Cannabidiol Exposure During the Mouse Adolescent Period Is Without Harmful Behavioral Effects on Locomotor Activity, Anxiety, and Spatial Memory

Cannabidiol (CBD) is a non-intoxicating phytocannabinoid whose purported therapeutic benefits and impression of a high safety profile has promoted its increasing popularity. CBD’s popularity is also increasing among children and adolescents who are being administered CBD, off label, for the treatment of numerous symptoms associated with autism spectrum disorder, attention deficit hyperactivity disorder, anxiety, and depression. The relative recency of its use in the adolescent population has precluded investigation of its impact on the developing brain and the potential consequences that may present in adulthood. Therefore, there’s an urgency to identify whether prolonged adolescent CBD exposure has substantive impacts on the developing brain that impact behavioral and cognitive processes in adulthood. Here, we tested the effect of twice-daily intraperitoneal administrations of CBD (20 mg/kg) in male and female C57BL/6J mice during the adolescent period of 25–45 days on weight gain, and assays for locomotor behavior, anxiety, and spatial memory. Prolonged adolescent CBD exposure had no detrimental effects on locomotor activity in the open field, anxiety behavior on the elevated plus maze, or spatial memory in the Barnes Maze compared to vehicle-treated mice. Interestingly, CBD-treated mice had a faster rate of learning in the Barnes Maze. However, CBD-treated females had reduced weight gain during the exposure period. We conclude that prolonged adolescent CBD exposure in mice does not have substantive negative impacts on a range of behaviors in adulthood, may improve the rate of learning under certain conditions, and impacts weight gain in a sex-specific manner.

Relationship of Multiplex Molecular Pneumonia Panel Results With Hospital Outcomes and Clinical Variables

Background

Antibiotic treatment decisions in severely ill patients must often be made in the absence of microbiologic results. The recently Food and Drug Administration-cleared BioFire FilmArray Pneumonia Panel (PN) detects 15 bacteria semiquantitatively, 3 atypical pneumonia bacteria, 8 viruses, and 7 antimicrobial resistance markers by multiplex PCR in ~1 hour in the laboratory. Previous reports have shown that the PN Panel bacterial detections are highly accurate, even when routine culture had no growth.

Methods

Consecutive bronchoalveolar lavage and endotracheal specimens submitted for culture between June and September 2018 from 270 patients with sufficient clinical and laboratory data were tested with the PN Panel. Patients were divided into 3 groups: (1) both culture and PN Panel positive, (2) PN Panel positive but culture uninformative (no growth or normal flora), and (3) patients with no PN Panel detections.

Results

Groups 1 and 2 had significantly higher maximum temperatures on the day of culture (P = .00036, analysis of variance [ANOVA] with Bonferroni correction), higher levels of an inflammatory response as measured by percent polymorphonuclear leukocytes in bronchoalveolar lavage (P = .00025, ANOVA with Bonferroni correction), and gram stain report of white blood cells, as previously reported [1].

Conclusions

Both group 1 (culture and PN Panel positive), and group 2 (PN Panel positive but culture uninformative) had higher levels of host response inflammatory responses compared with group 3, which had no targets detected, suggesting that PN Panel detections need to be interpreted in the clinical context, even if cultures are discordant. Depending on laboratory turnaround time, there could be opportunities for improved diagnosis and antibiotic stewardship.

Should cardiac rehabilitation programmes be specifically targeting sedentary time?

Funding Acknowledgements

Type of funding sources: None.

Background / Introduction

Structured exercise classes and advice regarding regular moderate intensity physical activity are well-established components of cardiac rehabilitation (CR). Sedentary behaviour, refers to activities typically sitting or lying that do not substantially increase energy expenditure above resting, and increasing evidence suggests adults should limit their sedentary time to less than 9 hours/day as such behaviour with increased cardiovascular and all-cause mortality with additional benefits likely gained sitting less than 6-8 hours/day. Nonetheless sedentary behaviours are often overlooked or are only partially assessed via self-report in CR programmes. Due to covid restrictions (lockdown, social distancing, suspension of face-to-face CR programmes) there is concern that sedentary time may further increase in this population. Thus, it may be important to effectively monitor and target sedentary time, alongside traditional advice, to minimise its negative health impacts.

Purpose

Can a CR programme, adapted to remote delivery due to covid, objectively measure sedentary behaviour in a way that is feasible in every day practice and acceptable to patients?

Methods

Consecutive cardiovascular patients attending an initial assessment (via telephone or video) on the Our Hearts Our Minds Programme for Cardiovascular Health between December 2020 and February 2021 were asked to wear activPAL (PAL technologies Ltd., Glasgow, UK), a triaxial accelerometer, on their thigh for 7 days to measure the postural aspect of sedentary behaviour. On return of the monitor, the data was analysed using proprietary algorithms (intelligent activity classification) generating a report summarising time spent sitting, prolonged sitting, step count average, number of sit to stand transitions, moderate intensity activity minutes, most sedentary time(s) of the day and percentages spent in these activities. This personalised report was shared with the patient and their goals in terms of sedentary behaviour and physical activity were discussed and agreed.

Results

59 referrals were received between mid December 2020 and February 2021, of which 52 had an initial virtual assessment. Of these, 50 patients accepted an activPAL (96% response rate). Mean age 62.6 years. The output from the activPal is shown in table 1. The average sitting time overall was 9 hours 36 minutes. The breakdown in proportions sitting for extended periods of time are detailed in table below

Conclusion

2/3 of cardiovascular patients attending CR had levels of sitting time greater than what is recommended following their IA. Measuring sedentary time beyond self-report in CR programmes using activPal was feasible in a CR programme with 96% of consecutive patients wearing and returning activPAL.  Repeat analysis at end of programme will show if use of this data results in reduction of same .

Referral Linkage to Preexposure Prophylaxis Care and Persistence on Preexposure Prophylaxis in an Integrated Health Care System

BACKGROUND

Successful linkage to preexposure prophylaxis (PrEP) and retention in care are important for HIV prevention. We examined gaps in PrEP care following referral and factors associated with PrEP linkage and persistence in an integrated health care system in the United States.

METHODS

We identified individuals referred for PrEP from 2014 to 2017 at the Kaiser Permanente Southern California using electronic health records and assessed linkage to care, PrEP prescription orders and fills, and PrEP persistence (medication possession ratio ≥80%) in the year after the first fill. We evaluated demographic and clinical factors potentially associated with PrEP linkage and persistence using a series of multivariable modified Poisson regression models.

RESULTS

Of 2995 referred individuals, 74.9% were linked to PrEP care. Nearly all those linked to care were prescribed PrEP and filled a prescription, but only 47.4% of those who filled a prescription were persistent on PrEP. Individuals aged <25 years (vs ≥25 years), female subjects (vs males), and individuals with high-deductible insurance (vs no high deductible) were less likely to be linked to care. Individuals aged <25 years and Hispanics (vs non-Hispanic whites) were less likely to be persistent. Those with alcohol use disorder were more likely to be linked to PrEP care but less likely to be persistent. New HIV diagnoses occurred in 38 individuals, and only 1 had PrEP in possession at diagnosis.

CONCLUSIONS

We observed PrEP care gaps and disparities among individuals referred for PrEP. Patient-centered interventions are needed in primary care to address barriers to successful PrEP linkage and persistence.

173 Early Results of a Variable-Angle Volar Locking Plate for Distal Radius Fractures: A Bi-Centre Study

Introduction

This study examines the clinical, functional and radiological outcomes of distal radius fracture fixation with the Aptus® (Medartis, Pennsylvania) locking plate in order to determine its efficacy and to identify notable findings related to treatment variations.

Method

This is a retrospective bi-centre study collecting patient details from a District General Hospital and a Regional Hand Unit. We assessed 61 consecutive patients with distal radius fractures (AO grade A = 19, B = 9, C = 33) fixed using Aptus® plate with a minimum of six months follow-up. Outcome measures included the DASH score, wrist range of movement and grip strength, and complications. Radiographs were reviewed to assess restoration of anatomy and union.

Results

All but two fractures united within six weeks. Mean ranges of movement were only mildly restricted compared to the normal wrist (flexion/extension = 102°; radial/ulna deviation = 53°; pronation/supination = 169°). Mean postoperative grip strength was 23.8kg which was comparable to the contralateral side at 31.5kg. The mean DASH score was 18.2. Seven patients had screws misplaced outside the distal radius although three of these remained asymptomatic.

Conclusions

Variable-angle locking systems benefit from flexibility of implant positioning and may allow enhanced inter-fragmentary reduction for accurate fixation of intra-articular fractures.

855 Patient Specific Digital Modelling And 3D Printing of Abdominal Anatomy- The Next Frontier in Surgical Simulation?

Introduction

Innovations in digital technologies afford new opportunities in surgical education.

We describe a novel method of combining medical imaging data with virtual 3D modelling and printing techniques that could facilitate patient specific pre-operative planning and rehearsal.

Method

A series of silicone castings was produced to simulate upper abdominal viscera using a novel polyvinyl alcohol (PVA) injection moulding method. Digital models were generated by segmenting CT dual phase imaging in ITK-SNAP. A 3D polygon mesh was exported and optimised in the computer graphics software: Blender. Two 3D printers were used to manufacture a dissolvable mould of the digital models. Moulds were injected with coloured silicones and dissolved in water to reveal the multicolour/multi-material models.

Results

The silicone models retained the anatomical detail of the digitally segmented CT data sets. The multi-colour models were achieved with a single print and at very low cost (approx. £248/ model) and possessed varying shore hardness between viscera recreating lifelike fidelity.

Conclusions

The hybrid 3D printing/injection moulding method offers an avenue to realistic surgical and anatomical simulation. A combination of both virtual models and 3D physical models may provide an enhanced surgical experience for preoperative and intraoperative planning allowing patient specific rehearsal.

134 A Quality Improvement Project—Physiotherapy Caseload Management on the Older Person’s Unit

Introduction

Complex health issues, co-morbidities and the number of patients living with frailty are critical concerns associated with the ageing population (Kojima et al, 2019). In this wider context, there is an emphasis on targeting resources efficaciously within the NHS. A consequence of capacity constraints, inpatient physiotherapy teams across the OPU at a large urban teaching hospital, prioritise their patient caseload, but lack evidence-based guidance on dosage and frequency of physiotherapy intervention, to inform the process. The aim of the quality improvement project was to design and deliver a staff education and training package to facilitate implementation of a newly-developed, evidence-based prioritisation resource.

Method

Plan-Do-Study-Act cycles and the Com-B model to influence behaviour changes were employed between October 2019 and March 2020. Stakeholders were engaged throughout the design process. Training to all 11 physiotherapists consisted of familiarisation with the resource through content discussion and “mock-use” training sessions to ensure intra/inter-rater-reliabilty. Physiotherapist staff knowledge and confidence of prioritisation was evaluated by questionnaire. Accuracy of use of the prioritisation tool was determined by comparison of staff prioritisation decision with expert opinion.

Results

From the 11 questionnaire responses, pre to post intervention physiotherapy knowledge of the prioritisation categories increased (43% to 100%), physiotherapist rated confidence using the prioritisation tool increased (mean score, 6.9 to 8.2/10) and accuracy of prioritisation of patients improved (mean 42.1% to 92.3%).

Conclusion

The education and training package developed to support implementation of the prioritisation tool resulted in improved staff knowledge and confidence of patient prioritisation and increased the accuracy of OPU physiotherapy targeting. This project has highlighted the importance of staff training in resource allocation to ensure that decisions regarding which patients receive physiotherapy intervention are efficacious. This has increased relevance in a department with a large number of rotational staff.

132 Physical Function Comparison of Acutely Unwell COVID-Negative Older Adults Pre-Pandemic and Through-Pandemic; “Covid-Protected”

Introduction

The risk of severe morbidity after COVID-19 infection is high in older adults (Lithander et al, 2020). Subsequent responsive UK Government guidance for older adults included self-isolation during the pandemic. It is therefore hypothesised that during the pandemic older adults are inadvertently deconditioned due to iatrogenic factors such as inactivity, social isolation, hospital-avoidance and malnutrition, and present with reduced resilience to illness and lower levels of function. The OPU continued to admit COVID-negative, or recently termed “COVID-protected”, patients throughout the pandemic. Data captured prior to, and during the COVID-19 pandemic has been compared to explore the implications on older adults, and elicit whether they are protected from the consequences of the pandemic?

Method

Demographic and physical function data (average 6 m gait-speed, Elderly Mobility Scale) were captured pre- and through-pandemic for all patients admitted to a COVID-negative OPU ward over a one month period. Ethical review was provided through local Trust governance process.

Results

Pre-pandemic 2019 (n = 67, mean(±SD) age 82.7(±8.2) years, 61%, hospital length-of-stay (LOS) 7.9(±7.3) days, hospital mortality-rate 7.2%) and through-pandemic 2020 (n = 73, 83.1(±8.3) years, 59%♀, LOS 9.0(±9.1) days, hospital mortality-rate 7.5%) data were captured during July 2019 and May 2020 respectively. There were no between-group differences in age [t(−.313) = 138, p = 0.755], gender [X², 1 df, p = 0.782], LOS [t(0.78) = 134, p = 0.44], or hospital mortality-rate [X² 1 df, p = 0.96]. Through-pandemic patients had a significantly slower 6 m gait-speed (0.11(±0.05) m.s-1) than pre-pandemic (0.16(±0.24) m.s-1); [t(2.74) = 93, p = 0.007] and lower median (IQR) Elderly Mobility Scale (4(6 IQR) vs 9 (12 IQR) [u = 866, p = 0.015]).

Conclusion

Our data indicates this relatively short period of self-isolation might have significant implications on the physical function of older adults. The likely mechanism is iatrogenic deconditioning. Critical Public Health and policy responses are required to mitigate these unforeseen risks by deploying prehabilitative counter-measures and accurately targeted hospital and community rehabilitation.

A109 LINKING PRIMARY AND SPECIALTY CARE FOR THE MANAGEMENT OF DIGESTIVE HEALTH CONDITIONS: AN EVALUATION OF GUT LINK IMPLEMENTATION

Background

Severe restrictions on in-person encounters and endoscopic procedures for digestive care have occurred as a result of the COVID-19 pandemic. This has exacerbated pre-existing barriers in access to gastroenterology (GI) care across Nova Scotia (NS) for patients and primary healthcare providers (PHCPs). In response, a provincial PHCP-GI consultative service (GUT LINK) was implemented at a single tertiary care center with the goal of supporting PHCPs in the management of non-urgent GI referral conditions.

Aims

To implement and evaluate the acceptability, feasibility, appropriateness, and early effectiveness of the GUT LINK PHCP-GI consultation service.

Methods

This is an ongoing prospective observational cohort study. All referrals received through the EMR-based referral and triage management system between May and November 2020 that were deemed to be amenable to management within primary care with specialist support were returned to the PHCP with the suggestion to arrange a GUT LINK telephone consultation. GUT LINK appointments were scheduled through an administrative support telephone line with the PHCP and a GI specialist. A post-consultation e-questionnaire was distributed to PHCPs who consented to participate. Feasibility (number of and indication for referrals, PHCP participation rates), acceptability and appropriateness (satisfaction, future use, likelihood to recommend) metrics and outcomes (case resolution, re-referrals, proportion requiring endoscopic investigations) were recorded. Patient charts were reviewed to determine whether the patient ultimately required GI speciality care. Analyses were descriptive and expressed as frequencies, means (+/-SD), medians (+/-SE), and proportions (%).

Results

A total of 45 GUT LINK consultations were completed between May and November 2020. Of these, 20% required GI specialist care and 80% have remained within primary care, with a median follow-up of 101 (+/-9.1) days. The indications for GUT LINK consultation included lower GI symptoms (64%), abnormal imaging or investigations (17%), and upper GI symptoms (19%).

To date, 21 PHCP agreed to be contacted for the post-consultation survey and 10 have been completed. All PHCPs reported that GUT LINK consultation was easy to access, while 90% found the advice helpful and 80% reported that that it resolved the issue. Following the GUT LINK appointment, 80% felt they would not need to refer their patient to GI.

Conclusions

The implementation of GUT LINK was acceptable, feasible, and improved access to specialist support for management of undifferentiated GI symptoms. Future research will focus on comprehensive stakeholder engagement in order to design, implement, and evaluate GUT LINK PHCP care pathways.

Funding Agencies

CAG

A85 THE CLINICAL IMPACT OF COVID-19 DELAYS ON PLASTIC BILIARY STENT REMOVAL IN NOVA SCOTIA

Background

The COVID-2019 pandemic continues to restrict access to endoscopy, resulting in delays or cancellation of non-urgent endoscopic procedures. A delay in the removal or exchange of plastic biliary stents may lead to stent occlusion with consensus recommendation of stent removal or exchange at three-month intervals [1–4]. We postulated that delayed plastic biliary stent removal (DPBSR) would increase complication rates.

Aims

We aim to report our single-centre experience with complications arising from DPBSR.

Methods

This was a retrospective, single-center, observational cohort study. All subjects who had ERCP-guided plastic biliary stent placement in Halifax, Nova Scotia between Dec 2019 and June 2020 were included in the study. DPBSR was defined as stent removal &gt;=90 days from insertion. Four endpoints were assigned to patients: 1. Stent removed endoscopically, 2. Died with stent in-situ (measured from stent placement to documented date of death/last clinical encounter before death), 3. Pending removal (subjects clinically well, no liver enzyme elevation, not expired, endpoint 1 Nov 2020), and 4. Complication requiring urgent reintervention. Kaplan-Meier survival analysis was used to represent duration of stent patency (Fig.1).

Results

102 (47.2%) had plastic biliary stents placed between 2/12/2019 and 29/6/2020. 49 (48%) were female, and the median age was 68 (R 16–91). Median follow-up was 167.5 days, 60 (58.8%) subjects had stent removal, 12 (11.8%) died before replacement, 21 (20.6%) were awaiting stent removal with no complications (median 230d, R 30–332), 9 (8.8%) had complications requiring urgent ERCP. Based on death reports, no deaths were related to stent-related complications.

72(70.6%) of patients had stents in-situ for &gt;= 90 days. In this population, median time to removal was 211.5d (R 91-441d). 3 (4.2%) subjects had stent-related complications requiring urgent ERCP, mean time to complication was 218.3d (R 94–441). Stent removal &gt;=90 days was not associated with complications such as occlusion, cholangitis, and migration (p=1.0). Days of stent in-situ was not associated with occlusion, cholangitis, and migration (p=0.57). Sex (p=0.275), cholecystectomy (p=1.0), cholangiocarcinoma (p=1.0), cholangitis (p=0.68) or pancreatitis (p=1.0) six weeks prior to ERCP, benign vs. malignant etiology (p=1.0) were not significantly associated with stent-related complications.

Conclusions

Plastic biliary stent longevity may have been previously underestimated. The findings of this study agree with CAG framework recommendations [5] that stent removal be prioritized as elective (P3). Limitations include small sample size that could affect Kaplan-Meier survival analysis. Despite prolonged indwelling stent time as a result of COVID-19, we did not observe an increased incidence of stent occlusion or other complications.

Funding Agencies

None

A112 THE IMPACT OF CENTRAL COORDINATION ON ENDOSCOPY EFFICIENCY

Background

The impacts of the COVID-19 pandemic have been far reaching and have necessitated many changes to healthcare delivery. At the QEII Health Sciences Center physical space limitations for patient check-in and recovery have restricted outpatient endoscopy to 3 of 4 available endoscopy suites. On June 1, 2020 a new system of central endoscopy triage and coordination for the Division of Digestive Care and Endoscopy (DC&E) was implemented in an effort to increase efficiency and maintain patient access to endoscopy. The components of the RESET (Re-introduce Endoscopy Safely and EfficienTly) Plan included a) a new endoscopy coordinator role to manage a common endoscopy waitlist, endoscopist schedules, and booking clerks, b) a modified triage system to improve waitlist consistency, c) a common endoscopy waitlist with patients booked in the next available appointment regardless of endoscopist, d) discontinuation of fixed endoscopy slots for endoscopists, and e) appointment scheduling no sooner than 4-weeks in advance to minimize no-shows and last-minute cancellations.

Aims

The aim of this study is to evaluate the impact of the RESET Plan on the efficiency of DC&E endoscopy.

Methods

A retrospective pre- and post-implementation study evaluating the volume and efficiency of outpatient endoscopy before and after implementation of the RESET Plan. The Pre-RESET period included all procedures performed from June 1, 2019 to October 31, 2019. The Post-RESET period included all procedures performed from June 1, 2020 to October 31, 2020. A separate endoscopy suite and triage system is used for endoscopic retrograde cholangiopancreatography (ERCP) and these cases were excluded. Early effectiveness outcomes were reported including a comparison of the number of endoscopic procedures per week and per list, pre- and post- implementation. Data analysis was primarily descriptive with data expressed as frequencies, means (SD), and proportions (%). Exploratory group comparisons were performed using independent-samples T-Test.

Results

During the 5-month Pre-RESET period, 2203 endoscopic procedures were performed. During the Post-RESET period a total of 1920 procedures were performed. Due to pandemic restrictions, there was a 29% decrease in available endoscopy lists from 2019 to 2020. There was a 24% increase in the number procedures performed per endoscopy list, from 6.4 to 8.0 (p=0.004, 95% CI 0.52–2.53), pre- and post-RESET.

Conclusions

While the COVID-19 pandemic has disrupted healthcare delivery, it has also provided an opportunity to implement health system structure and process changes. The RESET Plan resulted in significant gains in efficiency which largely offset losses in endoscopy throughput imposed by COVID-19 pandemic restrictions. Future research will determine what patient and health system factors most significantly impact system efficiency as well as the cost-effectiveness of the RESET Plan.

Funding Agencies

CAG

A107 IMPROVING ACCESS TO URGENT GASTROENTEROLOGICAL CONSULTATION: A POSITIVE PANDEMIC IMPACT

Background

The global COVID-19 pandemic has resulted in a dramatic re-alignment of clinical service delivery. In mid-March 2020 the Division of Digestive Care and Endoscopy at Dalhousie University leveraged eHealth technology to rapidly implemented a new referral management and triage system and established a new rapid outpatient consultation service to facilitate urgent virtual and face-to-face appointments. Standardized procedures for triaging, booking, and staffing the urgent gastroenterology consultation service were implemented.

Aims

The aim of this study was to evaluate the impact of the implementation of a standardized triage and consultation process on access to urgent gastroenterology consultative services at a single tertiary care center during the COVID-19 pandemic.

Methods

We performed a pre- and post-implementation study comparing efficiency metrics for urgent triage and urgent consultation. The pre-implementation cohort included all patients referred and triaged to an urgent clinic appointment between April 1, 2019 to September 30, 2019. The post-implementation cohort included all patients referred and triaged to an urgent clinic appointment between April 1, 2020 to September 30, 2020.

Healthcare efficiency data was extracted through electronic record review with specific dates and times for referral receipt (a), triage completion (b), appointment wait-listing (c), and clinic appointment (d). The time to triage (TT), time to visit (TV), and total time to consult (TC) were calculated (TT = c - a; TV = d - c; TC = TT + TV) for each patient. The Mann–Whitney U test was used to compare TT, TV, CT between patient cohorts.

Results

A total of 429 patients were booked for urgent clinic consultation, 176 during the pre-implementation period and 253 in the post-implementation period. The mean TT for the pre-and post-implementation cohorts was 4.8 days and 3.3 days, respectively (U=18,149, p=0.001). Mean TV was decreased from 16.2 days for the pre-implementation cohort to 3.6 days for the post-implementation cohort (U=6095, p=0.000). The mean time from a referral being received to the patient being seen in consultation (TC) decreased by 67% from 21 days to 6.9 days, Figure 1 (U=6,419, p=0.000).

Conclusions

The COVID-19 pandemic has had a dramatic impact on healthcare delivery in Nova Scotia. One positive result is that it facilitated the motivation and alignment needed to make a large health system change that may not have otherwise been possible. This study demonstrates that a standardized pathway for urgent outpatient gastroenterology assessment improves the timeliness of care delivery.

Funding Agencies

None

The effect of lifestyle and risk factor modification on occlusive peripheral arterial disease outcomes: standard healthcare vs structured programme-for a randomised controlled trial protocol

Background

Peripheral arterial disease (PAD) affects more than 200 million of the global population. PAD represents a marker for premature cardiovascular events. Patients with PAD, even in the absence of a history of myocardial infarction or ischemic stroke, have approximately the same relative risk of death from cardiovascular causes as patients with a history of coronary or cerebrovascular disease. Despite the high prevalence of PAD and the strong association with cardiovascular morbidity and mortality, patients with PAD are less likely to receive appropriate treatment for their atherosclerotic risk factors than those who are being treated for coronary artery disease.

Atherosclerotic risk factor identification and modification play an important role in reducing the number of adverse outcomes among patients with atherosclerosis. Risk reduction therapy decreases the risk of cardiovascular mortality and morbidity in patients with PAD. In this study, we aim to evaluate the effectiveness of a lifestyle and risk factor modification intervention programme in achieving treatment goals for PAD risk factors.

Methods

This is a randomised, parallel group, active-control trial to compare the effectiveness of the risk factor modification intervention programme to standard healthcare in a tertiary vascular care centre, in the reduction of modified risk factors in PAD patients. The primary outcome of this study is to evaluate the effectiveness of a lifestyle and risk factor modification intervention programme in achieving treatment goals for PAD risk factors at 3 and 12 months. The secondary outcomes are to compare the impact of the programme on clinical outcomes in PAD patients at 12 months. Secondary outcomes include amputation-free survival, clinical improvement, haemodynamic improvement, need for revascularisation procedures, outcomes of revascularisation procedures, changes in quality of life and the incidence of adverse events.

Discussion

This study will provide clear evidence on the effectiveness of a lifestyle and risk factor modification intervention programme in achieving treatment goals for PAD risk factors, through a high-quality, well-powered clinical trial.

Trial registration

This trial was registered (11/07/2017) on the European Clinical Trials Database (EudraCT number 2017-002964-41) and ClinicalTrials.gov (NCT03935776) which was registered on 02 May 2019.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-021-05087-x.

Susceptibility of widely diverse influenza a viruses to PB2 polymerase inhibitor pimodivir

Pimodivir exerts an antiviral effect on the early stages of influenza A virus replication by inhibiting the cap-binding function of polymerase basic protein 2 (PB2). In this study, we used a combination of sequence analysis and phenotypic methods to evaluate pimodivir susceptibility of influenza A viruses collected from humans and other hosts. Screening PB2 sequences for substitutions previously associated with reduced pimodivir susceptibility revealed a very low frequency among seasonal viruses circulating in the U.S. during 2015–2020 (<0.03%; 3/11,934) and among non-seasonal viruses collected in various countries during the same period (0.2%; 18/8971). Pimodivir potently inhibited virus replication in two assays, a single-cycle HINT and a multi-cycle FRA, with IC₅₀ values in a nanomolar range. Median IC₅₀ values determined by HINT were similar for both subtypes of seasonal viruses, A(H1N1)pdm09 and A(H3N2), across three seasons. Human seasonal viruses with PB2 substitutions S324C, S324R, or N510K displayed a 27–317-fold reduced pimodivir susceptibility by HINT. In addition, pimodivir was effective at inhibiting replication of a diverse group of animal-origin viruses that have pandemic potential, including avian viruses of A(H5N6) and A(H7N9) subtypes. A rare PB2 substitution H357N was identified in an A(H4N2) subtype poultry virus that displayed >100-fold reduced pimodivir susceptibility. Our findings demonstrate a broad inhibitory activity of pimodivir and expand the existing knowledge of amino acid substitutions that can reduce susceptibility to this investigational antiviral.

Evaluating very high energy electron RBE from nanodosimetric pBR322 plasmid DNA damage

This paper presents the first plasmid DNA irradiations carried out with Very High Energy Electrons (VHEE) over 100-200 MeV at the CLEAR user facility at CERN to determine the Relative Biological Effectiveness (RBE) of VHEE. DNA damage yields were measured in dry and aqueous environments to determine that ~ 99% of total DNA breaks were caused by indirect effects, consistent with other published measurements for protons and photons. Double-Strand Break (DSB) yield was used as the biological endpoint for RBE calculation, with values found to be consistent with established radiotherapy modalities. Similarities in physical damage between VHEE and conventional modalities gives confidence that biological effects of VHEE will also be similar-key for clinical implementation. Damage yields were used as a baseline for track structure simulations of VHEE plasmid irradiation using GEANT4-DNA. Current models for DSB yield have shown reasonable agreement with experimental values. The growing interest in FLASH radiotherapy motivated a study into DSB yield variation with dose rate following VHEE irradiation. No significant variations were observed between conventional and FLASH dose rate irradiations, indicating that no FLASH effect is seen under these conditions.

Mammalian pathogenicity and transmissibility of low pathogenic avian influenza H7N1 and H7N3 viruses isolated from North America in 2018

Low pathogenic avian influenza (LPAI) H7 subtype viruses are infrequently, but persistently, associated with outbreaks in poultry in North America. These LPAI outbreaks provide opportunities for the virus to develop enhanced virulence and transmissibility in mammals and have previously resulted in both occasional acquisition of a highly pathogenic avian influenza (HPAI) phenotype in birds and sporadic cases of human infection. Two notable LPAI H7 subtype viruses caused outbreaks in 2018 in North America: LPAI H7N1 virus in chickens and turkeys, representing the first confirmed H7N1 infection in poultry farms in the United States, and LPAI H7N3 virus in turkeys, a virus subtype often associated with LPAI-to-HPAI phenotypes. Here, we investigated the replication capacity of representative viruses from these outbreaks in human respiratory tract cells and mammalian pathogenicity and transmissibility in the mouse and ferret models. We found that the LPAI H7 viruses replicated to high titre in human cells, reaching mean peak titres generally comparable to HPAI H7 viruses. Replication was efficient in both mammalian species, causing mild infection, with virus primarily limited to respiratory tract tissues. The H7 viruses demonstrated a capacity to transmit to naïve ferrets in a direct contact setting. These data support the need to perform routine risk assessments of LPAI H7 subtype viruses, even in the absence of confirmed human infection.

A randomised controlled trial of energetic activity for depression in young people (READY): a multi-site feasibility trial protocol

BACKGROUND

Prevalence of depression is increasing in young people, and there is a need to develop and evaluate behavioural interventions which may provide benefits equal to or greater than talking therapies or pharmacological alternatives. Exercise could be beneficial for young people living with depression, but robust, large-scale trials of effectiveness and the impact of exercise intensity are lacking. This study aims to test whether a randomised controlled trial (RCT) of an intervention targeting young people living with depression is feasible by determining whether it is possible to recruit and retain young people, develop and deliver the intervention as planned, and evaluate training and delivery.

METHODS

The design is a three-arm cluster randomised controlled feasibility trial with embedded process evaluation. Participants will be help-seeking young people, aged 13-17 years experiencing mild to moderate low mood or depression, referred from three counties in England. The intervention will be delivered by registered exercise professionals, supported by mental health support workers, twice a week for 12 weeks. The three arms will be high-intensity exercise, low-intensity exercise, and a social activity control. All arms will receive a 'healthy living' behaviour change session prior to each exercise session and the two exercise groups are energy matched. The outcomes are referral, recruitment, and retention rates; attendance at exercise sessions; adherence to and ability to reach intensity during exercise sessions; proportions of missing data; adverse events, all measured at baseline, 3, and 6 months; resource use; and reach and representativeness.

DISCUSSION

UK National Health Service (NHS) policy is to provide young people with advice about using exercise to help depression but there is no evidence-based exercise intervention to either complement or as an alternative to medication or talking therapies. UK National Institute for Health and Care Excellence (NICE) guidelines suggest that exercise can be an effective treatment, but the evidence base is relatively weak. This feasibility trial will provide evidence about whether it is feasible to recruit and retain young people to a full RCT to assess the effectiveness and cost-effectiveness of an exercise intervention for depression.

TRIAL REGISTRATION

ISRCTN, ISRCTN66452702 . Registered 9 April 2020.

The use of Hereford sires over mature Angus dams can add value to Angus cattle herds

Context Overseas studies have quantified production differences of Hereford × Angus compared with purebred Angus for a range of traits including growth, carcass and reproductive traits. Aim This study aims to provide a comparison of Hereford × Angus and purebred Angus under modern grazing conditions in southern Australia. Methods Thirty Hereford and 22 Angus sires were mated to 1100 Angus cows and heifers in a large commercial herd run on pasture at Musselroe Bay, Tasmania. Approximately 1650 calves were born. Steers were grown on pasture for an average of 23 months and then slaughtered. Results Hereford sired calves were heavier at birth (+8.8%) and weaning (+4.1%). Hereford-sired calves from heifers (but not from mature cows) had more assisted births (+8.2%) and more calf deaths (10.0% vs 5.1%). Hereford-sired steers had higher hot standard carcass weight (+4.1%) and eye-muscle area (+3.2%) but when hot standard carcass weight was fitted as a covariate, eye-muscle area was no longer significant. Carcass quality measures (AUSMEAT marbling –25.8%, Meat Standards Australia marbling –10.5%, Meat Standards Australia index –1.0%) were poorer for Hereford-sired steers and fat colour (+6.9%) was darker. Meat samples from Hereford-sired steers had significantly lower colour indicators (L and b). There was no difference in cooking loss and shear force, and intramuscular fat was lower (3.0% vs 4.1%). Conclusions Hereford × Angus calves were heavier at birth than were purebred Angus, but had more calving difficulty and deaths associated with heifer dams. Hereford × Angus carcasses were heavier but had lower indicators of quality than did purebred Angus. Implications As Hereford × Angus steers produced a 4.1% heavier carcass, pure Angus steers would need to attract a premium of at least 4.1% for the additional marbling to give more value. Hereford bulls could be mated to Angus cows and not Angus heifers to avoid calving difficulties. Alternatively, good calving Hereford bulls could be selected using estimated breeding values when mating to Angus heifers.

Crossroads of highly pathogenic H5N1: overlap between wild and domestic birds in the Black Sea-Mediterranean impacts global transmission

Understanding transmission dynamics that link wild and domestic animals is a key element of predicting the emergence of infectious disease, an event that has highest likelihood of occurring wherever human livelihoods depend on agriculture and animal trade. Contact between poultry and wild birds is a key driver of the emergence of highly pathogenic avian influenza (HPAI), a process that allows for host switching and accelerated reassortment, diversification, and spread of virus between otherwise unconnected regions. This study addresses questions relevant to the spillover of HPAI at a transmission hotspot: what is the nature of the wild bird-poultry interface in Egypt and adjacent Black Sea-Mediterranean countries and how has this contributed to outbreaks occurring worldwide? Using a spatiotemporal model of infection risk informed by satellite tracking of waterfowl and viral phylogenetics, this study identified ecological conditions that contribute to spillover in this understudied region. Results indicated that multiple ducks (Northern Shoveler and Northern Pintail) hosted segments that shared ancestry with HPAI H5 from both clade 2.2.1 and clade 2.3.4 supporting the role of Anseriformes in linking viral populations in East Asia and Africa over large distances. Quantifying the overlap between wild ducks and H5N1-infected poultry revealed an increasing interface in late winter peaking in early spring when ducks expanded their range before migration, with key differences in the timing of poultry contact risk between local and long-distance migrants.

A patient and public involvement investigation into healthy eating and weight management advice during pregnancy

OBJECTIVE

To conduct patient and public involvement (PPI) to gain insight into the experience of healthy eating and weight management advice during pregnancy.

DESIGN

PPI in the planning and development of health interventions, aiming to ensure patient-centred care. Optimum nutrition and weight management are vital for successful pregnancy outcomes, yet many services report poor attendance and engagement.

SETTING

Community venues in Liverpool and Ulster (UK).

PARTICIPANTS

Two PPI representatives were involved in all aspects of the study: design, interview questions, recruitment and collection/analysis of feedback.

INTERVENTION

Feedback was collected via note taking during group discussions, two in Liverpool (n = 10 & 5); two in Ulster (n = 7 & 9) and an interview (n = 1, in Ulster).

MAIN OUTCOME MEASURES

Transcript data were collated and thematic analysis was applied in analysis.

RESULTS

Thematic analysis identified three themes: (i) weight gain is inevitable in pregnancy; (ii) healthy eating advice is important but currently lacks consistency and depth and (iii) expectations regarding the type of knowledge/support.

CONCLUSIONS

PPI provides opportunity to enhance research design and offers valuable insight towards the needs of healthcare users. Pregnant women want positive health messages, with a focus on what they can/should do, rather than what they should not do. Midwives need to consider their communication with pregnant women, to ensure that their unique relationship is maintained, especially when the topics of diet and weight management are addressed. A well-designed digital intervention could improve access to pregnancy-specific nutrition information; empowering midwives to communicate patient-centred, healthy eating messages with confidence. This has the potential to change dietary and weight management behaviour in pregnant women.