Opportunities For Intervention Research Articles

Exploring early life social and executive function development in infants and risk for autism: a prospective cohort study protocol of NICU graduates and infants at risk for cerebral palsy

BackgroundDelays in early social and executive function are predictive of later developmental delays and eventual neurodevelopmental diagnoses. There is limited research examining such markers in the first year of life. High-risk infant groups commonly present with a range of neurodevelopmental challenges, including social and executive function delays, and show higher rates of autism diagnoses later in life. For example, it has been estimated that up to 30% of infants diagnosed with cerebral palsy (CP) will go on to be diagnosed with autism later in life.MethodsThis article presents a protocol of a prospective longitudinal study. The primary aim of this study is to identify early life markers of delay in social and executive function in high-risk infants at the earliest point in time, and to explore how these markers may relate to the increased risk for social and executive delay, and risk of autism, later in life. High-risk infants will include Neonatal Intensive Care Unit (NICU) graduates, who are most commonly admitted for premature birth and/or cardiovascular problems. In addition, we will include infants with, or at risk for, CP. This prospective study will recruit 100 high-risk infants at the age of 3–12 months old and will track social and executive function across the first 2 years of their life, when infants are 3–7, 8–12, 18 and 24 months old. A multi-modal approach will be adopted by tracking the early development of social and executive function using behavioural, neurobiological, and caregiver-reported everyday functioning markers. Data will be analysed to assess the relationship between the early markers, measured from as early as 3–7 months of age, and the social and executive function as well as the autism outcomes measured at 24 months.DiscussionThis study has the potential to promote the earliest detection and intervention opportunities for social and executive function difficulties as well as risk for autism in NICU graduates and/or infants with, or at risk for, CP. The findings of this study will also expand our understanding of the early emergence of autism across a wider range of at-risk groups.

THE PREVALENCE OF SPECIAL NEEDS CHILDREN IN TWO SELECTED LOCAL GOVERNMENTS IN KADUNA STATE, NIGERIA

It is imperative that all children must be educated irrespective of their disability. This can only be possible if their disability is identified early enough for proper intervention. The identification of learners with special needs can help limit future academic challenges and also provide the opportunity for the right kind intervention hence, this study sought to determine the existence of learners with Special Educational Needs in two selected Local Government (LG) of Kaduna State which are Kaduna North and Kaduna South. The study was guided by three objectives; first to identify the existence of different categories of Special Need learners in regular public primary schools. Secondly, to ascertain the percentage of each category of learners with Special needs in public primary schools and finally, to determine the gender distribution of the different categories of identified learners with Special Needs in regular public primary schools in Kaduna state. A simple random sampling method was used to select a sample of forty one (41) schools was selected from seventy seven (77) public primary schools of both Kaduna North and Kaduna South LG. The instruments for data collection comprise of a checklist and an open ended questionnaire; both instruments were pilot-tested. The data gathered was inputted into Statistical Package for Social Sciences (SPSS) Version 27 and analyzed using descriptive statistic. The data revealed that eight (8) categories of learners with special needs were identified in public primary schools in Kaduna North and Kaduna South. The study also discovered a higher percentage of learners with learning Disabilities in all schools in both LG, also the gender distribution of learners with special needs revealed that more boys have one form of disability or the other. The study therefore recommended that the state Government should employ specialists to manage these learners and augment this by training regular teachers. KEYWORDS: learners, special needs, public schools, identification, gender

How do we understand the value of drug checking as a component of harm reduction services? A qualitative exploration of client and provider perspectives

BackgroundMortality related to opioid overdose in the U.S. has risen sharply in the past decade. In California, opioid overdose death rates more than tripled from 2018 to 2021, and deaths from synthetic opioids such as fentanyl increased more than seven times in those three years alone. Heightened attention to this crisis has attracted funding and programming opportunities for prevention and harm reduction interventions. Drug checking services offer people who use drugs the opportunity to test the chemical content of their own supply, but are not widely used in North America. We report on qualitative data from providers and clients of harm reduction and drug checking services, to explore how these services are used, experienced, and considered.MethodsWe conducted in-depth semi-structured key informant interviews across two samples of drug checking stakeholders: “clients” (individuals who use drugs and receive harm reduction services) and “providers” (subject matter experts and those providing clinical and harm reduction services to people who use drugs). Provider interviews were conducted via Zoom from June-November, 2022. Client interviews were conducted in person in San Francisco over a one-week period in November 2022. Data were analyzed following the tenets of thematic analysis.ResultsWe found that the value of drug checking includes but extends well beyond overdose prevention. Participants discussed ways that drug checking can fill a regulatory vacuum, serve as a tool of informal market regulation at the community level, and empower public health surveillance systems and clinical response. We present our findings within three key themes: (1) the role of drug checking in overdose prevention; (2) benefits to the overall agency, health, and wellbeing of people who use drugs; and (3) impacts of drug checking services at the community and systems levels.ConclusionThis study contributes to growing evidence of the effectiveness of drug checking services in mitigating risks associated with substance use, including overdose, through enabling people who use and sell drugs to test their own supply. It further contributes to discussions around the utility of drug checking and harm reduction, in order to inform legislation and funding allocation.

Patterns and correlates of health service contact prior to serious offences by people with severe mental illness.

Contact with health services prior to offences committed by people with mental illness is an opportunity for intervention and prevention. This study examines the pattern and correlates of health service contact by people with severe mental illness before a serious offence. Linkage of a cohort of 477 Forensic Patients found not guilty due to mental illness between 1990 and 2016, and statewide databases of contact with emergency departments, hospital admission and outpatient mental health services in the state of New South Wales, Australia. A total of 84% of the sample had contact with any health service and 76% had contact with an outpatient mental health service prior to the index offence. About two-thirds of the sample had contact with a mental health service in the year before the offence. Factors independently associated with the absence of contact at any point prior to the index offence were non-English-speaking background, being engaged in employment or study, and an absence of childhood abuse or neglect. Although nearly every Forensic Patient had a psychotic illness at the time of the index offence, psychosis was not diagnosed at the time of 61/106 (57.5%) emergency department presentations, in 54/174 (31.0%) hospital admissions and 149/222 (67.1%) attendances at outpatient mental health services prior to the offence. Most Forensic Patients had contact with health services prior to their offences but many were not identified as having a psychotic illness. Although the symptoms of psychosis may have emerged in the period between contact and the offence, the findings suggest that emerging or underlying psychosis were missed or attributed to other conditions.

Keratin 17 modulates the immune topography of pancreatic cancer

BackgroundThe immune microenvironment impacts tumor growth, invasion, metastasis, and patient survival and may provide opportunities for therapeutic intervention in pancreatic ductal adenocarcinoma (PDAC). Although never studied as a potential modulator of the immune response in most cancers, Keratin 17 (K17), a biomarker of the most aggressive (basal) molecular subtype of PDAC, is intimately involved in the histogenesis of the immune response in psoriasis, basal cell carcinoma, and cervical squamous cell carcinoma. Thus, we hypothesized that K17 expression could also impact the immune cell response in PDAC, and that uncovering this relationship could provide insight to guide the development of immunotherapeutic opportunities to extend patient survival.MethodsMultiplex immunohistochemistry (mIHC) and automated image analysis based on novel computational imaging technology were used to decipher the abundance and spatial distribution of T cells, macrophages, and tumor cells, relative to K17 expression in 235 PDACs.ResultsK17 expression had profound effects on the exclusion of intratumoral CD8+ T cells and was also associated with decreased numbers of peritumoral CD8+ T cells, CD16+ macrophages, and CD163+ macrophages (p < 0.0001). The differences in the intratumor and peritumoral CD8+ T cell abundance were not impacted by neoadjuvant therapy, tumor stage, grade, lymph node status, histologic subtype, nor KRAS, p53, SMAD4, or CDKN2A mutations.ConclusionsThus, K17 expression correlates with major differences in the immune microenvironment that are independent of any tested clinicopathologic or tumor intrinsic variables, suggesting that targeting K17-mediated immune effects on the immune system could restore the innate immunologic response to PDAC and might provide novel opportunities to restore immunotherapeutic approaches for this most deadly form of cancer.

Association between life’s essential 8 and frailty status among cancer survivors in the United States: a cross-sectional analysis

BackgroundFrailty not only affects disease survival but also impacts the long-term function and quality life of all adults diagnosed with and/or treated for cancer.The American Heart Association has introduced Life’s Essential 8 (LE8) as a novel metric for assessing cardiovascular health. Currently, LE8’s application in evaluating the frailty of cancer survivors remains unreported. This research seeks to explore the connection between LE8 scores and frailty levels in cancer survivors across the United States, thereby addressing a significant void in existing studies.MethodsThis study analyzed data from cancer survivors enrolled in the National Health and Nutrition Examination Surveys (NHANES) spanning the years 2005 to 2018, providing a comprehensive dataset. Multivariable logistic regression models were used to examine the linkage between LE8 rankings and frailty condition in cancer survivors. Furthermore, the study delved deeper into this correlation using restricted cubic spline (RCS) curves and subgroup analyses.ResultsIn the fully adjusted model, an increased LE8 level was closely associated with a reduced odds ratio of frailty among cancer survivors, with an OR of 0.95 (95% CI: 0.94–0.96, p < 0.0001).This pattern persisted across different categorizations of LE8 into low, moderate, and high groups, demonstrating a consistent trend. The analysis revealed a non-linear relationship between LE8 scores and frailty status, further supporting a straightforward association (p-value for non-linearity = 0.0729).ConclusionStudies have found that the higher the LE8 score, the less likely a cancer patient is to develop debilitating symptoms.This indicates that the LE8 scores may provide an opportunity for interventions aimed at improving the prognosis of cancer patients.

The cyclical cascade of HIV care: Temporal care engagement trends within a population-wide cohort.

The traditional HIV treatment cascade aims to visualise the journey of each person living with HIV from diagnosis, through initiation on antiretroviral therapy (ART) to treatment success, represented by virological suppression. This representation has been a pivotal tool in highlighting and quantifying sequential gaps along the care continuum. There is longstanding recognition, however, that this may oversimplify the complexity of real-world engagement with HIV services in settings with mature high-burden HIV epidemics. A complementary "cyclical" cascade has been proposed to represent the processes of disengagement at different points on the care continuum, with multiple pathways to re-engagement, although the feasibility of implementing this at scale has been uncertain. This study aimed to populate, refine, and explore the utility of a cyclical representation of the HIV cascade, using routine data from a high-burden HIV setting. This observational cohort study leveraged person-level data on all people living with HIV in the Western Cape (WC), South Africa, who accessed public health services in the 2 years prior to 31 December 2023. Programme data from disease registers were complemented by data from pharmacy and laboratory systems. At study closure, 494 370 people were included, constituting 93% of those of those estimated to be living with HIV in the province, of whom 355 104 were on ART. Substantial disengagement from HIV care was evident at every point on the cascade. Early treatment emerged as a period of higher risk of disengagement, but it did not account for the majority of disengagement. Almost all those currently disengaged had prior experience of treatment. While re-engagement was also common, overall treatment coverage had increased slowly over 5 years. The transition to dolutegravir-based regimens was dramatic with good virological outcomes for those in care, notwithstanding a clearly discernible impact of the Coronavirus Disease 2019 (COVID-19) pandemic on viral load (VL) testing. People currently engaged and disengaged in care are similar with respect to age and gender. Those who died or disengaged recently were previously distributed across a range of cascade statuses, and a substantial proportion of those newly initiating and re-initiating treatment were no longer on treatment 6 months later. The main limitation of this study was incomplete evidence of HIV testing, linkage to HIV-specific services, and out-of-facility mortality. Using routine data, it was possible to populate and automate a cyclical cascade of HIV care that continuously captured the nonlinear care journeys of individuals living with HIV. In this generalised mature HIV epidemic, most people are treatment experienced. Disengagement is common and occurs at various points along the cascade, making it challenging to identify high-impact intervention opportunities. While historical HIV cascades remain valuable for target setting and service monitoring, they can be complemented with insights from more detailed cyclical cascades.

Increases in Awareness and Uptake of Dating Apps’ Sexual Health Features Among US Men Who Have Sex with Men, 2018 to 2021

AbstractDating apps are now used by the majority of MSM to meet sexual and romantic partners. While research has demonstrated an association between app use and greater number of sex partners and STIs, dating apps also pose an opportunity for intervention. By advocating for new and improved sexual health features on dating apps, Building Healthy Online Communities (BHOC) aims to increase communication about sexual health on the apps. As a follow-up to our previous paper assessing the uptake of sexual health-related profile options on dating apps through Emory’s annual survey of 10,000 MSM in the US, BHOC and Emory partnered to explore the change in uptake over time, again through their annual survey. Among survey participants in 2021, 85% reported using dating apps to meet a partner in the past year, and among this group, 93% reported awareness of sexual health features, up from 77% in 2018 (p &lt; 0.0001). 71% of app users who were aware of features in 2021 reported using one or more sexual health feature, up from 61% in 2018 (p &lt; 0.0001). BHOC will continue to advocate for increased uptake of these features, especially among subgroups with lower levels of uptake.

Development of Inhibitors, Probes, and PROTAC Provides a Complete Toolbox to Study PARK7 in the Living Cell.

The integration of diverse chemical tools like small-molecule inhibitors, activity-based probes (ABPs), and proteolysis targeting chimeras (PROTACs) advances clinical drug discovery and facilitates the exploration of various biological facets of targeted proteins. Here, we report the development of such a chemical toolbox for the human Parkinson disease protein 7 (PARK7/DJ-1) implicated in Parkinson's disease and cancers. By combining structure-guided design, miniaturized library synthesis, and high-throughput screening, we identified two potent compounds, JYQ-164 and JYQ-173, inhibiting PARK7 in vitro and in cells by covalently and selectively targeting its critical residue, Cys106. Leveraging JYQ-173, we further developed a cell-permeable Bodipy probe, JYQ-196, for covalent labeling of PARK7 in living cells and a first-in-class PARK7 degrader JYQ-194 that selectively induces its proteasomal degradation in human cells. Our study provides a valuable toolbox to enhance the understanding of PARK7 biology in cellular contexts and opens new opportunities for therapeutic interventions.

SERPINE1: Role in Cholangiocarcinoma Progression and a Therapeutic Target in the Desmoplastic Microenvironment

A heterogenous population of inflammatory elements, other immune and nonimmune cells and cancer-associated fibroblasts (CAFs) are evident in solid malignancies where they coexist with the growing tumor mass. In highly desmoplastic malignancies, CAFs are the prominent mesenchymal cell type in the tumor microenvironment (TME), where their presence and abundance signal a poor prognosis. CAFs play a major role in the progression of various cancers by remodeling the supporting stroma into a dense, fibrotic matrix while secreting factors that promote the maintenance of cancer stem-like characteristics, tumor cell survival, aggressive growth and metastasis and reduced sensitivity to chemotherapeutics. Tumors with high stromal fibrotic signatures are more likely to be associated with drug resistance and eventual relapse. Identifying the molecular underpinnings for such multidirectional crosstalk among the various normal and neoplastic cell types in the TME may provide new targets and novel opportunities for therapeutic intervention. This review highlights recent concepts regarding the complexity of CAF biology in cholangiocarcinoma, a highly desmoplastic cancer. The discussion focuses on CAF heterogeneity, functionality in drug resistance, contributions to a progressively fibrotic tumor stroma, the involved signaling pathways and the participating genes.

Trends of Antihypertensive Prescription Among US Adults From 2010 to 2019 and Changes Following Treatment Guidelines: Analysis of Multicenter Electronic Health Records.

Guidelines for the use of antihypertensives changed in 2014 and 2017. To understand the effect of these guidelines, we examined trends in antihypertensive prescriptions in the United States from 2010 to 2019 using a repeated cross-sectional design. Using electronic health records from 15 health care institutions for adults (20-85 years old) who had ≥1 antihypertensive prescription, we assessed whether (1) prescriptions of beta blockers decreased after the 2014 Eighth Joint National Committee (JNC 8) report discouraged use for first-line treatment, (2) prescriptions for calcium channel blockers and thiazide diuretics increased among Black patients after the JNC 8 report encouraged use as first-line therapy, and (3) prescriptions for dual therapy and fixed-dose combination among patients with blood pressure ≥140/90 mm Hg increased after recommendations in the 2017Hypertension Clinical Practice Guidelines. The study included 1 074 314 patients with 2 133 158 prescription episodes. After publication of the JNC 8 report, prescriptions for beta blockers decreased (3% lower in 2018-2019 compared to 2010-2014), and calcium channel blockers increased among Black patients (20% higher in 2015-2017 and 41% higher in 2018-2019, compared to 2010-2014), in accordance with guideline recommendations. However, contrary to guidelines, dual therapy and fixed-dose combination decreased after publication of the 2017 Hypertension Clinical Practice Guidelines(9% and 11% decrease in 2018-2019 for dual therapy and fixed-dose combination, respectively, compared to 2015-2017), and thiazide diuretics decreased among Black patients after the JNC8 report (6% lower in 2018-2019 compared to 2010-2014). Adherence to guidelines on prescribing antihypertensive medication was inconsistent, presenting an opportunity for interventions to achieve better blood pressure control in the US population.

Co‐designing enduring learning analytics prediction and support tools in undergraduate biology courses

AbstractEven highly motivated undergraduates drift off their STEM career pathways. In large introductory STEM classes, instructors struggle to identify and support these students. To address these issues, we developed co‐redesign methods in partnership with disciplinary experts to create high‐structure STEM courses that better support students and produce informative digital event data. To those data, we applied theory‐ and context‐relevant labels to reflect active and self‐regulated learning processes involving LMS‐hosted course materials, formative assessments, and help‐seeking tools. We illustrate the predictive benefits of this process across two cycles of model creation and reapplication. In cycle 1, we used theory‐relevant features from 3 weeks of data to inform a prediction model that accurately identified struggling students and sustained its accuracy when reapplied in future semesters. In cycle 2, we refit a model with temporally contextualized features that achieved superior accuracy using data from just two class meetings. This modelling approach can produce durable learning analytics solutions that afford scaled and sustained prediction and intervention opportunities that involve explainable artificial intelligence products. Those same products that inform prediction can also guide intervention approaches and inform future instructional design and delivery.Practitioner notesWhat is already known about this topic Learning analytics includes an evolving collection of methods for tracing and understanding student learning through their engagements with learning technologies. Prediction models based on demographic data can perpetuate systemic biases. Prediction models based on behavioural event data can produce accurate predictions of academic success, and validation efforts can enrich those data to reflect students' self‐regulated learning processes within learning tasks. What this paper adds Learning analytics can be successfully applied to predict performance in an authentic postsecondary STEM context, and the use of context and theory as guides for feature engineering can ensure sustained predictive accuracy upon reapplication. The consistent types of learning resources and cyclical nature of their provisioning from lesson to lesson are hallmarks of high‐structure active learning designs that are known to benefit learners. These designs also provide opportunities for observing and modelling contextually grounded, theory‐aligned and temporally positioned learning events that informed prediction models that accurately classified students upon initial and later reapplications in subsequent semesters. Co‐design relationships where researchers and instructors work together toward pedagogical implementation and course instrumentation are essential to developing unique insights for feature engineering and producing explainable artificial intelligence approaches to predictive modelling. Implications for practice and/or policy High‐structure course designs can scaffold student engagement with course materials to make learning more effective and products of feature engineering more explainable. Learning analytics initiatives can avoid perpetuation of systemic biases when methods prioritize theory‐informed behavioural data that reflect learning processes, sensitivity to instructional context and development of explainable predictors of success rather than relying on students' demographic characteristics as predictors. Prioritizing behaviours as predictors improves explainability in ways that can inform the redesign of courses and design of learning supports, which further informs the refinement of learning theories and their applications.

Abstract PO3-08-01: Decision curve analysis to compare breast cancer risk predictions for a polygenic integrated clinical risk model with those of a gold standard

Abstract Risk-based guidelines have been developed to provide advice on options that are available to women who are at increased risk of breast cancer. We and others are focused on improving risk prediction models for general population use. For breast cancer, polygenic risk has been identified as important for risk prediction, especially when combined with clinical risk factors such as family history, anthropometric measures, breast imaging measures, and hormonal and reproductive risk factors. When comparing the performance of risk prediction models, the AUC is most often used but it focuses on performance in terms of distinguishing between affected and unaffected individuals and does not take into account differences in the specificity (true negative rate) and sensitivity (true positive rate) of the models being compared. In contrast, decision curve analysis takes sensitivity and specificity into account and enables the comparison of the net benefit of risk prediction tools at the clinical risk thresholds that are used to guide clinical management decisions. Herein, we use decision curve analysis to compare breast cancer risk prediction guidelines for BRISK and the Breast Cancer Risk Assessment Tool (BCRAT) in the UK Biobank, and for BRISK and IBIS version 7 in the Nurses’ Health Study. We evaluated the net benefit at the 5-year risk thresholds (1.67% and 3%) that are used to guide clinical management decisions around risk-reducing medication and at the remaining lifetime risk of 20% that is used to guide supplemental MRI surveillance. In the UK Biobank, BRISK showed a net benefit over BCRAT at the 5-year risk thresholds of 1.67% and 3.0%. The AUCs were 0.649 (95% CI = 0.640, 0.695) for BRISK and 0.567 (95% CI = 0.556, 0.577) for BCRAT and showed that, overall, BRISK discriminated between affected and unaffected women better than BCRAT (P &amp;lt; 0.001). In the Nurses’ Health Study, BRISK showed a net benefit over IBIS at the remaining lifetime risk threshold of 20%. The AUCs were 0.647; 95% CI = 0.627, 0.668 for BRISK and 0.571; 95% CI = 0.546, 0.595 for IBIS, a statistically significant improvement for BRISK over IBIS (P &amp;lt; 0.0001). We also looked at sensitivity, specificity, positive predictive value and negative predictive value even though these risk models are one-step removed from breast cancer diagnosis by screening/risk-reduction options. The positive predictive values are higher for the BRISK (27.1%) model compared to BCRAT (5.5%) in the UK Biobank dataset and higher for BRISK (15.4%) compared to IBISv7 (14.0%) in the Nurses’ dataset. We have shown the application of a statistical tool that can be used to directly compare risk models at clinically relevant thresholds. We have shown that BRISK, which comprises polygenic risk and clinical risk factors, shows higher net benefit at both 1.67% and 3% thresholds compared to BCRAT and at 20% remaining lifetime risk for IBIS version 7. In breast cancer risk prediction, a tool with high specificity (and therefore a necessary trade-off for low sensitivity) is preferred because we do not want to incorrectly classify women as not being at high risk and deny them the opportunity for intervention in the form of more frequent screening, alternative modes of screening or risk-reducing medication. This improvement in general population risk stratification that BRISK can provide has the potential to have a clinically significant effect on women’s health. Citation Format: Erika Spaeth, Bernard A Rosner, Gill Dite. Decision curve analysis to compare breast cancer risk predictions for a polygenic integrated clinical risk model with those of a gold standard [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 PO3-08-01.

Highlight of 2023: Unlocking the therapeutic potential of natural killer cells-advances in adaptive functions, cellular engineering and immunotherapy.

Natural killer (NK) cells possess potent cytotoxicity against infected and cancerous cells and hold promise in the development of new immunotherapies. This article for the Highlights of 2023 Series focuses on current advances in NK cell biology in cancerous and infectious settings and highlights opportunities for therapeutic interventions, including engineered NK cell therapies and advancements in feeder cell technologies.

Children dually involved with statutory child protection and juvenile justice in Australia: A developmental cascade framework

Children who experience dual involvement by child protection and juvenile justice statutory systems have poorer life outcomes attributable to higher levels of disadvantage and more complex needs compared to single system involved children. Literature regarding dual involved children in high income, western, and democratic nations are largely based on US studies. Whilst child protection and juvenile justice systems across the United States, United Kingdom, Canada, New Zealand, and Australia have somewhat similar legislative systems, cohort outcomes and relationships between risk factors and offending trajectories for dual involved children are influenced by differing legislative, geographic, and demographic contexts. Compared to international literature, significant gaps exist regarding the Australian context. Further, within Australia, there are no evaluated specific responses and/or strategies directed towards supporting this highly vulnerable cohort towards increased long-term positive outcomes. This is the first comprehensive review of Australian studies that examines the characteristics of children who have had dual involvement with juvenile justice and child protection agencies within Australia. Using a thematic analysis twenty-five studies with dual involved samples were analysed, examining the individual, familial, environmental, and systemic factors that contribute to the likelihood of children becoming involved in both child protection and juvenile justice systems within Australia. Six thematic factors emerged that characterised the trajectories of dual involved children: cumulative and destabilising adversity; maltreatment timing and type; offending onset and context; educational disadvantage and disengagement; co-occurring challenges; and First Nations overrepresentation. Our findings are applied to Developmental Systems Theory, extending on previous literature to depict an Australian first developmental cascade framework illustrating the context specific pathways of dual involved children and opportunities for intervention in Australia. The discussion highlights and compares differences between Australian and international contexts with the intention of emphasising key areas for future research, and policy and practice reform. This is important because of the nuanced differences between dual involved characteristics across different legislative and geographic contexts, with particular relevance to the experiences of First Nations children and families. Future research, policy and practice would benefit from continued reforms that focus resources on co-ordinated system responses and cohort specific services; namely, culturally appropriate diversion strategies that promote behavioural de-escalation and educational engagement.

Postoperative venous thromboembolism risk in patients with vulvar carcinoma: An analysis of the National surgical Quality Improvement Program (NSQIP) database

ObjectivesDue to low incidence of vulvar cancer (VC), incidence and predictors for development of venous thromboembolism (VTE) are poorly understood. We examined incidence and risk factors associated with VTE in patients undergoing surgery for VC. MethodsWe included patients who underwent surgery for VC from the National Surgical Quality Improvement Program database. VTE within the 30-day postoperative period was captured with Current Procedural Terminology codes. Baseline demographics and clinical characteristics were compared between patients with and without VTE. Univariable and multivariable-adjusted exact logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between risk factors and VTE. ResultsWe identified 1414 patients undergoing procedures for VC from the NSQIP database. Overall, 11 (0.8 %) patients developed VTE. Univariable predictors of VTE included surgery type [compared with simple vulvectomy: radical vulvectomy only (OR = 7.97, 95 % CI = 1.44, infinity) and radical vulvectomy plus unilateral IFN (OR = 15.98, 95 % CI = 2.70, infinity)], unplanned readmission (OR = 11.56, 95 % CI = 2.74, 46.38), deep surgical site infection (OR = 16.05, 95 % CI = 1.59–85.50), and preoperative thrombocytosis (OR = 6.53, 95 % CI = 0.00, 34.86). In a multivariable-adjusted model, longer operative time (≥72 min OR = 11.33, 95 % CI = 1.58–499.03) and preoperative functional status [compared with complete independence: total dependence (OR = 53.88, 95 % CI = 0.85, infinity) and partial dependence (OR = 53.88, 95 % CI = 0.85, infinity)] were associated with VTE. ConclusionIn this cohort of patients with VC undergoing radical vulvectomy, VTE incidence was low. Surgery type, longer operative time, dependent functional status, and wound disruption were identified as risk factors. Our findings highlight opportunities for prophylactic intervention in certain patients.

SUPPORTING PEOPLE WITH NEUROLOGICAL INJURY TO ENGAGE IN PHYSICAL ACTIVITY-FROM HOSPITAL TO HOME AND BEYOND

Accredited exercise physiologists are perfectly placed to assist people with neurological injury to reengage or explore new opportunities in physical activity. The benefits of physical activity in this population are well documented, however participation rates are low. Research shows that 75% of Australians living with a disability over the age of 15 do not meet the recommended levels of physical activity. While the need is high, the 2021-2022 ESSA workforce report found only 7% of accredited professionals are working with people living with neurological conditions. This highlights the gap between industry demand, workforce capacity and capability to deliver evidence based best practice. As clinicians with a collective experience of 30+ years, we have identified a need for greater dissemination of knowledge, experience, and practical translation of the evidence in this population. This presentation will explore the perspectives of three experienced AEP’s working from hospital to home and beyond. Each presenter will draw on their unique context and experience to describe the challenges and opportunities for AEP’s in each specific area. Sarah will provide an overview of the hospital setting and transition to community, highlighting the opportunities for early intervention and the role in supporting ongoing meaningful physical activity. Holly will discuss an exercise physiologist’s role in community rehabilitation, and our place in a multidisciplinary team. She will further explore what it looks like to move from exercise for rehabilitation mindset, into exercise for life. Emma will detail the opportunities in sports and competitions such as the Paralympics, particularly around how AEP’s can support performance goals. The team will close with provocative discussion around how AEP’s can contribute to the governments ELEVATE 2042 Strategy and we will invite AEP’s to join us on this journey.

Conceptual framework for preterm birth review in San Francisco

Preterm birth persists as a leading cause of infant mortality and morbidity despite decades of intervention effort. Intervention null effects may reflect failure to account for social determinants of health (SDH) or jointly acting risk factors. In some communities, persistent preterm birth trends and disparities have been consistently associated with SDH such as race/ethnicity, zip code, and housing conditions. Health authorities recommend conceptual frameworks for targeted action on SDH and precision public health approaches for preterm birth prevention. We document San Francisco, California’s experience identifying the need, rationale, methods, and pilot work for developing a conceptual framework for preterm birth review (PTBR) in San Francisco. The PTBR conceptual framework is intended to enable essential public health services in San Francisco that prevent a range of preterm birth phenotypes by guiding plans for data collection, hypothesis testing, analytical methods, reports, and intervention strategy. Key elements of the PTBR conceptual framework are described including, 10 domains of SDH, 9 domains at the whole person level, such as lived experience and health behaviors, 8 domains at the within-person level, such as biomarkers and clinical measures, 18 preterm birth phenotypes, and the interconnections between domains. Assumptions for the PTBR conceptual framework were supported by a scoping review of literature on SDH effects on preterm birth, health authority consensus reports, and PTBR pilot data. Researcher and health authority interest in each of the domains warrants the framework to prompt systematic consideration of variables in each proposed domain. PTBR pilot data, illustrated in heatmaps, confirm the feasibility of data collection based on the framework, prevalence of co-occurring risk factors, potential for joint effects on specific preterm birth phenotypes, and opportunity for intervention to block SDH effects on preterm birth. The proposed PTBR conceptual framework has practical implications for specifying (1) population groups at risk, (2) grids or heatmap visualization of risk factors, (3) multi-level analyses, and (4) multi-component intervention design in terms of patterns of co-occurring risk factors. Lessons learned about PTBR data collection logistics, variable choice, and data management will be incorporated into future work to build PTBR infrastructure based on the PTBR conceptual framework.

"WOOP is my safe haven": A qualitative feasibility and acceptability study of the Wish Outcome Obstacle Plan (WOOP) intervention for spouses of people living with early-stage dementia.

As symptoms emerge and worsen in people living with dementia, their spouses can benefit from behavioral interventions to support their adjustment as a care partner. The Wish Outcome Obstacle Plan (WOOP) intervention improves the well-being of spouses of people living with dementia early in the disease course, but intervention mechanisms and opportunities for improvement are unclear. The present study gave voice to spouses who participated in a trial of WOOP, describing how WOOP was incorporated into their lives and how it could be improved for future implementation. For this qualitative study, we conducted longitudinal semi-structured interviews among 21 spouses of people living with dementia (three interviews over three months; 63 interviews total). Codebook thematic analysis was performed. Three meta-themes were derived: (1) assessing baseline strengths and limitations of WOOP, (2) learning from experience, and (3) fine-tuning and sustaining WOOP. Participants described how WOOP addressed their interpersonal and emotional stressors, their responses to behaviors of the person living with dementia, and their relationship quality. Considerations for future intervention delivery (e.g., solo vs. in group settings) and instructions (e.g., encouraging writing vs. thinking through the four steps of WOOP) were identified as areas of improvement. WOOP was described as a practical, feasible, and desirable intervention for spouses at the early stages of their partner's dementia. Participants made WOOP easier to incorporate in their everyday lives by adapting the design into a mental exercise that they used as needed. Suggestions from participants specified how to make the everyday use of WOOP more feasible, sustainable, and applicable in a variety of contexts. ClinicalTrials.gov HIC 2000021852.

An extensive investigation into the bioactive component of breast milk, lactation, and clinical application of Galactagogues: A review

Nowadays, people are becoming more and more conscious of the link between nutrition, diet, and health. This bond is established from birth. In addition to being thought of as the finest nutrition for a newborn to preserve its physical and nutritional well-being, breastfeeding is usually seen as the best choice for a baby during the early stages of life. The American College of Obstetricians and Gynecologists (ACOG) advises breastfeeding exclusively for six months, after which the mother and child may decide to continue nursing in addition to introducing supplemental meals for the remainder of the baby's first year or beyond. Since breast milk includes a variety of bioactive ingredients, including proteins, vitamins, nucleotides, oligosaccharides, immunoglobulin, and some minerals, it is often regarded as the major nutritional supply for babies. A crucial opportunity for intervention to improve breastfeeding success is when inadequate supply of breast milk is often identified as the primary reason for early breastfeeding cessation. When non-drug breastfeeding support approaches fail to improve a persistently poor milk production, mothers frequently turn to drugs called galactagogues for assistance. Galactagogues function by interfering with the complex hormonal balance that controls breastfeeding, specifically with regard to prolactin and oxytocin. The available data about the effectiveness and safety of pharmacological treatments for lactation insufficiency is assessed in this narrative review. The majority of research has focused on the use of domperidone, and studies have indicated that there are modest short-term improvements for breast milk production. While there is less evidence supporting metoclopramide safety and efficacy than there is for domperidone, metoclopramide functions similarly to domperidone, thus in the event that domperidone is ineffective, it may be a good alternative for therapy. Lack of information on alternative medicines, such as metformin, oxytocin, prolactin, and herbal remedies, renders their clinical usage unreasonable. The study points out important gaps in the data and makes recommendations for possible future research topics related to galactagogues' impact on nursing.