Sensing the DNA-mismatch tolerance of catalytically inactive Cas9 via barcoded DNA nanostructures in solid-state nanopores

Single-molecule quantification of the strength and sequence specificity of interactions between proteins and nucleic acids would facilitate the probing of protein-DNA binding. Here we show that binding events between the catalytically inactive Cas9 ribonucleoprotein and any pre-defined short sequence of double-stranded DNA can be identified by sensing changes in ionic current as suitably designed barcoded linear DNA nanostructures with Cas9-binding double-stranded DNA overhangs translocate through solid-state nanopores. We designed barcoded DNA nanostructures to study the relationships between DNA sequence and the DNA-binding specificity, DNA-binding efficiency and DNA-mismatch tolerance of Cas9 at the single-nucleotide level. Nanopore-based sensing of DNA-barcoded nanostructures may help to improve the design of efficient and specific ribonucleoproteins for biomedical applications, and could be developed into sensitive protein-sensing assays.

Standardising outcome reporting for clinical trials of interventions for heavy menstrual bleeding: Development of a core outcome set

OBJECTIVE

To develop a core outcome set for heavy menstrual bleeding (HMB).

DESIGN

Core outcome set (COS) development methodology described by the COMET initiative.

SETTING

University hospital gynaecology department, online international survey and web-based international consensus meetings.

POPULATION OR SAMPLE

An international collaboration of stakeholders (clinicians, patients, academics, guideline developers) from 20 countries and 6 continents.

METHODS

Phase 1: Systematic review of previously reported outcomes to identify potential core outcomes. Phase 2: Qualitative studies with patients to identify outcomes most important to them. Phase 3: Online two-round Delphi survey to achieve consensus about which outcomes are most important. Phase 4: A consensus meeting to finalise the COS.

MAIN OUTCOME MEASURES

Outcome importance was assessed in the Delphi survey on a 9-point scale.

RESULTS

From the 'long list' of 114, 10 outcomes were included in the final COS: subjective blood loss; flooding; menstrual cycle metrics; severity of dysmenorrhoea; number of days with dysmenorrhoea; quality of life; adverse events; patient satisfaction; number of patients going on to have further treatment for HMB and haemoglobin level.

CONCLUSIONS

The final COS includes variables that are feasible for use in clinical trials in all resource settings and apply to all known underlying causes of the symptom of HMB. These outcomes should be reported in all future trials of interventions, their systematic reviews, and clinical guidelines to underpin policy.

Qualitative study exploring which research outcomes best reflect women's experiences of heavy menstrual bleeding: stakeholder involvement in development of a core outcome set

OBJECTIVE

This work contributed to the development of a core outcome set (COS) for heavy menstrual bleeding (HMB). The objective was to determine which research outcomes best reflect how HMB affects women's lives and to identify additional research outcomes, not previously reported. It was important to explore and record participants' reasoning for prioritising outcomes and use this information to reinforce the patients' voice during later phases of the COS development.

DESIGN

Patient workshop discussions and telephone interviews.

SETTING

East London teaching hospital.

PARTICIPANTS

Inclusion criteria were that participants must be over 18 years old, that either they or their partner had a history of HMB and that they had a good understanding of written and spoken English.

RESULTS

41 participants were recruited for the study. 8 women and 1 man completed the study. The eight female participants were representative of the different underlying causes and treatments for HMB. Participants ranged in age from their early 20s to their 60s and represented a range of ethnic groups. The five main themes that were identified as being important to patients were: 'restriction', 'relationships and isolation', 'emotions and self-perception', 'pain' and 'perceptions of treatment'. We identified eight coding nodes that did not correspond with our list of previously reported outcomes in studies of HMB. These nodes were consolidated and became five new outcomes for potential inclusion in the COS.

CONCLUSIONS

HMB stops women living their lives as they would wish. It affects their relationships, education, careers, reproductive wishes, social life and mental health. This is a condition of girls and women in the prime of their lives, but for many, the constant threat of a heavy period starting means that they sacrifice that freedom. The societal and economic costs of women being incapacitated every month has an effect on everyone.

TRIAL REGISTRATION

The COS study is registered with the COMET (Core Outcome Measures in Effectiveness Trials) Initiative-project reference number 789.

Variation in Outcome Reporting in Studies of Fertility‐Sparing Surgery for Cervical Cancer: a Systematic Review

BACKGROUND

Cervical cancer affects 3197 women in the UK, and 604 000 women worldwide annually, with peak incidence seen in women between 30 and 34 years of age. For many, fertility-sparing surgery is an appealing option where possible. However, absence of large-scale data, along with a notable variation in reported outcomes in relevant studies, may undermine future efforts for consistent evidence synthesis.

OBJECTIVES

To systematically review the reported outcomes measured in studies that include women who underwent fertility-sparing surgery for cervical cancer and identify whether variation exists.

SEARCH STRATEGY

We searched MEDLINE, EMBASE and CENTRAL from inception to February 2019.

SELECTION CRITERIA

Randomised controlled trials, cohort and observational studies, and case studies of more than ten participants from January 1990 to date.

DATA COLLECTION AND ANALYSIS

Study characteristics and all reported treatment outcomes.

MAIN RESULTS

A total of 104 studies with a sum of 9535 participants were identified. Most studies reported on oncological outcomes (97/104), followed by fertility and pregnancy (86/104), postoperative complications (74/104), intra-operative complications (72/104) and quality of life (5/104). There was huge variation and heterogeneity in reported outcomes, with only 12% being good quality and 87% being of poor quality.

CONCLUSIONS

There is significant heterogeneity in the reported outcomes. An agreed Core Outcome Set is necessary for future studies to effectively harmonise reported outcomes that are measurable and relevant to patients, clinicians and researchers. This systematic review sets the groundwork for the development of a Core Outcome Set for fertility-sparing surgery in cervical cancer.

P56 Involvement of young people in adolescent and young adult rheumatology services and research

Introduction/Background

The Barbara Ansell National Network for Adolescent Rheumatology (BANNAR) was established in 2012. Survey results from within the paediatric and adolescent rheumatology community at this time, highlighted the lack of young people’s involvement in rheumatology research, beyond the role of study participant. Following research to determine the young person’s perspective of research and how they wanted to be involved, Your Rheum, a national young person’s advisory group, for 11-24 year olds diagnosed with a rheumatic condition, was formed in 2016.

Description/Method

Aim: to assess the current involvement of young people in rheumatology research and service delivery. A questionnaire was created using Microsoft Office online forms and emailed to all BANNAR members (n = 105). Topics included demographics, youth involvement panels and Your Rheum.

Discussion/Results

23 responses were received (21% response rate), representing 18 rheumatology centres across the UK including 15 tertiary paediatric and adolescent rheumatology centres. The majority of respondents were Consultants (n = 18). Over half of respondents (n = 16) work in centres involved in rheumatology research.

15 centres reported having a hospital-wide youth forum/advisory panel, which they promote amongst young people within their services. However, nearly all respondents reported no specific youth advisory panel for rheumatology services. Young people are actively involved in a number of areas within clinical rheumatology services (table 1), however patient satisfaction surveys were the most commonly reported. Moreover, young people are involved in aspects of rheumatology research (table 1), although this was primarily as research participants.

Over half of respondents (n = 14) have not worked with Your Rheum. Most recruit young people to get involved in the group (n = 16), however, only three respondents said they do this routinely. Common barriers to promoting Your Rheum were: lack of time in consultations; forgetting; lack of interest from the young person(s); no designated member in clinic to discuss Your Rheum with young people.

Key learning points/Conclusion

There remains a need to support youth involvement strategies at a local level as well as nationally via Your Rheum. The recent introduction of a Your Rheum animation (https://bit.ly/yourRHEUM) will hopefully support future recruitment.

P49 The Barbara Ansell National Network for Adolescent Rheumatology – 10 years on

Introduction/Background

Over the last 10 years since BANNAR was established, there has been increasing awareness of the specific age and developmental needs of adolescents and young adults (AYA) with rheumatic disease. The aim of this study was to describe the current BANNAR membership to ensure representativeness and determine clinical and research capacity to inform future strategies.

Description/Method

An online survey on Microsoft Forms (version 2021) was developed, piloted with the BANNAR leadership team and then disseminated to existing members in addition to any new members as part of the membership process.

Discussion/Results

As of May 2022, there are 118 members. The BANNAR membership includes a wide variety of roles, from healthcare professionals reflecting the multidisciplinary team to charity representatives, academics, and researchers. Of the clinically active professionals (n = 93) there are more members working in the paediatric (n = 57) compared to the adult care setting (n = 34). There are 15 members in training posts, 16 members in research-only roles, and 9 charity representatives. Membership is predominantly female with a gender ratio of members F104: M14.

Members are predominantly White British (n = 81, 69%) and include representation from all regions of England and the devolved nations in addition to 1 researcher based in Australia. 27/116 (23.3%) members reported being currently involved in AYA research with 2 non-respondents. This research was wide ranging and involved both basic science as well as clinical research. Of the NHS clinicians (excluding the clinical academics), 34/79 (43%) had research in their job description and/or job plan.

Of 56 paediatric clinicians, 34 had access (61%) to a dedicated adolescent clinic in the paediatric setting. 37/93 NHS clinicians (40%) had access to a young adult clinic in adult services.

Of the 93 clinically active members, only 15 (16%) members reported regular in-service training for team members in AYA topics. 23/93 (25%) clinician members used/signposted team members to the Adolescent Health e-learning project (www.e-lfh.org.uk) but 55/93 (59%) reported that they were unaware of this resource.

Key learning points/Conclusion

BANNAR is a national network with membership reflecting the multidisciplinary team in addition to researchers and charity representatives. As such, along with its youth advisory panel – Your Rheum – it is an excellent resource to support future AYA rheumatology research. However, there remain challenges for clinicians in contributing to research, with less than half having formal provision for research in their job descriptions. Furthermore, even in this committed group of AYA-focussed individuals, there was not universal access to adolescent and/or young adult clinics and there are still areas for development in AYA rheumatology training.

Variation of outcome reporting in studies of interventions for heavy menstrual bleeding: a systematic review

Background: Heavy menstrual bleeding (HMB) detrimentally effects women. It is important to be able to compare treatments and synthesise data to understand which interventions are most beneficial, however, when there is variation in outcome reporting, this is difficult. Objectives: To identify variation in reported outcomes in clinical studies of interventions for HMB. Materials and methods: Searches were performed in medical databases and trial registries, using the terms ‘heavy menstrual bleeding’, menorrhagia*, hypermenorrhoea*, HMB, “heavy period „period“, effective*, therapy*, treatment, intervention, manage* and associated MeSH terms. Two authors independently reviewed and selected citations according to pre-defined selection criteria, including both randomised and observational studies. The following data were extracted- study characteristics, methodology and quality, and all reported outcomes. Analysis considered the frequency of reporting. Results: There were 14 individual primary outcomes, however reporting was varied, resulting in 45 specific primary outcomes. There were 165 specific secondary outcomes. The most reported outcomes were menstrual blood loss and adverse events. Conclusions: A core outcome set (COS) would reduce the evident variation in reporting of outcomes in studies of HMB, allowing more complete combination and comparison of study results and preventing reporting bias. What is new? This in-depth review of past research into heavy menstrual bleeding shows that there is the need for a core outcome set for heavy menstrual bleeding.

How group singing facilitates recovery from the symptoms of postnatal depression: a comparative qualitative study

BACKGROUND

Previous research has demonstrated that making music can enhance positive emotions as well as support positive psychological functioning. However, studies tend to be limited by lack of comparison with other psychosocial interventions. This study builds on a three-arm randomised controlled trial (RCT) that demonstrated that group singing for mothers and babies, but not group creative play, can lead to faster recovery from moderate-severe symptoms of postnatal depression than usual care. The aim was to elucidate the mechanisms of the group singing intervention in order to account for its recovery properties.

METHODS

Qualitative research was conducted with 54 mothers who had experienced symptoms of postnatal depression. Mothers completed a 10-week programme of either group singing or group creative play as part of the wider RCT study. Data were collected via a series of 10 semi-structured focus groups conducted at the end of each 10-week programme. These were designed to elicit subjective and constructed experiences of the singing and play interventions and were analysed inductively for emergent themes.

RESULTS

Five distinctive features of the group singing emerged: (i) providing an authentic, social and multicultural creative experience, (ii) ability to calm babies; (iii) providing immersive 'me time' for mothers; (iv) facilitating a sense of achievement and identity; (v) enhancing mother-infant bond.

CONCLUSIONS

Community group singing interventions may reduce symptoms of postnatal depression through facilitating a functional emotional response rooted in the needs of new motherhood. These features are of relevance to others seeking to implement creative interventions for maternal mental health.

TRIAL REGISTRATION

NCT02526407 . Registered 18 August 2015.