A-03 SCAT5 Cognitive Screening Normative Data and Reliable Change Indices

Objective

This study provides normative data on the SCAT5 Cognitive Screening, establishes test-retest reliability, and creates clinically relevant cut points for low performance.

Method

The multisport baseline sample was composed of 727 uninjured college athletes (52% female) at a Division I university who were administered the SCAT5 before the 2017–2018 season. Descriptive statistics, including base rates of low performance, were calculated for SCAT5 indices. Repeat baseline testing was completed by 325 athletes (48% female) at 1 year (days M = 352.56;SD = 56.03) who were included in the test-retest reliability and practice effect analyses. Reliable change indices were calculated.

Results

Descriptive statistics for SCAT5 were computed for both baselines (Baseline 1: SAC total M = 35.15,SD = 4.93; immediate recall total M = 20.01,SD = 3.46; delayed recall total M = 6.43,SD = 1.75). A difference in descriptive statistics and practice effects by sex on the SCAT5 Cognitive Screening has been demonstrated (Bailey, Meyer, Tangen et al., under review). For female athletes, the 1st administration cutoff scores for abnormal performance (<10th%ile) included SAC total score = 33, immediate recall score = 18, and delayed recall score = 6. For male athletes, the 1st administration cutoff scores for abnormal performance (<10th%ile) included SAC total score = 30, immediate recall score = 17, and delayed recall score = 5. Test-retest reliability of the SAC was similar to previous versions but varied by sex. Reliable change indices (RCI) were created with cut points for significant change.

Conclusions

The present study provides clinically relevant normative data for the SCAT5 Cognitive Screening. Cut points for low performance on both reliable chance indices (RCIs) and normative performance reflected meaningful sex differences that could influence clinical interpretation.

Extrachromosomal DNA-relieving heredity constraints, accelerating tumour evolution

Oncogene amplification on extrachromosomal DNA (ecDNA) provides a mechanism by which cancer cells can rapidly adapt to changes in the tumour microenvironment. These circular structures contain oncogenes and their regulatory elements, and, lacking centromeres, they are subject to unequal segregation during mitosis. This non-Mendelian mechanism of inheritance results in increased tumour heterogeneity with daughter cells that can contain increasingly amplified oncogene copy number. These structures also contain favourable epigenetic modifications including transcriptionally active chromatin, further fuelling positive selection. ecDNA drives aggressive tumour behaviour, is related to poorer survival outcomes and provides mechanisms of drug resistance. Recent evidence suggests one in four solid tumours contain cells with ecDNA structures. The concept of tumour evolution is one in which cancer cells compete to survive in a diverse tumour microenvironment under the Darwinian principles of variation and fitness heritability. Unconstrained by conventional segregation constraints, ecDNA can accelerate intratumoral heterogeneity and cellular fitness. In this review, we highlight some of the recent discoveries underpinning this process.

B-48 Effects of Anxiety on Response to a Subsymptom Threshold Exercise Program for Treatment of Persistent Post-Concussive Symptoms: A Pilot Randomized Clinical Trial

Objective

There is a growing literature to support the use of subsymptom threshold exercise for treatment of both acute and chronic post-concussion symptoms. The present study aimed to explore the influence of anxiety on response to exercise intervention for patients with persistent post-concussive symptoms.

Methods

Sixteen adolescents (ages 14-18) with persistent (>1 month) concussion symptoms were randomized into a light, home exercise group and a subsymptom threshold exercise group performed by PT’s (modeled after Leddy et al.,2019). Participants underwent intervention for 6 weeks and completed evaluations at Baseline, Mid-Point, and Follow-up after treatment; evaluations included State-Trait Anxiety Inventory (STAI), the Post-Concussive Scale-Revised (PCS-R), as well as additional measures of emotional functioning, balance disturbance, and neuropsychological functioning.

Results

Average PCS-R endorsement improved by 21 points from Baseline to Follow-up across treatment groups (PCS-R Total Change M = -21.29,SD = 13.54). There were meaningful Baseline differences between intervention groups in STAI state anxiety (p < .05) and STAI trait anxiety (p = 0.51); STAI variables were used as covariates in an ANOVA comparing mean PCS-R Percent Change between treatment and control groups. After removing the influence of anxiety, the intervention groups significantly differed and showed large effect (F(3,13) = 6.94,p < .05,partial eta2 = .41), with the intervention group improving (PCS-R Percent Change M = -63.3,SD = 17.4) more than the control group (PCS-R Percent Change M = -56.8,SD = 27.8).

Conclusion

Exercise intervention appears to be more effective than standard-of-care light activity in the treatment of persistent symptoms in adolescents; however, anxiety may alter response to intervention. Complimentary mental health treatment may augment response to exercise intervention and optimize concussion recovery trajectory in patients with persisting symptoms.

Retinal burns from laser pointers: a risk in children with behavioural problems

OBJECTIVE

To explore self-inflicted retinal burns from laser pointers in children.

METHODS

Literature review of laser pointer retinal injuries in childhood and online survey of UK Consultant Ophthalmologists. A cohort of local children with self-inflicted injury is described. The matter is topical. We review progress in recent legislation and policy change in the UK.

RESULTS

Four of 77 case reports of laser burns in childhood analysed reported psychological or behavioural issues. Three of four children in our cohort had such issues. Delay in diagnosis occurred in two of our patients. Structural retinal damage persisted for over 12 months in all four children (seven eyes). Our survey of UK ophthalmologists found 159 cases of injury (85% male), 80% under 20 years of age. The majority of the laser pointers were purchased online. Many patients (36%) suffered moderate vision loss (6/18 to 6/60 Snellen), while 17% (at least 11 patients) suffered severe vision loss (<6/60 Snellen).

CONCLUSION

We highlight the risk of macular damage and vision loss from handheld lasers specifically in children with behavioural, learning or mental health issues. The diagnosis may be difficult or delayed in such children. In children with uncertain macular changes, ophthalmologists should explore the history for possible instances of exposure to handheld lasers pointers. Regulatory authorities and manufacturers of handheld lasers need to be aware of the risk to children. Furthermore, there is a need to better inform parents, carers and teachers of the risk of ocular self-injury from such lasers pointers.

Gastric ulceration causing thoracic spondylodiscitis: a first case of a rare complication post oesophagectomy

We report the case of an 84-year-old male, who presented with septicaemia, abdominal and back pain. The patient had a background of oesophageal carcinoma and had undergone previous oesophagectomy and gastric pull-up operation 10 years ago. A computerised topography scan demonstrated a probable gastro-vertebral communication with a destructive process at the T8/T9 vertebral level. Further evaluation with MRI clearly showed the tract between the two structures and confirmed the diagnosis of spondylodiscitis at the adjacent spinal level. The patient was resuscitated, treated with intravenous antibiotics and kept nil by mouth. A subsequent gastroscopy demonstrated an eroding gastric ulcer at the enteric opening of the tract between the tubal stomach and the spinal column. The diagnosis was discussed with the patient, his family and the surgical multidisciplinary team. Given the extent of disease and his multiple medical co-morbidities, the decision was made for conservative management and symptom control. This is the first case of a gastro-vertebral communication causing spondylodiscitis to be described in the literature.

Simultaneous visualization of wall motion, beam propagation, and implosion symmetry on the National Ignition Facility (invited)

Achieving a symmetric implosion in National Ignition Facility indirect drive targets requires understanding and control of dynamic changes to the laser power transport in the hohlraum. We developed a new experimental platform to simultaneously visualize wall-plasma motion and dynamic laser power transport in the hohlraum and are using it to investigate correlations of these measurements with the imploded capsule symmetry. In a series of experiments where we made one single parameter variation, we show the value of this new platform in developing an understanding of laser transport and implosion symmetry. This platform also provides a new way to evaluate dynamic performance of advanced hohlraum designs.

'VIOLET': a fluorescence-based simulation exercise for training healthcare workers in the use of personal protective equipment

Background

Healthcare workers caring for patients with high-consequence infectious diseases (HCIDs) require protection from pathogen exposure, for example by wearing personal protective equipment (PPE). Protection is acquired through the inherent safety of the PPE components, but also their safe and correct use, supported by adequate training and user familiarity. However, the evidence base for HCID PPE ensembles and any associated training is lacking, with subsequent variation between healthcare providers.

Aim

To develop an evidence-based assessment and training tool for evaluating PPE ensembles and doffing protocols, in the assessment of patients with suspected HCIDs.

Methods

VIOLET (Visualising Infection with Optimised Light for Education and Training) comprises a healthcare mannequin adapted to deliver simulated bodily fluids containing UV-fluorescent tracers. On demand and remotely operated, the mannequin projectile vomits (blue), coughs (red), has diarrhoea (yellow) and is covered in sweat (orange). Wearing PPE, healthcare staff participate in an HCID risk assessment and examination of the ‘patient’, thereby becoming exposed to these bodily fluids. Contamination of PPE is visualized and body-mapped under UV light before and after removal. Observational findings and participant feedback, around its use as a training exercise, is also recorded.

Findings

Significant contamination from different exposure events was seen, enabling evaluation of PPE and doffing procedures used. Observational data and participant feedback demonstrated its strengths and success as a training technique.

Conclusion

Simulation exercises using VIOLET provide evidence-based assessment of PPE ensembles, and are a valuable resource for training of healthcare staff in wearing and safe doffing of PPE.

Are brown trout Salmo trutta fario and rainbow trout Oncorhynchus mykiss two of a kind? A comparative study of salmonids to temperature-influenced Tetracapsuloides bryosalmonae infection

Proliferative kidney disease (PKD) of salmonids caused by Tetracapsuloides bryosalmonae causes high mortalities of wild brown trout (Salmo trutta fario) and farmed rainbow trout (Oncorhynchus mykiss) at elevated water temperatures. Here the aim was to compare the temperature-dependent modulation of T. bryosalmonae in the two salmonid host species, which display different temperature optima. We used a novel experimental set-up in which we exposed brown trout and rainbow trout to an identical quantified low concentration of T. bryosalmonae for a short time period (1 hr). We followed the development of the parasite in the fish hosts for 70 days. PKD prevalence and parasite kinetics were assessed using qPCR. Exposures were performed at temperatures (12°C and 15°C) that reflect an environmental scenario that may occur in the natural habitat of salmonids. T. bryosalmonae infection was confirmed earliest in brown trout kept at 15°C (day 7 post-exposure) while, in all other groups, T. bryosalmonae was not confirmed until day 15 post-exposure. Moreover, significantly greater infection prevalence and a faster increase of parasite intensity were observed in brown trout kept at 15°C than in all other groups. These results indicate that PKD is differentially modulated by water temperature in related host species.

Use of ultraviolet-fluorescence-based simulation in evaluation of personal protective equipment worn for first assessment and care of a patient with suspected high-consequence infectious disease

BACKGROUND

Variations currently exist across the UK in the choice of personal protective equipment (PPE) used by healthcare workers when caring for patients with suspected high-consequence infectious diseases (HCIDs).

AIM

To test the protection afforded to healthcare workers by current PPE ensembles during assessment of a suspected HCID case, and to provide an evidence base to justify proposal of a unified PPE ensemble for healthcare workers across the UK.

METHODS

One 'basic level' (enhanced precautions) PPE ensemble and five 'suspected case' PPE ensembles were evaluated in volunteer trials using 'Violet'; an ultraviolet-fluorescence-based simulation exercise to visualize exposure/contamination events. Contamination was photographed and mapped.

FINDINGS

There were 147 post-simulation and 31 post-doffing contamination events, from a maximum of 980, when evaluating the basic level of PPE. Therefore, this PPE ensemble did not afford adequate protection, primarily due to direct contamination of exposed areas of the skin. For the five suspected case ensembles, 1584 post-simulation contamination events were recorded, from a maximum of 5110. Twelve post-doffing contamination events were also observed (face, two events; neck, one event; forearm, one event; lower legs, eight events).

CONCLUSION

All suspected case PPE ensembles either had post-doffing contamination events or other significant disadvantages to their use. This identified the need to design a unified PPE ensemble and doffing procedure, incorporating the most protective PPE considered for each body area. This work has been presented to, and reviewed by, key stakeholders to decide on a proposed unified ensemble, subject to further evaluation.

What goes around comes around: an investigation of resistance to proliferative kidney disease in rainbow trout Oncorhynchus mykiss (Walbaum) following experimental re-exposure

Rainbow trout Oncorhynchus mykiss surviving proliferative kidney disease (PKD) are reported not to develop the disease upon re-exposure. However, the mechanisms involved in the immune response to re-exposure are unknown. We examined disease susceptibility and the immune response of naive 1+ rainbow trout when first exposed to Tetracapsuloides bryosalmonae in comparison with that of 1+ rainbow trout re-exposed to T. bryosalmonae. PKD pathogenesis, parasite burden and transcriptional signatures of the host immune response were assessed at 10, 25 and 40 d.p.e (days post-exposure). In addition, we evaluated the presence of IgM+ B cells in the blood and the posterior kidney. The exposure of 1+ rainbow trout to T. bryosalmonae for the first time resulted in 100% infection prevalence, high parasite burdens and severe clinical PKD, while re-exposed fish were either able to avoid reinfection completely or mount an earlier and more efficient adaptive-type immune response. This response was characterized by a greater amount of IgM+ B cells in the blood and elevated mRNA levels of secretory IgM in the posterior kidney which minimized pathogen burden and kidney inflammation. Our findings suggest that rainbow trout is able to develop immune protection against T. bryosalmonae.

Application of OCT-angiography to characterise the evolution of chorioretinal lesions in acute posterior multifocal placoid pigment epitheliopathy

PurposeThe aim of this study was to determine a sequence of structural changes in acute posterior multifocal placoid pigment epitheliopathy (APMPPE) using optical coherence tomography-angiography (OCT-A) and comparing with other imaging modalities.Patients and methodsPatients with a new diagnosis of acute-onset APMPPE referred to a regional specialist centre from October 2015 to October 2016 were included. Multimodal imaging employed on all patients from diagnosis included the following: fundus fluorescein angiography, indocyanine green angiography, fundus autofluorescence, spectral domain-OCT (SD-OCT), and OCT-A. All non-invasive imaging processes were repeated during follow-up.ResultsTen eyes of five patients were included in the study, three males and two females, with a mean age of 26.2 years (range: 21-32) and a mean follow-up of 6.4 months (range: 2.6-13.3). All patients presented with bilateral disease and macular involving lesions. OCT-A imaging of the choriocapillaris was supportive of hypoperfusion at the site of APMPPE lesions during the acute phase of this condition with normalisation of choroidal vasculature during follow-up. Multimodal imaging consistently highlighted four sequential phases from presentation to resolution of active disease.ConclusionsMultimodal imaging in patients with APMPPE in acute and long-term follow-up demonstrates a reversible choroidal hypoperfusion supporting the primary inciting pathology as a choriocapillaritis. The evolution shows resolution of the ischaemia through a defined sequence that results in persistent changes at the level of the retinal pigment epithelium and outer retina. OCT-A was able to detect preclinical changes and chart resolution at the level of the choriocapillaris.