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Women with obesity are less likely to participate in mammographic screening and more likely to develop post-menopausal breast cancer. We describe the co-production of a novel training intervention for breast screening staff, targeting obesity-related barriers to participating in a population-based mammographic screening. A Stakeholder Consultant Group (SCG) was established to guide the co-production process. A narrative review of the literature was conducted, as well as first person interviews of women with lived experience of obesity, to identify/inform themes for service delivery staff training. Three themes from the narrative review emerged: (i) enhanced staff-client communication, (ii) promoting compassionate connections during client interactions (iii) tailored mammography positioning for women with obesity. Iterative co-design and consultation with the SCG resulted in six key sessions delivered within an in-service training day: determinants of obesity, weight stigma and healthcare, screening challenges for women living with obesity, empathy 'mapping', front-line training for reception staff, and screening challenges for radiographers when screening women with obesity. Subsequent practical workshops for radiographers provided hands-on positioning training using a real-life model and a 'mammo vest'. Feedback showed that 74 % of staff rated the training as "very good" or "excellent". Training to improve staff interactions with women with obesity appears to be acceptable. The intervention has been successfully implemented in a population-based breast screening program to improve the mammography experience for both clients and staff. Improving the mammogram experience will improve the likelihood of clients returning to screening when next due. Given the prevalence of obesity and body image issues, targeted interventions that optimize client interactions could significantly reduce breast cancer mortality through early detection. [ABSTRACT FROM AUTHOR]

Mammographic breast screening/rescreening rates are suboptimal for women with obesity and/or physical disabilities. This study describes development of an intervention framework targeting obesity- and disability-related barriers to improve participation. Mixed methods combined a systematic review with first-person perspectives to optimise screening engagement among women with obesity and/or physical disabilities. Phase 1 (systematic review) was conducted following the PRISMA framework. Phase 2 involved in-depth interviews with n = 8 women with lived experience of obesity and/or physical disabilities. An inductive coding approach was applied to the data which was then combined with Phase 1 results to develop the intervention framework. Six studies were included in the systematic review. Tailored education based on individual risk increased willingness to undergo mammographic screening. Recommendations to improve the screening experience included partnerships with consumers, targeted messaging, and enhanced professional development for breast screening staff. Participants also identified strategies to improve the uptake of screening and the experience itself. Development and evaluation of interventions informed by frameworks like the one developed in this study are needed to improve engagement in screening to promote regular participation among women with physical disabilities and/or obesity. Successful implementation of practice interventions co-designed by women with obesity and/or physical disabilities are likely to improve their breast screening participation. Enhanced training of radiographers aimed at upskilling in empathetic communication around required manoeuvring and potentially longer screening times for clients with obesity and/or physical disabilities may encourage more positive client practitioner interactions. Client information aimed at women with obesity should include information on how to prepare for the appointment and explain there may be equipment limitations compromising imaging which may not be completed at an initial appointment. [ABSTRACT FROM AUTHOR]

• A method assessing a structure's progressive collapse (PC) vulnerability is proposed. • The proposed energy flow approach (EFA) illustrates an energy – failure correlation. • This EFA predicts failure using Energy Flow vs Energy Flow Rate (E-R) failure thresholds. • This EFA to predicts PC of a damaged mid-rise steel building with repeatable accuracy. • The DOD's Alternate Path (AP) method approaches for PC is shown to be ineffective. This paper explains the correlation of energy flow and the rate energy flow to the susceptibility of progressive collapse (PC) for typical mid-rise steel framed buildings. Energy-time histories of structural members were analysed to determine the energy flow behaviour throughout the structural system. All structural elements, including all connections, were represented numerically to (more accurately) determine the building's susceptibility to PC, including the sequence of failing members. Assessing PC susceptibility with the incorporation of the rate of energy flow for a structure that accounts for the effects of connection resistance functions constitutes a novel approach. Advanced nonlinear transient dynamic finite element simulations were used to reveal the energy flow and its flow rate, and the de facto relationship with building response and failure. In addition, the efficacy of the current DOD approaches for PC assessment are examined in a comparative study with the proposed energy flow approach. [ABSTRACT FROM AUTHOR]

Epidemiologic research in pediatric heart failure (HF) is limited, focused on hospitalized children identified from administrative databases. Challenges in HF case ascertainment and lack of outpatient data constrain the estimates of HF incidence. Aims: to estimate a regional incidence of pediatric HF and describe cohort characteristics. In an observational retrospective cohort, children with HF were identified from the Electronic Data Warehouse (EDW) of a tertiary referral center 01/2010-12/2020. Inclusion criteria: Utah address; 31 days - 19 years old at receipt of a HF ICD code. Patients were included if assigned 2 or more HF ICD codes or assigned a code in an inpatient encounter and treated with a HF-specific medication; methods previously described. EDW data were linked with the Society of Thoracic Surgeons National Database. Patients undergoing VSD or AVSD repair, PDA closure were eligible only if HF ICD codes were assigned post-procedure. 763 patients were included. Chart review of 37% (282/763) demonstrated 80% diagnostic accuracy in identifying HF patients. Based on census data, the incidence of HF was 7.0 per 100,000 patient-years (95% CI 6.5, 7.5). Nearly 20% (152) of the cohort was diagnosed with HF while outpatient and 25% (38/152) were not hospitalized during follow-up. Congenital heart disease (CHD) was most prevalent (464; 61%). Patients had a median of 3 comorbidities at the time of HF diagnosis (IQR 2,4). Median time to hospitalization/rehospitalization following diagnosis was 2.4 months (IQR 1.2,7.2), similar across all subgroups: CHD, cardiomyopathy (CM), CHD+CM, other diagnoses (p= 0.57). Mechanical support was required by 106 (14%) and heart transplant (tx) by 46 (6%) patients. Median time to tx was shortest among CM patients (p<0.001). There were 140 deaths (18%), most taking place during the index HF admission. Younger age at diagnosis, increased number of comorbidities, simple biventricular CHD vs CM were associated with risk of hospitalization (p=0.029, <0.001, 0.035 respectively). Diagnoses of hypertrophic cardiomyopathy or complex biventricular CHD were associated with risk of death or tx (p< 0.028, 0.22 respectively). This contemporary study describes the estimated regional incidence of pediatric HF using granular single-center data. Risk of mortality and rehospitalization are confirmed to be high in this population. [ABSTRACT FROM AUTHOR]

Many epidemiological studies in pediatric heart failure (HF) use administrative databases, defining patient cohorts by the presence of a single HF ICD code. However, the precision of ICD codes to identify true HF patients is unknown in pediatrics. The study aim is to describe the accuracy of HF ICD-10 codes alone and in combination with medication billing codes, in identifying pediatric patients with HF through electronic health records. Clinical notes were reviewed for 378 patients 18 years old and younger in a pediatric HF clinic at a tertiary care medical center within 01/2016-12/2020. The initial outpatient note for each patient was reviewed. Patients were adjudicated as having HF if the provider note: 1) stated the patient had current/prior HF or was receiving HF-specific treatment or 2) described the patient as NYHA/Ross Class II-IV HF or ACC/AHA HF Stage C or D. ICD-10 codes for HF and medication billing codes during the month before and 6 months after the clinic encounter were obtained. Algorithms were developed to identify HF patients based on the presence of 1 or more inpatient or outpatient HF ICD codes, in combination with HF medications. Using the clinical note review as the adjudicated positive HF diagnosis, algorithms were assessed by sensitivity, specificity, positive and negative predictive values. For inpatient algorithms that could be applied to administrative databases, receiver operating characteristics curves were generated and accuracy reported. Median age was 10.1 years (IQR 4.5,14.8) with 39/378 adjudicated HF patients. Algorithm performance is shown in Table 1. This is the first study to describe characteristics of ICD code algorithms for case ascertainment in pediatric HF. Results suggest that a combination of an ICD code and carvedilol can identify a cohort of HF patients however many patients will be missed. Natural language processing approaches may improve the accuracy of patient identification for pediatric HF outcomes research, and should be tested. [ABSTRACT FROM AUTHOR]