Increases in loneliness among Older Americans Act participants during COVID-19

Loneliness is increasingly understood as a public health crisis, and older adults are experiencing particularly severe impacts. Social distancing efforts during the COVID-19 pandemic may have increased loneliness among older adults. Guided by the Social Ecological Model, this study uses two cross-sectional waves of the National Survey of Older Americans Act Participants (NSOAAP) from 2019 and 2021 to expand understanding and identify possible points of intervention to increase social support for vulnerable older adults. Results reveal that while home-delivered meal participants have higher levels of loneliness than congregate meal participants, levels of loneliness did not increase during the COVID-19 pandemic and their loneliness levels did not differ significantly by age, geographic location, or living arrangement. Congregate meal participants' loneliness increased during the first year of the pandemic, particularly for participants aged 65-74, those living in suburban or rural areas, and those living alone. These findings suggest opportunities for policymakers and aging services providers who seek to increase social engagement among older adults who participate in Older Americans Act (OAA) nutrition programs. The evidence suggests a need for increased social engagement initiatives through OAA programs that prioritize social support for groups who are disproportionately burdened by loneliness.

Incisional hernia following colorectal cancer surgery according to suture technique: Hughes Abdominal Repair Randomized Trial (HART)

BACKGROUND

Incisional hernias cause morbidity and may require further surgery. HART (Hughes Abdominal Repair Trial) assessed the effect of an alternative suture method on the incidence of incisional hernia following colorectal cancer surgery.

METHODS

A pragmatic multicentre single-blind RCT allocated patients undergoing midline incision for colorectal cancer to either Hughes closure (double far-near-near-far sutures of 1 nylon suture at 2-cm intervals along the fascia combined with conventional mass closure) or the surgeon's standard closure. The primary outcome was the incidence of incisional hernia at 1 year assessed by clinical examination. An intention-to-treat analysis was performed.

RESULTS

Between August 2014 and February 2018, 802 patients were randomized to either Hughes closure (401) or the standard mass closure group (401). At 1 year after surgery, 672 patients (83.7 per cent) were included in the primary outcome analysis; 50 of 339 patients (14.8 per cent) in the Hughes group and 57 of 333 (17.1 per cent) in the standard closure group had incisional hernia (OR 0.84, 95 per cent c.i. 0.55 to 1.27; P = 0.402). At 2 years, 78 patients (28.7 per cent) in the Hughes repair group and 84 (31.8 per cent) in the standard closure group had incisional hernia (OR 0.86, 0.59 to 1.25; P = 0.429). Adverse events were similar in the two groups, apart from the rate of surgical-site infection, which was higher in the Hughes group (13.2 versus 7.7 per cent; OR 1.82, 1.14 to 2.91; P = 0.011).

CONCLUSION

The incidence of incisional hernia after colorectal cancer surgery is high. There was no statistical difference in incidence between Hughes closure and mass closure at 1 or 2 years.

REGISTRATION NUMBER

ISRCTN25616490 (http://www.controlled-trials.com).

Impact of Ceftiofur Administration in Steers on the Prevalence and Antimicrobial Resistance of Campylobacter spp

Bacterial resistance to ceftiofur raises health concerns due to ceftiofur’s extensive veterinary usage and structural similarity with the human antibiotic ceftriaxone. Ceftiofur crystalline-free acid (CCFA) and ceftiofur hydrochloride (CHCL) are ceftiofur types used therapeutically in cattle, but their potential impacts on Campylobacter prevalence and antimicrobial resistance remain unclear. In this study two groups of steers were each treated with CCFA or CHCL. In vivo active drug concentrations were measured and fecal samples were analyzed for Campylobacter for up to 42 days post-treatment. Following administration, the colonic concentration of ceftiofur initially increased then dropped to pre-treatment levels by day 8. The estimated prevalence of Campylobacter spp. was significantly (p = 0.0009) higher during the first week after CCFA treatment than after CHCL treatment (81.3% vs. 45.2%). Campylobacter jejuni predominated overall, with other Campylobacter spp. mainly identified in the first week after CCFA treatment. No treatment impacts were noted on ceftiofur minimum inhibitory concentration (MIC) for C. jejuni (10–20 μg/mL). More C. jejuni genotypes were detected in CCFA-treated than CHCL-treated steers. These findings suggest that ceftiofur did not significantly impact Campylobacter prevalence or ceftiofur MIC. However, CHCL may be preferable due to the lower likelihood of temporary increases in Campylobacter prevalence.

Albumin and calcium reference interval using healthy individuals and a data-mining approach

BACKGROUND

Harmonization of reference intervals for analytes that have a sound calibration and metrological traceability is a widely recommended practice. The UK Pathology Harmony has recently harmonized reference intervals for calcium and albumin. In this study, we have determined the reference intervals for calcium and albumin on the UK's most commonly used analytical platforms.

METHOD

A prospective reference population of healthy individuals was recruited according to the IFCC CRIDL criteria. A second indirect population was collected from 14 primary care setting and measured in laboratories using various analytical platforms and methods (Roche, Abbott, Beckman and Siemens analytical platforms).

RESULTS

In total, 299 subjects were recruited; the central 95th centile values for calcium for three out of four analytical platforms were in a close agreement with UK Pathology Harmony reference intervals of 2.2-2.6 mmol/L. Reference intervals of BCG methods from both cohorts and irrespective of analytical platforms were higher for both lower and upper reference limits than those for BCP. In comparison, the indirect study showed an age-related variation. The younger population reference intervals varied by up to 5.7% at the lower reference limit and up to 12% at the upper reference limit compared with Pathology Harmony reference intervals, and the older population showed a variation of up to 14% at both limits.

CONCLUSION

While calcium reference intervals can be a subject for harmonization, albumin reference intervals studied showed large variation which is unsupportive of embracing a common reference interval for albumin.

The effect of different analytical platforms and methods on the performance of population-specific adjusted calcium equation

Background

A recent attempt to improve the diagnostic value of adjusted calcium addressed a primary care-specific adjusted calcium equation, but validated the new equation for Roche Cobas, BCG and NM-BAPTA methods only. In this study, we aim to validate a population-specific equation for other methods and platforms.

Method

We collected retrospective patient data-sets from 15 hospital laboratories using a range of commercially available analytical platforms and methods for calcium and albumin measurements. Raw data-sets were collected and filtered according to Payne’s criteria, and separate adjusted calcium equations were derived for hospitalized and primary care patients.

Results

Mean albumin and calcium results were significantly higher in primary care populations ( P <  0.0001). The prevalence of hypocalcaemia using adjusted calcium ranged between 6% and 44% for inpatient data-sets and was higher in users of BCG methods. The application of community-specific adjustment equation to primary care data-sets reduced the prevalence of hypocalcaemia (mean 1.7%, range 0.8–3.7%).

Conclusion

We demonstrated that the use of a community-specific calcium adjustment equation to a primary care population reduces both the percentage and the variation of hypocalcaemia between different laboratories.

Revisiting the sampling, sample preparation, and analytical variability associated with testing wheat for deoxynivalenol

Fifteen lots of wheat were sampled to characterise the total variance and distribution among sample test results associated with measuring deoxynivalenol (DON) in bulk wheat lots. An unbalanced nested experimental design based on past research was used to determine contributions to the total variance from sampling, sample preparation, and analysis. The wheat lots used in the study contained average DON concentrations that ranged from 0.17 to 24.5 mg/kg. Sampling was determined to be the largest contributor to the total variance of measuring DON at low mg/kg concentrations, which are relevant to existing maximum levels. With the experimental design parameters of 1 kg laboratory samples, sub-division of whole and ground grain using rotary sample division, sample comminution using a commercial-grade coffee grinder, extraction of 100 g test portions, and making one measurement of DON in the test portion by gas chromatography-mass spectrometry, the total variance of DON measurement at 2 mg/kg was 0.046 mg2/kg2 (coefficient of variation=10.7%). At this concentration, sampling contributed 67% to the total variance, followed by sample preparation (18%) and analysis (15%). The DON distribution among sample test results was accurately described by the normal distribution. The mathematical model of variance was used with the normal distribution of DON measurement results to construct operating characteristics curves to model the likelihood of mischaracterising a wheat lot as (non) compliant with a certain decision limit. With realistic laboratory sample and test portion sizes, as well as a practicable decision limit of 1.5 mg/kg, the estimated probability of mischaracterising a wheat lot containing 2 mg/kg DON as less than this concentration was reduced to 1%.

Does the performance of five back-associated exercises relate to the presence of low back pain? A cross-sectional observational investigation in regional Australian council workers

OBJECTIVES

Investigate the relationships between the ability/inability to perform five physical test exercises and the presence or absence of low back pain (LBP).

SETTING

Regional Australian council training facility.

PARTICIPANTS

Consecutive participants recruited during 39 back education classes (8-26 participants per class) for workers in general office/administration, parks/gardens maintenance, roads maintenance, library, child care and management. Total sample (n=539) was reduced through non-consent and insufficient demographic data to n=422. Age 38.6±15.3 years, range 18-64 years, 67.1% male.

METHODS

Cross-sectional, exploratory, observational investigation. LBP presence was ascertained from a three-response option questionnaire: 0=none/rarely (no) 1=sometimes (some), 2=mostly/always (most). Statistical correlation was performed with the number of the five test exercises the individual successfully performed: (1) extension in lying: 3 s; (2) 'toilet squat'; feet flat, feet touched: 3 s; (3) full squat then stand up: 5 times; (4) supine sit-up, knees flexed: 10 times; and (5) leg extension, supine bilateral: 10 times.

INTERVENTIONS

Nil.

RESULTS

For the group 'no-some', 94.3% completed 4-5 test exercises, while for group 'With', 95.7% completed 0-1 test exercises. The relationship between LBP presence and number of exercises performed was highly significant (χ²₍₁₀₎=300.61, p<0.001). Furthermore, multinomial logistic regression predicting LBP (0=no, 1=some, 2=most) from the number of exercises completed, substantially improved the model fit (initial-2LL=348.246, final-2LL=73.620, χ²₍₂₎=274.626, p<0.001). As the number of exercises performed increased, the odds of reporting 'some LBP' or 'most LBP' dropped substantially (ORs of 0.34 and 0.17, respectively).

CONCLUSION

The ability to complete/not complete five test exercises correlated statistically and significantly with a higher LBP absence/presence in a general working population. Training individuals to complete such exercises could facilitate reductions in LBP incidence; however, causality cannot be inferred. Randomised trials are recommended to establish the potential efficacy of exercise-based approaches, considering these five selected exercises, for predicting and managing LBP.

Storage of Unfed and Leftover Mothers' Own Milk

OBJECTIVE

The objective was to examine the bacteriological and immunological properties of freshly expressed, previously frozen, and leftover mothers' own milk during storage.

MATERIALS AND METHODS

In the first of two pilot studies, 12 mother-infant dyads participated. The milk studied included freshly expressed unfed and freshly expressed leftover milk. Milk samples were stored at 24°C, 4°C, or -20°C. In the second pilot study, 11 mother-infant dyads participated. The milk studied included milk that had been previously frozen, including previously frozen leftover milk. Milk samples were stored at 24°C and 4°C. After storage in both studies, the milk was analyzed for bacteriological and immunological properties.

RESULTS

Bacteriological and immunological characteristics of freshly expressed unfed and freshly expressed leftover milk and previously frozen unfed and previously frozen leftover milk remained stable during storage at 4°C for at least 6 days. The quality of all groups of mothers' milk declined when stored at 24°C for longer than 3 hours.

CONCLUSIONS

While this study provides evidence that human milk might be safe at longer storage times, storage guidelines should not be revised until more research is performed. This study serves as a call to action for more research on the topic of human milk storage, specifically leftover human milk. The study provides information to inform future study designs on the topic of unpasteurized human milk storage. More research is needed regarding leftover human milk storage with a greater number of participants, determination of the quality of human milk, and the storage of human milk in a real-life setting.

A pilot study of neuropsychological functions, APOE and amyloid imaging in patients with gliomas

Brain tumor patients treated with radiotherapy (RT) often develop cognitive dysfunction, and recent studies suggest that the APOE ε-4 allele may influence cognitive outcome. The ε-4 allele is known to promote beta (β) amyloid deposition in the cortex, and preliminary evidence suggests that RT may be associated with this process. However, it is unknown whether β-amyloid accumulation contributes to treatment neurotoxicity. In this pilot study, we assessed neuropsychological functions and β-amyloid retention using ¹⁸F-florbetaben (FBB) PET in a subset of brain tumor patients who participated in our study of APOE polymorphisms and cognitive functions. Twenty glioma patients treated with conformal RT ± chemotherapy participated in the study: 6 were APOE ε-4 carriers and 14 were non-ε-4 carriers. Patients completed a neuropsychological re-evaluation (mean time interval = 5 years, SD = 0.83) and brain MRI and FBB PET scans. Wilcoxon signed-rank test comparisons between prior and current neuropsychological assessments showed a significant decline in attention (Brief Test of Attention, p = 0.018), and a near significant decline in verbal learning (Hopkins Verbal learning Test-Learning, p = 0.07). Comparisons by APOE status showed significant differences over time in attention/working memory (WAIS-III digits forward, p = 0.028 and digits backward, p = 0.032), with a decline among APOE ε-4 carriers. There were no significant differences in any of the FBB PET analyses between APOE ε-4 carriers and non-ε-4 carriers. The findings suggest that glioma patients may experience worsening in attention and executive functions several years after treatment, and that the APOE ε-4 allele may modulate cognitive decline, but independent of increased β-amyloid deposition.

Storage of Unfed and Leftover Pasteurized Human Milk

OBJECTIVE

To determine the impact of storage on bacterial growth and immunological activity of pasteurized human milk and leftover pasteurized human milk that has been exposed to the microflora in an infant's mouth.

MATERIALS AND METHODS

Eighteen mother-infant dyads participated in two separate studies. Mother's milk was pasteurized, and each baby was fed 1 to 2 ounces. Pasteurized and leftover pasteurized milk were stored at room (24°C) and refrigerated temperatures (4°C). After storage, milk was analyzed for bacteria, total protein, lysozyme activity, and secretory immunoglobulin A (SIgA) activity.

RESULTS

In pasteurized and leftover pasteurized milk stored in the refrigerator for 7 days, total aerobic bacteria do not increase significantly and total protein and bioactive proteins are stable. At room temperature, there is a significant increase in total aerobic bacteria in leftover pasteurized milk during 12 hours of storage (p < 0.01) and a significant decrease in total protein and SIgA activity in pasteurized milk during 12 hours of storage (p = 0.02 and p = 0.03, respectively).

CONCLUSIONS

When stored in the refrigerator, pasteurized and leftover pasteurized milk may be stored for at least 7 days when considering the variables studied. Caution should be used when storing pasteurized and leftover pasteurized milk at room temperature to prevent an increase in bacterial growth and a decrease in total protein and SIgA activity.

Capacity of Listeria monocytogenes Strains from the 2011 Cantaloupe Outbreak To Adhere, Survive, and Grow on Cantaloupe

The 2011 listeriosis outbreak attributed to whole cantaloupe involved several genetically distinct strains of serotypes 1/2a and 1/2b that had not been previously reported in invasive listeriosis outbreaks. Here we investigated the potential of strains from the 2011 cantaloupe outbreak to adhere, survive, and grow on cantaloupe rind and flesh and in juice extracted from cantaloupe at different temperatures (4, 8, and 25°C). All strains were able to adhere and grow, with ∼10-fold increases after 7 days at 4 or 8°C and after 24 h at 25°C, with a propensity for more growth on rind than on flesh or in extract. No significant differences in growth potential were noted among the different strains or between them and unrelated strains from other listeriosis outbreaks involving celery, deli meats, or hot dogs. Similarly to the cantaloupe outbreak strains, these other strains exhibited greater propensity for growth on rind than on flesh or in extract. Rinsing of cantaloupe fragments in sterile water resulted in temporary reductions of the populations by 50- to 100-fold, suggesting the potential of such washing to reduce risk if the produce is promptly consumed. The absence of marked differences in adherence or growth between the cantaloupe outbreak strains and strains from other outbreaks highlights the need to further characterize the 2011 cantaloupe outbreak strains and elucidate potential biological attributes that contributed to their implication in the outbreak.

Effect of broiler breeder feeding programme and feeder space change at photostimulation using maize- or wheat-based diets on broiler progeny growth performance and leg health

1. The aim of this study was to evaluate the effects of diet type, maternal feeding programme at 29 weeks of age and breeder feeder space change at photostimulation on broiler progeny performance and leg health at 6 weeks of age. 2. Fast-feathering Cobb 500 broiler breeders were fed on either maize- or wheat-based diets that had been formulated to have similar nutrient composition during growing and layer phases. Two feeding programmes, fast or flow, were used from 14 to 29 weeks of age. At 22 weeks, 69 females from each pen were placed in a layer house where feeder space was either similar to that in rearing (6.3 to 6.5 cm/female) or was increased from 6.3 to 8.4 cm/female. Eggs produced at 32 and 44 weeks of age were collected and incubated for two broiler experiments. A total of 16 male and 16 female one-d-old chicks were placed in floor pens in two experiments, respectively, with 6 and 4 replicate pens. Broiler gait scores and leg problem prevalence were evaluated at 6 weeks of age. 3. Data were analysed as a 2 × 2 × 2 factorial design with diet type, feeding programme and feeder space change as main factors. 4. The wheat diet increased the probability of observing crooked toes in broiler progeny compared to the use of maize, but only when breeders were fed according to the fast feeding programme and given similar feeder space as during rearing. 5. Breeders given more feeder space in the laying period produced progeny with more locomotion problems compared with those provided similar feeder space, but only when maize was used and the slow feeding programme was applied to the breeders. 6. The maternal feeding programme interacted with other factors to influence progeny leg health, but it did not solely influence walking ability or leg problems of progeny. 7. In conclusion, an increased probability of observing walking impairment of broiler progeny was detected when breeders were given greater feeder space at photostimulation rather than no change and fed according to the slow feeding programme using maize diets in breeders and progeny.

Mixture models for gene expression experiments with two species

Cross-species research in drug development is novel and challenging. A bivariate mixture model utilizing information across two species was proposed to solve the fundamental problem of identifying differentially expressed genes in microarray experiments in order to potentially improve the understanding of translation between preclinical and clinical studies for drug development. The proposed approach models the joint distribution of treatment effects estimated from independent linear models. The mixture model posits up to nine components, four of which include groups in which genes are differentially expressed in both species. A comprehensive simulation to evaluate the model performance and one application on a real world data set, a mouse and human type II diabetes experiment, suggest that the proposed model, though highly structured, can handle various configurations of differential gene expression and is practically useful on identifying differentially expressed genes, especially when the magnitude of differential expression due to different treatment intervention is weak. In the mouse and human application, the proposed mixture model was able to eliminate unimportant genes and identify a list of genes that were differentially expressed in both species and could be potential gene targets for drug development.

A spatial ecology study on the effects of field conditions and crop rotation on the incidence of Plectris aliena (Coleoptera: Scarabaeidae) grub damage to sweetpotato roots

A farmscape study was conducted in commercial sweetpotato (Ipomoea batatas (L.) Lam) fields in Columbus County, NC, in 2010 and 2011 to investigate the effects of the following field conditions: soil drainage class, soil texture, field size, border habitat, land elevation, and the previous year's crop rotation on the incidence of damage caused by Plectris aliena Chapman (Coleoptera:Scarabaeidae) larval feeding. Soil drainage and crop rotation significantly affected the incidence of damage to roots, with well drained soils having a low estimated incidence of damaged roots (0.004) compared with all other drainage classes (0.009-0.011 incidence of damaged roots). Fields with soybeans [Glycine max (L.) Merr] planted the preceding year had the highest incidence of root damage (0.15) compared with all other crops. The effects of border habitats, which were adjacent to grower fields where roots were sampled, showed that as the location of the roots was closer to borders of soybean (planted the year before) or grass fields, the chance of damage to roots decreased. Results indicate that growers can use crop rotation as a management technique and avoid planting sweetpotatoes the year after soybeans to reduce the incidence of P. aliena larval feeding on sweetpotato roots. Environmental conditions such as fields with poor drainage and certain border habitats may be avoided, or selected, by growers to reduce risk of damage to roots by P. aliena.

Determination of 5-log reduction times for Escherichia coli O157:H7, Salmonella enterica, or Listeria monocytogenes in acidified foods with pH 3.5 or 3.8 3

A critical factor in ensuring the safety of acidified foods is the establishment of a thermal process that assures the destruction of acid-resistant vegetative pathogenic and spoilage bacteria. For acidified foods such as dressings and mayonnaises with pH values of 3.5 or higher, the high water phase acidity (acetic acid of 1.5 to 2.5% or higher) can contribute to lethality, but there is a lack of data showing how the use of common ingredients such as acetic acid and preservatives, alone or in combination, can result in a 5-log reduction for strains of Escherichia coli O157:H7, Salmonella enterica, and Listeria monocytogenes in the absence of a postpackaging pasteurization step. In this study, we determined the times needed at 10° C to achieve a 5-log reduction of E. coli O157:H7, S. enterica, and L. monocytogenes in pickling brines with a variety of acetic and benzoic acid combinations at pH 3.5 and 3.8. Evaluation of 15 different acid-pH combinations confirmed that strains of E. coli O157:H7 were significantly more acid resistant than strains of S. enterica and L. monocytogenes. Among the acid conditions tested, holding times of 4 days or less could achieve a 5-log reduction for vegetative pathogens at pH 3.5 with 2.5% acetic acid or at pH 3.8 with 2.5% acetic acid containing 0.1% benzoic acid. These data indicate the efficacy of benzoic acid for reducing the time necessary to achieve a 5-log reduction in target pathogens and may be useful for supporting process filings and the determination of critical controls for the manufacture of acidified foods.

Hydrodynamic dispersion within porous biofilms

Many microorganisms live within surface-associated consortia, termed biofilms, that can form intricate porous structures interspersed with a network of fluid channels. In such systems, transport phenomena, including flow and advection, regulate various aspects of cell behavior by controlling nutrient supply, evacuation of waste products, and permeation of antimicrobial agents. This study presents multiscale analysis of solute transport in these porous biofilms. We start our analysis with a channel-scale description of mass transport and use the method of volume averaging to derive a set of homogenized equations at the biofilm-scale in the case where the width of the channels is significantly smaller than the thickness of the biofilm. We show that solute transport may be described via two coupled partial differential equations or telegrapher's equations for the averaged concentrations. These models are particularly relevant for chemicals, such as some antimicrobial agents, that penetrate cell clusters very slowly. In most cases, especially for nutrients, solute penetration is faster, and transport can be described via an advection-dispersion equation. In this simpler case, the effective diffusion is characterized by a second-order tensor whose components depend on (1) the topology of the channels' network; (2) the solute's diffusion coefficients in the fluid and the cell clusters; (3) hydrodynamic dispersion effects; and (4) an additional dispersion term intrinsic to the two-phase configuration. Although solute transport in biofilms is commonly thought to be diffusion dominated, this analysis shows that hydrodynamic dispersion effects may significantly contribute to transport.

Sequencing and phylogenetic characterisation of a fatal Crimean - Congo haemorrhagic fever case imported into the United Kingdom, October 2012

A patient with fever, and haemorrhagic symptoms was admitted to a hospital in Glasgow on 2 October 2012. Since he had returned from Afghanistan, serum samples were sent for diagnosis at the Rare and Imported Pathogens Laboratory, where a real-time reverse transcriptase-PCR diagnosis of Crimean – Congo haemorrhagic fever was made within 3 hrs after receipt of the sample. Hereafter the patient was transferred to a high-security infectious diseases unit in London but died on 6 October.

Sequencing and phylogenetic characterisation of a fatal Crimean – Congo haemorrhagic fever case imported into the United Kingdom, October 2012

Binary file ES_Abstracts_Final_ECDC.txt matches

The Örebro Musculoskeletal Screening Questionnaire: validation of a modified primary care musculoskeletal screening tool in an acute work injured population

The original Örebro Musculoskeletal Pain Questionnaire (original-ÖMPQ) was developed to identify patients at risk of developing persistent back pain problems and is also advocated for musculoskeletal work injured populations. It is critiqued for its informal non-clinimetric development process and narrow focus. A modified version, the Örebro Musculoskeletal Screening Questionnaire (ÖMSQ), evolved and progressed the original-ÖMPQ to broaden application and improve practicality. This study evaluated and validated the ÖMSQ clinimetric characteristics and predictive ability through a single-stage prospective observational cohort of 143 acute musculoskeletal injured workers from ten Australian physiotherapy clinics. Baseline-ÖMSQ scores were concurrently recorded with functional status and problem severity outcomes, then compared at six months along with absenteeism, costs and recovery time to 80% of pre-injury functional status. The ÖMSQ demonstrated face and content validity with high reliability (ICC(2.1) = 0.978, p < 0.001). The score range was broad (40-174 ÖMSQ-points) with normalised distribution. Factor analysis revealed a six-factor model with internal consistency α = 0.82 (construct range α = 0.26-0.83). Practical characteristics included completion and scoring times (7.5 min), missing responses (5.6%) and Flesch-Kincaid readability (sixth-grade and 70% reading-ease). Predictive ability ÖMSQ-points cut-off scores were: 114 for absenteeism, functional impairment, problem severity and high cost; 83 for no-absenteeism; and 95 for low cost. Baseline-ÖMSQ scores correlated strongly with recovery time to 80% functional status (r = 0.73, p < 0.01). The ÖMSQ was validated prospectively in an acute work-injured musculoskeletal population. The ÖMSQ cut-off scores retain the predictive capacity intent of the original-ÖMPQ and provide clinicians and insurers with identification of patients with potentially high and low risks of unfavourable outcomes.

Physico-chemical characterization of grease interceptors with and without biological product addition

Hardened and insoluble fat, oil, and grease (FOG) deposits are the primary cause of sewer line blockages leading to sanitary sewer overflows (SSOs). However, there have been very few long-term assessments of the physico-chemical characteristics of full-scale grease interceptors (GIs), the first "line of defense" against FOG buildup in sewer lines. In this study, we assessed the physico-chemical characteristics of two full-scale GIs (at a restaurant and a retirement community kitchen) over a one-year period. Statistically significant differences between bioaugmented and untreated cycles were detected for several chemical and physical properties. The treated cycles had lower BOD and COD at the grease interceptor outlet. While the combined data for all treated cycles did not show lower FOG concentrations in the GI outlet compared to the combined data for all untreated cycles, comparison of specific individual treated and untreated cycles show a positive effect due to the addition of product.

Boosting enrolment in clinical trials: validation of a regional network model

BACKGROUND

Clinical trials of stroke therapy have been hampered by slow rates of enrolment.

PURPOSE

Our purpose is to validate a previously developed model for accelerating enrolment in clinical trials by replicating it at new locations. The model employs coordinators who travel from a host institution to enrol participants from a network of participating hospitals. Active surveillance assures identification of all eligible patients.

METHODS

Among 70 U.S. investigators participating in National Institutes of Health-funded trial of stroke prevention, five investigators were invited to develop local identification and outreach networks (LIONs). Each LION comprised a LION coordinating centre servicing multiple hospitals. Hospitals provided names of patients with stroke or transient ischaemic attack to researchers at the LION coordinating centre who initiated contact; patients were offered home visits for consent and randomization. Outcomes were feasibility, enrolment, data quality, and cost.

RESULTS

Five LIONs varied in size from two to eight hospitals. All 24 hospitals we approached agreed to participate. The average monthly rate of enrolment at the research sites increased from 1.4 participants to 3.5 after expanding from a single institution model to the LION format (mean change = 2.1, range 0.9-3.7). Monthly performance improved over time. Data quality was similar for LIONs and non-LION sites, except for drug adherence which was lower at LIONs. The average cost to randomize and follow one participant during the study interval was 2.4 times the cost under the per-patient, cost-reimbursement strategy at non-LION sites. The cost ratio declined from 3.4 in year one to 1.8 in year two.

LIMITATIONS

The LION strategy requires unprecedented collaboration and trust among institutions. Applicability beyond stroke requires confirmation.

CONCLUSION

LIONs are a practical, reproducible method to increase enrolment in trial research. Twelve months were required for the average site to reach its potential. The per-participant cost at LIONs was higher than conventional sites but declined over time.

Antiprostate-specific membrane antigen (PSMA)-based radioimmunotherapy: A combined analysis of radiolabeled-J591 studies

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Background: J591 is a monoclonal antibody which selectively binds the external domain of PSMA with high affinity. Two phase I trials of radiolabeled-J591 have been published; two additional studies have been completed. 90Y is a beta-emitting particle optimal for tumor lesions 28-42 mm in size; 177Lu is best suited for lesions 1-3 mm in diameter [O'Donoghue J Nuc Med 1995].

Methods: With WCMC IRB approval, long-term follow-up of 4 clinical trials and the ongoing studies was analyzed. Prospectively collected data were supplemented with retrospective additions when necessary. Median survival (OS) was calculated by Kaplan- Meier methodology.

Results: Between 10/00 and 7/10, 132 pts with metastatic CRPC received radiolabeled J591 (103 received 177Lu-J591, 29 90Y-J591) with a median follow-up of 68.5 months (mo). Median age 70.3 yrs; all progressed after multiple lines of hormonal therapy, 41.7% received prior chemo, 48.5% received post-J591 chemo. Median Halabi nomogram score for the group was 146 (range 97- 196). OS for the entire group was 16.7 mo [95% CI 13.8, 19.7]. 26 (19.7%) experienced > 30% PSA decline, with OS of 22.4 mo (vs 13.6 mo for those with any PSA increase, p=0.08; p=0.006 at phase II doses). Pts receiving 177Lu-J591 had more 30% PSA declines than 90Y-J591 (21.3% vs 6.9%, p=0.06). 37.9% had measurable disease; those who received 90Y-J591 were more likely to have measurable response than 177Lu-J591 [p=0.04]. All objective tumor responses also had significant PSA declines. Of 15 pts with baseline and follow-up CTC counts (CellSearch methodology), 12 (80%) became or remained favorable at follow-up; 3 became or remained unfavorable.

Conclusions: Radiolabled J591 is tolerable and efficacious. As predicted based upon their physical properties, 177Lu-J591 appears more effective for lower volume disease, with objective responses in larger volume disease only with 90Y-J591. Current trials utilizing 177Lu-J591 focus on predictive biomarkers, dose fractionation to improve tolerance and efficacy, combination with chemotherapy, and “salvage radioimmunotherapy” to delay the onset of metastases in men with progressive biochemical (micrometastatic) disease best suitable for 177Lu-J591.

[Table: see text]