Relevance of tributary inflows for driving molecular composition of dissolved organic matter (DOM) in a regulated river system

River regulation by dams can alter flow regimes and organic matter dynamics, but less is known about how unregulated tributaries regulate organic matter composition and processing in the regulated river below the confluence. This study reports on water chemistry, especially dissolved organic matter (DOM) concentration and composition (dissolved organic carbon (DOC), organic nitrogen (DON), organic phosphorus (DOP) and combined amino acids (DCAA)) along the regulated Tumut and unregulated Goobarragandra (tributary) rivers under different flow conditions (base flow vs storm event) in south-east Australia. The tributary was significantly different from regulated and downstream sites during base flow conditions with higher temperature, pH, buffering capacity, DOC and nutrient concentrations (DON, DOP, DCAA). DOM characterisation by spectrometry and size exclusion chromatography revealed that the tributary contained a higher proportion of terrestrially derived humic-like and fulvic-like DOM. In contrast, regulated and downstream sites contained higher proportion of microbially derived DOM such as low molecular weight neutrals and protein-like components. Storm pulses of tributary flows into the regulated system, influenced both concentration and composition of DOM at the downstream site, which more strongly resembled the tributary site than the regulated site during the storm event. Additionally, we found that the tributary supplied fresh DOM, including small organic molecules to the regulated system during storm events. The presence of these different types of labile DOM can increase primary productivity and ecological functioning within regulated river reaches downstream of tributary junctions. This has important implications for the protection of unregulated tributary inflows within regulated river basins.

CDK9 inhibition induces epigenetic reprogramming revealing strategies to circumvent resistance in lymphoma

Diffuse large B-cell lymphoma (DLBCL) exhibits significant genetic heterogeneity which contributes to drug resistance, necessitating development of novel therapeutic approaches. Pharmacological inhibitors of cyclin-dependent kinases (CDK) demonstrated pre-clinical activity in DLBCL, however many stalled in clinical development. Here we show that AZD4573, a selective inhibitor of CDK9, restricted growth of DLBCL cells. CDK9 inhibition (CDK9i) resulted in rapid changes in the transcriptome and proteome, with downmodulation of multiple oncoproteins (eg, MYC, Mcl-1, JunB, PIM3) and deregulation of phosphoinotiside-3 kinase (PI3K) and senescence pathways. Following initial transcriptional repression due to RNAPII pausing, we observed transcriptional recovery of several oncogenes, including MYC and PIM3. ATAC-Seq and ChIP-Seq experiments revealed that CDK9i induced epigenetic remodeling with bi-directional changes in chromatin accessibility, suppressed promoter activation and led to sustained reprograming of the super-enhancer landscape. A CRISPR library screen suggested that SE-associated genes in the Mediator complex, as well as AKT1, confer resistance to CDK9i. Consistent with this, sgRNA-mediated knockout of MED12 sensitized cells to CDK9i. Informed by our mechanistic findings, we combined AZD4573 with either PIM kinase or PI3K inhibitors. Both combinations decreased proliferation and induced apoptosis in DLBCL and primary lymphoma cells in vitro as well as resulted in delayed tumor progression and extended survival of mice xenografted with DLBCL in vivo. Thus, CDK9i induces reprogramming of the epigenetic landscape, and super-enhancer driven recovery of select oncogenes may contribute to resistance to CDK9i. PIM and PI3K represent potential targets to circumvent resistance to CDK9i in the heterogeneous landscape of DLBCL.

Stylized versus voxel phantoms: quantification of internal organ chord length distances

Dosimetric calculations, whether for radiation protection or nuclear medicine applications, are greatly influenced by the use of computational models of humans, called anthropomorphic phantoms. As anatomical models of phantoms have evolved and expanded, thus has the need for quantifying differences among each of these representations that yield variations in organ dose coefficients, whether from external radiation sources or internal emitters. This work represents an extension of previous efforts to quantify the differences in organ positioning within the body between a stylized and voxel phantom series. Where prior work focused on the organ depth distribution vis-à-vis the surface of the phantom models, the work described here quantifies the intra-organ and inter-organ distributions through calculation of the mean chord lengths. The revised Oak Ridge National Laboratory stylized phantom series and the University of Florida/National Cancer Institute voxel phantom series including a newborn, 1-, 5-, 10- and 15 year old, and adult phantoms were compared. Organ distances in the stylized phantoms were computed using a ray-tracing technique available through Monte Carlo radiation transport simulations in MCNP6. Organ distances in the voxel phantom were found using phantom matrix manipulation. Quantification of differences in organ chord lengths between the phantom series displayed that the organs of the stylized phantom series are typically situated farther away from one another than within the voxel phantom series. The impact of this work was to characterize the intra-organ and inter-organ distributions to explain the variations in updated internal dose coefficient quantities (i.e. specific absorbed fractions) while providing relevant data defining the spatial and volumetric organ distributions in the phantoms for use in subsequent internal dosimetric computations, with prospective relevance to patient-specific individualized dosimetry, as well as informing machine learning definition of organs using these reference models.

Statistical considerations for design and analysis of stability, comparability and formulation tests

This article considers designed experiments for stability, comparability, and formulation testing that are analyzed with regression models in which the degradation rate is a fixed effect. In this setting, we investigate how the number of lots, the number of time points and their locations affect the precision of the entities of interest, leverages of the time points, detection of non-linearity and interim analyses. This investigation shows that modifying time point locations suggested by ICH for stability studies can significantly improve these objectives. In addition, we show that estimates of precision can be biased when a regression model that assumes independent measurements is used in the presence of within-assay session correlation. This bias can lead to longer shelf life estimates in stability studies and loss of power in comparability studies. Mixed-effect models that take into account within-assay session correlation are shown to reduce this bias. The findings in this article are obtained from well known statistical theory but provide valuable practical advice to scientists and statisticians designing and interpreting these types of experiments.

Identification and interrogation of the gene regulatory network of CEBPA-double mutant acute myeloid leukemia

Acute myeloid leukemia (AML) is a heterogeneous hematological malignancy caused by mutations in genes encoding transcriptional and epigenetic regulators together with signaling genes. It is characterized by a disturbance of differentiation and abnormal proliferation of hematopoietic progenitors. We have previously shown that each AML subtype establishes its own core gene regulatory network (GRN), consisting of transcription factors binding to their target genes and imposing a specific gene expression pattern that is required for AML maintenance. In this study, we integrate gene expression, open chromatin and ChIP data with promoter-capture Hi-C data to define a refined core GRN common to all patients with CEBPA-double mutant (CEBPA^N/C) AML. These mutations disrupt the structure of a major regulator of myelopoiesis. We identify the binding sites of mutated C/EBPα proteins in primary cells, we show that C/EBPα, AP-1 factors and RUNX1 colocalize and are required for AML maintenance, and we employ single cell experiments to link important network nodes to the specific differentiation trajectory from leukemic stem to blast cells. Taken together, our study provides an important resource which predicts the specific therapeutic vulnerabilities of this AML subtype in human cells.

An Improved Impact Ratio for Identifying Critical Process Parameters in Pharmaceutical Manufacturing Processes

The identification of critical process parameters in biologics and small molecule process development is a key element of quality by design. The objectivity and consistency of procedures to identify critical process parameters can be improved with the use of impact ratios. Impact ratios quantify a process parameter's practical effect on a critical quality attribute relative to the critical quality attribute's acceptance limits. If the impact ratio is large, i.e., exceeds a predefined impact ratio threshold, the recommendation is to classify the process parameter as a critical process parameter. This article introduces an improved and mathematically well-defined impact ratio. Benefits of this impact ratio are a consistent interpretation for many scenarios commonly encountered in practice, high suitability to automation, and the possibility of standardizing on a single impact ratio definition for pharmaceutical manufacturing.

Abstract A06: Strategies to circumvent resistance to cyclin-dependent kinase-9 inhibition (CDK9i) in non-Hodgkin lymphoma (NHL)

Introduction Oncogenic programs are facilitated by activators of transcriptional machinery, including certain CDKs. CDK9, a component of the positive transcription elongation factor b (pTEFb) complex, has arisen as an attractive target due to its regulation of MYC and MCL1 transcription (Hashiguchi et al, 2019). Nevertheless, we and others have observed resistance to CDK9i in vitro and in vivo. Here we studied the effects of CDK9 inhibition using the novel selective CDK9 inhibitor AZD4573, currently under evaluation in clinical trials. Methods A panel of NHL cell lines (OCI-LY3/19, SUDHL4/10/16, VAL, U2932) and primary NHL cells were employed. Response to CDK9i was characterized using LC-MS proteomic analysis, RNA-Seq, and CRISPR-Cas9 Screening. Results NHL cells treated with AZD4573 for 6h exhibited a dose dependent reduction in phospho-RNAPIISer2, as well as loss of MYC and Mcl-1. CDK9i potently inhibited proliferation and induced apoptosis in a panel of NHL cell lines (IC50 range 5-30 nM). Two DLBCL cell lines underwent LC-MS proteomic analysis following AZD4573 treatment (30 nM, 3h). Treated cells exhibited rapid loss of MYC, Mcl-1, PIM3 and JUNB protein levels. We observed broad transcriptional repression via RNA-seq, including downregulation of PIM3 and JUNB (30 nM, 3h). However, a subset of genes, including MYC, PIM1 and JUNB underwent early transcriptional recovery, confirmed by immunoblotting, thus identifying candidate genes which may account for resistance to CDK9i. PIM kinases cooperate with the PI3K/ATK signaling pathway, and have been proposed as therapeutic targets in cancer. We next used SGI1776 (PIM1 specific) and AZD1208 (pan-PIM) in combination with AZD4573, and found synergy between them in a panel of 4 cell lines and primary samples. OCI-LY3 xenograft mice treated with a combination of AZD4573 (15 mg/kg; IP; once weekly) and AZD1208 (30 mg/kg; oral gavage, twice weekly) demonstrated restricted tumor growth and increased survival compared to control. To further understand pathways mediating resistance to CDK9i, we carried out a genome-wide loss of function CRISPR-Cas9 library screen. Two Cas9-expressing NHL cell lines were transduced with a CRISPR library comprised of ~5 unique sgRNA per gene. Loss of AKT, RPTOR, or mTOR, among others, sensitized cells to AZD4573. Concurrent treatment with PI3K inhibitors synergistically suppressed proliferation of NHL cell lines and primary cells treated with AZD4573 in vitro. OCI-LY3 xenograft mice were treated with AZD4573 (15 mg/kg; IP; once weekly), Copanlisib (15 mg/kg; IP; twice weekly), or a combination of both. Combo treatment restricted tumor growth and prolonged survival to a greater extent than either drug alone. Conclusions CDK9i with AZD4573 downregulated numerous oncoproteins. However, a subset of genes including MYC and PIM3 recovered transcription. PI3K/AKT pathway was implicated in resistance to CDK9i in CRISPR library screens. Concurrent targeting of pro-survival pathways (e.g., PIM, PI3K) partially reversed resistance to CDK9i.

Citation Format: Elana Thieme, Duanchen Sun, Nur Bruss, Geeta Sharma, Tingting Liu, Daniel Coleman, Tamilla Nechiporuk, Daniel Bottomly, Shannon McWeeney, Patrick Pirrotte, Zheng Xia, Alexey Danilov. Strategies to circumvent resistance to cyclin-dependent kinase-9 inhibition (CDK9i) in non-Hodgkin lymphoma (NHL) [abstract]. In: Proceedings of the Third AACR International Meeting: Advances in Malignant Lymphoma: Maximizing the Basic-Translational Interface for Clinical Application; 2022 Jun 23-26; Boston, MA. Philadelphia (PA): AACR; Blood Cancer Discov 2022;3(5_Suppl):Abstract nr A06.

Examining the social origins and young adult life trajectories of high traditional masculinity (HTM) males: A group at elevated suicide risk

OBJECTIVE

We investigated whether male high school students displaying high traditional masculinity (HTM), defined briefly as overacting male roles, possessed distinctive social origins and adult lifestyle trajectories differentiating them from others.

METHOD

Based upon four survey waves of the National Longitudinal Study of Adolescent to Adult Health cross-linked to the National Death Index, we contrasted surveys 1 and 2 respondents reporting HTM, n = 3138, 31%, with the remaining 69% (n = 6849) on various sociodemographic characteristics, problem behaviors, suicides, and other premature mortalities.

RESULTS

High traditional masculinity males showed higher suicide rates, but no other differences in premature mortalities, compared with non-HTM peers. More likely to be White, younger, less close to their fathers, they were more likely to run away from home, get into fights, act delinquently, and engage in problem drinking and drug use. At survey wave 3, more had been arrested. By wave 4, when approaching their early thirties, HTM males showed higher drug uses, more delinquency, completed less schooling, and were less likely to marry.

CONCLUSIONS

These data not only suggest higher suicide risks among this population after high school, but judging from the durability of HTM characteristics, but also they appear at risk of "deaths of despair" during later life.

Association of High Traditional Masculinity and Risk of Suicide Death: Secondary Analysis of the Add Health Study

This cohort study explores the association between high traditional masculinity and suicide death among US men using data from the Add Health study.

Microwave Thermolysis Reduces Generalized and Social Anxiety in Young Adults With Axillary Hyperhidrosis

BACKGROUND AND OBJECTIVE

Hyperhidrosis (HH) is associated with impairments in quality of life (QOL) and elevated anxiety. Microwave thermolysis is a newer treatment that reduces sweating, yet effects on QOL and emotional symptoms have not been examined. Two treatment sessions are recommended to achieve 80% amelioration of clinical HH. We hypothesized that microwave thermolysis would reduce sweat severity, improve QOL, and reduce anxiety in young adults suffering from axillary HH in a prospective clinical trial.

STUDY DESIGN/MATERIALS AND METHODS

We enrolled 24 young adults (mean age = 23.57 years, 54% female) with elevated scores on the Hyperhidrosis Disease Severity Scale. All participants received one session of microwave thermolysis, and 83% received two sessions. Participants completed measures of sweat severity, QOL, generalized anxiety, social anxiety, social avoidance, and anxious/depressive mood symptoms at baseline; post-first treatment; and following second treatment.

RESULTS

At baseline, all participants had severe sweating; 87.5% had impaired QOL, 75% had elevated social anxiety, 50% with generalized anxiety, 48% with social avoidance, and 38% with anxious/depressed mood. Paired samples t tests indicated significant improvements from baseline to first procedure, including decreased sweating (t(21) = 5.68, P < 0.001), improved QOL (t(23) = 4.97, P < 0.001), and decreased generalized anxiety (t(23) = 8.11, P < 0.001), social anxiety (t(22) = 4.55, P < 0.001), mood symptoms (t(21) = 3.81, P = 0.001), and social avoidance (t(22) = 3.12, P = 0.005). After second treatment, further improvements were noted in sweating (t(18) = 3.28, P = 0.004) and QOL (t(18) = 3.83, P = 0.003), and a marginal trend for generalized anxiety (t(19) = 1.96, P = 0.064).

CONCLUSION

There were significant improvements in sweat severity, skin-specific QOL, generalized anxiety, social anxiety, anxious/depressive symptoms, and social avoidance. The majority of the psychosocial benefit appears to emerge after one treatment of microwave thermolysis, whereas the level of sweat severity and QOL continued to show further improvements after a second treatment. Results would suggest that although two microwave thermolysis sessions are needed for maximal treatment optimization of axillary HH, patients may experience significant benefits in improving psychosocial functioning after just one session. Lasers Surg. Med. © 2020 Wiley Periodicals, Inc.

P373 Left atrial mechanics and aortic stiffness following high intensity interval training: a randomised controlled study

Background

Physical inactivity is associated with an increased risk of cardiovascular disease. High intensity interval training (HIIT) has been shown to improve important health parameters, including aerobic capacity, arterial blood pressure, cardiac autonomic modulation and left ventricular mechanics. However, adaptations in left atrial (LA) mechanics and aortic stiffness remain unclear. Therefore, the aim of the present study was to assess any left atrial and aortic adaptations to HIIT.

Methods

Forty-one physically inactive males and females (aged 23 ± 2.7 years) volunteered for the study. Participants were randomised to either a 4-week HIIT intervention (n = 21) or 4-week control period (n = 20). The HIIT protocol consisted of 3 x 30-second maximal cycle ergometer sprints with a resistance of 7.5% body weight, interspersed with 2-minutes of active unloaded recovery. Speckle tracking imaging of the left atrium and M-Mode tracing of the aorta was performed pre and post HIIT and control period using commercially available software (EchoPac; GE Medical Systems). Analysis of covariance, with baseline measures as the covariate, was used to explore any differences in left atrial mechanics and aortic stiffness between the intervention and control groups. Stepwise linear regression analysis using LA stiffness as the dependent variable was conducted.

Results

Following 4-weeks of HIIT, there was significant improvement in LA mechanics, including LA reservoir (13.9 ± 13.4%, p = 0.033) and LA stiffness (-0.05 ± 0.04%-1, p = 0.032) compared to the control condition. In addition, improvements were observed in aortic distensibility (2.1 ± 2.7 cm2 × dyn×-1 × 103, p = 0.031) and aortic stiffness index (-2.6 ± 4.6, p = 0.041) compared to the control condition. In stepwise linear regression analysis, aortic distensibility change was significantly associated with LA stiffness change (p = 0.002), with an R2 of 0.613.

Conclusion

A short-term programme of HIIT was associated with a significant improvement in LA mechanics and aortic stiffness. These adaptations may have important health implications and contribute to the improved left ventricular diastolic and systolic mechanics, aerobic capacity and reduced arterial blood pressure previously documented following HIIT.

Kognito's Avatar-Based Suicide Prevention Training for College Students: Results of a Randomized Controlled Trial and a Naturalistic Evaluation

OBJECTIVE

To evaluate the efficacy and effectiveness of Kognito At Risk for College Students, an online, interactive suicide prevention gatekeeper training.

METHODS

In Study 1, a randomized controlled trial was conducted to test the efficacy of Kognito. Retention of participants at follow-up was strong. In Study 2, administrative records were used to follow the help-seeking behavior of Kognito trainees for one academic year, contrasted with untrained students.

RESULTS

In Study 1, between-group changes in gatekeeper attitudes were large at time-two, but attenuated modestly by 2-month follow-up. Kognito trainees referred more peers at 2-month follow-up (Cohen's d = .56, p < .05) - training 4 students in Kognito produces 1 more peer referred. In Study 2, the help-seeking rate of Kognito trainees (14.4%) was two-times the rate (6.8%) of untrained students (p < .001). Training 14 students in Kognito leads to 1 more self-referral to the Counseling Center.

CONCLUSIONS

This first randomized controlled trial of the college student version of Kognito validates the findings of less rigorous studies. Few brief suicide prevention trainings have shown changes in trainee behaviors such as referrals of at-risk peers and trainees actual help-seeking behavior. These results are promising that Kognito may outperform other similar suicide prevention trainings.

Learning from the Outside In: Incorporating Wilderness Medicine into Traditional Emergency Medicine Education

[Full article available at http://rimed.org/rimedicaljournal-2019-02.asp].

Association of Exposure to Police Violence With Prevalence of Mental Health Symptoms Among Urban Residents in the United States

IMPORTANCE

Police violence is reportedly widespread in the United States and may pose a significant risk to public mental health.

OBJECTIVE

To examine the association between 12-month exposure to police violence and concurrent mental health symptoms independent of trauma history, crime involvement, and other forms of interpersonal violence exposure.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional, general population survey study of 1221 eligible adults was conducted in Baltimore, Maryland, and New York City, New York, from October through December 2017. Participants were identified through Qualtrics panels, an internet-based survey administration service using quota sampling.

EXPOSURES

Past 12-month exposure to police violence, assessed using the Police Practices Inventory. Subtypes of violence exposure were coded according to the World Health Organization domains of violence (ie, physical, sexual, psychological, and neglectful).

MAIN OUTCOMES AND MEASURES

Current Kessler Screening Scale for Psychological Distress (K6) score, past 12-month psychotic experiences (World Health Organization Composite International Diagnostic Interview), and past 12-month suicidal ideation and attempts.

RESULTS

Of 1221 eligible participants, there were 1000 respondents (81.9% participation rate). The sample matched the adult population of included cities on race/ethnicity (non-Hispanic white, 339 [33.9%]; non-Hispanic black/African American, 390 [39.0%]; Hispanic/Latino, 178 [17.8%]; other, 93 [9.3%]), age (mean [SD], 39.8 [15.2] years), and gender (women, 600 [60.0%]; men, 394 [39.4%]; transgender, 6 [0.6%]) within 10% above or beyond 2010 census distributions. Twelve-month prevalence of police violence was 3.2% for sexual violence, 7.5% for physical violence without a weapon, 4.6% for physical violence with a weapon, 13.2% for psychological violence, and 14.9% for neglect. Police violence exposures were higher among men, people of color, and those identified as homosexual or transgender. Respondents reported suicidal ideation (9.1%), suicide attempts (3.1%), and psychotic experiences (20.6%). The mean (SD) K6 score was 5.8 (6.1). All mental health outcomes were associated with police violence exposure in adjusted logistic regression analyses. Physical violence with a weapon and sexual violence were associated with greater odds of psychotic experiences (odds ratio [95% CI]: 4.34 [2.05-9.18] for physical violence with a weapon; 6.61 [2.52-17.36] for sexual violence), suicide attempts (odds ratio [95% CI]: 7.30 [2.94-18.14] for physical violence with a weapon; 6.63 [2.64-16.64] for sexual violence), and suicidal ideation (odds ratio [95% CI]: 2.72 [1.30-5.68] for physical violence with a weapon; 3.76 [1.72-8.20] for sexual violence).

CONCLUSIONS AND RELEVANCE

Police violence was commonly reported, especially among racial/ethnic and sexual minorities. Associations between violence and mental health outcomes did not appear to be explained by confounding factors and appeared to be especially pronounced for assaultive forms of violence.

The Oncogenic Transcription Factor RUNX1/ETO Corrupts Cell Cycle Regulation to Drive Leukemic Transformation

Oncogenic transcription factors such as the leukemic fusion protein RUNX1/ETO, which drives t(8;21) acute myeloid leukemia (AML), constitute cancer-specific but highly challenging therapeutic targets. We used epigenomic profiling data for an RNAi screen to interrogate the transcriptional network maintaining t(8;21) AML. This strategy identified Cyclin D2 (CCND2) as a crucial transmitter of RUNX1/ETO-driven leukemic propagation. RUNX1/ETO cooperates with AP-1 to drive CCND2 expression. Knockdown or pharmacological inhibition of CCND2 by an approved drug significantly impairs leukemic expansion of patient-derived AML cells and engraftment in immunodeficient murine hosts. Our data demonstrate that RUNX1/ETO maintains leukemia by promoting cell cycle progression and identifies G1 CCND-CDK complexes as promising therapeutic targets for treatment of RUNX1/ETO-driven AML.

A Risk Index and Data Display for Process Performance in the Pharmaceutical Industry

We propose a new index and graphical display for quantifying and visualizing process performance in the pharmaceutical industry. These tools can provide management a comprehensive, high level overview of the process performance of a global manufacturing network suitable for risk ranking, by which is meant: identifying those processes at greatest risk of failing to meet specifications, and prioritizing resources to drive continuous process improvement. Our index, like others currently in use, compares the observed variation of CQAs-critical quality attributes-to their specifications. However, instead of relying on traditional data summaries such as means and standard deviations to characterize process results, the proposed index uses sample quantiles. Quantiles are more accurate and reliable when data are skewed or short-tailed as is often observed for pharmaceutical processes. Perhaps just as important, we communicate the results with a new visual display that accurately compares processes and sites. The display identifies instances when the summaries may mislead and the subject matter expert needs to "drill down" into manufacturing data to assure correct understanding.LAY ABSTRACT: The proposed risk index and graphical display enables high-risk processes to be identified, process improvements to be prioritized, resources to be efficiently allocated, and strategic planning for continuous process improvement to be evidence-based.

Narcissistic Personality Disorder and suicidal behavior in mood disorders

The relationship of Narcissistic Personality Disorder (NPD) to suicidal behavior is understudied. The modest body of existing research suggests that NPD is protective against low-lethality suicide attempts, but is associated with high lethality attempts. Mood-disordered patients (N = 657) received structured interviews including Axis I and II diagnosis and standardized clinical measures. Following chi-square and t-tests, a logistical regression model was constructed to identify predictors of suicide attempt. While there was no bivariate relationship of NPD on suicide attempt, in the logistic regression patients with NPD were 2.4 times less likely to make a suicide attempt (OR = 0.41; 95% CI = 0.19 - 0.88; p < 0.05), compared with non-NPD patients and controlling for possible confounding variables. NPD was not associated with attempt lethality. NPD patients were more likely to be male, to have a substance use disorder, and to have high aggression and hostility scores. Limitations include that the sample consists of only mood-disordered patients, a modest sample size of NPD, and the data are cross-sectional. The multivariate protective effect of NPD on suicide attempt is consistent with most previous research. The lower impulsivity of NPD patients and less severe personality pathology relative to other personality disorders may contribute to this effect. No relationship of NPD to attempt lethality was found, contradicting other research, but perhaps reflecting differences between study samples. Future studies should oversample NPD patients and include suicide death as an outcome. Clinical implications include discussion of individualized suicide risk assessment with NPD patients.

Abstract 731: Integrative genomic analysis to identify emergent enzalutamide resistance mechanisms in castration-resistant prostate cancer

Background: Multiple lines of evidence demonstrate that castration-resistant prostate cancers (CRPCs) remain reliant on androgens that activate the androgen receptor. Treatment with the novel anti-androgen enzalutamide improves progression-free survival and overall survival in CRPC patients; however, nearly 50% of patients never respond, and progression is universal (Beer, 2014, Scher, 2012). Mechanisms of enzalutamide resistance are largely unknown and few treatments exist for enzalutamide-resistant CRPC. Recent work demonstrates that CRPC tumors harbor countless genomic aberrations that control many hallmarks of cancer (Grasso, 2012, Hanahan and Weinberg, 2011). Based on our prior work (Heiser, 2012, Vaske, 2010), we hypothesize that these aberrations operate in concert to drive enzalutamide resistance and influence specific cancer hallmarks.

Methods: We performed genomic studies using paired enzalutamide-sensitive and resistant LNCaP cell models. After transcriptional and copy number profiling, we performed an integrative pathway-informed PARADIGM analysis to identify differentially regulated cellular networks (Heiser, 2012, Vaske, 2010). These large-scale networks underwent regression analysis to identify sub-networks associated with acquired resistance. Genes residing within significant sub-networks were nominated for functional validation studies with RNAi or existing therapeutic compounds that impinge upon significant sub-networks in resistant models.

Results: We used PARADIGM to compare the genomic alterations between the parental and enzalutamide-resistant cell line models and identified critical deregulated networks that may be targeted therapeutically. Currently, we are applying this same PARADIGM analysis to additional model systems and metastatic patient tumors obtained prior to treatment and at the time of disease progression through a West Coast Dream Team prospective enzalutamide clinical trial.

Conclusions: PARADIGM integrative genomic analysis identifies specific sub-networks that contribute to enzalutamide resistance. A predicted outcome of our efforts is the development of rationally designed clinical trials with specific enzalutamide drug combinations in distinct molecular subsets of CRPC patients in the near-term.

Citation Format: Josha Woodward, Carly King, Daniel Coleman, Robert Lisac, Jacob Schwartzman, Nicholas Wang, Martin Gleave, Joe Gray, George Thomas, Tomasz M. Beer, Katy Van Hook, Robert Baertsch, Ted Goldstein, Josh Stuart, Lina Gao, Joshua Urrutia, Laura Heiser, Joshi J. Alumkal. Integrative genomic analysis to identify emergent enzalutamide resistance mechanisms in castration-resistant prostate cancer. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 731. doi:10.1158/1538-7445.AM2015-731

Abstract 3592: Androgens interfere with enzalutamide agonism of mutant F876L androgen receptor

Multiple lines of evidence demonstrate that castration-resistant prostate cancers (CRPCs) remain reliant on androgens that activate the androgen receptor (AR). Treatment with the novel anti-androgen enzalutamide improves both progression-free and overall survival in CRPC patients (Beer, 2014, Scher, 2012). However, progression is universal. Recently, F876L mutations in the AR ligand binding domain have been described (Balbas, 2013, Korpal, 2013, Joseph, 2013). This mutation confers resistance to enzalutamide treatment and in some cases converts enzalutamide to an AR agonist in pre-clinical studies (Balbas, 2013, Korpal, 2013, Joseph, 2013). Clinical studies demonstrate that ∼10% of patients harbor F876L mutations after treatment with novel anti-androgens (Joseph, 2013). However, anti-androgen withdrawal effects (PSA responses) after discontinuing enzalutamide are rarely seen clinically (Rodriguez-Vida, 2014).

An enzalutamide-resistant cell line was developed after chronic treatment of LNCaP cells in vivo. We found that this resistant cell line was dependent on AR expression for survival and that this cell line harbored an AR F876L mutation. When these resistant cells were cultured in complete serum, enzalutamide treatment did not lead to agonistic effects. However, enzalutamide treatment of these resistant cells or cell lines with ectopic expression of AR F876L cultured in androgen-depleted serum led to a significant agonistic effect - an effect that was attenuated by the addition of androgens to culture. Finally, prior work and our own demonstrated that F876L mutant and wild-type AR activate similar pathways (Joseph, 2013). Therefore, we determined if suppression of previously described transcriptional co-activators of wild-type AR also blocked AR F876L function. We found several targetable AR co-activators that met that standard.

Our data demonstrate that androgens interfere with enzalutamide-induced agonism of F876L mutant AR. Because androgens persist in enzalutamide-resistant CRPC, AR activation by androgens, rather than enzalutamide, may explain why enzalutamide discontinuation does not lead to anti-androgen withdrawal effects clinically. Further, our results provide a cautionary note on therapeutic efforts to deplete androgens concomitantly with enzalutamide treatment as this may accentuate AR agonism by enzalutamide in tumors harboring AR F876L mutations. Finally, targeting critical AR transcriptional co-activators is a promising strategy to suppress mutant AR F876L function irrespective of whether the AR agonist is androgens or enzalutamide.

Citation Format: Daniel Coleman, Katy Van Hook, Robert Lisac, Carly King, Nicholas Wang, Jacob Schwartzman, Martin Gleave, Lina Gao, Joshua Urrutia, Laura Heiser, Joshi J. Alumkal. Androgens interfere with enzalutamide agonism of mutant F876L androgen receptor. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 3592. doi:10.1158/1538-7445.AM2015-3592

Traditional Masculinity as a Risk Factor for Suicidal Ideation: Cross-Sectional and Prospective Evidence from a Study of Young Adults

Traditional masculinity is hypothesized to be associated with suicidal ideation, and traditional masculinity is predicted to interact with stressors, intensifying suicidal ideation. Cross-sectional and prospective data from a study of 2,431 young adults was analyzed using hierarchical regression main effects and interaction models. Traditional masculinity was associated with suicidal ideation, second only in strength to depression, including when controlling for other risk factors. Prospective effects were substantially weaker. There was mixed evidence for traditional masculinity by stress interactions. The results provide preliminary support for the role of traditional masculinity in suicidal ideation, but the relationship should be tested in studies of suicide attempts and mortality. Implications for prevention and intervention are explored.

Mode of delivery in pregnancies complicated by major fetal congenital heart disease: a retrospective cohort study

OBJECTIVE

To determine the mode of delivery in pregnancies complicated by complex fetal congenital heart disease (CHD).

STUDY DESIGN

Five-year retrospective cohort study at a tertiary fetal medicine center (2007 to 2011). Cases of complex fetal CHD (n=126) were compared with 45 069 non-anomalous singleton infants ⩾500 g to determine rates of emergency intrapartum cesarean section (CS), preterm delivery and induction of labor.

RESULT

Intrapartum CS is significantly higher in fetal CHD than non-anomalous controls (21% vs 13.5%, odds ratio (OR) 1.7, 95% confidence interval (CI): 1.0 to 2.7; P=0.035), predominantly related to CS for non-reassuring fetal status (OR 2.2, 95% CI: 1.1 to 4.1; P=0.022). Although fetal CHD did not increase emergency CS rates in nulliparous women, CS was significantly increased in multiparous pregnancies (OR 2.4, 95% CI: 1.8 to 4.6; P=0.014). Rates of preterm delivery (OR 3.4, 95% CI: 2.0 to 5.4; P<0.0001) and induction of labor (OR 1.9, 95% CI: 1.3 to 2.9; P=0.001) were higher in the CHD cases.

CONCLUSION

Emergency CS is increased in fetal CHD, attributed to a higher rate of CS for non-reassuring fetal status and seen mostly in multiparous women.

Science from evaluation: testing hypotheses about differential effects of three youth-focused suicide prevention trainings

As part of an evaluation component of a youth suicide prevention, a quasi-experimental repeated measures design tested hypotheses about two brief suicide prevention gatekeeper trainings (Question, Persuade, Refer [QPR] and RESPONSE) and one longer suicide intervention skills training (Applied Suicide Intervention Skills Training [ASIST]). All three trainings showed large changes in prevention attitudes and self-efficacy, largely maintained at follow-up. ASIST trainees had large increases in asking at-risk youth about suicide at follow-up. Convergent with other research, modeling and role-play in training are crucial to increased prevention behaviors. Practice and research implications are discussed, including social work roles in suicide prevention and research.

Quality by design approach for viral clearance by protein a chromatography

Protein A chromatography is widely used as a capture step in monoclonal antibody (mAb) purification processes. Antibodies and Fc fusion proteins can be efficiently purified from the majority of other complex components in harvested cell culture fluid (HCCF). Protein A chromatography is also capable of removing modest levels of viruses and is often validated for viral clearance. Historical data mining of Genentech and FDA/CDER databases systematically evaluated the removal of model viruses by Protein A chromatography. First, we found that for each model virus, removal by Protein A chromatography varies significantly across mAbs, while remains consistent within a specific mAb product, even across the acceptable ranges of the process parameters. In addition, our analysis revealed a correlation between retrovirus and parvovirus removal, with retrovirus data generally possessing a greater clearance factor. Finally, we describe a multivariate approach used to evaluate process parameter impacts on viral clearance, based on the levels of retrovirus-like particles (RVLP) present among process characterization study samples. It was shown that RVLP removal by Protein A is robust, that is, parameter effects were not observed across the ranges tested. Robustness of RVLP removal by Protein A also correlates with that for other model viruses such as X-MuLV, MMV, and SV40. The data supports that evaluating RVLP removal using process characterization study samples can establish multivariate acceptable ranges for virus removal by the protein A step for QbD. By measuring RVLP instead of a model retrovirus, it may alleviate some of the technical and economic challenges associated with performing large, design-of-experiment (DoE)-type virus spiking studies. This approach could also serve to provide useful insight when designing strategies to ensure viral safety in the manufacturing of a biopharmaceutical product.

Semisynthetic model calibration for monitoring glucose in mammalian cell culture with in situ near infrared spectroscopy

Near infrared (NIR) spectroscopy has the capability of providing real-time, multi-analyte monitoring of the complex reaction mixture associated with cell culture processes. However, the development of robust models to predict the concentration of key analytes has proven difficult. In this study, a modeling methodology using semisynthetic process samples was used to predict glucose concentrations in Chinese Hamster Ovary (CHO) cell culture processes. Partial Least Squares (PLS) regression models were built from in situ NIR spectra, and glucose levels between 4.0 and 14.0 g/L. Two models were constructed. The "standard model" used data provided by cell culture production process samples. The "full model" included the data provided from both cell culture production process samples and semisynthetic samples. The semisynthetic samples were generated by titrating cell culture samples with target viable cell density (VCD) and lactate levels to defined glucose concentrations. The robustness of each model was gauged by predicting glucose in a subsequent cell culture process utilizing a media formulation and cell line not contained in the calibration data sets. The "full model" generated glucose predictions with a root mean square error of prediction (RMSEP) of 0.99 g/L while the "standard model" provided glucose predictions with a RMSEP of 2.26 g/L. The modeling approach utilizing semisynthetic samples proved to be faster development and more effective than using just standard cell culture processes.

Higher capecitabine AUC in elderly patients with advanced colorectal cancer (SWOGS0030)

Background:

The aging process is accompanied by physiological changes including reduced glomerular filtration and hepatic function, as well as changes in gastric secretions. To investigate what effect would aging have on the disposition of capecitabine and its metabolites, the pharmacokinetics between patients ⩾70 years and <60 years were compared in SWOG0030.

Methods:

Twenty-nine unresectable colorectal cancer patients were stratified to either ⩾70 or <60 years of age, where the disposition of capecitabine and its metabolites were compared.

Results:

Notable increase in capecitabine area under the curve (AUC) was accompanied by reduction in capecitabine clearance in ⩾70 years patients (P<0.05). No difference in 5'-deoxy-5-fluorocytidine, 5'-deoxy-5-fluorouridine (DFUR), and 5-fluorouracil (5FU) AUCs between the two age groups, suggesting that carboxylesterase and cytidine deaminase (CDA) activity was similar between the two age groups. These results suggest that metabolic enzymes involved in converting capecitabine metabolites are not altered by age. An elevation in capecitabine Cmax and reduction in clearance was seen in females, where capecitabine AUC was 40.3% higher in women. Elevation of DFUR Cmax (45%) and AUC (46%) (P<0.05) was also noted, suggesting that CDA activity may be higher in females.

Conclusion:

Increases in capecitabine Cmax and AUC was observed in patients ⩾70 years when compared with younger patients who were >60 years.

Improved gross efficiency during long duration submaximal cycling following a short-term high carbohydrate diet

To assess the effect of dietary manipulation on gross efficiency (GE), 15 trained male cyclists completed 3×2 h tests at submaximal exercise intensity (60% Maximal Minute Power). Using a randomized, crossover design participants consumed an isoenergetic diet (~4 000 kcal.day-1) in the 3 days preceding each test, that was either high in carbohydrate (HighCHO, [70% of the total energy derived from carbohydrate, 20% fat, 10% protein]), low in carbohydrate (LowCHO, [70% fat, 20% carbohydrate, 10% protein]) or contained a moderate amount of carbohydrate (ModCHO, [45% carbohydrate, 45% fat, 10% protein]). GE along with blood lactate and glucose were assessed every 30 min, and heart rate was measured at 5 s intervals throughout. Mean GE was significantly greater following the HighCHO than the ModCHO diet (HighCHO=20.4%±0.1%, ModCHO=19.6±0.2%; P<0.001). Additionally, HighCHO GE was significantly greater after 25 min (P=0.015) and 85 min (P=0.021) than in the LowCHO condition. Heart rate responses in the HighCHO condition were significantly lower than during the LowCHO tests (P=0.005). Diet had no effect on blood glucose or lactate (P>0.05). This study suggests that before the measurement of gross efficiency, participants' diet should be controlled and monitored to ensure the validity of the results obtained.

Complex responses of intertidal molluscan embryos to a warming and acidifying ocean in the presence of UV radiation

Climate change and ocean acidification will expose marine organisms to synchronous multiple stressors, with early life stages being potentially most vulnerable to changing environmental conditions. We simultaneously exposed encapsulated molluscan embryos to three abiotic stressors-acidified conditions, elevated temperate, and solar UV radiation in large outdoor water tables in a multifactorial design. Solar UV radiation was modified with plastic filters, while levels of the other factors reflected IPCC predictions for near-future change. We quantified mortality and the rate of embryonic development for a mid-shore littorinid, Bembicium nanum, and low-shore opisthobranch, Dolabrifera brazieri. Outcomes were consistent for these model species with embryos faring significantly better at 26°C than 22°C. Mortality sharply increased at the lowest temperature (22°C) and lowest pH (7.6) examined, producing a significant interaction. Under these conditions mortality approached 100% for each species, representing a 2- to 4-fold increase in mortality relative to warm (26°C) non-acidified conditions. Predictably, development was more rapid at the highest temperature but this again interacted with acidified conditions. Development was slowed under acidified conditions at the lowest temperature. The presence of UV radiation had minimal impact on the outcomes, only slowing development for the littorinid and not interacting with the other factors. Our findings suggest that a warming ocean, at least to a threshold, may compensate for the effects of decreasing pH for some species. It also appears that stressors will interact in complex and unpredictable ways in a changing climate.

Performance measures in three rounds of the English bowel cancer screening pilot

OBJECTIVES

To compare performance measures across all three rounds of the English bowel cancer screening faecal occult blood test pilot and their relation to social deprivation and ethnicity.

METHODS

In each round in three primary care trusts, data for a restricted population of over 48,500 aged 60-69 years were analysed. Individual-based data included postcode linked to area-based data on the Index of Multiple Deprivation (IMD) 2004, and ethnicity. Outcomes were the rates of screening and colonoscopy uptake, positivity and detection of neoplasia (adenomas or bowel cancer) and bowel cancer, and the positive predictive values (PPVs) of a positive test for neoplasia and bowel cancer. Sensitivity was calculated by the proportional incidence method using data on interval cancers identified from cancer registrations.

RESULTS

The overall uptake rate was 61.8%, 57.0% and 58.7% in the first, second and third rounds, respectively. Although the PPV for cancer decreased over the course of the three rounds (10.9% in the 1st round, 6.5% in 3rd round), the PPV for all neoplasia remained relatively constant (42.6% in 1st round, 36.9% in 3rd round). Deprivation and non-white ethnic background (principally Indian subcontinent in the pilot region) were associated with low screening and colonoscopy uptake rates, and this changed little over the three screening rounds. Uptake was lower in men, although differences in uptake between men and women decreased over time. Non-participation in previous rounds was a strong predictor of low uptake.

CONCLUSIONS

Performance measures are commensurate with expectations in a screening programme reaching its third round of screening, but a substantial ongoing effort is needed, particularly to address the effects of deprivation and ethnicity in relation to uptake.

Moxifloxacin and pyrazinamide susceptibility testing in a complex case of multidrug-resistant tuberculosis

Multidrug-resistant tuberculosis (MDR-TB) is a public health problem of global concern. It is critical that drug susceptibility testing (DST) methods accurately predict clinical response. We present a patient with a challenging case of MDR-TB with additional resistance to quinolones and pyrazinamide. Treatment with a regimen including high-dosage moxifloxacin, based on additional genotypic and phenotypic DST, produced excellent results. This case highlights the possibility of treatment with high-dose fluoroquinolones despite apparent bacterial resistance to these agents. Improved DST methods are necessary for both agents. Development of genotypic approaches may offer a susceptibility profile rapidly, enabling early introduction of individualised treatments.

Reproducibility of limb power outputs and cardiopulmonary responses to exercise using a novel swimming training machine

The purpose of this study was to determine the reproducibility of limb power outputs and cardiopulmonary responses, to incremental whole-body exercise using a novel swimming training machine. 8 swimmers with a mean age of 23.7 ± 4.6 (yrs), stature 1.77 ± 0.13 (m) and body mass of 74.7 ± 2.8 (kg) gave informed consent and participated in repeat exercise testing on the machine. All subjects performed 2 incremental exercise tests to exhaustion using front crawl movements. From these tests peak oxygen consumption (VO(₂peak)), peak heart rate (HR(peak)), peak power output (W (peak)) and individual limb power outputs were determined. Results showed there were no significant differences between test 1 and 2 for any variable at exhaustion, and the CV% ranged from 2.8 to 3.4%. The pooled mean values were; VO(₂peak) 3.7 ± 0.65 L.min⁻¹, HR (peak) 178.7 ± 6.6 b.min⁻¹ and W (peak) 349.7 ± 16.5 W. The mean contributions to the total power output from the legs and arms were (37.3 ± 4.1% and 62.7 ± 5.1% respectively). These results show that it is possible to measure individual limb power outputs and cardiopulmonary parameters reproducibly during whole-body exercise using this training machine, at a range of exercise intensities.

Prevalence and impact of childhood maltreatment in incarcerated youth

The prevalence of childhood maltreatment and the magnitude of the association of maltreatment with internalizing mental health symptoms were examined in 398 incarcerated youth. The prevalence of abuse greatly exceeded general population rates. The proportion of variance in mental health symptoms accounted for by maltreatment was small but developmentally significant. Sexual abuse is a markedly stronger predictor of internalizing mental health problems in incarcerated youth than physical abuse. Consistent with a bio-psychological model of trauma, dissociation at the time of sexual abuse was the strongest nondemographic predictor of mental health symptoms. Physical abuse was associated with more internalizing mental health problems for children from families with mental health problems and families with lower socioeconomic status. Implications for practice and research are discussed.