Exploring the ageing methylome in the model insect, Nasonia vitripennis

BACKGROUND

The ageing process is a multifaceted phenomenon marked by the gradual deterioration of cellular and organismal functions, accompanied by an elevated susceptibility to diseases. The intricate interplay between genetic and environmental factors complicates research, particularly in complex mammalian models. In this context, simple invertebrate organisms have been pivotal, but the current models lack detectable DNA methylation limiting the exploration of this critical epigenetic ageing mechanism. This study introduces Nasonia vitripennis, the jewel wasp, as an innovative invertebrate model for investigating the epigenetics of ageing. Leveraging its advantages as a model organism and possessing a functional DNA methylation system, Nasonia emerges as a valuable addition to ageing research.

RESULTS

Whole-genome bisulfite sequencing unveiled dynamic alterations in DNA methylation, with differentially methylated CpGs between distinct time points in both male and female wasps. These changes were associated with numerous genes, enriching for functions related to telomere maintenance, histone methylation, and mRNA catabolic processes. Additionally, other CpGs were found to be variably methylated at each timepoint. Sex-specific effects on epigenetic entropy were observed, indicating differential patterns in the loss of epigenetic stability over time. Constructing an epigenetic clock containing 19 CpGs revealed a robust correlation between epigenetic age and chronological age.

CONCLUSIONS

Nasonia vitripennis emerges as a promising model for investigating the epigenetics of ageing, shedding light on the intricate dynamics of DNA methylation and their implications for age-related processes. This research not only expands the repertoire of ageing models but also opens avenues for deeper exploration of epigenetic mechanisms in the context of ageing.

Null effects of temporal prediction on recognition memory but evidence for differential neural activity at encoding. A registered report

Previous research has demonstrated that rhythmic presentation of stimuli during encoding boosts subsequent recognition and is associated with distinct neural activity compared with when stimuli are presented in an arrhythmic manner. However, it is unclear whether the effect is driven by automatic entrainment to rhythm or non-rhythmic temporal prediction. This registered report presents an Electroencephalographic (EEG) study aimed at establishing the cognitive and neural mechanisms of the effect of temporal prediction on recognition. In a blocked design, stimulus onset during encoding was systematically manipulated in four conditions prior to recognition testing: rhythmic fixed (RF), rhythmic variable (RV), arrhythmic fixed (AF), and arrhythmic variable (AV). By orthogonally varying rhythm and temporal position we were able to assess their independent contributions to recognition enhancement. Our behavioural results did not replicate previous findings that show a difference in recognition memory based on temporal predictability at encoding. However, event-related potential (ERP) component analysis did show an early (N1) interaction effect of temporal position and rhythm, and later (N2 and Dm) effects driven by temporal position only. Taken together, we observed effects of temporal prediction at encoding, but these differences did not translate to later effects of memory, suggesting that effects of temporal prediction on recognition are less robust than previously thought.

Bridging Neuroscience and Robotics: Spiking Neural Networks in Action

Robots are becoming increasingly sophisticated in the execution of complex tasks. However, an area that requires development is the ability to act in dynamically changing environments. To advance this, developments have turned towards understanding the human brain and applying this to improve robotics. The present study used electroencephalogram (EEG) data recorded from 54 human participants whilst they performed a two-choice task. A build-up of motor activity starting around 400 ms before response onset, also known as the lateralized readiness potential (LRP), was observed. This indicates that actions are not simply binary processes but rather, response-preparation is gradual and occurs in a temporal window that can interact with the environment. In parallel, a robot arm executing a pick-and-place task was developed. The understanding from the EEG data and the robot arm were integrated into the final system, which included cell assemblies (CAs)-a simulated spiking neural network-to inform the robot to place the object left or right. Results showed that the neural data from the robot simulation were largely consistent with the human data. This neurorobotics study provides an example of how to integrate human brain recordings with simulated neural networks in order to drive a robot.

Mapping healthy planning frameworks

AIMS

The aim of this research was to map available healthy planning frameworks to discover the range, composition, design, and implementation of healthy planning frameworks.

METHODS

A systematic scoping review with date, location, and usability limitations was augmented by a grey literature search. Data were extracted on key details, design, outcomes considered, and implementation features of the final 61 frameworks.

RESULTS

Data extracted indicated that most frameworks tend to focus on one element of the built environment, with active mobility, active environments, and transport being the most prevalent ones (34%). Most frameworks (40) stated their intended outcomes on health in general terms, rather than targeting specific health outcomes. Very few frameworks (12%) were aimed at the public, and only 11% of frameworks included an evaluation.

CONCLUSIONS

While there are a wide variety and number of frameworks available in the field of healthy urban planning, they are generally siloed, focusing on highly specific individual urban determinants, and rarely consider health outcomes in detail. There is significantly less provision available for citizen and community use. Frameworks tend to offer limited updating mechanisms and very rarely include ongoing evaluation processes, making their success difficult to assess.

Whole-Body Magnetic Resonance Imaging Assessment of the Contributions of Adipose and Nonadipose Tissues to Cardiovascular Remodeling in Adolescents

Background Greater body mass index is associated with cardiovascular remodeling in adolescents. However, body mass index cannot differentiate between adipose and nonadipose tissues. We examined how visceral and subcutaneous adipose tissue are linked with markers of early cardiovascular remodeling, independently from nonadipose tissue. Methods and Results Whole-body magnetic resonance imaging was done in 82 adolescents (39 overweight/obese; 36 female; median age, 16.3 [interquartile range, 14.4-18.1] years) to measure body composition and cardiovascular remodeling markers. Left ventricular diastolic function was assessed by echocardiography. Waist, waist:height ratio, and body mass index z scores were calculated. Residualized nonadipose tissue, subcutaneous adipose tissue, and visceral adipose tissue variables, uncorrelated with each other, were constructed using partial regression modeling to allow comparison of their individual contributions in a 3-compartment body composition model. Cardiovascular variables mostly related to nonadipose rather than adipose tissue. Nonadipose tissue was correlated positively with left ventricular mass (r=0.81), end-diastolic volume (r=0.70), stroke volume (r=0.64), left ventricular mass:end-diastolic volume (r=0.37), and systolic blood pressure (r=0.35), and negatively with heart rate (r=-0.33) (all P<0.01). Subcutaneous adipose tissue was associated with worse left ventricular diastolic function (r=-0.42 to -0.48, P=0.0007-0.02) and higher heart rates (r=0.34, P=0.007) but linked with better systemic vascular resistance (r=-0.35, P=0.006). There were no significant relationships with visceral adipose tissue and no associations of any compartment with pulse wave velocity. Conclusions Simple anthropometry does not reflect independent effects of nonadipose tissue and subcutaneous adipose tissue on the adolescent cardiovascular system. This could result in normal cardiovascular adaptations to growth being misinterpreted as pathological sequelae of excess adiposity in studies reliant on such measures.

Exploring the impact of athletic identity on gender role conflict and athlete injury fear avoidance in male English professional academy football players

Men's academy football can encourage a commitment to the athletic role and masculine norms. When injured, the ability to fulfil an athletic masculine identity is threatened and athletes may experience injury fear-avoidance behaviours as part of a negative injury appraisal. The aim of the study was to explore whether higher athletic identity (AI) was associated with higher gender role conflict and injury-related fear-avoidance. Seventy-two male English academy footballers completed an Athletic Identity Measurement Scale (AIMS), Gender Role Conflict Scale (GRCS), and Athlete Fear Avoidance Questionnaire (AFAQ) based on self-reported historical injuries. Correlational analyses were conducted for all variables, and a one-way ANOVA was used to compare high, moderate, and low AI. AIMS was significantly positively correlated with two GRCS subscales: success, power, and competition (SPC) and restricted affectionate behaviour between men (RAM). AIMS exclusivity also positively correlated with SPC and AIMS negative affectivity positively correlated with GRCS total and RAM. Additionally, the current study showed that high and moderate levels of AI had significantly higher levels of total GRCS than those with low AI. No significant results were found for AIMS, GRCS, and AFAQ. Results suggest that players with higher and more exclusive AI may be susceptible to masculine role conflicts, specifically, SPC and RAM, especially when there is a risk to their athletic role. The current study informs sport and health professionals of the need to monitor AI and masculine conformity in academy-level footballers to minimise gender-role conflict and potential maladaptive rehabilitation responses when their identities are threatened.

Enabling Deoxygenative C(sp2)-C(sp3) Cross-Coupling for Parallel Medicinal Chemistry

Herein we report the development of an automated deoxygenative C(sp²)-C(sp³) coupling of aryl bromide with alcohols to enable parallel medicinal chemistry. Alcohols are among the most diverse and abundant building blocks, but their usage as alkyl precursors has been limited. Although metallaphotoredox deoxygenative coupling is becoming a promising strategy to form C(sp²)-C(sp³) bond, the reaction setup limits its widespread application in library synthesis. To achieve high throughput and consistency, an automated workflow involving solid-dosing and liquid-handling robots has been developed. We have successfully demonstrated this high-throughput protocol is robust and consistent across three automation platforms. Furthermore, guided by cheminformatic analysis, we examined alcohols with comprehensive chemical space coverage and established a meaningful scope for medicinal chemistry applications. By accessing the rich diversity of alcohols, this automated protocol has the potential to substantially increase the impact of C(sp²)-C(sp³) cross-coupling in drug discovery.

Spatial attention is not affected by alpha or beta transcranial alternating current stimulation: A registered report

Using Electroencephalography (EEG) an event-related change in alpha activity has been observed over primary sensory cortices during the allocation of spatial attention. This is most prominent during top-down, or endogenous, attention, and nearly absent in bottom-up, or exogenous orienting. These changes are highly lateralised, such that an increase in alpha power is seen ipsilateral to the attended region of space and a decrease is seen contralaterally. Whether these changes in alpha oscillatory activity are causally related to attentional resources, or to perceptual processes, or are simply epiphenomenal, is unknown. If alpha oscillations are indicative of a causal mechanism whereby attention is allocated to a region of space, it remains an open question as to whether this is driven by ipsilateral increases or contralateral decreases in alpha power. This preregistered report set out to test these questions. To do so, we used transcranial Alternating Current Stimulation (tACS) to modulate alpha activity in the somatosensory cortex whilst measuring performance on established tactile attention paradigms. All participants completed an endogenous and exogenous tactile attention task in three stimulation conditions; alpha, sham and beta. Sham and beta stimulation operated as controls so that any observed effects could be attributed to alpha stimulation specifically. We replicated previous behavioural findings in all stimulation conditions showing a facilitation of cued trials in the endogenous task, and inhibition of return in the exogenous task. However, these were not affected by stimulation manipulations. Using Bayes-factor analysis we show strong support for the null hypotheses - that the manipulation of Alpha by tACS does not cause changes in tactile spatial attention. This well-powered study, conducted over three separate days, is an important contribution to the current debate regarding the efficiency of brain stimulation.

Myosteatotic and sarcopenic obesity impact postoperative outcomes more robustly than visceral obesity in general surgery patients, with differences by sex

BACKGROUND AND AIMS

Computed tomography (CT) defined myosteatotic, sarcopenic, and visceral obesity are associated with adverse surgical outcomes and mortality in patients with malignancies. These occult conditions may also be widely prevalent in today's general surgery patients who tend to be overweight/obese. This study identified the predominant obesity phenotypes in 906 patients aged 18-85 years who were scheduled for laparoscopic resection for benign abdominal or colorectal disease at Vanderbilt University Medical Center between 2010 and 2017.

METHODS

Sex and body mass index (BMI) specific cut-points were used to identify myosteatotic, sarcopenic, and visceral obesity phenotype from abdominal CT scan morphometrics. Multivariable regression modeling determined relationships between sex, obesity phenotype, and postoperative outcomes.

RESULTS

The myosteatostic + sarcopenic obesity phenotype associated with longer surgery duration and increased the likelihood for major complication (OR 1.34, 95%CI 1.01-1.74) and ICU admission (OR 1.39, 95%CI 1.04-1.90). Having myosteatotic obesity doubled the likelihood for hospital stay >7 days and discharge to a nursing home (OR 2.11, 95%CI 1.43,3.11), increasing the likelihood for readmission within 90 days. Obesity was more prevalent in females, but myosteatotic, sarcopenic, and visceral obesity were more prevalent in males, regardless of age or BMI. Males had more major complications (23.6% vs 17.7%, P = 0.03), particularly wound dehiscence or infection, and a 2-day longer hospital stay.

CONCLUSIONS

This study shows that sarcopenic and myosteatotic obesity phenotypes are highly prevalent, especially in male general surgery patients, regardless of age or BMI. Importantly, sarcopenic and myosteatostic obesity may be more detrimental than visceral obesity; these phenotypes robustly associated with adverse postoperative outcomes. Future work could use these findings for design of phenotype-specific interventions to reduce patient risk and prevent outcomes that are harmful and costly.

BATMAN: A Brain-like Approach for Tracking Maritime Activity and Nuance

As commercial geospatial intelligence data becomes more widely available, algorithms using artificial intelligence need to be created to analyze it. Maritime traffic is annually increasing in volume, and with it the number of anomalous events that might be of interest to law enforcement agencies, governments, and militaries. This work proposes a data fusion pipeline that uses a mixture of artificial intelligence and traditional algorithms to identify ships at sea and classify their behavior. A fusion process of visual spectrum satellite imagery and automatic identification system (AIS) data was used to identify ships. Further, this fused data was further integrated with additional information about the ship's environment to help classify each ship's behavior to a meaningful degree. This type of contextual information included things such as exclusive economic zone boundaries, locations of pipelines and undersea cables, and the local weather. Behaviors such as illegal fishing, trans-shipment, and spoofing are identified by the framework using freely or cheaply accessible data from places such as Google Earth, the United States Coast Guard, etc. The pipeline is the first of its kind to go beyond the typical ship identification process to help aid analysts in identifying tangible behaviors and reducing the human workload.

Validity of the UCEEM in use: How Does it Triangulate with Qualitative Data in Measuring the Effect of an Educational Intervention?

Objectives

Improving medical student placements relies on being able to reliably evaluate how students experience clinical learning environments. The Undergraduate Clinical Education Environment Measure (UCEEM) is an increasingly used validated tool designed to allow such evaluations. This study aims to further characterize how the UCEEM relates to qualitative evaluation.

methods

Students on placement at one hospital were invited to complete the UCEEM before and after the implementation of an innovative new placement structure. Additionally, focus groups were employed to collect qualitative data on their experiences. a novel protocol to triangulate the output of the UCEEM with the qualitative data was developed.

Results

The UCEEM showed good internal consistency (Cronbach's Alpha 0.79-0.91) and internal correlation. Implementation of the intervention created significant improvements in the overall UCEEM scores (P = .008) and in the "Learning in and through work and quality of supervision" (P = .048), "Preparedness for student entry" (P = .033) and "Workplace interaction patterns and student inclusion" (P = .039) domains. The triangulation of qualitative data with UCEEM output showed that the UCEEM allowed evaluation of some perceptions not reached through open questioning. However, mixed interpretations of UCEEM items by students led to the conflation of themes and challenges in deriving the meaning behind the score. This appeared to be the case for 14 of the 24 UCEEM items.

Conclusion

This investigation adds to the literature supporting the UCEEM as a validated tool. It also elucidates the limitations and relationships to qualitative data that investigators need to be aware of in its use.

Early Childhood Exposures to Fluorides and Child Behavioral Development and Executive Function: A Population-Based Longitudinal Study

It is important to both protect the healthy development and maintain the oral health of the child population. The study examined the effect of early childhood exposures to water fluoridation on measures of school-age executive functioning and emotional and behavioral development in a population-based sample. This longitudinal follow-up study used information from Australia's National Child Oral Health Study 2012-14. Children aged 5 to 10 y at baseline were contacted again after 7 to 8 y, before they had turned 18 y of age. Percent lifetime exposed to fluoridated water (%LEFW) from birth to the age 5 y was estimated from residential history and postcode-level fluoride levels in public tap water. Measures of children's emotional and behavioral development were assessed by the Strength and Difficulties Questionnaire (SDQ), and executive functioning was measured by the Behavior Rating Inventory of Executive Function (BRIEF). Multivariable regression models were generated to compare the associations between the exposure and the primary outcomes and controlled for covariates. An equivalence test was also conducted to compare the primary outcomes of those who had 100% LEFW against those with 0% LEFW. Sensitivity analysis was also conducted. A total of 2,682 children completed the SDQ and BRIEF, with mean scores of 7.0 (95% confidence interval, 6.6-7.4) and 45.3 (44.7-45.8), respectively. Those with lower %LEFW tended to have poorer scores of the SDQ and BRIEF. Multivariable regression models reported no association between exposure to fluoridated water and the SDQ and BRIEF scores. Low household income, identifying as Indigenous, and having a neurodevelopmental diagnosis were associated with poorer SDQ/BRIEF scores. An equivalence test confirmed that the SDQ/BRIEF scores among those with 100% LEFW were equivalent to that of those who had 0% LEFW. Exposure to fluoridated water during the first 5 y of life was not associated with altered measures of child emotional and behavioral development and executive functioning.

Assessment of Dietary Intake in Three Cohorts of Advanced Age in Two Countries: Methodology Challenges

OBJECTIVES

Dietary intake information is key to understanding nutrition-related outcomes. Intake changes with age and some older people are at increased risk of malnutrition. Application, difficulties, and advantages of the 24-hour multiple pass recall (24hr-MPR) dietary assessment method in three cohorts of advanced age in the United Kingdom (UK) and New Zealand (NZ) is described.

PARTICIPANTS

The Newcastle 85+ study (UK) recruited a single year birth cohort of people aged 85 years during 2006-7. LiLACS NZ recruited a 10-year birth cohort of Māori (indigenous New Zealanders) aged 80-90 years and a single year birth cohort of non-Māori aged 85 years in 2010.

MEASUREMENTS

Two 24hr-MPR were conducted on non-consecutive days by trained assessors. Pictorial resources and language were adapted for the New Zealand and Māori contexts. Detailed methods are described.

RESULTS

In the Newcastle 85+ study, 805 (93%) participants consented to the 24-MPR, 95% of whom completed two 24hr-MPR; in LiLACS NZ, 218 (82%) consented and 203 (76%) Māori and 353 (90%) non-Māori completed two 24hr-MPR. Mean time to complete each 24hr-MPR was 22 minutes in the Newcastle 85+ study, and 45 minutes for Māori and 39 minutes for non-Māori in LiLACS NZ. Dietary assessment of participants residing in residential care and those requiring proxy respondents were successfully included in both studies. Most participants (83-94%) felt that data captured by the 24hr-MPR reflected their usual dietary intake.

CONCLUSIONS

Dietary assessment using 24hr-MPR was successful in capturing detailed dietary data including information on portion size and time of eating for over 1300 octogenarians in the UK and New Zealand (Māori and non- Māori). The 24hr-MPR is an acceptable method of dietary assessment in this age group.

Social media and use of electronic nicotine delivery systems among school-going adolescents in a rural distressed Appalachian community

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Social media use to discuss ENDS among youth in distressed areas is understudied.

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Nearly 1 in 3 and 1 in 8 of youth were ever and current ENDS users, respectively.

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Nearly 1 in 5 of the youth reported using social media to talk about ENDS.

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Social media increased current and ever ENDS use by 4 and 3 times, respectively.

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Social media engagement may lead to ENDS uptake among youth in distressed areas.

Electronic nicotine delivery systems (ENDS) are the most used tobacco products among middle and high schoolers in the United States (U.S.). Familial relations and access play a major role in uptake among adolescents; yet the role of social media in this phenomenon in the context of communities impacted by tobacco-related health disparities is understudied. In Spring 2019, data were collected from adolescents in 8th and 9th grades in a school located in a rural distressed county in Tennessee to assess social media’s role in ENDS uptake. Descriptive and multivariable statistical analyses were performed to delineate factors associated with ENDS use. Of a total of 399 respondents, 12.5 % reported current ENDS use and 22.1 % indicated having ever discussed ENDS on social media. Closed messaging platforms (Snapchat) and video platforms (Facebook/Instagram/You Tube) were the most reported form of social media used (8.31 % and 8.31 % respectively). Social media use was positively associated with both ever ENDS use (odds ratio [OR] = 2.9) and current ENDS use (OR = 3.98). Parental advice against ENDS use was positively associated with ever ENDS use. In conclusion, social media use was positively associated with both ever and current ENDS use, and Snapchat was the most popular platform among this population of students. The results indicate that youth social media engagement may lead to exposure that can influence ENDS uptake. Future studies are needed to further examine these associations among distressed communities.

Effectiveness of an online module: climate-change and sustainability in clinical practice

BACKGROUND

Climate change has significant implications for health, yet healthcare provision itself contributes significant greenhouse gas emission. Medical students need to be prepared to address impacts of the changing environment and fulfil a key role in climate mitigation. Here we evaluate the effectiveness of an online module on climate-change and sustainability in clinical practice designed to achieve learning objectives adapted from previously established sustainable healthcare priority learning outcomes.

METHODS

A multi-media, online module was developed, and 3^rd and 4^th year medical students at Brighton and Sussex Medical School were invited to enrol. Students completed pre- and post-module questionnaires consisting of Likert scale and white space answer questions. Quantitative and qualitative analysis of responses was performed.

RESULTS

Forty students enrolled and 33 students completed the module (83% completion rate). There was a significant increase in reported understanding of key concepts related to climate change and sustainability in clinical practice (p < 0.001), with proportion of students indicating good or excellent understanding increasing from between 2 - 21% students to between 91 - 97% students. The majority (97%) of students completed the module within 90 min. All students reported the module was relevant to their training. Thematic analysis of white space responses found students commonly reported they wanted access to more resources related to health and healthcare sustainability, as well as further guidance on how to make practical steps towards reducing the environmental impact within a clinical setting.

CONCLUSION

This is the first study to evaluate learner outcomes of an online module in the field of sustainable health and healthcare. Our results suggest that completion of the module was associated with significant improvement in self-assessed knowledge of key concepts in climate health and sustainability. We hope this approach is followed elsewhere to prepare healthcare staff for impacts of climate change and to support improving the environmental sustainability of healthcare delivery.

TRIAL REGISTRATION

Study registered with Brighton and Sussex Medical School Research Governance and Ethics Committee (BSMS RGEC). Reference: ER/BSMS3576/8, Date: 4/3/2020.

Exploring the associative learning capabilities of the segmented attractor network for lifelong learning

This work explores the process of adapting the segmented attractor network to a lifelong learning setting. Taking inspirations from Hopfield networks and content-addressable memory, the segmented attractor network is a powerful tool for associative memory applications. The network's performance as an associative memory is analyzed using multiple metrics. In addition to the network's general hit rate, its capability to recall unique memories and their frequency is also evaluated with respect to time. Finally, additional learning techniques are implemented to enhance the network's recall capacity in the application of lifelong learning. These learning techniques are based on human cognitive functions such as memory consolidation, prediction, and forgetting.

Intensity and Duration of Physical Activity and Cardiorespiratory Fitness

OBJECTIVES

There is no clear guidance on the intensity and duration of physical activity (PA) that adolescents require to maximise cardiorespiratory fitness (CRF). We aimed to determine the strength of associations between each PA intensity and CRF, independently of other intensities, and the PA duration at each intensity associated with maximal CRF.

METHODS

PA and CRF were assessed in 339 adolescents aged 13 to 14 years by wrist-worn accelerometers and 20-m shuttle runs, respectively. Partial regression modeling was used to construct residualized PA variables at each PA intensity that were uncorrelated with each other. Moving average models were optimally fitted to determine relationships between residualized PA variables and CRF. Threshold regression models determined the duration of PA above which CRF improvement was minimal.

RESULTS

Greater vigorous PA (VPA) was associated with better CRF until about 20 minutes of daily VPA, when the relationship plateaued. Moderate and light PA, and sedentary time were not associated with CRF in partial models. Adolescents performing 14 (range 12-17) minutes of daily VPA had median CRF. Participants in the upper quartile of VPA had 1.03 z-scores higher CRF than those in the lowest quartile (95% confidence interval: 0.75 to 1.30).

CONCLUSIONS

Our data suggest that 20 minutes of daily VPA may be best for maximizing CRF in adolescence. As moderate-to-vigorous PA guidelines can be satisfied by only undertaking moderate PA, with no apparent independent benefit, we suggest that future guidelines focus on VPA alone, simplifying public health messaging.

Challenges and opportunities of remote public involvement and community engagement during a pandemic: refining the MapMe childhood healthy weight intervention

AIMS

Including parents and other stakeholders in the development of interventions to address the sensitive public health issues such as childhood obesity, through public involvement is critical. However, the Covid-19 pandemic has created a challenge for public involvement and engagement activities (PICE). The aim of this paper is to describe the process and challenges of setting up, maintaining, evaluating, and recording impact of three public and stakeholder groups via remote methods in the context of the MapMe2 study during the Covid-19 pandemic. Parental reaction to result letters received as part of the National Child Measurement Programme (NCMP) informing parents of their child's overweight status is often one of hostility or disbelief. As a result, parents often do not act on these letters to address child overweight. The MapMe2 study is working in collaboration with the NCMP and local authorities, building on previous work (MapMe) and aims to support parents of primary school-aged children to recognise and maintain a healthy weight in their child. The existing MapMe Intervention includes an enhanced NCMP child weight result letter, supplemented with Body Image Scales (BIS), and an intervention website with material to support healthy eating, physical activity, and signposting supporting information. The intervention was to be refined and the evaluation informed with PICE input.

METHODS

Covid-19 restrictions meant that planned face-to-face PICE methods had to be altered with all recruitment, all correspondence, and activities taking place remotely. A Parent Involvement Panel (PIP), a child panel, and an expert panel were established. Several adaptations were made to accommodate a new way of involving the public in research.

RESULTS/CONCLUSIONS

Working remotely created many challenges and was a learning experience for all involved. However, an active group was successfully established. Using continuous assessment and evaluation methods, we were able to demonstrate successful involvement and engagement in the refinement of the MapMe2 study. Through the sharing of PICE methods practice, this paper adds to the literature, the value of partnership working.

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.

Real-world treatment patterns and outcomes in patients initiating lurasidone for the treatment of schizophrenia in Europe

Introduction

Lurasidone is a second-generation antipsychotic shown to have a lower risk of weight gain and a lower incidence of metabolic adverse events compared with some medications in the same class.

Objectives

To describe treatment patterns, clinical outcomes and adverse drug reactions (ADRs) over 12 months following lurasidone initiation in patients with schizophrenia.

Methods

This was a multi-centre observational study involving data collection from patients’ medical records, conducted in seven mental health centres in the United Kingdom (UK) and Switzerland. The study included patients aged ≥18 years who initiated lurasidone after 1 January 2016 for the treatment of schizophrenia. Data were collected from medical records both retrospectively and prospectively using a standardised data collection form. Data collected included patient characteristics, treatment history, lurasidone regimens, clinical outcomes and ADRs.

Results

Forty-eight patients participated in the study. The median (interquartile range [IQR]) age at lurasidone initiation was 33.5 (25.5-50.3) years and 31 (65%) patients were male. The median (range) lurasidone starting dose was 37 mg daily (9.3–148 mg). Thirty-eight (79%) patients continued lurasidone for the entire 12-month follow-up period. Among the 14 (29%) patients with documented relapse, the median (IQR) time to relapse was 3.4 (1.5–7.9) months. Five ADRs were recorded in patient notes judged as related to lurasidone: agitation, nausea, akathisia, somnolence and vomiting (one patient each).

Conclusions

In this real-world study of patients with schizophrenia in the UK and Switzerland, 79% of patients continued lurasidone for at least 12 months, and ADRs were reported rarely in patient notes.

Disclosure

This study was sponsored by CNX Therapeutics Ltd (formerly Sunovion Pharmaceuticals Europe Ltd). AJ is an employee of CNX Therapeutics. MA is an employee of OPEN HEALTH who was contracted by CNX Therapeutics for data analysis and medical writing.

Temporal Expectation Improves Recognition Memory for Spatially Attended Objects

Recent evidence suggests that temporal expectation is beneficial to memory formation. Rhythmic presentation of stimuli during encoding enhances subsequent recognition and is associated with distinct neural activity compared with when stimuli are presented in an arrhythmic manner. However, no prior study has examined how temporal expectation interacts with another important form of facilitation-spatial attention-to affect memory. This study systematically manipulated temporal expectation and spatial attention during encoding to examine their combined effect on behavioral recognition and associated ERPs. Participants performed eight experimental blocks consisting of an encoding phase and recognition test, with EEG recorded throughout. During encoding, pairs of objects and checkerboards were presented and participants were cued to attend to the left or right stream and detect targets as quickly as possible. In four blocks, stimulus presentation followed a rhythmic (constant, predictable) temporal structure, and in the other four blocks, stimulus onset was arrhythmic (random, unpredictable). An interaction between temporal expectation and spatial attention emerged, with greater recognition in the rhythmic than the arrhythmic condition for spatially attended items. Analysis of memory-specific ERP components uncovered effects of spatial attention. There were late positive component and FN400 old/new effects in the attended condition for both rhythmic and arrhythmic items, whereas in the unattended condition, there was an FN400 old/new effect and no late positive component effect. The study provides new evidence that memory improvement as a function of temporal expectation is dependent upon spatial attention.

Vaginal Swelling After Intercourse: A Case Report

Introduction: A vulvar hematoma is a hemorrhagic fluid collection in the female external genitalia. The majority occur as an obstetrical complication, especially during labor. Non-obstetrical vulvar hematomas are usually the result of trauma, with coitus being the most common etiology. Case Report: We present the case of a 25-year-old woman with significant vaginal pain and swelling after vigorous sexual intercourse. She exhibited tenderness and swelling of the left labia majora and minora. The differential diagnosis included bleeding, abscess, and deep venous thrombosis. Laboratory studies were normal and computed tomography of the pelvis indicated the swelling was most likely due to blood. The patient was taken to the operating room, and approximately 150 cubic centimeters of clot was evacuated. The patient had an uneventful recovery and was discharged home the next day. Conclusion: This case illustrates the unique presentation and challenges in making the diagnosis of vulvar hematoma.

Building FAIR Functionality: Annotating Events in Time Series Data Using Hierarchical Event Descriptors (HED)

Human electrophysiological and related time series data are often acquired in complex, event-rich environments. However, the resulting recorded brain or other dynamics are often interpreted in relation to more sparsely recorded or subsequently-noted events. Currently a substantial gap exists between the level of event description required by current digital data archiving standards and the level of annotation required for successful analysis of event-related data across studies, environments, and laboratories. Manifold challenges must be addressed, most prominently ontological clarity, vocabulary extensibility, annotation tool availability, and overall usability, to allow and promote sharing of data with an effective level of descriptive detail for labeled events. Motivating data authors to perform the work needed to adequately annotate their data is a key challenge. This paper describes new developments in the Hierarchical Event Descriptor (HED) system for addressing these issues. We recap the evolution of HED and its acceptance by the Brain Imaging Data Structure (BIDS) movement, describe the recent release of HED-3G, a third generation HED tools and design framework, and discuss directions for future development. Given consistent, sufficiently detailed, tool-enabled, field-relevant annotation of the nature of recorded events, prospects are bright for large-scale analysis and modeling of aggregated time series data, both in behavioral and brain imaging sciences and beyond.

The Emirates Mars Mission

The Emirates Mars Mission (EMM) was launched to Mars in the summer of 2020, and is the first interplanetary spacecraft mission undertaken by the United Arab Emirates (UAE). The mission has multiple programmatic and scientific objectives, including the return of scientifically useful information about Mars. Three science instruments on the mission's Hope Probe will make global remote sensing measurements of the Martian atmosphere from a large low-inclination orbit that will advance our understanding of atmospheric variability on daily and seasonal timescales, as well as vertical atmospheric transport and escape. The mission was conceived and developed rapidly starting in 2014, and had aggressive schedule and cost constraints that drove the design and implementation of a new spacecraft bus. A team of Emirati and American engineers worked across two continents to complete a fully functional and tested spacecraft and bring it to the launchpad in the middle of a global pandemic. EMM is being operated from the UAE and the United States (U.S.), and will make its data freely available.

Declining fitness and physical education lessons in UK adolescents

Objectives

The objective was to determine recent cross-sectional trends in health-related fitness (HRF) in secondary school students by studying the 13–14 years old age group repeatedly over 6 years, considering parallel national trends in physical education (PE).

Methods

Height, weight, broad jump, grip strength, 20 m shuttle run and throwing and catching skills were measured by the same research team using standardised techniques from 2014 to 2019. Trends in these HRF measures were assessed by linear regression, adjusting for school, sex and height. Interactions with fitness and body mass index (BMI) were tested. The number of PE lessons reported in the UK Annual School Workforce Census between 2010 and 2019 for all state-funded secondary schools was analysed.

Results

Grip strength (B=−0.60, 95% CI −0.78 to –0.41), broad jump (B=−1.16, 95% CI −1.99 to –0.34), 20 m shuttle run (B=−1.85, 95% CI −2.58 to –1.12) and throwing and catching skills (B=−0.12, 95% CI −0.15 to –0.08) declined significantly over the study period. There was a greater reduction in broad jump and grip strength in adolescents with low fitness and a greater reduction in fitness and motor competence in adolescents with normal BMI. These declines coincided with a 16% reduction nationally in secondary school PE between 2010 (333 800 hours) and 2019 (280 725 hours).

Conclusion

Adolescent HRF has declined in recent years, in parallel with PE lessons. Declines were observed across all young people and particularly those of low fitness and normal BMI. To reach the majority of young people, policy makers could increase PE in schools to increase activity and prevent worsening fitness and health in future generations.