Efficacy and safety of a non-mineral oil adjuvanted injectable vaccine for the protection of Atlantic salmon (Salmo salar L.) against Flavobacterium psychrophilum

Flavobacterium psychrophilum is the causative agent of Rainbow Trout Fry Syndrome which has had a major impact on global salmonid aquaculture. Recent outbreaks in Atlantic salmon in Scotland and Chile have added to the need for a vaccine to protect both salmon and trout. At present no licensed vaccines are available in Europe, leaving antibiotics as the only course of action to contain disease outbreaks. Outbreaks generally occur in fry at temperatures between 10 and 15 °C. Recently outbreaks in larger fish have given added impetus to the development of a vaccine which can provide long term protection from this highly heterogeneous pathogen. Most fish injectable vaccines are formulated with oil emulsion adjuvants to induce strong and long lasting immunity, but which are known to cause side effects. Alternative adjuvants are currently sought to minimise these adverse effects. The current study was performed to assess the efficacy of a polyvalent, whole cell vaccine containing formalin-inactivated F. psychrophilum to induce protective immunity in Atlantic salmon. The vaccine was formulated with an adjuvant containing squalene and aluminium hydroxide, and was compared to a vaccine formulated with a traditional oil adjuvant, Montanide ISA 760VG, and a non-adjuvanted vaccine. Duplicate groups of salmon (23.5 ± 6.8 g) were vaccinated with each of the vaccine formulations or phosphate buffered saline by intraperitoneal injection. Fish were challenged by intramuscular injection with F. psychrophilum six weeks post-vaccination to test the efficacy of the vaccines. Cumulative mortality reached 70% in the control salmon, while the groups of salmon that received vaccine had significantly lower mortality than the controls (p = 0.0001), with no significant difference in survival between vaccinated groups. The squalene/alum adjuvant was safe, more readily metabolised by the fish and induced less histopathological changes than the traditional oil adjuvant.

Epidemiological Study on Factor VII, Factor VIII and Fibrinogen in an Industrial Population - II. Baseline Data on the Relation to Blood Pressure, Blood Glucose, Uric Acid, and Lipid Fractions

In a preceding paper the baseline data in the Munster Arteriosclerosis Study (PROCAM study) of the levels of fibrinogen, factor VIIc and factor VIIIc were described, and their correlation of age, body weight, smoking, alcohol, pill-using and menopause discussed. In this part the relationship of these coagulation factors to blood pressure, blood glucose, uric acid and lipid parameters, which were examined in 4186 apparently healthy individuals, is presented. The correlations are described using two different statistical models, first the Pearson correlation coefficients after allowing each clotting factor for the effects of age, cigarette and alcohol consumption, body weight, menopausal state, pill using and the other clotting factors, and secondly by a multiple regression analysis. The data suggest that there are multiple interrelationships between hemostatic factors and the variables under consideration. The most striking positive correlations were found for factor VII c to blood glucose and triglycerides in men and women and to HDDcholesterol in women.

Does 'hacking' surface type affect equine forelimb foot placement, movement symmetry or hoof impact deceleration during ridden walk and trot exercise?

BACKGROUND

Both pleasure and competition horses regularly exercise on surfaces such as tarmac, gravel and turf during 'hacking'. Despite this, there is limited evidence relating to the effect of these surfaces upon foot-surface interaction.

OBJECTIVES

To investigate forelimb foot placement, hoof vibration and movement symmetry in pleasure horses on three commonly encountered hacking surfaces.

STUDY DESIGN

Quantitative gait study in a convenience sample.

METHODS

Six horses regularly partaking in hacking exercise were ridden in walk and trot on all surfaces. Horses were equipped with one hoof-mounted, accelerometer and four body-mounted inertial measurement units (IMUs) to measure foot impact and movement symmetry. High-speed (400 FPS) video footage of foot-placement was acquired (dorsal, palmar, lateral views). Foot-impact and movement symmetry were analysed with a mixed effects model and Bowker symmetry tests for foot-placement analysis.

RESULTS

Vibration power and frequency parameters increase as perceived surface firmness increases from grass, to gravel, to tarmac (P≤0.001). Vibration power parameters were consistently greater at trot compared with walk (P≤0.001), but the same was not true for vibration frequency (P≥0.2). Greatest movement asymmetry was recorded during grass surface trotting. No significant difference in foot-placement was detected between the three surfaces.

MAIN LIMITATIONS

This was a field study using three commonly encountered hacking surfaces. Surface properties change easily with water content and temperature fluctuations so care must be taken when considering other similar surfaces, especially at different times of the year. Six leisure horses were used so the results may not be representative of horses of all types.

CONCLUSIONS

Vibration parameters generally increase as perceived surface firmness increases. Increasing speed alters vibration power but not frequency. Further investigations are required to determine the role that this may play in the development of musculoskeletal disease in horses.

Nurses' perceptions of personal attributes required when working with people with a learning disability and an offending background: a qualitative study

WHAT IS KNOWN ON THE SUBJECT?: Learning disability nursing in the area of people with a learning disability and an offending background has developed considerably over recent years, particularly since the publication of the Bradley (). There has been limited work into the competencies nurses require to work in this area, and even less about the personal attributes of learning disability nurses. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Learning disability nursing's specific contribution to the care of this population lies in their knowledge of the interaction between the learning disability, an individual's, sometimes abusive, personal history and an understanding of the subsequent offending behaviour. The knowledge base of nurses working with people with learning disabilities and an offending background needs to reflect the changing service user group. This is particularly in relation to substance misuse, borderline personality disorder, and mental health and the way such factors inter-relate with the learning disability. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Further research is required into the relationship among decision making, risk taking or reluctance to do this, and the personal attributes required by nurses to work in secure learning disability care. Learning disability secure services are likely to continue to undergo change as circumstances alter and the offending population demonstrate greater complexity; nursing competencies and personal attributes need similarly to adapt to such changes. Mental health nursing has a great deal to contribute to effective working with this population, specifically with regard to developing strong relationships when concerns around borderline personality disorder or substance misuse are particularly in evidence.

ABSTRACT

Aim To identify and discuss the personal attributes required by learning disability nurses to work effectively with people with an offending background in secure and community settings. Background This study was part of a larger research investigation into the nursing competencies required to work with people with an offending background. There are few existing studies examining the personal attributes necessary for working with this group. Design A qualitative study addressing the perceptions of nurses around the personal attributes required to work with people with learning disabilities and an offending background. Methods A semi-structured interview schedule was devised and constructed, and 39 individual interviews were subsequently undertaken with learning disability nurses working in high, medium, low secure and community settings. Data were collected over 1 year in 2010/11 and analysed using a structured thematic analysis supported by the software package MAXqda. Findings The thematic analysis produced three categories of personal attributes, named as looking deeper, achieving balance and connecting, each of which contained a further three sub-categories. Conclusion Nursing of those with a learning disability and an offending background continues to develop. The interplay among personal history, additional background factors, nurses' personal attributes and learning disability is critical for effective relationship building.

New developments in prenatal diagnosis of congenital adrenal hyperplasia

Congenital adrenal hyperplasia (CAH) owing to 21-hydroxylase deficiency is an autosomal recessive disorder caused by mutations in the CYP21A2 gene. Females affected with classical CAH are at risk for genital ambiguity, but can be treated in utero with dexamethasone before 9 gestational weeks to prevent virilization. Early genetic diagnosis is unavailable through current invasive methods of chorionic villus sampling and amniocentesis. New developments in prenatal genetic testing utilize fetal DNA extracted from maternal blood through noninvasive methods, which allow the determination of fetal gender and the diagnosis of CAH at an early gestational age (<9 weeks). Noninvasive prenatal diagnosis allows for the establishment of early and effective management plans in fetuses at risk for CAH and avoids unnecessary prenatal dexamethasone treatment.

Graphene electrodes for adaptive liquid crystal contact lenses

The superlatives of graphene cover a whole range of properties: electrical, chemical, mechanical, thermal and others. These special properties earn graphene a place in current or future applications. Here we demonstrate one such application - adaptive contact lenses based on liquid crystals, where simultaneously the high electrical conductivity, transparency, flexibility and elasticity of graphene are being utilised. In our devices graphene is used as a transparent conductive coating on curved PMMA substrates. The adaptive lenses provide a + 0.7 D change in optical power with an applied voltage of 7.1 V_rms - perfect to correct presbyopia, the age-related condition that limits the near focus ability of the eye.

Abstract P6-12-08: Healthcare barrier profiles in patients navigated for cancer screening and treatment and the impact of the affordable care act

Background: The underserved community experiences barriers to cancer screening that result in overall greater mortality rates across all cancers. Insurance coverage brought forth by the Affordable Care Act has the potential to significantly impact these barriers through reducing the burden of health care cost on the patient. In this study the authors observe the impact of the Affordable Care Act on the barrier profiles presented by the patients navigated for cancer screening and treatment.

Methods: Patient navigation encounters were recorded for a total of 1146 patients navigated for cancer screening and treatment at the Cleveland Clinic Foundation from the years 2012 through 2015. A total of 3259 encounters were classified into barrier types. Health care billed encounters were retrieved from EPIC for this group of patients from the time they entered patient navigation and classified in terms of insurance coverage. Patients were categorized according to their barrier profile. Appropriate generalized linear regression models were used to test for association of these profiles to number and types of navigation and health care encounters and cost, and to test for change in types of encounters and patient barrier profiles through time.

Results: The insurance barrier is present in 23% of all navigation encounters. Patients presenting with an insurance barrier had a greater mean number of navigation (p&lt;0.001) and health care encounters (p&lt;0.006), had a greater proportion of self-paid health care encounters (p&lt;0.001) and a lower total cost billed for health care encounters after controlling for number of encounters (p&lt;0.001) . The access barrier is present in 53% of navigation encounters while patients that present with only the access barrier account for 42% of the entire sample. Patients that present with only the access barrier have doubled every year (OR 2.2 per year, 95% CI [1.8 2.6]) from 2012 to 2015, while the proportion of self-paid health care encounters (OR 0.26 per year, 95% CI [0.25 0.28]) and the presence of the insurance barrier (OR 0.55 per year, 95% CI [ 0.49 0.62]) have more than halved during this time period.

Conclusion: Although the Affordable Care Act has clearly had an impact by lowering the number of insurance barrier navigation encounters through time, it has uncovered access as the predominant remaining barrier. Understanding and targeting the access barrier will be the most effective way to potentiate the effects of the ACA on patients being navigated for cancer screening and treatment.

Citation Format: Raska P, Ott MA, Steele A, Bailey A, Hickman D, Allen D, Urbanek D, Glass K, Bailey J, Bell K, Montero A, Abraham J. Healthcare barrier profiles in patients navigated for cancer screening and treatment and the impact of the affordable care act. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-12-08.

Abstract P1-09-03: Socioeconomic characteristics of African American women with breast cancer

Background: Breast cancer is the most common cancer among African American (AA) women. Despite having a lower incidence of breast cancer compared to white women (124.4 compared to 127.9 per 100,000), AAs have a higher death rate (30.2 compared to 21.3 per 100,000). One explanation for this discrepancy is that breast cancer in AAs is often detected at a later stage compared to white women. We conducted this retrospective study to examine socioeconomic characteristics among AA women with breast cancer to see if there were factors associated with stage of diagnosis which may contribute to the known disparities. Methods: We identified all AA women diagnosed with any stage breast cancer from 2006-2014 within the Cleveland Clinic Cancer Data Warehouse and classified them into either early or late stage disease at time of diagnosis. Stages 0-II were classified as early and stages III-IV as late. We examined several variables at diagnosis including age, marital status, tobacco use, alcohol use, Medicaid insurance status, and breast cancer subtype which included HER-2 positive (HER+), hormone receptor positive/HER2 negative (HR+/HER-), and triple negative(TN). AA median income was obtained from US census data according to the zip code at diagnosis. We conducted univariate logistic regression for individual estimates and confidence intervals and multiple logistic regression and model selection to determine significant predictors of stage of diagnosis. Results: Of the 771 AA women identified, 108 (14%) were diagnosed at a late stage of disease with a median age of 59 years. Receptor status distribution was 12.4%, 31%, and 16.6% for HER+, HR+/HER-, and TN respectively for early stage, and 15.7%, 27%, and 25% for late stage. Among early stage 50% were current or previous smokers and 2.6% had Medicaid insurance compared to late stage patients where 63% were current or previous smokers and 9.2% had Medicaid insurance. Multiplicative effect estimates and 95% confidence intervals from univariate logistic regressions identified the following significant factors: tobacco use 1.48 [1.11-1.96] and Medicaid 3.73 [1.56-8.51] (p-values&lt;0.01), and TNBC 1.67 [1.02-2.68] (p-value&lt;0.05). In a stepwise model selection, only tobacco use and Medicaid were retained in the model, as well as age at diagnosis. Conclusions: There are socioeconomic differences among AA women with breast cancer. Only tobacco use, Medicaid insurance, and age at diagnosis were predictive of late stage in this study.

Citation Format: Winter A, Raska P, Ornstein M, Moore H, Montero A, Budd GT, Tullio K, Bailey J, Abraham J. Socioeconomic characteristics of African American women with breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-09-03.

Laboratory tests to identify patients at risk of early major adverse events: a prospective pilot study

BACKGROUND/AIMS

To test whether commonly measured laboratory variables can identify surgical patients at risk of major adverse events (death, unplanned intensive care unit (ICU) admission or rapid response team (RRT) activation).

METHODS

We conducted a prospective observational study in a surgical ward of a university-affiliated hospital in a cohort of 834 surgical patients admitted for >24 h. We applied a previously validated multivariable model-derived risk assessment to each combined set of common laboratory tests to identify patients at risk. We compared the clinical course of such patients with that of control patients from the same ward who had blood tests but were identified as low risk.

RESULTS

We studied 7955 batches and 73,428 individual tests in 834 patients (males 55%; average age 65.8 ± 17.6 years). Among these patients, 66 (7.9%) were identified as 'high risk'. High-risk patients were older (75.9 vs 61.8 years of age; P < 0.0001), had much greater early (48 h) mortality (6/66 (9%) vs 4/768 (0.5%); P < 0.0001) and greater overall hospital mortality (11/66 (16.7%) vs 9/768 (1.2%); P < 0.0001). They also had more early (8/66 (12.1%) vs 14/768 (1.8%); P = 0.0001) and overall in-hospital unplanned ICU admissions (12/66 (18.2%) vs 18/768 (2.3%); P < 0.0001) and more early (26/66 (39.3%) vs 50/768 (6.5%); P < 0.0001) and overall in-hospital RRT calls (26/66 (39.4%) vs 55/768 (7.2%); P < 0.0001).

CONCLUSIONS

Commonly performed laboratory tests identify surgical ward patients at risk of early major adverse events. Further studies are needed to assess whether such identification system can be used to trigger interventions that help improve patient outcomes.

High-frequency acousto-optic effects in Bragg reflectors

Picosecond acoustic interferometry was used to study the acousto-optic properties of a distributed Bragg reflector (DBR) manufactured from two immiscible polymers (cellulose acetate and polyvinylcarbyzole). Picosecond strain pulses were injected into the structure and changes in its reflectance were monitored as a function of time. The reflectance exhibited single-frequency harmonic oscillations as the strain pulse traversed the DBR. A transfer matrix method was used to model the reflectance of the DBR in response to interface modulation and photo-elastic effects. This work shows that photo-elastic effects can account for the acousto-optic response of DBRs with acoustically matched layers.

Synthesis and Growth of Gallium Nitride by the Chemical Vapor Reaction Process (CVRP)

A new process for synthesis and bulk crystal growth of GaN is described. GaN single crystal c-plane platelets up to 9mm by 2mm by 100μm thick have been grown by the Chemical Vapor Reaction Process (CVRP). The reaction between gallium and a nitrogen precursor is produced by sublimation of solid ammonium chloride in a carrier gas, which passes over gallium at a temperature of approximately 900°C at near atmospheric pressures. Growth rates for the platelets were 25-100 μm/hr in the hexagonal plane. Seeded growth in the c-direction was also accomplished by re-growth on previously grown c-plane platelets. The crystals were characterized by X-ray diffractometry, atomic force microscopy, secondary ion mass spectrometry, inert gas fusion, and room temperature Hall effect and resistivity measurements.