Mapping Protocol Research Articles

After-discharge activity as a basis to change intraoperative mapping protocol for functionally significant brain areas

Background. After-discharge (AD) activity is a pattern that differs from background corticography, represented by rhythmic stereotypical slow waves and/or repetitive spike discharges with ≥1 Hz frequency, recorded after cessation of electrical stimulation and lasting for more than 2 seconds. Despite the accumulated experience in the field of intraoperative neuromonitoring, there is no unified protocol for high-frequency stimulation of cortical functional areas (FAs) upon the AD event.Objective: to demonstrate a need to change the intraoperative FAs mapping protocol in patients with brain tumor on awakening in cases of AD recording.Material and methods. Two clinical cases of awake surgical functional mapping followed by resection of the brain tumor are presented. Multimodal monitoring included high-frequency stimulation according to the approved intrahospital protocol with maximum stimulation force of auditory-speech zones of 2.5 mA, electrocorticography, and subcortical dynamic mapping.Results. In the first case, AD was registered while FAs mapping in a patient with a history of one epileptic seizure, upon reaching the maximum stimulation force of 2.5 mA, that was replaced by recording focal epileptiform activity with the following evolution to ictal generalized event and development of intraoperative convulsive seizure. In the second patient with a history of recurrent epileptic seizures, AD with spatiotemporal evolution of the pattern development of clinical ictal event was registered with stimulation at 2.5 mA. In both cases, the appearance of AD required to change mapping protocol with a stepwise decrease in stimulus strength to obtain cortical FAs data.Conclusion. Registration of AD is the basis for changing the protocol of high-frequency cortical stimulation in surgical treatment of brain tumor FAs.

Development of a ParticipACTION App–Based Intervention for Improving Postsecondary Students’ 24-Hour Movement Guideline Behaviors: Protocol for the Application of Intervention Mapping

The Canadian 24-Hour Movement Guidelines for adults provide specific recommendations for levels of physical activity, sedentary behavior, and sleep (ie, the movement behaviors) required for optimal health. Performance of the movement behaviors is associated with improved mental well-being. However, most postsecondary students do not meet the movement behavior recommendations within the Canadian 24-Hour Movement Guidelines and experience increased stress and declining well-being, suggesting the need for an intervention targeting students' movement behaviors. We aimed to develop and implement a theory-informed intervention intended to improve the movement behaviors and mental well-being of first-year postsecondary students. The Intervention Mapping protocol was applied in the development and implementation of the intervention. Intervention Mapping entailed performing a needs assessment, determining the intervention outcomes, selecting theory- and evidence-based change methods and applications, preparing and producing intervention plans and materials, developing the implementation plan, and finally developing an evaluation plan. The Theoretical Domains Framework and the Behavior Change Wheel were also used in conjunction with the Intervention Mapping protocol to ensure a solid theoretical basis for the intervention. This protocol led to the development and implementation of a 6-week, theory-informed ParticipACTION app-based intervention aimed at helping first-year postsecondary students improve their movement behaviors and mental well-being. The developed app content provided students with information on each of the movement behaviors and behavioral strategies (ie, goal setting, action planning, monitoring, and coping planning). The use of Intervention Mapping allowed for the continuous involvement of various multidisciplinary partners and end users, ensuring that the intervention design and implementation was appropriate for the target audience. The feasibility, acceptability, and potential impact of the intervention will be examined in a subsequent proof-of-concept study at 2 Canadian university campuses. Participant recruitment occurred during September 2021, and the intervention was conducted from October to December 2021. The deadline for completion of the postintervention questionnaire by participants was mid-December 2021. The analysis of data examining the feasibility, acceptability, and potential impact of the intervention began in January 2022, with the publication of the proof-of-concept evaluation expected in 2023. Intervention Mapping with the Theoretical Domains Framework and Behavior Change Wheel was a useful approach to combine evidence and theoretical concepts to guide the design and implementation of a ParticipACTION app-based intervention targeting postsecondary students' movement behaviors and mental well-being. This process may serve as an example for other researchers developing multiple behavior change app-based interventions. Should the forthcoming evaluation demonstrate the intervention's acceptability, feasibility, and potential impact, the intervention may provide a scalable method of improving postsecondary students' movement behaviors and mental well-being. RR1-10.2196/39977.

In vivo multi-parameter mapping of the habenula using MRI

The habenula is a small, epithalamic brain structure situated between the mediodorsal thalamus and the third ventricle. It plays an important role in the reward circuitry of the brain and is implicated in psychiatric conditions, such as depression. The importance of the habenula for human cognition and mental health make it a key structure of interest for neuroimaging studies. However, few studies have characterised the physical properties of the human habenula using magnetic resonance imaging because its challenging visualisation in vivo, primarily due to its subcortical location and small size. To date, microstructural characterization of the habenula has focused on quantitative susceptibility mapping. In this work, we complement this previous characterisation with measures of longitudinal and effective transverse relaxation rates, proton density and magnetisation transfer saturation using a high-resolution quantitative multi-parametric mapping protocol at 3T, in a cohort of 26 healthy participants. The habenula had consistent boundaries across the various parameter maps and was most clearly visualised on the longitudinal relaxation rate maps. We have provided a quantitative multi-parametric characterisation that may be useful for future sequence optimisation to enhance visualisation of the habenula, and additionally provides reference values for future studies investigating pathological differences in habenula microstructure.

Low‐Altitude UAV Imaging Accurately Quantifies Eelgrass Wasting Disease From Alaska to California

AbstractDeclines in eelgrass, an important and widespread coastal habitat, are associated with wasting disease in recent outbreaks on the Pacific coast of North America. This study presents a novel method for mapping and predicting wasting disease using Unoccupied Aerial Vehicle (UAV) with low‐altitude autonomous imaging of visible bands. We conducted UAV mapping and sampling in intertidal eelgrass beds across multiple sites in Alaska, British Columbia, and California. We designed and implemented a UAV low‐altitude mapping protocol to detect disease prevalence and validated against in situ results. Our analysis revealed that green leaf area index derived from UAV imagery was a strong and significant (inverse) predictor of spatial distribution and severity of wasting disease measured on the ground, especially for regions with extensive disease infection. This study highlights a novel, efficient, and portable method to investigate seagrass disease at landscape scales across geographic regions and conditions.

Predictors of one year pressure injury outcomes in hospitalized spinal cord injured veterans with one stage 3 or 4 pressure injury

Objective The purpose of this study is to investigate predictors of pressure injury (PrI) outcomes at one year after discharge for Veterans with spinal cord injury (SCI) hospitalized with a Stage 3 or 4 PrI. Design/Setting/Participants This is a retrospective medical record review from one VA Health Care System SCI unit. Participants were Veterans with traumatic or non-traumatic SCI admitted with one Stage 3 or 4 pelvic PrI treated medically (e.g. without flap surgery). Logistic models were used to select the significant predictors of PrI healing outcomes. Outcome Measure One year after discharge wound outcomes (healed vs non-healed) for Veterans with SCI hospitalized with a Stage 3 or 4 PrI. Results A total of 62 hospitalizations were included for analyses resulting in 33 healed and 29 non-healed PrIs. Three significant predictors of non-healed PrI outcomes included use of pressure mapping during hospitalization, greater PrI depth, and usage of alginate dressings. Two significant predictors of healed PrI outcomes included the use of animal-based tissue and hydrocolloid dressings. Area under curve of this logistic regression model was 79.98%. Conclusion The clinical decision of having a patient pressure mapped predicts that the PrI may not heal at one year of discharge. Pressure mapping protocol correlated with another variable that could not serve as a predictor by itself, including using powered pressure relief techniques. The three PrI treatment predictors may represent characteristics of the PrI itself, rather than the efficacy of the product. Further investigation on these clinical decision-making factors is warranted to ensure efficient and cost-effective treatment strategies for individuals with SCI hospitalized with PrIs.

Precision mapping of schistosomiasis and soil-transmitted helminthiasis among school age children at the coastal region, Kenya

Accurate mapping of schistosomiasis (SCH) and soil transmitted helminths (STH) is a prerequisite for effective implementation of the control and elimination interventions. A precision mapping protocol was developed and implemented in the coastal region of Kenya by applying the current World Health Organization (WHO) mapping guide at a much lower administrative level (ward). A two-stage cluster survey design was undertaken, with 5 villages in each ward selected. From within each village 50 households were randomly selected, and a single child between the ages of 8 and 14 sampled following appropriate assent. The prevalence and intensity of infection of Schistosoma mansoni and STH were determined using the Kato-Katz method (single stool, duplicate slides) and urine filtration for S. haematobium. Of the 27,850 school age children sampled, 6.9% were infected with at least one Schistosoma species, with S. haematobium being the most common 6.1% (95% CI: 3.1-11.9), and Tana River County having highest prevalence 19.6% (95% CI: 11.6-31.3). Prevalence of any STH infection was 5.8% (95% CI: 3.7-8.9), with Lamu County having the highest prevalence at 11.9% (95% CI: 10.0-14.1). The most prevalent STH species in the region was Trichuris trichiura at 3.1% (95% CI: 2.0-4.8). According to the WHO threshold for MDA implementation, 31 wards (in 15 sub-Counties) had a prevalence of ≥10% for SCH and thus qualify for annual MDA of all age groups from 2 years old. On the other hand, using the stricter Kenya BTS MDA threshold of ≥2%, 72 wards (in 17 sub-Counties) qualified for MDA and were targeted for treatment in 2021. The precision mapping at the ward level demonstrated the variations of schistosomiasis prevalence and endemicity by ward even within the same sub-counties. The data collected will be utilized by the Kenyan Ministry of Health to improve targeting.

Micro X-ray fluorescence reveals pore space details and spatially-resolved porosity of rock-based microfluidic devices.

Characterization of microscopic details of the fabric of mudstones and shales (i.e., structure and composition) is important to understand their storage and transport properties. Current characterization methods struggle to probe reliably multiple scales of interest (e.g., pore and fracture) and measure properties at the finest resolution under representative in situ conditions. Micro X-ray fluorescence (μXRF) is a high-performance imaging technique that produces elemental images at sub-10 μm spatial resolution and could offer insight into a diversity of shale properties, such as mineral composition, porosity, and in situ pressure gradients. This study designed and carried out a porosity mapping protocol using model and real-rock microfluidic devices and contrast fluids. Etched silicon micromodels with real-rock pore network patterns served as ideal models to establish a proof of concept. Measurements were performed on a novel μXRF microscope not powered by synchrotron radiation. We registered the μXRF datasets with the binary rock masks used for micromodel fabrication and applied segmentation algorithms to compare porosities. We assessed expected advantages and limitations through a sensitivity analysis and beam study. μXRF is an important new imaging technique for microfluidic applications.

Indigenous Peoples‐related environmental research within the basin of the Laurentian Great Lakes: A systematic map protocol

Abstract The North American Great Lakes Basin is the homeland for many First Nations, Métis and Native American Tribes. The terrestrial and aquatic ecological systems within this multinational region, which is of spiritual, cultural and subsistence significance to a diversity of Indigenous Peoples, are facing several natural and anthropogenic pressures. While there are many current and past research efforts and projects to address those pressures, the nature and range of environment‐related projects involving Indigenous Peoples or organizations remains unknown. This gap in knowledge presents a unique opportunity to identify and map past and current environmental and ecological research within the Great Lakes involving Indigenous Peoples. A systematic search strategy will be applied to identify and capture peer‐reviewed publications that pertain to past and current environmental research within the Great Lakes basin that involve or are connected to Indigenous Peoples, following the procedures outlined in this systematic mapping protocol. Publications that pertain to environmental and ecological research with, for and by Indigenous Peoples within the Great Lakes, as determined by the use of suitable keywords, will be retrieved from four proposed online bibliographic platforms and databases. Searches will only include peer‐reviewed publications in the English language. Final captures of the search results will be screened in two stages to identify potentially relevant papers. This will take place through (1) title and abstract screening and (2) full‐text analysis. Following the completion of the screening process, remaining papers will be coded and analysed through a narrative synthesis approach and descriptive statistics will be conducted. Environmental research captured through this systematic protocol will be geospatially mapped using the ArcGIS mapping software. It is anticipated that the information obtained from the resulting systematic map will be beneficial for identifying gaps in environmental research to support and inform future initiatives for environmental research planning, policy and decision‐making with, for and by Indigenous Communities within the Great Lakes basin.

Using Intervention Mapping to Develop an mHealth Intervention to Support Men Who Have Sex With Men Engaging in Chemsex (Budd): Development and Usability Study.

Chemsex refers to the intentional use of drugs before or during sex among men who have sex with men (MSM). Engaging in chemsex has been linked to significant negative impacts on physical, psychological, and social well-being. However, no evidence-based support tools have addressed either these harms or the care needs of MSM who engage in chemsex. The purpose of this paper was to describe the development of a mobile health intervention (named Budd) using the intervention mapping protocol (IMP). Budd aims to support and inform MSM who participate in chemsex, reduce the negative impacts associated with chemsex, and encourage more reasoned participation. The IMP consists of 6 steps to develop, implement, and evaluate evidence-based health interventions. A needs assessment was carried out between September 2, 2019, and March 31, 2020, by conducting a literature study and in-depth interviews. Change objectives were selected based on these findings, after which theory-based intervention methods were selected. The first version of the intervention was developed in December 2020 and pilot-tested between February 1, 2021, and April 30, 2021. Adjustments were made based on the findings from this study. A separate article will be dedicated to the effectiveness study, conducted between October 15, 2021, and February 24, 2022, and implementation of the intervention. The Budd app went live in April 2022. Budd aims to address individual factors and support chemsex participants in applying harm reduction measures when taking drugs (drug information, drug combination tool, and notebook), preparing for participation in a chemsex session (articles on chemsex, preparation tool, and event-specific checklist), planning sufficient time after a chemsex session to recover (planning tool), seeking support for their chemsex participation (overview of existing local health care and peer support services, reflection, personal statistics, and user testimonials), taking HIV medication or pre-exposure prophylaxis in a timely manner during a chemsex session (preparation tool), and contacting emergency services in case of an emergency and giving first aid to others (emergency information and personal buddy). The IMP proved to be a valuable tool in the planning and development of the Budd app. This study provides researchers and practitioners with valuable information that may help them to set up their own health interventions. RR1-10.2196/39678.

Tractography-based navigated TMS language mapping protocol.

This study explores the feasibility of implementing a tractography-based navigated transcranial magnetic stimulation (nTMS) language mapping protocol targeting cortical terminations of the arcuate fasciculus (AF). We compared the results and distribution of errors from the new protocol to an established perisylvian nTMS protocol that stimulated without any specific targeting over the entire perisylvian cortex. Sixty right-handed patients with language-eloquent brain tumors were examined in this study with one half of the cohort receiving the tractographybased protocol and the other half receiving the perisylvian protocol. Probabilistic tractography using MRtrix3 was performed for patients in the tractography-based group to identify the AF's cortical endpoints. nTMS mappings were performed and resulting language errors were classified into five psycholinguistic groups. Tractography and nTMS were successfully performed in all patients. The tractogram-based group showed a significantly higher median overall ER than the perisylvian group (3.8% vs. 2.9% p <.05). The median ER without hesitation errors in the tractogram-based group was also significantly higher than the perisylvian group (2.0% vs. 1.4%, p <.05). The ERs by error type showed no significant differences between protocols except in the no response ER, with a higher median ER in the tractogram-based group (0.4% vs. 0%, p <.05). Analysis of ERs based on the Corina cortical parcellation system showed especially high nTMS ERs over the posterior middle temporal gyrus (pMTG) in the perisylvian protocol and high ERs over the middle and ventral postcentral gyrus (vPoG), the opercular inferior frontal gyrus (opIFG) and the ventral precentral gyrus (vPrG) in the tractography-based protocol. By considering the white matter anatomy and performing nTMS on the cortical endpoints of the AF, the efficacy of nTMS in disrupting patients' object naming abilities was increased. The newly introduced method showed proof of concept and resulted in AF-specific ERs and noninvasive cortical language maps, which could be applied to additional fiber bundles related to the language network in future nTMS studies.

Predictors of One Year Pressure Injury Outcomes in Hospitalized Spinal Cord Injured Veterans

<h3>Research Objectives</h3> To investigate predictors of wound outcomes at 1 year of discharge of Veterans with spinal cord injury (SCI) hospitalized with one stage 3 or 4 pelvic pressure injury (PI). <h3>Design</h3> Retrospective medical record review between 1/1/2013-12/31/2018. <h3>Setting</h3> VA North Texas HealthCare System SCI unit. <h3>Participants</h3> Veterans with SCI admitted with one stage 3 or 4 pelvic PI. Traumatic and atraumatic SCI patients treated medically without flap surgery were included. <h3>Interventions</h3> Wound care. <h3>Main Outcome Measures</h3> Wound status at one year of discharge. A logistic model was built to select the significant predictors of wound healing outcomes. The area under the curve (AUC) was calculated using the leave-one-out cross validation method. P< 0.05 was considered statistically significant. <h3>Results</h3> A total of 62 hospitalizations were included for analyses: 33 healed, and 29 non-healed wounds. Three significant predictors of non-healed wound outcomes include: pressure mapping protocol during hospitalization, wound depth, and usage of alginates dressings. Two significant predictors of healed wound outcomes include: animal-based tissue and hydrocolloid dressings. The AUC of this logistic regression model is 79.98%. <h3>Conclusions</h3> The five wound outcome predictors are the depth of the wound, and clinical decision-making factors regarding seating and wound treatments. Pressure mapping protocol correlated with other variables that could not serve as a predictor by themselves including higher neurological level of injury and lack of manual pressure relief techniques. The clinical decision having a patient pressure mapped predicts that the wound may not heal at one year of discharge. The three wound treatment product predictors may represent characteristics of the wound. Further investigation on these clinical decision-making factors is warranted in utilizing treatment and healthcare recourses for SCI individuals hospitalized with PI. <h3>Author(s) Disclosures</h3> N/A.

Using Intervention Mapping to Develop a Workplace Digital Health Intervention for Preconception, Pregnant, and Postpartum Women: The Health in Planning, Pregnancy and Postpartum (HiPPP) Portal.

Digital health interventions that specifically target working women across the preconception, pregnancy and postpartum (PPP) life stages may address the unique barriers to engaging in healthy lifestyle behaviours and self-care during this life phase. This paper describes the development of a workplace digital health intervention to promote healthy lifestyles and wellbeing for PPP women working at a community service organization in Australia. Intervention Mapping is a framework that guides program development, implementation, and evaluation. Steps 1 to 5 of Intervention Mapping methodology (needs assessment through to program implementation) were used, including identification of determinants and change objectives across socioecological levels (i.e., individual, interpersonal, and organisational) and iterative co-design and stakeholder engagement processes. The workplace digital health intervention was successfully developed and implemented as an online portal. Content included key strategies, information, and supports to promote health and wellbeing across PPP, including supporting the return to work in the postpartum period. Examples of resource pages included a parental leave checklist, process flows, Pride resources, and Aboriginal and Torres Strait Islander resources. Findings from a pilot feasibility study indicate the portal was accessible and beneficial for women in PPP life stages. The Intervention Mapping protocol may offer a valuable roadmap for collaborative design of interventions targeting PPP women's behaviour and organisational work culture. Future work is needed to evaluate whether such interventions lead to improvements in women's health and wellbeing.

Reliability of multi-parameter mapping (MPM) in the cervical cord: A multi-center multi-vendor quantitative MRI study

MRI based multicenter studies which target neurological pathologies affecting the spinal cord and brain – including spinal cord injury (SCI) – require standardized acquisition protocols and image processing methods. We have optimized and applied a multi-parameter mapping (MPM) protocol that simultaneously covers the brain and the cervical cord within a traveling heads study across six clinical centers (Leutritz et al., 2020). The MPM protocol includes quantitative maps (magnetization transfer saturation (MT), proton density (PD), longitudinal (R1), and effective transverse (R2*) relaxation rates) sensitive to myelination, water content, iron concentration, and morphometric measures, such as cross-sectional cord area. Previously, we assessed the repeatability and reproducibility of the brain MPM data acquired in the five healthy participants who underwent two scan-rescans (Leutritz et al., 2020). This study focuses on the cervical cord MPM data derived from the same acquisitions to determine its repeatability and reproducibility in the cervical cord. MPM matrices of the cervical cord were generated and processed using the hMRI and the spinal cord toolbox. To determine reliability of the cervical MPM data, the intra-site (i.e., scan-rescan) coefficient of variation (CoV), inter-site CoV, and bias within region of interests (C1, C2 and C3 levels) were determined. The range of the mean intra- and inter-site CoV of MT, R1 and PD was between 2.5% and 12%, and between 1.1% and 4.0% for the morphometric measures. In conclusion, the cervical MPM data showed a high repeatability and reproducibility for key imaging biomarkers and hence can be employed as a standardized tool in multi-center studies, including clinical trials.

7548 “Second Parts Were Never Good:” Early Repeated Deep Infiltrating Endometriosis Surgery for Persistent Dyschezia

<h3>Study Objective</h3> To raise awareness of how complicated second and subsequent surgeries for deep infiltrating endometriosis are. To emphasize the relevance of good quality preoperative imaging when planning the first surgery for suspected DIE. <h3>Design</h3> Observational cohort study. <h3>Setting</h3> Single institution, Single-center endometriosis unit. <h3>Patients or Participants</h3> Five consecutive patients referred for persistent dyschezia after recent DIE surgery and postoperative hormonal support treatment with Dienogest. <h3>Interventions</h3> DIE imaging study protocol and second surgery by Endometriosis unit Surgical team. <h3>Measurements and Main Results</h3> Patients age ranged from 36 to 41 years. All 5 patients had previous DIE surgery within 12 months of referral/consultation in our unit. All patients presented with persistent dyschezia as their main complaint. Only one patient declared fertility desire. Previous surgical procedures included pelvic adhesiolysis (5), rectal shaving (3), subtotal hysterectomy (1), rectal segmental resection (1), unilateral adnexectomy (1) and unilateral oophorectomy. Imaging studies (Ultrasound Endometriosis systematic mapping protocol and pelvic contrasted MRI) depicted gross rectal nodules (1,5-4,5 cm), all of which had transmural rectal infiltration with variable distance to the anal verge (11-6 cm). All surgical procedures included rectal resection (2 discoid, 3 segmental), with 1 patient requiring a protective ileostomy. Operative time ranged from 150 to 210 minutes. All patients were discharged between 3-5 days. Follow up after surgery (8-20 months) show no late complications and no dyschezia recurrence. <h3>Conclusion</h3> An incomplete surgical excision of DIE rectal nodules can result in persistent dyschezia and prompt the need for further complex surgical procedures. We believe the first surgery for DIE should be preceded by an exhaustive clinical and imaging workup to plan an adequate personalized surgical procedure.

Using Intervention Mapping to develop an intervention to promote healthy child weight development

Abstract Background Clear documentation of the understanding of the problem, development process, and content of interventions is essential to understand why interventions succeed or fail. Transparent reporting will enable future researchers to build on previous evidence and replicate or adapt interventions for new contexts. This paper describes the theory- and evidence-based systematic development of the Bloom Trial - a home-based intervention to promote healthy weight development among infants and children in Denmark. Methods Development of the intervention is guided by the six-step planning tool the Intervention Mapping protocol. Step 1: Needs assessment including identification of risk factors in infancy and existing interventions, interviews with parents, and an organizational capacity assessment. Step 2: Development of program theory and matrices. Step 3: Selection of theoretical methods and practical applications for modifying personal and environmental determinants. Step 4: Development of intervention tools. Step 5: Planning of program adoption, implementation, and sustainability. Step 6: Generation of an evaluation plan. Results The Bloom intervention is universal but with a strong focus on families with low socio-economic position and non-Danish ethnic background. It is aimed at first-time parents and addresses early risk factors for child overweight such as parental skills and healthy habits related to food and meals, movement, screen time and sleep, and introduce a new theme: sense of security in the family. It will be integrated in existing services delivered by community health nurses supplemented with extra elements such as telephone consultations, family groups and a video library. Conclusions The transparency of the developmental process and theoretical, empirical, and contextual foundation of the Bloom Trial may enable future studies to build on our findings and accumulate knowledge to promote healthy weight development among infants and children. Key messages

Co-creating an intervention promoting healthy weight development during infancy

Abstract Background Childhood obesity is a major public health challenge, and it is recommended to promote healthy weight development already during infancy. It is important to co-create interventions to maximize the feasibility and thus improve the chances of successful implementation. This paper describes the co-creation process of the Danish Bloom Trial - an early intervention to promote healthy weight development among children of first-time parents. Methods Development of the trial is inspired by co-creation frameworks and the Intervention Mapping protocol. The co-creation process comprises three stages: 1) Evidence review, qualitative research with community health nurses (CHNs) and parents, and stakeholder consultations; 2) co-creation of the intervention content including workshops and group meetings with CHNs and other stakeholders and focus group discussions with parents; and 3) prototyping, feasibility- and pilot-testing. Currently, we are in stage 2 and have conducted four workshops with CHNs and one parent group discussion. Results During stage 1, we identified the intervention setting; the unique system of CHNs in Danish municipalities. Furthermore, we identified the need for developing intervention content focusing on nutrition, physical activity, sleep, screen time and sense of security to promote healthy child weight development. The main intervention components are a course for CHNs and guidelines on how to talk to parents about behavioral risk factors. The main components for parents are eight home visits and six telephone consultations from CHNs during pregnancy and until the child is 2½ years old and a video library. Conclusions The description of the development of the Bloom Trial provides an example of how to co-create an intervention balancing evidence, the practical work of the implementers and the needs of the families. Co-creation with relevant stakeholders increases the chances of producing a relevant, successful, and sustainable intervention. Key messages • The co-creation process resulted in development of intervention content focusing on nutrition, physical activity, sleep, screen time and sense of security from pregnancy to child age 2½ years. • Involving parents and stakeholders in the development of an intervention increases the chances of producing a relevant, successful, and sustainable intervention.

Group sleep intervention with adolescents attending a pupil referral unit using youth participation methodology: A report of the development of an intervention in practice

AbstractThis report of the development of an intervention in practice outlines the design, delivery, and evaluation of a tailored, school‐based, group adolescent sleep intervention utilising youth participation methodology and an intervention mapping protocol as a framework. The intervention also included supplementary video support. The intervention was delivered to 5‐year 11 students attending a pupil referral unit. This alternative education provision is organised to provide education for young people who cannot participate in school and may not otherwise receive suitable education in Britain. Through co‐formulation and cooperative design, the voice of the young people was sought throughout the design, implementation, and evaluation process. The behavioural objectives of the intervention were to increase stress management techniques and reduce technology usage. These were chosen to align with the overall outcomes: improving sleep behaviours and reducing negative sleep hygiene practices. Improvements in sleep behaviour and decreases in negative sleep hygiene practices were achieved post‐intervention and at 4‐month follow‐up. Strengths of the intervention, future intervention optimisation, and implications for practice are considered.

Developing the "Choosing Health" Digital Weight Loss and Maintenance Intervention: Intervention Mapping Study.

Digital health promotion programs tailored to the individual are a potential cost-effective and scalable solution to enable self-management and provide support to people with excess body weight. However, solutions that are widely accessible, personalized, and theory- and evidence-based are still limited. This study aimed to develop a digital behavior change program, Choosing Health, that could identify modifiable predictors of weight loss and maintenance for each individual and use these to provide tailored support. We applied an Intervention Mapping protocol to design the program. This systematic approach to develop theory- and evidence-based health promotion programs consisted of 6 steps: development of a logic model of the problem, a model of change, intervention design and intervention production, the implementation plan, and the evaluation plan. The decisions made during the Intervention Mapping process were guided by theory, existing evidence, and our own research-including 4 focus groups (n=40), expert consultations (n=12), and interviews (n=11). The stakeholders included researchers, public representatives (including individuals with overweight and obesity), and experts from a variety of relevant backgrounds (including nutrition, physical activity, and the health care sector). Following a structured process, we developed a tailored intervention that has the potential to reduce excess body weight and support behavior changes in people with overweight and obesity. The Choosing Health intervention consists of tailored, personalized text messages and email support that correspond with theoretical domains potentially predictive of weight outcomes for each participant. The intervention content includes behavior change techniques to support motivation maintenance, self-regulation, habit formation, environmental restructuring, social support, and addressing physical and psychological resources. The use of an Intervention Mapping protocol enabled the systematic development of the Choosing Health intervention and guided the implementation and evaluation of the program. Through the involvement of different stakeholders, including representatives of the general public, we were able to map out program facilitators and barriers while increasing the ecological validity of the program to ensure that we build an intervention that is useful, user-friendly, and informative. We also summarized the lessons learned for the Choosing Health intervention development and for other health promotion programs. RR2-10.1136/bmjopen-2020-040183.

Using a lightweight security mechanism to detect and localize jamming attack in wireless sensor networks

Recent years have seen a rise in the popularity of the Internet of Things (IoT) and its applications, due to its adaptability, usability, varied application potential, and ease of deployment. On the other hand, security threats get more attention. Where wireless sensor networks (WSN), which is the core of IoT, are vulnerable to the jammer's attack due to the fact that they are shared and have open access to a wireless channel. Moreover, the difficult conditions in which nodes are distributed, such as underwater, fires, volcanoes, animal habitats, or battlefields, node localization is a significant challenge for the majority of WSN applications. Additionally, the lack of accuracy in traditional localization algorithms has prompted researchers to propose optimization techniques capable of improving localization accuracies, such as genetic algorithms, gravitational search algorithms, neural networks, and deep learning; however, these techniques require additional hardware to perform their complex calculations. On the other side, uncomplicated algorithms like Virtual Force Iteration Localization (VFIL), Weighted Centroid Localization (WCL), and Centroid Localization (CL) are less accurate. To bridge that gap, this work proposes a lightweight algorithm for accurately locating the jammer's coordinates. Our algorithm consists of three phases firstly, a simple way to detect a jamming attack. Second novel designed technique to draw the jammed region using the mapping protocol. Moreover, a range-free technique is proposed to locate the jammer based on geometric calculations. Finally, A set of simulation experiments was undertaken to assess the suggested algorithm's performance. Experiments reveal that the suggested method is capable of precisely locating the jammer. Additionally, the presented method demonstrates superior efficiency in comparison to existing methods.

S3624 Incidental Finding of Gastric Signet Ring Cell Carcinoma: A Case Report

Introduction: The incidence of Gastric signet ring cell carcinoma (GSRC) has been on the rise in the United States (U.S.). GSRC is estimated to account for approximately 8% to 30% of all gastric cancers in the U.S., and despite this increase in cases, there are no population-wide screening guidelines allowing for early detection. It is notable that GSRC is typically not diagnosed until it has already reached an aggressive stage with a poor prognosis and low chemosensitivity. In this case, we present a patient with a family history of gastric cancer who was incidentally found to have early-stage GSRC on random gastric biopsies taken on endoscopy. Case Description/Methods: A 48-year-old male with family history of gastric cancer in his sibling presented for routine colonscopy. Although asymptomatic, he had an upper esophagogastroduodenoscopy (EGD) at the time of colonoscopy due to interest in screening for cancer. The patient was noted to have mild antral gastritis and gastric biopsies were taken at the time of the procedure. On random 0.7 mm gastric biopsies, the pathology was consistent with GSRC. He then underwent a subsequent EGD with mapping protocol in which biopsies were obtained from the incisura, antrum (lesser and greater curvature), and corpus (lesser and greater curvature). The lesion was found to be restricted to the antrum and he underwent a partial gastrectomy to prevent progression of disease. Discussion: This case describes an asymptomatic patient found to have GSRC on endoscopic biopsies at a time that allowed for early intervention. Currently, there are no definitive guidelines for screening gastric cancer or metaplastic changes in the U.S., placing the decision-making burden onto the physician. In the setting of increasing incidence of gastric cancer in the U.S., establishing and broadening guidelines for screening patients who are at higher risk than the average population, notably those with family history, male sex, tobacco use, and of certain ethnicities, is becoming increasingly important. The odds ratio of a first-degree relative developing gastric cancer is estimated to be anywhere from 2 to 10 depending on the corresponding risk factors and demographics of the patient. Further research is warranted for the development of screening protocols that can guide gastroenterologists on endoscopically screening for metaplastic or cancerous lesions of the stomach. Such guidelines have become a public health necessity given the astoundingly high morbidity and mortality rates of this cancer.