New Zealand Sites Research Articles

Molecular evidence for stress, inflammation and structural changes in non-specific ulcers in skin of farmed Chinook salmon (Oncorhynchus tshawytscha)

Fish skin is critical to physical defence against pathogens and there is a need to understand the physiological processes impacting ulcers and their healing. Ulcers have been reported in farmed Chinook salmon in New Zealand. This study investigated stress, immune and structural gene expression in farmed Chinook salmon skin with and without ulcers from two sites in New Zealand sampled from February (higher temperature, late summer) to May (lower temperature, late autumn). Skin samples taken adjacent to non-specific ulcers in May and control fish in February demonstrated upregulation of heat shock protein 70 relative to control fish in May. Anterior gradient 2 expression was upregulated in fish with ulcers relative to control fish (both February and May), suggesting increased mucous cell activity. Based on the results of this study, fish with non-specific ulcers showed evidence of stress, inflammation, re-epithelisation, and delayed healing near the ulcer site, elucidating the importance of these processes in the pathogenesis of non-specific ulcers in farmed chinook salmon.

Study protocol of a randomised, double-blind, placebo-controlled, two-arm parallel-group, multi-centre phase 3 pivotal trial to investigate the efficacy and safety of recombinant human alkaline phosphatase for treatment of patients with sepsis-associated acute kidney injury

IntroductionSepsis, the leading cause of acute kidney injury (AKI), is associated with a high morbidity and mortality. Alkaline phosphatase (ALP) is an endogenous detoxifying enzyme. A recombinant human ALP compound,...

The clinical features, management and outcomes of lymphoma in pregnancy: A multicentre study by the Australasian Lymphoma Alliance.

Lymphoma in pregnancy (LIP) presents unique clinical, social and ethical challenges; however, the evidence regarding this clinical scenario is limited. We conducted a multicentre retrospective observational study reporting on the features, management, and outcomes of LIP in patients diagnosed between January 2009 and December 2020 at 16 sites in Australia and New Zealand for the first time. We included diagnoses occurring either during pregnancy or within the first 12 months following delivery. A total of 73 patients were included, 41 diagnosed antenatally (AN cohort) and 32 postnatally (PN cohort). The most common diagnoses were Hodgkin lymphoma (HL; 40 patients), diffuse large B-cell lymphoma (DLBCL; 11) and primary mediastinal B-cell lymphoma (PMBCL; six). At a median follow up of 2.37 years, the 2- and 5-year overall survival (OS) for patients with HL were 91% and 82%. For the combined DLBCL and PMBCL group, the 2-year OS was 92%. Standard curative chemotherapy regimens were successfully delivered to 64% of women in the AN cohort; however, counselling regarding future fertility and termination of pregnancy were suboptimal, and a standardised approach to staging lacking. Neonatal outcomes were generally favourable. We present a large multicentre cohort of LIP reflecting contemporary practice and identify areas in need of ongoing research.

Abstract P5-01-07: Recruitment, clinical equipoise, patient acceptance and compliance in the UK-ANZ POSNOC trial

Abstract Background: POSNOC is a UK-ANZ multicentre, non-inferiority, randomised trial comparing systemic therapy alone with systemic therapy plus Axillary Treatment (Axillary radiotherapy or ALND) for women with ≤2 macrometastases at SNB. The primary outcome is axillary recurrence within 5 years. This paper describes screening, recruitment and compliance data. Methods: Sites were requested on a monthly basis to upload screening data and provide reasons for non-recruitment of eligible patients into the trial. Sites entered in the online database whether the patients were compliant with their randomisation allocation. Results: The study opened in July 2014 and completed target recruitment of 1900 women (24% of those screened) in July 2021, at 95 sites in the UK and 20 sites in Australia and New Zealand. The reason for non-enrolment was unknown in 1300 women. Of the remaining 4774 women with known reasons, who were screened but not randomised, the most common reasons for non-recruitment were due to either patients (n=2219, 46.5%) or their clinicians (n=782, 16.4%) favouring axillary treatment, or patients (n=490, 10.3%) or their clinicians (n=170, 3.6%) not wishing to have axillary treatment. Over the course of the study, there was an increase in the proportion of patients wanting axillary treatment and declining the trial (Mean % patients declined 2015 – 17.9%, 2021 – 39.1%). Mean number of participants recruited per site per month was 0.24 (SD 0.18) overall, 0.25 (SD 0.19) in the UK, and 0.19(SD 0.15) in ANZ. The mean was < 0.3 in 79 sites and >0.9 in only one site. Recruitment rate remained consistent throughout the study (mean 25.3 per month) except for during the first 6 months of recruitment (5.7) and during the COVID pandemic Apr-Sep 2020 (7.5). Of 89 (4.8%) participants non-compliant with allocation, n=45 (50.6%) received systemic therapy alone and n=44 (49.4%) received systemic therapy plus axillary treatment. There was no fluctuation in the direction of non-compliance during the study duration. There was increasing uptake of axillary radiotherapy to treat the axilla instead of ALND over the course of the study in patients receiving axillary treatment (Number who had ART of all who had axilla treatment2014-2017 - 248/454 (54.6 %); 2018-2021 – 315/449 (70.2%)). Conclusion: Recruitment and compliance with randomised allocation remained consistent over a seven-year period. POSNOC with in-built radiotherapy QA will provide definitive data on axillary management in patients undergoing mastectomy or BCS with ≤2 macrometastases on SNB. Citation Format: Amit Goyal, Cydney Bruce, Shabina Sadiq, Mickey Lewis, Alan Montgomery, G Bruce Mann, Heath Badger, Kathryn Monson, Valerie Jenkins, Lesley Fallowfield, Malcolm Reed, David Dodwell, Patricia Fairbrother, Tara Homer, Luke Vale, Roeum Butt, Elizabeth Miles, Shelley Dowey, Lucy Matthews, Hugh Jarrett, Juliet Jackson, Arfan Ali. Recruitment, clinical equipoise, patient acceptance and compliance in the UK-ANZ POSNOC trial [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-01-07.

Factors controlling shallow subsurface dissolved reactive phosphorus concentration and loss kinetics from poorly drained saturated grassland soils.

Shallow subsurface pathways dominate dissolved reactive phosphorus (DRP) losses in grassland soils that are: poorly drained, shallow, or have a perched water table in wetter months causing saturation-excess runoff. Saturated conditions can lead to anoxia, which can accelerate phosphorus (P) loss. Two scales of investigation were utilized in this study. First, at the field scale, soil cores were extracted to 2.5m, subdivided and samples extracted using water extractable P (WEP) and sodium-bicarbonate-dithionite extractable P (NaBD-P). Second, at the laboratory scale, detailed incubation studies using field-moist grassland topsoils from sites in Ireland and New Zealand examined the kinetics of WEP under anoxic (WEPanox ) and oxic (WEPox ) conditions with imposed temperature and soil P fertilizer input treatments. Results from soil-core samples showed that redox-sensitive NaBD-P concentrations were depleted where artificial drainage lines were installed (100cm deep), but WEP concentrations available to shallow flow were enriched in topsoil. The laboratory scale incubation experiment investigated the influence of temperature (3vs. 18 °C), anoxia (designed to simulate saturation following a rainfall event), and superphosphate fertilizer (10 to 60kg P ha-1 yr-1 ) on WEP concentrations over 24h in three grassland topsoils (clay, silt, and sandy loam textures). Concentrations increased with fertilizer rate, temperature, and-in two soils-anoxic conditions. This was commensurate with nitrate (NO3 - ) depletion and the reductive dissolution of iron and manganese. The release of P during anoxia was complete within 24h. The results highlighted late winter to spring as the riskiest period for topsoil P losses in shallow subsurface flow due to wet soil conditions, increasing temperatures, and low soil NO3 - concentrations. This knowledge highlights the necessity to consider and refine tests used to assess topsoil P loss risk, where in the landscape P losses are likely, and what strategies can be used to mitigate losses.

Measurements of Mesospheric Water Vapor From 1992 to 2021 at Three Stations From the Network for the Detection of Atmospheric Composition Change

AbstractWe present ground‐based microwave measurements of mesospheric water vapor made by the Water Vapor Millimeter‐wave Spectrometer (WVMS) instruments since the early 1990s from sites in California, Hawaii, and New Zealand. These measurements are compared with coincident measurements from the Halogen Occultation Experiment, the Aura Microwave Limb Sounder, and Sounding of the Atmosphere using Broadband Emission Radiometry; all of which combine to cover the entire time period of the ground‐based measurements. Comparisons are presented both on ∼weekly timescales in order to better identify discontinuities in the relative differences and on annual timescales in order to better study geophysical variations. The WVMS retrievals shown here are available on the Network for the Detection of Atmospheric Composition Change database. The range of WVMS trends and the differences from the satellite trends, with the latter varying over a range of ∼3%/decade, provide an estimate of how accurately it would be possible to determine multidecadal trends using ground‐based microwave instruments in a postsatellite era. This uncertainty is comparable to the trend in mesospheric water vapor that is expected to have occurred since the early 1990s.

Improving outcomes for patients with lymphoma: design and development of the Australian and New Zealand Lymphoma and Related Diseases Registry

BackgroundLymphoma is a malignancy of lymphocytes and lymphoid tissues comprising a heterogeneous group of diseases, with up to 80 entities now described. Lymphoma is the 6th most common cancer in Australia, affecting patients of all ages, with rising incidence rates. With the proliferation of efficacious novel agents, therapeutic strategies are increasingly diverse and survival is improving. There is a clear need for contemporary robust and detailed data on diagnostic, investigational and management strategies for this disease in Australia, New Zealand and worldwide, to inform and benchmark local and international standards of care. Clinical quality registries can provide these data, and support development of strategies to address variations in management, including serving as platforms for clinical trials and other research activities. The Lymphoma and Related Diseases Registry (LaRDR) was developed to capture details of patient demographics, disease characteristics, and management throughout their disease course and therapy and to develop outcome benchmarks nationally and internationally for lymphoma. This report describes the aims, development and implementation of the LaRDR, as well as challenges addressed in the process.MethodsThe LaRDR was established in 2016 as a multicentre, collaborative project at sites across Australia with a secure online database which collects prospective data on patients with a new diagnosis of lymphoma or chronic lymphocytic leukaemia (CLL). LaRDR development required multidisciplinary participation including specialist haematology, information technology, and biostatistical support, as well as secure funding. Here we describe the database development, data entry, ethics approval process, registry governance and support for participating sites and the coordinating centre.ResultsTo date more than 5,300 patients have been enrolled from 28 sites in Australia and New Zealand. Multiple challenges arose during the development, which we describe, along with approaches used to overcome them. Several confirmed international collaborations are now in place, and the registry is providing valuable data for clinicians, researchers, industry and government, including through presentations of results at major national and international conferences.ConclusionChallenges in establishing the LaRDR have been successfully overcome and the registry is now a valuable resource for lymphoma clinicians, researchers, health economists and others in Australia, New Zealand and globally.

How Alternative Education teachers embarked on getting to the heart of young people’s schooling stories

ABSTRACT This article documents the first phase of an Action Research project that examines how teachers can inquire with young people into critical moments across their schooling journey. Each year, approximately 3000 young people aged from 13 years to 16 years are directed to continue their schooling in Alternative Education sites in New Zealand. More than 60% are Māori young people. Most arrive in Alternative Education with just referral documents detailing the negative reasons for exclusion. Teachers are expected to make a fresh start with re-engaging young people in learning, while the stories young people hold closest remain largely unspoken. Six teachers volunteered to plan inquiries that give voice to students’ schooling experiences. The findings from this research should inspire a shift in schooling practices, particularly for those who are marginalised. Data from the first phase revealed that the teachers’ critically informed outlooks, their considered responses to the complexity of lived experience, and finding cultural reference points were all central to formulating their inquiry. Moreover, the teachers embraced Action Research as a professional learning opportunity. In turn, these approaches closely reflect a philosophy of pedagogy found in Alternative Education that make for potentially messy but, nevertheless, liberating inquiries.

Continuous measures of confidence in direction of environmental trends at site and other spatial scales

Managers and decision makers need to know if variables measured by environmental monitoring programs are increasing or decreasing, both at individual sites and at larger spatial scales, and the degree of statistical support for these assessments. Traditionally, null hypothesis significance testing (NHST) has been used to evaluate whether an assessed trend is a reliable estimate of the true (i.e., population) trend but has two shortcomings. First, failure to achieve “statistical significance” is often falsely interpreted as evidence that there was no trend. Second, the acceptable Type 1 error risk tends to be chosen arbitrarily and without consideration of the risk of failing to identify important trends. As an alternative to NHST, we propose a continuous measure of confidence in the direction of an individual site trend based on the posterior probability distribution. Confidence that the trend direction is correctly inferred (i.e., that the assessed trend direction has the same sign as the population value) is expressed as a probability. The approach is extended to assessing confidence in the direction of aggregate trends (i.e., trends observed over multiple sites representing a spatial domain such as a geographic region). The aggregate trend assessment accounts for the confidence in the individual site trends and spatial correlation in the observations, which reduces the effective size of the dataset. The approach is demonstrated for site and aggregate river water quality trends for 352 sites in New Zealand. Compact graphical reporting of the results indicated appreciable variation in trend direction between sites for all variables, as well as patterns in trend direction at larger spatial scales. The new method provides decision makers with a more complete description of the statistical support for the assessment of trend direction than an arbitrary “significant/not significant” designation associated with NHST.

Multistep optimization of HyPix model for flexible vertical scaling of soil hydraulic parameters

Efficient simulation of water-flow processes in the vadose zone is crucial to increase agricultural productivity within environmental limits. This requires deriving detailed soil hydraulic parameters of the soil profile that is highly challenging, particularly for heterogeneous soils. We therefore developed an alternative indirect methodology to calibrate the hydraulic parameters from soil water content time series measured at multiple depths by using the new physically based hydrological model HyPix.We propose a novel, efficient, multistep optimization algorithm for layered soils that derives an optimal set of hydraulic parameters for a desired number of soil layers. For each selected soil layer, HyPix derives five physical, bimodal, Kosugi hydraulic parameters that describe the soil water retention and hydraulic conductivity by using a novel algorithm that reduces the degree of sensitivity and freedom of the parameters. The optimization algorithm upscales the soil hydraulic parameters by gradually incorporating the soil heterogeneity. This method overcomes the problems associated with optimization of the hydraulic parameters of each layer individually, which leads to poor results because it does not represent the cohesive soil water dynamics across the unsaturated zone.We tested the method using soil water content measurements at different depths at five heterogeneous experimental sites in New Zealand. We show how the accuracy of the simulated water balance components increases with the number of soil layers. The multistep optimization upscales a detailed, layered profile of soil hydraulic parameters into a model with fewer layers. The methodology developed provides an estimate of the uncertainty of using a reduced number of soil layers. We also show that a pedological description can provide an indication of the minimum soil layers of vertical discretization required to accurately compute the soil water balance components.

Grapevine Leafroll-Associated Virus 3 Genotype Influences Foliar Symptom Development in New Zealand Vineyards.

Grapevine leafroll disease (GLD) constrains wine production worldwide. In New Zealand, the main causal agent of GLD is grapevine leafroll-associated virus 3 (GLRaV-3). To control GLD, an integrated management program is used and includes removing (roguing) GLRaV-3-infected vines from the vineyard. The classical foliar symptoms from virus-infected red-berry cultivars are leaves with dark red intervein, green veins, and downward rolling of margins. Growers use these phenotypic cues to undertake visual symptom identification (VSI) for GLD. However, the influence of the known large genetic variation among GLRaV-3 isolates on the foliar symptoms from different grapevine cultivars remains undescribed, especially in cool-climate growing environments, such as New Zealand. Over three vintages (2015, 2016, and 2017), VSI for GLD was undertaken at three field sites in New Zealand (Auckland, Hawke’s Bay, and Marlborough), each including four cultivars (Merlot, Pinot noir, Sauvignon blanc, and Pinot gris) infected with three GLRaV-3 genotypes (Groups I, VI, and X) or GLRaV-3-uninfected control plants. Throughout this study, no visual symptoms were observed on white-berry cultivars infected with GLRaV-3. For red-berry cultivars, the greatest variability in observed foliar symptoms among regional study sites, cultivars, and GLRaV-3 genotypes was observed early in the growing season. In particular, Group X had significantly delayed symptom expression across all three sites compared with Groups I and VI. As the newly infected, young vines matured in years 2 and 3, the GLRaV-3 genotype, cultivar, region, and environmental conditions had minimal influence on the accuracy of VSI, with consistently high (>95%) within-vintage identification by the end of each vintage. The results from this study strongly support the use of VSI for the GLD management of red-berry cultivar grapevines, Merlot and Pinot noir, as a reliable and cost-effective tool against GLD.

SPAR: A randomized placebo-controlled phase 2 trial of simvastatin in addition to standard chemotherapy and radiation in preoperative treatment for rectal cancer: An AGITG clinical trial.

TPS3646 Background: In retrospective studies statin use during preoperative chemo-radiation (pCRT) for rectal cancer is associated with improved overall survival, pathological tumor response and treatment toxicity. In vivo preclinical studies show that statins radiosensitize cancer cells, with improved tumor control and reduced radiation-induced gastrointestinal (GI) and skin toxicities. A prospective randomized trial is justified to confirm these clinically important benefits. Tumor regression following pCRT has strong prognostic significance, as assessed radiologically (MRI-based tumor regression grading [mrTRG]) prior to, or pathologically (pathTRG) following, surgery. Using mrTRG after each treatment phase in total neoadjuvant therapy (TNT) programs could assess incremental tumor regression and optimize patient management including surgery. Methods: Design: This double-blind phase 2 trial is recruiting 222 patients planned to receive long-course fluoropyrimidine-based pCRT for rectal adenocarcinoma at 17 sites in New Zealand and Australia. Patients are randomized to simvastatin 40mg or placebo daily for 90 days, starting 1 week prior to pCRT, with minimization for major prognostic variables. Pelvic MRI at baseline and 6-8 weeks after pCRT will assess mrTRG. A protocol amendment allows TNT using consolidation chemotherapy after pCRT; MRI timing is unchanged. Primary objective: comparison of rates of grades 1-2 mrTRG following pCRT with simvastatin or placebo, considering mrTRG in 4 ordered categories (1, 2, 3, 4-5). Secondary objectives: comparison of rates of grades 1-2 pathTRG in resected tumors; incidence of > grade 2 acute GI and non-GI adverse events (AE); incidence of late GI AE; compliance with intended pCRT and trial medication; proportion of patients undergoing surgical resection post-pCRT; 3-year local recurrence rate, disease-free and cancer-specific survival; and pathological scores for radiation colitis. Tertiary and correlative objectives: association between mrTRG and pathTRG grouping; inter-observer scoring agreement on mrTRG and pathTRG; comparison of the association between tumor CD3+ and/or CD8+ T-cell infiltrates in diagnostic biopsies and pathTRG; intensity and distribution of subsets of infiltrating T-cells in irradiated resected normal and malignant tissue; and the effect of simvastatin on markers of systemic inflammation (modified Glasgow prognostic score and the neutrophil-lymphocyte ratio). Eligibility criteria exclude statin use within 6 weeks prior to trial entry, patients intolerant of statins, and planned use of oxaliplatin or biological agents during pCRT. Trial recruitment commenced April 2018 and 95 of 222 patients have been recruited as at 21 January 2022. Clinical trial information: ACTRN12617001087347.

Three-year chronic follow-up from the pilot study of a substernal extravascular implantable cardioverter defibrillator

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Medtronic Background The investigational Extravascular Implantable Cardioverter-Defibrillator (EV ICD) uses a substernal lead and delivers defibrillation and pacing therapies, including antitachycardia pacing (ATP). Objective To characterize EV ICD system performance through 3 years. Methods The prospective, first-in-human EV ICD Pilot study was conducted at 4 sites in Australia and New Zealand. ICD-indicated patients were enrolled July-December of 2018. Defibrillation testing was conducted for all patients at implant, and chronically per physician discretion. Electrical testing was conducted at pre-hospital discharge, 2 weeks, 4-6 weeks and 3 months post-implant, and every 6 months thereafter. Posture effects on pacing and sensing were evaluated through 3 months. Results Of 26 patients enrolled, 21 underwent the EV ICD implant procedure. There were no intraprocedural complications. After successful implantation and testing, 17 of 21 patients entered chronic follow-up. 14 patients continue follow up, representing 523 patient-months. Eight elective chronic defibrillation tests converted 7 of 7 patients with ≤ 40 J (maximum energy). Five episodes of spontaneous ventricular tachycardia (VT) were detected in 1 patient and either self-terminated or successfully defibrillated with appropriate shock. Over the total course of follow-up, 3 patients received an inappropriate shock due to; lead tip displacement with subsequent P-wave oversensing; Electromagnetic interference (EMI) in a ungrounded hot-tub; and EMI while doing plumbing work on unearthed electrical pipes, resulting in an annualized inappropriate shock rate of 6.9%. Pacing capture thresholds remained stable across time (5.1 ± 2.0 V at implant and 5.5 ± 2.7 V at 3 years); similarly, R-wave amplitudes were stable across time (3.4 ±2.0 mV at implant and 4.2 ± 2.7 mV at 3 years). Pacing thresholds tended to be lowest with the patient lying on the right side and pacing threshold often increased relative to supine position for left-side, prone or bending postures. R-wave amplitude tended to be greater when bending forward. There were 10 system or procedure-related adverse events in 8 patients through 3 years, including 3 elective system removals for: a single inappropriate shock (1), chronic defibrillation testing showing no safety margin in a patient with arrhythmogenic right ventricular dysplasia (1), intolerance to ATP (1 - high pacing threshold and frequent VT). Other than the lead tip displacement within the first 3 months, no additional clinically significant lead displacements have been observed through 3 years. Conclusion The EV ICD is a novel platform for delivering high-voltage therapy. There were no procedure and system related complications observed after the first year post-implant. Lead position and chronic system performance have generally remained stable through 3 years with a low rate of adverse events.

Inferring parental areas of juvenile mussels using hydrodynamic modelling

Mussel aquaculture is heavily reliant on wild mussel populations that supply juveniles (spat) for seeding farms. However, little is often known about parent populations, representing a risk for the sustainability of the industry. We used hydrodynamic back-tracking models to identify potential parental areas that provision green-lipped mussel (Perna canaliculus) spat across a range of settlement sites in New Zealand's largest aquaculture area. Median parental area varied considerably between 19 km2 for sites located in enclosed bays and a maximum of >1150 km2 for sites located in open bays. Median distance to parent populations ranged between 1.8 and 21.4 km, with a maximum larval dispersal estimated to be ca. 100 km. Small seasonal variations in parental area and dispersal distance were detected in some regions, whereas inter-annual variability was relatively minor. Regional connectivity between settlement and parental regions ranged between a minimum of 45% of larvae originating in the same parental region, to maximum retention rates of 99.9% for sites in enclosed bays, implying a considerable regional variation in the potential for self-seeding and exporting mussel larvae other areas. Our results also delineate areas that support spatfall by identifying likely locations for wild or farmed parental populations, and by establishing the spatial extent where mussel reproduction and larval development through to settlement take place. These dispersal and connectivity patterns are crucial to support management decisions for the conservation and restoration of parental populations, and other environmental constraints, such as water quality, which are necessary to ensure the sustainability of spat catching operations that enable shellfish farming.

Evaluating the procedural validity of the multilingual computer assisted self interview (MultiCASI) in a refugee population

Multimedia-based administration of questionnaires, presenting items both in writing and spoken word, offers numerous potential benefits in transcultural psychiatry, such as improved comprehension of each question, ease of administration, prevention of missing or arbitrary responses, and obviating subsequent data entry. The concept has become known as “Computer-Assisted Self Interviewing” (CASI), and while preliminary results are promising, previous studies have not directly compared CASI to paper-and-pen administration in a large and representative sample of refugees. The aim of this study was to evaluate the procedural validity of multilingual CASI in comparison to paper-based-administration. The Hopkins Symptom Checklist-25 anxiety and depression subscales were administered in both modalities with a total of N = 281 participants from sites in Australia, New Zealand, and Denmark. We evaluated potential deviations in both the raw item and scale scores in each modality, while psychometric properties of each subscale were compared for an Arabic-speaking subsample (n = 125). Results showed no significant differences between raw item- or scale score across the two modalities, nor between the level of construct validity. In conclusion, this study supports a wider adaptation of multilingual CASI in the context of transcultural psychiatry, both for purposes of screening and treatment evaluation.

Evaluation of Multiscale SMAP Soil Moisture Products in Forested Environments

Quantifying the availability of soil moisture in forested environments has many implications for their ecosystem, and therefore the ability to map its dynamics accurately becomes important. Remote sensing offers the only viable strategy for cost-effective, global measurements of soil moisture and the launch of satellites with L-band microwave sensors such as the Soil Moisture Active Passive (SMAP) has extended those capabilities to forested areas. A number of retrieval algorithms have been developed by the SMAP mission that have generated multi-scale data products at 9 km, 3 and 1 km with the two finer-scale datasets derived by combining SMAP and Sentinel-1 C-band observations. In this study, we evaluated the ability of the three SMAP products to estimate the magnitude and dynamics of soil moisture in a relatively challenging environment of dense forest cover and topographic complexity using ground measurements from seven sites in New Zealand. We found that the finer-scale products had an overall smaller error and higher correlations when compared with the ground measurements, but did exhibit noise especially as canopy closure increased. On the other hand, the 9-km product had larger errors but was still able to capture the temporal dynamics of soil moisture. Our results are consistent with recent studies evaluating SMAP in forested environments, and the improved performance of the finer-scale products suggests a pathway towards accurate estimates of forested soil moisture using multi-scale data fusion.

Spatial variation of perfusion MRI reflects cognitive decline in mild cognitive impairment and early dementia

Cerebral blood flow (CBF) measured with arterial spin labelling (ASL) magnetic resonance imaging (MRI) reflects cerebral perfusion, related to metabolism, and arterial transit time (ATT), related to vascular health. Our aim was to investigate the spatial coefficient of variation (sCoV) of CBF maps as a surrogate for ATT, in volunteers meeting criteria for subjective cognitive decline (SCD), amnestic mild cognitive impairment (MCI) and probable Alzheimer’s dementia (AD). Whole-brain pseudo continuous ASL MRI was performed at 3 T in 122 participants (controls = 20, SCD = 44, MCI = 45 and AD = 13) across three sites in New Zealand. From CBF maps that included all grey matter, sCoV progressively increased across each group with increased cognitive deficit. A similar overall trend was found when examining sCoV solely in the temporal lobe. We conclude that sCoV, a simple to compute imaging metric derived from ASL MRI, is sensitive to varying degrees of cognitive changes and supports the view that vascular health contributes to cognitive decline associated with Alzheimer’s disease.

Abstract 13966: Chronic ICD Lead Removal From the Substernal Space is Feasible Without Complication

Introduction: The transvenous ICD is the device standard for treatment of ventricular arrhythmias, but ICD lead extraction from the heart and vasculature has morbidity and mortality concerns. The extravascular ICD (EV ICD) with lead placement in the anterior mediastinum (substernal space) is in development as an alternative to transvenous ICD. Described is the first reported substernal lead removal experience from humans. Hypothesis: The anterior mediastinum, a soft tissue space absent major vascular elements, provides a suitable environment for chronic lead removal without complication. Methods: The first-in-human EV ICD pilot study was a prospective study conducted at 4 sites in Australia and New Zealand. Subjects with a class I or IIa indication for single-chamber ICD were implanted via minimally invasive technique, with the distal end of the lead placed substernally via an incision near the xiphoid, and the proximal end tunneled subcutaneously to a left midaxillary device. Results: A total of 21 patients underwent the EV ICD procedure, and 17 entered chronic follow-up after successful implant and testing. Among these 17 patients, 3 were electively explanted at 85, 114 and 310 days post-implant. Respectively, the first patient experienced a lead tip displacement resulting in P-wave oversensing and inappropriate shock; the second underwent elective chronic defibrillation testing 3 months post-implant, where a 10-Joule safety margin was not established; and the third experienced recurrent VT and intolerance to ATP due to high pacing threshold. Lead removals were conducted per HRS guidelines. The proximal end of the lead was removed from the device pocket to the xiphoid incision, with minor resistance noted in pulling the lead connector through the subcutaneous tunnel. Light traction was sufficient to remove the distal end of the lead from the substernal space, with minor tissue adhesions observed near the lead incision site. All leads were removed intact, and there were no adverse events associated with system removal. Conclusions: ICD lead removal from the substernal space is feasible through 310 days without adverse events. Further understanding from a larger patient population with greater implant duration will help verify these early results.

NP-108: Improvement in patient experience with successful implementation of a Velcade at Home program in patients with myeloma

<h3>Background</h3> Traditionally subcutaneous Velcade is delivered in a day ward environment. To reduce hospital visits for our patients, we introduced a Velcade at Home program (VAH) consisting of two arms; self-injection and general practitioner (GP) delivery. Here we present data on the patient experience outcomes. <h3>Methods</h3> A Self-Injection Assessment Questionnaire was developed for both GP and self-injection arms, adapted from a previously validated tool (1). The questionnaire elicited respondents' feelings about GP administration or self-injection using a Likert scale format with free text questions used to evaluate time and cost burden. The questionnaire was completed each week during the first cycle in the chemotherapy day unit, prior to cycle 3 (after one full cycle in the community) and at the end of cycle 4. All data were analysed using descriptive statistics. <h3>Results</h3> The first 20 patients enrolled onto the VAH Program were consented to the study, with 19 completing the program (15 self-injection, 4 GP). In the self-injection arm 46% (7/15) of patients felt anxious prior to their first dose, this decreased to 0/15 by the end of cycle 4. No participants had difficulty removing the cap, depressing the plunger or administering the injection after their first cycle of training. The time reported to complete the injection was shorter for the self-injection arm when compared to their previous injections at hospital (mean 6 minutes and 280 minutes respectively). Similarly, patients in the self-injection arm reported a reduction in the cost burden associated with attending hospital. Of those who responded, 5/7 reported no costs associated with VAH. <h3>Conclusion</h3> The VAH program has been very well received with patients appreciating the opportunity to regain some control over their treatment and the potential for significant benefit in time and costs. We have been able to share our resources with 7 sites in Australia and New Zealand to help in the implementation of a similar program

Effect of climate variability on water quality trends in New Zealand rivers

Associations between temporal variability in 10 water quality variables and the El Niño–Southern Oscillation (ENSO) climate pattern, quantified by the Southern Oscillation Index (SOI), were assessed at 56 river sites in New Zealand over a 31-year period (1989–2019). Fluctuations in monthly observations of water quality at each site were correlated to varying degrees with the corresponding SOI value (ro). Trends for rolling windows of 5-, 10- and 15-year duration were evaluated for each site and variable using Kendall’s tau (τw) and for the SOI using linear regression (δSOIw). Aggregate trends for each variable, duration and time window were quantified as proportions of site trends that were increasing (Pw). Fluctuations in τw and Pw between time windows for all durations were explained by the corresponding SOI trend (δSOIw). Between-site and between-variable differences in the trend responses to the SOI trends were explained by the corresponding ro values and the median of the ro values (MF21087_IE1.gif) respectively. These results indicate that climate variability makes a significant contribution to water quality trends, even at timescales longer than ENSO cycles. Our models can be used to quantify this contribution for individual sites (i.e. τw) and for aggregate trends (i.e. Pw).