Building momentum through networks: Bioimaging across the Americas.

In September 2023, the two largest bioimaging networks in the Americas, Latin America Bioimaging (LABI) and BioImaging North America (BINA), came together during a 1-week meeting in Mexico. This meeting provided opportunities for participants to interact closely with decision-makers from imaging core facilities across the Americas. The meeting was held in a hybrid format and attended in-person by imaging scientists from across the Americas, including Canada, the United States, Mexico, Colombia, Peru, Argentina, Chile, Brazil and Uruguay. The aims of the meeting were to discuss progress achieved over the past year, to foster networking and collaborative efforts among members of both communities, to bring together key members of the international imaging community to promote the exchange of experience and expertise, to engage with industry partners, and to establish future directions within each individual network, as well as common goals. This meeting report summarises the discussions exchanged, the achievements shared, and the goals set during the LABIxBINA2023: Bioimaging across the Americas meeting.

Which parents provide zero-alcohol beverages to adolescents? A survey of Australian parents' practices and intentions.

OBJECTIVE: Zero-alcohol beverages (<0.5% alcohol by volume) appear and taste similar to alcoholic beverages but are regulated similarly to soft drinks in many countries, blurring the distinction between alcoholic and non-alcoholic beverages. How parents view provision of zero-alcohol beverages to adolescents is likely a key determinant of adolescent consumption. We investigated factors associated with parents' provision of zero-alcohol beverages to adolescents, including attitudes toward zero-alcohol beverages and demographic, knowledge, and behavioural factors known to be associated with provision of alcoholic beverages. METHODS: We conducted an online cross-sectional survey of N = 1197 Australian parents of adolescents aged 12-17 years in April-May 2022. We examined associations with zero-alcohol beverage provision using binomial logistic regression, and with future provision intentions using multinomial logistic regression analyses. RESULTS: Factors significantly associated (p < .001) with parents' provision and future intentions to provide zero-alcohol beverages to their adolescent included beliefs that zero-alcohol beverages had benefits for adolescents (Adjusted Odds Ratio [AOR] 2.69 (provision); 3.72 (intentions)), provision of alcoholic beverages (AOR 2.67 (provision); 3.72 (intentions)), and an incorrect understanding of alcohol guidelines for adolescents (AOR 2.38 (provision); 1.95 (intentions)). CONCLUSIONS: Parents' provision and intentions to provide zero-alcohol beverages were associated with beliefs about zero-alcohol beverages as well as some factors associated with provision of alcoholic beverages. Precautionary advice to parents that the provision of zero-alcohol beverages may serve to normalise alcohol consumption may be warranted.

Evaluation of a novel augmented reality educational tool and its effects on patient experience: A randomized controlled trial.

Introduction: Patient education is an essential element of the treatment pathway. Augmented reality (AR), with disease simulations and three-dimensional visuals, offers a developing approach to patient education. We aim to determine whether this tool can increase patient understanding of their disease and post-visit satisfaction in comparison to current standard of care (SOC) educational practices in a randomized control study. Methods: Our single-site study consisted of 100 patients with initial diagnoses of kidney masses or stones randomly enrolled in the AR or SOC arm. In the AR arm, a physician used AR software on a tablet to educate the patient. SOC patients were educated through traditional discussion, imaging, and hand-drawn illustrations. Participants completed pre- and post-physician encounter surveys adapted from the Press Ganey® patient questionnaire to assess understanding and satisfaction. Their responses were evaluated in the Readability Studio® and analyzed to quantify rates of improvement in self-reported understanding and satisfaction scores. Results: There was no significant difference in participant education level (P = 0.828) or visit length (27.6 vs. 25.0 min, P = 0.065) between cohorts. Our data indicate that the rate of change in pre- to post-visit self-reported understanding was similar in each arm (P ≥ 0.106 for all responses). The AR arm, however, had significantly higher patient satisfaction scores concerning the educational effectiveness and understanding of images used during the consultation (P < 0.05). Conclusions: While AR did not significantly increase self-reported patient understanding of their disease compared to SOC, this study suggests AR as a potential avenue to increase patient satisfaction with educational tools used during consultations.

Renal Mass Biopsy Mandate Is Associated With Change in Treatment Decisions.

PURPOSE: To prevent avoidable treatment and make more informed care decisions about small renal masses, the use of renal mass biopsies has increased since the early 2000s. In April 2017, Atrium Health Carolinas Medical Center began requiring biopsies before all percutaneous thermal ablation procedures for renal masses. We aim to determine the effect of this preablation biopsy mandate on small renal mass treatment decisions. MATERIALS AND METHODS: Our study is a retrospective analysis of a prospectively managed database designed to track patients with small renal masses presented at the Kidney Tumor Program from 2000-2020. We separated patients into 2 cohorts (pre- and postmandate) based on the initial encounter date, excluding those from April 2017-April 2018 to allow for implementation of the mandate. We also excluded patients with masses >4 cm. RESULTS: Overall, we found no significant difference between the pre- and postmandate cohorts, with race as an exception. Implementation of the mandate coincided with an increase in biopsies for both ablation and nonablation treatment pathways (P < .001, P = .01). Renal mass biopsy rates increased in all socioeconomic groups except the lowest quartile. Additionally, Black/Hispanic patients had the highest biopsy rate. We found significant changes in treatment decisions between our cohorts: surgery decreased 24% (P < .001), active surveillance increased 28% (P < .001), and patients with no follow-up decreased 8% (P = .03). CONCLUSIONS: Our data indicate that a preablation renal mass biopsy mandate is associated with the wider use of biopsies for all small renal mass patients, fewer surgical interventions, and an increase in active surveillance.

Quantifying social skill deficits and strengths profiles in autistic youth.

While social difficulties in autism are well-established, questions remain regarding whether these represent challenges in acquiring or performing such skills, reduced social strengths, or a unique distribution across these domains (i.e., social profile). This study empirically derived social profiles of 211 autistic and non-autistic youth (Mage  = 13.50; Autistic N = 150; Male N = 151; 85.3% White). Assessments occurred between 2016 and 2020. Results showed that autistic youth exhibit significantly more social acquisition and performance deficits and fewer strengths than nonautistic youth (ds = -.44 to .65). Performance deficits were most-and acquisition deficits least-prominent within autistic profiles, potentially implicating longstanding theoretical models of social difficulties in autism, and supporting new, idiographic approaches for conceptualizing, assessing, and treating social challenges.

School lunchboxes as an opportunity for health and environmental considerations: a scoping review.

Very little research has focussed on children's school lunchboxes from both a health and environment standpoint. This scoping review explores studies that considered children's lunchbox food consumption trends at school and the environmental impacts of lunchbox contents. We conducted a scoping review of peer-reviewed literature with a focus on lunchboxes of children in preschool or primary school settings that contained food packed from home, through the lens of food and nutrition in combination with environmental outcomes-particularly food and/or packaging waste. The review included 10 studies, with articles from Australia, USA, Spain, New Zealand and the UK. Half of them were intervention studies aiming to shift knowledge levels and attitudes of teachers, parents and children with regard to reducing packaged food choices and food waste, and improving dietary habits. Acknowledging the complexity of lunchbox packing and consumption practices, this review recommends the consideration of socio-ecological influences on children's health and sustainability behaviour, and mobilizing their pro-environmental agency.

School food environments play a key role in children's health and behaviour development. However, there are environmental implications of school food and this is not often considered in conjunction with schoolchildren's health based on their food consumption patterns. While wider environmental impacts of school food provision models have been studied, the more immediate and child-relevant outcomes (such as food and packaging waste) are also worth considering, especially in the context of school lunchboxes. This scoping review explored the existing literature for studies that focussed on school children's lunchbox contents and considered health attributes along with packaging and waste characteristics. Results from this review of 10 articles, which also describes the five interventions identified, pointed towards the merit of tapping into children's agency of change while also recognizing socio-ecological influences to drive sustainability practices for health co-benefits. The interconnectedness of nutritional quality and sustainability characteristics of school lunchboxes is an understudied phenomenon, but one with promising potential to promote and improve public health and planetary wellbeing.

Prevalence of parental supply of alcohol to minors: a systematic review.

Parental supply of alcohol to minors (i.e. those under the legal drinking age) is often perceived by parents as protective against harms from drinking, despite evidence linking it with adverse alcohol-related outcomes. This systematic review describes the prevalence of parental supply of alcohol, as reported in the international literature. The review was registered with PROSPERO (CRD42020218754). We searched seven online databases (Medline, Embase, PsycINFO, CINAHL, Scopus, Web of Science and Public Health Database) and grey literature from January 2011 to December 2022 and assessed the risk of bias with the JBI Critical Appraisal Checklist. Among 58 articles included in narrative synthesis from 29 unique datasets, there was substantial variation in the definition and measurement of parental supply of alcohol. Overall prevalence rates ranged from 7.0 to 60.0% for minor-report samples, and from 24.0 to 48.0% for parent-report samples. Data indicate that parental supply prevalence is generally proportionately higher for older minors or later-stage students, for girls, and has increased over time among minors who report drinking. Literature on the prevalence of parental supply of alcohol is robust in quantity but inconsistent in quality and reported prevalence. Greater consistency in defining and measuring parental supply is needed to better inform health promotion initiatives aimed at increasing parents' awareness.

A randomised experimental study comparing perceptions of two energy drink health warning labels.

ISSUE ADDRESSED: Consumption of energy drinks is a public health concern, particularly in adolescents and young adults. This study explored energy drink consumers' reactions to an energy drink-specific warning label (risk of cardiac effects) and a more general sugary drink warning label (risk of obesity). METHODS: An online experimental study randomly allocated Australian energy drink consumers aged 18-39 years (N = 435) to view one of two label conditions (cardiac effects or obesity). Participants were assessed on: intention to reduce energy drink consumption, perceived health threat, perceived label effectiveness and policy support for energy drink warning labels. RESULTS: Mean intentions to reduce consumption scores were similar across the two label conditions (Mobesity  = 2.5, Mcardiac  = 2.6) overall; and were higher for the cardiac label (compared to obesity label) for some subgroups: females (Mobesity  = 2.3, Mcardiac  = 2.8; p = .037), older (25-39 years; Mobesity  = 2.4, Mcardiac  = 2.8; p = .016); and higher education level (Mobesity  = 1.9, Mcardiac  = 2.7; p = .004). While perceived health threat measures were higher for obesity than cardiac effects, perceived label effectiveness measures of 'believable' and 'relevant to me' were higher for the cardiac label than the obesity label (believable: 71.0% vs 56.1%; relevant: 42.5% vs 29.4%). Participants who viewed the cardiac label were more likely to support policy than those shown the obesity label (OR = 1.6, 95%CI [1.1, 2.3], p = .02). CONCLUSIONS: Health effect warnings labels were perceived by energy drink consumers to be impactful and are supported. Labels with energy drink-specific health effects may offer additional benefit. SO WHAT?: Policy makers can feel confident that warning labels on energy drinks will confer public health benefit.

Reducing neuropathies between the 2020 and 2021 Covid-19 surges in a large UK intensive care unit: A quality improvement project.

BACKGROUND: Peripheral nerve injuries (PNIs) can be acquired by patients in intensive care unit (ICU) who are critically unwell with Covid pneumonitis. Prone position ventilation has been linked to this life-changing complication. AIM: To reduce the occurrence and severity of PNIs for patients with Covid pneumonitis requiring prone positioning whilst sedated and ventilated in ICU. STUDY DESIGN: This study is a quality improvement project that evolved over the course of the first two surges of Covid pneumonitis admissions within the ICU at the Queen Elizabeth Hospital Birmingham (Surge 1: March 2020-July 2020, 93 prone ventilation survivors; Surge 2: September 2020-May 2021, 309 prone ventilation survivors). Implementation of updated prone positioning guidelines that aimed to reduce the risk of PNI. This was supplemented by face-to-face teaching for ICU professionals. The number of patients who sustained PNI and the severity of such injuries were recorded. RESULTS: During the first surge 21 patients (22.6%) had at least one high grade PNI. During the second surge there were 12 patients (3.9%) sustaining an intermediate or high grade PNI. For PNI patients, there was an increase in the mean proning episodes (6-13) and duration (17.8-18.6 h). This represents an 82% reduction in PNI cases. High grade injuries reduced from 14/21 (66%) to 4/12 (33%). CONCLUSIONS: Optimizing the position of patients in the prone position in ICU with Covid pneumonitis may be key in reducing the development of PNI. Changes to pharmacological management may have influenced the results seen in this study. RELEVANCE TO CLINICAL PRACTICE: Clinicians working within ICU with acutely unwell patients with Covid pneumonitis should acknowledge the heightened risk of PNI and take relevant steps to reduce the risk of injury acquisition.

Impact of diabetes and chronic kidney disease on active surveillance outcomes for small renal masses: A cohort study.

Introduction: The American Cancer Society estimates 79,000 individuals will be diagnosed with kidney cancer in 2022, most of which are initially found as small renal masses (SRMs). Proper management of SRM patients includes careful evaluation of risk factors such as medical comorbidities and renal function. To investigate the importance of these risk factors, we examined their effect on crossover to delayed intervention (DI) and overall survival (OS) in patients undergoing active surveillance (AS) for SRMs. Methods: This is an Institutional Review Board-approved retrospective analysis of AS patients presented at kidney tumor conferences with SRMs between 2007 and 2017. Univariable and multivariable logistic regression analyses were performed to determine how factors including estimated glomerular filtration rate (eGFR), diabetes, and chronic kidney disease are associated with DI and OS. Results: A total of 111 cases were reviewed. In general, AS patients were elderly and had significant comorbidities. On univariate analysis, intervention was more likely to occur in patients with a younger age (P = 0.01), better kidney function (P = 0.01), and higher tumor growth rates (GRs) (P = 0.02). Higher eGFR was associated with better survival (P = 0.03), while higher tumor GRs (P = 0.014), greater Charlson Comorbidity Index (P = 0.01), and larger tumors (P = 0.01) were associated with worse OS. Of the comorbidities, diabetes was found to be an independent predictor of worse OS (P = 0.01). Conclusions: Patient-level factors - such as diabetes and eGFR - are associated with the rate of DI and OS among SRM patients. Consideration of these factors may facilitate better AS protocols and improve patient outcomes for those with SRMs.

Targeted reduction of airborne viral transmission risk in long-term residential aged care.

COVID-19 has demonstrated the devastating consequences of the rapid spread of an airborne virus in residential aged care. We report the use of CO2-based ventilation assessment to empirically identify potential 'super-spreader' zones within an aged care facility, and determine the efficacy of rapidly implemented, inexpensive, risk reduction measures.

Levels of Parental Drinking in the Presence of Children: An Exploration of Attitudinal Correlates.

AIMS: This study aimed to examine perceived social norms, the effect of parental drinking on these norms, alcohol use in front of children, and how norms and consumption vary based on child age and gender of the parent. METHODS: A cross-sectional online panel survey was undertaken with n = 1000 Australian adults (including 670 parents) aged 18-59 years. The survey assessed: alcohol consumption in front of children; normative attitudes towards drinking in the presence of children; and perceived social norms. RESULTS: Overall, 33.9% of parents reported drinking a glass of alcohol each day or a couple of times a week, 18.2% reported getting slightly drunk and 7.8% indicated getting visibly drunk each day or a couple of times a week with their children present. In total, 37.5% reported drinking in front of their children at least weekly. Fathers were more likely to drink in front of children than mothers. Most parents deemed drinking small amounts of alcohol in front of children as acceptable but did not accept drunkenness. Respondents were less concerned about a father drinking one or two drinks in front of their children than a mother. Social expectations were not related to child age, but norms related to others' perceived behaviour were. CONCLUSIONS: Many parents, particularly fathers consume alcohol in front of their children. There is a need to target health promotion strategies to adults and parents consuming in excess of health guidelines, and to the many parents who are consuming alcohol at higher levels in front of their children.

Adolescents' knowledge and beliefs regarding health risks of soda and diet soda consumption.

OBJECTIVE: To examine Australian adolescents' knowledge and beliefs regarding potential health consequences of soda and diet soda consumption and nutritional aspects of soda and explore associations with consumption. DESIGN: A survey utilising a nationally representative sample (stratified two-stage probability design) assessed knowledge of nutritional contents and health consequences of soda, and beliefs regarding health risks of diet soda, and soda and diet drink consumption. SETTING: Australia. PARTICIPANTS: 9102 Australian school students (12-17 years) surveyed in 2018. RESULTS: Adolescents had lower nutritional knowledge (sugar content (22·2 %), exercise equivalent (33·9 %), calories/kJ (3·1 %)) than general knowledge of health risks (87·4 %) and some health effects (71·7-75·6 % for tooth decay, weight gain and diabetes), with lower knowledge of heart disease (56·0 %) and cancer (19·3 %). Beliefs regarding health effects of diet soda were similar, albeit not as high. In general, female sex, older age and less disadvantage were associated with reporting health effects of soda and diet soda, and nutritional knowledge of soda (P < 0·001). Those reporting tooth decay, weight gain, heart disease and diabetes as health effects of soda and diet soda were lower consumers of soda and diet drinks (P < 0·001), as were those with higher nutritional knowledge (sugar content and exercise equivalent; P < 0·001). CONCLUSIONS: This study highlights possible knowledge gaps regarding the health effects of soda and nutritional knowledge for public health intervention. When implementing such interventions, it is important to monitor the extent to which adolescents may consider diet drinks as an alternative beverage given varied beliefs about health consequences and evolving evidence.

Which drinkers have changed their alcohol consumption due to energy content concerns? An Australian survey.

BACKGROUND: Alcohol is a discretionary, energy dense, dietary component. Compared to non-drinkers, people who consume alcohol report higher total energy intake and may be at increased risk of weight gain, overweight, and obesity, which are key preventable risk factors for illness. However, accurate consumer knowledge of the energy content in alcohol is low. To inform future behaviour change interventions among drinkers, this study investigated individual characteristics associated with changing alcohol consumption due to energy-related concerns. METHODS: An online survey was undertaken with 801 Australian adult drinkers (18-59 years, 50.2% female), i.e. who consumed alcohol at least monthly. In addition to demographic and health-related characteristics, participants reported past-year alcohol consumption, past-year reductions in alcohol consumption, frequency of harm minimisation strategy use (when consuming alcohol), and frequency of changing alcohol consumption behaviours because of energy-related concerns. RESULTS: When prompted, 62.5% of participants reported changing alcohol consumption for energy-related reasons at least 'sometimes'. Women, those aged 30-44 years, metropolitan residents, those with household income $80,001-120,000, and risky/more frequent drinkers had increased odds of changing consumption because of energy-related concerns, and unemployed respondents had reduced odds. CONCLUSIONS: Results indicate that some sociodemographic groups are changing alcohol consumption for energy-related reasons, but others are not, representing an underutilised opportunity for health promotion communication. Further research should investigate whether messaging to increase awareness of alcohol energy content, including through systems-based policy actions such as nutritional/energy product labelling, would motivate reduced consumption across a broader range of drinkers.

Investigating the breast cancer screening-treatment-mortality pathway of women diagnosed with invasive breast cancer: Results from linked health data.

OBJECTIVE: To examine the screening-treatment-mortality pathway among women with invasive breast cancer in 2006-2014 using linked data. METHODS: BreastScreen histories of South Australian women diagnosed with breast cancer (n = 8453) were investigated. Treatments recorded within 12 months from diagnosis were obtained from linked registry and administrative data. Associations of screening history with treatment were investigated using logistic regression and with cancer mortality outcomes using competing risk analyses, adjusting for socio-demographic, cancer and comorbidity characteristics. RESULTS AND CONCLUSION: For screening ages of 50-69 years, 70% had participated in BreastScreen SA ≤ 5 years and 53% ≤ 2 years of diagnosis. Five-year disease-specific survival post-diagnosis was 90%. Compared with those not screened ≤5 years, women screened ≤2 years had higher odds, adjusted for socio-demographic, cancer and comorbidity characteristics, and diagnostic period, of breast-conserving surgery (aOR 2.5, 95% CI 1.9-3.2) and radiotherapy (aOR 1.2, 95% CI 1.1-1.3). These women had a lower unadjusted risk of post-diagnostic cancer mortality (SHR 0.33, 95% CI 0.27-0.41), partly mediated by stage (aSHR 0.65, 95% CI 0.51-0.81), and less breast surgery (aSHR 0.78, 95% CI 0.62-0.99). Screening ≤2 years and conserving surgery appeared to have a greater than additive association with lower post-diagnostic mortality (interaction term SHR 0.42, 95% CI 0.23-0.78). The screening-treatment-mortality pathway was investigated using linked data.

Content analysis of school websites: policies and programs to support healthy eating and the environment.

Preschools and primary schools are important settings for the development of healthy eating habits and awareness of environmentally friendly practices. This study explored South Australian government schools' policies and programs in relation to healthy eating and environmentally friendly aspects of food choice (such as packaging), and whether any schools approached these issues in combination. Websites of 18 government preschools and primary schools in the Greater Adelaide region, stratified by low, medium and high socioeconomic status were reviewed for publicly available policies and other relevant content. A content analysis was undertaken, with policies and programs analysed deductively and thematically. Healthy eating (n = 8) and environment (n = 3) related policies were found on preschool websites only. The main themes observed across the three categories of interest (healthy eating, environmentally friendly practices and low-waste healthy foods) included the presence/absence of formal policy, promotional strategies and implementation. Expectations of children bringing healthy 'nude' foods that were environmentally friendly were mentioned informally on the websites but were not part of policy documents. Policies and programs around healthy eating and environmentally friendly practices (in combination) were lacking. There is scope to address this gap to improve health and sustainable outcomes within the school environment context.

Warning labels and interpretive nutrition labels: Impact on substitution between sugar and artificially sweetened beverages, juice and water in a real-world selection task.

Effective strategies to reduce free sugar intake are needed. This study examined exposure to a warning label, independently and in conjunction with a Health Star Rating (HSR) label, on the selection of commercially available cold beverages with real decision-making stakes. Participants (N = 511, 47.9% female, mean = 21.7 (SD = 6.1) years) accessed an online convenience store app via an on-campus laptop to select one of 10 beverages (5 sugar-sweetened beverages [SSBs], 1100% fruit juice, 2 artificially sweetened beverages [ASBs] and 2 waters). The task was repeated with the addition of a warning label on high-sugar drinks in Round 2, and the addition of an HSR label on all drinks in Round 3. Participants were informed that they would receive a complementary drink (valued at <$5AUD) based on their selections following the completion of a brief questionnaire. Baseline results indicated that SSBs and waters were the most and least popular choices, respectively. For both males and females, there was a significant decrease in SSB selection (p < 0.001) and significant increase in ASB and water selection (p < 0.001) following the addition of warning labels to high-sugar drinks. The decreased selection of SSBs and increased selection of waters was maintained in Round 3 when HSR labels were added to all drinks. 100% fruit juice selection decreased with the addition of a warning label for females only (p < 0.01), but increased following the addition of a 4-star HSR label, for both males (p < 0.05) and females (p < 0.001). Warning labels reduced young adults' selection of SSBs and promoted substitution to water. The HSR reinforced this effect for the least healthy drinks. Increased water selection may be further enhanced by ensuring that warning label thresholds and HSR algorithms align to present consistent messaging.

Further evidence from the LiveLighter® campaign: A controlled cohort study in Victoria and South Australia.

ISSUE ADDRESSED: The LiveLighter® healthy weight and lifestyle social marketing campaign, developed in Western Australia, employs graphic advertising to communicate negative health effects of overweight and motivate behaviour change. This study extends prior evidence of the effectiveness of the LiveLighter® campaign by evaluating its implementation in a new jurisdiction. METHODS: A controlled cohort design was employed in intervention (Vic) and comparison states (SA), with and without campaign exposure. Population surveys conducted at baseline (BL) (n = 1000 each state), had 75% retention at follow-up (FU) (Vic: n = 715; SA: n = 787). RESULTS: Total campaign awareness was moderate (61.5%). Exposed respondents indicated the campaign was "believable" (91.0%), made a strong argument for reducing weight (87.3%), made them "stop and think" (70.1%), motivated action to reach/stay a healthy weight (59.1%) and was "relevant" (55.6%). The proportion of respondents indicating "toxic fat build up" was a health consequence of overweight increased significantly from BL to FU in Vic and to a lesser extent in SA (Vic:55.7% vs 75.9%; SA:58.1% vs 62.6%, interaction P < .001). The proportion indicating cancer is a health consequence of overweight increased significantly from BL to FU in Vic, but not in SA (Vic:77.1% vs 83.4%; SA:77.8% vs 78.1%, interaction P < .05). CONCLUSIONS: This study extends the evidence base for the LiveLighter® campaign. Sustained campaign activity with clear behavioural recommendations is required to translate improved knowledge into behaviour change. SO WHAT: Evidence-based mass media campaigns can positively impact health behaviours to address the unsustainable increasing burdens of unhealthy weight, dietary risk and inadequate physical activity. A National Obesity Campaign is needed and LiveLighter® is a ready-made, relevant Australian resource.

Prevention of SARS-CoV-2 (COVID-19) transmission in residential aged care using ultraviolet light (PETRA): a two-arm crossover randomised controlled trial protocol.

BACKGROUND: SARS-CoV-2 poses a considerable threat to those living in residential aged care facilities (RACF). RACF COVID-19 outbreaks have been characterised by the rapid spread of infection and high rates of severe disease and associated mortality. Despite a growing body of evidence supporting airborne transmission of SARS-CoV-2, current infection control measures in RACF including hand hygiene, social distancing, and sterilisation of surfaces, focus on contact and droplet transmission. Germicidal ultraviolet (GUV) light has been used widely to prevent airborne pathogen transmission. Our aim is to investigate the efficacy of GUV technology in reducing the risk of SARS-CoV-2 infection in RACF. METHODS: A multicentre, two-arm double-crossover, randomised controlled trial will be conducted to determine the efficacy of GUV devices to reduce respiratory viral transmission in RACF, as an adjunct to existing infection control measures. The study will be conducted in partnership with three aged care providers in metropolitan and regional South Australia. RACF will be separated into paired within-site zones, then randomised to intervention order (GUV or control). The initial 6-week period will be followed by a 2-week washout before crossover to the second 6-week period. After accounting for estimated within-zone and within-facility correlations of infection, and baseline infection rates (10 per 100 person-days), a sample size of n = 8 zones (n = 40 residents/zone) will provide 89% power to detect a 50% reduction in symptomatic infection rate. The primary outcome will be the incidence rate ratio of combined symptomatic respiratory infections for intervention versus control. Secondary outcomes include incidence rates of hospitalisation for complications associated with respiratory infection; respiratory virus detection in facility air and fomite samples; rates of laboratory confirmed respiratory illnesses and genomic characteristics. DISCUSSION: Measures that can be deployed rapidly into RACF, that avoid the requirement for changes in resident and staff behaviour, and that are effective in reducing the risk of airborne SARS-CoV-2 transmission, would provide considerable benefit in safeguarding a highly vulnerable population. In addition, such measures might substantially reduce rates of other respiratory viruses, which contribute considerably to resident morbidity and mortality. Trial registration Australian and New Zealand Clinical Trials Registry ACTRN12621000567820 (registered on 14th May, 2021).

A randomised online experimental study to compare responses to brief and extended surveys of health-related quality of life and psychosocial outcomes among women with breast cancer.

PURPOSE: Collecting patient-reported outcomes is important in informing the well-being of women with breast cancer. Consumer perceptions are important for successful implementation of monitoring systems, but are rarely formally assessed. We compared reactions to two different surveys (assessing psychosocial outcomes and/or Health-related Quality of Life (HrQoL) outcomes) among Australian women with breast cancer. METHODS: Women (18 + years) within 5 years diagnosis of breast cancer were randomly allocated to complete one of two online surveys: (i) minimum HrQoL measures or (ii) minimum HrQoL measures plus psychosocial outcomes (body image, depression, anxiety stress, fear of cancer recurrence, decisional difficulties and unmet need). Participants completed questions regarding their perceptions of the survey, including qualitative feedback. RESULTS: Data were available for 171 participants (n(i) = 89; n(ii) = 82), with 92% (n = 158) providing 95-100% complete data. Perceptions were comparable between survey groups, and high (80-100%) regarding time burden, ease of completion, comprehensible, appropriateness and willingness to participate again and moderately high (67-74%) regarding willingness to answer more questions and relevance. Qualitative feedback indicated gaps across both surveys, including financial/work-related issues, satisfaction with information and care, need for nuanced questions, and impact of side effects/treatment, and from the minimum set only, emotional well-being and support. Impairment in some HrQoL and psychosocial outcomes were observed among participants. CONCLUSIONS: Assessment of HrQoL and psychosocial outcomes was well received by consumers. Results alleviate concern regarding possible patient burden imposed by longer more in-depth surveys. The importance placed on assessment brevity should not outweigh the need to assess outcomes that consumers consider important.