Occupational risk of COVID-19 in foreign-born employees in Denmark

BACKGROUND

Foreign-born workers in high-income countries experience higher rates of COVID-19 but the causes are only partially known.

AIMS

To examine if the occupational risk of COVID-19 in foreign-born workers deviates from the risk in native-born employees in Denmark.

METHODS

Within a registry-based cohort of all residents employed in Denmark (n = 2 451 542), we identified four-digit DISCO-08 occupations associated with an increased incidence of COVID-19-related hospital admission during 2020-21 (at-risk occupations). The sex-specific prevalence of at-risk employment in foreign born was compared with the prevalence in native born. Moreover, we examined if the country of birth modified the risk of a positive SARS-CoV-2 polymerase chain reaction (PCR) test and COVID-19-related hospital admission in at-risk occupations.

RESULTS

Workers born in low-income countries and male workers from Eastern Europe more often worked in at-risk occupations (relative risks between 1.16 [95% confidence interval {CI} 1.14-1.17] and 1.87 [95% CI 1.82-1.90]). Being foreign-born modified the adjusted risk of PCR test positivity (test for interaction P < 0.0001), primarily because of higher risk in at-risk occupations among men born in Eastern European countries (incidence rate ratio [IRR] 2.39 [95% CI 2.09-2.72] versus IRR 1.19 [95% CI 1.14-1.23] in native-born men). For COVID-19-related hospital admission, no overall interaction was seen, and in women, country of birth did not consistently modify the occupational risk.

CONCLUSIONS

Workplace viral transmission may contribute to an excess risk of COVID-19 in male workers born in Eastern Europe, but most foreign-born employees in at-risk occupations seem not to be at higher occupational risk than native born.

Oncological outcomes of standard versus prolonged time to surgery after neoadjuvant chemoradiotherapy for oesophageal cancer in the multicentre, randomised, controlled NeoRes II trial

BACKGROUND

The optimal time to surgery (TTS) after neoadjuvant chemoradiotherapy (nCRT) for oesophageal cancer is unknown and has traditionally been 4-6 weeks in clinical practice. Observational studies have suggested better outcomes, especially in terms of histological response, after prolonged delay of up to 3 months after nCRT. The NeoRes II trial is the first randomised trial to compare standard to prolonged TTS after nCRT for oesophageal cancer.

PATIENTS AND METHODS

Patients with resectable, locally advanced oesophageal cancer were randomly assigned to standard delay of surgery of 4-6 weeks or prolonged delay of 10-12 weeks after nCRT. The primary endpoint was complete histological response of the primary tumour in patients with adenocarcinoma (AC). Secondary endpoints included histological tumour response, resection margins, overall and progression-free survival in all patients and stratified by histologic type.

RESULTS

Between February 2015 and March 2019, 249 patients from 10 participating centres in Sweden, Norway and Germany were randomised: 125 to standard and 124 to prolonged TTS. There was no significant difference in complete histological response between AC patients allocated to standard (21%) compared to prolonged (26%) TTS (P = 0.429). Tumour regression, resection margins and number of resected lymph nodes, total and metastatic, did not differ between the allocated interventions. The first quartile overall survival in patients allocated to standard TTS was 26.5 months compared to 14.2 months after prolonged TTS (P = 0.003) and the overall risk of death during follow-up was 35% higher after prolonged delay (hazard ratio 1.35, 95% confidence interval 0.94-1.95, P = 0.107).

CONCLUSION

Prolonged TTS did not improve histological complete response or other pathological endpoints, while there was a strong trend towards worse survival, suggesting caution in routinely delaying surgery for >6 weeks after nCRT.

Nordic Crops as Alternatives to Soy-An Overview of Nutritional, Sensory, and Functional Properties

Soy (Glycine max) is used in a wide range of products and plays a major role in replacing animal-based products. Since the cultivation of soy is limited by cold climates, this review assessed the nutritional, sensory, and functional properties of three alternative cold-tolerant crops (faba bean (Vicia faba), yellow pea (Pisum sativum), and oat (Avena sativa)). Lower protein quality compared with soy and the presence of anti-nutrients are nutritional problems with all three crops, but different methods to adjust for these problems are available. Off-flavors in all pulses, including soy, and in cereals impair the sensory properties of the resulting food products, and few mitigation methods are successful. The functional properties of faba bean, pea, and oat are comparable to those of soy, which makes them usable for 3D printing, gelation, emulsification, and extrusion. Enzymatic treatment, fermentation, and fibrillation can be applied to improve the nutritional value, sensory attributes, and functional properties of all the three crops assessed, making them suitable for replacing soy in a broad range of products, although more research is needed on all attributes.

Optical polarization from colliding stellar stream shocks in a tidal disruption event

A tidal disruption event (TDE) occurs when a supermassive black hole rips apart a passing star. Part of the stellar material falls toward the black hole, forming an accretion disk that in some cases launches a relativistic jet. We performed optical polarimetry observations of a TDE, AT 2020mot. We find a peak linear polarization degree of 25 ± 4%, consistent with highly polarized synchrotron radiation, as is typically observed from relativistic jets. However, our radio observations, taken up to 8 months after the optical peak, do not detect the corresponding radio emission expected from a relativistic jet. We suggest that the linearly polarized optical emission instead arises from shocks that occur during accretion disk formation, as the stream of stellar material collides with itself.

Search for Gamma-Ray Spectral Lines from Dark Matter Annihilation up to 100 TeV toward the Galactic Center with MAGIC

Linelike features in TeV γ rays constitute a "smoking gun" for TeV-scale particle dark matter and new physics. Probing the Galactic Center region with ground-based Cherenkov telescopes enables the search for TeV spectral features in immediate association with a dense dark matter reservoir at a sensitivity out of reach for satellite γ-ray detectors, and direct detection and collider experiments. We report on 223 hours of observations of the Galactic Center region with the MAGIC stereoscopic telescope system reaching γ-ray energies up to 100 TeV. We improved the sensitivity to spectral lines at high energies using large-zenith-angle observations and a novel background modeling method within a maximum-likelihood analysis in the energy domain. No linelike spectral feature is found in our analysis. Therefore, we constrain the cross section for dark matter annihilation into two photons to ⟨σv⟩≲5×10^{-28}  cm^{3} s^{-1} at 1 TeV and ⟨σv⟩≲1×10^{-25}  cm^{3} s^{-1} at 100 TeV, achieving the best limits to date for a dark matter mass above 20 TeV and a cuspy dark matter profile at the Galactic Center. Finally, we use the derived limits for both cuspy and cored dark matter profiles to constrain supersymmetric wino models.

Economic burden of atherosclerotic cardiovascular disease: costs related to healthcare and loss of productivity; a matched case-control study in more than 450,000 Swedish individuals

Introduction

Atherosclerotic cardiovascular disease (ASCVD) is associated with significant morbidity and mortality. We aimed to quantify the impact of ASCVD on healthcare costs, risk of cardiovascular (CV) events and mortality.

Purpose

To examine the progression of direct healthcare costs, indirect costs and other outcomes over 5 years in people with ASCVD and matched controls in Sweden.

Methods

In this 5-year retrospective closed cohort study, adults (aged ≥18 years) living in Sweden on 1/1/2012 were identified in an existing database,1,2 and those with ASCVD (≥1 inpatient admission/outpatient visit with a main or sub-diagnosis relating to stroke, ischaemic heart disease or peripheral artery disease, or procedure codes related to revascularization or amputation, in the National Patient Register [1997–2011]) were propensity score matched to controls without ASCVD by birth year, sex and educational status. Study variables included costs of selected hospital-based care and prescription drugs, and mortality from the National Board of Health and Welfare; demographic and socioeconomic information from Statistics Sweden; and work absences from Försäkringskassan (Swedish Social Insurance Agency). We compared annual direct healthcare costs (inpatient, outpatient and drug costs) and indirect costs from lost productivity, and analysed risks of early retirement, stroke, myocardial infarction and mortality. Hazard ratios (HRs) were estimated using Cox proportional regression adjusted for baseline age, sex, comorbidities, education and marital status.

Results

Individuals with ASCVD (N=231,417) had similar ages, sex distribution and education to matched controls, but were more likely to have T2D or renal disease (Table). Over the 5-year study period, average annual total direct and indirect costs for people with ASCVD were 2.5 times higher than in controls; direct healthcare costs in the ASCVD group were three times those for controls (Figure). In both groups, indirect costs accounted for nearly two-thirds of total costs. In the ASCVD group, inpatient costs comprised 74% of total direct costs, whereas outpatient costs and drug costs contributed 15% and 11%. In controls, total direct costs were made up of 70% inpatient costs, 18% outpatient costs and 12% drug costs. All-cause mortality was 72% higher in people with ASCVD than in controls (HR: 1.72 [95% confidence interval: 1.69–1.75]). Individuals with ASCVD were also more likely than controls to experience stroke (HR: 1.89 [1.83–1.95]), myocardial infarction (HR: 2.33 [2.26–2.41]) and early retirement (HR: 3.04 [2.78–3.33]).

Conclusions

Individuals with ASCVD incurred more than 2.5 times the total costs of matched controls, and had a greater risk of death, CV events and early retirement. Effective measures to prevent ASCVD and to slow its progression could limit these substantial burdens for individuals, healthcare systems and society.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): This study was supported by a grant from Novo Nordisk A/S to the Swedish Institute for Health Economics. Medical writing support was provided by Oxford PharmaGenesis, Oxford, UK, with funding from Novo Nordisk A/S.

Direct and indirect costs, early retirement, cardiovascular events and mortality in more than 50,000 adults with chronic heart failure in Sweden: a matched case-control study

Introduction

Chronic heart failure (CHF) is a progressive condition that requires long-term treatment for symptom management; it is associated with reduced physical functioning and quality of life, and increased mortality. Real-world data from population-based registries can be used to quantify CHF impact on both individuals and healthcare systems.

Purpose

To examine the progression of direct and indirect healthcare costs, cardiovascular (CV) outcomes and mortality over 5 years in people with CHF and matched controls in Sweden.

Methods

In this closed cohort study, adults (aged ≥18 years) living in Sweden on 1/1/2012 were identified in an existing database,1,2 and those with CHF (≥1 inpatient admission/outpatient visit with a main or sub-diagnosis of heart failure in the National Patient Register [1997–2011]) were propensity score matched to controls without CHF by birth year, sex and educational status. Study variables included costs of selected hospital-based care and prescription drugs, and mortality from the National Board of Health and Welfare; demographic and socioeconomic information from Statistics Sweden; and work absences from Försäkringskassan (Swedish Social Insurance Agency). We compared annual and cumulative direct healthcare costs (inpatient, outpatient and drug costs) and indirect costs from lost productivity, and analysed risks of stroke, myocardial infarction (MI), early retirement, and mortality.

Results

After matching, there were 53,520 individuals in each cohort. Demographic characteristics were well matched (Table). Over 5 years (2012–2016), cumulative direct costs for people with CHF were four- to fivefold higher than those for controls (2012: €5477/€971; 2013: €10 074/€1986; 2014: €14,009/€2976; 2015: €17 622/€3950; 2016: €20,723/€4942); cumulative indirect costs were at least 2.5 times higher (2012: €5419/€2144; 2013: €10,524/€4047; 2014: €15,215/€5735; 2015: €19,595/€7285; 2016: €23,732/€8646). In people with CHF, inpatient costs comprised 78% of total annual mean direct costs over follow-up (€3995/€5144). Outpatient costs contributed 15% (€763) and drug costs contributed 8% (€386) of total annual direct costs. In controls, these were 71% (€808), 18% (€209) and 11% (€124), respectively, of total annual mean direct costs (€1141). People with CHF were significantly more likely than controls to experience stroke (hazard ratio [HR]: 1.61 [95% confidence interval (CI): 1.51–1.71]) or MI (1.75 [1.65–1.87]). All-cause mortality was nearly threefold higher (2.89 [2.80–2.98]) and the risk of early retirement was nearly fourfold higher (3.79 [3.16–4.53]). During follow-up, 31.3% (n=16,766) of people in the CHF cohort died, compared with 10.1% (n=5426) of controls (Figure).

Conclusions

This analysis demonstrates the considerable impact of CHF, in terms of risk of CV events and death, early retirement and healthcare costs. Inpatient admissions and lost productivity were major contributors to economic costs.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): This study was supported by a grant from Novo Nordisk A/S to the Swedish Institute for Health Economics. Medical writing support was provided by Oxford PharmaGenesis, Oxford, UK, with funding from Novo Nordisk A/S.

Autonomic responses during gambling: the effect of outcome type and sex in a large community sample of young adults

Introduction

Autonomic arousal is believed to be an underlying reinforcer for problematic gambling behavior. Theories suggests that near-misses (outcomes falling just short of a true win) are structural characteristics affecting emotion and motivation while increasing gambling persistence.

Objectives

Psychophysiological responses to different outcomes in gambling were investigated in a community-based sample of young adults. Furthermore, sex differences in responses to different gambling outcomes were investigated.

Methods

Young adults (n=270) performed a simplified virtual slot machine producing wins, two types of near-misses (before/after payline) and full-misses, with simultaneous measurements of heart rate (HR) and skin conductance responses (SCR). Self-reports of perceived chance of winning, pleasure and motivation to play were given by the participants on each trial.

Results

Near-misses were associated with the largest HR acceleration compared to wins and full-misses, and larger HR deceleration and SCRs compared to full-misses. Differential autonomic and subjective reports were observed for near-misses subtypes, suggesting that near-misses are processed differently depending on their position before or after payline. Females showed larger SCR responses and increased motivation following wins compared to males.

Conclusions

Slot machine gambling outcomes elicit differential physiological and subjective responses in young adults. Specifically, near-misses produce larger autonomic responses compared to regular full-misses. However, near-misses are complex, multifaceted events producing various emotional responses depending on their characterization. Males and females respond differently to wins, highlighting the importance of considering sex differences in experimental research on autonomic responses in gambling.

Disclosure

No significant relationships.

Trends in adolescent mental health problems: Differences by SES and gender

Background

Studies in Sweden and elsewhere have shown that mental health problems have increased among adolescents in recent decades. Unlike the previous studies, we extend the investigation to the trends of various mental health problems, namely: psychosomatic symptoms, suicide attempts, depressive symptoms, and suicide ideations in the last two decades, from 2004 to 2020. We also investigate the moderating role of gender and SES on these trends.

Methods

Data were collected through repeated bi-annual cross-sectional surveys between 2004 and 2020 among 32061 adolescents (49% girls) in middle and upper secondary schools in a county of Sweden. We fitted two linear and two logistic regressions with gender and socioeconomic status (SES) as predictors, and by interacting them with year of survey, we examined if they are associated with trends in mental health problems.

Results

Psychosomatic and depressive symptoms remained stable overtime (β = -0.04, p = 0.12; and β = 0.007, p = 0.69, respectively). Trend in depressive symptoms has declined overtime only for girls (β = -0.07, p &lt; 0.005) while gender did not have effect on the trend in psychosomatic symptoms. Both psychosomatic (β = -0.09, p &lt; 0.001) and depressive (β = -0.08, p &lt; 0.001) symptoms have declined overtime only among those with high SES. Trends in both suicidal ideations and attempts were stable. Suicidal ideations declined overtime only for the girls (OR = 0.86, CI = 0.82 - 0.91, p &lt; 0.001). However, gender did not have significant effect on trends in suicidal attempts. Both suicidal ideations (OR = 0.97, CI = 0.95 - 0.99, p = 0.02) and suicidal attempts (OR = 0.98, CI = 0.96 - 0.99, p = 0.007) declined overtime among those with higher SES.

Conclusions

Mental health problems seem to decrease from 2004 to 2020, however only for girls and adolescents with high SES. This indicates an increase in health inequalities especially for youth with low SES.

Key messages

Mental health problems declined in the last two decades, especially among girls. Adolescents with low SES did not show the same mental health improvement, which indicated that health inequalities in adolescent mental health seem to have increased in the last two decades.

Assessment and incidence of PV gaps as determined by HD Grid and circular mapping catheters

Funding Acknowledgements

Type of funding sources: None.

Background

Many tools and techniques are utilized to assess pulmonary vein isolation (PVI), such as evaluation of entrance and exit block, voltage mapping, and use of drugs such as adenosine. It is unclear which tools and techniques may provide greater sensitivity in the identification and elimination of pulmonary vein (PV) gaps, leading to better long-term outcomes. The HD Grid simultaneously records orthogonal bipolar EGMs to reduce directional sensitivity. Previously published data suggest that the use of HD Grid may improve sensitivity for gap identification.

Purpose

To determine, in a large cohort of procedures, the rate of gap detection when using HD Grid to check for PVI as compared to circular mapping catheters (CMC).

Methods

Anonymized, acute procedural data was prospectively collected in de novo AF ablation procedures in which either a 10- or 20-pole CMC or HD Grid catheter was used to assess PVI. Procedural data including gap detection and PVI assessment method were analyzed using chi-squared test.

Results

559 cases from over 60 institutions in 8 countries were analyzed. Of the 559 cases, 47.4% (265/599) used HD Grid, and 52.6% (294/599) used a CMC. PV gaps were found in 52.5% (139/265) of HD Grid procedures and in 36.7% (108/294) of CMC procedures (p &lt; 0.001). The most common PVI assessment method in both HD Grid and CMC groups was entrance/exit block (90.9%, 92.5%, respectively). Mapping as a post-ablation assessment method was used in 69.1% (183/265) of HD Grid procedures whereas it was only used in 42.8% (126/294) of CMC procedures (p &lt; 0.001). Of the 183 HD Grid procedures that utilized mapping for PV assessment, 57.9% (106/183) used both voltage and activation mapping, 41.0% (75/183) used voltage only and 1.1% (2/183) used activation mapping only. Significantly more gaps were found in the HD Grid group that used both activation and voltage mapping (83.0%, 88/106) as compared to voltage mapping only (49.3%, 37/75, p &lt; 0.001). At the end of the procedure, 95.8% of patients in the HD Grid group were in sinus rhythm, as compared to 84.7% of the CMC group.

Conclusions

While this analysis does not represent a direct comparison of the sensitivity of the two different technologies, HD Grid detected significantly more PV gaps compared to CMC in AF procedures. Previous publications have attributed similar findings to HD Grid’s ability to reduce voltage amplitude dependence on wavefront directionality. The significantly larger number of HD Grid cases that utilized mapping as a method of determining PVI could be explained by the need to maneuver the HD Grid around the circumference of the vein, which may naturally lead to map collection. This data also suggests that using both voltage and activation mapping identifies significantly more gaps as compared to only voltage mapping, however, further analysis could be warranted to better understand how these maps were collected and what map settings were used.

Surgical Morbidity and Mortality From the Multicenter Randomized Controlled NeoRes II Trial: Standard Versus Prolonged Time to Surgery After Neoadjuvant Chemoradiotherapy for Esophageal Cancer

OBJECTIVE

To investigate if prolonged TTS after completed nCRT improves postoperative outcomes for esophageal and esophagogastric junction cancer.

SUMMARY OF BACKGROUND DATA

TTS has traditionally been 4-6 weeks after completed nCRT. However, the optimal timing is not known.

METHODS

A multicenter clinical trial was performed with randomized allocation of TTS of 4-6 or 10-12 weeks. The primary endpoint of this sub-study was overall postoperative complications defined as Clavien-Dindo grade II-V. Secondary endpoints included complication severity according to Clavien-Dindo grade IIIb-V, postoperative 90-day mortality, and length of hospital stay. The study was registered in Clinicaltrials.gov (NCT02415101).

RESULTS

In total 249 patients were randomized. There were no significant differences between standard TTS and prolonged TTS with regard to overall incidence of complications Clavien-Dindo grade II-V (63.2% vs 72.6%, P = 0.134) or regarding Clavien-Dindo grade IIIb-V complications (31.6% vs 34.9%, P = 0.603). There were no statistically significant differences between standard and prolonged TTS regarding anastomotic leak (P = 0.596), conduit necrosis (P = 0.524), chyle leak (P = 0.427), pneumonia (P = 0.548), and respiratory failure (P = 0.723). In the standard TTS arm 5 patients (4.3%) died within 90 days of surgery, compared to 4 patients (3.8%) in the prolonged TTS arm (P = 1.0). Median length of hospital stay was 15 days in the standard TTS arm and 17 days in the prolonged TTS arm (P = 0.234).

CONCLUSION

The timing of surgery after completed nCRT for carcinoma of the esophagus or esophagogastric junction, is not of major importance with regard to short-term postoperative outcomes.

Bounds on Lorentz Invariance Violation from MAGIC Observation of GRB 190114C

On January 14, 2019, the Major Atmospheric Gamma Imaging Cherenkov telescopes detected GRB 190114C above 0.2 TeV, recording the most energetic photons ever observed from a gamma-ray burst. We use this unique observation to probe an energy dependence of the speed of light in vacuo for photons as predicted by several quantum gravity models. Based on a set of assumptions on the possible intrinsic spectral and temporal evolution, we obtain competitive lower limits on the quadratic leading order of speed of light modification.

Genetic parameters for noncoagulating milk, milk coagulation properties, and detailed milk composition in Swedish Red Dairy Cattle

The rennet-induced coagulation ability of milk is important in cheese production. For Swedish Red Dairy Cattle (RDC), this ability is reduced because of a high prevalence of noncoagulating (NC) milk. In this study, we simultaneously combined genetic parameters for NC milk, milk coagulation properties, milk composition, physical traits, and milk protein composition. Our aim was to estimate heritability and genetic and phenotypic correlations for NC milk and 24 traits (milk coagulation properties, milk composition, physical traits, and milk protein composition). Phenotypes and ∼7,000 SNP genotypes were available for all 600 Swedish RDC. The genotypes were imputed from ∼7,000 SNP to 50,000 SNP. Variance components and genetic parameters were estimated with an animal model. In Swedish RDC, a moderate heritability estimate of 0.28 was found for NC milk. For the other 24 traits, heritability estimates ranged from 0.12 to 0.77 (standard errors from 0.08 to 0.18). A total of 300 phenotypic and genetic correlations were estimated. For phenotypic and genetic correlations, 172 and 95 were significant, respectively. In general, most traits showing significant genetic correlations also showed significant phenotypic correlations. In this study, phenotypic and genetic correlations with NC milk suggest that many correlations between traits exist, making it difficult to predict the real consequences on the composition of milk, if selective breeding is applied on NC milk. We speculate that some of these consequences may lead to changes in the composition of milk, most likely affecting its physical and organoleptic properties. However, our results suggest that κ-casein could be used as an indicator trait to predict the occurrence of NC milk at the herd level.

P1023Comparison of gap identification using three technologies for confirmation of pulmonary vein isolation

Background

 Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation. Tools and techniques used for confirmation of PVI vary greatly, and it is unclear whether the use of any particular combination of tools and techniques provides greater sensitivity for identifying gaps periprocedurally. A high-density mapping catheter enabling simultaneous recording of adjacent bipolar EGMs in two directions is now available in multiple geographies, and it has been suggested that this technology may provide improved sensitivity for gap identification.

Purpose

 To identify trends in the incidence of gaps identified in de novo PVI lines using three diagnostic catheter technologies, which may be suggestive of improved sensitivity for gap identification.

Methods

 Self-reported procedural data was prospectively collected in de novo atrial fibrillation ablation cases utilizing one of three technologies to confirm PVI: 10-pole circular mapping catheter (CMC10), 20-pole circular mapping catheter (CMC20), and Advisor HD Grid catheter (HD Grid). Techniques for PVI confirmation were analyzed for each group, and the incidence and location of gaps identified by each technology was quantified. 

Results

 Data was collected in 99 cases across 11 centers in Europe and the United States. PVI was confirmed via entrance and/or exit block in all cases. CMC10 was utilized in 30 cases, CMC20 in 36, and HD Grid in 33. Use of adenosine varied across groups (CMC10: 6.7%; CMC20: 86.1%; HD Grid: 41.7%), as did application of a waiting period (CMC10: 96.7%; CMC20: 2.8%; HD Grid: 11.1%). Gaps were identified in in 36.7%, 38.9%, and 81.8% of cases using CMC10, CMC20, and HD Grid, respectively. HD Grid identified significantly more gaps than the other two technologies (p = 0.015), identifying an average of 49.0% and 139.1% more gaps per patient than CMC20 and CMC10, respectively (HD Grid: 2.15/patient; CMC20: 1.44/patient; CMC10: 0.9/patient). The location and incidence of gaps identified by each technology is shown in Figure 1. 

Conclusions

 Significantly more gaps were identified by the Advisor HD Grid catheter, as compared to a 10-pole or 20-pole circular mapping catheter. While this does not represent a direct comparison of the sensitivity for identification of gaps across these three technologies, and results could be impacted by other factors (e.g., operator, ablation technique, PVI confirmation technique, etc.), the strong trend toward an increased number of gaps identified with the HD Grid is striking. This may warrant further study including direct comparison of gap identification across technologies, and the resulting impact on long-term clinical outcomes when these additional gaps are ablated during the index procedure.

Abstract Figure.

Association between time interval from neoadjuvant chemoradiotherapy to surgery and complete histological tumor response in esophageal and gastroesophageal junction cancer: a national cohort study

The optimal time interval from neoadjuvant therapy to surgery in the treatment of esophageal cancer is not known. The aim of this study was to investigate if a prolonged interval between completed neoadjuvant chemoradiotherapy and surgery was associated with improved histological response rates and survival in a population-based national register cohort. The population-based cohort study included patients treated with neoadjuvant chemoradiotherapy and esophagectomy due to cancer in the esophagus or gastroesophageal junction. Patients were divided into two groups based on the median time from completed neoadjuvant treatment to surgery. The primary outcome was complete histological response. Secondary outcomes were lymph node tumor response, postoperative complications, R0 resection rate, 90-day mortality, and overall survival. In total, 643 patients were included, 344 (54%) patients underwent surgery within 49 days, and 299 (47%) after 50 days or longer. The groups were similar concerning baseline characteristics except for a higher clinical tumor stage (P = 0.009) in the prolonged time to surgery group. There were no significant differences in complete histological response, R0 resection rate, postoperative complications, 90-day mortality, or overall survival. Adjusted odds ratio for ypT0 in the prolonged time to surgery group was 0.99 (95% confidence interval: 0.64-1.53). Complete histological response in the primary tumor (ypT0) was associated with significantly higher overall survival: adjusted hazard ratio: 0.55 (95% CI 0.41-0.76). If lymph node metastases were present in these patients, the survival was, however, significantly lower: adjusted hazard ratio for ypT0N1: 2.30 (95% CI 1.21-4.35). In this prospectively collected, nationwide cohort study of esophageal and junctional type 1 and 2 cancer patients, there were no associations between time to surgery and histological complete response, postoperative outcomes, or overall survival. The results suggest that it is safe for patients to postpone surgery at least 7 to 10 weeks after completed chemoradiotherapy, but no evidence was seen in favor of recommending a prolonged time to surgery after neoadjuvant chemoradiotherapy for esophageal cancer. A definitive answer to this question requires a randomized controlled trial of standard vs. prolonged time to surgery.

P4700Work during treadmill rehabilitation predicts clinical benefit and muscle mitochondrial improvements in intermittent claudication

Background

Supervised exercise training is recommended for intermittent claudication in peripheral artery disease (PAD), but the relationship between work achieved during exercise and clinical outcomes is not well described. As in other training modalities, increased effort measured by cumulative work production is expected to be translate into to positive performance adaptations. In settings of constrained limb blood flow, this relationship is unknown. In addition, the impact of exercise on skeletal muscle oxygen use capacity changes is unknown. Near infrared spectroscopy (NIRS) offers a method of characterizing skeletal muscle mitochondrial adaptations before and after training programs.

Methods

We enrolled subjects (n=17, age 71±8.8 years, 20% female) with PAD and intermittent claudication (ankle brachial index [ABI]=0.76±0.21) in a 12-week supervised training program, randomized to traditional pain-based training strategy versus hypoxia-based training (using NIRS to direct training). Muscle work was calculated based on training performance. NIRS-based determination of mitochondrial capacity and microvascular flow were measured at baseline and after 12 weeks.

Results

Subjects trained for an average of 32.9±5.9 sessions walking at 54.4±13.4 m/min per session. Subjects achieved a mean of average workload of 4767±5112 kilogram force meter (kpm) per session and an aggregate of 148536±148020 kpm for the training program. Baseline pain-free walking time of 2.95±2.10 minutes increased by a mean of 3.74±2.47 minutes. Increase in walking time was proportional to the average work level achieved per session, with a correlating trend to the overall work level performed over 12 weeks (r=0.543, p=0.024). There was no increase in blood flow measured by ABI or limb microcirculation perfusion index over the training period. Skeletal muscle mitochondrial capacity increased over the training period and correlated with the overall work performed (r=0.573, p=0.016).

Figure 1

Conclusions

Treadmill exercise rehabilitation for intermittent claudication may be guided by total dose of exercise and NIRS-based indices of mitochondrial capacity rather than pain-levels achieved or changes in perfusion measures.

Acknowledgement/Funding

American Heart Association

A Novel Technique to Assess Distal Radioulnar Joint Stability Using Increasing Torque

Background  Previous studies on computed tomography (CT) in patients with a suspected triangular fibrocartilage complex (TFCC) injury have not been successful in assessing distal radioulnar joint (DRUJ) laxity. The aim of this study was to develop a novel servomotor-driven device for the assessment of DRUJ by applying increasing torque to the DRUJ in pronation and supination. Methods  A custom-built device was designed to function during four-dimensional (4D) CT of the wrist. A torque meter, positioned between the incoming hand holder, and a direct current (DC) servomotor were used for angular positioning and for applying rotational force to the patient's arm. A total of 110 healthy participants were recruited to gather reference values for the range of motion (ROM), maximum torque in neutral and supinated/pronated position, and the ability to withstand an increasing, device-generated torque in these positions. The device was also used during 4D DRUJ CT in five patients with suspected TFCC injuries. Results  A gender- and age-relevant reference chart for ROM and torque was created. Men showed a tendency (ns) toward having a larger ROM and increasing strength with increasing age, whereas women showed the opposite. Also, the dominant hand showed a tendency toward having a larger ROM and being stronger than the nondominant hand (ns). A smaller cohort of patients ( n  = 5) with suspected TFCC injuries showed a significantly decreased ability to withstand increasing torque in both supination (2.1 ± 0.3 vs. 3.1 ± 0.2 s; p  < 0.005) and pronation (2.3 ± 0.5 vs. 3.1 ± 0.4 s; p  < 0.0005) and also showed a clear laxity on real-time 4D CT image sequences. Decreased strength at all positions was also found (average 74% decrease compared to noninjured side). Conclusion  Reference values for torque strength and ability to withstand increasing torque can be used clinically in the assessment of patients with symptoms that could represent ligamentous injuries to the TFCC. The ability to use the device during CT enables radiographic evaluation of instability during increasing torque. Level of Evidence This is a Level II study.

Impact of prolonged storage of clinical samples at 4°C on the recovery of dermatophytes by culture or PCR analysis

Dermatophytes are common pathogens in superficial mycoses that are routinely identified by culture or PCR analysis of freshly collected skin, nail or hair specimens. Although clinical samples are normally processed without delay, practical or research issues may necessitate sample storage until later analysis. However, the influence of extended sample storage on the ability to recover fungi by culture vs. PCR analysis has not been specifically studied. Here, a total of 172 dermatological samples collected from 2013-2015 were examined before and after refrigerated storage at 4°C for 10.2-32.3 (mean 25.6) months. By culture, 35% of the dermatophyte-containing fresh samples remained positive at re-examination. At species level, only 19% of initially Trichophyton rubrum-positive samples yielded a positive result after refrigeration, whereas few samples containing Trichophyton violaceum, Microsporum canis or Microsporum audouinii remained culture-positive. Using PCR, 76% of dermatophyte DNA-positive fresh samples were still positive at re-analysis. Notably, 92% of the samples targeted by the T. rubrum DNA primer remained positive after storage. Hence, PCR analysis is more favourable than cultivation with regard to the detectability of dermatophytes in long-term refrigerated clinical samples.

Heritability of patellar luxation in the Chihuahua and Bichon Frise breeds of dogs and effectiveness of a Swedish screening programme

Patellar luxation is one of the more common orthopaedic diseases of dogs and is relatively frequent in some toy breeds, including the Chihuahua and Bichon Frise. Using data provided by the Swedish Kennel Club, genetic parameters, including heritability, were estimated for patellar luxation in the Chihuahua from 1999 to 2014 and in the Bichon Frise from 1997 to 2014. The effects of the current screening programmes for patellar luxation in these breeds were evaluated. Patellar luxation was defined as a binary trait, treating dogs as affected or unaffected. The edited data included 7024 records for the Chihuahua and 1071 records for the Bichon Frise. Patellar luxation was analysed using mixed linear and threshold animal models, including fixed effects of sex, birth month, birth year, age at veterinary examination, random effects of the examining veterinary surgeon, genetic effect of the individual and residual. The prevalence of patellar luxation was 23% in the Chihuahua and 12% in the Bichon Frise. Using threshold analysis, estimated heritabilities were 0.25 for the Chihuahua and 0.21 for the Bichon Frise on the observable scale, and 0.46 for the Chihuahua on the underlying scale. It was concluded that there is genetic variation in patellar luxation and that there has been a slight genetic improvement over the study period in the Chihuahua. Further genetic progress would be facilitated by selection using estimated breeding values based on veterinary screening records.

A psychometric Evaluation of the Parents as Social Context Questionnaire (PASCQ), Swedish version

To understand parent and child relations researchers have used three bipolar dimensions (warmth and rejection, structure and chaos, autonomy support, and coercion). These dimensions are not necessarily bipolar but could work as unipolar dimensions. The Parents as Social Context Questionnaire (PASCQ) has been used in parenting studies but needs to be further investigated in different populations to ensure the validity and reliability of the scale. The present study explored the structures of and provided evidence regarding validity and reliability of the PASCQ. This study aimed to examine whether the Swedish version of the PASCQ is a reliable questionnaire when measuring the six dimension of parenting. The participants consisted of 1634 adolescents (58.6% females) born in 1997 (52%) and 1999. Factor analyses were conducted to investigate whether the Swedish scale generated six dimensions. Regression analyses were conducted to measure the different factors and spearman correlations between dimensions were conducted. The analysis indicates that the PASCQ consists of five dimensions, however rejection (negative) and warmth (positive) loaded on the same dimension and are referred to as two separate factors, making the questionnaire consistent of six dimensions. All items had a factor score >0.4 and loaded in a coherent manner. Therefore, the PASCQ can be used to assess six dimensions of parenting styles. The PASCQ Swedish version can be used as a measure of parenting styles in a Swedish population. Further research is necessary to evaluate the validity and reliability in other samples as well.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Interaction Between Oxytocin Gene Variants and Perceived Parenting in Relation to Social Anxiety in Adolescents: Evidence for Differential Susceptibility Effects

Introduction

Adolescence is a period of increasing demands in independent social functioning where parenting style may have an impact on social anxiety. A context-dependent effect of oxytocin on human social behavior has been suggested, however research on the gene coding for oxytocin (OXT) has mostly been reported without considering contextual factors.

Aim

This study investigated interactions between parenting style and polymorphic variations in the OXT gene in association with social anxiety symptoms in a community sample of adolescents.

Methods

The study group consisted of 1359 adolescents. Two single nucleotide polymorphisms located near OXT, rs4813625 and rs2770378, were genotyped. Social anxiety and perceived parenting style were assessed by behavioral questionnaires.

Results

Significant joint effects in line with the differential susceptibility framework were observed for rs4813625 with parenting style. The levels of social anxiety among C allele carriers were conditional on the level of supportive parenting style whereas homozygote G carriers’ levels of social anxiety were unaffected by supportive parenting style. The nature of the interactions between rs2770378 and parenting style was in line with the diatheses-stress model. However, associations of rs2770378 and parenting style with social anxiety became nonsignificant in nonlinear models.

Conclusions

The study provides preliminary evidence for a modifying effect of supportive parenting style on the relationship between rs4813625 and social anxiety symptoms in adolescents, independent of sex. The findings may be interpreted from the perspective of the social salience hypotheses of oxytocin, with rs4813625 affecting social anxiety levels along a perceived unsafe–safe social context dimension.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Genetic association between leg conformation in young pigs and sow longevity

Longevity is important in pig production with respect to both economic and ethical aspects. Direct selection for longevity might be ineffective because 'true' longevity can only be recorded when a sow has been culled or died. Thus, indirect selection for longevity using information from other traits that can be recorded early in life and are genetically correlated with longevity might be an alternative. Leg conformation has been included in many breeding schemes for a number of years. However, proving that leg conformation traits are good early indicators for longevity still remains. Our aim was to study genetic associations between leg conformation traits of young (5 months; 100 kg) Swedish Yorkshire pigs in nucleus herds and longevity traits of sows in nucleus and multiplier herds. Data included 97 533 animals with information on conformation (Movement and Overall score) recorded at performance testing and 26 962 sows with information on longevity. The longevity traits were as follows: stayability from 1st to 2nd parity, lifetime number of litters and lifetime number of born alive piglets. Genetic analyses were performed with both linear models using REML and linear-threshold models using Bayesian methods. Heritabilities estimated using the Bayesian method were higher than those estimated using REML, ranging from 0.10 to 0.24 and 0.07 to 0.20, respectively. All estimated genetic correlations between conformation and longevity traits were significant and favourable. Heritabilities and genetic correlations between conformation and longevity indicate that selection on leg conformation should improve sow longevity.

Genetic analysis of a temperament test as a tool to select against everyday life fearfulness in Rough Collie

Fear-related problems are common among Rough Collies in Sweden. Annually, on average, >200 Rough Collies are subjected to the dog mentality assessment (DMA), a temperament test during which 33 behavioral reactions are rated. Previous research has shown that a dog's DMA result can be condensed into 5 underlying personality traits. The aim of the study was to evaluate if it is possible to use the DMA for selection for temperament in Swedish Rough Collies, in particular to decrease everyday life fearfulness. We also wanted to compare 2 methods to compute the personality traits: summated scales (SS) and factor scores (FS). The DMA data for 2,953 Rough Collies were used to estimate genetic parameters for the 5 personality traits (both SS and FS), using a linear animal model including fixed effects of sex, year and month of test, and random effects of litter, judge, test occasion, genetic effect of the individual, and residual. Age at test was included as linear and quadratic regressions. The DMA personality trait heritability estimates ranged from 0.13 to 0.25. The SS showed greater or equal heritability estimates compared with the FS. To validate the DMA, data on everyday life behavior of 1,738 Rough Collies were collected using an extended version of the Canine Behavioral Assessment and Research Questionnaire. Each dog's questionnaire result was condensed into 18 underlying behavioral subscales. Genetic parameters for the subscales were estimated using a linear animal model, including a fixed effect of sex and random genetic effect of the individual and residual. Age when the questionnaire was completed was included as linear and quadratic regressions. Heritability estimates for the questionnaire subscales were 0.06 to 0.36. There were high and significant genetic correlations between DMA personality traits and questionnaire subscales. For instance, the DMA personality trait Curiosity/Fearlessness correlated strongly genetically to the questionnaire subscale Non-social fear (-0.70), DMA Sociability to Stranger-directed interest (0.87) and Stranger-directed fear (-0.80), DMA Playfulness to Human-directed play interest (0.63), and DMA Chase-proneness to Chasing (0.73). We could not detect any obvious difference in validity between DMA SS and FS. We conclude that the DMA is an effective tool for selection of breeding animals with the goal to decrease everyday life fearfulness among Swedish Rough Collies. The DMA can also be used for breeding for other traits. The SS method seems to perform at least as good the FS method.

Macroporous microcarriers for introducing cells into a microfluidic chip

Macroporous gelatin beads (CultiSpher™ microcarriers) provide a convenient method for rapidly and reliably introducing cells cultured ex situ into a microfluidic device, where the spheres create a 3D environment for continued cell proliferation. We demonstrate the usefulness of this technique with a proof-of-concept viability analysis of cardiac cells after treatment with doxorubicin.

The Recovery Process of Postpartum Psychosis from Both the Woman's and Next of Kin's Perspective - An Interview Study in Sweden

Objectives:

The most serious type of psychiatric disorder in connection with childbirth is postpartum psychosis. With this disorder occasionally follows emotional rejection of the infant which has serious long term effect on mother and child. The aim of this study was to explore the experiences of the recovery process of postpartum psychosis from the women, from the partners of the women, and their next of kin.

Methods:

Interviews were conducted with seven women, who had previously suffered postpartum psychosis, and six of their next of kin. The interviews were transcribed verbatim and analysed using content analysis.

Results:

Two categories emerged: the recovery process and the circumstances of the support provided. The women and their next of kin spoke about the turning point in the illness, their own personal as well as their social recovery, the importance of support not only from relatives and friends, but also from professionals, and the use of medication. However, the key to recovery was an internal decision by the women themselves.

Conclusion:

Conclusion is that the recovery from this severe mental disorder requires hard work and the key to their recovery was the decision made by the women. This disorder causes a mental darkness to descend, but at the start of the recovery a dim light shines in the dark tunnel. The nursing staff must be made aware that good sleep is important for the psychiatric treatment and that recovery may take a long time. The nurse needs to provide hope and encouragement, as well as help the woman to recognise the strength that exists within her. To reduce the risk of a recurrence of the disorder, the staff needs to offer follow up visits.