Assessing domain match and feasibility of candidate instruments matching with OMERACT endorsed domains to measure flare in knee and hip osteoarthritis

PURPOSE

To evaluate the domain match (truth) and feasibility of candidate instruments assessing flare in knee and hip osteoarthritis (OA) according to the identified domains.

MATERIAL AND METHODS

From a literature review (575 papers), instruments were selected and evaluated using the truth and feasibility elements of the OMERACT Filter 2.2. These were evaluated by 26 experts, including patients, in two Delphi survey rounds. The final selection was obtained by a vote.

RESULTS

44 instruments were identified. In Delphi Round 1, five instruments were selected. In Round 2, all instruments obtained at least 75 % in terms of content match with the endorsed domains and feasibility. In the final selection, the Flare-OA questionnaire obtained 100 % favorable votes.

CONCLUSION

Through consensus of the working group, the Flare-OA questionnaire was selected as the best candidate instrument to move into a full assessment of its measurement properties using the OMERACT Filter 2.2.

Absolute emission intensities of the gamma rays from the decay of 224Ra and 212Pb progenies and the half-life of the 212 Pb decay

Absolute gamma-ray emission intensities for 36 characteristic gamma rays from the decay of 224Ra, 212Pb, and their progeny were determined by measuring sources calibrated for activity by means of primary methods based on well-defined high-purity germanium (HPGe) detectors at both NIST and NPL. Results from the two laboratories agree with recent data evaluations, except for gamma rays with low emission intensities. The decay schemes have been re-balanced based on the new results. In addition, the half-life for 212Pb was measured using several HPGe detectors, ionization chambers, and a well-type NaI(Tl) detector.

Evaluating the prospective utility of pharmacogenetics reporting among Canadian Armed Forces personnel receiving pharmacotherapy: a preliminary assessment towards precision psychiatric care

Pharmacological interventions for treating posttraumatic stress disorder in Canadian Armed Forces (CAF) members and Veterans often achieve modest results. The field of pharmacogenetics, or the study of how genes influence an individual's response to different medications, offers insight into how prior knowledge of gene-drug interactions may potentially improve the trial-and-error process of drug selection in pharmacotherapy, thereby improving treatment effects and remission rates. Given the relative recency of pharmacogenetics testing and sparse research in military samples, we used pharmacogenetics testing in a small pilot group (n=23) of CAF members and Veterans who were already engaged in pharmacotherapy for a service-related mental health condition to better understand the associated opportunities and challenges of pharmacogenetics testing in this population. Our preliminary evaluation involved: (1) reporting the prevalence of pharmacogenetics testing 'bin' status according to participants' reports ('green', 'yellow' or 'red'; intending to signal 'go', 'caution' or 'stop', regarding the potential for gene-drug interactions); (2) calculating the percentage of currently prescribed psychotropic medications that were assessed and included in the reports; (3) evaluating whether prescribers used pharmacogenetics testing information according to clinical notes and (4) collecting informal feedback from participating psychiatrists. While pharmacogenetics testing appeared to provide valuable information for a number of clients, a major limitation was the number of commonly prescribed medications not included in the reports.

Librarian and Researcher Assessments of Search Result Relevance: How Well Do They Align?

Conducting comprehensive but efficient literature searches for complex evidence syntheses involves selecting databases that will retrieve the greatest number of relevant results on the question. Lack of a comprehensive single database on allied health educational topics challenges those seeking such literature. In this study, six participants contributed research questions on instructional methods and materials for allied health patients, caregivers, and future health professionals. Two health sciences librarians created search strategies for these questions and searched eleven databases. Both the librarians and the six participants evaluated the search results using a rubric based on PICO to assess extent of alignment between the librarians' and requestors' relevance judgments. Intervention, Outcome, and Assessment Method constituted the most frequent bases for assessments of relevance by both librarians and participants. The librarians were more restrictive in all of their assessments except in a preliminary search yielding twelve citations without abstracts. The study's results could be used to identify effective techniques for reference interviewing, selecting databases, and weeding search results.

Prevalence and correlates of stocking up on drugs during the COVID-19 pandemic: Data from the C3PNO Consortium

BACKGROUND

Data from the COVID-19 pandemic describes increases in drug use and related harms, especially fatal overdose. However, evidence is needed to better understand the pathways from pandemic-related factors to substance use behaviours. Thus, we investigated stockpiling drugs among people who use drugs (PWUD) in five cities in the United States and Canada.

METHODS

We used data from two waves of interviews among participants in nine prospective cohorts to estimate the prevalence and correlates of stockpiling drugs in the previous month. Longitudinal correlates were identified using bivariate and multivariate generalized linear mixed-effects modeling analyses.

RESULTS

From May 2020 to February 2021, we recruited 1873 individuals who completed 2242 interviews, of whom 217 (11.6%) reported stockpiling drugs in the last month at baseline. In the multivariate model, stockpiling drugs was significantly and positively associated with reporting being greatly impacted by COVID-19 (Adjusted Odds Ratio [AOR]= 1.21, 95% CI: 1.09-1.45), and at least daily use of methamphetamine (AOR = 4.67, 95% CI: 2.75-7.94) in the past month.

CONCLUSIONS

We observed that approximately one-in-ten participants reported stocking up on drugs during the COVID-19 pandemic. This behaviour was associated with important drug-related risk factors including high-intensity methamphetamine use. While these correlations need further inquiry, it is possible that addressing the impact of COVID-19 on vulnerable PWUD could help limit drug stockpiling, which may lower rates of high-intensity stimulant use.

153 AN EVALUATION OF OLDER PERSONS WITH VESTIBULAR DYSFUNCTION AS IDENTIFIED DURING COMPREHENSIVE GERIATRIC ASSESSMENT

Background

Vestibular dysfunction accounts for 25% of dizziness complaints. In 30-50% of these cases, dizziness is attributed to Benign Paroxysmal Positional Vertigo (BPPV). Thirty percent of people will experience vestibular dysfunction in their lifetime, with likelihood increasing with age. Individuals with vestibular dysfunction are eight times more likely to experience a fall. Vestibular assessment and rehabilitation services can be difficult to access.

Methods

A Plan, Do, Study, Act (PDSA) cycle was undertaken. All referrals to the Older Persons’ Services Clinics from November 2021 to May 2022 were triaged by an Integrated Care Team for the Older Person and scheduled for Comprehensive Geriatric Assessment (CGA). In the course of CGA, patients who reported symptoms suggestive of vestibular dysfunction received assessment by a Physiotherapist with vestibular expertise. Results were entered on an Excel spreadsheet and analysed using descriptive statistics.

Results

Six patients (4 female, 2 male) received vestibular assessment and treatment. Mean age was 75 years (SD: 11) with median Clinical Frailty Score of 4 (vulnerable). Reported symptoms were dizziness (n=3) and spinning (n=3). Sixteen percent (n=1) reported a fall and 66% (n=4) reported fear of falling. All patients had symptom duration of >2 years. Following vestibular assessment, the following diagnoses were made; right posterior canal BPPV, (n=2), vestibular migraine (n=2), right horizontal canal canalithiasis BPPV, with secondary diagnosis of persistent postural-perceptual dizziness (n=1) and left peripheral vestibular hypofunction due to vestibular neuronitis (n=1). The mean number of Physiotherapy visits per person was 4. Three patients reported full resolution of symptoms. The remaining 3 reported an improvement in symptoms and confidence to self-manage.

Conclusion

This small cohort of older persons with chronic vestibular dysfunction benefited from vestibular diagnosis and intervention. The next step of the process is to include specific vestibular screening questions into CGA. This will enable Integrated Care Team members to screen more specifically for vestibular dysfunction.

233 COGNITIVE OUTCOMES AFTER A FIRST EPISODE OF DELIRIUM IN HOSPITAL – RESULTS FROM AN ADVANCED NURSE PRACTITIONER DELIRIUM CLINIC

Background

Cognitive outcomes for frail older adult inpatients with a first episode of Delirium are unknown. Aim: To determine cognitive outcomes of frail older inpatients after a first episode of Delirium.

Methods

Consecutive frail older inpatients with a 4AT score >/= 4, without a previous history of cognitive impairment, over a 12-month period (January to December 2021) were invited for formal cognitive assessment 8-12 weeks after their delirium occurred. Collateral history, medication review, Addenbrookes (ACE III), bloods and CT brain were undertaken. Data was prospectively entered onto Excel and analysed using descriptive statistics.

Results

Fifty-one patients with a mean age of 82 years (SD=6) were referred to the Advanced Nurse Practitioner (ANP) Delirium Clinic. Median Clinical Frailty Score (CFS) was 6 with a male: female ratio of 1:2. Forty- seven percent (n=24) attended; 35 % (n-18) did not attend; 18 % (n=9) died prior to assessment. The ratio of male to female attendees was 1: 2.4. There was no difference in CFS or age between attenders and non-attenders. Thirty-three percent (n=8) of patients who attended had potentially reversible causes (high anti-cholinergic burden, folate deficiency, sleep disorder) of cognitive impairment requiring intervention. Sixty-seven percent (n=16) were diagnosed with dementia at the Delirium Clinic; 16.6% (n=4) were diagnosed with Mild Cognitive Impairment; 4% (n=1) had a resolved delirium; 8% (n=2) were referred to consultant Memory Clinic and one patient remained too unwell to assess. The median ACE III score of patients diagnosed with dementia was 54/100 (SD = 18).

Conclusion

Pro-active follow up of patients with a first episode of Delirium led to early diagnosis of dementia and mild cognitive impairment with supportive interventions. Earlier ANP intervention, during the acute phase of delirium, has been introduced in order to improve clinic attendance.

330 RISK OF MALNUTRITION AND ITS ASSOCIATION WITH FRAILTY-ASSOCIATED FACTORS IN THE OLDER PERSON

Background

The aetiology of malnutrition is multifactorial, with age a facilitating factor. It is associated with poorer physical and mental health and functional ability in frail older persons. Nutritional screening is a key domain in Comprehensive Geriatric Assessment (CGA). This study assessed the relationship between malnutrition risk and other drivers of frailty in the older person by CGA.

Methods

All patients who had a CGA completed by an Integrated Care Team for Older Persons from March 2020 to July 2021 inclusive were studied. Data was entered onto an Excel database by a trained administrator. The variables included were: age, gender, swallow screen, living alone, cognition, loneliness, Clinical Frailty Scale (CFS) score, falls history and risk of malnutrition using the Malnutrition-Screening Tool (MST). Odds ratio (OR), 95% Confidence Intervals (CI) was used to determine if there was an association between malnutrition risk and each variable in the total group.

Results

In total, 567 patients (325 female, 242 male), mean age 82yrs (SD =19), with median CFS of 6 were studied. Sixty-eight percent (n=384) reported a fall, 37.2% (n=211) had a positive swallow screen, 44% (n=251) lived alone, 35% (n=198) had positive cognitive screening, 14% (n=80) reported loneliness and 31.6% (n=179) were identified as at risk of malnutrition. A positive association was identified between risk of malnutrition and cognitive impairment (OR 1.9, 95%CI 1.2-3.1) and a reported fall (OR 2.2, 95%CI 1.4-3.5). In the population who had a fall and risk of malnutrition, the association remained in those aged ≥80yrs (OR 2.6, 95% CI 1.46 – 4.5) and female (OR 3.6, 95%CI 1.7 – 7.4).

Conclusion

The risk of malnutrition is associated with falls risk and cognitive impairment in frail older persons. Frail older persons identified by integrated care team for older persons with falls risk & cognitive impairment will be targeted for specialist dietetic intervention.

Serum concentration trends and apparent half-lives of per- and polyfluoroalkyl substances (PFAS) in Australian firefighters

BACKGROUND

Per- and polyfluoroalkyl substances (PFASs) are persistent manmade compounds used in aqueous film forming foam (AFFF). The extensive use of AFFF has led to widespread environmental PFAS contamination and exposures of firefighters.

OBJECTIVES

To determine PFAS blood serum concentration trends and apparent serum half-lives in firefighters after the replacement of AFFF.

METHODS

Current and former employees of an Australian corporation providing firefighting services, where AFFF formulations had been used since the 1980s up until 2010, were recruited in 2018-2019 to participate in this study. Special focus was put on re-recruiting participants who had provided blood samples five years prior (2013-2014). Participants were asked to provide a blood sample and fill in a questionnaire. Serum samples were analysed for 40 different PFASs using HP LC-MS/MS.

RESULTS

A total of 799 participants provided blood samples in 2018-2019. Of these, 130 previously provided blood serum in 2013-2014. In 2018-2019, mean (arithmetic) serum concentrations of perfluorooctane sulfonate (PFOS, 27 ng/mL), perfluoroheptane sulfonate (PFHpS, 1.7 ng/mL) and perfluorohexane sulfonate (PFHxS, 14 ng/mL) were higher than the levels in the general Australian population. Serum concentrations were associated with the use of PFOS/PFHxS based AFFF. Participants who commenced service after the replacement of this foam had serum concentrations similar to those in the general population. Mean (arithmetic) individual apparent half-lives were estimated to be 5.0 years (perfluorooctanoic acid (PFOA)), 7.8 years (PFHxS), 7.4 years (PFHpS) and 6.5 years (PFOS).

CONCLUSION

This study shows how workplace interventions such as replacement of AFFF can benefit employees at risk of occupational exposure.

Concussion Management Guidelines Neglect Auditory Symptoms

Tinnitus, noise sensitivity, and hearing difficulties are commonly reported secondary to head injury. These auditory deficits have been shown to negatively impact daily functioning, and yet, often go unnoticed by health care professionals. The purpose of this editorial is to explain why it is essential for clinical practice guidelines that address the management of patients who have experienced a head injury to incorporate assessment and rehabilitation of auditory symptoms.

124 OUTCOME OF SPEECH AND LANGUAGE THERAPY CLINICAL DYSPHAGIA ASSESSMENT FOLLOWING AN INTERDISCIPLINARY SWALLOW SCREEN

Background

A 7 question non-validated swallow screen (Any reported swallowing difficulties? Any coughing with food or fluids? Any choking? Does food get stuck when eating? Any recurrent chest infections? Any pain when swallowing? Any difficulty swallowing tablets?) is used by an integrated care team for older persons to prioritise referrals to the Speech and Language Therapy (SLT) service.

This study identified the proportion of patients screened who appropriately required a clinical dysphagia assessment and intervention.

Methods

This was a retrospective study from September 2020 to June 2021. Patients were assessed by the Clinical Specialist SLT who determined if swallow impairment was present and whether intervention was required. Age, gender and clinical frailty score were documented. Patients who resided out of the catchment area or who had already received an SLT service were excluded.

Results

The average age was 80 years, range 67–103. The male to female ratio was 2:1 and the average clinical frailty score (CFS) was 5. N = 42(32%) screened positive. N = 29(69%) attended for SLT assessment. N = 27(93.1%) had a swallow impairment identified. N = 20 were discharged following a single intervention and 9 required further SLT intervention.

Conclusion

Presbyphagia is generally asymptomatic and results from age related anatomical and physiological changes, reduced functional reserve and sarcopenia. Older adults compensate for these difficulties and do not seek assistance. Presbyphagia may progress to dysphagia, resulting in adverse outcomes. The high rate of SLT confirmed swallow impairment and need for SLT intervention highlights a need to prospectively refine and validate this 7 question swallow screen.

44 BONE HEALTH AND FRACTURE RISK: KNOWLEDGE, OPINION AND PRACTICE OF PHYSIOTHERAPISTS

Background

Osteoporotic-related fractures are responsible for excess mortality, morbidity, chronic pain, reduction in quality of life, admission to long-term care and health and social care costs (Papaioannou et al, 2010).

Evidence for using Fracture Risk Assessment Tool (FRAX®) based community-screening in older people is increasing (Kanis et al, 2020). There is no published evidence on the use of FRAX® by Physiotherapists.

Methods

A questionnaire was sent to South Eastern Branch members of the Irish Society of Chartered Physiotherapists (ISCP).

Survey themes were: participant characteristics, knowledge and opinion in the areas of Bone Health and Fracture Risk. Responses were downloaded from Survey Monkey and analysed using descriptive statistics.

Results

The response rate was 27% (n = 56). 72% (n = 40) of those surveyed had at least 10 years clinical experience. For 65% (n = 37) of participants, older people made up more than half of their clinical caseload. 96% (n = 54) of participants treated people with frailty and other bone health risk factors; falls (93%), osteoporosis (89%), fracture or reduced mobility (87%).

On a scale of 1–10 (1 = least confident, 10 = most confident) 49% of respondents rated confidence in prescribing Bone Health Physiotherapy interventions at ≤5.

When interpreting results of a DEXA scan; 80% reported confidence to be ≤5.

Half (49%) of participants had never heard of FRAX®.

95% of respondents felt fracture risk was under addressed in clinical practice. All felt it was within their professional responsibility to discuss fracture risk with patients.

Conclusion

This is the first evaluation of bone health and fracture risk knowledge, opinion and practice of physiotherapists. The need for more knowledge of DEXA, FRAX® and bone health was highlighted. The use of FRAX® may improve fracture risk assessment in patients attending Physiotherapy. Based on these results, FRAX® has been introduced into a Rehabilitation Unit by Physiotherapists as part of Quality Improvement Project.

126 A QUALITY INITIATIVE TO IMPROVE THE ASSESSMENT AND RECOMMENDATION FOR TOTAL CALCIUM INTAKE

Background

This study assessed factors affecting adherence to calcium supplementation, estimated total calcium intake and potential to increase dietary calcium in the frail older adult.

Methods

Frail Older Adults who completed a comprehensive geriatric assessment (CGA) between January—June 2021 were included. Those taking calcium supplements were telephoned by a Dietitian. Nursing home residents, hospital inpatients and those unable to complete a telephone questionnaire were excluded. A modified version of the Short Calcium Intake List (SCAIL) was used and potential to improve dietary calcium was assessed (1). Data was analysed using descriptive statistics.

Results

N = 50 patients were taking a calcium supplement. N = 15 were excluded. 26 women and 9 men, aged 70 -96 yrs were included. Dietary intake ranged from 250– 1904 mg. 17% (N = 6) achieved >1,000 mg/day dietary calcium requirements from diet. 66% (N = 23) had potential to increase their dietary calcium. 97% (N = 34) were prescribed a Calcium supplement, ranging from 500– 2000 mg/day. Total Calcium Intake including supplementation ranged from 850 mg—2,737 mg. 82% (N = 29) exceeded their daily requirements.40% (N = 14) reported reduced compliance due to swallowing difficulties; 25%(N = 9) gastrointestinal upset; 11% (N = 4,) taste/consistency and 8% forgetting (N = 3).Dietitian recommendations included 31% (N = 11) to stop supplementation, 34% (N = 12) to reduce, 11% (N = 4) advice on managing concerns relating to supplement and 22% (N = 8) dietary education.

Conclusion

Most older adults did not meet their nutritional requirements for dietary calcium. Over two thirds could reduce or stop supplementation following dietary calcium assessment and advice. A dietary calcium estimator for the older adult, with education can be used to correct calcium intake. This modified SCAIL will be integrated into the CGA as part of a quality improvement initiative for the frail older adult.

Reference

1. Rasch L et al. (2017), Content Validity of a Short Calcium Intake List to Estimate Daily Dietary Calcium intake of Patients with Osteoporosis, Calcified Tissue International, 100(3): 271–277.

POS0270-HPR FLARE-OA QUESTIONNAIRE TO MEASURE FLARES IN OSTEOARTHRITIS OF THE KNEE AND HIP: ASSESSMENT OF ITS PSYCHOMETRIC PROPERTIES

Background:

Hip and knee OA is characterised by disease flares – understanding the determinants and consequences of OA flares has been hampered by lack of a standardized flare measure beyond the pain aspect. The patients point of view on the different aspect of their flares is essential.

Objectives:

The objective was to assess the psychometric properties of a new questionnaire for measuring the multidimensional aspect of flares in OA.

Methods:

Using a bilingual version of the questionnaire (33 items, response on a numeric scale, from 0 to 10), a multicentre survey (Australia, France and United States) was conducted on line with patients diagnosed with OA of the hip and/or the knee. Based on an international OMERACT/OARSI endorsed definition of the five core domains (pain, swelling, stiffness, consequences of symptoms and psychological aspects) composing a flare in OA [1], a confirmatory factorial analysis linked to the content analysis has been used to reduce the number of items and to determine the validity of the structure. The Flare-OA questionnaire (score from 0 to 100) has been tested in French and English for its internal consistency, its convergent validity with HOOS/KOOS and Mini-OAKHQOL questionnaires, and its discriminant validity.

Results:

Out of 398 patients (mean age 64 years old) who completed the questionnaire, 70.4% were female and 86.7% had knee OA. The confirmatory factorial analysis retained a model with 19 items (RMSEA =0.06; SRMR =0.04; CFI =0.96 and TLI = 0.94). The Cronbach Alpha was > 0.9 for the 5 domains and for the whole questionnaire. The correlations between the Flare-OA and the other instruments were in line with that hypothesis flare is related but different from other concepts usually measured. The discriminant validity was evidenced by a significant score difference (31.8; p<0,0001) between patients with and without flare, i.e. over twice the standard measurement error.

Conclusion:

The optimized Flare-OA questionnaire (19 items) is a reliable and valid instrument freely available from the authors for measuring the frequency and severity of flare in knee and hip OA in clinical research.

References:

[1]King LK, Epstein J, Cross M, et al. Establishing the Domains of Knee and Hip Osteoarthritis (OA) Flare: A Report from the OMERACT 2020 Inaugural Virtual Consensus Vote from the Flares in OA Working Group. (Submitted)

Disclosure of Interests:

None declared

Common mental disorders among Irish jockeys: prevalence and risk factors

OBJECTIVE

Jockeys compete in a sport, horseracing, renowned for its physical and psychological demands. Previous research has identified that common mental disorders (CMDs) may be prevalent among this unique population of athletes. The aim of the present study was to further explore the prevalence of CMDs among jockeys and to test for associations with potential risk factors.

METHODS

An anonymous survey was distributed to professional jockey online. Self-report screening tools for four CMDs (psychological distress, depression, generalized anxiety, and adverse alcohol use) were included alongside predictor variables from questionnaires assessing for burnout, career satisfaction, social support, and the contemplation of retirement. Binary logistic regression was used to explore associations between CMDs (present versus not present) and risk factors. Eighty-four professional jockeys completed the questionnaire (response rate = 52%).

RESULTS

In total, 79% of jockeys met the threshold for at least one CMD. Prevalence (%) of CMD varied as follows: adverse alcohol (61%), depression (35%), generalized anxiety (27%), and psychological distress (19%). Burnout, career (dis)satisfaction, lower levels of social support, and the contemplation of retirement increased the odds of meeting the criteria for CMDs.

CONCLUSION

The findings indicate that jockeys report CMD symptoms at comparable rates to athletes in other sports. The study was the first to highlight potential risk factors as predictors of CMDs among jockeys, including burnout, career satisfaction, and the current contemplation of retirement. Screening tools for the risk factors demonstrated may, therefore, provide useful in the early identification of CMDs among jockeys. The development of jockey-specific assessment tools, education programmes, and interventions may help better understand and support the mental health of jockeys.

142 Improving Functional Outcomes During Covid-19 for Both COVID-19 and Non COVID-19 Positive Older Adults Through the Introduction

Purpose

To improve the functional outcomes of older adults presenting to the Health and Ageing wards during the COVID-19 pandemic through a focussed rehabilitation list. The intended benefits to the older adult and service were for: 1. Daily rehabilitation input for older adults. 2. Older adults to spend less time immobile. 3. Ongoing rehabilitation intervention while awaiting medical clearance for discharge. 4. Increased staff satisfaction 5. Better outcomes on discharge. 6. Rehabilitation ethos on the Health and Ageing wards.

Methods

The quality improvement project was carried out using the Plan, Do, Study, Act (PDSA) cycle. Three iterative PDSA cycles were carried out over the course of the project to deliver proactive interventions as a result of analysis of baseline data and stakeholder involvement. These interventions were aimed at developing communication around the rehabilitation list within the team and sustainability of this list.

Results

The project resulted in better functional outcomes for older adults and increased staff morale. Between May 2020–June 2020, a total of 56 patients were seen on the rehabilitation list, with 84% of these patients seeing improvements in their Elderly Mobility Scores (EMS). 27% of patients on the rehabilitation list saw a change to their initial discharge plan, either needing reduced packages of care or reduced need for ongoing rehabilitation in an external setting.

Conclusions

The quality improvement project found that with focussed rehabilitation older adult inpatients with or without COVID-19 can make significant functional gains. These gains have wider effects on their outcomes on discharge and also for the service through increased morale and job satisfaction. Due to demand and capacity issues in the acute setting, older adults who would often benefit from ongoing input are not always reviewed regularly. This project demonstrates that with focussed rehabilitation older adults can improve and achieve better functional outcomes.

Determination of the half-life and the absolute photon emission intensities for the main gamma-ray energies of 124I

The National Institute of Standards and Technology (NIST) performed new standardization measurements for ¹²⁴I. As part of this work the absolute photon emission intensity for the main gamma-rays of ¹²⁴I were determined using several high-purity germanium (HPGe) detectors. In addition, the half-life for ¹²⁴I was also determined using an HPGe detector. Ionization chamber measurements were performed for additional sources, but it was not possible to obtain a precise half-life value.

Healthy choices in New South Wales health facilities for staff and visitors: a policy evaluation

Issue

Obesity and its determinants are risk factors for most leading causes of chronic diseases. In New South Wales (NSW), Australia, 1 in 2 adults and more than 1 in 5 children are above a healthy weight. As a key symbolic part of a suite of health eating policies, the NSW Ministry of Health implemented a Healthy Food and Drink in NSW Health facilities for Staff and Visitors Framework (Framework) across 18 Local Health Districts (LHDs). Many countries are grappling to understand the effectiveness of obesity prevention policies. Description 2: This policy evaluation synthesised evaluation study findings and internal records to assess the effectiveness of the Framework in achieving implementation targets: a) the removal of sugar-sweetened drinks (SSDs) from sale (Dec 2017), b) implementation of 12 food-based practices (Dec 2018).

Results

The overall implementation package was appropriate for the large, geographically dispersed, decentralised health system (160 health facilities; 927 food outlets;76 retailers) and variable retail arrangements. The Ministry provided LHDs with overall direction, phasing, and monitoring; the LHDs had local leadership, governance, cross-functional support and autonomy to implement in a way to suit them. Accountability and pace of implementation was driven most notably by monitoring and reporting using an electronic tool (PHIMS-N), and a 'network of practice' that was pivotal to problem solving. SSDs were removed from 96% (n = 606) of applicable food outlets; overall average achievement of all practices was high at 82% (22.4 SD). Nine in 10 (92%) consumers support the Framework, and retailers are accepting of its targets. Lessons: This was the right policy at the right time, with well-orchestrated implementation. Annual monitoring and reporting enabled by PHIMS-N is unique in this type of policy implementation and essential for tracking progress, informing decision making, and ensuring accountability.

Key messages

Implementation of the Framework has resulted in the removal of SSDs from sale, increased availability of healthier foods and decreased unhealthy foods as measured by 12 food-based practices. The Framework is feasible and effective in influencing retail practices in health facilities, has high consumer support for its goals, and overall acceptability and adoption amongst retailers.

New MPH curriculum in the United States: Report on successes and challenges

Background

In October 2016, the Council on Education for Public Health, the US accreditation agency for Master of Public Health (MPH) programs, revised its criteria. The new curricular model transitions a nearly 100-year-old knowledge-based curriculum to a competency-based curriculum tailored to today's public health needs in a global society. This presentation will highlight the new content and format of MPH curricula, including programs outside the US that have participated in US accreditation.

Objectives

CEPH has tracked implementation of the new curriculum as well as overall redesign of MPH programs. The presentation will describe strengths and challenges faced by programs implementing new curricula and will describe innovative curricular models.

Results

Data show that MPH programs are strong in epidemiological methods (99%), interpreting data (99%), and designing population-based policies or programs (93%). Programs have struggled to incorporate interprofessional practice (57%), systems thinking tools (55%), and negotiation skills (59%). Data indicate that 13% retained coursework in the traditional five core disciplines; 69% added to or adjusted the core; and 18% created a new or integrated core. Examples of each structure will be provided.

Conclusions

MPH programs in the US are experiencing a major change focused on development of competencies and skills for practice. While methodological skills remain strong, “soft” skills that are important for global public health practice are more of a challenge for faculty to integrate into the current training structure. Successful programs are incorporating innovative and cross-cutting curricula to meet these new requirements.

Key messages

MPH curricular requirements in the US have changed to focus on competencies and skills for public health practice. Critical public health leadership skills such as negotiation and interprofessional communication are lagging behind in integration into the new curriculum.

Accurate integral counting using multi-channel analyzers

Many techniques in radionuclide metrology rely on accurate measurement of the total count rate, that is integral counting, from a detector. We present the design and results from integral counting using a live-timed multi-channel analyzer (MCA) based on a list-mode digitizer and a live-timed scalar, both with imposed, extending dead times. These systems were benchmarked against an existing NIST anti-coincidence counting system. Both systems were used to determine correction factors to an MCA that uses Gedcke-Hale dead-time corrections. Tests were performed for a large-area gas-flow proportional counter and a NaI(Tl) detector for count rates up to 80 000 s-1. The results were used to create correction factors suitable for alpha- and beta-particle emission rate calibrations.

Quantifying Soft Tissue Artefacts and Imaging Variability in Motion Capture of the Fingers

This study assessed the accuracy of marker-based kinematic analysis of the fingers, considering soft tissue artefacts (STA) and marker imaging uncertainty. We collected CT images of the hand from healthy volunteers with fingers in full extension, mid- and full-flexion, including motion capture markers. Bones and markers were segmented and meshed. The bone meshes for each volunteer's scans were aligned using the proximal phalanx to study the proximal interphalangeal joint (PIP), and using the middle phalanx to study the distal interphalangeal joint (DIP). The angle changes between positions were extracted. The HAWK protocol was used to calculate PIP and DIP joint flexion angles in each position based on the marker centroids. Finally the marker locations were 'corrected' relative to the underlying bones, and the flexion angles recalculated. Static and dynamic marker imaging uncertainty was evaluated using a wand. A strong positive correlation was observed between marker- and CT-based joint angle changes with 0.980 and 0.892 regression slopes for PIP and DIP, respectively, and Root Mean Squared Errors below 4°. Notably for the PIP joint, correlation was worsened by STA correction. The 95% imaging uncertainty interval was < ± 1° for joints, and < ± 0.25 mm for segment lengths. In summary, the HAWK marker set's accuracy was characterised for finger joint flexion angle changes in a small group of healthy individuals and static poses, and was found to benefit from skin movements during flexion.

The effect of copper-oxide-treated soft and hard surfaces on the incidence of healthcare-associated infections: a two-phase study

BACKGROUND

Copper-oxide-impregnated linens and hard surfaces within the hospital environment have emerged as a novel technology to reduce environmental contamination and thereby potentially reduce the risk of healthcare-associated infections (HCAIs).

METHODS

This was a two-phase study. Phase 1 was a prospective, cluster-randomized, cross-over clinical trial in which one pod (eight beds) of our general ICU (GICU) utilized copper-oxide-impregnated linens whereas the other pod (eight beds) used standard hospital linens. Phase 2 was a two-year before-after study, following the relocation of three ICUs into a new ICU tower in which all the hard surfaces were treated with copper oxide (in addition to copper-impregnated linens). HCAIs were recorded using the National Healthcare Safety Network definitions.

FINDINGS

A total of 1282 patients were enrolled in phase 1. There was no difference in the rate of HCAI between the patients who received standard compared with copper oxide linen. In phase 2 there was a significant reduction in the number of infections due to Clostridioides difficile (2.4 per 1000 vs 0.7 per 1000 patient-days; incidence rate ratio: 3.3; 95% confidence interval: 1.4-8.7; P = 0.002) but no difference in the rate of central-line-associated bloodstream infections nor of catheter-associated urinary tract infections.

CONCLUSION

Copper-oxide-impregnated linens alone had no effect on the rate of HCAI. Our data suggest that copper-oxide-treated hard surfaces reduced the rate of infections due to C. difficile; however, important confounders cannot be excluded.

Determination of the internal pair production branching ratio of 90Y

The National Institute of Standards and Technology (NIST) measured the internal pair production branching ratio of ⁹⁰Y using two sources and four high purity germanium (HPGe) detectors to detect the resulting annihilation radiation. The internal pair production branching ratio determined from these measurements, (32.0 ± 1.5) × 10^-6 (k = 1), agrees within 1 standard uncertainty with the recommended value of (32.6 ± 0.7) × 10^-6 (k = 1) from the DDEP database.

Sleep quality is associated with vasopressin methylation in pregnant and postpartum women with a history of psychosocial stress

BACKGROUND

The relationship between disturbed sleep and stress is well-documented. Sleep disorders and stress are highly prevalent during the perinatal period, and both are known to contribute to a number of adverse maternal and foetal outcomes. Arginine vasopressin (AVP) is a hormone and a neuropeptide that is involved in stress response, social bonding and circadian regulation of the sleep-wake cycle. Whether the AVP system is involved in regulation of stress response and sleep quality in the context of the perinatal mental health is currently unknown. The objective of the present study was to assess the relationship between levels of cumulative and ongoing psychosocial risk, levels of disordered sleep and AVP methylation in a community sample of pregnant and postpartum women.

METHODS

A sample of 316 participants completed a battery of questionnaires during the second trimester of pregnancy (PN2, 12-14 weeks gestation), third trimester (PN3, 32-34 weeks gestation), and at 7-9 weeks postpartum (PP). Disordered sleep was measured using the Sleep Symptom Checklist at PN2, PN3 and PP; cumulative psychosocial risk was assessed with the Antenatal Risk Questionnaire (ANRQ) at PN2; salivary DNA was collected at the follow-up (FU, 2.9 years postpartum); and % methylation were calculated for AVP and for two of the three AVP receptor genes (AVPR1a and AVPR1b). Women were separated into high (HighPR) and low (LowPR) psychosocial risk groups, based on their scores on the ANRQ.

RESULTS

Women in the HighPR group had significantly worse sleep disturbances during PN2 (p < .001) and PN3 (p < .001), but not at PP (p = .146) than women in the LowPR group. In HighPR participants only, methylation of AVP at intron 1 negatively correlated with sleep disturbances at PN2 (r_s=-.390, p = .001), PN3 (r_s=-.384, p = .002) and at PP (r_s= -.269, p = .032). There was no association between sleep disturbances and AVPR1a or AVPR1b methylation, or between sleep disturbances and any of the AVP methylation for the LowPR group. Lastly, cumulative psychosocial stress was a moderator for the relationship between AVP intron 1 methylation and disordered sleep at PN2 (p < .001, adjusted R² = .105), PN2 (p < .001, adjusted R² = .088) and PP (p = .003, adjusted R² = .064).

CONCLUSIONS

Our results suggest that cumulative psychosocial stress exacerbates sleep disorders in pregnant women, and that salivary DNA methylation patterns of the AVP gene may be seen as a marker of biological predisposition to stress and sleep reactivity during the perinatal period. Further research is needed to establish causal links between AVP methylation, sleep and stress.

Image reconstruction in cardiovascular CT: Part 2 - Iterative reconstruction; potential and pitfalls

The use of IR in CT previously has been prohibitively complicated and time consuming, however improvements in computer processing power now make it possible on almost all CT scanners. Due to its potential to allow scanning at lower doses, IR has received a lot of attention in the medical literature and has become a successful commercial product. Its use in cardiovascular CT has been driven in part due to concerns about radiation dose and image quality. This manuscript discusses the various vendor permutations of iterative reconstruction (IR) in detail and critically appraises the current clinical research available on the various IR techniques used in cardiovascular CT.

Abstract P3-07-06: Evidence for tumor heterogeneity and clonal evolution during invasive progression in breast cancer

Purpose: Intratumoral heterogeneity is well recognized to be an important driver of treatment resistance and metastasis. We undertook this N of three study to measure the degree of heterogeneity in three large preinvasive lesions, all with invasive components to determine the relationship between tumor heterogeneity, spatial distribution, clonal evolution, and invasive progression.

Methods: We identified patients A, B, C with extensive DCIS measuring 7.5 cm, 6 cm, and 7 cm associated with 0.3 cm, 3.8cm, and 3.4 cm of an invasive component and 0, 7 and 1 positive lymph node, respectively. We sequenced the tumor sample for Case A from 32 unique blocks with precise geospatial localization; invasive cancer was identified in 3 of 32 blocks. Case B had 26 blocks sequenced with invasive cancer in 13 of 26 blocks. Case C had 23 blocks sequenced with invasive in 11 of 23 blocks. For germline reference, we sequenced DNA from an uninvolved tissue from each case. NGS libraries were made from FFPE derived DNA (20-40ng) for full exome sequencing. Variant calling was performed by GATK HaplotypeCaller, Platypus and Mutect. Identified somatic mutations were annotated with Oncotator and pathway enrichment analysis was performed with Bioconductor. To investigate the clonal evolution and progression history, phylogenetic trees were constructed in R and sub-clonal analysis was performed with Treeomics.

Results: The sequence data was analyzed with Platypus, MuTect and GATK HaplotypeCaller. The somatic mutation sites were concatenated into one sequence for each sample. Both neighbor-joining trees and maximum parsimony trees were built for each case. Phylogenetic analysis and sub-clonal analysis support the multi-clonal invasion model of invasive cells, in which invasive cancer can evolve from multiple clades, either early or late in the evolutionary history, independently. Dense sampling allowed reconstruction of the temporal order of mutations that accumulated in the cell lineage of the invasive cancers. Furthermore, phylogeny and sub-clone spatial analysis revealed that distant regions may be closely genetically related and showed a weak spatial sub-clone clustering pattern, which is consistent with the predictions of Big Bang model. For driver genes, we find that except for SETD2 in Case B, the majority of driver gene mutations are sub-clonal. Somatic mutations on ATP-binding cassette (ABC) transporter pathway was found in all cases.

Conclusions: Extensive sampling and sequencing of tumors yields important insights about tumor heterogeneity and tumor progression of DCIS to invasive cancer. Variable invasive propensity was identified, with foci of invasion were geospatially associated with preinvasive regions of progressively higher mutational load.

Citation Format: Ding Y, Marks J, King L, Hardman T, Hall A, Mallo D, Rodrigo A, Maley C, Hwang S. Evidence for tumor heterogeneity and clonal evolution during invasive progression in breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-07-06.

The relationship between sense of coherence and post-traumatic stress: a meta-analysis

Background: Antonovsky's concept of sense of coherence (SOC) - as a global orientation reflecting an individual's feeling of confidence in both the predictability of their internal and external environment and their ability to cope with stressful and challenging situations in life - shows a negative association with symptoms of post-traumatic stress. However, single studies varying in study characteristics provide heterogeneous effect size estimations. Objective: The purpose of the current study is to investigate the relationship between SOC and post-traumatic stress disorder (PTSD) symptom severity for the first time on a meta-analytical level. Method: The random-effects meta-analysis is based on zero-order correlations (r) and consists of 47 independent samples out of 45 studies (N = 10,883). Results: After correcting for sampling error, the mean correlation between SOC and PTSD symptoms was M(r) = -.41 (excluding four outliers: -.39). However, this effect could not be generalized to all types of PTSD samples owing to substantial remaining heterogeneity. Subsequent moderator analyses investigating the influence of different SOC and PTSD measures, trauma type and duration, mean age and gender imbalances per sample did not reveal significant moderating effects. Conclusions: The meta-analysis reveals a substantial correlation between SOC and PTSD symptom severity: higher SOC levels are associated with lower symptom severity. Thus, future research should progress to the question of whether the relationship between SOC and post-traumatic stress is causal, and by which factors it is moderated. Abbreviations: CD, Cook's distance; DSM, Diagnostic and Statistical Manual of Mental Disorders; (G)RR, general (and specific) resistance resources; IES(-R), Impact of Event Scale (Revised); PDS, Posttraumatic Stress Diagnostic Scale; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; PTSD, post-traumatic stress disorder; SDR, standard deleted residual; SOC, sense of coherence; SOC-R, Sense of Coherence Scale - Revised.

Time to look past TNF and thalidomide for cachexia - could mast cells and flavonoids be the answer?

Cachexia is a wasting condition associated with late stages of many chronic illnesses and may be present in up to 80% of patients with advanced cancers. Cachexia is a metabolic derangement resulting in a disturbance to the homeostasis of muscle breakdown and synthesis, favoring catabolism and muscle loss. Despite making strides in treating cancer itself, there have been no major advances in the treatment of cachexia pharmacologically or nutritionally. Clinical trials using anti-TNF biologics and thalidomide have largely failed. A new approach may be to focus on other possible waste-inducing mediators, possibly derived from mast cells, and the beneficial action of select natural flavonoids.

Improving disease knowledge in 6- to 10-year-olds with sickle cell disease: A quasi-experimental study

BACKGROUND

Increasing knowledge and understanding of disease is known to improve outcomes in persons living with a chronic illness. In this paper, we aim to compare the disease knowledge of children with sickle cell disease (SCD), age 6-10 years, who received an intervention (an educational colouring book on SCD) geared towards improving disease knowledge, to those who did not received the colouring book.

METHODS

A quasi-experimental study was conducted where disease knowledge was determined in 56 children who had received the colouring book and compared to 60 children who did not receive this intervention.

RESULTS

The mean knowledge score was significantly higher in the intervention group (mean difference = 2.65; 95% CI [1.43, 3.86]), as well as in older children and in those in higher grades but there was no difference between sexes. In a multiple regression model (adjusted R² : 0.39; p value < .001), knowledge score was significantly higher in those who received the intervention (β: 2.62; 95% CI [1.48, 3.76]) while adjusting for age, gender, persons living at home, and the father's employment status.

CONCLUSION

The study highlights that a simple, inexpensive (cost: US$1/book) child-friendly intervention can significantly improve knowledge about SCD even in young children. It also underlines various social factors that are associated with children's understanding of their disease.

Abstract P2-05-05: Not presented

This abstract was not presented at the symposium.

Determination of photon emission probability for the main gamma ray and half-life measurements of 64Cu

The National Institute of Standards and Technology (NIST) performed new standardization measurements for 64Cu. As part of this work the photon emission probability for the main gamma-ray line and the half-life were determined using several high-purity germanium (HPGe) detectors. Half-life determinations were also carried out with a NaI(Tl) well counter and two pressurized ionization chambers.

Insomnia, psychiatric disorders and suicidal ideation in a National Representative Sample of active Canadian Forces members

BACKGROUND

Past research on the association between insomnia and suicidal ideation (SI) has produced mixed findings. The current study explored the relationship between insomnia, SI, and past-year mental health status among a large Canadian Forces (CF) sample.

METHOD

Data was obtained from the 2013 Canadian Forces Mental Health Survey (CFMHS), and included a large representative sample of Canadian Regular Forces personnel (N = 6700). A series of univariate logistic regressions were conducted to test individual associations between past-year mental health status, insomnia, and potential confounds and SI. Mental health status included three groups: 0, 1, or two or more probable diagnoses of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), generalized anxiety disorder (GAD), panic disorder (PD) and alcohol abuse/dependence. Stepwise multivariate logistic regression was used to assess the relationship between insomnia and SI with mental health status as a moderator.

RESULTS

40.8% of respondents reported experiencing insomnia. Both insomnia and number of mental health conditions incrementally increased the risk of SI. However, past-year mental health status was a significant moderator of this relationship, such that for CF personnel with either no (AOR = 1.61, 1.37-1.89) or only one past-year mental health condition (AOR = 1.39, 1.12-1.73), an incremental increase in insomnia was associated with an increased likelihood of SI. However, in personnel with two or more past-year mental health disorders, insomnia was no longer significantly associated with SI (AOR = 1.04, 0.81-1.33).

CONCLUSIONS

Insomnia significantly increased the odds of SI, but only among individuals with no or one mental health condition. Findings highlight the importance of assessing insomnia among CF members in order to further suicide prevention efforts.

Abstract P1-05-30: Genomic and microenvironmental intra-tumor heterogeneity in DCIS

Intra-tumor heterogeneity drives neoplastic progression by supplying the fuel for natural selection among neoplastic cells. It also complicates screening and treatment of neoplasms. We hypothesize that the degree of intra-tumor heterogeneity in DCIS should predict which tumors are likely to become invasive and metastatic. We initiated a pilot project to test this hypothesis by comparing 9 cases of pure DCIS to 9 cases of DCIS with adjacent invasive disease. For each case, we sequenced the exome from two spatially distinct regions of DCIS as well as normal tissue taken from a lymph node with no tumor involvement. This required the development of new methods to extract high quality sequencing data from small amounts of DNA extracted from FFPE samples. We calculated the genetic divergence between the two tumor regions, defined as percent of the sequenced regions of the genome showing differences between the two samples that had sufficient sequencing coverage and quality scores for confident scoring. We also employed automated imaging analysis to score microenvironmental differences between the two tumor regions. These microenvironmental measures are based on ecological methods for measuring organismal interactions and habitats. We will present initial data on differences in phenotypic and genotypic intra-tumor heterogeneity comparing pure DCIS to DCIS associated with invasive breast cancer. Our methods can be readily translated to large tissue banks of FFPE samples from DCIS.

Citation Format: Fortunato A, King L, Mallo D, Kovacheva V, Yuan Y, Boddy A, Graham T, Aktipis A, Mardis ER, Hall A, Marks JR, Hwang S, Maley CC. Genomic and microenvironmental intra-tumor heterogeneity in DCIS [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-05-30.

Diverse veterans' pre- and post-intervention perceptions of home telemental health for posttraumatic stress disorder delivered via tablet

Objectives Home telemental health services have the potential to overcome many individual and systemic barriers to care facing military veterans with posttraumatic stress disorder. However, little is known about the home telemental health-related attitudes and experiences of highly underserved rural or ethnically, racially diverse veterans. This study evaluated whether ethnically/racially diverse U.S. veterans residing in the rural Pacific Islands would find the delivery of evidence-based treatment for posttraumatic stress disorder via home telemental health tablet devices useful and helpful. Method Clinicians located in a central urban location delivered Cognitive Processing Therapy for posttraumatic stress disorder directly into patients' homes via a tablet device and secure WiFi connection. Pre- and post-treatment measures were collected from a clinical sample of 47 veterans (average age: 49.3 years). Most (74.4%) self-identified as being of ethnic/racial minority background. Attitudinal, satisfaction, and usability scales were collected from home telemental health engaging ( n = 29) and non-engaging ( n = 18) veterans. Results Ratings on measures of home telemental health comfort, satisfaction with care, and usability were uniformly positive. Veterans were equally open to receiving mental health services at home via home telemental health or in the clinic. In the case of services for a physical problem, however, veterans preferred in-clinic care. Following treatment, veterans' attitudinal scores increased on items such as "There is enough therapist contact in home telemental health interventions." However, a small portion of veterans (7%) reported having technical or privacy concerns. Conclusion The provision of evidence-based posttraumatic stress disorder treatment directly into the patients' homes proved feasible and was well received by the large majority of rural ethnically/racially diverse veterans.