Visual access to an outdoor range early in life, but not environmental complexity, increases meat chicken ranging behavior

Not all chickens access an outdoor range when the opportunity is provided. This may be related to the abrupt change in environments from the stable rearing conditions to the complexity of the outdoor range. We aimed to prepare chickens to range by increasing the complexity of the indoor environment early in life with the intention to encourage range use. Mixed sex Cobb500 chickens were allocated to 1 of 3 treatment groups: visual access (VA) treatment provided VA to the outdoor range from day old via transparent pop-hole covers; environmental complexity (EC) treatment provided an artificial haybale, fan with streamers and a solid vertical barrier; Control treatment was a representative conventional environment. Chickens were given access to the outdoor range at 21 d of age. Behavior in the home pen was assessed in wk 1, 2 and 5 and individual ranging behavior was monitored through radio frequency identification (RFID) technology. The VA chickens were more active compared to EC (P = 0.006) and Control (P = 0.007) chickens and spent more time foraging than control chickens (P = 0.036) during the first week of life. More VA chickens accessed the range area compared to EC chickens (P = 0.015). VA chickens accessed the range sooner after they were first provided access and spent more time on the range than EC and control chickens (P < 0.001). Mortality was lower in the VA treatment compared to EC (P = 0.024) and control group (P = 0.002). There was evidence that VA chickens weighed less than Control and EC chickens, however results were inconsistent between age and sex. Hence, providing meat chickens with VA to an outdoor range early in life increased activity in early life, decreased latency to first access the range and increased time on the range and lowered mortality. Future work should aim to understand the mechanism behind these changes in behavior to develop recommendations for producers to implement in commercial conditions.

Reprogramming endothelial and vascular smooth muscle cells to prevent and treat hypertension

The major pathophysiological characteristic of hypertension is the occurrence of small artery remodeling and endothelial dysfunction. There is also solid evidence showing that microcirculation abnormalities occur prior to the onset of hypertension. However, the mechanism(s) that trigger these changes prior to the elevation of blood pressure are unknown, and this may limit our ability to identify the cause of this disease and effectively treat it. In hypertension, as with aging, the vasculature becomes less susceptible to repair. One of the reasons is because endothelial cells start to deteriorate and present with exacerbated endothelial-to-mesenchymal transition (EndMT). Likewise, vascular smooth muscle cells (VSMC) also dedifferentiate into a synthetic phenotype, whereby they start to produce and secrete extracellular vesicles with a high migration and proliferation capacity for repairing vascular injury. Uncontrolled EndMT and/or VSMC phenotype switching contributes to vascular diseases, but the initial trigger for these conditions is unidentified. Importantly, EndMT and synthetic VSMC exhibit plasticity and can return to adopt an endothelial cell-like fate and present contractile phenotype again, respectively. Therefore, in this hypothesis we will take advantage of this plasticity, and we propose to manipulate this fate by inducing partial cellular reprogramming without passing through the pluripotent state. Specifically, we suggest that activation of the three master transcription factors, Oct-4, Sox-2, and Klf-4 (collectively termed OSK) will reprogram endothelial cells and prevent and reduce EndMT and VSMC synthetic phenotype. It was recently shown that activation of OSK was able to restore lost vision in old mice, and cancer risk was reduced by excluding c-Myc. Therefore, OSK treatment could provide new possibilities for vascular rejuvenation and treatment of hypertension.

310 A COMPARATIVE ANALYSIS OF THE IRISH POST-GRADUATE GERIATRIC TRAINING SCHEME WITH THE EUROPEAN POST-GRADUATE CURRICULUM IN GERIATRIC MEDICINE

Background

Minimum training recommendations to become a specialist geriatrician in the EU have been published. In this study we sought to evaluate the curriculum of the higher specialist training scheme in Geriatric Medicine in Ireland and examine how it compares with the knowledge recommendations from the European post-graduate curriculum in Geriatric medicine, which is endorsed by both the European Geriatric Medicine Society (EuGMS) and the European Academy of Medicine of Ageing (EAMA).

Methods

In this study we examined the content of didactic study-day lectures given over a five-year rolling period which is the minimum duration of the higher specialist training programme in Geriatric medicine in Ireland. We also examined the published Irish curriculum and compared how both the Irish curriculum and content of the study-days matches up with the 36 items that are identified as the core knowledge content in the European post-graduate curriculum.

Results

There were 24 study days delivered over a five-year time period. The Irish geriatric medicine curriculum formally outlined that 30 of the 36 knowledge areas proposed in the European curriculum should be formally covered during post-graduate geriatric training in Ireland. The European curriculum recommended formal teaching in sarcopenia, sleep disorders, tissue viability, iatrogenic care delivered disorders, sexuality in older adults and geron-technology/e-health, none of which were referred to in the Irish curriculum. However, despite this discrepancy, formal teaching was delivered on 92% (n = 33) of proposed areas. Pain assessment, sleep disorders and tissue viability were areas not covered in Irish didactic study-days. 24 of 36 topics were covered at least twice.

Conclusion

There was high concordance between the content of the Irish and European post-graduate curriculum in Geriatric medicine. Benchmarking against European training standards is an opportunity to ensure that parity of education and training is achieved across the EU.

Cambridge hybrid closed-loop algorithm in children and adolescents with type 1 diabetes: a multicentre 6-month randomised controlled trial

BACKGROUND

Closed-loop insulin delivery systems have the potential to address suboptimal glucose control in children and adolescents with type 1 diabetes. We compared safety and efficacy of the Cambridge hybrid closed-loop algorithm with usual care over 6 months in this population.

METHODS

In a multicentre, multinational, parallel randomised controlled trial, participants aged 6-18 years using insulin pump therapy were recruited at seven UK and five US paediatric diabetes centres. Key inclusion criteria were diagnosis of type 1 diabetes for at least 12 months, insulin pump therapy for at least 3 months, and screening HbA1c levels between 53 and 86 mmol/mol (7·0-10·0%). Using block randomisation and central randomisation software, we randomly assigned participants to either closed-loop insulin delivery (closed-loop group) or to usual care with insulin pump therapy (control group) for 6 months. Randomisation was stratified at each centre by local baseline HbA1c. The Cambridge closed-loop algorithm running on a smartphone was used with either (1) a modified Medtronic 640G pump, Medtronic Guardian 3 sensor, and Medtronic prototype phone enclosure (FlorenceM configuration), or (2) a Sooil Dana RS pump and Dexcom G6 sensor (CamAPS FX configuration). The primary endpoint was change in HbA1c at 6 months combining data from both configurations. The primary analysis was done in all randomised patients (intention to treat). Trial registration ClinicalTrials.gov, NCT02925299.

FINDINGS

Of 147 people initially screened, 133 participants (mean age 13·0 years [SD 2·8]; 57% female, 43% male) were randomly assigned to either the closed-loop group (n=65) or the control group (n=68). Mean baseline HbA1c was 8·2% (SD 0·7) in the closed-loop group and 8·3% (0·7) in the control group. At 6 months, HbA1c was lower in the closed-loop group than in the control group (between-group difference -3·5 mmol/mol (95% CI -6·5 to -0·5 [-0·32 percentage points, -0·59 to -0·04]; p=0·023). Closed-loop usage was low with FlorenceM due to failing phone enclosures (median 40% [IQR 26-53]), but consistently high with CamAPS FX (93% [88-96]), impacting efficacy. A total of 155 adverse events occurred after randomisation (67 in the closed-loop group, 88 in the control group), including seven severe hypoglycaemia events (four in the closed-loop group, three in the control group), two diabetic ketoacidosis events (both in the closed-loop group), and two non-treatment-related serious adverse events. There were 23 reportable hyperglycaemia events (11 in the closed-loop group, 12 in the control group), which did not meet criteria for diabetic ketoacidosis.

INTERPRETATION

The Cambridge hybrid closed-loop algorithm had an acceptable safety profile, and improved glycaemic control in children and adolescents with type 1 diabetes. To ensure optimal efficacy of the closed-loop system, usage needs to be consistently high, as demonstrated with CamAPS FX.

FUNDING

National Institute of Diabetes and Digestive and Kidney Diseases.

33 ARE CLINICAL TRIALS RANDOMISING HOUSEHOLDS TO LIFESTYLE INTERVENTIONS FOR THE PREVENTION OF COGNITIVE DECLINE FEASIBLE?

Background

Dementia is increasing in prevalence worldwide. Several lifestyle factors have been identified as targets for dementia prevention, which may be more effective if targeted at households instead of an individual. To date there have been no clinical trials randomising households to lifestyle interventions of sleep, diet and/or physical activity to prevent cognitive decline. To inform future studies, qualitative approaches can give valuable in-depth insights into the values and beliefs of all household members towards behavioural change.

Methods

Semi structured interviews were carried out among eight households affected by cognitive impairment. Interview content was analysed, and important themes identified.

Results

Eighteen participants were interviewed within household pods. Among those, eight had cognitive impairment and the remainder were spouses or first-degree relatives living in the same home. Several themes of interest emerged including household members without dementia were more likely to report poor sleep habits; sleep was perceived the hardest behaviour to change; although most participants had healthy diets, most were interested in making a change and felt there was a strong link with nutrition and cognition; physical activity is challenging to adapt due to lack of motivation and focus when individuals are cognitively impaired and motivation to pursue physical activity in households centred on relaxation and social interaction.

Conclusion

This study identified beliefs and preferences of households towards lifestyle intervention trials. Barriers to study participation including risk of harm, complexity of intervention and deviation from routine emerged during discussions. Findings from this study should be used to inform future clinical trial protocols and future qualitative studies should explore acceptability and feasibility of digital intervention applications.

112 INTEGRATED CARE PROGRAMME FOR OLDER PEOPLE (ICPOP) IN A RURAL SETTING—ROLE OF ADVANCED NURSE PRACTITIONER (ANP)

Background

Sláintecare advocates for right care, in the right place at the right time. ANPs for Older Persons in the community are uniquely placed to deliver care as close as possible to the older person’s home and to lead a holistic, flexible model of care minimising admission to acute care and maximising existing local resources. A pilot programme aimed at providing ANP led comprehensive geriatric assessment (CGA) (with Geriatrician support) to older people in a defined area commenced in June 2019. This pilot was part of a larger Hub and Spoke model funded by Sláintecare which gave additional MDT support.

Methods

A referral template was designed. Criteria for referral included; age &gt; 75 years, Rockwood Frailty Scale 4–6 (focusing on Falls, Cognitive Impairment and Complex Frailty). Older people on the cusp of requiring long term care (LTC) were also prioritised. A prospective database of patients was maintained by the ANP to evaluate the service.

Results

From June 2019 to August 2021, 156 patients received an ANP led CGA, mostly conducted in the home. 247 reviews were conducted at the local spoke clinic and 46 joint ANP/Geriatrician home visits. Majority of referrals were from GP (n = 69), hospital (n = 30), LTC reviews (n = 22) and Community Nursing Units (CNUs) (n = 19). 449 outpatient appointments have been removed from the tertiary referral centre. Independent case load management from the ANP includes further appointments, telephone follow up/advice and she is a point of contact where crises arise before referral to acute services. 99% of patients surveyed reported satisfaction with the service especially the ease of local access and home visits.

Conclusion

Older Persons’ ANP can provide longitudinal care pathways for older adults in the community in conjunction with ICPOP and local CNUs, intervening before crises emerge and providing continuity of care and an alternative to acute care.

An objective analysis of quality and readability of online information on COVID-19

High quality, readable health information is vital to mitigate the impact of the COVID-19 pandemic. The aim of this study was to assess the quality and readability of online COVID-19 information using 6 validated tools. This is a cross-sectional study. "COVID-19" was searched across the three most popular English language search engines. Quality was evaluated using the DISCERN score, Journal of the American Medical Association benchmark criteria and Health On the Net Foundation Code of Conduct. Readability was assessed using the Flesch Reading Ease Score, Flesch-Kincaid Grade Level and Gunning-Fog Index. 41 websites were suitable for analysis. 9.8% fulfilled all JAMA criteria. Only one website was HONCode certified. Mean DISCERN score was 47.8/80 ("fair"). This was highest in websites published by a professional society/medical journal/healthcare provider. Readability varied from an 8th to 12th grade level. The overall quality of online COVID-19 information was "fair". Much of this information was above the recommended 5th to 6th grade level, impeding access for many.

324 Outcomes of the Exeter V40 Cemented Femoral Stem at a Minimum of 10 Years in a Non-designer Centre

Introduction

The Exeter V40 cemented femoral stem was first introduced in 2000. The largest single-centre analysis of this implant to date was published in 2018, with excellent results at a minimum of 10-years for the first 540 cases performed at the designer centre in the Exeter NHS Trust. The aim of this current study is to report long term outcomes and survivorship for the Exeter V40 stem in a non-designer centre.

Method

All patients undergoing primary total hip arthroplasty using the Exeter V40 femoral stem between January 1st 2005 and January 31st 2010 were eligible for inclusion. Outcome measures included data on all components in situ beyond 10 years, death occurring within 10 years with components in situ and all-cause revision surgery.

Results

A total of 829 stems were included in the data set. Of these, 808 (97.5%) had no further surgery within the follow-up period; 648 stems (78.1%) were in situ beyond 10 years, and 165 (19.9%) were in situ at death before 10 years. The mean preoperative WOMAC score was 61±15.9 with a mean postoperative score of 20.4±19.3.

Conclusions

The Exeter V40 cemented femoral stem demonstrates excellent functional outcomes and survival when used in a high-volume non-designer centre.

Abstract P112: Elevated Blood Pressure In Conventionalized Germ-free Rats Is Coupled With Upregulation Of Kynurenic Pathway Metabolites And Central Immune Responses

Background: Recent evidence supports that metabolic dysfunction underlies hypertension. Injection of kynurenate, a metabolite of tryptophan pathway, into the paraventricular nucleus of the hypothalamus (PVN) lowers blood pressure (BP). Intestinal absorption and metabolism of tryptophan are impacted by gut microbiota. Since gut-brain axis contributes to gut dysbiosis-inducd hypertension, we hypothesized that gut microbiota modulates the levels of kynurenic pathway metabolites that have central impact on BP regulation.

Methods: We, for the first time, used 7 weeks old male Germ-free (GF) Spague Dawley (SD) rats (n=5) and GF rats co-housed with conventional SD rats for 10 days (GFC) (n=6). BP was measured by tail-cuff. Serum metabolites were quantified by 6495 triple quandrople mass spectrometryand data was normalized using isotoplic labelled compounds. The nucleus of the solitary tract (NTS), the principal sensory nucleus for peripheral changes, and the PVN, a relay center projecting sympathetic output based on the integrated afferent inputs from brain regions including NTS, were analyzed by microarray hybridization for mRNA expression.

Results: Compared to the GF rats, GFC rats had significantly higher systolic (139 mmHg vs 115 mmHg, p <0.05), diastolic BP (96 mmHg vs 79 mmHg, p <0.05), and serum levels of kynurenic acid (-9.76 vs -10.21, p <0.05) and 3-hydroxy kynurenine (-6.49 vs -7.34, p <0.01). Coupled with these increases in kynurenic pathway metabolites, microarray analyses demonstrated increased immune responses (e.g. Cd74, Il1b, Cxcl1, Mmp14 ) in the PVN (gene ontology analysis, p <0.001) and increased cell differentiation and synaptic plasticity (e.g. Sox11, Tp53, Cdk6, Hoxb4, Foxo4, Cyr61 ) in the NTS (gene ontology analysis, p <0.01).

Conclusion: Colonization of gut microbiota in GF rats induced increased cell differentiation and synaptic plasticity in the NTS and immune responses in the PVN, indicating the restructured sensory neurons of the NTS and enhanced sympathetic output from the PVN. These are in line with increased levels of kynurenic acid and 3-hydroxy kynurenine, and BP, respectively, suggesting that BP regulation by the gut-brain axis may be mediated by kynurenic pathway.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

First International Public Health Film Competition 2016-reflections on the development and use of competition judging criteria

Background

Film competitions can be a helpful method to understand issues of quality in health films. In this paper, we describe the development and use of explicit quality criteria to identify the 'best' films for the first ever international public health film competition.

Methods

A film selection committee encompassing a range of stakeholders was compiled. The committee drew up 10 explicit quality criteria to judge films drawing upon other film festival's selection criteria. These criteria were then applied to a broad range of health-related films entered into a film competition to select the 'best' film to screen.

Results

Eighty-four films from 20 different countries were submitted to the public health film competition. The originality of the subject covered by the film, the public health importance of the issue and story-telling approach in the film were found to be the most discriminatory criteria to select films.

Conclusion

Selection of health films for festivals can be undertaken using explicit quality criteria. There are a number of advantages to such an approach; however, explicit selection involves a large commitment of resources from film festival organizers and there is further research required to test the validity of the quality criteria applied to health-related films.

Abstract P1126: Neutrophil Extracellular Traps: New Players in Hypertension

Aberrant immune responses are linked to hypertension; yet, neutrophils remain relatively understudied. Both neutrophilia and elevated neutrophil-to-lymphocyte (N/L) ratio are used as clinical biomarkers of hypertension. Likewise, neutrophilia is reported in spontaneously hypertensive rats. Whether these features are associated with an increase in neutrophil extracellular traps (NETs) generation is unknown. We hypothesized that neutrophilia and NETs directly correlate with hypertension whereby lowering neutrophilia and NETs are therapeutically beneficial to lower blood pressure (BP). Herein, we used various, genetic rat models divergent in BP to study the neutrophil-hypertension axis. These include the Dahl Salt-Sensitive (S) and Resistant (R) rats, and the low (LCR) and high (HCR) exercise capacity runner rats. LCR (2.1±0.3 10 9 /l) and S rats (1.2±0.5 10 9 /l) exhibited neutrophilia compared to HCR (0.98±0.5 10 9 /l) and R rats (1.04±0.5 10 9 /l), p<0.05, respectively. To determine whether neutrophil function was also augmented, peripheral neutrophils were stimulated with either PMA or LPS to induce ROS and NETs generation, respectively. LCR and S rats generated ~2-3 folds more ROS and NETs compared to their HCR and R counterparts. Intriguingly, LCR (11.4±1.0 U/ml) displayed reduced DNase I activity than HCR (17.8±0.8 U/ml), p<0.05, which indicated an inadequate clearance of NETs. Systemic and renal lipocalin-2 were 2-3 folds higher in the S rats compared to R rats, suggesting low-grade inflammation associated with NETs overabundance. Introducing a high-salt diet to S and R rats further potentiated neutrophilia, ROS and NETs, the extent of elevation being higher in S rats. Opposingly, oral administration of β-hydroxybutyrate (βOHB; a hypotensive ketone body) to S and R rats reduced neutrophilia, NETs and ROS. Similarly, subjecting LCR to exercise and fasting, both of which lower BP and increase βOHB, substantially attenuated neutrophilia, NETs and ROS. Collectively, our results demonstrate that NETs are an important feature directly linked to elevated BP in a strain-independent manner. Thus, blunting neutrophil responses through dietary intervention or exercise could serve as a novel therapeutic strategy against hypertension.

Abstract P337: Src Signaling and Toll-like Receptor 4 (TLR4) are Involved in Ouabain-induced Endothelial Cell Inflammation

Controversial evidence indicates that endogenous ouabain, a cardiotonic steroid can be synthesized in the adrenal cortex and hypothalamus and secreted as a hormone reaching nanomolar concentrations in the blood. The steroid has pathophysiological significance since its blood levels are positively correlated with blood pressure elevation. Inflammation of the vascular wall and endothelial dysfunction contribute to vascular stiffening in hypertension and it has been proposed that the endothelium is a site of action of ouabain. We hypothesized that ouabain would increase pro-inflammatory events in the endothelium. We observed that a low concentration ouabain (10nM; 24hr) sharply increased mRNA levels of the pro-inflammatory cytokines compared to control group (vehicle; 24h), TNF-α (59.9 fold vs con), IL-1β (3.23 fold vs con), COX2 (309.08 fold vs con), IL-6 (5.76 fold vs con) in cultured, human aortic endothelial cell (HAEC) and increased cyclooxygenase (COX2) expression (1.78 fold vs con). Simultaneously, a burst of nitric oxide (NO) was produced (1.2 fold vs con). Thus, low nanomolar concentrations of ouabain induced endothelial cell inflammation and dysfunction. Additionally, we observed that ouabain (10nM; 24hr) decreased mRNA expression of epidermal growth factor receptor (EGFR) (0.31 fold decrease vs con), and decreased the protein expression of EGFR (0.23 fold decrease vs con). But we found that ouabain induced the expression of non-receptor tyrosine kinase Src (2.27 fold vs con) and Toll-like receptor 4 (TLR4) (2.03 fold vs con), and activated the downstream signaling molecules, Myd88 (1.69 fold vs con), Akt (P-AKT/AKT, 4.31 fold vs con). Overall, the results provide a mechanism for ouabain-induced endothelial cell inflammation involving the inhibition of EGFR and the activation of Src and TLR4 to induce Akt signaling leading to secretion of pro-inflammatory cytokines.

Pleomorphic liposarcoma of bone: a rare primary malignant bone tumour

BACKGROUND

Liposarcoma is an extremely rare primary bone sarcoma.

CASE PRESENTATION

We report a case of primary pleomorphic liposarcoma that arose in an 18 year old male in the metaphysis of the left tibia. Plain radiographs showed a partly sclerotic lesion and MR imaging a heterogeneous tumour predominantly isointense on T1- and high-signal on T2-weighted sequences with focal areas of increased T1 signal that suppressed with fat saturation. PET/CT showed marked FDG uptake (SUV = 17.1) in the primary tumour as well as a metastasis in the right distal femur and multiple small pulmonary metastases. Histologically, the tumour was a pleomorphic liposarcoma containing large tumour cells with vacuolated cytoplasm and hyperchromatic pleomorphic nuclei as well as numerous lipoblasts and scattered brown fat-like cells. Tumour cells strongly expressed FABP4/aP2, a marker of adipocyte differentiation, and UCP1, a marker of brown fat, but not S100. The case was treated with neoadjuvant MAP chemotherapy, resulting in extensive (> 95%) necrosis in the primary tumour and almost complete resolution of the femoral and pulmonary metastases.

CONCLUSIONS

Pleomorphic liposarcoma can present as a sclerotic primary malignant bone tumour; markers of adipose differentiation are useful in histological diagnosis and neoadjuvant MAP chemotherapy results in significant tumor necrosis.

Abstract P525: Mtor Inhibitor Everolimus Decreases Aortic Sensitivity To Phenylephrine In Normotensive Rats

While targeted chemotherapeutics have improved cancer clinical outcomes, many of these agents have the drawback of cardiovascular complications. It has been established that the mTOR complexes have a pivotal role in many types of cancer, promoting cell growth, proliferation, and survival. Inhibitors of this pathway such as first generation Everolimus, and second generation PP242, have inhibited cancer cell proliferation and cancer progression. When compared with other target chemotherapeutics such as VEGF and tyrosine kinase inhibitors, first generation mTOR inhibitors have demonstrated decreased incidence of cardiovascular complications, however the specific vascular effects of mTOR inhibitors have not been investigated. Therefore, Everolimus, an inhibitor of mTORC1, and PP242, an inhibitor of mTORC1 and mTORC2, were evaluated for their effects on vascular reactivity of rat aorta. Previous studies have demonstrated that mTORC2 displayed cardioprotective effects. Therefore, we hypothesize that Everolimus, which does not inhibit mTORC2, will have a decreased contractile response to Phenylephrine (PE) and increased Acetylcholine (Ach)-induced relaxation. On the contrary, since PP242 inhibits mTORC2, we hypothesize that PP242 will increase contractile response to PE, and will decrease ACh-induced relaxation. Concentration response curves to PE (1nM - 30μM), and Ach (1nM - 30μM) were conducted in isolated aortic rings from male normotensive Wistar rats (12-15 weeks old) on a pin myograph ex vivo after 1 hour of incubation with each drug. Aortic rings treated with 31 μM of Everolimus showed decreased sensitivity to PE (LogEC 50 = -7.322 ±0.078 vs. treated: -6.578 ± 0.1116 p<0.05). No differences were observed in the contractile responses to PE for Everolimus (0.1 nM) or PP242 (245 nM) (p>0.05). Similarly, no differences were observed in the endothelium-dependent relaxation response to Ach for all three treatments. These results suggest that Everolimus may be a good therapeutic choice for cancer patients also suffering from cardiovascular dysfunction.

Association of low back pain on physical, sociodemographic and lifestyle factors across a general population sample within Greece

BACKGROUND

Although low back pain (LBP) is a debilitating problem internationally, there is not a lot of research on its impact on physical, psychosocial and lifestyle factors. Especially in mediterranean countries, such as Greece, it is not sufficiently explored whether physical (pain location, activity limitation etc.), sociodemographic (education, smoking etc.) or lifestyle factors (i.e. quality of life or anxiety) are influenced by LBP.

OBJECTIVE

To estimate LBP prevalence in the Greek general population and explore its association with particular sociodemographic, physical and lifestyle factors.

METHOD

A sample of 3125 people of the Greek adult population was randomly selected by stratified sampling encompassing rural and urban representation within the Greek mainland. An extended survey form was developed entailing three sections; personal (sociodemographic) information, questions on symptomatology and physical factors (i.e. pain characteristics, recurrence, physical disability etc.) and 3 self-administered questionnaires (including mostly lifestyle factors); Hospital Anxiety and Depression (HAD) scale for anxiety and depression, SF-12 for quality of life (QoL) and Roland-Morris for disability.

RESULTS

A total of 471 (15%) people reported LBP (210 males, mean age: 47.04 ± 15.03). Amongst them 60% reported sciatica, 76% suffered recurrent LBP and 70% received specialist care. Low disability levels, moderate to high pain intensity, gender differences and good self-reported QoL and psychosocial status were reported. Sociodemographic characteristics (income, smoking, marital status etc.) were not associated with LBP physical factors, apart from age which correlated with physical disability and wellness (r being 0.446 and 0.405, respectively, p< 0.001). Physical factors (particularly pain intensity and location) correlated with lifestyle factors (QoL) and disability (r ranging between 0.396 and 0.543, p< 0.001). Mental wellness, anxiety and depression (as lifestyle factors) were not associated with sociodemographic or physical factors.

CONCLUSIONS

Physical parameters were amongst the most prevalent characteristics of the Greek sample, thus offering a direction towards a more targeted treatment and rehabilitation planning. Unlike previous literature, most sociodemographic characteristics were not correlated with any LBP physical or lifestyle factors, thus possibly indicating a different socioeconomic background and aetiology domain to that of the usual non-specific LBP spectrum.

Temperature dependence of ice-on-rock friction at realistic glacier conditions

Using a new biaxial friction apparatus, we conducted experiments of ice-on-rock friction in order to better understand basal sliding of glaciers and ice streams. A series of velocity-stepping and slide-hold-slide tests were conducted to measure friction and healing at temperatures between -20°C and melting. Experimental conditions in this study are comparable to subglacial temperatures, sliding rates and effective pressures of Antarctic ice streams and other glaciers, with load-point velocities ranging from 0.5 to 100 µm s-1 and normal stress σn = 100 kPa. In this range of conditions, temperature dependences of both steady-state friction and frictional healing are considerable. The friction increases linearly with decreasing temperature (temperature weakening) from μ = 0.52 at -20°C to μ = 0.02 at melting. Frictional healing increases and velocity dependence shifts from velocity-strengthening to velocity-weakening behaviour with decreasing temperature. Our results indicate that the strength and stability of glaciers and ice streams may change considerably over the range of temperatures typically found at the ice-bed interface.This article is part of the themed issue 'Microdynamics of ice'.

Chromosome microarray proficiency testing and analysis of quality metric data trends through an external quality assessment program for Australasian laboratories

Chromosome microarrays are an essential tool for investigation of copy number changes in children with congenital anomalies and intellectual deficit. Attempts to standardise microarray testing have focused on establishing technical and clinical quality criteria, however external quality assessment programs are still needed. We report on a microarray proficiency testing program for Australasian laboratories. Quality metrics evaluated included analytical accuracy, result interpretation, report completeness, and laboratory performance data: sample numbers, success and abnormality rate and reporting times. Between 2009 and 2014 nine samples were dispatched with variable results for analytical accuracy (30-100%), correct interpretation (32-96%), and report completeness (30-92%). Laboratory performance data (2007-2014) showed an overall mean success rate of 99.2% and abnormality rate of 23.6%. Reporting times decreased from >90 days to <30 days for normal results and from >102 days to <35 days for abnormal results. Data trends showed a positive correlation with improvement for all these quality metrics, however only 'report completeness' and reporting times reached statistical significance. Whether the overall improvement in laboratory performance was due to participation in this program, or from accumulated laboratory experience over time, is not clear. Either way, the outcome is likely to assist referring clinicians and improve patient care.

Highlighting the need for more infection control practitioners in low- and middle-income countries

Background: Many low- and middle-income countries struggle to implement, monitor and evaluate the efficacy of infection control (IC) measures within health care facilities. This hampers their ability to prevent nosocomial infections, identify emerging pathogens and rapidly alert officials to possible outbreaks. The lack of dedicated and trained IC practitioners (ICPs) is a serious deficit in the health care workforce, and is worsened by the lack of institutions that offer IC training. Discussion: While no single individual can entirely eliminate the risk of nosocomial transmission, there is literature to support the value of designated IC persons. Recommendations from the World Health Organization in 2008 and 2009 describe the need for this specialized cadre of workers, but many countries lack the national regulations to authorize, train and manage such professionals at the national or local level. This article provides an overview of how ICPs are trained and credentialed in several countries, and discusses approaches countries can use to train ICPs. Conclusion: Trained ICPs can help prevent future outbreaks and control nosocomial transmission of diseases in health care facilities. For this to occur, supportive national policies, availability of training institutions and local administrative support will be required.