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Introduction: Children and young people (CYP) with asthma can benefit from reduced exposure to indoor environmental allergens and triggers but may not consistently have avoidance strategies implemented. To inform future interventions to increase trigger and allergen avoidance and enhance asthma control, a greater understanding of the influences on avoidance behaviours is necessary. Methods: A systematic scoping review was selected to summarize evidence on what influences family uptake of indoor environmental asthma trigger avoidance strategies for CYP with asthma and identify research gaps. Primary studies of any design, including CYP (≤18 years) with asthma, and/or parent-carers, available in English and conducted since 1993, were eligible. Searches included nine databases, hand-searching reference lists and citation searching. Findings: Thirty-three articles were included and are summarized narratively due to heterogeneity. Influences appear complex and multifactorial and include barriers to strategy uptake, health beliefs and personal motivation. Research specifically related to family understanding of allergic sensitisation status and exposure risks, and how these may inform avoidance implementation is required. Patient and public involvement (PPI) was not reported in included articles, although two studies used participatory methods. Conclusion: There is limited research on family asthma trigger management, particularly what influences current management behaviours. Variation in families' ability to identify important triggers, understand exposure risk and consistently reduce exposures warrants further exploratory research to explain how families reach avoidance decisions, and what future interventions should aim to address. Further PPI-informed research to address such gaps, could enable theory-based, person-centred interventions to improve the uptake of asthma trigger remediation. Patient or Public Contribution: An asthma-specific PPI group contributed to the decision-making for the funding for the wider project this review sits within. The findings of this scoping review have informed the subsequent phases of the project, and this was discussed with PPI groups (both adult and CYP groups) when proposing the next phases of the project.

Koi herpesvirus (KHV) is the causative agent of a highly infectious and notifiable disease of Cyprinus carpio L. Serology has the potential to identify koi or carp that have been previously exposed to KHV and which may be possible carriers of the virus. In the present study, sera (n = 162) from groups of farmed koi carp, previously screened for KHV using a variety of molecular methods as part of a surveillance program in Asia from 2008 to 2010, were subsequently tested here individually by ELISA using plates coated with purified virus (American isolate KHV-I, H361). Only 31% of koi from PCR-positive KHV fish groups or populations associated with KHV disease (n = 59/162) were seropositive when screened in the ELISA at a serum dilution of 1/200, in contrast to 52.9% of seropositive koi that were KHV-negative by PCR (n = 103/162). Furthermore >34% of those seropositive/PCR negative fish had titres of >1/400 (moderate-strong responders). This field data highlights the concerns related to carp populations that have been screened for KHV using molecular methods alone and supports the need for serology to accompany molecular testing in carp for this notifiable virus.

Patrick M McCarthy,1 Matthew J Rendo,2 Matthew D Uy,3 Alexandra M Adams,1 Anne E O’Shea,1 Daniel William Nelson,4 Joshua L Fenderson,2 Katherine M Cebe,3 Robert W Krell,1 Guy T Clifton,1 George E Peoples,5 Timothy J Vreeland1 1Department of Surgery, Brooke Army Medical Center, San Antonio, TX, USA; 2Department of Hematology and Oncology, Brooke Army Medical Center, San Antonio, TX, USA; 3Department of Pathology, Brooke Army Medical Center, San Antonio, TX, USA; 4Department of Surgery, William Beaumont Army Medical Center, El Paso, TX, USA; 5Cancer Vaccine Development Program, San Antonio, TX, USACorrespondence: Patrick M McCarthyDepartment of Surgery, Brooke Army Medical Center, 3551 Roger Brooke Dr., San Antonio, TX, 78234, USATel +1 240 285-0930Fax +1 210 916-6658Email p.m.mccarthy.0@gmail.comAbstract: Pancreatic ductal adenocarcinoma (PDAC) remains deadly despite advances in systemic therapies and surgical techniques. While there is increasing utilization of immune therapies across diverse cancer types, PDAC remains generally resistant to these treatments. We report a case of locally advanced PDAC treated with preoperative radiation and anti-PD-1 immunotherapy guided by preoperative PD-L1 tumor analysis. After 4 months of preoperative therapy, the patient was submitted to resection, demonstrating a near-complete pathologic response on final tumor analysis. We will discuss the relevant literature and current state of immunotherapeutics for PDAC.Keywords: pancreatic cancer, pembrolizumab, complete response, PD-L1, locally advanced, immune checkpoint inhibitor

Aquaculture systems are highly complex, dynamic and interconnected systems influenced by environmental, biological, cultural, socio-economic and human behavioural factors. Intensification of aquaculture production is likely to drive indiscriminate use of antibiotics to treat or prevent disease and increase productivity, often to compensate for management and husbandry deficiencies. Surveillance or monitoring of antibiotic usage (ABU) and antibiotic resistance (ABR) is often lacking or absent. Consequently, there are knowledge gaps for the risk of ABR emergence and human exposure to ABR in these systems and the wider environment. The aim of this study was to use a systems-thinking approach to map two aquaculture systems in Vietnam – striped catfish and white-leg shrimp – to identify hotspots for emergence and selection of resistance, and human exposure to antibiotics and antibiotic-resistant bacteria. System mapping was conducted by stakeholders at an interdisciplinary workshop in Hanoi, Vietnam during January 2018, and the maps generated were refined until consensus. Thereafter, literature was reviewed to complement and cross-reference information and to validate the final maps. The maps and component interactions with the environment revealed the grow-out phase, where juveniles are cultured to harvest size, to be a key hotspot for emergence of ABR in both systems due to direct and indirect ABU, exposure to water contaminated with antibiotics and antibiotic-resistant bacteria, and duration of this stage. The pathways for human exposure to antibiotics and ABR were characterised as: occupational (on-farm and at different handling points along the value chain), through consumption (bacterial contamination and residues) and by environmental routes. By using systems thinking and mapping by stakeholders to identify hotspots we demonstrate the applicability of an integrated, interdisciplinary approach to characterising ABU in aquaculture. This work provides a foundation to quantify risks at different points, understand interactions between components, and identify stakeholders who can lead and implement change.

The ability of Flavobacterium psychrophilum to adhere to and form biofilms on different types of materials used on rainbow trout (Oncorhynchus mykiss) farms was evaluated in this study. F. psychrophilum NCIMB 1947T, was inoculated onto a variety of different surfaces, including stainless steel, plastic, glass, wood, and zinc pyrithione encapsulated antibacterial plastic. The samples were then cultured in a humidified chamber or transferred into fish tanks containing either (1) freshwater or (2) filtered lake water. The formation of biofilms was quantified by fluorescent microscopy. F. psychrophilum formed biofilms on all of the surfaces tested; however, the adherence of the bacterium to the antibacterial plastic was much lower than the attachment observed on the other surfaces, illustrating the bacteriostatic properties of this material for F. psychrophilum. Moreover, bacterial numbers were greater on the surfaces maintained in lake water compared with those maintained in freshwater. The mineral composition of the lake water may have been responsible for the increased bacterial adherence observed between the two types of water. Treatment of the water, regular cleaning of equipment and the use of antimicrobial material to house the fish may help reduce biofilm formation by F. psychrophilum in fish farming systems.

This chapter also summarized eight different fish diseases from saline water, viz. 1) Saltwater Streptococcosis (Streptococcus Dysgalactiae, Streptococcus Iniae, Streptococcus parauberis), 2) Nocardiosis, 3) Mycobacterial disease, 4) Pasteurellosis, 5) Vibriosis, 6) Tenacibaculosis, 7) Edwardsiellosis (Edwardsiella tarda), and 8) bacterial hemolytic jaundice. The characteristics of disease agent, and pathogenesis, histopathological interest, diagnostic method, chemotherapy and disease control were introduced., E-book edition, E-book: 978-1-78021-040-7, Print: 978-1-78021-540-2, Authors, keywords, contents, Summary [p. 190-191], 1. Saltwater streptococcosis / Terutoyo Yoshida [p. 191-213], 2. Nocardiosis / Masahiro Sakai [p. 213-217], 3. Mycobacterial disease / Kim D. Thompson and Alexandra Adams [p. 217-221], 4. Pasteurellosis / Tae-Sung Jung and Takashi Aoki [p. 221-229], 5. Vibriosis / Yukinori Takahashi and Jun-ichi Hikima [p. 229-238], 6. Tenacibaculosis / Hisatsugu Wakabayashi [p. 239-244], 7. Edwardsiellosis (edwardsiella tarda) / Tomokazu Takano [p. 245-251], 8. Bacterial hemolytic jaundice / Takaji Iida [p. 251-254], Bibliography, biographical sketches [p. 254-277]

BACKGROUND/OBJECTIVES: Sleep has emerged as a potentially modifiable risk factor for obesity in children. The purpose of this investigation was to evaluate the association between overnight sleep duration and obesity among American Indian (AI) children ages 2–5 years. METHODS: Data were examined from the baseline assessment of children enrolling in the Healthy Children, Strong Families (HCSF2) study, which is a randomized lifestyle intervention trial in 5 diverse rural and urban AI communities nationally among children ages 2–5 years. Multivariable models were built to assess the relationship between sleep duration and BMI z-score while controlling for potential sociodemographic and behavioral covariates. RESULTS: Three-hundred and ninety-eight children had sufficient data to be included in analysis. In multivariable models controlling for potential covariates, overnight sleep duration was significantly and inversely associated with BMI z-score (B=−0.158, t=−1.774, p=0.006). Similarly, when controlling for covariates, children who slept 12 or more hours had significantly lower BMI z-scores compared to those who slept 8 to 10 hours (p=0.018) or less than 8 hours (p=0.035); the difference between 12+ hours and 10–12 hour groups did not reach statistical significance (p=0.073) but supported a linear relationship between overnight sleep duration and BMI. Weekday to weekend variability in overnight sleep duration was not associated with BMI z-score (B=0.010, t=0.206, p=0.837). CONCLUSIONS: Overnight sleep duration is independently and inversely related to BMI z-score among AI children ages 2–5 years, even when controlling for important sociodemographic and obesogenic lifestyle factors. This represents the first report, to our knowledge, of sleep duration as a risk factor for obesity among AI children.