Variations in antimicrobial resistance genes present in the rectal faeces of seals in Scottish and Liverpool Bay coastal waters

Antibiotic resistance genes originating from human activity are considered important environmental pollutants. Wildlife species can act as sentinels for coastal environmental contamination and in this study we used qPCR array technology to investigate the variety and abundance of antimicrobial resistance genes (ARGs), mobile genetic elements (MGEs) and integrons circulating within seal populations both near to and far from large human populations located around the Scottish and northwest English coast. Rectal swabs were taken from 50 live grey seals and nine live harbour seals. Nucleic acids were stabilised upon collection, enabling extraction of sufficient quality and quantity DNA for downstream analysis. 78 ARG targets, including genes of clinical significance, four MGE targets and three integron targets were used to monitor genes within 22 sample pools. 30 ARGs were detected, as well as the integrons intl1 and intl2 and tnpA transposase. Four β-lactam, nine tetracycline, two phenicol, one trimethoprim, three aminoglycoside and ten multidrug resistance genes were detected as well as mcr-1 which confers resistance to colistin, an important drug of last resort. No sulphonamide, vancomycin, macrolide, lincosamide or streptogramin B (MLSB) resistance genes were detected. Resistance genes were detected in all sites but the highest number of ARGs (n = 29) was detected in samples derived from grey seals on the Isle of May, Scotland during the breeding season, and these genes also had the highest average abundance in relation to the 16S rRNA gene. This pilot study demonstrates the effectiveness of a culture-independent workflow for global analysis of ARGs within the microbiota of live, free-ranging, wild animals from habitats close to and remote from human habitation, and highlights seals as a valuable indicator species for monitoring the presence, abundance and land-sea transference of resistance genes within and between ecosystems.

Design Development of the SMARTCLIC®/CLICWISE® Injection Device for Self-Administered Subcutaneous Therapies: Findings from Usability and Human Factor Studies

INTRODUCTION

An easy-to-use, multiuse, single-patient, electromechanical autoinjector, the SMARTCLIC®/CLICWISE® injection device, was recently developed to improve the self-administration options available to patients with chronic inflammatory disease treated with biologic agents. An extensive series of studies were conducted to guide the design and development of this device and to ensure its safety and effectiveness.

METHODS

Participants in two user preference studies and three formative human factor (HF) studies evaluated evolving iterations of the autoinjector device, dose dispenser cartridge, graphical user interface, and informational materials; participants in a summative HF test subsequently assessed the final proposed commercially representative product. In the user preference studies, rheumatologists and patients with chronic inflammatory disease, interviewed online and in-person, provided feedback on the design and functionality of four prototypes. In the HF studies, the safety, effectiveness, and usability of adapted prototypes were assessed under simulated-use conditions by patients with chronic inflammatory disease, caregivers, and healthcare professionals (HCPs). The safety and effectiveness of the final refined device and system were confirmed in a summative HF test by patients and HCPs in simulated-use scenarios.

RESULTS

Rheumatologists (n = 204) and patients (n = 39) interviewed in the two user preference studies provided feedback on the device size, feature ergonomics, and usability that guided prototype development in the subsequent formative HF studies. Observations from patients, caregivers, and HCPs (n = 55) participating in the latter studies yielded additional critical design revisions that culminated in development of the final device and system. Of 106 injection simulations conducted in the summative HF test, all resulted in successful medication delivery, and no potential harms were associated with injection-related use events.

CONCLUSION

Findings from this research facilitated development of the SmartClic/ClicWise autoinjector device and demonstrated that it could be used safely and effectively by participants representative of the intended-use population of patients, lay caregivers, and HCPs.

High Usability and Applicability Ratings for the New SmartClic®/ClicWise® Injection Device: Evidence from a Health Care Professional Opinion Study

INTRODUCTION

The SmartClic®/ClicWise® autoinjector is a new reusable, multi-use, single-patient device for the administration of subcutaneously administered biologics in the treatment of chronic conditions, including rheumatoid arthritis. The device will be used in conjunction with a mobile application (app). The aim of this study was to collect feedback on the usability, functionality, and applicability of the device and the companion app from health care professionals (HCPs) who perform injections as part of their role and care for patients with rheumatic conditions.

METHODS

The study was conducted from September to October 2020 in Germany. HCPs participated in a training session for the device and gained experience by performing simulated injections with water. Following the simulations, HCPs answered questions on the ease of use, feature design, effectiveness, and injection speed of the SmartClic/ClicWise device and estimate the patient training time required. They also answered questions on the functionality of the proposed app after attending a storyboard presentation. Responses were recorded as multiple-choice answers, Likert scale ratings (seven-point scale), or open-ended comments. The mean, median, and mode scores were recorded.

RESULTS

Twenty-five HCPs (mean age, 38.2 years; females, n = 22 [88%]; registered nurses, n = 19 [76%]) participated in the study. HCP feedback on questions related to the SmartClic/ClicWise device was positive overall, with mean scores > 4.50 across questions; mean scores < 5.00 were reported on 2/40 questions. Twenty-four of 25 participants (96%) estimated that a training time of ≤ 20 min would suffice for patients learning to use the device. Positive feedback was also reported on questions related to the companion app, with mean scores > 5.70.

CONCLUSIONS

Initial feedback from HCPs on the SmartClic/ClicWise device and proposed app was generally favorable, suggesting they will provide an acceptable alternative for self-administration of biologics for patients with rheumatoid arthritis and other chronic conditions.

Does a Kegel Exercise Program Prior to Resistance Training Reduce the Risk of Stress Urinary Incontinence?

This comparative pre-post intervention study investigated the feasibility and benefits of Kegel exercises amongst incontinent women, prior to commencing resistance training (RT), to reduce the risk of stress urinary incontinence (SUI) compared to a group of women without prior Kegel exercises (KE). Incontinence severity index (ISI) score, pelvic floor muscle strength (PFMS), and body composition (such as body mass index (BMI), fat, and muscle mass), were obtained pre and post intervention. Results demonstrated that RT reduced SUI to a significantly greater extent only if preceded by KE as was observed in the Kegel exercise plus RT group (KE + RT) over time. The improvements in total ISI in both the KE + RT and RT groups were large (d = 1.50 and d = 1.17 respectively). A two-way ANOVA indicated a statistically significant improvement in average PFMS within the KE + RT group over time and between the two groups. A positive correlation was found between the average strength of pelvic floor muscles and SUI. Participants in KE + RT group demonstrated a significant increase in muscle mass (p ≤ 0.001) and concomitant reduction in fat mass (p = 0.018). This study determined a dedicated program of KE preceding a RT program improved average pelvic floor muscle strength and was effective in reducing SUI among incontinent women.

AB1523-HPR USABILITY AND ACCEPTABILITY OF A NEW AUTOINJECTOR DEVICE AND ITS ASSOCIATED APP IN AUSTRALIAN, FRENCH, GERMANY AND JAPANESE RHEUMATOLOGY PATIENTS

Background

Smartclic/ClicWise is a new reusable autoinjector with a dose-dispensing cartridge for subcutaneous self-administration of biotherapeutics in development for patients with rheumatoid arthritis (RA) and other diseases. The device can connect to an optional mobile phone app (Smartclic, or ClicNote in Japan) to aid in tracking injections and other treatment or symptom data.

Objectives

The study objective was to collect ease of use and usability data on the Smartclic injector and companion app from experienced patients.

Methods

After completing a patient profiling questionnaire, adult patients (≥18 yrs) from Australia, France, Germany, and Japan with RA, psoriatic arthritis, or an original diagnosis of juvenile idiopathic arthritis who were prescribed an injectable biologic were enrolled in this study. For Japan, only patients with RA were enrolled. Each patient received training individually on the use of the Smartclic injector device and insertable cartridge and gained experience by performing simulated injections. Participants completed a questionnaire with evaluations of the device categories (number of questions): ‘ease of use’ (14), ‘usability effectiveness’ (11), ‘benefit of features’ (8), and ‘form factor’ (7). Participants also separately received a storyboard presentation summarizing the key features of the app, during which patients could explore the app (on a phone with either an android or iOS operating system), and completed 16 questions on the connectivity, usability, and benefit. Responses were recorded as Likert scale ratings from 1 (‘extremely negative’) to 7 (‘extremely positive’). Respondents also provided an estimate of patient training time for the device. Mean values were reported. The percentage of negative (Likert scale rating 1-2), neutral (3-5), and positive (6-7) responses for each category were determined.

Results

A total of 139 patients (mean age [range], 52 [18-84] yrs; 73% female) participated in the study (Table 1). Mean scores (percentage of positive responses) for the device were: ease of use 6.43 (86.2%), usability effectiveness 6.39 (86.5%), benefit of features 6.46 (89.4%), form factor 6.10 (77.2%); and 6.06 (74.2%) for connectivity and benefit of the app (Figure 1). Mean estimated time for training a patient to effectively use the device/cartridge was just under 9.5 min (range, 0-30 min).

Table 1.

Participant characteristics

CharacteristicPatients(N=139)Sex, n (%)Male38 (27)Female101 (73)Mean age (range), yrs52 (18-84)Age groups, n (%)18-30 yrs11 (8)31-59 yrs85 (61)>60 yrs43 (31)Diagnosis, n (%)Rheumatoid arthritis104 (75)Psoriatic arthritis34 (24)Juvenile idiopathic arthritis*1 (1)Handedness, n (%)Right-handed128 (92)Left-handed9 (6)Ambidextrous2 (1)

*Originally diagnosed with juvenile idiopathic arthritis, but now aged ≥18 yrs.

Conclusion

Rheumatology patients responded positively on the new autoinjector device and app across all categories, indicating its suitability for self-administration of biotherapeutics.

Acknowledgements

Medical writing support was provided by Jacob Evans, of Engage Scientific Solutions.

Disclosure of Interests

Rieke Alten Consultant of: AbbVie, Bristol-Myers Squibb, Gilead, Lilly, Novartis, Pfizer and UCB, Grant/research support from: AbbVie, Bristol-Myers Squibb, Galapagos, Gilead, Janssen, Lilly and Pfizer, Mark Latymer Shareholder of: Pfizer, Employee of: Pfizer, David C Gruben Shareholder of: Pfizer, Employee of: Pfizer, Lisa Gunther-LaVergne Employee of: Farm Design, Simon Moss Shareholder of: Pfizer, Employee of: Pfizer, Hideto Kameda Speakers bureau: AbbVie, Asahi-Kasei, Bristol-Myers Squibb, Chugai, Eisai, Janssen, Lilly, Mitsubishi-Tanabe, Novartis and Pfizer, Consultant of: AbbVie, Bristol-Myers Squibb, Janssen, Lilly, Novartis, Sanofi and UCB, Grant/research support from: AbbVie, Asahi-Kasei, Boehringer Ingelheim, Chugai, Eisai and Mitsubishi-Tanabe

An external telemetry system for recording resting heart rate variability and heart rate in free-ranging large wild mammals

Measures of heart rate variability (and heart rate more generally) are providing powerful insights into the physiological drivers of behaviour. Resting heart rate variability (HRV) can be used as an indicator of individual differences in temperament and reactivity to physical and psychological stress. There is increasing interest in deriving such measures from free ranging wild animals, where individuals are exposed to the natural and anthropogenic stressors of life. We describe a robust, externally mounted heart rate monitor for use in wild mammals, deployed here on wild breeding adult female grey seals (Halichoerus grypus), that delivers millisecond precise measures of inter beat intervals (IBIs), allowing computation of resting HRV parameters. Based on Firstbeat™ heart rate belts, our system allows for remote, continuous recording of IBI data from over 30 individuals simultaneously at ranges of up to 200m. We assessed the accuracy of the IBI data provided by the Firstbeat™ system using concurrent IBI data derived from in-field electrocardiogram (ECG) recordings. Bland-Altmann analyses demonstrated high correspondence between the two sets of IBI data, with a mean difference of 0.87±0.16ms. We used generalized additive mixed-effects models to examine the impact of the default Firstbeat™ software artefact correction procedure upon the generation of anomalous data (flats and stairs). Artefact correction and individual activity were major causes of flats and stairs. We used simulations and models to assess the impact of these errors on estimates of resting HRV and to inform criteria for subsampling relatively error free IBI traces. These analyses allowed us to establish stringent filtering procedures to remove traces with excessive numbers of artefacts, including flats and stairs. Even with strict criteria for removing potentially erroneous data, the abundance of data yielded by the Firstbeat™ system provides the potential to extract robust estimates of resting HRV. We discuss the advantages and limitations of our system for applications beyond the study system described here.

Bibliometric Profile and Density Visualizing Analysis of Yoga Intervention in Type 2 Diabetes: A 44 - Year Study on Global Scientific Research Output from 1975 to 2019

The aim of the paper is to provide an in-depth evaluation of the research output of yoga intervention on type 2 diabetes mellitus from 1975 to 2019 using large-scale data analysis, bibliometric indicators, and density equalizing mapping. Data related to yoga-diabetic research, as search descriptors were retrieved using the Scopus database. The most common bibliometric indicators were annual research output, total citations, productive countries and leading authors, journals and institutions, and frequently cited articles. The number of global research articles retrieved for yoga-diabetic research over the study period 1975-2019 was 411. The growth rate of global publications in 2015-2019 is four times as high as in 1975-2003. The total number of citations for the retrieved articles was 7189, and the average number of citations per article was 23.82. Of these journals, the Journal of Alternative and Complementary Medicine has published the highest number of papers, which accounts for 2.9% of total publications. This study showed a wide variety of journals in which yoga-diabetic articles are published; these bibliometric indicators provide useful information on performance assessment of productivity and quality of research output. Therefore, this study provides a helpful reference for endocrinologists, yoga therapists, policy decision-makers, and diabetes researchers.

Treating children with disinhibited social engagement disorder symptoms: Filial therapy

Introduction

Children affected by social neglect and other forms of abuse are at significant risk of developing mental health problems as well as social, academic, and behavioral functioning difficulties. Some studies have assessed the effectiveness of treatment for children with trauma-attachment disorder. Nevertheless, some questions remain to be answered regarding appropriate treatment.

Objectives

Aim This research identified how filial therapy affects the extent to which foster parents are responsive, sensitive, and attentive to the needs of their children in their care. Subsequently, the study explored how this bond, influenced during filial therapy, affects the signs and symptoms of disinhibited social engagement disorder.

Methods

Method This study used case study as the methodology to research the influence of filial therapy (CPRT) in foster children who show the symptoms of disinhibited social engagement disorder- aged three to six. Two sets of foster parents received a 10-session filial therapy model (CPRT) across 10 weeks. Pre and post measures of the parent-child relationship were analyzed.

Results

Result The findings indicate that filial therapy greatly enhances the bond between foster parents and children with DSEDs. Moreover, these improvements in the bond diminished the symptoms of disinhibited social engagement disorder.

Conclusions

Conclusion The impact of filial therapy as a responsive intervention reduced the symptoms of disinhibited social engagement disorder. The symptoms have declined very likely as a result of rebuilding, regenerating, and enhancing the relationship between foster children and foster parents.

Disclosure

No significant relationships.

A pen device for injection of recombinant human growth hormone: a European usability engineering study

OBJECTIVE

The Aluetta™ reusable pen device and instructions for use (IFU) for growth hormone (r-hGH; Saizen®, Merck KGaA, Darmstadt, Germany) administration were tested for Human-Factors Usability, to ensure it could be used safely and effectively by the intended users in the intended use environment.

RESEARCH DESIGN AND METHODS

Usability testing was conducted under simulated conditions in three groups of participants: pediatric or adult patients with growth hormone deficiency (GHD), participants without GHD, and healthcare professionals (HCPs). The testing comprised a 45-minute training session, a 2-hour testing session, and a participant-feedback session.

RESULTS

Twenty-six participants completed the training session and performed all critical tasks related to the pen use across three scenarios. The most difficult tasks were related to the preparation, checking, and maintenance of the device; only 8% of use errors occurred during tasks related to the injection process. Eighty-five percent considered the pen safe and effective to use without further modifications and the training to be clear and effective.

CONCLUSIONS

The pen device and associated materials benefited from Human Factors Engineering throughout the development process. These evaluations show that patients and HCPs could safely and effectively use the pen device, and the IFU and training were clear and effective.

Benchmarking nurse outcomes in Australian Magnet® hospitals: cross-sectional survey

Background

Positive reports of nursing-related outcomes such as quality nursing care, nursing engagement with work and good practice environment are crucial in attaining and maintaining Magnet® designation. The majority of Magnet®-designated organisations (N = 482) are in the USA, with their aggregate nursing outcomes widely published as benchmark data. Australian Magnet® outcomes have not been aggregated or published to date.

Methods

The aims are to benchmark educational preparation, occupational burnout, job satisfaction, intention to leave and working environment of nurses in Australian Magnet®-designated facilities and to determine the reliability of the Practice Environment Scale-Australia.

The design is a cross-sectional multisite survey set in all three Australian Magnet®-designated organisations.

The demographics included age, gender, level of education, years in practice, level of seniority and position title. Two items measured job satisfaction and intent to stay in current employment. The Maslach Burnout Inventory explored the three domains of nursing engagement: depersonalisation, personal achievement and emotional exhaustion. The Australian version of the Practice Environment Scale interrogated participants’ perceptions of their work environments.

Results

2004 nurses participated (response rate 45.9%). Respondents’ mean age was 39.2 years (range 20–72). They were predominantly female and had worked in their current facility for more than 5 years. Eighty five percent had a minimum of a Bachelor’s degree. Eighty-six percent of respondents were satisfied or very satisfied with their current position. Eighty eight percent had no intention of leaving their current employer within the next 12 months. Participants rated their hospitals highly in all domains of the practice environment. Respondents reported less burnout in the personal accomplishment and depersonalisation domains than in the emotional exhaustion domain, in which they reported average levels of burnout. The internal consistency of the Practice Environment Scale-Australia was confirmed in this sample (Cronbach α’s 0.87–0.9 for subscales and 0.89 for composite score).

Conclusion

In this paper, we present nursing outcome data from all Australian Magnet® hospitals for the first time. This provides a benchmark that facilitates comparison with nursing outcomes published by Australian non-Magnet® hospitals and with international Magnet® organisations.

The effect of yoga practice on glycemic control and other health parameters in the prediabetic state: A systematic review and meta-analysis

A systematic review and meta-analysis was conducted to investigate the effects of yoga on glycemic control, lipid profiles, body composition and blood pressure in people in the pre-diabetic state. Studies on the effectiveness of yoga on population groups under high risk for diabetes, called prediabetic or suffering from metabolic syndromes were extracted from a thorough search of PubMed, Scopus, Cochrane Library, EBSCO and IndMED databases. Both Randomised Controlled Trial (RCT) and non-RCT studies were included in the systematic review and meta-analysis. Studies published between Jan 2002 and Dec 2018 were included. Studies were considered for evaluation if they investigated a yoga intervention to prevent T2DM, against a control group, while also reporting glycemic control and other health parameters of T2DM management. Summary effect sizes and 95% confidence intervals (CI) were calculated using the Comprehensive Meta-Analysis software in addition to publication bias. Of the 46,500 identified studies, 14 studies with 834 participants of whom were 50% women, were found to be eligible for inclusion in our systematic review. Our quantitative synthesis included 12 randomized control trials and 2 non-randomized control trials, with the follow-up period ranging from 4 to 52 weeks. Compared to controls, yoga intervention improved fasting blood glucose (FBG) [Standard Mean Difference (SMD -0.064 mg/dL (95% CI -0.201 to 0.074)]; low density lipoprotein (LDL) [SMD-0.090 mg/dL (95% CI -0.270 to 0.090)]; triglycerides [SMD -0.148 mg/dL (95% CI -0.285 to -0.012)]; total cholesterol [SMD -0.058 mg/dL (95% CI -0.220 to 0.104)] and systolic blood pressure [SMD -0.058 mm Hg (95% CI -0.168 to 0.053)]. This meta-analysis uncovered clinically improved effects of yoga intervention on glycemic control, lipid profiles and other parameters of T2DM management in prediabetic population. These results suggest that yoga intervention may be considered as a comprehensive and alternative approach to preventing T2DM. Further adequately powered, well designed RCTs are needed to support our findings and investigate the long-term effects of yoga in T2DM patients.

The effectiveness of yoga to prevent diabetes mellitus type 2: A protocol for systematic review and meta-analysis

BACKGROUND

Type 2 diabetes mellitus (T2DM) is becoming a leading problem worldwide. Emerging reports reveal alarming evidence of increasing prevalence of T2DM that has reached pandemic levels. Despite the significant incidence, there are limited reliable data resources and comprehensive systematic review and meta-analysis on the effects of yoga on people who are a prediabetic or high risk for developing T2DM.

OBJECTIVE

The objective of this protocol is to conduct a full-scale systematic review and meta-analyses on the effects of yoga on people who are prediabetes or high risk of developing T2DM.

METHODS

The articles enrolled in the study will be retrieved from the online databases between 2002 and the date the searches are executed. The searches will be repeated just before the final analyses and further relevant studies for inclusion. We will conduct a bibliographic search in databases: Medline/PubMed, Scopus, Cochrane Library, EBSCO, and IndMED using keywords including prediabetes state, high risk for diabetes, metabolic syndrome, and yoga. A defined search strategy will be implemented along with selection criteria to obtain full-text articles of relevant studies. This study protocol was prepared according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Protocols 2015 guidelines. There will be no language restrictions.

ETHICS AND DISSEMINATION

The proposed study will be based on published studies and publicly available anonymized data without directly involving human participants and therefore requires neither formal human ethical review nor approval by a human research ethics committee. We published an outline of the protocol in the International Prospective Register of Systematic Reviews (PROSPERO) in 2018. We plan to disseminate the findings of this systematic review and meta-analysis through publication in a peer-reviewed journal and presentation at relevant conference proceedings. In addition, we believe the results of the systematic review will have implications for policy and practice. We will prepare policymaker summary using a validated format, disseminate through social media and email discussion groups.

REVIEW REGISTRATION NUMBER

PROSPERO registration number CRD 42018106657.

Final Results of the Prospective FH02 Mammographic Surveillance Study of Women Aged 35-39 at Increased Familial Risk of Breast Cancer

BACKGROUND

Many women who are at increased risk of breast cancer due to a mother or sister diagnosed with breast cancer aged under 40 do not currently qualify for surveillance before 40 years of age. There are almost no available data to assess whether mammography screening aged 35-39 years would be effective in this group, in terms of detection of breast cancer at an early stage or cost effective.

METHODS

A cohort screening study (FH02) with annual mammography was devised for women aged 35-39 to assess the sensitivity and screening performance and potential survival of women with identified tumours.

FINDINGS

2899 women were recruited from 12/2006-12/2015. These women underwent 12,086 annual screening mammograms and were followed for 13,365.8 years. A total of 55 breast cancers in 54 women occurred during the study period (one bilateral) with 50 cancers (49 women) (15 CIS) adherent to the screening. Eighty percent (28/35) of invasive cancers were ≤ 2 cm and 80% also lymph node negative. Invasive cancers diagnosed in FH02 were significantly smaller than the comparable (POSH-unscreened prospective) study group (45% (131/293) ≤ 2 cm in POSH vs 80% (28/35) in FH02 p < 0.0001), and were less likely to be lymph-node positive (54% (158/290, 3 unknown) in POSH vs 20% (7/35) in FH02: p = 0.0002. Projected and actual survival were also better than POSH. Overall radiation dose was not higher than in an older screened population at mean dose on study per standard sized breast of 1.5 mGy.

INTERPRETATION

Mammography screening aged 35-39 years detects breast cancer at an early stage and is likely to be as effective in reducing mortality as in women at increased breast cancer risk aged 40-49 years.

Positive social behaviours are induced and retained after oxytocin manipulations mimicking endogenous concentrations in a wild mammal

The neuropeptide hormone oxytocin modulates numerous social and parental behaviours across a wide range of species, including humans. We conducted manipulation experiments on wild grey seals (Halichoerus grypus) to determine whether oxytocin increases proximity-seeking behaviour, which has previously been correlated with endogenous oxytocin concentrations in wild seal populations. Pairs of seals that had never met previously were given intravenous injections of 0.41 µg kg-1 oxytocin or saline and were observed for 1 h post-manipulation. The dose was designed to mimic endogenous oxytocin concentrations during the observation period, and is one of the lowest doses used to manipulate behaviour to date. Seals given oxytocin spent significantly more time in close proximity to each other, confirming that oxytocin causes conspecifics to seek others out and remain close to one another. Aggressive and investigative behaviours also significantly fell after oxytocin manipulations. Despite using a minimal oxytocin dose, pro-social behavioural changes unexpectedly persisted for 2 days despite rapid dose clearance from circulation post-injection. This study verifies that oxytocin promotes individuals staying together, demonstrating how the hormone can form positive feedback loops of oxytocin release following conspecific stimuli, increased motivation to remain in close proximity and additional oxytocin release from stimuli received while in close proximity.

Dynamic habitat corridors for marine predators; intensive use of a coastal channel by harbour seals is modulated by tidal currents

Abstract

Previous studies have found that predators utilise habitat corridors to ambush prey moving through them. In the marine environment, coastal channels effectively act as habitat corridors for prey movements, and sightings of predators in such areas suggest that they may target these for foraging. Unlike terrestrial systems where the underlying habitat structure is generally static, corridors in marine systems are in episodic flux due to water movements created by tidal processes. Although these hydrographic features can be highly complex, there is generally a predictable underlying cyclic tidal pattern to their structure. For marine predators that must find prey that is often patchy and widely distributed, the underlying temporal predictability in potential foraging opportunities in marine corridors may be important drivers in their use. Here, we used data from land-based sightings and 19 harbour seals (Phoca vitulina) tagged with high-resolution GPS telemetry to investigate the spatial and temporal distribution patterns of seals in a narrow tidal channel. These seals showed a striking pattern in their distribution; all seals spent a high proportion of their time around the narrowest point of the channel. There was also a distinctive tidal pattern in the use of the channel; sightings of seals in the water peaked during the flood tide and were at a minimum during the ebb tide. This pattern is likely to be related to prey availability and/or foraging efficiency driven by the underlying tidal pattern in the water movements through the channel.

Significance Statement

To maximise foraging efficiency, predators often make use of narrow constrictions in habitat to intercept prey using these corridors for movement. In the marine environment, narrow channels may act as corridors, and sightings of predators suggest that they may target these for foraging. Despite this, there is little information on how individual predators use such areas. Here, we investigate how individual harbour seals use a narrow coastal channel subject to strong tidal currents; results showed that seals spent the majority of their time at the narrowest point of the channel foraging during peak tidal currents. This highlights the importance of narrow channels for marine predators and suggests that this usually wide-ranging predator may restrict its geographic range to forage in the channel as a result of increased prey availability and/or foraging efficiency driven by water movements through the narrow corridor.

Electronic supplementary material

The online version of this article (doi:10.1007/s00265-016-2219-7) contains supplementary material, which is available to authorized users.

Budner's Intolerance of Ambiguity: A Note concerning Intelligence

Budner's measure of intolerance of ambiguity has been applied as an explanatory device for a wide variety of behavioral phenomena. Data from 100 high school girls, given several scales, indicate a strong component of ability in the scores. The role of intelligence in studies of intolerance of ambiguity has been neglected; conceptual clarification of the issue appears warranted.

Development of an animal-borne blood sample collection device and its deployment for the determination of cardiovascular and stress hormones in phocid seals

An animal-borne blood sampler with data-logging functions was developed for phocid seals, which collected two blood samples for the comparison of endocrinological/biochemical parameters under two different conditions. The sampler can be triggered by preset hydrostatic pressure, acceleration (descending or ascending), temperature, and time, and also manually by light. The sampling was reliable with 39/50 (78%) successful attempts to collect blood samples. Contamination of fluids in the tubing to the next blood sample was <1%, following the prior clearance of the tubing to a waste syringe. In captive harbor seals (Phoca vitulina), the automated blood-sampling method was less stressful than direct blood withdrawal, as evidenced by lower levels of stress hormones (P < 0.05 for ACTH and P = 0.078 for cortisol). HPLC analyses showed that both cortisol and cortisone were circulating in seal blood. Using the sampler, plasma levels of cardiovascular hormones, atrial natriuretic peptide (ANP), AVP, and ANG II were compared in grey seals (Halichoerus grypus), between samples collected when the animals were on land and in the water. HPLC analyses determined that [Met¹²] ANP (1-28) and various forms of angiotensins (ANG II, III, and IV) were circulating in seal blood. Although water immersion profoundly changes the plasma levels of cardiovascular hormones in terrestrial mammals, there were only tendencies toward an increase in ANP (P = 0.069) and a decrease in AVP (P = 0.074) in the seals. These results suggest that cardiovascular regulation in phocid seals may have undergone adaptation during evolution of the carnivore to a semiaquatic lifestyle.

The Adolescent Risk-Taking Questionnaire

Compared to other life periods, adolescence is characterized by a heightened potential for risky behaviors. This study reports the systematic development and psychometric evaluation of a comprehensive Adolescent Risk-Taking Questionnaire (ARQ). It was developed using reports of 570 adolescents and was psychometrically evaluated with a sample of 925 adolescents between 11 and 18 years of age. Principal components analyses yielded a four-factor risk structure, and these factors were substantiated via a confirmatory factor analysis. One week test-retest and internal consistency indices were demonstrated to be sound. Age and gender differences were found to be consistent with reported trends in accident data. Older adolescents and boys reported lower risk perceptions and a higher frequency of risky behaviors than younger adolescents and girls, respectively, supporting the validity of the ARQ. Furthermore, consistent with past research, perceiving higher levels of risk typically related to lower levels of engaging in the respective behaviors.

GPs views and understanding of PSA testing, screening and early detection; survey

BACKGROUND

There is currently no national prostate cancer screening programme in the UK. However, patients 50 years and older are entitled to a prostate specific antigen (PSA) test, if informed on the advantages and disadvantages of testing and their risk of cancer. The Prostate Cancer Risk Management Programme (PCRMP) provides this guidance.

AIM

The aim of this study was to access GPs' views and understanding of PSA testing, prostate cancer screening and early detection.

METHOD

A total of 708 questionnaires were returned by GPs across two English regions in 2013 and the GP questionnaire responses were quantitatively analysed.

RESULTS

In the 699 completed questionnaires, the majority of GPs were well informed about PSA testing, screening and early detection. Only 32% used guidelines for referral, 14% knew all age-specific PSA referral levels, 71% that Black men have a higher prostate cancer risk than White men (22% correctly answered threefold increase) and 82% that family history is a risk factor. A further 78% thought electronic prompts during consultation would encourage PCRMP guideline usage and 75% had never been offered a PSA test and prostate cancer educational course, of which 73% would like to attend a course. Only 23% were aware of the latest PSA screening evidence and 94% would like an update.

CONCLUSIONS

Participating GPs seem to be well informed but need more information and tools to help follow recommended guidance. In particular, increased awareness of PCRMP guidelines especially by automated methods, further educational courses and evidence updates would be beneficial.

Prostate-specific antigen testing rates and referral patterns from general practice data in England

BACKGROUND

There is currently no national screening programme for prostate cancer in England, but eligible men can request a prostate-specific antigen (PSA) test from their general practitioner (GP). There are no routinely available data to monitor the extent of PSA testing and referral.

AIM

The aim of this study was to investigate the rate of PSA testing in general practice and subsequent patterns of referral.

DESIGN AND SETTING

Data obtained from the Clinical Practice Research Datalink (CPRD) for men aged 45-84 years who had a PSA test during 2010-2011, registered in practices in England with linked Hospital Episode Statistics (HES) data.

METHOD

Patient data were linked to previous tests and consultations. Rates of PSA testing and proportions of men retested and referred to secondary care were calculated.

RESULTS

Overall, 8.74 (95% CI 8.67-8.82) of men per 100 person-years were tested at least once in 2010, and 9.45 (95% CI 9.37-9.53) in 2011. Rates increased with age and decreased with increasing level of deprivation. Of the 53,069 men tested in 2010, 11,289 (21.3%) had a previous PSA test within the past 12 months. Of men with raised PSA according to age specific guidelines, 22.4% (2113/9425) were referred to secondary care within 14 days, with 36% of the remainder retested within 6 months.

CONCLUSIONS

Rates of PSA testing have increased compared with earlier studies; the data suggest that many GPs are retesting men with raised PSA rather than referring immediately. More routine data on PSA testing, including reasons for testing, and subsequent management and outcomes, are required.

Equine grass sickness, but not botulism, causes autonomic and enteric neurodegeneration and increases soluble N-ethylmaleimide-sensitive factor attachment receptor protein expression within neuronal perikarya

REASONS FOR PERFORMING STUDY

Equine grass sickness (EGS) is of unknown aetiology. Despite some evidence suggesting that it represents a toxico-infection with Clostridium botulinum types C and/or D, the effect of EGS on the functional targets of botulinum neurotoxins, namely the soluble N-ethylmaleimide-sensitive factor attachment receptor (SNARE) proteins, is unknown. Further, while it is commonly stated that, unlike EGS, equine botulism is not associated with autonomic and enteric neurodegeneration, this has not been definitively assessed.

OBJECTIVES

To determine: 1) whether botulism causes autonomic and enteric neurodegeneration; and 2) the effect of EGS on the expression of SNARE proteins within cranial cervical ganglion (CCG) and enteric neuronal perikarya.

STUDY DESIGN

Descriptive study.

METHODS

Light microscopy was used to compare the morphology of neurons in haematoxylin-eosin stained sections of CCG and ileum from 6 EGS horses, 5 botulism horses and 6 control horses. Immunohistochemistry was used to compare the expression of synaptosomal-associated protein-25, synaptobrevin (Syb) and syntaxin within CCG neurons, and of Syb in enteric neurons, from horses with EGS, horses with botulism and control horses. The concentrations of these SNARE proteins in extracts of CCG from EGS and control horses were compared using quantitative fluorescent western blotting.

RESULTS

EGS, but not botulism, was associated with autonomic and enteric neurodegeneration and with increased immunoreactivity for SNARE proteins within neuronal perikarya. Quantitative fluorescent western blotting confirmed increased concentrations of synaptosomal-associated protein-25, Syb and syntaxin within CCG extracts from EGS vs. control horses, with the increases in the latter 2 proteins being statistically significant.

CONCLUSIONS

The occurrence of autonomic and enteric neurodegeneration, and increased expression of SNARE proteins within neuronal perikarya, in EGS but not botulism, suggests that EGS may not be caused by botulinum neurotoxins. Further investigation of the aetiology of EGS is therefore warranted.

Conspecific recognition and aggression reduction to familiars in newly weaned, socially plastic mammals

Recognising conspecifics and behaving appropriately towards them is a crucial ability for many species. Grey seals (Halichoerus grypus) show varying capabilities in this regard: mother-pup recognition has been demonstrated in some geographical populations but is absent in others, yet there is evidence that individuals aggregate with prior associates. The recognition capabilities of newly weaned grey seal pups were investigated using class recognition trials within the habituation/dishabituation paradigm. Trials took place in pens, using pairs of individuals that either had previously cohabited (familiar) or that had never met before (stranger). Frequencies of olfactory and visual investigative behaviours ('checks') and aggressive interactions were recorded during trials. Familiar individuals recognised each other: paired strangers showed significantly more checks and aggressive interactions than were seen in trials pairing familiars. Oxytocin concentrations in post-trial plasma samples were analysed to investigate the underlying physiology modulating recognition abilities; however, no significant differences were detected between familiar or stranger trials. This study demonstrates that at a young age, grey seals can recognise individuals they have previously encountered. Recognition abilities in this species have adaptive value by allowing the reduction of costly aggressive interactions between familiar conspecifics, which is often cited as the first step towards the evolution of sociality in a species. This study is the first with wild subjects to find conspecific recognition abilities in a pinniped species outside of reproductive contexts. It demonstrates that even largely solitary species can be capable of recognition and pro-social behaviours that benefit them during times when they must aggregate.

Mammographic surveillance in women aged 35-39 at enhanced familial risk of breast cancer (FH02)

Although there have been encouraging recent studies showing a potential benefit from annual mammography in women aged 40-49 years of age with an elevated breast cancer risk due to family history there is little evidence of efficacy in women aged <40 years of age. A prospective study (FH02) has been developed to assess the efficacy of mammography screening in women aged 35-39 years of age with a lifetime breast cancer risk of ≥ 17 % who are not receiving MRI screening. Retrospective analyses from five centres with robust recall systems identified 47 breast cancers (n = 12 in situ) with an interval cancer rate of 15/47 (32%). Invasive tumour size, lymph node status and current vital status were all significantly better than in two control groups of unscreened women (including those with a family history) recruited to the POSH study. Further evaluation of the prospective arm of FH02 is required to assess the potential added value of digital mammography and the cancer incidence rates in moderate and high risk women in order to inform cost effectiveness analyses.

Physical and physiological characteristics in male team handball players by playing position - Does age matter?

AIM

The purpose of this study was to examine the variation in physical and physiological characteristics according to playing position in adolescent and adult male team handball (TH) players.

METHODS

Adolescent (N.=57, aged 14.9±1.4 yr) and adult (N.=39, 26.6±5.7 yr) players were examined for anthropometric characteristics, somatotype and body composition, and performed the physical working capacity test, a force-velocity test, the Wingate anaerobic test (WAnT), sit-and-reach test, handgrip strength test, squat jump (SJ), countermovement vertical jump without (CMJ) and with arm-swing, and a 30-s Bosco test. Eccentric utilization ratio (EUR) was calculated as the ratio CMJ to SJ.

RESULTS

In adult players, there were significant differences between wings and the other positions with regard to anthropometric and body composition parameters (body mass, -17.9% to -13.2%; height, -5.3% to -4.3%; and fat-free mass, -13.7% to -9.9%) and anaerobic power assessed by WAnT (peak power, -20.5% to -15.2%; and mean power, -20% to -14.8%); however, these characteristics did not differ significantly in adolescents, in which the only statistically significant difference was found between goalkeepers and the other positions in EUR (+8.1%).

CONCLUSION

Therefore, the differences in physical and physiological characteristics between playing positions are age-dependent. As adult players in this study were taken from players competing in the top Greek league, findings could serve as a base for talent identification and development for future studies. Moreover, knowledge about positional differences might enhance the ability to make tailored position-specific training programs among adult and adolescent players in the future.

Comparison of fully and semi-automated area-based methods for measuring mammographic density and predicting breast cancer risk

BACKGROUND

Mammographic density is a strong risk factor for breast cancer but the lack of valid fully automated methods for quantifying it has precluded its use in clinical and screening settings. We compared the performance of a recently developed automated approach, based on the public domain ImageJ programme, to the well-established semi-automated Cumulus method.

METHODS

We undertook a case-control study within the intervention arm of the Age Trial, in which ∼54,000 British women were offered annual mammography at ages 40-49 years. A total of 299 breast cancer cases diagnosed during follow-up and 422 matched (on screening centre, date of birth and dates of screenings) controls were included. Medio-lateral oblique (MLO) images taken closest to age 41 and at least one year before the index case's diagnosis were digitised for each participant. Cumulus readings were performed in the left MLO and ImageJ-based readings in both left and right MLOs. Conditional logistic regression was used to examine density-breast cancer associations.

RESULTS

The association between density readings taken from one single MLO and breast cancer risk was weaker for the ImageJ-based method than for Cumulus (age-body mass index-adjusted odds ratio (OR) per one s.d. increase in percent density (95% CI): 1.52 (1.24-1.86) and 1.61 (1.33-1.94), respectively). The ImageJ-based density-cancer association strengthened when the mean of left-right MLO readings was used: OR=1.61 (1.31-1.98).

CONCLUSIONS

The mean of left-right MLO readings yielded by the ImageJ-based method was as strong a predictor of risk as Cumulus readings from a single MLO image. The ImageJ-based method, using the mean of two measurements, is a valid automated alternative to Cumulus for measuring density in analogue films.

Pup mortality in a rapidly declining harbour seal (Phoca vitulina) population

The harbour seal population in Orkney, off the north coast of Scotland, has reduced by 65% between 2001 and 2010. The cause(s) of this decline are unknown but must affect the demographic parameters of the population. Here, satellite telemetry data were used to test the hypothesis that increased pup mortality could be a primary driver of the decline in Orkney. Pup mortality and tag failure parameters were estimated from the duration of operation of satellite tags deployed on harbour seal pups from the Orkney population (n = 24) and from another population on the west coast of Scotland (n = 24) where abundance was stable. Survival probabilities from both populations were best represented by a common gamma distribution and were not different from one another, suggesting that increased pup mortality is unlikely to be the primary agent in the Orkney population decline. The estimated probability of surviving to 6 months was 0.390 (95% CI 0.297 – 0.648) and tag failure was represented by a Gaussian distribution, with estimated mean 270 (95% CI = 198 – 288) and s.d. 21 (95% CI = 1 – 66) days. These results suggest that adult survival is the most likely proximate cause of the decline. They also demonstrate a novel technique for attaining age-specific mortality rates from telemetry data.

Evaluation of mammographic surveillance services in women aged 40-49 years with a moderate family history of breast cancer: a single-arm cohort study

BACKGROUND

Women with a significant family history of breast cancer are often offered more intensive and earlier surveillance than is offered to the general population in the National Breast Screening Programme. Up to now, this strategy has not been fully evaluated.

OBJECTIVE

To evaluate the benefit of mammographic surveillance for women aged 40-49 years at moderate risk of breast cancer due to family history. The study is referred to as FH01.

DESIGN

This was a single-arm cohort study with recruitment taking place between January 2003 and February 2007. Recruits were women aged < 50 years with a family history of breast or ovarian cancer conferring at least a 3% risk of breast cancer between ages 40 and 49 years. The women were offered annual mammography for at least 5 years and observed for the occurrence of breast cancer during the surveillance period. The age group 40-44 years was targeted so that they would still be aged < 50 years after 5 years of surveillance.

SETTING

Seventy-four surveillance centres in England, Wales, Scotland and Northern Ireland.

PARTICIPANTS

A total of 6710 women, 94% of whom were aged < 45 years at recruitment, with a family history of breast cancer estimated to imply at least a 3% risk of the disease between the ages of 40 and 50 years.

INTERVENTIONS

Annual mammography for at least 5 years.

MAIN OUTCOME MEASURES

The primary study end point was the predicted risk of death from breast cancer as estimated from the size, lymph node status and grade of the tumours diagnosed. This was compared with the control group from the UK Breast Screening Age Trial (Age Trial), adjusting for the different underlying incidence in the two populations.

RESULTS

As of December 2010, there were 165 breast cancers diagnosed in 37,025 person-years of observation and 30,556 mammographic screening episodes. Of these, 122 (74%) were diagnosed at screening. The cancers included 44 (27%) cases of ductal carcinoma in situ. There were 19 predicted deaths in 37,025 person-years in FH01, with an estimated incidence of 6.3 per 1000 per year. The corresponding figures for the Age Trial control group were 204 predicted deaths in 622,127 person-years and an incidence of 2.4 per 1000 per year. This gave an estimated 40% reduction in breast cancer mortality (relative risk = 0.60; 95% confidence interval 0.37 to 0.98; p = 0.04).

CONCLUSIONS

Annual mammography in women aged 40-49 years with a significant family history of breast or ovarian cancer is both clinically effective in reducing breast cancer mortality and cost-effective. There is a need to further standardise familial risk assessment, to research the impact of digital mammography and to clarify the role of breast density in this population.

TRIAL REGISTRATION

National Research Register N0484114809.

FUNDING

This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 17, No. 11. See the HTA programme website for further project information.

Characterizing the developmental profile of effort-induced motor overflow across a timed trial

Motor overflow is overt involuntary movement that accompanies voluntary movement. This study investigated the change in overflow production across a timed trial and the factors that affected this profile. Seventeen children (aged 8-11 years), 17 young adults (aged 18-35 years), and 17 older adults (aged 60-80 years) performed a 5-s finger pressing task by exerting 33% or 66% of their maximal force output using either index finger. Overflow was recorded as force from the alternative index finger. Young adult overflow remained stable over the 5 s. The rate of overflow increase over time was significantly greater for children than young adults. There was also a tendency for a greater overflow increase in older adults than in young adults. This overflow gradient was also greater in the right hand, particularly for children. These findings indicate that the neurological processes underlying overflow production are age dependent. Overflow progressed in a dynamic fashion over the course of a trial in children and older adults, probably because of increased bilateral cortical activation and the facilitation of motor task performance. This study is unique in quantitatively capturing the dynamic profile of overflow production in healthy participants across the life span.

Selective blubber fatty acid mobilization in lactating gray seals (Halichoerus grypus)

During negative energy balance periods, fatty acids (FAs) are mobilized to cover the metabolic demands of the body. FAs from adipose tissue are selectively mobilized according to their carbon length (CL) and number of double bonds (DBs); however, studies in vivo have focused only on fasting and nonlactating animals. During lactation, UK gray seals fast for 18 d, mobilizing a large amount of lipid from blubber to sustain their own metabolic demands and the nutritional requirements of pups. We investigated FA mobilization in individual gray seal mothers from two UK colonies sampled in 2005 and 2006. Linear mixed-effects models were used to examine to what extent the mobilization observed from FAs in blubber can be explained as a function of FAs' CL and number of DBs. FAs were mobilized according to their structure, such that for a given CL, mobilization increased with the number of DBs, and for a given number of DBs, mobilization decreased as CL increased. This pattern of selective mobilization was very similar between colonies, although the relative amounts of component FAs in blubber at early lactation were different between them. FAs, which are considered crucial to pup development, were mobilized more than predicted by the model. This suggests that selective mobilization of FAs is not related solely to the physicochemical characteristics of the FAs but also to the needs of a growing pup.

European guidelines for quality assurance in colorectal cancer screening and diagnosis: overview and introduction to the full supplement publication

Population-based screening for early detection and treatment of colorectal cancer (CRC) and precursor lesions, using evidence-based methods, can be effective in populations with a significant burden of the disease provided the services are of high quality. Multidisciplinary, evidence-based guidelines for quality assurance in CRC screening and diagnosis have been developed by experts in a project co-financed by the European Union. The 450-page guidelines were published in book format by the European Commission in 2010.  They include 10 chapters and over 250 recommendations, individually graded according to the strength of the recommendation and the supporting evidence. Adoption of the recommendations can improve and maintain the quality and effectiveness of an entire screening process, including identification and invitation of the target population, diagnosis and management of the disease and appropriate surveillance in people with detected lesions. To make the principles, recommendations and standards in the guidelines known to a wider professional and scientific community and to facilitate their use in the scientific literature, the original content is presented in journal format in an open-access Supplement of Endoscopy. The editors have prepared the present overview to inform readers of the comprehensive scope and content of the guidelines.