Scaling the yield of laser-driven electron-positron jets to laboratory astrophysical applications

We report new experimental results obtained on three different laser facilities that show directed laser-driven relativistic electron-positron jets with up to 30 times larger yields than previously obtained and a quadratic (∼E_{L}^{2}) dependence of the positron yield on the laser energy. This favorable scaling stems from a combination of higher energy electrons due to increased laser intensity and the recirculation of MeV electrons in the mm-thick target. Based on this scaling, first principles simulations predict the possibility of using such electron-positron jets, produced at upcoming high-energy laser facilities, to probe the physics of relativistic collisionless shocks in the laboratory.

How fluorescent labelling alters the solution behaviour of proteins

The impact of adding a fluorescent dye to a protein is examined using protein phase diagrams and numerical simulations. The addition of the dye is the equivalent of adding a large attractive patch to the surface of the protein, which results in significant changes to the protein solution behaviour.

Role of the pro-survival molecule Bfl-1 in melanoma

Bfl-1 is a pro-survival Bcl-2 family member overexpressed in a subset of chemoresistant tumours, including melanoma. Here, we characterised the expression and regulation of Bfl-1 in normal and malignant melanocytes and determined its role in protecting these cells from chemotherapy-induced apoptosis. Bfl-1 was mitochondrially resident in both resting and apoptotic cells and experienced regulation by the proteasome and NFκB pathways. siRNA-mediated knockdown enhanced sensitivity towards various relevant drug treatments, with forced overexpression of Bfl-1 protective. These findings identify Bfl-1 as a contributor towards therapeutic resistance in melanoma cells and support the use of NFκB inhibitors alongside current treatment strategies.

Health economic analysis of ticagrelor in patients with acute coronary syndromes intended for non-invasive therapy

Objective

To investigate the cost effectiveness of ticagrelor versus clopidogrel in patients with acute coronary syndromes (ACS) in the Platelet Inhibition and Patient Outcomes (PLATO) study who were scheduled for non-invasive management.

Methods

A previously developed cost effectiveness model was used to estimate long-term costs and outcomes for patients scheduled for non-invasive management. Healthcare costs, event rates and health-related quality of life under treatment with either ticagrelor or clopidogrel over 12 months were estimated from the PLATO study. Long-term costs and health outcomes were estimated based on data from PLATO and published literature sources. To investigate the importance of different healthcare cost structures and life expectancy for the results, the analysis was carried out from the perspectives of the Swedish, UK, German and Brazilian public healthcare systems.

Results

Ticagrelor was associated with lifetime quality-adjusted life-year (QALY) gains of 0.17 in Sweden, 0.16 in the UK, 0.17 in Germany and 0.13 in Brazil compared with generic clopidogrel, with increased healthcare costs of €467, €551, €739 and €574, respectively. The cost per QALY gained with ticagrelor was €2747, €3395, €4419 and €4471 from a Swedish, UK, German and Brazilian public healthcare system perspective, respectively. Probabilistic sensitivity analyses indicated that the cost per QALY gained with ticagrelor was below conventional threshold values of cost effectiveness with a high probability.

Conclusions

Treatment of patients with ACS scheduled for 12 months’ non-invasive management with ticagrelor is associated with a cost per QALY gained below conventional threshold values of cost effectiveness compared with generic clopidogrel.

Trial registration number

NCT000391872.

International comparisons of the management of patients with non-ST segment elevation acute myocardial infarction in the United Kingdom, Sweden, and the United States: The MINAP/NICOR, SWEDEHEART/RIKS-HIA, and ACTION Registry-GWTG/NCDR registries

Objectives

To compare management of patients with acute non-ST segment elevation myocardial infarction (NSTEMI) in three developed countries with national ongoing registries.

Background

Results from clinical trials suggest significant variation in care across the world. However, international comparisons in “real world” registries are limited.

Methods

We compared the use of in-hospital procedures and discharge medications for patients admitted with NSTEMI from 2007 to 2010 using the unselective MINAP/NICOR [England and Wales (UK); n = 137,009], the unselective SWEDEHEART/RIKS-HIA (Sweden; n = 45,069), and the selective ACTION Registry-GWTG/NCDR [United States (US); n = 147,438] clinical registries.

Results

Patients enrolled among the three registries were generally similar except those in the US who were younger but had higher rates of smoking, diabetes, hypertension, prior heart failure, and prior MI than in Sweden or in UK. Angiography and percutaneous coronary intervention (PCI) were performed more often in the US (76% and 44%) and Sweden (65% and 42%) relative to the UK (32% and 22%). Discharge betablockers were also prescribed more often in the US (89%) and Sweden (89%) than in the UK (76%). In contrast, discharge statins, angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB), and dual antiplatelet agents (among those not receiving PCI) were higher in the UK (92%, 79%, and 71%) than in the US (85%, 65%, 41%) and Sweden (81%, 69%, and 49%).

Conclusions

The care for patients with NSTEMI differed substantially among the three countries. These differences in care among countries provide an opportunity for future comparative effectiveness research as well as identify opportunities for global quality improvement.

Early experience of MAGEC magnetic growing rods in the treatment of early onset scoliosis

PURPOSE

Magnetically controlled growing rod systems have been introduced over recent years as an alternative to traditional growing rods for management of early onset scoliosis. The purpose of this paper is to report our early experience of a magnetically controlled growing rod system (MAGEC, Ellipse).

METHODS

Review of pre-operative, postoperative and follow-up Cobb angles and spinal growth in case series of eight patients with a minimum 23 months' follow-up (23-36 months).

RESULTS

A total of six patients had dual rod constructs implanted and two patients received single-rod constructs. Four patients had MAGEC rods as a primary procedure. Four were revisions from other systems. Mean age at surgery in the primary group was 4.5 years (range 3.9-6.9). In patients who had MAGEC as a primary procedure, mean pre-operative Cobb angle was 74° (63-94), with postoperative Cobb angle of 42° (32-56) p ≤ 0.001 (43% correction). Mean Cobb angle at follow-up was 42° (35-50). Spinal growth rate was 6 mm/year. One sustained proximal screw pull out. A final patient sustained a rod fracture. Mean age at surgery in the revision group was 10.9 years (range 9-12.6). Mean pre-operative Cobb angle was 45° (34-69). Postoperative Cobb angle was 42° (33-63) (2% correction). Mean Cobb angle at follow-up was 44° (28-67). Mean spinal growth rate was 12 mm/year. Two patients developed loss of distraction.

CONCLUSION

MAGEC growing rod system effectively controls early onset scoliosis when used as either a primary or revision procedure. Although implant-related complications are not uncommon, the avoidance of multiple surgeries following implantation is beneficial compared with traditional growing rod systems.

Gyrification of Broca's region is anomalously lateralized at onset of schizophrenia in adolescence and regresses at 2 year follow-up

Gyrification of the human cerebral cortex starts in the foetus and progresses in early infancy; the pattern of folding in later life provides a lead to early developmental aberration. By studying gyrification at illness onset in adolescence we hoped to clarify the pathophysiology of schizophrenia. Here we find 1) an area of hypergyria includes Broca's area and extends into the Sylvian fissure to encroach on the anterior insula in the left hemisphere, and 2) an area of hypogyria in the superior temporal lobe approximates to Wernicke's area but is located in the right hemisphere and encroaches on the posterior insula. In Broca's/anterior insula area, right lateralization was present in healthy controls but patients were left lateralized: at two year follow-up gyrification had decreased in patients while it increased in controls, and the reduction predicted impaired category fluency. Progressive change was unaccompanied by cortical thinning (investigated only in the brain regions showing baseline changes in gyrification) indicating that the disease process affecting these brain regions (insula, inferior frontal and superior temporal) is not primarily degenerative. A deviation in the lateralized development of peri-Sylvian areas for language production and comprehension appears critical to the pathophysiology of schizophrenia and may point to its species-specific origin.

The characterisation and risk factors of ischaemic heart disease in patients with coeliac disease

BACKGROUND

Studies have shown an increased risk of ischaemic heart disease (IHD) in patients with coeliac disease (CD), despite the patients' lack of traditional IHD risk factors.

AIM

To characterise IHD according to CD status.

METHODS

Data on duodenal or jejunal biopsies were collected in 2006-2008 from all 28 pathology departments in Sweden and were used to define CD (equal to villous atrophy; Marsh stage 3). We used the Swedish cardiac care register SWEDEHEART to identify IHD and to obtain data on clinical status and risk factors at time of first myocardial infarction for this case-only comparison. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). CD patients were compared with general population reference individuals.

RESULTS

We identified 1075 CD patients and 4142 reference individuals with subsequent IHD. CD patients with myocardial infarction had lower body mass index (P < 0.001) and cholesterol values (P < 0.001) and were less likely to be active smokers (OR = 0.74; 95% CI = 0.56-0.98) than reference individuals with myocardial infarction. CD patients had less extensive coronary artery disease at angiography (any stenosis: OR = 0.80; 95% CI = 0.66-0.97; three-vessel disease: OR = 0.73; 95% CI = 0.57-0.94); but there was no difference in the proportions of CD patients with positive biochemical markers of myocardial infarction (CD: 92.2% vs. reference individuals: 91.5%, P = 0.766).

CONCLUSION

Despite evidence of an increased risk of IHD and higher cardiovascular mortality, patients with coeliac disease with IHD have a more favourable cardiac risk profile compared with IHD in reference individuals.

Predicting 24-hour urinary protein excretion in Afro-Caribbean Barbadians by comparing urine protein excretion over different durations versus spot collection

AIM

The gold standard for the determination of proteinuria, an independent risk factor for cardiovascular and renal disease, is the measurement of protein in a 24-hour urine collection. However this method has been shown to be unreliable mainly due to poor compliance of sampling by patients. This study investigates other appropriate means of predicting 24-hour urinary protein excretion in a sample of Afro-Caribbeans in Barbados by assessing the correlation of actual and estimated urinary protein excretion between a 24-hour urine collection sample, 12-hour (AM and PM) and spot (AM and PM) urine collections.

SUBJECTS AND METHOD

A convenient sample of 30 healthy participants of Afro-Caribbean origin between the ages of21 and 55 years was recruited for the study The 24-hour urine samples and anthropometric data were collected as documented in the study s standard clinical procedure. A 24-hour urine sample was collected as two separate 12-hour AM and PM samples. In addition, two spot samples (AM and PM) were taken during each 12-hour sample collection period. Analysis of the urinary protein and creatinine was done with a Roche/Hitachi Modular System (Roche Diagnostics, IN, USA). SPSS version 19 was used to analyse the data to make inferences.

RESULTS

Thirty Afro-Caribbean persons participated in the study: 16 females and 14 males. The average age and body mass index (BMI) were 38 +/- 17 years and 25.32+/- 5.98 kg/m2, respectively. The Spearman Rho 's correlation was used to interpret associations of the urinary parameters in 24-hour collected sample and the other samples. The strongest correlation of the protein:creatinine ratio in the 24-hour collected sample to the other samples was observed with the 12-hour AM sample (r = + 0.743, p < O.01)followed by the 12-hour PM sample (r = +0.672, p < 0.01). On analysing gender, the more significant correlations found were among the males for the 12-hour timed samples with r = +0.945, p < 0.01 and r = +0.736, p < 0.01 for the AM and PM samples, respectively. There were very strong correlations between the 24-hour urinary protein excretion and the estimated 24-hour protein excretion from the 12-hour AM and PM samples (r = +0.846, p < 0.01 and r = +0.637, p < 0.01, respectively). Both males and females had the strongest correlation for the estimation of 24-hour protein excretion in the 12-hour AM sample (r = +0.795, p < 0.01 and r = +0.965, p < 0.01, respectively).

CONCLUSION

The use ofa 12-hour timed sample, specifically the morning sample, may be a more convenient way to assess proteinuria in the Afro-Caribbean population. This method allows for a quicker assessment of proteinuria which not only allows earlier diagnosis of renal disease but may also reduce the clinical cost of the disease s management.

Predicting 24-hour urinary sodium excretion in Afro-Caribbean Barbadians by comparing urine sodium excretion over different durations versus spot collection

AIM

Urinary sodium excretion is used as an assessment tool for salt intake and salt handling. Even though cumbersome, the most reliable and readily used method in clinical and epidemiological studies is the 24-hour urine collection. This study investigates other appropriate means ofpredicting 24-hour urinary sodium excretion in a sample of Afro-Caribbeans in Barbados by assessing the correlation of actual and estimated urinary sodium excretion between a 24-hour urine collection sample, 12-hour (AM and PM), and spot (AM and PM) urine collections.

METHOD

A convenient sample of 30 healthy participants of Afro-Caribbean origin between the ages of 21 and 55 years was recruited for the study. The 24-hour urine samples and anthropometric data were collected as documented in the study's standard clinical procedure. A 24-hour urine sample was collected as two separate 12-hour AM and PM samples. In addition, two spot samples (AM and PM) were taken during each 12-hour sample collection period. Analysis of the urinary sodium and creatinine was done with a Roche/Hitachi Modular System (Roche Diagnostics, IN, USA). SPSS version 19 was used to analyse the data to make inferences.

RESULTS

Thirty Afro-Caribbean subjects participated in this study: 16 females and 14 males. The average age and body mass index (BMI) were 38 +/- 17 years and 25.32 +/- 5.98 kg/m2, respectively. The greatest correlation of the estimated 24-hour sodium excretion to the measured 24-hour sodium excretion was observed in the 12-hour PM sample (Pearson's correlation, r = 0.786, p < 0.001) followed by the 12-hour AM sample (Pearson's correlation, r = 0.774, p < 0.001). The PM spot sample showed a weaker, but still statistically significant correlation to the 24-hour timed sample (Pearson 's correlation, r = 0.404, p < 0.045). The AM spot sample showed a very weak and insignificant correlation (Pearson 's correlation, r = 0.05, p = 0.807) to the 24-hour timed sample. Similarly to the whole sample, the gender analysis demonstrated that estimated 24-hour sodium excretion in the female's 12-hour PM sample had the greatest correlation (r = 0.819, p < 0.001) to the measured 24-hour sodium excretion, followed by the 12-hour AM (r = 0.793, p = 0.001) and the PM spot samples (r = 0.741, p = 0.02). The correlation between variables is weaker in males compared to the females.

CONCLUSION

Overall, this study shows a clear correlation between the estimated 24-hour sodium excretion from the 12-hour timed PM sample and the measured 24-hour sodium excretion. Such findings support the thought of using other alternatives to determine sodium excretion, in view of replacing the cumbersome 24-hour urinary collection with a smaller timed sample. Nonetheless, a more robust and randomized population sample as well as a method to correct for high creatinine variability is required to further enhance the significance of the obtained results.

Consideration of the influence of place on access to employment for persons with serious mental illness in northeastern Ontario

INTRODUCTION

Despite increasing attention to employment within the mental health sector, reports indicate that people with serious mental illness (SMI) continue to experience limited employment success in the province of Ontario, Canada. Research specifies that people with SMI who live in rural places are less likely than those living in urban centers to have access to satisfactory employment services or to become gainfully employed. The objective of this study was to examine access to employment from the perspectives of people with SMI, mental health and vocational service providers, and decision-makers, and to explore whether place influenced their access to work in northeastern Ontario.

METHODS

A qualitative case study using community-based participatory research methods was chosen to examine the experience of access to competitive employment in two northeastern Ontario communities. The cases selected for study were two geographic areas in northeastern Ontario which provided best-practice, mental health services to persons with SMI. Community-based site partners advertised and recruited participants, and a consumer advisory provided input on key stakeholders, questions, findings and the study action plan. The study findings were informed by individual and group interviews conducted with 46 individuals who resided in both rural and urban settings in the case communities, and feedback from 49 participants who attended town hall forums for presentation of study findings and development of an action plan. The qualitative data was supported by a secondary data source reporting on the employment outcomes of 4112 people with SMI who received disability income support and who resided in the case communities. Qualitative data were analyzed inductively, and categories and themes were developed. Findings were member checked with all informants and town hall participants in each case community.

RESULTS

This article draws on the findings of a larger study and reports on the influence of place to the low employment success experienced by people with SMI who reside in the case communities; 91.3% of those receiving disability income support are unemployed, and rural residents experience higher levels of unemployment than those in urban places. Place was found to influence access to employment in five ways: by limited access to employment support services in rural places, and to recommended ratios in urban places; by the use of different models and practices that were inconsistent with best practices for people with SMI; by the lack of a plan for the implementation of employment services in the case communities; by limited use of the available, dedicated vocational resources for employment purposes; and by inadequate supports provided to persons with SMI who wish to enter the workforce. The results also underscore how people with SMI continue to be perceived negatively regarding their capacity for employment. Such stereotypical attitudes additionally contributed to employment marginalization of people with SMI from the workforce, especially in rural communities.

CONCLUSIONS

The study highlights the influence of geography and human resources to the implementation of best practice employment services and supports for persons with SMI. Important policy implications include the need to consider place when implementing evidence-based practices in places where geography, distance and human health resources limit the communities' capacity to successfully do so. The study also underscores the need to build community capacity for supported employment, especially in rural places, in order to improve the participation of people with SMI in employment, and subsequently, to help shift the communities' thinking about their capacity for work.

Abstract 4858: Identification of ZDHHC14 as a novel tumor suppressor gene commonly downregulated in human cancers

Tumor suppressor genes (TSGs) play critical roles in preventing tumorigenesis and they are frequently inactivated in tumours. Recently developed high-density microarrays can detect subchromosomal deletions, recurrence of which usually indicates the location of TSGs within the deleted region. We analyzed testicular germ cell tumour (TGCT) clinical samples using SNP arrays and found a frequent small deletion on the region 6q25.3 containing only one known gene, ZDHHC14. While its cellular function is unknown, ZDHHC14 belongs to the recently discovered DHHC family, which are predicted to be involved in protein palmitoylation, a reversible lipid modification that regulates membrane tethering for key proteins in cell signaling, cancer, neuronal transmission, and membrane trafficking. Consistently, we found a dramatic under-expression of ZDHHC14 mRNA and protein in TGCTs, and this associated with chemoresistance. Oncomine database mining showed that ZDHHC14 is also under-expressed in lymphoma, liposarcoma, brain, kidney, lung and colorectal cancers. Thus, it appears that ZDHHC14 downregulation may be involved in other cancers. We studied ZDHHC14 expression in prostate cancer (PCa), detecting a decrease at mRNA and protein level. We also detected that ZDHHC14 mRNA was downregulated in a pilot study on breast cancer samples. As genomic loss of the ZDHHC14 region was only detected in a small number of PCa samples, we checked whether promoter hypermethylation was the cause for ZDHHC14 downregulation. However, no changes in methylation status were found. We then sequenced the whole genomic region surrounding ZDHHC14 by next generation sequencing in TGCTs and PCa and found several mutations in the promoter, the coding region, as well as in intronic regions. Finally, we tested the function of ZDHHC14 in cell-based studies. We generated a 293 T-REx tetracycline inducible ZDHHC14 overexpressing stable cell line, which showed that ZDHHC14 overexpression decreased cell viability. The induction of apoptosis by ZDHHC14 overexpression was detected both by FACS and caspase 7 and PARP cleavage analyses. This was confirmed by transient ZDHHC14 overexpression in the PCa cell line 22RV1. In vivo we xenografted mice using both tetracycline inducible ZDHHC14 overexpressing 293 T-REx cells and control cells transfected with the empty vector. ZDHHC14 expression was induced by tetracycline at the beginning of inoculation and we detected that ZDHHC14 overexpression blocked tumour initiation completely. In conclusion, these results implicate ZDHHC14 as a tumour suppressor gene commonly inactivated in human cancers, indicating that it might exert its tumor suppressor role through the induction of programmed cell death. This is the first study showing the involvement of ZDHHC14 in a specific pathway, the classic caspase-dependent apoptosis.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 4858. doi:1538-7445.AM2012-4858

Biosecurity-based interventions and strategies to reduce Campylobacter spp. on poultry farms

The prevention and control of Campylobacter colonization of poultry flocks are important public health strategies for the control of human campylobacteriosis. A critical review of the literature on interventions to control Campylobacter in poultry on farms was undertaken using a systematic approach. Although the focus of the review was on aspects appropriate to the United Kingdom poultry industry, the research reviewed was gathered from worldwide literature. Multiple electronic databases were employed to search the literature, in any language, from 1980 to September 2008. A primary set of 4,316 references was identified and scanned, using specific agreed-upon criteria, to select relevant references related to biosecurity-based interventions. The final library comprised 173 references. Identification of the sources of Campylobacter in poultry flocks was required to inform the development of targeted interventions to disrupt transmission routes. The approach used generally involved risk factor-based surveys related to culture-positive or -negative flocks, usually combined with a structured questionnaire. In addition, some studies, either in combination or independently, undertook intervention trials. Many of these studies were compromised by poor design, sampling, and statistical analysis. The evidence for each potential source and route of transmission on the poultry farm was reviewed critically, and the options for intervention were considered. The review concluded that, in most instances, biosecurity on conventional broiler farms can be enhanced and this should contribute to the reduction of flock colonization. However, complementary, non-biosecurity-based approaches will also be required in the future to maximize the reduction of Campylobacter-positive flocks at the farm level.

Weil osteotomy: assessment of medium term results and predictive factors in recurrent metatarsalgia

BACKGROUND

The angle of the Weil osteotomy is usually referenced relative to the floor irrespective of the plantar angulation of the metatarsal. This study aims to analyse the long term results following the Weil osteotomy and identify the cause of poor outcome.

METHODS

This study presents a retrospective review of 61 patients (86 feet), with mean follow-up of 31 months. Each patient underwent clinical, pedobarographic and radiological examination. The radiographs obtained included 'Metatarsal Skyline Views' (MSV), to assess the plantar declination of the metatarsal heads following the osteotomy. The functional scoring was performed using AOFAS and Foot Function Index.

RESULTS

Fifty-five patients (80 feet) showed good to excellent results clinically. Six patients had persistent metatarsalgia. All these 6 patients had callosities beneath metatarsal heads. Pedobarography showed peak pressures in the same distribution as callosities and the MSV showed increased plantar declination of the metatarsal heads. This correlation was found to be significant (p<0.05).

CONCLUSION

The Weil osteotomy is a safe and effective treatment for metatarsalgia. An MSV radiograph is helpful to identify the plantar prominence of metatarsal which can be associated with poor clinical outcomes.