Assessing Displacement of Plastic Interstitial Catheters in Image-Guided Gynecological HDR Brachytherapy

PURPOSE/OBJECTIVE(S)

Interstitial HDR brachytherapy involves precise, localized delivery to targets with high dose gradients, sparing adjacent organs at risk. Due to the proximity of the rectum and bladder to the target, deviations in the catheters with respect to patient anatomy can change dose to those structures. While utilizing plastic interstitial catheters allows the patient to receive hyperthermia therapy during their course of interstitial treatment, the plastic catheters were observed to show significant deflection when the metal stylets are removed for treatment. The hyperthermia electrodes and the HDR source cable are both wires of approximately the same thickness. The purpose of this study is to assess the magnitude and deflection of the plastic catheters for gynecologic interstitial plans and determine whether using flexible wires for visualization on pre-treatment imaging is suitable for reconstructing the actual treatment received.

MATERIALS/METHODS

Pre-treatment CT images where the stylets were utilized for catheter visualization were registered to a subsequent CT scan with the metal stylets removed. The original treatment dwell positions were adjusted to the second CT to evaluate 3D catheter displacement and dose distributions calculated for the bladder, rectum, and target. The plans were subsequently reconstructed on a pre-planning CT with flexible 20-gauge wires instead of metal stylets to determine their suitability as a surrogate for stylets.

RESULTS

Absolute 3D displacement for all patients was 3.5 ± 5.4 mm (n = 3433 catheter dwell positions, mean ± SD, p < 0.001) comparing plans with the stylet in versus out. Absolute catheter deflection for interstitial treatments increased with the removal of the metal stylets with a difference of 0.75 ± 0.49° (n = 313 catheters, mean ± SD, p < 0.01). The plans utilizing flexible wire instead of stylets are observed to correlate with the plans with no stylets with absolute 3D displacement and angular deflection of 1.1 ± 0.6 mm and 0.35° ± 0.3° respectively (n = 39 catheters, mean ± SD, p > 0.2). While the average target EQD2 D90 reduced by 5% ± 5% by planning without the stylets, four patients would have experienced a deviation from the prescription by >10%. There was an overall decrease in bladder D2cc and overall increase in rectal D2cc in the plans with the stylets utilized vs removed. Bladder D2cc, rectal D2cc, and target coverage showed no appreciable difference between utilizing flexible wires and the plans without. The difference in HU between the metal stylets and flexible wires was negligible.

CONCLUSION

Catheter reconstruction in interstitial gynecological treatments with CT imaging revealed significant changes in catheter positioning with respect to the target volume once the stylets are removed for treatment. Using flexible wires of similar thickness to the source cable allow for more accurate tracking during planning without distorting the patient's anatomy or the treatment images, preserving the integrity of the treatment plan.

Trends in International Cancer Research Investment 2006-2018

The International Cancer Research Partnership (ICRP) is an active network of cancer research funding organizations, sharing information about funded research projects in a common database. Data are publicly available to enable the cancer research community to find potential collaborators and avoid duplication. This study presents an aggregated analysis of projects funded by 120 partner organizations and institutes in 2006-2018, to highlight trends in cancer research funding. Overall, the partners’ funding for cancer research increased from $5.562 billion (bn) US dollars (USD) in 2006 to $8.511bn USD in 2018, an above-inflation increase in funding. Analysis by the main research focus of projects using Common Scientific Outline categories showed that Treatment was the largest investment category in 2018, followed by Early Detection, Diagnosis, and Prognosis; Cancer Biology; Etiology; Control, Survivorship, and Outcomes; and Prevention. Over the 13 years covered by this analysis, research funding into Treatment and Early Detection, Diagnosis, and Prognosis had increased in terms of absolute investment and as a proportion of the portfolio. Research funding in Cancer Biology and Etiology declined as a percentage of the portfolio, and funding for Prevention and Control, Survivorship and Outcomes remained static. In terms of cancer site–specific research, funding for breast cancer and colorectal cancer had increased in absolute terms but declined as a percentage of the portfolio. By contrast, investment for brain cancer, lung cancer, leukemia, melanoma, and pancreatic cancer increased both in absolute terms and as a percentage of the portfolio.

Dynamics of PfEMP1 Antibody Profile From Birth to 12 Months of Age in Beninese Infants

BACKGROUND

Plasmodium falciparum-infected erythrocytes bind to specific endothelial cell receptors via members of the PfEMP1 family exported onto the erythrocyte surface. These interactions are mediated by different types of cysteine-rich interdomain region (CIDR) domains found in the N-terminal region of all PfEMP1. CIDRα1 domains bind endothelial protein C receptor (EPCR), CIDRα2-6 domains bind CD36, whereas the receptor specificity of CIDRβ/γ/δ domains is unknown.

METHODS

In this study, we investigated the level of immunoglobulin (Ig)G targeting the different types of PfEMP1 CIDR during the first year of life. We used plasma collected longitudinally from children of pregnant women who had been followed closely through pregnancy.

RESULTS

Antibodies to CIDRα1 domains were more frequent in cord blood compared with antibodies to CIDRα2-6 domains. Higher IgG levels to EPCR-binding CIDRα1 variants positively correlated with the timing of first infections. Antibodies to all PfEMP1 types declined at similar rates to the point of disappearance over the first 6 months of life. At 12 months, children had acquired antibody to all types of CIDR domains, mostly in children with documented P falciparum infections.

CONCLUSIONS

These observations agree with the notion that the timing and phenotype of first P falciparum infections in life are influenced by the immune status of the mother.

Rapid detection and differentiation of mobile colistin resistance (mcr-1 to mcr-10) genes by real-time PCR and melt-curve analysis

BACKGROUND

The emergence of multi-drug-resistant (MDR) micro-organisms prompted new interest in older antibiotics, such as colistin, that had been abandoned previously due to limited efficacy or high toxicity. Over the years, several chromosomal-encoded colistin resistance mechanisms have been described; more recently, 10 plasmid-mediated mobile colistin resistance (mcr) genes have been identified. Spread of these genes among MDR Gram-negative bacteria is a matter of serious concern; therefore, reliable and timely mcr detection is paramount.

AIM

To design and validate a multiplex real-time polymerase chain reaction (PCR) assay for detection and differentiation of mcr genes.

METHODS

All available mcr alleles were downloaded from the National Center for Biotechnology Information Reference Gene Catalogue, aligned with Clustal Omega and primers designed using Primer-BLAST. Real-time PCR monoplexes were optimized and validated using a panel of 120 characterized Gram-negative strains carrying a wide range of resistance genes, often in combination. Melt-curve analysis was used to confirm positive results.

FINDINGS

In-silico analysis enabled the design of a 'screening' assay for detection of mcr-1/2/6, mcr-3, mcr-4, mcr-5, mcr-7, mcr-8 and mcr-9/10, paired with an internal control assay to discount inhibition. A 'supplementary' assay was subsequently designed to differentiate mcr-1, mcr-2, mcr-6, mcr-9 and mcr-10. Expected results were obtained for all strains (100% sensitivity and specificity). Melt-curve analysis showed consistent melting temperature results. Inhibition was not observed.

CONCLUSIONS

The assay is rapid and easy to perform, enabling unequivocal mcr detection and differentiation even when more than one variant is present. Adoption by clinical and veterinary microbiology laboratories would aid the surveillance of mcr genes amongst Gram-negative bacteria.

"There's always something else": Patient perspectives on improving the implementation of obesity guidelines in general practice

OBJECTIVES

The prevalence of obesity in Australia is rising. National guidelines for the management of overweight and obesity exist but our previous work demonstrates poor implementation of key elements in general practice. The aim of this study was to describe patient perspectives on the implementation of obesity guidelines in general practice.

METHODS

Qualitative study of 40 people living with obesity (PwO) who were recruited through general practices in Melbourne, Australia. PwO had a recorded BMI in the overweight range or above (>25), had attended a consultation in the last 6 months and had a diagnosis of at least one of the following: diabetes, kidney disease, hyperlipidemia, hypertension, or cardiovascular disease. Semi-structured telephone interviews were conducted with patients. Interviews were audio-recorded, transcribed verbatim and analysed thematically.

RESULTS

While a strong general practitioner (GP)-patient relationship enabled conversation to occur about weight management there was uncertainty as to whether patients or GPs should broach the topic of weight. Patients described complacency regarding their weight and often being unprepared to take up GP advice. Other health issues were felt to take precedence, and patients described inconsistent provision of information and resources to assist them in tackling their weight problems.

CONCLUSIONS

It is imperative to take into account patient perspectives on obesity management in general practice in order to improve health outcomes. This study provides valuable insights into how PwO can be better managed. Interventions should also include strategies to help patients maintain motivation in making lifestyle changes to support healthy weight loss.

Artificial Synthesis of Conjugated Microporous Polymers via Sonogashira-Hagihara Coupling

Amorphous network materials are becoming increasingly important with applications, for example, as supercapacitors, battery anodes, and proton conduction membranes. The design of these materials is hampered by the amorphous nature of the structure and sensitivity to synthetic conditions. Here, we show that through artificial synthesis, fully mimicking the catalytic formation cycle, and full synthetic conditions, we can generate structural models that can fully describe the physical properties of these amorphous network materials. This opens up pathways for the rational design where complex structural influences, such as the solvent and catalyst choice, can be taken into account.

Major risk factors for sexual minority young people's mental and physical health: findings from a county-wide school-based health needs assessment

BACKGROUND

Childhood health is an important adult health predictor. Sexual orientation is increasingly recognized as influential on children and young people's (CYP) mental and physical health.

METHODS

Data came from a cross-sectional survey of year 9 children attending schools in two local authorities in the north-west of England, including mental and physical health indicators, and demographic characteristics including sexual orientation. The sample of 8058 represented 67.8% of the eligible population. Data were analysed by sexual orientation, sexual majority or sexual minority.

RESULTS

Children reporting their sexual orientation as sexual minority reported worse mental and physical health outcomes and behaviours than sexual majority peers; had higher odds of being lonely (odds ratios (OR) = 8.24, 95% C.I.: 6.56-10.37), having self-harmed (OR = 7.28, 95% C.I.: 5.78-9.15), being bullied (OR = 4.76, 95% C.I.: 3.74-6.05) or perceiving themselves as overweight (OR = 2.40, 95% C.I.: 1.89-3.06).

CONCLUSIONS

It is important to identify and support children in a sexual minority. Research is required to understand differences between children within sexual minorities and the impact on outcomes and rights. Health and social policy and services, should respond to the vulnerabilities of sexual minority CYP.

"Bridging, brokering, and buffering": a theoretical exploration of school leaders' engagement with local school wellness policy implementation

Background

The Healthy, Hunger-Free Kids Act of 2010 (P.L. 111-296) prompted the expansion of federal requirements for local school wellness policies, which aim to improve health promoting practices across school districts in the USA. This qualitative study examined how school district superintendents—as key school leaders who are often listed as the district accountability figure for wellness policies applicable to kindergarten through 12th grade—engaged with wellness policy implementation. The inquiry was guided by evidence-informed implementation and leadership frameworks, including the Consolidated Framework for Implementation Research (CFIR) and “bridging, buffering, and brokering” strategies from education leadership theory.

Methods

We conducted focus groups and interviews with superintendents (n = 39) from 23 states. Interviews were recorded and professionally transcribed; transcripts were team-coded in Atlas.ti v8 using an iteratively revised coding guide that was informed by CFIR, pilot testing, and during weekly analyst meetings. Principles of constant comparative analysis were employed to develop themes.

Results

Most superintendents’ reported positive perspectives and personal motivations to engage with wellness policy implementation. Within the CFIR process domain, superintendents demonstrated adaptive leadership traits and employed a combination of “bridging, buffering, and brokering” strategies to lead implementation activities. Rather than focus on personal traits, an emphasis on specific strategies highlights actions that may be applied.

Conclusions

The findings offer practical strategies to support superintendents with implementation, as well as a formative contribution to the dearth of theoretical frameworks in school wellness literature, particularly by advancing the specific understanding of leadership roles within a broader implementation framework. The application of education theory allowed for a deeper inquiry into the potential ways that leaders’ strategies and engagement influences implementation more broadly.

"90% of the time, it's not just weight": General practitioner and practice staff perspectives regarding the barriers and enablers to obesity guideline implementation

OBJECTIVE

To identify the views of GPs and general practice staff regarding barriers and enablers to implementation of obesity guideline recommendations in general practice.

METHODS

Twenty general practitioners (GPs) and 18 practice staff from inner-eastern Melbourne, Australia, participated in semi-structured telephone interviews. The interview schedule was informed by the Theoretical Domains Framework (TDF). Interviews were audio-recorded, transcribed verbatim and underwent thematic analysis.

RESULTS

Participants lacked familiarity with and knowledge of the NHMRC obesity guidelines. Barriers and enablers were predominantly related to five theoretical domains: (1) environmental context and resources, (2) knowledge, (3) emotion, (4) beliefs about consequences, and (5) motivation and goals. Time pressures in consultations, costs for the patient, reluctance to add to patient burden particularly in those with comorbidities such as mental health issues, lack of awareness about services to refer patients to and GPs' fear of embarrassing patients and losing them were significant barriers. Enablers included having a strong doctor-patient relationship and a sense of responsibility to the patient to address weight.

CONCLUSIONS

Obesity guidelines and policy makers need to better engage with issues of multimorbidity, socioeconomic disadvantage and workforce issues if recommendations are to be widely adopted in general practice. Tasksharing, teamwork and technology are potential solutions to some of the barriers. Patient perspectives and approaches to being able to overcome stigma and legitimise obesity management in primary care consultations could also assist.

Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study

BACKGROUND

Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery.

METHODS

This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy.

RESULTS

Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI.

CONCLUSIONS

After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.

Zoonotic Transfer of Clostridium difficile Harboring Antimicrobial Resistance between Farm Animals and Humans

The emergence of Clostridium difficile as a significant human diarrheal pathogen is associated with the production of highly transmissible spores and the acquisition of antimicrobial resistance genes (ARGs) and virulence factors. Unlike the hospital-associated C. difficile RT027 lineage, the community-associated C. difficile RT078 lineage is isolated from both humans and farm animals; however, the geographical population structure and transmission networks remain unknown. Here, we applied whole-genome phylogenetic analysis of 248 C. difficile RT078 strains from 22 countries. Our results demonstrate limited geographical clustering for C. difficile RT078 and extensive coclustering of human and animal strains, thereby revealing a highly linked intercontinental transmission network between humans and animals. Comparative whole-genome analysis reveals indistinguishable accessory genomes between human and animal strains and a variety of antimicrobial resistance genes in the pangenome of C. difficile RT078. Thus, bidirectional spread of C. difficile RT078 between farm animals and humans may represent an unappreciated route disseminating antimicrobial resistance genes between humans and animals. These results highlight the importance of the "One Health" concept to monitor infectious disease emergence and the dissemination of antimicrobial resistance genes.

Endemic goitre and hypothyroidism in an adult female patient dependent on total parenteral nutrition

We present the case of a thirty-year-old female patient who was referred to the endocrinology team with an enlarging goitre and biochemical hypothyroidism. She had been dependent on total parenteral nutrition for the previous six years as a result of intestinal failure thought to be caused by possible underlying mitochondrial disease. The patient also suffers from a Desmin myopathy, and at present, the exact aetiology behind her intestinal failure is not certain. The goitre was smooth and had been enlarging slowly over the previous few months. Thyroid peroxidase antibodies were found to be within normal range. Further analysis of the case showed that twelve months earlier the patients total parenteral nutrition (TPN) feed had been altered as a result of manganese toxicity. The current feeding regimen did not contain a trace element additive which had previously supplied iodine supplementation. A little detective work established that iodine content to the TPN had been reduced, the trace element additive (Additrace) was recommenced providing 1 µmol of iodine per day, equating to 130 µg of iodine. Following this change, thyroid-stimulating hormone levels returned to normal and the goitre quickly reduced in size. We present a rare case of endemic goitre and hypothyroidism in a patient receiving inadequate iodine supplementation through total parenteral nutrition.

[Primary infection with cytomegalovirus: An infectious cause of splenic infarction]

INTRODUCTION

Cytomegalovirus-associated thrombosis has been extensively reported in the medical literature, mainly in immune-compromised patients. However, the association with splenic infarcts has rarely been reported.

CASE REPORT

We report a 32-year-old Caucasian and immunocompetent woman who presented with a splenic infarction during a primary infection with CMV. The differential diagnostic ruled out embolic, hematologic, gastrointestinal and coagulation disorders. The outcome was favorable with symptomatic treatment.

CONCLUSION

A primary infection with CMV must be added to the diagnostic work-up in the presence of a febrile splenic infarction, especially when it is associated with a biological mononucleosis reaction.

Surveillance of Periodic Fever Syndromes in Canada

BACKGROUND: Periodic fever syndromes (PFS) represent a group of rare, inflammatory disorders, which have their onset in childhood, and are associated with significant lifelong morbidity, and at times, increased mortality. The majority of affected children have recurrent, self-limited inflammatory episodes with unprovoked fever. The severe inflammatory state during an attack causes signs and symptoms in one or more organ systems. The Canadian Pediatric Surveillance Program (CPSP) studies relevant conditions of public health importance that are of such low incidence or prevalence that national ascertainment of cases are needed. Conditions that are studied share a high disability, morbidity and economic costs to society, despite the low frequency. More than 2400 pediatricians including relevant subspecialists, have been enrolled as CPSP participants. This program provides an ideal mechanism for surveillance of PFS in Canada.

OBJECTIVES: To estimate the incidence of periodic fever syndromes in the Canadian paediatric population, to describe the patterns of presentation, and to raise awareness in the medical community.

DESIGN/METHODS: This study was initiated through the Canadian Paediatric Surveillance Program (CPSP), and was carried out over a three year period ending in September 2014. The case definition included patients less than 18 years of age presenting with a newly diagnosed periodic fever syndrome (PFS). Conditions under surveillance included Familial Mediterranean fever (FMF), Tumor necrosis factor receptor-associated periodic syndrome (TRAPS), Hyperimmunoglobulin D syndrome (HIDS), cryopyrin-associated periodic syndromes (CAPS), Periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA), and Undefined periodic fever syndromes. The study protocol outlined established clinical and/or genetic criteria for diagnosis. Participating pediatricians and pediat-ric subspecialists across the country were sent monthly reporting forms. Detailed questionnaires were completed by physicians who report a recent diagnosis. Submissions were screened for accuracy and confirmed cases then entered into a database.

RESULTS: Between September 2011 and August 2014 a total of 221 cases of PFS were reported. Detailed questionnaires were completed on 194 (88%), from which 13 were excluded. Of the 181 confirmed cases, 85 (47%) were PFAPA, 72 (40%) were undefined PFS, 17 (10%) were FMF, and the remaining 6 cases were CAPS, TRAPS, and HIDS. The mean age at diagnosis was 5.5 years (range 12 months – 16 years). On average symptom onset occurred 2.5 years before diagnosis (range 1-4 years). The majority of reporting physicians were rheumatologists (58%), and paediatricians (36%). Cases were identified in all provinces across Canada with the majority (103, 57%) from Ontario. For the 72 undefined PFS cases the reporting physicians described 36% as PFAPA-like, 10% FMF-like, 5% HIDS-like, 3% CAPS-like, and 1% TRAPS-like. Such cases had features of the specified PFS but either did not meet the full criteria, or confirmatory tests were not available at the time of reporting. Among all cases reported in the study, 58% had genetic testing completed as part of their diagnosis. The majority of cases without any genetic testing had been diagnosed as PFAPA.

CONCLUSION: Periodic fever syndromes represent rare forms of autoin-flammatory disease, which affect many Canadian children. This CPSP study identified that the most common PFS diagnosed was PFAPA followed by undefined PFS and FMF. CAPS, HIDS, and TRAPS were rarely diagnosed. Children with PFS were seen by multiple physicians over an average of two to three years before a diagnosis was made. It is hoped that increased awareness of these rare conditions will facilitate earlier diagnosis and the initiation of effective treatments for these children.

Conservative management of midcarpal instability

Midcarpal instability is a complex condition that can present in various forms, from mild pain to debilitating subluxation. Once diagnosed, treatment guidelines for hand therapy are limited by the scarcity of high-level evidence. Evidence does exist for use of proprioceptive awareness and neuromuscular rehabilitation for instability of the knee, shoulder and ankle joint, but studies of similar programmes for the wrist joint have not been published. The purpose of this review is to examine the evidence supporting current concepts in the non-operative management of midcarpal instability, and to provide recommendations for the management of this condition with hand therapy.

Complications of injectable testosterone undecanoate in routine clinical practice

OBJECTIVE

Injectable testosterone undecanoate (TU) was marketed within the last decade, but its complications in routine clinical practice are not well defined.

DESIGN AND METHODS

Prospective observational study of consecutive TU injections in an Andrology Clinic to estimate the incidence of i) immediate cough/syncope due to pulmonary oil microembolisation (POME), ii) post-injection haematoma and iii) the prevalence of secondary polycythaemia.

RESULTS

In 3022 injections given to 347 patients over 3.5 years, POME was observed after 56 injections (66% mild, 19% severe; 40% with onset before injection completed) in 43 patients. The incidence of 19 (95% CI 14-24) per 1000 injections did not differ between three experienced nurse injectors, but recurrences were more frequent than by chance. No post-injection haematoma was reported including after 269 injections to men taking antiplatelet, anticoagulant or both drugs (upper 95% confidence limit 1%) with 56 not withholding drugs prior to TU administration (upper 95% confidence limit 5.4%). Mean haematocrit was 0.44±0.04 (s.d.) with 25 (7%) >0.50, 14 (4%) >0.52 and 3 (1%) >0.54.

CONCLUSION

TU injections produce a low incidence of POME with injections by experienced nurses, but recurrence is more frequent than by chance. Post-injection haematoma was not observed even among men using anticoagulant and/or antiplatelet drugs, and polycythaemia was a minor problem rarely requiring treatment other than optimising inter-injection interval.

Low bone mineral density and fractures in stages 3-5 CKD: an updated systematic review and meta-analysis

SUMMARY

The utility of bone mineral density (BMD) testing in chronic kidney disease (CKD) is not known. We performed a meta-analysis of studies reporting on BMD and fracture in CKD. All but one study was cross-sectional. BMD was lower in those with CKD and fractures compared to those without fractures.

INTRODUCTION

CKD is associated with an increased risk of fracture. The utility of dual energy X-ray absorptiometry (DXA) to assess fracture risk in CKD is unknown.

METHODS

We performed an updated meta-analysis and systematic review of published studies that reported on the association between DXA and fracture (morphometric spine or clinical nonspine) in predialysis and dialysis CKD. We identified 2,894 potential publications, retrieved 292 for detailed review, and included 13. All but one study was cross-sectional and three reported on the ability of DXA to discriminate fracture status in predialysis CKD. Results were pooled using a random effects model and statistical heterogeneity was assessed using the I2 statistic.

RESULTS

BMD was statistically significantly lower at the femoral neck, lumbar spine, the 1/3 and ultradistal radius in subjects with fractures compared to those without regardless of dialysis status. For example, femoral neck BMD was 0.06 g/cm2 lower in dialysis subjects and 0.102 g/cm2 lower in predialysis subjects with fractures compared to those without. Lumbar spine BMD was 0.05 g/cm2 lower in dialysis subjects and 0.108 g/cm2 lower in predialysis subjects with fractures compared to those without. Our meta-analysis was limited to studies with small numbers of subjects and even smaller numbers of fractures. All of the studies were observational and only one was prospective. There was statistical heterogeneity at the lumbar spine, 1/3 and ultradistal radius.

CONCLUSIONS

Our findings suggest that BMD can discriminate fracture status in predialysis and dialysis CKD. Larger, prospective studies are needed.

Empowering farmers for increased resilience in uncertain times

As farmers continue to face increasingly uncertain and often rapidly changing conditions related to markets, climate or the policy environment, people involved in agricultural research, development and extension (RD&E) are also challenged to consider how their work can contribute to supporting farmer resilience. Research from the social sciences conducted in the past decade has focussed on adaptability or adaptive capacity as a key attribute for individuals and groups to possess for managing resilience. It is, therefore, timely to ask the following: do current ways of doing and organising RD&E in the dairy sector in New Zealand and Australia contribute to supporting farm adaptability? This paper reports on results from an examination of case studies of challenges to resilience in the dairy sector in Australia and New Zealand (i.e. dairy farm conversion, climate-change adaptation, consent to farm) and the contribution of dairy RD&E in enhancing resilience of farmers, their farms and the broader industry. Drawing on concepts from resilience studies and considering an empowerment perspective, the analysis of these cases suggest that, currently, agricultural RD&E supports adaptability in general, but varies in the strength of its presence and level of activity in the areas known to enhance adaptability. This analysis is used to generate principles for dairy scientists and others in the RD&E system to consider in (1) research designs, (2) engaging different farmers in research and (3) presenting research results differently. This represents a significant shift for the science and advisory communities to move to methods that acknowledge uncertainty and facilitate learning.

Stakeholder attitudes towards the role and application of informed consent for newborn bloodspot screening: a study protocol

INTRODUCTION

Newborn bloodspot screening (NBS) involves testing a small sample of blood taken from the heel of the newborn for a number of serious and life-limiting conditions. In Canada, newborn screening programmes fall under provincial and territorial jurisdiction with no federal coordination. To date, we know very little about the underlying beliefs around different consent practices or how terminology is interpreted by different individuals. Differences in attitudes may have important healthcare consequences. This study will provide empirical data comparing stakeholder opinions on their understanding of consent-related terminology, the perceived applicability of different consent approaches to newborn screening, and the requirements of these different approaches.

METHODS AND ANALYSIS

Parents, healthcare professionals and policymakers will be recruited in the provinces of Ontario and Newfoundland and Labrador. Parents will be identified through records held by each provincial screening programme. Healthcare professionals will be purposively sampled on the basis of engagement with newborn screening. Within each province we will identify policymakers who have policy analysis or advisory responsibilities relating to NBS. Data collection will be by qualitative interviews. We will conduct 20 interviews with parents of young children, 10 interviews with key healthcare professionals across the range of appropriate specialties and 10 with policymakers at each site (40 per site, total, N=80). The examination of the transcripts will follow a thematic analysis approach. Recruitment started in June 2014 and is expected to be complete by June 2015.

ETHICS AND DISSEMINATION

This study received ethics approval from the Ottawa Health Science Network Research Ethics Board, the Children's Hospital of Eastern Ontario Research Ethics Board (both Ontario), and the Health Research Ethics Authority (Newfoundland and Labrador).

RESULTS

These will be reported in peer-reviewed publications and conference presentations. The results will have specific application to the development of parent education materials for newborn screening.

Abstract P1-10-01: Patient advocate involvement shapes UK’s first national breast cancer tissue bank - The breast cancer campaign tissue bank

The Breast Cancer Campaign Tissue Bank (BCCTB) was initiated in 2010 after the charity Breast Cancer Campaign heard from breast cancer experts that insufficient high quality breast cancer tissue was preventing research which would impact people with breast cancer1. The charity decided to involve patient advocates in the development of the BCCTB from the beginning.

Two advocates reviewed the initial applications to form the BCCTB. These included both single and multi-centre applications so they suggested that, rather than choosing one centre to form the Bank, the charity consider a collaboration of centres. Throughout the development of the BCCTB, the patient advocates asked the ‘elephant in the room’ questions and brought a different perspective. They also helped to design the Bank's processes, including the consent process and asking that all tissue applicants produce a lay summary of their research.

There are now two advocates on the Board which provides strategic direction to the BCCTB. The advocates have equal status to other Board members. There are also three advocates on the Tissue Access Committee which controls the use of tissue in the Bank. Lay summaries of projects have to be approved by all advocates before an application can proceed. This means that no precious tissue is released without the approval of a lay person, who can ensure maximum patient benefit will be achieved from any research. The Bank's data return policy was also driven by the patient advocates who were keen that the tissues donated were used to their maximum benefit. This has resulted in the first publication from BCCTB2

Patient advocates have been involved in promoting the use of tissue from the bank presenting at conferences and at BCCTB road shows. Patient advocates have also been involved in asking potential donors to consent to donate to the tissue bank.

The involvement of patient advocates in the development and oversight of the BCCTB has shown researchers that patient and public involvement works. The advocates can also help promote the Bank and the benefits of tissue donation to both professionals and lay groups.

The patient advocates involved in the Breast Cancer Campaign Tissue Bank are members of the charity Independent Cancer Patients’ Voice

1. Thompson P, Brennan K, Cox A, Gee J, Harcourt D, Harris A, Harvie M, Holen I, Howell A, Nicholson R, Steel M, Streuli C. Evaluation of the current knowledge limitations in breast cancer research: a gap analysis. Breast Cancer Res 2008: 10(2); R26.

2. Speirs V, Morgan A. Investment biobanking – increased returns on tissue samples. Nat Rev Clin Onc 2013; 10:128-129.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-10-01.

Molecular analysis of the muscle protein projectin in Lepidoptera

Striated muscles of both vertebrates and insects contain a third filament composed of the giant proteins, namely kettin and projectin (insects) and titin (vertebrates). All three proteins have been shown to contain several domains implicated in conferring elasticity, in particular a PEVK segment. In this study, the characterization of the projectin protein in the silkmoth, Bombyx mori L. (Lepidoptera: Bombycidae), and the monarch butterfly, Danaus plexippus L. (Lepidoptera: Nymphalidae), as well as a partial characterization in the Carolina sphinx, Manduca sexta L. (Lepidoptera: Sphingidae), are presented. This study showed that, similar to other insects, projectin's overall modular organization was conserved, but in contrast, the PEVK region had a highly divergent sequence. The analysis of alternative splicing in the PEVK region revealed a small number of possible isoforms and the lack of a flight-muscle specific variant, both characteristics being in sharp contrast with findings from other insects. The possible correlation with difference in flight muscle stiffness and physiology between Lepidoptera and other insect orders is discussed.

The relationship between genetic and cytogenetic maps of pea. II. Physical maps of linkage mapping populations

A cytogenetic analysis of inbred lines that have been used to generate genetic maps of pea is presented. Mitotic karyotyping of the inbred lines and meiotic studies of their F1 hybrids have been used to test the prediction that structural differences exist between the parental lines. The results are not compatible with the previously published molecular data. A reordered and updated linkage map of pea is presented that is consistent with the cytogenetic data.

Directional limits on persistent gravitational waves using LIGO S5 science data

The gravitational-wave (GW) sky may include nearby pointlike sources as well as stochastic backgrounds. We perform two directional searches for persistent GWs using data from the LIGO S5 science run: one optimized for pointlike sources and one for arbitrary extended sources. Finding no evidence to support the detection of GWs, we present 90% confidence level (C.L.) upper-limit maps of GW strain power with typical values between 2-20×10(-50)  strain(2) Hz(-1) and 5-35×10(-49)  strain(2) Hz(-1) sr(-1) for pointlike and extended sources, respectively. The latter result is the first of its kind. We also set 90% C.L. limits on the narrow-band root-mean-square GW strain from interesting targets including Sco X-1, SN 1987A and the Galactic center as low as ≈7×10(-25) in the most sensitive frequency range near 160 Hz.