Perceived reputation moderates the link between honor concerns and depressive symptoms

Prior research has shown that U.S. cultures of honor have higher rates of depression and suicide. While links between honor endorsement and suicide have been established in the literature, a direct test of the primary mechanism underlying this association (reputation damage leading to depression) has not yet been tested. The current study sought to address whether shifts in perceived reputation might be associated with higher levels of depression for honor endorsing individuals. An online sample of 305 participants were tracked across two time points, assessing perceived individual reputation and perceived family reputation, as well as depressive symptoms. Analyses revealed that higher levels of honor concern at Time 1 were linked with higher levels of depressive symptoms at Time 2, but only for those with low perceived reputation - these relationships held while controlling for the stability in reputation and depression across time points, as well as controlling for participants' gender. Findings provide the first empirical evidence that reputation damage may contribute to detriments in mental health in honor endorsers.

Concurrence of Ocular Cicatricial Pemphigoid in Chronic Ocular Graft-Versus-Host Disease

PURPOSE

The aim of this study was to report a series of 3 patients with ocular graft-versus-host disease (oGVHD) with progressive cicatricial conjunctival changes who were diagnosed with ocular cicatricial pemphigoid (OCP) after conjunctival biopsy.

METHODS

This study was a retrospective case series.

RESULTS

Three patients who received hematopoietic stem cell transplantation for hematologic malignancies developed oGVHD and subsequently were diagnosed with OCP. Case 1 was a 73-year-old woman with oGVHD who developed symblepharon and showed positive IgA, IgG, and C3 staining of the basement membrane zone (BMZ) on conjunctival biopsy, consistent with OCP. She was systemically treated with tacrolimus and prednisone with resolution of conjunctival inflammation. Case 2 was a 68-year-old man with oGVHD who developed symblepharon, severe dry eye, and corneal epithelial defect. An initial conjunctival biopsy was negative, but a repeat biopsy performed 10 years later showed positive BMZ IgA and IgG staining. Healing of the epithelial defect was achieved after treatment with high-dose systemic cyclosporine. Case 3 was a 75-year-old woman with oGVHD who had a nonhealing corneal epithelial defect and symblepharon with positive IgA BMZ staining on conjunctival biopsy, consistent with OCP. The patient responded well to methotrexate with healing of the epithelial defect.

CONCLUSIONS

Although low-grade conjunctival fibrotic changes may be observed in chronic oGVHD, development of severe and progressive cicatricial changes, including symblepharon formation, should prompt consideration of biopsy to rule out concurrent OCP, the management of which differs from that of oGVHD.

Long-term visual acuity outcomes following cataract surgery in eyes with ocular inflammatory disease

PURPOSE

To evaluate the long-term visual acuity (VA) outcome of cataract surgery in inflammatory eye disease.

SETTING

Tertiary care academic centres.

DESIGN

Multicentre retrospective cohort study.

METHODS

A total of 1741 patients with non-infectious inflammatory eye disease (2382 eyes) who underwent cataract surgery while under tertiary uveitis management were included. Standardised chart review was used to gather clinical data. Multivariable logistic regression models with adjustment for intereye correlations were performed to evaluate the prognostic factors for VA outcomes. Main outcome measure was VA after cataract surgery.

RESULTS

Uveitic eyes independent of anatomical location showed improved VA from baseline (mean 20/200) to within 3 months (mean 20/63) of cataract surgery and maintained through at least 5 years of follow-up (mean 20/63). Eyes that achieved 20/40 or better VA at 1 year were more likely to have scleritis (OR=1.34, p<0.0001) or anterior uveitis (OR=2.2, p<0.0001), VA 20/50 to 20/80 (OR 4.76 as compared with worse than 20/200, p<0.0001) preoperatively, inactive uveitis (OR=1.49, p=0.03), have undergone phacoemulsification (OR=1.45 as compared with extracapsular cataract extraction, p=0.04) or have had intraocular lens placement (OR=2.13, p=0.01). Adults had better VA immediately after surgery, with only 39% (57/146) paediatric eyes at 20/40 or better at 1 year.

CONCLUSIONS

Our results suggest that adult and paediatric eyes with uveitis typically have improved VA following cataract surgery and remain stable thereafter for at least 5 years.

Veteran suicide rates mirror, but do not account for, elevated suicide rates among the general population in US cultures of honor

INTRODUCTION

Veteran total and firearm suicide rates are higher compared to the general population. Among the general population, total and firearm suicide rates are higher in US states deemed cultures of honor compared to non-honor states, likely because honor states have higher firearm ownership rates and fewer firearm laws. Considering that veterans tend to live in states with fewer firearm laws and that veteran population rates predict both statewide total and firearm suicide rates, it is possible that the elevated suicide rates seen in honor states in part due to those states having a greater presence of veterans compared to non-honor states.

METHOD

Publicly available databases were used to obtain total and firearm suicide rates (per 100 k) for veterans and non-veterans, as well as our covariates (e.g., rurality).

RESULTS

Veteran population proportions were higher in honor states than non-honor states. Veteran and non-veteran total and firearm suicide rates were higher in honor states compared to non-honor states. Statewide differences in all four suicide rates were indirectly explained by honor states having higher firearm ownership than non-honor states.

CONCLUSIONS

These findings add to a growing body of literature showing that enacting firearm regulations may be a viable public health approach for preventing suicide.

When culture and health collide: feminine honor endorsement and attitudes toward catch-up HPV vaccinations in college women

Sexual promiscuity stigma constitutes a significant barrier which prevents young women from receiving catch-up human papillomavirus (HPV) vaccinations. Our objective was to explore how this stigma may be particularly detrimental to women in cultures of honor, where women are expected to maintain a reputation of sexual purity.

Participants were a sample of 182 young women who had not previously received an HPV vaccination.

We measured feminine honor endorsement, HPV sexual promiscuity stigma, HPV vaccination shame, HPV vaccination intentions, and a set of covariates.

Analyses revealed that the significant association between feminine honor endorsement and HPV vaccination intentions is fully explained by HPV sexual purity stigma and HPV vaccination shame.

These findings indicate that honor-endorsing women are significantly impacted by sexual purity stigma, minimizing intentions to receive HPV vaccinations. These findings also highlight the need for the inclusion of cultural factors in the study of HPV vaccine uptake.

Invincible honor: masculine honor, perceived invulnerability, and risky decision-making

Masculine honor ideology is characterized by the cultivation, maintenance, and defense of reputations for toughness, bravery, and strength. The link between masculine honor endorsement and increased risk-taking - especially an increased tolerance for and even expectation of violence - is well-established in the literature. However, little empirical research has examined what factors might explain this relationship. This study investigates perceived invulnerability, the cognitive bias that one is immune to threats, as a mediator in the relationship between masculine honor ideology and risky decision-making. Results show moderate support for this relationship's existence. These findings elaborate on previous research between honor and specific risky decisions by demonstrating honor to instill cognitive biases in its adherents that make them more tolerant of risk, and thus more likely to decide to engage in risky behaviors. The implications of these findings for interpreting previous research, guiding future research, and pursuing specific educational and policy-based efforts are discussed.

Damaged Masculinity: How Honor Endorsement Can Influence Prostate Cancer Screening Decision-Making and Prostate Cancer Mortality Rates

Prior research has established factors that contribute to the likelihood that men seek out prostate cancer screenings. The current study addresses how endorsing the ideology found in cultures of honor may serve as a barrier to prostate cancer screenings. Two studies were conducted which analyzed the impact of stigma on men's decisions to seek out prostate cancer screenings (Study 1) as well as how prostate cancer deaths may be higher in the culture of honor regions due to men's reticence to seek out screenings (Study 2). Results suggest that older, honor-endorsing men are less likely to have ever sought out a prostate cancer screening due to screening stigma and that an honor-oriented region (southern and western United States) displays higher rates of prostate cancer death than a non-honor-oriented region (northern United States). These findings suggest that honor may be a cultural framework to consider when practitioners address patients' screening-related concerns.

Assessment of a compounded synthetic adrenocorticotropic hormone product in 17 healthy dogs

OBJECTIVES

Synthetic adrenocorticotropic hormone or tetracosactide is routinely used in the diagnosis of hypoadrenocorticism and frequently in the diagnosis and treatment of hyperadrenocorticism. There have been repeated shortages of tetracosactide in recent years in Australia. This study investigated the agreement of serum cortisol after a compounded tetracosactide (Bova Aus), compared to commercial tetracosactide (Synacthen®) in healthy dogs.

METHODS

Prospective crossover study using 20 dogs. Ten dogs received 5 μg/kg Synacthen® on day 1 and 5 μg/kg compounded tetracosactide on Day 2. The other 10 dogs received the reverse order. Cortisol concentrations in each dog 1 h after injection were compared for agreement, which was defined as the limits of agreement of the Bland-Altman ratio to be within a range of 0.8-1.25. Passing-Bablok regression analysis examined for constant and proportional biases.

RESULTS

Three dogs were excluded with post-stimulation serum cortisol concentrations markedly outside reference interval. For the remaining 17 dogs, Bland-Altman ratio analysis of cortisol concentration (tetracosactide/Synacthen®) at 1 h found virtually no constant bias (mean of ratios 1.01;95% CI 0.97-1.05) and 95% limits of agreement were 0.88 (95% CI 0.78-0.90) and 1.17 (95% CI 1.13-1.25). This met our criteria for agreement between cortisol concentrations. Bias of the Bland-Altman difference was 2.8 nmol/L (95% CI -7.2 to 12.8); 95% limits of agreement -35.2 nmol/L (95% CI -57.0 to -26.1) and 40.8 nmol/L (95% CI 31.7-62.6). Passing-Bablok regression analysis did not identify bias.

CONCLUSION

In healthy dogs, cortisol concentrations were in agreement after compounded tetracosactide compared to commercial tetracosactide, Synacthen®.

Ocular Manifestations in Rheumatoid Arthritis

Rheumatoid arthritis (RA) is an inflammatory rheumatic disease that generally damages synovial-line joints. Extra-articular manifestations of RA have been reported in cases of multiorgan involvement. These manifestations can occur in the hematologic and cardiovascular system, lungs, kidneys, and eyes. Various ocular manifestations of RA have been previously reported including keratoconjunctivitis sicca, conjunctivitis, uveitis, scleritis, retinal vascular occlusion, optic neuritis, and amaurosis fugax. It is important to recognize these ocular issues as manifestations of RA since they can sometimes be a response marker for the onset of an immune reactivation. Urgent management of ocular complications is essential to manage sight-threatening complications and prevent further damage to the eyes.

The impact of snapchat usage on drunkorexia behaviors in college women

ObjectiveResearch has shown the deleterious effects of drunkorexia behaviors. The goal of this project was to examine the impact of college women's Snapchat usage on drunkorexia behavior frequencies and motives, through comparing one's body to others and internal drives for thinness.Participants636 college women (Study 1 N = 109, Study 2 N = 527) were recruited from a large research institution in the Southwestern U.S.MethodsParticipants completed an online survey regarding Snapchat usage, body comparison indices, drive for thinness, and drunkorexia behaviors and motives.ResultsFindings support the hypotheses that Snapchat usage impacts drunkorexia behaviors in general (Study 1), and specific drunkorexia motives (Study 2). These effects were mediated by an index of body comparisons and drive for thinness.ConclusionsCollege women may be at risk for drunkorexia due to their experiences on social media. Aspects of the platform may be pushing women toward disturbed eating habits.

Evidence of substantial heterogeneity in the preventive effect of stricter alcohol policy environments in young Swiss men

Introduction

The alcohol policy environment was shown to exert a preventive effect on alcohol consumption. However, little is known about the heterogeneity of this effect.

Objectives

To capture the extent of heterogeneity in the relationship between the strictness of alcohol policy environments and heavy drinking and to identify potential effect modifiers.

Methods

Method: Cross-sectional data from 5986 young Swiss men participating in the cohort study on substance use risk factors (C-SURF) in Switzerland was analysed. Self-reported risky single-occasion drinking (RSOD, drinking 6 standard drinks or more on a single occasion at least monthly) in the past 12 months was the outcome of interest. A previously-used index of alcohol policy environment strictness across Swiss cantons was analysed in conjunction with 21 potential effect modifiers. Random forest machine learning and individual conditional expectations captured high-dimensional interaction effects and the heterogeneity induced by the interaction effects and identified potential effect modifiers.

Results

Subject-specific absolute risk reductions ranged from 16.8% to -4.2%, with the latter implying a risk increase. Four prototypical subgroups were evident: “preventive” (alcohol policy environment decreased RSOD risk), “causative” (alcohol policy environment increased RSOD risk), “immune” (no effect due to low RSOD baseline risk), and “doomed” (no effect due to high RSOD baseline risk). Antisocial personality disorder and sensation seeking were major effect modifiers that reduced the preventive effect of stricter alcohol policy environments.

Conclusions

Conclusion: Whereas stricter alcohol policy environments were associated with a reduced RSOD risk, adding selective prevention measures that target high-risk subpopulations is necessary.

Disclosure

No significant relationships.

Socioeconomic status and mental illness stigma: the impact of mental illness controllability attributions and personal responsibility judgments

BACKGROUND

Prior research has suggested that higher levels of socioeconomic status (SES) may be linked with heightened mental illness stigma (MIS). It has been posited that this link is due to the resource-rich environment high-SES individuals live in, which predisposes them to seeing the certain phenomena as being more controllable in nature than low-SES individuals.

AIMS

The current study intended to address the attributional mechanisms behind the SES-MIS link.

METHODS

In a sample of 932 participants, we collected self-reported SES along with the controllability attributions and personal responsibility judgments participants make for individuals with mental illnesses.

RESULTS

Analyses indicated that SES was significantly associated with greater MIS levels, and that this link was significantly mediated by controllability attributions and personal responsibility judgments.

CONCLUSIONS

Findings suggest that high-SES individuals are more likely to see mental illness as due to internal, controllable factors, which leads to blaming the individual for mental illness onset and, ultimately, greater mental illness stigma. These results provide support for more socioeconomically diverse committees and panels where mental health funding decisions are made due to inherent attributional biases which may be present along the SES spectrum.

0860 Sleep Disorders In Female Military Personnel

Introduction

Sleep is an essential biological function and the disruption of sleep has deleterious consequences. Military personnel experience unique stressors related to their service, elevating the risk of developing sleep disorders. The etiologies and impact of sleep disorders on military women’s health is poorly understood. This study is the first to prospectively assess whether military women with insomnia, obstructive sleep apnea (OSA), or comorbid insomnia and OSA (COMISA) have different gender roles, military service-associated factors, and biological characteristics than military men with the same disorders.

Methods

This is a prospective observational study of military personnel with sleep disturbances. The study will evaluate women and men matched for sleep disorder. Participants will complete an evaluation to include polysomnography (PSG), sleep questionnaires and validated clinical assessments of associated disorders of interest. The baseline demographics, questionnaire, and PSG results will be analyzed to assess for commonalities or differences between genders.

Results

We have enrolled 45 patients (24% female). Males had a higher BMI (29.1) than females (26). Males were also older (38) than females (35). The leading diagnosis in males was OSA (44%) and insomnia in females (64%). In males, the apnea-hypopnea index (AHI) was 11.3/hr, arousal index (ARI) was 20/hr, and sleep efficiency (SE) was 86.5%. Total sleep time (TST), wake after sleep onset (WASO), and sleep onset latency (SOL) were 364.6, 40.9, and 12.6 minutes, respectively. In females, the average AHI was 6.6/hr, ARI was 15/hr, and SE was 87.2%. Their TST, WASO, and SOL were 359, 44, and 12.6 minutes, respectively.

Conclusion

Military personnel are at increased risk of sleep disorders. Literature comparing male and female characteristics and sleep disorders is scarce. In this study, baseline demographics were similar in both groups but insomnia was the leading diagnosis for women. This emphasizes the importance of adequate recognition and treatment of insomnia in this group.

Support

This study is supported by the Defense Health Agency, Defense Medical Research and Development Program, Clinical Research Intramural Initiative for Military Women’s Health.

Evidence of Pyrethroid Tolerance in the Bird Cherry-Oat Aphid Rhopalosiphum Padi in Ireland

Results of dose response bioassays 'in vivo' used to characterise the phenotypic response of pyrethroid resistant S. avenae in comparison to susceptible S. avenae, and two other cereal aphids, the rose-grain aphid (Metopholophium dirhodum) and the bird-cherry – oat aphid (Rhopalosiphum padi), are used to measure levels of pyrethroid resistance. Aphid pests on cereals in the British Isles are predominantly controlled by pyrethroid insecticides, especially since the implementation of the recent ban on neonicotinoid seed treatments on all outdoor crops. Resistance to pyrethroids has been detected in one of the main aphid pests, the grain aphid (Sitobion avenae), probably brought on by the sustained use of these pyrethroid sprays to control cereal aphids, which can transmit plant viruses, especially Barley Yellow Dwarf Virus (BYDV). The withdrawal of several insecticide compounds (e.g. pirimicarb, dimethoate, chlorpyrifos and the aforesaid neonicotinoids) for cereal aphid control will probably increase the selection pressure, leading to increased levels of resistance in S. avenae, and, potentially, the evolution of resistance in other cereal aphid species. In this article we present the results of dose response bioassays 'in vivo' used to characterise the phenotypic response of pyrethroid resistant S. avenae in comparison to susceptible S. avenae, and two other cereal aphids, the rosegrain aphid (Metopholophium dirhodum) and the bird-cherry– oat aphid (Rhopalosiphum padi), in order to measure levels of pyrethroid resistance. At present, little is known about the extent of pyrethroid resistance in S. avenae beyond the UK and in other cereal aphids. It therefore becomes increasingly important to monitor these pests to inform crop management decisions in light of the recent loss of other insecticides. The unintended consequences of the rapid withdrawal of insecticides, together with a failure to prepare and install alternative products and control approaches in advance, will probably ultimately lead to the loss of effectiveness of insecticidal compounds like pyrethroids.

Regulation of S1PR2 by the EBV oncogene LMP1 in aggressive ABC-subtype diffuse large B-cell lymphoma

The Epstein-Barr virus (EBV) is found almost exclusively in the activated B-cell (ABC) subtype of diffuse large B-cell lymphoma (DLBCL), yet its contribution to this tumour remains poorly understood. We have focused on the EBV-encoded latent membrane protein-1 (LMP1), a constitutively activated CD40 homologue expressed in almost all EBV-positive DLBCLs and which can disrupt germinal centre (GC) formation and drive lymphomagenesis in mice. Comparison of the transcriptional changes that follow LMP1 expression with those that follow transient CD40 signalling in human GC B cells enabled us to define pathogenic targets of LMP1 aberrantly expressed in ABC-DLBCL. These included the down-regulation of S1PR2, a sphingosine-1-phosphate (S1P) receptor that is transcriptionally down-regulated in ABC-DLBCL, and when genetically ablated leads to DLBCL in mice. Consistent with this, we found that LMP1-expressing primary ABC-DLBCLs were significantly more likely to lack S1PR2 expression than were LMP1-negative tumours. Furthermore, we showed that the down-regulation of S1PR2 by LMP1 drives a signalling loop leading to constitutive activation of the phosphatidylinositol-3-kinase (PI3-K) pathway. Finally, core LMP1-PI3-K targets were enriched for lymphoma-related transcription factors and genes associated with shorter overall survival in patients with ABC-DLBCL. Our data identify a novel function for LMP1 in aggressive DLBCL. Copyright © 2019 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

Identical and Nonidentical Twins: Risk and Factors Involved in Development of Islet Autoimmunity and Type 1 Diabetes

OBJECTIVE

There are variable reports of risk of concordance for progression to islet autoantibodies and type 1 diabetes in identical twins after one twin is diagnosed. We examined development of positive autoantibodies and type 1 diabetes and the effects of genetic factors and common environment on autoantibody positivity in identical twins, nonidentical twins, and full siblings.

RESEARCH DESIGN AND METHODS

Subjects from the TrialNet Pathway to Prevention Study (N = 48,026) were screened from 2004 to 2015 for islet autoantibodies (GAD antibody [GADA], insulinoma-associated antigen 2 [IA-2A], and autoantibodies against insulin [IAA]). Of these subjects, 17,226 (157 identical twins, 283 nonidentical twins, and 16,786 full siblings) were followed for autoantibody positivity or type 1 diabetes for a median of 2.1 years.

RESULTS

At screening, identical twins were more likely to have positive GADA, IA-2A, and IAA than nonidentical twins or full siblings (all P < 0.0001). Younger age, male sex, and genetic factors were significant factors for expression of IA-2A, IAA, one or more positive autoantibodies, and two or more positive autoantibodies (all P ≤ 0.03). Initially autoantibody-positive identical twins had a 69% risk of diabetes by 3 years compared with 1.5% for initially autoantibody-negative identical twins. In nonidentical twins, type 1 diabetes risk by 3 years was 72% for initially multiple autoantibody-positive, 13% for single autoantibody-positive, and 0% for initially autoantibody-negative nonidentical twins. Full siblings had a 3-year type 1 diabetes risk of 47% for multiple autoantibody-positive, 12% for single autoantibody-positive, and 0.5% for initially autoantibody-negative subjects.

CONCLUSIONS

Risk of type 1 diabetes at 3 years is high for initially multiple and single autoantibody-positive identical twins and multiple autoantibody-positive nonidentical twins. Genetic predisposition, age, and male sex are significant risk factors for development of positive autoantibodies in twins.

A host-feeding wasp shares several features of nitrogen management with blood-feeding mosquitoes

Adult feeding on hosts is common among parasitic wasps. The ingested host fluid is rich in nutrients, especially proteins. A study on Eupelmus vuilleti (Hymenoptera: Eupelmidae), a host-feeding parasitoid of larvae of Callosobruchus maculatus (F.) (Coleoptera: Bruchidae), showed that the carbohydrates (maybe lipids) but not proteins, gained from host feeding accounted for the increased egg production. Thus, host protein is probably utilized for general adult metabolism, allowing conservation of carbohydrate and/or lipid resources for direct allocation to oocytes. In that case, there should be increased N excretion by female parasitoids. To test this, we studied the dynamics of excretion in E. vuilleti with and without host exposure. The aim of this work was threefold: (i) to identify the major N-containing compounds in adult excreta, (ii) to assess whether protein consumption during host feeding increased the amount of N excreted, and (iii), if so, to compare the increase in N excreted with the amount taken in during a single host feeding. We found that uric acid is the predominant N-containing metabolite in excreta, although small quantities of urea and traces of allantoin were also found. A calculation of the N budget showed that the extra quantity of N excreted following a host meal corresponds to the quantity ingested, confirming that host-feeding in this species offers little or no net quantitative benefit in N allocation to oocytes, although the allocation of specific amino acids from host feeding cannot be discounted. Interestingly, host-feeding in parasitoids appears analogous to vertebrate blood-feeding in mosquitoes, both in terms of the N-containing compounds excreted and the offset of acquired N to metabolism, rather than to oocytes. Further comparative and detailed investigations of N excretion in insects living on other N-rich fluids might establish further metabolic commonalities.

Hydration health literacy in the elderly

BACKGROUND

Inadequate hydration in the elderly is associated with increased morbidity and mortality. However, few studies have addressed the knowledge of elderly individuals regarding hydration in health and disease. Gaps in health literacy have been identified as a critical component in health maintenance, and promoting health literacy should improve outcomes related to hydration associated illnesses in the elderly.

METHODS

We administered an anonymous survey to community-dwelling elderly (n = 170) to gauge their hydration knowledge.

RESULTS

About 56% of respondents reported consuming >6 glasses of fluid/day, whereas 9% reported drinking ≤3 glasses. About 60% of respondents overestimated the amount of fluid loss at which moderately severe dehydration symptoms occur, and 60% did not know fever can cause dehydration. Roughly 1/3 were not aware that fluid overload occurs in heart failure (35%) or kidney failure (32%). A majority of respondents were not aware that improper hydration or changes in hydration status can result in confusion, seizures, or death.

CONCLUSIONS

Overall, our study demonstrated that there were significant deficiencies in hydration health literacy among elderly. Appropriate education and attention to hydration may improve quality of life, reduce hospitalizations and the economic burden related to hydration-associated morbidity and mortality.

Chemical, biological, and DNA markers for tracing slaughterhouse effluent

Agricultural practices, if not managed correctly, can have a negative impact on receiving environments via waste disposal and discharge. In this study, a chicken slaughter facility on the rural outskirts of Sydney, Australia, has been identified as a possible source of persistent effluent discharge into a peri-urban catchment. Questions surrounding the facility's environmental management practices go back more than four decades. Despite there having never been a definitive determination of the facility's impact on local stream water quality, the New South Wales Environment Protection Authority (NSW EPA) has implemented numerous pollution reduction requirements to manage noise and water pollution at the slaughter facility. However, assessment of compliance remains complicated by potential additional sources of pollution in the catchment. To unravel this long-standing conundrum related to water pollution we apply a forensic, multiple lines of evidence approach to delineate the origin of the likely pollution source(s). Water samples collected between 2014 and 2016 from irrigation pipes and a watercourse exiting the slaughter facility had elevated concentrations of ammonia (max: 63,000µg/L), nitrogen (max: 67,000µg/L) and phosphorus (max: 39,000µg/L), which were significantly higher than samples from adjacent streams that did not receive direct runoff from the facility. Arsenic, sometimes utilised in growth promoting compounds, was detected in water discharging from the facility up to ~4 times (max 3.84µg/L) local background values (<0.5µg/L), with inorganic As^(∑V+III) being the dominant species. The spatial association of elevated water pollution to the facility could not unequivocally distinguish a source and consequently DNA analysis of a suspected pollution discharge event was undertaken. Analysis of catchment runoff from several local streams showed that only water sampled at the downstream boundary of the facility tested positive for chicken DNA, with traces of duck DNA being absent, which was a potential confounder given that wild ducks are present in the area. Further, PCR analysis showed that only the discharge water emanating from the slaughter facility tested positive for a generalized marker of anthropogenic pollution, the clinical class 1 integron-integrase gene. The environmental data collected over a three-year period demonstrates that the slaughter facility is indisputably the primary source of water-borne pollution in the catchment. Moreover, application of DNA and PCR for confirming pollution sources demonstrates its potential for application by regulators in fingerprinting pollution sources.

Using junior doctors to improve patient care: Creating a clinic to monitor the physical health of patients prescribed clozapine

Introduction

In the United Kingdom, compliance with guidelines on physical health monitoring of patients prescribed clozapine is poor. Our community team established a ‘clozapine clinic’, led by junior doctors, to monitor the physical health of this population.

Aims

The aims of this audit were:

– to ascertain levels of compliance with guidelines on the physical health monitoring of patients taking clozapine;

– to compare the current level of compliance with that prior to the establishment of the clinic.

Methods

Eleven standards were drawn from National Institute for Health and Care Excellence guidelines and the Maudsley Prescribing Guidelines in Psychiatry.

Three audit cycles were conducted: two prior to the establishment of the clinic and one after. In each cycle, searches of patient records were conducted and blood results were reviewed. This was supplemented by telephone calls to general practitioners to ensure a complete data set.

Analysis was conducted in Microsoft Excel™ and changes between the cycles were analysed using a two-tailed Z-score.

Results

Each audit cycle included 28–30 patients. In the current cycle compliance levels varied between 66% (annual ECG recording) and 100% (monthly full blood count). The average compliance level was 73% across all standards. This represents an overall improvement on previous audit cycles. Since the clinic was established there has been a statistically significant improvement in compliance with annual monitoring of weight (P = 0.147), body mass index (P = 0.0178), and ECG monitoring (P = 0.0244).

Conclusions

Improvements in the care of a vulnerable population may be achieved through setting clear standards, regular audit, and harnessing the leadership and enthusiasm of junior doctors.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Photothermal confocal multicolor microscopy of nanoparticles and nanodrugs in live cells

Growing biomedical applications of non-fluorescent nanoparticles (NPs) for molecular imaging, disease diagnosis, drug delivery, and theranostics require new tools for real-time detection of nanomaterials, drug nano-carriers, and NP-drug conjugates (nanodrugs) in complex biological environments without additional labeling. Photothermal (PT) microscopy (PTM) has enormous potential for absorption-based identification and quantification of non-fluorescent molecules and NPs at a single molecule and 1.4 nm gold NP level. Recently, we have developed confocal PTM providing three-dimensional (3D) mapping and spectral identification of multiple chromophores and fluorophores in live cells. Here, we summarize recent advances in the application of confocal multicolor PTM for 3D visualization of single and clustered NPs, alone and in individual cells. In particular, we demonstrate identification of functionalized magnetic and gold-silver NPs, as well as graphene and carbon nanotubes in cancer cells and among blood cells. The potential to use PTM for super-resolution imaging (down to 50 nm), real-time NP tracking, guidance of PT nanotherapy, and multiplex cancer markers targeting, as well as analysis of non-linear PT phenomena and amplification of nanodrug efficacy through NP clustering and nano-bubble formation are also discussed.