Southwest UK Research Articles

Assessment of bisphenol-A in the urban water cycle

The plasticizer bisphenol-A (BPA) is common to municipal wastewaters and can exert toxicity to exposed organisms in the environment. Here BPA concentration at 5 sewage treatment works (STW) and distribution throughout a river catchment in South West UK were investigated. Sampling sites included influent and effluent wastewater (n = 5), river water (n = 7) and digested sludge (n = 2) which were monitored for 7 consecutive days. Findings revealed average BPA loads in influent wastewater at two STWs were 10–37 times greater than the other wastewaters monitored. Concentrations up to ~100 μg L−1 were measured considerably higher than previously reported for municipal wastewaters. Temporal variability throughout the week (i.e., highest concentrations during weekdays) suggests these high concentrations are linked with industrial activity. Despite ≥90% removal during wastewater treatment, notable concentrations remained in tested effluent (62–892 ng L−1). However, minimal impact on BPA concentrations in river water was observed for any of the effluents. The maximum BPA concentration found in river water was 117 ng L−1 which is considerably lower than the current predicted no effect concentration of 1.6 μg L−1. Nevertheless, analysis of digested sludge from sites which received these elevated BPA levels revealed average concentrations of 4.6 ± 0.3 and 38.7 ± 5.4 μg g−1. These sludge BPA concentrations are considerably greater than previously reported and are attributed to the high BPA loading in influent wastewater. A typical sludge application regime to agricultural land would result in a predicted BPA concentration of 297 ng g−1 in soil. Further studies are needed on the toxicological thresholds of exposed terrestrial organisms in amended soils to better assess the environmental risk here.

The invasive alien plant, Impatiens glandulifera (Himalayan Balsam), and increased soil erosion: causation or association? Case studies from a river system in Switzerland and the UK

A monitoring investigation undertaken along the River Ibach, northwest Switzerland over the winter 2012/2013, found that riparian areas recently supporting the invasive plant Himalayan Balsam (HB) recorded significantly higher erosion rates than nearby uninvaded areas. This communication sythesises the latest findings about the influence of HB on sedimentation processes, again, from the Ibach, but also from a second river system in southwest UK. Erosion pins, a micro-profile bridge and a digital caliper were used to measure changes in soil surface profile (SSP) at selected riparian areas supporting HB plants along both rivers. Values were statistically compared against equivalent data recorded from nearby reference areas supporting mixed perennial vegetation. A comparison of source and sediment geochemistry was also undertaken on soil from HB-invaded and uninvaded floodplain areas along the Ibach, to assess the potential for identifying the extent to which either group acts as a sediment source. Erosion pin data indicate that soil loss from HB-colonised areas was significantly greater than soil loss from reference areas in two out of the four periods at the River Ibach site, and in two out of three measurement periods at the River Taw site. Colonisation of new HB sites may initially occur by hydrochorous processes, but HB plants may increase colonisation potential by trapping additional fine sediment and organic matter, including viable HB seeds. Geochemical results from the Ibach suggest that high inputs of suspended sediment originate from sources close to the river channel, but HB-invaded floodplain sources have geochemical properties that are most similar to suspended river sediment. The findings from both rivers led us to rethink our original hypothesis; that HB promotes soil erosion, to an amended hypothesis in which HB may be associated with areas where high erosion is sometimes recorded. Whilst initial colonisation may be due to hydrochorous processes, as HB becomes increasingly established, the displacement of perennial vegetation increases the risk of erosion during the winter period when live HB plants are absent. Preliminary geochemical findings of floodplain soils supporting different vegetation types along the Ibach tentatively suggest that at least some material originating from HB sites may enter the watercourse.

Changes in the geographical distribution of plant species and climatic variables on the West Cornwall peninsula (South West UK).

Recent climate change has had a major impact on biodiversity and has altered the geographical distribution of vascular plant species. This trend is visible globally; however, more local and regional scale research is needed to improve understanding of the patterns of change and to develop appropriate conservation strategies that can minimise cultural, health, and economic losses at finer scales. Here we describe a method to manually geo-reference botanical records from a historical herbarium to track changes in the geographical distributions of plant species in West Cornwall (South West England) using both historical (pre-1900) and contemporary (post-1900) distribution records. We also assess the use of Ellenberg and climate indicator values as markers of responses to climate and environmental change. Using these techniques we detect a loss in 19 plant species, with 6 species losing more than 50% of their previous range. Statistical analysis showed that Ellenberg (light, moisture, nitrogen) and climate indicator values (mean January temperature, mean July temperature and mean precipitation) could be used as environmental change indicators. Significantly higher percentages of area lost were detected in species with lower January temperatures, July temperatures, light, and nitrogen values, as well as higher annual precipitation and moisture values. This study highlights the importance of historical records in examining the changes in plant species’ geographical distributions. We present a method for manual geo-referencing of such records, and demonstrate how using Ellenberg and climate indicator values as environmental and climate change indicators can contribute towards directing appropriate conservation strategies.

Comparison between scarp and dip-slope rivers of the Cotswold Hills, UK

The Cotswold Hills, southwest UK, are properly described as a cuesta, with a steep, west-facing scarp slope and a plateau-like dip slope. Drainage reflects this surface morphology, with most rivers flowing southeast along topographic and stratigraphic dip. Here, we compare two superficially highly similar rivers – the Frome and Churn – whose sources are nearly coincident, but whose behaviour dramatically diverges thereafter. We examine longitudinal profiles, channel steepness, predicted discharge, and valley shapes, using digital topographic data. River discharge and water hardness/temperature values were obtained at seven sites on the Churn and nine on the Frome over a two-year sampling campaign, delineated into summer and winter phases. Nearly 100 borehole records were interrogated from the two catchments in order to assess groundwater level variations. The Frome, flowing west against regional dips, develops a steep course and has carved a deep and wide valley that exposes the full sequence of Cotswold Jurassic stratigraphy. On the other hand, discharge and channel gradients are lower for the dip-slope Churn, whose valley exposes less stratigraphy and fewer springs. Our measurements of river water hardness and temperature suggest that a greater proportion of groundwater flows into the Frome, regulating discharge and maintaining baseflow over summer. We suggest that flank uplift of the Cotswolds is at least part of the reason for the higher incision rates of the River Frome, leading to its intersecting a greater number of highly transmissive fractures that contribute to its discharge. In turn, the increased discharge could positively impact local incision rates.

Employing participatory methods to engage an under-researched group: Opportunities and challenges

In this article, we report on our experience of working on an exploratory project where the primary objective was to involve homeless service users with food-based participatory qualitative approaches. The project FLM aimed to explore food experiences and behaviours in a sample of users of homelessness services in a south west UK coastal city, in order to create solutions to improve their wellbeing. A mixture of qualitative methods was used, including observations, photo-elicitation and focus group discussions. We aimed to be participatory and ‘creative’ in our approach and in our analysis. Here, we focus on detailing and critiquing our approach to the collection and analysis of data.

Environmental and ecological factors influencing the spillover of the non-native kelp, Undaria pinnatifida, from marinas into natural rocky reef communities

The non-native kelp, Undaria pinnatifida, is considered one of the world’s worst invasive species. The northeast Atlantic is a hotspot of Undaria invasion, yet there is limited knowledge on its invasion dynamics. In the UK its distribution is strongly associated with artificial structures, primarily marina and harbour pontoons, with relatively few records of Undaria on natural substrates. Here, the southwest UK is used as a case region, to explicitly link Undaria distribution-abundance patterns in artificial marina habitats with those in natural rocky reef habitats. Using a mixture of in situ recording and video survey techniques, Undaria was found at all thirteen marina sites surveyed; but in only 17 of 35 rocky reef sites, all of which were in 2 of the 5 larger systems surveyed (Plymouth Sound and Torbay). The distribution-abundance patterns of Undaria at reef sites were analysed using zero-inflated models. The probability of finding Undaria on rocky reef increased with increasing proximity to marinas with high abundances of Undaria. Total propagule pressure from marinas also increased the probability of occurrence, and was positively related to Undaria abundance and cover at reef sites. Increases in the cover of native kelps, Laminaria spp., and wave exposure at reef sites were linked to a reduced probability of Undaria occurrence, and lower abundance and cover. Identifying high risk areas, natural boundaries and factors affecting the spread and abundance of non-native species in natural habitats is key to future management prioritisation. Where Undaria is confined to artificial substrates management may be deemed a low priority. However, the results of this study suggest that controlling the abundance and propagule pressure in artificial habitats may limit, to some extent, the spillover of Undaria into natural rocky reef habitats, where it has the potential to interact with and influence native communities.

Towards a marine biorefinery through the hydrothermal liquefaction of macroalgae native to the United Kingdom

Hydrothermal liquefaction (HTL) is a promising biomass conversion method that can be incorporated into a biorefinery paradigm for simultaneous production of fuels, aqueous fertilisers and potential remediation of municipal or mariculture effluents. HTL of aquatic crops, such as marine macro- or microalgae, has significant potential for the UK owing to its extensive coastline. As such, macroalgae present a particularly promising feedstock for future UK biofuel production. This study aimed to bridge the gaps between previous accounts of macroalgal HTL by carrying out a more comprehensive screen of a number of species from all three major macroalgae classes, and examining the correlations between biomass biochemical composition and HTL reactivity. HTL was used to process thirteen South West UK macroalgae species from all three major classes (Chlorophyceae, Heterokontophyceae and Rhodophyceae) to produce bio-crude oil, a bio-char, gas and aqueous phase products. Chlorophyceae of the genus Ulva generated the highest bio-crude yields (up to 29.9% for U. lactuca). Aqueous phase phosphate concentrations of up to 236 mg L−1 were observed, obtained from the Rhodophyta, S. chordalis. Across the 13 samples, a correlation between increasing biomass lipids and increasing bio-crude yield was observed, as well as an increase in biomass nitrogen generally contributing to bio-crude nitrogen content. A broader range of macroalgae species has been examined than in any study previously and, by processing using identical conditions across all feedstocks, has enabled a more cohesive assessment of the effects of biochemical composition.

Changing places: the Armed Forces, post-military space and urban change in Plymouth, UK

ABSTRACTThis article considers how militarism and post-militarism impact upon places and the people who live in them. The article focuses on Plymouth in Devon, south-west UK, examining how geopolitics and militarism have contributed to change in a ‘garrison town’.

The land management tool: Developing a climate service in Southwest UK

Seasonal climate forecasts (SCFs) have significant potential to support shorter-term agricultural decisions and longer-term climate adaptation plans, but uptake in Europe has to date been low. Under the European Union funded project, European Provision Of Regional Impacts Assessments on Seasonal and Decadal Timescales (EUPORIAS) we have developed the Land Management Tool (LMTool), a prototype seasonal climate service for land managers, working closely in collaboration with two stakeholder organizations, Clinton Devon Estates (CDE) and the National Farmers Union (NFU). LMTool was one of several prototype climate services selected for development within EUPORIAS, including those for the UK transport network, food security in Ethiopia, renewable energy production, hydroelectric energy production in Sweden, and river management in two French basins. The LMTool provides SCFs (1–3months ahead) to farmers in the Southwest UK, alongside 14-day site specific weather forecasts during the winter months when the skill of seasonal forecasts is greatest.We describe the processes through which the LMTool was co-designed and developed with the farmers, its technical development and key features; critically examine the lessons learned and their implications for providing future climate services for land managers; and finally assess the feasibility of delivering an operational winter seasonal climate service for UK land managers.A number of key learning points from developing the prototype may benefit future work in climate services for the land management and agriculture sector; many of these points are also valid for climate services in other sectors. Prototype development strongly benefitted from; working with intermediaries to identify representative, engaged land managers; an iterative and flexible process of co-design with the farmer group; and from an interdisciplinary project team. Further work is needed to develop a better understanding of the role of forecast skill in land management decision making, the potential benefits of downscaling and how seasonal forecasts can help support land managers decision-making processes. The prototype would require considerable work to implement a robust operational forecast system, and a longer period to demonstrate the value of the services provided. Finally, the potential for such services to be applied more widely in Europe is not well understood and would require further stakeholder engagement and forecast development.

Exploring residents\u2019 experiences of mealtimes in care homes: A qualitative interview study

BackgroundMany interventions aim to alleviate well-documented problems of malnutrition in residential care homes and improve residents’ health and wellbeing. Despite some positive findings, little is known about how and why mealtime interventions might be effective, and in particular, what effects residents’ experiences of mealtimes have on health outcomes. The aim of this study was to gain an insight into these experiences and explore some of the issues that may impact on residents’ enjoyment of meals, and resulting health and wellbeing.MethodsSemi-structured interviews were conducted with eleven residents from four care homes in the South West UK. Thematic analysis was used to derive content and meaning from transcribed interviews. Interviews were supplemented by researcher observations of mealtimes.ResultsThe dining experience was a focal point for participants’ broader experiences of residing in a care home. Three themes pertaining to residents’ experiences were identified: (1) Emotional and psychological connections with other residents; (2) managing competing interests with limited resources; and (3) familiarity and routine.ConclusionMealtimes are a mainstay of life in a care home through which residents’ experiences are characterised, exemplified and magnified. Understanding how residents interact with one another, accommodating their preferences and encouraging autonomy may enhance their mealtime experiences. It may also help to ease the transition from independent-living to life in care, which can be particularly stressful for some residents, and improve health and wellbeing over the long-term.

Assessing the usability and potential value of seasonal climate forecasts in land management decisions in the southwest UK: challenges and reflections

Abstract. The potential usability and benefits of seasonal climate forecasts (SCF) to help inform decision-making processes is widely accepted. However, the practical use of SCF in Europe is still fairly recent and, as such, current knowledge of the added benefits of SCF in supporting and improving decision-making is limited. This study is based on research conducted to co-develop a semi-operational climate service prototype – the Land Management Tool (LMTool) – with farmers in South West regions of the UK. The value of the SCF provided to the farmers was examined to help us understand the usability and (potential) value of these forecasts in farmers' decisions during the winter months of 2015/2016. The findings from the study point to the need to explore and develop (new) research methods capable of addressing the complexity of the decision-making processes, such as those in the farming sector. The farmers who used the SCF perceived it as useful and usable as it helped them change and adapt their decision-making and thus, avoid unnecessary costs. However, to fully grasp the potential value of using SCF, farmers emphasised the need for the provision of SCF for longer periods of time to allow them to build trust and confidence in the information provided. This paper contributes to ongoing discussions about how to assess the use and value of SCF in decision-making processes in a meaningful and effective way.

Zero suicide southwest UK initiative – Steps to mitigate suicide risk in local populations using quality improvement methodology and a whole life approach

BackgroundOnly 25% of people who die by suicide see mental health services. Suicide is not just a health issue. Its causation and consequences lie within all of society. Many erroneously believe that suicide is inevitable and not preventable, because its causation is too complex. Underlying associations with suicide are largely social. There are programmes in the USA, which have combined interventions to reduce suicides. The 2014 UK suicide rate per 100,000 was 10.8 but 11.1 in South West (SW) England (pop: 5 million). A whole system approach is necessary. Zero Suicides SW is a project to address this.Aim(1) To develop a regional strategy to reduce and prevent suicide. (2) To make whole populations suicide risk aware. (3) Reduce regional suicide rates.MethodA collaborative involving national and local 60 organisations including charities and voluntary sector was formed. Five collaborative meetings used narratives of suicide survivors, national experts led themed workshops, etc. to come up with a regional strategy. Quality Improvement (QI) Methodology was used to develop and examine the success of all projects.OutputsInitiatives such as using local radio stations for mental health promotion, collaboration via a poster campaign with local breweries and pubs to make men more self-aware of risk, suicide risk counselling for relatives/carers of patients admitted to psychiatric care, improving scrutiny to access to medication for recently discharged psychiatric patients have developed from the project. The QI model demonstrated how localised changes at person and organisation level could combine and have a powerful role in suicide prevention.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Spatio-temporal variation in wave power and implications for electricity supply

Wave energy resources are intermittent and variable over both spatial and temporal scales. This is of concern when considering the supply of power to the electricity grid. This paper investigates whether deploying arrays of devices across multiple spatially separated sites can reduce intermittency of supply and step changes in generated power, thereby smoothing the contribution of wave energy to power supply. The primary focus is on the southwest UK; SWAN wave model hindcast data are analysed to assess the correlation of the resource across multiple sites and the variability of power levels with wave directionality. Power matrices are used to calculate step changes in the generated power with increasing numbers of sites. This is extended to national and European scales using ECMWF hindcast data to analyse the impacts of generating power at multiple sites over wider areas. Results show that at all scales the step change in generated power and the percentage of time with zero generation decreases with increasing numbers of sites before plateauing. This has positive implications for performance of electricity grids with high levels of renewable penetration.

Molecular identification and distribution of leatherjackets (Diptera: Tipulidae) in U.K. agricultural grassland

Abstract DNA barcoding is useful for the identification of morphologically cryptic invertebrates. An important application is for pest species, for which it is critical to determine the distribution, biology and ecology of damaging life stages in order to target management effectively. Tipula paludosa (Meigen) and Tipula oleracea (Linnaeus) leatherjackets, the larvae of crane flies (Diptera: Tipulidae), are pests of agricultural grassland in Europe and the U.S.A. and are difficult to distinguish morphologically. We used cytochrome c oxidase subunit I (COI) barcoding to identify leatherjackets from 19 permanent grassland fields over 2 sampling seasons on the Rothamsted Research North Wyke Farm Platform, south west UK, to assess species-level distribution and genetic diversity. Most larvae (94%) were found to be T. paludosa, comprising 18 haplotypes that were spread across the sampling site in a panmictic population. However, T. oleracea were found in low abundance (3% of larval samples) and only in the second year of sampling. Other morphologically similar Dipteran larvae (3%) were also found. This dominance of one species suggests that there may be underlying differences in species biology, such as choice of oviposition site and dispersal ability, which is in agreement with other studies and has implications for monitoring and management.

Temporal variability of beryllium-7 fallout in southwest UK

Cosmogenic beryllium-7 has been widely employed as a sediment tracing tool and continued development of its use as a soil erosion tracer requires knowledge of fallout temporal dynamics. Data regarding beryllium-7 fallout in the UK are scarce and here the authors provide a record of beryllium-7 fallout in southwest England spanning a two-year period. A monthly fallout record was developed for Plymouth, UK using regular rainfall sampling to determine beryllium-7 rainfall activity concentration (Bq L−1) and deposition flux (Bq m−2). Data showed a general tendency for higher activity during the spring/summer months and lower activity in the autumn/winter months. Comparison with data for other UK sites (Chilton and Aberporth) for the same period found significant differences in 7Be activity in rainwater and lower variability in Plymouth than Chilton and Aberporth. Total deposition was largely controlled by rainfall in Plymouth although regression coefficients suggested greater importance of other atmospheric controls at the Chilton and Aberporth sites. Use of a deposition proportion to rainfall proportion ratio identified periods when deposition was influenced by varying 7Be activity in rainfall. Broad ranges in ratios were found for Chilton and Aberporth and this has implications for sediment tracer studies requiring estimates of 7Be deposition flux across months or seasons.

Pink sea fans (Eunicella verrucosa) as indicators of the spatial efficacy of Marine Protected Areas in southwest UK coastal waters

Globally, the need to identify and establish integrated and connected systems of Marine Protected Areas (MPAs) is becoming increasingly recognised. For best practice, these networks need to be planned and assessed against multiple criteria. However, building a sound evidence base to support decision-making processes is complex, as well as fiscally and logistically challenging. Recent studies have demonstrated the utility of integrating ‘citizen science’ data into mainstream scientific analysis, particularly where broad-scale spatial patterns of distribution are required. In UK waters, the pink sea fan (Eunicella verrucosa) is a nationally protected slow growing, cold-water coral, and is a representative species of reef features that provide habitat for many other sessile species. However, this species is vulnerable to physical impact and loss of suitable substratum, and is likely highly vulnerable to bottom-towed fishing gears. In this study, data from a volunteer-based marine survey programme (‘Seasearch’) are analysed with the aim of describing the spatial distribution and relative abundance of pink sea fan colonies throughout southwest UK coastal waters. The congruence between pink sea fans and the extant southern UK MPA network is reported, and the current threat from Bottom-Towed Gear (BTG) to pink sea fan dominated reefs, that have historically lacked protection, is quantitatively assessed. This analysis reveals that protection of this and other benthic species has been increased by management of previously ‘open access’ MPAs. Nonetheless, areas of pink sea fan habitat and their host reef systems exist outside extant protected areas in southwest UK seas, and as such are potentially at risk from bottom-towed fisheries. This analysis demonstrates the utility of well-organised citizen science data collection and highlights how such efforts can help inform knowledge on broad scale patterns of biodiversity.

Awareness of automated external defibrillators in the community: a local study

Automated external defibrillators (AEDs) are an important part of the chain of survival and provide a valuable first response to cardiac arrest. The National Defibrillator Programme instigated the installation of AEDs across England, but there is a need for greater local evidence concerning their installation. The aim of this study was to investigate the current status of AED provision within a single district in a county located in southwest UK. A mixed-methods study was undertaken including a quantitative survey and qualitative interviews. In total, 182 surveys were completed and seven interviews were undertaken with participants representing local organisations. Less than one third of organisations had installed AEDs and people were not clear about where the nearest AED was situated. Further awareness must be raised in order to develop public knowledge and confidence concerning the location, role and use of community AEDs.

Natural history, reasons for, and impact of low/non-adherence to medications for osteoporosis in a cohort of community-dwelling older women already established on medication: a 2-year follow-up study.

Approximately 15% of older women on oral medications for osteoporosis could be considered for alternatives including parenteral therapies. Collection of data on socio-demographic/clinical variables is unlikely to be helpful in predicting low/non-adherence. Alternative approaches are needed to identify individuals at risk of low/non-adherence. This study aims to identify individual patient reasons for stopping medications for osteoporosis, and to investigate whether this can be predicted from knowledge about socio-demographic/clinical data, or whether alternative approaches need to be used. The Cohort for Skeletal Health in Bristol and Avon (COSHIBA) recruited 3200 older women from South West UK, of whom a proportion were on medications for osteoporosis at baseline. Information on self-reported adherence and reasons for low/non-adherence were collected at 6-monthly intervals over a 2-year period. Data was also collected on potential predictors of and impact of low/non-adherence. Two hundred thirty-three of 3200 (7.3%) women were on medications for osteoporosis at baseline. Mean length of time on treatment prior to enrolment was 46months. Of those on osteoporosis medications, 94.9% were on bisphosphonates; 8.5% reported low adherence and 21.6% stopped their medication completely over the 2-year follow-up period. Length of time on medication at baseline did not influence rates of low/non-adherence. Reasons for low/non-adherence to bisphosphonates included side effects (53.9%), practical reasons such as forgetting to take them (18.0%) and beliefs about medications (20.5%). No convincing predictors of low/non-adherence were identified. Approximately 15% of older women on oral medications for osteoporosis could be considered for alternatives including parenteral therapies. This has important implications for healthcare provision. Collection of data on socio-demographic/clinical variables is unlikely to be helpful in predicting low/non-adherence. Alternative approaches are needed to identify individuals at risk of low/non-adherence to osteoporosis medications.

Disentangling the impacts of heat wave magnitude, duration and timing on the structure and diversity of sessile marine assemblages.

Extreme climatic events, including heat waves (HWs) and severe storms, influence the structure of marine and terrestrial ecosystems. Despite growing consensus that anthropogenic climate change will increase the frequency, duration and magnitude of extreme events, current understanding of their impact on communities and ecosystems is limited. Here, we used sessile invertebrates on settlement panels as model assemblages to examine the influence of HW magnitude, duration and timing on marine biodiversity patterns. Settlement panels were deployed in a marina in southwest UK for ≥5 weeks, to allow sufficient time for colonisation and development of sessile fauna, before being subjected to simulated HWs in a mesocosm facility. Replicate panel assemblages were held at ambient sea temperature (∼17 °C), or +3 °C or +5 °C for a period of 1 or 2 weeks, before being returned to the marina for a recovery phase of 2–3 weeks. The 10-week experiment was repeated 3 times, staggered throughout summer, to examine the influence of HW timing on community impacts. Contrary to our expectations, the warming events had no clear, consistent impacts on the abundance of species or the structure of sessile assemblages. With the exception of 1 high-magnitude long-duration HW event, warming did not alter not assemblage structure, favour non-native species, nor lead to changes in richness, abundance or biomass of sessile faunal assemblages. The observed lack of effect may have been caused by a combination of (1) the use of relatively low magnitude, realistic heat wave treatments compared to previous studies (2), the greater resilience of mature adult sessile fauna compared to recruits and juveniles, and (3) the high thermal tolerance of the model organisms (i.e., temperate fouling species, principally bryozoans and ascidians). Our study demonstrates the importance of using realistic treatments when manipulating climate change variables, and also suggests that biogeographical context may influence community-level responses to short-term warming events, which are predicted to increase in severity in the future.

Prognostic significance of NPM1 mutations in the absence of FLT3-internal tandem duplication in older patients with acute myeloid leukemia: a SWOG and UK National Cancer Research Institute/Medical Research Council report.

Younger patients with acute myeloid leukemia (AML) harboring NPM1 mutations without FLT3-internal tandem duplications (ITDs; NPM1-positive/FLT3-ITD-negative genotype) are classified as better risk; however, it remains uncertain whether this favorable classification can be applied to older patients with AML with this genotype. Therefore, we examined the impact of age on the prognostic significance of NPM1-positive/FLT3-ITD-negative status in older patients with AML. Patients with AML age ≥ 55 years treated with intensive chemotherapy as part of Southwest Oncology Group (SWOG) and UK National Cancer Research Institute/Medical Research Council (NCRI/MRC) trials were evaluated. A comprehensive analysis first examined 156 patients treated in SWOG trials. Validation analyses then examined 1,258 patients treated in MRC/NCRI trials. Univariable and multivariable analyses were used to determine the impact of age on the prognostic significance of NPM1 mutations, FLT3-ITDs, and the NPM1-positive/FLT3-ITD-negative genotype. Patients with AML age 55 to 65 years with NPM1-positive/FLT3-ITD-negative genotype treated in SWOG trials had a significantly improved 2-year overall survival (OS) as compared with those without this genotype (70% v 32%; P < .001). Moreover, patients age 55 to 65 years with NPM1-positive/FLT3-ITD-negative genotype had a significantly improved 2-year OS as compared with those age > 65 years with this genotype (70% v 27%; P < .001); any potential survival benefit of this genotype in patients age > 65 years was marginal (27% v 16%; P = .33). In multivariable analysis, NPM1-positive/FLT3-ITD-negative genotype remained independently associated with an improved OS in patients age 55 to 65 years (P = .002) but not in those age > 65 years (P = .82). These results were confirmed in validation analyses examining the NCRI/MRC patients. NPM1-positive/FLT3-ITD-negative genotype remains a relatively favorable prognostic factor for patients with AML age 55 to 65 years but not in those age > 65 years.