Exploring chemical space, scaffold diversity, and activity landscape of spleen tyrosine kinase active inhibitors

This study aims to comprehensively characterize 576 inhibitors targeting Spleen Tyrosine Kinase (SYK), a non-receptor tyrosine kinase primarily found in haematopoietic cells, with significant relevance to B-cell receptor function. The objective is to gain insights into the structural requirements essential for potent activity, with implications for various therapeutic applications. Through chemoinformatic analyses, we focus on exploring the chemical space, scaffold diversity, and structure-activity relationships (SAR). By leveraging ECFP4 and MACCS fingerprints, we elucidate the relationship between chemical compounds and visualize the network using RDKit and NetworkX platforms. Additionally, compound clustering and visualization of the associated chemical space aid in understanding overall diversity. The outcomes include identifying consensus diversity patterns to assess global chemical space diversity. Furthermore, incorporating pairwise activity differences enhances the activity landscape visualization, revealing heterogeneous SAR patterns. The dataset analysed in this work has three activity cliff generators, CHEMBL3415598, CHEMBL4780257, and CHEMBL3265037, compounds with high affinity to SYK are very similar to compounds analogues with reasonable potency differences. Overall, this study provides a critical analysis of SYK inhibitors, uncovering potential scaffolds and chemical moieties crucial for their activity, thereby advancing the understanding of their therapeutic potential.

An inventory of human light exposure behaviour

Light exposure is an essential driver of health and well-being, and individual behaviours during rest and activity modulate physiologically relevant aspects of light exposure. Further understanding the behaviours that influence individual photic exposure patterns may provide insight into the volitional contributions to the physiological effects of light and guide behavioural points of intervention. Here, we present a novel, self-reported and psychometrically validated inventory to capture light exposure-related behaviour, the Light Exposure Behaviour Assessment (LEBA). An expert panel prepared the initial 48-item pool spanning different light exposure-related behaviours. Responses, consisting of rating the frequency of engaging in the per-item behaviour on a five-point Likert-type scale, were collected in an online survey yielding responses from a geographically unconstrained sample (690 completed responses, 74 countries, 28 time zones). The exploratory factor analysis (EFA) on an initial subsample (n = 428) rendered a five-factor solution with 25 items (wearing blue light filters, spending time outdoors, using a phone and smartwatch in bed, using light before bedtime, using light in the morning and during daytime). In a confirmatory factor analysis (CFA) performed on an independent subset of participants (n = 262), we removed two additional items to attain the best fit for the five-factor solution (CFI = 0.95, TLI = 0.95, RMSEA = 0.06). The internal consistency reliability coefficient for the total instrument yielded McDonald's Omega = 0.68. Measurement model invariance analysis between native and non-native English speakers showed our model attained the highest level of invariance (residual invariance CFI = 0.95, TLI = 0.95, RMSEA = 0.05). Lastly, a short form of the LEBA (n = 18 items) was developed using Item Response Theory on the complete sample (n = 690). The psychometric properties of the LEBA indicate the usability for measuring light exposure-related behaviours. The instrument may offer a scalable solution to characterise behaviours that influence individual photic exposure patterns in remote samples. The LEBA inventory is available under the open-access CC-BY license. Instrument webpage: https://leba-instrument.org/ GitHub repository containing this manuscript: https://github.com/leba-instrument/leba-manuscript .

Examining the associations between control (primary and secondary) appraisals and posttraumatic stress disorder symptoms in Malaysian and Australian trauma survivors

Background

Little research has considered the influence of culture on control appraisals in the context of posttraumatic stress disorder (PTSD).

Objectives

This study aimed to investigate whether cultural group moderated the relationship between control (primary and secondary) appraisals and PTSD symptoms in trauma survivors from Western (Australian) and Asian (Malaysian) cultural contexts.

Methods

Trauma survivors (107 Australian with European cultural heritage; 121 Malaysian with Malay, Indian or Chinese cultural heritage) completed an online survey assessing PTSD symptoms and appraisals of control.

Results

Cultural group moderated the association between primary control and PTSD symptoms; the positive association was significant for the Australian group but not the Malaysian group. While cultural group did not moderate the association between secondary control and PTSD symptoms, there was an indirect pathway between secondary control appraisals and PTSD symptoms through interdependent self-construal for both cultural groups.

Conclusion

The findings indicate that cultural group and self-construal influence the associations between different types of control appraisals and PTSD. Further research exploring the role of culture and different appraisal types in PTSD is needed.

Cost of Acute and Sequelae Care for Japanese Encephalitis Patients, Bangladesh, 2011-2021

Japanese encephalitis (JE) is associated with an immense social and economic burden. Published cost-of-illness data come primarily from decades-old studies. To determine the cost of care for patients with acute JE and initial and long-term sequelae from the societal perspective, we recruited patients with laboratory-confirmed JE from the past 10 years of JE surveillance in Bangladesh and categorized them as acute care, initial sequalae, and long-term sequelae patients. Among 157 patients, we categorized 55 as acute, 65 as initial sequelae (53 as both categories), and 90 as long-term sequelae. The average (median) societal cost of an acute JE episode was US $929 ($909), of initial sequelae US $75 ($33), and of long-term sequelae US $47 ($14). Most families perceived the effect of JE on their well-being to be extreme and had sustained debt for JE expenses. Our data about the high cost of JE can be used by decision makers in Bangladesh.

Ultrasound simulation training to meet the 2021 Royal College of Radiologists' curriculum for radiology trainees: South East London experience

AIM

To enhance ultrasound teaching delivery to radiology trainees using a simulation course matched to the 2021 Royal College of Radiologists (RCR) curriculum.

MATERIAL AND METHODS

An ultrasound simulation training course was designed for specialty trainees (ST) 1 in radiology, which was based on the 2021 RCR curriculum and covered the top ultrasound training priorities. The course was piloted initially on two occasions in a 1-day format to the August 2021 and the March 2022 ST1 intake trainees. Based on the feedback, a comprehensive 4-day course was developed and delivered between October and December 2022 for the August 2022 ST1 intake, funded by Health Education England. The outcomes measured were subjective trainee feedback using numerical scores and free text.

RESULTS

All King's College Hospital NHS Foundation Trust radiology ST1 trainees from the August 2021 to the August 2022 intake participated in ultrasound simulation training. The training matched the RCR curriculum and increased the trainees' confidence and competency in medical ultrasound.

CONCLUSIONS

Ultrasound simulation training can be successfully delivered to ST1 trainees to match the 2021 RCR curriculum and enhance training in medical ultrasound for radiologists.

Mental health and suicide risk among homosexual males in Bangladesh

BACKGROUND

Homosexual individuals are at high risk of suicide, but there is a shortage of data from developing countries to confirm this. Estimates on mental health and suicide risk among male homosexuals in Bangladesh are needed to generate awareness and to plan services accordingly.

METHOD

We assessed mental health and suicidal behavior of 102 self-identified homosexual males from a community-based organization that works with the sexual minority population.

RESULTS

One-third of the participants (32.4%) had experienced attempted suicide, and almost half (47.1%) had a history of suicidal ideation and self-harm (40.2%). Compared to a heterosexual sample, homosexual males had poorer mental health as they scored higher on Beck Hopelessness Scale (Cohen's d = 0.29) and General Health Questionnaire (GHQ) (Cohen's d = 0.57). The results revealed positive correlations between self-harm, suicidal ideation and suicide attempt scores. Participants with history of suicide attempt, suicide ideation and self-harm reported worse general health, more social dysfunction, and severe depression than those without such history.

CONCLUSION

Suicidality and mental health conditions among homosexual males in Bangladesh have appeared to be alarming. Given the concerns, we offer some recommendations for practitioners and social workers who are serving this population in Bangladesh.

Light exposure behaviors predict mood, memory and sleep quality

Ample research has shown that light influences our emotions, cognition, and sleep quality. However, little work has examined whether different light exposure-related behaviors, such as daytime exposure to electric light and nighttime usage of gadgets, especially before sleep, influence sleep quality and cognition. Three-hundred-and-one Malaysian adults (Mean_Age±SD = 28 ± 9) completed the Light Exposure Behavior Assessment tool that measured five light exposure behaviors. They also completed the Morningness-Eveningness Questionnaire, Positive and Negative Affect Schedule, Pittsburgh Sleep Quality Index, and single items assessing trouble in memory and concentration. A partial least square structural equation model, showing 72.72% predictive power, revealed that less use of wearable blue filters outdoors during the day and more within one hour before sleep predicted early peak time (direct effect = -0.25). Increased time spent outdoors predicted a positive affect (direct effect = 0.33) and a circadian phase advancement (direct effect: rising time = 0.14, peak time = 0.20, retiring time = 0.17). Increased use of mobile phone before sleep predicted a circadian phase delay (direct effect: retiring time = -0.25; rising time = -0.23; peak time = -0.22; morning affect = -0.12), reduced sleep quality (direct effect = 0.13), and increased trouble in memory and concentration (total effect = 0.20 and 0.23, respectively). Increased use of tunable, LED, or dawn-simulating electric light in the morning and daytime predicted a circadian phase advancement (direct effect: peak time = 0.15, morning affect = 0.14, retiring time = 0.15) and good sleep quality (direct effect = -0.16). The results provide valuable insights into developing a healthy light diet to promote health and wellness.

The impact of state paid sick leave policies on weekday workplace mobility during the COVID-19 pandemic

OBJECTIVES

This study aimed to evaluate whether the Families First Coronavirus Response Act (FFCRA) modified the association between pre-existing state paid sick leave (PSL) and weekday workplace mobility between February 15 and July 7, 2020.

STUDY DESIGN

This was a longitudinal, observational study.

METHODS

The 50 US states and Washington, D.C., were divided into exposure groups based on the presence or absence of pre-existing state PSL policies. Derived from Google COVID-19 Community Mobility Reports, the outcome was measured as the daily percent change in weekday workplace mobility. Mixed-effects, interrupted time series regression was performed to evaluate weekday workplace mobility after the implementation of the FFCRA on April 1, 2020.

RESULTS

States with pre-existing PSL policies exhibited a greater drop in mobility following the passage of the FFCRA (β = -8.86, 95% confidence interval: -11.6, -6.10, P < 001). This remained significant after adjusting for state-level health, economic, and sociodemographic indicators (β = -3.13, 95% confidence interval: -5.92, -0.34; P = .039).

CONCLUSIONS

Pre-existing PSL policies were associated with a significant decline in weekday workplace mobility after the FFCRA, which may have influenced local health outcomes. The presence of pre-existing state policies may differentially influence the impact of federal legislation enacted during emergencies.

Modifiable and nonmodifiable factors associated with anxiety, depression, and stress after one year of the COVID-19 pandemic

BACKGROUND

People worldwide have experienced various mental health issues during the COVID-19 pandemic. This study investigates the modifiable and nonmodifiable predictors of anxiety, depression, and stress among Bangladeshi participants after one year of the pandemic.

METHOD

A large group of adult participants (N = 1897), recruited from eight administrative divisions in Bangladesh, completed an online survey in May and June 2021 when the Movement Control Order was in place. We used the Beck Anxiety Inventory, Patient Health Questionnaire-9, and Perceived Stress Scale-4 to assess the participants' anxiety, depression, and stress. We also gave the Mindful Attention Awareness Scale and Life-Orientation Test-Revised to assess mindfulness and optimism.

RESULTS

The results revealed that the prevalence rates for anxiety and depression were 62.5% and 45.3%, respectively. Multivariate analyses showed that several nonmodifiable factors, such as those who were students, unmarried and females, and those living in the Northern region (Rajshahi and Mymensingh division) and dwelling in the rural areas, suffered from worse mental health (accounted for 5%-23% of the variances in the mental health outcome scores). Modifiable factors accounted for an additional 10%-25% of the variances in the same outcome variables. Adults with higher mindfulness and optimism, living in the country's Southern region (Chattogram division) and those who took both vaccine doses and had no history of mental illness reported better mental health.

CONCLUSION

Anxiety, depression, and stress remained high in Bangladeshi adults after one year of the pandemic. The community-based interventions should aim to increase the mindfulness and optimism levels among the sufferers. More accelerated vaccination programs across the country could protect people from suffering from overall mental distress.

Exploring the associations between social support and symptoms of posttraumatic stress disorder among Malaysian and Australian trauma survivors

Background: Social support is an important feature in understanding posttraumatic stress disorder (PTSD) and its treatment. Non-clinical research has identified distinct profiles of culturally appropriate social support. Despite this, little research has examined cultural influences on social support in the context of PTSD.Objective: This study examined cultural differences in the associations between social support and symptoms of PTSD.Method: The study employed a cross-sectional design. Australian (n = 91) and Malaysian (n = 91) trauma survivors completed an online survey assessing PTSD symptomatology and social support (explicit and implicit social support, perceived helpfulness of support provider, attitudes towards professional help-seeking). A quasi-experimental paradigm assessed the influence of mutual (i.e. the sharing of support between relationship partners) and non-mutual support (i.e. where one person constantly receives support, while the other person constantly provides support) on negative emotion and subjective distress.Results: First, explicit social support was negatively associated with PTSD symptoms for the Australian group but not the Malaysian group. Second, perceived helpfulness of support from family was negatively associated with PTSD symptoms for the Malaysian group but not the Australian group. Third, the Malaysian group reported significantly greater distress for non-mutual support and significantly fewer negative emotions and distress for mutual support than the Australian group. Fourth, the Malaysian group reported that they were significantly more open to acknowledging psychological problems and the possibility of seeking professional help for these problems than the Australian group.Conclusions: As the PTSD social support literature continues to evolve, it is essential that cultural influences are considered given the important theoretical and clinical implications.

Does culture moderate the relationships between rumination and symptoms of posttraumatic stress disorder and depression?

Brooding rumination is positively associated with symptoms of both depression and posttraumatic stress disorder (PTSD). However, non-clinical cross-cultural research indicates that culture may influence these associations. This study aimed to examine the moderating effect of cultural group (Australian versus Malaysian) on the associations between brooding rumination and symptoms of depression and PTSD. European Australians (n = 109) and Malaysians of varying Asian heritages (n = 144) completed an online questionnaire containing the Hospital Anxiety and Depression Scale, PTSD checklist for DSM-5 and the Ruminative Response Scale-Short Form. First, Malaysian participants had higher brooding rumination than Australian participants. Second, higher levels of brooding rumination were positively associated with depression and PTSD symptom severity. Third, contrary to our expectations, cultural group did not moderate the relationships between brooding rumination and symptoms of depression and PTSD. If replicable, these results suggest that existing assessment and treatment approaches that target brooding rumination may apply to Malaysian individuals with depression and PTSD.

Psychometric evaluation of the Bangla-Translated Rotter’s Internal-External Scale through classical test theory and item response theory

There is no psychometric tool to assess locus of control for Bangla-speaking people. Hence, we attempted to translate the 23-item Rotter’s Internal-External scale into Bangla and validate it on Bangladeshi adult participants. In Study 1 (N = 300), we translated the items into Bangla and conducted an exploratory factor analysis, which gave a one-factor solution with 12 items. In Study 2, we conducted a validation study (N = 178) to accumulate evidence on the structural and concurrent validity of the 12-item scale. Structural validity assessed by confirmatory factor analysis yielded the best fit for the one-factor model with 11 items (CFI = 0.98, TLI = 0.97, RMSEA = 0.00). The scale’s significant correlations with Internal Control Index, which is also a measure of locus of control (r = −0.22, p &lt; 0.01), Neuroticism (r = 0.21, p &lt; 0.01) and Openness to Experience (r = −0.22, p &lt; 0.01) demonstrated its satisfactory concurrent validity. Reliability coefficient of this 11-item scale was satisfactory (McDonald’s Omega total = 0.72). The item quality was assessed on the combined samples of Study 1 &amp; 2 (N = 478) using the item response theory (IRT), which showed that the scale covered a sizable range of the underlying locus of control with items varying in difficulty (−1.09–2.79). Item discrimination analysis indicated sufficient discriminating power of the items (0.49–2.21). The test information curve showed the scale’s adequate ability to discriminate between external and internal locus of control. IRT analysis also indicated satisfactory marginal reliability for the scale (0.72). These psychometric properties suggest the usability of the Bangla version of Rotter’s Internal-External scale.

POS0756 DETERMINANTS OF HEALTH-RELATED QUALITY OF LIFE (HR-QoL) ACROSS THE SPECTRUM OF SYSTEMIC AUTOIMMUNE RHEUMATIC DISEASES: RESULTS FROM THE LEAP COHORT

Background

Poor health-related quality of life (HR-QoL) is recognised in patients with established connective tissue diseases (CTDs), however it is not clear how it affects patients with undifferentiated CTD (UCTD) which has traditionally been associated with a mild or more benign profile.

Objectives

To investigate HR-QoL in patients affected with a variety of CTDs (including UCTD) using the SF-36 questionnaire; and secondly, to review demographic and clinical factors predictive of a poor HR-QoL

Methods

The Lupus Extended Autoimmune Phenotype (LEAP) cohort is a multicentre prospective study of patients with a CTD. Rheumatologist diagnosis was used to classify patients into four groups: systemic lupus erythematosus (SLE), primary Sjögren’s syndrome (pSS), UCTD, and (combined because of low numbers) those with an idiopathic inflammatory myopathy (IIM), systemic sclerosis (SSc) or overlap syndrome. The SF-36 quality of life questionnaire was completed at enrolment and includes eight domains: physical function (PF), role physical (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role emotional (RE) and mental health (MH) which range from 0 to 100, with higher scores reflecting better HR-QoL. Physical (PCS) and mental component score (MCS) were calculated for each group, with a score below 50 representing a worse HR-QoL compared to the general UK population. Predictors for poor HR-QoL was chosen a priori, then tested using linear regression adjusted for age, gender and ethnicity. All statistical analysis was performed using STATA v14, with results expressed as beta coefficients with 95% confidence intervals (95%CI).

Results

Data were collected from 309 patients (280 [90.6%] women, with a mean [SD] age of 48.9 [12.9] years) from three UK rheumatology centres. The majority of patients were Caucasian (n=235, 76.1%). By rheumatologist diagnosis, 115 (37.2%) had SLE, 56 (18.1%) pSS, 72 (23.3%) UCTD and 66 (21.4%) SSc, IIM or an overlap syndrome. Patients with UCTD, pSS and SSc/IIM spectrum disorders had a shorter median disease duration (3.8, 3.7 and 6.1 years respectively) compared with patients with those with SLE (11.0 years), p<0.001. Previous steroid and immunosuppressant use was highest in patients with SLE and SSc/IIM spectrum disorders (p<0.001). The most affected domains include VT, GH and BP (Figure 1), and the PCS is more impaired compared with the MCS, with similar scores across disease groups. Agnostic of disease group, factors associated with a lower PCS include increasing age (beta -0.15 [95%CI -0.26, -0.06], p=0.008), prednisolone use (-3.1 [-6.05, -0.19], p=0.037), c-reactive protein (-0.09 [-0.62, -0.10], p=0.007), fatigue (-2.00 [-3.79, -0.22], p=0.028), and sicca syndrome (-4.70 [-7.66, -1.74] p=0.002), and these remained significant in a multivariate model.

Figure 1.

radar diagrams of eight SF-36 domains, and MCS and PCS boxplots. SLE; systemic lupus erythematosus; UCTD, undifferentiated CTD; pSS, primary Sjögren’s syndrome; IIM, idiopathic inflammatory myopathy; SSc, systemic sclerosis; PF, physical function; RP, role physical; BP, bodily pain; GH, general health; VT, vitality; SF, social functioning; RE, role emotional; MH, mental health

Conclusion

Patients with UCTD exhibit similar impairment in physical components of HR-QoL compared with other established CTDs, despite perceived differences in disease severity. This study highlights sicca syndrome, fatigue, and steroid burden as key targets for improving HR-QoL in patients across the spectrum of CTDs.

Disclosure of Interests

Sarah Dyball Grant/research support from: UCB and Eli Lilly, John Reynolds: None declared, Ariane Herrick Speakers bureau: Janssen, Consultant of: Arena, Boehringer-Ingelheim, Camurus, CSL-Behring, and Gesynta, Grant/research support from: Gesynta, Hector Chinoy Speakers bureau: UCB, Biogen, Consultant of: Novartis, Eli Lilly, Orphazyme, Astra Zeneca, Grant/research support from: Eli Lilly and UCB, Sahena Haque: None declared, Sophia Naz: None declared, Ellen Bruce: None declared, Ian N. Bruce Speakers bureau: AstraZeneca, GSK and UCB, Consultant of: AstraZeneca, Eli Lilly, GSK, Merck Serono, UCB and ILTOO, Grant/research support from: Genzyme/Sanofi, GSK, Roche and UCB, Ben Parker Speakers bureau: Eli Lilly and Roche, Consultant of: Fresenius-Kabi and AbbVie, Grant/research support from: Genzyme/Sanofi and GSK

Peer-Assisted skills learning in structured undergraduate medical curriculum: An experiential perspective of tutors and tutees

Background and Aims

: This study aims to evaluate the implication of peer-assisted learning model adopted in students' clinical skills training from the perspective of tutees and tutors at the end of a peer-tutored clinical skills program and peer tutors themselves.

Subjects and Methods

This cross-sectional study was conducted in the Faculty of Medicine, Bursa Uludag in between January and March 2018. Following the clinical skills training, a questionnaire designed to assess the views of tutees and peer tutors was filled out on a voluntary basis by 159 tutees and 43 tutors. The statistical analysis of the collected and processed data was analyzed by using IBM SPSS 23.0 statistical program. The statistical significance level was maintained as α = 0.05.

Results

According to the Likert scale, satisfaction with the tutors and the educational environment was high in general. The 2^nd term tutees provided more negative feedback compared to other terms. Among all the terms, the most positive answers were provided by the 3^rd term students. Although the tutors found themselves fully skilled in communication with colleagues, there were striking differences between the tutors in the 5^th and 6^th terms of providing a good role model for pre-clinical terms students.

Conclusion

Considering peer assisted learning (PAL)'s positive responses from this study, the adoption of PAL has been started to be used as a supplementary teaching method for the clinical skills training at the Faculty of Medicine, Bursa Uludag University. PAL is considered a successful education model since it is cost-efficient for undergraduate medical training and improves the professional skills of both teacher and learner students. It can be availed of as an alternative method in medical faculties where especially the number of academic members is insufficient.

Estimation of Serum Fibrinogen in Males with Type 2 Diabetes

The patient with diabetes mellitus (DM) and its complication is increasing in our country and all over the world. Fibrinogen is a renowned factor of progressive atherosclerotic lesions and a predictor of cardiovascular events. Level of fibrinogen is increases in patients with diabetes mellitus (DM) may accelerate thromboembolic risk for cardiovascular disease (CVD). This study was carried out to assess plasma fibrinogen level in subjects with type 2 diabetes mellitus. It was a cross sectional analytic study and conducted in the Department of Physiology, Dhaka Medical College, Dhaka, Bangladesh from July 2013 to June 2014. A total number of 200 adult male subjects were selected with age ranging from 40-60 years. Among them, 100 subjects with type 2 diabetes mellitus were included in the study group (Group B) and 100 healthy subjects with same age range were considered as controls (Group A) for comparison. The subjects were selected from BIRDEM hospital Dhaka and personal contact from different areas of Dhaka city on the basis of exclusion and inclusion criteria. The study parameter was plasma fibrinogen level, and was measured in the Department of Microbiology and Immunology of BIRDEM hospital, Dhaka, Bangladesh. The data were collected and recorded in pre-designed structured questionnaire by the researcher herself. For statistical analyses unpaired Student's 't' test and Pearson's correlation coefficient (r) test were performed as applicable using SPSS for windows version 19.0. In this study plasma fibrinogen level was significantly (p<0.001) higher in the study group than that of control group. From this study, it may be concluded that estimation of plasma fibrinogen level might be beneficial for prediction of future cardiovascular risk in adult diabetic male.

168 Innovation Surgical Leadership: Future Directions

Aim

Which theories, concepts and frameworks have been evidenced for surgical innovation in leadership in the United Kingdom, European Union, and the United States of America?

Method

Systematic scoping synthesis of literature will be employed where appropriate theories, concepts and frameworks will be identified. Drawing upon broader literature on leadership innovation in surgery further examples will be utilised within surgery. s and full- text articles will be used and reviewed for relevance to the research question against an inclusion and exclusion criteria.

Results

The theories of innovative leadership in surgery are broad and non-specific. It demands a professionalism, competence, teamwork, and motivation. Upon comparison of the three country/region profiles there are strong similarities but present differences. It is paramount to understand and underpin these theories in order to foster the future of innovation in surgery. Surgery is fast evolving and developments in leadership must evolve with it. Within innovation, leadership skills must be harnessed including experience and observation. It is through an interprofessional team that surgeons must collaborate in order to provide optimum results and to permit the profession to evolve.

Conclusions

Innovation and surgery are symbiotic, and the next generation of surgical leaders must foster an environment where this is possible to cultivate. Programmes across these country profiles must ensure innovative leadership is present through good mentorship, coaching, team empowerment and feedback. Future directions must be put in place in post -graduate surgical training programmes to ensure that patient care is optimised as the primary objective.

408 Blood Parameters as an Early Indicator of Complications Following Oesophagogastric Resection

Aim

Oesophageal and gastric cancers are the eighth and fifth most prevalent cancers with a high degree of morbidity and mortality. Oesophagogastric resections are associated with a high degree of complications postoperatively. Complications following resection are associated with poorer hospital recovery, recurrence of cancer, readmission to hospital and increased mortality. A study was carried out to examine if there was an association between post-operative bloods and the development of complications.

Method

Data was collected from theatre logbooks, Integrated Clinical Environment (ICE) and clinical portal. Patients undergoing oesophagogastric resection for gastric and oesophageal cancer between October 2010 and November 2014 were included. Complications were organised using the Clavien Dindo classification. Data was analysed using the Student’ T test and Chi-Squared test. A P-value of 0.05 was classed as being statiscally significant.

Results

94 patients met the inclusion criteria for this study. 55 patients (58.5%) underwent Oesophagectomy, 18 (19.1%) total gastrectomy and 21 (22.3%) partial gastrectomy. A significant association was seen between development of complications and higher Day 5 White Cell count (WCC) (p = 0.048), lower Day 2–5 Albumin (Day 2 Albumin p = 0.038) and higher Day 2–5 C Reactive Protein (CRP) (Day 2 CRP p&lt;0.001).

Conclusions

This study suggests Albumin, CRP and WCC may be used to predict postoperative complications in patients undergoing oesophagogastric resections for malignancy. Changes in the blood parameters present as early as day 2 postoperatively and can highlight patients who require closer monitoring, allowing earlier re-intervention if required.

Culture and understanding the role of feedback for health professions students: realist synthesis protocol

INTRODUCTION

Clinical education has moved to a 'competency-based' model with an emphasis on workplace-based learning and assessment which, in turn, depends on feedback to be effective. Further, the understanding of feedback has changed from information about a performance directed to the learner performing the task, to a dialogue, which enables the learner to act and develop.In health professional education, feedback is a complex interaction between trainee, supervisor and the healthcare system. Most published research on feedback in health professional education originates in Europe and North America. Our interest is on the impact of Culture on this process, particularly in the context of Asian cultures.The (scientific) realist approach of Pawson and Tilley provides a means to examine complex interventions in social situations, and thus is an appropriate lens to use for this study. This is a protocol for a realist synthesis which asks how, why and in what circumstances do Asian Cultures influence health professional trainees to seek, respond to and use feedback given in the clinical environment, if at all.

METHODS AND ANALYSIS

An initial search was performed to help define the scope of the review question and develop our initial programme theory. The formal electronic search was carried out in February 2020 and included: CINAHL, ERIC, Medline and PsycInfo, and repeated in October 2020. Retrieved articles were imported into Covidence for screening and data extraction, after which components of the Context-Mechanisms-Outcomes configurations will be sought to refine the initial programme theory.

ETHICS AND DISSEMINATION

As this study is a literature review, ethics approval is not required.The findings will be documented in line with the RAMESES (Realist And MEta-narrative Evidence Syntheses: Evolving Standards) publications standards for Realist syntheses, and we plan to disseminate the findings by means of a peer-reviewed journal article and conference presentation(s).

Effects of Daytime Electric Light Exposure on Human Alertness and Higher Cognitive Functions: A Systematic Review

This paper reports the results of a systematic review conducted on articles examining the effects of daytime electric light exposure on alertness and higher cognitive functions. For this, we selected 59 quantitative research articles from 11 online databases. The review protocol was registered with PROSPERO (CRD42020157603). The results showed that both short-wavelength dominant light exposure and higher intensity white light exposure induced alertness. However, those influences depended on factors like the participants' homeostatic sleep drive and the time of day the participants received the light exposure. The relationship between light exposure and higher cognitive functions was not as straightforward as the alerting effect. The optimal light property for higher cognitive functions was reported dependent on other factors, such as task complexity and properties of control light. Among the studies with short-wavelength dominant light exposure, ten studies (morning: 3; afternoon: 7) reported beneficial effects on simple task performances (reaction time), and four studies (morning: 3; afternoon: 1) on complex task performances. Four studies with higher intensity white light exposure (morning: 3; afternoon: 1) reported beneficial effects on simple task performance and nine studies (morning: 5; afternoon: 4) on complex task performance. Short-wavelength dominant light exposure with higher light intensity induced a beneficial effect on alertness and simple task performances. However, those effects did not hold for complex task performances. The results indicate the need for further studies to understand the influence of short-wavelength dominant light exposure with higher illuminance on alertness and higher cognitive functions.

Examining Cultural Differences in the Associations between Appraisals and Emotion Regulation and PostTraumatic Stress Disorder in Malaysian and Australian Trauma Survivors

Appraisals and emotional regulation play a central role in posttraumatic stress disorder (PTSD). Despite research demonstrating cultural differences in everyday appraisals and emotion regulation, little research has investigated the influence of culture on these processes in PTSD. This study examined cultural differences in the associations between appraisals, emotion regulation and PTSD symptoms using trauma survivors from an individualistic Western culture (Australia) and a collectivistic Asian culture (Malaysia). Trauma survivors (N = 228; 107 Australian with European cultural heritage, 121 Malaysian with Malay, Indian or Chinese cultural heritage) completed an on-line survey assessing PTSD (PTSD Checklist for the DSM-5 with Life Events Checklist), appraisals (trauma-related, fatalism, cultural beliefs about adversity) and emotion regulation (suppression, reappraisal, interpersonal). The Malaysian group reported significantly greater fatalism, cultural beliefs about adversity, suppression and interpersonal emotion regulation than the Australian group. Greater trauma-specific appraisals, greater suppression, fewer cultural beliefs about adversity, and less use of social skills to enhance positivity were generally associated with greater PTSD symptom severity, with little evidence of cultural group moderating these associations. Interdependent self-construal mediated the relationships between cultural adversity beliefs, enhanced positivity, reappraisal, perspective taking and PTSD symptoms. Independent self-construal mediated the relationships between fatalism and perspective taking and PTSD symptoms. Cultural group did not moderate these indirect effects. Interdependent self-construal mediated the associations between interpersonal regulation strategies of soothing and social modelling with PTSD symptoms for the Malaysian but not the Australian group. These findings demonstrate the importance of considering self-construal and culture in understanding factors associated with PTSD.

Implementation research on kangaroo mother care, Bangladesh

Objective

To describe the implementation, coverage and performance of the national kangaroo mother care programme in Bangladesh.

Methods

Kangaroo mother care services for clinically stable babies with birth weight under 2000 g were set up in government-run health-care facilities in rural and urban areas of Bangladesh. Each facility provided counselling on kangaroo mother care, ensured adequate nutrition, and followed up mothers and babies. We studied implementation of the programme from January 2016 to March 2020 using data from the national database. We tracked the number of eligible babies enrolled and their outcomes, mortality and post-discharge follow-up.

Findings

The numbers of kangaroo mother care facilities increased from 16 in 2016 to 108 in 2020. Over the 4-year period 64 426 babies weighing under 2000 g were born in these facilities,  6410 of whom received kangaroo mother care. The quarterly percentage of eligible babies receiving kangaroo mother care increased from 4.7% (37/792) during the first quarter to 21.7% (917/4226) during the last five quarters of the programme. Deaths of babies receiving kangaroo mother care showed a downward trend over the study period. The overall mortality was 1.2% (77/6410), with large quarterly fluctuations in mortality. Post-discharge follow-up was low and only 15–20% of babies received four follow-up visits.

Conclusion

Implementation of kangaroo mother care interventions is feasible in low-resource settings. Such care has the potential to reduce mortality among low-birth-weight and premature babies. Challenges include low coverage, expanding the programme to the community and strengthening the monitoring system.

COVID-19 pandemic related excessive electronic media exposure and mental health in Saudi Arabia

OBJECTIVE

Due to the continued spread of COVID-19 and the emergence of novel mutated viral variants, families all over the world are experiencing wide-ranging stressors that threaten not only their financial well-being but also their physical and mental health. The present study assessed the association between excessive electronic media exposure of pandemic-related news and mental health of the residents of Ha'il Province, Saudi Arabia. The present study also assessed the prevalence of perceived stress, fear of COVID-19, anxiety, depression, and loneliness due to COVID-19-related restrictions in the same population.

MATERIALS AND METHODS

A total of 490 residents of Ha'il Province participated in a cross-sectional online survey during a two-month period (March to April 2021). A validated 38-item self-report survey was used to collect the data.

RESULTS

Significant associations were reported between excessive electronic media exposure and the prevalence of perceived stress (χ2=140.56; p<.001), generalized anxiety (χ2=74.55; p<.001), depression (χ2=71.58; p<.001), COVID-19-related fear (χ2=24.54; p<.001), and loneliness (χ2=11.46; p<.001). It was also found that participants without depressive symptoms were 0.28 times less likely to have been exposed to excessive electronic media exposure (AOR: 0.28; C.I. 0.16-0.48; p<.001). Similarly, participants with no stress/mild stress were 0.32 times less likely to have been exposed to excessive electronic media exposure (AOR: 0.32; C.I. 0.19-0.52; p<.001).

CONCLUSIONS

The findings of the present study suggest an urgent need for educational resilience programs (online and in-person) for susceptible individuals (females, unemployed, urban residents, etc.). Such programs would help them to develop skills to cope with the psychological impact of the COVID-19 pandemic.

Autobiographical memory impairment among Rohingya refugee people: roles of direct and indirect trauma exposures and PTSD symptom severity

Literature indicates that trauma exposure leads to autobiographical memory (AM) impairment, but the differential effects of direct and indirect trauma on memory remain unclear. We investigated AMs of 100 Rohingya refugees (Mean_age= 35.79; SD_age= 15.36) recruited from camps in Bangladesh and communities in Malaysia. Each participant retrieved ten memories to word cues and rated to what extent those memories were self-defining on a 5-point scale. They also completed the PTSD-8 scale and a trauma checklist reporting the types of traumatic events they experienced. Results showed that participants with frequent exposure to direct and indirect trauma recalled more traumatic memories. Surprisingly, more direct-trauma memories appeared to be specific than indirect trauma and non-trauma memories. As expected, individuals who scored higher on the PTSD-8 scale recalled more non-specific AMs. Rohingyas in Bangladesh who migrated months before data collection, thus retaining recent trauma experiences , retrieved more non-specific memories than those in Malaysia who migrated years ago. The direct trauma memories of the Malaysian cohort were more self-defining than their counterparts. The participant's ability to recall more direct trauma memories with specificity could be attributed to the repeated recall of those memories to the relevant authorities of the host countries to justify their refugee status.

891 Fasting Times in Trauma List Patients

Introduction

To reduce the risk of regurgitation and aspiration of gastric contents, patients are to fast before anaesthesia. However, prolonged periods of fasting have been found to be unnecessary and potentially harmful. Our aim was to compare pre-operative fasting times in trauma patients against the AAGBI (Association of Anaesthetists of Great Britain and Ireland) guidelines and highlight areas for improvement. The AAGBI recommends minimum fasting periods of:

Method

50 patients were audited in each cycle. Data were collected prospectively using questionnaires in the initial audit and by interviewing patients in the re-audit. Patients in ITU and those with dementia were excluded. Questions included fasting instructions given, time of the last meal and drink (including kind of drink), IV fluids administration. Anaesthetic notes were checked for time of induction of anaesthesia.

Results

Average time fasted for food was 17.09 hours and 9.32 hours for water. In the re-audit, average time fasted was 16.43 hours for food and 5.27 hours for water. All the patients received information as to when they could eat or drink until. None of them was told ‘midnight’.

Conclusions

Although there was an improvement, this was still beyond the guidelines. The results highlighted the importance of regularly reviewing the fasting status throughout the day in order to achieve the standard.

414 Informed Consent for Neck of Femur Fracture Surgery During the Covid-19 Pandemic: An Evidence-Based Approach

Background

Surgical intervention for neck of femur fractures continues to be prioritised during the Covid-19 pandemic. However, there remains a lack of clarity for clinicians during the consent process. This study quantifies additional perioperative risks for Covid-19 positive patients undergoing neck of femur fracture surgery and establishes an evidence-based framework for facilitating informed consent during the Covid-19 pandemic.

Method

259 patients undergoing neck of femur fracture surgery in four hospitals at the epicentre of the United Kingdom’s first wave of Covid-19 were recruited. 51 patients were positive for Covid-19. Predefined outcomes were recorded in a 30-day postoperative period.

Results

Odds of intensive care admission were 4.64 times higher (95% CI 1.59-13.50, p = 0.005) and odds of 30-day mortality were 3 times higher (95% CI 1.22-7.40, p = 0.02) in Covid-19 positive patients. 74.5% of Covid-19 positive patients suffered post-operative complications. 35.3% of Covid-19 positive patients developed lower respiratory tract infection with 13.7% progressing to acute respiratory distress syndrome. 9.8% of Covid-19 positive patients experienced symptomatic thromboembolic events with a 3.9% incidence of pulmonary emboli.

Conclusions

The implications of Covid-19 on the informed consent process for neck of femur fracture surgery are profound. Covid-19 positive patients should be consented for increased risk of postoperative complications (including lower respiratory tract infection, acute respiratory distress syndrome and thromboembolic events), longer inpatient stay, increased frequency of intensive care admission and higher risk of mortality.

Variants of SARS-CoV-2, their effects on infection, transmission and neutralization by vaccine-induced antibodies

OBJECTIVE: The current study reviewed Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) variants for their effects on infection, transmission and neutralization by vaccine-induced antibodies. MATERIALS AND METHODS: The research articles for the current study were searched over PubMed, Google Scholar, EMBASE and Web of Science online databases. The keywords used were: (("SARS-CoV-2" OR "COVID-19") AND ("mutation" OR "variant") AND ("death" OR "hospitalization" OR "infection" OR "transmission") AND ("antibody" OR "neutralize" OR "vaccine")). A total of 333 research articles were retrieved through online-database search. These articles were further scrutinized for their relevancy. Additionally, searches were performed to find the latest relevant information over Google search engine and relevant news browsers. Finally, around 35 germane articles were considered for scripting the current report. RESULTS: The mutations have changed amino acids at key positions in spike protein viz. S477N, E484K, Q677H, E484Q, L452R, K417T, K417N and N501Y. These mutations are relevant for different characteristics and are present in newly evolved strains of SARS-CoV-2 like E484K in B.1.526, B.1.525, P.2, B.1.1.7, P.1 and B.1.351. Mutations have increased the immune escape potential leading to 3.5-6.5-folds decrease in neutralization of antibodies (Pfizer and Moderna vaccines). The variant, B.1.617 circulating in India and many other countries (double variant) having E484Q and L452R mutations, has raised the infection rate and decreased the neutralization capacity of the vaccine-induced antibodies. Deadly K417N+E484K+N501Y triplet mutations found in B.1.351 and P.1 have increased the transmission ability of these strains by 50% leading to greater COVID-19 hospitalization, ICU admissions and deaths. CONCLUSIONS: The new SARS-CoV-2 variants have compromised the neutralization potential of the currently used vaccines, but still, they have considerable efficacy to reduce infection and mortality.

Graphical Abstract

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Probing the self-defining period in memories of the Bangladesh independence war generation

This study investigated the self-defining periods (SPs) in private and public memories of Bangladeshi older adults (N = 476; mean age = 67.16 years) who, during adolescence and early adulthood, witnessed the 1960s Bengali nationalist movement and the 1971 Bangladesh War of Independence. Each participant retrieved three private and three public memories they considered to be highly significant. The lifespan distributions for private and public memories were identical; in both cases, participants recalled more than half of their memories from 10 to 29 years of age. The calendar-year distributions revealed that nearly one-fourth of private and one-third of public memories were recalled from the year of the War of Independence. The memory content analysis showed that participants sampled more negative than positive memories: 55% versus 45% for private memory and 66% versus 34% for public memory. The enhanced recollection of private and public memories from 10 to 29 years of age was predominantly shaped by memories of the independence struggle-a period that was self-defining for the entire Bangladeshi society.

Photodiagnostic services in the UK and Republic of Ireland: a British Photodermatology Group Workshop Report

BACKGROUND

Photodiagnostic investigations are essential for the accurate diagnosis of abnormal cutaneous photosensitivity and provide important information for the management of patients with photodermatoses (cutaneous photosensitivity disorders). Although photodiagnosis has been undertaken since the early 1970s, specialist services in the United Kingdom (UK) and Republic of Ireland are limited and there is no formal guidance on diagnostic approach. Indeed, there is a limited literature in this area of methodology and diagnostic practice.

OBJECTIVES

The primary objective was to undertake a British Photodermatology Group Workshop to review the role and activities of specialist centres in the UK and Republic of Ireland in order to ascertain whether there were consensus practices. Secondary objectives were to identify key priorities for service, training and research.

METHODS

An initial detailed survey review of current activities was undertaken prior to the Workshop and data from this survey were used to inform discussion at the Workshop, which was attended by key photodermatology experts from the UK and Republic of Ireland.

RESULTS/CONCLUSIONS

We have undertaken a detailed review of current Photodiagnostic Services in the UK and Republic of Ireland and report on our findings from the 12 centres and we have identified key areas of consensus practice. This is an important step in the process of standardising and optimising procedures and protocols and defining minimum clinical standards for photodiagnostic investigations, which are of such diagnostic importance in Dermatology.

Construction and Validation of a Generational Identity Scale on Bangladeshi Older Adults

There is a lack of a psychometric tool for generational identity. We have conducted two studies involving Bangladeshi older adults who have witnessed the Bangladesh liberation war in 1971 to develop a new generational identity scale (GIS). The first study (N = 300) prepared an initial pool of 31 items and got them vetted by expert judges, which retained 21 items to form the provisional GIS (GIS-21). An exploratory factor analysis on GIS-21 excluded eight items and offered a two-factor solution: (i) identification with the generation and (ii) awareness of the generational importance. The second study (N = 176) ran a confirmatory factor analysis on the resulting GIS-13 and dropped another item to achieve a better model fit (SRMR =0.058, GFI = 0.986, AGFI = 0.980, and NFI = 0.980). The remaining 12-item GIS (GIS-12) showed excellent reliability (Mc Donald's omega = 0.898) and satisfactory temporal stability (ICC = 0.59, 95% CI = 0.27-0.77) over a 4-week interval. The scale's moderate correlation with another measure for generational identification demonstrates its convergent validity. Participants' transitional experience caused by the Bangladesh independence war in 1971 was also moderately correlated with the GIS-12 supporting further theoretical convergence of this scale. We recommend that researchers could use this scale on different populations and age groups upon appropriate validation.

Phytochemicals induce apoptosis by modulation of nitric oxide signaling pathway in cervical cancer cells

OBJECTIVE

Nitric Oxide (NO) is produced by NO synthases (NOS) and is a key signaling molecule that regulates tumorigenesis, both aiding and alleviating it. Elevated NO levels are cytotoxic to cancer cells, making NOS an important target for cancer treatment. In the present study, the modulatory effects of the phytochemicals, quercetin, sulforaphane, genistein, and epigallocatechin-3-gallate on NO pathway and apoptosis were shown in HeLa cervical cancer cells.

MATERIALS AND METHODS

Fluorescent microscopy and flow cytometry were used to assess apoptosis. A Griess assay was used to quantitatively measure NO, quantitative PCR array was used to assess the expression levels of genes involved in the NO signaling pathway, and immunocytochemistry was used to determine NOS protein expression. The functional association among the modulated genes was evaluated using network biology analysis, gene set enrichment, and KEGG pathway analysis.

RESULTS

Treatment with the phytochemicals elevated NO levels in HeLa cells and modulated various genes involved in nitric oxide biosynthesis, superoxide metabolism, and oxidative stress, including NOS1, NOS2, NOS3, ALOX12, and SOD2, with a concomitant increase in NOS2 and NOS3 protein expression levels; also, the phytochemicals were found to induce apoptosis.

CONCLUSIONS

These results suggest that the phytochemical-induced cell death is partially attributed to the activation of the NO pathway and upregulation of pro-oxidant ROS generators. Further experimental studies are required to explore this mechanistic association of NO signaling pathway activation and induction of apoptosis in other types of cancer.

The Internal Realities of Individuals With Type 2 Diabetes: Mediators Influencing Self-Management Beliefs via Grounded Theory Approach

Background: There has been an unabated rise in the prevalence of type 2 diabetes (T2D) worldwide. Although T2D is highly preventable, these trends suggest that a paradigm change is much needed in the way both clinicians and policy makers view what effective T2D strategies conventionally entail. Hence, it is becoming increasingly clear that T2D patients require more than just a pharmacological approach to their disease. Evidence indicate that culturally specific mediators can help foster better self-management practices. We intend to discover psychosocial mediators that influence and support self-management beliefs in T2D patients. Methods: We adopted the grounded theory approach to guide in-depth interviews with T2D patients and health care professionals (HCP) at a regional primary care clinic in Malaysia. Twenty-four T2D patients and 10 HCPs were recruited through purposive sampling method to examine the inner psychological narratives about how they perceive and what they believe beliefs about the disease. Two focus group discussions were also were conducted for data triangulation. Results: A functional framework for the psychosocial mediators influencing self-management beliefs in T2D patients was designed and characterized by 4 major processes: (1) health promotion, (2) personal expectations, (3) person-centered care, and (4) psychosocial support. The fulfillment of patients’ personal expectations is central to better self-management beliefs. Conclusions: Positive emotional states are important in providing a positive environment to nurture self-management practices. A person-centered consultation that focuses on empathy and cultural sensitivities has the potential to foster behavioral change required to sustain self-care practices.

A Systematic Review of Autobiographical Memory and Mental Health Research on Refugees and Asylum Seekers

Research examining trauma, memory, and mental health among refugee and asylum-seeking people has increased in recent years. We systematically reviewed empirical work focusing on the link between autobiographical memory and mental health among these populations. The review protocol was registered with PROSPERO (CRD42018095888). Six major databases were searched in August-2020 with no time limit for publication. Following PRISMA Statement guidelines, 22 articles reporting ten quantitative, nine qualitative, and three mixed-method studies were selected from 254 articles identified in the initial search. A basic convergent and qualitative meta-integration technique was employed for data extraction. Four recurrent themes were extracted: (1) memory activation method, (2) memory features, (3) memory content, and (4) refugee mental health. Theme 1 illustrates that narrative interviews, important event recall, and cue word methods were used in most studies. Theme 2 highlights that memories of refugee people were often less specific, inconsistent, and negative-focused. Retrieval failure was also common among these people. Theme 3 reveals that refugee and asylum-seeking people frequently discussed their abandoned identities, lost resources, injustices, ongoing sufferings, and pointless futures. Finally, theme 4 identifies the prevalence of various mental health conditions like Post-traumatic Stress Disorder, depression, helplessness, and anger among these people. The results are discussed in the context of the current autobiographical memory and mental health theories, considering refugee-specific experiences in the asylum process and refugee status.

643 Near-Peer Surgical Teaching for Junior Doctors: A 16-Month Retrospective Analysis

Introduction

Surgical departments across the UK are having to mitigate service demands, budget constraints and changes to work patterns with their statutory duty to provide high-quality training and education. Securing consultant-led teaching has also become increasingly difficult leading to the rise of near-peer teaching. We evaluate the long-term effectiveness of near-peer surgical teaching for junior doctors.

Method

We developed a rolling 12-week trainee-led didactic surgical education programme for Foundation doctors and Core Surgical Trainees. Junior doctors delivered teaching to peers with registrar input; session and supervision feedback was recorded using 5-point scales and free-text responses.

Results

42 junior doctors responded to our end-of-programme feedback surveys covering December 2018 to April 2020. The overall programme (8.83±1.08/10), relevance (4.62±0.58/5), presentation quality (4.60±0.50/5) and supervisor knowledge (4.81±0.40/5) were rated highly by respondents. Attendees also reported significant improvements in subject knowledge (3.72±0.92/5 to 4.50±0.56/5, P &lt; 0.0001), clinical confidence, presentation and teaching skills.

Conclusions

Our near-peer teaching programme addressed the educational needs of junior doctors and developed their presentation and organisational skills. Supervision and input from registrars facilitated discussion and reinforced key concepts. The success of this programme highlights the role that trainees can play in designing, developing, and leading an effective surgical teaching programme.

Trauma, mental health, and everyday functioning among Rohingya refugee people living in short- and long-term resettlements

PURPOSE

This study investigated if Rohingya refugee people resettled in camps in rural Bangladesh and urban locations in Malaysia had different levels of trauma, mental health and everyday functioning. The study also examined if direct and indirect exposure to traumatic events could predict PTSD, depression, generalized anxiety, and everyday functioning in the two groups separately. An attempt was also made to see if the relations between trauma and mental health were different across the two settings.

METHODS

This was a cross-sectional study, for which we conveniently recruited 100 adult Rohingyas, 50 from each country; the majority was males. Rohingyas in Bangladesh fled Myanmar's Rakhine State following a major military crackdown in 2017, whereas Rohingyas in Malaysia fled Rakhine gradually over the last three decades because of recurrent violence and military operations. We assessed trauma (cumulative trauma, direct trauma, and indirect trauma), PTSD, depression, generalized anxiety, and everyday functioning of the participants using traumatic event questionnaire, PTSD-8, PHQ-9, GAD-7, and WHODAS-2.0.

RESULTS

The Bangladeshi cohort experienced more types of traumatic events (i.e., cumulative trauma) than did the Malaysian cohort (d = 0.58). Although the two cohorts did not differ in terms of indirect exposure to traumatic incidents (i.e., indirect trauma), the Malaysian cohort had direct exposure to traumatic events (i.e., direct trauma) more frequently than did the Bangladeshi cohort (d = 1.22). The Bangladeshi cohort showed higher PTSD (d = 1.67), depression (d = 0.81), generalized anxiety (d = 1.49), and functional impairment (d = 2.51) than those in Malaysia. Hierarchical linear regression analyses showed that after controlling for demographic variables, both direct and indirect trauma significantly predicted PTSD, depression, and functional impairment among Rohingyas in Bangladesh, with direct trauma being the stronger predictor. However, similar analyses showed that only indirect trauma predicted PTSD among Rohingyas in Malaysia, while all other effects were nonsignificant. The results also showed that the predictive relationship between direct trauma and PTSD was different across the two countries. With the same level of direct trauma, a participant from Malaysia would score 0.256 points lower in PTSD than a participant from Bangladesh.

CONCLUSION

The recently experienced direct and indirect trauma have impaired mental health and everyday functioning among the Bangladeshi cohort. However, only indirect trauma was active to cause PTSD in the Malaysian cohort as direct trauma was weakening due to the time elapsed since migration. We discuss the results in the context of the current theories of trauma and mental health and suggest therapeutic interventions for the refugee population.

The external realities of people with type 2 diabetes-Understanding disease perspective and self-management behaviour via Grounded Theory Approach

BACKGROUND

Qualitative strategies can uncover the relationship between the external realities of people living with type 2 diabetes (T2D) and the barriers that are associated with disease self-management. Information from in-depth interviews (IDI) and focus group discussions (FGD) can be used to devise psychological models that could potentially facilitate behaviour changes in people with T2D. We aim to identify salient factors that govern the external realities of people with T2D in relation to disease management.

METHODS

A qualitative study was conducted at a regional primary care clinic in Malaysia using a Grounded Theory Approach. People with T2D were recruited through purposeful sampling to determine their living experiences with the disease. A total of 34 IDIs with 24 people with T2D and 10 health care professionals, followed by two FGDs with people with T2D, were conducted.

RESULTS

Three major processes that arbitrate self-management practices include- 1) external reality, 2) internal reality, 3) mediators of behaviour. Within the context of external reality, three important sub-themes were identified-intrinsic background status, personal experience, and worldview. Lifestyle habits of persons with T2D play a central role in their disease management. Another common recurring concern is the issue of a low-quality food environment in the country. More importantly, individuals with T2D have a high degree of expectations for a more person-centered approach to their illness.

CONCLUSIONS

We identified modifiable and non-modifiable behavioural factors that influence the daily living environment of people with T2D. This information can be used to customize the management of T2D through targeted behavioural interventions.

Impact of COVID-19 on the cerebrovascular system and the prevention of RBC lysis

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) uses Angiotensin- converting enzyme 2 (ACE2) receptors to infect host cells which may lead to coronavirus disease (COVID-19). Given the presence of ACE2 receptors in the brain and the critical role of the renin-angiotensin system (RAS) in brain functions, special attention to brain microcirculation and neuronal inflammation is warranted during COVID-19 treatment. Neurological complications reported among COVID-19 patients range from mild dizziness, headache, hypogeusia, hyposmia to severe like encephalopathy, stroke, Guillain-Barre Syndrome (GBS), CNS demyelination, infarcts, microhemorrhages and nerve root enhancement. The pathophysiology of these complications is likely via direct viral infection of the CNS and PNS tissue or through indirect effects including post- viral autoimmune response, neurological consequences of sepsis, hyperpyrexia, hypoxia and hypercoagulability among critically ill COVID-19 patients. Further, decreased deformability of red blood cells (RBC) may be contributing to inflammatory conditions and hypoxia in COVID-19 patients. Haptoglobin, hemopexin, heme oxygenase-1 and acetaminophen may be used to maintain the integrity of the RBC membrane.

Mean Platelet Volume in Type 2 Diabetes Male

The patient with diabetes mellitus and its complication is increasing in our country and all over the world. Altered platelet morphology and function have been reported in patient with DM. Mean platelet volume has been suggested as a newly emerging and independent risk marker for atherothrombosis and cardiovascular disease. The present study was carried out to assess the mean platelet volume in subjects with type 2 diabetes mellitus. The present study was a cross sectional analytic study and conducted in the Department of Physiology, Dhaka Medical College, Dhaka, Bangladesh from July 2013 to June 2014. A total number of 200 adult male subjects were selected with age ranging from 40 to 60 years. Among them, 100 subjects with type 2 diabetes mellitus were included in the case (Group B) and 100 healthy subjects with same age range were considered as control (Group A) for comparison. The subjects were selected from BIRDEM hospital Dhaka and personal contact from different areas of Dhaka city on the basis of exclusion and inclusion criteria. The study parameter was mean platelet volume and was measured in the Department of Hematology of BIRDEM hospital, Dhaka. The data were collected and recorded in pre-designed structured questionnaire by the researcher herself. For statistical analyses unpaired Student's 't' test was performed as applicable using SPSS for windows version 19. In this study, mean platelet volume was significantly (p<0.001) higher in the case group than that of control group. Therefore, estimation of mean platelet volume might be beneficial for prediction of future cardiovascular risk in adult diabetic male.

AB1345-HPR THE MULTIDISCIPLINARY FOOT CLINIC: A SERVICE EVALUATION PROJECT

Background:

Patients with rheumatological foot disease are an overlooked population, and it was noted locally that these patients received a fragmented service; attending multiple appointments for the management of one clinical issue. This led to delays in treatment; significant inter-departmental correspondence and variations in the peri-operative management of disease modifying anti-rheumatic drug (DMARD) and biologic therapies. To remedy this a foot multidisciplinary (MDT) clinic was established, including input from rheumatology, orthopaedic surgery, specialist rheumatology podiatry and physiotherapy. The outcomes from the foot MDT clinic have been analysed in this service evaluation project.

Objectives:

To evaluate the outcomes of the multidisciplinary foot MDT clinic, with particular reference to concordance to the British Rheumatology Society (BSR) guidelines on peri-operative medicine guidelines.

Methods:

Data was collected retrospectively across all clinics from January 2017 to February 2019. Clinic letters were obtained, and data was collected using a standardised data collection sheet. Data was collected on patient demographics, rheumatological diagnoses, treatment outcomes from the foot MDT, appropriateness of peri-operative plan and post-operative complications. No data was available on these outcomes prior to the advent of the foot MDT clinic.

Results:

Data from 12 clinics was analysed (n=40). Patients had a median age of 66 years (IQR 27.5 years); 65% of patients were female and 35% of patients were male. The commonest rheumatological foot disease seen was rheumatoid arthritis (67%), followed by psoriatic arthritis (15%). All patients were treated with biologic or non-biologic DMARDs. Treatment outcomes were as follows: 27.5% were offered surgical treatment; 10% were offered intra-articular (IA) injections under ultrasound guidance; 10% were offered IA injections under general anaesthetic; 25% underwent specialist rheumatology podiatry, and the remaining 30% elected for a conservative approach after careful consideration of treatment options. Of those who were offered surgical treatment, 72% of patients were provided with a peri-operative plan which accorded with British Rheumatology Society (BSR) guidelines. Of those whom underwent surgery, one patient’s surgical treatment was complicated by a post-operative infection; however, the peri-operative DMARD/biologic plan was not felt to be contributing factor.

Conclusion:

The foot MDT clinic provides a comprehensive review of rheumatological foot conditions, with readily available access to a full range of treatment options. Co-location of all relevant professionals allows for real-time interdepartmental communication; shared decision making between clinicians and patients; avoids multiple appointments; reduces uncertainty with peri-operative planning as well as providing a cost-effective and efficacious service. Discrepancies in the peri-operative plan for medicines arose when the treating orthopaedic surgeon was not present in clinic. In these cases, the plan for surgical treatment was made outside of this clinic, without input from the treating rheumatologist. To improve concordance with BSR peri-operative medicine guidelines, it is recommended that all treatment decisions are made during the clinic, allowing input from all relevant partners. Informal feedback from patients commended the foot MDT, this shall be formalised through further qualitative data.

Disclosure of Interests:

None declared

OP0094 EULAR-ACR 2019 CLASSIFICATION CRITERIA FOR SLE: CAN WE CLASSIFY USING LABORATORY TESTS ALONE?

Background:

The EULAR-ACR 2019 (EULAR19) classification criteria for systemic lupus erythematosus (SLE) were developed to improve the sensitivity and specificity of previous criteria. Notably, both the EULAR19 and existing SLICC-SLE 2012 (SLICC12) criteria can classify patients as having SLE by the presence of immunology and haematological abnormalities in the absence of any signs or symptoms.

Objectives:

To validate the EULAR19 criteria, with comparison to existing criteria, in a large cohort of patients with an established systemic autoimmune rheumatic disease (SARD).

Methods:

We recruited 227 adult patients who were ANA positive with ≥1 clinical feature suggestive of a SARD, from three hospitals in the North West of England. Clinician diagnosis was used as gold standard; we then applied the EULAR19, SLICC12 and the ACR-SLE 1997 (ACR97) criteria.

Results:

Of the 227 patients recruited, by clinician diagnosis, 89 patients (36%) had SLE, 43 (17%) primary Sjögren’s (pSS), 62 (25%) undifferentiated CTD (UCTD), 25 (10%) systemic sclerosis (SSc) and 8 (3%) an inflammatory myositis. The characteristics of these patients and the breakdown of the EULAR19 criteria are outlined in figure 1.

Figure 1.

Baseline characteristics and classification criteria compared across five SARD diagnoses.

The sensitivity and specificity of the EULAR19 is similar to ACR97 (sensitivity 84% (95% CI 75-91%) vs. 87% (95% CI 78-93%) and specificity 78% (95% CI 70-84%) vs. 76% (95% CI 68-83%) respectively). The SLICC12 criteria by contrast are more sensitive (94% (95% CI 87-98%)) and less specific (61% (95% CI 52-69%)) in this cohort.

Figure 2 illustrates patients with a clinician diagnosis of SLE or UCTD who meet each of the classification criteria. Of the 89 patients with a clinician diagnosis of SLE, 39 (44%) patients would have sufficient points to meet EULAR19 criteria on blood test results alone in the absence of clinical symptoms. Four pSS patients and 4 UCTD patients would also meet EULAR19 criteria from positive blood results alone.

Figure 2.

Venn diagrams illustrating patients with SLE and UCTD who meet the EULAR19, ACR97 and SLICC12 classification criteria. No criteria refers to the patients not meeting any of the three SLE classification criteria.

Conclusion:

These results suggest that the EULAR19 criteria perform comparably to the ACR97 criteria when applied to an established cohort of SARDs. Similar to SLICC12, it is possible to classify patients as having SLE using the EULAR19 criteria by haematological and other laboratory tests. To what extent haematological abnormalities can be potentially used as the sole ‘clinical criteria’ needs consideration.

SLE n=89pSS n=43UCTD n=62SSc n=25Myositis n=8Female N (%)82 (92)42 (98)53 (85)24 (96)8 (100)Age, mean (SD) /years44 (13)52 (12)47 (13)60 (9)53 (7)Disease duration, mean (SD) /years12 (10)6 (5)5 (7)9 (11)3 (3)SLE classification criteriaEULAR SLE 2019, N (%)75 (84)10 (23)20 (32)1 (4)0ACR SLE 1997, N (%)77 (87)9 (21)21 (34)2 (8)1 (13)SLICC SLE 2012, N (%)84 (94)15 (35)33 (53)4 (16)2 (25)EULAR-ACR 2019 criteriaConstitutional, N (%)10 (11)2 (5)1 (2)01 (13)Neuropsychiatric, N (%)3 (3)01 (2)1 (4)0Mucocutaneous, N (%)71 (80)13 (30)27 (44)2 (8)2 (25)Serosal, N (%)13 (15)1 (2)2 (3)00Musculoskeletal, N (%)52 (58)14 (33)22 (35)3 (12)3 (38)Renal, N (%)30 (34)001 (4)0Haematological, N (%)44 (49)12 (28)10 (16)3 (12)0Antiphospholipid antibodies, N (%)43 (48)7 (16)17 (27)4 (16)0Low complement, N (%)48 (54)10 (23)10 (16)3 (12)1 (13)Anti-Sm, N (%)19 (21)2 (5)4 (6)1 (4)0Anti-dsDNA, N (%)50 (56)8 (19)12 (19)01 (13)

Disclosure of Interests:

Sarah Dyball: None declared, John Reynolds: None declared, Eoghan McCarthy: None declared, Sahena Haque: None declared, Ariane Herrick: None declared, Hector Chinoy: None declared, Ellen Bruce: None declared, Ben Parker Grant/research support from: GSK and Sanofi Genzyme, Consultant of: GSK, AstraZenaca, UCV, Abbvie, Pfizer, BMS, Celltrion, Ian N. Bruce Grant/research support from: Genzyme Sanofi, GSK, and UCB, Consultant of: Eli Lilly, AstraZeneca, UCB, Iltoo, and Merck Serono, Speakers bureau: UCB

Cubic crystals in an x-ray polarization-splitting geometry

Hexagonal and cubic crystals contain paired sets of internal planes that reflect the linearly polarized components of certain x rays into two separate, perpendicular directions. For the cubic crystals, two distinct crystal orientations provide the same polarization-splitting geometry. One of the orientations may have advantages for plasma spectroscopy by suppressing unwanted reflections. This paper demonstrates the two orientations with a germanium crystal and K characteristic lines from copper and zirconium.

Comparison of High Density Lipoprotein Cholesterol Level in Second and Third Trimester of Pregnancy in Mymensingh, Bangladesh

Pregnancy is accompanied by changes in the maternal lipoprotein metabolism that may serve to satisfy the nutritional demands of the fetus in addition to the energy requirements of the mother. Early pregnancy is considered the anabolic phase, characterized by increased hepatic production of triglycerides and enhanced removal of triglycerides from the circulation, resulting in an increased deposition of fat in maternal adipose tissue. Late pregnancy is referred to as the catabolic phase, the release of free fatty acids from adipocytes is enhanced due to both relative insulin resistance and stimulation of hormones. Although it is known that cholesterol rises in pregnancy, at present it is not routinely measured or treated. However, a growing body of evidence from animal and human studies suggests adverse consequences of high cholesterol levels in pregnancy. High lipid profile, a major factor behind atherosclerosis may leads to unconsciousness. To avoid such problems during pregnancy this longitudinal study was carried out in the department of Biochemistry, Mymensingh Medical College in co-operation with the Department of Obstetrics and Gynecology, Mymensingh Medical College Hospital and Community Based Medical College Hospital, Bangladesh from July 2011 to December 2012 to compare the changes in high density lipoprotein cholesterol level during 2nd and 3rd trimester of pregnancy. A total of one hundred subjects were participated in this study comprising of second and third trimester of pregnancy. All subjects were made to fast overnight at least for a minimum of 8 hours. Blood samples were taken and analyzed by enzymatic colorimetric kit method. Pregnancy has been found to be associated with changes in lipid profile and this differs with each trimester. The average results were analyzed with respect to each pregnancy for the whole group. The study proves that serum High Density Lipoprotein (HDL) cholesterol increases in second trimester (48.71±7.61mg/dl) than third trimester (47.01±7.45mg/dl) of Pregnancy. So, Lipid profile estimation and monitoring should be made as a part of routine investigation during antenatal period.