Seeking consensus on a play-based intervention framework for promoting play of children with HIV/Aids in a low-resourced setting: A Delphi study

INTRODUCTION

Implementing occupation-based practice in low-resourced settings can be challenging especially when working with children with HIV/Aids whose daily occupation of play is often affected by their health condition and other contextual factors such as poverty or stigma.

AIM

The aim of this paper is to obtain consensus from experts on the content and application of a play-based intervention for children with HIV/Aids living in a low-resourced setting.

METHODS

A Delphi study involving two rounds using an online survey format was conducted with experts from the field of child development, play and/or HIV/Aids. Consensus agreement was reached when at least 70% of Delphi experts rated each item at 3 or higher on a 5-point Likert scale.

CONSUMER AND COMMUNITY INVOLVEMENT

This paper is part of a multi-stage study that involved input and feedback from families of children who were born HIV/Aids, occupational therapists working with families of children with HIV/Aids, and input from local and international experts working with people with HIV/Aids.

RESULTS

Thirty-seven experts completed the first round, and 35 completed the second round of the study. Consensus was achieved on the application of the Cooper's Model of Children's Play, techniques to be used and the structure of the intervention. Experts also agreed on the inclusion of a pre-intervention workshop as part of the play-based intervention.

DISCUSSION AND CONCLUSION

The consensus on the content and application of a play-based intervention framework through a process of gaining expert perspectives provides confidence that the intervention planned to promote play for children with HIV/Aids living in low-resourced settings is likely to be effective.

Shigella sonnei utilises colicins during inter-bacterial competition

The mammalian colon is one of the most densely populated habitats currently recognised, with 1011-1013 commensal bacteria per gram of colonic contents. Enteric pathogens must compete with the resident intestinal microbiota to cause infection. Among these enteric pathogens are Shigella species which cause approximately 125 million infections annually, of which over 90 % are caused by Shigella flexneri and Shigella sonnei. Shigella sonnei was previously reported to use a Type VI Secretion System (T6SS) to outcompete E. coli and S. flexneri in in vitro and in vivo experiments. S. sonnei strains have also been reported to harbour colicinogenic plasmids, which are an alternative anti-bacterial mechanism that could provide a competitive advantage against the intestinal microbiota. We sought to determine the contribution of both T6SS and colicins to the anti-bacterial killing activity of S. sonnei. We reveal that whilst the T6SS operon is present in S. sonnei, there is evidence of functional degradation of the system through SNPs, indels and IS within key components of the system. We created strains with synthetically inducible T6SS operons but were still unable to demonstrate anti-bacterial activity of the T6SS. We demonstrate that the anti-bacterial activity observed in our in vitro assays was due to colicin activity. We show that S. sonnei no longer displayed anti-bacterial activity against bacteria that were resistant to colicins, and removal of the colicin plasmid from S. sonnei abrogated anti-bacterial activity of S. sonnei. We propose that the anti-bacterial activity demonstrated by colicins may be sufficient for niche competition by S. sonnei within the gastrointestinal environment.

Understanding evidence and provision of services around social isolation and loneliness of military widow/ers: A scoping review

BACKGROUND

Whilst the uniqueness of loneliness and social isolation is now recognised for members of the Armed Forces Community, there is currently a lack of evidence examining these experiences within the Military Widow/er population. Therefore, this scoping review aimed to search and synthesise the current evidence base exploring experiences of loneliness and social isolation in this community.

METHOD

Six databases were searched; ASSIA; CINAHL; ProQuest Dissertation & Theses Global; PsycArticles; Medline; Web of Science. Any article type was included if they focused on UK or international Military Widows and loneliness and social isolation. In the absence of loneliness and social isolation, related aspects were included, for example, social support.

RESULTS

A thematic synthesis was completed on the nine eligible papers, where key findings were coded and generated into four themes; Experiences of Loneliness and Social Isolation, The Uniqueness of the Military, Access to Social Support, and The Importance of Peer Support.

CONCLUSIONS

Evidence supports the need for military-specific support services with peers who recognise the individuals' unique experiences of loneliness and social isolation. None of the available evidence focused specifically on social isolation, however this was often prevalent in the results. All of the studies were carried out in the USA and Israel, with none including the views of widowers. Further evidence is required, particularly relating to a UK-context.

The experiences of older adult members of a combined lunch club and assisted shopping group and the perceived value in their occupational lives: A qualitative study

Background and Aims

Health and social care policies are increasingly focusing on community interventions for older adults with service providers diversifying services to widen their reach. As a result, new concepts are under‐researched, and it can be challenging to draw parallels with existing interventions. Evidence of the value of community interventions is often limited and conflicting and few researchers have considered the service‐user perspective. This qualitative research explores the experiences of members of a combined lunch club and assisted shopping group based in North‐East England to understand the perceived value in their lives from an occupational perspective.

Methods

Six older adult members were recruited through convenience sampling to participate in individual semistructured interviews January–March 2020. Interview data was subject to thematic analysis using an inductive approach and three key themes were constructed to represent the data.

Results

Themes identified were: “Togetherness: promoting social belonging”; “Meaningful engagement for older adults” and “Independence and staying active in later life.” Findings indicated largely positive experiences with themes depicting influences that motivate engagement and perceived benefits.

Conclusion

Participants particularly valued the opportunity for social engagement, as well as independence through supporting continued engagement with shopping in later life. In conclusion, successful community interventions for older adults need to be meaningful and purposeful.

Factors influencing the use of aquatic therapy: perspectives from occupational therapists

Background/Aims

Aquatic therapy has been identified as more conducive than land-based treatment options to improve health and quality of life in some patient populations. However, the prevalence of occupational therapists who implement aquatic therapy in practice is low. The aim of this study was to understand the perceptions of barriers and facilitators to aquatic therapy use by occupational therapists in the USA.

Methods

Individual semi-structured interviews were completed (via Skype) with four occupational therapists who held an ‘aquatic therapeutic exercise certificate’ from the Aquatic Therapy and Rehab Institute. Interviews were audio recorded and manually transcribed verbatim. Inductive thematic analysis was employed to identify themes and sub-themes in the data.

Results

The following three overarching themes were identified: institutional constraints and resources impact aquatic therapy implementation; the perceived lack of unity within the occupational and aquatic therapy communities; and implications of aquatic therapy's low prevalence within the occupational therapy profession.

Conclusions

Institutional factors including pool accessibility, insurance coverage, and employer support are determinants of practitioners' abilities to use aquatic therapy. The research identified a desire for support through networking and the need to build the authority of occupational therapists in aquatic therapy to offset the barriers implicated with being a minority profession.

POS0043-HPR DO COPING STRATEGIES, ILLNESS PERCEPTIONS AND RELATIONSHIP DYNAMICS CONTRIBUTE TO SEXUAL DYSFUNCTION FOR WOMEN WITH SJÖGREN’S SYNDROME?

Background

Women with Sjögren’s syndrome (SS) are more likely to experience vaginal dryness, dyspareunia and reduced sexual function than healthy controls1. There is limited data investigating relationships with psychosocial influences, such as coping mechanisms, illness perceptions, partners behaviours and relationship satisfaction.

Objectives

To investigate associations between sexual function and psychosocial parameters in women with SS.

Methods

Cisgender women aged 18+, diagnosed with SS, were invited to participate in a cross-sectional online survey. Ethical approval and informed consent were obtained. Participants completed the Female Sexual Function Index (FSFI), EULAR Sjӧgren’s Syndrome Patient Reported Index (ESSPRI), NRS scale for vaginal dryness (0-10), Profile of Fatigue and Discomfort (ProFaD), Cognitive Emotion Regulation Questionnaire (CERQ), Brief Illness Perceptions Questionnaire (BIPQ), West-Haven Yale Multidimensional Pain Inventory (WHYMPI – Part II) and Maudsley Marital Questionnaire (MMQ – Marital subscale). Associations between the FSFI and the outcome measures were assessed using Spearman’s correlations. Variables that significantly correlated with FSFI total score were entered into a backward stepwise multiple regression.

Results

The survey was completed by 98 women (M = 48.13, SD = 13.26), 70.4% were diagnosed as having primary SS (disease duration range = 3 – 348 months); 43.8% were premenopausal and 48% were postmenopausal. Vaginal dryness was reported by 92.9% of participants, and sexual dysfunction was identified in 85.2% (n = 69/81) of cases (<26.55). Participants who were not sexually active in the previous three-month period (n = 17) were excluded from analyses as inactivity may cause a low FSFI score which may be incorrectly construed as sexual dysfunction. Reduced sexual function was significantly associated with increases in age, vaginal dryness, mental fatigue (ProFaD), self-blame, rumination and catastrophising (CERQ), consequences and identity (BIPQ), negative partner responses (WHYMPI) and relationship dissatisfaction (MMQ). Reduced sexual function was also significantly associated with decreases in positive reappraisal and perspective (CERQ), personal control (BIPQ), solicitous responses and distracting responses (WHYMPI) (Table 1). No significant associations were found for disease duration, relationship duration or ESSPRI total. Results from regression analyses indicated that vaginal dryness (β = -.278, p = .004), CERQ positive reappraisal (β = .322, p = .003) and CERQ catastrophising (β = -.277, p = .009) were significantly related to sexual function and explained 42.0% of the variance in total FSFI scores (F(3,72) = 17.394, p < .001).

Table 1.

Associations between sexual function and psychosocial parameters

FSFI totalrsp95% CI (LB, UB)Age (years)-.270.015-.467-.049Disease duration (months)-.030.793-.253.196Relationship duration (months)-.180.119-.396.054VAS Vaginal dryness-.350.001-.533-.136ESSPRI total-.165.141-.376.062ProFaD Mental Fatigue-.294.008-.486-.074CERQ Self-Blame-.264.017-.461-.042CERQ Rumination-.296.007-.488-.077CERQ Positive Reappraisal.469.000.273.628CERQ Perspective.341.002.126.525CERQ Catastrophising-.499.000-.651-.310BIPQ Consequences-.237.033-.438-.013BIPQ Personal Control-.288.009-.481-.068BIPQ Identity-.294.008-.487-.075MMQ-.282.013-.483-.054WHYMPI Negative Responses-.252.028-.457-.021WHYMPI Solicitous Responses.267.020.037.470WHYMPI Distracting Responses.311.006.085.506

Note. N = 81. Associations that were not significant are not shown.

Conclusion

Women with SS using positive coping strategies have better sexual function than those with negative coping strategies. Learning positive coping strategies may be an important line of approach for managing sexual dysfunction in SS.

References

[1]Priori R, et al. Quality of sexual life in women with primary Sjögren syndrome. J Rheumatol. 2015;42(8): 1427-31.

Disclosure of Interests

None declared

Automatic surgical phase recognition in laparoscopic inguinal hernia repair with artificial intelligence

BACKGROUND

Because of the complexity of the intra-abdominal anatomy in the posterior approach, a longer learning curve has been observed in laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair. Consequently, automatic tools using artificial intelligence (AI) to monitor TAPP procedures and assess learning curves are required. The primary objective of this study was to establish a deep learning-based automated surgical phase recognition system for TAPP. A secondary objective was to investigate the relationship between surgical skills and phase duration.

METHODS

This study enrolled 119 patients who underwent the TAPP procedure. The surgical videos were annotated (delineated in time) and split into seven surgical phases (preparation, peritoneal flap incision, peritoneal flap dissection, hernia dissection, mesh deployment, mesh fixation, peritoneal flap closure, and additional closure). An AI model was trained to automatically recognize surgical phases from videos. The relationship between phase duration and surgical skills were also evaluated.

RESULTS

A fourfold cross-validation was used to assess the performance of the AI model. The accuracy was 88.81 and 85.82%, in unilateral and bilateral cases, respectively. In unilateral hernia cases, the duration of peritoneal incision (p = 0.003) and hernia dissection (p = 0.014) detected via AI were significantly shorter for experts than for trainees.

CONCLUSION

An automated surgical phase recognition system was established for TAPP using deep learning with a high accuracy. Our AI-based system can be useful for the automatic monitoring of surgery progress, improving OR efficiency, evaluating surgical skills and video-based surgical education. Specific phase durations detected via the AI model were significantly associated with the surgeons' learning curve.

Frequent callers to UK ambulance services in the COVID-19 pandemic: managing mental health, social isolation and loneliness

Objectives:

Patients who frequently call ambulance services are a vulnerable yet heterogeneous population with unmet multiple and complex physical health, mental health and/or social care needs. In this article, we report the challenges that the COVID-19 pandemic has introduced for ambulance services across the UK when managing frequent callers, and reflect on how existing systems and practices are adapting to support changing patient needs.

Methods:

Data reported in this article comprise reflections from the frequent caller leads in each ambulance service in the UK. All data were provided between 23 April 2020 and 1 May 2020, shortly after the peak of the outbreak in the UK. A single anonymised case study is also reported to illustrate how the pandemic is affecting people’s circumstances and contributing to frequent caller behaviour.

Results:

Ambulance services are observing changes to the frequent caller population, with many new frequent callers due to health anxiety caused or exacerbated by the pandemic. Management of frequent callers is also changing, with multidisciplinary and multi-agency working becoming more challenging due to decreased access to external services, whether in social care or the community and voluntary sector, and the redeployment of ambulance service staff. There is also decreased face-to-face contact with frequent callers, meaning that opportunities to deliver person-centred care are reduced. However, the introduction or increased use of tele/video conferencing with other organisations has mitigated some of these challenges, and in some cases has improved engagement among external organisations.

Conclusions:

Health anxieties, lack of access to other health, social and community and voluntary sector services and exacerbations of social isolation and/or loneliness have reportedly contributed to changing behaviour among frequent callers. The COVID-19 pandemic has also affected how ambulance services have been able to manage frequent callers. Ambulance services should continue to engage with external organisations to aid the delivery of person-centred care, particularly organisations with experience in multiple complex needs such as mental health, social isolation and/or loneliness. Future research should examine the consequences of the pandemic for frequent users of ambulance services, and how these impact on the wider health and care community.

OP0258-HPR IS THERE A SUBSET OF PATIENTS WITH SJÖGREN’S SYNDROME WHO ARE MORE AT RISK FOR SEXUAL DYSFUNCTION? RESULTS FROM A SCOPING REVIEW

Background:

Individuals with Sjögren’s syndrome (SS) experience significantly higher levels of sexual dysfunction and sexual distress than healthy controls (van Nimwegen et al., 2015). Identifying associated factors may help to identify a subgroup of patients with SS who may benefit from early intervention to maintain sexual wellbeing and avoid unnecessary sexual disruption.

Objectives:

To explore and map the salient symptoms and factors that influence alterations in sexual functioning and intimate relationships for people with SS.

Methods:

The protocol for this review was registered with the Open Science Framework prior to commencement of the searches. The peer-reviewed search strings were used to search the following databases from inception to June 2019: Cochrane Library, CINAHL [EBSCO], MEDLINE [ProQuest], PUBMED [MEDLINE], ScienceDirect, Scopus and Web of Science. Grey literature was searched for on academic databases, topic-specific repositories, and Google Scholar. Databases were searched using key terms corresponding to sexual functioning and intimate relationships. Studies were included if their participant sample was comprised of adults aged ≥18 years, with a diagnosis of primary or secondary SS. Studies were not excluded based on source type, methodology or design. To qualify for inclusion, studies needed to have been peer-reviewed and available in English. Retrieved articles were then screened against the inclusion/exclusion criteria by two reviewers. Hand-searching was conducted on the reference lists of included articles, as well as the three most prevalent publishing journals until saturation had been achieved.

Results:

The search strategy returned 3527 unique citations. After screening processes were completed, only 19 articles met the inclusion criteria. Studies were predominately conducted in European countries (79%), within the last decade (68%; 2010-2019), and were mainly quantitative (n = 17; 89.5%), case-controlled (88.3%), and cross-sectional (100%) in nature. In total there were 1281 patients, 47% (n = 605) were patients with primary SS and the remaining 53% (n = 676) were patients with secondary SS. Both patient groups were predominately comprised of females (n = 600; 99% and n = 673; 99.5%, respectively), with a combined mean age of 50.82 years (M ranges = 35 – 62.82 years). An amalgamation of results from 17 studies, found that women with SS who score higher on the ESSPRI scale (total score and the subdomains of pain, fatigue and dryness) were more likely to experience significantly greater levels of vaginal dryness, sexual dysfunction and sexual distress. Moreover, women with SS who present with clinical levels of anxiety or depression were also more likely to experience disruptions in their sexual functioning and appraise their sexual life more negatively. Furthermore, patients who report greater severity of oral or ocular dryness, or dyspareunia may experience vaginal dryness, which may have ramifications on sexual functioning. Women of all ages are at risk of experiencing sexual dysfunctions, however, younger women (≤50 years) may experience more burdensome disruptions than older women. Finally, women who do not use lubrication products during sexual activity may be impacted further.

Figure 1.

Factors significantly associated with sexual dysfunction and sexual distress for patients with SS.

Conclusion:

Younger women (≤50) with SS who present with more severe symptoms of fatigue, pain, and oral or ocular dryness, or with clinical levels of anxiety or depression, may be at increased risk of experiencing sexual dysfunction and sexual distress. Healthcare professionals should be aware of these potential risk factors and initiate conversations around sexuality as and when a potentially ‘at risk’ individual is identified.

References:

[1]van Nimwegen, J. F., Arends, S., van Zuiden, G. S., Vissink, A., Kroese, F. G. M., & Bootsma, H. (2015). The impact of primary Sjögren’s syndrome on female sexual function. Rheumatology, 54(7), 1286-1293.

Disclosure of Interests:

None declared

POS0047 OUTCOMES IN INFLAMMATORY ARTHROPATHY PATIENTS HOSPITALIZED FOR COVID-19

Background:

Covid 19 is a new and rapidly spreading corona virus which has reached pandemic proportions. As of 5/22/20 there are 5.08 million confirmed cases and 332,000 deaths worldwide. Primary manifestations are respiratory, with a subset developing severe hypoxic respiratory failure. Several risk factors predispose patients to worse outcomes including age, obesity, hypertension, chronic kidney disease, COPD, asthma, CHF, and diabetes. This is a retrospective cohort analysis of patients with Rheumatoid arthritis, Ankylosing spondylitis, or Psoriatic arthritis who were hospitalized for COVID-19 infection across 165 HCA hospitals from 1/1/2020 to 5/30/2020. We compared endpoints and calculated odds of ICU admission, invasive ventilation, mortality compared to control as well as length of stay and discharge location.

Objectives:

Our objectives include measuring the outcome of Patients in two arms, the first being those with Rheumatoid arthritis, Ankylosing spondylitis, and Psoriatic arthritis who are infected with COVID 19 to an age matched and comorbidity matched arm (using the Charlson comorbidity index) for the composite endpoint of ICU admission, invasive ventilation, and death. We believe the inflammatory arthropathy arm will have a worse composite endpoint then the control arm. we will also attempt to calculate a hazard ratio of this arm vs the control to the composite endpoint. We will also examine the length of stay as well as inflammatory markers mentioned in between the two arms. We suspect initial inflammatory markers will be lower in the inflammatory arthropathy arm, particularly CRP and LDH, due to chronic immune modulating medication and these markers will not correlate as closely with severe illness represented by the composite endpoint as in the control arm.

Methods:

We analyzed 86,217 patients admitted with COVID-19 comparing 751 patients who had inflammatory arthropathy to patients who did not. T tests were used for parametric outcome and chi square tests for non-parametric outcomes. Multivariate analysis included potential confounders such as age, and comorbidities such as diabetes, heart disease, etc.

Results:

The odds ratio for mortality in the arthropathy arm was 1.37 with a confidence interval of 1.09 to 1.71 with a p value of 0.006. The odds ratio for ventilation was 1.35 with CI of 1.09 to 1.67 and p value of 0.006. The odds ratio of ICU admission was 1.46 with CI of 1.24 to 1.72 and P value of 0.000. The average length of stay of the arthropathy arm was 8.51 days +/- 10.02 vs 4.59 days +/- 8.26 of the control, p < 0.001. The discharge disposition of the arthropathy arm vs control group is as follows, 13.32% died inpatient vs 5.87% in the control, 56.72% were discharged home vs 77.19%, 6.79% went to hospice care vs 3.10%, 4.79% remained inpatient at the end of the study interval vs 3.45%, 17.18% were discharged to rehab vs 8.43%, and other discharges not included in the above groupings were 1.2% vs 1.96%, p<0.001. 31.29% of the arthropathy group required ICU admission vs 16.32% and 13.98% required ventilation vs 6.9%, p <0.001. The average age was higher in the arthropathy arm vs control at 66.56 years old vs 51.53, p <0.001. Charlson comorbidity index was also higher in the arthropathy arm at 2.72 vs 0.96, p <0.001.

Conclusion:

This is a large analysis of inflammatory arthropathy patients hospitalized with COVID-19. While the arthropathy group was older, and had more co-morbidities, when adjusting for potential confounders, inflammatory arthropathy patients had a higher risk of death and mechanical ventilation, as well as longer length of stay.

Disclosure of Interests:

None declared.

How decision-making about euthanasia for animals is taught to Australasian veterinary students

This study set out to explore how euthanasia decision-making for animals was taught to students in eight Australasian veterinary schools. A questionnaire-style interview guide was used by a representative at each university to interview educators. Educators were interviewed about their teaching of euthanasia decision-making for four categories of animals: livestock, equine, companion and avian/wildlife. Using thematic analysis, the terms provided by participants to describe how (mode of teaching) and what (specific content) they taught to students were categorised. Information about content was categorised into human-centred factors that influence decision-making, and animal-based indicators used to directly inform decision-making. All eight representatives reported some teaching relevant to euthanasia decision-making at their university for livestock, companion animal and avian/wildlife. One representative reported no such teaching for equid animals at their university. Observation of a euthanasia case was rarely reported as a teaching method. Five universities reported multiple modes of teaching relevant information, while two universities made use of modalities that could be described as opportunistic teaching (e.g., 'Discussion of clinical cases'). Factors taught at most universities included financial considerations, and that it is the owner's decision to make, while animal-based indicators taught included QoL/animal welfare, prognosis and behaviour change. Overall, most universities used a variety of methods to cover relevant material, usually including lectures and several other approaches for all animal types. However, because two universities relied on presentation of clinical cases, not all students at these veterinary schools will be exposed to make, or assist in making, euthanasia decisions.

Marine mammal conservation: over the horizon

Marine mammals can play important ecological roles in aquatic ecosystems, and their presence can be key to community structure and function. Consequently, marine mammals are often considered indicators of ecosystem health and flagship species. Yet, historical population declines caused by exploitation, and additional current threats, such as climate change, fisheries bycatch, pollution and maritime development, continue to impact many marine mammal species, and at least 25% are classified as threatened (Critically Endangered, Endangered or Vulnerable) on the IUCN Red List. Conversely, some species have experienced population increases/recoveries in recent decades, reflecting management interventions, and are heralded as conservation successes. To continue these successes and reverse the downward trajectories of at-risk species, it is necessary to evaluate the threats faced by marine mammals and the conservation mechanisms available to address them. Additionally, there is a need to identify evidence-based priorities of both research and conservation needs across a range of settings and taxa. To that effect we: (1) outline the key threats to marine mammals and their impacts, identify the associated knowledge gaps and recommend actions needed; (2) discuss the merits and downfalls of established and emerging conservation mechanisms; (3) outline the application of research and monitoring techniques; and (4) highlight particular taxa/populations that are in urgent need of focus.

Augmented Reality Guided Laparoscopic Surgery of the Uterus

A major research area in Computer Assisted Intervention (CAI) is to aid laparoscopic surgery teams with Augmented Reality (AR) guidance. This involves registering data from other modalities such as MR and fusing it with the laparoscopic video in real-time, to reveal the location of hidden critical structures. We present the first system for AR guided laparoscopic surgery of the uterus. This works with pre-operative MR or CT data and monocular laparoscopes, without requiring any additional interventional hardware such as optical trackers. We present novel and robust solutions to two main sub-problems: the initial registration, which is solved using a short exploratory video, and update registration, which is solved with real-time tracking-by-detection. These problems are challenging for the uterus because it is a weakly-textured, highly mobile organ that moves independently of surrounding structures. In the broader context, our system is the first that has successfully performed markerless real-time registration and AR of a mobile human organ with monocular laparoscopes in the OR.

A new blue whale song-type described for the Arabian Sea and Western Indian Ocean

Blue whales Balaenoptera musculus in the Indian Ocean (IO) are currently thought to represent 2 or 3 subspecies (B. m. intermedia, B. m. brevicauda, B. m. indica), and believed to be structured into 4 populations, each with a diagnostic song-type. Here we describe a previously unreported song-type that implies the probable existence of a population that has been undetected or conflated with another population. The novel song-type was recorded off Oman in the northern IO/Arabian Sea, off the western Chagos Archipelago in the equatorial central IO, and off Madagascar in the southwestern IO. As this is the only blue whale song that has been identified in the western Arabian Sea, we label it the ‘Northwest Indian Ocean’ song-type to distinguish it from other regional song-types. Spatiotemporal variation suggested a distribution west of 70°E, with potential affinity for the northern IO/Arabian Sea, and only minor presence in the southwestern IO. Timing of presence off Oman suggested that intensive illegal Soviet whaling that took 1294 blue whales in the 1960s likely targeted this population, as opposed to the more widely distributed ‘Sri Lanka’ acoustic population as previously assumed. Based upon geographic distribution and potential aseasonal reproduction found in the Soviet catch data, we suggest that if there is a northern IO subspecies (B. m. indica), it is likely this population. Moreover, the potentially restricted range, intensive historic whaling, and the fact that the song-type has been previously undetected, suggests a small population that is in critical need of status assessment and conservation action.

Occupational therapy, loneliness and social isolation: a thematic review of the literature

Background/Aims

Loneliness and social isolation are thought to have a negative impact on health and wellbeing. There is little literature that provides an explicit focus on loneliness and social isolation in occupational therapy practice. The aim of this study was to explore themes related to loneliness and social isolation in occupational therapy-related literature and consider the implications for practice.

Methods

CINAHL, Medline, Pub Med, AMed, PsycINFO, TRIP Database, and Science direct and Web of science databases were used to identify articles pertaining to occupational therapy, loneliness and social isolation.

Results

A total of 20 articles were included and three themes were identified: loneliness and social isolation are detrimental to health and wellbeing; factors associated with increased loneliness and social isolation; factors that protect against the impact of loneliness and social isolation.

Conclusions

Loneliness and social isolation have a significant impact on the health and wellbeing of the people occupational therapists work with. Occupational therapy practice should include the recognition and assessment of loneliness and social isolation, and interventions to help reduce any impacts on health and wellbeing.

Additional cost in personal protective equipment to NHS services during COVID-19: a review of the expense incurred by Aneurin Bevan Healthboards Maxillofacial unit over a one-year period to meet current clinical guidelines

COVID-19 has led to increased levels of personal protective equipment (PPE) in surgical specialties. Aneurin Bevan Healthboard Oral and Maxillofacial unit sees approximately 2,808 patients per annum and to meet current guidelines this added PPE is estimated to cost an extra £32,292. Whilst this helps improve safety for clinicians and patients, we also recommend that evidence is regularly reviewed to assess what PPE is justified at different stages of viral prevalence.

SAT0633-HPR AN EXPLORATION INTO THE CONVERSATIONS AROUND SEXUAL FUNCTIONING THAT MALES WITH SJÖGREN’S SYNDROME HAVE ON AN INTERNET FORUM

Background:

Sjögren’s Syndrome (SS) is an autoimmune rheumatic disease that targets secretion glands throughout the body, causing symptoms of oral, ocular and genital dryness (van de Merwe, 2010). A small body of literature has investigated the impact of SS on women’s sexual functioning, however, no research currently exists that has explored this topic in males with SS. Gathering a snapshot of issues may prove difficult given the sensitivity of the topic. Therefore, data must be gathered from sources where individuals may have the confidence to talk openly. Research has shown that many patient groups turn to internet forums to discuss sensitive issues under the cloak of anonymity (White & Dorman, 2001). Analysing this source of data allows us to explore the conversations pertaining to sexual functioning that males with SS may not feel comfortable discussing in a traditional qualitative setting, and may be instrumental in guiding future intervention strategies.

Objectives:

To explore the conversations around sexual functioning that male users with SS have on an internet forum.

Methods:

A large publicly accessible internet forum that individuals with a diagnosis of SS used to discuss issues and share experiences with other users was selected. Thread names and post content were scraped using a web scraping tool, and posts identified as containing relevant keywords were exported into Excel. Braun & Clarke’s (2006) thematic analysis was used to analyse post content.

Results:

A total of 78 posts were identified as being pertinent to the topic of male sexual functioning. Conversations were predominately centred on symptom presence in the reproductive organs. Forum users discussed having fluctuating pain in the testicles, scrotum, groin, anus, and rectum. They also reported experiencing feelings of dryness at the base of the penis, around the testicles, under the foreskin, around the glans of the penis and in the anus. Discussions were also had about changes in the volume and consistency of seminal fluid released either prior to or during ejaculation. Another conversation theme revolved around how the symptoms they experienced affected their ability to engage in sexual intercourse. Forum users discussed how pain and dryness made sexual intercourse painful, resulting in them withdrawing from sexual activity indefinitely. Discussions were also had about the lack of information available to help understand and manage sexual dysfunction. Forum users discussed how feelings of embarrassment about the nature of the symptoms and the stigma of it being “a woman’s disease” kept them from seeking medical assistance. Those who had sought medical assistance shared their belief that health professionals (HPs) were misdiagnosing their symptoms and were prescribing ineffective treatments. They also reported that their HPs were dismissive of symptoms and unwilling to assist further.

Conclusion:

Utilising conversations from an internet forum was an effective method to use to gain insight into some of the issues that males with SS experience with sexual functioning. The absence of accessible information and lack of support from HPs for males with SS is hinted at in this research. Future research should focus on identifying issues surrounding male sexual functioning as this will both guide future intervention strategies and allow HPs to publish material to better support males with SS.

References:

[1]Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology.Qualitative Research in Psychology, 3(2), 77-101.

[2]van de Merwe, J. P. (2010).Sjögren’s Syndrome: Information for patients and professionals.Rotterdam: Erasmus MC.

[3]White, M., & Dorman, S. M. (2001). Receiving social support online: Implications for health education.Health Education Research, 16(6), 693-707.

Disclosure of Interests:

None declared

How management of grief associated with ending the life of an animal is taught to Australasian veterinary students

OBJECTIVE

Veterinarians have an important role in supporting and understanding their clients' grief. Veterinary schools have a duty to teach students how best to manage grief - both that of the students/future veterinarians and the clients. This study explores how grief management, associated with ending the life of an animal, was taught to students in eight Australasian veterinary schools.

METHODS

A questionnaire-style interview guide was used by a representative at each university to conduct structured interviews with educators in a snowball sampling approach. Educators were interviewed about the teaching of grief management for four categories of animals: livestock, equine, companion and avian/wildlife. The terms used by participants to describe what they taught were grouped into common themes. Teaching was defined by individual participants and included structured and unstructured approaches. The stage in the degree (preclinical or clinical years) that grief management was taught in the veterinary curriculum and by whom (e.g. clinicians or psychologists) is also described.

RESULTS

Grief management was taught more in preclinical than clinical years. However, due to how grief was characterised, much of this teaching was general 'nonspecific' teaching that included all categories of animals. Client grief was taught more generically, whereas, grief of veterinarians was taught using specific examples given by clinicians.

CONCLUSION

A more robust end-of-life (EoL) management curriculum that includes all aspects of grief management is likely to increase job satisfaction, client happiness and professional satisfaction.

Supportive strategies for men who perform a care role: an occupational perspective

Background/aims

Health and social care practitioners often work alongside caregivers. This study aimed to consider commonality in the experience of male caregiving using secondary analysis of research related to fathers of an adult child with intellectual disability and to older widowers.

Methods

Secondary analysis of findings arising from two qualitative studies of men who have experience of a caregiving role (fathers of an adult child with intellectual disability and older widowers) was applied using a triangulation approach to illuminate, develop and enrich inter-study findings.

Results

Overarching themes across the two studies included ‘aspects of a care role’ and ‘supportive mechanisms’. The findings demonstrate that men from these specific groups are actively involved in care and that there are varied aspects to a care role. Factors that support men include the provision of appropriate and timely information, time spent pursuing leisure activities and support from family, friends and individualised services.

Conclusions

There are multiple aspects involved in a care role and the provision of care has positive and negative impacts on men. If service providers are aware of support strategies that are useful to male carers, this may support the health and wellbeing of both the carer and the person they support.

Identifying animal welfare impacts of livestock air transport

Air transport of livestock occurs frequently from most Australian major cities. The total journey time starts with road transport from the farm or pre-export facility to the departing airport where livestock are crated, and ends with the unloading of animals at the premises or farm in the importing country. We reviewed the literature regarding airfreight and conclude that there was minimal information on current practices within this industry, particularly for procedures after arrival at the Australian airport, and during the on-board phase.

The personal communities of men experiencing later life widowhood

Increasingly men are becoming widowed in later life due in part to a longer life expectancy. Social networks and social support are thought to help buffer the negative consequences of such later life transitions. This paper explores the personal communities of a group of older men experiencing widowhood. Qualitative in-depth interviews were conducted, September 2013-February 2014, with seven older widowers, 71-89 years of age, in North Staffordshire, UK. Interviews included personal community diagrams to identify the structure of the older men's social relationships. Data analysis comprised thematic analysis of interview transcripts and content analysis of personal community diagrams. Three overarching themes were identified from the interview data: "Personal identity and resilience assist transition," "Continuity in personal communities provides stability" and "Changes in social relationships and practices facilitate adaptation." The study identified three types of personal community among the older widowers, comprising different combinations of family, friends and others. The findings illustrate that some older widowers have very restricted personal communities which puts them at greater risk of loneliness and social isolation. The social needs of long-term carers should be addressed as isolation and loneliness can begin long before the death of a spouse. It is important to consider gender differences and preferences when designing interventions for older people in order to promote engagement, social inclusion and well-being.

Assessing and mitigating post-operative castration pain in Bos indicus cattle

Cattle on pastoral land are subject to potentially painful husbandry procedures. In northern Australia, these practices generally occur once a year after the muster and the procedures are usually performed on animals older than 6 months of age. It is seldom that any pain mitigating medications are administered at this time and there is increasing concern that this perceived impost on the animal’s welfare will become more significant at both an economic and cultural level. There is a need to investigate the possibility of using simple, cost-effective, readily available medications, administered using relatively quick and easily taught techniques to increase the chance of industry adoption. This research used castration of 6–8-month-old Bos indicus calves as the test model because it is arguably one of the most common and most painful procedures endured by the animals. Forty-eight, 6–8-month-old Brahman bulls were surgically castrated after random assignment to six different treatment groups (n = 8): no castration Control (NC); castration (C); castration with post-operative meloxicam (CMpost-op); castration with lignocaine (CL); castration with lignocaine and post-operative meloxicam (CLMpost-op); castration with pre-operative meloxicam (CMpre-op). Serial measures of weight, blood cortisol concentrations, balk score, crush score, and daily activity (steps taken, number and duration of rest bouts) were taken. Linear mixed modelling was used to compare experimental groups. Bulls that were castrated and did not receive post-operative meloxicam (C and CL) had significantly lower average weights at all time points (Days 0–13, P < 0.001) of 170.9 kg and 168.6 kg, respectively, than those that did (CMpost-op and CLMpost-op) at 174.7 kg and 173.7 kg, respectively. When lignocaine was not administered before castration, Day 1 post-operative cortisol concentrations were significantly lower when post-operative meloxicam was provided than when it was not (CMpost-op: 47.2 nmol/L vs C: 65.5 nmol/L). When post-operative meloxicam was not given, animals that were given lignocaine before castration had significantly lower cortisol concentrations than those that received no lignocaine (CL: 52.7 nmol/L vs C: 65.5 nmol/L). Animals that were given pre-operative meloxicam had, on average, significantly lower Day 1 post-operative cortisol concentrations than animals that received no lignocaine or meloxicam (CMpre-op: 44.8 nmol/L vs C: 65.5 nmol/L). Analysis of Day 1 (the day following castration) data showed that animals that were given pre-operative meloxicam (CMpre-op) were significantly more active than animals in all other treatment groups (P = 0.038). It was concluded that 6–8-month old, Bos indicus bulls benefit from the administration of both lignocaine before surgery and peri-operative meloxicam. The analgesic methods used are readily adoptable by industry with respect to cost, efficiency and degree of technical skill required.

Students' opinions on welfare and ethics issues for companion animals in Australian and New Zealand veterinary schools

OBJECTIVE

To determine what veterinary students in Australia and New Zealand consider important competences in companion animal welfare and ethics (AWE) required on their first day of practice, and to explore how their priorities relate to gender and stage of study.

METHODS

Undergraduate students at all veterinary schools in Australia and New Zealand were sent an online survey. A subset of questions required participants to rank the importance of preselected AWE topics pertaining to companion animals. Data were analysed to determine differences in the way students of different gender or academic stage prioritised each of these AWE topics.

RESULTS

Of 3220 currently enrolled students, 851 participated in the survey: 79% were female, 17% male, 4% unspecified. Ranking of the AWE topics, from highest to lowest importance, was: neutering, companion animal husbandry, euthanasia, behaviour and training, animal breeding, over-servicing in relation to animal needs and cosmetic surgery. Female students consistently ranked competency in AWE issues surrounding neutering more highly than male students (P = 0.006). Students in senior years of study ranked the importance of competency in animal abuse/hoarding (P = 0.048), shelter medicine (P = 0.012) and animal breeding (P = 0.002) less highly than those in junior years.

CONCLUSIONS

Australasian veterinary students placed more importance on competency in AWE issues associated with clinical practice (such as neutering and euthanasia) than on professional behaviours (such as over-servicing and animal breeding). However, we consider that emphasis should still be placed on developing graduate competency in the latter categories to reflect growing societal concerns about companion animal over-supply and inappropriate professional conduct.

'It pushed me back into the human race': evaluative findings from a community Christmas event

Many older people in Britain spend Christmas day alone. The Christmas period may be especially difficult for older people who are socially isolated, living with dementia or who have physical impairments, and may feel particularly marginalised at this time of year. This paper draws on evaluative research findings from a community Christmas event held in December 2014 at the University of Salford for older people and their carers who would be on their own on Christmas day. A multi-method approach was employed, seven guests took part in semi-structured interviews to explore their experiences and perceptions of the event, seven staff and student volunteers participated in a group interview to explore and discuss their participation in the event. Data collection took place during April and May 2015. Interview transcripts were subjected to thematic analysis. Three overarching themes were identified from the interviews: 'reasons for participants attending the event', 'a different Christmas day: the impact on guests and volunteers', and 'learning, planning and moving forwards'. The findings illustrate that a range of people participated in the Christmas day event for a variety of reasons. The event itself had a positive impact, including the shared experience of social belonging, for all involved. There are tangible longer term benefits as a result of the event, such as ongoing contact between participants and the development of supportive networks in the local community.

Predicting QRS and PR interval prolongations in humans using nonclinical data

BACKGROUND AND PURPOSE

Risk of cardiac conduction slowing (QRS/PR prolongations) is assessed prior to clinical trials using in vitro and in vivo studies. Understanding the quantitative translation of these studies to the clinical situation enables improved risk assessment in the nonclinical phase.

EXPERIMENTAL APPROACH

Four compounds that prolong QRS and/or PR (AZD1305, flecainide, quinidine and verapamil) were characterized using in vitro (sodium/calcium channels), in vivo (guinea pigs/dogs) and clinical data. Concentration-matched translational relationships were developed based on in vitro and in vivo modelling, and the in vitro to clinical translation of AZD1305 was quantified using an in vitro model.

KEY RESULTS

Meaningful (10%) human QRS/PR effects correlated with low levels of in vitro Na_v 1.5 block (3-7%) and Ca_v 1.2 binding (13-21%) for all compounds. The in vitro model developed using AZD1305 successfully predicted QRS/PR effects for the remaining drugs. Meaningful QRS/PR changes in humans correlated with small effects in guinea pigs and dogs (QRS 2.3-4.6% and PR 2.3-10%), suggesting that worst-case human effects can be predicted by assuming four times greater effects at the same concentration from dog/guinea pig data.

CONCLUSION AND IMPLICATIONS

Small changes in vitro and in vivo consistently translated to meaningful PR/QRS changes in humans across compounds. Assuming broad applicability of these approaches to assess cardiovascular safety risk for non-arrhythmic drugs, this study provides a means of predicting human QRS/PR effects of new drugs from effects observed in nonclinical studies.

An occupational perspective of the lived experience of familial dementia caregivers: A thematic review of qualitative literature

Dementia caregiving is thought to have a negative impact on health and wellbeing. This critical review of qualitative literature explored the lived experience of familial dementia caregivers from an occupational therapy perspective. The method was informed by systematic review and qualitative research methodologies and was structured within the occupational dimensions framework of doing-being-becoming-belonging. A comprehensive search of major databases was undertaken which identified 484 studies on the topic; 14 met the inclusion criteria and were included in the review. Ten themes emerged within the doing-being-becoming-belonging framework from the analysis of the studies. The occupational participation of caregivers is conveyed within the 'doing' domain. Ways in which caregiving impacts upon opportunities for self-nurture are presented within the 'being' domain. The 'becoming' domain elucidates ways in which caregivers redefine themselves, their values and their priorities through their caregiving role. The 'belonging' domain depicts ways in which caregivers' connections with their care recipient and others are shaped over time. Practice implications for health and social care practitioners who work with familial dementia caregivers are presented in light of the findings.

Conducting longitudinal research with older widows: Exploring personal communities through multiple methods

This article reports on the process of undertaking a longitudinal multiple methods study with older women experiencing the transition of later-life widowhood. Three qualitative in-depth interviews were conducted with 26 older widows in North Staffordshire, United Kingdom. Interviews included the use of personal community diagrams to identify the structure of personal communities and Christmas and Christmas cards to further explore social relationships and practices during transition. Examples of cases are given to illustrate the findings derived from the methods employed. The cases demonstrate the diverse and often paradoxical nature of social relationships within similar networks.

Qualitative behavioural assessment of the motivation for feed in sheep in response to altered body condition score

Qualitative behavioural assessment (QBA) has been used to quantify the expressive behaviour of animals, and operant tests have been used to quantify measures of behavioural need. In this study we compared measures of behavioural expression and behaviour in operant tests. We examined the behavioural expression of pregnant ewes of body condition score (BCS) 2 and 3. The ewes were exposed to a feed motivation test in which they received a food reward. Pregnant ewes (48–70 days gestation) were assessed during a food motivation test after they had been maintained at BCS 3 (n = 7) or given a decreasing plane of nutrition that resulted in slow loss of 1 BCS unit (over 10–12 weeks; n = 7) or a fast loss of 1 BCS unit (over 4–6 weeks; n = 7). The feed motivation test involved ewes having the opportunity to approach a food reward and then being moved a given distance away from the reward by an automatic gate; they could then subsequently return to the feeder. Continuous video footage of each ewe during one cycle of the gate (approaching and returning from the food reward) was shown in random order to 11 observers who used their own descriptive terms (free-choice profiling methodology; FCP) to score the animals using QBA. Data of the assessment were analysed with generalised Procrustes analysis (GPA), a multivariate statistical technique associated with FCP. The research group also quantified the feeding behaviour of sheep in the same clips. These behaviours included how sheep approached the feeder, behaviours exhibited at the feeder, and how sheep returned from the feeder. There was consensus amongst observers in terms of their assessment of behavioural expression of the sheep (P < 0.001). The GPA found three main dimensions of assessed behavioural expression in the sheep, which together explained 44% of the variation observed. GPA dimension 1 differed between the three treatment groups (P < 0.05): ewes maintained at BCS 3 scored low on GPA dimension 1 (i.e. were described as more calm/bored/comfortable) compared with ewes that had a slow declining BCS (described as more interested/anxious/excited). GPA dimension 2 scores were not significantly different between treatment groups. However, quantitative behaviours exhibited by sheep during the clips were correlated with qualitative behavioural assessments made by the observers. Animals that spent more time ‘sniffing and looking for more feed’ were attributed lower GPA 2 scores (described as more hungry/searching/excited) (P < 0.05), and animals that ‘did not walk directly to the food reward (but stopped along the way)’ were attributed significantly higher GPA 2 scores (more curious/intimidated/uneasy) (P < 0.01). GPA dimension 3 scores also did not differ between the treatment groups; however, sheep that had a higher number of feeding events during the entire 23-h feed motivation test were attributed lower GPA dimension 3 scores (they were described as more hungry/bold/interested) (P < 0.05), and sheep that consumed a larger amount of the feed reward were attributed higher GPA dimension 3 scores (more curious/concerned/reserved) (P < 0.05). We conclude that QBA is a valuable method of assessing sheep behavioural expression under the conditions tested, in that it provided an integrative characterisation of sheep behavioural expression that was in agreement with quantitative behavioural measures of feeding.

Qualitative behavioral assessment of transport-naive and transport-habituated sheep

Objective and issue-neutral qualitative assessments of livestock behavior could provide a powerful assessment of welfare, augmenting quantitative measures such as autonomic and endocrine changes, which are often difficult to assess under many commercial livestock conditions. We set out to validate the use of qualitative behavioral assessment (QBA) in sheep using controlled experimental conditions (transport as a challenge) and comparing assessments against physiological variables. The behavioral expression of 14 Merino wethers, which had never experienced land transport, were assessed during their first road event (naïve to transport), and then again on their seventh event, 8 d later (habituated to transport). Blood samples were collected immediately before loading and after unloading, and heart rate and core body temperature were measured continuously throughout each event. Continuous video footage recorded during each event was used to provide clips of individual animals that were shown to observers for QBA. There was significant consensus (P < 0.001) amongst 63 observers in terms of their assessment of the behavioral expression of the sheep. Transport-naïve sheep were assessed as being more 'alert', 'anxious', and 'aware', whereas transport-habituated sheep were more 'comfortable', 'tired', and 'confident' (P = 0.015). Heart rate and heart rate variability, core body temperature and a stress leukogram were greater (P < 0.05) in sheep during the first (naïve) event compared with the habituated event, and were significantly correlated with the QBA scores (P < 0.05). In conclusion, QBA is a valid, practical and informative measure of behavioral responses to transport.