Shigella sonnei utilises colicins during inter-bacterial competition

The mammalian colon is one of the most densely populated habitats currently recognised, with 1011-1013 commensal bacteria per gram of colonic contents. Enteric pathogens must compete with the resident intestinal microbiota to cause infection. Among these enteric pathogens are Shigella species which cause approximately 125 million infections annually, of which over 90 % are caused by Shigella flexneri and Shigella sonnei. Shigella sonnei was previously reported to use a Type VI Secretion System (T6SS) to outcompete E. coli and S. flexneri in in vitro and in vivo experiments. S. sonnei strains have also been reported to harbour colicinogenic plasmids, which are an alternative anti-bacterial mechanism that could provide a competitive advantage against the intestinal microbiota. We sought to determine the contribution of both T6SS and colicins to the anti-bacterial killing activity of S. sonnei. We reveal that whilst the T6SS operon is present in S. sonnei, there is evidence of functional degradation of the system through SNPs, indels and IS within key components of the system. We created strains with synthetically inducible T6SS operons but were still unable to demonstrate anti-bacterial activity of the T6SS. We demonstrate that the anti-bacterial activity observed in our in vitro assays was due to colicin activity. We show that S. sonnei no longer displayed anti-bacterial activity against bacteria that were resistant to colicins, and removal of the colicin plasmid from S. sonnei abrogated anti-bacterial activity of S. sonnei. We propose that the anti-bacterial activity demonstrated by colicins may be sufficient for niche competition by S. sonnei within the gastrointestinal environment.

Diversity of mitochondrial DNA in 3 species of great whales before and after modern whaling

The 20th century commercial whaling industry severely reduced populations of great whales throughout the Southern Hemisphere. The effect of this exploitation on genetic diversity and population structure remains largely undescribed. Here, we compare pre- and post-whaling diversity of mitochondrial DNA (mtDNA) control region sequences for 3 great whales in the South Atlantic, such as the blue, humpback, and fin whale. Pre-whaling diversity is described from mtDNA extracted from bones collected near abandoned whaling stations, primarily from the South Atlantic island of South Georgia. These bones are known to represent the first stage of 20th century whaling and thus pre-whaling diversity of these populations. Post-whaling diversity is described from previously published studies reporting large-scale sampling of living whales in the Southern Hemisphere. Despite relatively high levels of surviving genetic diversity in the post-whaling populations, we found evidence of a probable loss of mtDNA lineages in all 3 species. This is evidenced by the detection of a large number of haplotypes found in the pre-whaling samples that are not present in the post-whaling samples. A rarefaction analysis further supports a loss of haplotypes in the South Atlantic humpback and Antarctic blue whale populations. The bones from former whaling stations in the South Atlantic represent a remarkable molecular archive for further investigation of the decline and ongoing recovery in the great whales of the Southern Hemisphere.

Red-list status and extinction risk of the world's whales, dolphins, and porpoises

To understand the scope and scale of the loss of biodiversity, tools are required that can be applied in a standardized manner to all species globally, spanning realms from land to the open ocean. We used data from the International Union for the Conservation of Nature Red List to provide a synthesis of the conservation status and extinction risk of cetaceans. One in 4 cetacean species (26% of 92 species) was threatened with extinction (i.e., critically endangered, endangered, or vulnerable) and 11% were near threatened. Ten percent of cetacean species were data deficient, and we predicted that 2-3 of these species may also be threatened. The proportion of threatened cetaceans has increased: 15% in 1991, 19% in 2008, and 26% in 2021. The assessed conservation status of 20% of species has worsened from 2008 to 2021, and only 3 moved into categories of lesser threat. Cetacean species with small geographic ranges were more likely to be listed as threatened than those with large ranges, and those that occur in freshwater (100% of species) and coastal (60% of species) habitats were under the greatest threat. Analysis of odontocete species distributions revealed a global hotspot of threatened small cetaceans in Southeast Asia, in an area encompassing the Coral Triangle and extending through nearshore waters of the Bay of Bengal, northern Australia, and Papua New Guinea and into the coastal waters of China. Improved management of fisheries to limit overfishing and reduce bycatch is urgently needed to avoid extinctions or further declines, especially in coastal areas of Asia, Africa, and South America.

Predictors and risk factors for admission to critical care in cervicofacial infections: a Maxillofacial Trainee Research Collaborative (MTReC) study

Cervicofacial infections carry significant morbidity. Patients present on a broad spectrum of severity, with some requiring outpatient management and others admission to higher level care. Recognition of risk factors is helpful in decision making regarding the need for admission to higher level care. Prospective data were captured on 1002 patients in 25 centres across 17 regions of the United Kingdom (UK) by the Maxillofacial Trainee Research Collaborative (MTReC). Patients admitted to critical care were compared with those who received ward-level care. Multivariate and receiver operating characteristic curve analyses were used to identify predictors for critical care admission. Our results show that the best predictor for critical care admission is the presence of three or more features of airway compromise (AUC 0.779), followed by C-reactive protein (CRP) >100 mg/L (OR 2.70; 95% CI 1.59 to 4.58; p < 0.005), submandibular space involvement (OR 3.82; 95% CI 1.870 to 7.81; p = 0.003), white cell count (WCC) >12 × 10⁹/ dl (1.05; 95% CI 1.01 to 1.10; p = 0.03), and positive systemic inflammatory response syndrome criteria (OR 2.78; CI 1.35 to 5.80; p = 0.006). Admission to critical care is multifactorial, however, the presence of three or more features of airway compromise is the best predictor. Awareness of this alongside other key clinical findings in cervicofacial infections may allow for the early recognition of patients who may require escalation to critical care.

Promoting nurse-led behaviour change interventions to prevent cardiovascular disease in disadvantaged communities: A scoping review

Cardiovascular diseases (CVD) are the leading cause of death worldwide and they disproportionally affect people living in disadvantaged communities. Nurse-led behaviour change interventions have shown great promise in preventing CVD. However, knowledge regarding the impact and nature of such interventions in disadvantaged communities is limited. This review aimed to address this knowledge gap. A six-stage scoping review framework developed by Arksey and O'Malley, with revisions by Levac et al., was used. The search process was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Extension for Scoping Reviews (PRISMA-ScR). Three electronic databases were searched (PUBMED/MEDLINE, CINAHL Plus, and Cochrane CENTRAL), and included studies were analysed using Braun and Clarke's 'Thematic Analysis' approach. Initial searches yielded 952 papers and 30 studies were included in the review following duplicate, title/abstract, and full-text screening. The included studies indicate that nurse-led behaviour change primary prevention interventions in disadvantaged areas are largely effective; albeit the considerable variety of intervention approaches, study populations and outcome measures used to date make it difficult to ascertain this. Other identified key areas in the promotion of nurse-led behaviour change included tailoring interventions to specific populations, providing adequate training for nurses, overcoming patient access difficulties and encouraging patient engagement. Overall, the findings indicate that nurse-led behaviour change interventions for high-risk CVD patients in disadvantaged areas show much promise, although there is considerable variety in the interventions employed and studied to date. Further research is needed to examine the unique barriers and facilitators of interventions for specific disadvantaged groups.

Carcinogenic air pollution along the United States' southern border: Neighborhood inequities in risk

Air pollution poses serious and socially inequitable risks to public health. Social disparities are marked along the US-Mexico border, yet prior research has not assessed inequities in air pollution exposure across the entire US-side of the border region. We apply an intersectional approach to examine contextually relevant sociodemographic variables, including (1) Hispanic/Latinx ethnicity by race and (2) nativity (US vs. Foreign) by citizenship, and cancer risks attributable to air pollution exposures. We pair data from the 2012-2016 American Community Survey with 2014 National Air Toxics Assessment estimates of carcinogenic risks from all sources of hazardous air pollutants at the census tract level (n = 1448) and use a series of generalized estimating equations to assess inequities in risk. Increased concentrations of renter-occupants, Hispanics, mid-to-high socioeconomic status households, and foreign-born citizens were associated with elevated risks. Hispanic ethnicity intersected with non-White racial identification to amplify risks. In contrast, increased concentrations of non-Hispanic Black people and foreign-born non-citizens were not associated with disparate risks. To ameliorate environmental health inequities in this context, research and policy actions must be tailored to the US-Mexico border and consider intersectional positions within the Hispanic population.

DeepPulse: An Uncertainty-aware Deep Neural Network for Heart Rate Estimations from Wrist-worn Photoplethysmography

Wearable Photoplethysmography (PPG) has gained prominence as a low cost, unobtrusive and continuous method for physiological monitoring. The quality of the collected PPG signals is affected by several sources of interference, predominantly due to physical motion. Many methods for estimating heart rate (HR) from PPG signals have been proposed with Deep Neural Networks (DNNs) gaining popularity in recent years. However, the "black-box" and complex nature of DNNs has caused a lack of trust in the predicted values. This paper contributes DeepPulse, an uncertainty-aware DNN method for estimating HR from PPG and accelerometer signals, with aims of increasing trust of the predicted HR values. To the best of the authors' knowledge no PPG HR estimation method has considered aleatoric and epistemic uncertainty metrics. The results show DeepPulse is the most accurate method for DNNs with smaller network sizes. Finally, recommendations are given to reduce epistemic uncertainty, validate uncertainty estimates, improve the accuracy of DeepPulse as well as reduce the model size for resource-constrained edge devices.

POS0043-HPR DO COPING STRATEGIES, ILLNESS PERCEPTIONS AND RELATIONSHIP DYNAMICS CONTRIBUTE TO SEXUAL DYSFUNCTION FOR WOMEN WITH SJÖGREN’S SYNDROME?

Background

Women with Sjögren’s syndrome (SS) are more likely to experience vaginal dryness, dyspareunia and reduced sexual function than healthy controls1. There is limited data investigating relationships with psychosocial influences, such as coping mechanisms, illness perceptions, partners behaviours and relationship satisfaction.

Objectives

To investigate associations between sexual function and psychosocial parameters in women with SS.

Methods

Cisgender women aged 18+, diagnosed with SS, were invited to participate in a cross-sectional online survey. Ethical approval and informed consent were obtained. Participants completed the Female Sexual Function Index (FSFI), EULAR Sjӧgren’s Syndrome Patient Reported Index (ESSPRI), NRS scale for vaginal dryness (0-10), Profile of Fatigue and Discomfort (ProFaD), Cognitive Emotion Regulation Questionnaire (CERQ), Brief Illness Perceptions Questionnaire (BIPQ), West-Haven Yale Multidimensional Pain Inventory (WHYMPI – Part II) and Maudsley Marital Questionnaire (MMQ – Marital subscale). Associations between the FSFI and the outcome measures were assessed using Spearman’s correlations. Variables that significantly correlated with FSFI total score were entered into a backward stepwise multiple regression.

Results

The survey was completed by 98 women (M = 48.13, SD = 13.26), 70.4% were diagnosed as having primary SS (disease duration range = 3 – 348 months); 43.8% were premenopausal and 48% were postmenopausal. Vaginal dryness was reported by 92.9% of participants, and sexual dysfunction was identified in 85.2% (n = 69/81) of cases (<26.55). Participants who were not sexually active in the previous three-month period (n = 17) were excluded from analyses as inactivity may cause a low FSFI score which may be incorrectly construed as sexual dysfunction. Reduced sexual function was significantly associated with increases in age, vaginal dryness, mental fatigue (ProFaD), self-blame, rumination and catastrophising (CERQ), consequences and identity (BIPQ), negative partner responses (WHYMPI) and relationship dissatisfaction (MMQ). Reduced sexual function was also significantly associated with decreases in positive reappraisal and perspective (CERQ), personal control (BIPQ), solicitous responses and distracting responses (WHYMPI) (Table 1). No significant associations were found for disease duration, relationship duration or ESSPRI total. Results from regression analyses indicated that vaginal dryness (β = -.278, p = .004), CERQ positive reappraisal (β = .322, p = .003) and CERQ catastrophising (β = -.277, p = .009) were significantly related to sexual function and explained 42.0% of the variance in total FSFI scores (F(3,72) = 17.394, p < .001).

Table 1.

Associations between sexual function and psychosocial parameters

FSFI totalrsp95% CI (LB, UB)Age (years)-.270.015-.467-.049Disease duration (months)-.030.793-.253.196Relationship duration (months)-.180.119-.396.054VAS Vaginal dryness-.350.001-.533-.136ESSPRI total-.165.141-.376.062ProFaD Mental Fatigue-.294.008-.486-.074CERQ Self-Blame-.264.017-.461-.042CERQ Rumination-.296.007-.488-.077CERQ Positive Reappraisal.469.000.273.628CERQ Perspective.341.002.126.525CERQ Catastrophising-.499.000-.651-.310BIPQ Consequences-.237.033-.438-.013BIPQ Personal Control-.288.009-.481-.068BIPQ Identity-.294.008-.487-.075MMQ-.282.013-.483-.054WHYMPI Negative Responses-.252.028-.457-.021WHYMPI Solicitous Responses.267.020.037.470WHYMPI Distracting Responses.311.006.085.506

Note. N = 81. Associations that were not significant are not shown.

Conclusion

Women with SS using positive coping strategies have better sexual function than those with negative coping strategies. Learning positive coping strategies may be an important line of approach for managing sexual dysfunction in SS.

References

[1]Priori R, et al. Quality of sexual life in women with primary Sjögren syndrome. J Rheumatol. 2015;42(8): 1427-31.

Disclosure of Interests

None declared

Automatic surgical phase recognition in laparoscopic inguinal hernia repair with artificial intelligence

BACKGROUND

Because of the complexity of the intra-abdominal anatomy in the posterior approach, a longer learning curve has been observed in laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair. Consequently, automatic tools using artificial intelligence (AI) to monitor TAPP procedures and assess learning curves are required. The primary objective of this study was to establish a deep learning-based automated surgical phase recognition system for TAPP. A secondary objective was to investigate the relationship between surgical skills and phase duration.

METHODS

This study enrolled 119 patients who underwent the TAPP procedure. The surgical videos were annotated (delineated in time) and split into seven surgical phases (preparation, peritoneal flap incision, peritoneal flap dissection, hernia dissection, mesh deployment, mesh fixation, peritoneal flap closure, and additional closure). An AI model was trained to automatically recognize surgical phases from videos. The relationship between phase duration and surgical skills were also evaluated.

RESULTS

A fourfold cross-validation was used to assess the performance of the AI model. The accuracy was 88.81 and 85.82%, in unilateral and bilateral cases, respectively. In unilateral hernia cases, the duration of peritoneal incision (p = 0.003) and hernia dissection (p = 0.014) detected via AI were significantly shorter for experts than for trainees.

CONCLUSION

An automated surgical phase recognition system was established for TAPP using deep learning with a high accuracy. Our AI-based system can be useful for the automatic monitoring of surgery progress, improving OR efficiency, evaluating surgical skills and video-based surgical education. Specific phase durations detected via the AI model were significantly associated with the surgeons' learning curve.

Preventing cardiovascular disease in at-risk patients: Protocol for a feasibility study in general practice (‘High-Risk Prevention Programme’)

Background: Cardiovascular disease (CVD) is the number one cause of death globally. Whilst initiatives such as Ireland’s ‘Chronic Disease Management Programme’ have helped in the fight against CVD, a more intensive approach may be required to meet high risk patients’ needs. The High-Risk Prevention Programme (HRPP), led by the Irish Heart Foundation, University College Dublin (UCD), and Ireland’s Health Service Executive (HSE) aims to design, deliver, and evaluate an intensive, six-week behaviour change programme among people at high risk of CVD living in Irish communities. In this paper, we aim to describe the HRPP intervention and the approach that will be used to evaluate it. Methods: The HRPP has been informed by an inclusive co-design process involving health provider and patient input, has been operating since February 2021 and will run until February 2023. Six general practices have agreed to take part in the project, and it is planned that 400 patients at high risk of CVD will participate. Participating patients attend either a practice nurse or health promotion coordinator-led six-week one-to-one consultation programme focusing on self-management of health issues. Feasibility, acceptability, and likely effectiveness will be assessed by means of a process evaluation involving quantitative survey (patient health and health behaviours assessments) at baseline and 12 months, and in-depth qualitative interviews with patients, practice nurses and general practitioners. Conclusions: Project findings will inform whether a general practice-based intervention to prevent CVD among at-risk patients is feasible, acceptable in practice, has a positive impact, and what outcome measures might form the focus of future research.

Pandemic Action Plan Policy and Regulatory Summary Telehealth Policy and Regulatory Considerations During a Pandemic

Reports, studies, and surveys have demonstrated telehealth provides opportunities to make health care more efficient, better coordinated, convenient, and affordable. Telehealth can also help address health income and access disparities in underserved communities by removing location and transportation barriers, unproductive time away from work, childcare expenses, and so on. Despite evidence showing high-quality outcomes, satisfaction, and success rates (e.g., 95% patient satisfaction rate and 84% success rate in which patients were able to completely resolve their medical concerns during a telehealth visit), nationwide adoption of telehealth has been quite low due to policy and regulatory barriers, constraints, and complexities.

Evolutionary drivers of morphological differentiation among three bottlenose dolphin lineages, Tursiops spp. (Delphinidae), in the northwest Indian Ocean utilizing linear and geometric morphometric techniques

Local adaptation and adaptive radiations are typically associated with phenotypic variation suited to alternative environments. In the marine environment, the nature of relevant ecological or environmental transitions is poorly understood, especially for highly mobile species. Here we compare three genetic lineages in the genus Tursiops (bottlenose dolphins), using linear measurements and geometric morphometric techniques, in the context of environmental variation in the northwest Indian Ocean. Cranial morphology was clearly differentiated comparing Tursiops truncatus and Tursiops aduncus, while a recently discovered genetic lineage, found in the Arabian Sea, was morphologically most similar to T. aduncus from the same region, but distinct for various measures, particularly metrics associated with the lateral dimension of the skull. The extent of divergence between T. truncatus and T. aduncus compared to differences between the T. aduncus lineages is consistent with the recent phylogeny for these species. Therefore, with the corroboration of genetic and morphological inference, we propose two conservation units of T. aduncus be recognized in the region at a sub-specific level so that their conservation can be managed effectively. We consider possible evolutionary mechanisms associated with regional habitat characteristics and the exploitation of distinct prey resources.

A Review of Wearable Multi-wavelength Photoplethysmography

Optical pulse detection photoplethysmography (PPG) provides a means of low cost and unobtrusive physiological monitoring that is popular in many wearable devices. However, the accuracy, robustness and generalizability of single-wavelength PPG sensing are sensitive to biological characteristics as well as sensor configuration and placement; this is significant given the increasing adoption of single-wavelength wrist-worn PPG devices in clinical studies and healthcare. Since different wavelengths interact with the skin to varying degrees, researchers have explored the use of multi-wavelength PPG to improve sensing accuracy, robustness and generalizability. This paper contributes a novel and comprehensive state-of-the-art review of wearable multi-wavelength PPG sensing, encompassing motion artifact reduction and estimation of physiological parameters. The paper also encompasses theoretical details about multi-wavelength PPG sensing and the effects of biological characteristics. The review findings highlight the promising developments in motion artifact reduction using multi-wavelength approaches, the effects of skin temperature on PPG sensing, the need for improved diversity in PPG sensing studies and the lack of studies that investigate the combined effects of factors. Recommendations are made for the standardization and completeness of reporting in terms of study design, sensing technology and participant characteristics.

Runs of homozygosity in killer whale genomes provide a global record of demographic histories

Runs of homozygosity (ROH) occur when offspring inherit haplotypes that are identical by descent from each parent. Length distributions of ROH are informative about population history; specifically, the probability of inbreeding mediated by mating system and/or population demography. Here, we investigated whether variation in killer whale (Orcinus orca) demographic history is reflected in genome-wide heterozygosity and ROH length distributions, using a global data set of 26 genomes representative of geographic and ecotypic variation in this species, and two F1 admixed individuals with Pacific-Atlantic parentage. We first reconstructed demographic history for each population as changes in effective population size through time using the pairwise sequential Markovian coalescent (PSMC) method. We found a subset of populations declined in effective population size during the Late Pleistocene, while others had more stable demography. Genomes inferred to have undergone ancestral declines in effective population size, were autozygous at hundreds of short ROH (<1 Mb), reflecting high background relatedness due to coalescence of haplotypes deep within the pedigree. In contrast, longer and therefore younger ROH (>1.5 Mb) were found in low latitude populations, and populations of known conservation concern. These include a Scottish killer whale, for which 37.8% of the autosomes were comprised of ROH >1.5 Mb in length. The fate of this population, in which only two adult males have been sighted in the past five years, and zero fecundity over the last two decades, may be inextricably linked to its demographic history and consequential inbreeding depression.

Pandemic Telemedicine Technology Response Plan and Technology Assessment Phase 2: Pandemic Action Plan Key Issues and Technology Solutions for Health Care Delivery Organizations in a Pandemic

Introduction:

The Covid-19 pandemic created critical challenges for hospitals and healthcare providers. Suddenly clinics were forced to close; scheduled visits were cancelled; emergency rooms were overcrowded; hospital beds, equipment and personal protective equipment (PPE) was in short supply; and staff were faced with rapidly changing circumstances, care protocols, trauma and personal risk. In order to better address the ongoing the Covid-19 pandemic and prepare for future pandemics, the National Telemedicine Technology Assessment resource Center (TTAC) was asked to develop an Pandemic Response Action Plan that would allow its user to address critical issues with available telemedicine and related technologies. The project was constructed into three phases: Phase 1. Develop a Pandemic Response Action Plan (this document) and a Policy document which identifies the regulatory challenges in the Pandemic Response as well as policy recommendations (published separately). Phase 2. Publish the plan and policy documents. Phase 3 Look at healthcare providers who used the approaches, tools and technology in the Pandemic Action Plan and document the results (to be published separately). TTAC will also assess selected technology and publish results as part of their normal course of services.

Materials and Methods

: A multi-disciplinary team was created representing leadership expertise and key stakeholders in healthcare delivery during a pandemic (administration, infection control, physicians, nurses, public health, contingency planning, disaster response, information technology) as well as a facilitator. The group used structured brainstorming, current literature and iterative review to identify the most critical challenges facing healthcare providers during the current Covid 19 pandemic. The team then used structured brainstorming, professional experience and current literature to take a deeper look into these impacts, identify applicable solutions and develop a plan to address the critical challenges using telemedicine and related technologies.

Result:

A Pandemic Action Response Plan that describes the critical challenges and then identifies approaches, tools and technology to address them as well as identifying samples of the technology.

Conclusions:

The impact of the Covid 19 Pandemic was severe and identified multiple critical challenges and weaknesses in most healthcare providers. Applying the approaches, tools and technology in this Pandemic Action Plan will help providers address these challenges and increase the capabilities and resilience of their organizations in the provision of care during this and future pandemics

Multigenerational immigrant trajectories and children's unequal exposure to fine particulate matter in the US

Fine particulate matter is a serious health threat and exposures are particularly damaging for children. The environmental justice (EJ) literature shows that racial/ethnic minority communities experience disproportionate exposure to particulate pollution in the US. While important, those EJ studies tend to neglect people's complex identities, including their nativity and their families' generational histories of residence in the US. Yet there is growing interest in the intersection of immigrant populations and EJ. Our use of individual-level data enables examination of immigrant generational status by race/ethnicity, which provides insights on the intergenerational persistence of environmental injustice. We pair data on 12,570 US third graders (from 2013 to 2014) collected through the Early Childhood Longitudinal Survey with PM_2.5 concentrations for the census tracts of their home and school locations. We apply generalized estimating equations to test for intergenerational disparities in exposure and to examine how those disparities vary between racial/ethnic groups. Independent of race/ethnicity, first- and second-generation children have greater PM_2.5 exposure than 2.5- and third-generation children. However, generational status disparities in exposures vary based on race/ethnicity. First-generation White children face greater exposure than White children of later generational statuses, with inequalities attenuating by the second generation. In contrast, Hispanic/Latinx children experience no significant drop in exposure until the third generation. Among Asian and Black children, generational status was not a significant determinant of exposure. Results quantify the intergenerational persistence of environmental injustices for persons of color while showing the amelioration of inequalities for Whites after just one generation is born in the US, reflecting another facet of White privilege in the US.

OP0258-HPR IS THERE A SUBSET OF PATIENTS WITH SJÖGREN’S SYNDROME WHO ARE MORE AT RISK FOR SEXUAL DYSFUNCTION? RESULTS FROM A SCOPING REVIEW

Background:

Individuals with Sjögren’s syndrome (SS) experience significantly higher levels of sexual dysfunction and sexual distress than healthy controls (van Nimwegen et al., 2015). Identifying associated factors may help to identify a subgroup of patients with SS who may benefit from early intervention to maintain sexual wellbeing and avoid unnecessary sexual disruption.

Objectives:

To explore and map the salient symptoms and factors that influence alterations in sexual functioning and intimate relationships for people with SS.

Methods:

The protocol for this review was registered with the Open Science Framework prior to commencement of the searches. The peer-reviewed search strings were used to search the following databases from inception to June 2019: Cochrane Library, CINAHL [EBSCO], MEDLINE [ProQuest], PUBMED [MEDLINE], ScienceDirect, Scopus and Web of Science. Grey literature was searched for on academic databases, topic-specific repositories, and Google Scholar. Databases were searched using key terms corresponding to sexual functioning and intimate relationships. Studies were included if their participant sample was comprised of adults aged ≥18 years, with a diagnosis of primary or secondary SS. Studies were not excluded based on source type, methodology or design. To qualify for inclusion, studies needed to have been peer-reviewed and available in English. Retrieved articles were then screened against the inclusion/exclusion criteria by two reviewers. Hand-searching was conducted on the reference lists of included articles, as well as the three most prevalent publishing journals until saturation had been achieved.

Results:

The search strategy returned 3527 unique citations. After screening processes were completed, only 19 articles met the inclusion criteria. Studies were predominately conducted in European countries (79%), within the last decade (68%; 2010-2019), and were mainly quantitative (n = 17; 89.5%), case-controlled (88.3%), and cross-sectional (100%) in nature. In total there were 1281 patients, 47% (n = 605) were patients with primary SS and the remaining 53% (n = 676) were patients with secondary SS. Both patient groups were predominately comprised of females (n = 600; 99% and n = 673; 99.5%, respectively), with a combined mean age of 50.82 years (M ranges = 35 – 62.82 years). An amalgamation of results from 17 studies, found that women with SS who score higher on the ESSPRI scale (total score and the subdomains of pain, fatigue and dryness) were more likely to experience significantly greater levels of vaginal dryness, sexual dysfunction and sexual distress. Moreover, women with SS who present with clinical levels of anxiety or depression were also more likely to experience disruptions in their sexual functioning and appraise their sexual life more negatively. Furthermore, patients who report greater severity of oral or ocular dryness, or dyspareunia may experience vaginal dryness, which may have ramifications on sexual functioning. Women of all ages are at risk of experiencing sexual dysfunctions, however, younger women (≤50 years) may experience more burdensome disruptions than older women. Finally, women who do not use lubrication products during sexual activity may be impacted further.

Figure 1.

Factors significantly associated with sexual dysfunction and sexual distress for patients with SS.

Conclusion:

Younger women (≤50) with SS who present with more severe symptoms of fatigue, pain, and oral or ocular dryness, or with clinical levels of anxiety or depression, may be at increased risk of experiencing sexual dysfunction and sexual distress. Healthcare professionals should be aware of these potential risk factors and initiate conversations around sexuality as and when a potentially ‘at risk’ individual is identified.

References:

[1]van Nimwegen, J. F., Arends, S., van Zuiden, G. S., Vissink, A., Kroese, F. G. M., & Bootsma, H. (2015). The impact of primary Sjögren’s syndrome on female sexual function. Rheumatology, 54(7), 1286-1293.

Disclosure of Interests:

None declared

POS0047 OUTCOMES IN INFLAMMATORY ARTHROPATHY PATIENTS HOSPITALIZED FOR COVID-19

Background:

Covid 19 is a new and rapidly spreading corona virus which has reached pandemic proportions. As of 5/22/20 there are 5.08 million confirmed cases and 332,000 deaths worldwide. Primary manifestations are respiratory, with a subset developing severe hypoxic respiratory failure. Several risk factors predispose patients to worse outcomes including age, obesity, hypertension, chronic kidney disease, COPD, asthma, CHF, and diabetes. This is a retrospective cohort analysis of patients with Rheumatoid arthritis, Ankylosing spondylitis, or Psoriatic arthritis who were hospitalized for COVID-19 infection across 165 HCA hospitals from 1/1/2020 to 5/30/2020. We compared endpoints and calculated odds of ICU admission, invasive ventilation, mortality compared to control as well as length of stay and discharge location.

Objectives:

Our objectives include measuring the outcome of Patients in two arms, the first being those with Rheumatoid arthritis, Ankylosing spondylitis, and Psoriatic arthritis who are infected with COVID 19 to an age matched and comorbidity matched arm (using the Charlson comorbidity index) for the composite endpoint of ICU admission, invasive ventilation, and death. We believe the inflammatory arthropathy arm will have a worse composite endpoint then the control arm. we will also attempt to calculate a hazard ratio of this arm vs the control to the composite endpoint. We will also examine the length of stay as well as inflammatory markers mentioned in between the two arms. We suspect initial inflammatory markers will be lower in the inflammatory arthropathy arm, particularly CRP and LDH, due to chronic immune modulating medication and these markers will not correlate as closely with severe illness represented by the composite endpoint as in the control arm.

Methods:

We analyzed 86,217 patients admitted with COVID-19 comparing 751 patients who had inflammatory arthropathy to patients who did not. T tests were used for parametric outcome and chi square tests for non-parametric outcomes. Multivariate analysis included potential confounders such as age, and comorbidities such as diabetes, heart disease, etc.

Results:

The odds ratio for mortality in the arthropathy arm was 1.37 with a confidence interval of 1.09 to 1.71 with a p value of 0.006. The odds ratio for ventilation was 1.35 with CI of 1.09 to 1.67 and p value of 0.006. The odds ratio of ICU admission was 1.46 with CI of 1.24 to 1.72 and P value of 0.000. The average length of stay of the arthropathy arm was 8.51 days +/- 10.02 vs 4.59 days +/- 8.26 of the control, p < 0.001. The discharge disposition of the arthropathy arm vs control group is as follows, 13.32% died inpatient vs 5.87% in the control, 56.72% were discharged home vs 77.19%, 6.79% went to hospice care vs 3.10%, 4.79% remained inpatient at the end of the study interval vs 3.45%, 17.18% were discharged to rehab vs 8.43%, and other discharges not included in the above groupings were 1.2% vs 1.96%, p<0.001. 31.29% of the arthropathy group required ICU admission vs 16.32% and 13.98% required ventilation vs 6.9%, p <0.001. The average age was higher in the arthropathy arm vs control at 66.56 years old vs 51.53, p <0.001. Charlson comorbidity index was also higher in the arthropathy arm at 2.72 vs 0.96, p <0.001.

Conclusion:

This is a large analysis of inflammatory arthropathy patients hospitalized with COVID-19. While the arthropathy group was older, and had more co-morbidities, when adjusting for potential confounders, inflammatory arthropathy patients had a higher risk of death and mechanical ventilation, as well as longer length of stay.

Disclosure of Interests:

None declared.

Quantifying Missingness in Wearable Heart Rate Recordings

Wrist-worn photoplethysmography (PPG) heart rate monitoring devices are increasingly used in clinical applications despite the potential for data missingness and inaccuracy. This paper provides an analysis of the intermittency of experimental wearable data recordings. Devices recorded heart rate with gaps of 5 or more minutes 41.6% of the time and 15 or more minutes 3.8% of the time.

How decision-making about euthanasia for animals is taught to Australasian veterinary students

This study set out to explore how euthanasia decision-making for animals was taught to students in eight Australasian veterinary schools. A questionnaire-style interview guide was used by a representative at each university to interview educators. Educators were interviewed about their teaching of euthanasia decision-making for four categories of animals: livestock, equine, companion and avian/wildlife. Using thematic analysis, the terms provided by participants to describe how (mode of teaching) and what (specific content) they taught to students were categorised. Information about content was categorised into human-centred factors that influence decision-making, and animal-based indicators used to directly inform decision-making. All eight representatives reported some teaching relevant to euthanasia decision-making at their university for livestock, companion animal and avian/wildlife. One representative reported no such teaching for equid animals at their university. Observation of a euthanasia case was rarely reported as a teaching method. Five universities reported multiple modes of teaching relevant information, while two universities made use of modalities that could be described as opportunistic teaching (e.g., 'Discussion of clinical cases'). Factors taught at most universities included financial considerations, and that it is the owner's decision to make, while animal-based indicators taught included QoL/animal welfare, prognosis and behaviour change. Overall, most universities used a variety of methods to cover relevant material, usually including lectures and several other approaches for all animal types. However, because two universities relied on presentation of clinical cases, not all students at these veterinary schools will be exposed to make, or assist in making, euthanasia decisions.

Marine mammal conservation: over the horizon

Marine mammals can play important ecological roles in aquatic ecosystems, and their presence can be key to community structure and function. Consequently, marine mammals are often considered indicators of ecosystem health and flagship species. Yet, historical population declines caused by exploitation, and additional current threats, such as climate change, fisheries bycatch, pollution and maritime development, continue to impact many marine mammal species, and at least 25% are classified as threatened (Critically Endangered, Endangered or Vulnerable) on the IUCN Red List. Conversely, some species have experienced population increases/recoveries in recent decades, reflecting management interventions, and are heralded as conservation successes. To continue these successes and reverse the downward trajectories of at-risk species, it is necessary to evaluate the threats faced by marine mammals and the conservation mechanisms available to address them. Additionally, there is a need to identify evidence-based priorities of both research and conservation needs across a range of settings and taxa. To that effect we: (1) outline the key threats to marine mammals and their impacts, identify the associated knowledge gaps and recommend actions needed; (2) discuss the merits and downfalls of established and emerging conservation mechanisms; (3) outline the application of research and monitoring techniques; and (4) highlight particular taxa/populations that are in urgent need of focus.

Augmented Reality Guided Laparoscopic Surgery of the Uterus

A major research area in Computer Assisted Intervention (CAI) is to aid laparoscopic surgery teams with Augmented Reality (AR) guidance. This involves registering data from other modalities such as MR and fusing it with the laparoscopic video in real-time, to reveal the location of hidden critical structures. We present the first system for AR guided laparoscopic surgery of the uterus. This works with pre-operative MR or CT data and monocular laparoscopes, without requiring any additional interventional hardware such as optical trackers. We present novel and robust solutions to two main sub-problems: the initial registration, which is solved using a short exploratory video, and update registration, which is solved with real-time tracking-by-detection. These problems are challenging for the uterus because it is a weakly-textured, highly mobile organ that moves independently of surrounding structures. In the broader context, our system is the first that has successfully performed markerless real-time registration and AR of a mobile human organ with monocular laparoscopes in the OR.

Genomics of Population Differentiation in Humpback Dolphins, Sousa spp. in the Indo-Pacific Ocean

Speciation is a fundamental process in evolution and crucial to the formation of biodiversity. It is a continuous and complex process, which can involve multiple interacting barriers leading to heterogeneous genomic landscapes with various peaks of divergence among populations. In this study, we used a population genomics approach to gain insights on the speciation process and to understand the population structure within the genus Sousa across its distribution in the Indo-Pacific region. We found 5 distinct clusters, corresponding to S. plumbea along the eastern African coast and the Arabian Sea, the Bangladesh population, S. chinensis off Thailand and S. sahulensis off Australian waters. We suggest that the high level of differentiation found, even across geographically close areas, is likely determined by different oceanographic features such as sea surface temperature and primary productivity.

A new blue whale song-type described for the Arabian Sea and Western Indian Ocean

Blue whales Balaenoptera musculus in the Indian Ocean (IO) are currently thought to represent 2 or 3 subspecies (B. m. intermedia, B. m. brevicauda, B. m. indica), and believed to be structured into 4 populations, each with a diagnostic song-type. Here we describe a previously unreported song-type that implies the probable existence of a population that has been undetected or conflated with another population. The novel song-type was recorded off Oman in the northern IO/Arabian Sea, off the western Chagos Archipelago in the equatorial central IO, and off Madagascar in the southwestern IO. As this is the only blue whale song that has been identified in the western Arabian Sea, we label it the ‘Northwest Indian Ocean’ song-type to distinguish it from other regional song-types. Spatiotemporal variation suggested a distribution west of 70°E, with potential affinity for the northern IO/Arabian Sea, and only minor presence in the southwestern IO. Timing of presence off Oman suggested that intensive illegal Soviet whaling that took 1294 blue whales in the 1960s likely targeted this population, as opposed to the more widely distributed ‘Sri Lanka’ acoustic population as previously assumed. Based upon geographic distribution and potential aseasonal reproduction found in the Soviet catch data, we suggest that if there is a northern IO subspecies (B. m. indica), it is likely this population. Moreover, the potentially restricted range, intensive historic whaling, and the fact that the song-type has been previously undetected, suggests a small population that is in critical need of status assessment and conservation action.

British Association of Critical Care Nurses: Evidence-based consensus paper for oral care within adult critical care units

BACKGROUND

Patients who are critically ill are at increased risk of hospital acquired pneumonia and ventilator associated pneumonia. Effective evidence based oral care may reduce the incidence of such iatrogenic infection.

AIM

To provide an evidence-based British Association of Critical Care Nurses endorsed consensus paper for best practice relating to implementing oral care, with the intention of promoting patient comfort and reducing hospital acquired pneumonia and ventilator associated pneumonia in critically ill patients.

DESIGN

A nominal group technique was adopted. A consensus committee of adult critical care nursing experts from the United Kingdom met in 2018 to evaluate and review the literature relating to oral care, its application in reducing pneumonia in critically ill adults and to make recommendations for practice. An elected national board member for the British Association of Critical Care Nurses chaired the round table discussion.

METHODS

The committee focused on 5 aspects of oral care practice relating to critically ill adult patients. The evidence was evaluated for each practice within the context of reducing pneumonia in the mechanically ventilated patient or pneumonia in the non-ventilated patient. The five practices included the frequency for oral care; tools for oral care; oral care technique; solutions used and oral care in the non-ventilated patient who is critically ill and is at risk of aspiration. The group searched the best available evidence and evaluated this using the Grading of Recommendations Assessment, Development, and Evaluation system to assess the quality of evidence from high to very low, and to formulate recommendations as strong, moderate, weak, or best practice consensus statement when applicable.

RESULTS

The consensus group generated recommendations, delineating an approach to best practice for oral care in critically ill adult patients. Recommendations included guidance for frequency and procedure for oral assessment, toothbrushing, and moisturising the mouth. Evidence on the use of chlorhexidine is not consistent and caution is advised with its routine use.

CONCLUSION

Oral care is an important part of the care of critically ill patients, both ventilated and non-ventilated. An effective oral care programme reduces the incidence of pneumonia and promotes patient comfort.

RELEVANCE TO CLINICAL PRACTICE

Effective oral care is integral to safe patient care in critical care.

Association between continuity and access in primary care: a retrospective cohort study

BACKGROUND

Continuity of care is a tenet of primary care. Our objective was to explore the relation between a change in access to a primary care physician and continuity of care.

METHODS

We conducted a retrospective cohort study among physicians in a primary care network in southwest Alberta who measured access consistently between 2009 and 2016. We used time to the third next available appointment as a measure of access to physicians. We calculated the provider and clinic continuity, discontinuity and emergency department use based on the physicians' own panels. Physicians who improved, worsened or maintained their level of access within a given year were assessed in multilevel models to determine the association with continuity of care at the physician and clinic levels and the emergency department.

RESULTS

We analyzed data from 190 primary care physicians. Physicians with improved access increased provider continuity by 6.8% per year, reduced discontinuity by 2.1% per year, and decreased emergency department encounters by 78 visits per 1000 patients per year compared to physicians with stable access. Physicians with worsening access had a 6.2% decrease in provider continuity and an increased number of emergency department encounters (64 visits per 1000 panelled patients per year) compared to physicians with stable access.

INTERPRETATION

Changes in access to primary care can affect whether patients seek care from their own physician, from another clinic or at the emergency department. Improving access by reducing the delay in obtaining an appointment with one's primary care physician may be one mechanism to improve continuity of care.

Additional cost in personal protective equipment to NHS services during COVID-19: a review of the expense incurred by Aneurin Bevan Healthboards Maxillofacial unit over a one-year period to meet current clinical guidelines

COVID-19 has led to increased levels of personal protective equipment (PPE) in surgical specialties. Aneurin Bevan Healthboard Oral and Maxillofacial unit sees approximately 2,808 patients per annum and to meet current guidelines this added PPE is estimated to cost an extra £32,292. Whilst this helps improve safety for clinicians and patients, we also recommend that evidence is regularly reviewed to assess what PPE is justified at different stages of viral prevalence.

SAT0633-HPR AN EXPLORATION INTO THE CONVERSATIONS AROUND SEXUAL FUNCTIONING THAT MALES WITH SJÖGREN’S SYNDROME HAVE ON AN INTERNET FORUM

Background:

Sjögren’s Syndrome (SS) is an autoimmune rheumatic disease that targets secretion glands throughout the body, causing symptoms of oral, ocular and genital dryness (van de Merwe, 2010). A small body of literature has investigated the impact of SS on women’s sexual functioning, however, no research currently exists that has explored this topic in males with SS. Gathering a snapshot of issues may prove difficult given the sensitivity of the topic. Therefore, data must be gathered from sources where individuals may have the confidence to talk openly. Research has shown that many patient groups turn to internet forums to discuss sensitive issues under the cloak of anonymity (White & Dorman, 2001). Analysing this source of data allows us to explore the conversations pertaining to sexual functioning that males with SS may not feel comfortable discussing in a traditional qualitative setting, and may be instrumental in guiding future intervention strategies.

Objectives:

To explore the conversations around sexual functioning that male users with SS have on an internet forum.

Methods:

A large publicly accessible internet forum that individuals with a diagnosis of SS used to discuss issues and share experiences with other users was selected. Thread names and post content were scraped using a web scraping tool, and posts identified as containing relevant keywords were exported into Excel. Braun & Clarke’s (2006) thematic analysis was used to analyse post content.

Results:

A total of 78 posts were identified as being pertinent to the topic of male sexual functioning. Conversations were predominately centred on symptom presence in the reproductive organs. Forum users discussed having fluctuating pain in the testicles, scrotum, groin, anus, and rectum. They also reported experiencing feelings of dryness at the base of the penis, around the testicles, under the foreskin, around the glans of the penis and in the anus. Discussions were also had about changes in the volume and consistency of seminal fluid released either prior to or during ejaculation. Another conversation theme revolved around how the symptoms they experienced affected their ability to engage in sexual intercourse. Forum users discussed how pain and dryness made sexual intercourse painful, resulting in them withdrawing from sexual activity indefinitely. Discussions were also had about the lack of information available to help understand and manage sexual dysfunction. Forum users discussed how feelings of embarrassment about the nature of the symptoms and the stigma of it being “a woman’s disease” kept them from seeking medical assistance. Those who had sought medical assistance shared their belief that health professionals (HPs) were misdiagnosing their symptoms and were prescribing ineffective treatments. They also reported that their HPs were dismissive of symptoms and unwilling to assist further.

Conclusion:

Utilising conversations from an internet forum was an effective method to use to gain insight into some of the issues that males with SS experience with sexual functioning. The absence of accessible information and lack of support from HPs for males with SS is hinted at in this research. Future research should focus on identifying issues surrounding male sexual functioning as this will both guide future intervention strategies and allow HPs to publish material to better support males with SS.

References:

[1]Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology.Qualitative Research in Psychology, 3(2), 77-101.

[2]van de Merwe, J. P. (2010).Sjögren’s Syndrome: Information for patients and professionals.Rotterdam: Erasmus MC.

[3]White, M., & Dorman, S. M. (2001). Receiving social support online: Implications for health education.Health Education Research, 16(6), 693-707.

Disclosure of Interests:

None declared

How management of grief associated with ending the life of an animal is taught to Australasian veterinary students

OBJECTIVE

Veterinarians have an important role in supporting and understanding their clients' grief. Veterinary schools have a duty to teach students how best to manage grief - both that of the students/future veterinarians and the clients. This study explores how grief management, associated with ending the life of an animal, was taught to students in eight Australasian veterinary schools.

METHODS

A questionnaire-style interview guide was used by a representative at each university to conduct structured interviews with educators in a snowball sampling approach. Educators were interviewed about the teaching of grief management for four categories of animals: livestock, equine, companion and avian/wildlife. The terms used by participants to describe what they taught were grouped into common themes. Teaching was defined by individual participants and included structured and unstructured approaches. The stage in the degree (preclinical or clinical years) that grief management was taught in the veterinary curriculum and by whom (e.g. clinicians or psychologists) is also described.

RESULTS

Grief management was taught more in preclinical than clinical years. However, due to how grief was characterised, much of this teaching was general 'nonspecific' teaching that included all categories of animals. Client grief was taught more generically, whereas, grief of veterinarians was taught using specific examples given by clinicians.

CONCLUSION

A more robust end-of-life (EoL) management curriculum that includes all aspects of grief management is likely to increase job satisfaction, client happiness and professional satisfaction.

Identifying animal welfare impacts of livestock air transport

Air transport of livestock occurs frequently from most Australian major cities. The total journey time starts with road transport from the farm or pre-export facility to the departing airport where livestock are crated, and ends with the unloading of animals at the premises or farm in the importing country. We reviewed the literature regarding airfreight and conclude that there was minimal information on current practices within this industry, particularly for procedures after arrival at the Australian airport, and during the on-board phase.

Investigation of wearable health tracker version updates

Background

Wearable fitness trackers are increasingly used in healthcare applications; however, the frequent updating of these devices is at odds with traditional medical device practices.

Objective

Our objective was to explore the nature and frequency of wearable tracker updates recorded in device changelogs, to reveal the chronology of updates and to estimate the intervals where algorithm updates could impact device validations.

Method

Updates for devices meeting selection criteria (that included their use in clinical trials) were independently labelled by four researchers according to simple function and specificity schema.

Results

Device manufacturers have diverse approaches to update reporting and changelog practice. Visual representations of device changelogs reveal the nature and chronology of device iterations. 13% of update items were unspecified and 32% possibly affected validations with as few as 5 days between updates that may affect validation.

Conclusion

Manufacturers could aid researchers and health professionals by providing more informative device update changelogs.

Killer whale genomes reveal a complex history of recurrent admixture and vicariance

Reconstruction of the demographic and evolutionary history of populations assuming a consensus tree-like relationship can mask more complex scenarios, which are prevalent in nature. An emerging genomic toolset, which has been most comprehensively harnessed in the reconstruction of human evolutionary history, enables molecular ecologists to elucidate complex population histories. Killer whales have limited extrinsic barriers to dispersal and have radiated globally, and are therefore a good candidate model for the application of such tools. Here, we analyse a global data set of killer whale genomes in a rare attempt to elucidate global population structure in a nonhuman species. We identify a pattern of genetic homogenisation at lower latitudes and the greatest differentiation at high latitudes, even between currently sympatric lineages. The processes underlying the major axis of structure include high drift at the edge of species' range, likely associated with founder effects and allelic surfing during postglacial range expansion. Divergence between Antarctic and non-Antarctic lineages is further driven by ancestry segments with up to four-fold older coalescence time than the genome-wide average; relicts of a previous vicariance during an earlier glacial cycle. Our study further underpins that episodic gene flow is ubiquitous in natural populations, and can occur across great distances and after substantial periods of isolation between populations. Thus, understanding the evolutionary history of a species requires comprehensive geographic sampling and genome-wide data to sample the variation in ancestry within individuals.

Culturally transmitted song exchange between humpback whales (Megaptera novaeangliae) in the southeast Atlantic and southwest Indian Ocean basins

In migratory marine species, investigating population connectivity and structure can be challenging given barriers to dispersal are less evident and multiple factors may influence individual movement patterns. Male humpback whales sing a song display that can provide insights into contemporary connectivity patterns, as there can be a cultural exchange of a single, population-wide shared song type with neighbouring populations in acoustic contact. Here, we investigated song exchange between populations located on the east and west coasts of Africa using 5 years of concurrent data (2001-2005). Songs were qualitatively and quantitatively transcribed by measuring acoustic features of all song units and then compared using both Dice's similarity index and the Levenshtein distance similarity index (LSI) to quantitatively calculate song similarity. Song similarity varied among individuals and potentially between populations depending on the year (Dice: 36-100%, LSI: 21-100%), suggesting varying levels of population connectivity and/or interchange among years. The high degree of song sharing indicated in this study further supports genetic studies that demonstrate interchange between these two populations and reinforces the emerging picture of broad-scale connectivity in Southern Hemisphere populations. Further research incorporating additional populations and years would be invaluable for better understanding of fine-scale, song interchange patterns between Southern Hemisphere male humpback whales.

Assessing and mitigating post-operative castration pain in Bos indicus cattle

Cattle on pastoral land are subject to potentially painful husbandry procedures. In northern Australia, these practices generally occur once a year after the muster and the procedures are usually performed on animals older than 6 months of age. It is seldom that any pain mitigating medications are administered at this time and there is increasing concern that this perceived impost on the animal’s welfare will become more significant at both an economic and cultural level. There is a need to investigate the possibility of using simple, cost-effective, readily available medications, administered using relatively quick and easily taught techniques to increase the chance of industry adoption. This research used castration of 6–8-month-old Bos indicus calves as the test model because it is arguably one of the most common and most painful procedures endured by the animals. Forty-eight, 6–8-month-old Brahman bulls were surgically castrated after random assignment to six different treatment groups (n = 8): no castration Control (NC); castration (C); castration with post-operative meloxicam (CMpost-op); castration with lignocaine (CL); castration with lignocaine and post-operative meloxicam (CLMpost-op); castration with pre-operative meloxicam (CMpre-op). Serial measures of weight, blood cortisol concentrations, balk score, crush score, and daily activity (steps taken, number and duration of rest bouts) were taken. Linear mixed modelling was used to compare experimental groups. Bulls that were castrated and did not receive post-operative meloxicam (C and CL) had significantly lower average weights at all time points (Days 0–13, P < 0.001) of 170.9 kg and 168.6 kg, respectively, than those that did (CMpost-op and CLMpost-op) at 174.7 kg and 173.7 kg, respectively. When lignocaine was not administered before castration, Day 1 post-operative cortisol concentrations were significantly lower when post-operative meloxicam was provided than when it was not (CMpost-op: 47.2 nmol/L vs C: 65.5 nmol/L). When post-operative meloxicam was not given, animals that were given lignocaine before castration had significantly lower cortisol concentrations than those that received no lignocaine (CL: 52.7 nmol/L vs C: 65.5 nmol/L). Animals that were given pre-operative meloxicam had, on average, significantly lower Day 1 post-operative cortisol concentrations than animals that received no lignocaine or meloxicam (CMpre-op: 44.8 nmol/L vs C: 65.5 nmol/L). Analysis of Day 1 (the day following castration) data showed that animals that were given pre-operative meloxicam (CMpre-op) were significantly more active than animals in all other treatment groups (P = 0.038). It was concluded that 6–8-month old, Bos indicus bulls benefit from the administration of both lignocaine before surgery and peri-operative meloxicam. The analgesic methods used are readily adoptable by industry with respect to cost, efficiency and degree of technical skill required.

Students' opinions on welfare and ethics issues for companion animals in Australian and New Zealand veterinary schools

OBJECTIVE

To determine what veterinary students in Australia and New Zealand consider important competences in companion animal welfare and ethics (AWE) required on their first day of practice, and to explore how their priorities relate to gender and stage of study.

METHODS

Undergraduate students at all veterinary schools in Australia and New Zealand were sent an online survey. A subset of questions required participants to rank the importance of preselected AWE topics pertaining to companion animals. Data were analysed to determine differences in the way students of different gender or academic stage prioritised each of these AWE topics.

RESULTS

Of 3220 currently enrolled students, 851 participated in the survey: 79% were female, 17% male, 4% unspecified. Ranking of the AWE topics, from highest to lowest importance, was: neutering, companion animal husbandry, euthanasia, behaviour and training, animal breeding, over-servicing in relation to animal needs and cosmetic surgery. Female students consistently ranked competency in AWE issues surrounding neutering more highly than male students (P = 0.006). Students in senior years of study ranked the importance of competency in animal abuse/hoarding (P = 0.048), shelter medicine (P = 0.012) and animal breeding (P = 0.002) less highly than those in junior years.

CONCLUSIONS

Australasian veterinary students placed more importance on competency in AWE issues associated with clinical practice (such as neutering and euthanasia) than on professional behaviours (such as over-servicing and animal breeding). However, we consider that emphasis should still be placed on developing graduate competency in the latter categories to reflect growing societal concerns about companion animal over-supply and inappropriate professional conduct.

Predicting QRS and PR interval prolongations in humans using nonclinical data

BACKGROUND AND PURPOSE

Risk of cardiac conduction slowing (QRS/PR prolongations) is assessed prior to clinical trials using in vitro and in vivo studies. Understanding the quantitative translation of these studies to the clinical situation enables improved risk assessment in the nonclinical phase.

EXPERIMENTAL APPROACH

Four compounds that prolong QRS and/or PR (AZD1305, flecainide, quinidine and verapamil) were characterized using in vitro (sodium/calcium channels), in vivo (guinea pigs/dogs) and clinical data. Concentration-matched translational relationships were developed based on in vitro and in vivo modelling, and the in vitro to clinical translation of AZD1305 was quantified using an in vitro model.

KEY RESULTS

Meaningful (10%) human QRS/PR effects correlated with low levels of in vitro Na_v 1.5 block (3-7%) and Ca_v 1.2 binding (13-21%) for all compounds. The in vitro model developed using AZD1305 successfully predicted QRS/PR effects for the remaining drugs. Meaningful QRS/PR changes in humans correlated with small effects in guinea pigs and dogs (QRS 2.3-4.6% and PR 2.3-10%), suggesting that worst-case human effects can be predicted by assuming four times greater effects at the same concentration from dog/guinea pig data.

CONCLUSION AND IMPLICATIONS

Small changes in vitro and in vivo consistently translated to meaningful PR/QRS changes in humans across compounds. Assuming broad applicability of these approaches to assess cardiovascular safety risk for non-arrhythmic drugs, this study provides a means of predicting human QRS/PR effects of new drugs from effects observed in nonclinical studies.