Annual Testing Research Articles

Managing the transition in cervical screening methods for Taiwan: Policy recommendations and perspectives

Since government-provided annual cervical cytology testing for all Taiwanese women aged 30 years or older became available in 1995, both cervical cancer incidence and death have decreased significantly. However, with the 2018 introduction of the national immunization program for human papillomavirus (HPV) vaccination in all schoolgirls aged 13-15 years old, the positive predictive value of cytology testing is expected to decrease with rising vaccination rates, and therefore a transition to more sensitive HPV-based testing may be needed. This position paper, derived from discussions by a panel of experts in cervical cancer screening, provides short-, medium-, and long-term policy recommendations to manage the transition between cervical screening methods for Taiwan. The recommendations include concrete suggestions regarding testing procedures, standards, accreditation, monitoring, promotion, and implementation. It is hoped that comprehensive preparation and management of this transition will enable Taiwan to repeat the previous successes of the cervical cytology testing program.

Baseline Features and Reasons for Nonparticipation in the Colonoscopy Versus Fecal Immunochemical Test in Reducing Mortality From Colorectal Cancer (CONFIRM) Study, a Colorectal Cancer Screening Trial

The Colonoscopy Versus Fecal Immunochemical Test in Reducing Mortality From Colorectal Cancer (CONFIRM) randomized clinical trial sought to recruit 50 000 adults into a study comparing colorectal cancer (CRC) mortality outcomes after randomization to either an annual fecal immunochemical test (FIT) or colonoscopy. To (1) describe study participant characteristics and (2) examine who declined participation because of a preference for colonoscopy or stool testing (ie, fecal occult blood test [FOBT]/FIT) and assess that preference's association with geographic and temporal factors. This cross-sectional study within CONFIRM, which completed enrollment through 46 Department of Veterans Affairs medical centers between May 22, 2012, and December 1, 2017, with follow-up planned through 2028, comprised veterans aged 50 to 75 years with an average CRC risk and due for screening. Data were analyzed between March 7 and December 5, 2022. Case report forms were used to capture enrolled participant data and reasons for declining participation among otherwise eligible individuals. Descriptive statistics were used to characterize the cohort overall and by intervention. Among individuals declining participation, logistic regression was used to compare preference for FOBT/FIT or colonoscopy by recruitment region and year. A total of 50 126 participants were recruited (mean [SD] age, 59.1 [6.9] years; 46 618 [93.0%] male and 3508 [7.0%] female). The cohort was racially and ethnically diverse, with 748 (1.5%) identifying as Asian, 12 021 (24.0%) as Black, 415 (0.8%) as Native American or Alaska Native, 34 629 (69.1%) as White, and 1877 (3.7%) as other race, including multiracial; and 5734 (11.4%) as having Hispanic ethnicity. Of the 11 109 eligible individuals who declined participation (18.0%), 4824 (43.4%) declined due to a stated preference for a specific screening test, with FOBT/FIT being the most preferred method (2820 [58.5%]) vs colonoscopy (1958 [40.6%]; P < .001) or other screening tests (46 [1.0%] P < .001). Preference for FOBT/FIT was strongest in the West (963 of 1472 [65.4%]) and modest elsewhere, ranging from 199 of 371 (53.6%) in the Northeast to 884 of 1543 (57.3%) in the Midwest (P = .001). Adjusting for region, the preference for FOBT/FIT increased by 19% per recruitment year (odds ratio, 1.19; 95% CI, 1.14-1.25). In this cross-sectional analysis of veterans choosing nonenrollment in the CONFIRM study, those who declined participation more often preferred FOBT or FIT over colonoscopy. This preference increased over time and was strongest in the western US and may provide insight into trends in CRC screening preferences.

Comparative Assessment of the Performances of GPS‐TEC Assisted NTCM, NeQuick2 and Neural Network Models to Describe the East‐African Equatorial Ionosphere

AbstractDifferent ionospheric climatological models such as NeQuick2 and NTCM have been developed to mitigate the ionosphere impact on the trans‐ionosphere propagating radio wave. Moreover, the Neural Network (NN) is used to model and characterize the ionosphere. However, no one has compared the performances of NeQuick2, NTCM, and NN after adapting to GPS TEC. This study evaluates their performances in the East‐African region in 2013 and 2015. It has been done by computing their drivers (effective ionization level, Az for NeQuick2 and ionization driving index, Id for NTCM) through least‐square fitting to TEC observation sense. NN‐algorithm has also been trained and tested with observed TEC used for NeQuick2 and NTCM adaptation. The annual performance test has shown that the correlation coefficient (R) values between observed and NTCM modeled TEC, after an adaption, are better than the corresponding values obtained from NeQuick2 and NN. It also shows that the standard deviations (STD) and root‐mean‐square errors (RMSE) obtained for NTCM are smaller than the STD and RMSE computed for NeQuick2 and NN. On the other hand, the daily performance test of now‐casting and predicting showed that the NN performs the best, followed by NTCM. However, the 1‐hr prediction test showed that NTCM performs the best among the models considered in this study.

342-OR: The Impact of Insulin Secretion and Insulin Sensitivity on Cognition in Adults with Prediabetes—The Diabetes Prevention Program Outcomes Study (DPPOS)

Dysglycemia is a significant risk factor for cognitive impairment. However, which pathophysiologic determinant of dysglycemia, impaired insulin sensitivity (ISens) or insulin secretion (ISecr), or both, contributes to poorer cognitive function is not established. Among 1,054 adults with prediabetes (PreD) from the DPPOS, who did not develop diabetes, we investigated the relationship between ISecr, ISens and cognitive function, hypothesizing that lower ISens and/or lower ISecr is associated with worse cognition. Early ISecr was estimated by the mean insulinogenic index (IGI; pmol/mmol) from repeated annual oral glucose tolerance tests and ISens was estimated by the mean 1/fasting insulin from repeated fasting blood draws. ISecr and ISens were calculated over approximately 12 years of follow-up. Verbal learning (Spanish-English Verbal Learning Test [SEVLT]) and processing speed (Digital Symbol Substitution Test [DSST]) were assessed at the end of the follow-up period. Separate linear regression models were run for each cognitive outcome. Models included both mean ISecr and mean ISens as the main predictor variables and were adjusted for demographic, lifestyle, cardiovascular factors, and medications. Contrary to our hypothesis and to prior studies, higher mean ISecr was associated with poorer performance on the DSST (-0.74 points per SD increase in IGI, 95% CI: -1.43, -0.05; p=0.03). Mean ISens was not associated with DSST, nor were mean ISecr or mean ISens associated with SEVLT. These results suggest that higher insulin secretion in people with longstanding PreD may negatively impact processing speed, a critical component of executive control. This relationship could reflect a compensatory response of insulin in people with worsening metabolic dysregulation, who may also have poorer cognition. Further study is needed to replicate these findings and to understand the role of insulin in cognitive function. Disclosure A. Shapiro: None. A.H. Tjaden: None. S. Edelstein: None. S.E. Kahn: Advisory Panel; Anji Pharmaceuticals, Bayer Inc., Boehringer Ingelheim Inc., Eli Lilly and Company, Merck &amp; Co., Inc. Other Relationship; Novo Nordisk. P. Srikanthan: None. W.C. Knowler: None. E.M. Venditti: None. S. Golden: Advisory Panel; Abbott Diabetes, Medtronic. O. Carmichael: Research Support; Eli Lilly and Company. Advisory Panel; Novo Nordisk. Research Support; Nestlé Health Science. K.M. Gadde: Research Support; BioKier, Inc., National Institute of Diabetes and Digestive and Kidney Diseases. J.A. Luchsinger: Consultant; Merck KGaA. Other Relationship; Wolters Kluwer Health. D. Research Group: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (UDK048489, UDK048339, UDK048377, UDK048349, UDK048381, UDK048468, UDK048434, UDK048485, UDK048375, UDK048514, UDK048437, UDK048413, UDK048411, UDK048406, UDK048380, UDK048397, UDK048412, UDK048404, UDK048387, UDK048407, UDK048443, UDK048400)

The impact of a formal teacher leadership program on student performance

Formal teacher leader programs that develop, position, and reward teachers to work with peers to improve instruction are a growing reform effort in the United States, yet there are few published studies of their efficacy. In this paper, we examine the impacts of one district’s teacher leadership program on students’ annual state test performance. The program placed full-time instructional coaches and partly released English language arts (ELA) and mathematics content specialists in each of 11 district schools. To assess the program’s impact, we examined five years of student-level state test data; two years before the adoption of the intervention and three years afterwards. Using an interrupted time series design, we examined trends in performance before and after the adoption of the intervention. Overall, there were no significant effects in ELA, and a small negative effect in mathematics. By contrast, in the stable sub-sample of students who were in the district for the five years examined in the study, there was a large significant positive effect in mathematics and large but non-significant positive effect in ELA. We conclude with a discussion the implications of these findings for research and policy.

Trends in gynecologic oncology before and during COVID - 19 pandemic in Tuzla Canton

Aim: The aim of this study was to assess the impact of the COVID-19 pandemic and its management on the rate of newly diagnosed cancers from the perspective of a tertiary referral center in Tuzla Canton.Methods: All patients diagnosed with gynecological cancer at Department of Gynecology and Obstetrics, University Clinical Center Tuzla, in prepandemic, pandemic and postpandemic period, were presented in this study. Gynecological cancer was defined as one of the following diagnoses: ovarian or tubal carcinoma, cervical carcinoma, endometrial carcinoma, uterine sarcoma, vulvar carcinoma, vaginal carcinoma, and germ cell tumors.A total of 579 patients with newly diagnosed cancers were collected in 2020. There were 109 newly diagnosed gynecological cancers in 2020., while in 2019 there were 134, and 136 in 2021. Numbers of gynecological cancers diagnosed during pandemic were compared to numbers in prepandemic and postpandemic period. Results: There was a total of 579 patients with newly diagnosed cancer in Clinical Center of Tuzla during 2020. That showes strong decline of newly diagnosed cancers compared to 2019 with 1030 newly diagnosed cancers. Of these 579 patients, 109 presented in 2020 with newly diagnosed gynecological cancers. That shows strong decrease compared to 2019. with 134 newly diagnosed gynecological cancers and 2021 with 136 gynecological cancers. In 2019. 4015 PAP tests were examined, with only 1917 PAP tests examined in 2020 (diagram 4). In 2019. we did 199 HPV typisation test, while in 2020. there were only 34.Conclusion: The lockdown coused by COVID - 19 pandemic led to decreased number of routine examinations including annual PAP smear testing and HPV typisation tests. It also led to decrease number of other checkups. All of that led to decreased number of newly diagnosed gynecological cancers.

#4126 LONG-TERM VISIT TO VISIT VARIABILITY IN HBA1C AND KIDNEY RELATED OUTCOMES IN PERSONS WITH DIABETES

Abstract Background and Aims Glycated hemoglobin (HbA1c) is central to the routine monitoring of glycemic control in persons with diabetes, and poor glycemic control is an established contributor to the occurrence and progression of CKD, but whether long-term visit-to-visit variability in glycemic control predicts kidney outcomes is not well studied. Method We included all adults with type 1 or type 2 diabetes in Stockholm, Sweden, during 2006–2019, who had at least one annual outpatient HbA1c test in three consecutive years. We evaluated associations between baseline and time-varying HbA1c variability score (HVS, the percentage of total HbA1c measures that vary by &amp;gt;0.5% [5.5 mmol/mol] during a 3-year window), with the risk of CKD progression (composite of &amp;gt;30% eGFR decline and kidney failure), acute kidney injury (AKI, by clinical diagnosis or increase in creatinine ≥0.3 mg/dL over 48 h or 1.5 times creatinine over 7 days), and worsening of albuminuria. Results We included 93,598 adults with diabetes undergoing 891,536 routine HbA1c tests (median 8 tests per person) during a median follow-up of 5.2 years. Compared with persons showing low HbA1c variability (HVS 0–20%), any increase in variability was associated with a higher risk of adverse kidney outcomes. For example, for patients with a baseline HbA1c variability of 81–100%, the adjusted HR was 1.47 (95% CI, 1.38-1.56) for CKD progression, 1.27 [1.19-1.36] for AKI, and 1.28 [1.21-1.36] for worsening of albuminuria. Results were robust across subgroups (diabetes subtypes, baseline eGFR or albuminuria categories) and in sensitivity analyses including time-weighted average HbA1c or alternative metrics of variability. Conclusion A higher long-term visit-to-visit HbA1c variability is robustly associated with the risks of CKD progression, AKI and worsening of albuminuria.

P308 Strategies for the screening of glucose tolerance abnormalities and diabetes in people with cystic fibrosis: a French position statement

The increase in life expectancy of people with cystic fibrosis (pwCF) has come with new comorbidities, particularly diabetes. Cystic fibrosis related diabetes is a major challenge in the care of (pwCF) because it is a morbidity and mortality factor at all stages of the disease. Early glucose tolerance abnormalities observed from childhood are also associated with a poor pulmonary and nutritional outcome. This justifies systematic screening with an annual oral glucose tolerance test (OGTT) from the age of 10 years.

Endoscopist volume and the quality of colonoscopy of the Korean National Cancer Screening Program.

6627 Background: The Korean government established the National Cancer Screening Program (KNCSP). The KNCSP has provided annual faecal immunochemical test (FIT) for adults aged 50 years or older, and colonoscopy or a double-contrast barium enema test to those with positive results from the FIT. High-quality screening colonoscopy is mandatory to achieve maximum possible CRC prevention. The case volume has been shown to correlate with outcomes in surgical specialties. In contrast, relevant data on colonoscopy is limited. This study aimed to assess the quality indicators of organized CRC screening according to annual colonoscopy volume using KNCSP data. Methods: We used the KNCSP data from 2018 to 2020, which accounted for 378,354 colonoscopy examinations. We used cancer registration data of an extended health insurance program using ICD-11 codes (C18-20). A total of 12,109 CRC patients were registered within 1 year of the date of colonoscopy. We calculated the annual number of colonoscopy examinations by an individual endoscopist. We excluded endoscopists who had a very low or high number of examinations with the highest 1% or lowest 1% as outliers. The final number of endoscopists was 16,552 and colonoscopy examinations were 331,231 during 2018–2020. The annual colonoscopy volume by individual endoscopists was divided into four groups (2–12, 13–24, 25–36, and 37 or more examinations). Multiple linear regression analysis was performed to confirm the association between test accuracy indicators and colonoscopy frequency using a generalized linear model (GLM). We calculated the estimates of the rates for each indicator by adjusting the year. Results: The positive and false positive rates, sensitivity, specificity, and positive predictive value were 4.09%, 1.07%, 83.53%, 98.93%, and 74.68%, respectively. The cancer detection and interval cancer rates were 30.53‰ and 6.29‰, respectively. Quality indicators were related to the annual colonoscopy volume of the endoscopist. Endoscopists with a higher annual colonoscopy volume were more likely to have higher sensitivity, specificity, and positive predictive value than those with a lower annual colonoscopy volume. Endoscopists with higher annual colonoscopy volumes were more likely to have lower positive rates, cancer detection rates, false positive rates, and interval cancers rate than those with lower annual colonoscopy volumes. Conclusions: This study found that the annual volume of colonoscopy examinations was associated with better colonoscopy quality in an organized CRC screening program. A high colonoscopy load could be a sign of substantial experience and lead to better outcomes, as has been shown for surgery. The relationship between quality indicators and case volume is logical and plausible; therefore, more research is required to determine the number of cases that need to be performed in a year to adequately maintain high colonoscopy quality.

Real world EGFR testing practices for non-small cell lung cancer by thoracic pathology laboratories across Europe.

e21064 Background: Testing for EGFR mutations is an essential recommendation in both the ESMO and ASCO guidelines for metastatic non-squamous NSCLC, and is considered mandatory in European countries. However, in practice, considerable challenges are often faced when performing routine biomarker testing, including access to testing, inadequate tissue samples, and long turnaround times (TATs). Methods: In order to evaluate the real-world EGFR testing practices of thoracic pathology laboratories across Europe, an online survey was set up and validated by The Pulmonary Pathology Working Group of the European Society of Pathology and distributed to 64 expert testing laboratories across Europe. The retrospective survey focused on the laboratory organisation and daily practice of pathologists and molecular biologists between 2018 and 2021, and covered the clinical circumstances in which EGFR testing was performed, sample types used, molecular biology techniques performed, average TATs for determining EGFR status, annual EGFR testing rates, laboratory accreditation, and external quality assessment. Results: TATs varied greatly depending on different parameters (notably relating to testing practices and methods used) both between and within countries. TATs were slightly (but non-significantly) faster for liquid biopsy samples (Mean: 7 days, IQR 4.5-12.5) when compared to tissue samples (mean 7 days, IQR 5-15) but were reported to take as long as 20 or 30 days, respectively. Discrepancies in TATs may be due in part to reflex testing practices, as 20% (11/54) of laboratories performed EGFR testing only at the request of the clinician. Many laboratories across Europe still favour targeted sequencing as a primary method of EGFR mutation identification; 32.7% indicated that they only used targeted techniques, and 45.1% indicated they used targeted sequencing followed by NGS, depending on the case. Reported testing volumes were consistent over time with no significant decrease in the number of EGFR tests performed observed in 2020, despite the increased pressure and difficulties faced by testing facilities during the COVID-19 pandemic. ISO 15189 accreditation was reported by 42% of molecular biology laboratories for targeted sequencing, and by 42.3% for NGS. 92% (49/53) of laboratories indicated they regularly participate in an EQA scheme. Conclusions: The results of the survey highlight the strong heterogeneity of EGFR testing that still occurs within thoracic pathology and molecular biology laboratories across Europe. Even among expert testing facilities there remains large variability in testing capabilities, reflex testing practice and laboratory accreditation, which stresses the urgent need to harmonize budgets and reimbursement in Europe, in addition to harmonization of the technologies and decision-making algorithms.

Abstract 49: Impact of Multimorbidity on Adherence to Follow-Up Recommendations for Long-Term Breast Cancer Survivors

Abstract Purpose: To study the impact of comorbidities, multimorbidity, second primary cancers and socioeconomic determinants on adherence to follow-up recommendations for long-term breast cancer survivors (LTBCS), defined as women who survive 5 years or more after a primary breast cancer. Methods: We identified women diagnosed with breast cancer between 2000-2006 and followed-up between 2012-2016, including those with at least one contact with health services (n=2,078). Follow-up recommendations for LTBCS in Spain include 1 annual visit plus 1 image test. A woman was considered adherent with &amp;gt;50% of years with annual image test and visit throughout follow-up period. Multivariate logistic regression models were adjusted to determine the relationship between adherence and comorbidities and multimorbidity (2 or more chronic diseases) and other clinical and sociodemographic variables. A hierarchical cluster analysis was used to define specific multimorbidity clusters. A sensitivity analysis was conducted with mammogram as specific image test. Statistical significance was considered at 5% level. Results: Adherence to recommendations was 79.5% and 63.3% when considering mammograms only. We observed a higher adherence among LTBCS with multimorbidity, in those &amp;lt;70 years old, and with 5 to 9 years of survivorship. In the multivariate models, age under 40 years (OR=4.2; 95%CI: 2.3-7.6), a survivorship time between 5-9 years (OR=1.4; 95%CI: 1.1-1.8) and the metabolic and degenerative (OR=2.2 CI95%: 1.4-3.5) and thyroid disorders clusters (OR=2 IC95% 1.1-3.6) were associated with adherence. Similar results were observed in adjusted analyses by mammogram. In both analyses all multimorbidity clusters presented more adherence than LTBCS without chronic comorbidities. LTBCS with higher deprivation were found more adherent than LTBCS less deprived. Our results suggest a higher adherence among women experiencing second primary cancers, but the results were not statistically significant (OR=1.22; 95%CI: 0.8-2.0). Conclusion: There are differences in adherence according to age, survivorship time, and presence of multimorbidity. These results suggest a moderate adherence to the current follow-up recommendations for certain groups, making it necessary to adapt clinical practice guidelines considering the comorbidities and characteristics of the patients. Citation Format: Laia Domingo, David Abbad, Mercè Comas, Paula Santiá, Anna Jansana, Xavier Castells, Maria Sala. Impact of Multimorbidity on Adherence to Follow-Up Recommendations for Long-Term Breast Cancer Survivors [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 49.

Changes in agricultural land use and its consequences on crop productivity, diversity, and food availability in an agriculturally developed state of India.

The present study, covering a period of 52years (1966-2017), explores changes in agricultural land use and its consequences on crop productivity, diversity, and food availability in Haryana, an agriculturally developed state of India. The time series data on different parameters (area, production, yield, etc.) were collected from the secondary sources and analyzed with the help of compound annual growth rate, trend tests (simple linear regression and Mann-Kendall), and change point detection tests such as Pettitt, standard normal homogeneity, Buishand range, and Neumann ratio. Apart from above, the relative share of area and yield to total change in output was determined using decomposition analysis. The results revealed that agricultural land use became intensive and underwent significant alteration with multifold shifting in area from coarse cereals (maize, jowar, and bajra) to fine food grains (wheat and rice). The yield of all crops, especially wheat and rice witnessed a significant increase which subsequently led to an upsurge in their production. However, the production of maize, jowar, and pulses recorded negative growth despite of an increase in their yield. The results also revealed manifold increase in use of modern key inputs during the first two periods (1966-1985), but afterwards input use rate slowed down. Additionally, the decomposition analysis revealed that yield effect remained positive in changing the production of all crops, but area contributed positively only in wheat, rice, cotton, and oilseeds. The major findings of this study imply that the production of crops can be enhanced only through improvement in yield because there is no further scope left for horizontal expansion in cultivable area of the state.

Associations of VGF with Neuropathologies and Cognitive Health in Older Adults.

VGF is proposed as a potential therapeutic target for Alzheimer's (AD) and other neurodegenerative conditions. The cell-type specific and, separately, peptide specific associations of VGF with pathologic and cognitive outcomes remain largely unknown. We leveraged gene expression and protein data from the human neocortex and investigated the VGF associations with common neuropathologies and late-life cognitive decline. Community-dwelling older adults were followed every year, died, and underwent brain autopsy. Cognitive decline was captured via annual cognitive testing. Common neurodegenerative and cerebrovascular conditions were assessed during neuropathologic evaluations. Bulk brain RNASeq and targeted proteomics analyses were conducted using frozen tissues from dorsolateral prefrontal cortex of 1,020 individuals. Cell-type specific gene expressions were quantified in a subsample (N = 424) following single nuclei RNASeq analysis from the same cortex. The bulk brain VGF gene expression was primarily associated with AD and Lewy bodies. The VGF gene association with cognitive decline was in part accounted for by neuropathologies. Similar associations were observed for the VGF protein. Cell-type specific analyses revealed that, while VGF was differentially expressed in most major cell types in the cortex, its association with neuropathologies and cognitive decline was restricted to the neuronal cells. Further, the peptide fragments across the VGF polypeptide resembled each other in relation to neuropathologies and cognitive decline. Multiple pathways link VGF to cognitive health in older age, including neurodegeneration. The VGF gene functions primarily in neuronal cells and its protein associations with pathologic and cognitive outcomes do not map to a specific peptide. ANN NEUROL 2023;94:232-244.

Universal HIV Testing and Treatment With Patient-Centered Care Improves ART Uptake and Viral Suppression Among Adults Reporting Hazardous Alcohol Use in Uganda and Kenya.

Determine whether patient-centered, streamlined HIV care achieves higher antiretroviral therapy (ART) uptake and viral suppression than the standard treatment model for people with HIV (PWH) reporting hazardous alcohol use. Community cluster-randomized trial. The Sustainable East Africa Research in Community Health trial (NCT01864603) compared an intervention of annual population HIV testing, universal ART, and patient-centered care with a control of baseline population testing with ART by country standard in 32 Kenyan and Ugandan communities. Adults (15 years or older) completed a baseline Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) and were classified as no/nonhazardous (AUDIT-C 0-2 women/0-3 men) or hazardous alcohol use (≥3 women/≥4 men). We compared year 3 ART uptake and viral suppression of PWH reporting hazardous use between intervention and control arms. We compared alcohol use as a predictor of year 3 ART uptake and viral suppression among PWH, by arm. Of 11,070 PWH with AUDIT-C measured, 1723 (16%) reported any alcohol use and 893 (8%) reported hazardous use. Among PWH reporting hazardous use, the intervention arm had higher ART uptake (96%) and suppression (87%) compared with control (74%, adjusted risk ratio [aRR] = 1.28, 95% CI: 1.19 to 1.38; and 72%, aRR = 1.20, 95% CI: 1.10 to 1.31, respectively). Within arm, hazardous alcohol use predicted lower ART uptake in control (aRR = 0.86, 95% CI: 0.78 to 0.96), but not intervention (aRR = 1.02, 95% CI: 1.00 to 1.04); use was not predictive of suppression in either arm. The Sustainable East Africa Research in Community Health intervention improved ART uptake and viral suppression among PWH reporting hazardous alcohol use and eliminated gaps in ART uptake between PWH with hazardous and no/nonhazardous use. Patient-centered HIV care may decrease barriers to HIV care for PWH with hazardous alcohol use.

Formulation of web accessibility policies and publication of annual test results in Japanese cities

Formulation of web accessibility policies and publication of annual test results in Japanese cities

Status of udder health performance indicators and implementation of on farm monitoring on German dairy cow farms: results from a large scale cross-sectional study.

Regional benchmarking data enables farmers to compare their animal health situation to that of other herds and identify areas with improvement potential. For the udder health status of German dairy cow farms, such data were incomplete. Therefore, the aim of this study was (1) to describe the incidence of clinical mastitis (CM), (2) to describe cell count based udder health indicators [annual mean test day average of the proportion of animals without indication of mastitis (aWIM), new infection risk during lactation (aNIR), and proportion of cows with low chance of cure (aLCC); heifer mastitis rate (HM)] and their seasonal variation, and (3) to evaluate the level of implementation of selected measures of mastitis monitoring. Herds in three German regions (North: n = 253; East: n = 252, South: n = 260) with different production conditions were visited. Data on CM incidence and measures of mastitis monitoring were collected via structured questionnaire-based interviews. Additionally, dairy herd improvement (DHI) test day data from the 365 days preceding the interview were obtained. The median (Q0.1, Q0.9) farmer reported incidence of mild CM was 14.8% (3.5, 30.8%) in North, 16.2% (1.9, 50.4%) in East, and 11.8% (0.0, 30.7%) in South. For severe CM the reported incidence was 4.0% (0.0, 12.2%), 2.0% (0.0, 10.8%), and 2.6% (0.0, 11.0%) for North, East, and South, respectively. The median aWIM was 60.7% (53.4, 68.1%), 59.0% (49.7, 65.4%), and 60.2% (51.5, 67.8%), whereas the median aNIR was 17.1% (13.6, 21.6%), 19.9% (16.2, 24.9%), and 18.3% (14.4, 22.0%) in North, East, and South, respectively with large seasonal variations. Median aLCC was ≤1.1% (≤ 0.7%, ≤ 1.8%) in all regions and HM was 28.4% (19.7, 37.2%), 35.7% (26.7, 44.2%), and 23.5% (13.1, 35.9%), in North, East and South, respectively. Participation in a DHI testing program (N: 95.7%, E: 98.8%, S: 89.2%) and premilking (N: 91.1%, E: 93.7%, S: 90.2%) were widely used. Several aspects of udder health monitoring, including exact documentation of CM cases, regular microbiological analysis of milk samples and the use of a veterinary herd health consultancy service were not applied on many farms. The results of this study can be used by dairy farmers and their advisors as benchmarks for the assessment of the udder health situation in their herds.

HIV testing and risk behaviors associated with depression in the United States

Given the high correlation between depression and HIV infection rates, our objective was to assess national rates for HIV testing and HIV risk behaviors among U.S. adults stratified by self-reports of depression. We conducted a cross-sectional study using data from the 2018–2020 Behavioral Risk Factor Surveillance System (BRFSS). We included respondents aged 18 years old and above with self-reported depression status (Sample size = 1,228,405). The primary outcomes included HIV testing and HIV-related risk behaviors. For respondents with prior HIV testing experience, we estimated the duration since the last HIV test. We applied a multivariable logistic regression model to analyze the correlation between depression and HIV testing or risk behaviors. The results showed people with depression had 51% higher odds of receiving HIV testing [adjusted odds ratio (AOR) = 1.51, 95% CI = 1.48, 1.55] and 51% higher odds of involvement in HIV risk behaviors [AOR = 1.51, 95% CI = 1.44, 1.58] after adjusting for covariates. Various socio-demographics and healthcare access variables were significantly associated with HIV testing and HIV risk behaviors. When comparing the average time from the last HIV test, people with depression had a shorter period compared to those without depression [Median time in months: 27.1 ± 0.45 vs. 29.3 ± 0.34]. Even though people with depression had higher rates of HIV testing, they still experienced long time periods (median = 2 + years) between HIV testing, which exceeded the recommended annual HIV testing for people at high risk from the Centers for Disease Control and Prevention.

Do age-based discontinuation recommendations influence cervical cancer screening rates? Evidence from the United States' Behavioral Risk Factor Surveillance System, 2016 and 2018

The United States Preventive Services Task Force (USPSTF) recommends that women with adequate prior screening and average cervical cancer risk discontinue routine cervical cancer screening after age 65. This study's objective was to estimate how the USPSTF recommendation affects Papanicolaou (Pap) test rates among women at age 66 in the United States. We used nationally representative 2016 and 2018 Behavioral Risk Factor Surveillance System data for women ages 56–76 (n = 226,031) and a regression discontinuity design to estimate changes in annual Pap test rates at age 66. Among women age 66–76, 22.5% reported receiving a Pap test within the past one year. At age 66, annual Pap rates declined by 5.9 percentage points (p.p.) (95% Confidence Interval [CI]: −7.7, −4.1) off a pre-66 rate of 39%. The change varied by race/ethnicity, education, and marital status. Pap rates did not change discretely for non-Hispanic Black women (0.8 p.p.; 95% CI: −5.4, 7.1) but did for women from other racial/ethnic groups. The decline was larger for women who graduated college (−9.0 p.p.; 95% CI: −12.0, −5.9) than for women without a college degree and for women who were never married (−9.4 p.p., 95% CI: −17.3, −1.5) than for women who were married/partnered or divorced/separated. The USPSTF recommendation to discontinue cervical cancer screening after age 65 leads to a sharp decline in Pap test rates at age 66 but disparately affects women based on race, education and marital status. Further study is needed to assess the consequences of these changes.

Data-driven state of health monitoring for maritime battery systems – a case study on sensor data from ships in operation

ABSTRACT IMO is implementing a stricter GHG strategy to reduce emissions from shipping. Battery powered ships, whether hybrid or fully electric, are a flexible solution with existing marine systems that can lower fuel consumption and emissions. However, relying on battery power for propulsion and maneuvering introduces new risks related to the available energy, which can be controlled by monitoring the SOH and SOC states. This paper conducts a detailed case study on applying Battery AI to operational data from real battery systems onboard ships, introducing state-of-the-art data-driven modelling and estimation of battery SOH, outlining the Battery AI, and providing corresponding recommendations to address issues detected during the test implementation. The performance of Battery AI is evaluated by comparing its results to annual SOH test results, with a maximum deviation underestimated by 3.21%. The paper concludes with a discussion of the results and recommendations for utilizing this method in risk assessment.

Optimal Time Intervals Between Personal Mammogram Test Decisions

Excluding skin cancer, breast cancer is the most common type of cancer in women in the United States, accounting for one in three diagnosed cases. A woman's chance of developing invasive breast cancer in her lifetime is approximately 1 in 8 (12%). While mammography has been effective in early detection, its use has resulted in a minor increase in the number of in situ cancers detected. However, mammography carries potential risks, such as exposure to unnecessary radiation, additional costs, psychological stress, and the possibility of false-positive results. Although the American Cancer Society recommends annual testing, it may be unnecessary for healthy women. In this paper, we aim to find the optimal interval between mammogram tests, balancing the benefits and risks of testing while reducing the false-positive rate and number of tests. To achieve this, we use decision trees, utility theory, and Bayes' theorem to calculate the quality-adjusted life years (QALYs) of patients.