Clinical inter-professional education activities: Students’ perceptions of their experiences

Background and purposeStudents from different health disciplines should learn together during certain periods of their education to acquire skills necessary for solving the health problems. The Faculty of Health Sciences of University of the Witwatersrand created inter-professional education (IPE) activities for students to assess clinical IPE groups’ perceptions of IPE experiences and to identify lessons learnt during IPE sessions.MethodsThis was a qualitative study with review of the students’ post IPE feedback forms. The students were granted ‘protected time’ of three full days over a period of two months to participate in IPE activities.ResultsStudents felt that knowledge about health team members was gained and that IPE groups should have more than one person from each field with the same level of clinical exposure. The students indicated the need to have regular IPE activities and if possible to incorporate this into clinical practice for them to experience it in daily clinical practice. ConclusionParticipating in the IPE activity made students gain appreciation and respect for other health professionals’ roles and scope. When student groups are big, patient observations can be done as this does not compromise IPE learning outcomes. Group composition should be kept in mind to cater for the learning needs of all students. If it is not possible to meet the needs of all professions, smaller groups with professions applicable to case can be created

0188: Suboptimal control of low-density lipoprotein cholesterol in French patients after an acute coronary syndrome. Contemporary data from DYSIS IIACS study

AimTo document low-density lipoprotein cholesterol (LDL-C) values during hospitalization of ACS patients with/without lipid-lowering therapy (LLT) at admission, and achievement of the ESC LDL-C target (LDL-C≤70mg/dL) at 4 months following the acute event using data from the French cohort of the DYSIS IIACS study.MethodsDYSIS IIACS was a multicentre prospective observational cohort study (recruitment: Oct 2013 to Oct 2014) conducted in 24 coronary care units in France. Adults hospitalized for an ACS event and who had a lipid panel measured within 24 hours of admission were consecutively enrolled. Eligible patients had to be on LLT for≥3 months or taking no LLT. A telephone follow-up interview was carried out with patients (or their next of kin) 120±15 days after the index event.ResultsOf the 468 patients enrolled, 50.6% had ST-elevation myocardial infarction/left bundle branch block, 40.8% had non-ST-elevation myocardial infarction, and 8.5% had unstable angina. Of the 277 (59.2%) patients on LLT at admission, 25.3% had an LDL-C<70mg/dl (Table). Most patients (96.4%) were on statin therapy at discharge (mean+SD dose calculated in atorvastatin 49±28mg/day). Non-statin LLT was used in 5.6% patients at discharge (61.5% with a cholesterol-absorption inhibitor). At 120 days after admission, 50.9% of ACS patients with follow-up data had achieved the LDL-C target.ConclusionsThese observational data from contemporary French clinical practice in coronary care units indicate suboptimal LDL-C control, with a substantial proportion of very high cardiovascular risk patients presenting with elevated LDL-C despite taking LLT. Four months after the acute event, half of the patients (with data) failed to achieve the target, with a large difference between mean value and target LDL-C.Abstract 0188 – Table: Characteristics of and lipid values in ACS patients: during hospitalization and at 120 daysAll patients (n=468)LLT at admission (n=277)No LLT at admission (n=191)Age (years)65±1267±1261±12***Men80.178.083.2Diabetes type 221.827.413.6**Chronic kidney disease3.84.03.7Lipid variables (within 24 h of admission)LDL-C (mg/dL)110.6±43.493.6±36.4135.3±40.9***LDL<70mg/dL (%)16.925.34.7***Difference between mean and target values (mg/dL)52.1±38.337.0±32.169.3±37.5***Statin at hospital discharge96.497.594.8Lipid variables (120 days after admission)(n=159)(n=86)(n=73)LDL-C (mg/dL)76.1±31.179.7±31.171.9±30.7*LDL-C<70mg/dL50.941.961.6*Difference between mean and target values (mg/dL)29.7±25.828.0±26.532.6±24.7Data are mean±SD or %.*P<0.05**P?0.001**P?0.0001 (LLT vs no LLT

0191: Poor achievement of low-density lipoprotein cholesterol targets in French patients with stable coronary heart disease. Contemporary data from DYSIS II CHD study

AimWe sought to determine achievement of lipid targets according to current European guidelines (low-density lipoprotein cholesterol [LDL-C]≤70mg/dL) in patients with stable coronary heart disease (CHD) with or without lipid-lowering therapy (LLT), in the French cohort of the Dyslipidemia International Study IICHD (DYSIS IICHD).MethodsDYSIS IICHD was a multicentre observational cross-sectional study conducted from July 2013 to October 2014 in 27 centres in France. Adults with stable CHD (defined as≥1 of the following:>50% stenosis on coronary angiography or computed tomography, prior percutaneous coronary intervention, prior coronary bypass graft, history of ACS>3 months previously) and a fasting lipid profile done within the previous 12 months were consecutively enrolled. Eligible patients had to be on LLT for≥3 months or taking no LLT.ResultsA total of 436 CHD patients were enrolled. Of the 424 patients (97.2%) on LLT, 91.5% were on statin treatment at the moment of inclusion (mean±SD dose calculated in atorvastatin 27±23mg/day). Non-statin LLT was used in 17.7% patients (79.2% were on a cholesterol-absorption inhibitor). Mean±SD LDL-C was 87.4±30.5mg/dL, 28.4% achieved LDL-C<70mg/dL, and 67.7% had an LDL-C<100mg/dL (Table).Abstract 0191 – Table: Characteristics of lipid values in patients with stable CHDAll patients (n=436)LLT (n=424)No LLT (n=12)Age (years)69±1269±1274±12Men80.079.791.7ACS>3 months previously70.070.066.7Diabetes type 227.027.316.7Chronic kidney disease5.05.20Lipid variablesLDL-C (mg/dL)87.4±30.586.0±29.6135.3±24.5**LDL<70mg/dL28.429.20*Distance to target of<70mg/dL (mg/dL)31.1±24.229.7±23.265.3±24.5**LDL<100mg/dL67.769.38.3**Data are mean±SD or %.*P<0.05**P?0.0001 (LLT vs no LLT)ConclusionsThese observational data from contemporary clinical practice in France indicate suboptimal lipid control, with over two-thirds of high-risk CHD patients failing to achieve the LDL-C target despite taking LLT, and a large difference between mean value and target LDL-C. More-intensive treatment is required to optimize achievement of lipid goals in CHD

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Retrospective evaluation of whole exome and genome mutation calls in 746 cancer samples

Funder: NCI U24CA211006Abstract: The Cancer Genome Atlas (TCGA) and International Cancer Genome Consortium (ICGC) curated consensus somatic mutation calls using whole exome sequencing (WES) and whole genome sequencing (WGS), respectively. Here, as part of the ICGC/TCGA Pan-Cancer Analysis of Whole Genomes (PCAWG) Consortium, which aggregated whole genome sequencing data from 2,658 cancers across 38 tumour types, we compare WES and WGS side-by-side from 746 TCGA samples, finding that ~80% of mutations overlap in covered exonic regions. We estimate that low variant allele fraction (VAF < 15%) and clonal heterogeneity contribute up to 68% of private WGS mutations and 71% of private WES mutations. We observe that ~30% of private WGS mutations trace to mutations identified by a single variant caller in WES consensus efforts. WGS captures both ~50% more variation in exonic regions and un-observed mutations in loci with variable GC-content. Together, our analysis highlights technological divergences between two reproducible somatic variant detection efforts

Search for gravitational-lensing signatures in the full third observing run of the LIGO-Virgo network

Gravitational lensing by massive objects along the line of sight to the source causes distortions of gravitational wave-signals; such distortions may reveal information about fundamental physics, cosmology and astrophysics. In this work, we have extended the search for lensing signatures to all binary black hole events from the third observing run of the LIGO--Virgo network. We search for repeated signals from strong lensing by 1) performing targeted searches for subthreshold signals, 2) calculating the degree of overlap amongst the intrinsic parameters and sky location of pairs of signals, 3) comparing the similarities of the spectrograms amongst pairs of signals, and 4) performing dual-signal Bayesian analysis that takes into account selection effects and astrophysical knowledge. We also search for distortions to the gravitational waveform caused by 1) frequency-independent phase shifts in strongly lensed images, and 2) frequency-dependent modulation of the amplitude and phase due to point masses. None of these searches yields significant evidence for lensing. Finally, we use the non-detection of gravitational-wave lensing to constrain the lensing rate based on the latest merger-rate estimates and the fraction of dark matter composed of compact objects

Search for eccentric black hole coalescences during the third observing run of LIGO and Virgo

Despite the growing number of confident binary black hole coalescences observed through gravitational waves so far, the astrophysical origin of these binaries remains uncertain. Orbital eccentricity is one of the clearest tracers of binary formation channels. Identifying binary eccentricity, however, remains challenging due to the limited availability of gravitational waveforms that include effects of eccentricity. Here, we present observational results for a waveform-independent search sensitive to eccentric black hole coalescences, covering the third observing run (O3) of the LIGO and Virgo detectors. We identified no new high-significance candidates beyond those that were already identified with searches focusing on quasi-circular binaries. We determine the sensitivity of our search to high-mass (total mass M&gt;70 M⊙) binaries covering eccentricities up to 0.3 at 15 Hz orbital frequency, and use this to compare model predictions to search results. Assuming all detections are indeed quasi-circular, for our fiducial population model, we place an upper limit for the merger rate density of high-mass binaries with eccentricities 0&lt;e≤0.3 at 0.33 Gpc−3 yr−1 at 90\% confidence level