Suillus: an emerging model for the study of ectomycorrhizal ecology and evolution

Research on mycorrhizal symbiosis has been slowed by a lack of established study systems. To address this challenge, we have been developing Suillus, a widespread ecologically and economically relevant fungal genus primarily associated with the plant family Pinaceae, into a model system for studying ectomycorrhizal (ECM) associations. Over the last decade, we have compiled extensive genomic resources, culture libraries, a phenotype database, and protocols for manipulating Suillus fungi with and without their tree partners. Our efforts have already resulted in a large number of publicly available genomes, transcriptomes, and respective annotations, as well as advances in our understanding of mycorrhizal partner specificity and host communication, fungal and plant nutrition, environmental adaptation, soil nutrient cycling, interspecific competition, and biological invasions. Here, we highlight the most significant recent findings enabled by Suillus, present a suite of protocols for working with the genus, and discuss how Suillus is emerging as an important model to elucidate the ecology and evolution of ECM interactions.

Making good on the promise of genomics in healthcare: the NSW Health perspective

NSW Health is implementing genomics as a mainstream component of clinical care. The strategic, holistic approach is considering infrastructure, data governance and management, workforce, education, service planning and delivery. This work is generating insights about how to realise the promise of genomics in healthcare, highlighting the need for strong foundations, real-world application, accessibility and a focus on people using genomic information in clinical care.

Genomic determination of breeding systems and trans-specific evolution of HD MAT genes in suilloid fungi

Studying the signatures of evolution can help to understand genetic processes. Here, we demonstrate how the existence of balancing selection can be used to identify the breeding systems of fungi from genomic data. The breeding systems of fungi are controlled by self-incompatibility loci that determine mating types between potential mating partners, resulting in strong balancing selection at the loci. Within the fungal phylum Basidiomycota, two such self-incompatibility loci, namely HD MAT locus and P/R MAT locus, control mating types of gametes. Loss of function at one or both MAT loci results in different breeding systems and relaxes the MAT locus from balancing selection. By investigating the signatures of balancing selection at MAT loci, one can infer a species' breeding system without culture-based studies. Nevertheless, the extreme sequence divergence among MAT alleles imposes challenges for retrieving full variants from both alleles when using the conventional read-mapping method. Therefore, we employed a combination of read-mapping and local de novo assembly to construct haplotypes of HD MAT alleles from genomes in suilloid fungi (genera Suillus and Rhizopogon). Genealogy and pairwise divergence of HD MAT alleles showed that the origins of mating types predate the split between these two closely related genera. High sequence divergence, trans-specific polymorphism, and the deeply diverging genealogy confirm the long-term functionality and multiallelic status of HD MAT locus in suilloid fungi. This work highlights a genomics approach to studying breeding systems regardless of the culturability of organisms based on the interplay between evolution and genetics.

Density of predating Asian hornets at hives disturbs the 3D flight performance of honey bees and decreases predation success

Automated 3D image-based tracking systems are new and promising devices to investigate the foraging behavior of flying animals with great accuracy and precision. 3D analyses can provide accurate assessments of flight performance in regard to speed, curvature, and hovering. However, there have been few applications of this technology in ecology, particularly for insects. We used this technology to analyze the behavioral interactions between the Western honey bee Apis mellifera and its invasive predator the Asian hornet, Vespa velutina nigrithorax. We investigated whether predation success could be affected by flight speed, flight curvature, and hovering of the Asian hornet and honey bees in front of one beehive. We recorded a total of 603,259 flight trajectories and 5175 predator-prey flight interactions leading to 126 successful predation events, representing 2.4% predation success. Flight speeds of hornets in front of hive entrances were much lower than that of their bee prey; in contrast to hovering capacity, while curvature range overlapped between the two species. There were large differences in speed, curvature, and hovering between the exit and entrance flights of honey bees. Interestingly, we found hornet density affected flight performance of both honey bees and hornets. Higher hornet density led to a decrease in the speed of honey bees leaving the hive, and an increase in the speed of honey bees entering the hive, together with more curved flight trajectories. These effects suggest some predator avoidance behavior by the bees. Higher honey bee flight curvature resulted in lower hornet predation success. Results showed an increase in predation success when hornet number increased up to 8 individuals, above which predation success decreased, likely due to competition among predators. Although based on a single colony, this study reveals interesting outcomes derived from the use of automated 3D tracking to derive accurate measures of individual behavior and behavioral interactions among flying species.

Extra credit for disruption: trend of disruption in radiology academic journals

AIM

To identify the most disruptive publications, which are those that are cited more frequently than their own references, in academic radiology journals and their characteristics, such as the number of authors and relative time to publication.

MATERIAL AND METHODS

A comprehensive literature search was undertaken to identify the 100 most disruptive publications in the field of radiology. Subsequently, statistical analysis was applied to establish the distribution of disruptive scores of the isolated publications using a non-parametric probability density function. The relation between disruptive scores and citation counts was then determined, with the aid of a correlation coefficient. Finally, data regarding any significant connection between disruption scores and time of publication, number of authors, and study design were examined.

RESULTS

Analysing the top 100 papers in increments of 10-year periods showed no significant difference in the distribution of disruption scores over time. No correlation between an article's citation count and disruption score was established. Additionally, no significant relation between the number of authors/study design and disruption scores was identified.

CONCLUSION

The disruption score highlights significant impact elements not entirely accounted for by citation count. Its potential benefit in assessing scientific impact should be contemplated.

Brain-mimicking phantom for biomechanical validation of motion sensitive MR imaging techniques

Motion sensitive MR imaging techniques allow for the non-invasive evaluation of biological tissues by using different excitation schemes, including physiological/intrinsic motions caused by cardiac pulsation or respiration, and vibrations caused by an external actuator. The mechanical biomarkers extracted through these imaging techniques have been shown to hold diagnostic value for various neurological disorders and conditions. Amplified MRI (aMRI), a cardiac gated imaging technique, can help track and quantify low frequency intrinsic motion of the brain. As for high frequency actuation, the mechanical response of brain tissue can be measured by applying external high frequency actuation in combination with a motion sensitive MR imaging sequence called Magnetic Resonance Elastography (MRE). Due to the frequency-dependent behavior of brain mechanics, there is a need to develop brain phantom models that can mimic the broadband mechanical response of the brain in order to validate motion-sensitive MR imaging techniques. Here, we have designed a novel phantom test setup that enables both the low and high frequency responses of a brain-mimicking phantom to be captured, allowing for both aMRI and MRE imaging techniques to be applied on the same phantom model. This setup combines two different vibration sources: a pneumatic actuator, for low frequency/intrinsic motion (1 Hz) for use in aMRI, and a piezoelectric actuator for high frequency actuation (30-60 Hz) for use in MRE. Our results show that in MRE experiments performed from 30 Hz through 60 Hz, propagating shear waves attenuate faster at higher driving frequencies, consistent with results in the literature. Furthermore, actuator coupling has a substantial effect on wave amplitude, with weaker coupling causing lower amplitude wave field images, specifically shown in the top-surface shear loading configuration. For intrinsic actuation, our results indicate that aMRI linearly amplifies motion up to at least an amplification factor of 9 for instances of both visible and sub-voxel motion, validated by varying power levels of pneumatic actuation (40%-80% power) under MR, and through video analysis outside the MRI scanner room. While this investigation used a homogeneous brain-mimicking phantom, our setup can be used to study the mechanics of non-homogeneous phantom configurations with bio-interfaces in the future.

Emergency endovascular stent-graft repair of a traumatic ruptured renal artery aneurysm: A case report

To describe the endovascular treatment of a traumatic rupture of a renal artery aneurysm (RAA) in an unstable patient using a stent-graft. A 49-year-old patient presented following trauma to her right chest and flank. The patient was unstable on arrival and following resuscitation, contrast CT angiogram identified a rupture of a left RAA. To occlude the aneurysm, a graft-stent was placed successfully to arrest the haemorrhage. In this case of ruptured RAA, an endovascular approach allowed rapid control of bleeding and preservation of the kidney function, whilst avoiding open surgery and possible nephrectomy.

Diminishing returns drive altruists to help extended family

Altruism between close relatives can be easily explained. However, paradoxes arise when organisms divert altruism towards more distantly related recipients. In some social insects, workers drift extensively between colonies and help raise less related foreign brood, seemingly reducing inclusive fitness. Since being highlighted by W. D. Hamilton, three hypotheses (bet hedging, indirect reciprocity and diminishing returns to cooperation) have been proposed for this surprising behaviour. Here, using inclusive fitness theory, we show that bet hedging and indirect reciprocity could only drive cooperative drifting under improbable conditions. However, diminishing returns to cooperation create a simple context in which sharing workers is adaptive. Using a longitudinal dataset comprising over a quarter of a million nest cell observations, we quantify cooperative payoffs in the Neotropical wasp Polistes canadensis, for which drifting occurs at high levels. As the worker-to-brood ratio rises in a worker's home colony, the predicted marginal benefit of a worker for expected colony productivity diminishes. Helping related colonies can allow effort to be focused on related brood that are more in need of care. Finally, we use simulations to show that cooperative drifting evolves under diminishing returns when dispersal is local, allowing altruists to focus their efforts on related recipients. Our results indicate the power of nonlinear fitness effects to shape social organization, and suggest that models of eusocial evolution should be extended to include neglected social interactions within colony networks.

Association of chain of survival factors with out of hospital cardiac arrest survival in a region with low average population-density: a retrospective population-based cohort study

Background

Out of hospital cardiac arrest (OHCA) has an average global survival rate to discharge of 8%. Chain of survival factors are heavily time-dependant and optimization can increase survival. Regions with low population density encounter challeges in providing optimal OHCA care. Nova Scotia's average population density is 17.4 persons per square kilometer in compasiron to Toronto with 4334.4 person per square kilometer. OHCAs have been described well in large urban centers globally, however the characterization of OHCA chain of survival in low density populations is sparse.

Purpose

To describe chain of survival factors and identify characteristics of survivors and non-survivors among those treated by paramedics in a low average density provincial population.

Methods

This was a retrospective cohort study of OHCAs responded to by paramedics. All OHCA responses with a cardiac etiology in Nova Scotia, Canada were included. Exclusion criteria were non-cardiac cause arrests, those with “do not resuscitate” (DNR) directives and expected deaths. The paramedic electronic patient care record was reviewed for demographic, bystander, out of hospital treatment and operational characteristics. Primary outcome was survival to hospital discharge. Descriptive statistics were calculated to describe differences between survivorship using Prism 8.0 (San Diego, CA) with alpha=0.05 applying unpaired, Mann-Whitney tests.

Results

Of 1517 OHCA, 463 were excluded leaving 1054 OHCA. Of these, 478 (45.3%) were treated by paramedics and included in this analysis. Most were men (67.2%; n=274) with a mean age 66.8 (±16.4). A total of 7.1% (n=75) survived to discharge with 76% of survivors (n=58) discharged home. Survivors were more likely to present with ventricular fibrillation than non-survivors (42.7% vs. 19.6%). Survivors compared to non-survivors had significantly shorter paramedic response time (8.1 vs. 10.7 min, P<0.001), paramedic time on scene (35.7 vs. 45.4 min, P=0.002), estimated time to paramedic defibrillation (13.2 vs 19.4 min, P<0.001), and estimated time to return of spontaneous circulation (ROSC) (22.9 vs 31.9min, P<0.001).

Conclusion

Links in the chain of survival are associated with survival from OHCA. OHCA survival is lower in the less densely populated province of Nova Scotia compared to studies in urban Canadian centers and worldwide. Our study is limited by the retrospective nature of data collection and lack of access to neurological outcomes. Even among survivors, EMS response is delayed compared to more densely populated centers. In Nova Scotia, longer paramedic response times are associated with decreased survival.

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): Maritime Heart Center

Sibling quality and the haplodiploidy hypothesis

The 'haplodiploidy hypothesis' argues that haplodiploid inheritance in bees, wasps, and ants generates relatedness asymmetries that promote the evolution of altruism by females, who are less related to their offspring than to their sisters ('supersister' relatedness). However, a consensus holds that relatedness asymmetry can only drive the evolution of eusociality if workers can direct their help preferentially to sisters over brothers, either through sex-ratio biases or a pre-existing ability to discriminate sexes among the brood. We show via a kin selection model that a simple feature of insect biology can promote the origin of workers in haplodiploids without requiring either condition. In insects in which females must found and provision new nests, body quality may have a stronger influence on female fitness than on male fitness. If altruism boosts the quality of all larval siblings, sisters may, therefore, benefit more than brothers from receiving the same amount of help. Accordingly, the benefits of altruism would fall disproportionately on supersisters in haplodiploids. Haplodiploid females should be more prone to altruism than diplodiploid females or males of either ploidy when altruism elevates female fitness especially, and even when altruists are blind to sibling sex.

Functional convergence in the decomposition of fungal necromass in soil and wood

Understanding the post-senescent fate of fungal mycelium is critical to accurately quantifying forest carbon and nutrient cycling, but how this organic matter source decomposes in wood remains poorly studied. In this study, we compared the decomposition of dead fungal biomass (a.k.a. necromass) of two species, Mortierella elongata and Meliniomyces bicolor, in paired wood and soil plots in a boreal forest in northern Minnesota, USA. Mass loss was quantified at four time points over an 8-week incubation and the richness and composition of the fungal communities colonizing fungal necromass were characterized using high-throughput sequencing. We found that the structure of fungal decomposer communities in wood and soil differed, but, in both habitats, there was relatively rapid decay (∼30% remaining after 56 days). Mass loss was significantly faster in soil and for high-quality (i.e. high nitrogen and low melanin) fungal necromass. In both habitats, there was a clear trajectory of early colonization by opportunistic fungal taxa followed by colonization of fungi with greater enzymatic capacities to degrade more recalcitrant compounds, including white-rot and ectomycorrhizal fungi. Collectively, our results indicate that patterns emerging regarding substrate quality effects on fungal necromass decomposition in soil and leaf litter can be largely extended to fungal necromass decomposition in wood.

Fungal functional ecology: bringing a trait-based approach to plant-associated fungi

Fungi play many essential roles in ecosystems. They facilitate plant access to nutrients and water, serve as decay agents that cycle carbon and nutrients through the soil, water and atmosphere, and are major regulators of macro-organismal populations. Although technological advances are improving the detection and identification of fungi, there still exist key gaps in our ecological knowledge of this kingdom, especially related to function. Trait-based approaches have been instrumental in strengthening our understanding of plant functional ecology and, as such, provide excellent models for deepening our understanding of fungal functional ecology in ways that complement insights gained from traditional and -omics-based techniques. In this review, we synthesize current knowledge of fungal functional ecology, taxonomy and systematics and introduce a novel database of fungal functional traits (Fun^Fun ). Fun^Fun is built to interface with other databases to explore and predict how fungal functional diversity varies by taxonomy, guild, and other evolutionary or ecological grouping variables. To highlight how a quantitative trait-based approach can provide new insights, we describe multiple targeted examples and end by suggesting next steps in the rapidly growing field of fungal functional ecology.

Optimising computerised decision support to transform medication safety and reduce prescriber burden: study protocol for a mixed-methods evaluation of drug-drug interaction alerts

INTRODUCTION

Drug-drug interaction (DDI) alerts in hospital electronic medication management (EMM) systems are generated at the point of prescribing to warn doctors about potential interactions in their patients' medication orders. This project aims to determine the impact of DDI alerts on DDI rates and on patient harm in the inpatient setting. It also aims to identify barriers and facilitators to optimal use of alerts, quantify the alert burden posed to prescribers with implementation of DDI alerts and to develop algorithms to improve the specificity of DDI alerting systems.

METHODS AND ANALYSIS

A controlled pre-post design will be used. Study sites include six major referral hospitals in two Australian states, New South Wales and Queensland. Three hospitals will act as control sites and will implement an EMM system without DDI alerts, and three as intervention sites with DDI alerts. The medical records of 280 patients admitted in the 6 months prior to and 6 months following implementation of the EMM system at each site (total 3360 patients) will be retrospectively reviewed by study pharmacists to identify potential DDIs, clinically relevant DDIs and associated patient harm. To identify barriers and facilitators to optimal use of alerts, 10-15 doctors working at each intervention hospital will take part in observations and interviews. Non-identifiable DDI alert data will be extracted from EMM systems 6-12 months after system implementation in order to quantify alert burden on prescribers. Finally, data collected from chart review and EMM systems will be linked with clinically relevant DDIs to inform the development of algorithms to trigger only clinically relevant DDI alerts in EMM systems.

ETHICS AND DISSEMINATION

This research was approved by the Hunter New England Human Research Ethics Committee (18/02/21/4.07). Study results will be published in peer-reviewed journals and presented at local and international conferences and workshops.

Plant-mediated partner discrimination in ectomycorrhizal mutualisms

Although ectomycorrhizal fungi have well-recognized effects on ecological processes ranging from plant community dynamics to carbon cycling rates, it is unclear if plants are able to actively influence the structure of these fungal communities. To address this knowledge gap, we performed two complementary experiments to determine (1) whether ectomycorrhizal plants can discriminate among potential fungal partners, and (2) to what extent the plants might reward better mutualists. In experiment 1, split-root Larix occidentalis seedlings were inoculated with spores from three Suillus species (S. clintonianus, S. grisellus, and S. spectabilis). In experiment 2, we manipulated the symbiotic quality of Suillus brevipes isolates on split-root Pinus muricata seedlings by changing the nitrogen resources available, and used carbon-13 labeling to track host investment in fungi. In experiment 1, we found that hosts can discriminate in multi-species settings. The split-root seedlings inhibited colonization by S. spectabilis whenever another fungus was available, despite similar benefits from all three fungi. In experiment 2, we found that roots and fungi with greater nitrogen supplies received more plant carbon. Our results suggest that plants may be able to regulate this symbiosis at a relatively fine scale, and that this regulation can be integrated across spatially separated portions of a root system.

The UNITE database for molecular identification of fungi: handling dark taxa and parallel taxonomic classifications

UNITE (https://unite.ut.ee/) is a web-based database and sequence management environment for the molecular identification of fungi. It targets the formal fungal barcode-the nuclear ribosomal internal transcribed spacer (ITS) region-and offers all ∼1 000 000 public fungal ITS sequences for reference. These are clustered into ∼459 000 species hypotheses and assigned digital object identifiers (DOIs) to promote unambiguous reference across studies. In-house and web-based third-party sequence curation and annotation have resulted in more than 275 000 improvements to the data over the past 15 years. UNITE serves as a data provider for a range of metabarcoding software pipelines and regularly exchanges data with all major fungal sequence databases and other community resources. Recent improvements include redesigned handling of unclassifiable species hypotheses, integration with the taxonomic backbone of the Global Biodiversity Information Facility, and support for an unlimited number of parallel taxonomic classification systems.

Evaluation of training on palliative care for staff working within a homeless hostel

BACKGROUND

In the UK, many people experiencing homelessness whose health is deteriorating remain in homeless hostels due to few suitable alternative places of care. Hostel staff struggle to support residents with deteriorating health and palliative care services are rarely involved. There is recognition of the need for multiagency working to support this group.

OBJECTIVES

To pilot and evaluate the impact of a two-day training course for hostel staff around supporting clients with palliative care needs, and increasing multiagency working.

DESIGN

Mixed methods evaluation using pre-and-post training data collection.

SETTINGS AND PARTICIPANTS

Frontline staff from two London homeless hostels.

METHODS

Staff from two hostels attended a two day training course. Self-perceived confidence in supporting residents with deteriorating health, knowledge of palliative care, openness to discussing deteriorating health and work related stress were assessed at baseline and immediately after training using a novel questionnaire. Qualitative data was collected via focus groups immediately after and three months post-training.

RESULTS

Twenty four participants attended at least one day of training, 21 (87%) completed the course. Training was reported to be useful and relevant. Modest improvements in self-perceived work related stress, knowledge, confidence and openness were observed following training. At three months, qualitative data indicated the beginnings of a shift in how palliative care was conceptualised and an increase in knowledge and confidence around supporting residents. Anxiety regarding the role of the hostel in palliative care, the recovery focused ethos of homelessness services and fragmented systems and services presented challenges to establishing changes.

CONCLUSIONS

Training can be useful for improving knowledge, confidence, openness and work related stress. Recommendations for implementing changes in how people experiencing homelessness are supported include embedding training into routine practice, promoting multidisciplinary working, incorporating flexibility within the recovery focused approach of services and recognising the need for emotional support for staff.

25 Evidence based training for hostel staff around supporting homeless people with deteriorating health

Introduction

Many people experiencing homelessness remain in homeless hostels as their health deteriorates due to lack of alternative places of care (Shulman et al. 2017). Palliative care services are rarely involved and hostel staff face significant emotional and practical difficulties (Hudson et al. 2017). We developed evidence-based training for hostel staff around supporting residents with deteriorating health.

Aims

To pilot and evaluate the impact of training.

Methods

Mixed methods pre-and-post training evaluation. Knowledge of palliative care confidence in and openness to supporting residents with deteriorating health and work-related stress were assessed at baseline and immediately post-training using a novel questionnaire. Following training group discussions were facilitated and participants identified team goals for implementation. Additional focus groups were held after three months.

Results

All staff from two hostels attended 87% completed the course (n=21). Modest improvements in knowledge confidence openness and work-related stress were observed. Participants particularly valued the inclusion of strategies for identifying and addressing their emotional needs. At three months team goals were partially met. Identification and recognition of palliative care needs had improved. However the recovery focused ethos of hostels and significant staff turnover limited change. Systems designed to monitor ‘recovery’ did not accommodate or encourage a person-centred approach for people with deteriorating health.

Conclusions

Training in isolation is not enough for system change. Recommendations include embedding ongoing training into routine practice identifying champions to promote multidisciplinary working and incorporating flexibility in outcome measures to reflect complexity in person-centred care including where recovery may not be realistic.

References

. Hudson BF, Shulman C, Low J, Hewett N, Daley J, Davis S, Brophy N, Howard D, Vivat B, Kennedy P, Stone P. Challenges to discussing palliative care with people who are homeless: A qualitative study. BMJ Open2017;7:e017502. doi:10.1136/bmjopen-2017-017502

. Shulman C, Hudson BF, Low J, Hewett N, Daley J, Kennedy P, et al. Homelessness at the end of life: A qualitative analysis of the barriers in providing palliative care for people who are homeless. Palliative Medicine2017. https://doi.org/10.1177/0269216317717101

Abstract P2-09-09: Polyligand profiling differentiates cancer patients according to their benefit of treatment

Introduction: Deconvolution of multi-nodal perturbations in cancer network architecture demands highly multiplexed profiling assays. We demonstrate the value of polyligand profiling of tumor systems states using libraries of single stranded oligodeoxynucleotides (ssODN) to distinguish between tumor tissue from breast cancer patients who did or did not derive benefit from treatment regimens containing trastuzumab.

Methods: This study included cases from women with invasive breast cancer who received chemotherapy+ trastuzumab (C+T) or trastuzumab monotherapy with available retrospective data on the time to next treatment (TTNT). A library of 2x1012 unique ssODN was exposed to FFPE tissues from patients who benefited (B) or not (NB) from trastuzumab-based regimens in several rounds of positive and negative selection. Two enriched libraries were screened on independent set of 42 B and 19 NB cases using a modified IHC protocol for detection of bound ssODNs. Poly-Ligand Profiles (PLP) were scored by a blinded pathologist. Two libraries, EL-NB and EL-B, showed significant p-values between groups of responders and non-responders. A Cox-PH model was fitted using either tumors' HER2 status or PLP test results as the independent variable. Median survival time was calculated from the Kaplan-Meier estimate. A separate group of 63 cases with TTNT data from chemotherapy without trastuzumab was used as a control to distinguish prognostic from predictive performance.

Results: The PLP scores of EL-NB and EL-B were assessed by receiver operating characteristic (ROC) curves and resulted in a combined AUC value of 0.81. EL-NB and EL-B were able to effectively classify B and NB patients with either HER2-negative/equivocal (AUC = 0.73) or HER2-positive cancers (AUC = 0.84). In contrast, HER2 status alone yielded an AUC value of 0.47. The combined PLP scores for the independent set of 63 patients treated with C excluding trastuzumab resulted in an AUC value of 0.53, indicating that the assay was predictive and not simply prognostic. Kaplan-Meier curves analysis shows that PLP+ cases have 429 days median TTNT, while PLP- cases have 129 days (HR = 0.38, log-rank p = 0.001). Analysis based on HER2 status showed no significant difference in TTNT between patients that were HER2+ (280 days) or HER2-negative/equivocal (336 days, HR = 1.27, log-rank p =0.45).

Summary: Performance of the PLP assay in differentiating patients who did or did not benefit from trastuzumab therapy outperforms the standard IHC assay for HER2 status. These results represent a promising step towards the development of a CDx to identify the 50-70% of HER2+ patients who will not benefit from trastuzumab. In addition, PLP also has the potential to identify the HER2-negative/equivocal patients who may benefit from trastuzumab-containing regimens.

Citation Format: Domenyuk V, Gatalica Z, Santhanam R, Wei X, Stark A, Kennedy P, Toussaint B, Levenberg S, Wang R, Xiao N, Greil R, Rinnerthaler G, Gampenrieder S, Heimberger AB, Berry DJ, Barker A, Demetri GD, Quackenbush J, Marshall JL, Poste G, Vacirca JL, Vidal GA, Schwartzberg LS, Halbert DD, Voss A, Miglarese MR, Famulok M, Mayer G, Spetzler D. Polyligand profiling differentiates cancer patients according to their benefit of treatment [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-09-09.

Host preference and network properties in biotrophic plant-fungal associations

Analytical methods can offer insights into the structure of biological networks, but mechanisms that determine the structure of these networks remain unclear. We conducted a synthesis based on 111 previously published datasets to assess a range of ecological and evolutionary mechanisms that may influence the plant-associated fungal interaction networks. We calculated the relative host effect on fungal community composition and compared nestedness and modularity among different mycorrhizal types and endophytic fungal guilds. We also assessed how plant-fungal network structure was related to host phylogeny, environmental and sampling properties. Orchid mycorrhizal fungal communities responded most strongly to host identity, but the effect of host was similar among all other fungal guilds. Community nestedness, which did not differ among fungal guilds, declined significantly with increasing mean annual precipitation on a global scale. Orchid and ericoid mycorrhizal fungal communities were more modular than ectomycorrhizal and root endophytic communities, with arbuscular mycorrhizal fungi in an intermediate position. Network properties among a broad suite of plant-associated fungi were largely comparable and generally unrelated to phylogenetic distance among hosts. Instead, network metrics were predominantly affected by sampling and matrix properties, indicating the importance of study design in properly inferring ecological patterns.

What does ‘responsible medical officer’ mean in a modern mental health service?

Dean (2001) found conflicting views among consultant psychiatrists about ‘what is actually meant by having responsible medical officer (RMO) status'. Many clearly feel that they are responsible for virtually all patients referred to secondary care: Tyrer et al (2001) found in a large audit many consultants with big personal case-loads of 200–300 patients. They concluded that the statutory duties of a RMO needed to be revised to avoid consultants merely becoming bureaucratic administrators of their case-load’.

Research in the real world

A new approach to research and development (R&D) for mental health services is developing in the North-East, Yorkshire and Humber. It derives from experience with service redesign using the ‘collaborative’ approach developed by the US Institute for Health Improvement. Kennedy & Griffiths (2003) described such an approach involving 37 mental health trusts, each with a multidisciplinary team, with the aim of improving acute in-patient wards. After studying the patient's journey through care they agreed a set of improvement targets that all teams would work to achieve. Progress towards targets was measured and reported by all teams, who met periodically to compare performance and learn from each other. Remarkable energy to achieve objectives was released among front-line staff involved. Focus was sustained on what most concerned and benefited patients. Good ideas and results quickly spread to all these services affecting thousands of patients.

Mental health ‘collaborative’ challenges care culture

The ‘collaborative’ method, developed by the US Institute of Health Improvement, has succeeded in motivating staff and responding to patients' concerns about acute in-patient psychiatric care across 37 trusts in the Northern, Yorkshire and Trent regions. The method puts into practice the new values underpinning government policies on ‘modernising’ and ‘shifting the balance of power’ in the NHS, i.e. seeing things through the eyes of patients, empowerment of frontline staff, learning networks and focus on measured outcomes. The evaluation suggests that organisational and management culture crucially determined the level of achievement of the trusts taking part in the collaborative. Evaluations of other collaboratives have raised doubts about the sustainability of the improvements achieved. It is argued that refining the collaborative method is less important than incorporating its principles into the existing management and organisational cultures of NHS trusts, and the leadership styles of chief executives and clinical directors.

Kerr/Haslam Inquiry into sexual abuse of patients by psychiatrists

Nearly 1000 pages of the Kerr/Haslam Inquiry report published in July 2005 tell in detail how, over a period of more than two decades, according to many female patients, two male psychiatrists working from the same hospital were able to sexually abuse them. By the time police investigations and the Inquiry were complete, a total of 67 patients had declared themselves victims of William Kerr and at least 10 of Michael Haslam. Kerr was convicted in 2000 on one count of indecent assault. He was considered too ill to face trial but was convicted on trial of the facts. Haslam was convicted on four counts of indecent assault in 2003 and was given a 3-year prison sentence.

End-of-life care for homeless people: A qualitative analysis exploring the challenges to access and provision of palliative care

BACKGROUND

Being homeless or vulnerably housed is associated with death at a young age, frequently related to medical problems complicated by drug or alcohol dependence. Homeless people experience high symptom burden at the end of life, yet palliative care service use is limited.

AIM

To explore the views and experiences of current and formerly homeless people, frontline homelessness staff (from hostels, day centres and outreach teams) and health- and social-care providers, regarding challenges to supporting homeless people with advanced ill health, and to make suggestions for improving care.

DESIGN

Thematic analysis of data collected using focus groups and interviews.

PARTICIPANTS

Single homeless people ( n = 28), formerly homeless people ( n = 10), health- and social-care providers ( n = 48), hostel staff ( n = 30) and outreach staff ( n = 10).

RESULTS

This research documents growing concern that many homeless people are dying in unsupported, unacceptable situations. It highlights the complexities of identifying who is palliative and lack of appropriate places of care for people who are homeless with high support needs, particularly in combination with substance misuse issues.

CONCLUSION

Due to the lack of alternatives, homeless people with advanced ill health often remain in hostels. Conflict between the recovery-focused nature of many services and the realities of health and illness for often young homeless people result in a lack of person-centred care. Greater multidisciplinary working, extended in-reach into hostels from health and social services and training for all professional groups along with more access to appropriate supported accommodation are required to improve care for homeless people with advanced ill health.

Challenges to discussing palliative care with people experiencing homelessness: a qualitative study

OBJECTIVES

To explore the views and experiences of people who are homeless and those supporting them regarding conversations and approaches to palliative care SETTING: Data were collected between October 2015 and October 2016 in homeless hostels and day centres and with staff from primary and secondary healthcare providers and social care services from three London boroughs.

PARTICIPANTS

People experiencing homelessness (n=28), formerly homeless people (n=10), health and social care providers (n=48), hostel staff (n=30) and outreach staff (n=10). METHODS: In this qualitative descriptive study, participants were recruited to interviews and focus groups across three London boroughs. Views and experiences of end-of-life care were explored with people with personal experience of homelessness, health and social care professionals and hostel and outreach staff. Saturation was reached when no new themes emerged from discussions.

RESULTS

28 focus groups and 10 individual interviews were conducted. Participants highlighted that conversations exploring future care preferences and palliative care with people experiencing homelessness are rare. Themes identified as challenges to such conversations included attitudes to death; the recovery focused nature of services for people experiencing homelessness; uncertainty regarding prognosis and place of care; and fear of negative impact.

CONCLUSIONS

This research highlights the need for a different approach to supporting people who are homeless and are experiencing advanced ill health, one that incorporates uncertainty and promotes well-being, dignity and choice. We propose parallel planning and mapping as a way of working with uncertainty. We acknowledge that these approaches will not always be straightforward, nor will they be suitable for everyone, yet moving the focus of conversations about the future away from death and dying, towards the present and the future may facilitate conversations and enable the wishes of people who are homeless to be known and explored.

Finite element analysis to investigate variability of MR elastography in the human thigh

PURPOSE

To develop finite element analysis (FEA) of magnetic resonance elastography (MRE) in the human thigh and investigate inter-individual variability of measurement of muscle mechanical properties.

METHODS

Segmentation was performed on MRI datasets of the human thigh from 5 individuals and FEA models consisting of 12 muscles and surrounding tissue created. The same material properties were applied to each tissue type and a previously developed transient FEA method of simulating MRE using Abaqus was performed at 4 frequencies. Synthetic noise was applied to the simulated data at various levels before inversion was performed using the Elastography Software Pipeline. Maps of material properties were created and visually assessed to determine key features. The coefficient of variation (CoV) was used to assess the variability of measurements in each individual muscle and in the groups of muscles across the subjects. Mean measurements for the set of muscles were ranked in size order and compared with the expected ranking.

RESULTS

At noise levels of 2% the CoV in measurements of |G^*| ranged from 5.3 to 21.9% and from 7.1 to 36.1% for measurements of ϕ in the individual muscles. A positive correlation (R² value 0.80) was attained when the expected and measured |G^*| ranking were compared, whilst a negative correlation (R² value 0.43) was found for ϕ.

CONCLUSIONS

Created elastograms demonstrated good definition of muscle structure and were robust to noise. Variability of measurements across the 5 subjects was dramatically lower for |G^*| than it was for ϕ. This large variability in ϕ measurements was attributed to artefacts.

ABC chromogenic agar: a cost-effective alternative to standard enteric media for Salmonella spp. isolation from routine stool samples

Salmonellosis is the second most common cause of bacterial gastroenteritis, yet the yield from routine stool culture is low. Commonly used selective enteric media have poor specificities for salmonella identification, resulting in a high laboratory workload. A special chromogenic medium, ABC agar, is a promising alternative but its cost-effectiveness has not been evaluated in diagnostic laboratories. A collaborative study is therefore undertaken in two district general hospitals laboratories. Routine stool samples (n=866) were subcultured onto ABC agar half plates after selective enrichment in selenite broth. Similarly, 246 and 620 stool samples were subcultured onto desoxycholate lactose sucrose (DCLS) and xylose lactose desoxycholate (XLD) whole agar plates, respectively. Salmonella spp. were isolated from only 14 (1.6%) of stool samples tested. Specificity was significantly higher for ABC (98%) than DCLS (67%) or XLD (78%) agars. Welcan workload units (ABC 4.8, XLD and DCLS both 7.3) and costs per specimen (ABC 1.26 pounds sterling, DCLS 3.81 pounds sterling and XLD 1.83 pounds sterling) were similarly lower with ABC agar. The results indicate that ABC chromogenic agar offers improvements in specificity, workload and costs over conventional enteric media for Salmonella spp. isolation.

Stepped-wedge cluster randomised controlled trial to assess the effectiveness of an electronic medication management system to reduce medication errors, adverse drug events and average length of stay at two paediatric hospitals: a study protocol

INTRODUCTION

Medication errors are the most frequent cause of preventable harm in hospitals. Medication management in paediatric patients is particularly complex and consequently potential for harms are greater than in adults. Electronic medication management (eMM) systems are heralded as a highly effective intervention to reduce adverse drug events (ADEs), yet internationally evidence of their effectiveness in paediatric populations is limited. This study will assess the effectiveness of an eMM system to reduce medication errors, ADEs and length of stay (LOS). The study will also investigate system impact on clinical work processes.

METHODS AND ANALYSIS

A stepped-wedge cluster randomised controlled trial (SWCRCT) will measure changes pre-eMM and post-eMM system implementation in prescribing and medication administration error (MAE) rates, potential and actual ADEs, and average LOS. In stage 1, 8 wards within the first paediatric hospital will be randomised to receive the eMM system 1 week apart. In stage 2, the second paediatric hospital will randomise implementation of a modified eMM and outcomes will be assessed. Prescribing errors will be identified through record reviews, and MAEs through direct observation of nurses and record reviews. Actual and potential severity will be assigned. Outcomes will be assessed at the patient-level using mixed models, taking into account correlation of admissions within wards and multiple admissions for the same patient, with adjustment for potential confounders. Interviews and direct observation of clinicians will investigate the effects of the system on workflow. Data from site 1 will be used to develop improvements in the eMM and implemented at site 2, where the SWCRCT design will be repeated (stage 2).

ETHICS AND DISSEMINATION

The research has been approved by the Human Research Ethics Committee of the Sydney Children's Hospitals Network and Macquarie University. Results will be reported through academic journals and seminar and conference presentations.

TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trials Registry (ANZCTR) 370325.

Numerical Analysis of Microcellular Injection Molding

This study presents a simulation model for the microcellular injection molding process in which supercritical fluid such as carbon dioxide or nitrogen is mixed with molten polymer and injected into the mold. Our model simulates the development of cells in the melt during injection molding. The effects of cell growth on material properties and flow have been investigated. Some simulation results such as melt pressure and final cell size distribution are compared with experimental results.

An audit of demographics and rehabilitation outcomes in non-traumatic spinal cord injury

STUDY DESIGN

Repeated measures, retrospective cohort study.

OBJECTIVES

To classify specific causes of injury in a cohort of non-traumatic spinal cord injury (NTSCI) patients, with the aim of exploring whether there are differences in demographics or rehabilitation outcomes depending on the cause of NTSCI.

SETTING

Tertiary care, spinal cord injury rehabilitation unit.

METHODS

Patients admitted to the unit with a non-traumatic SCI between July 2008 and April 2015 were considered for this study. Demographic information and rehabilitation outcomes were obtained from the Needs Assessment Checklist (NAC). NAC1 is completed within 4 weeks post mobilisation and NAC2 upon the patient moving to the pre-discharge ward. Data were obtained for 265 patients.

RESULTS

The most common causes were vertebral column degenerative disorders, infection and vascular disorders, which together accounted for 80% of all NTSCI in this sample. Patients with vertebral column degenerative disorders were less likely to have a complete injury than patients with infections or vascular disorders. There were differences in rehabilitation outcomes on several domains of the NAC. Overall, patients with an SCI caused by an infection have the highest needs (more dependent), and patients with vertebral column degenerative disorders have the lowest needs (more independent).

CONCLUSION

The relationship between non-traumatic cause of injury and rehabilitation outcomes may be mediated by severity of injury. Individuals with infection-related NTSCI are more likely to be complete, therefore, present more significant rehab needs, and lower rehabilitation outcomes particularly in physical health, activities of daily living and bowel management domains. This supports previous findings of Kay et al. and provides a possible explanation for the differences. This further informs future interventions.

Potential cutaneous hypersensitivity reaction to an inactive ingredient of thyroid hormone supplements in a dog

BACKGROUND

Although discussions about allergic reactions to thyroid supplements abound on professional forums, there is almost no information in the literature on these specific idiosyncratic drug reactions.

ANIMAL

A dog with a history of hypothyroidism-associated weight gain and mild lethargy was prescribed levothyroxine tablets (0.018 mg/kg twice daily). After 19 days the dog developed a severe skin condition that was responsive to levothyroxine withdrawal, and antibiotic and glucocorticoid therapy. Three weeks later a different levothyroxine tablet was prescribed. Within 48 h the dog developed a more severe cutaneous reaction that resolved with drug discontinuation and appropriate topical care.

OBJECTIVES

To confirm a possible hypersensitivity reaction and identify its chemical target.

METHODS AND RESULTS

The two prescribed levothyroxine formulations shared two inactive ingredients: magnesium stearate and polyvinylpyrrolidone. Nine months after discontinuation of thyroid supplement, a formulation without either of these two compounds was used for a second re-challenge. There was no recurrence of the drug reaction and after 1.5 years of treatment the dog remains normal.

CONCLUSIONS AND CLINICAL IMPORTANCE

These elements strongly suggest that this dog had an idiosyncratic reaction (likely immune-mediated) against one or both inactive ingredients in the first two formulations of levothyroxine. We are not aware of any previous confirmed delayed hypersensitivity to a thyroid supplement in a dog with the likely chemical trigger being an inactive ingredient rather than the therapeutic agent itself. We hope that this case will raise awareness about allergic reactions to thyroid supplements and allergic reactions to inactive formulation components.

A versatile retarding potential analyzer for nano-satellite platforms

The design of the first retarding potential analyzer (RPA) built specifically for use on resource-limited cubesat platforms is described. The size, mass, and power consumption are consistent with the limitations of a nano-satellite, but the performance specifications are commensurate with those of RPAs flown on much larger platforms. The instrument is capable of measuring the ion density, temperature, and the ram component of the ion velocity in the spacecraft reference frame, while also providing estimates of the ion composition. The mechanical and electrical designs are described, as are the operating modes, command and data structure, and timing scheme. Test data obtained using an ion source inside a laboratory vacuum chamber are presented to validate the performance of the new design.

Measuring laboratory-based influenza surveillance capacity: development of the 'International Influenza Laboratory Capacity Review' Tool

OBJECTIVES

The 2005 International Health Regulations (IHR 2005) emphasized the importance of laboratory capacity to detect emerging diseases including novel influenza viruses. To support IHR 2005 requirements and the need to enhance influenza laboratory surveillance capacity, the Association of Public Health Laboratories (APHL) and the Centers for Disease Control and Prevention (CDC) Influenza Division developed the International Influenza Laboratory Capacity Review (Tool).

STUDY DESIGN

Data from 37 assessments were reviewed and analyzed to verify that the quantitative analysis results accurately depicted a laboratory's capacity and capabilities.

METHODS

Subject matter experts in influenza and laboratory practice used an iterative approach to develop the Tool incorporating feedback and lessons learnt through piloting and implementation. To systematically analyze assessment data, a quantitative framework for analysis was added to the Tool.

RESULTS

The review indicated that changes in scores consistently reflected enhanced or decreased capacity. The review process also validated the utility of adding a quantitative analysis component to the assessments and the benefit of establishing a baseline from which to compare future assessments in a standardized way.

CONCLUSIONS

Use of the Tool has provided APHL, CDC and each assessed laboratory with a standardized analysis of the laboratory's capacity. The information generated is used to improve laboratory systems for laboratory testing and enhance influenza surveillance globally. We describe the development of the Tool and lessons learnt.

De novo assembly and characterisation of the field pea transcriptome using RNA-Seq

BACKGROUND

Field pea (Pisum sativum L.) is a cool-season grain legume that is cultivated world-wide for both human consumption and stock-feed purposes. Enhancement of genetic and genomic resources for field pea will permit improved understanding of the control of traits relevant to crop productivity and quality. Advances in second-generation sequencing and associated bioinformatics analysis now provide unprecedented opportunities for the development of such resources. The objective of this study was to perform transcriptome sequencing and characterisation from two genotypes of field pea that differ in terms of seed and plant morphological characteristics.

RESULTS

Transcriptome sequencing was performed with RNA templates from multiple tissues of the field pea genotypes Kaspa and Parafield. Tissue samples were collected at various growth stages, and a total of 23 cDNA libraries were sequenced using Illumina high-throughput sequencing platforms. A total of 407 and 352 million paired-end reads from the Kaspa and Parafield transcriptomes, respectively were assembled into 129,282 and 149,272 contigs, which were filtered on the basis of known gene annotations, presence of open reading frames (ORFs), reciprocal matches and degree of coverage. Totals of 126,335 contigs from Kaspa and 145,730 from Parafield were subsequently selected as the reference set. Reciprocal sequence analysis revealed that c. 87% of contigs were expressed in both cultivars, while a small proportion were unique to each genotype. Reads from different libraries were aligned to the genotype-specific assemblies in order to identify and characterise expression of contigs on a tissue-specific basis, of which 87% were expressed in more than one tissue, while others showed distinct expression patterns in specific tissues, providing unique transcriptome signatures.

CONCLUSION

This study provided a comprehensive assembled and annotated transcriptome set for field pea that can be used for development of genetic markers, in order to assess genetic diversity, construct linkage maps, perform trait-dissection and implement whole-genome selection strategies in varietal improvement programs, as well to identify target genes for genetic modification approaches on the basis of annotation and expression analysis. In addition, the reference field pea transcriptome will prove highly valuable for comparative genomics studies and construction of a finalised genome sequence.

Return-to-work intentions during spinal cord injury rehabilitation: an audit of employment outcomes

STUDY DESIGN

Single-centre, retrospective cohort study.

OBJECTIVES

To analyse the return-to-work intentions during spinal cord injury (SCI) rehabilitation.

SETTING

Tertiary care, spinal cord injury rehabilitation unit, National Spinal Injuries Centre, Stoke Mandeville Hospital, Ayelsbury, UK.

METHODS

Employment outcomes were obtained from the Needs Assessment Checklist (NAC), for all patients admitted to the unit between February 2008 and October 2014. NAC1 is completed within 4 weeks post-mobilisation and NAC2 upon the patient moving to the pre-discharge ward. Data from 362 participants were analysed for return-to-work intentions, by gender, age and injury severity.

RESULTS

Seventy-six percent of the sample population was employed at the time of their injury. At NAC1, 22.4% of individuals had made plans to return to work, whereas 44.2% had not; at NAC2, 34.3% had made plans to return to work and 31.2% had not. This difference was found to be statistically significant. There were significant differences in return-to-work intentions by injury severity at NAC1 but not NAC2, and by age group at NAC2 but not NAC1.

CONCLUSION

Less than half of those employed at the time of their injury had made plans to return to work before their discharge from the unit. The low proportion of individuals with SCI returning to work--just one in three--is concerning in view of the lost health and psychosocial benefits, and requires greater prominence during rehabilitation. Future research into effective employment interventions to improve employment outcomes in this population is required.

Effort versus Reward: Preparing Samples for Fungal Community Characterization in High-Throughput Sequencing Surveys of Soils

Next generation fungal amplicon sequencing is being used with increasing frequency to study fungal diversity in various ecosystems; however, the influence of sample preparation on the characterization of fungal community is poorly understood. We investigated the effects of four procedural modifications to library preparation for high-throughput sequencing (HTS). The following treatments were considered: 1) the amount of soil used in DNA extraction, 2) the inclusion of additional steps (freeze/thaw cycles, sonication, or hot water bath incubation) in the extraction procedure, 3) the amount of DNA template used in PCR, and 4) the effect of sample pooling, either physically or computationally. Soils from two different ecosystems in Minnesota, USA, one prairie and one forest site, were used to assess the generality of our results. The first three treatments did not significantly influence observed fungal OTU richness or community structure at either site. Physical pooling captured more OTU richness compared to individual samples, but total OTU richness at each site was highest when individual samples were computationally combined. We conclude that standard extraction kit protocols are well optimized for fungal HTS surveys, but because sample pooling can significantly influence OTU richness estimates, it is important to carefully consider the study aims when planning sampling procedures.

Rare complications of a low lying median arcuate coeliac ligament

Pancreaticoduodenal artery aneurysm is a rare complication of coeliac artery stenosis secondary to a low lying median arcuate coeliac ligament. This article reports the case of a 69-year old man who presented with left arm and leg weakness, clinically in keeping with right hemisphere stroke. Initial CT brain scan was within normal limits. The patient did not receive thrombolysis as he was outside the time window. 3 hours later the patient experienced sudden onset epigastric pain and acute shock. CT aorta abdominal was diagnostic of a ruptured inferior pancreaticoduodenal artery aneurysm. Repeat CT brain the following day showed subacute infarction within the right frontal lobe. Embolisation of the aneurysm was successfully performed. It is well documented that ischaemic stroke can cause acute hypertension. This acute hypertension probably contributed to the rupture of the pancreaticoduodenal artery aneurysm. The patient was well on discharge and remains well 2 months on.

Missing checkerboards? An absence of competitive signal in Alnus-associated ectomycorrhizal fungal communities

A number of recent studies suggest that interspecific competition plays a key role in determining the structure of ectomycorrhizal (ECM) fungal communities. Despite this growing consensus, there has been limited study of ECM fungal community dynamics in abiotically stressful environments, which are often dominated by positive rather than antagonistic interactions. In this study, we examined the ECM fungal communities associated with the host genus Alnus, which live in soils high in both nitrate and acidity. The nature of ECM fungal species interactions (i.e., antagonistic, neutral, or positive) was assessed using taxon co-occurrence and DNA sequence abundance correlational analyses. ECM fungal communities were sampled from root tips or mesh in-growth bags in three monodominant A. rubra plots at a site in Oregon, USA and identified using Illumina-based amplification of the ITS1 gene region. We found a total of 175 ECM fungal taxa; 16 of which were closely related to known Alnus-associated ECM fungi. Contrary to previous studies of ECM fungal communities, taxon co-occurrence analyses on both the total and Alnus-associated ECM datasets indicated that the ECM fungal communities in this system were not structured by interspecific competition. Instead, the co-occurrence patterns were consistent with either random assembly or significant positive interactions. Pair-wise correlational analyses were also more consistent with neutral or positive interactions. Taken together, our results suggest that interspecific competition does not appear to determine the structure of all ECM fungal communities and that abiotic conditions may be important in determining the specific type of interaction occurring among ECM fungi.

Quality of life in and after spinal cord injury rehabilitation: a longitudinal multicenter study

PURPOSE

To investigate the changes in quality of life (QOL) in persons with spinal cord injury (SCI) and their close persons during the first 2 years post injury.

METHOD

Longitudinal multiple sample multiple wave panel design. Data included 292 patients recruited from Austrian British German Irish and Swiss specialist SCI rehabilitation centers and 55 of their close persons. Questionnaire booklets were administered at 6 weeks 12 weeks 1 year and 2 years after injury to both samples.

RESULTS

Study 1 investigated the WHOQOL-BREF domains in individuals with SCI and found differences mostly in the physical domain indicating that QOL increases for persons with SCI from onset. An effect of the culture was observed in the psychological and environmental domains with higher QOL scores in the German-speaking sample. Study 2 compared individuals with SCI to their close persons and found differences in the physical environmental and social domains over time. The scores on the psychological dimension did not significantly differ between the persons with SCI and their close persons over time.

CONCLUSION

QOL measured by the WHOQOL-BREF shows that QOL changes during rehabilitation and after discharge. Apart from the physical dimension the persons with SCI and their close persons seem to experience a similar change in QOL. Further longitudinal research is suggested to clarify the mutual adjustment process of people with SCI and their close persons and to explore cultural differences in QOL between English-and German-speaking countries.