Complete Screening Research Articles

Association of Rurality With Annual Repeat Lung Cancer Screening in the Veterans Health Administration.

Lung cancer causes the largest number of cancer-related deaths in the United States. Lung cancer incidence rates, mortality rates, and rates of advanced stage disease are higher among those who live in rural areas. Known disparities in lung cancer outcomes between rural and nonrural populations may be in part because of barriers faced by rural populations. The authors tested the hypothesis that among Veterans who receive initial lung cancer screening, rural Veterans would be less likely to complete annual repeat screening than nonrural Veterans. A retrospective cohort study was conducted of 10 Veterans Affairs medical centers from 2015 to 2019. Rural and nonrural Veterans undergoing lung cancer screening were identified. Rural status was defined using the rural-urban commuting area codes. The primary outcome was annual repeat lung cancer screening in the 9- to 15-month window (primary analysis) and 31-day to 18-month window (sensitivity analysis) after the first documented lung cancer screening. To examine rurality as a predictor of annual repeat lung cancer screening, multivariable logistic regression models were used. In the final analytic sample of 11,402 Veterans, annual repeat lung cancer screening occurred in 27.7% of rural Veterans (641 of 2,316) and 31.8% of nonrural Veterans (2,891 of 9,086) (adjusted odds ratio: 0.86; 95% confidence interval: 0.73-1.03). Similar results were seen in the sensitivity analysis, with 41.6% of rural Veterans (963 of 2,316) versus 45.2% of nonrural Veterans (4,110 of 9,086) (adjusted odds ratio: 0.88; 95% confidence interval: 0.73-1.04) having annual repeat screening in the expanded 31-day to 18-month window. Among a national cohort of Veterans, rural residence was associated with numerically lower odds of annual repeat lung cancer screening than nonrural residence. Continued, intentional outreach efforts to increase annual repeat lung cancer screening among rural Veterans may offer an opportunity to decrease deaths from lung cancer.

Abstract PO-253: Overcoming barriers to colorectal cancer screening for underserved patients: Lessons from the COVID-19 pandemic

Abstract Introduction This patient navigation initiative works to address cancer health disparities by improving education and access to screening and cancer care. This initiative includes partnerships with local Federally Qualified Health Centers (FQHCs) and primary care physicians (PCPs), primarily focused on increasing colorectal cancer (CRC) screening rates among underserved populations in Western New York (WNY) who may have low health literacy. Grounded in health services research, we aimed to improve clinical care by implementing evidence-based guidelines into practice by working directly with underserved communities in our area to improve CRC screening rates at an urban FQHC. Methods Throughout the COVID-19 pandemic, our navigators pivoted to a hybrid schedule with remote access to health systems, splitting time between our cancer center and remotely at home until allowed back on-site to work at the FQHC. Colonoscopy halted in NY between March and June 2020, resulting in scheduling challenges due to significant backlogs of cancelled procedures during the shutdown and regional hold on elective procedures. Endoscopists across WNY had reduced capacity for postponed procedures, leading to the prioritization of scheduling for symptomatic patients. Therefore, navigators focused screening efforts on widely disseminating stool-based tests to patients due for average-risk CRC screening and prioritizing patients with positive screening results to coordinate colonoscopy appointments. Results Between April 2020 through March 2021, our pre-pandemic goal was to educate 550 patients and screen 300 patients. During this timeframe, navigators provided screening education to 632 patients and screened 232 patients despite significant challenges presented by the COVID-19 pandemic. With many colonoscopy procedures being cancelled and/or rescheduled, stool-based tests were widely available and became a more common choice for patients. To date, since April 2020, navigators have educated 807 patients and have navigated 306 patients to complete CRC screening. Of those 306 patients, 234 chose to complete at-home stool-based testing. In 2020, CRC screening rates remained over 50%, exceeding national FQHC targets. This was achieved through targeted patient outreach, education, and navigation, despite significant challenges with the shutdown and the COVID-19 pandemic. Conclusions Stool-based tests paired with targeted outreach and education were an efficient tool for CRC screening during this challenging time. Navigators regularly cross-check records to be sure results are received by ordering physicians and properly coded for accurate data reporting. This is especially important for positive test results and timely follow up, which may lead to improved health outcomes. Moving forward, this paired approach may be an effective strategy for improving screening rates among hard-to-reach patient populations and patients facing substantial barriers to accessing routine medical care. Citation Format: Kathryn M. Glaser, Christina Crabtree-Ide, Alyssa McNulty, Ellis Gomez, Nicole Donofrio, Tessa Flores, Mary E. Reid. Overcoming barriers to colorectal cancer screening for underserved patients: Lessons from the COVID-19 pandemic [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-253.

Comparative study of Tl-1223 superconductors prepared by the sol-gel route and solid-state reaction

This paper presents sol-gel (SG) and solid-state reaction (SSR) pathways to produce multiphase ceramic precursors of BCCO and then the superconducting phase of Tl-1223. The heat treatments showed that to obtain high-purity precursors prepared by SG and SSR methods are sufficient to heat treatments at 915 and 945 °C, respectively. Furthermore, the diamagnetic onset temperature of the superconducting transition for the Tl-1223 samples prepared by precursors SG at 915 °C and SSR at 945 °C is approximately 120 K, and complete screening of applied ac magnetic fields observed at T ≈ 102 and ≈ 94 K, respectively. In addition, the value of the transport critical current density Jc for SSR was 128 A/cm2, whereas for the SG sample it was precisely 174 A/cm2. Thus, we could conclude that using wet chemistry offers some advantages over classical solid-state ceramic processing, significantly better chemical homogeneity, and higher reactivity of the precursor powder.

Economic order quantity model for imperfect quality items with environmental regulations

In real life situation, advance technologies are used to produce items but due to some technical error imperfect items are produced. Therefore it is necessary to separate these imperfect items by complete screening process and such items are sold at discounted price at the end of screening process. This paper study about the EOQ model for imperfect items with shortage and zero lead time. Additionally, it provides a model to reduce emissions by including carbon cap, carbon tax, carbon cap and offset and carbon price. The main purpose of the developed model is to reduce the carbon emission when there are imperfect items using KKT(Karush Kuhn Tucker) conditions and the impact of imperfect quality items can be seen in the sensitive analysis part. The retailer should be more vigilant while ordering. Numerical examples are provided to illustrate the procedure.

Особенности обнаружения и измерения побочных электромагнитных излучений широкополосных сигналов

The article is devoted to the technical channels of Transient Electromagnetic Pulse Emanation (TEMPEST) information leakage. Methods of detection and measurement of TEMPEST, as well as broadband signals in general cases are briefly presented. The features of detection and measurement of broadband TEMPEST signals of modern digital interfaces (for example, DVI, HDMI, DisplayPort) are considered. These digital interfaces are selected as the most relevant at the moment, against analog ones that are coming out of mass use (VGA). The review of the main approaches to the identification of such signals is carried out. Detection and measurement of broadband TEMPEST signals is a non-trivial task, since both TEMPEST signals and broadband signals themselves have a low signal-to-noise ratio. A laboratory stand (an alternative measuring platform) is described in detail, where practical studies were carried out to identify and measure the broadband TEMPEST using the example of the HDMI interface. The influence of the shield camera on the results of research in cases of complete and partial screening of the object under study is demonstrated. The influence of the bandwidth value during measurements of the broadband TEMPEST on the displayed spectrum of such a signal is shown. After reaching a certain value of this bandwidth, the displayed spectrum becomes clearly distinguishable against the background of noise. The measurement of the signal levels of the broadband TEMPEST was carried out in two ways. The first method assumed that the spectrum of the broadband TEMPEST signal is continuous. In the second method, it was assumed that the spectrum of such a signal is discrete. Based on the results of these measurements, a conclusion was made about the actual nature of the spectrum of the signals of the broadband TEMPEST.

Clinical presentation and surgical resolution of atypical non-adenomas adrenal tumors

Adrenal tumors are very common in medical practice, including a wide spectrum of etiologies. Although most of them are adenomas, infrequent lesions can become a diagnostic and therapeutic challenge for clinicians. Here we present two atypical cases of non-adenomas adrenal tumors with specific imaging, biochemical profile, and surgical resolution. The first case is a 54-year-old woman with a history of hypertension and type 2 diabetes, with an incidentally discovered 7 cm adrenal mass on CT, compatible with a myelolipoma. Biochemical work-up was remarkable for hypersecretion of both cortisol and aldosterone. She underwent laparoscopic adrenalectomy. During follow-up, biochemical cure of hormonal hypersecretion was confirmed. The second case is a 44-year-old woman in whom a 7 cm left non-adenoma adrenal mass was diagnosed incidentally by magnetic resonance. Complete hormonal screening was normal. Laparoscopic adrenalectomy was performed. Biopsy informed a solid neoplasm separated from normal adrenal tissue, with immunohistochemistry compatible with a Schwannoma. These case vignettes describe atypical adrenal cases that should be considered in the differential diagnosis of non-adenomas adrenal tumors. They represent uncommon presentations and illustrate the importance of an appropriate multidisciplinary evaluation of adrenal tumors, in order to improve the surgical and clinicalmanagement of these patients. Keywords: adrenal incidentaloma; adrenal tumor; adrenal myelolipoma; adrenal schwannoma.

THE CONCEPT OF TEACHING MATHEMATICS IN THE 1ST GRADE OF A GENERAL EDUCATION SCHOOL

The teaching of mathematics should reflect the global trends in the development of mathematical and pedagogical scientific thought. The authors develop guidelines for studying mathematics in the 1st grade based on the Federal State Educational Standard. Thus, the structure and the form of the textbook content are described by chapter. The theoretical part should allow students to complete screening questions, univariate and multivariate tests, problems, and exercises. Each chapter of the developed textbook is divided into paragraphs, and each paragraph is divided into items. One item of theoretical material contains either a new idea to study or a set of interrelated concepts that define a new idea. According to this, it is possible to form mathematical knowledge trajectories. So, there are broad opportunities to transform knowledge elements into multimedia forms, including presentations, videos, test modules, and other newly emerging means of representation and visualization, using the achievements of artificial intelligence. It is possible to define main themes such as natural numbers counting, acquaintance with geometric shapes, comparison of objects in the value and quantity, acquaintance with a squared paper and measurement standards, the study of objects position, the sets consideration, introduction to the algorithm concept can. The authors’ conceptual directions of teaching mathematics in the 1st grade provide the foundation for mathematical education in general education schools for all the years of study.

The Incidence and Determinants of Metabolic Syndrome Amongst a Group of Migrants to Qatar: A Prospective Longitudinal Observational Cohort Study 24-Months Post-Migration.

While there is some evidence that migration to Western countries increases metabolic syndrome (MetS) risk, there is a lack of data pertaining to migration to the Middle East. This study aimed to investigate the relationship between migration and MetS incidence following 24-months of residency in Qatar and identify possible MetS determinants. Migrants to Qatar employed at Hamad Medical Corporation (the national health service) aged 18–65 years were invited to participate. Baseline and follow-up screening for MetS included HbA1c, triglycerides, HDL-cholesterol, blood pressure, and waist circumference. MetS-free migrants were rescreened 24-months post-migration, and the World Health Organization STEPwise questionnaire was administered, assessing changes in lifestyle from baseline. Of 1095 migrants contacted, 472 consented to participate, 205 of whom had normal metabolic parameters at baseline; 160 completed follow-up screening. Most participants were males (74.6%, n = 153) and Asian (81.0%, n = 166/205), and two thirds (66.3%, n = 136/205) were nurses. The incidence of new-onset MetS was 17.0% (n = 27/160, 95%CI; 11.0–23.0%), with 81.0% (n = 129/160, 95%CI; 73.8–86.0%) having at least one MetS element 24-months post-residency in Qatar. Male gender was a risk factor for MetS (adjusted odds ratio (AOR) = 3, p = 0.116), as was consuming medication that could induce MetS (AOR = 6.3, p < 0.001). There is merit in further research targeting these groups.

Addressing Transportation Insecurity Improves Attendance at Posthospitalization Appointments.

Transportation influences attendance at posthospitalization appointments (PHAs). In 2017, our pediatric hospital medicine group found that our patients missed 38% of their scheduled PHAs, with several being due to transportation insecurity. To address this, we implemented a quality improvement project to perform inpatient assessment of transportation insecurity and provide mitigation with the goal of improving attendance at PHAs. The process measure was the percentage of patients with completed transportation insecurity screening, and the outcome measure was PHA attendance. An interprofessional team performed plan-do-study-act cycles. These included educating staff about the significance of transportation insecurity, its assessment, and documentation; embedding a list of local transportation resources in discharge instructions and coaching families on using these resources; notifying primary care providers of families with transportation insecurity; and auditing PHA attendance. Between July 2018 and December 2019, electronic health record documentation of transportation insecurity assessment among patients on the pediatric hospital medicine service and discharged from the hospital (n = 1731) increased from 1% to 94%, families identified with transportation insecurity increased from 1.2% to 5%, and attendance at PHAs improved for all patients (62%-81%) and for those with transportation insecurity (0%-57%). Our balance measure, proportion of discharges by 2 pm, remained steady at 53%. Plan-do-study-act cycles revealed that emphasizing PHA importance, educating staff about transportation insecurity, and helping families identify and learn to use transportation resources all contributed to improvement. Interventions implemented during the inpatient stay to assess for and mitigate transportation insecurity led to improvement in pediatric PHA attendance.

Clinical decision support for tobacco screening and counseling parents of pediatric patients: A qualitative analysis of pediatric emergency department and urgent care professionals

BackgroundClinical Decision Support Systems (CDSS) embedded into electronic medical records is a best practices approach. However, information is needed on how to incorporate a CDSS to facilitate parental tobacco cessation counseling and reduce child tobacco smoke exposure (TSE) in Pediatric Emergency Department (PED) and Urgent Care (UC) settings. The objective was to explore the barriers and enablers of CDSS use to facilitate child TSE screening and parental tobacco cessation counseling by PED/UC nurses and physicians. MethodsWe conducted 29 semi-structured, focused interviews with nurses (n = 17) and physicians (n = 12) at a children's hospital PED/UC. The interview guide included a brief presentation about the design and components of a prior CDSS tobacco intervention. Participants were asked their opinions about CDSS components and recommendations for adapting and implementing the CDSS tobacco intervention in the PED/UC setting. A thematic framework analysis method was used to code and analyze qualitative data. ResultsParticipant mean (± SD) age was 42 (± 10.1) years; the majority were female (82.8%), non-Hispanic white (93.1%), and never tobacco users (86.2%); all were never electronic cigarette users. Four themes emerged: (1) explore optimal timing to complete CDSS screening and counseling during visits; (2) CDSS additional information and feedback needs; (3) perceived enablers to CDSS use, such as the systematic approach; and (4) perceived barriers to CDSS use, such as lack of time and staff. ConclusionsThe CDSS intervention for child TSE screening and parental tobacco cessation during PED/UC visits received endorsements and suggestions for optimal implementation from nurses and physicians.

A Multidisciplinary Approach to Screen Deployment-Limiting Health Conditions.

Disease non-battle injuries (DNBIs) are responsible for the majority of hospital admissions for soldiers in combat since the Vietnam War The U.S. Army prepares soldiers to deploy through a multistage process known as the Soldier Readiness Program (SRP). The current processes are reactive and address deployment-limiting health conditions (DLHCs) and the need for intervention and/or medical waivers late in the SRP process. This may compromise the quality and efficiency of pre-deployment medical clearance and result in DNBI medical evacuation from theater, which is costly and reduces the effectiveness of the unit. Implementation of a proactive and standardized screening process focused on behavioral health-related medical evacuations and psychotropic medication use will facilitate timely and effective interventions to improve readiness. The primary objective of this proof-of-concept (POC) study was to develop a standardized and sustainable process, known as the deployment-limiting medication (DLM) surveillance process, to screen soldiers for DLHCs that prevent mobilization. The A-3 performance improvement model was utilized to identify the root causes of limitations with the current medical SRP and to develop solutions. This process utilized the DLHC tool, a report created by the Defense Health Agency, as a basis to identify soldiers that require continued chart review based on prescription fill history. The results of the report were further assessed using published deployment eligibility standards and focused on psychotropic medications. Secondary measures [included] validation of the DLHC tool by assessing the accuracy of the DLHC report. This was determined by the proportion of soldiers screened who actually required intervention and/or waivers per deployment policy. This study took place within an Infantry Brigade Combat Team (IBCT). From August 2019 to March 2020, 959 soldiers in the IBCT were screened under the DLM surveillance process for DLHCs related to mental health and psychotropic medication use. The percentage of completed screenings of psychotropic-related DLHCs in the IBCT reached 100% after 3 months of implementing this POC study. After thorough chart review, a total of 421 soldiers met criteria for a medical intervention and/or waiver with 8% of these soldiers identified with a preexisting medical profile. The DLHC tool's ability to use medication history to accurately predict the need for an intervention and/or medical waiver was 59% (654/1,112 medications). Soldiers identified using the DLM surveillance process that did not meet criteria predominately involved antidepressant, anticonvulsant, and central nervous system DLHC categories. If the psychotropic-related DLHC categories are optimized in future reports, the report's accuracy may be increased to 90% while decreasing the time to complete the monthly review. The DLM surveillance measures were successfully incorporated into the SRP process to proactively screen for DLHCs. Early identification of DLHCs allowed for proper identification of medical intervention and/or waiver needs and may decrease deployment complications. This process may help to improve a soldier's deployability and improve overall readiness of the IBCT.

Uterine Transplantation: Recipient Patient Populations.

Uterine transplantation is an emerging treatment for patients with uterine factor infertility (UFI). In order to determine patient candidacy for transplant, it is imperative to understand how to identify, counsel and treat uterine transplant recipients. In this article, we focus on patient populations with UFI, whether congenital or acquired, including Mayer-Rokitansky-Kuster-Hauser, complete androgen insensitivity syndrome, hysterectomy, and other causes of nonabsolute UFI. Complete preoperative screening of recipients should be required to assess the candidacy of each individual prior to undergoing this extensive treatment option.

798. Incomplete Contact Investigation and Risk of Developing Tuberculosis Among Healthcare Professionals After Tuberculosis Exposure

BackgroundTuberculosis (TB) contact investigation is recommended for healthcare professionals (HCPs) after TB exposure. However, association between no participation in or incomplete contact investigation and subsequent TB development has not been well-described. This study aims to determine TB incidences and factors associated with TB development among HCPs requiring contact investigations.MethodsWe conducted a prospective cohort study among Thai HCPs with TB exposure from January 2013 to December 2017. Contact investigations, including baseline TB and latent tuberculosis infection (LTBI) screening and follow-up at 3 months after TB exposure, were recommended to all HCPs. The two-step tuberculin skin test (TST) was used for LTBI testing. All HCPs were followed for 2 years for TB development.ResultsOf the 342 HCPs with TB exposure included in the study, 311 (91%) participated in the contact investigations and 252 (74%) completed baseline TB and LTBI screening. Among the 210 HCPs with negative baseline TST, 45 (21%) completed the follow-up tests. The overall incidence of TB was 2.92/100 person-years. HCPs who did not complete follow-up TST had significantly higher TB incidence than those completed baseline and follow-up TST (3.55 vs. 0/100 person-years; P=0.01). No participation in the contact investigation and no chest radiograph performed at baseline were the independent factors associated with TB development among the HCPs [adjusted odds ratio (aOR) 6.69; P< 0.001 and aOR 8.85; P=0.01, respectively]. Contact with an index patient with concomitant TB at extrapulmonary sites (aOR 49.76, 10.03-246.99; P< 0.001) and with negative sputum AFB but positive sputum GeneXpert MTB/RIF (aOR 3.18, 1.35-7.50; P=0.008) were independently associated with no participation in the contact investigation.ConclusionThe findings indicate the risk of TB development among the HCPs who did not undergo or complete contact investigations and underscore the need for interventions to improve contact investigation participation and completeness.Disclosures All Authors: No reported disclosures

Individual head and neck screening: Initiating a dialogue about best approach

PurposeWe aim to investigate the true benefits of free individual HNC screening in a high-risk urban population as well as the associated risks. Materials and methodsThis is a retrospective descriptive study. Free HNC screening was performed from 2014 to 2019. Participants were issued a questionnaire at the time of screening. After exemption by the Institutional Review Board, completed screening questionnaires were entered into a database and descriptive statistics were generated. The primary outcome measure for this study was the detection rate for HNC. We hypothesized that screening would be low yield based on previous studies (Gogarty et al., 2016). ResultsThis was a volunteer sample with a total of 410 participants, and the highest yield screening year was 2019 (n = 187). For all years, the cancer detection rate was 0%. In 2019, 134 (77.9%) of participants did not recognize the early symptoms of HNC, and 120 (73.2%) reported the screening program increased their awareness of the disease. 13 (7.6%) reported HPV vaccination while 126 (71.2%) were unaware that HPV has been linked with head and neck cancer. ConclusionsHNC screening is an excellent opportunity for education regarding HNC risk factors. However, it is not a cost-effective use of physician time, does not increase detection rates even in high-risk segments of the general population, and is not completely without risk in the context of COVID-19. Perhaps the focus of HNC screening should shift from individualized screening to education and health promotion.

Extent of Extraskeletal Manifestations of Fibrous Dysplasia/McCune-Albright Syndrome in Patients with Mazabraud's Syndrome.

Mazabraud's syndrome (MZB) is a rare condition in which fibrous dysplasia of bone/the McCune-Albright syndrome (FD/MAS) co-exists with intramuscular myxomas. Both FD and the myxomas harbor the GNAS-mutation. Recent studies have shown that extraskeletal, GNAS-related features are associated with a more severe phenotype of FD/MAS. However, patients with MZB are often only seen by orthopedic surgeons. We therefore evaluated MZB patients seen in tertiary referral centers from the Netherlands (LUMC), USA (National Institutes of Health) and France (INSERM UMR 1033 (Lyos), Hôpital Edouard Herriot). All FD/MAS patients known in these centers with an additional diagnosis of a myxoma were included. Demographic information and data on disease extent and extraskeletal manifestations of FD/MAS such as precocious puberty (PP) or café-au-lait patches (CAL) were retrieved from patient's medical records. Thirty MZB patients were included: 20 women (67%) and 10 men (33%). Patients received a diagnosis of MZB (median 42years, range 16-19) significantly later than the diagnosis of FD/MAS (median 30years, range 0-60), p < 0.01. Twenty-six patients were diagnosed with polyostotic disease (87%). In 97% the myxoma was located near the skeletal FD lesion. The combination of MZB and MAS was made in 13 patients in whom PP (n = 7), CAL (n = 7), GH-excess (n = 3) and hyperthyroidism (n = 3) were present. Other extraskeletal features were (multinodular) goiter (n = 2) and thyroid cysts (n = 1). Furthermore, in this cohort of patients with MZB several (pre-)malignant tumors were observed; ductal carcinoma in situ of the breast in 3 patients (10%), breast cancer in 1 patient (3.3%), intra pancreatic mucinous neoplasms in 3 patients (10%) and liver adenomas in 2 patients (6.6%). A total of 47% of patients with MZB had an additional extraskeletal feature such as an endocrinopathy. In MZB, 87% of patients suffer from polyostotic FD, 43% of patients have extraskeletal GNAS-features such as an hyperfunctioning endocrinopathy and 30% (pre-)malignant tumors. We therefore advocate that MZB patients should undergo a complete screening and long-term follow-up for extent of bone disease, but also extraskeletal GNAS features of FD/MAS.

LUMOS - Low and Intermediate Grade Glioma Umbrella Study of Molecular Guided TherapieS at relapse: Protocol for a pilot study

IntroductionGrades 2 and 3 gliomas (G2/3 gliomas), when combined, are the second largest group of malignant brain tumours in adults. The outcomes for G2/3 gliomas at progression approach the dismal...

COVID-19 front door screening implementation: experiences of staff conducting screening

Background: Many hospitals have implemented COVID-19 risk screening of staff and visitors at point of entry. Little is known about staff perspectives of the screening implementation process. Aims: To investigate the experiences of staff conducting screening at a metropolitan hospital for a novel virus with constantly evolving messaging and knowledge, and to identify potential improvements to screening procedures. Methods: An exploratory cross-sectional survey study of 65 nurses who conducted screening at the hospital. The survey contained quantitative and open-ended questions. Descriptive analyses were conducted for quantitative data. Responses from open-ended questions were analysed using thematic analysis. Findings: Few survey participants (20%) received training prior to screening and under half (47%) felt prepared. A majority of participants rated visitors and staff as often or always willing to complete screening questions and have their temperature checked. Approximately half of participants rated their overall experience of screening as positive and most (81.5%) believed the questions were successful in directing at risk people for COVID-19 testing. Themes identified were: hospital environment and screening station setup; necessity for clear information; difficulties and discomfort; and screening is valuable psychologically and for risk reduction. Discussion: Suggested improvements included training for screening staff, clearly marked screening queues, additional signage explaining requirements, mandatory temperature checking, and separate entry points for staff and visitors. Conclusion: Participants felt their overall experience of conducting screening was more positive than negative and screening provided positive psychological value for staff and visitors; however, various ways to improve screening processes for staff were identified. What is already known about this topic? Physical distancing and infection prevention and control measures contribute to reducing COVID-19 infections, therefore to slow the spread of COVID-19 and ease the impact on health systems, screening of staff and visitors for possible viral exposure prior to entry was implemented at healthcare facilities across the world. However, little is known about staff perspectives of the screening implementation process. What this paper adds: Front door screening was perceived to reduce risk and increase public confidence. Nursing staff experiences suggest a need for improvements to the process, such as increased training for staff performing the screening, increased signage and clear screening expectations for visitors prior to reaching screening stations, and changes to screening station set up.

Multiple myeloma screening within a fracture liaison service (FLS).

A key role of the Fracture Liaison Service (FLS) is screening for secondary causes of osteoporosis. In 2019, the Royal Osteoporosis Society recommended that all patients attending FLS who are recommended anti-osteoporosis therapy have universal screening for myeloma based on serum electrophoresis, serum free light chains and urine electrophoresis. Here, we examined the impact of universal myeloma screening within an FLS. We sampled all patients seen by the Oxfordshire FLS between January and April 2018. The completion rates and outcomes of screening were checked using the hospital and FLS databases. Of 950 patients identified by the FLS, 628 were eligible for MM screening; 473 (75%) of these were female, and the average age was 78.4years. Overall, 584 had some form of myeloma screening, of which 577 (92%) had serum electrophoresis, 525 (84%) had serum free light chains and 407 (65%) had urine electrophoresis measured. A total of 327 (59%) patients had complete screening. Three patients (0.5%) had newly diagnosed myeloma and were urgently referred to Haematology Services. Furthermore, 46 (8%) patients had a detectable serum paraprotein with a likely diagnosis of monoclonal gammopathy of uncertain significance (MGUS) and referred for community annual surveillance according to local guidelines. Addition of universal myeloma screening to laboratory testing identified myeloma in 1 per 195 patients, and its precursor state MGUS in 1 per 13 patients, which may have otherwise been missed. Further analysis with long-term follow-up is needed to clearly define the value of diagnosing MGUS within the FLS setting and establish the benefits vs. costs and methods to improve screening completion rates.

Potential of Carbofuran Degradation by Soil Bacteria in Malaysia: A Review

Carbofuran is a very toxic and systemic carbamate pesticide which is used as an extensive carbamate insecticide, nematicide andacaricide. It is applied to the soil as a treatment to manage or destroy pests and parasites to improve the quality of agricultural production. It is also an anticholinesterase carbamate which is highly toxic to plants, animals andhumans. The consequences have received great concern as many health-associated problems have still been reported due to pesticide poisoning. In humans, carbofuran is associated with the inhibition of cholinesterase, which could develop a cholinergic crisis known as sludge syndrome. Therefore, it is essential to take quick action to eliminate this pesticide from the environment. Bacterial degradation is a very eco-friendly method for the elimination of carbofuran. Bacterial enzymes and degradation genes play an essential role in catalyzing new biochemical pathways during the bacterial degradation process. A complete screening of bacterial carbofuran metabolic pathway can develop marker genes or enzymes to determine useful bacteria in the contaminated sites capable to degrade carbofuran residues. Therefore, this review focused on the understanding of bacterial degradation of carbofuran in Malaysian soils and to explore the possibility of soil bacteria to degrade carbofuran effectively. Thus, we emphasize on the carbofuran toxicity, bacterial degradation, metabolic and molecular mechanisms of carbofuran's degradation process.

207.5: Impact of HLA Donor Specific Antibodies in the Era of Cell Therapy: Clinical Trajectories in Islet Allotransplantation Illustrate a Challenging Model

Introduction: Islet transplantation is a unique paradigm in the case of organ transplantation, since multiple injections and donors are required to achieve complete insulin-independence. Preformed or de novo DSAs may target one or several donor islets, which complexifies the analysis of their impact. Our objective is to discriminate illustrative clinical trajectories which can occur after transplantation. Methods: Adult type 1 diabetic pancreatic islet recipients transplanted between January 2005 and December 2018, were included in a monocentric observational study. Only patients with available sera tested by Luminex for Class I and II anti-HLA antibodies during their whole follow-up were analyzed. Results: 32 patients had a complete HLA antibodies screening during follow-up. Among them, 7 patients presented with DSA. Five clinical trajectories were identified according to the MFI-value, and the presence of preformed DSA, de novo DSA, or both. To simplify, we provide specific clinical-based trajectories considering an islet transplantation with 1- high MFI preformed DSA, 2- high MFI de novo DSA, 3- low-MFI preformed DSA, 4-low de novo DSA, and 5- a de novo DSA which becomes a preformed DSA because of multiple islet infusions. We analyzed also the specific case of islet-after-kidney transplantation. Recipients transplanted with preformed DSA had all favorable islet transplantation outcomes. The prognosis of de novo DSA was associated with unfavorable outcomes when following markers of unsteady glycemic control. Conclusion: Clinical-based trajectories and evidence from the literature reveal that islet transplantation with preformed DSA, even with high MFI values, can be associated with favorable outcomes. The fate of recipient presenting with de novo DSA is more questionable as both clinical data and preclinical studies show separate outcomes. Clinical phenotype and unsteady glycemic control before the emergence of DSA may lead the clinician to detect rejection.I-SITE ULNE.