Regulatory Toxicology and Pharmacology New limits proposed for the management of non-mutagenic impurities

Multiple international guidelines exist that describe both quality and safety considerations for the control of the broad spectrum of impurities inherent to drug substance and product manufacturing processes. However, regarding non-mutagenic impurities (NMI) the most relevant ICH Q3A/B guidelines are not applicable during early phases of drug development leading to confusion about acceptable limits at this stage. Thus, there is need for more flexible approaches that ensure that patient safety remains paramount, while taking into consideration the limited duration of exposure. An EFPIA survey, which collected quantitative data from different types of studies applied to qualify impurities in accordance with ICH Q3A, shows that no toxicities could be attributed to any of the 467 impurities at any tested level in vivo. This data combined with earlier published toxicological datasets encompassing drug substances and intermediates, food related substances and chemicals provide convincing evidence that for NMIs, the application of a generic 5 mg/day limit for an exposure duration <6 months, and a 1 mg/day generic limit for life-long exposure, provides sufficient margins to ensure patient safety. Hence, application of these absolute limits to trigger qualification studies (instead of the relative limits described in Q3A/B), is considered warranted. This approach will prevent conduct of unnecessary dedicated impurity qualification studies and the resulting use of animals.

Ten-year trend analysis of breast cancer, oncoplastic, and reconstructive breast surgery in a single institution (2010-2019), what has not changed?

PURPOSE

There has been a UK national directive to ensure that patients are offered reconstructive surgical options. We aimed to assess any change in oncoplastic practice over a 10-year period.

METHODS

The surgical management of 7019 breast cancers was retrospectively assessed at Nightingale Breast Centre, Manchester University UK, from 2010 to 2019. The procedures were categorised into breast conservative surgery (BCS) and mastectomy ± immediate reconstruction. The data were analysed using inclusion and exclusion criteria.

RESULTS

The overall rates of BCS and mastectomy were 60.1% and 39.9% respectively. No statistically significant change in the overall rates of BCS or mastectomy was observed over the last decade (p = 0.08). The rate of simple wide local excision (WLE) decreased from 98.7% to 89.3% (p < 0.001), whilst the rate of therapeutic mammoplasty (TM) increased from 1.3% to 8% (p < 0.01). The rate of chest wall perforator flaps (CWPF) changed from zero to account for 2.7% of all BCS by 2019. The overall rate of immediate breast reconstruction (IBR) did not significantly change over the study period, but it consistently remained above the national average of 27%. The rate of implant-based IBR increased from 61.3% to 76.5% (p = 0.012), whilst the rate of Latissimus Dorsi (LD) reconstruction decreased from 26.7% to 5.1% (p < 0.05). Additionally, the rate of nipple-sparing mastectomy significantly increased from 5.2% to 24%.

CONCLUSION

No significant changes in the overall rates of BCS was observed, the rates of advanced breast conservation techniques, nipple-sparing mastectomy, and implant-based IBR all have increased, whilst the use of LD reconstruction decreased.

Technical, economic, and environmental feasibility of rice hull ash from electricity generation as a mineral additive to concrete

A circular economy based on symbiotic relationships among sectors, where the waste from one is resource to another, holds promise for cost-effective and sustainable production. This research explores such a model for the agriculture, energy, and construction sectors in California. Here, we develop new an understanding for the synergistic utilization mechanisms for rice hull, a byproduct from rice production, as a feedstock for electricity generation and rice hull ash (RHA) used as a supplementary cementitious material in concrete. A suite of methods including experimental analysis, techno-economic analysis (TEA), and life-cycle assessment (LCA) were applied to estimate the cost and environmental performance of the system. TEA results showed that the electricity price required for break even on expenses without selling RHA is $0.07/kWh, lower than the market price. As such, RHA may be available at little to no cost to concrete producers. Our experimental results showed the viability of RHA to be used as a supplementary cementitious material, meaning it can replace a portion of the cement used in concrete. LCA results showed that replacing 15% of cement with RHA in concrete can reduce carbon dioxide equivalent (CO2e) emissions by 15% while still meeting material performance targets. While the substitution rate of RHA for cement may be modest, RHA generated from California alone could mitigate 0.2% of total CO2e from the entire cement production sector in the United States and 1% in California.

PET-CT-guided versus CT-guided biopsy in suspected malignant pleural thickening: a randomised trial

BACKGROUND

Pleural biopsy is the gold standard for diagnosis of pleural malignancy but a significant proportion will have an inconclusive biopsy despite ongoing clinical suspicion of malignancy. We investigated whether positron emission tomography-computed tomography (PET-CT) targeted pleural biopsy is superior to standard CT-guided pleural biopsy following an initial non-diagnostic biopsy.

METHODS

The TARGET trial was a multicentre, parallel group randomised trial. Patients with a previous inconclusive pleural biopsy but an ongoing suspicion of pleural malignancy were randomised (1:1) to receive either CT-guided biopsy (standard care) or PET-CT followed by a targeted CT biopsy (intervention). The primary outcome was pleural malignancy correctly identified from the trial biopsy.

RESULTS

Between September 2015 and September 2018, 59 participants were randomised from eight UK hospital sites: 29 to CT-only followed by targeted biopsy and 30 to PET-CT followed by targeted biopsy. The proportion of pleural malignancy correctly identified was similar between the groups (risk ratio 1.03 (95% CI 0.83-1.29); p=0.77). The sensitivity of the trial biopsy to identify pleural malignancy was 79% (95% CI 54-94%) in the CT-only group versus 81% (95% CI 54-96%) in the PET-CT group.

CONCLUSIONS

The results do not support the practice of PET-CT to guide pleural biopsies in patients with a previous non-diagnostic biopsy. The diagnostic sensitivity in the CT-only group was higher than anticipated and supports the practice of repeating a CT-guided biopsy following an inconclusive result if clinical suspicion of malignancy persists.

Detecting iodine deficiency risks from dietary transitions using shopping data

Plant-based product replacements are gaining popularity. However, the long-term health implications remain poorly understood, and available methods, though accurate, are expensive and burdensome, impeding the study of sufficiently large cohorts. To identify dietary transitions over time, we examine anonymised loyalty-card shopping records from Co-op Food, UK. We focus on 10,626 frequent customers who directly replaced milk with alternative milk. We then use product nutritional information to estimate weekly nutrient intake before and after the transition. 83% who converted to alternative milk saw a fall in iodine (44%), calcium (30%) and vitamin B12 (39%) consumption, with 57% reducing iodine purchase by more than 50%. The decline is even higher for those switching dairy and meat products. Our findings suggest that dietary transitions - such as replacing milk with alternative milk - could lead to nutritional deficiencies, notably iodine, which, if not addressed, may represent a significant public health concern, particularly in countries which do not mandate salt iodisation.

Early Video-assisted Thoracoscopic Surgery or Intrapleural Enzyme Therapy in Pleural Infection: A Feasibility Randomized Controlled Trial. The Third Multicenter Intrapleural Sepsis Trial-MIST-3

Rationale: Assessing the early use of video-assisted thoracoscopic surgery (VATS) or intrapleural enzyme therapy (IET) in pleural infection requires a phase III randomized controlled trial (RCT). Objectives: To establish the feasibility of randomization in a surgery-versus-nonsurgery trial as well as the key outcome measures that are important to identify relevant patient-centered outcomes in a subsequent RCT. Methods: The MIST-3 (third Multicenter Intrapleural Sepsis Trial) was a prospective multicenter RCT involving eight U.K. centers combining on-site and off-site surgical services. The study enrolled all patients with a confirmed diagnosis of pleural infection and randomized those with ongoing pleural sepsis after an initial period (as long as 24 h) of standard care to one of three treatment arms: continued standard care, early IET, or a surgical opinion with regard to early VATS. The primary outcome was feasibility based on >50% of eligible patients being successfully randomized, >95% of randomized participants retained to discharge, and >80% of randomized participants retained to 2 weeks of follow-up. The analysis was performed per intention to treat. Measurements and Main Results: Of 97 eligible patients, 60 (62%) were randomized, with 100% retained to discharge and 84% retained to 2 weeks. Baseline demographic, clinical, and microbiological characteristics of the patients were similar across groups. Median times to intervention were 1.0 and 3.5 days in the IET and surgery groups, respectively (P = 0.02). Despite the difference in time to intervention, length of stay (from randomization to discharge) was similar in both intervention arms (7 d) compared with standard care (10 d) (P = 0.70). There were no significant intergroup differences in 2-month readmission and further intervention, although the study was not adequately powered for this outcome. Compared with VATS, IET demonstrated a larger improvement in mean EuroQol five-dimension health utility index (five-level edition) from baseline (0.35) to 2 months (0.83) (P = 0.023). One serious adverse event was reported in the VATS arm. Conclusions: This is the first multicenter RCT of early IET versus early surgery in pleural infection. Despite the logistical challenges posed by the coronavirus disease (COVID-19) pandemic, the study met its predefined feasibility criteria, demonstrated potential shortening of length of stay with early surgery, and signals toward earlier resolution of pain and a shortened recovery with IET. The study findings suggest that a definitive phase III study is feasible but highlights important considerations and significant modifications to the design that would be required to adequately assess optimal initial management in pleural infection.The trial was registered on ISRCTN (number 18,192,121).

Epidemiological waves - Types, drivers and modulators in the COVID-19 pandemic

Introduction

A discussion of 'waves' of the COVID-19 epidemic in different countries is a part of the national conversation for many, but there is no hard and fast means of delineating these waves in the available data and their connection to waves in the sense of mathematical epidemiology is only tenuous.

Methods

We present an algorithm which processes a general time series to identify substantial, significant and sustained periods of increase in the value of the time series, which could reasonably be described as 'observed waves'. This provides an objective means of describing observed waves in time series. We use this method to synthesize evidence across different countries to study types, drivers and modulators of waves.

Results

The output of the algorithm as applied to epidemiological time series related to COVID-19 corresponds to visual intuition and expert opinion. Inspecting the results of individual countries shows how consecutive observed waves can differ greatly with respect to the case fatality ratio. Furthermore, in large countries, a more detailed analysis shows that consecutive observed waves have different geographical ranges. We also show how waves can be modulated by government interventions and find that early implementation of NPIs correlates with a reduced number of observed waves and reduced mortality burden in those waves.

Conclusion

It is possible to identify observed waves of disease by algorithmic methods and the results can be fruitfully used to analyse the progression of the epidemic.

Acute ischaemia of the glans penis post-circumcision managed with pentoxifylline, topical nitroglycerin and epidural

Acute ischaemia of the glans penis is a rare and serious complication following circumcision. We report the case of a teenage boy with glanular ischaemia shortly after circumcision with dorsal penile nerve block. This was successfully treated with total 11 days of topical 2% nitroglycerin ointment, 14 days of oral pentoxifylline 400 mg three times a day and 3 days of epidural (0.2% ropivocaine). There was marked clinical improvement at 4 days with a few patches of cyanosis remaining. Surgical intervention was not required, and the patient was discharged with follow-up review. At 12 days, there was complete resolution of ischaemia and the glans penis appeared normal. We suggest that oral, topical and epidural regimen of vasodilators and anti-sympathomimetic agents can be used in combination for acute ischaemia of the glans penis.

Optimized environmental justice calculations for air pollution disparities in Southern California

An Environmental Justice (EJ) analysis was carried out using full Chemical Transport Models (CTMs) over Los Angeles, California, to determine how the combination of domain size and spatial resolution affects predicted air pollution disparities in present day and future simulations when data support from measurements is not available. One set of simulations used the Weather Research and Forecasting (WRF) model coupled with Chemistry (WRF/Chem) with spatial resolution ranging from 250 m to 36 km, comparable to census tract sizes, over domains ranging in size from 320 km² to 10,000 km². A second set of simulations used the UCD/CIT CTM with spatial resolution ranging from 4 km to 24 km over domains ranging in size from 98,000 km² to 1,000,000 km². Overall WRF/Chem model accuracy improved approximately 9% as spatial resolution increased from 4 km to 250 m in present-day simulations, with similar results expected for future simulations. Exposure disparity results are consistent with previous findings: the average Non-Hispanic White person in the study domain experiences PM_2.5 mass concentrations 6-14% lower than the average resident, while the average Black and African American person experiences PM_2.5 mass concentrations that are 3-22% higher than the average resident. Predicted exposure disparities were a function of the model configuration. Increasing the spatial resolution finer than approximately 1 km produced diminishing returns because the increased spatial resolution came at the expense of reduced domain size in order to maintain reasonable computational burden. Increasing domain size to capture regional trends, such as wealthier populations living in coastal areas, identified larger exposure disparities but the benefits were limited. CTM configurations that use spatial resolution/domain size of 1 km/10³ km² and 4 km/10⁴ km² over Los Angeles can detect a 0.5 μg m^-3 exposure difference with statistical power greater than 90%. These configurations represent a balanced approach between statistical power, sensitivity across socio-economic groups, and computational burden when predicting current and future air pollution exposure disparities in Los Angeles.

Using mobile money data and call detail records to explore the risks of urban migration in Tanzania

Understanding what factors predict whether an urban migrant will end up in a deprived neighbourhood or not could help prevent the exploitation of vulnerable individuals. This study leveraged pseudonymized mobile money interactions combined with cell phone data to shed light on urban migration patterns and deprivation in Tanzania. Call detail records were used to identify individuals who migrated to Dar es Salaam, Tanzania's largest city. A street survey of the city's subwards was used to determine which individuals moved to more deprived areas. t-tests showed that people who settled in poorer neighbourhoods had less money coming into their mobile money account after they moved, but not before. A machine learning approach was then utilized to predict which migrants will move to poorer areas of the city, making them arguably more vulnerable to poverty, unemployment and exploitation. Features indicating the strength and location of people's social connections in Dar es Salaam before they moved ('pull factors') were found to be most predictive, more so than traditional 'push factors' such as proxies for poverty in the migrant's source region.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1140/epjds/s13688-022-00340-y.

The impact of COVID-19 restrictions on perceived health and wellbeing of adult Australian sport and physical activity participants

Individuals’ access to sport and physical activity has been hampered due to COVID-19 lockdown restrictions. In Australia participation in community sport was cancelled during lockdowns. There is limited research on the impact of sport participation restrictions on the health and wellbeing of adults.

Aim

The aim of this study was to investigate the perceived health and wellbeing of a sample of predominantly active Australian adults, both during COVID-19 and in comparison with one year earlier (pre COVID-19).

Methods

A survey was conducted during the first COVID-19 restrictions and lockdowns in Australia in May–June 2020. It was distributed by national and state sporting organisations and through researchers’ social media accounts. This particular paper focuses on adults aged 18–59 years. The survey collected information on participant demographics, the sport and physical activity patterns pre- COVID-19, and health and wellbeing outcomes during COVID-19 lockdown and compared to one year earlier. The health measures were cross-tabulated against the demographic and sport and physical activity variables, and group profiles compared with chi-square tests. Scales were derived from three wellbeing questions, and group differences were analysed by t-tests and F-tests.

Results

The survey sample included 1279 men and 868 women aged 18–59 years. Most (67%) resided in metropolitan cities. The great majority (83%) were sport participants. During COVID-19 lockdown men were significantly more likely than women to report worse or much worse general (p = 0.014), physical (p = 0.015) and mental health (p = 0.038) and lower life satisfaction (p = 0.016). The inactive adults were significantly more likely to report poorer general health (p = 0.001) and physical health (p = 0.001) compared to active adults. The younger age cohort (18–29 years) were significantly more likely to report poorer general wellbeing (p < 0.001), and lower life satisfaction (p < 0.001) compared to the older age groups.

Conclusion

It seems that the absence of playing competitive sport and training with friends, teams and within clubs has severely impacted males and younger adults in particular. Sports clubs provide an important setting for individuals’ health and wellbeing which is why clubs require the capacity to deliver sport and individuals may need to regain the motivation to return.

Investigation on the effect of fine solid wastes on the runoff purification performance of porous asphalt mixture

Fine solid wastes such as coal fly ash (CFA), diatomite, and red mud have been widely applied as alternative fillers for porous asphalt pavement (PAP), and have varying impacts on the mechanical performance of materials. However, whether they will affect the runoff purification performance of PAP has not been studied yet. Based on the laboratory simulation rainfall test, this study investigated the purification performance of porous asphalt mixture (PA) with three fine solid wastes fillers. Combined with the analysis of multi-scale pore characteristics of PA, the purification mechanism was further discussed. The results show that pollutants are mainly removed within 3 cm on the surface of PA in 20-30min rainfall. Diatomite and red mud fillers can effectively increase the removal rates of some heavy metals and nutrients by 20-40%. On the one hand, diatomite and red mud can leach some ions, which are conducive to physical adsorption and chemical degradation (including chemical precipitation and ion change) of pollutants. On the other hand, they also contain abundant porous structures and large specific surface areas, which significantly improve the micro-surface physical properties of PA and enhance the interaction between PA and pollutants.

Root Cause Analysis of Na131I Contamination

Establishing a cause-and-effect relationship for an adverse event is one of the key steps in preventing them and involves multiple people, resources, and steps, thus requiring a root cause analysis. Here, we describe a root cause analysis performed in the nuclear medicine department for an event involving Na¹³¹I contamination. Oral administration of Na¹³¹I in a capsule minimizes the risk of contamination and spills. However, the patient must be able to swallow a capsule. Na¹³¹I in capsule form is currently in widespread use for treatment of hyperthyroidism and thyroid cancer. Na¹³¹I in liquid form is rarely available immediately on demand and must be ordered at least 24-48 h in advance of the planned administration. The events leading to the incident, immediate remedial steps taken, and subsequent root cause analysis are described. The corrective actions taken after the root cause analysis, as well as the subsequent effectiveness of these actions, are mentioned. There may be one or multiple causes for an adverse event. It is important to identify the root cause. Corrective actions derived from the root cause can help prevent similar adverse events in the future. Therapeutic procedures in nuclear medicine involve unsealed radioactive sources, further adding a separate layer of immediate steps and reporting to the root cause analysis itself.

Impact of a 12-week supervised exercise program on weight loss trajectory, daily physical activity levels and sedentary behaviors after bariatric surgery

Background

The evidence suggests that physical activity (PA) following bariatric surgery can enhance weight loss and other metabolic outcomes. However, most individuals with severe obesity are insufficiently active, and without support, fail to make substantial increases in their daily PA levels postoperatively.

Purpose

The aim of this study was to investigate the effectiveness of a 12-week supervised exercise program on daily PA levels, sedentary time, and on maintenance of the weight loss trajectory following bariatric surgery.

Methods

Fifty-nine individuals with severe obesity (body mass index [BMI] ≥40 or ≥35 kg/m2 with comorbidities) eligible for bariatric surgery were randomly assigned (1:2) to either standard of care (CG, n=19) or a 12-week supervised exercise program (ExG, n=40). Daily PA levels and sedentary time were assessed using an armband accelerometer worn over a 3-day period (2 week-day and 1 weekend day). Body weight, body fat and fat-free mass were assessed using bioelectrical impedance balance. The exercise training program (60 min, 3 times per week for 12 weeks) started 3 months after the bariatric surgery and was supervised by a certified clinical exercise physiologist. Daily PA levels, sedentary time and anthropometric measurements were obtained preoperatively, and at 3, 6 and 12 months after bariatric surgery.

Results

Age of participants was 42±12 years, BMI was 46±6 kg/m2, and 76% were women. Before the exercise training program, PA parameters (daily PA levels, sedentary time and moderate to vigorous intensity PA [MVPA] were comparable between groups. Following the exercise training program, the ExG showed a significant reduction in sedentary time (753±113 to 721±88 min/day), an increase in daily PA levels (4544±1863 to 5853±3101 steps/day) and in MVPA levels (18.8±25.1 to 30.5±38.1 min/day). Further increase in daily MVPA levels were observed at the 12 months follow-up visit (p=0.05). In the standard of care group, changes in PA parameters were also comparable to those in the ExG. All anthropometric measurements indicate statistically significant changes postoperatively, after the intervention and up to 12 months follow-up (p&lt;0.001) without showing any difference between groups. Anthropometric changes up to 12 months follow-up show, respectively for CG and ExG, a total weight loss of 37.8±9.3% and 38.4±10.3%, a body fat reduction of 60.4±13.7% and 61.9±15.2% and fat-free mass loss of 16.6±5.4% and 15.1±7.9%.

Conclusion

This study shows that bariatric surgery candidates have low PA levels and rarely engage in MVPA. We found no additional effect to the standard of care treatment of a postoperative 12-week supervised exercise training program on weight loss trajectory, daily PA levels and sedentary behaviors.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Canadian Institutes of Health Research (CIHR)Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval (IUCPQ - UL)

Mapping the landscape of Consumer Food Waste

Since 2015 there has been a surge of academic publications and citations focused on consumer food waste. To introduce a special issue of Appetite focused on the drivers of consumer food waste we perform a transdisciplinary and historical review of the literature through a co-citation network analysis and topic modelling approach. We show that the rapid increase in publications is largely attributable to an urgency caused by the Sustainable Development Goals and climate change. Topic modelling reveals that the dramatic quantitative increase of publications has also produced a variety of evolving themes, and that a metaphorical Cambrian Explosion is occurring after decades of academic inactivity. Network analysis results show that consumer food waste features in thousands of articles and hundreds of journals, but that the citation practices of academics are becoming highly concentrated, as 20% of journals attract over 80% of citations. Finally, by examining the burstiness and transdisciplinary structure of citation networks we show that though the field has historically been dominated by empirical articles, it is now starting to show signs of maturity as a flurry of review papers help to consolidate knowledge.

Estimating the Reach of a Manifold via its Convexity Defect Function

The reach of a submanifold is a crucial regularity parameter for manifold learning and geometric inference from point clouds. This paper relates the reach of a submanifold to its convexity defect function. Using the stability properties of convexity defect functions, along with some new bounds and the recent submanifold estimator of Aamari and Levrard (Ann. Statist. 47(1), 177-204 (2019)), an estimator for the reach is given. A uniform expected loss bound over a C k model is found. Lower bounds for the minimax rate for estimating the reach over these models are also provided. The estimator almost achieves these rates in the C 3 and C 4 cases, with a gap given by a logarithmic factor.

Social eating initiatives and the practices of commensality

Social eating initiatives are a mode of food provisioning and eating that have become increasingly popular in the UK. These organisations provide a menu of low-cost meals prepared using food surpluses and deliberately serve food communally to improve social inclusion. Although these community initiatives have grown rapidly in popularity, research into their value from the perspective of participants is currently limited. This article presents data from a concurrent multi-method study conducted across multiple sites of the Nottingham Social Eating Network to explain the emergence of these novel social configurations. The results show this form of commensality, or group eating practice, is not simply a consequence of reducing food waste or food insecurity. Instead these initiatives are enacted through a series of intersecting social practices, which include: the restructuration of the shared mealtime; alimentary contribution; and performances of care. The findings provide important insights into the values expressed in these emergent initiatives and are therefore useful for framing social eating in public policy.

Interspecific and intraspecific foraging differentiation of neighbouring tropical seabirds

BACKGROUND

Social interactions, reproductive demands and intrinsic constraints all influence foraging decisions in animals. Understanding the relative importance of these factors in shaping the way that coexisting species within communities use and partition resources is central to knowledge of ecological and evolutionary processes. However, in marine environments, our understanding of the mechanisms that lead to and allow coexistence is limited, particularly in the tropics.

METHODS

Using simultaneous data from a suite of animal-borne data loggers (GPS, depth recorders, immersion and video), dietary samples and stable isotopes, we investigated interspecific and intraspecific differences in foraging of two closely-related seabird species (the red-footed booby and brown booby) from neighbouring colonies on the Cayman Islands in the Caribbean.

RESULTS

The two species employed notably different foraging strategies, with marked spatial segregation, but limited evidence of interspecific dietary partitioning. The larger-bodied brown booby foraged within neritic waters, with the smaller-bodied red-footed booby travelling further offshore. Almost no sex differences were detected in foraging behaviour of red-footed boobies, while male and female brown boobies differed in their habitat use, foraging characteristics and dietary contributions. We suggest that these behavioural differences may relate to size dimorphism and competition: In the small brown booby population (n < 200 individuals), larger females showed a higher propensity to remain in coastal waters where they experienced kleptoparasitic attacks from magnificent frigatebirds, while smaller males that were never kleptoparasitised travelled further offshore, presumably into habitats with lower kleptoparasitic pressure. In weakly dimorphic red-footed boobies, these differences are less pronounced. Instead, density-dependent pressures on their large population (n > 2000 individuals) and avoidance of kleptoparasitism may be more prevalent in driving movements for both sexes.

CONCLUSIONS

Our results reveal how, in an environment where opportunities for prey diversification are limited, neighbouring seabird species segregate at-sea, while exhibiting differing degrees of sexual differentiation. While the mechanisms underlying observed patterns remain unclear, our data are consistent with the idea that multiple factors involving both conspecifics and heterospecifics, as well as reproductive pressures, may combine to influence foraging differences in these neighbouring tropical species.

OxCOVID19 Database, a multimodal data repository for better understanding the global impact of COVID-19

Oxford COVID-19 Database (OxCOVID19 Database) is a comprehensive source of information related to the COVID-19 pandemic. This relational database contains time-series data on epidemiology, government responses, mobility, weather and more across time and space for all countries at the national level, and for more than 50 countries at the regional level. It is curated from a variety of (wherever available) official sources. Its purpose is to facilitate the analysis of the spread of SARS-CoV-2 virus and to assess the effects of non-pharmaceutical interventions to reduce the impact of the pandemic. Our database is a freely available, daily updated tool that provides unified and granular information across geographical regions. Design type Data integration objective Measurement(s) Coronavirus infectious disease, viral epidemiology Technology type(s) Digital curation Factor types(s) Sample characteristic(s) Homo sapiens.

Sport participation settings: where and 'how' do Australians play sport?

Background

Leisure-time physical activity and sport participation trends are often reported, both in aggregate and by specific activity. Recently there has been a rise in overall leisure-time physical activity, but little change in the prevalence of organised sport. It is important that the development of sport policy, infrastructure and strategic developments meet the changing landscape of participation. However, there has been relatively little research into the settings in which people participate. The aim of this study is to investigate the settings of participation of children and adults in 12 major Australian sports.

Methods

This study utilised data about participation in sport and recreational physical activity collected in the AusPlay survey from a representative sample of adults and children in the Australian state of Victoria. For each type of physical activity, the settings of participation are identified. Respondents can report participation in a particular activity in more than one setting. Therefore we use the term “instance of participation” to refer to a person playing a particular sport in a particular setting. Participation and settings across 12 major sports were investigated for children and adults.

Results

For children, the most popular sport was swimming with a weighted estimate of 323,565 (30.3%) instances of participation in the Victorian population, followed by Australian football (n = 180,459; 16.9%), and basketball (n = 137,169; 12.9%). For adults the most popular sports were swimming (n = 703,950; 30.9%) followed by golf (n = 274,729; 12.1%), and tennis (n = 260,814; 11.4%). There were considerable differences between the profiles of settings of participation for the 12 sports. Across the 12 sports, the majority of participation by children took place within a sports club or association setting, representing 63% of all instances of sport participation. For adults, sports clubs and associations was also the most popular setting, but it represented only 37% of instances of participation.

Conclusions

Traditionally, community clubs and inter-club competitions provided the main setting for sport participation, but this is no longer the case, particularly for adults. If the community sport sector is to continue to flourish, it must consider new strategies and participation options more attractive to other segments of its potential market.

The impact of an obstetrician-led, labor ward critical care unit: A prospective comparison of outcomes before and after establishment

OBJECTIVE

To investigate the outcomes of critically ill obstetric patients managed in a obstetric critical care unit in South Africa.

METHODS

Patients with severe maternal morbidity managed in the labor ward of Tygerberg Hospital were studied over three months before the establishment of the obstetrician-led obstetric critical care unit. One year later, patients managed in the obstetric critical care unit were studied using the same methods. The primary outcome measures were maternal morbidity and mortality.

RESULTS

In the before-obstetric critical care unit prospective audit 63 patients met criteria for obstetric critical care. During the second period 60 patients were admitted to the obstetric critical care unit. There were no significant differences between the groups in baseline characteristics, admission indications or Acute Physiology and Chronic Health Evaluation scores. Continuous positive airway pressure (p < 0.01) was utilized more in the second group. Seven deaths occurred in the first, but none in the second group (p = 0.01).

CONCLUSION

The establishment of an obstetrician-led obstetric critical care unit facilitated a decrease in maternal mortality.Trial registration: Not applicable.

LRRK2 activation controls the repair of damaged endomembranes in macrophages

Cells respond to endolysosome damage by either repairing the damage or targeting damaged endolysosomes for degradation via lysophagy. However, the signals regulating the decision for repair or lysophagy are poorly characterised. Here, we show that the Parkinson's disease (PD)‐related kinase LRRK2 is activated in macrophages by pathogen‐ or sterile‐induced endomembrane damage. LRRK2 recruits the Rab GTPase Rab8A to damaged endolysosomes as well as the ESCRT‐III component CHMP4B, thereby favouring ESCRT‐mediated repair. Conversely, in the absence of LRRK2 and Rab8A, damaged endolysosomes are targeted to lysophagy. These observations are recapitulated in macrophages from PD patients where pathogenic LRRK2 gain‐of‐function mutations result in the accumulation of endolysosomes which are positive for the membrane damage marker Galectin‐3. Altogether, this work indicates that LRRK2 regulates endolysosomal homeostasis by controlling the balance between membrane repair and organelle replacement, uncovering an unexpected function for LRRK2, and providing a new link between membrane damage and PD.

Investigation of a unilateral pleural effusion: What CT scan coverage is optimal?

The use of thoracic CT for patients presenting with a unilateral pleural effusion is well established. However, there is no consensus with regard to the inclusion of the entire abdomen and pelvis in the initial imaging protocol. In this prospective UK-based study, 249 patients presenting with a unilateral effusion had a CT thorax/abdomen/pelvis performed. The prevalence of malignancy on thoracic CT was 56% (140/249). Clinically significant findings below the diaphragm were identified in 59 patients (24%). Integrating this approach into standard practice allows more rapid identification of the primary malignancy, upstaging lesions or alternative sites for biopsy.

Enhancing group-based internet obesity treatment: A pilot RCT comparing video and text-based chat

OBJECTIVE

Internet delivery of behavioural weight control interventions offers potential for broad geographic reach and accessibility, but weight losses online fall short of those produced with the same programme delivered in-person. This pilot study examined feasibility and preliminary efficacy of a video-based platform for delivering weekly chat as part of a 6-month, 24-session online group behavioural weight control programme compared with the established text-based format, which has produced the best online weight losses to date.

METHOD

Women with obesity (N = 32) were randomized to either (a) weekly video group chat sessions and provided with a cellular-enabled scale (Video) or (b) Text-based weekly chat sessions and given a digital scale (Text) and followed for 6 months to determine weight loss and treatment engagement.

RESULTS

Women randomized to the ideo condition lost more weight than those in the Text condition (-5.0 ± 6.0% vs. -3.0 ± 4.1%, respectively) at 6 months, although the difference was not statistically significant. However, women in the Video condition had significantly greater treatment engagement, with greater self-monitoring and website utilization than those in the Text condition.

CONCLUSIONS

Videoconference delivery of group-based online weight control accompanied by a cellular-connected scale may promote greater treatment engagement and weight loss than text-based chat. A larger, adequately powered study is warranted to determine which elements drive these enhanced treatment outcomes.

Acticoat versus biobrane: a retrospective review on the treatment of paediatric mid-dermal torso burns

OBJECTIVES

Scalds involving toddlers commonly involve the torso and are frequently mid-dermal in depth. Initial management of a mid-dermal burn is conservative, progressing to grafting if healing has not been achieved in 10-14 days. Historically Biobrane^TM (UDL Laboratories, Inc., Sugar Land, TX) is thought to have more favourable clinical outcomes compared to Acticoat ^TM (Smith and Nephew, St. Petersburg, Fl, USA). The Burns Unit at The Children's Hospital at Westmead (CHW) uses both dressings on a regular basis, providing the opportunity to compare the results of the dressings in a cohort of patients with mid-dermal torso burns.

METHOD

A retrospective review was undertaken of all paediatric mid-dermal torso burns admitted to CHW between 2015 and 2017. The primary outcomes analysed were: time to complete healing and the need for grafting. Secondary outcomes included: operating theatre time, clinic visits, length of stay in hospital and positive wound swab colonisation.

RESULTS

78 children met the study criteria, 64 (82%) in the Acticoat group and 14 (18%) in the Biobrane group. 36 out of 78 children (56%) in the Acticoat group had their burns spontaneously healed without the need of skin graft surgery, compared with 10 out of 14 children (71%) in the Biobrane group. The days to complete healing were quicker in the Acticoat group (13 days) compared to the Biobrane group (17 days), although this was not statistically significant (P = 0.3). Overall patients managed with the Biobrane dressing required more operative sessions under general anaesthesia, a longer hospital stay, more clinic visits and a higher number of positive wound swab colonisation with heavy growth compared to the Acticoat group.

CONCLUSION

This study suggests that the use of the Biobrane dressing does not significantly improve the clinical outcomes of mid-dermal torso burns in children compared to the Acticoat dressing. Acticoat reduced healing time, decreased the requirements for a general anaesthesia, reduced inpatient hospital stay and risk of infection.

Experimental platform to facilitate novel back brace development for the improvement of spine stability

The spine or 'back' has many functions including supporting our body frame whilst facilitating movement, protecting the spinal cord and nerves and acting as a shock absorber. In certain instances, individuals may develop conditions that not only cause back pain but also may require additional support for the spine. Common movements such as twisting, standing and bending motions could exacerbate these conditions and intensify this pain. Back braces can be used in certain instances to constrain such motion as part of an individual's therapy and have existed as both medical and retail products for a number of decades. Arguably, back brace designs have lacked the innovation expected in this time. Existing designs are often found to be heavy, overly rigid, indiscrete and largely uncomfortable. In order to facilitate the development of new designs of back braces capable of being optimised to constrain particular motions for specific therapies, a numerical and experimental design strategy has been devised, tested and proven for the first time. The strategy makes use of an experimental test rig in conjunction with finite element analysis simulations to investigate and quantify the effects of back braces on flexion, extension, lateral bending and torsional motions as experienced by the human trunk. This paper describes this strategy and demonstrates its effectiveness through the proposal and comparison of two novel back brace designs.

Mealtime fast-acting insulin aspart versus insulin aspart for controlling postprandial hyperglycaemia in people with insulin-resistant Type 2 diabetes

AIM

This post hoc analysis explored whether mealtime fast-acting insulin aspart treatment provided an advantage in postprandial plasma glucose (PPG) control vs. insulin aspart in people with Type 2 diabetes receiving high doses of bolus insulin.

METHODS

A post hoc, post-randomization, subgroup analysis of a 26-week, randomized, double-blind, treat-to-target trial (onset 2) that compared mealtime fast-acting insulin aspart vs. mealtime insulin aspart, both in a basal-bolus regimen, in people with Type 2 diabetes uncontrolled on basal insulin therapy and metformin. At the end of trial, the impact of fast-acting insulin aspart and insulin aspart on PPG control was assessed with a standard liquid meal test and participants were grouped into three post-randomization subgroups: meal test bolus insulin dose ≤ 10 units per dose (n = 171), > 10-20 units per dose (n = 289) and > 20 units per dose (n = 146).

RESULTS

A statistically significant treatment difference in favour of fast-acting insulin aspart vs. insulin aspart was observed for the change in PPG increment at all post-meal time points (from 1 to 4 h) for those in the > 20 units bolus insulin subgroup. There was no difference in the magnitude of change from baseline in HbA_1c level between fast-acting insulin aspart and insulin aspart in any of the bolus insulin dose subgroups (data herein).

CONCLUSION

Fast-acting insulin aspart may hold promise as a more effective treatment compared with insulin aspart for controlling PPG in people with insulin-resistant Type 2 diabetes.

Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study

BACKGROUND

Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery.

METHODS

This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy.

RESULTS

Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI.

CONCLUSIONS

After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.

Patterns of Failure Following Dose-escalated Chemoradiotherapy for Fluorodeoxyglucose Positron Emission Tomography Staged Squamous Cell Carcinoma of the Oesophagus

AIMS

To analyse outcomes and patterns of failure following dose-escalated definitive chemoradiotherapy (CRT) for oesophageal squamous cell carcinoma using fluorodeoxyglucose positron emission tomography for staging and treatment planning.

MATERIALS AND METHODS

A retrospective review of patients with oesophageal squamous cell carcinoma receiving definitive CRT to a dose of ≥56 Gy was conducted. Patient and tumour characteristics, treatment received and first sites of relapse were analysed.

RESULTS

Between 2003 and 2014, 72 patients were treated with CRT to a median dose of 60 Gy (range 56-66 Gy). The median age was 63 years; most (61%) were stage III/IVa. The median follow-up was 57 months. Three year in-field control, relapse-free survival and overall survival was 64% (95% confidence interval 50-75%), 38% (95% confidence interval 27-50%) and 42% (95% confidence interval 30-53%), respectively. Of the 41 failures prior to death or at last follow-up date, isolated locoregional relapse occurred in 16 patients (22%) with isolated in-field recurrence in 11 patients (15%). Distant failure as first site of relapse was present in 25 patients (35%). No in-field failures occurred in the 11 patients with cT1-2, N0-1 tumours. The median survival for cT4 tumours was 8 months, with five of eight patients developing local progression within the first 6 months.

CONCLUSIONS

Dose-escalated radiotherapy was associated with promising rates of in-field local control, with the exception of cT4 tumours. Distant failure remains a significant competing risk. Our data supports the need for current trials re-examining the role of dose escalation in the modern era.

OxiMA: A Frequency-Domain Approach to Address Motion Artifacts in Photoplethysmograms for Improved Estimation of Arterial Oxygen Saturation and Pulse Rate

OBJECTIVE

The purpose of this paper is to demonstrate that a new algorithm for estimating arterial oxygen saturation can be effective even with data corrupted by motion artifacts (MAs).

METHODS

OxiMA, an algorithm based on the time-frequency components of a photoplethysmogram (PPG), was evaluated using 22-min datasets recorded from 10 subjects during voluntarily-induced hypoxia, with and without subject-induced MAs. A Nellcor OxiMax transmission sensor was used to collect an analog PPG while reference oxygen saturation and pulse rate (PR) were collected simultaneously from an FDA-approved Masimo SET Radical RDS-1 pulse oximeter.

RESULTS

The performance of our approach was determined by computing the mean relative error between the PR/oxygen saturation estimated by OxiMA and the reference Masimo oximeter. The average estimation error using OxiMA was 3 beats/min for PR and 3.24% for oxygen saturation, respectively.

CONCLUSION

The results show that OxiMA has great potential for improving the accuracy of PR and oxygen saturation estimation during MAs.

SIGNIFICANCE

This is the first study to demonstrate the feasibility of a reconstruction algorithm to improve oxygen saturation estimates on a dataset with MAs and concomitant hypoxia.

Exploring the perspectives of 10-, 11-, and 12-year-old primary school students on physical activity engagement-"'Cause you can't just be sitting at a desk all the time!"

BACKGROUND

Research indicates that 91% of Canadian children are not engaging in enough physical activity (PA) to achieve health benefits. Physical education (PE) classes have been identified as a way to improve child health by facilitating engagement in movement-based activities. The daily physical activity (DPA) initiative was created with similar intentions and requires that students participate in at least 20 min of PA daily via PE classes and/or during instructional time for other subjects. Despite recommendations that 150 min of exercise/play be incurred weekly through either avenue, nearly half of Canadian schools fail to achieve this goal. The disconnect between PA-related school policies and low reported participation rates suggests that additional research is warranted. The purpose of this study was to explore the perspectives of primary students regarding the facilitators, barriers, and recommendations for PA engagement at their schools.

METHODS

Researchers conducted nine group interviews with 53 children aged 10-12, representing six primary schools in Northwestern Ontario using a semi-structured interview format. Sessions were analysed using inductive content analysis.

RESULTS

Participants discussed several facilitators of PA including enjoying activities (alleviating boredom and participating with others), accomplishment (skill building and enhanced self-image), and benefits in the classroom (thinking clearly and enhanced readiness to learn). Barriers to PA participation included school rules and culture (PA/PE restrictions, heavy workload, and "no work, no PA"), personal struggles (physical challenges and varied skill levels), and technology (being addictive and a replacement for being active). Recommendations for enhancing engagement that were outlined by the children centred around PE and daily physical activity (increase opportunities and involve students in planning/delivery) and recess-based themes (decrease focus on safety and make equipment more available).

CONCLUSION

These student perspectives and related recommendations may be beneficial for administrators and teachers in similar contexts who are seeking to enhance PA engagement among students with the goal of improving child health.

Consumer segmentation and time interval between types of hospital admission: a clinical linkage database study

Background

Healthcare policies target unplanned hospital admissions and 30-day re-admission as key measures of efficiency, but do not focus on factors that influence trajectories of different types of admissions in the same patient over time.

Objectives

To investigate the influence of consumer segmentation and patient factors on the time intervals between different types of hospital admission.

Research design, subjects and measures

A cohort design was applied to an anonymised linkage database for adults aged 40 years and over (N = 58 857). Measures included Mosaic segmentation, multimorbidity defined on six chronic condition registers and hospital admissions over a 27-month time period.

Results

The shortest mean time intervals between two consecutive planned admissions were: 90 years and over (160 days (95% confidence interval (CI): 146-175)), Mosaic groups 'Twilight subsistence' (171 days (164-179)) or 'Welfare borderline' and 'Municipal dependency' (177 days (172-182)) compared to the reference Mosaic groups (186 days (180-193)), and multimorbidity count of four or more (137 days (130-145)). Mosaic group 'Twilight subsistence' (rate ratio (RR) 1.22 (95% CI: 1.08-1.36)) or 'Welfare borderline' and 'Municipal dependency' RR 1.20 (1.10-1.31) were significantly associated with higher rate to an unplanned admission following a planned event. However, associations between patient factors and unplanned admissions were diminished by adjustment for planned admissions.

Conclusion

Specific consumer segmentation and patient factors were associated with shorter time intervals between different types of admissions. The findings support innovation in public health approaches to prevent by a focus on long-term trajectories of hospital admissions, which include planned activity.

Assessing Human Judgment of Computationally Generated Swarming Behavior

Computer-based swarm systems, aiming to replicate the flocking behavior of birds, were first introduced by Reynolds in 1987. In his initial work, Reynolds noted that while it was difficult to quantify the dynamics of the behavior from the model, observers of his model immediately recognized them as a representation of a natural flock. Considerable analysis has been conducted since then on quantifying the dynamics of flocking/swarming behavior. However, no systematic analysis has been conducted on human identification of swarming. In this paper, we assess subjects’ assessment of the behavior of a simplified version of Reynolds’ model. Factors that affect the identification of swarming are discussed and future applications of the resulting models are proposed. Differences in decision times for swarming-related questions asked during the study indicate that different brain mechanisms may be involved in different elements of the behavior assessment task. The relatively simple but finely tunable model used in this study provides a useful methodology for assessing individual human judgment of swarming behavior.

Global phylogenetic relationships, population structure and gene flow estimation of Trialeurodes vaporariorum (Greenhouse whitefly)

Trialeurodes vaporariorum (Westwood, 1856) (Greenhouse whitefly) is an agricultural pest of global importance. It is associated with damage to plants during feeding and subsequent virus transmission. Yet, global phylogenetic relationships, population structure, and estimation of the rates of gene flow within this whitefly species remain largely unexplored. In this study, we obtained and filtered 227 GenBank records of mitochondrial cytochrome c oxidase I (mtCOI) sequences of T. vaporariorum, across various global locations to obtain a final set of 217 GenBank records. We further amplified and sequenced a ~750 bp fragment of mtCOI from an additional 31 samples collected from Kenya in 2014. Based on a total of 248 mtCOI sequences, we identified 16 haplotypes, with extensive overlap across all countries. Population structure analysis did not suggest population differentiation. Phylogenetic analysis indicated the 2014 Kenyan collection of samples clustered with a single sequence from the Netherlands to form a well-supported clade (denoted clade 1a) nested within the total set of sequences (denoted clade 1). Pairwise distances between sequences show greater sequence divergence between clades than within clades. In addition, analysis using migrate-n gave evidence for recent gene flow between the two groups. Overall, we find that T. vaporariorum forms a single large group, with evidence of further diversification consisting primarily of Kenyan sequences and one sequence from the Netherlands forming a well-supported clade.

Evaluation Of Mycotoxin Content In Soybean (Glycine max L.) Grown In Rwanda

Soybean is a critical food and nutritional security crop in Rwanda. Promoted by the Rwandan National Agricultural Research System for both adults and as an infant weaning food, soybean is grown by approximately 40% of households. Soybean may be susceptible to the growth of mycotoxin-producing moulds; however, data has been contradictory. Mycotoxin contamination is a food and feed safety issue for grains and other field crops. This study aimed to determine the extent of mycotoxin contamination in soybean, and to assess people's awareness on mycotoxins. A farm-level survey was conducted in 2015 within three agro-ecological zones of Rwanda suitable for soybean production. Soybean samples were collected from farmers (n=300) who also completed questionnaires about pre-and post-harvest farm practices, and aflatoxin awareness. The concentration of total aflatoxin in individual soybean samples was tested by enzymelinked immunosorbent assay (ELISA) using a commercially-available kit. Other mycotoxins were analyzed using liquid chromatography-mass spectrometry (LCMS/MS) on 10 selected sub samples. Only 7.3% of the respondents were aware of aflatoxin contamination in foods, but farmers observed good postharvest practices including harvesting the crop when the pods were dry. Using enzyme-linked immunosorbent assay (ELISA), only one sample had a concentration (11 µg/kg) above the most stringent EU maximum permitted limit of 4 µg/kg. Multi-mycotoxins liquid chromatography-mass spectrometry (LC-MS/MS) results confirmed that soybeans had low or undetectable contamination; only one sample contained 13µg/kg of sterigmatocystine. The soybean samples from Rwanda obtained acceptably low mycotoxin levels. Taken together with other studies that showed that soybean is less contaminated by mycotoxins, these results demonstrate that soybean can be promoted as a nutritious and safe food. However, there is a general need for educating farmers on mycotoxin contamination in food and feed to ensure better standards are adhered to safeguard the health of the consumers regarding these fungal secondary metabolites.