Precision Concussion Management: Approaches to Quantifying Head Injury Severity and Recovery

Mitigating the substantial public health impact of concussion is a particularly difficult challenge. This is partly because concussion is a highly prevalent condition, and diagnosis is predominantly symptom-based. Much of contemporary concussion management relies on symptom interpretation and accurate reporting by patients. These types of reports may be influenced by a variety of factors for each individual, such as preexisting mental health conditions, headache disorders, and sleep conditions, among other factors. This can all be contributory to non-specific and potentially misleading clinical manifestations in the aftermath of a concussion. This review aimed to conduct an examination of the existing literature on emerging approaches for objectively evaluating potential concussion, as well as to highlight current gaps in understanding where further research is necessary. Objective assessments of visual and ocular motor concussion symptoms, specialized imaging techniques, and tissue-based concentrations of specific biomarkers have all shown promise for specifically characterizing diffuse brain injuries, and will be important to the future of concussion diagnosis and management. The consolidation of these approaches into a comprehensive examination progression will be the next horizon for increased precision in concussion diagnosis and treatment.

Opening the Black Box of an mHealth Patient-Reported Outcome Tool for Diabetes Self-Management: Interview Study Among Patients With Type 2 Diabetes

BACKGROUND

Mobile health (mHealth) tools are used to collect data on patient-reported outcomes (PROs) and facilitate the assessment of patients' self-management behaviors outside the clinic environment. Despite the high availability of mHealth diabetes tools, there is a lack of understanding regarding the underlying reasons why these mHealth PRO tools succeed or fail in terms of changing patients' self-management behaviors.

OBJECTIVE

This study aims to identify the factors that drive engagement with an mHealth PRO tool and facilitate patients' adoption of self-management behaviors, as well as elicit suggestions for improvement.

METHODS

This qualitative study was conducted within the context of a randomized controlled trial designed to evaluate the efficacy of an mHealth PRO tool (known as i-Matter) versus usual care regarding reduction in glycated hemoglobin (HbA1c) levels and adherence to self-management behaviors at 12 months among patients with uncontrolled type 2 diabetes. Patients randomized to i-Matter participated in semistructured interviews about their experiences at the 3-, 6-, 9-, and 12-month study visits. A qualitative analysis of the interviews was conducted by 2 experienced qualitative researchers using conventional qualitative content analysis.

RESULTS

The sample comprised 71 patients, of whom 67 (94%) completed at least one interview (n=48, 72% female patients; n=25, 37% identified as African American or Black; mean age 56.65 [SD 9.79] years). We identified 4 overarching themes and 6 subthemes. Theme 1 showed that the patients' reasons for engagement with i-Matter were multifactorial. Patients were driven by internal motivating factors that bolstered their engagement and helped them feel accountable for their diabetes (subtheme 1) and external motivating factors that helped to serve as reminders to be consistent with their self-management behaviors (subtheme 2). Theme 2 revealed that the use of i-Matter changed patients' attitudes toward their disease and their health behaviors in 2 ways: patients developed more positive attitudes about their condition and their ability to effectively self-manage it (subtheme 3), and they also developed a better awareness of their current behaviors, which motivated them to adopt healthier lifestyle behaviors (subtheme 4). Theme 3 showed that patients felt more committed to their health as a result of using i-Matter. Theme 4 highlighted the limitations of i-Matter, which included its technical design (subtheme 5) and the need for more resources to support the PRO data collected and shared through the tool (subtheme 6).

CONCLUSIONS

This study isolated internal and external factors that prompted patients to change their views about their diabetes, become more engaged with the intervention and their health, and adopt healthy behaviors. These behavioral mechanisms provide important insights to drive future development of mHealth interventions that could lead to sustained behavior change.

Patient Perceptions of Integrating Meditation-based Interventions in Office-based Opioid Treatment with Buprenorphine: A Mixed-methods Survey

INTRODUCTION

Recent findings support the provision of meditation-based interventions (MBIs) in primary care. However, the acceptability of MBI among patients prescribed medications for opioid use disorder (eg, buprenorphine) in primary care remains unclear. This study assessed experiences and preferences for adopting MBI among patients prescribed buprenorphine in office-based opioid treatment (OBOT).

METHODS

This 23-item, semistructured cross-sectional survey was administered by study staff to patients enrolled in OBOT (N = 72) and consisted of demographic and clinical characteristics, perceptions, experiences with MBI, and preferred strategies to access MBI to support their treatment on buprenorphine.

RESULTS

Most participants reported practicing at least 1 category of MBI (90.3%) on at least a daily (39.6%) or weekly (41.7%) basis including (1) spiritual meditation (eg, centering prayer; 67.7%); (2) nonmantra meditation (eg, comfortable posture; 61.3%); (3) mindfulness meditation (eg, mindfulness-based stress reduction; 54.8%); and (4) mantra meditation (eg, transcendental meditation; 29.0%). Interest in MBI was motivated by improving one's general health and well-being (73.4%), treatment outcomes with medications for OUD (eg, buprenorphine; 60.9%), and relationships with others (60.9%). Perceived clinical benefits of MBI included reduced anxiety or depression symptoms (70.3%), pain (62.5%), illicit substance or alcohol use (60.9%), cravings for illicit substances (57.8%), and opioid-related withdrawal symptoms (51.6%).

CONCLUSIONS

Findings from this study indicate high acceptability for adopting MBI among patients prescribed buprenorphine in OBOT. Further research is needed to assess the efficacy of MBI to improve clinical outcomes among patients initiating buprenorphine in OBOT.

The fast camera (Fastcam) imaging diagnostic systems on the DIII-D tokamak

Two camera systems are installed on the DIII-D tokamak at the toroidal positions of 90° (90° system) and 225° (225° system), respectively. The cameras have two types of relay optics, namely, a coherent optical fiber bundle and a periscope system. The periscope system provides absolute intensity calibration stability while sacrificing resolution (10 lp/mm), while the fiber system provides high resolution (16 lp/mm) while sacrificing calibration stability. The periscope is available only for the 90° system. The optics of the 225° system were designed for view stability, repeatability, and easy maintenance. The cameras are located inside optimized neutron, x ray and magnetic shielding in order to reduce electronics damage, reboots, and magnetic and neutron interference, increasing the overall system reliability. An automated filter wheel, providing remote filter change, allows for remote wavelength selection. A software suite automates camera acquisition and data storage, allowing for remote operation and reduced operator involvement. System metadata is used to streamline the data analysis workflow, particularly for intensity calibration. The spatial calibration uses multiple observable wall features, resulting in a reconstruction accuracy ≤2 cm.

As and S speciation in a submarine sulfide mine tailings deposit and its environmental significance: The study case of Portmán Bay (SE Spain)

The dumping of an estimated amount of 57 million tons of hazardous sulfide mine waste from 1957 to 1990 into Portmán's Bay (SE Spain) caused one of the most severe cases of persistent anthropogenic impact in Europe's costal and marine environments. The resulting mine tailings deposit completely infilled Portmán's Bay and extended seawards on the continental shelf, bearing high levels of metals and As. The present work, where Synchrotron XAS, XRF core scanner and other data are combined, reveals the simultaneous presence of arsenopyrite (FeAsS), scorodite (FeAsO₄·2H₂O), orpiment (As₂S₃) and realgar (AsS) in the submarine extension of the mine tailings deposit. In addition to arsenopyrite weathering and scorodite formation, the, the presence of realgar and orpiment is discussed, considering both potential sourcing from the exploited ores and in situ precipitation from a combination of inorganic and biologically mediated geochemical processes. Whereas the formation of scorodite relates to the oxidation of arsenopyrite, we hypothesize that the presence of orpiment and realgar is associated to scorodite dissolution and subsequent precipitation of these two minerals within the mine tailings deposit under moderately reducing conditions. The occurrence of organic debris and reduced organic sulfur compounds evidences the activity of sulfate-reducing bacteria (SRB) and provides a plausible explanation to the reactions leading to the formation of authigenic realgar and orpiment. The precipitation of these two minerals in the mine tailings, according to our hypothesis, has important consequences for As mobility since this process would reduce the release of As into the surrounding environment. Our work provides for the first time valuable hints on As speciation in a massive submarine sulfide mine tailings deposit, which is highly relevant for similar situations worldwide.

Temperature dependent local inhomogeneity and magnetic moments of (Li1-xFex)OHFeSe superconductors

We have combined the extended X-ray absorption fine structure (EXAFS) and X-ray emission spectroscopy (XES) to investigate the local structure and the local iron magnetic moments of (Li_1-xFe_x)OHFeSe (x∼0.2) superconductors. The local structure, studied by Fe K-edge EXAFS measurements, is found to be inhomogeneous that is characterized by different Fe-Se bond lengths. The inhomogeneous phase exhibits a peculiar temperature dependence with lattice anomalies in the local structural parameters at the critical temperature T_c (36 K) and at the spin density wave (SDW) transition temperature T_N (130 K). Fe Kβ XES shows iron to be in a low spin state with the local Fe magnetic moment evolving anomalously as a function of temperature. Apart from a quantitative measurement of the local structure of (Li_1-xFe_x)OHFeSe, providing direct evidence of nanoscale inhomogeneity, the results provide further evidence of the vital role that the coupled electronic, lattice and magnetic degrees of freedom play in the iron-based superconductors.

A Systematic Approach to Standardizing Drinking Outcomes From Timeline Followback Data

Objective

The timeline followback (TLFB) interview is the gold standard for the quantitative assessment of alcohol use. However, self-reported "drinks" can vary in alcohol content. If this variability is not accounted for, it can compromise the reliability and validity of TLFB data. To improve the precision of the TLFB data, we developed a detailed standard operating procedure (SOP) to calculate standard drinks more accurately from participant reports.

Method

For the new SOP, the volume and alcohol content by volume (ABV) of distinct types of alcoholic beverages were determined based on product websites and other reliable sources. Recipes for specific cocktails were constructed based on recipes from bartending education websites. One standard drink was defined as 0.6 oz (14 g) of absolute alcohol. Standard drink totals were contrasted for the new SOP approach and the standard procedure, which generally assumed that one self-reported drink was equivalent to one standard drink.

Results

Relative to the standard TLFB procedure, higher numbers of standard drinks were reported after implementing the TLFB SOP.

Conclusions

Variability in procedures for conversion of self-reported alcohol consumption to standard drinks can confound the interpretation of TLFB data. The use and reporting of a detailed SOP can significantly reduce the potential for such inconsistencies. Detailed and consistent procedures for calculation of standard drinks can enhance the quality of TLFB drinking data.

The CLEAR X-ray emission spectrometer available at the CLAESS beamline of ALBA synchrotron

The CLEAR X-ray emission spectrometer installed at the CLAESS beamline of the ALBA synchrotron is described. It is an energy-dispersive spectrometer based on Rowland circle geometry with 1 m-diameter circle. The energy dispersion is achieved by the combination of a diced analyzer crystal and a unidimensional detector. A single unconventional dynamically bent analyzer crystal (Si 111) permits a wide energy range to be covered, just by exploiting its different reflections (333, 444, 555, 777, 888): 6-22 keV, with a spectrometer efficiency that decreases above 11 keV because of the Si detector thickness (Mythen, 350 µm), while the relative scattering intensities for the Si 333, 444, 555, 777 and 888 reflections correspond to 36, 40, 21, 13 and 15, respectively. The provided energy resolution is typically below 1-2 eV and depends on the beam size, working Bragg angle and reflection exploited. In most cases the energy dispersion ranges from 10 to 20 eV and can be enlarged by working in the out-of-Rowland geometry up to 40 eV. The spectrometer works in full backscattering geometry with the beam passing through the two halves of the analyzer. The vacuum beam path and the particular geometry allow a typical average noise of only 0.5 counts per second per pixel. The spectrometer is mainly used for measuring emission lines and high-resolution absorption spectra, with a typical scanning time for highly concentrated systems of around half an hour, including several repeats. The intrinsic energy dispersion allows systematic collection of resonant X-ray emission maps by measuring high-resolution absorption spectra. Moreover, it allows spectra to be measured on a single-shot basis. Resonant inelastic X-ray scattering experiments to probe electronic excitations are feasible, although the spectrometer is not optimized for this purpose due to the limited energy resolution and scattering geometry provided. In that case, to minimize the quasi-elastic line, the spectrometer is able to rotate along the beam path. Advantages and disadvantages with respect to other existing spectrometers are highlighted.

GENERATIVITY AND OLDER ADULTS’ COVID-19 ADJUSTMENT AND MENTAL HEALTH

Generativity, the capacity to be productive, caring, and concerned with the well-being of the next generation, has been linked to positive mental health outcomes and posttraumatic growth (Bellizzi, 2004). Generativity may be particularly important nowadays as older adults adjust to the pandemic and its aftermath. For example, after months of social distancing, the availability of vaccines has enabled many older adults to begin resuming social activities. Considering the meaning-making function of generativity, generativity may be associated with more positive outcomes, including better mental health and views on quality of life and family relationships during this post-pandemic adjustment period. The current study used a community sample of 136 older adults (M age = 67.77, range 50-91; 69.3% females; 93% White) to explore whether generativity predicted older adults’ anxiety and depressive symptoms, and attitudes about how the pandemic affected their quality of life and family relationships. Using hierarchical linear regressions controlling for age and gender, we found that generativity was negatively linked to anxiety and depressive symptoms. Furthermore, those with greater generativity were more likely to report that their family relationships improved because of the pandemic. In contrast, generativity was not associated with positive growth in the personal domain or with perceptions that the pandemic had harmed either personal or family domains. Our findings are consistent with Erikson’s theory on the important role that generativity plays in shaping well-being and psychological health in older adults, and our findings suggest these effects may be especially pronounced during this post-pandemic adjustment period.

LINKS BETWEEN LONELINESS AND SLEEP AMONG PARTNERED OLDER ADULTS: AFFECTIONATE TOUCH AS A MODERATOR

Sleep problems and loneliness both increase with age and undercut older adults’ health and well-being. Loneliness is a predictor of sleep problems, however, research in this area often fails to also consider the role of relationship quality. The current study therefore focuses on spousal relationship quality as it has been shown to have a proximal influence on sleep. We examined relative effects of physical and emotional facets of relationship quality–namely affectionate touch and emotional support (in addition to loneliness). We further examined the potential for relationship quality to buffer effects of loneliness on sleep. We utilized data from a nationally representative sample of older adults from the National Social Life Health and Aging Project (NSHAP). Participants were partnered (N = 559) and completed a novel sleep module that included subjective (i.e., insomnia symptoms) and objective (i.e., Wake After Sleep Onset; WASO) markers of sleep. Upon controlling for demographics and mental and physical health, a different pattern of findings emerged for each facet of sleep. For subjective sleep, older adults who were more lonely reported more insomnia symptoms, but only when spousal emotional support was low. For objective sleep, older adults who reported more affectionate touch experienced less WASO. These findings suggest that loneliness that occurs in the context of low emotional support from spouses is particularly damaging for older adults’ subjective sleep quality. Further, affectionate touch from spouses may represent an important intervention target for promoting felt security that helps older adults stay asleep throughout the night.

MARITAL QUALITY AND LONELINESS AMONG AGING COMBAT VETERANS: THE MODERATING ROLE OF PTSD SYMPTOMS

Loneliness is a robust predictor of aging veterans’ health. Even married older adults may experience loneliness if their relationships are of poor quality. We therefore examined facets of marital quality as predictors of loneliness within a sample of aging veterans: (1) companionship (relationship promotes connection to spouse) and (2) sociability (relationship promotes connection to others). We further evaluated whether veterans’ PTSD symptoms moderated these associations. We utilized two waves of data from 269 Vietnam-era combat veterans (M age = 60.5, SD = .73) collected in 2010 and 2016. Upon controlling for baseline loneliness, demographics, and chronic conditions, higher companionship and sociability each predicted lower subsequent loneliness. We detected interactions between companionship and PTSD subclusters. For example, companionship protected against loneliness only for veterans with low and moderate (but not high) avoidance. Findings highlight nuances in how marital quality predicts aging veterans’ loneliness, some of which are dependent on PTSD symptoms.

THE ROLE OF SOCIABILITY IN OLDER ADULTS' ADAPTATION TO COVID-19

Some older adults may be particularly sensitive to the negative effects of social disruptions due to COVID-19 (Tyrrell & Williams, 2020). For example, the unique circumstances of the pandemic may have made greater sociability a liability (Wijngaards et al., 2020). The current study used a community sample of 136 older adults (M age = 67.77, range 50-91; 69.3% females; 93% White) to explore whether sociability moderated links between disruptions to contact with friends and family and indicators of mental health. Using a series of hierarchical linear regressions, we found that sociability moderated the association between disruptions in family interactions and depressive symptoms. For more sociable individuals, disruptions in family interactions were more strongly positively associated with depressive symptoms. Given the potential for future social disruptions due to COVID-19, our findings point to the importance of considering the role of sociability in developing interventions targeting older adults.

COPING AND UNCERTAINTY IN THE CONTEXT OF COVID-19: DIFFERENCES BETWEEN PARTNERED AND UNPARTNERED OLDER ADULTS

The initial conditions of the COVID-19 pandemic made it such that individuals—especially older adults—experienced uncertainty about their own health/well-being, as well as that of their loved ones and communities. The current study examined how older adults’ social context shaped their well-being (i.e., anxiety, depressive symptoms, and sleep quality) early in the pandemic. Specifically, we tested whether there were differences in uncertainty, communal coping, and well-being among partnered individuals who indicated that their partner was their primary source of emotional support during the pandemic versus un-partnered individuals who indicated another social tie as their primary source of emotional support. Data were collected between May and August 2020 from 101 older adults (Mage = 80.63, SD = 8.96). Correlational analyses showed that uncertainty about one’s own health/well-being was positively associated with anxiety (p < .05) and communal coping (i.e., viewing the pandemic as a stressful period that will be worked through together) was negatively associated with depressive symptoms (p = .001) and anxiety (p < .01). Results from independent samples t-tests showed that, on average, partnered older adults reported fewer depressive symptoms (p < .05), less uncertainty about their own health/well-being (p < .05), and higher communal coping (p < .001) compared to un-partnered older adults. Unexpectedly, no group differences were found for anxiety or sleep quality. Results suggest the unique benefit of having a partner as an emotional support confidant in the context of the pandemic, perhaps because older adults were largely confined to their homes during lockdown.

Development and validation of a new ECG algorithm based on the analysis of lead V3 to determine the origin of outflow tract ventricular arrhythmias

Funding Acknowledgements

Type of funding sources: None.

Introduction (Aim)

To preoperatively differentiate the site of origin outflow tract ventricular arrhythmias (OT-VA) it is of utmost importance for procedure planning yet challenging for those with a precordial transition (PT) at lead V3: close-proximity anatomical structures produce similar VA morphologies, thus leading to possible misdiagnosis. We sought to create an ECG algorithm that could be accurate and useful in overcoming this problem.

Methods and Results

74 consecutive patients (Pts) with OT-VA who underwent successful radio-frequency catheter ablation (V3 PT 60.8%) were enrolled. The ECG characteristics of the first 30 Pts were analyzed (retrospective cohort); those with a PT at lead V3 underwent activation-mapping of both OT to ensure a correct diagnosis. LV-OT and RV-OT groups shared similar characteristics, including BMI and BSA.

Above all ECG measurements, the V3 duration index (DI) and amplitude percentage, both calculated with the formula [R\(R+S)]*100 (computing duration and amplitude measurements respectively), showed the greatest AUC. A V3 DI < 50% established a certain diagnosis of origin at RV-OT (sensitivity 86.7%, specificity 100%, PPV 100%, NPV 88.2%; AUC 0.931). If the V3 DI was ≥ 50%, a V3 R wave percentage ≥ 50% established a certain diagnosis of origin at LV-OT (sensitivity 86.7%, specificity 100%, PPV 100%, NPV 88.2%, AUC 0.951). While a direct study of the RV-OT or LV-OT is suggested in these first two cases, few classification errors occurred only in the rare event of a V3 DI ≥ 50% with a V3 R wave percentage < 50% (Figure 1).

In the prospective cohort, the two indices were confirmed to have the two best AUCs (0.992 and 0.986, respectively), and the algorithm showed an accuracy of 95.45%.

Since the aortic cusps are structures posterior to RV-OT, therefore further away from V2, these foci more frequently show a QRS onset at ≥ V3; a characteristic which in our series was associated with an odds ratio for LV-OT origin of 4.1 [95% CI 1.47 – 11.39], p = 0.007.

Using the transition ratio, we found a statistical significance only in lead V3, with a cut-off of ≥ 1 for predicting an LV-OT origin (LV-OT vs. RV-OT: 7.70 ± 12.75 vs. 0.70 ± 0.55, p < 0.001; AUC 0.898). Analyzing the overall case series, we can generalize the following: duration and amplitude indices showed an increasing AUC passing from lead V1 to V3 (Figure 2). The indices based on the complete measurement of the wave R compared to the QRS showed better AUCs than those on partial measures in V2 and V3: the duration index was better than the deflection index, as well as the amplitude percentage was better than the amplitude ratio.

Conclusions

The usefulness of the algorithm lies in providing preoperatively two assured outcomes in most cases (86.36%), allowing to limit the procedure to one OT directly - even in the event of a V3 PT - while it can select a small subgroup of complex Pts in which a study of both OT is recommended.

P281 A CASE OF ACUTE PULMONARY EMBOLISM IN A PATIENT WITH CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION MISSED: PROFITABLE COLLABORATION BETWEEN A SPOKE CENTER AND A HUB

Conclusion

The case describes a patient with an episode of acute pulmonary embolism on a pre–existing unrecognized thromboembolic pulmonary hypertension, which partially benefited from percutaneous thrombectomy. Cases of CTEPH are infrequent; however, they must be recognized and sent, for a thorough evaluation, to an expert centre, to start the appropriate diagnostic therapeutic path, as in the case reported.

Naloxone protection, social support, network characteristics, and overdose experiences among a cohort of people who use illicit opioids in New York City

Background

Despite increased availability of take-home naloxone, many people who use opioids do so in unprotected contexts, with no other person who might administer naloxone present, increasing the likelihood that an overdose will result in death. Thus, there is a social nature to being “protected” from overdose mortality, which highlights the importance of identifying background factors that promote access to protective social networks among people who use opioids.

Methods

We used respondent-driven sampling to recruit adults residing in New York City who reported recent (past 3-day) nonmedical opioid use (n = 575). Participants completed a baseline assessment that included past 30-day measures of substance use, overdose experiences, and number of “protected” opioid use events, defined as involving naloxone and the presence of another person who could administer it, as well as measures of network characteristics and social support. We used modified Poisson regression with robust variance to estimate unadjusted and adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs).

Results

66% of participants had ever been trained to administer naloxone, 18% had used it in the past three months, and 32% had experienced a recent overdose (past 30 days). During recent opioid use events, 64% reported never having naloxone and a person to administer present. This was more common among those: aged ≥ 50 years (PR: 1.18 (CI 1.03, 1.34); who identified as non-Hispanic Black (PR: 1.27 (CI 1.05, 1.53); experienced higher levels of stigma consciousness (PR: 1.13 (CI 1.00, 1.28); and with small social networks (< 5 persons) (APR: 1.14 (CI 0.98, 1.31). Having a recent overdose experience was associated with severe opioid use disorder (PR: 2.45 (CI 1.49, 4.04), suicidality (PR: 1.72 (CI 1.19, 2.49), depression (PR: 1.54 (CI 1.20, 1.98) and positive urinalysis result for benzodiazepines (PR: 1.56 (CI 1.23, 1.96), but not with network size.

Conclusions

Results show considerable gaps in naloxone protection among people who use opioids, with more vulnerable and historically disadvantaged subpopulations less likely to be protected. Larger social networks of people who use opioids may be an important resource to curtail overdose mortality, but more effort is needed to harness the protective aspects of social networks.

A Mixed-Methods Evaluation of the Feasibility of a Medical Management-Based Text Messaging Intervention Combined With Buprenorphine in Primary Care

Background:

Mobile health (mHealth) tools offer an effective and personalized approach to enhance chronic disease management and may partially offset provider-level barriers to increasing buprenorphine prescribing in primary care. This study assessed the feasibility of integrating a text messaging-based medical management tool (TeMeS) in primary care among patients initiating buprenorphine.

Methods:

TeMeS messages are categorized per the medical management model, programed in a HIPAA-compliant texting software (Apptoto©), and delivered in a tiered fashion over 8-weeks to patients. This mixed-methods evaluation of TeMeS utilized key stakeholder feedback (patients, physicians, administrators, nursing), text messaging software process measures, thematic analysis of patient participant text message content, and electronic administrative data (eg, appointment adherence, treatment retention) at 2-months.

Results:

The study team approached 65 patients and n = 14 (21%) were ineligible or declined to participate in the study. Most eligible participants owned a smartphone (90%), responded to at least one text query (88%) over an average of 24 days, and few requested to stop receiving texts (6%). Participant text replies included responses to cognitive behavioral therapy-based queries (13.8%), confirming or rescheduling appointments (6.1%), and insurance, pharmacy, or clinical issues pertaining to buprenorphine dispensation or dosing (2%). Suggestions for design modifications included personalizing message content and adjusting message frequency per patient risk of illicit opioid reuse, use of video-based informational content, and real-time provider and staff support for emergent issues.

Conclusion:

Our findings highlight the acceptability, feasibility, and high rates of engagement of utilizing text messaging to enhance self-management among patients initiating buprenorphine treatment.

Sleep and Loneliness as Mechanisms Through Which Marital Quality Predicts Depression Among Older Adults

Pathways through which spousal support and strain influence older adults’ well-being are poorly understood. We examined sleep quality and loneliness as mechanisms through which support and strain predict depressive symptoms across ten years utilizing National Social Life, Health, and Aging Project data. Our sample included partnered participants at waves 1 and 2 (N = 1,293; 39% female, M age = 66, SD = 6.93). Support (e.g., rely on spouse) and strain (e.g., spouse criticizes you) were measured at W1, loneliness (UCLA) and sleep quality (restless sleep) were measured at W2, and depression (CES-D) was measured at W3. We estimated latent-variable structural equation models, controlling for age, gender, and W1 depression. Indirect effects of support and strain on depressive symptoms through loneliness were significant. There was an additional trend-level indirect effect of spousal strain on depressive symptoms through restless sleep. Findings highlight multiple pathways through which marital quality predicts later-life well-being.

Effects of Late-Life Health Transitions on Spouses’ Psychological Well-Being

Declining physical health likely affects not only older adults’ own well-being, but also that of their spouse. Using two waves of data from 610 couples in the National Social Life, Health and Aging Project, we examined effects of health declines over five years on change in self and spousal psychological well-being. Actor-Partner Interdependence Model findings showed that declines in spouses’ physical health (i.e., increased pain and decreased physical and cognitive function) predicted increases in older adults’ anxiety. Given the increasing importance of later-life social ties outside of marriage, we further considered the role of non-spousal health confidants. Preliminary findings suggest that effects of health declines on both partners’ well-being depend on the availability of these confidants. When older adults have people in addition to their spouse with whom they can talk about their health, detrimental effects of spouses’ declining health on older adults’ well-being are weakened for some health outcomes

Older Adults' Social Stress Profiles: A Cross-Country Comparison of the United States and Mexico

Older adults face heightened risks for loneliness due to social isolation. Low-quality relationships also fuel loneliness. Because living arrangements and family norms differ between countries, cultural differences may arise in the stress of isolation, loneliness, and difficult relationships. To examine social stress profiles in the US and Mexico, HRS (N=17,878) and MHAS (N=15,001) participants rated their loneliness, whether they lived alone, and relationship quality with their spouse, children, and friends. Five latent classes emerged in both samples: lonely and isolated; lonely with poor relationships; moderately lonely with ambivalent relationships; moderately lonely and unhappily married; and low social stress. Lonely isolation was most common among Americans (23.4%), but least common among Mexicans (14.0%). The highest risks for loneliness coincided with living alone in the US, but with low-quality relationships in Mexico. Results reveal undercurrents of older adults’ social stress that were common to both countries, as well as important cultural differences.

Prognostic value of brain tissues' volumes in patients with essential tremor treated with MRgFUS thalamotomy

MRgFUS Vim thalamotomy is a novel, effective, minimally invasive therapeutic option for patients with essential tremor (ET). Among the selection criteria, some parameters related to the patient's anatomy, such as the skull density ratio (SDR), are well recognized. The role of brain tissue interposed between the target and the ultrasound transducers has never been explored. Therefore, the purpose of our study was to evaluate the correlation and the possible predictive value between brain tissue volumes (grey matter - GM, white matter - WM, and cerebrospinal fluid - CSF) and several treatment-related variables (periprocedural parameters, MRI imaging findings, and the clinical outcome). We analysed data from thirty ET patients previously submitted to MRgFUS thalamotomy. Pre-treatment images were automatically segmented in sopra-tentorial (ST) WM, GM, and CSF using SPM 12. The most significant findings were a positive correlation of the ST-GM with the Accumulated Thermal Dose (ATD) (p < 0,001) and a negative correlation of the ATD temperature with ST-CSF and ST-TIV (p < 0,001). Ultrasound propagation speed is lower in fluids than brain tissues. Also, WM has an attenuation rate of 1.5 higher than the GM. Therefore, the difference in the ATD may be explained by the different acoustic properties of normal brain tissues interposed between the transducers and the VIM.

Synergy of diffraction and spectroscopic techniques to unveil the crystal structure of antimonic acid

The elusive crystal structure of the so-called 'antimonic acid' has been investigated by means of robust and state-of-the-art techniques. The synergic results of solid-state magic-angle spinning nuclear magnetic resonance spectroscopy and a combined Rietveld refinement from synchrotron X-ray and neutron powder diffraction data reveal that this compound contains two types of protons, in a pyrochlore-type structure of stoichiometric formula (H₃O)_1.20(7)H_0.77(9)Sb₂O₆. Some protons belong to heavily delocalized H₃O⁺ subunits, while some H⁺ are directly bonded to the oxygen atoms of the covalent framework of the pyrochlore structure, with O-H distances close to 1 Å. A proton diffusion mechanism is proposed relying on percolation pathways determined by bond-valence energy landscape analysis. X-ray absorption spectroscopy results corroborate the structural data around Sb⁵⁺ ions at short-range order. Thermogravimetric analysis and differential scanning calorimetry endorsed the conclusions on the water content within antimonic acid. Additional 0.7 water molecules per formula were assessed as moisture water by thermal analysis.

Harmful smartphone applications promoting alcohol and illicit substance use: a review and content analysis in the United States

Few studies have conducted analysis of commercially available smartphone applications designed to promote alcohol and illicit substance use. The aim of this review is to determine harmful themes of content in applications promoting alcohol and illicit substance use found using recovery app search terms. A systematic search, via Apple iTunes and Google Play stores, was conducted of applications targeting abstinence or reduced substance use in online app stores (n = 1,074 apps) in March 2018. We conducted a secondary analysis of apps encouraging alcohol and illicit substance use in July 2018. Our initial search yielded 904 apps pertaining to alcohol and illicit substance use. Four reviewers conducted a content analysis of 102 apps meeting inclusion criteria and assessed app design, delivery features, text, and multimedia content pertaining to substance use. The initial coding scheme was refined using a data-driven, iterative method grouping in thematic categories. The number of apps coded to a specific substance include: alcohol (n = 74), methamphetamine (n =13), cocaine (n = 15), heroin (n = 12), and marijuana (n = 15), with nine apps overlapping more than one substance. Key themes identified among apps included: (i) tangibility (alcohol home delivery services); (ii) social networks (builtin social media platforms promoting substance use); (iii) software design (gamification or simulation of substance use); and (iv) aesthetics (sexual or violent imagery). Despite claims of restricting apps promoting substance use, further efforts are needed by online app stores to reduce the availability of harmful content.

Diagnostic value of ECG characteristics in precordial leads V1-V3 for the diagnosis of the origin of outflow tract ventricular arrhythmias with a lead V3 precordial transition

Funding Acknowledgements

Type of funding sources: None.

Background and Purpose. To distinguish the origin of outflow tract ventricular arrhythmias (OTVAs) with a V3 precordial transition is still a challenge. To date, numerous diagnostic algorithms have been described, mainly by analysis of leads V1 and V2, while a complete study of lead V3 has never been conducted.

Methods. The ECG characteristics of 45 patients (Pts) with a left bundle branch block pattern OTVAs (LVOT 51.1%, RVOT 48.9%) who underwent successful catheter ablation were retrospectively analyzed. The region where the radiofrequency delivery resulted in the persistent suppression of the arrhythmia was identified as the site of origin.

For every duration or amplitude variable and for derivative indices, the comparison of means (U Mann Whitney or t-test), the determination of the AUC by ROC curves, and the correlation with BMI and BSA were performed. The odds ratio was calculated for every variable with an AUC ≥ 0.700. The three best results are described.

Results. Pts with a LVOT origin were older (59.91 ± 10.48 vs 50.95 ± 15.48, p = 0.027) and predominantly males (82.6% vs 54.5%, p = 0.042) but they shared similar BMI (24.74 ± 2.76 vs 24.09 ± 2.94, p = 0.45) and BSA (1.83 ± 0.12 vs 1.77 ± 0.16, p = 0.157).

In leads V1 – V2 the duration but not the amplitude of the R wave showed a significant correlation with the BSA; no variable, with the exception of the S wave amplitude, exhibited an AUC ≥ 0.700. Criteria based on the prevalence of the R wave in those leads were very specific but not sensitive as a V1 – V2 duration index ≥ 50% and a V1 – V2 amplitude ratio ≥ 30% were present only in 13.04 and 26.08% respectively of patients with a LVOT origin.

No measurement in lead V3 showed any correlation with auxological characteristics. The three best ECG variables were: 1) the V3 R wave duration index (R wave \ QRS duration); AUC 0.905, LVOT origin if ≥ 50%, OR 74.80 95% CI [7.97 – 701.48], p &lt; 0.001; 2) the V3 R wave duration; AUC 0.900, LVOT origin if ≥ 80 msec, OR 47.25 95% CI [7.73 – 288.82], p &lt; 0.001; 3) the V3 R wave percentage (amplitude of the R wave with respect to the global amplitude of the QRS, expressed as a percentage); AUC 0.888, LVOT origin if ≥ 50%, OR 36 95% CI [6.19 – 209.06], p &lt; 0.001.

Based on the V2 transition ratio calculation formula, we calculated the V3 transition ratio (AUC 0.843, LVOT origin if ≥ 1) which was very sensitive but less specific; OR 30 CI [3.32 – 270.37], p = 0.002.

To multivariate analysis, only a V3 R wave percentage ≥ 50% proved to be an independent predictor of LVOT origin; OR 9 CI [2.08 – 38.78], p = 0.003, even if the criterion with the highest accuracy was a V3 duration index ≥ 50% (88.89%).

Conclusions. Although it has been poorly analyzed in previous studies on the origin of OTVAs, the morphological characteristics of lead V3 seem to provide valid elements for the creation of diagnostic algorithms. Abstract Figure. Comparison of ECG characteristics

"I Felt I Was Reaching a Point with My Health": Understanding Reasons for Engagement and Acceptability of Treatment Services for Unhealthy Alcohol Use in Primary Care

INTRODUCTION/OBJECTIVES

Despite increasing need, there are large gaps in provision of care for unhealthy alcohol use. Primary care practices have become increasingly important in providing services for unhealthy alcohol use, yet little is known about the reasons patients engage in these services and their views on acceptability of such programs. The purpose of this study was to examine primary care patients' reasons for engagement, experiences with, and acceptability of a primary care practice-based program for treating unhealthy alcohol use.

METHODS

This qualitative study was conducted in a primary care practice that was developing a collaborative care model for treating unhealthy alcohol use in primary care. Semi-structured interviews were conducted with 24 primary care patients. Data were analyzed using conventional qualitative content analysis.

RESULTS

Findings suggest that patients engaged for both internal (concerns about drinking and health) and external reasons (family or provider concern). Patient experiences in the program were shaped by their affective responses (enjoyable, enlightening), as well as therapeutic benefits (gaining new insights about drinking; staff/provider support). Acceptability was driven by core program elements (medication, therapy, integration) as well as positive impacts on drinking cognition and behavior and flexible, patient-centered approaches.

CONCLUSIONS

Offering flexible and comprehensive programs with mutiple elements and both abstinence and moderation goals could also improve patient engagement and views on acceptability. Primary care practices will need to be thoughtful about the resources needed to implement these programs in terms of staffing, training, and program support.

The imaging fast ion D-alpha diagnostic (IFIDA) on DIII-D

An Imaging Fast Ion D-alpha (IFIDA) diagnostic, characterized by a high optical spatial resolution of ≤2 mm for accurate validation of energetic particle (EP) transport models, has been developed on DIII-D. The diagnostic provides a 2D image in the radial-poloidal plane of the FIDA signal generated by EP emission after charge exchange with an injected neutral beam. A narrow passband filter integrates the FIDA signal in the spectral region of 650-652 nm (blue-shifted FIDA tail), which is mostly generated by co-passing EPs of energies E ≃ 40-80 keV. A beam modulation technique is employed to estimate the active component of the signal, which is then used to compute EP profiles and gradients with a higher accuracy than the standard spectroscopic FIDA diagnostic. The current diagnostic time resolution is ≃3 ms. In this work, the IFIDA diagnostic design is explained and data are compared with the spectroscopic FIDA diagnostic, which shares the same viewing geometry, to assess the improvements in EP profile reconstruction.

Mn substitution effect on the local structure of La(Fe1-x Mn x )AsO studied by temperature dependent x-ray absorption measurements

The local structure of La(Fe1-x Mn x )AsO has been investigated using temperature dependent Fe K-edge extended x-ray absorption fine structure (EXAFS) measurements. The EXAFS data reveal distinct behavior of Fe-As and Fe-Fe atomic displacements with a clear boundary between x ⩽ 0.02 and x > 0.02. The Fe-As bondlength shows a gradual thermal expansion while the Fe-Fe bond manifests a temperature dependent anomaly at ∼180 K for x > 0.02. It is interesting to find characteristically different nature of Fe-As and Fe-Fe bondlengths shown by the temperature dependent mean square relative displacements. Indeed, the Fe-As bond, stiffer than that of the Fe-Fe, gets softer for x ⩽ 0.02 and hardly shows any change for x > 0.02. On the other hand, Fe-Fe bond tends to be stiffer for x ⩽ 0.02 followed by a substantial softening for x > 0.02. Such a distinction has been seen also in the As K-edge x-ray absorption near edge structure, probing local geometry around As atom together with the valence electronic structure. The results suggest that local atomic displacements by Mn substitution inducing increased iron local magnetic moment that should be the main reason for its dramatic effect in iron-based superconductors.

Links Between Rumination and Sleep Quality Among Older Adults: An Examination of the Role of Social Support

Rumination is a maladaptive coping strategy that gives rise to and sustains stress. Individuals who ruminate more, therefore, tend to sleep more poorly. Studies of rumination and sleep often neglect the role of social context. Social support may buffer the degree to which rumination predicts poorer sleep quality. Further, individuals with more support may ruminate less, resulting in better sleep quality. Finally, rumination may also erode social support, resulting in poorer sleep quality. The current study tested these three hypotheses within a sample of 131 partnered older adults. We examined support from spouses and friends/family separately. Findings indicated that spousal (not family/friend) support buffered the negative association between rumination and sleep quality. Neither type of support predicted rumination; however, rumination predicted lower levels of family/friend (not spousal) support. Thus, spousal support protects older adults’ sleep quality from rumination, and support from their peripheral ties may be more vulnerable to rumination.

Detecting illicit opioid content on Twitter

INTRODUCTION AND AIMS

This article examines the feasibility of leveraging Twitter to detect posts authored by people who use opioids (PWUO) or content related to opioid use disorder (OUD), and manually develop a multidimensional taxonomy of relevant tweets.

DESIGN AND METHODS

Twitter messages were collected between June and October 2017 (n = 23 827) and evaluated using an inductive coding approach. Content was then manually classified into two axes (n = 17 420): (i) user experience regarding accessing, using, or recovery from illicit opioids; and (ii) content categories (e.g. policies, medical information, jokes/sarcasm).

RESULTS

The most prevalent categories consisted of jokes or sarcastic comments pertaining to OUD, PWUOs or hypothetically using illicit opioids (63%), informational content about treatments for OUD, overdose prevention or accessing self-help groups (20%), and commentary about government opioid policy or news related to opioids (17%). Posts by PWUOs centered on identifying illicit sources for procuring opioids (i.e. online, drug dealers; 49%), symptoms and/or strategies to quell opioid withdrawal symptoms (21%), and combining illicit opioid use with other substances, such as cocaine or benzodiazepines (17%). State and public health experts infrequently posted content pertaining to OUD (1%).

DISCUSSION AND CONCLUSIONS

Twitter offers a feasible approach to identify PWUO. Further research is needed to evaluate the efficacy of Twitter to disseminate evidence-based content and facilitate linkage to treatment and harm reduction services.

PATIENTS’ PAIN AND THEIR SPOUSAL CAREGIVERS’ NEGATIVE AFFECT: THE MODERATING ROLE OF SELF-EFFICACY

Spousal caregivers of chronic pain patients may experience high levels of negative affect, perhaps in part because they regularly witness patients’ suffering. Yet, few studies have examined the relation between patients’ chronic pain and spousal caregivers’ negative affect. According to social cognitive theory, individuals’ self-efficacy may modulate how much negative affect they experience in response to stressful situations. The purpose of this study was to test the hypothesis that spousal caregivers would report higher levels of negative affect on days when patients experienced higher levels of knee pain. We also tested the hypothesis that patients’ and spouses’ self-efficacy for managing pain would each buffer this positive association. A total of 144 knee osteoarthritis (OA) patients and their spouses completed baseline interviews and a 22-day diary assessment. Multilevel models indicated that patients’ self-efficacy, but not spouses’ self-efficacy, moderated the positive association between patients’ pain and their spouses’ negative affect, even after controlling for spouses’ gender, age, and depressive symptoms. That is, spouses reported higher levels of negative affect on days when patients experienced more pain, but only among patients whose self-efficacy for managing pain was low. These findings suggest that patients’ self-efficacy for managing pain may serve as a protective factor for their spousal caregivers’ daily negative affect. Interventions targeting patients’ self-efficacy for managing pain may be beneficial for couples coping with knee OA.

Temperature dependent local atomic displacements in NaSn2As2 system

NaSn₂As₂ is mechanically exfoliable layered van der Waals (vdW) Zintl phase that is getting interesting due to its low thermal conductivity and recently observed superconductivity. Here, we have investigated the temperature dependent local structure of NaSn₂As₂ by a combined analysis of As K-edge and Sn K-edge extended x-ray absorption fine structure measurements. The system is intrinsically disordered with the interatomic distances largely consistent to those estimated by average structure measurements. The stretching force constants of different bond distances have been determined using temperature dependent mean square relative displacements. The Sn-As distance is the strongest bond in this system, having covalent nature, unlike the weaker interlayer distances which are characterized by vdW type bonding. Among them, As-Na distance is slightly weaker than Sn-Sn(i) below  ∼200 K and tends to get stronger above this temperature. The anomalous behavior of As-Na bond suggests that the mechanical exfoliation in this system is likely to be temperature dependent. The anomaly in the interlayer atomic correlations may be due to a charge density wave-like instability around this temperature, indicated by earlier experiments. The local structure and disorder are discussed in relation to the physical properties of NaSn₂As₂.

P1712The Impella percutaneous mechanical circulatory support device in cardiogenic shock: a single-center, real-world, observational experience

Background

The Impella () percutaneous mechanical circulatory support device is a catheter-based, impeller-driven, axial-flow pump. It reduces left ventricular (LV) stroke work and myocardial oxygen demand while increasing systemic and coronary perfusion in the setting of cardiogenic shock (CS).

Purpose

The aim of the study was to evaluate clinical characteristics and outcomes of patients with CS treated with Impella at our center.

Methods

Our single-center, real-world, observational registry included all consecutive patients with CS treated with Impella 2.5, CP, 5.0, or RP at our center from February 2013 to June 2018. Indication for Impella implantation was CS, defined as hypotension (systolic blood pressure <90 mmHg) despite adequate filling status with signs of hypoperfusion.

Results

A total of 130 patients were included in the registry, mean age was 61±12 years, and 79.2% were males. A history of prior MI, chronic heart failure, and chronic kidney disease was present in 28.9%, 26.1%, and 18.3%, respectively. The etiologies of CS were the following: fulminant myocarditis in 6.1% of the patients, acute coronary syndromes in 59.2%, peri-procedural CS during ventricular tachycardia ablation in 7.7% and acute heart failure in 27%. Out-of-hospital cardiac arrest was present in 30.4% of the patients; 60.2% were in INTERMACS I class at presentation. At admission, mean arterial pressure (MAP) was 65±18 mmHg, serum lactate was 6.7±5.5 mmol/L, mean left ventricular ejection fraction 21.4±11.7%, right ventricular dysfunction was indeed present in 48.6% of the patients. Inotropic drugs support was used in 66.4% of the patients. Impella 2.5, CP, and 5.0 were implanted in 76.1%, 15.4%, and 1.5% of the patients, respectively. Impella RP was also used in 11.5% of patients.The mean duration of support was 135±167 hours. Of note, extra-corporeal membrane oxygenation (ECMO) and intra-aortic balloon pump (IABP) were implanted before Impella insertion in 42.8% and 46.7% of the patients, respectively. Escalation to ECMO, ventricular assist device, or heart transplantation was needed in 35.8% of the patients. During hospital stay, acute kidney injury occurred in 56.7% of the patients; need of renal replacement therapy (RRT) 31.7%; access site-related bleeding 14.3%; life-threatening bleeding 31.5%; acute limb ischemia 14.5%; hemolysis 33.3%. The rate of all-cause mortality at 30 day was 39.7%. Need of RRT was the only independent predictor of 30-day mortality (OR 6.56; CI 1.71–25.15; p=0.006).

Conclusion

Our single-center, real-world, observational experience reports acceptable clinical outcomes after Impella implantation in a particularly complex population of patients with CS (INTERMACS class I in 60.2% of patients, prior use of ECMO in 42.8% of patients). All-cause mortality at 30 days was 39.7%, and need of RRT was the only independent predictor for 30-day mortality.

P5735Feasibility and safety of Impella mechanical circulatory support in different clinical scenarios: a single-centre experience

Background

The Impella (Abiomed, Danvers, MA) mechanical circulatory support is a catheter-based axial-flow pump. It reduces left ventricular (LV) stroke work and myocardial oxygen demand while increasing systemic and coronary perfusion in the setting of cardiogenic shock (CS), and it provides hemodynamic support during high-risk percutaneous coronary intervention (PCI).

Purpose

To evaluate the outcomes of Impella-supported patients in the context of CS and protected-PCI.

Methods

This single-center registry includes all patients implanted with Impella device at our institution between February 2013 and June 2018. Indications for Impella support were CS (hypotension despite adequate filling status with signs of hypoperfusion) and protected-PCI (prophylactic hemodynamic support during non-emergent high-risk PCI).

Results

A total of 145 patients were implanted with Impella: 130 (89.7%) for CS and 15 (10.3%) for protected-PCI. Among CS patients, mean age was 61.6±12.9, 79.2% males. The prevalence of chronic heart failure (HF) was 26.1%, prior myocardial infarction (MI) 29% and myocardial revascularization 36.6%, chronic kidney disease (CKD) 18.3%. Among protected PCI patients, mean age was 73.4±8.7 years, 86.7% males. The prevalence of HF was 85.7%, prior MI 42.9%, myocardial revascularization 35.7%, CKD 57.1%. In CS group, the indications for Impella implantation were myocarditis in 8 (6.2%) patients, acute coronary syndromes in 77 (59.2%), periprocedural ventricular tachycardia ablation CS in 10 (7.7%), decompensated heart failure in 26.9%. Out of hospital cardiac arrest occurred in 35 (30.4%) patients, INTERMACS I class in 70 (59.3%), mean arterial pressure was 65.4±18.4 mmHg, serum lactate 6.7±5.5 mmol/l, at least 1 inotropic agent use in 73 (66.4%), mean LV EF 21.4±11,7%, right ventricular dysfunction in 53 (48.6%). The rate of device-related complications was not negligible in CS group: 18 (14.5%) patients had limb ischemia and vascular surgery was required in 14, 17 (14.3%) had access-site bleeding. A total of 42 (33.3%) had haemolysis, and 67 (56.8%) acute kidney injury (AKI), half of whom requiring renal replacement therapy. Escalation to other therapies was necessary in 43 cases. Conversely, in the protected-PCI group a low rate of AKI (n=4, 28.6%) and acute limb ischemia (n=1, 7.1%) was observed, whereas no cases of haemolysis nor need of escalation therapy were recorded. Mean Impella support was 135.5±167.21 days for CS group, 60.6±80 for protected-PCI group. Survival at 30 days was 60.33% for CS group and 92.9% for protected-PCI group. One-year all-cause death was 50% for CS group and 13.3% for protected-PCI group.

Conclusion

Mechanical circulatory support with Impella is associated with good outcomes and reasonable rates of complications in the protected-PCI group, whereas less favorable results were observed in CS population probably due to the greater severity of clinical presentation.

A laser heating facility for energy-dispersive X-ray absorption spectroscopy

A double-sided laser heating setup for diamond anvil cells installed on the ID24 beamline of the ESRF is presented here. The setup geometry is specially adopted for the needs of energy-dispersive X-ray absorption spectroscopic (XAS) studies of materials under extreme pressure and temperature conditions. We illustrate the performance of the facility with a study on metallic nickel at 60 GPa. The XAS data provide the temperature of the melting onset and quantitative information on the structural parameters of the first coordination shell in the hot solid up to melting.

P1246Age-, body size-, and sex-specific reference values for tricuspid valve apparatus parameters by real-time three-dimensional transthoracic echocardiography

Background

and Purpose-Tricuspid valve (TV) apparatus parameters can vary significantly with demographic and anthropometric factors and could be useful for clinical decision making. Our aim was to (1) establish the reference values for TV apparatus parameters using transthoracic three-dimensional (3D) echocardiography; (2) investigate the influence of age, sex, and body size on TV anatomy.

Methods-A total of 180 healthy subjects referred in 2015 to our institution for a screening transthoracic echocardiography were enrolled (mean age 49.7+17.4 years, range 20 to 80 years: 30 subjects per age decade were included in the study, 15 for each gender). A real-time zoom 3D image of the TV and full volume 3D data set were collected from an apical window including TV using Philips iE33 and GE Vivid E9 Ultrasound Machines. After acquisition, the 3D data sets were analysed using 3D Qlab and EchoPAC PC softwares. The volumetric data set was analysed with multiplanar reformatting function to obtain three simultaneous orthogonal 2D slices (sagittal, coronal and axial planes). The following TV parameters were obtained and measured: 1. the 3D diastolic annular diameters (Major and Minor diameters); 2. the 3D diastolic annular area (TDAA); 3. the Tricuspid annular fractional area changes (TAFAC). Results are presented as mean ± SD. Differences between and among groups were tested for significance using the independent samples t-test and ANOVA test for continuous variables. Univariate Pearson correlation was used to assess the relation between these parameters and age, and body size. A p <0.05 was considered significant.

Results- Minor and major diastolic diameters in overall population were 26.1±3.9 and 32.3±4.1 mm, respectively. Minor diastolic diameter (mDD) (26.9±4.2 vs 25.1±3.4 mm, p <0.05) and major diastolic diameter (MDD) (33.4±4.0 vs 30.9±3.8, p <0.05) were significantly different between males and females. After normalization for BSA, mDD and MDD in overall population were 14.6±2.2 and 18.3±2.3 mm/m2. Normalized mDD (14.3±2.3 vs 14.9±2.2 mm/m2, p >0.05) and normalized MDD (18.1±2.4 vs 18.4±2.3 mm/m2, p>0.05) did not differ significantly between males and females. TTDAA and TAFAC in overall population were 76.7±17.3 mm2 and 29.6±8.6%. TDAA was significantly different between males and females (82.5±18.3 vs 69.7±13.0 mm2, respectively; p < 0.05); whereas TAFAC did not differ (28.8±8.2% vs 30.7±8.9%, p>0.05). After normalization for BSA, TDAA in overall population was 43.3±9.0 mm2/m2. Also normalized TDAA was significantly different between males and females (44.4±9.4 vs 42.0±8.4 mm2/m2, p < 0.05). mDD, MDD, TDAA and TAFAC showed no correlation with age (r = 0.16, p 0.04; r = 0.028, p 0.7; r = 0.17, p 0.27; r = 0.16, p 0.16; respectively).

Conclusion- This study can provide normal reference values for TV anatomic parameters that may be useful in the clinical practice, considering the effects of age, sex, and body size.

Temperature dependent EXAFS study on transition metal dichalcogenides MoX2 (X = S, Se, Te)

The local structure of molybdenum dichalcogenide MoX2 (X  =  S, Se, Te) single crystal has been studied by means of multi-edge (Mo, Se, and Te K-edges) extended x-ray absorption fine-structure spectroscopy as function of temperature. The temperature dependences of the interatomic distances Mo-X, Mo-Mo and X-X (X  =  S, Se, and Te) and of the corresponding Debye-Waller factors have been extracted over the 70-500 K temperature range. Exploiting the correlated Einstein model, we found that the Einstein frequencies of Mo-X and X-X bonds obtained by present data are in close agreement with the frequencies of the optical (Raman and infrared) stretching modes for both MoS2 and MoSe2, whereas a significant deviation has been found for MoTe2. A similar anomaly has been found for the force constants related to the Mo-X bonds in the MoTe2 case. Our findings, accordingly with the results reported in a recent theoretical paper, support the idea that the optical vibrational modes have a dominant role in MoS2 and MoSe2, whereas the effects of acoustic vibrational modes cannot be neglected in the case of MoTe2.

Identification of mutations in AP4S1/SPG52 through next generation sequencing in three families

BACKGROUND AND PURPOSE

The term hereditary spastic paraplegia (HSP) covers a spectrum of genetically heterogeneous disorders in which lower limb spasticity is the common clinical feature. Many patients with childhood-onset HSP are mistakenly diagnosed with cerebral palsy (CP).

METHODS

A group of as yet molecularly undiagnosed HSP patients were analyzed using SpastoPlex, a customized target re-sequencing panel able to investigate the coding regions of 72 genes linked to HSP, spastic ataxias or related motor diseases.

RESULTS

Our investigations identified loss-of-function mutations in AP4S1/SPG52 in four children (three families) who had previously received a diagnosis of diplegic/quadriplegic CP. The patients presented spastic paraparesis, mild facial dysmorphisms, moderate-to-severe intellectual disability and severe speech delay. Two patients manifested febrile seizures and childhood-onset focal seizures. In all the patients, brain magnetic resonance imaging (MRI) showed a peculiar hypoplastic posterior corpus callosum, often associated with ventriculomegaly, white matter loss and cerebral atrophy.

CONCLUSION

Adaptor protein 4 (AP-4) deficiency disorders should be suspected in children with spastic paraparesis, cognitive deficit and absent speech accompanied by suggestive MRI features. Seizures might be amongst the clinical manifestations of the syndrome.