Understanding clinician barriers to providing equitable healthcare for ethnic minority populations

Background

It has long been recognised that ethnic minority groups have worse health outcomes in the UK. Social determinants of health (SDH) contribute significantly to these inequalities. However, inequalities persist, even after controlling for these determinants. As well as being less likely to engage with healthcare services, ethnic minority groups are more likely to report poor experiences. The majority of healthcare in the UK is delivered through patient: clinician interactions (PCI), therefore a good working relationship with patients is paramount. Recent focus has been placed on ensuring “cultural competence”. Whilst this is important, we suggest also examining the culture within healthcare itself. Healthcare professionals are not immune to bias, preconceptions and the stresses of work and this must be taken into account. A seminal piece of work on this is the “culture of medicine” framework proposed by Boutin-Foster et al, which examines the impact of these factors.

Aims and Methodology

This paper aims to examine barriers within PCI that impact healthcare for ethnic minorities. A formal literature review was conducted and 131 relevant studies were identified. Grounded theory was used for analysis and data was categorised into themes with Boutin-Foster’s framework used as a structure.

Results

The review found that the concept of implicit bias was paramount in PCI. Three major barriers resulting from this bias are suggested: its impact on clinical decision making, the impact on clinician-patient communication and finally the resultant lack of trust in clinicians and poor perceived quality of care by ethnic minority groups.

Conclusions

Clinician implicit bias is a major barrier to equitable healthcare for ethnic minority populations. A solution we propose is to acknowledge our own preconceptions. Awareness of our own culture, preconceptions and the pressures around us will allow us to find solutions to these barriers, including further research and education.

Key messages

• Clinician implicit bias within the “Culture of Medicine” is a barrier to equitable healthcare for ethnic minority populations.

• Awareness of our own culture and preconceptions is paramount to addressing these barriers.

Outcomes to measure the effects of pharmacological interventions for pain management for women during labour and birth: a review of systematic reviews and randomised trials

BACKGROUND

Pharmacological pain management options can relieve women's pain during labour and birth. Trials of these interventions have used a wide variety of outcomes, complicating meaningful comparisons of their effects. To facilitate better assessment of the effectiveness of labour pain management in trials and meta-analyses, consensus about key outcomes and the development of a core outcome set is essential.

OBJECTIVE

To identify all outcomes used in studies of pharmacological pain management interventions during labour and birth.

DESIGN

A review of systematic reviews and their included randomised controlled trials was undertaken.

SEARCH STRATEGY

Cochrane CENTRAL was searched to identify all Cochrane systematic reviews describing pharmacological pain management options for labour and birth. Search terms included 'pain management', 'labour' and variants, with no limits on year of publication or language.

SELECTION CRITERIA

Cochrane reviews and randomised controlled trials contained within these reviews were included, provided they compared a pharmacological intervention with other pain management options, placebo or no treatment.

DATA COLLECTION AND ANALYSIS

All outcomes reported by reviews or trials were extracted and tabulated, with frequencies of individual outcomes reported.

MAIN RESULTS

Nine Cochrane reviews and 227 unique trials were included. In total, 146 unique outcomes were identified and categorised into maternal, fetal, neonatal, child, health service, provider's perspective or economic outcome domains.

CONCLUSIONS

Outcomes of pharmacological pain management interventions during labour and birth vary widely between trials. The standardisation of trial outcomes would permit the assessment of meta-analyses for best clinical practice.

TWEETABLE ABSTRACT

Outcomes to measure pharmacological pain management options during labour are highly variable and require standardisation.

RCT of Harti Hauora Tamariki: a holistic family-centred programme for child health and equity

Background

In Aotearoa New Zealand (NZ), paediatric admissions (& readmissions) with diseases of poverty are common & this preventable burden is more severe for Māori (Indigenous) tamariki (children) & their whānau (families). In response, the Harti Hauora Tamariki (HHT) programme was developed. This is family-centred multilevel programme that consists of: culturally safe engagement for whānau; comprehensive high-quality wellbeing screening; standardised evidence-based protocols for addressing identified need(s); & navigation for and with whānau into services & support.

Methods

In 2019, over 980 children (0-4 years) admitted to the acute paediatric ward at Waikato Hospital in Aotearoa NZ were randomised (with their whānau) to intervention (HHT) or usual clinical care. Measures of effectiveness include the level of unmet need identified; the impact of HHT on meeting those needs & achieving improved outcomes for tamariki; qualitative assessment of how HHT led to the outcomes; & whānau satisfaction with hospital care. The primary quantitative endpoint is relative readmission risk.

Results

Qualitative case studies demonstrate the importance of engagement with staff and services, and that the HHT programme can create a high trust environment where whānau feel safe to reveal their needs. Needs are common. Many needs identified that impact whānau wellbeing (such as food insecurity and lack or resources including carseats) are not recognised through standard hospital care. Quantitative primary and secondary outcome analyses are underway.

Conclusions

Enhanced health promotion and prevention measures are required to achieve health equity for children in Aotearoa NZ, and the whole of health system (including secondary hospital care) has the responsibility and ability to manage such measures. The HHT programme is whānau-centred, adaptable, evidence-based, and able to address the broader determinants of common paediatric illness as well as support wellbeing and whānau ora.

Key messages

A family-centred holistic screening programme, with culturally safe engagement, improves inpatient care and enhances the determinants of health. Indigenous leadership and commitment to Indigenous wellbeing and health equity facilitates effective evolution and programme improvement, within the framework of a randomised controlled trial.

Co-design of data collection with participants of the Aberdeen Children of the 1950s cohort study

Background

The Aberdeen Children of the 1950s (ACONF) cohort comprises 12,150 people born in Scotland in the 50s. It contains rich early life data, questionnaire data from mid-life and linked electronic health records. Involving participants in designing future data collection is key to ensure research is acceptable and reflects public priorities.

Aim

Gather ACONF members views to inform how to: research healthy ageing, optimise recruitment and maximise participation.

Methods

3 co-design workshops with 30 ACONF members. A discussion was led by a facilitator using guidance questions developed by the study team. Workshops were recorded and transcribed.

Results

Participants viewed healthy ageing as keeping socially and physically active, taking responsibility for oneself and having a positive attitude to ageing. Research priorities were dementia, improvements in the social care system and engaging hard-to-reach groups. Members were keen for future research involvement. Recruitment may be maximised by: more information online, involving participants in recruiting other study members and clarity about potential benefits to themselves or others. It was acceptable to ask their offspring to participate. There were high levels of trust in researchers, but ongoing data protection is vital. Participation may be improved by regular contact (informing members of results, engagement events, phone “apps”). Participants viewed various data collection methods (questionnaires, applications, wearable devices, in-person tests, DNA collection and electronic record linkage) as acceptable.

Conclusions

Participant involvement is a fundamental part of securing a social license for research. Participants were in favour of ongoing research, including recruitment of their children. The workshops highlighted key considerations for future research and data collection.

Key messages

Co-design is vital for highlighting research topics which are important and relevant to the general population. Co-design can highlight strategies for maximising research participation and securing a social license for research.

37 Enhance GP-Geriatrician Care Homes Multidisciplinary Team

Introduction

Peterborough Care Home Support Team (CHST) have worked on a small pilot of 4 care homes with a local GP and an interface geriatrician to address the complex needs of the residents within those care homes to improve patient experience, quality of care and reduce attendances and admissions to hospital in a geographical area of 5000 care home beds.

Methods

The multidisciplinary team (MDT) consisted of a General Practitioner, Interface Geriatrician, Pharmacist from the medicine optimisation team and Care Home Support Team member with once a month meeting in the selected Care Home. We measure the impact of our intervention comparing the data predating our intervention comparing 4 selected care homes with high A&E attendances in each period 2017 and 2018.

Results

50% reduction in hospital attendances with £4985.48 cost saving following medication review in the 4 care homes under study.

Conclusions

Commissioners, Local Authorities and Care Home Providers have started to look towards more innovative solutions to improve patient experience, quality of care and reduce attendances and admissions to hospital. Our experience and results aim to consider enhance GP-Geriatrician Care Homes MDT as a good model of care.

Potential solutions to the major greenhouse-gas issues facing Australasian dairy farming

The Australasian dairy industry is facing the dual challenges of increasing productivity, while also reducing its emissions of the greenhouse gases (GHG) methane and nitrous oxide. Following the COP21 Paris Agreement, all sectors of the economy will be expected to contribute to GHG abatement. Enteric methane is the major source of GHG emissions from dairy production systems (>70%), followed by nitrous oxide (13%) and methane (12%) from animal waste, with nitrogen (N)-fertiliser use contributing ~3.5% of total on-farm non-carbon dioxide equivalent (non-CO2e) emissions. Research on reducing methane emissions from dairy cattle has focussed on feeding dietary supplements (e.g. tannins, dietary oils and wheat), rumen modification (e.g. vaccine, inhibitors), breeding and animal management. Research on reducing nitrous oxide emissions has focussed on improving N fertiliser efficiency and reducing urinary N loss. Profitable options for significant abatement on farm are still limited, with the industry focusing instead on improving production efficiency, while reducing emission intensity (t CO2e/t product). Absolute emission reduction will become an imperative as the world moves towards carbon neutrality by 2050 and, thus, a priority for research. However, even with implementation of best-practice abatement, it is likely that some residual emissions will remain in the foreseeable future. The soil organic carbon content of dairy soils under well fertilised, high-rainfall or irrigated permanent pastures are already high, therefore limiting the potential for further soil carbon sequestration as an offset against these residual emissions. The Australasian dairy industry will, therefore, also need to consider how these residual emissions will be offset through carbon sequestration mainly in trees and, to a more limited extent, increasing soil organic carbon.

Partition of dietary energy by sheep fed fresh ryegrass (Lolium perenne) with a wide-ranging composition and quality

Context Perennial ryegrass (Lolium perenne L.) is an important forage in temperate ruminant agricultural systems, but its quality and composition is highly variable and can become dominated by senescent material during summer and dry periods. Nutritive value is often predicted on the basis of chemical composition and calculated metabolisable energy (ME), which is rarely measured. Aim To measure the partition of energy from ryegrasses with widely varying proportions of leaf and senescent material, among faeces, urine and methane (CH4) in sheep. Methods Three experiments were undertaken with two groups of young wether sheep, fed seven diets of freshly cut ryegrass, at maintenance levels of intake to measure the partition of dietary energy among faeces, urine and CH4, enabling ME to be calculated. Across the seven diets, green leaf accounted for 16.0–87.6% of feed offered, whereas senescent material ranged from 2.8% to 65.0% and nitrogen (N) ranged between 8.6 and 31.2 g/kg DM. Measured ME was compared with predicted values based on digestible energy. Methane emissions were determined by both open-circuit respiration chambers and sulfur hexafluoride marker dilution. Key results Apparent digestibility (g/100 g) of DM ranged from 51.8 to 75.3 and N from 26.7 to 73.9. The percentage of the gross energy of feeds partitioned to CH4 (chamber) was 6.01–7.42, and 1.77–5.69 to urine. Effects of digestibility on CH4 yields (g/kg DM intake) were minor and the sum of energy losses to CH4 and urine were 13.5–17.6% of digestible energy (DE) intake, suggesting an underestimation of ME when predicted from DE. Use of sulfur hexafluoride substantially overestimated CH4 emissions when the permeation tubes had been in the sheep for 80 days. Conclusions A high proportion of senescent material in ryegrass had little effect on CH4 yields from sheep and energy losses to urine were mostly less than 3% of energy intake and were related to dietary N concentration. Implications Dietary ME calculated from DE is likely to be underestimated when ryegrass contains a high proportion of senescent material, due to reduced urinary energy losses, as CH4 yields are largely unaffected by maturity or senescence.

A-76 Specificity of the Repeatable Battery for the Assessment of Neuropsychological Status Digit Span as a Validity Indicator in Patients with Mild Cognitive Impairment and Dementia

Objective

The current study sought to examine the specificity of Digit Span (DS) scaled score from the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) as a performance validity test (PVT) in older adults with Mild Cognitive Impairment (MCI) or dementia.

Method

Archival data were utilized and included 195 patients (mean age = 72.8; mean education = 13.2) who underwent outpatient neuropsychological evaluations. Cases that had missing data, did not meet criteria for a neurocognitive disorder, or whose performance was deemed invalid were excluded. Participants were classified according to their evaluation diagnosis of MCI (n = 72; mean RBANS total score = 86.8) or dementia. Those diagnosed with dementia were divided by MoCA performance and categorized as mild dementia (n = 90; MoCA≥15; mean RBANS Total Score = 71.0) or moderate dementia (n = 33; MoCA < 15; mean RBANS Total Score = 55.9). Scaled score frequencies were analyzed to calculate specificity for each group.

Results

An RBANS DS scaled score of ≤4 occurred infrequently in older adults with MCI and mild dementia, resulting in specificity values of 0.93 and 0.90, respectively. In moderate dementia, specificity fell to 0.68 when using a scaled score of ≤4, with a cutoff of ≤2 required to maintain adequate specificity.

Conclusions

Findings suggest utility of RBANS DS scaled score as a PVT in dementia evaluations provided use of appropriate cutoffs. A more stringent cutoff was required in examinees with moderate dementia relative to patients with MCI and mild dementia. Future research should examine the RBANS DS sensitivity to invalid performance, as well as DS specificity across specific etiologies of MCI and dementia.

A Systematic Review of the Specificity of the Test of Memory Malingering in Children

Objective

The present study, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, is the first systematic review of the Test of Memory Malingering (TOMM) to examine the specificity of traditional adult cutoffs in children ages 5-18.

Data Selection

Article search terms and selection criteria were identified a priori. A search of PsycINFO and PubMED in January 2018 identified 539 peer-reviewed journal articles published from 1997-2017. Studies were excluded if they did not involve a pediatric sample, did not provide a means for ensuring validity external to the TOMM, contained samples overlapping those of other included studies, or did not provide sufficient data to calculate specificity values at traditional cutoffs. Frequencies of true negatives and false positives were extracted. When not available, these counts were calculated from sample size and specificity values. Data extraction was completed independently by the first two authors with any discrepancies rectified via discussion. Data were synthesized using a fixed effects model to calculate overall specificity.

Data Synthesis

Application of selection criteria resulted in 9 articles comprising 13 samples for Trial 2 and 3 studies comprising 5 samples for Retention. Weighted mean specificity was 0.98 for Trial 2 (n = 662) and 0.99 for Retention (n = 173) at standard cutoffs.

Conclusions

TOMM Trial 2 and Retention at traditional cutoffs maintain specificity values in pediatrics comparable to those of adults. Given limited research on the potential impact of very young age and extremely low cognitive functioning, further research will be important in determining the generalizability of these results across all pediatric populations.

Digit Span Forward as a Performance Validity Test in Dementia Evaluations: Specificity in Mild Cognitive Impairment, Mild Dementia, and Moderate Dementia

Objective

Traditional performance validity tests (PVTs) often yield high false positive rates in dementia evaluations. The current study examined the frequency of extremely low scores (≤ 2 percentile) on WAIS-IV Digit Span Forward (DSF) in older adults with Mild Cognitive Impairment (MCI) or dementia to evaluate its possible utility as a PVT in these populations.

Method

Archival data from outpatient neuropsychological evaluations were analyzed. Individuals who were not diagnosed with a neurocognitive disorder, had missing data, or were believed to be invalidly performing were excluded. Participants (n = 195; mean age = 72.8; mean education = 13.2 years) were classified according to their evaluation diagnosis of MCI (n = 72; mean RBANS Total Score = 86.8) or dementia. Dementia patients were further divided by MoCA score into groups of mild dementia (n = 90; MoCA≥15; mean RBANS Total Score = 71.0) or moderate dementia (n = 33; MoCA < 15; mean RBANS Total Score = 55.9). Frequencies of scaled scores were analyzed to calculate specificity values for each group.

Results

A WAIS-IV DSF scaled score of ≤4 (≤ 2 percentile) resulted in specificity values of 0.99 and 0.94 in MCI and mild dementia, respectively. Conversely, in moderate dementia, ≥0.90 specificity was achieved only when using a more conservative cutoff of ≤2.

Conclusions

Low DSF scaled scores occurred infrequently in MCI and mild dementia, indicating strong specificity and potential utility as a PVT in these populations. However, in moderate dementia, low DSF scores were more common, requiring use of a more stringent cutoff. Future research should examine DSF sensitivity to invalid performance, as well as DSF specificity according to specific etiologies of MCI and dementia.

Increasing Access to Physical Activity Within Low Income and Diverse Communities: A Systematic Review

Objective:

The purpose of this review is to uncover some best practices for increasing access to physical activity opportunities by examining efforts used within low income and diverse communities. The theoretical lens used is from the Active Living by Design (ALbD) Community Action Model, with a focus on the 6 essential practices (health equity focus, community engagement, facilitative leadership, sustainable thinking, culture of learning, and strategic communication) describing how partnerships can guide and sustain meaningful change in a community.

Methods:

A 2-step process guided the literature search. In step 1, 4 databases (PubMed, Psych INFO, Social Science Citation Index, and Cochrane Library) were searched using Boolean connections and variations in the key terms. Step 2 assessed articles by title, abstract, and full text to determine whether the studies met the inclusion and exclusion criteria guided by Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Additionally, included articles were compared against the 6 essential practices outlined by the ecological framework, ALbD.

Results:

Of 1775 total articles, 14 studies met inclusion criteria. Most of the studies were case studies located in the United States using several different approaches including, changes in the built environment, implementation of a community-based physical activity program, creating partnerships to leverage resources, and policy change. This review compared the 14 studies against the 6 essential practices of the ALbD model and found 2 studies that met all 6 criteria, and only a few studies meeting more than 2 criteria.

Conclusions:

Overall, the conclusions are 2-fold, (1) only 14 cases demonstrate success in increasing access to physical activity opportunities, suggesting that more can be done to address inequalities. (2) Of the existing efforts, few utilize crucial components to create a sustainable change in the community. Future research should take into consideration the ALbD ecological framework, the best existing theory for this type of work, to guide the creation and implementation of a sustainable community access effort.

Dietary Iodine Exposure and Brain Structures and Cognition in Older People. Exploratory Analysis in the Lothian Birth Cohort 1936

BACKGROUND

Iodine deficiency is one of the three key micronutrient deficiencies highlighted as major public health issues by the World Health Organisation. Iodine deficiency is known to cause brain structural alterations likely to affect cognition. However, it is not known whether or how different (lifelong) levels of exposure to dietary iodine influences brain health and cognitive functions.

METHODS

From 1091 participants initially enrolled in The Lothian Birth Cohort Study 1936, we obtained whole diet data from 882. Three years later, from 866 participants (mean age 72 yrs, SD±0.8), we obtained cognitive information and ventricular, hippocampal and normal and abnormal tissue volumes from brain structural magnetic resonance imaging scans (n=700). We studied the brain structure and cognitive abilities of iodine-rich food avoiders/low consumers versus those with a high intake in iodine-rich foods (namely dairy and fish).

RESULTS

We identified individuals (n=189) with contrasting diets, i) belonging to the lowest quintiles for dairy and fish consumption, ii) milk avoiders, iii) belonging to the middle quintiles for dairy and fish consumption, and iv) belonging to the middle quintiles for dairy and fish consumption. Iodine intake was secured mostly though the diet (n=10 supplement users) and was sufficient for most (75.1%, median 193 µg/day). In individuals from these groups, brain lateral ventricular volume was positively associated with fat, energy and protein intake. The associations between iodine intake and brain ventricular volume and between consumption of fish products (including fish cakes and fish-containing pasties) and white matter hyperintensities (p=0.03) the latest being compounded by sodium, proteins and saturated fats, disappeared after type 1 error correction.

CONCLUSION

In this large Scottish older cohort, the proportion of individuals reporting extreme (low vs. high)/medium iodine consumption is small. In these individuals, low iodine-rich food intake was associated with increased brain volume shrinkage, raising an important hypothesis worth being explored for designing appropriate guidelines.

Clinical effectiveness and cost-effectiveness of foot orthoses for people with established rheumatoid arthritis: an exploratory clinical trial

OBJECTIVES

Foot orthoses are commonly prescribed as an intervention for people with rheumatoid arthritis (RA). Data relating to the cost-effectiveness of foot orthoses in people with RA are limited. The aim was to evaluate the clinical and cost-effectiveness of two types of foot orthoses in people with established RA.

METHOD

A single-blind randomized controlled trial was undertaken to compare custom-made foot orthoses (CMFOs) and simple insoles (SIs) in 41 people with established RA. The Foot Function Index (FFI) was used to measure foot pain, disability, and functional limitation. Costs were estimated from the perspective of the UK National Health Service (NHS), societal (patient and family) perspective, and secondary care resource use in terms of the intervention and staff time. Effects were assessed in terms of health gain expressed as quality-adjusted life years (QALYs).

RESULTS

At baseline, 20 participants received a CMFO and 21 participants received an SI. After 16 weeks foot pain improved in both the CMFOs (p = 0.000) and the SIs (p < 0.01). However, disability scores improved for CMFOs (p < 0.001) but not for SIs (p = 0.40). The cost-effectiveness results demonstrated no difference in cost between the arms (CMFOs: £159.10; SIs: £79.10; p = 0.35), with the CMFOs being less effective in terms of cost per QALY gain (p < 0.001).

CONCLUSIONS

In people with established RA, semi-rigid customized foot orthoses can improve pain and disability scores in comparison to simple insoles. From a cost-effectiveness perspective, the customized foot orthoses were far more expensive to manufacture, with no significant cost per QALY gain.

Maternal gestational weight gain and offspring's risk of cardiovascular disease and mortality

OBJECTIVE

To examine the effect of maternal gestational weight gain (GWG) on adult offspring mortality, cardiovascular morbidity and cerebrovascular morbidity.

METHODS

The Aberdeen Children of the Nineteen Fifties (ACONF) is a population-based cohort of adults born in Aberdeen, Scotland between 1950 and 1956. GWG of the mothers of cohort members was extracted from original birth records and linked to the data on offspring morbidity and mortality up to 2011 obtained from Scottish national records. HRs for cardiovascular events and mortality in offspring according to maternal weight gain in pregnancy were estimated adjusting for maternal and offspring confounders using a restricted cubic spline model.

RESULTS

After exclusions, 3781 members of the original ACONF cohort were analysed. Of these, 103 (2.7%) had died, 169 (4.5%) had suffered at least one cardiovascular event and 73 (1.9%) had had a hospital admission for cerebrovascular disease. Maternal weight gain of 1 kg/week or more was associated with increased risk of cerebrovascular event in the offspring (adjusted HR 2.70 (95% CI 1.19 to 6.12)). There was no association seen between GWG and offspring's all-cause mortality or cardiovascular event. Adult offspring characteristics (smoking, body mass index (BMI) and diabetes) were strongly associated with each outcome.

CONCLUSIONS

Maternal GWG above 0.9 kg/week may increase the risk of cerebrovascular disease in the adult offspring, but not all-cause mortality or cardiovascular disease. Health and lifestyle factors such as smoking, BMI and diabetes in the adult offspring had a stronger influence than maternal and birth characteristics on their mortality and morbidity.

Methane emissions from young and mature dairy cattle

Daily methane (CH4) emissions (g) and CH4 yield (g/kg dry matter intake) were measured from 10 dairy heifers (<1 year old) and nine rumen-fistulated cows (>6 years old) fed ryegrass (Lolium perenne) chaffage indoors. The CH4 emissions were estimated using the sulfur hexafluoride tracer technique in four ~5-day periods beginning in June 2008 and repeated 4, 6 and 7 months later. Respiratory chambers were used in four ~13-day periods beginning in November 2008 and repeated 2, 5 and 6 months later. Third and fourth sulfur hexafluoride tracer periods overlapped with the first and second chamber measurement periods, respectively. Averaged over the four measurement periods the CH4 yields determined using both techniques were similar for heifers and cows. The mean CH4 yield estimated by the sulfur hexafluoride tracer technique was 25.3 ± 0.52 for heifers and 24.1 ± 0.55 for mature cows, whereas the mean CH4 yield measured in respiratory chambers was 23.7 ± 0.66 for heifers and 23.6 ± 0.66 for mature cows. Averaged over the eight measurements irrespective of technique, CH4 yields for heifers (24.5 ± 0.42) and cows (23.8 ± 0.43) were similar. There was also no difference between CH4 methods for assessing CH4 yield during the overlapping measurement periods. It was concluded that no consistent differences in CH4 yield existed between heifers and mature cows. Therefore, we do not recommend adoption of an age-related emission factor for cattle in the national inventory calculations for New Zealand.

Using food intake records to estimate compliance with the Eatwell Plate dietary guidelines

BACKGROUND

The UK Eatwell Plate is consumer based advice recommending the proportions of five food groups for a balanced diet: starchy foods, fruit and vegetables, dairy foods, nondairy sources of protein and foods and drinks high in fat or sugar. Many foods comprise ingredients from several food groups and consumers need to consider how these fit with the proportions of the Eatwell Plate. This involves disaggregating composite dishes into proportions of individual food components. The present study aimed to match the diets of adults in Scotland to the Eatwell Plate dietary recommendations and to describe the assumptions and methodological issues associated with estimating Eatwell Plate proportions from dietary records.

METHODS

Foods from weighed intake records of 161 females and 151 males were assigned to a single Eatwell group based on the main ingredient for composite foods, and the overall Eatwell Plate proportions of each subject's diet were calculated. Food group proportions were then recalculated after disaggregating composite foods.

RESULTS

The fruit and vegetables and starchy food groups consumed were significantly lower than recommended in the Eatwell Plate, whereas the proportions of the protein and foods high in fat or sugar were significantly higher. Failing to disaggregate composite foods gave an inaccurate estimate of the food group composition of the diet.

CONCLUSIONS

Estimating Eatwell Plate proportions from dietary records is not straightforward, and is reliant on methodological assumptions. These need to be standardised and disseminated to ensure consistent analysis.

Quantitation of reflux and outflow obstruction in patients with CVD and correlation with clinical severity

AIM

Chronic venous disease (CVD) is the result of venous reflux, obstruction or a combination of both. So far, attempts to correlate venous hemodynamic measurements with symptoms and signs of CVD have produced poor to moderate results, probably because of lack of methods to quantitate obstruction and combine measurements of reflux and obstruction. Our hypothesis is that the combination of quantitative measurements of (a) overall reflux (superficial and deep) and (b) overall outflow resistance i.e. including the collateral circulation would provide a hemodynamic index that should be related to the severity of the disease.

METHODS

Twenty-five limbs with chronic venous disease and 1 limb from a healthy volunteer (VCSS 0-13) were studied. The clinical CEAP classification was C0 in one limb, C1 in 2 limbs, C2 in 10 limbs, C3 in 3 limbs, C4 in 1 limb, C5 in 6 limbs and C6 in 3 limbs. Air-plethysmography was used to measure reflux (VFI in mL/s) when the subject changed position from horizontal to standing. Subsequently, with the subject horizontal and the foot elevated 15 cm, simultaneous recordings of pressure and volume were made on release of a proximal thigh cuff inflated to 70 mmHg. Pressure change was recorded with a needle in the foot and volume change with air-plethysmography. Flow (Q in mL/min) was calculated at intervals of 0.1 seconds from tangents on the volume outflow curve. Outflow resistance (R) was calculated at 0.1 second intervals by dividing pressure by the corresponding flow (R=P/Q). R increased markedly at pressures lower than 25 mmHg due to decrease in vein cross-sectional area, so resistance at 25 mmHg (R25) was used in this study.

RESULTS

In a multivariable linear regression analysis with VCSS as the dependent variable, both VFI and R25 were independent predictors (P<0.001). Using the constant (0.595) and regression coefficients, the regression equation provided a Hemodynamic Index (HI) or estimated VCSS=0.595 + (VFI x 0.41) + (R25 x 98). Thus, HI could be calculated for every patient by substituting VFI and R25 in the equation. HI or calculated VCSS was linearly related to the observed VCSS (r=0.86).

CONCLUSION

The results indicate that the combination of quantitative measurements of reflux and outflow resistance provide a hemodynamic index which is linearly related to the VCSS. These findings need to be confirmed in larger series.

SASOP Biological Psychiatry Congress 2013 Abstracts

<p><strong>List of abstracts and authors:</strong></p><p><strong>1. Bipolar disorder not otherwise specified -overdiagnosed or underdiagnosed?</strong></p><p>E Allers</p><p><strong>2. The prognosis of major depression untreated and treated: Does the data reflect the true picture of the prognosis of this very common disorder?</strong></p><p>E Allers</p><p><strong>3. Can we prolong our patients' life expectancy? Providing a better quality of life for patients with severe mental illness</strong></p><p>O A Betencourt</p><p><strong>4. The scope of ECT practice in South Africa</strong></p><p>J Benson-Martin, P Milligan</p><p><strong>5. Biomarkers for schizophrenia: Can we evolve like cancer therapeutics?</strong></p><p>P Buckley<strong></strong></p><p><strong>6. Relapse in schizophrenis: Major challenges in prediction and prevention</strong></p><p>P Buckley</p><p><strong>7. Informed consent in biological treatments: The right to know the duty to inform</strong></p><p><strong></strong>I Chetty</p><p><strong>8. Effectiveness of a long-acting injectable antipsychotic plus an assertive monitoring programme in first-episode schizophrenia</strong></p><p><strong></strong>B Chiliza, L Asmal, O Esan, A Ojagbemi, O Gureje, R Emsley</p><p><strong>9. Name, shame, fame</strong></p><p>P Cilliers</p><p><strong>10. Can we manage the increasing incidence of violent raging children? We have to!</strong></p><p>H Clark</p><p><strong>11. Serotonin, depression and antidepressant action</strong></p><p>P Cowen</p><p><strong>12. Prevalence and correlates of comorbid psychiatris illness in patients with heroin use disorder admitted to Stikland Opioid Detoxification Unit</strong></p><p>L Dannatt, K J Cloete, M Kidd, L Weich</p><p><strong>13. Investigating the association between diabetes mellitus, depression and psychological distress in a cohort of South African teachers</strong></p><p>A K Domingo, S Seedat, T M Esterhuizen, C Laurence, J Volmink, L Asmal</p><p><strong>14. Neuropeptide S -emerging evidence for a role in anxiety</strong></p><p>K Domschke</p><p><strong>15. Pathogenetics of anxiety</strong></p><p>K Domschke</p><p><strong>16. The effects of HIV on the fronto-striatal system</strong></p><p>S du Plessis, M Vink, J Joska, E Koutsilieri, C Scheller, B Spottiswoode, D Stein, R Emsley</p><p><strong>17. Effects of acute antipsychotic treatment on brain morphology in schizophrenia</strong></p><p>R Emsley, L Asmal, B Chiliza, S du Plessis, J Carr, A Goosen, M Kidd, M Vink, R Kahn</p><p><strong>18. Development of a genetic database resource for monitoring of breast cancer patients at risk of physical and psychological complications</strong></p><p>K Grant, F J Cronje, K Botha, J P Apffelstaedt, M J Kotze</p><p><strong>19. Unipolar mania reconsidered: Evidence from a South African study</strong></p><p><strong></strong>C Grobler</p><p><strong>20. Antipsychotic-induced movement disorders: Occurence and management</strong></p><p>P Haddad</p><p><strong>21. The place of observational studies in assessing the effectiveness of long-acting injectable antipsychotics</strong></p><p>P Haddad</p><p><strong>22. Molecular mechanisms of d-cycloserine in fear extinction: Insights from RNS sequencing</strong></p><p>S Hemmings, S Malan-Muller, L Fairbairn, M Jalali, E J Oakeley, J Gamieldien, M Kidd, S Seedat</p><p><strong>23. Schizophrenia: The role of inflammation</strong></p><p>DC Henderson</p><p><strong>24. Addictions: Emergent trends and innovations</strong></p><p>V Hitzeroth</p><p><strong>25. The socio-cultural-religious context of biological psychiatric practice</strong></p><p>B Janse van Rensburg</p><p><strong>26. Biochemical markers for identifying risk factors for disability progression in multiple sclerosis</strong></p><p><strong></strong>S Janse van Rensburg, M J Kotze, F J Cronje, W Davis, K Moremi, M Jalali Sefid Dashti, J Gamieldien, D Geiger, M Rensburg, R van Toorn, M J de Klerk, G M Hon, T Matsha, S Hassan, R T Erasmus</p><p><strong>27. Alcohol-induced psychotic disorder: Brain perfusion and psychopathology - before and after antipsychotic treatment</strong></p><p>G Jordaan, J M Warwick, D G Nel, R Hewlett, R Emsley</p><p><strong>28.'Pump and dump': Harm reduction strategies for breastfeeding while using substances</strong></p><p>L Kramer</p><p><strong>29. Adolescent neuropsychiatry - an emerging field in South African adolescent psychiatric services</strong></p><p>A Lachman</p><p><strong>30. Recovery versus remission, or what it means to be healthy for a psychiatric patient?</strong></p><p>B Latecki</p><p><strong>31. Holistic methods utilised to normalise behaviours in youth diagnosed with neuro-biochemical disorders</strong></p><p>P Macqueen</p><p><strong>32. Candidate genes and novel polymorphisms for anxiety disorder in a South African cohort</strong></p><p>N McGregor, J Dimatelis, S M J Hemmings, C J Kinnear, D Stein, V Russel, C Lochner</p><p><strong>33. Higher visual functioning</strong></p><p>A Moodley</p><p><strong>34. The effects of prenatal methylmercury exposure on trace element and antioxidant levels in rat offspring following 6-hydroxydopamine-induced neuronal insult</strong></p><p>Z M Moosa, W M U Daniels, M V Mabandla</p><p><strong>35. Paediatric neuropsychiatric movement disorders</strong></p><p>L Mubaiwa</p><p><strong>36. The South African national female offenders study</strong></p><p>M Nagdee, L Artz, C de Clercq, P de Wet, H Erlacher, S Kaliski, C Kotze, L Kowalski, J Naidoo, S Naidoo, J Pretorius, M Roffey, F Sokudela, U Subramaney</p><p><strong>37. Neurobiological consequences of child abuse</strong></p><p>C Nemeroff</p><p><strong>38. What do Stellenbosch Unviversity medical students think about psychiatry - and why should we care?</strong></p><p>G Nortje, S Suliman, K Seed, G Lydall, S Seedat</p><p><strong>39. Neurological soft skins in Nigerian Africans with first episode schizophrenia: Factor structure and clinical correlates</strong></p><p><strong></strong>A Ojagbemi, O Esan, O Gureje, R Emsley</p><p><strong>40. Should psychiatric patients know their MTHFR status?</strong></p><p>E Peter</p><p><strong>41. Clinical and functional outcome of treatment refractory first-episode schizophrenia</strong></p><p>L Phahladira, R Emsley, L Asmal, B Chiliza</p><p><strong>42. Bioethics by case discussion</strong></p><p>W Pienaar</p><p><strong>43. Reviewing our social contract pertaining to psychiatric research in children, research in developing countries and distributive justice in pharmacy</strong></p><p>W Pienaar</p><p><strong>44. The performance of the MMSE in a heterogenous elderly South African population</strong></p><p>S Ramlall, J Chipps, A I Bhigjee, B J Pillay</p><p><strong>45. Biological basis addiction (alocohol and drug addiction)</strong></p><p>S Rataemane</p><p><strong>46. Volumetric brain changes in prenatal methamphetamine-exposed children compared with healthy unexposed controls</strong></p><p><strong></strong>A Roos, K Donald, G Jones, D J Stein</p><p><strong>47. Single voxel proton magnetic resonance spectroscopy of the amygdala in social anxiety disorder in the context of early developmental trauma</strong></p><p>D Rosenstein, A Hess, S Seedat, E Meintjies</p><p><strong>48. Discussion of HDAC inhibitors, with specific reference to supliride and its use during breastfeeding</strong></p><p>J Roux</p><p><strong>49. Prevalence and clinical correlates of police contact prior to a first diagnosis of schizophrenia</strong></p><p>C Schumann, L Asmal, K Cloete, B Chiliza, R Emsley</p><p><strong>50. Are dreams meaningless?</strong></p><p>M Solms</p><p><strong>51. The conscious id</strong></p><p>M Solms<strong></strong></p><p><strong>52. Depression and resilience in HIV-infected women with early life stress: Does trauma play a mediating role?</strong></p><p>G Spies, S Seedat</p><p><strong>53. State of affairs analysis for forensic psychiatry in SA</strong></p><p>U Subramaney</p><p><strong>54. Escitalopram in the prevention of post-traumatic stress disorder: A pilot randomised controlled trial</strong></p><p>S Suliman, S Seedat, J Pingo, T Sutherland, J Zohar, D J Stein</p><p><strong>55. Epigenetic consequences of adverse early social experiences in primates</strong></p><p>S Suomi</p><p><strong>56. Risk, resilience, and gene x environment interactions in primates</strong></p><p>S Suomi</p><p><strong>57. Biological aspects of anorexia nervosa</strong></p><p>C Szabo</p><p><strong>58. Agents used and profiles of non-fatal suicidal behaviour in East London</strong></p><p>H Uys</p><p><strong>59. The contributions of G-protein coupled receptor signalling to opioid dependence</strong></p><p>J van Tonder</p><p><strong>60. Emerging trend and innovation in PTSD and OCD</strong></p><p>J Zohar</p><p><strong>61. Making the SASOP treatment guidelines operational</strong></p><p>E Allers</p><p><strong>Poster Presentations</strong></p><p><strong>62. Neuropsychological deficits in social anxiety disorder in the context of early developmental trauma</strong></p><p><strong></strong>S Bakelaar, D Rosenstein, S Seedat</p><p><strong>63.Social anxiety disorder in patients with or without early childhood trauma: Relationship to behavioral inhibition and activation and quality of life</strong></p><p><strong></strong>S Bakelaar, C Bruijnen, A Sambeth, S Seedat</p><p><strong>64. Exploring altered affective processing in obssessive compulsive disorder symptom subtypes</strong></p><p>E Breet, J Ipser, D Stein, C Lochner<strong><br /></strong></p><p><strong>65. To investigate the bias toward recognising the facial expression of disgust in obsessive compulsive disorder as well as the effect of escitalopram</strong></p><p>E Breet, J Ipser, D Stein, C Lochner</p><p><strong>66. A fatal-case of nevirapine-induced Stevens-Johnson's syndrome in HIV mania</strong></p><p>A Bronkhorst, Z Zingela, W M Qwesha, B P Magigaba<strong></strong></p><p><strong>67. Association of the COMT G472A (met/met) genotype with lower disability in people diagnosed with multiple sclerosis</strong></p><p>W Davis, S J van Rensburg, L Fisher, F J Cronje, D Geiger, M J Kotze</p><p><strong>68. Homocycsteine levels are associated with the fat mass and obesity associated gene FTO(intron 1 T&gt;A) polymorphism in MS patients</strong></p><p>W Davis, S J Van Rensburg, M J Kotze, L Fisher, M Jalali, F J Cronje, K Moremi, J Gamieldien, D Geiger, M Rensburg, R van Toorn, M J de Klerk, G M Hon, T Matsha, S Hassan, R T Erasmus</p><p><strong>69. Analysis of the COMT 472 G&gt;A (rs4680) polymorphism in relation to environmental influences as contributing factors in patients with schizophrenia</strong></p><p>D de Klerk, S J van Rensburg, R A Emsley, D Geiger, M Rensburg, R T Erasmus, M J Kotze</p><p><strong>70. Dietary folate intake, homocysteine levels and MTHFR mutation detection in South African patients with depression: Test development for clinical application </strong></p><p>D Delport, N vand der Merwe, R Schoeman, M J Kotze</p><p><strong>71. The use ofexome sequencing for antipsychotic pharmacogenomic applications in South African schizophrenia patients</strong></p><p>B Drogmoller, D Niehaus, G Wright, B Chiliza, L Asmal, R Emsley, L Warnich</p><p><strong>72. The effects of HIV on the ventral-striatal reward system</strong></p><p>S du Plessis, M Vink, J Joska, E Koutsilieri, C Scheller, B Spottiswoode, D Stein, R Emsley</p><p><strong>73. Xenomelia relates to asymmetrical insular activity: A case study of fMRI</strong></p><p>S du Plessis, M Vink, L Asmal</p><p><strong>74. Maternal mental helath: A prospective naturalistic study of the outcome of pregancy in women with major psychiatric disorders in an African country</strong></p><p>E du Toit, L Koen, D Niehaus, B Vythilingum, E Jordaan, J Leppanen</p><p><strong>75. Prefrontal cortical thinning and subcortical volume decrease in HIV-positive children with encephalopathy</strong></p><p>J P Fouche, B Spottiswoode, K Donald, D Stein, J Hoare</p><p><strong>76. H-magnetic resonance spectroscopy metabolites in schizophrenia</strong></p><p>F Howells, J Hsieh, H Temmingh, D J Stein</p><p><strong>77. Hypothesis for the development of persistent methamphetamine-induced psychosis</strong></p><p><strong></strong> J Hsieh, D J Stein, F M Howells</p><p><strong>78. Culture, religion, spirituality and psychiatric practice: The SASOP Spirituality and Psychiatry Special Interest Group Action Plan for 2012-2014</strong></p><p>B Janse van Rensburg</p><p><strong>79. Cocaine reduces the efficiency of dopamine uptake in a rodent model of attention-deficit/hyperactivity disorder: An <em>in vivo</em> electrochemical study</strong></p><p><strong></strong>L Kellaway, J S Womersley, D J Stein, G A Gerhardt, V A Russell</p><p><strong>80. Kleine-Levin syndrome: Case in an adolescent psychiatric unit</strong></p><p>A Lachman</p><p><strong>81. Increased inflammatory stress specific clinical, lifestyle and therapeutic variables in patients receiving treatment for stress, anxiety or depressive symptoms</strong></p><p>H Luckhoff, M Kotze, S Janse van Rensburg, D Geiger</p><p><strong>82. Catatonia: An eight-case series report</strong></p><p>M Mabenge, Z Zingela, S van Wyk</p><p><strong>83. Relationship between anxiety sensitivity and childhood trauma in a random sample of adolescents from secondary schools in Cape Town</strong></p><p>L Martin, M Viljoen, S Seedat</p><p><strong>84. 'Making ethics real'. An overview of an ethics course presented by Fraser Health Ethics Services, BC, Canada</strong></p><p>JJ McCallaghan</p><p><strong>85. Clozapine discontinuation rates in a public healthcare setting</strong></p><p>M Moolman, W Esterhuysen, R Joubert, J C Lamprecht, M S Lubbe</p><p><strong>86. Retrospective review of clozapine monitoring in a publica sector psychiatric hospital and associated clinics</strong></p><p>M Moolman, W Esterhuysen, R Joubert, J C Lamprecht, M S Lubbe</p><p><strong>87. Association of an iron-related TMPRSS6 genetic variant c.2007 C&gt;7 (rs855791) with functional iron deficiency and its effect on multiple sclerosis risk in the South African population</strong></p><p>K Moremi, S J van Rensburg, L R Fisher, W Davis, F J Cronje, M Jalali Sefid Dashti, J Gamieldien, D Geiger, M Rensburg, R van Toorn, M J de Klerk, G M Hon, T Matsha, S Hassan, R T Erasmus, M Kidd, M J Kotze</p><p><strong>88. Identifying molecular mechanisms of apormophine-induced addictive behaviours</strong></p><p>Z Ndlazi, W Daniels, M Mabandla</p><p><strong>89. Effects of lifestyle factors and biochemistry on the major neck blood vessels in patients with mutiple sclerosis</strong></p><p>M Nelson, S J van Rensburg, M J Kotze, F Isaacs, S Hassan</p><p><strong>90. Nicotine protects against dopamine neurodegenration and improves motor deficits in a Parkinsonian rat model</strong></p><p>N Ngema, P Ngema, M Mabandla, W Daniels</p><p><strong>91. Cognition: Probing anatomical substrates</strong></p><p>H Nowbath</p><p><strong>92. Chronic exposure to light reverses the effects of maternal separation on the rat prefrontal cortex</strong></p><p>V Russel, J Dimatelis</p><p><strong>93. Evaluating a new drug to combat Alzheimer's disease</strong></p><p>S Sibiya, W M U Daniels, M V Mabandla</p><p><strong>94. Structural brain changes in HIV-infected women with and without childhood trauma</strong></p><p>G Spies, F Ahmed, C Fennema-Notestine, S Archibald, S Seedat</p><p><strong>95. Nicotine-stimulated release of hippocampal norepinephrine is reduced in an animal model of attention-deficit/ hyperactivity disorder: the spontaneously hypertensive rat</strong></p><p>T Sterley</p><p><strong>96. Brain-derive neurotrophic factor (BDNF) protein levels in anxiety disorders: Systematic review and meta-regression analysis</strong></p><p>S Suliman, S M J Hemmings, S Seedat</p><p><strong>97. A 12-month retrospective audit of the demographic and clinical profile of mental healthcare users admitted to a district level hospital in the Western Cape, South Africa</strong></p><p>E Thomas, K J Cloete, M Kidd, H Lategan</p><p><strong>98. Magnesium recurarization: A comparison between reversal of neuromuscular block with sugammadex v. neostigmine/ glycopyrrolate in an <em>in vivo</em> rat model</strong></p><p><strong></strong>M van den Berg, M F M James, L A Kellaway</p><p><strong>99. Identification of breast cancer patients at increased risk of 'chemobrain': Case study and review of the literature</strong></p><p>N van der Merwe, R Pienaar, S J van Rensburg, J Bezuidenhout, M J Kotze</p><p><strong>100. The protective role of HAART and NAZA in HIV Tat protein-induced hippocampal cell death</strong></p><p>S Zulu, W M U Daniels, M V Mabandla</p>

Salmonella enterica serovar Enteritidis phage type 4 outbreak associated with eggs in a large prison, London 2009: an investigation using cohort and case/non-case study methodology

In September 2009, an outbreak of Salmonella enterica serovar Enteritidis affected 327 of 1419 inmates at a London prison. We applied a cohort design using aggregated data from the kitchen about portions of food distributed, aligned this with individual food histories from 124 cases (18 confirmed, 106 probable) and deduced the exposures of those remaining well. Results showed that prisoners eating egg cress rolls were 26 times more likely to be ill [risk ratio 25.7, 95% confidence interval (CI) 15.5-42.8, P<0.001]. In a case/non-case multivariable analysis the adjusted odds ratio for egg cress rolls was 41.1 (95% CI 10.3-249.7, P<0.001). The epidemiological investigation was strengthened by environmental and microbiological investigations. This paper outlines an approach to investigations in large complex settings where aggregate data for exposures may be available, and led to the development of guidelines for the management of future gastrointestinal outbreaks in prison settings.

Sources of infant feeding information used by pregnant women

Selecting an infant feeding method is one of the most important decisions a mother-to-be makes. Little information is available to characterize women who plan to use both formula and breast milk. In this study, 89 pregnant women indicated their anticipated feeding method and the sources and initiator of infant feeding information. No differences were found in the type of resources used by women who planned to breastfeed, formula feed, or combination feed. Women in the study were four times more likely to initiate a conversation about infant feeding methods with a family member or friend than with a health care provider. Involving these key individuals in perinatal education classes and support programs is a simple, but powerful, strategy that childbirth educators can use to promote breastfeeding.

Production of rare isotope beams at the Texas A&M University Cyclotron Institute

The Cyclotron Institute at Texas A&M is currently configuring a scheme for the production of radioactive-ion beams that incorporates a light-ion guide and a heavy-ion guide coupled with an electron-cyclotron-resonance ion source constructed for charge-breeding. This scheme is part of an upgrade to the facility and is intended to produce radioactive beams suitable for injection into the K500 superconducting cyclotron. The current status of the project and details on the ion sources used in the project is presented.

THE PRODUCTION OF PERSISTENT ALOPECIA IN RABBITS BY ROENTGEN RADIATION; A STUDY OF THE MINIMUM DOSE REQUIRED AND THE CONSISTENCY OF THE REACTION

Seven areas on the abdomen of each of fourteen rabbits were exposed to soft Roentgen radiation of constant quality in doses varying, in the region of the value critical for the production of persistent alopecia, by regular steps of about 4 per cent. Without exception the critical dose was found to lie between two such values, the upper limit being represented by exposures on eight of the animals and the lower on ten of them. With certain reservations, the critical dose corresponds to the production of 2.04 x 10¹⁵ ions of either sign per gm. of tissue.

STUDIES ON X-RAY EFFECTS : XIV. THE EFFECT OF X-RAY ON THE DIVISION RATE OF PARAMECIUM

Two races of paramecium were submitted for varying lengths of time to x-radiation and a large number of individuals were observed to determine the effect on the rate of division. The division rate of both races suffered a slight initial depression lasting for 2 to 5 days following the exposure. This depression is followed by complete recovery. Within rather wide limits the length of the exposure has, in these experiments, made no appreciable difference. Apparently the maximum effect of the x-rays is produced by relatively short exposures. Continued radiation produces little further change until exposures of 3 and 4 hours are used, when precisely the opposite results are obtained from those obtained with shorter exposures. Doses repeated at various intervals have in general failed to interfere more markedly with the division rate than a single dose. Repeated radiation causes the cells to become slightly swollen without apparent interference with their viability.

THE INACTIVATION OF TRYPSIN BY X-RAYS

1. The inactivating effect of soft x-rays on trypsin in solutions of various degrees of concentration has been studied. 2. It has been found to run parallel with spontaneous heat inactivation. It is almost, if not entirely, confined to the free or active trypsin. 3. Under radiation of constant intensity, the inactivation follows the simple exponential law which indicates a monomolecular reaction. 4. Estimates have been made of the amount of ionization required to inactivate trypsin to half value in these experiments and in those of Hussey and Thompson, who employed the beta rays from Radium B and C. The close agreement corroborates the idea that the effect is a function of ionization only. 5. The nature of the process of inactivation is discussed; inactivation seems to result from electrical neutralization of the trypsin ion.

ON THE TITRATION OF BACTERIOPHAGE AND THE PARTICULATE HYPOTHESIS

1. The theory of the serial dilution method of titration of bacterio-phage has been worked out on the basis of the simple particulate hypothesis. 2. It has been shown that, if the dilution constant is .1, only about 60 per cent of parallel runs on the same solution should give the same end-point, the average being taken over a great number of titrations of each of a great variety of solutions. 3. The discrepancy between this figure, 60 per cent, and Dr. Bronfenbrenner's estimate, 85 per cent, is considerable. 4. Inasmuch as the particulate hypothesis is well founded, no explanation of the discrepancy is suggested.

IBSIMU: a three-dimensional simulation software for charged particle optics

A general-purpose three-dimensional (3D) simulation code IBSIMU for charged particle optics with space charge is under development at JYFL. The code was originally developed for designing a slit-beam plasma extraction and nanosecond scale chopping for pulsed neutron generator, but has been developed further and has been used for many applications. The code features a nonlinear FDM Poisson's equation solver based on fast stabilized biconjugate gradient method with ILU0 preconditioner for solving electrostatic fields. A generally accepted nonlinear plasma model is used for plasma extraction. Magnetic fields can be imported to the simulations from other programs. The particle trajectories are solved using adaptive Runge-Kutta method. Steady-state and time-dependent problems can be modeled in cylindrical coordinates, two-dimensional (slit) geometry, or full 3D. The code is used via C++ programming language for versatility but it features an interactive easy-to-use postprocessing tool for diagnosing fields and particle trajectories. The open source distribution and public documentation make the code well suited for scientific use. IBSIMU has been used for modeling the 14 GHz ECR ion source extraction and for designing a four-electrode extraction for a 2.45 GHz microwave ion source at Jyväskylä. A grid extraction has also been designed for producing large uniform beam for creating conditions similar to solar wind. The code has also been used to design a H(-) extraction with electron dumping for the Cyclotron Institute of Texas A&M University.

Repeatability of the measurement of augmentation index in the clinical assessment of arterial stiffness using radial applanation tonometry

OBJECTIVE

Aortic augmentation index (AIx) measured using applanation tonometry is a non-invasive indicator of arterial stiffness. The objective of this study was to assess its repeatability when used by nurses with limited experience of the technique.

MATERIAL AND METHODS

Blood pressure/augmentation index (BP/AIx) was measured 4 times in 20 consecutive ambulant patients (16 male) after they rested supine for 15 min. Two nurses independently and alternately measured BP/AIx using the same equipment (Omron HEM-757; SphygmoCor with Millar hand-held tonometer). Nurses were blinded to patient medical records and their colleague's AIx/BP. 'Within' and 'between' observer differences were assessed using intra-class correlation coefficients (rI) and 95 % limits of agreement (95 % LoA) derived from Bland-Altman plots.

RESULTS

Mean age was 56 (mean BP 136/79; mean pulse 64). Mean AIx was 24.1 (range 2.8 to 41.0). Both 'between' and 'within' observer repeatability was very high, with intra-class correlation coefficients ranging from 0.92 to 0.98. Mean AIx readings 'between' observers differed by only 0.68 (95 % CI -0.24 to 1.59) with a high rI (0.98; 95 % CI 0.95 to 0.99) and a narrow 95 % LoA (-3.22 to 4.57). The 95 % LoA for 'within' observer repeatability was -6.75 to 7.95. Differences in AIx measurement did not vary over time or with increasing levels of AIx.

CONCLUSIONS

Even when undertaken by relatively inexperienced operators, both 'within' and 'between' observer repeatability of AIx measurement is very high. Such non-invasive assessment of arterial stiffness has the potential to be included in the clinical assessment of ambulant patients.

Regional variation in gene expression in the healthy colon is dysregulated in ulcerative colitis

OBJECTIVE

To investigate differential intestinal gene expression in patients with ulcerative colitis and in controls.

DESIGN

Genome-wide expression study (41,058 expression sequence tags, 215 biopsies).

SETTING

Western General Hospital, Edinburgh, UK, and Genentech, San Francisco, USA.

PATIENTS

67 patients with ulcerative colitis and 31 control subjects (23 normal subjects and 8 patients with inflamed non-inflammatory bowel disease biopsies).

INTERVENTIONS

Paired endoscopic biopsies were taken from 5 specific anatomical locations for RNA extraction and histology. The Agilent microarray platform was used and confirmation of results was undertaken by real time polymerase chain reaction and immunohistochemistry.

RESULTS

In healthy control biopsies, cluster analysis showed differences in gene expression between the right and left colon. (chi(2) = 25.1, p<0.0001). Developmental genes, homeobox protein A13 (HOXA13), (p = 2.3x10(-16)), HOXB13 (p<1x10(-45)), glioma-associated oncogene 1 (GLI1) (p = 4.0x10(-24)), and GLI3 (p = 2.1x10(-28)) primarily drove this separation. When all ulcerative colitis biopsies and control biopsies were compared, 143 sequences had a fold change of >1.5 in the ulcerative colitis biopsies (0.01>p>10(-45)) and 54 sequences had a fold change of <-1.5 (0.01>p>10(-20)). Differentially upregulated genes in ulcerative colitis included serum amyloid A1 (SAA1) (p<10(-45)) the alpha defensins 5 and 6 (DEFA5 and 6) (p = 0.00003 and p = 6.95x10(-7), respectively), matrix metalloproteinase 3 (MMP3) (p = 5.6x10(-10)) and MMP7 (p = 2.3x10(-7)). Increased DEFA5 and 6 expression was further characterised to Paneth cell metaplasia by immunohistochemistry and in situ hybridisation. Sub-analysis of the inflammatory bowel disease 2 (IBD2) and IBD5 loci, and the ATP-binding cassette (ABC) transporter genes revealed a number of differentially regulated genes in the ulcerative colitis biopsies.

CONCLUSIONS

Key findings are the expression gradient in the healthy adult colon and the involvement of novel gene families, as well as established candidate genes in the pathogenesis of ulcerative colitis.

The SF6 tracer technique for measurements of methane emission from cattle – effect of tracer permeation rate

Previous experiments have suggested that estimates of methane (CH4) emissions from ruminant animals made using the sulphur hexafluoride (SF6) tracer might be influenced by the permeation rate of SF6 (PR). This study examined the latter issue with cattle. For this, analyses of data sets from two grazing trials involving large herds (exps. 1 and 2) and a specifically designed controlled trial (exp. 3) were conducted. Individual daily CH4 emissions from 296 (exp. 1) and 388 (exp. 2) Friesian × Jersey cows in mid-lactation were measured with herds subdivided into four (exp. 1) or five (exp. 2) measurement groups and dry matter intake (DMI) estimated by energy metabolism algorithms. The ranges of tracer PR in exps. 1 and 2 were 2.624–5.689 and 2.214–3.594 mg d-1, respectively. Experiment 3 was conducted using 12 rumen-fistulated beef steers pen-fed on lucerne silage and design arranged as a 4 × 4 Latin square with three replications. Permeation tubes with four levels of nominal PR (three tubes each): low (L), medium (M), medium-high (MH) and high (H) were randomly assigned to four rumen deployment sequences (L-M-MH-H, H-MH-M-L, MH-L-H-M and M-H-L-MH). The grazing experiments revealed a positive effect of PR on the CH4 emission estimates (1 mg SF6 d-1 accounting for 0.6–2.3 g kg-1 DMI), but this effect was significant (R2 = 0.06–0.23, P < 0.05) only when there was a large range in PR (exp. 1), whereas with a narrower PR range (exp. 2) the effect was not significant (R2 < 0.04, P > 0.05). Experiment 3 revealed that the influence of PR upon CH4 emission estimates was linear. It is concluded that despite an influence of PR on CH4 emission estimates, accuracy and precision of the tracer technique is warranted provided that PR are used in a narrow range and balanced between the experimental treatments. Key words: Methane, permeation rate, SF6 tracer, cattle, variation

Fumaric acid supplements have no effect on methane emissions per unit of feed intake in wether lambs

Recent reports suggest that supplementing the diet of ruminants with up to 10% fumaric acid (FA) can produce large reductions in methane (CH4) emissions, but the results have been equivocal. This trial evaluates the potential of FA to reduce enteric CH4 emissions from 18-month-old wethers fed lucerne. On two occasions, methane emissions were measured on 20 wethers fed a diet of dried ground lucerne with FA added to the diet at 0, 4, 6, 8 and 10 g FA/100 g dry matter (n = 4 wethers/treatment). Individual daily CH4 emissions were estimated using the sulfur hexafluoride (SF6) tracer gas technique together with measurements of daily dry matter intake (DMI) and total faecal output. Rumen samples were collected twice during the treatment periods in order to evaluate the effect of FA on rumen pH. There was a significant negative regression between FA% in the diet and CH4 emissions/day. However, the addition of FA did not affect CH4 emissions/kg DMI because high levels of FA supplementation reduced DMI. Rumen pH increased linearly with increasing level of FA supplementation. In conclusion, the effect of FA on CH4 emissions in this trial was associated with the resulting reduction in DMI and there were no decreases in CH4 emissions/kg DMI.

Methane emissions from grazing Jersey×Friesian dairy cows in mid lactation

As part of a large quantitative trait loci trial, methane emissions were measured on 698 second and third lactation dairy cows which were the progeny of six bulls. The trial ran over two 4-week periods in January 2004 and 2005. Methane samples were collected over 24 h on each of four consecutive days in 2004 and three consecutive days in 2005. Methane emissions were measured using the sulfur hexafluoride (SF6) tracer dilution technique. During measurement periods, all cows grazed grass–clover pasture with ad libitum herbage allowances. Herbage dry matter intakes (DMI) were calculated using Australian Feeding Standards based on individual cow data of milk yield, liveweight, liveweight change and cow body condition. The average DMI was estimated to be 17.1 kg/day (s.d. = 2.0). Daily methane emissions ranged from 151 to 497 g/day with an average of 311 g/day (s.d. = 43.8) or 18.2 g/kg DMI (s.d. = 2.8); this is 15.7% lower than the figure currently used in the New Zealand national inventory. This study also indicates that there are large differences between cows in methane emissions per kg DMI when estimated using the SF6 tracer technique.