The effect of human-machine interface modality, specificity, and timing on driver performance and behavior while using vehicle automation

The effectiveness of the human-machine interface (HMI) in a driving automation system during takeover situations is based, in part, on its design. Past research has indicated that modality, specificity, and timing of the HMI have an impact on driver behavior. The objective of this study was to examine the effectiveness of two HMIs, which vary by modality, specificity, and timing, on drivers' takeover time, performance, and eye glance behavior. Drivers' behavior was examined in a driving simulator study with different levels of automation, varying traffic conditions, and while completing a non-driving related task. Results indicated that HMI type had a statistically significant effect on velocity and off-road eye glances such that those who were exposed to an HMI that gave multimodal warnings with greater specificity exhibited better performance. There were no effects of HMI on acceleration, lane position, or other eye glance metrics (e.g., on road glance duration). Future work should disentangle HMI design further to determine exactly which aspects of design yield between safety critical behavior.

Prevalence of Medical Payment Products Promoted on US Hospitals' Websites

This cross-sectional study examines the prevalence of hospital-promoted medical payment products (MPPs) by whether hospitals offered any MPP or an interest-bearing MPP.

Achievement of Target Gain Larger than Unity in an Inertial Fusion Experiment

On December 5, 2022, an indirect drive fusion implosion on the National Ignition Facility (NIF) achieved a target gain G_{target} of 1.5. This is the first laboratory demonstration of exceeding "scientific breakeven" (or G_{target}>1) where 2.05 MJ of 351 nm laser light produced 3.1 MJ of total fusion yield, a result which significantly exceeds the Lawson criterion for fusion ignition as reported in a previous NIF implosion [H. Abu-Shawareb et al. (Indirect Drive ICF Collaboration), Phys. Rev. Lett. 129, 075001 (2022)PRLTAO0031-900710.1103/PhysRevLett.129.075001]. This achievement is the culmination of more than five decades of research and gives proof that laboratory fusion, based on fundamental physics principles, is possible. This Letter reports on the target, laser, design, and experimental advancements that led to this result.

Co-crystallisation and humanisation of an anti-HER2 single-domain antibody as a theranostic tool

Human epidermal growth factor receptor-2 (HER2) is a well-recognised biomarker associated with 25% of breast cancers. In most cases, early detection and/or treatment correlates with an increased chance of survival. This study, has identified and characterised a highly specific anti-HER2 single-domain antibody (sdAb), NM-02, as a potential theranostic tool. Complete structural description by X-ray crystallography has revealed a non-overlapping epitope with current anti-HER2 antibodies. To reduce the immunogenicity risk, NM-02 underwent a humanisation process and retained wild type-like binding properties. To further de-risk the progression towards chemistry, manufacturing and control (CMC) we performed full developability profiling revealing favourable thermal and physical biochemical 'drug-like' properties. Finally, the application of the lead humanised NM-02 candidate (variant K) for HER2-specific imaging purposes was demonstrated using breast cancer HER2+/BT474 xenograft mice.

In Vivo Screening Unveils Pervasive RNA-Binding Protein Dependencies in Leukemic Stem Cells and Identifies ELAVL1 as a Therapeutic Target

Acute myeloid leukemia (AML) is fueled by leukemic stem cells (LSC) whose determinants are challenging to discern from hematopoietic stem cells (HSC) or uncover by approaches focused on general cell properties. We have identified a set of RNA-binding proteins (RBP) selectively enriched in human AML LSCs. Using an in vivo two-step CRISPR-Cas9 screen to assay stem cell functionality, we found 32 RBPs essential for LSCs in MLL-AF9;NrasG12D AML. Loss-of-function approaches targeting key hit RBP ELAVL1 compromised LSC-driven in vivo leukemic reconstitution, and selectively depleted primitive malignant versus healthy cells. Integrative multiomics revealed differentiation, splicing, and mitochondrial metabolism as key features defining the leukemic ELAVL1-mRNA interactome with mitochondrial import protein, TOMM34, being a direct ELAVL1-stabilized target whose repression impairs AML propagation. Altogether, using a stem cell-adapted in vivo CRISPR screen, this work demonstrates pervasive reliance on RBPs as regulators of LSCs and highlights their potential as therapeutic targets in AML.

SIGNIFICANCE

LSC-targeted therapies remain a significant unmet need in AML. We developed a stem-cell-adapted in vivo CRISPR screen to identify key LSC drivers. We uncover widespread RNA-binding protein dependencies in LSCs, including ELAVL1, which we identify as a novel therapeutic vulnerability through its regulation of mitochondrial metabolism. This article is highlighted in the In This Issue feature, p. 171.

Associations between living in localities with e-cigarette sales restrictions and e-cigarette use change among young adults in Los Angeles County

INTRODUCTION

Local e-cigarette sales restrictions (ESRs) may impact e-cigarette use. This study examined the associations between living in localities with various ESR policies and changes in e-cigarette use among young adults in Los Angeles (LA) County, California, USA.

METHODS

Data were from a cohort of LA County young adults (18-21 years; n=2100) who completed two waves of surveys (Fall 2018-Summer 2019 and Summer-Fall 2020). Local flavoured (n=9) and comprehensive (n=2) ESRs in LA County implemented between June 2019 and May 2020 were identified, coded and merged with the baseline data. Multivariable logistic regressions were used to examine the associations between living in ESR localities and e-cigarette use at follow-up, controlling for covariates and stratified by cigarette smoking at baseline.

RESULTS

Overall, 20.9% and 14.3% of participants lived in localities with flavoured and comprehensive ESRs, respectively. Participants who were non-Hispanic, had higher socioeconomic statuses and were currently using e-cigarettes were generally more likely to live in ESR localities than their counterparts. The associations between living in ESR localities and e-cigarette use at follow-up were not found among baseline non-e-cigarette users regardless of their cigarette smoking status; a positive relationship was found among baseline e-cigarette users who also smoked cigarettes but not among non-smokers.

DISCUSSION

Participants who lived in localities with various ESR policies were different in their baseline e-cigarette use and socioeconomic backgrounds. Future research examining the potential impact of ESRs on e-cigarette use change should consider the localities' overall sociodemographic and tobacco-using characteristics and individuals' cigarette smoking histories.

Apabetalone, a BET inhibitor, attenuates inflammation induced by viral RNA mimetic and reduces SARS-CoV-2 spike protein binding regardless of variants

Background/Introduction

Hyperinflammatory responses to SARS-CoV-2 can cause myocarditis and cardiac dysfunction including congestive heart failure [1]. SARS-CoV-2 RNA induces type I interferon (IFN-I), activating IFN regulatory factors (IRFs) and downstream IFN stimulated genes (ISGs) to initiate inflammatory processes. SARS-CoV-2 variants may develop immune escape, undercutting benefits of vaccinations. These challenges highlight the need of variant-independent therapies to improve COVID-19 outcomes. Apabetalone is an epigenetic BD2-selective BET inhibitor in phase 3 trials for cardiovascular disease [2]. Apabetalone has the potential to treat COVID-19. It counters inflammatory signals caused by cytokine storm (CS), preventing cardiac dysfunction associated with severe COVID-19 symptoms in cardiac organoids [3]. It also downregulates angiotensin-converting enzyme 2 (ACE2) expression, the main host cell receptor for SARS-CoV-2 spike protein thus impeding propagation of wild-type SARS-CoV-2 [3,4].

Purpose

1) Evaluate apabetalone's effect on inflammatory processes induced by viral-RNA mimetic in human lung cells; 2) Assess apabetalone's ability to prevent binding of the highly contagious delta variant spike protein to human lung cells.

Methods

Inflammatory gene expression was examined by real-time PCR in apabetalone treated human bronchial epithelial cells (Calu-3) stimulated with poly I:C, a well-accepted viral RNA mimetic that elicits inflammatory signals similar to SARS-CoV-2 RNA [5]. Binding of SARS-CoV-2 delta or wild-type spike protein to apabetalone treated Calu-3 cells was determined by flow cytometry.

Results

In Calu-3 cells, apabetalone dose-dependently downregulated poly I:C induced transcription of key COVID-19 associated cytokines (IL6, CXCL10, CCL2) to a similar extent as baricitinib (up to 86%, p<0.0001), an anti-inflammatory agent in emergency use for COVID-19 treatment. Moreover, apabetalone but not baricitinib diminished IL1B mRNA levels (up to 66%, p<0.0001). Apabetalone and baricitinib opposed poly I:C induced expression of IFNB1 (an IFN-I), IRF1 and IRF9 (upstream regulators) as well as IFIT1 and IFIT2 (downstream ISGs that regulate CXCL10 expression; up to 90%, p<0.0001). Clinically relevant doses of apabetalone did not alter expression of anti-viral IFITM2, an ISG that blocks SARS-CoV-2, particularly omicron, endosomal entry [6]. Therefore, apabetalone counters the expression of inflammatory factors with roles in CS and IFN-I signaling in response to poly I:C. Additionally, apabetalone reduced delta and wild-type spike protein binding to unstimulated Calu-3 cells (up to 72%, p<0.0001).

Conclusions

Apabetalone's dual anti-viral and anti-inflammatory mechanism positions it as a variant-independent COVID-19 therapeutic. Together with an established safety profile from >2000 treatment-years with apabetalone, the data provide rationale for an ongoing clinical trial (NCT04894266) which includes analysis of cardiac damage.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Resverlogix Corp

Lawson Criterion for Ignition Exceeded in an Inertial Fusion Experiment

For more than half a century, researchers around the world have been engaged in attempts to achieve fusion ignition as a proof of principle of various fusion concepts. Following the Lawson criterion, an ignited plasma is one where the fusion heating power is high enough to overcome all the physical processes that cool the fusion plasma, creating a positive thermodynamic feedback loop with rapidly increasing temperature. In inertially confined fusion, ignition is a state where the fusion plasma can begin "burn propagation" into surrounding cold fuel, enabling the possibility of high energy gain. While "scientific breakeven" (i.e., unity target gain) has not yet been achieved (here target gain is 0.72, 1.37 MJ of fusion for 1.92 MJ of laser energy), this Letter reports the first controlled fusion experiment, using laser indirect drive, on the National Ignition Facility to produce capsule gain (here 5.8) and reach ignition by nine different formulations of the Lawson criterion.

Exploring the hypothetical impact of flavored cigar sales restrictions among black young adult cigar smokers: a semi-structured in-depth interview investigation

This study assessed the hypothetical impact of flavored cigar sales restrictions on cigar smoking among Black young adult cigar smokers (ages 21-29). Forty in-depth interviews were conducted in 2020. Interviews were independently coded and analyzed using thematic analysis. When asked how they would smoke cigars given a flavor sales restriction, half of participants reported they would smoke in the same way, a third would stop or reduce smoking, and a few were unsure of what they would do. Cigar smoking outcome expectancies, preference for flavors, and perceived addictiveness of cigar products may predict cigar smoking change given flavor sales restrictions.

SP7.7 Open Appendicectomy Confidence and Experience Study (OACES): a multicentre survey of UK non-consultant grade surgeons

Aims

Minimally invasive technique has eclipsed open in most cases, and reserved only when clinically necessary. However, surgeons must remain able to employ and deploy open technique at will with efficacy. This study aims to assess non-consultant grade surgeons’ confidence and experience to perform open appendicectomy.

Methods

Retrospective cohort study via digital survey consisting of 14 questions distributed to non-consultant grade surgeons in 3 UK deaneries and a professional surgery association.

Results

40 responses ranging from CT1 to ST8 surgeons below consultant totalling 431 cases. 55% respondents disagreed to strongly disagreed they felt confident to perform open appendicectomy independently. 32.5% respondents agreed to strongly agreed they were confident to convert from laparoscopic to open appendicectomy independently if required. Table 1 summarises open and laparoscopic appendicectomy quantitative experience.

Conclusion

Laparoscopic overwhelmingly exceeds open appendicectomy confidence and experience amongst the cohort of trainee surgeons. The majority have not assisted or performed open appendicectomy, and those that have constitute low single digit case numbers. This may translate into lower ability to perform open appendicectomy when required. The decline in open experience and confidence could continue increase as the minimally invasive uptrend continues. Programme directors and trainers should be aware of this phenomenon to safeguard training to mitigate lack of confidence and experience, as this could jeopardise future surgical patient care and safety.

Blood T-cell profiling in metastatic melanoma patients as a marker for response to immune checkpoint inhibitors combined with radiotherapy

BACKGROUND

The addition of stereotactic ablative radiotherapy (SABR) to immune checkpoint inhibitors (ICIs) has the potential to significantly improve outcomes in the treatment of metastatic melanoma. We analysed peripheral blood immune cells of patients receiving combination SABR and ICI to detect the effect of treatment and identify potential biomarkers that predict outcome.

METHODS

24 polymetastatic melanoma patients participated in the SABR IMPACT trial, receiving standard dose immunotherapy with anti-PD-1 and/or anti-CTLA-4 and stereotactic ablative radiotherapy to one site. Comprehensive immunophenotyping of T-cells was performed with flow cytometry on blood samples from 13 patients at baseline and following the first 4 cycles of treatment.

RESULTS

Following four cycles of immunotherapy and SABR, the proportion of naïve subsets were reduced within both the CD4 and CD8 T-cell lineages. Independently, SABR resulted in increased expression of PD-1 (p = 0.019) and ICOS (p = 0.046) on the CD8+ T-cells, accompanied by a reduction in regulatory T-cell frequencies (p = 0.048). A multivariate discriminant analysis revealed a baseline signature of lower levels of CD8+ naive T-cells and higher expression of TIM-3 on regulatory T-cells and memory T-cells better predicted response.

CONCLUSION

The combination of immunotherapy and SABR changed the immunophenotype of blood T cells, with some shifts attributable to SABR. Importantly, we identified a T-cell signature at baseline that best predicted response. Validation of these findings in an independent cohort could confirm these as biomarkers at baseline or early during treatment, and whether these can be utilised to stratify patients for high or low intensity treatment to reduce toxicity.

Oncogenic ZMYND11-MBTD1 fusion protein anchors the NuA4/TIP60 histone acetyltransferase complex to the coding region of active genes

A recurrent chromosomal translocation found in acute myeloid leukemia leads to an in-frame fusion of the transcription repressor ZMYND11 to MBTD1, a subunit of the NuA4/TIP60 histone acetyltransferase complex. To understand the abnormal molecular events that ZMYND11-MBTD1 expression can create, we perform a biochemical and functional characterization comparison to each individual fusion partner. ZMYND11-MBTD1 is stably incorporated into the endogenous NuA4/TIP60 complex, leading to its mislocalization on the body of genes normally bound by ZMYND11. This can be correlated to increased chromatin acetylation and altered gene transcription, most notably on the MYC oncogene, and alternative splicing. Importantly, ZMYND11-MBTD1 expression favors Myc-driven pluripotency during embryonic stem cell differentiation and self-renewal of hematopoietic stem/progenitor cells. Altogether, these results indicate that the ZMYND11-MBTD1 fusion functions primarily by mistargeting the NuA4/TIP60 complex to the body of genes, altering normal transcription of specific genes, likely driving oncogenesis in part through the Myc regulatory network.

A systems approach discovers the role and characteristics of seven LysR type transcription factors in Escherichia coli

Although Escherichia coli K-12 strains represent perhaps the best known model bacteria, we do not know the identity or functions of all of their transcription factors (TFs). It is now possible to systematically discover the physiological function of TFs in E. coli BW25113 using a set of synergistic methods; including ChIP-exo, growth phenotyping, conserved gene clustering, and transcriptome analysis. Among 47 LysR-type TFs (LTFs) found on the E. coli K-12 genome, many regulate nitrogen source utilization or amino acid metabolism. However, 19 LTFs remain unknown. In this study, we elucidated the regulation of seven of these 19 LTFs: YbdO, YbeF, YcaN, YbhD, YgfI, YiaU, YneJ. We show that: (1) YbdO (tentatively re-named CitR) regulation has an effect on bacterial growth at low pH with citrate supplementation. CitR is a repressor of the ybdNM operon and is implicated in the regulation of citrate lyase genes (citCDEFG); (2) YgfI (tentatively re-named DhfA) activates the dhaKLM operon that encodes the phosphotransferase system, DhfA is involved in formate, glycerol and dihydroxyacetone utilization; (3) YiaU (tentatively re-named LpsR) regulates the yiaT gene encoding an outer membrane protein, and waaPSBOJYZU operon is also important in determining cell density at the stationary phase and resistance to oxacillin microaerobically; (4) YneJ, re-named here as PtrR, directly regulates the expression of the succinate-semialdehyde dehydrogenase, Sad (also known as YneI), and is a predicted regulator of fnrS (a small RNA molecule). PtrR is important for bacterial growth in the presence of l-glutamate and putrescine as nitrogen/energy sources; and (5) YbhD and YcaN regulate adjacent y-genes on the genome. We have thus established the functions for four LTFs and identified the target genes for three LTFs.

EPCO-12. STING IS SILENCED IN GBM BY PROMOTER METHYLATION THAT IS ESTABLISHED BY TISSUE OF ORIGIN

STING (Stimulator of interferon genes) is an initiator of endogenous antitumor immunity. Loss of STING expression has been observed in various cancer types. Here we describe a mechanism of STING suppression that is common to brain tumors, occurring through regional promoter hypermethylation (RPH) near its transcriptional start site. The RPH-mediated suppression of STING expression is selective to normal brain and neuroectoderm-derived tumors, but not present in most other tumor types and cells in the brain tumor microenvironment. A pan-cancer comparison revealed that STING RPH levels in tumors correlate with the respective tissue of origin, including tumors metastasizing to the brain. We demonstrate that STING RPH suppression in glioma cells may be reversed by treatment with decitabine, a DNA methyltransferase inhibitor that is used in the treatment of hematologic malignancies. Collectively, our results suggest that the epigenetic silencing of STING occurs early in brain development and may provide an immunosuppressive context for the genesis of brain tumors. Furthermore, our findings that STING suppression in brain tumor cells can be reversed by epigenetic modulation have significant therapeutic implications for the treatment of glioblastoma and potentially other STING-silenced, immunologically-cold cancers.

EP.TH.860Audit to review the post-operative blood transfusion rate in open hernia repairs in order to reduce the number of pre-operative Group and Save Tests obtained

Aims

Open hernia repair is a common elective and emergency surgical procedure. The majority of hernia repairs are performed without complications. Current dogma dictates 2 pre-operative group and save tests must be obtained prior to hernia repair. Post-operative haemorrhage is rare and there is equipoise as to whether all patients must be group and saved pre-operatively.

Methods

Retrospective review of electronic patient records between April 2018 to March 2019 in a large district general hospital. Cross referencing of operative, blood transfusion and blood science records was performed.

Results

410 open hernia repairs including inguinal, femoral and all other abdominal wall hernias were performed. The hernia repairs were elective and emergency procedures with patients ASA 1 - 5.

A total of 820 pre-operative group and save test were obtained with a total cost of £7,978.60. The post-operative blood transfusion rate was 1.46%.

Conclusions

A large number of open hernia repairs were performed over a 12-month period with a very low post-operative blood transfusion rate. This small single centre study indicates that many pre-operative group and save tests may be unnecessary as the majority of hernia repairs were performed without post-operative blood transfusion. Abolishing unnecessary group and save tests could reduce clinical and financial burden without compromising patient safety. The study also suggests that a selective group and save policy be instituted for certain patient characteristics such as emergency repair, ASA ≥3 or abdominal wall reconstruction for incisional hernia. A selective group and save policy will be implemented and re-audit in 6 months.

EP.TH.109Full cycle audit reviewing the post-operative blood transfusion rate in open hernia repairs in order to reduce the number of pre-operative Group and Save Tests required: an aid to rational resource utilisation of finite resources during the COVID-19 pandemic

Aims

Open hernia repairs are common elective and emergency surgical procedures; the majority are performed without complication. A primary audit indicated pre-operative group and save could be disregarded without compromising safety. A selective group and save policy was introduced, and safety of this approach examined with a 2^nd cycle audit.

Methods

Retrospective review of electronic patient records between October 2019 to September 2020. Cross referencing of operative and blood transfusion records performed compared to the primary audit cycle of April 2018 to March 2019.

Results

A total of 225 open hernia repairs including inguinal, femoral and all other abdominal wall hernias were performed during the 2^nd cycle compared to 410 in the 1^st cycle. Patients were ASA 1-5 including emergencies.

The post-operative blood transfusion rate was reduced from 1.46% to 0% following implementation of the selective policy. The number of pre-operative group and saves obtained reduced to 117; saving £6,840.19.

Conclusions

This single centre full cycle audit indicates pre-operative group and save tests are unnecessary in open hernia repair. A selective group and save policy introduced for certain patient characteristics such as emergency repair, ASA ≥3 or abdominal wall reconstruction reduced the post-operative blood transfusion rate to 0%.

Discontinuing mandatory pre-operative group and save is a safe approach synchronously reducing clinical and financial burden. COVID-19 has stretched already limited resources, resulting in reduced surgical services and diminished case numbers during the 2^nd cycle. Therefore, rational resource utilisation with a selective group and save policy maintains patient safety during the pandemic.

Reduction in the risk of MACE with apabetalone in patients with recent acute coronary syndrome and diabetes according to NAFLD fibrosis score: exploratory analysis of the BETonMACE trial

Background/Introduction

Both major adverse cardiovascular events (MACE) and non-alcoholic fatty-liver disease (NAFLD) are highly prevalent in patients with high BMI and long-standing type 2 diabetes (T2DM). NAFLD is characterized by an augmented hepatic inflammation and fat deposition and is strongly associated with metabolic syndrome. Patients with NAFLD are at an increased risk of cardiovascular (CV) events, and MACE is the leading cause of death for patients with NAFLD. Apabetalone (APB) is a novel selective inhibitor of bromodomain and extra-terminal (BET) proteins, epigenetic regulators of gene expression. In the Phase 3 BETonMACE trial treatment of 2,425 T2DM patients post ACS with APB, resulted in hazard ratios (HR) of 0.82 (p=0.11) for the primary endpoint of ischemic MACE (CV death, non-fatal MI or stroke) and 0.59 (p=0.03) for the secondary endpoint of heart failure hospitalization (HFH) vs placebo (PBO). Transient elevations of alanine aminotransferase greater than 5xULN occurred in 3.3% of APB treated patients.

Purpose

In this exploratory post hoc analysis of BETonMACE we evaluated risk modification for a composite of MACE+HFH by APB based on the Angulo NAFLD fibrosis score (FS) using 6 variables (age, BMI, hyperglycemia/diabetes, AST/ALT ratio, platelet count, and albumin). The NAFLD FS categorizes individuals into groups that correlate with differing levels of fibrosis in biopsy studies: (FS F0-F2, no significant fibrosis; FS ID, indeterminant; and FS F3-F4, significant fibrosis).

Methods

Baseline characteristics and blood measurements were used to determine NAFLD FS at baseline. The incidence of MACE+HHF was compared between treatment groups.

Results

Based on FS, there were 618 pts were classified as FS F0-F2 (n=328 APB, n=290 PBO), 1,440 pts were classified as FS ID (n=708 APB, n=732 PBO) and 289 pts were classified as FS F3-F4 (n=144 APB, n=145). MACE+HHF in the PBO group was higher in FS ID and FS F3-F4 compared to FS F0-F2 (17.2% vs 15.0% vs 9.7%) and therefore the former two groups were combined into an elevated risk FS+ group. FS+ pts were older (63 vs 56), had longer duration of T2DM (9.0 vs 7.3 yrs), and higher BMI (30.8 vs 28.6) compared to FS- pts. Overall, APB was associated with fewer MACE+HHF (HR 0.78, 95% CI 0.60–1.01, p=0.06) compared to PBO in the FS+ pts with adjustment for age, duration of T2DM and BMI.

Conclusions

Patients with T2DM and ACS may share common risk factors with patients with NAFLD. Apabetalone appears to exert a favorable effect on MACE in patients with risk factors for NAFLD. Whether apabetalone has a modulatory effect on the development and progression of NAFLD is an important question requiring further investigation.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Resverlogix Corp.

Enabling Lithium Metal Anode in Nonflammable Phosphate Electrolyte with Electrochemically Induced Chemical Reactions

Lithium metal anode holds great promises for next-generation battery technologies but is notoriously difficult to work with. The key to solving this challenge is believed to lie in the ability of forming stable solid-electrolyte interphase (SEI) layers. To further address potential safety issues, it is critical to achieve this goal in nonflammable electrolytes. Building upon previous successes in forming stable SEI in conventional carbonate-based electrolytes, here we report that reversible Li stripping/plating could be realized in triethyl phosphate (TEP), a known flame retardant. The critical enabling factor of our approach was the introduction of oxygen, which upon electrochemical reduction induces the initial decomposition of TEP and produces Li₃ PO₄ and poly-phosphates. Importantly, the reaction was self-limiting, and the resulting material regulated Li plating by limiting dendrite formation. In effect, we obtained a functional SEI on Li metal in a nonflammable electrolyte. When tested in a symmetric Li∥Li cell, more than 300 cycles of stripping/plating were measured at a current density of 0.5 mA cm^-2 . Prototypical Li-O₂ and Li-ion batteries were also fabricated and tested to further support the effectiveness of this strategy. The mechanism by which the SEI forms was studied by density functional theory (DFT), and the predictions were corroborated by the successful detection of the intermediates and products.

P24 Audit reviewing viability of removing pre-operative Group and Save Tests prior to Transurethral Prostate Surgery during the COVID19 pandemic

Introduction

COVID19 has stressed and stretched healthcare resources to the limit, thus the rational deployment of any resource should be necessary and of patient benefit. This retrospective audit aims to ascertain if a policy of two valid group and save tests prior to transurethral prostate surgery is necessary and if this resource can be redistributed safely during the ongoing pandemic.

Methods

A retrospective review of electronic patient records for patients that underwent transurethral prostate surgery from June 2017 to June 2018. During a single admission for surgery it was identified how many pre-operative group and save tests, and if a post-operative blood transfusion patients underwent.

Results

146 patients underwent transurethral prostate surgery between June 2017 to June 2018.

97 patients had two valid group and save tests prior to surgery. 49 patients did not have 2 valid group and save tests. 21 patients had expired tests, 20 had only one valid sample, and 8 had no group and save test at all.

No patient underwent a blood transfusion during their admission for transurethral prostate surgery.

Conclusion

This single centre study illustrates pre-operative group and save tests before transurethral prostate surgery are unnecessary as no patient required an associated blood transfusion during admission; and can safely be omitted. The clinical time and resource could be redirected elsewhere for greater patient benefit. £2855.00 of efficiency savings could be made foregoing unneeded group and save tests.

A policy omitting pre-operative group and save before transurethral prostate surgery will be implemented under COVID19 pandemic conditions and re-audited in 6 months.

Clinical features and outcomes of adults with coronavirus disease 2019: A systematic review and pooled analysis of the literature

BACKGROUND

The 2019 coronavirus disease (COVID-19) has become a global pandemic and the published literature describing the virus has grown exponentially.

METHODS

We conducted a systematic review of the literature to identify the symptoms, comorbidities present, radiological features and outcomes for adults testing positive for COVID-19 admitted to hospital. The results across multiple studies were numerically pooled to yield total estimated.

RESULTS

A total of 45 studies were included in this review with 14 358 adult participants (average age 51 years, male 51%). The pooled findings suggest that the most common symptom among patients was fever (81.2%) followed by cough (62.9%), fatigue (38.0%) and anorexia/loss of appetite (33.7%). The comorbidities that were most prevalent among patients with the virus were hypertension (19.1%), cardiovascular disease (17.9%), endocrine disorder (9.3%) and diabetes (9.2%). Abnormal chest X-ray findings were present in 27.7% of patients and ground-glass opacity was demonstrated on chest computerized tomography in 63.0% of patients. The most frequent adverse outcomes were acute respiratory distress syndrome (27.4%), acute cardiac injury (16.2%) and acute kidney injury (12.6%). Death occurred in 8.2% of patients and 16.3% required intensive care admission and 11.7% had mechanical ventilation. Bacterial or secondary infections affected 8.5% of patients and 6.9% developed shock.

CONCLUSIONS

COVID-19 most commonly presents with fever, cough, fatigue and anorexia and among patients with existing hypertension and cardiovascular disease. It is important as serious adverse outcomes can develop such as acute respiratory distress syndrome, acute cardiac injury, acute kidney injury and death.

A comparative study of experimental urinary catheters containing silver and zinc for biofilm inhibition

Both commercial and experimental antibacterial urinary catheters were investigated for their efficacy in preventing planktonic growth and biofilm formation of Escherichia Coli bacteria in a synthetic urine solution. Experimental antibacterial catheters having thin (<500 µm) dispersions of Ag, Ag/Ag₂O, or Zn/Ag₂O in polydimethylsiloxane (PDMS) binder all exhibited significant antimicrobial activity, outperforming traditional commercial antibacterial catheters. All experimental catheters prevented planktonic growth of bacteria and did not exhibit biofilm formation during a six-day test period using a colony forming unit (CFU) measurement method. On the other hand, the best performing commercial catheters demonstrated efficacy for only 3 days in planktonic growth tests and formed multiple bacterial colonies in CFU measurements. The Zn/Ag₂O/PDMS experimental catheter was the only catheter observed to produce hydrogen peroxide, a reactive oxygen species known to inhibit biofilm formation; lack of detectable hydrogen peroxide production by the Ag₂O/PDMS and Ag/Ag₂O/PDMS experimental catheters suggests that bactericidal action most likely arises from release of silver ions present in the PDMS coatings.

Methods to disinfect and decontaminate SARS-CoV-2: a systematic review of in vitro studies

BACKGROUND

Cleaning is a major control component for outbreaks of infection. However, for the SARS-CoV-2 pandemic, there is limited specific guidance regarding the proper disinfection methods that should be used.

METHODS

We conducted a systematic review of the literature on cleaning, disinfection or decontamination methods in the prevention of SARS-CoV-2.

RESULTS

A total of 27 studies were included, reporting a variety of methods with which the effectiveness of interventions were assessed. Virus was inoculated onto different types of material including masks, nasopharyngeal swabs, serum, laboratory plates and simulated saliva, tears or nasal fluid and then interventions were applied in an attempt to eliminate the virus including chemical, ultraviolet (UV) light irradiation, and heat and humidity. At body temperature (37°C) there is evidence that the virus will not be detectable after 2 days but this can be reduced to non-detection at 30 min at 56°C, 15 min at 65°C and 2 min at 98°C. Different experimental methods testing UV light have shown that it can inactivate the virus. Light of 254-365 nm has been used, including simulated sunlight. Many chemical agents including bleach, hand sanitiser, hand wash, soap, ethanol, isopropanol, guandinium thiocynate/t-octylphenoxypolyethoxyethanol, formaldehyde, povidone-iodine, 0.05% chlorhexidine, 0.1% benzalkonium chloride, acidic electrolysed water, Clyraguard copper iodine complex and hydrogen peroxide vapour have been shown to disinfect SARS-CoV-2.

CONCLUSIONS

Heating, UV light irradiation and chemicals can be used to inactivate SARS-CoV-2 but there is insufficient evidence to support one measure over others in clinical practice.

Assessing the Safety of a Cell-Based Immunotherapy for Brain Cancers Using a Humanized Model of Hematopoiesis

Despite a surge in the preclinical development of immunotherapies, current models are unable to predict putative toxicity, particularly the "on-target, off-tumor" effects of these therapeutics. To address this gap, we used a humanized mouse model of hematopoiesis to examine the toxicity profile of CAR-Ts targeting brain tumor-antigens also expressed in the hematopoietic system. In assessing the safety of cell-based therapies, we aim to develop and integrate a preclinical evaluation protocol as a necessary step in the clinical development pathway. For complete details on the use and execution of this protocol, please refer to Vora et al. (2020).

Apabetalone, a selective BET protein inhibitor, reduces ischemic cardiovascular events and hospitalization for heart failure in patients with acute coronary syndrome and type 2 diabetes

Background

Despite established treatments, patients with type 2 diabetes mellitus (T2DM) and acute coronary syndrome (ACS) are at higher risk of ischemic cardiovascular (CV) events and hospitalization for heart failure (HHF) compared to those without T2DM. LDL-C lowering or use of GLP-1 agonists predominantly affects ischemic CV events, with little effect on HHF. Conversely, treatment with SGLT-2 inhibitors reduces HHF, with less effect on ischemic CV events. Preclinical studies indicate that bromodomain and extra-terminal (BET) proteins coordinate gene transcription for pathways that promote atherothrombotic events as well as heart failure. We assessed the clinical effect of apabetalone (APB), a novel BET protein inhibitor, on a composite of non-fatal ischemic CV events, HHF, and CV death in a post hoc analysis of the BETonMACE trial

Methods

BETonMACE was a double-blind, placebo-controlled phase 3 study in patients with T2DM and recent acute coronary syndrome receiving standard of care risk factor management. In 13 countries, 2425 patients were enrolled. We conducted a time-to-event analysis for first adjudicated CV death or non-fatal MI, stroke, or HHF using a log-rank test and Cox proportional hazards model.

Results

At baseline median age was 62 years, 25.6% were female, 87.6% white, and use of high intensity statin, ACE inhibitors/ angiotensin II blockers, dual antiplatelet therapy and beta blocker were 90, 88, 92 and 91% respectively. A total of 312 subjects had an endpoint event, with 139 (11.5%) patients in the ABP group and 173 (14.3%) among PBO (HR 0.78, 95% CI 0.63–0.98, p=0.03, Figure). At 26 months, the absolute risk reduction was 3.2% and number needed to treat was 31. Numerically favorable HRs were observed for each component endpoint except for stroke (Table).

Conclusion

This present analysis suggests that BET inhibition with APB may be a novel pathway through which to reduce both HHF and ischemic CV events in high risk patients with T2DM thus impacting broader clinical outcomes with potentially large benefits for patients and healthcare systems.

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Resverlogix Corp

The Rational Development of CD133-Targeting Immunotherapies for Glioblastoma

CD133 marks self-renewing cancer stem cells (CSCs) in a variety of solid tumors, and CD133+ tumor-initiating cells are known markers of chemo- and radio-resistance in multiple aggressive cancers, including glioblastoma (GBM), that may drive intra-tumoral heterogeneity. Here, we report three immunotherapeutic modalities based on a human anti-CD133 antibody fragment that targets a unique epitope present in glycosylated and non-glycosylated CD133 and studied their effects on targeting CD133+ cells in patient-derived models of GBM. We generated an immunoglobulin G (IgG) (RW03-IgG), a dual-antigen T cell engager (DATE), and a CD133-specific chimeric antigen receptor T cell (CAR-T): CART133. All three showed activity against patient-derived CD133+ GBM cells, and CART133 cells demonstrated superior efficacy in patient-derived GBM xenograft models without causing adverse effects on normal CD133+ hematopoietic stem cells in humanized CD34+ mice. Thus, CART133 cells may be a therapeutically tractable strategy to target CD133+ CSCs in human GBM or other treatment-resistant primary cancers.

The design of a line velocity interferometer for any reflector for inertial confinement experiments on the Z-machine

A line VISAR (Velocity Interferometer System for Any Reflector) has been designed and commissioned at the Sandia National Laboratory's Z-machine. The instrument consists of an F/2 collection system, beam transport, and an interferometer table that contains two Mach-Zehnder type interferometers and an eight channel Gated Optical Imaging (GOI) system. The VISAR probe laser operates at the 532 nm wavelength, and the GOI bandpass is 540-600 nm. The output of each interferometer is passed to an optical streak camera with four selectable sweep speeds. The system is designed with three interchangeable optics modules to select a full field of view of 1 mm, 2 mm, or 4 mm. The optical beam transport system connects the target image plane to the interferometers and the gated optical imagers. The target is integrated into a sacrificial final optics assembly that is integral to the transport beamline.

Stereocontrolled Synthesis of Arylomycin-Based Gram-Negative Antibiotic GDC-5338

We report herein an efficient, stereocontrolled, and chromatography-free synthesis of the novel broad spectrum antibiotic GDC-5338. The route features the construction of a functionalized tripeptide backbone, a high-yielding macrocyclization via a Pd-catalyzed Suzuki-Miyaura reaction, and the late-stage elaboration of key amide bonds with minimal stereochemical erosion. Through extensive reaction development and analytical understanding, these key advancements allowed the preparation of GDC-5338 in 17 steps, 15% overall yield, >99 A % HPLC, and >99:1 dr.

P6151Fully automated epicardial adipose tissue volume and density measured from non-contrast CT predict major adverse cardiovascular events in asymptomatic subjects

Background

Epicardial adipose tissue (EAT) volume and density has shown to correlate with standard markers of coronary artery disease (CAD) and may predict major adverse cardiovascular events (MACE).

Purpose

We aimed to evaluate the prognostic value of EAT volume and density measured by fully automated deep-learning software from non-contrast cardiac computed tomography (CT).

Methods

We assessed 2071 consecutive asymptomatic subjects (age 56±9 years, 59% male) from the EISNER (Early Identification of Subclinical Atherosclerosis by Noninvasive Imaging Research) trial with long-term follow-up after coronary artery calcium (CAC) measurement. EAT volume and mean density were quantified using automated deep-learning software from non-contrast cardiac CT. MACE was defined as myocardial infarction (MI), cardiac death, late (>90 days) revascularization and acute coronary syndrome (ACS). EAT volume and density were systematically compared to CAC score and atherosclerotic cardiovascular disease (ASCVD) risk score using Cox proportional hazards regression for MACE prediction.

Results

At 14±3 years, 217 subjects suffered MACE. In age-and-gender-adjusted multivariate analysis, ASCVD risk score, CAC (two-fold increase) and EAT volume (two-fold increase) were associated with increased risk of suffering MACE [Hazard Ratio (HR) (95% CI): 1.03 (1.01–1.04); 1.25 (1.19–1.30); and 1.36 (1.08–1.70) respectively, p<0.01 for all] (Figure); the corresponding Harrell's C-statistic was 0.76. The area-under-the curve from receiver-operator characteristic analysis for MACE prediction increased significantly from 0.69 to 0.77 (p<0.0001) when EAT volume and CAC were added to the current clinical standard (ASCVD, family history and obesity measures BMI and BSA). Both in men and women, increase in EAT volume was associated with increased risk of MACE, with HR 1.14 (1.06–1.22), p<0.001 in men vs. 1.15 (1.01–1.31), p=0.03 in women, for each 20 cubic centimeter increase in volume. EAT density (HU) was independently inversely associated with MACE [HR: 0.96 (0.93–0.99), p=0.01].

MACE Prediction

Conclusions

EAT volume and density measurements improve prediction of MACE in asymptomatic populations over the current clinical standard. Fully automated EAT volume and density quantification by deep-learning from non-contrast cardiac CT can provide additional prognostic value for the asymptomatic patient.

Acknowledgement/Funding

1R01HL133616, Forschungsstiftung Medizin Universitätsklinikum Erlangen, grant from Dr Miriam and Sheldon G. Adelson Medical Research Foundation