Text Reminders in Colorectal Cancer Screening (TRICCS): Protocol for a randomised controlled trial

Background

Screening with the guaiac faecal occult blood test (gFOBt) is associated with improved colorectal cancer (CRC) survival, and is offered biennially to men and women aged 60–74 years in England’s national Bowel Cancer Screening Programme (BCSP). Uptake of the gFOBt is low, with only 54 % of the eligible population completing the test. Text-message reminders could improve uptake of gFOBt.

Methods/design

This paper describes the protocol for a randomised controlled trial, which will examine the effectiveness of a text-message reminder to promote uptake of gFOBt screening in the BCSP. Individual mobile telephone data from 180 general practices in London with existing mobile-health services will be linked to the national BCSP information system via a secure on-line network. All screening-eligible adults registered with a participating practice will be randomised, to receive either usual care (N = 1600) or usual care plus a text-message reminder to self-complete and return their kit eight weeks after their initial invitation (N = 1600). The primary outcome will be the proportion of individuals who return an adequately completed gFOBt kit within 18 weeks of the initial invitation. Differences in uptake between groups will be evaluated using a logistic regression analysis, adjusting for individual-level and area-level socio-demographic variables.

Discussion

This will be the first large-scale randomised trial of a text-message reminder in a national screening programme for CRC. If effective, this study provides a cost-effective means to promote uptake of CRC screening in an organised programme.

Trial registration

Current Controlled Trials ISRCTN70904476 (18/09/2015).

Assessment of arterial stiffness from pedal artery Korotkoff sound recordings: feasibility and potential utility

Brachial artery (BA) Korotkoff sound (KS) timing reflects arterial stiffness. We recorded pedal artery (PA) KS in 68 healthy subjects using an electronic stethoscope and electrocardiography. Intervals between QRS complex of the electrocardiogram and KS waveform peaks (termed the QKD interval) were measured for 60 seconds, averaged, and QKD velocity (v) calculated. Carotid-BA and carotid-PA pulse wave velocities (PWVs) were measured by applanation tonometry. Analyzable KS recordings were obtained from BA and PA in 100% and 92% subjects. PA QKDv decreased less than BA QKDv with progressive cuff inflation. At diastolic blood pressure + 20 mm Hg (maximal yield), BA QKDv was independently associated with weight and pulse pressure, whereas PA QKDv was related to weight and age. PA QKDv correlated with its corresponding PWV stronger than BA QKDv. In conclusion, PA KS is optimally recorded at diastolic blood pressure + 20 mm Hg; PA QKDv is correlated with age and better correlates with PWV than does BA QKDv. This technique may provide a simple arterial stiffness measure.

Simultaneous dynamic electrical and structural measurements of functional materials

A new materials characterization system developed at the XMaS beamline, located at the European Synchrotron Radiation Facility in France, is presented. We show that this new capability allows to measure the atomic structural evolution (crystallography) of piezoelectric materials whilst simultaneously measuring the overall strain characteristics and electrical response to dynamically (ac) applied external stimuli.

Efficacy and tolerability of albiglutide versus placebo or pioglitazone over 1 year in people with type 2 diabetes currently taking metformin and glimepiride: HARMONY 5

AIMS

To investigate the efficacy and tolerability of albiglutide, a weekly glucagon-like peptide-1 receptor agonist, when added to metformin and glimepiride in a triple therapy regimen in people with type 2 diabetes mellitus.

METHODS

This was a 156-week, randomized, double-blind, parallel-group, multicentre study. In the present paper we describe the primary results, namely those at 52 weeks. Adult participants (n = 685) were randomly assigned to albiglutide (30 mg/week), pioglitazone (30 mg/day) or placebo. If needed, blinded uptitration of albiglutide (to 50 mg/week) and pioglitazone (to 45 mg/day) was allowed. The participant's current dose of metformin (>1500 mg/day) was maintained throughout. The glimepiride dose (4 mg/day), standardized before randomization, could be decreased if persistent hypoglycaemia occurred.

RESULTS

The week 52 model-adjusted difference in change of glycated haemoglobin (primary endpoint) for albiglutide versus placebo was -0.87 [95% confidence interval (CI) -1.07, -0.68]%-units (p < 0.001), and for albiglutide versus pioglitazone it was 0.25 (95% CI 0.10, 0.40)%-units; therefore, not non-inferior. In the albiglutide group only, fasting plasma glucose reduced rapidly in the first 2 weeks. Confirmed hypoglycaemia occurred in 14% of participants on albiglutide, 25% on pioglitazone and 14% on placebo. The mean (± standard error) weight change was -0.42 (±0.2) kg with albiglutide, +4.4 (±0.2) kg (p < 0.001) with pioglitazone, and -0.40 (±0.4) kg with placebo and serious adverse events occurred in 6.3, 9.0 and 6.1% of participants in the respective groups. Injection site reactions occurred in 13% of participants on albiglutide and resulted in treatment discontinuation for four participants (1.4%).

CONCLUSIONS

Albiglutide, as part of triple therapy, provided effective glucose-lowering and was generally well tolerated.

Different animal welfare orientations towards some key research areas of current relevance to pastoral dairy farming in New Zealand

The New Zealand dairy industry needs to meet public expectations regarding animal welfare in order to retain the freedom to operate and achieve market success. Three key orientations towards animal welfare assessment have been identified, namely biological functioning, affective state and natural living, the last two of which are more recent foci for societal concern. Biological functioning was the first and most-studied aspect of animal welfare and continues to be important, but now the contribution of affective state to animal well-being is emphasised much more. Natural living, or naturalness, has received relatively less attention from animal welfare science. It is proposed that increasing the use of naturalness as a contextual reference point for considering species-specific behavioural expressions of affective state will enhance its inclusion in animal welfare assessment. Nevertheless, all three orientations need to be considered in order to evaluate the significance of welfare research findings. On this basis, five key aspects of the New Zealand dairy industry that have been the subject of recent research, due to the risk of them not meeting public expectations, are highlighted and discussed. The aspects are provision of shade and shelter, meeting targets for body condition, provision of comfortable surfaces for rearing calves, and for adult cows while off pasture, and pain relief for disbudding of calves. Research evidence indicates that the industry guidelines on body condition score, if met, would satisfy public expectations across the three orientations to animal welfare, whereas further work is needed on the other aspects. It is concluded that considering these three orientations to animal welfare when planning research and then evaluating the outcomes will help to promote the market success of the dairy industry in New Zealand.

Evaluating use of neutral electrolyzed water for cleaning near-patient surfaces

OBJECTIVE

This study aimed to monitor the microbiological effect of cleaning near-patient sites over a 48-hour period with a novel disinfectant, electrolyzed water.

SETTING

One ward dedicated to acute care of the elderly population in a district general hospital in Scotland.

METHODS

Lockers, left and right cotsides, and overbed tables in 30 bed spaces were screened for aerobic colony count (ACC), methicillin-susceptible Staphylococcus aureus (MSSA), and methicillin-resistant S. aureus (MRSA) before cleaning with electrolyzed water. Sites were rescreened at varying intervals from 1 to 48 hours after cleaning. Microbial growth was quantified as colony-forming units (CFUs) per square centimeter and presence or absence of MSSA and MRSA at each site. The study was repeated 3 times at monthly intervals.

RESULTS

There was an early and significant reduction in average ACC (360 sampled sites) from a before-cleaning level of 4.3 to 1.65 CFU/cm(2) at 1 hour after disinfectant cleaning ( P < .0001). Average counts then increased to 3.53 CFU/cm(2) at 24 hours and 3.68 CFU/cm(2) at 48 hours. Total MSSA/MRSA (34 isolates) decreased by 71% at 4 hours after cleaning but then increased to 155% (53 isolates) of precleaning levels at 24 hours.

CONCLUSIONS

Cleaning with electrolyzed water reduced ACC and staphylococci on surfaces beside patients. ACC remained below precleaning levels at 48 hours, but MSSA/MRSA counts exceeded original levels at 24 hours after cleaning. Although disinfectant cleaning quickly reduces bioburden, additional investigation is required to clarify the reasons for rebound contamination of pathogens at near-patient sites.

Abstract 1156: Shed syndecan-1 downregulates histone acetyltransferase activity and shuttles HGF to the nucleus of tumor and host cells

The cell surface heparan sulfate proteoglycan syndecan-1 (CD138) is expressed by myeloma tumor cells, is proteolytically shed from the cell surface and accumulates in the serum. High levels of serum syndecan-1 are an independent indicator of poor prognosis. Our lab has demonstrated that shed syndecan-1 drives myeloma tumor progression in vivo, but the mechanism(s) mediating this are not fully understood. The role of heparan sulfate proteoglycans on the cell surface and in the extracellular matrix has been extensively studied, but their presence and function within the nucleus is often overlooked. However, recent findings indicate that nuclear heparan sulfate has important regulatory functions. Based on preliminary findings, we hypothesized that shed syndecan-1 binds to the tumor cell surface and translocates to the nucleus where it regulates gene expression thereby promoting aggressive tumor behavior. We utilized murine myeloma cells which were grown in the presence of medium containing human shed syndecan-1. Strikingly, the shed syndecan-1 was rapidly taken up by these cells and translocated to the nucleus. Additionally, exogenous human shed syndecan-1 added to murine stromal cells also bound to the cell surface and translocated to the nucleus. This is the first demonstration that shed proteoglycans can translocate to the nucleus of cells. When stromal cells were grown in the presence of tumor-derived shed syndecan-1, acetylated histone H3 was decreased. Additionally, tumor cells engineered to express high levels of shed SDC1 have a 58% reduction in histone acetyltransferase activity. This may be due to syndecan-1 directly binding to p300/CBP-associated factor, a HAT enzyme. Moreover, HGF bound to shed syndecan-1 was shuttled to the nucleus of myeloma cells as a complex. Shed syndecan-1 and HGF translocation to the nucleus is dependent on intact heparan sulfate chains present on the syndecan-1 core protein. These data reveal a novel mechanism of tumor-host crosstalk whereby syndecan-1, shed by tumor cells, alters histone acetyltransferase activity and shuttles heparin-binding factors to the nucleus to reprogram cells and alter gene expression. Therapeutic regulation of syndecan-1 shedding, its binding to the cell surface or translocation to the nucleus represent novel strategies to control the progression of myeloma and other cancers.

Citation Format: Mark Stewart, Vishnu Ramani, Ralph Sanderson. Shed syndecan-1 downregulates histone acetyltransferase activity and shuttles HGF to the nucleus of tumor and host cells. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 1156. doi:10.1158/1538-7445.AM2014-1156

Bilateral Morgagni hernia: operative discovery of appendix lying on superior pulmonary vein

A patient presented having an acute abdomen on a background of a twelve-month history of worsening asthma. Computed tomography showed giant bilateral intrathoracic hernias extending to both thoracic apices. Our case was unusual as the defect was bilateral and left-sided. Surgical repair revealed each hernia sac measuring >20 cm and to contain the entirety of the small bowel and colon (including retroperitoneal bowel). The appendix was discovered adjacent to right superior pulmonary vein. Both sacs were excised and the defects dissected and transfixed in a single stage operation. In the post-operative stage, he developed a 6.3 cm fluid collection anterior to the right atrium and a left-sided pleural effusion. Morgagni hernias can escape detection and be attributed to other diagnoses courtesy of false localising signs on clinical examination and symptoms in the history.

The effect of rearing substrate and space allowance on the behavior and physiology of dairy calves

The objective of this study was to investigate the effect of rearing substrate and space allowance on the behavior and physiology of dairy calves. At 1 wk of age, 72 calves were moved into 1 of 18 experimental pens (n=4 calves/pen) where they remained until 6 wk of age. Half of the pens had floors covered with quarry stones (QS) and the other half were covered with sawdust (SW). For each substrate type, calves were reared at 1 of 3 space allowances: 1.0, 1.5, or 2.0 m(2)/calf. Behavior was video-recorded continuously for 24 h in the home pen at 2, 4, and 6 wk of age; the time calves spent lying, standing, walking, and running were estimated using 1-min instantaneous scan sampling. Body weight, cleanliness, fecal fluidity, and skin surface temperature were recorded at 1, 4, and 6 wk of age. Escherichia coli numbers were assessed on the skin surface of the shoulder and in feces of calves at 4 and 6 wk of age. Blood samples were taken at 1, 4, and 6 wk of age to measure cortisol, creatine kinase, immunoglobulin G, serum amyloid A, and total protein concentrations. Calves reared on QS spent less time lying and walking and more time standing at 4 and 6 wk of age compared with calves reared on SW. Furthermore, calves reared at a space allowance of 2.0 m(2)/calf spent less time lying and more time standing and walking compared with calves reared at a space allowance of 1.0 and 1.5 m(2)/calf. Calves reared on QS had lower skin surface temperatures compared with calves reared on SW. Fecal fluidity scores were lower in calves reared on QS than SW at 2 wk of age. Fewer E. coli were recovered from the shoulder of calves reared on QS than those of calves reared on SW, but fecal E. coli counts were similar between rearing substrates and space allowances. Serum amyloid A concentrations were lower in calves reared on QS than SW. We detected no effect of rearing substrate or space allowance on body weight, cleanliness, or concentrations of cortisol, creatine kinase, immunoglobulin G, and total protein. In conclusion, lower skin temperature in combination with reduced lying behavior may reflect reduced comfort of calves reared on QS. Furthermore, a space allowance of 2.0 m(2)/calf may provide calves with more opportunity to perform active behaviors.

An evaluation of the effectiveness of engaging Canadian clients as partners in in-home care

This exploratory quasi-experimental evaluation assessed the effectiveness of the use of a concrete discussion guide to promote organisation-wide application of a partnering approach to engage older home-care clients with chronic disease/disabilities as care partners. A post-test-only design with an independent pre-test sample was used to compare selected outcomes with those of standard in-home care. The theoretically informed discussion guide portrayed how to go about the process of empowering partnering by using language and open-ended conversational leads to construct partnering, partnering effort and health as a resource for everyday living through social interaction. The discussion guide was provided to all providers for use with all clients in one home-care programme in Ontario, Canada and this organisation was compared with a similar but geographically distanced organisation, also in Ontario. Seven hundred and ninety-one randomly selected clients (mean age = 72.5 years) receiving 3+ months of in-home care for chronic conditions/disabilities from the two home-care programmes between September 2007 and May 2010 completed a researcher-administered questionnaire at either baseline, 1 year or 2 years. Instruments included the Client's Partnering Experience, Health-Promoting Partnering Effort, a modified version of Locus of Authority in Decision-Making, the Medical Outcomes Survey Self-Rated Health Scale, Health and Social Services Utilization and a modified Functional Independence Measure. Analysis of covariance revealed that the use of the concrete discussion guide to promote organisation-wide application of a partnering approach achieved significantly greater client partnering experience and health-promoting partnering effort over time than did the usual approach to in-home-care interactions. Using the discussion guide enhanced client/provider partnering, hence, interdependence, contributing positively to promoting clients' health as a resource for everyday living.

Factors associated with early neonatal attendance to a paediatric emergency department

AIM

To examine the demographic and perinatal factors involved in the presentation of newborn babies to a paediatric emergency department (PED) and outcome following attendance.

METHODS

Term babies who attended the PED of the Royal Belfast Hospital for Sick Children (RBHSC) in the first 2 weeks of life, during two separate 3-month periods in summer and winter 2010-2011 were identified retrospectively from the PED electronic database. Perinatal and demographic data were also obtained on all babies born in the Royal Jubilee Maternity Hospital (RJMH) during the same time period.

RESULTS

A total of 223 attendances to the PED involving 208 babies were identified with almost equal distribution during summer and winter months. Almost two thirds (n=139, 62%) of babies presented out-of-hours. Over half of babies were self-referred by parent/carer. The most common presentation was feeding difficulty, vomiting or faltering growth, accounting for 36%. Significant factors associated with attendance to PED included birth weight <2500 g, deprivation and postnatal stay more than 2 days. Sixty-one babies (24%) presenting to PED were admitted to hospital. Significant factors for admission included age ≤ 48 h and presentation during the standard working day. Overall, a third of babies admitted stayed less than 24 h (34%).

CONCLUSIONS

Large numbers of babies attend the PED in the first 2 weeks of life, commonly out of hours, from deprived areas and with feeding difficulties. A quarter of babies attending are admitted to hospital, with one-third discharged following an overnight stay. Services should be reevaluated, particularly in this current financial climate, in an attempt to find new models of care for these young babies.

Quantitative Video Laryngoscopy to Monitor Recovery from Recurrent Laryngeal Nerve Injury in the Rat

Recovery from unilateral vocal-fold paralysis is lengthy, unpredictable, and often incomplete, highlighting the need for better treatments of the injured recurrent laryngeal nerve. To be able to monitor recovery of vocal-fold motion in studies with rats, we developed a procedure for quantitative video laryngoscopy. An asymmetry index was defined as a continuous and robust measure of unequal vocal-fold motion and calculated from spectral-density plots of vocal-fold displacements. In a cohort of 8 animals, unilateral vocal-fold paralysis was observed within seconds after clamping of the right recurrent laryngeal nerve and was accompanied by a markedly negative asymmetry index. Over the next month, the asymmetry index gradually returned to zero, concomitant with a visible recovery of vocal-fold motion. Our results suggest that quantitative video laryngoscopy is a sensitive and discriminating method for monitoring recovery from recurrent laryngeal nerve injury and set the stage for testing novel surgical and pharmacological treatments of unilateral vocal-fold paralysis.

Development and usability testing of a web-based cancer symptom and quality-of-life support intervention

The feasibility and acceptability of computerized screening and patient-reported outcome measures have been demonstrated in the literature. However, patient-centered management of health information entails two challenges: gathering and presenting data using "patient-tailored" methods and supporting "patient-control" of health information. The design and development of many symptom and quality-of-life information systems have not included opportunities for systematically collecting and analyzing user input. As part of a larger clinical trial, the Electronic Self-Report Assessment for Cancer-II project, participatory design approaches were used to build and test new features and interfaces for patient/caregiver users. The research questions centered on patient/caregiver preferences with regard to the following: (a) content, (b) user interface needs, (c) patient-oriented summary, and (d) patient-controlled sharing of information with family, caregivers, and clinicians. Mixed methods were used with an emphasis on qualitative approaches; focus groups and individual usability tests were the primary research methods. Focus group data were content analyzed, while individual usability sessions were assessed with both qualitative and quantitative methods. We identified 12 key patient/caregiver preferences through focus groups with 6 participants. We implemented seven of these preferences during the iterative design process. We deferred development for some of the preferences due to resource constraints. During individual usability testing (n = 8), we were able to identify 65 usability issues ranging from minor user confusion to critical errors that blocked task completion. The participatory development model that we used led to features and design revisions that were patient centered. We are currently evaluating new approaches for the application interface and for future research pathways. We encourage other researchers to adopt user-centered design approaches when building patient-centered technologies.

Relation of autonomic and cardiac abnormalities to ventricular fibrillation in a rat model of epilepsy

Cardiac autonomic, conduction, and structural changes may occur in epilepsy and may contribute to sudden unexpected death in epilepsy (SUDEP), e.g. by increasing the risk for ventricular fibrillation (VF). In a model of chronic seizures in rats, we sought to study (1) cardiac and autonomic derangements that accompany the epileptic state, (2) whether chronically seizing rats experienced more significant cardiac effects after severe acute seizures, and (3) the susceptibility of chronically seizing rats to VF arising from autonomic and hypoxemic changes, which commonly occur during seizures. Sprague-Dawely rats were injected with saline or kainic acid to induce chronic seizures. At 2-3 months or 7-11 months after injection, these rats were studied with both 12-lead electrocardiography (to assess heart rate variability and QT dispersion) and echocardiography under ketamine/xylazine or urethane anesthesia. Hearts were subsequently excised, weighed, and examined histologically. Epileptic rats exhibited decreased vagal tone, increased QT dispersion, and eccentric cardiac hypertrophy without significant cardiac fibrosis, especially at 7-11 months post-injection. Of these three findings, vagal tone was inversely correlated with heart weights. Epileptic rats exhibited diminished systolic function compared to controls after severe acute seizures. However, animals with long-standing chronic seizures were less susceptible to autonomic/hypoxemia-driven VF, and their susceptibility inversely correlated with mean left ventricular wall thickness on histology. On the basis of this model, we conclude that cardiac changes accompany epilepsy and these can lead to significant seizure-associated cardiac performance decreases, but these cardiac changes actually lower the probability of VF.