Prospective manipulation of the gut microbiome with microbial ecosystem therapeutic 4 (MET4) in HPV-related locoregionally-advanced oropharyngeal cancer squamous cell carcinoma (LA-OPSCC) undergoing primary chemoradiation: ROMA2 study

BACKGROUND

Gut microbiome modulation to boost antitumor immune responses is under investigation.

METHODS

ROMA-2 evaluated the microbial ecosystem therapeutic (MET)-4 oral consortia, a mixture of cultured human stool-derived immune-responsiveness associated bacteria, given with chemoradiation (CRT) in HPV-related oropharyngeal cancer patients. Co-primary endpoints were safety and changes in stool cumulative MET-4 taxa relative abundance (RA) by 16SRNA sequencing. Stools and plasma were collected pre/post-MET-4 intervention for microbiome and metabolome analysis.

RESULTS

Twenty-nine patients received ≥1 dose of MET-4 and were evaluable for safety: drug-related adverse events (AEs) occurred in 13/29 patients: all grade 1-2 except one grade 3 (diarrhea). MET-4 was discontinued early in 7/29 patients due to CRT-induced toxicity, and in 1/29 due to MET-4 AEs. Twenty patients were evaluable for ecological endpoints: there was no increase in stool MET-4 RA post-intervention but trended to increase in stage III patients (p = 0.06). MET-4 RA was higher in stage III vs I-II patients at week 4 (p = 0.03) and 2-month follow-up (p = 0.01), which correlated with changes in plasma and stool targeted metabolomics.

CONCLUSIONS

ROMA-2 did not meet its primary ecologic endpoint, as no engraftment was observed in the overall cohort. Exploratory findings of engraftment in stage III patients warrants further investigation of microbiome interventions in this subgroup.

Selinexor for the treatment of recurrent or metastatic salivary gland tumors: Results from the GEMS-001 clinical trial

OBJECTIVES

We aimed to evaluate the activity of selinexor, an oral selective inhibitor of nuclear export, in patients with recurrent or metastatic salivary gland tumors (SGT).

METHODS

GEMS-001 is an open-label Phase 2 study for patients with recurrent or metastatic SGT with two parts. In Part 1 of the protocol, patients had tumor samples profiled with targeted next generation sequencing as well as immunohistochemistry for androgen receptor, HER-2 and ALK. For Part 2, patients with no targeted therapies available were eligible to receive selinexor 60 mg given twice weekly every 28 days. The primary endpoint was objective response rate. Secondary endpoints included progression-free survival (PFS) and prevalence of druggable alterations across SGT.

RESULTS

One hundred patients were enrolled in GEMS-001 and underwent genomic and immunohistochemistry profiling. A total of 21 patients who lacked available matched therapies were treated with selinexor. SGT subtypes (WHO classification) included adenoid cystic carcinoma (n = 10), salivary duct carcinoma (n = 3), acinic cell carcinoma (n = 2), myoepithelial carcinoma (n = 2), carcinoma ex pleomorphic adenoma (n = 2) and other (n = 2). Of 18 evaluable patients, stable disease (SD) was observed in 17 patients (94%) (SD ≥6 months in 7 patients (39%)). However, no objective responses were observed. The median PFS was 4.9 months (95% confidence interval, 3.4-10). The most common treatment-related Grade 1-2 adverse events were nausea [17 patients (81%)], fatigue [16 patients (76%)], and dysgeusia [12 patients (57%)]. Most common treatment-related Grade 3-4 adverse events were hyponatremia [3 patients (14%)], neutrophil count decrease [3 patients (14%)] and cataracts [2 patients (10%)]. No treatment-related deaths were observed.

CONCLUSIONS

Although tumor reduction was observed across participants, single agent selinexor anti-tumor activity was limited.

Magnetotelluric support for edge-driven convection and shear-driven upwelling in the Newer Volcanics Province

Intraplate volcanic provinces present significant natural hazards to many populated regions globally but their origins are poorly understood. Though hypotheses involving mantle plumes are predominant, the Newer Volcanics Province of southeast Australia-a relatively young (< 4.5 Ma), EW trending collection of over 400 volcanic centres-is increasingly attributed to some combination of edge-driven convection (EDC) and shear-driven upwelling (SDU). In this paper, we provide magnetotelluric (MT) data in support of these geodynamic processes. Three-dimensional inversion of 49 new broadband MT sites, in combination with 143 previously collected broadband, long-period, and geomagnetic depth soundings, reveals an elongate zone of moderately low resistivity (∼ 10-300 Ω m) spanning the Mt Gambier subprovince at a depth of between 20 and 40 km. The newly defined Gambier Conductor is contiguous to, and orientationally aligned with, significant step in the seismically-defined lithosphere-asthenosphere boundary (LAB) presented by earlier studies. Moderately low resistivity is interpreted as fluid-catalysed alteration of iron-bearing crust resulting from percolating magmatic volatiles. We argue that localised low resistivity (< 10 Ω m) at ~ 25 km depth in the mid-lower crust is associated with 1.2-3.6% partial melt. Supporting evidence indicates possible crustal thickening from 5.8 Ma at a rate comparable to estimates of SDU-induced surface eruptions and previous NVP production rate estimates.

Perceptions of friendship, peers and influence on adolescent smoking according to tobacco control context: a systematic review and meta-ethnography of qualitative research

BACKGROUND

A relationship between smoking and interpersonal influences has been well established within the literature. There have been cultural shifts in denormalisation and a reduction in tobacco smoking in many countries. Hence there is a need to understand social influences on adolescents' smoking across smoking normalisation contexts.

METHODS

The search was conducted in July 2019 and updated in March 2022 within 11 databases and secondary sources. Search terms included schools, adolescents, smoking, peers, social norms and qualitative research. Screening was conducted by two researchers independently and in duplicate. Study quality was assessed using the eight-item Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-centre) tool for the appraisal of qualitative studies. Results were synthesised using a meta-narrative lens for meta-ethnography and compared across smoking normalisation contexts.

RESULTS

Forty one studies were included and five themes were developed, mapping onto the socio ecological model. The social processes by which adolescents take up smoking differed according to a mixture of school type, peer group structure and the smoking culture within the school, as well as the wider cultural context. Data available from smoking denormalised contexts, described changes in social interactions around smoking to cope with its stigmatisation. This was manifested through i) direct peer influence, whereby subtle techniques were employed, ii) group belonging whereby smoking was less likely to be seen as a key determinant of group membership and smoking was less commonly reported to be used as a social tool, and iii) popularity and identity construction, whereby smoking was perceived more negatively in a denormalised context, compared with a normalised context.

CONCLUSIONS

This meta-ethnography is the first study to demonstrate, drawing on international data, that peer processes in adolescent smoking may undergo changes as smoking norms within society change. Future research should focus on understanding differences across socioeconomic contexts, to inform the adaptation of interventions.

A-45 Clinical Considerations of Neuropsychologists for Treating Concussions

Purpose: The purpose of this study was to explore sex specific clinical considerations by neuropsychologists’ and general clinical considerations for the treatment of concussion. Methods: Fourteen clinical neuropsychologists who see concussion patients regularly (&gt;1 case per week) were interviewed using a semi-structured guide that included a generic patient vignette. Participants were asked about clinical considerations that they faced while assessing, managing, and treating concussion. Two investigators independently coded the transcriptions and met to compare coding processes, definitions, and categories. A final codebook was developed in an iterative fashion and reapplied to all transcripts. Independent coding and member checks contributed to the trustworthiness of the data. Results: Participants’ clinical experience in treating concussion ranged from 1 to 40 years, and the sample was 64% female (9/14). Four major themes were identified, including patients’ sex considerations, sleep and napping, patient education and reassurance, and mental health considerations. Several participants (4/14; 29%) noted the lack of action-oriented clinical recommendations for previously documented sex differences (i.e., menstruation). There was a lack of uniformity in sleep and napping recommendations across the participants (e.g., permitting napping vs recommended nap-length). Participants noted that a large portion of their clinical time was spent educating and reassuring patients that concussion is treatable. Comorbid mental health considerations such as anxiety were a prevailing clinical concern across participants. Conclusions: The study revealed the need for better action-oriented clinical recommendations in consensus statements that address the four main themes of sex considerations, sleep and napping considerations, patient education and reassurance, and mental health considerations.

Abstract 2237: Rates of intervention after initial versus subsequent whole-body MRI screening in Li-Fraumeni Syndrome

Background: Yearly whole-body MRI is recommended for cancer screening in patients with the rare high risk cancer predisposition syndrome, Li-Fraumeni syndrome (LFS). This is based on data from multiple studies demonstrating an approximately 7% cancer detection rate on baseline screening. However, the rate of actionable findings and malignancies on initial versus subsequent screenings has yet to be compared in a patient cohort.

Patients and Methods: We identified 68 adult LFS patients in a single institutional cohort that received more than one full body MRI (including brain MRI). For each screening instance, findings and subsequent recommended interventions (immediate and short-term imaging, biopsy, and/or surgery) were recorded. Invasive interventions (biopsy and/or surgery) were denoted with free text describing pathology results. We analyzed findings on initial versus subsequent scans.

Results: There were 258 instances of whole-body MRI screenings performed in 68 patients (28% male, 72% female) in the cohort. The mean number of screenings per patient analyzed was 3.8±1.9 over 3.3±2.4 years. Among 68 initial screenings, 26 (38.2%) required follow-up imaging or invasive intervention. Among 190 subsequent screenings, the follow-up intervention rate was significantly lower (n=36, 18.9%, p=0.0026). Eleven screenings (5.8%) required invasive follow-up (biopsy or surgery); two (3% of patients) were from an initial screening and nine (13% of patients) were from a subsequent screening. From these interventions, we identified six total cancers in five patients amongst the cohort (7% of patients), with two cancers (3% of patients) being identified on the first screening and four (6% of patients) being identified on a subsequent screening.

Conclusion: Cancer detection rates were similar between initial and subsequent whole-body MRI screenings in LFS patients. Follow-up interventions decreased significantly on subsequent screenings compared to the initial screen. These findings may be useful in counseling of LFS patients initiating a screening program. Limitations of this study include lack of inclusion of other screening modalities in the analysis, short follow-up duration, and loss to follow-up. Further studies involving a larger cohort with longer-term follow-up are needed to fully determine the impact of long-term whole-body MRI screening in LFS.

Citation Format: Yun K. Du, Conrad Fernandes, Anh N. Le, Madeline Good, Miche Duvall, Sarah Jennings, Jacquelyn Powers, Kristen Zelley, Bryson W. Katona, Suzanne P. MacFarland, Kara N. Maxwell. Rates of intervention after initial versus subsequent whole-body MRI screening in Li-Fraumeni Syndrome [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 2237.

Ocean resource use: building the coastal blue economy

Humans have relied on coastal resources for centuries. However, current growth in population and increased accessibility of coastal resources through technology have resulted in overcrowded and often conflicted spaces. The recent global move towards development of national blue economy strategies further highlights the increased focus on coastal resources to address a broad range of blue growth industries. The need to manage sustainable development and future exploitation of both over-utilised and emergent coastal resources is both a political and environmental complexity. To address this complexity, we draw on the perspectives of a multi-disciplinary team, utilising two in depth exemplary case studies in New Zealand and within the Myanmar Delta Landscape, to showcase barriers, pathways and actions that facilitate a move from Business as Usual (BAU) to a future aligned with the Sustainable Development Goals (SDGs) and the UN International Decade of Ocean Science for Sustainable Development 2021-2030. We provide key recommendations to guide interest groups, and nations globally, towards sustainable utilisation, conservation and preservation of their marine environments in a fair and equitable way, and in collaboration with those who directly rely upon coastal ecosystems. We envision a sustainable future driven by conflict mitigation and resolution,  where:(i)Change is motivated and facilitated(ii)Coastal ecosystems are co-managed by multiple reliant groups(iii)Networks that maintain and enhance biodiversity are implemented(iv)Decision-making is equitable and based on ecosystem services(v)Knowledge of the marine realm is strengthened-'mapping the ocean of life'(vi)The interests of diverse user groups are balanced with a fair distribution of benefits.

Deep aspirations: towards a sustainable offshore Blue Economy

ABSTRACT

The ocean economy is experiencing rapid growth that will provide benefits but will also pose environmental and social risks. With limited space and degraded resources in coastal areas, offshore waters will be a particular focus of Blue Economy expansion over the next decade. When emerging and established economic sectors expand in offshore waters (within national Exclusive Economic Zones), different potential Blue Economy opportunities and challenges will arise. Following a series of interdisciplinary workshops, we imagine two technically possible futures for the offshore Blue Economy and we identify the actions required to achieve the more sustainable outcome. Under a business as usual scenario the focus will remain on economic growth, the commodification of nature, the dominance of private over public and cultural interests, and prioritisation of the interests of current over future generations. A more sustainable scenario would meet multiple UN Sustainable Development Goals and ensure inclusive economic developments, environmental sustainability, and fair and equitable access to resources and technologies across users, nations, and generations. Challenges to this more sustainable future are a lack of infrastructure and technology to support emerging offshore sectors, limited understanding of environmental impacts, inequitable outcomes, and a lack of planning and governmental oversight. Addressing these challenges will require a shift in societal values, a more balanced allocation of funding to offshore activities, transparency in information sharing between industries and across nations, and adjustment of international legal and institutional mechanisms. The sustainable and equitable offshore Blue Economy we envisage is achievable and provides a unique opportunity to build global capacity and partnership.

Ocean resource use: building the coastal blue economy

Humans have relied on coastal resources for centuries. However, current growth in population and increased accessibility of coastal resources through technology have resulted in overcrowded and often conflicted spaces. The recent global move towards development of national blue economy strategies further highlights the increased focus on coastal resources to address a broad range of blue growth industries. The need to manage sustainable development and future exploitation of both over-utilised and emergent coastal resources is both a political and environmental complexity. To address this complexity, we draw on the perspectives of a multi-disciplinary team, utilising two in depth exemplary case studies in New Zealand and within the Myanmar Delta Landscape, to showcase barriers, pathways and actions that facilitate a move from Business as Usual (BAU) to a future aligned with the Sustainable Development Goals (SDGs) and the UN International Decade of Ocean Science for Sustainable Development 2021-2030. We provide key recommendations to guide interest groups, and nations globally, towards sustainable utilisation, conservation and preservation of their marine environments in a fair and equitable way, and in collaboration with those who directly rely upon coastal ecosystems. We envision a sustainable future driven by conflict mitigation and resolution,  where:(i)Change is motivated and facilitated(ii)Coastal ecosystems are co-managed by multiple reliant groups(iii)Networks that maintain and enhance biodiversity are implemented(iv)Decision-making is equitable and based on ecosystem services(v)Knowledge of the marine realm is strengthened-'mapping the ocean of life'(vi)The interests of diverse user groups are balanced with a fair distribution of benefits.

Deep aspirations: towards a sustainable offshore Blue Economy

ABSTRACT

The ocean economy is experiencing rapid growth that will provide benefits but will also pose environmental and social risks. With limited space and degraded resources in coastal areas, offshore waters will be a particular focus of Blue Economy expansion over the next decade. When emerging and established economic sectors expand in offshore waters (within national Exclusive Economic Zones), different potential Blue Economy opportunities and challenges will arise. Following a series of interdisciplinary workshops, we imagine two technically possible futures for the offshore Blue Economy and we identify the actions required to achieve the more sustainable outcome. Under a business as usual scenario the focus will remain on economic growth, the commodification of nature, the dominance of private over public and cultural interests, and prioritisation of the interests of current over future generations. A more sustainable scenario would meet multiple UN Sustainable Development Goals and ensure inclusive economic developments, environmental sustainability, and fair and equitable access to resources and technologies across users, nations, and generations. Challenges to this more sustainable future are a lack of infrastructure and technology to support emerging offshore sectors, limited understanding of environmental impacts, inequitable outcomes, and a lack of planning and governmental oversight. Addressing these challenges will require a shift in societal values, a more balanced allocation of funding to offshore activities, transparency in information sharing between industries and across nations, and adjustment of international legal and institutional mechanisms. The sustainable and equitable offshore Blue Economy we envisage is achievable and provides a unique opportunity to build global capacity and partnership.

Abstract P154: Genomic profiling and matched therapy for recurrent or metastatic salivary gland neoplasms. Results from the matched cohort of the GEMS-001 clinical trial

Background Salivary gland tumors (SGT) are rare and heterogeneous diseases with limited systemic options available. Results from recent basket trials including SGT cohorts for specific actionable alterations (AA) have described promising outcomes with molecularly targeted approaches (TA). Methods The GEMS-001 study (NCT02069730) is an ongoing multi-arm trial with two phases. In part 1, recurrent or metastatic (R/M) SGT patients (pts) undergo comprehensive immunohistochemistry (IHC) including HER2, androgen receptor (AR) and ALK translocation and multigene panel testing (NGS). Based on the molecular profiling results in part 1, R/M SGT pts are matched to available targeted therapies on disease progression. Here, we present the efficacy results for the matched cohort of the GEMS-001 study. Results As of July 2021, 100 pts underwent molecular profiling within part 1. According to the SGT subtype (WHO 2017): 49% adenoid cystic carcinoma (ACC), 18% salivary duct carcinoma (SDC), 9% acinic (ACI) and 24% other subtypes (O). Overall, on IHC HER2 overexpression was present in 10%, AR 24% and ALK translocation 0%. On NGS, PIK3CA mutation (mut) was in 10%, HRAS mut 7%, ERBB2/3 alterations (alt) 5%, NOTCH1-3 mut 2% and ETV6-NTRK3 fusion 2%. Up to 45% pts displayed at least 1 AA and 25% had ≥2 AA. AA were enriched in SDC (100% ≥1 AA) as compared to ACI (33% ≥1 AAs), O (58% ≥1 AA) or ACC (22% ≥1 AA) (p&lt;0.001 Fisher's exact test). A total of 34 pts (34%) were matched to proteomic or genomic alterations. Of those matched, median age was 62 years (range 47-84), M:F 26:8, 100% ECOG≤1, and their AA-TA included 15 AR (leuprolide+bicalutamide), 4 HER2 or ERBB2 alt (trastuzumab+pertuzumab), 4 PIK3CA mut (PIK3CA inhibitor), 2 cyclin pathway alt (palbociclib), 2 ETV6-NTRK3 fusion (larotrectinib) and 7 other AAs (1 EGFR L858 mut (afatinib), 1 c-KIT mut (imatinib), 1 BAP1 mut (olaparib), 1 Non-V600 BRAF mut (pan-RAF inhibitor), 1 CHEK2 mut (olaparib), 1 ATM mut (olaparib) and 1 PTCH1 (vismodegib)). As per efficacy, overall response rate was 24% and median progression free survival 6.4 months (m) (95%CI 3.4-8.9 m) for the matched population. Complete responses were observed in 2 pts treated with leuprolide+biculatamide (AR). Partial responses were observed in 2 pts treated with larotrectinib (ETV6-NTRK3), 3 pts treated with trastuzumab+pertuzumab (HER2) and 1 pt treated with leuprolide+biculatamide (AR). Notably, among responders median duration of response was 13.9 m (95%CI 4.6-18.0 m). Conclusions In our cohort, more than one third of the population were matched to TA with promising efficacy outcomes. Our results support comprehensive molecular and IHC profiling but its clinical utility may vary depending on the SGT subtype.

Citation Format: Alberto Hernando-Calvo, Eoghan Malone, Daphne Dai, Amy Prawira, Ilan Weinreb, Anneli Eliason, Angela Rodriguez, Katherine Lajkosz, Sarah Jennings, Anna Spreafico, Lillian L. Siu, Aaron Hansen. Genomic profiling and matched therapy for recurrent or metastatic salivary gland neoplasms. Results from the matched cohort of the GEMS-001 clinical trial [abstract]. In: Proceedings of the AACR-NCI-EORTC Virtual International Conference on Molecular Targets and Cancer Therapeutics; 2021 Oct 7-10. Philadelphia (PA): AACR; Mol Cancer Ther 2021;20(12 Suppl):Abstract nr P154.

Prospective manipulation of the gut microbiome with Microbial Ecosystem Therapeutic 4 (MET4) in locoregionally advanced oropharyngeal squamous cell carcinoma (LA-OPSCC) undergoing primary chemoradiation (ROMA2)

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Background: Therapeutic manipulation of the gut microbiome in cancer patients (pts) is an area of active investigation. MET4 (NuBiyota) is an oral alternative to fecal transplant consisting of a mixture of human gut bacteria associated with immunotherapy (IO) response. We previously reported variation in IO-responsive taxa across stages in human papilloma virus related (HPV+) LA-OPSCC pts treated with chemoradiotherapy (CRT) (Oliva et al., ASCO 2020). ROMA-2 is the first interventional study evaluating the safety, feasibility and ecological effect of MET4, in combination with definitive CRT in HPV+ LA-OPSCC (NCT03838601). Methods: This is an investigator-initiated study of pts with HPV+ LA-OPSCC treated with standard of care CRT. MET4 is administered daily until week 4 of CRT or unacceptable toxicity. Stool samples are collected at baseline, week 4, week 8-10, and 2-months post CRT. Bacterial V4 16S rDNA was extracted from stool and sequenced. Microbiome analyses were conducted in R using DADA2, phyloseq and DESeq2. Results: As of February 11 2021, 25 pts have been enrolled. A total of 50 stool samples from the first 14 pts were collected (98% adherence) and analyzed. Baseline cohort characteristics: median age = 62.5 (range, 48-69); Stage I/II/III = 5/1/8; use of antibiotics = 1pt. 3 pts did not complete the 3-week course of MET4 treatment due to non-compliance (n = 1), withdrawal of consent (n = 1) and grade 2 diarrhea (n = 1). Other reported MET4-related adverse events (all grade 1) included bloating (n = 2), flatulence (n = 1) and belching (n = 1). No longitudinal changes in alpha-diversity were seen from baseline through follow up. Administration of MET4 resulted in a transient trend towards increased cumulative MET4 taxa relative abundance (RA) by week 4. Stage III patients demonstrated the lowest MET4 taxa RA at baseline, and the greatest increase in MET4 taxa RA from baseline to week 4. By week 4 the following taxa in all pts were increased compared to baseline: Eubacterium hallii (21.71 Log2Fold change[L2FC], padj < 0.001) and Parabacteroides johnsonii (23.67 L2FC, padj < 0.001). An increase in the following taxa was observed by weeks 8-10 compared to baseline: Akkermansia muciniphilla (3.75 L2FC, padj = 0.027), Bacteroides fragilis (6.73 L2FC, padj = 0.010), Alistipes onderdonkii (3.30 L2FC, padj = 0.049) and Parabacteroides distasonis (24.43 L2FC, padj < 0.001). Conclusions: Manipulation of the gut microbiota in these pts was feasible and safe. MET4-induced ecological changes are heterogenous and vary by taxa. MET4 taxa implicated in IO-response were increased by week 4 and week 8-10. This increase was higher in pts with stage III disease. These data suggest that specific subgroups may benefit from combination IO therapy and may guide pt selection for further interventional clinical trial design. Clinical trial information: NCT03838601.

Molecular profiling and targeted agents in recurrent, metastatic salivary gland tumor (R/M SGT) patients (pts) treated at two academic centers

6081

Background: Treatment selection based on actionable alterations (AAs) is an appealing strategy for pts with R/M SGT. The GEMS-001 study (NCT02069730) at Princess Margaret Cancer Centre (PM) and the Vall D´Hebron Institute of Oncology (VHIO) pre-screening program facilitate the identification of AAs for R/M SGT pts and treatment selection. Methods: We analyzed R/M SGT treated at PM and VHIO from 2015 to 2020. Clinicopathological features, molecular alterations and treatment modalities were correlated with outcomes. The primary endpoint was overall response rate (ORR) by RECIST 1.1. Clinical benefit rate (CBR) was defined by pts with partial response or stable disease ≥4 months. Clinical actionability of multigene panel testing (NGS) and immunohistochemistry (IHC) were assessed as per institutional molecular tumor boards or investigators. Pts were opportunistically matched to available therapies from each center. Results: In total 206 pts were enrolled. On IHC, HER2 overexpression was present in 9%, Androgen Receptor (AR) 33%, Estrogen/Progesterone Receptor (ER/PR) 11% and ALK overexpression 0%. On NGS, PIK3CA mutation (mut) was in 9%, NTRK fusion 6%, NOTCH1-3 mut 5%, HRAS mut 6%, ERBB2/3 alterations (alt) 4% and FGFR1-4 alt 3%. Up to 92 pts (45%) displayed at least 1 AA and 36 pts (18%) had ≥2 AAs. A total of 60 pts (29%) were matched to AAs. Of those matched, median age was 60 years (range 33-84), M:F 21:39, 95% ECOG≤1 with a median number of prior treatment lines 0 (range 0-3), and their AAs included 26 AR, 9 HER2 or ERBB2 overexpression, 9 PIK3CA mut, 3 NTRK fusion, 3 FGFR1-3 alt and 10 other AAs (2 ER/PR overexpression, 2 EGFR mut, 1 c-kit mut, 1 BAP1 mut, 1 Non-V600 BRAF mut, 1 CDKN2A mut, 1 CHEK2 mut and 1 PTCH1 mut). Overall, ORR was 27% for the matched population. See table for outcomes. Conclusions: In our cohort, almost one third of the population received therapies matched to AAs. Our results suggest that targeted therapies have promising activity in pts with R/M SGT supporting comprehensive molecular and IHC profiling in treatment determination.[Table: see text]

Upper Gastrointestinal Cancer Risk and Surveillance Outcomes in Li-Fraumeni Syndrome

INTRODUCTION

To assess the upper gastrointestinal (UGI) cancer risk and surveillance outcomes in Li-Fraumeni syndrome (LFS).

METHODS

Analysis of the International Agency for Research on Cancer database and a single-center adult LFS cohort.

RESULTS

UGI cancer was present in 7.2% of families and 3.9% of individuals with a pathogenic/likely pathogenic TP53 mutation in International Agency for Research on Cancer; 29% occurred before age 30. Our institutional cohort had 35 individuals (31% of the LFS cohort) with 48 cumulative upper endoscopies; 3 (8.5%) individuals had concerning UGI findings.

DISCUSSION

UGI cancer is observed in LFS. Upper endoscopy should be part of a comprehensive LFS surveillance program.

A-26 A Principal Component Analysis of Clinical Outcomes Among Adolescent Patients Following Concussion

Objective

Previous research utilizing factor analytic methods, such as principal components analysis (PCA) has focused on concussion factors derived from symptom scales (Piland, 2003; Kontos, 2012) and neurocognitive testing (Schatz, 2013). However, researchers have yet to conduct a PCA that incorporates symptoms, cognitive, ocular, and vestibular outcomes. The purpose was to utilize PCA to examine the factor structure of concussion among adolescents within 31 days of injury.

Method

Participants included 238 adolescents (41.2% female) diagnosed with concussion. Average age was 14.81 ± 1.57 years (10 to 17 years). A PCA was performed on 11 variables, including PCSS (via symptom factors: cognitive/fatigue/migraine, affective, somatic, and sleep), near point of convergence (NPC), ImPACT composites, and VOMS symptoms. Items retained in the factor models on the basis of having a primary factor loading of .6 or above.

Results

A three-component model was supported that accounted for 65.12% of the variance: 1) cognitive, 2) symptoms, and 3) vestibular/ocular. The cognitive component included visual motor speed, reaction time, verbal, and visual memory (37.95%). Symptoms component included affective, cognitive/fatigue/migraine, and sleep (17.42%). Vestibular/ocular component included vestibular and ocular symptoms (9.75%). All items loaded into the PCA, with exception of somatic and NPC average were retained.

Conclusions

The current study supported three factors and extended findings of previous PCAs by including ocular and vestibular components. The current study better reflects contemporary models of concussion involving clinical profiles or subtypes (e.g., Harmon, 2019). Moving forward, researchers should examine factors across subacute and chronic time points to evaluate potential temporal changes in factors.

A-24 Influence of Biopsychosocial Factors on First-Appointment Presentation After Sport Related Concussion (SRC)

Objective

To examine the influence of biopsychosocial factors on clinical outcomes and recovery time following SRC

Method

59 athletes with SRC (51% male) aged 14.42, SD= 1.65 years from two concussion specialty clinics between May 2019 and January 2020. Patients completed the Behavioral Regulation Assessment for Concussion (BRAC) inventory measuring sleep, diet, hydration, physical activity and stress; on a 4-point Likert scale, ImPACT, and PCSS. Analyses included one-way ANOVAs with Tukey’s post-hoc test and chi-square analyses.

Results

Verbal memory scores were higher F(3,55)= 2.85, p&lt;.05 in participants reporting 8-10hrs of sleep “most of the time” (M= 85.12, SD = 10.58) vs. “some of the time “ (M= 75.65, SD= 11.91). Verbal memory differed when engaged in stress regulation F(4,54)= 2.65, p&lt;.05; “MOT” (M=81.38, SD= 10.95); “SOT” (M=82.33, SD= 12.64) and “never” (M= 84.05, SD= 13.07). PCSS sleep factor scores increased when individuals obtained 8-10hrs of sleep “MOT” (M=.30, SD=.423) “SOT” (M= 1.40, SD= 1.54) and “seldom/rarely” (M= 1.95, SD= 1.58). PCSS somatic scores were associated with decreased sleep X2(1, N=57) = 37.68; p= .001, and hydration X2(1, N=57) = 60.70 p&lt; .001. Sleep and recovery time X2(1, N=55) = 120.82 p= .028.

Conclusions

Findings suggest that biopsychosocial factors including sleep, stress, and hydration are associated with symptoms, cognitive function, and recovery time following SRC and should be monitored by clinicians.

Circulating tumor DNA dynamics as prognostic and predictive biomarkers of response to pembrolizumab in patients with virally-related tumors (VRT) treated within the INSPIRE study

3068

Background: We previously showed a correlation between circulating tumor DNA (ctDNA) dynamics and response to pembrolizumab in a cohort of mixed tumors treated in the INSPIRE study (Yang et al, ESMO 2019). We investigated the prognostic and predictive value of ctDNA dynamics in patients (pts) with VRT. Methods: Pts with VRT (HPV+ squamous cell carcinoma (SCC), EBER+ nasopharyngeal carcinoma (NPC) and MCPyV+ Merkel carcinoma (MC)) and a control cohort of non-VRT (HPV- head and neck SCC) treated with single-agent pembrolizumab were selected for the analysis. ctDNA was assayed at baseline and start of cycle 3 using a pt-specific amplicon-based NGS assay (Signatera). Samples were considered ctDNA positive if ≥2 of 16 pt-specific targets met the qualifying confidence score threshold. Whole exome sequencing (WES) performed in baseline tumor tissue; presence of HPV, EBV and MCPyV in tumor determined through bioinformatic analysis of WES data (VirusFinder, PMID23717618). Changes in tumor size (mm) and response data using RECIST 1.1 were collected. Progression-free survival (PFS) and overall survival (OS) were estimated by Kaplan-Meier method. Results: Twenty pts with VRT (HPV+ head and neck = 8, cervical = 2 and anal = 2 SCC; EBER+NPC = 2; MC = 6) and 11 pts with non-VRT were included. Median follow-up: 11 months (0,5-11). Treatment response: VRT 6 responders (CR + PR + SD > 18weeks) and 14 non-responders (SD < 18 weeks + PD); non-VRT 3 responders and 8 non-responders. Median OS and PFS for all pts were 10.61 and 3.2 months, respectively. No differences in PFS (p = 0.60) nor OS (p = 0.66) were observed among responders between VRT and non-VRT. Among non-responders, VRT had significantly higher OS but not PFS when compared to non-VRT (HR 0.30, p = 0.01 and HR 0.82 p = 0.62, respectively). VRT had quantitatively higher ctDNA at baseline vs non-VRT (Mean 7.9 vs 0.4 ng, p < 0.001). ΔctDNA (Change in ctDNA between baseline and cycle 3) strongly correlated with changes in tumor measurements and response by RECIST 1.1 (Spearman Rho = 0.75) and was associated with survival regardless of viral status (Table). Conclusions: ΔctDNA strongly correlated with changes in tumor response and survival in both VRT and non-VRT. Higher baseline ctDNA was found in VRT. Correlation with circulating viral DNA and radiomics analyses is on-going. [Table: see text]

Recurrent or metastatic salivary gland tumor (MSGT) patients treated with selinexor, a first in class selective exportin-1 (XPO1) inhibitor

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Background: MSGT are rare with limited systemic treatments. This single institution, prospective study in recurrent or metastatic (RM) MSGT involved 2 phases: genomic profiling followed by treatment with either genomically-matched or unmatched therapy. Here we present the results of the unmatched arm for patients (pts) treated with S an oral selective inhibitor of XPO1 that leads to activation of tumor suppressor proteins and retention of oncoprotein mRNAs in the cell nucleus, inducing cancer cell apoptosis. Methods: Patients (pts) with RM-MSGT had archived paraffin embedded tumor samples profiled with targeted next generation sequencing, immunohistochemistry for androgen receptor (AR) and fluorescent in-situ hybridization for HER-2 and ALK. If no actionable mutations were identified or if no matched agents were available, pts with progressive disease could receive S (60mg given twice weekly Q28 days). The study had a simon-2 stage design; 1 partial response in the first 18 pts treated with S, would trigger an additional 7pts to receive S in stage 2. Results: Between July 2014 and April 2019 85 pts were enrolled on study: 73 had sequencing which identified 41 with no actionable mutations and 32 with actionable mutations. 18 pts (10F/8M, median age 61 years [40-79]) were treated with S and included adenoid cystic (n = 8), salivary duct (n = 4), acinic cell (n = 2) and other subtypes (n = 4). Of these 18, 4 pts had actionable aberrations: AR amplification (n = 2), mutations in SMARCB1 (n = 1) and CDKN2A (n = 1). 13pts were treatment naïve, 3pts and 2pts received 1 and 2 or more lines of treatment respectively prior to enrollment: androgen deprivation therapy (n = 2), chemotherapy (n = 3), early phase clinical trials (n = 3). The median number of cycles of S received were 3 (range: 1-19). The best response by RECIST was SD in 13pts (72%) (SD > 6 months (range: 6-18 months) in 5pts (28%); tumor reduction measured in 7pts (39%)), no PRs, PD in 3pts (17%), and 2pts (11%) were not evaluable for response due to insufficient duration of treatment coming off early due to toxicity. The median PFS (95% CI) was 7.6 (3.5-NA) months and the median OS (95% CI) was 15.4 (7.3-NA) months. The most common drug-related toxicities were grade 1-2 fatigue 14pts (78%), nausea 13pts (72%) and dysguesia 10pts (56%). 5 (28%) pts had a dose reduction and 6 (33%) in total had a dose interruption due to toxicity. Conclusions: Single agent antitumor activity was limited and the side effect profile was tolerable. No specific genomic aberration was associated with response to S. Clinical trial information: NCT02069730 .

Assertive outreach treatment versus care as usual for the treatment of high-need, high-cost alcohol related frequent attenders: study protocol for a randomised controlled trial

BACKGROUND

Alcohol-related hospital admissions have doubled in the last ten years to > 1.2 m per year in England. High-need, high-cost (HNHC) alcohol-related frequent attenders (ARFA) are a relatively small subgroup of patients, having multiple admissions or attendances from alcohol during a short time period. This trial aims to test the effectiveness of an assertive outreach treatment (AOT) approach in improving clinical outcomes for ARFA, and reducing resource use in the acute setting.

METHODS

One hundred and sixty ARFA patients will be recruited and following baseline assessment, randomly assigned to AOT plus care as usual (CAU) or CAU alone in equal numbers. Baseline assessment includes alcohol consumption and related problems, physical and mental health comorbidity and health and social care service use in the previous 6 months using standard validated tools, plus a measure of resource use. Follow-up assessments at 6 and 12 months after randomization includes the same tools as baseline plus standard measure of patient satisfaction. Outcomes for CAU + AOT and CAU at 6 and 12 months will be compared, controlling for pre-specified baseline measures. Primary outcome will be percentage of days abstinent at 12 months. Secondary outcomes include emergency department (ED) attendance, number and length of hospital admissions, alcohol consumption, alcohol-related problems, other health service use, mental and physical comorbidity 6 and 12 months post intervention. Health economic analysis will estimate the economic impact of AOT from health, social care and societal perspectives and explore cost-effectiveness in terms of quality adjusted life years and alcohol consumption at 12-month follow-up.

DISCUSSION

AOT models piloted with alcohol dependent patients have demonstrated significant reductions in alcohol consumption and use of unplanned National Health Service (NHS) care, with increased engagement with alcohol treatment services, compared with patients receiving CAU. While AOT interventions are costlier per case than current standard care in the UK, the rationale for targeting HNHC ARFAs is because of their disproportionate contribution to overall alcohol burden on the NHS. No previous studies have evaluated the clinical and cost-effectiveness of AOT for HNHC ARFAs: this randomized controlled trial (RCT) targeting ARFAs across five South London NHS Trusts is the first.

TRIAL REGISTRATION

International standard randomized controlled trial number (ISRCTN) registry: ISRCTN67000214, retrospectively registered 26/11/2016.

Autonomous adaptation to climate-driven change in marine biodiversity in a global marine hotspot

While governments and natural resource managers grapple with how to respond to climatic changes, many marine-dependent individuals, organisations and user-groups in fast-changing regions of the world are already adjusting their behaviour to accommodate these. However, we have little information on the nature of these autonomous adaptations that are being initiated by resource user-groups. The east coast of Tasmania, Australia, is one of the world's fastest warming marine regions with extensive climate-driven changes in biodiversity already observed. We present and compare examples of autonomous adaptations from marine users of the region to provide insights into factors that may have constrained or facilitated the available range of autonomous adaptation options and discuss potential interactions with governmental planned adaptations. We aim to support effective adaptation by identifying the suite of changes that marine users are making largely without government or management intervention, i.e. autonomous adaptations, to better understand these and their potential interactions with formal adaptation strategies.

Comparison of Clinical Outcomes Following Patients' First and Second Concussions

Purpose

The objective of this study was to examine differences in self-reported symptoms, neurocognitive performance, and vestibular-ocular insufficiencies between patients’ first and second concussions. A secondary purpose was to explore the role of risk factors on recovery.

Methods

We conducted a retrospective medical chart review of 73 (32-M/41-F) patients aged 15.69 (SD=1.67) years from a concussion specialty clinic with two separate concussions (84.9% of 1st and 79.5% of 2nd sport-related) that occurred between August 2010 and April 2018. Clinical outcomes included the PCSS, ImPACT, and the Vestibular/Ocular Motor Screening (VOMS). A series of paired samples t-tests were used to compare clinical outcomes along with chi-square analyses for risk factor associations.

Results

Verbal memory scores were higher following the second (M=80.67, SD=15.3) (M=76.32, SD=15.65) (t[73]=–2.18, p=.03) concussion. Visual motor processing speed was faster following the second concussion (M=35.04, SD= 7.90) (M=31.35, SD=7.63) (t[73]=–5.72, p<.001). There were no other significant differences observed. Recovery time was similar for the first (61.07, SD=58.41.5) and second (67.91 SD=70.10) respectively, t(70)=–.91, p=.37. There was no relationship between any risk factors, and recovery time for either injury with the exception a significant association between gender and recovery time (>21 days) with the 1st injury for females (χ2, N=73)=10.58, p=.001.

Conclusion

Findings suggest that a second concussion does not result in more pronounced symptoms, worse neurocognitive performance, or increased deficits on vestibular/ocular performance and/or longer recovery time. The only significant risk factor to a recovery over 21 days included gender.

PCNT point mutations and familial intracranial aneurysms

OBJECTIVE

To identify novel genes involved in the etiology of intracranial aneurysms (IAs) or subarachnoid hemorrhages (SAHs) using whole-exome sequencing.

METHODS

We performed whole-exome sequencing in 13 individuals from 3 families with an autosomal dominant IA/SAH inheritance pattern to look for candidate genes for disease. In addition, we sequenced PCNT exon 38 in a further 161 idiopathic patients with IA/SAH to find additional carriers of potential pathogenic variants.

RESULTS

We identified 2 different variants in exon 38 from the PCNT gene shared between affected members from 2 different families with either IA or SAH (p.R2728C and p.V2811L). One hundred sixty-four samples with either SAH or IA were Sanger sequenced for the PCNT exon 38. Five additional missense mutations were identified. We also found a second p.V2811L carrier in a family with a history of neurovascular diseases.

CONCLUSION

The PCNT gene encodes a protein that is involved in the process of microtubule nucleation and organization in interphase and mitosis. Biallelic loss-of-function mutations in PCNT cause a form of primordial dwarfism (microcephalic osteodysplastic primordial dwarfism type II), and ≈50% of these patients will develop neurovascular abnormalities, including IAs and SAHs. In addition, a complete Pcnt knockout mouse model (Pcnt ^-/-) published previously showed general vascular abnormalities, including intracranial hemorrhage. The variants in our families lie in the highly conserved PCNT protein-protein interaction domain, making PCNT a highly plausible candidate gene in cerebrovascular disease.

Comment on "Tracking the global footprint of fisheries"

Kroodsma et al (Reports, 23 February 2018, p. 904) mapped the global footprint of fisheries. Their estimates of footprint and resulting contrasts between the scale of fishing and agriculture are an artifact of the spatial scale of analysis. Reanalyses of their global (all vessels) and regional (trawling) data at higher resolution reduced footprint estimates by factors of >10 and >5, respectively.

Ecology can inform genetics: Disassortative mating contributes to MHC polymorphism in Leach's storm-petrels (Oceanodroma leucorhoa)

Studies of MHC-based mate choice in wild populations often test hypotheses on species exhibiting female choice and male-male competition, which reflects the general prevalence of females as the choosy sex in natural systems. Here, we examined mutual mate-choice patterns in a small burrow-nesting seabird, the Leach's storm-petrel (Oceanodroma leucorhoa), using the major histocompatibility complex (MHC). The life history and ecology of this species are extreme: both partners work together to fledge a single chick during the breeding season, a task that requires regularly travelling hundreds of kilometres to and from foraging grounds over a 6- to 8-week provisioning period. Using a 5-year data set unprecedented for this species (n = 1078 adults and 925 chicks), we found a positive relationship between variation in the likelihood of female reproductive success and heterozygosity at Ocle-DAB2, a MHC class IIB locus. Contrary to previous reports rejecting disassortative mating as a mechanism for maintaining genetic polymorphism in this species, here we show that males make significant disassortative mate-choice decisions. Variability in female reproductive success suggests that the most common homozygous females (Ocle-DAB2*01/Ocle-DAB2*01) may be physiologically disadvantaged and, therefore, less preferred as lifelong partners for choosy males. The results from this study support the role of mate choice in maintaining high levels of MHC variability in a wild seabird species and highlight the need to incorporate a broader ecological framework and sufficient sample sizes into studies of MHC-based mating patterns in wild populations in general.

Biodiversity redistribution under climate change: Impacts on ecosystems and human well-being

Distributions of Earth's species are changing at accelerating rates, increasingly driven by human-mediated climate change. Such changes are already altering the composition of ecological communities, but beyond conservation of natural systems, how and why does this matter? We review evidence that climate-driven species redistribution at regional to global scales affects ecosystem functioning, human well-being, and the dynamics of climate change itself. Production of natural resources required for food security, patterns of disease transmission, and processes of carbon sequestration are all altered by changes in species distribution. Consideration of these effects of biodiversity redistribution is critical yet lacking in most mitigation and adaptation strategies, including the United Nation's Sustainable Development Goals.

Morphological and genetic factors shape the microbiome of a seabird species (Oceanodroma leucorhoa) more than environmental and social factors

BACKGROUND

The microbiome provides multiple benefits to animal hosts that can profoundly impact health and behavior. Microbiomes are well-characterized in humans and other animals in controlled settings, yet assessments of wild bird microbial communities remain vastly understudied. This is particularly true for pelagic seabirds with unique life histories that differ from terrestrial bird species. This study was designed to examine how morphological, genetic, environmental, and social factors affect the microbiome of a burrow-nesting seabird species, Leach's storm petrel (Oceanodroma leucorhoa). These seabirds are highly olfactory and may rely on microbiome-mediated odor cues during mate selection. Composition and structure of bacterial communities associated with the uropygial gland and brood patch were assessed using 16S rRNA amplicon-based Illumina Mi-Seq analysis and compared to burrow-associated bacterial communities. This is the first study to examine microbial diversity associated with multiple body sites on a seabird species.

RESULTS

Results indicate that sex and skin site contribute most to bacterial community variation in Leach's storm petrels and that major histocompatibility complex (MHC) genotype may impact the composition of bacterial assemblages in males. In contrast to terrestrial birds and other animals, environmental and social interactions do not significantly influence storm petrel-associated bacterial assemblages. Thus, individual morphological and genetic influences outweighed environmental and social factors on microbiome composition.

CONCLUSIONS

Contrary to observations of terrestrial birds, microbiomes of Leach's storm petrels vary most by the sex of the bird and by the body site sampled, rather than environmental surroundings or social behavior.

Flight-Test of a Tactile Situational Awareness System in a Land-based Deck Landing Task

The National Research Council of Canada and Defence Research and Development Canada flight-tested the U.S. Naval Aerospace Medical Research Laboratory's Tactile Situational Awareness System (TSAS) in a dynamic task. The TSAS vest uses small pneumatic actuators or ‘tactors’ to transmit information to the pilot. Eleven pilots used the TSAS to cue horizontal axis performance in a land-based deck landing task flown in the NRC Bell 205 helicopter. Pilots tracked a vertically moving target with and without the TSAS in good and degraded visual conditions. The TSAS effectively cued longitudinal fore/aft drifts and reduced RMS error. It had less effect on lateral positioning error, possibly due to the presence of strong visual cues. Pilot situational awareness during degraded visual environment conditions in high sea states was significantly improved by the TSAS, as measured by the China Lake situational awareness rating scale. No change in workload, as measured by Modified Cooper Harper Workload Scale, was attributable to the TSAS use. The improvements in situational awareness and the reduction in longitudinal error suggest that the TSAS would be beneficial for helicopter ship deck landing.

Evaluating control activity as a measure of workload in flight test

This paper describes an investigation of a workload measurement technique based on pilot control movements. The Dynamic Interface Modeling and Simulation System Product Metric (DIMSS PM) assumes that pilot control activity can be used to evaluate pilot workload. Three qualified test pilots flew the fly-bywire NRC Bell 205 helicopter in a short test program that compared the DIMSS PM with subjective workload ratings and handling qualities ratings. The pilots performed a variation of an ADS-33E bob-up with varying levels of simulated turbulence and modified cyclic control characteristics. Good agreement was found for most in-flight test conditions between DIMSS Workload Metric scores and subjective workload ratings from the Bedford Workload Scale and Cooper-Harper handling qualities ratings. While, the DIMSS Workload Metric did not accurately reflect workload increases due to variations in the cyclic stick characteristics, the metric shows promise as an objective measurement tool of pilot workload in well-defined tests.

Is economic valuation of ecosystem services useful to decision-makers? Lessons learned from Australian coastal and marine management

Economic valuation of ecosystem services is widely advocated as being useful to support ecosystem management decision-making. However, the extent to which it is actually used or considered useful in decision-making is poorly documented. This literature blindspot is explored with an application to coastal and marine ecosystems management in Australia. Based on a nation-wide survey of eighty-eight decision-makers representing a diversity of management organizations, the perceived usefulness and level of use of economic valuation of ecosystem services, in support of coastal and marine management, are examined. A large majority of decision-makers are found to be familiar with economic valuation and consider it useful - even necessary - in decision-making, although this varies across groups of decision-makers. However, most decision-makers never or rarely use economic valuation. The perceived level of importance and trust in estimated dollar values differ across ecosystem services, and are especially high for values that relate to commercial activities. A number of factors are also found to influence respondent's use of economic valuation. Such findings concur with conclusions from other studies on the usefulness and use of ESV in environmental management decision-making. They also demonstrate the strength of the survey-based approach developed in this application to examine this issue in a variety of contexts.

Modelling marine community responses to climate-driven species redistribution to guide monitoring and adaptive ecosystem-based management

As a consequence of global climate-driven changes, marine ecosystems are experiencing polewards redistributions of species - or range shifts - across taxa and throughout latitudes worldwide. Research on these range shifts largely focuses on understanding and predicting changes in the distribution of individual species. The ecological effects of marine range shifts on ecosystem structure and functioning, as well as human coastal communities, can be large, yet remain difficult to anticipate and manage. Here, we use qualitative modelling of system feedback to understand the cumulative impacts of multiple species shifts in south-eastern Australia, a global hotspot for ocean warming. We identify range-shifting species that can induce trophic cascades and affect ecosystem dynamics and productivity, and evaluate the potential effectiveness of alternative management interventions to mitigate these impacts. Our results suggest that the negative ecological impacts of multiple simultaneous range shifts generally add up. Thus, implementing whole-of-ecosystem management strategies and regular monitoring of range-shifting species of ecological concern are necessary to effectively intervene against undesirable consequences of marine range shifts at the regional scale. Our study illustrates how modelling system feedback with only limited qualitative information about ecosystem structure and range-shifting species can predict ecological consequences of multiple co-occurring range shifts, guide ecosystem-based adaptation to climate change and help prioritise future research and monitoring.

Information preferences for the evaluation of coastal development impacts on ecosystem services: A multi-criteria assessment in the Australian context

Ecosystem based management requires the integration of various types of assessment indicators. Understanding stakeholders' information preferences is important, in selecting those indicators that best support management and policy. Both the preferences of decision-makers and the general public may matter, in democratic participatory management institutions. This paper presents a multi-criteria analysis aimed at quantifying the relative importance to these groups of economic, ecological and socio-economic indicators usually considered when managing ecosystem services in a coastal development context. The Analytic Hierarchy Process (AHP) is applied within two nationwide surveys in Australia, and preferences of both the general public and decision-makers for these indicators are elicited and compared. Results show that, on average across both groups, the priority in assessing a generic coastal development project is for the ecological assessment of its impacts on marine biodiversity. Ecological assessment indicators are globally preferred to both economic and socio-economic indicators regardless of the nature of the impacts studied. These results are observed for a significantly larger proportion of decision-maker than general public respondents, questioning the extent to which the general public's preferences are well reflected in decision-making processes.

Pulmonary Veno-Occlusive Disease

Pulmonary hypertension is a well-known though poorly characterized disease in veterinary medicine. In humans, pulmonary veno-occlusive disease (PVOD) is a rare cause of severe pulmonary hypertension with a mean survival time of 2 years without lung transplantation. Eleven adult dogs (5 males, 6 females; median age 10.5 years, representing various breeds) were examined following the development of severe respiratory signs. Lungs of affected animals were evaluated morphologically and with immunohistochemistry for alpha smooth muscle actin, desmin, CD31, CD3, CD20, and CD204. All dogs had pulmonary lesions consistent with PVOD, consisting of occlusive remodeling of small- to medium-sized pulmonary veins, foci of pulmonary capillary hemangiomatosis (PCH), and accumulation of hemosiderophages; 6 of 11 dogs had substantial pulmonary arterial medial and intimal thickening. Ultrastructural examination and immunohistochemistry showed that smooth muscle cells contributed to the venous occlusion. Increased expression of CD31 was evident in regions of PCH indicating increased numbers of endothelial cells in these foci. Spindle cells strongly expressing alpha smooth muscle actin and desmin co-localized with foci of PCH; similar cells were present but less intensely labeled elsewhere in non-PCH alveoli. B cells and macrophages, detected by immunohistochemistry, were not co-localized with the venous lesions of canine PVOD; small numbers of CD3-positive T cells were occasionally in and around the wall of remodeled veins. These findings indicate a condition in dogs with clinically severe respiratory disease and pathologic features resembling human PVOD, including foci of pulmonary venous remodeling and PCH.

A Survey of GPs Awareness and Use of Risk Assessment Tools and Cardiovascular Disease Prevention Guidelines

Cardiovascular disease (CVD) is the leading cause of death worldwide. This study aimed to benchmark awareness and use of CVD risk assessment (RA) tools and prevention guidelines in Irish general practice. 493 (18%) Irish general practitioners (GPs) were invited to participate in a cross-sectional study in 2011. 213 (43%) GPs responded with most being male (n = 128, 58.2%) and aged ≥ 45 years (n = 124, 56.8%). While 197 (92.5%) GPs were aware of at least one RA tool, only 69 (32.4%) GPs reported frequent use. 187 (87.8%) GPs were aware of one or more CVD prevention guidelines with 115 (54.0%) GPs reporting frequent use of at least one guideline. No age or gender difference observed. Barriers to implementation of CVD prevention guidelines were lack of remuneration, too many CVD guidelines and time constraints. Most Irish GPs were aware of RA tools and CVD prevention guidelines with half reporting frequent use of guidelines.

Trends in percutaneous coronary intervention and angiography in Ireland, 2004-2011: Implications for Ireland and Europe

BACKGROUND/OBJECTIVES

To study temporal trends in crude and age standardised rates of cardiac catheterisation and percutaneous coronary intervention (PCI) in Ireland, 2004-2011.

METHODS

Two data sources were used: a) a survey of publicly and privately funded hospitals with cardiac catheter laboratories to obtain the annual number of procedures performed and b) anonymised data from the Hospital In-Patient Enquiry (HIPE) for angiography and PCI in acute publicly funded hospitals; age standardised rates were calculated to study trends over time.

RESULTS

From 2004 to 2011 the crude rate of angiography and PCI increased by 47.8% and 35.9% respectively, with rates of 6689 and 1825 per million population in 2011. Following age standardisation, however, PCI activity showed a non-significant decrease over time. The PCI to angiography ratio decreased from 30% to 27% and PCI was performed predominantly for stable coronary heart disease (54%) in 2011.

CONCLUSION

Angiography and PCI rates have increased in Ireland but PCI crude and age adjusted rates show divergent trends. While Ireland differs from USA and UK, with a higher proportion of PCI being performed for stable CHD in recent years, little systematic surveillance of cardiological interventions within Europe is available to benchmark improvements in Ireland.

Primary care in nursing homes revisited: survey of the experiences of primary care physicians

The Irish Health Information and Quality Authority (HIQA) published National Quality Standards for Residential Care Settings for Older People in 2009. We reported on experiences of general practitioners (GPs) in Dublin caring for nursing home patients (NHPs) in 2006. We revisit these experiences following publication of HIQA's standards. 400 GPs received an anonymous postal survey. Of 204 respondents, 145 (71%) felt NHPs required more contact time and 124 (61%) reported more complex consultations compared to other patients. Only 131 (64%) felt adequately trained in gerontology. 143 (70%) reported access to specialist advice, but only 6 (3%) reported a change in this following HIOA standards. 65 (32%) had witnessed substandard care in a NH, of which 16 (25%) made no report, similar figures to 2006. There remains similar levels of concern regarding patient complexity, substandard care, access to specialist support and training in the care of NHPs. Many GPs expressed uncertainty regarding their role in implementing HIQA standards.

Acute childhood asthma in Galway city from 1985-2005: relationship to air pollution and climate

We examine the relationship of air pollution and climatic variables to asthma admission rates of children in Galway city over a 21 year period. Paediatric asthma admissions were recorded from 1985-2005, and admission rates per thousand calculated for pre-school (1-4 years), school aged (5-14 years) and all children (1-14 years) on a monthly and annual basis. These data were compared to average monthly and annual climatic variables (rainfall, humidity, sunshine, wind speed and temperature) and black smoke levels for the city. Simple correlation and Poisson Generalized Additive Models (GAM) were used. Admission rates each month are significantly correlated with smoke levels (p = 0.007). Poisson GAM also shows a relationship between admissions and pollution (p = 0.07). Annual smoke levels impact more on admission rates of preschoolers (p = 0.04) than school age children (p = 0.10). These data suggest that air pollution is an important factor in the epidemiology of acute childhood asthma.