Queensland as the reference. General population data were obtained from the Australian Bureau of Statistics.

FINDINGS

The rate of mortality in the cohort was higher than in the age- and sex-matched general population of Queensland for all causes [SMR = 4.0, 95% confidence interval (CI) = 2.9-5.4] and drug-related causes (SMR = 32, 95% CI = 19-55). In a multivariable model, adjusting for age, sex and Indigenous status, factors associated with increased mortality risk included expecting to have average or better funds available on release (AHR = 2.9, 99% CI = 1.2-7.1), poor mental health (AHR = 2.6, 99% CI = 1.1-6.1) and self-reported life-time history of overdose (AHR = 2.5, 99% CI = 1.04-6.2).

CONCLUSIONS

People released from prison in Queensland, Australia are at increased risk of death, due particularly to drug-related causes. Those at greatest risk of death are characterized by poor physical and mental health and a history of risky substance use.

Evaluating concurrent validity of criminal justice and clinical assessments among women on probation

BACKGROUND

Women in the criminal justice (CJ) system experience complex and comorbid medical, psychiatric, and substance use disorders, which often contribute to CJ involvement. To identify intersections between CJ and health needs, we calculated Spearman r correlations between concurrent CJ and clinical assessments from women on probation in Connecticut who were enrolled in a clinical trial. We examined longitudinal trends in CJ risk scores over 9 years of observation (2005-2014), modeling time to probation recidivism with shared gamma frailty models and comparing contiguous time points by Wilcoxon matched-pairs signed rank tests.

RESULTS

Women (N = 31) were predominantly white (67.7%) with at least some high school education (58.1%) and mostly unemployed (77.4%) and unstably housed (83.9%). Most met clinical criteria for severe substance use and/or psychiatric disorders. Concurrent measures of substance use, mental health, social support, partnerships, and risk by the Level of Service Inventory-Revised (LSI-R) and clinical assessments were not significantly correlated. The LSI-R personal/emotional sub-score, however, positively correlated with the Addiction Severity Index psychiatric composite score (r = 0.40, 95% CI 0.03-0.68, p = 0.03). After adjusting for age, race and number of previous events, having some high school education versus none marginally decreased the hazard for probation recidivism and having > 5 inpatient psychiatric admissions versus none increased the hazard of probation recidivism 7-fold (HR 7.49, 95% CI 1.33-42.12, p = 0.022). Women with 0-1 recurrent probation terms (n = 16) had a significantly lower mean LSI-R score than those with 2-4 recurrent probation terms (35.9 [SD 6.4] versus 39.2 [SD 3.0], p = 0.019), but repeated LSI-R scores did not change over time, nor vary significantly beyond the group mean.

CONCLUSIONS

In this small, quantitative study of women on probation, widely used CJ assessment tools poorly reflected women's comorbid medical, psychiatric, and substance use needs and varied minimally over time. Findings illustrate the limitations of contemporary CJ assessment tools for women with complex needs. The field requires more comprehensive assessments of women's social and health needs to develop individualized targeted case plans that simultaneously improve health and CJ outcomes.

Use of prescribed smoking cessation pharmacotherapy following release from prison: a prospective data linkage study

BACKGROUND

A significant proportion of people who cycle through prisons express a desire to quit smoking, yet smoking rates in this population are two to four times higher than in the general community. Smoking cessation pharmacotherapy (SCP) is an important component of evidence-based cessation support, yet no studies have examined use of this pharmacotherapy after release from prison.

METHODS

We linked data from a survey of 971 smokers who were within 8 weeks of release from prison in Queensland, Australia, with federal Pharmaceutical Benefits Scheme (PBS) records for the 2 years after release, to identify subsidised use of SCP (varenicline, bupropion and nicotine patches). We used Cox proportional hazards regression to identify independent predictors of SCP use.

FINDINGS

According to PBS data, 86 participants (8.9%) accessed SCP in the 2 years following release from prison. Participants who were aged 25 years or older (HR 2.51, 95% CI 1.19 to 5.31), employed before prison (HR 1.93, 95% CI 1.14 to 3.28), highly nicotine dependent at baseline (HR 2.21, 95% CI 1.23 to 3.97) and using non-psychotropic medications in prison (HR 2.29, 95% CI 1.24 to 4.22) were more likely to use subsidised SCP during follow-up.

CONCLUSION

Despite a very high rate of tobacco use among people cycling through prisons and the very low cost of (subsidised) SCP in Australia, few ex-prisoners obtain pharmaceutical assistance with quitting smoking. Policy attention needs to focus on supporting former prisoners to access SCP, to reduce the high rate of tobacco-related morbidity and mortality in this profoundly marginalised population.

High rates of general practice attendance by former prisoners: a prospective cohort study

OBJECTIVES

To determine the rates at which people recently released from prison attend general practitioners, and to describe service users and their encounters.

DESIGN, PARTICIPANTS AND SETTING

Prospective cohort study of 1190 prisoners in Queensland, interviewed up to 6 weeks before expected release from custody (August 2008 - July 2010); their responses were linked prospectively with Medicare and Pharmaceutical Benefits Scheme data for the 2 years after their release. General practice attendance was compared with that of members of the general Queensland population of the same sex and in the same age groups.

MAIN OUTCOME MEASURES

Rates of general practice attendance by former prisoners during the 2 years following their release from prison.

RESULTS

In the 2 years following release from custody, former prisoners attended general practice services twice as frequently (standardised rate ratio, 2.04; 95% CI, 2.00-2.07) as other Queenslanders; 87% of participants visited a GP at least once during this time. 42% of encounters resulted in a filled prescription, and 12% in diagnostic testing. Factors associated with higher rates of general practice attendance included history of risky opiate use (incidence rate ratio [IRR], 2.09; 95% CI, 1.65-2.65), having ever been diagnosed with a mental disorder (IRR, 1.32; 95% CI, 1.14-1.53), and receiving medication while in prison (IRR, 1.82; 95% CI, 1.58-2.10).

CONCLUSIONS

Former prisoners visited general practice services with greater frequency than the general Queensland population. This is consistent with their complex health needs, and suggests that increasing access to primary care to improve the health of former prisoners may be insufficient, and should be accompanied by improving the quality, continuity, and cultural appropriateness of care.

Self-harm following release from prison: A prospective data linkage study

OBJECTIVE

Prisoners are at increased risk of both self-harm and suicide compared with the general population, and the risk of suicide after release from prison is three times greater than for those still incarcerated. However, surprisingly little is known about the incidence of self-harm following release from prison. We aimed to determine the incidence of, identify risk factors for and characterise emergency department presentations resulting from self-harm in adults after release from prison.

METHOD

Cohort study of 1325 adults interviewed prior to release from prison, linked prospectively with State correctional and emergency department records. Data from all emergency department presentations resulting from self-harm were secondarily coded to characterise these presentations. We used negative binomial regression to identify independent predictors of such presentations.

RESULTS

During 3192 person-years of follow-up (median 2.6 years per participant), there were 3755 emergency department presentations. In all, 83 (6.4%) participants presented due to self-harm, accounting for 165 (4.4%) presentations. The crude incidence rates of self-harm for males and females were 49.2 (95% confidence interval: [41.2, 58.7]) and 60.5 (95% confidence interval: [44.9, 81.6]) per 1000 person-years, respectively. Presenting due to self-harm was associated with being Indigenous (incidence rate ratio: 2.01; 95% confidence interval: [1.11, 3.62]), having a lifetime history of a mental disorder (incidence rate ratio: 2.13; 95% confidence interval: [1.19, 3.82]), having previously been hospitalised for psychiatric treatment (incidence rate ratio: 2.68; 95% confidence interval: [1.40, 5.14]) and having previously presented due to self-harm (incidence rate ratio: 3.91; 95% confidence interval: [1.85, 8.30]).

CONCLUSION

Following release from prison, one in 15 ex-prisoners presented to an emergency department due to self-harm, within an average of 2.6 years of release. Demographic and mental health variables help to identify at-risk groups, and such presentations could provide opportunities for suicide prevention in this population. Transition from prison to the community is challenging, particularly for those with a history of mental disorder; mental health support during and after release may reduce the risk of adverse outcomes, including self-harm.

Agreement between self-reported healthcare service use and administrative records in a longitudinal study of adults recently released from prison

BACKGROUND

Studies of healthcare service use often rely on self-reported data, especially in disadvantaged populations. Despite this, the reliability of self-reported healthcare service use is often questioned and routinely-collected, administrative data are usually considered preferable. In this paper we examine the agreement between self-reported healthcare service use and administrative records, in a large cohort of adults recently released from prison in Australia.

METHODS

Baseline interviews within 6 weeks of expected release from prison and follow-up interviews at 1, 3 and 6 months post-release were linked to routinely-collected, administrative health records over the same time period. Outcomes of interest included use of primary care, emergency department presentation, hospitalisation and dispensing of subsidised pharmaceuticals. Kappa statistics and positive and negative predictive values were calculated for each service type and time point, and a modified Poisson regression was used to identify participant characteristics associated with better agreement.

RESULTS

864 participants completed interviews and were successfully linked to administrative records. There was good agreement between self-report and administrative health records. Agreement between data sources at 1 month was best for psychotropic medications (kappa = 0.79) and primary care visits (kappa = 0.69).

CONCLUSION

Despite a common perception that studies using self-reported data are subject to bias, particularly among the disadvantaged, our findings suggest that self-reported healthcare may be valid in vulnerable populations.

A Century of Progress: Reading Interventions for Students in Grades 4-12, 1914-2014

The history of research on interventions for struggling readers in Grades 4 through 12 dates back to 19th-century case studies of seemingly intelligent children who were unable to learn to read. Physicians, psychologists, educators, and others were determined to help them. In the process, they launched a century of research on a wide variety of approaches to reading intervention. As shown in this systematic narrative review, much has changed over time in the conceptualization of reading interventions and the methods used to determine their efficacy in improving outcomes for struggling readers. Building on the knowledge gathered over the past 100 years, researchers and practitioners are well-poised to continue to make progress in developing and testing reading interventions over the next 100 years.