Support for a browser plug-in blocking online alcohol imagery among Australian participants: A qualitative interview study

ISSUES ADDRESSED

Alcohol depictions are extremely common online, and there is a reported relationship between alcohol exposure and alcohol use. A browser plug-in specifically designed to block online alcohol depictions may be helpful to prevent the uptake of alcohol or increased alcohol use.

METHODS

Twenty-five semi-structured interviews were conducted, examining participants' beliefs about the effects of online alcohol exposure and their support for developing the browser plug-in.

RESULTS

Using reflexive thematic analysis, we found participants highlighted a clear impact of viewing alcohol online and offline alcohol use. Participants believed a browser plug-in that blocked alcohol was acceptable and would be especially useful for minors (to prevent alcohol initiation) and those who are aiming to reduce their alcohol use.

CONCLUSIONS

Participants emphasised that viewing online alcohol exposure had an impact on drinking behaviours, such as increased craving and temptation. The browser plug-in was considered an easy intervention tool for both parents and people who are experiencing alcohol-related problems or trying to reduce their drinking. SO WHAT?: Participants' continuous support of an alcohol-blocking browser plug-in suggests that future health promotion strategies should consider the development of a prototype plug-in.

Perceptions of palliative care in Huntington's disease: A qualitative study

INTRODUCTION

Palliative care focuses on improving patient and family quality of life by managing symptoms, psychosocial issues and spiritual concerns. Huntington's disease is a progressive neurodegenerative disorder with no current disease modifying therapy. Although the palliative care model has been postulated to be an integral part of HD care, there are gaps in knowledge about how this care should be implemented. This study aims to identify perceptions of palliative care in Huntington's Disease (HD), palliative care needs of people living with HD, and at what point they feel they would benefit from these resources.

METHODS

Participants volunteered from a large academic institution patient base to be involved in semi structured interviews that explored patient and caregiver experience surrounding their diagnosis, disease management, quality of life, and areas for improvement. Inclusion criteria for participants was a diagnosis of Huntington's disease and/or a self-identified caregiver of a person living with the disease.

RESULTS

A total of 12 independent patients, three independent caregivers, and five dyads completed the interviews. Themes identified included needs that would provide patient and caregiver centered treatment, current gaps in care, an openness and desire for palliative care, and knowledge about the desired timing of palliative care in treatment plans.

CONCLUSION

People living with HD and caregivers of people with HD most desire access to treatment that would focus on symptom management, availability of social resources, advanced care planning and spiritual wellbeing. The preferred timing of this intervention for most individuals would be at the onset of symptoms.

Drinking alcohol at home feels different from drinking in public places: a qualitative study of midlife Australians

This paper shows how drinking in one's own home affords different affective experiences to drinking in public settings such as bars, pubs and restaurants. A thematic analysis of interviews with 40 Australians aged 30-65 identified three main variations in alcohol-associated feelings, sensations and urges. Alcohol was used at home to decelerate, but in contrast, people were enlivened when drinking in public venues. Drinking in public generated a sense of vigilance and greater requirement to self-monitor than usually felt necessary at home. For some, drinking at home seemed more habitual; governed by urges rather than intentionality, than drinking outside it did. Policy and interventions that target drinking in the home should be prioritised, such as those focussed on off-premise pricing and availability.

Alcohol's contribution to climate change and other environmental degradation: a call for research

Climate change is the single biggest health threat facing humanity. The production, distribution and consumption of many fast-moving consumer goods contribute substantially to climate change, principally through releasing greenhouse gas emissions. Here we consider just some of the ways that alcohol-already a key contributor to an array of health, social and economic burdens-exacerbates environmental harms and climate change. We explore current evidence on alcohol production as a resource- and energy-intensive process, contributing to significant environmental degradation through water usage and other carbon emission costs. We argue that the impacts of alcohol production on climate change have been minimally explored by researchers. Yet the extent of the unfolding catastrophe beholds us to consider all available ways to mitigate unnecessary emissions, including from products such as alcohol. We then turn to suggestions for a research agenda on this topic, including investigations of commercial determinants, inequalities and product advice to help consumers choose lower-carbon options. We conclude by arguing that public health researchers already have an array of methodological expertise and experience that is well placed to produce the evidence needed to inform regulation and efforts by alcohol producers and consumers to minimize their contributions to environmental harms.

Educating students about volatile substance use in Australian schools: Is the current approach evidence-based, and how should we do it?

Australian national, state and territory school-based drug education policies advise that volatile substance use (VSU) should be excluded from general drug education curriculum for fear of alerting young people to the intoxicating properties of substances such as petrol, sprays and glues. We review evidence from the United States and United Kingdom on the effects of including volatile substances in school-based drug education, to argue that these policies are due for reconsideration. Nitrous oxide and nitrites are classified as volatile substances along with solvents such as those listed above, although their patterns of use, effects and harms are different. In an era of widespread social media access, more young people than in the past are likely to have heard about VSU. But because VSU is often short-term, parents and teachers may be unaware when young people in their care consume volatile substances. The general silence about VSU in schools, difficulty in detecting use and the varying sets of risks associated with inhaling different substances mean that young people may be unaware of toxicity or harm reduction strategies when they consume volatiles as drugs. We consider some implementation challenges to be negotiated if VSU education were introduced in Australian schools.

Strategies to support midlife women to reduce their alcohol consumption: an Australian study using human-centred design

Alcohol consumption is causally associated with long-term health-related consequences, such as cancer and cardiovascular disease, and short-term harms, such as accidents and injuries. Alcohol consumption has increased among midlife women (aged 40-65) over the last two decades in high-income countries. This study aimed to centre women's voices by using co-design methodologies to investigate what women identify as strategies that could assist them and other women their age to reduce their alcohol consumption. Human-centred design workshops were undertaken with 39 women, and conventional qualitative content analysis was used to analyse information from written workshop materials to develop categories in the data and count their occurrence. Six categories, or strategies, emerged, listed here from most to least represented: 'Participate in alternative activities to drinking alcohol', 'Track alcohol consumption and set goals', 'Seek support from family and friends', 'Drink alcohol-free beverages', 'Reduce supply of alcohol in the home' and 'Seek professional support'. Our findings identify strategies that are realistic and feasible to midlife women; our sample, however, likely reflects a more affluent subsection of this group, and as such, any focus on individual-level strategies must be complemented by policies that increase equitable access to healthcare and act on the social and commercial determinants of health. An intersectional approach to alcohol and other drug research is required to examine how the interplay of gender and other markers of social identities shape alcohol consumption.

An observation study of mathematics instruction for students with IDD in grades K-2

This observation study documents the amount and quality of mathematics instruction provided to students with intellectual and developmental disabilities in kindergarten through second grade in self-contained special education settings. We observed six special education teachers and their students (N = 12) during a total of 967 min allotted to early numeracy and mathematics instruction. Mathematics and early numeracy instruction comprised 61.2% of all observed time allotted for mathematics, followed by non-instruction (32.7%), mathematics assessment (5.7%), and instruction in other areas (0.3%). Observed mathematics content included Numbers and Quantitative Reasoning, and Measurement. Mean ratings of student engagement and instructional quality across areas were medium and low-average, respectively. Although student engagement did not differ by who was leading instruction, instructional quality differed between teachers and paraeducators. Class sizes were small, and teachers most often taught students as a whole class or individually. Students used technology, manipulatives, and printed instructional materials during learning.

Efficacy of Single-Fraction Postoperative Radiotherapy in Resected, Early-Stage Merkel Cell Carcinoma with High-Risk Features

PURPOSE/OBJECTIVE(S)

Merkel cell carcinoma (MCC) is an aggressive skin cancer with a high recurrence risk. Postoperative radiotherapy (PORT) improves the local recurrence rate (LRR) in early-stage MCC with risk factors per NCCN guidelines: primary tumor size > 1cm, head/neck (HN) location, immunosuppression, lymphovascular invasion (LVI), and positive/narrow surgical margins. Conventionally fractionated PORT (C-PORT, ∼50 Gy in 25 fractions) is often recommended for localized MCC with these risk factors; however, some institutions elect observation. Prior studies suggest LRR of ∼20% for stage I/II MCC with high-risk features managed with surgery alone. C-PORT significantly decreases LRR but may cause significant morbidity and financial toxicity. We have previously reported that single fraction (SF)-PORT with 8 Gy achieves high rates of in-field control both in the metastatic and adjuvant settings with minimal morbidity. Here, we present updated long-term outcomes of SF-PORT, offered as an alternative to C-PORT with the hypothesis that it improves LRR relative to observation while minimizing toxicity, for resected stage I/II MCC.

MATERIALS/METHODS

A retrospective, single-institution analysis was completed for stage I/II MCC patients receiving SF-PORT following surgical management. The primary objective was estimating the LRR, defined as recurrence within 2 cm of the primary tumor. Patients with resected, stage I/II MCC with at least one high-risk feature were offered C-PORT as standard of care or SF-PORT as an alternative.

RESULTS

Forty-six patients (median age: 74.5; range 50-96 years) received SF-PORT to the primary tumor site at a median 44 days after wide local excision (85%), shave/excisional biopsy (13%), or Mohs (2%). Fifty-four percent of patients had 1 high-risk feature, 35% had 2, and 11% had 3 or more. HN (74%) was the most common primary site, 26% of tumors were > 1cm, 26% were LVI+, and 15% of patients were immunosuppressed (pathological margin status was often not available). There were no local recurrences (LRR = 0%) at a median follow-up time of 2.3 years. In-field locoregional control was 96% (44/46 patients) with 2 in-field, regional recurrences observed in draining nodal basins of HN primary lesions. There were 2 out-of-field regional nodal recurrences (1 patient with IMS; neither received elective nodal SFRT). Of 9 patients who received elective nodal SF-PORT, 8 did not have a successful sentinel lymph node biopsy. No MCC-specific deaths were observed. The most common side effect was in-field, grade 1 erythema (13%); no side effects > grade 1 (CTCAE v5) were noted.

CONCLUSION

SF-PORT is associated with a very low LRR which has proven durable with long-term follow-up. The LRR for SF-PORT appears lower than historical controls treated with surgery alone for patients with resected, stage I/II MCC with high-risk features.

Influencing the global governance of alcohol: Alcohol industry views in submissions to the WHO consultation for the Alcohol Action Plan 2022-2030

BACKGROUND

In 2020, the Secretariat of the World Health Organization (WHO) conducted an open consultation, with public submissions, for the purpose of developing an Alcohol Action Plan to "strengthen implementation" of the WHO's 2010 Global Strategy to Reduce the Harmful Use of Alcohol. The consultation process and public submissions provided an opportunity to critically examine alcohol industry perspectives and arguments in relation to the global governance of alcohol.

METHODS

48 alcohol industry submissions to the WHO's 2020 consultation were included for analysis. Directed content analysis was used to examine the policy positions and arguments made by industry actors. Thematic analysis was employed to further explore the framing of industry arguments.

RESULTS

In framing their arguments, alcohol industry actors positioned themselves as important stakeholders in policy debates; differentiated "normal" drinking from consumption that merits intervention; argued that alcohol policy should be made at the national, rather than global, level; and supported industry self-regulation or co-regulation rather than cost-effective public health measures to prevent harms from alcohol.

CONCLUSION

The alcohol industry's submissions to the WHO's 2020 consultation could be seen as efforts to stymie improvements in the global governance of alcohol, and repeats several framing strategies that the industry has used in other forums, both national and global. However, their arguments appear to have had little traction in the creation of the Alcohol Action Plan. Changes from the Working Document to the adopted Action Plan show little acceptance by WHO of industry arguments.

Sex differences in young children's perceptions of situational drinking norms over time

OBJECTIVES

To date, there have been no previous studies examining sex differences in the development of alcohol-related perceptions over time, a potential avenue for targeted prevention and early intervention efforts. This article examines any potential sex differences in young children's development of situational drinking norms over time.

METHOD

Two hundred ninety-eight children (aged 4-6 years at baseline) completed the Dutch electronic Appropriate Beverage Task-which involves attributing alcoholic beverages to adults in varying situational contexts-annually over 3 years (2015, 2016, 2017). Three-level regression models were estimated examining whether perceptions of situational drinking norms varied as a function of the sex of the participant and whether there were any changes over time.

RESULTS

Over time children did not attribute more alcoholic beverages to adults in various situations, instead both boys and girls became more accurate at correctly identifying situations in which drinking is more common. Over time, both boys and girls attributed more alcoholic beverages in common situations and less in uncommon situations, with no significant sex differences in attributions of alcohol found.

CONCLUSIONS

We identified no significant sex differences in the development of situational drinking norms over time, suggesting that education and prevention campaigns can be unified/nontargeted by sex. However, given our findings differ from previous studies that identify significant sex differences between children on the development of other alcohol-related cognitions beyond situational drinking norms, there is a need for more international research in this space to understand the importance and nature of the development of alcohol-related perceptions over time. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

All alcohol exposure counts - testing parental, older sibling, best friend and peer exposure on young adolescent drinking in a seven-wave longitudinal study

AIMS

Role models around the adolescent, including parents, peers, best friends and older siblings, all act in ways to socialize the adolescent into alcohol use. This study aims to examine the effect of exposure to siblings' drinking alongside the more traditionally examined role models on alcohol use among adolescents.

DESIGN

A longitudinal study followed adolescents (45.6% male) who completed a questionnaire every 6 months over 3 years (seven in total).

SETTING

Netherlands PARTICIPANTS: This resulted in 5112 observations clustered in 765 participants aged between 10 and 16 years.

MEASUREMENTS

We examined three alcohol use measures: alcohol use in the last 6 months, in the last 4 weeks and binge drinking in the last 4 weeks-both cross-sectionally at each time-point and their change from one time-point to the next in a series of multi-level logistic regression models.

FINDINGS

Results revealed a non-significant difference in any of the exposure or alcohol use variables between those with or without older siblings. Higher exposure to sibling drinking was significantly associated with all alcohol use outcomes: use in the last 6 months, odds ratio (OR) = 1.54, 95% confidence interval (CI) = 1.25-1.91; last 4 weeks, OR = 2.04, 95% CI = 1.60-2.60; and binge drinking, OR = 2.35, 95% CI = 1.82-3.05. When adding the other role models (i.e. peers, mothers, fathers and best friends), the significant association between siblings' exposure and adolescents' alcohol use remains.

CONCLUSIONS

It would appear that, after adjustment for the effect of role models, adolescents who are exposed to more sibling drinking are more likely to have drunk alcohol during the past 6 months and past 4 weeks and also to binge drink.

Validation of the revised Alcohol Expectancy Task [rAET]

Alcohol expectancies are well-established determinants of alcohol consumption. Traditionally, expectancies were assessed using self-report questionnaires. However, researchers have increasingly begun to explore the use of pictographic assessments, for example, the revised Alcohol Expectancy Task [rAET]. The current research aimed to examine the factor structure of the task in relation to the hypothesised expectancy dimensions, participants' endorsement of these dimensions, and whether rAET scores are associated with drinking patterns. The rAET presents participants with several illustrated scenarios in which people are displaying emotions, following the Circumplex Model of Affect. For each scenario, participants select which type of drink the person presented in the illustration was most likely to have drunk. The rAET was administered online to a convenience sample (n = 1,192, female: 50.7%, Mage = 36.8, SD = 13.7). The confirmatory factor analysis demonstrated adequate fit of the hypothesised four-factor model. Mean comparisons demonstrated that positive expectancies were more pronounced than negative expectancies, and a distinction between arousal and sedation expectancies was found. Results of a structural equation model found that positive sedation and positive arousal were related to high drinking frequency. There were no links between usual quantity of alcohol use or binge drinking. It appears that the rAET can be successfully used to assess alcohol expectancies in terms of the emotions that are expected to occur from alcohol consumption. Future research is needed to establish the tool's assessment properties in different settings, and its utility in predicting alcohol consumption in different age groups, particularly children and young adolescents. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Home alone: Patterns and perceptions of solitary home alcohol consumption in an Australian convenience sample

INTRODUCTION

In contrast with extensive literature exploring sociable alcohol use, few studies focus on drinking alone at home, even though the home is the place where the majority of drinking occurs.

METHODS

We draw on survey and interview data gathered in 2018/2019 prior to the COVID-19 pandemic, to identify prevalence and perceptions of solitary home drinking in an Australian convenience sample of heavy and light drinkers (LD).

RESULTS

A substantial minority of survey participants identified drinking home alone, with over a quarter of heavy drinkers (27%) reporting that they only drank alone in their own home (compared to 15% of LD). In interviews, solitary home drinking was frequently constructed as signifying personal inadequacy, heavy consumption and harm. However, tensions arose through solitary home drinking bringing pleasures, such as relaxation. It was regarded as more socially acceptable for men than women and lighter home drinking patterns were viewed more positively than heavy drinking. Perceptions of what constitutes solitary home drinking varied, with some suggesting it includes drinking with others present who are not themselves drinking, and others using a more limited definition of consuming alcohol while alone in a house.

DISCUSSION AND CONCLUSIONS

While strong social sanctions against it persist, solitary home drinking can reflect a lack of opportunity to drink with others and also be associated with more harmful regular patterns of alcohol use. Increasing recognition of home drinking provides a new imperative to better understand the complex stigmatisation that frames solitary home drinking and to explore opportunities to limit associated harms.

Effects of exposure to mother's and father's alcohol use on young children's normative perceptions of alcohol

BACKGROUND

While consumption of alcohol does not often begin until early adolescence, young children are highly capable of internalizing normative information through observational learning. We used a longitudinal multiple-informant family study to examine the impact of exposure to mothers' and fathers' drinking on young children's normative perceptions of who drinks alcohol.

METHODS

Three hundred twenty-nine children (4 to 6 years old at baseline [M_age 4.78 (SD = 0.725)], 51% girls) completed the Dutch electronic appropriate beverage task [eABT] where they attributed alcoholic beverages to a variety of persons depicted in an illustrated scenario. Their parents completed an online survey that included information on alcohol use and exposure.

RESULTS

Children more frequently exposed to their mothers' drinking provided females shown in the eABT illustrations with alcohol significantly more often than children less frequently exposed to mothers' drinking. There was no effect of mother's exposure on providing males in the eABT with alcoholic beverages. Similarly, children more frequently exposed to their fathers' drinking provided fathers with alcoholic beverages significantly more often than children less frequently exposed to their fathers' drinking. There was no effect of father's exposure on providing the females with alcoholic beverages, nor was there an effect of father's exposure on providing "other males" with alcohol. These patterns held after adjusting for age and sex.

CONCLUSIONS

This study demonstrates that there are gender-specific effects of exposure to parents' (particularly mothers') drinking on young children's perceptions of person-specific drinking norms. The findings provide unique evidence in a young population group of effects on an understudied dimension of alcohol-related perceptions with implications for future drinking behavior.

59 Associations of Biological Sex with Clinicopathologic Features of Cutaneous Melanoma

Aim

It is commonly known that women have better prognosis than men after diagnosis of primary cutaneous melanoma. However, few studies have investigated whether histopathological prognostic factors are associated with this difference. This study aimed to investigate if there were sex-specific differences in prognostic features of primary melanoma at time of diagnosis in a large clinical series.

Method

This was a records-based observational study of unselected patients treated for melanoma in a major tertiary oncology centre in the United Kingdoms, 2002–2016. Prognostic features (age at diagnosis; thickness of primary melanoma; ulceration and mitotic count) were extracted from histological reports and sex-specific differences tested for significance using X2 test.

Results

Among 1323 melanoma patients of median age 61 years (range 15–99), and roughly equal proportions of males (640, 48%) and females (683,52%), females had significantly earlier age of presentation on average than males (58 vs 64 years) (p<0.001). Comparing Breslow thickness of <2mm vs ≥2mm, significantly more females (414, 67%) than males (282, 55%) had melanomas <2mm (p<0.001). Other key histopathological factors namely presence of ulceration (p=0.073) and mitotic rate (p=0.618) were not significantly different by sex.

Conclusions

We found that female melanoma patients presented at an earlier age and with thinner primary melanomas than males, but mitotic rate (speed of tumour growth) was not significantly different. These data suggest that females’ better prognosis is explained by their tendency to present earlier with suspicious skin lesions than males.

Transport and migration of plutonium in different soil types and rainfall regimes

Leaching and transport of contaminants is a complex interacting system affected by a suite of environmental factors. This study demonstrates the potential significance of weather events and moisture movement when interpreting plutonium (Pu) migration and advective transport in the soil matrix. Using a column transport experiment, two soil types, a sandy soil and clay-rich soil, were spiked with ²³⁸Pu as a tracer to observe the effect of simulated tropical and arid rainfall events on Pu mobility. Partition coefficients (Kd) were determined over a period of weeks and under varying rainfall rates to establish the impact of changing weather events on Pu mobility. The variability of these temporal Kds covers six orders of magnitude over a relatively brief time period. This demonstrates the necessity for non-static Kds to accurately describe Pu transport in these systems. The Pu Kds determined by these column transport experiments fall within the bounds of anticipated values (approximately 80-300,000 mL g^-1) from immobile (magnitude 10⁶ mL g^-1) to moderately mobile (magnitude 10¹ mL g^-1). The overall transport rate, shown by a decrease in calculated Kd, increases in environments where rainfall is more episodic, such as in arid regions as opposed to the consistently abundant rainfall in tropical regions. In contrast to the ²³⁸Pu spike, ^239+240Pu resulting from contamination from nuclear tests in the sandy soil (aged for >30 years) showed higher mobility; we hypothesise that the ageing of the contamination, in particular Pu-bearing particles, accounts for this significant increase in Pu mobility. Low intensity, high frequency events in tropical sandy soil systems containing Pu particle contamination have the potential to mobilise Pu (>10⁵ decrease in calculated Kd) over shorter periods of weeks, and not years as previously assumed. This increased mobility, when applied to radioecological models using Kd as a site-specific parameter, shows that there is likely to be a continued impact (risk quotient >1) on non-human biota in tropical sandy soil ecosystems.

Parents' management of alcohol in the context of discourses of 'competent' parenting: A qualitative analysis

How parents manage potential tensions between normative discourses of 'competent parenting' and their desires to consume alcohol has received little attention. In this article, we explore the elements that encourage or constrain parents' drinking and investigate how parents consider and manage their alcohol use in the context of multiple social roles with sometimes conflicting demands and expectations around 'competent parenting'. Our analysis draws on 30 semi-structured interviews with Australian parents, conducted as part of a broader project which aimed to explore how home drinking is integrated into everyday life. While parents' accounts of drinking alcohol highlighted effects such as embodied experiences of relaxation and facilitating shared adult moments, many participants described drinking less than they otherwise would if their children were not present. Participants discussed various social roles and routines which constrained consumption, with drinking bounded by responsibility. As such, drinking emerged as something needing to be actively negotiated, particularly in light of discourses that frame expectations of what constitutes 'competent parenting'. When considering parents' alcohol consumption in the future, we argue that it is important to destigmatise their consumption by acknowledging the importance of adults' pleasure and wellbeing, alongside children's needs for safety and modelling of safer alcohol consumption.

POS0325 THE ASSOCIATION BETWEEN OBESITY, SOCIOECONOMIC POSITION AND KNEE JOINT REPLACEMENT SURGERY IN PATIENTS WITH OSTEOARTHRITIS: RESULTS FROM THE ENGLISH LONGITUDINAL STUDY OF AGEING

Background

Evidence suggests that associations of lower socioeconomic position (SEP) with increased incidence of osteoarthritis (OA) are partially mediated by obesity. Obesity and lower SEP are also associated with increased symptoms in OA (i.e. pain/function). However, few studies have investigated whether obesity and lower SEP are also associated with increased risk of knee joint replacement surgeries (kJRS).

Objectives

To investigate the relationships of obesity and SEP at time of diagnosis with kJRS at follow-up in people with knee OA (kOA).

Methods

The English Longitudinal Study of Ageing is a nationally representative panel study of adults aged ≥50 years with biannual waves of data collection (2002–2019). Participants who self-reported OA diagnosis for the first time in waves 2–8 and knee pain in the same or previous wave of diagnosis were defined as having kOA (baseline). Participants with at least one body mass index (BMI) measurement and one follow-up assessment were included. Underweight/normal weight, overweight and obesity were defined using BMI <25 kg/m2, 25–30 kg/m2 and ≥30kg/m2, respectively. Education, occupation (current or last occupation if retired), wealth quintiles (all individual-based) and index of multiple deprivation quintiles (area-based) were used as SEP indicators. Outcome was the first self-reported kJRS (left or right knee) in waves 3–9. Cox proportional hazards models were used to investigate the associations of obesity and SEP with kJRS, controlling for baseline covariates. Person year follow up was calculated from baseline to either a) date of self-reported kJRS, b) loss to follow-up, c) end of follow-up (wave 9).

Results

The analysis sample included 1499 people who reported kOA and had ≥1 BMI measure (62.3% female; mean age 66.5y (SD 9.4); 96% white; 47.4% obese). Number of person-years included in the analysis was 8427. Over a mean follow-up of 4.7 years (SD 2.8), 144 (9.6%) reported having kJRS. Obese kOA patients were more likely to report kJRS than non-obese patients (adjHR 1.89 (95% CI 1.33, 2.68)), independent of age, gender, SEP, cardiovascular disease (self-reported) and HbA1c values (measured from collected blood samples). Education and occupation were not associated with kJRS. However, those living in the most deprived areas and with the least amount of wealth were less likely to undergo kJRS compared with the least deprived and wealthiest (HRs adjusted for age and gender 0.37 (95% CI 0.19, 0.73) and 0.55 (95% CI 0.33, 0.93), respectively). There was no evidence of interactions between obesity and SEP indicators.

Conclusion

Obesity increased the likelihood of undergoing kJRS in kOA patients. Therefore, reducing obesity in kOA patients may help to reduce the need for kJRS. Area-deprivation and lower wealth were associated with lower likelihood of kJRS. Taken together with findings from other studies which report associations between lower SEP and worse OA symptoms, our results suggest that there may be social inequalities in the provision of kJRS in England.

Table 1.

The relationships between obesity at baseline and rates of knee joint replacement surgery over a mean of 4.7 (SD 2.8) years in follow-up in those with knee OA at baseline in the English Longitudinal Study of Ageing

PredictorsHR (95% CI)UnadjustedAdjusted for age and genderAdjusted for age, gender and SEPAdjusted for age, gender, SEP, CVD and HbA1cObesity1.56 (1.12, 2.17)1.63 (1.17, 2.28)1.77 (1.26, 2.50)1.89 (1.33, 2.68)Non-obesityrefrefrefrefObesity3.53 (1.77, 7.02)3.58 (1.80, 7.12)4.01 (2.01, 8.03)4.35 (2.16, 8.74)Overweight2.91 (1.43, 5.91)2.81 (1.38, 5.73)2.93 (1.44, 5.98)2.98 (1.46, 6.09)Underweight/normal weightrefrefrefrefBMI per 1 kg/m2 increment1.05 (1.02, 1.07)1.05 (1.03, 1.08)1.06 (1.04, 1.09)1.07 (1.04, 1.10)

HR, hazard ratio; CI, confidence interval; SEP, socioeconomic position; CVD, cardiovascular disease; ref, reference category; BMI, body mass index.

Disclosure of Interests

None declared

Hepatitis C Virus Reflex Testing Protocol in an Emergency Department

Introduction: Our aim was to measure hepatitis C virus (HCV) screening and linkage-to-care rates in an urban emergency department (ED) before and after implementing an HCV viral RNA (vRNA) reflex testing protocol within a HCV screening program for at-risk patients. Our hypothesis was that using a reflex testing protocol would increase HCV testing rates of at-risk patients in the ED, which would increase the linkage-to-care rate. Methods: In August 2018, our institution implemented an automated, electronic health record-based HCV screening protocol in the ED for at-risk patients. In January 2019, we implemented an HCV vRNA reflex testing protocol (reflex testing) for all positive HCV antibody (Ab) tests that were initiated through the screening protocol. We compared completion rates of HCV vRNA testing and the rate of linkage to care for patients with positive HCV Ab test results before and after implementation of reflex testing (five months per study period). Results: Prior to reflex testing implementation, 233/425 (55%) patients with a positive HCV Ab test had an HCV vRNA test performed, whereas 270/323 (84%) patients with a positive HCV Ab test result had vRNA testing after reflex testing implementation (odds ratio [OR], 4.2; 95% confidence interval (CI): 3.0-6.0; P < 0.001). Of the eligible patients with positive HCV Ab test results who could be linked to care, 45 (10.6%) were linked to care before HCV reflex implementation and 46 (14.2%) were linked to care with reflex testing (OR, 1.4; 95% CI: 0.9-2.2; P = 0.13). Conclusion: Implementing a reflex testing initiative into an HCV screening program in the ED can result in an increase of the percentage of patients who receive an HCV vRNA test after having had a positive HCV Ab. Hepatitis C virus vRNA reflex testing was not associated with a statistically significant increase in linkage-to-care rates for HCV Ab-positive patients; however, further studies are required.

Decomposition of Kemp’s ridley (Lepidochelys kempii) and green (Chelonia mydas) sea turtle carcasses and its application to backtrack modeling of beach strandings

When a sea turtle dies, it typically sinks to the bottom, begins decomposing, and floats to the surface once sufficient internal gases have accumulated to produce positive buoyancy. This process is poorly characterized and is essential to understanding where and when sea turtles found on shore may have died. We conducted decomposition studies with detailed time-temperature histories using carcasses of cold-stunned sea turtles (22 Kemp’s ridleys Lepidochelys kempii and 15 green sea turtles Chelonia mydas) at temperatures of 14-32°C and depths of 2.2-9.5 m. We found strong depth/pressure-related effects; carcasses took longer to float when incubated at greater depths than shallower depths at similar temperatures. Furthermore, carcasses incubated at colder temperatures (~15°C) took 8 times longer to float than those at 32°C at the same depth. We applied accumulated degree hours (ADH; hourly sum of ambient temperatures a carcass experienced) to characterize environmental conditions associated with different stages of decomposition and key events, including buoyancy and sinking. A formula for temperature-correction of ADH was calculated to fit a non-linear increase in decomposition at higher temperatures. These data were then used to improve an existing backtracking model by incorporating water temperature, depth (pressure), bathymetry, and postmortem condition. Heat maps of the probable mortality locations from the model agreed well with carcass and effigy drift experiments, demonstrating the overall reliability of the enhanced model. Our method can be used to estimate at-sea locations where sea turtles found washed ashore in the northern Gulf of Mexico likely died and may help inform similar efforts in other regions.

Men and Women's Alcohol Consumption by 4- to 8-Year-Olds: A Longitudinal Investigation of Gendered Drinking Norms

INTRODUCTION

Evidence suggests an association between perceived alcohol-related norms and personal consumption. These perceptions develop over years of observation and exposure to alcohol, likely beginning in early childhood, and likely differing by sex. Understanding the early development of perceptions of drinking may provide insight into the development of gendered drinking practices. The aim of this study was to explore boys' and girls' perceptions about men and women's alcohol consumption and whether and how these change over time as children age.

METHODS

329 children (aged 4-6 years at baseline) completed the Dutch electronic Appropriate Beverage Task annually for three consecutive years (2015 [baseline], 2016, 2017). Regression models were used to examine whether perceptions of consumption varied as a function of the gender of the adult, the participants' sex, and any changes over time.

RESULTS

In illustrated pictures, children perceived that men (39%) drank alcoholic beverages more often than women (24%). Men were perceived to drink alcohol more frequently than women at baseline and this difference increased with age. Girls were more likely to perceive men drinking at baseline (aged 4-6), but there were few sex differences by time point three (aged 6-8).

DISCUSSION/CONCLUSION

From a young age, children perceive that men drink more than women. These perceptions strengthen as children grow older, with young girls perceiving these gender differences at earlier ages than boys. Understanding children's perceptions of gendered drinking norms and their development over time can enable targeted prevention efforts.

'They're like little police': Australian parents' perceptions of their children's awareness of drinking during COVID-19

INTRODUCTION

As a result of COVID-19 and associated lockdown restrictions, children may have been exposed to more home-based alcohol consumption and parents' drinking practices. This paper explores Australian parents' perceptions of their children's awareness of drinking and their reflections on the impact of COVID-19 on children's exposure and acquisition of alcohol-related knowledge.

METHODS

In-depth interviews were undertaken with 30 parents and carers of children aged four to 12 years from across Australia. Participants described their family lives, the role of alcohol, any changes in alcohol and family dynamics experienced because of COVID-19 and their children's exposure and knowledge of alcohol before and during their experience of COVID-19. Using social learning theory as a guiding framework, transcripts were analysed to identify relevant themes.

RESULTS

Pre-COVID-19 children were commonly thought to be aware of behavioural changes owing to alcohol consumption, made associations between people, beverages and activities and recognised boundaries around consumption. COVID-19 was suggested to have impacted the environments in which children were exposed and the types of modelling and practices they were exposed to. It was more common for participants to describe COVID-19 affecting other children's learning and knowledge of alcohol, rather than their own.

DISCUSSION AND CONCLUSIONS

Participants were mindful of children's knowledge and the role they played in modelling consumption practices prior to and during the COVID-19 lockdowns. There may be scope to use the insights provided here to support parents in modelling approaches and engaging with children about alcohol in ways that challenge or disrupt its prominence or acceptability.

Examining trends in the representation of young people and alcohol in Australian newspapers over twenty years (2000-2019)

BACKGROUND

The news media can reflect and influence public opinion, as well as affect individual practice. In the context of significant changes in alcohol consumption among young people over the past twenty years, we examined Australian newspaper reporting of young people (under 18 years) and alcohol to assess whether there have been changes over time in the content and slant of articles that reflect or elucidate these trends.

METHODS

Factiva was used to search newspaper articles from major Australian newspapers over a twenty year period (2000-2019). After screening, two researchers coded 2415 newspaper articles across four key domains: article type, article theme, sources cited and topic slant (e.g. approving, disapproving tone). Change over time across the study period was assessed using joinpoint Poisson regression analyses.

RESULTS

There was a significant increase in articles on young people and alcohol between 2000 and 2008, before a corresponding decrease to 2019. Policy or prevention strategies were the most common theme of articles (35.8%), followed by articles reporting on risks or harms associated with alcohol use for young people (18.1%). Researchers were the most common source reported (25.1%), followed by politicians (19.0%). Three quarters of articles (75.9%) had a socially disapproving topic slant, which increased significantly up until 2011, with a corresponding decrease thereafter.

CONCLUSION

Attention to, and problematisation of, young people and alcohol increased in the first decade of this millennium which may have acted to sustain or accelerate declining drinking trends. However, this dissipated back to baseline levels in the second decade, which may indicate a lag time in recognition of young people's drinking becoming less of a public health 'problem'.

Change Over Time in Australian Newspaper Reporting of Drinking During Pregnancy: A Content Analysis (2000-2017)

AIMS

This paper analyses the content of news media messages on drinking during pregnancy in Australia over an 18-year period to understand whether and how the nature of messages communicated to women has changed over time.

METHODS

Factiva was used to search Australian newspapers from 2000 to 2017, resulting in a sample of 1394 articles from the 18 major national and state-based newspapers. Content analysis of articles was undertaken, and Poisson regression analysis was used to assess changes over time.

RESULTS

The largest number of articles on drinking during pregnancy was published in 2007. Themes that significantly increased over time included Harms to the Child (from 0.97% in 2008 to 29.69% in 2015) and Prevention Initiatives (from 0% in 2005 to 12.50% in 2017). Articles endorsing women not consuming alcohol during pregnancy significantly increased over time (from 20.69% in 2001 to 53.78% in 2013), matched by a decreasing trend in the proportion of articles presenting mixed advice (from 15.93% in 2009 to 0% in 2017). The largest number of articles adopted no position in relation to women's consumption.

CONCLUSIONS

A stronger abstinence message during pregnancy has been communicated through Australian newspaper media over time. The mixed messaging and large number of articles not endorsing a position on consumption may reflect the inconclusiveness of the evidence on harms from low to moderate levels of alcohol consumption during pregnancy. Opportunities remain for researchers to work with public health advocates to disseminate balanced messages based on evidence-based research.

Agile fusion method for the determination of Pu isotopes in diverse sediments

Atmospheric nuclear testing has occurred worldwide resulting in trace amounts of plutonium (Pu) isotopes in soils and sediments across the globe. Soils and sediments can vary greatly in both physical and chemical properties within close geographic regions presenting a major challenge for sample preparation in the analysis of fallout radionuclides. It is vital to have a rapid, agile method for the complete digestion of samples containing refractory Pu particles to address this challenge. A radioanalytical procedure for the analysis of Pu isotopes in soils/sediments has been developed improving sample preparation using fusion. This is done by eliminating the need for pre-dissolution combustion to remove organic material and providing greater application to a diverse range of samples including those of metal-bearing mineralogy. The integration of borate and peroxide flux materials creates a sample dissolution procedure that is greater than the sum of its parts. This method is applicable to the analysis of ^239/240Pu in soil/sediment samples with a sample mass of 3 g, ranging from 0.05 to 5000 mBq/g achieving ²⁴²Pu tracer recoveries between 50 and 94%, with a trace-level detection limit of 0.04 mBq/g and measurement uncertainties down to 19%; adjustable to measurement priorities with variation in count time, background counts, chemical recovery and total activity of the sample. This sample preparation technique can be utilized with complementary analysis of alpha spectrometry or ICP-MS. Achieving these parameters provides a highly adaptable standard method for ^239/240Pu in soil/sediment analysis applicable to samples from radioecological research at trace environmental levels to emergency response scenarios with 48-h turn-around producing highly repeatable, succinct and high-quality analysis.

Rehabilitation of the former nuclear test site at Maralinga

Large areas of the former British nuclear test site at Maralinga were contaminated by the explosive dispersal of plutonium. The Australian Government, in consultation with stakeholders, determined that the site should be cleaned-up so that it is fit for unrestricted habitation by the Aboriginal traditional owners (Maralinga Tjarutja). Engagement with the stakeholders, particularly the Maralinga Tjarutja, determined that the specific criterion for rehabilitation was 5 mSv y^-1and that some restrictions on permanent occupancy should remain. Remediation of the site began in 1995, took 5 years and cost AU$106 million. The site was returned to its traditional owners in 2009 and is now the site of a flourishing tourism operation.

The nature of Pu-bearing particles from the Maralinga nuclear testing site, Australia

The high-energy release of plutonium (Pu) and uranium (U) during the Maralinga nuclear trials (1955–1963) in Australia, designed to simulate high temperature, non-critical nuclear accidents, resulted in wide dispersion µm-sized, radioactive, Pu–U-bearing ‘hot’ particles that persist in soils. By combining non-destructive, multi-technique synchrotron-based micro-characterization with the first nano-scale imagining of the composition and textures of six Maralinga particles, we find that all particles display intricate physical and chemical make-ups consistent with formation via condensation and cooling of polymetallic melts (immiscible Fe–Al–Pu–U; and Pb ± Pu–U) within the detonation plumes. Plutonium and U are present predominantly in micro- to nano-particulate forms, and most hot particles contain low valence Pu–U–C compounds; these chemically reactive phases are protected by their inclusion in metallic alloys. Plutonium reworking was observed within an oxidised rim in a Pb-rich particle; however overall Pu remained immobile in the studied particles, while small-scale oxidation and mobility of U is widespread. It is notoriously difficult to predict the long-term environmental behaviour of hot particles. Nano-scale characterization of the hot particles suggests that long-term, slow release of Pu from the hot particles may take place via a range of chemical and physical processes, likely contributing to on-going Pu uptake by wildlife at Maralinga.

Future migration: Key environmental indicators of Pu accumulation in terrestrial sediments of Queensland, Australia

Plutonium (Pu) interactions in the environment are highly complex. Site-specific variables play an integral role in determining the chemical and physical form of Pu, and its migration, bioavailability, and immobility. This paper aims to identify the key variables that can be used to highlight regions of radioecological sensitivity and guide remediation strategies in Australia. Plutonium is present in the Australian environment as a result of global fallout and the British nuclear testing program of 1952-1958 in central and west Australia (Maralinga and Montebello islands). We report the first systematic measurements of ^239+240Pu and ²³⁸Pu activity concentrations in distal (≥1000 km from test sites) catchment outlet sediments from Queensland, Australia. The average ^239+240Pu activity concentration was 0.29 mBq.g ^-1 (n = 73 samples) with a maximum of 4.88 mBq.g ^-1.²³⁸Pu/^239+240Pu isotope ratios identified a large range (0.02-0.29 (RSD: 74%)) which is congruent with the heterogeneous nuclear material used for the British nuclear testing programme at Maralinga and Montebello Islands. The use of a modified PCA relying on non-linear distance correlation (dCorr) provided broader insight into the impact of environmental variables on the transport and migration of Pu in this soil system. Primary key environmental indicators of Pu presence were determined to be actinide/lanthanide/heavier transition metals, elevation, electrical conductivity (EC), CaO, SiO₂, SO₃, landform, geomorphology, land use, and climate explaining 81.7% of the variance of the system. Overall this highlighted that trace level Pu accumulations are associated with the coarse, refractive components of Australian soils, and are more likely regulated by the climate of the region and overall soil type.

Beverage-specific situational norms: Evidence from the Dutch electronic appropriate beverage task

INTRODUCTION AND AIMS

By the time young adolescents initiate alcohol consumption they have firmly established attitudes, expectations and beliefs about alcohol and its effects. To further unravel the origins of this knowledge in childhood, we aim to address Dutch children's knowledge of the types of alcoholic beverages adults typically consume in certain situational contexts (i.e. their knowledge of beverage-specific situational norms).

DESIGN AND METHODS

A total of 329 children (4-8 years old) completed the Dutch electronic Appropriate Beverage Task at three-time points (2015, 2016, 2017). Three-level regression models were estimated examining whether children's beverage-specific situational norms depend on the gender of the person displayed in the task, sex of the participant and whether there were any beverage-specific changes over time.

RESULTS

Beverage-specific findings seem to be robust across the appropriateness of the situation. Beer was the most frequently attributed alcoholic beverage overall and across the common drinking situations. White wine was attributed significantly more to females in the task. Beer, red wine and champagne were attributed significantly more to males. Attributions of individual alcoholic beverages did not change significantly over time. There were no significant differences between the participating boys and girls.

DISCUSSION AND CONCLUSIONS

Results suggest that 4-8-year olds are yet to form knowledge of beverage-specific situational norms. Independent of the situation, time and participants' sex, the gender of the person displayed in the task seemed to be more salient to children than situational or environmental indicators in determining consumption.

Australians' support for alcohol price-based policies

BACKGROUND

Price-based policies are effective alcohol harm minimisation policy options. This paper examines public support for price-based policies based on patterns of consumption and expenditure, to determine if the extent to which an individual may be affected by a policy influences their support.

METHODS

The current study included 1,684 Australian residents (59.8% male, M_age 43.8 [SD=16.7]). Respondents who purchased and consumed alcohol in the past six months were asked about their support for potential changes in a series of price-based policies.

RESULTS

Increasing price was less likely to be supported than either implementing a minimum price or a tax-increase earmarked to pay for alcohol harms. Increasing price and taxing drinkers were more likely to be supported by older people and women. We found no relationship between income or perceived impact of price increases on purchasing and level of support.

CONCLUSION

Contrary to the idea that public support might be partly influenced by ability to pay for alcohol, support for a minimum unit price was not related to price paid per drink or income, only amount consumed. Thus, heavier drinkers may be inherently unlikely to support price-based policies even when these policies would have little impact on their actual purchasing.

Do different drinks make you feel different emotions? Examination of young adolescents' beverage-specific alcohol expectancies using the Alcohol Expectancy Task

The aim of this paper is to explore whether in the eyes of young adolescents the consumption of different alcoholic beverages is associated with different alcohol expectancies, namely beliefs on what emotional outcomes take place when alcohol is consumed. 283 nine to 12-year olds from Switzerland completed the Alcohol Expectancy Task (AET). Participants were asked to assign one of 12 beverages (four alcoholic, eight non-alcoholic) to 16 adults depicting four emotional states (happy, angry, relaxed, sad). General linear modelling was used to examine beverage attributions across the four different emotional states. Beer was the most commonly attributed beverage across all 16 adults depicted. Happy and angry persons were most commonly attributed beer. Gender variations were found for relaxed persons, with females predominantly attributed champagne and males predominantly attributed beer. Young adolescents predominantly gave white wine to sad persons. Findings reveal a level of nuanced knowledge existing among young adolescents with minimal drinking experience, in that they hold very different expectancies for different beverages, prompting for future investigations to examine beverage-specific expectancies. Furthermore, findings showing beverage-specific expectancies among young adolescents may have implications for researchers' considerations of how alcohol-related knowledge and expectancies develop throughout childhood.

Alcohol Industry vs. Public Health Presentations at Judicial Reviews of Liquor Licence Applications in Australia

Greater densities of alcohol outlets are associated with greater incidence of alcohol-related harms. In Australia, public health advocates aiming to limit alcohol availability expend significant energy objecting to new outlets in licensing and planning hearings. This study identifies and reviews the key scientific arguments put forward by industry and public health representatives in liquor and planning hearings to determine the factors that contribute to decisions by the presiding authority and to identify ways forward for researchers wishing to facilitate harm minimisation through these regulatory forums. Scientific evidence presented in 23 cases from Victoria, New South Wales and Western Australia between 2010 and 2018 were assessed using directed content analysis. Cases were identified through the AustLii and Westlaw online databases. The full transcripts of two cases that were identified as representative of the scientific arguments presented in other included cases were also reviewed. Four main arguments that industry used during hearings were identified-causal inference, non-linearities, differentiation and risk mitigation. These arguments were used across many included hearings and raised fundamental questions that public health evidence was often ill-equipped to respond to. The overall success of industry arguments in liquor and planning hearings highlighted the challenges of applying epidemiological evidence to individual case studies. These findings have particular implications and will be of use for researchers and public health experts participating in future licensing hearings, especially those wishing to prevent alcohol-related harm through regulatory mechanisms such as state licensing authorities (i.e. courts).

Exploring assessor cognition as a source of score variability in a performance assessment of practice-based competencies

BACKGROUND

A common feature of performance assessments is the use of human assessors to render judgements on student performance. From a measurement perspective, variability among assessors when assessing students may be viewed as a concern because it negatively impacts score reliability and validity. However, from a contextual perspective, variability among assessors is considered both meaningful and expected. A qualitative examination of assessor cognition when assessing student performance can assist in exploring what components are amenable to improvement through enhanced rater training, and the extent of variability when viewing assessors as contributing their individual expertise. Therefore, the purpose of this study was to explore assessor cognition as a source of score variability in a performance assessment of practice-based competencies.

METHOD

A mixed-method sequential explanatory study design was used where findings from the qualitative strand assisted in the interpretation of results from the quantitative strand. Scores from one objective structured clinical examination (OSCE) were obtained for 95 occupational therapy students. Two Generalizability studies were conducted to examine the relative contribution of assessors as a source of score variability and to estimate the reliability of domain and holistic scores. Think-aloud interviews were conducted with eight participants assessing a subset of student performances from the OSCE in which they participated. Findings from the analysis of think-aloud data and consideration of assessors' background characteristics were used to assist in the interpretation of variance component estimates involving assessors, and score reliability.

RESULTS

Results from two generalizability analyses indicated the highest-order interaction-error term involving assessors accounted for the second-highest proportion of variance, after student variation. Score reliability was higher in the holistic vs. analytic scoring framework. Verbal analysis of assessors' think-aloud interviews provided evidential support for the quantitative results.

CONCLUSIONS

This study provides insight into the nature and extent of assessor variability during a performance assessment of practice-based competencies. Study findings are interpretable from the measurement and contextual perspectives on assessor cognition. An integrated understanding is important to elucidate the meaning underlying the numerical score because the defensibility of inferences made about students' proficiencies rely on score quality, which in turn relies on expert judgements.

Embodiment and Estrangement: Results from a First-in-Human "Intelligent BCI" Trial

While new generations of implantable brain computer interface (BCI) devices are being developed, evidence in the literature about their impact on the patient experience is lagging. In this article, we address this knowledge gap by analysing data from the first-in-human clinical trial to study patients with implanted BCI advisory devices. We explored perceptions of self-change across six patients who volunteered to be implanted with artificially intelligent BCI devices. We used qualitative methodological tools grounded in phenomenology to conduct in-depth, semi-structured interviews. Results show that, on the one hand, BCIs can positively increase a sense of the self and control; on the other hand, they can induce radical distress, feelings of loss of control, and a rupture of patient identity. We conclude by offering suggestions for the proactive creation of preparedness protocols specific to intelligent-predictive and advisory-BCI technologies essential to prevent potential iatrogenic harms.