Introduction In the United Kingdom, the self-administration of prescribed medicines by hospitalized patients has been supported by the Department of Health and pharmaceutical and nursing bodies. Drug ...and patient data were also extracted to determine the association between these factors and self-administration.Results In the twelve-month period analyzed, 45,115 patients were admitted to hospital. ...work is also necessary to evaluate the role of electronic prescribing and medicine administration systems in supporting the self-administration of medicines in patients where it is safe and appropriate.Disclosure of Interest S. Richardson : Grant/research support from:
A needs assessment was conducted to determine the existence and extent of differences between Vietnam-era veterans and other veterans residing within the catchment area of the Northport Veterans ...Administration Medical Center. The results of a questionnaire completed by 486 veterans indicated that, compared with World War II and Korean War veterans, a greater percentage of Vietnam-era veterans reported experiencing the symptoms of posttraumatic stress disorder. They also reported more situational adjustment problems. A great number of Vietnam-era veterans expressed a need for psychotherapy and anger-control therapy, and they generally preferred to be treated with other Vietnam-era veterans who have had similar combat experience.
The pharmacokinetics of the commonly used contraceptive steroids ethinyloestradiol and levonorgestrel were investigated after oral and intravenous administration in six women with cystic fibrosis. ...The results were compared with data obtained from healthy women of similar age. The total body clearance of ethinyloestradiol was significantly higher in the patients with cystic fibrosis (0.61 (SD 0.19) l/h/kg) than in control women (0.32 (0.16) l/h/kg; p less than 0.02). In addition, the oral bioavailability of ethinyloestradiol was greater in women with cystic fibrosis than in controls (76.9% (11.7%) compared with 47.3% (7.5%); p less than 0.001). As a result of these two changes, the area under the plasma concentration--time curve after an oral dose of ethinyloestradiol was similar in patients and controls. The pharmacokinetics of levonorgestrel did not differ significantly between patients with cystic fibrosis and healthy women. The data suggest that women with cystic fibrosis will receive similar contraceptive protection from these steroids as do healthy women.
In a group of 23 patients with histologically confirmed malignant mesothelioma of the pleura who could not recall exposure to asbestos dust, survival was significantly longer than in a group of 83 ...patients with known exposure. Asbestos bodies were found by a quantitative method significantly less frequently in the unexposed than in the exposed group. The longer survival of patients without known exposure could not be correlated with any significant difference in the histological cell types of the tumours from those of exposed patients. In the 83 patients with known exposure survival did not relate to duration of exposure. Consequently, although the tumours of patients unable to recall exposure may be caused by unrecognised environmental contamination with asbestos dust, the longer survival of these patients would suggest a different aetiology.
Webspinners in the genus Haploembia Verhoeff (Embioptera: Oligotomidae) were introduced into California from their native range in the Mediterranean region. In that region the genus has long been ...thought to comprise a single widespread species Haploembia solieri (Rambur) with both sexual and asexual populations and two additional sexual species with restricted ranges in the Mediterranean. For most of its known history in California, only asexual populations of Haploembia solieri were collected. However, within the last couple of decades, sexual populations have been discovered. The purpose of this project is to determine whether a single species of Haploembia solieri exists in California, which may imply reacquisition of sex, or whether these populations represent two or more species. To resolve this question DNA sequence data were acquired from multiple populations (sexual and asexual) of Californian, New Mexican, and Mediterranean Haploembia solieri, including both nuclear (histone 3) and mitochondrial (cytochrome oxidase I) genes. These data were included in a phylogenetic analysis to resolve relationships between these individuals. Our analysis shows asexual California specimens grouping with the asexual specimens from Sardinia; whereas the sexual California specimens group separately from both asexual specimens, and sexual Mediterranean specimens. Therefore, we conclude that there are two species of Haploembia introduced into California and at least three species involved in what was historically considered H. solieri.
Diverse microbial assemblages inhabit subglacial aquatic environments. While few of these environments have been sampled, data reveal that subglacial organisms gain energy for growth from reduced ...minerals containing nitrogen, iron, and sulfur. Here we investigate the role of microbially mediated sulfur transformations in sediments from Subglacial Lake Whillans (SLW), Antarctica, by examining key genes involved in dissimilatory sulfur oxidation and reduction. The presence of sulfur transformation genes throughout the top 34 cm of SLW sediments changes with depth. SLW surficial sediments were dominated by genes related to known sulfur-oxidizing chemoautotrophs. Sequences encoding the adenosine-5'-phosphosulfate (APS) reductase gene, involved in both dissimilatory sulfate reduction and sulfur oxidation, were present in all samples and clustered into 16 distinct operational taxonomic units. The majority of APS reductase sequences (74%) clustered with known sulfur oxidizers including those within the "Sideroxydans" and Thiobacillus genera. Reverse-acting dissimilatory sulfite reductase (rDSR) and 16S rRNA gene sequences further support dominance of "Sideroxydans" and Thiobacillus phylotypes in the top 2 cm of SLW sediments. The SLW microbial community has the genetic potential for sulfate reduction which is supported by experimentally measured low rates (1.4 pmol cm(-3)d(-1)) of biologically mediated sulfate reduction and the presence of APS reductase and DSR gene sequences related to Desulfobacteraceae and Desulfotomaculum. Our results also infer the presence of sulfur oxidation, which can be a significant energetic pathway for chemosynthetic biosynthesis in SLW sediments. The water in SLW ultimately flows into the Ross Sea where intermediates from subglacial sulfur transformations can influence the flux of solutes to the Southern Ocean.
Background:
Mantle cell lymphoma (MCL) is a B cell malignancy accounting for 3‐10% of all Non‐Hodgkin Lymphomas and arises mainly in older adults with a male predominance (McKey et al). Historically, ...median survival was 4–5 years (Herrmann et al, 2009) however this is now in the order of 8–12 years in younger fitter patients who are able to tolerate intensive therapies (Eskelund et al, 2016). The current standard treatment is chemoimmunotherapy with or without autologous stem cell transplantation (ASCT). Although intensive therapy can achieve durable responses most patients eventually succumb to their disease. Novel therapeutic agents have shown efficacy in relapsed/refractory disease and are now being tested as frontline treatment (Sharma et al., 2018).
Aims:
We report a single centre experience of MCL and its treatment.
Methods:
Retrospective data was collected on all patients diagnosed with MCL at Ipswich Hospital NHS Trust over a nine year period between January 2010 and January 2019.
Results:
Forty‐two patients were included in the analysis. Median age was 68yrs with a male to female ratio of 5:1. Eastern Co‐operative Oncology Group (ECOG) performance status ranged from 0‐1 in 66%, ≥2 in 14% and 19% had no status documented.
Twenty‐four patients (57%) received a non‐intensive chemoimmunotherapy regimen; rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R‐CHOP) or rituximab‐bendamustine (BR) as first line treatment with twenty of these patients receiving rituximab maintenance. Thirteen patients (31%) were fit enough to receive an intensive chemoimmunotherapy regimen with all but one consolidated with an ASCT. Of those transplanted five went on to receive rituximab maintenance. The remaining 12% of patients received either R‐Chlorambucil, palliative radiotherapy, FCR or supportive care.
The median Kaplan‐Meier overall survival (OS) for all patients had not been reached. Median progression free survival (PFS) was 48 months. Comparing first line therapies, the median OS for those that received RCHOP/BR was 60 months with a median PFS of 35 months vs. not reached for both OS and PFS with intensive chemoimmunotherapy followed by ASCT. Eighteen patients had relapsed during the nine year period. There was no standard second line treatment. Eight patients received further chemoimmunotherapy including BR, R‐cytarabine and FCR, one PEP‐C, three ibrutinib, four palliative radiotherapy and two received supportive care only. After first relapse median PFS was 6 months and median OS was only 10 months. Nine patients received a third line treatment, of which 3 received ibrutinib and one venetoclax and the median OS was 9 months.
The six relapsed/refractory patients that received Ibrutinib at either first or second relapse had a median OS of 8 months vs. 12 months in those that received other forms of therapy.
Summary/Conclusion:
As expected the best outcomes were with high intensity regimens consolidated by ASCT. Our data period was not long enough to show the continuous pattern of relapse despite durable responses that have now been shown by long term follow up data (Eskelund et al, 2016). The outlook was poor for relapsed/refractory disease with a median OS of 10 months. Rule et al analysed data from 370 patients receiving ibrutinib for relapsed/refractory MCL, enrolled across three different studies (PCYC‐1104, SPARK, and RAY), and demonstrated an excellent outcome, with a median PFS of 13 months and median OS of 26.7 months. We did not see a beneficial effect on OS with the use of novel therapies in our patients (8 months vs. 12 months) although our study numbers were small.
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