Regulatory Toxicology and Pharmacology New limits proposed for the management of non-mutagenic impurities

Multiple international guidelines exist that describe both quality and safety considerations for the control of the broad spectrum of impurities inherent to drug substance and product manufacturing processes. However, regarding non-mutagenic impurities (NMI) the most relevant ICH Q3A/B guidelines are not applicable during early phases of drug development leading to confusion about acceptable limits at this stage. Thus, there is need for more flexible approaches that ensure that patient safety remains paramount, while taking into consideration the limited duration of exposure. An EFPIA survey, which collected quantitative data from different types of studies applied to qualify impurities in accordance with ICH Q3A, shows that no toxicities could be attributed to any of the 467 impurities at any tested level in vivo. This data combined with earlier published toxicological datasets encompassing drug substances and intermediates, food related substances and chemicals provide convincing evidence that for NMIs, the application of a generic 5 mg/day limit for an exposure duration <6 months, and a 1 mg/day generic limit for life-long exposure, provides sufficient margins to ensure patient safety. Hence, application of these absolute limits to trigger qualification studies (instead of the relative limits described in Q3A/B), is considered warranted. This approach will prevent conduct of unnecessary dedicated impurity qualification studies and the resulting use of animals.

Ten-year trend analysis of breast cancer, oncoplastic, and reconstructive breast surgery in a single institution (2010-2019), what has not changed?

PURPOSE

There has been a UK national directive to ensure that patients are offered reconstructive surgical options. We aimed to assess any change in oncoplastic practice over a 10-year period.

METHODS

The surgical management of 7019 breast cancers was retrospectively assessed at Nightingale Breast Centre, Manchester University UK, from 2010 to 2019. The procedures were categorised into breast conservative surgery (BCS) and mastectomy ± immediate reconstruction. The data were analysed using inclusion and exclusion criteria.

RESULTS

The overall rates of BCS and mastectomy were 60.1% and 39.9% respectively. No statistically significant change in the overall rates of BCS or mastectomy was observed over the last decade (p = 0.08). The rate of simple wide local excision (WLE) decreased from 98.7% to 89.3% (p < 0.001), whilst the rate of therapeutic mammoplasty (TM) increased from 1.3% to 8% (p < 0.01). The rate of chest wall perforator flaps (CWPF) changed from zero to account for 2.7% of all BCS by 2019. The overall rate of immediate breast reconstruction (IBR) did not significantly change over the study period, but it consistently remained above the national average of 27%. The rate of implant-based IBR increased from 61.3% to 76.5% (p = 0.012), whilst the rate of Latissimus Dorsi (LD) reconstruction decreased from 26.7% to 5.1% (p < 0.05). Additionally, the rate of nipple-sparing mastectomy significantly increased from 5.2% to 24%.

CONCLUSION

No significant changes in the overall rates of BCS was observed, the rates of advanced breast conservation techniques, nipple-sparing mastectomy, and implant-based IBR all have increased, whilst the use of LD reconstruction decreased.

The impact of COVID-19 restrictions on perceived health and wellbeing of adult Australian sport and physical activity participants

Individuals’ access to sport and physical activity has been hampered due to COVID-19 lockdown restrictions. In Australia participation in community sport was cancelled during lockdowns. There is limited research on the impact of sport participation restrictions on the health and wellbeing of adults.

Aim

The aim of this study was to investigate the perceived health and wellbeing of a sample of predominantly active Australian adults, both during COVID-19 and in comparison with one year earlier (pre COVID-19).

Methods

A survey was conducted during the first COVID-19 restrictions and lockdowns in Australia in May–June 2020. It was distributed by national and state sporting organisations and through researchers’ social media accounts. This particular paper focuses on adults aged 18–59 years. The survey collected information on participant demographics, the sport and physical activity patterns pre- COVID-19, and health and wellbeing outcomes during COVID-19 lockdown and compared to one year earlier. The health measures were cross-tabulated against the demographic and sport and physical activity variables, and group profiles compared with chi-square tests. Scales were derived from three wellbeing questions, and group differences were analysed by t-tests and F-tests.

Results

The survey sample included 1279 men and 868 women aged 18–59 years. Most (67%) resided in metropolitan cities. The great majority (83%) were sport participants. During COVID-19 lockdown men were significantly more likely than women to report worse or much worse general (p = 0.014), physical (p = 0.015) and mental health (p = 0.038) and lower life satisfaction (p = 0.016). The inactive adults were significantly more likely to report poorer general health (p = 0.001) and physical health (p = 0.001) compared to active adults. The younger age cohort (18–29 years) were significantly more likely to report poorer general wellbeing (p < 0.001), and lower life satisfaction (p < 0.001) compared to the older age groups.

Conclusion

It seems that the absence of playing competitive sport and training with friends, teams and within clubs has severely impacted males and younger adults in particular. Sports clubs provide an important setting for individuals’ health and wellbeing which is why clubs require the capacity to deliver sport and individuals may need to regain the motivation to return.

Wound fluid sampling methods for proteomic studies: A scoping review

Understanding why some wounds are hard to heal is important for improving care and developing more effective treatments. The method of sample collection used is an integral step in the research process and thus may affect the results obtained. The primary objective of this study was to summarise and map the methods currently used to sample wound fluid for protein profiling and analysis. Eligible studies were those that used a sampling method to collect wound fluid from any human wound for analysis of proteins. A search for eligible studies was performed using MEDLINE, Embase and CINAHL Plus in May 2020. All references were screened for eligibility by one reviewer, followed by discussion and consensus with a second reviewer. Quantitative data were mapped and visualised using appropriate software and summarised via a narrative summary. After screening, 280 studies were included in this review. The most commonly used group of wound fluid collection methods were vacuum, drainage or use of other external devices, with surgical wounds being the most common sample source. Other frequently used collection methods were extraction from absorbent materials, collection beneath an occlusive dressing and direct collection of wound fluid. This scoping review highlights the variety of methods used for wound fluid collection. Many studies had small sample sizes and short sample collection periods; these weaknesses have hampered the discovery and validation of novel biomarkers. Future research should aim to assess the reproducibility and feasibility of sampling and analytical methods for use in larger longitudinal studies.

Impact of a 12-week supervised exercise program on weight loss trajectory, daily physical activity levels and sedentary behaviors after bariatric surgery

Background

The evidence suggests that physical activity (PA) following bariatric surgery can enhance weight loss and other metabolic outcomes. However, most individuals with severe obesity are insufficiently active, and without support, fail to make substantial increases in their daily PA levels postoperatively.

Purpose

The aim of this study was to investigate the effectiveness of a 12-week supervised exercise program on daily PA levels, sedentary time, and on maintenance of the weight loss trajectory following bariatric surgery.

Methods

Fifty-nine individuals with severe obesity (body mass index [BMI] ≥40 or ≥35 kg/m2 with comorbidities) eligible for bariatric surgery were randomly assigned (1:2) to either standard of care (CG, n=19) or a 12-week supervised exercise program (ExG, n=40). Daily PA levels and sedentary time were assessed using an armband accelerometer worn over a 3-day period (2 week-day and 1 weekend day). Body weight, body fat and fat-free mass were assessed using bioelectrical impedance balance. The exercise training program (60 min, 3 times per week for 12 weeks) started 3 months after the bariatric surgery and was supervised by a certified clinical exercise physiologist. Daily PA levels, sedentary time and anthropometric measurements were obtained preoperatively, and at 3, 6 and 12 months after bariatric surgery.

Results

Age of participants was 42±12 years, BMI was 46±6 kg/m2, and 76% were women. Before the exercise training program, PA parameters (daily PA levels, sedentary time and moderate to vigorous intensity PA [MVPA] were comparable between groups. Following the exercise training program, the ExG showed a significant reduction in sedentary time (753±113 to 721±88 min/day), an increase in daily PA levels (4544±1863 to 5853±3101 steps/day) and in MVPA levels (18.8±25.1 to 30.5±38.1 min/day). Further increase in daily MVPA levels were observed at the 12 months follow-up visit (p=0.05). In the standard of care group, changes in PA parameters were also comparable to those in the ExG. All anthropometric measurements indicate statistically significant changes postoperatively, after the intervention and up to 12 months follow-up (p&lt;0.001) without showing any difference between groups. Anthropometric changes up to 12 months follow-up show, respectively for CG and ExG, a total weight loss of 37.8±9.3% and 38.4±10.3%, a body fat reduction of 60.4±13.7% and 61.9±15.2% and fat-free mass loss of 16.6±5.4% and 15.1±7.9%.

Conclusion

This study shows that bariatric surgery candidates have low PA levels and rarely engage in MVPA. We found no additional effect to the standard of care treatment of a postoperative 12-week supervised exercise training program on weight loss trajectory, daily PA levels and sedentary behaviors.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Canadian Institutes of Health Research (CIHR)Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval (IUCPQ - UL)

Mapping the landscape of Consumer Food Waste

Since 2015 there has been a surge of academic publications and citations focused on consumer food waste. To introduce a special issue of Appetite focused on the drivers of consumer food waste we perform a transdisciplinary and historical review of the literature through a co-citation network analysis and topic modelling approach. We show that the rapid increase in publications is largely attributable to an urgency caused by the Sustainable Development Goals and climate change. Topic modelling reveals that the dramatic quantitative increase of publications has also produced a variety of evolving themes, and that a metaphorical Cambrian Explosion is occurring after decades of academic inactivity. Network analysis results show that consumer food waste features in thousands of articles and hundreds of journals, but that the citation practices of academics are becoming highly concentrated, as 20% of journals attract over 80% of citations. Finally, by examining the burstiness and transdisciplinary structure of citation networks we show that though the field has historically been dominated by empirical articles, it is now starting to show signs of maturity as a flurry of review papers help to consolidate knowledge.

Interspecific and intraspecific foraging differentiation of neighbouring tropical seabirds

BACKGROUND

Social interactions, reproductive demands and intrinsic constraints all influence foraging decisions in animals. Understanding the relative importance of these factors in shaping the way that coexisting species within communities use and partition resources is central to knowledge of ecological and evolutionary processes. However, in marine environments, our understanding of the mechanisms that lead to and allow coexistence is limited, particularly in the tropics.

METHODS

Using simultaneous data from a suite of animal-borne data loggers (GPS, depth recorders, immersion and video), dietary samples and stable isotopes, we investigated interspecific and intraspecific differences in foraging of two closely-related seabird species (the red-footed booby and brown booby) from neighbouring colonies on the Cayman Islands in the Caribbean.

RESULTS

The two species employed notably different foraging strategies, with marked spatial segregation, but limited evidence of interspecific dietary partitioning. The larger-bodied brown booby foraged within neritic waters, with the smaller-bodied red-footed booby travelling further offshore. Almost no sex differences were detected in foraging behaviour of red-footed boobies, while male and female brown boobies differed in their habitat use, foraging characteristics and dietary contributions. We suggest that these behavioural differences may relate to size dimorphism and competition: In the small brown booby population (n < 200 individuals), larger females showed a higher propensity to remain in coastal waters where they experienced kleptoparasitic attacks from magnificent frigatebirds, while smaller males that were never kleptoparasitised travelled further offshore, presumably into habitats with lower kleptoparasitic pressure. In weakly dimorphic red-footed boobies, these differences are less pronounced. Instead, density-dependent pressures on their large population (n > 2000 individuals) and avoidance of kleptoparasitism may be more prevalent in driving movements for both sexes.

CONCLUSIONS

Our results reveal how, in an environment where opportunities for prey diversification are limited, neighbouring seabird species segregate at-sea, while exhibiting differing degrees of sexual differentiation. While the mechanisms underlying observed patterns remain unclear, our data are consistent with the idea that multiple factors involving both conspecifics and heterospecifics, as well as reproductive pressures, may combine to influence foraging differences in these neighbouring tropical species.

Sport participation settings: where and 'how' do Australians play sport?

Background

Leisure-time physical activity and sport participation trends are often reported, both in aggregate and by specific activity. Recently there has been a rise in overall leisure-time physical activity, but little change in the prevalence of organised sport. It is important that the development of sport policy, infrastructure and strategic developments meet the changing landscape of participation. However, there has been relatively little research into the settings in which people participate. The aim of this study is to investigate the settings of participation of children and adults in 12 major Australian sports.

Methods

This study utilised data about participation in sport and recreational physical activity collected in the AusPlay survey from a representative sample of adults and children in the Australian state of Victoria. For each type of physical activity, the settings of participation are identified. Respondents can report participation in a particular activity in more than one setting. Therefore we use the term “instance of participation” to refer to a person playing a particular sport in a particular setting. Participation and settings across 12 major sports were investigated for children and adults.

Results

For children, the most popular sport was swimming with a weighted estimate of 323,565 (30.3%) instances of participation in the Victorian population, followed by Australian football (n = 180,459; 16.9%), and basketball (n = 137,169; 12.9%). For adults the most popular sports were swimming (n = 703,950; 30.9%) followed by golf (n = 274,729; 12.1%), and tennis (n = 260,814; 11.4%). There were considerable differences between the profiles of settings of participation for the 12 sports. Across the 12 sports, the majority of participation by children took place within a sports club or association setting, representing 63% of all instances of sport participation. For adults, sports clubs and associations was also the most popular setting, but it represented only 37% of instances of participation.

Conclusions

Traditionally, community clubs and inter-club competitions provided the main setting for sport participation, but this is no longer the case, particularly for adults. If the community sport sector is to continue to flourish, it must consider new strategies and participation options more attractive to other segments of its potential market.

The impact of an obstetrician-led, labor ward critical care unit: A prospective comparison of outcomes before and after establishment

OBJECTIVE

To investigate the outcomes of critically ill obstetric patients managed in a obstetric critical care unit in South Africa.

METHODS

Patients with severe maternal morbidity managed in the labor ward of Tygerberg Hospital were studied over three months before the establishment of the obstetrician-led obstetric critical care unit. One year later, patients managed in the obstetric critical care unit were studied using the same methods. The primary outcome measures were maternal morbidity and mortality.

RESULTS

In the before-obstetric critical care unit prospective audit 63 patients met criteria for obstetric critical care. During the second period 60 patients were admitted to the obstetric critical care unit. There were no significant differences between the groups in baseline characteristics, admission indications or Acute Physiology and Chronic Health Evaluation scores. Continuous positive airway pressure (p < 0.01) was utilized more in the second group. Seven deaths occurred in the first, but none in the second group (p = 0.01).

CONCLUSION

The establishment of an obstetrician-led obstetric critical care unit facilitated a decrease in maternal mortality.Trial registration: Not applicable.

Enhancing group-based internet obesity treatment: A pilot RCT comparing video and text-based chat

OBJECTIVE

Internet delivery of behavioural weight control interventions offers potential for broad geographic reach and accessibility, but weight losses online fall short of those produced with the same programme delivered in-person. This pilot study examined feasibility and preliminary efficacy of a video-based platform for delivering weekly chat as part of a 6-month, 24-session online group behavioural weight control programme compared with the established text-based format, which has produced the best online weight losses to date.

METHOD

Women with obesity (N = 32) were randomized to either (a) weekly video group chat sessions and provided with a cellular-enabled scale (Video) or (b) Text-based weekly chat sessions and given a digital scale (Text) and followed for 6 months to determine weight loss and treatment engagement.

RESULTS

Women randomized to the ideo condition lost more weight than those in the Text condition (-5.0 ± 6.0% vs. -3.0 ± 4.1%, respectively) at 6 months, although the difference was not statistically significant. However, women in the Video condition had significantly greater treatment engagement, with greater self-monitoring and website utilization than those in the Text condition.

CONCLUSIONS

Videoconference delivery of group-based online weight control accompanied by a cellular-connected scale may promote greater treatment engagement and weight loss than text-based chat. A larger, adequately powered study is warranted to determine which elements drive these enhanced treatment outcomes.

Identification of Circulating Genomic and Metabolic Biomarkers in Intrahepatic Cholangiocarcinoma

Intrahepatic cholangiocarcinoma (ICC) is an aggressive cancer arising from the bile ducts with a need for earlier diagnosis and a greater range of treatment options. KRAS/NRAS mutations are common in ICC tumours and 6-32% of patients also have isocitrate dehydrogenase 1 and 2 (IDH1 and IDH2) gene mutations associated with metabolic changes. This feasibility study investigated sequencing circulating tumour DNA (ctDNA) combined with metabolite profiling of plasma as a method for biomarker discovery in ICC patients. Plasma was collected from four ICC patients receiving radio-embolisation and healthy controls at multiple time points. ctDNA was sequenced using Ampliseq cancer hotspot panel-v2 on Ion Torrent PGM for single nucleotide variants (SNV) detection and with Illumina whole genome sequencing for copy number variants (CNV) and further targeted examination for SNVs. Untargeted analysis of metabolites from patient and control plasma was performed using liquid chromatography coupled with high-resolution tandem mass spectrometry (LC-MS/MS). Metabolite identification was performed using multi-parameter comparisons with analysis of authentic standards, and univariate statistical analysis was performed to identify differences in metabolite abundance between patient and control samples. Recurrent somatic SNVs and CNVs were identified in ctDNA from three out of four patients that included both NRAS and IDH1 mutations linked to ICC. Plasma metabolite analysis revealed biomarker metabolites associated with ICC and in particular 2-hydroxyglutarate (2-HG) levels were elevated in both samples from the only patient showing a variant allele in IDH1. A reduction in the number of CNVs was observed with treatment. This study demonstrates that ctDNA and metabolite levels can be identified and correlated in ICC patient blood samples and differentiated from healthy controls. We conclude that combining genomic and metabolic analysis of plasma offers an effective approach to biomarker identification with potential for disease stratification and early detection studies.

Experimental platform to facilitate novel back brace development for the improvement of spine stability

The spine or 'back' has many functions including supporting our body frame whilst facilitating movement, protecting the spinal cord and nerves and acting as a shock absorber. In certain instances, individuals may develop conditions that not only cause back pain but also may require additional support for the spine. Common movements such as twisting, standing and bending motions could exacerbate these conditions and intensify this pain. Back braces can be used in certain instances to constrain such motion as part of an individual's therapy and have existed as both medical and retail products for a number of decades. Arguably, back brace designs have lacked the innovation expected in this time. Existing designs are often found to be heavy, overly rigid, indiscrete and largely uncomfortable. In order to facilitate the development of new designs of back braces capable of being optimised to constrain particular motions for specific therapies, a numerical and experimental design strategy has been devised, tested and proven for the first time. The strategy makes use of an experimental test rig in conjunction with finite element analysis simulations to investigate and quantify the effects of back braces on flexion, extension, lateral bending and torsional motions as experienced by the human trunk. This paper describes this strategy and demonstrates its effectiveness through the proposal and comparison of two novel back brace designs.

Mealtime fast-acting insulin aspart versus insulin aspart for controlling postprandial hyperglycaemia in people with insulin-resistant Type 2 diabetes

AIM

This post hoc analysis explored whether mealtime fast-acting insulin aspart treatment provided an advantage in postprandial plasma glucose (PPG) control vs. insulin aspart in people with Type 2 diabetes receiving high doses of bolus insulin.

METHODS

A post hoc, post-randomization, subgroup analysis of a 26-week, randomized, double-blind, treat-to-target trial (onset 2) that compared mealtime fast-acting insulin aspart vs. mealtime insulin aspart, both in a basal-bolus regimen, in people with Type 2 diabetes uncontrolled on basal insulin therapy and metformin. At the end of trial, the impact of fast-acting insulin aspart and insulin aspart on PPG control was assessed with a standard liquid meal test and participants were grouped into three post-randomization subgroups: meal test bolus insulin dose ≤ 10 units per dose (n = 171), > 10-20 units per dose (n = 289) and > 20 units per dose (n = 146).

RESULTS

A statistically significant treatment difference in favour of fast-acting insulin aspart vs. insulin aspart was observed for the change in PPG increment at all post-meal time points (from 1 to 4 h) for those in the > 20 units bolus insulin subgroup. There was no difference in the magnitude of change from baseline in HbA_1c level between fast-acting insulin aspart and insulin aspart in any of the bolus insulin dose subgroups (data herein).

CONCLUSION

Fast-acting insulin aspart may hold promise as a more effective treatment compared with insulin aspart for controlling PPG in people with insulin-resistant Type 2 diabetes.

Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study

BACKGROUND

Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery.

METHODS

This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy.

RESULTS

Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI.

CONCLUSIONS

After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.

Patterns of Failure Following Dose-escalated Chemoradiotherapy for Fluorodeoxyglucose Positron Emission Tomography Staged Squamous Cell Carcinoma of the Oesophagus

AIMS

To analyse outcomes and patterns of failure following dose-escalated definitive chemoradiotherapy (CRT) for oesophageal squamous cell carcinoma using fluorodeoxyglucose positron emission tomography for staging and treatment planning.

MATERIALS AND METHODS

A retrospective review of patients with oesophageal squamous cell carcinoma receiving definitive CRT to a dose of ≥56 Gy was conducted. Patient and tumour characteristics, treatment received and first sites of relapse were analysed.

RESULTS

Between 2003 and 2014, 72 patients were treated with CRT to a median dose of 60 Gy (range 56-66 Gy). The median age was 63 years; most (61%) were stage III/IVa. The median follow-up was 57 months. Three year in-field control, relapse-free survival and overall survival was 64% (95% confidence interval 50-75%), 38% (95% confidence interval 27-50%) and 42% (95% confidence interval 30-53%), respectively. Of the 41 failures prior to death or at last follow-up date, isolated locoregional relapse occurred in 16 patients (22%) with isolated in-field recurrence in 11 patients (15%). Distant failure as first site of relapse was present in 25 patients (35%). No in-field failures occurred in the 11 patients with cT1-2, N0-1 tumours. The median survival for cT4 tumours was 8 months, with five of eight patients developing local progression within the first 6 months.

CONCLUSIONS

Dose-escalated radiotherapy was associated with promising rates of in-field local control, with the exception of cT4 tumours. Distant failure remains a significant competing risk. Our data supports the need for current trials re-examining the role of dose escalation in the modern era.

OxiMA: A Frequency-Domain Approach to Address Motion Artifacts in Photoplethysmograms for Improved Estimation of Arterial Oxygen Saturation and Pulse Rate

OBJECTIVE

The purpose of this paper is to demonstrate that a new algorithm for estimating arterial oxygen saturation can be effective even with data corrupted by motion artifacts (MAs).

METHODS

OxiMA, an algorithm based on the time-frequency components of a photoplethysmogram (PPG), was evaluated using 22-min datasets recorded from 10 subjects during voluntarily-induced hypoxia, with and without subject-induced MAs. A Nellcor OxiMax transmission sensor was used to collect an analog PPG while reference oxygen saturation and pulse rate (PR) were collected simultaneously from an FDA-approved Masimo SET Radical RDS-1 pulse oximeter.

RESULTS

The performance of our approach was determined by computing the mean relative error between the PR/oxygen saturation estimated by OxiMA and the reference Masimo oximeter. The average estimation error using OxiMA was 3 beats/min for PR and 3.24% for oxygen saturation, respectively.

CONCLUSION

The results show that OxiMA has great potential for improving the accuracy of PR and oxygen saturation estimation during MAs.

SIGNIFICANCE

This is the first study to demonstrate the feasibility of a reconstruction algorithm to improve oxygen saturation estimates on a dataset with MAs and concomitant hypoxia.

Exploring the perspectives of 10-, 11-, and 12-year-old primary school students on physical activity engagement-"'Cause you can't just be sitting at a desk all the time!"

BACKGROUND

Research indicates that 91% of Canadian children are not engaging in enough physical activity (PA) to achieve health benefits. Physical education (PE) classes have been identified as a way to improve child health by facilitating engagement in movement-based activities. The daily physical activity (DPA) initiative was created with similar intentions and requires that students participate in at least 20 min of PA daily via PE classes and/or during instructional time for other subjects. Despite recommendations that 150 min of exercise/play be incurred weekly through either avenue, nearly half of Canadian schools fail to achieve this goal. The disconnect between PA-related school policies and low reported participation rates suggests that additional research is warranted. The purpose of this study was to explore the perspectives of primary students regarding the facilitators, barriers, and recommendations for PA engagement at their schools.

METHODS

Researchers conducted nine group interviews with 53 children aged 10-12, representing six primary schools in Northwestern Ontario using a semi-structured interview format. Sessions were analysed using inductive content analysis.

RESULTS

Participants discussed several facilitators of PA including enjoying activities (alleviating boredom and participating with others), accomplishment (skill building and enhanced self-image), and benefits in the classroom (thinking clearly and enhanced readiness to learn). Barriers to PA participation included school rules and culture (PA/PE restrictions, heavy workload, and "no work, no PA"), personal struggles (physical challenges and varied skill levels), and technology (being addictive and a replacement for being active). Recommendations for enhancing engagement that were outlined by the children centred around PE and daily physical activity (increase opportunities and involve students in planning/delivery) and recess-based themes (decrease focus on safety and make equipment more available).

CONCLUSION

These student perspectives and related recommendations may be beneficial for administrators and teachers in similar contexts who are seeking to enhance PA engagement among students with the goal of improving child health.

Global phylogenetic relationships, population structure and gene flow estimation of Trialeurodes vaporariorum (Greenhouse whitefly)

Trialeurodes vaporariorum (Westwood, 1856) (Greenhouse whitefly) is an agricultural pest of global importance. It is associated with damage to plants during feeding and subsequent virus transmission. Yet, global phylogenetic relationships, population structure, and estimation of the rates of gene flow within this whitefly species remain largely unexplored. In this study, we obtained and filtered 227 GenBank records of mitochondrial cytochrome c oxidase I (mtCOI) sequences of T. vaporariorum, across various global locations to obtain a final set of 217 GenBank records. We further amplified and sequenced a ~750 bp fragment of mtCOI from an additional 31 samples collected from Kenya in 2014. Based on a total of 248 mtCOI sequences, we identified 16 haplotypes, with extensive overlap across all countries. Population structure analysis did not suggest population differentiation. Phylogenetic analysis indicated the 2014 Kenyan collection of samples clustered with a single sequence from the Netherlands to form a well-supported clade (denoted clade 1a) nested within the total set of sequences (denoted clade 1). Pairwise distances between sequences show greater sequence divergence between clades than within clades. In addition, analysis using migrate-n gave evidence for recent gene flow between the two groups. Overall, we find that T. vaporariorum forms a single large group, with evidence of further diversification consisting primarily of Kenyan sequences and one sequence from the Netherlands forming a well-supported clade.

Targeted and Untargeted Metabolic Profiling of Wild Grassland Plants identifies Antibiotic and Anthelmintic Compounds Targeting Pathogen Physiology, Metabolism and Reproduction

Plants traditionally used by farmers to manage livestock ailments could reduce reliance on synthetic antibiotics and anthelmintics but in many cases their chemical composition is unknown. As a case study, we analyzed the metabolite profiles of 17 plant species and 45 biomass samples from agricultural grasslands in England using targeted and untargeted metabolite profiling by liquid-chromatography mass spectrometry. We identified a range of plant secondary metabolites, including 32 compounds with known antimicrobial/anthelmintic properties which varied considerably across the different plant samples. These compounds have been shown previously to target multiple aspects of pathogen physiology and metabolism in vitro and in vivo, including inhibition of quorum sensing in bacteria and egg viability in nematodes. The most abundant bioactive compounds were benzoic acid, myricetin, p-coumaric acid, rhamnetin, and rosmarinic acid. Four wild plants (Filipendula ulmaria (L.) Maxim., Prunella vulgaris L., Centuarea nigra L., and Rhinanthus minor L.) and two forage legumes (Medicago sativa L., Trifolium hybridium L.) contained high levels of these compounds. Forage samples from native high-diversity grasslands had a greater abundance of medicinal compounds than samples from agriculturally improved grasslands. Incorporating plants with antibiotic/anthelmintic compounds into livestock feeds may reduce global drug-resistance and preserve the efficacy of last-resort drugs.

Evaluation Of Mycotoxin Content In Soybean (Glycine max L.) Grown In Rwanda

Soybean is a critical food and nutritional security crop in Rwanda. Promoted by the Rwandan National Agricultural Research System for both adults and as an infant weaning food, soybean is grown by approximately 40% of households. Soybean may be susceptible to the growth of mycotoxin-producing moulds; however, data has been contradictory. Mycotoxin contamination is a food and feed safety issue for grains and other field crops. This study aimed to determine the extent of mycotoxin contamination in soybean, and to assess people's awareness on mycotoxins. A farm-level survey was conducted in 2015 within three agro-ecological zones of Rwanda suitable for soybean production. Soybean samples were collected from farmers (n=300) who also completed questionnaires about pre-and post-harvest farm practices, and aflatoxin awareness. The concentration of total aflatoxin in individual soybean samples was tested by enzymelinked immunosorbent assay (ELISA) using a commercially-available kit. Other mycotoxins were analyzed using liquid chromatography-mass spectrometry (LCMS/MS) on 10 selected sub samples. Only 7.3% of the respondents were aware of aflatoxin contamination in foods, but farmers observed good postharvest practices including harvesting the crop when the pods were dry. Using enzyme-linked immunosorbent assay (ELISA), only one sample had a concentration (11 µg/kg) above the most stringent EU maximum permitted limit of 4 µg/kg. Multi-mycotoxins liquid chromatography-mass spectrometry (LC-MS/MS) results confirmed that soybeans had low or undetectable contamination; only one sample contained 13µg/kg of sterigmatocystine. The soybean samples from Rwanda obtained acceptably low mycotoxin levels. Taken together with other studies that showed that soybean is less contaminated by mycotoxins, these results demonstrate that soybean can be promoted as a nutritious and safe food. However, there is a general need for educating farmers on mycotoxin contamination in food and feed to ensure better standards are adhered to safeguard the health of the consumers regarding these fungal secondary metabolites.

Epileptic seizure detection using wristworn biosensors

Single signal seizure detection algorithms suffer from high false positive rates. We have found a set of signals which can be easily monitored by a wristworn device and which produce a distinctive pattern during seizure for patients in an epilepsy monitoring unit (EMU). This pattern is much less likely to be reproduced by nonseizure events in the patient's daily life than are changes in heart rate alone. We collected 108 hours of data from three EMU patients who suffered a combined total of seven seizures, then developed a time series analysis/pattern recognition based algorithm which distinguishes the seizures from nonseizure events with 100% accuracy.

A randomised pilot study comparing 13 G vacuum-assisted biopsy and conventional 14 G core needle biopsy of axillary lymph nodes in women with breast cancer

AIM

To compare the acceptability, safety, and feasibility of vacuum-assisted biopsy (VAB) and core needle biopsy (CNB) of axillary lymph nodes in women with breast cancer.

MATERIALS AND METHODS

This parallel, non-blinded, randomised study was approved by the National Research Ethics Service. Following written informed consent, women with abnormal appearing axillary lymph nodes and radiologically malignant breast masses were randomised 1:1 to lymph node sampling under local anaesthetic with either 14 G CNB or 13 G VAB in a single UK centre. Primary outcomes were study uptake rate and patient willingness to undergo a repeat procedure if necessary. Procedure duration, immediate and post-procedure pain scores, diagnostic yield, complications, and surgical histopathology were recorded.

RESULTS

Ninety-five women were approached; 81 (85.3%) consented and were randomised. Forty underwent CNB; 40 underwent VAB; one was excluded. Median age was 57 years. The median procedure time was 2 minutes for both techniques. The median number of samples obtained was three for CNB and four for VAB. Median pain scores for the procedure and first 3 days were 1/10 and 1/10 for CNB and 1/10 and 2/10 for VAB (p=0.11 and 0.04). More women were prepared to undergo repeat CNB compared to VAB, but the difference was not significant (38/39 versus 33/39; p=0.11). Two patients developed a haematoma after VAB. One CNB and six VABs failed to yield adequate tissue (p=0.11), but the sensitivity was similar at 79% and 78%.

CONCLUSION

Study uptake was high. Acceptability of the two procedures was similar, but VAB was associated with more post-procedure pain. The sensitivity appears to be similar.

Abstract P1-09-08: Does adverse tumour biology contribute to inferior outcomes for Indigenous Australians diagnosed with breast cancer?

Background: Analyses across multiple Australian states have consistently demonstrated significantly inferior breast cancer survival for Indigenous patients (IPs). Studies compensating for increased remoteness, socioeconomic disadvantage and later presentation demonstrate a residual unexplained detriment. This survival disadvantage is confined to the first five years, akin to the inferior outcomes demonstrated by higher risk biological breast cancer subtypes. We postulated that a preponderance of such higher risk subtypes could explain the disparate mortalities.

Methods: The distribution of breast cancer subtypes in Western Australian IPs diagnosed between 2001 and 2010 was assessed to explore the contribution of adverse prognostic subtypes to poorer outcome. This was a retrospective cohort study of Indigenous women (n=114) and 3:1 age and remoteness matched non-Indigenous women (n=310) diagnosed with invasive, non-metastatic, unilateral breast cancer, who underwent definitive local treatment. Subtypes were assigned as luminal A, B, HER2 enriched and triple negative by ER, PR, HER2 and tumour grade comparisons. Differences in basic tumour demographics and biological sub-types were analysed and racial survival discrepancies explored within biological subtype cohorts.

Results: Hazards for overall and breast cancer-specific mortality in IPs were 4.07 (95% CI 2.55-6.49) and 4.19 (95% CI 2.42-7.25). IPs were significantly more likely to have grade 3 tumours (41 v 25%, p&lt;0.001), LN positive disease (39 v 27%, p&lt;0.001) and larger tumours (median 20 v 10 mm, p&lt;0.001). No significant differences in proportions of classical histological sub-types (ductal v lobular) or in tumours showing ER, PR or HER2 positivity were observed. There were no significant differences in biological sub-type proportions although IPs were diagnosed with numerically more non-Luminal A subtypes (56 v 44%, p=0.08), accounted for by increased Luminal B (21 v 15%) and HER2 enriched (10 v 5%) sub-types. The significant relative five-year survival deficit for IPs noted overall (94 v73%, p&lt;0.0001) was observed for each sub-type with the exception of HER2 positive patients. This extended from the relatively low risk luminal A sub-type where oral anti-estrogens are the mainstay of treatment (98 v 82%, p=0.0002) to the high risk triple negative sub-type where intravenous chemotherapy is the standard adjuvant therapy (94 v 50%, p=0.0014).

Conclusions: The contribution of adverse tumour biological subtype to poorer outcomes for Indigenous women is modest. Indigenous women with almost all biological subtypes fare significantly worse than their non-Indigenous contemporaries. Ongoing work includes more detailed biological comparisons of RNA expression and DNA mutation between groups as well as an exploration of potentially disparate treatment patterns.

Citation Format: Redfern A, Lee E, Bulsara M, Threlfall T, Harvey J, Cordell D. Does adverse tumour biology contribute to inferior outcomes for Indigenous Australians diagnosed with breast cancer?. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-09-08.

A wrist-worn biosensor system for assessment of neurological status

EEG based monitoring for the purpose of assessing a patient's neurological status is conspicuous and uncomfortable at best. We are analyzing a set of physiological signals that may be monitored comfortably by a wrist worn device. We have found that these signals and machine based classification allows us to accurately discriminate among four stress states of individuals. Further, we have found a clear change in these signals during the 70 minutes preceding a single convulsive epileptic seizure. Our classification accuracy on all data has been greater than 90% to date.