How accurate is the clinical component of triple assessment

Introduction: There are eight SBD Clinics (symptomatic breast clinics) across the Republic of Ireland (plus Letterkenny satellite), where over 40,000 new patients are referred by their General Practitioner (GP) each year. Same day triple assessment clinics (TAC) worked well when the TACs were small, but with the current volumes it is not possible to image all patients same day. The first component of the triple assessment is clinical (E score). The E score dictates what imaging is required (E1 normal, E2 benign, E3 likely benign, E4 suspicious, E5 clinically breast cancer) and triages patients into urgent /non urgent and this became even more important in the COVID crisis. Despite the importance of the E score, there is very little in the literature about its accuracy. The aim of this study was to look at how good the E score is at indicating/not indicating cancer in a large volume SBD clinic in Dublin. Method(s): Single large centre SBD clinic in St James Hospital, Dublin. The study included the E score and cancer/not in all patients attending TAC clinic from 2018 to 2021. Data was collected prospectively and collated by database manager. Result(s): [Formula presented] Conclusion(s): This single centre study suggests that the E score is a reliable triage tool in a busy TAC clinic. As breast surgeons we need to establish a standard level of accuracy for clinical assessment in the TAC similar to that for the R (radiology ) score and B (biopsy) score.Copyright © 2023

The 'omics of obesity in B-cell acute lymphoblastic leukemia.

The obesity pandemic currently affects more than 70 million Americans and more than 650 million individuals worldwide. In addition to increasing susceptibility to pathogenic infections (eg, SARS-CoV-2), obesity promotes the development of many cancer subtypes and increases mortality rates in most cases. We and others have demonstrated that, in the context of B-cell acute lymphoblastic leukemia (B-ALL), adipocytes promote multidrug chemoresistance. Furthermore, others have demonstrated that B-ALL cells exposed to the adipocyte secretome alter their metabolic states to circumvent chemotherapy-mediated cytotoxicity. To better understand how adipocytes impact the function of human B-ALL cells, we used a multi-omic RNA-sequencing (single-cell and bulk transcriptomic) and mass spectroscopy (metabolomic and proteomic) approaches to define adipocyte-induced changes in normal and malignant B cells. These analyses revealed that the adipocyte secretome directly modulates programs in human B-ALL cells associated with metabolism, protection from oxidative stress, increased survival, B-cell development, and drivers of chemoresistance. Single-cell RNA sequencing analysis of mice on low- and high-fat diets revealed that obesity suppresses an immunologically active B-cell subpopulation and that the loss of this transcriptomic signature in patients with B-ALL is associated with poor survival outcomes. Analyses of sera and plasma samples from healthy donors and those with B-ALL revealed that obesity is associated with higher circulating levels of immunoglobulin-associated proteins, which support observations in obese mice of altered immunological homeostasis. In all, our multi-omics approach increases our understanding of pathways that may promote chemoresistance in human B-ALL and highlight a novel B-cell-specific signature in patients associated with survival outcomes.

Impact of covid-19 on commercial laboratory testing for hiv in the United States

Background: On March 13, 2020, the United States declared a national emergency to combat coronavirus disease 2019 (COVID-19). Many states and localities issued shelter-in-place or stay-at-home orders to reduce the spread of COVID-19, limiting movement outside the home to essential activities. Since that time the pandemic has been associated with documented disruptions in routine preventive and other nonemergency care. Screening for HIV infection as well as HIV-1 viral load monitoring for persons living with HIV have likely been affected by the pandemic. Laboratory data from the National Syndromic Surveillance Program provide one way to assess the impact of the COVID-19 pandemic on HIV screening, HIV diagnoses and HIV-1 viral load monitoring. Methods: Using data reported daily to CDC from a large commercial laboratory, we identified lab test reports for HIV screening or HIV-1 viral load testing. For reports with HIV screening test results, we assessed how often the final HIV test algorithm result was confirmed positive. We plotted daily counts of each of the three HIV test types and 7-day moving averages. We also calculated the difference in the number of each type of test performed between March 13, 2019 and September 30, 2019 from those performed during the same time period in 2020. Results: Compared with number of tests performed in 2019, there were 669,847 fewer HIV screening tests, 4,910 fewer confirmed HIV-1 diagnoses, and 67,694 fewer HIV-1 viral load tests performed during March 13 to September 30, 2020. The 7-day average number of HIV tests performed dropped dramatically after March 13, 2020 and did not recover to 2019 levels by September 30, 2020 (Figure). Conclusion: During the national COVID-19 emergency, routine screening for HIV and HIV-1 viral load monitoring may have been delayed or foregone by many patients and clinicians. Undiagnosed HIV infection and higher viral loads could have led to increased morbidity and transmission. Although the number of tests being performed has partially recovered from a nadir this spring, testing at this commercial lab has not yet rebounded to make up what was lost. Healthcare system adaptations including home testing, home sample collection, and telemedicine visits for HIV care can help to address this shortfall as the COVID-19 pandemic persists in the US.

Implementing un Sustainability Development Goals through Engagement within University Communities of Practice

In 2015 the United Nations General Assembly adopted 17 Sustainability Development Goals (SDGs) which are interpreted as a blueprint to achieve a better and more sustainable future for all by 2030. For the university sector, including other Higher Education Institutions (HEIs), there is an increasing expectation to implement the UN SDGs, not only into wider operations, but also specifically into course delivery. By widening participation through improved societal and community engagement it is argued that the role of the university will have greater impact in how sustainable knowledge is produced for and with society (Gibbons et al 1994). Achieving sustainability as a goal requires us to consider how we improve collaborative engagements with various stakeholders (Bartunek 2011, Van de Ven 2007) and within communities of practice (CoP). Changing university activities to achieve this is an inherently complex activity. To effectively do so universities must engage purposefully, to a far greater extent than ever before, with a complex array of communities and their input and co-operation (Wenger-Traynor 2020) is needed to integrate the SDGs into everyday activities. This paper introduces a knowledge management (KM) approach for improving sustainable engagement with a specific focus on increasing engagement with and within student engineering communities of practice. We consider how the significant pivotal change from dominant classroom delivery to a new normal of virtual delivery due to the COVID-19 pandemic will impact on collaborative engagements within a CoP of engineering students and staff. As a way forward principles for maintaining student engagement, while meeting the UN SDGs, are outlined. We identify, in the principles, some organisational characteristics and attributes that inform pedagogy to be considered when designing KM processes and systems for sustainable student engagement. We conclude that in order to successfully support the CoPs the university will need to allocate resources to facilitate building a holistic picture of the university's knowledge ecosystem and address any contradictions identified. The university will also have to encourage the mutual development of interrelated CoPs and provide university support to develop share practices for effective CoP networking. Exposing staff-student communities to broader curricula will also help to exploit existing hidden social networks within the university and support integrating the UN SDGs into the university's operations and course delivery. © 2020 Academic Conferences Limited. All rights reserved.