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Although the benefits of surveillance mammography for older breast cancer survivors have not been quantified prospectively, it is unlikely that mammography provides substantial benefit (and possible that mammography is harmful) to women with limited life expectancy and a low risk for in-breast cancer events.We identified 1268 women aged 77 and older with a history of Stage I-III breast cancer, who did not undergo bilateral mastectomy, were diagnosed with cancer at least three years prior to study entry, and who had consented to be surveyed as part of the Mayo Clinic Breast Disease Registry. We mailed them a one-time survey asking about their experiences with surveillance mammography. Women with metastatic disease were excluded. The primary endpoint was whether or not women reported at least one mammogram since breast cancer surgery.Eight hundred forty-six of 1268 (67%) returned the survey, 734 of whom were eligible for analysis. The median age at the time of survey was 82, and the median time since cancer diagnosis was 12 years. Ninety-three percent reported having had at least one mammogram since their initial breast cancer surgery. Seventy-nine percent reported that they had surveillance mammography annually over the prior three years, including 76% of the 491 aged 80+ and 64% of the 189 aged 85 + .Most older breast cancer survivors who have residual breast tissue are undergoing annual mammograms. Additional educational materials may be beneficial for patients and clinicians to better individualize plans for surveillance mammography in older breast cancer survivors.

Women are often viewed as outsiders in the videogaming environment, particularly in first-person shooter games. Perceived infringement on an overwhelmingly masculine space pushes women to the margins of online team-based games, where gender norms inform the presumption that they play supportive roles that are viewed as passive and unskilled rather than actively contributing to team objectives. This study explores why women continue to play these roles, even as they are belittled, how societal expectations of women translate to the gaming space, and consequences for gender as a social structure. Findings suggest similarities to gendered labor in that women report feeling obligated to shoulder tasks that nobody else desires, much in the same way that professional work characterized as feminine is devalued. In addition, women must perform emotion work as they game by hiding their role preferences, feeling shame at fulfilling harmful gender stereotypes, and justifying their utility.

Methods matter. They influence what we know and who we come to know about in the context of hazards and disasters. Research methods are of profound importance to the scholarly advancement of the field and, accordingly, a growing number of publications focus on research methods and ethical practices associated with the study of extreme events. Still, notable gaps exist. The National Science Foundation-funded Social Science Extreme Events Research (SSEER) network was formed, in part, to respond to the need for more specific information about the status and expertise of the social science hazards and disaster research workforce. Drawing on data from 1,013 SSEER members located across five United Nations (UN) regions, this article reports on the demographic characteristics of SSEER researchers; provides a novel inventory of methods used by social science hazards and disaster researchers; and explores how methodological approaches vary by specific researcher attributes including discipline, professional status, researcher type based on level of involvement in the field, hazard/disaster type studied, and disaster phase studied. The results have implications for training, mentoring, and workforce development initiatives geared toward ensuring that a diverse next generation of social science researchers is prepared to study the root causes and social consequences of disasters.

This study explores how domestic cats and their connections to humans are represented in a modern photo-sharing context through content analysis of Reddit, a popular social media website. By examin...

Background The Paediatric Improvement Plan (PIP) is a 12 workstream plan covering the main paediatric areas in the hospital as well as key themes such as medicines management. It was constructed to ensure the department provides the level of care expected by the Trust and the Care Quality Commission (CQC). 27 of the actions within the plan address the CQC domain ‘safe’, 25 ‘well led’, and four ‘effective’. Objectives The main aims were: Documentation of operational policies and practices. Ensuring nursing training competencies were met, documented and used to facilitate safe rostering. Standardising paperwork and practices. Improving communication around governance. Ensuring children and young people cared for outside the paediatric department were provided with equitable care. Methods The PIP started with 50 points to be actioned, and review identified a further six. These were split into three time divisions based on importance and feasibility of implementing the recommendations. The majority fell into the 0–6 month timeframe (other timeframes are 6 months-2 years and 2–5 years). Points were marked as ‘Red’ if no action had been taken, ‘Amber’ if action was in progress, ‘Green’ if actions were complete, and ‘Blue’ if the impact had been evidenced. Results Over a four month period, 34 (92%) ‘Red’ actions have been addressed and 10 completed (‘Green’ or ‘Blue’). There are now no ‘Red’ actions in the 0–6 month timeframe. Key achievements: A rapid access clinic has been established to see patients who require urgent but not emergency review. It also addresses training needs of paediatric registrars. Evidencing and documentation of nursing competencies such as life support training has improved and is factored into rostering. Training on nurse-led discharge, medicine management, ‘TTA’ pre-packs and controlled drugs has resumed. Seven operational and clinical policies were written, and another five are in progress. Many involved clinicians who had not previously written such documents. While awaiting the Trust wide introduction of governance boards, a monthly paediatric governance newsletter was designed. Neonatal governance meetings were reintroduced and a monthly medicine management meeting started. A neonatal quality improvement group now meets monthly. Conclusions A written plan with clearly documented actions, responsible owner and timeframes proved invaluable, as did having a co-ordinator with dedicated time. Involving and motivating the whole multi-disciplinary team was perhaps most crucial to the success of the PIP. My background as a paediatric registrar allowed me to see through a clinical lens and understand competing demands. During the four month period, 11 junior doctors became involved in improvement projects, and a number joined the neonatal quality improvement group. The COVID-19 pandemic created unique challenges. Demands on the workforce were immense and there was little spare capacity to take on additional improvement work. Many face-to-face courses and training sessions were cancelled or moved online. This remains a challenge to addressing outstanding training requirements, particularly life support training for nursing staff.

91 Background: Most screening clinical trials are not representative of the populations susceptible to disparities in breast cancer outcomes. Strategies are needed to address known structural barriers to clinical trial participation. We partnered with a federally qualified health center to provide no-cost ride-share services as a strategy to facilitate enrollment of uninsured, Hispanic women in Maricopa County, Arizona into a national trial offering no-cost mammography screening. Objective: This pilot survey study explored the feasibility and experiences of uninsured, Hispanic women with a no-cost ride share program as part of the National Cancer Institute funded ECOG-ACRIN clinical trial, TMIST, studying mammography screening at the Mayo Clinic Arizona in Phoenix. Methods: Participants completed a validated survey by phone and interview-style. Survey items assessed women’s use of and experiences with the ride share service including barriers, benefits, and if the ride share service facilitated their participation in the screening trial. Descriptive statistics were calculated using SAS. Results: A total of 30 women completed the survey (response rate = 30/33). All women first-time Mayo Clinic trial participants and 90% lived at least 30 minutes away from trial facility. The mean age of women was X years, 90% had a high school degree or less, and 97% were Spanish speaking. Most women (73.7%) said that travel distance was a barrier to participation in prior clinical trials. A large proportion of women (73%) reported using ride share services for this trial and all agreed that the ride service made it easier for them to attend their trial visit. Nearly 1/3 (64%) said that they were uncertain or would not have been able to participate without the ride-share as an option. Among women using the ride share service, the main benefits of the program included at-home pick up and the service being of no-cost. Other benefits included flexible timing (86%) and one-on-one service (86%). The primary barrier of the program was the driver not speaking the dominant native language (27.3%). Conclusions: Despite lengthy travel distances, women reported overwhelming positive experiences with the no-cost ride share program and agreed that the service helped facilitate their participation in the clinical trial. Thus, no-cost ride share programs are a promising and feasible strategy to reduce barriers to clinical trial participation among historically underserved populations. Future studies should continue to explore the benefits and sustainability of ride-share programs, including benefits to clinical trial retention.

419 Background: The patient portal is part of an electronic health record (EHR) that allows patients to communicate with their healthcare team. The portal also provides a platform for patients to receive and complete symptom surveys that can be directly integrated into the EHR, allowing clinical care teams to monitor symptoms and provide cancer symptom management. The Improving Management of symPtoms during And following Cancer Treatment (IMPACT) consortium, supported by the National Cancer Institute’s Cancer MoonshotSM, aims to improve symptom control for cancer patients through assessment and symptom management interventions deployed via the EHR. This initiative presents an opportunity to examine portal enrollment and variation in use, factors critical to successful implementation, especially among groups that have high cancer symptom burden. To this end, we examine: 1) relationships between portal enrollment prior to the launch of IMPACT interventions and neighborhood broadband access, demographic, and social characteristics; and 2) frequency of pre-intervention portal use for any purpose among enrollees. Methods: Data are derived from two of three IMPACT research centers. Enrollment in and frequency of portal use, mode of accessing the portal (web vs. phone), social, demographic, and cultural factors were extracted from the EHR. Rural Urban Commuting Area (RUCA) codes were used to classify population density and degree of rurality. Broadband access was estimated using 2015-2019 American Community Survey estimates matched to zip codes from enrolled IMPACT patients and classified as a patient’s residence being in a community with high (≥85% of households) or low (< 85% of households) access. Bivariate comparisons and adjusted odds ratios were used to describe all associations. Results: Forty-seven percent of patients (22,596/48,034) were enrolled in the portal prior to the intervention. Patients in zip codes with low broadband access and those who were men, > 65 years old, not White, of Hispanic ethnicity, or disabled or not employed had significantly lower odds of being enrolled in the portal. If enrolled, 21% (n = 4825) used the portal at least once a week. Less variation was found in the average frequency of portal use, but patients younger than 40, and those who were Black, disabled, unemployed, or those who used a mobile device to access the portal had the lowest odds of accessing it at least once a week. Conclusions: Significant disparities in portal enrollment exist across demographic groups and among those with limited broadband access. Among those enrolled, most used the portal less than once a week. Fewer differences in frequency of use were observed by sociodemographic factors. Improving portal enrollment and frequency of use may be critical for symptom management interventions deployed via patient portals.

Although children and youth have often been cast as “vulnerable victims” during disasters, their actions have repeatedly demonstrated their capacity to evoke positive change in the face of an ever more turbulent natural environment. This chapter highlights a range of child- and youth-initiated efforts to reduce disaster risk and to promote more disaster resilient communities. The chapter examines the types of activities that children and youth have helped to create and lead, including disaster risk reduction (DRR) initiatives, community-based preparedness programs, and long-term recovery efforts. Both international as well as domestic efforts are compared and contrasted. It also discusses the challenges associated with sustaining such efforts as well as future opportunities for deeper inclusion of child- and youth-led coalitions in traditional emergency management programs.

Background: The patient-centered medical home (PCMH) shows promise for improving care and reducing costs. We sought to reduce the uncertainty regarding the time and cost of PCMH transformation by quantifying the direct costs of transforming 57 practices in a medical group to National Committee for Quality Assurance (NCQA)-recognized Level III PCMHs. Methods: We conducted structured interviews with corporate leaders, and with physicians, practice administrators, and office managers from a representative sample of practices regarding time spent on PCMH transformation and NCQA application, and related purchases. We then developed and sent a survey to all primary care practices (practice-level response rate: initial recognition—44.6%, renewal—35.7%). Direct costs were estimated as time spent multiplied by average hourly wage for the relevant job category, plus observed expenditures. Results: We estimated HealthTexas9 corporate costs for initial NCQA recognition (2010–2012) at $1,508,503; for renewal (2014–2016), $346,617; the Care Coordination resource costs an additional ongoing $390,790/year. A hypothetical 5-physician HealthTexas practice spent another estimated 239.5 hours ($10,669) obtaining, and 110.5 hours ($4,957) renewing, recognition. Conclusion: Centralized PCMH support reduces the burden on practices; however, overall time and cost remains substantial, and should be weighed against the mixed evidence regarding PCMH9s impact on quality and costs of care.

Climate change represents a significant and growing threat to population health. Rural areas face unique challenges, such as high rates of vulnerable populations; economic uncertainty due to their reliance on industries that are vulnerable to climate change; less resilient infrastructure; and lower levels of access to community and emergency services than urban areas. This article fills a gap in public health practice by developing climate and health environmental public health indicators for a local public health department in a rural area. We adapted the National Environmental Public Health Tracking Network’s framework for climate and health indicators to a seven-county health department in Western Kentucky. Using a three-step review process, we identified primary climate-related environmental public health hazards for the region (extreme heat, drought, and flooding) and a suite of related exposure, health outcome, population vulnerability, and environmental vulnerability indicators. Indicators that performed more poorly at the county level than at the state and national level were defined as “high vulnerability.” Six to eight high vulnerability indicators were identified for each county. The local health department plans to use the results to enhance three key areas of existing services: epidemiology, public health preparedness, and community health assessment.

Outbreaks can be prevented with strict biosecurity and microbiological monitoring., We investigated the extent of lymphocytic choriomeningitis virus (LCMV) infection in employees and rodents at 3 commercial breeding facilities. Of 97 employees tested, 31 (32%) had IgM and/or IgG to LCMV, and aseptic meningitis was diagnosed in 4 employees. Of 1,820 rodents tested in 1 facility, 382 (21%) mice (Mus musculus) had detectable IgG, and 13 (0.7%) were positive by reverse transcription PCR; LCMV was isolated from 8. Rats (Rattus norvegicus) were not found to be infected. S-segment RNA sequence was similar to strains previously isolated in North America. Contact by wild mice with colony mice was the likely source for LCMV, and shipments of infected mice among facilities spread the infection. The breeding colonies were depopulated to prevent further human infections. Future outbreaks can be prevented with monitoring and management, and employees should be made aware of LCMV risks and prevention.

Previous research has found an association between childhood trauma and insecure attachment and psychological distress, risk of violence and engagement in therapy. The aim of this study was to investigate the relationships between these factors in a forensic population. Sixty-four participants from three secure psychiatric hospitals completed the Childhood Trauma Questionnaire (CTQ), the Relationship Scales Questionnaire (RSQ) and the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM). Overall scores from participants' Historical Clinical Risk Management Violence Risk Assessment Scheme, (HCR-20) were calculated. Staff evaluated participants' engagement in therapy via completion of the Service Engagement Scale (SES). This retrospective study found childhood trauma and insecure attachment significantly predicted psychological distress and risk of violence. No associations with engagement were found, but methodological reasons for this outcome were acknowledged. The importance of routinely assessing for a history of childhood trauma and insecure attachment was highlighted.

Series elastic actuators primarily use linear springs in their drivetrains, which introduces a design tradeoff: soft springs provide higher torque resolution at the cost of system bandwidth, whereas stiff springs provide a fast response but lower torque resolution. Nonlinear springs (NLSs) potentially incorporate the benefits of both soft and stiff springs, but such springs are often large. An NLS design was recently proposed that combines a variable radius cam with a rubber elastic element, enabling a compact spring design. However, the rubber introduces hysteresis, which can lead to poor torque tracking if not accounted for in the controller. To overcome this limitation, we here propose a state observer that captures hysteretic effects exhibited by the rubber to provide an accurate estimate of actuator torque. We perform torque-control experiments with this observer on an actuator testbed and compare the performance of the NLS to both soft and stiff linear metal springs. Experiments show that the NLS exhibits improved output impedance compared to both linear springs, and comparable bandwidth to the stiff linear spring up to 1.5 Hz. However, the hysteresis in the urethane rubber introduces instability in higher-frequency conditions, suggesting that future NLS designs can be improved by use of a different rubber as the elastic element.