Body image and psychosocial well-being among UK military personnel and veterans who sustained appearance-altering conflict injuries

A modest but significant number of military personnel sustained injuries during deployments resulting in an altered-appearance (e.g., limb loss and/or scarring). Civilian research indicates that appearance-altering injuries can affect psychosocial wellbeing, yet little is known about the impact of such injuries among injured personnel. This study aimed to understand the psychosocial impact of appearance-altering injuries and possible support needs among UK military personnel and veterans. Semi-structured interviews with 23 military participants who sustained appearance-altering injuries during deployments or training since 1969 were conducted. The interviews were analyzed using reflexive thematic analysis, identifying six master themes. These themes indicate that in the context of broader recovery experiences, military personnel and veterans experience a variety of psychosocial difficulties related to their changed appearance. While some of these are consistent with evidence from civilians, military-related nuances in the challenges, protective experiences, coping approaches, and preferences for support are evident. Personnel and veterans with appearance-altering injuries may require specific support for adjusting to their changed appearance and related difficulties. However, barriers to acknowledging appearance concerns were identified. Implications for support provision and future research are discussed.

Multiplex ligation-dependent probe amplification copy number variant analysis in patients with acquired long QT syndrome

AIMS

Thirteen genetic loci map to families with congenital long QT syndrome (cLQT) and multiple single nucleotide mutations have been functionally implicated in cLQT. Studies have investigated copy number variations (CNVs) in the cLQT genes to ascertain their involvement in cLQT. In these studies 3-12% of cLQT patients who were mutation negative by all other methods carried CNVs in cLQT genes. Prolongation of the QT interval can also be acquired after exposure to certain drugs [acquired LQT (aLQT)]. Single nucleotide mutations in cLQT genes have also been associated with and functionally implicated in aLQT, but to date no studies have explored CNVs as an additional susceptibility factor in aLQT. The aim of this study was to explore the contribution of CNVs in determining susceptibility to aLQT.

METHODS AND RESULTS

In this study we screened the commonest cLQT genes (KCNQ1; KCNH2; SCN5A; KCNE1, and KCNE2) in a general population of healthy volunteers and in a cohort of subjects presenting with aLQT for CNVs using the multiplex ligation-dependent probe amplification method. Copy number variants were detected and confirmed in 1 of 197 of the healthy volunteers and in 1 of 90 subjects with aLQT. The CNV in the aLQT subject was functionally characterized and demonstrated impaired channel function.

CONCLUSION

Copy number variation is a possible additional risk factor for aLQT and should be considered for incorporation into pharmacogenetic screening of LQTS genes in addition to mutation detection to improve the safety of medication administration.

Abstract 5088: Exploring ATM deficiency as a potential therapeutic target for the PARP inhibitor olaparib in head and neck squamous cell carcinoma

Background: Ataxia telangiectasia mutated (ATM) gene, localized in chromosome 11q22-23 is a key player in the signaling response to double strand breaks (DSBs). Impaired DSB repair due to ATM deficiency in tumor cells may lead to a wider application of the ‘‘synthetic lethality’’ approach seen with PARP inhibitors in BRCA-deficient tumors. Targeting DNA repair mechanisms with specific small molecule inhibitors will in principle sensitize tumor cells to DNA-damaging agents such as radiation. Radiation therapy remains the most common treatment of choice for head and neck cancers; however, there is still a large scope for improvement. Loss of distal 11q chromosome and subsequent ATM deficiency has been reported in primary head and neck tumors. Therefore, there are two aims to this work. First, we will establish the potential of targeting this cellular deficiency with the potent poly (ADP-ribose) polymerase (PARP) inhibitor olaparib; second, we will determine the prognostic significance of ATM deficiency in patients with head and neck squamous cell carcinoma (HNSCC) undergoing radiotherapy.

Methods: A panel of 10 HNSCC cell lines was screened for sensitivity to radiation in combination with olaparib by clonogenic survival assay in normoxic and anoxic conditions. The effect of olaparib as a single agent was also assessed in a PE/CA PJ34 (ATM deficient) xenograft model. A panel of 155 HNSCC biopsies taken prior to treatment with radiotherapy and where 5 year outcome data was available were used for ATM expression analysis by immunohistochemistry (IHC) and fluorescent in situ hybridization (FISH).

Results: Olaparib enhanced the effect of ionizing radiation (IR) in all HNSCC cell lines. In vitro, the increase in sensitivity to 2Gy after olaparib treatment ranged between 1.5- and 8.4-fold in normoxia and between 1.2- and 3.9-fold in anoxia. In vivo, administration of olaparib (50mg/kg p.o) as a single agent in PE/CA PJ34 xenografts daily for 5 days caused a substantial increase in tumor growth delay compared to vehicle alone. The IHC and FISH studies of the 155 HNSCC biopsies showed a variable level of ATM deficiency and the prognostic significance (if any) of these observations are being established.

Conclusion: We demonstrate that olaparib is a promising candidate as a single agent in tumors with ATM deficiency, and given the radiosensitizing effects in vitro and in vivo it warrants consideration for combining with radiation for the treatment of HNSCC.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 5088. doi:10.1158/1538-7445.AM2011-5088

Isolation and extraction of circulating tumor DNA from patients with small cell lung cancer

There is no consensus on the optimal protocol for isolation of circulating tumor DNA. We report our comparison of several extraction methods and variables that may affect yield, quality, and contamination of tumor DNA. DNA was extracted from the plasma and serum of five healthy volunteers by means of four different commercially available kits and DNA yield was quantified by real-time PCR. DNA was extracted using the optimum kit from the plasma and serum of an additional 10 healthy volunteers and 10 patients with small cell lung cancer (SCLC) to compare yield and DNA fragment size in plasma versus serum and in those with SCLC versus controls. Time to sample processing was also examined. We found that DNA yield was greatest using the QIAamp Viral Spin Kit. Delayed time to processing led to increased DNA concentrations in serum, but not plasma. The plasma DNA concentration in SCLC patients was significantly higher than in healthy volunteers (24.5 ng/mL versus 5.1 ng/mL, P= 0.002). In contrast, there was no significant difference in serum DNA concentrations between controls and patients that may be explained by the wide variability and range of DNA concentrations in serum. A significantly higher proportion of longer fragments (272 bp/60 bp) was observed in the plasma DNA extracted from patients with SCLC than in healthy controls (13% versus 8%, P= 0.04). There was absence of DNA fragments of 512 bp in healthy control plasma, but faint bands were observed in serum, which is thought to be due to cellular contamination. We conclude that plasma is a more reliable source of tumor DNA then serum and have optimized a robust procedure for plasma tumor DNA isolation that can be applied to translational research studies.

Psychometric properties of the CAHPS 1.0 survey measures. Consumer Assessment of Health Plans Study

OBJECTIVES

Consumer surveys are being used increasingly to assess the quality of care provided by health plans, physician groups, and clinicians. The purpose of the Consumer Assessment of Health Plans Study (CAHPS) is to develop an integrated and standardized set of surveys designed to collect reliable and valid information about health plan performance from consumers. This article reports psychometric results for the CAHPS 1.0 survey items in samples of individuals with Medicaid or private health insurance coverage.

METHODS

Reliability estimates for CAHPS 1.0 measures were estimated in a sample of 5,878 persons on Medicaid and 11,393 persons with private health insurance. Correlations of the CAHPS global rating of the health plan with willingness to recommend the plan and intention to re-enroll were estimated in a sample of 313 persons on Medicaid. The association of the rating of the health plan with ratings using a 5-point Excellent-to-Poor response scale also was investigated in the latter sample and in a sample of 539 persons with private health insurance.

RESULTS

The CAHPS measures appeared to have good reliability, particularly at the health-plan level. Responses from 300 consumers per health plan tend to yield estimates that are reliable enough for health plan comparisons, especially among the privately insured. The global health plan rating was significantly correlated with consumers' willingness to recommend the plan to family and friends and to their intention to re-enroll in the plan if given a choice.

CONCLUSIONS

The CAHPS 1.0 survey instrument appears to have excellent psychometric properties.

Special issues addressed in the CAHPS survey of Medicare managed care beneficiaries. Consumer Assessment of Health Plans Study

OBJECTIVES

This article describes the process through which the MMC survey was developed and examines issues in using this survey with Medicare beneficiaries that have implications for all CAHPS surveys. These include the ability of Medicare beneficiaries to use MMC navigational features, whether access measures are meaningful for this population, and whether beneficiaries' familiarity with managed care influences their health plan assessments.

BACKGROUND

The Health Care Financing Administration (HCFA) is mandated to provide comparative plan information, based partly on consumer surveys, to Medicare beneficiaries. The Consumer Assessments of Health Plans Study (CAHPS) is an integrated set of tested, standardized surveys of health plan enrollees. To meet its goal, HCFA has invested in the development of a CAHPS survey of beneficiaries enrolled in Medicare Managed Care plans (MMC).

METHODS

Cognitive interviews were completed with 31 Medicare beneficiaries. A field test also was conducted with beneficiaries to examine patterns of survey response. A sample of 956 eligible individuals was selected from six health plans. Using a combination of mail and telephone data collection, 663 (69%) questionnaires were completed. This article provides selective results from these tests.

RESULTS

The use of screening questions, skip instructions, and tailored "not applicable" response options appeared to facilitate the response task. Some CAHPS access questions were not meaningful to Medicare beneficiaries. The data do not support the need to adjust for length of plan enrollment.

CONCLUSION

Analyses suggested changes to improve the MMC survey and to make other CAHPS surveys consistent with these changes.

In situ microviscoelastic measurements by polarization-interferometric monitoring of indentation depth

new type of computer-controlled instrument has been developed to measure microviscoelastic properties of thin materials. It can independently control and measure indentation loads and depths in situ revealing information about material creep and relaxation. Sample and indenter positions are measured with a specially designed polarization interferometer. Indenter loadings can be varied between 0.5 and 10 g and held constant to +/-41 mg. The resulting indentation depths can be measured in situ to +/-1.2 nm. The load required to maintain constant indentation depths from 0.1 to 5.0 microim can be measured in situ to +/-3.3 mg and the depth held constant to +/-15 nm.