Economic evaluation of the Very Early Rehabilitation in SpEech (VERSE) intervention

INTRODUCTION

There is limited evidence on the costs and outcomes of patients with aphasia after stroke. The aim of this study was to estimate costs in patients with aphasia after stroke according to the aphasia therapies provided.

METHODS

A three-arm, prospective, randomized, parallel group, open-label, blinded endpoint assessment trial conducted in Australia and New Zealand. Usual ward-based care (Usual Care) was compared to additional usual ward-based therapy (Usual Care Plus) and a prescribed and structured aphasia therapy program in addition to Usual Care (the VERSE intervention). Information about healthcare utilization and productivity were collected to estimate costs in Australian dollars for 2017-18. Multivariable regression models with bootstrapping were used to estimate differences in costs and outcomes (clinically meaningful change in aphasia severity measured by the WAB-R-AQ).

RESULTS

Overall, 202/246 (82%) participants completed follow-up at 26 weeks. Median costs per person were $23,322 (Q1 5,367, Q3 52,669, n = 63) for Usual Care, $26,923 (Q1 7,303, Q3 76,174, n = 70) for Usual Care Plus and $31,143 (Q1 7,001. Q3 62,390, n = 69) for VERSE. No differences in costs and outcomes were detected between groups. Usual Care Plus was inferior (i.e. more costly and less effective) in 64% of iterations, and in 18% was less costly and less effective compared to Usual Care. VERSE was inferior in 65% of samples and less costly and less effective in 12% compared to Usual Care.

CONCLUSION

There was limited evidence that additional intensively delivered aphasia therapy within the context of usual acute care provided was worthwhile in terms of costs for the outcomes gained.

Establishing a Chinese older hip fracture registry for older patients: a Delphi study to define the focus and key variables for this registry

A national hip fracture registry does not yet exist in China. This is the first to recommend a core variable set for the establishment of a Chinese national hip fracture registry. Thousands of Chinese hospitals will build on this and improve the quality of management for older hip fracture patients. The rapidly ageing population of China already experiences over half a million hip fractures every year. Many countries have developed national hip fracture registries to improve the quality of hip fracture management, but such a registry does not exist in China. The study is aimed at determining the core variables of a national hip fracture registry for older hip fracture patients in China. A rapid literature review was conducted to develop a preliminary pool of variables from existing global hip fracture registries. Two rounds of an e-Delphi survey were conducted with experts. The e-Delphi survey used a Likert 5-point scale and boundary value analysis to filter the preliminary pool of variables. The list of core variables was finalised following an online consensus meeting with the experts. Thirty-one experts participated. Most of the experts have senior titles and have worked in a corresponding area for more than 15 years. The response rate of the e-Delphi was 100% for both rounds. The preliminary pool of 89 variables was established after reviewing 13 national hip fracture registries. With two rounds of the e-Delphi and the expert consensus meeting, 86 core variables were recommended for inclusion in the registry. This study is the first to recommend a core variable set for the establishment of a Chinese national hip fracture registry. The further development of a registry to routinely collect data from thousands of hospitals will build on this work and improve the quality of management for older hip fracture patients in China.

187 ‘OUR LANGUAGE’: AN INITIATIVE TO RAISE STAFF AWARENESS OF THE IMPACT OF OUR CHOICE OF WORDS ON PATIENTS

Background

In a hospital specialising in older persons’ rehabilitation, the Speech & Language Therapy team (SLT) commenced an initiative to raise awareness of the impact of all staff’s language on patients. Our language can either support or undermine patient well-being. Supportive language is easy-to-follow, everyday English and respects each person’s autonomy (‘Would you like help to eat?’). Unnecessary jargon or impersonal words can be undermining (e.g. ‘He needs supervision with feeding’). This is supported by national and international guidance tools such as the online ‘Plain Language Style Guide’ by the Health Service Executive Health Promotion Unit and National Adult Literacy Agency.

Methods

Quality improvement methodology was adopted to facilitate an ongoing, flexible approach. SLT delivered pilot workshops on person-centred language to ward staff. Afterward, staff spent a week self-identifying examples of language that could be improved during their work day. Examples were collated and presented back to teams. Online feedback surveys were conducted. Trolley rounds were then rolled out with quiz-style exercises to raise staff awareness across the hospital. Examples of person-centred language generated by staff were shown on rolling videos in key areas across the hospital.

Results

Staff engaged actively in workshop and trolley activities generating a range of examples of more person-centred language. Surveys revealed a new awareness of the need to adapt our language. Several months later, staff continue to demonstrate increased vigilance with their choice of words and regularly consult SLT for advice on language in clinical sessions, documentation or signage. There is still room for improvement in the language used in other areas such as Care Planning Meetings and clinical documentation.

Conclusion

This initiative has started to increase staff awareness of the importance of our choice of words to patient well-being. With the support of hospital management, this initiative will be continued, reviewed and reported on a rolling basis.

P-263 Clinical factors influencing the incidence of tripronuclear zygotes in IVF

Study question

Is the incidence of tripronuclear zygotes (3PN) in IVF cycles influenced by clinical, patient and treatment parameters?

Summary answer

Tripronuclear zygotes incidence in IVF cycles was influenced by Antral Follicle Count, number of oocytes retrieved, sperm progressive motility, and the use of fresh semen.

What is known already

Tripronuclear zygotes are indicative of abnormal fertilisation and are not routinely considered suitable for transfer. It is therefore important to optimise their detection and minimise their occurrence. Tripronuclear zygotes can originate as a result of the combination of one maternal and two paternal sets of chromosomes (fertilisation of a haploid oocyte by two haploid spermatozoa or by one diploid spermatozoon) or the combination of one paternal and two maternal sets of chromosomes (fertilisation of a diploid oocyte by one haploid spermatozoon) (1).

Study design, size, duration

This is a retrospective study of 550 IVF cycles performed between April 2018- April 2021, in a single UK clinic. IVF cycles either within (group 1) or exceeding (group 2) the key performance indicator (KPI) for the incidence of 3PN (<6%) (2), were assessed for associations with quantitative cycle variables. Proportion of 3PN per cycle was assessed for associations with qualitative variables. Cycles using donor oocytes (n = 73) were excluded for analyses assessing patient (maternal) parameters.

Participants/materials, setting, methods

Continuous variables including age, body mass index, Antral Follicle Count (AFC), anti-Mullerian hormone (AMH), oocytes recovered, timing from sperm production to insemination or oocyte recovery to insemination, sperm concentration, progressive motility and morphology were analysed by Mann-Whitney U Test. Qualitative variables including patient ethnicity, own/donor oocyte source, fresh/frozen sperm, stimulation regimen and oocyte recovery needle were analysed by logistic regression assuming binomial errors. Significance was assumed at p < 0.05.

Main results and the role of chance

There was no difference between groups where 3PN incidence exceeded or fell within the KPI when procedure timings and clinical parameters were assessed. There was also no relationship between patient characteristics (age, body mass index, AMH levels, ethnicity, oocyte source (own/donor)), semen concentration or semen morphology and the proportion of 3PN per cycle. However, number of oocytes retrieved in group 2 was significantly higher than group 1 (group 1, n cycles = 307, median oocytes retrieved = 8; group 2, n cycles = 170, median oocytes retrieved = 12 [95% CI -4, -1]) (p < 0.001). Similarly, AFC was significantly increased in group 2 (group 1, n cycles = 254, median AFC = 11; group 2, cycles n = 150, median AFC = 13 [95% CI -4, -1]) (p = 0.009). Likewise, the mean sperm motility parameters were higher for cycles exceeding the 6% 3PN KPI, with 64.6 ± 0.91% vs 68.8 ± 1.11% total motility (p = 0.004), and 57.1 ± 0.97% vs 61.7 ± 1.2% progressive motility (p = 0.003) for group 1 and 2 respectively. Proportion of 3PN per cycle was also significantly higher with fresh semen compared to frozen (6.6 ± 0.39% vs 4.7 ± 0.51%) (p = 0.006).

Limitations, reasons for caution

This is a retrospective study of a single UK clinic. Further analysis, expanding sample size, are required to confirm these findings.

Wider implications of the findings

Our finding that number of oocytes recovered influences 3PN incidence is in agreement with previous studies (3, 4). Fresh and high progressively motile sperm may be more capable of zona pellucida penetration leading to polyspermy and 3PN. Adjustment of sperm concentration at insemination could be considered in higher risk circumstances.

Trial registration number

na

Single-agent anti-PD-1 or combined with ipilimumab in patients with mucosal melanoma: an international, retrospective, cohort study

BACKGROUND

Mucosal melanoma (MM) is a rare melanoma subtype with distinct biology and poor prognosis. Data on the efficacy of immune checkpoint inhibitors (ICIs) is limited. We determined the efficacy of ICIs in MM, analysed by primary site and ethnicity/race.

PATIENTS AND METHODS

Retrospective cohort study from 25 cancer centres in Australia, Europe, USA and Asia. Patients with histologically confirmed MM were treated with anti-PD1+/-ipilimumab. Primary endpoints were response rate (RR), progression-free survival (PFS), overall survival (OS) by primary site (naso-oral, urogenital, anorectal, other), ethnicity/race (Caucasian, Asian, Other) and treatment. Univariate and multivariate Cox proportional hazard model analyses were conducted.

RESULTS

In total, 545 patients were included: 331 (63%) Caucasian, 176 (33%) Asian and 20 (4%) Other. Primary sites included 113 (21%) anorectal, 178 (32%) urogenital, 206 (38%) naso-oral and 45 (8%) other. 348 (64%) received anti-PD1 and 197 (36%) anti-PD1/ipilimumab. RR, PFS and OS did not differ by primary site, ethnicity/race or treatment. RR for naso-oral was numerically higher for anti-PD1/ipilimumab (40%, 95% CI 29-54%) compared with anti-PD1 (29%, 95% CI 21-37%). 35% of patients that initially responded progressed. Median duration of response (mDOR) was 26 months (95% CI 18-NR [Not Reached]). Factors associated with short PFS were ECOG PS ≥3 (p<0.01), LDH >ULN (p=0.01), lung metastases (p<0.01) and ≥1 previous treatments (p<0.01). Factors associated with short OS were ECOG PS ≥1 (p<0.01), LDH >ULN (p=0.03), lung metastases (p<0.01) and ≥1 previous treatments (p<0.01).

CONCLUSIONS

MM has poor prognosis. Treatment efficacy of anti-PD1+/-ipilimumab was similar and did not differ by ethnicity/race. Naso-oral primaries had numerically higher response to anti-PD1/ipilimumab, without difference in survival. The addition of ipilimumab did not show greater benefit over anti-PD1 for other primary sites. In responders, mDOR was short and acquired resistance was common. Other factors, including site and number of metastases were associated with survival.

The mutationathon highlights the importance of reaching standardization in estimates of pedigree-based germline mutation rates

In the past decade, several studies have estimated the human per-generation germline mutation rate using large pedigrees. More recently, estimates for various nonhuman species have been published. However, methodological differences among studies in detecting germline mutations and estimating mutation rates make direct comparisons difficult. Here, we describe the many different steps involved in estimating pedigree-based mutation rates, including sampling, sequencing, mapping, variant calling, filtering, and appropriately accounting for false-positive and false-negative rates. For each step, we review the different methods and parameter choices that have been used in the recent literature. Additionally, we present the results from a ‘Mutationathon,’ a competition organized among five research labs to compare germline mutation rate estimates for a single pedigree of rhesus macaques. We report almost a twofold variation in the final estimated rate among groups using different post-alignment processing, calling, and filtering criteria, and provide details into the sources of variation across studies. Though the difference among estimates is not statistically significant, this discrepancy emphasizes the need for standardized methods in mutation rate estimations and the difficulty in comparing rates from different studies. Finally, this work aims to provide guidelines for computational and statistical benchmarks for future studies interested in identifying germline mutations from pedigrees.

1115 Does the Published Evidence Support Cell Transplantation in Liver Disease?

Introduction

Although a significant body of evidence proposes a role for cell transplantation as a bridge or alternative to orthotopic liver transplantation for a range of liver disorders, this therapy is not performed in the United Kingdom. Several cell types, including human hepatocytes and mesenchymal stem cells, have been assessed for safety and efficacy, with numerous transfusion protocols. In this review we critically evaluated published human studies of hepatocyte transplantation in respect of (i) methods used to evaluate efficacy of therapy, particularly the use of validated prognostic scores for liver disease (MELD or Child-Pugh), and (ii) discrepancies in patient outcomes between studies using different cell types and transfusion protocols.

Method

We reviewed 20 studies on cell transplantation as an alternative to orthotopic liver transplantation. Patient demographics, study design and outcome measures were compared. Outcome measures were post-cell transplant patient survival to (i) the end of the follow-up window, (ii) receipt of a liver transplant, or (iii) death.

Results

Inconsistencies found in study protocols included strategies for cell transfusion, post-transplant immunosuppression and follow-up interval and duration. Comparison of results was complicated by the outcome measures themselves, as neither receipt of a graft nor mortality can be represented in the prognostic scores used. Furthermore, many studies reported biochemistry data which could not be incorporated into MELD/Child-Pugh score format.

Conclusions

Meta-analysis of hepatocyte transplant studies is not possible on account of methodological inconsistencies and lack of large, controlled trials. These may be important factors preventing wider adoption of this intervention.

1702 A Proforma To Improve Documentation of Surgical Ward Rounds

Aim

The ward round is an important vehicle in the care of surgical inpatients. Good quality documentation is essential in recording patient progress over time and communicating clearly between multidisciplinary team (MDT) members. This quality improvement project aimed to implement a standardised proforma to improve the quality of ward round documentation, improving MDT communication and patient safety.

Method

Ward round entries from an elective surgical unit at a District General Hospital were retrospectively reviewed using a fifteen-item checklist to assess quality of documentation. These criteria were divided into:

A re-audit was performed following introduction of a ward round proforma using the same criteria.

Results

The pre-intervention arm included 41 entries and the post-intervention arm included 27 entries. Improvements were seen in twelve of the fifteen criteria assessed. The greatest improvements were seen in documentation of management plans; documentation of discharge plan improved from 58.5% to 100%, VTE prophylaxis from 42% to 100% and drain/ catheter plan from 42 to 93%. Documentation of two criteria (signature and bleep) decreased and documentation of date remained at 100%.

Conclusions

The use of a standardised proforma improves documentation of surgical ward rounds, particularly patient’s’ onward management plans. Further modifications to the proforma could aim to improve documentation of bleep and signature.

Transcriptomic analysis of eyelid pigmentation in Hereford cattle

The study of skin color in cattle holds both economic and scientific interest. Several ocular diseases of cattle have been associated with low pigmentation of the eyelids, including ocular squamous cell carcinoma and infectious keratoconjunctivitis, the two most common ocular diseases affecting cattle production. Although low eyelid pigmentation is a well-known risk factor for various ocular diseases, the genetic and biological basis of this relationship is largely unknown. We investigated the transcriptome of eyelid skin in Hereford cattle using RNA-sequencing technology. Two contrasting groups were evaluated: steers that were completely pigmented and steers with no pigmentation in both eyelids. Most of the up-regulated genes in pigmented samples are directly implicated in melanogenesis and melanosome development, whereas up-regulated genes in non-pigmented samples are implicated in cancer development and the immune system, among other functions. Interestingly, network analysis comparing pigmented vs. non-pigmented samples revealed significant differences in the co-expression patterns of genes related to melanosome, pigmentation and defense response to bacteria, showing higher gene activity, greater co-expression patterns and tighter co-regulation mechanisms in pigmented samples. Overall, our findings indicate that bovine eyelid pigmentation depends on the expression of many genes involved not only in pigmentation and melanosome function but also related to inflammatory response, infection and tumoral pathways.

Internal parasitic burdens in brown rats (Rattus norvegicus) from Grenada, West Indies

This study identified the endoparasites in Brown rat (Rattus norvegicus) during May to July 2017 in Grenada, West Indies. A total of 162 rats, 76 females and 86 males were trapped from St. George and St. David parishes in Grenada. The collected fecal samples were examined for parasitic eggs and/or oocysts using simple fecal flotation technique. Adult parasites found in the intestinal tract were examined for identification. The overall prevalence of intestinal parasites among rats was 79 %.

Ten helminth species were recovered, several of which were reported for the first time in rodents in Grenada. The internal parasites consist of seven nematodes (Angiostrongylus spp., Nippostrongylus braziliensis, Heterakis spumosa, Strongyloides ratti, Aspiculuris tetraptera, Syphacia spp. and Protospirura spp.), one cestode (Hymenolepsis diminuta), one acanthocephalan (Moniliformis moniliformis) and one protozoa species (Eimeria spp.). The most prevalent zoonotic species were Angiostrongylus spp. (35.2%), Hymenolepsis diminuta (7.4%) and Moniliformis moniliformis (3.1%). Several nonzoonotic endoparasites; which included Nippostrongylus braziliensis (50.6%), Heterakis spumosa (15.4%), Strongyloides ratti (43.2%), Aspiculuris tetraptera (2.5%), Syphacia spp. (1.9%), Protospirura spp. (1.2%) and Eimeria spp. (4.7%) were also identified. The most prevalent parasites were Nippostrongylus brasiliensis (50.6%), Strongyloides ratti (43.2%) and Angiostrongylus spp. (35.2%). Co-infections occurred with up to six species per rat showing different combinations of parasitic infections.

Novel genetic polymorphisms associated with carcass traits in grazing Texel sheep

Improving meat production traits has increased its importance in sheep breeding. We report novel associations of SNP present in genes related to lipid metabolism and growth with several carcass traits in purebred Texel lambs. Expected progeny differences (EPD) predictions from 461 animals from the Central Progeny Testing of Texel breed in Uruguay were used for the association analysis. Live weights at different stages, ultrasound and post-mortem traits were analyzed. Markers in several genes were associated with growth, carcass and meat quality traits. Among others: PPARGC1A with valuable cuts weight, hot carcass weight and carcass fatness; DGAT1 with live weights, fat thickness, rib-eye area and shoulder weight; CAST with birth weight and fat thickness; GHR with birth weight and carcass fatness, and GHRHR with live weights and fat thickness. Genotypic effects ranged from 0.035 to 0.923 (DGAT1 vs. weaning weight) units of phenotypic SD. Most of the associations described are novel in sheep breeding, deserving further analyses.

Comprehensive re-evaluation of historical von Willebrand disease diagnosis in association with whole blood platelet aggregation and function

INTRODUCTION

Diagnosis of von Willebrand disease (VWD) is challenging, particularly for type 1. The current diagnostic guidelines emphasize simultaneous bleeding symptoms and von Willebrand factor (VWF) levels of <30-40 IU/dL. Historical diagnoses require updated evaluation. We assessed the accuracy of past VWD diagnoses in our comprehensive care center with the standardized bleeding score (BS) and central laboratory analysis, focusing on VWF-dependent platelet functions in whole blood.

METHODS

Our study comprised 83 adults with prior VWD who were diagnosed a median of 20 years ago. We assessed BS, VWF antigen and activity (minimum of 3 measurements), FVIII, PFA-100^® , and platelet aggregation via Multiplate^® . Genetic testing was targeted to types 3, 2N, 2B, and equivocal cases.

RESULTS

All 13/13 (100%) type 3 and 29/32 (90%) type 2, but only 10/38 (26%) of type 1 (overall 52/83 (63%)) patients met the current criteria for VWD. All confirmed cases had abnormal BS, impaired PFA-100^® , and decreased or absent ristocetin-induced platelet aggregation (RIPA), except subtype 2B. VWF, FVIII, RIPA, and PFA correlated with BS including all study subjects. Ten of the 38 patients with previous type 1 had low VWF (35-50 IU/dL) and variable VWF-dependent platelet function. Altogether, 21/83 patients (25%) had repeatedly normal VWF:RCo (>50 IU/dL).

CONCLUSION

von Willebrand disease is associated with impaired VWF-dependent whole blood platelet functions that match traditional VWF measurements. We detected normal VWF in 25% of historically diagnosed patients, mainly type 1 patients, implying that there is a need to systematically re-evaluate historical VWD diagnoses.

An equivalence study: Are patient-completed and telephone interview equivalent modes of administration for the EuroQol survey?

Background

To determine if the EuroQol Health Related Quality of Life survey produces equivalent results when administered by phone interview or patient-completed forms.

Methods

People awaiting hip or knee arthroplasty at a major metropolitan hospital participated. They were randomly assigned to receive the EuroQol Health Related Quality of Life survey via telephone, followed by a patient completed form 1 week later, or vice versa. Equivalence was determined using two one-sided tests (TOST) based on minimal clinically-important differences for the visual analogue scale (VAS) and the summary Utility Index. Cohen’s Kappa scores were computed to determine agreement for the individual EuroQoL Likert scale items.

Results

Seventy-six from 90 (84%) participants completed the survey twice. Based on limits set at ±7 and ±0.11 for the VAS and Utility Index, respectively, equivalence was established between the two methods of administration for both the VAS (mean difference 0.05 [90% CI −3.76–3.67]) and the Utility Index (mean difference 0.06 [90% CI 0.02–0.11]). Varying levels of agreement, ranging from slight to substantial (κ = 0.17–0.67), were demonstrated for the individual health domains. The order of telephone and patient-completed survey administration had no significant effect on results.

Conclusions

Equivalent results are obtained between telephone and patient-completed administration for the VAS and Utility Index of the EuroQol Survey in people with advanced hip or knee osteoarthritis. The limits of agreement for the individual health domains vary which prevents the accurate interpretation of real change in these items across modes.

Twelve tips for applying the science of learning to health professions education

Findings from the science of learning have clear implications for those responsible for teaching and curricular design. However, this data has been historically siloed from educators in practice, including those in health professions education. In this article, we aim to bring practical tips from the science of learning to health professions educators. We have chosen to organize the tips into six themes, highlighting strategies for 1) improving the processing of information, 2) promoting effortful learning for greater retention of knowledge over time, 3) applying learned information to new and varied contexts, 4) promoting the development of expertise, 5) harnessing the power of emotion for learning, and 6) teaching and learning in social contexts. We conclude with the importance of attending to metacognition in our learners and ourselves. Health professions education can be strengthened by incorporating these evidence-based techniques.

Evaluation of a two-question screening tool in the detection of intimate partner violence in a primary healthcare setting in South Africa

Introduction: Intimate partner violence has been recognised globally as a human rights violation. It is universally under-diagnosed and the institution of timeous multi-faceted interventions has been noted to benefit intimate partner violence victims. Currently the concept of using a screening tool to detect intimate partner violence has not been widely explored in a primary healthcare setting in South Africa, and for this reason the current study was undertaken. The objectives of this study were: (1) to determine the operating characteristics of a two-question screening tool for intimate partner violence (Women Abuse Screening Tool–short); and (2) to estimate the prevalence of intimate partner violence among women attending an outpatient department, using a validated questionnaire (Women Abuse Screening Tool). Methods: A cross-sectional study was conducted prospectively at the outpatient department of a primary care hospital, with systematic sampling of one in eight women over a period of three months. Participants were asked about their experience of intimate partner violence during the past 12 months. The Women Abuse Screening Tool–short was used to screen patients for intimate partner violence. To verify the result of the screening, women were also asked the remaining questions from the full Women Abuse Screening Tool. Results: Data were collected from 400 participants, with a response rate of 99.3%. Based on the results for the Women Abuse Screening Tool, the prevalence of intimate partner violence in the sample was 32%. The Women Abuse Screening Tool–short was shown to have a sensitivity of 45.2% and specificity of 98%. Conclusion: With its high prevalence, intimate partner violence is a health problem at this facility. The Women Abuse Screening Tool–short lacks sufficient sensitivity and therefore is not an ideal screening tool for this primary care ambulatory setting. The low sensitivity can be attributed to the participants’ understanding of the screening questions, which utilise Eurocentric definitions of intimate partner violence.  Improvement in the sensitivity of the Women Abuse Screening Tool–short in this setting may be achieved by lowering the threshold for a positive result.

Radiation exposure to comforters and carers during paediatric molecular radiotherapy

BACKGROUND

To show whether the incidental radiation exposure received by comforters and carers of children undergoing molecular radiotherapy was kept as low as reasonably achievable and was within English national dose constraints.

PROCEDURE

The radiation exposure of adult comforters and carers was routinely monitored with a whole body personal dose meter while the child was in hospital. Data were collected on iodine-131 meta-iodobenzylguanidine (¹³¹ I-mIBG), lutetium-177 DOTATATE (¹⁷⁷ Lu-DOTATATE), and iodine-131 sodium iodide (¹³¹ I-NaI) treatments.

RESULTS

Data were available for 50 treatments with high-administered activity double-infusion ¹³¹ I-mIBG and 12 single administrations; 15 ¹⁷⁷ Lu-DOTATATE treatments and 28 ¹³¹ I-NaI administrations. The median age was 7 years (1-18). The median administered activity of: ¹³¹ I-mIBG was 16.2 GBq (6.8-59 GBq) for double infusion patients and 8.1 GBq (5.26-16.25 GBq) for single administrations; ¹⁷⁷ Lu-DOTATATE was 7.2 GBq (2.5-7.5 GBq); and ¹³¹ I-NaI was 3 GBq for thyroid remnant ablation and 5.5 GBq for cancer therapy. The median number of comforters and carers for all administrations was 2 (range 1-9). The median exposure values for comforters and carers for high-administered activity ¹³¹ I-mIBG administrations was 302 µSv (0-5282 µSv); for single fraction ¹³¹ I-mIBG 163 µSv (3-3104 µSv); ¹⁷⁷ Lu-DOTATATE 6 µSv (1-79 µSv); and ¹³¹ I-NaI 37 µSv (0-274 µSv). Only one of the comforters and carers exceeded the dose constraint of 5 mSv.

CONCLUSIONS

Doses to comforters and carers were in all but one case within the dose constraint nationally recommended by the Health Protection Agency, now part of Public Health England. New evidence is presented which show that comforter and carer radiation exposure levels from paediatric molecular radiotherapy in routine clinical practice are acceptably low. Pediatr Blood Cancer 2015;62:235-239. © 2014 Wiley Periodicals, Inc.

Is walking aid height critical?

A study is reported in which 20 healthy subjects performed a non weight-bearing aided gait with elbow crutches. The crutches were adjusted to a conventional height and also to heights 2cm and 4cm above and below this setting. Temporospatial and kinetic data were acquired and the results indicated that no significant differences were demonstrated for most parameters across the various height settings. Only at the setting 4cm above conventional was there a significant increase in the abduction moment at the shoulder joint. The conclusion of the study was that height adjustment of elbow crutches with this gait was not a critical issue except at a height 4cm above the conventional setting, and that the subjective impression of the user regarding comfort was a good indicator of correctness of fit.

Phenotypic and genotypic characterization of 10 Finnish patients with von Willebrand disease type 3: discovery of two main mutations

Severe von Willebrand's disease (VWD) type 3 is a rare autosomal-recessively inherited bleeding disorder, showing considerable genotypic heterogeneity. We investigated the phenotype in correlation with the genotype in Finnish type 3 VWD patients. Ten patients previously diagnosed with VWD type 3 treated at the Coagulation Disorder Unit in Helsinki University Hospital were re-evaluated for bleeding tendency and treatment. Phenotypic characterization included coagulation and platelet function testing confirming the diagnosis. The genotype was assessed by initial screening for the common c.2435delC mutation and subsequently if needed, by analysing all 51 coding exons of the von Willebrand factor gene. Our result confirmed the diagnosis of type 3 VWD for all 10 patients. We discovered two common mutations: nine of the 20 alleles (45%) were found to carry the c.2435delC frameshift mutation, previously described to be frequent in countries surrounding the Baltic Sea. The nonsense mutation c.4975C>T (p.R1659X) was found on 8/20 (40%) of the alleles. In addition, three novel mutations, a potential splice site mutation (c.874+2T>C) and two frameshift mutations (c.1668delC and c.2072delCCinsG) were found. Seven patients were homozygous and three compound heterozygous for the reported mutations. This study indicates that mainly two mutations (c.2435delC and p.R1659X) cause the majority of type 3 VWD in Finland. This result sets future standards for the genetic testing among the Finnish type 3 VWD population.

Genetic diversity analysis of the Uruguayan Creole cattle breed using microsatellites and mtDNA markers

The Uruguayan Creole cattle population (N = 600) is located in a native habitat in south-east Uruguay. We analyzed its genetic diversity and compared it to other populations of American Creole cattle. A random sample of 64 animals was genotyped for a set of 17 microsatellite loci, and the D-loop hyper-variable region of mtDNA was sequenced for 28 calves of the same generation. We identified an average of 5.59 alleles per locus, with expected heterozygosities between 0.466 and 0.850 and an expected mean heterozygosity of 0.664. The polymorphic information content ranged from 0.360 to 0.820, and the global FIS index was 0.037. The D-loop analysis revealed three haplotypes (UY1, UY2 and UY3), belonging to the European matriline group, with a haplotype diversity of 0.532. The history of the population, changes in the effective population size, bottlenecks, and genetic drift are possible causes of the genetic variability patterns that we detected.

Epitaxial growth of visible to infra-red transparent conducting In2O3 nanodot dispersions and reversible charge storage as a Li-ion battery anode

Unique bimodal distributions of single crystal epitaxially grown In2O3 nanodots on silicon are shown to have excellent IR transparency greater than 87% at IR wavelengths up to 4 μm without sacrificing transparency in the visible region. These broadband antireflective nanodot dispersions are grown using a two-step metal deposition and oxidation by molecular beam epitaxy, and backscattered diffraction confirms a dominant (111) surface orientation. We detail the growth of a bimodal size distribution that facilitates good surface coverage (80%) while allowing a significant reduction in In2O3 refractive index. This unique dispersion offers excellent surface coverage and three-dimensional volumetric expansion compared to a thin film, and a step reduction in refractive index compared to bulk active materials or randomly porous composites, to more closely match the refractive index of an electrolyte, improving transparency. The (111) surface orientation of the nanodots, when fully ripened, allows minimum lattice mismatch strain between the In2O3 and the Si surface. This helps to circumvent potential interfacial weakening caused by volume contraction due to electrochemical reduction to lithium, or expansion during lithiation. Cycling under potentiodynamic conditions shows that the transparent anode of nanodots reversibly alloys lithium with good Coulombic efficiency, buffered by co-insertion into the silicon substrate. These properties could potentially lead to further development of similarly controlled dispersions of a range of other active materials to give transparent battery electrodes or materials capable of non-destructive in situ spectroscopic characterization during charging and discharging.

Genetic characterization of Latin-American Creole cattle using microsatellite markers

Genetic diversity in and relationships among 26 Creole cattle breeds from 10 American countries were assessed using 19 microsatellites. Heterozygosities, F-statistics estimates, genetic distances, multivariate analyses and assignment tests were performed. The levels of within-breed diversity detected in Creole cattle were considerable and higher than those previously reported for European breeds, but similar to those found in other Latin American breeds. Differences among breeds accounted for 8.4% of the total genetic variability. Most breeds clustered separately when the number of pre-defined populations was 21 (the most probable K value), with the exception of some closely related breeds that shared the same cluster and others that were admixed. Despite the high genetic diversity detected, significant inbreeding was also observed within some breeds, and heterozygote excess was detected in others. These results indicate that Creoles represent important reservoirs of cattle genetic diversity and that appropriate conservation measures should be implemented for these native breeds in order to minimize inbreeding and uncontrolled crossbreeding.

Estudio genealógico del perro Cimarrón uruguayo

Para evaluar la variabilidad genética de la raza canina Cimarrón Uruguayo, se analizó la totalidad de la información genealógica disponible (n= 6079) utilizando el programa informático ENDOG v4.5. Los datos recabados sugieren sobrerepresen-tación de determinados reproductores y pérdida de genotipos fundacionales. La F media para la población de referencia viva apta para la reproducción fue de 0,03, la cual ha aumentado en generaciones recientes. La población ha tenido una evolución favorable en relación a crecimiento en número de individuos, aunque es muy heterogénea y requiere la aplicación de criterios en los cruzamientos que tiendan a minimizar el nivel de consanguinidad por generación.

Current challenges of pharmacovigilance in bleeding disorders: converting the burden to benefit

SUMMARY

Safety surveillance studies have proven essential in research and development of new biological therapies for bleeding disorders as well as other diseases. Although product safety regarding HIV, hepatitis, and other blood-borne infections is currently excellent, potential new infectious agents require continued vigilant monitoring. Inhibitor development is the most common serious side effect of haemophilia replacement therapy. Several aetiological factors associated with inhibitors have been identified, but their true impact is still largely unknown. Moreover, whether plasma-derived and recombinant factor products differ in their immunogenic profiles is an unresolved issue. Coagulation factor products under development and those currently on the market require uniform, long-term surveillance. The European Haemophilia Safety Surveillance (EUHASS) project was recently established to meet these goals. The pharmaceutical industry and clinicians face common challenges complying with these requirements. In rare diseases like haemophilia, obtaining adequate patient numbers poses a challenge. Another challenge is a lack of methods for assessing disease severity, a surprising deficiency in the era of modern medical and laboratory technology. National and international registries can be used to gather required safety surveillance information. Simultaneously, clinicians benefit from well-organized registry data in their daily practice and harmonize the quality of comprehensive haemophilia care by homogeneous follow-up platforms. Experience with such registries comes, for example, from Europe (PEDNET), the USA (CDC/UDC), the UK (UKHCDO), and Sweden (Malmö). It is important to commit to future pharmacovigilance efforts, aiming at high-quality safety surveillance programmes at both the pharmaceutical research community and clinical levels.

beta-1,2,3-Triazolyl-nucleosides as nicotinamide riboside mimics

The synthesis of a series of pyridine- and piperidine-substituted 1,2,3-triazolides linked to a riboside moiety is described. The presence of a triazolide substituent on the pyridine moiety permitted the facile reduction of the latter under mild hydrogenation conditions. These analogues were modelled as to define their similarity to nicotinamide riboside and quantify their ability to bind NAD-dependent protein deacetylases.

Anaerobic treatment of low-strength municipal wastewater by a two-stage pilot plant under psychrophilic conditions

A two-stage anaerobic treatment pilot plant was tested for the treatment of raw domestic wastewater under temperatures ranging from 21 to 14 degrees C. The plant consisted of a hydrolytic upflow sludge bed (HUSB) digester (25.5m3) followed by an upflow anaerobic sludge blanket (UASB) digester (20.36m3). The hydraulic retention time (HRT) varied from 5.7 to 2.8h for the first stage (HUSB digester) and from 13.9 to 6.5h for the second stage (UASB digester). Total suspended solids (TSS), total chemical oxygen demand (TCOD), and biochemical oxygen demand (BOD) removals ranged from 76% to 89%, from 49% to 65%, and from 50% to 77%, respectively, for the overall system. The percentage of influent COD converted to methane was 36.1%, the hydrolysis of influent volatile suspended solids (VSS) reached 59.7% and excess biomass was 21.6% of the incoming VSS. Plant performance was influenced by the wastewater concentration and temperature, yet better results were obtained for influent COD higher than 250mg/l.

Successful liver-kidney transplantation in two children with aHUS caused by a mutation in complement factor H

A 12-month-old boy and his 16-year-old aunt became acutely ill 6 months apart and were diagnosed to have atypical hemolytic uremic syndrome (aHUS). Genetic analysis revealed heterozygous R1215Q mutation in complement factor H (CFH) in both patients. The same mutation was found in five healthy adult relatives indicating incomplete penetrance of the disease. The patients developed terminal renal failure and experienced reversible neurological symptoms in spite of plasma exchange (PE) therapy. In both cases, liver-kidney transplantation was successfully performed 6 months after the onset of the disease. To minimize complement activation and prevent thrombotic microangiopathy or overt thrombotic events due to the malfunctioning CFH, extensive PE with fresh frozen plasma was performed pre- and perioperatively and anticoagulation was started a few hours after the operation. No circulatory complications appeared and all four grafts started to function immediately. Also, no recurrence or other major clinical setbacks have appeared during the postoperative follow-up (15 and 9 months) and the grafts show excellent function. While more experience is needed, it seems that liver-kidney transplantation combined with pre- and perioperative PE is a rational option in the management of patients with aHUS caused by CFH mutation.