Complete Assessment Research Articles

KNOWLEDGE, ATTITUDE, AND PRACTICES ON BIOMEDICAL WASTE MANAGEMENT AMONG MEDICAL INTERNS OF A TERTIARY CARE HOSPITAL IN NORTH KARNATAKA

Objective: Every health-care personnel is expected to have adequate knowledge, good attitude, safe practice, and capacity to guide others for appropriate biomedical waste (BMW) collection and management. The study aims to assess the knowledge, attitude and practices regarding BMW management among the budding yet responsible doctors- the medical interns in ESIC Medical College and Hospital, Gulbarga. Methods: A cross-sectional study was conducted among all the 81 interns currently posted in ESIC Medical College and Hospital, Gulbarga. Data were collected using pre-designed and semi-structured questionnaire to assess the knowledge, attitude, and practices on BMW management. Results: The study found that a majority (69.1%) of interns demonstrated fair knowledge regarding BMW management. Majority (93.8–98.8%) of the interns showed a positive attitude towards BMW segregation, self-responsibility, observation of charts at workplace, and training on BMW management. Furthermore, only 12.3% interns viewed BMW management as an extra burden on work. However, only 44.4% of interns were pre-treating liquid waste, and 50.6% were using a needle hub cutter. Alarmingly, 23.3% indicated that they would not report injuries. Conclusion: BMW management practices can be further improved with strict supervision and incorporation of BMW management in the assessment of internship completion in addition to periodic training

AssemblyQC: a Nextflow pipeline for reproducible reporting of assembly quality.

Genome assembly projects have grown exponentially due to breakthroughs in sequencing technologies and assembly algorithms. Evaluating the quality of genome assemblies is critical to ensure the reliability of downstream analysis and interpretation. To fulfil this task, we have developed the AssemblyQC pipeline that performs file-format validation, contaminant checking, contiguity measurement, gene- and repeat-space completeness quantification, telomere inspection, taxonomic assignment, synteny alignment, scaffold examination through Hi-C contact-map visualization, and assessments of completeness, consensus quality and phasing through k-mer analysis. It produces a comprehensive HTML report with method descriptions, tables, and visualizations. The pipeline uses Nextflow for workflow orchestration and adheres to the best-practice established by the nf-core community. This pipeline offers a reproducible, scalable, and portable method to assess the quality of genome assemblies-the code is available online at GitHub: https://github.com/Plant-Food-Research-Open/assemblyqc.

A Digital Approach to Improve Infection Screening Among Solid Organ Transplant Candidates.

Pretransplantinfection screening (IS) of potential organ recipientsis essential to optimal outcome of solid organ transplantation (SOT). A pre-post study was performed during 2020-2023 to investigate the impact of the STREAM (Solid organ TRansplant stEwArdship and Multidisciplinary approach) intervention to improve IS in SOT. The intervention, performed in 2022, included the implementation of IS through educational meetings, local guidelines, and the availability of a digital screening tool. The objective of the study was the assessment of IS completion, including a list of 17 laboratory tests and the investigation of vaccination status. The reduction of unnecessary tests was also analyzed. The test of proportions and a multilevel multivariate Poisson regression model were used to compare IS completion before and after STREAM. infectious diseases (ID) consultation and urgent evaluation were investigated as predictors of IS completion. A total of 171 patients were enrolled, including liver (44%), heart (32%), and kidney (24%) transplant candidates. Mean age was 56 ± 11 years, and most patients (77%) were males. Ninety-five (56%) patients were included before the intervention and 76 (44%) after STREAM. IS completion increased after STREAM (IRR 1.41, p < 0.001) with significant improvement recorded for seven (39%) IS items. Unnecessary tests decreased by 43% after the intervention. ID consultation (IRR 1.13, p = 0.02) and urgent evaluation (p = 0.68, p < 0.001) were predictors of IS improvement. STREAM was successful in improving IS completion. Further research is needed to investigate the impact of this intervention on posttransplant infections.

The Efficacy of a Mental Skills Training Course for Collegiate Athletes.

Psychological skills training improves performance in athletes. However, authors of few studies have looked at the efficacy and satisfaction of mental skills training programs for collegiate athletes. To evaluate the satisfaction of collegiate athletes with a 6-session mental skills course and to assess changes in mental toughness and coping skills before and after the course. Cohort study. Division I collegiate athletic teams. Fifty-four Division I female athletes (mean age = 19.8 years) participated in the program, and 42 (77.7%) completed precourse assessments, which subsequent evaluations were matched to. The Athletic Coping Skills Inventory (ACSI; range, 0-84) and Mental Toughness Index (MTI; range, 8-56) assessed coping skills and mental toughness precourse, immediately postcourse, and 4 months postcourse. Satisfaction was assessed on a 10-point scale. For participants with paired precourse and immediately postcourse data (n = 37, 68.5%), MTI scores improved by a mean 2.6 points (95% CI = 1.1, 4.1; P = .001), and ACSI scores improved by a mean 4.0 points (95% CI = 0.6, 7.4; P = .02). At the 4-month follow-up (n = 25, 46.2%), no change was detected from precourse in mean MTI score (P = .72), but a significant increase of 3.4 points in mean ACSI (95% CI = 0.4, 6.4; P = .03) occurred. Overall satisfaction had a median score of 9/10 (interquartile range, 8-10) at postcourse, and 18 participants (48.6%) shared positive free-text comments regarding course delivery, content, and impact. No negative feedback was reported. Mental toughness and coping skills scores significantly improved at postcourse assessment, with coping skills scores maintaining their effect at 4 months. The improvements identified spark the question of the potential impact of mental skills training programs when studied in larger athlete populations or over more sustained periods of time. Athletes reported being highly satisfied with course content and reported overall positive experiences.

Automatic Extraction and Cluster Analysis of Natural Disaster Metadata Based on the Unified Metadata Framework

The development of information technology has led to massive, multidimensional, and heterogeneously sourced disaster data. However, there’s currently no universal metadata standard for managing natural disasters. Common pre-training models for information extraction requiring extensive training data show somewhat limited effectiveness, with limited annotated resources. This study establishes a unified natural disaster metadata standard, utilizes self-trained universal information extraction (UIE) models and Python libraries to extract metadata stored in both structured and unstructured forms, and analyzes the results using the Word2vec-Kmeans cluster algorithm. The results show that (1) the self-trained UIE model, with a learning rate of 3 × 10−4 and a batch_size of 32, significantly improves extraction results for various natural disasters by over 50%. Our optimized UIE model outperforms many other extraction methods in terms of precision, recall, and F1 scores. (2) The quality assessments of consistency, completeness, and accuracy for ten tables all exceed 0.80, with variances between the three dimensions being 0.04, 0.03, and 0.05. The overall evaluation of data items of tables also exceeds 0.80, consistent with the results at the table level. The metadata model framework constructed in this study demonstrates high-quality stability. (3) Taking the flood dataset as an example, clustering reveals five main themes with high similarity within clusters, and the differences between clusters are deemed significant relative to the differences within clusters at a significance level of 0.01. Overall, this experiment supports effective sharing of disaster data resources and enhances natural disaster emergency response efficiency.

Abstract PO4-19-12: Trial in progress: An Observational Study to Examine Changes in Metabolic Syndrome Components in Patients With Breast Cancer Receiving (Neo)Adjuvant Aromatase Inhibitors

Abstract Background: (Neo) adjuvant systemic therapy has been shown to adversely impact metabolic health manifested as weight gain, dyslipidemia, and insulin resistance, which ultimately lead to the development of metabolic syndrome (MetS). MetS increases the risk of development for type 2 diabetes mellitus and cardiovascular disease and is associated with an increased risk of breast cancer recurrence, death due to breast cancer, and all-cause mortality. We have previously reported that 76% of metabolically healthy women receiving (neo) adjuvant chemotherapy will develop MetS at a median of 15 weeks. The impact of aromatase inhibitors (AIs) on metabolic health has not been systematically assessed in a longitudinal study. We hypothesize that AIs in the (neo) adjuvant setting will alter metabolic parameters and have embarked on a clinical trial to study this. Methods: This is a prospective observational study that will include: postmenopausal patients with newly diagnosed, early-stage hormone receptor (HR)-positive breast cancer with planned (neo)adjuvant treatment with an AI. Participants will be excluded if they have received or have planned treatment with (neo)adjuvant chemotherapy or are currently receiving antidiabetic medications or cholesterol-lowering agents. All patients will undergo a baseline assessment that includes: BMI, physical exam inclusive of blood pressure, waist circumference, assessment of body fat, lipid profile, insulin, metabolic biomarkers, and completion of the Functional Assessment of Cancer Therapy – Endocrine Symptoms (FACT-ES). Following institution of an AI, reassessment of the aforementioned tests will be repeated after 4 months and 12 months of therapy. The primary endpoint is the change in insulin resistance (as measured by HOMA-IR, homeostatic model assessment for insulin resistance) at 4 months. Secondary endpoints include the change in HOMA-IR at 12 months and the change in individual MetS components, metabolic biomarkers, anthropometric measurements, as well as FACT-ES scores from baseline to 4- and 12-months of AI treatment. The mean paired differences will be calculated for HOMA-IR measurements as well as for the secondary endpoints, and the 1-sided paired t-test will be used to test for statistical significance. One-way analysis of covariance will be used to compare means while adjusting for age, race/ethnicity, and BMI. Using a 1-sided paired t-test for the mean difference in HOMA-IR measurements from baseline to 4 months, we will have 80% power to detect an effect size of 0.405 with 40 patients (α = 0.05). Enrollment began in April 2023 and is ongoing. Contact alevee@coh.org for more information. Given the increased recognition of the importance of metabolic health in breast cancer outcomes, this data will inform future trials that focus on maintaining metabolic health in breast cancer survivors. Citation Format: Alexis LeVee, Nora Ruel, Victoria Seewaldt, Joanne Mortimer. Trial in progress: An Observational Study to Examine Changes in Metabolic Syndrome Components in Patients With Breast Cancer Receiving (Neo)Adjuvant Aromatase Inhibitors [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-19-12.

NeRF-NQA: No-Reference Quality Assessment for Scenes Generated by NeRF and Neural View Synthesis Methods.

Neural View Synthesis (NVS) has demonstrated efficacy in generating high-fidelity dense viewpoint videos using a image set with sparse views. However, existing quality assessment methods like PSNR, SSIM, and LPIPS are not tailored for the scenes with dense viewpoints synthesized by NVS and NeRF variants, thus, they often fall short in capturing the perceptual quality, including spatial and angular aspects of NVS-synthesized scenes. Furthermore, the lack of dense ground truth views makes the full reference quality assessment on NVS-synthesized scenes challenging. For instance, datasets such as LLFF provide only sparse images, insufficient for complete full-reference assessments. To address the issues above, we propose NeRF-NQA, the first no-reference quality assessment method for densely-observed scenes synthesized from the NVS and NeRF variants. NeRF-NQA employs a joint quality assessment strategy, integrating both viewwise and pointwise approaches, to evaluate the quality of NVS-generated scenes. The viewwise approach assesses the spatial quality of each individual synthesized view and the overall inter-views consistency, while the pointwise approach focuses on the angular qualities of scene surface points and their compound inter-point quality. Extensive evaluations are conducted to compare NeRF-NQA with 23 mainstream visual quality assessment methods (from fields of image, video, and light-field assessment). The results demonstrate NeRF-NQA outperforms the existing assessment methods significantly and it shows substantial superiority on assessing NVS-synthesized scenes without references. An implementation of this paper are available at https://github.com/VincentQQu/NeRF-NQA.

Autonomic impairment is not explained by neurological level of injury or motor-sensory completeness.

Cross-sectional study. Determine how well common clinical assessments of level and completeness of injury are correlated with symptoms of autonomic blood pressure instability and secondary medical complications after spinal cord injury (SCI). Academic medical center, United States. Eighty-two individuals with (n = 48) and without (n = 34) SCI had symptoms of autonomic blood pressure instability quantified with the Autonomic Dysfunction Following SCI (ADFSCI) survey. Health histories quantified the secondary medical complications through number of urinary tract infections and hospitalizations in the past year, time to complete bowel program, and lifetime pressure injuries. Regression models were completed to identify strengths of associated correlations. ADFSCI scores were significantly higher in individuals with SCI than controls. Neurological level of injury and ASIA impairment scale were both minimally correlated to symptoms of autonomic blood pressure instability, accounting for only 11.5% of variability in regression models. Secondary medical complications had similar, minimal correlations to level and motor/sensory completeness of SCI (R2 = 0.07 and R2 = 0.03 respectively). Contrasting this, symptoms of blood pressure instability on ADFSCI far outperformed the common clinical motor/sensory bedside exam, with moderately strong correlations to the ranked number of secondary medical complications after SCI (R2 = 0.31). Neurological level of injury and motor/sensory completeness provided limited insights into which individuals with SCI would have blood pressure instability or secondary medical complications. Interestingly, symptoms of blood pressure instability outperform the clinical motor/sensory bedside exam, with higher correlations to secondary medical complications after SCI.

A text message intervention aimed at nurturing peer outreach to help meet drinking limit goals: A remote pilot randomized trial in non-collegiate young adults

ObjectiveScalable interventions attempting to nurture peer outreach to help young adults meet drinking limit goals remain under-developed. To address this gap, we developed ASPIRE, a text message intervention focused on coaching individuals to engage with close peers to assist them in meeting drinking limit goals. MethodNon-collegiate young adults who had reported one or more heavy drinking days in the preceding month and were at least contemplating change were recruited through social media. Participants were randomly assigned to one of three 6-week text message interventions: Control, Goal Support, or ASPIRE. All groups completed baseline assessments and received weekly text message assessments on Thursdays and Sundays. Control and ASPIRE groups were prompted to complete web-based outcome assessments at 6- and 12-weeks. ResultsWe enrolled 92 young adults from 31 US states (65% female; 73% White). All groups had high text response rates but intervention usability was sub-optimal. Follow-up rates were 87% at 6-weeks and 79% at 12-weeks. Compared to Control, ASPIRE participants reported significantly more peer support and less peer pressure to drink. ASPIRE exhibited higher goal confidence compared to the Goal Support group. Using multiple imputation, there were no significant differences in drinking outcomes between groups. ConclusionsPreliminary findings from this pilot study suggest that a text message intervention focused on nurturing peer outreach to help meet drinking limit goals holds promise in altering peer support and pressure as well as boosting drinking limit goal confidence. Design improvements are needed to reduce alcohol consumption.

Neuroanatomical and neurocognitive correlates of delusion in Alzheimer’s disease and mild cognitive impairment

BackgroundNeuropsychiatric symptoms and delusions are highly prevalent among people with dementia. However, multiple roots of neurobiological bases and shared neural basis of delusion and cognitive function remain to be characterized. By utilizing a fine-grained multivariable approach, we investigated distinct neuroanatomical correlates of delusion symptoms across a large population of dementing illnesses.MethodsIn this study, 750 older adults with mild cognitive impairment and Alzheimer’s disease completed brain structural imaging and neuropsychological assessment. We utilized principal component analysis followed by varimax rotation to identify the distinct multivariate correlates of cortical thinning patterns. Five of the cognitive domains were assessed whether the general cognitive abilities mediate the association between cortical thickness and delusion.ResultsThe result showed that distributed thickness patterns of temporal and ventral insular cortex (component 2), inferior and lateral prefrontal cortex (component 1), and somatosensory-visual cortex (component 5) showed negative correlations with delusions. Subsequent mediation analysis showed that component 1 and 2, which comprises inferior frontal, anterior insula, and superior temporal regional thickness accounted for delusion largely through lower cognitive functions. Specifically, executive control function assessed with the Trail Making Test mediated the relationship between two cortical thickness patterns and delusions.DiscussionOur findings suggest that multiple distinct subsets of brain regions underlie the delusions among older adults with cognitive impairment. Moreover, a neural loss may affect the occurrence of delusion in dementia largely due to impaired general cognitive abilities.

Gender Identity and Mental Health Symptom Severity Among Adolescents Admitted to an Inpatient Psychiatric Hospital.

Transgender youth are at an increased risk of suicide, substance use, experiencing violent assaults, and reporting major depressive episodes and greater psychological distress compared to their cisgender counterparts. This study examined mental health symptom severity in adolescents admitted to an inpatient psychiatric hospital who wished they were of a different gender compared to those who did not. A group of 180 adolescents admitted to an inpatient psychiatric hospital completed assessments to measure mental health symptom severity at admission. Gender diverse (n = 90) and cisgender (n = 90) groups were established. Analyses of variance (ANOVA) were used to examine between group (gender diverse vs. cisgender) difference on depression, anxiety, suicide risk, nighttime sleep quality, and emotion regulation problems. Results revealed significant differences in emotion regulation difficulties at admission, specifically in nonacceptance and awareness. There were no significant differences on measures of depression, anxiety, suicide risk, and nighttime sleep quality at admission. This study is one of the first to measure mental health symptom severity in gender diverse adolescents while admitted to an inpatient psychiatric setting. Adolescents in the gender diverse group had significantly higher level of difficulty with emotion regulation, which may indicate an increased risk of developing psychiatric symptoms such as depression and anxiety. This paper demonstrates the importance of using targeted interventions to address difficulties with emotion regulation in at-risk adolescents.

Virtual to Reality: Understanding the Role of Metaverse as a Pedagogical Strategy

The use of the metaverse in education has gained increasing attention as a potential supplement to traditional teaching methods. This study aimed to investigate the impact of experiential learning on students' intent to use metaverse learning platforms and to explore how the metaverse can support these approaches. The study included participants from three countries and used metaverse scenes, such as a restaurant or Hong Kong scene, to complete learning tasks and interact with Non-Player Characters (NPCs) to complete assessments over a semester. The results of a correlational analysis showed that pedagogical factors had a greater impact on students' intent to use the metaverse for educational purposes than technical factors, which was unexpected. However, the study also identified challenges in adapting content to match the needs and skills of students who may not be familiar with games, as well as using the metaverse for more advanced pedagogical approaches, due to limitations in integrating content. Based on the findings, recommendations for educators, designers, and researchers are provided to enhance the effectiveness of metaverse-based education. Overall, the results of this study suggest that the metaverse can be a valuable addition to traditional teaching methods.

(212) The Questionable Clinical Utility of Sperm Morphology: Rate of Isolated Teratospermia in a Population of Fertile Men

Abstract Introduction Over the last several decades, sperm morphology has represented a standard component of semen analysis. However, its clinical utility is not well-defined, despite continual efforts by the WHO to address critiques of semen morphology criteria through increasingly strict guidelines. Issues with intra- and inter-laboratory technical variability, in addition to the subjective nature of the morphology assessment, have been thoroughly discussed in existing literature. Furthermore, current literature has highlighted the low predictive value of sperm morphology abnormalities in assisted fertility treatment (ART) and natural pregnancy outcomes. As of 2020, the American Society for Reproductive Medicine (ASRM) guidelines have noted that morphology alone is not highly predictive or diagnostic of infertility. However, past survey studies have demonstrated the pervasive belief among physicians of the value of sperm morphology, potentially leading to counseling patients towards more expensive ART methods. These concerns call into question the emphasis placed on sperm morphology assessment and its value in the clinical setting. Objective To better understand the impact of sperm morphology on fertility, we assessed sperm morphology in a population of known fertile men. Methods Healthy men over 18 years of age were recruited to provide one semen sample prior to vasectomy from March 2020 through November 2022. Inclusion criteria for the study was as follows: (1) patients were required to have biological children under the age of 5 years old, with no history of difficulty achieving pregnancy, and (2) had undergone no prior fertility procedures. Sperm morphology was analyzed using Papanicolaou stain with Kruger strict criteria by two technicians in an Andrology specialty laboratory per the WHO 5th edition manual. Results There were 83 men who participated in the study, 68 of whom (81.9%) had a complete sperm morphology assessment available. On average, participants were 37 years of age and had a mean BMI of 28 (22.8, 33.2). Of those with a smoking history available (n=61), 38 (62.3%) were non-smokers, 7 (11.5%) were former smokers, and 16 (26.2%) were current smokers. Patients had an average of 3 children with a mean youngest child age of 11.5 months old. There were 38 patients (55.9%) with 3% or lower normal sperm morphology, including two patients who had 0% normal morphology (Table 1). The most common morphologic abnormalities were head shape defects (n=59, 84.3%), followed by coiled tails (n=14, 20.3). Men 3% or lower normal sperm morphology were four times as likely to have both head and tail abnormalities than men with 4% or greater normal sperm morphology (n=8 vs n=2, respectively); half of these men also had lower than normal motility, whereas none of the men with 4% or greater normal sperm morphology had lower than normal motility. Conclusions More than half of fertile male patients (65.6%) had lower than normal sperm morphology in our study. The results of our study further question the clinical relevance of sperm morphology on fertility outcomes and if the current approach in assessing morphology is too strict. Disclosure No.

(115) Utility of Thermography as a Screening Tool for Erectile Disorder

Abstract Introduction Ultrasonography remains the gold standard for the evaluation of penile vasculature in men with erectile disorder. Despite its value, ultrasound assessment can be costly for patients, and requires an intracavernosal injection prior to imaging. With estimates of psychogenic ED being up to 40% or more in clinical populations, a less invasive method of quantifying penile vascular response would be beneficial in directing patients for further assessment and treatment. One such method that has potential is thermography as it requires no genital contact, can indirectly measure blood flow through temperature change, and has been validated in self-reported clinical non-clinical populations for the measurement of sexual response. Objective To determine whether thermography could be used to differentiate psychogenic from organic erectile disorder by comparing thermography to penile doppler ultrasound in men being assessed for erectile disorder. Methods 81 patients (m age = 43 years) recruited through a hospital Urology clinic completed penile vascular assessment across two different sessions: 1) thermographic measurement during a 15-minute baseline neutral and 15-minute sexually explicit film; 2) standard penile ultrasound assessment with an ICI of Prostaglandin E1. Demographic and sexual functioning questionnaires were completed, and urologist diagnosis following ultrasound assessment was used to classify patients as having psychogenic or organic ED. Results 45 patients had PSV values consistent with organic ED, while 36 patients were classified into the psychogenic ED group. Men with organic ED were significantly older than those in the psychogenic ED group (p &amp;lt; .05), and more likely to have concurrent health conditions (p &amp;lt; .05). A Repeated Measures ANOVA on temperature change measured through thermal imaging demonstrated that men with psychogenic ED had significantly greater penile temperature (m = 32.45°C, SD = 1.34) during sexual arousal than those with organic ED (m = 31.73°C, SD = 1.34; p &amp;lt;. 05), and also had a significantly (p &amp;lt; .01) stronger correlation between their self-reported and physical sexual response during thermographic assessment (psychogenic ED mean r =.49; organic ED mean r = .27). Furthermore, a hierarchical cluster analysis of thermography measures grouped patients into three distinct categories (high, medium and low temperature change), with significantly more of the psychogenic ED group being classified into the highest temperature cluster (82%). The medium and low temperature clusters were less sensitive at differentiating organic and psychogenic ED. Conclusions Thermography could provide a less costly and less invasive way to screen out patients presenting with ED who have a high degree of temperature change during sexual response. While thermography has been shown to differentiate between self-reported and clinical populations, this is the first evaluation of this instrument as a tool to differentiate within ED diagnostic groups. Although men with psychogenic ED were more likely to be classified in the highest temperature change cluster, thermography was less sensitive at differentiating organic and psychogenic ED in the middle and lower temperature groupings. Further research with larger samples would be beneficial in exploring potential clinical cutoffs for penile temperature change. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Dare Biosciences, Initiator Pharma.

Psychosocial factors associated with treatment preference in mental health.

Studies examining the effects of incorporating patients' preferences into treatment outcomes highlight their impact on crucial aspects such as reduced dropout rates and enhanced effectiveness. Recognizing individuals' rights to participate in decisions about their treatments underscores the importance of studying treatment preferences and the factors influencing these choices. This study aims to identify treatment preferences (psychological, pharmacological, or combined) among a sample of patients and to discern the psychosocial and clinical factors influencing these preferences. A total of 2,133 individuals receiving care at a community mental health unit completed assessments on anxious-depressive symptoms, social and occupational adjustment, and their treatment preference. Data analysis was conducted using SPSS, with descriptive statistics, Chi-square tests, and one-way ANOVA applied. Preferences for treatments were distributed as follows: Combined (49.8%), psychological (33%), and pharmacological (10.6%). Factors such as diagnosis, severity of depressive and anxious symptoms, and functional impact were related to treatment preference with a moderate effect size. Meanwhile, various sociodemographic factors correlated with the selected treatment, though with a weak effect size. There is a pronounced preference for combined treatments. The significance of psychological treatments is evident, as four out of five participants favored them in their choices. Addressing these preferences calls for an exploration within the broader context of prescription freedom in mental health.

Ear and hearing outcomes in Aboriginal infants living in an urban Australian area: the Djaalinj Waakinj birth cohort study

Objective Describe the ear and hearing outcomes in Aboriginal infants in an Australian urban area. Design Aboriginal infants enrolled in the Djaalinj Waakinj prospective cohort study had ear health screenings at ages 2-4, 6-8 and 12-18 months and audiological assessment at ∼12 months of age. Sociodemographic, environmental characteristics, otoscopy, otoacoustic emissions, tympanometry and visual reinforcement audiometry data were collected. Study Sample 125 infants were enrolled in the study; 67 completed audiological assessment, 62, 54, and 58 of whom attended ear screenings at 2-4, 6-8 and 12-18 months. Results Of the children that attended the audiological assessment, 36.5%, 50% and 64.3% of infants had otitis media (OM) at 2-4, 6-8 and 12-18 months. Using a 10 dB correction factor, 44.8% of infants had hearing loss (HL) (≥ 25 dB HL) at ∼ 12 months of age. More males (X2=5.4 (1df, p = 0.02)) and infants with OM at audiological assessment (X2=5.8 (1df, p = 0.02)) had HL. More infants that used a pacifier at 12-18 months of age had HL (X2=4.7 (1df, p = 0.03)). Conclusion Aboriginal infants in an urban area have high rates of HL and OM, which requires early surveillance and timely treatment to reduce the medical and developmental impacts of OM and HL.

Clinical Audit on the Quality of Pre-Anaesthesia Assessment based on Predefined Pre-anaesthesia Assessment Form

Objective: To determine the percentage completion of individual GQI indicators and the overall percentage of completed predefined Pre-anaesthesia assessment forms and identify any areas for improvement in the documentation of pre-anaesthesia assessment. Study Design: Cross-sectional study. Place and Duration of Study: Department of Anaesthesiology, Combined Military Hospital, Sialkot Pakistan, from Mar to Sep 2021. Methodology: Patients who reported to the operation theatre during the study period for elective surgery after having undergone formal pre-anaesthesia assessment preoperatively based on predefined Pre-anaesthesia assessment form (PAAF) were included. The quality of Pre-anaesthesia assessments from completion was assessed using a modified Global Quality Index with twenty-seven components. Results: The overall completion rate for all pre-anaesthesia assessment form components was 77.10±30.26%. The lowest completed items were local examination (0.00%), airway assessment, neck mobility, mouth opening, thyromental distance (24,10.61%), weight (25, 11.36%), GIT (86, 38.64%) and CNS/GCS (108, 48.48%) assessment, pre-operative vitals (121, 54.55%) and family history (129, 58.33%). Conclusion: We need to improve the quality of pre-anaesthesia assessment forms at our institution by ensuring that all relevant information is collected and documented.

Beyond NICE: Updated Systematic Review on the Current Evidence of Using Puberty Blocking Pharmacological Agents and Cross-Sex-Hormones in Minors with Gender Dysphoria

Beyond NICE: Updated Systematic Review on the Current Evidence of Using Puberty Blocking Pharmacological Agents and Cross-Sex-Hormones in Minors with Gender Dysphoria Abstract: Objective: The suppression of physiological puberty using puberty-blocking pharmacological agents (PB) and prescribing cross-sex hormones (CSH) to minors with gender dysphoria (GD) is a current matter of discussion, and in some cases, PB and CSH are used in clinical practice for this particular population. Two systematic reviews (one on PB, one on CSH treatment) by the British National Institute for Clinical Excellence (NICE) from 2020 indicated no clear clinical benefit of such treatments regarding critical outcome variables. In particular, these two systematic NICE reviews on the use of PB and CSH in minors with GD detected no clear improvements of GD symptoms. Moreover, the overall scientific quality of the available evidence, as discussed within the above-mentioned two NICE reviews, was classified as "very low certainty" regarding modified GRADE criteria. Method: The present systematic review presents an updated literature search on this particular topic (use of PB and CSH in minors with GD) following NICE principles and PICO criteria for all relevant new original research studies published since the release of the two above-mentioned NICE reviews (updated literature search period was July 2020-August 2023). Results: The newly conducted literature search revealed no newly published original studies targeting NICE-defined critical and important outcomes and the related use of PB in minors with GD following PICO criteria. For CSH treatment, we found two new studies that met PICO criteria, but these particular two studies had low participant numbers, yielded no significant additional clear evidence for specific and clearly beneficial effects of CSH in minors with GD, and could be classified as "low certainty" tfollowing modified GRADE criteria. Conclusions: The currently available studies on the use of PB and CSH in minors with GD have significant conceptual and methodological flaws. The available evidence on the use of PB and CSH in minors with GD is very limited and based on only a few studies with small numbers, and these studies have problematic methodology and quality. There also is a lack of adequate and meaningful long-term studies. Current evidence doesn't suggest that GD symptoms and mental health significantly improve when PB or CSH are used in minors with GD. Psychotherapeutic interventions to address and reduce the experienced burden can become relevant in children and adolescents with GD. If the decision to use PB and/or CSH is made on an individual case-by-case basis and after a complete and thorough mental health assessment, potential treatment of possibly co-occurring mental health problems as well as after a thoroughly conducted and carefully executed individual risk-benefit evaluation, doing so as part of clinical studies or research projects, as currently done in England, can be of value in terms of generation of new research data. The electronic supplement (ESM) 1 is an adapted and abreviated English version of this work.

Pivekimab sunirine (IMGN632), a novel CD123-targeting antibody–drug conjugate, in relapsed or refractory acute myeloid leukaemia: a phase 1/2 study

Pivekimab sunirine (IMGN632) is a first-in-class antibody-drug conjugate comprising a high-affinity CD123 antibody, cleavable linker, and novel indolinobenzodiazepine pseudodimer payload. CD123 is overexpressed in several haematological malignancies, including acute myeloid leukaemia. We present clinical data on pivekimab sunirine in relapsed or refractory acute myeloid leukaemia. This first-in-human, phase 1/2 dose-escalation and dose-expansion study enrolled participants aged 18 years or older at nine hospitals in France, Italy, Spain, and the USA with CD123+ haematological malignancies (Eastern Cooperative Oncology Group performance status of 0-1); participants reported here were in a cohort of participants with acute myeloid leukaemia who were refractory to or had relapsed on one or more previous treatments for acute myeloid leukaemia. The 3 + 3 dose-escalation phase evaluated two dosing schedules: schedule A (once every 3 weeks, on day 1 of a 3-week cycle) and fractionated schedule B (days 1, 4, and 8 of a 3-week cycle). The dose-expansion phase evaluated two cohorts: one cohort given 0·045 mg/kg of bodyweight (schedule A) and one cohort given 0·090 mg/kg of bodyweight (schedule A). The primary endpoints were the maximum tolerated dose and the recommended phase 2 dose. Antileukaemia activity (overall response and a composite complete remission assessment) was a secondary endpoint. The study is ongoing and registered with ClinicalTrials.gov, NCT03386513. Between Dec 29, 2017, and May 27, 2020, 91 participants were enrolled (schedule A, n=68; schedule B, n=23). 30 (44%) of schedule A participants were female and 38 (56%) were male; 60 (88%) were White, six (9%) were Black or African American, and two (3%) were other races. Pivekimab sunirine at doses of 0·015 mg/kg to 0·450 mg/kg in schedule A was administered in six escalating doses with no maximum tolerated dose defined; three dose-limiting toxicities were observed (reversible veno-occlusive disease; 0·180 mg/kg, n=1 and 0·450 mg/kg, n=1; and neutropenia; 0·300 mg/kg, n=1). Schedule B was not pursued further on the basis of comparative safety and antileukaemia findings with schedule A. The recommended phase 2 dose was selected as 0·045 mg/kg once every 3 weeks. At the recommended phase 2 dose (n=29), the most common grade 3 or worse treatment-related adverse events were febrile neutropenia (three [10%]), infusion-related reactions (two [7%]), and anaemia (two [7%]). Treatment-related serious adverse events occurring in 5% or more of participants treated at the recommended phase 2 dose were febrile neutropenia (two [7%]) and infusion-related reactions (two [7%]). Among 68 participants who received schedule A, one death (1%) was considered to be treatment-related (cause unknown; 0·300 mg/kg cohort). At the recommended phase 2 dose, the overall response rate was 21% (95% CI 8-40; six of 29) and the composite complete remission rate was 17% (95% CI 6-36; five of 29). Pivekimab sunirine showed single-agent activity across multiple doses, with a recommended phase 2 dose of 0·045 mg/kg once every 3 weeks. These findings led to a phase 1b/2 study of pivekimab sunirine plus azacitidine and venetoclax in patients with CD123-positive acute myeloid leukaemia. ImmunoGen.

Assessing frailty amongst older people admitted to hospital in a low-income setting: a multicentre study in northern Tanzania

BackgroundPopulations are ageing globally and Low- and Middle-Income Countries (LMICs) are experiencing the fastest rates of demographic change. Few studies have explored the burden of frailty amongst older people in hospital in LMICs, where healthcare services are having to rapidly adapt to align with the needs of older people. This study aimed to measure the prevalence of frailty amongst older people admitted to hospital in Tanzania and to explore their demographic and clinical characteristics.MethodsThis study had a prospective observational design. Over a six-month period, all adults ≥ 60 years old admitted to medical wards in four hospitals in northern Tanzania were invited to participate. They were screened for frailty using the Clinical Frailty Scale (CFS) and the Frailty Phenotype (FP). Demographic and clinical characteristics of interest were recorded in a structured questionnaire. These included the Barthel Index, the Identification of Elderly Africans Instrumental Activities of Daily Living (IADEA-IADL) and Cognitive (IDEA-Cog) screens, the EURO-D depression scale and Confusion Assessment Method.Results540 adults aged ≥ 60 were admitted, and 308 completed assessment. Frailty was present in 66.6% using the CFS and participants with frailty were significantly older, with lower levels of education and literacy, greater disability, greater comorbidity, poorer cognition and higher levels of delirium. Using the FP, 57.0% of participants were classed as frail though a majority of participants (n = 159, 51.6%) could not be classified due to a high proportion of missing data.ConclusionsThis study indicates that the prevalence of frailty on medical wards in northern Tanzania is high according to the CFS. However, the challenges in operationalising the FP in this setting highlight the need for future work to adapt frailty screening tools for an African context. Future investigations should also seek to correlate frailty status with long-term clinical outcomes after admission in this setting.