Serum concentrations of the biomarkers CA125, CA15-3, PSA and PAPP-A in early pregnancy

Blood samples were collected serially from 14 women with healthy pregnancies, beginning in gestational week 4 at the time of a positive pregnancy test through to the identification of a foetal heart by ultrasound. Six biomarkers were measured in the serum retrospectively including two reproductive hormones (progesterone and human chorionic gonadotrophin (hCG)) and four additional biomarkers (prostate-specific antigen (PSA), cancer antigen 15-3 (CA15-3), cancer antigen 125 (CA125) and pregnancy-associated plasma protein A (PAPP-A)) measured on a Siemens Centaur XP and a Roche Cobas e411 automated analysers, respectively. The progesterone and hCG results were unremarkable following established patterns, but distinctive patterns of change were seen in the other four biomarkers during this period of early pregnancy. PAPP-A and PSA levels rose steadily as the pregnancies progressed, while CA125 levels rose until week 5.5 and then returned to baseline values. CA15-3 serum concentrations were observed to drop as the pregnancies progressed. These biomarker results suggest further investigation is warranted to allow a non-invasive correlation of the biomarkers with the various stages of embryogenesis, implantation and placentation

‘Imagine if I gave up smoking ...’: a qualitative exploration of Aboriginal participants’ perspectives of a self-management pilot training intervention

Author version made available in accordance with the publisher's policy.This paper reports on a pilot qualitative study investigating Aboriginal participants’ perspectives of the Flinders Living Well Smoke Free (LWSF) “training intervention”. Health workers nationally have been trained in this program, which offers a self-management approach to reducing smoking among Aboriginal clients. A component of the training involves Aboriginal clients volunteering their time in a mock care planning session providing the health workers with an opportunity to practise their newly acquired skills. During this simulation the volunteer clients receive one condensed session of the LWSF intervention imitating how the training will be implemented when the health workers have completed the training. For the purpose of this study ten Aboriginal clients who had been volunteers in the mock care planning process, underwent a semi-structured interview at seven sites in Australia, including mainstream health services, Aboriginal Medical Services and remote Aboriginal communities. The study aimed to gauge their perspectives of the training intervention they experienced. Early indications suggest that Aboriginal volunteer clients responded positively to the process, with many reporting substantial health behaviour change or plans to make changes since taking part in this mock care planning exercise. Enablers of the intervention are discussed along with factors to be considered in the training program

Serum concentrations of the biomarkers CA125, CA15-3, CA72-4, tPSA and PAPP-A in natural and stimulated ovarian cycles

Objective: Biomarkers associated with cancer screening (CA125, CA15-3, CA72-4, total prostate specific antigen [tPSA]) and the monitoring of pregnancy (pregnancy associated plasma protein-A [PAPP-A]) were measured during natural and stimulated ovarian cycles in disease-free non-pregnant women to determine if they could reflect normal events relating to ovulation and/or endometrial changes. Methods: A total of 73 blood samples (10 women) collected throughout the natural menstrual cycle, and 64 blood samples (11 women) taken during stimulated ovarian cycles, were analysed on the Roche Cobas e411 automated analyser. Results: Detectable levels of tPSA were measured in at least one point in the cycle in 6/10 of women in the natural cycle and 10/11 of women in stimulated cycles, and CA72-4 was detected in only 12/21 women tested. Concentrations of CA125, tPSA, CA15-3 and CA72-4 showed no significant difference between the natural and stimulated ovarian cycle groups. On average the mean PAPP-A of the natural group was (2.41±0.58) mIU/L higher than the stimulated group (t=4.10, P\u3c 0.001). CA125 and CA15-3 results were both significantly influenced by the stage of the cycle (P\u3c0.0001), whereas tPSA and PAPP-A concentrations revealed no significant changes (P≥0.65). CA72-4 was not affected by the stage of the cycle nor ovarian stimulation. Conclusion: Ovarian stimulation reduced serum PAPP-A levels, CA125 and CA15-3 levels were generally unaffected by ovarian stimulation but displayed cyclical changes throughout both natural and stimulated cycles, whilst tPSA and CA72-4 were not affected by the stage of the cycle or ovarian stimulation

Prostate Surgery for Men with Lower Urinary Tract Symptoms: Do We Need Urodynamics to Find the Right Candidates?:Exploratory Findings from the UPSTREAM Trial

BackgroundIdentifying men whose lower urinary tract symptoms (LUTS) may benefit from surgery is challenging.ObjectiveTo identify routine diagnostic and urodynamic measures associated with treatment decision-making, and outcome, in exploratory analyses of the UPSTREAM trial.Design, setting, and participantsA randomised controlled trial was conducted including 820 men, considering surgery for LUTS, across 26 hospitals in England (ISCTRN56164274).InterventionMen were randomised to a routine care (RC) diagnostic pathway (n = 393) or a pathway that included urodynamics (UDS) in addition to RC (n = 427).Outcome measurements and statistical analysisMen underwent uroflowmetry and completed symptom questionnaires, at baseline and 18 mo after randomisation. Regression models identified baseline clinical and symptom measures that predicted recommendation for surgery and/or surgical outcome (measured by the International Prostate Symptom Score [IPSS]). We explored the association between UDS and surgical outcome in subgroups defined by routine measures.Results and limitationsThe recommendation for surgery could be predicted successfully in the RC and UDS groups (area under the receiver operating characteristic curve 0.78), with maximum flow rate (Qmax) and age predictors in both groups. Surgery was more beneficial in those with higher symptom scores (eg, IPSS >16), age 47.6, and bladder contractility index >123.0. In the UDS group, urodynamic measures were more strongly predictive of surgical outcome for those with Qmax >15, although patient-reported outcomes were also more predictive in this subgroup.ConclusionsTreatment decisions were informed with UDS, when available, but without evidence of change in the decisions reached. Despite the small group sizes, exploratory analyses suggest that selective use of UDS could detect obstructive pathology, missed by routine measures, in certain subgroups.Patient summaryBaseline clinical and symptom measurements were able to predict treatment decisions. The addition of urodynamic test results, while useful, did not generally lead to better surgical decisions and outcomes over routine tests alone

Stakeholder deliberation on developing affordable housing strategies: Towards inclusive and sustainable transit-oriented developments

Transit-oriented developments (TODs) are commanding high land and rental values due to improved accessibility and economic opportunities. Owing to the increase in land and rental values, the highly desirable TODs are gradually becoming inaccessible to the poor, creating social exclusion and housing inequities within the TODs. To address this consequence, the study proposes a three-level stakeholder deliberation framework (inform, involve, and collaborate) towards developing inclusive housing strategies for equitable and sustainable TODs. The framework is applied to the context of the Yeshwanthpur industrial area, Bengaluru, India. The first level of deliberation, 'information', foregrounds the need for affordable housing strategies for stakeholders. In the second level of deliberation, the stakeholders involved identify the major challenges in incorporating affordable housing into TODs. In the third level of deliberation, stakeholders collaborate to contemplate strategies to combat each challenge. The results show that mandatory inclusionary zoning, special-purpose planning vehicles, land banking entities, innovative financing tools, and local area level plans in collaboration with the community, emerged as potentially feasible strategies to create inclusive housing outcomes in the TOD case study area

Connectivity between white shark populations off Central California, USA and Guadalupe Island, Mexico

Marine animals often move beyond national borders and exclusive economic zones resulting in a need for trans-boundary management spanning multiple national jurisdictions. Highly migratory fish vulnerable to over-exploitation require protections at international level, as exploitation practices can be disparate between adjacent countries and marine jurisdictions. In this study we collaboratively conducted an analysis of white shark connectivity between two main aggregation regions with independent population assessment and legal protection programs; one off central California, USA and one off Guadalupe Island, Mexico. We acoustically tagged 326 sub-adult and adult white sharks in central California (n=210) and in Guadalupe Island (n=116) with acoustic transmitters between 2008-2019. Of the 326 tagged white sharks, 30 (9.20%) individuals were detected at both regions during the study period. We used a Bayesian implementation of logistic regression with a binomial distribution to estimate the effect of sex, maturity, and tag location to the response variable of probability of moving from one region to the other. While nearly one in ten individuals in our sample were detected in both regions over the study period, the annual rate of trans-regional movement was low (probability of movement = 0.015 yr-1, 95% credible interval = 0.002, 0.061). Sub-adults were more likely than adults to move between regions and sharks were more likely to move from Guadalupe Island to central California, however, sex, and year were not important factors influencing movement. This first estimation of demographic-specific trans-regional movement connecting US and Mexico aggregations with high seasonal site fidelity represents an important step to future international management and assessment of the northeastern Pacific white shark population as a whole