First Measurement of η Meson Production in Neutrino Interactions on Argon with MicroBooNE

We present a measurement of η production from neutrino interactions on argon with the MicroBooNE detector. The modeling of resonant neutrino interactions on argon is a critical aspect of the neutrino oscillation physics program being carried out by the DUNE and Short Baseline Neutrino programs. η production in neutrino interactions provides a powerful new probe of resonant interactions, complementary to pion channels, and is particularly suited to the study of higher-order resonances beyond the Δ(1232). We measure a flux-integrated cross section for neutrino-induced η production on argon of 3.22±0.84(stat)±0.86(syst) 10^{-41}  cm^{2}/nucleon. By demonstrating the successful reconstruction of the two photons resulting from η production, this analysis enables a novel calibration technique for electromagnetic showers in GeV accelerator neutrino experiments.

Search for Heavy Neutral Leptons in Electron-Positron and Neutral-Pion Final States with the MicroBooNE Detector

We present the first search for heavy neutral leptons (HNLs) decaying into νe^{+}e^{-} or νπ^{0} final states in a liquid-argon time projection chamber using data collected with the MicroBooNE detector. The data were recorded synchronously with the NuMI neutrino beam from Fermilab's main injector corresponding to a total exposure of 7.01×10^{20} protons on target. We set upper limits at the 90% confidence level on the mixing parameter |U_{μ4}|^{2} in the mass ranges 10≤m_{HNL}≤150  MeV for the νe^{+}e^{-} channel and 150≤m_{HNL}≤245  MeV for the νπ^{0} channel, assuming |U_{e4}|^{2}=|U_{τ4}|^{2}=0. These limits represent the most stringent constraints in the mass range 35 Collapse

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A survey in the West Midlands of the United Kingdom of current practice in managing hypotension in lower segment caesarean section under spinal anaesthesia

BACKGROUND

Spinal anaesthesia, the most common form of anaesthesia for caesarean section, leads to sympathetic blockade and profound maternal hypotension resulting in adverse maternal and neonatal outcomes. Hypotension, nausea and vomiting remain common but until the publication of the National Institute of Health and Care Excellence (NICE) 2021 guidance, no national guideline existed on how best to manage maternal hypotension following spinal anaesthesia for caesarean section. A 2017 international consensus statement recommended prophylactic vasopressor administration to maintain a systolic blood pressure of >90% of an accurate pre-spinal value, and to avoid a drop to <80% of this value. This survey aimed to assess regional adherence to these recommendations, the presence of local guidelines for management of hypotension during caesarean section under spinal anaesthesia, and the individual clinician's treatment thresholds for maternal hypotension and tachycardia.

METHODS

The West Midlands Trainee-led Research in Anaesthesia and Intensive Care Network co-ordinated surveys of obstetric anaesthetic departments and consultant obstetric anaesthetists across 11 National Health Service Trusts in the Midlands, England.

RESULTS

One-hundred-and-two consultant obstetric anaesthetists returned the survey and 73% of sites had a policy for vasopressor use; 91% used phenylephrine as the first-line drug but a wide range of recommended delivery methods was noted and target blood pressure was only listed in 50% of policies. Significant variation existed in both vasopressor delivery methods and target blood pressures.

CONCLUSIONS

Although NICE has since recommended prophylactic phenylephrine infusion and a target blood pressure, the previous international consensus statement was not adhered to routinely.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

Effect of overdispersion of lethal lesions on cell survival curves

The linear-quadratic (LQ) model is the most commonly used mechanism to predict radiobiological outcomes. It has been used extensively to describe dose-responsein vitroandin vivo. There are, however, some questions about its applicability in terms of its capacity to represent some profound mechanistic behaviour. Specifically, empirical evidence suggests that the LQ model underestimates the survival of cells at low doses while overestimating cell death at higher doses. It is believed to be driven from the usual LQ model assumption that radiogenic lesions are Poisson distributed. In this context, we use a negative binomial (NB) distribution to study the effect of overdispersion on the shapes and the possibility of reducing dose-response curvature at higher doses. We develop an overdispersion model for cell survival using the non-homologous end-joining (NHEJ) pathway double-strand break (DSB) repair mechanism to investigate the effects of the overdispersion on probabilities of repair of DSBs. The error distribution is customised to ensure that the refined overdispersion parameter depends on the mean of the distribution. The predicted cell survival responses for V79, AG and HSG cells exposed to protons, helium and carbon ions are compared with the experimental data in low and high dose regions at various linear energy transfer (LET) values. The results indicate straightening of dose-response and approaching a log-linear behaviour at higher doses. The model predictions with the measured data show that the NB modelled survival curves agree with the data following medium and high doses. Model predictions are not validated at very tiny and very high doses; the approach presented provides an analysis of mechanisms at the microscopic level. This may help improve the understanding of radiobiological responses of survival curves and resolve discrepancies between experimental and theoretical predictions of cell survival models.

Search for an Excess of Electron Neutrino Interactions in MicroBooNE Using Multiple Final-State Topologies

We present a measurement of ν_{e} interactions from the Fermilab Booster Neutrino Beam using the MicroBooNE liquid argon time projection chamber to address the nature of the excess of low energy interactions observed by the MiniBooNE Collaboration. Three independent ν_{e} searches are performed across multiple single electron final states, including an exclusive search for two-body scattering events with a single proton, a semi-inclusive search for pionless events, and a fully inclusive search for events containing all hadronic final states. With differing signal topologies, statistics, backgrounds, reconstruction algorithms, and analysis approaches, the results are found to be either consistent with or modestly lower than the nominal ν_{e} rate expectations from the Booster Neutrino Beam and no excess of ν_{e} events is observed.

First Measurement of Energy-Dependent Inclusive Muon Neutrino Charged-Current Cross Sections on Argon with the MicroBooNE Detector

We report a measurement of the energy-dependent total charged-current cross section σ(E_{ν}) for inclusive muon neutrinos scattering on argon, as well as measurements of flux-averaged differential cross sections as a function of muon energy and hadronic energy transfer (ν). Data corresponding to 5.3×10^{19} protons on target of exposure were collected using the MicroBooNE liquid argon time projection chamber located in the Fermilab booster neutrino beam with a mean neutrino energy of approximately 0.8 GeV. The mapping between the true neutrino energy E_{ν} and reconstructed neutrino energy E_{ν}^{rec} and between the energy transfer ν and reconstructed hadronic energy E_{had}^{rec} are validated by comparing the data and Monte Carlo (MC) predictions. In particular, the modeling of the missing hadronic energy and its associated uncertainties are verified by a new method that compares the E_{had}^{rec} distributions between data and a MC prediction after constraining the reconstructed muon kinematic distributions, energy, and polar angle to those of data. The success of this validation gives confidence that the missing energy in the MicroBooNE detector is well modeled and underpins first-time measurements of both the total cross section σ(E_{ν}) and the differential cross section dσ/dν on argon.

Search for Neutrino-Induced Neutral-Current Δ Radiative Decay in MicroBooNE and a First Test of the MiniBooNE Low Energy Excess under a Single-Photon Hypothesis

We report results from a search for neutrino-induced neutral current (NC) resonant Δ(1232) baryon production followed by Δ radiative decay, with a ⟨0.8⟩  GeV neutrino beam. Data corresponding to MicroBooNE's first three years of operations (6.80×10^{20} protons on target) are used to select single-photon events with one or zero protons and without charged leptons in the final state (1γ1p and 1γ0p, respectively). The background is constrained via an in situ high-purity measurement of NC π^{0} events, made possible via dedicated 2γ1p and 2γ0p selections. A total of 16 and 153 events are observed for the 1γ1p and 1γ0p selections, respectively, compared to a constrained background prediction of 20.5±3.65(syst) and 145.1±13.8(syst) events. The data lead to a bound on an anomalous enhancement of the normalization of NC Δ radiative decay of less than 2.3 times the predicted nominal rate for this process at the 90% confidence level (C.L.). The measurement disfavors a candidate photon interpretation of the MiniBooNE low-energy excess as a factor of 3.18 times the nominal NC Δ radiative decay rate at the 94.8% C.L., in favor of the nominal prediction, and represents a greater than 50-fold improvement over the world's best limit on single-photon production in NC interactions in the sub-GeV neutrino energy range.

The role of echocardiography in the diagnosis of adult patients with myocarditis: a systematic review and meta-analysis

Funding Acknowledgements

Type of funding sources: None.

Background

Transthoracic echocardiography (TTE) plays a key diagnostic role in the initial work-up of patients presenting with myocarditis. Its utility in myocarditis is for identification of structural and functional changes, which may assist with diagnosis, surveillance and prognostication.

Purpose

The purpose of this systematic review and meta-analysis was to appraise the evidence associated with the use of echocardiography for the diagnosis of myocarditis in adults.

Methods

A systematic literature search of medical databases including Pubmed, Ovid Online, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, Scopus, ProQuest, Science Direct and grey literature was performed using PRISMA principles to identify all relevant TTE studies on myocarditis in adult patients (1995-2020; English only; PROSPERO registration CRD42021243598). Data for a range of TTE parameters were individually extracted and then meta-analysed using a random-effects model for overall effect size through standard mean difference (SMD).

Results

Of the 13 relevant studies, 6 were included and revealed that myocarditis can be reliably differentiated from healthy controls, both in the acute and sub-acute phase by left ventricular (LV) global longitudinal strain, and less so by LV ejection fraction and LV end-diastolic volume (p &lt; 0.05 for all). See Table. LV-GLS demonstrated the strongest ability to discriminate myocarditis patients from healthy controls when compared to standard two-dimensional measures of LV size and function (p &lt; 0.05).

Conclusions

LV-GLS demonstrated the best discriminatory ability for differentiation of myocarditis from adult healthy controls. Further research is required to characterize the utility of these quantitative parameters in the diagnostic work-up of these patients. Abstract Figure.

Unilateral diaphragmatic paresis following supracostal post-percutaneous nephrolithotomy

Unilateral acquired diaphragmatic paresis is a known complication of thoracic surgeries. Direct mechanical injury to the phrenic nerve during surgery results in this complication. However its occurrence post-percutaneous nephrolithotomy (PCNL) has not been described. We report a 43-year-old man who underwent prone PCNL for endourological management of left complete staghorn calculus. Access via the 10^th left intercostal space, under fluoroscopy, was carried out to remove the calculus. Post-operative, the routine chest radiograph revealed left hemidiaphragmatic blunting. Computerized tomography of the chest confirmed left hemidiaphragmatic elevation, suggesting unilateral diaphragmatic paresis. He did not have any respiratory symptoms, was managed conservatively with chest physiotherapy and incentive spirometry and responded extremely well. The absence of reported cases of diaphragmatic paresis post PCNL lends to a dearth in knowledge regarding recognition and management. This case report aims to acquaint urologists with this rare complication associated with supracostal PCNL and provide a rational management plan.

Patterns of left ventricular recovery in patients with heart failure with mid-range ejection fraction

Background

Heart failure with mid-range ejection fraction (HFmEF) represents a new classification of heart failure with intermediate clinical characteristics to those with HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). A proportion of HFmEF is attributed to atrio-ventricular dyssynchrony from atrial fibrillation (AF) as opposed to a primary cardiomyopathy with intrinsic cardiac myocyte dysfunction.

Purpose

We aim to compare the rate of left ventricular ejection fraction (LVEF) recovery in those with AF-mediated cardiomyopathy compared to those with primary myocyte dysfunction.

Methods

Consecutive patients with stable non-ischaemic cardiomyopathy with LVEF 40–49% on transthoracic echocardiography (TTE) were recruited from our institution's heart failure clinic and followed for 18 months. Patients with ischaemic, valvular or congenital heart disease, incomplete follow-up or poor quality TTE images were excluded. Eligible patients were separated into two groups: AF-mediated (n=44); and primary myocyte dysfunction (n=116).

Results

A total of 160 patients (62.1±16.4 years, 62% men) were included. There was no significant difference in age (p=0.06) and gender (p=0.59). Comorbid AF was higher in those with AF-mediated HFmEF (100 vs 28.4%; p&lt;0.01), otherwise no significant differences in clinical history was found between groups. AF-mediated HFmEF had lower rates of cardiac-specific beta-blocker use (15.9 vs 47.4%; p&lt;0.01). Baseline TTE showed similar LVEF and LV global longitudinal strain. On log-rank analysis there was no significant difference in all-cause death (p=0.75), or HF-related hospitalisation (p=0.14), however, higher rates of LVEF recovery were observed in the AF-mediated HFmEF group (p&lt;0.01). See figure 1.

Conclusion

There were higher rates of LVEF recovery in those with AF-mediated HFmEF compared to those with a primary myocardial disorder despite lower rates of cardiac-specific beta-blocker use. This did not translate to improvements in intermediate-term survival or HF related hospitalisation. These findings provide insight into the natural history of the disorder and its clinical phenotype.

Funding Acknowledgement

Type of funding sources: None. Figure 1. Rate of LVEF Recovery

LV-GLS is a predictor of all-cause death and cardiovascular MACE events in patients with neuro-immunological disorders

Background

Neuro-immunological disorders encompass several disease states, including multiple sclerosis (MS), autoimmune encephalitis (AE) and myasthenia gravis (MG). These autoimmune conditions are mediated via pro-inflammatory cytokines, and there is growing evidence to suggest cardiovascular involvement within these inflammatory states. Left ventricular global longitudinal strain (LV-GLS) is proposed to be a more sensitive measure of LV systolic function when compared to standard two-dimensional measures such as LV ejection fraction (LVEF).

Purpose

The purpose of this study was to assess for subclinical cardiac dysfunction in a cohort of patients with neuro-immunological disorders and correlate this with the development of outcomes on follow-up.

Methods

Consecutive patients with MS, AE and MG admitted to our institution during 2013–2020 were assessed (n=102). Patients without pre-existing cardiovascular disease, LVEF &lt;50% or lack of comprehensive transthoracic echocardiography during their index admission were included (n=55). This group was compared to age- and gender-matched controls (n=55) LV-GLS was measured offline using vendor-independent software (TomTec Arena, Germany v4.6) by two cardiologists blinded to the patient group or outcomes. These patients were followed for up for the composite outcome of all-cause death and major adverse cardiovascular events (MACE).

Results

A total of 55 patients (31 MS, 14 AE and 10 MG) were age- and gender- matched to 55 controls. There was no significant difference in baseline demographic characteristics or cardiovascular risk factors between groups. Patients with neuro-immunological disorders demonstrated impaired LV-GLS (−17.6±3.5 vs −20.8±1.9; p&lt;0.01) when compared to healthy controls, despite an LVEF within the normal range (60.9±7.7 vs 64.1±5.7; p=0.02) in both groups. There were a total of 9 (16.4%) outcomes during a mean follow-up of 41.0±33.0 months. LV-GLS was the only significant echocardiographic predictor of all-cause death and MACE events (p=0.013) on multi-variate analysis.

Conclusions

Our results suggest that patients with neuro-immunological disorders have subclinical LV dysfunction as assessed by LV-GLS which has prognostic capacity in this population. Further larger studies are required to further characterize this phenomenon.

Funding Acknowledgement

Type of funding sources: None.

Patients with rare autoimmune inflammatory disorders demonstrate sub-clinical left ventricular dysfunction

Background

ANCA-associated Vasculitis (AAV) and inflammatory myositis (IM) are rare inflammatory autoimmune disorders mediated via pro-inflammatory cytokines and result in a systemic inflammatory state with multi-organ involvement. There is growing evidence to suggest cardiovascular involvement within these inflammatory states. Left ventricular global longitudinal strain (LV-GLS) is proposed to be a more sensitive measure of LV systolic function when compared to standard two-dimensional measures such as LV ejection fraction (LVEF).

Purpose

The purpose of this study was to assess for subclinical cardiac dysfunction in these cohorts when compared to controls.

Methods

Consecutive patients with AAV (n=56) and IM (n=68) admitted to our institution during 2013–2021 were assessed. Patients with pre-existing cardiovascular disease, significant renal impairment (eGFR &lt;30mL/min/1.73m2), LVEF &lt;50% or lack of comprehensive transthoracic echocardiography during admission were excluded (n=72). LV-GLS was measured offline using vendor-independent software (TomTec Arena, Germany v4.6).

Results

A total of 52 patients (22 AAV and 30 IM) were age- and gender-matched to 52 controls. In comparison of the two study populations (AAV and IM), patients with AAV had higher rates of renal impairment (p=0.02) but lower rates of interstitial lung disease when compared to IM (p=0.02). There were no differences between the two groups in terms of cardiovascular risk factors, demographics or other laboratory investigations (p&gt;0.05 for all). In comparison to the control population, patients with AAV and IM had higher indexed LV mass and a lower TAPSE, respectively, when compared to controls. These cohorts also demonstrated impaired LV-GLS (−17.7±2.6 vs −20.6±2.4; p&lt;0.01) when compared to healthy controls, despite no differences in LVEF (62.6±7.8 vs 61.8±5.4; p=0.56) between both groups.

Conclusions

Our results suggest that patients with autoimmune inflammatory disorders demonstrate subclinical LV dysfunction which is likely secondary to a chronic inflammatory state.

Funding Acknowledgement

Type of funding sources: None.

Search for a Higgs Portal Scalar Decaying to Electron-Positron Pairs in the MicroBooNE Detector

We present a search for the decays of a neutral scalar boson produced by kaons decaying at rest, in the context of the Higgs portal model, using the MicroBooNE detector. We analyze data triggered in time with the Fermilab NuMI neutrino beam spill, with an exposure of 1.93×10^{20} protons on target. We look for monoenergetic scalars that come from the direction of the NuMI hadron absorber, at a distance of 100 m from the detector, and decay to electron-positron pairs. We observe one candidate event, with a standard model background prediction of 1.9±0.8. We set an upper limit on the scalar-Higgs mixing angle of θ<(3.3-4.6)×10^{-4} at the 95% confidence level for scalar boson masses in the range (100-200)  MeV/c^{2}. We exclude, at the 95% confidence level, the remaining model parameters required to explain the central value of a possible excess of K_{L}^{0}→π^{0}νν[over ¯] decays reported by the KOTO collaboration. We also provide a model-independent limit on a new boson X produced in K→πX decays and decaying to e^{+}e^{-}.

Cosmic Ray Background Removal With Deep Neural Networks in SBND

In liquid argon time projection chambers exposed to neutrino beams and running on or near surface levels, cosmic muons, and other cosmic particles are incident on the detectors while a single neutrino-induced event is being recorded. In practice, this means that data from surface liquid argon time projection chambers will be dominated by cosmic particles, both as a source of event triggers and as the majority of the particle count in true neutrino-triggered events. In this work, we demonstrate a novel application of deep learning techniques to remove these background particles by applying deep learning on full detector images from the SBND detector, the near detector in the Fermilab Short-Baseline Neutrino Program. We use this technique to identify, on a pixel-by-pixel level, whether recorded activity originated from cosmic particles or neutrino interactions.

167 The Experience and Outcomes of Elective Urgent and Cancer Surgery in A District General Hospital in The United Kingdom During Covid-19 Pandemic

Background

Many urgent and elective surgeries were postponed to cope with the Coronavirus disease (COVID-19) pandemic, with latest data found a substantial postoperative mortality risk (25·6%, 18.9%) after emergency and elective surgery, respectively.

Our institution was one of the first trust to offer essential elective surgery using a “COVID-free” designated site during the start of the pandemic.

The aim of this study is to analyse the clinical outcomes of patients who underwent essential elective procedures during the virus outbreak in the UK.

Method

Retrospective analysis of outcomes all patients who had undergone urgent elective and cancer surgery, from 30th March 2020 to 21st May 2020, using an implemented “Super Green Pathway”.

The primary endpoints were 30 days mortality and COVID related morbidities, and the secondary endpoints were surgical related complications and oncological outcomes.

Results

92 patients (Male:45%; Female:55%) across 5 surgical specialties were identified. There was no record of mortality in our cohort. Only 1 patient was tested positive for SARS-CoV-2, 18 days after the initial operation without any pulmonary complications.

Conclusions

It is possible to mitigate the high mortality risk of postoperative complications associated with COVID-19, with no delay to essential surgeries for cancer patients, thus delivering safe practice during the pandemic.

Acceleration of cutaneous wound healing by Lucilia sericata maggots in diabetic Wistar rats

The study was aimed to evaluate the effectiveness of maggot therapy in healing of cutaneous infected wound in streptozotocin (STZ) induced diabetic Wistar rat. For live maggots, the sterilized eggs of Lucilia sericata were obtained from colonies established in laboratory. Diabetes model was established in 48 male Wister rat by intra-peritoneal injection of STZ at the dose of 60 mg/kg body-weight. Cutaneous wounds exposed with mixed colonies of bacteria like Staphylococcus aureus, E. coli and Pseudomonas aeruginosa were prepared in all rat. The animals equally divided in 4 groups with 12 rats each being presented as treatment group of control, antibiotic, maggot and maggot with antibiotic in combination. All treatments were done once and hold for 24 hours. Wound kinetics and bacterial bio burden were measured at weekly interval to till complete healing. Significant reduction in wound area with maximum contraction was found (>95%) in maggot treated group when compared to antibiotic treated (79%) and control (72%). In maggot as well as maggot and antibiotic in combination group showed early elimination of bacterial bio-burden 7.88±0.03log CFU/ml to 1.12±0.65log CFU/ml and 7.86±0.04) log CFU/ml to 1.54±0.52log CFU/ml respectively in three weeks of time. Early healing indication was also experienced on histomorphological examination of wounded tissue of maggot treated groups by early and better epithelialization, collagenation and neovascularization with complete healing of wound in three weeks in comparison to antibiotic and control respectively. However, the present study did not show any difference in healing of wound with use of maggot alone or in antibiotic combination. Live maggot of Lucilia sericata effectively lower bacterial bioburden and and accelerate healing of infected cutaneous wound in diabetic conditions.

Can Mobile Health Improve Depression Treatment Access and Adherence Among Rural Indian Women? A Qualitative Study

Major Depressive Disorder (MDD) is associated with low rates of treatment and medication non-adherence, more so in low- and middle-income countries (LMICs). Mobile mental health (mHealth) interventions offer promise as a tool to address these problems. However, the feasibility and acceptability of mHealth interventions among rural women in LMICs is unknown. We examined barriers to accessing mental health treatment, reasons for non-adherence, and attitudes towards mHealth solutions among women with MDD in rural south India. Six focus groups were conducted among women with MDD (n = 69) who had been in treatment at a rural community health center. The discussion was transcribed and analyzed using a modified grounded-theory approach. Women perceived limited autonomy within their family structure, and experienced financial and systemic barriers as contributing to poor treatment access and non-adherence. Illiteracy, limited personal access to mobile phones, and preference for in-person clinical consultation were identified as barriers to use of mHealth. This is the first qualitative study, to our knowledge, that examines attitude towards mHealth among women with MDD in a rural setting in India. The study identified contextual barriers that will be important to address before implementing mHealth interventions.

First Measurement of Differential Charged Current Quasielasticlike ν_{μ}-Argon Scattering Cross Sections with the MicroBooNE Detector

We report on the first measurement of flux-integrated single differential cross sections for charged-current (CC) muon neutrino (ν_{μ}) scattering on argon with a muon and a proton in the final state, ^{40}Ar (ν_{μ},μp)X. The measurement was carried out using the Booster Neutrino Beam at Fermi National Accelerator Laboratory and the MicroBooNE liquid argon time projection chamber detector with an exposure of 4.59×10^{19} protons on target. Events are selected to enhance the contribution of CC quasielastic (CCQE) interactions. The data are reported in terms of a total cross section as well as single differential cross sections in final state muon and proton kinematics. We measure the integrated per-nucleus CCQE-like cross section (i.e., for interactions leading to a muon, one proton, and no pions above detection threshold) of (4.93±0.76_{stat}±1.29_{sys})×10^{-38}  cm^{2}, in good agreement with theoretical calculations. The single differential cross sections are also in overall good agreement with theoretical predictions, except at very forward muon scattering angles that correspond to low-momentum-transfer events.

Key changes in indices of myocardial work in cardiometabolic disease states

Background

Hypertension (HTN) and diabetes mellitus (DM) are prevalent cardiovascular disease states which have been shown to be associated with adverse cardiac remodelling and subclinical myocardial dysfunction. Myocardial work (MW) indices are novel non-invasive measures of left ventricular (LV) function. We aimed to characterise key differences in MW indices in patients with these conditions.

Methods

Outpatients with HTN and DM undergoing transthoracic echocardiography (TTE; 2016–2019) at our institution were assessed and compared to healthy controls. Only patients without cardiac disease with normal diastolic parameters on TTE were recruited. Patients with impaired LV function, cardiac ischaemia or arrhythmia, structural and valvular heart disease or poor-quality images were excluded. Recruited patients were stratified into 3 groups (Group1: Healthy Controls; Group 2: HTN; Group 3: HTN-DM). MW assessment was performed using GE E-95 EchoPac v2.2 system.

Results

Three hundred patients (57.3±17.4y, 51% female) were recruited. HTN and HTN-DM patients were associated with higher resting systolic blood pressure (SBP), indexed LV mass (LVMI), e' and E/e' compared to controls but no differences were noted in these parameters between HTN and HTN-DM. Global myocardial work index (GWI) was higher in HTN patients compared to Controls but not different compared to HTN-DM. Of interest, HTN-DM patients had higher global myocardial wasted work (GWW) and lower global myocardial work efficiency (GWE) compared to HTN patients and Controls.

Conclusions

MW indices may be a sensitive tool for the detection of subclinical changes in cardiac function in cardiometabolic disease states.

Funding Acknowledgement

Type of funding source: None

Effect of prevalent atrial fibrillation on cardiovascular outcomes in patients with chronic kidney disease

Background

The global increase in incidence and prevalence of chronic kidney disease (CKD) is associated with a parallel rise in co-morbid atrial fibrillation (AF). Concurrent presence of both conditions increases clinical complexity and may portend poor outcomes in this population.

Purpose

The aim of our study was to assess the impact of prevalent AF on mortality and cardiovascular outcomes in patients with CKD.

Methods

Consecutive patients with CKD (Stages 2 to 5) attending the Nephrology outpatient clinics in our health district between Jan 2007-Dec 2017 were retrospectively evaluated. Detailed appraisal of patient demographics, anthropometrics, clinical co-morbidities (including aetiology, stage and management of CKD) and pharmacotherapeutics was undertaken. These patients were followed for up to ten years for the composite outcomes of all-cause death and major adverse cardiovascular events (MACE). We excluded patients with incomplete clinical data and patients with concomitant medical co-morbidity limiting lifespan to &lt;6 months.

Results

2008 patients (63.61±17.17 yrs; 55.7% men) were assessed. The mean eGFR was 37.53±21.88 mL/min/m2. Patients with prevalent AF (n=440, 22%) were older (p&lt;0.01), with lower eGFR (p&lt;0.01) and higher rates of renal replacement therapy (p&lt;0.01). They also had a greater burden of coronary disease (p&lt;0.01), heart failure (p&lt;0.01), stroke (p&lt;0.01), obstructive sleep apnoea (p&lt;0.01), chronic obstructive pulmonary disease (p&lt;0.01), anaemia (p&lt;0.01) and obesity (p&lt;0.01). Over the mean follow-up period of 44.04±34.96 months, 832 patients met the composite outcome (410 all-cause death, 422 MACE). On log rank tests, prevalent AF was a predictor of the composite outcome (Figure 1; p&lt;0.01) and remained an independent predictor of all-cause death and MACE on multivariate analysis (HR 1.65; 95% CI 1.24–2.21, p&lt;0.01).

Conclusions

Prevalent AF is an independent predictor of all-cause death and MACE in patients with CKD.

Figure 1. Kaplan Meier Curve

Funding Acknowledgement

Type of funding source: None

Toward a hemorrhagic trauma severity score: fusing five physiological biomarkers

BACKGROUND

To introduce the Hemorrhage Intensive Severity and Survivability (HISS) score, based on the fusion of multi-biomarker data; glucose, lactate, pH, potassium, and oxygen tension, to serve as a patient-specific attribute in hemorrhagic trauma.

MATERIALS AND METHODS

One hundred instances of Sensible Fictitious Rationalized Patient (SFRP) data were synthetically generated and the HISS score assigned by five clinically active physician experts (100 [5]). The HISS score stratifies the criticality of the trauma patient as; low(0), guarded(1), elevated(2), high(3) and severe(4). Standard classifier algorithms; linear support vector machine (SVM-L), multi-class ensemble bagged decision tree (EBDT), artificial neural network with bayesian regularization (ANN:BR) and possibility rule-based using function approximation (PRBF) were evaluated for their potential to similarly classify and predict a HISS score.

RESULTS

SVM-L, EBDT, ANN:BR and PRBF generated score predictions with testing accuracies (majority vote) corresponding to 0.91 ± 0.06, 0.93 ± 0.04, 0.92 ± 0.07, and 0.92 ± 0.03, respectively, with no statistically significant difference (p > 0.05). Targeted accuracies of 0.99 and 0.999 could be achieved with SFRP data size and clinical expert scores of 147[7](0.99) and 154[9](0.999), respectively.

CONCLUSIONS

The predictions of the data-driven model in conjunction with an adjunct multi-analyte biosensor intended for point-of-care continual monitoring of trauma patients, can aid in patient stratification and triage decision-making.

Catheter-induced urethral injury and tubularized urethral plate urethroplasty in such iatrogenic hypospadias

Background

Catheter-induced urethral erosion can involve meatus, glans and any extent of penile shaft. These injuries cause a lot of psychological, social and sexual trauma to the patient. Though the use of condom drainage system can render this spinal cord injury patient effectively dry, but can lead to penile or urethral complications. Many of these patients are kept on indwelling catheter. Long duration catheterization, poor catheter care in such paraplegic patients and other morbid patients may lead to urethral erosions. We conducted a prospective study of catheter-induced urethral injury from July 2014 to February 2016 in our tertiary care centre. The demographics, past history of illness, catheter material, and duration of catheterization, securing of catheter, local examination findings and associated comorbidities were recorded. Factors leading to urethral erosion were evaluated. And patients, who were fit and were willing for surgery, underwent tubularized urethral plate urethroplasty after 4–6-week supra-pubic diversion. The objective of the study was to evaluate factors of urethral erosion, and the results tubularized urethral plate urethroplasty in iatrogenic hypospadias.

Results

We had twelve patients of catheter associated urethral injury in the study period. Age of the patients varied from 34 to 95 years with a mean of 61.25 years. Duration of catheterization ranged from 6 to 24 months with a mean duration 10.9 months. Catheters used were silicon coated, not secured to abdomen and had comorbid condition of neurological or cardiac origin in all patients. Long duration of catheter, poor quality of catheter and poor catheter care such moribund with poor body resistance patients were the main causative factor for urethral erosion. Urethral injuries varied from erosion of distal 2 cm to entire ventral urethra till penoscrotal junction with or without penile torque. Six of these patients underwent tubularized urethral plate urethroplasty with good cosmetic and functional postoperative outcome.

Conclusion

Patients of spinal cord injury, patients with comorbid condition like diabetes mellitus and ischaemic heart disease, poor catheter care and long duration catheterization are likely to have severe urethral injury. Extent of injury may vary from meatal erosion to erosion of entire ventral urethra till penoscrotal junction leading to iatrogenic hypospadias. These patients either may be put on clean intermittent catheterization or supra-pubic catheterization. Results of tubularized urethral plate urethroplasty in such iatrogenic hypospadias are very good.

OP0307 A NOVEL TARGETED APPROACH TO ACHIEVE IMMUNE SYSTEM RESET: CD45-TARGETED ANTIBODY DRUG CONJUGATES AMELIORATE DISEASE IN PRECLINICAL AUTOIMMUNE DISEASE MODELS AND ENABLE AUTO-HSCT

Background:

Resetting the immune system through autologous hematopoietic stem cell transplant (autoHSCT) is a highly effective treatment in selected patients with autoimmune diseases. AutoHSCT can induce long-term remission with 80% progression free survival in multiple sclerosis patients (Muraro 2017, Burt 2019). Use of autoHSCT in scleroderma patients has achieved superior outcomes in two randomized studies compared to standard of care (Tyndall 2014, Sullivan 2018). These impressive results are achieved by a combination of the eradication of autoreactive immune effector cells and re-establishment of self-tolerance, i.e., immune system reset. However, only a small fraction of eligible patients undergo autoHSCT, largely due to toxicity associated with current conditioning protocols.

Objectives:

As part of our goal to enable more patients to benefit from immune system reset, we have generated novel anti-human CD45 ADCs that cross react with nonhuman primates (NHP) and an anti-mouse CD45 ADC to model the approach in mouse models of AID.

Methods:

The human-targeted CD45-ADC is an affinity-matured mAb that targets an epitope present on all human CD45 isoforms, is cross-reactive with NHP CD45, and is conjugated to a payload that efficiently kills both quiescent and cycling cells. This ADC is engineered to eliminate Fc-mediated effector function, enable site-specific conjugation of linker/payload, and enable rapid clearance. This ADC was evaluated in vitro and in vivo in hNSG and NHPs. The murine tool ADC specifically targets the CD45.2 isoform of mouse CD45, and is also engineered to eliminate effector function, allow for site-specific conjugation of linker payload, and be rapidly cleared. The payload for this murine tool ADC is potent and preferentially kills dividing cells. This ADC was tested for the ability to enable immune reset and ameliorate autoimmune disease in multiple disease models.

Results:

The anti-human CD45-ADC showed efficient killing of human HSCs and human and cyno PBMC, including CD3+cells from healthy donors and patients with MS. In hNSG, single doses of the CD45-ADC were well-tolerated and led to substantial depletion of human cells. In NHPs, single doses of CD45-ADC were well tolerated and depleted both peripheral lymphocytes and HSCs. Administration of a single dose of anti-human CD45-ADC to hNSGs with sclerodermatous xenoGVHD resulted in depletion of human T cells and resolution of symptoms. A single-dose of the anti-mouse CD45-ADC enabled full myeloablation and complete durable donor chimerism with congenic HSCT at 16 weeks. In a murine immunization model of MS, MOG-induced EAE, a single dose of the CD45-ADC followed by congenic HSCT prior to disease onset enabled full donor chimerism, significantly delayed disease onset and reduced disease severity. We are generating additional data in an adoptive transfer model of EAE to confirm and extend these results. In a murine model of arthritis, therapeutic treatment with a single dose of the CD45-ADC followed by congenic HSCT enabled complete donor chimerism and halted disease progression, comparable to with the effects of an anti-TNFα antibody. The ADC is being further evaluated in a model of type 1 diabetes and those data will be presented. These data demonstrate that CD45-ADC conditioning followed by congenic HSCT is sufficient for full myeloablation and immune reset.

Conclusion:

These results demonstrate that targeted immune depletion with a single dose of CD45-ADC can enable auto-HSCT and immune reset in multiple AID indications without toxic side effects. Targeted conditioning with CD45-ADC may represent a better tolerated approach for removing disease-causing cells as part of immune reset through auto-HSCT and enable more patients to benefit.

Disclosure of Interests:

Geoffrey Gillard Shareholder of: Magenta Therapeutics, Employee of: Magenta Therapeutics, Jennifer Proctor Shareholder of: Magenta Therapeutics, Employee of: Magenta Therapeutics, Sharon Hyzy Shareholder of: Magenta Therapeutics, Employee of: Magenta Therapeutics, Oliver Mikse Shareholder of: Magenta Therapeutics, Employee of: Magenta Therapeutics, Tahirih Lamothe Shareholder of: Magenta Therapeutics, Employee of: Magenta Therapeutics, Sean McDonough Shareholder of: Magenta Therapeutics, Employee of: Magenta Therapeutics, Nicholas Clark Shareholder of: Magenta Therapeutics, Employee of: Magenta Therapeutics, Rahul Palchaudhuri Shareholder of: Magenta Therapeutics, Employee of: Magenta Therapeutics, Anjali Bhat Shareholder of: Magenta Therapeutics, Employee of: Magenta Therapeutics, Melissa Brooks Shareholder of: Magenta Therapeutics, Employee of: Magenta Therapeutics, Ganapathy Sarma Shareholder of: Magenta Therapeutics, Employee of: Magenta Therapeutics, Prashant Bhattarai Shareholder of: Magenta Therapeutics, Employee of: Magenta Therapeutics, Pranoti Sawant Shareholder of: Magenta Therapeutics, Employee of: Magenta Therapeutics, Brad Pearse Shareholder of: Magenta Therapeutics, Employee of: Magenta Therapeutics, Charlotte McDonagh Shareholder of: Magenta Therapeutics, Employee of: Magenta Therapeutics, Tony Boitano Shareholder of: Magenta, Employee of: Magenta, Michael Cooke Shareholder of: Magenta, Employee of: Magenta

Engineering the ABIO-BIO interface of neurostimulation electrodes using polypyrrole and bioactive hydrogels

Following spinal cord injury, the use of electrodes for neurostimulation in animal models has been shown to stimulate muscle movement, however, the efficacy of such treatment is impaired by increased interfacial impedance caused by fibrous encapsulation of the electrode. Sputter-deposited gold-on-polyimide electrodes were modified by potentiostatic electrodeposition of poly(pyrrole-co-3-pyrrolylbutyrate-conj-aminoethylmethacrylate): sulfopropyl methacrylate [P(Py-co-PyBA-conj-AEMA):SPMA] to various charge densities (0–100 mC/cm2) to address interfacial impedance and coated with a phosphoryl choline containing bioactive hydrogel to address biocompatibility at the ABIO-BIO interface. Electrodes were characterized with scanning electron microscopy (surface morphology), multiple-scan rate cyclic voltammetry (peak current and electroactive area), and electrochemical impedance spectroscopy (charge transfer resistance and membrane resistance). SEM analysis and electroactive area calculations identified films fabricated with a charge density of 50 mC/cm2 as well suited for neurostimulation electrodes. Charge transfer resistance demonstrated a strong inverse correlation (−0.83) with charge density of electrodeposition. On average, the addition of polypyrrole and hydrogel to neurostimulation electrodes decreased charge transfer resistance by 82 %. These results support the use of interfacial engineering techniques to mitigate high interfacial impedance and combat the foreign body response towards epidurally implanted neurostimulation electrodes.

Differences in caregiver behaviors of infants at-risk for autism and typically developing infants from 9 to 15 months of age

During an object sharing paradigm, we compared infant-caregiver interactions between two groups: i) infants at high-risk (HR) for being diagnosed with Autism Spectrum Disorder (ASD) and ii) low-risk (LR) infants, observed at 9, 12, and 15 months of age. 16 HR infants (14 infants with an older sibling diagnosed with ASD and 2 preterm infants that received a diagnosis of ASD at 2 years) and 16 LR infants (typically developing infants without older siblings diagnosed with ASD) were included in the study. At each visit, infants played with objects in the presence of their caregivers as crawlers or walkers. Previously, we found that HR infants are less likely to share their object play with caregivers at walker ages. The present study found that caregivers of HR infants used greater directive bids including being more proximal to infants and using greater verbal and non-verbal bids to sustain their infant's attention and to ensure their compliance during the task compared to caregivers of LR infants. Our study emphasizes the bidirectional and dynamic nature of infant-caregiver interactions. Our findings have implications for caregiver training programs that teach parents appropriate strategies to promote early social communication skills in at-risk infants.

Toward Impedimetric Measurement of Acidosis with a pH-Responsive Hydrogel Sensor

A pH-responsive, poly(2-hydroxyethyl methacrylate) [poly(HEMA)]-based hydrogel has been fashioned into an impedimetric pH sensor for the continual measurement and monitoring of tissue acidosis that can arise due to hemorrhaging trauma. Four hydrogel systems molecularly engineered to influence water distribution and ionic abundance were studied: a cationogenic primary amine, N-(2-aminoethyl) methacrylate (AEMA), a tertiary amine moiety, N,N-(2-dimethylamino)ethyl methacrylate (DMAEMA), and a combined AEMA-DMAEMA formulation. Electrochemical impedance spectroscopy (EIS) of hydrogel discs held between platinized Type 304 stainless steel mesh electrodes in pH-adjusted 4-(2-hydroxyethyl)-1-piperazineethanesulfonic acid sodium salt (HEPES) buffer and equivalent circuit modeling indicated that the AEMA hydrogel had the highest sensitivity containing the relevant pathophysiological range (pH 7.0-8.0). Thus, the AEMA formulation was studied at 0, 1, 3, 4.4, and 30 mol % AEMA. The 1 mol % AEMA was found to significantly (p < 0.05) discern nominal pH (7.35, 7.40, 7.45). The Taguchi Design of Experiments approach was employed and confirmed composition as a factor and 1 mol % AEMA to be the most robust. DMAEMA (0, 4.4, 14, 30 mol %) and AEMA-DMAEMA (0, 4.4, 14, 30 mol %) allowed the use of the one-factor Response Surface Methodology optimizer to confirm the AEMA 1 mol % system to be most robust, sensitive, and possessing optimal sensitivity in the pathophysiological pH sensing range (7.35-7.45) for hemorrhagic trauma. This composition was fashioned as a responsive membrane on a microlithographically fabricated interdigitated microsensor electrode and the sensitivity was determined using R(QR)(QR) analysis. Water distribution within the AEMA (0, 1, 4.4, 30 mol %), determined by gravimetric analysis and differential scanning calorimetry, revealed a strong anticorrelation between nonfreezable bound water and pH sensitivity (-0.82) and was in good agreement with the total hydration (-0.70). Nonfreezable bound water was found to be the most strongly correlated factor that governs the pH response of hydrogels.