bluuebunny/crossref_metadata_2025 huggingface dataset:
Cellular Stoichiometry of Chemotaxis Proteins in Sinorhizobium meliloti
Authors: Arapov Timofey D. , Saldaña Rafael Castañeda , Sebastian Amanda L. , Ray W. Keith , Helm Richard F. , Scharf Birgit E.
Published: May 2020

Chemotaxis systems enable microbes to sense their immediate environment, moving toward beneficial stimuli and away from those that are harmful. In an effort to better understand the chemotaxis system of Sinorhizobium meliloti, a symbiont of the legume alfalfa, the cellular stoichiometries of all ten chemotaxis proteins in S. meliloti were determined. A combination of quantitative immunoblot and mass spectrometry revealed that the protein stoichiometries in S. meliloti varied greatly from those in Escherichia coli and Bacillus subtilis. To compare protein ratios to other systems, values were normalized to the central kinase CheA. All S. meliloti chemotaxis proteins exhibited increased ratios to various degrees. The 10-fold higher molar ratio of adaptor proteins CheW1 and CheW2 to CheA might result in the formation of rings in the chemotaxis array that consist of only CheW instead of CheA and CheW in a 1:1 ratio. We hypothesize that the higher ratio of CheA to the main response regulator CheY2 is a consequence of the speed-variable motor in S. meliloti, instead of a switch-type motor. Similarly, proteins involved in signal termination are far more abundant in S. meliloti, which utilizes a phosphate sink mechanism based on CheA retrophosphorylation to inactivate the motor response regulator versus CheZ-catalyzed dephosphorylation as in E. coli and B. subtilis. Finally, the abundance of CheB and CheR, which regulate chemoreceptor methylation, was increased compared to CheA, indicative of variations in the adaptation system of S. meliloti. Collectively, these results mark significant differences in the composition of bacterial chemotaxis systems.

IMPORTANCE The symbiotic soil bacterium Sinorhizobium meliloti contributes greatly to host-plant growth by fixing atmospheric nitrogen. The provision of nitrogen as ammonium by S. meliloti leads to increased biomass production of its legume host alfalfa and diminishes the use of environmentally harmful chemical fertilizers. To better understand the role of chemotaxis in host-microbe interaction, a comprehensive catalogue of the bacterial chemotaxis system is vital, including its composition, function, and regulation. The stoichiometry of chemotaxis proteins in S. meliloti has very few similarities to the systems in Escherichia coli and Bacillus subtilis. In addition, total amounts of proteins are significantly lower. S. meliloti exhibits a chemotaxis system distinct from known models by incorporating new proteins as exemplified by the phosphate sink mechanism.
CSF studies which ultimately led to the possible diagnosis of anti-NMDAR encephalitis
Authors: Roberts Caroline , McEachern Morgan , Mounsey Anne
Published: May 2020

A 17-year-old man with no significant medical history presented with new-onset seizure activity and altered mental status manifesting as bizarre behaviour, which included rapid pressured and tangential speech, psychomotor agitation, insomnia and delusions. He also had autonomic dysregulation, manifested in labile blood pressures. He had been recently discharged from his first psychiatric hospitalisation. Many studies were performed, including electroencephalogram (EEG), head CT, laboratory work, urine drug screen and lumbar puncture with cerebral spinal fluid studies, which ultimately led to the diagnosis of anti-N-methyl-D-aspartate receptor (NMDAR) autoimmune encephalitis. He was treated with five rounds of plasmapheresis with complete resolution of his altered mental status. This case highlights the importance of being familiar with the presentation of anti-NMDAR autoimmune encephalitis, especially in cases of new-onset mental status changes with psychotic like symptoms, seizure-like activity and autonomic dysregulation as early detection and treatment improves chances of good prognosis with return to baseline cognitive function.
Outcome measurement in speech and language therapy: a digital journey
Authors: Moyse Kathryn , Enderby Pamela , Chadd Katie , Gadhok Kamini , Bedwell Mark , Guest Patrick
Published: May 2020

Background

Evidencing the impact of speech and language therapy interventions is challenging. The UK’s professional body for speech and language therapists (SLTs) is supporting a consistent approach to outcome measurement and analysis using Therapy Outcome Measures (TOMs).

Objective

To develop a digital solution for collecting TOMs data, evaluate the impact of therapeutic interventions and explore contributing factors to outcome variation across clinical areas.

Method

Agile methodology was applied to software development. Organisations were recruited to provide data. Criteria were identified to exemplify outcome variability.

Results

A digital tool was developed. 21 organisations provided data on 16 356 individuals. Improvement in at least one domain of TOMs occurred in 77.1% of instances. Data for two clinical areas exemplify the tool’s effectiveness in highlighting the impact of speech and language therapy.

Conclusion

This established outcomes data set can be used to evaluate the impact of speech and language therapy, and explore variation in outcomes.
Estimation of the prevalence of depression using diagnostic instruments in the elderly population in India, 2000–2019: a systematic review protocol
Authors: Behera Priyamadhaba , Pilania Manju , Yadav Vikas , Bairwa Mohan , Dabar Deepti , Behera Surama Manjari , Poongothai Subramani , Mohan Viswanathan , Gupta Shiv Dutt
Published: May 2020

Introduction

Depression is a common mental disorder in the elderly population, which significantly impacts their quality of life. However, correct estimates of its magnitude are not available in the elderly in India. The present systematic review and meta-analysis would attempt to estimate the prevalence of depression using diagnostic instruments among elderly persons aged 60 years and above.

Methods and analysis

Searches will be performed in PubMed, Scopus, Embase, Web of Science, CINAHL and PsycINFO. Community-based cross-sectional and cohort studies (2001 to September 2019) reporting the prevalence of depression in the elderly, using diagnostic instruments will be included. Studies conducted among chronic disease patients, in-hospital patients and special groups such as with disaster-stricken populations, and studies reporting the only one or two subcategories of depression, will be excluded. Disagreements in study selection and data abstraction will be resolved by consensus and arbitration by a third reviewer. AXIS critical appraisal tool will be used for quality assessment of individual studies. Findings of eligible studies will be pooled using fixed-effects or random-effects meta-analysis whichever is appropriate. Heterogeneity between studies will be examined by Cochran’s Q test and quantified by I² statistic. A cumulative meta-analysis will be used to detect temporal trends in the prevalence of depression and the effect of poor-quality studies on the pooled estimate. Publication bias will be assessed by visual inspection of funnel plots and the Egger test.

Ethics and dissemination

No ethical approval will be needed because it will be a systematic review. Data from previously published studies will be retrieved and analysed. Findings will be disseminated through a peer-reviewed publication in a scientific journal and conferences.

PROSPERO registration number

CRD42019138453.
Cow’s Milk Fat Obesity pRevention Trial (CoMFORT): a primary care embedded randomised controlled trial protocol to determine the effect of cow’s milk fat on child adiposity
Authors: Vanderhout Shelley M , Aglipay Mary , Birken Catherine , Li Patricia , O'Connor Deborah L , Thorpe Kevin , Constantin Evelyn , Davis Marie-Adele , Feldman Mark , Ball Geoff D C , Janus Magdalena , Jüni Peter , Junker Anne , Laupacis Andreas , L'Abbé Mary , Manson Heather , Moretti Myla E , Persaud Nav , Omand Jessica A , Relton Clare , Wong Peter , Yamashiro Hirotaka , Tavares Erika , Weir Shannon , Maguire Jonathon L
Published: May 2020

Introduction

Cow’s milk is a dietary staple for children in North America. Though clinical guidelines suggest children transition from whole (3.25% fat) milk to reduced (1% or 2%) fat milk at age 2 years, recent epidemiological evidence supports a link between whole milk consumption and lower adiposity in children. The purpose of this trial is to determine which milk fat recommendation minimises excess adiposity and optimises child nutrition and growth.

Methods and analysis

Cow’s Milk Fat Obesity pRevention Trial will be a pragmatic, superiority, parallel group randomised controlled trial involving children receiving routine healthcare aged 2 to 4–5 years who are participating in the TARGet Kids! practice-based research network in Toronto, Canada. Children (n=534) will be randomised to receive one of two interventions: (1) a recommendation to consume whole milk or (2) a recommendation to consume reduced (1%) fat milk. The primary outcome is adiposity measured by body mass index z-score and waist circumference z-score; secondary outcomes will be cognitive development (using the Ages and Stages Questionnaire), vitamin D stores, cardiometabolic health (glucose, high-sensitivity C-reactive protein, non-high density lipoprotein (non-HDL), low density lipoprotein (LDL), triglyceride, HDL and total cholesterol, insulin and diastolic and systolic blood pressure), sugary beverage and total energy intake (measured by 24 hours dietary recall) and cost effectiveness. Outcomes will be measured 24 months postrandomisation and compared using analysis of covariance (ANCOVA), adjusting for baseline measures.

Ethics and dissemination

Ethics approval has been obtained from Unity Health Toronto and The Hospital for Sick Children. Results will be presented locally, nationally and internationally and published in a peer-reviewed journal. The findings may be helpful to nutrition guidelines for children in effort to reduce childhood obesity using a simple, inexpensive and scalable cow’s milk fat intervention.

Trial registration number

NCT03914807; pre-results.
Randomised controlled trial to compare the diagnostic yield of positron emission tomography CT (PET-CT) TARGETed pleural biopsy versus CT-guided pleural biopsy in suspected pleural malignancy (TARGET trial)
Authors: de Fonseka Duneesha , Underwood Wendy , Stadon Louise , Rahman Najib , Edey Anthony , Rogers Chris , Maskell Nick A
Published: May 2020

Introduction

Pleural malignancy, particularly malignant pleural mesothelioma (MPM) is increasing in incidence due to the long latency period from exposure to asbestos to development of the disease. MPM can be challenging to diagnose. For patients presenting without a pleural effusion, CT-guided biopsy remains the primary choice of biopsy, but the diagnostic sensitivity of this investigation is 70%–75%. Therefore, a proportion of patients will go on to require further biopsies. If the first biopsy is non-diagnostic, the chances of further non-diagnostic biopsies are high in MPM.

Methods

Target is a multicentre randomised controlled trial, aiming to recruit 78 patients over a 30-month period, from 10 centres in the UK. Patients will be randomised to either the standard arm which is a second CT-guided biopsy, or the interventional arm, a positron emission tomography-CT scan followed by a targeted CT-guided biopsy. Patients will be followed up for 12 months (patients recruited in the last 6 months of recruitment will have 6 months of follow-up). MPM biomarker mesothelin will be checked at baseline, 6 month and 12 month follow-up appointments where patients are able to attend these appointments.

Ethics and dissemination

Ethical approval for this trial was granted by the South West—Exeter research and ethics committee (reference number 15/SW/0156). Results of the trial will be published in a peer-reviewed journal and presented at an international conference.

Trial registration number

ISRCTN14024829; Pre-results.
Effect of sports massage on performance and recovery: a systematic review and meta-analysis
Authors: Davis Holly Louisa , Alabed Samer , Chico Timothy James Ainsley
Published: May 2020

Objective

Massage is ubiquitous in elite sport and increasingly common at amateur level but the evidence base for this intervention has not been reviewed systematically. We therefore performed a systematic review and meta-analysis examining the effect of massage on measures of sporting performance and recovery.

Design and eligibility

We searched PubMed, MEDLINE and Cochrane to identify randomised studies that tested the effect of manual massage on measures of sporting performance and/or recovery. We performed separate meta-analyses on the endpoints of; strength, jump, sprint, endurance, flexibility, fatigue and delayed onset muscle soreness (DOMS).

Results

We identified 29 eligible studies recruiting 1012 participants, representing the largest examination of the effects of massage. We found no evidence that massage improves measures of strength, jump, sprint, endurance or fatigue, but massage was associated with small but statistically significant improvements in flexibility and DOMS.

Conclusion

Although our study finds no evidence that sports massage improves performance directly, it may somewhat improve flexibility and DOMS. Our findings help guide the coach and athlete about the benefits of massage and inform decisions about incorporating this into training and competition.
Standards for the provision of antenatal care for patients with inflammatory bowel disease: guidance endorsed by the British Society of Gastroenterology and the British Maternal and Fetal Medicine Society
Authors: Selinger Christian , Carey Nicola , Cassere Shelley , Nelson-Piercy Catherine , Fraser Aileen , Hall Veronica , Harding Kate , Limdi Jimmy , Smith Lyn , Smith Marie , Gunn Melanie Catherine , Mohan Aarthi , Mulgabal Khasia , Kent Alexandra , Kok Klaartje Bel , Glanville Tracey
Published: May 2020

Background

Pregnant women with inflammatory bowel disease (IBD) are at increased risk of adverse pregnancy outcomes. Comprehensive guidelines on medical management have been published; yet, there is limited guidance on service set-up and minimum standards of care for pregnant women with IBD.

Aim

To develop a position statement on service set-up and minimum standards of care in the UK.

Methods

A working group consisting of 16 gastroenterologists, obstetricians, obstetric physician, IBD specialist nurses and midwives was assembled. Initial draft statements were produced and a modified Delphi process with two rounds of voting applied. Statements were modified according to voters’ feedback after each round. Statements with ≥80% agreement were accepted.

Results

All 15 statements met criteria for inclusion. To facilitate optimal care, regular and effective communication between IBD and obstetric teams is required. There should be nominated link clinicians for IBD in obstetric units and for pregnancy in IBD units. Preconception counselling should be available for all women with IBD. All pregnant women should be advised on the safety of IBD medication during pregnancy and breast feeding, the optimal mode of delivery, the management of biologics (where applicable) and safety of childhood vaccinations. Regular audit of pregnancy outcomes and documentation of advice given is recommended.

Conclusion

Position statements have been developed that advise on the importance of joined-up multidisciplinary care, proactive decision-making with clear documentation and communication to the woman and other healthcare practitioners.
Association of lipoprotein(a) levels with recurrent events in patients with coronary artery disease
Authors: Liu Hui-Hui , Cao Ye-Xuan , Jin Jing-Lu , Zhang Hui-Wen , Hua Qi , Li Yan-Fang , Guo Yuan-Lin , Zhu Cheng-Gang , Wu Na-Qiong , Gao Ying , Xu Rui-Xia , Hong Li-Feng , Li Jian-Jun
Published: May 2020

Objective

Whether lipoprotein(a) (Lp(a)) is a predictor for recurrent cardiovascular events (RCVEs) in patients with coronary artery disease (CAD) has not been established. This study, hence, aimed to examine the potential impact of Lp(a) on RCVEs in a real-world, large cohort of patients with the first cardiovascular event (CVE).

Methods

In this multicentre, prospective study, 7562 patients with angiography-diagnosed CAD who had experienced a first CVE were consecutively enrolled. Lp(a) concentrations of all subjects were measured at admission and the participants were categorised according to Lp(a) tertiles. All patients were followed-up for the occurrence of RCVEs including cardiovascular death, non-fatal myocardial infarction and stroke.

Results

During a mean follow-up of 61.45±19.57 months, 680 (9.0%) RCVEs occurred. The results showed that events group had significantly higher Lp(a) levels than non-events group (20.58 vs 14.95 mg/dL, p<0.001). Kaplan-Meier analysis indicated that Lp(a) tertile 2 (p=0.001) and tertile 3 (p<0.001) groups had significantly lower cumulative event-free survival rates compared with tertile 1 group. Moreover, multivariate Cox regression analysis further revealed that Lp(a) was independently associated with RCVEs risk (HR: 2.01, 95% CI: 1.44 to 2.80, p<0.001). Moreover, adding Lp(a) to the SMART risk score model led to a slight but significant improvement in C-statistic (∆C-statistic: 0.018 (95% CI: 0.011 to 0.034), p=0.002), net reclassification (6.8%, 95% CI: 0.5% to 10.9%, p=0.040) and integrated discrimination (0.3%, 95% CI: 0.1% to 0.7%, p<0.001).

Conclusions

Circulating Lp(a) concentration was indeed a useful predictor for the risk of RCVEs in real-world treated patients with CAD, providing additional information concerning the future clinical application of Lp(a).
Baseline ASPECTS and hypoperfusion intensity ratio influence the impact of first pass reperfusion on functional outcomes
Authors: Mohammaden Mahmoud H , Haussen Diogo C , Pisani Leonardo , Al-Bayati Alhamza R , Perry da Camara Catarina , Bhatt Nirav , Belagaje Samir R , Liberato Bernardo Boaventura , Bianchi Nicolas , Anderson Aaron M , Frankel Michael R , Nogueira Raul G
Published: May 2020

Background

First pass reperfusion (FPR) has been established as a key performance metric in mechanical thrombectomy (MT). The impact of FPR may be more relevant in fast progressors. We aim to study the impact of baseline Alberta Stroke Program Early CT Score (ASPECTS) on non-contrast CT and hypoperfusion intensity ratio (HIR) on CT perfusion on clinical outcomes after FPR.

Methods

A prospective MT database was reviewed for patients with isolated occlusion of the intracranial internal carotid artery and/or middle cerebral artery M1 segment who underwent MT with complete reperfusion (modified Thrombolyis in Cerebral Infarction score 2c–3) from January 2012 to May 2019. The overall population was divided into ASPECTS >7 versus ≤7 and the subgroup of patients with baseline CT perfusion was divided into HIR <0.3 versus ≥0.3. Univariable and multivariable analyses were performed to establish the predictors of 90-day functional independence (modified Rankin Scale (mRS) ≤2) in each subgroup.

Results

A total of 436 patients were included in the analyses. FPR was achieved in 254 (58.3%) patients. ASPECTS modified the effect of FPR on clinical outcomes, with FPR predicting good outcomes in patients with ASPECTS ≤7 (46% vs 29%, adjusted OR 3.748; 95% CI 1.590 to 8.838, p=0.003) while no significant effect was detected in those with ASPECTS >7 (62.3% vs 53.1%, adjusted OR 1.372; 95% CI 0.798 to 2.358, p=0.25). Similarly, FPR predicted good outcomes in patients with HIR ≥0.3 (54.8% vs 41.9%, adjusted OR 2.204; 95% CI 1.148 to 4.233, p=0.01) but not in those with HIR <0.3 (62.9% vs 52.8%, adjusted OR 1.524; 95% CI 0.592 to 3.920, p=0.38).

Conclusions

The impact of FPR on functional outcomes is highly dependent on baseline imaging characteristics, with a more prominent influence in patients presenting with lower ASPECTS and/or higher HIR.
A rationale and framework for seeking remote electronic or phone consent approval in endovascular stroke trials – special relevance in the COVID-19 environment and beyond
Authors: Rai Ansaar T , Frei Donald
Published: May 2020

Background

Enrollment in time-sensitive endovascular stroke trials can be challenging because of an inability to consent a debilitated patient. Often the legally authorized representative is not on site. Remote consent procedures in the US are inconsistent with the majority of sites shunning these approaches. The current pandemic with visitor restrictions highlights the need for enhancing these options.

Methods

Remote electronic and phone consent procedures specifically for endovascular stroke trials from two comprehensive stroke centers (CSC) are presented. An overview of the genesis of informed consent procedures in the US is also included.

Results

The two CSCs identified as Institution-1 and Institution-2 are large tertiary systems. Institution-1 is a non-profit university-affiliated academic medical center in rural geography. Institution-2 is an HCA hospital in an urban environment. Both serve patients through a spoke-and-hub network, have participated in multiple randomized endovascular stroke trials, and have successfully used these remote options for enrollment. A tiered approach is employed at both institutions with an emphasis on obtaining informed consent in person and resorting to alternatives methods when efforts to that are unsuccessful. A rationale for electronic and phone consent is included, followed by step-by-step illustration of the process at each institution.

Conclusion

Two examples of remote electronic or phone consent procedures from institutions in different geographic environments and organization structures demonstrate that these options can be successfully used for enrollment in stroke trials. The current pandemic highlights the need to enhance these approaches while maintaining appropriate adherence to ethical and legal frameworks.
O1A.5 Emergent role of epigenetic biomarkers of pesticides exposure: a case study among women of childbearing age living in meknes (morocco)
Authors: Menouni Aziza , Duca Radu-Corneliu , Gosh Manosij , Zouine Noura , Lhilali Ilham , Jaafari Samir El , Godderis Lode
Published: May 2020

Pesticide exposure has been associated with acute and chronic adverse health effects. Current evidence supports that epigenetics may mediate these effects. DNA methylation (DNAm) is one of the broadly investigated epigenetic alteration. Therefore, to date, only limited human data is linking pesticide exposure to global DNAm alterations. Therefore, the aim of this study was to characterize pesticides exposure in women of reproductive age and investigate whether DNA methylation patterns were related to pesticides exposure level.

In a pilot study among 100 women from Meknes (Morocco), we measured 45 analytes (parent molecules and their metabolites) from three chemical families of pesticides: Organochlorines, organophosphates, pyrethroids, in urine and hair using HPLC/MS-MS and GC/MS. Commercial kits were used for quantification of 8-OHdG. We used LC/MS for measuring GSH. Pyrosequencing was used to measure Alu and LINE-1 methylation in DNA isolated from whole blood samples.

Pesticides are associated with genomic instability, which is proposed to be sensitive to nutritional intake and may also induce epigenetic changes. We evaluated the effect of life style and dietary intake on epigenetic instability in women. Our research prompts a re-thinking of the role of epigenetics on the understanding of the environmental exposure. We will then explore the role of epigenetic changes in the onset of cancer through the oxidative stress and DNA damage pathways.
O4C.6 ‘Healthy on the outside, sick on the inside’ -forestry workers, embodiment and biosociality
Authors: Lovelock Kirsten
Published: May 2020

Health outcomes for workers in forestry are shaped by a complex range of exposures, including exposures related to the work environment generated by the industry itself and within a natural environment. We understand how the worker experiences these exposures is shaped by a range of contextual factors including external factors such as market prices and legislation; employer specific factors (e.g. pace of work, provision of Personal Protective Equipment (PPE)); to task specific factors (e.g. repetition, worker control). And, health outcomes from these exposures can range from immediate to delayed, and in duration from acute to chronic. This paper draws on a qualitative research project conducted with forestry workers, their contractors and the CEOs of corporate forests in New Zealand and argues that we need to know more if we are to intervene effectively. Face to face interviews and focus groups were conducted with 100 participants at multiple sites throughout New Zealand (Northland, Gisborne, Central North Island, Hawkes Bay, Wanganui and Otago). This paper focuses specifically on the experiential aspects of being a forestry worker and contractor and how the concept of embodiment and bio-sociality is a useful means by which to understand how bodies are produced and reproduced through labour, how labour converts bodies into social entities and that the body is not exclusively in either the biological or social world, rather bodies are made, have social value and the sociality of bodies shapes altered biologies. These concepts allow us to understand why it is that workers self-describe and are described as being ‘healthy on the outside, sick on the inside’ or ‘fit on the outside, sick on the inside’ and to unpack how social groups form around biological identities marked by ill health or illness susceptibility.
O4D.1 Longitudinal analysis of incidence of beryllium sensitization in a us nuclear workforce
Authors: Golden Ashley , Dally Miranda , Miller Jeffery , Newman Lee , Cragle Donna
Published: May 2020

The goal of this study was to evaluate trends in incidence of beryllium sensitization (BeS) and the impact of exposure regulation in a US Department of Energy (DOE) nuclear worker cohort. The 1999 DOE final rule for Chronic Beryllium Disease Prevention Program was established to accomplish three goals: reduce the number of workers currently exposed to beryllium; minimize exposures and the potential for exposure; and establish medical surveillance requirements to ensure early detection of disease. While the impact of this rule has been evaluated through observational reports, with decreases in exposure and reported cases, there have been no published studies assessing whether exposure reduction measures result in the prevention of BeS.

Methods

We examined the incidence of beryllium sensitization in a cohort of 6915 workers with almost 29,000 BeLPT results obtained between 1994–2018. All workers were employed at a single DOE nuclear site that implemented the DOE beryllium rule between 1999–2002. Workers were classified as BeS when they met one of the following definitions: two abnormal blood BeLPT results, one abnormal and one borderline blood BeLPT result, three borderline blood BeLPT results, or one abnormal lung lavage BeLPT result. Descriptive statistics, longitudinal analyses, and correlation analyses were utilized to evaluate the trends in incidence before and after implementation of the beryllium rule.

Results

Results indicated a general decrease in exposure and BeS incidence rates, though there are some years with notable increases presumably due to increased clean-up activity, where construction and decommissioning workers had opportunity for exposure from legacy beryllium operation materials that were not part of normal current production activity.

Conclusion

These findings provide support for the hypothesis that the DOE Beryllium Rule helps prevent beryllium sensitization. Future research will more precisely assess the relationship between beryllium exposure levels and beryllium incidence over time.
O4D.4 Changes in kidney function among sugarcane cutters on a moderately hot sugar plantation in south africa
Authors: Magombo Mollen , Barregard Lars , Kgalamono Spo , George Jaya , Naicker Saraladevi , Dorkin Elton , Made Felix , Rees David
Published: May 2020

Introduction

Epidemic chronic kidney disease of unknown cause (CKDu) occurs among sugar cane workers, notably cane cutters doing heavy manual work in hot tropical environments in Mesoamerica. Repetitive dehydration consequent on strenuous work in heat is posited as the cause. A Nicaraguan cohort study showed remarkable kidney function decreases across six weeks of the cane cutting season consistent with the dehydration hypothesis. This Nicaraguan study was replicated on a sugar plantation in South Africa about 3 500 kms from the equator and cooler than previous study locations to examine whether less extreme ambient conditions resulted in reduced kidney stress.

Methods

38 cane cutters and 36 referents of similar socio-economic status but doing less strenuous work on the same plantations provided pre- and post-shift blood and urine samples for measures of kidney function and hydration on Day 1 and Week 9 of the cutting season. Frozen specimens were transported to a chemical pathology laboratory in Johannesburg for analysis. Parameters measured included cystatin C, eGFR (derived from cystatin C), serum creatinine, serum neutrophil gelatinase-associated lipocalin (NGAL), serum uric acid and osmolality.

Results

Minimum and maximum temperatures were 20.9 and 26.5o C on Day 1 and 13.6 and 26.6 o C on Week 9. There were clinically modest, albeit statistically significant, increases in mean cystatin C pre-shift values between Day 1 and Week 9 in the cane cutters: 0.847 to 1.011 mg/L (p=0.00) which means a considerable decline in eGFR. Other results were not consistent among the various markers of effect on the kidneys. The magnitude of the increase in cystatin C among referents was similar to the cutters: 0.771 to 0.904 mg/L.

Conclusions

Kidney function markers seemed to be much less affected in the cooler study location than in the hotter one.
O4E.1 Cross-walking countries’ industry classifications using concordance files compared to fuzzy data matching, to utilise an international exposure dataset
Authors: Selvaraj Ganesh , Butchard Michael
Published: May 2020

Background

Carcinogen exposure data can potentially guide the work of health and safety (H and S) regulators. This project aims to use CAREX Canada data to estimate carcinogen exposures in New Zealand industries. This requires the creation of a cross-walk between the countries’ industry classifications.

Methods

Agile and big-data-science methodologies were used to construct two versions of an industry classification cross-walk from the 2006 Australian and New Zealand Standard Industrial Classification (ANZSIC06) to the Canadian version of the 2002 North American Industrial Classification (NAICS2002), used by CAREX Canada.

Firstly, concordance files from government statistics bureaus cross-walked the path: ANZSIC06 ->International Standard Industrial Classification of All Economic Activities Rev4 ->NAICS2017->NAICS2012->NAICS2007->NAICS2002. The cross-walk accounted for ‘one-to-many-to-one’, non-machine formats, and missing/erroneous values.

Secondly, a fuzzy data matching pipeline was designed. Data preparation removed redundant, stop, and common domain words, and lemmatised using morphological analysis (e.g. fishing to fish). Data matching used a hybrid algorithm combining ‘JaroWinkler-distance’ and a token-sort approach (i.e. ignoring the positional occurrence of words in a sentence) to match descriptions. A trial-and-error approach was used to assign weightings and concatenate the hierarchical industry classification levels to improve match accuracy. Python language was used for implementation.

For each method, random samples of 50 matches were manually classified as either poor or sufficient by two people. Disagreements were discussed and consensus reached.

Results

The concordance cross-walk sample had 52% (95% C.I. 38%–66%) sufficient matches compared to 84% (95% C.I. 74%–94%) for the fuzzy data matching pipeline cross-walk sample.

Conclusions

Cross-walking countries’ industry classifications using a fuzzy data matching pipeline was more accurate than using a concordance cross-walk. The pipeline is modular enough to easily include more components. This work is part of a vision to design a semantic big-data lake, enabling integration of any data relevant to H and S.
O1A.6 The carcinogenicity of pesticides used in new zealand
Authors: Mannetje Andrea ‘t
Published: May 2020

Introduction

Yearly over 3000 tonnes of pesticide active ingredients are applied in New Zealand agriculture. Since the 1980’s, epidemiological studies have reported increased risks of lymphopoietic cancers in agricultural sectors with high pesticide use. Here we aim to estimate the number and total volume of currently used pesticides in New Zealand that are known or suspected human carcinogens, in order to inform interventions.

Methods

For each of the pesticide active ingredients most commonly used in New Zealand, the carcinogenicity classification of three regulatory agencies (The New Zealand Environmental Protection Authority [NZ-EPA], the US Environmental Protection Agency [US-EPA], and the European Chemicals Agency [EU]) were extracted, as well as the classification of the International Agency for Research on Cancer (IARC) Monograph Programme. Total tonnes of active ingredients that are known or suspected human carcinogens was calculated for each classification.

Results

None of the pesticides used in New Zealand are classified as known human carcinogens by any of the three regulatory agencies or IARC. Annually New Zealand uses 148–756 tonnes of active pesticide ingredients that are classified as suspected human carcinogens by the three regulatory agencies. If also including the pesticides classified by IARC as possible or probable human carcinogens, the upper estimate doubles to 1475 tonnes, representing half of the total volume of pesticide active ingredients used in New Zealand agriculture. The percentage and volume of active ingredients classified as suspected carcinogens by the three regulatory agencies was highest for the fungicides (8%–60%; 72–540 tonnes), followed by herbicides (3%–10%; 60–200 tonnes), and insecticides (8%, 16 tonnes).

Conclusions

Although no known human carcinogens are used as pesticides, New Zealand’s high use of pesticides that are suspected carcinogens requires a greater awareness of the presence of potential carcinogens in the agricultural sector and the development of an intervention strategy to reduce cancer risk.
O5A.4 Overexertion related age-specific wmsds claims among construction workers in ohio, USA: 2007–2013
Authors: Kaur Harpriya , Lampl Mike , Grosch James , Wurzelbacher Steven , Tseng Chih-Yu , Bushnell Tim , Scholl Juliann , Meyers Alysha , Ortiz Bermang
Published: May 2020

Background

As the proportion of older workers in the U.S. increases, understanding the health and safety needs of an aging workforce is critical, especially in the hazardous and physically demanding construction industry. According to the Bureau of Labor Statistics (BLS), in 2016 the rate of work-related musculoskeletal disorders (WMSDs) in construction was 32.7 per 10 000 full-time equivalent workers, which was 11% higher than the rate for all industries combined. The objective of this study was to examine the rate and cost of WMSDs due to overexertion, the leading cause of WMSDs, among construction workers by age group in Ohio using workers’ compensation claims.

Methods

Overexertion related WMSDs allowed claims, submitted to Ohio Bureau of Worker’s Compensation (OBWC) by workers in the construction industry for injuries occurring from 2007–2013 were analyzed to compute rates of allowed claims and claim costs by age group. The American Community Survey of the U.S. Census Bureau was used to determine the proportion of construction workers in each age group in Ohio. For this study, age was categorized as 14–24, 25–34, 35–44, 45–54 and ≥55 years old.

Results

There were 7434 overexertion related WMSD claims accepted by OBWC for construction workers who were injured due to overexertion in 2007–2013. Workers 35–44 years old experienced the highest claim rate of 7.28 per 1000 for WMSDs due to overexertion. However, the highest mean medical compensation cost for WMSD claims due to overexertion was for construction workers 55 years and older.

Conclusion

Overexertion-related WMSD claims appear to rise and then fall with age (≥55). There is a need to understand how aging interacts with WMSDs risk factors. Age-specific interventions to reduce WMSDs may help to retain older and skilled workers whose knowledge and experience might otherwise be lost when workers need to leave work because of debilitating WMSDs.
O5C.2 Long term physical and mental health impact of military service
Authors: Sim Malcolm , Xie Jing , Forbes Andrew , Kelsall Helen
Published: May 2020

Background

There is emerging recognition of the important co-morbidities and long term relationships between physical and psychological health in military and veteran populations. The aim was to investigate the longitudinal relationships between multisymptom illness (MSI) and psychological disorders.

Methods

A cohort of 1990–1991 Gulf War veterans and military comparison group was assessed at Wave 1 (2000–2002) and Wave 2 (2011–2012), including military service characteristics, symptoms, modified Centers for Disease Control (CDC) definition of MSI, the posttraumatic stress disorder (PTSD) Checklist (PCL), and Alcohol Use Disorder Identification Test (AUDIT). The Composite International Diagnostic Interview (CIDI v.2.1) assessed psychological disorders using DSM-IV criteria. Incident cases were defined as participants who did not meet criteria for a health outcome at Wave 1 but met these criteria at Wave 2.

Results

Overall participation at Wave 2 was 1390/2779 (50.0%); 99.8% completed a health questionnaire including 1356 male participants who were included in these analyses. The adjusted incident rate ratio (IRR) of MSI at Wave 2 was higher for those with, compared to those without, CIDI-defined PTSD IRR 3.3 (95% CI 1.8–6.0), major depression 2.1 (1.3–3.5) and alcohol disorder 1.8 (1.0–3.3) at Wave 1. The adjusted IRR of incident CIDI-defined PTSD 3.7 (2.2–6.3) major depression 2.0 (1.2–3.2) and AUD 2.1 (1.1–3.8) at Wave 2 were increased for those with, compared to those without, MSI at Wave 1.

Conclusions

Longitudinally, psychological disorders, in particular PTSD and depression, were found to be a risk factor for the development of MSI and the presence of MSI was a risk factor for the development of psychological disorders, in particular PTSD and depression. These findings have important implications for clinical and occupational health practice, service provision and longer term health in military and veteran populations.
O5C.5 Sarin exposures in a cohort of british military participants in human experimental research at porton down 1945–1987
Authors: Keegan Thomas J , Carpenter Lucy M , Brooks Claire , Langdon Toby , Venables Katherine M
Published: May 2020

Background

The effects of exposure to chemical warfare agents in humans are topical. Porton Down, near Salisbury, is the UK’s centre for research on chemical warfare. Since WWI, a programme of experiments involving approximately 30 000 participants drawn from the UK armed services has been undertaken there.

Objectives

Our aim is to report on exposures to nerve agents, particularly sarin, using detailed exposure data in a cohort of servicemen who attended Porton Down.

Methods

We have used existing data on exposures to UK servicemen who attended the human volunteer programme at Porton Down to examine exposures to nerve agents in general and to sarin in particular.

Results

Six principal nerve agents were tested on humans, all between 1945 and 1987. Of the 4299 nerve agent tests recorded, 3511 (82%) were with sarin, most commonly in an exposure chamber, with inhalation being the commonest exposure route (85%). Biological response to sarin exposure was expressed as percentage change in cholinesterase activity and, less commonly, change in pupil size. For inhalation tests, assessed by changes in red blood cell cholinesterase median inhibition for was 41% (IQR 24%–51%), with a maximum of 87%. For dermal exposures, assessed by changes in unspecified cholinesterase, median inhibition was 22% (IQR 10%–37%), with a maximum inhibition of 99%. There was a clear association between increasing exposure to sarin and depression of cholinesterase activity but the strength f the association varied by exposure route and the presence of chemical or physical protection. Pupil size decreased with increased exposure but this relationship was less apparent when protection was present.

Conclusions

These results, drawn from high quality experimental data, offer a unique insight into the effects of these chemical agents on humans.

Acknowledgement

We thank Nicola Fear and Gemma Archer, our collaborators in new work on these data, for their input.
O6A.1 Aggregation of work-related health problems throughout working-life in a population-based sample of women
Authors: Amaro Joana , Monjardino Teresa , Lucas Raquel , Ubalde-Lopez Mònica , Barros Henrique
Published: May 2020

Introduction

Multimorbidity potentiates a spectrum of adverse health outcomes that surpass those of individual diseases. However, little is known on disease aggregation related to occupational exposures.

Objective

To assess the impact of life course occupational experience on health problem aggregation.

Methods

We evaluated 4330 adult women at the 10-year-old follow-up wave of the population-based birth cohort Generation XXI, using a self-administered version of the Labour Force Survey item inquiring whether they had ever had a ‘physical or mental health problem that was caused or made worse by your current work or any previous work’ with 11 close-ended and one open-ended response options. Disease aggregation was assessed using principal components (PC) analysis and component scores were summarized by sociodemographic, anthropometric and work-related characteristics.

Results

We identified five components to describe disease aggregation which accounted for 54.7% of observed variance. PC1 gathered all items on musculoskeletal disorders (back, upper and lower limb); participants with lower educational level, higher BMI, blue-collar jobs, working in the private sector, and with a history of occupational accidents scored higher in this component. PC2 gathered the item on mental disorders (including anxiety and depression) together with headache and/or eyestrain, and showed higher scores among women with higher educational level, white-collar jobs, and in the public sector. PC3 included the item on other disorders (comprising neurological, endocrine, autoimmune and voice-related) with some loading from digestive and hearing disorders, and showed higher scores in older and blue-collar workers. PC4 grouped respiratory with infectious diseases; it associated with working in the public sector and reporting work-related accident history. PC5 was composed by circulatory system conditions and associated with former smoking, higher BMI, and white-collar jobs.

Conclusion

Work-related diseases aggregated in five distinct components, supporting the need for a shift from a disease-by-disease approach towards a worker-centered approach.
O6B.6 Occupational radiation exposure and the risk of cancer and cardiovascular diseases among medical radiation workers
Authors: Lee Won Jin , Cha Eun Shil , Ko Seulki
Published: May 2020

Background

Medical radiation workers occupy the largest group of radiation workers and the numbers are rapidly increasing worldwide. This presentation purposes to report findings from the Korean medical radiation workers’ study.

Methods

Data on all diagnostic medical radiation workers enrolled at the national dose registry between 1996 and 2011 (n=94,396) were merged with the death and cancer incidence data with coverage through the end of 2015. We reconstructed historical radiation doses and estimated organ-specific doses for all workers. The cancer risks were calculated using standardized mortality ratios (SMRs), standardized incidence ratios (SIRs), excess relative risk (ERR), and lifetime attributable risk (LAR). For radiologic technologists (n=12,906), we conducted a survey and merged the data with the national health insurance data of 2006–2016 for investigation of non-cancer diseases.

Results

The mean cumulative badge doses for all workers were 10.6 mSv (men) and 2.7 mSv (women). Medical radiation workers have more favorable mortality than in general population for all causes of death among men (SMR=0.45) and women (SMR=0.49). Based on 2192 of primary cancer cases, the SIR for all cancers significantly decreased in men (SIR=0.88) and increased in women (SIR=1.10). However, there were no significant ERRs of all cancer incidences in both men and women. LARs for all cancer combined ranged from 9 to 402 per 1 00 000 varied by sex and job title. Among radiologic technologists, the odds ratios for cardiovascular diseases showed a significant increasing trend with colon doses (trend p=0.024) after adjusting for potential risk factors.

Conclusions

Our findings provide some evidence of occupation radiation exposure and its health effects among medical radiation workers. The risks were generally small but not acceptable at high risk groups. Continuous monitoring and further follow-up is warranted to optimize the work practices for the protection of potential health risks in medical radiation workers.
O1B.5 Infertility in a cohort of male danish firefighters
Authors: Hansen Johnni , Petersen Kajsa , Bonde Jens Peter , Ebbehøj Niels
Published: May 2020

Introduction

Firefighters are exposed to many hazardous agents, including heat, stress, nightwork and chemicals, which may have negative impact on their fertility. Despite this, there is a lack of epidemiologic studies in the field. We aimed to examine infertility among male Danish firefighters.

Methods

We established a cohort of 4710 male Danish firefighters born from 1964 to 1992 based on historical records from employers and trade unions. The firefighter’s unique personal identification number, applied to all residents in Denmark, was used as a key identifier for linkage of information from nationwide registers. Information on vital status and female partners was obtained from the Danish Civil Registration System. Information on diagnoses of, conditions related to and treatments for infertility was retrieved from theIn VitroFertilisation (IVF) Register and the National Patient Register (NPR). Hazard ratios and their 95% confidence intervals for both male factor and overall infertility were estimated through cox regression analyses comparing the firefighters to two reference groups: a) a random sample of employees and b) military employed men.

Results

Among the full time firefighters (n=1,253), male factor infertility was significantly increased compared to the sample of employees (IVF model HR=1.5, 95% CI 1.1–1.9 and NPR model HR=1.5, 95% CI 1.2–2.). Results were less consistent using the military employees as reference. Further, the increase in infertility seemed restricted to the time employed as firefighter and, thus disappeared when the men quit firefighting. No increase in risk of either male factor or overall infertility was seen among the part time/volunteer firefighters (n=3,497).

Conclusion

Full time firefighting was associated with an increased risk of being diagnosed with male factor infertility. This was not the case for part time firefighters. The increased risk seemed confined to actual firefighting time, indicating an occupational association,