Text summarization with ChatGPT for drug labeling documents

Text summarization is crucial in scientific research, drug discovery and development, regulatory review, and more. This task demands domain expertise, language proficiency, semantic prowess, and conceptual skill. The recent advent of large language models (LLMs), such as ChatGPT, offers unprecedented opportunities to automate this process. We compared ChatGPT-generated summaries with those produced by human experts using FDA drug labeling documents. The labeling contains summaries of key labeling sections, making them an ideal human benchmark to evaluate ChatGPT's summarization capabilities. Analyzing >14000 summaries, we observed that ChatGPT-generated summaries closely resembled those generated by human experts. Importantly, ChatGPT exhibited even greater similarity when summarizing drug safety information. These findings highlight ChatGPT's potential to accelerate work in critical areas, including drug safety.

Novel high throughput screen reports that benzo(a)pyrene overrides mouse trophoblast stem cell multipotency, inducing SAPK activity, HAND1 and differentiated trophoblast giant cells

INTRODUCTION

Cultured mouse trophoblast stem cells (mTSC) maintain proliferation/normal stemness (NS) under FGF4, which when removed, causes normal differentiation (ND). Hypoxic, or hyperosmotic stress forces trophoblast giant cells (TGC) differentiate. Hypoxic, hyperosmotic, and genotoxic benzo(a)pyrene (BaP), which is found in tobacco smoke, force down-regulation of inhibitor of differentiation (Id)2, enabling TGC differentiation. Hypoxic and hyperosmotic stress induce TGC by SAPK-dependent HAND1 increase. Here we test whether BaP forces mTSC-to-TGC while inducing SAPK and HAND1.

METHODS

Hand1 and SAPK activity were assayed by immunoblot, mTSC-to-TGC growth and differentiation were assayed at Tfinal after 72hr exposure of BaP, NS, ND, Retinoic acid (RA), or sorbitol. Nuclear-stained cells were micrographed automatically by a live imager, and assayed by ImageJ/FIJI, Biotek Gen 5, AIVIA proprietary artificial intelligence (AI) software or open source, CellPose artificial intelligence/AI software.

RESULTS

BaP (0.05-1μM) activated SAPK and HAND1 without diminishing growth. TSC-to-TGC differentiation was assayed with increasingly accuracy for 2-4 N cycling nuclei and >4 N differentiating TGC nuclei, using ImageJ/FIJI, Gen 5, AIVIA, or CellPose AI software. The AIVIA and Cellpose AI software matches human accuracy. The lowest BaP effects on SAPK activation/HAND1 increase are >10-fold more sensitive than similar effects for mESC. RA induces 44-47% 1st lineage TGC differentiation, but the same RA dose induces only 1% 1st lineage mESC differentiation.

DISCUSSION

First, these pilot data suggest that mTSC can be used in high throughput screens (HTS) to predict toxicant exposures that force TGC differentiation. Second, mTSC differentiated more cells than mESC for similar stress exposures, Third, open source AI can replace human micrograph quantitation and enable a miscarriage-predicting HTS.

RxNorm for drug name normalization: a case study of prescription opioids in the FDA adverse events reporting system

Numerous studies have been conducted on the US Food and Drug Administration (FDA) Adverse Events Reporting System (FAERS) database to assess post-marketing reporting rates for drug safety review and risk assessment. However, the drug names in the adverse event (AE) reports from FAERS were heterogeneous due to a lack of uniformity of information submitted mandatorily by pharmaceutical companies and voluntarily by patients, healthcare professionals, and the public. Studies using FAERS and other spontaneous reporting AEs database without drug name normalization may encounter incomplete collection of AE reports from non-standard drug names and the accuracies of the results might be impacted. In this study, we demonstrated applicability of RxNorm, developed by the National Library of Medicine, for drug name normalization in FAERS. Using prescription opioids as a case study, we used RxNorm application program interface (API) to map all FDA-approved prescription opioids described in FAERS AE reports to their equivalent RxNorm Concept Unique Identifiers (RxCUIs) and RxNorm names. The different names of the opioids were then extracted, and their usage frequencies were calculated in collection of more than 14.9 million AE reports for 13 FDA-approved prescription opioid classes, reported over 17 years. The results showed that a significant number of different names were consistently used for opioids in FAERS reports, with 2,086 different names (out of 7,892) used at least three times and 842 different names used at least ten times for each of the 92 RxNorm names of FDA-approved opioids. Our method of using RxNorm API mapping was confirmed to be efficient and accurate and capable of reducing the heterogeneity of prescription opioid names significantly in the AE reports in FAERS; meanwhile, it is expected to have a broad application to different sets of drug names from any database where drug names are diverse and unnormalized. It is expected to be able to automatically standardize and link different representations of the same drugs to build an intact and high-quality database for diverse research, particularly postmarketing data analysis in pharmacovigilance initiatives.

Loss of Bmp2 impairs odontogenesis via dysregulating pAkt/pErk/GCN5/Dlx3/Sp7

BMP2 signaling plays a pivotal role in odontoblast differentiation and maturation during odontogenesis. Teeth lacking Bmp2 exhibit a morphology reminiscent of dentinogenesis imperfecta (DGI), associated with mutations in dentin matrix protein 1 (DMP1) and dentin sialophosphoprotein (DSPP) genes. Mechanisms by which BMP2 signaling influences expressions of DSPP and DMP1 and contributes to DGI remain elusive. To study the roles of BMP2 in dentin development, we generated Bmp2 conditional knockout (cKO) mice. Through a comprehensive approach involving RNA-seq, immunohistochemistry, promoter activity, ChIP, and Re-ChIP, we investigated downstream targets of Bmp2. Notably, the absence of Bmp2 in cKO mice led to dentin insufficiency akin to DGI. Disrupted Bmp2 signaling was linked to decreased expression of Dspp and Dmp1, as well as alterations in intracellular translocation of transcription factors Dlx3 and Sp7. Intriguingly, upregulation of Dlx3, Dmp1, Dspp, and Sp7, driven by BMP2, fostered differentiation of dental mesenchymal cells and biomineralization. Mechanistically, BMP2 induced phosphorylation of Dlx3, Sp7, and histone acetyltransferase GCN5 at Thr and Tyr residues, mediated by Akt and Erk42/44 kinases. This phosphorylation facilitated protein nuclear translocation, promoting interactions between Sp7 and Dlx3, as well as with GCN5 on Dspp and Dmp1 promoters. The synergy between Dlx3 and Sp7 bolstered transcription of Dspp and Dmp1. Notably, BMP2-driven GCN5 acetylated Sp7 and histone H3, while also recruiting RNA polymerase II to Dmp1 and Dspp chromatins, enhancing their transcriptions. Intriguingly, BMP2 suppressed the expression of histone deacetylases. we unveil hitherto uncharted involvement of BMP2 in dental cell differentiation and dentine development through pAkt/pErk42/44/Dlx3/Sp7/GCN5/Dspp/Dmp1.

Developing diagnostic tools for canine periodontitis: combining molecular techniques and machine learning models

BACKGROUND

Dental plaque microbes play a key role in the development of periodontal disease. Numerous high-throughput sequencing studies have generated understanding of the bacterial species associated with both canine periodontal health and disease. Opportunities therefore exist to utilise these bacterial biomarkers to improve disease diagnosis in conscious-based veterinary oral health checks. Here, we demonstrate that molecular techniques, specifically quantitative polymerase chain reaction (qPCR) can be utilised for the detection of microbial biomarkers associated with canine periodontal health and disease.

RESULTS

Over 40 qPCR assays targeting single microbial species associated with canine periodontal health, gingivitis and early periodontitis were developed and validated. These were used to quantify levels of the respective taxa in canine subgingival plaque samples collected across periodontal health (PD0), gingivitis (PD1) and early periodontitis (PD2). When qPCR outputs were compared to the corresponding high-throughput sequencing data there were strong correlations, including a periodontal health associated taxa, Capnocytophaga sp. COT-339 (rs =0.805), and two periodontal disease associated taxa, Peptostreptococcaceae XI [G-4] sp. COT-019 (rs=0.902) and Clostridiales sp. COT-028 (rs=0.802). The best performing models, from five machine learning approaches applied to the qPCR data for these taxa, estimated 85.7% sensitivity and 27.5% specificity for Capnocytophaga sp. COT-339, 74.3% sensitivity and 67.5% specificity for Peptostreptococcaceae XI [G-4] sp. COT-019, and 60.0% sensitivity and 80.0% specificity for Clostridiales sp. COT-028.

CONCLUSIONS

A qPCR-based approach is an accurate, sensitive, and cost-effective method for detection of microbial biomarkers associated with periodontal health and disease. Taken together, the correlation between qPCR and high-throughput sequencing outputs, and early accuracy insights, indicate the strategy offers a prospective route to the development of diagnostic tools for canine periodontal disease.

Temperature and Pressure Effects on Unrecoverable Voids in Li Metal Solid-State Batteries

All-solid-state batteries (ASSB) can potentially achieve high gravimetric and volumetric energy densities (900 Wh/L) if paired with a lithium metal anode and solid electrolyte. However, there is a lack in critical understanding about how to operate lithium metal cells at high capacities and minimize unwanted degradation mechanisms such as dendrites and voids. Herein, we investigate how pressure and temperature influence the formation and annihilation of unrecoverable voids in lithium metal upon stripping. Stack pressure and temperature are effective means to initiate creep-induced void filling and decrease charge transfer resistances. Applying stack pressure enables lithium to deform and creep below the yield stress during stripping at high current densities. Lithium creep is not sufficient to prevent cell shorting during plating. Three-electrode experiments were employed to probe the kinetic and morphological limitations that occur at the anode-solid electrolyte during high-capacity stripping (5 mAh/cm2). The role of cathode-LLZO interface, which dictates cyclability and capacity retention in full cells, was also studied. This work elucidates the important role that temperature (external or in situ generated) has on reversible operation of solid-state batteries.

Ten second triage: A novel and pragmatic approach to major incident triage

Triage is a key principle in the effective management of major incidents and has traditionally been performed using an assessment of a casualty's physiology. However, it has become apparent from recent experiences of major incidents that physiological triage may practically not be possible, especially in the early stages of an incident. A key factor is the speed with which it is possible to perform triage, and subsequently, the speed at which key life-saving interventions (e.g., management of external haemorrhage and airway opening manoeuvres) are able to be performed simultaneously as part of the triage process. Addressing this issue was a priority for the review of major incident triage undertaken by NHS England and culminated in the development of the Ten Second Triage (TST) tool.

Tisagenlecleucel therapy for relapsed or refractory B-cell acute lymphoblastic leukaemia in infants and children younger than 3 years of age at screening: an international, multicentre, retrospective cohort study

BACKGROUND

Children aged younger than 3 years were excluded from the ELIANA phase 2 trial of tisagenlecleucel in children with acute lymphoblastic leukaemia. The feasibility, safety, and activity of tisagenlecleucel have not been defined in this group, the majority of whom have high-risk (KMT2A-rearranged) infant acute lymphoblastic leukaemia and historically poor outcomes despite intensification of chemotherapy, and for whom novel therapies are urgently needed. We aimed to provide real-world outcome analysis of the feasibility, activity, and safety of tisagenlecleucel in younger children and infants with acute lymphoblastic leukaemia.

METHODS

We did an international, multicentre, retrospective cohort study at 15 hospitals across ten countries in Europe. Eligible patients were children aged younger than 3 years at screening between Sept 1, 2018, and Sept 1, 2021, who were screened for tisagenlecleucel therapy for relapsed or refractory B-cell precursor acute lymphoblastic leukaemia according to licensed indications. Patients received a single intravenous infusion of tisagenlecleucel. We tracked chimeric antigen receptor T-cell therapy outcomes using a standardised data reporting form. Overall survival, event-free survival, stringent event-free survival, B-cell aplasia, and toxicity were assessed in all patients who received a tisagenlecleucel infusion.

FINDINGS

38 eligible patients were screened, of whom 35 (92%) received a tisagenlecleucel infusion. 29 (76%) of 38 patients had KMT2A-rearranged acute lymphoblastic leukaemia, and 25 (66%) had relapsed after previous allogeneic haematopoietic stem-cell transplantation (HSCT). Patients had previously received a median of 2 lines (IQR 2-3) of (non-HSCT) therapy. Seven (18%) of 38 patients had received inotuzumab and 14 (37%) had received blinatumomab. After a median of 14 months (IQR 9-21) of follow-up, overall survival at 12 months after tisagenlecleucel infusion was 84% (64-93; five patients had died), event-free survival was 69% (47-83; nine events), and stringent event-free survival was 41% (23-58; 18 events). The probability of ongoing B-cell aplasia was 70% (95% CI 46-84; seven events) at 12 months. Adverse events included cytokine release syndrome, which occurred at any grade in 21 (60%) of 35 patients and at grade 3 or worse in five (14%), and neurotoxicity at any grade in nine (26%), none of which were severe. Measurable residual disease-negative complete response with or without haematological recovery occurred in 24 (86%) of 28 patients who had measurable disease.

INTERPRETATION

These data suggest that tisagenlecleucel has antitumour activity and has an acceptable safety profile for young children and infants with B-cell precursor acute lymphoblastic leukaemia.

FUNDING

None.

Adolescence and the development of social behaviour in giraffes

All mammals experience different life stages as they develop, each of which is characterised by particular physical and behavioural changes. Despite the emergence of sophisticated behaviour analysis techniques, the ways in which social behaviour varies by life stage, and how this is influenced by an individual’s sex, is relatively understudied in most social mammals other than primates and elephants. Understanding the social requirements of mammals should be a central and critical component to their conservation, captive management and welfare. Here, we apply social network analysis techniques to understand how social behaviour differs with life stage in the giraffe, a gregarious fission–fusion mammal. We studied two wild populations of giraffes in Kenya and found that adolescents have significantly stronger associations with adolescents of their own sex first and foremost, then adults of their own sex. Other associations were significantly lower than would be expected, or non-significant. Our results suggest that adolescence in both male and female giraffes shares similar features to adolescence in other social mammal species. We discuss how the application of such knowledge might improve the management and welfare of captive giraffes.

Acute ST-segment elevation myocardial infarction secondary to vaccine-induced immune thrombosis with thrombocytopaenia (VITT)

A 40-year-old man with no cardiac history presented with central chest pain 8 days after receiving the ChAdOx1 nCov-19 vaccine against COVID-19. Initial blood tests demonstrated a thrombocytopaenia (24×10⁹ μg/L) and a raised d-dimer (>110 000 μg/L), and he was urgently transferred to our tertiary referral central for suspected vaccine-induced immune thrombocytopaenia and thrombosis (VITT). He developed dynamic ischaemic electrocardiographic changes with ST elevation, a troponin of 3185 ng/L, and regional wall motion abnormalities. An occlusion of his left anterior descending coronary artery was seen on CT coronary angiography. His platelet factor-4 (PF-4) antibody returned strongly positive. He was urgently treated for presumed VITT with intravenous immunoglobulin, methylprednisolone and plasma exchange, but remained thrombocytopaenic and was initiated on rituximab. Argatroban was used for anticoagulation for his myocardial infarction while he remained thrombocytopaenic. After 6 days, his platelet count improved, and his PF-4 antibody level, troponin and d-dimer fell. He was successfully discharged after 14 days.

Using a 3D handheld scanner to capture trochlear groove shape: proof of concept study

INTRODUCTION

Trochleoplasty is a surgical procedure used to treat patellar instability by modifying the trochlear groove. Analysis of the groove with a handheld scanner would enable accurate real-time planning and facilitate tailormade correction. We aimed to measure trochlear depth, sulcus angle, trochlear facet ratio, trochlear angle and lateral trochlear inclination angle and to establish inter- and intra-rater reliability for knee models to determine reliability and repeatability.

METHODS

The trochlear grooves of three knee models were scanned by two investigators. Three-dimensional reference models were created and surface-matched. Custom software was used to determine the desired parameters. The intraclass correlation coefficient (ICC) was used to determine test-retest reliability and the parameter results for each model that showed best reproducibility.

RESULTS

There was good interobserver reliability (trochlear depth, 1.0mm; sulcus angle, 2.7°; trochlear angle, 4.0°; lateral trochlear inclination angle, 4.0°), except in the trochlear facet ratio (32.0%) of one knee model. With outliers removed, the ICC was moderate to excellent in 73.34% of measurements, with trochlear depth showing the best reproducibility.

DISCUSSION

This feasibility study showed a handheld scanner in conjunction with supporting software can measure trochlear parameters with good to excellent inter- and intra-observer reliability.

199 Use of A 3D Hand-Held Scanner to Capture Trochlear Groove Shape, A Proof-of-Concept Study

Introduction

Trochleoplasty is a surgical procedure used to treat patellar instability through modifying the trochlear groove. Analysis of the groove with a hand-held scanner would enable accurate real time planning and facilitate tailor made correction. We aimed to measure trochlear depth, sulcus angle, trochlear facet ratio, trochlear angle and lateral trochlear inclination angle and establish inter- and intra-rater reliability for each knee model.

Method

The trochlear groove of the knee models was scanned by two investigators and 3D reference models created. These were surface matched and custom software along with Excel was utilised to determine the desired parameters. Intraclass correlation coefficient (ICC) was used for test-retest reliability and to determine which parameter results, for each model, showed the best reproducibility.

Results

There was good inter-observer reliability - trochlear depth (1.0 mm), sulcus angle (2.7°), trochlear angle (4.0°) and lateral trochlear inclination angle (4.0°), except in the trochlear facet ratio (32.0%) of one knee model. With outliers removed ICC was good-excellent in (46.7%) of measurements, with trochlear depth showing the best reproducibility.

Conclusions

This feasibility study showed that the hand-held scanner in conjunction with supporting software can measure trochlear parameters in a controlled environment and justifies extending research into its use in trochleoplasty.

Impact of solitary pulmonary nodule size on qualitative and quantitative assessment using 18F-fluorodeoxyglucose PET/CT: the SPUTNIK trial

PURPOSE

To compare qualitative and semi-quantitative PET/CT criteria, and the impact of nodule size on the diagnosis of solitary pulmonary nodules in a prospective multicentre trial.

METHODS

Patients with an SPN on CT ≥ 8 and ≤ 30 mm were recruited to the SPUTNIK trial at 16 sites accredited by the UK PET Core Lab. Qualitative assessment used a five-point ordinal PET-grade compared to the mediastinal blood pool, and a combined PET/CT grade using the CT features. Semi-quantitative measures included SUVmax of the nodule, and as an uptake ratio to the mediastinal blood pool (SURBLOOD) or liver (SURLIVER). The endpoints were diagnosis of lung cancer via biopsy/histology or completion of 2-year follow-up. Impact of nodule size was analysed by comparison between nodule size tertiles.

RESULTS

Three hundred fifty-five participants completed PET/CT and 2-year follow-up, with 59% (209/355) malignant nodules. The AUCs of the three techniques were SUVmax 0.87 (95% CI 0.83;0.91); SURBLOOD 0.87 (95% CI 0.83; 0.91, p = 0.30 versus SUVmax); and SURLIVER 0.87 (95% CI 0.83; 0.91, p = 0.09 vs. SUVmax). The AUCs for all techniques remained stable across size tertiles (p > 0.1 for difference), although the optimal diagnostic threshold varied by size. For nodules < 12 mm, an SUVmax of 1.75 or visual uptake equal to the mediastinum yielded the highest accuracy. For nodules > 16 mm, an SUVmax ≥ 3.6 or visual PET uptake greater than the mediastinum was the most accurate.

CONCLUSION

In this multicentre trial, SUVmax was the most accurate technique for the diagnosis of solitary pulmonary nodules. Diagnostic thresholds should be altered according to nodule size.

TRIAL REGISTRATION

ISRCTN - ISRCTN30784948. ClinicalTrials.gov - NCT02013063.

Subgingival microbiota of dogs with healthy gingiva or early periodontal disease from different geographical locations

BACKGROUND

Periodontal disease is the most common oral disease of dogs worldwide and results from a complex interplay between plaque bacteria, the host and environmental factors. Recent studies have enhanced our understanding of the associations between the plaque microbiota and canine periodontal disease. These studies, however, were limited in their geographical reach. Thus associations between the canine oral microbiota and geographical location were investigated by determining the composition of subgingival plaque samples from 587 dogs residing in the United Kingdom (UK), United States of America (USA), China and Thailand using 454-pyrosequencing.

RESULTS

After quality filtering 6,944,757 sequence reads were obtained and clustering of these at ≥98% sequence resulted in 280 operational taxonomic units (OTUs) following exclusion of rare OTUs (present at < 0.05% in all four countries). The subgingival plaque from dog populations located in the UK, USA, China and Thailand had a similar composition although the abundance of certain taxa varied significantly among geographical locations. Exploration of the effect of clinical status and age revealed a marked similarity among the bacteria associated with increased age and those associated with gingivitis: Young dogs and those with no gingivitis were dominated by taxa from the phyla Bacteroidetes and Proteobacteria whereas older dogs and those with moderate gingivitis were dominated by members of the Firmicutes. The plaque microbiota of small breed dogs was found to significantly differ to medium and large breeds and was dominated by species belonging to the Firmicutes.

CONCLUSIONS

The bacterial associations with health, gingivitis and periodontitis were conserved across dogs from the UK, USA, China and Thailand. These bacterial signatures of periodontal health and disease have potential as biomarkers for disease detection.

Are British urban foxes (Vulpes vulpes) "bold"? The importance of understanding human-wildlife interactions in urban areas

Human-wildlife interactions are believed to be increasing in urban areas. In Britain, numerous media reports have stated that urban foxes (Vulpes vulpes) are becoming "bolder," thereby posing a risk to public safety. However, such claims overlook how an individual's personality might influence urban fox behavior. Personality determines multiple aspects of an animal's interactions with both conspecifics and its environment, and can have a significant impact on how people perceive wildlife. Furthermore, describing urban foxes as "bold" confounds two different but inter-related behaviors, both of which influence an animal's propensity to take risks. Neophobia affects an animal's reaction to novelty, wariness its reaction to potential threats. Since urban wildlife frequently encounters both novel and threatening stimuli, a highly adaptable species such as the red fox might be predicted to exhibit reduced neophobia and wariness. We investigated how social status influenced both behaviors in Bristol's fox population. Dominant foxes were significantly more neophobic and warier than subordinates, which adopt a more exploratory and risk-taking lifestyle to meet their energetic and other needs. We found no seasonal effect on neophobia and wariness, although this may be due to sample size. The presence of conspecifics decreased neophobia for dominants, and wariness for both dominants and subordinates. We highlight the importance of considering animal social status and personality when planning management protocols, since interventions that destabilize fox social groups are likely to increase the number of subordinate foxes in the population, thereby increasing rather than decreasing the number of interactions between humans and urban foxes.

Very low birth weight is associated with reduced right ventricular function detected by strain imaging in early adulthood – findings from a prospective matched cohort study

Introduction

Being born at very low birth weight (VLBW, &lt;1500g) is associated with increased rates of cardiopulmonary disorders in childhood. As survivors age, late cardiac effects, including right ventricular (RV) remodelling and occult pulmonary hypertension are emerging. Strain imaging provides prognostically important information regarding RV dysfunction in diverse cardiopulmonary conditions however, these indices have not previously been described within VLBW cohorts.

Purpose

To assess differences in right heart function using strain in young adults born at VLBW, compared to normal weight term born controls.

Methods

The New Zealand Very Low Birth Weight Study has followed all infants born in 1986 with birth weight &lt;1500g. Of 323 survivors to adulthood, 228 (71%) had echocardiograms at 26–30 years which were compared to age and sex-matched term-born, normal-weight controls (n=100). RV global longitudinal strain (GLS) was measured by speckle tracking echocardiography by an investigator blinded to group allocation. Established measures of RV function (fractional area change (FAC), tricuspid annular systolic velocity (RV S') and tricuspid regurgitation velocities) were also obtained.

Results

VLBW subjects were smaller than their peers as young adults (Table 1). Strain measurement showed reduced myocardial deformation among VLBW subjects (RV myocardial GLS: −22.4% vs −23.5%, p=0.008; RV endocardial GLS: −23.6% vs −24.9%, p=0.005; free wall myocardial GLS −25.2% vs −26.1%, p=0.039; free wall endocardial GLS −26.7% vs −27.9%, p=0.009). TR velocity was higher in VLBW: 224 cm/s v 210 cm/s (p=0.002). RV S', and FAC were not different.

Conclusion

Young adults born at VLBW have impaired myocardial strain despite preserved RV function as assessed by standard techniques. Echocardiographic strain imaging may be an important tool to detect subclinical RV dysfunction.

Graph 1

Funding Acknowledgement

Type of funding source: None

Prevalence of chronic kidney disease in adults in England: comparison of nationally representative cross-sectional surveys from 2003 to 2016

OBJECTIVES

To identify recent trends in chronic kidney disease (CKD) prevalence in England and explore their association with changes in sociodemographic, behavioural and clinical factors.

DESIGN

Pooled cross-sectional analysis.

SETTING

Health Survey for England 2003, 2009/2010 combined and 2016.

PARTICIPANTS

17 663 individuals (aged 16+) living in private households.

PRIMARY AND SECONDARY OUTCOME MEASURES

Prevalence of estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 and albuminuria (measured by albumin-creatinine ratio) during 2009/2010 and 2016 and trends in eGFR between 2003 and 2016. eGFR was estimated using serum creatinine Chronic Kidney Disease Epidemiology Collaboration and Modification of Diet in Renal Disease equations.

RESULTS

GFR <60 mL/min/1.73 m2 prevalence was 7.7% (95% CI 7.1% to 8.4%), 7.0% (6.4% to 7.7%) and 7.3%(6.5% to 8.2%) in 2003, 2009/2010 and 2016, respectively. Albuminuria prevalence was 8.7% (8.1% to 9.5%) in 2009/2010 and 9.8% (8.7% to 10.9%) in 2016. Prevalence of CKD G1-5 (eGFR <60 mL/min/1.73 m2 or albuminuria) was 12.6% (11.8% to 13.4%) in 2009/2010 and 13.9% (12.8% to 15.2%) in 2016. Prevalence of diabetes and obesity increased during 2003-2016 while prevalence of hypertension and smoking fell. The age-adjusted and gender-adjusted OR of eGFR <60 mL/min/1.73 m2 for 2016 versus 2009/2010 was 0.99 (0.82 to 1.18) and fully adjusted OR was 1.13 (0.93 to 1.37). There was no significant period effect on the prevalence of albuminuria or CKD G1-5 from 2009/2010 to 2016 in age and gender or fully adjusted models.

CONCLUSION

The fall in eGFR <60 mL/min/1.73 m2 seen from 2003 to 2009/2010 did not continue to 2016. However, absolute CKD burden is likely to rise with population growth and ageing, particularly if diabetes prevalence continues to increase. This highlights the need for greater CKD prevention efforts and continued surveillance.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Machine learning to predict early recurrence after oesophageal cancer surgery

BACKGROUND

Early cancer recurrence after oesophagectomy is a common problem, with an incidence of 20-30 per cent despite the widespread use of neoadjuvant treatment. Quantification of this risk is difficult and existing models perform poorly. This study aimed to develop a predictive model for early recurrence after surgery for oesophageal adenocarcinoma using a large multinational cohort and machine learning approaches.

METHODS

Consecutive patients who underwent oesophagectomy for adenocarcinoma and had neoadjuvant treatment in one Dutch and six UK oesophagogastric units were analysed. Using clinical characteristics and postoperative histopathology, models were generated using elastic net regression (ELR) and the machine learning methods random forest (RF) and extreme gradient boosting (XGB). Finally, a combined (ensemble) model of these was generated. The relative importance of factors to outcome was calculated as a percentage contribution to the model.

RESULTS

A total of 812 patients were included. The recurrence rate at less than 1 year was 29·1 per cent. All of the models demonstrated good discrimination. Internally validated areas under the receiver operating characteristic (ROC) curve (AUCs) were similar, with the ensemble model performing best (AUC 0·791 for ELR, 0·801 for RF, 0·804 for XGB, 0·805 for ensemble). Performance was similar when internal-external validation was used (validation across sites, AUC 0·804 for ensemble). In the final model, the most important variables were number of positive lymph nodes (25·7 per cent) and lymphovascular invasion (16·9 per cent).

CONCLUSION

The model derived using machine learning approaches and an international data set provided excellent performance in quantifying the risk of early recurrence after surgery, and will be useful in prognostication for clinicians and patients.

Skull morphology diverges between urban and rural populations of red foxes mirroring patterns of domestication and macroevolution

Human activity is drastically altering the habitat use of natural populations. This has been documented as a driver of phenotypic divergence in a number of wild animal populations. Here, we show that urban and rural populations of red foxes (Vulpes vulpes) from London and surrounding boroughs are divergent in skull traits. These changes are primarily found to be involved with snout length, with urban individuals tending to have shorter and wider muzzles relative to rural individuals, smaller braincases and reduced sexual dimorphism. Changes were widespread and related to muscle attachment sites and thus are likely driven by differing biomechanical demands of feeding or cognition between habitats. Through extensive sampling of the genus Vulpes, we found no support for phylogenetic effects on skull morphology, but patterns of divergence found between urban and rural habitats in V. vulpes quantitatively aligned with macroevolutionary divergence between species. The patterns of skull divergence between urban and rural habitats matched the description of morphological changes that can occur during domestication. Specifically, urban populations of foxes show variation consistent with 'domestication syndrome'. Therefore, we suggest that occurrences of phenotypic divergence in relation to human activity, while interesting themselves, also have the potential to inform us of the conditions and mechanisms that could initiate domestication. Finally, this also suggests that patterns of domestication may be developmentally biased towards larger patterns of interspecific divergence.

0198 Psychomotor/Cognitive Effects, Pharmacokinetics and Safety of V117957, a Novel, Highly Potent and Selective Partial Agonist for Nociceptin/Orphanin-FQ Peptide (NOP) Receptors, Administered in Combination with Alcohol in Healthy Subjects

Introduction

V117957 is an investigational nociceptin/orphanin-FQ peptide (NOP) receptor partial agonist designed to treat insomnia by promoting sleep onset and maintenance with minimal residual next-day somnolence or psychomotor impairment. The satisfactory safety/tolerability profile of V117957 has been previously established in ~200 healthy subjects with maximum doses at 30mg following a single oral administration and 10mg once daily for 2 weeks. The present study was conducted to assess the safety/tolerability and pharmacokinetics (PK) of V117957 with co-administered alcohol.

Methods

A randomized, double-blind, double-dummy, placebo-controlled, balanced six-period crossover design was employed. Single doses (2mg, 6mg) of V117957 and placebo were administered orally to healthy subjects in the morning with and without alcohol (0.7g/kg). Pharmacodynamic (PD) effects of V117957 were assessed, and safety/tolerability and PK interactions were also characterized. The primary PD endpoints (body sway, Digit Vigilance Test, and numeric working memory) were measured through 12 hours postdosing.

Results

Forty-eight subjects were enrolled and randomized; 46 completed. Compared with placebo, alcohol alone showed an impairment on psychomotor/cognitive performances through 2 hours postdose. V117957 alone showed a dose-dependent impairment. Compared with V117957 alone and alcohol alone, co-administration of alcohol and V117957 showed greater impairment until 8 hours postdose. No subject discontinued due to an adverse event (AE). No clinically meaningful treatment-emergent (TE) changes in clinical laboratory values, vital signs, SpO2 measurements, or 12-lead ECG results were observed. The most common TEAE was somnolence. All plasma and urine PK parameters for V117957 and alcohol were comparable when V117957 or alcohol was administered alone or in combination.

Conclusion

Single oral doses of V117957, 2mg or 6mg, administered alone or in combination with alcohol in healthy subjects resulted in no notable PK interaction between V117957 and alcohol. A dose-effect relationship in the magnitude and duration of impairment was observed for most psychomotor/cognitive performance parameters. Greater effects of V117957 with alcohol were observed for most psychomotor/cognitive performance parameters up to 8 hours post-dose.

Support

Funded by Imbrium Therapeutics, a subsidiary of Purdue Pharma L.P.

0500 Evaluation of the Human Abuse Potential of Single Oral Doses of V117957, a Novel, Highly Potent and Selective Partial Agonist for Nociceptin/Orphanin-FQ Peptide (NOP) Receptors

Introduction

The satisfactory safety/tolerability profile of V117957, an investigational NOP receptor partial agonist, has been previously established in ~200 healthy subjects with maximum doses at 30mg following a single oral administration and 10mg once daily for 2 weeks. V117957 exhibited linear plasma exposures at doses up to 10mg. In patients with insomnia disorder, V117957 demonstrated dose-dependent improvement in sleep efficiency and sleep maintenance between 0.5mg and 10mg as measured by polysomnography and patient diaries. The current study evaluated the abuse potential and safety of V117957 in healthy, nondependent recreational polydrug users with a history of central nervous system (CNS) depressant use.

Methods

The abuse potential of V117957 (1mg, 6mg, 10mg), placebo, and triazolam (0.5mg, 1mg) were assessed in a randomized, double-blind, double-dummy, placebo- and positive-controlled crossover study. Triazolam was utilized as a positive control based on its comparable pharmacokinetic and pharmacodynamic characteristics. V117957 doses (1mg, 6mg, 10mg) were selected to represent therapeutic, mid-range supratherapeutic, and maximum-tolerated supratherapeutic doses, respectively. Subjects were qualified based on pharmacodynamic responses following a single oral 0.75mg triazolam dose. Drug liking was measured through 24 hours, including the primary endpoint of maximum “at the moment” Drug-Liking Visual Analog Scale, as recommended by FDA. Secondary endpoints included Divided Attention Test (DAT) and Choice Reaction Time (CRT).

Results

The positive control (triazolam 0.5mg, 1mg) produced statistically significant greater abuse potential and cognitive/motor impairment versus placebo, which demonstrated study validity. In contrast, V117957 at 1mg was not statistically significantly different from placebo. At the supra-therapeutic doses of 6 and 10mg, V117957 was associated with abuse potential and cognitive/motor impairment greater than placebo, yet similar to those of triazolam 0.5 and 1mg.

Conclusion

Overall, in this valid study, V117957 1mg and placebo were associated with statistically significant lower potential for abuse and reduced cognitive/motor impairment compared with the two supratherapeutic doses of V117957 (6mg, 10mg), and triazolam (0.5mg, 1mg). V117957 1mg met FDA’s statistical criterion for similarity to placebo.

Support

Funded by Imbrium Therapeutics, a subsidiary of Purdue Pharma L.P.

Asymmetrical gene flow in five co-distributed syngnathids explained by ocean currents and rafting propensity

Ocean circulation driving macro-algal rafting is believed to serve as an important mode of dispersal for many marine organisms, leading to predictions on population-level genetic connectivity and the directionality of effective dispersal. Here, we use genome-wide single nucleotide polymorphism data to investigate whether gene flow directionality in two seahorses (Hippocampus) and three pipefishes (Syngnathus) follows the predominant ocean circulation patterns in the Gulf of Mexico and northwestern Atlantic. In addition, we explore whether gene flow magnitudes are predicted by traits related to active dispersal ability and habitat preference. We inferred demographic histories of these co-distributed syngnathid species, and coalescent model-based estimates indicate that gene flow directionality is in agreement with ocean circulation data that predicts eastward and northward macro-algal transport. However, the magnitude to which ocean currents influence this pattern appears strongly dependent on the species-specific traits related to rafting propensity and habitat preferences. Higher levels of gene flow and stronger directionality are observed in Hippocampus erectus, Syngnathus floridae and Syngnathus louisianae, which closely associated with the pelagic macro-algae Sargassum spp., compared to Hippocampus zosterae and the Syngnathus scovelli/Syngnathus fuscus sister-species pair, which prefer near shore habitats and are weakly associated with pelagic Sargassum. This study highlights how the combination of population genomic inference together with ocean circulation data can help explain patterns of population structure and diversity in marine ecosystems.

Gemcitabine-based adjuvant chemotherapy in subtypes of ampullary adenocarcinoma: international propensity score-matched cohort study

BACKGROUND

Whether patients who undergo resection of ampullary adenocarcinoma have a survival benefit from adjuvant chemotherapy is currently unknown. The aim of this study was to compare survival between patients with and without adjuvant chemotherapy after resection of ampullary adenocarcinoma in a propensity score-matched analysis.

METHODS

An international multicentre cohort study was conducted, including patients who underwent pancreatoduodenectomy for ampullary adenocarcinoma between 2006 and 2017, in 13 centres in six countries. Propensity scores were used to match patients who received adjuvant chemotherapy with those who did not, in the entire cohort and in two subgroups (pancreatobiliary/mixed and intestinal subtypes). Survival was assessed using the Kaplan-Meier method and Cox regression analyses.

RESULTS

Overall, 1163 patients underwent pancreatoduodenectomy for ampullary adenocarcinoma. After excluding 187 patients, median survival in the remaining 976 patients was 67 (95 per cent c.i. 56 to 78) months. A total of 520 patients (53·3 per cent) received adjuvant chemotherapy. In a propensity score-matched cohort (194 patients in each group), survival was better among patients who received adjuvant chemotherapy than in those who did not (median survival not reached versus 60 months respectively; P = 0·051). A survival benefit was seen in patients with the pancreatobiliary/mixed subtype; median survival was not reached in patients receiving adjuvant chemotherapy and 32 months in the group without chemotherapy (P = 0·020). Patients with the intestinal subtype did not show any survival benefit from adjuvant chemotherapy.

CONCLUSION

Patients with resected ampullary adenocarcinoma may benefit from gemcitabine-based adjuvant chemotherapy, but this effect may be reserved for those with the pancreatobiliary and/or mixed subtype.

Health resource utilization of labor induction versus expectant management

BACKGROUND

Although induction of labor of low-risk nulliparous women at 39 weeks reduces the risk of cesarean delivery compared with expectant management, concern regarding more frequent use of labor induction remains, given that this intervention historically has been thought to incur greater resource utilization.

OBJECTIVE

The objective of the study was to determine whether planned elective labor induction at 39 weeks among low-risk nulliparous women, compared with expectant management, was associated with differences in health care resource utilization from the time of randomization through 8 weeks postpartum.

STUDY DESIGN

This is a planned secondary analysis of a multicenter randomized trial in which low-risk nulliparous women were assigned to induction of labor at 39 weeks or expectant management. We assessed resource utilization after randomization in 3 time periods: antepartum, delivery admission, and discharge through 8 weeks postpartum.

RESULTS

Of 6096 women with data available, those in the induction of labor group (n = 3059) were significantly less likely in the antepartum period after randomization to have at least 1 ambulatory visit for routine prenatal care (32.4% vs 68.4%), unanticipated care (0.5% vs 2.6%), or urgent care (16.2% vs 44.3%), or at least 1 antepartum hospitalization (0.8% vs 2.2%, P < .001 for all). They also had fewer tests (eg, sonograms, blood tests) and treatments (eg, antibiotics, intravenous hydration) prior to delivery. During the delivery admission, women in the induction of labor group spent a longer time in labor and delivery (median, 0.83 vs 0.57 days), but both women (P = .002) and their neonates (P < .001) had shorter postpartum stays. Women and neonates in both groups had similar frequencies of postpartum urgent care and hospital readmissions (P > .05 for all).

CONCLUSION

Women randomized to induction of labor had longer durations in labor and delivery but significantly fewer antepartum visits, tests, and treatments and shorter maternal and neonatal hospital durations after delivery. These results demonstrate that the health outcome advantages associated with induction of labor are gained without incurring uniformly greater health care resource use.

Translational outcomes in a full gene deletion of ubiquitin protein ligase E3A rat model of Angelman syndrome

Angelman syndrome (AS) is a rare neurodevelopmental disorder characterized by developmental delay, impaired communication, motor deficits and ataxia, intellectual disabilities, microcephaly, and seizures. The genetic cause of AS is the loss of expression of UBE3A (ubiquitin protein ligase E6-AP) in the brain, typically due to a deletion of the maternal 15q11-q13 region. Previous studies have been performed using a mouse model with a deletion of a single exon of Ube3a. Since three splice variants of Ube3a exist, this has led to a lack of consistent reports and the theory that perhaps not all mouse studies were assessing the effects of an absence of all functional UBE3A. Herein, we report the generation and functional characterization of a novel model of Angelman syndrome by deleting the entire Ube3a gene in the rat. We validated that this resulted in the first comprehensive gene deletion rodent model. Ultrasonic vocalizations from newborn Ube3am-/p+ were reduced in the maternal inherited deletion group with no observable change in the Ube3am+/p- paternal transmission cohort. We also discovered Ube3am-/p+ exhibited delayed reflex development, motor deficits in rearing and fine motor skills, aberrant social communication, and impaired touchscreen learning and memory in young adults. These behavioral deficits were large in effect size and easily apparent in the larger rodent species. Low social communication was detected using a playback task that is unique to rats. Structural imaging illustrated decreased brain volume in Ube3am-/p+ and a variety of intriguing neuroanatomical phenotypes while Ube3am+/p- did not exhibit altered neuroanatomy. Our report identifies, for the first time, unique AS relevant functional phenotypes and anatomical markers as preclinical outcomes to test various strategies for gene and molecular therapies in AS.

A systematic review of ground-based shooting to control overabundant mammal populations

Abstract Context Ground-based shooting is widely used in management programs aiming to alleviate the impacts of invasive or overabundant wildlife populations. However, evaluations of individual shooting operations have shown variable results, and the effectiveness of ground-shooting as a population-management intervention has not been systematically examined. Aims Our review aimed to (1) assess the efficacy of shooting as a population management tool, and (2) identify commonalities among studies that will help managers identify situations where ground-shooting is most likely to be effective. Methods We systematically reviewed the literature to identify studies involving ground-shooting. From each study, we collated information about operational objectives, target taxa, geographic context, type of shooter used, effort, effectiveness, and use of additional control tools. Key results Most studies had no a priori quantifiable objectives. However, 60% of the 64 case studies produced a detectable reduction in population density and/or damage. The most common type of operation used unpaid or commercial harvest-oriented shooters to reduce herbivore density or damage. Only 30% of the operations that used volunteer shooters or recreational hunters achieved their objectives. Target taxa, geographic area or integration of shooting with other population-control methods had no detectable effect on the effectiveness of shooting operations. Common factors that hindered the effectiveness of shooting operations included immigration of target species from adjacent areas (n=13), decreasing effort from shooters as the target population declined (n=7) and selective harvesting (n=7). Conclusions Ground-based shooting can be an effective management tool for overabundant wildlife populations, but many shooting operations did not achieve a notable decrease in animal abundance or damage. The source of failure could often be attributed to an inability to remove a sufficient proportion of the population to cause a population decline. Implications Managers contemplating using ground-based shooting to reduce the impacts or density of wildlife populations should (1) carefully consider whether this is a suitable management tool to achieve the desired outcomes, (2) establish clear objectives that aim to meet defined outcomes and allow for continuous improvement, and (3) ensure that operations are sufficiently resourced to achieve and maintain those objectives.

P5430Long term outcomes of patients receiving Implantable Cardioverter Defibrillators in a contemporary implant population in the Essex region of the UK

Introduction

Implantable cardioverter-defibrillators (ICD) reduce the risk of sudden cardiac death in patients who are at risk and amongst among heart failure (HF) patients with a reduced left ventricular ejection fraction (LVEF).

Objective

The aim of this study was to determine the differences in outcomes amongst patients in a contemporary ICD implant population based on primary or secondary indications and an ischaemic or non-ischaemic aetiology. The primary outcome was death or appropriate device therapy for a ventricular arrhythmia. The secondary outcome was inappropriate shock therapy.

Purpose

The study cohort included consecutive patients who had an ICD or CRT-D implanted at a high-volume regional referral centre in Essex between 2014 and 2015. The censor point for follow up was 31/12/2018. Cumulative incidences were analysed by the method of Kaplan–Meier and compared using the log-rank test. In addition, the relationship between several clinical variables were tested in a multivariate Cox model to predict long-term mortality and this is described with hazard ratios (HR) and 95% CI.

Results

407 patients who received ICD treatment were followed up for a mean of 50±4 months. 63% had an Ischaemic cardiomyopathy and 60% had a primary prevention indication. Majority were men (81.5%), mean LVEF was (31±11) and mean age (71±11). The incidence of appropriate ICD therapy at 1-year post ICD insertion was 6.8% in all patients. This was significantly higher in patients with a secondary prevention indication compared to primary prevention (11.7% v 3.6% p=0.015) but similar in ischaemic compared to non-ischaemic patients (7.8% v 5.2% p=0.46). 1.9% patients had an inappropriate shock at 1 year and between group rate was similar. Overall 8.1% of patients did not survive beyond 1-year post implant with a mean time to death of 5.6±3.6 months. The cumulative incidence of the primary end-point at 1 year was similar in ischaemic and non-Ischaemic patients (7.8% v 8.6%; HR: 1.04, 95% CI 0.7–1.5, p=0.83) but was significantly higher at the end of study period in patients with an ischaemic aetiology (32.4% v 21%; HR: 1.59, 95% CI: 1.1–2.4, p=0.024) (Fig.1). In an adjusted Cox Hazard model, appropriate ICD therapy at 1 year (HR: 0.28, 95% CI: 0.17–0.47, p<0.001) and a secondary indication for ICD treatment (HR: 0.47, 95% CI: 0.31–0.73, p=0.001) were strongly associated with long-term mortality.

Figure 1

Conclusions

Our study highlights outcomes in a long-term follow up of ICD patients and in light of the debate around the DANISH trial, we have shown that at 1 year, the benefit of ICD therapy is comparable in non-ischaemic compared to ischaemic cardiomyopathies. Moreover, patients who had an ICD implanted for secondary prevention had a 3-fold mortality benefit at 1 year and had a higher rate of death. Appropriate ICD therapy and a secondary prevention indication predicted long term mortality.

Building a population management informatics infrastructure for oncology care

315

Background: While most primary care practices have informatics infrastructures to support population management, such infrastructures are not commonplace in oncology. Yet, value-based care requires that oncology practices be able to identify patients in real time, use risk stratification to target care efficiently, and monitor care quality to identify improvement opportunities. We describe an oncology informatics infrastructure development initiative in a large academic medical center. Methods: We convened a quality improvement team of administrators, analysts, clinicians, health services researchers and performance improvement staff. The team was sponsored by a senior leadership committee convened for a strategic planning initiative. We used PDSA cycles to develop and test ways to leverage data from an electronic health record (EHR) and billing system for oncology patient identification, risk stratification, and routine quality monitoring. We used clinician engagement, medical record review, and tumor registry comparisons to validate query strategies. Results: After considering different query strategies, we opted to identify patients via a new cancer treatment episode (as defined by a cancer diagnosis combined with evidence of pharmaceutical, radiation, and/or surgical treatment for cancer with no evidence of such treatment in the prior six months). This was done using diagnostic and procedural codes for chemo/immunotherapy and radiation treatment, and pathology reports and procedural codes for surgery. Using this approach, we identified over 7800 cancer treatment episodes within the health system in 2018. These episodes corresponded to 4178 chemo/immunotherapy, 1437 radiation, and 3440 surgical treatments. Quality monitoring has identified opportunities to enhance data capture, harmonize documentation processes across practitioners and practices, and initiate quality improvement efforts. Conclusions: Using data from the EHR and billing systems we are able to identify oncology patients as they initiate a cancer treatment episode. In so doing, we are able to track the quality of care delivered to oncology patients as they move across the care continuum from treatment to survivorship.

Understanding the intricacy of canid social systems: Structure and temporal stability of red fox (Vulpes vulpes) groups

Red foxes have a highly flexible social system. Despite numerous studies worldwide, our understanding of the pattern and stability of fox social relationships remains limited. We applied social network analysis to camera trap data collected at high-quality foraging patches to examine the social structure of a population of urban red foxes. Foxes encountered a conspecific on 13% of patch visits, and had significant preferred and avoided companionships in all seasons. They also associated in communities that matched territorial space use, confirming that territories can be analysed separately to increase power without excluding too many social partners. Foxes maintained stable, long-term relationships with other territory residents, but the average longevity of relationships varied seasonally, suggesting that social connectivity, particularly between foxes from different social groups, is influenced by their annual life cycle. The probability of re-association after a given time lag was highest in spring and summer, during cub birth and rearing, and lowest in the winter mating season, when mean relationship duration was shorter. 33% of fox relationships lasted for four consecutive seasons and were probably between territory residents. 14% lasted for around 20 days and were probably between residents and visitors from adjacent territories. The majority (53%) lasted less than one day, particularly during dispersal and mating, and were probably between foxes from non-adjacent social groups. Social structure varied between groups; in one group the death of the dominant male caused significant social disruption for two seasons. This is the first application of social network analysis to multiple red fox social groups. However, our analyses were based on interactions at high quality food patches; social connections may differ when foxes are resting, travelling and foraging elsewhere in their territory. Our results will inform management practices, particularly for disease spread and population control.

Genomes from bacteria associated with the canine oral cavity: A test case for automated genome-based taxonomic assignment

Taxonomy for bacterial isolates is commonly assigned via sequence analysis. However, the most common sequence-based approaches (e.g. 16S rRNA gene-based phylogeny or whole genome comparisons) are still labor intensive and subjective to varying degrees. Here we present a set of 33 bacterial genomes, isolated from the canine oral cavity. Taxonomy of these isolates was first assigned by PCR amplification of the 16S rRNA gene, Sanger sequencing, and taxonomy assignment using BLAST. After genome sequencing, taxonomy was revisited through a manual process using a combination of average nucleotide identity (ANI), concatenated marker gene phylogenies, and 16S rRNA gene phylogenies. This taxonomy was then compared to the automated taxonomic assignment given by the recently proposed Genome Taxonomy Database (GTDB). We found the results of all three methods to be similar (25 out of the 33 had matching genera), but the GTDB approach required fewer subjective decisions, and required far less labor. The primary differences in the non-identical taxonomic assignments involved cases where GTDB has proposed taxonomic revisions.

The crucible of early career psychiatry

OBJECTIVE

To capture the voices of psychiatrists as they reflect on challenges at the early stages of the career trajectory.

METHOD

Early career psychiatrists contributed reflections that identified various challenges in the transition from trainee to consultant psychiatrist.

RESULTS

Common difficulties included negotiating role transition and conflict. Specific events had deep impact such as involvement with a patient who had committed suicide.

CONCLUSIONS

Challenges in the early career stage as a consultant psychiatrist may have lasting or career defining impact. Written reflection is a valuable tool that can impart collective learning, provide validation and engender support among peers.

The challenges of recognising individuals with few distinguishing features: Identifying red foxes Vulpes vulpes from camera-trap photos

Over the last two decades, camera traps have revolutionised the ability of biologists to undertake faunal surveys and estimate population densities, although identifying individuals of species with subtle markings remains challenging. We conducted a two-year camera-trapping study as part of a long-term study of urban foxes: our objectives were to determine whether red foxes could be identified individually from camera-trap photos, and highlight camera-trapping protocols and techniques to facilitate photo identification of species with few or subtle natural markings. We collected circa 800,000 camera-trap photos over 4945 camera days in suburban gardens in the city of Bristol, UK: 152,134 (19%) included foxes, of which 13,888 (9%) contained more than one fox. These provided 174,063 timestamped capture records of individual foxes; 170,923 were of foxes ≥ 3 months old. Younger foxes were excluded because they have few distinguishing features. We identified the individual (192 different foxes: 110 males, 49 females, 33 of unknown sex) in 168,417 (99%) of these capture records; the remainder could not be identified due to poor image quality or because key identifying feature(s) were not visible. We show that carefully designed survey techniques facilitate individual identification of subtly-marked species. Accuracy is enhanced by camera-trapping techniques that yield large numbers of high resolution, colour images from multiple angles taken under varying environmental conditions. While identifying foxes manually was labour-intensive, currently available automated identification systems are unlikely to achieve the same levels of accuracy, especially since different features were used to identify each fox, the features were often inconspicuous, and their appearance varied with environmental conditions. We discuss how studies based on low numbers of photos, or which fail to identify the individual in a significant proportion of photos, risk losing important biological information, and may come to erroneous conclusions.