UK endoscopy trainer survey: perspectives on current endoscopy training delivery, experience, barriers and opportunities

Objective

UK endoscopy training is delivered by trainers possessing well developed endoscopy and teaching skills to help learners perform high-quality endoscopy. Train The Trainer (TTT) courses are effective, but additional trainer support is variable with little formal quality assurance. We performed a survey to map UK endoscopy training, assess trainer perspectives on training delivery and identify factors that would enhance training.

Design/Method

An online survey was designed by trainer representatives, in collaboration with the JAG training committee, and collected responses from trainers registered on JAG endoscopy training system e-portfolio from April to June 2022.

Results

There were 1024 responses from all trainer disciplines, with 813 (79%) completing TTT courses and 584 (57%) having job planned dedicated training lists (DTLs). Clinical endoscopists most frequently had job-planned DTLs (71%), and DTLs occurring at least weekly (58%). 293 (29%) respondents participated as course faculty. Trainers reported high levels of pre-procedure preparation, effective dialogue and frequent feedback. The DOPS forms were 'always/often' completed by 81% of clinical endoscopists, 73% of gastroenterologist and 58% of surgeons. 435 (42%) trainers never had peer feedback. Responses suggested training could improve by protecting training time, attending courses, participating as faculty and receiving feedback from experienced trainers.

Conclusion

This survey demonstrates substantial proportions of highly motivated UK trainers who value time spent teaching and learning how to teach. Skills taught on the TTT courses are often actively used in everyday training. Improved trainer course access, protected training time and formal use of existing feedback tools by peers were highlighted as measures that could support trainers' development.

114 Pain and objectively measured cognitive performance in adults with multiple sclerosis: a systematic review

Background

Pain and cognition are important symptoms in multiple sclerosis (MS). Cognitive processes contributing to pain experience are increasingly documented. Any relationship between pain and objectively measured cognitive performance (OMCP) in MS, including potential mediating factors such as fatigue and medication, remains unclear. Understanding this relationship may facilitate targeted treatment strategies.

Objective

Determine the relationship between pain and OMCP in MS.

Methods

We conducted a systematic review, following a pre-registered protocol, of clinical studies examining relationships between pain and OMCP in MS. We searched MEDLINE, Embase and PsychInfo. We assessed confounders and described findings using neuropsychologist-assigned cognitive domains. Risk of bias was assessed using a modified Newcastle-Ottawa Scale.

Results

10 studies were included. Eight studies identified a relationship between pain and OMCP. In six studies, worse pain scores were associated with worse cognition. However, no evidence was available for several cognitive domains. Studies infrequently controlled for confounders. Most studies were judged to be at risk of bias.

Conclusions

While several studies suggest that pain in MS is related to worse objective cognitive perfor- mance, conclusions are limited by study design and limited evidence in many cognitive domains. Future studies should better establish this relationship and delineate the neurological substrate underpinning it.

Longitudinal retinal imaging study of newly diagnosed relapsing-remitting multiple sclerosis in Scottish population: baseline and 12 months follow-up profile of FutureMS retinal imaging cohort

Objective

Multiple sclerosis (MS) is an inflammatory degenerative condition of central nervous system. The disease course and presentation of MS is highly heterogeneous. Advanced retinal imaging techniques such as optic coherence tomography (OCT) can capture abnormalities of anterior visual pathway with high resolution, which may contribute greater insights into the pathophysiology of MS.

Methods

People with newly diagnosed relapsing-remitting MS were recruited for FutureMS retinal imaging study from two study centres in Scotland. The baseline visit was completed within 6 months of diagnosis with initial follow-up 12 months after the baseline visit. The assessments included in FutureMS retinal imaging study were visual acuity test, self-reported eye questionnaire and OCT scan.

Results

A total of 196 FutureMS participants completed the retinal imaging study of FutureMS with 185 participants at M0 and 155 at M12. A total of 144 participants completed both M0 and M12 visits. At the whole cohort level, the distribution of retinal measures is generally consistent between baseline and follow-up.

Conclusion

The FutureMS retinal imaging study aims to demonstrate that patient with MS present with different extent of retinal abnormalities that can be captured by retinal imaging modalities such as OCT soon after diagnosis. These changes may sensitively mirror the brain atrophy or serve as predictors for disease activity. By developing sensitive, quantifiable and objective retinal biomarkers, FutureMS retinal imaging study will provide an opportunity to stratify patient with MS at an early stage and support future therapeutic strategies for a better outcome.

041 Determinants of prolonged time to diagnosis in relapsing-remitting multiple sclerosis in Scotland

Background

There is increasing emphasis on earlier diagnosis in patients with relapsing remitting multiple sclerosis (RRMS) as evidence is accumulating that earlier treatment reduces long-term disability accumu- lation. Much inter-individual variability in time to diagnosis remains unexplained.

Objectives

To examine factors associated with longer time to diagnosis in a cohort of adult patients diagnosed with RRMS in Scotland between January 2016 and February 2019.

Methods

Clinical and demographic features were collected as part of an incidence cohort study. Time to diagnosis was defined as interval between date of first symptom to date of diagnosis and considered prolonged if it was greater than the median value. Age at onset, sex, weight, smoking status, employ- ment status, socioeconomic status and onset symptom type were examined for association with time to diagnosis using logistic regression.

Results

We recruited 440 patients. Median time to diagnosis was 1.75 years. Current employment (OR

2.016 [1.186–3.428] p=0.010) was associated with longer time to diagnosis. We found no association with other variables measured.

Conclusions

Time to diagnosis in RRMS in Scotland is employment status-dependent. A considerable proportion of variance in time to diagnosis remains unexplained in RRMS.

fraser@tonnard.co.uk

032 Systematic review of prediction models in relapsing remitting multiple sclerosis

Background

Prediction of individual disease course in relapsing remitting multiple sclerosis (RRMS) is chal- lenging. This has important implications for informed decision making in clinical practice.

Objectives

To conduct a systematic review in order to establish methodological quality of published prediction models in RRMS.

Methods

We searched Medline, Embase and Web of Science. Reviewers screened abstracts and full text for eligibility and assessed risk of bias. Studies reporting development or validation of prediction models for adults with RRMS were included. Data collection was guided by checklist for critical appraisal and data extraction for systematic reviews and applicability and methodological quality assessment by prediction model risk of bias assessment tool.

Results

30 studies were included. Applicability was assessed as high risk of concern in 29 studies. Risk of bias was assessed as high for all studies. The single most frequently included predictor was baseline EDSS (n=11). T2 Lesion volume or number and brain atrophy were each retained in seven studies. Five studies included external validation. None included impact analysis.

Conclusions

Although a number of prediction models for RRMS have been reported, most are at high risk of bias and lack external validation and impact analysis, restricting their application in clinical practice.

fraser@tonnard.co.uk

Transcriptomic analysis reveals pronounced changes in gene expression due to sub-lethal pyrethroid exposure and ageing in insecticide resistance Anopheles coluzzii

BACKGROUND

Malaria control is heavily reliant on the use of insecticides that target and kill the adult female Anopheline vector. The intensive use of insecticides of the pyrethroid class has led to widespread resistance in mosquito populations. The intensity of pyrethroid resistance in some settings in Africa means mosquitoes can contact bednets treated with this insecticide class multiple times with minimal mortality effects. Furthermore, both ageing and diel cycle have been shown to have large impacts on the resistance phenotype. Together, these traits may affect other aspects of vector biology controlling the vectorial capacity or fitness of the mosquito.

RESULTS

Here we show that sublethal exposure of a highly resistant Anopheles coluzzii population originally from Burkina Faso to the pyrethroid deltamethrin results in large and sustained changes to transcript expression. We identify five clear patterns in the data showing changes to transcripts relating to: DNA repair, respiration, translation, behaviour and oxioreductase processes. Further, we highlight differential regulation of transcripts from detoxification families previously linked with insecticide resistance, in addition to clear down-regulation of the oxidative phosphorylation pathway both indicative of changes in metabolism post-exposure. Finally, we show that both ageing and diel cycle have major effects on known insecticide resistance related transcripts.

CONCLUSION

Sub-lethal pyrethroid exposure, ageing and the diel cycle results in large-scale changes in the transcriptome of the major malaria vector Anopheles coluzzii. Our data strongly supports further phenotypic studies on how transcriptional changes such as reduced expression of the oxidative phosphorylation pathway or pyrethroid induced changes to redox state might impact key mosquito traits, such as vectorial capacity and life history traits.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

Economic Impact of Implementing Malnutrition Screening and Nutritional Management in Older Adults in General Practice

OBJECTIVES

Malnutrition is a common and significant public health problem, especially for older adults, as the consequences are costly. National guidelines (NICE CG32/QS24) highlight the need to identify and manage malnutrition, the implementation of which was deemed "high impact to produce cost savings". The 'Malnutrition Pathway', endorsed by NICE and other professional bodies, is a practical evidence-based guide to help community healthcare professionals (HCP) to implement guidance on malnutrition management. Published evaluations of its use are needed.

DESIGN

This service evaluation in older adults assessed the impact of implementing the 'Malnutrition Pathway' on health care use and costs, as well as the acceptability of the management strategies and effect on malnutrition risk.

SETTING

5 GP surgeries in Gloucestershire.

PARTICIPANTS

163 older adults (80±9 years) with a range of primary diagnoses, living in their own home, were screened using the Malnutrition Universal Screening Tool ('MUST') (n50 low risk (LR); n41 medium risk (MR); n72 high risk (HR)). All patients were managed according to risk (LR: no further management; MR: dietary advice (DA); and HR: DA plus two oral nutritional supplements (ONS) (1 serve 300kcal, 18g protein; 125ml).

MEASUREMENTS

At each review (6weeks, 3 and 6 months), 'MUST' score, compliance and satisfaction to their management plan were recorded. Healthcare use was collected from GP records 6 months before and after implementation of the pathway. A simple cost analysis was completed.

RESULTS

Implementing appropriate management of malnutrition led to significant reductions in hospital admissions (p=0.028), length of hospital stay (p=0.05), GP visits (p=0.007) and antibiotic prescriptions (p=0.05). Over 6 months, the costs to manage malnutrition (HCP time, ONS) were more than offset by the savings associated with these reductions in health care use (per patient savings of -£395.64 MR+HR; -£997.02 HR). The proportion of individuals at risk of malnutrition reduced over time, and patients reported being satisfied with the DA (97%) and ONS (96%), consuming 90% of their ONS prescription.

CONCLUSION

Managing malnutrition significantly reduces healthcare use, with a positive budget impact, in older malnourished patients in primary care. This represents an opportunity to improve patient care with benefit on health care spend.

Synthesis and thermoluminescence of erbium-activated lithium niobate

Erbium-activated lithium niobate; 1, 2, and 4 mol% (LN-1, LN-2 and LN-4 respectively) were synthesized by solid-state method and their thermoluminescent (TL) properties were analyzed. The glow curve of LN-4 showed a maximum at 177 °C and its linear dose-response interval ranged from 50 to 350 Gy. Its TL intensity was two orders of magnitude greater compared to those of pure lithium niobate (LN), LN-1 and LN-2. We conclude that LN-4 is an interesting material for TL dosimetry applications.

Play Within the Pre-registration Children's Nursing Curriculum Within the United Kingdom: A Content Analysis of Programme Specifications

PURPOSE

To determine the number of programme specifications which cite play within the curriculum and in what context. Play is an essential part of childhood. Therefore we might expect nurses caring for children to be trained in how to facilitate play within their clinical areas. Programme specifications provide information on course aims, the intended learning outcomes and what the learner is expected to achieve.

DESIGN AND METHOD

Inductive qualitative content analysis.

RESULTS

Only 13% (seven out of 54) programme specifications published by Higher Education Institutions cite play. Where play is mentioned there is a clear link made to use play as a communication tool. Also distraction figured prominently within the same sentence as play, despite these two terms being quite distinct. The availability of the programme specifications was also noted with 49% (28 out of 57) were easily accessible from the university web sites. A further 16% (9 out of 57) provided web links when access was requested. 35% were not publicly accessible without requesting access. Three Universities declined to be involved.

CONCLUSION

It is clear that even if play is embedded within the child field nursing curriculum, it is not clearly stated as a priority within 87% of universities programme specifications which make no mention of it.

PRACTICE IMPLICATIONS

If play is not part of programme specifications its importance could be lost to educators already delivering a full curriculum. Nurses could be qualifying with little or no knowledge around their role in facilitating play for their patients.

Erratum: The Beaker phenomenon and the genomic transformation of northwest Europe

This corrects the article DOI: 10.1038/nature25738.

The Beaker phenomenon and the genomic transformation of northwest Europe

From around 2750 to 2500 bc, Bell Beaker pottery became widespread across western and central Europe, before it disappeared between 2200 and 1800 bc. The forces that propelled its expansion are a matter of long-standing debate, and there is support for both cultural diffusion and migration having a role in this process. Here we present genome-wide data from 400 Neolithic, Copper Age and Bronze Age Europeans, including 226 individuals associated with Beaker-complex artefacts. We detected limited genetic affinity between Beaker-complex-associated individuals from Iberia and central Europe, and thus exclude migration as an important mechanism of spread between these two regions. However, migration had a key role in the further dissemination of the Beaker complex. We document this phenomenon most clearly in Britain, where the spread of the Beaker complex introduced high levels of steppe-related ancestry and was associated with the replacement of approximately 90% of Britain's gene pool within a few hundred years, continuing the east-to-west expansion that had brought steppe-related ancestry into central and northern Europe over the previous centuries.

Transseptal course of anomalous left main coronary artery originating from single right coronary orifice presenting as unstable angina

Transseptal course of coronary artery has often been described as a benign entity; however, this report and literature analysis provides growing evidence of high risk of serious cardiovascular events in this anomaly. We present a case of unstable angina in a patient with anomalous common origin of left and right coronary arteries from a single coronary ostium at the right sinus of Valsalva, with subsequent transseptal course of the left main artery, review of relevant literature, and discussion of possible management options.

Efficient Hydrogen-Dependent Carbon Dioxide Reduction by Escherichia coli

Hydrogen-dependent reduction of carbon dioxide to formic acid offers a promising route to greenhouse gas sequestration, carbon abatement technologies, hydrogen transport and storage, and the sustainable generation of renewable chemical feedstocks [1]. The most common approach to performing direct hydrogenation of CO₂ to formate is to use chemical catalysts in homogeneous or heterogeneous reactions [2]. An alternative approach is to use the ability of living organisms to perform this reaction biologically. However, although CO₂ fixation pathways are widely distributed in nature, only a few enzymes have been described that have the ability to perform the direct hydrogenation of CO₂ [3, 4, 5]. The formate hydrogenlyase (FHL) enzyme from Escherichia coli normally oxidizes formic acid to carbon dioxide and couples that reaction directly to the reduction of protons to molecular hydrogen [6]. In this work, the reverse reaction of FHL is unlocked. It is established that FHL can operate as a highly efficient hydrogen-dependent carbon dioxide reductase when gaseous CO₂ and H₂ are placed under pressure (up to 10 bar). Using intact whole cells, the pressurized system was observed to rapidly convert 100% of gaseous CO₂ to formic acid, and >500 mM formate was observed to accumulate in solution. Harnessing the reverse reaction has the potential to allow the versatile E. coli system to be employed as an exciting new carbon capture technology or as a cell factory dedicated to formic acid production, which is a commodity in itself as well as a feedstock for the synthesis of other valued chemicals.

•

Escherichia coli produces a formate hydrogenlyase (FHL) enzyme

•

FHL can function in two modes dependent on the prevailing environmental conditions

•

Pressurized CO₂ and H₂ allow FHL to function as a hydrogen-dependent CO₂ reductase

•

The produced formic acid accumulates outside of the bacterial cells

Effect of rest stop duration during long-distance transport on welfare indicators in recently weaned beef calves

Forty newly weaned beef calves (260 ± 32.6 kg) were transported 15 h in a livestock trailer (7.3 by 2.1 m) on 2 separate hauls 1 wk apart (20 calves/haul) to evaluate the effect of rest stop duration on indicators of calf welfare. Immediately following the 15-h journey, 15 calves/haul were randomly unloaded at a feedlot and randomly assigned to 1 of 3 rest stop treatments; calves without resting time (5 calves/haul) remained on the trailer and were used as the control group. Treatments included 0- (Control [CON]), 5- (RS5), 10- (RS10), or 15-h (RS15) rest periods in pens containing ad libitum access to water and long-stem hay. Following each rest period, calves were reloaded onto the same trailer and taken on another 5-h journey, before they were unloaded at the same feedlot, for a total transport event lasting 20 h. Control calves did not have access to feed or water until the end of the 20-h transit event. Behavioral measurements included bunk attendance (min/d) and standing and lying duration (min/d) recorded for 5 h after the 20-h transport event. Physiological measurements included saliva and hair cortisol, complete blood cell count, serum NEFA, haptoglobin, and substance P concentrations. All physiological measurements as well as BW were taken immediately prior to initial loading, at arrival at the feedlot after the 20-h event, and 48 h after the transport to the same feedlot. Hair cortisol was collected prior to the initial loading and 25 d after transportation. No differences ( = 0.78) in BW loss were observed among treatments after transportation. Standing time was greater ( < 0.001) in CON calves compared with RS5, RS10, and RS15 calves. Salivary cortisol was greater ( < 0.01) in CON and RS15 calves than in RS5 and RS10 calves at the end of the 20-h journey. Serum NEFA concentration was greater ( = 0.03) in RS5 and RS10 calves at arrival compared with CON and RS15 calves, but those differences were no longer observed ( = 0.49) 48 h after transportation. Concentration of substance P did not differ ( = 0.18) between treatments, and haptoglobin concentration tended to be greater ( = 0.07) in CON calves compared with the other treatments 48 h after arrival. Hair cortisol tended ( = 0.10) to be lower in RS5 calves compared with the other treatments. The results of this study indicate that rest stop periods ≥ 10 h did not prevent short- and long-term stress after transport in weaned calves.

Termoluminiscencia de titanato de indio activado con europio

El titanato de indio, In2TiO5, es un buen aislante a temperatura ambiente debido a su ancho de banda prohibida que es de  3.2 eV. En este trabajo se reportan las propiedades termoluminiscentes de In2TiO5 activado con europio que fue sintetizado mediante reacción de estado sólido. El material fue caracterizado con microscopía electrónica de barrido, espectroscopia de dispersión de energía y por difracción de rayos X. La intensidad termoluminiscente del In2TiO5 activado con europio se incrementó cerca de seis veces respecto a la observada para In2TiO5 sin ion activador. La cuva de brillo de In2TiO5: Eu, es una banda ancha y con un máximo en 382 K. Se realizó análisis de deconvolución a las curvas de brillo asumiendo el modelo de cinética de orden general. Se determinaron cinco picos con máximos en 372, 382, 432, 488 y 556 K, los cuales coinciden con los datos experimentales obtenidos con el método de blanqueo térmico Tm-Tstop. La respuesta termoluminiscente respecto a la dosis gama fue lineal entre 31 y 1200 Gy, seguido de una región de saturación a partir de 1400 Gy. La reproducibilidad de la señal termoluminiscente fue 5.7 % en su desviación estándar. El desvanecimiento de la señal TL a temperatura ambiente, fue significativamente influenciado por el pico de baja temperatura (382 K). Los resultados obtenidos sugieren que In2TiO5: Eu podría ser considerado como un fósforo para dosimetría de alta radiación gamma.

BK Virus Associated Nephropathy, a Cause of Early Renal Allograft Dysfunction: A Single Centre Study

BACKGROUND

BK virus associated nephropathy (BKVN) is an important cause of early graft dysfunction in renal transplant recipients. The present study was carried out to determine the burden of BKVN in a single renal transplant centre in Australia.

METHOD

A retrospective analysis of de novo renal transplant recipients from 2010 to 2013 was performed to identify biopsy proven BKVN. Estimated glomerular filtration rate (eGFR) was compared at baseline, at BKVN diagnosis and 3 and 12 months postdiagnosis.

RESULT

Of the 317 de novo renal transplants recipients in the study period, 20 (6.3%) developed BKVN. The mean age was 54.8 ± 13.1 years and 13 (65%) were male. The mean time from transplant to BKVN was 8.7 ± 6.7 months with 17 (85%) diagnosed within 12 months. Four recipients each were diagnosed BKVN on 3 and 12 month surveillance biopsy. Six (30%) had normal eGFR at diagnosis. Mean eGFR at diagnosis was 38.8 ± 19.2 ml/min/1.73 m2, which was significantly lower (p < 0.01) than that at baseline (50.3 ± 16.4 ml/min/1.73 m2). eGFR improved numerically at 3 and 12 months post-diagnosis, however the difference was not significant. One patient had graft failure, 19 months after diagnosis.

CONCLUSION

BKVN generally occurs in first post-transplant year and is an important cause of early graft dysfunction. Surveillance biopsy helps in detecting subclinical BKVN.

The Healing Power of Play: Therapeutic Work with Chronically Neglected and Abused Children

This article concerns a therapeutic intervention with a group of abandoned children living in a Romanian pediatric hospital. The children, ranging in age from one to ten years old, had suffered chronic neglect and abuse. They had previously spent most of their lives tied in the same cot in the same hospital ward. They were poorly fed and their nappies were rarely changed. Although able to see and hear the other abused children, they experienced little in the way of social interaction. The article focuses on the play-based methods that were employed to aid the children’s recovery, while at the same time highlighting the general benefits of this very specific therapeutic approach to children’s recovery and development. In particular, there is an exploration of concepts such as symbolic representation, negative capability, joining, and the significance of play cues. However, despite the clear value of these individually focused techniques, the article proposes the tentative hypothesis that the most powerful healing factor was the unfettered playful interaction between the children themselves. In other words, the children in a very real sense may have healed each other while playing.

Thermoluminescence response and glow curve structure of Sc₂TiO₅ ß-irradiated

Discandium titanate (Sc2TiO5) powder was synthesized in order to analyze its thermoluminescence (TL) response. The TL glow curve structure shows two peaks: at 453-433 K and at 590-553 K. The TL beta dose-response has a linear behavior over the dose range 50-500 Gy. The T(stop) preheat method shows five glow peaks that were taken into account to calculate the kinetic parameters using the CGCD procedure. TL results support the possible use of Sc2TiO5 as a new phosphor in high ß-dose dosimetry.

Investigating the feasibility of mid infrared spectroscopy for monitoring an industrial de-racemization biotransformation process

Biotransformation processes have become industrially important in recent years as routes to the manufacture of high value chemical intermediates. However, measurements of key process features and analyte concentrations during these processes are still typically carried out using off-line analysis methods. Vibrational spectroscopic techniques have been extensively utilised for the monitoring and control of a variety of industrial processes. Despite the techniques success with a range of challenging biological matrices, including fermentation and cell culture systems, application of this approach to biotransformation systems has been limited. In the present study the potential of mid infrared spectroscopy to monitor an industrially relevant de-racemization biotransformation process has been investigated. This process presents a number of difficulties due to the optically challenging sample media, close structural similarities and stoichiometric relationship between the key analytes of interest. A PLS model based on the mid infrared spectra obtained during three replicates of the biotransformation process was constructed. In order to ensure that co-linearity within the system had been adequately addressed the spectral contributors to the model were examined. External validation of the constructed model was achieved by challenging the model with two previously unseen replicates of the process. The constructed model was able to predict the concentrations of two key analytes in various samples from these unseen replicates without the requirement for any time consuming sample pre-treatment stages, thus demonstrating the feasibility of near real-time mid infrared monitoring of such an industrial de-racemization biotransformation process.

The effect of insulin intensification in children and young persons with Type 1 diabetes differs in relation to ethnic group; a prospective observational study

AIMS

We prospectively evaluated the effect of insulin intensification on glycaemic control and lipid levels in children and young persons with Type 1 diabetes in relation to ethnicity.

METHODS

In the first 2 years of a 3-year observation period, as part of routine clinical care, 231 children and young persons (40% white, 28% South Asian, 32% black) from a single clinic were offered intensive insulin therapy. After 2 years, 222 were on intensive therapy and their data were compared between ethnic groups at the end of year 3.

RESULTS

We observed ethnic differences in HbA(1c) levels during the study [study beginning and end: white children and young persons 77 and 70 mmol/mol (9.2 and 8.6%) vs. South Asian 72 and 68 mmol/mol (8.7 and 8.4%) vs. black 83 and 79 mmol/mol (9.7 and 9.4%), P-value for ANCOVA = 0.007]. By study end, South Asians had the lowest HDL cholesterol (2.0 vs. 1.4 vs. 1.6 mmol/l, P-value = 0.03) and highest triglyceride levels (0.9 vs. 1.8 vs. 1.0 mmol/l, P-value = 0.001). In linear mixed modelling, after adjustment for socio-economic deprivation and other covariates: (1) black ethnicity was associated with poorer glycaemic control (P < 0.001) and (2) South Asian ethnicity was associated with higher triglyceride levels (P < 0.001), independent of HbA(1c).

CONCLUSIONS

The effect of insulin intensification on glycaemic control and lipid profile in children and young persons with Type 1 diabetes differs in relation to ethnic group.

Space allowance during commercial long distance transport of cattle in North America

The objective of the present work was to study space allowance in cattle during commercial long haul transport (≥400 km; n = 6,152 journeys). Surveys, delivered to livestock transport carriers, gathered information on the number, BW, and distribution of cattle by trailer compartment as well as the characteristics of the transport vehicles used. Space allowance (SA; m(2)/animal), allometric coefficient (k = SA / BW(0.6667)), and the percentage of deviation from recommended SA (DRSA; %) in the Canadian Codes of Practice were calculated for each compartment of the trailers. All quad-axle (77%) and tri-axle (23%) cattle trailers were reported with 5 compartments (nose, deck, belly, back, and doghouse). Sixty percent of all animals were carried in the middle compartments (deck and belly), 30% in the rear (back and doghouse), and 10% in the front or nose. Approximately 30% of the journeys required that the cattle be redistributed at the Canada-USA border to comply with different axle weight regulations, and most journeys moved them between the deck and the doghouse. Total loaded weight increased and the number of animals decreased with increasing BW of the animals. space allowance, k-value, and DRSA were least for calves and feeders compared with fat and cull cattle (p < 0.01). Both total loaded weight and number of animals increased with the number of axles in the trailer, being greatest in quad-axle trailers pulled by push tractors, which were most frequently used. Space allowance (k-value) was least in vehicles with greater number of axles and transporting the lightest cattle (i.e., quad-axles trailers transporting calves and feeders). Space allowance, k-value, and variability among journeys were least in the middle compartments (belly and deck), followed by the back, then doghouse and nose compartments of the trailers showing the largest values (p < 0.05). Many factors contributed to the variability in SA such as body size (smaller animals are placed more densely), compartment of the trailer (greater density in belly and deck), and number of axles on the vehicle (greater density with more axles). The present study provides a framework to assess and understand factors affecting SA during commercial long distance transport of cattle. This information is vital in assessing the consequences of changing industry standards, guidelines, recommended values, laws and regulations on animal welfare, the industry, and economics.

Factors affecting body weight loss during commercial long haul transport of cattle in North America

The objective of the present study was to identify and quantify several factors affecting shrink in cattle during commercial long-haul transport (≥400 km; n = 6,152 journeys). Surveys were designed and delivered to transport carriers to collect relevant information regarding the characteristics of animals, time of loading, origin and destination, and loaded weight before and after transport. In contrast to fat cattle, feeder cattle exhibited greater shrink (4.9 vs. 7.9 ± 0.2% of BW, respectively; P < 0.01), and experienced longer total transport durations (12.4 vs. 14.9 ± 0.99, respectively; P < 0.01) due to border crossing protocols which require mandatory animal inspection. Shrink was greater (P < 0.001) for feeder cattle loaded at ranches/farms and feed yards compared with those loaded at auction markets. Cattle loaded during the afternoon and evening shrank more than those loaded during the night and morning (P < 0.05). Shrinkage was less in cattle transported by truck drivers having 6 or more years of experience hauling livestock compared with those with 5 yr or less (P < 0.05). Shrink increased with both midpoint ambient temperature (% of BW/°C; P < 0.001) and time on truck (% of BW/h; P < 0.001). Temperature and time on truck had a multiplicative effect on each other because shrink increased most rapidly in cattle transported for both longer durations and at higher ambient temperatures (P < 0.001). The rate of shrink over time (% of BW/h) was greatest in cull cattle, intermediate in calves and feeder cattle, and slowest in fat cattle (P < 0.05) but such differences disappeared when the effects of place of origin, loading time, and experience of truck drivers were included in the model. Cull cattle, calves and feeder cattle appear to be more affected by transport compared with fat cattle going to slaughter because of greater shrink. Several factors should be considered when developing guidelines to reduce cattle transport stress and shrink including type of cattle, ambient temperature, transport duration, driving quality, and time and origin of loading.

Thermoluminescence study of polyminerals extracted from clove and marjoram for detection purposes

Food irradiation is a widely employed technology for food treatment. Since in several countries no regulations prevail, it is difficult to detect whether food has been irradiated or not. Among different analytical methods the study of the thermoluminescent (TL) emission of polymineral extracted from food is one of the most useful physical identification method. The aim of this work is to analyze the TL properties of inorganic polyminerals extracted from commercial clove (Syzygium aromaticum L.) and marjoram (Origanum majorana L.) spices exposed to (60)Co gamma radiation for detection purposes. The feasibility of using the TL method for irradiated food detection and absorbed dose determination is assessed.