Abstract P1-06-04: IMPACTS OF TREATMENT DELAY ON BREAST CANCER MORTALITY AND BENEFIT OF TIMELY CARE IN BLACK AND NON-BLACK WOMEN

BACKGROUND: The impact of treatment delays on cancer outcomes has been well documented, but few published studies explicitly attempt to identify subgroups which would benefit the most from potential interventions improving timeliness of care. Using the state of North Carolina and breast cancer as an example, we sought to quantify race-specific associations between frontline treatment delay and breast cancer mortality, and estimate the potential impact of improvements in timeliness by racial sub-group. METHODS: We conducted a retrospective cohort study, utilizing multipayer insurance claims linked to cancer registry data from the Cancer Information and Population Health Resource, of females diagnosed with stage I-III breast cancer from 2004 to 2014. Our exposure of interest was treatment delay, defined as initial cancer directed therapy received ≥ 60 days after diagnosis. Our outcome was death certificate identified breast cancer mortality within 5-years of follow-up. To quantify the association between treatment delay and mortality we estimated hazard ratios (HR) and 95% confidence limits (CL) where non-breast cancer deaths were treated as competing events. We then simulated the effect of treating all patients within 60 days using inverse probability of treatment weighting (IPTW), and estimated the potential impact by comparing the simulated data with observed data. Models were adjusted for age and stage at diagnosis, tumor grade, hormone receptor status, and modality of first treatment. Models were stratified by race, dichotomized as Black or non-Black, and geographic subregion for evaluation. RESULTS: Our analytic cohort comprised 21,200 patients, of whom 19% were Black. Treatment delays >60 days were twice as frequent among Black compared with non-Black patients (13.5% vs. 6.5%). We found a positive association between treatment delay and breast cancer mortality in the overall cohort (HR=1.3; CL: 1.1, 1.6). The association differed between Black (HR=1.4; CL: 1.1, 1.8) and Non-Black (HR=1.2; CL: 0.9, 1.6) patient subgroups. For both racial groups, the strength of the relationship between treatment delay and mortality varied across geographic subregions. The estimated potential improvement in 5-year cumulative breast cancer mortality from delivering timely care to all patients differed in magnitude across sub-populations. The magnitude of potential improvement in breast cancer mortality at 5 years in the overall analytic cohort was 0.3% (5-year risk of breast cancer mortality in observed cohort: 7.2% vs 6.9% with simulated universal timely treatment). In the Black subcohort, the potential decrease in mortality for timely treatment was 1.0% (observed: 12.3% vs simulated: 11.4%), while in the non-Black population the potential decrease was 0.1% (observed: 6.1% vs simulated: 5.9%). CONCLUSIONS: The magnitude of association between delayed treatment of stage I-III breast cancer and breast cancer mortality differed between Black and non-Black patients, highlighting that interventions to avert treatment delays may have a meaningful impact for this group. Further research is needed to identify factors underlying this difference, which may include a direct effect of differences in timeliness, or downstream differences in the intensity and quality of cancer care beyond the 60-day landmark for delayed patients. Our findings suggest that comprehensive intervention at the state level to improve the timeliness of breast cancer treatment could potentially reduce breast cancer mortality, and that targeting such intervention to patient groups with larger projected benefit, such as Black patients, may be a more efficient use of resources. We have illustrated how a counterfactual approach may be useful in identifying subgroups where focused intervention efforts may yield greater improvements in outcomes.

Citation Format: Bradford Jackson, Stephanie Wheeler, Juan Yanguela, Matthew LeBlanc, Tzy-Mey Kuo, Christopher Baggett, Katherine Reeder-Hayes. IMPACTS OF TREATMENT DELAY ON BREAST CANCER MORTALITY AND BENEFIT OF TIMELY CARE IN BLACK AND NON-BLACK WOMEN [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-06-04.

Safety and efficacy of tenecteplase in patients with wake-up stroke assessed by non-contrast CT (TWIST): a multicentre, open-label, randomised controlled trial

BACKGROUND

Current evidence supports the use of intravenous thrombolysis with alteplase in patients with wake-up stroke selected with MRI or perfusion imaging and is recommended in clinical guidelines. However, access to advanced imaging techniques is often scarce. We aimed to determine whether thrombolytic treatment with intravenous tenecteplase given within 4·5 h of awakening improves functional outcome in patients with ischaemic wake-up stroke selected using non-contrast CT.

METHODS

TWIST was an investigator-initiated, multicentre, open-label, randomised controlled trial with blinded endpoint assessment, conducted at 77 hospitals in ten countries. We included patients aged 18 years or older with acute ischaemic stroke symptoms upon awakening, limb weakness, a National Institutes of Health Stroke Scale (NIHSS) score of 3 or higher or aphasia, a non-contrast CT examination of the head, and the ability to receive tenecteplase within 4·5 h of awakening. Patients were randomly assigned (1:1) to either a single intravenous bolus of tenecteplase 0·25 mg per kg of bodyweight (maximum 25 mg) or control (no thrombolysis) using a central, web-based, computer-generated randomisation schedule. Trained research personnel, who conducted telephone interviews at 90 days (follow-up), were masked to treatment allocation. Clinical assessments were performed on day 1 (at baseline) and day 7 of hospital admission (or at discharge, whichever occurred first). The primary outcome was functional outcome assessed by the modified Rankin Scale (mRS) at 90 days and analysed using ordinal logistic regression in the intention-to-treat population. This trial is registered with EudraCT (2014-000096-80), ClinicalTrials.gov (NCT03181360), and ISRCTN (10601890).

FINDINGS

From June 12, 2017, to Sept 30, 2021, 578 of the required 600 patients were enrolled (288 randomly assigned to the tenecteplase group and 290 to the control group [intention-to-treat population]). The median age of participants was 73·7 years (IQR 65·9-81·1). 332 (57%) of 578 participants were male and 246 (43%) were female. Treatment with tenecteplase was not associated with better functional outcome, according to mRS score at 90 days (adjusted OR 1·18, 95% CI 0·88-1·58; p=0·27). Mortality at 90 days did not significantly differ between treatment groups (28 [10%] patients in the tenecteplase group and 23 [8%] in the control group; adjusted HR 1·29, 95% CI 0·74-2·26; p=0·37). Symptomatic intracranial haemorrhage occurred in six (2%) patients in the tenecteplase group versus three (1%) in the control group (adjusted OR 2·17, 95% CI 0·53-8·87; p=0·28), whereas any intracranial haemorrhage occurred in 33 (11%) versus 30 (10%) patients (adjusted OR 1·14, 0·67-1·94; p=0·64).

INTERPRETATION

In patients with wake-up stroke selected with non-contrast CT, treatment with tenecteplase was not associated with better functional outcome at 90 days. The number of symptomatic haemorrhages and any intracranial haemorrhages in both treatment groups was similar to findings from previous trials of wake-up stroke patients selected using advanced imaging. Current evidence does not support treatment with tenecteplase in patients selected with non-contrast CT.

FUNDING

Norwegian Clinical Research Therapy in the Specialist Health Services Programme, the Swiss Heart Foundation, the British Heart Foundation, and the Norwegian National Association for Public Health.

Incidence, Mechanisms, and Characteristics of Injuries in Pole Dancers: A Prospective Cohort Study

OBJECTIVE

Pole dancing is a challenging physical activity. Prospective injury studies in pole dancing are lacking. The aim of this study was to describe the incidence, mechanisms, and characteristics of injuries in pole dancers.

METHODS

A total of 66 pole dancers from 41 studios across Australia were prospectively followed over 12 months. An intake questionnaire was administered including items on pole dancers' demographics and training characteristics. Exposure was assessed using a daily online training diary. Self-reported injury data were collected via an incident report form and subsequently coded using the Orchard Sports Injury Classification System. Injuries occurring during pole-specific and pole-related activities were included in the analyses.

RESULTS

The sample included 63 females and 3 males, mean age 32.3 ± 8.9 years and mean pole training experience 3.5 ± 2.8 years. 25 of 66 participants completed the full study. The 1-year incidence of all new injuries was 8.95/1,000 exposure hours (95% CI 6.94 - 10.96), 7.65/1,000 hrs (95% CI 5.79 - 9.51) for pole-specific injuries and 1.29/1,000 hrs (95% CI 0.53 - 2.06) for pole-related injuries. A total of 103 injuries occurred, 62.1% of which were sudden onset and 37.9% gradual onset. Mechanism of onset included 54.4% acute and 45.6% repetitive in nature. Shoulder (20.4%) and thigh (11.7%, majority ham¬string) were the most reported anatomic injury sites. Non-contact mechanisms accounted for the majority of injuries (57.3%). The most reported primary contributor to injury onset at the shoulder were manoeuvres characterised by loaded internal humeral rotation (33.3%), and at the hamstring were manoeuvres and postures involving front splits (100.0%).

CONCLUSION

The findings indicate that pole dancers are at high risk for injuries. Future research is needed to understand the biomechani¬cal demand of manoeuvres and training characteristics of pole dancing (e.g., workload and recovery) to guide the development of preventative interventions, particularly targeted toward the shoulder and hamstring.

Experiential Family Intervention for Children and Youth

Introduction

Reviews suggest that family interventions including family therapy are effective for a range of disorders in youth. Family sculpting is used in different clinical settings to help young patients, their parents and siblings when words are not enough.

Objectives

Participants will be able to understand the clinical relevance of family sculpting: shifting from discussions about family problems to physical representations of family dynamics and how to apply in their practice.

Methods

There will be a brief overview of the general principle of family sculpting followed by clinical vignettes of patients combined with videos of the intervention. These examples will guide the discussion on how relevant in our clinical work this therapeutic practice may be. This variation on sculpting incorporates theater warmup exercises and therapists joining the family experience.

Results

Family sculpting captures an immediate picture of the family dynamics that is a therapeutic turning point for families and gives voice to the children. The clinical cases and videos will guide clinicians on how to integrate into their own practice.

Conclusions

This presentation will make possible integrating family sculpting into your own practice, providing an engaging alternative modality for complex cases.

Disclosure

No significant relationships.

Longitudinal integrated clerkship evaluations in UK medical schools: a narrative literature review

PURPOSE

Longitudinal Integrated Clerkships (LICs) are a recognised model of curriculum design used internationally as an alternative to traditional block rotations in medical schools that have been shown to offer a multitude of educational benefits. As a relatively new development in the United Kingdom (UK), it is not yet clear whether these benefits will translate into a UK healthcare context. This article provides an early review of evaluations of UK LIC programmes.

METHODS

A narrative literature review of LIC programme evaluations in UK medical schools.

RESULTS

UK students and faculty found value in the LIC programmes with reported benefits including continuity of relationships, increased responsibility and purpose for students, a patient-centred approach and development of professional skills. However, students and GP tutors expressed initial anxieties adapting to the newness of the programme design and preparedness for exams.

CONCLUSIONS

UK LIC programmes appear to be offering benefits for UK medical students and faculty members including personal and professional development in line with international literature. However, the current data is limited with significant gaps that need addressing for the impacts to be fully realised.

Induction of specific brain oscillations may restore neural circuits and be used for the treatment of Alzheimer's disease

Brain oscillations underlie the function of our brains, dictating how we both think and react to the world around us. The synchronous activity of neurons generates these rhythms, which allow different parts of the brain to communicate and orchestrate responses to internal and external stimuli. Perturbations of cognitive rhythms and the underlying oscillator neurons that synchronize different parts of the brain contribute to the pathophysiology of diseases including Alzheimer's disease, (AD), Parkinson's disease (PD), epilepsy and other diseases of rhythm that have been studied extensively by Gyorgy Buzsaki. In this review, we discuss how neurologists manipulate brain oscillations with neuromodulation to treat diseases and how this can be leveraged to improve cognition and pathology underlying AD. While multiple modalities of neuromodulation are currently clinically indicated for some disorders, nothing is yet approved for improving memory in AD. Recent investigations into novel methods of neuromodulation show potential for improving cognition in memory disorders. Here, we demonstrate that neuronal stimulation using audiovisual sensory stimulation that generated 40-HZ gamma waves reduced AD-specific pathology and improved performance in behavioural tests in mouse models of AD, making this new mode of neuromodulation a promising new avenue for developing a new therapeutic intervention for the treatment of dementia.

Frequency shift algorithm: Application to a frequency-domain multiplexing readout of x-ray transition-edge sensor microcalorimeters

In the frequency-domain multiplexing (FDM) scheme, transition-edge sensors (TESs) are individually coupled to superconducting LC filters and AC biased at MHz frequencies through a common readout line. To make efficient use of the available readout bandwidth and to minimize the effect of non-linearities, the LC resonators are usually designed to be on a regular grid. The lithographic processes, however, pose a limit on the accuracy of the effective filter resonance frequencies. Off-resonance bias carriers could be used to suppress the impact of intermodulation distortions, which, nonetheless, would significantly affect the effective bias circuit and the detector spectral performance. In this paper, we present a frequency shift algorithm (FSA) to allow off-resonance readout of TESs, while preserving the on-resonance bias circuit and spectral performance, demonstrating its application to the FDM readout of an x-ray TES microcalorimeter array. We discuss the benefits in terms of mitigation of the impact of intermodulation distortions at the cost of increased bias voltage and the scalability of the algorithm to multi-pixel FDM readout. We show that with FSA, in the multi-pixel and frequencies shifted on-grid, the line noises due to intermodulation distortion are placed away from the sensitive region in the TES response and the x-ray performance is consistent with the single-pixel, on-resonance level.

A peer support intervention for first-time mothers: Feasibility and preliminary efficacy of the mummy buddy program

BACKGROUND

The transition to motherhood, although joyous, can be highly stressful, and the availability of professional postpartum support for mothers is often limited. Peer volunteer support programs may offer a viable and cost-effective method to provide community-based support for new mothers.

AIM

To determine the feasibility of a peer volunteer support program-The Mummy Buddy Program-in which experienced volunteer mothers are paired with, and trained to offer social support to, first-time mothers.

METHODS

Using a single-group non-randomised feasibility trial, a total of 56 experienced mothers participated in the Mummy Buddy training program, which was focused on education and practical exercises relating to the provision of various forms of social support. Experienced mothers ('Mummy Buddies') were subsequently paired with expectant first-time mothers (n=47 pairs), and were encouraged to provide support until 24-weeks postpartum.

FINDINGS

In terms of key feasibility considerations, 95.1% of Mummy Buddies felt that they were trained sufficiently to perform their role, and 85.8% of New Mothers were satisfied with the support provided by their Buddy. Analyses of preliminary efficacy (i.e., program outcomes) revealed that the first-time mothers maintained normal levels of stress and depressive symptomology, and possessed relatively strong maternal functioning, across the program duration.

CONCLUSION

The Mummy Buddy Program appears to be a feasible and potentially valuable peer volunteer support program for first-time mothers. This study provides a foundation for program expansion and for work designed to examine program outcomes-for first-time mothers, Mummy Buddies, and entire family units-within a sufficiently-powered randomised controlled trial.

What’s in a Name? Comparative Analysis of Laboratory Test Naming Guidelines as Applied to Common Confusing Test Names

Introduction/Objective

Laboratory test names frequently do not enable easy understandability or promote correct test utilization, which leads to difficulty for providers in finding the correct test and results in unnecessary cost and medical errors. Laboratory test names are also largely unstandardized and are not named by a consistent set of conventions. To address these issues, the TRUU-Lab (Test Renaming for Understanding & Utilization) initiative aims to generate a consensus test naming guideline for better human understandability of laboratory test names. These studies address the first aim of the TRUU-Lab initiative: to identify root causes and challenges in understanding and using laboratory test names.

Methods

We conducted survey studies to capture the most problematic laboratory test names, then performed analysis of these names to identify aspects of these names that led to confusion among providers. A subset of these test names were used to evaluate five existing laboratory test naming guidelines (LOINC, ONC TigerTeam, Pan- Canadian iEHR Viewer Name, Standards for Pathology Informatics (Australia), and ARUP Laboratories internal style guides) for their ability to produce understandable test names.

Results

274 survey responses yielded ~100 unique laboratory tests cited as confusing, and highlighted substantial diversity both in the names of these tests between institutions and in respondent opinion on the best alternative names. The top 10 most commonly-cited tests yielded ≥ 3 unique names, and the top 2 tests (Vitamin D and anti- factor Xa) yielded ≥ 10 unique names. Post-survey analysis identified eight characteristics associated with poor understandability of a test name, including ambiguity, abbreviations, homophones, multiple indications for a single test, proprietary names, synonyms, truncation, and “panels” where components are obfuscated. Existing guidelines produced highly variable names given the same prompt, and varied in their ability to avoid pitfalls associated with poor understandability.

Conclusion

These studies highlight aspects of existing laboratory test names that lead to confusion among ordering providers, and identify the inability of existing laboratory test naming practices to adequately address these issues. Efforts are ongoing within TRUU-Lab to use these results to inform novel laboratory test naming guidelines to promote universal human understandability.

TRUU-Lab: Methods for Optimizing Test Names for Understanding and Utilization

Introduction/Objective

Poor understandability of laboratory test names increases the risk for inappropriate test utilization and medical errors. Yet, human understandability has not been a major consideration in existing laboratory test names or naming guidelines. TRUU-Lab (Test Renaming for Understanding and Utilization for Laboratory Test Names) is a national initiative that now has more than 45 members representing more than 20 academic and industry organizations, the CDC, and the FDA. The goals of the initiative include: 1) Identify root causes and challenges in understanding and using laboratory test names; 2) Share resources related to potential solutions; 3) Develop consensus guidelines for laboratory test naming; 4) Establish consensus names for existing laboratory tests; and 5) Promote the adoption and implementation of consensus laboratory test names.

Methods

We previously addressed the first two goals of this initiative by identifying problematic test names and features of test names that contribute to misutilization. We also identified the advantages and limitations of current test naming guidelines and previous standardization efforts. This current study addresses goals 3 and 4. We developed an iterative process of guideline development. This process includes collecting feedback on consensus names to improve guidelines, which then informs the improvement of the consensus names.

Results

By analyzing test name characteristics, we found that the requirements for understandability vary with respect to the clinical scenario and provider background. We have used these results to design a 30-min long survey to test candidate names. The survey will be distributed through the Brand Institute, which offers expertise in pharmaceutical name and brand identity development. This pilot survey will be sent to primary care providers to assesses intuitive name preferences given a short and specific prompt. The second phase will take place in a simulated electronic medical record environment to present clinical scenarios where physicians will select an appropriate test.

Conclusion

We expect that results from survey studies will directly inform the development of TRUU-Lab naming guidelines, in turn permitting development of better-optimized laboratory test names. This process represents a new strategy for the intentional design of laboratory test names that are understandable and promote correct provider utilization.

FRI0501 CARDIOVASCULAR DISEASE RISK ASSESSMENT IN PATIENTS WITH FAMILIAL MEDITERRANEAN FEVER RELATED AMYLOIDOSIS

Background:

FMF is an autosomal recessive disorder. Systemic inflammation in autoinflammatory disorders cause secondary systemic AA amyloidosis, which has been suggested as an important contributing factor to the excess cardiovascular disease (CVD) risk in patients with FMF.

Objectives:

Our aim was to investigate the CVD-related clinical outcomes in patients with FMF-related amyloidosis and to define risk factors for CVD events (CVDEs).

Methods:

A cross-sectional evaluation with prospective follow-up of consecutive patients with FMF-related amyloidosis or other non-diabetic primary glomerulonephropathy (PGN) was performed. Patients were followed for CVDEs. Flow-mediated dilatation (FMD), FGF-23 levels, serum lipid levels, hsCRP, BMI and homeostasis model assessment (HOMA) were assessed. A Cox regression analysis was performed to evaluate the probability of CVDEs associated with each risk factor.

Results:

There were 107 patients in FMF-related amyloidosis group and 126 patients with PGN group. Forty-seven CVDEs were registered during the 4.2-years follow up; all 28 patients in the FMF-related amyloidosis versus 14/19 patients with PGN group who developed CVDEs before 40 years of age (P=0.002) (Figure 1). CVD mortality was 2.8 times higher (95% CI 1.02-7.76, p=0.03) in patients with FMF-related amyloidosis (n=12) than PGN (n=5). Mortality due to CVD was higher in patients less than 40 years old with amyloidosis than PGN (12/107 and 3/126 respectively, RR=4.71, 95% CI 1.36-16.25, p=0.006). Patients with CVDEs had higher levels of proteinuria, hsCRP and FGF23, and lower FMD compared to patients without CVDEs. Across both groups, FGF23 and FMD levels were independently associated with the risk of CVDEs (Table 1).

Table 1.

Multivariate analysis of factors associated with the risk of suffering a cardiovascular event

BHR95.0% CI for Exp(B)pVariablesLowerUpperAll GroupsFGF23.0331.0341.0171.051<.001FMD-.946.388.262.575<.001PrimaryFGF23.0501.0511.0191.084.002glomerulopathyFMD-.651.522.300.908.021AmyloidosisFGF23.0341.0351.0121.058.003FMD-1.531.216.109.430<.001hsCRP-.040.961.9151.009.108

FMD, Flow-mediated dilatation; hsCRP, high sensitivity C reactive protein; CI, Confidence interval

Figure 1.

Comparison of cardiovascular disease survival between patients with FMF-related amyloidosis or primary glomerulopathy.

Conclusion:

Patients with FMF-related amyloidosis are at increased risk of CVDEs with early mortality age. These patients should be closely monitored and if inflammation is poorly controlled with colchicine, biological agents must be added to treatment even if they develop amyloidosis. We also found that hsCRP, FGF 23 and FMD levels were the strongest predictors of CVD risk in patients with FMF. These biomarkers can stratify risk of early CVD in patients with FMF-related amyloidosis.

References:

[1] Yilmaz, M.I., et al.,Endothelial function in patients with familial Mediterranean fever-related amyloidosis and association with cardiovascular events.Rheumatology (Oxford), 2014.53(11): p. 2002-8.

Disclosure of Interests:

None declared

Cholecystectomy does not worsen progression or outcomes in non-alcoholic fatty liver disease

Background

Cholecystectomy is a frequently performed surgical procedure for symptomatic cholelithiasis, which is reported to be more common in patients with non-alcoholic steatohepatitis (NASH), given the common risk factors. However, the data remains unclear on the association of cholecystectomy with NASH. We performed a retrospective study to examine the association of cholecystectomy and NASH.

Methods

Medical charts of patients with steatohepatitis related liver disease at a tertiary care center from 2004 to 2011 were stratified by cholecystectomy and defined by its history and/or absence of gallbladder on ultrasonography. Logistic regression model was built for predictors of cholecystectomy. Patients with NASH were stratified based on timing of cholecystectomy. The diagnosis of NASH and timing of cholecystectomy were compared based on baseline characteristics and outcomes (liver disease complications and survival) on follow up. Kaplan-Meier curves were generated for the two group comparisons. Chi-square and unpaired t-tests were used for comparing outcomes on follow up. P value <0.05 was considered significant.

Results

Analysis of 584 patients [379 non-alcoholic fatty liver disease (NAFLD)] showed that patients with cholecystectomy (N=191) were more likely to be female (57% vs. 44%), diabetic (53% vs. 37%), have liver biopsy (43% vs. 25%) and diagnosis of NAFLD (80% vs. 58%) P<0.001 for all. NAFLD diagnosis was associated with 2.79 folds odds of cholecystectomy. Among 379 (192 cholecystectomy) NAFLD patients, cirrhosis and female gender were associated with over 2 and 1.5 folds of cholecystectomy. Of 141 patients with data on timing of cholecystectomy, 55 (39%) with cholecystectomy at or after NAFLD diagnosis vs. 86 with cholecystectomy within median of 6 years prior to NAFLD diagnosis were similar on all characteristics except on model for end-stage liver disease (MELD) score (9.2±8.4 vs. 6.4±7.1, P=0.045). Of 28 with available histology data, there were no differences on histology based on timing of cholecystectomy. On a median follow up of 5 years, timing of cholecystectomy did not impact on development of cirrhosis (74% vs. 67%, P=0.45), ascites (31% vs. 38%, P=0.76), variceal bleeding (11% vs. 16%, P=0.44), hepatic encephalopathy (22% vs. 29%, P=0.74), hepatocellular carcinoma (HCC) (15% vs. 9%, P=0.59), and patient survival (95% vs. 98%, P=0.3).

Conclusions

Cholecystectomy is associated with NAFLD diagnosis. We did not find cause and effect of cholecystectomy in the development of severity of NAFLD. Prospective studies are suggested to examine the role of cholecystectomy and bile acids in the pathogenesis of NAFLD.

Diverse strains of Actinobacillus lignieresii isolated from clinically affected cattle in a geographically restricted area

OBJECTIVE

To investigate whether an outbreak of Actinobacillus lignieresii was caused by one or multiple strains.

METHODS

Nine isolates of A. lignieresii were obtained from the lymph nodes of 15 affected cattle from two farms to determine whether a single strain was involved. An enterobacterial repetitive insertion consensus sequence (ERIC) PCR was used for genotyping, and the repeats-in-toxin genes were analysed by PCR and sequencing.

RESULTS

Isolates from the two farms belonged to two and three genotypes, with a total of four genotypes detected. Genes of the apxICABD operons of some strains had deletions in the apxIA (~697 bp) and in the apxID (~187 bp) genes. The toxin gene deletions and the ERIC PCR patterns suggested the involvement of different A. lignieresii genotypes.

CONCLUSION

There was no evidence that a unique genotype was associated with actinobacillosis on the two farms, confirming that this disease was associated with other contributing factors.

A six-degree-of-freedom micro-vibration acoustic isolator for low-temperature radiation detectors based on superconducting transition-edge sensors

Dilution and adiabatic demagnetization refrigerators based on pulse tube cryocoolers are nowadays used in many low temperature physics experiments, such as atomic force and scanning tunneling microscopy, quantum computing, radiation detectors, and many others. A pulse tube refrigerator greatly simplifies the laboratory activities being a cryogen-free system. The major disadvantage of a pulse tube cooler is the high level of mechanical vibrations at the warm and cold interfaces that could substantially affect the performance of very sensitive cryogenic instruments. In this paper, we describe the performance of a very simple mechanical attenuation system used to eliminate the pulse-tube-induced low frequency noise of the superconducting transition-edge sensors under development for the instruments of the next generation of infra-red and X-ray space observatories.

Erratum to: Measurement of the W boson polarisation in t t ¯ events from pp collisions at s = 8 TeV in the lepton + jets channel with ATLAS

[This corrects the article DOI: 10.1140/epjc/s10052-017-4819-4.].

Impact of exercise on productivity, behavior, and immune functioning of weaned Bos indicus-cross calves housed in drylots

The effects of 2 exercise regimes on cattle productivity, immune function, and behavior were evaluated against a control ( = 4 pens/treatment) using weaned -cross calves ( = 203) housed in drylots (16-18 calves/single sex pens). Three treatments were applied 3 times per week for 4 wk: 1) programmatic exercise (PRO), in which cattle and a stockperson walked in the alleyway behind their home pen for 20 min; 2) free exercise (FREE), in which cattle were moved into the drovers alley for 60 min, not exercised by a stockperson, and were allowed free access to their home pen and alleyway; and 3) control (CON), in which calves were removed from their home pen only for routine husbandry. Behavior observations were conducted on d -2 and -1 relative to treatment implementation (d 0) and on d 5, 6, 12, 13, 19, 20, 26, and 27. Instantaneous scan sampling was used to create behavioral profiles for cattle (posture: stand, lie, and walk; and behavior: feed, drink, and ruminate). Focal observations recorded the incidence of social behaviors (allogrooming, social play, and agonistic interactions) and animal-environment interactions (AEI; fencepost licking, rock eating, tongue rolling, and cross-suckling). Body weights, exit velocities, and antibody titers to a bovine viral diarrhea virus type 1b vaccine were measured on d -10, 10, and 28. A linear mixed model (PROC MIXED) was used to evaluate the impact of exercise treatment, sex, time, and their interactions on cattle behavior, health, and productivity. Statistical differences were not observed ( = 0.11) for overall ADG among cattle receiving FREE (1.00 kg ± 0.04) PRO (0.85 kg ± 0.04), or CON (0.86 kg ± 0.05) exercise treatments. Allogrooming ( = 0.05), lying ( < 0. 01), AEI ( < 0.01), rumination ( < 0.01), and agonistic interactions ( < 0.01) increased over time. Comfort-related behaviors (e.g., lying, rumination) increased over the evaluation period, suggesting that calves became acclimated to the environment. Exercise did not alter behaviors or vaccine response and did not reduce the performance of production-critical (e.g., feeding, resting, ruminating) behaviors.

Beak and feather disease virus carriage by Knemidocoptes pilae in a sulphur-crested cockatoo (Cacatua galerita)

BACKGROUND

This paper describes the pathology associated with psittacine beak and feather disease in a wild sulphur-crested cockatoo with concurrent knemidocoptic mange, cestodiasis and mycotic encephalitis.

METHODS & RESULTS

Large numbers of Knemidocoptes pilae Lavoipierre and Griffiths, 1951 (Acari: Epidermoptidae, Knemidokoptinae) were identified in affected skin associated with enhanced expression of beak and feather disease virus (BFDV) determined by immunohistochemistry. Also, BFDV antigen was demonstrated in high concentration in the gut and faecal sacs of mites, raising the possibility of ectoparasites as fomites and vectors of BFDV transmission. Large numbers of Raillietina spp. cestodes were present in the intestines. Within the brain there was a focally extensive region of necrosis and inflammation associated with branching, septate, pigmented hyphae consistent with zygomycete fungal infection.

CONCLUSION

This case highlights the potential immunosuppressive effects of BFDV infection and its potential as a keystone pathogen in the Australian environment.

Abattoir surveillance of Sarcocystis spp., Cysticercosis ovis and Echinococcus granulosus in Tasmanian slaughter sheep, 2007-2013

OBJECTIVE

To estimate the prevalence of macroscopic Sarcocystis spp., Cysticercus ovis and Echinococcus granulosus recorded at routine postmortem inspection of Tasmanian slaughter sheep during 2007 to 2013.

METHODS

A retrospective analysis of routine postmortem meat inspection data maintained on 352,325 Tasmanian adult slaughter sheep inspected across nine abattoirs in Tasmania, Victoria and South Australia as part of the National Sheep Health Monitoring Project (NSHMP).

RESULTS

During the period 1 September 2007 to 30 June 2013, the estimated prevalence of macroscopic Sarcocystis spp. was 14.3%, C. ovis was 3.2% and E. granulosus was 0.01%. Mean Sarcocystis spp. line prevalence ranged from 0% to 33.5%. Significant between-abattoir differences in the level of sarcosporidiosis (P < 0.001) and C. ovis were found (P < 0.001). Overall, very low levels of hydatidosis were recorded throughout the surveillance period. Predicted within-line prevalence of macroscopic sarcocysts in animals coming from a known/recorded local government area (LGA) (P < 0.001) was lower than that of lines where the LGA was unknown or not recorded. A higher prevalence of sarcocystosis was recorded in lines of sheep aged ≥ 2 years compared with those < 2 years (P < 0.001).

CONCLUSION

Reasons for the significant between-abattoir differences in recorded levels of ovine sarcosporidiosis and cysticercosis remain unknown, but may represent sampling bias, with subsets of slaughter sheep going to abattoirs with different tiers or access to markets. Further investigation into apparent differences, including epidemiological studies of properties with high lesion prevalence, comparing meat inspector diagnostic sensitivity, assessing the effect of line speed and tiers and market access in different abattoirs, may be useful.

Outcomes of fluoroscopic and ultrasound-guided placement versus laparoscopic placement of peritoneal dialysis catheters

Background

Several peritoneal dialysis catheter (PDC) placement techniques have been described. The objective of this study was to compare the fluoroscopy and ultrasound guidance technique with the laparoscopic technique.

Methods

We retrospectively reviewed the medical records of 260 patients who had their first PDC placed between January 2005 and June 2016. We compared the outcomes of the fluoroscopic and ultrasound-guided catheter placement technique (radiologic group, n = 50) with the laparoscopic catheter placement technique (laparoscopic group, n = 190). The primary endpoint was complication-free catheter survival at 365 days. Secondary endpoints were complication-free catheter survival at 90 days, overall catheter survival at 90 and 365 days, median days to first complication and median days to catheter removal.

Results

In the radiologic group, the complication-free catheter survival at 90 and 365 days was 64% and 48%, respectively, while in the laparoscopic group it was 71% (P = 0.374) and 53% (P = 0.494), respectively. Catheter malfunction was significantly higher in the laparoscopic group (30%) compared with the radiologic group (16%, P = 0.048). The overall catheter survival at 90 and 365 days was 76% and 52%, respectively, in the radiologic group, while in the laparoscopic group it was 88% (P = 0.0514) an 48% (P = 0.652), respectively. There was no significant difference in the median days to first complication and the median days to catheter removal between the two groups (P = 0.71).

Conclusion

The technique of fluoroscopic and ultrasound-guided PDC placement is a clinically effective and safe alternative to laparoscopic catheter placement with similar survival and complication rates.

Biomarkers of Renal Injury in Cirrhosis: Association with Acute Kidney Injury and Recovery after Liver Transplantation

BACKGROUND

To define urine or serum biomarkers in predicting renal function recovery after liver transplantation (LT).

METHODS

Adults listed for LT (February 2011-July 2014) and with modified diet for renal disease-6 (MDRD-6) <60 mL/min provided urine/blood samples at baseline and serially until LT for biomarkers in serum (pg/mL) and urine (pg/mg creatinine).

RESULTS

Of 271 LT listed patients (mean age 57 years, 63% males, median listing MELD 17.5), 1 year acute kidney injury (AKI) probability was 49%, with odds of 1.3-, 3.0-, 4.6-, and 8.5-fold times for listing MELD 16-20, 21-25, 26-30, and >30, compared to MELD <16. Thirty-seven people died over 1 year from the time of listing, with twofold increased odds with AKI. Among 67 patients with MDRD <60, only urinary epidermal growth factor was different comparing AKI (increase in serum creatinine ≥0.3 mg/dL from baseline within past 3 months) vs. no AKI (2,254 vs. 4,253, p = 0.003). Differences between acute tubular necrosis (ATN) and hepatorenal syndrome could not be ascertained for a small sample of 3 patients with ATN. Analyzing 15 of 43 receiving LT and MDRD-6 <30 prior to LT, biomarkers were not different comparing 5 patients recovering renal function (MDRD-6 >50 mL/min) at 6 months vs. 10 without recovery.

CONCLUSIONS

AKI is common among LT listed patients, with a negative impact on transplant-free survival. Serum and urine biomarkers are not associated with the recovery of renal function after LT. Multicenter studies are suggested to (a) develop strategies to reduce the development of AKI and (b) derive novel biomarkers for use in accurately predicting renal recovery after LT.

Fiducial, total and differential cross-section measurements of t-channel single top-quark production in pp collisions at 8 TeV using data collected by the ATLAS detector

Detailed measurements of t-channel single top-quark production are presented. They use 20.2 fb[Formula: see text] of data collected by the ATLAS experiment in proton-proton collisions at a centre-of-mass energy of 8 TeV at the LHC. Total, fiducial and differential cross-sections are measured for both top-quark and top-antiquark production. The fiducial cross-section is measured with a precision of 5.8% (top quark) and 7.8% (top antiquark), respectively. The total cross-sections are measured to be [Formula: see text] for top-quark production and [Formula: see text] for top-antiquark production, in agreement with the Standard Model prediction. In addition, the ratio of top-quark to top-antiquark production cross-sections is determined to be [Formula: see text]. The differential cross-sections as a function of the transverse momentum and rapidity of both the top quark and the top antiquark are measured at both the parton and particle levels. The transverse momentum and rapidity differential cross-sections of the accompanying jet from the t-channel scattering are measured at particle level. All measurements are compared to various Monte Carlo predictions as well as to fixed-order QCD calculations where available.

Topological cell clustering in the ATLAS calorimeters and its performance in LHC Run 1

The reconstruction of the signal from hadrons and jets emerging from the proton-proton collisions at the Large Hadron Collider (LHC) and entering the ATLAS calorimeters is based on a three-dimensional topological clustering of individual calorimeter cell signals. The cluster formation follows cell signal-significance patterns generated by electromagnetic and hadronic showers. In this, the clustering algorithm implicitly performs a topological noise suppression by removing cells with insignificant signals which are not in close proximity to cells with significant signals. The resulting topological cell clusters have shape and location information, which is exploited to apply a local energy calibration and corrections depending on the nature of the cluster. Topological cell clustering is established as a well-performing calorimeter signal definition for jet and missing transverse momentum reconstruction in ATLAS.

Measurements of the production cross section of a [Formula: see text] boson in association with jets in pp collisions at [Formula: see text] TeV with the ATLAS detector

Measurements of the production cross section of a [Formula: see text] boson in association with jets in proton-proton collisions at [Formula: see text] TeV are presented, using data corresponding to an integrated luminosity of 3.16 fb[Formula: see text] collected by the ATLAS experiment at the CERN Large Hadron Collider in 2015. Inclusive and differential cross sections are measured for events containing a [Formula: see text] boson decaying to electrons or muons and produced in association with up to seven jets with [Formula: see text] GeV and [Formula: see text]. Predictions from different Monte Carlo generators based on leading-order and next-to-leading-order matrix elements for up to two additional partons interfaced with parton shower and fixed-order predictions at next-to-leading order and next-to-next-to-leading order are compared with the measured cross sections. Good agreement within the uncertainties is observed for most of the modelled quantities, in particular with the generators which use next-to-leading-order matrix elements and the more recent next-to-next-to-leading-order fixed-order predictions.

Reconstruction of primary vertices at the ATLAS experiment in Run 1 proton-proton collisions at the LHC

This paper presents the method and performance of primary vertex reconstruction in proton-proton collision data recorded by the ATLAS experiment during Run 1 of the LHC. The studies presented focus on data taken during 2012 at a centre-of-mass energy of [Formula: see text] TeV. The performance has been measured as a function of the number of interactions per bunch crossing over a wide range, from one to seventy. The measurement of the position and size of the luminous region and its use as a constraint to improve the primary vertex resolution are discussed. A longitudinal vertex position resolution of about [Formula: see text] is achieved for events with high multiplicity of reconstructed tracks. The transverse position resolution is better than [Formula: see text] and is dominated by the precision on the size of the luminous region. An analytical model is proposed to describe the primary vertex reconstruction efficiency as a function of the number of interactions per bunch crossing and of the longitudinal size of the luminous region. Agreement between the data and the predictions of this model is better than 3% up to seventy interactions per bunch crossing.

Performance of the ATLAS trigger system in 2015

During 2015 the ATLAS experiment recorded [Formula: see text] of proton-proton collision data at a centre-of-mass energy of [Formula: see text]. The ATLAS trigger system is a crucial component of the experiment, responsible for selecting events of interest at a recording rate of approximately 1 kHz from up to 40 MHz of collisions. This paper presents a short overview of the changes to the trigger and data acquisition systems during the first long shutdown of the LHC and shows the performance of the trigger system and its components based on the 2015 proton-proton collision data.

Measurements of top-quark pair differential cross-sections in the [Formula: see text] channel in pp collisions at [Formula: see text] TeV using the ATLAS detector

This article presents measurements of [Formula: see text] differential cross-sections in a fiducial phase-space region, using an integrated luminosity of 3.2 fb[Formula: see text] of proton-proton data at a centre-of-mass energy of [Formula: see text] TeV recorded by the ATLAS experiment at the LHC in 2015. Differential cross-sections are measured as a function of the transverse momentum and absolute rapidity of the top quark, and of the transverse momentum, absolute rapidity and invariant mass of the [Formula: see text] system. The [Formula: see text] events are selected by requiring one electron and one muon of opposite electric charge, and at least two jets, one of which must be tagged as containing a b-hadron. The measured differential cross-sections are compared to predictions of next-to-leading order generators matched to parton showers and the measurements are found to be consistent with all models within the experimental uncertainties with the exception of the Powheg-Box [Formula: see text] Herwig++ predictions, which differ significantly from the data in both the transverse momentum of the top quark and the mass of the [Formula: see text] system.

Measurement of the W boson polarisation in [Formula: see text] events from pp collisions at [Formula: see text] = 8 TeV in the lepton + jets channel with ATLAS

This paper presents a measurement of the polarisation of W bosons from [Formula: see text] decays, reconstructed in events with one high-[Formula: see text] lepton and at least four jets. Data from pp collisions at the LHC were collected at [Formula: see text] = 8 TeV and correspond to an integrated luminosity of 20.2 fb[Formula: see text]. The angle [Formula: see text] between the b-quark from the top quark decay and a direct W boson decay product in the W boson rest frame is sensitive to the W boson polarisation. Two different W decay products are used as polarisation analysers: the charged lepton and the down-type quark for the leptonically and hadronically decaying W boson, respectively. The most precise measurement of the W boson polarisation via the distribution of [Formula: see text] is obtained using the leptonic analyser and events in which at least two of the jets are tagged as b-quark jets. The fitted fractions of longitudinal, left- and right-handed polarisation states are [Formula: see text], [Formula: see text] and [Formula: see text], and are the most precisely measured W boson polarisation fractions to date. Limits on anomalous couplings of the Wtb vertex are set.

Performance of algorithms that reconstruct missing transverse momentum in [Formula: see text]= 8 TeV proton-proton collisions in the ATLAS detector

The reconstruction and calibration algorithms used to calculate missing transverse momentum ([Formula: see text] ) with the ATLAS detector exploit energy deposits in the calorimeter and tracks reconstructed in the inner detector as well as the muon spectrometer. Various strategies are used to suppress effects arising from additional proton-proton interactions, called pileup, concurrent with the hard-scatter processes. Tracking information is used to distinguish contributions from the pileup interactions using their vertex separation along the beam axis. The performance of the [Formula: see text] reconstruction algorithms, especially with respect to the amount of pileup, is evaluated using data collected in proton-proton collisions at a centre-of-mass energy of 8 [Formula: see text] during 2012, and results are shown for a data sample corresponding to an integrated luminosity of [Formula: see text]. The simulation and modelling of [Formula: see text]  in events containing a Z boson decaying to two charged leptons (electrons or muons) or a W boson decaying to a charged lepton and a neutrino are compared to data. The acceptance for different event topologies, with and without high transverse momentum neutrinos, is shown for a range of threshold criteria for [Formula: see text] , and estimates of the systematic uncertainties in the [Formula: see text]  measurements are presented.

Measurement of jet activity produced in top-quark events with an electron, a muon and two b-tagged jets in the final state in pp collisions at [Formula: see text] TeV with the ATLAS detector

Measurements of jet activity in top-quark pair events produced in proton-proton collisions are presented, using 3.2 fb[Formula: see text] of pp collision data at a centre-of-mass energy of 13 TeV collected by the ATLAS experiment at the Large Hadron Collider. Events are chosen by requiring an opposite-charge [Formula: see text] pair and two b-tagged jets in the final state. The normalised differential cross-sections of top-quark pair production are presented as functions of additional-jet multiplicity and transverse momentum, [Formula: see text]. The fraction of signal events that do not contain additional jet activity in a given rapidity region, the gap fraction, is measured as a function of the [Formula: see text] threshold for additional jets, and is also presented for different invariant mass regions of the [Formula: see text] system. All measurements are corrected for detector effects and presented as particle-level distributions compared to predictions with different theoretical approaches for QCD radiation. While the kinematics of the jets from top-quark decays are described well, the generators show differing levels of agreement with the measurements of observables that depend on the production of additional jets.

Electron efficiency measurements with the ATLAS detector using 2012 LHC proton-proton collision data

This paper describes the algorithms for the reconstruction and identification of electrons in the central region of the ATLAS detector at the Large Hadron Collider (LHC). These algorithms were used for all ATLAS results with electrons in the final state that are based on the 2012 pp collision data produced by the LHC at [Formula: see text] = 8 [Formula: see text]. The efficiency of these algorithms, together with the charge misidentification rate, is measured in data and evaluated in simulated samples using electrons from [Formula: see text], [Formula: see text] and [Formula: see text] decays. For these efficiency measurements, the full recorded data set, corresponding to an integrated luminosity of 20.3 fb[Formula: see text], is used. Based on a new reconstruction algorithm used in 2012, the electron reconstruction efficiency is 97% for electrons with [Formula: see text] [Formula: see text] and 99% at [Formula: see text] [Formula: see text]. Combining this with the efficiency of additional selection criteria to reject electrons from background processes or misidentified hadrons, the efficiency to reconstruct and identify electrons at the ATLAS experiment varies from 65 to 95%, depending on the transverse momentum of the electron and background rejection.

The impact of oral Polypodium leucotomos extract on ultraviolet B response: A human clinical study

BACKGROUND

There is a rationale for adding systemic photoprotective agents to the current photoprotection regimen.

OBJECTIVE

This study was designed to objectively evaluate the molecular and photobiologic effects of oral administration of Polypodium leucotomos extract (PLE).

METHODS

In all, 22 subjects with Fitzpatrick skin phototype I to III were enrolled. On day 1, subjects were irradiated with visible light, ultraviolet (UV) A1, and UVB (using 308-nm excimer laser). Evaluation was done immediately and 24 hours after irradiation. On days 3 and 4, irradiation and evaluation process was repeated after ingestion of PLE.

RESULTS

Clinical assessments and colorimetry data showed a decrease in UVB-induced changes in 17 of 22 subjects post-PLE administration; histology findings demonstrated such a decrease in all 22 subjects.

LIMITATIONS

Only 2 doses of PLE were given. Furthermore, subjects with skin phototypes I to III only were studied.

CONCLUSION

The results suggest that PLE can potentially be used as an adjunctive agent to lessen the negative photobiologic effects of UVB.

Search for triboson [Formula: see text] production in pp collisions at [Formula: see text] [Formula: see text] with the ATLAS detector

This paper reports a search for triboson [Formula: see text] production in two decay channels ([Formula: see text] and [Formula: see text] with [Formula: see text]) in proton-proton collision data corresponding to an integrated luminosity of 20.3 [Formula: see text] at a centre-of-mass energy of 8 [Formula: see text] with the ATLAS detector at the Large Hadron Collider. Events with exactly three charged leptons, or two leptons with the same electric charge in association with two jets, are selected. The total number of events observed in data is consistent with the Standard Model (SM) predictions. The observed 95% confidence level upper limit on the SM [Formula: see text] production cross section is found to be 730 fb with an expected limit of 560 fb in the absence of SM [Formula: see text] production. Limits are also set on WWWW anomalous quartic gauge couplings.

Measurement of the prompt J/[Formula: see text] pair production cross-section in pp collisions at [Formula: see text] TeV with the ATLAS detector

The production of two prompt [Formula: see text] mesons, each with transverse momenta [Formula: see text] GeV and rapidity [Formula: see text], is studied using a sample of proton-proton collisions at [Formula: see text] TeV, corresponding to an integrated luminosity of 11.4 fb[Formula: see text] collected in 2012 with the ATLAS detector at the LHC. The differential cross-section, assuming unpolarised [Formula: see text] production, is measured as a function of the transverse momentum of the lower-[Formula: see text] [Formula: see text] meson, di-[Formula: see text] [Formula: see text] and mass, the difference in rapidity between the two [Formula: see text] mesons, and the azimuthal angle between the two [Formula: see text] mesons. The fraction of prompt pair events due to double parton scattering is determined by studying kinematic correlations between the two [Formula: see text] mesons. The total and double parton scattering cross-sections are compared with predictions. The effective cross-section of double parton scattering is measured to be [Formula: see text] mb.