Validation of a multiplex-tandem RT-PCR for the detection of bovine respiratory disease complex using Scottish bovine lung samples

The welfare and economic impact of bovine respiratory disease complex (BRDC), and its associated antibiotic usage, are major challenges to cattle rearing and beef cattle finishing industries. Accurate pathogen diagnosis is important to undertake appropriate treatment and long-term management strategies, such as vaccine selection. Conventional diagnostic approaches have several limitations including high costs, long turnaround times and difficulty in test interpretation, which could delay treatment decisions and lead to unnecessary animal losses. We describe the validation of a multiplex-tandem (MT) reverse transcription-polymerase chain reaction (RT-PCR) for the detection of seven common pathogens associated with BRDC. This test has the potential to advance pathogen identification and to overcome many of the limitations of current testing methods. It requires a single sample and results are obtained quickly and not influenced by prior antimicrobial therapy or overgrowth of contaminating organisms. We demonstrated a test specificity of 100% and sensitivity ranging from 93.5% to 100% for these seven common pathogens. This test will be a useful addition to advance BRDC investigation and diagnosis.

Elevated A-to-I RNA editing in COVID-19 infected individuals

Given the current status of coronavirus disease 2019 (COVID-19) as a global pandemic, it is of high priority to gain a deeper understanding of the disease's development and how the virus impacts its host. Adenosine (A)-to-Inosine (I) RNA editing is a post-transcriptional modification, catalyzed by the ADAR family of enzymes, that can be considered part of the inherent cellular defense mechanism as it affects the innate immune response in a complex manner. It was previously reported that various viruses could interact with the host's ADAR enzymes, resulting in epigenetic changes both to the virus and the host. Here, we analyze RNA-seq of nasopharyngeal swab specimens as well as whole-blood samples of COVID-19 infected individuals and show a significant elevation in the global RNA editing activity in COVID-19 compared to healthy controls. We also detect specific coding sites that exhibit higher editing activity. We further show that the increment in editing activity during the disease is temporary and returns to baseline shortly after the symptomatic period. These significant epigenetic changes may contribute to the immune system response and affect adverse outcomes seen in post-viral cases.

Impact of the COVID-19 pandemic on a post-mortem CT service for adult non-suspicious death

Due to the COVID-19 pandemic, the post-mortem computed tomography (PMCT) service was expanded from three to seven cases per day to help mortuary services and avoid invasive autopsy. Additional targeted angiography and pulmonary ventilation procedures were stopped and triage rules relaxed to allow more indications to be scanned, including those requiring toxicology. A service evaluation was performed for the first 3-months of the COVID-19 pandemic compared to the equivalent period the previous year to study the impact of these changes. It was found that, despite the increase in deaths regionally, coronial referrals remained about 100 per month, a reduction in referral rate. The number undergoing PMCT rose from 28% to 74% of cases. Turnaround time remained the same. For cases triaged to PMCT, the need for subsequent autopsy increased from 7.9% to 15.8%. No significant changes were seen in diagnosis rates, including cardiac or respiratory. There was an increase in patients with coronary death without severe coronary calcification who underwent autopsy after PMCT. These may have been diagnosed by targeted coronary angiography. Fifty-three cases requiring toxicology/biochemistry had PMCT, with 38 having PMCT only. In 8/11 (72.7%) cases with normal PMCT and toxicology as the key diagnostic test, autopsy was performed prior to results. This suggests the pathology team were reluctant to risk an "unascertained" outcome. This study shows that it is possible to increase PMCT services by widening referral criteria and by limiting the use of enhanced imaging techniques, without significantly changing diagnosis rates of key diseases; however, selectively restarting targeted angiography may help avoid autopsy in some cases.

Motion Effects on Spatially Fractionated Lattice Therapy

PURPOSE/OBJECTIVE(S)

The practice of spatially fractionated radiation therapy (SFRT), such as grid and lattice, has been shown to be effective in managing large-size tumors for palliation or more recently for medium-sized tumors with definitive intents. The main feature that differentiates SFRT from standard radiation therapy is the deliberately high degree of dose heterogeneity in the gross tumor volume (GTV). The key parameter in assessing an SFRT plan is the valley-to-peak dose ratio (VPDR), which can be defined as a simple dose ratio between the low- and high-dose region in the tumor. The belief is that the healthy tissues in the low-dose regions of the tumor would serve as centers of tissue repair, while the high dose would kill the cancerous cells and induce the bystander effects. However, the compartments of low- and high-dose regions can be washed out due to motion, for example in cases when the disease is at or near the diaphragm. This work aims at examining motion effects on VPDR and equivalent uniform dose (EUD) in SFRT plans.

MATERIALS/METHODS

This work focuses on the effects of sinusoidal motion in lattice therapy, a 3D version of SFRT. A lattice VMAT plan with 6X was generated using the treatment planning system. Dose vertices were placed in a body-centered tetragonal lattice in a virtual water phantom. Each vertex was 1 cm3 and received 15 Gy to at least half of its volume. The volume ratio between the lattice and the GTV is about 3%. The distance between the two nearest vertice centers is 3 cm. A sinusoidal motion was introduced in the direction along the line connecting the two nearest neighbors and was binned into 10 phases with equal time intervals. The location of the phantom in each phase was determined by its average amplitude. The effect of the motion was assessed from the sum of all the plans in the 10 bins, each being scaled down by one-tenth of the prescribed dose. Dose coverage between the static and the sum plan is compared. Their difference in the VPDR and normal tissue damage with EUD are evaluated. The EUD was calculated based on Niemierko's formalism. The LQ model was used to estimate cell survival for normal tissues with a and b values of 0.366/Gy and 0.188 Gy2, respectively.

RESULTS

It is common to have the VPDR at around 1/3 or lower. Our study shows that it increases from 0.26 to 0.55 for the 1.5 cm motion and the EUD for normal tissue from 5 to 7 Gy. See Table 1 for more results. A large VPDR can reduce the ability of healthy tissues in the low-dose area for repair and a lower maximum dose in the vertices may diminish the bystander effects.

CONCLUSION

Motion may increase VPDR and normal tissue damage. Motion techniques such as gating or tracking can be used on disease sites subjected to respiratory motion.

1360 REVIEW OF OUTCOMES OF PATIENTS ADMITTED TO AN ENHANCED ASSESSMENT BED AT AN INTERMEDIATE CARE UNIT

Introduction

The Norman Power Centre (NPC) is an Intermediate Care Unit, in Birmingham, UK, providing enhanced assessment beds (EAB) where patients undergo functional assessment after an acute admission. There is little published data regarding the outcomes for patients admitted to EAB, so we set out to analyse outcomes in our unit.

Method

Data was collected from 50 patients who were discharged from EAB between September 2021 and March 2022.

Results

The mean length of stay was 36 days, median was 29 days. Of the 50 patients: 4 went home with no services, 9 went home with Early Intervention Community Team (EICT) support, 5 went home with package of care (not EICT), 13 went to new residential home placements, 6 went to new nursing home placements, 11 were re-admitted to hospital, 1 died and 1 received palliative care. 28 patients went to the destination that was originally intended on admission, 9 went to a less restrictive option and 12 required a higher dependency destination (predominantly re-admission to hospital.) The change in Elderly Mobility Scale from admission to discharge ranged from -1 to +15. Mode and median were both 0 and mean change was +2. 49 patients had Barthel scores on admission and discharge. Change in score ranged between -1 and +9. Mode and median change was 0, and mean was +1.7.

Conclusions

This data shows positive outcomes in terms of discharging most patients to their intended, or better, destinations. It also gives us an objective measure of the change in functional status that patients are achieving during their stay. There is a high rate of hospital re-admissions, indicating the unstable nature of the health of frail people. We are now ready to move onto a PDSA cycle to see if we can improve outcomes for our patients.

293 PRE-ADMISSION POTENTIALLY INAPPROPRIATE PRESCRIBING PREVALENCE ON A CARE OF THE OLDER ADULT MEDICAL WARD

Background

Potentially Inappropriate Prescribing (PIP) is a common but critical issue in care of the older adult. It is estimated that between 50 and 70% of those over 65 years are receiving at least one potentially inappropriate medication. Polypharmacy is a good indicator of PIP as it can indicate over- and inappropriate prescribing through prescribing cascade, exposing patients to risks of drug interactions and Adverse Drug Events (ADEs). 10-20% of hospital admissions of older adults are directly related to ADE of inappropriately prescribed drugs.

Methods

Point prevalence study using the ‘Screening Tool of Older Persons Prescriptions’ (STOPP) to identify PIPs on a geriatric medicine ward. Patients over 65 years of age admitted from home were included in the study. Patients’ pre-admission medications and changes made to these were assessed using STOPP.

Results

Sixteen patients out of 22 met the inclusion criteria. The average age of the patients included in the study was 82.3 years with a range from 70 to 88 years. 75% were female. 94% had polypharmacy prior to admission with an average of 2.25 PIPs (range 0 to 5). 43% (n=7) had all their PIPs addressed by a geriatrician as per STOPP, with a further 18% (n=3) having some of their PIPs altered. 25% (n=4) did not have any alterations to their PIPs.

Conclusion

Despite widely known impacts of PIPs on older adults, PIP remains highly prevalent in those admitted to hospital. PIP and polypharmacy can increase incident frailty two-fold and polypharmacy and frailty can lead to a 6-fold increase in mortality within two and a half years. We must actively educate all those involved in prescribing for this cohort of patients to reduce PIPs and their adverse effects.

Comparison of testing for failure of passive transfer in calf serum using four different testing methods

Failure of passive transfer (FPT) in calves is defined as failure to absorb colostral antibodies sufficient to achieve a serum immunoglobulin G (IgG) concentration of >10g/L within the first week of life. The aim of this study was to compare four different tests to diagnose FPT in a convenience sample of 1-7 day old dairy calves in Scotland. Published cutpoints for Brix and total protein (TP) refractometry and zinc sulphate turbidity (ZST) were compared with the reference test radial immunodiffusion (RID) for suitability to detect FPT. In addition, the current commercial RID reference test offered in Scotland was validated. FPT prevalence was estimated to be 14.17% (95% confidence intervals, 10.58 - 17.75) based on RID test results. There was moderate agreement between the reference (RID) and indirect tests (kappa=0.28 for Brix; 0.34 for TP; 0.24 for ZST). Brix and TP refractometry underestimated IgG concentration, resulting in an overestimation of FPT prevalence (40.54% and 29.46%, respectively). Similarly, ZST overestimated the prevalence of FPT (46.29%), but the variability was more consistent across all IgG concentrations. The performance of all three indirect methods was improved by lowering test cutpoints (to 5g/dL for TP; 8.2% for Brix; 15 units for ZST) which improved test specificity and accuracy of these screening tests.

A reassessment of TBT action levels for determining the fate of dredged sediments in the United Kingdom

As part of reviewing the United Kingdom (UK) action levels (ALs) of contaminants for managing the disposal of dredged marine sediment material, tributyl tin (TBT) has been reassessed. TBT is a banned biocide capable of causing severe harm to the marine environment. Its presence is routinely screened for prior to marine disposal of dredged sediment material. Dredged sediment TBT concentrations have been studied using UK monitoring data obtained between 2000 and 2018. The changes in these TBT concentrations have guided the reassessment of ALs. Recent toxicity studies have also guided the reassessment of TBT ALs. This study, which itself forms part of a larger review by the Department for Environment, Food and Rural Affairs, has concluded that current UK TBT ALs may no longer be fit for purpose. A more environmentally protective approach for controlling release of TBT into the marine environment is recommended.

CDC field triage criteria accurately predicts outcomes in high impact trauma

BACKGROUND

The precision of emergency medical services (EMS) triage criteria dictates whether an injured patient receives appropriate care. The trauma triage protocol is a decision scheme that groups patients into triage categories of major, moderate and minor. We hypothesized that there is a difference between trauma triage category and injury severity score (ISS).

METHODS

This retrospective, observational study was conducted to investigate a difference between trauma triage category and ISS. Bivariate analysis was used to test for differences between the subgroup means. The differences between the group means on each measure were analyzed for direction and statistical significance using ANOVA for continuous variables and chi square tests for categorical variables. Logistic and linear regressions were performed to evaluate factors predicting mortality, ICU length of stay.

RESULTS

With respect to trauma triage category, our findings indicate that minor and moderate triage categories are similar with respect to ISS, GCS, ICU LOS, hospital LOS, and mortality. However, after excluding for low impact injuries (falls), differences between the minor and moderate categories were evident when comparing to ISS, GCS, ICU LOS, and hospital LOS. Additionally, after excluding for low impact injures, ISS, ICU LOS, and hospital stay were found to correlate well with trauma triage category.

CONCLUSIONS

In this retrospective, observational study significant differences were not seen when comparing ISS with the trauma triage categories of moderate and minor during our initial analysis. However, a difference was found after excluding for low impact injuries. These findings suggest that CDC criteria accurately predicts outcomes in high impact trauma.

Feeding behaviour and activity as early indicators of disease in pre-weaned dairy calves

Across the industry, there is large variation in health status of dairy calves and as a result, disease incidence and antibiotic use is high. This has significant implications for animal welfare, productivity and profitability of dairy and dairy-beef production systems. Technology-based early detection systems could alleviate these issues; however, methods of early detection of disease in dairy calves have not been widely explored. This study aimed to determine whether changes in activity and feeding behaviour can be used as early warning indicators of respiratory disease in calves. In total, 100 pre-weaned male Holstein calves (age: ~8-42 days) were used. Calves were group-housed and provided with starter diet, straw bedding and ad libitum water. Calves were fed milk replacer ad libitum through an automatic calf feeder, and each calf was fitted with a leg-mounted activity monitor. Daily activity and feeding behaviour variables were calculated for each calf. Each calf was assessed daily using a modified version of the Wisconsin Scoring System to assess respiratory disease status. Calves were classed as 'Diseased', 'Intermediate' or 'Healthy' based on their cumulative health score. The peak day of the most extreme illness event was identified for each calf. Data from Diseased and Healthy calves were paired for analysis based on age and BW. Data were compared for the day of peak illness, and for the 3 days previous and post. Compared to healthy calves, diseased calves lay for longer and tended to have longer lying bouts (daily lying: 17.6 ± 0.3 vs 16.7 ± 0.2 h, P < 0.01; bout length: 74.8 ± 10.6 vs 56.0 ± 3.7 min, P = 0.09 for diseased and healthy calves, respectively). Diseased calves fed for a shorter time and had fewer feeder visits (with intake) each day compared to healthy calves (feeding time (min): 19.3 ± 1.4 vs 22.8 ± 1.5; P < 0.05; visits: 2.1 ± 0.2 vs 3.2 ± 0.4; P < 0.05). Importantly, differences between diseased and healthy calves were evident in both activity and feeding behaviour on the days prior to the peak day of disease. Lying bout length was greater in diseased calves for the 2 days prior to the peak day (P < 0.05), lying time was longer on day -1 (P < 0.05) and feeder visits with milk intake were less frequent on day -3 (P < 0.05). Thus, measurement of feeding and activity using precision technology within early detection systems could facilitate early intervention and optimized treatment.

Diagnosis of gestational diabetes: a 'teachable moment'

AIMS

Research regarding the determinants of concordance with gestational diabetes mellitus (GDM) treatment is limited. Here, we test whether the psychosocial changes outlined in the teachable moments model, as proposed by McBride et al. (McBride CM, Emmons KM, Lipkus IM. Understanding the potential of teachable moments: the case of smoking cessation. Health Educ Res 2003; 18: 156-170) are associated with following GDM treatment recommendations.

METHODS

Fifty-nine women completed a baseline questionnaire (1 week after GDM diagnosis) in which they reported risk perception, social support, emotional response, the importance of their maternal identity and self-efficacy. One month later, participants reported their concordance with instructions regarding glucose monitoring, diet and, if applicable, medication. We used regression analysis to test for associations between the psychosocial factors measured at baseline and concordance at 1-month follow-up.

RESULTS

Those who perceived their risk as higher or felt supported by family or friends were more likely to report a high level of concordance with GDM treatment. Emotional response, identity salience and self-efficacy were not related to concordance.

CONCLUSIONS

Future interventions designed to increase concordance could benefit from a focus on risk perception and social support, as these factors appear to be most strongly associated with following GDM treatment recommendations.

The impact of immigration detention on mental health: a systematic review

BACKGROUND

The number of asylum seekers, refugees and internally displaced people worldwide has increased dramatically over the past 5 years. Many countries are continuing to resort to detaining asylum seekers and other migrants, despite concerns that this may be harmful. In light of the considerable body of recent research, this review aims to update and expand on a 2009 systematic review on the mental health consequences of detention on adult, adolescent and child immigration detainees, which found (on the basis on 9 studies) that there was consistent evidence that immigration detention had adverse effects on mental health.

METHODS

Three databases were searched using key terms relating to immigration detention and mental health. Electronic searches were supplemented by reference screening. Studies were included if they were quantitative, included individuals detained for immigration purposes, reported on mental health problems and were published in peer-reviewed journals. Two reviewers independently screened papers for eligibility, and a further two reviewers completed quality appraisals for included studies.

RESULTS

Twenty- six studies (21 of which were not included in the 2009 review) reporting on a total of 2099 participants were included in the review. Overall, these studies indicated that adults, adolescents and children experienced high levels of mental health problems. Anxiety, depression and post-traumatic stress disorder were most commonly reported both during and following detention. Higher symptom scores were found in detained compared to non-detained refugees. In addition (and more clearly than was evident in 2009), detention duration was positively associated with severity of mental symptoms. Greater trauma exposure prior to detention was also associated with symptom severity.

CONCLUSIONS

The literature base reviewed in this paper consistently demonstrated severe mental health consequences amongst detainees across a wide range of settings and jurisdictions. There is a pressing need for the proper consideration of mental health and consequent risk of detention-related harm in decisions surrounding detention as well as for improved care for individuals within detention facilities. Recommendations based on these findings are presented, including increased focus on the identification of vulnerability and on minimising the duration of detention.

The use of infrared thermography for detecting digital dermatitis in dairy cattle: What is the best measure of temperature and foot location to use?

Lameness in dairy cattle is a persistent problem, indicating pain caused by underlying disease states and is associated with reduced milk yields. Digital dermatitis is a common cause of lameness. Thermal imaging is a technique that may facilitate early detection of this disease and has the potential for use in automated detection systems. Previous studies with thermal imaging have imaged either the heels or the coronary band of the foot and typically only used the maximum temperature (Max) value as the outcome measure. This study investigated the utility of other statistical descriptors: 90th percentile (90PCT), 95th percentile (95PCT), standard deviation (SD) and coefficient of variation (CoV) and compared the utility of imaging the heel or coronary band. Images were collected from lame and healthy cows using a high-resolution thermal camera. Analyses were done at the cow and foot level. There were significant differences between lame and healthy feet detectable at the heels (95th percentile: P<0.05; SD: P<0.05) and coronary band (SD: P<0.05). Within lame cows, 95PCT values were higher at the heel (P<0.05) and Max values were higher at the coronary band (P<0.05) in the lame foot compared to the healthy foot. ROC analysis showed an AUC value of 0.72 for Max temperature and 0.68 for 95PCT at the heels. It was concluded that maximum temperature is the most accurate measure, but other statistical descriptors of temperature can be used to detect lameness. These may be useful in certain contexts, such as where there is contamination. Differentiation of lame from healthy feet was most apparent when imaging the heels.

The contribution of previous lameness events and body condition score to the occurrence of lameness in dairy herds: A study of 2 herds

It has been demonstrated that low body condition and previous occurrence of lameness increase the risk of future lameness in dairy cows. To date the population attributable fraction (PAF), which provides an estimate of the contribution that a risk factor makes toward the total number of disease events in a population, has not been explored for lameness using longitudinal data with repeated measures. Estimation of PAF helps to identify control measures that could lead to the largest improvements on-farm. The aim of this study was to use longitudinal data to evaluate the proportion of lameness that could be avoided in 2 separate herds (2 populations) through (1) reduced recurrence of previous lameness events, (2) and moving body condition score (BCS) into more optimal ranges. Data were obtained from 2 UK dairy herds: herd A, a 200-cow herd with 8 yr of data from a total of 724 cows where lameness events were based on weekly locomotion scores (LS; 1 to 5 scale), and herd B, a 600-cow herd with data recorded over 44 mo from a total of 1,040 cows where treatment of clinical cases was used to identify lameness events. The PAF for categories of BCS were estimated using a closed equation appropriate for multiple exposure categories. Simulation models were used to explore theoretical scenarios to reflect changes in BCS and recurrence of previous lameness events in each herd. For herd A, 21.5% of the total risk periods (cow-weeks) contained a lameness event (LS 3, 4, or 5), 96% of which were repeat events and 19% were recorded with BCS <2 (3 wk previously; 0 to 5 scale). When lameness events were based on 2 consecutive weeks of LS 4 or 5, 4% of risk periods were recorded as lame, of which 89.5% were repeat events. For herd B, 16.3% of the total risk periods (consecutive 30 d) contained a lameness event (72.6% were repeat events) and 20% were recorded with BCS ≤2 (0 to 120 d previously). The median PAF for all previous lameness was between 79 and 83% in the 2 herds. Between 9 and 21% of lameness events could be attributed to previous lameness occurring >16 wk before a risk period. The median PAF estimated for changes in BCS were in the region of 4 to 11%, depending on severity of lameness. Repeated bouts of lameness made a very large contribution to the total number of lameness events. This could either be because certain cows are initially susceptible and remain susceptible, due to the increased risk associated with previous lameness events, or due to interactions with environmental factors. This area requires further research.

Are brief alcohol interventions targeting alcohol use efficacious in military and veteran populations? A meta-analysis

BACKGROUND

Rates of hazardous and harm-related drinking are higher in the military and veteran populations compared to the general population. Brief alcohol interventions (BAIs) targeting alcohol use appear to reduce harmful drinking in the general population. However, less is known about the efficacy of BAIs targeting alcohol in military and veteran populations.

METHODS

A systematic review and meta-analysis was conducted to assess the type and efficacy of BAIs used to reduce alcohol use in military and veteran populations conducted from 2000 onwards. The meta-analysis was conducted using a standardised outcome measure of change in average weekly drinks (AWDs) from baseline to follow-up.

RESULTS

The search revealed 10 papers that met the search criteria, and that reported data on 11 interventions included in the systematic review. 8 papers (reporting on 9 different interventions) were included in the meta-analysis after 2 papers were excluded for which the relevant outcome data were not available. There was no overall effect of BAIs; a non-significant weekly drink reduction of 0.95 drinks was found (95% CI, -0.17 to 2.07). This lack of efficacy persisted regardless of military group (conscripts, serving or veterans) and method of delivery (i.e., face-to-face, web-based or written information). Furthermore, sensitivity analyses revealed this small drink reduction was driven mainly by a single study.

CONCLUSIONS

Based on these findings, existing BAIs do not seem to be efficacious in reducing alcohol use in military populations, despite some encouraging results from one electronic intervention which was of extensive duration.

Abstract P4-13-02: Long-term effects of weight loss on breast cancer biomarkers in postmenopausal women

Background: Obesity increases risk for postmenopausal breast cancer, and is associated with elevated blood levels of inflammation-related marker C-reactive protein (CRP), insulin, glucose, and the angiogenesis-related biomarker vascular endothelial growth factor (VEGF). The long-term effect of weight loss on these breast cancer risk biomarkers is unknown. This study aim was to test the 30-month effect of weight loss on breast cancer biomarkers in postmenopausal overweight/obese women, who had completed a randomized control trial test of behavioral weight loss and/or exercise compared to control.

Methods: From 1/2005-7/2008, women (N=438) were randomized to 1 of 4 arms: reduced calorie weight loss diet (D; N=118); moderate intensity aerobic exercise (E; 225 minutes/week) (N=117); both interventions (D+E; N=116); or control (C, no intervention; N=87). The D intervention goals were: 1200-2000 calories/day, dietary fat &lt; 30% of calories, and &gt; 10% loss of initial weight. The E goal was &gt; 45 minutes of moderate-intensity exercise 5 days/week. The D+E interventions were identical to those for D and E. A total of 157 women returned for a 30-month blood draw (18 months after end-of-study).

Analysis: We compared the average changes in outcomes from baseline to 30 months in weight loss (combining D and D+E groups) vs. no weight loss (combining C and E groups), according to the intention-to-treat principle, using generalized estimating equations (GEE). As a secondary, pre-planned analysis, we combined data for all women regardless of randomization group, and divided them into four categories based on change from baseline to 30 months: 1) gained weight or remained weight stable; 2) lost &lt; 5% of baseline weight; 3) lost 5% - &lt;10% of baseline weight; and 4) lost &gt; 10% of baseline weight. We then compared 30-month analyte changes by these 30-month weight loss groups, with category 1 as referent.

Results: Mean 30-month weight changes from baseline were: D+E, - 7.7%; D, - 6.3%; E, -1.9%; and C, -3%. CRP was 22.5% lower than baseline for women randomized to a diet group, compared with a 4% reduction from baseline in women in a non-diet group (p=0.07). Insulin was 33% lower in women randomized to diet, while it was 20% lower in women not randomized to a diet group (p=0.10). Women who lost 5% - &lt;10% of baseline weight at 30-months experienced an 18% (p&lt;0.001) decrease in CRP compared to baseline, while those who lost &gt; 10% had a 56% lower CRP level (p&lt;0.001). VEGF decreased to a similar amount (14% -15%) in women who lost &lt;10% of baseline weight; and decreased by 26% in those whose 30-month weight decreased by &gt; 10% (p&lt;0.002). Compared with baseline levels, insulin decreased by 16% in those who lost &lt; 5% of baseline weight. In contrast, insulin levels decreased by 31% and 44% (each p=0.004), in those whose 30-month weight loss was 5% - &lt;10% lower than baseline and &gt; 10% lower than baseline, respectively. Glucose levels increased in women whose weight loss was &lt; 5%, but remained stable in those whose 30-month weight was &gt; 5% lower than baseline (each p=0.04).

Conclusions: Long-term weight loss of at least 5% may have biological effects relevant to breast cancer prevention in overweight or obese postmenopausal women.

Citation Format: McTiernan A, Duggan C, Tapsoba JdD, Mason C, Wang C-Y. Long-term effects of weight loss on breast cancer biomarkers in postmenopausal women [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-13-02.

Lameness in dairy heifers; impacts of hoof lesions present around first calving on future lameness, milk yield and culling risk

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More severe claw horn lesions were associated with increased risk of future lameness.

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More severe sole lesions were associated with reduction in daily yield of 2.68 kg.

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Managing heifers to reduce severe lesions is likely to have positive herd impacts.

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Mild claw horn lesions associated with reduced risk of future lameness and culling.

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Mild insult may lead to adaptive changes in the hoof which are beneficial.

The importance of lameness in primiparous dairy heifers is increasingly recognised. Although it is accepted that clinical lameness in any lactation increases the risk of future lameness, the impact of foot lesions during the first lactation on long-term lameness risk is less clear. This retrospective cohort study aimed to investigate the impacts of foot lesions occurring around the time of first calving in heifers on future lameness risk, daily milk yield and survival within a dairy herd. Records were obtained for 158 heifers from one UK dairy herd. Heifers were examined in 2 month blocks from 2 months pre-calving through to 4 months post-calving. Sole lesions and white line lesions were scored on a zero to 10 scale and digital dermatitis on a zero to 3 scale. Outcomes investigated were; lameness risk based on weekly locomotion scores, average daily milk yield and culling risk. Mixed effect models were used to investigate associations between maximum lesion scores and outcomes. Lesion scores in the highest score categories for claw horn lesions (sole lesions and white line lesions) in the 2 to 4 month post-calving period were associated with an increased risk of future lameness; heifers with white line lesion scores ≥3 compared with scores zero to 1 and heifers with sole lesion scores ≥4 compared with score 2, at this time point, had a predicted increased risk of future lameness of 1.6 and 2.6 respectively. Sole lesions ≥4 were also associated with a reduction in average daily milk yield of 2.68 kg. Managing heifers to reduce claw horn lesions during this time period post-calving may provide health, welfare and production benefits for the long-term future of those animals. A novel finding from the study was that mild lesion scores compared with scores zero to 1, were associated with a reduced risk of future lameness for white line lesions and sole lesions occurring in the pre-calving or 2 to 4 months post-calving periods respectively. Mild sole lesions in the pre-calving period were also associated with a reduced risk of premature culling. One hypothesis for this result is that a mild insult may result in adaptive changes to the foot leading to greater biomechanical resilience and so increased longevity.

The Geography of Corporate Philanthropy in the United Kingdom

The shift away from a state-dominated welfare state towards a pluralistic mix of diverse welfare agencies is placing a greater reliance upon the voluntary sector. The role of company support for the voluntary sector has become an issue of considerable significance in recent years, yet has been little analysed by geographers. Considerable variations are revealed in the geographical distribution of funds allocated by directly funded corporate charitable trusts to voluntary organisations in the United Kingdom; the patterns may be related to the sector of the companies that fund the trusts together with the location and nature of the charities receiving funds, The patterns suggest that the key element determining the geography of corporate philanthropy is the nature of the audience which the company is seeking to address through their donations policy. Manufacturing companies would appear to have stronger traditions of philanthropy being directed towards the communities where their production facilities are based, whereas service-based companies tend to disperse their donations more widely.

7: INTEGRATED PATHWAY ANALYSIS OF MICRORNA EXPRESSION IN PLASMA OF OVARIAN CANCER (OVCA) PATIENTS SHOWS LACK OF BH3 PROTEIN DEPENDENT SIGNALING

Purpose of Study

More than 100,000 pelvic surgeries to remove ovarian masses (BOM) are performed yearly in the USA only 8% of those remove ovarian cancer. Circulating microRNA are biomarkers for disease detection. Purpose of study:

1. To analyze patterns of microRNAs in women with BOM vs. OvCa

2. Discover pathway involved malignant transformation.

Methods Used

Plasma from 32 women OvCa, 24 controls 32 (BOM) was analyzed using ABI Taqman OpenArray MicroRNA pools A and B to measure the expression of 754 known miRNAs .Real-time PCR was performed on the Taqman Open Array MicroRNA arrays using the Applied Biosystem Open Array Real-Time PCR system. Data were processed using the OpenArray Real-Time qPCR Analysis software and exported for analysis using the Applied Biosystems DataAssist Software Data analysis was done with the R programming language. A cutoff for Ct values at 30 was used. MiRNAs with Ct values higher than 30 were considered not detected. Data was normalized using a mean-centering restricted (MCR), a modification of the traditional delta Ct method and uses miRNAs which are expressed in all samples for data normalization. Statistical analysis was performed via custom scripts based on the R/Bioconductor package LIMMA (Linear Models for Microarray).

Summary of Results

BOM had higher expression (2–14 fold higher) of miRs −195, −126, −139-5p, −27b, −127, −152, −28, −106b, −17, −363, −181a, −192 relative to OvCa (p<0.0006). OvCa over-expressed of miRs −1274a, −720 and −625-3p (p<0.0007). Reactome pathway analysis detected involvement of miRs into pathways of activation of BAD, PI3/AKT signaling in CD28 and activation of BH3 in BOM these pathways were not detected in OvCa (p<0.000596).

Conclusions

BOM patients have immune recognition and pro-apoptotic protective circulating microRNAs. It is unknown whether miRs originate in ovary or another tissue. Recent work shows that BH3 mimetics are very effective in inducing cancer cell death.

P6: CIRCULATING MICRORNA PATTERN DEFINES A BIOLOGICALLY DISTINCT BREAST CANCER PATTERN IN BLACK (B) WOMEN RELATIVE TO ONE CCCURRING IN WHITE (W) WOMEN

Purpose of Study

Black women with triple negative breast cancer have 46% lower survival rates attributed to differences in tumor biology. We analyzed presurgical plasma microRNA of white (W) and black (B) women with TNBC enrolled in our breast ovarian tissue bank between 2004 and 2014.

Aims

Detect microRNA patterns in pre-surgical plasma of TNBC W or B Analyze differences by integrated approach to detect pathways differentially activated in the two groups.

Methods Used

Between 2004 and 2014 we investigated patterns of plasma miRNAs collected before, after surgery, during and after chemotherapy in 67 patients presenting for surgery for breast cancer (W=44 & B=44) and 25 age and race matched normal controls. Two-sample t-test was used for all 2-sample comparison and ANOVA followed by Benjamin Hochberg post-hoc test to compare the mean response between subject factors of interest. All tests were 2-tailed and results with a p<0.05 were considered statistically significant. Coremine was used to identify datasets in breast cancer microarray with emphasis on our differentially expressed circulating miRs.

Summary of Results

Mean age cancer 48 (range 35–78), control 44 (range 35–67): B patients did not express over 70% of pre-surgical plasma miRs over-expressed in the W pre-surgical plasma. Black patients had lower expression of MiRs: −16-5p, −484, −126, −150-5p, −142-3p; −30c-5p, −186-5p, 139-5p. Samples from white patients overexpressed miRs−126, −150-5p, −142-3p; −30c-5p, −186-5p, 139-5p compared to healthy controls. These miRs significantly suppressed in blacks p<0.05.

Coremine text mining suggests differentially regulated microRNA are involved in mitochondrial quality control and biogenesis.

Conclusions

Deregulation in circulating miRs between B and W patients point to pathways involved in mitochondrial fission and fusion. Aberrant mitochondria biogenesis was reported as mechanism for cancer stem cell survival and detrimental to innate immunity. Such pathways could explain the lower survival seen in black breast cancer patients.

P2: SNP ANALYSIS IN BRCA POSITIVE AND BRCA NEGATIVE SUBJECTS WITH AND WITHOUT BREAST CANCER (BRCA) REVEAL CENTRAL ROLE OF ALK SNPS AND TGFBETA SUPERFAMILY IN MALIGNANT TRANSFORMATION

Purpose of Study

Over 240,000 individuals are diagnosed with breast cancer each year in the USA. Outcomes depend on DNA deregulations in tumors. Carriers of deleterious BRCA1 and BRCA2 mutations are predisposed to 30 fold higher lifetime risks of breast and ovarian cancer.

Aims:

1. To check for differences in SNPs of genomic DNA obtained in BRCA+/− with and without BrCa.

2. Analyze correlates of molecular mechanisms occurring in BRCA mutant patients.

Methods Used

We analyzed 94 subjects (41 BRCA positive) with or without BrCa to detect SNPs whose expression is significantly differentially expressed between breast cancer and controls. DNA samples were extracted from PBMCs. Samples were measured for DNA concentration using an Invitrogen QuBit Fluorometer, and diluted to 50 ng/µL.

All samples were collected between 2010 and 2014 and survival data was known in all cancer patients. Processed samples were sequenced using an Illumina MiSeq Sequencer with a 300 cycle kit to detect SNPs. Variant Call Files were analyzed in Microsoft Excel using Fisher's Exact Test.

Summary of Results

ALK SNPs were commonly found in cancer relative to control. Significant associations of ALK SNPs were seen in BRCA mutation subjects. ALK protein was overexpressed in 47% of BRCA mutations cases, which was significantly higher than in non-BRCA cases. Our results show that the ALK signaling pathway possibly is more common in early onset of breast cancer as seen with BRCA mutations. Coremine analysis showed SNPs identified in cancer were most commonly associated with deregulation of Transforming Growth Factor-Beta Superfamily protein synthesis and binding function.

Conclusions

Differences in the associations of the modifying polymorphisms with BrCarisk for BRCA1 and BRCA2 mutation carriers are likely to reflect differences in the biology of tumor development in these two groups of women at high risk of breast cancer. The identification of modifying polymorphisms could therefore lead to a better understanding of the etiology of tumors in mutation carriers and also to the development of effective and more specific therapies for BrCa in mutation carriers.

P4: CIRCULATING MIRNA PROFILES POINT TO DYSREGULATION IN TGFBETA/SMAD3 TUMOR SUPPRESSOR SIGNATURE IN BRCA POSITIVE BREAST CANCER PATIENTS

Purpose of Study

Over 240,000 individuals are diagnosed with breast cancer (BrCa) of which 12,000 individuals carry BRCA germline mutations. MicroRNA dysregulation is common in malignancy and may correlate with germline mutations.

Aims:

1. Analyze microRNAs in patients with breast cancer with or without BRCA germ line mutations, with and without cancer.

2. Identify molecular BRCA mutant patients to deduct reasons for accelerated malignancy.

Methods Used

We analyzed plasma miR expression from 94 br cancer patients (41 BRCA positive) relative to 24 normal controls. All samples were collected between 2010 and 2014 and survival data was known for all cancer patients. TaqMan Open Array panel was used to simultaneously run hundreds of microRNA assays in the Applied Biosystem Open array real time PCR. Using AB open array real time PCR, 756 miRNA species were detected. Two-sample t-test was used for all 2-sample comparison and ANOVA followed by Tukey HSD post-hoc test to compare the miRs mean differences. All tests were 2-tailed and results with a p<0.05 were considered statistically significant.

Summary of Results

BRCA+underexpressed hsa-mir-10a and hsa-mir-376c and over-expressed Hsa- mir- 326 and Hsa-mir-143 relative to BRCA-; p<0.05.

Using Coremine data mining linking genes and diseases differentially expressed circulating miRs are linked to tumor suppressor TGFbeta/SMAD3.

Conclusions

The early onset of breast cancer in BRCA mutant patients may recapitulate the pro-oncogenic effects of TGF-β. The context dependent SMAD3 binding & tumor suppression TGF-β effects are abrogated in BRCA mutant patients. TGF-β/Smad3 tumor-suppressor signature suppresses local inflammation in the tumor microenvironment.

Recovery of chronically lame dairy cows following treatment for claw horn lesions: a randomised controlled trial

A positively controlled, randomised controlled trial (RCT) was undertaken to test recovery of cows with claw horn lesions resulting in lameness of greater than two weeks duration. Cows on seven commercial farms were mobility scored fortnightly and selected by lameness severity and chronicity. Study cows all received a therapeutic trim then random allocation of: no further treatment (trim only (TRM)), plastic shoe (TS) or plastic shoe and NSAID (TSN). Recovery was assessed by mobility score at 42 (±4) days post treatment by an observer blind to treatment group. Multivariable analysis showed no significant effect of treatment with an almost identical, low response rate to treatment across all groups (Percentage non-lame at outcome: TRM – 15 per cent, TS – 15 per cent, TSN – 16 per cent). When compared with results of a similar RCT on acutely lame cows, where response rates to treatment were substantially higher, it can be concluded that any delay in treatment is likely to reduce the rate of recovery, suggesting early identification and treatment is key. Thirty-eight per cent of animals treated in this study were lame on the contralateral limb at outcome suggesting that both hindlimbs should be examined and a preventive or if necessary a therapeutic foot trim performed when lameness is identified particularly if the duration of lameness is unknown.

Baseline survey of marine sediments collected from the State of Kuwait: PAHs, PCBs, brominated flame retardants and metal contamination

A geographically extensive baseline survey of sediment contamination was undertaken at twenty nine locations around Kuwait. Samples were assessed in relation to a wide range of industrial pollutants, including metals, PAHs, PCBs, PBDEs and HBCDs. The data generated indicated that levels of pollutants were generally low and below commonly applied sediment quality guidelines (SQGs). However, naturally high background concentrations of certain metals present in sediment from the region may prohibit the direct assessment against some of the routinely applied SQGs. Hot spots of contamination were identified for PAHs, PCBs and PBDEs, that were mainly associated with the Shuaiba Industrial Area, located south of the city, and known to contain a diverse mix of both light and heavy industry.

Tissue-Engineered Tracheal Replacement in a Child: A 4-Year Follow-Up Study

In 2010, a tissue-engineered trachea was transplanted into a 10-year-old child using a decellularized deceased donor trachea repopulated with the recipient's respiratory epithelium and mesenchymal stromal cells. We report the child's clinical progress, tracheal epithelialization and costs over the 4 years. A chronology of events was derived from clinical notes and costs determined using reference costs per procedure. Serial tracheoscopy images, lung function tests and anti-HLA blood samples were compared. Epithelial morphology and T cell, Ki67 and cleaved caspase 3 activity were examined. Computational fluid dynamic simulations determined flow, velocity and airway pressure drops. After the first year following transplantation, the number of interventions fell and the child is currently clinically well and continues in education. Endoscopy demonstrated a complete mucosal lining at 15 months, despite retention of a stent. Histocytology indicates a differentiated respiratory layer and no abnormal immune activity. Computational fluid dynamic analysis demonstrated increased velocity and pressure drops around a distal tracheal narrowing. Cross-sectional area analysis showed restriction of growth within an area of in-stent stenosis. This report demonstrates the long-term viability of a decellularized tissue-engineered trachea within a child. Further research is needed to develop bioengineered pediatric tracheal replacements with lower morbidity, better biomechanics and lower costs.

Tissue-Engineered Tracheal Replacement in a Child: A 4-Year Follow-Up Study

In 2010, a tissue-engineered trachea was transplanted into a 10-year-old child using a decellularized deceased donor trachea repopulated with the recipient's respiratory epithelium and mesenchymal stromal cells. We report the child's clinical progress, tracheal epithelialization and costs over the 4 years. A chronology of events was derived from clinical notes and costs determined using reference costs per procedure. Serial tracheoscopy images, lung function tests and anti-HLA blood samples were compared. Epithelial morphology and T cell, Ki67 and cleaved caspase 3 activity were examined. Computational fluid dynamic simulations determined flow, velocity and airway pressure drops. After the first year following transplantation, the number of interventions fell and the child is currently clinically well and continues in education. Endoscopy demonstrated a complete mucosal lining at 15 months, despite retention of a stent. Histocytology indicates a differentiated respiratory layer and no abnormal immune activity. Computational fluid dynamic analysis demonstrated increased velocity and pressure drops around a distal tracheal narrowing. Cross-sectional area analysis showed restriction of growth within an area of in-stent stenosis. This report demonstrates the long-term viability of a decellularized tissue-engineered trachea within a child. Further research is needed to develop bioengineered pediatric tracheal replacements with lower morbidity, better biomechanics and lower costs.

The prevalence of mental health disorders in (ex-)military personnel with a physical impairment: a systematic review

BACKGROUND

Having a visual, hearing or physical impairment (defined as problems in body function or structure) may adversely influence the mental well-being of military personnel. This paper reviews the existing literature regarding the prevalence of mental health problems among (ex-)military personnel who have a permanent, predominantly, physical impairment.

METHOD

Multiple electronic literature databases were searched for relevant studies (EMBASE (1980-January 2014), MEDLINE (1946-January 2014), PsycINFO (2002-January 2014), Web of Science (1975-January 2014)).

RESULTS

25 papers were included in the review, representing 17 studies. Studies conducted among US military personnel (n=8) were most represented. A range of mental health disorders were investigated; predominately post-traumatic stress disorder (PTSD), but also depression, anxiety disorder (excluding PTSD), psychological distress and alcohol misuse. The findings indicate that mental health disorders including PTSD (range 2-59%), anxiety (range 16.1-35.5%), depression (range 9.7-46.4%) and psychological distress (range 13.4-36%) are frequently found whereby alcohol misuse was least common (range 2.2-26.2%).

CONCLUSIONS

Common mental health disorders were frequently identified among (ex-)military personnel with a physical impairment. Adequate care and support is necessary during the impairment adaptation process to facilitate the psychosocial challenges (ex-)military personnel with an impairment face. Future research should be directed into factors impacting on the mental well-being of (ex-)military personnel with an impairment, how prevalence rates vary across impairment types and to identify and act on specific needs for care and support.

Comparison of antibiotic susceptibility in viridans group streptococci in low and high antibiotic-prescribing General Practices

WHAT IS KNOWN AND OBJECTIVE

Antibiotic resistance has become a global public health issue. Most antibiotics are prescribed in the community, although there is less stewardship of such agents in the community compared to secondary and tertiary care. Few studies have attempted to examine the prescribing practices in General Practice and its impact on antibiotic resistance and, therefore, a study was performed in order to compare antibiotic susceptibilities of commensal viridans group streptococci (VGS) obtained from patient cohorts in General Practices (GP), who were high and low prescribers of oral antibiotics.

METHOD

Sixty-five patients (<1 month-81 years; 77% female: 23% male) were enrolled onto the study, and viridans group streptococci (n = 5/patient) were collected from each patient's nasal passages and oropharynx region and tested for antibiotic susceptibility against (i) tetracyclines (doxycycline); (ii) macrolides (erythromycin); (iii) β-lactams (penicillin G); and (iv) fluoroquinolones (ofloxacin & levofloxacin).

RESULTS AND DISCUSSION

There were no significant differences in MICs between high and low GP prescribers with doxycycline (P = 0·094), erythromycin (P = 0·122), ofloxacin (P = 0·193) and levofloxacin (P = 0·058). However, there was a significant difference between high and low GP practices with regard to penicillin G (P = 0·031). This finding is important as the β-lactams are the most commonly prescribed oral antibiotic in the community.

WHAT IS NEW AND CONCLUSION

This study demonstrates that high prescribing practices may lead to an altered (higher) level of resistance to these agents in the commensal VGS population, which may be important as reservoirs of antibiotic resistance determinants in subsequent horizontal gene transfer events, particularly with newly colonizing pathogens, including pneumococci. Primary care physicians should be aware that increased prescribing of antibiotics may led to increased level of penicillin resistance.

Psychologists' views of inter-disciplinary psychosocial communication within the cancer care team

BACKGROUND

Little is known about how psychologists working in cancer care centres communicate clinical information to other members of the multidisciplinary team or what information is communicated.

PURPOSE

This study surveyed Australian cancer care psychologists regarding their communication practices and their views on barriers to and facilitators of effective inter-disciplinary communication.

METHODS

Psychologists were invited to complete an online survey containing purpose-designed items that addressed study aims.

RESULTS

Forty-four psychologists completed the survey. Psychologists' most common method of recording initial consultations was in patient medical records, with 69 % of respondents recording notes in either most of the time or all of the time. Twenty-two percent of psychologists said they did not regularly feedback the results of an initial assessment to a referrer and more than 40 % used verbal and e-mail communication to do so.

CONCLUSIONS

This study provides data that will assist in the development of guidelines for inter-professional communication between psychologists and other members of the cancer care team.

Effects of individual and combined dietary weight loss and exercise interventions in postmenopausal women on adiponectin and leptin levels

BACKGROUND

Excess body weight and a sedentary lifestyle are associated with the development of several diseases, including cardiovascular disease, diabetes and cancer in women. One proposed mechanism linking obesity to chronic diseases is an alteration in adipose-derived adiponectin and leptin levels. We investigated the effects of 12-month reduced calorie, weight loss and exercise interventions on adiponectin and leptin concentrations.

METHODS

Overweight/obese postmenopausal women (n = 439) were randomized as follows: (i) a reduced calorie, weight-loss diet (diet; N = 118), (ii) moderate-to-vigorous intensity aerobic exercise (exercise; N = 117), (iii) a combination of a reduced calorie, weight-loss diet and moderate-to-vigorous intensity aerobic exercise (diet + exercise; N = 117), and (iv) control (N = 87). The reduced calorie diet had a 10% weight-loss goal. The exercise intervention consisted of 45 min of moderate-to-vigorous aerobic activity 5 days per week. Adiponectin and leptin levels were measured at baseline and after 12 months of intervention using a radioimmunoassay.

RESULTS

Adiponectin increased by 9.5% in the diet group and 6.6% in the diet + exercise group (both P ≤ 0.0001 vs. control). Compared with controls, leptin decreased with all interventions (diet + exercise, -40.1%, P < 0.0001; diet, -27.1%, P < 0.0001; exercise, -12.7%, P = 0.005). The results were not influenced by the baseline body mass index (BMI). The degree of weight loss was inversely associated with concentrations of adiponectin (diet, P-trend = 0.0002; diet + exercise, P-trend = 0.0005) and directly associated with leptin (diet, P-trend < 0.0001; diet + exercise, P-trend < 0.0001).

CONCLUSION

Weight loss through diet or diet + exercise increased adiponectin concentrations. Leptin concentrations decreased in all of the intervention groups, but the greatest reduction occurred with diet + exercise. Weight loss and exercise exerted some beneficial effects on chronic diseases via effects on adiponectin and leptin.