Assessment of ethanol and nicotine interactions using a reinforcer demand modeling with grouped and individual levels of analyses in a long-access self-administration model using male rats

Previous reports have indicated the reciprocal effects of nicotine and ethanol on their rewarding and reinforcing properties, but studies using methodological approaches resembling substance use in vulnerable populations are lacking. In our study, rats first self-administered ethanol, and their sensitivity to ethanol's reinforcing effects was assessed using a reinforcer demand modeling approach. Subsequently, rats were equipped with intravenous catheters to self-administer nicotine, and their sensitivity to nicotine's reinforcing effects was evaluated using the same approach. In the final phase, rats were allowed to self-administer ethanol and nicotine concurrently, investigating the influence of one substance on the rate of responding for the other substance. Group analyses revealed notable differences in demand among sucrose, sweetened ethanol, and ethanol-alone, with sucrose demonstrating the highest demand and ethanol-alone exhibiting greater sensitivity to changes in cost. At the individual level, our study finds significant correlations between rats' demand for sucrose and sweetened ethanol, suggesting parallel efforts for both substances. Our individual data also suggest interconnections in the elasticity of demand for sweetened ethanol and ethanol-alone, as well as a potential relationship in price response patterns between ethanol and nicotine. Furthermore, concurrent self-administration of ethanol and nicotine at the group level displayed reciprocal effects, with reduced responding for nicotine in the presence of ethanol and increased responding for ethanol in the presence of nicotine. This study provides valuable insights into modeling the co-use of ethanol and nicotine and assessing their interaction effects using reinforcer demand modeling and concurrent self-administration or noncontingent administration tests. These findings contribute to our understanding of the complex interplay between ethanol and nicotine and have implications for elucidating the underlying mechanisms involved in polydrug use.

Abstract 984: Race- and ancestry-related metabolites and SNPs associated with response to secondary hormonal therapy in metastatic castration-resistant prostate cancer

The number of new cases and deaths from prostate cancer (PCa) is highest for Black men compared with other racial and ethnic groups, and Black PCa patients have a shorter average survival as well as a greater risk of tumor recurrence than men of other racial and ethnic groups. However, recent studies have shown that Black PCa patients have a better response to certain therapeutic regimens than White PCa patients. This study focuses on addressing the critical need to determine novel relationships between ancestry-related genetic variation and PCa aggressiveness and response to secondary hormonal therapy in metastatic castration-resistant PCa (mCRPC). We conducted correlative science in a DoD Prostate Cancer Clinical Trials Consortium (PCCTC) prospective multicenter study of secondary hormonal therapy in mCRPC stratified by race, Abi Race. This study enrolled 50 self-reported Black and 50 self-reported White mCRPC patients, and such patients received abiraterone and prednisone until disease progression or adverse event. We performed metabolic profiling using serum samples from fasting patients at baseline and after treatment. In addition, we performed genome-wide genotyping using genomic DNA from whole blood specimens from patients at baseline. We then identified race- and ancestry-related metabolite and SNP variations that associated with outcome using a penalized Cox model approach. In addition, we used Ingenuity Pathway Analysis (IPA) and Lasso Analysis to further study race-related metabolites and SNPs. From these analyses, we identified sphingolipids such as ceramide as race-related metabolites associated with outcome as well as SNPs in Sphingosine Kinase Type 1-Interacting Protein (SKIP) associated with outcome. In addition, our analyses suggest that sphingolipids such as ceramides and SKIP may regulate cancer-related biofunctions differently in Black and White mCRPC patients undergoing abiraterone treatment. Both sphingolipids and SKIP are components of the Sphingosine Rheostat, the regulatory component of sphingolipid cellular metabolism often exploited by various cancers, in which ceramides displays a pro-apoptotic role whereas sphingosine-1-phosphate (S1P) is associated with an anti-apoptotic role and is indirectly regulated by SKIP via regulating the activity of Sphingosine Kinase (SPK1). Evaluation of the function of these sphingolipids and SKIP in PCa cell drug response and aggressiveness are currently underway. These findings are furthering understanding of race- and ancestry-related biological factors that influence response to secondary hormonal therapy in mCRPC and have the potential to impact selection of patients for secondary hormonal therapy and to mitigate PCa disparity.

Citation Format: Sean Alan Piwarski, Tyler Allen, Bonnie LaCroix, Lauren Howard, Morgan Paul, Nick Bachelder, Alex Sibley, Steve Patierno, Terry Hyslop, Kouros Owzar, Daniel George, Jennifer Freedman. Race- and ancestry-related metabolites and SNPs associated with response to secondary hormonal therapy in metastatic castration-resistant prostate cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 984.

What affected UK adults' adherence to medicines during the COVID-19 pandemic? Cross-sectional survey in a representative sample of people with long-term conditions

Aim

Medicines non-adherence is associated with poorer outcomes and higher costs. COVID-19 affected access to healthcare, with increased reliance on remote methods, including medicines supply. This study aimed to identify what affected people's adherence to medicines for long-term conditions (LTCs) during the pandemic.

Subject and methods

Cross-sectional online survey of UK adults prescribed medicines for LTCs assessing self-reported medicines adherence, reasons for non-adherence (using the capability, opportunity and motivation model of behaviour [COM-B]), medicines access and COVID-19-related behaviours.

Results

The 1746 respondents reported a mean (SD) of 2.5 (1.9) LTCs, for which they were taking 2.4 (1.9) prescribed medicines, 525 (30.1%) reported using digital tools to support ordering or taking medicines and 22.6% reported medicines non-adherence. No access to at least one medicine was reported by 182 (10.4%) respondents; 1048 (60.0%) reported taking at least one non-prescription medicine as a substitute; 409 (23.4%) requested emergency supply from pharmacy for at least one medicine. Problems accessing medicines, being younger, male, in the highest socioeconomic group and working were linked to poorer adherence. Access problems were mostly directly or indirectly related to the COVID-19 pandemic. Respondents were generally lacking in capabilities and opportunities, but disruptions to habits (automatic motivation) was the major reason for non-adherence.

Conclusion

Navigating changes in how medicines were accessed, and disruption of habits during the COVID-19 pandemic, was associated with suboptimal adherence. People were resourceful in overcoming barriers to access. Solutions to support medicines-taking need to take account of the multiple ways that medicines are prescribed and supplied remotely.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10389-022-01813-0.

Who are the 10%? Characteristics of the populations and communities receiving fluoridated water in England

OBJECTIVES

In England, around 10% of the population receive optimally fluoridated water. This coverage has evolved through a combination of historical local decision-making and natural geography, rather than being strategically targeted at the national level. It is important to understand if the current distribution is equitable according to indicators of oral health need and to identify any population-level differences in socio-demographic characteristics that could introduce bias to studies evaluating the effectiveness of water fluoridation.

BASIC RESEARCH DESIGN

Descriptive analysis comparing the census characteristics of populations that received optimally fluoridated (=/⟩ 0.7 mg F/L) and non-fluoridated water (⟨0.7 mg F/L) between 2009 and 2020.

RESULTS

Populations receiving fluoridated water between 2009-2020 were on average slightly younger, more urban, more deprived, with lower education levels, higher unemployment and lower car and home ownership than the populations who received non-fluoridated water. They are more ethnically diverse, with a higher proportion of Asian ethnicity and a lower proportion of White ethnicity, compared to the non-fluoridated population.

DISCUSSION

This descriptive analysis provides evidence that water fluoridation coverage within England is targeted reasonably equitably in relation to population-level indicators of need. It also confirms the need to consider the impact of underlying differences in age, deprivation, rurality, and ethnicity when evaluating the impact of water fluoridation on health outcomes in England.

Enhancing Coordination Around Cancer Biomarker and Hereditary Genetic Testing Among Members of the Multidisciplinary Care Team

Introduction/Objective

Advances in precision medicine necessitate a closer integration across pathologists, genetic counselors, and other members of the multidisciplinary cancer care team (MDT). Recognizing that physical distancing and fragmented communication may hinder care delivery, the Association of Community Cancer Centers (ACCC) ran a multi-year initiative to explore ways to improve MDT care coordination.

Methods/Case Report

ACCC held a multistakeholder leadership summit to identify and discuss critical issues regarding biomarker and hereditary genetic testing and the ways in which pathology and genetic counseling professionals interface with the cancer MDT. Through a consensus-driven process, participants identified key opportunities for achieving optimal integration. ACCC also conducted a national survey to explore barriers around biomarker and hereditary genetic testing. Building off these insights, ACCC conducted virtual workshops at three community cancer programs to improve processes around biomarker testing and targeted treatment planning.

Results (if a Case Study enter NA)

The pathology leadership summit identified the following priorities: 1) streamline and standardize the biomarker test ordering process; 2) improve tissue handling to optimize timely biomarker testing; 3) strengthen communication between pathologists and genetic counselors; 4) empower pathologists with leadership opportunities. In the ACCC survey (n=659), 57% indicated that some or most of their pathologists were generalists. 21% only held one general tumor board. 6% indicated that pathologists often do not attend tumor boards or cancer committee meetings. 64% indicated that pathologists can directly access some or all medical oncology patient records. 67% sent some or most biopsy samples out for biomarker testing. In the ACCC workshops, cancer programs in KS, NC, and NV identified ways to improve the timeliness of genetic counseling referrals and coordinate biomarker testing. Following the workshops, 64% indicated they planned to make moderate or significant changes in their processes.

Conclusion

Improving collaboration across pathologists, genetic counselors, and the rest of the cancer MDT may lead to more timely and comprehensive biomarker and hereditary genetic testing. These findings may help cancer programs refine processes of care.

Workforce Planning Models for Oral Health Care: A Scoping Review

BACKGROUND

For health care services to address the health care needs of populations and respond to changes in needs over time, workforces must be planned. This requires quantitative models to estimate future workforce requirements that take account of population size, oral health needs, evidence-based approaches to addressing needs, and methods of service provision that maximize productivity. The aim of this scoping review was to assess whether and how these 4 elements contribute to existing models of oral health workforce planning.

METHODS

A scoping review was conducted. MEDLINE, Embase, HMIC, and EconLit were searched, all via OVID. Additionally, gray literature databases were searched and key bodies and policy makers contacted. Workforce planning models were included if they projected workforce numbers and were specific to oral health. No limits were placed on country. A single reviewer completed initial screening of abstracts; 2 independent reviewers completed secondary screening and data extraction. A narrative synthesis was conducted.

RESULTS

A total of 4,009 records were screened, resulting in 42 included articles detailing 47 models. The workforce planning models varied significantly in their use of data on oral health needs, evidence-based services, and provider productivity, with most models relying on observed levels of service utilization and demand.

CONCLUSIONS

This review has identified quantitative workforce planning models that aim to estimate future workforce requirements. Approaches to planning the oral health workforce are not always based on deriving workforce requirements from population oral health needs. In many cases, requirements are not linked to population needs, while in models where needs are included, they are constrained by the existence and availability of the required data. It is critical that information systems be developed to effectively capture data necessary to plan future oral health care workforces in ways that relate directly to the needs of the populations being served.

KNOWLEDGE TRANSFER STATEMENT

Policy makers can use the results of this study when making decisions about the planning of oral health care workforces and about the data to routinely collect within health services. Collection of suitable data will allow for the continual improvement of workforce planning, leading to a responsive health service and likely future cost savings.

Contextual considerations using the 'control-chaos continuum' for return to sport in elite football - Part 1: Load planning

The 'control-chaos continnum' is an adaptable framework developed to guide the on-pitch rehabilitation process in elite football. One of the key objectives of the continuum is to progressively return players to their preinjury chronic running load, while incorporating the qualitative aspects of movement and cognitive stresses integral to competitive match-play. Whilst injury and player-specific considerations are key to an individualised rehabilitation approach, a host of contextual factors also play an important role in return to sport (RTS) planning. In this article, we highlight some key intrinsic and extrinsic contextual factors for the practitioner to consider in the RTS planning process to help mitigate reinjury risk upon a return to team training. While a return to chronic running load is generally a critical component of the framework, we highlight circumstances in elite football where it is a less relevant factor in RTS decision-making.

Characterization of a castrate-resistant prostate cancer xenograft derived from a patient of West African ancestry

BACKGROUND

Prostate cancer is a clinically and molecularly heterogeneous disease, with highest incidence and mortality among men of African ancestry. To date, prostate cancer patient-derived xenograft (PCPDX) models to study this disease have been difficult to establish because of limited specimen availability and poor uptake rates in immunodeficient mice. Ancestrally diverse PCPDXs are even more rare, and only six PCPDXs from self-identified African American patients from one institution were recently made available.

METHODS

In the present study, we established a PCPDX from prostate cancer tissue from a patient of estimated 90% West African ancestry with metastatic castration resistant disease, and characterized this model's pathology, karyotype, hotspot mutations, copy number, gene fusions, gene expression, growth rate in normal and castrated mice, therapeutic response, and experimental metastasis.

RESULTS

This PCPDX has a mutation in TP53 and loss of PTEN and RB1. We have documented a 100% take rate in mice after thawing the PCPDX tumor from frozen stock. The PCPDX is castrate- and docetaxel-resistant and cisplatin-sensitive, and has gene expression patterns associated with such drug responses. After tail vein injection, the PCPDX tumor cells can colonize the lungs of mice.

CONCLUSION

This PCPDX, along with others that are established and characterized, will be useful pre-clinically for studying the heterogeneity of prostate cancer biology and testing new therapeutics in models expected to be reflective of the clinical setting.

Test-retest reliability of RC21X: a web-based cognitive and neuromotor performance measurement tool

OBJECTIVE

As computerized cognitive testing becomes increasingly popular in clinical and research settings, conducting studies on efficacy and psychometric properties is essential. One such program is RC21X, a web-based brain performance measurement tool. Based on empirically supported neurocognitive and neuromotor tasks, the 12-min test consists of 15 modules measuring memory, motor coordination, processing speed, and executive functioning. Because individuals may use RC21X repeatedly to track changes in cognitive performance, establishing reliability of the program is imperative. The current study examined test-retest reliability of RC21X within a 2-week period.

METHOD

The sample consisted of 222 individuals: 192 (86.5%) were male, and 30 (13.5%) were female. Average age was 44.06 years (SD = 17.76), with ages ranging from 7 to 82 years. We computed Pearson's correlation coefficients for module and composite scores to determine reliability between performance at times 1 and 2.

RESULTS

All correlations were statistically significant (p < .001). The 2-week test-retest reliability for composite score was 0.72, with subtest coefficients ranging from 0.54 on an auditory memory recognition task to 0.89 on a finger tapping task. We replicated these analyses with participants' (n = 43) test sessions 3 and 4; we found similar results to those from test 1 and test 2 analyses, suggesting stability of results over multiple administrations.

CONCLUSIONS

Results for RC21X were comparable to existing literature that supports moderate to high reliability of other computer-based tests. Although future research needs to investigate validity of RC21X, our findings support potential applications in research, clinical use, and personal brain performance measurement.

Modern Open and Minimally Invasive Stabilization of Chronic Lateral Ankle Instability

Chronic lateral ankle instability is the sensation of the ankle giving way along with recurrent sprains, chronic pain and swelling of the ankle for 1 year. The lateral ankle complex comprises the anterior talofibular ligament, calcaneofibular ligament, and posterior talofibular ligament. The anterior talofibular ligament is the most commonly injured ligament of the lateral ankle. Evaluation comprises a history and physical with concomitant imaging to confirm the diagnosis and can be used to evaluate for concurrent pathology. The most popular treatment is a direct anatomic repair; however, additional options can be used in specific patient populations.

Drill design using the 'control-chaos continuum': Blending science and art during return to sport following knee injury in elite football

Establishing the level of risk, planning and adapting the return to sport (RTS) process following a complex knee injury involves drawing on a combination of relevant high-quality evidence and practitioner experience. On-pitch rehabilitation is a critical element of this process, providing an effective transition from rehabilitation to team training. The 'control-chaos continuum' (CCC) is an adaptable framework for on-pitch rehabilitation moving from high control to high chaos, progressively increasing running load demands and incorporating greater perceptual and neurocognitive challenges within sport-specific drills. Drills are a key element of the CCC, and are designed to ensure specificity, ecological validity and maintaining player interest. We showcase drill progression through the phases of the CCC, highlighting the use of constraints to create drills that incorporate the physical, technical, tactical and injury-specific needs of the player. We also provide recommendations to help practitioners create training session content using the CCC to help replicate the demands of team training within their own environment.

Localising evidence for decision-making: participatory approach to inform schistosomiasis control

Background

The linear theories of change which ground many interventions do not account for the complex processes and systems in which they are implemented. This reductionist approach prioritises statistical methods which do not accommodate the stochastic, non-linear, dynamic interactions between humans and their environment. The inclusion of practitioners in the process of evidence development and utilisation of complex systems methods mitigates these issues and results in locally relevant, timely evidence for decision-making.

Methods

The aim of this work was to develop localised evidence for decision-making for schistosomiasis control in Uganda, Malawi, and Tanzania. Workshops were conducted with practitioners from the Ministries of Health at various levels and partner organisations to identify evidence needs for their decision-making processes and perceptions of disease transmission and control activities. Participatory systems mapping was used to identify factors directly and indirectly related to transmission. The maps were synthesised to a master complex systems map, which served as the blueprint for a generalised spatial agent-based model and specific ABMs tailored to the evidence needs of decision-makers.

Results

There was a gap in available evidence for practitioners to advocate for resources within the MoH and government budgets, as well as intervention efficacy and resource allocation. The adaptable and data-inclusive characteristics of the AMBs made them well-suited to produce localised outputs. Converted to NetLogo with a tailored user interface, these models were appropriate and responsive to the needs of decision-makers from village to national levels and across country contexts.

Conclusions

Used together, participatory and agent-based modelling resulted in the development of responsive and relevant evidence for practitioner decision-making. This process is generalisable and transferable to other diseases and locations outside of those in this study.

Key messages

The use of participatory systems mapping to develop agent-based models resulted in relevant and timely evidence for practitioner decision-making. The approach used here is transferable and generalisable outside schistosomiasis control and the contexts in this study.

Participatory systems mapping for localised evidence and decision-making: helminth control, SSA

Background

Evidence-informed decision-making to assist public health practitioners in local-level programme implementation requires adaptive approaches to research, policy and practice. To address these needs there is focus on using participatory methods. Adopting such methods, this research asks: what are the evidence needs of local public health practitioners? How do evidence and decision-making processes interact? We reflect on the process of using Participatory Systems Mapping (PSM) and implications for localising evidence-informed decision-making.

Methods

We conducted workshops with district and national-level MoH personnel in Uganda and Malawi using PSM to elicit insights into local modes of schistosomiasis transmission and control, and group discussions on evidence needs and use in implementing control programmes. PSM maps are analysed, triangulated with thematic analysis of group discussion transcripts.

Results

Analysing PSM outputs alongside discussions on evidence provides critical methodological and policy insights with implications for localised evidence and decision-making. Further insights into the local dynamics of public health decision-making are gained by triangulating PSM with discussions on the meanings and importance of 'factors' identified. Information which is accessible and useful for local practitioner's decision-making in implementing disease control measures does not always align with academic production and dissemination of evidence, nor across levels where policy is produced or implemented.

Conclusions

An array of factors influence local decision-making with implications for global health policies and practices such as for schistosomiasis control. Processes of decision-making and evidence needs of local practitioners need to be better understood within broader context. Evidence and knowledge production on health interventions rarely feedback or respond to local implementation needs, decision-making practices and public health practitioners.

Key messages

Processes of decision-making and evidence needs of local practitioners need to be better understood within broader context. Evidence and knowledge production on health interventions rarely feedback or respond to local implementation needs, decision-making practices and public health practitioners.

Abstract 3507: Race-related genetic variation and response to secondary hormonal therapy in metastatic castration-resistant prostate cancer

Prostate cancer (PCa) is the second most common cancer diagnosed in men globally, after lung cancer. PCa incidence, aggressiveness and mortality are significantly higher among African Americans (AAs) compared with men of other racial/ethnic groups. Despite the worse prognosis associated with African ancestry, several recent studies have shown that PCa patients of African ancestry have a better response to certain PCa therapeutic regimens than those of European ancestry. The overall objective of our study is to identify ancestry-related genetic variation that associates with outcomes on abiraterone/prednisone therapy in metastatic castration-resistant prostate cancer (mCRPC). Our central hypothesis is that differences in ancestry-related single nucleotide polymorphisms (SNPs), gene expression and polymorphic CAG trinucleotide repeats located in the androgen receptor (AR) gene will associate with prostate-specific antigen (PSA) response and time to progression on secondary hormonal therapy in mCRPC patients. Toward our objective, we collected whole blood at baseline and archival tumor tissue from 50 self-identified AA and 50 self-identified white patients enrolled in the Abi Race study, a Phase II study of abiraterone/prednisone in AA and white men with mCRPC. To perform ancestral and genome-wide genotyping, we isolated DNA from the whole blood samples collected at baseline and interrogated DNA using the Infinium Multi-Ethnic Global BeadChip (Illumina). We identified nine candidate SNPs in genes having previously reported relevance to cancer and/or PCa that were associated with longer time to confirmed PSA progression (TTP) in blacks and shorter TTP in whites. To perform gene expression profiling, we isolated RNA from archival formalin-fixed, paraffin-embedded PCa tissue and interrogated RNA using a NanoString Custom CodeSet (NanoString Technologies). Preliminary analysis revealed significant race-related differential expression of 30 PCa-related genes. To accomplish AR CAG repeat length profiling, we performed PCR using primers flanking the CAG repeat region and utilized a DNA Bioanalyzer to measure the relative nucleotide length. AR CAG repeat lengths varied from 8 to 40 and we are currently investigating the association between length and patient outcomes on abiraterone/prednisone therapy. Future analyses will focus on defining the functional significance of the aforementioned ancestry-related genetic variation using preclinical cancer models and validation of the aforementioned ancestry-related genetic variation in an independent cohort. These findings will further understanding of ancestry-related biological factors that influence response to secondary hormonal therapy in mCRPC and could have direct implications for the timing and selection of AA patients for secondary hormonal therapy and those needing additional therapy. As secondary hormonal therapy use expands to earlier disease settings, these findings could support the need for further studies in AA men in these disease settings. Ultimately, such strategies have the potential to mitigate PCa disparity.

Citation Format: Tyler Allen, Gary Lipton, Alexander B. Sibley, Patrick Healy, Brendon Patierno, Bonnie Lacroix, Steven Patierno, Kouros Owzar, Terry Hyslop, Daniel J. George, Jennifer A. Freedman. Race-related genetic variation and response to secondary hormonal therapy in metastatic castration-resistant prostate cancer [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 3507.

Tumor cell-derived exosomes home to their cells of origin and can be used as Trojan horses to deliver cancer drugs

Cancer is the second leading cause of death worldwide and patients are in urgent need of therapies that can effectively target cancer with minimal off-target side effects. Exosomes are extracellular nano-shuttles that facilitate intercellular communication between cells and organs. It has been established that tumor-derived exosomes contain a similar protein and lipid composition to that of the cells that secrete them, indicating that exosomes might be uniquely employed as carriers for anti-cancer therapeutics. Methods: We isolated exosomes from two cancer cell lines, then co-cultured each type of cancer cells with these two kinds of exosomes and quantified exosome. HT1080 or Hela exosomes were systemically injected to Nude mice bearing a subcutaneous HT1080 tumor to investigate their cancer-homing behavior. Moreover, cancer cell-derived exosomes were engineered to carry Doxil (a common chemotherapy drug), known as D-exo, were used to detect their target and therapeutic efficacy as anti-cancer drugs. Exosome proteome array analysis were used to reveal the mechanism underly this phenomenon. Results: Exosomes derived from cancer cells fuse preferentially with their parent cancer cells, in vitro. Systemically injected tumor-derived exosomes home to their original tumor tissues. Moreover, compared to Doxil alone, the drug-loaded exosomes showed enhanced therapeutic retention in tumor tissues and eradicated them more effectively in nude mice. Exosome proteome array analysis revealed distinct integrin expression patterns, which might shed light on the underlying mechanisms that explain the exosomal cancer-homing behavior. Conclusion: Here we demonstrate that the exosomes' ability to target the parent cancer is a phenomenon that opens up new ways to devise targeted therapies to deliver anti-tumor drugs.

microRNA-21-5p dysregulation in exosomes derived from heart failure patients impairs regenerative potential

Exosomes, as functional paracrine units of therapeutic cells, can partially reproduce the reparative properties of their parental cells. The constitution of exosomes, as well as their biological activity, largely depends on the cells that secrete them. We isolated exosomes from explant-derived cardiac stromal cells from patients with heart failure (FEXO) or from normal donor hearts (NEXO) and compared their regenerative activities in vitro and in vivo. Patients in the FEXO group exhibited an impaired ability to promote endothelial tube formation and cardiomyocyte proliferation in vitro. Intramyocardial injection of NEXO resulted in structural and functional improvements in a murine model of acute myocardial infarction. In contrast, FEXO therapy exacerbated cardiac function and left ventricular remodeling. microRNA array and PCR analysis revealed dysregulation of miR-21-5p in FEXO. Restoring miR-21-5p expression rescued FEXO's reparative function, whereas blunting miR-21-5p expression in NEXO diminished its therapeutic benefits. Further mechanistic studies revealed that miR-21-5p augmented Akt kinase activity through the inhibition of phosphatase and tensin homolog. Taken together, the heart failure pathological condition altered the miR cargos of cardiac-derived exosomes and impaired their regenerative activities. miR-21-5p contributes to exosome-mediated heart repair by enhancing angiogenesis and cardiomyocyte survival through the phosphatase and tensin homolog/Akt pathway.

Biosurveillance: a systematic review of global infectious disease surveillance systems from 1900 to 2016

Biosurveillance is crucial to detect, identify and minimise the negative consequences of infectious disease. Its value to society and importance to global public health and global health security are growing. Despite the long history and global importance of biosurveillance, a systematic review of all existing biosurveillance systems across the 'One Health' spectrum has not yet been published. This study conducted a systematic review to identify all extant and defunct biosurveillance systems from 1900 to 2016. Of the 815 systems examined, the majority surveyed human, animal or plant data discretely. Some 105 collected human and animal data, whereas only 31 collected data on all three categories. The authors found a large increase in the number of global biosurveillance systems between 1900 and 2008, but a reduction in the number of biosurveillance systems from 2008 to the present. The number of syndromic systems created, versus laboratory-based biosurveillance systems, increased rapidly after 1980 across the globe.

Mesenchymal Stem Cell/Red Blood Cell-Inspired Nanoparticle Therapy in Mice with Carbon Tetrachloride-Induced Acute Liver Failure

Acute liver failure is a critical condition characterized by global hepatocyte death and often time needs a liver transplantation. Such treatment is largely limited by donor organ shortage. Stem cell therapy offers a promising option to patients with acute liver failure. Yet, therapeutic efficacy and feasibility are hindered by delivery route and storage instability of live cell products. We fabricated a nanoparticle that carries the beneficial regenerative factors from mesenchymal stem cells and further coated it with the membranes of red blood cells to increase blood stability. Unlike uncoated nanoparticles, these particles promote liver cell proliferation in vitro and have lower internalization by macrophage cells. After intravenous delivery, these artificial stem cell analogs are able to remain in the liver and mitigate carbon tetrachloride-induced liver failure in a mouse model, as gauged by histology and liver function test. Our technology provides an innovative and off-the-shelf strategy to treat liver failure.

Abstract 90: Metastatic melanoma and cervical tumor cell clusters can exit blood vessels through angiopellosis augmenting tumor formation ability

Introduction Accumulating data suggests metastatic primary tumor cells can travel through the circulation and form secondary tumors as multicellular clusters. However, whether these clusters must first dissociate into single cells prior to exiting of blood vessels remains largely unknown. Of late, researchers have identified a mechanism of cell extravasation (exiting blood vessel), termed angiopellosis (Allen 2016). However, whether tumor cell clusters possess the ability to exit vessles using the angiopellosis method is unstudied. We hypothesized that circulating tumor cell (CTC) clusters could exit blood vessels while maintaining a multicellular phenotype, through angiopellosis.

Methodology To test this, we used an in vivo zebrafish larvae model using the tg(fli1a:egfp) line, in which blood vessels exclusively fluoresce. First, we infused fluorescent human melanoma (A375), mouse melanoma (B16F10), and human cervical (HeLa) cells into the circulation of the larvae. Next, we used lightsheet microscopy to observe the method the tumor cells used to exit blood vessels. Additionally, mouse melanoma (B16F10) cells were intravenously infused into the circulation of C57BL/6J mice as either tumor clusters or individual cells. The mice were imaged for metastatic lung foci, to determine cluster extravasation potential.

Experimental results The intravital lightsheet microscopy allowed us to determine that tumor cells can utilize angiopellosis to exit blood vessels in the zebrafish model, both as individual CTCs and CTC clusters. Extravasating CTCs exited blood vessels through angiopellosis at 94%, with only 6% exiting through the diapedesis method (n=30). CTCs which exited as a cluster through angiopellosis were observed to form tumor masses at an 88% higher rate compared to individual tumor cells in vivo, over the course of 96 hours. In the murine model, CTCs clusters which were infused via tail vein (n=4) showed significantly higher metastatic lung foci in comparison to individual CTCs that were infused (n=3). Following isolation and analysis of metastatic CTCs, multiple genes were shown to be differentially expressed in CTC clusters in both the zebrafish and murine models.

Discussion Here, we show circulating tumor cell clusters possess the ability to exit blood vessels through the recently identified angiopellosis. We determined tumor cell clusters exhibit an augmented ability to proliferate in vivo, while individually tumor cells are more prone to dormancy. Our results challenge the belief that circulating tumor cell clusters must first disassociate to exit the circulation, and posits an alternative model. We propose tumor cells both travel and exit the circulation while maintaining a multicellular phenotype, using angiopellosis, stimulating proliferation-augmenting genetic/molecular alterations. This has been termed the Cancer Exodus Hypothesis.

Citation Format: Tyler Allen, Emmanuel Amu, Dana Asad, Ke Cheng. Metastatic melanoma and cervical tumor cell clusters can exit blood vessels through angiopellosis augmenting tumor formation ability [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 90.

Inter-rater reliability of DartfishTM movement analysis software for measuring maximum flexion and extension at the hip and knee in older adults with osteoporosis and osteopenia

Various methods are used to measure hip and knee joint motion angles; however, their use is often limited by cost or inability to measure dynamic movements. The assessment of movement patterns is clinically useful in individuals with osteoporosis (OP) and osteopenia (OPe) through its potential to optimize fracture risk assessment. This study evaluates the inter-rater reliability of using Dartfish^TM 2-D Motion Analysis Software to measure maximum flexion and extension angles at the hip and knee in individuals with OP or OPe while performing five tasks of the Safe Functional Motion test. Twelve participants were videotaped performing the pour, footwear, newspaper, sweep, and sit-to-floor tasks. Five raters used Dartfish^TM to analyze maximum flexion and extension angles at the hip and knee, and an intra-class correlation coefficients (ICC) and SEM were calculated for each measurement. In all five tasks, ICC and SEM values ranged from 0.23 to 0.95, and 1.75 to 11.54 degrees, respectively, with maximum knee flexion angles generally having higher ICC, and lower SEM point estimates. The results indicate that Dartfish^TM measurements of maximum knee flexion angles in uniplanar tasks demonstrate a moderate to excellent degree of inter-rater reliability, while measurements at the hip joint should be used with caution. Given that the results of this study display moderate to excellent reliability, they lay the groundwork for future research aimed at determining the validity of these measurements. Such research would help to further develop the base of evidence surrounding the usefulness of Dartfish^TM Motion Analysis in fracture risk analysis among individuals with OP.

Global disparities in maternal morbidity and mortality

The disparity in maternal mortality for African American women remains one of the greatest public health inequities in the United States (US). To better understand approaches toward amelioration of these differences, we examine settings with similar disparities in maternal mortality and "near misses" based on race/ethnicity. This global analysis of disparities in maternal mortality/morbidity will focus on middle- and high-income countries (based on World Bank definitions) with multiethnic populations. Many countries with similar histories of slavery and forced migration demonstrate disparities in health outcomes based on social determinants such as race/ethnicity. We highlight comparisons in the Americas between the US and Brazil-two countries with the largest populations of African descent brought to the Americas primarily through the transatlantic slave trade. We also address the need to capture race/ethnicity/country of origin in a meaningful way in order to facilitate transnational comparisons and potential translatable solutions. Race, class, and gender-based inequities are pervasive, global themes. This approach is human rights-based and consistent with the UN Millennium Development Goals (MDG) and post 2015-sustainable development goals' aim to place women's health the context of health equity/women's rights. Solutions to these issues of inequity in maternal mortality are nation-specific and global.

Effect of Histophilus somni on Heart and Brain Microvascular Endothelial Cells

Histophilus somni is a pathogenic gram-negative bacterium responsible for pneumonia and septicemia in cattle. Sequelae include infectious thrombotic meningoencephalitis (ITME), myocarditis, arthritis, and abortion. These syndromes are associated with widespread vasculitis and thrombosis, implicating a role for endothelium in pathogenesis. Histopathologic and immunohistochemical investigation of 10 natural cases of bovine H. somni myocarditis and 1 case of ITME revealed intravascular H. somni in large biofilm-like aggregates adherent to the luminal surface of microvascular endothelium. Ultrastructurally, bacterial communities were extracellular and closely associated with degenerating or contracted endothelial cells. Histophilus somni was identified by bacterial culture and/or immunohistochemistry. Western blots of the bacterial isolates revealed that they expressed the immunodominant protective 40 kDa OMP and immunoglobulin-binding protein A (IbpA) antigens. The latter is a large surface antigen and shed fibrillar antigen with multiple domains. The cytotoxic DR2Fic domain of IbpA was conserved as demonstrated by polymerase chain reaction. Treatment of endothelial cells in vitro with IbpA in crude culture supernatants or purified recombinant GST-IbpA DR2Fic (rDR2) cytotoxin induced retraction of cultured bovine brain microvascular endothelial cells. By contrast, no retraction of bovine endothelium was induced by mutant rDR2H/A with an inactive Fic motif or by a GST control, indicating that the cytotoxic DR2Fic motif plays an important role in endothelial cell retraction in vasculitis. The formation of biofilm-like aggregates by H. somni on bovine microvascular endothelium may be fundamental to its pathogenesis in heart and brain.

Kidney preservation at subzero temperatures using a novel storage solution and insect ice-binding proteins

BACKGROUND

Contemporary kidney preservation methods involve storing at 4 degree C up to 24 h prior to transplantation. By decreasing the storage temperature to below 0 degree C, we hypothesized that the safe storage time could be significantly lengthened.

OBJECTIVE

The efficacy of a proprietary CryoStasis (CrS) storage solution for the subzero preservation of kidneys was tested, with or without addition of a hyperactive insect antifreeze protein (TmAFP).

MATERIALS AND METHODS

Rat kidneys were stored in either University of Wisconsin (UW) solution (4 degree C, 24 h), CrS (-2 degree C, 48 h), or CrS with 61.5 µM TmAFP (-4.4 degree C, 72 h). Following storage, viability was assessed with MTT reduction assays and live vs. dead cell (FDA/PI) staining. Markers of ischemic damage were analyzed using fluormetric substrates for caspase-3 and calpain activity.

RESULTS

Kidneys stored in CrS for 48 h and CrS with TmAFP for 72 h displayed similar levels of enzymatic activity compared to 24 h UW controls.

CONCLUSION

This methodology shows promise to prolong the safe storage time of kidneys and offers the potential of increased organ availability for renal transplants.

Exposure factors of Victoria's active motorcycle fleet related to serious injury crash risk

OBJECTIVE

The purpose of this study was to describe the nature and extent of current powered 2-wheeler (PTW) risk exposures in order to support future efforts to improve safety for this mode of transport.

METHODS

A cross-sectional analysis of the control arm of a population-based case-control study was conducted. The control sample was selected from 204 sites on public roads within 150 km of the city of Melbourne that were locations of recent serious injury motorcycle crashes. Traffic observations and measurements at each site were sampled for a mean of 2 h on the same type of day (weekday, Saturday, or Sunday) and within 1 h of the crash time. Photographs of passing riders during this observation period recorded data relating to characteristics of PTWs, age of riders, travel speed of PTWs and all vehicles, time gaps between vehicles, visibility, and protective clothing use.

RESULTS

Motorcycles and scooters represented 0.6% of all traffic (compared with 4% of all vehicle registrations). Riders were significantly more likely to have larger time gaps in front and behind when compared to other vehicles. The average travel speed of motorcycles was not significantly different than the traffic, but a significantly greater proportion were exceeding the speed limit when compared to other vehicles (6 vs. 3%, respectively). The age of registered owners of passing motorcycles was 42 years. Over half of riders were wearing dark clothing with no fluorescent or reflective surfaces. One third of motorcyclists had maximum coverage of motorcycle-specific protective clothing.

CONCLUSIONS

A very low prevalence of motorcyclists combined with relatively higher rates of larger time gaps to other vehicles around motorcycles may help explain their overrepresentation in injury crashes where another vehicle fails to give way. An increased risk of injury in the event of a crash exists for a small but greater proportion of motorcyclists (compared to other vehicle types) who were exceeding the speed limit. An apparent shift toward older age of the active rider population may be reducing injury crash risk relative to exposure time. There is significant scope to improve the physical conspicuity of motorcyclists and the frequency of motorcycle specific protective clothing use. These results can be used to inform policy development and monitor progress of current and future road safety initiatives.

Social functioning and facial expression recognition in children with neurofibromatosis type 1

BACKGROUND

This study examined social functioning and facial expression recognition (FER) in children with neurofibromatosis type 1 (NF1) compared to typically developing peers. Specifically, the current research aimed to identify hypothesised relationships between neurocognitive ability, FER and social functioning.

METHOD

Children, ages 8 to 16, with NF1 (n = 23) and typically developing peers (n = 23) were recruited during regularly scheduled clinic visits and through advertisements on an institutional clinical trials website, respectively. Participants completed a measure of FER, an abbreviated intelligence test and questionnaires regarding their quality of life and behavioural functioning. Parents were also asked to complete questionnaires regarding the social-emotional and cognitive functioning of their child.

RESULTS

As expected, there were significant differences between children with NF1 and typically developing peers across domains of social functioning and FER. Within the sample of children with NF1, there were no significant associations observed between cognitive measures, social functioning and facial recognition skills.

CONCLUSION

Children with NF1 exhibited high rates of social impairment and weak FER skills compared to controls. The absence of associations between FER with cognitive and social variables, however, suggests something unique about this skill in children with NF1. Theoretical comparisons are made to children with autism spectrum disorders, as this condition may serve as a potentially useful model in better understanding FER in children with NF1.

Adult Lung Spheroid Cells Contain Progenitor Cells and Mediate Regeneration in Rodents With Bleomycin-Induced Pulmonary Fibrosis

Lung diseases are devastating conditions and ranked as one of the top five causes of mortality worldwide according to the World Health Organization. Stem cell therapy is a promising strategy for lung regeneration. Previous animal and clinical studies have focused on the use of mesenchymal stem cells (from other parts of the body) for lung regenerative therapies. We report a rapid and robust method to generate therapeutic resident lung progenitors from adult lung tissues. Outgrowth cells from healthy lung tissue explants are self-aggregated into three-dimensional lung spheroids in a suspension culture. Without antigenic sorting, the lung spheroids recapitulate the stem cell niche and contain a natural mixture of lung stem cells and supporting cells. In vitro, lung spheroid cells can be expanded to a large quantity and can form alveoli-like structures and acquire mature lung epithelial phenotypes. In severe combined immunodeficiency mice with bleomycin-induced pulmonary fibrosis, intravenous injection of human lung spheroid cells inhibited apoptosis, fibrosis, and infiltration but promoted angiogenesis. In a syngeneic rat model of pulmonary fibrosis, lung spheroid cells outperformed adipose-derived mesenchymal stem cells in reducing fibrotic thickening and infiltration. Previously, lung spheroid cells (the spheroid model) had only been used to study lung cancer cells. Our data suggest that lung spheroids and lung spheroid cells from healthy lung tissues are excellent sources of regenerative lung cells for therapeutic lung regeneration.

SIGNIFICANCE

The results from the present study will lead to future human clinical trials using lung stem cell therapies to treat various incurable lung diseases, including pulmonary fibrosis. The data presented here also provide fundamental knowledge regarding how injected stem cells mediate lung repair in pulmonary fibrosis.

First Report of Phakopsora pachyrhizi on Soybean in Costa Rica

Phakopsora meibomiae (Arthur) Arthur has been reported to occur in several legume species in the tropical regions of Central and South America. In Costa Rica, this pathogen was initially reported as P. pachyrhizi Sydow (1); however, to our knowledge, P. pachyrhizi has not been detected in Costa Rica. In routine evaluations of a 0.2-ha field planted with soybean (Glycine max (L.) Merr var. CIGRAS 06) in La Garita, Alajuela, Costa Rica, symptoms similar to Asian soybean rust were observed in December 2012 and January 2013. Soybean plants were at growth stages R4 to R5 when these symptoms were observed, which included yellow spots on leaves with brown spots on the abaxial surface. Further evaluations at growth stage R5 to R6 indicated that the spots had coalesced, turned grayish-brown, and caused substantial defoliation. Microscopic examination of symptomatic leaves showed the presence of uredinia and urediniospores on the lower surface of the leaf. While initial symptoms were on the southern side of the field, a substantial area of the field was infected at the second evaluation. Infected leaves were submitted to the USDA-ARS Foreign Disease-Weed Science Research Unit under the appropriate USDA-Animal Plant Health Inspection Service permit for molecular characterization and identification. Urediniospores were collected by washing infected leaves with sterile water and then pelleted by centrifugation. DNA was extracted from urediniospore pellets and excised leaf pieces using a DNeasy Plant Mini Kit (Qiagen, Germantown, MD), and eight samples were amplified in real-time polymerase chain reaction (PCR) with P. pachyrhizi-specific primers Ppm1 and Ppa2 but not with the P. meibomiae-specific primers Ppm1 and Pme2 (2). Nucleotide sequence alignment of the internal transcribed spacer (ITS) regions 1 and 2 that were amplified by PCR using the primers Ppa1 and Ppa2 further confirmed the identification as P. pachyrhizi. To the best of our knowledge, this is the first known confirmation of soybean rust, caused by P. pachyrhizi in Costa Rica. CIGRAS-06 is the only soybean variety bred in the country as well as one of the very few varieties available for growers. Given that breeding for disease resistance is not a short-term option for P. pachyrhizi, alternative disease management strategies will have to be developed. References: (1) K. R. Bromfield. Soybean Rust, Monograph No. 11. APS Press, St. Paul, MN, 1984. (2) R. D. Frederick et al. Phytopathology 92:217, 2002.

Brief sexuality communication--a behavioural intervention to advance sexually transmitted infection/HIV prevention: a systematic review

BACKGROUND

Throughout the last decade substantial research has been undertaken to develop evidence-based behaviour change interventions for sexual health promotion. Primary care could provide an opportunistic entry for brief sexual health communication.

OBJECTIVES

We conducted a systematic review to explore opportunistic sexual and reproductive health services for sexual health communication delivered at primary health care level.

SEARCH STRATEGY

We searched for studies on PubMed, ProQuest, CINAHL, Jstor, Scopus/Science Direct, Cochrane database of systematic reviews, EBSCO, CINAHL, PsychoInfo, and Web of Knowledge. Both published and unpublished articles were reviewed.

SELECTION CRITERIA

All randomised controlled trials and controlled clinical trials were included. Participants of all ages, from adolescence onwards were included. Brief (10-60 minutes) interventions including some aspect of communication on sexual health issues were included.

DATA COLLECTION AND ANALYSIS

Data were extracted by two reviewers independently using a standardised form. Interventions differed from each other, hence meta-analysis was not performed, and results are presented individually.

MAIN RESULTS

A total of 247 articles were selected for full-text evaluation, 31 of which were included. Sexually transmitted infections (STIs)/HIV were less often reported in the intervention group compared with the control group. Condom use was higher in most studies in the intervention group. Numbers of sexual partners and unprotected sexual intercourse were lower in the intervention groups.

CONCLUSIONS

There is evidence that brief counselling interventions have some effect in the reduction and prevention of STIs/HIV. Some questions could not be answered, such as the effect over time and in different settings and population groups.

Impacts of pay for performance on the quality of primary care

Increasingly, financial incentives are being used in health care as a result of increasing demand for health care coupled with fiscal pressures. Financial incentive schemes are one approach by which the system may incentivize providers of health care to improve productivity and/or adapt to better quality provision. Pay for performance (P4P) is an example of a financial incentive which seeks to link providers’ payments to some measure of performance. This paper provides a discussion of the theoretical underpinnings of P4P, gives an overview of the health P4P evidence base, and provide a detailed case study of a particularly large scheme from the English National Health Service. Lessons are then drawn from the evidence base. Overall, we find that the evidence for the effectiveness of P4P for improving quality of care in primary care is mixed. This is to some extent due to the fact that the P4P schemes used in primary care are also mixed. There are many different schemes that incentivize different aspects of care in different ways and in different settings, making evaluation problematic. The Quality and Outcomes Framework in the United Kingdom is the largest example of P4P in primary care. Evidence suggests incentivized quality initially improved following the introduction of the Quality and Outcomes Framework, but this was short-lived. If P4P in primary care is to have a long-term future, the question about scheme effectiveness (perhaps incorporating the identification and assessment of potential risk factors) needs to be answered robustly. This would require that new schemes be designed from the onset to support their evaluation: control and treatment groups, coupled with before and after data.

Inner ear insult ablates the arousal response to hypoxia and hypercarbia

INTRODUCTION

Sudden Infant Death Syndrome (SIDS) remains the leading cause of infant mortality in Western societies. A prior study identified an association between hearing suppression on the newborn hearing test and subsequent death from SIDS. This is the first finding of an abnormality in SIDS cases prior to death. A following study identified that inner ear dysfunction precipitates a marked suppression of the hypercapnic ventilatory response (HCVR). Failure of arousal has been proposed to be a key component in SIDS. The objective of the present study was to assess whether inner ear dysfunction not only weakens the hypercapnic response, but also plays a role in suppressing the arousal response to suffocating gas mixtures.

METHODS

Wild-type mice (n=28) received intra-tympanic gentamicin (IT-Gent) injections bilaterally or unilaterally to precipitate inner ear hair cell dysfunction. Three control groups (n=22) received intra-tympanic saline (IT-Saline) bilaterally or unilaterally (right or left), or intra-peritoneal gentamicin (IP-Gent). The body movement arousal responses to severe hypoxia-hypercarbia combined (5% CO2 in nitrogen) were tested under light anesthesia 8 days following the administration of gentamicin or saline.

RESULTS

After injections, the bilateral and unilateral IT-Gent-treated animals behaved similarly to controls, however the HCVR as well as the arousal movements in response to severe hypoxia-hypercarbia were suppressed in IT-Gent-treated animals compared to control animals (P<0.05). Thus the HCVR was significantly decreased in the bilateral (n=9) and unilateral IT-Gent-treated mice (n=19) compared to bilateral (n=7) and unilateral IT-Saline (n=9) control groups (p<0.05). Arousal movements were suppressed in the bilateral IT-Gent group (n=9) compared to bilateral IT-Saline controls (n=7, P<0.0001) and in the unilateral IT-Gent group (n=19) compared to unilateral IT-Saline controls (n=10, P<0.0001).

DISCUSSION

The findings support the theory that inner ear dysfunction could be relevant in the pathophysiology of SIDS. The inner ear appears to play a key role in arousal from suffocating gas mixtures that has not been previously identified.

Hypertensive disease in pregnancy: an examination of ethnic differences and the Hispanic paradox

OBJECTIVE

The "Hispanic paradox" refers to the epidemiological finding that Hispanics in the US have better health outcomes than the average population despite what their aggregate socioeconomic determinants would predict. The aim of this study was to evaluate obstetric outcomes for a multiethnic population with hypertensive diseases.

METHODS

We performed a retrospective review of parturients with hypertensive disease delivering at Duke University Medical Center. We analyzed maternal sociodemographic characteristics and ethnic differences in hypertensive disease types using Chi Square tests.

RESULTS

A total of 3,124 women delivered during a period of one year; 9% of them had hypertensive diseases in pregnancy. Gestational hypertension was more commonly diagnosed in Whites, whereas chronic hypertension and mild preeclampsia were more frequently encountered in Blacks and Hispanics respectively (Chi-square = 39.11, p < 0.001). The overall incidence of preeclampsia was less in Hispanics. However, severe preeclampsia rates were equal across groups. Hispanics were more likely to be uninsured and younger, enter prenatal care later, and least likely to complete high school. There was no significant difference in smoking or parity. Stratified analyses by ethnicity showed that the relationship between severe preeclampsia and comorbidities (intrauterine growth restriction, low birth weight, and need for admission to intensive care nursery) were least pronounced in Hispanics and strongest in Black women.

CONCLUSION

Despite similar rates of severe preeclampsia and adverse sociodemographic characteristics, Hispanic women with severe preeclampsia had better pregnancy outcomes than Black or White women with the disease.