The development of a cancer genetic-specific measure of coping: the GRACE

OBJECTIVE

Generic measures of coping fail to capture the process of undergoing specific health processes such as cancer genetic risk assessment. The Genetic Risk Assessment Coping Evaluation (GRACE) has been developed to provide greater specificity of measurement.

METHOD

Based upon previous research findings, the GRACE measures the degree of stress associated with 11 recognised sources of stress for individuals undergoing the early stages of cancer genetic risk assessment, and the use of up to eight coping strategies they may elicit. This paper reports preliminary data from the piloting of the GRACE within a randomised trial of a coping intervention.

RESULTS

Of the 265 participants who completed and returned their baseline questionnaire (prior to being informed of their level of genetic risk), 257 completed the GRACE. The most highly endorsed sources of stress involved concerns relating to family members, endorsed by over 60% of respondents, and concerns about how the participants would cope if found to be at increased risk (59%). Participants made use of multiple coping strategies across different sources of stress. The most frequently reported coping strategies were emotion-focused, which may reflect the stage of the assessment process.

CONCLUSION

The completion rates for the matrix and specificity of responses provided suggest that the GRACE may be an acceptable measurement tool. Further data collection and validation is ongoing.

Pertussis outbreak in northwest Ireland, January – June 2010

We report a community pertussis outbreak that occurred in a small town located in the northwest of Ireland. Epidemiological investigations suggest that waning immunity and the absence of a booster dose during the second year of life could have contributed to the outbreak. The report also highlights the need to reinforce the surveillance of pertussis in Ireland and especially to improve the clinical and laboratory diagnosis of cases.

Pertussis outbreak in northwest Ireland, January - June 2010

We report a community pertussis outbreak that occurred in a small town located in the northwest of Ireland. Epidemiological investigations suggest that waning immunity and the absence of a booster dose during the second year of life could have contributed to the outbreak. The report also highlights the need to reinforce the surveillance of pertussis in Ireland and especially to improve the clinical and laboratory diagnosis of cases.

Analysis of X chromosome genomic DNA sequence copy number variation associated with premature ovarian failure (POF)

BACKGROUND

Premature ovarian failure (POF) is a heterogeneous disease defined as amenorrhoea for >6 months before age 40, with an FSH serum level >40 mIU/ml (menopausal levels). While there is a strong genetic association with POF, familial studies have also indicated that idiopathic POF may also be genetically linked. Conventional cytogenetic analyses have identified regions of the X chromosome that are strongly associated with ovarian function, as well as several POF candidate genes. Cryptic chromosome abnormalities that have been missed might be detected by array comparative genomic hybridization.

METHODS

In this study, samples from 42 idiopathic POF patients were subjected to a complete end-to-end X/Y chromosome tiling path array to achieve a detailed copy number variation (CNV) analysis of X chromosome involvement in POF. The arrays also contained a 1 Mb autosomal tiling path as a reference control. Quantitative PCR for selected genes contained within the CNVs was used to confirm the majority of the changes detected. The expression pattern of some of these genes in human tissue RNA was examined by reverse transcription (RT)-PCR.

RESULTS

A number of CNVs were identified on both Xp and Xq, with several being shared among the POF cases. Some CNVs fall within known polymorphic CNV regions, and others span previously identified POF candidate regions and genes.

CONCLUSIONS

The new data reported in this study reveal further discrete X chromosome intervals not previously associated with the disease and therefore implicate new clusters of candidate genes. Further studies will be required to elucidate their involvement in POF.

Clinical validation of an autoantibody test for lung cancer

Background: Autoantibodies may be present in a variety of underlying cancers several years before tumours can be detected and testing for their presence may allow earlier diagnosis. We report the clinical validation of an autoantibody panel in newly diagnosed patients with lung cancer (LC).

Patients and methods: Three cohorts of patients with newly diagnosed LC were identified: group 1 (n = 145), group 2 (n = 241) and group 3 (n = 269). Patients were individually matched by gender, age and smoking history to a control individual with no history of malignant disease. Serum samples were obtained after diagnosis but before any anticancer treatment. Autoantibody levels were measured against a panel of six tumour-related antigens (p53, NY-ESO-1, CAGE, GBU4-5, Annexin 1 and SOX2). Assay sensitivity was tested in relation to demographic variables and cancer type/stage.

Results: The autoantibody panel demonstrated a sensitivity/specificity of 36%/91%, 39%/89% and 37%/90% in groups 1, 2 and 3, respectively, with good reproducibility. There was no significant difference between different LC stages, indicating that the antigens included covered the different types of LC well.

Conclusion: This assay confirms the value of an autoantibody panel as a diagnostic tool and offers a potential system for monitoring patients at high risk of LC.

Technical validation of an autoantibody test for lung cancer

Background: Publications on autoantibodies to tumour-associated antigens (TAAs) have failed to show either calibration or reproducibility data. The validation of a panel of six TAAs to which autoantibodies have been described is reported here.

Materials and methods: Three separate groups of patients with newly diagnosed lung cancer were identified, along with control individuals, and their samples used to validate an enzyme-linked immunosorbant assay. Precision, linearity, assay reproducibility and antigen batch reproducibility were all assessed.

Results: For between-replicate error, samples with higher signals gave coefficients of variation (CVs) in the range 7%–15%. CVs for between-plate variation were only 1%–2% higher. For between-run error, CVs were in the range 15%–28%. In linearity studies, the slope was close to 1.0 and correlation coefficient values were generally >0.8. The sensitivity and specificity of individual batches of antigen varied slightly between groups of patients; however, the sensitivity and specificity of the panel of antigens as a whole remained constant. The validity of the calibration system was demonstrated.

Conclusions: A calibrated six-panel assay of TAAs has been validated for identifying nearly 40% of primary lung cancers via a peripheral blood test. Levels of reproducibility, precision and linearity would be acceptable for an assay used in a regulated clinical setting.

Oscillometric blood pressure devices and simulators: measurements of repeatability and differences between models

PRIMARY OBJECTIVE

To measure the repeatability and pressure pulse envelope of simulators used for testing oscillometric non-invasive blood pressure (NIBP) devices; to study the effect of different envelopes on NIBP devices, and to measure the difference between NIBP devices due to different oscillometric algorithms.

METHODS

Three different models of NIBP simulator and 18 different patient monitors with NIBP function were studied. We developed a pressure measurement system (accuracy 0.048?mmHg) to measure the repeatability of simulators. The effect of changing the envelope was measured by using three simulators with one NIBP device. Differences between 18 NIBP devices were measured using one simulator at seven blood pressure settings.

MAIN OUTCOMES AND RESULTS

Simulators generate repeatable pressure pulse envelopes (< 0.2 mmHg) but the magnitude and shape depends on the model of simulator. Oscillometric NIBP devices are highly repeatable (< 2 mmHg) when presented with a repeatable pressure pulse envelope, but different devices employ different algorithms and give different results. For a simulated standard blood pressure setting of 120/80 mmHg, estimates of systolic pressure ranged from 112.6 to 126.6 mmHg (sd of 3.0 mmHg), and diastolic pressure ranged from 74.8 to 86.9 mmHg (sd of 3.5 mmHg).

CONCLUSIONS

Simulators and NIBP devices are sufficiently repeatable for clinical use, but further systematic clinical studies are required to better characterize the pressure pulse envelope for different patient groups.

An innovative sustainability assessment for urban wastewater infrastructure and its application in Chengdu, China

Sustainability assessments are an increasingly common tool for measuring progress towards sustainable development. Despite their popularity, sustainability assessments and the indicators that compose them are said to have had little impact on the policy arena. In this paper we discuss four attributes that we contend will improve the use of sustainability assessments to guide decision making: non-compartmentalization, site specificity, built-in guidance for target setting, and ability to measure active sustainability. We present a novel assessment tool for wastewater treatment infrastructure that illustrates these attributes. The assessment is composed of two-dimensional indicators we call "burden to capacity" ratios, that reveal and quantify the local value of resources embodied in wastewater and treatment byproducts, and the tradeoffs between designing systems for disposal versus reuse. We apply the sustainability assessment framework to an existing treatment plant in Chengdu, China and discuss the results.

Treatment with the Kv7 potassium channel activator flupirtine is beneficial in two independent mouse models of pulmonary hypertension

BACKGROUND AND PURPOSE

Voltage-gated potassium (K(v)) channels contribute to resting membrane potential in pulmonary artery smooth muscle cells and are down regulated in patients with pulmonary arterial hypertension (PAH) and a contribution from K(v)7 channels has been recently proposed. We investigated the effect of the K(v)7 channel activator, flupirtine, on PAH in two independent mouse models: PAH induced by hypoxia and spontaneous PAH in mice over-expressing the 5-HT transporter (SERT(+) mice).

EXPERIMENTAL APPROACH

Right ventricular pressure was assessed in vivo in mice chronically treated with flupirtine (30 mg.kg(-1).day(-1)). In separate in vitro experiments, pulmonary arteries from untreated mice were mounted in a wire myograph. Relaxations to acute administration of flupirtine and contractions to K(v) channel blocking drugs, including the K(v)7 channel blocker linopirdine, were measured.

KEY RESULTS

In wild-type (WT) mice, hypoxia increased right ventricular pressure, pulmonary vascular remodelling and right ventricular hypertrophy. These effects were attenuated by flupirtine, which also attenuated these indices of PAH in SERT(+) mice. In the in vitro experiments, flupirtine induced a potent relaxant response in arteries from untreated WT and SERT(+) mice. The relaxation was fully reversed by linopirdine, which potently contracted mouse pulmonary arteries while other K(v) channel blockers did not.

CONCLUSIONS AND IMPLICATIONS

Flupirtine significantly attenuated development of chronic hypoxia-induced PAH in mice and reversed established PAH in SERT(+) mice, apparently via K(v)7 channel activation. These results provide the first direct evidence that drugs activating K(v)7 channels may be of benefit in the treatment of PAH with different aetiologies.