Further Evidence for Shape Coexistence in ^{79}Zn^{m} near Doubly Magic ^{78}Ni

Isomers close to doubly magic _{28}^{78}Ni_{50} provide essential information on the shell evolution and shape coexistence near the Z=28 and N=50 double shell closure. We report the excitation energy measurement of the 1/2^{+} isomer in _{30}^{79}Zn_{49} through independent high-precision mass measurements with the JYFLTRAP double Penning trap and with the ISOLTRAP multi-reflection time-of-flight mass spectrometer. We unambiguously place the 1/2^{+} isomer at 942(10) keV, slightly below the 5/2^{+} state at 983(3) keV. With the use of state-of-the-art shell-model diagonalizations, complemented with discrete nonorthogonal shell-model calculations which are used here for the first time to interpret shape coexistence, we find low-lying deformed intruder states, similar to other N=49 isotones. The 1/2^{+} isomer is interpreted as the bandhead of a low-lying deformed structure akin to a predicted low-lying deformed band in ^{80}Zn, and points to shape coexistence in ^{79,80}Zn similar to the one observed in ^{78}Ni. The results make a strong case for confirming the claim of shape coexistence in this key region of the nuclear chart.

Differentiating multi-MeV, multi-ion spectra with CR-39 solid-state nuclear track detectors

The development of high intensity petawatt lasers has created new possibilities for ion acceleration and nuclear fusion using solid targets. In such laser-matter interaction, multiple ion species are accelerated with broad spectra up to hundreds of MeV. To measure ion yields and for species identification, CR-39 solid-state nuclear track detectors are frequently used. However, these detectors are limited in their applicability for multi-ion spectra differentiation as standard image recognition algorithms can lead to a misinterpretation of data, there is no unique relation between track diameter and particle energy, and there are overlapping pit diameter relationships for multiple particle species. In this report, we address these issues by first developing an algorithm to overcome user bias during image processing. Second, we use calibration of the detector response for protons, carbon and helium ions (alpha particles) from 0.1 to above 10 MeV and measurements of statistical energy loss fluctuations in a forward-fitting procedure utilizing multiple, differently filtered CR-39, altogether enabling high-sensitivity, multi-species particle spectroscopy. To validate this capability, we show that inferred CR-39 spectra match Thomson parabola ion spectrometer data from the same experiment. Filtered CR-39 spectrometers were used to detect, within a background of ~ 2 × 1011 sr-1 J-1 protons and carbons, (1.3 ± 0.7) × 108 sr-1 J-1 alpha particles from laser-driven proton-boron fusion reactions.

The fluctuation-dissipation measurement instrument at the Linac Coherent Light Source

The development of new modes at x-ray free electron lasers has inspired novel methods for studying fluctuations at different energies and timescales. For closely spaced x-ray pulses that can be varied on ultrafast time scales, we have constructed a pair of advanced instruments to conduct studies targeting quantum materials. We first describe a prototype instrument built to test the proof-of-principle of resonant magnetic scattering using ultrafast pulse pairs. This is followed by a description of a new endstation, the so-called fluctuation-dissipation measurement instrument, which was used to carry out studies with a fast area detector. In addition, we describe various types of diagnostics for single-shot contrast measurements, which can be used to normalize data on a pulse-by-pulse basis and calibrate pulse amplitude ratios, both of which are important for the study of fluctuations in materials. Furthermore, we present some new results using the instrument that demonstrates access to higher momentum resolution.

HCV cure: an appropriate moment to reduce cannabis use in people living with HIV? (ANRS CO13 HEPAVIH data)

BACKGROUND

Thanks to direct-acting antivirals, hepatitis C virus (HCV) infection can be cured, with similar rates in HCV-infected and HIV-HCV co-infected patients. HCV cure is likely to foster behavioral changes in psychoactive substance use, which is highly prevalent in people living with HIV (PLWH). Cannabis is one substance that is very commonly used by PLWH, sometimes for therapeutic purposes. We aimed to identify correlates of cannabis use reduction following HCV cure in HIV-HCV co-infected cannabis users and to characterize persons who reduced their use.

METHODS

We used data collected on HCV-cured cannabis users in a cross-sectional survey nested in the ANRS CO13 HEPAVIH cohort of HIV-HCV co-infected patients, to perform logistic regression, with post-HCV cure cannabis reduction as the outcome, and socio-behavioral characteristics as potential correlates. We also characterized the study sample by comparing post-cure substance use behaviors between those who reduced their cannabis use and those who did not.

RESULTS

Among 140 HIV-infected cannabis users, 50 and 5 had reduced and increased their use, respectively, while 85 had not changed their use since HCV cure. Cannabis use reduction was significantly associated with tobacco use reduction, a decrease in fatigue level, paying more attention to one's dietary habits since HCV cure, and pre-HCV cure alcohol abstinence (p = 0.063 for alcohol use reduction).

CONCLUSIONS

Among PLWH using cannabis, post-HCV cure cannabis reduction was associated with tobacco use reduction, improved well-being, and adoption of healthy behaviors. The management of addictive behaviors should therefore be encouraged during HCV treatment.

A highly virulent variant of HIV-1 circulating in the Netherlands

We discovered a highly virulent variant of subtype-B HIV-1 in the Netherlands. One hundred nine individuals with this variant had a 0.54 to 0.74 log₁₀ increase (i.e., a ~3.5-fold to 5.5-fold increase) in viral load compared with, and exhibited CD4 cell decline twice as fast as, 6604 individuals with other subtype-B strains. Without treatment, advanced HIV-CD4 cell counts below 350 cells per cubic millimeter, with long-term clinical consequences-is expected to be reached, on average, 9 months after diagnosis for individuals in their thirties with this variant. Age, sex, suspected mode of transmission, and place of birth for the aforementioned 109 individuals were typical for HIV-positive people in the Netherlands, which suggests that the increased virulence is attributable to the viral strain. Genetic sequence analysis suggests that this variant arose in the 1990s from de novo mutation, not recombination, with increased transmissibility and an unfamiliar molecular mechanism of virulence.

Utilizing the temporal superresolution approach in an optical parametric synthesizer to generate multi-TW sub-4-fs light pulses

The Fourier-transform limit achieved by a linear spectral phase is the typical optimum by the generation of ultrashort light pulses. It provides the highest possible intensity, however, not the shortest full width at half maximum of the pulse duration, which is relevant for many experiments. The approach for achieving shorter pulses than the original Fourier limit is termed temporal superresolution. We demonstrate this approach by shaping the spectral phase of light from an optical parametric chirped pulse amplifier and generate sub-Fourier limited pulses. We also realize it in a simpler way by controlling only the amplitude of the spectrum, producing a shorter Fourier-limited duration. Furthermore, we apply this technique to an optical parametric synthesizer and generate multi-TW sub-4-fs light pulses. This light source is a promising tool for generating intense and isolated attosecond light and electron pulses.

Practical management of epidermolysis bullosa: consensus clinical position statement from the European Reference Network for Rare Skin Diseases

Inherited epidermolysis bullosa (EB) comprises rare disorders that manifest with fragility and blistering of the skin and mucous membranes, with variable clinical severity. Management of EB is challenging due to disease rarity and complexity, the wide range of extracutaneous manifestations and a profound impact on daily life for the patient and family members. Although reference centres providing multidisciplinary care for EB exist in each European country, it is common for healthcare professionals that are not specialized in this rare disorder to treat EB patients. Here, experts of the European Reference Network for Rare and Undiagnosed Skin Diseases (ERN-Skin, https://ern-skin.eu) propose practical recommendations for the diagnosis and management of the commonest clinical issues, skin blisters and wounds, oral manifestations, pain and itch.

POS0686 BARICITINIB DECREASES ANTI-DSDNA AND IGG ANTIBODIES IN ADULTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS FROM A PHASE 2 DOUBLE-BLIND, RANDOMIZED, PLACEBO-CONTROLLED TRIAL

Background:

Baricitinib (BARI), an oral, selective Janus kinase (JAK)1 and JAK2 inhibitor, improved disease severity in adults with systemic lupus erythematosus (SLE) receiving standard background therapy in a phase 2 trial1. There were no meaningful reductions in least squares mean change from baseline (BL) in levels of serologic biomarkers for SLE with BARI treatment, including anti-double-stranded deoxyribonucleic acid (anti-dsDNA) antibodies and complement component (C)3 and C41.

Objectives:

Evaluate the median change from BL in serologic biomarkers in subgroups and the overall population of BARI-treated SLE patients, in addition to the Systemic Lupus Erythematosus Responder Index-4 (SRI-4) response by normalization of anti-dsDNA.

Methods:

Data were assessed from the phase 2 trial JAHH (NCT02708095). The median change from BL in anti-dsDNA, IgG, C3, and C4 was evaluated over time among the following populations at BL: anti-dsDNA positive (≥30 IU/mL), low C3 (<90 mg/dL), low C4 (<10 mg/dL), and all patients for IgG. Statistical tests were conducted for BARI 2-mg and 4-mg compared with placebo (PBO). Among patients who were anti-dsDNA positive at BL, SRI-4 responder rate was compared for those who stayed positive or achieved normal levels by Week (Wk) 24.

Results:

Among patients who were anti-dsDNA positive at BL, significant decreases of anti-dsDNA antibodies were observed for BARI 2-mg and 4-mg compared to PBO beginning at Wks 2 and 4, respectively, and continuing through Wk 24 (Figure 1 and Table 1). Moreover, reductions of IgG levels were found for BARI-treated patients including significant decreases for BARI 4-mg compared to PBO at Wks 12 and 24 (Table 1). Among patients who had low levels of C3 and C4 at BL, no significant differences in median change from BL were observed over time with BARI compared to PBO. For patients who were anti-dsDNA positive at BL, no relationship in SRI-4 responder rate was observed for those who stayed positive or achieved normal levels by Wk 24, possibly due to the limited sample size.

Conclusion:

BARI treatment resulted in a rapid and sustained significant decrease in anti-dsDNA antibodies compared to PBO among anti-dsDNA positive SLE patients at BL, as well as a significant decrease in IgG levels in the 4-mg group at Wks 12 and 24. These data suggest that BARI may have an effect on B cell activity in SLE.

References:

[1]Wallace D et al. Lancet. 2018;392:222-231.

Table 1.PBOBARI 2-mgBARI 4-mgWeek412244122441224Anti-dsDNA (IU/mL)a0.2 (-17.2, 17.3)2.6 (-14.8, 18.4)3.0 (-14.9, 28.3)-15.4** (-31.4, 1.9)-18.1* (-42.0, 4.1)-29.6** (-55.1, 10.3)-17.9** (-42.7, 1.8)-23.3*** (-50.9, -5.9)-15.1** (-71.9, -4.6)IgG (g/L)b-0.31 (-1.1, 0.4)0.09 (-1.1, 0.7)-0.04 (-0.9, 0.9)-0.60 (-1.3, 0.6)-0.30 (-1.3, 0.4)-0.51 (-1.7, 0.6)-0.56 (-1.2, 0.2)-0.65** (-1.3, 0.2)-0.60** (-1.7, 0.2)

Data are median change from baseline (25th, 75th percentiles). aData were assessed for patients that were anti-dsDNA positive (≥30 IU/mL) at baseline (PBO N=51, BARI 2-mg N=56, BARI 4-mg N=53). bData were assessed for all patients (PBO N=105, BARI 2-mg N=105, BARI 4-mg N=104). *p≤0.05, **p≤0.01, ***p≤0.001 for BARI vs. PBO.

Acknowledgements:

The authors would like to acknowledge Nicole L. Byers, of Eli Lilly and Company, for medical writing and process support.

Disclosure of Interests:

Thomas Dörner Speakers bureau: Eli Lilly and Company, Roche, and Samsung, Consultant of: AbbVie, Celgene, Eli Lilly and Company, Janssen, Novartis, Roche, Samsung, and UCB, Grant/research support from: Janssen, Novartis, Roche, Sanofi, and UCB, Ronald van Vollenhoven Consultant of: Abbvie, Biotest, BMS, Celgene, Crescendo, Eli Lilly and Company, GSK, Janssen, Merck, Novartis, Pfizer, Roche, UCB, and Vertex, Grant/research support from: Abbvie, Amgen, BMS, GSK, Pfizer, Roche, and UCB, Andrea Doria Speakers bureau: GSK, Janssen, Pfizer, and Roche, Consultant of: Celgene, Eli Lilly and Company, and GSK, Bochao Jia Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Damiano Fantini Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Jorge Ross Terres Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Maria Silk Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Stephanie de Bono Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Peter Fischer Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Daniel J. Wallace Consultant of: Amgen, Aurunia, Eli Lilly and Company, EMD Merck Serono, GSK, and Pfizer

POS0997 PERFORMANCE OF ASDAS VERSUS BASDAI DURING PREGNANCY

Background:

Disease activity in patients with axial spondyloarthritis (axSpA) can be measured by BASDAI and ASDAS. Both instruments were validated in non-pregnant patients with cutoff values for active diseases. In pregnant women with axSpA, however, BASDAI and ASDAS scores might be biased by signs and symptoms of pregnancy itself.

Objectives:

To compare the performance of ASDAS and BASDAI during pregnancy

Methods:

Patients with axSpA were prospectively followed before pregnancy, at each trimester and 6 to 12 weeks postpartum. Disease activity was assessed by BASDAI, ASDAS, patient global assessment (PGA) and physician global assessment (PhGA). We analysed the disease course throughout pregnancy and postpartum, the correlation between BASDAI and ASDAS and the agreement in the classification of active disease. We applied receiver operating curves (ROC) to evaluate the cut-off points in pregnant patients.

Results:

The study involved 40 women with axSpA. Disease activity scores were higher during pregnancy (median ASDAS score: 2.5, median BASDAI score 3.1) than during a non-pregnant state (median ASDAS score 2.3, median BASDAI score 2.1). Median BASDAI scores were highest at the first trimester, median ASDAS scores were highest at the second trimester. ASDAS strongly correlated with BASDAI, both in the pregnant and in the non-pregnant state (r=0.796, r=0.727). However, there was a discordance when analysing the proportion of patients with high disease activity using the common cut-off values (ASDAS >2.1, BASDAS >4). More patients had high disease activity when measured by ASDAS (1st trimester (T): 63%, 2nd T: 76%, 3rd T: 61%) compared to those measured by BASDAI (1st T 43%, 2nd T: 39%, 3rd T: 34%). The κ coefficient showed only fair agreement (κ=0.39). ROC analysis among pregnant patients showed that the cut-off point estimation for high disease activity using ASDAS >2.75 corresponded to a BASDAI >4. The ASDAS >2.75 cut-off for high disease activity had a good agreement with BASDAI >4 (κ=0.657). When ASDAS >2.75 was applied in pregnant women with axSpA, about 40% experienced high disease activity.

Conclusion:

During pregnancy, the majority of women with axSpA experience ongoing disease activity. However, the cut-off values defining low and high disease activity might differ between pregnant and non-pregnant individuals since BASDAI and ASDAS are biased by pregnancy related symptoms like fatigue and mechanical back pain.

Disclosure of Interests:

None declared.

Microelimination or Not? The Changing Epidemiology of Human Immunodeficiency Virus-Hepatitis C Virus Coinfection in France 2012–2018

Background

The arrival of highly effective, well-tolerated, direct-acting antiviral agents (DAA) led to a dramatic decrease in hepatitis C virus (HCV) prevalence. Human immunodeficiency virus (HIV)-HCV–coinfected patients are deemed a priority population for HCV elimination, while a rise in recently acquired HCV infections in men who have sex with men (MSM) has been described. We describe the variations in HIV-HCV epidemiology in the French Dat’AIDS cohort.

Methods

This was a retrospective analysis of a prospective cohort of persons living with HIV (PLWH) from 2012 to 2018. We determined HCV prevalence, HCV incidence, proportion of viremic patients, treatment uptake, and mortality rate in the full cohort and by HIV risk factors.

Results

From 2012 to 2018, 50 861 PLWH with a known HCV status were followed up. During the period, HCV prevalence decreased from 15.4% to 13.5%. HCV prevalence among new HIV cases increased from 1.9% to 3.5% in MSM but remained stable in other groups. Recently acquired HCV incidence increased from 0.36/100 person-years to 1.25/100 person-years in MSM. The proportion of viremic patients decreased from 67.0% to 8.9%. MSM became the first group of viremic patients in 2018 (37.9%). Recently acquired hepatitis represented 59.2% of viremic MSM in 2018. DAA treatment uptake increased from 11.4% to 61.5%. More treatments were initiated in MSM in 2018 (41.2%) than in intravenous drug users (35.6%). In MSM, treatment at the acute phase represented 30.0% of treatments in 2018.

Conclusions

A major shift in HCV epidemiology was observed in PLWH in France from 2012 to 2018, leading to a unique situation in which the major group of HCV transmission in 2018 was MSM.

Clinical Trials Registration. NCT02898987.

Crystallization of ApoA1 and ApoE4 nanolipoprotein particles and initial XFEL-based structural studies

Nanolipoprotein particles (NLPs), also called “nanodiscs”, are discoidal particles with a patch of lipid bilayer corralled by apolipoproteins. NLPs have long been of interest due to both their utility as membrane-model systems into which membrane proteins can be inserted and solubilized and their physiological role in lipid and cholesterol transport via HDL and LDL maturation, which are important for human health. Serial femtosecond crystallography (SFX) at X-ray free electron lasers (XFELs) is a powerful approach for structural biology of membrane proteins, which are traditionally difficult to crystallize as large single crystals capable of producing high-quality diffraction suitable for structure determination. To facilitate understanding of the specific role of two apolipoprotein/lipid complexes, ApoA1 and ApoE4, in lipid binding and HDL/LDL particle maturation dynamics and develop new SFX methods involving NLP membrane protein encapsulation, we have prepared and crystallized homogeneous populations of ApoA1 and ApoE4 NLPs. Crystallization of empty NLPs yields semi-ordered objects that appear crystalline and give highly anisotropic and diffuse X-ray diffraction, similar in characteristics to fiber diffraction. Several unit cell parameters were approximately determined for both NLPs from these measurements. Thus, low-background, sample conservative methods of delivery are critical. Here we implemented a fixed target sample delivery scheme utilizing the Roadrunner fast-scanning system and ultra-thin polymer/graphene support films, providing a low-volume, low-background approach to membrane protein SFX. This study represents initial steps in obtaining structural information for ApoA1 and ApoE4 NLPs and developing this system as a supporting scaffold for future structural studies of membrane proteins crystalized in a native lipid environment.

Integrating Palliative Care for Patients on Clinical Trials: Opportunities for Oncology Nurses

The purpose of this article is to describe the lessons learned in the course of a 5-year research study on a palliative care intervention for persons on a Phase 1 clinical trial. Patients who are participating in Phase 1 trials and the families who care for them may be especially vulnerable and require special attention. The patients are generally experiencing the effects of advanced disease, and they also may soon experience unknown side effects, intense treatment regimens, and the emotional stress of an uncertain future as a result of clinical trial participation. Oncology nurses in all roles including clinical trials/research nurses, clinicians, educators, and advanced practice registered nurses play a critical role in addressing the quality-of-life concerns in this population. Palliative care can provide better symptom control and information on treatment options and facilitate a better understanding of patient/family goals. Attending to these factors can ultimately mean improved survival for the advanced cancer patient, and support for these patients can assist in advancing the field of oncology as these investigational therapies hold the promise for enhancing survival.

Presence of Viable Mould Propagules in the Indoor Air of Houses

The aim of the first port of this study was to select the optimal technique for the enumeration and identification of viable mould propagules in the indoor air of houses. A comparison was made between the results obtained with six commercially available air sampling devices in combination with four culture media. The optimal technique was defined as the technique with the best precision and the highest yield. The coefficients of variation were high (generally > 20%) for all combinations. Statistical analysis showed that the Slit sampler and the N6-Andersen sampler in combination with DG18 and MEA gave the best precision and the highest yield in terms of CFU/m3 and number of species isolated. In the second part of this study the presence of viable mould propagules in the indoor air of 46 houses in relation to the dampness of these houses was investigated, using the N6-Andersen sampler in combination with DG18. To assess the variability in time, the measurements were repeated after five weeks. Overall, between the two periods no difference was found between the average number of CFU/m3 in the investigated homes. However, the variation between homes was much smaller than the variation within homes. The mean number of CFU/m3 was somewhat higher in “damp” houses than in “dry” houses. However, this difference was not significant. Furthermore, there were no demonstrable differences in the presence of specific mould species in “damp” and “dry” houses.

A fixed-target platform for serial femtosecond crystallography in a hydrated environment

For serial femtosecond crystallography at X-ray free-electron lasers, which entails collection of single-pulse diffraction patterns from a constantly refreshed supply of microcrystalline sample, delivery of the sample into the X-ray beam path while maintaining low background remains a technical challenge for some experiments, especially where this methodology is applied to relatively low-ordered samples or those difficult to purify and crystallize in large quantities. This work demonstrates a scheme to encapsulate biological samples using polymer thin films and graphene to maintain sample hydration in vacuum conditions. The encapsulated sample is delivered into the X-ray beam on fixed targets for rapid scanning using the Roadrunner fixed-target system towards a long-term goal of low-background measurements on weakly diffracting samples. As a proof of principle, we used microcrystals of the 24 kDa rapid encystment protein (REP24) to provide a benchmark for polymer/graphene sandwich performance. The REP24 microcrystal unit cell obtained from our sandwiched in-vacuum sample was consistent with previously established unit-cell parameters and with those measured by us without encapsulation in humidified helium, indicating that the platform is robust against evaporative losses. While significant scattering from water was observed because of the sample-deposition method, the polymer/graphene sandwich itself was shown to contribute minimally to background scattering.

1 kHz fixed-target serial crystallography using a multilayer monochromator and an integrating pixel detector

Reliable sample delivery and efficient use of limited beam time have remained bottlenecks for serial crystallography (SX). Using a high-intensity polychromatic X-ray beam in combination with a newly developed charge-integrating JUNGFRAU detector, we have applied the method of fixed-target SX to collect data at a rate of 1 kHz at a synchrotron-radiation facility. According to our data analysis for the given experimental conditions, only about 3 000 diffraction patterns are required for a high-quality diffraction dataset. With indexing rates of up to 25%, recording of such a dataset takes less than 30 s.

Contrast improvement of sub-4 fs laser pulses using nonlinear elliptical polarization rotation

Temporal-intensity contrast is crucial in intense laser-matter interaction to circumvent the undesirable expansion of steep high-density plasma prior to the interaction with the main pulse. Nonlinear elliptical polarization rotation in an argon filled hollow-core fiber is used here for cleaning pedestals/satellite pulses of a chirped-pulse-amplifier based Ti:Sapphire laser. This source provides ∼35  μJ energy and sub-4-fs duration, and the process has >50% internal efficiency, more than the most commonly used pulse cleaning methods. Further, the contrast is improved by 3 orders of magnitude when measured after amplifying the pulses to 16 TW using non-collinear optical parametric chirped pulse amplification with a prospect to even further enhancement.

Scaling of domain cascades in stripe and skyrmion phases

The origin of deterministic macroscopic properties often lies in microscopic stochastic motion. Magnetic fluctuations that manifest as domain avalanches and chaotic magnetization jumps exemplify such stochastic motion and have been studied in great detail. Here we report Fourier space studies of avalanches in a system exhibiting competing magnetic stripe and skyrmion phase using a soft X-ray speckle metrology technique. We demonstrate the existence of phase boundaries and underlying critical points in the stripe and skyrmion phases. We found that distinct scaling and universality classes are associated with these domain topologies. The magnitude and frequency of abrupt magnetic domain jumps observed in the stripe phase are dramatically reduced in the skyrmion phase. Our results provide an incisive way to probe and understand phase stability in systems exhibiting complex spin topologies.

Switching of magnetic materials often occurs through discrete random avalanches. Singh et al. observe sharply reduced avalanches in the topologically protected skyrmion phase of a Fe/Gd heterostructure and obtain different critical behaviour in the stripe and skyrmion phases, suggesting distinct universality classes.

[The Nocturnal Respiratory Rate in COPD Patients of Varying GOLD Severity with/without Nicotine Consumption: Calculation by Means of Breath Sound Analysis]

Respiratory rate is an important risk marker and enables early detection of critically ill and vulnerable patients in clinical routine. The aim of this pilot study with 31 patients (COPD severity levels II - IV) was to determine the mean nocturnal respiratory rate based on breath sound recordings and to investigate the dependence of respiratory rate on COPD severity level and smoker status. The mean respiratory rate of the total collective was 19/min. For the COPD-GOLD severity levels, no significant differences in mean respiratory rate could be observed. When nicotine consumption is taken into account, active smokers showed a significantly higher mean respiratory rate of 20.84 ± 4.45/min compared to non-smokers with 17.41 ± 3.14/min (p < 0.05). In addition, active smokers in the study were significantly more frequent among patients with night-time wheezing (60 % vs. 23.8 %). This might suggest that smokers need to perform increased breathing work with increased breathing rate to compensate for oxygen deficiency in bronchial obstruction. The results of the present study show that with the acoustic recording of breath sounds, a reliable representation and calculation of the breath frequency is possible.

Structure and Nanomechanics of Dry and Hydrated Intermediate Filament Films and Fibers Produced from Hagfish Slime Fibers

Intermediate filaments (IFs) are known for their extensibility, flexibility, toughness, and their ability to hydrate. Using keratin-like IFs obtained from slime fibers from the invertebrate Atlantic hagfish ( Myxine glutinosa), films were produced by drop-casting and coagulation on the surface of a MgCl₂ buffer. Drop-casting produced self-supporting, smooth, and dense films rich in β-sheets (61%), whereas coagulation formed thin, porous films with a nanorough surface and a lower β-sheet content (51%). The films hydrated and swelled immediately when immersed in water and did not dissolve. X-ray diffraction showed that the β-crystallites remained stable upon hydration, that swelling presumably happens in the amorphous C-terminal tail-domains of the IFs, and that high salt conditions caused a denser network mesh size, suggesting polyelectrolyte behavior. Hydration resulted in a roughly 1000-fold decrease in apparent Young's modulus from 10⁹ to 10⁶ Pa as revealed by atomic force microscopy nanoindentation. Nanoindentation-based power-law rheology and stress-relaxation measurements indicated viscoelasticity and a soft-solid hydrogel character for hydrated films, where roughly 80% of energy is elastically stored and 20% is dissipated. By pulling coagulation films from the buffer interface, macroscopic fibers with highly aligned IF β-crystals similar to natural hagfish fibers were produced. We propose that viscoelasticity and strong hydrogen bonding interactions with the buffer interface are crucial for the production of such long biomimetic fibers with aligned β-sheets. This study demonstrates that hagfish fiber IFs can be reconstituted into functional biomimetic materials that are stiff when dry and retain the ability to hydrate to become soft and viscoelastic when in water.

Phosphorus saturation and superficial fertilizer application as key parameters to assess the risk of diffuse phosphorus losses from agricultural soils in Brazil

In Brazil, a steady increase in phosphorus (P) fertilizer application and agricultural intensification has been reported for recent decades. The concomitant P accumulation in soils potentially threatens surface water bodies with eutrophication through diffuse P losses. Here, we demonstrated the applicability of a soil type-independent approach for estimating the degree of P saturation (DPS; a risk parameter of P loss) by a standard method of water-soluble phosphorus (WSP) for two major soil types (Oxisols, Entisols) of the São Francisco catchment in Brazil. Subsequently, soil Mehlich-1P (M1P) levels recommended by Brazilian agricultural institutions were transformed into DPS values. Recommended M1P values for optimal agronomic production corresponded to DPS values below critical thresholds of high risks of P losses (DPS=80%) for major crops of the catchment. Higher risks of reaching critical DPS values due to P accumulation were found for Entisols due to their total sorption capacities being only half those of Oxisols. For complementary information on soil mineralogy and its influence on P sorption and P binding forms, Fourier transformation infrared (FTIR) spectroscopic analyses were executed. FTIR analyses suggested the occurrence of the clay minerals palygorskite and sepiolite in some of the analyzed Entisols and the formation of crandallite as the soil specific P binding form in the investigated Oxisols. Palygorskite and sepiolite can enhance P solubility and hence the risk of P losses. In contrast, the reshaping of superphosphate grains into crandallite may explain the chemical processes leading to previously observed low dissolved P concentrations in surface runoff from Oxisols. To prevent high risk of P losses, we recommend avoiding superficial fertilizer application and establishing environmental thresholds for soil M1P based on DPS. These measures could help to prevent eutrophication of naturally oligotrophic surface waters, and subsequent adverse effects on biodiversity and ecosystem function.

Effect of ionic strength and seawater cations on hagfish slime formation

The defensive slime of hagfish consists of a polyanionic mucin hydrogel that synergistically interacts with a fiber network forming a coherent and elastic hydrogel in high ionic strength seawater. In seawater, the slime deploys in less than a second entrapping large quantities of water by a well-timed thread skein unravelling and mucous gel swelling. This rapid and vast hydrogel formation is intriguing, as high ionic strength conditions generally counteract the swelling speed and ratio of polyelectrolyte hydrogels. In this work we investigate the effect of ionic strength and seawater cations on slime formation dynamics and functionality. In the absence of ionic strength skeins swell radially and unravel uncontrolled, probably causing tangling and creating a confined thread network that entraps limited water. At high ionic strength skeins unravel, but create a collapsed and dense fiber network. High ionic strength conditions therefore seem crucial for controlled skein unraveling, however not sufficient for water retention. Only the presence of naturally occurring Ca2+ or Mg2+-ions allowed for an expanded network and full water retention probably due to Ca2+-mediated vesicle rupture and cross-linking of the mucin. Our study demonstrates that hagfish slime deployment is a well-timed, ionic-strength, and divalent-cation dependent dynamic hydrogel formation process.

Palliative Care and Phase 1 Trials: Intervention to Improve Quality of Life and Provide Education

BACKGROUND

Patients in phase 1 clinical trials often have significant symptom burdens and quality-of-life concerns that increase as they progress along the cancer trajectory and experience drug toxicities from the clinical trial. 
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OBJECTIVES

The interdisciplinary intervention described is aimed at providing optimum palliative care to support patients with solid tumors participating in a phase 1 clinical trial.
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METHODS

The intervention includes a baseline evaluation using quantitative surveys, a comprehensive palliative care assessment by a research nurse based on patient baseline evaluation, and a goals-of-care discussion by the treating oncologist. The second component includes an interdisciplinary meeting where palliative care recommendations are made, followed by two patient education sessions.
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FINDINGS

The initial experience with the palliative care intervention suggests a need for support for this population, as well as potential benefits from integrating palliative care for patients enrolled in phase 1 clinical trials.

The degree of phosphorus saturation of agricultural soils in Germany: Current and future risk of diffuse P loss and implications for soil P management in Europe

Decades of intensive agricultural production with excessive application of P fertilizer have resulted in the accumulation of P in soils, threatening water bodies in most industrialized countries with eutrophication. In our study, we elucidated the risk of P loss of German agricultural soils by transforming provided monitoring data of plant-available P determined by the calcium-acetate-lactate (PCAL) and double-lactate method (PDL) into the degree of phosphorus saturation (DPS). As water-soluble phosphorus (WSP) is correlated to DPS, we derived a pedotransfer function (PTF) between PCAL and WSP for different soil types. Considering all soils together resulted in WSP=0.1918×PCAL (R²=0.80, n=54). Subsequently, risk parameters DPS and EPC0 were calculated from PCAL and PDL monitoring data (n>337,000) by using the determined PTF and soil type-independent correlations with WSP, as published in an earlier study. Calculated DPS values from monitoring data indicated high risks of dissolved P loss for >76% of German arable soils. Recent suggestions by the Association of German Agricultural Analytical and Research Institutes (VDLUFA) to reduce recommended PCAL levels are crucial for the reduction of P loss risks in the future. The accuracy of predicted DPS and EPC0 values by CAL and other methods used in Europe to estimate plant-available P is limited by the soil type-dependency of these methods. Consequently, we recommend considering WSP as an agri-environmental soil P test across Europe. Our results indicate that a WSP level in soils can be defined that constitutes a reasonable compromise between the securing of agronomic production and the fulfillment of environmental goals.

Nanosecond X-Ray Photon Correlation Spectroscopy on Magnetic Skyrmions

We report an x-ray photon correlation spectroscopy method that exploits the recent development of the two-pulse mode at the Linac Coherent Light Source. By using coherent resonant x-ray magnetic scattering, we studied spontaneous fluctuations on nanosecond time scales in thin films of multilayered Fe/Gd that exhibit ordered stripe and Skyrmion lattice phases. The correlation time of the fluctuations was found to differ between the Skyrmion phase and near the stripe-Skyrmion boundary. This technique will enable a significant new area of research on the study of equilibrium fluctuations in condensed matter.

Hagfish slime exudate stabilization and its effect on slime formation and functionality

Hagfish produce vast amounts of slime when under attack. The slime is the most dilute hydrogel known to date, and is a highly interesting material for biomaterial research. It forms from a glandular secrete, called exudate, which deploys upon contact with seawater. To study slime formation ex vivo and to characterize its material properties, stabilization of the sensitive slime exudate is crucial. In this study, we compared the two main stabilization methods, dispersion in high osmolarity citrate/PIPES (CP) buffer and immersion in oil, and tested the influence of time, temperature and pH on the stability of the exudate and functionality of the slime. Using water retention measurements to assess slime functionality, we found that CP buffer and oil preserved the exudate within the first 5 hours without loss of functionality. For longer storage times, slime functionality decreased for both stabilization methods, for which the breakdown mechanisms differed. Stabilization in oil likely favored temperature-sensitive osmotic-driven swelling and rupture of the mucin vesicles, causing the exudate to gel and clump. Extended storage in CP buffer resulted in an inhibited unraveling of skeins. We suggest that a water soluble protein glue, which mediates skein unraveling in functional skeins, denatures and gradually becomes insoluble during storage in CP buffer. The breakdown was accentuated when the pH of the CP buffer was raised from pH 6.7 to pH 8.5, probably caused by increased denaturation of the protein glue or by inferior vesicle stabilization. However, when fresh exudate was mixed into seawater or phosphate buffer at pH 6-9, slime functionality was not affected, showing pH insensitivity of the slime formation around a neutral pH. These insights on hagfish exudate stabilization mechanisms will support hagfish slime research at a fundamental level, and contribute to resolve the complex mechanisms of skein unraveling and slime formation.

Direct-acting antiviral treatment against hepatitis C virus infection in HIV-Infected patients - "En route for eradication"?

OBJECTIVES

Direct-Acting Antivirals (DAAs) opened a new era in HCV treatment. We report the impact of HCV treatment in French HIV-HCV coinfected patients.

METHODS

All HIV-HCV patients from the Dat'AIDS cohort followed between 2012 and 2015 were included. HCV status was defined yearly as naive, spontaneous cure, sustained virological response (SVR12), failure or reinfection.

RESULTS

Among 32,945 HIV-infected patients, 15.2% were positive for anti-HCV antibodies. From 2012 to 2015, HCV incidence rate increased from 0.35%PY to 0.69%PY in MSM, while median incidence was 0.08%PY in other patients. Median reinfection rate was 2.56%PY in MSM and 0.22%PY in other patients. HCV treatment initiation rate rose from 8.2% in 2012 to 29.6% (48.0% in pre-treated patients vs 22.6% in naïve patients). SVR12 rate increased from 68.7% to 95.2%. By the end of 2015, 62.7% of the patients were cured either spontaneously or following SVR.

CONCLUSIONS

HCV treatment dramatically increased in HIV-HCV patients in France from 2012 to 2015 resulting in HCV cure in nearly two-thirds of the patients in this cohort. Combined with a declining HCV prevalence, the prevalence of active HCV infection among HIV patients will drastically decrease in the forthcoming years.

Application of Large-Scale Inversion Algorithms to Hydraulic Tomography in an Alluvial Aquifer

Large-scale inversion methods have been recently developed and permitted now to considerably reduce the computation time and memory needed for inversions of models with a large amount of parameters and data. In this work, we have applied a deterministic geostatistical inversion algorithm to a hydraulic tomography investigation conducted in an experimental field site situated within an alluvial aquifer in Southern France. This application aims to achieve a 2-D large-scale modeling of the spatial transmissivity distribution of the site. The inversion algorithm uses a quasi-Newton iterative process based on a Bayesian approach. We compared the results obtained by using three different methodologies for sensitivity analysis: an adjoint-state method, a finite-difference method, and a principal component geostatistical approach (PCGA). The PCGA is a large-scale adapted method which was developed for inversions with a large number of parameters by using an approximation of the covariance matrix, and by avoiding the calculation of the full Jacobian sensitivity matrix. We reconstructed high-resolution transmissivity fields (composed of up to 25,600 cells) which generated good correlations between the measured and computed hydraulic heads. In particular, we show that, by combining the PCGA inversion method and the hydraulic tomography method, we are able to substantially reduce the computation time of the inversions, while still producing high-quality inversion results as those obtained from the other sensitivity analysis methodologies.

A final report of a phase I study of veliparib (ABT-888) in combination with low-dose fractionated whole abdominal radiation therapy (LDFWAR) in patients with advanced solid malignancies and peritoneal carcinomatosis with a dose escalation in ovarian and fallopian tube cancers

BACKGROUND

The combination of low-dose radiation therapy with PARP inhibition enhances anti-tumor efficacy through potentiating DNA damage. We combined low-dose fractionated whole abdominal radiation (LDFWAR) with ABT-888 in patients with peritoneal carcinomatosis with a dose escalation in ovarian and fallopian cancer patients (OV).

METHODS

Patients were treated with veliparib, 40-400mg orally BID on days 1-21 of 3 28-day cycles on 6 dose levels. Dose levels 5 and 6 included only OV patients. LDFWAR consisted of 21.6Gy in 36 fractions, 0.6Gy twice daily on days 1 and 5 for weeks 1-3 of each cycle. Circulating tumor material and quality of life were serially assessed.

RESULTS

32pts were treated. Median follow-up was 45months (10-50). The most common treatment-related grade 3 and 4 toxicities were lymphopenia (59%), anemia (9%), thrombocytopenia (12%), neutropenia (6%), leukopenia (6%), nausea (6%), diarrhea (6%), anorexia (6%), vomiting (6%) and fatigue (6%). The maximum tolerated dose was determined to be 250mg PO BID. Median PFS was 3.6months and median OS was 9.1months. In OV patients, OS was longer for platinum-sensitive patients (10.9mo) compared to platinum-resistant patients (5.8mo). QoL decreased for all groups during treatment. Germline BRCA status was known for 14/18 patients with OV cancers, 5 of whom were BRCA mutation carriers. One objective response (3%) was observed.

CONCLUSION

ABT-888 plus LDFWAR is tolerable with gastrointestinal symptoms, fatigue and myelosuppression as the most common toxicities. The single observed objective response was in a germline BRCA mutated, platinum-sensitive patient.

Integration of palliative care for patients with solid tumors on phase I clinical trials

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Background: Cancer patients receiving Phase I clinical trials are a population with advanced disease, high symptom burden, and with multiple QOL concerns including use of advance directives. Methods: An NCI funded R01 is currently in progress (2014-2019) as a randomized clinical trial to test a palliative care intervention (PCI) in this population. The PCI includes comprehensive patient assessment, goals of care communication, interdisciplinary care planning and patient teaching. Aims and hypotheses test the impact of the PCI on symptoms, QOL, resource use, spirituality and distress. Outcomes for the study (N = 400) will be conducted at the conclusion of the RCT. This paper reports preliminary baseline data of the first 100 subjects accrued. Results: Subjects mean age was 59 years and 59% were female, similar to prior trials. Forty eight percent (48%) were ethnic minorities, higher than prior trials (3% non-white, Finlay E, 2014; 9%, Parsons JA, et al. PLoS One 2012) with colon (22%) and lung (21%) cancers as dominant. Patients had a mean of 2 comorbidities (range 0-8) and 40% of the patients are > 65 years of age. The most common symptoms reported by PRO-CTCAE (1 = least to 5 = most concern) were sexuality (4.2), fatigue (2.9), pain (2.6) and anxiety (2.5). Psychological Distress Thermometer, (0 - least to 10 = most distress) mean score was 4. FACIT spiritual concerns (1 = least to 5 = most concerning) identified greatest concerns of illness strengthening faith (2.0), strength from faith (2.0) and sense of harmony (2.6). There was limited use of supportive care services, PC consultation, or advanced directives. Conclusions: The population of Phase I trial patients is an important group for palliative care integration with major unmet needs in symptom management and advance care planning.

Mechanically Enhanced Liquid Interfaces at Human Body Temperature Using Thermosensitive Methylated Nanocrystalline Cellulose

The mechanical performance of materials at oil/water interfaces after consumption is a key factor affecting hydrophobic drug release. In this study, we methylated the surface of nanocrystalline cellulose (NCC) by mercerization and dimethyl sulfate exposure to produce thermosensitive biopolymers. These methylated NCC (metNCC) were used to investigate interfacial thermogelation at air/water and medium-chain triglyceride (MCT)/water interfaces at body temperature. In contrast to bulk fluid dynamics, elastic layers were formed at room temperature, and elasticity increased significantly at body temperature, which was measured by interfacial shear and dilatational rheology in situ. This unique phenomenon depends on solvent quality, temperature, and polymer concentration at interfaces. Thus, by adjusting the degree of hydrophobicity of metNCC, the interfacial elasticity and thermogelation of the interfaces could be varied. In general, these new materials (metNCC) formed more brittle interfacial layers compared to commercial methylcellulose (MC A15). Thermogelation of methylcellulose promotes attractive intermolecular forces, which were reflected in a change in self-assembly of metNCC at the interface. As a consequence, layer thickness and density increased as a function of temperature. These effects were measured by atomic force microscopy (AFM) images of the displaced interface and confirmed by neutron reflection. The substantial structural and mechanical change of methylcellulose interfaces at body temperature represents a controllable encapsulation parameter allowing optimization of lipid-based drug formulations.

Particulate matter air pollution components and risk for lung cancer

BACKGROUND

Particulate matter (PM) air pollution is a human lung carcinogen; however, the components responsible have not been identified. We assessed the associations between PM components and lung cancer incidence.

METHODS

We used data from 14 cohort studies in eight European countries. We geocoded baseline addresses and assessed air pollution with land-use regression models for eight elements (Cu, Fe, K, Ni, S, Si, V and Zn) in size fractions of PM2.5 and PM10. We used Cox regression models with adjustment for potential confounders for cohort-specific analyses and random effect models for meta-analysis.

RESULTS

The 245,782 cohort members contributed 3,229,220 person-years at risk. During follow-up (mean, 13.1 years), 1878 incident cases of lung cancer were diagnosed. In the meta-analyses, elevated hazard ratios (HRs) for lung cancer were associated with all elements except V; none was statistically significant. In analyses restricted to participants who did not change residence during follow-up, statistically significant associations were found for PM2.5 Cu (HR, 1.25; 95% CI, 1.01-1.53 per 5 ng/m(3)), PM10 Zn (1.28; 1.02-1.59 per 20 ng/m(3)), PM10 S (1.58; 1.03-2.44 per 200 ng/m(3)), PM10 Ni (1.59; 1.12-2.26 per 2 ng/m(3)) and PM10 K (1.17; 1.02-1.33 per 100 ng/m(3)). In two-pollutant models, associations between PM10 and PM2.5 and lung cancer were largely explained by PM2.5 S.

CONCLUSIONS

This study indicates that the association between PM in air pollution and lung cancer can be attributed to various PM components and sources. PM containing S and Ni might be particularly important.

Estimation of the degree of soil P saturation from Brazilian Mehlich-1 P data and field investigations on P losses from agricultural sites in Minas Gerais

The degree of phosphorus saturation (DPS) of agricultural soils is studied worldwide for risk assessment of phosphorus (P) losses. In previous studies, DPS could be reliably estimated from water-soluble P (WSP) for European and Brazilian soils. In the present study, we correlated measured WSP and Mehlich-1 P (M1P) from soils of Minas Gerais (MG) and Pernambuco (PE) (R(2) = 0.94, n = 59) to create a DPS map from monitoring data. The resulting DPS map showed high spatial variability and low values of DPS (54 ± 22%, mean and standard deviation; n = 1,827). Measured soil DPS values amounted to 63 ± 14% and resulted in relatively low dissolved P concentrations measured in a surface runoff study in MG. However, fertilizer grains on the soil surface led to high WSP values (>30 mg/kg) indicating high risks of dissolved P losses. We suppose that small Oxisol particles with Fe and Al hydroxides sorbed most of the dissolved fertilizer P in runoff so that P was mainly exported in particulate form. In soils with lower contents of P sorption and binding partners, e.g. Entisols in PE, this effect may be less dominant. Consequently, superficial fertilizer effects have to be considered in addition to DPS in risk assessment of P losses from agricultural areas in Brazil.