An observational analysis of trends in rheumatic heart disease incidence and mortality in EU15+ countries over 29 years

Background

Rheumatic heart disease (RHD) is a debilitating sequela of acute rheumatic fever (ARF), caused by Group A streptococcus (GAS) infection. Repeated episodes of ARF results in valvular damage over time. As a preventable disorder which was once common worldwide, RHD has largely been eradicated in affluent nations due to widespread availability of penicillin, improvement in socioeconomic standards and advancements in health and social infrastructures. However, it has been speculated that the global refugee crisis, especially in Europe, might contribute to a resurgence of RHD cases in these regions.

Purpose

This observational study aimed to analyse trends in RHD incidence and mortality rates in European Union 15+ (EU15+) over a 29-year period.

Methods

Data was obtained from the Global Burden of Disease database. Age-standardised mortality and incidence rates for RHD were extracted for the EU15+ countries for the years 1990–2019. Trends were subsequently analysed using Joinpoint regression analysis.

Results

Over the 29-year period, an overall declining trend in RHD incidence and mortality across EU 15+ nations was observed. The United Kingdom demonstrated the largest decrease in RHD incidence amongst females (−54.9%) and Finland amongst males (−55.3%). Both RHD incidence and mortality were higher among females compared to males across EU15+ countries over the observed period. The most recent incidence trends, starting predominantly after 2014, demonstrated a rise in RHD incidence in most countries. For both sexes, increases were seen in Australia, Belgium, Ireland, Italy, Netherlands, Norway, Sweden and USA. For males specifically, increase in RHD incidence was seen in Spain, and Finland, and for females only in Canada and Ireland. The recent increasing RHD incidence rates ranged from +0.4% to + 24.7% for males and +0.6% to +11.4% for females.

Conclusion

Whilst overall there are decreases in incidence and mortality from RHD, we observe more than half of EU15+ countries have increasing incidence trends in RHD in recent years. This increasing trend primarily started after 2014, overlapping with the start of the European migration crisis. Although speculative, disparities in access to healthcare for migrants, amongst other socioeconomic factors, may be potential causes; subsequently, further efforts by governments and public health officials are required to recognise and control the resurgence of RHD in high income nations.

Funding Acknowledgement

Type of funding sources: None.

12 Trends in Neck of Femur Fracture Incidence in EU15+ Countries From 1990–2017

Background

Neck of femur fractures (NOFF) pose significant socio-economic costs to society with a high degree of morbidity and mortality. Its incidence rate has been collated within the Global Burden of Disease (GBD) database; however, to date, no comparison across countries has been reported.

Method

NOFF age-standardised incidence rates (ASIR) per 100,000 population were extracted from the GBD database for European Union (EU) 15+ countries over the period 1990 to 2017. Joinpoint regression analysis of the data identified trends in ASIR and associated estimated annual percentage changes (EAPC). These were analysed by specified timeframe, country, and gender.

Results

Of the 19 EU15+ countries, 11 (58%) had overall increases in NOFF ASIRs in 2017 compared to 1990. The median ASIRs were 240/100,000 and 322/100,000 for males and females, respectively, in 1990. By 2017, this had increased to 259/100,000 and 325/100,000, respectively. Females consistently had relatively higher NOFF ASIRs with a median gender fracture gap of 62/100,000 in 2017. Males had a higher percentage change in increasing ASIRs, with a smaller percentage change in decreasing ASIRs for all included countries. The highest national ASIRs was observed in Australia, followed by Finland and Belgium. Conversely the Mediterranean countries demonstrated the lowest ASIRs, closely followed by the USA.

Conclusions

Despite significant advances in primary and secondary hip fracture prevention strategies over the 28-year study period, significant increases in NOFF ASIRs among most EU15+ countries were observed, especially with respect to gender.

A247 MEDITATION AND YOGA FOR IRRITABLE BOWEL SYNDROME (MY-IBS): A RANDOMIZED CONTROLLED TRIAL

Background

When delivered in person, yoga is effective in managing Irritable Bowel Syndrome (IBS) symptoms. However, research is needed to determine the feasibility and effectiveness of yoga as a therapeutic option when delivered virtually.

Aims

The aim was to explore the feasibility and effectiveness of a yoga program, delivered virtually, for patients with IBS. We hypothesized the program would be feasible and effective in improving outcomes in the intervention group compared to the control group.

Methods

Adults diagnosed with IBS were randomized to receive either a Hatha yoga intervention or to an advice-only control group. The intervention consisted of facilitator-led weekly online classes for eight weeks delivered using Microsoft Office Teams and daily home practice. Yoga sessions included sequential delivery of postures, chanting, breathing exercises, and meditation over four weeks, with integrated practice over the final four weeks. Feasibility was evaluated with recruitment and attrition rates, adherence, and safety. The primary outcome was severity of IBS symptoms (IBS-Symptom Severity Score, IBS-SSS). Secondary outcomes included anxiety (General Anxiety Disorder-7), depression (Patient Health Questionnaire-9), and stress (Perceived Stress Scale) assessed at baseline and eight weeks. Unadjusted and adjusted analysis of variance (and covariance) models compared baseline and post-intervention data between groups using intent to treat analysis.

Results

Sixty-five participants participated (32 treatment, 33 control). The mean age was 44.2±14.1 years and 91% identified as female. Participants had been living with IBS for 11.7±11 years. Fifteen participants were lost to follow-up (20% attrition rate). Participants attended on average 5.9±1.7 out of a possible 8 sessions (74% adherence) and accumulated 1,187±545 minutes in daily practice over eight weeks. No adverse events were reported. The groups did not differ at baseline (P>0.05). From baseline to post intervention, unadjusted ANOVA models indicated the yoga program was not statistically superior to the control group for IBS-symptoms (-17.5 points; 95% CI -62.6 to 27.6; P = 0.440), anxiety (-0.91 points; 95% CI -2.47 to 0.64; P = 0.245) and stress (-0.65 points; 95% CI -1.73 to 0.44; P = 0.239). Significant differences between groups were seen for depression (-1.82 points; 95% CI -3.49 to -0.15; P = 0.033). A second model considered relevant covariates including age, comorbidities, and years since diagnosis (i.e., ANCOVA), and the results were similar to the unadjusted model.

Conclusions

Our virtual Hatha yoga and mediation program was feasible, and participants showed improvement in their depression scores. However, they did not experience a significant improvement in their IBS symptoms, anxiety, or stress, perhaps due to the short timeframe of the intervention.

Funding Agencies

None

Trends in incidence and mortality from non-rheumatic degenerative mitral valve disease across europe, over the past three decades

Background

Valvular heart disease is common globally; mitral regurgitation is the most common valve pathology in the general population and subsequently the second most frequent indication for valve surgery in Europe. Whilst the European epidemiology of aortic stenosis is well elucidated in the literature, no Europe-wide study has been undertaken to identify trends in incidence and mortality secondary to non-rheumatic degenerative mitral valve disease.

Purpose

Our aim is to describe trends in degenerative mitral valve disease incidence and mortality throughout Europe from 1990 to 2019.

Methods

We performed a temporal analysis of data deposited in the Global Burden of Disease Study Database across the European Union. We extracted age-standardised incidence and age-standardised mortality rates for 20 member states from the database. We graphically inspected the data and performed Joinpoint regression analysis to detect and summarise periods of significant change. These periods were described using estimated annual percentage change (EAPC).

Results

Trends in age-standardised incidence and mortality rates were heterogenous amongst the 20 member states included. A gender disparity in mortality rates favouring males were present in Austria, Belgium, Greece, Hungary and the Netherlands throughout the time period studied. Except for Hungary, this disparity was not reflected in the incidence rates for the aforementioned countries. Incidence rates of degenerative mitral valve disease in 2019 were highest in Italy for both males and females with 90.6 and 140.1 cases per 100,000 respectively. Mortality rates in 2019 were highest in the Netherlands for both males in females with 1.7 and 2.0 cases per 100,000 respectively; this was preceded by a downwards trend in mortality with an EAPC of −7.3% and −8.5% respectively. Other notable inflection points in incidence trends were observed in Italy, with an EAPC of −4.9% females between 1994 to 2004 followed by an EAPC of 0.8% between 2009 to 2019.

Conclusion

No overall trends in non-rheumatic mitral valve disease were observed throughout Europe, but gender disparities and some notable deviations in incidence and mortality rates from the European median were identified. Overall, however, incidence rates remained static in most countries studied despite the ubiquity of colour flow doppler echocardiography. Further analysis of the burden of mitral valve disease can help elucidate this geographical variation.

Funding Acknowledgement

Type of funding sources: None.

Trends in infective endocarditis mortality in the United Kingdom and EU 15+ countries between 1990–2019: an analysis of the Global Burden of Diseases database

Background

Infective Endocarditis (IE) is a relatively uncommon but lethal condition, with no convincing evidence to date of improving mortality trends (1). The epidemiology of IE is complex, driven by a wide range of constantly evolving factors. While marked international variation has been recently reported (2), temporal trends in mortality over recent decades remain unclear.

Purpose

To describe trends in IE mortality in high income countries over the last 30 years.

Methods

Age-standardised mortality rates (ASMR) for IE, stratified by sex, were extracted from the Global Burden of Disease (GBD) database (3) between 1990 and 2019. The United Kingdom and selected countries with comparable health expenditure (EU15+ countries) were included. Relative changes in ASMR over the observation period were determined and trends were analysed using Joinpoint regression analysis.

Results

Between 1990–2019 ASMR from IE increased for both sexes in all included countries except Finland (−20.1% in males, −15.1% in females) and Austria (−8.98% in males, −22.6% in females). The largest increase in ASMR in males was observed in Greece (+197%), while the largest increase in females was observed in Italy (246%). Joinpoint regression analysis identified multiple significant trends within this observation period (Figure 1; clear squares indicate males, filled circles indicate females and lines represent modelled trends based on joinpoint data). At the end of the observation period the Netherlands had the highest ASMR in both males and females (2.28/100,000 in males and 2.37/100,000 in females), while Finland had the lowest ASMR in both males and females (0.45/100,000 and 0.23/100,000 respectively).

Conclusions

Significant international variation in IE mortality rates were observed. While mortality from IE has generally increased over the last 30 years, recent data suggest this trend may now be plateauing or even reversing in certain countries.

Funding Acknowledgement

Type of funding sources: None. Figure 1

1447 Trends in Lower Extremity Amputation Incidence in European Union 15+ Countries 1990-2017

Aim

To assess trends in lower extremity amputation (LEA) incidence in European Union (EU15+) countries for the years 1990-2017.

Method

This was an observational study using data obtained from the 2017 Global Burden of Disease (GBD) Study. Age standardised incidence rates (ASIRs) for LEA (stratified into toe amputation, and LEA proximal to toes) were extracted from the GBD Results Tool (http://ghdx.healthdata.org/gbd-results-tool) for EU15+ countries for each of the years 1990-2017. Trends were analysed using Joinpoint regression analysis.

Results

Between 1990 and 2017, variable trends in the incidence of LEA were observed in EU15+ countries. For LEAs proximal to toes, increasing trends were observed in six of 19 countries and decreasing trends in nine of 19 countries, with four countries showing varying trends between sexes. For toe amputation, increasing trends were observed in eight of 19 countries and decreasing trends in eight of 19 countries for both sexes, with three countries showing varying trends between sexes. Australia had the highest ASIRs for both sexes in all LEAs at all time points, with steadily increasing trends. The USA observed the greatest reduction in all LEAs in both sexes over the time period analysed (LEAs proximal to toes: female patients 22.93%, male patients 29.76%; toe amputation: female patients 29.93%, male patients 32.67%). The greatest overall increase in incidence was observed in Australia.

Conclusions

Variable trends in LEA incidence were observed across EU15+ countries. These trends do not reflect previously observed reductions in incidence of PAOD over the same time period.

Analysis of Antimicrobial and Antibiofilm Activity of Human Milk Lactoferrin Compared to Bovine Lactoferrin against Multidrug Resistant and Susceptible Acinetobacter baumannii Clinical Isolates

Acinetobacter baumannii is an opportunistic bacterial pathogen that causes severe infections in immunocompromised patients. The emergence of multi- and pan-drug resistant strains of A. baumannii from clinical sources has confounded treatment and enhanced morbidity and mortality associated with these infections. One way that A. baumannii circumnavigates environmental and antimicrobial challenge is by forming tertiary architectural structures of cells known as biofilms. Biofilm-inhibiting molecules could be deployed as a potential chemotherapeutic strategy to inhibit or disrupt A. baumannii biofilms and mitigate adverse outcomes due to infection. Lactoferrin is an innate immune glycoprotein produced in high concentrations in both human and bovine milk which has previously been shown to have antibacterial and antibiofilm activities. We sought to test lactoferrin against a bank of clinical isolates of A. baumannii to determine changes in bacterial growth or biofilm formation. Our results indicate that human lactoferrin has slightly more potent antibacterial activities than bovine lactoferrin against certain strains of A. baumannii and that these effects are associated with anatomical site of isolation. Additionally, we have shown that both bovine and human lactoferrin can inhibit A. baumannii biofilm formation and that these effects are associated with anatomical site of isolation and whether the strain forms robust or weak biofilms.

O48 Incongruous trends in peripheral arterial disease and amputation in Australia

Introduction

We aimed to compare the incidence trends for peripheral arterial disease (PAD) and lower extremity amputation (LEA) in Australia with European Union (EU) 15+ countries.

Method

For the years 1990–2017, we extracted PAOD and LEA incidence data from the Global Burden of Disease (GBD) Study and compared trends across EU15+ countries (19 countries with similar health expenditure—including Australia, the US and the UK).

Result

In 2017, the age-standardised incidence rate (ASIR) for PAOD was lower in Australia than any other EU15+ country for males (90.0/100,000) and third lowest in females (99.9/100,000) (only females in Norway and Spain had lower 2017 ASIRs for PAD). However for LEA, the 2017 ASIRs were higher in Australia for both sexes than in any other EU15+ country (male 119.8/100,000, female 78.0/100,000).

Furthermore, contrasting and anomalous time trends in the incidence of PAOD and LEA were observed in Australia between 1990–2017. The PAOD ASIR decreased over the 28-year period for both males (-16.5%) and females (-17.4%), whereas the LEA ASIR increased over the same time period for both sexes (males +12.5%, females +10.3%). Given the frequency with which LEAs are precipitated by PAOD, these divergent trends were unexpected, especially within a developed country such as Australia.

Conclusion

Our data raises the concern that the true incidence of PAOD in Australia is under-diagnosed, with at-risk patients potentially being recognised late in the disease-process, manifesting as high amputation rates relative to countries with similar health expenditure.

Take-home Message

Australia has anomalous trends in amputation and peripheral arterial disease when compared with other countries with similar health expenditure. Our data raises the concern that the true incidence of PAOD in Australia is under-diagnosed, with at-risk patients potentially being recognised late in the disease-process, manifesting as high amputation rates relative to countries with similar health expenditure.

Analysis of virulence phenotypes and antibiotic resistance in clinical strains of Acinetobacter baumannii isolated in Nashville, Tennessee

BACKGROUND

Acinetobacter baumannii is a gram-negative bacterium which causes opportunistic infections in immunocompromised hosts. Genome plasticity has given rise to a wide range of strain variation with respect to antimicrobial resistance profiles and expression of virulence factors which lead to altered phenotypes associated with pathogenesis. The purpose of this study was to analyze clinical strains of A. baumannii for phenotypic variation that might correlate with virulence phenotypes, antimicrobial resistance patterns, or strain isolation source. We hypothesized that individual strain virulence phenotypes might be associated with anatomical site of isolation or alterations in susceptibility to antimicrobial interventions.

METHODOLOGY

A cohort of 17 clinical isolates of A. baumannii isolated from diverse anatomical sites were evaluated to ascertain phenotypic patterns including biofilm formation, hemolysis, motility, and antimicrobial resistance. Antibiotic susceptibility/resistance to ampicillin-sulbactam, amikacin, ceftriaxone, ceftazidime, cefotaxime, ciprofloxacin, cefepime, gentamicin, levofloxacin, meropenem, piperacillin, trimethoprim-sulfamethoxazole, ticarcillin- K clavulanate, tetracyclin, and tobramycin was determined.

RESULTS

Antibiotic resistance was prevalent in many strains including resistance to ampicillin-sulbactam, amikacin, ceftriaxone, ceftazidime, cefotaxime, ciprofloxacin, cefepime, gentamicin, levofloxacin, meropenem, piperacillin, trimethoprim-sulfamethoxazole, ticarcillin- K clavulanate, tetracyclin, and tobramycin. All strains tested induced hemolysis on agar plate detection assays. Wound-isolated strains of A. baumannii exhibited higher motility than strains isolated from blood, urine or Foley catheter, or sputum/bronchial wash. A. baumannii strains isolated from patient blood samples formed significantly more biofilm than isolates from wounds, sputum or bronchial wash samples. An inverse relationship between motility and biofilm formation was observed in the cohort of 17 clinical isolates of A. baumannii tested in this study. Motility was also inversely correlated with induction of hemolysis. An inverse correlation was observed between hemolysis and resistance to ticarcillin-k clavulanate, meropenem, and piperacillin. An inverse correlation was also observed between motility and resistance to ampicillin-sulbactam, ceftriaxone, ceftoxamine, ceftazidime, ciprofloxacin, or levofloxacin.

CONCLUSIONS

Strain dependent variations in biofilm and motility are associated with anatomical site of isolation. Biofilm and hemolysis production both have an inverse association with motility in the cohort of strains utilized in this study, and motility and hemolysis were inversely correlated with resistance to numerous antibiotics.

Abstract PO-089: Profiling of salivary proteome specific for the diagnosis of head and neck cancer among African Americans

Head and Neck Squamous Cell Carcinoma (HNSCC) is one the types of Cancer in The United States with inequality in the mortality rate among Black patients when compared to White patients. Patients of European dissent (Whites) are more likely to be diagnosed with any type of HNSCC but patients of African dissents (Blacks) are more likely to die from ant type of HNSCC when all patients are HPV negative. The difference in survival based on race and ethnicity prompted the need for a better and early diagnostic marker for HNSCC among Blacks and other groups with poor prognosis of HNSCC. The present research seeks to identify a specific and safe salivary proteome marker for the early diagnosis of HNSCC. The hypothesis of this article is that there is a significant difference in the salivary proteome of AA patients with HNSCC when compared to WA patients which is specific to cancer site. Eight patient samples with confirmed diagnosis of Laryngeal cancer at Nashville General hospital (IRB Protocol Number 14-03-172) were collected with appropriate informed consent. Patient samples were pooled together and analyzed using IHC for the presence of shared protein expression. Each protein sample was later analyzed individually using IHC in order to obtain specific proteins expressed by each patient’s salivary proteome. A Multidimensional Protein Identification Technology (MUDPIT) was used to analyze salivary samples to increase resolution for identifying proteins and peptides. MUDPIT was used to increase resolution of analyzed proteins and was compared with other proteins associated with LaCa using a known online protein database called WebGestalt. The most highly expressed proteins in each of the samples were further analyzed using The Human Protein Atlas in order to study the location of the salivary proteome and its function when expressed. 20 unique protein genes obtained from Label Free Quantification (LFQ) analysis was further analyzed for the function of the genes and gene co-localization in the body using an online database known as GeneMANIA. Finally, PEAKS was used to ascertain the effect of proteins. Result shows differences in the salivary proteome of AA patients compared to WA’s. Specifically, proteins involved in transcriptional mis-regulation were over- represented in AA>WA patients which included some proteins associated with metastasis (JUP), dis-functional immune cells (CD14), over-expressed tumor- suppressor proteins (DMBT1 and DRB2) and elevated level of antimicrobial innate immunity (His 1 & 3) are all higher than the normal values in healthy patients without LaCa both among AA and WA. Future research is required to expand on these identified proteins to help provide a safe and specific biomarker for the diagnosis of LaCa among AA patients. Future research can also provide direction as to where therapeutics can be directed and how they can be safely administered to generate the most effective treatment that can improve the prognosis of the disease among AA patients and others with groups with poor prognosis.

Citation Format: Oyinloye A. Jose, Oladipupo Anibire, Derek Wagner, Dana Marshall, Billy Ballard, Siddharth Pratap, Victor Paramov. Profiling of salivary proteome specific for the diagnosis of head and neck cancer among African Americans [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-089.

Abstract PO-233: HPV+ and HPV- HNSCC show similar nrf2 nuclear and cytoplasmic staining patterns

This study set out to observe and better understand the differences, if any, in staining patterns for the oxidative stress response transcription factor Nrf2 in HNSCC patients who were HPV+ non- tobacco and alcohol users vs. HPV- tobacco and alcohol users. Increased Nrf2 activity is associated with resistance to therapy and poor outcomes. Tissues samples were obtained from the head and neck cancer repository of Nashville General Hospital at Meharry and Meharry Medical College. Nashville General Hospital at Meharry is a safety net hospital that serves the under- and uninsured citizens of Davidson County TN. FFPE sections were stained with anti- human Nrf2 antibody (Abcam 31163) and scored using a semi-quantitative evaluation gradient scale from 0-3 with 0 indicating no stain and 3 indicating strong positive Nrf2 staining. This study made use of 5 HPV+ and 2 HPV- patients. The results show that all HNSCC in the HPV+ and HPV- samples revealed positive staining for Nrf2 that ranged from weak to intense. We observed that the poorly differentiated HNSCC had a strong positive nuclear stain for Nrf2 when compared to lower tumor grades. Irrespective of whether the patient was in the HPV+ nonsmoker-nondrinker or HPV- smoker-drinker group, histological data indicates there was a positive correlation between increased Nrf2 staining and worsening tumor grade. These preliminary data suggest that potential use of Nrf2 as a prognostic biomarker for HNSCC will need to be evaluated differently for HPV+ and HPV- tumors, as HPV+ tumors are generally more responsive to therapy. Developing therapy that specifically targets Nrf2 could potentially play an immense role in managing HNSCC. Some of the limitations encountered in this study includes limited sample size.

Citation Format: Oladipupo O. Anibire, Oyinloye Jose, Kenyada Williams, Billy R. Ballard, Michael G. Izban, Dana Marshall. HPV+ and HPV- HNSCC show similar nrf2 nuclear and cytoplasmic staining patterns [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-233.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

Autism Spectrum Social Stories In Schools Trial 2 (ASSSIST2): study protocol for a randomised controlled trial analysing clinical and cost-effectiveness of Social Stories™ in primary schools

Background

Interventions designed to support children with a diagnosis of Autism Spectrum Conditions (ASC) can be time consuming, needing involvement of outside experts. Social Stories™ are a highly personalised intervention aiming to give children with ASC social information or describing an otherwise difficult situation or skill. This can be delivered daily by staff in education settings. Studies examining Social Story™ use have yielded mostly positive results but have largely been single case studies with a lack of randomised controlled trials (RCTs). Despite this numerous schools are utilising Social Stories™, and a fully powered RCT is timely.

Methods

A multi-site pragmatic cluster RCT comparing care as usual with Social Stories™ and care as usual. This study will recruit 278 participants (aged 4–11) with a clinical diagnosis of ASC, currently attending primary school in the North of England. Approximately 278 school based staff will be recruited to provide school based information about participating children with approximately 140 recruited to deliver the intervention. The study will be cluster randomised by school. Potential participants will be screened for eligibility prior to giving informed consent. Follow up data will be collected at 6 weeks and 6 months post randomisation and will assess changes in participants’ social responsiveness, goal based outcomes, social and emotional health. The primary outcome measure is the Social Responsiveness Scale Second Edition (SRS-2) completed by school based staff at 6 months. Approvals have been obtained from the University of York’s Research Governance Committee, Research Ethics Committee and the Health Research Authority. Study results will be submitted for publication in peer-reviewed journals and disseminated to participating families, educational staff, local authority representatives, community groups and Patient and Participant Involvement representatives. Suggestions will be made to NICE about treatment evidence dependent on findings.

Discussion

This study addresses a much used but currently under researched intervention and results will inform school based support for primary school children with a diagnosis of ASC.

Trial registration

The trial is registered on the ISRCTN registry (registration number: ISRCTN11634810). The trial was retrospectively registered on 23rd April 2019.

Abstract B129: Does insurance status explain the racial disparity in survival outcome seen in upper aerodigestive tract cancers in the United States?

Upper Aerodigestive tract (UADT) cancers are primarily squamous cell carcinomas that affect the oral cavity (hard palate, front 2/3 of tongue, gums, mucosal lining of lips and cheeks, and the floor of the mouth), oropharynx (base of the tongue, soft palate, and tonsils), hypopharynx, larynx (epiglottis and vocal cords), and the upper third of the esophagus with a five-year survival rate of 65.3% for oral cavity and pharyngeal cancers. If the cancer is detected during the localized stage, the survival rate improves to 84.4% (SEER 18 2009-2015).There have been several risk factors implicated in the pathogenesis of UADT cancers such as, male gender, smoking, alcohol use, and infection with human papilloma virus (HPV) for oropharyngeal cancers. The current literature suggests that regardless of stage people of African descent have a lower incidence of UADT cancers, but higher mortality rates compared to Caucasians. There are many proposed explanations for this paradoxical trend seen in African Americans. However, there is a paucity of research addressing this problem. We seek to understand if socioeconomic status is the underlying factor driving this disparity. We analyzed de-identified data collected from the Surveillance, Epidemiology, and End Results (SEER) program for 114,510 UADT cancer patients diagnosed from 2007-2016. We hypothesized that people who were uninsured or on Medicaid would have a life expectancy that was significantly reduced compared to those that had private insurance or Medicare regardless of race, tumor grade, gender or site of the cancer. Our study design is retrospective cohort. Our multivariate analysis model utilizes survival analysis techniques such as Kaplan-Meier survival, hazard curves and proportional hazards regression to analyze the survival time of our patients as a function of demographic and clinical variables. Survival months ranged from 0 to 119 months, with 25,122 patients experiencing death due to UADT cancers. The proportional hazards regression revealed that across all insurance groups (Insured, Uninsured, Medicaid, and Unknown) the survival time for Non-Hispanic Black People was significantly reduced compared to the other race/ethnicities (Asians, Caucasians, Hispanics (all races)) with Non-Hispanic Caucasians having the highest survival rate. Determining that the racial disparity exists regardless of insurance status, tumor grade, gender, and site of cancer can guide future researchers to focus on biological differences or other factors such as lack of access to care that underlie disease survival for UADT cancers.

Citation Format: Joycemary G Amponsem, Dana Marshall, Derek Wilus, Mohammad Tabatabai. Does insurance status explain the racial disparity in survival outcome seen in upper aerodigestive tract cancers in the United States? [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B129.

Abstract D129: The salivary proteome of African American and white American males diagnosed with laryngeal cancer

Early detection of head and neck cancers (HNCa) correlate with improved outcomes. Salivary proteins may potentially be used for effective screening, which may result in increased survival time. This project aims to find potential biomarkers for laryngeal cancer, which ultimately could be detected by testing saliva or a swab of the back of the mouth. These simple screening methods would be of great benefit to high-risk individuals, and could potentially decrease disparities seen between minorities and white Americans. African American (AA) and white American (WA) men share similar incidences of laryngeal and tonsillar cancer, which affect men at a much higher rate than women. Among AA and WA men there is an alarming disparity, in which AA men are two to three times more likely to succumb to their disease. It is hypothesized that the salivary proteomes for tonsillar and laryngeal cancer, from AA and WA men, possess prognostic potential illustrating an association with the molecular characteristics of the tumor. MUDPIT proteomic analysis was done on four groups of pooled samples, four per group. Samples were collected with the approval of the Meharry Medical College Institutional Review Board. Inclusion criteria were males diagnosed with late stage (III or IV) laryngeal or tonsillar HNCa, active smokers, and HPV negative. Exclusion criteria were non-smokers and HPV positive. Groups were designated as AA/T, WA/T, AA/L and WA/L. A total number of 117 proteins were identified. AA/L had 111 proteins while WA/L had 116 proteins. Twenty proteins were detected from 1.6-fold to 1.62E+06 –fold greater in AA/L relative to WA/L. Eighty proteins were detected from 1.5-fold to 7.9E+07-fold greater in WA/L relative to AA/L. The resulting salivary proteomes were analyzed using WebGestalt. Pathway analysis for AA/L vs WA/L showed significant alignment with Reactome pathways. 8 proteins were found to be associated with innate immune function. There were no significant categories for enrichment category disease_Disgenet, however several proteins aligned with cancer categories at a non-significant level, such as annexin A1. Disease_GLAD4U recognized a statistically significant enrichment category of dental plaque. Represented proteins include CA6, PRH1 and MUC5B. Pathway analysis with KEGG, Panther and Reactome, were used for proteins greater in WA/L, and revealed overrepresentation of proteins associated with metabolic activity, hypoxia and the innate immune system. In addition, disease_disgenet showed proteins mapping to mouth neoplasms, SCC of esophagus, and cancer invasion. Finally, GLAD4U showed significance with periodontal diseases, ischemia and inflammation. A limitation of this research is the small sample size, nevertheless the potential differences between racial groups promotes further investigation. Exploration of these specific proteins or protein signatures can give insight into varying physiological responses to disease and can be used to create a more personalized therapeutic approach.

Citation Format: Derek Wagner, Hannah Trew, Billy Ballard, Victor Paramov, Sid Pratap, Dana Marshall. The salivary proteome of African American and white American males diagnosed with laryngeal cancer [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D129.

Determination of Oxytetracycline/Oxytetracycline Hydrochloride in Animal Feed, Fish Feed, and Veterinary Medicinal Products by Liquid Chromatography with Fluorescence Detection: Collaborative Study

A method for determining oxytetracycline (OTC) in animal feed, fish feed, and veterinary medicinal products at medicated use and contamination levels was collaboratively studied. The method is applicable to the analysis of animal feeds and mineral premixes containing levels 2 mg/kg, and fish feed containing levels 10 mg/kg. Oxytetracycline hydrochloride (OTC.HCl) is extracted from ground feed material in acidmethanol solution using mechanical agitation. After centrifugation for 5 min at 1230 g, an aliquot of the extract is diluted with water and/or acidmethanol so that the concentration of OTC.HCl is approximately the same as that in the working standard, and the solutions contain at least 50 water. Injectable veterinary medicinal materials (also called animal remedy materials) are diluted with water and/or extractant to reach the target concentration. The extracts are filtered and analyzed by reversed-phase liquid chromatography with fluorescence detection with excitation at 390 nm and emission at 512 nm. Twenty-eight test samples of medicated feeds, supplements, and drug premixes, including 4 test samples for trace-level analysis, were sent to 17 collaborators in Canada, The Netherlands, and the United States. Results were received from 11 laboratories. The RSDr values (within-laboratory repeatability) ranged from 1.26 to 9.21; RSDR values (among-laboratory reproducibility) ranged from 2.14 to 12.9, and HorRat values ranged from 0.54 to 3.02. It is recommended that this method be adopted AOAC Official First Action.

P5664Trends in incidence and mortality from atrial fibrillation across europe, 1990 - 2017

Background

Atrial fibrillation (AF) is one of the most common arrhythmias found in the general population, carrying risk of associated cardiovascular and cerebrovascular complications, and presenting a significant global health burden. Better understanding of its epidemiology may have public health implications.

Purpose

To describe trends in AF incidence and mortality throughout Europe from 1990 to 2017.

Methods

We performed a temporal analysis of data deposited in the Global Burden of Disease Study Database for countries across the European Union. We extracted age-standardised incidence and age-standardised death rates from the database and graphically inspected the data, as well as summarised the changes in trends using percentage change from the beginning of the observation period (1990) to the end of the observation period (2017).

Results

A total of 24 member states were included. In 1990, the overall median male incidence and mortality from AF were 81.4 cases per 100,000 and 5.0 deaths per 100,000 respectively. The corresponding female median incidence and mortality in 1990 were 66.3 cases per 100,000 and 7.3 deaths per 100,000 respectively. Mortality rates in 2017 were highest in Sweden and Germany. There was an increasing trend in all countries between 1990 and 2017 for both incidence and mortality. For men, the countries with the greatest percentage increases in incidence were Slovenia (+77%) and Poland (+71%). For women, the greatest increases in AF incidence were in Poland (+58%) and Estonia (+48%). The greatest percentage increases in AF related mortality were, in men, Estonia (+195%) and Sweden (+145%), and, in women, Greece (+151%) and Bulgaria (+147%).

Conclusion

AF represents a significant health burden in an aging population; general increases in incidence rates may suggest improvement in detection throughout Europe. However, AF associated mortality is more pronounced in Western Europe.

Systematic review of methods for quantifying teamwork in the operating theatre

Background

Teamwork in the operating theatre is becoming increasingly recognized as a major factor in clinical outcomes. Many tools have been developed to measure teamwork. Most fall into two categories: self‐assessment by theatre staff and assessment by observers. A critical and comparative analysis of the validity and reliability of these tools is lacking.

Methods

MEDLINE and Embase databases were searched following PRISMA guidelines. Content validity was assessed using measurements of inter‐rater agreement, predictive validity and multisite reliability, and interobserver reliability using statistical measures of inter‐rater agreement and reliability. Quantitative meta‐analysis was deemed unsuitable.

Results

Forty‐eight articles were selected for final inclusion; self‐assessment tools were used in 18 and observational tools in 28, and there were two qualitative studies. Self‐assessment of teamwork by profession varied with the profession of the assessor. The most robust self‐assessment tool was the Safety Attitudes Questionnaire (SAQ), although this failed to demonstrate multisite reliability. The most robust observational tool was the Non‐Technical Skills (NOTECHS) system, which demonstrated both test–retest reliability (P > 0·09) and interobserver reliability (Rwg = 0·96).

Conclusion

Self‐assessment of teamwork by the theatre team was influenced by professional differences. Observational tools, when used by trained observers, circumvented this.

Twenty-eight years of liaison psychiatry at a general hospital

Aims and method

A questionnaire was used to measure physician satisfaction with the unit and comparison of referral numbers and diagnoses with 1967, when the unit was new, and in 1985 when it was re-audited.

Results

Despite physicians' satisfaction with the service, the referral rate remains unchanged.

Clinical implications

Liaison psychiatry should not concern itself with trying to increase referral rates. Research into patient outcome should be a priority and guide its future direction.

Prediction of haematocrit in dried blood spots from the measurement of haemoglobin using commercially available sodium lauryl sulphate

Background When preparing dried blood spots (DBSs), haematocrit (Hct) can affect the ability of the blood to spread through the filter paper, thus resulting in varying quantities of sample being measured when fixed subpunches of the DBSs are taken. It may be important to predict the sample Hct to correct volume differences. Methods Blood (10  µL) was applied to Perkin Elmer 226® paper. The samples ( n = 165) were allowed to dry for 24 h, and the entire blood spots were cut out. Subpunch analysis was also performed on blood spots prepared from 75  µL EDTA blood, taking 6 mm subpunches centrally and peripherally from the spots ( n = 59). The spots were eluted with 100  µL water, and a 10  µL aliquot of lysate was added to sulfolyser reagent (80  µL) in a microtitre plate. Hb was measured at 550 nm using an ELISA plate reader. DBS samples were compared against blood samples measured on a routine Sysmex XN-9000 analyser. Results The Passing and Bablock regression showed Hct (DBS-predicted) = 0.99 Hct (Sysmex) -0.02, R²= 0.87. Intra-assay imprecision measured at Hct values of 0.27, 0.40 and 0.52, gave CVs of 4.1%, 2.8% and 4.2%, respectively. Inter-assay imprecision showed CVs of 6.2%, 5.2% and 4.2%, respectively. DBS samples were stable for up to two days at 60℃, one month at room temperature and six months at 4℃. Conclusion This method provides a simple and fast estimation of predicted Hct in dried blood spots.

Tolerability and Adherence Problems in Patients on a Stable Dose of Methotrexate: Results of a Multicentre Survey

INTRODUCTION

Methotrexate is commonly used in patients with inflammatory arthritis. The aim of the present study was to ascertain the prevalence of side effects that patients on methotrexate were tolerating and to establish their adherence to the medication.

METHOD

A questionnaire was developed for completion by the healthcare professional with the patient, and piloted in one centre. The questionnaire was then used in six other centres, with the addition of a question about the attractiveness of stopping methotrexate treatment. Efficacy and toxicities were scored for severity on a 10-cm visual analogue scale (VAS). Adherence to the drug was also explored.

RESULTS

The prevalence of 'any side effect' ranged from 57% to 86%. The most frequent side effects were fatigue (53%); nausea (38%); mouth ulcers (23%) and hair loss (23%). Efficacy averaged 6.5 cm on the VAS. Results from the combined survey revealed that toxicity averaged 5.9 cm for fatigue, 4.8 cm for nausea, 4.4 for mouth ulcers, 3.9 cm for hair loss and 5.7 cm for 'other' side effects. 13.5% of patients revealed that they had forgotten to take the drug for an average of two weeks, and 25% for an average of 2.5 weeks in the previous year. Participants were more likely to reveal this to a nurse than a doctor.

CONCLUSION

Patients put up with a considerable number of side effects in order to benefit from methotrexate therapy. Adherence to this drug merits further study. Copyright © 2015 John Wiley & Sons, Ltd.

Proceedings of the 15th Annual UT-KBRIN Bioinformatics Summit 2016

I1 Proceedings of the Fifteenth Annual UT- KBRIN Bioinformatics Summit 2016

Eric C. Rouchka, Julia H. Chariker, Benjamin J. Harrison, Juw Won Park

P1 CC-PROMISE: Projection onto the Most Interesting Statistical Evidence (PROMISE) with Canonical Correlation to integrate gene expression and methylation data with multiple pharmacologic and clinical endpoints

Xueyuan Cao, Stanley Pounds, Susana Raimondi, James Downing, Raul Ribeiro, Jeffery Rubnitz, Jatinder Lamba

P2 Integration of microRNA-mRNA interaction networks with gene expression data to increase experimental power

Bernie J Daigle, Jr.

P3 Designing and writing software for in silico subtractive hybridization of large eukaryotic genomes

Deborah Burgess, Stephanie Gehrlich, John C Carmen

P4 Tracking the molecular evolution of Pax gene

Nicholas Johnson; Chandrakanth Emani

P5 Identifying genetic differences in thermally dimorphic and state specific fungi using in silico genomic comparison

Stephanie Gehrlich, Deborah Burgess, John C Carmen

P6 Identification of conserved genomic regions and variation therein amongst Cetartiodactyla species using next generation sequencing

Kalpani De Silva, Michael P Heaton, Theodore S Kalbfleisch

P7 Mining physiological data to identify patients with similar medical events and phenotypes

Teeradache Viangteeravat, Rahul Mudunuri, Oluwaseun Ajayi, Fatih Şen, Eunice Y Huang

P8 Smart brief for home health monitoring

Mohammad Mohebbi, Luaire Florian, Douglas J Jackson, John F Naber

P9 Side-effect term matching for computational adverse drug reaction predictions

AKM Sabbir, Sally R Ellingson

P10 Enrichment vs robustness: A comparison of transcriptomic data clustering metrics

Yuping Lu, Charles A Phillips, Michael A Langston

P11 Deep neural networks for transcriptome-based cancer classification

Rahul K Sevakula, Raghuveer Thirukovalluru, Nishchal K. Verma, Yan Cui

P12 Motif discovery using K-means clustering

Mohammed Sayed, Juw Won Park

P13 Large scale discovery of active enhancers from nascent RNA sequencing

Jing Wang, Qi Liu, Yu Shyr

P14 Computationally characterizing genomic pipelines and benchmarking results using GATK best practices on the high performance computing cluster at the University of Kentucky

Xiaofei Zhang, Sally R Ellingson

P15 Development of approaches enabling the identification of abnormal gene expression from RNA-Seq in personalized oncology

Naresh Prodduturi, Gavin R Oliver, Diane Grill, Jie Na, Jeanette Eckel-Passow, Eric W Klee

P16 Processing RNA-Seq data of plants infected with coffee ringspot virus

Michael M Goodin, Mark Farman, Harrison Inocencio, Chanyong Jang, Jerzy W Jaromczyk, Neil Moore, Kelly Sovacool

P17 Comparative transcriptomics of three Acinetobacter baumanii clinical isolates with different antibiotic resistance patterns

Leon Dent, Mike Izban, Sammed Mandape, Shruti Sakhare, Siddharth Pratap, Dana Marshall

P18 Metagenomic assessment of possible microbial contamination in the equine reference genome assembly

M Scotty DePriest, James N MacLeod, Theodore S Kalbfleisch

P19 Molecular evolution of cancer driver genes

Chandrakanth Emani, Hanady Adam, Ethan Blandford, Joel Campbell, Joshua Castlen, Brittany Dixon, Ginger Gilbert, Aaron Hall, Philip Kreisle, Jessica Lasher, Bethany Oakes, Allison Speer, Maximilian Valentine

P20 Biorepository Laboratory Information Management System

Naga Satya V Rao Nagisetty, Rony Jose, Teeradache Viangteeravat, Robert Rooney, David Hains

Time Since Migration and HIV Risk Behaviors Among Puerto Ricans Who Inject Drugs in New York City

BACKGROUND

Among people who inject drugs (PWID) in the United States, those who initiated drug injection in Puerto Rico (immigrant Puerto Rican PWID) engage in more injection and sexual risk behaviors, and have higher HIV incidence than non-Hispanic whites.

OBJECTIVE

Understand the persistence of these HIV behaviors.

METHODS

In a cross-sectional study conducted in New York City (NYC) in 2012 (National HIV Behavioral Surveillance), PWID aged ≥18 years were recruited using Respondent-Driven Sampling, interviewed, and tested for HIV. Participants were categorized into 5 different groups: (1) US-born non-Hispanic PWID, (2) US-born Puerto Rican PWID, (3) recent immigrant Puerto Rican PWID (≤3 years in NYC), (4) medium-term immigrant Puerto Rican PWID (>3 and ≤10 years in NYC), and (5) long-term immigrant Puerto Rican PWID (>10 years in NYC). We examined the relationship between time since migrating on sexual and injection risk behaviors among immigrant Puerto Rican PWID, compared with U.S.-born Puerto Rican PWID and US-born non-Hispanic PWID. Adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) were estimated using logistic regression.

RESULTS

A total of 481 PWID were recruited. In adjusted analyses using US-born non-Hispanic PWID as the comparison group, syringe sharing was significantly more likely among medium-term immigrants; and unprotected sex with casual partners was more likely among recent and long-term immigrants.

CONCLUSIONS

The risk-acculturation process for immigrant Puerto Rican PWID may be nonlinear and may not necessarily lead to risk reduction over time. Research is needed to better understand this process.