Lessons from a large outbreak of Escherichia coli O157:H7 infections: insights into the infectious dose and method of widespread contamination of hamburger patties

Between November 1992 and February 1993, a large outbreak of Escherichia coli O157:H7 infections occurred in the western USA and was associated with eating ground beef patties at restaurants of one fast-food chain. Restaurants that were epidemiologically linked with cases served patties produced on two consecutive dates; cultures of recalled ground beef patties produced on those dates yielded E. coli O157:H7 strains indistinguishable from those isolated from patients, confirming the vehicle of illness. Seventy-six ground beef patty samples were cultured quantitatively for E. coli O157:H7. The median most probable number of organisms was 1.5 per gram (range, < 0.3-15) or 67.5 organisms per patty (range, < 13.5-675). Correlation of the presence of E. coli O157:H7 with other bacterial indicators yielded a significant association between coliform count and the presence of E. coli O157:H7 (P = 0.04). A meat traceback to investigate possible sources of contamination revealed cattle were probably initially colonized with E. coli O157:H7, and that their slaughter caused surface contamination of meat, which once combined with meat from other sources, resulted in a large number of contaminated ground beef patties. Microbiological testing of meat from lots consumed by persons who became ill was suggestive of an infectious dose for E. coli O157:H7 of fewer than 700 organisms. These findings present a strong argument for enforcing zero tolerance for this organism in processed food and for markedly decreasing contamination of raw ground beef. Process controls that incorporate microbiological testing of meat may assist these efforts.

High prevalence of calcified silent neurocysticercosis in a rural village of Mexico

Human neurocysticercosis (NC) is a parasitic disease caused by TAENIA SOLIUM when its larvae lodge in the central nervous system. NC prevalence estimates are obscured by the variable and often asymptomatic clinical picture. While infection depends on exposure, severity is possibly related with various host factors (immunity, genes and gender). This epidemiological study of cranial CT scans in an endemic rural community found that 9.1% of apparently healthy subjects had calcified lesions and were completely asymptomatic. Silent NC cases did not correlate with the exposure factors tested but showed family aggregation and higher rates of positive serology. Thus, NC prevalence may be higher than currently considered and host-related factors appear to be involved in infection and pathogenesis.

Epidemiology and control of egg-associated Salmonella enteritidis in the United States of America

The isolation rate for Salmonella enterica serotype Enteritidis (SE) in humans in the United States of America (USA) increased from 1,207 sporadic isolates identified in 1976 (0.6 isolates/100,000 population) to 10,201 identified in 1995 (4.0/100,000 population). The proportion of reported Salmonella isolates which were SE increased from 5% to 25% during the same time period. In 1990, 1994, and 1995, SE was the most commonly reported reported Salmonella serotype in the USA. Much of this increase has been associated with the consumption of contaminated shell eggs. An examination of the results of a United States Department of Agriculture (USDA) survey of spent hens at slaughter and unpasteurised liquid egg at breaker plants (liquid egg processors) in 1991 and 1995 reveals an increase in the prevalence of SE isolates overall and in most regions of the USA. SE phage type 4 (pt 4), the predominant SE phage type in other parts of the world, has emerged in the egg industry in the western USA concurrent with a sharp increase in the number of sporadic human SE pt 4 isolates in California and Utah. Research on the molecular structure and virulence of SE pt 4 isolates from the USA as compared with isolates from other parts of the world (human and poultry) should be a priority. A comparison of DNA from pt 4 isolates from the USA and Europe may provide information about the potential threat to public health and poultry in the USA from this phage type. Some regional success in the reduction of human illness as a result of SE control efforts is apparent. The Pennsylvania Egg Quality Assurance Program has shown progress in reducing SE infection in participating flocks. At a national level, however, neither the incidence of human illness due to SE nor the prevalence of SE in flocks and unpasteurised liquid eggs have decreased significantly, despite the implementation of the USDA 'trace back' regulation from 1990 to 1995, and intensified efforts to educate food handlers and to enforce safe food handling practices. More effort is needed to control SE at every stage of the egg continuum, from production through to consumption. A risk-reduction approach, with barriers to the introduction and multiplication of the pathogen throughout the farm-to-table continuum, is the most practical method for reducing human illness from SE in shell eggs at present. An effective long-term solution will require interdisciplinary efforts involving government, industry, consumers, and academics. Interventions should be developed and evaluated in compliance with the potential for reducing the risk to human health and cost-effectiveness.

Normative database for trunk range of motion, strength, velocity, and endurance with the Isostation B-200 Lumbar Dynamometer

A review of related literature and trends was used to develop a protocol for testing range of motion, isometric strength, velocity, endurance, and consistency of effort in the low-back pain (LBP) population by the use of the triaxial, Isostation B-200 Lumbar Dynamometer. Eighty-five men and 83 women with no history of LBP for the past 6 months volunteered for the study. Relationships between demographic and test measures were calculated by the use of the Pearson r correlation analysis and ANOVA. Body weight, age, and gender all showed strong (P less than .001), positive relationships to various test measures. The normative database is reported in terms of descriptive statistics allowing comparison of future test results within the normal distribution and corrected for significant demographic features.

Clinical features and outcomes of HIV-related cytomegalovirus pneumonia

OBJECTIVE

To describe the characteristics and outcomes of HIV-infected patients with biopsy-proven cytomegalovirus (CMV) pneumonia.

DESIGN

Retrospective study.

SETTING

A 900-bed acute facility in New York City.

PATIENTS

Eighteen HIV-infected patients with pathologically confirmed CMV inclusions in lung tissue without other pathogens and 36 control patients with biopsy-proven Pneumocystis carinii pneumonia (PCP) selected for comparisons by computer-generated random sequential numbers.

MAIN OUTCOME MEASURES

Demographic, clinical, laboratory, radiological findings, and in-hospital mortality.

RESULTS

Eighteen HIV-infected patients were found to have CMV lung infection alone. Pathologic findings were pneumonitis (n = 11); pneumonitis and pulmonary vasculitis (n = 1); and CMV inclusions alone (n = 6). All presented with respiratory symptoms (cough or dyspnea), 89% had fever, 83% had radiological abnormalities, and 56% had severe hypoxemia. The pulmonary presentation was similar except for higher lactate dehydrogenase (median, 449 versus 329 IU/l; P = 0.03) and presence of pleural effusions (33 versus 0%; P = 0.001) in CMV patients. Multivariate analysis showed that CD4 counts < or = 12 x 10(6)/l (odds ratio; 9.2; P = 0.029) and extrapulmonary CMV (odds ratio, 20.4; P = 0.039) were independently associated with CMV pneumonia. Seventeen patients received specific anti-CMV therapy for a mean of 22 +/- 13 days. In-hospital mortality was higher in patients with CMV pneumonia (odds ratio, 11.9; P = 0.002). The median time from admission to death was 31 days.

CONCLUSIONS

CMV lung infection was seen in severely immunosuppressed HIV-positive patients and associated with clinical pneumonitis with high early mortality. Although the clinical features resemble PCP, the presence of extrapulmonary CMV disease should suggest the diagnosis of CMV pneumonia.

The effects of inpatient music therapy on self-reported symptoms at an academic cancer center: a preliminary report

PURPOSE

Music therapy has shown benefits for reducing distress in individuals with cancer. We explore the effects of music therapy on self-reported symptoms of patients receiving inpatient care at a comprehensive cancer center.

METHODS

Music therapy was available as part of an inpatient integrative oncology consultation service; we examined interventions and symptoms for consecutive patients treated by a board-certified music therapist from September 2016 to May 2017. Patients completed the Edmonton Symptom Assessment Scale (ESAS, 10 symptoms, scale 0-10, 10 most severe) before and after the intervention. Data was summarized by descriptive statistics. Changes in ESAS symptom and subscale scores (physical distress (PHS), psychological distress (PSS), and global distress (GDS)) were evaluated by Wilcoxon signed rank test.

RESULTS

Data were evaluable for 96 of 100 consecutive initial, unique patient encounters; 55% were women, average age 50, and majority with hematologic malignancies (47%). Reasons for music therapy referral included anxiety/stress (67%), adjustment disorder/coping (28%), and mood elevation/depression (17%). The highest (worst) symptoms at baseline were sleep disturbance (5.7) and well-being (5.5). We observed statistically and clinically significant improvement (means) for anxiety (- 2.3 ± 1.5), drowsiness (- 2.1 ± 2.2), depression (- 2.1 ± 1.9), nausea (- 2.0 ± 2.4), fatigue (- 1.9 ± 1.5), pain (- 1.8 ± 1.4), shortness of breath (- 1.4 ± 2.2), appetite (- 1.1 ± 1.7), and for all ESAS subscales (all ps < 0.02). The highest clinical response rates were observed for anxiety (92%), depression (91%), and pain (89%).

CONCLUSIONS

A single, in-person, tailored music therapy intervention as part of an integrative oncology inpatient consultation service contributed to the significant improvement in global, physical, and psychosocial distress. A randomized controlled trial is justified.

Structural analysis of the regulatory region of the human corticotropin releasing hormone gene

A DNA fragment containing the human corticotropin releasing hormone (CRH) gene, along with 9 kb of upstream and 4 kb of downstream sequences, was isolated from a human genomic DNA library. Nucleotide sequence analysis of the proximal 918 nucleotides 5' flanking the putative major mRNA start site of the human gene and comparison to the 866 nucleotide long homologous ovine sequence, revealed that this region of the CRH gene consists of two distinct areas with different degrees of homology, varying from 72% to 94%. The putative functional features of the human sequence were identified. Many, but not all, features were conserved in the ovine sequence. The highly conserved nature of the regulatory region of this gene makes it a good candidate for tracing possible related genetic defects of the hypothalamic-pituitary-adrenal (HPA) axis.

Flea market finds and global exports: Four multistate outbreaks of human Salmonella infections linked to small turtles, United States-2015

Zoonotic transmission of Salmonella infections causes an estimated 11% of salmonellosis annually in the United States. This report describes the epidemiologic, traceback and laboratory investigations conducted in the United States as part of four multistate outbreaks of Salmonella infections linked to small turtles. Salmonella isolates indistinguishable from the outbreak strains were isolated from a total of 143 ill people in the United States, pet turtles, and pond water samples collected from turtle farm A, as well as ill people from Chile and Luxembourg. Almost half (45%) of infections occurred in children aged <5 years, underscoring the importance of the Centers for Disease Control and Prevention recommendation to keep pet turtles and other reptiles out of homes and childcare settings with young children. Although only 43% of the ill people who reported turtle exposure provided purchase information, most small turtles were purchased from flea markets or street vendors, which made it difficult to locate the vendor, trace the turtles to a farm of origin, provide education and enforce the United States federal ban on the sale and distribution of small turtles. These outbreaks highlight the importance of improving public awareness and education about the risk of Salmonella from small turtles not only in the United States but also worldwide.

Exact relationship for third-order structure functions in helical flows

An exact law for turbulent flows is written for third-order structure functions taking into account the invariance of helicity, a law akin to the so-called "4/5 law" of Kolmogorov. Here, the flow is assumed to be homogeneous, incompressible and isotropic but not invariant under reflectional symmetry. Our result is consistent with the derivation by O. Chkhetiani [JETP Lett. 10, 808, (1996)] of the von Karman-Howarth equation in the helical case, leading to a linear scaling relation for the third-order velocity correlation function. The alternative relation of the Kolmogorov type we derive here is written in terms of mixed structure functions involving combinations of differences of all components for both the velocity and vorticity fields. This relationship could prove to be a stringent test for the measuring of vorticity in the laboratory, and provide a supplementary tool for the study of the properties of helical flows.

Group Yoga Effects on Cancer Patient and Caregiver Symptom Distress: Assessment of Self-reported Symptoms at a Comprehensive Cancer Center

Background. Complementary and integrative health approaches such as yoga provide support for psychosocial health. We explored the effects of group-based yoga classes offered through an integrative medicine center at a comprehensive cancer center. Methods. Patients and caregivers had access to two yoga group classes: a lower intensity (YLow) or higher intensity (YHigh) class. Participants completed the Edmonton Symptom Assessment System (ESAS; scale 0-10, 10 most severe) immediately before and after the class. ESAS subscales analyzed included global (GDS; score 0-90), physical (PHS; 0-60), and psychological distress (PSS; 0-20). Data were analyzed examining pre-yoga and post-yoga symptom scores using paired t-tests and between types of classes using ANOVAs. Results. From July 18, 2016, to August 8, 2017, 282 unique participants (205 patients, 77 caregivers; 85% female; ages 20-79 years) attended one or more yoga groups (mean 2.3). For all participants, we observed clinically significant reduction/improvement in GDS, PHS, and PSS scores and in symptoms (ESAS decrease ≥1; means) of anxiety, fatigue, well-being, depression, appetite, drowsiness, and sleep. Clinically significant improvement for both patients and caregivers was observed for anxiety, depression, fatigue, well-being, and all ESAS subscales. Comparing yoga groups, YLow contributed to greater improvement in sleep versus YHigh (−1.33 vs −0.50, P = .054). Improvement in fatigue for YLow was the greatest mean change (YLow −2.12). Conclusion. A single yoga group class resulted in clinically meaningful improvement of multiple self-reported symptoms. Further research is needed to better understand how yoga class content, intensity, and duration can affect outcomes.

Development and initial psychometric evaluation of a COVID-related psychosocial experiences questionnaire for cancer survivors

BACKGROUND

Cancer survivors are at elevated risk of psychological problems related to COVID-19, yet no published measure adequately assesses their psychosocial experiences during the pandemic.

PURPOSE

Describe the development and factor structure of a comprehensive, self-report measure (COVID-19 Practical and Psychosocial Experiences questionnaire [COVID-PPE]) assessing the pandemic's impact on US cancer survivors.

METHODS

The sample (n = 10,584) was divided into three groups to assess COVID-PPE factor structure by conducting: (1) initial calibration/exploratory analysis of the factor structure of 37 items (n = 5070), (2) confirmatory factor analysis of the best-fitting model (36 items after item removal; n = 5140), and (3) post-hoc confirmatory analysis with an additional six items not collected in the first two groups (42 items; n = 374).

RESULTS

The final COVID-PPE was divided into two sets of subscales, conceptualized as Risk Factors and Protective Factors. The five Risk Factors subscales were labeled Anxiety Symptoms, Depression Symptoms, Health Care Disruptions, Disruptions to Daily Activities and Social Interactions, and Financial Hardship. The four Protective Factors subscales were labeled Perceived Benefits, Provider Satisfaction, Perceived Stress Management Skills, and Social Support. Internal consistency was acceptable for seven subscales (αs = 0.726-0.895; ωs = 0.802-0.895) but poor or questionable for the remaining two subscales (αs = 0.599-0.681; ωs = 0.586-0.692).

CONCLUSIONS

To our knowledge, this is the first published self-report measure comprehensively capturing psychosocial impact-both positive and negative-of the pandemic on cancer survivors. Future work should evaluate predictive utility of COVID-PPE subscales, particularly as the pandemic evolves, which may inform recommendations for cancer survivors and facilitate identification of survivors most in need of intervention.

[3H]-flunitrazepam binding after morphine treatment and under abstinence syndrome

Chronic morphine treatment produced increases in [3H]-flunitrazepam binding in some hippocampal areas of the rat brain. The differences in binding were statistically significant in some cases. Both morphine-dependent and morphine-deprived (abstinence syndrome) animals showed an identical response in binding, which confirms a real, although small, increase in benzodiazepine binding sites in the hippocampus after morphine treatment, that is not affected by a naloxone-induced abstinence syndrome under the conditions studied. These findings support the hypothesis of a morphine-induced up-regulation of benzodiazepine binding sites in the hippocampus. A possible different response in benzodiazepine binding sites 1 and 2 could explain the different findings reported in the literature. Our data suggest that the detected increase in benzodiazepine binding would be mainly due to type 2 binding sites, since the hippocampus has a higher density of this type of benzodiazepine binding sites.

Electrical properties of a Na+-dependent phenylalanine transport in lizard (Lacerta galloti) duodenum

The unidirectional transepithelial fluxes of L-phenylalanine across lizard duodenum were determined in flux chambers. Phenylalanine was preferentially transferred from the mucosal to the serosal fluid. This transport was accompanied by an accumulation of substrate from the mucosal medium into the tissue to a similar level and against a concentration gradient. There was no net movement of phenylalanine when the sodium was substituted by choline. The influx of L-phenylalanine into the epithelial cells of lizard duodenum was examined by incubating slices of intestine in radioactively-labelled solutions of the substrate for 2 min. The steady-state uptake was assessed after similar incubations lasting 45 min. Phenylalanine influx obeys the Michaelis-Menten equation with a Km of 5.1 and is dependent on the presence of sodium ions in the incubation medium. Phenylalanine has been used to induce changes in short-circuit current (delta Isc) across intestine. delta Isc was a hyperbolic function of amino acid concentration characterized by the parameters Jm (maximum change in delta Isc) and Km (concentration needed to attain an delta Isc equal to half the Jm). delta Isc determined Km constants showed good agreement with values obtained from direct measurements of phenylalanine uptake into tissue.

Effects of Center-Based Delivery of Tai Chi and Qi Gong Group Classes on Self-Reported Symptoms in Cancer Patients and Caregivers

Background: There is increasing interest in complementary approaches such as Tai Chi (TC) and Qi Gong (QG) in oncology settings. We explored the effects of TC/QG delivered in group classes at a comprehensive cancer center. Methods: Patients and caregivers who participated in TC or QG completed assessments before and after an in-person group class. Assessments included questions about expectancy/satisfaction and common cancer symptoms (Edmonton Symptom Assessment Scale [ESAS]). ESAS distress subscales analyzed included global (GDS), physical (PHS), and psychosocial (PSS). Results: Three hundred four participants (184 patients, 120 caregivers) were included in the analysis. At baseline, caregivers had a greater expectancy for change in energy level as a result of class participation compared with patients (22.9% vs 9.9%). No significant difference was observed between baseline patient and caregiver PSS. Clinically significant improvement in well-being was observed among patients in TC classes (1.0) and caregivers in QG classes (1.2). For fatigue, patients (1.4) and caregivers (1.0) participating in QG experienced clinically significant improvement. Both TC and QG classes were associated with clinically significant improvements (ESAS GDS decrease ≥3) in global distress for patients (TC = 4.52, SD= 7.6; QG = 6.05, SD = 7.9) and caregivers (TC = 3.73, SD = 6.3; QG = 4.02, SD = 7.8). Eighty-nine percent of participants responded that their expectations were met. Conclusions: Patients and caregivers participating in TC or QG group classes were satisfied overall and experienced significant improvement in global distress. Additional research is warranted to explore the integration of TC and QG in the delivery of supportive cancer care.

von Kármán-Howarth relationship for helical magnetohydrodynamic flows

We derive an exact equation for homogeneous isotropic magnetohydrodynamic (MHD) turbulent flows with nonzero helicity; this result is of the same nature as the classical von Kármán-Howarth (VKH-HM) formulation for the kinetic energy of turbulent fluids. Helical MHD is relevant to the astrophysical flows such as in the solar corona, or the interstellar medium, and in the dynamo problem. The derivation involves the new writing of the general form of tensors for that case, for either vectors or (pseudo)axial vectors. It is shown that, for general third-order tensors, four generating functions are needed when taking into account the nonmirror invariance of helical fluids, instead of two as in the fully isotropic case. The new equation obtained, denoted by VKH-HM, links the dissipation of magnetic helicity to the third-order correlations involving combinations of the components of the velocity, the magnetic field, and the magnetic potential. Finally, in the long-time and nonresistive limit, this relationship leads to a linear scaling with separation of the third-order tensor, correlating the two normal components of the electromotive force and of the magnetic potential.

Multidisciplinary lifestyle modification program (IM-FIT) for cancer survivors: implementation of a reimbursable model in a cancer hospital

PURPOSE

We examined the initial effects of a real-world application of a multimodal, reimbursable program to improve lifestyle and promote healthy weight loss in cancer survivors as part of their care.

METHODS

The lifestyle program (Integrative Medicine Fitness Program; IM-FIT) focusing on increasing physical activity and strength training, improving nutrition, and facilitating stress management and behavior change was delivered in a group format over 12 weeks. Patients met weekly with a physical therapist, dietitian, and psychologist. Body composition and behavioral data were collected at the start and end of 12 weeks, as well as fitness, nutrition, and psychological data. The first cohort started in September 2017, and the last cohort ended in August 2019.

RESULTS

Twenty-six patients (92% female; mean age = 62.7, SD = 9) completed the program, which was pre-approved and covered as in-network by their health insurance. Patients lost an average of 3.9% of their body weight (SD =  - 2.2). There was a significant reduction in white bread and desserts and increase in legumes and non-dairy milk. Time spent in vigorous exercise (p < .001), strength training (p < .001), and total exercise (p < .001) significantly increased. Patients reported reduction in depression (7.76 to 4.29; p = .01), anxiety (6.14 to 3.29; p < .01), and overall distress (4.70 to 3.40; p < .01).

CONCLUSION

We demonstrated that a multi-disciplinary weight loss program can be tailored to cancer survivors leading to weight reduction and improvements in lifestyle factors and mental health. This program showed successful real-world implementation with insurance reimbursement.

Frequencies and predictors of health psychology referrals after integrative oncology consultation

Objective

Health psychology (HP) plays a critical role within a multidisciplinary, integrative oncology team. HP in integrative oncology is not well established and criteria for referral have not been examined. This study examined characteristics of referral to HP.

Methods

A chart review of 1827 patients in the Integrative Medicine Center (IMC) between 2019 and 2020 was conducted. Patient assessments included the Edmonton Symptom Assessment Scale, Measure Yourself Concerns and Well-being, and PROMIS10. Chi-square tests were used to compare categorical variables, Mann-Whitney test for non-normally distributed continuous variables, and t-tests for normally distributed continuous variables comparing those referred and not referred to HP.

Results

Patients referred (n = 316) were mostly female (85.4%), White (67.1%), married/partnered (67.7%), obese (42.1%), and with breast cancer (52.2%). When comparing the two groups, patients referred to HP and patients not referred to HP, patients referred had a higher proportion of female and Black patients than expected (p ≤ .01); patients referred were also younger and had higher BMIs (p ≤ .01). Referred patients reported worse fatigue, sleep, depression, anxiety, well-being, spiritual pain, financial distress, memory, overall mental health, physical health, and global health (p ≤ .01). Most common concerns of referrals were diet/nutrition, overall health, and stress/anxiety. Compared to non-referred, HP referrals were more likely to prioritize depression, spirituality, and stress/anxiety (p ≤ .01).

Conclusions

Patient characteristics are well-suited treatment targets for HP, including addressing emotional distress, healthy lifestyle, and quality of life. Our findings can help programs develop strategies to facilitate engagement with psychological counseling.

The role of aldosterone in water and electrolyte transport across the colonic epithelium of the lizard, Gallotia galloti

1. The effects of D-aldosterone on the electrical properties and ionic transport have been analysed (in vitro) in the colonic epithelium of the lizard, Gallotia galloti. 2. The injection of 30 g of D-aldosterone induced a significant rise of plasma aldosterone concentration, sustained for 4 hr after administration. 3. Intraperitoneal injections of D-aldosterone caused a slight reduction of transmural potential difference (PD) and short-circuit current (Isc). 4. Net absorption of Na+ across the colon from aldosterone-treated lizards did not increase when compared to colon from normal lizards. Cl- absorption was increased in treated lizards. 5. Addition of mucosal barium to treated tissues brought about a sustained increase of PD and Isc. 6. The absorption of fluid in normal lizards was reversed to fluid secretion in treated lizards. 7. The effects of D-aldosterone on lizard colon are compared with those reported for the colon of mammals and birds.

Passive scalar convective-diffusive subrange for low Prandtl numbers in isotropic turbulence

In this Rapid Communication, we study the behavior of a strongly diffusive passive scalar field T submitted to a freely decaying, homogeneous and isotropic turbulence with eddy-damped quasinormal Markovian simulations. We present a new subrange located between the k(-17/3) inertial-diffusive subrange and the Kolmogorov wave number k(η). This subrange is generated by small-scale convection linked to k(η) that balances diffusion effects. Thus, we build a typical length scale k(CD)(-1) based on convection and diffusion and give an expression for the shape of the passive scalar spectrum in this subrange E(T)∼√[Pr]k(-11/3) using physical arguments. This result unifies two different theories coming from Batchelor [G. K. Batchelor, J. Fluid. Mech. 5, 113 (1959)] and Chasnov [J. Chasnov et al., Phys. Fluids A 1, 1698 (1989)] and explains results previously obtained experimentally.

The impact of negative COVID-19 experiences on cancer survivors' health-related quality of life and psychological distress: a moderated mediation model

Introduction

Cancer survivors experienced poorer health-related quality of life (HRQoL) and greater psychological distress during the COVID-19 pandemic than those without cancer. However, the underlying mechanisms that may explain how negative experiences during the pandemic are associated with distress and HRQoL remain unknown. We examined whether psychosocial risk factors (i.e., healthcare disruption, disruption to daily activities and social interaction [DDASI], and financial hardship) mediated the relationship between negative COVID-19-related experiences and cancer survivors' HRQoL and psychological distress (i.e., depressive symptoms, and anxiety) and whether the mediating effects were moderated by psychosocial protective factors (i.e., stress management ability and social support).

Methods

A total of 9,651 cancer survivors completed a questionnaire assessing negative COVID-19-related experiences, psychosocial and practical experiences, and HRQoL. Conditional process analysis was used to evaluate the proposed moderated mediation models.

Results

Participants had a mean age of 63.8 years (SD = 12.3) and were mostly non-Hispanic White (82.3%). DDASI and financial hardship mediated the relationship between negative COVID-19-related experiences and cancer survivor's HRQoL and psychological distress. Stress management ability buffered the indirect effect of DDASI on cancer survivors' HRQoL and psychological distress. Social support buffered the indirect effect of financial hardship on HRQoL and depressive symptoms.

Conclusion

Financial resources and social interactions may buffer negative effects of major disruptions such as the COVID-19 pandemic. Future studies should assess the longitudinal impact of these associations.

Effects of Tai Chi and Qi Gong group class participation on self-reported symptoms in cancer patients and caregivers: A preliminary report

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Background: Tai chi and qi gong are movement-based, mind-body approaches offered as part of an integrative oncology program at a comprehensive cancer center. We explored the effects of tai chi and qi gong group class participation on cancer patient and caregiver self-reported symptoms. Methods: Patients and caregivers attending a tai chi and/or qi gong group class completed the Edmonton Symptom Assessment Scale (ESAS) immediately before and after participation. The ESAS assessed 10 symptoms (scale 0-10, 10 worst possible); ESAS subscales analyzed included global (GDS), physical (PHS), and psychosocial (PSS). Descriptive statistics; Chi-Squared test, Fisher’s exact test, Wilcoxon rank-sum test and Wilcoxon signed-rank test were used for data analysis. Results: 304 participants (Oct 2017-April 2019; 184 patients, 120 caregivers; 72% women, 60% white; mean age 58) were included in the analysis. For patients (symptom reduction by class type: tai chi -4.5 SD 7.6; qi gong -6.1 SD 7.9) and caregivers (tai chi -3.7 SD 6.3; qi gong -4.0 SD 7.8), both class types contributed to clinically and statistically significant improvement (ESAS GDS decrease ≥3; p’s ≤0.0001) in global distress. Patients (-2.07 SD 5.49) and caregivers (-2.34 SD 3.71) participating in tai chi experienced clinically and statistically significant improvement in physical distress (ESAS PHS decrease ≥2; p’s ≤0.0001). For the individual symptom of well-being, we observed clinically and statistically significant improvement for caregivers participating in qi gong (-1.2 SD 2) and patients participating in tai chi (-1.0 SD 1.8) (p’s ≤0.0001). For fatigue, patients (-1.4) and caregivers (-1.0) participating in qi gong experienced clinically and statistically significant improvement (p’s ≤0.0001). Conclusions: Patients and caregivers participating in both class types experienced significant improvement in physical and global distress. Additional research is warranted to learn more about how differences in class content (tai chi vs qi gong) and participants may contribute to observed differences in symptom change.

P-166 Beyond deep learning: automatic morpho-kinetic parameter extraction using spatial attention

Study question

Can interpretable deep learning Artificial Intelligence automatically learn to extract morphokinetic parameters from time-lapse embryo videos?

Summary answer

We trained several popular interpretable AI architectures that were successfully able to recognize most embryo developmental stages from day 1 to 5.

What is known already

Several deep learning AI approaches have been applied to IVF, leading to promising but heterogeneous and perfectible results. However, none of these « black box » models are interpretable, preventing users from having access to the features included in the model and thus from critically analyzing its results. Some interpretable AIs, have been recently developed and could help users visualize the regions of interest in a picture. These interpretable AI have not been adapted and tested to embryo IVF images/videos but could be extremely relevant in this field, providing more insight into AI functioning, and allowing critical analysis.

Study design, size, duration

In this monocentric study we used 756 randomly selected time lapse videos recorded between 2011 and 2016 (approximately 10% of all the videos generated over this period) and used half of the dataset for the training phase of the AI and the other half for the final evaluation.

Participants/materials, setting, methods

We used popular deep learning architectures augmented with spatial attention modules that allow the AI to focus on specific areas of the image. We used ResNet-50 as the principal model and combined it with B-CNN, BR-NPA, ProtoPNet, and ProtoTree attention modules. We also applied state-of-the-art generic explanation methods like Grad-CAM, Grad-CAM ++, or Score-CAM. We used standard training procedures and visualized the explanation map produced with a heatmap.

Main results and the role of chance

We trained several popular interpretable AI architectures to distinguish the 16 development phases of embryos from day 1 to 5 and obtained overall 70 % accuracy, as compared to manual annotation by experts. The inspection of the explanation maps highlighted various patterns of focus on the embryo of one particular model, BR-NPA. At the fertilization stage, this interpretable AI focused on the pro-nuclei, whereas from phase t5 to t9+ the model focused on the separate cells. At the blastocyst stage, the model was able to separate the ICM from the rest of the embryo (trophectoderm). This shows that interpretable AI can indeed be applied to time-lapse videos and focus on relevant regions of the embryo at all developmental stages, producing interpretable results. The role of chance was minimal in this study as we obtained consistent results across various AI architectures, the dataset was selected randomly among all available videos and the dataset was large enough to ensure minimal selection bias.

Limitations, reasons for caution

Our study suffers from the inherent limitations of monocentric studies. Indeed, lab procedures and characteristics of the population can vary from one setting to another and question the generalizability of our findings. However, deep learning is versatile and similar results can probably be obtained on data from other centers.

Wider implications of the findings

We postulate that this original approach will help improve the acceptability and the trust of embryologists in AI-based software, which will improve data handling and consistency, ultimately benefiting infertile patients with improved clinical success rates.

Trial registration number

Not applicable

Contribution of Reynolds stress distribution to the skin friction in compressible turbulent channel flows

An exact relationship for the local skin friction is derived for the compressible turbulent wall-bounded flow (channel, pipe, flat plate). This expression is an extension of the compressible case of that derived by Fukagata [Phys. Fluids 14, L73 (2002)] in the case of incompressible wall-bounded flows. This decomposition shows that the skin friction can be interpreted as the contribution of four physical processes, i.e., laminar, turbulent, compressible, and a fourth coming from the interaction between turbulence and compressibility. Compressible numerical simulations show that, even at Mach number M=2 , the main contribution comes from the turbulence, i.e., the Reynolds stress term.

Characterization of atrial lesion safety and efficacy utilizing a circular catheter and the IRE generator with an in vivo porcine model

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): Biosense Webster, Inc.

Introduction/Objectives:

Pulsed field ablation (PFA) is a non-thermal ablative method that delivers high voltage, very-short duration pulses that cause pore formation in the cytoplasmic membrane and cell death. The tissue selectivity of PFA is expected to reduce the risk of collateral tissue injury compared to radiofrequency catheter ablation (RFCA), while maintaining effectiveness.  The objective of this study was to perform pulmonary vein (PV) isolation in a porcine model to characterize the safety and performance of a novel, fully-integrated biphasic PFA system. The system is comprised of a multi-channel generator, a variable loop circular catheter, and an integrated irreversible electroporation (IRE) mapping software module.

Methods

The study evaluated safety and efficacy of IRE in 8 healthy swine. First, to evaluate safety, multiple ablations were performed at various cardiac structures, including within the lumen of the right pulmonary vein (RIPV), at the right superior pulmonary vein (RSPV) ostium, and adjacent to the esophagus. Second, to evaluate efficacy, animals were recovered and followed for 30 (±3) days, then re-mapped. Gross pathological and histopathological examinations were performed to assess for procedural injury, chronic thrombosis, tissue ablation, depth of penetration, healing, and level of inflammatory response.

Results

All 8 swine survived for the 30 (±3) day follow up (FU) period. There were no acute (day of procedure) incidents of pulmonary vein narrowing of &gt;70%, nor at 30 d follow-up (FU), even when ablation was purposefully performed directly deep to the ostium of the vein. No injury was seen grossly or histologically in the adjacent esophagus. All PVs were durably isolated as confirmed by bidirectional block at the 30 (±3) day re-map procedure, and histological examination showed complete, transmural necrosis around the entire circumference of the ablated section of the right PVs [Figure].

Conclusion(s): This pre-clinical evaluation of a fully integrated PFA system demonstrated effective and durable ablation of cardiac tissue and PV isolation with no collateral damage to adjacent structures. Notably, histological staining confirmed complete transmural cell necrosis around the circumference of the ostial PV at 30 days. Abstract Figure. PVI maps (A) histology (B) and safety(C)