Corrigendum: "A new hope" for positive psychology: a dynamic systems reconceptualization of hope theory

[This corrects the article DOI: 10.3389/fpsyg.2022.809053.].

Patients' experiences of a suppoRted self-manAGeMent pAThway In breast Cancer (PRAGMATIC): quality of life and service use results

PURPOSE

To describe trends and explore factors associated with quality of life (QoL) and psychological morbidity and assess breast cancer (BC) health service use over a 12-month period for patients joining the supported self-management (SSM)/patient-initiated follow-up (PIFU) pathway.

METHODS

Participants completed questionnaires at baseline, 3, 6, 9 and 12 months that measured QoL (FACT-B, EQ 5D-5L), self-efficacy (GSE), psychological morbidity (GHQ-12), roles and responsibilities (PRRS) and service use (cost diary).

RESULTS

99/110 patients completed all timepoints; 32% (35/110) had received chemotherapy. The chemotherapy group had poorer QoL; FACT-B total score mean differences were 8.53 (95% CI: 3.42 to 13.64), 5.38 (95% CI: 0.17 to 10.58) and 8.00 (95% CI: 2.76 to 13.24) at 6, 9 and 12 months, respectively. The odds of psychological morbidity (GHQ12 >4) were 5.5-fold greater for those treated with chemotherapy. Financial and caring burdens (PRRS) were worse for this group (mean difference in change at 9 months 3.25 (95% CI: 0.42 to 6.07)). GSE and GHQ-12 scores impacted FACT-B total scores, indicating QoL decline for those with high baseline psychological morbidity. Chemotherapy patients or those with high psychological morbidity or were unable to carry out normal activities had the highest service costs. Over the 12 months, 68.2% participants phoned/emailed breast care nurses, and 53.3% visited a hospital breast clinician.

CONCLUSION

The data suggest that chemotherapy patients and/or those with heightened psychological morbidity might benefit from closer monitoring and/or supportive interventions whilst on the SSM/PIFU pathway. Reduced access due to COVID-19 could have affected service use.

Functional Connectivity Analysis of Visually Evoked ERPs for Mild Cognitive Impairment: Pilot Study

Mild cognitive impairment (MCI) is considered the early stage of Alzheimer's disease, characterized as mild memory loss. A novel method of functional connectivity (FC) analysis can be used to detect MCI before memory is significantly impaired allowing for preventative measures to be taken. FC examines interactions between EEG channels to grant insight on underlying neural networks and analyze the effects of MCI. Applying FC method of weighted phase lag index (wPLI) to P300 ERPs provided insight on the link between the pathology of Alzheimer's disease and cognitive loss. wPLI was analyzed per frequency band (θ, α, μ, β) and by channel combination groups (intra-hemispheric short, intra-hemispheric long, inter-hemispheric short, inter-hemispheric long, transverse). MCI was found to have a statistically significant lower ΔwPLIP300 compared to normal controls in the μ intra-hemispheric short (p = 0.0286), μ intra-hemispheric long (p = 0.0477), μ inter-hemispheric short (p = 0.0018) and the α intra-hemispheric short (p = 0.0423). Results indicate a possible deficiency in the dorsal visual processing pathway among MCI subjects as well as an unbalanced coordination between the two hemispheres.

Survival and health of children who are HIV-exposed uninfected: study protocol for the CHERISH (Children HIV-Exposed Uninfected - Research to Inform Survival and Health) dynamic, prospective, maternal-child cohort study

INTRODUCTION

CHERISH is designed to establish a long-term sustainable system for measurement of in utero and postnatal exposures and outcomes in children who are HIV-exposed uninfected (HEU) and HIV-unexposed to compare survival, hospitalisation, growth and neurodevelopment in the Western Cape, South Africa.

METHODS AND ANALYSIS

During 2022-2025, the CHERISH dynamic cohort is prospectively enrolling pregnant people with and without HIV at 24-36 weeks gestation from one urban and one rural community, following mother-child pairs, including children who are HEU (target N=1200) and HIV-unexposed (target N=600) for 3 years from the child's birth. In-person visits occur at enrolment, delivery, 12 months, 24 months and 36 months with intervening 3-monthly telephone data collection. Children and mothers without HIV are tested for HIV at all in-person visits. Data on exposures and outcomes are collected from routine standardised healthcare documentation, maternal interview, measurement (growth and neurodevelopment) at in-person visits and linkage to the Western Cape Provincial Health Data Centre (survival and hospitalisation). A priori adverse birth outcomes, advanced maternal HIV and maternal mental health are considered potential mediators of outcome disparities in children who are HEU and will be evaluated as such in multivariable models appropriate for each outcome.

ETHICS AND DISSEMINATION

Mothers interested in joining the study are taken through a visual informed consent document for their and their child's participation, with the option to consent to anonymised de-identified data being contributed to a public data repository. All data is captured directly into an electronic database using alphanumeric identifiers devoid of identifying information. The cohort study is approved by Human Research Ethics Committees of Stellenbosch University (N20/08/084), University of Cape Town (723/2021) and Western Cape Government (WC_2021_09_007). Findings will be shared with participants, participating communities, local and provincial stakeholders, child health clinicians, researchers and policymakers at local, national and international forums and submitted for publication in peer-reviewed journals.

PSX-B-19 Producers’ Perception of Utilization of Reproductive Technologies in Small Cattle Herds

A multitude of assisted reproductive technologies (ART) are available to producers for the use of improving their herds production and optimizing efficiency. Nonetheless, current utilization of ART is less than 50% among cattle producers and even less amongst producers with less than 100 head of cattle. The objective of this study was to investigate what reproductive technologies small beef herd producers in Texas currently use and what affects their decision not to utilize available technologies. A 19-question survey was populated using Qualtrics. A population was asked to complete the survey via a link connected to a QR code. The survey comprised questions regarding producer demographics, herd demographics, use of reproductive technologies, and perception of available pregnancy detection methods. A total of 152 surveys were collected with a final of 122 being evaluated. Survey answers were recorded in Qualtrics. Means and frequencies of responses were calculated for each question. The usage of ART within herds, including currently implemented breeding technologies, pregnancy detection methods, and factors affecting the decision to use technologies was investigated. Of producers surveyed, 66.3% do not utilize any form of breeding technologies within their herd and instead rely on natural cover of the bull. For pregnancy detection methods, 44.35% utilize palpation while 34.68% use no form of detection. There was a numerically similar distribution of reasons for not utilizing available technologies with time (12.10%), money (8.87%), and the combination of the two (11.29%), standing above other reasons such as access to technology and information available. The results of this investigation will be utilized to implement a series of workshops available to producers. The goal of these workshops is to create an opportunity for producers to continue their education and establish a working relationship with Tarleton State University.

Increasing precision in the measurement of change in pediatric neurodegenerative disease

Due to the surge in new brain-directed treatments, metrics to detect the alteration in developmental trajectories in cognition and adaptive behavior have become increasingly important. We propose Growth Scale Values (GSVs) as a solution to monitoring children with severe neurologic/neurodegenerative conditions. This report stems from a panel of experts presenting at the Gorlin symposium (WORLD Symposium) and a subsequent open Webinar sponsored by the National MPS Society. Because norm-referenced scores (Standard Scores or Intelligence Quotient, i.e., IQ) do not yield information about gain, stability, or loss of skills, they are not suitable for natural history studies or clinical trials. Age-equivalent (AE) scores have been the standard metric used in natural history studies. While AEs are familiar and interpretable to clinicians and parents, they are imprecise due to lack of standard deviations, standard errors of measurement, and equal intervals between scores. Raw scores also have unequal intervals and are not comparable between ages or ability levels. The GSV, a nonlinear transformation of raw scores using item calibration to make an interval scale score, can be used for accurate measures of within-person change. GSVs have been identified as a useful metric for longitudinal measurement of other conditions involving neurodiversity. These growth scores circumvent inaccurate AEs in infants, are not limited by age and can be used for impaired patients who are chronologically above the normative age range. GSVs have interval properties (a given difference between GSV values represents the same difference in ability at all score levels) and each GSV value has a known standard error of measurement (SEM). GSVs are recommended to measure change in cognitive and adaptive behavior in natural history studies and in clinical trials for children with neurologic disease.

Growth and CD4 patterns of adolescents living with perinatally acquired HIV worldwide, a CIPHER cohort collaboration analysis

INTRODUCTION

Adolescents living with HIV are subject to multiple co-morbidities, including growth retardation and immunodeficiency. We describe growth and CD4 evolution during adolescence using data from the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER) global project.

METHODS

Data were collected between 1994 and 2015 from 11 CIPHER networks worldwide. Adolescents with perinatally acquired HIV infection (APH) who initiated antiretroviral therapy (ART) before age 10 years, with at least one height or CD4 count measurement while aged 10-17 years, were included. Growth was measured using height-for-age Z-scores (HAZ, stunting if <-2 SD, WHO growth charts). Linear mixed-effects models were used to study the evolution of each outcome between ages 10 and 17. For growth, sex-specific models with fractional polynomials were used to model non-linear relationships for age at ART initiation, HAZ at age 10 and time, defined as current age from 10 to 17 years of age.

RESULTS

A total of 20,939 and 19,557 APH were included for the growth and CD4 analyses, respectively. Half were females, two-thirds lived in East and Southern Africa, and median age at ART initiation ranged from <3 years in North America and Europe to >7 years in sub-Saharan African regions. At age 10, stunting ranged from 6% in North America and Europe to 39% in the Asia-Pacific; 19% overall had CD4 counts <500 cells/mm3 . Across adolescence, higher HAZ was observed in females and among those in high-income countries. APH with stunting at age 10 and those with late ART initiation (after age 5) had the largest HAZ gains during adolescence, but these gains were insufficient to catch-up with non-stunted, early ART-treated adolescents. From age 10 to 16 years, mean CD4 counts declined from 768 to 607 cells/mm3 . This decline was observed across all regions, in males and females.

CONCLUSIONS

Growth patterns during adolescence differed substantially by sex and region, while CD4 patterns were similar, with an observed CD4 decline that needs further investigation. Early diagnosis and timely initiation of treatment in early childhood to prevent growth retardation and immunodeficiency are critical to improving APH growth and CD4 outcomes by the time they reach adulthood.

"A New Hope" for Positive Psychology: A Dynamic Systems Reconceptualization of Hope Theory

In this review of the central tenets of hope theory, we examine the meta-theoretical, theoretical, and methodological foundations of the literature base. Our analysis moves from a broad examination of the research landscape in hope theory across disciplines, to a deeper investigation of the empirical literature in university students. This review highlights the significant impact of this body of research in advancing our understanding of aspects of thriving characterized by hope. However, we also evidence several limitations that may impede the advancement of the next wave of growth in this field. To address these limitations, we argue for an interdisciplinary approach to expanding the meta-theoretical, theoretical, and methodological horizons, enabling a more dynamic systems approach to the study of hope. Drawing on the intersection of positive psychology with systems thinking, we describe a methodological approach that enables a deeper examination of the processes and interactions through which hope emerges, using an analysis of the lived experience of young people. It is proposed that this research agenda will bring to life an alternate story about the resourcefulness of our youth through their own voice, enabling us to leverage this in the design of more effective strategies to facilitate hope in the future. This research agenda provides a roadmap that will provide alternative methodologies that address the current limitations in the field of hope research and, importantly, can provide fuel to spur on the acceleration of the next wave of research and practice in the field of positive psychology more broadly.

A comparison of ultrasound guided bilateral single injection shot Erector Spinae Plane blocks versus wound infiltration for post-operative analgesia in laparoscopic assisted colonic surgery- a prospective randomised study

Background

Both wound infiltration (WI) with local anaesthetic and Erector Spinae Plane block (ESPB) have been described for post-operative analgesia after abdominal surgery. This study compared the efficacy of WI versus ESPB for post-operative analgesia after laparoscopic assisted colonic surgery.

Methods

Seventy-two patients between 18 and 85 years of age undergoing elective surgery were randomised to receive either WI or ESPB. In the WI group a 40 ml bolus of 0.5% Ropivacaine, infiltrated at the ports and minimally invasive wound at subcutaneous and fascia layers. In the ESPB group at T8 level, under ultrasound guidance, a 22-gauge nerve block needle was passed through the Erector Spinae muscle to reach its fascia. A dose up to 40 ml of 0.5% Ropivacaine, divided into two equal volumes, was injected at each side. Both groups had a multimodal analgesic regime, including regular Paracetamol, dexamethasone and patient-controlled analgesia (PCA) with Fentanyl. The primary end point was a post-operative pain score utilising a verbal Numerical Rating Score (NRS, 0–10) on rest and coughing in the post anaesthetic care unit (PACU) and in the first 24 h. Secondary outcomes measured were: opioid usage, length of stay and any clinical adverse events.

Results

There was no significant treatment difference in PACU NRS at rest and coughing (p-values 0. 382 and 0.595respectively). Similarly, there were no significant differences in first 24 h NRS at rest and coughing (p-values 0.285 and 0.431 respectively). There was no significant difference in Fentanyl use in PACU or in the first 24 h (p- values 0.900 and 0.783 respectively). Neither was there a significant difference found in mean total Fentanyl use between ESPB and WI groups (p-value 0.787).

Conclusion

Our observations found both interventions had an overall similar efficacy.

Trial registration

The study was registered with the Australian New Zealand Clinical Trial Registry (ACTRN: 12619000113156).

Process evaluation of We Can Quit- stop-smoking programme for women in socio-disadvantage in Ireland

Background

Smoking tobacco poses a serious risk of early preventable death and disease for women living with socioeconomic disadvantage (SED). A smoking cessation programme ‘We Can Quit' (WCQ) tailored to women living in four SED areas developed in Ireland included group support delivered by trained lay local women and free nicotine replacement therapy (NRT). The intervention was pilot tested in a community-based, cluster randomised controlled trial, ‘We Can Quit 2'. Results of an embedded process evaluation to assess feasibility and acceptability of the programme and trial processes are presented.

Methods

The design was qualitative using the Medical Research Council's (MRC) process evaluation framework. Semi-structured interviews with trial participants (N = 18) and Community Facilitators (CFs) who delivered WCQ (N = 8) were conducted. An inductive approach was used and data were analysed using thematic coding.

Results

Peer-modelling, a non-judgemental environment, and CFs supportive role were viewed as facilitative elements of group support. Potential for broader message diffusion into the social networks of participating women was observed. Participants reported that free access to NRT was helpful for cessation. Some participants expressed concerns about NRT side effects. Community pharmacists provided important guidance relating to NRT and additional support between group sessions. Provision of a saliva samples proved challenging. Low literacy was a barrier to engagement with the programme and completion of trial-related materials. Hypothetical scenarios of direct or indirect observational fidelity assessment for a definitive trial (DT) were acceptable.

Conclusions

The MRC framework proved useful to capture the experience of women smokers in SED areas of engaging with a community-based smoking cessation trial. Programme and trial-related processes were feasible and acceptable. A future DT will need to address low literacy.

Key messages

A group-based stop-smoking programme including free NRT was acceptable and feasible to programme deliverers and women smokers living in disadvantaged communities. Women’s low literacy was a barrier to engagement with trial and completion of programme materials.

1161 Streamlining the Patient Journey for Operative Management During COVID 19

Aim

Leeds, UK is a high-volume acute surgery unit. Emergency operating was drastically affected by the pandemic and time from admission to definitive procedure significantly increased. This intervention aimed to streamline the patient journey from acute admission to the operating theatre.

Method

An audit considering delays to transfer, theatre access and recovery discharge, along with the criteria used for ‘Hot’ theatre was undertaken. Data was collected prospectively between 02/06/2020-06/07/2020 via a standardised proforma. Preliminary results suggested a geographically remote ‘hot’ theatre was associated with multi-factorial delays so was relocated to more familiar surroundings. This was re-audited between 06/07/2020-06/08/2020 aiming to characterise factors contributing to delay. A dedicated in-hours acute theatres porter was introduced for a trial period. Data was collected retrospectively between 24/08/2020-14/09/2020 and prospectively between 14/09-05/10/2020 via hospital electronic systems.

Results

Initially the average time from patient transfer to leaving theatre recovery was 4h6m55s (N = 52). Relocating theatres reduced this to 2h48m04s (N = 74)- an average reduction of 1h18m51s. The greatest reduction was seen in anaesthetic time between 1h17m54s to 41m29s. The introduction of a dedicated porter reduced the average transfer time to theatre from 36 minutes (N = 53) to 21 minutes (N = 68) (p &lt; 0.05).

Conclusions

Delay to theatre has a high cost financially and in its effect on patient outcomes. Delays are often multifactorial and robust systems are essential to minimise delays. Patients are best served by well-trained, dedicated ‘Acute’ team in familiar surroundings. Long-term implementation of dedicated portering service will save time, money and improve patient care.

616 Preventing Biofilms on BACTIGON® Coated Camstent Urinary Catheters in Patients Undergoing Elective Colorectal Surgery: A Single Centre Pilot Study

Introduction

Catheter associated urinary tract infections account for 40% of hospital acquired infections. They are associated with biofilms consisting of bacterial cells enmeshed in a self-generated extracellular matrix adhering to catheter surfaces. We have developed a novel polymer family that, coated onto urinary catheters, creates a “non-stick” surface preventing biofilm development.

Method

Prospective cohort of elective colorectal patients recruited pre-operatively, received a standard silicone (SS) or Camstent (BACTIGON®) coated urinary catheter. After removal, catheters were cut longitudinally into 3 segments. Biomass and biomineralisation were analysed using confocal fluorescence microscopy. Data were normalised by square rooting the catheter indwelling duration. Environmental scanning electron microscopy and energy dispersive x-ray spectroscopy was performed.

Results

Of 40 patients, 20 each received a SS or coated catheter. Between SS and coated catheters, average indwelling duration was similar and biofilm biomass was 32.068µg/cm2 (95%CI ±21.950) vs. 1.948µg/cm2 (95%CI ±2.595) (P = 0.0111). Confocal microscopy suggested a 93.93% reduction in biofilm biomass on coated catheters. Mineral compositions were different with biofilm and struvite/apatite on SS and calcium oxalate, endogenously derived, on coated catheters.

Conclusions

Inert BACTIGON® coated catheters appear superior at preventing biofilm formation than SS catheters. Clinical trials are needed to determine the clinical and health economic benefit of this intervention.

Astropharmacy: Exploring the Pharmacist’s Role in Space travel

Introduction

Significant alterations occur in human physiology and the way medications function in space (1). Understanding the efficacy and pitfalls of pharmacological intervention and developing space-related pharmacy services is therefore integral to ensuring a sustained presence for human spaceflight. In contemporary society, the pharmacist plays a significant role in a person’s health. However, pharmacist input towards the spaceflight participant’s health is minimal to nil.

Aim: T

o explore stakeholder perspectives towards the role of Astropharmacy in the space sector.

Methods

Pharmacists (n = 18) across the globe and space sector participants (n = 18) from governmental, commercial, and space tourism sectors participated, via 27 qualitative interviews and three focus groups. Participants were recruited via purposive and snowball sampling. A six-step thematic analysis was used and mapped into the Job Characteristics Model (JCM). JCM is a theory within work design, aiming to promote work experiences and personal outcomes. There are five job dimensions – skill variety, task identity, task significance, autonomy, and feedback which influence three psychological states required for a well-designed job. The three psychological states are meaningfulness, responsibility, and knowledge of work results, which lead to positive work and personal experiences (2).

Results

Three key themes were generated: medication management, medication research, and regulation/licensing. Medication management encompassed safeguarding the space traveller’s health, like space tourists, by conducting medication reviews (pre-and post-flight), medication advice (digital astro-telepharmacy information services during spaceflight) and developing personalised medication. Medication management also included ensuring shelf-life and continuous medication supply for deep space exploration. Medication research included novel drug development, innovative manufacturing, and understanding clinical applications of the pharmacokinetic and pharmacodynamic changes of medications in space. Innovative manufacturing like 3-D printing raises questions regarding the need for regulations/licensing of medications use and manufacturing in space. Based on the JCM our findings indicate that Astropharmacy possesses diverse duties eliciting meaningfulness, with clear responsibility and observable workplace results promoting task significance, and both the medication and patient focus promoting task identity. Autonomy was blurred within Astropharmacy as a degree of autonomy is needed due to the field’s novelty, but workforce regulations by governmental space agencies are expected. Lastly, workplace feedback can be achieved in Astropharmacy through performance reviews.

Conclusion

The Astropharmacy role is perceived to involve medication management, medication research and regulation/licensing of medications for space. The work design of astropharmacy is well-reflected in the JCM, implying that a novel and energising opportunity for the pharmacy profession is forthcoming. Although the data generated by qualitative research are not generalizable to other settings, these themes represent the first study to investigate the space sector qualitatively in the context of pharmacy, providing rich foundational data for future research. Consequently, the amalgamation of two previously distinct workplace domains may be a conceivable reality for the future of pharmacy practice.

References

1. Blue RS, Bayuse TM et al. Supplying a pharmacy for NASA exploration spaceflight: challenges and current understanding. Npj Microgravity. 2019;5(1):1–12.

2. Hackman RJ, Oldham G. Motivation through the design of work: Test of a theory. Organizational Behavior and Human Performance. 1976;16(2):250–279.

Wellbeing Literacy: A Capability Model for Wellbeing Science and Practice

Wellbeing science is the scientific investigation of wellbeing, its' antecedents and consequences. Alongside growth of wellbeing science is significant interest in wellbeing interventions at individual, organizational and population levels, including measurement of national accounts of wellbeing. In this concept paper, we propose the capability model of wellbeing literacy as a new model for wellbeing science and practice. Wellbeing literacy is defined as a capability to comprehend and compose wellbeing language, across contexts, with the intention of using such language to maintain or improve the wellbeing of oneself, others or the world. Wellbeing literacy is underpinned by a capability model (i.e., what someone is able to be and do), and is based on constructivist (i.e., language shapes reality) and contextualist (i.e., words have different meanings in different contexts) epistemologies. The proposed capability model of wellbeing literacy adds to wellbeing science by providing a tangible way to assess mechanisms learned from wellbeing interventions. Moreover, it provides a framework for practitioners to understand and plan wellbeing communications. Workplaces and families as examples are discussed as relevant contexts for application of wellbeing literacy, and future directions for wellbeing literacy research are outlined.

System-mapping the child health system at a local level to reduce health inequalities

Background

Systems thinking has emerged as a promising approach to addressing complex public health issues. For children, the focus of the approach has been on single outcomes e.g. obesity, rather than addressing the broad range of inequalities in health outcomes. We report on an approach to developing a system-oriented perspective on the determinants of inequalities in child health and wellbeing in English local authorities.

Methods

Qualitative group concept mapping workshops (a 'soft' system science approach) were held in two contrasting English local authorities with a range of stakeholders: professionals (N = 35); children and young people (N = 33) and carers (N = 5). Initial area maps were refined using data from qualitative interviews with professionals (N = 16) and resulting maps reviewed and validated by expert stakeholders in each area (N = 9; N = 35). Commonalities between two area-specific system maps (and removal of locality-specific factors) were used to develop a map that could be applied in any English local area. Two rounds of online consultation (N = 21; N = 8) and qualitative interviews (N = 12) with experts in public health, local governance and systems science refined the final system map displaying the determinants of child health inequalities, and give insight into its potential utilisation.

Results

The process created a map of over 150 factors influencing inequalities in health outcomes for children aged 0-25 years at the local area level. The system map has six domains; physical environment, governance, economic, social, service, and personal.

Conclusions

To our knowledge this is the first study taking a systems approach to addressing inequalities across all aspects of child health. Group concept mapping can support systems thinking at the local level. The resulting system map illustrates the complexity of factors influencing child health inequalities and is a useful tool for strategy development, action prioritisation and systems evaluation planning.

Key messages

Group concept mapping can be successfully applied to facilitate a systems approach to child health inequalities at the local area level. Mapping the local child health system highlights complex relationships between physical, social, personal, service, governance and economic factors which influence inequalities and health outcomes.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

Feed-derived iodine overrides environmental contribution to cow milk

Diets worldwide are deficient in iodine, leading to a range of undesirable health effects at the population level. Dairy products are a primary source of iodine in diets for those populations in which iodized salt is not systematically used or available. However, the flows of iodine through dairy agroecosystems are not well understood. The aim of this research was to investigate iodine flows though the dairy agroecosystem, including the influence of atmospheric depositional inputs, environmental variables, season, husbandry, and diet. Three farm-based sampling campaigns were carried out in this investigation, with milk, soil, silage, grass, and feed iodine determined by inductively coupled plasma mass spectroscopy, and nonparametric statistical analysis tests were conducted on data sets obtained. Natural iodine inputs into the environment are dominated by atmospheric deposition, which mainly from sea spray, and thus the location of farms relative to the coast and prevailing wind direction. Herbage and silage produced from grass-based systems strongly correlated with soil iodine, yet there was a strong disconnect between soil, forage, and feed and the milk that results. This was due to the levels of iodine in supplemental feeds being approximately 10-fold higher than those in forage-derived feeds. The practice of feed supplementation, accentuated by summer housing of cows, led to elevated milk iodine.

Safety and tolerability of injectable Rilpivirine LA in HPTN 076: A phase 2 HIV pre-exposure prophylaxis study in women

BACKGROUND

Daily oral TDF/FTC is protective against HIV infection when used for pre-exposure prophylaxis (PrEP). However, daily adherence to oral PrEP is difficult for many; therefore, finding alternative PrEP strategies remains a priority. HPTN 076 evaluated the long-acting injectable form of rilpivirine (RPV), known as RPV LA for safety, pharmacokinetics and acceptability.

METHODS

HPTN 076 (NTC 02165202) was a phase 2, double-blind, 2:1 randomized trial comparing the safety of 1200mg RPV LA (LA) to placebo (P). The study included a 28-day oral run-in phase of daily, self- administered oral RPV (25 mg), with directly observed oral dosing about six times. Of 136 enrolled sexually active, HIV-uninfected, low HIV-risk African (100) and US (36) adult women, injectable product was administered in two gluteal, intramuscular (IM) injections once every eight weeks to 122 participants following the oral run-in phase. A maximum of six injection time points occurred over a 48-week period. Acceptability, safety, tolerability and pharmacokinetic (PK) data were collected throughout the study. This paper includes primary endpoint data collected up to the week 52 post enrollment.

FINDINGS

The median age of the enrolled population was 31 years (IQR: 25,38), median weight 75 kg (IQR: 64, 89), median body mass index (BMI) 30 (IQR: 27, 35), 46% married, 94% Black and 60% unemployed. A total of 122 (80 LA, 42 P) women received at least one injection and 98 (64 LA, 34 P) received all six injections. During the injection phase, three women withdrew from the study (2 LA, 1 P) and 16 women discontinued study product (10 LA, 6 P). Fourteen women (11 LA and 3 P) discontinued oral study product and did not enter the injection phase. Study product discontinuations were not significantly different between the two arms throughout. Of the product discontinuations in the injection phase, 8% in LA and 5% in P arm were due to adverse events (AEs), including one randomized to the P arm with prolonged QTc interval on EKG. The proportion of women who experienced Grade 2 or higher AEs during the injection phase as the primary outcome was not significantly different between the two arms [73.8%, 95% CI: (63.2%, 82.1%) for LA and 73.8%, 95% CI: (58.9%, 84.7%), p>0.99]. Transient Grade ≥2 liver abnormalities occurred in 14% of women in the LA arm compared with 12% in P arm. Three LA women (4%) developed Grade 3 injection site reactions compared with none in P arm. In participants who received at least 1 injection, the geometric mean of overall RPV trough concentrations (Ctrough) was 62.2 ng/mL. In participants who received all six injections, the geometric mean of CTrough through the injection phase and after the last injection were 72.8 ng/mL and 100.9 ng/mL, respectively. At week 52 (eight weeks after last injection), the geometric mean of RPV Ctrough was 75.0 ng/mL. At the last injection visit (Week 44), 80 % of women who answered acceptability questions strongly agreed that they would think about using- and 68% that they would definitely use a PrEP injectable in the future.

INTERPRETATION

RPV LA IM injections every eight weeks in African and US women were safe and acceptable. Overall, despite more injection site reactions and pain in the participants receiving RPV LA the injections were well tolerated. Data from this study support the further development of injectable PrEP agents.

Magnesium isotopes of the bulk solar wind from Genesis diamond-like carbon films

NASA's Genesis Mission returned solar wind (SW) to the Earth for analysis to derive the composition of the solar photosphere from solar material. SW analyses control the precision of the derived solar compositions, but their ultimate accuracy is limited by the theoretical or empirical models of fractionation due to SW formation. Mg isotopes are "ground truth" for these models since, except for CAIs, planetary materials have a uniform Mg isotopic composition (within ≤1‰) so any significant isotopic fractionation of SW Mg is primarily that of SW formation and subsequent acceleration through the corona. This study analyzed Mg isotopes in a bulk SW diamond-like carbon (DLC) film on silicon collector returned by the Genesis Mission. A novel data reduction technique was required to account for variable ion yield and instrumental mass fractionation (IMF) in the DLC. The resulting SW Mg fractionation relative to the DSM-3 laboratory standard was (-14.4‰, -30.2‰) ± (4.1‰, 5.5‰), where the uncertainty is 2ơ SE of the data combined with a 2.5‰ (total) error in the IMF determination. Two of the SW fractionation models considered generally agreed with our data. Their possible ramifications are discussed for O isotopes based on the CAI nebular composition of McKeegan et al. (2011).

Cigarettes and Straws: Late Positive Potential Modulation in Mental Illness and Nicotine Addiction

Tobacco use remains a major preventable cause of death worldwide, accumulating billions of dollars in healthcare spending annually in the U.S. alone. Evidence has found that among those addicted, individuals suffering with psychiatric illnesses are disproportionally abusing. To assess this disparity, our study observed event related potential (ERP) responses recorded with electroencephalogram (EEG) in chronic smokers with (MI; n=6) and without mental illness (NMI; n=6). We found that the MI group alone presented heightened late positive potential (LPP) responses while processing cigarette (addictive) stimuli compared to neutral images (t-value = 3.11 at Cz, 3.92 at Pz). Our study illustrates the significance of the LPP as a promising biomarker to assess tobacco addiction in individuals facing mental illness.

Determination of ß-Glucan in Barley and Oats by Streamlined Enzymatic Method: Summary of Collaborative Study

A collaborative study was conducted involving 8 laboratories (including the authors’ laboratories) to validate the streamlined enzymatic method for determination of ß-D-glucan in barley and oats. In the method, the flour sample is cooked to hydrate and gelatinize ß-glucan, which is subsequently hydrolyzed to soluble fragments with the lichenase enzyme. After volume and pH adjustments and filtration, the solution is treated with ß-glucosidase, which hydrolyzes ß-gluco-oligosaccharides to D-glucose. D-Glucose is measured with glucose oxidase-peroxidase reagent. Other portions of lichenase hydrolysate are treated directly with glucose oxidase-peroxidase reagent to measure free glucose in test sample. If levels of free glucose are high, the sample is extracted first with 80% ethanol. For all samples analyzed, the repeatability relative standard deviation (RSDr) values ranged from 3.1 to 12.3% and the reproducibility relative standard deviation (RSDR) values ranged from 6.6 to 12.3%. The streamlined enzymatic method for determination of ß-D-glucan in barley and oats has been adopted first action by AOAC INTERNATIONAL.

Applying a New REFINE Approach in Zymomonas mobilis Identifies Novel sRNAs That Confer Improved Stress Tolerance Phenotypes

As global controllers of gene expression, small RNAs represent powerful tools for engineering complex phenotypes. However, a general challenge prevents the more widespread use of sRNA engineering strategies: mechanistic analysis of these regulators in bacteria lags far behind their high-throughput search and discovery. This makes it difficult to understand how to efficiently identify useful sRNAs to engineer a phenotype of interest. To help address this, we developed a forward systems approach to identify naturally occurring sRNAs relevant to a desired phenotype: RNA-seq Examiner for Phenotype-Informed Network Engineering (REFINE). This pipeline uses existing RNA-seq datasets under different growth conditions. It filters the total transcriptome to locate and rank regulatory-RNA-containing regions that can influence a metabolic phenotype of interest, without the need for previous mechanistic characterization. Application of this approach led to the uncovering of six novel sRNAs related to ethanol tolerance in non-model ethanol-producing bacterium Zymomonas mobilis. Furthermore, upon overexpressing multiple sRNA candidates predicted by REFINE, we demonstrate improved ethanol tolerance reflected by up to an approximately twofold increase in relative growth rate compared to controls not expressing these sRNAs in 7% ethanol (v/v) RMG-supplemented media. In this way, the REFINE approach informs strain-engineering strategies that we expect are applicable for general strain engineering.

Characterizing Direct-to-Consumer Stem Cell Businesses in the Southwest United States

There are currently hundreds of businesses across the United States offering direct-to-consumer stem cell treatments that have not been through regulatory approval by the Food and Drug Administration (FDA). Here, we provide a detailed characterization of nearly 170 stem cell businesses operating in the Southwest United States. We draw specific attention to two as-yet understudied facets of these businesses. First, we identify differences in the degree to which a given business focuses their practice on stem cell treatments. Second, we compare the stated expertise of the care providers in stem cell businesses with the range of conditions they purport to treat. These findings deepen our knowledge of the growing industry around unapproved stem cell treatments, and are used here to offer suggestions for how the FDA might target its resources with respect to regulatory oversight.

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We characterize 169 direct-to-consumer stem cell businesses in the southwest US

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We show differences in degree of clinic focus on providing stem cell treatments

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We compare care provider expertise with the stem cell-based interventions they offer

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We offer suggestions for regulatory oversight of direct-to-consumer stem cell businesses

Facial Recognition Task for the Classification of Mild Cognitive Impairment with Ensemble Sparse Classifier

Conventional methods for detecting mild cognitive impairment (MCI) require cognitive exams and follow-up neuroimaging, which can be time-consuming and expensive. A great need exists for objective and cost-effective biomarkers for the early detection of MCI. This study uses a sequential imaging oddball paradigm to determine if familiar, unfamiliar, or inverted faces are effective visual stimuli for the early detection of MCI. Unlike the traditional approach where the amplitude and latency of certain deflection points of event-related potentials (ERPs) are selected as electrophysiological biomarkers (or features) of MCI, we used the entire ERPs as potential biomarkers and relied on an advanced machine-learning technique, i.e. an ensemble of sparse classifier (ESC), to choose the set of features to best discriminate MCI from healthy controls. Five MCI subjects and eight age-matched controls were given the MoCA exam before EEG recordings in a sensory-deprived room. Traditional time-domain comparisons of averaged ERPs between the two groups did not yield any statistical significance. However, ESC was able to discriminate MCI from controls with 95% classification accuracy based on the averaged ERPs elicited by familiar faces. By adopting advanced machine-learning techniques such as ESC, it may be possible to accurately diagnose MCI based on the ERPs that are specifically elicited by familiar faces.

Mediators of the Effect of Multiple Micronutrient Supplementation in Pregnancy on Infant Mortality in Tanzania (P24-050-19)

Objectives

Maternal micronutrient supplementation (MMS) in pregnancy has been shown to improve birthweight among infants in low- and middle-income countries (LMIC). Recent evidence also suggests that the survival benefits of MMS are greater for female infants as compared to males, but the biological mechanisms leading to the differential effect remain unclear. The objective of this study was to conduct a causal mediation analysis to examine the mechanisms through which MMS may operate on infant mortality.

Haider BA, Bhutta ZA. Multiple-micronutrient supplementation for women during pregnancy. Cochrane Database Syst Rev. 2017;4: CD004905

Methods

We utilized data from a randomized, double-blind, placebo-controlled trial of MMS conducted in Tanzania to examine mediators of the effect of MMS on six-week infant mortality. Causal mediation analyses were conducted for assessing the contributions of MMS on survival via their effects on birthweight, gestational age, weight-for-gestational age, and the joint effect of gestational age and weight-for-gestational age.

Results

Among 7486 participants (3762 randomized to MMS, 3724 randomized to placebo), we observed that the effect of MMS on survival was fully mediated through the joint effect of gestational age and weight-for-gestational age. Further, when analyses were stratified by sex, gestational age and weight-for-gestational age fully mediated the survival benefits for female infants while these factors accounted for only 34% of the effect among male infants.

Conclusions

We determined that increases in gestational age and birth weight fully mediate the beneficial effect of MMS on mortality among female infants; however, these mechanisms do not appear to be major contributors to a potential effect among males.

Funding Sources

This research was supported in part by the National Institutes of Health (NIH) predoctoral training grants, and was a secondary analysis of data from a study supported by a grant from the National Institute of Child Health and Human Development.

Effect of diet and type of pregnancy on plasma metabolic response in sheep and its further effect on lamb performance

This trial evaluated the individual and interactional effects of diet and type of pregnancy (twin or single) on plasma metabolic response in ewes and their lambs from late pre-partum to late post-partum. Thus, a flock of 18 Ile de France breed sheep, consisting of 8 twin-bearing and 10 single-bearing ewes, were allocated to one of two groups according to their diet, either based on ad libitum naturalized pasture hay (NPH) or red clover hay (RCH), from d 45 pre-partum to d 60 post-partum. Plasma samples were collected at different times to determine albumin, cholesterol, total protein and urea, plus glucose and β-hydroxybutyrate (BHB) concentration in ewes. The data was processed using the lme4 package for R, and SPSS Statistics 23.0 for Windows. The results showed that both diet and type of pregnancy influenced the metabolic profile in ewes, showing an inverse relationship between single- and twin-bearing ewes regarding glucose and especially BHB proportions from pre-partum to birth. During post-partum, higher urea concentrations were observed in twin- and single-bearing ewes fed RCH in contrast to those fed NPH, as a result of the higher-quality forage offered to ewes. Regarding lambs, the diet and type of pregnancy influenced the total protein and urea levels, where an inverse relationship at birth and early post-partum between albumin and cholesterol vs. total protein and urea was detected, reflecting a trend (P value between 0.06 and 0.07) to a better performance by groups of single lambs, especially those from single-bearing ewes fed RCH. Finally, under the conditions of this study, the maternal diet and type of pregnancy influenced the plasma metabolic response in ewes and their lambs, affecting the lamb performance especially at birth.