Search

Background/Aims In long-term conditions like rheumatic diseases, medical interventions are estimated to account for only 10-20% of the factors that impact on health outcomes. Social determinants of health and health-related behaviours account for 80-90%. While our department has a long history of embedding patient and public involvement and engagement (PPIE) in research, it is still a relatively new way of working in health service improvement. PPIE allows us to involve patients in what we do based on the principle of “no decision about me without me”. In 2021, a year into the pandemic, our Adolescent & Young Adult (AYA) Rheumatology team planned for our service improvements strategy. We aimed to engage service users using a co-production model. Methods Following two funding awards, we started the implementation of this project with the aim to enable young people (YP) and clinical staff to sustainably co-produce individual health outcomes and service improvement. Our baseline data identified significant variations in clinical consultations with no standardised approach to supporting YP with self-management, and a third of clinicians knew about health coaching (HC). HC is a technique that aims to “help patients gain the knowledge, skills, tools, and confidence to become active participants in their care so that they can reach their self-identified health goals”. Results We built our HC core capabilities for the whole AYA rheumatology multidisciplinary team. Four staff members completed European Mentoring & Coaching Council accredited HC training. A follow-up survey identified that clinicians started to embed HC into clinical consultation in 30% of our consultations with YP. We developed and embedded HC tools in our electronic health records to improve efficiency and standardisation in clinic consultation. We are piloting a dedicated HC clinic for YP with complex needs. We engaged with our service users, conducted one-to-one meetings with them, and organised workshops. We selected activities that matched our engagement aims. We used system thinking, structured coaching conversation, and quality improvement methodologies. Discussion between service users and clinicians fed into our two key projects: co-producing healthcare consultations, and setting up a peer support scheme. We now plan for three YP to participate in an internship scheme and work with us to deliver these projects. They will be part of our journey in co-creating health and service improvement for service users. Conclusion In this project, we aimed to embed co-production in the clinician-patient relationship using health coaching conversations and extended this approach into co-creating services with users. Like many other services, we are still learning from our improvement journey. Building relationships with YP and treating them as equal partners enables alignment of the service and its intended impacts with what matters most to the YP we serve. Disclosure S. Mavrommatis: None. A. Bouraoui: None. C. Fisher: None. I. Ahmed: None. R. Burman: None. N. Celik: None. A. Shah: None. K. Smith-Junkere: None. T. Al-Sulaim: None. S. Begum: None. C. Ciurtin: None. S. Devi Seegoolam: None. J. Gupta: None. R. Harvey-Regan: None. M. Leandro: None. S. Meyer: None. E. Williams: None. L. Williamson: None. D. Sen: None.

Background Over the past few years, several alternative leather technologies have emerged and promise advantages over incumbent leathers with respect to sustainability despite most containing enough plastic to prevent safe and effective biodegradation. Of the alternative leathers in production or advanced development, few fit the dual criteria of low-carbon and near-zero plastic. Reishi™ is a leather alternative, grown using MycoWorks’ Fine Mycelium™ technology, with less than 1% polymer content and satisfies the same performance, quality, and hand feel as animal leather. We present here the first Life Cycle Assessment (LCA) of Reishi™, detailing its “cradle-to-gate” carbon footprint and broader environmental profile. The pilot- and full-scale production of 1 m2 of post-processed, finished, and packaged Reishi™ both before and after production improvement implementations is modeled, and the environmental footprint impact assessment method is performed. Results It was found that Reishi’s™ carbon footprint is as low as 2.76 kg CO2-eq per m2, or 8% of the value of the bovine leather benchmark modeled. Furthermore, it was found that Reishi™ has a lower impact compared to bovine leather modeled across a number of impact categories, including eutrophication, ecotoxicity, human health effects, and others. Reishi’s™ impact “hotspots” were determined, with the largest opportunity for further reduction being improved energy efficiency in the growth of mycelium, in particular, the process’s sterilization of raw material inputs via autoclave tools. It is also shown that MycoWorks’ passive process for growing mycelium has a carbon footprint two orders of magnitude lower than incumbent mycelium growth processes that actively consume carbon dioxide gas, which MycoWorks’ process does not require. Conclusions Reishi™ is shown to be a promising sustainable material through its unique combination of natural quality, low-carbon footprint as determined by this LCA, and biodegradability due to its lack of plastic or crosslinked content. Its manufacturing process is low impact even when produced at a scale of tens of thousands of square meters per year—a miniscule fraction of the billions of square meters of bovine leather already sold per year. With further use of this leather alternative, additional efficiency gains are likely to be realized.

Studies of thunderstorm asthma to understand risk factors using high-resolution climate data and asthma outcomes on a large scale are scarce. Moreover, thunderstorm asthma is not well studied in the United States.We examined whether climate parameters involved in thunderstorms are associated with emergency department (ED) visits for acute asthma attacks in the United States.We analyzed 63,789 asthma-related, daily ED visits for all age groups, and thunderstorm-associated climate data in Louisiana during 2010 through 2012. We performed time-series analyses using quasi-Poisson regression models with natural cubic splines of date, parish, holiday, day of week, season, daily maximum concentrations of ozone (On thunderstorm days, higher asthma-related ED visits were associated with higher daily mean precipitation [Higher precipitation and lower temperature on thunderstorm days appear to contribute to asthma attacks among people with asthma, suggesting they should consider taking precautions during thunderstorms. EDs should consider preparing for a potential increase of asthma-related visits and ensuring sufficient stock of emergency medication and supplies for forecasted severe thunderstorm days. https://doi.org/10.1289/EHP10440.

Olfactory studies frequently utilize odor stimuli consisting of volatiles created from liquid dilutions of various chemicals. A problem arises if the researcher relies on these liquid dilutions to extrapolate vapor concentrations based on ideal gas behavior. For most chemicals, the relationship between liquid and vapor concentration deviates from these laws of proportionality due to interactions between the chemical and the solvent. Here, we describe a method to estimate vapor-phase concentrations of diluted odorants using a photoionization detector. To demonstrate the utility of this method, we assessed the relationship between liquid-/vapor-phase concentrations for 14 odorants (7 alcohols, 1 ester, and 6 aldehydes) in 5 different solvents (water, mineral oil, diethyl phthalate, dipropylene glycol, and propylene glycol). An analysis of 7 additional esters is also included to assess how carbon chain length and functional group, interacts with these solvents (for a total of 105 odorant/solvent pairs). Our resulting equilibrium equations successfully corrected for behavioral sensitivity differences observed in mice tested with the same odorant in different solvents and were overall similar to published measurements using a gas chromatography-based approach. In summary, this method should allow researchers to determine the vapor-phase concentration of diluted odorants and will hopefully assist in more accurate comparisons of odorant concentrations across olfactory studies.

Measures of behavioral sensitivity provide an important guide for choosing the stimulus concentrations used in functional experiments. This information is particularly valuable in the olfactory system as the neural representation of an odorant changes with concentration. This study focuses on acetate esters because they are commonly used to survey neural activity in a variety of olfactory regions, probe the behavioral limits of odor discrimination, and assess odor structure–activity relationships in mice. Despite their frequent use, the relative sensitivity of these odorants in mice is not available. Thus, we assayed the ability of C57BL/6J mice to detect seven different acetates (propyl acetate, butyl acetate, pentyl acetate, hexyl acetate, octyl acetate, isobutyl acetate, and isoamyl acetate) using a head-fixed Go/No-Go operant conditioning assay combined with highly reproducible stimulus delivery. To aid in the accessibility and applicability of our data, we have estimated the vapor-phase concentrations of these odorants in five different solvents using a photoionization detector-based approach. The resulting liquid-/vapor-phase equilibrium equations successfully corrected for behavioral sensitivity differences observed in animals tested with the same odorant in different solvents. We found that mice are most sensitive to isobutyl acetate and least sensitive to propyl acetate. These updated measures of sensitivity will hopefully guide experimenters in choosing appropriate stimulus concentrations for experiments using these odorants.

Probing the neural mechanisms that underlie each sensory system requires the presentation of perceptually appropriate stimulus concentrations. This is particularly relevant in the olfactory system as additional odorant receptors typically respond with increasing stimulus concentrations. Thus, perceptual measures of olfactory sensitivity provide an important guide for functional experiments. This study focuses on aliphatic alcohols because they are commonly used to survey neural activity in a variety of olfactory regions, probe the behavioral limits of odor discrimination, and assess odor-structure activity relationships in mice. However, despite their frequent use, a systematic study of the relative sensitivity of these odorants in mice is not available. Thus, we assayed the ability of C57BL/6J mice to detect a homologous series of primary aliphatic alcohols (1-propanol to 1-heptanol) using a head-fixed Go/No-Go operant conditioning assay combined with highly reproducible stimulus delivery. To aid in the accessibility of our data, we report the animal’s threshold to each odorant according to the 1) ideal gas condition, 2) nonideal gas condition (factoring in the activity of the odorant in the solvent), and 3) the liquid dilution of the odorant in the olfactometer. Of the odorants tested, mice were most sensitive to 1-hexanol and least sensitive to 1-butanol. These updated measures of murine sensitivity will hopefully guide experimenters in choosing appropriate stimulus concentrations for experiments using these odorants.

Introduction The clinical manifestations of COVID-19 infection in recipients of allogeneic hematopoietic stem cell transplantation (HSCT) have been reported in multiple retrospective cohorts of patients, but there have been no prospective studies to date. Previous studies report that HSCT recipients are at higher risk, with cumulative incidence of death between 17-35%. Although an excessive pro-inflammatory viral response has been documented in the general population, its role in the immune incompetent HSCT setting has not been documented. We present a combined prospective and retrospective national study run through the UK IMPACT trial network to characterize the clinical and immunological features of COVID-19 infection in 96 adult and pediatric recipients of HSCT in the United Kingdom. Methods HSCT recipients of any age and transplanted for any indication, with an RT-PCR-proven COVID-19 infection, were eligible for this study. Patients within 72 hours of COVID-19 diagnosis, who had not received cytokine-targeted treatment, were recruited to a prospective cohort. All other patients were eligible for a retrospective cohort. Prospective patients provided blood samples within 72 hours of COVID-19 diagnosis, and again within 72 hours of clinical deterioration (defined as requirement for oxygen administration) if applicable. Follow-up data were collected on patients 30 and 100 days after COVID-19 diagnosis. Results 100 patients were recruited from 16 sites across the UK between May 2020-June 2021, comprising 12 in a prospective cohort and 88 recruited retrospectively. 96 patients were evaluable, as 4 proved ineligible post-registration. Patients were diagnosed with COVID-19 at a median of 11 months after HSCT. Patient/HSCT characteristics are shown Table 1. The most common symptoms associated with the onset of COVID-19 were fever in 8 prospective (73%) and 35 (41%) retrospective patients, followed by cough in 5 (45%) prospective and 35 (41%) retrospective patients and dyspnea in 4 (36%) prospective and 16 (19%) retrospective patients. 8 (73%) prospective and 40 (47%) retrospective patients were actively immunosuppressed at the time of COVID-19 infection. 16% of the patients had moderate/severe disease at baseline. At day 30 (±2 days) after COVID-19 diagnosis, 2 prospective and 8 retrospective patients continued to demonstrate SARS-CoV-2 positivity on respiratory PCR testing. The median time to viral clearance was 40 (IQR 17-78) days for the prospective and 34 (IQR 15-70) days for the retrospective cohort. Prolonged (more than 14 days) neutropenia was reported in 4 (5%) patients in the retrospective cohort, prolonged thrombocytopenia in 2 (18%) prospective and 11 (13%) retrospective patients. 1 retrospective patient developed secondary hemophagocytic lymphohistiocytosis, and graft rejection was reported in 1 (1%) retrospective patient, within 30 days of COVID-19 diagnosis. In the prospective cohort, 3 (27%) patients died, all by day 30, and all due to COVID-19. In the retrospective cohort, 13 (17%) patients died by day 30, rising to 18 (21%) by day 100, 61% of deaths were attributed to COVID-19. Lower baseline platelets (p=0.013, Mann-Whitney U test), lymphocytes (p=0.012), albumin (p=0.028), and higher baseline CRP (p=0.007), were seen in patients who died following COVID-19 diagnosis. Additionally, exploratory univariate logistic regression of the retrospective cohort found mortality at day 100 to be associated with increased age at diagnosis (OR 1.04, 95% CI 1.01-1.08, p=0.04), and no requirement compared with requirement for invasive ventilation (OR 0.02, 95% CI 0.00-0.16, p=0.001). The 11 prospective patients showed normal levels of interleukin (IL)-2, -4, -10, interferon gamma and tumor necrosis factor alpha at COVID-19 presentation. IL-6 was minimally raised (up to 127 pg/ml, nv Conclusion Our study confirms a significant mortality rate in patients affected by COVID-19 post HSCT and confirms age as well as requirement for invasive ventilation to be independent risk factors associated with death at day 100. Baseline laboratory data at disease presentation can identify patients at higher risk of COVID-19 related death. In the prospective cohort of our study, pathophysiology of the viral disease did not seem related to cytokine storm-mediated inflammation. Figure 1 Figure 1. Disclosures Protheroe: Jazz Pharmaceuticals: Honoraria; Astellas: Honoraria; Kite Gilead: Honoraria. Peggs: Autolus: Consultancy, Current equity holder in publicly-traded company. Craddock: Novartis Pharmaceuticals: Other: Advisory Board ; Celgene/BMS: Membership on an entity's Board of Directors or advisory committees, Research Funding. Nicholson: BMS/Celgene: Consultancy; Kite, a Gilead Company: Other: Conference fees, Speakers Bureau; Novartis: Consultancy, Other: Conference fees; Pfizer: Consultancy. Amrolia: ADC Therapeutics: Other: Named inventor on a patent which is being transferred to ADCT.; Autolus: Patents & Royalties.

Ellie Williams of Brooke explains some of the worldwide issues they are tackling

Given basic components and the right trainer, it's easy to create a 401 (k) training program customized to your needs, time, and budget.