A survey of severe asthma in Canada: results from the CASCADE practice reflective program

BACKGROUND

Since the last guidance was published by the Canadian Thoracic Society, there have been several advances in the clinical management of severe asthma. To gain a better understanding of the current standards of care and treatment patterns of patients, the CASCADE practice reflective program was established to conduct a real-world analysis of severe asthma management among specialists in Canada with a goal of identifying areas of opportunity to enhance patient management and outcomes.

METHODS

The CASCADE program was a two-part practice reflective and assessment program delivered through an on-line portal for selected specialists (Respirologists and Allergists) in Canada. The program consisted of a one-time overview survey of physician practice to establish overall practice parameters, followed by a review of at least 5 severe asthma patients to establish the current landscape of severe asthma management.

RESULTS

The program collected practice overview surveys from 78 specialists (52 Respirologists, 24 Allergists, and 2 General practice physicians with an interest in respiratory disease) in 8 provinces. Practices included a variety of types in both large metropolitan centres and smaller regional settings. There were 503 patients reviewed and included in the program. Most (65%) patients were currently using a biologic treatment, 30% were biologic naive, and 5% had used a biologic treatment in the past. Most patients (53%) were reported to have mixed allergic and eosinophilic phenotypes, despite a perception that allergic, eosinophilic and mixed phenotypes were evenly balanced in the physician practice. Overall, patients currently treated with biologic agents had parameters suggesting higher control and were more satisfied with treatment. However, there was less than optimal treatment satisfaction for more than half of all patients, particularly for those patients not treated with a biologic agent.

CONCLUSIONS

Phenotyping is hampered by poor availability for several assessments, and the full range of treatments are not currently fully utilized, partly due to physician familiarity with the agents and partly due to prescribing restrictions. Even when treated with biologic agents, patient satisfaction can still be improved.

Glass-Like Phonon Dynamics and Thermal Transport in a GeTe Nano-Composite at Low Temperature

In this work, the experimental evidence of glass-like phonon dynamics and thermal conductivity in a nanocomposite made of GeTe and amorphous carbon is reported, which is of interest for microelectronics, and specifically phase change memories. It is shown that, the total thermal conductivity is reduced by a factor of three at room temperature with respect to pure GeTe, due to the reduction of both electronic and phononic contributions. This latter, similarly to glasses, is small and weakly increasing with temperature between 100 and 300 K, indicating a mostly diffusive thermal transport and reaching a value of 0.86(7) Wm-1K-1 at room temperature. A thorough investigation of the nanocomposite's phonon dynamics reveals the appearance of an excess intensity in the low energy vibrational density of states, reminiscent of the Boson peak in glasses. These features can be understood in terms of an enhanced phonon scattering at the interfaces, due to the presence of elastic heterogeneities, at wavelengths in the 2-20 nm range. The findings confirm recent simulation results on crystalline/amorphous nanocomposites and open new perspectives in phonon and thermal engineering through the direct manipulation of elastic heterogeneities.

Reactivity Switch of Platinum with Gallium: From Reverse Water Gas Shift to Methanol Synthesis

The development of efficient catalysts for the hydrogenation of CO2 to methanol using "green" H2 is foreseen to be a key step to close the carbon cycle. In this study, we show that small and narrowly distributed alloyed PtGa nanoparticles supported on silica, prepared via a surface organometallic chemistry (SOMC) approach, display notable activity for the hydrogenation of CO2 to methanol, reaching a 7.2 molCH3OH h-1 molPt-1 methanol formation rate with a 54% intrinsic CH3OH selectivity. This reactivity sharply contrasts with what is expected for Pt, which favors the reverse water gas shift reaction, albeit with poor activity (2.6 molCO2 h-1 molPt-1). In situ XAS studies indicate that ca. 50% of Ga is reduced to Ga0 yielding alloyed PtGa nanoparticles, while the remaining 50% persist as isolated GaIII sites. The PtGa catalyst slightly dealloys under CO2 hydrogenation conditions and displays redox dynamics with PtGa-GaOx interfaces responsible for promoting both the CO2 hydrogenation activity and methanol selectivity. Further tailoring the catalyst interface by using a carbon support in place of silica enables to improve the methanol formation rate by a factor of ∼5.

COVID-19 vaccination uptake in people with epilepsy in wales

PURPOSE

People with epilepsy (PWE) are at increased risk of severe COVID-19. Assessing COVID-19 vaccine uptake is therefore important. We compared COVID-19 vaccination uptake for PWE in Wales with a matched control cohort.

METHODS

We performed a retrospective, population, cohort study using linked, anonymised, Welsh electronic health records within the Secure Anonymised Information Linkage (SAIL) Databank (Welsh population=3.1 million).We identified PWE in Wales between 1st March 2020 and 31st December 2021 and created a control cohort using exact 5:1 matching (sex, age and socioeconomic status). We recorded 1st, 2nd and booster COVID-19 vaccinations.

RESULTS

There were 25,404 adults with epilepsy (127,020 controls). 23,454 (92.3%) had a first vaccination, 22,826 (89.9%) a second, and 17,797 (70.1%) a booster. Comparative figures for controls were: 112,334 (87.8%), 109,057 (85.2%) and 79,980 (62.4%).PWE had higher vaccination rates in all age, sex and socioeconomic subgroups apart from booster uptake in older subgroups. Vaccination rates were higher in older subgroups, women and less deprived areas for both cohorts. People with intellectual disability and epilepsy had higher vaccination rates when compared with controls with intellectual disability.

CONCLUSIONS

COVID-19 vaccination uptake for PWE in Wales was higher than that for a matched control group.

Targeting the BRAF pathway in haematological diseases

Since the recognition of BRAF V600E mutations in the majority of cases of hairy cell leukaemia, Erdheim-Chester disease and Langerhans cell histiocytosis, the targeted oral kinase inhibitors dabrafenib and vemurafenib have been adapted for their treatment. Like other targeted agents, these drugs produce high response rates and predictable but unique side effects. Physician familiarity is essential for the effective use of these agents. We review the Australian experience of BRAF/MEK inhibitor therapy in these rare haematological cancers.

Analysis of rare disruptive germline mutations in 2,135 enriched BRCA-negative breast cancers excludes additional high-impact susceptibility genes

BACKGROUND

Breast cancer has a significant heritable basis, of which approximately 60% remains unexplained. Testing for BRCA1/BRCA2 offers useful discrimination of breast cancer risk within families, and identification of additional breast cancer susceptibility genes could offer clinical utility.

PATIENTS AND METHODS

We included 2,135 invasive breast cancer cases recruited via the BOCS study, a retrospective UK study of familial breast cancer.

ELIGIBILITY CRITERIA

female, BRCA-negative, white European ethnicity, and one of: i) breast cancer family history, ii) bilateral disease, iii) young age of onset (<30 years), iv) concomitant ovarian cancer. We undertook exome sequencing of cases and performed gene-level burden testing of rare damaging variants against those from 51,377 ethnicity-matched population controls from gnomAD.

RESULTS

159/2135 (7.4%) cases had a qualifying variant in an established breast cancer susceptibility gene, with minimal evidence of signal in other cancer susceptibility genes. Known breast cancer susceptibility genes PALB2, CHEK2 and ATM were the only genes to retain statistical significance after correcting for multiple testing. Due to the enrichment of hereditary cases in the series, we had good power (>80%) to detect a gene of BRCA1-like risk (odds ratio = 10.6) down to a population minor allele frequency of 4.6 x 10^-5 (1 in 10,799, less than one tenth that of BRCA1)and of PALB2-like risk (odds ratio = 5.0) down to a population minor allele frequency of 2.8 x 10^-4 (1 in 1,779, less than half that of PALB2). Power was lower for identification of novel moderate penetrance genes (odds ratio = 2-3) like CHEK2 and ATM.

CONCLUSIONS

This is the largest case-control whole-exome analysis of enriched breast cancer published to date. Whilst additional breast cancer susceptibility genes likely exist, those of high penetrance are likely to be of very low mutational frequency. Contention exists regarding the clinical utility of such genes.

Innovation in Fischer-Tropsch: A Sustainable Approach to Fuels Production : A cost-effective method of converting any carbon source into high-quality liquid hydrocarbon fuels

A sustained global effort is required over the next few decades to reduce greenhouse gas emissions, in order to address global warming as society seeks to deliver the Paris Agreement temperature goals. The increasing availability of renewable electricity will reduce our reliance on fossil fuels. However, some applications, such as long-haul aviation, are particularly challenging to decarbonise. The conversion of waste, biomass or existing CO2 emissions into sustainable fuels via Fischer-Tropsch (FT) synthesis offers one solution to this problem. This paper describes some of the challenges associated with this route to these alternative fuels and how Johnson Matthey and bp have solved them.

Effects of invasive wetland macrophytes on habitat selection and movement by freshwater turtles

Invasive species can significantly impact native wildlife by structurally altering habitats and access to resources. Understanding how native species respond to habitat modification by invasive species can inform effective habitat restoration, avoiding inadvertent harm to species at risk. The invasive graminoids Phragmites australis australis (hereafter Phragmites) and Typha ×  glauca are increasingly dominating Nearctic wetlands, often outcompeting native vegetation. Previous research suggests that turtles may avoid invasive Phragmites when moving through their home ranges, but the mechanisms driving avoidance are unclear. We tested two hypotheses that could explain avoidance of invaded habitat: (1) that stands of invasive macrophytes (Phragmites and Typha x glauca) impede movement, and (2) that they provide inadequate thermal conditions for turtles. We quantified active-season movements of E. blandingii (n = 14, 1328 relocations) and spotted turtles (Clemmys guttata; n = 12, 2295 relocations) in a coastal wetland in the Laurentian Great Lakes. Neither hypothesis was supported by the data. Phragmites and mixed-species Typha stands occurred within the home ranges of mature, active E. blandingii and C. guttata, and were used similarly to most other available habitats, regardless of macrophyte stem density. Turtles using stands of invasive macrophytes did not experience restricted movements or cooler shell temperatures compared to other wetland habitat types. Control of invasive macrophytes can restore habitat heterogeneity and benefit native wetland species. However, such restoration work should be informed by the presence of at-risk turtles, as heavy machinery used for control or removal may injure turtles that use these stands as habitat.

Peri-operative COVID-19 infection in urgent elective surgery during a pandemic surge period: a retrospective observational cohort study

Maintaining safe elective surgical activity during the global coronavirus disease 2019 (COVID-19) pandemic is challenging and it is not clear how COVID-19 may impact peri-operative morbidity and mortality in this population. Therefore, adaptations to normal care pathways are required. Here, we establish if implementation of a bespoke peri-operative care bundle for urgent elective surgery during a pandemic surge period can deliver a low COVID-19-associated complication profile. We present a single-centre retrospective cohort study from a tertiary care hospital of patients planned for urgent elective surgery during the initial COVID-19 surge in the UK between 29 March and 12 June 2020. Patients asymptomatic for COVID-19 were screened by oronasal swab and chest imaging (chest X-ray or computed tomography if aged ≥ 18 years), proceeding to surgery if negative. COVID-19 positive patients at screening were delayed. Postoperatively, patients transitioning to COVID-19 positive status by reverse transcriptase polymerase chain reaction testing were identified by an in-house tracking system and monitored for complications and death within 30 days of surgery. Out of 557 patients referred for surgery (230 (41.3%) women; median (IQR [range]) age 61 (48-72 [1-89])), 535 patients (96%) had COVID-19 screening, of which 13 were positive (2.4%, 95%CI 1.4-4.1%). Out of 512 patients subsequently undergoing surgery, 7 (1.4%) developed COVID-19 positive status (1.4%, 95%CI 0.7-2.8%) with one COVID-19-related death (0.2%, 95%CI 0.0-1.1%) within 30 days. Out of these seven patients, four developed pneumonia, of which two required invasive ventilation including one patient with acute respiratory distress syndrome. Low rates of COVID-19 infection and mortality in the elective surgical population can be achieved within a targeted care bundle. This should provide reassurance that elective surgery can continue, where possible, despite high community rates of COVID-19.

Quantitative carbon distribution analysis of hydrocarbons, alcohols and carboxylic acids in a Fischer-Tropsch product from a Co/TiO2 catalyst during gas phase pilot plant operation

Comprehensive two-dimensional gas chromatography (GCxGC) analysis for 1-alcohols and gas chromatography–mass spectrometry (GC-MS) analysis for carboxylic acids, derivatised as their methyl esters, have been applied to liquid and wax Fischer-Tropsch (FT) hydrocarbon products. These methods in combination with conventional one-dimensional gas chromatography (GC) analysis of the aqueous, gaseous, liquid hydrocarbon and wax products plus conventional high-performance liquid chromatography (HPLC) analysis of the aqueous phase has allowed a quantitative distribution analysis of FT hydrocarbon and oxygenated products to be demonstrated for a Co/TiO2 catalyst operating in a fixed bed gas phase pilot plant utilising CANSTM catalyst carrier devices. The GC-MS method used is, to the best of our knowledge, the first application of this derivatisation route for the quantification of individual carboxylic acids in FT hydrocarbon product streams.

Whilst the hydrocarbons and oxygenates that were identified are known compounds formed during the low temperature, Co catalysed, FT process the combination of the multiple analysis techniques used has allowed a level of detail to be gained on the product composition that is seldom reported.

Additionally, 1H nuclear magnetic resonance spectroscopy (NMR) and 13C NMR analyses were used to quantify the average concentration of 1-olefin, cis- and trans-2-olefins, 1-alcohol and aldehyde as appropriate for the technique used. Comparison of GCxGC versus 1H NMR and GC-MS versus a KOH titration confirmed the applicability of the chromatographic methods for the quantitative analysis of FT oxygenated compounds. Long-chain 1-alcohols and carboxylic acids, ≥ C3, were found to be present at levels of 1/10th and 1/1000th that of hydrocarbons of equivalent carbon chain length respectively. The 1-olefin:n-paraffin ratio in the hydrocarbon liquid and wax products was found to decrease significantly with increasing carbon chain length and much more so than those of the 2-olefin or 1-alcohol.

Innovation in Fischer–Tropsch: Developing Fundamental Understanding to Support Commercial Opportunities

In this contribution we provide details of the BP-Johnson Matthey proprietary Fischer–Tropsch technology and the advanced CANS reactor and catalyst system. The advanced CANS catalyst carrier reactor provides superior heat transfer, reduced pressure drop and higher productivity that lead to major economic savings. Fundamental understanding of catalyst behaviour is also key to obtaining a catalyst that is stable over the lifetime of its use. Synthesis, calcination and reduction steps introduce changes in the catalyst properties prior to syngas introduction. In particular, the presence of water can affect the final catalyst performance. The activity of a good catalyst can be significantly reduced by a sub-optimal activation or start-up. Similarly, stable operation and minimising deactivation are vital for long and stable catalyst life, with years of operation without requiring regeneration. In this report we also share a fundamental study on the catalyst activation across different catalyst supports. This combines advanced in situ techniques with reactor testing to explore the role of the support on catalyst performance. The results illustrate the critical need for a logical and systematic catalyst development programme to explore these effects to optimise the whole FT process. The combination of a joint approach in development plays a key role in a long term success in a process. The fundamental catalyst understanding, optimisation and improvements in combination with the novel CANS reactor design maximise their potential and offer the potential for a world leading technology.

X-ray physico-chemical imaging during activation of cobalt-based Fischer-Tropsch synthesis catalysts

The imaging of catalysts and other functional materials under reaction conditions has advanced significantly in recent years. The combination of the computed tomography (CT) approach with methods such as X-ray diffraction (XRD), X-ray fluorescence (XRF) and X-ray absorption near-edge spectroscopy (XANES) now enables local chemical and physical state information to be extracted from within the interiors of intact materials which are, by accident or design, inhomogeneous. In this work, we follow the phase evolution during the initial reduction step(s) to form Co metal, for Co-containing particles employed as Fischer-Tropsch synthesis (FTS) catalysts; firstly, working at small length scales (approx. micrometre spatial resolution), a combination of sample size and density allows for transmission of comparatively low energy signals enabling the recording of 'multimodal' tomography, i.e. simultaneous XRF-CT, XANES-CT and XRD-CT. Subsequently, we show high-energy XRD-CT can be employed to reveal extent of reduction and uniformity of crystallite size on millimetre-sized TiO₂ trilobes. In both studies, the CoO phase is seen to persist or else evolve under particular operating conditions and we speculate as to why this is observed.This article is part of a discussion meeting issue 'Providing sustainable catalytic solutions for a rapidly changing world'.

Protocol and quality assurance for carotid imaging in 100,000 participants of UK Biobank: development and assessment

Background Ultrasound imaging is able to quantify carotid arterial wall structure for the assessment of cerebral and cardiovascular disease risks. We describe a protocol and quality assurance process to enable carotid imaging at large scale that has been developed for the UK Biobank Imaging Enhancement Study of 100,000 individuals. Design An imaging protocol was developed to allow measurement of carotid intima-media thickness from the far wall of both common carotid arteries. Six quality assurance criteria were defined and a web-based interface (Intelligent Ultrasound) was developed to facilitate rapid assessment of images against each criterion. Results and conclusions Excellent inter and intra-observer agreements were obtained for image quality evaluations on a test dataset from 100 individuals. The image quality criteria then were applied in the UK Biobank Imaging Enhancement Study. Data from 2560 participants were evaluated. Feedback of results to the imaging team led to improvement in quality assurance, with quality assurance failures falling from 16.2% in the first two-month period examined to 6.4% in the last. Eighty per cent had all carotid intima-media thickness images graded as of acceptable quality, with at least one image acceptable for 98% of participants. Carotid intima-media thickness measures showed expected associations with increasing age and gender. Carotid imaging can be performed consistently, with semi-automated quality assurance of all scans, in a limited timeframe within a large scale multimodality imaging assessment. Routine feedback of quality control metrics to operators can improve the quality of the data collection.

Differentiating the effects of climate and land use change on European biodiversity: A scenario analysis

Current observed as well as projected changes in biodiversity are the result of multiple interacting factors, with land use and climate change often marked as most important drivers. We aimed to disentangle the separate impacts of these two for sets of vascular plant, bird, butterfly and dragonfly species listed as characteristic for European dry grasslands and wetlands, two habitats of high and threatened biodiversity. We combined articulations of the four frequently used SRES climate scenarios and associated land use change projections for 2030, and assessed their impact on population trends in species (i.e. whether they would probably be declining, stable or increasing). We used the BIOSCORE database tool, which allows assessment of the effects of a range of environmental pressures including climate change as well as land use change. We updated the species lists included in this tool for our two habitat types. We projected species change for two spatial scales: the EU27 covering most of Europe, and the more restricted biogeographic region of 'Continental Europe'. Other environmental pressures modelled for the four scenarios than land use and climate change generally did not explain a significant part of the variance in species richness change. Changes in characteristic bird and dragonfly species were least pronounced. Land use change was the most important driver for vascular plants in both habitats and spatial scales, leading to a decline in 50-100% of the species included, whereas climate change was more important for wetland dragonflies and birds (40-50 %). Patterns of species decline were similar in continental Europe and the EU27 for wetlands but differed for dry grasslands, where a substantially lower proportion of butterflies and birds declined in continental Europe, and 50 % of bird species increased, probably linked to a projected increase in semi-natural vegetation. In line with the literature using climate envelope models, we found little divergence among the four scenarios. Our findings suggest targeted policies depending on habitat and species group. These are, for dry grasslands, to reduce land use change or its effects and to enhance connectivity, and for wetlands to mitigate climate change effects.

Cohort profile: Pacific Islands Families (PIF) growth study, Auckland, New Zealand

PURPOSE

This article profiles a birth cohort of Pacific children participating in an observational prospective study and describes the study protocol used at ages 14-15 years to investigate how food and activity patterns, metabolic risk and family and built environment are related to rates of physical growth of Pacific children.

PARTICIPANTS

From 2000 to 2015, the Pacific Islands Families Study has followed, from birth, the growth and development of over 1000 Pacific children born in Auckland, New Zealand. In 2014, 931 (66%) of the original cohort had field measures of body composition, blood pressure and glycated haemoglobin. A nested subsample (n=204) was drawn by randomly selecting 10 males and 10 females from each decile of body weight. These participants had measurement of body composition by dual-energy X-ray absorptiometry, food frequency, 6 min walk test and accelerometer-determined physical activity and sedentary behaviours, and blood biomarkers for metabolic disease such as diabetes. Built environment variables were generated from individual addresses.

FINDINGS TO DATE

Compared to the Centres for Disease Control and Prevention (CDC) reference population with mean SD scores (SDS) of 0, this cohort of 931 14-year-olds was taller, weighed more and had a higher body mass index (BMI) (mean SDS height >0.6, weight >1.6 and BMI >1.4). 7 of 10 youth were overweight or obese. The nested-sampling frame achieved an even distribution by body weight.

FUTURE PLANS

Cross-sectional relationships between body size, fatness and growth rate, food patterns, activity patterns, pubertal development, risks for diabetes and hypertension and the family and wider environment will be examined. In addition, analyses will investigate relationships with data collected earlier in the life course and measures of the cohort in the future. Understanding past and present influences on child growth and health will inform timely interventions to optimise future health and reduce inequalities for Pacific people.

Post-exposure prophylaxis for human immunodeficiency virus infection in the Royal Infirmary of Edinburgh - an audit

The purpose of the audit was to assess the implementation of the protocols developed by Lothian University National Health Service Trust for post-exposure prophylaxis (PEP) against blood-borne virus infections.

Patients at risk of infection after an injury were referred to the Department of Genitourinary Medicine (GUM) Edinburgh Royal Infirmary for assessment. A brief description of the incident, the time of the incident, the time of referral and the decision made was documented. The notes of these patients were reviewed 12 months later for the results of prospective HIV test after each incident.

There were 76 referrals to the GUM Department in year 2001. Occupational Health (OH) and the Accident and Emergency (A&E) Departments each made 35 referrals. The latter cases were exposures in community settings. Amongst A&E referrals the time interval between the incident and assessment was significantly longer than for OH referrals ( P = 0.001). Female health workers reported exposure incidents sooner than their male counterparts ( P = 0.01). Post-exposure prophylaxis for HIV was offered to 22 (29%) of 76 referred individuals, and was accepted by 13 (59%) persons. The course of PEP drugs was discontinued by five (38%) of the 13 individuals after consented postincident HIV testing of the source patients showed that they were HIV-seronegative. Five of eight individuals completed the course of PEP medication. Only 11 (14%) persons attended for serological testing for blood-borne virus infection three or more months after exposure. None of these 11 persons, one of whom had been given PEP medication, had become infected.

Further training and emphasis on the necessity of immediate reporting of occupational incidents and consented post-incident HIV testing of the source patient is needed. The current guidelines appear to work fairly well, but further counselling of those with significant injuries to undertake HIV serological testing after appropriate time interval is required.

Large-scale discovery of novel genetic causes of developmental disorders

Despite three decades of successful, predominantly phenotype-driven discovery of the genetic causes of monogenic disorders, up to half of children with severe developmental disorders of probable genetic origin remain without a genetic diagnosis. Particularly challenging are those disorders rare enough to have eluded recognition as a discrete clinical entity, those with highly variable clinical manifestations, and those that are difficult to distinguish from other, very similar, disorders. Here we demonstrate the power of using an unbiased genotype-driven approach to identify subsets of patients with similar disorders. By studying 1,133 children with severe, undiagnosed developmental disorders, and their parents, using a combination of exome sequencing and array-based detection of chromosomal rearrangements, we discovered 12 novel genes associated with developmental disorders. These newly implicated genes increase by 10% (from 28% to 31%) the proportion of children that could be diagnosed. Clustering of missense mutations in six of these newly implicated genes suggests that normal development is being perturbed by an activating or dominant-negative mechanism. Our findings demonstrate the value of adopting a comprehensive strategy, both genome-wide and nationwide, to elucidate the underlying causes of rare genetic disorders.

An investigation of the support needs of men and partners throughout the prostate cancer journey

OBJECTIVE

Prostate cancer is one of the mostly commonly diagnosed cancers in men. Unfortunately, the treatment for this cancer can have a number of negative side effects, both for the man himself and his partner. This study investigated the support needs of both men and partners throughout the prostate cancer journey and how this journey may be optimally managed.

METHODS

Thirty-one men who had undergone prostate cancer treatment within the last 6 years and 31 partners answered a questionnaire, which explored support care issues as identified in the literature and from focus groups.

RESULTS

Men and partners were moderately satisfied with information given regarding diagnosis, treatment and side effects, but partners were more satisfied with information relating to the particular chosen treatment. Men's understanding of their chosen treatment's potential side effects was significantly different from their understanding of diagnosis, cancer outcome, treatment options and selected treatment. Timing of information delivery was preferred by men at diagnosis, whereas partners preferred after the diagnosis. Men wanted more time to think about the diagnosis and treatment, whereas partners wanted an opportunity to discuss the diagnosis. The management of common side effects such as emotional changes, incontinence and erectile dysfunction was rated as 'somewhat' satisfactory.

CONCLUSION

Men and partners may have different educational and supportive needs throughout the prostate cancer journey that require attention and tailored management.

Virio- and bacterioplankton microscale distributions at the sediment-water interface

The marine sediment-water interface is an important location for microbially controlled nutrient and gas exchange processes. While microbial distributions on the sediment side of the interface are well established in many locations, the distributions of microbes on the water side of the interface are less well known. Here, we measured that distribution for marine virio- and bacterioplankton with a new two-dimensional technique. Our results revealed higher heterogeneity in sediment-water interface biomass distributions than previously reported with a greater than 45- and 2500-fold change cm(-1) found within bacterial and viral subpopulations compared to previous maxima of 1.5- and 1.4-fold cm(-1) in bacteria and viruses in the same environments. The 45-fold and 2500-fold changes were due to patches of elevated and patches of reduced viral and bacterial abundance. The bacterial and viral hotspots were found over single and multiple sample points and the two groups often coincided whilst the coldspots only occurred over single sample points and the bacterial and viral abundances showed no correlation. The total mean abundances of viruses strongly correlated with bacteria (r = 0.90, p<0.0001, n = 12) for all three microplates (n = 1350). Spatial autocorrelation analysis via Moran's I and Geary's C revealed non-random distributions in bacterial subpopulations and random distributions in viral subpopulations. The variable distributions of viral and bacterial abundance over centimetre-scale distances suggest that competition and the likelihood of viral infection are higher in the small volumes important for individual cell encounters than bulk measurements indicate. We conclude that large scale measurements are not an accurate measurement of the conditions under which microbial dynamics exist. The high variability we report indicates that few microbes experience the 'average' concentrations that are frequently measured.

Rationalising the role of solid-acid sites in the design of versatile single-site heterogeneous catalysts for targeted acid-catalysed transformations

Probing multifunctional acid centres in nanoporous architectures through in situ spectroscopy affords a strategy for predictive design of novel catalysts.

Applying 21st century imaging technology to wound healing: an Avant-Gardist approach

A significant arising complication in the care of patients with diabetes is increased susceptibility to chronic wounds, including diabetic foot ulcers and pressure sores. This is driven by, e.g., neuropathy and peripheral arterial disease. It is well recognized that best practice in wound care requires wound assessment, including measurement, on presentation and regularly throughout the treatment program. Proper assessment is necessary to ensure that the most appropriate and cost-effective therapy is used at all times, with quantitative measurement necessary to track the efficacy of the chosen approach. A documented assessment can also assist patient-clinician dialog and discussion within the multidisciplinary team. Remote evaluation and assessment of the wound is also of increasing importance and practicality through the use of a telemedicine approach. There has been considerable progress in the space of imaging for wounds, including systems that include three-dimensional measurement and telemedicine features. This literature review examines the available options and reviews the clinical evidence for measurement accuracy, scope for remote assessment, and published user feedback on the systems.

Bringing ecosystem services into economic decision-making: land use in the United Kingdom

Landscapes generate a wide range of valuable ecosystem services, yet land-use decisions often ignore the value of these services. Using the example of the United Kingdom, we show the significance of land-use change not only for agricultural production but also for emissions and sequestration of greenhouse gases, open-access recreational visits, urban green space, and wild-species diversity. We use spatially explicit models in conjunction with valuation methods to estimate comparable economic values for these services, taking account of climate change impacts. We show that, although decisions that focus solely on agriculture reduce overall ecosystem service values, highly significant value increases can be obtained from targeted planning by incorporating all potential services and their values and that this approach also conserves wild-species diversity.

A pilot study of the development and implementation of a ‘best practice’ patient information booklet for patients with chronic venous insufficiency

Objective

Chronic venous insufficiency (CVI) is a chronic condition that has a significant impact on the individual. For the effective, long-term management of CVI, it is important that patients are educated on the patho-physiology of the condition and strategies that can minimize the related complications. Therefore, the aim of this study was to develop and pilot a ‘best practice’ information booklet for CVI and to assess the impact of this booklet on CVI-related knowledge and quality of life (QOL).

Method

A ‘best practice’ CVI booklet was developed based on the best available evidence from the literature. Participants with a formal diagnosis of CVI with a clinical, aetiological, anatomical and pathological elements (CEAP) classification of 3–6 were recruited from vascular outpatient clinics at a tertiary hospital. Each participant was given and explained the CVI booklet and asked to undertake the recommended activities at home over the next six-month period. Measurements were taken at baseline, one month and six months postbooklet implementation via the previously validated Health Education Impact and the CVI Questionnaires.

Results

Twenty-six participants, aged 38–90 years (mean 71.8 ± 12.9 years) initially participated in the study, with 20 participants remaining at the six-month time point (77% completion rate). At the end of one month, there had been a significant improvement in doing at least one activity to improve CVI ( P = 0.010), monitoring CVI ( P = 0.045), having effective ways to prevent CVI symptoms ( P = 0.045), knowing CVI triggers ( P = 0.005), ability to travel by car and bus ( P = 0.05), undertaking social activities ( P = 0.030) and feeling less embarrassed about the legs ( P = 0.025). At trial end (6 months), there was a significant improvement in doing at least one activity to improve CVI ( P = 0.003), knowing CVI triggers ( P = 0.016), having effective ways of preventing CVI symptoms ( P = 0.008), worrying about the CVI ( P = 0.030), feeling hopeless because of CVI problems ( P = 0.007), leg and ankle pain ( P = 0.038), ability to do domestic duties ( P = 0.017), feeling nervous and tense ( P = 0.026), and feeling less embarrassed about the legs ( P = 0.008). Although other domains improved in the study, none of these improvements were statistically significant.

Conclusion

Although a small pilot study, the outcomes demonstrate that the implementation of a ‘best practice’ CVI information booklet into a patients management routine can improve both CVI-related knowledge and QOL.

Ppm1E is an in cellulo AMP-activated protein kinase phosphatase

Activation of 5'-AMP-activated protein kinase (AMPK) is believed to be the mechanism by which the pharmaceuticals, metformin and phenformin, exert their beneficial effects for treatment of type 2 diabetes. These biguanide drugs elevate 5'-AMP, which allosterically activates AMPK and promotes phosphorylation on Thr172 of AMPK catalytic α subunits. Although kinases phosphorylating this site have been identified, phosphatases that dephosphorylate it are unknown. The aim of this study is to identify protein phosphatase(s) that dephosphorylate AMPKα-Thr172 within cells. Our initial data indicated that members of the protein phosphatase Mg/Mn(2+)-dependent [corrected] (PPM) family and not those of the PPP family of protein serine/threonine phosphatases may be directly or indirectly inhibited by phenformin. Using antibodies raised to individual Ppm phosphatases that facilitated the assessment of their activities, phenformin stimulation of cells was found to decrease the Mg(2+)/Mn(2+)-dependent [corrected] protein serine/threonine phosphatase activity of Ppm1E and Ppm1F, but not that attributable to other PPM family members, including Ppm1A/PP2Cα. Depletion of Ppm1E, but not Ppm1A, using lentiviral-mediated stable gene silencing, increased AMPKα-Thr172 phosphorylation approximately three fold in HEK293 cells. In addition, incubation of cells with low concentrations of phenformin and depletion of Ppm1E increased AMPK phosphorylation synergistically. Ppm1E and the closely related Ppm1F interact weakly with AMPK and assays with lysates of cells stably depleted of Ppm1F suggest [corrected] that this phosphatase contributes to dephosphorylation of AMPK. The data indicate that Ppm1E and probably PpM1F are in cellulo AMPK phosphatases and that Ppm1E is a potential anti-diabetic drug target.

The carrier clinic: an evaluation of a novel clinic dedicated to the follow-up of BRCA1 and BRCA2 carriers--implications for oncogenetics practice

BACKGROUND

A novel oncogenetic clinic was established in 2002 at the Royal Marsden NHS Foundation Trust offering advice and specialist follow-up for families with a germline mutation in BRCA1 or BRCA2. The remit of this multidisciplinary clinic, staffed by individuals in both oncology and genetics, is to provide individualised screening recommendations, support in decision making, risk reducing strategies, cascade testing, and an extensive research portfolio.

METHODS

A retrospective analysis was performed to evaluate uptake of genetic testing, risk reducing surgery and cancer prevalence in 346 BRCA1/BRCA2 families seen between January 1996 and December 2006.

RESULTS

661 individuals attended the clinic and 406 mutation carriers were identified; 85.8% mutation carriers have chosen to attend for annual follow-up. 70% of mutation carriers elected for risk reducing bilateral salpingo-oophorectomy (RRBSO). 32% of unaffected women chose risk reducing bilateral mastectomy. 32% of women with breast cancer chose contralateral risk reducing mastectomy at time of diagnosis. Some women took over 8 years to decide to have surgery. 91% of individuals approached agreed to participate in research programmes.

INTERPRETATION

A novel specialist clinic for BRCA1/2 mutation carriers has been successfully established. The number of mutation positive families is increasing. This, and the high demand for RRBSO in women over 40, is inevitably going to place an increasing demand on existing health resources. Our clinic model has subsequently been adopted in other centres and this will greatly facilitate translational studies and provide a healthcare structure for management and follow-up of such people who are at a high cancer risk.

Tools for the prioritization of substances on the Domestic Substances List in Canada on the basis of hazard

A precedent setting legislative mandate under the Canadian Environmental Protection Act 1999 to establish priorities for assessment based on systematic consideration of all of the approximately 23,000 Existing Chemicals in Canada required the development and refinement of methodology in a number of important areas. This included development of simple and complex exposure and hazard tools for priority setting which draw maximally and efficiently on available data to systematically identify substances that are highest priorities in relation to their potential to cause adverse effects on the general population. The hierarchical approach in the simple and complex hazard tools described here efficiently and effectively sets substances aside as non-priorities, or prioritizes them for consideration additionally in assessment. The hazard tools efficiently incorporate previous work, contributing to consistency internationally, and involve hierarchical consideration of sources of information based on their relative weighting. They are health protective, based on their incorporated degree of conservatism, and provide direction for additional assessment for substances deemed to be priorities. Although designed for prioritization of Existing Substances in Canada, these tools have potential for broader application in other national and international programs to provide focus and increase efficiency in human health risk assessment.

The TP53 Arg72Pro and MDM2 309G>T polymorphisms are not associated with breast cancer risk in BRCA1 and BRCA2 mutation carriers

Background:

The TP53 pathway, in which TP53 and its negative regulator MDM2 are the central elements, has an important role in carcinogenesis, particularly in BRCA1- and BRCA2-mediated carcinogenesis. A single nucleotide polymorphism (SNP) in the promoter region of MDM2 (309T>G, rs2279744) and a coding SNP of TP53 (Arg72Pro, rs1042522) have been shown to be of functional significance.

Methods:

To investigate whether these SNPs modify breast cancer risk for BRCA1 and BRCA2 mutation carriers, we pooled genotype data on the TP53 Arg72Pro SNP in 7011 mutation carriers and on the MDM2 309T>G SNP in 2222 mutation carriers from the Consortium of Investigators of Modifiers of BRCA1/2 (CIMBA). Data were analysed using a Cox proportional hazards model within a retrospective likelihood framework.

Results:

No association was found between these SNPs and breast cancer risk for BRCA1 (TP53: per-allele hazard ratio (HR)=1.01, 95% confidence interval (CI): 0.93–1.10, P_trend=0.77; MDM2: HR=0.96, 95%CI: 0.84–1.09, P_trend=0.54) or for BRCA2 mutation carriers (TP53: HR=0.99, 95%CI: 0.87–1.12, P_trend=0.83; MDM2: HR=0.98, 95%CI: 0.80–1.21, P_trend=0.88). We also evaluated the potential combined effects of both SNPs on breast cancer risk, however, none of their combined genotypes showed any evidence of association.

Conclusion:

There was no evidence that TP53 Arg72Pro or MDM2 309T>G, either singly or in combination, influence breast cancer risk in BRCA1 or BRCA2 mutation carriers.