bluuebunny/crossref_metadata_2025 huggingface dataset:
Low risk of new dysplastic lesions in an inflammatory bowel disease population study with dye chromoendoscopy
Authors: Sicilia Beatriz , González-Lama Yago , Velayos Benito , Suárez Patricia , Maroto-Martín Carlos , Nuñez Aljandro , Hernández Luis , Sáiz-Chumillas Rosa M. , Relea Lucia , Fernández-Salazar Luis , Sierra-Ausín Mónica , Barrio Andrés Jesús , Muñoz Fernando , Arias García Lara
Published: March 2023

Background and study aims Rates of new dysplastic lesions or cancer progression after first dye chromoendoscopy in the era of high-definition endoscopy have yet to be determined.

Patients and methods A multicenter, population-based, retrospective cohort study was performed in seven hospitals in Spain. Patients with inflammatory bowel disease and fully resected (R0) dysplastic colon lesions under surveillance with high-definition dye-based chromoendoscopy were sequentially enrolled between February 2011 and June 2017, with a minimum endoscopic follow-up of 36 months. The aim was to assess the incidence of developing more advanced metachronous neoplasia by analyzing possible associated risk factors.

Results The study sample included 99 patients and 148 index lesions (145 low-grade dysplasia lesions and three high-grade dysplasia [HGD] lesions with a mean follow-up of 48.76 months [IQR: 36.34–67.15]). The overall incidence of new dysplastic lesions was 0.23 per 100 patient-years, 1.15 per 100 patients at 5 years and 2.29 per 100 patients at 10 years. A history of dysplasia was associated with a higher risk of developing any grade of dysplasia during follow-up (P = 0.025), whereas left colon lesions were associated with a lower risk (P = 0.043). The incidence of more advanced lesions at 1 year and 10 years was 1 % and 14 % respectively, with lesion size > 1 cm being a risk factor (P = 0.041). One of the eight patients (13 %) with HGD lesions developed colorectal cancer during follow-up.

Conclusions The risk of dysplasia progressing to advanced neoplasia and, specifically, the risk of new neoplastic lesions after endoscopic resection of colitis-associated dysplasia, are both very low.
Structural and Molecular Imaging for Clinically Uncertain Parkinsonism
Authors: Sasikumar Sanskriti , Strafella Antonio P.
Published: March 2023

Neuroimaging is an important adjunct to the clinical assessment of Parkinson disease (PD). Parkinsonism can be challenging to differentiate, especially in early disease stages, when it mimics other movement disorders or when there is a poor response to dopaminergic therapies. There is also a discrepancy between the phenotypic presentation of degenerative parkinsonism and the pathological outcome. The emergence of more sophisticated and accessible neuroimaging can identify molecular mechanisms of PD, the variation between clinical phenotypes, and the compensatory mechanisms that occur with disease progression. Ultra-high-field imaging techniques have improved spatial resolution and contrast that can detect microstructural changes, disruptions in neural pathways, and metabolic and blood flow alterations. We highlight the imaging modalities that can be accessed in clinical practice and recommend an approach to the diagnosis of clinically uncertain parkinsonism.
In situ high-pressure wide-angle hard x-ray photon correlation spectroscopy: A versatile tool probing atomic dynamics of extreme condition matter
Authors: Zeng Qiaoshi
Published: March 2023

With the advent of new synchrotron radiation x-ray sources that provide a significantly enhanced coherent flux, high-energy x-ray photon correlation spectroscopy measurements can be performed on materials in a diamond anvil cell. Essential information on atomic dynamics that was previously inaccessible can be obtained for various novel phenomena emerging under extreme conditions. This article discusses the importance, feasibility, and experimental details of this technique, as well as the opportunities that it offers to address critical scientific challenges.
celebrates its 50th volume
Authors: Shabala Sergey
Published: March 2023

This Editorial reflects on the past 50 years of Functional Plant Biology and its future directions.
Whānau Āwhina Plunket nurses’ views on the use of the PHQ-3 postnatal depression screening tool: a survey
Authors: Faulkner Jenny , Moir Chris
Published: March 2023

Introduction In New Zealand, nurses visiting families postnatally use the Patient Health Questionnaire-3 (PHQ-3) to screen and detect postnatal depression. Exploring nurses’ perception of the tool when using it with women across cultures is central to ensuring the PHQ-3 tool supports equitable screening and detection of postnatal depression, yet little is known about nurses’ confidence with, and use of, the tool with people of differing cultures. Aim The aim of this study was to understand nurses’ confidence in using the PHQ-3 to screen for postnatal depression, particularly its use cross-culturally. Methods Quantitative online survey research was carried out in 2019. Fifty-two percent of eligible registered nurses participated (n = 187), completing Likert scale responses and open questions about the use of the screening tool with specific groups, and barriers and facilitators to screening. Results Ninety-five percent of participants were confident in their use of the PQH-3, 70% of nurses agreed the PHQ-3 supports the identification of postnatal depression, and most respondents (54.5%) disagreed that the PHQ-3 was a good screening tool cross-culturally. Discussion Nurses were confident in their use of the PHQ-3, and it was relatively highly regarded in its ability to detect postnatal depression. However, less confidence in its use across cultures implies the PHQ-3 does not translate to evidence-based, cross-cultural care. To serve culturally diverse populations, consultation is needed on both languages used and cultural practices so that tools are appropriate, otherwise they cannot be validated for use cross-culturally.
Asian migrants navigating New Zealand primary care: a qualitative study
Authors: Xiang Valerie , Parackal Sherly , Gurung Gagan , Subramaniam Rathan M.
Published: March 2023

Introduction Information on the responsiveness of the New Zealand (NZ) health system to Asians to enable navigation of healthcare services is currently lacking. Barriers experienced by Asian patients to enable optimal navigation of, and engagement with, healthcare services are also sparse. Aim This research aimed to: (1) document and analyse resources available on the websites of general practices that aid in optimal health care navigation for NZ Asians; and (2) explore the barriers perceived by Asian migrants to navigating the NZ Health System, particularly primary care. Methods This study involved qualitative document analysis of existing resources on general practice websites. Information on perceived barriers and experiences of navigating the health system was collected through semi-structured interviews (n = 9). Results Overall, 293 general practice websites were analysed. The themes from content analysis were: availability of basic information, linguistic accessibility, and culturally appropriate support for patients. Relevant and reliable information facilitating effective navigation of the NZ health system by Asians was lacking. Interview data supported the findings about the general practices, with participants reporting significant difficulties navigating and understanding NZ primary care services. Discussion Current navigational resources presume knowledge that Asian migrants do not often possess. Participants felt this lack of accessible information acutely, and it influenced how they perceived and engaged with healthcare services. Increased accessibility through resources in Asian languages, including an overview of how Health NZ functions in providing health care and professional interpreter services, would be critical to increase appropriate engagement with healthcare services and thus contribute to better health outcomes for Asians.
Describing and assessing interactional competence in a second language
Authors: Malabarba Taiane , Betz Emma
Published: March 2023

The contributions to this Special Issue employ conversation analysis to illustrate how detailed analysis of
language use can lead to the identification of assessable features of second/foreign language Interactional Competence (L2 IC) and
the development of institutional testing instruments and practices. L2 IC has been the focus of much research at the intersection
of social interaction and second language acquisition. It has also been treated as a construct in the field of language
assessment. However, scholars in each research branch have just begun to collaborate systematically. This Special Issue furthers
this collaboration, connecting research on L2 IC in diverse learning contexts with practical questions regarding the assessment of
individual learners. It adopts a dialogic ‘full paper–commenting paper’ structure: Four empirical papers are each paired with
invited commentaries that provide critical discussion and a complementary view of the topics the full papers address. The final
discussion papers take a broader perspective on the complex nature of L2 IC and assessment and propose ways to productively move
forward. Besides introducing the notion of L2 IC and each individual contribution, this introductory article explains the
rationale behind the Special Issue in relation to current research.
Rethinking the innovation, effectiveness and perceptions of flipped classroom (Repensar la innovación, la eficacia y las percepciones del aula invertida)
Authors: Deng Haoxi
Published: March 2023

Flipped classroom (FC) is a popular teaching pattern at the present stage. Based on a review of related literature, this paper rethinks the innovation, effectiveness and perceptions of FC from nine aspects, including the theoretical basis, teaching principles, teaching practice, genesis of effectiveness, effectiveness per se, objectivity and rigorousness of effect evaluation, roles played by technology, influence of different disciplines and cost performance. It is argued that (i) the innovation of FC needs to be further clarified, (ii) the effectiveness of it needs to be further validated and (iii) the perceptions of it remain to be deepened. FC therefore deserves a rational reconsideration.
A method for simultaneously preparing crack-based and composite-based PDMS strain sensors by mixing AgNWs and Ag microparticles
Authors: Gao Kunpeng , Wang Qianjin , Tang Junqi , Liu Yingkai
Published: March 2023

Resistive-type strain sensors have been widely studied because of their high precision and convenient measurement. But the high sensitivity and large strain range of this kind of sensor conflict with each other. It is difficult to prepare a sensor with high sensitivity and a large tensile range at the same time. Here, we propose a method to use AgNWs/Ag microparticles (AgMPs) and PDMS to simultaneously manufacture two strain sensors with different principles, a crack-based sensor and a composite-based sensor. On the one hand, the crack-based sensor has a low detection limit of 0.5% strain and high sensitivity of GF ≈ 90 at the strain of 0 ∼ 50%. It is suitable for the detection of small strains and can detect throat vibration when speaking. On the other hand, the composite-based sensor has a large strain range of 0 ∼ 240% and excellent stability. After 1000 cycles of stretching-releasing at 50% strain, the resistance change rate remains unchanged. It is suitable for the detection of large strains. Moreover, the sensitivity and working range of the composite-based sensor can be adjusted by changing the ratio and total amount of AgNWs/AgMPs composites. It can accurately monitor the different bending angles of the elbow joint and a people’s walking status and pace. The strain sensor prepared by this method has great practical value in wearable devices and electronic skin.
Low-rank approximation of continuous functions in Sobolev spaces with dominating mixed smoothness
Authors: Griebel Michael , Harbrecht Helmut , Schneider Reinhold
Published: March 2023

Let

Ω
i

⊂

R

n
i

\Omega _i\subset \mathbb {R}^{n_i}

,

i
=
1
,
…
,
m

i=1,\ldots ,m

, be given domains. In this article, we study the low-rank approximation with respect to

L
2

(

Ω
1

×
⋯
×

Ω
m

)

L^2(\Omega _1\times \dots \times \Omega _m)

of functions from Sobolev spaces with dominating mixed smoothness. To this end, we first estimate the rank of a bivariate approximation, i.e., the rank of the continuous singular value decomposition. In comparison to the case of functions from Sobolev spaces with isotropic smoothness, compare Griebel and Harbrecht [IMA J. Numer. Anal. 34 (2014), pp. 28–54] and Griebel and Harbrecht [IMA J. Numer. Anal. 39 (2019), pp. 1652–1671], we obtain improved results due to the additional mixed smoothness. This convergence result is then used to study the tensor train decomposition as a method to construct multivariate low-rank approximations of functions from Sobolev spaces with dominating mixed smoothness. We show that this approach is able to beat the curse of dimension.
Sun Protection in German Outdoor Workers: Differences by Sex and Job-Related Characteristics
Authors: Diehl Katharina , Brokmeier Luisa , Konkel Tobias , Breitbart Eckhard W , Drexler Hans , Görig Tatiana
Published: March 2023

Background

Ultraviolet (UV) exposure during outdoor work increases the risk of developing skin cancer. Therefore, the uptake of recommended sun protection behaviors is important to prevent UV-related skin damage in the population of outdoor workers. To develop targeted prevention campaigns, information on the use of sun protection behaviors in different industries is needed.

Methods

A total of 486 outdoor workers were surveyed on the use of several sun protection measures as part of the 7th wave of the National Cancer Aid Monitoring. Furthermore, details on job-related characteristics, sociodemographics, and skin type were assessed. Descriptive analyses stratified by sex were conducted.

Results

In general, use of sun protection was insufficient (e.g. 38.4% used sunscreen on the face). Sun protection behavior differed between female and male outdoor workers with females being more likely to use sunscreen and males being more likely to wear sun protective clothes and headgear. For male outdoor workers, we revealed several associations with job-related characteristics. For instance, those who were employed full time were more likely to wear sun protective clothes (e.g. shoulder-covering shirt: 87.1% versus 50.0%, P < 0.001).

Discussion

We identified deficits in sun protection behavior in outdoor workers and differences by sex- and job-related characteristics. These differences offer starting points for targeted prevention measures. In addition, the findings may inspire qualitative research.
Reliable Digit Span Scores Among Latin American Monolingual Spanish Speakers
Authors: Rosenstein Leslie D , Edgar Veronica Bordes , Nieves Emmanuel Rosario
Published: March 2023

Objective

The Reliable Digit Span (RDS) is an embedded measure used to assess performance validity. The purpose of this study was to determine whether the RDS can be used with Spanish speakers from Latin America.

Method

The Digit Span subtest of the Wechsler Adult Intelligence Scale-IV was administered to 66 Spanish-speaking patients, 66 English-speaking patients, and 30 Spanish-speaking normal controls. The Spanish-speaking patients had a mean age of 65.82 (standard deviation [SD] = 12.44) and mean education of 6.62 years (SD = 4.91), whereas the controls had a mean age of 48.27 (SD = 10.97) and mean education of 8.33 (SD = 3.04). The English-speaking patients had a mean age of 56.44 (SD = 13.53) and mean education of 12.14 (SD = 2.37).

Results

The average RDS among the Spanish-speaking patients was 5.36 (SD = 1.27) and the average RDS among the controls was 5.90 (SD = 1.06). The mean RDS of the English-speaking patients was 7.83 (SD = 1.72). The modal RDS among Spanish-speaking patients was 5. The modal RDS among Spanish-speaking controls was also 5, though the distribution was bimodal in nature with nearly as many 7 s as 5 s. The modal RDS among the English-speaking patients was 7. Among patients with ≥9 years of education and controlling for age, there remained a significant difference between both language patient groups on the RDS (F(1, 79) = 30.85, p < .0001).

Conclusions

These data suggest that the RDS may not be a valuable measure in assessing performance validity among monolingual Spanish speakers from Latin America, particularly among those with low levels of education.
Plasma phosphorylated tau 217 in preclinical Alzheimer’s disease
Authors: Jonaitis Erin M , Janelidze Shorena , Cody Karly A , Langhough Rebecca , Du Lianlian , Chin Nathaniel A , Mattsson-Carlgren Niklas , Hogan Kirk J , Christian Bradley T , Betthauser Tobey J , Hansson Oskar , Johnson Sterling C
Published: March 2023

An accurate blood test for Alzheimer’s disease that is sensitive to preclinical proteinopathy and cognitive decline has clear implications for early detection and secondary prevention. We assessed the performance of plasma phosphorylated tau 217 (pTau217) against brain PET markers of amyloid [[11C]-labelled Pittsburgh compound B (PiB)] and tau ([18F]MK-6240) and its utility for predicting longitudinal cognition. Samples were analysed from a subset of participants with up to 8 years follow-up in the Wisconsin Registry for Alzheimer’s Prevention (WRAP; 2001–present; plasma 2011–present), a longitudinal cohort study of adults from midlife, enriched for parental history of Alzheimer’s disease. Participants were a convenience sample who volunteered for at least one PiB scan, had usable banked plasma and were cognitively unimpaired at first plasma collection. Study personnel who interacted with participants or samples were blind to amyloid status. We used mixed effects models and receiver–operator characteristic curves to assess concordance between plasma pTau217 and PET biomarkers of Alzheimer’s disease and mixed effects models to understand the ability of plasma pTau217 to predict longitudinal performance on WRAP’s preclinical Alzheimer’s cognitive composite (PACC-3). The primary analysis included 165 people (108 women; mean age = 62.9 ± 6.06; 160 still enrolled; 2 deceased; 3 discontinued). Plasma pTau217 was strongly related to PET-based estimates of concurrent brain amyloid (β^ = 0.83 (0.75, 0.90), P < 0.001). Concordance was high between plasma pTau217 and both amyloid PET (area under the curve = 0.91, specificity = 0.80, sensitivity = 0.85, positive predictive value = 0.58, negative predictive value = 0.94) and tau PET (area under the curve = 0.95, specificity = 1, sensitivity = 0.85, positive predictive value = 1, negative predictive value = 0.98). Higher baseline pTau217 levels were associated with worse cognitive trajectories (β^pTau×age = −0.07 (−0.09, −0.06), P < 0.001). In a convenience sample of unimpaired adults, plasma pTau217 levels correlate well with concurrent brain Alzheimer’s disease pathophysiology and with prospective cognitive performance. These data indicate that this marker can detect disease before clinical signs and thus may disambiguate presymptomatic Alzheimer’s disease from normal cognitive ageing.
Monitoring tafamidis treatment with quantitative SPECT/CT in transthyretin amyloid cardiomyopathy
Authors: Rettl René , Wollenweber Tim , Duca Franz , Binder Christina , Cherouny Bernhard , Dachs Theresa-Marie , Camuz Ligios Luciana , Schrutka Lore , Dalos Daniel , Beitzke Dietrich , Loewe Christian , Badr Eslam Roza , Kastner Johannes , Hacker Marcus , Bonderman Diana
Published: March 2023

Aims

Tafamidis treatment positively affects left ventricular (LV) structure and function and improves outcomes in patients with transthyretin amyloid cardiomyopathy (ATTR-CM). We aimed to investigate the relationship between treatment response and cardiac amyloid burden identified by serial quantitative 99mTc-DPD SPECT/CT. We furthermore aimed to identify nuclear imaging biomarkers that could be used to quantify and monitor response to tafamidis therapy.

Methods and results

Forty wild-type ATTR-CM patients who underwent 99mTc-DPD scintigraphy and SPECT/CT imaging at baseline and after treatment with tafamidis 61 mg once daily [median, 9.0 months (interquartile range 7.0–10.0)] were divided into two cohorts based on the median (−32.3%) of the longitudinal percent change in standardized uptake value (SUV) retention index. ATTR-CM patients with a reduction greater than or equal to the median (n = 20) had a significant decrease in SUV retention index (P < 0.001) at follow-up, which translated into significant benefits in serum N-terminal prohormone of brain natriuretic peptide levels (P = 0.006), left atrial volume index (P = 0.038), as well as LV [LV global longitudinal strain: P = 0.028, LV ejection fraction (EF): P = 0.027, LV cardiac index (CI): P = 0.034] and right ventricular (RV) [RVEF: P = 0.025, RVCI: P = 0.048] functions compared with patients with a decrease less than the median (n = 20).

Conclusion

Treatment with tafamidis in ATTR-CM patients results in a significant reduction in SUV retention index, associated with significant benefits for LV and RV function and cardiac biomarkers. Serial quantitative 99mTc-DPD SPECT/CT imaging with SUV may be a valid tool to quantify and monitor response to tafamidis treatment in affected patients.

Translational perspective

99mTc-DPD SPECT/CT imaging with determination of SUV retention index as part of a routine annual examination can provide evidence of treatment response in ATTR-CM patients receiving disease-modifying therapy. Further long-term studies with 99mTc-DPD SPECT/CT imaging may help to evaluate the relationship between tafamidis-induced reduction in SUV retention index and outcome in patients with ATTR-CM and will demonstrate whether highly disease-specific 99mTc-DPD SPECT/CT imaging is more sensitive than routine diagnostic monitoring.
Health economic consequences of optimal vs. observed guideline adherence of coronary angiography in patients with suspected obstructive stable coronary artery in Germany: a microsimulation model
Authors: Seleznova Yana , Bruder Oliver , Loeser Simon , Artmann Jörg , Shukri Arim , Naumann Marie , Stock Stephanie , Wein Bastian , Müller Dirk
Published: March 2023

Aims

While the number of patients with stable coronary artery disease (SCAD) is similar across European countries, Germany has the highest per capita volume of coronary angiographies (CA). This study evaluated the health economic consequences of guideline-non-adherent use of CA in patients with SCAD.

Methods and results

As part of the ENLIGHT-KHK trial, a prospective observational study, this microsimulation model compared the number of major adverse cardiac events (MACE) and the costs of real-world use of CA with those of (assumed) complete guideline-adherent use (according to the German National Disease Management Guideline 2019). The model considered non-invasive testing, CA, revascularization, MACE (30 days after CA), and medical costs. Model inputs were obtained from the ENLIGHT-KHK trial (i.e. patients’ records, a patient questionnaire, and claims data). Incremental cost-effectiveness ratios were calculated by comparing the differences in costs and MACE avoided from the perspective of the Statutory Health Insurance (SHI). Independent on pre-test probability (PTP) of SCAD, complete guideline adherence for usage of CA would result in a slightly lower rate of MACE (–0.0017) and less cost (€–807) per person compared with real-world guideline adherence. While cost savings were shown for moderate and low PTP (€901 and €502, respectively), for a high PTP, a guideline-adherent process results in slightly higher costs (€78) compared with real-world guideline adherence. Sensitivity analyses confirmed the results.

Conclusion

Our analysis indicates that improving guideline adherence in clinical practice by reducing the amount of CAs in patients with SCAD would lead to cost savings for the German SHI.
Using an Immersive Video Environment to Assess Pedestrians’ Compliance With COVID Distance Keeping Interventions
Authors: Stenkamp Jan , Karic Benjamin , Scharf Paula , Verstegen Judith A , Kray Christian
Published: March 2023

Physical distancing is a key measure to slow the spread of many highly infectious diseases, e.g. COVID-19. Streetscape interventions such as pedestrian signage can contribute to ensuring distances are kept, but it is unclear to what extent people comply with these in practice. This paper tackles this question using an immersive video environment to realistically simulate real-life streetscapes in the lab. In a controlled user study, we augmented panoramic video footage with pedestrian one-way street signage and recorded route decisions to assess compliance with distance keeping measures. Our results indicate that such signage affects routing decisions and can thus help pedestrians to avoid crowded situations where distance keeping is difficult. We also identified further factors affecting decisions and a correlation between intention to comply and actual compliance. The experimental method we used enabled us to effectively and safely carry out a study of a phenomenon that in the real world depends on interaction with the physical environment. This method may have applications in other areas in which simulations of physical environments are important.
A4 PREDNISOLONE, A GLUCOCORTICOID WIDELY USED FOR TREATMENT OF IBD, ENHANCES A HUMAN INTERLEUKIN-4-ACTIVATED MACROPHAGE PHENOTYPE
Authors: Deshpande R S , Callejas Pina B E , Peng R , Sousa J A , Wang A , Panaccione R , McKay D M
Published: March 2023

Background

With cellular immunotherapy, the individuals’ medication could ablate (or enhance) any therapeutic benefit of the transferred cells. Murine and human macrophages activated with IL-4 (i.e., M(IL4)) improve wound healing and reduce the severity of disease in murine models of colitis. Advancing the position that autologous M(IL4) could be a novel approach to IBD, a critical question arises: will concurrent medication impact the M(IL4)s anti-colitic effect? To address this, we tested if prednisolone, a synthetic, anti-inflammatory glucocorticoid used to induce remission in IBD flares,impacts human M(IL4) phenotype and function.

Purpose

To determine if prednisolone suppresses or enhances a human M(IL4) phenotype as defined by canonical marker molecules and wound healing and anti-colitic activities.

Method

Macrophages were differentiated from the blood monocytes of healthy volunteers using M-CSF (7 days) and treated with GMP-grade IL-4 (10 ng/mL, 48h) ± a 24h treatment with prednisolone (1μg/mL). Subsequently, conditioned medium was collected for TGFb measurement by ELISA and for use in a T84 epithelial cell in vitro wound healing assay. Retrieved M(IL4) and M(IL4,pred.) were characterized by mRNA expression of CD206 (mannose receptor), RAMP1 (CGRP receptor), and CD14 (LPS co-receptor). One million murine bone marrow-derived M(IL4) or M(IL4,pred.) were injected into BALB/c mice 48h prior to intra-rectal DNBS (3mg), and colitis was assessed 72h-post DNBS.

Result(s)

Human M(IL4)s displayed increased mRNA expression of CD206 and RAMP1, and reduced CD14 compared to M(0), with the CD206 and RAMP1 being further increased by prednisolone treatment. M(IL4,pred.) produced more TGF-β than M(IL4) upon LPS stimulation [363 ± 30 vs. 241 ± 24 pg/ml, n= 4, p<0.05], which would predict an enhanced wound healing capacity. Stimulated M(IL4,pred.) produced more IL-10 than M(IL4). Furthermore, murine M(IL4,pred.) retained an anti-colitic capacity comparable to M(IL4) as determined by disease activity score in the DNBS model.

Conclusion(s)

Human M(IL4)s subsequently exposed to the potent immunomodulatory glucocorticoid, prednisolone show increased expression of phenotypic markers and increased output of TGFb and IL-10. Crucially M(IL4,pred.) retained an anti-colic effect in the murine DNBS model of colitis. Interpreting these data, we suggest that the anti-colitic effect of M(IL4) immunotherapy would not be adversely offset by the individuals concomitant use of steroids. Our preliminary findings support pursuing M(IL4) transfers as a novel approach to the management of IBD.

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Other

Please indicate your source of funding;

Helmsley Charitable Trust

Disclosure of Interest

None Declared
A66 PROTON PUMP INHIBITORS AND THE RISK OF INFLAMMATORY BOWEL DISEASE: A REAL WORLD POPULATION-BASED COHORT STUDY
Authors: Yanofsky R P , Abrahami D , Pradhan R , Yin H , McDonald E G , Bitton A , Azoulay L
Published: March 2023

Background

Proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs) are acid suppressant drugs indicated in highly prevalent conditions such as gastroesophageal reflux disease and peptic ulcer disease. A recent observational study reported an increased risk of inflammatory bowel disease (IBD) with the use of PPIs. However, this association may have been driven by certain methodological shortcomings, such as failure to properly account for protopathic bias, a conclusion-altering bias.

Purpose

To determine whether the use of PPIs compared with the use of H2RAs is associated with an increased risk of IBD.

Method

Using the longitudinal primary care records from the United Kingdom Clinical Practice Research Datalink database, we identified 1,498,416 initiators of PPIs and 322,474 initiators of H2RAs from January 1, 1990, through December 31, 2018, with follow-up until December 31, 2019. Standardized morbidity ratio weighted Cox proportional hazards models were used to estimate marginal hazard ratios (HRs) and 95% confidence intervals (CIs). Patients were analyzed according to the timing of the IBD events after treatment initiation (early versus late). In the early-event analysis, IBD events were assessed within the first two years of treatment initiation, an analysis subject to potential protopathic bias. In the late-event analysis, all exposures were lagged by two years to account for latency and minimize protopathic bias.

Result(s)

In the early-event analysis, the use of PPIs was associated with an increased risk of IBD within the first two years of treatment initiation, compared with H2RAs (HR: 1.39, 95% CI: 1.14-1.69). In contrast, the use of PPIs was not associated with an increased risk of IBD in the late-event analysis (HR: 1.05, 95% CI: 0.90 to 1.22). The results remained consistent in several sensitivity analyses.

Image

Conclusion(s)

Compared with H2RAs, PPIs were not associated with an increased risk of IBD, after accounting for protopathic bias.

Please acknowledge all funding agencies by checking the applicable boxes below

CIHR

Disclosure of Interest

R. Yanofsky: None Declared, D. Abrahami Employee of: pfizer, R. Pradhan: None Declared, H. Yin: None Declared, E. McDonald: None Declared, A. Bitton Consultant of: Member of Advisory Boards for Abbie, Pfizer, Takeda, Jansen, and Merck, Speakers bureau of: Has received speaker fees for Abbie, Jansen, Takeda, and Pfizer, L. Azoulay Consultant of: Has received consults fees from Jansen, Pfizer, and Roche, Speakers bureau of: Has received speaker fees from Jansen, Pfizer, and Roche
A71 SIGNIFICANT RACIAL/ETHNIC DIFFERENCES EXIST IN THE RECEIPT OF IBD-RELATED SURGERY: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Chhibba T , Tandon P , Natt N , Brar G , Malhi G , Nguyen G
Published: March 2023

Background

Patients with inflammatory bowel disease (IBD) may require surgical intervention for management of their disease. There is a rising incidence of IBD in racial and ethnic minorities but studies regarding healthcare utilization patterns in these populations have yielded variable results.

Purpose

We aimed to examine the differences in surgical rates of ethnic and racial groups compared to White patients with IBD.

Method

Electronic databases were searched through December 20, 2021. Studies that compared ulcerative colitis (UC) or Crohn’s disease (CD) surgery rates between different racial/ethnic groups were included. Both pediatric and adult studies were included. Pooled event rates were generated and p-value < 0.05 was considered statistically significant in generating odds ratios (OR) with 95% confidence interval (CI). We also compared differences in disease location, phenotype, and IBD-medication exposure amongst different groups included.

Result(s)

Forty-one studies stratified rates of IBD-related surgeries by race or ethnicity (n=1,094,693 patients). Black patients were less likely to undergo IBD-related surgeries compared to White patients (pooled OR 0.70, 95% CI, 0.55-0.89, I2=87.0%). Black patients were also less likely compared to White patients to undergo an emergent colectomy with an incidence rate ratio of 0.43 (95% CI, 0.32-0.58). Furthermore, Hispanic patients were less likely to undergo a CD-related surgery (pooled OR 0.57, 95% CI, 0.48-0.68, I2=0%) compared to White patients. Finally, Asian patients had no significant difference in likelihood of CD-related and UC-related surgeries compared to White patients. Black patients were more likely to have perianal disease (pooled OR 1.40, 95% CI, 1.06-1.86), I2=58.2%) but otherwise disease characteristics and phenotypes were similar across all populations compared to Caucasians.

Conclusion(s)

Black and Hispanic patients with IBD are less likely to have surgery, including emergent surgery, for IBD compared to White patients with IBD, despite similar disease phenotype characteristics. Disparities in access to care may be contributory toward these findings and efforts should be made to provide equitable care to all persons living with IBD, regardless of race and ethnicity.

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Other

Please indicate your source of funding below:

Nil

Disclosure of Interest

None Declared
A96 IMPROVING AUTOMATED TELEHEALTH SERVICES TO MEET THE NEEDS OF PATIENTS AND HEALTHCARE PROFESSIONALS
Authors: Calman T'ien L , Galorport C , Enns R A
Published: March 2023

Background

There is a growing demand for automated telehealth programs in medicine to improve health-related behaviours such as adherence to treatment schedules. In addition, these services are a promising alternative to increase access to medical care for rural and marginalized patients.

Although promising, telehealth programs need to be evaluated based on patient responsiveness in order to tailor automated services to their target population and identify factors that minimize response rates.

Purpose

To evaluate the effect of socioeconomic, health and structural factors on the response rate of an automated follow-up program implemented at St. Paul’s Hospital in Vancouver, BC.

Method

A retrospective chart review was conducted of patients who did not respond when contacted by a PAtient-Guided Complication Tracking System (PACTS). PACTS sent Short Message Service (SMS) to outpatients having a flexible sigmoidoscopy, gastroscopy and/or colonoscopy one week post-procedure.

Patients who received PACTS SMS between 03/21-08/21 were included in this study. Individuals were considered non-responsive if they failed to reply after receiving an initial SMS and a second reminder text message (sent 24 hours after the first SMS).

Socioeconomic factors including: age, sex and personal annual income were assessed. Income was analyzed using postal code census data. To study health factors, patient comorbidity was evaluated using the Charlson Comorbidity Index (CCI) where CCI > 2 was considered high. Finally, access to a general practitioner (GP) was investigated to study structural factors influencing responsiveness to PACTS.

Result(s)

Of the 200 people studied, 109 of these individuals were male (54%) and 91 were female (46%). The mean age of non-respondents was 60.2 ± 16.4. Postal codes were reported for 144 patients (72%) and the mean annual income of these individuals was $48 928 ± $9710. The mean Charlson Comorbidity Index was 2.1 ± 1.7. 109 non-respondents (54%) had a family doctor listed in their chart and 91 non-respondents (46%) did not.

Conclusion(s)

Based on the age, sex, personal annual income and comorbidity results, socioeconomic and health factors do not impact response rate. The large number of non-respondents without GPs indicate that structural factors influence responsiveness. The high proportion of non-respondents lacking GPs may represent a subgroup of individuals that under-use healthcare services.

Further evaluation of non-respondents and comparative analysis with a large group of respondents are pending and will likely support these conclusions.

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A101 VIRTUAL MINDFULNESS-BASED STRESS REDUCTION FOR ADULTS WITH INFLAMMATORY BOWEL DISEASE: FEASIBILITY TRIAL PRELIMINARY RESULTS
Authors: Chappell K , Goodman K J , Le Melledo J -M , Meakins D , Marsh-Joyal M , Kroeker K I
Published: March 2023

Background

Patients with Inflammatory Bowel Disease (IBD) often suffer from high levels of anxiety and depression. Despite high rates of mental health comorbidity, a low proportion of patients receive psychiatric referrals and treatment. In Canada, provincial health care plans cover psychiatric services, making them affordable for patients and making referral efficient for gastroenterologists. Psychiatrist-led virtually-delivered Mindfulness-Based Stress Reduction (MBSR) has been associated with reducing feelings of stress, anxiety, and depression in several high-quality randomized control trials. It also reduces cost and travel requirements for patients, both which have been identified as barriers to accessing mental health treatment.

Purpose

To assess the feasibility of online-delivered MBSR for IBD patients, with feasibility outcomes defined as recruitment success, and attendance, adherence, and attrition of participating patients.

Method

Eligible participants were adult IBD patients aged 18-65 attending gastroenterology clinics in Edmonton, Alberta who self-identified as being anxious or depressed and/or were referred by their gastroenterologist. A research coordinator contacted eligible patients who expressed interest in participating after completing an assessment of symptoms and a semi-structured interview with a psychiatrist. The MBSR protocol was an 8-week group-based intervention aimed at giving participants tools to cope with stress effectively. Participants attended 8 weekly sessions lasting 2.5 hours/week and a one-time weekend session lasting 5 hours. They were also asked to practice every night for 45-60 minutes. Completion of the program required attendance of at least 6 of 8 weekly sessions and the weekend session. Two groups, led by the same team of qualified psychiatrists, started MBSR, with sessions occurring in the evening via Zoom.

Result(s)

Of the 64 patients referred to the study, 16 (25%) agreed to participate. Reasons for declining to participate are shown in Table 1, with 80% indicating they were too busy. Of the 16 patients enrolled, the median age was 36 (range: 18-55), 10 identified as female (62.5%) and 8 had Crohn’s Disease (50%). Attendance, adherence, and attrition data from the first group of 7 participants were recorded. Only 3 (42.8%) successfully completed the program. The participants that completed the program had an attendance rate of 100% and practiced 6 nights a week for an average of 25 minutes a night. A second group with 9 participants is currently ongoing.

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Conclusion(s)

Although interest in a cost-free, virtual stress management resource was relatively high, willingness to enroll in MBSR specifically, was low, largely due to the time commitment. Follow-up interviews with those who enrolled and did not enroll in the intervention are underway to highlight the benefits and barriers to MBSR.

Disclosure of Interest

None Declared
A110 INCIDENCE AND PREDICTORS OF ASYMPTOMATIC ABNORMALITIES IN BIOCHEMICAL AND RADIOLOGIC PANCREATIC MARKERS FOLLOWING UNCOMPLICATED ERCP
Authors: Samnani S , Chau M , Ruan Y , Forbes N
Published: March 2023

Background

Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is common. Its diagnosis relies on characteristic abdominal pain in addition to biochemical and/or radiographic evidence of pancreatic inflammation.

Purpose

Little is known regarding the frequency with which asymptomatic alterations in biochemical and/or imaging parameters occur following uncomplicated ERCP. We sought to assess the incidence and predictors of such alterations following uncomplicated ERCP.

Method

This study was an analysis of a prospectively maintained ERCP registry. All inpatients ³ 18 years old who underwent ERCP between 2018/09/01 and 2022/02/28 were identified. Patients with acute pancreatitis or abdominal pain following ERCP were excluded, as were patients with lipase levels ≥3x the upper limit of normal (ULN) within 7 days preceding ERCP. Primary outcomes were (1) asymptomatic lipase elevation within 48 hours of uncomplicated ERCP or (2) asymptomatic cross-sectional imaging findings of pancreatic inflammation within 14 days of ERCP.Descriptive statistics were presented as means with accompanying standard deviations (SD) and percentages by lipase categories and PEP, or by imaging categories. Multiple logistic regression was used to examine the associations of exposure variables with PEP or imaging findings.

Result(s)

A total of 646 patients were analyzed in the biochemical cohort, and 187 patients were analyzed in the radiologic cohort. In the biochemical cohort, 478 patients (74.0%) had no elevations in pancreatic enzymes, while 81 (12.5%) had elevations up to 2x ULN, 26 (4.0%) had elevations between 2-3x ULN, and 61 (9.4%) had elevations >3x ULN. In the radiologic cohort, 148 (79.1%) had no abnormalities on cross-sectional imaging within 14 days of ERCP, while 39 (20.9%) had one or more imaging finding typically associated with acute pancreatitis. Among these, 22 (11.8%) had peri-pancreatic fluid collections and 2.1-9.6% of patients had pancreatic findings that included edema, enlargement, inflammation, or fat-stranding. On multivariable analysis, predictors of lipasemia >3x ULN included balloon sphincteroplasty (odds ratio, OR, 2.29, 95% confidence intervals, CI, 1.08 to 4.85) and the placement of a common bile duct stent (OR 4.19, 95% CI 1.37 to 12.77), whereas cannulation of the pancreatic duct or performance of a pancreatogram were not significantly associated (OR 0.75, 95% CI 0.24 to 2.35 and OR 1.07, 95% CI 0.18 to 6.26, respectively).

Conclusion(s)

Over 25% of patients will have asymptomatic elevations in pancreatic enzymes following ERCP, while over 20% will have asymptomatic cross-sectional imaging findings suggestive of pancreatic inflammation. Clinical symptoms should guide post-ERCP care rather than biochemical or imaging parameters.

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A115 THE PERFORMANCE OF NATURAL LANGUAGE PROCESSING IN INTERPRETING COLONOSCOPY REPORTS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Sabrie N , Jogendran R , Khan R , Scaffidi M , Gimpaya N , Lightfoot D , Grover S
Published: March 2023

Background

Screening colonoscopy is integral in the effort to identify and remove potentially cancerous lesions. Important quality indicators include the adenoma detection rate and more recently, the sessile/serrated adenoma detection rate. Natural language processing (NLP) is a computer-based linguistic technique that leverages artificial intelligence to abstract meaningful information from text. This tool carries the potential to automate the task of analyzing large volumes of colonoscopy and pathology reports to generate data on key performance metrics.

Purpose

The aim of this study is to systematically review the available literature on the performance of NLP in identifying the presence of an adenoma or a sessile/serrated adenoma in colonoscopy reports.

Method

We performed a systematic review and meta-analysis according to PRISMA recommendations. A comprehensive literature query was conducted on MEDLINE, EMBASE, CINAHL, and CDSR, through July 2022. Studies were included if they evaluated the performance of NLP in extracting data from colonoscopy reports. Our primary outcome was the performance of NLP models in correctly identifying an adenoma reported in a colonoscopy report. Two authors independently screened studies and abstracted data using an a priori designed data collection form. We pooled the sensitivity and specificity of our primary outcome using a univariate analysis first, followed by a bivariate analysis. Using the open-source package ‘mada’ which is written in R, we generated a summary estimate and a summary receiver operating characteristic curve.

Result(s)

From the 1030 unique studies obtained from our literature search, 13 studies met the inclusion criteria. Eligible studies were used for our meta-analysis. In the univariate analysis, the pooled sensitivity and specificity for detecting an adenoma by the NLP systems was 0.978 (95% CI 0.938-0.992) and 0.997 (95% CI 0.984-0.999), respectively. Similarly, in univariate analysis, the pooled sensitivity and specificity for detecting a sessile/serrated adenoma by the NLP systems was 0.984 (95% CI 0.929-0.996) and 1.0 (95% CI 0.998-1.000), respectively. In the bivariate analysis, the summary estimates for the sensitivity and specificity of the NLP system in detecting an adenoma were 0.973 (95% CI 0.929-0.990) and 0.992 (95%CI 0.978-0.997) respectively. For detecting a sessile/serrated adenoma, the summary estimates for sensitivity and specificity were 0.964 (95% CI 0.895-0.988) and 0.998 (95% CI 0.995-0.999) respectively.

Conclusion(s)

NLP models have excellent performance in extracting quality metric data from colonoscopy reports. Based on the available literature, we suggest integration of NLP in quality improvement efforts in colonoscopy.

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Disclosure of Interest

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