A Spin-Charge-Regulated Self-Powered Nanogenerator for Simultaneous Pyro-Magneto-Electric Energy Harvesting

In view of the depletion of natural energy resources, harvesting energy from waste is a revolution to simultaneously capture, unite, and recycle various types of waste energies in flexible devices. Thus, in this work, a spin-charge-regulated pyro-magneto-electric nanogenerator is devised at a well-known ferroelectric P(VDF-TrFE) copolymer. It promptly stores thermal-magnetic energies in a "capacitor" that generates electricity at room temperature. The ferroelectric domains are regulated to slip at the interfaces (also twins) of duly promoting polarization and other properties. An excellent pyroelectric coefficient p ∼ 615 nC·m-2·K-1 is obtained, with duly enhanced stimuli of a thermal sensitivity ∼1.05 V·K-1, a magnetoelectric coefficient αme ∼8.8 mV·cm-1·Oe-1 at 180 Hz (resonance frequency), and a magnetosensitivity ∼473 V/T. It is noteworthy that a strategy of further improving p (up to 41.2 μC·m-2·K-1) and αme (up to 23.6 mV·cm-1·Oe-1) is realized in the electrically poled dipoles. In a model hybrid structure, the spins lead to switch up the electric dipoles parallel at the polymer chains in a cohesive charged layer. It is an innovative approach for efficiently scavenging waste energies from electric vehicles, homes, and industries, where abundant thermal and magnetic energies are accessible. This sustainable strategy could be useful in next-generation self-powered electronics.

A core-shell magnet Mn70Bi30 grown at seeds in magnetic fields and its impacts on its spin-dynamics, Curie point and other tailored properties

The MnBi alloys is a model series of rare-earth free magnets for surge of technologies of small parts of automobiles, power generators, medical tools, memory systems, and many others. The magnetics stem primarily at unpaired Mn-3d5 spins (a 4.23 B moment) align parallel via an orbital moment 0.27 B of Bi-5d106s2p3 in a crystal lattice. Thus, using a surplus Mn (over Bi) in a Mn70Bi30 type alloy designs a spin-rich system of duly tailored properties useful for magnetics and other devices. In this view, we report here a strategy of a refined alloy powder Mn70Bi30 can grow into small crystals of hexagonal (h) plates at seeds as annealed in magnetic fields (in H2 gas). So, small h-plates (30 to 50 nm widths) are grown up at (002) facets, wherein the edges are turned down in a spiral ( 2.1 nm thicknesses) in a core-shell structure. The results are described with X-ray diffraction, lattice images and magnetic properties of a powder Mn70Bi30 (milled in glycine) is annealed at 573 K for different time periods, so to the Mn/Bi order at the permeable facets (seeds). Duly annealed samples exhibit an enhanced magnetization, Ms  70.8 emu/g, with duly promoted coercivity Hc  10.810 kOe (15.910 kOe at 350 K), energy-product 14.8 MGOe, and the crystal-field-anisotropy, K1  7.6x107 erg/cm3, reported at room temperature. Otherwise, Ms should decline at any surplus 3d5-Mn spins order antiparallel at the antisites. Enhanced Curie point 658.1 K (628 K at Mn50Bi50 alloy) anticipates that a surplus Mn does favor the Mn-Bi exchange interactions. Proposed spin models well describe the spin-dynamics and lattice relaxations (on anneals) over the lattice volume (with twins) and spin clusters.

Structural ordering at magnetic seeds with twins at boundaries of a core-shell alloy Mn60Bi40and tailored magnetic properties

A spin Mn3d⁵-rich Mn₆₀Bi₄₀alloy reveals a model system in order to tailor profound magnetic properties at unpaired 3d⁵spins in such alloys of a core-shell structure. As annealed (at a critical temperature 573 K in H₂gas), a refined powder (in glycine) grows onα-MnBi seeds (crystallites) present in it at Mn/Bi atoms order over topological layers, preferentially along (110) planes, at a self-confined structure at seeds of an anisotropic shape of hexagonal (h) plates (25-85 nm widths). In terms of the HRTEM images, the atoms turn down at edges (at the plates grow up) in a spiral layer, ≤ 2.1 nm thickness, of small core-shells. A spin model is proposed to delineate a way at the spins can pin down at the edges, form single magnetic domains, and raise coercivity (H_c), with no much loss of net magnetic moment. The X-ray diffraction and HRTEM images corroborate the results of topological pacing of atoms at the h-plates at anneals. A novelty is that a core-shell leads to tailor a superbH_c, as much as 11.110 kOe (16.370 kOe at 350 K), with a fairly large magnetization, 76.5 emu g^-1, at near 300 K. An enhanced Curie point 650.1 K (628 K at Mn₅₀Bi₅₀alloy) confers a surplus 3d⁵-Mn spin sensitively tunesα-MnBi stoichiometry and so its final magnetic structure. A refined alloy powder so made is useful to make powerful magnets and devices in the forms of films and bonded magnets in different shapes for uses as small tools, tweezers, and other devices.

AB1250 TOFACITINIB IS A SAFE AND EFFECTIVE TREATMENT OPTION FOR JUVENILE IDIOPATHIC ARTHRITIS

Background

The management of juvenile idiopathic arthritis(JIA) is often constrained by the limited number of oral drugs available. Whether JAK inhibitors would add a much needed therapeutic armamentarium in this regard needs to be explored.

Objectives

To assess the safety and efficacy of tofacitinib in juvenile idiopathic arthritis (JIA) patient who were prescribed during the period January 2021 to December 2021.

Methods

It’s a retrospective study of JIA patients who were prescribed tofacitinib during the period Jan 21 to Dec 21 with minimum of 3 months’ follow-up after prescribing tofacitinib. The demographics,details of medications,investigations parameters and any adverse events were noted.

Results

There were a total of 35 patients who were given tofacitinib during this period. Male is to female ratio is 25:10, mean age of 12.91(4.81) yrs., the mean disease duration was 58.6 months. Enthesitis related arthritis(ERA) was the commonest seen in 12, followed by oligo articular in 10, polyarticular in 7 and systemic onset in 6. In the ERA group 10 were HLA B27 +VE, of the oligo articular 6 were ANA +VE, in the polyarticular one was RF +ve. Out of the 35,14 were already on biologicals (tocilizumab and anti TNFs). Tofacitinib was stopped in 8 patients during this period, 5 as they achieved remission, 2 with no response and one because of itching and abdominal pain. There were no documented infections. There was significant reduction in the inflammatory markers (ESR, CRP), leucocyte count and platelet count.

Before tofaAfter tofap valueMethotrexate in mg (week) mean(stdev)9.64(1.94)8.88(3.34)0.66Steroid in mg mean (stdev)3(2.35)2.8(1.8)0.91Leucocyte count mean(stdev)11242(1858)7884(1471)0.005Platelet count in lakhsMean(stdev)4.51(0.48)3.37(0.82)0.017ESR mm/1hr57.75(17.25)30.83(11.48)0.009CRP mg/L25.36(10.9)12.36(7.97)0.05

Conclusion

Tofacitinib seems to be a promising drug in the management of JIA with good safety profile and efficacy.

References

[1] Brunner HI, Schanberg LE, Kimura Y et al. New medications are needed for children with juvenile idiopathic arthritis. Arthritis Rheumatol. 2020; 72: 1945-1951.

Disclosure of Interests

None declared

Associations between breast implants and postpartum lactational mastitis in breastfeeding women: retrospective study

OBJECTIVE

To examine the putative associations between breast implants and postpartum lactational mastitis.

DESIGN

Observational retrospective study.

SETTING

Digital database of Maccabi Healthcare Services, integrated health maintenance organisation in Israel.

POPULATION

Breastfeeding mothers from 2003 to 2016 based on an initial health maintenance organisation data set of 28 383 singleton live births in Israel.

METHODS

Multivariate analysis and propensity score matching were used to test the extent to which breast implants were associated with lactational mastitis during the 6-month postpartum period in breastfeeding mothers. Analyses for potential confounders were adjusted for socio-economic status, smoking and parity.

MAIN OUTCOME MEASURE

Lactational mastitis among breastfeeding women with breast implants compared with women without breast implants.

RESULTS

Mothers with breast implants (n = 6099) were significantly (P < 0.001) more likely to be diagnosed with postpartum mastitis (8.3%) than mothers with no breast implants(n = 22 284) (6.6%) at an odds ratio of 1.22 (95% CI 1.09-1.35) after adjusting for confounders.

CONCLUSION

Breast augmentation is associated with an increased risk of postpartum lactational mastitis in the 6-month postpartum period. In light of these findings, it is important for health professionals to instruct women who have undergone breast augmentation on correct breastfeeding techniques, ways to avoid risk factors, and to be alert to signs permitting the early detection of lactational mastitis.

TWEETABLE ABSTRACT

A study of over 28,000 breastfeeding women has shown that breast augmentation is associated with an increased risk of postpartum lactational mastitis in the six-month postpartum period.

Spin-up conversion, exchange-interactions, and tailored magnetic properties in core-shell La2NiMnO6of small crystallites

La₂NiMnO₆-a ferromagnetic (FM) insulator offers tunable charge carriers and spins useful to devise its multiple properties and applications. In this view, we studied a core-shell La₂NiMnO₆(2-3 nm shell on 65 - 80 nm core) of a Ni²⁺/Ni³⁺(d⁷) to Mn⁴⁺/Mn³⁺(d⁴) spin-up conversion- revived a new FM phase-2, raising a spin-densityσ_s = 0.7 s a^-1over the Ni^2+/Mn⁴⁺species (phase-1),σ_s = 0.5 s a^-1, i.e. 2.12μ_B/f.u. larger spin moment. HRTEM images studied with x-ray diffraction characterizing core-shell structure that plays a crucial role in tuning the high spin FM phase-2 of profound properties. Below 110 K, the dc magnetization and ac magnetic susceptibilityχ(ω,T) reveal a metastable magnetic behavior on an antiferromagnetic canting of a spin-glass nature. The results follow a Vogel-Fulcher type relaxation with a relaxation timeτ₀∼ 10^-13s, confirming a spin-glass freezing behavior. Uniquely, FM field of phase-1 controls magnetics of phase 2 of a coupled magnet, modulating joint features with small thermal magnetic hysteresis on heating-cooling cycles.

Small core-shell Mn0.5Bi0.5-Bi (⩽3 at%) magnets, the anisotropic growth of crystallite nanoplates, interface-bridging, and tailored magnetic properties

The binary alloy Mn_0.5+xBi_0.5-x, x ⩽ 0.05, is a promising rare-earth-free magnetic material, with high-energy-density (a critical characteristic for electric motors and power electronics), low cost, and significant magnetic properties for multiple uses at room temperature. In this article, we report how a free Bi, when precipitated over Mn_0.5+xBi_0.5-x (x ⩽ 0.05) of small crystallites, diffuses back into a stable Mn_0.5+xBi_0.5-x, x → 0, via a peritectic reaction, which facilitates preferential growth of small core-shell crystallites with multiple facets, having the potential for tailored magnetic properties. This growth travels slowly in the anisotropic channels of vacancies on annealing the reactive nanopowder at a critical 573 K temperature in Ar gas. Thus, an initial crystallite size of D ∼ 27 nm grows to only 38 nm in a reaction extended over a period of 96 h. A transient phase, x > 0, which has Bi vacancies, primarily grows in the (101) and (110) facets, filling the vacancies over a 6.41% larger crystal density. If any excess Mn is present, it segregates over a saturated phase, combines with free Bi, and ultimately forms a stable alloy phase. The small crystallites contain an inbuilt surface Bi-layer (shell), with a 1-2 nm thickness, in a core-shell of nanoplates (20-60 nm width), as shown in the high resolution transmission electron microscope images. In the proposed microscopic model, with hybridized Mn-d⁵ and Bi-p³ electrons (also spins), the magnetic properties are readily controlled. Thus, at 300 K, a maximum coercivity H_c = 9.850 kOe (14.435 kOe at 350 K) develops (H_c = 5.010 kOe in the initial) in critical single domains (D ∼ 33 nm). A net 72.5 emu g^-1 magnetization occurs, with an enhanced T_C = 641.5 K (600.5 K at x ∼ 0.05) on an order of enhanced anisotropy constant K₁, demonstrating the significant effects of this core-shell structure of small crystallites.

Transcutaneous electrical nerve stimulation (TENS) for pain management in sickle cell disease

BACKGROUND

Sickle cell disease (SCD), one of the most common inherited disorders, is associated with vaso-occlusive pain episodes and haemolysis leading to recurrent morbidity, hospital admissions and work or school absenteeism. The crises are conventionally treated with opioids, non-opioids and other adjuvants with the risk of developing complications, addictions and drug-seeking behaviour. Different non-pharmacological treatments, such as transcutaneous electrical nerve stimulation (TENS) have been used for managing pain in other painful conditions. Hence, the efficacy of TENS for managing pain in SCD needs to be reviewed.

OBJECTIVES

To assess the benefits and harms of TENS for managing pain in people with SCD who experience pain crises or chronic pain (or both).

SEARCH METHODS

We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Haemoglobinopathies Register, comprising of references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. We also searched online trial registries and the reference lists of relevant articles and reviews. Date of the last search: 26 Febraury 2020.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) and quasi-RCTs, where TENS was evaluated for managing pain in people with SCD.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed the eligibility of the trials identified by the literature searches according to the inclusion criteria. Two review authors then independently extracted data, assessed for risk of bias using the Cochrane standard tool and rated the quality of evidence using the GRADE guidelines.

MAIN RESULTS

One double-blind cross-over RCT with 22 participants with SCD (aged 12 to 27 years) was eligible for inclusion. Following stratification into four pain crises severity grades, participants were then randomised to receive TENS or placebo (sham TENS). The trial was concluded after 60 treatment episodes (30 treatment episodes of each treatment group). There is a lack of clarity regarding the trial design and the analysis of the cross-over data. If a participant was allocated to TENS treatment for an episode of pain and subsequently returned with a further episode of a similar degree of pain, they would then receive the sham TENS treatment (cross-over design). For those experiencing a pain episode of a different severity, it is not clear whether they were re-randomised or given the alternate treatment. Reporting and analysis was based on the total number pain events and not on the number of participants. It is unclear how many participants were crossed over from the TENS group to the sham TENS group and vice versa. The trial had a high risk of bias regarding random sequence generation and allocation concealment; an unclear risk regarding the blinding of participants and personnel; and a low risk regarding the blinding of the outcome assessors and selective outcome reporting. The trial was small and of very low quality; furthermore, given the issue with trial design we were unable to quantitatively analyse the data. Therefore, we present only a narrative summary and caution is advised in interpreting the results. In relation to our pre-defined primary outcomes, the included trial did not report pain relief at two to four weeks post intervention. The trial authors reported that no difference was found in the changes in pain ratings (recorded at one hour and four hours post intervention) between the TENS and the placebo groups. In relation to our secondary outcomes, the analgesic usage during the trial also did not show any difference between groups. Given the quality of the evidence, we are uncertain whether TENS improves overall satisfaction as compared to sham TENS. The ability to cope with activities of daily living was not evaluated. Regarding adverse events, although one case of itching was reported in the TENS group, the site and nature of itching was not clearly stated; hence it cannot be clearly attributed to TENS. Also, two participants receiving 'sham' TENS reported a worsening of pain with the intervention.

AUTHORS' CONCLUSIONS

Since we have only included one small and very low-quality trial, with a high risk of bias across several domains, we are unable to conclude whether TENS is harmful or beneficial for managing pain in people with SCD. There is a need for a well-designed, adequately-powered, RCT to evaluate the role of TENS in managing pain in people with SCD.

Green Synthesis of Cr3+ Doped CaIn₂O₄-Carbon Hybrid Nanostructure and Its Light Absorption and Emission Properties

In this research article, we have used a novel route for synthesis of a greenish phosphor C-CaIn₂O₄ doped with Cr³⁺ ions using green plant (aloe vera gel) and measured its light absorption and emission properties. Our main aim was to enhance the light absorption and emission properties of undoped C-CaIn₂O₄ in order to widen its applications. The introduction of CrO₃ ions can produce Cr ion defects that favor charge balance in Cr³⁺:C-CaIn₂O₄ to facilitate its photoluminescence. The effect of doping in core-shell nanostructure can effectively transfer energy from charge-transfer absorption band of optical host material to characteristic transition of Cr³⁺ ions, utilizing more energy from host absorption for the photoluminescence of Cr³⁺ ions. As-prepared Cr³⁺:C-CaIn₂O₄ exhibits two bands at 270 nm and 370 nm, which are shifted to at 265 and 370 nm when it is annealed at higher dosage of Cr³⁺ ions. These are the ligand-to-metal O^2- to Cr³⁺ charge transfer bands. The light-emission is studied in analyzing migration, transfer and recombination processes of light-induced e^--h⁺ pairs. The results are described in correlation to a Cr³⁺:C-CaIn₂O₄ core-shell nanostructure.

The importance of ensuring artificial intelligence and machine learning can be understood at the human level

With rapid developments in big data technology and the prevalence of large-scale datasets from diverse sources, the healthcare predictive analytics (HPA) field is witnessing a dramatic surge in interest. In healthcare, it is not only important to provide accurate predictions, but also critical to provide reliable explanations to the underlying black-box models making the predictions. Such explanations can play a crucial role in not only supporting clinical decision-making but also facilitating user engagement and patient safety. If users and decision makers do not have faith in the HPA model, it is highly likely that they will reject its use. Furthermore, it is extremely risky to blindly accept and apply the results derived from black-box models, which might lead to undesirable consequences or life-threatening outcomes in domains with high stakes such as healthcare. As machine learning and artificial intelligence systems are becoming more capable and ubiquitous, explainable artificial intelligence and machine learning interpretability are garnering significant attention among practitioners and researchers. The introduction of policies such as the General Data Protection Regulation (GDPR), has amplified the need for ensuring human interpretability of prediction models. In this talk I will discuss methods and applications for developing local as well as global explanations from machine learning and the value they can provide for healthcare prediction.

Synthesis of Broad Band Violet-Blue Light-Emitting Core-Shell Cr3+:C-CaIn₂O₄ Nanowires

We developed a simple, effective and green method for synthesis of broad band violet-blue lightemitting core-shell Cr³⁺:C-CaIn²O⁴ nanowires (1-10 mol% of Cr³⁺) using aloe vera nectar. Calcium indate (CaIn²O⁴) is an important wideband gap semiconductor that could be explored for optical doping such as transition metals and/or rare-earths useful to make light-emitters, optical data storage, and other devices. The nectar embeds the cations in a gel so as it controls an ionic conversion Cr⁶⁺ to Cr³⁺ in ambient air. When grafting a carbon layer on surface of Cr³⁺:CaIn²O⁴ crystallites it yields a core-shell structure of tailored dielectric, optical and other properties. Asprepared Cr³⁺:CaIn²O⁴-C exhibits two bands at 270 nm and 360 nm, which got shifted-to at 265 and 370 nm when annealed at higher dosage of Cr³⁺ ions. These are the ligand-to-metal O^2- to Cr³⁺ charge transfer bands. We studied the light-emission properties in analyzing migration, transfer and recombination processes of light-induced e^--h⁺ pairs in detail in correlation to a Cr³⁺:CaIn²O⁴-C core-shell nanostructure.

Biogenic Synthesis of Graphitic Carbon Nitride for Photocatalytic Degradation of Organic Dyes

A simple approach of template growth of graphitic-carbon nitride (g-CN), a polymeric unit consisting of C, N, O, and H elements derived from extracts of green plant Aloe vera, which are rich in several chemical constituents, has been successfully experimented in this work. Comparing several other methods used for synthesizing g-CN involving a large amount of toxic components, here, we propose the simplest route economically and environmentally highly viable for near future. Green plants are highly rich in natural carbon and nitrogen compounds, such as acemannan, glucose, aloin, protein, etc. Way before g-CN research, many carbon-based materials have been synthesized for multifunctional properties, but g-CN has much benefit over them due to the presence of elements such as C, N, O, and H, thus making it electron-rich. Multifunctional properties of graphitic-carbon nitride interface bonding as a supercapacitor or as a metal-free catalyst thus help degrade dyes. Violet-blue broad band emission was even noticed when excited at 240 nm via C-C bonding (π-π* transition) in the absorption band with an extinction coefficient of ∼10⁴ M^-1 cm^-1. With our research, we want to pave new ways of synthesizing such materials present in our nature in a biological form, which can protect our environment, thus causing less harm to mankind.

Abstract PD5-08: Neoadjuvant chemotherapy alters the genomic landscape and immune microenvironment of breast cancers

Understanding how standard-of-care drug treatments affect tumor intrinsic biology and microenvironment is critical for elucidating drug resistance mechanisms and developing better combination therapies as well as new therapies. To characterize the effects of neoadjuvant chemotherapy (NAC) on the genome, transcriptome and tumor infiltrating leukocytes (TILs), we have conducted whole exome and whole transcriptome sequencing of a large longitudinal breast cancer cohort consisting of 146 cases and 281 paired tumor samples. In total, 52 (38%) patients achieved pathologic complete response (pCR) while 85 patients (62%) had residual disease with standard chemotherapy regimen. Tumor biopsies were collected for each patient at three time points – pre-treatment, three weeks after the first cycle of anthracycline and cyclophosphamide (AC) and at the time of surgery after 3 more cycles of AC followed by 4 cycles of taxane or taxane plus Herceptin in case of HER2+ subtype. We detected 5,955 protein-altering somatic mutations affecting 4,414 genes in pretreatment samples and 502 acquired mutations in surgery samples affecting 477 genes including 19recurrently mutated genes such as TP53 and NOTCH1. Across all subtypes, 4,346 genes were differentially expressed (DE) following NAC treatment and significantly enriched in pathways such as cell cycle, ER signaling, PI3K/mTOR, immune and metabolism. Expression-based virtual microdissection analysis indicated that NAC treatment induced an increase in the fractions of stromal and adjacent normal tissue compartment, consistent with observed reduction in tumor cellularity. To assess the NAC induced changes in the molecular landscape of these tumors, we compared molecular features including gene expression signatures, mutation prevalence and copy number alteration between three time points while adjusting for confounding effects of molecular subtype and tumor cellularity. We found that NAC induced dynamic changes in gene expression signatures associated with proliferation and immunomodulatory treatment response. We further validated the observed pattern of change in TILs through histopathology and digital imaging analyses. In pretreatment tumors, 116 genes were DE between patients with pCR vs. those with residual disease with significant enrichment in immune/inflammatory pathways. Further, pre-treatment TIL levels were found to be significantly associated with pCR, echoing previous reports in breast cancers that implicated anti-tumor immunity in mediating the efficacy of chemotherapies. Our analyses also revealed associations between NAC response and baseline genomic attributes such as genomic alterations that affect DNA damage repair pathways. Taken together, these results suggest that NAC induced a multitude of changes on the genomic landscape and immune microenvironment of breast cancers, some of which point to combination strategies with immunomodulatory therapies and therapies that target DNA damage repair.

Citation Format: Kan Z, Lal S, Ding Y, Lee JE, Lee S-H, Lee SK, Yu JH, Choi Y-l, Kim SW, Nam SJ, Kim J-Y, Ram S, Powell E, Ching K, Cho SY, Bonato V, Deng S, Park W-Y, Rejto P, Bienkowska J, Park Y-H. Neoadjuvant chemotherapy alters the genomic landscape and immune microenvironment of breast cancers [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD5-08.

Abstract P2-07-01: Integrative analyses of immunophenotypes and multi-omics profiles in breast cancers

The advent of immuno-oncology (IO) therapies has made it an imperative to characterize intratumoral immune microenvironment in addition to oncogenic alterations through molecular profiling of the tumor. To elucidate the baseline profiles of tumor infiltrating leukocytes (TILs) in breast cancer (BC) in the context of molecular subtypes and oncogenic alterations, we performed whole-exome sequencing (WES) and RNA-Seq of an Asian BC cohort (SMC) consisting of 178 treatment naïve primary tumors. A subset of 120 tumors was further analyzed by H&E and IHC using a panel of 8 TIL markers (CD45, CD4, CD8, CD163, PD1, PD-L1, IDO1 and FOXP3). Using expression signatures representing distinct immune cell types, we classified an expression compendium of 2,781 tumor samples, including SMC and multiple cancers from TCGA, into three immune subtypes with high, medium and low levels of TILs. Basal and HER2 subtypes show higher levels of TILs than Luminal subtypes, consistent with observed clinical responses to checkpoint blockade in clinical trials. Moreover, Asian BCs were significantly enriched in TIL-high subtype (35.3%) compared to the primarily Caucasian TCGA BC cohort (20.2%) while 50.6% of the highly immunogenic Lung adenocarcinoma was TIL-high. We then applied machine learning methods to detect and quantify TILs from H&E images of 120 SMC and 349 TCGA BC tumors. The expression signature analysis results were concordant with independently derived histology based TIL data. Taken together, our findings suggest that IO therapies may be more effective in HR negative BC subtypes and Asian BCs.

Leukocyte exclusion (LE), an immunophenotype where TILs concentrate at the tumor periphery, has been linked to worse prognosis and resistance to IO therapies. Visual assessment of whole tumor IHC images identified LE patterns in 25% of SMC cases. We observed differential distribution of LE by molecular subtype and evidence for selective exclusion of immune cell subsets. Covariate analyses with clinical and molecular data while controlling for subtype as a confounder identified significant associations with tumor proliferation index, percent tumor purity and TP53 mutations. LE is also significantly associated with expression signatures of chemokine signaling, macrophages, angiogenesis and hypoxia, indicating that marked distinctions exist in both tumor intrinsic and microenvironment characteristics between TIL excluded and TIL infiltrated tumors. To validate these findings, we independently identified LE for 200 cases of TCGA BCs based on patterns of TILs extracted from H&E images and saw significant concordance of covariate relationships identified between TCGA and SMC. Our study provided a rare comprehensive resource for studying tumor associated immunity in breast cancers by generating the integrated multi-omics and IO profiles for a large cohort of primary tumors. Comparative analyses revealed that TIL activities are highly variable across different intrinsic subtypes and geographic origins of BC, with potential implications for IO therapeutic application. Correlative analyses of immunophenotypes with molecular data further yielded insights into LE's role in immune escape and identified hallmark signatures for LE indicative of causal molecular mechanisms.

Citation Format: Kan Z, Powell E, Ram S, Ching K, Ding Y, Vizcarra P, Nichols T, Hardwick J, Lee S-H, Cho SY, Choi Y-L, Yu J-H, Park YH. Integrative analyses of immunophenotypes and multi-omics profiles in breast cancers [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-07-01.

An evidenced based checklist to support anti-dementia medication withdrawal in people with down syndrome (DS), intellectual disability (Id) and dementia

DS with aging is associated with greatly increased risk of developing dementia similar to Alzheimer's. Anti-dementia drug discontinuation is recommended when clinical benefit is not determined. In DS it is more complex as medication ill effects of stopping needs to be weighed in balance to extraneous processes such as environment changes, sensory impediments and physical ill health and natural progression of dementia.

Aim

Can identified risk factors extracted from a comprehensive literature review be developed into an evidence based check list to support risk minimized person centered withdrawal of anti-dementia drugs when considered not to be efficacious in DS?

Method

A detailed literature review using Medline, PsychInfo, Cinahl and Embase with relevant search terms in various permutations and combinations without any date limit enquiring current evidence base on anti-dementia medication withdrawal was conducted. The review also looked to extract the common risk factors in stopping medication. All risk factors were collated, reviewed by a focus group of experts, developed into a checklist.

Results

Thirty abstracts were obtained following the search. Six papers were short-listed. No papers identified a structured approach to medication reduction. An 18-factor checklist was applied prospectively to 30 cases. The checklist was sensitive to identify change to guide clinical decision-making.

Conclusions

Currently, decision to peg medication withdrawal risk is arbitrary and clinical in dementia especially in DS dementia. The evidenced based developed checklist is useful to support and structure clinical decisions. It helps clinicians and patients to focus on promoting safety, reduce harm and guide treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Abstract P1-05-15: Multi-omics and immuno-oncology profiling reveal distinct molecular signatures of young Asian breast cancers

Breast cancers (BC) in younger, premenopausal patients (YBC) tend to be more aggressive with worse prognosis, higher chance of relapse and poorer response to endocrine therapies compared to breast cancers in older patients. The proportion of YBC (age ≤ 40) among BC in East Asia is estimated to be 16-32%, significantly higher than the 7% reported in Western countries. To characterize the molecular bases of Asian YBC, we have performed whole-exome sequencing (WES) and whole-transcriptome sequencing (WTS) on tumor and matched normal samples from 134 Korean BC patients consisting of 74 YBC cases (age ≤ 40) and 60 OBC cases (age &gt; 40). We then performed comparison analyses and integrative analyses with the TCGA BC cohort consisting of 1,116 tumors from primarily Caucasian patients, also grouped by age into YBC (age ≤ 40), IBC (40 &lt; age ≤ 60) and OBC (age &gt; 60).

Somatic mutation prevalence analysis identified 7 significantly mutated genes and the same top three genes – TP53, GATA3 and PIK3CA – were reported by the TCGA BC study. To identify differentially expressed (DE) genes and pathways in YBCs vs. OBCs, we performed logistic regression analyses while controlling for the confounding effects of tumor purity and stage. We were surprised to see a significant overlap in DE pathways between a comparison of adjacent normal tissues in younger vs. older TCGA cohorts and a comparison of YBC vs. OBC tumors, indicating that normal tissue compartment could contribute to observed differences between bulk tumors. To separately examine molecular signatures from tumor, stroma and normal compartments, we used non-negative matrix factorization (NMF) analyses to virtually dissect bulk tumor expression data and identified 14 factors including 3 factors associated with normal tissues, 1 factor associated with stroma and 1 factor associated with tumor infiltrating lymphocytes (TIL). Integrative analyses of tumor associated factors and DE pathways revealed that estrogen response, endocrine therapy resistance, and oxidative phosphorylation pathways are up-regulated in YBCs compared to OBCs while cell cycle and proliferation pathways are up-regulated in Asian OBCs. Interestingly, many immune and inflammation pathways correlated with the TIL factor were significantly upregulated in OBCs vs. YBCs. Using gene expression signatures representing distinct immune cell types, we classified our cohort into four subtypes of varying TIL activities and observed significant enrichment of the TIL-high subtype in OBCs compared to YBCs. These observations were confirmed by IHC analyses of four TIL markers (CD45, CD4, CD8 and CD163) in 120 tumors.

To our knowledge, this is the first large-scale multi-omics study of Asian breast cancer and would significantly contribute to the compendium of molecular data available for studying young breast cancers. The major landmarks in the molecular landscape looked similar across BCs of different ethnicities and ages, however, we have identified a number of distinguishing molecular characteristics associated with Asian YBC. The sources for some signatures were further traced to non-tumor intrinsic compartments, indicating that tumor microenvironment may play potentially important roles in driving the carcinogenesis of young breast cancers.

Citation Format: Kan Z, Ding Y, Cho S, Lee S-H, Powell E, Jung HH, Chung W, Deng S, Choi Y-l, Kim J, Park W-Y, Vizcarra P, Fernandez-Banet J, Nichols T, Ram S, Lee SK, Kim SW, Lee JE, Ching KA, Kim J-Y, Ahn JS, Im Y-H, Nam SJ, Park YH. Multi-omics and immuno-oncology profiling reveal distinct molecular signatures of young Asian breast cancers [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-05-15.

Screening for tuberculosis and LTBI in diabetes patients, Pohnpei, Federated States of Micronesia

A retrospective cohort study was performed in Pohnpei, a small Pacific Island, to evaluate the feasibility and results of screening adult diabetes (DM) patients for tuberculosis (TB) and latent tuberculous infection (LTBI) using a symptom screen, tuberculin skin testing and chest radiography. Of 79 patients, 65 (82%) completed screening. Two (3%) patients with active TB and 16 (25%) with LTBI were referred for anti-tuberculosis treatment and isoniazid preventive therapy, respectively. It is feasible and worthwhile to screen diabetes patients for TB, but a number of changes are needed to improve both the screening process and the diagnostic yield.

Tuberculosis case burden and treatment outcomes in children, adults and older adults, Vanuatu, 2007-2011

SETTING

All five DOTS centres in Vanuatu.

OBJECTIVES

To determine across the age spectrum the tuberculosis (TB) case burden, disease pattern and treatment outcomes in patients registered between 2007 and 2011.

DESIGN

Retrospective cohort study involving reviews of TB registers and treatment cards.

RESULTS

Of 588 TB patients, 142 (24%) were children (aged 0-14 years), 327 (56%) adults (aged 15-54 years) and 119 (20%) were older adults (aged ⩾55 years; subdivided into 55-64 and ⩾65 years); 568 were new patients, 13 had been treated previously and 7 had unknown status. Compared with adults, children with new TB had a higher prevalence of extra-pulmonary TB (75% vs. 34%, OR 5.7, 95%CI 3.6-9.0) and a lower prevalence of smear-positive pulmonary TB (11% vs. 45%, OR 0.15, 95%CI 0.1-0.3), while older adults with new TB had a higher prevalence of smear-negative pulmonary TB (38% vs. 21%, OR 2.4, 95%CI 1.5-3.8). Overall TB treatment success was 83%, but in the second category of older adults (⩾65 years) treatment success was 67% and case fatality was 18%.

CONCLUSION

Children and older adults constitute 45% of the TB burden in Vanuatu. Differences in disease patterns and poorer treatment outcomes in older adults have implications for policy and practice.

Screening adult tuberculosis patients for diabetes mellitus in Ebeye, Republic of the Marshall Islands

A retrospective cohort study was conducted to evaluate the screening of adult TB patients for diabetes (DM) using glycated haemoglobin (HbA1C) in Ebeye, Republic of the Marshall Islands. Of 62 patients registered between July 2010 and December 2012, 28 (45%) had DM. The only significant difference in baseline characteristics between those with and those without DM was higher age in those with DM. Two-month sputum smears and cultures were also not different between the two groups. Despite the limited sample size, this study shows that screening TB patients for DM in Ebeye is feasible and worthwhile and that it should be continued.

Mentorship for operational research capacity building: hands-on or hands-off?

Mentorship is a key feature of operational research training courses run by the International Union Against Tuberculosis and Lung Disease and Médecins Sans Frontières. During the recent South Pacific paper writing module, the faculty discussed 'hands-on' mentorship (direct technical assistance) vs. 'hands-off' mentorship (technical advice). This article explores the advantages and disadvantages of each approach. Our collective experience indicates that 'hands-on' mentorship is a valuable learning experience for the participant and a rewarding experience for the mentor. This approach increases the likelihood of successful course completion, including publishing a well written paper. However, mentors must allow participants to lead and take ownership of the paper, in keeping with a first author position.

Building operational research capacity in the Pacific

Operational research (OR) in public health aims to investigate strategies, interventions, tools or knowledge that can enhance the quality, coverage, effectiveness or performance of health systems. Attention has recently been drawn to the lack of OR capacity in public health programmes throughout the Pacific Islands, despite considerable investment in implementation. This lack of ongoing and critical reflection may prevent health programme staff from understanding why programme objectives are not being fully achieved, and hinder long-term gains in public health. The International Union Against Tuberculosis and Lung Disease (The Union) has been collaborating with Pacific agencies to conduct OR courses based on the training model developed by The Union and Médecins Sans Frontières Brussels-Luxembourg in 2009. The first of these commenced in 2011 in collaboration with the Fiji National University, the Fiji Ministry of Health, the World Health Organization and other partners. The Union and the Secretariat of the Pacific Community organised a second course for participants from other Pacific Island countries and territories in 2012, and an additional course for Fijian participants commenced in 2013. Twelve participants enrolled in each of the three courses. Of the two courses completed by end 2013, 18 of 24 participants completed their OR and submitted papers by the course deadline, and 17 papers have been published to date. This article describes the context, process and outputs of the Pacific courses, as well as innovations, adaptations and challenges.

Descriptive analysis of diabetes-related amputations at the Colonial War Memorial Hospital, Fiji, 2010-2012

SETTING

The Colonial War Memorial Hospital (CWMH) in Fiji.

OBJECTIVE

To determine the characteristics of patients with diabetes mellitus (DM) who underwent lower limb amputations at the CWMH from 2010 to 2012.

DESIGN

This was a retrospective review of data contained in operating theatre registers and clinical records of DM patients who had undergone amputations during the study period.

RESULT

Of the 938 amputations performed at the CWMH during the study period, significantly more patients were male than female (54.1% vs. 45.9%) and more i-Taukei (indigenous Fijian) than Indo-Fijian (71% vs. 26.2%); 15.9% of patients had not previously been diagnosed as having DM when they presented with foot sepsis. The rate of smoking was highest in male i-Taukei patients. A large proportion of patients (76.8%) had poor glycaemic control.

CONCLUSION

This study suggests that male i-Taukeis are most at risk, and that uncontrolled DM is a significant factor associated with amputations. There is a need to strengthen DM screening and improve glycaemic control. Foot care education needs to be implemented at diagnosis and re-enforced with regular clinic visits and complication screening sessions.

Pre-treatment loss to follow-up among smear-positive pulmonary tuberculosis cases: a 10-year audit of national data from Fiji

SETTING

All tuberculosis (TB) diagnostic and treatment centres in Fiji.

OBJECTIVES

To report on pre-treatment loss to follow-up rates over a 10-year period (2001-2010) and to examine if patients' age, sex and geographic origin are associated with the observed shortcomings in the health services.

METHODS

A retrospective review of routine programme data reconciling TB laboratory and treatment registers.

RESULTS

A total of 690 sputum smear-positive TB patients were diagnosed in the laboratory, of whom 579 (84%) were started on anti-tuberculosis treatment-an overall pre-treatment loss to follow-up of 111 (16%). Peak loss to follow-up rates were seen in 2003, 2004 and 2010. Pre-treatment losses were all aged ≥15 years. In the Western Division of Fiji, 33% of sputum-positive patients were declared pre-treatment loss to follow-up; this division had over five times the risk of such an adverse outcome compared to the Central Division (OR 5.2, 95%CI 3.1-8.9, P < 0.0001).

CONCLUSION

This study has identified an important shortcoming in programme linkage, communication and feedback between TB diagnostic and treatment services, leading to high pre-treatment loss to follow-up rates. This negatively influences TB services, and ways to rectify this situation are discussed.

Self-poled transparent and flexible UV light-emitting cerium complex-PVDF composite: a high-performance nanogenerator

Cerium(III)-N,N-dimethylformamide-bisulfate [Ce(DMF)(HSO4)3] complex is doped into poly(vinylidene fluoride) (PVDF) to induce a higher yield (99%) of the electroactive phases (β- and γ-phases) of PVDF. A remarkable enhancement of the output voltage (∼32 V) of a nanogenerator (NG) based on a nonelectrically poled cerium(III) complex containing PVDF composite film is achieved by simple repeated human finger imparting, whereas neat PVDF does not show this kind of behavior. This high electrical output resembles the generation of self-poled electroactive β-phase in PVDF due to the electrostatic interactions between the fluoride of PVDF and the surface-active positive charge cloud of the cerium complex via H-bonding and/or bipolar interaction among the opposite poles of cerium complex and PVDF, respectively. The capacitor charging capability of the flexible NG promises its applicability as piezoelectric-based energy harvester. The cerium(III) complex doped PVDF composite film exhibit an intense photoluminescence in the UV region, which might be due to a participation of electron cloud from negative pole of bipolarized PVDF. This fact may open a new area for prospective development of high-performance energy-saving flexible solid-state UV light emitters.

Causes of stress and their change with repeated sessions as perceived by undergraduate medical students during high-fidelity trauma simulation

BACKGROUND

It is known that simulation training is associated with stress for the trainees, at all levels of trainee experience. We explored the factors which were perceived by the trainees to cause them the maximum stress related to their simulation experience and their temporal changes over three simulation sessions.

METHODS

Ninety-seven final year medical students were administered a Likert-type questionnaire on perceived stressors after trauma simulation training. These stressors were classified as intrapsychic (relating to internal feelings); interpersonal (relating to interaction with others) and interactive (related to interaction with the simulated patient). Non-parametric tests were used for statistical analysis.

RESULTS

Death of the simulated patient scored highest of all stressors. When the median scores for intrapsychic, interpersonal or interactive items were plotted session-wise, three distinct types of graphs were obtained. Eight of 13 items had a decrease in perceived stress scores from the first to the second session. Only 'death of the simulated patient' showed a significant increase in the score from the second to the third session.

CONCLUSION

Undergraduate medical trainees experienced stress due to various factors during their first simulation session, which reduced with repeated sessions. However, perceived stress related to simulated death of a patient continued to remain high even after two repetitions. We suggest that simulation training programmes for undergraduate medical students should have at least one repeat session to reduce the stress and that facilitators should consider keeping the simulated patient alive throughout the training sessions.

Describing the burden of non-communicable disease risk factors among adults with diabetes in Wallis and Futuna

BACKGROUND

The South Pacific Territory of Wallis and Futuna has a high burden of non-communicable diseases (NCD): 18% of adults have diabetes mellitus (DM) and 87% are classified as overweight or obese.

OBJECTIVE

To characterise the burden of additional World Health Organization (WHO) recognised NCD risk factors, such as smoking, obesity, high blood pressure, eating less than five fruit or vegetable servings per day and a sedentary lifestyle, among adults with DM.

DESIGN

Re-analysis of cross-sectional data from a 2009 national survey. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.

RESULTS

Of 487 adults sampled, 87 (18%) had DM. Nearly 99% of individuals with DM had at least one additional NCD risk factor, and 62% had three or more concurrent NCD risk factors. Individuals with DM were more likely to be obese (OR 1.66, 95%CI 1.01-2.74) and had a much higher prevalence of high blood pressure (OR 3.02, 95%CI 1.87-4.86).

CONCLUSION

DM is rarely identified in the absence of other NCD risk factors. We recommend an integrated approach to the management of DM and other NCD risk factors in routine care rather than a disease-specific approach.

Consecutive magnetic and magnetocaloric transitions in herringbone nanostructured Heusler Mn50Ni41Sn9 alloy

A herringbone nanostructured Mn-rich Heusler Mn50Ni50-Sndelta (8 - 9) alloy exhibits tailored magnetocaloric properties in the martensite and ferro <-> paramagnetic transitions concur in a narrow temperature window. In a Sn --> Ni substitution 8 - 9, the martensite (M) <-- austenite (A) transition up-lifts adequately well above the room temperature - 310.5 K in the DSC thermogram and magnetization scanned with temperature. A noninterrupted heating following a cooling in DSC at a given rate gives a smaller enthalpy change deltaH(M <-- A) - deltaH(M --> A approximately equal to 282 mJ/g (deltaC(P)(M <-- A) - deltaC(P)(M --> A) approximately equal to 0.025 mJ/g-K in the heat capacity), i.e., the M <-> A transition process lacks a complete reversibility. Warming a zero-field cooled sample retains lower magnetization (sigma) at low fields B, e.g., by 58% over the field cooled value at 5 mT, wherein merely low field magnetic susceptibility imparts the magnetization process. A reversible thermal hysteresis thus the transition traces in cooling and heating. The field diminishes difference in two sigma-values progressively, e.g., only - 12% lasts at 5 T. The two curves bifurcate below 160 K (B-5 mT) and the gap grows exponentially over lower temperatures before sigma(M <-- A) gets steady near 60 K in a superparamagnetic (SPM) behavior. The SPM feature (follows the Langevin model) below a paramagnetic regime begins (> or = 250 K) before a ferromagnetic A-state lines-up the successive transitions. Temperature and frequency dependence ac and dc susceptibilities describe the surface spins dynamics.

Effectiveness of Group Psycho-education on Well-being and Depression Among Breast Cancer Survivors of Melaka, Malaysia

Background:

The psychological stress after diagnosis of breast cancer is often severe. Most of the women with breast cancer and their families suffer from emotional, social, financial and psychological disturbances.

Materials and Methods:

A cluster non-randomized trial was conducted at a Cancer Society in Melaka, Malaysia to assess the effectiveness of psycho-education on well-being status and depression among breast cancer patients. The study period was for one month (11^th June 2011 and 16^th July 2011). Participants in this study were 34 adult women suffering from non-metastatic breast cancer and on appropriate allopathic medication. The WHO-five Well-being Index (1998 version) was used as the screening instrument for the assessment of well-being and depression. The data collected were tabulated and analyzed by using the Statistical Package for Social Sciences (SPSS) version 11.0. Wilcoxon Signed-rank Test was applied for comparison between pre-test and post-test scores. A P value <0.05 was considered as statistically significant.

Results:

This study revealed that majority of the participants was in the state of adequate well-being after the psycho-education 33 (97.1%). The proportion of depressed individuals had also reduced from 8 (23.5%) to 1 (2.9%) after the psychological intervention. The post-test results significantly improved after the intervention for the items related to “I have felt calm and relaxed”, “I woke up feeling fresh and rested” and “my daily life has been filled with things that interest me” along with the “overall impression” in the WHO-5 Well-being Index.

Conclusion:

Group psycho-education played a significant role in improving the well-being status and reducing depression of breast cancer survivors.

Outpatient taping in the treatment of idiopathic congenital talipes equinovarus

The Ponseti and French taping methods have reduced the incidence of major surgery in congenital idiopathic clubfoot but incur a significant burden of care, including heel-cord tenotomy. We developed a non-operative regime to reduce treatment intensity without affecting outcome. We treated 402 primary idiopathic clubfeet in patients aged < three months who presented between September 1991 and August 2008. Their Harrold and Walker grades were 6.0% mild, 25.6% moderate and 68.4% severe. All underwent a dynamic outpatient taping regime over five weeks based on Ponseti manipulation, modified Jones strapping and home exercises. Feet with residual equinus (six feet, 1.5%) or relapse within six months (83 feet, 20.9%) underwent one to three additional tapings. Correction was maintained with below-knee splints, exercises and shoes. The clinical outcome at three years of age (385 feet, 95.8% follow-up) showed that taping alone corrected 357 feet (92.7%, 'good'). Late relapses or failure of taping required limited posterior release in 20 feet (5.2%, 'fair') or posteromedial release in eight feet (2.1%, 'poor'). The long-term (> 10 years) outcomes in 44 feet (23.8% follow-up) were assessed by the Laaveg-Ponseti method as excellent (23 feet, 52.3%), good (17 feet, 38.6%), fair (three feet, 6.8%) or poor (one foot, 2.3%). These compare favourably with published long-term results of the Ponseti or French methods. This dynamic taping regime is a simple non-operative method that delivers improved medium-term and promising long-term results.

Local strains, calorimetry, and magnetoresistance in adaptive martensite transition in multiple nanostrips of Ni39+x Mn50Sn11-x (x ⩽ 2) alloys

Ni_39+x Mn₅₀Sn_11-x (x = 0.5, 1.0, 1.5 and 2) alloys comprise multiple martensite nanostrips of nanocrystallites when cast in small discs, for example, ∼15 mm diameter and 8 mm width. A single martensite phase with a L1₀ tetragonal crystal structure at room temperature can be formed at a critical Sn content of 9.0 at.% (x = 2), whereas an austenite cubic L2₁ phase turns up at smaller x ⩽ 1.5. The decrease in the Sn content from x = 2 to 0.5 also results in a gradual increase in the crystallite size from 11 to 17 nm. Scanning electron microscopy images reveal arrays of regularly displaced multiple martensite strips (x ≽ 1.5) with an average thickness of 20 nm. As forced oscillators, these strips carry over the local strains, magnetic dipoles, and thermions simultaneously in a martensite-austenite (or reverse) phase transition. A net residual enthalpy change ΔH_M↔A = -0.12 J g^-1 arises in the process that lacks reversibility between the cooling and heating cycles. A large magnetoresistance of (-)26% at 10 T is observed together with a large entropy change of 11.8 mJ g^-1 K^-1, nearly twice the value ever reported in such alloys, in the isothermal magnetization at 311 K. The ΔH_M↔A irreversibility accounts for a thermal hysteresis in the electrical resistivity. Strain induced in the martensite strips leads them to have a higher electrical resistivity than that of the higher-temperature austenite phase. A model considering time-dependent enthalpy relaxation explains the irreversibility features.

Occurrence of plasmid linked multiple drug resistance in bacterial isolates of tannery effluent

Effluents of three different tanneries (T-1, T-2, & T-3) were investigated to isolate and scrutinize antibiotic, chromate and salinity resistant bacteria. Total 18 isolates of 9 different bacterial genera were screened out and identified; some strains established in all effluents. Amongst the three effluents tested; T-1 exhibited largest population of all isolates compared to T-2 and T-3 effluents. The T-1 effluent contained largest 4.4 x10(6) cfu/ml population of Pseudomonas aeruginosa followed by 3.9 x10(6) cfu/ml in T-2 effluent. The lowest 0.7 x10(6) cfu/ml count of Aeromonas spp. was recorded in T-3 effluent. Furthermore, antibiotic susceptibility tests were performed with 7 antibiotics which include ampicillin, sulfafurazole, ciprofloxacin, norfloxacin, tetracycline and amikacin. Three strains of P. aeruginosa and one strain of Escherichia coli deserved as multiple drug resistant (MDR). The P. aeruginosaT-3 and E. coliT-1 showed strongest MDR feature for 5 antibiotics. The response of chromate (50, 100, 200, 250 and 300 μg/ml) and NaCl concentrations (20, 40, 60 and 80 g/l) was incredible for 4 MDR isolates. Nearly each strain showed tolerance up to 300 μg/ml of chromate and 80 g/l of NaCl. The P. aeruginosaT-1, P. aeruginosaT-2, P. aeruginosaT-3 and E. coliT-1 were most tolerant isolates. Plasmid profiling of resistant strains was conducted with agarose gel electrophoresis. As consequence, plasmids from two strains of P. aeruginosa and E. coliT-1 represented different bands. At least for confirmation of plasmids nature; these were transformed and transformants were screened on medium having antibiotics. The study of plasmid transformation has confirmed the plasmid mediated resistance in isolates.

Antibiotic lock technique for prevention of cuffed tunnel catheter associated bacteremia

BACKGROUND

Central venous cuffed tunnel catheters are commonly used for short term or long term hemodialysis access. However, catheter-associated bacteremia is a common complication. It has been suggested that the addition of antibiotics to the catheter during the interdialytic interval results in a decrease in bacterial colonization and thereby a decrease in catheter associated infections. To test this hypothesis, a prospective, randomized study was performed comparing a gentamicin citrate mixture to standard heparin as the catheter lock. The effect of covering the catheter hub in a sterile bag on the infection rate was additionally tested.

METHODS

From January 1999 to April 2000, all patients who underwent tunnel catheter placement or change (55 catheters) in the Nephrology Interventional Laboratory at Louisiana State University Health Sciences Center in Shreveport, were prospectively randomized as follows: group 1 (n=14): Antibiotic lock with tricitrasol (46.7%), gentamicin (40 mg/ml) and saline in a ratio of 1:5:5 and catheter hub covered with a sterile plastic bag after cleaning with a 10% povidone iodine solution; group 2 (n=22): Heparin lock and sterile plastic bag over catheter hub after cleaning with povidone iodine; and group 3 (n=19): Heparin lock alone. The primary end points of the study were catheter-associated bacteremia and thrombosis. Catheter loss due to access maturation, transplant or transfer were censored.

RESULTS

There were a total of 4,805 at risk patient-days. The total number of catheter associated bacteremias were one in group 1, four in group 2 and four in group 3. The number of catheter associated bacteremias per 1000 patient-days in each group was 0.62, 3.05, and 2.11 respectively. The sixty day percent survival of catheters in each group was 74 +/- 12, 55 +/- 12 and 59 +/- 11 respectively.

CONCLUSIONS

1) Tricitrasol and gentamicin as an antibiotic lock reduced the incidence of catheter associated bacteremia; 2) Covering the catheter hub with a sterile bag did not provide an additional advantage; 3) The antibiotic lock improved overall survival of catheters.

Language in tuberculosis services: can we change to patient-centred terminology and stop the paradigm of blaming the patients?

The words 'defaulter', 'suspect' and 'control' have been part of the language of tuberculosis (TB) services for many decades, and they continue to be used in international guidelines and in published literature. From a patient perspective, it is our opinion that these terms are at best inappropriate, coercive and disempowering, and at worst they could be perceived as judgmental and criminalising, tending to place the blame of the disease or responsibility for adverse treatment outcomes on one side-that of the patients. In this article, which brings together a wide range of authors and institutions from Africa, Asia, Latin America, Europe and the Pacific, we discuss the use of the words 'defaulter', 'suspect' and 'control' and argue why it is detrimental to continue using them in the context of TB. We propose that 'defaulter' be replaced with 'person lost to follow-up'; that 'TB suspect' be replaced by 'person with presumptive TB' or 'person to be evaluated for TB'; and that the term 'control' be replaced with 'prevention and care' or simply deleted. These terms are non-judgmental and patient-centred. We appeal to the global Stop TB Partnership to lead discussions on this issue and to make concrete steps towards changing the current paradigm.

Nanomagnets La0.8Pb0.2(Fe0.8Co0.2)O3 assembled with a bonded surface graphene oxide: sensitive for sensing small gas molecules

Nanocrystallites La0.8Pb0.2(Fe0.8Co0.2)O3 (LPFC) when bonded through a surface layer (carbon) in small ensembles display surface sensitive magnetism useful for biological probes, electrodes, and toxic gas sensors. A simple dispersion and hydrolysis of the salts in ethylene glycol (EG) in water is explored to form ensembles of the nanocrystallites (NCs) by combustion of a liquid precursor gel slowly in microwave at 70-80 dgrees C (apparent) in a closed container in air. In a dilute sample, the EG molecules mediate hydrolyzed species to configure in small groups in process to form a gel. Proposed models describe how a residual carbon bridges a stable bonded layer of a graphene-oxide-like hybrid structure on the LPFC-NCs in attenuating the magnetic structure. SEM images, measured from a pelletized sample which was used to study the gas sensing features in terms of the electrical resistance, describe plate shaped NCs, typically 30-60 nm widths, 60-180 nm lengths and -50 m2/g surface area (after heating at -750 degrees C). These NCs are arranged in ensembles (200-900 nm size). As per the X-ray diffraction, the plates (a Pnma orthorhombic structure) bear only small strain -0.0023 N/m2 and oxygen vacancies. The phonon and electronic bands from a bonded surface layer disappear when it is etched out slowly by heating above 550 degrees C in air. The surface layer actively promotes selective H2 gas sensor properties.