In search of consensus on aphasia management.

Morag Bixley and colleagues discuss their analysis of current UK aphasia practice

Reduction of carboplatin induced emesis by ondansetron.

Ondansetron is a selective 5-HT3 antagonist with significant antiemetic properties in patients receiving cytotoxic chemotherapy. Patients who had suffered severe vomiting on carboplatin alone (23 patients with ovarian carcinoma) or in combination (two patients with testicular cancer) despite intensive antiemetic regimens were treated with ondansetron, given as 8 mg immediately prior to carboplatin followed by 8 mg orally, 8 hourly for 5 days. Twenty-five patients received 58 courses of ondansetron. In the first 24 h after the first course of chemotherapy with ondansetron, 17 patients (68%) experienced no vomiting, five patients (20%) had almost complete control and the other three patients had partial control. During the subsequent 4 days slightly lesser control was achieved. Nausea was similarly controlled in most patients. Twenty-two patients stated a preference for ondansetron with future chemotherapy. Fourteen patients received additional chemotherapy with ondansetron and in only three patients did the efficacy of therapy lessen. Toxicity was mild and transient with headache and constipation predominant. No extrapyramidal reaction was seen. Sedation was absent. Ondansetron is highly effective in refractory vomiting associated with carboplatin chemotherapy. It may be particularly beneficial when an extrapyramidal reaction has occurred on previous antiemetics and when sedation is unacceptable

Comparative genomics in chicken and Pekin duck using FISH mapping and microarray analysis

BACKGROUND: The availability of the complete chicken (Gallus gallus) genome sequence as well as a large number of chicken probes for fluorescent in-situ hybridization (FISH) and microarray resources facilitate comparative genomic studies between chicken and other bird species. In a previous study, we provided a comprehensive cytogenetic map for the turkey (Meleagris gallopavo) and the first analysis of copy number variants (CNVs) in birds. Here, we extend this approach to the Pekin duck (Anas platyrhynchos), an obvious target for comparative genomic studies due to its agricultural importance and resistance to avian flu. RESULTS: We provide a detailed molecular cytogenetic map of the duck genome through FISH assignment of 155 chicken clones. We identified one inter- and six intrachromosomal rearrangements between chicken and duck macrochromosomes and demonstrated conserved synteny among all microchromosomes analysed. Array comparative genomic hybridisation revealed 32 CNVs, of which 5 overlap previously designated "hotspot" regions between chicken and turkey. CONCLUSION: Our results suggest extensive conservation of avian genomes across 90 million years of evolution in both macro- and microchromosomes. The data on CNVs between chicken and duck extends previous analyses in chicken and turkey and supports the hypotheses that avian genomes contain fewer CNVs than mammalian genomes and that genomes of evolutionarily distant species share regions of copy number variation ("CNV hotspots"). Our results will expedite duck genomics, assist marker development and highlight areas of interest for future evolutionary and functional studies

Structure of the sporulation histidine kinase inhibitor Sda from Bacillus subtilis and insights into its solution state

The crystal structure of the DNA-damage checkpoint inhibitor of sporulation, Sda, from Bacillus subtilis, has been solved by the MAD technique using selenomethionine-substituted protein. The structure closely resembles that previously solved by NMR, as well as the structure of a homologue from Geobacillus stearothermophilus solved in complex with the histidine kinase KinB. The structure contains three molecules in the asymmetric unit. The unusual trimeric arrangement, which lacks simple internal symmetry, appears to be preserved in solution based on an essentially ideal fit to previously acquired scattering data for Sda in solution. This interpretation contradicts previous findings that Sda was monomeric or dimeric in solution. This study demonstrates the difficulties that can be associated with the characterization of small proteins and the value of combining multiple biophysical techniques. It also emphasizes the importance of understanding the physical principles behind these techniques and therefore their limitations

Aphasia management in an acute setting, what are we doing and why?

TITLE OF PAPER: APHASIA MANAGEMENT IN AN ACUTE SETTING, WHAT ARE WE DOING AND WHY? KEYWORDS: THERAPY, RATIONALES, EXPERTS • WHY THE STUDY WAS UNDERTAKEN The Specific Interest Group in Aphasia Therapy has been involved with two projects looking into what Speech and Language Therapists (SLTs) do for people with aphasia in the acute setting. In the first phase of their research Bixley et al (2011) collated the different activities reported by 86 SLTs from 55 different adult trusts. This research suggested that therapist activity could be divided into five categories. A follow up study (Bixley et al, 2013) asked SLTs to confirm these groups, estimate the amount of time spent on each activity and provide a rationale for why this therapy intervention was important. Twenty two therapists confirmed that their activities could be categorised into the five different types. Eight of these therapists were able to estimate the amount of time spent on each type of activity. These activities were: 1) Assessment - 32% 2) Multidisciplinary team working (MDT) - 26% 3) Therapy choices - 23% 4) SLT administration - 13% and 5) Support training and education (STE) - 6%. This paper expands on this research by presenting a grounded theme analysis of the rationales for intervention for people with aphasia in the acute setting. • HOW THE STUDY WAS DONE Therapists were asked to complete a short questionnaire that had been distributed opportunistically through the SIG network. Twenty two SLTs from 14 different NHS trusts participated in this research. Twenty one participants (95%) estimated that they spent an average of 43% of their time in work providing aphasia management. Typically they worked in departments of three therapists providing 17 sessions of acute aphasia care. Eleven therapists (50%) had less than five years SLT experience and typically were on pay scale 5 or 6. Four very experienced therapists (18%) who had worked for ten to twenty years were paid at band 8. • WHAT WAS FOUND AND IMPLICATIONS FOR FUTURE POLICY AND PRACTICE Rationales were provided for each of the five management options. Assessment: Words used to describe reasons for assessment activities (basis, develop, establish, estimate, focus, gain, guide, indicate, inform, make, plan, provide and suggest) indicate that assessment is an active, ongoing, reflective process. Assessment was linked to both therapist belief and recommended practice (Royal College of Physicians, 2012 and National Institute for Health and Clinical Excellence, 2013). MDT: Therapists reported that the role of MDT working was goal setting for the benefit of the client management. However some therapists were not employed as part of an MDT and found it difficult to influence this decision making process. Therapy: SLTs thought that impairment, functional and psychological therapies were equally important. They acknowledged that this was challenging in the acute sector where clients were discharged quickly and were not always well enough to engage fully with rehabilitation. 19/22 therapists (86%) suggested they would like more time to provide SLT input. This paper presents a consensus of current SLT expert opinion. Despite the small sample size this research could be used to guide targets for future SLT intervention in the acute sector and it could be used as a focus for discussion about intervention choices within the SLT profession. REFERENCES Bixley, M., Blagdon, B., Dean, M., Langley, J. & Stanton, D. (2013) Best practice for aphasia in the acute sector: a consensus of expert opinions. British Aphasiology Society Biennial International Conference Book of Abstracts, 8-9. Bixley, M., Blagdon, B., Dean, M., Langley, J. & Stanton, D. (2011) In search of consensus on aphasia management. Royal College of Speech and Language Therapists Bulletin, October, 18-20. Intercollegiate Stroke Working Party. (2012) National clinical guideline for stroke, 4th edition. London: Royal College of Physicians. National Institute For Health And Clinical Excellence. (2013) Stroke rehabilitation: 2nd guideline consultation