CAnceR IN PreGnancy (CARING) - a retrospective study of cancer diagnosed during pregnancy in the United Kingdom

BACKGROUND

The incidence of cancer diagnosed during pregnancy is increasing. Data relating to investigation and management, as well as maternal and foetal outcomes is lacking in a United Kingdom (UK) population.

METHODS

In this retrospective study we report data from 119 patients diagnosed with cancer during pregnancy from 14 cancer centres in the UK across a five-year period (2016-2020).

RESULTS

Median age at diagnosis was 33 years, with breast, skin and haematological the most common primary sites. The majority of cases were new diagnoses (109 patients, 91.6%). Most patients were treated with radical intent (96 patients, 80.7%), however, gastrointestinal cancers were associated with a high rate of palliative intent treatment (63.6%). Intervention was commenced during pregnancy in 68 (57.1%) patients; 44 (37%) had surgery and 31 (26.1%) received chemotherapy. Live births occurred in 98 (81.7%) of the cases, with 54 (55.1%) of these delivered by caesarean section. Maternal mortality during the study period was 20.2%.

CONCLUSIONS

This is the first pan-tumour report of diagnosis, management and outcomes of cancer diagnosed during pregnancy in the UK. Our findings demonstrate proof of concept that data collection is feasible and highlight the need for further research in this cohort of patients.

The complex circumstellar environment of supernova 2023ixf

The early evolution of a supernova (SN) can reveal information about the environment and the progenitor star. When a star explodes in vacuum, the first photons to escape from its surface appear as a brief, hours-long shock-breakout flare1,2, followed by a cooling phase of emission. However, for stars exploding within a distribution of dense, optically thick circumstellar material (CSM), the first photons escape from the material beyond the stellar edge and the duration of the initial flare can extend to several days, during which the escaping emission indicates photospheric heating3. Early serendipitous observations2,4 that lacked ultraviolet (UV) data were unable to determine whether the early emission is heating or cooling and hence the nature of the early explosion event. Here we report UV spectra of the nearby SN 2023ixf in the galaxy Messier 101 (M101). Using the UV data as well as a comprehensive set of further multiwavelength observations, we temporally resolve the emergence of the explosion shock from a thick medium heated by the SN emission. We derive a reliable bolometric light curve that indicates that the shock breaks out from a dense layer with a radius substantially larger than typical supergiants.

The way to a man's heart is through his stomach? A unique case report of transient constrictive pericarditis secondary to infarction of herniated omentum following bariatric surgery

Background

Intrapericardial diaphragmatic hernias are a rare form of diaphragmatic hernia. The presentation is usually acute due to trauma or from iatrogenic causes. In some instances however, these patients can present years later. We describe an unusual case of transient constrictive pericarditis associated with herniation of omentum through a diaphgragmatic hernia extending into the pericardial space, which infarcted following recent bariatric surgery. A multi-disciplinary approach was required with surgical correction of the diaphragmatic defect and removal of omentum from the pericardial space.

Case summary

A 38-year-old gentleman with a history of a remote abdominal stab wound and recent laparoscopic gastric sleeve procedure presented with sharp central chest pain radiating to the shoulder. Chest imaging [echocardiography, computed tomography (CT), and cardiac magnetic resonance imaging (MRI)] revealed the presence of an intrapericardial diaphragmatic hernia and herniation of devascularized omentum into the pericardial space. Surgery was undertaken to remove the pericardial omentum. Echocardiography and cardiac MRI revealed changes of pericardial constriction which resolved with anti-inflammatories.

Discussion

A multi-disciplinary approach was required in this case with surgical correction of the diaphragmatic defect and removal of omentum from the pericardial space. Multi-modal imaging proved essential in the diagnosis of this rare condition, aiding in timely diagnosis, ongoing management decisions, and for assessing therapeutic response.

AB0019 TREATMENT OF AUTOIMMUNE AND INFLAMMATORY SKIN DISEASES USING SKIN-TARGETING BIFUNCTIONAL ANTIBODIES: A LOCALIZED IMMUNOMODULATION APPROACH

Background:

Current treatment approaches for autoimmune conditions comprise primarily of systemic immunosuppressants or cytokine blockade. The concentration of therapeutic molecules to the tissues that are the sites of autoimmune and inflammatory diseases is a promising approach with the potential to induce therapeutic benefit and avert risks associated with systemic immunotherapies. Pandion Therapeutics is developing a bifunctional antibody platform that can drive localized immune modulation by combining a “tether antibody” that targets a tissue of choice and “an effector end” that activates specific regulatory immune pathways to restore immune-homeostasis.

Objectives:

Here we report the engineering of a skin-tethered PD-1 agonist and a skin-tethered CD39 that inhibit T cell activation and function and deplete local ATP, respectively, modulating different arms of the immune system in a tissue specific manner.

Methods:

Biophysical assays were performed to characterize Skin-tethered immune effectors for drug-like properties and in vitro and in vivo assays for target binding, cellular activity and tissue specific-localization. Moreover, these bifunctionals were tested in pathway-relevant preclinical models such as Vitiligo and Contact Hypersensitivity.

Results:

Biophysical characterization of the bifunctional molecules showed desired drug like properties including specificity, stability, and manufacturability. The skin tethered bifunctionals showed effector activity in in vitro assays and selectively localized to the skin. Skin localization strikingly correlated with a tether-dependent efficacy compared to a non-tether control.

Conclusion:

We believe that this therapeutic approach has the potential to drive the resolution of cutaneous inflammation, providing an opportunity for developing new targeted therapies for autoimmune and inflammatory skin diseases.

Disclosure of Interests:

Susmita Borthakur Shareholder of: Pandion Therapeutics Inc., Employee of: Pandion therapeutics Inc., Purvi Mande: None declared, Daniel Rios: None declared, Patrick Halvey: None declared, Angela Boisvert: None declared, MIchael Rowe: None declared, Anisha Agrawal: None declared, Minasri Borah: None declared, Mike Cianci: None declared, Joanne L. Viney Shareholder of: Pandion therapeutics Inc., Consultant of: Harpoon, Finch, Quench, HotSpot, Employee of: Pandion Therapeutics Inc., Katalin Kis-Toth: None declared, Kevin L. Otipoby Shareholder of: Pandion Therapeutics Inc., Employee of: Pandion Therapeutics Inc., Ivan Mascanfroni: None declared, Nathan Higginson-Scott Shareholder of: Pandion Therapeutics Inc., Consultant of: Mediar Tx, Employee of: Pandion Therapeutics Inc.

Longitudinal characterisation of haematological and biochemical parameters in cancer patients prior to and during COVID-19 reveals features associated with outcome

BACKGROUND

Cancer patients are at increased risk of death from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Cancer and its treatment affect many haematological and biochemical parameters, therefore we analysed these prior to and during coronavirus disease 2019 (COVID-19) and correlated them with outcome.

PATIENTS AND METHODS

Consecutive patients with cancer testing positive for SARS-CoV-2 in centres throughout the United Kingdom were identified and entered into a database following local governance approval. Clinical and longitudinal laboratory data were extracted from patient records. Data were analysed using Mann-Whitney U test, Fisher's exact test, Wilcoxon signed rank test, logistic regression, or linear regression for outcomes. Hierarchical clustering of heatmaps was performed using Ward's method.

RESULTS

In total, 302 patients were included in three cohorts: Manchester (n = 67), Liverpool (n = 62), and UK (n = 173). In the entire cohort (N = 302), median age was 69 (range 19-93 years), including 163 males and 139 females; of these, 216 were diagnosed with a solid tumour and 86 with a haematological cancer. Preinfection lymphopaenia, neutropaenia and lactate dehydrogenase (LDH) were not associated with oxygen requirement (O2) or death. Lymphocyte count (P < 0.001), platelet count (P = 0.03), LDH (P < 0.0001) and albumin (P < 0.0001) significantly changed from preinfection to during infection. High rather than low neutrophils at day 0 (P = 0.007), higher maximal neutrophils during COVID-19 (P = 0.026) and higher neutrophil-to-lymphocyte ratio (NLR; P = 0.01) were associated with death. In multivariable analysis, age (P = 0.002), haematological cancer (P = 0.034), C-reactive protein (P = 0.004), NLR (P = 0.036) and albumin (P = 0.02) at day 0 were significant predictors of death. In the Manchester/Liverpool cohort 30 patients have restarted therapy following COVID-19, with no additional complications requiring readmission.

CONCLUSION

Preinfection biochemical/haematological parameters were not associated with worse outcome in cancer patients. Restarting treatment following COVID-19 was not associated with additional complications. Neutropaenia due to cancer/treatment is not associated with COVID-19 mortality. Cancer therapy, particularly in patients with solid tumours, need not be delayed or omitted due to concerns that treatment itself increases COVID-19 severity.

0501 Development and Initial Evaluation of Web-Based Cognitive Behavioral Therapy for Insomnia “Nitecapp” in Rural Dementia Caregivers: A Mixed-Methods Study

Introduction

Informal caregivers (CGs) of persons with dementia frequently experience insomnia. The time consuming and unpredictable schedule of CGs, and associated emotional/physical exhaustion emphasize the need for brief, easily accessible interventions to treat insomnia. Internet-based behavioral insomnia interventions hold promise, particularly for rural CGs who have limited access to traditional in-person treatments. This study aimed to 1) translate an efficacious 4 session cognitive behavioral therapy for insomnia (CBT-I) to web-based “NiteCAPP” for dementia caregivers, and 2) conduct NiteCAPP usability testing/evaluate acceptability of content and features.

Methods

NiteCAPP is an online CBT-I that incorporates guided delivery through weekly therapist moderator feedback. A stepwise approach was implemented in order to explore user needs and validate NiteCAPP content in a focus group of rural dementia caregivers (n=5) and primary care providers (PCPs; n=5). Participants conducted usability testing and provided ratings of program content (1-least favorable to 5-most favorable) regarding ease of use, amount of information, website maintaining interest, adequate font size, videos maintaining interest/easy to understand/helpful. Participants also indicated whether they had at home internet access, method of internet access, and provided open ended feedback on NiteCAPP. Feedback transcripts were compiled and analyzed independently (C.S.M., A.F.C.) through deductive content analysis. Topics mentioned frequently were categorized and merged into common themes during consensus meeting, and NiteCAPP was subsequently adapted.

Results

Average ratings for NiteCAPP features were high, ranging from 4.1/5 to 4.7/5 across all items. All participants had access to internet through both phone and computer. No barriers to use identified. Feedback themes were largely positive (e.g., comprehensive written material, promotes independence, excellent visual tools for therapy moderator feedback, good pacing, use of visual contrast). Negative themes for improvement/adaptation included adding font size options, a light/dark mode, tab with all videos, reducing amount of scrolling, adding a glossary of terms.

Conclusion

Rural dementia CGs and PCPs evaluated NiteCAPP as easy to use with acceptable features and program content and no barriers to access. Improvement themes were used to adapt NiteCAPP. Next steps are to evaluate feasibility and preliminary efficacy of NiteCAPP in rural dementia CGs with insomnia.

Support

none

Relevance of a subjective quality of life questionnaire for long-term homeless persons with schizophrenia

BACKGROUND

Increasing numbers of programs are addressing the specific needs of homeless people with schizophrenia in terms of access to housing, healthcare, basic human rights and other domains. Although quality of life scales are being used to evaluate such programs, few instruments have been validated for people with schizophrenia and none for people with schizophrenia who experience major social problems such as homelessness. The aim of the present study was to validate the French version of the S-QoL a self-administered, subjective quality of life questionnaire specific to schizophrenia for people with schizophrenia who are homeless.

METHODS

In a two-step process, the S-QoL was first administered to two independent convenience samples of long-term homeless people with schizophrenia in Marseille, France. The objective of the first step was to analyse the psychometric properties of the S-QoL. The objective of the second step was to examine, through qualitative interviews with members of the population in question, the relevance and acceptability of the principle quality of life indicators used in the S-QoL instrument.

RESULTS

Although the psychometric characteristics of the S-QoL were found to be globally satisfactory, from the point of view of the people being interviewed, acceptability was poor. Respondents frequently interrupted participation complaining that questionnaire items did not take into account the specific context of life on the streets.

CONCLUSIONS

Less intrusive questions, more readily understandable vocabulary and greater relevance to subjects' living conditions are needed to improve the S-QoL questionnaire for this population. A modular questionnaire with context specific sections or specific quality of life instruments for socially excluded populations may well be the way forward.

Acquired resistance to oxaliplatin is not directly associated with increased resistance to DNA damage in SK-N-ASrOXALI4000, a newly established oxaliplatin-resistant sub-line of the neuroblastoma cell line SK-N-AS

The formation of acquired drug resistance is a major reason for the failure of anti-cancer therapies after initial response. Here, we introduce a novel model of acquired oxaliplatin resistance, a sub-line of the non-MYCN-amplified neuroblastoma cell line SK-N-AS that was adapted to growth in the presence of 4000 ng/mL oxaliplatin (SK-N-AS^rOXALI⁴⁰⁰⁰). SK-N-AS^rOXALI⁴⁰⁰⁰ cells displayed enhanced chromosomal aberrations compared to SK-N-AS, as indicated by 24-chromosome fluorescence in situ hybridisation. Moreover, SK-N-AS^rOXALI⁴⁰⁰⁰ cells were resistant not only to oxaliplatin but also to the two other commonly used anti-cancer platinum agents cisplatin and carboplatin. SK-N-AS^rOXALI⁴⁰⁰⁰ cells exhibited a stable resistance phenotype that was not affected by culturing the cells for 10 weeks in the absence of oxaliplatin. Interestingly, SK-N-AS^rOXALI⁴⁰⁰⁰ cells showed no cross resistance to gemcitabine and increased sensitivity to doxorubicin and UVC radiation, alternative treatments that like platinum drugs target DNA integrity. Notably, UVC-induced DNA damage is thought to be predominantly repaired by nucleotide excision repair and nucleotide excision repair has been described as the main oxaliplatin-induced DNA damage repair system. SK-N-AS^rOXALI⁴⁰⁰⁰ cells were also more sensitive to lysis by influenza A virus, a candidate for oncolytic therapy, than SK-N-AS cells. In conclusion, we introduce a novel oxaliplatin resistance model. The oxaliplatin resistance mechanisms in SK-N-AS^rOXALI⁴⁰⁰⁰ cells appear to be complex and not to directly depend on enhanced DNA repair capacity. Models of oxaliplatin resistance are of particular relevance since research on platinum drugs has so far predominantly focused on cisplatin and carboplatin.

Inappropriate expression of the translation elongation factor 1A disrupts genome stability and metabolism

The translation elongation factor eEF1A is one of the most abundant proteins found within cells, and its role within protein synthesis is well documented. Levels of eEF1A are tightly controlled, with inappropriate expression linked to oncogenesis. However, the mechanisms by which increased eEF1A expression alters cell behaviour are unknown. Our analyses in yeast suggest that elevation of eEF1A levels leads to stabilisation of the spindle pole body and changes in nuclear organisation. Elevation of the eEF1A2 isoform also leads to altered nuclear morphology in cultured human cells, suggesting a conserved role in maintaining genome stability. Gene expression and metabolomic analyses reveal that the level of eEF1A is crucial for the maintenance of metabolism and amino acid levels in yeast, most likely because of its role in the control of vacuole function. Increased eEF1A2 levels trigger lysosome biogenesis in cultured human cells, also suggesting a conserved role within metabolic control mechanisms. Taken together, our data suggest that the control of eEF1A levels is important for the maintenance of a number of cell functions beyond translation and that its de-regulation might contribute to its oncogenic properties.

Summary: The translation elongation factor eEF1A is elevated in some cancers. We use yeast and human cell models to show that eEF1A elevation leads to genome instability and metabolic alterations that might affect its oncogenic properties.

New face for a familiar friend: the deGramont regimen in the treatment of metastatic colorectal cancer given as an outpatient: a feasibility study

The use of elastomeric infusional devices to administer chemotherapy is becoming established in a number of malignancies. Historically, hospitals have admitted patients for treatments such as the deGramont regimen, used in advanced colorectal cancer. This consists of intermittent infusional 5-fluorouracil (5-FU) and folinic acid and usually requires two to three inpatient days, every two weeks.

We performed a prospective, single-center, study to assess the feasibility of administering the deGramont regimen on an outpatient basis using elastomeric infusional devices. In addition, we assessed patient acceptability of this mode of administration and the effects on quality of life (using the self-completed EORTC QLQ-C30 questionnaire). Crude cost-benefit analysis was performed and we attempted to define the group of patients for whom this is a viable option.

Twenty-six patients, all receiving the same regimen, were recruited into the study. Two cohorts were (nonrandomly) allocated to receive either standard inpatient (n=13) or novel out-patient (n=13) chemotherapy. Administration of the deGramont regimen using elastomeric infusional devices through an indwelling central venous catheter was found to be both feasible and highly acceptable to patients. Those patients receiving this modality of administration reported marked benefits, improved morale and did not suffer from impaired quality of life. Taking into account the costs of inpatient hospital stay, the outpatient regimen conferred considerable cost savings.

Given the continued use of this popular regimen, either alone or in combination with newer, more active agents such as irinotecan and oxaliplatin, these findings have potential implications for a large number of patients and institutions. It also raises possibility of exploring this approach for other types of ambulatory infusion device chemo-therapy and may hasten the advent of home-based chemotherapy.

The use of ultrasound to assess fetal growth in a guinea pig model of fetal growth restriction

Fetal growth restriction (FGR) is a common and potentially severe pregnancy complication. Currently there is no treatment available. The guinea pig is an attractive model of human pregnancy as placentation is morphologically very similar between the species. Nutrient restriction of the dam creates growth-restricted fetuses while leaving an intact uteroplacental circulation, vital for evaluating novel therapies for FGR. Growth-restricted fetuses were generated by feeding Dunkin Hartley guinea pig dams 70% of ad libitum intake from four weeks before and throughout pregnancy. The effect of maternal nutrient restriction (MNR) on dams and fetuses was carefully monitored, and ultrasound measurements of pups collected. There was no difference in maternal weight at conception, however by five weeks post conception MNR dams were significantly lighter ( P < 0.05). MNR resulted in significantly smaller pup size from 0.6-0.66 gestation. Ultrasound is a powerful non-invasive tool for assessing the effect of therapeutic interventions on fetal growth, allowing longitudinal measurement of fetuses. This model and method yield data applicable to the human condition without the need for animal sacrifice and will be useful in the translation of therapies for FGR into the clinic.

Early diversification of sperm size in the evolutionary history of the old world leaf warblers (Phylloscopidae)

Sperm morphological traits are highly variable among species and are commonly thought to evolve by post-copulatory sexual selection. However, little is known about the evolutionary dynamics of sperm morphology, and whether rates of evolutionary change are variable over time and among taxonomic groups. Here, we examine sperm morphology from 21 species of Old World leaf warblers (Phylloscopidae), a group of generally dull, sexually monochromatic birds, which are known to have high levels of extra-pair paternity. We found that sperm length differs markedly across species, spanning about 40% of the range observed across a larger selection of passerine birds. Furthermore, we found strong support for an 'early-burst' model of trait evolution, implying that the majority of divergence in sperm length has occurred early in the evolutionary history of this clade with subsequent evolutionary stasis. This large early divergence matches the early divergence reported in ecological traits (i.e. body size and feeding behaviour). Our findings demonstrate that rates of evolution in sperm morphology can change over time in passerine taxa, and that evolutionary stasis in sperm traits can occur even in species exhibiting characteristics consistent with moderate-to-high levels of sperm competition. It remains a major challenge to identify the selection mechanisms and possible constraints responsible for these variable rates of sperm evolution.

New insights into stop codon recognition by eRF1

In eukaryotes, translation termination is performed by eRF1, which recognizes stop codons via its N-terminal domain. Many previous studies based on point mutagenesis, cross-linking experiments or eRF1 chimeras have investigated the mechanism by which the stop signal is decoded by eRF1. Conserved motifs, such as GTS and YxCxxxF, were found to be important for termination efficiency, but the recognition mechanism remains unclear. We characterized a region of the eRF1 N-terminal domain, the P1 pocket, that we had previously shown to be involved in termination efficiency. We performed alanine scanning mutagenesis of this region, and we quantified in vivo readthrough efficiency for each alanine mutant. We identified two residues, arginine 65 and lysine 109, as critical for recognition of the three stop codons. We also demonstrated a role for the serine 33 and serine 70 residues in UGA decoding in vivo. NMR analysis of the alanine mutants revealed that the correct conformation of this region was controlled by the YxCxxxF motif. By combining our genetic data with a structural analysis of eRF1 mutants, we were able to formulate a new model in which the stop codon interacts with eRF1 through the P1 pocket.

Mental health outreach and street policing in the downtown of a large French city

CONTEXT

Marseille, the second largest city in France, has a large population of homeless persons. A mental health outreach team was created in 2005 as a response to high rates of mental illness among this group. In a national political context where security is a government priority, a new central police station was created in Marseille in 2006 to address robberies, violence and illegal traffic in the downtown area of the city. While not directly related to such crimes, police also are responsible for public safety or behavioral issues related to the presence of individuals who are homeless in this area.

OBJECTIVE

This report on a two-year pilot study (2009-2011) addresses collaborative work between a mental health outreach team and the police department responding to the clinical needs of persons who are homeless with serious psychiatric disorders. It also describes the homeless persons' interactions with, and perceptions of the presence of, police and mental health professionals on the streets.

METHODS

Investigators adopted a mixed-methods approach. Data were collected on 40 interactions using brief standardized report for each interaction. Focus groups were conducted with police officers, outreach team members, peer workers, and service users. Minutes of partnership meetings between police officers and outreach workers also served as a source of qualitative data.

RESULTS

Outreach workers initiated just over half (n=21) of the encounters (n=40) between police and outreach workers. Interactions mainly involved persons with psychosis (77%), the vast majority (80%) of which involved persons in an acute phase of psychosis. Two key themes that emerged from data analysis included the violent nature of life on the streets and the high percentage of ethnic minorities among subjects of the interactions. In addition, it was found that the practices of the outreach workers are sometimes similar to those of the police, especially when outreach workers use coercive methods. "Users" (homeless persons) described police as sometimes using less coercion than the outreach team, and noted that they were more fearful of psychiatrists than police.

CONCLUSION

Formal initiatives between mental health outreach teams and police departments involve some common street practices. This study demonstrates the potential for closer working relationships between the two parties to help persons who are homeless with mental illnesses receive needed care, and to reduce inappropriate coercion including involuntary hospitalization and arrests.

More pernicious course of bipolar disorder in the United States than in many European countries: implications for policy and treatment

BACKGROUND

There is some controversy but growing evidence that childhood onset bipolar disorder may be more prevalent and run a more difficult course in the United States than some European countries.

METHODS

We update and synthesize course of illness data from more than 960 outpatients with bipolar disorder (average age 40) from 4 sites in the U.S. and 3 sites in Netherlands and Germany. After giving informed consent, patients reported on parental history, childhood and lifetime stressors, comorbidities, and illness characteristics.

RESULTS

Almost all aspects of bipolar disorder were more adverse in patients from the US compared with Europe, including a significantly higher prevalence of: bipolar disorder in one parent and a mood disorder in both parents; childhood verbal, physical, or sexual abuse; stressors in the year prior to illness onset and the last episode; childhood onsets of bipolar illness; delay to first treatment; anxiety disorder, substance abuse, and medical comorbidity; mood episodes and rapid cycling; and nonresponse to prospective naturalistic treatment.

LIMITATIONS

Selection bias in the recruit of patients cannot be ruled out, but convergent data in the literature suggest that this does not account for the findings. Potential mechanisms for the early onset and more adverse course in the U.S. have not been adequately delineated and require further investigation.

CONCLUSIONS

The data suggest the need for earlier and more effective long-term treatment intervention in an attempt to ameliorate this adverse course and its associated heavy burden of psychiatric and medical morbidity.

Increased parental history of bipolar disorder in the United States: association with early age of onset

OBJECTIVE

Early-onset bipolar (BP) disorder and other poor prognosis characteristics are more prevalent in patients from the United States than from the Netherlands and Germany (abbreviated as Europe). We explored the impact of parental loading for affective illness on onset and other characteristics of BP disorder.

METHOD

Parental history for unipolar (UP) and bipolar (BP) depression and course of illness characteristics were obtained from self-report in adults (average age 42) with BP disorder. Illness characteristics were examined by χ2 and multinomial logistic regression in relationship to the degree of parental loading: i) both parents negative; ii) one UP disorder; iii) one with BP disorder; and iv) both affected.

RESULTS

After controlling for many poor prognosis factors, compared with those from Europe, patients from the United States had more iii) one parent with BP disorder and iv) both parents affected. An early age of onset of BP disorder was independently associated with this increased parental loading for affective disorder.

CONCLUSION

Parental history of BP disorder and both parents with a mood disorder were more common in the United States than Europe and were associated with an early onset of bipolar disorder and other poor prognosis characteristics. These findings deserve replication and exploration of the potential mechanisms involved and their therapeutic implications.

Technology-mediated learning in physiotherapy education: The social construction of practice knowledge

Clinical practice is complex, requiring practitioners to interpret adiverse range of inter-related variables in order to make clinical decisions as part ofpatient management. This process is often intuitive and therefore hidden from studentsand less experienced clinicians, making the cognitive processes that inform clinicaldecision-making difficult to learn. In addition, educators still emphasise the learningof knowledge and skills through didactic teaching methods, such as lectures, in whichstudents are passive “recipients” of knowledge. Unless physiotherapy educators designactivities that aim to induct students into the professional culture and help them todevelop ways of thinking and being that go beyond knowledge and skills, our studentswill continue to struggle with clinical reasoning.In this position paper, we argue that the careful integration of technology as an adjunct to traditional lectures can be usedto facilitate discussion and interaction as a way of developing practice knowledge in students. This leads to higher cognitivefunctioning as it provides the means by which learners construct their own personally meaningful understanding of the worldthrough interaction with others. The promise of technology in physiotherapy education lies in its ability to create transformativelearning experiences through enhanced communication that is mediated by more experienced teachers or peers. If technology isused to enhance the learning environment by providing richer and more meaningful platforms for communication and discussion,it may have a role to play in the social construction of knowledge as part of contextualised learning spaces.

Structural definition is important for the propagation of the yeast [PSI+] prion

Prions are propagated in Saccharomyces cerevisiae with remarkable efficiency, yet we know little about the structural basis of sequence variations in the prion protein that support or prohibit propagation of the prion conformation. We show that certain single-amino-acid substitutions in the prion protein Sup35 impact negatively on the maintenance of the associated prion-based [PSI(+)] trait by combining in vivo phenotypic analysis with solution NMR structural studies. A clear correlation is observed between mutationally induced conformational differences in one of the oligopeptide repeats (R2) in the N terminus of Sup35 and the relative ability to propagate [PSI(+)]. Strikingly, substitution of one of a Gly-Gly pair with highly charged residues that significantly increase structural definition of R2 lead to a severe [PSI(+)] propagation defect. These findings offer a molecular explanation for the dominant-negative effects of such psi-no-more (PNM) mutations and demonstrate directly the importance of localized structural definition in prion propagation.

Smoking cessation in pregnant women with mental disorders: a cohort and nested qualitative study

OBJECTIVE

To investigate whether 1) pregnant smokers with mental disorders are less likely to accept referrals to smoking cessation services compared with pregnant smokers without disorders; 2) they experience specific barriers to smoking cessation.

DESIGN

Cohort study supplemented by cross-sectional survey and nested qualitative study.

SETTING

Three maternity services, London, UK.

POPULATION

Pregnant smokers with and without mental disorders.

METHODS

Case notes were examined on a cohort of 400 consecutive pregnant smokers; data were triangulated with routinely collected data on 845 pregnant smokers at two other sites; 27 pregnant smokers were interviewed using qualitative methods.

MAIN OUTCOME MEASURES

Acceptance of referral to smoking cessation services; perceived barriers to quitting.

RESULTS

Pregnant smokers with a mental disorder recorded by midwives were one-quarter of the cohort (97, 23%), were more likely to accept referral to smoking cessation services (69% versus 56%, adjusted odds ratio 1.70, 95% confidence interval 1.03-2.79), but more likely to still smoke at delivery (69% versus 56%, adjusted odds ratio 2.63, 95% confidence interval 1.41-4.92). Discussion about smoking was documented in 7.7% of subsequent antenatal visits in women with or without mental disorders. Pregnant smokers with diagnosed mental disorders reported that they and health practitioners did not prioritise smoking advice because of concern about adversely impacting mental health.

CONCLUSIONS

Pregnant women with mental disorders appear more motivated, yet find it more difficult, to stop smoking. Prioritisation of mental health over smoking may therefore lead to increasing health inequality for this group. Research into effective smoking cessation interventions is required for those with mental disorders.

The Use of a Wiki to Facilitate Collaborative Learning in a South African Physiotherapy Department

The dominant form of teaching in higher education remains the lecture,even though evidence suggests that it alone is inadequate to facilitate the development ofthe higher order thinking skills required in clinical practice. The use of wikis may have a roleto play in facilitating collaborative learning practices that are important for professionaldevelopment. This descriptive survey evaluated the use of a wiki for a collaborative learningactivity within small groups of undergraduate physiotherapy students in a South Africanuniversity. Students participated in a wiki-based assignment and were then surveyedusing open- and closed-ended questions to determine their perceptions and experiences of the process. The results indicate thatalthough a wiki can be used to develop relevant content, there were significant challenges in its implementation. These included apoor understanding by students of how to work effectively in groups, a lack of physical and epistemological access to the internet,and the need for adequate preparation and support. Some features of the wiki were found to have an impact on the quality ofthe work produced, including the use of Discussion pages, peer review, and the public nature of the wiki. The conclusion is thatwikis may have a role to play in collaborative groupwork, but that that students need to be adequately prepared and supportedthroughout the process.

Physiotherapy Students’ Use of Online Technology as part of their Learning Practices: A Case Study

The relevance of non-technical skills have long been acknowledged asimportant components of clinical learning, and there is evidence that integrating technologycan facilitate their development by encouraging reflection, and by enhancing communicationand reasoning. However, effectively integrating technology into learning practices must takethe contextual needs of students into consideration. The aim of this study was to determinewhat online tools undergraduate physiotherapy students at one South African university arefamiliar with, and how they use them as part of their learning practices.The case study was conducted in a university physiotherapy department in the WesternCape during 2010. A cross-sectional, descriptive design used a survey to obtain quantitativeand qualitative data from participants, and a pilot study was conducted to test the reliability of the instrument. All ethicalconsiderations were adhered to.Seventy six percent of participants had access to the internet at home, and 93% of them belonged to a social network, althoughfewer than half used it for their studying. Few students reported using the internet for more than information retrieval but reportedwanting to use it for enhanced communication with lecturers. Almost all respondents believed that lectures were a useful way tolearn. However, 61% added that integrating online learning activities with lectures could have value.Integrating technology into healthcare education has the potential to develop non-technical skills that are relevant for clinicalpractice. However, this group of students currently lack the experience and insight to use technology effectively as part of theirlearning practices. Educators must take cognisance of the educational and contextual needs of students if they wish to integratetechnology into clinical teaching.

A presentation of penile Mondor's disease

Mondor's disease can manifest itself in the penile dorsal vein. It is a rare complaint with a quoted incidence of 1.39%. We report a case of a 41-year-old man who has sex with men (MSM), who presented with penile swelling and painful erections following intensive and vigorous sexual activity. He was found to have a thrombosis of the penile dorsal veins. He was managed with non-steroidal anti-inflammatory drugs and sexual abstinence and his symptoms resolved in the following two weeks. Practitioners need to beware of Mondor's disease as a differential diagnosis in the presence of penile swelling and not underestimate the anxiety it can cause the patient.

Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis in adults characterized by high viral genome load within circulating natural killer cells

Epstein-Barr virus (EBV)-associated hemophagocytic lymphohistiocytosis (HLH) is a rare and aggressive disease usually encountered in the context of primary EBV infection. In most analyzed cases, EBV has been found predominantly in T cells. We describe the novel finding of high EBV genome numbers within circulating natural killer cells in adult patients with EBV-HLH.

Mentoring and coaching in promoting publications in the Department of Physiotherapy at a local university in South Africa

A  growing  shift  towards  research  and  evidence  based  practice  in academia  is  associated  with  requirements  to  disseminate  research  results  in  the  form of publication in peer reviewed journals.  Mentoring has been identified as an important component of developing young authors, as it increases confidence and competence, and facilitates professional development. This led to the formation of a support group to stimulate peer-review publication in the physiotherapy department at  the  University  of  the  Western  Cape.  The  Kirkpatrick  Framework  of  Evaluation  was  used  to  evaluate  the  success  of  the  mentoring  process  which  made  use  of  a  participatory  action  research  methodology. The  writing  group  consisted  of  nine  academic members of staff and took place over ten weeks.  The programme included writing, giving feedback, discussion and peer review on a weekly basis.  Focus group discussions were taped and transcribed in order to evaluate the mentoring process  by  identifying  relationships  within  the  data  and  categorising  key  concepts,  which were shaped into a thematic framework.  The findings indicated that participants experienced a variety of emotions throughout the programme, with an overall feeling of personal growth by the end. In addition, participants also reported improved writing, reviewing and communication skills.  Six months following the programme, six participants had submitted at least one article to a peer reviewed journal.  It is clear from this study that some academics still find the task of writing and reviewing articles daunting, and that guidance and support in the form of a writing programme can be useful.

The use of information and communication technology by South African physiotherapy students

The global shift toward the use of information and commu -nication technology (ICT) in health education and practice has been shown toenhance both the educational opportunities and the support provided to studentsand healthcare professionals.  This study aimed to investigate the use of ICTby South A frican physiotherapy students and what their experiences and perceptions were regarding their use of ICT as part of their studies.  The studydesign was a cross-sectional, descriptive survey using a self-administered questionnaire.  The survey populationincluded all of the undergraduate physiotherapy students from six of the eight universities offering the physiotherapydegree in South A frica (N=1105).  The sample size consisted of 529 students from the survey population who completed and returned questionnaires, indicating a response rate of 48%.  The results of the study showed that the useof ICT by South A frican physiotherapy students varied according to task, racial group and university attended.Furthermore, the reported use of ICT for communication, research and continuing professional development was low.In conclusion, this study indicates that with a move toward the use of ICT to enhance health education and practice in South A frica, certain groups of physiotherapy students may be at a disadvantage if required to make use of ICT asa means of improving communication, enhancing education, participating in lifelong learning opportunities andaccessing support.

Situational predictors of sexual risk episodes among men with HIV who have sex with men

BACKGROUND

Men with HIV who have sex with men (MSM) represent the largest group of people living with HIV/AIDS in the United States. It is important to understand the sexual risk-taking behaviours that may be linked to the transmission of HIV and other sexually transmitted infections in this population. Models of HIV risk that focus solely on personal factors have been demonstrated to be ineffective at explaining risk behaviour. Rather, in order to fully understand sexual risk-taking, it is important to examine the factors linked to high-risk sexual situations and not solely the factors linked to potentially high-risk people.

METHODS

A diverse sample of 100 MSM with HIV completed a 6-week internet-based sex diary that collected detailed information on recent sexual encounters. In total, information on over 250 sexual episodes was collected and analysed. Generalised linear mixed models were used to examine situational predictors of risk episodes.

RESULTS

Analyses revealed that drug use by self and sex partners (examined individually and together) were positively related to risk episodes. Likewise, having a sex partner met online and having a sexual encounter in a sex party or bathhouse setting was linked to risk episodes. Sexual episodes that involved a sex-partner who was perceived as sexually desirable and those involving communication about HIV and/or condom use with partners each were negatively related to risk.

CONCLUSIONS

Situational factors play an important role in explaining sexual risk-taking among MSM with HIV. Researchers should place a greater focus on drug use and characteristics of sex partners and settings in which sexual behaviours occur as situational predictors of risk in order to comprehensively understand sexual risk-taking in this population.

Is 'bareback' a useful construct in primary HIV-prevention? Definitions, identity and research

The terms bareback and bareback identity are increasingly being used in academic discourse on HIV/AIDS without clear operationalization. Using in-depth, face-to-face interviews with an ethnically diverse sample of 120 HIV-infected and -uninfected men, mainly gay-identifying and recruited online in New York City, this study explored respondents' definitions of bareback sex, the role that intentionality and risk played in those definitions, and whether respondents identified as 'barebackers'. Results showed overall agreement with a basic definition of bareback sex as condomless anal intercourse, but considerable variation on other elements. Any identification as barebacker appeared too loose to be of use from a public health prevention perspective. To help focus HIV-prevention efforts, we propose a re-conceptualization that contextualises risky condomless anal intercourse and distinguishes between behaviours that are intentional and may result in HIV-primary transmission from those that are not.