Protocol for a construct and clinical validation study of MyCog Mobile: a remote smartphone-based cognitive screener for older adults

INTRODUCTION

Annual cognitive screening in older adults is essential for early detection of cognitive impairment, yet primary care settings face time constraints that present barriers to routine screening. A remote cognitive screener completed on a patient's personal smartphone before a visit has the potential to save primary care clinics time, encourage broader screening practices and increase early detection of cognitive decline. MyCog Mobile is a promising new remote smartphone-based cognitive screening app for primary care settings. We propose a combined construct and clinical validation study of MyCog Mobile.

METHODS AND ANALYSIS

We will recruit a total sample of 300 adult participants aged 65 years and older. A subsample of 200 healthy adult participants and a subsample of 100 adults with a cognitive impairment diagnosis (ie, dementia, mild cognitive impairment, cognitive deficits or other memory loss) will be recruited from the general population and specialty memory care centres, respectively. To evaluate the construct validity of MyCog Mobile, the healthy control sample will self-administer MyCog Mobile on study-provided smartphones and be administered a battery of gold-standard neuropsychological assessments. We will compare correlations between performance on MyCog Mobile and measures of similar and dissimilar constructs to evaluate convergent and discriminant validity. To assess clinical validity, participants in the clinical sample will self-administer MyCog Mobile on a smartphone and be administered a Mini-Cog screener and these data will be combined with the healthy control sample. We will then apply several supervised model types to determine the best predictors of cognitive impairment within the sample. Area under the receiver operating characteristic curve, accuracy, sensitivity and specificity will be the primary performance metrics for clinical validity.

ETHICS AND DISSEMINATION

The Institutional Review Board at Northwestern University (STU00214921) approved this study protocol. Results will be published in peer-reviewed journals and summaries provided to the study's funders.

Systematic Review of Hypofractionated Radiation Therapy for the Treatment of Oesophageal Squamous Cell Carcinoma and Oesophageal Adenocarcinoma

BACKGROUND AND AIM

There has been limited progress made in improving the suboptimal outcomes delivered by conventionally fractionated radiotherapy (RT) for oesophageal adenocarcinoma (OAC) and squamous cell carcinoma (OSCC). A greater biological effect may be achieved using hypofractionated RT (HFRT), though the toxicity, tolerability and efficacy of this approach in OAC and OSCC is uncertain.

METHODS

A systematic literature review was carried out in accordance with Preferred Reporting Items for Systematic Reviews guidance. Medline, EMBASE, PubMed, Cochrane, CINAHL, Scopus and Web of Science databases were searched for terms relating to HFRT (>2.4Gy per fraction) for OAC or OSCC. All relevant clinical studies published between January 2000 and April 2023 were included. Study quality was assessed using predefined criteria.

RESULTS

Ninety-six studies were screened and 20 subsequently included, together incorporating 1208 patients. Fourteen studies focussed on neoadjuvant or definitive treatment. These were predominantly retrospective (n = 10, 71%) though two (n = 2, 14%) early phase trials were identified. Most focussed on OSCC (n = 7, 47%) or mixed OSCC/OAC (n = 6, 43%) populations. Four (28.6%) included a conventionally fractionated chemoradiotherapy (CRT) comparator, against which median overall (mOS) and progression free survival outcomes from HFRT did not differ. Reported mOS for HFRT ranged between 29-36 months at 2.5-3.125Gy per fraction (total dose 50-60Gy) for OAC and OSCC combined. Toxicity and tolerability with HFRT was comparable with conventionally fractionated CRT up to, but not exceeding, 5Gy. Three (50%) of the six palliative-intent studies were early phase trials and most (n = 4, 67%) focussed on OAC and OSCC. Response rates with HFRT in the palliative setting were 63.6-88.0%.

CONCLUSION

These data provide evidence in OAC/OSCC for promising efficacy and an acceptable toxicity profile for moderately HFRT, alone or with concurrent chemotherapy. These data should prompt prospective, randomised comparisons of HFRT and conventionally fractionated CRT and single-modality RT schedules.

REGISTRATION DETAILS

PROSPERO; CRD42023457791.

Remote Self-Administration of Cognitive Screeners for Older Adults Prior to a Primary Care Visit: Pilot Cross-Sectional Study of the Reliability and Usability of the MyCog Mobile Screening App

BACKGROUND

Routine cognitive screening is essential in the early detection of dementia, but time constraints in primary care settings often limit clinicians' ability to conduct screenings. MyCog Mobile is a newly developed cognitive screening system that patients can self-administer on their smartphones before a primary care visit, which can help save clinics' time, encourage broader screening practices, and increase early detection of cognitive decline.

OBJECTIVE

The goal of this pilot study was to examine the feasibility, acceptability, and initial psychometric properties of MyCog Mobile. Research questions included (1) Can older adults complete MyCog Mobile remotely without staff support? (2) Are the internal consistency and test-retest reliability of the measures acceptable? and (3) How do participants rate the user experience of MyCog Mobile?

METHODS

A sample of adults aged 65 years and older (N=51) self-administered the MyCog Mobile measures remotely on their smartphones twice within a 2- to 3-week interval. The pilot version of MyCog Mobile includes 4 activities: MyFaces measures facial memory, MySorting measures executive functioning, MySequences measures working memory, and MyPictures measures episodic memory. After their first administration, participants also completed a modified version of the Simplified System Usability Scale (S-SUS) and 2 custom survey items.

RESULTS

All participants in the sample passed the practice items and completed each measure. Findings indicate that the Mobile Toolbox assessments measure the constructs well (internal consistency 0.73 to 0.91) and are stable over an approximately 2-week delay (test-retest reliability 0.61 to 0.71). Participants' rating of the user experience (mean S-SUS score 73.17, SD 19.27) indicated that older adults found the usability of MyCog Mobile to be above average. On free-response feedback items, most participants provided positive feedback or no feedback at all, but some indicated a need for clarity in certain task instructions, concerns about participants' abilities, desire to be able to contact a support person or use in-app technical support, and desire for additional practice items.

CONCLUSIONS

Pilot evidence suggests that the MyCog Mobile cognitive screener can be reliably self-administered by older adults on their smartphones. Participants in our study generally provided positive feedback about the MyCog Mobile experience and rated the usability of the app highly. Based on participant feedback, we will conduct further usability research to improve support functionality, optimize task instructions and practice opportunities, and ensure that patients feel comfortable using MyCog Mobile. The next steps include a clinical validation study that compares MyCog Mobile to gold-standard assessments and tests the sensitivity and specificity of the measures for identifying dementia.

Online Oncology Careers Events to Attract the Future Oncology Medical Workforce: An Exemplar Event and Review of the Literature

AIMS

There are too few oncologists to meet the increasing burden imposed by the rising incidence of cancer. This results from issues with the retention of established oncologists and longstanding challenges to the recruitment of adequate numbers of trainees. To counter this, the British Oncology Network for Undergraduate Societies (BONUS) devised an online oncology careers event for medical students and junior doctors who are yet to select a specialty.

MATERIALS AND METHODS

An online careers event was devised with a focus on oncology practice and related subspecialties, as well as research. Event attendees were asked to respond to piloted pre- and post-event surveys. Knowledge and attitudes towards a career in oncology were evaluated using Likert scale and multiple-choice questions. A systematic literature search was carried out to contextualise these data.

RESULTS

Of the 73 attendees, 44 (60%) participants completed both the pre- and post-event surveys; 79.5% of attendees believed that information on a career in oncology is lacking in medical training. This viewpoint was supported by the systematic review, which highlighted a need for relevant focussed interventions targeted at medical students and fledgling doctors. The education event led to an increase in the median reported understanding of the oncology career pathway from 6.0 to 8.0 (P < 0.05 and P < 0.001), as well as the likelihood of pursuing a career in oncology (8.0-9.0; P < 0.05). It was also associated with a proportional increase in medical and surgical oncology interest, albeit with a fall in interest in clinical and interventional oncology as well as academia.

CONCLUSION

A targeted online careers event increases knowledge of and interest in a career in oncology, albeit predominantly for medical and surgical subspecialties. Broader initiatives based on our model should be developed and careers in academia as well as clinical and interventional oncology emphasised.

The impact of endoscopic ultrasound on the management and outcome of patients with oesophageal cancer: an update of a systematic review

AIM

To provide an updated systematic review concerning the impact of endoscopic ultrasound (EUS) in the modern era of oesophageal cancer staging.

MATERIALS AND METHODS

To update the previous systematic review, databases including MEDLINE and EMBASE were searched and studies published from 2005 onwards were selected. Studies reporting primary data in patients with oesophageal or gastro-oesophageal junction cancer who underwent radiological staging and treatment, regardless of intent, were included. The primary outcome was the reported change in management after EUS. Secondary outcomes were recurrence rate and overall survival. Two reviewers extracted data from included articles. This study was registered with PROSPERO (CRD42021231852).

RESULTS

Eighteen studies with 11,836 patients were included comprising 2,805 patients (23.7%) who underwent EUS compared to 9,031 (76.3%) without EUS examination. Reported change of management varied widely from 0% to 56%. When used, EUS fine-needle aspiration precluded curative treatment in 37.5%-71.4%. Overall survival improvements ranged between 121 and 639 days following EUS intervention compared to patients without EUS. Smaller effect sizes were observed in a randomised controlled trial, compared to larger differences reported in observational studies.

CONCLUSION

Current evidence for the effectiveness of EUS in oesophageal cancer pathways is conflicting and of limited quality. In particular, the extent to which EUS adds value to contemporary cross-sectional imaging techniques is unclear and requires formal re-evaluation.

A national cross-sectional survey investigating the use of endoscopic ultrasound in the diagnosis and treatment of oesophageal cancer in the UK

AIM

To evaluate variation in the pre-pandemic use of endoscopic ultrasound (EUS) for oesophageal cancer diagnosis and treatment planning up to 2019, and which factors contributed to this.

MATERIALS AND METHODS

A UK-wide online survey of oesophagogastric multidisciplinary team lead clinicians was undertaken to determine perceptions towards, and the use of, EUS to aid staging and treatment planning in oesophageal cancer.

RESULTS

Thirty-five responses were received, representing 97 UK National Health Service Trusts/Health Boards. A majority of centres (n=21, 60%) did not have formal written guidance for EUS use. Although all respondents had access to EUS, a perceived lack of utility (n=7) and concerns about delaying treatment start dates (n=8) each restricted EUS use for a fifth of respondents. For most centres (n=24, 68.6%), EUS use is case-specific, whereas for 10 (28.6%) EUS is used for all patients with potentially curable disease. A majority of centres use diagnostic positron-emission tomography for radiotherapy target volume delineation (TVD), whereas 22 (62.9%) use EUS. The factors contributing to decisions to use EUS for staging, TVD and surgical planning varied between centres. The proportion of centre respondents who would request EUS in each of six clinical scenarios varied considerably.

CONCLUSION

There were substantial differences in the patient and disease characteristics that are perceived to be indications for EUS use for both staging and treatment planning. Research to clarify in which patients with oesophageal cancer EUS affords benefit is required, as is urgent standardisation of its role in the diagnostic pathway.

Short communication: Variation in serum immunoglobulin G concentrations from birth to 112 days of age in Holstein calves fed a commercial colostrum replacer or maternal colostrum

Serum IgG concentrations in dairy calves change throughout their first weeks of life, peaking at 24 h and then steadily decreasing until calves begin to produce endogenous IgG. The objective of this study was to observe serum IgG dynamics from birth until 16 wk of life in calves fed either maternal colostrum (MC) or colostrum replacer (CR). A total of 44 Holstein calves were randomly assigned to 1 of the 4 colostrum treatments and followed throughout the study. Treatments consisted of feeding high-quality MC, low-quality MC supplemented with CR, or 1 of 2 distinct levels of IgG concentration from CR. Overall, the interaction between type of colostrum fed and sampling time was significant. Individual differences for this effect were found at d 1, 7, 14, 21, 28, and 98, while the other time points were not different.

Effect of converting weaned dairy calves from a component-fed diet to a total mixed ration on growth and nutrient digestibility

The objective was to determine the effects of converting calves from a component-fed ration to a total mixed ration (TMR) at 8, 10, or 12 wk of age on intake, growth, and nutrient digestibility. Holstein calves (n = 40) were randomly assigned to 1 of 4 groups (no TMR, TMR conversion at 8, 10 or 12 wk; T0, T8, T10, and T12, respectively). Calves were weaned at 6 wk of age, housed individually, and studied from 7 to 14 wk of age. Rations, consisting of a 20% crude protein texturized starter and grass hay, were offered ad libitum as separate components or as a TMR with 85% starter and 15% grass hay on a dry matter (DM) basis. Intakes and body weights (BW) were measured weekly. Component intake for TMR was calculated from the proportion of grass hay and starter contained in the TMR. Fecal grab samples were collected every 9 h over 3 d for a total of 8 samples that formed a composite at 9, 11, and 13 wk of age from the same 4 calves per group. Rumen fluid samples were collected via esophageal tube at -1, 0, 3, and 7 d relative to conversion from component to TMR. Feed and feces were evaluated for DM, neutral detergent fiber, acid detergent fiber, and acid detergent lignin (internal flow marker) to estimate digestibility. Average daily gain and final BW tended to be least for T8. Empty BW gain was significantly less for T8 than for T0 but not different from T10 or T12 (T0 = 1.07, T8 = 0.93, T10 = 1.02, T12 = 1.04 kg/d). Hip growth tended to be least for T8 and resulted in lower final hip width (T0 = 25.9, T8 = 25.2, T10 = 25.6, T12 = 25.8 cm). Intake tended to be reduced for calves converted to TMR earlier. Throughout the study, calves fed TMR ate more hay and less starter than component-fed calves. Metabolizable energy intake was less for T8 versus T0 but not different from T10 or T12 (T0 = 8.46, T8 = 7.55, T10 = 8.01, T12 = 8.23 Mcal/d). We observed no differences in feed efficiency for the duration of the study. Differences in DM digestibility were not observed, but fiber digestibility was greater for calves fed TMR at 9, 11, and 13 wk of age. Conversion to TMR increased rumen pH. These results indicate that TMR conversion increased hay consumption and subsequently decreased starter and total DM intake. This led to reduced weight and structural growth; however, calves that were converted to TMR as early as 8 wk still achieved adequate growth. The increase in rumen pH and subsequent increase in fiber digestibility allowed for calves to be converted to a 15% grass hay TMR as early as 8 wk and still achieve desirable growth goals.

Comparison of immunoglobulin G absorption in calves fed maternal colostrum, a commercial whey-based colostrum replacer, or supplemented maternal colostrum

Successful passive transfer of antibodies in neonatal calves can be achieved by feeding an adequate quantity and quality of maternal colostrum (MC) or colostrum replacer (CR). An alternative could be feeding low-quality maternal colostrum (LMC) with added IgG from a CR. The objective of this study was to determine if a commercial whey-based CR product containing low levels of casein (Premolac PLUS Bovine IgG; Zinpro Corporation, Eden Prairie, MN) fed to replace MC or supplement LMC could lead to adequate serum IgG levels and apparent efficiency of absorption (AEA) in neonatal dairy calves. Holstein calves (n = 20 per treatment) were separated from their dam after birth and randomly assigned to be fed 3.79 L of MC (106 g/L of IgG; 401 g of IgG fed), LMC (30 g/L IgG) supplemented with CR (41 g/L IgG; 154 g of IgG total fed; LMC-CR), or 1.3 L of 1 of 2 levels of CR (110 or 150 g of IgG fed; CR-110 or CR-150) within 1.5 h of birth. Colostrum was obtained from the first (MC) or second and third milkings (LMC) of cows from Pennsylvania State University dairy and pooled by source into large batches. Blood samples were taken from calves before colostrum feeding and 24 h after birth and were analyzed for serum total protein, total IgG, hematocrit, and Brix percentage. Calves fed MC had higher 24-h IgG values (means ± SEM) than calves fed LMC-CR (27.04 ± 1.07 vs. 22.33 ± 1.08 mg/mL, respectively). Feeding 150 g of IgG from CR led to higher 24-h serum IgG values than feeding 110 g of IgG (16.90 ± 1.09 vs. 12.79 ± 1.08 mg/mL). Serum IgG levels were different between the CR-fed calves and the calves fed LMC-CR and MC, but all had average values >10 mg/mL IgG. Calves fed LMC-CR had greater AEA than calves fed MC (54.58 ± 2.39 vs. 24.38 ± 2.36%, respectively). Among calves fed CR-110 or CR-150, AEA did not differ. Serum total protein and Brix percentage had strong correlations with actual IgG values across the entire study. We found no differences in average daily gain or health variables measured, and no differences in final hip width, withers height, or body weight for calves fed MC, LMC-CR, CR-150, or CR-110. These results indicate that CR can be fed successfully as an alternative to MC or as a supplement to colostrum with low IgG.

Symposium review: Colostrum management and calf nutrition for profitable and sustainable dairy farms

Multistate dairy management research project NC-2042, which is part of the National Institute of Food and Agriculture, has devoted an ongoing objective to calf and heifer nutrition and management. Within this objective, colostrum research has been a priority due to continued opportunities to improve this area on US dairy farms. Research has focused on heating colostrum to reduce bacterial populations and pathogens while increasing IgG absorption. Research also identified other proteins that are reduced when heating colostrum. Studies indicated an apparent upper limit to IgG absorption from colostrum fed to calves. Additional studies have shed light on absorption of IgG from colostrum replacers and evaluated the use of lactoferrin and sodium bicarbonate in both maternal colostrum and colostrum replacers. Milk replacer formulation, feeding strategies, and the effect of calfhood nutrition on future performance have also been researched. Finally, water quality and its effect on calves and heifers have been studied. This review focuses on research done by multistate research project NC-2042 member states in the area of colostrum and calf nutrition and management.

Hypofractionated Radiotherapy in Oesophageal Cancer for Patients Unfit for Systemic Therapy: A Retrospective Single-Centre Analysis

AIMS

Chemoradiotherapy (CRT) is established as a superior treatment option to definitive radiotherapy in the non-surgical management of oesophageal cancer. For patients precluded from CRT through choice or comorbidity there is little evidence to guide delivery of single-modality radiotherapy. In this study we outline outcomes for patients unfit for CRT who received a hypofractionated radiotherapy (HRT) regimen.

MATERIALS AND METHODS

A retrospective UK single-centre analysis of 61 consecutive patients with lower- or middle-third adenocarcinoma (OAC; 61%) or squamous cell carcinoma of the oesophagus managed using HRT with radical intent between April 2009 and 2014. Treatment consisted of 50 Gy in 16 fractions (n = 49, 80.3%) or 50-52.5 Gy in 20 fractions (n = 12, 19.7%). Outcomes were referenced against a contemporaneous comparator cohort of 80 (54% OAC) consecutive patients managed with conventionally fractionated CRT within the same centre.

RESULTS

Three-year and median overall survival were, respectively, 56.9% and 29 months with HRT compared with 55.5% and 26 months for CRT; adjusted hazard ratio 0.79 (95% confidence interval 0.48-1.28). Grade 3 and 4 toxicity rates were low at 16.4% (n = 10) for those receiving HRT and 40.2% (n = 32) for the CRT group. In patients with OAC, CRT delivered superior overall survival (hazard ratio 0.46; 95% confidence interval 0.25-0.85) and progression-free survival (hazard ratio 0.45; 95% confidence interval 0.23-0.88) when compared with HRT.

CONCLUSIONS

The HRT regimen described here was safe and tolerable in patients unable to receive CRT, and delivered promising survival outcomes. The use of HRT for the treatment of oesophageal cancer, both alone and as a sequential or concurrent treatment with chemotherapy, requires further study. New precision radiotherapy technologies may provide additional scope for improving outcomes in oesophageal cancer using HRT-based approaches and should be evaluated.

Low rates of dental attendance by the age of one and inequality between local government administrative areas in England

OBJECTIVE

To describe child dental attendance (DA) by 1 year of age in England and its relationship with area deprivation.

BASIC RESEARCH DESIGN

Analysis of National Health Service data for the 12 months to June 2017. Deprivation was measured by Index of Multiple Deprivation Rank of Average Score (2015) for upper-tier and unitary local authorities in England (LAs, n=151). DA rates were calculated for children under 1 year (⟨1yr) and children aged 1 year and under (⟨1yr). A Spearman's test assessed strength of association with deprivation. The Slope Index of Inequality (SII) and Relative Index of Inequality (RII) explored equity.

CLINICAL SETTING

Upper-tier and unitary LAs in England.

MAIN OUTCOME MEASURE

Attending an NHS primary care dental service.

RESULTS

DA rates ranged from 0 to 12.3% (Median:2; IQR:1.4,3.9) in children ⟨1yr and from 3.7 to 37.6% (Median:10; IQR:7.4,17) in children ≤1yr. DA rates decreased as deprivation decreased (Spearman=-0.25, p=0.0019 in children ⟨1yr; Spearman=-0.21, p=0.0104 in children ≤1yr). The SII suggested a 2 percentage point difference in DA rate across the deprivation distribution in children ⟨1yr (SII=-0.02, 95% CI=-0.01,-0.04; p=⟨0.001); and a 5 point difference in children ≤1yr (SII=-0.05, 95% CI=-0.02,-0.09; p=0.003). The DA rate in the most deprived LA was 2.1 higher than the least deprived LA (RII=2.1, 95% CI=1.4,3.2; p=⟨0.001) in children ⟨1yr and 1.5 higher (RII=1.5, 95% CI=1.2,2; p=0.004) in children ≤1yr.

CONCLUSIONS

DA rates were low for all LAs and only partially explained by deprivation. More deprived LAs were, unexpectedly, more likely to report higher DA rates.

Effects of once- versus twice-a-day feeding of pasteurized milk supplemented with yeast-derived feed additives on growth and health in female dairy calves

The objective of this study was to compare the effects of feeding preweaning dairy calves pasteurized milk once or twice a day with or without a combination of yeast-derived products. Holstein heifer calves (n = 48) from The Pennsylvania State University dairy herd were fed 3.8 L of colostrum in 1 feeding and randomly assigned to 1 of 4 treatments (once-a-day milk feeding with or without live yeast culture and mannan-rich fraction and twice-a-day milk feeding with or without live yeast culture and mannan-rich fraction). All calves were fed 6 L of milk daily. Weekly growth measurements and blood samples were taken 3 h after the morning milk feeding for all animals. Growth measurement included body weight, hip width, and withers height. Calf starter refusal was recorded weekly, and a sample was taken to determine dry matter intake. Daily health scores were recorded for each calf using a standard scoring system. Intake, growth measurements, haptoglobin, and health scores data were analyzed using repeated measures analysis with calf included as a random variable. Preweaning average daily gain was 553.4 and 512.1 g/d for calves fed milk once and twice a day, respectively, and we found no difference between treatments. Preweaning calf starter intake was 242.3 and 198.7 g/d for calves fed milk once and twice a day, respectively, and we found no treatment differences. Preweaning calf starter intake was 224.3 and 216.6 g/d for calves fed yeast and without yeast, respectively. Withers height and hip width were similar in calves fed milk either once or twice a day; however, calves fed yeast tended to have greater withers height and hip width than control calves. Haptoglobin concentration as a measure of stress had least squares means of 4.0 and 9.5 ± 3.5 µg/mL for calves fed milk once or twice a day, respectively, and we found no difference among treatments. Scours score and total daily score were similar for calves fed milk once or twice a day. These results suggest that feeding milk once a day can be successfully applied to a calf feeding system and that yeast products may improve structural growth.

A qualitative exploration of driving stress and driving discourtesy

BACKGROUND

Driving courtesy, and conversely driving discourtesy, recently has been of great interest in the public domain. In addition, there has been increasing recognition of the negative impact of stress upon the individual's health and wellbeing, with a plethora of interventions aimed at minimising stress more generally. The research literature regarding driving dis/courtesy, in comparison, is scant, with a handful of studies examining the dis/courteous driving behaviour of road users, and the relationship between driving discourtesy and driving stress.

AIM

To examine courteous and discourteous driving experiences, and to explore the impact of stress associated with such driving experiences.

METHOD

Thirty-eight drivers (20 females) from the Sunshine Coast region volunteered to participate in one of four 1-1.5 h focus groups. Content analysis used the verbatim utterances captured via an Mp3 device.

RESULTS

Three themes pertaining to stressful and discourteous interactions were identified. Theme one pertained to the driving context: road infrastructure (eg, roundabouts, roadwork), vehicles (eg, features), location (eg, country vs city, unfamiliar areas), and temporal aspects (eg, holidays). Theme two pertained to other road users: their behaviour (eg, tailgating, merging), and unknown factors (eg, illicit and licit drug use). Theme three pertained to the self as road user: their own behaviours (eg, deliberate intimidation), and their emotions (eg, angry reaction to other drivers, being in control).

DISCUSSION AND CONCLUSIONS

Driving dis/courtesy and driving stress is a complex phenomenon, suggesting complex intervention efforts are required. Driving discourtesy was reported as being highly stressful, therefore intervention efforts which encourage driving courtesy and which foster emotional capacity to cope with stressful circumstances appear warranted.

The caries experience of 5 year-old children in Scotland in 2013-2014, and in England and Wales in 2014-2015. Reports of cross-sectional dental surveys using BASCD criteria

OBJECTIVE

We report the findings from and comment on the surveys of the oral health of 5-year-old children undertaken in Scotland (2013-14), Wales (2014-15) and England (2014-15). This was the fourteenth survey in Scotland since 1988. In England and Wales it is the third survey since 2007 when changes were required in consent arrangements.

METHOD

Representative samples were drawn within Health Boards across Scotland and local authorities across England and Wales. Consent was sought via opt-out parental consent in Scotland and opt-in parental consent in England and Wales. Children examined were those aged five in England and those in Primary 1 (school year aged 5 to 6) in Scotland and Wales. Examinations were conducted in schools by trained and calibrated examiners. Caries was visually diagnosed at the dentinal threshold.

RESULTS

There is a continuing decline in d₃mft in all three countries. d₃mft was 1.27 (opt-out consent) for Scotland, 0.84 for England (opt-in consent) and 1.29 for Wales (opt-in consent). Tooth decay levels remain higher in more deprived areas across Great Britain, with clear inequalities gradients demonstrated across all geographies. Attempts to measure changes in dental health inequalities across the three countries show no conclusive trends.

CONCLUSION

Inter-country comparisons provide further oral health intelligence despite differences in approach and timing. The third surveys in England and Wales using the new consent arrangements have enabled trend analysis. Dental health inequalities gradients were shown across all geographies and all of the indicators of inequality.

Pooled analysis of two randomized, double-blind trials comparing proposed biosimilar LA-EP2006 with reference pegfilgrastim in breast cancer

Background

Following the functional and physicochemical characterization of a proposed biosimilar, comparative clinical studies help to confirm biosimilarity by demonstrating similar safety and efficacy to the reference product in a sensitive patient population.

Patients and methods

LA-EP2006 is a proposed biosimilar that has been developed for pegfilgrastim, a long-acting form of granulocyte colony-stimulating factor for the prevention of neutropenia. The current analysis reports data pooled from two independent, multinational, prospective, randomized, controlled, double-blind phase III studies of similar design comparing the safety and efficacy of reference pegfilgrastim with LA-EP2006 in patients with breast cancer receiving myelotoxic (neo)adjuvant TAC (docetaxel, doxorubicin, and cyclophosphamide) chemotherapy and requiring granulocyte colony-stimulating factor.

Results

A total of 624 patients were randomized in the PROTECT-1 and PROTECT-2 studies (NCT01735175; NCT01516736) (LA-EP2006: n = 314; reference: n = 310). Baseline characteristics of patients were well balanced across treatment groups. The primary end point, mean duration of severe neutropenia in the first chemotherapy cycle was similar in both the LA-EP2006 and reference groups (1.05 ± 1.055 days versus 1.01 ± 0.958 days), with a treatment difference of - 0.04 days [95% confidence interval (CI): -0.19 to 0.11] that met the equivalence criteria (the 95% CI were within the defined margin of ±1 day). Secondary end points, such as the nadir of absolute neutrophil count and the incidence of febrile neutropenia, were also similar between LA-EP2006 and reference pegfilgrastim. The safety and tolerability profile of LA-EP2006 was similar to that observed with reference pegfilgrastim, and there were no reports of neutralizing antibodies.

Conclusions

This pooled analysis confirms, as a part of totality of evidence approach, that the proposed biosimilar pegfilgrastim LA-EP2006 has a comparable efficacy and safety profile to reference pegfilgrastim in patients with breast cancer receiving TAC chemotherapy.

Clinical trial numbers

NCT01735175 and NCT01516736.

Children's thoughts and feelings about their donor and security of attachment to their solo mothers in middle childhood

STUDY QUESTION

What is the relationship between children's thoughts and feelings about their donor and their security of attachment to their solo mothers in middle childhood?

SUMMARY ANSWER

Children with higher levels of secure–autonomous attachment to their mothers were more likely to have positive perceptions of the donor, and those with higher levels of insecure–disorganized attachment to their mothers were more likely to perceive him negatively.

WHAT IS KNOWN ALREADY

There is limited understanding of the factors that contribute to children's thoughts and feelings about their donor in solo mother families. In adolescence, an association was found between adolescents’ curiosity about donor conception and their security of attachment to their mothers.

STUDY DESIGN, SIZE, DURATION

19 children were administered the Friends and Family Interview and Donor Conception Interview between December 2015 and March 2016 as part of the second phase of a longitudinal, multi-method, multi-informant study of solo mother families.

PARTICIPANTS/MATERIALS, SETTING, METHODS

All children were aged between 7 and 13 years and had been conceived by donor insemination to solo mothers. Interviews were conducted in participants’ homes. The Friends and Family Interview was rated according to a standardized coding scheme designed to measure security of attachment in terms of secure–autonomous, insecure–dismissing, insecure–preoccupied and insecure–disorganized attachment patterns. Quantitative analyses of the Donor Conception Interview yielded two factors: interest in the donor and perceptions of the donor. Qualitative analyses of the Donor Conception Interview were conducted using qualitative content analysis and thematic analysis.

MAIN RESULTS AND THE ROLE OF CHANCE

Statistically significant associations were found between the perception of the donor scale and the secure–autonomous and insecure–disorganized attachment ratings. Children with higher levels of secure–autonomous attachment to their mothers were more likely to have positive perceptions of the donor (r = 0.549, P = 0.015), and those with higher levels of insecure–disorganized attachment to their mothers were more likely to perceive him negatively (r = −0.632, P = 0.004). Children's narratives about the donor depicted him as a stranger (n = 8), a biological father (n = 4), a social parent (n = 3), or in ambivalent terms (n = 4).

LIMITATIONS, REASONS FOR CAUTION

Findings are limited by the wide age range of children within a small overall sample size. Participants were those willing and able to take part in research on donor conception families. The statistical significance of correlation coefficients was not corrected for multiple comparisons.

WIDER IMPLICATIONS OF THE FINDINGS

Findings highlight the importance of situating children's ideas about the donor within family contexts. It is recommended that those working with donor conception families consider this when advising parents about whether, what and how to tell children about donor conception.

STUDY FUNDING/COMPETING INTEREST(S)

This study was funded by the Wellcome Trust [097857/Z/11/Z]. The authors have no conflicts of interest to declare.

Abstract P2-11-05: Safety, immunogenicity and efficacy of proposed biosimilar pegfilgrastim (LA-EP2006) compared with reference pegfilgrastim in breast cancer: Pooled analysis of two randomized, double-blind, phase III trials

Background: Biosimilars are highly similar to a biological reference product with no clinically meaningful differences in terms of efficacy and safety. Here we present the pooled analysis of two randomized trials (PROTECT1 and 2) comparing the efficacy, safety and immunogenicity of proposed biosimilar pegfilgrastim (LA-EP2006) with reference pegfilgrastim (Neulasta®*).

Methods: Two multinational, independent, prospective, double-blind, phase III studies (EudraCT: 2011-004532-58; 2012-002039-28) enrolled adult chemotherapy-naïve women with breast cancer scheduled to receive ≤6 cycles of (neo)-adjuvant chemotherapy with docetaxel 75 mg/m2, doxorubicin 50 mg/m2 and cyclophosphamide 500 mg/m2 (TAC). Patients were randomized to receive a single 6 mg injection of LA-EP2006 or reference on Day 2 of each cycle. Primary endpoint was duration of severe neutropenia (DSN) (number of consecutive days with ANC &lt;0.5x109/L) in Cycle 1. Equivalence was confirmed if the 95% confidence intervals (CI) for the difference in mean DSN between groups were within a pre-defined margin of ±1 day. Secondary efficacy endpoints included incidences of febrile neutropenia (FN), fever and infections, and depth of ANC nadir and time to ANC recovery (≥2×109/L after the nadir) in Cycle 1. Safety was assessed at each visit with follow-up visits at 4 weeks and 6 months (PROTECT1 only) after last administration of pegfilgrastim. Immunogenicity was assessed before the first pegfilgrastim injection, on Day 15 of cycle 6, and 4 weeks and 6 months (PROTECT1 only).

Results: A total of 624 patients were randomized (LA-EP2006: n=314; reference: n=310). Baseline demographics were well balanced (mean age: LA-EP2006: 49.3 years, reference: 49.8; median duration (months) since initial diagnosis: LA-EP2006: 1.33 [0.1−76.0], reference: 1.35 [0.2−11.2]; ECOG status 0: LA-EP2006: 78%, reference: 75%). Mean DSN difference in Cycle 1 was -0.04 days (95% CI: -0.19, 0.11), showing statistical equivalence. FN was reported in 5.7% of patients with LA-EP2006 vs. 8.4% with reference in Cycle 1 (all cycles: 8.0% vs. 10.3%). Across all cycles, frequency of fever (LA-EP2006: 18.5%; reference: 19.7%) and infections (LA-EP2006: 15.6%; reference: 18.1%) were similar in both groups. Mean ANC time courses were almost superimposable in the two groups, with similar time and depth of ANC nadir and median time to ANC recovery was 2 days in both groups in Cycle 1. Treatment-emergent adverse events (TEAEs) were similar across groups (LA-EP2006: 92%; reference: 89%), and TEAEs with a suspected relationship to pegfilgrastim were reported in 22.6% of patients with LA-EP2006 and 21.3% with reference across all cycles, with the most frequent being musculoskeletal and connective tissue disorders (LA-EP2006: 10.2%; reference: 9.7%). Serious TEAEs were reported in 14.3% (LA-EP2006) vs. 17.1% (reference) across all cycles. No neutralizing or clinically relevant anti-pegfilgrastim antibodies were identified.

Conclusions: LA-EP2006 demonstrated similar clinical efficacy and safety to reference pegfilgrastim in patients with breast cancer receiving myelotoxic chemotherapy.

*Neulasta® is a registered trademark of Amgen Inc.

Citation Format: Blackwell K, Gascon P, Jones CM, Nixon A, Nakov R, Mo M, Krendyukov A, Nadia H. Safety, immunogenicity and efficacy of proposed biosimilar pegfilgrastim (LA-EP2006) compared with reference pegfilgrastim in breast cancer: Pooled analysis of two randomized, double-blind, phase III trials [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-11-05.

Beyond Zar: the use and abuse of classification statistics for otolith chemistry

Classification method performance was evaluated using otolith chemistry of juvenile Atlantic menhaden Brevoortia tyrannus when assumptions of data normality were met and were violated. Four methods were tested [linear discriminant function analysis (LDFA), quadratic discriminant function analysis (QDFA), random forest (RF) and artificial neural networks (ANN)] using computer simulation to determine their performance when variable-group means ranged from small to large and their performance under conditions of typical skewness to double the amount of skewness typically observed. Using the kappa index, the parametric methods performed best after applying appropriate data transformation, gaining 2% better performance with LDFA performing slightly better than QDFA. RF performed as well as QDFA and showed no difference in performance between raw and transformed data while the performance of ANN was the poorest and worse with raw data. All methods performed well when group differences were large, but parametric methods outperformed machine-learning methods. When data were skewed the performance of all methods declined and worsened with greater skewness, but RF performed consistently as well or better than the other methods in the presence of skewness. The parametric methods were found to be more powerful when assumptions of normality can be met and can be used confidently when skewness and kurtosis are minimized. When these assumptions cannot be minimized, then machine-algorithm methods should also be tried.

Reference data for cerebrospinal fluid and the utility of amino acid measurement for the diagnosis of inborn errors of metabolism

Background: Cerebrospinal fluid (CSF) amino acid analysis is fundamental to the investigation of several inherited metabolic diseases, particularly those presenting with unexplained seizures. CSF glycine measurement is often crucial to the diagnosis of glycine encephalopathy (GE), low CSF serine concentrations are characteristic of 3-phosphoglycerate dehydrogenase deficiency (3-PGDD) and the presence of sulphocysteine is pathognomonic of sulphite oxidase deficiency (SOD), and a vital clue to molybdenum cofactor deficiency (MCD). Limited information is available in the literature on reference values of amino acids in CSF during infancy and CSF samples from healthy individuals are not easily obtained.

Methods: In order to establish paediatric CSF amino acid reference ranges, we performed a retrospective analysis of all quantitative CSF amino acid data collected in our laboratory over a five-year period. Amino acid analysis was performed using ion-exchange chromatography on a Biochrom-20 amino acid analyser with ninhydrin detection. CSF samples were collected from infants undergoing investigation for unexplained seizures.

Results: About 18 of the 95 samples received were excluded from the reference data-set; one was from a patient in whom a diagnosis of GE was confirmed by enzyme analysis, one was from a patient with CSF sulphocysteine of 19 μmol/L in whom a diagnosis of SOD was confirmed by enzyme analysis; the remaining 16 were clearly bloodstained ( n = 4) or xanthochromic ( n = 12). Frequency of distribution analysis revealed that concentration values for each amino acid demonstrated a right-skewed distribution which was not normalized by log transformation. Data were therefore analysed using non-parametric descriptive statistics and reference ranges were defined by the 2.5th and 97.5th centile limits.

Conclusions: Our reference data were derived from 77 CSF samples taken from 77 infants. Median CSF glycine concentration was 9 μmol/L with a reference range of 3-19 μmol/L. For serine, the median CSF concentration was 52 μmol/L with a reference range of 25-105 μmol/L. Sulphocysteine was not normally present in detectable quantities (<1 μmol/L).

Straw particle size in calf starters: Effects on digestive system development and rumen fermentation

Two trials were conducted to determine effects of straw particle size in calf starter on rumen fermentation and development in calves. Holstein calves (n = 17 in trial 1; n = 25 in trial 2) were housed in individual pens; bedding (wood shavings) was covered with landscape fabric to completely avoid consumption of bedding. Milk replacer was fed at 12% of birth body weight per day and water offered free choice. Calves were randomly assigned to 4 treatments differing in geometric mean particle length (X_gm) of straw comprising 5% of starter dry matter. Straw was provided within the pellet at manufacture (PS; 0.82 mm X_gm) or mixed with the pellet at time of feeding at X_gm of 3.04 (SS), 7.10 (MS), or 12.7 (LS) mm. Calves (n = 12; 3/treatment) in trial 1 were fitted with a rumen cannula by wk 2 of age. A fixed amount of starter that was adjusted with age and orts were fed through the cannula in cannulated calves. Calves were euthanized 6 wk after starter was offered (9 and 7 wk of age for trials 1 and 2, respectively). Rumen digesta pH linearly decreased with age, whereas volatile fatty acid concentration increased with age. Overall pH had a cubic trend with SS lower than that of PS and MS. Molar proportion of acetate decreased with age whereas propionate proportion increased. Overall molar proportions of volatile fatty acids were not affected by diet. Fecal X_gm was not different in spite of changes in diet particle size and rumen digesta of PS being greater than SS, MS, and LS at slaughter. Fecal pH and starch concentration were not affected by diet; however, pH decreased whereas starch content increased with age. Weight of stomach compartments, rumen papillae length and width, and rumen wall thickness did not differ between diets. Omasum weight as a percentage of body weight at harvest linearly decreased as straw particle size increased. Under the conditions of this study, modifying straw particle length in starter grain resulted in minimal rumen fermentation parameter changes and no changes in rumen development. Rumen pH and fermentation changes with age were likely effects of increasing starter intake.

Dental survey of the Falkland Islands' child population

In November 2013 the first dental epidemiological survey of 5, 12 and 15 year old children was undertaken on The Falkland Islands. The census survey used the ICDAS II system and achieved an overall response rate of 87.4%. To allow international comparisons obvious decay experience is reported. The mean dmft of 5-year-olds was 1.2 teeth, the prevalence of decay experience was 34.6%. The mean DMFT of 12-year-old children was 0.9 teeth, the prevalence of decay experience was 36.7%. The mean DMFT of 15-year-olds was 1.78 teeth, and the prevalence of decay experience was 66.7%. This first dental survey showed that levels of child dental decay in the Falkland Islands are similar to western European countries. The results can now be used as a baseline and benchmark to follow future trends in dental health in this British Overseas Territory.

Digestive development in neonatal dairy calves with either whole or ground oats in the calf starter

A series of 3 trials was conducted to determine effects of whole or ground oats in starter grain on reticulorumen fermentation and digestive system development of preweaned calves. Male Holstein calves (43.1±2.3kg at birth; n=8, 9, and 7 for trials 1, 2, and 3, respectively) were housed in individual pens in a heated facility; bedding was covered with landscape fabric to prevent consumption of bedding by the calves. In trials 1 and 2 only, calves were fitted with rumen cannulas by wk 2 of life. In all trials, a fixed amount of starter (containing 25% oats either ground and in the pellet or whole) was offered daily; orts were fed through the cannula in trials 1 and 2. Calves were randomly assigned to an all-pelleted starter or pellets plus whole oats. Rumen contents (trials 1 and 2) were sampled weekly at -8, -4, 0, 2, 4, 8, and 12 h after grain feeding for determination of pH and volatile fatty acids. Calves were killed 3 wk (trial 1) or 4 wk (trials 2 and 3) after grain was offered; organs were harvested, emptied, rinsed, and weighed to gauge digestive organ development. Starter intake was not different between treatments. Weekly measurements of rumen digesta pH did not change and only subtle changes were observed in molar proportions of individual volatile fatty acids. Molar proportion of butyrate and pH linearly decreased with age, whereas acetate proportion increased. Reticulorumen weight and papillae length tended to be greater for calves fed pelleted starter, whereas abomasum weight was greater for calves fed pellets plus whole oats. Fecal particle size and starch content were greater for calves fed pellets plus whole oats. Under the conditions of this study, physical form of oats in starter grain did not affect rumen fermentation measurements; greater rumen weight and papillae length in calves fed pelleted starter may be the result of greater nutrient availability of ground oats. Under the conditions of this study with young calves on treatments for <4 wk, increasing particle size of the starter by feeding whole oats did not affect rumen fermentation nor did it improve digestive system development.

Validated age, growth and maturity of the bonnethead Sphyrna tiburo in the western North Atlantic Ocean

The age, growth and maturity of bonnetheads Sphyrna tiburo inhabiting the estuarine and coastal waters of the western North Atlantic Ocean (WNA) from Onslow Bay, North Carolina, south to West Palm Beach, Florida, were examined. Vertebrae were collected and aged from 329 females and 217 males ranging in size from 262 to 1043 mm and 245 to 825 mm fork length, LF , respectively. Sex-specific von Bertalanffy growth curves were fitted to length-at-age data. Female von Bertalanffy parameters were L∞  = 1036 mm LF , k = 0·18, t0  = -1·64 and L0  = 272 mm LF . Males reached a smaller theoretical asymptotic length and had a higher growth coefficient (L∞  = 782 mm LF , k = 0·29, t0  = -1·43 and L0  = 266 mm LF ). Maximum observed age was 17·9 years for females and 16·0 years for males. Annual deposition of growth increments was verified by marginal increment analysis and validated for age classes 2·5+ to 10·5+ years through recapture of 13 oxytetracycline-injected specimens at liberty in the wild for 1-4 years. Length (LF50 ) and age (A50 ) at 50% maturity were 819 mm and 6·7 years for females, and 618 mm and 3·9 years for males. Both female and male S. tiburo in the WNA had a significantly higher maximum observed age, LF50 , A50 and L∞ , and a significantly lower k and estimated L0 than evident in the Gulf of Mexico (GOM). These significant differences in life-history parameters, as well as evidence from tagging and genetic studies, suggest that S. tiburo in the WNA and GOM should be considered separate stocks.

Independence and oral health: implications of the Scottish referendum

On 18 September 2014, a referendum will be held on Scotland becoming a nation independent from the rest of the United Kingdom. Since devolution in 1999 child dental health in Scotland has improved significantly, although the National Health Service in Scotland has always been governed through a separate legislative framework from that in England and Wales. Scotland was also first to introduce a ban on smoking in public places and is pursuing minimum alcohol pricing to directly improve public health. This article explores if a vote for an independent Scotland would influence either dental and/or general health.

The caries experience of 5-year-old children in Scotland, Wales and England in 2011-2012: reports of cross-sectional surveys using BASCD criteria

OBJECTIVE

This paper collates differences in methods and trends in caries prevalence in surveys of the oral health of young children undertaken in Scotland, Wales and England in 2011-12. For Wales and England this was the second survey carried out since changes were required in consent arrangements.

METHOD

In compliance with BASCD criteria representative samples were drawn within the geographies of primary care organisations across the UK, and within Local Authorities across England and Wales. Consent was sought in two ways; via opt-in parental consent in England and Wales and opt-out parental consent in Scotland. Children aged five were examined in England and those aged 5 to 6 were examined in Wales and Scotland. Examinations were conducted in schools by trained and calibrated examiners and caries was diagnosed at the dentinal threshold using visual criteria.

RESULTS

In Scotland there is a continuing decline in caries prevalence in young school children. Comparison with the previous survey using positive consent in England and Wales shows a decline in caries in both England and Wales although decay levels remain higher in more deprived areas.

CONCLUSION

International comparisons assist in interpreting data and trends even if there are some differences in approach. A trend line is more useful than a single data point for monitoring of oral health. This second survey using positive parental consent in England and Wales has enabled trend analysis for the first time since the consent arrangements changed.

Heat treatment of colostrum increases immunoglobulin G absorption efficiency in high-, medium-, and low-quality colostrum

Previous studies with heat-treated colostrum fed to neonatal calves have consistently used average-quality colostrum. Studies have not compared colostrum across a range of immunoglobulin levels. This study was conducted to investigate IgG absorption in neonatal dairy calves using colostrum of various qualities. Colostrum from the Pennsylvania State University dairy was collected over 2 yr and sorted into high, medium, and low quality based on colostrometer measurement. Colostrum within each category was pooled to create 3 unique, uniform batches. Half of each batch was frozen to be fed without heat treatment. The second half of each batch was heat treated at 60°C for 30min. This process was conducted in September 2011, and repeated in June 2012. Colostrum treatments were analyzed for standard plate count, coliforms, noncoliform gram-negative bacteria, and total IgG concentration. Plasma samples were collected from 145 calves 48h after birth and analyzed for IgG1, IgG2, total protein, and hematocrit. Colostrum quality (high, medium, or low), treatment (unheated or heat treated), and their interactions were analyzed as fixed effects, with year included as a random effect. Heat treatment significantly reduced all types of bacteria and IgG concentration. Plasma IgG concentration at 48h increased linearly with the concentration of IgG in the colostrum that was consumed. Heat treatment of colostrum increased plasma IgG concentration by 18.4% and apparent efficiency of absorption by 21.0%. Results of this study suggest that heat treatment of colostrum containing approximately 50 to 100mg IgG/mL increases absorption of IgG from colostrum.

Transcriptome profiling of the whitefly Bemisia tabaci reveals stage-specific gene expression signatures for thiamethoxam resistance

Bemisia tabaci has developed high levels of resistance to many insecticides including the neonicotinoids and there is strong evidence that for some compounds resistance is stage-specific. To investigate the molecular basis of B. tabaci resistance to the neonicotinoid thiamethoxam we used a custom whitefly microarray to compare gene expression in the egg, nymph and adult stages of a thiamethoxam-resistant strain (TH-R) with a susceptible strain (TH-S). Gene ontology and bioinformatic analyses revealed that in all life stages many of the differentially expressed transcripts encoded enzymes involved in metabolic processes and/or metabolism of xenobiotics. Several of these are candidate resistance genes and include the cytochrome P450 CYP6CM1, which has been shown to confer resistance to several neonicotinoids previously, a P450 belonging to the Cytochrome P450s 4 family and a glutathione S-transferase (GST) belonging to the sigma class. Finally several ATP-binding cassette transporters of the ABCG subfamily were highly over-expressed in the adult stage of the TH-R strain and may play a role in resistance by active efflux. Here, we evaluated both common and stage-specific gene expression signatures and identified several candidate resistance genes that may underlie B. tabaci resistance to thiamethoxam.

Identifying efficient dairy heifer producers using production costs and data envelopment analysis

During November and December 2011, data were collected from 44 dairy operations in 13 Pennsylvania counties. Researchers visited each farm to collect information regarding management practices and feeding, and costs for labor, health, bedding, and reproduction for replacement heifers from birth until first calving. Costs per heifer were broken up into 4 time periods: birth until weaning, weaning until 6 mo of age, 6 mo of age until breeding age, and heifers from breeding to calving. Milk production records for each herd were obtained from Dairy Herd Improvement. The average number of milking cows on farms in this study was 197.8 ± 280.1, with a range from 38 to 1,708. Total cost averaged $1,808.23 ± $338.62 from birth until freshening. Raising calves from birth to weaning cost $217.49 ± 86.21; raising heifers from weaning age through 6 mo of age cost $247.38 ± 78.89; raising heifers from 6 mo of age until breeding cost $607.02 ± 192.28; and total cost for bred heifers was $736.33 ± 162.86. Feed costs were the largest component of the cost to raise heifers from birth to calving, accounting for nearly 73% of the total. Data envelopment analysis determined that 9 of the 44 farms had no inefficiencies in inputs or outputs. These farms best combined feed and labor investments, spending, on average, $1,137.40 and $140.62/heifer for feed and labor. These heifers calved at 23.7 mo of age and produced 88.42% of the milk produced by older cows. In contrast, the 35 inefficient farms spent $227 more on feed and $78 more on labor per heifer for animals that calved 1.6 mo later and produced only 82% of the milk made by their mature herdmates. Efficiency was attained by herds with the lowest input costs, but herds with higher input costs were also able to be efficient if age at calving was low and milk production was high for heifers compared with the rest of the herd.

The caries experience of 11 to 12 year-old children in Scotland and Wales and 12 year-olds in England in 2008-2009: reports of co-ordinated surveys using BASCD methodology

OBJECTIVE

This paper brings together summarised findings on surveys of 106,828 mainstream school pupils aged 11-12 years old undertaken in Scotland, Wales and England in 2008/09. These surveys are the latest in a series using common criteria for measurement and a range of consent arrangements which, for this age group, allow comparison between the three "countries" and over time.

METHOD

Representative samples were drawn within the geographies of primary care organisations in the three countries and within English Local Authorities according to BASCD criteria for sampling. Consent was sought from pupils in Wales and England and passive consent was used in Scotland. Children aged twelve were examined in England and children in school year 7 (rising 12) were examined in Wales and Scotland. Examinations were conducted in schools by trained and calibrated examiners using BASCD standard criteria and caries was diagnosed at the dentinal threshold using visual criteria.

RESULTS

The trend for reducing caries prevalence and severity continues in this age group in all three countries. Unlike data for 5 year old children, the impact of seeking positive consent from pupils does not appear to have introduced bias into the results. Variation in caries levels between and within geographical areas continues.

CONCLUSION

Caries prevalence surveys of children aged 11-12 years have been conducted across Great Britain. Those carried out with positive consent appear to produce unbiased results, comparable with previous surveys. Health inequalities in this age group persist, as does the burden of disease for those with end-stage caries.

The caries experience of 5 year-old children in Scotland, Wales and England in 2007-2008 and the impact of consent arrangements. Reports of co-ordinated surveys using BASCD criteria

OBJECTIVE

This paper brings together summarised findings and comment on surveys of young children undertaken in Scotland, Wales and England in 2007-08. These surveys are the latest in a series using common criteria for measurement but changes in the consent arrangements for Wales and England mean that these datasets are no longer directly comparable with Scottish data.

METHOD

Representative samples were drawn within the geographies of primary care organisations in the three countries, and in England within Local Authorities also, according to BASCD criteria. Consent was sought in three different ways. Children aged five were examined in England and those in Primary 1 (rising 6) were examined in Wales and Scotland. Examinations were conducted in schools by trained and calibrated examiners and caries was diagnosed at the dentinal threshold using visual criteria.

RESULTS

The impact of seeking positive consent appeared to depress the caries severity and prevalence in Wales and England whilst the reduced caries levels in Scotland may be attributed to the pro-active health improvement measures affecting this cohort. The results for positive consent suggest bias against participation of children with higher levels of tooth decay.

CONCLUSION

Caries prevalence surveys of children at the start of formal education have been conducted in Great Britain. Those carried out with the need for positive parental consent have produced new baseline data. Data presented after 2007-08 should be annotated to show the participation rate and the inappropriateness of comparing data collected using different types of consent.

Evaluation of calf milk pasteurization systems on 6 Pennsylvania dairy farms

Waste milk has been fed to calves for many years, but concerns with bacterial contamination as well as possible transmission of diseases have discouraged widespread use of this feed. Pasteurization of waste milk is one option to reduce management risk while utilizing a valuable, low-cost, liquid feed source for calves. However, many farms currently pasteurizing waste milk lack a system to adequately monitor the efficiency of the process. A study was carried out to evaluate 6 on-farm pasteurization systems, including high-temperature, short-time pasteurizers and low-temperature, batch pasteurizers. Milk samples were taken pre- and postpasteurization as well as from the calf buckets and immediately frozen for later bacterial culture. Samples were collected twice daily for 15 d. Milk samples were examined for standard plate count (SPC), coagulase-negative staphylococci count, environmental streptococci count, coliform count, gram-negative noncoliform count, Streptococcus agalactiae count, and Staphylococcus aureus count. Before pasteurization, 68% of the samples had SPC <20,000 cfu/mL, and 39% of samples contained <100 cfu/mL of coliform bacteria. After pasteurization, 96% of samples had SPC <20,000 cfu/mL, and 92% had coliform counts <100 cfu/mL. Bacteria counts were significantly reduced by pasteurization, and pasteurized milk contained acceptable numbers of bacteria in >90% of samples. These results indicate that pasteurization can be very effective in lowering bacterial contamination of milk. However, bacteria numbers significantly increased after pasteurization and, in some cases, bacteria counts in milk fed to calves were similar to prepasteurization levels. Milk handling after pasteurization was identified as an important issue on the farms studied.

Diagnostic accuracy meta-analysis: review of an important tool in radiological research and decision making

The importance of evidence-based diagnostic practice has been increasingly recognised over the past decade. Meta-analyses are used to summarise and assess the literature and are therefore particularly important tools in radiological research. Diagnostic radiology is driven by emerging technologies that are increasingly under scrutiny in the radiological literature. Correspondingly, diagnostic meta-analyses are better at addressing the intricacies of diagnostic accuracy measures, whilst retaining robust methodology. The ability to interpret results for application to clinical practice is increasingly important for radiology owing to the close relationship with the diagnostic process. However, confusing terminology and a lack of understanding of the principles of diagnostic meta-analysis leads to difficulty in interpretation by clinicians. Hierarchical summary receiver operating characteristic analysis is becoming the standard method for diagnostic test meta-analysis. This article explains the basic principles of interpreting diagnostic meta-analyses.