Complex associations between cancer progression and immune gene expression reveals early influence of transmissible cancer on Tasmanian devils

The world's largest extant carnivorous marsupial, the Tasmanian devil, is challenged by Devil Facial Tumor Disease (DFTD), a fatal, clonally transmitted cancer. In two decades, DFTD has spread across 95% of the species distributional range. A previous study has shown that factors such as season, geographic location, and infection with DFTD can impact the expression of immune genes in Tasmanian devils. To date, no study has investigated within-individual immune gene expression changes prior to and throughout the course of DFTD infection. To explore possible changes in immune response, we investigated four locations across Tasmania that differed in DFTD exposure history, ranging between 2 and >30 years. Our study demonstrated considerable complexity in the immune responses to DFTD. The same factors (sex, age, season, location and DFTD infection) affected immune gene expression both across and within devils, although seasonal and location specific variations were diminished in DFTD affected devils. We also found that expression of both adaptive and innate immune genes starts to alter early in DFTD infection and continues to change as DFTD progresses. A novel finding was that the lower expression of immune genes MHC-II, NKG2D and CD8 may predict susceptibility to earlier DFTD infection. A case study of a single devil with regressed tumor showed opposite/contrasting immune gene expression patterns compared to the general trends observed across devils with DFTD infection. Our study highlights the complexity of DFTD's interactions with the host immune system and the need for long-term studies to fully understand how DFTD alters the evolutionary trajectory of devil immunity.

Manganese Exacerbates Seasonal Health Declines in a Suicidally Breeding Mammal

Reproductive costs must be balanced with survival to maximize lifetime reproductive rates; however, some organisms invest in a single, suicidal bout of breeding known as semelparity. The northern quoll (Dasyurus hallucatus) is an endangered marsupial in which males, but not females, are semelparous. Northern quolls living near mining sites on Groote Eylandt, Northern Territory, Australia, accumulate manganese (Mn) in their brains, testes, and hair, and elevated Mn impacts motor performance. Whether Mn is associated with other health declines is yet unknown. In the present study we show that male and female northern quolls with higher Mn accumulation had a 20% reduction in immune function and a trend toward reduced cortisol concentrations in hair. The telomere lengths of male quolls did not change pre- to postbreeding, but those with higher Mn levels had longer telomeres; in contrast, the telomeres of females shortened during the breeding season but recovered between the first year and second year of breeding. In addition, the telomeres of quolls that were recaptured declined at significantly higher rates in quolls with higher Mn between prebreeding, breeding, and/or postbreeding seasons. Future research should determine whether changes in cortisol, immune function, or telomere length affect reproductive output or survival-particularly for semelparous males. Environ Toxicol Chem 2024;43:74-86. © 2023 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.

An investigation of politicians' responses to urban diversity and disadvantage: The case of the Danish 'parallel societies'

We examine how Danish politicians articulate views on the 'parallel society agreement' (aka, the 'ghetto-laws'), a controversial legislative intervention aiming to manage urban migration-related diversity. Through nationwide urban redevelopment aimed at facilitating residential 'mixing', the goal of the legislation is to eliminate so-called 'parallel societies'-socio-economically deprived neighbourhoods characterized by high concentrations of ethnic minorities. In-depth interviews with Danish politicians (n = 11) explored how this proposal was supported, contested or rejected in situated discourse. Following social representations theory, we focus on how 'parallel societies' were constructed in relation to differing ideas about 'mainstream society' and value-laden oppositional meaning-categories (i.e. themata). In particular, we highlight processes of socio-ethical reasoning that occurred through thematization of a shared oppositional meaning-category: 'freedom-constraint'. Views on the intervention were articulated around this oppositional meaning-category. Moreover, a connection was observed between the views articulated by individual politicians and sets of congruent ideas and images mobilized to represent 'parallel societies'. We discuss the theoretical value of taking a social representations approach to urban policy debates, and the practical limitations of dominant representations for successfully promoting intercultural dialogue and engagement-the stated goal of this intervention.

The impact of an extreme climatic event on adder (Vipera berus) demography in southern Sweden

Climate change has been shown to have significant negative effects on wildlife populations owing to both gradual shifts in mean climatic conditions and an increased frequency of extreme climatic events. Based on a long-term study spanning 40 years, we explore the demographic effect of the exceptionally hot and dry summer of 2018 on the demography of an isolated adder (Vipera berus) population in southern Sweden. In spring 2019, we observed a dramatic decline in adder relative body mass and a concomitant 50% reduction in population size. Our results strongly suggest that the negative impacts on adder demography were the result of a combination of low prey abundance and adder dehydration caused by the extreme climatic conditions during the previous summer. The study provides an example of the significant negative effects of ongoing climate change on vertebrate populations and emphasizes the importance of long-term studies to document the demographic effects of extreme climatic events.

Polyandry and non-random fertilisation maintain long-term genetic diversity in an isolated island population of adders (Vipera berus)

Conservation genetic theory suggests that small and isolated populations should be subject to reduced genetic diversity i.e., heterozygosity and allelic diversity. Our 34 years study of an isolated island population of adders (Vipera berus) in southern Sweden challenges this notion. Despite a lack of gene flow and a yearly mean estimated reproductive adult population size of only 65 adult adders (range 12-171), the population maintains high levels of heterozygosity and allelic diversity similar to that observed in two mainland populations. Even a 14-year major "bottleneck" i.e., a reduction in adult adder numbers, encompassing at least four adder generations, did not result in any reduction in the island adders' heterozygosity and allelic diversity. Female adders are polyandrous, and fertilisation is non-random, which our empirical data and modelling suggest are underpinning the maintenance of the population's high level of heterozygosity. Our empirical results and subsequent modelling suggest that the positive genetic effects of polyandry in combination with non-random fertilisation, often overlooked in conservation genetic analyses, deserve greater consideration when predicting long-term survival of small and isolated populations.

Telomeres, the loop tying cancer to organismal life-histories

Recent developments in telomere and cancer evolutionary ecology demonstrate a very complex relationship between the need of tissue repair and controlling the emergence of abnormally proliferating cells. The trade-off is balanced by natural and sexual selection and mediated via both intrinsic and environmental factors. Here, we explore the effects of telomere-cancer dynamics on life history traits and strategies as well as on the cumulative effects of genetic and environmental factors. We show that telomere-cancer dynamics constitute an incredibly complex and multifaceted process. From research to date, it appears that the relationship between telomere length and cancer risk is likely nonlinear with good evidence that both (too) long and (too) short telomeres can be associated with increased cancer risk. The ability and propensity of organisms to respond to the interplay of telomere dynamics and oncogenic processes, depends on the combination of its tissue environments, life history strategies, environmental challenges (i.e., extreme climatic conditions), pressure by predators and pollution, as well as its evolutionary history. Consequently, precise interpretation of telomere-cancer dynamics requires integrative and multidisciplinary approaches. Finally, incorporating information on telomere dynamics and the expression of tumour suppressor genes and oncogenes could potentially provide the synergistic overview that could lay the foundations to study telomere-cancer dynamics at ecosystem levels.

Transmissible cancer and longitudinal telomere dynamics in Tasmanian devils (Sarcophilus harrisii)

A plethora of intrinsic and environmental factors have been shown to influence the length of telomeres, the protector of chromosome ends. Despite the growing interest in infection-telomere interactions, there is very limited knowledge on how transmissible cancers influence telomere maintenance. An emblematic example of transmissible cancer occurs in the Tasmanian devil (Sarcophilus harrisii), whose populations have been dramatically reduced by infectious cancer cells. To investigate associations between telomere dynamics and the transmissible cancer, we used longitudinal data from a Tasmanian devil population that has been exposed to the disease for over 15 years. We detected substantial temporal variation in individual telomere length (TL), and a positive significant association between TL and age, as well as a marginally significant trend for devils with devil facial tumour disease (DFTD) having longer telomeres. A proportional hazard analysis yielded no significant effect of TL on the development of DFTD. Like previous studies, we show the complexity that TL dynamics may exhibit across the lifetime of organisms. Our work highlights the importance of long-term longitudinal sampling for understanding the effects of wildlife diseases on TL.

Age and the European Society of Cardiology 0/1-hour high sensitivity troponin T algorithm for the evaluation of patients with possible acute myocardial infarction: results from the STOP-CP study

Background

The European Society of Cardiology (ESC) 0/1-hour high sensitivity troponin (hs-cTn) algorithm is widely used in the evaluation of patients presenting to the Emergency Department (ED) with symptoms suspicious for non ST-segment elevation myocardial infarction (NSTEMI). The effect of increasing patient age with its use has not been studied in any detail.

Purpose

The objective of this secondary analysis of the STOP-CP (High Sensitivity Cardiac Troponin T to Optimize Chest Pain Risk Stratification) United States (US) multicenter study was to evaluate the efficacy and safety of use of the ESC 0/1-hour hs-cTnT algorithm in younger, middle-aged, and older patients.

Methods

Patients (≥21 years old) presenting to the (ED) with symptoms suggestive of NSTEMI were enrolled (1/25/2017–9/6/2018) at 8 US medical centers. The ESC hs-cTnT 0/1-hour hs-cTnT algorithm was used to place patients into rule-out, observe, and rule-in NSTEMI zones. Algorithm performance for rapid NSTEMI rule-out and 30-day adverse outcomes was studied in 3 patient age (years) intervals: younger (21–45). middle aged (46–64) and older (≥65). Major adverse cardiovascular events (MACE) consisted of cardiac death, myocardial infarction, or coronary revascularization at 30-days. Fisher's exact tests were used to compare NSTEMI ruled out and MACE rates between patient age intervals. Negative likelihood ratios (NLR) with 95% confidence interval (CI) were calculated for 30-day MACE.

Results

Overall 1430 participants were enrolled with 15.7% (224/1430) young, 57.4% (821/1430) middle-aged, and 26.9% (385/1430) being older. The ESC 0/1 hour hs-cTnT algorithm NSTEMI rule-out rates were 79.9% (179/224), 62.1% (510/821) and 35.6% (137/385) respectively for these age groups (p<0.0001). The overall 30-day MACE rate was 14.2% (203/1430) with interval age rates of 7.1% (16/224) in younger, 13.1% (108/821) middle aged and 20.5% (79/385) older patients. Amongst NSTEMI ruled-out patients MACE occurred in 1.1% (2/179) of younger, 3.3% (17/510) middle aged and 2.9% (4/137) older individuals (p=0.320). NLR for 30-day MACE was 0.15 (95% CI 0.04, −0.54) in younger, 0.23 (95% CI 0.15–0.35) middle aged and 0.12 (95% CI 0.04–0.31) for older patients.

Conclusions

With increasing age ED patients were less often rapidly ruled out for NSTEMI during their initial cardiac evaluations. The STOP-CP US study demonstrated that older age interval alone was not an independent variable that increased the risk for 30-day MACE in patients ruled out for NSTEMI using the ESC 0/1 hour hs-cTnT algorithm. Our report suggests that cardiac risk stratification scores using age as an independent variable for predicting 30-day MACE in these patients require reevaluation.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Roche, Basel, Switzerland

Patients with known coronary artery disease who are ruled out for acute myocardial infarction using a high sensitivity troponin T 0/1-hour algorithm have increased 30-day major adverse cardiac events

Background

The European Society of Cardiology (ESC) 0/1-hour high sensitivity troponin (hs-cTn) algorithm is widely used in the evaluation of patients presenting to the Emergency Department (ED) with symptoms suspicious for non ST-segment elevation myocardial infarction (NSTEMI). There is limited data available for the use of this algorithm comparing NSTEMI rule-out rates and 30-day adverse outcomes in patients with and without known coronary artery disease (CA), defined as prior myocardial infarction [MI], coronary revascularization, or ≥70% coronary stenosis.

Purpose

The objective of this secondary analysis of the STOP-CP (High Sensitivity Cardiac Troponin T to Optimize Chest Pain Risk Stratification) United States (US) multicenter study was to compare the ESC 0/1-hour algorithm for rapid NSTEMI rule-out and 30-day adverse outcomes in patients with and without known CAD.

Methods

Patients (≥21 years old) presenting to the (ED) with symptoms suggestive of NSTEMI were enrolled (1/25/2017–9/6/2018) at 8 US medical centers. The ESC hs-cTnT 0/1-hour hs-cTnT algorithm was used to stratify patients into rule-out, observe, and rule-in zones. Algorithm performance for 30-day adverse outcomes was analyzed in patients with or without known CAD. Major adverse cardiovascular events (MACE) consisted of cardiac death, MI, or coronary revascularization. Fisher's exact tests were used to compare NSTEMI rule-out and 30-day MACE rates in patients with and without known CAD. Negative likelihood ratios (NLR) with a 95% confidence interval (CI) were calculated for 30-day MACE.

Results

Overall 1430 patients were enrolled. Of these 31.4% (449/1430) had known CAD while 14.2% (203 /1430) experienced 30-day MACE. Using the ESC 0/1-hour hs-cTnT algorithm 39.6% (178/449) of patients with known CAD were placed in the rule-out zone compared to 66.1% (648/981) without CAD (p<0.0001). Of patients with known CAD 23.2% (104/449) had 30-day MACE compared to 10.1% (99/981) of those without known CAD (p<0.0001). Additionally, amongst those patients placed in the rule-out zone, 30-day MACE occurred in 7.9% (14/178) of individuals with known CAD and 1.4% (9/648) of those without known CAD (p<0.0001). NLR for 30-day MACE was 0.28 (95% CI 0.17–0.47) in patients with known CAD and 0.13 (95% CI 0.07–0.23) in those without CAD.

Conclusions

In the multicenter US STOP-CP study patients with known CAD were less often rapidly ruled out for NSTEMI and had higher 30-day MACE rates than those without known CAD. Patients with known CAD who were rapidly ruled out for NSTEMI had a higher 30-day MACE rate compared to those without known CAD. Our analysis suggests that patients with known CAD require further cardiac reevaluations whether they are ruled out for NSTEMI by the ESC 0/1 hour hs-cTnT algorithm or not.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Roche, Basel, Switzerland

Negative frequency-dependent selection on polymorphic color morphs in adders

Color pattern polymorphism occurs when more than one form is found within the same population. It is widespread in a variety of taxa, leading us to ask what maintains this variation. One stabilizing mechanism is negative frequency-dependent selection, also known as apostatic selection, in which the fitness of a phenotype decreases with its frequency.^1-6 Negative frequency-dependent selection has been proposed as one of the most powerful selective forces in maintaining phenotypic and genetic diversity in both plant and animal populations.^1,5 Despite its importance and experimental evidence,^1,2,6 no study has documented that natural selection due to predation may result in negative frequency-dependent selection in a wild undisturbed vertebrate population. Here, we report the results of a long-term study, spanning 37 years from 1984 to 2020, of two distinct color morphs, zigzag and melanistic, within a population of adult adders (Vipera berus) on the island of Hallands Väderö in southern Sweden (Figure 1). Our results strongly suggest that the color pattern polymorphism is maintained by negative frequency-dependent natural selection in both males and females.

The association between melatonin and suicide: a nationwide cohort study

Introduction

Melatonin is often prescribed to patients experiencing sleep disturbances, which has been linked to elevated risks of suicide. However, it remains to be assessed whether melatonin is associated with suicide and suicide attempts.

Objectives

We aimed to investigate whether individuals in treatment with melatonin had higher rates of suicide and suicide attempt when compared to individuals not in treatment.

Methods

Using longitudinal data on all persons aged 10+ years living in Denmark between 2007-2016 were obtained. Data from the National Prescription Register was used to identify periods of being in treatment with melatonin based on number of tablets and daily defined dose. Suicide and suicide attempt were identified in hospital and cause of death registries.

Results

Among 5,798,923 included individuals, 10,577 (0.18%) were in treatment with melatonin (mean treatment length 50 days). Out of 5,952 individuals who died by suicide, 22 (0.37%) were in melatonin treatment, while 134 (0.53%) out of 25,136 had a first suicide attempt. After adjustment for sex and age-group, people in treatment with melatonin were found to have a higher rate of suicide (IRR: 4.2; 95% CI, 2.7-6.4) and suicide attempt (IRR: 6.7-fold (95% CI, 5.7-7.9) when compared to those not in treatment.

Conclusions

Treatment with melatonin was associated with higher rates of suicide and suicide attempt. The association might be explained through mediators, such as psychiatric comorbidity and sleep disorders. Our findings indicate that attention towards these issues might be warranted.

Disclosure

No significant relationships.

The association between benzodiazepine and non-benzodiazepine and suicide: a nationwide cohort study

Introduction

Benzodiazepines and non-benzodiazepines have been linked to a variety of adverse effects including addiction. Long term use of these drugs has been associated with an increased risk of suicide.

Objectives

We assessed if individuals in treatment with non-benzodiazepine (n-BZD) and benzodiazepine (BZD) had higher rates of suicide when compared to individuals not in treatment with these drugs.

Methods

We utilized a cohort design and national longitudinal data on all individuals aged 10 or above who lived in Denmark between 1995 and 2018. Treatment with either n-BZD or BZD was identified via the Danish National Prescription Registry and suicide deaths were identified in the national cause of death registries.

Results

In a total of 6,494,206 individuals, 10,862 males and 4,214 females died by suicide. Of these, 1,220 (11.2%) males and 792 (18.8%) females had been in treatment with n-BZD, resulting in adjusted IRR for suicide of 4.2 (95% CI, 4.0 – 4.5) and 3.4 (95% CI, 3.1 – 3.7) for males and females, respectively, when compared to those not in treatment. In all, 529 (4.8%) males and 395 (9.3%) females who died by suicide had been in treatment with BZD. The IRRs for suicide were 2.4 (95% CI, 2.2 – 2.6) and 2.5 (95% CI, 2.3 – 2.8) for males and females, respectively, and compared to those not in treatment.

Conclusions

In this study we find that those in treatment experienced higher suicide rates than those not in treatment, this persisted when also adjusting for a large variety of covariates.

Disclosure

No significant relationships.

Association of hospital-diagnosed sleep disorders with suicide: a nationwide cohort study

Introduction

Sleep disorders and psychiatric disease are closely related, and psychiatric diseases are associated with elevated suicide risks. Yet, the association between sleep disorders and suicide remains to be assessed using a consistent measure of sleep disorders.

Objectives

The aim of this study was to examine whether people with a hospital-diagnosis of sleep disorders had higher suicide rates than people with no diagnosis.

Methods

In a cohort study, nationwide data on all persons aged 15+ years living in Denmark during 1980-2016 were analysed. Sleep disorders were identified through diagnoses recorded during contacts to somatic hospitals. Incidence Rate Ratios (IRR) were estimated using Poisson regression models and adjusted for relevant covariates.

Results

In all, 3,674,563 males and 3,688,164 females were included, of whom 82,223 (2.2%, mean age: 50.2, SD: 17.5) males and 40,003 (1.1%, mean age: 50.6, SD: 19.9) females had sleep disorder diagnoses. Compared to those with no sleep disorders, the adjusted IRRs for suicide were 1.6 (95% CI, 1.4-1.7) and 2.2 (95% CI, 1.8-2.6) for males and females with sleep disorders, respectively. Excess rates for narcolepsy were found for males (IRR:1.2, 95% CI, 1.0-1.5) and females (IRR:3.3, 95% CI, 3.0-4.1), and for sleep apnea in males (IRR:1.8, 95% CI, 1.5-2.2). Males and females had IRRs of 4.1 (95% CI, 3.1-5.5) and 7.0 (95% CI, 4.8-10.1), respectively, 6 months after being diagnosed with a sleep disorder.

Conclusions

Sleep disorders were associated with higher suicide rates even after adjusting for pre-existing mental disorders. Our findings suggest attention towards suicidal ideation in patients suffering from sleep disorders is warranted.

Disclosure

Disclosures and Acknowledgements: Adam Spira has received honoraria for serving as a consultant to Merck and from Springer Nature Switzerland AG for guest editing special issues of Current Sleep Medicine Reports. The other authors report no conflict of in

Mass-related differences in metabolic rate and fasting endurance explain divergence in seasonal activity of Mediterranean lizards

We analysed the effects of body mass on the monthly activity patterns of six Mediterranean lacertid lizard taxa, four relatively small species, the Italian wall lizard (Podarcis siculus), the common wall lizard (Podarcis muralis), the blue-throated keeled lizard (Algyroides nigropunctatus), and the Ionian wall lizard (Podarcis ionicus), and two larger species, the western green lizard (Lacerta bilineata) and the Balkan green lizard (Lacerta trilineata). The highest number of observations for all six species occurred in April and May and the lowest in July and August, the latter being the hottest and driest months of the year. The two larger species were mainly active from March to July, whereas the four smaller species had an additional period of high activity from September to November. As all six species reproduce during spring, the increase in activity of the smaller species in autumn was consequently unrelated to reproductive behaviour. There was no difference in seasonal activity of the two smaller Italian species at sites with or without the larger green lizards. It is therefore unlikely that interference competition/predation by green lizards caused the increased autumnal activity of the smaller lizards. We suggest that due to their lower mass-specific metabolic rates, larger species can obtain sufficient lipid stores over a shorter annual activity to ensure successful reproduction the subsequent spring. By contrast, smaller species have greater need to replenish their lipid reserves after summer fasting and therefore resume much higher activity levels in September to November to attain this goal.

Transmissible cancer influences immune gene expression in an endangered marsupial, the Tasmanian devil (Sarcophilus harrisii)

Understanding the effects of wildlife diseases on populations requires insight into local environmental conditions, host defence mechanisms, host life‐history trade‐offs, pathogen population dynamics, and their interactions. The survival of Tasmanian devils (Sarcophilus harrisii) is challenged by a novel, fitness limiting pathogen, Tasmanian devil facial tumour disease (DFTD), a clonally transmissible, contagious cancer. In order to understand the devils’ capacity to respond to DFTD, it is crucial to gain information on factors influencing the devils’ immune system. By using RT‐qPCR, we investigated how DFTD infection in association with intrinsic (sex and age) and environmental (season) factors influences the expression of 10 immune genes in Tasmanian devil blood. Our study showed that the expression of immune genes (both innate and adaptive) differed across seasons, a pattern that was altered when infected with DFTD. The expression of immunogbulins IgE and IgM:IgG showed downregulation in colder months in DFTD infected animals. We also observed strong positive association between the expression of an innate immune gene, CD16, and DFTD infection. Our results demonstrate that sampling across seasons, age groups and environmental conditions are beneficial when deciphering the complex ecoevolutionary interactions of not only conventional host‐parasite systems, but also of host and diseases with high mortality rates, such as transmissible cancers.

Genetic rescue restores long-term viability of an isolated population of adders (Vipera berus)

Climate change is regarded as a major threat to global biodiversity [1]. However, another key driver of declines in biodiversity during the last century has been, and still is, the devastating impact of anthropogenic habitat destruction [2]. Human degradation of natural habitats has resulted in large, formerly homogeneous areas becoming exceedingly isolated and fragmented, resulting in reduced genetic diversity and a concomitant increased vulnerability to pathogens [3] and increased risk of inbreeding [4]. In order to restore genetic diversity in small isolated or fragmented populations, genetic rescue - that is, an intervention in which unrelated individuals are brought into a population, leading to introduction of novel alleles - has been shown to reduce the deleterious effects of inbreeding [4,5].

Evaluation of European Society of Cardiology (ESC) 0/1-hour algorithm in the diagnosis of 90-day major adverse cardiovascular events: a multicenter United States cohort study

Background

The ESC 0/1-hour algorithm using high sensitivity troponin (ESC 0/1-h) is a rapid triage protocol for diagnosing acute coronary syndrome, however the classification performance of the algorithm in the US population is uncertain. Further, evidence for the use of ESC 0/1-h in the long-term diagnosis of major adverse cardiovascular events (MACE) remains limited.

Purpose

To evaluate the performance of the ESC 0/1-h algorithm in diagnosing 90-day MACE in a diverse US cohort.

Methods

In this prospective, multicenter, observational cohort study, adult emergency department patients who were evaluated for suspected ACS were enrolled at eight sites in the US. Serial 1-hour blood samples were collected and high sensitivity troponin T (hs-cTnT) concentrations were measured in a central laboratory using the hs-cTnT assay. Primary outcome included major adverse cardiovascular events (MACE) within 90 (+30) days of enrollment. MACE defined as myocardial infarction (MI), cardiovascular or uncertain death, and coronary revascularization. Presence of MI and cardiovascular death were adjudicated by independent reviewers blinded to hs-cTnT results. Each participant was stratified to one of three risk groups as determined by ESC 0/1-h algorithm. Diagnostic classification performance metrics with exact confidence intervals (i.e. negative predictive value [NPV], positive predicted value [PPV], sensitivity, and specificity) were evaluated for each risk group where appropriate.

Results

Among 1430 eligible participants, 45.8% (655/1430) were women and 36.6% (524/1430) were African American with a mean age of 57.6±12.8 years. MACE at 90-days occurred in 15.5% (221/1430). ESC 0/1-h stratified 59.5% (851/1430) subjects in Rule-Out range and 13.0% (186/1430) subjects in Rule-In range. The Rule-Out criteria had an NPV and sensitivity for 90-day MACE of 96.8% (95% CI: 95.4–97.9%) and 87.8% (95% CI: 82.7–91.8%), respectively. For 90-day cardiovascular death or MI, Rule-Out criteria had an NPV of 98.2% (95% CI: 97.1–99.0%) and sensitivity was 92.4% (95% CI: 87.8–95.7%). The Rule-In criteria had a PPV of 60.8% (95% CI: 53.3–67.8%) for both outcomes. Rule-In criteria had a specificity for 90-day MACE and 90-day cardiovascular death or MI of 94.0% (95% CI: 92.5–95.2%) and 94.1% (95% CI: 92.6–95.3%), respectively. Among the 27.5% (393/1430) participants classified in neither risk groups, the prevalence of 90-day MACE was 20.6% (81/393) and the prevalence of 90-day cardiovascular death or MI was 17.8% (70/393)

Conclusion

In a prospective, multicenter, US cohort, the ESC 0/1-h algorithm was unable to achieve a sufficiently high NPV to safely exclude the diagnosis of MACE within 90 days after emergency department presentation. New hs-cTn algorithms specific to the US population may be warranted.

ESC 0/1-h 90 Day Outcomes

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Roche Diagnostics

High suicide rates during psychiatric inpatient stay and shortly after discharge

OBJECTIVE

Over recent decades, intense efforts to address suicides in psychiatric admitted people have been initiated. The aim was to calculate suicide rates, rate ratios, population attributable risks (PAR) and trends among people admitted to or recently discharged from psychiatric wards.

METHODS

Using a cohort design, we obtained nationwide register data on 6 292 932 individuals aged 15+ living in Denmark during 1995-2016. Of these, 178 703 (5.73%) males and 201 033 females (6.33%) had been admitted to psychiatric hospital. Incidence rate ratios (IRR) were obtained using Poisson regression analyses while adjusting for age and calendar period. Trends were assessed using joinpoint analyses.

RESULTS

In total, 15 075 persons died by suicide, of which 6174 had been psychiatrically admitted. Among males, the suicide rate during the first week of admission and after discharge was 3409 and 3148 per 100 000 person-years, respectively. The corresponding values for females were 1267 and 1631. Generally, estimated suicide rates were highest in those with affective or anxiety stress disorders. During first week of hospitalization, the IRR was 237 for males and of 322 for females when compared with those never hospitalized. In first week after discharge, the IRR was 225 and 425 for males and females, respectively. PAR estimates indicated 6% of male suicides and 13% of female suicides attributes to first week of admission and discharge. The inpatient suicide rate decreased annually 2.5% until 2009 followed by a 7.5% annual percentage increase. The suicide rate after discharge decreased steadily annually over the study period.

CONCLUSION

Despite finding declining post-discharge suicide rates, the period surrounding a psychiatric admission was still associated with extremely high suicide rates.

Between frustration and education: Transitioning students’ stress and coping through the lens of semiotic cultural psychology

This article proposes an alternative conceptualization of the processes with which new university students try to overcome the challenges and potential stresses experienced in their movement into the university context. Instead of viewing coping efforts as solely directed towards avoiding stress and enhancing well-being, efforts of overcoming difficulties and stress are to be seen in relation to students’ goal-oriented movement towards becoming students at a particular institution and in a particular field of study. By drawing on the concepts of (hyper)generalized affective semiotic fields, and equifinality and bifurcation points, it is suggested that the process of making sense of a difficult situation is related to the dynamics between well-defined short-term goals and ill-defined long-term goals. In this conceptualization, students not only cope with a specific problem in the here-and-now but make sense of the problem while negotiating their unique trajectory towards more distanced imagined educational outcomes.

Relative deprivation and revolt: current and future directions

We review research applying relative deprivation theory to comprehend social, economic, and political phenomena relating to social change. We highlight areas illuminated by relative deprivation and limitations of this contemporary research. Next, we outline four theoretical elaborations of relative deprivation theory to advance understanding of complex socio-economic and political processes of underlying rallies, riots, and revolutions. We end by suggesting methodological approaches and research agendas to understand psychological processes of social change.

"Well Now we Have Entered University and So On, but". Autodialogue and Circumvention Strategies in Reflections about Being a University Student

In higher education, there is nowadays a production of discourses about the negative effects of academic life on the well-being of the students. In the specific Danish context, we wondered how to understand the process involved in coping with problems and decisions of everyday life. To investigate this question, we present an empirical study on the microgenetic processes unfolding when students discuss their experiences with peers. We develop Josephs and Valsiner's (Social Psychology Quarterly, 61,(1), 68-82, 1998) concepts of circumvention strategies and autodialogue. The study covers 2 focus-group discussions among 2nd semester psychology students aged 20-25, attending the same psychology course at a Danish university. The students were presented with a dilemmatic situation, that they are required make sense of, based on minimal information, by integrating it in their own representations, expectations and life experiences. Our analysis suggests that the students' investment of meaning in themselves and others often occurred through autodialogical negotiation. In such negotiations, circumvention strategies offer the students a solution, enabling them not to get stuck in a dilemma between two oppositional ways of relating to a certain issue, or offers them a new and less upsetting perspective. These findings suggest that reaching a conclusion about themselves and their experience is not just a clear-cut process of making a statement, but a dynamic and complex process in which multiple perspectives and meanings are in play.

Demography and spatial requirements of the endangered northern quoll on Groote Eylandt

Abstract ContextAustralia has experienced the highest number of mammal extinctions of any continent over the past two centuries. Understanding the demography and spatial requirements of populations before declines occur is fundamental to confirm species trajectory, elucidate causes of decline and develop effective management strategies. AimsWe evaluated the demography and spatial requirements of a northern quoll, Dasyurus hallucatus, population on Groote Eylandt, Northern Territory. Groote Eylandt is considered a refuge for the species because key threatening processes are absent or limited; cane toads and introduced ungulates are absent, feral cats are infrequently detected and the fire regime is benign compared with mainland Northern Territory. MethodsWe conducted a 4-year capture–mark–recapture study to monitor growth, reproduction and survival of northern quolls within a 128-ha area, and we evaluated spatial requirements by attaching GPS units to both sexes. To assess the status of the Groote Eylandt population, we compared the demographics with existing data from mainland populations. Key resultsThe average density of northern quolls was 0.33ha−1. However, there was a 58% decline in female density, primarily between 2012 and 2013, corresponding with a decrease in female body mass. Females survived and bred in up to 3 years and adult survival rates did not vary among years, suggesting that juvenile recruitment drives population fluctuations. Male quolls were semelparous, with die-off occurring in the months following breeding. The median female and male home ranges were 15.7ha and 128.6ha respectively, and male ranges increased significantly during breeding, with 1616ha being the largest recorded. ConclusionsThe northern quoll population on Groote Eylandt had a higher density, female survival and reproductive success than has been previously recorded on the mainland. However, a marked decline was recorded corresponding with a decrease in female mass, indicating below-average rainfall as the likely cause. ImplicationsGroote Eylandt remains a refuge for the endangered northern quoll. However, even in the absence of key threatening processes, the population has declined markedly, highlighting the impact of environmental fluctuations. Maintaining the ecological integrity of Groote Eylandt is imperative for population recovery, and managing threats on the mainland over appropriate spatial scales is necessary to increase population resilience.

P2247Pregnancies and childbirth in women with arrhythmogenic right ventricular cardiomyopathy are associated with low risk of ventricular arrhythmias

Background

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is associated with a risk of ventricular arrhythmias (VA) and sudden cardiac death (SCD). Even though female patients with ARVC are considered to be at lower risk of VA, the impact of pregnancy and child birth on the arrhythmic risk and development of arrhythmic substrate in the context of ARVC remains insufficiently studied.

Objective

To assess the risk of VA in relation to childbirth in women with ARVC and the impact of multiple pregnancies on progression of arrhythmic manifestations of the disease.

Methods

The study included 186 females with definite ARVC (n=107, 70 probands) or unaffected mutation-carriers (n=79) with median age at the end of follow up of 48 (IQR 34–60) years. Seventeen women had 1, 59 had 2 and 29 had ≥3 child births by the age of 40 years. VA was defined as ventricular tachycardia, appropriate ICD therapy, aborted cardiac arrest or SCD. Proportions of patients who experienced VA by the age of 40 years were compared between nulliparous women (n=81) and those with reported child births (n=105). VA-free survival after accomplished pregnancies was assessed for women ≥40 years of age (n=119). Cumulative probability of VA for each pregnancy (n=230) was assessed from conception through 2 years after child birth and compared between those that occurred before ARVC diagnosis (Pre-Ds, n=164), after it (Post-Ds, n=11) and in unaffected mutation carriers (No-Ds, n=55).

Results

The nulliparous women had lower age at ARVC diagnosis (37 vs 44, p=0.023) and more often had VA before the age of 40 (31% vs 13%, p=0.003) while the number of child births was not related to the prevalence of VA (18% among women with 1 childbirth, 12% in those with 2 and 14% in those with 3 or more, ns). Three women suffered SCD before the age of 40. VA-free survival after 40 years did not differ between nulliparous and those who gave birth (Figure A). Only four pregnancy-related events were documented (Figure B): 1 in the Post-Ds group and three in the Pre-Ds group. No pregnancy-related events were reported in the unaffected mutation carriers.

Conclusion

In this Scandinavian cohort of women with ARVC we observed no indication of an increased VA risk either associated with pregnancies or during long-term follow up after the last child birth.

P992Incidence, predictors, and success of ventricular tachycardia catheter ablation in arrhythmogenic right ventricular cardiomyopathy (ARVC): A long-term cohort study from the Nordic ARVC registry

Background

Catheter ablation may reduce ventricular tachycardia (VT) burden in arrhythmogenic right ventricular cardiomyopathy (ARVC) patients. However, little is known about factors predicting need for ablation and various outcomes have been reported.

Purpose

We sought to investigate predictors and use of VT ablation and to evaluate the post-procedural outcome in ARVC patients.

Methods

We studied 435 patients from the Nordic ARVC registry including 220 probands with definite ARVC according to the 2010 task force criteria and 215 mutation-carrying relatives identified through cascade screening. Patients were followed until first-time VT ablation, death, heart transplantation, or January 1st 2018. Additionally, patients undergoing VT ablation were further followed from the time of ablation for recurrent ventricular arrhythmias.

Results

Cumulative use of VT ablation was 4% (95% CI 3%-6%) and 11% (95% CI 8%-15%) after 1 and 10 years. All procedures were performed in probands in whom the cumulative use was 8% (95% CI 5%-12%) and 20% (95% CI 15%-26%). In adjusted analyses restricted to probands, only young age predicted need for ablation. In patients undergoing ablation, risk of recurrent arrhythmias was 59% (95% CI 44%-71%) and 74% (95% CI 59%-84%) 1 and 5 years after the procedure. Despite high recurrence rates, the burden of ventricular arrhythmias was reduced after ablation (p=0.0042). Young age, use of several antiarrhythmic drugs and inducibility to VT immediately after ablation were associated with an unfavorable outcome.

Conclusions

Twenty percent of ARVC probands developed a clinical indication for VT ablation within 10 years after diagnosis whereas mutation-carrying relatives were without such need. Although the burden of ventricular arrhythmias decreased after ablation, risk of recurrence was substantial.

Genetic diversity, inbreeding and cancer

Genetic diversity is essential for adaptive capacities, providing organisms with the potential of successfully responding to intrinsic and extrinsic challenges. Although a clear reciprocal link between genetic diversity and resistance to parasites and pathogens has been established across taxa, the impact of loss of genetic diversity by inbreeding on the emergence and progression of non-communicable diseases, such as cancer, has been overlooked. Here we provide an overview of such associations and show that low genetic diversity and inbreeding associate with an increased risk of cancer in both humans and animals. Cancer being a multifaceted disease, loss of genetic diversity can directly (via accumulation of oncogenic homozygous mutations) and indirectly (via increased susceptibility to oncogenic pathogens) impact abnormal cell emergence and escape of immune surveillance. The observed link between reduced genetic diversity and cancer in wildlife may further imperil the long-term survival of numerous endangered species, highlighting the need to consider the impact of cancer in conservation biology. Finally, the somewhat incongruent data originating from human studies suggest that the association between genetic diversity and cancer development is multifactorial and may be tumour specific. Further studies are therefore crucial in order to elucidate the underpinnings of the interactions between genetic diversity, inbreeding and cancer.

Multiple paternity and precocial breeding in wild Tasmanian devils, Sarcophilus harrisii (Marsupialia: Dasyuridae)

Polyandry, a common reproductive strategy in various animal species, has potential female benefits, which include enhanced offspring fitness. Benefits can be direct, such as reduced risk of male infanticide of offspring, or indirect, such as increased genetic diversity of offspring and the acquisition of ‘good genes’. Multiple paternity of litters has been recorded in numerous marsupial species but has not been reported in Tasmanian devils, Sarcophilus harrisii (Boitard). We investigated whether multiple paternity occurred in litters within a wild population of Tasmanian devils. Using major histocompatibility complex-linked and neutral microsatellite markers, the paternity of nine litters was analysed. We found multiple paternity in four out of nine litters and that yearling (> 1, < 2 years old) male devils were siring offspring. This is the first record of multiple paternity and of male precocial breeding in wild Tasmanian devils. To date, there are no data relating to the subsequent survival of devils from single- vs. multiple-sired litters; therefore, we do not know whether multiple paternity increases offspring survival in the wild. These results have implications for the Tasmanian devil captive insurance programme, because group housing can lead to multiple-sired litters, making the maintenance of genetic diversity over time difficult to manage.

KDM5 Histone Demethylase Activity Links Cellular Transcriptomic Heterogeneity to Therapeutic Resistance

Members of the KDM5 histone H3 lysine 4 demethylase family are associated with therapeutic resistance, including endocrine resistance in breast cancer, but the underlying mechanism is poorly defined. Here we show that genetic deletion of KDM5A/B or inhibition of KDM5 activity increases sensitivity to anti-estrogens by modulating estrogen receptor (ER) signaling and by decreasing cellular transcriptomic heterogeneity. Higher KDM5B expression levels are associated with higher transcriptomic heterogeneity and poor prognosis in ER⁺ breast tumors. Single-cell RNA sequencing, cellular barcoding, and mathematical modeling demonstrate that endocrine resistance is due to selection for pre-existing genetically distinct cells, while KDM5 inhibitor resistance is acquired. Our findings highlight the importance of cellular phenotypic heterogeneity in therapeutic resistance and identify KDM5A/B as key regulators of this process.

Fitness variation in isogenic populations leads to a novel evolutionary mechanism for crossing fitness valleys

Individuals in a population often have different fitnesses even when they have identical genotypes, but the effect of this variation on the evolution of a population through complicated fitness landscapes is unknown. Here, we investigate how populations with non-genetic fitness variation cross fitness valleys, common barriers to adaptation in rugged fitness landscapes in which a population must pass through a deleterious intermediate to arrive at a final advantageous stage. We develop a stochastic computational model describing the dynamics of an asexually reproducing population crossing a fitness valley, in which individuals of the same evolutionary stage can have variable fitnesses. We find that fitness variation that persists over multiple generations increases the rate of valley crossing through a novel evolutionary mechanism different from previously characterized mechanisms such as stochastic tunneling. By reducing the strength of selection against deleterious intermediates, persistent fitness variation allows for faster adaptation through rugged fitness landscapes.

Efficient computation of the joint probability of multiple inherited risk alleles from pedigree data

The Elston-Stewart peeling algorithm enables estimation of an individual's probability of harboring germline risk alleles based on pedigree data, and serves as the computational backbone of important genetic counseling tools. However, it remains limited to the analysis of risk alleles at a small number of genetic loci because its computing time grows exponentially with the number of loci considered. We propose a novel, approximate version of this algorithm, dubbed the peeling and paring algorithm, which scales polynomially in the number of loci. This allows extending peeling-based models to include many genetic loci. The algorithm creates a trade-off between accuracy and speed, and allows the user to control this trade-off. We provide exact bounds on the approximation error and evaluate it in realistic simulations. Results show that the loss of accuracy due to the approximation is negligible in important applications. This algorithm will improve genetic counseling tools by increasing the number of pathogenic risk alleles that can be addressed. To illustrate we create an extended five genes version of BRCAPRO, a widely used model for estimating the carrier probabilities of BRCA1 and BRCA2 risk alleles and assess its computational properties.

Comparing post-deployment mental health services utilization in soldiers deployed to Balkan, Iraq and Afghanistan

OBJECTIVE

Insight on how different missions have impacted rates of mental health service (MHS) utilization is unexplored. We compared postdeployment MHS utilization in a national cohort of first-time deployed to missions in Balkan, Iraq, and Afghanistan respectively.

METHODS

A prospective national cohort study of 13 246 first-time deployed in the period 1996 through 2012 to missions in Balkan area, Iraq, or Afghanistan respectively. Soldiers 'MHS utilization was also compared with a 5:1 sex-, age-, and calendar year-matched never-deployed background population. Postdeployment utilization of MHS was retrieved from national coverage registers. Using Cox survival analyses, participants were followed and compared with regard to receiving three different types of psychiatric services: (i) admission to psychiatric hospital, (ii) psychiatric outpatient contact, and (iii) prescriptions of psychotropics.

RESULTS

Utilizing of psychiatric outpatient services and psychotropics was significantly higher in first-time deployed to Iraq and Afghanistan compared with deployed to Balkan. However, the rate of postdeployment admission to psychiatric hospital did not differ between missions. Postdeployment rates of psychiatric admission and psychiatric outpatient treatment were significantly higher in Afghanistan-deployed personnel compared with the background population.

CONCLUSIONS

Utilization of MHS differed significantly between mission areas and was highest after the latest mission to Afghanistan.