Systematic update to the mammalian relative potency estimate database and development of best estimate toxic equivalency factors for dioxin-like compounds

The World Health Organization (WHO) assesses potential health risks of dioxin-like compounds using Toxic Equivalency Factors (TEFs). This study systematically updated the relative potency (REP) database underlying the 2005 WHO TEFs and applied advanced methods for quantitative integration of study quality and dose-response. Data obtained from fifty-one publications more than doubled the size of the previous REP database (∼1300 datasets). REP quality and relevance for these data was assessed via application of a consensus-based weighting framework. Using Bayesian dose-response modeling, available data were modeled to produce standardized dose/concentration-response Hill curves. Study quality and REP data were synthesized via Bayesian meta-analysis to integrate dose/concentration-response data, author-calculated REPs and benchmark ratios. The output is a prediction of the most likely relationship between each congener and its reference as model-predicted TEF uncertainty distributions, or the 'best estimate TEF' (BE-TEF). The resulting weighted BE-TEFs were similar to the 2005 TEFs, though provide more information to inform selection of TEF values as well as to provide risk assessors and managers with information needed to quantitatively characterize uncertainty around TEF values. Collectively, these efforts produce an updated REP database and an objective, reproducible approach to support development of TEF values based on all available data.

Direct current cardioversion in pregnancy: a multicentre study

OBJECTIVE

Direct current cardioversion (DCCV) in pregnancy is rarely required and typically only documented in single case reports or case series. A recent UK confidential enquiry reported on several maternal deaths where appropriate DCCV appeared to have been withheld.

DESIGN

Retrospective cohort study.

SETTING

Seventeen UK and Ireland specialist maternity centres.

SAMPLE

Twenty-seven pregnant women requiring DCCV in pregnancy.

MAIN OUTCOME MEASURES

Maternal and fetal outcomes following DCCV.

RESULTS

Twenty-seven women had a total of 29 DCCVs in pregnancy. Of these, 19 (70%) initial presentations were to Emergency Departments and eight (30%) to maternity settings. There were no maternal deaths. Seventeen of the women (63%) had a prior history of heart disease. Median gestation at DCCV was 28 weeks, median gestation at delivery was 35 weeks, with a live birth in all cases. The abnormal heart rhythms documented at the first cardioversion were atrial fibrillation in 12/27 (44%) cases, atrial flutter in 8/27 (30%), supraventricular tachycardia in 5/27 (19%) and atrial tachycardia in 2/27 (7%). Fetal monitoring was undertaken following DCCV on 14/29 (48%) occasions (10 of 19 (53%) at ≥26 weeks) and on 2/29 (7%) occasions, urgent delivery was required post DCCV.

CONCLUSIONS

Direct current cardioversion in pregnancy is rarely required but should be undertaken when clinically indicated according to standard algorithms to optimise maternal wellbeing. Once the woman is stable post DCCV, gestation-relevant fetal monitoring should be undertaken. Maternity units should develop multidisciplinary processes to ensure pregnant women receive the same standard of care as their non-pregnant counterparts.

The use of arts-based methodologies and methods with young people with complex psychosocial needs: A systematic narrative review

BACKGROUND

Arts-based methodologies and methods (ABM) can elicit rich and meaningful data with seldom-heard groups and empower participants in research. Young people with complex psychosocial needs could be better engaged in research using arts-based approaches to overcome communication and literacy issues as well as distrust of those with power, including researchers. A critical review of the use and impact of ABM among this population is timely. The purpose of this review is to synthesize and examine the experience and use of ABM with young people with complex psychosocial needs.

METHODS

A systematic narrative literature review was conducted with a search of the literature from 2009 to 2021. All abstracts were reviewed independently by two authors and full papers were screened for eligibility against inclusion and exclusion criteria. Data synthesis focused on a descriptive numerical summary and a thematic analysis focused on key patterns across papers relating to the review objectives.

RESULTS AND DISCUSSION

A total of 25 papers were included. The most common issues of focus were mental health (n = 10) and homelessness (n = 11) and methods using Photovoice (n = 12) and Body Mapping (n = 5). Individual interview data (n = 20) were the most commonly analysed, followed by created works (n = 19). Less than half the studies involved young people in the interpretation of the data collected. Knowledge translation was not described in almost half the studies, with public exhibits (n = 7) and forums with service providers (n = 4) being the most common activities. Key themes across the studies were valued over traditional methods in eliciting data, ABM as an approach to engage these young people in research and the impact of the use of ABM on participants and on key stakeholders through knowledge translation.

CONCLUSIONS

The growing field of ABM presents opportunities to enhance research with young people with complex psychosocial needs by promoting meaningful exploration of experiences, engaging participants in research and strengthening knowledge translation. The involvement of young people in the interpretation of data and ensuring that knowledge translation occurs are key areas for future attention.

PATIENT OR PUBLIC CONTRIBUTION

The findings of this review will inform future research to improve the engagement of young people with complex psychosocial needs in research and promote power sharing between researchers and research participants.

Integrating Trauma and Violence Informed Care in Primary Health Care Settings for First Nations Women Experiencing Violence: A Systematic Review

It is imperative that access to primary health care services is equitable as health care practitioners are often the first responders to women who experience violence. This is of particular importance for First Nations women who disproportionately experience interpersonal and structural violence when compared to non-First Nations women, as well as the ongoing impact of colonization, racism, and intergenerational trauma. To understand how primary health care services can provide equitable and effective care for First Nations women, we explored how trauma and violence informed care is integrated in primary health care settings through the lens of an equity-oriented framework. A systematic search of electronic databases included Medline (via Ovid), Scopus, Informit, and PubMed and grey literature. Six studies were included in the review and we undertook a narrative synthesis using the equity-oriented framework to draw together the intersection of trauma and violence informed care with culturally safe and contextually tailored care. This review demonstrates how equity-oriented primary health care settings respond to the complex and multiple forms of violence and intergenerational trauma experienced by First Nations women and thus mitigate shame and stigma to encourage disclosure and help seeking. Key attributes include responding to women's individual contexts by centering family, engaging elders, encouraging community ownership, which is driven by a culturally competent workforce that builds trust, reduces retraumatization, and respects confidentiality. This review highlights the importance of strengthening and supporting the workforce, as well as embedding cultural safety within intersectoral partnerships and ensuring adequate resourcing and sustainability of initiatives.

Emergency Department Initiated Mental Health Interventions for Young People: A Systematic Review

OBJECTIVE

Young people (10-24 years old) with mental health concerns are increasingly presenting to hospital emergency departments (EDs). The purpose of this review was to identify the core components and outcomes of mental health interventions for young people that are initiated in the ED, such that they are delivered in the ED and/or by ED health workers.

METHODS

Six electronic databases were systematically searched. Primary peer-reviewed qualitative or quantitative studies describing an ED-initiated mental health intervention for young people published between 2009 and 2020 were included.

RESULTS

Nine studies met the inclusion criteria. The included studies demonstrated that compared with traditional ED care, ED-initiated mental health interventions lead to improved efficiency of care and decreased length of stay, and a core component of this care was its delivery by allied health practitioners with mental health expertise. The studies were limited by focusing on service efficiencies rather than patient outcomes. Further limitations were the exclusion of young people with complex mental health needs and/or comorbidities and not measuring long-term positive mental health outcomes, including representations and whether young people were connected with community health services.

CONCLUSIONS

This systematic review demonstrated that ED-initiated mental health interventions result in improved service outcomes, but further innovation and robust evaluation are required. Future research should determine whether these interventions lead to better clinical outcomes for young people and staff to inform the development of best practice recommendations for ED-initiated mental health care for young people presenting to the ED.

What is next in African neuroscience?

Working in Africa provides neuroscientists with opportunities that are not available in other continents. Populations in this region exhibit the greatest genetic diversity; they live in ecosystems with diverse flora and fauna; and they face unique stresses to brain health, including child brain health and development, due to high levels of traumatic brain injury and diseases endemic to the region. However, the neuroscience community in Africa has yet to reach its full potential. In this article we report the outcomes from a series of meetings at which the African neuroscience community came together to identify barriers and opportunities, and to discuss ways forward. This exercise resulted in the identification of six domains of distinction in African neuroscience: the diverse DNA of African populations; diverse flora, fauna and ecosystems for comparative research; child brain health and development; the impact of climate change on mental and neurological health; access to clinical populations with important conditions less prevalent in the global North; and resourcefulness in the reuse and adaption of existing technologies and resources to answer new questions. The article also outlines plans to advance the field of neuroscience in Africa in order to unlock the potential of African neuroscientists to address regional and global mental health and neurological problems.

Returning to the emergency department: a retrospective analysis of mental health re-presentations among young people in New South Wales, Australia

OBJECTIVES

This study aimed to describe mental health emergency department (ED) presentations among young people aged 8-26 years in New South Wales, Australia, and to identify key characteristics associated with higher risk of ED mental health re-presentation.

DESIGN, SETTING AND PARTICIPANTS

Retrospective analysis of linked ED data records for mental health presentations between 1 January 2015 and 30 June 2018.

MAIN OUTCOME MEASURES

The main outcome was the total number of mental health ED re-presentations within 1 year, following initial presentation. Count regression models were fitted to estimate factors associated with higher likelihood of re-presentations.

RESULTS

Forty thousand two hundred and ninety patients were included in the analyses, and 9713 (~25%) re-presented during the following year; 1831 (20%) presented at least three times. On average, patients re-presented 0.61 times per 365 person-days, with average time until first re-presentation of ~92 days but greatest risk of re-presentation within first 30-60 days. Young people with self-harm or suicidal diagnoses at initial presentation were more likely to re-present. Re-presentations were highest among young people <15 years (IRR 1.18 vs ≥20 years old), female (IRR=1.13 vs male), young people residing outside of major cities (IRR 1.08 vs major cities) and Aboriginal and Torres Strait Islander young people (IRR 1.27 vs non-Indigenous).

CONCLUSIONS

ED mental health re-presentation is high among young people. We demonstrate factors associated with re-presentation that EDs could target for timely, high-quality care that is youth friendly and culturally safe, with appropriate referral pathways into community-based primary and mental healthcare services.

Screening and social prescribing in healthcare and social services to address housing issues among children and families: a systematic review

OBJECTIVES

Housing is a social determinant of health that impacts the health and well-being of children and families. Screening and referral to address social determinants of health in clinical and social service settings has been proposed to support families with housing problems. This study aims to identify housing screening questions asked of families in healthcare and social services, determine validated screening tools and extract information about recommendations for action after screening for housing issues.

METHODS

The electronic databases MEDLINE, PsycINFO, EMBASE, Ovid Emcare, Scopus and CINAHL were searched from 2009 to 2021. Inclusion criteria were peer-reviewed literature that included questions about housing being asked of children or young people aged 0-18 years and their families accessing any healthcare or social service. We extracted data on the housing questions asked, source of housing questions, validity and descriptions of actions to address housing issues.

RESULTS

Forty-nine peer-reviewed papers met the inclusion criteria. The housing questions in social screening tools vary widely. There are no standard housing-related questions that clinical and social service providers ask families. Fourteen screening tools were validated. An action was embedded as part of social screening activities in 27 of 42 studies. Actions for identified housing problems included provision of a community-based or clinic-based resource guide, and social prescribing included referral to a social worker, care coordinator or care navigation service, community health worker, social service agency, referral to a housing and child welfare demonstration project or provided intensive case management and wraparound services.

CONCLUSION

This review provides a catalogue of housing questions that can be asked of families in the clinical and/or social service setting, and potential subsequent actions.

Evidence of horizontal urban heat advection in London using six years of data from a citizen weather station network

Recent advances in citizen weather station (CWS) networks, with data accessible via crowd-sourcing, provide relevant climatic information to urban scientists and decision makers. In particular, CWS can provide long-term measurements of urban heat and valuable information on spatio-temporal heterogeneity related to horizontal heat advection. In this study, we make the first compilation of a quasi-climatologic dataset covering six years (2015-2020) of hourly near-surface air temperature measurements obtained via 1560 suitable CWS in a domain covering south-east England and Greater London. We investigated the spatio-temporal distribution of urban heat and the influences of local environments on climate, captured by CWS through the scope of Local Climate Zones (LCZ)-a land-use land-cover classification specifically designed for urban climate studies. We further calculate, for the first time, the amount of advected heat captured by CWS located in Greater London and the wider south east England region. We find that London is on average warmer by about 1.0 ∘C-1.5 ∘C than the rest of south-east England. Characteristics of the southern coastal climate are also captured in the analysis. We find that on average, urban heat advection (UHA) contributes to 0.22 ± 0.96 ∘C of the total urban heat in Greater London. Certain areas, mostly in the centre of London are deprived of urban heat through advection since heat is transferred more to downwind suburban areas. UHA can positively contribute to urban heat by up to 1.57 ∘C, on average and negatively by down to -1.21 ∘C. Our results also show an important degree of inter- and intra-LCZ variability in UHA, calling for more research in the future. Nevertheless, we already find that UHA can impact green areas and reduce their cooling benefit. Such outcomes show the added value of CWS when considering future urban design.

The Experiences of Persistent Pain Among Women With a History of Intimate Partner Violence: A Systematic Review

Women experience persistent pain at higher rates than men; however, women are less likely to be provided with adequate or appropriate care and more likely to have their pain experiences dismissed. The purpose of this review is to consider the complex interaction of the biopsychosocial factors in the experience of persistent pain in order to inform improved models of care. Given persistent pain is among the most frequently reported health consequences of intimate partner violence (IPV), this review focused on studies exploring the association between persistent pain and IPV. Three reviewers independently and systematically searched seven databases. Qualitative and quantitative studies describing the association between IPV and persistent pain published between January 2000 and June 2018 were included. Twelve studies met the inclusion criteria. The included studies demonstrated that a history of IPV places an additional burden on women who experience persistent pain that cannot be explained by an underlying psychological condition. Health care practitioners should be aware of this phenomena to ensure diagnosis, assessment, and treatment plans are targeted accordingly. Future policy directives and research should account for and seek to elucidate this additional burden.

Temporal changes in total and metabolically active ruminal methanogens in dairy cows supplemented with 3-nitrooxypropanol

The purpose of this study was to investigate the effect of 3-nitrooxypropanol (3-NOP), a potent methane inhibitor, on total and metabolically active methanogens in the rumen of dairy cows over the course of the day and over a 12-wk period. Rumen contents of 8 ruminally cannulated early-lactation dairy cows were sampled at 2, 6, and 10 h after feeding during wk 4, 8, and 12 of a randomized complete block design experiment in which 3-NOP was fed at 60 mg/kg of feed dry matter. Cows (4 fed the control and 4 fed the 3-NOP diet) were blocked based on their previous lactation milk yield or predicted milk yield. Rumen samples were extracted for microbial DNA (total) and microbial RNA (metabolically active), PCR amplified for the 16S rRNA gene of archaea, sequenced on an Illumina platform, and analyzed for archaea diversity. In addition, the 16S copy number and 3 ruminal methanogenic species were quantified using the real-time quantitative PCR assay. We detected a difference between DNA and RNA (cDNA)-based archaea communities, revealing that ruminal methanogens differ in their metabolic activities. Within DNA and cDNA components, methanogenic communities differed by sampling hour, week, and treatment. Overall, Methanobrevibacter was the dominant genus (94.3%) followed by Methanosphaera, with the latter genus having greater abundance in the cDNA component (14.5%) compared with total populations (5.5%). Methanosphaera was higher at 2 h after feeding, whereas Methanobrevibacter increased at 6 and 10 h in both groups, showing diurnal patterns among individual methanogenic lineages. Methanobrevibacter was reduced at wk 4, whereas Methanosphaera was reduced at wk 8 and 12 in cows supplemented with 3-NOP compared with control cows, suggesting differential responses among methanogens to 3-NOP. A reduction in Methanobrevibacter ruminantium in all 3-NOP samples from wk 8 was confirmed using real-time quantitative PCR. The relative abundance of individual methanogens was driven by a combination of dietary composition, dry matter intake, and hydrogen concentrations in the rumen. This study provides novel information on the effects of 3-NOP on individual methanogenic lineages, but further studies are needed to understand temporal dynamics and to validate the effects of 3-NOP on individual lineages of ruminal methanogens.

COVID-19 testing in outbreak-free care homes: what are the public health benefits?

BACKGROUND

COVID-19 care home outbreaks represent a significant proportion of COVID-19 morbidity and mortality in the UK. National testing initially focused on symptomatic care home residents, before extending to asymptomatic cohorts.

AIM

The aim was to describe the epidemiology and transmission of COVID-19 in outbreak free care homes.

METHODS

A two-point prevalence survey of COVID-19, in 34 Liverpool care homes, was performed in April and May 2020. Changes in prevalence were analysed. Associations between care home characteristics, reported infection, prevention and control interventions, and COVID-19 status were described and analysed.

FINDINGS

No resident developed COVID-19 symptoms during the study. There was no significant difference between: the number of care homes containing at least one test positive resident between the first (17.6%, 95% confidence interval (CI) 6.8-34.5) and second round (14.7%, 95% CI 5.0-31.1) of testing (p>0.99); and the number of residents testing positive between the first (2.1%, 95% CI 1.2-3.4) and second round (1.0%, 95% CI 0.5-2.1) of testing (P=0.11). Care homes providing nursing care (risk ratio (RR) 7.99, 95% CI 1.1-57.3) and employing agency staff (RR 8.4, 95% CI 1.2-60.8) were more likely to contain test positive residents. Closing residents shared space was not associated with residents testing positive (RR 2.63, 95% CI 0.4-18.5).

CONCLUSIONS

Asymptomatic COVID-19 care homes showed no evidence of disease transmission or development of outbreaks; suggesting that current infection prevention and control measures are effective in preventing transmission. Repeat testing at two to three weeks had limited or no public health benefits over regular daily monitoring of staff and residents for symptoms. These results should inform policies calling for regular testing of asymptomatic residents.

Multicentre study on pulmonary arterial hypertension therapies in fontan patients: underutilised or of limited use?

Introduction

The Fontan circulation is successful in abolishing cyanosis and chronic volume overload in congenital heart disease (CHD) patients with single ventricle physiology. “Fontan failure” is a major cause of poor quality of life and mortality in these patients. Recently, pulmonary arterial hypertension (PAH) therapies have been used in Fontan patients with variable success, even though patients included in these studies are generally at the best end of the spectrum.

Aim

To assess contemporary patterns of PAH therapy in Fontan patients in large specialist CHD centres.

Methods

We identified all adult patients with a Fontan-type circulation under active follow-up in 8 specialist CHD centres between 2009 and 2019. Patients on PAH therapies were matched by age and gender to untreated patients (1:1 or 1:2). Baseline data were collated immediately prior to initiation of therapy (treated group) or from a synchronous routine clinical assessment (untreated group).

Results

During the study period, 70 Fontan patients were started on PAH therapy (6.5% of those under follow-up). The majority 63 (90.0%) were started on monotherapy with a phosphodiesterase-5 (PDE5) inhibitor, 6 (8.6%) patients were started on an endothelin receptor antagonist (ERA) and 1 (1.4%) received early sequential therapy with a PDE5 inhibitor and ERA. Prostacyclin analogues were not used, and no patients received triple therapy. Overall, 51 (72.9%) patients started therapy electively (49% in outpatient clinic, 51% as day case admission), while 18 (25.7%) were treated following urgent hospital admission with fluid overload +/− acute kidney injury. The remainder (2,2.9%) started therapy following cardiac surgery. Adverse events during treatment were rare. Patients starting PAH therapy were matched to 112 untreated patients (table 1). Patients were well matched between groups for age (p=0.52) and sex (p=0.27). Treated patients were more likely to be significantly impaired than matched patients (56.7% vs. 8.6% in NYHA class III/IV, p&lt;0.0001) and were more likely to have ascites (16.2% vs. 0.9%, p=0.0002). Treated patients were also more likely to have a lower albumin level (43 [14–56] vs. 45 [29–54], p=0.01) or to be on a loop diuretic e.g. furosemide (p&lt;0.0001), at a higher daily dose (p&lt;0.0001) than matched patients. Only a quarter of patients on therapies had no high-risk features (24.2%), 80% of whom were from a single centre.

Conclusion

A small minority of Fontan patients followed in specialist centres receive PAH therapies. PAH therapy was reserved in most centres for patients with more advanced disease, targeting predominantly those with a “failing Fontan” in an individualised approach, in line with the recent adult CHD American Heart Association (AHA) guidelines. Further studied are needed to establish the role of PAH therapies in Fontan patients, provided that adult patients with advanced disease who are at increased risk of adverse outcome are included.

Figure 1

Funding Acknowledgement

Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Dr Constantine received an educational grant from Actelion Pharmaceuticals, a Janssen company of Johnson & Johnson, which helped to pay for travel for data collection.

The single-use rhinolaryngoscope: an evaluation and cost comparison

BACKGROUND

This study investigated whether the single-use rhinolaryngoscope is clinically and economically comparable to the conventional reusable rhinolaryngoscope within a tertiary otolaryngology centre in the UK.

METHODS

A non-blinded, prospective and single-arm evaluation was carried out over a 5-day period, in which micro-costing was used to compare single-use rhinolaryngoscopes with reusable rhinolaryngoscopes.

RESULTS

Overall, 68 per cent of the investigators perceived the single-use rhinolaryngoscope to be 'good' or 'very good', while 85 per cent believed the single-use rhinolaryngoscope could replace the reusable rhinolaryngoscope (n = 59). The incremental costs of reusable rhinolaryngoscope eyepieces and videoscopes in the out-patient clinic, when compared to single-use rhinolaryngoscopes, were £30 and £11, respectively. The incremental costs of reusable rhinolaryngoscope eyepieces and videoscopes in the acute surgical assessment unit, when compared to single-use rhinolaryngoscopes, were -£4 and -£73, respectively.

CONCLUSION

The single-use rhinolaryngoscope provides a clinically comparable, and potentially cost-minimising, alternative to the reusable rhinolaryngoscope for use in the acute surgical assessment unit of our hospital.

Responses to the primary health care needs of Aboriginal and Torres Strait Islander women experiencing violence: A scoping review of policy and practice guidelines

ISSUE ADDRESSED

It is demonstrated that primary health care (PHC) providers are sought out by women who experience violence. Given the disproportionate burden of violence experienced by Aboriginal and Torres Strait Islander women, it is essential there is equitable access to appropriate PHC services. This review aimed to analyse whether Australian PHC policy accounts for the complex needs of Aboriginal and Torres Strait Islander women experiencing violence and the importance of PHC providers responding to violence in culturally safe ways.

METHODS

Using the Arskey and O'Malley framework, an iterative scoping review determined the policies for analysis. The selected policies were analysed against concepts identified as key components in responding to the needs of Aboriginal and Torres Strait Islander women experiencing violence. The key components are Family Violence, Violence against Aboriginal and Torres Strait Islander Women, Social Determinants of Aboriginal and Torres Strait Islander Health and Wellbeing, Cultural Safety, Holistic Health, Trauma, Patient-Centred Care and Trauma-and-Violence-Informed Care.

RESULTS

Following a search of Australian government websites, seven policies were selected for analysis. Principally, no policy embedded or described best practice across all key components.

CONCLUSION

The review demonstrates the need for a specific National framework supporting Aboriginal and Torres Strait Islander women who seek support from PHC services, as well as further policy analysis and review. SO WHAT?: Aboriginal and Torres Strait Islander women disproportionately experience more severe violence, with complex impact, than other Australian women. PHC policy and practice frameworks must account for this, together with the intersection of contemporary manifestations of colonialism and historical and intergenerational trauma.

A-09 The Relationship Between Subjective Cognitive Complaints, Depression, and Executive Functioning in mTBI Veterans

Objective

Among individuals with mild traumatic brain injury (mTBI), those with depression report greater subjective cognitive complaints than those without depression. In mTBI patients with general cognitive complaints, depression may account for poor performance on objective neuropsychological measures. This study seeks to expand this research by examining depression, subjective executive functioning (EF) complaints, and objective EF performance in Veterans with mTBI.

Method

Fifty-seven Veterans with deployment-related mTBI (12% female; age M = 42.0, SD = 13.6; years education M = 15.0, SD = 1.8) with (n = 29) or without (n = 28) a chart diagnosis of depression. Participants were administered the Behavioral Rating Inventory of Executive Functioning (BRIEF) and objective neuropsychological measures of working memory (i.e., Weschler Adult Intelligence Scale-IV Working Memory Index) and aspects of EF (i.e., Trail Making Test B and Delis-Kaplan Executive Functioning System (D-KEFS) subtests).

Results

Principal component analysis identified similar domains of EF to the BRIEF, including: task monitoring (Trail Making Test B, D-KEFS Letter Fluency, and D-KEFS Tower Test, eigenvalue = 1.93) and shifting (D-KEFS: Color-Word Interference Conditions 3 and 4, and Category Switching, eigenvalue = 1.24). Individuals with depression had greater subjective EF complaints in each BRIEF domain than non-depressed individuals (p’s ≤ .01). However, subjective complaints in these domains were not related to objective performance (r’s = −0.17,-0.19, p’s &gt; .05). Moreover, depressed and non-depressed individuals performed similarly on all EF measures (p’s &gt; .05).

Conclusions

mTBI Veterans with depression report more subjective EF complaints than those without depression. The lack of association between subjective complaints and objective EF performance suggests it is important to treat depression in mTBI patients to remedy perceived cognitive deficits.

C-24 Longitudinal Trajectories of Working Memory Performance in Typically Aging Older Adults

Objective

Cross-sectional studies have shown age-related differences in working memory (WM), but the trajectory is unclear due to the scarcity of longitudinal studies. Additional research is needed to better characterize the course of age-related changes in WM in older adults. The present study sought to address this gap in the literature by conducting serial assessments of WM in a longitudinally followed cohort of typically aging adults. We hypothesized a significant age × time interaction, such that WM would show pronounced declines with advancing age.

Methods

640 functionally intact participants in an aging cohort (clinical dementia rating = 0; age range 52-99, mean age = 75) completed a computerized WM measure, Running Letter Memory (RLM), every ~15 months for up to 8.5 years (mean follow-up = 1.9 years). Longitudinal changes in RLM scores were analyzed using linear mixed effects models, allowing for random slopes and intercepts. All models were adjusted for sex and education.

Results

RLM performance did not significantly decline over time (b = -.14, p = .43). As hypothesized, there was a significant age × time interaction predicting RLM scores (b = -.08, p = .006). Specifically, RLM performance remained relatively stable (or slightly improved) until around age 75, beyond which increasingly precipitous declines were observed with advancing age.

Conclusion

The present results suggest that WM performance does not evidence declines until the mid-70s in typically aging adults, at which point increasingly steep decline trajectories are observed with advancing age. These findings highlight that cognitive aging does not occur at a constant rate in late life.

Maternal and fetal outcomes in pregnancies complicated by the inherited aortopathy Loeys-Dietz syndrome

OBJECTIVE

Pregnancies in women with Loeys-Dietz syndrome (LDS) are rare and are typically documented in case reports only. Early reports suggested high rates of maternal complications during pregnancy and the puerperium, including aortic dissection and uterine rupture, but information on fetal outcomes was very limited.

DESIGN

A retrospective cohort study.

SETTING

Eight specialist UK centres.

SAMPLE

Pregnant women with LDS.

METHODS

Data was collated on cardiac, obstetric, and neonatal outcomes.

MAIN OUTCOME MEASURES

Maternal and perinatal outcomes in pregnancies complicated by LDS.

RESULTS

Twenty pregnancies in 13 women with LDS were identified. There was one miscarriage, one termination of pregnancy, and 18 livebirths. In eight women the diagnosis was known prior to pregnancy but only one woman had preconception counselling. In four women the diagnosis was made during pregnancy through positive genotyping, and the other was diagnosed following delivery. Five women had a family history of aortic dissection. There were no aortic dissections in our cohort during pregnancy or postpartum. Obstetric complications were common, including postpartum haemorrhage (33%) and preterm delivery (50%). In all, 14/18 (78%) of deliveries were by elective caesarean section, at a median gestational age at delivery of 37 weeks. Over half the infants (56%) were admitted to the neonatal unit following delivery.

CONCLUSION

Women with LDS require multidisciplinary specialist management throughout pregnancy. Women should be referred for preconception counselling to make informed decisions around pregnancy risk and outcomes. Early elective preterm delivery needs to be balanced against a high infant admission rate to the neonatal unit.

TWEETABLE ABSTRACT

Pregnancy outcomes in women with Loeys-Dietz syndrome.

Long-term exposure to chemicals in sewage sludge fertilizer alters liver lipid content in females and cancer marker expression in males

BACKGROUND

The increased incidence of diseases, including metabolic syndrome and infertility, may be related to exposure to the mixture of chemicals, which are ubiquitous in the modern environment (environmental chemicals, ECs). Xeno-detoxification occurs within the liver which is also the source of many plasma proteins and growth factors and plays an important role in the regulation of homeostasis.

OBJECTIVES

The objective of this study was to investigate the effects of ECs on aspects of liver function, in a well characterized ovine model of exposure to a real-life EC mixture.

METHODS

Four groups of sheep (n = 10-12/sex/treatment) were maintained long-term on control or sewage sludge-fertilized pastures: from conception to culling at 19 months of age in females and from conception to 7 months of age and thereafter in control plots until culling at 19 months of age in males. Environmental chemicals were measured in sheep livers and RNA and protein extracts were assessed for exposure markers. Liver proteins were resolved using 2D differential in-gel electrophoresis and differentially expressed protein spots were identified by liquid chromatography/tandem mass spectroscopy.

RESULTS

Higher levels of polycyclic aromatic hydrocarbons (PAHs) and lower levels of polychlorinated biphenyls (PCBs) in the livers of control males compared to control females indicated sexually dimorphic EC body burdens. Increased levels of the PAHs Benzo[a]anthracene and chrysene and reduced levels of PCB 153 and PCB 180 were observed in the livers of continuously exposed females. EC exposure affected xenobiotic and detoxification responses and the liver proteome in both sexes and included major plasma-secreted and blood proteins, and metabolic enzymes whose pathway analysis predicted dysregulation of cancer-related pathways and altered lipid dynamics. The latter were confirmed by a reduction in total lipids in female livers and up-regulation of cancer-related transcript markers in male livers respectively by sewage sludge exposure.

CONCLUSIONS

Our results demonstrate that chronic exposure to ECs causes major physiological changes in the liver, likely to affect multiple systems in the body and which may predispose individuals to increased disease risks.

Nutrient transporter expression in both the placenta and fetal liver are affected by maternal smoking

Introduction

The placenta controls nutrient transfer between mother and fetus via membrane transporters. Appropriate transplacental passage of nutrients is essential for fetal growth and development. We investigated whether transporter transcript levels in human placenta-liver pairs from first and early second trimester pregnancies exhibit gestational age- or fetal sex-specific profiles and whether these are dysregulated by maternal smoking.

Methods

In a step-change for the field, paired placenta and fetal livers from 54 electively terminated, normally-progressing pregnancies (7–20 weeks of gestation, Scottish Advanced Fetal Research Study, REC 15/NS/0123) were sexed and cigarette smoking-exposure confirmed. Thirty-six nutrient transporter transcripts were quantified using RT-qPCR.

Results

While fetal, liver and placenta weights were not altered by maternal smoking, levels of transporter transcripts changed with fetal age and sex in the placenta and fetal liver and their trajectories were altered if the mother smoked. Placental levels of glucose uptake transporters SLC2A1 and SLC2A3 increased in smoking-exposed fetuses while smoking was associated with altered levels of amino acid and fatty acid transporter genes in both tissues. SLC7A8, which exchanges non-essential amino acids in the fetus for essential amino acids from the placenta, was reduced in smoking-exposed placentas while transcript levels of four hepatic fatty acid uptake transporters were also reduced by smoking.

Discussion

This data shows that fetal sex and age and maternal smoking are associated with altered transporter transcript levels. This could influence nutrient transport across the placenta and subsequent uptake by the fetal liver, altering trophic delivery to the growing fetus.

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Nutrient transporters show differential expression in first/second trimesters.

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Maternal smoking alters transporter expression of three essential nutrient groups.

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Fatty acid transporter expression is reduced in smoke-exposed fetal livers.

Screening for Atrial Fibrillation

Approximately 10% of ischemic strokes are associated with atrial fibrillation (AF) first diagnosed at the time of stroke. Detecting asymptomatic AF would provide an opportunity to prevent these strokes by instituting appropriate anticoagulation. The AF-SCREEN international collaboration was formed in September 2015 to promote discussion and research about AF screening as a strategy to reduce stroke and death and to provide advocacy for implementation of country-specific AF screening programs. During 2016, 60 expert members of AF-SCREEN, including physicians, nurses, allied health professionals, health economists, and patient advocates, were invited to prepare sections of a draft document. In August 2016, 51 members met in Rome to discuss the draft document and consider the key points arising from it using a Delphi process. These key points emphasize that screen-detected AF found at a single timepoint or by intermittent ECG recordings over 2 weeks is not a benign condition and, with additional stroke factors, carries sufficient risk of stroke to justify consideration of anticoagulation. With regard to the methods of mass screening, handheld ECG devices have the advantage of providing a verifiable ECG trace that guidelines require for AF diagnosis and would therefore be preferred as screening tools. Certain patient groups, such as those with recent embolic stroke of uncertain source (ESUS), require more intensive monitoring for AF. Settings for screening include various venues in both the community and the clinic, but they must be linked to a pathway for appropriate diagnosis and management for screening to be effective. It is recognized that health resources vary widely between countries and health systems, so the setting for AF screening should be both country- and health system-specific. Based on current knowledge, this white paper provides a strong case for AF screening now while recognizing that large randomized outcomes studies would be helpful to strengthen the evidence base.

Placental transporter localization and expression in the Human: the importance of species, sex, and gestational age differences†

The placenta is a critical organ during pregnancy, essential for the provision of an optimal intrauterine environment, with fetal survival, growth, and development relying on correct placental function. It must allow nutritional compounds and relevant hormones to pass into the fetal bloodstream and metabolic waste products to be cleared. It also acts as a semipermeable barrier to potentially harmful chemicals, both endogenous and exogenous. Transporter proteins allow for bidirectional transport and are found in the syncytiotrophoblast of the placenta and endothelium of fetal capillaries. The major transporter families in the human placenta are ATP-binding cassette (ABC) and solute carrier (SLC), and insufficiency of these transporters may lead to deleterious effects on the fetus. Transporter expression levels are gestation-dependent and this is of considerable clinical interest as levels of drug resistance may be altered from one trimester to the next. This highlights the importance of these transporters in mediating correct and timely transplacental passage of essential compounds but also for efflux of potentially toxic drugs and xenobiotics. We review the current literature on placental molecular transporters with respect to their localization and ontogeny, the influence of fetal sex, and the relevance of animal models. We conclude that a paucity of information exists, and further studies are required to unlock the enigma of this dynamic organ.

First Report of Meloidogyne marylandi Infecting Bermudagrass in Oklahoma

Meloidogyne marylandi is a nematode commonly associated with turfgrasses and has been reported to occur in Texas and Arkansas (1,3). In the fall of 2013, a stand of ultradwarf bermudagrass (Cynodon dactylon × C. transvaalensis) plants in a sand-based, research putting green in Stillwater, Oklahoma, exhibited symptoms of decline. Roots of the affected plants had small galls and upon staining of the root system, numerous egg masses were evident. Egg masses were collected, placed in water, and the morphology of 20 hatched, second-stage juveniles were examined. The characteristics of the juveniles were: body length averaged 393.1 ± 19.87 (range: 361 to 425) μm, mean width averaged 16.6 ± 0.7 (15.6 to 17.8) μm, stylet lengths averaged 12.1 ± 0.7 (10.4 to 12.9) μm, dorsal gland orifice from stylet base averaged 2.9 ± 0.4 (2.5 to 3.6) μm, tail lengths averaged 53.7 ± 3.8 (46.2 to 60.4) μm, and the hyaline region of the tails averaged 10.4 ± 1.1 (8.4 to 12.7) μm. Genomic DNA was extracted from six females that were removed from roots. Amplification and sequencing of the mitochondrial DNA region between COII and 16S rRNA genes was performed with primers 1RNAF (5'-TACCTTTGACCAATCACGCT-3') and CO11R (5'-GGTCAATGTTCAGAAATTTGTGG-3') as previously described (2). A PCR product approximately 510 bp in length was obtained and sequenced at the Oklahoma State University Core Facility. Sequences were compared with those in NCBI's nucleotide database using BLAST and had 97% identity with two sequences from M. marylandi (KC473862.1 and KC473863.1) and the next most similar species being M. graminis (JN241898.1) with 83% identity. To our knowledge, this is the first report of the root-knot nematode M. marylandi in Oklahoma. As bermudagrass becomes more commonly used for putting greens in the turfgrass transition zone, M. marylandi may become a more common and damaging pathogen in the region. References: (1) A. A. Elmi et al. Grass For. Sci. 55:166, 2000. (2) M. A. McClure et al. Plant Dis. 96:635, 2012. (3) J. L. Starr et al. Nematrop. 37:43, 2007.

Effects of an exogenous protease on the fermentation and nutritive value of corn silage harvested at different dry matter contents and ensiled for various lengths of time

The objective of this experiment was to evaluate the effects of adding an experimental protease to corn plants harvested at different maturities on silage fermentation and in vitro ruminal starch digestibility (IVSD). Corn plants were harvested at maturities resulting in plants with 31 or 40% dry matter (DM). Plants were chopped, kernel processed, and treated with (1) only a 0.1 M phosphate buffer (pH 5.5, 5% vol/wt of fresh forage), (2) buffer with protease to obtain a final concentration of 20mg of protease/kg of wet forage, and (3) buffer with protease to obtain a final concentration of 2,000 mg of protease/kg of wet forage. Treated forages (about 500 g) were ensiled in nylon-polyethylene pouches and stored between 21 and 23°C for 0, 45, 90, and 150 d. Data were analyzed as a 2 × 3 × 4 factorial arrangement of treatments, with the main effects of harvest DM, dose of protease, days of ensiling, and their interactions. The treatment with the highest dose of protease resulted in more robust fermentations across harvest DM with higher concentrations of lactic and acetic acids compared with untreated silage. Concentrations of soluble protein (% of crude protein) increased with time of ensiling, regardless of DM content at harvest. However, averaged over both harvest DM contents, it increased by 37% for silages treated with the high dose of protease compared with an average 11% increase for untreated silages and silage treated with the low dose of protease, between d 0 and 45. Averaged over both harvest DM contents, the concentration of soluble protein peaked in silages treated with the high dose of protease after 45 d of ensiling, whereas it peaked at d 90 in untreated silages and silage treated with the low dose of protease. Similar changes occurred in the concentration of NH3-N due to length of ensiling and treatment with protease. In fresh forages, the concentration of starch for early- and late-harvested forages was similar, but IVSD was lower in the latter. After 45 d of ensiling, IVSD was highest in both early- and late-harvested silages that were treated with the high level of protease. After 150 d of ensiling, IVSD was similar among silages treated with protease, regardless of DM at harvest. Treating corn plants with a high dose of an experimental protease at harvest accelerated proteolysis during ensiling, resulting in corn silages with levels of IVSD after 45 d of ensiling that were only obtained in untreated corn silages after 150 d of ensiling.

Attainment of metabolic goals in the integrated UK islet transplant program with locally isolated and transported preparations

The objective was to determine whether metabolic goals have been achieved with locally isolated and transported preparations over the first 3 years of the UK's nationally funded integrated islet transplant program. Twenty islet recipients with C-peptide negative type 1 diabetes and recurrent severe hypoglycemia consented to the study, including standardized meal tolerance tests. Participants received a total of 35 infusions (seven recipients: single graft; 11 recipients: two grafts: two recipients: three grafts). Graft function was maintained in 80% at [median (interquartile range)] 24 (13.5-36) months postfirst transplant. Severe hypoglycemia was reduced from 20 (7-50) episodes/patient-year pretransplant to 0.3 (0-1.6) episodes/patient-year posttransplant (p < 0.001). Resolution of impaired hypoglycemia awareness was confirmed [pretransplant: Gold score 6 (5-7); 24 (13.5-36) months: 3 (1.5-4.5); p < 0.03]. Target HbA1c of <7.0% was attained/maintained in 70% of recipients [pretransplant: 8.0 (7.0-9.6)%; 24 (13.5-36) months: 6.2 (5.7-8.4)%; p < 0.001], with 60% reduction in insulin dose [pretransplant: 0.51 (0.41-0.62) units/kg; 24 (13.5-36) months: 0.20 (0-0.37) units/kg; p < 0.001]. Metabolic outcomes were comparable 12 months posttransplant in those receiving transported versus only locally isolated islets [12 month stimulated C-peptide: transported 788 (114-1764) pmol/L (n = 9); locally isolated 407 (126-830) pmol/L (n = 11); p = 0.32]. Metabolic goals have been attained within the equitably available, fully integrated UK islet transplant program with both transported and locally isolated preparations.