Multiline molecular tagging velocimetry of nitric oxide at 100 kHz using an injection-seeded burst-mode OPO

An injection-seeded, burst-mode optical parametric oscillator (OPO) operating at a repetition rate of 100 kHz is used to demonstrate the multiline molecular tagging velocimetry of an underexpanded jet using nitric oxide fluorescence. The very narrow linewidth of the OPO system, along with the relatively high pulse energies of the burst-mode system, enables efficient single-photon excitation of nitric oxide along multiple laser beam lines at a high repetition rate. Simultaneous one-dimensional velocity profile measurements were obtained of an underexpanded jet system at six different locations using a reference initial image and single-shot delayed images. A methodology for calculating the uncertainty of single-shot velocity is also described. Mean and root-mean-square velocity profiles are obtained at multiple locations simultaneously over a sampling time of 1 ms. The high-repetition-rate velocity measurements also appear to capture the onset of velocity oscillations and has the potential to reveal velocity frequency content occurring in the tens of kHz. The demonstrated velocimetry technique could be paired with other emerging burst-mode laser capabilities for a quantitative multiparameter gas property or multicomponent gas velocity measurements for supersonic and hypersonic flows, especially within ground test facilities that are limited to very short run durations.

Responsiveness to Vedolizumab Therapy in Ulcerative Colitis is Associated With Alterations in Immune Cell-Cell Communications

BACKGROUND

Ulcerative colitis (UC) and Crohn's disease are 2 types of inflammatory bowel disease (IBD), a group of chronic digestive disorders caused by aberrant immune responses to intestinal microbes. Although changes in the composition of immune cell subsets in the context of IBD have been previously described, the interactions and communication among cells are less well understood. Moreover, the precise mechanisms of action underlying many biologic therapies, including the anti-α4β7 integrin antagonist vedolizumab, remain incompletely understood. Our study aimed to explore possible additional mechanisms through which vedolizumab acts.

METHODS

We performed cellular indexing of transcriptomes and epitopes by sequencing (CITE-seq) on peripheral blood and colon immune cells derived from patients with ulcerative colitis treated with the anti-α4β7 integrin antagonist vedolizumab. We applied a previously published computational approach, NicheNet, to predict immune cell-cell interactions, revealing putative ligand-receptor pairs and key transcriptional changes downstream of these cell-cell communications (CCC).

RESULTS

We observed decreased proportions of T helper 17 (TH17) cells in UC patients who responded to vedolizumab and therefore focused the study on identifying cell-cell communications and signals of TH17 cells with other immune cells. For example, we observed that colon TH17 cells from vedolizumab nonresponders were predicted to have a greater degree of interactions with classical monocytes compared with responders, whereas colon TH17 cells from vedolizumab responders exhibited more interactions with myeloid dendritic cells compared with nonresponders.

CONCLUSIONS

Overall, our results indicate that efforts to elucidate cell-cell communications among immune and nonimmune cell types may increase the mechanistic understanding of current and investigational therapies for IBD.

Assessing social needs among patients with cardiovascular and psychiatric comorbidities in free community health clinics

BACKGROUND

Community-related health assessments have been shown to improve several outcomes in socioeconomically disadvantaged populations with comorbid chronic health conditions. However, while it is recognized that modifiable social determinant of health (SDH) factors might be responsible for up to 60% of preventable deaths, it is not yet standard of care to routinely screen and address these at preventive health appointments. The objective of this study was to identify the social needs of socioeconomically disadvantaged patients.

METHODS

We performed a retrospective review of the socioeconomic screening questionnaires distributed to under- and uninsured patients seen at a medical student-run free primary care-based community clinic. This study included participants of all ages (0 and up), genders, languages, and ethnicities who filled out the social screening questionnaire. Socioeconomic screening questionnaires assessed the need for critical resources such as food, housing, utilities, finances, transportation, childcare, employment, education, legal support, companionship, health literacy, and community assistance. The primary study outcome was to identify unmet social needs of our medical student-run free clinic patients. We secondarily sought to identify associations between these needs and chronic health conditions. We hypothesized that patients with multiple chronic health problems and financial stressors would have the highest requests for resources.

RESULTS

Our retrospective review identified 264 uninsured participants who were evaluated for social needs using a screening questionnaire. Participants who reported unmet social needs had significantly more cardiovascular risk factors than those who did not. Cardiovascular comorbidities and a history of psychiatric illness were the two most common medical problems significantly associated with several unmet social needs.

CONCLUSION

This study provides support for the preemptive identification and appropriate management of physical, mental, and social care to improve disproportionate disparities in long-term health outcomes.

Identification of CD8 + T-Cell-Immune Cell Communications in Ileal Crohn's Disease

INTRODUCTION

Crohn's disease (CD) is a major subtype of inflammatory bowel disease (IBD), a spectrum of chronic intestinal disorders caused by dysregulated immune responses to gut microbiota. Although transcriptional and functional changes in a number of immune cell types have been implicated in the pathogenesis of IBD, the cellular interactions and signals that drive these changes have been less well-studied.

METHODS

We performed Cellular Indexing of Transcriptomes and Epitopes by sequencing on peripheral blood, colon, and ileal immune cells derived from healthy subjects and patients with CD. We applied a previously published computational approach, NicheNet, to predict immune cell types interacting with CD8 + T-cell subsets, revealing putative ligand-receptor pairs and key transcriptional changes downstream of these cell-cell communications.

RESULTS

As a number of recent studies have revealed a potential role for CD8 + T-cell subsets in the pathogenesis of IBD, we focused our analyses on identifying the interactions of CD8 + T-cell subsets with other immune cells in the intestinal tissue microenvironment. We identified ligands and signaling pathways that have implicated in IBD, such as interleukin-1β, supporting the validity of the approach, along with unexpected ligands, such as granzyme B, which may play previously unappreciated roles in IBD.

DISCUSSION

Overall, these findings suggest that future efforts focused on elucidating cell-cell communications among immune and nonimmune cell types may further our understanding of IBD pathogenesis.

Latino dentists in the U.S. Census from 1980 to 2019: Implications for dental care access

OBJECTIVES

This study describes the supply of Latino dentists in the United States from 1980 to 2019, as tabulated by the Census. The number of Latino dentists per 100,000 Latino population was compared to the number of non-Hispanic White (NHW) dentists per 100,000 NHW population. These four-decade comparisons were made for the entire country as well as the five states having the largest Latino populations.

METHODS

Data from the decennial census and the American Community Survey were used to identify the nationwide population, the number of dentists, and their respective Spanish-language abilities, stratified by race/ethnic group (Latinos and non-Hispanic Whites).

RESULTS

In 1980, there were only 18 Latino dentists for every 100,000 Latino population in the entire nation, compared to 70 NHW dentists per 100,000 NHW population. While there was an increase to 21 Latino dentists per 100,000 in 1990, the supply remained virtually the same over this almost 40-year period, ending back at 18 per 100,000 in 2019. In comparison, there were about four times as many non-Hispanic White dentists as Latino dentists. This national discrepancy was also reflected in the five states that were evaluated. Similarly, Latino dentists were far more likely to speak Spanish than NHW dentists at both the national and state levels.

CONCLUSIONS

The Latino dentist supply, already inadequate in 1980, has remained virtually unchanged over the past almost 40 years. The authors believe that this deficiency will have profound consequences, and recommend that initiatives be undertaken to increase the number of Latino dentists.

Laser Applications to Chemical, Security, and Environmental Analysis: introduction to the feature issue

The eighteenth topical meeting on Laser Applications to Chemical, Security, and Environmental Analysis (LACSEA) was held in Vancouver, Canada from 11-15 July 2022, as part of the Optica Optical Sensors and Sensing Congress in a hybrid format allowing on-site and online attendance. The meeting featured a broad range of distinguished papers focusing on recent advances in laser and optical spectroscopy. A total of 52 contributed and invited papers were presented during the meeting, including topics such as photo-acoustic spectroscopy, imaging, non-linear technologies, frequency combs, remote sensing, environmental monitoring, aerosols, combustion diagnostics, hypersonic flow diagnostics, nuclear diagnostics, fs/ps applications, and machine learning and computational sensing.

Small intestine and colon tissue-resident memory CD8+ T cells exhibit molecular heterogeneity and differential dependence on Eomes

Tissue-resident memory CD8+ T (TRM) cells are a subset of memory T cells that play a critical role in limiting early pathogen spread and controlling infection. TRM cells exhibit differences across tissues, but their potential heterogeneity among distinct anatomic compartments within the small intestine and colon has not been well recognized. Here, by analyzing TRM cells from the lamina propria and epithelial compartments of the small intestine and colon, we showed that intestinal TRM cells exhibited distinctive patterns of cytokine and granzyme expression along with substantial transcriptional, epigenetic, and functional heterogeneity. The T-box transcription factor Eomes, which represses TRM cell formation in some tissues, exhibited unexpected context-specific regulatory roles in supporting the maintenance of established TRM cells in the small intestine, but not in the colon. Taken together, these data provide previously unappreciated insights into the heterogeneity and differential requirements for the formation vs. maintenance of intestinal TRM cells.

Latina Women in the U.S. Physician Workforce: Opportunities in the Pursuit of Health Equity

PURPOSE

Some progress has been made in gender diversity in undergraduate medical education and the physician workforce, but much remains to be done to improve workforce disparities for women, particularly women from underrepresented populations, such as Latinas. This study examines the current level of representation and demographic characteristics of Latina physicians, including age, language use, nativity, and citizenship status.

METHOD

The authors used data from the 2014-2018 U.S. Census Bureau's American Community Survey (ACS) 5-year estimates for their analyses. During the time period covered by this analysis, ACS response rates ranged from 92.0% to 96.7%. The authors included in this study individuals who self-reported their occupation as physician and who self-identified their race/ethnicity as either non-Hispanic White (NHW) or Hispanic/Latino, regardless of race. The authors used person-level sampling weights provided by the ACS to convert the original 1% sample to a 100% enumeration of the population.

RESULTS

According to the ACS 2014-2018 5-year estimates, NHW physicians make up 65.8% (660,031/1,002,527) of physicians in the United States. Women comprise 36.1% (361,442) of the total U.S. physician population; however, Hispanic/Latina women comprise only 2.4% (24,411). The female physician population is younger than the male physician population, and Hispanic female physicians are the youngest. Latina physicians are far more likely to speak Spanish at home than NHW physicians. Immigrants make up 40.1% (9,782/24,411) of the Hispanic female physician population, and 12.3% (3,012/24,411) of Hispanic female physicians are not U.S. citizens.

CONCLUSIONS

This study suggests that Latina physicians in the United States are younger, more likely to be bilingual and speak Spanish at home, and very underrepresented, compared with NHW female and male physicians. Increasing their share of the U.S. physician workforce would benefit the pursuit of health equity for an ever more diverse population.

Office of Management and Budget Racial/Ethnic Categories in Mortality Research: A Framework for Including the Voices of Racialized Communities

Since its founding, the US government has sorted people into racial/ethnic categories for the purpose of allowing or disallowing their access to social services and protections. The current Office of Management and Budget racial/ethnic categories originated in a dominant racial narrative that assumed a binary biological difference between Whites and non-Whites, with a hard-edged separation between them. There is debate about their continued use in researching group differences in mortality profiles and health outcomes: should we use them with modifications, cease using them entirely, or develop a new epistemology of human similarities and differences? This essay offers a research framework for including in these debates the daily lived experiences of the 110 million racialized non-White Americans whose lived experiences are the legacy of historically limited access to society's services and protections. The experience of Latinos in California is used to illustrate the major elements of this framework that may have an effect on mortality and health outcomes: a subaltern fuzzy-edged multivalent racial narrative, agency, voice, and community and cultural resilience.

Emissions in short-gated ns/ps/fs-LIBS for fuel-to-air ratio measurements in methane-air flames

A study of short-gated 10 nanosecond (ns), 100 picosecond (ps), and 100 femtosecond (fs) laser induced breakdown spectroscopy (LIBS) was conducted for fuel-to-air ratio (FAR) measurements in an atmospheric Hencken flame. The intent of the work is to understand which emission lines are available near the optical range in each pulse width regime and which emission ratios may be favorable for generating equivalence ratio calibration curves. The emission spectra in the range of 550-800 nm for ns-LIBS and ps-LIBS are mostly similar with slightly elevated atomic oxygen lines by ps-LIBS. Spectra from fs-LIBS show the lowest continuum background and prominent individual atomic lines, though have significantly weaker ionic emission from nitrogen. A qualitative explanation based on assumed local thermodynamic equilibrium and electron temperatures calculated by the ${{\rm{N}}_{\rm{II}}}({{565}}\;{\rm{nm}})$ and ${{\rm{N}}_{\rm{II}}}({{594}}\;{\rm{nm}})$ emissions is presented. In studying line emission ratios for FAR calculation, it is found that ${{\rm{H}}_\alpha}({{656}}\;{\rm{nm}})/{{\rm{N}}_{\rm{II}}}({{568}}\;{\rm{nm}})$ is best for FAR measurements with ns-LIBS and remains viable for ps-LIBS, while ${{\rm{H}}_\alpha}({{656}}\;{\rm{nm}})/{{\rm{O}}_{\rm I}}({{777}}\;{\rm{nm}})$ is optimal for the ps-LIBS and fs-LIBS cases. Due to low continuum background and short time delay for spectra collection, fs-LIBS is very promising for high-speed FAR measurements using short-gated LIBS.

Laser applications to chemical, security, and environmental analysis: introduction to the feature issue

This Applied Optics feature issue on laser applications to chemical, security, and environmental analysis (LACSEA) highlights papers presented at the LACSEA 2020 Seventeenth Topical Meeting sponsored by The Optical Society (OSA).

Recommendations for the diagnosis and management of vaccine-induced immune thrombotic thrombocytopenia

There have recently been safety concerns regarding an increased risk of vaccine-induced immune thrombotic thrombocytopenia (VITT) following administration of SARS-CoV-2 adenoviral vector vaccines. The Southern African Society of Thrombosis and Haemostasis reviewed the emerging literature on this idiosyncratic complication. A draft document was produced and revised by consensus agreement by a panel of professionals from various specialties. The recommendations were adjudicated by independent international experts to avoid local bias. We present concise, practical guidelines for the clinical management of VITT.

Outcomes with Preoperative Biliary Stenting After Pancreaticoduodenectomy In the Modern Era

BACKGROUND

Previous studies have documented increased complications following pancreaticoduodenectomy in patients who undergo preoperative biliary stenting (PBS). However, in the modern era, the vast majority of patients with jaundice are stented. We hypothesized that there is no difference in short-term postoperative outcomes between PBS and no PBS in patient with obstructive jaundice undergoing pancreaticoduodenectomy.

METHODS

We performed an analysis using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) participant use file (2014-2017). Patients who received neoadjuvant chemotherapy and required stenting were excluded from the analysis. A propensity-matched analysis was performed to select obstructive jaundice patients who underwent PBS and those who did not with similar characteristics prior to pancreaticoduodenectomy. Short-term postoperative outcome measures included superficial surgical site infection (S-SSI), deep surgical site infection (D-SSI), hospital length of stay (LOS), postoperative pancreatic fistula (POF), hospital readmission, minor morbidity (Clavien-Dindo I-II), major morbidity (Clavien-Dindo III, IV, V), and 30-day mortality.

RESULTS

A total of 5851 patients with obstructive jaundice underwent pancreaticoduodenectomy without neoadjuvant chemotherapy. 81.6% underwent PBS. Based on the propensity-matched analysis, 927 patients who received PBS and 927 patients who did not were selected for comparing the outcomes between the two groups. There was no significant difference in outcome measures between the two groups with respect to S-SSI (OR 1.30 , 95% CI = 0.94-1.80, p = 0.12), D-SSI (OR 1.07, 95% CI = 0.81-1.41, p = 0.62), POF (OR 1.11, 95% CI = 0.87-1.42, p = 0.40), hospital readmission (OR 0.99, 95% CI = 0.77-1.27, p = 0.94), minor morbidity (OR 0.91, 95% CI = 0.76-1.11, p = 0.36), major morbidity (OR 0.84, 95% CI = 0.67-1.06, p = 0.14), and 30-day mortality (OR 1.05, 95% CI = 0.57-1.95, p = 0.87). Patients who underwent PBS were more likely to have shorter LOS (RR 0.87, 95% CI = 0.81-0.93, p < 0.0001).

CONCLUSION

Contrary to previously reported studies, there was no increased risk of short-term postoperative outcomes after pancreaticoduodenectomy between PBS and N-PBS in a propensity-matched analysis. Preoperative biliary stenting is safe and does not need to be avoided before surgical intervention in patients who present with obstructive jaundice.

Applying a Prediction Model for Vaginal Birth after Cesarean to a Latina Inner-City Population

Background  The Maternal-Fetal Medicine Units (MFMU) Network developed a prediction model for calculating the likelihood of successful vaginal birth after cesarean (VBAC) in patients undergoing a trial of labor after cesarean (TOLAC). In this prediction model, Latina ethnicity is considered a negative predictive factor for successful VBAC. Subsequent studies have found mixed results regarding VBAC success in Latina ethnicity. Objective  Our aim was to compare the predicted chance of successful VBAC (as calculated using the MFMU prediction model) to actual TOLAC outcomes in a large Latina sample. Study Design  We performed a retrospective cohort study of Latinas who underwent TOLAC at our institution from January 1, 2013 to December 31, 2016. The MFMU prediction model was used to calculate each participant's predicted success, and the participants were then categorized into three groups based on predicted success: low (<35%), moderate (35-65%), and high (>65%). The predicted success rates versus actual outcomes were compared among the three groups. Results  A total of 567 Latinas met inclusion criteria. Successful VBAC occurred in 476 patients (84%). VBAC was achieved in 65.3% of the low predicted success group, 84.4% of the moderate predicted success group, and 91.7% of the predicted high success group. Actual VBAC success rates exceeded the predicted success rates for the low and moderate groups. Conclusion  Our results question whether Latina ethnicity should continue to be considered a negative predictive factor for VBAC success. Our results also suggest that Latinas with a low predicted VBAC success should not necessarily be discouraged from attempting TOLAC.

Extending Time to Reperfusion with Mild Therapeutic Hypothermia: A New Paradigm for Providing Primary Percutaneous Coronary Intervention to Remote ST Segment Elevation Myocardial Infarction Patients

Primary percutaneous coronary intervention (PPCI) is the preferred treatment for acute ST segment elevation myocardial infarction (STEMI). The goal is reperfusion within 90 minutes of first medical contact (FMC) or 120 minutes if transfer is needed. Otherwise, fibrinolytic therapy is recommended. Mild therapeutic hypothermia (MTH) (≤35°C) before coronary reperfusion decreases myocardial infarct size. If applied before reperfusion, hypothermia could potentially lengthen the FMC-reperfusion time without increasing infarct size. Thirty-six swine had their mid left anterior descending coronary artery acutely occluded. All animals had an initial 30 minutes of occlusion to simulate typical delay before seeking medical attention. Eighteen animals were studied under normothermic conditions with reperfusion after an additional 40 minutes (the porcine equivalent of a 120-minute clinical FMC to reperfusion time) and 18 were treated with hypothermia but not reperfused until another 80 minutes (clinical equivalent of 240 minutes). Primary outcome was myocardial infarct size (infarct/area at risk [AAR]) at 24 hours. The two groups differed in systemic temperature at the time of reperfusion (39.1°C ± 1.0°C vs. 35.5°C ± 0.7°C; p < 0.0001). Myocardial infarct size was not significantly different despite the longer time to reperfusion in those treated with hypothermia (60.6% ± 12% of the AAR [normothermic] vs. 65.8% ± 11.8% of the AAR [hypothermic]; p = 0.39). Rapid induction of MTH during an anterior STEMI made it possible to extend the FMC to reperfusion time by the equivalent of an extra two clinical hours (120-240 minutes) without increasing the myocardial infarct size. This strategy could allow more STEMI patients to receive PPCI rather than the less effective intravenous fibrinolysis.

Time-Gated Single-Shot Picosecond Laser-Induced Breakdown Spectroscopy (ps-LIBS) for Equivalence-Ratio Measurements

Time-gated picosecond laser-induced breakdown spectroscopy (ps-LIBS) for the determination of local equivalence ratios in atmospheric-pressure adiabatic methane-air flames is demonstrated. Traditional LIBS for equivalence-ratio measurements employ nanosecond (ns)-laser pulses, which generate excessive amounts of continuum, reducing measurement accuracy and precision. Shorter pulse durations reduce the continuum emission by limiting avalanche ionization. Furthermore, by contrast the use of femtosecond lasers, plasma emission using picosecond-laser excitation has a high signal-to-noise ratio (S/N), allowing single-shot measurements suitable for equivalence-ratio determination in turbulent reacting flows. We carried out an analysis of the dependence of the plasma emission ratio H_α (656 nm)/N_II (568 nm) on laser energy and time-delay for optimization of S/N and minimization of measurement uncertainties in the equivalence ratios. Our finding shows that higher laser energy and shorter time delay reduces measurement uncertainty while maintaining high S/N. In addition to atmospheric-pressure flame studies, we also examine the stability of the ps-LIBS signal in a high-pressure nitrogen cell. The results indicate that the plasma emission and spatial position could be stable, shot-to-shot, at elevated pressure (up to 40 bar) using a lower excitation energy. Our work shows the potential of using ps-duration pulses to improve LIBS-based equivalence-ratio measurements, both in atmospheric and high-pressure combustion environments.

The barriers of workplace safety and health management: from the supervisor’s perspective

Background

Previous researches demonstrated that workplace safety and health (WSH) management plays a major role in promoting worker’s health and well-being. However, organizational factors hinder promoting WSH management program. The main aim of this study is to explore the probable existence of barrier from WSH supervisor’s perspective.

Methods

This study employed a qualitative design to gain an in-depth and holistic understanding of WSH from the supervisor’s perspective. Eight focus groups were conducted in Taiwan. A total of 81 supervisors (employer, human resource section, environmental safety section) from the manufacturing industry, construction industry, and service industry participated in this study. All interview contents were transcribed and coded. Matrices were constructed to identify themes and evolving concepts.

Results

Three main barriers were identified1. Lacking of top management commitment and support (e.g., top management focused more on employees’ work performance than their safety and health, top management commitment was just a declaration but with no action, and top management only conducted the traditional occupational hazards control to fit the minimum standards of national policy, and ignored employees’ mental health and well-being); 2.Lacking of employee’s safety awareness (e.g., employee lacked the motivation to attend training program; 3.Organizational resources were not enough to implement occupational safety and health management (e.g., the supervisor lacked professional skills in promoting WSH program).

Conclusions

The study findings provide an integrated basis for practical application and further research. The workplace supervisor should be trained the professional skills in workplace safety and health management. Then, the workplace psychosocial safety climate can be built while top management and employee have higher workplace safety and health awareness.

Key messages

This study contributes to occupational health research from the supervisor’s perspective. This study also hints at the potential role of top management promoting employee’s health and well-being.

Rectal cancer in the young: analysis of contributing factors and surgical outcomes

Background

Rectal cancer (RC) among young patients (≤50 years) is on the rise. The factors associated with development of RC are established however; factors leading to early RC remain unclear. The aim of this study was to assess factors associated with RC among young patients.

Methods

National estimates for patients with RC were abstracted from the National Inpatient Sample (NIS) database [2010-2012]. Patients were divided into two groups: young (≤50 years) and old (>50 years). Demographic, comorbidities, procedures performed, and hospital outcomes were collected. Regression analysis was performed to compare both groups.

Results

A total of 68,699 patients with RC were included. Incidence of RC among young patients increased significantly over the study period (2.4% vs. 3.4%; P=0.04). Majority of young patients with RC were white females. Bleeding was the most common presentation among young patients (P=0.03). Younger patients were more likely to have a family history of RC (P=0.01) and were more likely to undergo elective surgery (P=0.04) and laparoscopic surgery (P=0.02) compared to the older patients. Younger patients with RC were also more likely to use alcohol (P=0.03), be obese (P=0.02) compared to elder patients. There was no difference in the other co-morbidities between the two groups. After controlling for all factors in a regression model, younger patients had a lower complication rate (P=0.01), hospital LOS (P=0.02), and mortality rate (P=0.04).

Conclusions

RC in younger patients appears as a different disease with different outcomes. There appears to be multifactorial and environmental factors contributing to this trend. Race and gender also play a role in the incidence of RC in the young. Identifying these risk factors will lead to a more robust intervention plan to help improve care among younger patients with RC.

Racially Ambiguous Babies and Racial Narratives in the United States: A Growing Contradiction for Health Disparities Research

Researchers attempting to identify and track health disparities and inequities generally use five racial or ethnic (R/E) categories-four racial groups (white, black, Asian/Pacific Islander, and American Indian) and one ethnic group (Hispanic)-to analyze and predict variations in health outcomes in the overall U.S. population. These categories are used as if they were permanent, naturally occurring, internally homogeneous, and discrete. However, the United States is becoming increasingly racially ambiguous because of (1) the growth of the Latino population, nearly half of whom do not identify with one of the four racial groups; and (2) the growing population of racially ambiguous babies, whose mothers and fathers are of different R/E groups. In California, an average annual 52.6% of the babies born between 2011 and 2015 were racially ambiguous (i.e., their parents were from different R/E groups or at least one parent was something other than a single race).We describe the social-legal construction of hard-edged, binary racial categories in the United States from 1790 to the present (and the subsequent racial structuring of U.S. society along those categories). Researchers should shift the conceptualization of race from that of an innate, individual trait to that of a narrative, and should consider the impact that racial narratives can have on the life courses of individuals categorized as nonwhite. In light of the increasing racial ambiguity in the United States, the Latino fuzzy-edged, multivalent racial narrative that embraces racial mixing may be one alternative to the United States' hard-edged, binary one.

Quantitative fuel-to-air ratio determination for elevated-pressure methane/air flames using chemiluminescence emission

The fuel/air ratio (FAR) in a methane-air Hencken flame at pressures of 1-5 bar is measured using the chemiluminescence-based method. Emission spectra are used to investigate the effects of pressure on the OH^* (308 nm), CH^* (430 nm), and C2* (500 nm) emissions and the effect on equivalence ratio determination from the ratios of these emission peaks. Both OH^*/CH^* and C2^*/CH^* ratios are linear to FAR at atmospheric pressure. At elevated pressures, C2^*/CH^* remains roughly linear to FAR, while OH^*/CH^* becomes highly nonlinear. There are significant spectral contributions from continuum radiation at higher pressures, likely due to increasing soot production. Therefore, while it is a truly passive and nonintrusive diagnostic method, the use of chemiluminescence for FAR determination at high pressures could be limited. Possible improvements to the measurement setup and future studies are discussed.

Selenium and Type 2 Diabetes: Systematic Review

Several studies have investigated the potential role of selenium (Se) in the development of type 2 diabetes (T2D) with disparate findings. We conducted a systematic review and meta-analysis to synthesize the evidence of any association between Se and T2D. PubMed, Embase, and Scopus were searched following the Preferred Reporting Items for Systematic Reviews and Meta-analysis Approach (PRISMA). Sixteen studies from 15 papers met inclusion criteria defined for this review. Of the 13 observational studies included, 8 demonstrated a statistically significant positive association between concentrations of Se and odds for T2D, with odds ratios (95% confidence intervals) ranging from 1.52 (1.01–2.28) to 7.64 (3.34–17.46), and a summary odds ratio (OR) (95% confidence interval (CI)) of 2.03 (1.51–2.72). In contrast, among randomized clinical trials (RCTs) of Se, a higher risk of T2D was not observed for those who received Se compared to a placebo (OR = 1.18, 95% CI 0.95–1.47). Taken together, the results for the relationship between Se and T2D differ between observational studies and randomized clinical trials (RCTs). It remains unclear whether these differences are the result of uncontrolled confounding in the observational studies, or whether there is a modest effect of Se on the risk for T2D that may vary by duration of exposure. Further investigations on the effects of Se on glucose metabolism are needed.

A Randomized, Double-blind, Phase II Trial of PSA-TRICOM (PROSTVAC) in Patients with Localized Prostate Cancer: The Immunotherapy to Prevent Progression on Active Surveillance Study

The Immunotherapy to Prevent Progression on Active Surveillance Study is the first trial of immunotherapy for localized prostate cancer. We randomized active surveillance patients to PSA-TRICOM (PROSTVAC) or placebo for 5mo. Final results will be available in 2019.

California And The Changing American Narrative On Diversity, Race, And Health

The historical narrative on diversity, race, and health would predict that California's population change from 22 percent racial/ethnic minority in 1970 to 62 percent in 2016 would lead to a massive health crisis with high mortality rates, low life expectancy, and high infant mortality rates-particularly given the state's high rates of negative social determinants of health: poverty, high school incompletion, and uninsurance. We present data that suggest an alternative narrative: In spite of these negative factors, California has very low rates of mortality and infant mortality and long life expectancy. This alternative implies that racial diversity may offer opportunities for good health outcomes and that community agency may be a positive determinant. Using national-level mortality data on racial/ethnic groups, we suggest that new theoretical models and methods be developed to assist the US in achieving high-level wellness as it too becomes "majority minority."

Higher Plasma Selenium Concentrations Are Associated with Increased Odds of Prevalent Type 2 Diabetes

Background

Selenium, an essential trace element, has been investigated as a potential cancer prevention agent. However, several studies have indicated that selenium supplementation may be associated with an increased risk of type 2 diabetes (T2D), although an equivocal relation of this nature requires confirmation.

Objective

We examined the association between baseline plasma concentrations of selenium and the prevalence of T2D, as well as whether participant characteristics or intake of other antioxidant nutrients modified this relation.

Methods

We conducted cross-sectional analyses of 1727 participants from the Selenium Trial, a randomized clinical trial of selenium supplementation for colorectal adenoma chemoprevention that had data for baseline selenium plasma concentrations, T2D status, and dietary intake. Logistic regression modeling was used to evaluate the associations between plasma selenium concentrations and prevalent T2D, adjusting for confounding factors. Heterogeneity of effect by participant characteristics was evaluated utilizing likelihood-ratio tests.

Results

Mean ± SD plasma selenium concentrations for those with T2D compared with those without T2D were 143.6 ± 28.9 and 138.7 ± 27.2 ng/mL, respectively. After adjustment for confounding, higher plasma selenium concentrations were associated with a higher prevalence of T2D, with ORs (95% CIs) of 1.25 (0.80, 1.95) and 1.77 (1.16, 2.71) for the second and third tertiles of plasma selenium, respectively, compared with the lowest tertile (P-trend = 0.007). No significant effect modification was observed for age, sex, body mass index, smoking, or ethnicity. Increased odds of T2D were seen among those who were in the highest tertile of plasma selenium and the highest category of intake of β-cryptoxanthin (P-trend = 0.03) and lycopene (P-trend = 0.008); however, interaction terms were not significant.

Conclusions

These findings show that higher plasma concentrations of selenium were significantly associated with prevalent T2D among participants in a selenium supplementation trial. Future work is needed to elucidate whether there are individual characteristics, such as blood concentrations of other antioxidants, which may influence this relation.

Racial and gender disparities in the incidence of anal cancer: analysis of the Nationwide Inpatient Sample (NIS)

Background

Racial and gender disparities have been shown in other gastrointestinal cancers. However, there is a paucity of data on racial and gender disparities in anal cancer (AC). The aim of this study was to assess racial and gender disparities among patients with AC.

Methods

We analyzed data from the National Inpatient Sample (NIS) 2011 database of patients diagnosed with AC with age ≥18. Demographic data including age, race and gender were assessed. Patients were stratified based on race and gender. Log binomial regression was used to generate risk ratios.

Results

A total of 6,013,105 patients were assessed and 1,956 (0.03%) patients had AC. Female patients were more at risk of developing AC [relative risk (RR): 1.14, P=0.02]. Whites and Blacks had the highest incidence followed by Asians/Pacific Islanders. Black males had increased risk of AC (RR: 1.43, P<0.01). Amongst Hispanics; both males (RR: 0.69, P=0.05) and females (RR: 0.46, P<0.0001) had decreased risk of developing AC. Finally, we saw that Asian females had a much lower risk of developing AC (RR: 0.33, P<0.01).

Conclusions

Racial disparities and gender differences exist in the incidence of AC. Potential causes for this disparity are disparate access to healthcare, lack of education, and lack of awareness. Greater understanding of the racial disparity in AC can help identify at risk population and eventually lead to improved preventative measures to ultimately reduce the incidence of AC.

Cardiolipin remodeling by TAZ/tafazzin is selectively required for the initiation of mitophagy

Tafazzin (TAZ) is a phospholipid transacylase that catalyzes the remodeling of cardiolipin, a mitochondrial phospholipid required for oxidative phosphorylation. Mutations of TAZ cause Barth syndrome, which is characterized by mitochondrial dysfunction and dilated cardiomyopathy, leading to premature death. However, the molecular mechanisms underlying the cause of mitochondrial dysfunction in Barth syndrome remain poorly understood. Here we investigated the role of TAZ in regulating mitochondrial function and mitophagy. Using primary mouse embryonic fibroblasts (MEFs) with doxycycline-inducible knockdown of Taz, we showed that TAZ deficiency in MEFs caused defective mitophagosome biogenesis, but not other autophagic processes. Consistent with a key role of mitophagy in mitochondria quality control, TAZ deficiency in MEFs also led to impaired oxidative phosphorylation and severe oxidative stress. Together, these findings provide key insights on mitochondrial dysfunction in Barth syndrome, suggesting that pharmacological restoration of mitophagy may provide a novel treatment for this lethal condition.

Abstract P5-12-04: De-escalating doses of letrozole in post menopausal women at high risk for breast cancer

Background: Although breast cancer (BC) may occur at any age, its prevalence is greater postmenopause. Greater than 75 % of postmenopausal BCs are hormone dependent. Aromatase inhibitors suppress postmenopausal estrogen biosynthesis. Letrozole has demonstrated efficacy against BC in the adjuvant and metastatic setting at the treatment dose of 2.5 mg daily. Its potential role in BC prevention has been inferred from reductions in contralateral BCs. Its side effect profile, similar to other AIs, includes exacerbation of menopausal symptoms that negatively impact quality of life (QOL) and may result in discontinuation of the drug. Both anastrazole and exemestane have been demonstrated to reduce BC in high-risk women.

Hypothesis: Lower and intermittent doses of letrozole effectively suppress estrogen in the high-risk postmenopausal woman and provide a better side effect profile.

Methods: A randomized, double-blind study comparing the impact of varying letrozole doses (2.5 mg daily, 2.5 mg MWF, 1.0 mg MWF, or 0.25 mg MWF) on estrogen suppression and side effects--lipids, bone resorption, menopause, and QOL-- was conducted. Participants randomized to intermittent dosing received placebo on nontreatment days.

Results: 112 participants were enrolled at 2 clinical sites. Mean patient age was 62.8 years, and average BMI was 29.8. Analysis of available data after 24 weeks of therapy revealed statistically significant increase in triglycerides (N=94): 114.67±48.39 to 125.79±54.31 (p&lt;0.01); vasomotor symptoms (N=95): 2.25±1.26 to 2.74±1.67 (p&lt;0.01); and C-telopeptide (N=75): 0.39±0.23 to 0.55±0.28 (p&lt;0.0001). Statistically significant decrease in estradiol (N=68): 5.57±5.19 to 1.26±1.41 (p&lt;0.0001) and estrone (N=68): 22.39±13.02 to 1.64±2.66 (p&lt;0.0001) were observed. No differences in QOL (SF 36) were noted after letrozole treatment. P-values were derived from paired t-test (signed rank test) for the difference between baseline and after 24 weeks of study drug.

Conclusions: De-escalating doses of letrozole suppress postmenopausal estrogen effectively and result in statistically significant increases in triglycerides, C-telopeptide and vasomotor symptoms without impact on QOL. Presentation will include unblinded intervention arm outcomes.

Citation Format: Ana Maria Lopez, Hsiao Hui Sherry Chow, Denise Frank, Sandhya Puthi, Judy Boughey, Paul Hsu, Jose Guillen, Marjorie Perloff, Michelle Ley, Julie E Lang. De-escalating doses of letrozole in post menopausal women at high risk for breast cancer [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P5-12-04.

Sustained outcomes following mild traumatic brain injury: results of a five-emergency department longitudinal study

OBJECTIVE

To report on the occurrence of sustained outcomes including post-concussion symptoms, health services used and indicators of social disruption following a mild traumatic brain injury (MTBI).

RESEARCH DESIGN

A dual cohort comparing MTBI Emergency Department (ED) patients and a comparison group of non-head injured ED patients.

METHODS AND PROCEDURES

The outcomes measures employed were the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) and indicators of health services used and social disruption all recorded at the ED and at 3 and 6 months post-ED discharge. 'Sustained' meant a positive response to these measures at 3 and 6 months.

MAIN OUTCOMES AND RESULTS

Reasonable follow-up success was achieved at 3 and 6 months and the cohorts were alike on all demographic descriptors. RPQ average score and symptom occurrence were far more frequent among MTBI patients than for the comparison cohort from 3 to 6 months. The use of health services and indicators of social disruption were also more frequent among MTBI post-discharge patients.

CONCLUSIONS

These findings argue that some with an MTBI suffer real complaints and they are sustained from 3 to at least 6 months. More effort should be given toward specificity of these symptoms from those reported by members of the comparison group.

Rehabilitation after trauma; does age matter?

BACKGROUND

Variability exits in the ability to predict overall recovery after trauma and inpatient rehabilitation. The aim of this study was to identify factors predicting functional improvement in trauma patients undergoing inpatient rehabilitation.

METHODS

We performed a 3-y retrospective cohort analysis on a prospectively collected database of all trauma patients discharged from a level I trauma center to a single inpatient rehabilitation center. Patient's Functional Independence Measures (FIM) scores on hospital discharge and on discharge from the rehabilitation center were collected. Delta FIM was defined as the difference in FIM between rehabilitation center discharge and hospital discharge. Multiple linear regressions were performed to identify hospital admission factors associated with delta FIM.

RESULTS

We included 160 patients, 69% were male, mean age 54.6 ± 22 y, and median Injury Severity Score 14 [10-50]. Based on rehabilitation admission FIM scores, 29 were totally dependent and 131 were partially dependent. The mean change in FIM was 39.4 ± 13. Age, gender, Glasgow Coma Scale on presentation, Injury Severity Score, systolic blood pressure on presentation, and intensive care unit length of stay were not predictive of delta FIM. Hospital length of stay and head Abbreviated Injury Score on hospital admission were negative predictors of delta FIM.

CONCLUSIONS

In our study, age as an independent factor was not predictive of functional outcome after injury. The extent of head injury continues to negatively affect the overall functional improvement based on FIM.

Intimate partner violence and anal intercourse in young adult heterosexual relationships

CONTEXT

Although intimate partner violence and anal intercourse are common in young adult relationships, few studies have examined whether these behaviors are associated with each other.

METHODS

Data from 6,280 women aged 18-28 who took part in Wave 3 of the National Longitudinal Study of Adolescent Health were used to examine the association between physical and sexual intimate partner violence and anal intercourse in 10,462 relationships. Multivariate hierarchical random effects models were used to adjust for the clustered survey design and for the multiple relationships reported per participant.

RESULTS

Physical violence occurred in 29% of relationships, sexual violence in 11% and anal intercourse in 14%. The odds that a couple had had anal intercourse were greater among relationships that included physical violence perpetrated by both partners or only by the woman than among nonviolent relationships (odds ratios, 1.7 and 1.9, respectively). The odds of anal intercourse were also elevated among sexually abusive relationships, although only if the woman was the sole victim or the sole perpetrator (1.3 and 2.0, respectively). In relationships that included anal intercourse, the odds of condom use were lower if the woman was a victim of physical violence than if no violence occurred (0.2). Sexual violence was not associated with condom use.

CONCLUSION

Women in physically violent relationships may be at increased risk for STDs because of their elevated exposure to unprotected anal intercourse. More information on the context surrounding anal intercourse and intimate partner violence is needed to understand the nuances of this association.