Increased PI3K pathway activity is associated with recurrent breast cancer in patients with low and intermediate 21-gene recurrence score

AIMS

We investigated key signalling pathways' activity and mutational status of early-stage breast carcinomas with low and intermediate 21-gene recurrence score (RS) to identify molecular features that may predict recurrence.

METHODS

This is a retrospective case-control study of 18 patients with recurrent breast carcinoma with low and intermediate 21-gene RS (<25) and control group of 15 non-recurrent breast cancer patients. DNA and mRNA were extracted from tumour tissue. mRNA expression of genes involved in oestrogen receptor (ER), androgen receptor (AR), PI3K and MAPK signalling pathways was measured by real-time quantitative reverse transcription-qPCR (OncoSIGNal G4 test, InnoSIGN). Tumour mutational landscape was assessed by targeted DNA sequencing (Oncomine Precision Assay).

RESULTS

There were no statistical differences between the groups' demographic and clinicopathological characteristics. PI3K pathway showed significantly higher activity in cases compared with controls (p=0.0014). Receiver operating characteristic curve analysis showed an area under the curve of 0.79 for PI3K pathway activity in the prediction of recurrent disease in low and intermediate 21-gene RS breast cancer. There was no difference in ER, AR and MAPK pathway activity. PIK3CA alterations were the most common driver mutations, but no difference was found between the groups (p=0.46) and no association with PI3K pathway activity (p=0.86). Higher Ki67 gene expression was associated with recurrences (p=0.042) CONCLUSION: Increased PI3K pathway activity, independent of PIK3CA mutations, may play a role in the recurrence of early-stage breast cancer with low and intermediate 21-gene RS. Pathway analysis can help to identify high-risk patients in this setting.

Relationship between in feed drugs, antibiotics and organic enrichment in marine sediments at Canadian Atlantic salmon aquaculture sites

The presence of in-feed anti-sea lice drugs and their relationship with organic enrichment is poorly understood in sediment surrounding salmon farms. Using data from an aquaculture monitoring program (2018-2020), we describe this relationship at ten sites in four Canadian provinces. Three anti-sea lice pesticides (lufenuron, teflubenzuron, emamectin benzoate and metabolite desmethyl emamectin benzoate), and one antibiotic (oxytetracycline) were detected. Concentrations were often below limits of quantification. Values are also lower than those reported in other aquaculture salmon-producing countries. Highest concentrations, along with organic enrichment, were observed ~200 m of cages with lower concentrations detected up to 1.5 km away. Most samples had at least two drugs present: 75.2 % (British Columbia), 91.4 % (Newfoundland), and 54.8 % (New Brunswick/Nova Scotia) highlighting the potential for cumulative effects. Emamectin benzoate and oxytetracycline were detected four and three years respectively after last known treatments, demonstrating the need for research on overall persistence of compounds.

Metabolization of emamectin benzoate into desmethyl emamectin benzoate in spiked marine sediments

Emamectin benzoate (EMB) (4″deoxy- 4″-epi-methylaminoavermectin) is a pesticide developed to control pests on various crops, and in forestry. It is also used in salmon aquaculture to control sea lice infestations as an in-feed therapeutant. Little is known about EMB metabolites and potential associated toxicities in marine sediments. In this study, we used natural marine sediments (sand and mud) fortified at an EMB concentration of 60 ppb (wet weight). Results show an almost immediate transformation of EMB to Desmethyl EMB (DES) with no increased rates of metabolization when stored sediment samples were incubated for up to 16 h. The transformation ratio of EMB to DES represented between 0.16 and 0.39% of EMB; values are lower than what has been observed in fish tissue. Data suggest that DES is generated through both abiotic (tested after autoclaving marine sediments) and biological processes. Further work on freshly sampled marine sediments with EMB deposits, different organic regimes, and a detailed assessment of active bacterial communities are necessary to better evaluate the EMB to DES rate of transformation around aquaculture sites.

Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry

AIMS

The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation.

METHODS AND RESULTS

Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin.

CONCLUSION

The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.

630 Hailey-Hailey Disease: A Rare Presentation in the Hypopharnyx

Background

Hailey-Hailey disease or familial benign pemphigus is a rare genetic blistering skin disease due to mutation of the ATP2C1 gene inherited in autosomal dominant fashion. Prevalence is around 1 in 50,000 and positive family history is observed in 75% of cases. Patients typically present with well-demarcated painful erosive and yellow-crusted rash in the skin folds, following a relapsing-remitting pattern. There are very limited known cases of extra-dermatological presentation of this disease.

Case

64-year-old gentleman presented with dysphagia, hoarseness, sore throat, dry cough, and intermittent haemoptysis. Initial flexible nasendoscopy showed mild erythema of epiglottis and false cords, post-cricoid oedema and very mild Reinke's oedema. He was treated as acid reflux with omeprazole but to little effect. Endoscopy 4 months later showed similar findings hence biopsy of the hypopharynx was taken. The sample demonstrated intraepithelial clefting, suspicious of intraepithelial vesiculobullous disorder particularly pemphigus vulgaris.

Looking into this gentleman's medical history, it was found that he is under the care of dermatology for Hailey-Hailey disease, which he was diagnosed 30 years ago. He also has a strong family history of this condition. Based on the biopsy findings and patient profile, it was concluded that this gentleman has a hypopharyngeal manifestation of Hailey-Hailey disease.

Discussion

Hailey-Hailey disease is traditionally described as a dermatological condition. This gentleman is one of the rare few cases of non-dermatological manifestation of this disease.

Rifampicin-resistant TB: discordance between Xpert® MTB/RIF and MTBDRplus results

BACKGROUND: South Africa´s diagnostic algorithm for TB diagnosis from 2011 to 2017 employed the Xpert^® MTB/RIF assay as the initial screening test for TB diagnosis and rifampicin (RIF) susceptibility, followed by submission of a specimen for GenoType^® MTBDRplus. This study aimed to determine the concordance between the two assays in terms of RIF susceptibility and explore reasons for discordance.METHODS: This was a retrospective laboratory-based study that included all MTBDRplus results of tests performed at the Braamfontein Mycobacteriology Referral Laboratory between 1 September 2014 and 31 August 2015. The patient´s Xpert RIF result was linked with the MTBDRplus result.RESULTS: The overall concordance between RIF susceptibility results was 96.4%. There were 68 discordant RIF results. The most common reasons for discordance identified were possible false Xpert RIF-resistant results (22%), mixed infection/heteroresistance (16%), transcription errors (7%) and erroneous manual interpretation of the MTBDRplus strip (7%). Xpert RIF resistance detected using delayed hybridisation was associated with discordance.CONCLUSIONS: The overall concordance between the MTBDRplus and Xpert RIF results were very good. Management of discordance should include repeat specimens for Xpert and MTBDRplus and rpoB sequencing. All variables should then be considered before treatment regimens are altered.

Climate effects on US infrastructure: the economics of adaptation for rail, roads, and coastal development

Changes in temperature, precipitation, sea level, and coastal storms will likely increase the vulnerability of infrastructure across the USA. Using models that analyze vulnerability, impacts, and adaptation, this paper estimates impacts to railroad, roads, and coastal properties under three infrastructure management response scenarios: No Adaptation; Reactive Adaptation, and Proactive Adaptation. Comparing damages under each of these potential responses provides strong support for facilitating effective adaptation in these three sectors. Under a high greenhouse gas emissions scenario and without adaptation, overall costs are projected to range in the $100s of billions annually by the end of this century. The first (reactive) tier of adaptation action, however, reduces costs by a factor of 10, and the second (proactive) tier reduces total costs across all three sectors to the low $10s of billions annually. For the rail and road sectors, estimated costs for Reactive and Proactive Adaptation scenarios capture a broader share of potential impacts, including selected indirect costs to rail and road users, and so are consistently about a factor of 2 higher than prior estimates. The results highlight the importance of considering climate risks in infrastructure planning and management.

Assessing trace-elements as indicators of marine finfish aquaculture across three distinct Canadian coastal regions

Several trace-elements have been identified as indicators of finfish aquaculture organic enrichment. In this study, sediment sampling at finfish farms was completed as part of an Aquaculture Monitoring Program in three distinct Canadian regions. Despite diverse datasets, multivariate analyses show a consistent clustering of known direct (Cu and Zn) and indirect (Cd, Mo and U) tracers of aquaculture activities with sediment organic matter (OM) and/or total dissolved sulfides concentrations. OM content was also a predictor of Cu, Zn, Mo and U concentrations according to decision tree analyses. Distance from cages did not emerge as a strong driver of differences among sampling points; however, a tendency towards negative associations is clear especially for Zn. Enriched stations as determined after geochemical normalization were mostly localized within 150 m of net-pens. Selected trace-elements (in particular Zn) can be useful indicators of aquaculture organic enrichment in different ecosystems and valuable tools for monitoring programs.

O40 Predictive models of individual risk of elective caesarean section complications: a systematic review

Introduction

With increasing caesarean section (c-section) rates, personalised communication of risk has become paramount. A reliable tool to predict complications would support evidence-based discussion around planned mode of birth.

Method

MEDLINE, Embase, Web of Science, CINAHL, and the Cochrane Library were searched on 27th January with the terms relating to c-section, prognostic models, and complications such as infection. Any study developing and/or validating a prognostic model for maternal complications of c-section in the English language after January 1995 was included. Data extracted encompassed: source of data, participant criteria, outcome to be predicted, candidate predictors, actual predictors, sample size, model development, and model performance. PROBAST (Prediction model Risk Of Bias Assessment Tool) was utilised for risk of bias analysis and applicability concern in the prognostic model studies.

Result

7,752 studies were identified, of which 16 were reviewed producing 3 studies where 3 prognostic models were identified which predicted risk of: blood transfusion, spinal hypotension, and postpartum haemorrhage. From the 3 studies, a total of 29 unique candidate predictors were identified and 15 predictors in the final model. Study authors deemed their studies to be exploratory, exploratory, and confirmatory respectively. None were externally validated and all had a high risk of bias due to analysis technique.

Conclusion

Few models have been developed to predict complications of elective c-section. Existing models predicting blood transfusion, spinal hypotension, and postpartum haemorrhage cannot be recommended for clinical practice. Future research should focus on identifying predictors known before surgery and validating resulting models.

Take-home Message

Systematic review of prediction models for planned C-section complications found none suitable for practice.

CD47 expression and CD163+ macrophages correlated with prognosis of pancreatic neuroendocrine tumor

Background

Recent studies have suggested the important roles of CD47 and tumor-associated macrophages in the prognosis and immunotherapy of various human malignancies. However, the clinical significance of CD47 expression and CD163+ TAMs in pancreatic neuroendocrine tumor (PanNET) remains unclear.

Methods

In this study, 47 well-differentiated PanNET resection specimens were collected. CD47 expression and CD163+ macrophages were evaluated using immunohistochemistry and correlated with clinicopathologic properties.

Results

Positive CD47 staining was seen in all PanNETs as well as adjacent normal islets. Compared to normal islets, CD47 overexpressed in PanNETs (p = 0.0015). In the cohort, lymph node metastasis (LNM), lymphovascular invasion (LVI), and perineural invasion (PNI) were found in 36.2, 59.6, and 48.9% of the cases, respectively. Interestingly, PanNETs with LNM, LVI, or PNI had significantly lower H-score of CD47 than those without LNM (p = 0.035), LVI (p = 0.0005), or PNI (p = 0.0035). PanNETs in patients with disease progression (recurrence/death) also showed a significantly lower expression of CD47 than those without progression (p = 0.022). In contrast, CD163+ macrophage counts were significantly higher in cases with LNM, LVI, and PNI.

Conclusions

Our data suggest relative low CD47 expression and high CD163+ TAMs may act as indicators for poor prognosis of PanNETs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-021-08045-7.

Sequencing identifies multiple early introductions of SARS-CoV-2 to the New York City region

Effective public response to a pandemic relies upon accurate measurement of the extent and dynamics of an outbreak. Viral genome sequencing has emerged as a powerful approach to link seemingly unrelated cases, and large-scale sequencing surveillance can inform on critical epidemiological parameters. Here, we report the analysis of 864 SARS-CoV-2 sequences from cases in the New York City metropolitan area during the COVID-19 outbreak in spring 2020. The majority of cases had no recent travel history or known exposure, and genetically linked cases were spread throughout the region. Comparison to global viral sequences showed that early transmission was most linked to cases from Europe. Our data are consistent with numerous seeds from multiple sources and a prolonged period of unrecognized community spreading. This work highlights the complementary role of genomic surveillance in addition to traditional epidemiological indicators.

Concurrent Identification of Novel EGFR-SEPT14 Fusion and ETV6-RET Fusion in Secretory Carcinoma of the Salivary Gland

Salivary gland secretory carcinoma, also termed mammary analogue secretory carcinoma (MASC), is a recently described salivary gland neoplasm with characteristic histomorphologic findings similar to those of secretory carcinoma of the breast and harboring recurrent ETV6-NTRK3 fusions. Recent findings have expanded the molecular profile of salivary gland secretory carcinoma to include multiple novel ETV6 fusion partners, including RET, MET, and MAML3. Here, we report a case of cystic MASC with cribriform and papillary histology harboring two gene fusions, ETV6-RET and EGFR-SEPT14, identified by targeted RNA sequencing. The presence of the rearrangements was confirmed by FISH, RT-PCR, and Sanger sequencing. This is the first EGFR-SEPT14 fusion reported in secretory carcinoma as a single event or in association with an ETV6 rearrangement. This finding adds to the expanding molecular profile of this tumor entity, and may translate into novel treatment strategies.

Sequencing identifies multiple early introductions of SARS-CoV-2 to the New York City Region

Effective public response to a pandemic relies upon accurate measurement of the extent and dynamics of an outbreak. Viral genome sequencing has emerged as a powerful approach to link seemingly unrelated cases, and large-scale sequencing surveillance can inform on critical epidemiological parameters. Here, we report the analysis of 864 SARS-CoV-2 sequences from cases in the New York City metropolitan area during the COVID-19 outbreak in Spring 2020. The majority of cases had no recent travel history or known exposure, and genetically linked cases were spread throughout the region. Comparison to global viral sequences showed that early transmission was most linked to cases from Europe. Our data are consistent with numerous seeds from multiple sources and a prolonged period of unrecognized community spreading. This work highlights the complementary role of genomic surveillance in addition to traditional epidemiological indicators.

WITHDRAWN: ASSOCIATION OF INITIAL VIRAL LOAD IN SARS-CoV-2 PATIENTS WITH OUTCOME AND SYMPTOMS

The Publisher regrets that this article is an accidental duplication of an article that has already been published, https://doi.org/10.1016/j.ajpath.2020.07.001. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.

Health-related quality of life and balance confidence among participants in a senior community-based exercise (SWIFT) program compared to age matched controls: a cross-sectional study

BACKGROUND

Staying Well, Independent and Fit Together (SWIFT), a seniors' exercise program, aims to promote health, strength, mobility and community engagement. We compared quality of life and balance confidence in SWIFT participants and non-participants, aged 60 years and older.

METHODS

Cross-sectional study comparing participants and non-participants in SWIFT program using Older People's Quality of Life Questionnaire (OPQOL) and Activities-specific Balance Confidence Scale (ABCS).

RESULTS

Seventy participants completed surveys, 41 in experimental and 29 in control group. We found a statistically significant between group difference favoring the control group in overall OPQOL score but not in OPQOL subscale nor overall ABCS scores. Participants in both groups participating in weekly exercises had non-significantly higher quality of life subscale scores.

CONCLUSION

Results suggest seniors in both study groups who participate in exercise have non-significantly higher quality of life scores compared to those who do not participate in exercise. Participation in the SWIFT exercise program or activity in general, contributes to quality of life in seniors.

Adult rhabdomyoma presenting as thyroid nodule on fine-needle aspiration in patient with Birt-Hogg-Dubé syndrome: Case report and literature review

Extracardiac rhabdomyoma is an uncommon benign striated muscle tumor with a predilection for the head and neck region. However, it is extremely rare for extracardiac rhabdomyoma to present as a thyroid nodule. We report a case of rhabdomyoma diagnosed by thyroid fine-needle aspiration (FNA) in a patient with Birt-Hogg-Dubé (BHD) syndrome. A 60-year-old man with BHD syndrome presented for recurrent pneumothorax. Chest CT incidentally identified a thyroid nodule. Subsequent sonography confirmed a 4.44 × 2.28 × 2.82 cm solid, hypoechoic nodule with smooth margins in the right upper pole. Ultrasound-guided FNA revealed many clusters and scattered isolated large polygonal cells with abundant granular cytoplasm and small peripherally located nuclei. Vague striations in the cytoplasm were focally identified. No follicular cells or colloid was present. Immunocytochemistry on one direct smear slide demonstrated diffuse positivity for desmin, supporting muscular differentiation. Subsequent surgery identified an adult rhabdomyoma originating from the inferior constrictor muscle of the neck and anteriorly displacing the thyroid. Because the mass was intimately associated with the thyroid gland, it was initially mistaken for a thyroid nodule on ultrasound. Diagnosis of rhabdomyoma on FNA is challenging, especially when rhabdomyoma mimics a thyroid nodule on imaging. The differential diagnosis includes Hurthle cell neoplasm, granular cell tumor, colloid nodule, and normal striated skeletal muscle. Adequate radiologic data and familiarity with the cytologic features of rhabdomyoma are critical for an accurate diagnosis.

Towards a European health research and innovation cloud (HRIC)

The European Union (EU) initiative on the Digital Transformation of Health and Care (Digicare) aims to provide the conditions necessary for building a secure, flexible, and decentralized digital health infrastructure. Creating a European Health Research and Innovation Cloud (HRIC) within this environment should enable data sharing and analysis for health research across the EU, in compliance with data protection legislation while preserving the full trust of the participants. Such a HRIC should learn from and build on existing data infrastructures, integrate best practices, and focus on the concrete needs of the community in terms of technologies, governance, management, regulation, and ethics requirements. Here, we describe the vision and expected benefits of digital data sharing in health research activities and present a roadmap that fosters the opportunities while answering the challenges of implementing a HRIC. For this, we put forward five specific recommendations and action points to ensure that a European HRIC: i) is built on established standards and guidelines, providing cloud technologies through an open and decentralized infrastructure; ii) is developed and certified to the highest standards of interoperability and data security that can be trusted by all stakeholders; iii) is supported by a robust ethical and legal framework that is compliant with the EU General Data Protection Regulation (GDPR); iv) establishes a proper environment for the training of new generations of data and medical scientists; and v) stimulates research and innovation in transnational collaborations through public and private initiatives and partnerships funded by the EU through Horizon 2020 and Horizon Europe.

Electrochemical characteristics of ultramicro-dimensioned SIROF electrodes for neural stimulation and recording

OBJECTIVE

With ever increasing applications of neural recording and stimulation, the necessity for developing neural interfaces with higher selectivity and lower invasiveness is inevitable. Reducing the electrode size is one approach to achieving such goals. In this study, we investigated the effect of electrode geometric surface area (GSA), from 20 μm² to 1960 μm², on the electrochemical impedance and charge-injection properties of sputtered iridium oxide (SIROF) coated electrodes in response to current-pulsing typical of neural stimulation. These data were used to assess the electrochemical properties of ultra-small SIROF electrodes (GSA  <  200 μm²) for stimulation and recording applications.

APPROACH

SIROF charge storage capacities (CSC), impedance, and charge-injection characteristics during current-pulsing of planar, circular electrodes were evaluated in an inorganic model of interstitial fluid (model-ISF).

MAIN RESULTS

SIROF electrodes as small as 20 μm² could provide 1.3 nC/phase (200 μs pulse width, 0.6 V versus Ag|AgCl interpulse bias) of charge during current pulsing. The 1 kHz impedance of all electrodes used in this study were below 1 MΩ, which is suitable for neural recording.

SIGNIFICANCE

Ultra-small SIROF electrodes are capable of charge injection in buffered saline at levels above some reported thresholds for neural stimulation with microelectrodes.

Protocol for a Randomised controlled trial to Evaluate the effectiveness and cost benefit of prescribing high dose FLuoride toothpaste in preventing and treating dEntal Caries in high-risk older adulTs (reflect trial)

BACKGROUND

Dental caries in the expanding elderly, predominantly-dentate population is an emerging public health concern. Elderly individuals with heavily restored dentitions represent a clinical challenge and significant financial burden for healthcare systems, especially when their physical and cognitive abilities are in decline. Prescription of higher concentration fluoride toothpaste to prevent caries in older populations is expanding in the UK, significantly increasing costs for the National Health Services (NHS) but the effectiveness and cost benefit of this intervention are uncertain. The Reflect trial will evaluate the effectiveness and cost benefit of General Dental Practitioner (GDP) prescribing of 5000 ppm fluoride toothpaste and usual care compared to usual care alone in individuals 50 years and over with high-risk of caries.

METHODS/DESIGN

A pragmatic, open-label, randomised controlled trial involving adults aged 50 years and above attending NHS dental practices identified by their dentist as having high risk of dental caries. Participants will be randomised to prescription of 5000 ppm fluoride toothpaste (frequency, amount and duration decided by GDP) and usual care only. 1200 participants will be recruited from approximately 60 dental practices in England, Scotland and Northern Ireland and followed up for 3 years. The primary outcome will be the proportion of participants receiving any dental treatment due to caries. Secondary outcomes will include coronal and root caries increments measured by independent, blinded examiners, patient reported quality of life measures, and economic outcomes; NHS and patient perspective costs, willingness to pay, net benefit (analysed over the trial follow-up period and modelled lifetime horizon). A parallel qualitative study will investigate GDPs' practises of and beliefs about prescribing the toothpaste and patients' beliefs and experiences of the toothpaste and perceived impacts on their oral health-related behaviours.

DISCUSSION

The Reflect trial will provide valuable information to patients, policy makers and clinicians on the costs and benefits of an expensive, but evidence-deficient caries prevention intervention delivered to older adults in general dental practice.

TRIAL REGISTRATION

ISRCTN: 2017-002402-13 registered 02/06/2017, first participant recruited 03/05/2018. Ethics Reference No: 17/NE/0329/233335. Funding Body: Health Technology Assessment funding stream of National Institute for Health Research. Funder number: HTA project 16/23/01. Trial Sponsor: Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL. The Trial was prospectively registered.

A limb to stand on? A scoping review of employability assessment in Australian total and permanent disability insurance claims

Purpose: Employability assessment helps in deciding to pay or decline Australian total and permanent disability insurance claims, yet it has not been critically examined. This paper reviews employability assessment from forensic vocational assessment, life insurance/superannuation, and legal perspectives.Methods: In a scoping review, we searched six multidisciplinary databases and various industry-specific resources. Items pertinent to forensic employability/vocational assessment and life insurance total and permanent disability claims were included. Return-to-work assessment, the vocational assessor, medical or functional evaluation, and case law items were excluded. Quality appraisal measures were used for research studies and other items. From 104 full-text reviews, 39 items were included for thematic synthesis from the three perspectives of interest.Results: Our review found that employability assessment is derived from forensic vocational assessment, but methodology differs in claimant contact and psychosocial aspects. Employability assessment practice is informed by policy, market changes, and legal interpretation. Assessors may work for opposing sides in forensic or indirect settings therefore high standards and credentials must prevail.Conclusions: Foundational research into the effectiveness of employability assessment and the experience of claimants is warranted. Future research into methodology, assessor credentials, and legal aspects will broaden understanding of this relatively new topic.Implications for rehabilitationEmployability assessment is an emergent and hitherto unexamined model that operates in the multi-billion-dollar Australian total and permanent disability insurance market.Total and permanent disability insurance policies and their legal interpretation are ever-changing and substantially inform employability assessment practice.Employability assessment lacks methodology and variables that are common elements in proven forensic vocational assessment models in the United States.Training and credentialing of rehabilitation professionals who conduct employability assessments are required to withstand legal scrutiny and meet international forensic standards.

Using an adapted Delphi process to develop a survey evaluating employability assessment in total and permanent disability insurance claims

BACKGROUND

No research has been undertaken about employability assessment of total and permanent disability (TPD) insurance claims. Employability assessment provides vocational information to life insurers to help decide claims. To determine how helpful employability assessment is, a new measure was needed to survey insurers.

OBJECTIVE

To generate survey items by harnessing the knowledge and agreement of rehabilitation advisors with expertise in employability assessment.

METHODS

A panel of 10 (89% of eligible Australian rehabilitation advisors) participated in an adapted three-round Delphi process. Rounds 2 and 3 were incorporated into a novel real-time card sort format.

RESULTS

From 94 potential items submitted for first round qualitative analysis, 36 items in four domains-quality, content, utility, and claims-were generated. Two quantitative ranking rounds in one face-to-face session produced a 21-item prototype. The final electronic survey instrument contained 11 sections seeking insurer demographics and feedback on: external providers; employability assessment concepts, components, quality, and usefulness; functional, occupational, labor market items; and finally, cost and type. Our Delphi process was anonymous, completed in four weeks with 100% response rate and 75% agreement. More time between Rounds 2 and 3 would enhance statistical analysis.

CONCLUSIONS

Our adapted Delphi methodology for survey item generation is generalizable for any panel able to meet in person.

Increasing inequality in childhood obesity in primary schools in a northern English town

OBJECTIVE

To undertake an analysis of National Child Measurement Programme (NCMP) data to quantify the obesity prevalence gap over time between children in primary schools in the most and least deprived areas of Doncaster.

STUDY DESIGN

The research design for this study was retrospective quantitative analysis of secondary data.

METHODS

The study undertook secondary analysis of NCMP data on obesity prevalence in children in Reception Year and Year 6 in primary schools in Doncaster for the period 2006-2007 to 2014-2015. Data were combined into three 3-year periods (2006-2007 to 2008-2009; 2009-2010 to 2011-2012; and 2012-2013 to 2014-2015), and schools were grouped by deprivation based on the national Indices of Multiple Deprivation 2015. Analysis was undertaken to assess whether there is a difference in obesity prevalence for Reception Year and Year 6 children in schools in the most deprived areas compared with the least deprived (prevalence gap), over time.

RESULTS

The difference in obesity prevalence between children attending schools in the most and least deprived areas has increased over time. For Reception Year children, the prevalence gap has widened from a difference of 1.01% higher in the most deprived schools in 2006-2007 to 2008-2009 to 3.64% higher in 2012-2013 to 2014-2015. In the same time periods, for Year 6 children, the obesity prevalence gap has also increased over time from 2.82% to 5.08%.

CONCLUSIONS

There is inequality in relation to obesity in primary school children in Doncaster with those in schools in the most deprived areas carrying the greatest burden. Research is needed to understand why the plateau seen nationally is not reaching the most deprived children.

Analysis of potential response predictors to capecitabine/temozolomide in metastatic pancreatic neuroendocrine tumors

The capecitabine and temozolomide (CAPTEM) regimen is active in the treatment of metastatic pancreatic neuroendocrine tumors (pNETs), with response rates ranging from 30 to 70%. Small retrospective studies suggest that O(6)-methylguanine DNA methyltransferase (MGMT) deficiency predicts response to temozolomide. High tumor proliferative activity is also commonly perceived as a significant predictor of response to cytotoxic chemotherapy. It is unclear whether chromosomal instability (CIN), which correlates with alternative lengthening of telomeres (ALT), is a predictive factor. In this study, we evaluated 143 patients with advanced pNET who underwent treatment with CAPTEM for radiographic and biochemical response. MGMT expression (n=52), grade (n=128) and ALT activation (n=46) were investigated as potential predictive biomarkers. Treatment with CAPTEM was associated with an overall response rate (ORR) of 54% by RECIST 1.1. Response to CAPTEM was not influenced by MGMT expression, proliferative activity or ALT pathway activation. Based on these results, no biomarker-driven selection criteria for use of the CAPTEM regimen can be recommended at this time.

Field test kits for collection of ignitable liquids and ignitable liquid residues used by the NSW fire scene investigators

The detection of ignitable liquid residues (ILR) on samples related to fire scenes provides investigators with important information. Field test kits were developed as an alternative procedure to swabbing using cotton wool and cotton tip applicators for situations where direct sampling is not possible. Central to the kits is a piece of white absorbent non-woven material consisting of polypropylene fibres (cloth). Experiments were carried out in our laboratory using the polypropylene cloths and cotton wool for collection of burnt and unburnt petrol residues from porous and non-porous surfaces. Every aspect of this new procedure was validated, involving more than 200 analyses of fire debris samples, where the polypropylene cloth was used to sample ILR comprising all common accelerants. The use of field test kits for collection of petrol and medium petroleum distillate (MPD) residues from hands was validated on the hands of 11 volunteers. The polypropylene cloth was found to be suitable for application in field test kits for the collection and recovery of petroleum-based liquids and liquid residues from both fire scenes and hands.

Subcortical structure alterations impact language processing in individuals with schizophrenia and those at high genetic risk

OBJECTIVE

Cortical structural and functional anomalies have been found to associate with language impairments in both schizophrenia patients and genetic high risk individuals for developing schizophrenia. However, subcortical structures that contribute to language processing haven't been well studied in this population, and thus became the main objective of this study.

METHOD

We examined structural MRI data from 20 patients with schizophrenia, 21 individuals at genetic high risk, and 48 controls. Surface shape and volume differences of 6 subcortical structures that are involved in language processing, including nuclei pallidum, putamen, caudate, amygdala, thalamus, and hippocampus from both hemispheres, were compared between groups. Performance scores of language-associated cognitive tests were obtained to identify relationships of subcortical structures to language-related behaviors.

RESULTS

Significantly reduced volumes of both the left and right side caudate nuclei, thalami and right side amygdala were shown in patients when compared with controls. Very interestingly, the high risk group demonstrated significantly increased correlations between volumes of left side pallidum nucleus and bilateral thalami and language-related cognitive test scores when compared to controls.

CONCLUSIONS

This study furthers our understanding of subcortical structural alterations in schizophrenia and high risk individuals, and suggests the contribution of subcortical structures to the language impairments that may serve as an early sign for impending development of schizophrenia.

Predictors of Postpartum Depression Among Immigrant Women in the Year After Childbirth

BACKGROUND

Immigrant women are at increased risk for postpartum depression (PPD). The factors that influence PPD among immigrant women are poorly understood. The purpose of this study was to identify individual- and community-level factors predictive of PPD among immigrant women living in a large Ontario city at 6 weeks, 6 months, and 1 year postpartum.

METHODS

The study involved a secondary analysis of a prospective cohort study, The Ontario Mother and Infant Study 3. This study included 519 immigrant women who were recruited from two hospitals in one urban city and delivered full-term singleton infants. Women completed a written questionnaire in hospital, followed by structured telephone interviews at 6 weeks, 6 months, and 1 year after hospital discharge. Generalized estimating equations were used to explore factors associated with PPD, measured using the Edinburgh Postnatal Depression Scale (EPDS) and two thresholds for depression (≥12 and ≥9).

RESULTS

Rates of PPD at all time points were 8%-10% for EPDS scores of ≥12. For EPDS scores of ≥9, rates of PPD more than doubled at all time points. A lack of social support was strongly associated with PPD in all analyses. Living in Canada for ≤2 years, poor perceptions of health, and lower mental health functioning were other important predictors of PPD. Living in communities with a high prevalence of immigrants and low income also was associated with PPD.

CONCLUSIONS

Complex individual and community-level factors are associated with PPD in immigrant women. Understanding these contextual factors can inform a multifaceted approach to addressing PPD.

Evaluation of the risks of chemotherapy in dogs with thrombocytopenia

Thrombocytopenia is commonly encountered in veterinary oncology. Currently, there are no standard guidelines regarding the administration of chemotherapy to the patients with thrombocytopenia. This observational epidemiological cohort study aimed to determine whether thrombocytopenic dogs were at increased risk of gastrointestinal adverse effects (vomiting, diarrhoea, inappetence) or haemorrhage following administration of standard doses of chemotherapy. The adverse effects following 77 prospectively identified episodes of thrombocytopenia (platelet count, <200 000 µL^-1 ) were compared with the adverse effects experienced in a retrospective cohort (platelet count >200 000 µL^-1 ), and evaluated by statistical analysis. Overall, there was no statistically significant difference in the incidence of gastrointestinal adverse effects or haemorrhage between thrombocytopenic and control dogs. The control group of dogs with lymphoma were statistically more likely to experience vomiting as an adverse effect of chemotherapy (P = 0.028). The results presented here showed no evidence for an increased risk of gastrointestinal adverse effects or haemorrhage in thrombocytopenic dogs after receiving standard doses of chemotherapy.

Defining the genomic landscape of head and neck cancers through next-generation sequencing

Next-generation sequencing (NGS) has revolutionized the field of genomics and improved our understanding of cancer biology. Advances have been achieved by sequencing tumor DNA and using matched normal DNA to filter out germ line variants to identify cancer-specific changes. The identification of high incidences of activating mutations in head and neck squamous cell carcinoma (HNSCC) amenable to drug targeting has been made, with clear distinctions between the mutational profile of HPV-positive and HPV-negative tumors. This wealth of new understanding undoubtedly ameliorates our understanding of HNSCC cancer biology and elucidates clear targets for drug targeting which will guide future personalized medicine.

MRSA bacteraemia complicating amphotericin B treatment of cryptococcal meningitis

Intravenous amphotericin B is a key component of the antifungal therapy for cryptococcal meningitis recommended in South African and international guidelines. Unfortunately, its use is associated with significant toxicity including deterioration in renal function, electrolyte disturbance, anaemia and infusion reactions. Chemical phlebitis is common following administration via peripheral cannulae. This can be complicated by bacterial infection, resulting in localised cellulitis or bacterial sepsis. Here we describe two patients with cryptococcal meningitis who developed methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia during, or shortly after treatment with amphotericin B. These cases illustrate the dangers of line-related sepsis in hospitalised individuals and some of the difficulties encountered during treatment of this condition.