Mistletoe, Viscum album (Santalaceae), in Britain and Ireland; a discussion and review of current status and trends

The status of Viscum album L. (Mistletoe) in Britain and Ireland is discussed and current trends reviewed. An overview of life-cycle is given, including discussion of dispersal, germination and host connection, all aspects important in understanding status and trends. A summary of hosts and habitats is followed by a review of distribution; the long-established pattern in the south-west midlands plus recent and ongoing changes. The biodiversity value of mistletoe for other species is discussed. The seasonal mistletoe trade, its history and implications, is outlined. Some current conservation, control and planting projects are described. A brief summary of toxicity and medicinal uses is given. Concluding remarks outline various research opportunities; particularly those that would help understand and set a baseline to measure current and future trends.

West Midlands Endourology Meeting Abstracts

West Midlands Endourology Meeting Abstracts

Non-pest household arthropods as a reservoir of human opportunistic pathogens

Arthropods are recognised as potential mechanical and biological vectors for infectious diseases in outdoor environments. However, a comprehensive understanding of the indoor arthropod community diversity and of the role that their associated microbiota may have as disease vectors is largely unexplored. Here, we study the arthropod community and the associated microbiota diversity of twenty indoor environments, sampled over a period of twelve months from urban and suburban households by citizen scientists in the West Midlands (UK). We compare the arthropods diversity between environments and over the sampling months. We characterize the exogenous (exoskeleton) and endogenous (gut) bacterial communities associated with all specimens of arthropods actively captured using both a traditional culture-based and an unbiased metabarcoding approach. For the first time, we describe the exogenous and endogenous microbiota composition and diversity of 14 arthropod families found in indoor environments. We find that both the exogenous and the endogenous microbiota are potential carriers of human opportunistic pathogens, with potential implications for public health. We discover that many bacteria families are shared across the exogenous microbiota of arthropods, likely influenced by the bacteria present in the environment. Conversely, the endogenous microbiota composition is unique to the arthropod families, and likely genetically determined. We show that the metabarcoding unbiased approach is a superior tool to characterize the microbiota associated with each arthropod family. This study provides new insights into bacterial carriage in household arthropods as potential reservoirs of infectious disease.

Detection of the Phoma pathogens Plenodomus biglobosus subclades ‘brassicae’ and ‘canadensis’ on wasabi, and ‘canadensis’ in Europe

Phoma stem canker / blackleg is an internationally important disease of Brassicas including B. napus (oilseed rape, OSR), caused by multiple genetic subclades of the fungi Plenodomus lingam (formerly Leptosphaeria maculans) and P. biglobosus (L. biglobosa). In Spring 2021, Phoma-like disease symptoms were observed on leaves and stems of Eutrema japonicum (wasabi) crops at three UK sites (Northern Ireland, Southern England and the West Midlands). Fungal isolation from wasabi leaf spots yielded colonies with two distinct phenotypes on potato dextrose agar (PDA). Isolates from the Northern Ireland and Southern England sites had white colonies with abundant pink cirri that were confirmed (based on ITS rDNA, beta tubulin and actin sequences) as P. biglobosus subclade ‘canadensis’ (Pbc). Those from the West Midlands site, however, had yellow pigmented colonies and were confirmed by sequencing as P. biglobosus subclade ‘brassicae’ (Pbb). Greenhouse pathogenicity testing showed that Pbb and Pbc wasabi isolates were pathogenic not only to this host but also OSR, B. oleracea (cabbage), and B. rapa (pak choi). Re-isolation of the fungi was attempted and confirmed from lesions that developed on inoculated OSR and wasabi, thus completing Koch’s postulates. These findings represent new discoveries for both Pbb and Pbc on wasabi, plus for Pbc in Europe. The crop health implications of these results are briefly considered.

CPX-351 for Acute Myeloid Leukaemia: Real World Results Are Comparable to Trial Outcomes and Exceeds Them in Non-Adverse Risk Patients- a Multicentre Experience from West Midlands Hospitals on Behalf of West Midlands Research Consortium ( WMRC) UK

Patients with secondary AML or MDS derived AML have poor outcomes compared to de-novo AML. The benefits of intensive chemotherapy without anticipated transplant consolidation have been previously doubted. Outcomes in USA trial centres have not often been closely replicable in real world settings. From November 2018 CPX-351 has been available in the UK for secondary AML, therapy related AML, AML with MDS related Karyotype (AML-MRC) and licensed but not funded for AML with myelodysplastic related changes. Objectives Here we report our experience specifically on patient outcomes and toxicity across 5 Hospitals in West Midlands, UK Methods Patients receiving CPX 351 outcomes were evaluated retrospectively from 2018 to 2021. Baseline genetics, CPX 351 indications, patient's comorbidities, overall survival, remission status, number of cycles delivered, early mortality, reasons for early discontinuation, intensive care admission and time for neutrophil recovery (>0.5) was recorded. Time-to-event outcomes reported here are from a data cut on 01-06-21 Results In a total cohort of 57 patients baseline characteristics are shown on table 1 and compared with the original trial CPX-351 group. Median follow up was 376 days (range 21 to 1248 days). The mean age was 63, 17 patients were under 60, 31 males and 26 females. The most common indication for CPX-351 was AML with antecedent MDS/MPN 51% (N=29), therapy related 14% (N=8), MDS related karyotype (AML-MRC) 19% (N=11) and 16% (N=9) other patients. Mean Charleston co-morbidity score was 2.7 (range 0-6), 10.5% (N=6) had previous non myeloid malignancies, 8.7% (N=5) had prior ischaemic heart disease, only 3.5% (N=2) had ejection fractions under 50%. The most common mutations were TP53 21% (N=12), ASXL1 15.7% (N=9), TET2 15.7% (N=9), IDH2 10.5% (N=6), RUNX1 10.5% (N=6), SRSF2 7% (N=4), JAK2 3.5% (N=2), FLT3 5% (N=3), NPM1 5%(N=3) and IDH1 5% (N=3). MRC cytogenetic risk was adverse in 19 patients (33%), intermediate in 35 patients (61%) and favourable in 3 patients (5%). 30 patients (53%) had adverse European Leukaemia Network classification, 17 (30%) had intermediate and 10 (17%) had favourable. 30-day mortality was 3/57 (5%), 60-day mortality was 6 (10.5%) comparable to the 5.9% and 10.6% rates for the original trial. 9% or 5/57 patients were admitted to ITU with 2 survivors beyond 60 days. Neutropenic fever requiring antibiotics was 100% whereas only 5/57 (9%) had radiological evidence of fungal infection. Only one patient died from COVID 19. The mean time to neutrophil recovery was 35 days with a range of 12 to 84 days. 29 patients completed 1 cycle, 25 completed 2 cycles, only 3 completed 3 cycles. The reasons for stopping were death, refractory disease, drop in performance status, alternative chemotherapy chosen or moving to transplantation (39%). Composite remission rate including CRi was 61% 36/57, adverse ELN group demonstrated 50% 15/30, intermediate 76% 13/17 and favourable 80% 8/10. Mutated P53 was associated with a 50% 6/12 rate whereas in wild type P53 the remission rate was 60% 30/45. Overall median survival from diagnosis was 429 days [95% CI 274 to 788 days]. To compare with the original trial, we removed the under 60s and those with less than 1 year follow up, in this cohort of 30 patients the median survival was 289 days (9.5 months) with 95% CI of 255 to 476 days. P53 mutated patients had an estimated median survival of 257 days versus wild type p53 with 524 days hazard ratio of 2.418 (CI 1.077 to 5.248) with p value of 0.032. Median survival for ELN groups was 373 days (adverse), 413 days (intermediate) and not reached for favourable. Of the 36 patients who achieved a remission, 22 went on to receive an allogenic transplant with follow from 254 to 1248 days, median survival estimated 706 days (95% CI 429-not reached). Patients in remission who haven't received a transplant have a similar estimated survival of 788 days (305-not reached) pending longer follow up. Conclusion This is the first UK multicentre analysis to show comparable results to the landmark trial (median survival 9.5 months in equivalent cases). The improved overall remission rate 61% versus the 47% in the trial and the longer median survival 14 months versus 9.5 months in the trial is expected given the younger age and increase in favourable risk genetics. This study therefore supplies further data of CPX-351 efficacy in younger patients not included in the original studies and may now be used as a standard comparator arm. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Examples from practice

I want to draw on the experiences of two practitioners. Jodie, who is an experienced room leader at a family owned and managed, private setting in the West Midlands. And Thandi, who is in her second year of teaching a reception class in Yorkshire. Prior to moving into teaching, Thandi began as a nursery nurse before managing a charity ran nursery.

913. Re-engagement using Historical Hepatitis C Antibody Results: Is it Worth the Effort?

Background The World Health Organisation aim to eliminate hepatitis C (HCV) as a public health concern by 2030. One aspect of Public Health England’s (PHE) strategy to meet this target is to use historical surveillance data of anti-HCV positive patients identified by PHE to re-engage with offers of PCR testing and treatment if RNA-positive. Operational Delivery Networks (ODN) are responsible for enacting this initiative across 22 regions in England. We present an interim analysis and evaluation of the effectiveness of using this data to re-engage HCV-infected persons in the West Midlands ODN of England. Methods A dataset of historical anti-HCV positive antibody patients provided to the West Midlands ODN by PHE was cross-referenced with HCV RNA data from 01/01/1996 to 01/01/2019 from 5 regional laboratories and regional treatment databases. If HCV RNA positive, letters were sent to the general practitioner and to the patient to invite them for further testing and, if necessary, treatment to achieve SVR. This received no additional funding or support and occurred in addition to the routine clinical workload. Results From a dataset of 4,540 anti-HCV antibody results, 31.7% (n=1,440) had a PCR result: 48.1% (n=693) were PCR positive for HCV RNA with no evidence of cure. 693 letters were sent to GPs from Oct 2019 to Feb 2020 with responses from 14.2% (n=99). From July to Oct 2020 only 212 patient letters were sent (due to significant interruption due to the COVID-19 pandemic) and 11.3% (n=24) replied by May 2021. 17 presented for PCR testing and 4 were found to be viraemic. To date, one patient has achieved SVR and three have completed treatment awaiting SVR. Re-Engagement Process Flow diagram of re-engagement of patients with historical antibody-positive results for hepatitis C virus. * Of the 17 deemed not suitable to contact by the GP: 4 treated elsewhere, 3 had negative PCR elsewhere, 1 was unknown reason, 2 were under care of another hospital, 7 had died Conclusion The use of historical anti-HCV antibody results to re-engage people into testing and treatment for hepatitis C in this format is low yield. Rollout was limited by ongoing clinical work and the COVID-19 pandemic. Dedicated time and resources with a less restrictive cohort might improve yields. Disclosures All Authors: No reported disclosures

Exploring innovation in challenging contexts: The experiences of ethnic minority restaurant owners during COVID-19

This article explores how Bangladeshi immigrants who run and own restaurants in the West Midlands of England (UK) participated in forms of innovation in response to the challenges created by COVID-19. Contributing to debates on innovation and diversification in the ethnic minority entrepreneurship literature, we explore through qualitative interview data how restaurant owners innovatively engaged with particular resources to secure their survival and longer-term futures in localised economies. This form of innovation is significant as it occurs among a population of entrepreneurs who have traditionally been portrayed as reluctant to innovate and embrace change. Our study therefore explores how a long-held culturally rooted reluctance to innovate intersects with a contemporary need to innovate for a demographic responding to the crisis. We theorise the form of innovation we identify as situated between a forced bricolage and a neoclassical approach to innovation.