To assess the performance of an artificial intelligence (AI) algorithm in the Australian mammography screening program which routinely uses two independent readers with arbitration of discordant results. A total of 7533 prevalent round mammograms from 2017 were available for analysis. The AI program classified mammograms into deciles on the basis of breast cancer (BC) risk. BC diagnoses, including invasive BC (IBC) and ductal carcinoma in situ (DCIS), included those from the prevalent round, interval cancers, and cancers identified in the subsequent screening round two years later. Performance was assessed by sensitivity, specificity, positive and negative predictive values, and the proportion of women recalled by the radiologists and identified as higher risk by AI. Radiologists identified 54 women with IBC and 13 with DCIS with a recall rate of 9.7%. In contrast, 51 of 54 of the IBCs and 12/13 cases of DCIS were within the higher AI score group (score 10), a recall equivalent of 10.6% (a difference of 0.9% (CI -0.03 to 1.89%, p= 0.06). When IBCs were identified in the 2017 round, interval cancers classified as false negatives or with minimal signs in 2017, and cancers from the 2019 round were combined, the radiologists identified 54/67 and 59/67 were in the highest risk AI category (sensitivity 80.6% and 88.06 % respectively, a difference that was not different statistically). As the performance of AI was comparable to that of expert radiologists, future AI roles in screening could include replacing one reader and supporting arbitration, reducing workload and false positive results. AI analysis of consecutive prevalent screening mammograms from the Australian BreastScreen program demonstrated the algorithm's ability to match the cancer detection of experienced radiologists, additionally identifying five interval cancers (false negatives), and the majority of the false positive recalls. • The AI program was almost as sensitive as the radiologists in terms of identifying prevalent lesions (51/54 for invasive breast cancer, 63/67 when including ductal carcinoma in situ). • If selected interval cancers and cancers identified in the subsequent screening round were included, the AI program identified more cancers than the radiologists (59/67 compared with 54/67, sensitivity 88.06 % and 80.6% respectively p = 0.24). • The high negative predictive value of a score of 1-9 would indicate a role for AI as a triage tool to reduce the recall rate (specifically false positives).

Abstract Introduction Poor sleep and circadian misalignment are associated with poorer performance. In elite Australian Rules football (ARF), both sex and professionalism could alter or exacerbate these associations. This study provides preliminary insights on how the relationships of sleep and circadian alignment with cognitive performance differ between male full-professional and female semi-professional elite ARF athletes. Methods Participants were 72 elite ARF athletes (42% female; M-age = 24.1±4.4 years). During pre-season, participants completed two weeks of sleep/wake monitoring via actigraphy, and a circadian phase assessment (dim light melatonin onset; DLMO) after one week. Cognitive performance testing (psychomotor vigilance task, PVT; and the balloon analogue risk task; BART) was conducted five times throughout this period. Results Preliminary findings suggest average total sleep time and sleep efficiency, sleep regularity, DLMO, and phase angle (interval between average sleep onset and DLMO) did not predict reaction time on the PVT, nor did sex moderate these relationships. After controlling for sex, longer sleepers demonstrated greater risk taking on the BART. Only among male athletes did larger angles predict greater risk taking. Discussion Elite ARF athletes, regardless of sex, sleep, or circadian alignment, have similar reaction times. Risk taking is greater among longer sleepers and in male athletes experiencing relatively delayed circadian phases. Where risk-taking has negative implications (e.g., injury and sporting errors), these findings identify at-risk groups. Few sex-specific findings may suggest that the semi-professional status of female ARF (and associated lifestyle factors such as scheduling and income) is not altering elite performance in controlled settings.

PurposeTo assess the feasibility and clinical outcomes of telehealth-delivered pelvic floor muscle training (PFMT) for urinary incontinence (UI) and/or faecal incontinence (FI) after gynaecological cancer surgery.MethodsIn this pre-post cohort clinical trial, patients with incontinence after gynaecological cancer surgery underwent a 12-week physiotherapist-supervised telehealth-delivered PFMT program. The intervention involved seven videoconference sessions with real-time feedback from an intra-vaginal biofeedback device and a daily home PFMT program. Feasibility outcomes included recruitment, retention, engagement and adherence rates. Clinical outcomes were assessed at baseline, immediately post-intervention and a 3-month post-intervention using International Consultation on Incontinence questionnaires for UI (ICIQ-UI-SF) and Bowel function (ICIQ-B) and the intra-vaginal biofeedback device. Means and 95%CIs for all time points were analysed using bootstrapping methods.ResultsOf the 63 eligible patients, 39 (62%) consented to the study. Three participants did not complete baseline assessment and were not enrolled in the trial. Of the 36 participants who were enrolled, 32 (89%) received the intervention. Retention was 89% (n=32/36). The majority of participants (n=30, 94%) demonstrated high engagement, attending at least six videoconference sessions. Adherence to the daily PFMT program was moderate, with 24 participants (75%) completing five-to-seven PFMT sessions per week during the intervention. All clinical outcomes improved immediately post-intervention; however, the magnitude of these improvements was small.ConclusionTelehealth-delivered PFMT may be feasible to treat incontinence after gynaecological cancer surgery.Trial registrationClinicalTrials.gov Identifier: ACTRN12621000880842)

Purpose of ReviewTo consider ethical aspects of rhinologic surgery including surgical and medical treatment options, new technologies and techniques, informed consent and patient choice.Recent FindingsThe ethical principles of autonomy, justice, beneficence, non-maleficence and fidelity are fundamental to the practice of medicine as well as to the clinical research that informs new treatment options. Here, they are discussed in the context of treatment of benign rhinologic disease.SummarySurgeons are ethically bound to act in the best interests of the patient, informing and involving them in the clinical decisions and avoiding harm. This requires full and honest discussion with patients about the available treatment options, their potential benefits and risks and cost-effectiveness of newer techniques and technologies.

A 7-year-old male castrated Ragdoll cat was presented for chronic shoulder instability after a previous medial luxation of the right shoulder. Upon examination, there was palpable instability of the glenohumeral joint and an increased abduction angle. Surgical stabilisation was elected due to lameness and instability after closed reduction, rest and medical management. A low-profile bone-anchor and a ligament prosthesis were used to stabilise the glenohumeral joint with minimal disruption to the cat's natural shoulder stabilisers. Clinical signs resolved after surgery and the cat remained non-symptomatic at the 12-month follow-up. Feline shoulder luxation is rarely described in the veterinary literature. To the authors' knowledge, this is the first report describing stabilisation of the glenohumeral joint in a cat using a bone anchor and a ligament prosthesis.

Interprofessional learning (IPL), where nursing students learn how to work with multiple health professionals in their future practice to deliver the highest quality of care, has become an essential feature of undergraduate nursing programs. Intraprofessional learning (IaPL) is where individuals of two or more disciplines within the same profession collaborate; however, there is a dearth of literature investigating its effects in nursing education. The aim of this study is to investigate the impact of IaPL on the development of nursing students' knowledge, skills, and attitudes for collaborative practice. The study will utilize a mixed methods approach with surveys conducted at six time points across two years of two nursing programs and focus groups at the end of the program. Participants will be recruited from the Diploma and Bachelor of Nursing programs at an Australian Training and Further Education institute. Four specific IaPL educational experiences incorporating simulation will be developed on aged care, mental health, complex care and acute care. The study will provide nursing students with multiple opportunities to develop the necessary capabilities for collaborative practice. It will longitudinally evaluate nursing students' attitudes towards IaPL and examine whether IaPL motivates Diploma of Nursing students to pathway into a Bachelor of Nursing degree. The study will also investigate awareness amongst nursing students of the scope of practice, roles and responsibilities of the nursing team.

Congenital luxation of the ulnar and radius is a rare orthopaedic condition in the dog. This case report describes a novel surgical treatment for congenital elbow luxation in a medium-breed dog. A 6-week-old Kelpie presented for left forelimb lameness and deformity. Radiographs and computed tomography (CT) confirmed the diagnosis of unilateral ulnar and radius luxation. The surgical repair involved open reduction followed by fixation with an extraarticular pin and a transarticular external fixator. The outcome of surgery was improved leg function and weight-bearing, however, reluxation of the radial head was diagnosed 7 weeks following surgery. This technique may offer an alternative surgical option to improve clinical signs, as well as insight into improving the management of this condition.

Pedicled transverse rectus abdominis myocutaneous (TRAM) flaps are well-established autologous reconstructive options for breast reconstruction. Preoperative computed tomographic angiography (CTA) has since become part of the routine workup in breast reconstruction with deep inferior epigastric artery perforator (DIEP) flaps. CTA provides an improved understanding of perforator anatomy which can facilitate optimal choice of hemiabdominal wall, and guide sheath harvest. Despite this knowledge, the role of preoperative CTA for breast reconstruction with the pedicled TRAM flap has not yet been established. A consecutive cohort of patients undergoing breast reconstruction with pedicled TRAM flaps without preoperative imaging were compared to a similar cohort of consecutive patients undergoing the same procedure with the use of preoperative CTA. Both flap and donor outcomes were assessed. Thirty-four consecutive patients undergoing ipsilateral breast reconstruction with pedicled TRAM flaps were included. There was no statistical difference in the operative times or outcomes between the two groups. There were no complete flap losses in either group. The use of preoperative CTA may help to guide surgical technique and provide the surgeon with greater confidence intraoperatively, however, this study did not show significant change in operative outcomes. Further study and risk/benefit analysis may better highlight the role of CTA in pedicled TRAM flap planning.

Abstract Introduction Iron oxide nanoparticles have been used in preclinical and clinical research as imaging agents for decades because of their magnetic properties and their known safety profile. We have been developing the MagSense® HER2 Test Reagent (MSH2TR), a formulation of anti-human epidermal growth factor receptor 2 (HER2) conjugated iron oxide nanoparticles, for the noninvasive detection of metastatic lymph nodes to aid in staging of HER2 positive (HER2+) breast cancer patients. Currently, nodal staging requires a patient’s lymph nodes to be surgically removed or biopsied for histopathological examination. MSH2TR is currently being investigated in a first-in-human phase I study in subjects with HER2+ primary breast cancer who, in the judgment of the investigator, have a likelihood of lymph node metastasis. Methods This phase I study is designed to be a preliminary proof-of-principle study with the primary objective of achieving an initial assessment of the safety and tolerability of the MSH2TR injectable imaging agent. A secondary objective of the study is the confirmation that the route of administration is effective in allowing the imaging agent to reach the patient’s lymph nodes. The exploratory objectives of the study include a comparison of the two imaging modalities: magnetic resonance imaging (MRI) and a novel proprietary technology called magnetic relaxometry (MRX), to standard clinical tissue histopathology. The exploratory objectives are expected to provide a preliminary assessment as to whether the MagSense® HER2 imaging agent, when used with one or both imaging modalities, might be able to provide a non-invasive alternative to nodal biopsy. All eligible subjects receive a 30mg injection of MSH2TR into the subareolar interstitial tissue or area near and around the primary tumor. MRI of the axilla are performed before and 24 to 72 hours after MSH2TR injection followed by core biopsy or dissection of the suspected lymph node tissue as per standard of care (SOC) procedures for histopathology assessments and also for ex vivo MRX measurements using the MagSense® Relaxometry Instrument. Review of the MRI scans and histopathology are performed in respective central laboratories. The study is currently enrolling in 4 clinical sites in Australia. Results From an interim evaluation of the first five patients that have completed the study, MSH2TR appears to be safe and well tolerated and no safety issues reported related to the imaging agent. The imaging agent, as administered, is reaching the lymph nodes. The study intends to enroll approximately 15 patients for the preliminary efficacy assessment. Safety and efficacy results from available patients’ data will be presented. Conclusion Available data to date from the ongoing phase I study show that the MagSense® HER2 imaging agent, as administered, appear to be safe and drains to the axillary lymph nodes within the timeframe of interest. Further data collection is ongoing for the preliminary evaluation of efficacy. Citation Format: Yalia Jayalakshmi, Jane Fox, Natalie Yang, Marie Zhang, Robert Proulx, Steven Reich. Noninvasive Detection of Lymph Node Involvement in Subjects with Human Epidermal Growth Factor Receptor 2 Positive (HER2+) Breast Cancer using the MagSense® HER2 Test Reagent – A First-In-Human Phase 1 Study [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-09-02.

Granulomatous and vasculitic diseases of the airway may be part of more widespread systemic disease but can occur in isolation. They may present to the ear, nose, and throat (ENT) surgeon initially with vague symptoms that mimic more common chronic inflammatory unified airway conditions, such as rhinitis, chronic rhinosinusitis, and asthma. Early diagnosis is associated with better long-term outcomes, so a high index of suspicion is required. Bloody nasal discharge and crusting are highly suspicious for granulomatous disease, which should also be considered in atypical or recalcitrant disease. A combination of clinical findings, serologic tests, imaging, and histology may be required to confirm the diagnosis..