A protocol of a pilot randomised trial (Action-RESPOND) to support rural and regional communities with implementing community-based systems thinking obesity prevention initiatives

BACKGROUND

Over a quarter of children aged 2-17 years living in Australia are overweight or obese, with a higher prevalence reported in regional and remote communities. Systems thinking approaches that seek to support communities to generate and implement locally appropriate solutions targeting intertwined environmental, political, sociocultural, and individual determinants of obesity have the potential to ameliorate this. There have however been reported challenges with implementation of such initiatives, which may be strengthened by incorporating implementation science methods.

METHODS

This pilot randomised controlled trial protocol outlines the development and proposed evaluation of a multicomponent implementation strategy (Action-RESPOND). to increase the implementation of community-based systems thinking child obesity prevention initiatives The target of this intervention is ten rural and regional communities (or local government areas as the unit of allocation) within Northeast Victoria who were participants in a whole-of-systems intervention (RESPOND). Action-RESPOND builds on this intervention by assessing the impact of offering additional implementation strategies to five communities relative to usual care. The development of the multicomponent implementation strategy was informed by the Promoting Action on Research Implementation in Health Services (PARIHS) framework and consists of seven implementation strategies primarily delivered via 'facilitation' methods. Implementation strategies aimed to ensure initiatives implemented are i) evidence-based, ii) address community's specific needs and iii) are suitable for local context. Strategies also aimed to increase the community's capacity to implement, through iv) improving the health promotion team's implementation knowledge and skills, fostering v) leadership, vi) physical resources and vii) community culture to drive implementation. The feasibility, acceptability, potential impact, and cost of the strategy will be assessed at baseline and follow up using surveys administered to key representatives within the community and internal records maintained by the research team.

DISCUSSION

By leveraging an existing community-based whole-of-systems intervention, Action-RESPOND offers a unique opportunity to collect pilot feasibility and early empirical data on how to apply implementation and systems science approaches to support obesity prevention in rural and regional communities in Victoria.

A joint physics and radiobiology DREAM team vision - Towards better response prediction models to advance radiotherapy

Radiotherapy developed empirically through experience balancing tumour control and normal tissue toxicities. Early simple mathematical models formalized this practical knowledge and enabled effective cancer treatment to date. Remarkable advances in technology, computing, and experimental biology now create opportunities to incorporate this knowledge into enhanced computational models. The ESTRO DREAM (Dose Response, Experiment, Analysis, Modelling) workshop brought together experts across disciplines to pursue the vision of personalized radiotherapy for optimal outcomes through advanced modelling. The ultimate vision is leveraging quantitative models dynamically during therapy to ultimately achieve truly adaptive and biologically guided radiotherapy at the population as well as individual patient-based levels. This requires the generation of models that inform response-based adaptations, individually optimized delivery and enable biological monitoring to provide decision support to clinicians. The goal is expanding to models that can drive the realization of personalized therapy for optimal outcomes. This position paper provides their propositions that describe how innovations in biology, physics, mathematics, and data science including AI could inform models and improve predictions. It consolidates the DREAM team's consensus on scientific priorities and organizational requirements. Scientifically, it stresses the need for rigorous, multifaceted model development, comprehensive validation and clinical applicability and significance. Organizationally, it reinforces the prerequisites of interdisciplinary research and collaboration between physicians, medical physicists, radiobiologists, and computational scientists throughout model development. Solely by a shared understanding of clinical needs, biological mechanisms, and computational methods, more informed models can be created. Future research environment and support must facilitate this integrative method of operation across multiple disciplines.

The COVID-19 ambulance response assessment (CARA) study: a national survey of ambulance service healthcare professionals' preparedness and response to the COVID-19 pandemic

Background

The COVID-19 pandemic placed significant demand on the NHS, including ambulance services, but it is unclear how this affected ambulance service staff and paramedics in other clinical settings (e.g. urgent and primary care, armed services, prisons). This study aimed to measure the self-perceived preparedness and impact of the first wave of the pandemic on paramedics' psychological stress and perceived ability to deliver care.

Methods

Ambulance clinicians and paramedics working in other healthcare settings were invited to participate in a three-phase sequential online survey during the acceleration (April 2020), peak (May 2020) and deceleration (September/October 2020) phases of the first wave of COVID-19 in the United Kingdom. Recruitment used social media, Trust internal bulletins and the College of Paramedics' communication channels, employing a convenience sampling strategy. Data were collected using purposively developed open- and closed-ended questions and the validated general health questionnaire-12 (GHQ-12). Data were analysed using multi-level linear and logistic regression models.

Results

Phase 1 recruited 3717 participants, reducing to 2709 (73%) by phase 2 and 2159 (58%) by phase 3. Participants were mostly male (58%, n = 2148) and registered paramedics (n = 1992, 54%). Mean (standard deviation) GHQ-12 scores were 16.5 (5.2) during phase 1, reducing to 15.2 (6.7) by phase 3. A total of 84% of participants (n = 3112) had a GHQ-12 score ≥ 12 during the first phase, indicating psychological distress. Participants that had higher GHQ-12 scores were feeling unprepared for the pandemic, and reported a lack of confidence in using personal protective equipment and managing cardiac arrests in confirmed or suspected COVID-19 patients.

Conclusions

Most participants reported psychological distress, the reasons for which are multi-factorial. Ambulance managers need to be aware of the risks to staff mental health and take action to mitigate these, to support staff in the delivery of unscheduled, emergency and urgent care under these additional pressures.

Route of drug administration in out-of-hospital cardiac arrest: A protocol for a randomised controlled trial (PARAMEDIC-3)

Aims

The PARAMEDIC-3 trial evaluates the clinical and cost-effectiveness of an intraosseous first strategy, compared with an intravenous first strategy, for drug administration in adults who have sustained an out-of-hospital cardiac arrest.

Methods

PARAMEDIC-3 is a pragmatic, allocation concealed, open-label, multi-centre, superiority randomised controlled trial. It will recruit 15,000 patients across English and Welsh ambulance services. Adults who have sustained an out-of-hospital cardiac arrest are individually randomised to an intraosseous access first strategy or intravenous access first strategy in a 1:1 ratio through an opaque, sealed envelope system. The randomised allocation determines the route used for the first two attempts at vascular access. Participants are initially enrolled under a deferred consent model.The primary clinical-effectiveness outcome is survival at 30-days. Secondary outcomes include return of spontaneous circulation, neurological functional outcome, and health-related quality of life. Participants are followed-up to six-months following cardiac arrest. The primary health economic outcome is incremental cost per quality-adjusted life year gained.

Conclusion

The PARAMEDIC-3 trial will provide key information on the clinical and cost-effectiveness of drug route in out-of-hospital cardiac arrest.Trial registration: ISRCTN14223494, registered 16/08/2021, prospectively registered.

Microplastic pollution on historic facades: Hidden 'sink' or urban threat?

Despite the increasing concerns surrounding the health and environmental risks of microplastics (MPs), the research focus has primarily been on their prevalence in air and the oceans, consequently neglecting their presence on urban facades, which are integral to our everyday environments. Therefore, there is a crucial knowledge gap in comprehending urban MP pollution. Our pioneering interdisciplinary study not only quantifies but also identifies MPs on historic facades, revealing their pervasive presence in a medium-sized urban area in the UK. In this case study, we estimated a mean density of 975,000 fibres/m^2 (0.10 fibres/mm^2) for fibre lengths between 30 and 1000 μm with a ratio of 1:5 for natural to artificial fibres. Our research identifies three groups of fibre length frequencies across varied exposure scenarios on the investigated urban facade. Sheltered areas (4m height) show a high prevalence of 60-120 μm and 180-240 μm fibres. In contrast, less sheltered areas at 3m exhibit lower fibre frequencies but similar lengths. Notably, the lowest area (2-1.5m) features longer fibres (300-1000 μm), while adjacent area S, near a faulty gutter, shows no fibres, highlighting the impact of exposure, altitude, and environmental variables on fibre distribution on urban facades. Our findings pave one of many necessary paths forward to determine the long-term fate of these fibres and provoke a pertinent question: do historic facades serve as an urban 'sink' that mitigates potentially adverse health impacts or amplifies the effects of mobile microplastics? Addressing MP pollution in urban areas is crucial for public health and sustainable cities. More research is required to understand the multi-scale factors behind MP pollution in large cities and to find mitigation strategies, paving the way for effective interventions and policies against this growing threat.

Achievement of Target Gain Larger than Unity in an Inertial Fusion Experiment

On December 5, 2022, an indirect drive fusion implosion on the National Ignition Facility (NIF) achieved a target gain G_{target} of 1.5. This is the first laboratory demonstration of exceeding "scientific breakeven" (or G_{target}>1) where 2.05 MJ of 351 nm laser light produced 3.1 MJ of total fusion yield, a result which significantly exceeds the Lawson criterion for fusion ignition as reported in a previous NIF implosion [H. Abu-Shawareb et al. (Indirect Drive ICF Collaboration), Phys. Rev. Lett. 129, 075001 (2022)PRLTAO0031-900710.1103/PhysRevLett.129.075001]. This achievement is the culmination of more than five decades of research and gives proof that laboratory fusion, based on fundamental physics principles, is possible. This Letter reports on the target, laser, design, and experimental advancements that led to this result.

Barriers and facilitators to consuming pulses: a qualitative exploration including effects of trying recipes at home

Pulses are a healthy, sustainable, low cost food, but consumption levels are low for a variety of reasons, including practical and cooking concerns. This work aimed to explore barriers and facilitators towards pulse consumption and increasing consumption, and the potential value of cooking suggestions and recipes for changing these perceptions. Two qualitative studies were undertaken. In Study 1, 21 participants (10 males, 11 females, of a range of ages, cooking responsibilities, and experiences with pulses) were interviewed both before and after receiving cooking suggestions and recipes. In Study 2, 12 participants (2 males, 10 females, as above) were interviewed once after trying recipes. Interviews were audio-recorded, transcribed, and analysed using thematic analysis. Seven themes described barriers and facilitators towards pulse consumption: 'Enjoyment and Sensory properties'; 'Benefits and Recommendations'; 'Practical Concerns'; 'Cooking Concerns'; 'Compatibility with current diet'; 'Personal Influences'; and 'External Influences'. Some similar themes also referred to increasing consumption: 'Willingness'; 'Awareness, Knowledge of Benefits'; 'Knowledge of Cooking and Practical Concerns'; and 'Compatibility with current diet'. Cooking suggestions and recipe use resulted in themes on 'Awareness'; 'Willingness, Trying New Things'; 'Small Changes'; and facilitators associated with 'Enjoyment, Sensory Properties, Practical Concerns, Benefits' and 'Knowledge, Cooking Ideas and Confidence, Incorporation, Cooking Solutions'. Barriers related to 'Risk and Preconceptions'; 'Awareness, but' inaction and additional considerations were also found. Our findings demonstrate a positive role for pulse consumption for increased experience, familiarity, and confidence with preparing, cooking, and consuming these healthy and sustainable foods.

Response-Adapted Omission of Radiotherapy in Pediatric Patients with Intermediate- and High-Risk Hodgkin Lymphoma Treated per EuroNet-PHL-C1: A Single Institution Analysis of Outcomes and Patterns of Failure

PURPOSE/OBJECTIVE(S)

EuroNet-PHL-C1 demonstrated that 40% of intermediate- and high-risk pediatric Hodgkin lymphoma (HL) patients treated with OEPA-COPDAC chemotherapy achieved adequate response (AR) at early response assessment (ERA), and thus were able to omit radiotherapy (RT). However, patterns of failure with this treatment paradigm, and specifically, whether or not all initial sites of disease require RT for those with inadequate response (IR) at ERA is unknown. The purpose of our study is to examine outcomes and patterns of failure for those treated per EuroNet-PHL-C1 at our institution. Our hypothesis is that limiting RT to only sites of IR at ERA does not result in increased failures.

MATERIALS/METHODS

An IRB-approved retrospective review of all intermediate- and high-risk classical HL pediatric patients treated at our institution per EuroNet-PHL-C1 between 2015 and 2021 was performed. Patients were treated per protocol with radiation omitted for those with AR (Deauville 1-2 and >75% tumor shrinkage) at ERA (PET/CDT after 2 cycles of chemo). For those with IR who required RT, only sites of IR (Deauville 3-5) at ERA were treated using involved site radiation treatment (ISRT), instead of all initial sites of disease as on EuroNet-PHL-C1. Outcomes including overall survival (OS) and progression free survival (PFS) were calculated using Kaplan-Meier curves and patterns of failure were classified as either initial site only, new site only, or initial and new sites.

RESULTS

A total of 35 patients were identified, of which 33 had evaluable follow up with median follow up of 33 months. The median age at diagnosis was 14 (range, 4-18) and 48% were female. Of the 33, 7 (21%) had IR at ERA and thus required RT, while 26 (79%) were spared RT. In the group who received RT, 4/7 (57%) had initial B-symptoms and 4/7 (57%) had initial bulky disease, compared to 9/26 (35%) and 20/26 (77%), respectively, in those who did not receive RT. For our entire cohort, 2-year PFS and OS were 91% and 100%, respectively. For those who had RT, 2-year PFS was 83% compared to 92% in those who did not need RT. There was a total of 3 relapses (9%) at last follow up with 1/7 (14%) in those who had RT vs. 2/26 (8%) in those without RT. For the patient who relapsed after RT, relapse occurred both at initial and new sites. For the 2 who relapsed who did not receive RT, 1 was both in initial and new sites, while the other was initial site only.

CONCLUSION

At our institution, the majority of patients treated per EuroNet-PHL-C1 avoided RT with excellent outcomes. For those requiring RT, limiting RT to only sites of IR at ERA does not appear to adversely affect outcomes, though analysis is limited by the low number of failures.

Chemical Mixtures and Multiple Stressors: Same but Different?

Ecosystems are strongly influenced by multiple anthropogenic stressors, including a wide range of chemicals and their mixtures. Studies on the effects of multiple stressors have largely focussed on nonchemical stressors, whereas studies on chemical mixtures have largely ignored other stressors. However, both research areas face similar challenges and require similar tools and methods to predict the joint effects of chemicals or nonchemical stressors, and frameworks to integrate multiple chemical and nonchemical stressors are missing. We provide an overview of the research paradigms, tools, and methods commonly used in multiple stressor and chemical mixture research and discuss potential domains of cross-fertilization and joint challenges. First, we compare the general paradigms of ecotoxicology and (applied) ecology to explain the historical divide. Subsequently, we compare methods and approaches for the identification of interactions, stressor characterization, and designing experiments. We suggest that both multiple stressor and chemical mixture research are too focused on interactions and would benefit from integration regarding null model selection. Stressor characterization is typically more costly for chemical mixtures. While for chemical mixtures comprehensive classification systems at suborganismal level have been developed, recent classification systems for multiple stressors account for environmental context. Both research areas suffer from rather simplified experimental designs that focus on only a limited number of stressors, chemicals, and treatments. We discuss concepts that can guide more realistic designs capturing spatiotemporal stressor dynamics. We suggest that process-based and data-driven models are particularly promising to tackle the challenge of prediction of effects of chemical mixtures and nonchemical stressors on (meta-)communities and (meta-)food webs. We propose a framework to integrate the assessment of effects for multiple stressors and chemical mixtures. Environ Toxicol Chem 2023;42:1915-1936. © 2023 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.

Extra-mandibular Osteoradionecrosis after the Treatment of Head and Neck Cancer

AIMS

Osteoradionecrosis (ORN) is a serious toxicity of head and neck radiotherapy. It predominantly affects the mandible. Extra-mandibular ORN is rare. The aim of this study was to report the incidence and outcomes of extra-mandibular ORNs from a large institutional database.

MATERIALS AND METHODS

In total, 2303 head and neck cancer patients were treated with radical or adjuvant radiotherapy. Of these, extra-mandibular ORN developed in 13 patients (0.5%).

RESULTS

Maxillary ORNs (n = 8) were a consequence of the treatment of various primaries (oropharynx = 3, sinonasal = 2, maxilla = 2, parotid = 1). The median interval from the end of radiotherapy to the development of ORN was 7.5 months (range 3-42 months). The median radiotherapy dose in the centre of the ORN was 48.5 Gy (range 22-66.5 Gy). Four patients (50%) healed in 7, 14, 20 and 41 months. All temporal bone ORNs (n = 5) developed after treatment to the parotid gland (of a total of 115 patients who received radiotherapy for parotid gland malignancy). The median interval from the end of radiotherapy to the development of ORN was 41 months (range 20-68 months). The median total dose in the centre of the ORN was 63.5 Gy (range 60.2-65.3 Gy). ORN healed in only one patient after 32 months of treatment with repeated debridement and topical betamethasone cream.

CONCLUSION

Extra-mandibular ORN is a rare late toxicity and this current study provides useful information on its incidence and outcome. The risk of temporal bone ORN should be considered in the treatment of parotid malignancies and patients should be counselled. More research is required to determine the optimal management of extra-mandibular ORN, particularly on the role of the PENTOCLO regimen.

Role of Adjuvant Radiotherapy in Acinic Cell Carcinoma of the Salivary Glands: A Systematic Review

A systematic review was carried out to evaluate if adjuvant radiotherapy for acinic cell carcinomas (ACCs) of salivary glands improves survival. Twelve retrospective studies published between 2000 and 2020 that analysed the effect of radiotherapy on salivary gland neoplasms and ACCs of salivary glands and met the inclusion criteria were included in the review. The overall quality of the studies was moderate to low. There was no high-quality evidence for improved survival with radiotherapy for ACCs of the salivary gland. Some evidence suggests that there may be an advantage for patients with high-grade tumours, but these data should be interpreted with caution due to the small number of patients and low-quality evidence. Good quality of evidence is lacking. Recommendation for adjuvant radiotherapy for tumours with poor prognostic factors will require discussion and shared decision-making with the patients.

The social sciences are increasingly ill-equipped to design system-level reforms

Our social policy landscape is characterized by incrementalism, while public calls for more radical reform get louder. But the social sciences cannot be relied upon to generate a steady stream of radical, system-level policies. Long-standing trends in social science - in particular, increasing specialization, an increasing emphasis on causal inference, and the growing replication crisis - are barriers to system-level policy development.

Lived experience of participants who engaged in the co-creation of initiatives to improve children's health in a rural Australian community

OBJECTIVE

To describe participants' lived experience of co-creating and implementing initiatives to improve children's health.

DESIGN

This manuscript reports an embedded case study design, which aims to describe participants' lived experiences of co-creating community-based initiatives. Information was gathered from an online survey and two focus groups. The two transcribed discussions from the focus groups were analysed using a 6-step phenomenological process.

SETTING

Mansfield, Australia, population 4787, is one of ten local government areas (LGA) participating in the Reflexive Evidence and Systems Interventions to Prevent Obesity and Non-communicable Disease (RESPOND) project.

PARTICIPANTS

Participants were purposively selected from established community groups previously engaged by RESPOND using a co-creation approach. The recruitment for the focus groups was a convenient sampling from participants that provided their email addresses in the online survey.

RESULTS

Eleven participants completed the online survey. A total of ten participants attended the two focus groups of 1-h duration: five participants in each. Participants reported feeling empowered to create unique, locally relevant and readily adaptable community-wide change. They were supported by a strong partnership that mobilised funding for a part-time health promotion employee. Strengthened social connections were an unexpected though highly valued outcome.

CONCLUSION

Co-creation processes may assist stakeholders in delivering prevention strategies in ways that are empowering for them, responsive to the changing needs of the community, strengthen organisational partnerships and enhance community participation, social inclusion and engagement.

Perceived impacts of COVID-19 and bushfires on the implementation of an obesity prevention trial in Northeast Victoria, Australia

BACKGROUND

Calls for the adoption of a systems approach to chronic disease prevention date back at least ten years because of the potential to empower communities to identify and address the complex causes of overnutrition, undernutrition and climate change. Australia, like many countries, has high levels of obesity and extreme climate events. The Reflexive Evidence and Systems interventions to Prevent Obesity and Non-communicable Disease (RESPOND) trial aims to prevent unhealthy weight gain in children in 10 intervention and two pilot communities in north-east Victoria, Australia using community-based participatory approaches informed by systems science. Intervention activities co-designed in 2019 were disrupted by COVID-19 and bushfires. This paper explores the impacts of these 'shocks' on the local prevention workforce to implement actions within communities.

METHODS

A case study design involving one-hour online focus groups and an on-line survey (November 2021-February 2022). Purposive sampling was used to achieve diverse representation from RESPOND stakeholders including local council, health services, primary care partnerships and department of health. The focus group interview schedule and survey questions were based on Durlak and DuPre's implementation factors.

RESULTS

Twenty-nine participants from seven different communities participated in at least one of nine focus groups to discuss the impacts of COVID-19 and bushfires on localised implementation. Twenty-eight participants (97% of focus group sample) also completed the on-line survey. Implementation of RESPOND stalled or stopped in most communities due to bushfires and/or COVID-19. These shocks resulted in organisational priorities changing, loss of momentum for implementation, redeployment of human resources, culminating in fatigue and exhaustion. Participants reported adaptation of RESPOND, but implementation was slowed due to limited resources.

CONCLUSION

Further research is needed to advance risk management strategies and protect resources within health promotion. System shocks such as bushfires and COVID-19 are inevitable, and despite multiple adaptation opportunities, this intervention approach was not 'shock proof'.

What do we want? Training! When do we want it? Now? A training needs analysis for adaptive radiotherapy for therapeutic radiographers

INTRODUCTION

Therapeutic radiographers (TRs) have adapted to the changing requirements and demands of the oncology service and in response to advanced techniques such as on-line adaptive MRI-guided radiotherapy (MRIgRT). The skills required for MRIgRT would benefit many TRs not just those involved in this technique. This study presents the results of a training needs analysis (TNA) for the required MRIgRT skills in readiness for training TRs for current and future practice.

METHODS

A UK-based TNA was used to ask TRs about their knowledge and experience with essential skills required for MRIgRT based on previous investigations into the topic. A five-point Likert scale was used for each of the skills and the difference in values were used to calculate the training need for current and future practice.

RESULTS

261 responses were received (n = 261). The skill rated the most important to current practice was CBCT/CT matching and/or fusion. The current highest priority needs were radiotherapy planning and radiotherapy dosimetry. The skill rated the most important to future practice was CBCT/CT matching and/or fusion. The future highest priority needs were MRI acquisition and MRI Contouring. Over 50% of participants wanted training or additional training in all skills. There was an increase in all values for skills investigated from current to future roles.

CONCLUSION

Although the examined skills were viewed as important to current roles, the future training needs, both overall and high priority, were different compared to current roles. As the 'future' of radiotherapy can arrive rapidly, it is essential that training is delivered appropriately and timely. Before this can occur, there must be investigations into the method and delivery of this training.

IMPLICATIONS FOR PRACTICE

Role development. Education changes for therapeutic radiographers.

Tool for automatic macrozone characterization from EBSD data sets of titanium alloys

Microtexture heterogeneities are commonly found in titanium forgings because of the thermomechanical processing. Also known as macrozones, these regions can reach millimetres in length, with grains sharing a similar crystallographic orientation leading to less resistance to crack propagation. Since the link between macrozones and the reduction of cold-dwell-fatigue performance on rotative components in gas turbine engines was established, efforts have been put into macrozone definition and characterization. The electron backscatter diffraction (EBSD) technique, widely used for texture analysis, allows for a qualitative macrozone characterization; however, further processing is required to define the boundaries and disorientation spread of each macrozone. Current approaches often use c-axis misorientation criteria, but this can sometimes lead to a large disorientation spread within a macrozone. This article describes the development and application of a computational tool implemented in MATLAB for automatic macrozone identification from EBSD data sets on the basis of a more conservative approach where both the c-axis tilting and rotation are considered. The tool allows for detection of macrozones according to the disorientation angle and density-fraction criteria. The clustering efficiency is validated by pole-figure plots, and the effects of the key parameters defining the macrozone clustering (disorientation and fraction) are discussed. In addition, this tool was successfully applied to both fully equiaxed and bimodal microstructures of titanium forgings.

Extensive regional variation in the phenology of insects and their response to temperature across North America

Climate change models often assume similar responses to temperatures across a species range, but local adaptation or phenotypic plasticity can lead plants and animals to respond differently to temperature in different parts of their range. To date, there have been few tests of this assumption at the scale of continents, so it is unclear if this is a large-scale problem. Here, we examined the assumption that insect taxa show similar responses to temperature at 96 sites in grassy habitats across North America. We sampled insects with Malaise traps during 2019-2021 (N = 1041 samples) and examined the biomass of insects in relation to temperature and time of season. Our samples mostly contained Diptera (33%), Lepidoptera (19%), Hymenoptera (18%), and Coleoptera (10%). We found strong regional differences in the phenology of insects and their response to temperature, even within the same taxonomic group, habitat type and time of season. For example, biomass of nematoceran flies increased across the season in the central part of the continent, but it only showed a small increase in the northeast and a seasonal decline in the southeast and west. At a smaller scale, insect biomass at different traps operating on the same days was correlated up to about 75 km apart. Large-scale geographic and phenological variation in insect biomass and abundance has not been studied well, and it is a major source of controversy in previous analyses of insect declines that have aggregated studies from different locations and time periods. Our study illustrates that large-scale predictions about changes in insect populations, and their causes, will need to incorporate regional and taxonomic differences in the response to temperature.

Images and images: Current roles of therapeutic radiographers

INTRODUCTION

Therapeutic radiography is a small profession and has adapted in response to advanced techniques. An increase in on-line adaptive MRI-guided radiotherapy (MRIgRT) will require role extension for therapeutic radiographers (TRs). This study will investigate the current role description for TRs and the activities they currently undertake with regards to MRIgRT.

METHOD

A training needs analysis was used to ask TRs about their current roles and responsibilities and essential skills required for MRIgRT. For the purposes of this paper, the authors present the results from the demographics of the individual, their current job title with roles and responsibilities, and experience with decision making and image assessment. Descriptive statistics was used to analyse the data.

RESULTS

261 responses were received (n = 261). Only 28% of job titles listed contained the protected title of 'therapeutic radiographer'. Advanced clinical practice roles were expressed by participants indicating that if a service need is presented, emerging roles will be created. Variation existed across the standardised roles of TRs and this discrepancy could present challenges when training for MRIgRT. TRs are pivotal in image verification and recognition on a standard linac, and skills developed there can be transferred to MRIgRT. Decision making is crucial for adaptive techniques and there are many skills within their current scope of practice that are indispensable for the MRIgRT.

CONCLUSION

It has been demonstrated that TRs have a range of roles that cover vast areas of the oncology pathway and so it is important that TRs are recognised so the pivotal role they play is understood by all. TRs have extensive soft-tissue IGRT knowledge and experience, aiding the evolution of decision-making skills and application of off-protocol judgments, the basis of MRIgRT.

IMPLICATIONS FOR PRACTICE

Role development and changes in education for therapeutic radiographers.

Lawson Criterion for Ignition Exceeded in an Inertial Fusion Experiment

For more than half a century, researchers around the world have been engaged in attempts to achieve fusion ignition as a proof of principle of various fusion concepts. Following the Lawson criterion, an ignited plasma is one where the fusion heating power is high enough to overcome all the physical processes that cool the fusion plasma, creating a positive thermodynamic feedback loop with rapidly increasing temperature. In inertially confined fusion, ignition is a state where the fusion plasma can begin "burn propagation" into surrounding cold fuel, enabling the possibility of high energy gain. While "scientific breakeven" (i.e., unity target gain) has not yet been achieved (here target gain is 0.72, 1.37 MJ of fusion for 1.92 MJ of laser energy), this Letter reports the first controlled fusion experiment, using laser indirect drive, on the National Ignition Facility to produce capsule gain (here 5.8) and reach ignition by nine different formulations of the Lawson criterion.

Knowledge and attitudes toward repetitive transcranial magnetic stimulation (rTMS) as a treatment for postpartum and peripartum depression

Introduction

Postpartum and peripartum depression are debilitating disorders that impact the mother and their ability to care for their children’s emotional, social, and physical needs. Current treatments include psychotherapy, pharmacotherapy, and electroconvulsive therapy. These treatments are moderately effective or come with side effects that can negatively impact mother and child. As a result, many mothers view some treatments as unacceptable while pregnant or breastfeeding. Over the last decade, repetitive transcranial magnetic stimulation (rTMS) has shown promise as an effective and safe treatment option for postpartum and peripartum depression. However, little is known regarding people’s knowledge and attitudes towards this emerging technology, with no research assessing this in Canada.

Objectives

We aim to identify gaps in knowledge and to assess attitudes toward rTMS as a treatment for postpartum and peripartum depression in mental health professionals, patients, and the general public living in Canada.

Methods

A mixed methods study design will be employed. The qualitative portion will consist of individual semi-structured interviews. An inductive thematic analysis will be completed. The quantitative portion will consist of an anonymous, self-administered survey shared through REDCap. Focus groups with rTMS experts will be conducted to inform survey creation.

Results

No resulst at this time.

Conclusions

Understanding gaps in knowledge and attitudes toward rTMS is the first step toward ensuring that everyone is well informed and able to access safe and effective treatments. With limited treatment options available to a postpartum and/or peripartum depression patients being well informed on all treatments is crucial towards accessing treatments that best suit their needs.

Disclosure

No significant relationships.

Universal Germline Panel Testing for Individuals With Pheochromocytoma and Paraganglioma Produces High Diagnostic Yield

BACKGROUND

Practice guidelines to identify individuals with hereditary pheochromocytomas and paragangliomas (PPGLs) advocate for sequential gene testing strategy guided by specific clinical features and predate the routine use of multigene panel testing (MGPT).

OBJECTIVE

To describe results of MGPT for hereditary PPGL in a clinically and ancestrally diverse cohort.

SETTING

Commercial laboratory based in the United States.

METHODS

Clinical data and test results were retrospectively reviewed in 1727 individuals who had targeted MGPT from August 2013 through December 2019 because of a suspicion of hereditary PPGL.

RESULTS

Overall, 27.5% of individuals had a pathogenic or likely pathogenic variant (PV), 9.0% had a variant of uncertain significance, and 63.1% had a negative result. Most PVs were identified in SDHB (40.4%), followed by SDHD (21.1%), SDHA (10.1%), VHL (7.8%), SDHC (6.7%), RET (3.7%), and MAX (3.6%). PVs in FH, MEN1, NF1, SDHAF2, and TMEM127 collectively accounted for 6.5% of PVs. Clinical predictors of a PV included extra-adrenal location, early age of onset, multiple tumors, and positive family history of PPGL. Individuals with extra-adrenal PGL and a positive family history were the most likely to have a PV (85.9%). Restricting genetic testing to SDHB/C/D misses one-third (32.8%) of individuals with PVs.

CONCLUSION

Our data demonstrate a high diagnostic yield in individuals with and without established risk factors, a low inconclusive result rate, and a substantial contribution to diagnostic yield from rare genes. These findings support universal testing of all individuals with PPGL and the use of concurrent MGPT as the ideal platform.

Shock first, ask questions later…

A 39-year-old man presented to the Emergency Department following a sudden onset of palpitations an hour earlier. He was clammy and felt generally unwell. He was normally fit and active with no history of cardiac symptoms including palpitations - he mentioned as a teenager he was told that he had an 'extra bit of wiring in his heart' but nothing further was done. His only regular medication was Sertraline. He drank alcohol to excess. On examination, he was hypotensive but pain free. Bloods including potassium and magnesium were within normal limits - venous lactate was mildly elevated at 2.8.

Relapsing Klebsiella pneumoniae meningitis in a patient with COVID-19

Klebsiella pneumoniae is a common cause of potentially life‐threatening infection. This report describes a relapsing healthcare‐associated Klebsiella pneumoniae meningitis in a 60‐year‐old patient who had SARS‐CoV‐2 infection. During their initial admission for COVID‐19 pneumonitis and treatment with corticosteroids, the patient developed signs and symptoms suggestive of bacterial meningitis. Blood and cerebrospinal fluid cultures confirmed Klebsiella pneumoniae as the causative organism. The patient was treated with a prolonged course of high‐dose meropenem and made an apparent recovery. Four days after hospital discharge, the patient re‐presented critically unwell. Klebsiella pneumoniae was once again isolated from cerebrospinal fluid. During their second admission, the patient deteriorated despite antimicrobial treatment, and life‐sustaining therapies were withdrawn. This case highlights that all COVID‐19 patients receiving immunosuppressive therapy should be monitored for potential opportunistic infection. Prompt recognition and early antimicrobial therapy are key to improving patient outcomes.

Radiographer-led online image guided adaptive radiotherapy: A qualitative investigation of the therapeutic radiographer role

INTRODUCTION

Online MRI guided adaptive radiotherapy (MRIgRT) is resource intensive. To maintain and increase uptake traditional roles and responsibilities may need refining. This novel study aims to provide an in-depth understanding and subsequent impact of the roles required to deliver on-line adaptive MRIgRT by exploring the current skills and knowledge of radiographers.

METHOD

A purposive sampling approach was used to invite radiographers, clinicians and physicists from centres with experience of MRIgRT to participate. Focus Group Interviews were conducted with two facilitators using a semi-structure interview guide (Appendix 1). Four researchers independently familiarised themselves and coded the data using framework analysis. A consensus thematic framework of ptive Radiotherapy codes and categories was agreed and systematically applied.

RESULTS

Thirty participants took part (Radiographers: N = 18, Physicists: N = 9 and Clinicians: N = 3). Three key themes were identified: 'Current MRIgRT', 'Training' and 'Future Practice'. Current MRIgRT identified a variation in radiographers' roles and responsibilities with pathways ranging from radiographer-led, clinician-light-led and MDT-led. The consensus was to move towards radiographer-led with the need to have a robust on-call service heavily emphasised. Training highlighted the breadth of knowledge required by radiographers including MRI, contouring, planning and dosimetry, and treatment experience. Debate was presented over timing and length of training required. Future Practice identified the need to have radiographers solely deliver MRIgRT, to reduce staff present which was seen as a main driver, and time and resources to train radiographers seen as the main barriers.

CONCLUSION

Radiographer-led MRIgRT is an exciting development because of the potential radiographer role development. A national training framework created collaboratively with all stakeholders and professions involved would ensure consistency in skills and knowledge.

IMPLICATIONS FOR PRACTICE

Role development and changes in education for therapeutic radiographers.

P152 Poor sleep quality, individual experiences and increased risk of self-harm – A multi-method study

Introduction

The COVID-19 pandemic has caused significant psychological distress to many people across the globe. Poor sleep quality may be linked to poor mental health and increased suicide ideation. To contextualise the risk factors associated with self-harm or suicidal ideation during the COVID-19 pandemic, this cross-sectional study examined links between poor sleep quality, individual experiences and self-harm risk.

Methods

N=1544 (Mage=44.3y) from 63 countries completed an online survey in March-April 2020. Participants reported their pandemic experiences as free text responses, which were examined quantitatively for frequent word usage using Linguist Inquiry and Word Count software. Pittsburgh Sleep Quality Index assessed poor sleep quality (cut-off score >8). Item-9 of Patient Health Questionnaire-9 measured the risk of self-harm.

Results

Individuals with poor sleep quality (45%) used more negative emotional tone and had greater use of anxiety or money-related words in their comments than good sleepers (all ps<.05). Additionally, 19% of respondents (n=295) reported thoughts of self-harm at least several days a week (3.4% nearly every day). Logistic regression indicated that younger individuals, males, and those feeling isolated or less resilient had 1.2 to 1.5 times greater risk of self-harm (all ps<.001). Poor sleep quality was associated with a two-fold increased risk of self-harm (95%CI=1.5–2.7, p<.0001) after controlling for demographic variables.

Discussion

Poor sleep quality is linked to negative emotionality and increased risk of self-harm during the COVID-19 pandemic. Sleep is a modifiable factor; therefore interventions aimed at addressing sleep disturbances may improve resilience and reduce the risk of self-harm in vulnerable individuals.

COVID-19 mitigation policies and psychological distress in young adults

The COVID-19 pandemic has seen an unusually high proportion of the population suffering from mental health difficulties, but of particular concern is the disproportionate increase in psychological distress among younger adults. In this article, we exploit an explanatory sequential mixed-methods design to examine which aspects of the COVID-19 pandemic 18-25-year-olds found most challenging. We report analyses of American Voices Project (AVP) qualitative in-depth interview data, a MyVoice text-message open-ended survey, and Census Bureau Household Pulse Survey (HPS) data, all collected in 2020. Our interview and text-message results show that young adults were distressed about the effects of COVID-19 on the health of loved ones and older Americans. Young adults expressed concerns that the pandemic was not being treated sufficiently seriously by some politicians and the general public. The policy response was seen to be inadequate to the task of containing the disease, and some feared that the pandemic would never end. Statistical analyses of the HPS confirm that young adults' scores on the HPS's anxiety scale were significantly negatively associated with state-level policy responses. Overall, our results show that young adults found virus mitigation strategies challenging, but that a strong policy response was associated with reduced levels of psychological distress. Our results suggest that public health policy might have also operated as mental health policy during the COVID-19 pandemic.

The public health community's use of social media for policy advocacy: a scoping review and suggestions to advance the field

OBJECTIVES

This study aimed to investigate the extent and key characteristics of academic research and scholarship on the public health community's use of social media for policy advocacy purposes. This will enable an evaluation of extant research and provide insight into directions for future research.

STUDY DESIGN

This study was a scoping review of academic literature.

METHODS

A scoping review of academic literature published between 1 January 2011 and 31 December 2020 was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. Boolean searches were conducted using a university library platform, which included databases, such as EBSCO host, Informit, Scopus, and ScienceDirect. Data were extracted using an a priori code frame, and publication, content, and disciplinary characteristics were analysed. The results of coding and screening comparison checks were within acceptable limits.

RESULTS

In total, 2672 works from around the world were identified and screened for inclusion. Twenty-two English language articles were included in the final analysis. The public health community's use of social media for policy advocacy purposes has largely been approached from a health perspective, despite research and scholarship about social media in communication and policy disciplines (among others). Reported research aims or questions emphasised functional rather than theoretical contributions. Most analysed works used empirical or case study-based methods and were produced by authors in Western geographies. Among the health issues discussed, tobacco and tobacco control were discussed most frequently. While recognising issues with social media, most publications framed social media as more of an opportunity than a problem.

CONCLUSIONS

The public health community's use of social media for policy advocacy purposes is an emerging field. There is considerable potential to expand scholarship and research in this field internationally, especially by integrating transdisciplinary knowledge and perspectives and by applying social media to foster policy change around identified global health challenges. Greater representation of authors from institutions in the Global South is also encouraged, as are applied and theoretical contributions.

Understanding Knowledge of OT and Perceived Barriers to Service Among Owners of Sober Living Homes

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.

This study examined sober living home (SLH) owners' knowledge of OT and perceived barriers to implementing OT within SLHs. In this pretest–posttest survey, statistically significant median increase in knowledge of OT services (z = –3.512, p &lt; .001) was detected from pretest to posttest. Most participants reported lack of finances as a barrier to using OT services. OTs can advocate and provide education to address barriers.

Primary Author and Speaker: Gloria Farag

Additional Authors and Speakers: Anna M. Quigg

Contributing Authors: Michelle Jackson, Stacy Buckingham-Howes, Amanda Polton, and Monica Clement

Universal Multi Gene Panel Testing For Individuals With Pheochromocytomas And Paragangliomas

Background: Pheochromocytomas (PCCs) and paragangliomas (PGLs) (PPGLs) are a genetically heterogeneous entity, with roughly 25-40% of cases found to harbor a pathogenic or likely pathogenic germline alteration. Existing practice guidelines advocating for the use of a sequential gene testing strategy to identify individuals with hereditary PPGL are driven by the presence of specific clinical features and predate the routine use of multigene panel testing (MGPT). Here we describe results of MGPT for hereditary PPGL in a clinically and ancestrally diverse cohort from a diagnostic laboratory. Methods: Demographic and clinical information of individuals undergoing targeted MGPT for hereditary PPGL were collected from test requisition forms and supporting clinical documents provided by the ordering clinician and retrospectively reviewed. Individuals underwent MGPT of 10-12 genes depending on test order date. From August 2013 through May 2015, 560 individuals had targeted MGPT that included 10 genes (NF1, MAX, SDHA/B/C/D/AF2, RET, TMEM127, and VHL), and from May 2015 through December 2019, 1167 individuals had panel testing of 12 genes due to the addition of MEN1 and FH. Results: Overall, 27.5% of individuals had a pathogenic or likely pathogenic variant (PV), 9.0% had a variant of uncertain significance, and 63.1% had a negative result. Out of all PVs, most were identified in SDHB (40.4%), followed by SDHD (21.1%), SDHA (10.1%), VHL (7.8%), SDHC (6.7%), RET (3.8%), and MAX (3.6%). PVs in FH, MEN1, NF1, SDHAF2, and TMEM127 collectively accounted for 6.5% of PVs. Clinical predictors of a PV included extra-adrenal location, diagnosis before the age of 45 years, multiple tumors, and positive family history (fhx) of PPGL. Affected individuals with a fhx of PPGL were the most likely to have a PV (70.6% of individuals with PCC + fhx; 85.9% of individuals with PGL + fhx). The positive rate in nearly all clinical subgroups even without predictors of a PV remained over 10%, including individuals with a single tumor (PCC = 16.7%; PGL = 46.7%) and those without a fhx (PCC and negative fhx = 15.8%; PGL and negative fhx = 43.7%). Restricting genetic testing of hereditary PPGL to only SDHB/C/D genes misses a third (31.8%) of individuals with PVs. Among individuals with PVs in syndromic genes, over half (41.5%) did not have any additional syndromic features beyond PPGL reported by the ordering clinician. Conclusion: Our data demonstrate a high diagnostic yield in individuals with and without established risk factors, a low inconclusive result rate, numerous individuals with syndromic PVs presenting with isolated PPGL, and a substantial contribution to diagnostic yield from rare genes when included in testing. These findings support updating practice guidelines to incorporate universal testing of all individuals with PPGL and the use of concurrent MGPT as the ideal platform.