Pre-existing Database Research Articles

Evaluating macroinvertebrate metrics for ecological assessment of large saline rivers (Argentina).

Benthic macroinvertebrates have been used around the world as indicators of the biological quality of freshwater habitats. Because of the intensive deterioration of waterbodies as a result of different land uses, indicators are used for environmental monitoring, control and remediation. The aim of this study was to assess (1) the sensitivity of taxonomical metrics and (2) functional traits to select the most appropriate for evaluating environmental impacts on rivers with high salinity and (3) to propose a multimetric index based on the selected metrics. Information from a preexisting database on twenty-eight sites in the Salado River basin (Argentina) was used. One hundred and twenty-three metrics were calculated to assess sensitivity to different land uses along the gradient of habitat condition, from low-disturbed (reference), to medium-disturbed (agricultural and industrial) and high-disturbed (agricultural, industrial and urban). This gradient was defined by available information in original articles and by quantifying the percentage of the different land uses. Filtering collectors (%), Gathering collectors (%), Ostracoda density, Limnodrilus hoffmeisteri/Total density, Naididae (%), Tubifex/Total density and Pristina/Total density were the metrics that distinguished the different land uses along the gradient of habitat condition. These metrics were used to propose a macroinvertebrate multimetric index in saline rivers: Index of Benthic Invertebrates in Saline Rivers (IBIS). Thus, this study provides a useful tool for management and monitoring of saline rivers and diagnoses of salinized environments.

P117 Changes in prescription of home non-invasive ventilation (NIV) in Southern Adelaide Local Health Network (SALHN) from 2016 – 2020

Abstract Background Long term NIV is established therapy for patients with chronic type 2 respiratory failure (T2RF) due to neuromuscular disorders and obesity hypoventilation syndrome (OHS) without significant OSA. There is emerging evidence that COPD patients with T2RF also benefit from NIV. In our centre, there appears to be an increase in the prescription of long term NIV to patients over time, with 60% of all active long term NIV patients commencing therapy from 2017 onwards. In this study we will determine if (i) there has been increased provision of long term NIV to ward patients recovering from acute T2RF, (ii) there has been an increase in patients with COPD and T2RF commenced on long term NIV, (iii) there are patients with OHS and comorbid OSA who can be changed from NIV to CPAP and (iv) there is adequate follow up for patients who initiated NIV in the ward acutely. Methods Retrospective, observational study using a pre-existing database of all current and previous patients commenced on NIV from July 2016 to July 2020. Progress to date All active long term NIV patients have been identified and a database (n= 220) created containing all relevant information including date and place of NIV initiation and indication. Intended outcome and impact This audit will objectively assess the growth of our NIV service to facilitate better allocation of resources. It will also determine if our commencement and management of those on long term NIV is aligned with current evidence and best practice guidelines.

Maxillary incisor internal root anatomy evaluated by cone-beam computed tomography in a population of the Autonomous City of Buenos Aires, Argentina.

In the field of anthropology, discrete traits are considered as minimal epigenetic variations. However, they can elicit complications in endodontic therapy. Thorough understanding of root canal morphology is essential to achieving predictable results in endodontic practice, and may be attained by using cone-beam computed tomography (CBCT) scans. The aim of the present study was to research the internal root anatomy of maxillary central and lateral incisors in vivo and quantify its variation in a population of the Autonomous City of Buenos Aires, Argentina. A total 697 CBCT scans from a pre-existing database were observed, and the configuration type for each tooth was determined according to Vertucci's classification. The data were described by absolute frequencies and percentages with 95% confidence intervals (CI). The CI was estimated by the Wilson Score method. Chi-square test (χ2) was used for comparing frequencies, with a 5% significance level. 238 CBCT scans met the inclusion criteria, resulting in 761 teeth assessed. Vertucci Type I configuration was observed in 760 teeth (99.9%) and the Type II was found in only one tooth (0.1%), in which the anatomy was compatible with dens in dente. When differences were analyzed according to sex, all the teeth in all women had Vertucci Type I configuration. In men, all maxillary central incisors were Vertucci Type I. Of 151 maxillary lateral incisors, 150 had Vertucci Type I configuration (99.3%) and 1 had Type II (0.7%). Conclusions: Maxillary incisor internal root anatomy prevalence was estimated from CBCT scans for the first time in an Argentine population. 99.9% of the sample presented Vertucci Type I configuration, and 0.1% had Vertucci Type II configuration. The clinical finding of maxillary incisors with anatomical complexity should be considered as a possibility in endodontic practice.

P–715 Nomogram for anti-Mullerian hormone (AMH) and follicle-stimulating hormone (FSH) in healthy infertile women according to the cause of subfertility

Abstract Study question Does the cause of subfertility affect any age-related changes observed in anti-Mullerian hormone (AMH) and follicle-stimulating hormone (FSH)? Summary answer There was no significant effect of the cause of subfertility on AMH and FSH, however women with unexplained subfertility were significantly older than controls. What is known already Ovarian reserve and consequently female fecundity irreversibly diminish with age. Subfertility is an increasingly prevalent clinical presentation with a multitude of underlying pathologies. Ovarian reserve testing, including biomarkers, plays a crucial role in the management of subfertility, particularly in predicting ovarian response during in-vitro fertilisation (IVF) treatment. For some couples, no cause can be identified and their subfertility remains unexplained thus making prognosis and treatment challenging. It has been proposed that these couples may have an ovarian reserve at the extreme lower end of normal. Study design, size, duration: This clinical audit retrospectively investigated 864 subfertile healthy women who had undergone investigation at the Royal Derby Hospital fertility clinic. Data were collected in Excel including age, serum AMH, serum FSH if available, and subfertility diagnosis. The data were collected from a pre-existing database produced by a group of researchers pre–2016 at the Royal Derby Hospital. The researchers had access to pathology lab reports and computerised hospital records containing clinical details. Participants/materials, setting, methods: Subfertility diagnoses were categorised by cause: male factor and tubal factor were combined and served as a control group, oligo-anovulatory factor, endometriosis factor, and unexplained subfertility. If multiple factors were present, oligo-anovulation was taken as the presiding factor. One-way ANOVA using Minitab was used for statistical analysis to assess the effect of cause of subfertility on age, on AMH, and on FSH. For AMH and FSH, age was incorporated as a covariate. Main results and the role of chance AMH significantly decreased with age (p < 0.001) and FSH significantly increased with age (p < 0.05). The age-related change in AMH was more pronounced than in FSH. The cause of subfertility had a statistically significant effect on age. The nature of this was that the unexplained group was significantly older than the control group and the oligo-anovulatory group (p < 0.001). Compared to the control group, AMH was lower in the unexplained and endometriosis groups and higher in the oligo-anovulatory group. However, after adjusting for age, the effect of cause of subfertility on AMH was not significant (R2(adj)=24.91%, p > 0.05). Compared to the control group, FSH was lower in the unexplained, oligo-anovulatory, and endometriosis groups. However, after adjusting for age, the effect of cause of subfertility on FSH was not significant (R2(adj)=2.05%), p > 0.05). Limitations, reasons for caution The previous group of researchers may have exhibited selection bias and clinical interpretation during data collection. The study population was unevenly distributed across the different causes of subfertility. Only the effect of age was accounted for despite many factors being known to affect female fertility. Wider implications of the findings: Respective nomograms for AMH and FSH according to cause of subfertility provide a reference point for clinicians, especially to predict ovarian response during IVF treatment. Although AMH was not significantly lower in the unexplained group compared to the control group, the women were significantly older implying a lower ovarian reserve. Trial registration number Not applicable

The Relationship between Gestational Diabetes Metabolic Control and Fetal Autonomic Regulation, Movement and Birth Weight

(1) Background: Maternal metabolic control in gestational diabetes is suggested to influence fetal autonomic control and movement activity, which may have fetal outcome implications. We aimed to analyze the relationship between maternal metabolic control, fetal autonomic heart rate regulation, activity and birth weight. (2) Methods: Prospective noninterventional longitudinal cohort monitoring study accompanying 19 patients with specialist clinical care for gestational diabetes. Monthly fetal magnetocardiography with electro-physiologically-based beat-to-beat heart rate recording for analysis of heart rate variability (HRV) and the ‘fetal movement index’ (FMI) was performed. Data were compared to 167 healthy pregnant women retrieved from our pre-existing study database. (3) Results: Fetal vagal tone was increased with gestational diabetes compared to controls, whereas sympathetic tone and FMI did not differ. Within the diabetic population, sympathetic activation was associated with higher maternal blood-glucose levels. Maternal blood-glucose levels correlated positively with birth weight z scores. FMI showed no correlation with birth weight but attenuated the positive correlation between maternal blood-glucose levels and birth weight. (4) Conclusion: Fetal autonomic control is altered by gestational diabetes and maternal blood-glucose level, even if metabolic adjustment and outcome is comparable to healthy controls.

Predicting One's Turn With Both Body and Mind: Anticipatory Speech Postures During Dyadic Conversation.

In natural conversation, turns are handed off quickly, with the mean downtime commonly ranging from 7 to 423 ms. To achieve this, speakers plan their upcoming speech as their partner’s turn unfolds, holding the audible utterance in abeyance until socially appropriate. The role played by prediction is debated, with some researchers claiming that speakers predict upcoming speech opportunities, and others claiming that speakers wait for detection of turn-final cues. The dynamics of articulatory triggering may speak to this debate. It is often assumed that the prepared utterance is held in a response buffer and then initiated all at once. This assumption is consistent with standard phonetic models in which articulatory actions must follow tightly prescribed patterns of coordination. This assumption has recently been challenged by single-word production experiments in which participants partly positioned their articulators to anticipate upcoming utterances, long before starting the acoustic response. The present study considered whether similar anticipatory postures arise when speakers in conversation await their next opportunity to speak. We analyzed a pre-existing audiovisual database of dyads engaging in unstructured conversation. Video motion tracking was used to determine speakers’ lip areas over time. When utterance-initial syllables began with labial consonants or included rounded vowels, speakers produced distinctly smaller lip areas (compared to other utterances), prior to audible speech. This effect was moderated by the number of words in the upcoming utterance; postures arose up to 3,000 ms before acoustic onset for short utterances of 1–3 words. We discuss the implications for models of conversation and phonetic control.

Media Forensics Considerations on DeepFake Detection with Hand-Crafted Features.

DeepFake detection is a novel task for media forensics and is currently receiving a lot of research attention due to the threat these targeted video manipulations propose to the trust placed in video footage. The current trend in DeepFake detection is the application of neural networks to learn feature spaces that allow them to be distinguished from unmanipulated videos. In this paper, we discuss, with features hand-crafted by domain experts, an alternative to this trend. The main advantage that hand-crafted features have over learned features is their interpretability and the consequences this might have for plausibility validation for decisions made. Here, we discuss three sets of hand-crafted features and three different fusion strategies to implement DeepFake detection. Our tests on three pre-existing reference databases show detection performances that are under comparable test conditions (peak AUC > 0.95) to those of state-of-the-art methods using learned features. Furthermore, our approach shows a similar, if not better, generalization behavior than neural network-based methods in tests performed with different training and test sets. In addition to these pattern recognition considerations, first steps of a projection onto a data-centric examination approach for forensics process modeling are taken to increase the maturity of the present investigation.

Abstract LB227: Automated image registration and alignment facilitates assessment of change in pigmented lesions of patients at risk for melanoma

Abstract Introduction: Melanoma develops either de novo or from non-obligate precursor lesions known as atypical/dysplastic nevi. Assessment of change in number and morphology of pigmented cutaneous lesions over time is critical to early detection of skin cancers and may provide preliminary signals of efficacy in early phase therapeutic prevention trials for melanoma. Despite the use of total body digital photography for at least 20 years to document the presence of these lesions, as well as recent progress in computer-aided diagnosis of lesions in clinical images, automated methods to characterize the evolution of skin lesions are still lacking. The purpose of this study was to develop and validate a computer vision approach to facilitate detection and quantification of changes in nevi in serial digital photographs. Methods: The ‘DermaViz' mathematical algorithms were developed to register nevi between sequential images and to align images for improved comparison. The technique is based on the bispectrum algorithm, modified to adapt for human skin changes. Adaptive normalization techniques adjust for lighting and skin tone variations. Warping and shear of skin are accommodated by a hierarchical iteration of these algorithms coupled with probabilistic matching techniques for accurate alignment. The technology allows both for improved qualitative comparison by clinicians when the aligned images are toggled between dates, and for digital quantification of changes in (a)symmetry, (b)order, (c)olor, and (d)iameter of the lesions. In this pilot study, serial posterior truncal photographs from 17 patients with multiple atypical nevi and a history of melanoma were obtained from a pre-existing image and nevus biobanking protocol database at our institution. De-identified images were processed and analyzed with DermaViz software, and results were validated by a panel of Melanoma Program clinicians. Results: DermaViz software had a high sensitivity for detection of cutaneous lesions as small as 2mm, which was limited by the quality of the archival photographs. The software registered specific nevi accurately in most cases, with sight errors in a small number of lesions that were primarily located at the edges of the images. In the 17-patient pilot study, registration and alignment of serial images enabled clinicians to identify new and enlarged nevi in 3 to 11 additional patients vs the unregistered images. Quantification with DermaViz correlated with physician assessment of new and enlarged nevi in 90% of evaluated lesions. Conclusion: Software has been designed, applied, and validated that dramatically improves detection of changes in nevi over time and enables quantification of these changes. It helped clinicians to identify numerous changes that were missed in the original unregistered images. We plan to incorporate an expanded ruler and color balance tape in future photographs for improved analyses of border, color, and size changes. Dermaviz will be used in a planned Phase II trial of sulforaphane for therapeutic prevention of melanoma (EA6201). Citation Format: William F. Maguire, Paul H. Haley, Catherine M. Dietz, Mike Hoffelder, Clara S. Brandt, Robin Joyce, Melissa D. Wilson, Darcy Ploucha, Christopher Minnier, Cindy Sander, Hong Wang, Hassane M. Zarour, Kevin J. Mitchell, Ellen K. Hughes, John M. Kirkwood. Automated image registration and alignment facilitates assessment of change in pigmented lesions of patients at risk for melanoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr LB227.

METTL14 promotes tumorigenesis by regulating lncRNA OIP5-AS1/miR-98/ADAMTS8 signaling in papillary thyroid cancer

BackgroundPapillary thyroid cancer (PTC) is the most common type of cancer of the endocrine system. Long noncoding RNAs (lncRNAs) are emerging as a novel class of gene expression regulators associated with tumorigenesis. Through preexisting databases available for differentially expressed lncRNAs in PTC, we uncovered that lncRNA OIP5-AS1 was significantly upregulated in PTC tissues. However, the function and the underlying mechanism of OIP5-AS1 in PTC are poorly understood.MethodsExpression of lncRNA OIP5-AS1 and miR-98 in PTC tissue and cells were measured by quantitative real-time PCR (qRT-PCR). And expression of METTL14 and ADAMTS8 in PTC tissue and cells were measured by qRT-PCR and western blot. The biological functions of METTL14, OIP5-AS1, and ADAMTS8 were examined using MTT, colony formation, transwell, and wound healing assays in PTC cells. The relationship between METTL14 and OIP5-AS1 were evaluated using RNA immunoprecipitation (RIP) and RNA pull down assay. And the relationship between miR-98 and ADAMTS8 were examined by luciferase reporter assay. For in vivo experiments, a xenograft model was used to investigate the effects of OIP5-AS1 and ADAMTS8 in PTC.ResultsFunctional validation revealed that OIP5-AS1 overexpression promotes PTC cell proliferation, migration/invasion in vitro and in vivo, while OIP5-AS1 knockdown shows an opposite effect. Mechanistically, OIP5-AS1 acts as a target of miR-98, which activates ADAMTS8. OIP5-AS1 promotes PTC cell progression through miR-98/ADAMTS8 and EGFR, MEK/ERK pathways. Furthermore, RIP and RNA pull down assays identified OIP5-AS1 as the downstream target of METTL14. Overexpression of METTL14 suppresses PTC cell proliferation and migration/invasion through inhibiting OIP5-AS1 expression and regulating EGFR, MEK/ERK pathways.ConclusionsCollectively, our findings demonstrate that OIP5-AS1 is a METTL14-regulated lncRNA that plays an important role in PTC progression and offers new insights into the regulatory mechanisms underlying PTC development.

Supervised topic modeling for predicting molecular substructure from mass spectrometry

Small-molecule metabolites are principal actors in myriad phenomena across biochemistry and serve as an important source of biomarkers and drug candidates. Given a sample of unknown composition, identifying the metabolites present is difficult given the large number of small molecules both known and yet to be discovered. Even for biofluids such as human blood, building reliable ways of identifying biomarkers is challenging. A workhorse method for characterizing individual molecules in such untargeted metabolomics studies is tandem mass spectrometry (MS/MS). MS/MS spectra provide rich information about chemical composition. However, structural characterization from spectra corresponding to unknown molecules remains a bottleneck in metabolomics. Current methods often rely on matching to pre-existing databases in one form or another. Here we develop a preprocessing scheme and supervised topic modeling approach to identify modular groups of spectrum fragments and neutral losses corresponding to chemical substructures using labeled latent Dirichlet allocation (LLDA) to map spectrum features to known chemical structures. These structures appear in new unknown spectra and can be predicted. We find that LLDA is an interpretable and reliable method for structure prediction from MS/MS spectra. Specifically, the LLDA approach has the following advantages: (a) molecular topics are interpretable; (b) A practitioner can select any set of chemical structure labels relevant to their problem; (c ) LLDA performs well and can exceed the performance of other methods in predicting substructures in novel contexts.

Morphological and Genetic Divergence within the Phymaturus payuniae Clade (Iguania: Liolaemidae), with the Description of Two New Species

The Phymaturus payuniae clade is an endemic group of lizards inhabiting rocky outcrops of central western Argentina. All recognized species are found in an area of endemism called “Payunia.” Recent studies using morphological data and DNA markers found that the payuniae clade comprises at least 10 terminal taxa. In the present study, we revisited the morphology of all previously considered terminals and analyzed two new populations discovered in Neuquen province in 2005 and 2016. The revised character list allowed us to score morphological characters for several taxa whose morphologies were unknown prior to this study. In the present study, we sequenced ND4 for three terminals (completing other sequences available for these taxa), and Cytb, COI, 12S, and C-mos for one terminal (for which no DNA data had been reported). We then added these sequences to the pre-existing DNA databases for the genus. We estimated genetic distances for three mitochondrial markers among all members of the clade and calculated the evolutionary lability of morphological characters for the whole patagonicus group. Variation of 26 continuous characters was analyzed with Principal Component Analysis for all members of the payuniae clade and species of other clades of the patagonicus and palluma group. Additionally, we revised genital characters for all members of the group and included a description of the new taxa's hemipenial morphology. Considering the distribution of morphological characters among species, their genetic distances, different genital morphology, and the phylogenetic structure inferred, we are able to support the taxonomic status of all species of the group and add the formal description of two new species.

Liver transplantation in adult polycystic liver disease: the Ontario experience

BackgroundLiver transplantation (LT) remains the curative treatment for symptomatic Polycystic Liver Disease (PCLD) patients and is associated with excellent survival rates. The aim of the study is to review the Ontario experience in LT for PCLD.MethodsA retrospective study was performed from pre-existing LT databases from the LT Units at Toronto General Hospital and London Health Sciences Center, which are the two LT programs in Ontario, Canada. This database contains demographic, clinical parameters and follow-up of all patients transplanted for PCLD. Data was extracted for patients who underwent LT between January 2000–April 2017 and included follow up until December 31st, 2018.ResultsA total of 3560 patients underwent LT, of whom 51 (1.4%) had PCLD and met inclusion criteria. 43 (84%) of these patients were female. The median physiologic Model for End Stage Liver Disease (MELD-Na) score at time of referral was 13 (IQR = 7–22), however all patients required MELD-Na exception points to receive LT. The median age of transplant was 62 years (IQR = 59–64) for male vs. 52 (IQR = 45–56) for female patients. 33 (65%) of our cohort had PCLD while 9 (17.5%) had ADPKD and 9 (17.5%) had both diseases. 39 (76%) had LT due to symptoms of mass effect, while 8 (16%) had portal hypertensive complications. After a median follow-up of 6.3 (IQR = 2.9–12.5) years, the probability of survival was 96% (95% CI: 90%, 100%). Log-rank test, comparing survival analysis between males and females did not show a statistically significant difference (p = 0.26).ConclusionMost patients underwent LT for PCLD due to symptoms of mass effect with women being more likely than men to undergo LT. LT for PCLD had excellent long-term survival.

Childhood-onset of primary Sjögren's syndrome: phenotypic characterization at diagnosis of 158 children.

To characterize the phenotypic presentation at diagnosis of childhood-onset primary SS. The Big Data Sjögren Project Consortium is an international, multicentre registry using worldwide data-sharing cooperative merging of pre-existing clinical SS databases from the five continents. For this study, we selected those patients in whom the disease was diagnosed below the age of 19 years according to the fulfilment of the 2002/2016 classification criteria. Among the 12 083 patients included in the Sjögren Big Data Registry, 158 (1.3%) patients had a childhood-onset diagnosis (136 girls, mean age of 14.2 years): 126 (80%) reported dry mouth, 111 (70%) dry eyes, 52 (33%) parotid enlargement, 118/122 (97%) positive minor salivary gland biopsy and 60/64 (94%) abnormal salivary US study, 140/155 (90%) positive ANA, 138/156 (89%) anti-Ro/La antibodies and 86/142 (68%) positive RF. The systemic EULAR Sjögren's syndrome disease activity index (ESSDAI) domains containing the highest frequencies of active patients included the glandular (47%), articular (26%) and lymphadenopathy (25%) domains. Patients with childhood-onset primary SS showed the highest mean ESSDAI score and the highest frequencies of systemic disease in 5 (constitutional, lymphadenopathy, glandular, cutaneous and haematological) of the 12 ESSDAI domains, and the lowest frequencies in 4 (articular, pulmonary, peripheral nerve and CNS) in comparison with patients with adult-onset disease. Childhood-onset primary SS involves around 1% of patients with primary SS, with a clinical phenotype dominated by sicca features, parotid enlargement and systemic disease. Age at diagnosis plays a key role in modulating the phenotypic expression of the disease.

Anterior Skull Base Sarcomas: Report of Characteristics and Outcomes at a Tertiary Care Cancer Center.

Objective This study was aimed to describe our institutional experience on characteristics and treatment outcomes of sinonasal sarcomas invading the anterior skull base. Design Present study is a retrospective review. Setting The study was conducted at an academic cancer care center. Participants Thirty-one patients with skull base sarcomas treated with primary surgery from 1979 to 2015 were identified for this study from a preexisting database. Main Outcome Measures Survival and recurrence outcomes using the Kaplan-Meier method were the focus areas of the study. Results The median age was 44 years (range: 13-69 years). Twenty patients were male (64.5%). Twenty-nine patients underwent open craniofacial resection (93.5%) and two patients underwent endoscopic resection (6.5%). The majority of tumors were staged pT4 (77.4%). The most common pathologies were leiomyosarcoma (19.4%), osteosarcoma (16.1%), and chondrosarcoma (12.9%). Of those with known margin status, 10 patients had positive/close margins (32.2%) and 16 patients had negative margins (51.6%). Most tumors were high grade (74.2%). Twenty-three patients (74.2%) received adjuvant radiation and four patients (12.9%) received adjuvant chemotherapy. There were nine postoperative complications (29%) including one mortality and three cerebrospinal fluid leaks. There were 10 local, 2 regional, and 5 distant recurrences over a median follow-up of 74 months (range: 1-300 months). The 5-year disease-specific survival (DSS) was 69.8%. The 5-year locoregional recurrence-free probability (RFP) was 63.2% and the 10-year distant RFP was 71.7%. The 5-year DSS for high grade tumors was 64.2 and 85.7% for low grade tumors ( p = 0.117). Conclusion This study contributes an updated analysis of anterior skull base sarcomas. Five-year DSS is approximately 70%. Analysis of survival outcomes based on grade, tumor size, and other factors is limited by small sample size and the rarity of these tumors.

Patterns of urgent hoarseness referrals to ENT-When should we be suspicious of cancer?

Current UK referral criteria stipulate that hoarseness should be persistent to merit 2week wait (2WW) or urgent suspicion of cancer (USOC) referral. This study delineates patterns of hoarseness presentation with a view to assisting referral pathways, and whereby reassurance could be provided. A pre-existing database of patients referred with hoarseness under the urgent suspicion of cancer (USOC) category was analysed. Univariate and multivariate analyses were performed on a variety of demographic and comorbid features to produce odds ratios (OR) of features either related or not related to laryngeal cancer. Of 698 consecutive hoarseness referrals were studied. In these referrals there were 506(73%) with persistent hoarseness and 192(27%) with intermittent hoarseness. The most significant patient variables related to laryngeal cancer were persistent hoarseness (OR 4.97), recreational drug use (OR 4.94), male gender (OR 4.01) and weight loss (OR 3.75). Significant patient variables present not related to laryngeal cancer diagnosis were intermittent hoarseness (OR 0.2), the presence of cough (OR 0.2), globus sensation (OR 0.25) and recent viral infection (OR 0.29). The strongest association with cancer is seen in patients that are persistently hoarse. Patients with fluctuating hoarseness do not need an "urgent suspicion of cancer" referral. Additional demographic referral information could help to streamline the referral of these patients, and reassure others.

Hot off the press: SGEM#308: Taking care of patients every day with physician assistants and nurse practitioners.

The role of advanced practice providers (APPs) in emergency medicine is evolving over time, with increased patient visits seen by physician assistants and nurse practitioners, as well as higher acuity patients. Little data exists regarding the impact of APPs on productivity, flow, and safety in the emergency department setting. We discuss a study by Pines et al in the December issue of Academic Emergency medicine, in which they evaluate the effect of APPs on productivity, safety, and flow of patients in a large, multicenter emergency medicine group. We provide critical evaluation and commentary, and highlight social media discussion.

Why Black and Brown Youth Fear and Distrust Police: An Exploration of Youth Killed by Police in the US (2016/2017), Implications for Counselors and Service Providers

Black and Brown youth homicides by police remain a public health epidemic. Such occurrences can contribute to these youth’s fear and distrust toward officers. The purpose of this manuscript was to provide evidence of why Black and Brown youth fear and distrust police, and to discuss implications for counselors and service providers who work with survivors of youth killings by police. Using a preexisting database, this work explored the frequency of youth killings by police in 2016/2017. Descriptive statistics were used for data analysis. Results revealed that 116 youth were killed by police. Black males were killed four times more often than Brown and White males, and White females were killed four times more often than Black females. Recommendations for government and judicial services, along with youth activists and mental health care providers, are discussed.

A single-center experience in observation of small pancreatic neuroendocrine tumors: to operate or not to operate?

Presenter: Ariana Naaseh BA | University of California, Irvine Background: Pancreatic neuroendocrine tumors (pNET), particularly non-functioning, have gained recent attention due to their malignant transformation potential. The 2019 National Comprehensive Cancer Network (NCCN) Guidelines state optimal management of larger, invasive, or node positive pNET is surgical resection. For small (less than or equal to 2 cm) primary non-metastatic non-functioning pNET observation is recommended in select cases, usually when the tumor is low grade and < 1 cm in size. Decisions to proceed with surveillance versus resection include both consideration of surgical risk and patient co-morbidities as either distal pancreatectomy with or without splenectomy or pancreatoduodenectomy are not without complications. Our study aims to assess whether conservative, non-operative management of small, low-grade non-functioning pNETs is appropriate. Methods: A retrospective review of all patients with a diagnosis of pNET since 2004 referred to our high-volume multidisciplinary hepato-pancreato-biliary center was conducted. Patients with pNET were identified from pre-existing institutional hepato-biliary service database and confirmed via chart review of consultations and follow-up visits, radiologic imaging, and pathology reports. Results: 126 patients were found to have the diagnosis of biopsy-proven pNET. 8 patients were found to have metastatic disease at time of presentation and were excluded from further analysis. Of the 118 patients analyzed, 26 (22.0%) had functioning lesions and 92 (77.9%) non-functioning lesions. All 26 patients with biopsy-proven functioning lesions underwent surgical resection. Of 92 biopsy-proven non-functioning lesions, 36 had lesions less than or equal to 2.0 cm. Of these 36 patients, 31 were observed and 5 underwent an attempt at surgical resection. All 5 operative patients had biopsy-proven Grade 3 lesions. Two of the 5 operative patients were found to have intra-operative metastasis not detected on pre-operative imaging and subsequent resection procedure was aborted. Of the 31 observed patients, 20 (64.5%) were Grade 1 and 11 (35.5%) Grade 2. 10 of the 31 patients (32.2%) had tumor size < 1 cm. The mean follow-up time in months for patients who were observed with lesions less than or equal to 2.0 cm is 27.24 months. Of 31 patients, 24 presented with consistently stable disease on follow up imaging, 7 presented with decreased disease burden (defined as reduction in size or complete absence) and none presented with disease expansion. Of the 7 patients with decreased disease, 5/7 (71.4%) presented with no evidence of pancreatic disease on imaging, despite previous biopsy proven and radiographic proven evidence of disease. Three patients observed with lesions less than or equal to 2 cm died during follow-up, however mortality was not secondary to pNET progression or malignancy. No patients in the non-operative group underwent surgical resection at any time during the follow-up surveillance period. Conclusion: Our retrospective study demonstrates that observation is appropriate for low grade pNET tumors < 1cm, consistent with NCCN guidelines. Additionally, we demonstrate that close observation rather than surgical resection can be considered for non-functioning grade 1 or 2 pNET tumors less than or equal to 2cm, while grade 3 lesions should proceed with surgical resection. Further study is needed to guide standardized management recommendations.

Finding out fast about the impact of Covid-19: The need for policy-relevant methodological innovation.

In this viewpoint we explore one joint research initiative in Bangladesh to illustrate how methodological innovations using mobile phone technologies and pre-existing survey databases can generate rapid and insightful data on the impacts of the Covid-19 pandemic with significant policy influence. Situating this innovation within theoretical and methodological antecedents for rapid appraisal, we show how strong local ownership can facilitate innovation, rapid research and strong policy engagement amidst even the most difficult research conditions. Such rapid surveys and analysis must remain a research priority in times of crisis. Academic researchers in partner organisations further afield must ask important questions around how they can best support such locally-led research initiatives: in preparing for, analysing or writing up the research or in joining efforts to communicate them to wider communities of policy-makers and practitioners globally.

Data curation-research: practices of data standardization and exploration in a precision medicine database

Key to precision medicine is the development of expert database projects that gather data, integrate them in the pre-existing database, and publish the product of their processing for others to make use of. Increasingly, it is required that data infrastructure managers and curators pursue and lead research projects on the data so as to learn about new ways data could be used or information that could be potentially generated from them. I call these efforts “data curation-research” and use the case study of COSMIC, the Catalogue of Somatic Mutations in Cancer, to analyze the contextual factors shaping the science of data curation-research. I build on March’s organizational learning categories of exploitation and exploration to place these factors within a theory of organizational change and innovation, and contribute to a richer picture of the social drivers of cancer genomics.