Longitudinal outcomes of obeticholic acid therapy in ursodiol-nonresponsive primary biliary cholangitis: Stratifying the impact of add-on fibrates in real-world practice

BACKGROUND

Suboptimal response to ursodeoxycholic acid occurs in 40% of primary biliary cholangitis (PBC) patients, affecting survival. Achieving a deep response (normalisation of alkaline phosphatase [ALP] and bilirubin ≤0.6 upper limit of normal) improves survival. Yet, the long-term effectiveness of second-line treatments remains uncertain.

AIMS

To evaluate the long-term effectiveness of obeticholic acid (OCA) ± fibrates. Focusing on biochemical response (ALP ≤1.67 times the upper limit of normal, with a decrease of at least 15% from baseline and normal bilirubin levels), normalisation of ALP, deep response and biochemical remission (deep response plus aminotransferase normalisation).

METHODS

We conducted a longitudinal, observational, multicentre study involving ursodeoxyccholic acid non-responsive PBC patients (Paris-II criteria) from Spain and Portugal who received OCA ± fibrates.

RESULTS

Of 255 patients, median follow-up was 35.1 months (IQR: 20.2-53). The biochemical response in the whole cohort was 47.2%, 61.4% and 68.6% at 12, 24 and 36 months. GLOBE-PBC and 5-year UK-PBC scores improved (p < 0.001). Triple therapy (ursodeoxycholic acid plus OCA plus fibrates) had significantly higher response rates than dual therapy (p = 0.001), including ALP normalisation, deep response and biochemical remission (p < 0.001). In multivariate analysis, triple therapy remained independently associated with biochemical response (p = 0.024), alkaline phosphatase normalisation, deep response and biochemical remission (p < 0.001). Adverse effects occurred in 41.2% of cases, leading to 18.8% discontinuing OCA. Out of 55 patients with cirrhosis, 12 developed decompensation. All with baseline portal hypertension.

CONCLUSION

Triple therapy was superior in achieving therapeutic goals in UDCA-nonresponsive PBC. Decompensation was linked to pre-existing portal hypertension.

Edge Artificial Intelligence (AI) for real-time automatic quantification of filariasis in mobile microscopy

Filariasis, a neglected tropical disease caused by roundworms, is a significant public health concern in many tropical countries. Microscopic examination of blood samples can detect and differentiate parasite species, but it is time consuming and requires expert microscopists, a resource that is not always available. In this context, artificial intelligence (AI) can assist in the diagnosis of this disease by automatically detecting and differentiating microfilariae. In line with the target product profile for lymphatic filariasis as defined by the World Health Organization, we developed an edge AI system running on a smartphone whose camera is aligned with the ocular of an optical microscope that detects and differentiates filarias species in real time without the internet connection. Our object detection algorithm that uses the Single-Shot Detection (SSD) MobileNet V2 detection model was developed with 115 cases, 85 cases with 1903 fields of view and 3342 labels for model training, and 30 cases with 484 fields of view and 873 labels for model validation before clinical validation, is able to detect microfilariae at 10x magnification and distinguishes four species of them at 40x magnification: Loa loa, Mansonella perstans, Wuchereria bancrofti, and Brugia malayi. We validated our augmented microscopy system in the clinical environment by replicating the diagnostic workflow encompassed examinations at 10x and 40x with the assistance of the AI models analyzing 18 samples with the AI running on a middle range smartphone. It achieved an overall precision of 94.14%, recall of 91.90% and F1 score of 93.01% for the screening algorithm and 95.46%, 97.81% and 96.62% for the species differentiation algorithm respectively. This innovative solution has the potential to support filariasis diagnosis and monitoring, particularly in resource-limited settings where access to expert technicians and laboratory equipment is scarce.

Myocardial native T1 mapping at 3T cardiac magnetic resonance-closing the full-vendor reporting cycle of normal values

AIM

Cardiac magnetic resonance is currently an indispensable tool in the diagnosis of cardiac pathologies, with mapping techniques being one of the most recent advances in this area. T1 mapping is a robust tool that uses the T1 magnetic relaxation time as a quantitative marker of myocardial tissue composition. However, multiple T1 mapping sequences are used, and data comparing them, especially on different vendors, is limited. This study aims to determine the T1 relaxation values in the cardiac muscle of healthy individuals using GE's Discovery 3T scanner, allowing the use of the T1 mapping technique in patients on a sustained basis.

MATERIAL AND METHODS

Thirty-one healthy volunteers were submitted to T1 mapping at 3T magnetic resonance imaging (MRI) equipment, with 3 being excluded from the analysis (54% women; mean age: 39.2 ± 13.9 years). The MOLLI 5(3)3 sequence was used, acquiring one short axis slice at midventricular level. Native T1 values were presented as means (± standard deviation), and t-student independent samples tests evaluated gender differences in T1 values.

RESULTS

The results show an average global native T1 value of 1193 ± 39 ms, with women's values being statistically higher than men (1211 ± 40 vs 1173 ± 27 ms, respectively, p<0.006). Gender remained the only determinant of native T1 times on a multiple linear regression model that included age, ejection fraction, and T2 status.

CONCLUSION

This study has established one of the few native T1 values for a 3T GE Discovery scanner that are on par with those already reported by other vendors for a similar sequence, closing the circle in full-vendor reporting.

Digital Microscopy Augmented by Artificial Intelligence to Interpret Bone Marrow Samples for Hematological Diseases

Analysis of bone marrow aspirates (BMAs) is an essential step in the diagnosis of hematological disorders. This analysis is usually performed based on a visual examination of samples under a conventional optical microscope, which involves a labor-intensive process, limited by clinical experience and subject to high observer variability. In this work, we present a comprehensive digital microscopy system that enables BMA analysis for cell type counting and differentiation in an efficient and objective manner. This system not only provides an accessible and simple method to digitize, store, and analyze BMA samples remotely but is also supported by an Artificial Intelligence (AI) pipeline that accelerates the differential cell counting process and reduces interobserver variability. It has been designed to integrate AI algorithms with the daily clinical routine and can be used in any regular hospital workflow.

A scoping review of person-centred care strategies used in diagnostic Nuclear Medicine

INTRODUCTION

Person-centred care (PCC) emphasises the need for the health care professional to prioritise individual patient needs, thereby fostering a collaborative and emphatic environment that empowers patients to actively participate in their own care. This article will explore the purpose of PCC in Nuclear Medicine (NM), while discussing strategies that may be used to implement PCC during diagnostic NM examinations performed on adult patients.

METHODS

The scoping review was conducted in accordance with the Joanna Briggs Institute methodology. The search was performed on PubMed, Embase and Cinhal in June 2023 and included studies in English, Spanish, Portuguese and Italian. The research equation combined keywords and Medical Subject Heading terms (MeSH) related to person-centred care (PCC), for all types of nuclear medicine diagnostic examinations performed. Three independent review authors screened all abstracts and titles, and all eligible full-text publications were included in this scoping review.

RESULTS

Fifty-three articles, published between 1993 and 2022, met the inclusion criteria for this scoping review. Seven articles were published in 2015 while 56.6 % of all included studies were performed in Europe. Most studies (n = 39/53) focused on the patients only, with the identified patient benefits being: improve patient experience (67.9 %), increase patient comfort (13.2 %), increase patient knowledge (5.7 %), reduction of patient anxiety (9.4 %) and reduction of waiting/scan time (3.8 %).

CONCLUSION

The scoping review identified a lack of research investigating the use of person-centred care strategies in NM. Future research will focus on using an international survey to explore this topic in nuclear medicine departments overseas.

IMPLICATIONS FOR PRACTICE

By applying PCC principles, the NM professional can improve the patient care pathway and increase patient satisfaction, leading to enhanced clinical outcomes.

Antagonists of the stress and opioid systems restore the functional connectivity of the prefrontal cortex during alcohol withdrawal through divergent mechanisms

Chronic alcohol consumption leads to dependence and withdrawal symptoms upon cessation, contributing to persistent use. However, the brain network mechanisms by which the brain orchestrates alcohol withdrawal and how these networks are affected by pharmacological treatments remain elusive. Recent work revealed that alcohol withdrawal produces a widespread increase in coordinated brain activity and a decrease in modularity of the whole-brain functional network using single-cell whole-brain imaging of immediate early genes. This decreased modularity and functional hyperconnectivity are hypothesized to be novel biomarkers of alcohol withdrawal in alcohol dependence, which could potentially be used to evaluate the efficacy of new medications for alcohol use disorder. However, there is no evidence that current FDA-approved medications or experimental treatments known to reduce alcohol drinking in animal models can normalize the changes in whole-brain functional connectivity. In this report, we tested the effect of R121919, a CRF1 antagonist, and naltrexone, an FDA-approved treatment for alcohol use disorder, on whole-brain functional connectivity using the cellular marker FOS combined with graph theory and advanced network analyses. Results show that both R121919 and naltrexone restored the functional connectivity of the prefrontal cortex during alcohol withdrawal, but through divergent mechanisms. Specifically, R121919 increased FOS activation in the prefrontal cortex, partially restored modularity, and normalized connectivity, particularly in CRF1-rich regions, including the prefrontal, pallidum, and extended amygdala circuits. On the other hand, naltrexone decreased FOS activation throughout the brain, decreased modularity, and increased connectivity overall except for the Mu opioid receptor-rich regions, including the thalamus. These results identify the brain networks underlying the pharmacological effects of R121919 and naltrexone and demonstrate that these drugs restored different aspects of functional connectivity of the prefrontal cortex, pallidum, amygdala, and thalamus during alcohol withdrawal. Notably, these effects were particularly prominent in CRF1- and Mu opioid receptors-rich regions highlighting the potential of whole-brain functional connectivity using FOS as a tool for identifying neuronal network mechanisms underlying the pharmacological effects of existing and new medications for alcohol use disorder.

Reduced period from follicular wave emergence to luteolysis generated greater steroidogenic follicles and estrus intensity in dairy cows

The onset of productive life in dairy cattle, concomitant to parturition, is accompanied by a substantial decrease in fertility in comparison with non-lactating, nulliparous heifers. Follicular growth patterns differ between parous and nulliparous dairy cattle. Nulliparous heifers ovulate follicles with reduced antral age (RAA). This study aimed to exogenously reduce ovulatory follicle age in lactating dairy cows from 7 to 5 days old. Cows (n = 80) had their estrous cycles synchronized with the Double-Ovsynch program. At the final portion of this program, luteolysis was induced at either 5 (RAA) or 7 (Control) days following follicular wave emergence. RAA outcomes were estimated in comparison with Controls. RAA resulted in smaller follicles 2 days post-treatment. Despite lower serum concentrations of 17β-estradiol before treatment compared with Controls, the rate of increase in this hormone was greater for the RAA treatment. There was no difference in luteolysis rates between treatments. Proestrus (luteolysis onset to estrus onset) was prolonged in RAA cows. Cows with RAA had more intense estruses. Collectively, these results indicate that decreasing the age of the ovulatory follicle may improve the steroidogenic capacity of the dominant follicle and estrus expression intensity in lactating dairy cows.

Evaluation of the Performance of a 3D-Printed Smartphone-Based Retinal Imaging Device as a Screening Tool for Retinal Pathology in Mozambique

Low-income countries carry approximately 90% of the global burden of visual impairment, and up to 80% of this could be prevented or cured. However, there are only a few studies on the prevalence of retinal disease in these countries. Easier access to retinal information would allow differential diagnosis and promote strategies to improve eye health, which are currently scarce. This pilot study aims to evaluate the functionality and usability of a tele-retinography system for the detection of retinal pathology, based on a low-cost portable retinal scanner, manufactured with 3D printing and controlled by a mobile phone with an application designed ad hoc. The study was conducted at the Manhiça Rural Hospital in Mozambique. General practitioners, with no specific knowledge of ophthalmology or previous use of retinography, performed digital retinographies on 104 hospitalized patients. The retinographies were acquired in video format, uploaded to a web platform, and reviewed centrally by two ophthalmologists, analyzing the image quality and the presence of retinal lesions. In our sample there was a high proportion of exudates and hemorrhages-8% and 4%, respectively. In addition, the presence of lesions was studied in patients with known underlying risk factors for retinal disease, such as HIV, diabetes, and/or hypertension. Our tele-retinography system based on a smartphone coupled with a simple and low-cost 3D printed device is easy to use by healthcare personnel without specialized ophthalmological knowledge and could be applied for the screening and initial diagnosis of retinal pathology.

Ordering properties of anisotropic hard bodies in one-dimensional channels

The phase behavior and structural properties of hard anisotropic particles (prisms and dumbbells) are examined in one-dimensional channels using the Parsons-Lee (PL) theory, and the transfer-matrix and neighbor-distribution methods. The particles are allowed to move freely along the channel, while their orientations are constrained such that one particle can occupy only two or three different lengths along the channel. In this confinement setting, hard prisms behave as an additive mixture, while hard dumbbells behave as a non-additive one. We prove that all methods provide exact results for the phase properties of hard prisms, while only the neighbor-distribution and transfer-matrix methods are exact for hard dumbbells. This shows that non-additive effects are incorrectly included into the PL theory, which is a successful theory of the isotropic-nematic phase transition of rod-like particles in higher dimensions. In the one-dimensional channel, the orientational ordering develops continuously with increasing density, i.e., the system is isotropic only at zero density, while it becomes perfectly ordered at the close-packing density. We show that there is no orientational correlation in the hard prism system, while the hard dumbbells are orientationally correlated with diverging correlation length at close packing. On the other hand, positional correlations are present for all the systems, the associated correlation length diverging at close packing.

Real-time in vivo dose measurement using ruby-based fibre optic dosimetry during internal radiation therapy

In vivo dosimetry (IVD) in a commonly used liver cancer treatment of selective internal radiation therapy (SIRT) has been done based on the post-treatment image-based dosimetry approach. Real-time IVD is necessary to verify the dose delivery and detect errors during the treatment for better patient outcomes. This study aims to develop a fibre optic dosimeter (FOD) for in vivo real-time dose rate measurement during internal beta radiation therapy, e.g., SIRT. A ruby fibre optic probe was prepared and studied the radioluminescence (RL) characteristics, including its major challenge of stem effect arising from Cherenkov radiation and luminescence from the irradiated fibre. The stem signal was suppressed adequately using the stem removal technique of optical filtering, and only 2.3 ± 1.1% stem signal was contributed to the measured RL signal. A linear dose rate response was observed during the exposure of the ruby probe to varying dose rates using a 6 MeV electron beam and a positron-emitting radionuclide fluorine-18. The ruby exhibited a temporally non-constant RL signal, which increased the RL signal by 0.84 ± 0.29 counts/sec2 during the irradiation of the maximum dose rate used in this study of 9 Gy/min for 2 min. The ability of ruby FOD to measure the absolute dose rate with sufficient stem effect suppression and the linear RL dose rate response indicates its suitability for real-time IVD during internal beta radiation therapy. Future work will investigate the time-dependent RL characteristic of ruby and validate post-treatment image-based dosimetry using ruby-based FOD.

Structural properties of hard-disk fluids under single-file confinement

The structural properties of confined single-file hard-disk fluids are studied analytically by means of a mapping of the original system onto a one-dimensional mixture of non-additive hard rods, the mapping being exact in the polydisperse limit. Standard statistical-mechanical results are used as a starting point to derive thermodynamic and structural properties of the one-dimensional mixture, where the condition that all particles have the same chemical potential must be taken into account. Analytical results are then provided for the nth neighbor probability distribution function, the radial distribution function, and the structure factor, a very good agreement being observed upon comparison with simulation data from the literature. Moreover, we have analyzed the scaling form for the disappearance of defects in the zigzag configuration for high pressure and have obtained the translational correlation length and the structural crossover in the oscillation frequency for asymptotically large distances.

Commonalities between the Atacama Desert and Antarctica rhizosphere microbial communities

Plant-microbiota interactions have significant effects on plant growth, health, and productivity. Rhizosphere microorganisms are involved in processes that promote physiological responses to biotic and abiotic stresses in plants. In recent years, the interest in microorganisms to improve plant productivity has increased, mainly aiming to find promising strains to overcome the impact of climate change on crops. In this work, we hypothesize that given the desertic environment of the Antarctic and the Atacama Desert, different plant species inhabiting these areas might share microbial taxa with functions associated with desiccation and drought stress tolerance. Therefore, in this study, we described and compared the composition of the rhizobacterial community associated with Deschampsia antarctica (Da), Colobanthus quitensis (Cq) from Antarctic territories, and Croton chilensis (Cc), Eulychnia iquiquensis (Ei) and Nicotiana solanifolia (Ns) from coastal Atacama Desert environments by using 16S rRNA amplicon sequencing. In addition, we evaluated the putative functions of that rhizobacterial community that are likely involved in nutrient acquisition and stress tolerance of these plants. Even though each plant microbial rhizosphere presents a unique taxonomic pattern of 3,019 different sequences, the distribution at the genus level showed a core microbiome with a higher abundance of Haliangium, Bryobacter, Bacillus, MND1 from the Nitrosomonadaceae family, and unclassified taxa from Gemmatiamonadaceae and Chitinophagaceae families in the rhizosphere of all samples analyzed (781 unique sequences). In addition, species Gemmatirosa kalamazoonesis and Solibacter usitatus were shared by the core microbiome of both Antarctic and Desert plants. All the taxa mentioned above had been previously associated with beneficial effects in plants. Also, this microbial core composition converged with the functional prediction related to survival under harsh conditions, including chemoheterotrophy, ureolysis, phototrophy, nitrogen fixation, and chitinolysis. Therefore, this study provides relevant information for the exploration of rhizospheric microorganisms from plants in extreme conditions of the Atacama Desert and Antarctic as promising plant growth-promoting rhizobacteria.

Translational and rotational non-Gaussianities in homogeneous freely evolving granular gases

The importance of roughness in the modeling of granular gases has been increasingly considered in recent years. In this paper, a freely evolving homogeneous granular gas of inelastic and rough hard disks or spheres is studied under the assumptions of the Boltzmann kinetic equation. The homogeneous cooling state is studied from a theoretical point of view using a Sonine approximation, in contrast to a previous Maxwellian approach. A general theoretical description is done in terms of d_{t} translational and d_{r} rotational degrees of freedom, which accounts for the cases of spheres (d_{t}=d_{r}=3) and disks (d_{t}=2, d_{r}=1) within a unified framework. The non-Gaussianities of the velocity distribution function of this state are determined by means of the first nontrivial cumulants and by the derivation of non-Maxwellian high-velocity tails. The results are validated by computer simulations using direct simulation Monte Carlo and event-driven molecular dynamics algorithms.

Evaluation of the thermographic response of the lumbar region in dogs with bilateral hip osteoarthritis

Infrared thermography is suggested as a method of medical assistance for evaluating anatomical regions where there may be some inflammatory or painful condition that requires immediate medical attention. For this reason, this study aimed to characterize digital thermography of the lumbar region in police working dogs with hip osteoarthritis, 47 dogs with bilateral hip osteoarthritis were evaluated. A thermographic dorsoventral view of the dogs' backs were obtained, and mean and maximum temperatures were determined. In addition, results from the Canine Brief Pain Inventory, Liverpool Osteoarthritis in Dogs (LOAD), the Canine Orthopedic Index, and weight-bearing distribution evaluation were collected. Results were compared with an Independent Samples T-Test or ANOVA, followed by an LSD post hoc. Multiple regression was run to predict temperatures from age, sex, breed, body weight, and Orthopedic Foundation for Animals hip score and to predict clinical metrology scores and weight-bearing distribution results from temperature results. The sample included 28 males and 19 females, with a mean age of 6.3 ± 2.5 years and bodyweight of 26.9 ± 5.1 kg, with osteoarthritis hip scores of mild (70.2%), moderate (21.3%), and severe (8.5%). Significant differences were observed in mean temperatures between German Shepherd Dogs (GSD) and Labrador Retrievers (LR) (p < 0.01), and LR and Belgian Malinois (BM) (p=0.02). Mean temperature contributed to the prediction of LOAD and stiffness. LR showed significantly higher temperature values than GSD and BM. No differences were observed between osteoarthritis hip scores and mean temperature values contributed to LOAD scores' prediction. This relation needs to be addressed in further studies, involving a larger number of animals, and to determine changes in response to treatment.

COVID-19 impedimetric biosensor based on polypyrrole nanotubes, nickel hydroxide and VHH antibody fragment: specific, sensitive, and rapid viral detection in saliva samples

SARS-CoV-2 rapid spread required urgent, accurate, and prompt diagnosis to control the virus dissemination and pandemic management. Several sensors were developed using different biorecognition elements to obtain high specificity and sensitivity. However, the task to achieve these parameters in combination with fast detection, simplicity, and portability to identify the biorecognition element even in low concentration remains a challenge. Therefore, we developed an electrochemical biosensor based on polypyrrole nanotubes coupled via Ni(OH)₂ ligation to an engineered antigen-binding fragment of heavy chain-only antibodies (VHH) termed Sb#15. Herein we report Sb#15-His6 expression, purification, and characterization of its interaction with the receptor-binding domain (RBD) of SARS-CoV-2 in addition to the construction and validation of a biosensor. The recombinant Sb#15 is correctly folded and interacts with the RBD with a dissociation constant (K_D) of 27.1 ± 6.4 nmol/L. The biosensing platform was developed using polypyrrole nanotubes and Ni(OH)₂, which can properly orientate the immobilization of Sb#15-His6 at the electrode surface through His-tag interaction for the sensitive SARS-CoV-2 antigen detection. The quantification limit was determined as 0.01 pg/mL using recombinant RBD, which was expressively lower than commercial monoclonal antibodies. In pre-characterized saliva, both Omicron and Delta SARS-CoV-2 were accurately detected only in positive samples, meeting all the requirements recommended by the World Health Organization for in vitro diagnostics. A low sample volume of saliva is needed to perform the detection, providing results within 15 min without further sample preparations. In summary, a new perspective allying recombinant VHHs with biosensor development and real sample detection was explored, addressing the need for accurate, rapid, and sensitive biosensors.

HMGB1 acts as an agent of host defense at the gut mucosal barrier

Mucosal barriers provide the first line of defense between internal body surfaces and microbial threats from the outside world. ¹ In the colon, the barrier consists of two layers of mucus and a single layer of tightly interconnected epithelial cells supported by connective tissue and immune cells. ² Microbes colonize the loose, outer layer of colonic mucus, but are essentially excluded from the tight, epithelial-associated layer by host defenses. ³ The amount and composition of the mucus is calibrated based on microbial signals and loss of even a single component of this mixture can destabilize microbial biogeography and increase the risk of disease. ^4-7 However, the specific components of mucus, their molecular microbial targets, and how they work to contain the gut microbiota are still largely unknown. Here we show that high mobility group box 1 (HMGB1), the prototypical damage-associated molecular pattern molecule (DAMP), acts as an agent of host mucosal defense in the colon. HMGB1 in colonic mucus targets an evolutionarily conserved amino acid sequence found in bacterial adhesins, including the well-characterized Enterobacteriaceae adhesin FimH. HMGB1 aggregates bacteria and blocks adhesin-carbohydrate interactions, inhibiting invasion through colonic mucus and adhesion to host cells. Exposure to HMGB1 also suppresses bacterial expression of FimH. In ulcerative colitis, HMGB1 mucosal defense is compromised, leading to tissue-adherent bacteria expressing FimH. Our results demonstrate a new, physiologic role for extracellular HMGB1 that refines its functions as a DAMP to include direct, virulence limiting effects on bacteria. The amino acid sequence targeted by HMGB1 appears to be broadly utilized by bacterial adhesins, critical for virulence, and differentially expressed by bacteria in commensal versus pathogenic states. These characteristics suggest that this amino acid sequence is a novel microbial virulence determinant and could be used to develop new approaches to diagnosis and treatment of bacterial disease that precisely identify and target virulent microbes.

Equation of state of hard-disk fluids under single-file confinement

The exact transfer-matrix solution for the longitudinal equilibrium properties of the single-file hard-disk fluid is used to study the limiting low- and high-pressure behaviors analytically as functions of the pore width. In the low-pressure regime, the exact third and fourth virial coefficients are obtained, which involve single and double integrals, respectively. Moreover, we show that the standard irreducible diagrams do not provide a complete account of the virial coefficients in confined geometries. The asymptotic equation of state in the high-pressure limit is seen to present a simple pole at the close-packing linear density, as in the hard-rod fluid, but, in contrast to the latter case, the residue is 2. Since, for an arbitrary pressure, the exact transfer-matrix treatment requires the numerical solution of an eigenvalue integral equation, we propose here two simple approximations to the equation of state, with different complexity levels, and carry out an extensive assessment of their validity and practical convenience vs the exact solution and available computer simulations.

Time to increase in pregnancy-specific protein B following artificial insemination is a direct determinant of subsequent pregnancy loss in lactating dairy cows

Increasing progesterone (P4) during early conceptus development may be crucial for establishment of pregnancy in dairy cattle. The objective of this study was to determine if human chorionic gonadotropin (hCG) at various times after ovulation will increase serum P4 during elongation and increase the chances for, and reduce variability to, initial increase in pregnancy-specific protein B (PSPB) following artificial insemination (AI). Time to PSPB increase was defined as the first day of increase in concentrations of PSPB between d 18 and 28 after ovulation in cows with ≥12.5% increases for 3 consecutive days compared with baseline. Lactating cows (n = 368) synchronized to Double-Ovsynch (first service) or Ovsynch (second or greater service) received one of 4 treatments: no hCG (control), or 3,000 IU of hCG on d 2 (D2), 2 and 5 (D2+5), or 5 (D5) after ovulation. All cows were examined via ultrasound on d 5 and 10 postovulation to determine percentage of cows with hCG-induced accessory CL (aCL) and to quantify and measure all luteal structures. Samples for serum P4 were collected on d 0, 5, 19, and 20 postovulation. The P4 was increased in D2, D2+5, and D5 groups compared with control. The D2+5 and D5 treatments increased aCL and P4 compared with D2 and control. The D2 treatment increased P4 on d 5 after ovulation compared with control. Serum PSPB samples were collected daily from all cows on d 18 through 28 after ovulation for determination of d of PSPB increase. Pregnancy diagnoses were performed via ultrasound examination on d 35, 63, and 100 after ovulation and AI. The D5 treatment reduced percentage of cows with, and increased the time to, PSPB increase. Primiparous cows with ipsilateral aCL had reduced pregnancy loss before d 100 postovulation compared with cows with contralateral aCL. Cows that had PSPB increase >21 d postovulation had 4× greater chances of pregnancy loss compared with cows that had PSPB increase on d 20 or 21. The highest quartile of P4 on d 5, but not on d 19 and 20, was associated with reduced time to PSPB increase. Time to PSPB increase appears to be an important measurement to understand reasons for pregnancy loss in lactating dairy cows. Increasing P4 utilizing hCG after ovulation did not enhance early pregnancy or reduce pregnancy losses in lactating dairy cows.

Measuring the effect of climate change in Antarctic microbial communities: toward novel experimental approaches

The Antarctic continent is undergoing a rapid warming, affecting microbial communities throughout its ecosystems. This continent is a natural laboratory for studying the effect of climate change, however, assessing the microbial communities' responses to environmental changes is challenging from a methodological point of view. We suggest novel experimental designs, including multivariable assessments that apply multiomics methods in combination with continuous environmental data recording and new warming simulation systems. Moreover, we propose that climate change studies in Antarctica should consider three main objectives, including descriptive studies, short-term temporary adaptation studies, and long-term adaptive evolution studies. This will help us to understand and manage the effects of climate change on the Earth.

Cardiovascular Profile of patients with COVID-19 infection admitted at a tertiary hospital

Funding Acknowledgements

Type of funding sources: None.

Introduction

In December 2019, a novel Coronavirus disease 2019 (COVID-19) was discovered and spread rapidly worldwide. The virus spared no country in its contagiousness. The most common clinical manifestations are respiratory symptoms; but COVID-19 may induce arrhythmias, myocardial infarction, heart failure, and other cardiovascular diseases due to the systemic inflammatory response coupled with localized vascular inflammation. The study aims to provide knowledge about the clinical profile, cardiovascular complications, and clinical outcomes among adult COVID-19 patients admitted to a tertiary hospital.

Methods

This study is a single-centered cross-sectional retrospective study of hospitalized adult COVID-19 patients between March 2020 to May 2022. COVID-19 confirmed patients who met the inclusion criteria with clinical data upon hospitalization are followed up for occurrence of critical illness. The study's primary outcome is determining the demographic profile and clinical course of COVID-19 infection regarding cardiovascular signs and symptoms. Data were retrieved from electronic health records. All outcomes were obtained with standardized data collection forms, and clinical severity was defined based on the National Institute of Health guidelines.

Results

A total of 1341 hospitalized adult COVID-19 patients were admitted with a mean age of 50.41±15.92 years. More males than females account for 60.2% of the total number of patients. Hypertension is the most common comorbidity among COVID-19 patients, comprising 44% of cases, followed by diabetes at 31.9% and dyslipidemia at 11.4%. About 5.4% had coronary artery disease, followed by heart disease 6 (3.6%) and arrhythmia (0.6%). Most COVID-19 patients were smokers 12% and alcoholic beverage drinkers (11.4%). A univariate analysis associated with mortality showed diabetes mellitus (odds ratio 2.7, p = 0.029) and hypertension (odds ratio 3.4, p = 0.11). In the multiple logistic regression analysis, factors' age (OR 1.095, estimate coefficient 0.091, standard error 0.028, p-value &lt;0.05) and admission duration (OR 0.906, estimate coefficient -0.099, standard error 0.028, p-value &lt;0.05) were significantly associated with mortality. Based on the fitted model, older people are more likely to be deceased than younger people. The log odds for mortality increase by 0.091 units for each year. During hospital admission, 24.43% of patients developed acute COVID-19 infection, with an in-hospital case-fatality rate of 13.89%. During hospital stay, COVID-19 patients had a significant QTc (.43 ± 0.04, p«0.001). Patients admitted to Non-ICU had lower QTc (.44 ± 0.045) compared to ICU patients (.45 ± .05).

Conclusion

Myocardial injury and significant cardiovascular risk factors increased mortality among critically-ill COVID-19 patients. Hence, aside from risk factor modification, emphasis on cardiovascular protection should also be considered during treatment for COVID-19.

Anxiety and depression disorders in Portugal during the COVID-19 pandemic

Background

Mental disorders are a major contributor to the global burden of disease. During the first year of the pandemic by COVID-19, increases of 25% in the prevalence of anxiety and depression were reported globally. In Portugal, studies conducted during lockdown showed an increase in the prevalence of these disorders. However, previous studies have shown that negative life events, such as exposure to disasters or grief, later lead to resilience or recovery. It is therefore necessary to study the evolution of these disorders in order to adapt mental health measures.

Methods

The number of patients registered with “P76 - Depressive Disorder” and “P74 - Anxiety Disorder/anxiety state”, according to ICPC-2 criteria, and the total number of patients registered in the Portuguese Health Centers for the months of January 2019 to 2022 were obtained from the Portuguese NHS Information and Monitoring System (SIM@SNS). We calculated the percentage of patients with each of the disorders, individually and combined. Data by health regions were also obtained in order to compare the evolution within each region (North, Center, Lisbon and Tagus Valley, Alentejo and Algarve).

Results

Between January 2019 and 2022, the proportion of patients with anxiety disorder increased linearly from 8% to 9%. Similarly, the proportion of patients with depressive disorder increased from 11% to 12%. When considered together, anxiety and depression disorders affected 21% of users in mainland Portugal at the beginning of 2022. The Alentejo and Center regions have the highest prevalence of anxiety and depression (24.9% and 24%, respectively) and the Algarve region has the lowest (16.74%). The increases were consistent across health regions, with the largest increase in the North region (2.6%) and the smallest in the Central region (1.7%).

Conclusions

Anxiety and depression disorders increased in mainland Portugal during the years of the COVID-19 pandemic.

Key messages

• Mental health has been an important factor in public health since before the pandemic.

• Monitoring depression and anxiety levels in the general public can guide priorities after the pandemic.

COVID-19 contact tracing apps in Europe, technological feat or failure?

Background

In the context of infectious disease control (IDC), public health services (PHS) have been under great pressure during the COVID-19 pandemic, especially with the burden of contact tracing. Most European Union countries have developed contact tracing apps for smartphones (CTA) with the goal of aiding PHS in IDC. CTAs generally use proximity data from mobile devices to determine a user's risk of exposure to SARS-CoV-2, thus providing testing and isolation recommendations. This review aimed to study the acceptance and adoption of CTAs in Europe.

Methods

5 European countries were selected: Germany, Spain, France, Ireland, Italy. A literature review was carried out and official sources of information from each country were consulted in order to compare the adoption of each national CTA. Criterias included number of downloads, rating in the app stores, costo of development, proportion of positive tests registered. Potential factors influencing population adherence to CTAs were also investigated.

Results

In proportion to their population, the number of downloads varied significantly in each country (18 % in Spain, 67% in France, 75% in Ireland). Except for Spain, all countries integrated additional functions into the CTA to increase its uptake, such as access to the vaccination certificate. App stores ratings ranged from 3.0 (Spain) to 3.9 (France and Ireland). The proportion of tests added in the apps varied significantly (1% in Italy and Spain, 4% in Ireland, 10% in France and 17% in Germany). Concerns that lead to the non-use of CTAs were related to data protection, smartphone battery drainage and app bugs.

Conclusions

CTAs as a way to identify contacts from a positive case had a low impact in the analyzed countries, with low population adherence being an important factor. Adding more features within the apps, minimizing bugs, and increasing public confidence in data privacy seem essential to increase uptake in the future.

Key messages

Gauging Public Health Literacy needs through Google Trends: the COVID-19 vaccination example

Background

The rollout of the COVID-19 vaccination program in Portugal was one of the most successful in the world. However, there was still a challenge for Public Health services to determine the health literacy needs of the population in the context of a new vaccine and the uncertainty of the pandemic. The goal of this study was to evaluate the usefulness of Google Trends data to gauge the health literacy needs of the general population during the pandemic.

Methods

A Google Trends search was performed for Portugal including 5 topics related to health literacy needs of the population (“vaccination”, “scheduling”, “isolation”, “booster dose” and “vaccination certificate” ) between the 28th of december 2019 and the 10th of march 2022. The variation shows the relative popularity of each term referring to the total number of Google searches during that period in a normalized scale of 0-100. The variation was compared to the number of doses administered daily in Portugal and key moments of the vaccination campaign as defined by the Directorate-General for Health in Portugal.

Results

The terms “vaccination” and “isolation” had a steady rise in popularity from December 2019 to January 2021. The term “vaccination” was the most popular search term with peak popularity in July 2021 and a downward trend followed by an ascent to a lower peak in popularity in January 2022. The terms “scheduling” and “vaccination certificate” both followed a similar pattern, though at lower popularity levels. The term “isolation” was low on popularity since February 2021, with a significant rise and peak in January 2022. This variation relates to key dates during the Portuguese vaccination campaign.

Conclusions

Google Trends data seems to correlate with key events during the Portuguese COVID-19 vaccination campaign. That data might be incorporated in the planning framework of health literacy activities for national and local Public Health services.

Key messages

• Google Trends might be an important source of information for public health teams.

• There is a need for further research into how Google Trends data can be incorporated with other sources of information to inform health literacy activities.

Kinetic Theory and Memory Effects of Homogeneous Inelastic Granular Gases under Nonlinear Drag

We study a dilute granular gas immersed in a thermal bath made of smaller particles with masses not much smaller than the granular ones in this work. Granular particles are assumed to have inelastic and hard interactions, losing energy in collisions as accounted by a constant coefficient of normal restitution. The interaction with the thermal bath is modeled by a nonlinear drag force plus a white-noise stochastic force. The kinetic theory for this system is described by an Enskog–Fokker–Planck equation for the one-particle velocity distribution function. To get explicit results of the temperature aging and steady states, Maxwellian and first Sonine approximations are developed. The latter takes into account the coupling of the excess kurtosis with the temperature. Theoretical predictions are compared with direct simulation Monte Carlo and event-driven molecular dynamics simulations. While good results for the granular temperature are obtained from the Maxwellian approximation, a much better agreement, especially as inelasticity and drag nonlinearity increase, is found when using the first Sonine approximation. The latter approximation is, additionally, crucial to account for memory effects such as Mpemba and Kovacs-like ones.

Initial psychometric evaluation of the Portuguese version of the Liverpool Osteoarthritis in Dogs

BACKGROUND

Osteoarthritis (OA) is the most commonly diagnosed joint disease in companion animals, and proper tools are necessary to assess patients and response to treatment. We aimed to perform an initial psychometric evaluation of the Portuguese version of the Liverpool Osteoarthritis in Dogs (LOAD).Fifty Police working dogs with bilateral hip OA were assessed in a prospective, randomized, double-blinded study. Canine handlers, who were native Portuguese speakers, completed a copy of the translated version of the LOAD. Their results were compared with those of fifty sound dogs. Construct validity was evaluated by assessing differences between OA and sound animals with the Mann-Whitney test. Further evaluation was performed with the Kaiser-Meyer-Olkin measure of sampling adequacy, Eigenvalue, and scree-plot analysis. Internal consistency was tested with Cronbach's α.

RESULTS

A significant difference was observed between OA and sound dogs (p < 0.01), indicating construct validity. Two factors accounted for 81.5% of the total variance. Cronbach's α was 0.96, and a high inter-item correlation was observed, raging from 0.76 to 0.95, showing strong internal consistency. We presented criterion and construct validity of the Portuguese version of the LOAD, which is valid for use in the Portuguese language. It is an additional stage in providing a broader number of clinicians with an accessible tool to evaluate dogs with osteoarthritis. Further studies are required.

Outcomes in pregnant women with valvular heart disease from sub Saharan Africa transferred to a developed nation. A distinct care model

Background

Pregnant women with valvular heart disease (VHD) in African countries still bear a disproportionate burden of maternal morbidity and mortality, due to the reduced accessibility to health care and the scarcity of skilled professionals. It is unclear if outcomes would be improved by care-delivery model changes.

Purpose

We performed a clinical audit of African pregnant women with VHD who were transferred for their care from five countries to our cardio-obstetrics unit, during a twenty-year period, through a memorandum of agreement of international cooperation.

Methods

A retrospective analysis of 81 pregnancies (P) in 45 African women with VHD (median age 24, IQR 22–29 years) from 2001 to 2020. The main outcome measures were major maternal complications and perinatal outcome.

Results

History of rheumatic heart disease was determined in 74.1% of the P. Most women were in NHYA I or II before P (79.0%), 43.2% had previous cardiac medication and 60.5% were anticoagulated (33.3% with acenocoumarol and 27.2% with warfarin). 59.3% of P had at least one valvular prosthesis, including 38 mechanical prosthetic valve (MPV) and 10 biological valves. 22.2% had prior surgical or percutaneous VHD correction, excluding prosthesis implantation. At baseline, impaired left ventricular ejection fraction was found in 12.3%. Previous arrhythmic event, stroke or infectious endocarditis were found in 12.3%, 8.6% and 6.2% of P, respectively.

During P, deterioration in NYHA functional class occurred in 42.0% and 9.9% required initiation or intensified cardiac medication. For MPV, 51% maintained a vitamin K antagonist, 15.7% used LMWH from 6 to 12th weeks and 9.8% used LMWH throughout P. Valve thrombosis occurred in 4 women (4.9% of P), with one maternal death in a patient with double MPV.

Hemorrhagic complications happened in 8.6% of P, all anticoagulated, in immediate postpartum or puerperal period. The 81 P resulted in 56 live births (69.1%), with a medium birth weight of 3026±471g. Delivery by caesarean section was performed in 28.3% of newborns. The incidence of miscarriage was 23.5% and fetal malformations occurred in 14.8%, with warfarin embryopathy in 4 cases. In univariate analysis, the presence of valvular protheses (p=0.001), and anticoagulation (p=0.001) were related to unsuccessful P. In multivariate analysis, VKA therapy was the unique independent predictor of unsuccessful P (p=0.048).

Conclusion

With the multidisciplinary care provided, pregnancy was relatively well tolerated and successful for women transferred from sub–Saharan Africa. However, the presence of a valvular prothesis is associated with unsuccessful pregnancy even in a developed nation. Efforts other than the implantation of a MPV should be pursued vigorously in sub Saharan Africa.

Funding Acknowledgement

Type of funding sources: None.

Potential impact of replacing SCORE with SCORE-2 on risk classification and statin eligibility – a coronary calcium score correlation study

Background

Recently, the European Society of Cardiology issued new algorithms to estimate the 10-year risk of atherosclerotic cardiovascular disease (ASCVD), along with new age-specific thresholds to classify individuals as low-to-moderate, high, or very-high risk.

The aim of this study was to compare the latest SCORE-2 model with the older SCORE (Systematic COronary Risk Evaluation) in their ability to identify individuals with high coronary artery calcium score (CACS), and assess the relationship between potential eligibility for statin therapy and CACS.

Methods

Individuals 40–69 years old without diabetes or known ASCVD were identified in a single center registry of patients undergoing CACS and coronary CT angiography for suspected coronary artery disease. SCORE and SCORE-2 were calculated and used with each patient's untreated LDL-C values to assess eligibility for statin therapy. High CACS was defined as an Agatston score ≥100.

Results

A total of 389 pts (46% men, mean age 58±8 years) were included, of which 15% (n=60) were active smokers. The mean systolic blood pressure and untreated LDL-C values were 136±17 mmHg and 155±65 mg/dL, respectively.

The proportion of patients classified as low-to-moderate risk, high risk, and very high risk was 93%, 6% and 1% using the SCORE algorithm, and 42%, 44%, and 14% using SCORE-2, respectively. Overall, 218 patients (56%) would have their risk category revised upwards, while no patients would be downgraded.

The median CACS was 5 (IQR 0–71 AU), with 166 patients (43%) having CACS = 0, and 81 (21%) presenting CACS values ≥100.

SCORE and SCORE-2 showed similar discriminative power to identify patients with CACS ≥100 (C-statistic 0.77, 95% CI 0.71–0.82, vs. 0.75, 95% CI 0.69–0.80, P=0.109 for comparison]. The up-reclassification of risk conveyed by SCORE-2 affected patients across all categories of CACS (Fig. 1).

The proportion of patients in whom statin therapy would generally be indicated was higher with the SCORE-2 criteria vs. the SCORE algorithm (61% vs. 29%, respectively, p&lt;0.001). The broadening of potential indication for statin therapy spanned all categories of CACS, including patients with CACS = 0 (Fig. 2).

Conclusion

Even though the discriminative power of SCORE-2 is similar to the older SCORE, the introduction of age-specific thresholds results in the up-reclassification of risk in roughly half of the patients. The application of SCORE-2 will broaden statin eligibility overall, not only in patients with high atherosclerotic burden, but also in those with CACS = 0. These findings support the use of risk modifiers in selected patients to improve the effectiveness of statin therapy.

Funding Acknowledgement

Type of funding sources: None.

Use of coronary calcium score to refine the cardiovascular risk classification of the new SCORE2 and SCORE2-OP algorithms in patients undergoing coronary CT angiography

Introduction

Recently, the European Society of Cardiology issued new algorithms (SCORE-2 and SCORE2-OP) to estimate the 10-year risk of atherosclerotic cardiovascular disease (ASCVD). CACS has been shown to reclassify a significant proportion of patients when applied on top of several scores, but data on its use with these new algorithms are lacking.

The aim of this study was to assess the risk reassignment that can be attained by using CACS as a risk modifier of the SCORE-2 / SCORE2-OP classification, in patients referred for coronary CT angiography (CCTA).

Methods

Individuals without diabetes or known ASCVD were included in a single center registry of patients undergoing CCTA for suspected coronary artery disease (CAD). The 10-year risk of cardiovascular disease was calculated for each patient using SCORE-2 (ages 40–69) or SCORE2-OP (ages 70–89), and categorised as low-to-moderate, high, or very-high risk, according to guideline-recommended age-specific thresholds. CACS was considered to reclassify risk one level downward if = 0 in high or very-high risk patients, and reclassify risk upward if &gt;100 (or &gt;75th percentile) in those with low-to-moderate risk, or &gt;1000 in those with high-risk.

Results

A total of 529 patients (43% men, mean age 63±10 years) were included, of which 13% (n=69) were active smokers. The mean systolic blood pressure and non-HDL-C values were 137±18 mmHg and 140±37 mg/dL, respectively.

A total of 47 patients (9%) had obstructive CAD on CCTA, classifying them as very-high risk. In the remainder 482 patients without obstructive CAD, the median CACS was 8 (IQR 0–80 AU), with 194 patients (40%) having CACS = 0, and 111 (23%) presenting CACS values ≥100.

The proportion of patients classified as low-to-moderate risk, high risk, and very high risk was 36%, 46% and 19% using the SCORE-2 / SCORE2-OP algorithm.

Using CACS would reclassify 150 patients (31%): 107 patients (22%) downward, and 43 patients (9%) upward. The extent of risk reclassification conveyed by CACS was 33% in patients assessed with SCORE-2, and 25% with SCORE-2 OP (p=0.082). Overall, most of the risk reassignment (42%, n=93) would occur in patients originally classified as high-risk – Fig. 1.

At the time of testing, 32% (n=61) of patients with CACS = 0 were being treated with statins, whereas 52% (n=58) of those with CACS ≥100 were not.

Conclusion

Even when the most recent SCORE-2 / SCORE-2 OP algorithms are used, risk refinement with CACS leads to the reclassification of nearly one third of the patients undergoing CCTA, mostly from downgrading risk. This opportunistic use of CACS may be employed to improve the allocation of primary prevention therapies.

Funding Acknowledgement

Type of funding sources: None.

The influence of IL-1 and C-reactive protein levels in synovial fluid of companion dogs with bilateral hip osteoarthritis on various clinical disease parameters

OBJECTIVE

To evaluate IL-1 and C-reactive protein (CRP) levels in the synovial fluid in dogs with bilateral hip osteoarthritis and their relation to animals' clinical, radiographic, and thermographic disease signs.

SAMPLE

100 joints from police working dogs.

PROCEDURES

Synovial fluid, IL-1, and CRP levels, weight distribution, joint range of motion, thigh girth, digital thermography, and radiographic signs of the joints were recorded. Data from 4 clinical metrology instruments (CMIs) were collected. Results were compared by age, sex, and Orthopedic Foundation for Animals hip scores with the independent samples t test, ANOVA, and Pearson correlation coefficient (P < .05).

RESULTS

The sample included 100 pelvic limbs, equally distributed between left and right pelvic limbs 30 males and 20 females, with a mean age of 6.5 ± 2.4 years and body weight of 26.7 ± 5.2 kg. IL-1 levels, particularly above 200 pg/mL, may be related to the development of caudolateral curvilinear osteophyte, which then expresses a toll on the patient's levels of pain and activity. It was unclear if the CRP levels were a consequence of inflammatory activity within the joint or a reflection of a better prognosis. Increasing body weight was related to worse CMI scores.

CLINICAL RELEVANCE

We described the relation of IL-1 and CRP synovial concentration levels with several clinical signs, diagnostic imaging, laboratory findings, and CMI results of animals with osteoarthritis. Further studies are required to determine the interest of each parameter for the prognosis and treatment monitoring.

A first report on the efficacy of a single intra-articular administration of blood cell secretome, triamcinolone acetonide, and the combination of both in dogs with osteoarthritis

Background

Osteoarthritis represents a significant welfare problem for many dogs, with limited therapeutic options other than palliative pain control. To evaluate the effect of the intra-articular administration of blood cell secretome and triamcinolone, 15 dogs with bilateral hip osteoarthritis were randomly assigned to a blood cell secretome (BCSG, n = 5), triamcinolone (TG) or their combination group (BCS + TG, n = 5). BCSG received a single intra-articular administration of 3 ml of blood cell secretome, TG 0.5 ml of triamcinolone acetonide 40 mg/ml, and BCS + TG received the combined products. The volume to administrate was corrected to 3.5 ml with saline. On days 0, 8, 15, 30, 60, 90, 120, 150, and 180, a copy of the Canine Brief Pain Inventory (divided into pain interference score—PIS and Pain Severity Score—PSS), Liverpool Osteoarthritis in Dogs (LOAD), Hudson Visual Analogue Scale (HVAS), and Canine Orthopedic Index (COI, divided into function, gait, stiffness, and quality of life) was completed. Results were analyzed with the Kruskal–Wallis test and the Kaplan–Meier estimators were conducted and compared with the Log Rank test, p < 0.05.

Results

Animals in the sample had a mean age of 9.0 ± 2.9 years and a bodyweight of 28.8 ± 4.1 kg. Hips were classified as moderate (8) and severe (7) osteoarthritis. No differences were found between groups at T0 regarding considered evaluations. Significant differences were observed between groups in pain scores from + 8d- + 150d, with BCS + TG exhibiting better results. The same was observed for HVAS and LOAD, from + 8d- + 120d. Improvements were also observed in several dimensions of the COI. Kaplan–Meier estimators showed that BCS + TG produced longer periods with better results, followed by BCSG and TG.

Conclusion

The intra-articular administration of blood cell secretome improved the clinical signs and scores of several clinical metrology instruments in dogs with hip OA, particularly when combined with triamcinolone. Further studies are required.

Research ethics systems, processes, and awareness across Europe: Radiography research ethics standards for Europe (RRESFE)

INTRODUCTION

The Radiography Research Ethics Standards for Europe (RRESFE) project aims to provide a cross-sectional snapshot of current research ethics systems, processes, and awareness of such, across Europe together with identifying the associated challenges, education, and training needs.

METHODS

A cross-sectional online survey targeting radiography researchers in Europe was conducted. Data collection took place between April 26 and July 12, 2021, using a snowball sampling approach. Descriptive and analytical statistics were used to identify trends in research ethics frameworks across Europe.

RESULTS

285 responses were received across 33 European and 23 non-European countries. Most (n = 221; 95%) European respondents stated ethics approval is required before commencing research in their country. Requirements around research ethics approval and awareness of such requirements varied by European region (X² (2, n = 129) = 7.234, p = 0.013) and were found to differ depending on the type of research participant and study design. Additionally, European respondents reported ethics approval is a national requirement more often than their non-European counterparts (X² (1, n = 282) = 4.316, p = 0.049). Requirements for ethics approval were also associated with the undergraduate programme duration (2-year vs. 3-year vs. 3.5 year vs. 4-year vs. multiple programme durations; X² (4, n = 231) = 10.075, p = 0.016) and availability of postgraduate training (postgraduate training available vs. postgraduate training not available; X² (1, n = 231) = 15.448, p = <0.001) within respondents' country.

CONCLUSION

Respondents from countries with longer programme durations/availability of multiple programme lengths, availability of postgraduate training, and establishment of European Qualifications Framework Level 6 were generally associated with less uncertainty and more comprehensive research ethics requirements.

IMPLICATIONS FOR PRACTICE

Results are informative of the current status of research ethics within evidence-based radiography.

Research ethics training, challenges, and suggested improvements across Europe: Radiography research ethics standards for Europe (RRESFE)

INTRODUCTION

The Radiography Research Ethics Standards for Europe (RRESFE) project aimed to provide a cross-sectional view of the current state of radiography research ethics across Europe. This included investigating education and training in research ethics, and identifying the key challenges and potential improvements associated with using existing research ethics frameworks.

METHODS

This cross-sectional online survey targeting radiography researchers in Europe was conducted between April 26 and July 12, 2021. Descriptive and analytical statistics were used to identify research ethics education and training trends. Content analysis of qualitative responses was employed to identify significant challenges and proposed improvements in research ethics frameworks of practice.

RESULTS

There were 232 responses received across 33 European countries. Most (n = 132; 57%) respondents had received some research ethics training; however, fewer participants had received training on safeguarding vulnerable patients (n = 72; 38%), diversity and inclusivity (n = 62; 33%), or research with healthy volunteers (n = 60; 32%). Training was associated with a greater perceived importance of the need for research ethics review (p = 0.031) and with the establishment of EQF Level 6 training (p = 0.038). The proportion of formally trained researchers also varied by region (p = <0.001). Time-to-ethics-approval was noted as the biggest challenge for professionals making research ethics applications.

CONCLUSION

Early and universal integration of research-oriented teaching within the radiography education framework which emphasises research ethics is recommended. Additionally, study findings suggest research ethics committee application and approval processes could be further simplified and streamlined.

IMPLICATIONS FOR PRACTICE

The survey contributes to a growing body of knowledge surrounding the importance of education and training in research ethics for assuring a high standard of research outputs in Radiography and has identified hurdles to obtaining research ethics approval for further investigation and address.

Dairy heifers have an earlier increase in serum pregnancy-specific protein B compared with lactating dairy cows. Is this an indicator of earlier conceptus attachment?

This study was designed to use within-individual daily increases in circulating pregnancy-specific protein B (PSPB) to determine time to increase in serum PSPB in nulliparous heifers and multiparous dairy cows following artificial insemination (AI). Weekly cohorts of lactating Holstein cows (n = 56) averaging 122 ± 7 d in milk at AI and nulliparous Holstein heifers (n = 23) averaging 16 ± 0.24 mo old at AI were used in this study. Lactating cows received AI to either Ovsynch (n = 38) or at ~12 h following observed standing estrus (n = 18). All heifers were inseminated ~12 h after observed standing estrus. Blood samples for measurement of PSPB were collected daily from d 15 through d 35 postovulation. Nulliparous heifers had increases in serum PSPB earlier compared with both primiparous and multiparous cows. Day of increase in serum PSPB was defined as the day serum PSPB optical density levels initially increased ≥10% from baseline and continued to increase from baseline of ≥10% the following 2 d. Average PSPB were greater in pregnant heifers compared pregnant cows from d 23 through 29. Early lactation nonpregnant cows maintained greater average optical density of serum PSPB from 15 to 35 d postovulation compared with nonpregnant heifers (n = 38). In summary, fertility differences in heifers versus lactating cows may be due to the differences in timing of increases in serum PSPB. This appears to be one of the first publications that used daily PSPB sampling to investigate possible differences in fertility in heifers versus lactating cows.

Phenotypic and transcriptional study of the antimicrobial activity of silver and zinc oxide nanoparticles on a wastewater biofilm-forming Pseudomonas aeruginosa strain

The extensive use of nanoparticles (NPs) in industrial processes makes their potential release into the environment an issue of concern. Ag and ZnO NPs are among the most frequently used NPs, potentially reaching concentrations of 1-4 and 64 mg/kg, respectively, in Wastewater Treatment Plants (WWTPs), with unknown effects over microbial populations. Thus, we examined, in depth, the effect of such NPs on a P. aeruginosa strain isolated from a WWTP. We evaluated the growth, ROS production and biofilm formation, in addition to the transcriptomic response in presence of Ag and ZnO NPs at concentrations potentially found in sewage sludge. The transcriptomic and phenotypic patterns of P. aeruginosa in presence of Ag NPs were, in general, similar to the control treatment, with some specific transcriptional impacts affecting processes involved in biofilm formation and iron homeostasis. The biofilms formed under Ag NPs treatment were, on average, thinner and more homogeneous. ZnO NPs also alters the biofilm formation and iron homeostasis in P. aeruginosa, however, the higher and more toxic concentrations utilized caused an increase in cell death and eDNA release. Thus, the biofilm development was characterized by EPS production, via eDNA release. The number of differentially expressed genes in presence of ZnO NPs was higher compared to Ag NPs treatment. Even though the responses of P. aeruginosa to the presence of the studied metallic NPs was at some extent similar, the higher and more toxic concentrations of ZnO NPs produced greater changes concerning cell viability and ROS production, causing disruption in biofilm development.

Remote analysis of sputum smears for mycobacterium tuberculosis quantification using digital crowdsourcing

Worldwide, TB is one of the top 10 causes of death and the leading cause from a single infectious agent. Although the development and roll out of Xpert MTB/RIF has recently become a major breakthrough in the field of TB diagnosis, smear microscopy remains the most widely used method for TB diagnosis, especially in low- and middle-income countries. This research tests the feasibility of a crowdsourced approach to tuberculosis image analysis. In particular, we investigated whether anonymous volunteers with no prior experience would be able to count acid-fast bacilli in digitized images of sputum smears by playing an online game. Following this approach 1790 people identified the acid-fast bacilli present in 60 digitized images, the best overall performance was obtained with a specific number of combined analysis from different players and the performance was evaluated with the F1 score, sensitivity and positive predictive value, reaching values of 0.933, 0.968 and 0.91, respectively.

Thermal versus entropic Mpemba effect in molecular gases with nonlinear drag

Loosely speaking, the Mpemba effect appears when hotter systems cool sooner or, in a more abstract way, when systems further from equilibrium relax faster. In this paper, we investigate the Mpemba effect in a molecular gas with nonlinear drag, both analytically (by employing the tools of kinetic theory) and numerically (direct simulation Monte Carlo of the kinetic equation and event-driven molecular dynamics). The analysis is carried out via two alternative routes, recently considered in the literature: first, the kinetic or thermal route, in which the Mpemba effect is characterized by the crossing of the evolution curves of the kinetic temperature (average kinetic energy), and, second, the stochastic thermodynamics or entropic route, in which the Mpemba effect is characterized by the crossing of the distance to equilibrium in probability space. In general, a nonmutual correspondence between the thermal and entropic Mpemba effects is found, i.e., there may appear the thermal effect without its entropic counterpart or vice versa. Furthermore, a nontrivial overshoot with respect to equilibrium of the thermal relaxation makes it necessary to revise the usual definition of the thermal Mpemba effect, which is shown to be better described in terms of the relaxation of the local equilibrium distribution. Our theoretical framework, which involves an extended Sonine approximation in which not only the excess kurtosis but also the sixth cumulant is retained, gives an excellent account of the behavior observed in simulations.

Effect of a single intra-articular administration of stanozolol in a naturally occurring canine osteoarthritis model: a randomised trial

Osteoarthritis (OA) is a disease with a high negative impact on patient’s quality of life and a high financial burden. It is a source of chronic pain and affects all mammals, including humans and dogs. As the dog is a common model for translation research of human OA, and exploring spontaneous dog OA can improve the health and well-being of both humans and dogs. To describe the effect of the intra-articular administration of stanozolol in a naturally occurring canine OA model, forty canine (N = 40) hip joints were randomly assigned to receive stanozolol or saline (control). On treatment day and at 8, 15, 30, 90, and 180 days post-treatment, several evaluations were conducted: weight distribution, joint range of motion, thigh girth, digital thermography, and radiographic signs. Also, synovial fluid C-reactive protein and interleukin-1 levels were evaluated. Results from four Clinical Metrology Instruments was also gathered. Results were compared with Repeated Measures ANOVA, with a Huynh–Feldt correction, paired-samples t-test, or Wilcoxon signed-rank test, with p < 0.05. OA was graded as mild (90%), moderate (5%), and severe (5%), including both sexes. They had a mean age of 6.5 ± 2.4 years and a bodyweight of 26.7 ± 5.2 kg. No differences were found between groups at treatment day in all considered evaluations. Weight distribution showed significant improvements with stanozolol from 15 days (p < 0.05) up to 180 days (p < 0.01). Lower values during thermographic evaluation in both views taken and improved joint extension at 90 (p = 0.02) and 180 days (p < 0.01) were observed. Pain and function scores improved up to 180 days. In the control group, radiographic signs progressed, in contrast with stanozolol. The use of stanozolol was safe and produced significant improvements in weight-bearing, pain score, and clinical evaluations in a naturally occurring canine OA model.

Characterization of weight-bearing compensation in dogs with bilateral hip osteoarthritis

To describe the weight-bearing compensation in working dogs with bilateral hip osteoarthritis (OA), fifty police working dogs were evaluated with a weight distribution platform at the initial evaluation and after intra-articular treatment (a negative control - 0.9% sodium chloride (NaCl), a platelet concentrate, Hylan G-F 20, triamcinolone hexacetonide or stanozolol). Six evaluation sessions were performed, over a 180-day period. Results were compared by breed, age, sex, weight and Orthopedic Foundation for Animals hip grade scores with the Independent Samples T-Test, repeated samples Analysis of variance and Pearson correlation coefficient, p<0.05. Animals had a mean age of 6.5±2.4 years and a bodyweight of 26.7±5.2kg. No significant differences were observed when comparing weight-bearing for different breeds, sex, hip grades or weight during the initial evaluation. Significant differences were observed in deviation (p<0.01) and symmetry index (p<0.01) between the control and treatment groups during the follow-up period. A weight shift from pelvic to thoracic limbs was observed, with a weak, although significant, correlation between a pelvic limb and the opposing contralateral thoracic limb. Labrador Retrievers showed higher symmetry index and deviation from normal values during the follow-up period than German Shepherd Dogs and Dutch Shepherd Dogs. Male dogs also showed higher symmetry index and deviation comparing with females. At this period, the symmetry index showed a weak, although significant, correlation with body weight. Weight-bearing of all limbs correlated with the remaining limbs, reflecting a more balanced weight distribution than the initial evaluation. The weight distribution platform can be used to evaluate patients, at the initial presentation and during the assessment of response to treatment.

Nontuberculous Mycobacteria in Portugal: Trends from the last decade

INTRODUCTION AND OBJECTIVES

Nontuberculous mycobacteria (NTM) are opportunistic human pathogens found in the environment. The transmission seems to be associated with inhalation of aerosol droplets, ingestion or trauma events. Recent studies indicate that NTM disease is increasing worldwide, however, the true clinical impact of NTM infections is difficult to determine due to challenges in discriminating between disease and colonization as they are ubiquitous in the environment. In addition, understanding the epidemiology of NTM is difficult and has not yet been established. In this work, we used a country NTM representative collection from the National Reference Laboratory for Tuberculosis (NRL-TB) of the National Institute of Health (INSA), to characterize the circulation trends of NTM species in Portugal and the most affected regions, contributing to a better understanding of the NTM epidemiology.

MATERIAL AND METHODS

We conducted a nationwide retrospective study where all individuals with positive NTM cultures at the NRL-TB of the INSA from 2014 to December 2020 were included. Positive cultures were identified using GenoType Mycobacterium CM/AS® (Hain Lifescience) according to manufacturer's instructions, or hsp65 DNA sequencing as previously described. Social-demographic data from patients were also analyzed and patients classified into 3 groups according only to microbiological data, "definite NTM disease", "NTM colonization" and, "possible NTM disease".

RESULTS

In the period 2014-2020, the NRL-TB performed 50397 cultures. Among these, 1118 cultures were NTM positive retrieved from 944. Most of our cases were in patients whose mean age was 64±15.9 years, and no significant differences between gender was observed, although more frequent in male patients. Overall, from the 944 cases, we were able to identified 93 "definite NTM disease" cases and 79 "possible NTM disease". Mycobacterium avium complex (MAC) (40,8%), Mycobacterium abscessus-chelonae complex (MABC) (9,6%) and Mycobacterium fortuitum (6,3%) were responsible for most of the infections. The geographical distribution of NTM cases varied significantly and was possible to observe that was independent of population density. The region were most cases occurred was Lisbon Metropolitan Area (31,9%), followed by North (25,3%) and Centre (24,4%), however North region has the highest number of "definite NTM disease" cases (n=33).

CONCLUSIONS

This is the first national wide epidemiological study on this subject, contributing to a better understanding of NTM dynamics in Portugal. MAC was the NTM species responsible for the majority of infections and, LMA the region with the highest number of cases. It was also possible to conclude that the number of NTM isolates is independent of the demography of the region.

Structural properties of additive binary hard-sphere mixtures. III. Direct correlation functions

An analysis of the direct correlation functions c_{ij}(r) of binary additive hard-sphere mixtures of diameters σ_{s} and σ_{b} (where the subscripts s and b refer to the "small" and "big" spheres, respectively), as obtained with the rational-function approximation method and the WM scheme introduced in previous work [S. Pieprzyk et al., Phys. Rev. E 101, 012117 (2020)2470-004510.1103/PhysRevE.101.012117], is performed. The results indicate that the functions c_{ss}(r<σ_{s}) and c_{bb}(r<σ_{b}) in both approaches are monotonic and can be well represented by a low-order polynomial, while the function c_{sb}(r<1/2(σ_{b}+σ_{s})) is not monotonic and exhibits a well-defined minimum near r=1/2(σ_{b}-σ_{s}), whose properties are studied in detail. Additionally, we show that the second derivative c_{sb}^{''}(r) presents a jump discontinuity at r=1/2(σ_{b}-σ_{s}) whose magnitude satisfies the same relationship with the contact values of the radial distribution function as in the Percus-Yevick theory.

Acylase enzymes disrupting quorum sensing alter the transcriptome and phenotype of Pseudomonas aeruginosa, and the composition of bacterial biofilms from wastewater treatment plants

Biofilms represent an essential way of life and colonization of new environments for microorganisms. This feature is regulated by quorum sensing (QS), a microbial communication system based on autoinducer molecules, such as N-acyl-homoserine lactones (AHLs) in Gram negative bacteria. In artificial ecosystems, like Wastewater Treatment Plants (WWTPs), biofilm attachment in filtration membranes produces biofouling. In this environment, the microbial communities are mostly composed of Gram-negative phyla. Thus, we used two AHLs-degrading enzymes, obtained from Actinoplanes utahensis (namely AuAAC and AuAHLA) to determine the effects of degradation of QS signals in the biofilm formation, among other virulence factors, of a Pseudomonas aeruginosa strain isolated from a WWTP, assessing molecular mechanisms through transcriptomics. Besides, we studied the possible effects on community composition in biofilms from activated sludge samples. Although the studied enzymes only degraded the AHLs involved in one of the four QS systems of P. aeruginosa, these activities produced the deregulation of the complete QS network. In fact, AuAAC -the enzyme with higher catalytic efficiency- deregulated all the four QS systems. However, both enzymes reduced the biofilm formation and pyocyanin and protease production. The transcriptomic response of P. aeruginosa affected QS related genes, moreover, transcriptomic response to AuAAC affected mainly to QS related genes. Regarding community composition of biofilms, as expected, the abundance of Gram-negative phyla was significantly decreased after enzymatic treatment. These results support the potential use of such AHLs-degrading enzymes as a method to reduce biofilm formation in WWTP membranes and ameliorate bacterial virulence.