Polyamidoamine dendrimer-mediated hydrogel for solubility enhancement and anti-cancer drug delivery

The application of hydrogels for anti-cancer drug delivery has garnered considerable interest in the medical field. Current cancer treatment approaches, such as chemotherapy and radiation therapy, often induce severe side effects, causing significant distress and substantial health complications to patients. Hydrogels present an appealing solution as they can be precisely injected into specific sites within the body, facilitating the sustainable release of encapsulated drugs. This localized treatment approach holds great potential for reducing toxicity levels and improving drug delivery efficacy. In this study we developed a hydrogel delivery system containing polyamidoamine (PAMAM) dendrimer and polyethylene glycol (PEG) for solubility enhancement and sustained delivery of hydrophobic anti-cancer drugs. The three selected model drugs, e.g. silibinin, camptothecin, and methotrexate, possess limited aqueous solubility and thus face restricted application. In the presence of vinyl sulfone functionalized PAMAM dendrimer at 45 mg/mL concentration, drug solubility is increased by 37-fold, 4-fold, and 10-fold for silibinin, camptothecin, and methotrexate, respectively. By further crosslinking of the functionalized PAMAM dendrimer and thiolated PEG, we successfully developed a fast-crosslinking hydrogel capable of encapsulating a significant payload of solubilized cancer drugs for sustained release. In water, the drug encapsulated hydrogels release 30%-80% of their loads in 1-4 days. MTT assays of J82 and MCF7 cells with various doses of drug encapsulated hydrogels reveal that cytotoxicity is observed for all three drugs on both J82 and MCF7 cell lines after 48 h. Notably, camptothecin exhibits higher cytotoxicity to both cell lines than silibinin and methotrexate, achieving up to 95% cell death at experimental conditions, despite its lower solubility. Our experiments provide evidence that the PAMAM dendrimer-mediated hydrogel system significantly improves the solubility of hydrophobic drugs and facilitates their sustained release. These findings position the system as a promising platform for controlled delivery of hydrophobic drugs for intratumoral cancer treatment.

Clinical Validation of HPV ctDNA for Early Detection of Residual Disease Following Chemoradiation in Cervical Cancer

PURPOSE/OBJECTIVE(S)

Despite chemoradiation (CRT), 30-40% of patients with locally advanced cervical cancer relapse. Most cases are caused by human papilloma virus (HPV), and HPV circulating tumor DNA (ctDNA) may identify patients at highest risk of relapse. Our previous pilot study showed that detectable HPV ctDNA at the end of CRT is associated with inferior progression-free survival (PFS) using digital polymerase chain reaction (dPCR), and that a next generation sequencing approach (HPV-seq) may outperform dPCR. We hypothesized that HPV ctDNA may identify cervical cancer patients at increased risk of relapse following CRT and aimed to prospectively validate HPV ctDNA as a tool for early detection of residual disease.

MATERIALS/METHODS

This prospective, multicenter validation study accrued 70 patients with HPV+ stage IB-IVA cervical cancer treated with definitive CRT from 2017-2022. Patients underwent phlebotomy at baseline, end of, 4-6 weeks and 3 months post CRT for HPV ctDNA levels. HPV genotyping was performed on the baseline plasma sample using HPV-seq. HPV genotype-specific DNA levels in plasma were quantified using both dPCR and HPV-seq. PFS was estimated using the Kaplan-Meier method and compared using the log rank test. Multivariable Cox regression analyses incorporating stage and HPV ctDNA detectability assessed independent prognostic factors associated with PFS.

RESULTS

At the time of abstract, results for 67 patients were available. The majority had squamous histology (84%) and stage IIB (36%) or IIIC1 (25%) disease. HPV genotyping using HPV-seq revealed 54% (36/67) of cases harboring HPV-16, and 46% harboring other HPV types: 15 HPV-18; 5 HPV-59; 2 HPV-31; 2 HPV-33; 2 HPV-52; 1 each HPV-39, HPV-45, HPV-53, HPV-58, and HPV-82. With a median follow up of 2.2 (range 0.4 - 5.2) years, there were 21 PFS events. Most recurrences (14/21) were distant and/or paraaortic; 4 local and nodal/distant; 2 pelvic nodal; and 1 local. Patients with detectable HPV ctDNA on dPCR at the end of, 4-6 weeks and 3 months post CRT had significantly worse 2-year PFS compared to those with undetectable HPV ctDNA (78 vs 52%, p = 0.04; 82 vs 26%, p < 0.001; and 80 vs 23%, p = < 0.001, respectively). HPV-seq showed similar results (87 vs 55%, p = 0.02; 81 vs 45%, p = 0.003; and 84 vs 31%, p = < 0.001, respectively). On multivariable analyses, detectable HPV ctDNA on dPCR and HPV-seq remained independently associated with inferior PFS (see table).

CONCLUSION

HPV-seq enables HPV genotyping directly from plasma in locally advanced cervical cancer. Persistent HPV ctDNA following CRT is independently associated with inferior PFS in this prospective validation study. HPV ctDNA testing can be used to identify, as early as at the end of CRT, patients at high risk of recurrence in future treatment intensification trials.

Significant Enhancement of Two-Photon Excited Fluorescence in Water-Soluble Triphenylamine-Based All-Organic Compounds

Understanding water-soluble and environmentally friendly two-photon absorption (TPA) molecules benefits the design of superior organic complexes for biomedical, illumination, and display applications. In this work, we designed two triphenylamine-based all-organic compounds and explored the mechanism of enhanced TP fluorescence in water solutions for potential applications. Experimentally, we showed that adding protein into our TPA molecule solution can drastically boost the TP fluorescence. Numerical simulations reveal that the TPA molecules prefer to dock inside the protein complex. We hypothesize that the interaction between our triphenylamine-based all-organic compounds and water molecules lead to non-radiative decay processes, which prevent strong TP fluorescence in the water solution. Therefore, the protection by, for example, protein molecules from such interactions can be a universal strategy for superior functioning of organic TPA molecules. Further experiments and numerical simulations support our hypothesis. The present study may facilitate the design of superior water-soluble and environmentally friendly superior organic complexes.

POS0876 SERUM INTERFERON SCORE PREDICTS SEVERITY OF PATIENT REPORTED HAND DISABILITY IN SYSTEMIC SCLEROSIS

Background

Hand involvement is a major cause of disability in systemic sclerosis (SSc) patients. Loss of hand function is the result of a complex and overlapping series of manifestations including Raynaud’s, cutaneous ulcerations as well as skin fibrosis, joint inflammation, and contractures. The natural history of hand involvement in SSc and potential biomarkers to predict its outcome are still poorly defined. Type 1 Interferon (IFN) activation has been extensively correlated with skin fibrosis, joint disease activity, vascular manifestations, and poor prognosis in SSc patients.

Objectives

To characterize hand disability burden in SSc and explore its relationship with IFN activation in a national, multicenter, longitudinal, observational cohort of patients with SSc.

Methods

The Cochin Hand Function Scale (CHFS) was assessed in consecutively enrolled SSc patients at baseline and after 12 months. CHFS values above the patient acceptable symptom state (PASS)(CHFS>25)1 were considered as clinically meaningful hand impairment (CMHI). Minimal clinically important difference (MCID) in CHFS for improvement (reduction of 13.1%) and worsening (increase >24.6%) were assessed in longitudinal analysis. Serum IFN score was evaluated as previously described2.

Results

A total of 397 SSc patients from 10 centers (female 85.3%, aged 54.9±11.5 years, white Caucasian 88.2%) were available for longitudinal (12m) analysis. The median disease duration was 9 (IQR 3-16) years, 37.1% of patients had a diffuse cutaneous variant, while anticentromere (ACA) and anti-Scl70 antibody positivity was reported in 41.2% and 33.5% of cases, respectively. Hand digital ulcers, forearm-hand-finger skin score ≥6, and tenosynovitis/arthritis were clinically reported in 24.0%, 15.3%, and 17.9% of patients, respectively. 37.3% of patients reported a CHFS > PASS at baseline. CMHI was associated with male gender (p<.001), diffuse cutaneous variant (p<.001), anti Scl70 positivity (p<.001), ACA negativity (p=.002), and digital ulcers (p=.001). Patients with CMHI had greater serum IFN score than patients with CHFS < PASS (p=.002). In multivariate logistic regression analysis, high serum IFN score remained associated with CHFS>PASS when adjusted for male gender, ACA positivity, anti-Scl70 positive, diffuse subset, and current digital ulcers (OR 2.67, p=.005). Over the 12-month follow-up, vasoactive and immunosuppressive treatment were escalated or introduced in 7.2 and 7.8% of patients, respectively. Median CHFS worsened over time (from 18 (IQR 5-37) to 21 (IQR 6-37), p=.002)) with 32.5% of patients having a clinically meaningful worsening and 32.0% improving their hand function. Functional hand worsening was associated with lower baseline CHFS (p=.001) and ACA negativity (p=.002), while improving with female gender (p=.047), limited cutaneous subset (p=.029), higher baseline CHFS (p=.001), and active baseline tenosynovitis (p=.014).

Conclusion

One third of the patients within our cohort complain of a significant hand impairment. This is associated with higher IFN activation and worsens at group level in patients despite standard of care treatment.

References

[1]Daste C et al. Semin Arthritis Rheum. 2019;48(4):694-700. [2] Hinchcliff M et al. Arthritis Rheumatol. 2021; 73 (suppl 10).

Disclosure of Interests

Enrico De Lorenzis: None declared, Vishal Kakkar: None declared, rebecca ross: None declared, Stefano Di Donato: None declared, Theresa Barnes: None declared, Benazir Saleem: None declared, Ariane Herrick: None declared, Muhammad Nisar: None declared, Catherine Morley: None declared, Karen Douglas: None declared, Christopher P Denton: None declared, Emma Derrett-Smith: None declared, Philip Helliwell Consultant of: PH received consulting fees (Eli Lilly) and fees for educational services (Abbvie, Amgen, Novartis, Janssen), Grant/research support from: PH received consulting fees (Eli Lilly) and fees for educational services (Abbvie, Amgen, Novartis, Janssen), Francesco Del Galdo Consultant of: FDG has received research support and personal fees, not directly related to the content of this study, from

Abbvie, AstraZeneca, Boehringer-Ingelheim, Capella Biosciences, Chemomab LTD, Janssen, Kymab LTD, Mitsubishi-Tanabe, Grant/research support from: FDG has received research support and personal fees, not directly related to the content of this study, from

Abbvie, AstraZeneca, Boehringer-Ingelheim, Capella Biosciences, Chemomab LTD, Janssen, Kymab LTD, Mitsubishi-Tanabe

PSII-B-20 Benefits of a lecture teaching assistant in hiflex courses

The Covid-19 pandemic has required implantation of online education strategies, even for animal science courses, that are traditionally delivered face-to-face (F2F). As universities reopened many students were given the option of attending classes either F2F or remotely via live stream. This scenario, where some students are present in-person while others are present online simultaneously, is referred to as hiflex teaching. Face-to-face and online teaching strategies are established and literature contains pedagogical information, however hiflex teaching presents previously unencountered challenges. It can be difficult for instructors to maintain engagement with, essentially, two separative audiences of students. The objective was to address this issue by providing a graduate teaching assistant (TA) to large lecture courses, where traditionally TA positions were reserved only for lab courses. The hypothesis was that this would enable both audiences to receive appropriate focus. In this study, a TA attended the F2F lecture for an introductory equine science course (total students: n = 75; remote students: n= ~55), with the role of monitoring the simultaneous Zoom session with remote students. We found that questions from remote students increased when they had the ability to post them in real-time using the Zoom chat feature, as opposed waiting for a break in instruction in F2F situations. Having the TA present in the classroom enabled them to answer basic questions via Zoom, and to interact with the instructor should a question arise online that would benefit all students in the course. This allowed the instructor to effectively teach without taking up valuable class time alternating between programs on the computer and risking missing an online student question. This approach received positive feedback from the instructor and students alike. Additionally, it provided a novel teaching experience for a graduate TA. Similar strategies may be used to help to facilitate future success in hiflex courses.

252 Better Preparing Animal Science Students for Education Associated Careers

An Animal Science degree prepares students for a broad range of career opportunities yet the two most discussed in the literature and assumed by society are in animal science industry or veterinary medicine. However, studies indicate that -60% of our students enter into education as a career path, yet animal science departments typically do not emphasize educational careers or provide opportunities for students to develop skills in methods relevant for animal science related teaching. To combat this lack of representation for educational career opportunities, our research university’s animal science department has acted in two ways:-Developed a laboratory teaching methods course that allows undergraduate students to serve as teaching assistants for an animal handling lab with support and supervision from the course and graduate student lab instructors-Performed a content analysis to identify the type, frequency, and way educational career paths are discussed and/or assessed in introductory animal science courses. These are the first steps in ensuring that students are as prepared for pursuit of a possible educational career at a level equal to that for industry or veterinary careers. Sustainability of animal science includes retaining students in educational careers and actively improving our educational practices within the discipline. These changes better prepare our undergraduate students to have more realistic job expectations and competence in teaching when they pursue graduate school or animal science related educational career options. The university animal science program also benefits, as the undergraduate teaching assistants improve the instructor-to-student ratio thus positively impacting safety and logistics of hands-on large animal labs while increasing one-on-one instruction time with students. These practices increase student engagement and learning. Additionally, the field of animal science will prosper from increased competence in pedagogical techniques providing a richer, more complete educational experience for our students both in and out of university settings.

SAT0609-HPR DELPHI CONSENSUS FOR THE OPTIMAL TREATMENT & MANAGEMENT OF COMPLEX RHEUMATOID ARTHRITIS (RA) PATIENTS

Background:

A significant proportion of patients with rheumatoid arthritis (RA) have additional considerations that must be taken into account for managing their disease.1These include; co-morbidities, extra-articular manifestations and poor prognostic factors.2-5Tailored management could reduce the burden on patients, the health system and wider society.

The ‘complex’ RA patient group is ill-defined and no specific recommendations exist for their optimal management and treatment.

Objectives:

A group of UK Rheumatology experts aimed to provide a set of recommendations to support consistent and high quality management, grounded in current evidence, expert opinion and best practice.

Methods:

A steering group meeting identified priority topics associated with complex RA.

Table 1.

Topics for consensus

TopicNo. of statementsDefinition of ‘complex’ RA from a medical perspective19Definition of patient factors that may contribute to ‘complex’ RA3Outcomes for RA patients with co-morbidities and/or extra articular manifestations5Prescribing options for ‘complex’ RA8Evidence vs. best practice requirements4Burden of ‘complex’ RA4TOTAL NUMBER OF STATEMENTS43

For each topic, the group defined statements they all agreed with. Delphi methodology was used to ratify these statements with rheumatology peers.

High levels of agreement (over 70%) were achieved in the first round, the group proceeded to formulate the recommendations.

Figure 1.

Responses received (n=163)

Figure 2.

Consensus Plot (total responses n=163)

Conclusion:

These recommendations are offered:

References:

[1]Uhlig T, Moe RH, Kvien TK. The burden of disease in rheumatoid arthritis. Pharmacoeconomics 2014;32:841–51

[2]Dougados M, et al. Ann Rheum Dis 2014;73:62–68.

[3]Parodi M et al,Rheumatism, 2005, 57(3): 154-60.

[4]Young A & Koduri G. Best Pract Res Clin Rheumatol. 2007 Oct;21(5):907-27.

[5]Holroyd CR, et al. Rheumatology 2019;58:e3-e42

Acknowledgments:

Support for medical writing/editorial assistance, provided by Tim Warren at Triducive was funded by Roche Products Ltd. & Chugai Pharma Ltd. in accordance with Good Publication Practice (GPP3) guidelines (http://www.ismpp.org/gpp3).

Disclosure of Interests:

Gurdeep Dulay Grant/research support from: Educational grants to attend congress meetings/conferences from Roche, Chugai, UCB, Internis, Pfizer, Lilly, Sandoz, Consultant of: Honoraria for advisory board services from Roche, Chugai, Novartis, Speakers bureau: Speaker fees from Roche, Chugai, Novartis, Amgen, Lilly, Sandoz, Ernest Choy Grant/research support from: Amgen, Bio-Cancer, Chugai Pharma, Ferring Pharmaceuticals, Novimmune, Pfizer, Roche, UCB, Consultant of: AbbVie, Amgen, AstraZeneca, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Chelsea Therapeutics, Chugai Pharma, Daiichi Sankyo, Eli Lilly, Ferring Pharmaceuticals, GlaxoSmithKline, Hospita, Ionis, Janssen, Jazz Pharmaceuticals, MedImmune, Merck Sharp & Dohme, Merrimack Pharmaceutical, Napp, Novartis, Novimmune, ObsEva, Pfizer, R-Pharm, Regeneron Pharmaceuticals, Inc., Roche, SynAct Pharma, Sanofi Genzyme, Tonix, UCB, Speakers bureau: Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Chugai Pharma, Eli Lilly, Hospira, Merck Sharp & Dohme, Novartis, Pfizer, Regeneron Pharmaceuticals, Inc., Roche, Sanofi-Aventis, UCB, Theresa Barnes Consultant of: Ad boards for Roche, Actelion and Abbvie, Speakers bureau: Speaker for MSD, UCB, Pfizer, Abbvie, Actelion, Roche and BMS, Debbie Chagadama Consultant of: Roche, Chugai, BI, Speakers bureau: Roche, Chugai, BI, Zoe Cole Consultant of: Consultancy work for Roche, Lilly, Gilead, Abbvie, Pfizer, UCB, Speakers bureau: Lilly, BMS, Abbvie, Pfizer, UCB, Janssen, Anshuman Malaviya Consultant of: Roche, Chugai, MSD, Pfizer, Novartis, Lily, BMS, Speakers bureau: Roche, BMS, Pfizer, MSD, Sandra Robinson Consultant of: Eli Lilly for Education Nurse Meeting, David Walker Grant/research support from: Gilead, Consultant of: Gilead, Lilly, Pfizer, Roche, Speakers bureau: Lilly, Pfizer, Roche, Chris Daly Employee of: Roche, Nicola Savill Employee of: Roche, Tim Warren Consultant of: Roche, Employee of: AstraZeneca, Nick Williams Shareholder of: MSD, Consultant of: Roche, Employee of: MSD

PSXIV-40 Utilization of a group project in an introductory animal science course to concurrently develop collaborative work skills and increase animal science industry awareness

It is expected that students entering the workforce should have skills to allow them to effectively perform in the workplace. However, there is a gap between expected development of these “soft skills” and their actual attainment by students. Due to this discrepancy, Texas A&M has developed university mandated learning outcomes that address soft skills within course content. The objective of this paper is to present teaching methodology useful for achieving Texas A&M University level learning outcomes as they relate to the “Professional Conduct” learning outcome, as assessed via performance indicators such as working collaboratively, feedback, and conflict management. Additionally, this project aims to help bridge the gap in understanding between current animal science industry practices and public perception. This project titled “Ag-vocating for Animal Science Industry Practices” utilizes methods appropriate for large classes, conducted face-to-face or online, and targets students at the introductory level. Based on criteria from education literature, the semester-long project is broken down into multiple low stakes assignments comprising half of the project points which allows for multiple feedback opportunities from both the group members and the professor. These assignments include a Catme survey to assign groups based on interest and schedule, as well as submitting topic-related articles, a script, a rough-draft video, final video, and peer assessment survey online through eCampus, the university’s learning management system. This utilization of this collaborative project fulfills university undergraduate learning outcome of demonstrating professional conduct measured by attainment performance indicators such as “identify characteristics of a functional team” and “accept objective and constructive criticism.” This is an innovative approach to assessing soft skill development within the context of the animal science discipline. In conclusion, this project is useful in evaluating groupwork skills in undergraduates, as well as providing students with an opportunity to critically analyze industry practices.

Coupling between oxygen redox and cation migration explains unusual electrochemistry in lithium-rich layered oxides

Lithium-rich layered transition metal oxide positive electrodes offer access to anion redox at high potentials, thereby promising high energy densities for lithium-ion batteries. However, anion redox is also associated with several unfavorable electrochemical properties, such as open-circuit voltage hysteresis. Here we reveal that in Li1.17-x Ni0.21Co0.08Mn0.54O2, these properties arise from a strong coupling between anion redox and cation migration. We combine various X-ray spectroscopic, microscopic, and structural probes to show that partially reversible transition metal migration decreases the potential of the bulk oxygen redox couple by > 1 V, leading to a reordering in the anionic and cationic redox potentials during cycling. First principles calculations show that this is due to the drastic change in the local oxygen coordination environments associated with the transition metal migration. We propose that this mechanism is involved in stabilizing the oxygen redox couple, which we observe spectroscopically to persist for 500 charge/discharge cycles.

A potential role for mTORC1/2 in β2 adrenergic regulation of skeletal muscle glucose oxidation in models of intrauterine growth restriction

The epidemic of intrauterine growth restriction (IUGR) continues to be a leading cause of perinatal morbidity and mortality throughout the world. This condition has been linked to the development of metabolic health problems such as obesity, hypertension, glucose intolerance, and type 2 diabetes at all ages. Previous studies have demonstrated that IUGR fetal adaptations impair proper glucose homeostasis in part via changes in insulin responsiveness in key tissues including skeletal muscle and liver, and that these deficits persists into adulthood. Many components of insulin signaling pathways associated with glucose metabolic regulation have been evaluated in IUGR tissues for adaptive changes. Among these are mammalian target of rapamycin complexes 1 and 2 (mTORC1/2) and their associated pathways, which function in mitochondrial control and maintenance. However, recent findings demonstrate that β₂ adrenoceptors (β₂AR) appear to activate an insulin-independent pathway or pathways that modify glucose metabolism via mTORC1/2 complexes. These findings represent a novel potential target for interventions that could improve the treatment and prevention of lUGR-induced metabolic disorders. This review will focus on mechanistic components of β₂AR-mTORC1/2 signaling as well as their role in regulating glucose oxidative metabolism within skeletal muscle.

Nature and quality of antipsychotic prescribing practice in UK psychiatry of intellectual disability services

BACKGROUND

Antipsychotics are perceived to be over-used in the management of behavioural problems in people with an intellectual disability (ID). Published guidelines have set good practice standards for the use of these drugs for behavioural indications. We sought to identify the range of indications for which antipsychotic drugs are prescribed in people with ID and to audit clinical practice against the standards.

METHOD

Data were collected from the clinical records of individuals with ID who were under the care of mental health services in the UK, and prescribed an antipsychotic drug.

RESULTS

The sample comprised 2319 patients from 39 clinical services. Twenty-seven per cent of the patients had a diagnosis of a psychotic illness (ICD-10 F20-29) and 27% an affective illness (ICD-10 F30-39). The proportion who did not have a psychiatric diagnosis ranged from 6% of those with borderline/mild ID to 21% of those with severe/profound ID. Overall, the most common indications for prescribing an antipsychotic drug were comorbid psychotic illness, anxiety and agitation, and a range of behavioural disturbances. The prevalence of use of antipsychotic drugs to manage challenging behaviour in the absence of concomitant mental illness increased with the severity of ID and accounted for almost half of prescriptions in those with severe/profound ID. Adherence to the audit standards related to documentation of clinical indications and review of efficacy was high. Side effect monitoring was less assiduous.

CONCLUSIONS

In clinical practice, most prescriptions for antipsychotic drugs in people with ID are consistent with the evidence base and the overall quality of prescribing practice, as measured against recognised standards, is good, although in some patients potentially remedial side effects may not be detected and treated.

Functional classes and equivalence relations

Three adult subjects were taught a set of two-choice simultaneous discriminations, with three positive and three negative stimuli; all possible combinations of positive and negative stimuli yielded nine different pairs. The discriminations were repeatedly reversed and rereversed, the former positive stimuli becoming negative and the former negative stimuli becoming positive. With all subjects, a reversal of the contingencies for one pair of stimuli became sufficient to change their responses to all of the other pairs. The reversals had produced functional stimulus classes. Then, all subjects showed conditional discriminations emerging between members of a functional class; given a sample from one class and comparisons from both classes, they selected the comparison that was in the same class as the sample. Next, 2 of the subjects showed that the within-class conditional relations possessed the symmetric and transitive properties of equivalence relations; after having been taught to relate new stimuli to existing class members, the subjects then matched other class members to the new stimuli. Subsequent tests of two-choice discriminations showed that the conditional discriminations had transferred functional class membership to the new stimuli. The 3rd subject, who did not show equivalence relations among functional class members, was also found to have lost the within-class conditional relations after the equivalence tests.

Spin-lozenge thermodynamics and magnetic excitations in Na(3)RuO(4)

We report inelastic and elastic neutron scattering, magnetic susceptibility, and heat capacity measurements for polycrystalline sodium ruthenate (Na(3)RuO(4)). Previous work suggests that this material consists of isolated tetramers of S = 3/2  Ru(5+) ions in a so-called lozenge configuration. Comparisons of magnetic susceptibility and inelastic and elastic neutron scattering results with analytic calculations for several cluster models show that although there may be significant spin-spin correlations within the lozenge cluster, a simple isolated lozenge model is not appropriate for Na(3)RuO(4).

Prevention of vascular damage in scleroderma and autoimmune Raynaud's phenomenon: a multicenter, randomized, double-blind, placebo-controlled trial of the angiotensin-converting enzyme inhibitor quinapril

OBJECTIVE

To evaluate the efficacy and tolerability of prolonged administration of quinapril, a long-acting angiotensin-converting enzyme inhibitor, in the management of the peripheral vascular manifestations of limited cutaneous systemic sclerosis (lcSSc) and in the prevention of the progression of visceral organ involvement in the disease.

METHODS

This was a multicenter, randomized, double-blind, placebo-controlled study evaluating quinapril 80 mg/day, or the maximum tolerated dosage, in 210 patients with lcSSc or with Raynaud's phenomenon (RP) and the presence of SSc-specific antinuclear antibodies. Treatment was for 2-3 years. The primary outcome measure was the number of new ischemic ulcers appearing on the hands; secondary measures were the frequency and severity of RP attacks, skin score, treatments for ischemia, health status (measured by the Short Form 36 instrument), measures of kidney and lung function, and echocardiographic estimates of pulmonary artery pressure. An intent-to-treat analysis was used.

RESULTS

Quinapril did not affect the occurrence of digital ulcers or the frequency or severity of RP episodes. It did not alter the treatments that were prescribed for either infected ulcers or severe RP symptoms. There was no apparent effect on the estimated tricuspid gradient. Health status was not affected by quinapril, and one-half of the patients who believed they had benefited from the trial treatment were in the placebo arm. Quinapril was not tolerated by one-fifth of the patients, with dry cough being the most frequent side effect.

CONCLUSION

Administration of quinapril for up to 3 years had no demonstrable effects on the occurrence of upper limb digital ulcers or on other vascular manifestations of lcSSc in this patient population.

Dynamic contrast enhanced MRI of bone marrow oedema in rheumatoid arthritis

AIMS

The aim of this work was to assess the feasibility of using dynamic contrast enhanced (DCE) MRI of bone marrow oedema, to compare it with conventional marrow oedema scoring systems, and to determine the effects of anti-tumour necrosis factor (TNF)alpha therapy.

METHODS

The wrist and metacarpophalangeal (MCP) joints of 25 patients with rheumatoid arthritis were studied. A total of 14 were imaged before and 1-2 weeks after anti-TNFalpha therapy. T2-weighted fat-suppressed images were collected. A dynamic series of 24 3D spoiled gradient-echo images were acquired before, during and after the intravenous administration of gadolinium-based contrast medium. Oedema was scored using the conventional Rheumatoid Arthritis MRI Scoring (RAMRIS) system from T2-weighted images. The relative enhancement rate (RER) was calculated using the dynamic series from oedematous bone, bone adjacent to oedema and from an uninvolved bone.

RESULTS

A total of 56% of patients showed bone marrow oedema. The RER was significantly increased in and adjacent to areas of marrow oedema. There was a significant reduction in the RER after treatment, but not in the RAMRIS score.

CONCLUSIONS

Dynamic contrast enhanced MRI of bone marrow oedema yields additional information to RAMRIS scoring and may be a more sensitive marker of inflammatory activity and response to treatment.

Drivers of professional mobility in the Northern Territory: dental professionals

INTRODUCTION

Attracting and retaining an efficient allied health workforce is a challenge faced by communities in Australia and overseas. High rates of staff turnover in the professional workforce diverts resources away from core business and results in the loss of valuable skills and knowledge. Understanding what attracts professionals to a particular place, and why they leave, is important for developing effective strategies to manage turnover and maximise workforce productivity. The Northern Territory (NT) faces particular workforce challenges, in part because of its geographic location and unusual demography. Do these factors require the development of a tailored approach to recruitment and retention? This article reports on a study undertaken to examine the motivations for coming to, staying in and leaving the NT for dental professionals, and the implications of results on workforce management practices.

METHODS

In 2006, dentists, dental specialists, dental therapists and dental hygienists who were working or had worked in the NT, Australia, in the recent past were surveyed to collect demographic and workforce data and to establish the relative importance of social and work-related factors influencing their migration decisions. Multivariate logistic regression models were generated to describe the demographic characteristics of dental professionals who stayed in the NT for more than 5 years and to analyse why dental professionals left. The analyses, based on a 42% response rate, explained 60-80% of the variation in responses.

RESULTS

Generally dental professionals who had stayed for more than 5 years were older, had invested in the purchase of homes and were more involved in social and cultural activities. Those who moved to the NT as a result of financial incentives or who had strong expectations that working in the NT would be an exciting, novel experience tended to stay for no more than 5 years, often leaving because they found the work environment too stressful. In contrast, those who stayed longer came because they had existing social networks and were familiar with the NT environment, staying primarily because they have enjoyed the NT lifestyle, particularly the sense of community and the opportunities available through living in smaller centres.

CONCLUSION

There are benefits in actively engaging newly recruited professionals and their families in social networks. Work related stress and departure was associated with administrative deficiencies within the management system. Despite the NT's unusual demographic profile, the factors influencing recruitment and retention are not markedly different from those reported elsewhere.

Cancer diagnosis and treatment in the Northern Territory: assessing health service performance for indigenous Australians

Indigenous Australians with cancer are diagnosed with more advanced disease and have lower survival than other Australians. To investigate reasons for these differences. Retrospective cohort study of 1197 indigenous and nonindigenous people in the Northern Territory diagnosed with cancers of the colon and rectum, lung, breast, cervix and non-Hodgkin lymphoma between 1991 and 2000. Outcome measures were stage at diagnosis and relative risk of cancer death. Indigenous people compared with nonindigenous people had higher relative odds of advanced stage of cancer at diagnosis (relative odds 1.9, 95% CI 1.3-2.7) for four cancers but lower relative odds for lung cancer (relative odds 0.3, 95% CI 0.2-0.5). None of the potentially contributing factors examined could explain this difference. Risk of cancer death (adjusted for cancer type and age and stage at diagnosis) was higher in indigenous than in nonindigenous people (relative risk 1.7, 95% CI 1.4-2.1). This difference, however, was confined to indigenous people with an indigenous first language (relative risk 2.9, 95% CI 2.2-3.8). Adjustment for cancer treatment variables further reduced but did not eliminate this higher risk of death. Although more advanced stage at diagnosis appeared to be a sufficient explanation for poorer cancer outcome in indigenous people whose first language was English, poorer treatment also contributed to, but was still not sufficient to explain, poorer outcome in those who had an indigenous first language. Other factors, possibly including communication difficulties, knowledge of and attitudes to cancer symptoms and treatment and social and cultural 'distance' from mainstream health services, may also be involved.

An innovative rapid response radiotherapy program to reduce waiting time for palliative radiotherapy

BACKGROUND

Waiting for radiation therapy (RT) in Ontario has been a major problem for the past decade. In 1996, the Toronto-Sunnybrook Regional Cancer Centre (TSRCC) initiated a Rapid Response Radiotherapy Program (RRRP) to provide timely palliative RT for symptom relief of patients with terminal cancer.

PURPOSE

This study reviews the clinical activity of the RRRP over the past 8 years to evaluate if we are meeting the objectives of the program.

MATERIALS AND METHODS

From the TSRCC oncology patient information system (OPIS) database, we retrieved the number of patients referred to the RRRP, their demographics, diagnosis and treatment for the calendar years 1996 to 2003 inclusive. We calculated the time interval between referral to consultation, consultation to simulation and the percentage of cases who started RT on their initial consultation for all new cases referred to the RRRP.

RESULTS

From 1996 to 2003, the number of cases seen in consultation increased from just over 200 cases annually in the first 2 years to about 500 cases per year in the last 4 years, for a total of 3,290. There were 1,792 (54%) men and 1,498 (46%) women; median age was 69 years (range, 21-95 years). Breast, lung, genitourinary and gastrointestinal primaries accounted for over 80% of all referrals. The majority was referred for palliative treatment of symptomatic bone (70%) or brain (14%) metastases. The dose fractionation for bone metastases was a single 8-Gy fraction in 45%, 20 Gy in five fractions in 42%, 30 Gy in ten fractions in 4% and other dose fractionations in 9%. Nearly 90% were seen within 2 weeks of referral (38% within 1 week). Eighty-five percent were simulated on the day of their initial consultation. Sixty percent started their RT treatment on the day of their consultation visit. The overall median interval from referral to treatment was 8 days.

CONCLUSION

Over the past 8 years, the annual number of new cases referred to the RRRP has doubled. The overall median interval from referral to consultation was 8 days. Sixty percent were simulated, planned and started treatment on the day of their initial consultation. We therefore are meeting our goal of providing rapid access to palliative RT for symptomatic cancer patients.

The sexual habits of British men and women over 40 years old

OBJECTIVE

To obtain a greater understanding of sexual behaviour and habits among men with and without erectile dysfunction (ED), and their female partners, to improve the management of ED in heterosexual men.

SUBJECTS AND METHODS

A population-based study was conducted amongst men and women aged > 40 years. None of the subjects were partners in the same sexual relationship. Interviews were conducted on the Internet via a panel-based questionnaire.

RESULTS

In all, 225 (32%) men had self-reported ED and 88 (26%) women reported that their partner had ED. For all men (with or without ED) the mean time from first thinking of intercourse to beginning intercourse was just under 1 h. During their most recent period of sexual activity, 87% of men with and 78% of men without ED had intercourse with ejaculation at most once within 24 h; 81% of men and 89% of women felt that it was neither very nor extremely important to have intercourse with ejaculation more than once in a 24-h period.

CONCLUSIONS

This study reports for the first time the frequency of sexual activity in British men and women in heterosexual relationships, and describes the usual timings of sexual events. Few significant differences were identified between men with or with no ED.

Comorbidity of substance misuse and mental illness in community mental health and substance misuse services

BACKGROUND

Improved management of mental illness and substance misuse comorbidity is a National Health Service priority, but little is known about its prevalence and current management.

AIMS

To measure the prevalence of comorbidity among patients of community mental health teams (CMHTs) and substance misuse services, and to assess the potential for joint management.

METHOD

Cross-sectional prevalence survey in four urban UK centres.

RESULTS

Of CMHT patients, 44% (95% CI 38.1-49.9) reported past-year problem drug use and/or harmful alcohol use; 75% (95% CI 68.2-80.2) of drug service and 85% of alcohol service patients (95% CI 74.2-93.1) had a past-year psychiatric disorder. Most comorbidity patients appear ineligible for cross-referral between services. Large proportions are not identified by services and receive no specialist intervention.

CONCLUSIONS

Comorbidity is highly prevalent in CMHT, drug and alcohol treatment populations, but may be difficult to manage by cross-referral psychiatric and substance misuse services as currently configured and resourced.