Survey of infection control and antimicrobial stewardship practices in Australian residential aged-care facilities

This study assessed infection prevention and antimicrobial stewardship (AMS) practices in Australian residential aged-care facilities (RACF). Two hundred and sixty-five surveys (15.6%) were completed with all states represented and the majority (177 (67.3%)) privately run. Only 30.6% RACF had infection control trained staff on site. Few facilities had AMS policies, only 14% had antimicrobial prescribing restrictions. Most facilities offered vaccination to residents (influenza vaccination rates >75% in 73% of facilities), but pneumococcal vaccination was poor.

Changes in astrocyte functional markers and β-amyloid metabolism-related proteins in the early stages of hypercholesterolemia

Cholesterol is an essential substance for maintaining normal structure and function of the brain. But unfortunately, a long-term high-cholesterol diet can lead to a variety of pathological changes of the brain such as β-amyloid (Aβ) accumulation, Tau hyperphosphorylation, reactive gliosis, neuroinflammation, neuronal death and synaptic degeneration. These pathological changes have complex internal relations with one other, causing memory impairment and participating in the pathogenesis of Alzheimer's disease (AD). However, early hypercholesterolemia-induced events that lead to brain deterioration are not clear. To address this, 6-month-old female mice were fed a 3% cholesterol diet for 8weeks, followed by behavioral, biochemical and neuropathological analyses. The high-cholesterol-fed mice did not show neuronal and synaptic impairment or cognitive deficits compared with mice given a normal diet, but astrocytes were mildly activated with increased expression of functional markers including apolipoprotein E and aquaporin 4 in the hippocampus. Hippocampal interleukin-1β expression slightly increased, but interleukin-6 (IL-6) and tumor necrosis factor-α did not change significantly compared with those in the control group. Levels of Aβ, and its precursor protein, were unaffected, but levels of presenilin 1 and insulin-degrading enzyme (IDE), that initiate Aβ generation and degradation, respectively, increased in the hippocampus of the model mice. In addition, Tau phosphorylation levels were not different between the control and model groups. These results suggest that changes in astrocyte functional markers and Aβ metabolism proteins, which contribute to maintaining brain cholesterol and Aβ homeostasis, are early events in the process of hypercholesterolemia-related neuropathological changes.

Non-Antarctic notothenioids: Past phylogenetic history and contemporary phylogeographic implications in the face of environmental changes

The non-Antarctic Notothenioidei families, Bovichtidae, Pseudaphritidae and Eleginopsidae, diverged early from the main notothenioid lineage. They are important in clarifying the early evolutionary processes that triggered notothenioid evolution in the Antarctic. The early-diverged group represents 8% of all notothenioid species and never established themselves on the Antarctic shelf. Most attention has been paid to the Antarctic notothenioids and their limited physiological tolerance to climate change and increased temperatures. In this review, we discuss key life history traits that are characteristic of the non-Antarctic early-diverged notothenioid taxa as well as the genetic resources and population differentiation information available for this group. We emphasise the population fitness and dynamics of these species and indicate how resource management and conservation of the group can be strengthened through an integrative approach. Both Antarctic waters and the non-Antarctic regions face rapid temperature rises combined with strong anthropogenic exploitation. While it is expected that early-diverged notothenioid species may have physiological advantages over high Antarctic species, it is difficult to predict how climate changes might alter the geographic range, behaviour, phenology and ultimately genetic variability of these species. It is possible, however, that their high degree of endemism and dependence on local environmental specificities to complete their life cycles might enhance their vulnerability.

Lifestyle and Ice: The Relationship between Ecological Specialization and Response to Pleistocene Climate Change

Major climatic changes in the Pleistocene had significant effects on marine organisms and the environments in which they lived. The presence of divergent patterns of demographic history even among phylogenetically closely-related species sharing climatic changes raises questions as to the respective influence of species-specific traits on population structure. In this work we tested whether the lifestyle of Antarctic notothenioid benthic and pelagic fish species from the Southern Ocean influenced the concerted population response to Pleistocene climatic fluctuations. This was done by a comparative analysis of sequence variation at the cyt b and S7 loci in nine newly sequenced and four re-analysed species. We found that all species underwent more or less intensive changes in population size but we also found consistent differences between demographic histories of pelagic and benthic species. Contemporary pelagic populations are significantly more genetically diverse and bear traces of older demographic expansions than less diverse benthic species that show evidence of more recent population expansions. Our findings suggest that the lifestyles of different species have strong influences on their responses to the same environmental events. Our data, in conjunction with previous studies showing a constant diversification tempo of these species during the Pleistocene, support the hypothesis that Pleistocene glaciations had a smaller effect on pelagic species than on benthic species whose survival may have relied upon ephemeral refugia in shallow shelf waters. These findings suggest that the interaction between lifestyle and environmental changes should be considered in genetic analyses.

A novel phantom technique for evaluating the performance of PET auto-segmentation methods in delineating heterogeneous and irregular lesions

BACKGROUND

Positron Emission Tomography (PET)-based automatic segmentation (PET-AS) methods can improve tumour delineation for radiotherapy treatment planning, particularly for Head and Neck (H&N) cancer. Thorough validation of PET-AS on relevant data is currently needed. Printed subresolution sandwich (SS) phantoms allow modelling heterogeneous and irregular tracer uptake, while providing reference uptake data. This work aimed to demonstrate the usefulness of the printed SS phantom technique in recreating complex realistic H&N radiotracer uptake for evaluating several PET-AS methods.

METHODS

Ten SS phantoms were built from printouts representing 2mm-spaced slices of modelled H&N uptake, printed using black ink mixed with 18F-fluorodeoxyglucose, and stacked between 2mm thick plastic sheets. Spherical lesions were modelled for two contrasted uptake levels, and irregular and spheroidal tumours were modelled for homogeneous, and heterogeneous uptake including necrotic patterns. The PET scans acquired were segmented with ten custom PET-AS methods: adaptive iterative thresholding (AT), region growing, clustering applied to 2 to 8 clusters, and watershed transform-based segmentation. The difference between the resulting contours and the ground truth from the image template was evaluated using the Dice Similarity Coefficient (DSC), Sensitivity and Positive Predictive value.

RESULTS

Realistic H&N images were obtained within 90 min of preparation. The sensitivity of binary PET-AS and clustering using small numbers of clusters dropped for highly heterogeneous spheres. The accuracy of PET-AS methods dropped between 4% and 68% for irregular lesions compared to spheres of the same volume. For each geometry and uptake modelled with the SS phantoms, we report the number of clusters resulting in optimal segmentation. Radioisotope distributions representing necrotic uptakes proved most challenging for most methods. Two PET-AS methods did not include the necrotic region in the segmented volume.

CONCLUSIONS

Printed SS phantoms allowed identifying advantages and drawbacks of the different methods, determining the most robust PET-AS for the segmentation of heterogeneities and complex geometries, and quantifying differences across methods in the delineation of necrotic lesions. The printed SS phantom technique provides key advantages in the development and evaluation of PET segmentation methods and has a future in the field of radioisotope imaging.

Quantification of the activity of tritium produced during the routine synthesis of (18)F fluorodeoxyglucose for positron emission tomography

Gamma emitting radioactive by-products generated during the cyclotron irradiation of (18)O labelled water by protons to produce (18)FDG (fluorodeoxyglucose) for positron emission tomography are well characterised. However, the production of tritium ((3)H) through the (18)O(p,t)(16)O nuclear reaction has not been investigated in detail. The aim of this study was to measure tritium activity produced during a large number of (18)FDG production runs in order to obtain a better perspective on its impact on radioactive waste management, particularly as regards storage and disposal. Tritium was assayed by liquid scintillation counting in recovered (18)O water from 24 separate production runs. The mean (SD) values of activity and activity concentration were 170 (20) kBq and 81 (8) kBq ml(-1) respectively. Both quantities were positively correlated with the activity of (18)F. Tritium was detected in much lower concentration in water used to rinse the target vessel. The activity of tritium is such that it is exempt from regulatory control and may be combined with bulk non-active waste for disposal as Very Low Level Waste. However, variations in the irradiation conditions or the procedures for the collection of recovered water might result in its classification as Low Level Waste, necessitating a more complex disposal regime.

De novo WNT5A-associated autosomal dominant Robinow syndrome suggests specificity of genotype and phenotype

Robinow Syndrome (RS), a rare skeletal dysplasia syndrome, is characterized by dysmorphic features resembling a fetal face, mesomelic limb shortening, hypoplastic external genitalia in males, and renal and vertebral anomalies. Both autosomal dominant and autosomal recessive patterns of inheritance have been reported. Since the description of autosomal dominant Robinow Syndrome (ADRS; OMIM 180700) in 1969 by Meinhard Robinow and colleagues, the molecular etiology remained elusive until only recently. WNT5A was proposed to be the candidate gene for ADRS, as mutations were found in two affected families, one of those being the originally described index family. We report three families with RS caused by novel heterozygous WNT5A mutations, which were confirmed in the first family by whole exome sequencing, and in all by Sanger sequencing. To our knowledge, this is the largest number of published families with ADRS in whom a WNT5A mutation was identified. Families 1 and 2 are the first cases showing de novo inheritance in the affected family members and thus strengthen the evidence for WNT5A as the causative gene in ADRS. Finally, we propose WNT5A mutation specificity in ADRS, which may affect interactions with other proteins in the Wnt pathway.

Influence of cold walls on PET image quantification and volume segmentation: a phantom study

PURPOSE

Commercially available fillable plastic inserts used in positron emission tomography phantoms usually have thick plastic walls, separating their content from the background activity. These "cold" walls can modify the intensity values of neighboring active regions due to the partial volume effect, resulting in errors in the estimation of standardized uptake values. Numerous papers suggest that this is an issue for phantom work simulating tumor tissue, quality control, and calibration work. This study aims to investigate the influence of the cold plastic wall thickness on the quantification of 18F-fluorodeoxyglucose on the image activity recovery and on the performance of advanced automatic segmentation algorithms for the delineation of active regions delimited by plastic walls.

METHODS

A commercial set of six spheres of different diameters was replicated using a manufacturing technique which achieves a reduction in plastic walls thickness of up to 90%, while keeping the same internal volume. Both sets of thin- and thick-wall inserts were imaged simultaneously in a custom phantom for six different tumor-to-background ratios. Intensity values were compared in terms of mean and maximum standardized uptake values (SUVs) in the spheres and mean SUV of the hottest 1 ml region (SUVmax, SUVmean, and SUVpeak). The recovery coefficient (RC) was also derived for each sphere. The results were compared against the values predicted by a theoretical model of the PET-intensity profiles for the same tumor-to-background ratios (TBRs), sphere sizes, and wall thicknesses. In addition, ten automatic segmentation methods, written in house, were applied to both thin- and thick-wall inserts. The contours obtained were compared to computed tomography derived gold standard ("ground truth"), using five different accuracy metrics.

RESULTS

The authors' results showed that thin-wall inserts achieved significantly higher SUVmean, SUVmax, and RC values (up to 25%, 16%, and 25% higher, respectively) compared to thick-wall inserts, which was in agreement with the theory. This effect decreased with increasing sphere size and TBR, and resulted in substantial (>5%) differences between thin- and thick-wall inserts for spheres up to 30 mm diameter and TBR up to 4. Thinner plastic walls were also shown to significantly improve the delineation accuracy for the majority of the segmentation methods tested, by increasing the proportion of lesion voxels detected, although the errors in image quantification remained non-negligible.

CONCLUSIONS

This study quantified the significant effect of a 90% reduction in the thickness of insert walls on SUV quantification and PET-based boundary detection. Mean SUVs inside the inserts and recovery coefficients were particularly affected by the presence of thick cold walls, as predicted by a theoretical approach. The accuracy of some delineation algorithms was also significantly improved by the introduction of thin wall inserts instead of thick wall inserts. This study demonstrates the risk of errors deriving from the use of cold wall inserts to assess and compare the performance of PET segmentation methods.

Biochemical and pharmacological characterization of AZD1981, an orally available selective DP2 antagonist in clinical development for asthma

BACKGROUND AND PURPOSE

The discovery of DP2 as a second receptor for PGD2 has prompted the search for antagonists as potential novel therapies based on the associations between PGD2 and disease. Here we describe the biochemical and pharmacological properties of 4-(acetylamino)-3-[(4-chlorophenyl)thio]-2-methyl-1H-indole-1-acetic acid (AZD1981), a novel DP2 receptor antagonist.

EXPERIMENTAL APPROACH

Binding to DP2 , functional receptor pharmacology and selectivity were studied in both human and animal systems.

KEY RESULTS

AZD1981 displaced radio-labelled PGD2 from human recombinant DP2 with high potency (pIC50 = 8.4). Binding was reversible, non-competitive and highly selective against a panel of more than 340 other enzymes and receptors, including DP1 (>1000-fold selective). AZD1981 inhibited DP2 -mediated shape change and CD11b up-regulation in human eosinophils, shape change in basophils and chemotaxis of human eosinophils and Th2 cells with similar potency. AZD1981 exhibited good cross-species binding activity against mouse, rat, guinea pig, rabbit and dog DP2 . Evaluation in mouse, rat or rabbit cell systems was not possible as they did not respond to DP2 agonists. Agonist responses were seen in guinea pig and dog, and AZD1981 blocked DP2 -mediated eosinophil shape change. Such responses were more robust in the guinea pig, where AZD1981 also blocked DP2 -dependent eosinophil emigration from bone marrow.

CONCLUSIONS AND IMPLICATIONS

AZD1981 is a DP2 antagonist that blocks functional responses in eosinophils, Th2 cells and basophils. It exhibited similar potency irrespective of the cell type, DP2 agonist or species used. This selective orally active agent is currently under clinical evaluation as a potential therapeutic agent in respiratory diseases including asthma.

WE-F-211-01: The Evolving Landscape of Scientific Publishing

The dissemination of scientific advances has changed little since the first peer-reviewed journal was published in 1665 - that is, until this past decade. The print journal, delivered by mail and stored on office shelves and in library reading rooms around the world, has been transformed by immediate, on-demand access to scientific discovery in electronic form. At the same time, the producers and consumers of that scientific content have greatly increased in number, and the balance between supply and demand has required innovations in the world of scientific publishing. In light of technological advances and societal expectations, the dissemination of scientific knowledge has assumed a new form, one that is dynamic and rapidly changing. The academic medical physicist must understand this evolution to ensure that appropriate decisions are made with regard to journal submission strategies and that relevant information on new findings is obtained in a timely manner. Medical Physics is adapting to these changes in substantive ways. This new scientific publishing landscape has implications for subscription models, targeted access through semantic enrichment, user interactivity with content, customized content delivery, and advertising opportunities. Many organizations, including the AAPM, depend on scientific publishing as a significant source of revenue, but web-based delivery raises the expectation that access should be free and threatens this model. The purpose of this symposium is to explore the factors that have contributed to the current state of scientific publishing, to anticipate future directions in this arena, and to convey how medical physicists may benefit from the expanded opportunities, both as authors and as readers.

LEARNING OBJECTIVES

1. To appreciate the importance of scientific and clinical practice communication for the advancement of the medical physics field 2. To understand the roles of the Editorial Board and the Journal Business Management Committee in the promotion and advancement of Medical Physics 3. To explore technology-driven content delivery mechanisms and their role in facilitating content access and driving content usage 4. To understand the potential benefits and pitfalls of various economic and editorial models of scientific publications and the recent shifts away from the traditional role of libraries.

Isolation and characterization of an enzyme from the Greenshell™ mussel Perna canaliculus that hydrolyses pectenotoxins and esters of okadaic acid

An enzyme capable of hydrolysing pectenotoxins (PTXs) and okadaic acid (OA) esters within the hepatopancreas of the Greenshell™ mussel Perna canaliculus was isolated and characterized. The enzyme was purified by sequential polyethylene glycol fractionation, anion exchange, hydrophobic interaction, gel filtration and hydroxyapatite chromatography. The enzyme was an acidic (pI ∼ 4.8), monomeric, 67 kDa, serine esterase with optimum activity at pH 8.0 and 25 °C. PTX2 and PTX1 were hydrolysed but the enzyme was inactive against PTX11, PTX6 and acid isomerised PTX2 and PTX11. PTX11 and PTX2b competitively inhibited PTX2 hydrolysis. The enzyme also hydrolysed short and medium chain length (C2-C10) 4-nitrophenyl-esters, okadaic acid C8-C10 diol esters and DTX1 7-O-palmitoyl ester (DTX3). MALDI-Tof MS/MS analysis showed that the enzyme had some homology with a juvenile hormone esterase from the Red Flour Beetle Tribolium castaneum, although BLAST searches of several data bases using de novo amino acid sequences failed to identify any homology with known proteins.