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1. Variable exposure to multiple climate stressors across the California marine protected area network and policy implications

Author

Hamilton, SL, Kennedy, EG, Zulian, M, Hill, TM, Gaylord, B, Sanford, E, Ricart, AM, Ward, M, Spalding, AK, and Kroeker, K

Subjects
Environmental Sciences, Environmental Management, Life on Land, Life Below Water, acidification, climate change, dissolved oxygen, hypoxia, marine heatwave, multiple stressors, pH, temperature, Fisheries
Abstract

The efficacy of marine protected areas (MPAs) may be reduced when climate change disrupts the ecosystems and human communities around which they are designed. The effects of ocean warming on MPA functioning have received attention but less is known about how multiple climatic stressors may influence MPAs efficacy. Using a novel dataset incorporating 8.8 million oceanographic observations, we assess exposure to potentially stressful temperatures, dissolved oxygen concentrations, and pH levels across the California MPA network. This dataset covers more than two-thirds of California's 124 MPAs and multiple biogeographic domains. However, spatial-temporal and methodological patchiness constrains the extent to which systematic evaluation of exposure is possible across the network. Across a set of nine well-monitored MPAs, the most frequently observed combination of stressful conditions was hypoxic conditions (

Published
2023

12. A113 DIAGNOSTIC ACCURACY OF COMPUTED TOMOGRAPHY ENTEROGRAPHY COMPARED TO BALLOON ASSISTED ENDOSCOPY IN CROHN’S DISEASE

Author

Cooper, J, primary, Dang, T, additional, Reeson, M, additional, Dang, J, additional, Dieleman, L, additional, Kroeker, K, additional, Baumgart, D, additional, Wong, K, additional, Peerani, F, additional, Zepeda-Gomez, S, additional, Wasilenko, S, additional, Hoentjen, F, additional, Wiebe, E, additional, and Halloran, B, additional

Published
2023
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39. A80 ADHERENCE TO GUIDELINES AND BEST PRACTICES FOR IBD FLARE MANAGEMENT AND CORTICOSTEROID ADMINISTRATION: A RETROSPECTIVE CHART REVIEW

Author

Sutton R, Ellina Lytvyak, Pincock D, Baumgart D, Sadowski D, Fedorak R, and Kroeker K

Subjects
Posters Of Distinction
Abstract

BACKGROUND: Induction and maintenance of remission is a primary treatment goal for inflammatory bowel disease (IBD). Active disease is often treated with corticosteroids (CS). Although effective, CS have significant negative effects, and not recommended for long term or frequent use, especially when safer medications are now available. Nonetheless, literature suggests that cumulative exposure to CS in IBD patients has not changed. Gaps in clinician adherence to international guidelines for IBD care have also been identified. AIMS: We aim to: (1) assess adherence of practitioners to guidelines for CS use and treatment of disease flares, and (2) associate guideline adherence with outcomes at 12 months. METHODS: A retrospective, single-center study using data collected from outpatients of the University of Alberta IBD Clinic, receiving >1 dispensation of CS from an IBD practitioner between March 2014–2016. Data for CS dispensations including and for 18 months following the initial dispensation were extracted from provincial databases. Other data was manually extracted from the region-specific electronic medical record (EMR). Regression analyses were performed with clinical remission as the dependent variable (95% confidence). RESULTS: Of 345 charts identified, 244 met inclusion. The majority, 157 (64.3%), had Crohn’s disease (CD). At the initial dispensation, median age was 40 (IQR: 28–50) years. Maintenance medications: 72 (29.5%) on no IBD medication, 75 (30.7%) 5-ASA only, 34 (13.9%) immunomodulators, and 63 (25.8%) biologic therapy. CS were prescribed in clinic for 125 (51.2%), at endoscopy for 54 (22.1%), in hospital for 29 (11.9%), and by telephone for 36 (14.8%). The majority of CS prescribed were prednisone (176, 72.1%), the remainder budesonide. CONCLUSIONS: There are gaps between guidelines and clinical practice for some aspects of IBD patient care, particularly documentation and fecal calprotectin. Providers seem more likely to document clinical scores when patients have severe disease. Making better use of EMR functionality may be of utility to automate and improve clinical documentation and testing. Additionally, prescribing of steroids beyond an initial flare does not appear to be associated with better outcome. FUNDING AGENCIES: CCC, CIHRUniversity of Alberta

Published
2019

48. A84 HIGH FECAL CALPROTECTIN LEVELS IN ULCERATIVE COLITIS PATIENTS IN CLINICAL REMISSION ARE ASSOCIATED WITH SPECIFIC CLINICAL AND DIETARY INTAKE PARAMETERS

Author

Keshteli, A H, Hoevers, T, Madsen, K, Hotte, N, Nickurak, C, Kroeker, K I, van Den Brand, F, Valcheva, R S, Fedorak, R, and Dieleman, L A

Subjects
Poster Presentations
Abstract

BACKGROUND: Ulcerative colitis (UC) is a debilitating chronic inflammation with frequent relapses. Fecal calprotectin (FCP), a cytosolic protein of mucosal neutrophils, is the most promising non-invasive fecal marker of intestinal inflammation. We have previously shown that UC patients in clinical remission who had FCP>150 µg/g had a significantly higher chance of relapse within the next 12 months. AIMS: In this study we aimed to investigate which demographic, clinical, laboratory, dietary and lifestyle related factors were associated with high FCP. METHODS: In this cross-sectional study, FCP was measured using ELISA on samples from adult UC patients who were in clinical remission (Partial Mayo score150 µg/g, defined as “high FCP”. The prevalence of high FCP in males and females was 54.2 and 32.4%, respectively (P=0.09). After adjusting for gender, age and BMI, patients with high FCP had a significantly higher carbohydrate (233.0 ± 34.8 vs. 214.4 ± 25.1 g/d, P=0.02) intake, but lower consumption of alcohol (2.1 ± 3.8 vs. 4.4 ± 5.1 g/d, P=0.05), monounsaturated (25.7 ± 11.7 vs. 29.3 ± 7.8 g/d, P=0.08), and polyunsaturated fatty acids (12.3 ± 6.5 vs. 14.7 ± 5.5g/d, P=0.06). The prevalence of high FCP in patients who had previous history of proctitis, left-sided colitis, and pancolitis was 0, 38, and 49%, respectively (P=0.02). Serum albumin level was higher in patients with normal FCP than in patients with high FCP (44.8 ± 2.4 vs. 43.2 ± 2.9 g/L, P=0.02). FCP was not related to vitamin D, B12, iron, obesity, physical activity, and quality of life status. CONCLUSIONS: Increased fecal calprotectin as a marker of subclinical disease in UC patients is associated with high carbohydrate intake and low consumption of monounsaturated and polyunsaturated fatty acids in male patients with more extensive previous disease. These findings suggest that diet can be a significant determining factor in modulation of inflammation in UC patients who are in clinical remission. FUNDING AGENCIES: Alberta Innovates - Bio Solutions

Published
2018

49. A139 AGREEMENT OF IBDOC® AND QUANTON CAL® RAPID LATERAL FLOW-BASED FECAL CALPROTECTIN TESTS WITH ACCEPTED LAB-BASED ASSAYS FOR MONITORING INFLAMMATORY BOWEL DISEASE

Author

Sutton, R T, Prosser, C, Dhami, N, Sadowski, D, van Zanten, S, Kroeker, K I, Wong, K, Halloran, B P, Fedorak, R, and Huang, V

Subjects
Paper Sessions
Abstract

BACKGROUND: Fecal calprotectin (FCP) is a useful biomarker for monitoring inflammatory bowel disease, showing good correlation to endoscopic disease activity. Currently used lab tests take 2–4 weeks to return a result, limiting their usefulness. Recently, lateral flow-based rapid tests have been combined with smartphone applications to allow patients to complete FCP testing at home, with their physician receiving the result the same day. AIMS: We aim to compare FCP results from two point-of-care test (POCT) devices (IBDoc; Buhlmann, Quanton Cal; Preventis) in real world use, to two widely accepted lab based methods. METHODS: Patients brought first morning stool to the University of Alberta IBD clinic, completed partial Mayo (pMayo) and Harvey-Bradshaw index (mHBI) scores, received training, and performed the IBDoc test. A portion of their raw sample was sent to the hospital lab, stored at -20°C, thawed and then analyzed using Quanton Cal POCT kits (performed by laboratory staff) and two weight-based lab tests: Immunodiagnostik (ELISA) and Buhlmann Turbo (immunoturbidimetric) assays. Numerical FCP values were tabulated and dichotomized by ≥250 µg/ml (active) or 250 µg/ml are not reproducible and would be misleading if used to monitor disease progression. FCP close to cutoffs should be repeated and does not correlate very well with patient reported symptoms. FUNDING AGENCIES: None

Published
2018

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