Population Mobility Trends, Deprivation Index and the Spatio-Temporal Spread of Coronavirus Disease 2019 in Ireland

Like most countries worldwide, the coronavirus disease (COVID-19) has adversely affected Ireland. The aim of this study was to (i) investigate the spatio-temporal trend of COVID-19 incidence; (ii) describe mobility trends as measured by aggregated mobile phone records; and (iii) investigate the association between deprivation index, population density and COVID-19 cases while accounting for spatial and temporal correlation. Standardised incidence ratios of cases were calculated and mapped at a high spatial resolution (electoral division level) over time. Trends in the percentage change in mobility compared to a pre-COVID-19 period were plotted to investigate the impact of lockdown restrictions. We implemented a hierarchical Bayesian spatio-temporal model (Besag, York and Mollié (BYM)), commonly used for disease mapping, to investigate the association between covariates and the number of cases. There have been three distinct "waves" of COVID-19 cases in Ireland to date. Lockdown restrictions led to a substantial reduction in human movement, particularly during the 1st and 3rd wave. Despite adjustment for population density (incidence ratio (IR) = 1.985 (1.915-2.058)) and the average number of persons per room (IR = 10.411 (5.264-22.533)), we found an association between deprivation index and COVID-19 incidence (IR = 1.210 (CI: 1.077-1.357) for the most deprived quintile compared to the least deprived). There is a large range of spatial heterogeneity in COVID-19 cases in Ireland. The methods presented can be used to explore locally intensive surveillance with the possibility of localised lockdown measures to curb the transmission of infection, while keeping other, low-incidence areas open. Our results suggest that prioritising densely populated deprived areas (that are at increased risk of comorbidities) during vaccination rollout may capture people that are at risk of infection and, potentially, also those at increased risk of hospitalisation.

The interplay between spatial and heliconical orientational order in twist-bend nematic materials

The helical pitch formed by organic molecules, such as the α-helix of proteins, usually requires hydrogen bonding between chiral units and long-range positional order. It was recently found that certain liquid crystal oligomers can have a twist-bend nematic (NTB) phase with nanoscale heliconical structure without hydrogen bonding, molecular chirality or positional order. To understand the nature of this unique structure, here we present hard and resonant tender X-ray scattering studies of two novel sulfur containing dimer materials. We simultaneously measure the temperature dependences of the helical pitch and the correlation length of both the helical and positional order. In addition to an unexpected strong variation of the pitch with the length of the spacer connecting the monomer units, we find that at the transition to the NTB phase the positional correlation length drops. The helical structure was found not only in the NTB phase but observed even in the upper range of a smectic phase that forms just below the NTB state. The coexistence of smectic layering and the heliconical order indicates a layered (SmATB) phase wherein the rigid units of the dimers are tilted with respect to the smectic layer normal in order to accommodate the bent conformation of the dimers and the tilt direction rotates along the heliconical axis.

Human myelomeningocele risk and ultra-rare deleterious variants in genes associated with cilium, WNT-signaling, ECM, cytoskeleton and cell migration

Myelomeningocele (MMC) affects one in 1000 newborns annually worldwide and each surviving child faces tremendous lifetime medical and caregiving burdens. Both genetic and environmental factors contribute to disease risk but the mechanism is unclear. This study examined 506 MMC subjects for ultra-rare deleterious variants (URDVs, absent in gnomAD v2.1.1 controls that have Combined Annotation Dependent Depletion score ≥ 20) in candidate genes either known to cause abnormal neural tube closure in animals or previously associated with human MMC in the current study cohort. Approximately 70% of the study subjects carried one to nine URDVs among 302 candidate genes. Half of the study subjects carried heterozygous URDVs in multiple genes involved in the structure and/or function of cilium, cytoskeleton, extracellular matrix, WNT signaling, and/or cell migration. Another 20% of the study subjects carried heterozygous URDVs in candidate genes associated with gene transcription regulation, folate metabolism, or glucose metabolism. Presence of URDVs in the candidate genes involving these biological function groups may elevate the risk of developing myelomeningocele in the study cohort.

Abstract P6-08-17: Pregnancy associated breast cancer: Evaluating maternal outcomes. A multicentre study

Background

Pregnancy associated breast cancer (PABC) is defined as breast cancer (BC) diagnosed during the gestational period (GP) or in the first year postpartum (PP). Despite its infrequent occurrence, the incidence of PABC appears to be rising due to the increasing propensity for women to delay childbirth. We have established the first combined prospective and retrospective registry study of PABC in Ireland to examine specific clinicopathological characteristics, treatments and maternal outcomes. We present the retrospective findings to date.

Methods

We performed a retrospective multicentre observational study of patients (pts) with PABC treated in the eight Irish cancer centres from August 2001 to March 2017. Data extracted included information on pt demographics, tumour biology, staging, treatment administered and maternal outcomes. Standard biostatistical methods were used for analysis.

Results

111 PABC patients were identified. Sixty pts (54%) were diagnosed during the GP and 51 (46%) within 1 year PP. Median age at diagnosis was 36 years (yrs). Table 1 illustrates baseline characteristics. Two thirds of pts were node positive and a similar proportion had grade 3 pathology. Seventy pts (63%) were estrogen receptor (ER) positive, 36 (32%) HER2 positive, 25 (22%) triple negative. Twenty-two pts (20%) were metastatic at presentation. Seven pts (6%) had a known BRCA 1/2 mutation. The median OS (overall survival) and DFS (disease free survival) for the entire cohort was 107.4 and 94.2 months respectively (resp). There was no survival difference between those diagnosed during the GP versus PP. 5 yr DFS and OS was 68.6% and 69.2% resp. This compares unfavourably to results reported by the National Cancer Registry of Ireland in a similar age-matched BC population between 2000-2012 where the 5 yr OS was 86.5%. Variables in our study associated with poorer outcomes included younger age, tumour size, node positivity and lack of estrogen expression.

Baseline characteristics PABC patients (n=11) %(n)Diagnosed in GP (n=60) %(n)Diagnosed 1yr PP (n=51) %(n)p valueDemographic    Age at diagnosis3636(25-49)36(21-44)0.31Stage    I-II54(60)55(33)53(27)0.85III23(26)23(14)23(12)1IV20(22)18(11)22(11)0.81Unknown3(3)3(2)2(1)1Pathology    Grade 366(74)70(42)63(32)0.43Node positive66(73)68(41)63(32)0.55ER+/HER2-41(45)38(23)43(22)0.69ER+/HER2+23(25)28(17)16(8)0.17ER-/HER2+14(16)17(10)12(6)0.59Triple negative22(25)17(10)29(15)0.11Surgery    Breast conservation23(26)25(15)21(11)0.82Mastectomy56(63)57(34)59(30)0.84Adjuavnt/Neoadjuvant treatment    Chemotherapy73(81)77(46)69(35)0.39Anthracycline68(55)78(36)54(19)0.03Taxane89(72)93(43)83(29)0.16Anti HER2 agent21(23)18(11)24(12)0.63Endocrine therapy64(52)63(29)66(23)0.84Radiotherapy79(64)74(34)86(30)0.85Relapse in Stage I-III    Local relapse15(13)12(6)18(7)0.55Distant relapse24(21)22(11)25(10)0.80

Conclusions

PABC patients may have a poorer outcome. Our study reported higher rates of triple negative and HER2 positive breast cancer which are associated with more aggressive biology. Prospective evaluation of clinicopathological features, pharmacokinetics of treatments selected and maternal and fetal outcomes is imperative in this distinct pt group.

Citation Format: Prior L, Teo M, Greally M, Ward C, O'Leary C, Aslam R, Darwish W, Ahmed N, Watson G, Kelly D, Kiely L, Hassan A, Gleeson J, Featherstone H, Lim M, Murray H, Gallagher D, Westrup J, Hennessy B, Leonard G, Grogan L, Breathnach O, Horgan A, Coate L, O'Mahony D, Coate L, O'Reilly S, Gupta R, Keane M, Duffy K, O'Connor M, Kennedy J, McCaffrey J, Higgins M, Kelly C, Carney D, Gullo G, Crown J, Walshe J. Pregnancy associated breast cancer: Evaluating maternal outcomes. A multicentre study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-08-17.

First reported finding of a Malignant Pleural Mesothelioma in a patient post Liver Transplant

The case history of a liver transplant recipient is presented, who presented with acute dyspnoea after an innocuous fall. His early management was complicated and he was eventually diagnosed with malignant mesothelioma. This is the first such case report in the literature.

Mesophase structure and behaviour in bulk and restricted geometry of a dimeric compound exhibiting a nematic–nematic transition

We demonstrate a liquid crystal system exhibiting a variety of modulated structures on different length-scales: from helicoidal nematic to modulated smectic.

The cost of photoselective vaporization of the prostate compared to transurethral resection of the prostate: Experience in a large public Australian teaching centre

Objective:

The purpose of this study was to compare the cost of photoselective vaporization of the prostate (PVP) with transurethral resection of the prostate (TURP) in the treatment of men with bladder outflow obstruction (BOO).

Patients and methods:

Men underwent PVP or TURP for clinical BOO or urinary retention. We developed a cost framework to calculate the costs of theatre, recovery and ward time in our publically funded institution and calculated a cost for each procedure including the initial stay and any associated admissions over the first 60 days. These costs were statistically analyzed.

Results:

A total of 99 men underwent PVP and 97 had TURP. Groups were well matched for age and operative indication. The American Society of Anesthesia (ASA) grade was higher for the PVP group with more taking anticoagulants (36% versus 3.1%). PVP was 74% more expensive (median AUD$4243 vs AUD$2439, p<0.001) than TURP, even in a sub-set analysis excluding the anticoagulated patients. This was because of longer operating time and unavoidable disposable costs.

Conclusions:

Previous cost studies have all had significant flaws. Using our “bottom up” cost framework suggests that the unavoidable costs of purchasing a laser, single use laser fibers and other paraphernalia will almost always exceed the costs associated with in-patient stay. We caution against establishing a PVP service in a public hospital setting.

Methadone dosing and prescribed medication use in a prospective cohort of opioid-dependent pregnant women

AIMS

This study aimed to (i) describe methadone dosing before, during and after pregnancy, (ii) to compare the incidence of neonatal abstinence syndrome (NAS) between those with dose decreases and those with steady or increasing doses and (iii) to describe prescribed medication use among opioid-dependent pregnant women.

DESIGN

Prospective cohort study.

SETTING

Two Irish tertiary care maternity hospitals.

PARTICIPANTS

A total of 117 pregnant women on methadone maintenance treatment (MMT) recruited between July 2009 and July 2010.

MEASUREMENTS

Electronic dispensing records from addiction clinics and the Primary Care Reimbursement Service were used to determine methadone doses and dispensed medications in the year preceding and the month following delivery. The Finnegan score was used to determine need for medical treatment of NAS.

FINDINGS

Of the 117 participants, sufficient dosing data were available for 89 women treated with MMT throughout pregnancy; 36 (40.4%) had their dose decreased from a mean pre-pregnancy dose of 73.3 mg [standard deviation (SD) 25.5] to a third-trimester dose of 58.0 mg (SD 26.0). The corresponding figures for those with increased doses (n = 31, 34.8%) were 70.7 mg (SD 25.3) and 89.7 mg (SD 21.0), respectively. The incidence of medically treated NAS did not differ between dosage groups. Antidepressants were dispensed for 29 women (25.7%) during pregnancy, with the rate decreasing from pre-pregnancy to postpartum. Benzodiazepines were prescribed for 43 women (38.0%).

CONCLUSION

In the Irish health service, opioid-dependent women frequently have their methadone dose decreased during pregnancy but this does not appear to affect the incidence of the neonatal abstinence syndrome in their babies.

Methadone and perinatal outcomes: a prospective cohort study

AIMS

  Methadone use in pregnancy has been associated with adverse perinatal outcomes and neonatal abstinence syndrome (NAS). This study aimed to examine perinatal outcomes and NAS in relation to (i) concomitant drug use and (ii) methadone dose.

DESIGN

  Prospective cohort study.

SETTING

  Two tertiary care maternity hospitals.

PARTICIPANTS

  A total of 117 pregnant women on methadone maintenance treatment recruited between July 2009 and July 2010.

MEASUREMENTS

  Information on concomitant drug use was recorded with the Addiction Severity Index. Perinatal outcomes included pre-term birth (<37 weeks' gestation), small-for-gestational-age (<10th centile) and neonatal unit admission. NAS outcomes included: incidence of medically treated NAS, peak Finnegan score, cumulative dose of NAS treatment and duration of hospitalization.

FINDINGS

  Of the 114 liveborn infants 11 (9.6%) were born pre-term, 49 (42.9%) were small-for-gestational-age, 56 (49.1%) had a neonatal unit admission and 29 (25.4%) were treated medically for NAS. Neonates exposed to methadone-only had a shorter hospitalization than those exposed to methadone and concomitant drugs (median 5.0 days versus 6.0 days, P = 0.03). Neonates exposed to methadone doses ≥80 mg required higher cumulative doses of morphine treatment for NAS (median 13.2 mg versus 19.3 mg, P = 0.03). The incidence and duration of NAS did not differ between the two dosage groups.

CONCLUSIONS

  The incidence and duration of the neonatal abstinence syndrome is not associated with maternal methadone dose, but maternal opiate, benzodiazepine or cocaine use is associated with longer neonatal hospitalization.

Centralised urban stormwater harvesting for potable reuse

Urban impervious areas provide a guaranteed source of runoff, especially in cities with high rainfall - this represents a source of water with low sensitivity to unfavourable climate change. Whilst the potential to reuse stormwater has long been recognised, its quality has largely limited usage to non-potable applications requiring the use of a third-pipe network, a prohibitively expensive option in established urban areas. Given recent advances in membrane filtration, this study investigates the potential of harvesting and treating stormwater to a potable standard to enable use of the potable distribution network. A case study based on the Throsby Creek catchment in Newcastle explores the issue. The high seasonally uniform rainfall provides insight into the maximum potential of such an option. Multicriterion optimisation was used to identify Pareto optimal solutions for harvesting, storing and treating stormwater. It is shown that harvesting and treating stormwater from a 13 km² catchment can produce yields ranging from 8.5 to 14.2 ML/day at costs ranging from AU$2.60/kL to AU$2.89/kL, which may become viable as the cost of traditional supply continues to grow. However, there are significant social impacts to deal with including alienation of public land for storage and community acceptance of treated stormwater.

Second-harmonic generation in a bent-core nematic liquid crystal

Second-harmonic generation (SHG) is studied in the magnetically aligned nematic phase of a bent-core liquid crystal (BCN) and compared to similar measurements made on a conventional rodlike (calamitic) nematic compound. The second-harmonic (SH) light detected from both materials is predominantly due to scattering and therefore incoherent. Results on the calamitic are consistent with a polarization induced by ordinary director fluctuations in the nematic phase. However, the SH scattering collected in the BCN exhibits a different temperature and angular dependence. We discuss how these differences could arise from the effects of short-range correlated, smectic-C-type molecular clusters, which have been detected in recent studies on various BCN materials.

Acute-phase and 1-year follow-up results of a randomized controlled trial of CBT versus Befriending for first-episode psychosis: the ACE project

BACKGROUND

The ACE project involved 62 participants with a first episode of psychosis randomly assigned to either a cognitive behaviour therapy (CBT) intervention known as Active Cognitive Therapy for Early Psychosis (ACE) or a control condition known as Befriending. The study hypotheses were that: (1) treating participants with ACE in the acute phase would lead to faster reductions in positive and negative symptoms and more rapid improvement in functioning than Befriending; (2) these improvements in symptoms and functioning would be sustained at a 1-year follow-up; and (3) ACE would lead to fewer hospitalizations than Befriending as assessed at the 1-year follow-up.

METHOD

Two therapists treated the participants across both conditions. Participants could not receive any more than 20 sessions within 14 weeks. Participants were assessed by independent raters on four primary outcome measures of symptoms and functioning: at pretreatment, the middle of treatment, the end of treatment and at 1-year follow-up. An independent pair of raters assessed treatment integrity.

RESULTS

Both groups improved significantly over time. ACE significantly outperformed Befriending by improving functioning at mid-treatment, but it did not improve positive or negative symptoms. Past the mid-treatment assessment, Befriending caught up with the ACE group and there were no significant differences in any outcome measure and in hospital admissions at follow-up.

CONCLUSIONS

There is some preliminary evidence that ACE promotes better early recovery in functioning and this finding needs to be replicated in other independent research centres with larger samples.

Intussusception associated with bacterial meningitis

Despite its common association with viral illnesses, intussusception has only rarely been found in the presence of bacterial infections. Two infants are described, both of whom were admitted to hospital with bilious vomiting, drowsiness, and dehydration. Both infants required urgent intravenous volume expansion. Intussusception was confirmed, and reduction was achieved by enema in both cases. Recovery was slow, and one infant developed a seizure. Evidence of meningococcal meningitis was found in both, with septicaemia in one. Neurological outcome is normal to date, and there has been no recurrence of intussusception in either case.

Regional synaptic pathology in Alzheimer's disease

Synaptic pathology in Alzheimer's disease (AD) may occur diffusely or may have regional predilections. A new antibody called EP10 which detects synaptophysin-like immunoreactivity was used to study synapses in postmortem brain tissue. Four brain regions from cases of AD and controls were studied. Controls with a wide range of ages were used to investigate the possibility of age-related changes in synaptophysin-like immunoreactivity. A significant reduction in the EP10 antigen was observed to occur with age in the control caudate but not in the hippocampus or temporal or occipital cortices. Antigen levels were significantly reduced in the hippocampus (77%) and the temporal cortex (54%) in AD. The expected abnormal pallor of the outer two-thirds of the dentate gyrus molecular layer was observed with immunocytochemistry. In the temporal cortex, the reduction in synaptophysin-like immunoreactivity was inversely correlated with the neurofibrillary tangle count. No such relationship existed in the hippocampus. These results suggest that at least certain components of the synaptic loss in AD occur regionally and are disproportionately large in the hippocampus.

Pneumocystis carinii pneumonia treated with eflornithine in AIDS patients resistant to conventional therapy

Eflornithine (DFMO) was used to treat 31 AIDS patients with confirmed Pneumocystis carinii pneumonia who had clinically failed treatment with pentamidine, sulphamethoxazole-trimethoprim or both agents as their first-line therapy. Twenty-one of 31 (68%) responded to second-line treatment with 400mg/kg per day of eflornithine. Five patients discontinued treatment because of bone marrow toxicity. Eflornithine appears to be a useful salvage therapy in patients failing first-line treatments.

Prospectively randomised trial of proximal gastric vagotomy either with or without pyloroplasty in treatment of uncomplicated duodenal ulcer

A consecutive series of 100 men with uncomplicated duodenal ulcer was randomly divided into two groups: one group of 52 underwent proximal gastric vagotomy (PGV), the other group (48) underwent PGV with pyloroplasty (PGVP). Preoperative peak acid output (PAOP) was measured in all patients. Those with a higher preoperative PAOP were significantly more likely to develop recurrent ulceration. Three patients developed recurrent ulceration after PGV and seven after PGVP. Dumping was both more common and more severe after PGVP than PGV. An overall satisfactory result was achieved in 92% after PGV and 81% after PGVP. We conclude that combining pyloroplasty with PGV has no appreciable advantages.

Selective proximal vagotomy with and without pyloroplasty

The early results of a prospective randomized clinical trial of selective proximal vagotomy with and without gastric drainage in a total of 36 patients are reported. In spite of adequate average acid reduction and little evidence of gastric retention two definite recurrent ulcers have occurred in the 16 patients who did not have a pyloroplasty. Further trials of the effect of selective proximal vagotomy without gastric drainage are necessary before the procedure is widely adopted.