Randomized controlled trial demonstrates novel tools to assess patient outcomes of Indigenous cultural safety training

BACKGROUND

Health care routinely fails Indigenous peoples and anti-Indigenous racism is common in clinical encounters. Clinical training programs aimed to enhance Indigenous cultural safety (ICS) rely on learner reported impact assessment even though clinician self-assessment is poorly correlated with observational or patient outcome reporting. We aimed to compare the clinical impacts of intensive and brief ICS training to control, and to assess the feasibility of ICS training evaluation tools, including unannounced Indigenous standardized patient (UISP) visits.

METHOD

Using a prospective parallel group three-arm randomized controlled trial design and masked standardized patients, we compared the clinical impacts of the intensive interactive, professionally facilitated, 8- to10-h Sanyas ICS training; a brief 1-h anti-bias training adapted to address anti-Indigenous bias; and control continuing medical education time-attention matched to the intensive training. Participants included 58 non-Indigenous staff physicians, resident physicians and nurse practitioners from family practice clinics, and one emergency department across four teaching hospitals in Toronto, Canada. Main outcome measures were the quality of care provided during UISP visits including adjusted odds that clinician would be recommended by the UISP to a friend or family member; mean item scores on patient experience of care measure; and clinical practice guideline adherence for NSAID renewal and pain assessment.

RESULTS

Clinicians in the intensive or brief ICS groups had higher adjusted odds of being highly recommended to friends and family by standardized patients (OR 6.88, 95% CI 1.17 to 40.45 and OR 7.78, 95% CI 1.05 to 58.03, respectively). Adjusted mean item patient experience scores were 46% (95% CI 12% to 80%) and 40% (95% CI 2% to 78%) higher for clinicians enrolled in the intensive and brief training programs, respectively, compared to control. Small sample size precluded detection of training impacts on clinical practice guideline adherence; 100% of UISP visits were undetected by participating clinicians.

CONCLUSIONS

Patient-oriented evaluation design and tools including UISPs were demonstrated as feasible and effective. Results show potential impact of cultural safety training on patient recommendation of clinician and improved patient experience. A larger trial to further ascertain impact on clinical practice is needed.

TRIAL REGISTRATION

Clinicaltrials.org NCT05890144. Retrospectively registered on June 5, 2023.

Cryptococcal laryngitis in an immunocompetent asthmatic patient using inhaled corticosteroids

We present a case of laryngeal cryptococcosis caused by cryptococcosis neoformans var. grubii affecting a patient using excessive inhaled corticosteroids. The patient experienced symptoms for several months prior to specialist review and the visualization of a mass lesion by nasopharyngoscopy. Fortunately a biopsy was performed and through histopathology & microbiological assessment a diagnosis of cryptococcal laryngitis was made. Treatment with 6 months of fluconazole resulted in clinical cure and resolution of symptoms. It is important to raise awareness of the risk of non-Candida fungal infections in patients on high dose corticosteroids, especially in the post covid era were steroids are more commonly prescribed.

Sarcina sp. as a presumptive cause of fatal acute gastric dilation and gastric emphysema in rhesus macaques

A 4-y-old female and 3-y-old male rhesus macaque (Macaca mulatta), both housed in the same facility, died unexpectedly within 2 wk. Postmortem examination revealed severe gastric dilation in both macaques and gastric emphysema in the female macaque. Histologically, bacteria consistent with Sarcina sp. were present in both macaques within the lungs and lumen of the trachea, esophagus, and gastrointestinal (GI) tract without associated inflammation. Additionally, in the female macaque, the bacteria were found in the gastric mucosa and associated with emphysematous spaces in the gastric wall without associated inflammation. PCR and Sanger sequencing of amplicons were subsequently performed on GI contents and non-alimentary tissues from the 2 affected monkeys and on comparative samples from unaffected rhesus monkeys in the same facility and an adjacent primate facility. The cases were compared using the 2-tailed Fisher exact test (p-value at 95% confidence). PCR identified Sarcina in GI contents of both affected and unaffected monkeys (p = 0.6084) and in non-alimentary tissues of affected monkeys only (p = 0.0083). These results suggest that the presence of Sarcina sp. in non-alimentary tissues is associated with gastric distension, gas accumulation, and unexpected death in nonhuman primates.

The effect of preference and actual days spent working from home on stress and musculoskeletal pain in older workers

OBJECTIVES

The rapid shift to working from home (WFH) due to the COVID-19 pandemic provided a unique opportunity to examine the relationship between preferred and actual days spent working from home on employees musculoskeletal pain (MSP) and stress in older workers.

METHODS

This study uses three waves of data from the Employees Working from Home (EWFH) study collected in May 2021 (n = 451), November 2021 (n = 358) and May 2022 (n = 320) during the COVID-19 pandemic. A generalised mixed-effect model was used to model the relationships between preference and actual days spent WFH, stress and MSP. Exploratory mediation analysis was conducted to further explore significant relationships between actual days WFH and outcomes.

RESULTS

WFH was associated with increasing stress levels in older participants, when the actual number of days WFH increased (B: 0.051, 95% CI: 0.008, 0.094) and when the number of days WFH exceeded their preferences (B: 0.218, 95% CI: 0.087, 0.349). Actual number of days spent WFH and stress in older employees was mediated through their sense of community (Indirect effect: 0.014, 95% CI: 0.003, 0.03; p = 0.006). The relationship between WFH and MSP was variable. For older employees, WFH more than their preferred number of days was associated with a higher likelihood of reporting MSP (OR: 4.070, 95% CI: 1.204, 13.757).

CONCLUSIONS

Findings from this study support the need for flexible policies to support WFH which take into account employees preferences. For older workers, a sense of community was found to be important and proactive attempts to restore this will be important for maintain their health and supporting sustainable employment.

Single-cell RNA sequencing of neurofibromas reveals a tumor microenvironment favorable for neural regeneration and immune suppression in a neurofibromatosis type 1 porcine model

Neurofibromatosis Type 1 (NF1) is one of the most common genetically inherited disorders that affects 1 in 3000 children annually. Clinical manifestations vary widely but nearly always include the development of cutaneous, plexiform and diffuse neurofibromas that are managed over many years. Recent single-cell transcriptomics profiling efforts of neurofibromas have begun to reveal cell signaling processes. However, the cell signaling networks in mature, non-cutaneous neurofibromas remain unexplored. Here, we present insights into the cellular composition and signaling within mature neurofibromas, contrasting with normal adjacent tissue, in a porcine model of NF1 using single-cell RNA sequencing (scRNA-seq) analysis and histopathological characterization. These neurofibromas exhibited classic diffuse-type histologic morphology and expected patterns of S100, SOX10, GFAP, and CD34 immunohistochemistry. The porcine mature neurofibromas closely resemble human neurofibromas histologically and contain all known cellular components of their human counterparts. The scRNA-seq confirmed the presence of all expected cell types within these neurofibromas and identified novel populations of fibroblasts and immune cells, which may contribute to the tumor microenvironment by suppressing inflammation, promoting M2 macrophage polarization, increasing fibrosis, and driving the proliferation of Schwann cells. Notably, we identified tumor-associated IDO1 +/CD274+ (PD-L1) + dendritic cells, which represent the first such observation in any NF1 animal model and suggest the role of the upregulation of immune checkpoints in mature neurofibromas. Finally, we observed that cell types in the tumor microenvironment are poised to promote immune evasion, extracellular matrix reconstruction, and nerve regeneration.

Influences on reproductive decision-making among forcibly displaced women resettling in high-income countries: a scoping review and thematic analysis

BACKGROUND

Forced displacement impacts the health, rights and safety of women, which is further compounded by gender inequality. In particular, this has consequences for forcibly displaced women's reproductive health once resettled in a new country. To ensure the reproductive health and rights of forcibly displaced women during and after resettlement, there must be careful consideration of their reproductive decision-making taking into account the context and environment of the host country.

AIM

This scoping review aimed to explore the influences on reproductive decision-making among forcibly displaced women resettling in high-income countries.

METHOD

A scoping review was conducted following the PRISMA-ScR for reporting. EBSCO was used to search databases covering global health, health policy, psychology, sociology, and philosophy for articles published from 1 January 2012 to 27 April 2022. Data extracted from each article included author(s), year of publication, publication type, aims/objectives, study design, sampling method, data collection or eligibility criteria, study population (i.e., sample size and characteristics), migration status, country(ies) of origin, host country(ies), key findings and limitations. Two independent reviewers screened all articles against eligibility criteria using Covidence. Data charting and thematic analysis were performed independently by one reviewer.

FINDINGS

Nineteen articles published between 2013 and 2022 mostly conducted in the United States (36.8%) and Australia (21.1%), with the majority reporting on qualitative findings (68.4%), and women from a wide array of countries and cultures (most commonly African countries) were included. Influences on women's reproductive decision-making related to the contexts before displacement, during displacement, and after arrival, with influences on women's reproductive decision-making identified specific to the context. The influences before displacement included conflict; religious beliefs; socio-cultural gendered expectations; and external control over reproductive autonomy. During displacement influences included paternalism and access to education. Influences after arrival included pressure, restriction, coercion; knowledge and misconceptions; patriarchal power dynamics; and seeking empowerment. An adapted socio-ecological model was developed to interpret the findings.

CONCLUSION

This review highlights the complexity and nuances within forcibly displaced women's experiences which influence their reproductive decision-making. Further research may review the evidence base to provide guidance for healthcare professionals and health policies aimed at empowering women to make autonomous reproductive decisions; develop training for healthcare professionals to prevent pressure, restriction and coercion of women's reproductive autonomy; and inform development of policy that takes an intersectional approach to women's health rights and gender equality.

In Vivo Adaptive Bayesian Regularized Lagrangian Carotid Strain Imaging for Murine Carotid Arteries and Its Associations With Histological Findings

OBJECTIVES

Non-invasive methods for monitoring arterial health and identifying early injury to optimize treatment for patients are desirable. The objective of this study was to demonstrate the use of an adaptive Bayesian regularized Lagrangian carotid strain imaging (ABR-LCSI) algorithm for monitoring of atherogenesis in a murine model and examine associations between the ultrasound strain measures and histology.

METHODS

Ultrasound radiofrequency (RF) data were acquired from both the right and left common carotid artery (CCA) of 10 (5 male and 5 female) ApoE tm1Unc/J mice at 6, 16 and 24 wk. Lagrangian accumulated axial, lateral and shear strain images and three strain indices-maximum accumulated strain index (MASI), peak mean strain of full region of interest (ROI) index (PMSRI) and strain at peak axial displacement index (SPADI)-were estimated using the ABR-LCSI algorithm. Mice were euthanized (n = 2 at 6 and 16 wk, n = 6 at 24 wk) for histology examination.

RESULTS

Sex-specific differences in strain indices of mice at 6, 16 and 24 wk were observed. For male mice, axial PMSRI and SPADI changed significantly from 6 to 24 wk (mean axial PMSRI at 6 wk = 14.10 ± 5.33% and that at 24 wk = -3.03 ± 5.61%, p < 0.001). For female mice, lateral MASI increased significantly from 6 to 24 wk (mean lateral MASI at 6 wk = 10.26 ± 3.13% and that at 24 wk = 16.42 ± 7.15%, p = 0.048). Both cohorts exhibited strong associations with ex vivo histological findings (male mice: correlation between number of elastin fibers and axial PMSRI: rs = 0.83, p = 0.01; female mice: correlation between shear MASI and plaque score: rs = 0.77, p = 0.009).

CONCLUSION

The results indicate that ABR-LCSI can be used to measure arterial wall strain in a murine model and that changes in strain are associated with changes in arterial wall structure and plaque formation.

Do work-family conflict or family-work conflict mediate relationships between work-related hazards and stress and pain?

INTRODUCTION

Previous research has identified associations between work-family conflict (WFC) and health outcomes (e.g., musculoskeletal pain). This study investigated whether WFC and family-work conflict explain relationships between exposure to work-related hazards and musculoskeletal pain and stress for workers undertaking some or all of their work at home. Possible differences by home workspace location were also explored.

METHODS

Longitudinal survey data were collected from workers in Australia engaged in work from home for at least two days per week. Data was collected at four timepoints approximately 6 months apart (Baseline [October 2020] n = 897; Wave 1 [May/June 2021] n = 368; Wave 2 [October/November 2021] n = 336; Wave 3 [May 2022] n = 269). Subjective measures of work-related psychosocial hazards, occupational sitting and physical activity, musculoskeletal pain, and stress were collected via an online questionnaire. Mediation analyses were conducted using the R package "mediation." Analyses were also conducted with the data set stratified by home office location, using R version 4.1.3.

RESULTS

Both WFC and family-work conflict acted as mediators between psychosocial work-related hazards and musculoskeletal pain and stress. WFC mediated more relationships than family-work conflict. Location of home workspace was important, particularly for those working in a space at home where they may be subject to interruptions.

CONCLUSION

Addressing WFC is a legitimate means through which musculoskeletal pain and stress can be reduced. Organizational risk management strategies need to address all work-related risks, including those stemming from work-life interaction.

Changes in carotid artery texture by ultrasound and elastin features in a murine model

OBJECTIVE

In humans, arterial grayscale ultrasound texture features independently predict adverse cardiovascular disease (CVD) events and change with medical interventions. We performed this study to examine how grayscale ultrasound texture features and elastin fibers change in plaque-free segments of the arterial wall in a murine model prone to atherosclerosis.

METHODS

A total of 10 Apoetm1Unc/J mice (n = 5 male, n = 5 female) were imaged at 6, 16, and 24 weeks of age. Two mice were euthanized at 6 and 16 weeks and the remaining mice at 24 weeks. Texture features were extracted from the ultrasound images of the distal 1.0 mm of the common carotid artery wall, and elastin measures were extracted from histology images. Two-way analysis of variance was used to evaluate associations between week, sex, and grayscale texture features. Texture feature and elastin number comparisons between weeks were conducted using the sex-by-week two-way interaction contrasts. Sex-specific correlations between the number of elastin fibers and grayscale texture features were analyzed by conducting non-parametric Spearman's rank correlation analyses.

RESULTS

Arterial wall homogeneity changed significantly in male mice from 6 to 24 weeks, with a mean (SD) of 0.14 (0.03) units at 6 weeks and 0.18 (0.03) units at 24 weeks (p = 0.026). Spatial gray level dependence matrices-homogeneity (SGLD-HOM) also correlated with carotid artery plaque score (rs = 0.707, p = 0.033). Elastin fibers in the region of interest decreased from 6 to 24 weeks for both male and female mice, although only significantly in male mice. The mean (SD) number of elastin fibers for male mice was 5.32 (1.50) at 6 weeks and 3.59 (0.38) at 24 weeks (p = 0.023). For female mice, the mean (SD) number of elastin fibers was 3.98 (0.38) at 6 weeks and 3.46 (0.19) at 24 weeks (p = 0.051).

CONCLUSION

Grayscale ultrasound texture features that are associated with increased risk for CVD events in humans were used in a murine model, and the grayscale texture feature SGLD-HOM was shown to change in male mice from 6 weeks to 24 weeks. Structural alterations of the arterial wall (change in elastin fiber number) were observed during this time and may differ by sex.

Re-defining reproductive coercion using a socio-ecological lens: a scoping review

BACKGROUND

Reproductive coercion is a significant public health issue in Australia which has mainly been conceptualised as a form of violence at the interpersonal level. This limited scope ignores the role of the gendered drivers of violence and fails to encompass a socio-ecological lens which is necessary to consider the multiple interacting layers that create the context in which reproductive coercion occurs. The aim of the scoping review was to explore how the reproductive coercion is defined by international research. Specifically, how is reproductive coercion defined at the social-cultural-systems-structural levels, and are the definitions of reproductive coercion inclusive of the conditions and contexts in which reproductive coercion occurs?

METHODS

A scoping review was undertaken to explore existing definitions of reproductive coercion. Searches were conducted on Embase, Cochrane Library, Informit Health Collection, and the EBSCOHost platform. Google was also searched for relevant grey literature. Articles were included if they were: theoretical research, reviews, empirical primary research, grey literature or books; published between January 2018 and May 2022; written in English; and focused on females aged 18-50 years. Data from eligible articles were deductively extracted and inductively thematically analysed to identify themes describing how reproductive coercion is defined.

RESULTS

A total of 24 articles were included in the scoping review. Most research defined reproductive coercion at the interpersonal level with only eight articles partially considering and four articles fully considering the socio-cultural-systems-structural level. Thematic analysis identified four main themes in reproductive coercion definitions: Individual external exertion of control over a woman's reproductive autonomy; Systems and structures; Social and cultural determinants; and Freedom from external forces to achieve reproductive autonomy.

CONCLUSIONS

We argue for and propose a more inclusive definition of reproductive coercion that considers the gendered nature of reproductive coercion, and is linked to power, oppression and inequality, which is and can be perpetrated and/or facilitated at the interpersonal, community, organisational, institutional, systems, and societal levels as well as by the state.

Validation of CT-based ventilation and perfusion biomarkers with histopathology confirms radiation-induced pulmonary changes in a porcine model

Imaging biomarkers can assess disease progression or prognoses and are valuable tools to help guide interventions. Particularly in lung imaging, biomarkers present an opportunity to extract regional information that is more robust to the patient's condition prior to intervention than current gold standard pulmonary function tests (PFTs). This regional aspect has particular use in functional avoidance radiation therapy (RT) in which treatment planning is optimized to avoid regions of high function with the goal of sparing functional lung and improving patient quality of life post-RT. To execute functional avoidance, detailed dose-response models need to be developed to identify regions which should be protected. Previous studies have begun to do this, but for these models to be clinically translated, they need to be validated. This work validates two metrics that encompass the main components of lung function (ventilation and perfusion) through post-mortem histopathology performed in a novel porcine model. With these methods validated, we can use them to study the nuanced radiation-induced changes in lung function and develop more advanced models.

The victims, villains and heroes of 'panic buying': News media attribution of responsibility for COVID-19 stockpiling

Societies often respond to a crisis by attributing blame to some groups while constructing others as victims and heroes. While it has received scant sociological attention, 'panic buying' is a critical indicator of such public sentiment at the onset of a crisis, and thus a crucial site for analysis. This article traces dynamics of blame in news media representations of an extreme period of panic buying during COVID-19 in Australia. Analysis reveals that lower socio-economic and ethnically diverse consumers were blamed disproportionately. Unlike wealthier consumers who bulk-bought online, shoppers filling trollies in-store were depicted as selfish and shameful, described using dehumanising language, and portrayed as 'villains' who threatened social order. Supermarkets were cast simultaneously as 'victims' of consumer aggression and 'heroes' for their moral leadership, trustworthiness and problem-solving. This portrayal misunderstands the socio-emotional drivers of panic buying, exacerbates stigma towards already disadvantaged groups, and veils the corporate profiteering that encourages stockpiling.

Insecticide resistance compromises the control of Aedes aegypti in Bangladesh

BACKGROUND

With no effective drugs or widely available vaccines, dengue control in Bangladesh is dependent on targeting the primary vector Aedes aegypti with insecticides and larval source management. Despite these interventions, the dengue burden is increasing in Bangladesh, and the country experienced its worst outbreak in 2019 with 101 354 hospitalized cases. This may be partially facilitated by the presence of intense insecticide resistance in vector populations. Here, we describe the intensity and mechanisms of resistance to insecticides commonly deployed against Ae. aegypti in Dhaka, Bangladesh.

RESULTS

Dhaka Ae. aegypti colonies exhibited high-intensity resistance to pyrethroids. Using CDC bottle assays, we recorded 2-24% mortality (recorded at 24 h) to permethrin and 48-94% mortality to deltamethrin, at 10× the diagnostic dose. Bioassays conducted using insecticide-synergist combinations suggested that metabolic mechanisms were contributing to pyrethroid resistance, specifically multi-function oxidases, esterases, and glutathione S-transferases. In addition, kdr alleles were detected, with a high frequency (78-98%) of homozygotes for the V1016G mutation. A large proportion (≤ 74%) of free-flying and resting mosquitoes from Dhaka colonies survived exposure to standard applications of pyrethroid aerosols in an experimental free-flight room. Although that exposure affected the immediate host-seeking behavior of Ae. aegypti, the effect was transient in surviving mosquitoes.

CONCLUSION

The intense resistance characterized in this study is likely compromising the operational effectiveness of pyrethroids against Ae. aegypti in Dhaka. Switching to alternative chemical classes may offer a medium-term solution, but ultimately a more sustainable and effective approach to controlling dengue vectors is required. © 2023 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Employees Working from Home: Do Leadership Factors Influence Work-Related Stress and Musculoskeletal Pain?

In March 2020, the COVID-19 pandemic necessitated a rapid public health response, which included mandatory working from home (WFH) for many employees. However, given the rapid change from traditional ways of working, evidence is limited on the role of leaders, managers, and supervisors in supporting their employees' physical and mental health whilst WFH. The study aimed to examine the impact of leaders through their management of psychosocial working conditions on employees' stress and musculoskeletal pain (MSP) levels whilst WFH.

METHODS

Data from 965 participants (230 males, 729 females, 6 other) involved in the Employees Working from Home (EWFH) study, collected in October 2020, and April and November 2021, were analysed. Generalised mixed-effect models were used to test relationships between psychosocial leadership factors and employees' stress and MSP levels.

RESULTS

Higher quantitative demands are associated with increased stress (B: 0.289, 95%CI 0.245, 0.333), presence of MSP (OR: 2.397, 95%CI 1.809, 3.177), and increased MSP levels (RR: 1.09, 95%CI 1.04, 1.14). Higher levels of vertical trust decreased stress (B: -0.094, 95%CI -0.135, -0.052) and presence of MSP (OR: 0.729, 95%CI 0.557, 0.954). Role clarity decreased stress (B: -0.055, 95%CI -0.104, -0.007) and levels of MSP (RR: 0.93, 95%CI 0.89, 0.96). Working with interruptions was associated with increased stress (B: 0.199, 95%CI 0.119, 0.280) and MSP (OR: 1.834, 95%CI 1.094, 3.072).

CONCLUSION

Leaders will need to take a broad view of job design, taking into account physical and psychosocial aspects of work, to effectively support employees WFH and manage stress and MSP.

Working from home during the COVID 19 pandemic: a longitudinal examination of employees' sense of community and social support and impacts on self-rated health

BACKGROUND

The COVID 19 pandemic resulted in the introduction of public health measures including mandated and recommended work from home orders to reduce transmission. This provided a unique opportunity to examine sense of community and social support within the workplace and self-rated general health. This paper examines employees' workplace sense of community and social support across one year of the COVID 19 pandemic and associated self-rated general health.

METHODS

Analysis of longitudinal data (October 2020, May 2021, and November 2021) from the Employees Working from Home study conducted in Victoria, Australia during the COVID 19 pandemic was undertaken. Trajectory analyses were used to describe workplace sense of community and social support over time. Multinomial logistic regression was used to determine the associations between demographics, gender, caring responsibilities, and group membership based on the Growth Mixture Modelling. Generalised Mixed Models were used to measure effects of sense of community and social support on self-rated health.

RESULTS

Increasing sense of community and social support in the workplace resulted in increased self-rated health. Trajectory analysis found two stable and distinct groups for sense of community. Social support varied with time; however, trajectory membership was not dependent on gender or caring responsibilities and had no relationship with return to the office.

CONCLUSION

Sense of community and social support in the workplace are important determinants of employees' health, and as such, workplace strategies to improve sense of community and social support are required not only for employees working from home, but also those who have returned to the office, particularly as hybrid work arrangements become more common.

In Vivo Longitudinal Monitoring of Cardiac Remodeling in Murine Ischemia Models With Adaptive Bayesian Regularized Cardiac Strain Imaging: Validation Against Histology

Adaptive Bayesian regularized cardiac strain imaging (ABR-CSI) uses raw radiofrequency signals to estimate myocardial wall contractility as a surrogate measure of relative tissue elasticity incorporating regularization in the Bayesian sense. We determined the feasibility of using ABR-CSI -derived strain for in vivo longitudinal monitoring of cardiac remodeling in a murine ischemic injury model (myocardial infarction [MI] and ischemia-reperfusion [IR]) and validated the findings against ground truth histology. We randomly stratified 30 BALB/CJ mice (17 females, 13 males, median age = 10 wk) into three surgical groups (MI = 10, IR = 12, sham = 8) and imaged pre-surgery (baseline) and 1, 2, 7 and 14 d post-surgery using a pre-clinical high-frequency ultrasound system (VisualSonics Vevo 2100). We then used ABR-CSI to estimate end-systolic and peak radial (er) and longitudinal (el) strain estimates. ABR-CSI was found to have the ability to serially monitor non-uniform cardiac remodeling associated with murine MI and IR non-invasively through temporal variation of strain estimates post-surgery. Furthermore, radial end-systole (ES) strain images and segmental strain curves exhibited improved discrimination among infarct, border and remote regions around the myocardium compared with longitudinal strain results. For example, the MI group had significantly lower (Friedman's with Bonferroni-Dunn test, p = 0.002) ES er values in the anterior middle (infarcted) region at day 14 (n = 9, 9.23 ± 7.39%) compared with the BL group (n = 9, 44.32 ± 5.49). In contrast, anterior basal (remote region) mean ES er values did not differ significantly (non-significant Friedman's test, χ2 = 8.93, p = 0.06) at day 14 (n = 6, 33.05 ± 6.99%) compared with baseline (n = 6, 34.02 ± 6.75%). Histology slides stained with Masson's trichrome (MT) together with a machine learning model (random forest classifier) were used to derive the ground truth cardiac fibrosis parameter termed histology percentage of myocardial fibrosis (PMF). Both radial and longitudinal strain were found to have strong statistically significant correlations with the PMF parameter. However, radial strain had a higher Spearman's correlation value (εresρ = -0.67, n = 172, p < 0.001) compared with longitudinal strain (εlesρ = -0.60, n = 172, p < 0.001). Overall, the results of this study indicate that ABR-CSI can reliably perform non-invasive detection of infarcted and remote myocardium in small animal studies.

A Multilevel Grounded Theory of Quantitative Job Quality Among Mothers, Fathers and Childless Women and Men in a Gendered, Classed and Aged "Growth-Driven" Organisation

Poor quality jobs, incorporating job demands, resources and rewards, can impact employees' health and wellbeing inside and outside work. However, jobs' changing nature and employees' increasingly diverse backgrounds mean existing job quality models may not adequately explain individuals' job quality experiences within their individual, organisational and societal contexts. The paper aimed to understand mothers, fathers and childless women and men's gendered, classed and aged experiences of quantitative job demands (including work amount, speed, effort, length and timing) and their resources and rewards, within multilevel contexts. We conducted a qualitative case-study of an Australian organisation, employing a critical feminist grounded theory design. We collected and analysed data from open-ended questionnaire responses from 47 employees and iterative in-depth interviews with 10 employees. Participants' experiences of excessive quantitative demands, whether they could meet such demands, and whether they felt extrinsically or intrinsically resourced and rewarded for doing so, were embedded within ComCo's masculine-neoliberal-capitalist growth imperative, cultures, policies and practices reinforcing growth, and quantitatively extreme and qualitatively conformant ideal worker discourses, as well as participants' organisationally and societally-embedded individual, family and community-level contexts; producing nuanced gendered, classed and aged experiences among mothers, fathers and childless women and men. Although confirming well-established objective job quality dimensions, our research suggests individuals' nuanced and subjective job quality experiences are embedded within individual, family, community, organisational and societal contexts.

Who do Australian women seek social support from during the reproductive decision-making process?

Limited evidence exists about women's experiences of social support for reproductive decision-making, particularly who women seek social support from during decision-making. Using a concurrent mixed methods approach, this research explored who women aged 25-35 years living in Victoria, Australia, seek social support from during reproductive decision-making. Women seek social support for reproductive decision-making from multiple sources. However, through exploring women's support seeking for reproductive decision-making, rather than once a reproductive decision had been made, the study highlights the nuanced and contextual nature of support seeking for reproductive decision-making demonstrating support seeking is influenced by: type of reproductive decision; women's relationships with members of their social network; previous experiences of support seeking for reproductive decisions; expectations of the support they would receive; homophily; and temporality. This research provides important insight into who women seek support from for reproductive decision-making. Understanding this will help inform future social and public health interventions.

183 DEVELOPING AND FACILITATING ONLINE INTERGENERATIONAL CAFÉS

Background

Many older people throughout their lives will require nursing care, consequentially most nurses will care for older people during their career. It is important that older people and student nurses are provided with shared learning opportunities so that professional caring partnerships can be nurtured and realised for mutual benefit. Intergenerational projects offer opportunities for intergenerational learning. However, few projects explore student nurse-older person dyads and how these can be integrated within undergraduate pre-registration programmes. This paper describes the development and facilitation of online older person-student nurse intergenerational cafés.

Methods

The project was managed by a design team comprising senior administration, lecturers in BSc Nursing programmes and a lecturer in Design for Health and Wellbeing. The ‘world café’ concept along with values of enablement and participation underpinned the design. The initiative was planned to align with a year three community care module. Regular online team meetings were held to agree the aims and outcomes for student nurse-older person cohorts, decide recruitment strategies, agree the process and format of facilitation. Older people were recruited through retirement, church, volunteer, social and sporting organisations, media and also using snowballing methods.

Results

Both student nurse and older person cohorts were offered support on how to access and participate in the café. Participants attended one of three online cafés hosted through Microsoft Teams. Each café followed the same format: 1) Group meeting convened with all participants; 2) Breakout small group ‘table’ discussions with student nurse-older people participants and design team facilitation; 3) The café was reconvened to whole group meeting where feedback was collated to elicit shared learning.

Conclusion

The initiative proved successful and there is merit in embedding intergenerational cafés into professionally accredited health care programmes. Through sharing life experiences and perspectives, intergenerational barriers can be reduced and new insights developed on person-centred gerontological care.

Wolbachia wAlbB inhibit dengue and Zika infection in the mosquito Aedes aegypti with an Australian background

Biological control of mosquito vectors using the endosymbiotic bacteria Wolbachia is an emerging strategy for the management of human arboviral diseases. We recently described the development of a strain of Aedes aegypti infected with the Wolbachia strain wAlbB (referred to as the wAlbB2-F4 strain) through simple backcrossing of wild type Australian mosquitoes with a wAlbB infected Ae. aegypti strain from the USA. Field releases of male wAlbB2-F4 mosquitoes resulted in the successful suppression of wild populations of mosquitoes in the trial sites by exploiting the strain's Wolbachia-induced cytoplasmic incompatibility. We now demonstrate that the strain is resistant to infection by dengue and Zika viruses and is genetically similar to endemic Queensland populations. There was a fourfold reduction in the proportion of wAlbB2-F4 mosquitoes that became infected following a blood meal containing dengue 2 virus (16.7%) compared to wild type mosquitoes (69.2%) and a 6-7 fold reduction in the proportion of wAlbB2-F4 mosquitoes producing virus in saliva following a blood meal containing an epidemic strain of Zika virus (8.7% in comparison to 58.3% in wild type mosquitoes). Restriction-site Associated DNA (RAD) sequencing revealed that wAlbB2-F4 mosquitoes have > 98% Australian ancestry, confirming the successful introduction of the wAlbB2 infection into the Australian genomic background through backcrossing. Genotypic and phenotypic analyses showed the wAlbB2-F4 strain retains the insecticide susceptible phenotype and genotype of native Australian mosquitoes. We demonstrate that the Wolbachia wAlbB2-F4, in addition to being suitable for population suppression programs, can also be effective in population replacement programs given its inhibition of virus infection in mosquitoes. The ease at which a target mosquito population can be transfected with wAlbB2, while retaining the genotypes and phenotypes of the target population, shows the utility of this strain for controlling the Ae. aegypti mosquitoes and the pathogens they transmit.

Working From Home During COVID-19: Does Work-Family Conflict Mediate the Relationship Between Workplace Characteristics, Job Satisfaction, and General Health?

OBJECTIVE

The aim of the study is to investigate whether work-family conflict and/or family-work conflict mediated the relationship between workplace characteristics and general health and job satisfaction in a sample of workers working from home in a recommended/mandatory context due to COVID-19 measures.

METHODS

Data were collected via online questionnaire as part of the Employees Working from Home study. Analyses in this article used data collected at 2 time points 6 months apart, including 965 complete responses from the first questionnaire and 451 complete responses from the second questionnaire.

RESULTS

Relationships between predictor and outcome variables were in the directions expected, and both work-family conflict and family-work conflict mediated these relationships.

CONCLUSIONS

Work-life interaction partly explains the relationship between work characteristics and general health and job satisfaction health in a population undertaking involuntary working from home.

Serological evidence of possible high levels of undetected transmission of Zika virus among Papua New Guinea military personnel, 2019

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In total, 208 Papua New Guinea military personnel (PNGMP) participated in this survey.

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The overall seroprevalence of Zika virus IgG using indirect enzyme-linked immunosorbent assay was 67%.

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The overall seroprevalence of Zika virus by neutralizing assay was 65%.

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Five of 19 anti-ZIKV-IgM⁺ samples met the criteria of the World Health Organization for confirmed ZIKV infection.

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An undetected Zika virus outbreak may have occurred in PNGMP in 2019.

Objectives

The Papua New Guinea (PNG) Health Department retrospectively reported six cases of Zika virus (ZIKV) from a cohort of febrile patients during outbreaks of dengue and malaria in 2016. However, the transmission of ZIKV remains unclear due to lack of testing capability. This study aimed to determine the level of immunity to ZIKV among PNG military personnel (PNGMP) in 2019.

Methods

Sera of 208 PNGMP recruited in April 2019 was tested for the presence of anti-ZIKV immunoglobulin G (IgG) and M (IgM) antibodies using Euroimmun IgG/IgM detection kits, and anti-ZIKV neutralizing antibody (Nab) against a ZIKV African strain on all anti-ZIKV-IgG/IgM⁺ samples.

Results

Anti-ZIKV seropositivity of these sera was as follows: IgG, 67%; IgM, 9%; and Nab, 65%. Five of 19 anti-ZIKV-IgM⁺ samples had anti-ZIKV-Nab titres ≥20, as well as an anti-ZIKV-Nab titre ratio ≥4 compared with the Nab titres of four anti-dengue serotypes, so met the criteria of the World Health Organization (WHO) for confirmed ZIKV infection.

Conclusions

The prevalence of anti-ZIKV-Nab of 65% suggests that there are high levels of ZIKV exposure among PNGMP. Five of the 19 anti-ZIKV-IgM⁺ samples met the WHO criteria for confirmed ZIKV infection, suggesting a recent undetected outbreak in PNGMP. These results provide better understanding of the current ZIKV epidemic status in PNGMP.

Strategies to manage working from home during the pandemic: the employee experience

Many Australian workers were mandated to work from home during the COVID-19 pandemic. Using a qualitative approach, this study aimed to identify optimal work from home management strategies, by analysing the experience of Australian employees working from home (WFH) during this time. A purposive sample, drawn from the Australian Employees Working from Home Study, of managers and non-managers from a range of sectors, was invited to participate in focus groups. Data were analysed using thematic analysis and mapped to the work-systems framework approach to determine strategies implemented to support WFH. Most participants' experiences were more negative than positive, in part due to extreme lockdowns including curfews, with childcare and school closures compounding their WFH experiences. Effective workplace-initiated strategies to optimise WFH included: management support of flexible work hours; provision of necessary equipment with ICT support; regular online communication; performance management adjustments; and manager training.

Seroprevalence of chikungunya virus among military personnel in Papua New Guinea, 2019

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The seroprevalence of chikungunya virus was investigated among military personnel in Papua New Guinea.

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The seroprevalence of anti-chikungunya virus immunoglobulin G antibodies on enzyme-linked immunosorbent assay was 47%.

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The seroprevalence of anti-chikungunya virus neutralizing antibodies was 35%.

Objectives

The first outbreak of chikungunya virus (CHIKV) was reported in West Sepik, Papua New Guinea (PNG) in June 2012, and spread rapidly throughout PNG. CHIKV imported from PNG to Queensland has been reported occasionally, but transmission of CHIKV in PNG remains unclear due to the lack of testing capability. This study investigated the degree of CHIKV exposure among PNG military personnel (PNGMP) in 2019, 7 years after its first emergence.

Methods

Sera of 204 PNGMP recruited in April 2019 was tested for the presence of anti-CHIKV immunoglobulin G (IgG) antibodies using a commercially available IgG detection kit, and anti-CHIKV neutralizing antibodies against a CHIKV Reunion strain using a neutralizing assay.

Results

Anti-CHIKV seropositivity of the sera was 47% and 35%, respectively, using the enzyme-linked immunosorbent assay (ELISA) and neutralizing assay. Five percent (n=11) of samples were found to be IgG negative or borderline, but neutralizing antibody positive.

Conclusions

The prevalence of anti-CHIKV neutralizing antibody of 35% suggests that CHIKV infection has become endemic among PNGMP. Current commercially available CHIKV ELISA detection kits may not be suitable for diagnostic purposes in multiple alphavirus endemic areas such as PNG, due to serological cross-reactivity among alphaviruses. Re-emergence of CHIKV in PNGMP is possible.

Murine cardiac fibrosis localization using adaptive Bayesian cardiac strain imaging in vivo

An adaptive Bayesian regularized cardiac strain imaging (ABR-CSI) algorithm for in vivo murine myocardial function assessment is presented. We report on 31 BALB/CJ mice (n = 17 females, n = 14 males), randomly stratified into three surgical groups: myocardial infarction (MI, n = 10), ischemia–reperfusion (IR, n = 13) and control (sham, n = 8) imaged pre-surgery (baseline- BL), and 1, 2, 7 and 14 days post-surgery using a high frequency ultrasound imaging system (Vevo 2100). End-systole (ES) radial and longitudinal strain images were used to generate cardiac fibrosis maps using binary thresholding. Percentage fibrotic myocardium (PFM) computed from regional fibrosis maps demonstrated statistically significant differences post-surgery in scar regions. For example, the MI group had significantly higher PFM_Radial (%) values in the anterior mid region (p = 0.006) at Day 14 (n = 8, 42.30 ± 14.57) compared to BL (n = 12, 1.32 ± 0.85). A random forest classifier automatically detected fibrotic regions from ground truth Masson’s trichrome stained histopathology whole slide images. Both PFM_Radial (r = 0.70) and PFM_Longitudinal (r = 0.60) results demonstrated strong, positive correlation with PFM_{Histopathology} (p < 0.001).

Working from home in Australia during the COVID-19 pandemic: cross-sectional results from the Employees Working From Home (EWFH) study

OBJECTIVES

To investigate the impacts, on mental and physical health, of a mandatory shift to working from home during the COVID-19 pandemic.

DESIGN

Cross sectional, online survey.

SETTING

Online survey was conducted from September 2020 to November 2020 in the general population.

PARTICIPANTS

Australian residents working from home for at least 2 days a week at some time in 2020 during the COVID-19 pandemic.

MAIN OUTCOME MEASURES

Demographics, caring responsibilities, working from home arrangements, work-related technology, work-family interface, psychosocial and physical working conditions, and reported stress and musculoskeletal pain.

RESULTS

924 Australians responded to the online questionnaire. Respondents were mostly women (75.5%) based in Victoria (83.7%) and employed in the education and training and healthcare sectors. Approximately 70% of respondents worked five or more days from home, with only 60% having a dedicated workstation in an uninterrupted space. Over 70% of all respondents reported experiencing musculoskeletal pain or discomfort. Gendered differences were observed; men reported higher levels of family to work conflict (3.16±1.52 to 2.94±1.59, p=0.031), and lower levels of recognition for their work (3.75±1.03 to 3.96±1.06, p=0.004), compared with women. For women, stress (2.94±0.92 to 2.66±0.88, p<0.001) and neck/shoulder pain (4.50±2.90 to 3.51±2.84, p<0.001) were higher than men and they also reported more concerns about their job security than men (3.01±1.33 to 2.78±1.40, p=0.043).

CONCLUSIONS

Preliminary evidence from the current study suggests that working from home may impact employees' physical and mental health, and that this impact is likely to be gendered. Although further analysis is required, these data provide insights into further research opportunities needed to assist employers in optimising working from home conditions and reduce the potential negative physical and mental health impacts on their employees.

NSW Cannabis Medicines Advisory Service preliminary survey results - Enquirer perceptions and patient outcomes

Background

In 2018, an innovative, State government‐funded cannabis medicines drug information service was established for health professionals in New South Wales (NSW). The NSW Cannabis Medicines Advisory Service (CMAS) provides expert clinical guidance and support to medical practitioners considering prescribing a cannabis medicine to their patient(s).

Aims

This research examines quality assurance and patient outcomes related to enquirers' experience with NSW CMAS.

Methods

Data collection involved an online, anonymous survey with two components. Following a health professional enquiry, quality assurance data were collected about the enquirers' experience with NSW CMAS. The second survey focussed on patient outcomes and provides real‐world observational data about cannabis medicines safety and effectiveness across a wide range of indications.

Results

Data collection occurred between January 2020 and June 2021. Preliminary analyses were based on 68 quality assurance and 50 patient outcomes survey responses. General practitioners represented the highest proportion of survey responses (n = 33; 49%). The most common enquiry involved ‘patient‐specific advice’ (n = 50; 74%). Patient‐specific information provided by the service was mainly used for prescribing decision support (n = 45; 90%).

Conclusions

Preliminary findings highlight the impact of an innovative cannabis medicines drug information service in supporting health professional clinical practice in an area of rapid knowledge translation. Quality assurance data indicate that the service is perceived well by the majority of enquirers. Patient outcomes data across a wide range of indications suggest some effectiveness and a reasonable safety profile for prescribed cannabis medicines for most patients.

Bayesian Regularized Strain Imaging for Assessment of Murine Cardiac Function In vivo

A cardiac strain imaging framework with adaptive Bayesian regularization (ABR) is proposed for in vivo assessment of murine cardiac function. The framework uses ultrasound (US) radio-frequency data collected with a high frequency (f_c = 30MHz) imaging system and a multi-level block matching algorithm with ABR to derive inter-frame cardiac displacements. Lagrangian cardiac strain (radial, e_r and longitudinal, e_l) tensors were derived by segmenting the myocardial wall starting at the ECG R-wave and accumulating interframe deformations over a cardiac cycle. In vivo feasibility was investigated through a longitudinal study with two mice (one ischemia-perfusion (IR) injury and one sham) imaged at five sessions (pre-surgery (BL) and 1,2,7 and 14 days post-surgery). End-systole (ES) strain images and segmental strain curves were derived for quantitative evaluation. Both mice showed periodic variation of e_r and e_l strain at BL with segmental synchroneity. Infarcted regions of IR mouse at Day 14 were associated with reduced or sign reversed ES e_r and e_l values while the sham mouse had similar or higher strain than at BL. Infarcted regions identified in vivo were associated with increased collagen content confirmed with Masson's Trichrome stained ex vivo heart sections.Clinical Relevance-Higher quality cardiac strain images derived with RF data and Bayesian regularization can potentially improve the sensitivity and accuracy of non-invasive assessment of cardiovascular disease models.

Working at Home: The Impacts of COVID 19 on Health, Family-Work-Life Conflict, Gender, and Parental Responsibilities

OBJECTIVE

To examine the impact of working at home on general health, pain, stress, and work-family and family-work conflict, and differences based on gender and parental responsibilities.

METHODS

A convenience sample of 658 adults completed an online questionnaire. Regression modeling examined the effects and interactions of gender and parental responsibility on general health, musculoskeletal discomfort/pain frequency and severity, stress, and work-family and family-work conflict.

RESULTS

Women reported more pain and discomfort, regardless of the presence of children, than men with children. Women with children experienced increased stress compared with men with children. Women without children experienced less work-family conflict, and those without children experienced less family-work conflict than men with children.

CONCLUSIONS

The impact on pain, stress, and work-family and family-work conflict, due to mandated working at home, is gendered and influenced by parental responsibilities.

Trends in cardiovascular mortality of cancer patients in the US over two decades 1999–2019

Background

Cancer is the second most common cause of death globally after cardiovascular (CV) disease. The present study sought to compare the trends in CV mortality between patients with and without cancer in the US over two decades (1999 to 2019), stratified by sociodemographic factors such as age, sex and geographical location.

Methods

In this retrospective study, the number of deaths, crude- and age-adjusted mortality rates between January 1, 1999, and December 31, 2019, were obtained from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) data set

Results

We examined a total of 53,422,612 deaths between 1999 and 2019; of which 33.4% were defined as CV mortality and 25.6% had malignancy. During this period, among patients with cancer, the age-adjusted mortality rate dropped by 52%. (Vs, 38% in patients with no malignancy). CV mortality was highest in patients with gastrointestinal and prostate malignancy where CV mortality accounts together for over 40% of all CV mortality in patients with cancer in 1999 and 33.6% in 2019. The age-adjusted CV mortality rate (per 100,000 people) of patients with GI and prostate cancer nearly halved over twenty years from 2.7 to 1.0 and 2.5 to 1.0.

The CV age-adjusted mortality rate dropped more significantly among patients with gastrointestinal, breast, and prostate malignancy than among patients with hematological malignancy (59–63% vs. 41%. We observed that crude CV mortality rates amongst patients with cancer declined over the study period in all age groups but was more prominent among patients over 65 years old than those aged 55–64 and under 55 (51%-55% Vs. 41%, 25%, respectively).Similar reductions in mortality in men and women (54% and 53% reduction) were observed

During the study period the decline in cardiovascular mortality was more prominent in metro areas which led to lower age adjusted CV mortality in Metro compared to non-Metro areas (5.7–6.3 vs 7.2). The decline in age adjusted CV mortality in patients with cancer differed significantly in different states

Conclusions

In our temporal analysis we show a 50% decline in CV mortality in the US over two decades in both male and female patients with cancer, that has exceeded the reduction in CV mortality seen in the non-cancer population. The greatest reductions in CV mortality were observed in patients with GI, breast and prostate malignancies, those residing in metro areas and in patients aged 65 and over.

Funding Acknowledgement

Type of funding sources: None. CV death among cancer patients

Sugar prevalence in Aedes albopictus differs by habitat, sex and time of day on Masig Island, Torres Strait, Australia

Background

Sugar feeding is a fundamental behaviour of many mosquito species. For Aedes albopictus, an important vector of dengue virus and chikungunya virus, little is known about its sugar-feeding behaviour, and no studies have been conducted on this in the southern hemisphere. This knowledge is pivotal for determining the potential of attractive targeted sugar baits (ATSBs) to control this important vector.

Methods

The prevalence of sugar was assessed in 1808 Ae. albopictus from Masig Island, Torres Strait, Australia collected between 13 and 25 March 2020. Fructose presence and content in field-collected Ae. albopictus were quantified using the cold anthrone assay.

Results

Significantly more male (35.8%) than female (28.4%) Ae. albopictus were sugar fed. There was a significant interaction between sex and time of day on the probability of capturing sugar-fed Ae. albopictus. For both sexes, fructose prevalence and content were higher in mosquitoes caught in the morning than in the afternoon. Female Ae. albopictus collected in the residential habitat were significantly more likely to be sugar fed than those collected in the woodland habitat.

Conclusions

These findings provide baseline information about the sugar-feeding patterns of Ae. albopictus and provide essential information to enable an assessment of the potential of ATSBs for vector suppression and control on Masig Island, with relevance to other locations where this species occurs.

Graphical abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s13071-021-05020-w.

Improving the Sexual Health of Young People (under 25) in High-Risk Populations: A Systematic Review of Behavioural and Psychosocial Interventions

Background: Ensuring young people experience good sexual health is a key public health concern, yet some vulnerable groups of young people remain at higher risk of poor sexual health. These individuals require additional support to achieve good sexual health but the best way to provide this remains needs to be better understood. Methods: We searched for randomised controlled trials of behavioural and psychosocial interventions aimed at promoting sexual health in high-risk young populations. Outcomes of interest were indicators of sexual health (e.g., condom use, attitudes to contraception, knowledge of risk). Participants were under 25 years old and in one of the following high-risk groups: alcohol and other drug use; ethnic minority; homeless; justice-involved; LGBTQI+; mental ill-health; or out-of-home care. Results: Twenty-eight papers from 26 trials met our inclusion criteria, with all but one conducted in North America. Condom use was the most frequently reported outcome measure along with knowledge and attitudes towards sexual health but considerable differences in measures used made comparisons across studies difficult. Change in knowledge and attitudes did not consistently result in long-term change in behaviours. Conclusions: There remains a dearth of research undertaken outside of North America across all high-risk groups of young people. Future interventions should address sexual health more broadly than just the absence of negative biological outcomes, with LGBTQI+, homeless and mental ill-health populations targeted for such work. An international consensus on outcome measures would support the research field going forward, making future meta-analyses possible.

Longitudinal evaluation of laboratory-based serological assays for SARS-CoV-2 antibody detection

Serological assays for SARS-CoV-2 infection are now widely available for use in diagnostic laboratories. Limited data are available on the performance characteristics in different settings, and at time periods remote from the initial infection. Validation of the Abbott (Architect SARS-CoV-2 IgG), DiaSorin (Liaison SARS-CoV-2 S1/S2 IgG) and Roche (Cobas Elecsys Anti-SARS-CoV-2) assays was undertaken utilising 217 serum samples from 131 participants up to 7 months following COVID-19 infection. The Abbott and DiaSorin assays were implemented into routine laboratory workflow, with outcomes reported for 2764 clinical specimens. Sensitivity and specificity were concordant with the range reported by the manufacturers for all assays. Sensitivity across the convalescent period was highest for the Roche at 95.2-100% (95% CI 81.0-100%), then the DiaSorin at 88.1-100% (95% CI 76.0-100%), followed by the Abbott 68.2-100% (95% CI 53.4-100%). Sensitivity of the Abbott assay fell from approximately 5 months; on this assay paired serum samples for 45 participants showed a significant drop in the signal-to-cut-off ratio and 10 sero-reversion events. When used in clinical practice, all samples testing positive by both DiaSorin and Abbott assays were confirmed as true positive results. In this low prevalence setting, despite high laboratory specificity, the positive predictive value of a single positive assay was low. Comprehensive validation of serological assays is necessary to determine the optimal assay for each diagnostic setting. In this low prevalence setting we found implementation of two assays with different antibody targets maximised sensitivity and specificity, with confirmatory testing necessary for any sample which was positive in only one assay.

Prospects for beyond the Standard Model physics searches at the Deep Underground Neutrino Experiment: DUNE Collaboration

The Deep Underground Neutrino Experiment (DUNE) will be a powerful tool for a variety of physics topics. The high-intensity proton beams provide a large neutrino flux, sampled by a near detector system consisting of a combination of capable precision detectors, and by the massive far detector system located deep underground. This configuration sets up DUNE as a machine for discovery, as it enables opportunities not only to perform precision neutrino measurements that may uncover deviations from the present three-flavor mixing paradigm, but also to discover new particles and unveil new interactions and symmetries beyond those predicted in the Standard Model (SM). Of the many potential beyond the Standard Model (BSM) topics DUNE will probe, this paper presents a selection of studies quantifying DUNE's sensitivities to sterile neutrino mixing, heavy neutral leptons, non-standard interactions, CPT symmetry violation, Lorentz invariance violation, neutrino trident production, dark matter from both beam induced and cosmogenic sources, baryon number violation, and other new physics topics that complement those at high-energy colliders and significantly extend the present reach.

A rapid review of mental and physical health effects of working at home: how do we optimise health?

BACKGROUND

The coronavirus (COVID-19) pandemic has resulted in changes to the working arrangements of millions of employees who are now based at home and may continue to work at home, in some capacity, for the foreseeable future. Decisions on how to promote employees' health whilst working at home (WAH) need to be based on the best available evidence to optimise worker outcomes. The aim of this rapid review was to review the impact of WAH on individual workers' mental and physical health, and determine any gender difference, to develop recommendations for employers and employees to optimise workers' health.

METHOD

A search was undertaken in three databases, PsychInfo, ProQuest, and Web of Science, from 2007 to May 2020. Selection criteria included studies which involved employees who regularly worked at home, and specifically reported on physical or mental health-related outcomes. Two review authors independently screened studies for inclusion, one author extracted data and conducted risk of bias assessments with review by a second author.

RESULTS

Twenty-three papers meet the selection criteria for this review. Ten health outcomes were reported: pain, self-reported health, safety, well-being, stress, depression, fatigue, quality of life, strain and happiness. The impact on health outcomes was strongly influenced by the degree of organisational support available to employees, colleague support, social connectedness (outside of work), and levels of work to family conflict. Overall, women were less likely to experience improved health outcomes when WAH.

CONCLUSIONS

This review identified several health outcomes affected by WAH. The health/work relationship is complex and requires consideration of broader system factors to optimise the effects of WAH on workers' health. It is likely mandated WAH will continue to some degree for the foreseeable future; organisations will need to implement formalised WAH policies that consider work-home boundary management support, role clarity, workload, performance indicators, technical support, facilitation of co-worker networking, and training for managers.

Social Support and Women's Reproductive Decision Making: Testing Emergent Fit of "Optimizing Support for the Preservation of Self"

Despite the strong association between social support and positive health outcomes, little is understood about its role in women's reproductive decision making. Developing insight into how women perceive, mobilize, and experience social support is critical to understanding their lived experiences of reproductive decision making and to implementing appropriate supporting structures to help women realize their reproductive choices. In this study, emergent fit with existing inductive research on the phenomenon of reproductive support is discussed. The existing theory of "optimizing social support for the preservation of self" and its underpinning categorical framework is maintained, but the extant categorical themes were all nuanced, refined, replaced, or removed to better reflect the support phenomenon among a wider cohort of women. This article builds on the existing knowledge base by producing a substantive theory of "optimizing social support for the preservation of self" with wider applicability.

The SLAC RCE Platform for ProtoDUNE

The ProtoDUNE-SP is a single-phase liquid argon time projection chamber (LArTPC) prototype for the Deep Underground Neutrino Experiment (DUNE). Signals from 15,360 electronic channels are received by 60 Reconfigurable Cluster Elements (RCEs), which are processing elements designed at SLAC for a wide range of applications and are based upon the “system-onchip” Xilinx Zynq family of FPGAs. The RCEs are housed in industry-standard ATCA shelves on a custom blade, called the Cluster on Board (COB). The RCE platform and its processing functions for the ProtoDUNE-SP will be presented.

Macrophages Educated with Exosomes from Primed Mesenchymal Stem Cells Treat Acute Radiation Syndrome by Promoting Hematopoietic Recovery

In the setting of radiation-induced trauma, exposure to high levels of radiation can cause an acute radiation syndrome (ARS) causing bone marrow (BM) failure, leading to life-threatening infections, anemia, and thrombocytopenia. We have previously shown that human macrophages educated with human mesenchymal stem cells (MSCs) by coculture can significantly enhance survival of mice exposed to lethal irradiation. In this study, we investigated whether exosomes isolated from MSCs could replace direct coculture with MSCs to generate exosome educated macrophages (EEMs). Functionally unique phenotypes were observed by educating macrophages with exosomes from MSCs (EEMs) primed with bacterial lipopolysaccharide (LPS) at different concentrations (LPS-low EEMs or LPS-high EEMs). LPS-high EEMs were significantly more effective than uneducated macrophages, MSCs, EEMs, or LPS-low EEMs in extending survival after lethal ARS in vivo. Moreover, LPS-high EEMs significantly reduced clinical signs of radiation injury and restored hematopoietic tissue in the BM and spleen as determined by complete blood counts and histology. LPS-high EEMs showed significant increases in gene expression of STAT3, secretion of cytokines like IL-10 and IL-15, and production of growth factors like FLT-3L. LPS-EEMs also showed increased phagocytic activity, which may aid with tissue remodeling. LPS-high EEMs have the potential to be an effective cellular therapy for the management of ARS.

A comparison of four risk models for the prediction of cardiovascular complications in patients with a history of atrial fibrillation undergoing non-cardiac surgery

It is unclear how best to predict peri-operative cardiovascular risk in patients with atrial fibrillation undergoing non-cardiac surgery. This study examined the accuracy of the revised cardiac risk index and three atrial fibrillation thrombo-embolic risk models for predicting 30-day cardiovascular events after non-cardiac surgery in patients with a pre-operative history of atrial fibrillation. We conducted a prospective cohort study in 28 centres from 2007 to 2013 of 40,004 patients ≥ 45 years of age undergoing inpatient non-cardiac surgery who were followed until 30 days after surgery for cardiovascular events (defined as myocardial injury, heart failure, stroke, resuscitated cardiac arrest or cardiovascular death). The 2088 patients with a pre-operative history of atrial fibrillation were at higher risk of peri-operative cardiovascular events compared with the 34,830 patients without a history of atrial fibrillation (29% vs. 13%, respectively, adjusted odds ratio 1.30 (95%CI 1.17-1.45). Compared with the revised cardiac risk index (c-index 0.60), all atrial fibrillation thrombo-embolic risk scores were significantly better at predicting peri-operative cardiovascular events: CHADS₂ (c-index 0.62); CHA₂ DS₂ -VASc (c-index 0.63); and R₂ CHADS₂ (c-index 0.65), respectively. Although the three thrombo-embolic risk prediction models were significantly better than the revised cardiac risk index for prediction of peri-operative cardiovascular events, none of the four models exhibited strong discrimination metrics. There remains a need to develop a better peri-operative risk prediction model.

Lesion distribution in cases of canine atopic dermatitis in South Australia

OBJECTIVE

To determine the lesion distribution patterns in different breeds of dogs affected by atopic dermatitis in South Australia.

METHODS

The presence or absence of erythematous skin lesions in 267 cases of canine atopic dermatitis (CAD) was recorded across 36 anatomical sites. Breeds represented by ≥ 9 dogs were included in the analysis. The percentage of dogs showing lesions at each of the body sites was calculated and illustrated on colour-coded diagrams. Variations in affected body sites within and between breeds were compared using Kruskal-Wallis ANOVA and Dunn's multiple comparison tests.

RESULTS

The prevalence of skin lesions at different body sites differed significantly both in the population as a whole and within breeds. The sites affected in ≥ 75% dogs were the dorsal and ventral aspects of the front and hind paws. The sites affected in 50-74% were the medial pinnae, axillae, ventral chest, abdomen and perineum. Sites affected in 25-49% of dogs included the face, periocular region and forelimb. Remaining body sites were affected in < 25% of dogs. Analysis at the breed level revealed some differences from this standard distribution pattern.

CONCLUSION

The results of this study confirmed the typical lesion distributions seen in CAD and highlighted some subtle differences in breeds commonly seen in South Australia. This will be useful for clinical practitioners in prioritising differential diagnoses for pruritic skin conditions.

Snapshot of medication abortion provision in the primary health care setting of regional and rural Victoria

OBJECTIVE

This study aimed to identify enablers and barriers to the provision of medication abortion in the primary health care setting of regional and rural areas of Victoria, Australia.

DESIGN

An online cross-sectional questionnaire was used.

SETTING

Regional and rural areas of Victoria, Australia.

PARTICIPANTS

Thirty-nine GPs and 30 primary health care nurses.

MAIN OUTCOME MEASURES

Abortion views, medication abortion knowledge and practice, interest in medication abortion training and provision, and perceived uptake barriers.

RESULTS

Most participants reported being consulted by women with unintended pregnancies and most of them included abortion counselling in their consultation. However, familiarity with provision of medication abortion was limited, and only five GPs and two primary health care nurses were currently medication abortion providers. The majority of participants expressed a high level of interest in receiving medication abortion training, but indicated a wide range of barriers to service provision, such as a lack of training opportunities, legal uncertainties or surgical access concerns in case of complications.

CONCLUSIONS

Findings demonstrate the need for education on medication abortion and training opportunities. Most identified barriers to service uptake are addressable and relate to a lack of local support services, including the absence of a 24-hour contact advice service, insufficient follow-up access and a lack of local ultrasound facilities. These barriers require educational programs at professional, organisational and community level to ensure that interested rural and regional primary health care providers can start offering medication abortion for their patients.