'It's a man's world': a gender-equitable scoping review of gender, transportation, and work

The deeply embedded inequalities in gender which mark most contemporary societies have led to a world shaped by male perspectives. This world fails to accommodate adequately the needs and experiences of women: no more evident than in the transport sector, where a 'default male' perspective dominates the planning and policies that shape our roads, railways, airlines, and shipping. This paper argues that the ways in which masculinity infuses transport systems mean they are integral to debates on gender and work. They impact both the way women experience travel and their access to places of work. A multi-transport domain scoping study has been conducted to review the literature for key gender factors that influence the use of road, rail, aviation, and maritime transport modes. A multi-disciplinary approach is proposed which incorporates perspectives and methods from the social sciences that can help to foster Gender-Equitable Human Factors (GE-HF).Practitioner summary: This paper seeks to identify the gender issues related to transport and work. A scoping review provides key factors that detail how women are disadvantaged by current transport systems. It presents gaps in knowledge that future research needs to fill. Women must be included in key decisions within the transport sector.

P-147 LAPAROSCOPIC SURGERY IS SUITABLE FOR MOST PATIENTS FOR INGUINAL HERNIA REPAIR AND IS AN EXCELLENT OPTION IN EXPERT HANDS

Introduction

This study reviews the practice of a high-volume surgeon, comparing laparoscopic and open surgery for inguinal hernia. In suitable patients the default was laparoscopic Totally Extra Peritoneal (TEP) approach.

Materials & Methods

Data from patients referred over 5 years with inguinal hernias was collated prospectively and analysed retrospectively. Short and long-term outcomes of laparoscopic and open repairs were compared.

Results

205 patients underwent repair of 288 hernias (90.7% laparoscopic, 9.3% open). 83 patients underwent bilateral repair (95.2% laparoscopic). 22 patients underwent repair of 27 recurrent hernias (68% laparoscopic).

1 case (0.5%), started laparoscopically was converted to open. Complication rates were 13.4% vs 36.8% in the laparoscopic and open arms respectively (p<0.01): superficial infection (1.6% vs 0%, p=0.58); haematoma (6.3% vs 15.8%, p=0.14); seroma (4.8% vs 5.3%, p=0.94); persisting numbness (0% vs 5.3%, p<0.01) and chronic pain (1.1% vs 0%, p=0.65). No patients suffered mesh infections or explantation.

Mean stay was significantly longer in open group (p=0.03), median stay was 0 nights in both groups. At median follow up 1.8 years (Interquartile-range 0.9–3.6 years) recurrence rate was 1.1% (0 female, 2 male) and 15.8% (1 female, 2 male) in the laparoscopic and open arms respectively (p<0.01). Open surgery was associated with significantly higher risk of recurrence (HR: 16.3, 95% CI: 2.7–97.8, p<0.01).

Conclusions

This series demonstrates the vast majority of inguinal hernias, both primary and recurrent can be treated with laparoscopic TEP repair. Higher recurrence and complication rates were associated with open repair, with a caveat of strong selection bias.

OC-029 LAPAROSCOPIC INGUINAL HERNIA REPAIR IS FEASIBLE IN PATIENTS WHO HAVE HAD PREVIOUS ABDOMINO-PELVIC SURGERY WITH NO INCREASED RISK OF COMPLICATIONS COMPARED TO OPEN REPAIR

Introduction

This study aims to understand whether previous abdomino-pelvic (AP) surgery is a predictor of peri-operative complication in inguinal hernia surgery and if there are discrepancies between laparoscopic or open repairs.

Material & Methods

All patients operated on within a 5-year period were audited and subcategorised based upon history of AP surgery. Patients were also categorised into laparoscopic and open groups. Data collected included complication rates, recurrence rates and readmission within 30 days.

Results

205 patients underwent repair of 288 hernias. 80 (39%) patients had a history of AP surgery. 32 patients suffered a complication (15.6%). 85% of the repairs were laparoscopic in the AP group vs 96.4% in the non-AP group (p=0.02). Complication rates were 17.5% and 14.4% in the AP group and non-AP group respectively (p=0.55). These included superficial infection (0% vs 2.4%, p=0.16), haematoma (11.3% vs 4.8%, p=0.08), seroma (5.0% vs 4.8%, p=0.95), persisting numbness (0% vs 0.8%, p=0.42), and chronic pain (1.3% vs 0.8%, p=0.75). There were no mesh infections or explantation in either arm. A greater proportion of patients in AP group required overnight stays (32.5% vs 21%, p=0.08). At median follow up 1.8 years, recurrence rates were 3.8% vs 1.6%, p=0.33 in AP and non-AP groups respectively.

Conclusions

Laparoscopic inguinal hernia is feasible in most patients with a history of AP surgery. Compared to open repair, there were no significant differences in recurrence or complication rates in patients with previous AP surgery. Therefore, previous AP surgery should not be a contraindication for laparoscopic repair.

P-048 DOES BILATERAL REPAIR INCREASE COMPLICATION RATES COMPARED TO UNILATERAL REPAIR IN PATIENTS UNDERGOING LAPAROSCOPIC TOTALLY EXTRAPERITONEAL INGUINAL HERNIA SURGERY?

Introduction

There is ongoing debate over whether to fix asymptomatic contralateral inguinal hernias during repair of the presenting hernia. This study reviewed the practice of one high-volume hernia surgeon, comparing unilateral and bilateral laparoscopic repairs, to establish if bilateral repair is associated with an increased risk of post-operative complications compared to unilateral repair.

Material & Methods

All patients operated on within a 5-year period were audited and subcategorised depending on whether they underwent unilateral or bilateral repair. Data was collected on complication rates, rates of recurrence, readmission within 30 days and duration of operation.

Results

186 patients underwent repair of 265 hernias. 79 patients underwent bilateral repair. 25 patients suffered a complication (13.4%). Complication rates were 11.2% and 16.5% in the unilateral group and bilateral group respectively (p=0.50). These included superficial infection (1.9% vs 1.3%, p=0.75), haematoma (5.6% vs 7.6%, p=0.59), seroma (2.8 vs 7.6%, p=0.13), and chronic pain (0% vs 2.5%, p=0.01). There were no mesh infections, persisting numbness or explantation in either arm. In both groups, median nights stayed was 0. At median length of follow-up of 1.8 years, recurrence rates were 1.9% vs 0% in the unilateral and bilateral arms respectively (p=0.22).

Conclusions

There was no significant difference in rates of complications between the bilateral and unilateral arms. Opportunistic repair may reduce risk of future surgeries and morbidity and does not appear to be associated with increased complications. Surgeons may wish to consider this when consenting patients.

POS0152 DIRECT AND INDIRECT EFFECT OF TNF INHIBITORS ON SPINAL MOBILITY IN PEOPLE WITH AXIAL SPONDYLOARTHRITIS AND THE MEDIATOR ROLE OF DISEASE ACTIVITY

Background

Although it may be difficult to detect changes in spinal mobility on the short term, spinal mobility is considered an important measure to assess the efficacy of drugs used to treat axial spondyloarthritis (axSpA). However, few studies evaluated the long-term impact of biologic treatment on spinal mobility.

Objectives

To describe the long-term effect of TNF inhibitors (TNFi) on spinal mobility in patients with axSpA, and to determine whether the use of TNFi treatment influences spinal mobility, and if this due to a direct or indirect effect (mediated by disease activity).

Methods

We performed a retrospective observational study, using data collected from patients with a clinical diagnosis of axSpA treated with TNFi at a tertiary care centre where disease activity and metrology assessments are routinely done. Adult patients with at least two Bath Ankylosing Spondylitis Metrology Index (BASMI) measurements were included. Disease activity was measured using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score C-reactive protein (ASDAS). The longitudinal association between TNFi and improvement in BASDAI/ASDAS was tested using a linear mixed effects model with BASMI as dependent variable. To test whether TNFi had a direct effect on BASMI, not mediated by disease activity, we tested that TNFi treatment was not conditionally independent of BASMI given BASDAI/ASDAS (Figure 1). We tested whether the nodes TNFi and BASMI were disconnected if we removed BASDAI and ASDAS. To test this conditional independence, we first built a linear mixed effects model for BASMI given BASDAI or ASDAS when the patient was under TNFi and used this model to predict a 95% confidence interval (CI) for BASMI given the data for BASDAI/ASDAS when the patient was without TNFi. We checked whether the true value of BASMI lay within this 95% CI and performed a hypothesis test for binomial distribution where H0: p=0.95. To test for the indirect effect of TNFi on BASMI reduction, mediated through the disease activity, we regressed BASMI on BASDAI/ASDAS, TNFi (if there was a direct effect), demographics, presence of radiographic (r-) axSpA and HLA-B27 positivity, using a linear mixed effects model adjusted for within-patient correlation.

Figure 1.

Indirect effect of TNFi on BASMI (represented by the full line), through the influence of TNFi on disease activity, adjusted by other confounders and direct effect of TNFi on BASMI (dashed line), independently of disease activity.

Results

Data from 188 patients and 1326 visits were analysed. Mean age was 45.6 (SD 11.6) years, mean disease duration was 15.8 (SD 9.64) years, 152 (80.9%) were male, 120 (73.6%) had r-axSpA, and 83 (74.8%) were HLA-B27 positive. Mean follow-up time was 8.0 (SD 4.4) years, ranging from 0.8 to 18.2 years. Treatment with TNFi was significantly associated with long-term improvement in BASMI (B=-0.423, 95% CI=[-0.553,-0.292], p<0.001). An indirect effect of TNFi on BASMI improvement was observed, mediated by reduction in disease activity, measured by BASDAI (B=0.146, 95% CI=[0.092, 0.200], p<0.001) or ASDAS (B=0.405, 95% CI=[0.260, 0.549], p<0.001). Using conditional independence tests, a direct effect of TNFi on BASMI improvement was also observed, independently of disease activity, when BASDAI was used (p<0.001) as a covariate, but not when ASDAS was used (p=0.3104). The direct effect of TNFi (B=-0.300, 95% CI=[-0.576,-0.025], p<0.001) on BASMI was estimated in the BASDAI-adjusted mixed effects model.

Conclusion

TNFi are effective at improving BASMI in patients with axSpA, in a real-life setting. This effect is mainly explained by the reduction in disease activity. However, a direct effect of TNFi on BASMI could also be demonstrated, when disease activity was measured by BASDAI, suggesting that ASDAS captures additional factors that can influence spinal mobility. These potential factors deserve further investigation, but they could for example include biomechanical properties of tendons and myofascial tissue.

Disclosure of Interests

Ana Sofia Pinto: None declared, Bohao Yao: None declared, Claire Harris: None declared, Rhys Hayward: None declared, Andrew Keat: None declared, Pedro Machado Speakers bureau: Received consulting/speaker’s fees from Abbvie, BMS, Celgene, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB, all unrelated to this

manuscript, Consultant of: Received consulting/speaker’s fees from Abbvie, BMS, Celgene, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB, all unrelated to this

manuscript

AB1081 FLARES OF RHEUMATOID ARTHRITIS FOLLOWING CORONAVIRUS VACCINATION

Background

With the emergence of the Coronavirus vaccine and the clear and important role it provides in maintaining the health of individuals and the population (1), it is important that our patients receive or are recommended the vaccine. We here document a case series of patients who have long-term quiescent rheumatoid arthritis who then experienced a flare of disease activity after receiving a vaccine. This information is important to understand as it allows informed discussions regarding the side effect profile of the vaccine and also the influence this may have on the patient’s disease control and future management options.

Objectives

To understand the changes to control of rheumatoid arthritis in those experiencing a flare of disease after receiving the coronavirus vaccine.

Methods

Patients were reviewed in clinic as part of standard care. Individuals with Rheumatoid Arthritis who had experienced a flare defined as a self-reported disease activity score of >5.1 in otherwise stable disease were noted and their response to treatment reviewed. This was a review of usual clinical practice and did not alter the treatment undertaken or monitoring of the patent. Information obtained was through the consultation with a rheumatologist and the data was collected retrospectively through review of clinical notes and clinic letters.

Results

The table below outlines the patient details and treatment responses.

All flares occurred within two weeks of receiving the vaccine. Of the patients who flared, two required short term steroid treatment; three an increase in the usual medications and one who had been in disease remission to re-start previous therapy. More patients in the Pfizer vaccine group required an escalation of usual care compared to the AstraZeneca vaccine group.

Table 1Antibody statusVaccine brandTime since diagnosisTime since last flareFlare after 1st or 2nd doseUsual treatmentFlare managementSeropositive, anti-CCP positiveAstraZeneca13 years3 years1stEtanercept, MethotrexateIntramuscular MethylprednisoloneSeropositive, anti-CCP positiveAstraZeneca11 years4 years1stEtanercept, SulfasalazineIntramuscular Methylprednisolone, local joint injectionSeronegative, anti-CCP negativeAstraZenica13 years2 years1stMethotrexateIncrease methotrexate doseSeronegative, anti-CCP positivePfizer23 years11 years1stInfliximabLocal joint injection, reduce interval of infusionsSeronegative, anti-CCP positivePfizer7 years3 years2ndSulfasalazine, hydroxychloroquineIncrease Sulfasalazine doseSeropositive, anti-CCP positivePfizer7 years4 years2ndnilRe-start methotrexate, hydroxychloroquine

Conclusion

We report 6 cases of rheumatoid arthritis flare soon after receipt of the coronavirus vaccine. In all, disease control was returned with minimal changes to treatment, 42% of those requiring either no treatment or an intramuscular steroid injection alone. Therefore, we recommend that clinicians should counsel patients of this potential effect, but continue to advocate the vaccine, as the risk of complications to their underlying arthritis is very low and seemingly easily treatable.

References

[1]Tenforde MW, Olson SM, Self WH, Talbot HK, Lindsell CJ, Steingrub JS, et al. Effectiveness of Pfizer-BioNTech and Moderna Vaccines Against COVID-19 Among Hospitalized Adults Aged ≥65 Years - United States, January-March 2021. MMWR. Morbidity and mortality weekly report. 2021; 70 (18): 674-679. Available from: doi: 10.15585/mmwr.mm7018e1

Disclosure of Interests

None declared

73 Computed Tomography Imaging to Determine Reduction in Intracrainal Pressure Before & After Posterior Vault Expansion in Apert Syndrome

Introduction

Apert syndrome is an autosomal dominant malformation syndrome, accounting for 4.5% of all craniosynostoses. Raised intracranial pressure (ICP) in Apert syndrome has a multifactorial aetiology, with an incidence of up to 45% if left untreated [1, 2]. Raised ICP can be determined clinically, with non-invasive and invasive methods. In this study, we want to assess whether the use of CT scans is reliable in identifying changes in ICP.

Method

Pre and postoperative CT scans for 13 Apert syndrome patients who had posterior vault expansion were assessed and graded for severity of intracranial pressure (ICP). The grading system used was departmental specific and the assessment was carried out by a single clinician on different brain structures. This process was repeated on the same patients, using the same CT scans, 4 months later to determine consistency and repeatability. The relationship between the pre and postoperative scans was explored using the chi squared test. Intra-observer variability was assessed using Kappa statistics [SS1].

Results

There was no statistically significant difference between the pre and postoperative CT scan grading. Across instances, only one assessed structure had a p-value &lt;0.05. The Kappa interobserver reliability test did not identify a strong agreement in the comparison of the two instances of data analysis.

Conclusions

Assessment of CT scans is not a reliable method to determine changes in intracranial pressure in Apert syndrome patients who have had a posterior vault expansion.

nSeP: immune and metabolic biomarkers for early detection of neonatal sepsis-protocol for a prospective multicohort study

INTRODUCTION

Diagnosing neonatal sepsis is heavily dependent on clinical phenotyping as culture-positive body fluid has poor sensitivity, and existing blood biomarkers have poor specificity.A combination of machine learning, statistical and deep pathway biology analyses led to the identification of a tripartite panel of biologically connected immune and metabolic markers that showed greater than 99% accuracy for detecting bacterial infection with 100% sensitivity. The cohort study described here is designed as a large-scale clinical validation of this previous work.

METHODS AND ANALYSIS

This multicentre observational study will prospectively recruit a total of 1445 newborn infants (all gestations)-1084 with suspected early-or late-onset sepsis, and 361 controls-over 4 years. A small volume of whole blood will be collected from infants with suspected sepsis at the time of presentation. This sample will be used for integrated transcriptomic, lipidomic and targeted proteomics profiling. In addition, a subset of samples will be subjected to cellular phenotype and proteomic analyses. A second sample from the same patient will be collected at 24 hours, with an opportunistic sampling for stool culture. For control infants, only one set of blood and stool sample will be collected to coincide with clinical blood sampling. Along with detailed clinical information, blood and stool samples will be analysed and the information will be used to identify and validate the efficacy of immune-metabolic networks in the diagnosis of bacterial neonatal sepsis and to identify new host biomarkers for viral sepsis.

ETHICS AND DISSEMINATION

The study has received research ethics committee approval from the Wales Research Ethics Committee 2 (reference 19/WA/0008) and operational approval from Health and Care Research Wales. Submission of study results for publication will involve making available all anonymised primary and processed data on public repository sites.

TRIAL REGISTRATION NUMBER

NCT03777670.

Comparison of risk factors for coronary event in people with unattributed and non-coronary chest pain: an electronic health record cohort study

Background

Patients presenting to primary care with chest pain are often not given a cause. Patients with such unattributed chest pain have an increased risk of future cardiovascular disease (CVD) compared to patients with diagnosed non-coronary chest pain. It is unknown whether risk factors for CVD determined in the general population are the same for the population with unattributed or non-coronary chest pain.

Purpose

To determine if key risk factors for a coronary event in patients with unattributed chest pain are similar to those for patients with non-coronary chest pain and previously identified in the general population.

Methods

The study used primary care information from the Clinical Practice Research Datalink Aurum linked to hospital inpatient and mortality data. Patients aged ≥18 years with an incident record of unattributed or non-coronary chest pain in 2002–2018 and no diagnosis of CVD were included. We included as potential risk factors those established for CVD in the general population and non-coronary explanations for chest pain. Flexible parametric models estimated hazard ratios (95% confidence intervals (CI)) between factors and incident coronary event (defined as myocardial infarction, angina, coronary heart disease, percutaneous intervention, and coronary artery bypass graft surgery).

Results

There were 375,240 patients with unattributed chest pain (53% female: mean age 49; 47% male: mean age 47) and 245,329 patients with non-coronary chest pain (58% female: mean age 47; 42% male: mean age 44). Median duration of follow-up was 5 years. In the unattributed chest pain group, there were 111 (95% CI: 109, 112) and 140 (138, 142) coronary events per 10,000 person-years in females and males, respectively. Lower rates of coronary event were observed in the non-coronary chest pain group (females: 73 (72, 75); males: 96 (94, 98)). Within females (Figure), in both chest pain groups the strongest risk factors were type I and type II diabetes, atrial fibrillation, and hypertension whereas no associations were observed for migraine and chronic kidney disease. Whilst alternative explanations for non-coronary chest pain also increased the risk of coronary events, associations were less strong than for established general population risk factors. Similar findings were found in males although family history of coronary event was a stronger risk factor in the non-coronary chest pain group compared to the unattributed chest pain group.

Conclusions

The pool of factors found to increase the risk of coronary events in patients presenting with recorded unattributed or non-coronary chest pain are similar but not identical to those identified for the general population. Further research is needed to develop prognostic models to identify patients at the most risk of a coronary event as models developed in the general population are unlikely to be applicable given the increased underlying risk of coronary events in these populations.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Study funded by the British Heart Foundation, reference PG/19/46/34307. KJ also supported by matched funding awarded to the NIHR Applied Research Collaboration (West Midlands). Risk factors for coronary event

In situ characterization of advanced glycation end products (AGEs) in collagen and model extracellular matrix by solid state NMR

Non-enzymatic glycation of extracellular matrix with (U-13C5)-d-ribose-5-phosphate (R5P), enables in situ 2D ssNMR identification of many deleterious protein modifications and crosslinks, including previously unreported oxalamido and hemiaminal (CH3-CH(OH)NHR) substructures. Changes in charged residue proportions and distribution may be as important as crosslinking in provoking and understanding harmful tissue changes.

Evaluation of a system for providing information resources to nurses

The authors describe a study to plan and implement an information system for nurses. The objectives were to (1) determine the clinical information needs of nurses; (2) adapt an existing clinical information system (CLINT) to address their expressed needs; and (3) evaluate nurses’ use of and satisfaction with the enhanced system.

Thirty-nine nurses on a medical teaching unit in a tertiary hospital in Canada participated in the project. A needs assessment influenced the design of the nursing interface to CLINT and the development of educational and participatory strategies to promote its use. Data were collected before, after, and throughout the implementation period. Qualitative and quantitative methods, including focus groups, online questionnaires, and automated usage data collection, were used to describe nurses’ use of and satisfaction with the system.

The results suggested that peer mentorship, organizational support, and collaboration were the most effective strategies for promoting system use. The hospital information system (IHIS), Netscape, drug information and basic texts were the most frequently used databases. Nurses were satisfied with the system and reported progress in changing clinical practice. CLINT helped them to keep up with educational and professional development.

In conclusions, nurses are willing to use information systems that are relevant to their needs and user friendly. There is, however, a paucity of resources available for evidence-based clinical decision making.

Rosiglitazone treatment and cardiovascular disease in the Veterans Affairs Diabetes Trial

AIMS

To evaluate the relationship between patterns of rosiglitazone use and cardiovascular (CV) outcomes in the Veterans Affairs Diabetes Trial (VADT).

METHODS

Time-dependent survival analyses, case-control and 1 : 1 propensity matching approaches were used to examine the relationship between patterns of rosiglitazone use and CV outcomes in the VADT, a randomized controlled study that assessed the effect of intensive glycaemic control on CV outcomes in 1791 patients with type 2 diabetes (T2D) whose mean age was 60.4 ± 9 years. Participants were recruited between 1 December 2000 and 31 May 2003, and were followed for 5-7.5 years (median 5.6) with a final visit by 31 May 2008. Rosiglitazone (4 mg and 8 mg daily) was initiated per protocol in both the intensive-therapy and standard-therapy groups. Main outcomes included a composite CV outcome, CV death and myocardial infarction (MI).

RESULTS

Both daily doses of rosiglitazone were associated with lower risk for the primary composite CV outcome [4 mg: hazard ratio (HR) 0.63, 95% confidence interval (CI) 0.49-0.81 and 8 mg: HR 0.60, 95% CI 0.49-0.75] after adjusting for demographic and clinical covariates. A reduction in CV death was also observed (HR 0.25, p < 0.001, for both 4 and 8 mg/day rosiglitazone); however, the effect on MI was less evident for 8 mg/day and not significant for 4 mg/day.

CONCLUSIONS

In older patients with T2D the use of rosiglitazone was associated with decreased risk of the primary CV composite outcome and CV death. Rosiglitazone use did not lead to a higher risk of MI.

Demonstration of the need for cardiovascular and pulmonary normative data for cancer survivors

Despite evidence that cancer and its treatments severely reduce cardiorespiratory fitness (CRF), normative data for cancer survivors do not exist. The present study identifies age and gender-specific CRF distributions in a cancer population. The use of cancer-specific normative CRF data may help stratify initial fitness status and assess improvements in response to exercise interventions in cancer survivors. Data from 703 cancer survivors were analyzed for this study. Quintiles were compiled for peak oxygen consumption (VO2peak), forced vital capacity (FVC), and forced expiratory volume (FEV1) for males and females in 5 age groups (19-39, 40-49, 50-59, 60-69, and ≥70 years of age). VO2peak values for the cancer population were significantly lower than the general US population. The cancer population average in each age group fell within the "very poor" classification of VO2peak values for the general population. FVC values in the cancer population were similar to the general population. Cancer survivors had very low age group-specific VO2peak values compared to the apparently healthy general US population. Previously, CRF values of cancer survivors were compared to normative values for the apparently healthy general population, which yielded imprecise classifications of initial fitness and changes in fitness, resulting in patient discouragement.

Effects of treadmill training on combined goserelin acetate and doxorubicin-induced osteopenia in female rats

OBJECTIVES

This study examined individual and combined effects of the cancer treatments goserelin acetate (GA) and doxorubicin (DOX) on bone and determined if treadmill running (TM) provides osteoprotection.

METHODS

Ten-week-old female Sprague-Dawley rats were randomly assigned to sedentary (SED) or TM groups. SED received GA, DOX, combined GA and DOX (GA+DOX), or placebo and maintained normal cage activity. TM received GA, DOX, GA+DOX, or placebo and participated in a progressive motorized treadmill protocol. After 8 weeks, tibiae were evaluated using micro computed tomography.

RESULTS

Negative drug effects were observed in cancellous bone (bone volume/tissue volume, trabecular number, trabecular thickness, trabecular spacing; P<0.05). An additive bone volume/tissue volume and trabecular spacing effect was observed in SED GA+DOX (vs. SED+GA and SED+DOX, P<0.05) but not in TM GA+DOX (vs. TM+GA and TM+DOX, P>0.05). Negative drug effects were observed in cortical bone (cross-sectional volume, cortical volume, marrow volume; P<0.05), but combined GA+DOX did not exacerbate these effects. Additionally, there were no protective cortical bone effects observed in TM.

CONCLUSIONS

Combined GA+DOX exacerbates cancellous osteopenia in the tibia, and treadmill running provided only minor protection.

Role of cerebellum in fine speech control in childhood: persistent dysarthria after surgical treatment for posterior fossa tumour

Dysarthria following surgical resection of childhood posterior fossa tumour (PFT) is most commonly documented in a select group of participants with mutism in the acute recovery phase, thus limiting knowledge of post-operative prognosis for this population of children as a whole. Here we report on the speech characteristics of 13 cases seen long-term after surgical treatment for childhood PFT, unselected for the presence of post-operative mutism (mean time post-surgery=6y10m, range 1;4-12;6 years, two had post-operative mutism), and examine factors affecting outcome. Twenty-six age- and sex- matched healthy controls were recruited for comparison. Participants in both groups had speech assessments using detailed perceptual and acoustic methods. Over two-thirds of the group (69%) with removal of PFT had a profile of typically mild dysarthria. Prominent speech deficits included consonant imprecision, reduced rate, monopitch and monoloudness. We conclude that speech deficits may persist even up to 10 years post-surgery in participants who have not shown mutism in the acute phase. Of cases with unilateral lesions, poorer outcomes were associated with right cerebellar tumours compared to left, consistent with the notion based on adult data that speech is controlled by reciprocal right cerebellar/left frontal interactions. These results confirm the important role of the cerebellum in the control of fine speech movements in children.

MRI study of the natural history and risk factors for pseudomeningocoele formation following postfossa surgery in children

Surgical approaches to the posterior fossa may be complicated by pseudomeningocoele formation. We report on its natural history and risk factors for its formation, as seen on serial MRI postoperatively in children with posterior fossa tumours. In a retrospective study of 84 children undergoing surgery for posterior fossa tumours, 13 (16%) developed clinically apparent pseudomeningocoeles. On postoperative MRI, pseudomeningocoeles were apparent in 34 (41%) patients at 1-5 days, but in only four patients at 10-15 months postsurgery. There was a progressive decrease in the mean depth of pseudomeningocoele measured from the MRI scans postoperatively. Patients with pseudomeningocoeles were more likely to have a postoperative CSF leak from the wound (39 v. 13%), lumbar punctures or lumbar drains (54 v. 25%), wound re-closures (23 v. 1%) and prolonged hospital stay (19.9 v. 14.5 days). On multivariate analysis, patients with pseudomeningocoeles were also more likely to have undergone a suboccipital craniectomy than those without pseudomeningocoeles (69 v. 38%). Postoperative pseudomeningocoele formation following posterior fossa surgery is more apparent radiologically than clinically, but there is clinical and radiological evidence that pseudomeningocoeles gradually resolve over the postoperative period. The risk of pseudomeningocoele formation is increased by performing a suboccipital craniectomy and there is an association with increased CSF leaks, needing re-closure of the wounds.

Cancer treatment-induced alterations in muscular fitness and quality of life: the role of exercise training

BACKGROUND

Cancer survivors experience muscular weakness and reduced mobility, thereby compromising quality of life. This investigation utilized moderate prescriptive exercise to improve upper- and lower-body muscular fitness, flexibility, depression and quality of life in cancer patients.

PATIENTS AND METHODS

One hundred and thirty-five breast and prostate cancer survivors received cancer and medical history screening and a medical examination, as well as assessments of muscular strength (handgrip dynamometer) and endurance (bench press, lateral pull-down, leg press, shoulder press and curl-up crunch test), flexibility (Modified Sit and Reach), depression (Beck Depression Inventory) and quality of life (Quality of Life Index). Following the exercise assessments, cancer survivors trained in resistance exercise for 6 months during treatment or following treatment based on their results from the assessments and health status.

RESULTS

Cancer survivors following treatment showed significant (P = 0.006) improvements in upper-body muscular endurance (+46.8%), lower-body muscular endurance (+67.1%), core muscular endurance (+32.5%) and flexibility (+6.2%), with concomitant improvements (P = 0.013) in depression (-25.6%) and total quality of life (+7.2%). Cancer survivors during treatment showed significant (P = 0.012) improvements in upper-body muscular endurance (+79.1%) and lower-body muscular endurance (+49.7%) while maintaining core endurance and flexibility in conjunction with improvements (P = 0.022) in depression (-43.0%) and quality of life (+11.5%).

CONCLUSIONS

Moderate-intensity individualized prescriptive exercise is a safe and efficacious means to augment muscular function and improve the quality of life of cancer survivors.

Androgen deprivation therapy and cardiac function: effects of endurance training

PURPOSE

This study examined the effects of an 8-week androgen deprivation therapy treatment using Zoladex and an endurance training regimen on cardiac function.

METHODS

Male Sprague-Dawley rats received either Zoladex or placebo. Animals remained sedentary or endurance trained during the drug treatment period. On day 57, ex vivo cardiac function was analyzed.

RESULTS

Hearts from sedentary animals receiving Zoladex possessed significant cardiac dysfunction. However, hearts from exercise trained rats receiving Zoladex possessed cardiac function values similar to those from hearts from placebo animals.

CONCLUSIONS

An 8-week treatment with Zoladex promoted cardiac dysfunction. Endurance training during Zoladex treatment protected against this cardiac dysfunction.

Adenoid-tonsillectomy to treat visual dysfunction in a child with craniosynostosis

We report a child with isolated saggital synostosis where a gradual deterioration of the P100 component of the pattern reversal visual evoked potential recorded during the day was associated with episodes of upper airway obstruction during sleep that correlated with periods of ICP spiking. Adenoid-tonsillectomy reversed this deterioration with coincident increase in SaO2 and decreased sleep apnoea.

Speech and language skills and cognitive functioning in children with Apert syndrome: a pilot study

There are few studies that report findings on the speech and language characteristics of Apert syndrome and little is known about the cognitive profile of the syndrome. The current study addresses this gap and explores speech, language, resonance/voice, attention oro-motor and cognitive skills in a group of 10 children (4;1-5;11) with Apert syndrome. The speech and language battery included: the CELF-Pre-school, the PLS-3, the Vocal Profile Analysis, GOS.SP.ASS, PACS; and the Brodsky Drooling Scale. Subscales of the BAS II-Early Years Version were used to assess cognition. Data were also collected on other factors that could influence developmental outcome such as audiological history and management; occlusion/dentition; respiratory problems and management; neuroanatomical abnormalities; the number and nature of cranial surgeries; and the occurrence of raised intracranial pressure. All children for whom a Performance IQ was obtained (n = 8) had abilities within the average range and IQ scores were considerably higher than those reported in previous studies. Eight children had moderate or severe language difficulties and expressive language difficulties were the most frequent. These language difficulties were not associated with a general cognitive deficit. All the children had problems with attention, speech and oro-motor skills. Nine had abnormal voice. In addition, a range of other associated factors that could affect functioning were identified. The discrepancies between the current study and previous investigations are outlined. Parameters for assessment are considered. The implications of these findings for valid assessments of children with Apert syndrome are discussed. Multidisciplinary assessment of children with Apert syndrome across a broad range of dimensions is recommended to obtain a profile of each child's strengths and weaknesses to ensure that appropriate educational placements and early interventions are implemented. Considering patterns of development over time at key ages is also argued to be of central importance.

Fostering an Internet-based work group in community health through action research

In this article, we describe an action research study to foster an Internet-based work group as part of a two-year community health research training program in Alberta, Canada. The objectives of our study were to incorporate Internet-based technology into the program, establish a distributed work group over time, and reflect on the lessons learned. The participants represented seventeen health regions. There were thirty-five instructors and expert resource persons (varied over time), two training coordinators, four support staff, a program coordinator, two action researchers, and two independent consultants. The data collected included program documents, phone interviews, online surveys, meeting notes, online discussions, computer usage log, site visits, keystroke entry logs, help desk logs, and program evaluation reports. Content analysis was conducted with NUD*IST to identify concepts and themes from the data. Our findings suggest that role clarification, facilitative support, network linkages, and workplace learning are important aspects of fostering Internet-based work groups in a health setting, where members strive to establish themselves, seek meaning in their work, support each other, and add value to their organizations.

The tortoise and the love-machine: Grey Walter and the politics of electroencephalography

The life of the pioneer electroencephalographer, William Grey Walter, initially appears to be a paradigmatic example of the process of network building and delegation identified by Michel Callon and Bruno Latour. In his professional career, Walter continually repositioned himself, moving from an unhappy beginning as an expert in the apparently unless and suspect technology of the EEG, to become a self-styled crucial mediator in subjects as diverse as medical diagnosis, forensic detection, marriage counseling, and international diplomacy. This position was achieved moreover through the construction and co-option of human and mechanical accomplices - laboratory assistants, electrical tortoises, and mechanical analyzers - which sustained his research and propagated his arguments. However in contrast to Callon and Latour's atomistic account of scientific power and agency, this paper will extend their analysis to explore the impact of network building and delegation on domestic life, human desire, and personal identity. Walter's engagement with the complexities of love and the human brain demonstrates how the transformative power of scientific rhetoric extends simultaneously into both the organization of the world and the subjectivity of the individual.

Gain of 1q and loss of 22 are the most common changes detected by comparative genomic hybridisation in paediatric ependymoma

Ependymomas are the third most common brain tumour in the paediatric population. Although cytogenetic and molecular analyses have pinpointed deletions of chromosomes 6q, 17, and 22 in a subset of tumours, definitive patterns of genetic aberrations have not been determined. In the present study, we analysed 40 ependymomas from paediatric patients for genomic loss or gain using comparative genomic hybridisation (CGH). Eighteen of the tumours (45%) had no detectable regions of imbalance. In the remaining cases, the most common copy number aberrations were loss of 22 (25% of tumours) and gain of 1q (20%). Three regions of high copy number amplification were noted at 1q24-31 (three cases), 8q21-23 (two cases), and 9p (one case). Although there was no association with the loss or gain of any chromosome arm or with benign versus anaplastic histologic characteristics, the incidence of gain of 7q and 9p and loss of 17 and 22 was significantly higher in recurrent versus primary tumours. This study has identified a number of chromosomal regions that may contain candidate genes involved in the development of different subgroups of ependymoma.