PSAT116 Perceived Facilitators and Barriers Using Telemedicine for Gender-Affirming Care in Youth: A Qualitative Study

Background

Multi-disciplinary gender-affirming care centers (GACC) are seeing increasing numbers of transgender and non-binary (TNB) youth seeking medical care. In the wake of the COVID pandemic, telemedicine use in clinical settings, including GACC, have increased. There is a paucity of research in the provision of care by telemedicine for gender care as well as TNB youth's perspectives on its use.

Objective

To explore perspectives of TNB youth in the use of telemedicine for gender-affirming care.

Methods

Participants aged 13-21 years, who identified as TNB, were recruited from gender center at a large academic center to participate in a semi-structured interview and demographics survey. Interviews were audio-recorded and transcribed verbatim. Survey results were analyzed using descriptive statistics. Two independent coders reviewed the transcripts, developed a preliminary coding scheme, and reached consensus on discrepancies. ATLAS.ti® was used for thematic analysis.

Results

TNB youth (n=30) had a mean age of 17 years; 30% identified as female/trans female, 47% as male/trans male, and 23% as non-binary or gender fluid. Overall, participants favored in-person visits over telemedicine because of connection with their provider. Patients also had a lack of perceived knowledge about telemedicine despite having good working knowledge of technology. They had mixed feelings regarding clinic staff's role in telemedicine (some felt it was a waste of time, others found it helpful to orient and offer future visits). There were minimal concerns around confidentiality and having a secure line. Advantages to telemedicine included convenience (no travel time or missing school), and discussion of hormone therapy, medication changes, and lab results. However, it was not optimal for full assessment of treatment progress because there was no physical exam.

Conclusions

Despite participants’ preference for in-person visits, telemedicine is a viable option for TNB youth in receiving gender-affirming medical care because of convenience and perceived confidentiality. Efforts to increase telemedicine use could center on providers and clinic staff providing education on the technical aspects of telemedicine use and promoting its availability for discussion-based visits.

Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Aerial strategies advance volcanic gas measurements at inaccessible, strongly degassing volcanoes

Volcanic emissions are a critical pathway in Earth's carbon cycle. Here, we show that aerial measurements of volcanic gases using unoccupied aerial systems (UAS) transform our ability to measure and monitor plumes remotely and to constrain global volatile fluxes from volcanoes. Combining multi-scale measurements from ground-based remote sensing, long-range aerial sampling, and satellites, we present comprehensive gas fluxes-3760 ± [600, 310] tons day^-1 CO₂ and 5150 ± [730, 340] tons day^-1 SO₂-for a strong yet previously uncharacterized volcanic emitter: Manam, Papua New Guinea. The CO₂/S_T ratio of 1.07 ± 0.06 suggests a modest slab sediment contribution to the sub-arc mantle. We find that aerial strategies reduce uncertainties associated with ground-based remote sensing of SO₂ flux and enable near-real-time measurements of plume chemistry and carbon isotope composition. Our data emphasize the need to account for time averaging of temporal variability in volcanic gas emissions in global flux estimates.

"Always Events® "… just another quality improvement tool … or is it?

INTRODUCTION

Always Events® are defined as "those aspects of the care experience that should always occur when patients, their family members or other care partners, and service users interact with health care professionals and the health care system". It is a quality improvement methodology that starts by asking our patients the simple question "what matters to you?" and then through coproduction, works out a way to achieve this.

METHODS AND RESULTS

This article tells our story and highlights the value of undertaking an Always Event® within the Radiology department at Warrington and Halton Hospitals. It will demonstrate how this approach combines research, an evaluation of findings and implementation of those findings within a very short timeframe. Embedded within the article are comments from our staff, volunteers and patients which reflect upon their experiences, our limitations, the outcomes we achieved and the impact it has had upon our patients and staff.

CONCLUSION AND IMPLICATIONS FOR PRACTICE

It was important to our patients that they would be informed of how long they would wait for their examination once they booked in at x-ray reception. By undertaking an Always Event® this process is now embedded in our departments everyday activities with over 90% of our patients now being informed of their waiting time. This continued collaboration has really emphasised the value of listening to our patients, and the benefits this can lead to. It has also encouraged a positive research culture within our department (optimisation studies, working with industry, quality projects), helping to progress our profession and resulting in a quality service for our patients.

Combined ground and aerial measurements resolve vent-specific gas fluxes from a multi-vent volcano

Volcanoes with multiple summit vents present a methodological challenge for determining vent-specific gas emissions. Here, using a novel approach combining multiple ultraviolet cameras with synchronous aerial measurements, we calculate vent-specific gas compositions and fluxes for Stromboli volcano. Emissions from vent areas are spatially heterogeneous in composition and emission rate, with the central vent area dominating passive emissions, despite exhibiting the least explosive behaviour. Vents exhibiting Strombolian explosions emit low to negligible passive fluxes and are CO₂-dominated, even during passive degassing. We propose a model for the conduit system based on contrasting rheological properties between vent areas. Our methodology has advantages for resolving contrasting outgassing dynamics given that measured bulk plume compositions are often intermediate between those of the distinct vent areas. We therefore emphasise the need for a vent-specific approach at multi-vent volcanoes and suggest that our approach could provide a transformative advance in volcano monitoring applications.

Combining multiple ultraviolet cameras with synchronous aerial measurements, the authors here present vent-specific gas compositions and fluxes for Stromboli volcano. The results show that gas compositions vary between different vents, mirroring differences in eruptive behavior.

Understanding Rapid Adjustments to Diverse Forcing Agents

Rapid adjustments are responses to forcing agents that cause a perturbation to the top of atmosphere energy budget but are uncoupled to changes in surface warming. Different mechanisms are responsible for these adjustments for a variety of climate drivers. These remain to be quantified in detail. It is shown that rapid adjustments reduce the effective radiative forcing (ERF) of black carbon by half of the instantaneous forcing, but for CO2 forcing, rapid adjustments increase ERF. Competing tropospheric adjustments for CO2 forcing are individually significant but sum to zero, such that the ERF equals the stratospherically adjusted radiative forcing, but this is not true for other forcing agents. Additional experiments of increase in the solar constant and increase in CH4 are used to show that a key factor of the rapid adjustment for an individual climate driver is changes in temperature in the upper troposphere and lower stratosphere.

Quantifying the Importance of Rapid Adjustments for Global Precipitation Changes

Different climate drivers influence precipitation in different ways. Here we use radiative kernels to understand the influence of rapid adjustment processes on precipitation in climate models. Rapid adjustments are generally triggered by the initial heating or cooling of the atmosphere from an external climate driver. For precipitation changes, rapid adjustments due to changes in temperature, water vapor, and clouds are most important. In this study we have investigated five climate drivers (CO2, CH4, solar irradiance, black carbon, and sulfate aerosols). The fast precipitation responses to a doubling of CO2 and a 10-fold increase in black carbon are found to be similar, despite very different instantaneous changes in the radiative cooling, individual rapid adjustments, and sensible heating. The model diversity in rapid adjustments is smaller for the experiment involving an increase in the solar irradiance compared to the other climate driver perturbations, and this is also seen in the precipitation changes.

A PDRMIP multi-model study on the impacts of regional aerosol forcings on global and regional precipitation

Atmospheric aerosols such as sulfate and black carbon (BC) generate inhomogeneous radiative forcing and can affect precipitation in distinct ways compared to greenhouse gases (GHGs). Their regional effects on the atmospheric energy budget and circulation can be important for understanding and predicting global and regional precipitation changes, which act on top of the background GHG-induced hydrological changes. Under the framework of the Precipitation Driver Response Model Inter-comparison Project (PDRMIP), multiple models were used for the first time to simulate the influence of regional (Asian and European) sulfate and BC forcing on global and regional precipitation. The results show that, as in the case of global aerosol forcing, the global fast precipitation response to regional aerosol forcing scales with global atmospheric absorption, and the slow precipitation response scales with global surface temperature response. Asian sulphate aerosols appear to be a stronger driver of global temperature and precipitation change compared to European aerosols, but when the responses are normalised by unit radiative forcing or by aerosol burden change, the picture reverses, with European aerosols being more efficient in driving global change. The global apparent hydrological sensitivities of these regional forcing experiments are again consistent with those for corresponding global aerosol forcings found in the literature. However, the regional responses and regional apparent hydrological sensitivities do not align with the corresponding global values. Through a holistic approach involving analysis of the energy budget combined with exploring changes in atmospheric dynamics, we provide a framework for explaining the global and regional precipitation responses to regional aerosol forcing.

An unexpected diagnosis of breast malignancy

Inflammatory breast cancer constitutes 5% of all breast cancer diagnoses. Diagnosis is based on clinical signs including skin changes, erythema and oedema, together with rapid progression and involvement of more than one-third of the affected breast. It is an aggressive tumour with great metastatic potential, metastases being present in 30% of patients at first presentation. Primary non-Hodgkin's lymphoma of the breast is rare but is well reported. It accounts for 0.5% of all breast malignancies and 1% of all non-Hodgkin's diagnoses. Prognosis of primary breast lymphoma varies depending on the stage of disease with stage IE having a 5-year survival rate of 78-83% and stage IIE having a 5-year survival rate of 20-57%. We present a rare case of non-Hodgkin's lymphoma mimicking an inflammatory breast cancer. The aim of this case report is to highlight an unusual presentation of non-Hodgkin's lymphoma and the diagnostic difficulties that arise.

PDRMIP: A Precipitation Driver and Response Model Intercomparison Project, Protocol and preliminary results

As the global temperature increases with changing climate, precipitation rates and patterns are affected through a wide range of physical mechanisms. The globally averaged intensity of extreme precipitation also changes more rapidly than the globally averaged precipitation rate. While some aspects of the regional variation in precipitation predicted by climate models appear robust, there is still a large degree of inter-model differences unaccounted for. Individual drivers of climate change initially alter the energy budget of the atmosphere leading to distinct rapid adjustments involving changes in precipitation. Differences in how these rapid adjustment processes manifest themselves within models are likely to explain a large fraction of the present model spread and needs better quantifications to improve precipitation predictions. Here, we introduce the Precipitation Driver and Response Model Intercomparison Project (PDRMIP), where a set of idealized experiments designed to understand the role of different climate forcing mechanisms were performed by a large set of climate models. PDRMIP focuses on understanding how precipitation changes relating to rapid adjustments and slower responses to climate forcings are represented across models. Initial results show that rapid adjustments account for large regional differences in hydrological sensitivity across multiple drivers. The PDRMIP results are expected to dramatically improve our understanding of the causes of the present diversity in future climate projections.

The impact of tuition fees amount on mental health over time in British students

BACKGROUND

Previous studies have shown a relationship between debt and mental health problems in students. This study aimed to examine the effect of differences in tuition fees amount on changes in mental health over time.

METHODS

A prospective cohort study followed 390 first-year British students who differed on their tuition fees level at 4 time points across their first 2 years at university. Participants completed measures of global mental health, depression, anxiety, stress, alcohol-related problems at up to four time points in their first two years at university. Mixed-factorial ANOVAs were used to assess the impact of tuition fees amount on changes in scores over time.

RESULTS

There was no difference based on fees at Time 1 for anxiety, stress, depression and global mental health. At Time 2, those charged £0-2.9k or £3-4k improved while those charged £8-9k stayed the same. However, this trend reversed by Times 3 and 4.

CONCLUSIONS

Undergraduates mental health is partially affected by the level of tuition fees; however, the recent increase in tuition fees does not appear to have had a lasting impact at present.

Toward a trustworthy voice: increasing the effectiveness of automated outreach calls to promote colorectal cancer screening among African Americans

INTRODUCTION

Colorectal cancer screening rates are lower among African-American members of Kaiser Permanente Colorado (KPCO) than among members of other races and ethnicities. This study evaluated use of a linguistically congruent voice in interactive voice response outreach calls about colorectal cancer screening as a strategy to increase call completion and response.

METHODS

After an initial discussion group to assess cultural acceptability of the project, 6 focus groups were conducted with 33 KPCO African-American members. Participants heard and discussed recordings of 5 female voices reading the same segment of the standard-practice colorectal cancer message using interactive voice response. The linguistic palette included the voices of a white woman, a lightly accented Latina, and 3 African-American women.

RESULTS

Participants strongly preferred the African-American voices, particularly two voices. Participants considered these voices the most trustworthy and reported that they would be the most effective at increasing motivation to complete an automated call. Participants supported the use of African-American voices when designing outgoing automated calls for African Americans because the sense of familiarity engendered trust among listeners. Participants also indicated that effective automated messages should provide immediate clarity of purpose; explain why the issue is relevant to African Americans; avoid sounding scripted; emphasize that the call is for the listener's benefit only; sound personable, warm, and positive; and not create fear among listeners.

DISCUSSION

Establishing linguistic congruence between African Americans and the voices used in automated calls designed to reach them may increase the effectiveness of outreach efforts.

Dental examiners consistency in applying the ICDAS criteria for a caries prevention community trial

AIM

To examine dental examiners' one-year consistency in utilizing the International Caries Detection and Assessment System (ICDAS) criteria after baseline training and calibration.

METHODS

A total of three examiners received baseline training/calibration by a "gold standard" examiner, and one year later re-calibration was conducted. For the baseline training/calibration, subjects aged 8-16 years, and for the re-calibration subjects aged five to six years were recruited for the study. The ICDAS criteria were used to classify visual caries lesion severity (0-6 scale), lesion activity (active/inactive), and presence of filling material (0-9 scale) of all available tooth surfaces of permanent and primary teeth. The examination used a clinical light, mirror and air syringe. Kappa (weighted: Wkappa, unweighted: Kappa) statistics were used to determine inter-and intra-examiner reliability at baseline and re-calibration.

RESULTS

For lesion severity and filling criteria, the baseline calibration on 35 subjects indicated an inter-rater Wkappa ranging from 0.69-0.92 and intra-rater Wkappa ranging from 0.81-0.92. Re-calibration on 22 subjects indicated an inter-rater Wkappa of 0.77-0.98 and intra-rater Wkappa ranged from 0.93-1.00. The Wkappa for filling was consistently in the excellent range, while lesion severity was in the good to excellent range. Activity kappa was in the poor to good range. All examiners improved with time.

CONCLUSIONS

The baseline training/calibration in ICDAS was crucial to maintain the stability of the examiners reliability over a one year period. The ICDAS can be an effective assessment tool for community-based clinical trials.

A review and meta-analysis of computerized cognitive behaviour therapy for the treatment of pain in children and adolescents

BACKGROUND

Chronic pain is relatively common in children and adolescents. Cognitive behaviour therapy (CBT) has been shown to be effective for treating pain in this age group. This paper aims to review the literature on the use of computerized cognitive behavioural therapy (cCBT) with children and adolescents with pain.

METHODS

Three databases, Pubmed (including Medline), Embase and PsychInfo, were searched and papers were identified using specific inclusion criteria.

RESULTS

Four studies met the inclusion criteria, all of which indicated beneficial results of using cCBT, with those who completed cCBT being more likely to experience at least a 50% post-treatment reduction in symptoms than those in a control group. A meta-analysis suggested a medium effect size of -0.41 for reduced pain intensity post treatment for cCBT compared with the control groups. A mean odds ratio of 6.03 was found for achieving a clinically significant reduction in pain in the cCBT group compared with the control groups.

CONCLUSION

This review tentatively suggests potential for using cCBT for pain in children and adolescents. However, there is only a small body of research exploring this relationship at present, and so further research is needed before any solid conclusions can be drawn.

Randomized control trial investigating the influence of coffee on heart rate variability in patients with ST-segment elevation myocardial infarction

BACKGROUND

Cardiac autonomic dysfunction post ST-segment elevation myocardial infarction (STEMI) has been linked to an excess risk of premature cardiovascular morbidity and mortality above those with normal autonomic function post-STEMI.

AIM

The aim of this study was to evaluate the effect of acute ingestion of coffee on autonomic function and cardiovascular outcomes in patients with acute STEMI.

DESIGN

Randomized control trial.

METHODS

We randomized 103 patients with acute STEMI, admitted to our Coronary Care Unit, to receive regular coffee (caffeinated) or de-caffeinated coffee using a randomized controlled double-blinded design. Heart rate variability was assessed 5 days post-STEMI to assess the effect of caffeine on autonomic function.

RESULTS

In the group randomized to regular coffee, parasympathetic activity increased by up to 96% (P = 0.04) after 5 days. There was no detrimental effect of regular coffee on cardiac rhythm post-STEMI.

CONCLUSION

Coffee ingestion is associated with an increase in parasympathetic autonomic function immediately post-STEMI. Coffee was found to be safe and not associated with any adverse cardiovascular outcomes in the short term.

The Social Communication Questionnaire in a sample of the general population of school-going children

BACKGROUND

The social communication questionnaire (SCQ) for autistic spectrum disorder was previously validated in clinical populations.

AIMS

To describe the distribution of SCQ-scores in the general child population, and identify if traits from all domains of autism are present.

METHODS

The SCQ was completed by parents of children attending a mixed-gender primary school of 240 children.

RESULTS

Total SCQ scores ranged from 1 to 20, with a mode 1 and corrected mean of 3.89, SD = 2.77. SCQ items corresponding to all three domains of autism were found in the sample. Some items on the SCQ were answered as "autism-positive" for up to 41.8% of children in the general population sample.

CONCLUSIONS

The SCQ has a wide range in the general population, with traits from all three domains of autism. Some items in the SCQ do not discriminate children with autism from other school-going children.

Immediate in-patient management of hyperglycaemia--confusion rather than consensus?

BACKGROUND

In-patients with high blood glucose levels have much greater mortality and morbidity rates compared to normoglycaemic individuals hospitalized with the same condition.

AIM

To examine prospectively the glucose-lowering treatments used for patients admitted as acute medical emergencies with admission hyperglycaemia (11-17 mmol/l) under the care of non-diabetes specialist teams. Individuals with acute diabetes emergencies (e.g. diabetic ketoacidosis or HONK or glucose levels >17 mmol/l) were excluded.

METHODS

Patients' notes were examined as they were admitted without any interventions from the diabetes team. Choice of treatment for their hyperglycaemia was noted and the average blood glucose level was calculated each day of admission for the first 5 days based on bedside fingerstick glucose measurements.

RESULTS

Seventy-three in-patients [37 men, average (SD) age 74.1(12) years] with hyperglycaemia [average 13.7(1.6) mmol/l] on admission were included. Fourteen were not known to have diabetes, three had type 1 and 56 type 2 diabetes. Glycaemic control was suboptimal and achieved values were unrelated to the mode of delivery of glucose-lowering therapies. Length of stay and death rates in hospital were greatest in the group of patients who were not previously known to have diabetes.

CONCLUSION

Untreated or under-treated hyperglycaemia was a common occurrence in patients admitted to hospital with an acute medical emergency. There may be a role for hospital-based specialist diabetes teams to take a lead in facilitating more acceptable glucose control to achieve standard 8 of the National Service Framework for Diabetes.

Investigation of MR image distortion for radiotherapy treatment planning of prostate cancer

MR imaging based treatment planning for radiotherapy of prostate cancer is limited due to MR imaging system related geometrical distortions, especially for patients with large body sizes. On our 0.23 T open scanner equipped with the gradient distortion correction (GDC) software, the residual image distortions after the GDC were <5 mm within the central 36 cm x 36 cm area for a standard 48 cm field of view (FOV). In order to use MR imaging alone for treatment planning the effect of residual MR distortions on external patient contour determination, especially for the peripheral regions outside the 36 cm x 36 cm area, must be investigated and corrected. In this work, we performed phantom measurements to quantify MR system related residual geometric distortions after the GDC and the effective FOV. Our results show that for patients with larger lateral dimensions (>36 cm), the differences in patient external contours between distortion-free CT images and GDC-corrected MR images were 1-2 cm because of the combination of greater gradient distortion and loss of field homogeneity away from the isocentre and the uncertainties in patient setup during CT and MRI scans. The measured distortion maps were used to perform point-by-point corrections for patients with large dimensions inside the effective FOV. Using the point-by-point method, the geometrical distortion after the GDC were reduced to <3 mm for external contour determination and the effective FOV was expanded from 36 cm to 42 cm.

Focus group findings about the influence of culture on communication preferences in end-of-life care

BACKGROUND

Little guidance is available for health care providers who try to communicate with patients and their families in a culturally sensitive way about end-of-life care.

OBJECTIVE

To explore the content and structure of end-of-life discussions that would optimize decision making by conducting focus groups with two diverse groups of patients that vary in ethnicity and socioeconomic status.

DESIGN

Six focus groups were conducted; 3 included non-Hispanic white patients recruited from a University hospital (non-Hispanic white groups) and 3 included African-American patients recruited from a municipal hospital (African-American groups). A hypothetical scenario of a dying relative was used to explore preferences for the content and structure of communication.

PARTICIPANTS

Thirty-six non-Hispanic white participants and 34 African-American participants.

APPROACH

Content analysis of focus group transcripts.

RESULTS

Non-Hispanic white participants were more exclusive when recommending family participants in end-of-life discussions while African-American participants preferred to include more family, friends and spiritual leaders. Requested content varied as non-Hispanic white participants desired more information about medical options and cost implications while African-American participants requested spiritually focused information. Underlying values also differed as non-Hispanic white participants expressed more concern with quality of life while African-American participants tended to value the protection of life at all costs.

CONCLUSIONS

The groups differed broadly in their preferences for both the content and structure of end-of-life discussions and on the values that influence those preferences. Further research is necessary to help practitioners engage in culturally sensitive end-of-life discussions with patients and their families by considering varying preferences for the goals of end-of-life care communication.