Competitive Valerate Binding Enables RuO2-Mediated Butene Electrosynthesis in Water

The (non)-Kolbe oxidation of valeric acid, sourced from a hydrolysis product of cellulose, provides a sustainable synthetic route to access value-added products, such as butene. An essential mechanistic step preceding product formation involves the oxidative and decarboxylative cleavage of a C-C bond. Yet, the role of the electrode surface in mediating this oxidative step remains an open question: the electron transfer can occur either via an inner-sphere or outer-sphere mechanism. Here, we report the electrochemical, in situ spectroscopic, computational, and reactivity studies of RuO2-mediated oxidative decarboxylation of valeric acid to butene in aqueous electrolytes. We find that carboxylates bind to RuO2 anode surfaces at potential values where decarboxylation products are observed. Our results are consistent with a reaction scheme where the competitive and catalytic oxygen evolution reaction (OER) is impeded by these bound carboxylate species while these species are inert toward butene formation. Our results implicate an outer-sphere electron transfer mechanism for decarboxylation where the surface chemistry of the RuO2 electrode serves to enable higher non-Kolbe reaction selectivity by suppressing the parasitic OER. Our findings delineate interfacial design principles for selective electrochemical systems that utilize water as the ultimate oxidant for sustainable decarboxylation.

Improving Conversations about Parkinson's Dementia

BACKGROUND

People with Parkinson's disease (PD) have an increased risk of dementia, yet patients and clinicians frequently avoid talking about it due to associated stigma, and the perception that "nothing can be done about it". However, open conversations about PD dementia may allow people with the condition to access treatment and support, and may increase participation in research aimed at understanding PD dementia.

OBJECTIVES

To co-produce information resources for patients and healthcare professionals to improve conversations about PD dementia.

METHODS

We worked with people with PD, engagement experts, artists, and a PD charity to open up these conversations. 34 participants (16 PD; 6 PD dementia; 1 Parkinsonism, 11 caregivers) attended creative workshops to examine fears about PD dementia and develop information resources. 25 PD experts contributed to the resources.

RESULTS

While most people with PD (70%) and caregivers (81%) shared worries about cognitive changes prior to the workshops, only 38% and 30%, respectively, had raised these concerns with a healthcare professional. 91% of people with PD and 73% of caregivers agreed that PD clinicians should ask about cognitive changes routinely through direct questions and perform cognitive tests at clinic appointments. We used insights from the creative workshops, and input from a network of PD experts to co-develop two open-access resources: one for people with PD and their families, and one for healthcare professionals.

CONCLUSION

Using artistic and creative workshops, co-learning and striving for diverse voices, we co-produced relevant resources for a wider audience to improve conversations about PD dementia.

The underwater soundscape of the North Sea

As awareness on the impact of anthropogenic underwater noise on marine life grows, underwater noise measurement programs are needed to determine the current status of marine areas and monitor long-term trends. The Joint Monitoring Programme for Ambient Noise in the North Sea (JOMOPANS) collaborative project was funded by the EU Interreg to collect a unique dataset of underwater noise levels at 19 sites across the North Sea, spanning many different countries and covering the period from 2019 to 2020. The ambient noise from this dataset has been characterised and compared - setting a benchmark for future measurements in the North Sea area. By identifying clusters with similar sound characteristics in three broadband frequency bands (25-160 Hz, 0.2-1.6 kHz, and 2-10 kHz), geographical areas that are similarly affected by sound have been identified. The measured underwater sound levels show a persistent and spatially uniform correlation with wind speed at high frequencies (above 1 kHz) and a correlation with the distance from ships at mid and high frequencies (between 40 Hz and 4 kHz). Correlation with ocean current velocity at low frequencies (up to 200 Hz), which are susceptible to nonacoustic contamination by flow noise, was also evaluated. These correlations were evaluated and simplified linear scaling laws for wind and current speeds were derived. The presented dataset provides a baseline for underwater noise measurements in the North Sea and shows that spatial variability of the dominant sound sources must be considered to predict the impact of noise reduction measures.

Real-World Evaluation of the Feasibility, Acceptability and Safety of a Remote, Self-Management Parkinson's Disease Care Pathway: A Healthcare Improvement Initiative

BACKGROUND

There is significant unmet need for effective and efficiently delivered care for people with Parkinson's disease (PwP). We undertook a service improvement initiative to co-develop and implement a new care pathway, Home Based Care (HBC), based on supported self-management, remote monitoring and the ability to trigger a healthcare contact when needed.

OBJECTIVE

To evaluate feasibility, acceptability and safety of Home Based Care.

METHODS

We evaluated data from the first 100 patients on HBC for 6 months. Patient monitoring, performed at baseline and 6-monthly, comprised motor (MDS-UPDRS II and accelerometer), non-motor (NMSQ, PDSS-2, HADS) and quality of life (PDQ) measures. Care quality was audited against Parkinson's UK national audit standards. Process measures captured feasibility. Acceptability was assessed using a mixed-methods approach comprising questionnaires and semi-structured interviews.

RESULTS

Between October 2019 and January 2021, 108 PwP were enrolled onto HBC, with data from 100 being available at 6 months. Over 90% of all questionnaires were returned, 97% were complete or had < 3 missing items. Reporting and communications occurred within agreed timeframes. Compared with baseline, after 6m on HBC, PD symptoms were stable; more PwP felt listened to (90% vs. 79%) and able to seek help (79% vs. 68%). HBC met 93% of national audit criteria. Key themes from the interviews included autonomy and empowerment.

CONCLUSIONS

We have demonstrated acceptability, feasibility and safety of our novel remotely delivered Parkinson's care pathway. Ensuring scalability will widen its reach and realize its benefits for underserved communities, enabling formal comparisons with standard care and cost-effectiveness evaluation.

DNA Mismatch Repair Gene Variant Classification: Evaluating the Utility of Somatic Mutations and Mismatch Repair Deficient Colonic Crypts and Endometrial Glands

Germline pathogenic variants in the DNA mismatch repair (MMR) genes (Lynch syndrome) predispose to colorectal (CRC) and endometrial (EC) cancer. Lynch syndrome specific tumor features were evaluated for their ability to support the ACMG/InSiGHT framework in classifying variants of uncertain clinical significance (VUS) in the MMR genes. Twenty-eight CRC or EC tumors from 25 VUS carriers (6xMLH1, 9xMSH2, 6xMSH6, 4xPMS2), underwent targeted tumor sequencing for the presence of microsatellite instability/MMR-deficiency (MSI-H/dMMR) status and identification of a somatic MMR mutation (second hit). Immunohistochemical testing for the presence of dMMR crypts/glands in normal tissue was also performed. The ACMG/InSiGHT framework reclassified 7/25 (28%) VUS to likely pathogenic (LP), three (12%) to benign/likely benign, and 15 (60%) VUS remained unchanged. For the seven re-classified LP variants comprising nine tumors, tumor sequencing confirmed MSI-H/dMMR (8/9, 88.9%) and a second hit (7/9, 77.8%). Of these LP reclassified variants where normal tissue was available, the presence of a dMMR crypt/gland was found in 2/4 (50%). Furthermore, a dMMR endometrial gland in a carrier of an MSH2 exon 1-6 duplication provides further support for an upgrade of this VUS to LP. Our study confirmed that identifying these Lynch syndrome features can improve MMR variant classification, enabling optimal clinical care.

Implementation of the CAPABLE Program With Older Adults During the COVID-19 Pandemic

This study explores the implementation and impact of an evidence-based client-driven program, CAPABLE (Community Aging in Place Advancing Better Living for Elders), during the COVID-19 pandemic. The study reviews outcomes related to client engagement and retainment, client-directed goals, therapeutic intervention, home modifications, and functional outcomes of older adult participants. The CAPABLE program addresses basic and instrumental activities of daily living, medication use, pain, mobility, fall prevention, and environmental modifications within the home. The services were provided by an interprofessional team which included an occupational therapist, a registered nurse, and home contractor professional. The study team utilized descriptive, paired t test, and correlational analyses to evaluate the CAPABLE programs' influence on the functional outcomes of older adults living within the city of St. Louis, during the COVID-19 pandemic. This study identified significant improvement in instrumental activities of daily living (IADLs) independence, readiness to change, self-reported health status, and depressive symptoms, and 11 significant correlations were found between age, implementation expenses, and functional outcomes.

Telehealth Delivery of Evidence-Based Intervention Within Older Adult Populations: A Scoping Review

Telehealth services enable individuals to participate in meaningful occupations; however, the evidence on this topic has not been synthesized in older adult populations. This scoping review synthesized the evidence on interventions delivered through telehealth (and the mode of delivery) in occupational therapy for older adult populations. A search for studies on occupational therapy, older adults, and telehealth was performed in six research databases, and identified 536 articles. Four reviewers independently screened the titles and abstracts; and reviewed eligible full text. Ten articles were extracted into a table and summarized through narrative format. The studies focused on performance-based intervention (60%), cognition (10%), health (10%), occupation (10%), and the environment (10%) in older adult populations (N = 1 - 208); including those with Alzheimer's disease, chronic pain, cancer, and stroke. The interventions were delivered through electronic audio-visual platforms (e.g., zoom) (80%) and teleconference platforms (e.g., phone calls) (20%).

Identifying primary and secondary MLH1 epimutation carriers displaying low-level constitutional MLH1 methylation using droplet digital PCR and genome-wide DNA methylation profiling of colorectal cancers

BACKGROUND

MLH1 epimutation is characterised by constitutional monoallelic MLH1 promoter hypermethylation, which can cause colorectal cancer (CRC). Tumour molecular profiles of MLH1 epimutation CRCs were used to classify germline MLH1 promoter variants of uncertain significance and MLH1 methylated early-onset CRCs (EOCRCs). Genome-wide DNA methylation and somatic mutational profiles of tumours from two germline MLH1: c.-11C > T and one MLH1: c.-[28A > G; 7C > T] carriers and three MLH1 methylated EOCRCs (< 45 years) were compared with 38 reference CRCs. Methylation-sensitive droplet digital PCR (ddPCR) was used to detect mosaic MLH1 methylation in blood, normal mucosa and buccal DNA.

RESULTS

Genome-wide methylation-based Consensus Clustering identified four clusters where the tumour methylation profiles of germline MLH1: c.-11C > T carriers and MLH1 methylated EOCRCs clustered with the constitutional MLH1 epimutation CRCs but not with the sporadic MLH1 methylated CRCs. Furthermore, monoallelic MLH1 methylation and APC promoter hypermethylation in tumour were observed in both MLH1 epimutation and germline MLH1: c.-11C > T carriers and MLH1 methylated EOCRCs. Mosaic constitutional MLH1 methylation in MLH1: c.-11C > T carriers and 1 of 3 MLH1 methylated EOCRCs was identified by methylation-sensitive ddPCR.

CONCLUSIONS

Mosaic MLH1 epimutation underlies the CRC aetiology in MLH1: c.-11C > T germline carriers and a subset of MLH1 methylated EOCRCs. Tumour profiling and ultra-sensitive ddPCR methylation testing can be used to identify mosaic MLH1 epimutation carriers.

A tumor focused approach to resolving the etiology of DNA mismatch repair deficient tumors classified as suspected Lynch syndrome

Routine screening of tumors for DNA mismatch repair (MMR) deficiency (dMMR) in colorectal (CRC), endometrial (EC) and sebaceous skin (SST) tumors leads to a significant proportion of unresolved cases classified as suspected Lynch syndrome (SLS). SLS cases (n = 135) were recruited from Family Cancer Clinics across Australia and New Zealand. Targeted panel sequencing was performed on tumor (n = 137; 80×CRCs, 33×ECs and 24xSSTs) and matched blood-derived DNA to assess for microsatellite instability status, tumor mutation burden, COSMIC tumor mutational signatures and to identify germline and somatic MMR gene variants. MMR immunohistochemistry (IHC) and MLH1 promoter methylation were repeated. In total, 86.9% of the 137 SLS tumors could be resolved into established subtypes. For 22.6% of these resolved SLS cases, primary MLH1 epimutations (2.2%) as well as previously undetected germline MMR pathogenic variants (1.5%), tumor MLH1 methylation (13.1%) or false positive dMMR IHC (5.8%) results were identified. Double somatic MMR gene mutations were the major cause of dMMR identified across each tumor type (73.9% of resolved cases, 64.2% overall, 70% of CRC, 45.5% of ECs and 70.8% of SSTs). The unresolved SLS tumors (13.1%) comprised tumors with only a single somatic (7.3%) or no somatic (5.8%) MMR gene mutations. A tumor-focused testing approach reclassified 86.9% of SLS into Lynch syndrome, sporadic dMMR or MMR-proficient cases. These findings support the incorporation of tumor sequencing and alternate MLH1 methylation assays into clinical diagnostics to reduce the number of SLS patients and provide more appropriate surveillance and screening recommendations.

A tumor focused approach to resolving the etiology of DNA mismatch repair deficient tumors classified as suspected Lynch syndrome

Routine screening of tumors for DNA mismatch repair (MMR) deficiency (dMMR) in colorectal (CRC), endometrial (EC) and sebaceous skin (SST) tumors leads to a significant proportion of unresolved cases classified as suspected Lynch syndrome (SLS). SLS cases (n=135) were recruited from Family Cancer Clinics across Australia and New Zealand. Targeted panel sequencing was performed on tumor (n=137; 80xCRCs, 33xECs and 24xSSTs) and matched blood-derived DNA to assess for microsatellite instability status, tumor mutation burden, COSMIC tumor mutational signatures and to identify germline and somatic MMR gene variants. MMR immunohistochemistry (IHC) and MLH1 promoter methylation were repeated. In total, 86.9% of the 137 SLS tumors could be resolved into established subtypes. For 22.6% of these resolved SLS cases, primary MLH1 epimutations (2.2%) as well as previously undetected germline MMR pathogenic variants (1.5%), tumor MLH1 methylation (13.1%) or false positive dMMR IHC (5.8%) results were identified. Double somatic MMR gene mutations were the major cause of dMMR identified across each tumor type (73.9% of resolved cases, 64.2% overall, 70% of CRC, 45.5% of ECs and 70.8% of SSTs). The unresolved SLS tumors (13.1%) comprised tumors with only a single somatic (7.3%) or no somatic (5.8%) MMR gene mutations. A tumor-focused testing approach reclassified 86.9% of SLS into Lynch syndrome, sporadic dMMR or MMR-proficient cases. These findings support the incorporation of tumor sequencing and alternate MLH1 methylation assays into clinical diagnostics to reduce the number of SLS patients and provide more appropriate surveillance and screening recommendations.

Antenatal preventative pelvic floor muscle exercise intervention led by midwives to reduce postnatal urinary incontinence (APPEAL): protocol for a feasibility and pilot cluster randomised controlled trial

Background

Antenatal pelvic floor muscle exercises (PFME) in women without prior urinary incontinence (UI) are effective in reducing postnatal UI; however, UK midwives often do not provide advice and information to women on undertaking PFME, with evidence that among women who do receive advice, many do not perform PFME.

Methods

The primary aim of this feasibility and pilot cluster randomised controlled trial is to provide a potential assessment of the feasibility of undertaking a future definitive trial of a midwifery-led antenatal intervention to support women to perform PFME in pregnancy and reduce UI postnatally.

Community midwifery teams in participating NHS sites comprise trial clusters (n = 17). Midwives in teams randomised to the intervention will be trained on how to teach PFME to women and how to support them in undertaking PFME in pregnancy. Women whose community midwifery teams are allocated to control will receive standard antenatal care only.

All pregnant women who give birth over a pre-selected sample month who receive antenatal care from participating community midwifery teams (clusters) will be sent a questionnaire at 10–12 weeks postpartum (around 1400–1500 women). Process evaluation data will include interviews with midwives to assess if the intervention could be implemented as planned. Interviews with women in both trial arms will explore their experiences of support from midwives to perform PFME during pregnancy. Data will be stored securely at the Universities of Birmingham and Exeter.

Results will be disseminated through publications aimed at maternity service users, clinicians, and academics and inform a potential definitive trial of effectiveness. The West Midlands–Edgbaston Research Ethics Committee approved the study protocol.

Discussion

Trial outcomes will determine if criteria to progress to a definitive cluster trial are met. These include women’s questionnaire return rates, prevalence of UI, and other health outcomes as reported by women at 10–12 weeks postpartum. Progress to a definitive trial however is likely to be prevented in the UK context by new perinatal pelvic health service, although this may be possible elsewhere.

Trial registration

10.1186/ISRCTN10833250. Registered 09/03/2020

023 Evaluating a home-based care pathway for people with Parkinson’s disease

Background

Current care pathways for people with Parkinson’s (PwP) are not tailored to need. In line with the NHS Long Term Plan, together with PwP, we have co-developed, piloted and evaluated an innovative care pathway, ‘Home Based Care (HBC)’, based on supported self-management, triggered contacts and digitally-enabled remote monitoring.

Method

Evaluation was performed at baseline and 6-monthly of motor (UPDRS II and accelerometer) and non-motor (NMSQ, PDSS2, HADS) symptoms, acceptability and self-management efficacy. Care was audited using Parkinson’s UK national audit standards. Process measures captured feasibility.

Results

Data are available for 93 patients at baseline and 38 at 6m. Compared with baseline, after 6m on HBC, fewer PwP had uncontrolled bradykinesia (55.3% vs 63.4%), severe non-motor symptom burden (32.4% vs 50.6%), depression (2.9% vs 15.9%) and anxiety (17.1% vs 23.2%); median UPDRS II improved from 12.0 to 9.0; PwP felt more involved in care (70% vs 42%), listened to (72% vs 48%) and treated as an individual (81% vs 58%), as well as having increased PD understanding (57% vs 38%) and ability to self- manage (45% vs 34%). HBC met 93% of national audit criteria.

Conclusions

We have demonstrated acceptability, feasibility and effectiveness of our novel Parkinson’s care pathway.

e.king6@nhs.net|NIHR Bursary

Predicting the role of touchless technologies within diagnostic radiography: Results of an international survey

INTRODUCTION

The evolution of technology within healthcare is continuing at a rapid rate. Touchless technologies (i.e. those involving gestures and voice commands) are rapidly being integrated into daily life. The aim of this study was to investigate the potential role for such technologies within diagnostic radiography.

METHODS

An online survey was developed, piloted and deployed using SurveyMonkey as part of an online radiology congress. Eligible respondents were radiographers or radiologic technologists, including students. The survey covered ten themes relating to the potential role of touchless technologies within diagnostic radiography. Results were analysed using descriptive and inferential statistics.

RESULTS

155 people completed the questionnaire. 100 (64.9%) were women and clinical experience ranged from 13.5 (0-40) years. The majority, 54 (35.1%), had a Bachelor's degree with respondents being from 23 different countries (five continents). 34 (21.9%) respondents did not personally own nor intended to purchase touchless technologies. 89 (84.8%) respondents saw themselves using touchless technologies, if available on current imaging equipment. 25 (16.0%) respondents reported that they currently have access to touchless technologies within their workplace. 88 (81.5%) and 67 (65.0%) respondents reported that they saw voice and gesture controls as being key in improving exam efficiency.

CONCLUSION

Participants clearly perceived a role for touchless technologies within diagnostic radiography. Access to such technologies is not yet widely available within X-ray rooms. Voice activated technologies appear more appealing that gesture-based aids. The primary role for such technologies was defined by participants as focusing on improving examination efficiency.

IMPLICATIONS FOR PRACTICE

Touchless technologies have been identified and as important and potentially useful in diagnostic radiography. Collaboration between healthcare institutions, industry and academia is required to design and successfully implement these technologies into practice.

Making tiestalls more comfortable: III. Providing additional lateral space to improve the resting capacity and comfort of dairy cows

Dairy cows housed in tiestalls are restricted to one space; therefore, this space should be designed to accommodate all the activities cows need to perform. Lying is a very important behavior for dairy cows as well as a critical measure in the assessment of stall designs, to ensure that the cows' needs for resting space are met. The objective of this study was to determine if increasing tiestall width alters the lying behavior of lactating dairy cows. Two treatments were compared: the current recommendation (139 cm) and a double stall (284 cm). Sixteen cows were blocked by parity and lactation stage, then randomly allocated to a treatment and a stall within 1 of 2 rows in the research barn, for 6 wk. The average stall length was 188 cm. Leg-mounted accelerometers were used to record lying behaviors. Cows were video-recorded 24 h/wk using surveillance cameras positioned above the stalls. Video data from wk 1, 3, and 6 were extracted at a rate of 1 image/min and analyzed by a trained observer to assess the position and the location of the cow's body, head, and limbs during the lying hours. Lying behaviors and frequency of each position and location were analyzed in SAS (SAS Institute Inc., Cary, NC) using a mixed model in which treatment, block, and week were included as fixed factors, and cow and row as random factors. Multiple comparisons were adjusted using the Scheffé method. Results indicate that cows in double stalls fully extended their hindlimbs more often than single stall cows (21.7 vs. 7.6% of lying time). Cows in double stalls also intruded in the neighboring stalls with their hindlimbs less often (1.3 vs. 14.7% of lying time), instead positioning them inside their own stall more often (92.7 vs. 84.6% of lying time). Use of the second stall in the double stall group totaled 11.6, 5.1, 33.8, and 18.0% of lying time, respectively, for the head, front legs, hind legs, and body. Total lying time was not statistically different between double (716 min/d) and single stall (671 min/d) groups. Contacts with stall hardware during lying-down movements were also less frequent in double stalls (43.1 vs. 77.1% of lying events) compared with single stalls. These results suggest that dairy cows housed in double stalls modified their resting habits and used the extra space made available to them. Increasing stall width beyond the current recommendation is likely to benefit the cows by improving their ability to rest.

Several strategies for clinical partners and universities are perceived to enhance physiotherapy student engagement in non-metropolitan clinical placements: a mixed-methods study

QUESTION

What strategies can clinical partners and universities implement to enhance physiotherapy student engagement in non-metropolitan clinical placements?

DESIGN

Mixed-method research design combining focus groups and survey.

PARTICIPANTS

First-year physiotherapy students from one university at the commencement of their course (n=26); third-year and fourth-year students who had completed a non-metropolitan placement (n=39 survey, n=25 focus group); and clinical educators from three non-metropolitan clinical sites (n=15).

INTERVENTION

The cohort of first-year physiotherapy students was surveyed to establish their perceptions regarding non-metropolitan clinical education placements. A survey and four focus groups were conducted with third-year and fourth-year students after they had attended non-metropolitan clinical placements, to explore recent experiences. Two focus groups were conducted with clinical educators regarding student engagement at non-metropolitan placements. Quantitative data were summarised with descriptive statistics. Qualitative data were analysed using thematic analysis, synthesising the perspectives of students and clinical educators.

RESULTS

At the commencement of their physiotherapy course, interest in undertaking a non-metropolitan clinical placement was higher for students with a non-metropolitan upbringing. Concerns about attending non-metropolitan sites included finances, change in living situation, and perceived inferior quality of clinical education. After completing a non-metropolitan placement, four themes were identified in an analysis of student and educator perceptions: individual factors, clinical experience, logistical challenges and strategies for success.

CONCLUSION

Strategies that were perceived to enhance student engagement in non-metropolitan placements included: tailoring preparation for students, paired rather than individual placements, and near-peer presentations for physiotherapy students prior to undertaking non-metropolitan placements. Dedicated clinical coordinator positions at non-metropolitan sites and assistance in accessing affordable accommodation are likely to positively influence the student experience. [Francis-Cracknell A, Maver S, Kent F, Edwards E, Iles R (2017) Several strategies for clinical partners and universities are perceived to enhance physiotherapy student engagement in non-metropolitan clinical placements: a mixed-methods study. Journal of Physiotherapy 63: 243-249].