Re-envisioning Youth Sexual Health Care: Supporting Sex Positivity in a Digital World

INTRODUCTION

Youth in a digital world face challenges to the healthy development of their sexuality from exposure to sexting, pornography, and other sexually explicit media. School-based sexual health education does not cover digital sexual content and its impact on sexuality and sexual relationships. Youth often avoid discussing sexual health with parents or other trusted adults, thus often relying on peers, making them ill-prepared to navigate the complexities (e.g., socially, emotionally, and romantically) of sexually explicit content.

METHOD

A review of emerging evidence for application into clinical practice.

RESULTS

This paper provides nurse practitioners with resources and information to incorporate this re-envisioned approach to sexual health care into practice to provide current, timely, and holistic youth sexual health care.

DISCUSSION

Youth sexual health care must be re-envisioned. Nurse practitioners can improve youth sexual health by incorporating pornography and sexual media literacy, safe sexting, and concepts of consent into care using a sex-positive lens.

Evolution of brain MRI lesions in paediatric myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD) and its relevance to disease course

BACKGROUND

Lesion resolution is often observed in children with myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD), and asymptomatic lesions are less commonly reported in MOGAD than in multiple sclerosis (MS).

OBJECTIVE

We aimed to evaluate brain MRI changes over time in paediatric MOGAD.

METHODS

Retrospective study in eight UK paediatric neuroscience centres. Acute brain MRI and available follow-up MRIs were reviewed. Predictors for lesion dynamic were evaluated using multivariable regression and Kaplan-Meier survival analyses were used to predict risk of relapse, disability and MOG-Ab status.

RESULTS

200 children were included (MOGAD 97; MS 103). At first MRI post attack, new symptomatic and asymptomatic lesions were seen more often in MS versus MOGAD (52/103 vs 28/97; p=0.002 and 37/103 vs 11/97; p<0.001); 83% of patients with MOGAD showed at least one lesion's resolution at first follow-up scan, and 23% had normal MRI. Only 1 patient with MS had single lesion resolution; none had normal MRI. Disappearing lesions in MOGAD were seen in 40% after the second attack, 21% after third attack and none after the fourth attack.New lesions at first follow-up scan were associated with increased likelihood of relapse (p=0.02) and persistent MOG-Ab serostatus (p=0.0016) compared with those with no new lesions. Plasma exchange was associated with increased likelihood of lesion resolution (p=0.01). Longer time from symptom onset to steroids was associated with increased likelihood of new lesions; 50% increase at 20 days (p=0.01).

CONCLUSIONS

These striking differences in lesion dynamics between MOGAD and MS suggest greater potential to repair. Early treatment with steroids and plasma exchange is associated with reduced likelihood of new lesions.

COVID-19 in the intensive care unit: Unmasking the critical factors impacting patient survival

In the midst of the coronavirus disease 2019 (COVID-19) pandemic, intensive care units (ICUs) around the world have been pushed to their limits as they grapple with the effects of the severe acute respiratory syndrome coronavirus 2 virus. Identifying prognostic factors that influence mortality in COVID-19 patients admitted to the ICU could offer valuable insights for clinicians seeking to prevent disease progression. A retrospective analysis was conducted on COVID-19 patients admitted to the ICU between January and September 2020. The analysis considered patient demographics, comorbidities, neurological and non-neurological symptoms, as well as laboratory markers. The multivariate logistic regression analysis aims to uncover associations between these factors and patient outcomes. Of the 387 patients included in this study, nearly half (48.5%) of the ICU patients succumbed to COVID-19. Factors that contributed to increased mortality included being 60 years of age or older, impaired consciousness, lung disease, elevated international normalized ratio (INR), and elevated blood urea nitrogen (BUN) levels. Surprisingly, symptoms such as dizziness/lightheadedness, myalgia, and headache were associated with a higher likelihood of survival. In addition, elevated D-dimer and aspartate aminotransferase (AST) levels, as well as lymphopenia, were more commonly observed in deceased patients. The study concluded that those who died in the ICU tended to be older, white, and burdened with more comorbidities and impaired consciousness. With the intriguing link between specific symptoms and survival, further research is essential to uncover the underlying pathophysiological mechanisms that influence ICU patient outcomes in the context of COVID-19.

Cognitive impairment and health-related quality of life amongst older Australians: evidence from a longitudinal investigation

INTRODUCTION

Australia's population is steadily growing older, with older persons expected to make up over 20% of the population by 2066. Ageing is strongly associated with a significant drop in cognitive ability, ranging from mild cognitive impairment to severe cognitive impairment (dementia). This study examined the association between cognitive impairment and health-related quality of life (HRQoL) in older Australians.

METHODS

Two waves of longitudinal data from the nationally representative Household, Income and Labour Dynamics in Australia (HILDA) survey were utilised, with the age cut-off for older Australians defined as above 50. The final analysis included 10,737 person-year observations from 6892 unique individuals between 2012 and 2016. This study utilised the Backwards Digit Span (BDS) test and Symbol Digit Modalities test (SDMT) to assess cognitive function. HRQoL was measured using the physical and mental component summary scores of the SF-36 Health Survey (PCS and MCS). Additionally, HRQoL was measured using health state utility values (SF-6D score). A longitudinal random-effects GLS regression model was used to analyse the association between cognitive impairment and HRQoL.

RESULTS

This study found that approximately 89% of Australian adults aged 50 or older had no cognitive impairment, 10.16% had moderate cognitive impairment, and 0.72% had severe cognitive impairment. This study also found that moderate and severe cognitive impairment were both negatively associated with HRQoL. Older Australians with moderate cognitive impairment scored worse on the PCS (β = - 1.765, SE = 0.317), MCS (β = - 1.612, SE = 0.326), and SF-6D (β = - 0.024, SE = 0.004) than peers without cognitive impairment given other covariates reference categories remain constant. Older adults experiencing severe cognitive had lower PCS (β = - 3.560, SE = 1.103), and SF-6D (β = - 0.034, SE = 0.012) scores compared to their counterparts with no cognitive impairment given other covariates reference categories remain constant.

CONCLUSION

We found evidence that HRQoL is negatively associated with cognitive impairment. Our findings will be beneficial for the future cost-effectiveness intervention targeted at reducing cognitive impairment since it provides information on the disutility associated with moderate and severe cognitive impairment.

A single-center retrospective study of hospitalized COVID-19 patients: demographics, laboratory markers, neurological complications, ICU admission, and mortality

The coronavirus disease 2019 (COVID-19) pandemic has unveiled a wide array of clinical biomarkers, and neurological manifestations in affected patients, necessitating further exploration.

Methods

This single-center retrospective study evaluated clinical and neurological sequelae, demographics, as well as laboratory markers, in hospitalized COVID-19 patients from January to September 2020.

Results

Among 1248 inpatients (median age: 68 years; 651 women), 387 (31%) were admitted to the ICU. Central nervous system (CNS) manifestations were present in 521 (41.74%) patients, while peripheral nervous system manifestations were observed in 84 (6.73%). COVID-19-related mortality occurred in 314 (25.16%) cases. ICU-admitted patients were predominantly male (P<0.0001), older (age≥60; P=0.037) and had more comorbidities such as diabetes (P=0.001), hyperlipidemia (P=0.043), and coronary artery disease (P=0.015). ICU patients exhibited more CNS manifestations (P=0.001), including impaired consciousness (P<0.0001) and acute cerebrovascular disease (P=0.023). Biomarkers linked to admission to the ICU included elevated white blood cell count, ferritin, lactate dehydrogenase, creatine kinase, blood urea nitrogen, creatinine, and acute phase reactants (e.g. erythrocyte sedimentation rate and C-reactive protein). ICU patients demonstrated lower lymphocyte and platelet counts compared to non-ICU patients. Those with CNS involvement in the ICU often exhibited elevated blood urea nitrogen, creatinine, and creatine kinase levels. Higher mortality from COVID-19 was observed in ICU patients (P<0.0001).

Conclusions

Multiple serum biomarkers, comorbidities, and neurological manifestations in COVID-19 patients have been consistently documented and may be linked to increased morbidity, ICU admission, and mortality. Recognizing and addressing these clinical and laboratory markers is essential for effective COVID-19 management.

A mixed methods study of Aboriginal health workers' and exercise physiologists' experiences of co-designing chronic lung disease 'yarning' education resources

BACKGROUND

Despite the high incidence of chronic obstructive pulmonary disease (COPD) in Aboriginal communities in Australia, Aboriginal Health Workers (AHWs) have limited knowledge about effective management.

AIM

To evaluate an online education program, co-designed with AHWs and exercise physiologists (EPs) or physiotherapists (PTs), to increase knowledge about COPD and its management.

METHODS

AHWs and EPs from four Aboriginal Community Controlled Health Services (ACCHS) were recruited. An Aboriginal researcher and a physiotherapist experienced in COPD management and pulmonary rehabilitation (PR) delivered seven online education sessions. These sessions used co-design principles and an Aboriginal pedagogy framework '8 Ways of learning', which incorporates Aboriginal protocols and perspectives to realign teaching techniques and strengthen learning outcomes. Topics covered were: How the lungs work; What is COPD; Medications and how to use inhalers and COPD Action Plans; Why exercise is important; Managing breathlessness; Healthy eating; Managing anxiety and depression. After each session, AHWs with support from EPs, co-designed education 'yarning' resources using Aboriginal ways of learning to ensure topics were culturally safe for the local Aboriginal community and practiced delivering this at the following session. At the end of the program participants completed an anonymous online survey (5-point Likert scale) to assess satisfaction, and a semi-structured interview about their experience of the online education.

RESULTS

Of the 12 participants, 11 completed the survey (7 AHWs, 4 EPs). Most (90%) participants strongly agreed or agreed that the online sessions increased knowledge and skills they needed to support Aboriginal patients with COPD. All (100%) participants felt: their cultural perspectives and opinions were valued and that they were encouraged to include cultural knowledge. Most (91%) reported that delivering their own co-designed yarning scripts during the online sessions improved their understanding of the topics. Eleven participants completed semi-structured interviews about participating in online education to co-design Aboriginal 'yarning' resources. Themes identified were: revealing the Aboriginal lung health landscape; participating in online learning; structuring the online education sessions; co-designing with the facilitators.

CONCLUSIONS

Online education using co-design and 8 Ways of learning was rated highly by AHWs and EPs for improving COPD knowledge and valuing cultural perspectives. The use of co-design principles supported the cultural adaptation of COPD resources for Aboriginal people with COPD.

TRIAL REGISTRATION

PROSPERO (registration number: CRD42019111405).

Coils for large standoff relaxometry with unilateral magnets

Maximizing standoff distance by direct placement of probe coils on magnet bodies, while maximizing signal-to-noise is critical to the successful application of unilateral NMR. Two types of radio frequency (rf) coils for linear array, unilateral magnets are described: "simple fringe" and "split fringe coils." These coils are designed to fully exploit the standoff distance of the unilateral magnet by placement directly on the magnet surface. Such placement fails for normal surface coils used for magnetic resonance due to eddy current induced shielding by the conductive magnet surface. The coil design strategy includes a rectangular cross section solenoid coil, either continuous or split in the center, mounted with the center axis of the coil parallel to the magnet surface. These geometries, when placed on a conducting surface, enhance the rf field produced in the sample region, outside of the solenoid coil. The spatial homogeneity of both rf coils are characterized using the ANSYS™ finite element modelling software. ANSYS™ modeled coil geometries led to homogeneous, surface displaced rf fields. These coils were then constructed and characterized with magnetic resonance imaging. Finally, two experiments that use these coils to perform large standoff relaxation measurements are described.

Implementing evidence into practice to improve chronic lung disease management in Indigenous Australians: the breathe easy, walk easy, lungs for life (BE WELL) project (protocol)

BACKGROUND

Strong evidence exists for the benefits of pulmonary rehabilitation (PR) for people with chronic obstructive pulmonary disease (COPD), however the availability of culturally safe PR for Aboriginal and Torres Strait Islander (Indigenous) Peoples is limited. The study aims to determine whether PR can be implemented within Aboriginal Community Controlled Health Services (ACCHS) to improve outcomes for Indigenous people with COPD.

METHODS

Multi-centre cohort study using participatory action research guided by the Knowledge-to-Action Framework. ACCHS supportive of enhancing services for chronic lung disease will be recruited. Aboriginal Health Workers (AHW) and the exercise physiologist (EP) or physiotherapist (PT) within these ACCHS will attend a workshop aimed at increasing knowledge and skills related to management of COPD and the provision of PR. Indigenous people with COPD will be invited to attend an 8-week, twice weekly, supervised PR program.

OUTCOMES

AHW, EP/PT knowledge, skills and confidence in the assessment and management of COPD will be measured before and immediately after the BE WELL workshop and at 3, 6 and 12 months using a survey. PR participant measures will be exercise capacity (6-minute walk test (6MWT), health-related quality of life and health status at commencement and completion of an 8-week PR program. Secondary outcomes will include: number, length and cost of hospitalisations for a COPD exacerbation in 12-months prior and 12-months post PR; local contextual factors influencing implementation of PR; specific respiratory services provided by ACCHS to manage COPD prior to project commencement and at project completion. Repeated measures ANOVA will be used to evaluate changes in knowledge and confidence over time of AHWs and EP/PTs. Paired t-tests will be used to evaluate change in patient outcomes from pre- to post-PR. Number of hospital admissions in the 12 months before and after the PR will be compared using unpaired t-tests.

DISCUSSION

Pulmonary rehabilitation is an essential component of best-practice management of COPD and is recommended in COPD guidelines. Indigenous peoples have limited access to culturally safe PR programs. This study will evaluate whether PR can be implemented within ACCHS and improve outcomes for Indigenous people with COPD. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12617001337369, Registered 2nd September 2017 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373585&isClinicalTrial=False.

Mental Health Consequences of the COVID-19 Pandemic Among Older Adults With Chronic Conditions

The COVID-19 pandemic may have a negative impact on mental health, especially among older adults with chronic conditions who are more vulnerable to severe illness. This cross-sectional qualitative study evaluated how the pandemic has impacted the ways that adults aged 50 and older with chronic conditions managed their mental health. Participants included a total of 492 adults (M = 64.95 years, SD = 8.91, range = 50 – 94) from Michigan (82.1%) and 33 other U.S. states who reported a diagnosis of at least one chronic condition and completed an anonymous online survey between May 14 and July 9, 2020. Participants provided open-ended responses to a question about the pandemic’s impact on how they were taking care of their mental health. The data were coded to ascertain relevant concepts and were reduced to develop major themes. We determined four main themes. The pandemic impacted how participants took care of their mental health through: (1) pandemic-related barriers to social interaction; (2) pandemic-related routine changes; (3) pandemic-related stress; and (4) pandemic-related changes to mental health care. Taken as a whole, this study indicates that older adults with chronic conditions encountered a variety of challenges to managing their mental health in the early months of the COVID-19 pandemic, but also demonstrated considerable resilience. These findings identify potential risk and protective factors to target as part of personalized interventions to preserve their well-being during this pandemic and in future public health crises.

The Common Sunstar Crossaster papposus-A Neurotoxic Starfish

Saxitoxins (STXs) are a family of potent neurotoxins produced naturally by certain species of phytoplankton and cyanobacteria which are extremely toxic to mammalian nervous systems. The accumulation of STXs in bivalve molluscs can significantly impact animal and human health. Recent work conducted in the North Sea highlighted the widespread presence of various saxitoxins in a range of benthic organisms, with the common sunstar (Crossaster papposus) demonstrating high concentrations of saxitoxins. In this study, an extensive sampling program was undertaken across multiple seas surrounding the UK, with 146 starfish and 5 brittlestars of multiple species analysed for STXs. All the common sunstars analysed (n > 70) contained quantifiable levels of STXs, with the total concentrations ranging from 99 to 11,245 µg STX eq/kg. The common sunstars were statistically different in terms of toxin loading to all the other starfish species tested. Two distinct toxic profiles were observed in sunstars, a decarbomylsaxitoxin (dcSTX)-dominant profile which encompassed samples from most of the UK coast and an STX and gonyautoxin2 (GTX2) profile from the North Yorkshire coast of England. Compartmentalisation studies demonstrated that the female gonads exhibited the highest toxin concentrations of all the individual organs tested, with concentrations >40,000 µg STX eq/kg in one sample. All the sunstars, male or female, exhibited the presence of STXs in the skin, digestive glands and gonads. This study highlights that the common sunstar ubiquitously contains STXs, independent of the geographical location around the UK and often at concentrations many times higher than the current regulatory limits for STXs in molluscs; therefore, the common sunstar should be considered toxic hereafter.

The taxonomic position of Anoplotaenia dasyuri (Cestoda) as inferred from molecular sequences

Anoplotaenia dasyuri Beddard, 1911 (Cestoda), from the Tasmanian devil, Sarcophilus harrisii (Boitard, 1842), is a taxonomic enigma, where a combination of morphological features, host type and geographical location have prevented it from being placed within a family and it is considered incertae sedis, despite its accepted validity. We performed a phylogenetic analysis of three A. dasyuri specimens collected from three Tasmanian devils using 18S and 28S rRNA sequences. Anoplotaenia dasyuri was found to have closest affinity with the family Paruterinidae, especially the genus Cladotaenia Cohn, 1901. The postulated theory of transfer of an ancestor of Anoplotaenia Beddard, 1911 transferring to the Tasmanian devil from an unrelated carnivorous host, such as an accipitriform or other carnivorous bird, is discussed and supported.

Creating doorways: finding meaning and growth through art therapy in the face of life-threatening illness

OBJECTIVES

This article presents the findings of a pilot study situated in a tertiary care cancer centre and examines the impact of an art therapy group on the experiences of women living through breast cancer.

STUDY DESIGN

The study design used in this study is a qualitative cross-case comparative case.

METHODS

Ten women were interviewed about their experiences making art, many for the first time. Interviews were transcribed and analysed, along with the participants' artist statements.

RESULTS

Categories include the following: the significant benefits of art therapy on their sense of self-efficacy; the emotionally enhancing nature of making art for the first time; the power of their artwork to trigger insights about themselves (including subcategories of self-actualization, existential growth, and post-traumatic growth) or in communicating their experiences to loved ones; and how making art changed their worldview and life philosophies, creating doorways of possibilities.

CONCLUSION

This study suggests that art therapy provides a safe context to reflect on profound personal changes and to re-story losses following adversity through creative practices as a dimension of care.

Non-EPI-DWI for Detection, Disease Monitoring, and Clinical Decision-Making in Thyroid Eye Disease

BACKGROUND AND PURPOSE

The Clinical Activity Score is widely used to grade activity of thyroid eye disease and guide treatment decisions, but as a subjective measurement and being confined to the anterior orbit, it has limitations. Non-EPI-DWI of the extraocular muscles may offer advantages as a functional imaging technique with reduced skull base artifacts, but the correlation with the Clinical Activity Score and patient outcome is unknown. Our aim was to establish the correlation between the Clinical Activity Score and non-EPI-DWI and to describe the additional value provided by adjunctive non-EPI-DWI in making clinical decisions.

MATERIALS AND METHODS

This was a retrospective longitudinal study of 31 patients seen in a multidisciplinary thyroid eye disease clinic during 5 years who had at least 1 ophthalmic and endocrine assessment including the Clinical Activity Score and a non-EPI-DWI ADC calculation. The Spearman rank correlation coefficient was used to determine the relationship between the Clinical Activity Score and non-EPI-DWI. A patient flow chart was constructed to evaluate clinical decision-making, and receiver operating characteristics were generated.

RESULTS

From 60 non-EPI-DWI scans, 368 extraocular muscles were selected for analysis. There was a significant positive correlation between the Clinical Activity Score and ADC (r _s = 0.403; 95% CI, 0.312-0.489; P < .001). ADC values were significantly higher in the Clinical Activity Score ≥ 3 group compared with the Clinical Activity Score < 3 group (P < .001). Our patient flow chart identified a third intermediate-severity cohort in which the non-EPI-DWI was particularly useful in guiding clinical decisions.

CONCLUSIONS

The non-EPI-DWI correlated well with the Clinical Activity Score in our patients and was a useful adjunct to the Clinical Activity Score in making clinical decisions, especially in patients with intermediate activity and severity of thyroid eye disease.

Plasma modification of vanadium oxynitride surfaces: Characterization by in situ XPS experiments and DFT calculations

Plasma modification of transition metal nitride/oxynitride (MO_xN_y) surfaces for enhanced surface properties is highly desirable, given the scalability of such methods and limitations of thermal treatments. In situ x-ray excited photoelectron spectroscopy demonstrates that the O₂ plasma oxidation of VO_xN_y films generates non-lattice N1s surface features with binding energies near 396.5 eV, which are associated with the nitrogen reduction reaction activity but not observed upon thermal oxidation. The NH₃ plasma generates N1s surface features near 400.5 eV binding energy. The O₂+NH₃ plasma generates both types of N1s features. Annealing in UHV to <1000 K reverses plasma-induced changes to N1s spectra. Density functional theory (DFT) calculations integrated with the experiments indicate that the plasma-induced N1s features at ∼396.5 eV and 400.5 eV are V≡N: and V-NH₂ sites, respectively, with significantly lower thermal stabilities than lattice N sites. These results provide practical insight regarding the plasma modification of MO_xN_y surfaces for important applications.

Case report: cranial angiosarcoma with multiple hemorrhagic brain metastasis in a child

BACKGROUND AND IMPORTANCE

Angiosarcoma is a rare malignant tumor with an aggressive course and poor prognosis. It is typically seen in adults but very rarely seen in children. Angiosarcoma of the skull with brain metastasis is exceptionally rare. Due to the rare nature of these tumors, much is left unknown about clinical progression and treatment guidelines are not well established.

CLINICAL PRESENTATION AND COURSE

A 14-year-old male patient presented with an enlarging mass on the parietal region of the head. Further investigations revealed a mass lesion involving scalp and skull tissue. Biopsy result showed angiosarcoma and the patient underwent multiple surgical interventions including scalp excision, craniectomy on tumor site, and excision of brain metastases. He also received chemotherapy and radiation therapy. Despite aggressive treatment, disease progression could not be controlled.

CONCLUSION

Here we report a pediatric patient with intracranially invasive angiosarcoma of the scalp and skull, with recurrent hemorrhagic metastases to the brain. This is a very rare case in pediatric age group with very poor prognosis. Our patient had impressively longer survival than those reported in the literature despite multiple hemorrhagic brain metastasis and this is most likely related to our aggressive treatment strategy that includes multiple craniotomies for metastatic tumor resection in addition to neoadjuvant chemotherapy and radiation therapy. We believe optimal treatment of skull angiosarcoma in children should aim gross total resection of the skull tumor including involving scalp and dura as well as neoadjuvant chemotherapy and radiation therapy, and the patient should be followed closely with repeated brain MRI studies to pursue additional surgeries to remove brain metastasis if feasible.

Multiple New Paralytic Shellfish Toxin Vectors in Offshore North Sea Benthos, a Deep Secret Exposed

In early 2018, a large easterly storm hit the East Anglian coast of the UK, colloquially known as the 'Beast from the East', which also resulted in mass strandings of benthic organisms. There were subsequent instances of dogs consuming such organisms, leading to illness and, in some cases, fatalities. Epidemiological investigations identified paralytic shellfish toxins (PSTs) as the cause, with toxins present in a range of species and concentrations exceeding 14,000 µg STX eq./kg in the sunstar Crossaster papposus. This study sought to better elucidate the geographic spread of any toxicity and identify any key organisms of concern. During the summers of 2018 and 2019, various species of benthic invertebrates were collected from demersal trawl surveys conducted across a variety of locations in the North Sea. An analysis of the benthic epifauna using two independent PST testing methods identified a 'hot spot' of toxic organisms in the Southern Bight, with a mean toxicity of 449 µg STX eq./kg. PSTs were quantified in sea chervil (Alcyonidium diaphanum), the first known detection in the phylum bryozoan, as well as eleven other new vectors (>50 µg STX eq./kg), namely the opisthobranch Scaphander lignarius, the starfish Anseropoda placenta, Asterias rubens, Luidia ciliaris, Astropecten irregularis and Stichastrella rosea, the brittlestar Ophiura ophiura, the crustaceans Atelecyclus rotundatus and Munida rugosa, the sea mouse Aphrodita aculeata, and the sea urchin Psammechinus miliaris. The two species that showed consistently high PST concentrations were C. papposus and A. diaphanum. Two toxic profiles were identified, with one dominated by dcSTX (decarbamoylsaxitoxin) associated with the majority of samples across the whole sampling region. The second profile occurred only in North-Eastern England and consisted of mostly STX (Saxitoxin) and GTX2 (gonyautoxin 2). Consequently, this study highlights widespread and variable levels of PSTs in the marine benthos, together with the first evidence for toxicity in a large number of new species. These findings highlight impacts to 'One Health', with the unexpected sources of toxins potentially creating risks to animal, human and environmental health, with further work required to assess the severity and geographical/temporal extent of these impacts.

Health Literacy Environment of Breast and Cervical Cancer among Black African Women Globally: A Systematic Review Protocol of Mixed Methods

Adequate health literacy is a necessity to enable effective decision making to seek, access and utilise appropriate health care service. Evidence exists indicating a low level of general health literacy among Black African women, especially those with a refugee background. Breast and cervical are the most common cancers, with Black African women or women with African ethnicity being disproportionately overrepresented. The level of health literacy specific to breast and cervical cancer among Black African women, especially those with a refugee background, has not been reviewed systematically. The present study describes a protocol for a systematic review of the available evidence on the level of health literacy specific to breast and cervical cancer among Black African women globally. We will perform a systematic review of the available quantitative and qualitative studies. The search will include studies that describe the level of health literacy specific to breast and cervical cancer among Black African women. We will conduct a preliminary search on Google scholar to build the concepts for search terms, and a full search strategy using the identified concepts and keywords across four databases namely PubMed, SCOPUS, CINAHL and Web of Sciences. We will use Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) to schematically present the search strategy. We will use the standardized Joanna Briggs Institute quality appraisal and selection tool to recruit studies, and the data extraction tool to synthesise the information extracted from the recruited studies. We will be guided by socioecological theory and Indigenous epistemology to synthesise the non-quantifiable information thematically, and pool the quantitative information using meta-analysis, based on the availability of information.

Evaluation of a Novel Bony Landmark-Based Method for Teaching Percutaneous Insertion of Subclavian Venous Catheters in Pediatric Patients

BACKGROUND

Surgical trainees performing subclavian vein (SCV) cannulation often incorrectly perceive needle trajectory and anatomical relations. As surface landmark-based methods derived from adult surgical practice may be less effective in younger patients, we developed and evaluated a novel bony landmark-based method for teaching SCV cannulation for central venous access device (CVAD) placement in children.

METHODS

Over 2 sequential 3-year periods, pediatric surgical trainees were taught infraclavicular SCV cannulation via surface- and bony-landmark approaches, respectively. We prospectively recorded patient, surgeon and operative details on all Hickman line and port-a-cath insertions placed by trainees as the first surgeon via percutaneous infraclavicular SCV puncture and compared procedural outcomes and complications across both periods.

RESULTS

Of 271 cases included in the study, trainees performed 52 (50.5%) and 92 (54.8%) procedures in the first and second periods, respectively. Patients in both periods did not differ by gender, disease, CVAD device, or prior CVAD, chemotherapy or infection status. In the second (bony landmark) period, although patients were younger (6.0 vs. 8.7 years, P = 0.003) mean procedural duration was shorter (42.5 vs. 58.3 min, P < 0.001). Also, cannulation attempts and complication rates did not differ significantly between study periods (P = 0.257 and 1.0, respectively).

CONCLUSIONS

With the bony landmark approach, trainees could perform the procedures faster despite operating on younger patients, without impacting complication rates and cannulation attempts. Bony landmarks may better approximate SCV position across a range of ages, thus improving the consistency of SCV cannulation in CVAD placements in children.

Traumatic orbital third nerve palsy

We present a case series of three patients who developed acute traumatic orbital third nerve palsies. To our knowledge, reported cases have mainly been localised to the intracranial course of the nerve and often associated with visual impairment. Those in which the orbit is the site of injury are rare. Our case series highlights the importance of careful preoperative assessment of patients with orbital trauma (particularly when there is a coexisting fracture) and the need to assess ocular movements and pupillary reactions to distinguish between a neurogenic and soft tissue injury. Early diagnosis is helpful in deciding on the timing of the operation and enables patients to be given appropriate counselling to make sure that their expectations are realistic.

Abstract OT2-08-01: Personalized breast cancer screening in a population based study: Women Informed to Screen Depending On Measures of risk (WISDOM)

Background: WISDOM is a 100,000 healthy women preference-tolerant, pragmatic study comparing annual to personalized risk-based breast screening. The novelty of WISDOM personalized screening is the integration of previously validated genetic and clinical risk factors (age, family history, breast biopsy results, ethnicity, mammographic density) into a single risk assessment model that directs the starting age, timing, and frequency of screening. The goal of WISDOM is to determine if personalized screening, compared to annual screening, is as safe, less morbid, enables prevention, and is preferred by women. The study is registered on ClinicalTrials.gov, NCT02620852.

Methods: Women aged 40-74 years with no history of breast cancer or DCIS, and no previous double mastectomy can join the study online at wisdomstudy.org. Participants can elect randomization or self-select a study arm, and provide electronic consent and Release for Medical Information using DocuSign. For all participants, 5-year risk of developing breast cancer is calculated according to the Breast Cancer Screening Consortium (BCSC) model. Participants in the personalized arm undergo panel-based mutation testing, and their 5-year risk is calculated using the BCSC score combined with a Polygenic Risk Score (BCSC-PRS) that includes 75 single nucleotide polymorphisms (SNPs, increase to 229) known to increase breast cancer risk. SNPs and mutations (BRCA1, BRCA2, TP53, PTEN, STK11, CDH1, ATM, PALB2, and CHEK2) are assessed by saliva-based testing through Color Genomics. 5-year risk level thresholds are used to stratify for low-, moderate- and high risk. Risk stratification determines age to start, stop, and frequency of screening.

Enrollment: As of July 2018, the WISDOM study is open to all eligible women in California, North Dakota, South Dakota, Minnesota and Iowa. To date, 23,329 eligible women have registered and 14,393 women have consented to participate in the trial. We analyzed 3,255 participants who have completed risk assessment in the personalized arm. The median age was 56 years. 82% were Caucasian, 1% African-American, and 6% Asian. 9% self-reported as Hispanic. We are partnering with health insurers and self-insured companies using coverage with evidence progression. To strengthen generalizability, we are expanding to other states. WISDOM enrollment will continue past 2019.

Feasibility: To evaluate the addition of PRS, we used paired statistical tests (McNemar) to compare the distributions of BCSC, and BCSC-PRS risk estimates around low-risk (&lt;1.3%), and very-high risk (&gt;6%) thresholds, the latter corresponding to 5-year risk of a BRCA mutation carrier. The median 5-year risk was 1.5% (IQR 1.0-2.1%) using the BCSC model, and 1.4% (IQR 0.8-2.5%) using the BCSC-PRS model. The BCSC-PRS model classified more women into the low (&lt;1%) and very high (≥6%) risk categories compared to the BCSC model (p &lt; 0.001).

Conclusions: Our findings demonstrate that incorporating genetic variants into a validated clinical model is feasible and impacts risk classification compared to a model without genetic risk factors. Results at 5 years will reveal if this classification improves healthcare value by reducing screen volumes and costs without jeopardizing outcomes.

Citation Format: Acerbi I, Shieh Y, Madlensky L, Tice J, Ziv E, Eklund M, Blanco A, DeRosa D, Tong B, Goodman D, Nassereddine L, Anderson N, Harvey H, Layton T, Park HL, Petruse A, Stewart S, Wernisch J, Risty L, Koenig B, Sarrafan S, Firouzian R, Kaplan C, Hiatt R, Parker BA, Wenger N, Lee V, Heditsian D, Brain S, Stover Fiscalini A, Borowsky AD, Anton-Culver H, Naeim A, Kaster A, Talley M, van 't Veer LJ, LaCroix A, Wisdom Study and Athena Breast Health Network Investigators and Advocate Partners, Esserman LJ. Personalized breast cancer screening in a population based study: Women Informed to Screen Depending On Measures of risk (WISDOM) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT2-08-01.

Estimation of visceral fat in 9- to 13-year-old girls using dual-energy X-ray absorptiometry (DXA) and anthropometry

OBJECTIVES

Accumulation of visceral fat (VF) in children increases the risk of cardiovascular disease and type 2 diabetes, and measurement of VF in children using computed tomography and magnetic resonance imaging (MRI) is expensive. Dual-energy X-ray absorptiometry (DXA) may provide a low-cost alternative. This study aims to determine if DXA VF estimates can accurately estimate VF in young girls, determine if adding anthropometry would improve the estimate and determine if other DXA fat measures, with and without anthropometry, could be used to estimate VF in young girls.

METHODS

Visceral fat was measured at lumbar intervertebral sites (L1-L2, L2-L3, L3-L4 and L4-L5) using 3.0T MRI on 32 young girls (mean age 11.3 ± 1.3 years). VF was estimated using the GE CoreScan application. Measurement of DXA android and total body fat was performed. Weight, height and waist circumference (WC) measurements were also obtained.

RESULTS

Waist circumference and body mass index were both strongly correlated with MRI, although WC was the best anthropometric covariate. Per cent fat (%fat) variables had the strongest correlation and did best in regression models. DXA %VF (GE CoreScan) and DXA android %fat and total body %fat accounted for 65% to 74% of the variation in MRI VF.

CONCLUSION

Waist circumference predicted MRI VF almost as well as DXA estimates in this population, and a combination of WC and DXA fat improves the predictability of VF. DXA VF estimate was improved by the addition of WC; however, DXA android %fat with WC was better at predicting MRI VF.