Enumeration and Confirmation of Bacillus cereus in Foods: Collaborative Study

A collaborative study was conducted in 15 laboratories to evaluate 2 different techniques for enumerating Bacillus cereus in foods. A direct plating technique using mannitol-egg yolk-polymyxin agar and a most probable number (MPN) technique using trypticase-soy-polymyxin broth were compared for the enumeration of high and low populations of B. cereus in mashed potatoes. The collaborative results showed that the overall mean recovery obtained with the low population level was essentially the same by both techniques. However, the overall mean recovery was significantly higher by the direct plating technique at the high population level. A statistical evaluation of the data also showed that the direct plating technique had better repeatability and reproducibility than did the MFN technique at both the high and low population levels. These results suggest that the MPN technique is suitable for examining foods containing low populations of B. cereus, but that the direct plating technique is preferable for foods that contain a high population of this organism. The confirmatory technique used in the proposed method is reliable for presumptive identification of isolates as B. cereus. The method has been adopted as official first action.

Gas Chromatographic Determination of Volatile Congeners in Spirit Drinks: Interlaboratory Study

An interlaboratory study of a gas chromatographic (GC) method for the determination of volatile congeners in spirit drinks was conducted; 31 laboratories from 8 countries took part in the study. The method uses GC with flame ionization detection and incorpo rates several quality control measures which permit the choice of chromatographic system and conditions to be selected by the user. Spirit drink samples were prepared and sent to participants as 10 blind duplicate or split-level test materials for the determination of 1,1-diethoxyethane (acetal), 2-methylbutan-1-ol (active amyl alcohol), 3-methylbutan-1-ol (isoamyl alcohol), methanol (methyl alcohol), ethyl ethanoate (ethyl acetate), butan-1-ol (n-butanol), butan-2-ol (sec-butanol), 2-methylpropan-1-ol(isobutyl alcohol), propan-1-ol (n-propanol), and ethanal (acetaldehyde). The precision of the method for 9 of the 10 analytes was well within the range predicted by the Horwitz equation.The precision of the most volatile analyte, ethanal, was just above statistically predicted levels. This method is recommended for official regulatory purposes.

Utilization of a mouse/human chimeric model for long term metabolic testing of human skin

Until now, ex vivo human skin explant utilization in tissue culture has consisted of limited short-term studies (less than a week). This short timeframe does not allow for the investigation of metabolic responses of complex tissues to specific molecules or compounds. Here, we aim to develop an improved mouse transplantation model that maintains the viability, structure and functionality of the human skin explants for prolonged periods of time. Healthy human skin explants derived from biopsies were grafted onto nude mice and used to perform a toxicological study of the reactivity and functionality of grafted skin explants after one month. Histological observations suggest that the tissue properties and phenotype of the human skin graft are conserved as a result of re-vascularization upon tissue integration. The toxicological test performed shows that the human skin graft reacts to systemic exposure of a xenobiotic metabolic inducer when applied to this mouse model. This mouse/human chimeric model can be effective for the long-term study of human skin reactivity to chemicals as well to study in vivo responses to complex co-exposures.

The Nab experiment: A precision measurement of unpolarized neutron beta decay

Neutron beta decay is one of the most fundamental processes in nuclear physics and provides sensitive means to uncover the details of the weak interaction. Neutron beta decay can evaluate the ratio of axial-vector to vector coupling constants in the standard model, λ = gA/gV, through multiple decay correlations. The Nab experiment will carry out measurements of the electron-neutrino correlation parameter a with a precision of δa/a = 10−3 and the Fierz interference term b to δb = 3 × 10−3 in unpolarized free neutron beta decay. These results, along with a more precise measurement of the neutron lifetime, aim to deliver an independent determination of the ratio λ with a precision of δλ/λ = 0.03% that will allow an evaluation of Vud and sensitively test CKM unitarity, independent of nuclear models. Nab utilizes a novel, long asymmetric spectrometer that guides the decay electron and proton to two large area silicon detectors in order to precisely determine the electron energy and an estimation of the proton momentum from the proton time of flight. The Nab spectrometer is being commissioned at the Fundamental Neutron Physics Beamline at the Spallation Neutron Source at Oak Ridge National Lab. We present an overview of the Nab experiment and recent updates on the spectrometer, analysis, and systematic effects.

The Anagen System for Automated Fluorometric Immunoassay

We describe a new discrete microprocessor-controlled analyzer, the AN2000, which fully automates fluorometric immunoassays by using a magnetic separation of the solid phase and an alkaline phosphatase label. It can operate in random-access or batch mode with a dwell time typically less than 20 min. The analysis rate is 75 samples per hour and the system can hold refrigerated reagents for as many as 20 different analytes. The substrate and wash buffer are common to all analytes. The system can hold as many as 80 samples at once. The operator can select from the menu-driven operator interface any combination of the available analytes to be run for each sample, using either the touch screen or the keyboard. Results are calculated from a stored calibration curve that is stable for greater than or equal to 1 month. The AN2000 is capable of automating most assay formats because the available timings, volumes, incubations, and wash cycles can be used in any combination.

Guidelines for safe transfer of the brain-injured patient: trauma and stroke, 2019: Guidelines from the Association of Anaesthetists and the Neuro Anaesthesia and Critical Care Society

The location of care for many brain-injured patients has changed since 2012 following the development of major trauma centres. Advances in management of ischaemic stroke have led to the urgent transfer of many more patients. The basis of care has remained largely unchanged, however, with emphasis on maintaining adequate cerebral perfusion as the key to preventing secondary injury. Organisational aspects and training for transfers are highlighted, and we have included an expanded section on paediatric transfers. We have also provided a table with suggested blood pressure parameters for the common types of brain injury but acknowledge that there is little evidence for many of our recommendations. These guidelines remain a mix of evidence-based and consensus-based statements. We have received assistance from many organisations representing clinicians who care for these patients, and we believe our views represent the best of current thinking and opinion. We encourage departments to review their own practice using our suggestions for audit and quality improvement.

Characteristics of Persons Who Inject Drugs with Recent HIV Infection in the United States: National HIV Behavioral Surveillance, 2012

We evaluated characteristics associated with recent HIV infection among persons who inject drugs (PWID) from 19 U.S. cities who participated in 2012 National HIV Behavioral Surveillance. Recent infection was defined as having a reactive HIV test, a Bio-Rad Avidity index cutoff ≤ 30%, no reported HIV diagnosis ≥ 12 months before interview, and no evidence of viral suppression. Of 8667 PWID, 50 (0.6%) were recently HIV infected. Having a greater number of sex partners (≥ 2 partners vs. 0) [prevalence ratio (PR) 4.7, 95% confidence interval (CI) 1.3-17.8], injecting heroin and other drugs (PR 3.0, 95% CI 1.3-6.6) or exclusively non-heroin drugs (PR 5.9, 95% CI 1.7-20.7) compared to injecting only heroin, and having male-male sex in the past year (PR 7.1, 95% CI 3.0-16.6) were associated with recent infection. Promoting not only safe injection practices but also safe sex practices will be key to preventing new HIV infections.

Determination of Zearalenone in Barley, Maize and Wheat Flour, Polenta, and Maize-Based Baby Food by Immunoaffinity Column Cleanup with Liquid Chromatography: Interlaboratory Study

An interlaboratory study was performed on behalf of the UK Food Standards Agency to evaluate the effectiveness of an affinity column cleanup liquid chromatography (LC) method for the determination of zearalenone (ZON) in a variety of cereals and cereal products at proposed European regulatory limits. The test portion is extracted with acetonitrile:water. The sample extract is filtered, diluted, and applied to an affinity column. The column is washed, and ZON is eluted with acetonitrile. ZON is quantified by reversed-phase LC with fluorescence detection. Barley, wheat and maize flours, polenta, and a maize-based baby food naturally contaminated, spiked, and blank (very low level) were sent to 28 collaborators in 9 European countries and 1 collaborator in New Zealand. Participants were asked to spike test portions of all samples at a ZON concentration equivalent to 100 μg/kg. Average recoveries ranged from 91–111%. Based on results for 4 artificially contaminated samples (blind duplicates) and 1 naturally contaminated sample (blind duplicate), the relative standard deviation for repeatability (RSDr) ranged from 6.9–35.8%, and the relative standard deviation for reproducibility (RSDR) ranged from 16.4–38.2%. The method showed acceptable within- and between-laboratory precision for all 5 matrixes, as evidenced by HorRat values <1.7.

Petrifilm™ Rapid S. aureus Count Plate Method for Rapid Enumeration of Staphylococcus aureus in Selected Foods: Collaborative Study

A rehydratable dry-film plating method for Staphylococcus aureusin foods, the 3M™ Petrifilm™ Rapid S. aureus Count Plate method, was compared with AOAC® Official MethodSM 975.55 (Staphylococcus aureus in Foods). Nine foods—instant nonfat dried milk, dry seasoned vegetable coating, frozen hash browns, frozen cooked chicken patty, frozen ground raw pork, shredded cheddar cheese, fresh green beans, pasta filled with beef and cheese, and egg custard—were analyzed for S. aureus by 13 collaborating laboratories. For each food tested, the collaborators received 8 blind test samples consisting of a control sample and 3 levels of inoculated test sample, each in duplicate. The mean log counts for the methods were comparable for pasta filled with beef and cheese; frozen hash browns; cooked chicken patty; egg custard; frozen ground raw pork; and instant nonfat dried milk. The repeatability and reproducibility variances of the Petrifilm Rapid S. aureus Count Plate method were similar to those of the standard method.

Alyna Smith

Ms Smith with discuss the range of structural barriers confronted by people who are undocumented, in accessing health services, at the policy and practical levels, including intersectional challenges (e.g., for undocumented sex workers, homeless, users of drugs, etc.).

The association between vaginal bacterial composition and miscarriage: a nested case-control study

Objective

To characterise vaginal bacterial composition in early pregnancy and investigate its relationship with first and second trimester miscarriages.

Design

Nested case–control study.

Setting

Queen Charlotte’s and Chelsea Hospital, Imperial College Healthcare NHS Trust, London.

Population

161 pregnancies: 64 resulting in first trimester miscarriage, 14 in second trimester miscarriage and 83 term pregnancies.

Methods

Prospective profiling and comparison of vaginal bacteria composition using 16S rRNA gene‐based metataxonomics from 5 weeks’ gestation in pregnancies ending in miscarriage or uncomplicated term deliveries matched for age, gestation and body mass index.

Main outcome measures

Relative vaginal bacteria abundance, diversity and richness. Pregnancy outcomes defined as first or second trimester miscarriage, or uncomplicated term delivery.

Results

First trimester miscarriage associated with reduced prevalence of Lactobacillus spp.‐dominated vaginal microbiota classified using hierarchical clustering analysis (65.6 versus 87.7%; P = 0.005), higher alpha diversity (mean Inverse Simpson Index 2.5 [95% confidence interval 1.8–3.0] versus 1.5 [1.3–1.7], P = 0.003) and higher richness 25.1 (18.5–31.7) versus 16.7 (13.4–20), P = 0.017), compared with viable pregnancies. This was independent of vaginal bleeding and observable before first trimester miscarriage diagnosis (P = 0.015). Incomplete/complete miscarriage associated with higher proportions of Lactobacillus spp.‐depleted communities compared with missed miscarriage. Early pregnancy vaginal bacterial stability was similar between miscarriage and term pregnancies.

Conclusions

These findings associate the bacterial component of vaginal microbiota with first trimester miscarriage and indicate suboptimal community composition is established in early pregnancy. While further studies are required to elucidate the mechanism, vaginal bacterial composition may represent a modifiable risk factor for first trimester miscarriage.

Tweetable abstract

Vaginal bacterial composition in first trimester miscarriage is associated with reduced Lactobacillus spp. abundance and is independent of vaginal bleeding.

Vaginal bacterial composition in first trimester miscarriage is associated with reduced Lactobacillus spp. abundance and is independent of vaginal bleeding.

First Measurement of Inclusive Muon Neutrino Charged Current Differential Cross Sections on Argon at E_{ν}∼0.8 GeV with the MicroBooNE Detector

We report the first measurement of the double-differential and total muon neutrino charged current inclusive cross sections on argon at a mean neutrino energy of 0.8 GeV. Data were collected using the MicroBooNE liquid argon time projection chamber located in the Fermilab Booster neutrino beam and correspond to 1.6×10^{20} protons on target of exposure. The measured differential cross sections are presented as a function of muon momentum, using multiple Coulomb scattering as a momentum measurement technique, and the muon angle with respect to the beam direction. We compare the measured cross sections to multiple neutrino event generators and find better agreement with those containing more complete treatment of quasielastic scattering processes at low Q^{2}. The total flux integrated cross section is measured to be 0.693±0.010(stat)±0.165(syst)×10^{-38}  cm^{2}.

Attack, flare-up, or exacerbation? The terminology preferences of patients with severe asthma

Background: People with severe asthma experience frequent life-threatening acute asthma events. A Lancet commission recently highlighted that terms "exacerbations" and "flare-ups" are seen to trivialize these episodes and recommended use of the term "attacks." Clinicians however, preferentially use the term "exacerbation" and some guidelines recommend the use of "exacerbation" with patients.Objective: This descriptive qualitative study aimed to understand the patient's experience and perspectives of these events and language used to describe them.Methods: Semi-structured one-on-one interviews were conducted in Australia and the UK in 18 people with severe asthma and 10 with mild-moderate asthma regarding their usage and preferences for such terminologies. Additionally, nine people with severe asthma participated in two focus groups in which use of preferred terminology was explored.Results: Mean age of participants was 57 ± 14.03 yr and 65% were female. A total 67 quotes were recorded in which 16 participants with severe asthma spontaneously used either the term "attack," "flare-up" and/or "exacerbation." Of these quotes, all 16 participants used "attack," one used all three terms and two used both "exacerbation" and "attack." The term "attack" was used to describe frightening events having major impacts on participant's lives, whereas "exacerbation" and "flare-up" were used to refer to both severe and mild, transient asthma-related events.Conclusion: Usage of the term "attack" was preferred by patients with severe asthma. Adoption of this language may assist in patient-clinician communication and disease management and outcomes. Wider stakeholder engagement is needed to confirm this suggestion. AbbreviationsFEV₁forced expiratory volume in 1 secondATSAmerican Thoracic SocietyERSEuropean Respiratory SocietyACQAsthma Control QuestionnaireICSinhaled corticosteroidsOCSoral corticosteroidsBTSBritish Thoracic SocietySIGNScottish Intercollegiate Guidelines NetworkWAPwritten action plan.

Reducing Implant Infection in Orthopaedics (RIIiO): Results of a pilot study comparing the influence of forced air and resistive fabric warming technologies on postoperative infections following orthopaedic implant surgery

BACKGROUND

Active warming during surgery prevents perioperative hypothermia but the effectiveness and postoperative infection rates may differ between warming technologies.

AIM

To establish the recruitment and data management strategies needed for a full trial comparing postoperative infection rates associated with forced air warming (FAW) versus resistive fabric warming (RFW) in patients aged >65 years undergoing hemiarthroplasty following fractured neck of femur.

METHODS

Participants were randomized 1:1 in permuted blocks to FAW or RFW. Hypothermia was defined as a temperature of <36°C at the end of surgery. Primary outcomes were the number of participants recruited and the number with definitive deep surgical site infections.

FINDINGS

A total of 515 participants were randomized at six sites over a period of 18 months. Follow-up was completed for 70.1%. Thirty-seven participants were hypothermic (7.5% in the FAW group; 9.7% in the RFW group). The mean temperatures before anaesthesia and at the end of surgery were similar. For the primary clinical outcome, there were four deep surgical site infections in the FAW group and three in the RFW group. All participants who developed a postoperative infection had antibiotic prophylaxis, a cemented prosthesis, and were operated under laminar airflow; none was hypothermic. There were no serious adverse events related to warming.

CONCLUSION

Surgical site infections were identified in both groups. Progression from the pilot to the full trial is possible but will need to take account of the high attrition rate.

PGR - 1 A Pediatric Case Study of Autism Spectrum Disorder Associated with Germinal Matrix-Intraventricular Hemorrhage, Periventricular Leukomalacia, and Cerebral Palsy

Objective

Germinal matrix-intraventricular hemorrhage (GMH-IVH) is a serious complication of prematurity that places infants at risk for damage to important white matter pathways which can result in periventricular leukomalacia (PVL) and ultimately cerebral palsy (CP). GMH-IVH also increases the risk of developmental and intellectual disabilities for preterm infants, highlighting the need for early detection and treatment.

Method

This case study presents on the neuropsychological profile of a 4-year-old boy who was born micropremature and had a history of multiple hemorrhages, extensive PVL, and CP in the context of significant developmental and social delays.

Results

Neuropsychological testing revealed severe impairments in intellectual functioning (Stanford Binet-5 FSIQ = 42, Nonverbal IQ = 43, Verbal IQ = 47; Leiter-3 Nonverbal IQ = 41), adaptive skills, language, social cognition, visuomotor abilities, spatial skills, pre-academic skills, and attention/executive functioning. He scored in the significant range on measures specific to Autism Spectrum Disorder (ADOS-2; CARS-2; SCQ) and behavioral-emotional functioning. Lastly, he exhibited intermittent staring behaviors that were concerning for possible seizure activity.

Conclusions

Recommendations were made to increase special education services for the child and to modify his academic goals. Recommendations were also given to aid in treatment planning for his referring neurologist and clinical interventions (e.g., ABA, social work, speech/language, occupational therapy, and physical therapy). This case study demonstrates the need for early neuropsychological detection and treatment for children with complications of prematurity during this important period of brain development, particularly as there are higher rates of autism in this population. Prompt detection leads to earlier treatment and better outcomes.

B-09 Cerebral Grey Matter After Out-Of-Hospital Cardiac Arrest In Good Outcome Survivors

Objective

The purpose of this study was to evaluate the impact of out-of-hospital cardiac arrest (OHCA) on cognitive functioning and brain volumes, in good outcome survivors.

Method

Participants were medically stable OHCA survivors. Two control groups were also recruited: patients who experienced myocardial infarction (MI), and healthy controls (HC) with no history of cardiovascular disease. Neuropsychological assessment was conducted using the Neuropsychological Assessment Battery (NAB). Imaging was performed on a 3T Siemens Trio MRI scanner. Cerebral grey matter volume (GM; measured by voxel-based morphometry in SPM12) results are presented.

Results

Participants (nOHCA = 9, nMI = 19, nHC = 13) ranged in age from 30 to 85 years. When controlling for age, whole-brain analyses revealed decreased GM in anterior cingulate cortex, bilateral hippocampus in the OHCA and in the MI group compared to the HC group. In addition, the MI group had decreased GM compared to the HC in the thalamus and the right dorsolateral prefrontal cortex (p < .001). No significant differences in GM were observed between the MI and OHCA groups. The hippocampus was selected as a region-of-interest for further analyses. The Total NAB Index was correlated with hippocampal GM in the OHCA group but not in the MI group (rOHCA = .78, p = .014).

Conclusions

Results revealed select areas of GM reduction in OHCA and MI groups, suggesting a contribution of cardiovascular disease to observed atrophy. Reductions are related to cognitive performance only in the cardiac arrest group which may suggest that these volume losses represent clinically meaningful changes.

Treatment in thrombotic antiphospholipid syndrome: a review

Antiphospholipid syndrome an autoimmune disease characterized by thrombosis and/or pregnancy morbidity alongside the presence of antiphospholipid antibodies (aPL). This review evaluates primary and secondary thromboprophylaxis in patients with aPL and thrombotic events. In primary thromboprophylaxis a risk-stratified approach is needed based on aPL, comorbidity with other autoimmune conditions and cardiovascular vascular risk factors. In primary thromboprophylaxis, the efficacy of low-dose aspirin is debatable and requires better-designed controlled studies. So far warfarin has not been shown to improve venous and/or arterial thrombosis incidence in aPL carriers and instead increased safety concerns. The benefit of hydroxychloroquine is inconclusive despite promising data, requiring large, controlled trials. For secondary thromboprophylaxis warfarin seems to be the best option with potential in renal transplant recipients and better efficacy at high intensity, although maintenance of target international normalized ratio needs careful monitoring. Aspirin has not shown to be beneficial, and data on rivaroxaban are limited and contradictory. Despite all data being informative, there are limitations that need to be addressed with robust clinical trials.

Total hip arthroplasty following failed intertrochanteric hip fracture fixation treated with a cephalomedullary nail

AIMS

Cephalomedullary nails (CMNs) are commonly used for the treatment of intertrochanteric hip fractures. Total hip arthroplasty (THA) may be used as a salvage procedure when fixation fails in these patients. The aim of this study was to analyze the complications of THA following failed intertrochanteric hip fracture fixation using a CMN.

PATIENTS AND METHODS

Patients who underwent THA were identified from the 5% subset of Medicare Parts A/B between 2002 and 2015. A subgroup involving those with an intertrochanteric fracture that was treated using a CMN during the previous five years was identified and compared with the remaining patients who underwent THA. The length of stay (LOS) was compared using both univariate and multivariate analysis. The incidence of infection, dislocation, revision, and re-admission was compared between the two groups, using multivariate analysis adjusted for demographic, hospital, and clinical factors.

RESULTS

The Medicare data yielded 56 522 patients who underwent primary THA, of whom 369 had previously been treated with a CMN. The percentage of THAs that were undertaken between 2002 and 2005 in patients who had previously been treated with a CMN (0.346%) more than doubled between 2012 and 2015 (0.781%). The CMN group tended to be older and female, and to have a higher Charlson Comorbidity Index and lower socioeconomic status. The mean LOS was 1.5 days longer (5.3 vs 3.8) in the CMN group (p < 0.0001). The incidence of complications was significantly higher in the CMN group compared with the non-CMN group: infection (6.2% vs 2.6%), dislocation (8.1% vs 4.5%), revision (8.4% vs 4.3%), revision for infection (1.1% vs 0.37%), and revision for dislocation (2.2% vs 0.6%).

CONCLUSION

The incidence of conversion to THA following failed intertrochanteric hip fracture fixation using a CMN continues to increase. This occurs in elderly patients with increased comorbidities. There is a significantly increased risk of infection, dislocation, and LOS in these patients. Patients with failed intertrochanteric hip fracture fixation using a CMN who require THA should be made aware of the increased risk of complications, and steps need to be taken to reduce this risk. Cite this article: Bone Joint J 2019;101-B(6 Supple B):91-96.

Electronic Longitudinal Alcohol Study in Communities (ELAStiC) Wales - protocol for platform development

Introduction

Excessive alcohol consumption has adverse effects on health and there is a recognised need for the longitudinal analysis of population data to improve our understanding of the patterns of alcohol use, harms to consumers and those in their immediate environment. The UK has a number of linkable, longitudinal databases that if assembled properly could support valuable research on this topic.

Aims and Objectives

This paper describes the development of a broad set of cross-linked cohorts, e-cohorts, surveys and linked electronic healthcare records (EHRs) to construct an alcohol-specific analytical platform in the United Kingdom using datasets on the population of Wales.The objective of this paper is to provide a description of existing key datasets integrated with existing, routinely collected electronic health data on a secure platform, and relevant derived variables to enable population-based research on alcohol-related harm in Wales. We illustrate our use of these data with some exemplar research questions that are currently under investigation.

Methods

Record-linkage of routine and observational datasets. Routine data includes hospital admissions, general practice, and cohorts specific to children. Two observational studies were included. Routine socioeconomic descriptors and mortality data were also linked.

Conclusion

We described a record-linked, population-based research protocol for alcohol related harm on a secure platform. As the datasets used here are available in many countries, ELAStiC provides a template for setting up similar initiatives in other countries. We have also defined a number of alcohol specific variables using routinely-collected available data that can be used in other epidemiological studies into alcohol related outcomes. With over 10 years of longitudinal data, it will help to understand alcohol-related disease and health trajectories across the lifespan.

Moving toward the elimination of cervical cancer: modelling the health and economic benefits of increasing uptake of human papillomavirus vaccines

Background

The human papillomavirus (hpv) is a common sexually transmitted infection and a primary cause of cervical cancer. The Government of Canada has set a target of reaching 90% hpv vaccine coverage among adolescents by 2025. Here, we examine hpv vaccine uptake in school-based immunization programs across Canada and explore how achieving the 90% target could affect the future incidence of cervical cancer, mortality, and health system expenditures in a cohort of Canadian women.

Methods

Data for hpv vaccine uptake in the most recent reported school year available in each jurisdiction were provided in 2017 by jurisdictional school-based immunization programs and were used to estimate a national weighted average of 67%. The OncoSim microsimulation model (version 2.5) was used to compare 3 different levels of hpv vaccine uptake (0%, 67%, 90%) on health and economic outcomes for a hypothetical cohort of all 5- to 10-year-old girls in Canada in 2015.

Results

Vaccine uptake for girls in school-based programs varied from 55.0% to 92.0% in the jurisdictions reviewed. The OncoSim model projects that increasing uptake to 90% from 67% would result in a 23% reduction in cervical cancer incidence rates (to 3.1 cases from 4.0 cases per 100,000, averaged across the lifetime of the cohort) and a 23% decline in the average annual mortality rate (to 1.0 deaths from 1.3 deaths per 100,000). Finally, the model projects that the health system will incur a cost of $9 million (1% increase) during the lifetime of the cohort if uptake is increased to 90% from 67%. Costs are discounted (1.5%) and expressed in 2016 Canadian dollars. Costs reflect the payer perspective.

Conclusions

Our model shows that increasing hpv vaccine uptake to 90% from current levels for girls in school-based immunization programs could result in substantial reductions in the future incidence and mortality rates for cervical cancer in Canada.

Meconium Ileus in Two Irish Newborns: The Presenting Feature of Cystic Fibrosis

Introduction Meconium Ileus (MI) is the presenting feature of CF in approximately 10-15% of cases. This report outlines the clinical presentation, imaging and management of two neonates with MI and subsequent diagnosis of Cystic Fibrosis (CF). Methods A retrospective chart review was performed to evaluate the clinical course of two neonates with MI. Results Case 1 and 2 presented clinically with signs of abdominal obstruction. Subsequent laparotomies confirmed MI. MI is strongly associated with CF and CF is the most common genetically inherited disease in Ireland. Genetic testing was positive for a homozygous ∆ F508 mutation in both case 1 and 2, securing a diagnosis of MI secondary to CF. Conclusion Our cases highlight that all infants born in Ireland with MI should be considered as CF positive until proven otherwise.

Prospective observational study of vaginal microbiota pre- and post-rescue cervical cerclage

OBJECTIVE

To investigate the relation between vaginal microbiota composition and outcome of rescue cervical cerclage.

DESIGN

Prospective observational study.

SETTING

Queen Charlotte's and Chelsea Hospital, London.

POPULATION

Twenty singleton pregnancies undergoing a rescue cervical cerclage.

METHODS

Vaginal microbiota composition was analysed in women presenting with a dilated cervix and exposed fetal membranes before and 10 days following rescue cervical cerclage and was correlated with clinical outcomes.

MAIN OUTCOME MEASURES

Composition of vaginal bacteria was characterised by culture-independent next generation sequencing. Successful cerclage was defined as that resulting in the birth of a neonate discharged from hospital without morbidity. Unsuccessful cerclage was defined as procedures culminating in miscarriage, intrauterine death, neonatal death or significant neonatal morbidity.

RESULTS

Reduced Lactobacillus spp. relative abundance was observed in 40% of cases prior to rescue cerclage compared with 10% of gestation age-matched controls (8/20, 40% versus 3/30, 10%, P = 0.017). Gardnerella vaginalis was over-represented in women presenting with symptoms (3/7, 43% versus 0/13, 0%, P = 0.03, linear discriminant analysis, LDA (log 10) and cases culminating in miscarriage (3/6, 50% versus 0/14, 0%, P = 0.017). In the majority of cases (10/14, 71%) bacterial composition was unchanged following cerclage insertion and perioperative interventions.

CONCLUSIONS

Reduced relative abundance of Lactobacillus spp. is associated with premature cervical dilation, whereas high levels of G. vaginalis are associated with unsuccessful rescue cerclage cases. The insertion of a rescue cerclage does not affect the underlying bacterial composition in the majority of cases.

TWEETABLE ABSTRACT

Preterm cervical dilatation associates with reduced Lactobacillus spp. Presence of Gardnerella vaginalis predicts rescue cerclage failure.

Abstract P1-12-04: Preliminary evaluation of a mind-body intervention to improve body and/or self-image: A phase II randomized trial

Background: The number of cancer survivors is growing and expected to be 18.9 million by 2024. Addressing survivorship issues, such as sexual health, are a critical part of health promotion. Women diagnosed with breast or gynecologic cancer can experience distressing changes in their self and/or body image, which affects their sexual health. This study evaluates hypnosis compared to progressive muscle relaxation (PMR) to improve self/body image in order to improve sexuality.

Methods: Women with a history of breast or gynecologic cancer, who also report negative body image changes, were randomized in a 2:1 fashion to a 6-week intervention of hypnotic relaxation or PMR. Both intervention arms consisted of three 30-minute sessions delivered face-to-face by a trained therapist, one every two weeks, along with home practice using a CD. The primary outcome was impact of treatment on body image using the Impact of Treatment Scale (ITS). Secondary outcomes included mood (Positive/Negative Affect Scale-PANAS), sexual satisfaction (PROMIS satisfaction), and perceived change (Global Impression of Change Scale -GCIS). Outcomes were measured at baseline and 6 weeks except for the GCIS measured only at 6 weeks. A series of independent samples t-tests were used to compare changes in outcome measures between arms. The intention-to-treat principle was applied.

Results: The final randomized sample consisted of 87 women. There was no statistically significant difference (p=.15) in the change in ITS between groups at 6 weeks, with both groups significantly improving (within group effect size Cohen's d .49 - .75). There were non-significant differences between groups on secondary outcomes. Change from baseline for positive affect (PANAS) was 1.7 in the hypnosis group and 3.8 in the PMR group while negative affect change was very similar being about 2.8 in both groups. Change from baseline for the PROMIS general sexual satisfaction scale was 1.5 in the hypnosis group and 1.3 in the PMR group. On the GCIS at 6 weeks, 42% of the hypnosis group reported moderate to very much improvement on self/body image (GCIS) while only 32% of the PMR group reported this level of improvement; and 36% of the hypnosis group versus 11% of the PMR group reported moderate to very much improvement in their sexuality.

Implications: The stress relieving strategies applied in this study may contribute substantially to decreasing the distress of the cancer experience related to altered self/body image and sexuality. The variable improvement across domains suggests that hypnosis and PMR may work in different ways, mechanistically. Further mechanistic studies of interventions to optimally promote survivorship health are warranted.

Citation Format: Barton D, Brooks T, Cieslak A, Elkins G, Clark P, Baydoun M, Smith A, VanPoznak C. Preliminary evaluation of a mind-body intervention to improve body and/or self-image: A phase II randomized trial [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-12-04.