Low temperature Raman spectroscopic study of anharmonic and spin-phonon coupled quasi-two dimensional rare earth based francisites

Mineral francisites Cu3Bi(SeO3)2O2Cl are unique compounds with interesting quasi two-dimensional structure along with fascinating magnetic properties. The magnetic properties can be fine-tuned when non-magnetic Bi is replaced by a suitable rare earth (RE) metal. It is because of the inclusion of additional magnetic sub-centre RE apart from Cu. Temperature dependent Raman spectroscopy measurements in RE based francisites [Cu3RE(SeO3)2O2Cl, shortly RECufr] were performed in the range of 11 K-295 K. Among the three studied RECufr (LaCufr, NdCufr, and DyCufr) compounds, the properties of phonon vibration vary from moderate (in DyCufr) to weak (in LaCufr) spin phonon coupled and the absence of spin phonon coupling (SPC) (i.e. strictly anharmonic in nature) was observed in NdCufr and the reason for this observation has been provided. More specifically, two Raman-active phonons soften below the antiferromagnetic ordering temperature ofTN≈ 39 K in DyCufr compound, indicating the existence of moderate SPC. This trend of phonon vibration is correlated with magnetic properties, particularly field induced metamagnetic transition (MMT). Strong MMT enabled DyCufr develops SPC, while weak MMT enabled NdCufr is unable to develop SPC.

Local Sources of Protein in Low- and Middle-Income Countries: How to Improve the Protein Quality?

Protein inadequacy is a major contributor to nutritional deficiencies and adverse health outcomes of populations in low- and middle-income countries (LMICs). People in LMICs often consume a diet predominantly based on staple crops, such as cereals or starches, and derive most of their daily protein intakes from these sources. However, plant-based sources of protein often contain low levels of indispensable amino acids (IAAs). Inadequate intake of IAA in comparison with daily requirements is a limiting factor that results in protein deficiency, consequently in the long-term stunting and wasting. In addition, plant-based sources contain factors such as antinutrients that can diminish protein digestion and absorption. This review describes factors that affect protein quality, reviews dietary patterns of populations in LMICs and discusses traditional and novel small- and large-scale techniques that can improve the quality of plant protein sources for enhanced protein bioavailability and digestibility as an approach to tackle malnutrition in LMICs. The more accessible small-scale food-processing techniques that can be implemented at home in LMICs include soaking, cooking, and germination, whereas many large-scale techniques must be implemented on an industrial level such as autoclaving and extrusion. Limitations and considerations to implement those techniques locally in LMICs are discussed. For instance, at-home processing techniques can cause loss of nutrients and contamination, whereas limitations with larger scale techniques include high energy requirements, costs, and safety considerations. This review suggests that combining these small- and large-scale approaches could improve the quality of local sources of proteins, and thereby address adverse health outcomes, particularly in vulnerable population groups such as children, adolescents, elderly, and pregnant and lactating women.

The role of dairy consumption in the relationship between wealth and early life physical growth in India: evidence from multiple national surveys

INTRODUCTION

Prevalence of undernutrition continues to be high in India and low household wealth is consistently associated with undernutrition. This association could be modified through improved dietary intake, including dairy consumption in young children. The beneficial effect of dairy on child growth has not been explored at a national level in India. The present analyses aimed to evaluate the direct and indirect (modifying association of household level per adult female equivalent milk and milk product consumption) associations between household wealth index on height for age (HAZ) and weight for age (WAZ) in 6-59 months old Indian children using data from of nationally representative surveys.

METHODS

Two triangulated datasets of two rounds of National Family Health Survey, (NFHS-3 and 4) and food expenditure (National Sample Survey, NSS61 and 68) surveys, were produced by statistical matching of households using Non-Iterative Bayesian Approach to Statistical Matching technique. A Directed Acyclic Graph was constructed to map the pathways in the relationship of household wealth with HAZ and WAZ based on literature. The direct association of wealth index and its indirect association through per adult female equivalent dairy consumption on HAZ and WAZ were estimated using separate path models for each round of the surveys.

RESULTS

Wealth index was directly associated with HAZ and WAZ in both the rounds, but the association decreased from NFHS-3 (βHAZ: 0.145; 95% CI: 0.129, 0.16) to NFHS-4 (βHAZ: 0.102; 95%CI: 0.093, 0.11). Adult female equivalent milk intake (increase of 10gm/day) was associated with higher HAZ (β_NFHS-3=0.001;95% CI: 0, 0.002; β_NFHS-4=0.002;95% CI: 0.002, 0.003) but had no association with WAZ. The indirect association of wealth with HAZ through dairy consumption was 2-fold higher in NFHS-4 compared to NFHS-3.

CONCLUSIONS

The analysis of triangulated survey data shows that household level per- adult female equivalent dairy consumption positively modified the association between wealth index and HAZ, suggesting that regular inclusion of milk and milk products in the diets of children from households across all wealth quintiles could improve linear growth in this population.

Highly correlated structural, local structural, Raman spectroscopic and magnetic properties of Mn-substituted Cu2V2O7

Low-dimensional quantum spin ½ system Cu2V2O7has been investigated in the framework of Mn-substitution at the Cu site, which is really un-investigated. The studied compounds Cu2 -xMnxV2O7(x= 0, 0.05, 0.1 and 0.15) have been synthesized and characterized structurally, spectroscopically, local structurally and magnetically via x-ray diffraction, Raman, x-ray absorption and temperature, field dependent magnetization measurements respectively. Although Cu2V2O7can be found inα, βandγ-phase, however all of the studied compounds are found in single orthorhombicα-phase which has crucial magneto-electric application potential. Temperature dependent Raman spectra indicated anharmonic phonon-phonon scattering but there is no spin-phonon coupling for VO4vibrational modes. The local structure probed via x-ray absorption near edge structure and extended x-ray absorption fine structure spectroscopy at 15 K, 300 K indicates Cu2+, V5+and mixed valent Mn2+and Mn3+ionic states and justified local structure for the probed ions. Magnetic measurements indicate long-range antiferromagnetic ordering with doping independent Neel temperature (32.5 K). Further observations are strong magnetic hysteresis at 5 K (due to canted spin structure), zero field exchange-bias and their noteworthy enhancement upon Mn-substitution. Interesting correlation between structural parameters and magnetic exchanges has been developed.

Estimation of Hydration and Density of Fat-Free Mass in Indian Children Using a 4-Compartment Model: Implications for the Estimation of Body Composition Using 2-Compartment Models

BACKGROUND

Accurate methods are needed to measure body fat mass (FM), particularly in South Asian children who are thought to have greater adiposity for a given body size. The accuracy of simple 2-compartment (2C) models of measuring FM depends on the primary measurement of the fat free mass (FFM) and the validity of assumed constants for FFM hydration and density. These have not been measured in this particular ethnic group.

OBJECTIVES

To measure FFM hydration and density in South Indian children using a 4-compartment (4C) model and to compare FM estimates from this 4C-model with 2C-model-based estimates from hydrometry and densitometry, using literature-reported FFM hydration and density in children.

METHODS

This study included 299 children (45% boys), aged 6-16 y from Bengaluru, India. Total body water (TBW), bone mineral content (BMC), and body volume were measured using deuterium dilution, dual-energy X-ray absorptiometry, and air displacement plethysmography, respectively, to calculate the FFM hydration and density, and the FM using 4C and 2C models. The agreement between FM estimates from 2C and 4C models was also evaluated.

RESULTS

Mean FFM hydration and density were 74.2% ± 2.1% and 71.4% ± 2.0% and 1.095 ± 0.008 kg/L and 1.105 ± 0.008 kg/L in boys and girls respectively, which were significantly different from published values. Using the presently estimated constants, the mean hydrometry-based FM (as % body weight) estimates decreased by 3.5% but increased by 5.2% for densitometry-based 2C methods. When 2C-FM (using previously reported FFM hydration and density) were compared with 4C-FM estimates, the mean difference was -1.1 ± 0.9 kg for hydrometry and 1.6 ± 1.1 kg for densitometry.

CONCLUSIONS

Previously published constants of hydration and density of FFM may induce errors of -12% to +17% in FM (kg) when using different 2C models in comparison to the 4C models in Indian children. J Nutr 20xx;x:xx.

P-116 UNUSUAL VISCERAL CONTENT IN PARASTOMAL HERNIAS - A REVIEW OF LITERATURE

Parastomal hernias remain the most common complication of an ileostomy or colostomy - It is estimated that upto 50 percent of patients with a stoma will develop one. They may be classified as Interstitial, Subcutaneous, Intrastomal or Peristomal. The most common contents of Parastomal Hernias are bowel and omentum.However, other visceras have been reported as a content of a parastomal hernia. This presentation is aimed at a literature review of such surprise surgical situations that are challenging to the surgeons.

Presence of gallbladder in a parastomal hernia has been reported by multiple authors - there is reported incidence of incarceration or acute inflammation of the gallbladder. Cholecystectomy t the time of parastomal hernia repair has been reported though some patients have been treated non-operatively as well.

Similarly, there have been multiple reports of stomach beong the contents of parastomal hernias - there have been patients presenting with gastric outlet obstruction who have been found to have the stomach being a content of their parastomal herniation.

This presentation reviews the available literature and presents the challenges and oprions that a surgeon may face when treating similar patients.

P-115 HYBRID REPAIR OF RECURRENT COMPLEX GROIN HERNIA - CHALLENGES AND LESSONS LEARNT

A 45 year old lady presented with a recurrent swelling over the right groin that had gradually turned tense and tender over the last 48 hours. Having undergone an urgent right femoral hernia repair in 2002, she underwent an inguinal hernioplasty in 2004 and amesh repair of a recurrent inguinal hernia in 2008. She developed a third recurrence that slowly increased in size and needed an urgent repair. At assessment, she was found to have a large complete recurrent irreducible right inguinal hernia containing loops of bowel.

At laparoscopy, multiple loops of bowel and omentum were reduced from a large multiloculated hernial sac. In view of the large sac which had incorporated the previously placed meshes in the wall, a decision was made to abandon laparoscopic approach. The myopectineal orifice was approached through a groin incision and the hernial sac with it's locules, including a prevascular component, was defined. The posterior sheath was defined and the rigt rectus muscle, displaced by the hernia, was repositioned. The dissection was carried upto the Space of Bogros to ensure that no component of the hernia was missed out. After completing a formal herniotomy, a sandwich prosthesis, created by stitching a biomesh and a polypropylene mesh, was utilised for hernia repair.

The patient had an uneventful recovery.

The presentation is aimed at discussing the challenges of repairing a complex recurrent hernia, the possible pitfalls and lessons learnt.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

Association Between Longitudinal Changes in Body Mass Index (BMI) and Body Fat With Cardiometabolic Risk Factors in Indian Children and Adolescents

Objectives

To evaluate the associations between longitudinal changes in body mass index (BMI) and body fat mass (FM%) with cardiometabolic risk factors in school-aged children and adolescents from South India.

Methods

This prospective school-based study comprised 4,289 children and adolescents (44.2% male) aged 5–17y participating in the PEACH-II and III studies in Bengaluru, India. Anthropometry and FM% (BOD POD, Cosmed; 5.2.0) were measured twice with a median age gap of 2.8y. Waist circumference (WC), systolic/diastolic blood pressure, HbA1c, and lipid profile were measured at endline. BMI-for-age z-scores were calculated using the World Health Organization Child Growth Standards, and were used to define overweight (≥+1 SD to < +2 SD) and obesity (≥+2 SD). Linear regression was used to examine the associations between longitudinal changes in BMI-for-age z-scores and FM% with cardiometabolic risk factors, after adjusting for parental BMI, socioeconomic status, age of menarche, inflammation (c-reactive protein), physical activity and night sleep duration.

Results

The prevalence of overweight/obesity and mean FM% increased from 15.2% to 20.5%, and 19.5% to 21.7%, respectively during follow-up. Overall, 43.8% and 15.5% of the participants had high triglycerides (TG, ≥200 mg/dL), and elevated HbA1C (≥5.7%), while 40.9% had low HDL (< 40 mg/dL); a total of 69.1% of participants had ≥ 1 abnormal biomarker(s). Increment in BMI for-age z-score of 1SD overtime was significantly associated with higher WC (β: 2.9, [SE:0.20] cm), TG (8.4, [1.3] mg/dL), HbA1c (0.17, [0.06] %), total cholesterol (1.6, [0.56] mg/dL), and lower HDL (−1.3, [0.26] mg/dL). Longitudinal increment in FM% was associated with higher WC (0.3, [0.03] cm), TG (1.2, [0.15] mg/dL) and total cholesterol (0.4, [0.1] mg/dL).

Conclusions

The burden of overweight/obesity and FM% substantially increased in this population of South Indian children and adolescents overtime, and were associated with cardiometabolic risk factors. Regular monitoring of BMI and body composition can help to identify children at risk of developing cardiovascular diseases. Appropriate dietary and lifestyle interventions for children at risk are needed in India, where chronic diseases and associated deaths are increasing at alarming rate in young and older adults.

Funding Sources

Funded by Indian Council of Medical Research.

Central obesity in low BMI as a risk factor for COVID-19 severity in South Indians

BACKGROUND AND OBJECTIVES

South Asians are known to have excess adiposity at a lower body mass index, with truncal fat accumulation. Whether this confers higher risk to develop severe COVID-19 is not known. This study evaluated body mass index, body fat mass and waist circumference as risk factors for COVID-19 severity and its progression, in South Asian adults.

METHODS AND STUDY DESIGN

Details of COVID-19 patients (19-90 years) were obtained prospectively, along with weight, height, waist circumference and body fat mass assessed by bioelectrical impedance analysis. Binomial logistic and Poisson regression were performed to test associations between waist circumference, body fat mass and body mass index to evaluate the adjusted OR or relative risk for disease severity at admission and length of stay.

RESULTS

After adjusting for age, sex, height and co-morbidities, body mass index >23 kg/m2 (adjusted OR 2.758, 95% CI 1.025, 7.427), waist circumference (adjusted OR 1.047, 95% CI 1.002, 1.093) and body fat mass (adjusted OR 1.111, 95% CI 1.013, 1.219) were associated with a significant risk for disease severity at admission, while only waist circumference (adjusted relative risk 1.004, 95% CI 1.001, 1.008), and body fat mass (adjusted relative risk 1.011, 95% CI 1.003, 1.018), were associated with a significantly longer length of stay.

CONCLUSIONS

Body mass index, at a lower cut-off of >23 kg/m2, is a significant risk factor for COVID-19 disease severity in the group of patients studied. The waist circumference and body fat mass are also good indicators for both severity at admission and length of stay.

Prevalence and molecular characterization of extended-spectrum β-lactamase (ESBL) producing Escherichia coli isolated from dogs suffering from diarrhea in and around Kolkata

BACKGROUND

Dogs are the favorite companion animals among humans. The close interaction between dogs and people increases the risk of antibiotic resistance spreading. Surveillance for antimicrobial resistance and the identification of ESBL-producing Escherichia coli as an indicator bacterium is an important tool for managing antimicrobial drug therapy.

AIMS

The present study targeted to identify and characterize ESBL-producing E. coli among dogs suffering from diarrhea in and around Kolkata.

METHODS

Isolation and identification of E. coli from dogs suffering from diarrhea (n=70) along with screening for the production of both ESBL and AmpC. The isolates were further characterized through antimicrobial resistance profiling, resistance genes (bla _CTX-M, bla _TEM, and bla _SHV) screening, and phylogenetic group study.

RESULTS

Among the 70 isolates, 21 (30%) were confirmed ESBL producers. An antibiogram typing of ESBL-producing E. coli revealed that the majority of them were resistant to norfloxacin (85.7%) followed by tetracycline (61.90%), doxycycline (57.14%), piperacillin/tazobactam (52.38%), cotrimoxazole (47.62%), gentamicin (42.62%), amikacin (23.81%), and chloramphenicol (19.05%). Major resistance genes included bla _CTX-M (100%), bla _TEM (28.57%), and bla _SHV (9.50%). The predominant phylogenetic groups were phylogroup A (76%) followed by phylogroup D (24%).

CONCLUSION

The current investigation reported a high prevalence of both ESBL and AmpC β-lactamase (AmpC) producing E. coli, co-resistance to a distinct group of antibiotics, and co-existence of different ESBL genes in dogs. Our findings highlight the importance of diagnostic antimicrobial susceptibility testing for proper antimicrobial therapy and to prevent antimicrobial resistance from spreading to humans from dogs in Kolkata and the surrounding area.

Absence of clinical benefit of FDG PET-CT in staging T1 part-solid lung adenocarcinoma

AIM

To assess the rates of nodal and metastatic disease and change in management when staging part-solid T1 lung adenocarcinomas using integrated 2-[¹⁸F]-fluoro-2-deoxy-d-glucose (FDG) positron-emission tomography (PET)-computed tomography (CT) in a UK population.

MATERIALS AND METHODS

This was a retrospective review of PET-CT examinations performed to stage radiologically suspected T1 part-solid lung adenocarcinoma (n=58) from two different centres. Rates of detection of nodal and metastatic disease, change in management, and final patient outcome were recorded.

RESULTS

PET-CT changed the stage in one patient from N0 to N1. It did not change final management in any patient.

CONCLUSIONS

In this UK population, PET-CT had minimal additional diagnostic benefit in staging patients with T1 part-solid lung adenocarcinoma. Especially given its cost, the inclusion of PET-CT for this indication in guidelines should be reviewed.

Effect of Co and Mg doping at Cu site on structural, magnetic and dielectric properties of α-Cu2V2O7

We have studied the effect of doping of both magnetic (Co) and nonmagnetic (Mg) ions at the Cu site on phase transition in polycrystalline α-Cu₂V₂O₇through structural, magnetic, and electrical measurements. X-ray diffraction reveals that Mg doping triggers an onset ofα- toβ-phase structural transition in Cu_2-xMg_xV₂O₇above a critical Mg concentrationx_c= 0.15, and both the phases coexist up tox= 0.25. Cu₂V₂O₇possesses a non-centrosymmetric crystal structure and antiferromagnetic ordering along with a non-collinear spin structure in theαphase, originated from the microscopic Dzyaloshinskii-Moriya interaction between the neighboring Cu spins. Accordingly, a weak ferromagnetic (FM) behavior has been observed up tox= 0.25. However, beyond this concentration, Cu_2-xMg_xV₂O₇exhibits complex magnetic properties. A clear dielectric anomaly is observed in α-Cu_2-xMg_xV₂O₇around the magnetic transition temperature, which loses its prominence with the increase in Mg doping. The analysis of experimental data shows that the magnetoelectric coupling is nonlinear, which is in agreement with the Landau theory of continuous phase transitions. Co doping, on the other hand, initiates a sharpαtoβphase transition around the same critical concentrationx_c= 0.15 in Cu_2-xCo_xV₂O₇but the FM behavior is very weak and can be detected only up tox= 0.10. We have drawn the magnetic phase diagram which indicates that the rate of suppression in transition temperature is the same for both types of doping, magnetic (Co) and nonmagnetic (Zn/Mg).

Evaluation of Protein Quality in Humans and Insights on Stable Isotope Approaches to Measure Digestibility - A Review

The recent Food and Agricultural Organization/World Health Organization/United Nations University expert consultations on protein requirements and quality have emphasized the need for the new Digestible Indispensable Amino Acid Score (DIAAS), as a measure of protein quality. This requires human measurements of the true ileal digestibility of individual indispensable amino acids (IAAs) until the end of the small intestine. Digestibility is measured using standard oro-ileal balance methods, which can only be achieved by an invasive naso-ileal intubation in healthy participants or fistulation at the terminal ileum. Significant efforts have been made over the last 2 decades to develop noninvasive or minimally invasive methods to measure IAA digestibility in humans. The application of intrinsically labeled (with stable isotopes like 13C, 15N, and 2H) dietary proteins has helped in circumventing the invasive oro-ileal balance techniques and allowed the differentiation between endogenous and exogenous protein. The noninvasive indicator amino acid oxidation (IAAO) technique, which is routinely employed to measure IAA requirements, has been modified to estimate metabolic availability (a sum of digestibility and utilization) of IAA in foods, but provides an estimate for a single IAA at a time and is burdensome for participants. The recently developed minimally invasive dual isotope tracer method measures small intestinal digestibility of multiple amino acids at once and is suitable for use in vulnerable groups and disease conditions. However, it remains to be validated against standard oro-ileal balance techniques. This review critically evaluates and compares the currently available stable isotope-based protein quality evaluation methods with a focus on the digestibility and metabolic availability measurements in humans. In view of building a reliable DIAAS database of various protein sources and subsequently supporting protein content claims in food labeling, a re-evaluation and harmonization of the available methods are necessary.

22 Motivations, Barriers, And Social Media: A Qualitative Study of Uptake of Women into Neurosurgery

Objective

To explore how social media could be utilised to influence an individual’s motivation to pursue a neurosurgical career, an emerging topic area. The focus of this study was on women interested in neurosurgery.

Background

Women are significantly under-represented in neurosurgery. 18% of all neurosurgeons – including 8% of consultants – are women. Most previous studies have used quantitative methods that are not best suited to gaining an in-depth understanding of the barriers that women face in pursuing a career in neurosurgery, or what would enable more women to go into the speciality.

Method

In this qualitative study, individual semi-structured interviews were conducted until data saturation was achieved. Participants were women pre-neurosurgical trainees. The interview data was examined through a thematic analysis involving open and axial coding.

Results

Thirty women participated in the study. Four overarching themes were identified: (1) mentorship, (2) testimony from other women doing neurosurgery, (3) social media as a means of increasing interest in neurosurgery as a career choice, and (4) real-life exposure to the speciality.

Conclusions

There is scope to further improve uptake of women into neurosurgical training in the UK. Motivations and barriers to women pursuing neurosurgery should be addressed openly through early experience, role models and mentorship. Social media can help facilitate these opportunities, disseminate information and inspiration, and has the potential to undo societal biases.

476 The Role of Medical Students in an International, Collaborative, Multi-Centre Global Surgery Study

Introduction

The gaps in formal education caused by the pandemic have provided medical students with opportunities to redefine their role in settings across clinical medicine, education and research. This task shifting could provide avenues for students to engage with global surgery, where the cultivation of research skills, networking, and global collaboration amongst students is imperative for sustainable progress.

COVIDPaedsCancer is an international collaborative cohort study assessing the impact of the pandemic on paediatric cancer services. We aimed to trial a student and junior doctor-lead team to perform the day-to-day running of this research.

Method

An operations team of 47 students and junior doctors across 11 countries was assembled. Sub-teams were created for social media, network management, email communications, REDCap, research support and graphics. Together, they ran the study under guidance from the steering committee.

Results

To date, the operations team has coordinated study collaborators in collecting data for 1252 patients from 78 centres across 39 countries. Cooperation between sub-teams enabled the recruitment of collaborators from 558 hospitals in total. They also identified 2 errors in the protocol and resolved them with steering committee input, and continuously managed hospital leadership issues and general queries throughout the course of the study. The team was able to adapt in response to the evolving needs of collaborators and the steering committee.

Conclusions

Medical students were able to aid the delivery of an international, multicentre, collaborative, global surgery research study while benefiting from learning opportunities, networking opportunities, and developing interest and understanding of global surgery.

244 Traumatic Brain Injury Related Paediatric Mortality and Morbidity in Low- And Middle-Income Countries: A Systematic Review and Meta-Analysis

Aim

Three million cases of paediatric traumatic brain injury (pTBI) occur annually, the majority of which occur in low-and-middle-income countries (LMICs). However, there is a paucity of data on the outcomes of pTBI available. We aimed to systematically review and synthesise the reported morbidity and mortality from pTBI in the published literature about LMICs.

Method

A systematic review and meta-analysis were conducted. MEDLINE, EMBASE, Global Health, and Global Index Medicus were searched for relevant articles from January 2000 to May 2020. Observational or experimental studies on pTBI (individuals between the ages of 0 to 16 years) in LMICs were included. Morbidity data were descriptively analysed, and a random-effects model was used to pool mortality rates. PROSPERO ID: CRD42020171276.

Results

We included 145 studies from 38 countries representing 174073 patients with pTBI. Males were twice (95% CI: 1.6 – 2.4) as likely to have a pTBI than females. Where available, mild TBI represented ≥ 60% of all pTBI cases in most reports (n = 24/43, 56%). The commonest cited cause of pTBI was road traffic accidents (n = 16643/43083, 39%), followed by falls (n = 10927/43083, 25%). 4385 patients (n = 4385/18092, 24%) had a reduction from normal function on discharge. On average, there were 6.7 deaths per 100 cases of pTBI.

Conclusions

Only 38 LMICs have published data on the volume and burden of pTBI in their country. Limited data available suggests that young male children are at a high-risk of pTBIs in LMICs, particularly from road traffic accidents.

Perspective: When the cure might become the malady: the layering of multiple interventions with mandatory micronutrient fortification of foods in India

When public health programs with single nutrients are perceived to have a poor impact on the target health outcome, the policy response can be to supply more, by layering additional mandatory programs upon the extant programs. However, we argue for extreme caution, because nutrients (like medicines) are beneficial in the right dose, but potentially harmful when ingested in excess. Unnecessary motivations for the reactionary layering of multiple intervention programs emerge from incorrect measurements of the risk of nutrient inadequacy in the population, or incorrect biomarker cutoffs to evaluate the extent of nutrient deficiencies. The financial and social costs of additional layered programs are not trivial when traded off with other vital programs in a resource-poor economy, and when public health ethical dilemmas of autonomy, equity, and stigma are not addressed. An example of this conundrum in India is the perception of stagnancy in the response of the prevalence of anemia to the ongoing pharmacological iron supplementation program. The reaction has been a policy proposal to further increase iron intake through mandatory iron fortification of the rice provided in supplementary feeding programs like the Integrated Child Development Services and the School Mid-Day Meal. This is in addition to the ongoing pharmacological iron supplementation as well as other voluntary iron fortifications, such as those of salt and manufactured food products. However, before supplying more, it is vital to consider why the existing program is apparently not working, along with consideration of the potential for excess intake and related harms. This is relevant globally, particularly for countries contemplating multiple interventions to address micronutrient deficiencies. Supplying more by layering multiple nutrient interventions, instead of doing it right, without thoughtful considerations of social, biological, and ethics frameworks could be counterproductive. The cure, then, might well become the malady.

AB0223 MODIFIED DOSE RITUXIMAB BIOSIMILAR IN RHEUMATOID ARTHRITIS COMPARING B-CELL DEPLETION EFFECT AND DISEASE ACTIVITY SCORES

Background:

In emerging economies self-funding patients opt for less costly options, influencing both compliance and maintenance of treatment for chronic illness. Studies comparing originator rituximab 1000mgx2 and 500mgx2 doses in Rheumatoid arthritis (RA) have yielded interesting results1. Evidence of B cell depletion, measured by CD19 count, maybe a marker for disease improvement2. However effect of different dose of biosimilar Rituximab (bRTX) on B cell depletion and disease activity needs exploration.

Objectives:

To determine correlation of CD19 count defining B cell depletion and disease activity with different dosages of bRTX treatment.

Methods:

Between April 2019 and March 2020, all RA patients with DMARD failure were screened for eligibility of biologics as routine clinical practice. Depending on individual choice, after full consent, patients received either 1000mgx2 or 500mgx2 bRTX. All patients had CD19 count before and 12 months after the first dose. Effectiveness of bRTX 1000 mg×2 and 500 mg×2 was assessed by DAS28 and EULAR response. Comparative adjusted analysis was performed by analysis of variance (ANOVA).

Results:

Out of 468 eligible patient, 84 opted for biologic. Of which 27 patients consented for bRTX (17 female, mean age 39.5 years).13 patients opted for 1000mg×2 and 14 for 500mg×2 dose. 74% (20/27) patients were on concomitant methotrexate and 26% on hydroxychloroquine (7/27). Both doses led to significant reduction in ESR, CRP, and DAS28-ESR at 12 months (p<0.001) (Table 1).

Table 1.

RA outcome-measurement scores at 12 months post biosimilar Rituximab therapy.

VariableBaseline12 monthsRTX 1000mg x 2(n=13)RTX 500mg x 2(n=14)RTX 1000mg x 2(n=13)RTX 500mg x 2(n=14)ESR*53.9±23.957.1±24.723.9±2.924.1±4.7CRP*6.1±3.96.9±2.92.1±0.92.3±0.9DAS28-ESR*6.1±0.36.1±0.24.0±0.44.1±0.2CD 19+ Count*# (105/L)1191.6±308.41155±289.6128.8±90.4139±90.6

* p<0.0001 as compared to 12 mos vs baseline; # p<0.0001 as compared amongst group

At the end of 12 months, compared to 1000mg, CD19 count was higher in 500mg group (p=0.25). Percentage of patients achieving EULAR moderate or no response was higher in 500mg group (37%vs29%, p=0.205), both complete and incomplete B cell depletion, but patients achieving good response was same in both groups (14.8%vs18.5%, p = 0.25). (Figure 1).

Figure 1.

EULAR Response at 12 months

Conclusion:

Low dose bRTX is effective in DMARD refractory RA patients with similar improvements as regular dose, although CD19 depletion was less in low dose group. A larger study to establish radiographic regression with CD19 depletion and disease activity score can help in further strengthening the use of lower dose bRTX in RA leading to significant economic advantage.

References:

[1]Chatzidionysiou K, Lie E, Nasonov E, Lukina G,et al. Rheumatic Diseases Portuguese Register. Effectiveness of two different doses of rituximab for the treatment of rheumatoid arthritis in an international cohort: data from the CERERRA collaboration. Arthritis Res Ther. 2016 Feb 16;18:50.

[2]Vital EM, Rawstron AC, Dass S, Henshaw K, Madden J, Emery P, McGonagle D. Reduced-dose rituximab in rheumatoid arthritis: efficacy depends on degree of B cell depletion. Arthritis Rheum. 2011 Mar;63(3):603-8.

Disclosure of Interests:

None declared

721 Imaging for Suspected Bowel Obstruction in Pennine Acute Trust (PAT): A Comparison with the National Audit of Small Bowel Obstruction’s (NASBO) recommendations

Background

NASBO recommends Computed Topography (CT) over plain abdominal X-ray (AXR) for the investigation of bowel obstruction (BO). AXR is routinely used within PAT for investigation of BO which may be exposing patients to unnecessary radiation and adding unnecessary cost to the service.

Method

A retrospective audit collected data on patients with CT confirmed BO between July 2019 and February 2020. This looked at the percentage of patients who had both CT and AXR to investigate BO. The cost of these AXRs and the percentage of these AXRs that were normal were also calculated.

Results

A search identified 141 patients with CT proven BO. 81/141(57.4%) patients had both AXR and CT as a part of their initial investigations. Of those patients 26/81(32.1%) had no AXR features suggestive of BO. Only 12/81(14.8%) of those patients had serial AXRs following initial imaging. The cost for one AXR is £34.15 which means £2766.15 was spent on potentially unnecessary AXRs within this period.

Conclusions

PAT is performing potentially unnecessary AXRs which is exposing patients to unnecessary radiation and costing the trust. Plain AXRs do not rule out BO. We have recommended an investigation flowchart to PAT A&E departments to reduce unnecessary AXRs being performed.

77 The Development of Core Outcome Sets and Common Data Elements in Clinical Neurosciences: A Scoping Review

Introduction

The use of core outcome sets (COS) and common data elements (CDEs) minimises research wastage by increasing the cross-comparison and meta-analysis of study findings. Our study sought to identify the clinical neuroscience subspecialties that have developed COS and CDEs, the countries of origin of authors, and the process through which COS and CDEs were developed.

Method

A search between 2000-2020 of the top 40 Impact Factor neurosurgical and neurological journals was conducted. A scoping review was performed in accordance with the PRISMA-ScR Checklist.

Results

Our search returned 169 papers, of which 35 were eligible for inclusion. The USA published the majority of papers (20/35). The papers mostly related to neurosurgery (30/35), with the most common neurosurgical sub-specialty being traumatic brain injury (14/35). There is an increasing publication trend over time, with 12 papers published in 2019. Five papers were systematic reviews conducting with the intention of COS/CDE development. 27 papers reported CDE development and 2 papers reported COS development. The COS development papers utilised international consensus meetings and adhered to international development statements.

Conclusions

COS and CDEs are increasingly being developed within clinical neurosciences. There is a need for greater international collaboration with regards to COS and CDEs development.

13 Medical Students’ Mood Adversely Affected By COVID-19 Pandemic: An Interim Analysis from the SPICE-19 Prospective Cohort Study Of 2075 Medical Students and Interim Foundation Doctors

Introduction

In order to appropriately support medical students and foundation year doctors, it is imperative that we understand the impact the COVID-19 pandemic has had upon them. This study assessed the effects of the COVID-19 pandemic on medical students and interim foundation year doctors across the United Kingdom (UK), and the support that they received and sought.

Method

A prospective, observational, multicentre study was conducted. All medical students and interim foundation year doctors were eligible to participate.

Results

A total of 2075 individuals participated. There was a decrease in participants’ mood when comparing their mood before the pandemic to during the pandemic (p < 0.0001). Social distancing negatively impacted the mood of the greatest number of participants. All areas of life included in the study were found to have been significantly more negatively impacted than positively impacted (p < 0.0001). 931 participants wanted more support from their university.

Conclusions

When medical students return to their universities, there is likely to be a need for enhanced wellbeing support, adaptations in the short-term and long-term strategies for medical education, and provision of financial guidance. If no action is taken, there may be a knock-on effect on workforce planning and the health of our future workforce.

Metal contaminations in sediment and associated ecological risk assessment of river Mahanadi, India

Mahanadi is one of the major rivers of peninsular India. Like other Indian rivers, it is contaminated with sewages, industrial discharges, and agricultural runoff. Thus, necessity was felt to monitor its pollution status. Present work was part of that program and aimed to assess the sediment contamination due to the trace metals Cd, Cr, Cu, Mn, Pb, and Zn during 2012-2015. Sediment pollution status and ecological risks were evaluated calculating contamination factor (CF), geo-accumulation (I_geo), pollution load index (PLI), potential ecological risk (EⁱR), etc. The recorded metal concentrations were Cd BDL of flame mode of AAS; Cr BDL - 73.9; Cu BDL - 44.4; Mn 37.2 - 1887.0; Pb BDL - 29.5; and Zn BDL - 92.5 mg kg^-1. As per US EPA guidelines, Cr concentrations at many locations were in the moderately polluted range. I_geo, CF, mC_d, PLI, and EⁱR indicated low pollution levels and low ecological risks due to the trace metals assessed. The sediment quality guidelines (SQGs) indicated that Cr and Cu concentrations exceeded (16% sample) the threshold effect concentrations and may occasionally exhibit adverse biological effects. The association of sediment organic matter, conductivity and content of Cu, and their grouping in component 1 of PCA revealed that the anthropogenic input was dominant and so also the component 2 where Cr exhibited moderately good correlation with organic matter. Cluster analysis of the sampling sites based on pollution status yielded 3 groups: relatively uncontaminated (S3, S4), low to moderately contaminated (S2), and moderately contaminated (S1, S5, S6) stretches.

Protein intakes of pregnant women and children in India-protein quality implications

The recent National Family Health Survey (NFHS-4, 2016) reports a national average of 18% for low birthweight (LBW) and 38% for stunting in children <5 years. Nutrition and environmental influences (chronic enteric pathogenic exposure through poor water, sanitation, and hygiene) are two critical factors that impact the health outcomes of the populxation. This is particularly relevant for vulnerable age groups such as pregnant women and children <5 years, who bear long-lasting and intergenerational consequences of impoverished nutrition and suboptimal living conditions. The present review provides, for the first time, an analysis of indispensable amino acid (IAA) requirements for pregnant women, separately for the second and third trimesters, using protein accretion data from a recent Indian study. Furthermore, using these estimates for pregnancy, and the current IAA requirements for young children, the quality of protein was assessed in Indian diets consumed by pregnant women and children (1-3 and 4-6 years) from national representative rural National Nutrition Monitoring Bureau survey. The assessment was considered in the context of an adverse environment and in relation to outcomes such as LBW, stunting, and underweight. Finally, an assessment was made of the proportion of the surveyed population at risk of dietary quality protein inadequacy and implications for planning nutrition intervention programmes. Specifically, state-wise estimates of the risk of quality protein inadequacy are provided, in addition to evaluations of additional dietary supplementation, which could inform the policy of supplementary nutrition programmes to improve health outcomes.

An uncertainty estimate of the prevalence of stunting in national surveys: the need for better precision

Background

Stunting is determined by using the World Health Organization (WHO) child growth standard which was developed using precise measurements. However, it is unlikely that large scale surveys maintain the same level of rigour and precision when measuring the height of children. The population measure of stunting in children is sensitive to over-dispersion, and the high prevalence of stunting observed in surveys in low and middle-income countries (LMIC) could partly be due to lower measurement precison.

Objectives

To quantify the incongruence in the dispersion of height-for-age in national surveys of < 5 y children, in relation to the standard WHO Multicenter Growth Reference Study (MGRS), and propose a measure of uncertainty in population measures of stunting.

Methods

An uncertainty factor was proposed and measured from the observed incongruence in dispersion of the height-for-age of < 5 y children in the MGRS against carefully matched populations from the Demographic Health Survey of 17 countries (‘test datasets’, based on the availability of data). This also allowed for the determination of uncertainty-corrected prevalence of stunting (height-for-age Z score < − 2) in < 5 y children.

Results

The uncertainty factor was estimated for 17 LMICs. This ranged from 0.9 to 2.1 for Peru and Egypt respectively (reference value 1). As an explicit country example, the dispersion of height-for-age in the Indian National Family Health Survey-4 test dataset was 39% higher than the MGRS study, with an uncertainty factor of 1.39. From this, the uncertainty-adjusted Indian national stunting prevalence estimate reduced to 18.7% from the unadjusted estimate of 36.2%.

Conclusions

This study proposes a robust statistical method to estimate uncertainty in stunting prevalence estimates due to incongruent dispersions of height measured in national surveys for children < 5 years in relation to the WHO height-for-age standard. The uncertainty is partly due to population heterogeneity, but also due to measurement precision, and calls for better quality in these measurements.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-020-09753-8.

Metabolic Availability of Lysine in Milk and a Vegetarian Cereal-Legume Meal Determined by the Indicator Amino Acid Oxidation Method in Indian Men

BACKGROUND

Lysine rich foods such as milk and legumes serve as important food additions to the lysine deficient cereal-based diets of vegetarian populations in low- and middle-income countries (LMICs) to alleviate the risk of quality corrected dietary protein inadequacy. Dietary protein quality can be determined by estimating the metabolic availability (MA) of lysine.

OBJECTIVES

The study aimed to estimate the MA of lysine in spray-dried cow milk powder (SMP), heat-treated spray-dried cow milk powder (HSMP), and a habitually consumed cereal-legume based vegetarian meal (VM), using the indicator amino acid oxidation (IAAO) slope-ratio method.

METHODS

The MA of lysine in SMP, HSMP, and VM was estimated in 7 healthy young men aged 19-24 y with BMI of 21.5 ± 0.5 kg/m2 in a repeated measures design. The IAAO response slopes with 2 graded lysine intakes (10.5 and 15.0 mg·kg-1·d-1) from the SMP and VM were compared with the response slope generated with 3 graded crystalline lysine intakes (6.0, 10.5, and 15.0 mg·kg-1·d-1) at the subrequirement level. To produce HSMP, pasteurized cow milk was heat treated and spray dried. The MA of lysine in HSMP was tested at a single level of lysine intake (15 mg·kg-1·d-1). A total of 8 IAAO experiments were conducted on each participant in randomized order. The IAAO slopes were estimated using a linear mixed-effect regression model.

RESULTS

The MA of lysine in SMP, HSMP, and VM was 91.9%, 69.9%, and 86.6% respectively.

CONCLUSIONS

Heat treatment reduced the MA of lysine by 22% in HSMP compared with SMP in healthy Indian adults. The lysine MA estimates can be used to optimize lysine limited cereal-based diets, with the addition of appropriately processed legumes and milk powder, to meet the protein requirement. This trial was registered at Clinical Trials Registry of India (http://ctri.nic.in) as CTRI/2019/08/020568.

Multi-drug resistant, biofilm-producing high-risk clonal lineage of Klebsiella in companion and household animals

Antimicrobial resistance is a global emergency which needs one health approach to address. The present study was conducted to detect the prevalence of beta-lactamase and biofilm-producing Klebsiella strains in rectal swabs (n = 624) collected from healthy dogs, cats, sheep and goats reared as companion or household animals in India. The dogs and cats were frequently exposed to third- or fourth-generation cephalosporins for therapy. The sheep and goats were occasionally exposed to antibiotics and had environmental exposure. Phenotypical ESBL (n = 93) and ACBL (n = 88)-producing Klebsiella were isolated significantly more (P < 0·05) from companion animals than household animals. Majority of the Klebsiella possessed bla_CTX-M-15 . The sequences bla_CTX-M-15.2 , bla_CTX-M-197 and bla_CTX-M-225 are reported first time from the companion animals. All ACBL-producing isolates possessed bla_AmpC . The present study detected 65·8% of Klebsiella strains as biofilm producers possessing the studied biofilm associated genes. The isolates showed phenotypical resistance against chloramphenicol, tetracycline, doxycycline, co-trimoxazole, ampicillin, cefotaxime/clavulanic acid. The present study showed that companion and household animals (dogs, cats, sheep, goats) may act as a carrier of ESBL/biofilm-producing, multi-drug resistant, high-risk clonal lineage of Klebsiella.

Are thalassemia patients oxidatively challenged?

Background

Repeated blood transfusions is the mainstay of treatment for beta thalassemia major patients. Multiple blood transfusions lead to significant iron overload in these patients. Iron overload causes liberation of oxygen free radicals and peroxidative lipid injury. This study has been designed to study whether thalassemics suffer from oxidative injury. It also aims to study the quantum of oxidative injury.

Methods

It is a cross sectional study using cases and controls. Thirty thalassemic patients receiving multiple blood transfusions were included in this study and thirty healthy age and sex matched controls were recruited for the study. Serum ferritin levels, malondialdehyde, nitric oxide levels were estimated.

Results

Levels of all the three parameters were significantly increased (p < 0.05) in the cases compared to controls. Mean levels of all three parameters were correlated with serum ferritin levels and number of blood transfusions in increasing order. All the parameters showed fair degree of correlation (r ≥ 0.25, p ≤ 0.05).

Conclusion

Thalassemic patients receiving multiple blood transfusion suffer from iron overload which results in increased oxidative stress.

Characterization of beta-lactamase and biofilm producing Enterobacteriaceae isolated from organized and backyard farm ducks

This study was undertaken to detect the occurrence of beta-lactamase and biofilm producing Enterobacteriaceae in healthy ducks. A total 202 cloacal swabs were collected from ducks kept in organized (n = 92) and backyard (n = 110) farms in West Bengal (India). The ducks had no history of antibiotic intake. Among the 87 phenotypically beta-lactamase producing Escherichia coli, 19 (17·43%), 6 (5·05%) and 15 (13·76%) isolates possessed bla_TEM , bla_SHV and bla_CTX-M respectively. Whereas, 5 (38·46%) Salmonella isolates were found to harbour bla_CTX-M . In K. pneumoniae 10 (33·33%), 3 (13·33%), 4 (13·33%) isolates possessed bla_TEM , bla_SHV and bla_CTX-M respectively. The sequences of selected PCR products were found 98% cognate with bla_CTX-M-9, bla_SHV-12 and bla_TEM-1 . Beta-lactamase producing E. coli isolates belonged to 14 different serogroups such as O1, O2, O3, O5, O7, O8, O35, O83, O84, O88, O119, O128, O145 and O157. Moreover, 87 E. coli (79·82%), six Samonella (46·15%) and 13 K. pneumoniae (43·33%) isolates were detected as AmpC producers possessing bla_AmpC . Majority of E. coli (46·79%), Salmonella (46·15%) and K. pneumoniae (70%) isolates were detected as biofilm producers and possessed the associated genes (csgA, sdiA, rcsA, rpoS). Significantly higher occurrence of beta-lactamase and biofilm producing Enterobacteriaceae isolates was detected in backyard ducks than organized farms. SIGNIFICANCE AND IMPACT OF THE STUDY: Consumption of antibiotic through feed or during therapy is considered as potential reason for generation of antimicrobial resistant bacteria in birds. This study provides valuable evidence that exposure to contaminated environment may be an additional source for generation of antimicrobial resistant bacteria in backyard ducks. The backyard ducks are reared by marginal farmers in India who cannot offer antibiotics to them either through feed or during therapy due to high cost. The study also reveals a significant correlation between biofilm formation and possession of antimicrobial resistance genes in the bacterial isolates from the ducks.

Effect of a cereal and milk meal with or without fruits and nuts on the postprandial glycemic response in Indian men

BACKGROUND AND OBJECTIVES

Some cereals, consumed at breakfast, have shown lower glycemic responses. Limited data exist in the Indian context, where the effect could be modified due to genetic or racial differences. This study aimed to investigate the effect of cereal and milk, with or without fruits/nuts, on the glycemic response in healthy Indian men.

METHODS AND STUDY DESIGN

A randomized cross-over study was carried out on 16 men (18 - 45 years), with 3 interventions providing equal amounts of glycemic carbohydrate: a glucose drink (Reference), cereal and milk (CM), and cereal, milk, fruits and nuts (CMO), on separate days. Plasma glucose, serum insulin, C-peptide, ghrelin, energy expenditure (EE), substrate oxidation and appetite/satiety were measured repeatedly over 3 hours post meal.

RESULTS

A significant time effect and time x meal interaction between the meals, higher for the Reference meal, was observed for plasma glucose (p<0.001), insulin (p<0.001), C-peptide (p<0.001), and carbohydrate oxidation (p<0.001); while lower for satiety (p<0.001). The plasma glucose concentrations of CM and CMO meals returned to baseline 60 min postprandially, then remained there, unlike the Reference meal, where the plasma glucose values returned to baseline at 120 min and dipped significantly below baseline at 150 and 180 min. A significant effect of time (p<0.001) was observed for EE between meals. Ghrelin levels did not differ significantly between the test meals.

CONCLUSIONS

Cereal with milk, along with fruits and nuts at breakfast, has a lower and stable glycemic response, along with increased satiety among healthy male subjects.

T-Cell Responses in Adults During Natural Respiratory Syncytial Virus Infection

Background

The pathogenesis of respiratory syncytial virus (RSV) in older adults may be due to age-related T-cell immunosenescence. Thus, we evaluated CD4 and CD8 T-cell responses during RSV infection in adults across the age spectrum.

Methods

Peripheral blood mononuclear cells collected during RSV infection in adults, age 26-96 years, were stimulated with live RSV and peptide pools representing F, M, NP, and G proteins and analyzed by flow cytometry.

Results

There were no significant age-related differences in frequency of CD4+ T cells synthesizing interferon (IFN)γ, interleukin (IL)2, IL4, IL10, or tumor necrosis factor (TNF)α or in CD8+IFNγ+ T cells. IL4+CD4+ T-cell numbers were low, as were IL13 and IL17 responses. However, in univariate analysis, CD4 T-cell IFNγ, IL2, IL4, IL10, and TNFα responses and CD8+IFNγ+ T cells were significantly increased with more severe illness requiring hospitalization. In multivariate analysis, viral load was also associated with increased T-cell responses.

Conclusions

We found no evidence of diminished RSV-specific CD4 or CD8 T-cell responses in adults infected with RSV. However, adults with severe disease seemed to have more robust CD4 and CD8 T-cell responses during infection, suggesting that disease severity may have a greater association with T-cell responses than age.

Variability of the EG95 antigen-coding gene of Echinococcus granulosus in animal and human origin: implications for vaccine development

In the present study, the genetic variability of the EG95 protein-coding gene in several animal and human isolates of Echinococcus granulosus was investigated. A total of 24 isolates collected from cattle, buffalo, sheep, goat, dog and man were amplified by Eg95-coding gene-specific primers. From the generated sequence information, a conceptual amino acid sequence was deduced. Phylogenetically, the Eg95 coding gene belongs to the Eg95-1/Eg95-2/Eg95-3/Eg95-4 cluster. Further confirmation on the maximum composite likelihood analysis revealed that the overall transition/transversion bias was 2.913. This finding indicated thatthere is bias towards transitional and transversional substitution. Using artificial neural networks, a B-cell epitope was predicted on primary sequence information. Stretches of amino acid residues varied between animal and human isolates when hydrophobicity was considered. Flexibility also varied between larval and adult stages of the organism. This observation is important to develop vaccines. However, cytotoxic T-lymphocyte epitopes on primary sequence data remained constant in all isolates. In this study, agretope identification started with hydrophobic amino acids. Amino acids with the same physico-chemical properties were present in the middle. The conformational propensity of the Eg95-coding gene of 156 amino acid residues had α-turns and β-turns, and α-amphipathic regions up to 129, 138-156 and 151-155 residues, respectively. The results indicated potential T-cell antigenic sites. The overall Tajima's D value was negative (-2.404165), indicative of negative selection pressure.

Effect of CoFe dusting layer and annealing on the magnetic properties of sputtered Ta/W/CoFeB/CoFe/MgO layer structures

We explored the effect of a CoFe wedge inserted as a dusting layer (0.2 nm-0.4 nm thick) at the CoFeB/MgO interface of a sputtered Ta(2 nm)/W(3 nm)/CoFeB(0.9 nm)/MgO(3 nm)/Ta(2 nm) film-a typical structure for spin-orbit torque devices. Films were annealed at temperatures varying between 300 °C and 400 °C in an argon environment. Ferromagnetic resonance studies and vibrating sample magnetometry measurements were carried out to estimate the effective anisotropy field, the Gilbert damping, the saturation magnetization and the dead layer thickness as a function of the CoFe thickness and across several annealing temperatures. While the as-deposited films present only easy-plane anisotropy, a transition along the wedge from in-plane to out-of-plane was observed across several annealing temperatures, with evidence of a spin-reorientation transition separating the two regions.

Metamagnetic transition and observation of spin-fluctuations in the antiferromagnetic Heusler compound Pd2MnIn

We report detailed investigations on the structural, magnetic, magneto-transport and calorimetric aspects of a partially ordered Heusler compound Pd₂MnIn. The sample shows antiferomagnetic (AFM) state below around 120 K, though positive paramagnetic Curie temperature signifies a complex magnetic ground state with the presence of both ferromagnetic (FM) and AFM correlations. A clear spin-flop type metamagnetic transition is observed as evident from the magnetization and resistivity data. However, non-saturation of magnetization even at 145 kOe of applied field implies that the high field state may be a spin canted state, originating from the enhanced FM correlations by field induced conduction electron spin polarization. The sample shows a profound quadratic temperature dependence of resistivity below about 20-25 K indicating a spin-fluctuation dominated low temperature region. Previous electronic structure calculations show the existence of a subtle balance between superexchange mediated AFM state and an RKKY (Ruderman-Kittel-Kasuya-Yoshida) interaction mediated FM state in Pd₂MnIn. Such competing AFM-FM correlations can be accounted for the observed spin fluctuations.