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Context Thyroid hormone (TH) is crucial for the adaptation to cold. Objective To evaluate the effect of hyperthyroidism on resting energy expenditure (REE), cold-induced thermogenesis (CIT) and changes in body composition and weight. Methods This was a prospective cohort study at the endocrine outpatient clinic of a tertiary referral center. Eighteen patients with overt hyperthyroidism were included. We measured REE during hyperthyroidism, after restoring euthyroid TH levels and after 3 months of normal thyroid function. In 14 of the 18 patients, energy expenditure (EE) was measured before and after a mild cold exposure of 2 hours and CIT was the difference between EEcold and EEwarm. Skin temperatures at 8 positions were recorded during the study visits. Body composition was assessed by dual X-ray absorption. Results Free thyroxine (fT4) and free triiodothyronine (fT3) decreased significantly over time (fT4, P = .0003; fT3, P = .0001). REE corrected for lean body mass (LBM) decreased from 42 ± 6.7 kcal/24 hour/kg LBM in the hyperthyroid to 33 ± 4.4 kcal/24 hour/kg LBM (–21%, P Conclusion CIT is not increased in patients with overt hyperthyroidism.

Background Brown adipose tissue (BAT) is a thermogenic tissue which can generate heat in response to mild cold exposure. As it constitutes a promising target in the fight against obesity, we need reliable techniques to quantify its activity in response to therapeutic interventions. The current standard for the quantification of BAT activity is [18F]FDG PET/CT. Various sequences in magnetic resonance imaging (MRI), including those measuring its relative fat content (fat fraction), have been proposed and evaluated in small proof-of-principle studies, showing diverging results. Here, we systematically compare the predictive value of adipose tissue fat fraction measured by MRI to the results of [18F]FDG PET/CT. Methods We analyzed the diagnostic reliability of MRI measured fat fraction (FF) for the estimation of human BAT activity in two cohorts of healthy volunteers participating in two prospective clinical trials (NCT03189511, NCT03269747). In both cohorts, BAT activity was stimulated by mild cold exposure. In cohort 1, we performed [18F]FDG PET/MRI; in cohort 2, we used [18F]FDG PET/CT followed by MRI. Fat fraction was determined by 2-point Dixon and 6-point Dixon measurement, respectively. Fat fraction values were compared to SUVmean in the corresponding tissue depot by simple linear regression. Results In total, 33 male participants with a mean age of 23.9 years and a mean BMI of 22.8 kg/m2 were recruited. In 32 participants, active BAT was visible. On an intra-individual level, FF was significantly lower in high-SUV areas compared to low-SUV areas (cohort 1: p

ImportanceThe antiviral activity and efficacy of anti-SARS-CoV-2 monoclonal antibody (mAb) therapies to accelerate recovery from COVID-19 is important to define.ObjectiveTo determine safety and efficacy of the mAb bamlanivimab to reduce nasopharyngeal (NP) SARS-CoV-2 RNA levels and symptom duration.DesignACTIV-2/A5401 is a randomized, blinded, placebo-controlled platform trial. Two dose cohorts were enrolled between August 19 and November 17, 2020 for phase 2 evaluation: in the first, participants were randomized 1:1 to bamlanivimab 7000 mg versus placebo, and in the second to bamlanivimab 700 mg versus placebo. Randomization was stratified by time from symptom onset (≤ or >5 days) and risk of progression to severe COVID-19 (“higher” vs “lower”).SettingMulticenter trial conducted at U.S. sites.ParticipantsNon-hospitalized adults ≥18 years of age with positive SARS-CoV-2 antigen or nucleic acid test within 7 days, ≤10 days of COVID-19 symptoms, and with oxygen saturation ≥92% within 48 hours prior to study entry.InterventionSingle infusion of bamlanivimab (7000 or 700 mg) or placebo.Main Outcomes and MeasuresDetection of NP SARS-CoV-2 RNA at days 3, 7, 14, 21, and 28, time to improvement of all of 13 targeted COVID-19 symptoms by daily self-assessment through day 28, and grade 3 or higher treatment emergent adverse events (TEAEs) through day 28. Secondary measures included quantitative NP SARS-CoV-2 RNA, all-cause hospitalizations and deaths (composite), area under the curve of symptom scores from day 0 through day 28, plasma bamlanivimab concentrations, plasma and serum inflammatory biomarkers, and safety through week 24.ResultsNinety-four participants were enrolled to the 7000 mg cohort and 223 to the 700 mg cohort and initiated study intervention. The proportion meeting protocol criteria for “higher” risk for COVID-19 progression was 42% and 51% for the 7000 and 700 mg cohort, respectively. Median time from symptom onset at study entry for both cohorts was 6 days. There was no difference in the proportion with undetectable NP SARS-CoV-2 RNA at any post-treatment timepoints (risk ratio compared to placebo, 0.82-1.05 for 7000 mg dose [overall p=0.88] and 0.81-1.21 for 700 mg dose [overall p=0.49]), time to symptom improvement (median of 21 vs 18.5 days, p=0.97, for 7000 mg bamlanivimab vs placebo and 24 vs 20.5 days, p=0.08, for 700 mg bamlanivimab vs placebo), or grade 3+ TEAEs with either dose compared to placebo. Median NP SARS-CoV-2 RNA levels were lower at day 3 and C-reactive protein, ferritin, and fibrinogen levels significantly reduced at days 7 and 14 for bamlanivimab 700 mg compared to placebo, with similar trends observed for bamlanivimab 7000 mg. Viral decay modeling supported more rapid decay with bamlanivimab compared to placebo.Conclusions and RelevanceTreatment with bamlanivimab 7000 mg and 700 mg was safe and compared to placebo led to more rapid reductions in NP SARS-CoV-2 RNA and inflammatory biomarkers, but did not decrease time to symptom improvement. The clinical utility of mAbs for outcomes other than hospitalizations and deaths is uncertain.Trial RegistrationClinicalTrials.gov Identifier: NCT04518410KEY POINTSQuestionWhat is the safety and efficacy of bamlanivimab monoclonal antibody (mAb) treatment for mild to moderate COVID-19?FindingsIn this randomized, placebo-controlled phase 2 trial of 317 non-hospitalized adults with COVID-19, there was no relationship between symptoms or disease progression risk and nasopharyngeal (NP) virus shedding. Bamlanivimab was safe and reduced NP SARS-CoV-2 RNA levels and inflammatory biomarker levels more than placebo, but did not shorten symptom duration.MeaningNasal virus shedding was not associated with symptoms or baseline risk factors for severe COVID-19. Bamlanivimab, which has been associated with reduced hospitalizations in high-risk individuals, demonstrated antiviral activity with early post-treatment NP sampling but did not accelerate symptom improvement. The clinical utility of bamlanivimab for outcomes other than hospitalizations and deaths, including longer-term outcomes, is uncertain.

Li-Fraumeni Syndrome (LFS) is a hereditary cancer predisposition syndrome in which affected individuals are prone to developing a wide spectrum of malignancies. LFS is caused by germline mutations in the TP53 tumour suppressor gene. LFS patients develop cancer significantly earlier than the general population and may experience multiple malignancies in their lifetime. Studies have indicated that environmental influences like radiation exposure and tobacco smoke may further increase cancer risk in LFS patients. Currently, there is no cure for LFS, and screening for early tumour detection is the standard of care for LFS patients. Recently, microbes have been found to be involved in cancer development, progression, and treatment responsiveness. Moreover, microbes have anti-tumourigenic properties that can be harnessed for therapeutic intervention. The interaction between microbes and cancer can be through contact-dependent, contact-independent, and/or immunological interactions. Profiling the microbiome in the context of cancer may provide prognostic and/or diagnostic options for patients. However, interactions between the microbiome and mutant p53 in LFS has not been studied to date. We induced dysbiosis using a combination of antibiotics in LFS mice harbouring the heterozygous Trp53 R172H mutation. Following 7 days of treatment, we challenged mice with subcutaneous injections of the MC38 colon adenocarcinoma cell line. We observed an increase in tumour volume in LFS mice treated with antibiotics; this change was not observed in p53 wildtype mice. These findings highlight potentially unique interactions between mutant p53 and the microbiome which influence tumour growth in the context of LFS. We also found that LFS mice treated with metformin have smaller tumours compared to untreated mice. A particular genus of bacteria, Faecalibaculum sp., was found to be upregulated in a cohort of metformin treated mice, and the abundance of this bacterium is inversely proportional to tumour volume. Zagato et al. have shown that Faecalibaculum rodentium has anti-tumourigenic properties through the production of short-chain fatty acid (SCFA). Altogether, these observations suggest that microbes may influence tumour growth in LFS mice. The study of interactions between the microbiome and mutant p53 and the influence of these interactions on cancer development in LFS may, with further study, provide avenues of prognostic and/or diagnostic interest. Differences in the microbiome in cancer-affected and cancer-free LFS patients may also introduce the possibility to exploit the microbiome for treatment and/or preventative purposes in these patients. Citation Format: Noel Wei Ong, Camilla Maria Giovino, Nicholas William Fischer, Pamela Psarianos, David Malkin. Investigating the interaction between the microbiome and mutant p53 in Li-Fraumeni Syndrome [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3047.

Recent clinical trials have moved iodine-131 (I-131) metaiodobenzylguanidine (MIBG) therapy into frontline management of high-risk neuroblastoma. With this expansion, it is reasonable to anticipate the need for intensive care level resuscitations. Radiation exposure remains the greatest risk to health care professionals managing these patients. We combined shock simulation scenario data with actual radiation dosimetry data to create a care model allowing for aggressive, prolonged in situ resuscitation of a critically ill pediatric patient after I-131 MIBG administration. This model will maintain a critical care provider's radiation level below 10% of the annual occupational dose limit (5 mSv, 500 mrem) per patient managed.

Background Brown adipose tissue (BAT) is a thermogenic tissue which can generate heat in response to mild cold exposure. As it constitutes a promising target in the fight against obesity, we need reliable techniques to quantify its activity in response to therapeutic interventions. The current standard for the quantification of BAT activity is [18F]FDG PET/CT. Various sequences in magnetic resonance imaging (MRI), including those measuring its relative fat content (fat fraction), have been proposed and evaluated in small proof-of-principle studies, showing diverging results. Here, we systematically compare the predictive value of adipose tissue fat fraction measured by MRI to the results of [18F]FDG PET/CT. Methods We analyzed the diagnostic reliability of MRI measured fat fraction (FF) for the estimation of human BAT activity in two cohorts of healthy volunteers participating in two prospective clinical trials (NCT03189511, NCT03269747). In both cohorts, BAT activity was stimulated by mild cold exposure. In cohort 1, we performed [18F]FDG PET/MRI; in cohort 2, we used [18F]FDG PET/CT followed by MRI. Fat fraction was determined by 2-point Dixon and 6-point Dixon measurement, respectively. Fat fraction values were compared to SUVmean in the corresponding tissue depot by simple linear regression. Results In total, 33 male participants with a mean age of 23.9 years and a mean BMI of 22.8 kg/m2 were recruited. In 32 participants, active BAT was visible. On an intra-individual level, FF was significantly lower in high-SUV areas compared to low-SUV areas (cohort 1: p

The purpose of this study was to assess the attitudes of occupationally exposed employees at a large teaching hospital about wearing their assigned personal radiation dosimeters. A 16-question multiple-answer survey was used to report the reasons why medical professionals may not wear their dosimetry during procedures involving ionizing radiation. In all, 302 employees responded to the survey. The majority of respondents who reported always or almost always wearing their dosimeters do so because they consider themselves well informed concerning the importance of personal dosimetry measurement and appreciate the importance of federal and state regulations. For respondents who reported not always wearing their dosimeters, the most commonly stated reason was the inconvenience of remembering to bring and wear their dosimeters when working in multiple locations, for which a potential solution would be to provide dosimeters to each affected wearer in each location where they work.

Submitted by Rosangela Silva (rosangela.silva3@unioeste.br) on 2019-01-08T14:04:31Z No. of bitstreams: 2 William Fischer da Silva Junior.pdf: 2849732 bytes, checksum: ce74b827359aa0cddccd384dff1ce011 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Made available in DSpace on 2019-01-08T14:04:31Z (GMT). No. of bitstreams: 2 William Fischer da Silva Junior.pdf: 2849732 bytes, checksum: ce74b827359aa0cddccd384dff1ce011 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2018-08-16 The theme investigated in this study is about the strategy and sustainability of the third sector, with the objective of investigating how management control systems can stimulate donations to the social causes of Civil Society Organizations (CSOs) from the gift theory perspective. The contribution, therefore, is focused on describing the interaction between effective management and the building of relationships and relationships with donors, which will provide better fundraising, promoting the sustainability of the organization. The theoretical framework deals with the Gift Theory, a social phenomenon that seeks to relate solidarity and alliance between people and groups, creating the cause and effect necessary for the durability of some relationships. On the systems of managerial control with emphasis in the approach of the model of the levers of control of Simons (1995), that favor the coordination and the control of the organizational processes. Also on fundraising with an inherent approach to the formulation of mobilization strategies. The methodology used will be descriptive with the consensus analysis and will be carried out in two non-profit entities of the municipality of Cascavel. The field of study entities are the Association of Parents and Friends of the Exceptional (APAE) and the Cascavelense Association of Friends of the Deaf (ACAS), and the data collection was done through questionnaires with closed questions and sent to the donors of both organizations. As a conclusion, the results ratified the initial proposals of this study and it was possible to understand that there is consensus among donors about donating time, financial resources and materials for social organizations. These, in turn, need to improve their management models in order to elicit the necessary stimulus for donations to be expanded. Finally, future research could address the main obstacles to management in non-profit organizations, contributing to their development of better corporate governance and a communication strategy with society that is able to attract and retain supporters as well as analyze the aspects related to its intangible assets. O tema investigado neste estudo versa sobre como o uso de sistemas de controle gerencial podem estimular as doações às causas sociais das Organizações da Sociedade Civil (OSC) sob a ótica da Teoria da Dádiva. Portanto, a contribuição centra-se em descrever a interação entre a administração eficaz e a construção de laços e relacionamentos com os doadores que proporcionará melhor captação de recursos, promovendo a sustentabilidade da organização. O referencial teórico discorre sobre a Teoria da Dádiva, fenômeno social que procura relacionar a solidariedade e a aliança entre pessoas e grupos, criando a causa e o efeito necessários para a durabilidade de algumas relações. Sobre os sistemas de controle gerencial com ênfase na abordagem do modelo das alavancas de controle de Simons (1995), que favorecem a coordenação e o controle dos processos organizacionais, e sobre a captação de recursos no intuito de uma abordagem inerente à formulação de estratégias de mobilização dos mesmos na dimensão relacional com base na Teoria da Dádiva. A metodologia utilizada será descritiva com a análise de consenso e será realizada em duas entidades sem fins lucrativos do município de Cascavel. As entidades campo de estudo são a Associação de Pais e Amigos dos Excepcionais (APAE) e a Associação Cascavelense de Amigos de Surdos (ACAS), sendo a coleta de dados realizada por meio de questionários com perguntas fechadas e encaminhados aos doadores de ambas as organizações. Como conclusão tem-se que os resultados ratificaram as proposições iniciais deste estudo e foi possível compreender que há consenso moderado e acentuado entre os doadores sobre doar tempo como voluntário, recursos financeiros e materiais para as organizações sociais. Estas, por sua vez, precisam aprimorar os seus modelos de gestão no intuito de provocar o estímulo necessário para que as doações sejam ampliadas. Por fim, futuras pesquisas poderiam tratar a respeito de apontar quais as principais deficiências na gestão das organizações sem fins lucrativos, contribuindo para que desenvolvam uma melhor governança corporativa e também uma estratégia de comunicação com a sociedade capaz de atrair e reter os seus doadores, bem como analisar os aspectos relacionados com os seus ativos intangíveis.

Changing the properties of a bar of iron so as to make it float requires changing its gravitational properties, which in turn requires changing its specific density, which in turn requires changing either the size of its unit cells or the number and kinds of atoms within them. Changing the number and kinds of atoms requires changing a feature that seems to be constitutive of being iron. (Iron just is the chemical element with atomic number 26.) Likewise, changing the size of its unit cells results in a change in the features determined by the lattice structure of those cells (cleavage, crystal habit, optical properties, etc.). Iron is a transition metal, lying between manganese and cobalt on the Periodic Table. Thus, the range of possible densities for iron is highly restricted by these neighboring transition elements. But such leeway for changes in density isn’t anywhere near what’s required to make iron float. So either way, changing the properties of iron so as to make it float appears to result in something that isn’t iron.

Suppose that disgust can provide evidence of moral wrongdoing. What account of disgust might make sense of this? A recent and promising theory is the social contagion view, proposed by Alexandra Plakias. After criticizing both its descriptive and normative claims, I draw two conclusions. First, we should question the wisdom of drawing so straight a line from biological poisons and pathogens to social counterparts. Second, we don’t need to explain the evidential value of disgust by appealing to what the response tracks. These lessons point toward an alternative: namely, that disgust is a moral heuristic. On the heuristic view, disgust is a trigger for the subconscious use of a particular rule: I show how this view fits with a plausible hypothesis about the social function of disgust, and then apply it to Leon Kass’s famous use of repugnance to criticize cloning.

Background Hand hygiene (HH) is the single most important practice in the prevention of healthcare-associated infections (HAIs). However, HH is commonly suboptimal, with compliance often only 30–60%. In 2010, the Joint Commission Center for Transforming Healthcare launched the Targeted Solutions Tool (TST) for Hand Hygiene to aid institutions to increase HH compliance. After successfully deploying the TST at our medical center in 2015, we noted a remarkable improvement in overall HH. Unfortunately, improvements in HH across services were not uniform. Some services, like the environmental services (EVS), remained set in their old ways and continued to perform suboptimal HH. Methods We continued to engage staff using the TST model and just-in-time coaching (JITC) to encourage best HH practices. In addition, we often met with small groups for HH huddles, and reinforced the importance of EVS staff and their HH in helping to protect themselves and our patients, and reduce HAIs. Increasing EVS leadership commitment was key to further engage EVS staff and encourage better HH amongst EVS staff. Review of HH metrics was hard wired into the daily functions of the EVS department. Results Figure 1 shows EVS HH compliance from January 2014 through October 2017. This highlights the substantial progressive, albeit slow, improvement in EVS HH practices from a baseline of 40% to 60% to 80% over the course of nearly 4 years. Conclusion EVS HH rates remained suboptimal for prolonged periods. Initially the lack of leadership commitment and high staff turnover made training and engagement difficult. Continued interventions and use of just-in-time coaching proved to be effective to help improve compliance and better understand barriers to best practices. Connecting with EVS staff in small group huddles and the engagement of EVS leadership was key to success. Disclosures J. P. Parada, Merck: Speaker’s Bureau, Speaker honorarium.

International audience; As chartered by the Science Definition Team, the Mars 2020 mission addresses four primary objectives: A. Characterize the processes that formed and modified the geologic record within an astrobiologically relevant ancient environment, B. Perform astrobiologically relevant investigations to determine habitability, search for materials with biosignature presentation potential, and search for evidence of past life, C. Assemble a returnable cache of samples and D. Contribute to preparation for human exploration of Mars. The SuperCam instrument, selected for the Mars 2020 rover, as a suite of four instruments, provides nested and co-aligned remote investigations: Laser Induced Breakdown Spectroscopy (LIBS), Raman spectroscopy and time-resolved fluorescence (TRF), visible and near-infrared spectroscopy (VISIR), and high resolution color imaging (RMI). SuperCam appeals broadly to the four Mars 2020 objectives.In detail, SuperCam will perform:1. Microscale mineral identification by combining LIBS elemental and VISIR mineralogical spectroscopies, especially targeting secondary minerals2. Determine the sedimental stratigraphy through color imaging and LIBS and VISIR spectroscopy3. Search for organics and bio-signatures with LIBS and Raman spectroscopy4. Quantify the volatile content of the rocks by LIBS spectroscopy to determine the degree of aquaeous alteration5. Characterize the texture of the rocks by color imaging to determine their alteration processes6. Characterize the rocks' coatings by LIBS spectroscopy7. Characterize the soil and its potential for biosignature preservation8. Monitor the odd-oxygen atmospheric chemistry.To meet these goals SuperCam will perform LIBS spectroscopy on 0.5 mm spot up to 7-meter distance, perform Raman and time-resolved fluoresence up to 12-m distance with a 0.8 mrad angular resolution, a 100 ns time gating in the 534-850 nm spectral range, acquire VISIR spectra in the range 0.4-0.85 μm with a resolution of 0.35 nm, and in the IR range over 1.3-2.6 μm, rich in mineral signatures, with a resolution of 20 nm, and provide RGB images with an angular resolution of 40 μrad over a FOV of 20 mrad.We will present the science performances of SuperCam and the forecasted operation plans.

Kurzfassung Die Lastannahmen sind ein wesentlicher, wenn nicht der bedeutendste Teil der Vorarbeiten von Berechnung, Konstruktion, Fertigung, Prüfung und Überlegung zu Nutzungszeit und Lebensdauer von Komponenten, Maschinen und Anlagen. Die Ausgangslage bildet das „System‟ mit einer gedachten Funktion. Sein Verhalten ist Grundlage der Festigkeit unter Betriebsbedingungen. Lastannahmen haben viele Randbedingungen zu berücksichtigen und sollen auch besondere Ereignisse einbeziehen, die sich dem „schnellen‟ Denken gern entziehen. Beispiele für Annahmen bei auftretenden und ertragbaren Beanspruchungen werden bildhaft dargestellt. Über diese Thematik hat der Autor häufig mit H. Zenner diskutiert. Er und seine Mitarbeiter haben auch die FVA-Forschungsvorhaben „Sonderereignisse‟ bearbeitet. Jegliche Zusammenarbeit war fruchtbar und erfreulich, so dass der Dank auch an dieser Stelle zu Recht steht. Die nachstehenden Ausführungen sind insbesondere für Jüngere, Nachfolgende gedacht; Gespräche mit solchen haben gezeigt, dass einige Hinweise auf Zusammenhänge zwischen den Begriffen des Themas zweckdienlich sein können. Zum Thema ist auch der DVM-Bericht 134 des DVM-AK „Betriebsfestigkeit‟ zu „Lastannahmen und Betriebsfestigkeit‟ im Oktober 2007 in Wolfsburg zu empfehlen.

Prader–Willi syndrome (PWS) is due to loss of paternally expressed genes in the 15q11–q13 region generally from a paternal 15q11–q13 deletion. The proximal deletion breakpoint in the 15q11–q13 region occurs at one of two sites located within either of two large duplicons allowing for identification of two typical deletion subgroups. The larger type I (TI) deletion involving breakpoint 1 (BP1) is nearer to the centromere and located proximal to the microsatellite marker D15S1035, while the smaller type II (TII) deletion involves breakpoint 2 (BP2) and distal to D15S1035. Breakpoint 3 (BP3) is located at the distal end of the 15q11–q13 region and common to both typical deletion subgroups. Using high resolution aCGH, BP1 spanned a region from 18.683 to 20.220 Mb, BP2 from 20.812 to 21.357 Mb and BP3 from 25.941 to 27.286 Mb. The TI deletion ranged in size from 5.721 to 8.147 Mb (mean 6.583) and the type II deletion from 4.770 to 6.435 Mb (mean 5.330). A subset of the TI subjects showed larger deletions including the loss of at least three genes/transcripts (i.e., LOC283755, POTE5, OR4N4) in addition to the four genes between BP1 and BP2 (i.e., GCP5, CYFIP1, NIPA1, NIPA2). Interestingly, four PWS subjects had duplications of the 15q11 region in addition to the typical deletion. Furthermore, most PWS subjects had copy number variation (CNV) of 50 kb or larger in other chromosome regions; most common were deletions and duplications of 8p and 3q, previously recognized sites of CNV in the human genome. © 2008 Wiley-Liss, Inc.

BACKGROUND: Knee arthrocentesis is a commonly performed diagnostic and therapeutic procedure in rheumatology and orthopedic surgery. Classic teaching of arthrocentesis skills relies on hands-on practice under supervision. Video-based online teaching is an increasingly utilized educational tool in higher and clinical education. YouTube is a popular video-sharing Web site that can be accessed as a teaching source. OBJECTIVE: The objective of this study was to assess the educational value of YouTube videos on knee arthrocentesis posted by health professionals and institutions during the period from 2008 to 2012. METHODS: The YouTube video database was systematically searched using 5 search terms related to knee arthrocentesis. Two independent clinical reviewers assessed videos for procedural technique and educational value using a 5-point global score, ranging from 1 = poor quality to 5 = excellent educational quality. As validated international guidelines are lacking, we used the guidelines of the Swiss Society of Rheumatology as criterion standard for the procedure. RESULTS: Of more than thousand findings, 13 videos met the inclusion criteria. Of those, 2 contained additional animated video material: one was purely animated, and one was a check list. The average length was 3.31 +/- 2.28 minutes. The most popular video had 1388 hits per month. Our mean global score for educational value was 3.1 +/- 1.0. Eight videos (62 %) were considered useful for teaching purposes. Use of a "no-touch" procedure, meaning that once disinfected the skin remains untouched before needle penetration, was present in all videos. Six videos (46%) demonstrated full sterile conditions. There was no clear preference of a medial (n = 8) versus lateral (n = 5) approach. CONCLUSIONS: A discreet number of YouTube videos on knee arthrocentesis appeared to be suitable for application in a Web-based format for medical students, fellows, and residents. The low-average mean global score for over educational value suggests an improvement of future video-based instructional materials on YouTube would be necessary before regular use for teaching could be recommended.

This paper deals with history, difference of loading in shaft and gear dendendum and flank, load time histories and distributions, transformation of load to stress as well as with examples and cases of damage or loss regarding the particularities of structural fatigue of toothed gears.

Background: X-chromosome inactivation (XCI) is the mechanism by which gene dosage uniformity is achieved between female mammals with two X chromosomes and male mammals with a single X chromosome, and is thought to occur randomly. For molecular genetic testing, accessible tissues (eg blood) are commonly studied, but the relationship with inaccessible tissues (eg brain) is poorly understood. For accessible tissues to be informative for genetic analysis, a high degree of concordance of genetic findings among tissue types is required. Objective: To determine the relationship among multiple tissues within females at different ages (fetus to 82 years). M ethods: XCI patterns were analysed using the polymorphic androgen receptor ( AR ) gene assay. DNA was isolated from 26 different human females without history of malignancy, using 34 autopsy tissues representing the three embryonic germ layers. Results: 33 of the 280 tissue samples analysed from 13 of the 26 females showed skewed XCI values (>80:20%). Average XCI value was not significantly different among the tissues, but a trend for increasing XCI variability was observed with age in blood and other tissues studied (eg the SD for all tissues studied for the 0–2 years group was 9.9% compared with 14.8% in the >60 years group). We found a significant correlation (rs = 0.51, p = 0.035) between XCI values for blood and/or spleen and brain tissue, and in most other tissues representing the three embryonic germ layers. Conclusions: In our study, XCI data were comparable among accessible (eg blood) and inaccessible tissues (eg brain) in females at various ages, and may be useful for genetic testing. A trend was seen for greater XCI variability with increasing age, particularly in older women (>60 years).

Background Knee arthrocentesis is a commonly performed diagnostic and therapeutic procedure in rheumatology and orthopedic surgery. Classic teaching of arthrocentesis skills relies on hands-on practice under supervision. Video-based online teaching is an increasingly utilized educational tool in higher and clinical education. YouTube is a popular video-sharing Web site that can be accessed as a teaching source. Objectives The objective of this study was to assess the educational value of YouTube videos on knee arthrocentesis posted by health professionals and institutions during the period from 2008 to 2012. Methods The YouTube video database was systematically searched using 5 search terms related to knee arthrocentesis. Two independent clinical reviewers assessed videos for procedural technique and educational value using a 5-point global score, ranging from 1 = poor quality to 5 = excellent educational quality. As validated international guidelines are lacking, we used the guidelines of the Swiss Society of Rheumatology as criterion standard for the procedure. Results Of more than thousand findings, 13 videos met the inclusion criteria. Of those, 2 contained additional animated video material: one was purely animated, and one was a check list. The average length was 3.31±2.28 minutes. The most popular video had 1388 hits per month. Our mean global score for educational value was 3.1±1.0. Eight videos (62%) were considered useful for teaching purposes. Use of a “no-touch” procedure, meaning that once disinfected the skin remains untouched before needle penetration, was present in all videos. Six videos (46%) demonstrated full sterile conditions. There was no clear preference of a medial (n=8) versus lateral (n=5) approach. Conclusions A discreet number of YouTube videos on knee arthrocentesis appeared to be suitable for application in a Web-based format for medical students, fellows, and residents. The low-average mean global score for overall educational value suggests an improvement of future video-based instructional materials on YouTube would be necessary before regular use for teaching could be recommended. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.1786

Background Recent investigations have provided substantial evidence that distinct molecular and morphological changes in subchondral bone tissue, most notably sclerosis, play an active and important role in the pathogenesis of OA. The cellular and molecular regulation of this pathological process remains poorly understood. Objectives We investigated whether osteoimmunology, the reciprocal signaling between cells from the immune and bone system, is involved in OA subchondral bone sclerosis. Methods Tibial plateaus and informed consent were obtained from patients undergoing total knee arthroplasty due to end-stage OA. Subchondral bone mineralization distribution was analyzed using computed tomography osteoabsoptiometry (CT-OAM) and standardized cryosections of low (non-sclerotic) and high (sclerotic) bone mineralization were prepared ( n =18 each). Cartilage degeneration was graded in Safranin- O -stained sections using the Mankin scoring system. The presence of T-lymphocytes, B-cells and macrophages was assessed using immunohistochemical staining of their respective surface markers CD3, CD20 and CD68. Osteoclast activity was visualized by staining of the enzyme marker tartrate-resistant acid phosphatase (TRAP). Cellular characterization of ex vivo subchondral bone outgrowth cultures was performed using alkaline phosphatase (ALP), TRAP staining. Correlation between histological parameters was assessed using Spearman´s rank correlation. Statistical differences were calculated using Wilcoxon signed rank test or paired t -test, where appropriate. Results CT-OAM revealed a heterogeneous distribution of subchondral bone mineralization in OA tibial plateaus, displaying focal areas of sclerosis that overlapped macroscopically with areas of cartilage damage. These data were confirmed at the histological level by a strong correlation between Mankin score and grade of sclerosis ( r =0.7, p + , but not CD3 + , lymphocytes and CD68 + mononuclear (macrophage) and multinucleated (osteoclast) cells were present in subchondral marrow spaces. Notably, the number of CD20 + lymphocytes and CD68 + cells was significantly ( p p + cells in sclerotic bone. Finally, the number of CD68 + cells was strongly correlated ( p r =0.7), grade of sclerosis ( r =0.8), CD20 + lymphocytes ( r =0.8), and TRAP-positive cells ( r =0.9). Outgrowth cultures of subchondral bone showed cells of different morphologies including fibroblast-shaped osteoblasts and macrophage-like cells. Expression of ALP was detected in the prior, while TRAP expression was evident in the latter. Corresponding with histological analyses, the number of TRAP + cells was increased in ex vivo outgrowth cultures of sclerotic compared to non-sclerotic subchondral bone. Conclusions Together, our data suggest that osteoimmunological mechanisms, specifically the interaction of CD68 + macrophages with bone-resident cells, play a - previously unknown - role in regulating subchondral bone sclerosis in progressive OA. Targeting osteoimmunology might hold potential as a disease-modifying treatment for OA. Disclosure of Interest None Declared