Changes in Brain Activity Immediately Post-Exercise Indicate a Role for Central Fatigue in the Volitional Termination of Exercise

Electroencephalography (EEG) allows for the evaluation of real time changes in brain (electrocortical) activity during exercise. A few studies have examined changes in electrocortical activity using stationary cycling, but the findings have been mixed. Some of these studies have found increases in brain activity following exercise, while others have found decreases in brain activity following exercise. Hence, it is of importance to identify post-exercise changes in brain activity. Sixteen healthy, untrained subjects (8 males; 8 females) participated in the study. All 16 participants performed a graded exercise test (GXT) to volitional exhaustion on an upright cycle ergometer. Continuous EEG recordings were sampled before (PRE) and immediately following (IP) the GXT. Regions of interest were primarily the dorsolateral prefrontal cortex (DLPFC), ventrolateral prefrontal cortex (VLPFC), and left and right motor cortex (MC). In the DLPFC, a frontal asymmetry index was also identified. There was a statistically significant increase in theta power in the DLPFC, VLPFC, and left and right MC from PRE to IP (all p < 0.05). There was also a shift towards right hemisphere asymmetry at the IP time point in the DLPFC (p < 0.05). Finally, there was an increase in alpha power from PRE to IP in the right MC (p < 0.05). EEG could prove to be an important way to measure the effects of central fatigue on brain activity before and immediately following exercise.

Designing bacterial consortia for the complete biodegradation of insensitive munitions compounds in waste streams

Insensitive munitions compounds (IMCs), such as 2,4-dinitroanisole (DNAN) and 3-nitro-1,2,4-triazol-5-one (NTO), are replacing conventional explosives in munitions formulations. Manufacture and use of IMCs generate waste streams in manufacturing plants and load/assemble/pack facilities. There is a lack of practical experience in executing biodegradation strategies to treat IMCs waste streams. This study establishes a proof-of-concept that bacterial consortia can be designed to mineralize IMCs and co-occurring nitroaromatics in waste streams. First, DNAN, 4-nitroanisole (4-NA), and 4-chloronitrobenzene (4-CNB) in a synthetic DNAN-manufacturing waste stream were biodegraded using an aerobic fluidized-bed reactor (FBR) inoculated with Nocardioides sp. JS 1661 (DNAN degrader), Rhodococcus sp. JS 3073 (4-NA degrader), and Comamonadaceae sp. LW1 (4-CNB degrader). No biodegradation was detected when the FBR was operated under anoxic conditions. Second, DNAN and NTO were biodegraded in a synthetic load/assemble/pack waste stream during a sequential treatment comprising: (i) aerobic DNAN biodegradation in the FBR; (ii) anaerobic NTO biotransformation to 3-amino-1,2,4-triazol-5-one (ATO) by an NTO-respiring enrichment; and (iii) aerobic ATO mineralization by an ATO-oxidizing enrichment. Complete biodegradation relied on switching redox conditions. The results provide the basis for designing consortia to treat mixtures of IMCs and related waste products by incorporating microbes with the required catabolic capabilities.

Context Matters for Food Security: Multi-Sited Evidence of Shared Cultural Models of Food Consumption

Anthropologists have long emphasized the social significance of foods and the contexts in which they are consumed. Expanding on this idea, we define the context of consumption as the non-eating behaviors that surround eating, such as the manner of food preparation, food sharing, and dietary patterns. In this study, we used cultural consensus analysis to assess whether there exist consistently shared, normative ideas about preferable context of food consumption in three diverse research sites: urban Ethiopia, rural Brazil, and rural Haiti. Our analysis demonstrates that in all three communities, there are distinct sets of behaviors that people identified as non-preferable because they reliably associate them with poverty and food insecurity, and behaviors that people identify as preferable because they reliably associate them with wealth and food security. Across the settings, there was little variation in agreement about behaviors across household composition, age, gender, and food security status. These findings suggest that people do indeed share culturally specific ideas about the context in which foods should be prepared and consumed, beyond the actual content of one's diet. Exploring these cultural models elucidates the social consequences of food insecurity, enabling researchers to better examine the relationship between food insecurity, social context, and well-being.

The Development of a National Paediatric Psycho-Oncology Service

Aims To investigate the psychological care provided to children and young adolescents with cancer and their families within the National Children's Cancer Service (NCCS), Ireland, in respect of the national and international standards of care. Methods A retrospective audit of 316 referrals made over 32 months by the NCCS to the psychology service in malignant haematology and oncology was performed. Results The audit revealed that out of 316 patients, a yearly average of 189 (50%) of urgently referred patients received psychological support within the NCCS between January 2013 and August 2016. Furthermore only 20 (22%) undergoing haematopoietic stem cell transplantation (HSCT), 14 (22%) referred to the paediatric palliative care team, and 84 (62%) of teenage patients received psychological input during this timeframe. Conclusion The audit revealed that the current psychology service provision is failing to meet the international standards of care. Due to the data provided by this audit, in conjunction with a clinical risk assessment of the service, funds for the post of principal psychologist have been secured. Further psychology posts (HSCT, late-effects and neuropsychology), and development of the psycho-oncology model of care are required to ensure equality of access and evidence-based psychological care for all children with cancer.

Leptomeningeal Relapse of Embryonal Rhabdomyosarcoma after 15 years

Aim Rhabdomyosarcoma (RMS) is the most common malignant soft tissue tumour of childhood. We present the case of a late relapse of RMS to the leptomeninges after 15 years. Methods A 20 year old male presented with a 3 week history of headaches and nausea. He previously had RMS of his right ear diagnosed at age 5 years which was treated with concurrent chemoradiotherapy. An MRI Brain and Spine confirmed extensive leptomeningeal disease and CSF analysis confirmed the presence of recurrent embryonal RMS. Results He completed two cycles of cyclophosphamide and topotecan followed by 45Gy/25Fr of craniospinal radiotherapy. Conclusion Late relapses beyond five years can be seen in up to 9% of patients, however very late recurrences (>10 years) are exceedingly rare. Molecular based methods such as gene expression profiling can aid risk stratification and survivorship clinics may become increasingly useful in following patients with high risk features.

A Study to Evaluate the Need for Comminution in the Preparation of Food Materials for Testing of Listeria monocytogenes, Staphylococcus Species, and Generic Escherichia coli

BACKGROUND

Comminution reduces the sampling error arising from distributional heterogeneity of the target contaminant/target analyte in the material, facilitating the selection of a more representative test portion. A laboratory sampling method incorporating comminution prior to selection of the test portion (Sampling Method B) was compared to current sampling methods that used no comminution step (Sampling Method A).

OBJECTIVE

This required the development of an efficient process for comminution of food samples prior to removal of the test portion for the detection and isolation of Listeria monocytogenes and the enumeration of Staphylococcus species and Escherichia coli.

METHOD

From December 2016 to December 2017, 2742 tests were conducted on 778 unique food samples. For all food samples, a test portion (TPA) was first removed using Sampling Method A, and then the remainder of the material was comminuted and a second test portion (TPB) was removed using Sampling Method B and tested alongside the first portion.

RESULTS

Across all food matrices and microbial targets, 17 additional targets were detected using only Sampling Method B, and positive detections of target analytes increased by 77% using Sampling Method B from the test portions taken using Sampling Method A.

CONCLUSION

Utilizing a sample preparation method that includes a comminution step resulted in an increased number of pathogen detections.

HIGHLIGHTS

The introduction of a comminution step in the preparation of food samples for detection of three common microbial contaminants resulted in an increase in the rate of detection of natural contaminates in a variety of ready to eat foods. An efficient aseptic process for commutation that can be adapted to a wide range of laboratory settings was identified.

Fertility Preservation in Adolescent Males

Aim Survival rates of childhood cancer are now above 80%, so there is increasing emphasis on survivorship. A major late effect of cancer treatment is fertility loss. International best practice indicates that post-pubertal boys with cancer should be offered sperm cryopreservation prior to treatment. The aim of this study was to demonstrate the feasibility of a national sperm cryopreservation program for adolescent males and to examine outcomes for a pilot. Methods Patient demographics and semen parameters of adolescent male oncology patients referred to our service were analysed. Sperm analyses were performed in accordance with WHO guidelines. Results Fifteen patients were referred, 12 of whom (80%) attempted sperm production. Of these 12 samples, 25% (3/12) were unsuitable for freezing. One patient was too unwell to produce a sample. Eight patients (age range 12-17 years) had sperm successfully cryopreserved. Of these 8 samples, 25% were within WHO 'normal' limits, 50% had reduced sperm concentration. The number of cryopreserved samples (straws) ranged from 4-8 per patient. Conclusion We have established a successful, structured fertility preservation service for adolescent males in Ireland. Sperm cryopreservation is an accessible method of safeguarding fertility in male patients facing cancer treatment and should be offered to all.

Indigenous knowledge and federal environmental assessments in Canada: applying past lessons to the 2019 impact assessment act

Policy-makers ideally pursue well-informed, socially just means to make environmental decisions. Indigenous peoples have used Indigenous knowledge (IK) to inform decisions about environmental management for millennia. In the last 50 years, many western societies have used environmental assessment (EA) processes to deliberate on industrial proposals, informed by scientific information. Recently EA processes have attempted to incorporate IK in some countries and regions, but practitioners and scholars have criticized the ability of EA to meaningfully engage IK. Here we consider these tensions in Canada, a country with economic focus on resource extraction and unresolved government-to-government relationships with Indigenous Nations. In 2019, the Canadian government passed the Impact Assessment Act, reinvigorating dialogue on the relationship between IK and EA. Addressing this opportunity, we examined obstacles between IK and EA via a systematic literature review, and qualitative analyses of publications and the Act itself. Our results and synthesis identify obstacles preventing the Act from meaningfully engaging IK, some of which are surmountable (e.g., failures to engage best practices, financial limitations), whereas others are substantial (e.g., knowledge incompatibilities, effects of colonization). Finally, we offer recommendations for practitioners and scholars towards ameliorating relationships between IK and EA towards improved decision-making and recognition of Indigenous rights.

Assessment of age-related decline of neurovascular coupling responses by functional near-infrared spectroscopy (fNIRS) in humans

Preclinical studies provide strong evidence that age-related impairment of neurovascular coupling (NVC) plays a causal role in the pathogenesis of vascular cognitive impairment (VCI). NVC is a critical homeostatic mechanism in the brain, responsible for adjustment of local cerebral blood flow to the energetic needs of the active neuronal tissue. Recent progress in geroscience has led to the identification of critical cellular and molecular mechanisms involved in neurovascular aging, identifying these pathways as targets for intervention. In order to translate the preclinical findings to humans, there is a need to assess NVC in geriatric patients as an endpoint in clinical studies. Functional near-infrared spectroscopy (fNIRS) is a non-invasive neuroimaging technique that enables the investigation of local changes in cerebral blood flow, quantifying task-related changes in oxygenated and deoxygenated hemoglobin concentrations. In the present overview, the basic principles of fNIRS are introduced and the application of this technique to assess NVC in older adults with implications for the design of studies on the mechanistic underpinnings of VCI is discussed.

A Type 1 Diabetes Genetic Risk Score Predicts Progression of Islet Autoimmunity and Development of Type 1 Diabetes in Individuals at Risk

OBJECTIVE

We tested the ability of a type 1 diabetes (T1D) genetic risk score (GRS) to predict progression of islet autoimmunity and T1D in at-risk individuals.

RESEARCH DESIGN AND METHODS

We studied the 1,244 TrialNet Pathway to Prevention study participants (T1D patients' relatives without diabetes and with one or more positive autoantibodies) who were genotyped with Illumina ImmunoChip (median [range] age at initial autoantibody determination 11.1 years [1.2-51.8], 48% male, 80.5% non-Hispanic white, median follow-up 5.4 years). Of 291 participants with a single positive autoantibody at screening, 157 converted to multiple autoantibody positivity and 55 developed diabetes. Of 953 participants with multiple positive autoantibodies at screening, 419 developed diabetes. We calculated the T1D GRS from 30 T1D-associated single nucleotide polymorphisms. We used multivariable Cox regression models, time-dependent receiver operating characteristic curves, and area under the curve (AUC) measures to evaluate prognostic utility of T1D GRS, age, sex, Diabetes Prevention Trial-Type 1 (DPT-1) Risk Score, positive autoantibody number or type, HLA DR3/DR4-DQ8 status, and race/ethnicity. We used recursive partitioning analyses to identify cut points in continuous variables.

RESULTS

Higher T1D GRS significantly increased the rate of progression to T1D adjusting for DPT-1 Risk Score, age, number of positive autoantibodies, sex, and ethnicity (hazard ratio [HR] 1.29 for a 0.05 increase, 95% CI 1.06-1.6; P = 0.011). Progression to T1D was best predicted by a combined model with GRS, number of positive autoantibodies, DPT-1 Risk Score, and age (7-year time-integrated AUC = 0.79, 5-year AUC = 0.73). Higher GRS was significantly associated with increased progression rate from single to multiple positive autoantibodies after adjusting for age, autoantibody type, ethnicity, and sex (HR 2.27 for GRS >0.295, 95% CI 1.47-3.51; P = 0.0002).

CONCLUSIONS

The T1D GRS independently predicts progression to T1D and improves prediction along T1D stages in autoantibody-positive relatives.

Proton therapy in paediatric oncology: an Irish perspective

BACKGROUND

Proton therapy (PT) is a radiotherapy treatment modality that uses protons, rather than conventional photons. PT is often used in paediatric oncology due to its reported capability to reduce acute and late adverse treatment effects. As PT is unavailable in Ireland, patients are referred abroad for treatment.

AIMS

To: (1) produce a descriptive study of Irish children referred abroad for PT, and (2) discuss the case for PT in general.

METHODS

A retrospective review of all children referred for PT before October 2015 was performed. Information was gathered regarding demographics, diagnosis, referral timeline, adverse effects attributable to PT, current status and cost. A review of the relevant literature was performed.

RESULTS

Seventeen children treated in Ireland have been referred abroad for PT. The largest number was in the 0-4 year old group. At initial diagnosis the median age was 4.8 years. The average cost per child was €37,312. Two patients suffered disease relapse. Four have encountered PT-related adverse effects.

CONCLUSION

Despite the fact that >100,000 patients worldwide have been treated with PT, the level of published evidence to support superiority over conventional treatment remains low. It is debated that randomised control trials in this area would be inconsistent with the principle of clinical equipoise. In contrast, there is a call for level 1 evidence to justify drastic changes in patient care, particularly in light of recent reports of unexpected toxicities. In time, careful evaluation, follow-up and clinical trials will likely support the preferential use of PT in children.

Molecular analysis of urothelial cancer cell lines for modeling tumor biology and drug response

The utility of tumor-derived cell lines is dependent on their ability to recapitulate underlying genomic aberrations and primary tumor biology. Here, we sequenced the exomes of 25 bladder cancer (BCa) cell lines and compared mutations, copy number alterations (CNAs), gene expression and drug response to BCa patient profiles in The Cancer Genome Atlas (TCGA). We observed a mutation pattern associated with altered CpGs and APOBEC-family cytosine deaminases similar to mutation signatures derived from somatic alterations in muscle-invasive (MI) primary tumors, highlighting a major mechanism(s) contributing to cancer-associated alterations in the BCa cell line exomes. Non-silent sequence alterations were confirmed in 76 cancer-associated genes, including mutations that likely activate oncogenes TERT and PIK3CA, and alter chromatin-associated proteins (MLL3, ARID1A, CHD6 and KDM6A) and established BCa genes (TP53, RB1, CDKN2A and TSC1). We identified alterations in signaling pathways and proteins with related functions, including the PI3K/mTOR pathway, altered in 60% of lines; BRCA DNA repair, 44% and SYNE1–SYNE2, 60%. Homozygous deletions of chromosome 9p21 are known to target the cell cycle regulators CDKN2A and CDKN2B. This loci was commonly lost in BCa cell lines and we show the deletions extended to the polyamine enzyme methylthioadenosine (MTA) phosphorylase (MTAP) in 36% of lines, transcription factor DMRTA1 (27%) and antiviral interferon epsilon (IFNE, 19%). Overall, the BCa cell line genomic aberrations were concordant with those found in BCa patient tumors. We used gene expression and copy number data to infer pathway activities for cell lines, then used the inferred pathway activities to build a predictive model of cisplatin response. When applied to platinum-treated patients gathered from TCGA, the model predicted treatment-specific response. Together, these data and analysis represent a valuable community resource to model basic tumor biology and to study the pharmacogenomics of BCa.

Utility of local suicide data for informing local and national suicide prevention strategies

OBJECTIVES

The practice of 'suicide audit' refers to the systematic collection of local data on suicides in order to learn lessons and inform suicide prevention plans. Little is known about the utility of this activity. The aim of this study was to ascertain from Directors of Public Health in England how they were conducting suicide audit and what resources they were investing in it; how the findings were being used, and how the process might be improved.

STUDY DESIGN

E-mail survey.

METHODS

A questionnaire was sent to all 153 Primary Care Trusts (PCTs) in England prior to their dissolution in 2013. Simple descriptive statistics were performed in an Excel database.

RESULTS

Responses were received from 49% of PCTs, of which 83% were conducting a regular audit of deaths by suicide. Many had worked hard to overcome procedural obstacles and were investing huge amounts of time and effort in collecting data, but it is not clear that the findings were being translated effectively into action. With few exceptions, PCTs were unable to demonstrate that the findings of local audits had influenced their suicide prevention plans.

CONCLUSIONS

In the light of fresh calls for the practice of suicide audit to be made mandatory in England, these results are worrying. The study suggests that there is a pressing need for practical guidance on how the findings of local suicide audits can be put to use, and proposes a framework within which such guidance could be developed.

Non-infectious lung disease in patients with adenosine deaminase deficient severe combined immunodeficiency

Adenosine deaminase deficiency is a disorder of purine metabolism manifesting severe combined immunodeficiency (ADA-SCID) and systemic abnormalities. Increased levels of the substrate deoxyadenosine triphosphate (dATP) lead to immunodeficiency and are associated in a murine model with pulmonary insufficiency. We compared a cohort of patients with ADA-SCID and X-linked SCID and found that despite similar radiological and respiratory findings, positive microbiology is significantly less frequent in ADA-SCID patients (p < 0.0005), suggesting a metabolic pathogenesis for the lung disease. Clinicians should be aware of this possibility and correct metabolic abnormalities either through enzyme replacement or haematopoietic stem cell transplant, in addition to treating infectious complications.

Indications for admission, treatment and improved outcome of paediatric haematology/oncology patients admitted to a tertiary paediatric ICU

BACKGROUND

Overall survival in paediatric cancer has improved significantly over the past 20 years. Treatment strategies have been intensified, and supportive care has made substantial advances. Historically, paediatric oncology patients admitted to an intensive care unit (ICU) have had extremely poor outcomes.

METHODS

We conducted a retrospective cohort study over a 3-year period in a single centre to evaluate the outcomes for this particularly vulnerable group of patients admitted to a paediatric ICU.

RESULTS

Fifty-five patients were admitted a total of 66 times to the ICU during the study period. The mortality rate of this group was 23% compared with an overall ICU mortality rate of 5%. 11/15 patients who died had an underlying haematological malignancy. Twenty-eight percent of children with organism-identified sepsis died.

CONCLUSIONS

While mortality rates for paediatric oncology patients admitted to a ICU have improved, they are still substantial. Those with a haematological malignancy or admitted with sepsis are most at risk.

The place and promotion of well-being in mental health services: a qualitative investigation

The study investigated the place and promotion of well-being from the perspectives of services users and mental health professionals. * Data from focus groups and interviews were analysed and found that well-being promotion was available, for example weight management groups in mental health services. However, they also found that there were some contradictions between the groups of people interviewed about what was available and what to promote in the future. * The study concludes suggesting partnerships with local communities to further develop well-being services, such as opportunities for physical activity, for people with mental health problems. Abstract This study explored service users' and mental health professionals' understandings, experiences and opinions of well-being and its promotion within mental health services. A qualitative case study methodology included nine participants (five adult service users, three mental health professionals, one senior manager) who were purposively sampled from a Mental Health Trust in England. Service users participated in a focus group, while individual semi-structured interviews were held with the mental health professionals and senior manager. Interpretative phenomenological analysis of the data revealed five main themes including well-being as a holistic concept; well-being promotion; the place, promotion and position of well-being; role of mental health services in well-being promotion; and areas for further improvement. Findings revealed evidence of well-being promotion; however, there were contradictions regarding what was known between the groups of participants and what could be provided in the future. Implications for practice include the need to establish more effective partnership working between mental health services and local communities, especially in light of financial constraints within health services at large. This could assist the increased provision of therapeutic services for well-being promotion.