Short-term changes in mental health help-seeking behaviors following exposure to multiple social stressors and a natural disaster

In 2020, unprecedented circumstances led to significant mental health consequences. Individuals faced mental health stressors that extended beyond the devastating impact of the COVID-19 pandemic, including widespread social unrest following the murder of George Floyd, an intense hurricane season in the Atlantic, and the politically divisive 2020 election. The objective of this analysis was to consider changes in help-seeking behavior following exposure to multiple social stressors and a natural disaster. Data from Crisis Text Line (CTL), a national text-based mental health crisis counseling service, was used to determine how help-seeking behavior changed in the wake of each event. Wilcoxon rank sum tests assessed changes in help-seeking behavior for each event in 2020 as compared to the same period in 2019. AutoRegressive Integrated Moving Average (ARIMA) models examined if changes in crisis conversation volumes following each event differed. Higher median conversation volumes noted for the COVID-19 pandemic (+1 to +5 conversations), Hurricane Laura (+1 to +7 conversations) and the 2020 Election (+1 to +26 conversations). ARIMA models show substantial increases in help-seeking behavior following the declaration of a national emergency for the COVID-19 pandemic (+4.3 to +38.2%) and following the 2020 election (+3 to +24.44%). Our analysis found that the mental health response following social stressors may be distinct from natural events, especially when natural disasters occur in the context of multiple social stressors. This analysis adds to the growing body of literature considering the mental health impact of exposure to multiple co-occurring societal stressors, like police violence and a global pandemic.

Targeted effect of ischemic preconditioning on the gas exchange threshold in healthy males and females

Ischemic preconditioning (IPC) appears to improve exercise performance although there is uncertainty about the intensity dependence of this effect. The present study sought to clarify effects of IPC on physiological responses at and below peak oxygen uptake, including the gas exchange threshold (GET). Ten male and female participants completed five cycling ramp tests (10 W/min) to failure, with the final two tests preceded by either IPC (4 × 5 min 220 mmHg bilateral leg occlusions) or SHAM (20 mmHg), in a randomised crossover design. The rates of O2 uptake ( V ˙ O2), carbon dioxide output ( V ˙ CO2), and expired ventilation ( V ˙ E) were measured at rest and throughout exercise. Exercise data were fitted using several functions to identify GET, two ventilatory thresholds and peak V ˙ O2. IPC increased V ˙ O2 at GET by ~ 9% (IPC: 1.89 ± 0.51 L/min, SHAM: 1.73 ± 0.56 L/min; p = 0.055) and power output at GET by ~ 11% (IPC: 133 ± 36 W, SHAM: 120 ± 39 W; p = 0.022). In addition, peak power output increased by 2.4% following IPC (IPC: 217 ± 50 W, SHAM: 212 ± 51 W; p = 0.052), but there was no significant effect of IPC on peak V ˙ O2 (IPC: 2.87 ± 0.68 L/min, SHAM: 2.84 ± 0.73 L/min; p = 0.60) or the ventilatory thresholds. The present results suggest that IPC improves GET and peak power output but not peak V ˙ O2 during a maximal graded test.

The Blunt Liver and Spleen Trauma (BLAST) audit: national survey and prospective audit of children with blunt liver and spleen trauma in major trauma centres

PURPOSE

To compare the reported and observed management of UK children with blunt liver or spleen injury (BLSI) to the American Pediatric Surgical Association (APSA) 2019 BLSI guidance.

METHODS

UK Paediatric Major Trauma Centres (pMTCs) undertook 1 year of prospective data collection on children admitted to or discussed with those centres with BLSI and an online questionnaire was distributed to all consultants who care for children with BLSI in those centres.

RESULTS

All 21/21 (100%) pMTCs participated; 131 patients were included and 100/152 (65%) consultants responded to the survey. ICU care was reported and observed to be primarily determined using haemodynamic status or concomitant injuries rather than injury grade, in accordance with APSA guidance. Bed rest was reported to be determined by grade of injury by 63% of survey respondents and observed in a similar proportion of patients. Contrary to APSA guidance, follow-up radiological assessment of the injured spleen or liver was undertaken in 44% of patients before discharge and 32% after discharge, the majority of whom were asymptomatic.

CONCLUSIONS

UK management of BLSI differs from many aspects of APSA guidance. A shift towards using clinical features to determine ICU admission and readiness for discharge is demonstrated, in line with a strong evidence base. However, routine bed rest and re-imaging after BLSI is common, contrary to APSA guidance. This disparity may exist due to concern that evidence around the incidence, presentation and natural history of complications after conservatively managed BLSI, particularly bleeding from pseudoaneurysms, is weak.

Prevalence of incidental sonographic findings of hepatic steatosis in children under 4 years of age

BACKGROUND

The age of onset of nonalcoholic fatty liver disease (NAFLD) and its prevalence in young children is incompletely understood.

OBJECTIVE

We sought to evaluate the prevalence of ultrasound findings of hepatic steatosis in a cohort of children less than 4 years of age.

MATERIALS AND METHODS

This is an institutional review board-approved retrospective review of ultrasounds performed on children less than 4 years of age from January 2022 to August 2022 at a single quaternary care center. Two independent blinded reviewers evaluated for qualitative and semi-quantitative findings of hepatic steatosis. Per prior literature, hepatorenal index (HRI)>1.75 was used as a threshold suggestive of hepatic steatosis. Chi-square, Mann-Whitney U test, and logistic regression analyses were performed for univariable and multivariable statistical analyses. Kappa statistics were used to assess agreement between reviewers.

RESULTS

Eighty-five males and 102 females, median age of 1.1 years (interquartile range 2.1 years), were included. Qualitative findings of hepatic steatosis were seen in 26/187 (14%; 95% CI 10-20%). An HRI>1.75 was present in 15/187 (8%; 95% CI: 5-13%) of examinations, including 11 females and 4 males, and 7/123 (6%) participants <2 years old. Among participants with overweight or obesity, 8/43 (19%) had HRI>1.75 vs. 7/144 (5%) participants without overweight or obesity (P=0.004). Each percentile increase in anthropometrics percentile (weight-to-length or BMI, depending on age) was associated with 22 increased odds of HRI>1.75 (P=0.02).

CONCLUSION

Prevalence of sonographic findings of hepatic steatosis in an unselected sample of preschool-age children is 8-14%, and are more common in participants with overweight/obesity.

Detection of Alicyclobacillus spp. and Identification of Guaiacol Production Using the GENE-UP® PRO ACB, IFU Method No. 12, and Cosmo Bio Assays

Some species of Alicyclobacillus spoil beverages by producing guaiacol. Current culture-based methods detect the presence of Alicyclobacillus spp. and a subsequent peroxidase assay determines if the isolate can produce guaiacol. However, these methods are time-consuming and can yield false negatives due to differences in growth optima among species. The purpose of this study was to compare a RT-PCR-based method, the GENE-UP® PRO ACB assay, to the IFU Method No. 12 Enumeration and Enrichment methods. Ten species of Alicyclobacillus were detected using the tested RT-PCR assay, while A. dauci and A. kakegewensis were not detected using either IFU protocol. Low concentrations (1-10, 10-100, and 100-1,000 CFU/10 mL) of A. acidoterrestris, A. suci, and A. acidocaldarius were tested in five matrices. The proportion of positive samples identified using the tested RT-PCR assay (62/84) or the IFU Enrichment protocol (62/84) did not differ significantly from the proportion of inoculated samples (63/84). However, the IFU Enumeration method (32/84) detected statistically fewer positives. Additionally, methods identifying guaiacol production were compared. The proportion of correctly identified guaiacol producers using the tested RT-PCR assay (51/63) was not significantly different than those identified using the 3 h Cosmo Bio assay (54/63). Finally, four commercial samples of orange juice and sucrose solution were tested. Alicyclobacillus spp. were identified in all four samples using the IFU Enrichment method and in two samples using the tested RT-PCR assay. However, Alicyclobacillus was not detected in any sample using the IFU Enumeration method. Overall, this study showed consistent detection of Alicyclobacillus spp. using either the IFU Enrichment protocol or the tested RT-PCR assay, which both outperformed the IFU Enumeration protocol. Both the 3 h guaiacol bioassay and the tested RT-PCR assays consistently differentiated guaiacol-producing and nonproducing strains.

Cascading disasters and mental health: The February 2021 winter storm and power crisis in Texas, USA

In February 2021, the state of Texas and large parts of the US were affected by a severe cold air outbreak and winter weather event. This event resulted in large-scale power outages and cascading impacts, including limited access to potable water, multiple days without electricity, and large-scale infrastructure damage. Little is known about the mental health implications of these events, as most research has predominantly focused on the mental health effects of exposure to hurricanes, wildfires, or other natural disasters that are more commonly found in the summer months. This study aimed to analyze the crisis responses from the 2021 winter weather event in Texas using Crisis Text Line, a text-based messaging service that provides confidential crisis counseling nationwide. To date, Crisis Text Line is the largest national crisis text service, with over 8 million crisis conversations since its inception in 2013. We employed multiple analytic techniques, including segmented regression, interrupted time series, autoregressive integrated moving average (ARIMA), and difference-in-difference (DID), to investigate distinct time periods of exposure for all crisis conversations. ARIMA and DID were further utilized to examine specific crisis outcomes, including depression, stress/anxiety, and thoughts of suicide. Results found increases in total crisis conversations and for thoughts of suicide after the initial winter weather event; however, crisis outcomes varied in time. Thoughts of suicide in high-impact regions were higher across multiple time periods (e.g., 4-weeks, 3-months, 6-months, 9-months and 11-months) compared to low-impact regions and were elevated compared to pre-event time periods for 6-months and 11-months from the initial event. Total crisis volume also remained elevated for high-impact regions compared to low-impact regions up to 11-months after the beginning of the winter event. Our work highlights that cascading winter weather events, like the Texas 2021 Winter storm, negatively impacted mental health. Future research is needed across different disaster types (e.g., cascading, concurrent events) and for specific crisis outcomes (e.g., depression, suicidal ideation) to understand the optimal timing of crisis intervention post-disaster.

Crisis Response and Suicidal Behaviors of Essential Workers and Children of Essential Workers During the COVID-19 Pandemic

OBJECTIVE

The COVID-19 pandemic has put unprecedented stress on essential workers and their children. Limited cross-sectional research has found increases in mental health conditions from workload, reduced income, and isolation among essential workers. Less research has been conducted on children of essential workers. We examined trends in the crisis response of essential workers and their children from April 2020 through August 2021.

METHODS

We investigated the impact during 3 periods of the pandemic on workers and their children using anonymized data from the Crisis Text Line on crisis help-seeking texts for thoughts of suicide or active suicidal ideation (desire, intent, capability, time frame), abuse (emotional, physical, sexual, unspecified), anxiety/stress, grief, depression, isolation, bullying, eating or body image, gender/sexual identity, self-harm, and substance use. We used generalized estimating equations to study the longitudinal change in crisis response across the later stages of the pandemic using adjusted odds ratios (aORs) for worker status and crisis outcomes.

RESULTS

Results demonstrated higher odds of crisis outcomes for thoughts of suicide (aOR = 1.06; 95% CI, 1.00-1.12) and suicide capability (aOR = 1.14; 95% CI, 1.02-1.27) among essential workers than among nonessential workers. Children of essential workers had higher odds of substance use than children of nonessential workers (aOR = 1.33; 95% CI, 1.08-1.65), particularly for Indigenous American children (aOR = 2.76; 95% CI, 1.35-5.36). Essential workers (aOR = 1.17; 95% CI, 1.07-1.27) and their children (aOR = 1.18; 95% CI, 1.07-1.30) had higher odds of grief than nonessential workers and their children.

CONCLUSION

Essential workers and their children had elevated crisis outcomes. Immediate and low-cost psychologically supportive interventions are needed to mitigate the mental health impacts of the COVID-19 pandemic on these populations.

Spatio-Temporal Clustering of Adolescent Bereavement in the United States During the Extended Response to COVID-19: A Follow-Up Study

PURPOSE

This follow-up study investigated the spatio-temporal clustering of adolescent bereavement during the extended response to COVID-19 from October 2020-January 2022 in the continental United States.

METHODS

Deidentified and anonymized bereavement data from Crisis Text Line (CTL), a text-based crisis intervention service, and SaTScan cluster analysis were used to identify space-time clustering of bereavement among adolescents, aged 24 years and less, during the COVID-19 pandemic.

RESULTS

Clustering of bereavement conversations occurred during waves of high COVID-19 case and death counts, with the highest risk occurring in the Southeastern United States during the fall of 2020 (relative risk: 5.86, confidence interval: 3.48-8.24). Of the CTL texters who shared their demographic information, Indigenous American, Black, male, and female adolescents were more likely to seek help for bereavement when compared to the other CTL users.

DISCUSSION

Findings show an increased need for bereavement counseling resources during periods of high COVID-19 cases and deaths.

Effect of nitrous oxide (N2O) on the structure and function of nitrogen-oxide reducing microbial communities

Nitrous oxide (N₂O) is a potent greenhouse gas that can be produced by nitrifying and denitrifying bacteria. Yet the effects of N₂O on microbial communities is not well understood. We used batch tests to explore the effects of N₂O on mixed denitrifying communities. Batch tests were carried out with acetate as the electron donor and with the following electron acceptors: nitrate (NO₃^-), nitrite (NO₂^-), N₂O, NO₃^- + N₂O, and NO₂^- + N₂O. Activated sludge from a municipal wastewater treatment plant was used as the inoculum. The bacteria grew readily with N₂O as the sole acceptor. When N₂O was provided along with NO₃^- or NO₂^-, it was used concurrently and resulted in higher growth rates than the same acceptors without added N₂O. The microbial communities resulting from N₂O addition were significantly different at the genus level from those with just NO₃^- or NO₂^-. Tests with N₂O as the sole added acceptor revealed a reduced diversity. Analysis of inferred gene content using PICRUSt2 indicated a greater abundance of genera with a complete denitrification pathway when growing on N₂O or NO₂^-, relative to all other tests. This suggests that specific N₂O reduction rates are high, and that N₂O alone selects for a low-diversity, fully denitrifying community. When N₂O is present with NO₂^- or NO₃^-, the microbial communities were more diverse and did not select exclusively for full denitrifiers. N₂O alone appears to select for a "generalist" community with full denitrification pathways and lower diversity. In terms of denitrification genes, the combination of acceptors with N₂O appeared to increase the number of microbes carrying nirK, while fully denitrifying bacteria appear more likely to carry nirS. Lastly, all the taxa in NO₂^- and N₂O samples were predicted to harbor nosZ. This suggests the potential for reduced N₂O emissions in denitrifying systems.

Characterization of pediatric brain tumors using pre-diagnostic neuroimaging

Purpose

To evaluate for predictive neuroimaging features of pediatric brain tumor development and quantify tumor growth characteristics in patients who had neuroimaging performed prior to a diagnosis of a brain tumor.

Methods

Retrospective review of 1098 consecutive pediatric patients at a single institution with newly diagnosed brain tumors from January 2009 to October 2021 was performed to identify patients with neuroimaging prior to the diagnosis of a brain tumor. Pre-diagnostic and diagnostic neuroimaging features (e.g., tumor size, apparent diffusion coefficient (ADC) values), clinical presentations, and neuropathology were recorded in those patients who had neuroimaging performed prior to a brain tumor diagnosis. High- and low-grade tumor sizes were fit to linear and exponential growth regression models.

Results

Fourteen of 1098 patients (1%) had neuroimaging prior to diagnosis of a brain tumor (8 females, mean age at definitive diagnosis 8.1 years, imaging interval 0.2-8.7 years). Tumor types included low-grade glioma (n = 4), embryonal tumors (n = 2), pineal tumors (n=2), ependymoma (n = 3), and others (n = 3). Pre-diagnostic imaging of corresponding tumor growth sites were abnormal in four cases (28%) and demonstrated higher ADC values in the region of high-grade tumor growth (p = 0.05). Growth regression analyses demonstrated R²-values of 0.92 and 0.91 using a linear model and 0.64 and 0.89 using an exponential model for high- and low-grade tumors, respectively; estimated minimum velocity of diameter expansion was 2.4 cm/year for high-grade and 0.4 cm/year for low-grade tumors. High-grade tumors demonstrated faster growth rate of diameter and solid tumor volume compared to low-grade tumors (p = 0.02, p = 0.03, respectively).

Conclusions

This is the first study to test feasibility in utilizing pre-diagnostic neuroimaging to demonstrate that linear and exponential growth rate models can be used to estimate pediatric brain tumor growth velocity and should be validated in a larger multi-institutional cohort.

What Are the Double Lines of the Fetal Cavum Septi Pellucidi on Ultrasound?

OBJECTIVE

To demonstrate the significance of the double line appearance of the septi pellucidi laminae (SPL) on fetal ultrasound.

METHOD

A total of 522 uncomplicated singleton pregnancies (15 to 39 weeks' gestational age) with fetal ultrasounds were enrolled. The presence of a single versus double line SP as well as measurement of the cavum septi pellucidi (CSP) was determined retrospectively. Ultrasound settings from the CSP images were recorded. Thickness of the SPL was measured in 20 ultrasound and 14 MRI cases; histology was reviewed from one neonate. Maternal BMI and gestational age were also recorded.

RESULTS

The presence of double line SPL is a normal sonographic finding, seen in 47% (188/403) of normal fetuses. Thickness of the SPL in 10 cases with double line averaged 1.4 mm and in 10 cases with single line averaged 0.8 mm; MRI measurements were within 0.1 mm of the corresponding ultrasound measurements. Double line cavum was more often seen with mid-dynamic contrast range settings (5, 6) rather than high range settings (7-10) (P value <.05). The double line was only visualized on ultrasound when the angle of insonation was at or near perpendicular to the laminae; it was never visualized on coronal ultrasound imaging or MRI imaging.

CONCLUSION

A double line septum pellucidum lamina is a normal finding seen in almost 50% of uncomplicated singleton pregnancies. It may be attributed to borders of cell layers within each lamina that form separate specular reflections on both sides; this can be accentuated by ultrasound settings and beam angulation.

Did it hurt? COVID-19 vaccination experience in people with multiple sclerosis

Background

Current guidelines recommend vaccination against SARS-CoV2 for people with multiple sclerosis (pwMS). The long-term review of the safety and effectiveness of COVID-19 vaccines in pwMS is limited.

Methods

Service re-evaluation. PwMS using the MS service at Barts Health National Health Service Trust were sent questionnaires via email to report symptoms following first and second COVID-19 vaccinations (n = 570). A retrospective review of electronic health records was conducted for clinical and safety data post-vaccination(s); cut-off was end of September 2021. Separate logistic regressions were carried out for symptoms experienced at each vaccination. Two sets of regressions were fitted with covariates: (i) Disease-modifying therapy type and (ii) patient characteristics for symptoms experienced.

Results

193/570 pwMS responded. 184 pwMS had both vaccinations. 144 received the AZD1222 and 49 the BNT162b2 vaccine. 87% and 75% of pwMS experienced any symptoms at first and second vaccinations, respectively. The majority of symptoms resolved within a short timeframe. No severe adverse effects were reported. Two pwMS subsequently died; one due to COVID-19 and one due to aspiration pneumonia. Males were at a reduced risk of reporting symptoms at first vaccination. There was evidence that pwMS in certain treatment groups were at reduced risk of reporting symptoms at second vaccination only.

Conclusions

Findings are consistent with our preliminary data. Symptoms post-vaccination were similar to the non-MS population and were mostly temporary. It is important to inform the MS community of vaccine safety data.

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.

984 ADVANCE CARE PLANNING ON THE COMPLEX CARE WARDS AT ROYAL BOLTON HOSPITAL

Introduction

Advance care planning (ACP) is an important aspect of geriatric medicine, giving patients the opportunity to express their wishes and identify their preferred place of care and death whilst reducing unwanted hospital admissions. At Royal Bolton Hospital we reviewed the Complex Care department’s performance in engaging with ACP discussions with appropriate patients and considered how this could be improved.

Method

In October 2020, patients were identified from the current inpatients on the Complex Care wards using the following criteria: nursing home resident, clinical frailty score (CFS) 7 or above, or CFS 6 with 3 or more hospital admissions in the last 6 months. We reviewed the patient notes to ascertain whether any ACP had occurred and then followed the patients up at 6 and 12 months. At 6 and 12 months we identified the mortality and readmission rates to quantify whether the patients had been appropriate for ACP.

Results

35 patients identified as appropriate for ACP. ACP had been conducted in 10 patients. At 6 months, 13 patients had died and 17 had had hospital readmissions, totalling 196 readmission days. At 12 months, 8 patients had died, and 8 patients had been readmitted to hospital, totalling 85 readmission days. Combining the data for the 6- and 12-month results revealed 21 patients had died and 25 had been readmitted to hospital, totalling 281 readmission days. Only 4 of the 35 patients had neither died nor been readmitted to hospital.

Conclusion

Appropriate patients were accurately identified for ACP as confirmed by their subsequent mortality and readmission rates. However, there is scope for improving the quantity of ACP discussions by the Complex Care department in these patients. Further education for the medical staff, a patient leaflet and poster aimed at the ward juniors will be introduced with the aim of doing this.

Crisis text-line interventions: Evaluation of texters' perceptions of effectiveness

OBJECTIVE

Crisis Text Line (CTL), the largest provider of text-based crisis intervention services in the U.S., has answered nearly 7 million conversations since its inception in 2013. The study's objective was to assess texter's perceptions of the effectiveness of CTL crisis interventions.

METHOD

Survey data completed by 85,877 texters linked to volunteer crisis counselor (CC) reports from October 12, 2017, to October 11, 2018 were analyzed. The relationship of several effectiveness measures with texters' demographic and psychosocial characteristics, frequency of CTL usage, and texters' perceptions of engagement with their CCs was examined using a series of logistic regression analyses.

RESULTS

By the end of the text-based conversation, nearly 90% of suicidal texters reported that the conversation was helpful, and nearly half reported being less suicidal.

CONCLUSIONS

Our study offers evidence for CTL's perceived effectiveness. These findings are of critical importance in light of the launch of a nationwide three-digit number (988) for suicide prevention and mental health crisis supports in the U.S., which will include texting.

Individuals who text crisis text line: Key characteristics and opportunities for suicide prevention

OBJECTIVE

Text-based crisis services are increasingly prominent, with inclusion in the national 988 crisis number launching in 2022. Yet little is known about who uses them. This study seeks to understand the population served by Crisis Text Line (CTL), the largest crisis text service in the United States.

METHODS

Secondary data analysis was conducted on de-identified Crisis Counselor reports, texter post-conversation survey responses, and anonymized text conversation data from 85,877 texters who contacted CTL during a 12-month period. We examined Crisis Counselor's ratings of suicide ideation severity, texters' reports of race, gender, sexual orientation, recent mental health symptoms, and additional sources of help, and logs of frequency of contact.

RESULTS

76% of texters were under 25. 79% were female. 48% identified as other than heterosexual/straight. 64% had only one conversation. 79% were above the clinical cutoff for depression and 80% for anxiety, while 23% had thoughts of suicide. 23% received help from a doctor or therapist, and 28% received help only from CTL.

CONCLUSIONS

CTL reaches a highly distressed, young, mostly female population, including typically underserved minorities and a substantial percentage of individuals who do not receive help elsewhere. These findings support the decision to include texting in the forthcoming national 988 implementation.

Identification of Distinct Long COVID Clinical Phenotypes Through Cluster Analysis of Self-Reported Symptoms

Background

We aimed to describe the clinical presentation of individuals presenting with prolonged recovery from coronavirus disease 2019 (COVID-19), known as long COVID.

Methods

This was an analysis within a multicenter, prospective cohort study of individuals with a confirmed diagnosis of COVID-19 and persistent symptoms >4 weeks from onset of acute symptoms. We performed a multiple correspondence analysis (MCA) on the most common self-reported symptoms and hierarchical clustering on the results of the MCA to identify symptom clusters.

Results

Two hundred thirty-three individuals were included in the analysis; the median age of the cohort was 43 (interquartile range [IQR], 36–54) years, 74% were women, and 77.3% reported a mild initial illness. MCA and hierarchical clustering revealed 3 clusters. Cluster 1 had predominantly pain symptoms with a higher proportion of joint pain, myalgia, and headache; cluster 2 had a preponderance of cardiovascular symptoms with prominent chest pain, shortness of breath, and palpitations; and cluster 3 had significantly fewer symptoms than the other clusters (2 [IQR, 2–3] symptoms per individual in cluster 3 vs 6 [IQR, 5–7] and 4 [IQR, 3–5] in clusters 1 and 2, respectively; P < .001). Clusters 1 and 2 had greater functional impairment, demonstrated by significantly longer work absence, higher dyspnea scores, and lower scores in SF-36 domains of general health, physical functioning, and role limitation due to physical functioning and social functioning.

Conclusions

Clusters of symptoms are evident in long COVID patients that are associated with functional impairments and may point to distinct underlying pathophysiologic mechanisms of disease.

A highly virulent variant of HIV-1 circulating in the Netherlands

We discovered a highly virulent variant of subtype-B HIV-1 in the Netherlands. One hundred nine individuals with this variant had a 0.54 to 0.74 log₁₀ increase (i.e., a ~3.5-fold to 5.5-fold increase) in viral load compared with, and exhibited CD4 cell decline twice as fast as, 6604 individuals with other subtype-B strains. Without treatment, advanced HIV-CD4 cell counts below 350 cells per cubic millimeter, with long-term clinical consequences-is expected to be reached, on average, 9 months after diagnosis for individuals in their thirties with this variant. Age, sex, suspected mode of transmission, and place of birth for the aforementioned 109 individuals were typical for HIV-positive people in the Netherlands, which suggests that the increased virulence is attributable to the viral strain. Genetic sequence analysis suggests that this variant arose in the 1990s from de novo mutation, not recombination, with increased transmissibility and an unfamiliar molecular mechanism of virulence.

Understanding the concurrent risk of mental health and dangerous wildfire events in the COVID-19 pandemic

Little research has examined the mental health risks of concurrent disasters. For example, disasters like wildfires have been shown to have a strong association with psychological symptoms-the 2020 U.S. Western wildfire season was the worst on record and occurred while the country was still navigating the COVID-19 pandemic. We implemented two quasi-experimental analyses, an interrupted time series analysis, and a difference-in-difference analysis to evaluate the impacts of wildfires and COVID-19 on mental health crisis help-seeking patterns. Both methods showed no statistical association between exposure to wildfires and the seeking of mental health support during the COVID-19 pandemic. Results highlighted that 2020 wildfires were not associated with an acute increase in crisis texts for youth in the two months after the events, likely due to an already elevated text volume in response to the COVID-19 pandemic from March 2020 throughout the fall wildfire season (Aug to Oct 2020). Future research is needed outside of the context of the pandemic to understand the effects of extreme and concurrent climatic events on adolescent mental health, and targeted interventions are required to ensure youth and adolescents are receiving adequate support during these types of crisis events.

Crisis Response and Suicidal Patterns in U.S. Youth Before and During COVID-19: A Latent Class Analysis

PURPOSE

This study characterized the unobserved patterns in crisis response among youth in the U.S. from March to December 2020 and determined the characteristics of vulnerable subgroups who were at increased risk for suicide due to the pandemic.

METHODS

A latent class analysis of crisis support-seeking from a national text-based crisis platform, (n = 179,497, aged 24 years or younger) for 11 crisis concerns (e.g., depression, anxiety/stress, suicidal thoughts, isolation, abuse, bereavement, relationships) was performed on three study periods: (1) January 2017 to December 2020, (2) prepandemic: 1 January 2017 to 12 March 2020, and (3) pandemic: 13 March to 20 December 2020. Demographic characteristics (age, race/ethnicity, sexual orientation, and gender identity) were used as predictors for class membership using the three-step method.

RESULTS

Four latent classes were identified: (1) depression/isolation/self-harm (D/I/S) (18,694 texters, 10.4%), (2) interpersonal stress/mood-anxiety (I/M) (32,640 texters, 18.2%), (3) suicidal thoughts/depressed (S/D) (34,067, 19.0%), and (4) adjustment/stress (A/S) (94,096 texters, 52.4%). During the pandemic, an increase in suicidal thoughts and active rescues occurred in the D/I/S and S/D higher-risk subclasses. Characteristics of vulnerable groups in higher-risk classes since the pandemic included children, LGBTQ, American Indian, White, Black, Asian, female, and gender-nonconforming youth.

CONCLUSIONS

Results identified a strong association with class membership in more severe risk classes during the pandemic and an increase in suicidal help-seeking, particularly among children and LGBTQ youth. Low-cost and targeted crisis text-based platforms for support-seeking in youth may be one potential safety net strategy to address the effects of the COVID-19 pandemic on mental health in youth.

[Comparison of subjective improvement in quality of life of patients after open and minimally invasive surgical techniques for recanalization of lacrimal duct stenosis in 2015-2018]

BACKGROUND

Open and minimally invasive tear duct surgery are among the common surgical indications; however, little is known so far about the respective influences on the quality of life.

OBJECTIVE

The aim of this study was to compare the subjective influence on the quality of life of patients after open and minimally invasive surgical techniques for recanalization of dacryostenosis.

MATERIAL AND METHODS

From the collective of patients who were surgically treated at the University Medical Center Hamburg-Eppendorf from 2015 to 2018, a total of 169 patients (111 dacryocystorhinostomy, DCR, 58 endoscopy) took part in the survey and answered 9 questions about subjective satisfaction, which were evaluated also comparatively.

RESULTS

When asked about postoperative satisfaction, the patients were significantly more satisfied after DCR (p = 0.001) than the patients who underwent a lacrimal endoscopy. There was no significant difference in terms of postoperative complications (p = 0.348). The rate of reoperations, however, was significantly higher in the patient group who underwent lacrimal endoscopy (χ2-test, p = 0.004).

CONCLUSION

In summary it can be said that DCR is not inferior to lacrimal endoscopy in terms of patient satisfaction.

ReIMAGINE: a prostate cancer research consortium with added value through its patient and public involvement and engagement

BACKGROUND

ReIMAGINE aims to improve the current prostate specific antigen (PSA)/biopsy risk stratification for prostate cancer (PCa) and develop a new image-based method (with biomarkers) for diagnosing high/low risk PCa in men. ReIMAGINE's varied patient and public involvement (PPI) and engagement (PE) strategy maximises the impact of its scientific output by informing and shaping the different stages of research.

AIMS

Through including the voice of patients and the public, the ReIMAGINE Consortium aims to translate these different perspectives into the design and implementation process. This will improve the overall quality of the research by: reflecting the needs and priorities of patients and the public, ensuring methods and procedures are feasible and appropriate ensuring information is relevant and accessible to those being recruited to the study identifying dissemination channels relevant to patients/the public and developing outputs that are accessible to a lay audience With support from our patient/user groups, the ReIMAGINE Consortium aims to improve our ability to derive prognostic information and allocate men to the most appropriate and effective therapies, using a novel image-based risk stratification with investigation of non-imaging biomarkers.

FINDINGS

We have been working with patients and the public from initiation of the project to ensure that the research is relevant to men and their families. Our PPI Sub-Committee, led by a PCa patient, has been involved in our dissemination strategy, outreach activities, and study design recommendations. For example, the sub-committee have developed a variety of informative videos relevant and accessible to those being recruited, and organised multiple online research engagement events that are accessible to a lay audience. As quoted by one of the study participants, "the more we present the benefits and opportunities to patients and the public, the more research commitment we obtain, and the sooner critical clinical questions such as PCa diagnostics will be addressed".

77 Lessons Learnt from Managing Orthopaedic Trauma During the First Wave of the COVID-19 Pandemic at a UK District General Hospital

Background

The Coronavirus disease (COVID-19) pandemic has contributed to over 900,000 deaths worldwide. Hospitals responded by expanding services to accommodate the forecasted rise in COVID-19-related admissions. We describe the effects these changes had on management of orthopaedic trauma and patient outcomes at a district general hospital in Southern England.

Method

Data were extrapolated retrospectively from two separate six-week periods in 2019 and 2020 (1st April - 13th May) using electronic records of patients referred to the orthopaedic team. Soft tissue injuries were included where a confirmed diagnosis was made with radiological evidence. Patients were excluded if no orthopaedic intervention was required. Data were compared between the two time periods.

Results

There were fewer attendances to hospital in 2020 compared with 2019 (178 vs 328), but time from presentation to surgery significantly increased in 2020 (2.94 days vs 4.91 days, p = 0.009). There were fewer operative complications in 2020 (36/145 vs 11/88, p &lt; 0.001). However, ordinal logistic regression analysis found a significantly greater complication severity in 2020 including death (p = 0.039). Complication severity was unrelated to COVID-19 status.

Conclusions

Restructuring of orthopaedic services in response to the COVID-19 pandemic has been associated with significant delays to surgery and higher post-operative complication severity. Our results demonstrate the need for fast-track emergency operative orthopaedic services in UK district general hospitals whilst the COVID-19 pandemic continues.

Validation Study for VERIPRO® SARS-CoV-2 Env Assay for the Detection of SARS-CoV-2 from Stainless-Steel Environmental Surface Swabs: Emergency Response Validation-AOAC Performance Tested MethodSM 122001

Background

The VERIPRO SARS-CoV-2 Env assay uses reverse transcriptase PCR (RT-PCR) to detect SARS-CoV-2, the causative agent of COVID-19, from stainless steel environmental sample swabs.

Objective

To validate the VERIPRO SARS-CoV-2 Env assay as part of the AOAC Research Institute’s Emergency Response Validation Performance Tested Method^SM program.

Methods

The VERIPRO SARS-CoV-2 Env assay was evaluated for specificity using in silico analysis of 15 764 SARS-CoV-2 sequences and 65 exclusivity organisms (both near neighbors and background organisms). The candidate method was evaluated in an unpaired study design for one environmental surface (stainless steel) and compared to the U.S. Centers for Disease Control and Prevention 2019-Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel, Instructions for Use (Revision 4, Effective 6/12/2020).

Results

Results of the in silico analysis demonstrated the specificity of the method in being able to detect target sequences and discriminate them from near neighbors. In the matrix study, the candidate method demonstrated statistically significant better recovery of the target analyte than the reference method.

Conclusions

The VERIPRO SARS-CoV-2 Env assay is a rapid and accurate method that can be utilized by food producers to detect the causative agent of COVID-19 on food contact surfaces.

Highlights

The VERIPRO SARS-CoV-2 Env assay can be performed without the need for an optional RNA purification step to detect SARS-CoV-2 from environmental surfaces.

Spatial Clustering of Adolescent Bereavement in the United States During the COVID-19 Pandemic

PURPOSE

Few studies have examined grief and bereavement in the context of a pandemic, particularly among young people during the ongoing COVID-19 pandemic.

METHODS

The objective of this study is to examine spatiotemporal clustering of bereavement using data from Crisis Text Line, an SMS-based intervention with widespread usage among youth and adolescents in the United States from January 2017 to September 2020.

RESULTS

Results found significant spatial clustering of bereavement during the pandemic period in the late summer months compared with the onset of the pandemic.

CONCLUSION

Our study provides the first evidence of elevated bereavement in adolescents using a technique for rapidly identifying clusters of bereavement risk among this vulnerable subgroup. Findings can be leveraged for targeted interventions and supportive counseling in geographic hotspots.

918 COVID-19: A Detailed Analysis on Fit-Testing for Respiratory Protective Equipment in the UK

Introduction

There is limited data in the literature regarding the adequacy of generic FFP3 masks and their facial fit to ensure adequate protection. Mask fit-testing is therefore essential to protect healthcare workers.

Method

Using the Freedom of Information Act, 137 acute NHS trusts in the UK were approached on the 26/3/2020 by an independent researcher to provide data on the outcome of fit testing at each site.

Results

85 Trusts responded to the FOI with 51 trusts providing pertinent data relevant to the FOI request. There was a total of 72 mask types used across 51 trusts. The commonest of which was the FFP3M1863 (used by 47/51 trusts, 92.16%). A positive correlation was found between staff members and number of mask types used (r = 0.75, P = &lt;0.05).

Overall fit-testing pass rates were provided by 32 trusts. The mean percentage pass rate was 80.74%.

Gender specific failure rates were provided by seven trusts. 4386 males underwent fit-testing in comparison to 16305 females. Across all seven trusts 20.08% of men tested failed the fit-test while only 19.89% of women failed the fit-test.

Conclusions

Our results may be utilised in choosing respirators for fit testing programme in healthcare-workers during the COVID-19 pandemic.

Fit-testing of respiratory protective equipment in the UK during the initial response to the COVID-19 pandemic

Background

Public Health England guidance stipulates the use of filtering facepiece (FFP3) masks for healthcare workers engaged in aerosol-generating procedures. Mask fit-testing of respiratory protective equipment is essential to protect healthcare workers from aerosolized particles.

Aim

To analyse the outcome of mask fit-testing across National Health Service (NHS) hospitals in the UK during the first wave of the coronavirus disease 2019 (COVID-19) pandemic.

Methods

Using the Freedom of Information Act, 137 NHS hospitals were approached on May 26^th, 2020 by an independent researcher to provide data on the outcome of fit-testing at each site.

Findings

Ninety-six hospitals responded to the request between May 26^th, 2020 to October 29^th, 2020. There was a total of 86 mask types used across 56 hospitals, 13 of which were used in at least 10% of these hospitals; the most frequently used was the FFP3M1863, used by 92.86% of hospitals. Overall fit-testing pass rates were provided by 32 hospitals with mean pass rate of 80.74%. The most successful masks, in terms of fit-test failure rates, were the Alpha Solway 3030V and the Alpha Solway S–3V (both reporting mean fit-test failures of 2%). Male- and female-specific pass and failure rates were provided by seven hospitals. Across the seven hospitals, 20.1% of men tested failed the fit-test for all masks used, whereas 19.9% of women tested failed the fit-test for all masks used. Failure rates were significantly higher in staff from Black, Asian, and Minority Ethnic (BAME) backgrounds 644/2507 (25.69%) across four hospitals.

Conclusion

Twenty percent of healthcare workers tested during the first response to the pandemic failed fit-testing for masks. A small sample revealed that this was most prominent in staff from BAME backgrounds.

Prospects for beyond the Standard Model physics searches at the Deep Underground Neutrino Experiment: DUNE Collaboration

The Deep Underground Neutrino Experiment (DUNE) will be a powerful tool for a variety of physics topics. The high-intensity proton beams provide a large neutrino flux, sampled by a near detector system consisting of a combination of capable precision detectors, and by the massive far detector system located deep underground. This configuration sets up DUNE as a machine for discovery, as it enables opportunities not only to perform precision neutrino measurements that may uncover deviations from the present three-flavor mixing paradigm, but also to discover new particles and unveil new interactions and symmetries beyond those predicted in the Standard Model (SM). Of the many potential beyond the Standard Model (BSM) topics DUNE will probe, this paper presents a selection of studies quantifying DUNE's sensitivities to sterile neutrino mixing, heavy neutral leptons, non-standard interactions, CPT symmetry violation, Lorentz invariance violation, neutrino trident production, dark matter from both beam induced and cosmogenic sources, baryon number violation, and other new physics topics that complement those at high-energy colliders and significantly extend the present reach.

P48 Exploration of variation in Management of Acutely Symptomatic Hernia – results from the MASH practice survey

Introduction

There is minimal evidence to guide the emergency management of groin and abdominal wall hernia. The aim of this project is to understand current variations in clinical practice across the UK when managing common types of acutely symptomatic hernia.

Methods

A survey of clinical practice was developed to explore the management of acutely symptomatic abdominal wall hernia (ASH) including groin (GH), umbilical (UH), and incisional hernia (IH). The survey captured respondent characteristics. It explored preferences in the management of each type of ASH, including factors related to treatment and repair strategy. Surgeons at ST3+ level with a UK practice were invited to participate through Twitter and collaborative networks.

Results

In total, 144 responses were received (response rate 26%). Of these, 62 (43.1%) were Consultant Surgeons, 105 (72.9%) did not have a specialist hernia practice, and 95 (66%) did not follow specific guidelines for emergency hernia repair. There was variation in investigations used e.g. CT required for IH (91%) but less for GH (34.7%) and UH (47.2%). Open repair was preferred in all settings. For GH with ischaemic bowel 76 (52.8%) would suture repair vs. 67 (46.5%) who would use a mesh (64.2% permanent synthetic) this is similar for IH, where 59 (41%) chose suture vs. 71 (49.3%) mesh, although 61.9% favoured biologic mesh for IH. Suture repair was preferred for UH with ischaemic bowel (69.4%).

Conclusion

The survey demonstrates variation in treatment of ASH. Areas which require further exploration include use of mesh and laparoscopy in the emergency setting.

[Comparative analysis of refractive and topographic changes after eyelid surgery]

Hintergrund und Ziel der Arbeit

Über die Frage, ob nach Blepharoplastik, Levatorresektion oder lateraler Zügelplastik Refraktions- oder Topographieveränderungen zu erwarten sind, besteht weitestgehend Unklarheit.

Material und Methoden

Daher wurden in der vorliegenden Studie prä- sowie postoperativ von 78 Patienten objektive Refraktion, Vorderabschnittstomographie mittels Pentacam und Visusprüfung durchgeführt und der Analyse zugeführt. Die Untersuchung erfolgte präoperativ, zum Zeitpunkt des Fadenzugs nach 10 Tagen sowie nach 3 Monaten.

Ergebnisse

Wir fanden postoperativ weder nach Blepharoplastik noch nach lateraler Zügelplastik signifikante Veränderungen von Visus oder Refraktion noch in der Topographie. Hingegen zeigt der Wilcoxon-Vorzeichen Test 10 Tage nach der Levatorresektion einen signifikanten Anstieg des Zylinders nach 10 Tagen im Vergleich zum präoperativen Niveau (p = 0,042). Diese Veränderung war jedoch nach 3 Monaten nicht mehr nachweisbar.

Schlussfolgerung

Wir postulieren daher, dass eine umfangreiche Aufklärung von Patienten hinsichtlich passagerer Sehveränderungen insbesondere bei Levatorresektionen unabdingbar ist und postoperativ eine ergänzende Refraktions- und Topographiekontrolle sinnvoll sein kann.

The presence of an insulin-like peptide-binding protein (ILPBP) in the ovary and its involvement in the ovarian development of the red deep-sea crab, Chaceon quinquedens

Invertebrate insulin-like peptide-binding proteins (ILPBPs) are structurally homologous to vertebrate insulin-like growth factor binding protein 7 (IGFBP7). One of the invertebrate ILPBPs is considered as a potential binding protein of insulin-like androgenic gland factor (IAG) in males of crayfish, Cherax quadricarinatus. However, the ILPBP expression is not limited in the androgenic gland and found in most examined tissues, implicating that ILPBP may have additional functions in crustaceans. Here, the full-length cDNA sequence of ILPBP (termed ChqILPBP) is isolated from the ovary of the red deep-sea crab, Chaceon quinquedens. ChqILPBP transcripts are present in the various tissues, as similar to other crab species. The crustacean ILPBPs have their putative amino acid sequences conserved much less than vertebrate IGFBP7s. To understand if ChqILPBP is involved in ovarian development, examined are levels of ChqILPBP, together with vitellogenin (ChqVTG) in the same ovary and hepatopancreas of adult females at the different ovarian stages: 2, 3, and 5. Chaceon hepatopancreas exhibits as the primary VTG synthesis site, while VTG transcript levels do not differ by the ovarian stages. The ovary contains ChqILPBP transcripts ~10-fold higher than hepatopancreas that changes significantly from stage 2 to 3. Such an expression pattern mirrors that of ovarian ChqVTG. In hepatopancreas, ChqILPBP transcripts are similar at stages 2 and 3 and increase significantly at stage 5. The data indicate that ovarian ILPBP may function differently from that of the hepatopancreas and may play a role in ovarian development. ChqAK transcripts are ~six folds higher in the ovary than the hepatopancreas. While they do not differ by ovarian stages, suggesting that AK may not be involved in vitellogenesis of the cold water crustacean species.

Metabolomics and a breath sensor identify acetone as a biomarker for heart failure

Introduction

Metabolomics delivers more biological and clinical insight than targeted investigations. We applied metabolomics to patients with heart failure (HF) with reduced ejection fraction (HFrEF).

Methods

46 patients with HFrEF and 20 controls underwent metabolomic profiling, including liquid/gas chromatography mass spectrometry (LC-MS/GC-MS), nuclear magnetic resonance (NMR) metabolomics and solid-phase microextraction (SPME) volatilomics in plasma and urine. HFrEF was defined using left ventricular global longitudal strain (GLS) &lt;18%, ejection fraction &lt;50% and NTproBNP ≥35 pmol/L. A low cost consumer breath acetone (BrACE) sensor validated SPME results in 69 patients.

Results

34 metabolites were identified by GCMS, 33 by LCMS and 2 volatiles by SPME (acetone, 2-pentanone in plasma and urine). Alanine, aspartate and glutamate, citric acid cycle, arginine biosynthesis, glyoxylate and dicarboxylate metabolism were altered in HFrEF. Plasma acetone correlated with NT-proBNP (r=0.59, 95% CI 0.4 to 0.7), triacylglycerol (55:9), 2-oxovaleric and cis-aconitic acid, involved with ketone metabolism and mitochondrial energetics. BrACE &gt;1.5 ppm discriminated HF from other cardiac pathology (AUC 0.88, 95% CI 0.77 to 0.99, P&lt;0.0001).

Conclusion

Breath acetone was detectable in HFrEF patients using a consumer sensor ($1/test) and although not cardiac specific, discriminated HF from other cardiac pathology.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Health Research Council of New Zealand

Aboriginal Human Research Ethics Committees ensuring culturally appropriate research

Aboriginal and Torres Strait Islander people, Australia's Indigenous peoples, make up three percent of the population of Australia. Like many other Indigenous peoples in colonised countries, they suffer the worst health and social status of any population group. Australian Indigenous people have a lower life expectancy (8.6 years lower for men and 7.8 years for women) compared with other Australians (ABS 2018a). The reasons for the poorer health outcomes are complex and include historical, political and social factors (AIHW 2015a).

The health disparity has driven a high number of research projects with a focus on Australian Indigenous people or mainstream research projects where Australian Indigenous people are overrepresented. Given the uniqueness of Australian Indigenous cultures as well as the historical, political and social context, in 1998, the Aboriginal Health and Medical Research Council of New South Wales (AH&MRC) established an Australian Indigenous-specific human research ethics committee (HREC). The AH&MRC is the Indigenous peak health body of New South Wales.

This presentation will outline the role and benefit of the AH&MRC HREC as a specialised HREC. The AH&MRC HREC is fully constituted and registered under the National Health and Medical Research Council (NHMRC). The NHMRC is the leading expert body in health and medical research in Australia and develops health research guidelines. The AH&MRC HREC is one of three AHRECs in Australia. The AH&MRC Ethics Committee not only guarantees that research is conducted ethically but also ensures research involving Indigenous people is undertaken in a culturally appropriate manner. One of the key elements required by the AH&MRC is that researchers consult Indigenous communities across all stages of the project from the design, implementation, analysis and write up.

The AH&MRC HREC is essential, ensuring the research is of benefit to the Indigenous community in NSW and is conducted in a culturally safe manner.

Key messages

Specialised Indigenous human resarch ethics committees are vital to enuring research is culturally appropriate. Spscialised human resarch ethics committees can be of benefit for other disctinct populations.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

Negative emotions towards others are diminished in remitted major depression

Background:

One influential view is that vulnerability to major depressive disorder (MDD) is associated with a proneness to experience negative emotions in general. In contrast, blame attribution theories emphasise the importance of blaming oneself rather than others for negative events. Our previous exploratory study provided support for the attributional hypothesis that patients with remitted MDD show no overall bias towards negative emotions, but a selective bias towards emotions entailing self-blame relative to emotions that entail blaming others. More specifically, we found a decreased proneness for contempt/disgust towards others relative to oneself (i.e. self-contempt bias). Here, we report a definitive test of the competing general negative versus specific attributional bias theories of MDD.

Methods:

We compared a medication-free remitted MDD (n = 101) and a control group (n = 70) with no family or personal history of MDD on a previously validated experimental test of moral emotions. The task measures proneness to specific emotions associated with different types of self-blame (guilt, shame, self-contempt/disgust, self-indignation/anger) and blame of others (other-indignation/anger, other-contempt/disgust) whilst controlling for the intensity of unpleasantness.

Results:

We confirmed the hypothesis that patients with MDD exhibit an increased self-contempt bias with a reduction in contempt/disgust towards others. Furthermore, they also showed a decreased proneness for indignation/anger towards others.

Conclusions:

This corroborates the prediction that vulnerability to MDD is associated with an imbalance of specific self- and other-blaming emotions rather than a general increase in negative emotions. This has important implications for neurocognitive models and calls for novel focussed interventions to rebalance blame in MDD.

High-pressure developments for resonant X-ray scattering experiments at I16

An experimental setup to perform high-pressure resonant X-ray scattering (RXS) experiments at low temperature on I16 at Diamond Light Source is presented. The setup consists of a membrane-driven diamond anvil cell, a panoramic dome and an optical system that allows pressure to be measured in situ using the ruby fluorescence method. The membrane cell, inspired by the Merrill-Bassett design, presents an asymmetric layout in order to operate in a back-scattering geometry, with a panoramic aperture of 100° in the top and a bottom half dedicated to the regulation and measurement of pressure. It is specially designed to be mounted on the cold finger of a 4 K closed-cycle cryostat and actuated at low-temperature by pumping helium into the gas membrane. The main parts of the body are machined from a CuBe alloy (BERYLCO 25) and, when assembled, it presents an approximate height of 20-21 mm and fits into a 57 mm diameter. This system allows different materials to be probed using RXS in a range of temperatures between 30 and 300 K and has been tested up to 20 GPa using anvils with a culet diameter of 500 µm under quasi-cryogenic conditions. Detailed descriptions of different parts of the setup, operation and the developed methodology are provided here, along with some preliminary experimental results.

Correlation of extent of ALK FISH positivity and crizotinib efficacy in three prospective studies of ALK-positive patients with non-small-cell lung cancer

Background

In clinical trials of patients with anaplastic lymphoma kinase (ALK)-positive non-small-cell lung cancer (NSCLC) treated with crizotinib, evaluation of the relationship between the percentage of ALK-positive cells by fluorescence in situ hybridization (FISH)-particularly near the cut-off defining positive status-and clinical outcomes have been limited by small sample sizes.

Patients and methods

Data were pooled from three large prospective trials (one single-arm and two randomized versus chemotherapy) of crizotinib in patients with ALK-positive NSCLC determined by Vysis ALK Break Apart FISH using a cut-off of ≥15% ALK-positive cells. Logistic regression and proportional hazards regression analyses were used to explore the association of percent ALK-positive cells with objective response and progression-free survival (PFS), respectively.

Results

Of 11 081 screened patients, 1958 (18%) were ALK positive, 7512 (68%) were ALK negative, and 1540 (14%) were uninformative. Median percentage of ALK-positive cells was 58% in ALK-positive patients and 2% in ALK-negative patients. Of ALK-positive patients, 5% had 15%-19% ALK-positive cells; of ALK-negative patients, 2% had 10%-14% ALK-positive cells. Objective response rate for ALK-positive, crizotinib-treated patients with ≥20% ALK-positive cells was 56% (n = 700/1246), 55% (n = 725/1312) for those with ≥15% ALK-positive cells, and 38% for those with 15%-19% ALK-positive cells (n = 25/66). As a continuous variable, higher percentages of ALK-positive cells were estimated to be associated with larger differences in objective response and PFS between crizotinib and chemotherapy; however, tests for interaction between treatment and percentage of ALK-positive cells were not significant (objective response, P = 0.054; PFS, P = 0.17).

Conclusions

Patients with ALK-positive NSCLC benefit from treatment with crizotinib across the full range of percentage of ALK-positive cells, supporting the clinical utility of the 15% cut-off. The small number of patients with scores near the cut-off warrant additional study given the potential for misclassification of ALK status due to technical or biologic reasons.