Electronically ascertained extended pedigrees in breast cancer genetic counseling

A comprehensive pedigree, usually provided by the counselee and verified by medical records, is essential for risk assessment in cancer genetic counseling. Collecting the relevant information is time-consuming and sometimes impossible. We studied the use of electronically ascertained pedigrees (EGP). The study group comprised women (n = 1352) receiving HBOC genetic counseling between December 2006 and December 2016 at Landspitali in Iceland. EGP's were ascertained using information from the population-based Genealogy Database and Icelandic Cancer Registry. The likelihood of being positive for the Icelandic founder BRCA2 pathogenic variant NM_000059.3:c.767_771delCAAAT was calculated using the risk assessment program Boadicea. We used this unique data to estimate the optimal size of pedigrees, e.g., those that best balance the accuracy of risk assessment using Boadicea and cost of ascertainment. Sub-groups of randomly selected 104 positive and 105 negative women for the founder BRCA2 PV were formed and Receiver Operating Characteristics curves compared for efficiency of PV prediction with a Boadicea score. The optimal pedigree size included 3° relatives or up to five generations with an average no. of 53.8 individuals (range 9-220) (AUC 0.801). Adding 4° relatives did not improve the outcome. Pedigrees including 3° relatives are difficult and sometimes impossible to generate with conventional methods. Pedigrees ascertained with data from pre-existing genealogy databases and cancer registries can save effort and contain more information than traditional pedigrees. Genetic services should consider generating EGP's which requires access to an accurate genealogy database and cancer registry. Local data protection laws and regulations have to be addressed.

Cognitive-behavioural therapy in medication-treated adults with attention-deficit/hyperactivity disorder and co-morbid psychopathology: a randomized controlled trial using multi-level analysis

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by high rates of co-morbid psychopathology. Randomized controlled trials of multimodal interventions, combining pharmacological and psychological treatments, have shown a robust treatment effect for ADHD symptoms but outcomes for co-morbid symptoms have been mixed. This may be accounted for by the type of intervention selected and/or by methodological problems including lack of follow-up and low power. The current study addressed these limitations in a parallel-group randomized controlled trial conducted in Iceland.

METHOD

A total of 95 adult ADHD patients who were already being treated with medication (MED) were randomly assigned to receive treatment as usual (TAU/MED) or 15 sessions of cognitive-behavioural therapy (CBT/MED) using the R&R2ADHD intervention which employs both group and individual modalities. Primary measures of ADHD symptoms and severity of illness, and secondary measures of anxiety, depression and quality of life were given at baseline, end of treatment and 3-month follow-up. Primary outcomes were rated by clinicians blind to treatment condition assignment.

RESULTS

CBT/MED showed overall (combined outcome at end of treatment and 3-month follow-up) significantly greater reduction in primary outcomes for clinician-rated and self-rated ADHD symptoms. Treatment effect of primary outcomes was maintained at follow-up, which suggests robust and lasting findings. In contrast to the primary outcomes, the secondary outcomes showed significant improvement over time.

CONCLUSIONS

The study provides evidence for the effectiveness of R&R2ADHD and demonstrates that there are differential effects over time for ADHD symptoms versus co-morbid problems, the latter taking longer to show positive effects.

WE-G-217BCD-11: A New Phantom to Study Combined Effects of In-Plane (x,y) and Z Axis Resolution for 3-D Imaging

PURPOSE

The aim of this work is to develop phantoms that can be used to sample the radial and 3D properties of a CT image, including in-plane (x,y) and z-axis information. The Phantom is amenable to mathematical analysis of the x, y, and z axis resolution properties separately and combined.

METHODS

A periodic pattern of a pair of opposed (30°) angled ramps is configured to produce a waveform profile across the CT image. A perfect CT image (with no loss of resolution) of the test object would produce a consistent geometric pattern of the intersection of a line with the pair of angled ramps. However, due to the finite resolution (x, y and z), the CT waveform profile will not yield the perfect profile; rather it will be influenced by slice thickness, and in-plane resolution (PSF, MTF), as well as noise limitations, and other sources of non-uniformity such as beam hardening etc. Various characteristics of the waveform profile including, amplitude, frequency, and slope (rate of climb) of the peaks, can be studied using mathematical analysis such as the Fourier transform. It will be shown how these performance characteristics are encoded in the wave pattern.

RESULTS

The waveform profiles are visually examined and mathematically analyzed, to demonstrate the effect of Slice Thickness (z axis) and changes of In-Plane (x,y) Resolution and non-uniformity across the image field; moreover, the harmonic analysis of the waveform is used to predict, either the in-plane resolution (MTF), or the z-axis MTF when one of the two is already known.

CONCLUSIONS

The Wave pattern phantom offers a way to consider 3-D imaging characteristics of a CT scanner by scanning a single repetitive test object that encodes both in-plane resolution and z-axis resolution and also offers a way to study non-uniformity effects throughout the CT plane (volume). DJG is a consultant to The Phantom Laboratory and Image OWL, Salem, NY. Funding of other authors is supplied by Image OWL Salem, NY.

SU-E-I-38: Optimizing CT Slice Width Measurements

PURPOSE

For almost four decades bead and wire ramps have been used in the evaluation of slice width as part of QA testing for CT scanners. While each of these approaches have been recognized and accepted as reliable, in this paper we investigate the differences, advantages and limitations of these tools. Moreover, we study the effect of varying the field of view (FOV) and focal spot size.

METHODS

The Catphan® 700 phantom includes two pairs of bead ramps (coarse and fine) and a pair of wire ramps in the same module providing an ideal setting for comparing bead ramps and wire ramps. The phantom was scanned using three devices from two different manufacturers. The data set consisted of 428 slices of 0.5,1,2,4,8 and 10 mm thickness. For the study of FOV and focal spot, 512 slices from the Catphan® 600 were acquired. All images were analyzed using Image Owl Catphan® QA software.

RESULTS

For 0.5mm slices, bead ramps gave more accurate and precise (lower variance) estimation of the thickness than wire ramps. For 2-4 mm slices, the two approaches performed on equal terms while for the thickest slices (8 and 10mm), the wires gave more precise results. For thin slices, a small FOV (100mm) gave better results and lower spread than a large FOV (240mm). Finally, a small focal spot gave significantly better results than a large one using wire ramps for 0.5 and 1mm slices.

CONCLUSIONS

For measuring thin slices, the use of bead ramps, with adequately small FOV and a small focal spot should be advised. For measuring thick slices, wire ramps will give less variability although bead ramps give equally accurate results on average. Funding provided by The Phantom Laboratory, Incorporated and Image Owl, Incorporated.

[Musculoskeletal symptoms among supermarket workers.]

OBJECTIVES

The aim was to study the prevalence of musculoskeletal symptoms among supermarket workers in Iceland with special emphasis on the checkers.

MATERIAL AND METHODS

The sample was all workers in supermarkets in Reykjavik and Akureyri, which had at least three check-out stations. The sample comprised 653 persons, 448 females and 205 males. The Nordic Questionnaire was mailed to the participants' home addresses. Symptoms of female checkers were compared to symptoms among other workers by Mantel-Haenszel test (OR) and 95% confidence intervals (95% CI) were calculated.

RESULTS

Compared to other females symptoms among the checkers who worked 20 hours or more a week were high for neck (OR=4.0; 95% CI=1.5-10.7), shoulders (OR=4.5; 95% CI=1.4-14.4), upper back (OR=2.3; 95% CI=1.1-4.7) and wrists (OR=1.2; 95% CI=0.4-3.0) when adjusted for age. Taking years at work into account gives similar results. For hips OR was 0.3 (95% CI=0.1-0.9). Women who had jobs with different work tasks, including checker work, had substantially lower prevalence of symptoms compared to women who only did checker work.

CONCLUSIONS

The high prevalence of symptoms from neck, shoulders and upper back among checkers with extended working hours could be related to the repetitive movements which the job demands. It is suggested that those working as checkers should have alternative work tasks and the time at the checkout-stations should be limited.

Normalization of the dexamethasone suppression test at discharge from hospital. Its prognostic value

Fourteen patients with RDC diagnosis of primary, endogenous, major depressive disorder were studied in an inpatient setting. All were non-suppressors on the Dexamethasone Suppression Test on admission to hospital and were retested at discharge. Over 70% of patients continued to be non-suppressors at discharge, when in clinical remission. Four out of 14 patients converted to normal suppression. All 10 of the non-normalizers did poorly on follow-up: 3 patients committed suicide. All normalizers did well. Non-normalization of the DST at discharge from hospitalization may be more common than previously suspected and predicts poor clinical outcome.