Search for B^{+}→K^{+}νν[over ¯] Decays Using an Inclusive Tagging Method at Belle II

A search for the flavor-changing neutral-current decay B^{+}→K^{+}νν[over ¯] is performed at the Belle II experiment at the SuperKEKB asymmetric energy electron-positron collider. The data sample corresponds to an integrated luminosity of 63  fb^{-1} collected at the ϒ(4S) resonance and a sample of 9  fb^{-1} collected at an energy 60 MeV below the resonance. Because the measurable decay signature involves only a single charged kaon, a novel measurement approach is used that exploits not only the properties of the B^{+}→K^{+}νν[over ¯] decay, but also the inclusive properties of the other B meson in the ϒ(4S)→BB[over ¯] event, to suppress the background from other B meson decays and light-quark pair production. This inclusive tagging approach offers a higher signal efficiency compared to previous searches. No significant signal is observed. An upper limit on the branching fraction of B^{+}→K^{+}νν[over ¯] of 4.1×10^{-5} is set at the 90% confidence level.

Does tuberculosis screening improve individual outcomes? A systematic review

BACKGROUND

To determine if tuberculosis (TB) screening improves patient outcomes, we conducted two systematic reviews to investigate the effect of TB screening on diagnosis, treatment outcomes, deaths (clinical review assessing 23 outcome indicators); and patient costs (economic review).

METHODS

Pubmed, EMBASE, Scopus and the Cochrane Library were searched between 1/1/1980-13/4/2020 (clinical review) and 1/1/2010-14/8/2020 (economic review). As studies were heterogeneous, data synthesis was narrative.

FINDINGS

Clinical review: of 27,270 articles, 18 (n=3 trials) were eligible. Nine involved general populations. Compared to passive case finding (PCF), studies showed lower smear grade (n=2/3) and time to diagnosis (n=2/3); higher pre-treatment losses to follow-up (screened 23% and 29% vs PCF 15% and 14%; n=2/2); and similar treatment success (range 68-81%; n=4) and case fatality (range 3-11%; n=5) in the screened group. Nine reported on risk groups. Compared to PCF, studies showed lower smear positivity among those culture-confirmed (n=3/4) and time to diagnosis (n=2/2); and similar (range 80-90%; n=2/2) treatment success in the screened group. Case fatality was lower in n=2/3 observational studies; both reported on established screening programmes. A neonatal trial and post-hoc analysis of a household contacts trial found screening was associated with lower all-cause mortality. Economic review: From 2841 articles, six observational studies were eligible. Total costs (n=6) and catastrophic cost prevalence (n=4; range screened 9-45% vs PCF 12-61%) was lower among those screened.

INTERPRETATION

We found very limited patient outcome data. Collecting and reporting this data must be prioritised to inform policy and practice.

FUNDING

WHO and EDCTP.

Tuberculosis screening costs and cost-effectiveness in high-risk groups: a systematic review

BACKGROUND

Systematic screening for active tuberculosis (TB) is a strategy which requires the health system to seek out individuals, rather than waiting for individuals to self-present with symptoms (i.e., passive case finding). Our review aimed to summarize the current economic evidence and understand the costs and cost-effectiveness of systematic screening approaches among high-risk groups and settings.

METHODS

We conducted a systematic review on economic evaluations of screening for TB disease targeting persons with clinical and/or structural risk factors, such as persons living with HIV (PLHIV) or persons experiencing homelessness. We searched three databases for studies published between January 1, 2010 and February 1, 2020. Studies were included if they reported cost and a key outcome measure. Owing to considerable heterogeneity in settings and type of screening strategy, we synthesized data descriptively.

RESULTS

A total of 27 articles were included in our review; 19/27 (70%) took place in high TB burden countries. Seventeen studies took place among persons with clinical risk factors, including 14 among PLHIV, while 13 studies were among persons with structural risk factors. Nine studies reported incremental cost-effectiveness ratios (ICERs) ranging from US$51 to $1980 per disability-adjusted life year (DALY) averted. Screening was most cost-effective among PLHIV. Among persons with clinical and structural risk factors there was limited evidence, but screening was generally not shown to be cost-effective.

CONCLUSIONS

Studies showed that screening is most likely to be cost-effective in a high TB prevalence population. Our review highlights that to reach the "missing millions" TB programmes should focus on simple, cheaper initial screening tools (i.e., symptom screen and CXR) followed by molecular diagnostic tools (i.e., Xpert®) among the highest risk groups in the local setting (i.e., PLHIV, urban slums). Programmatic costs greatly impact cost-effectiveness thus future research should provide both fixed and variable costs of screening interventions to improve comparability.

The resilience of the developing reading system: multi-modal evidence of incident and recovery after a pediatric stroke

Decades of neuroscientific findings have elucidated the highly specialized brain areas involved in reading, especially along the ventral occipitotemporal stream where the critical step of recognizing words occurs. We report on a 14-year-old female with temporary dyslexia after a left ventral occipitotemporal ischemic stroke. Our longitudinal multimodal findings show that the resolution of the reading impairment was associated with heightened activity in the left posterior superior and inferior temporal gyri. Our findings highlight the role of the left inferior temporal gyrus in reading and the importance of perilesional and ipsilateral cortical areas for functional recovery after childhood stroke.

46 Promoting Advance Care Planning of Patients with Parkinsonism in the Community

Introduction

NICE guideline recommends that all patients with Parkinson’s disease should be reviewed every 6–12 months and offered opportunities to discuss Advanced Care Planning (ACP) (1, 2). There is evidence demonstrating that Advanced Care Plans results in shorter length of stay in the last year of life and lower hospital costs (2, 3). A local baseline audit showed that Advanced Care Planning was not performed adequately.

Methods

A local baseline audit on community care home patients with Parkinsonism was completed in February 2018. A community-based Parkinson’s clinic was commenced in June 2018. Patients with parkinsonism who were unable to attend hospital clinics due to underlying frailty, neuropsychiatry and physical issues, were reviewed. At each visit, advice was provided on medicines management and there were discussions around Advance Care Planning.

A re-audit was completed in August 2019. Patient’s Electronic Patient Records were scrutinised to evaluate progress and identify those who had died. Data was analysed using Microsoft Excel.

Results

The initiative contributed directly to end of life care in 7/17 patients. Parkinson’s disease medications were rationalised in 11/17 (64.70%). 14/17 (82.35%) had a community-based Do Not Resuscitate order completed.

Conclusions

The community Parkinson’s clinic service promoted Advance Care Planning in patients with Parkinsonism. This service provides specialist input in frail older people with Parkinsonism who were unable to attend hospital clinic, promoting end of life choices around where they wished to die and avoiding unnecessary hospitalisation in the final stages of their life.

A132 ENDOSCOPIC ULTRASOUND-GUIDED GASTROENTEROSTOMY USING A NOVEL DOUBLE BALLOON DEVICE IN THE MANAGEMENT OF MALIGNANT GASTRIC OUTLET OBSTRUCTION

Background

EUS-gastroenterostomy (EUS-GE) is a novel modality in the management of malignant gastric outlet obstruction (MGOO). It is, however, technically challenging limiting its widespread application. To facilitate EUS-GE, a double balloon catheter has been developed in Japan. While this tool is not available outside of Asia, we have conceived a similar device using a widely available vascular balloon catheter. We aim to determine the clinical efficacy and safety of EUS-GE using this double balloon device (DBD).

Aims

We aim to determine the clinical efficacy and safety of EUS-GE using this double balloon device (DBD).

Methods

This is a single-centre, retrospective study of consecutive patients who underwent DBD assisted EUS-GE for MGOO from January 2019-June 2020 (IRB approved). The DBD consists of two 60 mm vascular balloons (Coda, Cook Medical, USA) fashioned together with the balloons 10 cm apart (Figure 1). It is inserted across the obstruction over a wire to the ligaments of Treitz. Both balloons are then inflated followed by saline and contrast infusion into the occluded small bowel segment to facilitate EUS-guided insertion of a 15 mm cautery assisted lumen apposing metal stent (AxiosTM, Boston Scientific Inc, USA). The primary endpoint is the rate of technical success defined as adequate deployment of the stent. Secondary endpoints include rate of clinical success and adverse events.

Results

A total of 11 patients were included in this study. 45% were female with a mean age of 64.9 ± 8.6 years old. The etiology of MGOO was 73% pancreatic cancer, 9% gastric cancer, 9% duodenal cancer, and 9% metastatic cervical cancer. Procedures were performed under general anesthesia and conscious sedation in 82% and 18%, of patients respectively. The mean procedure time was 64.8 ± 25.8 minutes. Technical and clinical success (intention to treat) was 91%. The only technical failure was due to poor patient tolerance of the procedure under conscious sedation. There was one adverse event (9%) due to stent migration rated as severe. Two patients (18%) required re-intervention for stent obstruction secondary to food impaction associated with non-compliance to a low-residue diet. Following re-enforced instructions, no further obstruction occurred.

All patients started a clear liquid diet within 1 day of the procedure with a mean time to a low residue diet of 3.25 days ± 2.5. The median length of hospital stay following the procedure was 5 days ± 13. The median follow-up time was 84 days (IQR 152).

Conclusions

DBD assisted EUS-GE is clinically effective and safe. This balloon device may greatly facilitate the technical aspect of EUS-GE while potential enhancing its safety and clinical use. Larger studies are needed to validate this approach to EUS-GE.

Funding Agencies

None

A222 ASSOCIATION BETWEEN PROTON PUMP INHIBITOR USE AND DEVELOPMENT OF HEPATIC ENCEPHALOPATHY AND SPONTANEOUS BACTERIAL PERITONITIS IN HOSPITALIZED PATIENTS WITH CIRRHOSIS

Background

Proton pump inhibitors (PPIs) are commonly prescribed medications which are indicated in various different gastrointestinal (GI) diseases, including peptic ulcer disease, gastroesophageal reflux disorder and upper GI bleeding. There is some evidence to suggest that PPI use in cirrhosis may predispose to the development of hepatic encephalopathy (HE) and spontaneous bacterial peritonitis (SBP), albeit with some controversy.

Aims

We aim to conduct a retrospective epidemiological analysis of the association between PPI use in hospitalized patients with cirrhosis and prevalence of HE and SBP.

Methods

This was a retrospective cohort study of 953 adult patients (mean age 62.3 (SD=12.2)) with cirrhosis admitted to the Ottawa Hospital between January 1, 2011 and December 31, 2015. A chart review was conducted and relevant information extracted.

Results

Average MELD-Na on admission was 17.4 (SD = 7.5) with no significant differences when stratified by in-hospital PPI use (p=0.53). 14.7% of patients had a prior history of HE, 5.4% SBP, 31.6% ascites, 9.3% hepatocellular carcinoma and 1.2% hepatorenal syndrome. 26.4% of patients had a history of varices, of which 34.4% had previous variceal bleeding. 45.4% of patients were on a PPI prior to admission and 69.8% during their hospitalization. Patients with a previous history of HE (16.8% vs. 9.6% p=0.006), varices (31.4% vs. 14.2% p<0.001) and variceal bleed (11.6% vs. 3.1% p<0.001) were more likely to be exposed to a PPI in-hospital. Mortality rate during index admission was 19.4%.

There was no significant association noted between the incidence of HE (31.2% vs. 25.0% p=0.06) or SBP (10.4% vs. 8.0% p=0.25) and in-hospital PPI use. There was also no significant association between PPI use and infectious complications, including bacteremia (8.6% vs. 7.6% p=0.63), pneumonia (12.7% vs. 12.5% p=0.95), urinary tract infections (9.2% vs. 6.6% p=0.19) and clostridium difficile (3.8% vs. 2.1% p=0.18). Patients on a PPI had greater in-hospital mortality (22.0% vs. 13. 5% p=0.002), although there was no significance between cause of death (p=0.31) nor death from infectious complications (18.5% vs. 23.1% p=0.52) between groups. Length of stay (LOS) was longer in patients exposed to PPI (median (IQR) 7 (4–17) vs 6 (3–13) p=0.03). Similar findings were noted on subgroup analysis of decompensated patients.

Conclusions

We did not observe a significant difference in HE, SBP or infectious complications among this cohort of cirrhotic patients by in-hospital PPI use. However, there was a significantly higher mortality rate noted in hospital and longer LOS, despite similar baseline MELD-Na and causes of death. Further study and judicious PPI prescribing practices in this vulnerable population of patients is warranted.

Funding Agencies

None

Risk stratification and prognostic value of CMR in DCM; parametric mapping and GLS- value beyond EF and LGE?

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Dr Pamela Brown was suppoerted by funding from Alliance Medical.

Background; Arrhythmia risk stratification and device implantation in dilated cardiomyopathy (DCM) poses significant challenges and as demonstrated by the DANISH trial appears to have reached the asymptote of clinical efficacy. A body of evidence now demonstrates that risk stratification of and device selection for DCM patients may be enhanced by inclusion of patients" LGE-status. Furthermore, it has been suggested that CMR based parametric mapping and strain analysis may further advance risk stratification.

Methods; 703 patients with DCM undergoing clinically indicated CMR scans and prospectively enrolled into the UHSM-CMR study (NCT02326324) between 03/2015-12/2018 were analysed. Multivariable Cox proportional hazard models and Youden index driven C-statistics were used to assess additive prognostic value of GLS, T1 and ECV mapping on the combined endpoint of cardiovascular death, cardiac transplantation, LVAD  insertion  or hospitalisation for heart failure in models incorporating NHYA class, EF and LGE status. Additionally. the value of GLS, T1, and ECV on predicting significant arrhythmic events (SAV) (ventricular arrhythmia (VA), resuscitated cardiac arrest (rCA) or sudden cardiac death (SCD)) was assessed.

Results; Patients (mean age 59, 66% male, 60% ≥NYHA II, mean EF 42%, mean GLS -12%, mean ECV 27%) were on good medical therapy (beta blocker 74%%, ACE 79%, MRA 38%, Entresto 5%, CRT 23%). Mean follow-up was 21 months; the combined endpoint occurred in 34 patients (5%). On univariate analysis NYHA class (HR 2.44 (1.67-3.57), p < 0.001), ECV (HR 1.14 (1.05-1.22), p < 0.001), GLS% (HR 1.14 (1.07-1.21) p < 0.001,) T1 (HR 1.06 (1.005-1.1), p = 0.03), RVEF (HR 0.95 (0.93-0.98), p < 0.001), LVEF (HR 0.92 (0.9-0.95), p < 0.001) were all significantly associated with outcome. On multivariate analysis only EF and NYHA class was associated with outcome.

SAV occurred as the first manifestation of disease or during follow up in 27 patients (4%). At univariate analysis LGE, ECV, GLS, EF and NYHA class were all associated with SAV. However, on multivariable analysis only EF, LGE  and ECV (HR 1.11 (1.01-1.22), p = 0.03) but not GLS remained independently predictive in a model already incorporating EF, NYHA and LGE.

Conclusion

Optimally treated DCM populations have very low event rates. CMR based assessment of fibrosis status/burden with both LGE and ECV assessment has the potential to enhance patient selection for ICD therapy. Whilst GLS is increasingly recognised as a sensitive imaging biomarker of early disease detection it provides no additive value,  likely because of it’s high co-linearity with EF, in models already containing EF, NYHA class and LGE status.

Application of radiochromic gel dosimetry to commissioning of a megavoltage research linear accelerator for small-field animal irradiation studies

PURPOSE

To develop and implement an efficient and accurate commissioning procedure for small-field static beam animal irradiation studies on an MV research linear accelerator (Linatron-M9) using radiochromic gel dosimetry.

MATERIALS

The research linear accelerator (Linatron-M9) is a 9 MV linac with a static fixed collimator opening of 5.08 cm diameter. Lead collimators were manually placed to create smaller fields of 2 × 2 cm² , 1 × 1 cm² , and 0.5 × 0.5 cm² . Relative dosimetry measurements were performed, including profiles, percent depth dose (PDD) curves, beam divergence, and relative output factors using various dosimetry tools, including a small volume ionization chamber (A14), GAFCHROMIC™ EBT3 film, and Clearview gel dosimeters. The gel dosimeter was used to provide a 3D volumetric reference of the irradiated fields. The Linatron profiles and relative output factors were extracted at a reference depth of 2 cm with the output factor measured relative to the 2 × 2 cm² reference field. Absolute dosimetry was performed using A14 ionization chamber measurements, which were verified using a national standards laboratory remote dosimetry service.

RESULTS

Absolute dosimetry measurements were confirmed within 1.4% (k = 2, 95% confidence = 5%). The relative output factor of the small fields measured with films and gels agreed with a maximum relative percent error difference between the two methods of 1.1 % for the 1 × 1 cm² field and 4.3 % for the 0.5 × 0.5 cm² field. These relative errors were primarily due to the variability in the collimator positioning. The measured beam profiles demonstrated excellent agreement for beam size (measured as FWHM), within approximately 0.8 mm (or less). Film measurements were more accurate in the penumbra region due to the film's finer resolution compared with the gel dosimeter. Following the van Dyk criteria, the PDD values of the film and gel measurements agree within 11% in the buildup region starting from 0.5 cm depth and within 2.6 % beyond maximum dose and into the fall-off region for depths up to 5 cm. The 2D beam profile isodose lines agree within 0.5 mm in all regions for the 0.5 × 0.5 cm² and the 1 × 1 cm² fields and within 1 mm for the larger field of 2 × 2 cm² . The 2D PDD curves agree within approximately 2% of the maximum in the typical therapy region (1-4 cm) for the 1 × 1 cm² and 2 × 2 cm² and within 5% for the 0.5 × 0.5 cm² field.

CONCLUSION

This work provides a commissioning process to measure the beam characteristics of a fixed beam MV accelerator with detailed dosimetric evaluation for its implementation in megavoltage small animal irradiation studies. Radiochromic gel dosimeters are efficient small-field relative dosimetry tools providing 3D dose measurements allowing for full representation of dose, dosimeter misalignment corrections and high reproducibility with low inter-dosimeter variability. Overall, radiochromic gels are valuable for fast, full relative dosimetry commissioning in comparison to films for application in high-energy small-field animal irradiation studies.

Prevalence, correlates and prognostic relevance of mid-wall late gadolinium enhancement in patients with ischaemic cardiomyopathy

Background

LGE imaging is an established CMR imaging technique for the assessment of myocardial replacement fibrosis. The presence of mid-wall LGE has been described in ∼30% of patients with non-ischemic dilated cardiomyopathy and is known to be associated with poor outcome. Conversely, little is known regarding the clinical significance of mid-wall LGE in patients with ischemic cardiomyopathy (ICM). Aim of the present study was to investigate the prevalence, correlates and prognostic role of mid-wall late gadolinium enhancement (LGE) in a consecutive cohort of patients with ICM.

Methods

A total of 319 consecutive outpatients with ICM (mean age 64±11 years, 87% males) were included. All patients had CMR with LGE imaging and were followed for a median of 13 months. The outcome end-point was a composite of cardiovascular death, aborted sudden cardiac death, appropriate implantable cardioverter-defibrillator therapy, heart failure hospitalisations, implantation of left ventricular (LV) assist device or occurrence of heart transplant.

Results

Mean LV ejection was 37±9%, mean ischemic-type LGE expressed as % of LV mass was 16±9%, while mid-wall LGE was observed in 32 (10%) patients. LVEDV index (OR 1.02, 95% CI 1.01–1.03, p=0.001) and LV sphericity index (OR 1.04, 95% CI 1.01–1.07, p=0.024) were the only variables significantly and independently related to the presence of mid-wall LGE. The outcome end-point was documented in 37 (12%) patients. Ischemic-type LGE expressed as % of LV mass (HR 1.04, 95% CI 1.01–1.08; p=0.015) and the presence of mid-wall LGE (HR 4.5, 95% CI 2.2–9.2; p<0.001) were the only independent predictors of the composite outcome. Mid-wall LGE had significant incremental predictive value compared to the extent of ischemic-type LGE (Δχ2=16.5, p<0.001). The Kaplan-Meier survival curves showing survival from the composite end-point according to the presence/absence of mid-wall LGE in patients with ischemic-type LGE expressed as % of LV mass < the median value 14.6% and. ≥14.6% are shown in the Figure.

Conclusions

Mid-wall LGE is observed in a substantial minority of patients with ICM. In this population, the presence of mid-wall LGE is associated with adverse LV remodeling and worse prognosis.

Figure 1

Funding Acknowledgement

Type of funding source: None

Adenosine stress native T1 mapping demonstrates impaired myocardial perfusion reserve in non-ischemic dilated cardiomyopathy

Background

Impaired myocardial perfusion reserve has been demonstrated in non-ischemic dilated cardiomyopathy (NIDCM) by positron emission tomography (PET) and adenosine-stress first-pass perfusion cardiac magnetic resonance (CMR) imaging. Adenosine stress native T1 mapping is a novel CMR technique able to assess myocardial perfusion without the use of contrast agents. The aim of the present study was to determine the clinical utility of this novel CMR technique in NIDCM.

Methods

A total of 20 consecutive patients (mean age 61±12 years, 80% males) with diagnosis of NIDCM who consented to be enrolled in the UHSM CMR registry were included in the present study. CMR at 3T including 1. cine imaging for the assessment of LV volumes, mass and global longitudinal strain (GLS) by tissue-tracking imaging; 2. rest and stress (adenosine 140 mcg/kg/min) MOLLI T1 mapping of mid-ventricular slice for the assessment of rest and stress T1 values and T1 reactivity (ΔT1%); 3. first-pass perfusion imaging for the assessment of myocardial perfusion reserve index (MPRI) and 4. late gadolinium enhancement (LGE) imaging for the assessment of myocardial replacement fibrosis, was performed. Twenty control patients without history of known coronary artery disease and evidence of reversible ischemia or previous myocardial infarct on CMR imaging were included for comparison purposes.

Results

NIDCM patients had significantly higher native T1 value (1263±47 ms vs. 1234±38 ms, p=0.031), significantly lower ΔT1% (3.2±1.5% vs. 5.7±1.7%, p<0.001, Figure A), significantly lower MPRI (1.32±0.18 vs. 1.67±0.13, p<0.001) and significantly impaired GLS (−10±4% vs. −16±2%, p<0.001) as compared to controls. A significant strong relation between ΔT1% and MPRI (β=0.76, p<0.001, Figure B) and significant moderate relation between ΔT1% and GLS (β=−0.54, p<0.001) were observed.

Conclusion

T1 reactivity, myocardial perfusion reserve and GLS are significantly reduced in NIDCM patients compared to controls. Adenosine stress T1 mapping holds promise for detection of impaired myocardial perfusion reserve in NIDCM without the requirement for contrast agents.

Funding Acknowledgement

Type of funding source: None

Search for Axionlike Particles Produced in e^{+}e^{-} Collisions at Belle II

We present a search for the direct production of a light pseudoscalar a decaying into two photons with the Belle II detector at the SuperKEKB collider. We search for the process e^{+}e^{-}→γa, a→γγ in the mass range 0.2<m_{a}<9.7  GeV/c^{2} using data corresponding to an integrated luminosity of (445±3)  pb^{-1}. Light pseudoscalars interacting predominantly with standard model gauge bosons (so-called axionlike particles or ALPs) are frequently postulated in extensions of the standard model. We find no evidence for ALPs and set 95% confidence level upper limits on the coupling strength g_{aγγ} of ALPs to photons at the level of 10^{-3}  GeV^{-1}. The limits are the most restrictive to date for 0.2<m_{a}<1  GeV/c^{2}.

A Model for Outreach Technical Assistance

Like many other schools for the blind, the Texas School for the Blind and Visually Impaired has expanded its outreach services to increase the availability of appropriate services for students with visual impairments throughout the state. A staff of 12 professionals and a director, with the assistance of campus staff, serves as a resource for families of children with visual and dual sensory impairments and to the related agencies and local service providers who serve them.

Improving patient outcomes with regenerative medicine: How the Regenerative Medicine Manufacturing Society plans to move the needle forward in cell manufacturing, standards, 3D bioprinting, artificial intelligence-enabled automation, education, and training

The Regenerative Medicine Manufacturing Society (RMMS) is the first and only professional society dedicated toward advancing manufacturing solutions for the field of regenerative medicine. RMMS's vision is to provide greater patient access to regenerative medicine therapies through innovative manufacturing solutions. Our mission is to identify unmet needs and gaps in regenerative medicine manufacturing and catalyze the generation of new ideas and solutions by working with private and public stakeholders. We aim to accomplish our mission through outreach and education programs and securing grants for public-private collaborations in regenerative medicine manufacturing. This perspective will cover four impact areas that the society's leadership team has identified as critical: (a) cell manufacturing and scale-up/out, respectively, for allogeneic and autologous cell therapies, (b) standards for regenerative medicine, (c) 3D bioprinting, and (d) artificial intelligence-enabled automation. In addition to covering these areas and ways in which the society intends to advance the field in a collaborative nature, we will also discuss education and training. Education and training is an area that is critical for communicating the current challenges, developing solutions to accelerate the commercialization of the latest technological advances, and growing the workforce in the rapidly expanding sector of regenerative medicine.

Distance to treatment as a factor for loss to follow up of hepatitis C patients in North East England

BACKGROUND

A large proportion of the 200 000 HCV-infected individuals in the UK are undiagnosed or lost to follow-up. Engaging known infected individuals in treatment is essential for elimination.

METHODS

Using PHE surveillance data and HCV treatment registers from North East of England (NE) treatment centres for 1997-2016, we estimated the number of HCV cases not linked to treatment and the proportion with active infection. We compared distances of treated and untreated cases to treatment services, and assessed the effect of expanding HCV treatment into existing drug and alcohol treatment centres in the NEE on treatment accessibility.

RESULTS

The odds of being treated was associated with distance to treatment services. Confirmatory results for ~50% were not reported to PHE NE. Overall, 3385 patients reported to PHE NE had no record of treatment; we estimated 1621 of these may have been lost to follow-up after confirmation of active infection.

CONCLUSIONS

Poor access to healthcare services may contribute to under-diagnosis or loss to follow-up. Expanding HCV treatment delivery into NEE drug and alcohol treatment centres would improve the accessibility of treatment services to people infected with/at risk of HCV. This may increase the proportion receiving treatment and support progress towards elimination.