The impact of COVID-19 on the hot food takeaway planning regulatory environment: perspectives of local authority professionals in the North East of England

AIMS

Planning regulations have been used to prevent the over-proliferation of hot food takeaways, minimising the impact of local obesogenic environments. To help mitigate the effects of lockdown, the UK government introduced temporary changes in March 2020 to Planning Regulations for England, allowing food retailers to open for takeaway services beyond 'ancillary' level without needing to apply for planning permission through permitted development rights (PDR). Businesses are required to notify their local authority (LA) when they implement PDRs. To better understand the impact of regulations on the policy and practice of key professional groups, Public Health England commissioned Teesside University to undertake scoping research in the North East of England.

METHODS

A focus group and interviews were conducted with 15 professionals from 7 of 12 North East LAs. Professions included Planners, Public Health Leads, Environmental Health Officers and Town Centre Managers. Data were analysed using a codebook thematic analysis approach. An interpretation meeting with some participants was conducted.

RESULTS

LAs were not aware of most businesses notifying them of new regulation adherence despite taking up PDRs, but were considered low-priority with many lacking formal recording procedures. There were concerns about health consequences of the changes, and consensus relating to ongoing issues with capacity across all professional groups, largely due to the continuing pandemic and absence of a strategy out of temporary measures. Concerns existed around ensuring cessation of restaurants trading as takeaways, and hygiene inspections backlog. Many (personally) saw new takeaways as a lifeline, offering broader menus and preserving local economies.

CONCLUSION

Lack of information around the number of restaurants/pubs using PDR to trade as takeaway services, ongoing capacity issues of LAs and, at the time, the absence of a strategy post regulation changes, meant there were high levels of uncertainty regarding the impacts of these temporary measures.

Regulatory mechanisms to create healthier environments: planning appeals and hot food takeaways in England

AIMS

To explore existing regulatory mechanisms to restrict hot food takeaway (HFT) outlets through further understanding processes at local and national levels.

METHODS

The Planning Appeals Portal was utilised to identify recent HFT appeal cases across England between December 2016 and March 2020. Eight case study sites were identified using a purposive sampling technique and interviews carried out with 12 professionals involved in planning and health to explore perceptions of and including factors that may impact on the HFT appeal process. Additionally, documents applicable to each case were analysed and a survey completed by seven Local Authority (LA) health professionals. To confirm findings, interpretation meetings were conducted with participants and a wider group of planning and public health professionals, including a representative from the Planning Inspectorate.

RESULTS

Eight case study sites were identified, and 12 interviews conducted. Participants perceived that LAs would be better able to work on HFT appeal cases if professionals had a good understanding of the planning process/the application of local planning policy and supplementary planning documents; adequate time and capacity to deal with appeals cases; access to accurate, robust, and up to date information; support and commitment from elected members and senior management; good lines of communication with local groups/communities interested in the appeal; information and resources that are accessible and easy to interpret across professional groups.

CONCLUSIONS

Communication across professional groups appeared to be a key factor in successfully defending decisions. Understanding the impact of takeaway outlets on health and communities in the long term was also important. To create a more robust appeals case and facilitate responsiveness, professionals involved in an appeal should know where to locate current records and statistical data. The enthusiasm of staff and support from senior management/elected officials will play a significant role in driving these agendas forward.

Nature-positive goals for an organization's food consumption

Organizations are increasingly committing to biodiversity protection targets with focus on 'nature-positive' outcomes, yet examples of how to feasibly achieve these targets are needed. Here we propose an approach to achieve nature-positive targets with respect to the embodied biodiversity impacts of an organization's food consumption. We quantify these impacts using a comprehensive database of life-cycle environmental impacts from food, and map exploratory strategies to meet defined targets structured according to a mitigation and conservation hierarchy. By considering the varying needs and values across the organization's internal community, we identify a range of targeted approaches towards mitigating impacts, which balance top-down and bottom-up actions to different degrees. Delivering ambitious nature-positive targets within current constraints will be challenging, particularly given the need to mitigate cumulative impacts. Our results evidence that however committed an organization is to being nature positive in its food provision, this is unachievable in the absence of systems change.

Microbial community of MX80 bentonite and their interaction with iron

MX80 bentonite has been selected as the buffer and backfill in a proposed method of long-term deep geological storage of nuclear waste. Extensive studies have been carried out on the geomechanical properties of MX80; however, it is not clear what effect microbes will have on its ability to function as an effective barrier. Specifically, in the UK, as carbon steel waste canisters will contribute iron oxides and rust products to the immediate environment, iron-reducing bacteria are of interest. Iron-reducing bacteria can reduce structural or external Fe (III) to Fe (II) and some species are adapted to high temperatures and low water availability, in keeping with conditions within the waste repository. Indigenous iron-interacting bacteria have been identified in compacted MX80 and microbially-influenced iron-reduction was observed in groundwater salinity up to 0.45M NaCl. Experiments investigating gas production, and silica-solubilising abilities of this community were carried out. Further experiments in pressurised test cells investigated microbial activities at the clay / steel interface. Significant increases in hydrogen production were observed when microbes were present, and biogenically influenced changes in structure and appearance of MX80 were seen in all experiments. Additionally, silica release occurred, likely coupled to metal / microbe interactions. Corrosion products differed depending on microbial presence following incubation in test cells. Biogenic transformation of clay minerals through iron reduction or release of silica to groundwater could significantly impact the geomechanical properties of MX80, as indicated by observed changes in clay plasticity, and ultimately this could affect the behavior of the material as a barrier.

Survival and activity of an indigenous iron-reducing microbial community from MX80 bentonite in high temperature / low water environments with relevance to a proposed method of nuclear waste disposal

MX80 bentonite clay has been selected as the buffer and backfill in a proposed method for long-term deep geological storage of nuclear waste. Extensive studies have been carried out on the geomechanical properties of the clay; however, it is not clear what effect microbes, specifically iron-reducing bacteria, will have on its ability to function as an affective barrier. Iron-reducing bacteria can reduce structural or external Fe(III) to Fe(II) and have been previously identified in the indigenous microbial community of MX80 bentonite. Experiments to assess bacterial survival at the high temperature and low water conditions likely to exist in the repository were carried out at different temperatures with the addition of steel to represent a nuclear waste canister. The resulting microbial enrichments were analysed, and mineralogical and geomechnical analysis was carried out on the clay. Microbial sequencing revealed that iron-reducing bacteria, and other indigenous species can survive these conditions in MX80 bentonite in either an active or dormant state. Microbial influenced mineralogical changes may lead to a loss of silica from the clay and reduction of Fe(III) to Fe(II). These changes could alter the ability of the clay to act as an effective barrier in nuclear waste disposal. Furthermore, evidence of reduced steel corrosion when microbes were present suggested that microbial activity may lead to either a protective coating on the steel or depletion of oxygen to slow corrosion. The production of such a layer would benefit nuclear waste disposal by inhibiting corrosion of a metal waste canister.

Contribution of periphytic biofilm of paddy soils to carbon dioxide fixation and methane emissions

Rice paddies are major contributors to anthropogenic greenhouse gas emissions via methane (CH₄) flux. The accurate quantification of CH₄ emissions from rice paddies remains problematic, in part due to uncertainties and omissions in the contribution of microbial aggregates on the soil surface to carbon fluxes. Herein, we comprehensively evaluated the contribution of one form of microbial aggregates, periphytic biofilm (PB), to carbon dioxide (CO₂) and CH₄ emissions from paddies distributed across three climatic zones, and quantified the pathways that drive net CH₄ production as well as CO₂ fixation. We found that PB accounted for 7.1%-38.5% of CH₄ emissions and 7.2%-12.7% of CO₂ fixation in the rice paddies. During their growth phase, PB fixed CO₂ and increased the redox potential, which promoted aerobic CH₄ oxidation. During the decay phase, PB degradation reduced redox potential and increased soil organic carbon availability, which promoted methanogenic microbial community growth and metabolism and increased CH₄ emissions. Overall, PB acted as a biotic converter of atmospheric CO₂ to CH₄, and aggravated carbon emissions by up to 2,318 kg CO₂ equiv ha^-1 season^-1. Our results provide proof-of-concept evidence for the discrimination of the contributions of surface microbial aggregates (i.e., PB) from soil microbes, and a profound foundation for the estimation and simulation of carbon fluxes in a potential novel approach to the mitigation of CH₄ emissions by manipulating PB growth.

Novel functions of S1P in chronic itchy and inflammatory skin diseases

S1P is a pleotropic sphingolipid signalling molecule that acts through binding to five high-affinity G-protein coupled receptors. S1P-signaling affects cell fate in a multitude of ways, e.g. influencing cell differentiation, proliferation, and apoptosis, as well as playing an important role in immune cell trafficking. Though many effects of S1P-signaling in the human body have been discovered, the full range of functions is yet to be understood. For inflammatory skin diseases such as atopic dermatitis and psoriasis, evidence is emerging that dysfunction and imbalance of the S1P-axis is a contributing factor. Multiple studies investigating the efficacy of S1PR modulators in alleviating the severity and symptoms of skin conditions in various animal models and human clinical trials have shown promising results and validated the interest in the S1P-axis as a potential therapeutic target. Even though the involvement of S1P-signalling in inflammatory skin diseases still requires further clarification, the implications of the recent findings may prompt expansion of research to additional skin conditions and more S1P-axis modulatory pharmaceuticals.

Controls on anthropogenic radionuclide distribution in the Sellafield-impacted Eastern Irish Sea

Understanding anthropogenic radionuclide biogeochemistry and mobility in natural systems is key to improving the management of radioactively contaminated environments and radioactive wastes. Here, we describe the contemporary depth distribution and phase partitioning of ¹³⁷Cs, Pu, and ²⁴¹Am in two sediment cores taken from the Irish Sea (Site 1: the Irish Sea Mudpatch; Site 2: the Esk Estuary). Both sites are located ~10 km from the Sellafield nuclear site. Low-level aqueous radioactive waste has been discharged from the Sellafield site into the Irish Sea for >50 y. We compare the depth distribution of the radionuclides at each site to trends in sediment and porewater redox chemistry, using trace element abundance, microbial ecology, and sequential extractions, to better understand the relative importance of sediment biogeochemistry vs. physical controls on radionuclide distribution/post-depositional mobility in the sediments. We highlight that the distribution of ¹³⁷Cs, Pu, and ²⁴¹Am at both sites is largely controlled by physical mixing of the sediments, physical transport processes, and sediment accumulation. Interestingly, at the Esk Estuary, microbially-mediated redox processes (considered for Pu) do not appear to offer significant controls on Pu distribution, even over decadal timescales. We also highlight that the Irish Sea Mudpatch likely still acts as a source of historical pollution to other areas in the Irish Sea, despite ever decreasing levels of waste output from the Sellafield site.

Toxicological analysis of aerosols derived from three electronic nicotine delivery systems using normal human bronchial epithelial cells

Electronic nicotine delivery systems (ENDS) are a rapidly growing global market advertised as a safer alternative to combustible cigarettes. However, comprehensive investigations of END aerosol physicochemical and toxicological properties have not been fully explored across brands to assess relative safety. In this study, we evaluated aerosols collected from three ENDS - Juul Fruit Medley (5% nicotine), Logic Power (2.4% nicotine), and Mistic (1.8% nicotine). ENDS aerosols were generated using standard machine puffing regimen and collected with a novel fluoropolymer condensation trap. Triple quadrupole-inductively coupled plasma-mass determined the presence of heavy metals in collected aerosols. The toxicological effects of ENDS aerosols on normal human bronchial epithelial cells (NHBE) were investigated using cellular viability, reactive oxygen species, oxidative stress assays, along with DNA damage assessments using the CometChip©. Results indicated the total metal concentrations within collected ENDS aerosols were higher for Mistic and Logic compared to Juul. Logic Power aerosols elicited higher reactive oxygen species levels than Mistic and Juul in NHBE after 24-h exposure. Similar dose-dependent reductions of cellular viability and total glutathione were found for each exposure. However, Logic and Juul aerosols caused greater single stranded DNA damage compared to Mistic. Our study indicates that regardless of brand, ENDS aerosols are toxic to upper airway epithelial cells and may pose a potential respiratory hazard to occasional and frequent users.

Low-Temperature Pretreatment of Organic Feedstocks with Selected Mineral Wastes Sustains Anaerobic Digestion Stability through Trace Metal Release

A low-cost approach for enhancing mesophilic (37 °C) anaerobic digestion (AD) of organic waste using a low-temperature (37 °C) pretreatment with different mineral wastes (MW) was investigated. A higher and stable methane production rate, in comparison to MW-free controls, was achieved for 80 days at organic loading rates of 1-2 g VS/L·d, using a feed substrate pretreated with incinerator bottom ash (IBA). The boiler ash and cement-based waste pretreatments also produced high methane production rates but with some process instability. In contrast, an incinerator fly ash pretreatment showed a progressive decrease in methane production rates and poor process stability, leading to reactor failure after 40 days. To avoid process instability and/or reactor failure, two metrics had to be met: (a) a methanogenesis to fermentation ratio higher than 0.6 and (b) a cell-specific methanogenic activity to cell-specific fermentation activity ratio of >1000. The prevalence of Methanofastidiosum together with a mixed community of acetoclastic (Methanosaeta) and hydrogenotrophic (Methanobacterium) methanogens in the stable IBA treatment indicated the importance of Methanofastidiosum as a potential indicator of a healthy and stable reactor.

In depth metagenomic analysis in contrasting oil wells reveals syntrophic bacterial and archaeal associations for oil biodegradation in petroleum reservoirs

Microbial biodegradation of hydrocarbons in petroleum reservoirs has major consequences in the petroleum value and quality. The identification of microorganisms capable of in-situ degradation of hydrocarbons under the reservoir conditions is crucial to understand microbial roles in hydrocarbon transformation and the impact of oil exploration and production on energy resources. The aim of this study was to profile the metagenome of microbial communities in crude oils and associated formation water from two high temperature and relatively saline oil-production wells, where one has been subjected to water flooding (BA-2) and the other one is considered pristine (BA-1). The microbiome was studied in the fluids using shotgun metagenome sequencing. Distinct microbial compositions were revealed when comparing pristine and water flooded oil wells in contrast to the similar community structures observed between the aqueous and oil fluids from the same well (BA-2). The equal proportion of archaea and bacteria together with the greater anaerobic hydrocarbon degradation potential in the BA-1 pristine but degraded reservoir contrasted with the predominance of bacteria over archaea, aerobic pathways and lower frequency of anaerobic degradation genes in the BA-2 water flooded undegraded well. Our results suggest that Syntrophus, Syntrophomonas, candidatus Atribacteria and Synergistia, in association with mainly acetoclastic methanogenic archaea of the genus Methanothrix, were collectively responsible for the oil biodegradation observed in the pristine petroleum well BA-1. Conversely, the microbial composition of the water flooded oil well BA-2 was mainly dominated by the fast-growing and putatively aerobic opportunists Marinobacter and Marinobacterium. This presumable allochthonous community introduced a greater metabolic versatility, although oil biodegradation has not been detected hitherto perhaps due to in-reservoir unfavorable physicochemical conditions. These findings provide a better understanding of the petroleum reservoir microbiomes and their potential roles in biogeochemical processes occurring in environments with different geological and oil recovery histories.

Improving the methane productivity of anaerobic digestion using aqueous extracts from municipal solid waste incinerator ash

This study investigated the effects of mineral waste extracts (MWE) on laboratory-scale two-stage anaerobic digesters treating synthetic organic waste. MWE was prepared as aqueous extracts from different ash samples (incineration bottom ash (IBA), fly ash (FA) and boiler ash (BA) taken from a municipal solid waste incineration plant. At 20 days hydraulic retention time, all three MWE stimulated hydrogen production in their respective acidogenic reactor by around 35% (c.f. control acidogenic reactor), whilst no difference was seen in the methane productivity of the linked methanogenic reactors (average 527 ± 45 mL CH₄/g VS, including control methanogenic reactor). Following a step reduction in hydraulic retention time from 20 to 10 days and a doubling of the organic loading rate from 2.5 g to 5 g VS/L. d, no significant change was seen in hydrogen production (p > 0.05) in the acidogenic reactor amended with MWE from IBA and BA, or the control acidogenic reactor. However, the acidogenic reactor receiving MWE from FA had 45% lower hydrogen productivity. The step change in hydraulic retention time and organic loading rates led to the failure of most methanogenic reactors (≤100 mL CH₄/g VS), however, the one receiving feed containing MWE from IBA showed stable performance without signs of failure, and had higher volumetric methane productivity, albeit at lower methane yields (370 ± 20 mL CH₄/g VS). 16S rRNA analysis using the Illumina sequencing platform revealed acidogenesis by Lactobacillaceae in the acidogenic reactor and syntrophic acetate oxidation by Synergistaceae linked to enrichment of the candidatus genus Methanofastidiosum, in the stable methanogenic reactor receiving MWE from IBA.

Combining thermal hydrolysis and methylation-gas chromatography/mass spectrometry with X-ray photoelectron spectroscopy to characterise complex organic assemblages in geological material

What follows is a method applicable generically to the analysis of low levels of organic matter that is embedded in either loose fine-grained or solid geological material. Initially, the range of organic compounds that could be detected in a geological sample using conventional pyrolysis chromatography/mass spectrometry was compared to the range that was detected using thermally assisted hydrolysis and methylation-gas chromatography/mass spectrometry (THM-GC/MS). This method was used to validate the synthetic components fitted to X-ray photoelectron spectroscopy (XPS) carbon spectra of the sample. Reciprocally, XPS analysis was able to identify the constituent carbon-carbon, carbon-oxygen and carbon-nitrogen bonds of the functional groups in the compounds identified by THM-GC/MS. The two independently derived outputs from the THM-GC/MS and the XPS techniques mutually validated the identification of organic compounds in our geological samples. We describe in detail the improvements to: •The preparation of geological samples for analysis by XPS.•Measurements of organic material in geological samples using GC/MS.•The use of THM-GC/MS and XPS data used together to characterise low levels of organic material in geological samples.

The organic stratigraphy of Ontong Java Plateau Tuff correlated with the depth-related presence and absence of putative microbial alteration structures

Structures in geological samples are often interpreted as fossilised life; however, such interpretations are equivocal, as abiotic processes can be invoked to explain their presence. Thus, additional lines of chemical evidence are invaluable in confirming or refuting such morphological evidence. Glass shards in tuff from the Ontong Java Plateau (OJP) contain microtubular structures that are in close proximity to functionalised nitrogen substituted aromatic compounds that may be indicative of the chemical remnants of biological activity. The organic composition of the OJP tuff containing microtubular alteration structures was compared with tuff without such features. In addition, organic matter associated with horizons with compacted remnants of woody material buried in the OJP tuff and overlying pelagic calcareous foraminifer sediment were also characterised, to ascertain the provenance of the organic matter found in the OJP tuff. As a further control, the organic material in submarine and terrestrial basalts from other locations were also characterised providing further evidence to support the view that the organic matter in the OJP tuff is authigenic. Carbon-nitrogen chemistry was detected across all OJP tuff samples irrespective of the presence or absence of microtubular features, but was not detected in either the wood material, the overlying pelagic sediments or in the basalts from other locations. The results indicate no direct link between the OJP nitrogenous organic compounds and the presence or absence of microtubular features.

Data of metal and microbial analyses from anaerobic co-digestion of organic and mineral wastes

High concentrations of minerals, heavy metals are often found in mineral wastes (MWs) originated from municipal solid waste incineration plants, so as construction/demolition sites. Such by-products (minerals) often have buffering capacity. The current work provides analysis of total and soluble (dissolved) metal concentrations released by four different MWs (a. cement-based waste, b. incineration (bottom), c. fly and d. boiler ash) supplemented to anaerobic reactors of organic waste at 37 °C. The reactors (continuous stirred tank reactor (CSTR)) were ran for 75 days at hydrolytic retention time of 20 days. Genomic DNA extraction, and qPCR and Illumina HiSeq (16S V4) analyses were conducted to investigate microbial community population and composition in anaerobic digestate samples collected from these reactors. Output data from Illumina sequencing analysis were FastQ files analysed using the QIIME2 pipeline to produce a feature table listing the frequency of each assigned microbial taxa per samples. Additional study was conducted on the microbial data to visualise variations in microbial communities using the STAMP software and phyloseq R package. Detailed interpretation and discussion of the results can be found in the related research article [1].

Co-digestion of organic and mineral wastes for enhanced biogas production: Reactor performance and evolution of microbial community and function

Mineral wastes (MWs) from municipal solid waste incineration plants and construction demolition sites are rich in minerals, heavy metals and have acid neutralising capacity. This renders such MWs a promising source of bulk and trace elements to enhance and stabilize biogas production in anaerobic processes. However, finding a MW with typical heavy metal concentrations, which promotes anaerobic digestion (AD) without adverse effects on the microbial community of the reactor is of major importance. To investigate the impact of several MW additives (1. incineration bottom ash; 2. fly ash; 3. boiler ash; 4. cement-based waste) as AD co-substrates, six 5 L single stage mesophilic, continuously stirred tank reactors (CSTR) were setup. Two different feeding regimes were employed including: (a) a liquid-recycled feeding method (LRFM); (b) a draw-and-fill feeding method (DFFM). Under the LRFM regime, one gram MW per gram organic waste enhanced process stability (pH), increased methane production (25-45% increase), and yielded (450-520 mL CH₄/g VS); DFFM enhanced digestibility to a lesser degree. Illumina HiSeq 16S rRNA community sequencing of reactors showed that the microbial community compositions were unaffected by the presence of MW additives in comparison to unamended controls, but MW amendment accelerated bacterial growth (determined by qPCR). In contrast, different feeding regimes altered the microbial communities; Methanoculleus (hydrogenotrophic) and Methanosaeta (acetoclastic) were the most abundant methanogenic genera in the LRFM reactors, and the more metabolically versatile Methanosarcina genus dominated under DFFM.

Management of common adverse effects of antipsychotic medications

The benefits of antipsychotic medications are sometimes obscured by their adverse effects. These effects range from relatively minor tolerability issues (e.g., mild sedation or dry mouth) to very unpleasant (e.g., constipation, akathisia, sexual dysfunction) to painful (e.g., acute dystonias) to disfiguring (e.g., weight gain, tardive dyskinesia) to life-threatening (e.g., myocarditis, agranulocytosis). Importantly, adverse effect profiles are specific to each antipsychotic medication and do not neatly fit into first- and second-generation classifications. This paper reviews management strategies for the most frequent side effects and identifies common principles intended to optimize net antipsychotic benefits. Only use antipsychotics if the indication is clear; only continue antipsychotics if a benefit is discernible. If an antipsychotic is providing substantial benefit, and the adverse effect is not life-threatening, then the first management choice is to lower the dose or adjust the dosing schedule. The next option is to change the antipsychotic; this is often reasonable unless the risk of relapse is high. In some instances, behavioral interventions can be tried. Finally, concomitant medications, though generally not desirable, are necessary in many instances and can provide considerable relief. Among concomitant medication strategies, anticholinergic medications for dystonias and parkinsonism are often effective; beta-blockers and anticholinergic medications are useful for akathisia; and metformin may lead to slight to moderate weight loss. Anticholinergic drops applied sublingually reduce sialorrhea. Usual medications are effective for constipation or dyslipidemias. The clinical utility of recently approved treatments for tardive dyskinesia, valbenazine and deutetrabenazine, is unclear.

Microbial diversity in degraded and non-degraded petroleum samples and comparison across oil reservoirs at local and global scales

Microorganisms have shown their ability to colonize extreme environments including deep subsurface petroleum reservoirs. Physicochemical parameters may vary greatly among petroleum reservoirs worldwide and so do the microbial communities inhabiting these different environments. The present work aimed at the characterization of the microbiota in biodegraded and non-degraded petroleum samples from three Brazilian reservoirs and the comparison of microbial community diversity across oil reservoirs at local and global scales using 16S rRNA clone libraries. The analysis of 620 16S rRNA bacterial and archaeal sequences obtained from Brazilian oil samples revealed 42 bacterial OTUs and 21 archaeal OTUs. The bacterial community from the degraded oil was more diverse than the non-degraded samples. Non-degraded oil samples were overwhelmingly dominated by gammaproteobacterial sequences with a predominance of the genera Marinobacter and Marinobacterium. Comparisons of microbial diversity among oil reservoirs worldwide suggested an apparent correlation of prokaryotic communities with reservoir temperature and depth and no influence of geographic distance among reservoirs. The detailed analysis of the phylogenetic diversity across reservoirs allowed us to define a core microbiome encompassing three bacterial classes (Gammaproteobacteria, Clostridia, and Bacteroidia) and one archaeal class (Methanomicrobia) ubiquitous in petroleum reservoirs and presumably owning the abilities to sustain life in these environments.

The RUDY study platform - a novel approach to patient driven research in rare musculoskeletal diseases

BACKGROUND

Research into rare diseases is becoming more common, with recognition of the significant diagnostic and therapeutic care gaps. Registries are considered a key research methodology to address rare diseases. This report describes the structure of the Rare UK Diseases Study (RUDY) platform that aims to improve research processes and address many of the challenges of carrying out rare musculoskeletal disease research. RUDY is an internet-based platform with online registration, initial verbal consent, online capture of patient reported outcome measures and events within a dynamic consent framework. The database structure, security and governance framework are described.

RESULTS

There have been 380 participants recruited into RUDY with completed questionnaire rates in excess of 50 %. There has been one withdrawal and two participants have amended their consent options.

CONCLUSIONS

The strengths of RUDY include low burden for the clinical team, low research administration costs with high participant recruitment and ease of data collection and access. This platform has the potential to be used as the model for other rare diseases globally.

Towards a mechanistic understanding of carbon stabilization in manganese oxides

Minerals stabilize organic carbon (OC) in sediments, thereby directly affecting global climate at multiple scales, but how they do it is far from understood. Here we show that manganese oxide (Mn oxide) in a water treatment works filter bed traps dissolved OC as coatings build up in layers around clean sand grains at 3%w/wC. Using spectroscopic and thermogravimetric methods, we identify two main OC fractions. One is thermally refractory (>550 °C) and the other is thermally more labile (<550 °C). We postulate that the thermal stability of the trapped OC is due to carboxylate groups within it bonding to Mn oxide surfaces coupled with physical entrapment within the layers. We identify a significant difference in the nature of the surface-bound OC and bulk OC . We speculate that polymerization reactions may be occurring at depth within the layers. We also propose that these processes must be considered in future studies of OC in natural systems.

Minerals are known to stabilize organic carbon in sediments, affecting biogeochemical cycles and global climate, but the mechanism is not understood. Here, the authors suggest that manganese oxides can trap organic carbon and may act as a ‘mineral pump', transforming carbon between labile and refractory forms.

Hematopoietic androgen receptor deficiency promotes visceral fat deposition in male mice without impairing glucose homeostasis

Androgen deficiency in men increases body fat, but the mechanisms by which testosterone suppresses fat deposition have not been elucidated fully. Adipose tissue macrophages express the androgen receptor (AR) and regulate adipose tissue remodeling. Thus, testosterone signaling in macrophages could alter the paracrine function of these cells and thereby contribute to the metabolic effects of androgens in men. A metabolic phenotyping study was performed to determine whether the loss of AR signaling in hematopoietic cells results in greater fat accumulation in male mice. C57BL/6J male mice (ages 12-14 weeks) underwent bone marrow transplant from either wild-type (WT) or AR knockout (ARKO) donors (n = 11-13 per group). Mice were fed a high-fat diet (60% fat) for 16 weeks. At baseline, 8 and 16 weeks, glucose and insulin tolerance tests were performed, and body composition was analyzed with fat-water imaging by MRI. No differences in body weight were observed between mice transplanted with WT bone marrow [WT(WTbm)] or ARKO bone marrow [WT(ARKObm)] prior to initiation of the high-fat diet. After 8 weeks of high-fat feeding, WT(ARKObm) mice exhibited significantly more visceral and total fat mass than WT(WTbm) animals. Despite this, no differences between groups were observed in glucose tolerance, insulin sensitivity, or plasma concentrations of insulin, glucose, leptin, or cholesterol, although WT(ARKObm) mice had higher plasma levels of adiponectin. Resultant data indicate that AR signaling in hematopoietic cells influences body fat distribution in male mice, and the absence of hematopoietic AR plays a permissive role in visceral fat accumulation. These findings demonstrate a metabolic role for AR signaling in marrow-derived cells and suggest a novel mechanism by which androgen deficiency in men might promote increased adiposity. The relative contributions of AR signaling in macrophages and other marrow-derived cells require further investigation.

A retrospective analysis of RET translocation, gene copy number gain and expression in NSCLC patients treated with vandetanib in four randomized Phase III studies

Background

To determine the prevalence of RET rearrangement genes, RET copy number gains and expression in tumor samples from four Phase III non-small-cell lung cancer (NSCLC) trials of vandetanib, a selective inhibitor of VEGFR, RET and EGFR signaling, and to determine any association with outcome to vandetanib treatment.

Methods

Archival tumor samples from the ZODIAC (NCT00312377, vandetanib ± docetaxel), ZEAL (NCT00418886, vandetanib ± pemetrexed), ZEPHYR (NCT00404924, vandetanib vs placebo) and ZEST (NCT00364351, vandetanib vs erlotinib) studies were evaluated by fluorescence in situ hybridization (FISH) and immunohistochemistry (IHC) in 944 and 1102 patients.

Results

The prevalence of RET rearrangements by FISH was 0.7% (95% CI 0.3–1.5%) among patients with a known result. Seven tumor samples were positive for RET rearrangements (vandetanib, n = 3; comparator, n = 4). 2.8% (n = 26) of samples had RET amplification (innumerable RET clusters, or ≥7 copies in > 10% of tumor cells), 8.1% (n = 76) had low RET gene copy number gain (4–6 copies in ≥40% of tumor cells) and 8.3% (n = 92) were RET expression positive (signal intensity ++ or +++ in >10% of tumor cells). Of RET-rearrangement-positive patients, none had an objective response in the vandetanib arm and one patient responded in the comparator arm. Radiologic evidence of tumor shrinkage was observed in two patients treated with vandetanib and one treated with comparator drug. The objective response rate was similar in the vandetanib and comparator arms for patients positive for RET copy number gains or RET protein expression.

Conclusions

We have identified prevalence for three RET biomarkers in a population predominated by non-Asians and smokers. RET rearrangement prevalence was lower than previously reported. We found no evidence of a differential benefit for efficacy by IHC and RET gene copy number gains. The low prevalence of RET rearrangements (0.7%) prevents firm conclusions regarding association of vandetanib treatment with efficacy in the RET rearrangement NSCLC subpopulation.

Trial registration

Randomized Phase III clinical trials (NCT00312377, ZODIAC; NCT00418886, ZEAL; NCT00364351, ZEST; NCT00404924, ZEPHYR).

Electronic supplementary material

The online version of this article (doi:10.1186/s12885-015-1146-8) contains supplementary material, which is available to authorized users.

Time from first presentation in primary care to treatment of symptomatic colorectal cancer: effect on disease stage and survival

Background:

British 5-year survival from colorectal cancer (CRC) is below the European average, but the reasons are unclear. This study explored if longer provider delays (time from presentation to treatment) were associated with more advanced stage disease at diagnosis and poorer survival.

Methods:

Data on 958 people with CRC were linked with the Scottish Cancer Registry, the Scottish Death Registry and the acute hospital discharge (SMR01) dataset. Time from first presentation in primary care to first treatment, disease stage at diagnosis and survival time from date of first presentation in primary care were determined. Logistic regression and Cox survival analyses, both with a restricted cubic spline, were used to model stage and survival, respectively, following sequential adjustment of patient and tumour factors.

Results:

On univariate analysis, those with <4 weeks from first presentation in primary care to treatment had more advanced disease at diagnosis and the poorest prognosis. Treatment delays between 4 and 34 weeks were associated with earlier stage (with the lowest odds ratio occurring at 20 weeks) and better survival (with the lowest hazard ratio occurring at 16 weeks). Provider delays beyond 34 weeks were associated with more advanced disease at diagnosis, but not increased mortality. Following adjustment for patient, tumour factors, emergency admissions and symptoms and signs, no significant relationship between provider delay and stage at diagnosis or survival from CRC was found.

Conclusions:

Although allowing for a nonlinear relationship and important confounders, moderately long provider delays did not impact adversely on cancer outcomes. Delays are undesirable because they cause anxiety; this may be fuelled by government targets and health campaigns stressing the importance of very prompt cancer diagnosis. Our findings should reassure patients. They suggest that a health service's primary emphasis should be on quality and outcomes rather than on time to treatment.

Antibody validation of immunohistochemistry for biomarker discovery: recommendations of a consortium of academic and pharmaceutical based histopathology researchers

As biomarker discovery takes centre-stage, the role of immunohistochemistry within that process is increasing. At the same time, the number of antibodies being produced for “research use” continues to rise and it is important that antibodies to be used as biomarkers are validated for specificity and sensitivity before use. This guideline seeks to provide a stepwise approach for the validation of an antibody for immunohistochemical assays, reflecting the views of a consortium of academic and pharmaceutical based histopathology researchers. We propose that antibodies are placed into a tier system, level 1–3, based on evidence of their usage in immunohistochemistry, and that the degree of validation required is proportionate to their place on that tier.

Identification of a subset of human non-small cell lung cancer patients with high PI3Kβ and low PTEN expression, more prevalent in squamous cell carcinoma

PURPOSE

The phosphoinositide 3-kinase (PI3K) pathway is a major oncogenic signaling pathway and an attractive target for therapeutic intervention. Signaling through the PI3K pathway is moderated by the tumor suppressor PTEN, which is deficient or mutated in many human cancers. Molecular characterization of the PI3K signaling network has not been well defined in lung cancer; in particular, the role of PI3Kβ and its relation to PTEN in non-small cell lung cancer NSCLC remain unclear.

EXPERIMENTAL DESIGN

Antibodies directed against PI3Kβ and PTEN were validated and used to examine, by immunohistochemistry, expression in 240 NSCLC resection tissues [tissue microarray (TMA) set 1]. Preliminary observations were extended to an independent set of tissues (TMA set 2) comprising 820 NSCLC patient samples analyzed in a separate laboratory applying the same validated antibodies and staining protocols. The staining intensities for PI3Kβ and PTEN were explored and colocalization of these markers in individual tumor cores were correlated.

RESULTS

PI3Kβ expression was elevated significantly in squamous cell carcinomas (SCC) compared with adenocarcinomas. In contrast, PTEN loss was greater in SCC than in adenocarcinoma. Detailed correlative analyses of individual patient samples revealed a significantly greater proportion of SCC in TMA set 1 with higher PI3Kβ and lower PTEN expression when compared with adenocarcinoma. These findings were reinforced following independent analyses of TMA set 2.

CONCLUSIONS

We identify for the first time a subset of NSCLC more prevalent in SCC, with elevated expression of PI3Kβ accompanied by a reduction/loss of PTEN, for whom selective PI3Kβ inhibitors may be predicted to achieve greater clinical benefit.

Validation of the BRCA1 antibody MS110 and the utility of BRCA1 as a patient selection biomarker in immunohistochemical analysis of breast and ovarian tumours

BRCA1 protein measurement has previously been evaluated as a potential diagnostic marker without reaching a conclusive recommendation. In this study, we applied current best practice in antibody validation to further characterize MS110, a widely used antibody targeting BRCA1. Antibody specificity was investigated using different biochemical validation techniques. We found that BRCA1 could not be reliably detected using immunoprecipitation and Western blot in endogenously expressing cells. We used immunohistochemistry on formalin-fixed paraffin-embedded cell pellets to establish compatibility with formalin-fixed paraffin-embedded samples. We demonstrated that in transfected cells and cell lines with known genetic BRCA1 status, MS110 successfully detected BRCA1 giving the expected level of staining in immunohistochemistry. Following this, we investigated the use of BRCA1 protein measurement by immunohistochemistry in a cohort of triple negative breast and serous ovarian tumour samples to explore the use of BRCA1 protein measurement by immunohistochemistry for patient stratification. Using MS110 in repeated standardized experiments, on serial sections from a panel of patient samples, results demonstrated considerable run-to-run variability. We concluded that in formalin-fixed tissue samples, MS110 does detect BRCA1; however, using standard methodologies, BRCA1 expression levels in tissue samples is incompatible with the use of this protein as a statistically robust patient selection marker in immunohistochemistry. These results demonstrate the need for further development to deliver BRCA1 protein quantification by immunohistochemistry as a patient stratification marker.

Abstract 4172: Identification of a low PTEN / high PI3Kα expressing subset of squamous non-small-cell lung cancer (NSCLC)

Background The PI3K/AKT/mTOR signalling network is a critical regulator of many cellular processes including proliferation, survival and transformation. PI3Kα and PI3Kα are positioned on chromosome 3q (3q25-27), a region often amplified in NSCLC. The activity of the PI3K enzymes is counteracted by the tumor suppressor PTEN, a nonredundant phosphatase. Clinically, PTEN mutations and deficiencies are prevalent in many types of human cancers and severe PTEN deficiency is also associated with advanced tumor stage and therapeutic resistance. In lung cancer, loss of PTEN protein occurs via a number of mechanisms including promoter methylation and LOH, however, neither epigenetic silencing nor deletion appear to predict with protein loss by immunohistochemistry (IHC). The molecular characterization of the PI3K/AKT/mTOR signalling network in lung cancer is not as well defined as in other tumour types, yet de-regulation of this pathway has been linked to resistance to therapy (EGFR). In particular, the role of PI3Kα in NSCLC has not been studied. Methods Eight tissue microarrays (TMAs) comprising 211 surgically resected formalin-fixed paraffin-embedded NSCLC specimens (99 squamous cell carcinomas; 112 adenocarcinomas) were examined by IHC using validated antibodies directed against PI3Kα and PTEN. In addition, an independent investigation was conducted at the MDACC using the same validated antibody methods across thirty two TMAs comprising 290 squamous and 530 adenocarcinoma samples. Results Tumour expression of PI3Kα was largely cytoplasmic, while PTEN was localized to both cytoplasmic and nuclear compartments. Results from the AZ dataset reveal significantly (p&lt;0.001) elevated expression of cytoplasmic PI3Kα expression in squamous cell carcinomas compared with adenocarcinomas. Conversely, adenocarcinoma samples displayed significantly higher levels of cytoplasmic (p&lt;0.001) and nuclear (p&lt;0.001) PTEN (88.3% and 74.8% positive, respectively) compared with squamous samples (60.6% and 45.5% positive, respectively). Interestingly, over-expression of cytoplasmic PI3Kα in squamous samples correlated significantly (66.3% of squamous samples; p&lt;0.001) with negative or low cytoplasmic and nuclear PTEN expression, with only 11.5% of adenocarcinoma samples showing this pattern of expression and 50% exhibiting a converse relationship. Analyses of data derived from the MDACC identified a similar profile of expression confirming identification of a subset of squamous NSCLC samples with over-expression of PI3Kα and low or negative PTEN. Supplementary evaluation of KRAS and EGFR mutation status and survival endpoints in this segment has also been performed and will be discussed. Conclusions These data identify a pattern of over-expression of PI3Kα in squamous NSCLC that, accompanied by loss/reduced PTEN, could represent a subset for therapeutic intervention.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 4172. doi:1538-7445.AM2012-4172

Comparison of the GMFM-66 and the PEDI Functional Skills Mobility domain in a group of Chinese children with cerebral palsy

BACKGROUND

Previous research has suggested there is a high level of comparability between the Gross Motor Function Measure-66 (GMFM-66) and the Pediatric Evaluation of Disability Inventory (PEDI) Functional Skills Mobility domain. However, there are only a few studies that have examined the correlations between these instruments. The purpose of this study was to determine the correlation between the GMFM-66 and the PEDI Functional Skills Mobility domain scaled scores in a group of Chinese children with spastic cerebral palsy, at the ages of 12-70 months, in order to explore the feasibility of using them interchangeably.

METHODS

Secondary data analysis was conducted of data collected during a prospective international collaborative study that used the GMFM-66 and the PEDI to examine the impact of treatment. This study examined the Pearson correlations between the GMFM-66 and the PEDI Functional Skills Mobility domain at six time points over the course of 28 consecutive weeks for 115 Chinese children who participated at baseline.

RESULTS

Pearson correlations between the GMFM-66 and the PEDI Functional Skills Mobility domain ranged from 0.83 to 0.90 for the six time points of data collection, with statistically significant P-values <0.0001 for each correlation.

CONCLUSIONS

These results support previous research that the GMFM-66 and the PEDI Functional Skills Mobility domain are complementary assessments that may be used interchangeably when it is not possible to administer both.

Which women default from follow-up cervical cytology tests? A cohort study within the TOMBOLA trial

OBJECTIVE

To identify factors associated with default from follow-up cervical cytology tests.

METHODS

A cohort study was conducted involving 2166 women, aged 20-59, with recent low-grade cervical cytology taken within the NHS Cervical Screening Programmes in Scotland and England, and managed by 6-monthly cytology in primary care. For the first (6-month) and second (12-month) surveillance cytology tests separately, women were categorized as 'on-time attendees' (attended ≤6 months of test being due), 'late attendees' (attended greater than 6 months after test was due) or 'non-attendees' (failed to attend). Multivariate odds ratios (ORs) were computed for factors associated with late and non-attendance.

RESULTS

For the first surveillance test, risk of non-attendance was significantly higher in younger women, those without post-secondary education, and non-users of prescribed contraception. Factors significantly associated with late attendance for the first test were the same as for non-attendance, plus current smoking and having children. The most important predictor of non-attendance for the second surveillance test was late attendance for the first test (OR = 9.65; 95% CI, 6.60-16.62). Non-attendance for the second test was also significantly higher among women who were younger, smokers and had negative cytology on the first surveillance test. Late attendance for the second surveillance test was higher in women who were younger, smokers, had children and attended late for the first test.

CONCLUSIONS

Women at highest risk of default from follow-up cytology tend to be young, smoke, lack post-secondary education, and have defaulted from a previous surveillance appointment. Tackling default will require development of targeted strategies to encourage attendance and research to better understand the reasons underpinning default.

Vascular endothelial growth factor receptors VEGFR-2 and VEGFR-3 are localized primarily to the vasculature in human primary solid cancers

PURPOSE

Vascular endothelial growth factor (VEGF) signaling is key to tumor angiogenesis and is an important target in the development of anticancer drugs. However, VEGF receptor (VEGFR) expression in human cancers, particularly the relative expression of VEGFR-2 and VEGFR-3 in tumor vasculature versus tumor cells, is poorly defined.

EXPERIMENTAL DESIGN

VEGFR-2- and VEGFR-3-specific antibodies were identified and used in the immunohistochemical analysis of human primary cancers and normal tissue. The relative vascular localization of both receptors in colorectal and breast cancers was determined by coimmunofluorescence with vascular markers.

RESULTS

VEGFR-2 and VEGFR-3 were expressed on vascular endothelium but not on malignant cells in 13 common human solid tumor types (n > 400, bladder, breast, colorectal, head and neck, liver, lung, skin, ovarian, pancreatic, prostate, renal, stomach, and thyroid). The signal intensity of both receptors was significantly greater in vessels associated with malignant colorectal, lung, and breast than adjacent nontumor tissue. In colorectal cancers, VEGFR-2 was expressed on both intratumoral blood and lymphatic vessels, whereas VEGFR-3 was found predominantly on lymphatic vessels. In breast cancers, both receptors were localized to and upregulated on blood vessels.

CONCLUSIONS

VEGFR-2 and VEGFR-3 are primarily localized to, and significantly upregulated on, tumor vasculature (blood and/or lymphatic) supporting the majority of solid cancers. The primary clinical mechanism of action of VEGF signaling inhibitors is likely to be through the targeting of tumor vessels rather than tumor cells. The upregulation of VEGFR-3 on tumor blood vessels indicates a potential additional antiangiogenic effect for dual VEGFR-2/VEGFR-3-targeted therapy.

Vascular endothelial growth factor receptors VEGFR-2 and VEGFR-3 are localized primarily to the vasculature in human primary solid cancers

PURPOSE

Vascular endothelial growth factor (VEGF) signaling is key to tumor angiogenesis and is an important target in the development of anticancer drugs. However, VEGF receptor (VEGFR) expression in human cancers, particularly the relative expression of VEGFR-2 and VEGFR-3 in tumor vasculature versus tumor cells, is poorly defined.

EXPERIMENTAL DESIGN

VEGFR-2- and VEGFR-3-specific antibodies were identified and used in the immunohistochemical analysis of human primary cancers and normal tissue. The relative vascular localization of both receptors in colorectal and breast cancers was determined by coimmunofluorescence with vascular markers.

RESULTS

VEGFR-2 and VEGFR-3 were expressed on vascular endothelium but not on malignant cells in 13 common human solid tumor types (n > 400, bladder, breast, colorectal, head and neck, liver, lung, skin, ovarian, pancreatic, prostate, renal, stomach, and thyroid). The signal intensity of both receptors was significantly greater in vessels associated with malignant colorectal, lung, and breast than adjacent nontumor tissue. In colorectal cancers, VEGFR-2 was expressed on both intratumoral blood and lymphatic vessels, whereas VEGFR-3 was found predominantly on lymphatic vessels. In breast cancers, both receptors were localized to and upregulated on blood vessels.

CONCLUSIONS

VEGFR-2 and VEGFR-3 are primarily localized to, and significantly upregulated on, tumor vasculature (blood and/or lymphatic) supporting the majority of solid cancers. The primary clinical mechanism of action of VEGF signaling inhibitors is likely to be through the targeting of tumor vessels rather than tumor cells. The upregulation of VEGFR-3 on tumor blood vessels indicates a potential additional antiangiogenic effect for dual VEGFR-2/VEGFR-3-targeted therapy.

Characterization of AZD8931, a potent reversible small molecule inhibitor against epidermal growth factor receptor (EGFR), erythroblastic leukemia viral oncogene homolog 2 (HER2) and 3 (HER3) with a unique and balanced pharmacological profile

11072

Background: Successful combined pharmacological inhibition of EGFR, HER2, and HER3 signaling is currently under investigation in the clinic. HERs (erbB receptors including EGFR, erbB2, erbB3, erbB4) undergo various types of alteration and in many cancers HER ligands are produced either by the tumor cells themselves or surrounding stromal cells. These mechanisms of receptor activation all lead to constitutive proliferative and/or survival signaling driven by homo- and/or heterodimerization of the HER family. Characterization of a novel tyrosine kinase inhibitor with a potent and balanced profile against EGFR, HER2 (erbB2), and HER3 (erbB3) has been carried out. Methods: A range of assays has been developed to assess the detailed pharmacology of AZD8931 and understand how the profile of AZD8931 compares with other HER family inhibitors, such as gefitinib and lapatinib. These assays have provided unique insights into the pharmacology of these drugs that result from the varying levels of HER and their associated ligands. Results: Across a number of cell systems, AZD8931 has been shown to be a potent inhibitor of tumor cell growth. This effect is through the ability of AZD8931 to inhibit potently the phosphorylation of EGFR (0.004 μM; 95% CIR: 1.377), HER2 (0.003 μM; 95% CIR: 1.817) and HER3 (0.004 μM; 95% CIR: 1.890) in a balanced manner. Furthermore, when compared to control AZD8931 has significant and dramatic effects on the downstream signaling pathways (pAKT [p=0.002] & pMAK [NS]), apoptotic (M30 [p=0.004]), and proliferative (Ki67 [p<0.0005]) endpoints. The novel agent AZD8931 displays a distinct pharmacological profile compared to both gefitinib and lapatinib. Conclusions: Based on our data as well as published literature, the combined pharmacological inhibition of EGFR, HER2, and HER3 signaling has not yet been tested in the clinic. AZD8931 offers an agent to test the hypothesis that combined inhibition of HER signaling could provide additional clinical benefit in cancer, particularly in the majority of solid tumors that do not overexpress HER2.

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COPD-related morbidity and mortality after smoking cessation: status of the evidence

The evidence base for the benefit of quitting smoking as regards morbidity and mortality outcomes in patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) is limited. The present article is a review of the existing literature. A systematic literature search in medical databases was performed until March 2006, and subsequently until September 1, 2007. The outcomes examined were COPD-related morbidity and mortality (including all-cause mortality) in COPD patients in connection with smoking cessation. A total of 21 and 27 published articles on morbidity and mortality, respectively, were identified and reviewed. For both outcomes, only a few of the studies included patients with severe COPD. Most of the studies reported a beneficial effect of smoking cessation compared with continued smoking, whereas a few found no improvement. Methodological problems, including small study sizes, poor data quality, possibility of reverse causality and incomplete ascertainment of cause of death, limit interpretation of some of the studies. The evidence as a whole supports the conclusion that, even in severe chronic obstructive pulmonary disease, smoking cessation slows the accelerated rate of lung function decline and improves survival compared with continued smoking.

Short stature: increased in children with severe learning disability

INTRODUCTION

'Health for all children' recommends that children should be screened for growth disorders at school entry with a 0.4th centile 'cut-off'. Following the diagnosis of growth hormone deficiency in four children attending local special schools, our aim was to compare the height distribution of children attending special schools with mainstream schools.

METHODS

Children at two local special schools were measured using a Leicester height measurer and values converted to standard deviation scores (SDS). Children were categorized according to whether there were known factors that could affect height. The data were compared with those collected from local mainstream schools.

RESULTS

In total, 242 children were registered at the two special schools and 192 children were measured. The mean height SDS of children in mainstream school (n = 2301) was similar to national standards at -0.09 (SD 1.02). The mean height SDS distribution of the 192 children in special schools (age range 3.2-18.4 years; median age 11.3 years) was -0.73; 95%CI -0.9 to -0.5. In those with no established diagnosis to explain altered growth (n = 120) this was -0.613; 95%CI -0.8 to -0.4. Both pre-pubertal (n = 37) and pubertal (n = 83) children were short and eight (6.7%) had a height less than the 0.4th centile.

CONCLUSIONS

Children attending special school with severe or profound learning disability were shorter than those attending mainstream school. This is still the case following the exclusion of children with a known cause for abnormal growth. This underlines the importance of each child being assessed by professionals with a refined knowledge of normal and abnormal growth.

Semantic security: specification and enforcement of semantic policies for security-driven collaborations

Collaborative research can often have demands on finer-grained security that go beyond the authentication-only paradigm as typified by many e-Infrastructure/Grid based solutions. Supporting finer-grained access control is often essential for domains where the specification and subsequent enforcement of authorization policies is needed. The clinical domain is one area in particular where this is so. However it is the case that existing security authorization solutions are fragile, inflexible and difficult to establish and maintain. As a result they often do not meet the needs of real world collaborations where robustness and flexibility of policy specification and enforcement, and ease of maintenance are essential. In this paper we present results of the JISC funded Advanced Grid Authorisation through Semantic Technologies (AGAST) project (www.nesc.ac.uk/hub/projects/agast) and show how semantic-based approaches to security policy specification and enforcement can address many of the limitations with existing security solutions. These are demonstrated into the clinical trials domain through the MRC funded Virtual Organisations for Trials and Epidemiological Studies (VOTES) project (www.nesc.ac.uk/hub/projects/votes) and the epidemiological domain through the JISC funded SeeGEO project (www.nesc.ac.uk/hub/projects/seegeo).