Handling 'carbon footprint' in orthopaedics

INTRODUCTION

The National Health Service contributes 4%-5% of England and Wales' greenhouse gases and a quarter of all public sector waste. Between 20% and 33% of healthcare waste originates from a hospital's operating room, and up to 90% of waste is sent for costly and unneeded hazardous waste processing. The goal of this study was to quantify the amount and type of waste produced during a selection of common trauma and elective orthopaedic operations, and to calculate the carbon footprint of processing the waste.

METHODS

Waste generated for both elective and trauma procedures was separated primarily into clean and contaminated, paper or plastic, and then weighed. The annual carbon footprint for each operation at each site was subsequently calculated.

RESULTS

Elective procedures can generate up to 16.5kg of plastic waste per procedure. Practices such as double-draping the patient contribute to increasing the quantity of waste. Over the procedures analysed, the mean total plastic waste at the hospital sites varied from 6 to 12kg. One hospital site undertook a pilot of switching disposable gowns for reusable ones with a subsequent reduction of 66% in the carbon footprint and a cost saving of £13,483.89.

CONCLUSIONS

This study sheds new light on the environmental impact of waste produced during trauma and elective orthopaedic procedures. Mitigating the environmental impact of the operating room requires a collective drive for a culture change to sustainability and social responsibility. Each clinician can have an impact upon the carbon footprint of their operating theatre.

The carbon footprint of arthroscopic procedures

INTRODUCTION

The healthcare sector contributes the equivalent of 4.4% of global net emissions to the climate carbon footprint; between 20% and 70% of healthcare waste originates from a hospital's operating theatre and up to 90% of waste is sent for costly and unneeded hazardous waste processing. This study aimed to quantify the amount and type of waste produced during an arthroscopic anterior cruciate ligament reconstruction (ACLR) and an arthroscopic rotator cuff repair (RCR), calculate the carbon footprint and assess the cost of the waste disposal.

METHODS

The amount of waste generated from ACLR and RCR procedures was calculated across a range of hospital sites. The waste was separated primarily into clean and contaminated, paper or plastic. Both carbon footprint and cost of disposal across the hospital sites was subsequently calculated.

RESULTS

RCR generated 3.3-15.5kg of plastic waste and 0.9-2.3kg of paper waste. ACLR generated 2.4-9.6kg of plastic waste and 1.1-1.6kg of paper waste. The cost to process waste varies widely between hospital sites, waste disposal contractors and method of waste disposal. The annual burden of the included hospital sites for the arthroscopic procedures undertaken was 6.2 tonnes of carbon dioxide.

CONCLUSIONS

The data collected demonstrated a significant variability in waste production and cost for waste disposal between hospital sites. At a national level, consideration should be given to the procurement of appropriate products such that waste can be efficiently recycled or disposed of by environmentally sustainable methods.

Steady Laminar Flow Decreases Endothelial Glycolytic Flux While Enhancing Proteoglycan Synthesis and Antioxidant Pathways

Endothelial cells in steady laminar flow assume a healthy, quiescent phenotype, while endothelial cells in oscillating disturbed flow become dysfunctional. Since endothelial dysfunction leads to atherosclerosis and cardiovascular disease, it is important to understand the mechanisms by which endothelial cells change their function in varied flow environments. Endothelial metabolism has recently been proven a powerful tool to regulate vascular function. Endothelial cells generate most of their energy from glycolysis, and steady laminar flow may reduce endothelial glycolytic flux. We hypothesized that steady laminar but not oscillating disturbed flow would reduce glycolytic flux and alter glycolytic side branch pathways. In this study, we exposed human umbilical vein endothelial cells to static culture, steady laminar flow (20 dynes/cm2 shear stress), or oscillating disturbed flow (4 ± 6 dynes/cm2 shear stress) for 24 h using a cone-and-plate device. We then measured glucose and lactate uptake and secretion, respectively, and glycolytic metabolites. Finally, we explored changes in the expression and protein levels of endothelial glycolytic enzymes. Our data show that endothelial cells in steady laminar flow had decreased glucose uptake and 13C labeling of glycolytic metabolites while cells in oscillating disturbed flow did not. Steady laminar flow did not significantly change glycolytic enzyme gene or protein expression, suggesting that glycolysis may be altered through enzyme activity. Flow also modulated glycolytic side branch pathways involved in proteoglycan and glycosaminoglycan synthesis, as well as oxidative stress. These flow-induced changes in endothelial glucose metabolism may impact the atheroprone endothelial phenotype in oscillating disturbed flow.

Post-Prostatectomy Risk Stratification of Biochemical Recurrence Using Transfer Learning-Based Multi-Modal Artificial Intelligence

PURPOSE/OBJECTIVE(S)

For patients undergoing radical prostatectomy for prostate cancer (PCa), accurate risk stratification is essential to guide post-prostatectomy therapeutic decision making. Recently, there has been success in the use of multi-modal artificial intelligence models for men after prostate biopsy to aid in risk stratification. Herein, we trained and tested a TRansfer learning-based multi-modal Artificial InteLligence model (TRAIL) for biochemical recurrence (BCR) risk stratification following radical prostatectomy.

MATERIALS/METHODS

Patients contained within a prospective PCa registry at a single institution were utilized. Digital pathology slides from the diagnostic biopsies prior to radical prostatectomy for patients with clinically localized PCa were scanned at 20x resolution. Features were extracted for the TRAIL model from pathology slides via two transfer learning steps: (1) InceptionResNetv2 that first determines a heatmap of tumor areas, and (2) A ResNet18 that extracts representative features from the high tumor probability areas. Least Absolute Shrinkage and Selection Operator (LASSO) was used for feature selection from the pathology-extracted features. Finally, TRAIL combines the clinical and pathology-extracted features via a classification ensemble model based on weak tree learners to predict 2- and 5-year BCR defined as two consecutive serum PSA levels ≥0.2 ng/mL. TRAIL training was performed on 250 patients and was then locked and applied to the test set of 125 patients. Accuracy and the area under the curve (AUC) were calculated. Comparison to CAPRA-S and to clinical-only features were assessed.

RESULTS

A total of 818 digital whole pathology biopsy slides from 375 patients treated with subsequent radical prostatectomy were included. Surgical margins were positive in 29% of the patients, and 41% had extra-prostatic extension. The median follow-up was 48 months (Range: 1-132 months). The rates of 2-and 5-year BCR were 11% and 18% respectively. A total of 19 digital pathology-driven features were included in TRAIL. Clinical factors included age, ISUPG, Gleason score, PSA, pathological T and N stages, surgical margin involvement, and the presence of extra-prostatic extension. On the testing set, TRAIL achieved a 2-year BCR AUC of 0.76 and accuracy of 0.87, and was superior to CAPRA-S (AUC = 0.57) and clinical-only features (AUC 0.50, accuracy 0.14). For 5-year BCR, TRAIL achieved an AUC of 0.69 and accuracy of 0.78, and performed better than CAPRA-S (AUC = 0.58), and clinical only features (AUC = 0.50, accuracy = 0.23).

CONCLUSION

Through a combination of deep and ensemble learning, TRAIL incorporates clinical and histopathology features, enabling an improved BCR risk stratification post-prostatectomy when compared to the currently used clinicopathologic models. Future work with larger datasets with metastatic events is warranted to further optimize the model for clinical use.

Evidence of Electron Heating by Alpha Particles in JET Deuterium-Tritium Plasmas

The fusion-born alpha particle heating in magnetically confined fusion machines is a high priority subject for studies. The self-heating of thermonuclear fusion plasma by alpha particles was observed in recent deuterium-tritium (D-T) experiments on the joint European torus. This observation was possible by conducting so-called "afterglow" experiments where transient high fusion yield was achieved with neutral beam injection as the only external heating source, and then termination of the heating at peak performance. This allowed the first direct evidence for electron heating of plasmas by fusion-born alphas to be obtained. Interpretive transport modeling of the relevant D-T and reference deuterium discharges is consistent with the alpha particle heating observation.

Something to eat: experiences of food insecurity on the farm

The health of farm owners and farmworkers has significant impacts on farm businesses, farming families, and local rural communities where agriculture is an important driver of social and economic activity. Rural residents and farmworkers have higher rates of food insecurity, but little is known about food insecurity among farm owners and the collective experiences of farm owners and farmworkers. Researchers and public health practitioners have stressed the need for policies that target the health and well-being of farm owners and farmworkers while remaining sensitive to the nature of life on the farm, yet farm owner and farmworker lived experiences have been understudied, especially in relation to one another. In-depth qualitative interviews were conducted with 13 farm owners and 18 farmworkers in Oregon. Modified grounded theory was used to analyze interview data. Data were coded using a three-stage process to identify salient core characteristics of food insecurity. Farm owner and farmworker meanings and interpretations of their food insecurity were often contradicted by evaluated food security scores using validated quantitative measures. According to such measures, 17 experienced high food security, 3 had marginal food security, and 11 had low food security, but narrative experiences suggested higher rates. Narrative experiences were categorized by core characteristics of food insecurity, including seasonal food shortages, resource stretching, working extended hours most days of the week, limited use of food assistance, and the tendency to downplay hardship. These unique factors have important implications for developing responsive policies and programs to support the health and well-being of farm livelihoods whose work enables health and well-being among consumers. Future studies to test the relationships between the core characteristics of food insecurity identified in this study and farm owner and farmworker meanings and interpretations of food insecurity, hunger, and nourishment are warranted.

Implementing Opt-Out HIV Testing in the Alameda County Jails

Incorporating routine opt-out HIV testing in correctional settings is a critical component of an effective strategy to end the HIV/AIDS epidemic. Between 2012 and 2017, Alameda County jails implemented opt-out HIV testing to identify new cases, link those who were newly diagnosed to care, and reengage those who were previously diagnosed but not in care. Over a 6-year period, 15,906 tests were conducted, with a positivity rate of 0.55% for both newly diagnosed cases and previously diagnosed but out of care. Nearly 80% of those who tested positive were linked to care within 90 days. The high positivity and successful linkage and reengagement with care underscores the need to support HIV testing programs in correctional settings.

The effect of tibialis anterior weakness on foot drop and toe clearance in patients with facioscapulohumeral dystrophy

BACKGROUND

Facioscapulohumeral dystrophy is a genetic disease characterized by progressive muscle weakness leading to a complex combination of postural instability, foot drop during swing and compensatory strategies during gait that have been related to an increased risk of falling. The aim is to assess the effect of tibialis anterior muscle weakness on foot drop and minimum toe clearance of patients with facioscapulohumeral dystrophy during gait.

METHODS

Eight patients allocated to a subgroup depending on the severity of tibialis anterior muscle weakness, assessed by manual muscle testing (i.e., severe and mild weakness), and eight matched control participants underwent gait analysis at self-selected walking speeds.

FINDINGS

Walking speed, for all facioscapulohumeral dystrophy patients, and step length, for patients with severe weakness only, were significantly decreased compared to control participants. Minimum toe clearance was similar across all groups, but its variability was increased only for patients with severe weakness. A greater foot drop was systematically observed for patients with severe weakness during swing and only in late swing for patients with mild weakness. Individual strategies to compensate for foot drop remain unclear and may depend on other muscle impairment variability.

INTERPRETATION

Although all patients were able to control the average height of their foot trajectory during swing, patients with severe tibialis anterior muscle weakness exhibited increased foot drop and minimum toe clearance variability. Manual muscle testing is a simple, cheap and effective method to assess tibialis anterior muscle weakness and seems promising to identify facioscapulohumeral dystrophy patients with an increased risk of tripping.

A model of non-Maxwellian electron distribution function for the analysis of ECE data in JET discharges

Recent experiments performed in JET at high level of plasma heating, in preparation of, and during the DT campaign have shown significant discrepancies between electron temperature measurements by Thomson Scattering (TS) and Electron Cyclotron Emission (ECE). In order to perform a systematic analysis of this phenomenon, a simple model of bipolar distortion of the electron distribution function has been developed, allowing analytic calculation of the EC emission and absorption coefficients. Extensive comparisons of the modelled ECE spectra (at both the 2nd and the 3rd harmonic extraordinary mode) with experimental measurements display good agreement when bulk electron distribution distortions around 1-2 times the electron thermal velocity are used and prove useful for a first level of analysis of this effect.

The Effect of Pollen Diet Composition and Quantity on Diapause Survival and Performance in an Annual Pollinator (Bombus Impatiens)

Most pollination services are provided by annual bees that go through a winter diapause, during which they are exposed to extreme temperatures, pathogens, and starvation. The ability of bees to successfully face these stressors during diapause and subsequently initiate a nest depends on their overall nutritional state and an adequate preparatory diet. Here, we used queens of the common eastern bumble bee, Bombus impatiens, to examine how pollen diets varying in their protein to lipid ratio and total nutrient amounts affected queen performance during and after diapause. We compared diapause survival and reproductive performance post-diapause across different diets and found that queen survival was highest when pollen had a nutritional ratio of approximately 5:1 (protein to lipid). This diet is significantly enriched in proteins compared to the pollen fed to bumble bees in the lab (1:1) or commonly available in agricultural landscapes. Altering the quantity of macronutrients within this ratio did not improve survival or performance. Our results emphasize the importance of adequate nutrition for diapause performance in bees with annual life cycles and the importance of providing annual bees with floral provisioning based on their individual nutritional targets.

Investigation of Te measurements discrepancies between ECE and Thomson diagnostics in high-performance plasmas in JET

For high-temperature JET and TFTR discharges, electron cyclotron emission (ECE) measurements of central electron temperature were systematically found to be up to 20% higher than those taken with Thomson scattering. In recent high-performance JET discharges, central Te measurements, performed with LIDAR Thomson scattering and the X-mode ECE interferometer, have been studied in a large database, including deuterium (DD), and deuterium-tritium plasmas (DT). Discrepancies between Te measurements have been observed outside of the experimental uncertainties. ECE measurements, at high Te, have been found to be higher or lower than those of LIDAR, depending on the specific plasma scenario. In addition, discrepancies between the peaks of the second and third harmonic ranges of the ECE spectrum have been interpreted as evidence for the presence of non-Maxwellian features in the electron distribution function. These comparisons seem to suggest that such features can be found in most of the high-performance scenarios selected in this JET database.

A high-resolution neutron spectroscopic camera for the SPARC tokamak based on the Jet European Torus deuterium-tritium experience

Dedicated nuclear diagnostics have been designed, developed, and built within EUROFUSION enhancement programs in the last ten years for installation at the Joint European Torus and capable of operation in high power Deuterium-Tritium (DT) plasmas. The recent DT Experiment campaign, called DTE2, has been successfully carried out in the second half of 2021 and provides a unique opportunity to evaluate the performance of the new nuclear diagnostics and for an understanding of their behavior in the record high 14 MeV neutron yields (up to 4.7 × 10¹⁸ n/s) and total number of neutrons (up to 2 × 10¹⁹ n) achieved on a tokamak. In this work, we will focus on the 14 MeV high resolution neutron spectrometers based on artificial diamonds which, for the first time, have extensively been used to measure 14 MeV DT neutron spectra with unprecedented energy resolution (Full Width at Half Maximum of ≈1% at 14 MeV). The work will describe their long-term stability and operation over the DTE2 campaign as well as their performance as neutron spectrometers in terms of achieved energy resolution and high rate capability. This important experience will be used to outline the concept of a spectroscopic neutron camera for the SPARC tokamak. The proposed neutron camera will be the first one to feature the dual capability to measure (i) the 2.5 and 14 MeV neutron emissivity profile via the conventional neutron detectors based on liquid or plastics scintillators and (ii) the 14 MeV neutron spectral emission via the use of high-resolution diamond-based spectrometers. The new opportunities opened by the spectroscopic neutron camera to measure plasma parameters will be discussed.

Critical Consciousness for Connectivity: Decoding Social Isolation Experienced by Latinx and LGBTQ+ Youth Using a Multi-Stakeholder Approach to Health Equity

Systemic oppression creates a context in which Latinx LGBTQ+ youth experience social isolation. Social isolation has been associated with mental and physical health disparities, including disproportionate levels of depression, substance use, self-harm, and attempted suicide. These disparities are often magnified in rural and suburban areas with fewer identity-affirming spaces. This community-engaged study reports on the formative process of developing a Latinx LGBTQ+ telenovela (soap opera) allyship intervention based on critical consciousness theory. We conducted eight focus groups with community advisory boards, which included Latinx LGBTQ+ youth (n = 12), health and social service providers serving LGBTQ+ youth (n = 10), 4-H Latinx alumni youth (n = 12), and 4-H Latinx parents (n = 8). We interviewed nine Latinx LGBTQ+ youth enrolled in a film-making workshop. As a result of our multi-stakeholder approach, we: (1) described how stakeholders reflected on and decoded intersectional isolation on the individual, community, and structural levels; and (2) identified ways that stakeholders suggested taking action by improving access to resources to address social isolation, provide culturally competent healthcare, and co-create an enabling social environment. Our study indicated the importance of tapping into core values and intersectional identities to build solidarity among and within marginalized groups to dismantle oppressive systems.

Lost alpha Faraday cup foil noise characterization during Joint European Torus plasma post-processing analysis

Capacitive plasma pickup is a well-known and difficult problem for plasma-facing edge diagnostics. This problem must be addressed to ensure an accurate and robust interpretation of the real signal measurements vs noise. The Faraday cup fast ion loss detector array of the Joint European Torus (JET) is particularly prone to this issue and can be used as a testbed to prototype solutions. The issue of separation and distinction between warranted fast ion signal and electromagnetic plasma noise has traditionally been solved with hardware modifications, but a more versatile post-processing approach is of great interest. This work presents post-processing techniques to characterize the signal noise. While hardware changes and advancements may be limited, the combination with post-processing procedures allows for more rapid and robust analysis of measurements. The characterization of plasma pickup noise is examined for alpha losses in a discharge from JET's tritium campaign. In addition to highlighting the post-processing methodology, the spatial sensitivity of the detector array is also examined, which presents significant advantages for the physical interpretation of fast ion losses.

A new dedicated signal processing system for gamma-ray spectrometers in high power deuterium-tritium plasma scenarios in tokamaks

The most performant deuterium-tritium (DT) plasma discharges realized by the Joint European Torus (JET) tokamak in the recent DT campaign have produced neutron yields on the order of 10¹⁸ n/s. At such high neutron yields, gamma-ray spectroscopy measurements with scintillators are challenging as events from the neutron-induced background often dominate over the signal, leading to a significant fraction of pileup events and instability of the photodetector gain along with the consequent degradation of the reconstructed spectrum. Here, we describe the solutions adopted for the tangential lanthanum bromide spectrometer installed at JET. A data acquisition system with free streaming mode digitization capabilities for the entire duration of the discharge has been used to solve dead-time related issues and a data reconstruction code with pileup recovery and photodetector gain drift restoration has been implemented for off-line analysis of the data. This work focuses on the acquired data storage and parsing, with a detailed explanation of the pileup recovery and gain drift restoration algorithms.

Fusion product measurements by nuclear diagnostics in the Joint European Torus deuterium-tritium 2 campaign (invited)

A new deuterium-tritium experimental, DTE2, campaign has been conducted at the Joint European Torus (JET) between August 2021 and late December 2021. Motivated by significant enhancements in the past decade at JET, such as the ITER-like wall and enhanced auxiliary heating power, the campaign achieved a new fusion energy world record and performed a broad range of fundamental experiments to inform ITER physics scenarios and operations. New capabilities in the area of fusion product measurements by nuclear diagnostics were available as a result of a decade long enhancement program. These have been tested for the first time in DTE2 and a concise overview is provided here. Confined alpha particle measurements by gamma-ray spectroscopy were successfully demonstrated, albeit with limitations at neutron rates higher than some 10¹⁷ n/s. High resolution neutron spectroscopy measurements with the magnetic proton recoil instrument were complemented by novel data from a set of synthetic diamond detectors, which enabled studies of the supra-thermal contributions to the neutron emission. In the area of escaping fast ion diagnostics, a lost fast ion detector and a set of Faraday cups made it possible to determine information on the velocity space and poloidal distribution of the lost alpha particles for the first time. This extensive set of data provides unique information for fundamental physics studies and validation of the numerical models, which are key to inform the physics and scenarios of ITER.

The role of SNAP and WIC participation and racialized legal status in U.S. farmworker health

Background

Policies that restrict access to and use of the Supplemental Nutrition Assistance Program (SNAP) and Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC) by legal status may disproportionately disadvantage particular racial and ethnic groups. While immigrant legal status, race, and ethnicity are recognized as independent social determinants of health, studies examining the extent to which legal status structures racial and ethnic health disparities are limited. Research is needed to identify factors that mitigate disparate health outcomes, such as SNAP and WIC.

Methods

Cross-sectional data from the 2009/2010 National Agricultural Workers Survey (N = 3,961) were analyzed. Chi-square tests and logistic regressions examined associations among self-reported health, race, ethnicity, legal status, and SNAP/WIC participation.

Results

Farmworkers reporting excellent or good health were more likely to be non-Hispanic White, U.S. citizen, aged 18–25, single, male, educated beyond primary school, living above the poverty level, without chronic health conditions, and located in the Midwest. Hispanic farmworkers had lower odds of reporting excellent or good health (OR 0.27, 95% CI 0.12–0.62). Among SNAP/WIC participants, Hispanic farmworkers had higher odds of reporting excellent or good health (OR 6.74, 95% CI 1.54–29.57) compared to non-Hispanic White farmworkers. There was no significant association between self-reported health and legal status.

Discussion

This study complements the extant literature showing racial and ethnic health disparities among the U.S. farmworker population. Results provide valuable insight on the health-protective potential of programs like SNAP and WIC, particularly among Hispanic farmworkers, who may be both less likely to be eligible and more hesitant to participate. These findings underscore the need to expand U.S. farmworkers’ eligibility and participation in SNAP and WIC.

The COVID-19 Mirage: A Young Biologist With an Atypical Presentation of a Zoonotic Disease During the COVID-19 Pandemic

COVID-19 has become one of the main causes of febrile illness among emergency department patients and is always a differential diagnosis to keep in mind. Nonetheless, some patients with a history of exposure, persistent fever, and suspicion of COVID-19 end up having entirely different etiologies. Here, we present the case of a 29-year-old male biologist with an uncommon presentation of a zoonotic disease, characterized by unspecific signs and symptoms, which led to a delayed diagnosis, causing significant emotional distress in the patient. We also coin the term “COVID-19 Mirage," to serve as a constant reminder for clinicians of the effect that COVID-19 has caused on the differential diagnosis of fever of unknown etiology.

Will Polycrystalline Platinum Tip Sliding on a Gold(111) Surface Produce Regular Stick-Slip Friction?

Friction measurements by an atomic force microscope (AFM) frequently showed regular stick-slip friction signals with atomic-scale resolutions. Typically, for an AFM metal tip sliding on a metal crystal surface, the microstructure of the tip made from the thermally evaporated metal coating on a silicon cantilever was polycrystalline. Our detailed molecular dynamics(MD) simulations of a polycrystalline Pt tip (R = 10 nm in radius) sliding on an Au(111) surface revealed how the geometry of the polycrystalline tip took effect on the friction behavior at the contact interface. We found that the apex of the Pt tip with multiple grains near the edge of contact could induce severe plastic deformations of the gold substrate, leading to irregular stick-slip frictions upon sliding. Simulation results showed that in order to achieve a clear stick-slip friction signal with single atomic slips, the apex of the Pt tip must adopt a single crystalline protrusion without any neighboring grains involved in the metal contact. We showed that such a single crystalline protrusion, which presumably could be achieved during initial run-in or wear-out of high-energy Pt atoms in the neighboring grains, was passivated by a large number of gold atoms due to metal adhesion in the contact periphery. Using such a crystalline protrusion tip, we demonstrated that the stick-slip friction produced was very "tolerant" to the adhesion of a large number of gold atoms on the tip apex. We further showed that AFM tip mass used in MD simulations also played an important role in determining the transition between friction regimes, which could be well explained by the Prandtl-Tomlinson thermal activation model.

CONCERTO at APEX: Installation and first phase of on-sky commissioning

CONCERTO (CarbON CII line in post-rEionisation and ReionisaTiOn) is a large field-of-view (FoV) spectro-imager that has been installed on the Cassegrain Cabin of Atacama Pathfinder EXperiment (APEX) telescope in April 2021. CONCERTO hosts 2 focal planes and a total number of 4000 Kinetic Inductance Detectors (KID), with an instantaneous FoV of 18.6 arcminutes in the range of 130-310 GHz. The spectral resolution can be easily tuned down to 1 GHz depending on the scientific target. The scientific program of CONCERTO has many objectives, with two main programs focused on mapping the fluctuations of the [CII] line intensity in the reionisation and postreionisation epoch (4.5<z<8.5), and on studying galaxy clusters via the thermal and kinetic Sunyaev-Zel’dovich (SZ) effect. CONCERTO will also measure the dust and molecular gas contents of local and intermediate-redshift galaxies, it will study the Galactic star-forming clouds and finally it will observe the CO intensity fluctuations arising from 0.3<z<2 galaxies.

The design of the instrument, installation at APEX and current status of the commissioning phase and science verification will be presented. Also we describe the deployment and first on-sky tests performed between April and June 2021.

Predictors of patients' choice of hospitals under universal health coverage: a case study of the Nicaraguan capital

BACKGROUND

This study looks at the factors that can shape patients' choice of healthcare providers. Understanding this process can help with making high quality healthcare more accessible for all. We focus on distance, patient's health status, (perceived) quality of healthcare facility, and referrals to investigate how these factors compete in shaping patients' choice of hospitals.

METHODS

This study was carried out in Managua, the capital of Nicaragua. Utilizing an exit-survey, patients were interviewed across five public hospitals in 2017 and then six in 2019 when a new highly-equipped hospital was added to the system. We used a multinomial logit model to investigate patients' preference of a specific hospital over the rest within each wave.

RESULTS

Our results show that being referred to a hospital is the strongest predictor and in some cases, it can increase the relative risk ratio of choosing a facility by a factor of 49 (p < 0.01; 95% CI: 27.39-87.17). For the remaining factors, the hierarchy of importance was less clear-cut yet all these factors remained significantly important at various levels.

CONCLUSIONS

Overall, our results highlight the importance of referral systems in making quality healthcare more equitable. Moreover, with distance also being a key predictor and in the absence of an organized referral system, those with low-income would either be further deprived by having to settle with locally available healthcare (regardless of its quality) or face high amounts of out-of-pocket expenditure when seeking help from the private sector.

Engaging Latino Families About COVID-19 Vaccines: A Qualitative Study Conducted in Oregon, USA

Objectives

Latinos are disproportionately vulnerable to severe COVID-19 due to workplace exposure, multigenerational households, and existing health disparities. Rolling out COVID-19 vaccines among vulnerable Latinos is critical to address disparities. This study explores vaccine perceptions of Latino families to inform culturally centered strategies for vaccine dissemination.

Method

Semistructured telephone interviews with Latino families (22 mothers and 24 youth, 13–18 years old) explored COVID-19 vaccine perceptions including (1) sources of information, (2) trust of vaccine effectiveness and willingness to get vaccinated, and (3) access to the vaccine distribution. We identified thematic patterns using immersion–crystallization.

Results

We found that (1) 41% expressed optimism and willingness to receive the vaccine coupled with concerns about side effects; (2) 45% expressed hesitancy or would refuse vaccination based on mistrust, myths, fear of being used as “guinea pigs,” and the perceived role of politics in vaccine development; (3) families “digested” information gathered from social media, the news, and radio through intergenerational communication; and (4) participants called for community-led advocacy and “leading by example” to dispel fear and misinformation. Optimistic participants saw the vaccine as a way to protect their families, allowing youth to return to schools and providing safer conditions for frontline essential workers.

Conclusions

Culturally centered vaccine promotion campaigns may consider the Latino family unit as their target audience by providing information that can be discussed among parents and youth, engaging a range of health providers and advocates that includes traditional practitioners and community health workers, and disseminating information at key venues, such as schools, churches, and supermarkets.

Levels and trends of adolescent marriage and maternity in West and Central Africa, 1986-2017

Background

The world has made considerable progress in the reduction of adolescent maternity and early marriage. However, this progress has been uneven, with many countries finding themselves far from achieving the Sustainable Development Goals in this dimension. We assessed levels and trends over time in adolescent marriage and maternity prevalence within the West and Central African region as well as their correlation with select macro-level indicators for income and social institutions.

Methods

We estimated country-specific prevalence rates using survey data (pooled cross-sectional) conducted between 1986 and 2017. The pooled sample provides information on 262 721 adolescent girls between the ages of 15 and 19. We assessed the relative country-level trends by comparing prevalence rates from the first and latest available survey in each country. We further analyzed regional trends by country income group (low- and middle-income) and examined the association of prevalence rates with measurements of gender discrimination and social institutions at the country-level. Estimations were conducted using survey weights and country-specific weights for population shares in the pooled sample.

Results

Prevalence of adolescent maternity declined from 30.1 percent (95% confidence interval (CI) = 29.6%-32.2%) in the 1990s, to 28.7 percent (95% CI = 27.9%-29.6%) in the 2000s and 26.2 percent (95% CI = 25.4%-27.1%) in the 2010s. Adolescent marriage rates decreased from 37.3 percent (95% CI = 35.5%-39.1%) in the 1990s to 27.5 percent (95% CI = 26.5%-28.6%) in the 2000s, and to 24.9 percent (95% CI = 24.1%-25.7%) in the 2010s. Between 1986 and 2017, adolescent marriage decreased in all countries except for the Central African Republic (with a rise from 39% to 55%) and Niger (56% to 61%). The prevalence of adolescent maternity decreased in all but three countries: Congo, Dem. Rep. (25% to 37%), Niger (36% to 40%), and the Central African Republic (36% to 49%). When grouped by income level, the prevalence was 8 percentage points higher in low-income countries than in middle-income countries in both outcomes. We did not establish any statisticly significant association between adolescent marriage and maternity with country-level measures of discrimination against women. However, we found evidence of an association between specific legal measures of protection against early marriage and lower prevalence rates for both early marriage and maternity.

Conclusions

Despite considerable progress in the reduction of adolescent maternity and marriage over the last 30 years, current levels of both indicators remain overall high in the WCA region, with high heterogeneity across individual countries. Countries with higher income level and higher standard in legal protection of young girls perform consistently better on both indicators. The prevalence rates of adolescent marriage and maternity reversed over the course of three decades, so that nowadays adolescent maternity rates exceed adolescent marriage rates in most countries. Further research is needed to understand the weak or non-existent association between adolescent marriage and maternity with gender discrimination and social institutions.

Socio-economic predictors of adolescent marriage and maternity in West and Central Africa between 1986 and 2017

BACKGROUND

Early marriage and maternity prevalence rates among adolescent girls remain alarmingly high in West and Central Africa (WCA). This study aims to explore the associations between socio-economic factors and the prevalence of early marriage and maternity, thus contributing to the identification of girls at risk of early pregnancy or marriage.

METHODS

We pooled data from national representative surveys (1986 - 2017) for 23 countries in WCA to examine associations between wealth, educational attainment, religious affiliation, and place of residence with adolescent marriage and maternity. We decomposed the wealth and education gradients for individual countries, while controlling for common characteristics of the local environment via the use of primary sampling unit fixed-effects. The pooled sample provides information on 262 721 girls (age 15-19 years). Survey weights and population share weights were used in the estimations.

RESULTS

The prevalence of adolescent maternity and marriage exhibited a wealth and education gradient. Prevalence of marriage in the poorest wealth quintile was 41.1% (95% confidence interval (CI) = 38.8%-43.5%) and 10.5% (95% CI = 9.5%-11.6%) in the richest. For maternity it was 38.3% (95% CI = 36.4%-40.3%) in the poorest quintile and 12.7% (95% CI = 11.5%-13.9%) in the richest. Marriage/maternity is three/two times more likely to occur among girls with incomplete primary or no formal education than in those with at least primary. Maternity and marriage among adolescents exhibit a geographical pattern and differences between religious groups. Adolescent marriage prevalence was 34.4% (95% CI = 32.9%-35.8%) in rural areas compared to 13.3% (95% CI = 12.3%-14.2%) in urban areas. Adolescent maternity prevalence was 32.8% (95% CI = 31.7%-33.9%) in rural compared to 16.3% (95% CI = 15.3%-17.3%) in urban areas. Finally, the prevalence of adolescent marriage was substantially higher among Muslims compared to all other religious groups.

CONCLUSIONS

Our results highlight the disparities in the prevalence of adolescent marriage and maternity and confirm the existence of wealth and education gradients. These findings can help to improve targeting of vulnerable adolescents and to identify areas for policy implementation.

P–704 Does the type of ovarian stimulation scheme and dose matter when calculating the amount of gonadotropins used to obtain an egg?

Study question

Is the controlled ovarian stimulation protocol important to determine the ovarian sensitivity index (number of oocytes retrieved / total gonadotropin dose)?

Summary answer

OSI in an interesting tool in estimating the ovarian sensitivity to exogenous gonadotropins and can be adjusted when different kinds of COS procotols are used.

What is known already

In our country, Argentina, as the fertility treatments are financed by different health care insurance companies, COS protocols may vary depending on the drugs provided. The objective of our study is to assess the oocyte retrieval number in patients undergoing COS, for IVF or fertility preservation (egg freezing), on the basis of the kind of protocol and the average gonadotropin dose.

Study design, size, duration

This is a retrospective and descriptive study in which 684 cycles, performed between November 2018 and March 2020, were evaluated. Patients underwent COS for IVF or fertility preservation purposes.

Participants/materials, setting, methods

COS protocols were analysed including different parameters such as: number of mature follicles (17mm or more) the trigger day, number of oocytes retrieved, number of M2 retrieved, follicle to oocyte index (FOI), and the kind of protocol.Each of these groups were divided into four groups depending on the protocol used. Group A: FSHr; Group B: FSHr/LHr; Group C: FSHr + HMG; Group D: Clomiphene citrate + HMG. Oocyte donors and incomplete medical records were excluded

Main results and the role of chance

The total number of cycles analysed was 684. There were 135(19.7%) cycles in the under 35 age group; 340(42%) in the 35 to 39 group; 209(38%) in the older than 40 group. They were subdivided in Group A: 54(6.67%) cycles; Group B 93(11.11%) cycles; Group C 465(71.72%); Group D 72(10.5%). A total number of 11351 oocytes were retrieved, with a mean average of 4.6 +- 2.5 SD per patient. Assessment of dose of gonadotropin per oocyte retrieved in each different group: GROUP A 360IU+–38 SD; GROUP B 390IU+–43 SD; GROUP C 375IU +–44 SD; GROUP D 479+–36 SD.

Limitations, reasons for caution

This is a retrospective study. Further prospective studies and a higher sample size are needed to confirm whether the OSI is a useful tool to adjust gonadotropins doses related to an specific COS protocol and improve the oocyte pick up.

Wider implications of the findings: The main conclusion obtained was that the average dose of gonadotropin needed to obtain one mature oocyte was 360 to 390 IU. The HMG and clomiphene citrate protocol needed the highest dose of gonadotropin (479 IU) but no significant stadistical differences were observed.

Trial registration number

NA

Nanoghosts: Mesenchymal Stem cells derived nanoparticles as a unique approach for cartilage regeneration

Osteoarthritis (OA) is a chronic degenerative disease, which affects the joints and is characterized by inflammation, cartilage loss and bone changes. Nowadays, there are no treatments for OA, and current therapies are focused on relieving the symptoms. As a new therapy approach, micro and nanoparticles have been extensively explored and among all the studied particles, the use of cell-membrane-based particles is expanding. Another promising approach studied to treat OA, is the use of mesenchymal stem cells (MSCs) which play an important role modulating inflammation. We developed a novel kind of MSCs' cytoplasmic-membrane-based nanoparticles, termed nano-ghosts (NGs). Retaining MSCs' surface properties and lacking cells' internal machinery allow the NGs to have immunomodulatory capacity and to be immune-evasive while not susceptible to host-induced changes. In this study, we demonstrate NGs' ability to target cartilage tissues, in vitro and in vivo, while modulating the inflammatory process. In vivo studies demonstrated NGs ability to act as an immunomodulatory drug slowing down cartilage degeneration process. Our proof-of-concept experiments show that NGs system is a versatile nano-carrier system, capable of therapeutics loading, with targeting capabilities towards healthy and inflamed cartilage cells. Our results, along with previously published data, clearly reveal the NGs system as a promising nano-carrier platform and as a potential immunomodulatory drug for several inflammation-related diseases.

13C Metabolic Flux Analysis Indicates Endothelial Cells Attenuate Metabolic Perturbations by Modulating TCA Activity

Disrupted endothelial metabolism is linked to endothelial dysfunction and cardiovascular disease. Targeted metabolic inhibitors are potential therapeutics; however, their systemic impact on endothelial metabolism remains unknown. In this study, we combined stable isotope labeling with ¹³C metabolic flux analysis (¹³C MFA) to determine how targeted inhibition of the polyol (fidarestat), pentose phosphate (DHEA), and hexosamine biosynthetic (azaserine) pathways alters endothelial metabolism. Glucose, glutamine, and a four-carbon input to the malate shuttle were important carbon sources in the baseline human umbilical vein endothelial cell (HUVEC) ¹³C MFA model. We observed two to three times higher glutamine uptake in fidarestat and azaserine-treated cells. Fidarestat and DHEA-treated HUVEC showed decreased ¹³C enrichment of glycolytic and TCA metabolites and amino acids. Azaserine-treated HUVEC primarily showed ¹³C enrichment differences in UDP-GlcNAc. ¹³C MFA estimated decreased pentose phosphate pathway flux and increased TCA activity with reversed malate shuttle direction in fidarestat and DHEA-treated HUVEC. In contrast, ¹³C MFA estimated increases in both pentose phosphate pathway and TCA activity in azaserine-treated cells. These data show the potential importance of endothelial malate shuttle activity and suggest that inhibiting glycolytic side branch pathways can change the metabolic network, highlighting the need to study systemic metabolic therapeutic effects.

Social Determinants of Discrimination and Access to Health Care Among Transgender Women in Oregon

Purpose: Transgender women in the United States experience health disparities and limited access to gender-affirming health services. This study describes the social determinants of health that shape access to health services for transgender women in Oregon, a state with a high tally of gender-affirming policies.

Methods: We conducted qualitative interviews with 25 transgender women between 18 and 39 years of age. Interviews explored the social, economic, cultural, and legal factors that shape access to health. A Qualtrics survey captured sociodemographic characteristics. We identified facilitators and barriers to accessing gender-affirming services using thematic analysis of qualitative data.

Results: Our participants perceived gender-affirming health services in Oregon to be relatively trans-friendly, compared to other parts of the United States. This perception drew several transgender women in our sample to migrate to Oregon from other “more conservative” states. Facilitators included ease with legal name change (60% had completed), inclusiveness of hormone therapy in the Oregon Health Plan, and availability of informed consent hormone therapy. However, for our participants, economic and social discrimination were major limiting factors to accessing and navigating health services. Social factors exacerbated difficulties navigating and understanding health systems to achieve coverage; 20% had insurance that did not cover hormone therapy. Specialized surgeons were located in urban/suburban centers; electrolysis coverage was limited; and 10% had gender-affirming surgery.

Conclusion: This study indicates that services are necessary to assist with navigating access to gender-affirming health care, even in affirming policy contexts like Oregon.

Population-based trends in hospitalizations due to injection drug use-related serious bacterial infections, Oregon, 2008 to 2018

BACKGROUND

Injection drug use has far-reaching social, economic, and health consequences. Serious bacterial infections, including skin/soft tissue infections, osteomyelitis, bacteremia, and endocarditis, are particularly morbid and mortal consequences of injection drug use.

METHODS

We conducted a population-based retrospective cohort analysis of hospitalizations among patients with a diagnosis code for substance use and a serious bacterial infection during the same hospital admission using Oregon Hospital Discharge Data. We examined trends in hospitalizations and costs of hospitalizations attributable to injection drug use-related serious bacterial infections from January 1, 2008 through December 31, 2018.

RESULTS

From 2008 to 2018, Oregon hospital discharge data included 4,084,743 hospitalizations among 2,090,359 patients. During the study period, hospitalizations for injection drug use-related serious bacterial infection increased from 980 to 6,265 per year, or from 0.26% to 1.68% of all hospitalizations (P<0.001). The number of unique patients with an injection drug use-related serious bacterial infection increased from 839 to 5,055, or from 2.52% to 8.46% of all patients (P<0.001). While hospitalizations for all injection drug use-related serious bacterial infections increased over the study period, bacteremia/sepsis hospitalizations rose most rapidly with an 18-fold increase. Opioid use diagnoses accounted for the largest percentage of hospitalizations for injection drug use-related serious bacterial infections, but hospitalizations for amphetamine-type stimulant-related serious bacterial infections rose most rapidly with a 15-fold increase. People living with HIV and HCV experienced increases in hospitalizations for injection drug use-related serious bacterial infection during the study period. Overall, the total cost of hospitalizations for injection drug use-related serious bacterial infections increased from $16,305,129 in 2008 to $150,879,237 in 2018 (P<0.001).

CONCLUSIONS

In Oregon, hospitalizations for injection drug use-related serious bacterial infections increased dramatically and exacted a substantial cost on the health care system from 2008 to 2018. This increase in hospitalizations represents an opportunity to initiate substance use disorder treatment and harm reduction services to improve outcomes for people who inject drugs.

Bicuspid aortic valve disease associates with abnormal wall shear stress, viscous energy loss, and pressure drop within the ascending thoracic aorta

Introduction

We use 4D Flow MRI to (1) investigate the effects of bicuspid aortic valve (BAV) disease on downstream pressure drop (PD), wall shear stress (WSS), and viscous energy loss (EL) in the ascending aorta (AAo) and (2) explore the associations between AAo diameter and PD, WSS, and EL.

Hypothesis

BAV patients show increased PD, WSS, and EL in the AAo compared to age-matched controls

Methods

32 healthy controls (41±15 y, 10 female) and 53 BAV patients (44±16 y, 19 female) underwent cardiac MRI at 3T, inclusive of cine imaging and 4D flow. Cross sections were placed along segmented aortas at the: left ventricular outflow tract (LVOT), sinuses of Valsalva (SOV), mid-ascending aorta (MAA), and proximal to first aortic branch (AA1). Locations were analyzed for (i) net flow, (ii) aortic diameter (normalized to BSA), (iii) systolic PD (referenced to LVOT), (iv) systolic EL (measured within LVOT-AA1 volume and normalized by LVOT net flow; mW/mL), and (v) systolic WSS. Sub-vectors of WSS, axial (WSSax) and circumferential (WSScirc), were also analyzed.

Results

In comparison to controls, BAV patients showed greater PD (e.g. MAA: 9.5±8.0 vs. 2.8±2.4mmHg; p&lt;0.01), EL (0.09±0.05 vs. 0.04±0.01 mW/mL; p≤0.01), and WSScirc (e.g. MAA: 0.3±0.1 vs. 0.2±0.06 Pa; p≤0.01) throughout the AAo (Table 1 and Fig. 1). BAV patients exhibited significantly lower WSS and WSSax only at the SOV. In univariate analyses, AAo diameter was inversely correlated with WSS (R=−0.32, p&lt;0.01) and WSSax (R=−0.51, p≤0.01). In multivariate analyses, AAo diameter was associated with WSS (β=−0.36, p&lt;0.01) and WSSax (β=−0.26, p&lt;0.01).

Conclusions

BAV patients demonstrate significantly increased PD, EL, and WSScirc in the AAo, and an inverse association between AAo diameter and WSS measures.

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): Alberta Health Services

Respostas religiosas à AIDS no Brasil

O texto encontra-se estruturado em quatro partes. Na primeira delas, apresentamos um conjunto de considerações e informações acerca da situação da aids no Brasil, das relações entre religião, sexualidade, aids e estado laico, bem como uma descrição mais clara do Projeto Respostas Religiosas ao HIV/Aids no Brasil, do qual este texto apresenta algumas impressões de pesquisa preliminares. A seguir, dedicamos um item a apresentação da Pastoral de DST/Aids, sua história, estrutura e objetivos. No item seguinte problematizamos diversas questões em particular no âmbito das relações Estado e Igreja, relações entre agentes de pastoral e hierarquia da Igreja, e questões ligadas mais diretamente à sexualidade e aids, todas referenciadas ao trabalho da Pastoral de DST/Aids. Ao final, apresentamos a bibliografia e fontes consultadas.

Truncated Nonlinear Interferometry for Quantum-Enhanced Atomic Force Microscopy

Nonlinear interferometers that replace beam splitters in Mach-Zehnder interferometers with nonlinear amplifiers for quantum-enhanced phase measurements have drawn increasing interest in recent years, but practical quantum sensors based on nonlinear interferometry remain an outstanding challenge. Here, we demonstrate the first practical application of nonlinear interferometry by measuring the displacement of an atomic force microscope microcantilever with quantum noise reduction of up to 3 dB below the standard quantum limit, corresponding to a quantum-enhanced measurement of beam displacement of 1.7  fm/sqrt[Hz]. Further, we minimize photon backaction noise while taking advantage of quantum noise reduction by transducing the cantilever displacement signal with a weak squeezed state while using dual homodyne detection with a higher power local oscillator. This approach may enable quantum-enhanced broadband, high-speed scanning probe microscopy.

126Dynamic high density functional substrate mapping improves outcomes in ventricular tachycardia ablation

Introduction

Activation and entrainment mapping of VT remains the gold standard for identifying critical sites for ablation of VT, however, this method is limited by poorly tolerated or non-sustained VT. Several substrate guided approaches have been developed, however, outcomes when comparing both methods are similar and overall success can be as low as 47%. A key element in facilitating VT is the presence of dynamic changes within the substrate which may not be evident during sinus rhythm substrate mapping, but may form a critical aspect of the tachycardia mechanism when conduction velocity slows dynamically and tissue refractory periods lengthen. These are rarely studied as part of clinical VT mapping. 

Purpose

This study aimed to investigate dynamic substrate changes to local abnormal ventricular activity (LAVA) and late potentials (LP), in relation to critical sites for VT ablation using high resolution mapping of the ventricle with the HD Grid (Abbott, Inc, USA), during short coupled singe extra stimuli from the right ventricle (RV) (Barts Sense Protocol), designed to invoke conduction delay. We hypothesized that the dynamic functional late potential mapping would improve the identification of critical substrate and ablation of these regions would improve outcomes. 

Methods

Thirty patients (age 67 +/- 9yrs, 27Male) underwent ablation. Mean ejection fraction was 25% (+/- 10%). Mapping was performed with the AdvisorTM HD Grid multipolar catheter. A bipolar voltage map was obtained during sinus rhythm (SR) and RV Sensed Protocol (SP) single extra pacing. SR and SP late potential (LP) and local abnormal ventricular activity (LAVA) maps were made and compared with critical sites for ablation, defined as sites of best entrainment or pace mapping. Ablation was then performed to critical sites and LP/LAVA identified by the SP.

Results

At a median follow up of 10 months 90% of patients were free from symptomatic ATP or ICD shocks. The median area of late potentials across the 30 patients during sinus rhythm was 6.4mm2 during sinus rhythm mapping and 19.3mm2 during sense protocol pacing (p = 0.001). The functional unmasking of LP and LAVA was seen in 26 patients and showed good correlation to critical regions of the VT circuit (sites of best entrainment or pace map). In 24 patients functionally unmasked late potentials were located within 10mm of critical regions within the mapped VT circuit, with a median distance of 8.5mm, compared to 7 patients during sinus rhythm mapping with a median distance of 22mm (p= &lt;0.001). Figure 1 demonstrates and example of the SP, where increased functional LP are seen along the mapped VT isthmus. 

Conclusion

Functional LP and LAVA can be unmasked by the sense protocol enabling better delineation of critical regions for VT ablation which may not be visible during sinus rhythm. This unique delineation of functional substrate changes combined with activation or pacemapping may improve outcomes.

Abstract Figure 1

THU0053 CONTRIBUTION OF DEFECTIVE NON-APOPTOTIC FAS SIGNALING TO IMMUNE DYSREGULATION IN AUTOIMMUNE LYMPHOPROLIFERATIVE SYNDROME (ALPS)

Background:

ALPS patients show impaired generation of humoral memory for T independent antigens whereas they generate memory for self-antigens due to impaired FAS-dependent removal of autoreactive germinal center B cells. It is known that FAS signaling via caspase activation results in cell apoptosis. However, FAS ligation may also initiate or modulate non-apoptotic signaling as shown for example by its ability to activate NF-κB. Recent data implicate a regulatory role of FAS in the modulation of mTOR signaling in ALPS double-negative T cells. Moreover, a recently described C194V FAS mutation disturbs its post-translational modification leading to impaired apoptosis induction while non-apoptotic signalling is still intact. Consequently, C194V FAS protects from the autoimmune phenotype in the murine ALPS system. This supports the view that FAS may prevent autoimmunity with other mechanisms than inducing apoptosis.

Objectives:

We hypothesize that FAS mutations impair this modulatory signaling, leading to hyper-activation of B cells. Therefore we aim to investigate non apoptotic FAS signaling in B cells derived from healthy individuals and ALPS patients.

Methods:

We studied resting and activated B cells in ALPS patients in presence or absence of FAS ligand by flow cytometry analysing relevant molecules to the CD40 signaling pathway. We used mass cytometry to perform functional phenotyping of B cells isolated from secondary lymphoid organs. Proteomic studies were performed to identify potential signaling circuits and RNA sequencing to study the consequences of FAS signaling on B cell fate.

Results:

In CD40L activated B cells, FAS signaling results in specific modulation of the mTOR signaling pathway. This modulation is absent in ALPS derived B cells. In line with these data germinal center B cells and plasmablast from secondary lymphoid organs of ALPS patients show hyperactive mTOR signaling pathway. Proteomic studies identify a circuit that links FAS to the phosphatase PTEN via DAXX and the deubiquitinase USP7.

Conclusion:

We describe a new role of FAS in the regulation of B cell activation. Defects in FAS signaling in ALPS contribute to dysregulation of the mTOR signaling pathway and disturbed B cell development.

Disclosure of Interests:

None declared

1102 Relationship Between Emotional Distress And Sleep Duration Among Hispanics Using The 2018 National Health Interview Survey Dataset

Introduction

Although Hispanics experience a high level of shorter sleep duration (&lt; 7 hrs./24 period), a clear mechanism or cause is lacking. Previous research indicate that emotional distress may explain the burden of shorter sleep among blacks. Applying these findings to Hispanics, we investigated whether emotional distress explains the burden of short sleep duration (&lt; 7 hrs.) among Hispanics and if this relationship varies by sex

Methods

We used data from the 2018 National Health Interview Survey (NHIS) dataset, a nationally representative sample, in which only Hispanic ethnicity participants (N=3,091) were analyzed. Average sleep duration was self-reported and measured in hours. Emotional distress was measured using Kessler 6, which measures how an individual felt over the past 30 days: nervous, hopeless, restless/fidgety, depressed, effortful and worthless. To assess the association between short sleep duration and emotional distress, we performed Pearson correlation, hierarchical regression analyses, and stratified this relationship by sex to determine if this relationship differed between males and females, adjusting for covariates.

Results

Of the total sample of 3,091 Hispanics, 1,762 were female, and 1,329 were male. Sleep duration and emotional distress were negatively correlated among females (r = -.27, p &lt;.001) and males (r=-.18, p &lt;.001). Among Hispanic females, sleep duration significantly predicted emotional distress, β = -.27, t = -11.60, p &lt;.001, and explained a significant portion of variance in emotional distress, R2 = .07, F= 134.63, p &lt;.001. While, among Hispanic males, sleep significantly predicted emotional distress (β = -.18, t =-6.5, p &lt;.001) and explained a significant portion of the variance in emotional distress (R2 = .03, F= 42.37, p &lt;.001).

Conclusion

Our findings indicate that a negative sleep-ED relationship, suggesting that shorter sleep was predictive of higher levels of emotional distress among Hispanics and that this relationship is greater among Hispanic females, compared males.

Support

K01HL135452, R01MD007716, R01HL142066, and K07AG052685

1189 Recruiting, Training, And Implementing Sleep Health Educators In Community-based Research To Improve Sleep Health

Introduction

Adherence to OSA assessment and treatment is low among racial/ethnic minorities, particularly among blacks. Navigating patients along the continuum of care from assessment to treatment adherence requires motivation, social support, and self-efficacy. Previous studies indicate that community health educators can provide motivation, social support, and skills to patients to better navigate the complex OSA care continuum. However, recruiting, training, and implementing sleep health educators in clinical or research settings is complex. For the current study, we describe how we recruit, train, and implement sleep health educators in research and clinical settings and assess what makes a sleep health educator successful.

Methods

We recruited and trained twenty-five self-identified black sleep health educators for a randomized clinical trial (R01MD007716) focused on increasing OSA assessment and treatment adherence among blacks. During recruitment, we assessed key personality attributes that translate to being an effective sleep health educator, via behavioral and personality surveys, focused groups, and process forms filled out by educators. Sleep health educators underwent an 8-week training program on sleep health and motivational interviewing. In order to be certified, sleep health educators had to pass a written and scenario-based assessment. During the implementation phase of the trial, we assessed how many interviews each health educator conducted and whether individual characteristics were related to how many interviews.

Results

Of the trained educators, 80% were female, ranging from 25 to 58 years old. They all completed at least high school. All educators rated the program highly and were very satisfied with dispensing tailored sleep health education. Educators who displayed the highest knowledge about sleep health, provided frequent emotional and strategic support, committed to helping their assigned participants, and who rated their rapport highly with their assigned participants were most effective in getting their participant to adhere to OSA assessment and treatment.

Conclusion

Sleep health educators can be vital to increasing OSA assessment and treatment adherence among blacks. In order to ensure success, sleep health educators must undergo a thorough recruitment, training, and implementation and dissemination process.

Support

K01HL135452, R01MD007716, R01HL142066, K01HL135452,and K07AG052685