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Per- and poly-fluoroalkyl substances (PFASs) have been widely used and detected in human matrices. Evidence that PFAS exposure may be associated with adverse human reproductive health effects exists, however, data is limited. The use of a human matrix such as follicular fluid to determine chemical exposure, along with reproductive data will be used to investigate if there is a relationship between PFAS exposure and human fertility. Objective: This study aims to: (1) assess if associations exist between PFAS concentrations and/or age and fertilisation rate (as determined in follicular fluid of women in Australia who received assisted reproductive treatment (ART)); and (2) assess if associations exist between PFAS concentrations and infertility aetiology. Methods: Follicular fluids were originally collected from participants who underwent fully stimulated ART treatment cycles at an in vitro fertilisation (IVF) clinic in the period 2006–2009 and 2010–11 in Queensland, Australia. The samples were available for analysis of 32 PFASs including perfluorooctane sulfonate (PFOS), perfluorooctanoic acid (PFOA), perfluorohexane sulfonate (PFHxS), and perfluorononanoic acid (PFNA) using high performance liquid chromatography tandem mass spectrometry (HPLC-MS/MS). 97 samples were matched with limited demographic data (age and fertilisation rate) and five infertility factors (three known female factors): 1) endometriosis, 2) polycystic ovarian syndrome (PCOS), and 3) genital tract infections - tubal/pelvic inflammation disease; as well as 4) male factor, and 5) idiopathic or unknown from either males or females. SPSS was used for linear regression analysis. Results: PFASs were detected in all follicular fluid samples with the mean concentrations of PFOS and PFOA, 4.9, and 2.4 ng/ml, respectively. A lower fertilisation rate was observed at higher age when age was added as a covariate, but there was no relationship between PFAS concentrations and fertilisation rate. There were fe

The objective of the study was to determine the human serum elimination half-life of polybrominated diphenyl ethers (PBDEs) adjusted for ongoing exposure in subjects moving from a higher exposure region (North America) to a lower exposure region (Australia). The study population was comprised of exchange students and long-term visitors from North America moving to Brisbane, Australia (N = 27) and local residents (N = 23) who were followed by repeated serum sampling every other month. The local residents were sampled to adjust for ongoing exposure in Australia. Only one visitor remained in Australia for a period of time similar to the elimination half-life and had a sufficiently high initial concentration of PBDEs to derive a half-life. This visitor arrived in Australia in March of 2011 and remained in the country for 1.5 years. Since the magnitude of PBDE exposure is lower in Australia than in North America we observed an apparent 1st order elimination curve over time from which we have estimated the serum elimination half-lives for BDE28, BDE47, BDE99, BDE100, and BDE153 to be 0.942, 1.19, 1.03, 2.16, and 4.12 years, respectively. Uncertainty in the estimates were estimated using a Monte Carlo simulation. The human serum elimination half-life adjusted for ongoing exposure can allow us to assess the effectiveness and reduction in exposure in the general population following phase out of commercial penta- and octaBDE in 2004 in the United States.

Objectives Ultrasound has an established role in the diagnostic pathway for children with suspected appendicitis. Relevant clinical information can influence the diagnostic probability and reporting of ultrasound findings. A Bayesian network (BN) is a directed acyclic graph (DAG) representing variables as nodes connected by directional arrows permitting visualisation of their relationships. This research developed a BN model with ultrasonographic and clinical variables to predict acute appendicitis in children. Methods A DAG was designed through a hybrid method based on expert opinion and a review of literature to define the model structure; and the discretisation and weighting of identified variables were calculated using principal components analysis, which also informed the conditional probability table of nodes. Results The acute appendicitis target node was designated as an outcome of interest influenced by four sub-models, including Ultrasound Index, Clinical History, Physical Assessment, and Diagnostic Tests. These sub-models included four sonographic, three blood-test, and six clinical variables. The BN was scenario tested and evaluated for face, predictive, and content validity. A lack of similar networks complicated concurrent and convergent validity evaluation. Conclusions To our knowledge, this is the first BN model developed for the identification of acute appendicitis incorporating imaging variables. It has particular benefit for cases in which variables are missing because prior probabilities are built into corresponding nodes. It will be of use to clinicians involved in ultrasound examination of children with suspected appendicitis, as well as their treating clinicians. Prospective evaluation and development of an online tool will permit validation and refinement of the BN.

Purpose The purpose of this study was to determine whether the awareness and inclusion of secondary sonographic signs of appendicitis, in combination with a structured evaluation as part of engagement and training for sonographers, improved appendix visualization rates and reduced equivocal findings in children with suspected acute appendicitis. Methods This was a prospective study of 230 children at a tertiary children’s hospital in Australia referred for an ultrasound examination of suspected appendicitis. The ultrasound findings, radiology reports, histology, clinical results, and follow-up were collated. Secondary signs were used as an additional assessment of the likelihood of disease where possible, even in the absence of an identified appendix. Results The implementation of a structured evaluation as part of sonographer engagement and training resulted in a 28% improvement in appendix visualization (68.7%) compared with a prior retrospective study in a similar population (40.7%). The diagnostic accuracy was 91.7%, with likelihood ratios suggesting a meaningful influence of the pre-test probability of appendicitis in children studied (positive likelihood ratio, 11.22; negative likelihood ratio, 0.09.). Only 7.8% of the findings were equivocal. A binary 6-mm diameter cut-off did not account for equivocal cases, particularly lymphoid hyperplasia. Conclusion Engagement of sonographers performing pediatric appendiceal ultrasound through training in the scanning technique and awareness of secondary signs significantly improved the visualization rate and provided more meaningful findings to referrers.

Background: Emerging scientific evidence suggests that exposure to environmental pollutants is associated with negative effects on fecundity as measured by time to pregnancy (TTP). Objectives: To conduct a systematic review of the literature on the association between selected endocrine disrupting chemicals (EDCs), and fecundity as measured by TTP in humans. Compounds included in this review are: brominated flame retardants (BFRs) such as hexabromocyclododecane, tetrabromobiphenol A and polybrominated diphenyl ethers; organophosphates flame retardants (OPFRs); and phthalates. Methods: Scopus, MEDLINE via Ebscohost and EMBASE databases were searched for articles exploring the relationships between selected EDCs and fecundity as measured by time to pregnancy. We assessed the quality of included studies and evidence for causality was graded using the criteria developed by the World Cancer Research Fund. Results: 14 studies of 191 full-text articles assessed for eligibility were included for qualitative synthesis. Five studies examined BFRs and 10 studies examined phthalates. Among the fourteen, one study assessed both BFRs and phthalates. There were no studies which investigated fecundity as measured by TTP on HBCD, TBBPA, or OPFRs. We recorded plausible fecundity outcomes as measured by TTP related to some of these EDCs. BFRs or phthalates increased TTP. However, results were inconsistent. Conclusion: We recorded mostly weak associations between exposure to selected EDCs and fecundity. However, evidence was considered limited to conclude a causal relationship due to inconsistency of results. The health risks posed by these chemicals in exposed populations are only beginning to be recognized and prospective measurement of the environmental effects of the chemicals in large cohort studies are urgently needed to confirm these relationships and inform policies aimed at exposure prevention.

The authors regret that the last sentence in the current Acknowledgement section, i.e. “The analytical data in this study was partly provided by the research from the Vietnam National Science and Technology Research Pro-gram (Grant number KHCN-33.01/11-15; research and overcoming long-term consequences of Agent Orange/Dioxin on the environment and the human health in Vietnam)” was incorrect. The correct sentence should be appeared in the acknowledgement is: “The laboratory analytical data of study was funded by Vietnam National Foundation for Science and Technology Development (NAFOSTED) under grant number 104.04-2014.40”. The authors would like to apologise for any inconvenience caused.

Purpose To develop a method for scoring online cone‐beam CT (CBCT)‐to‐planning CT image feature alignment to inform prostate image‐guided radiotherapy (IGRT) decision‐making. The feasibility of incorporating volume variation metric thresholds predictive of delivering planned dose into weighted functions, was investigated. Methods Radiation therapists and radiation oncologists participated in workshops where they reviewed prostate CBCT‐IGRT case examples and completed a paper‐based survey of image feature matching practices. For 36 prostate cancer patients, one daily CBCT was retrospectively contoured then registered with their plan to simulate delivered dose if (a) no online setup corrections and (b) online image alignment and setup corrections, were performed. Survey results were used to select variables for inclusion in classification and regression tree (CART) and boosted regression trees (BRT) modeling of volume variation metric thresholds predictive of delivering planned dose to the prostate, proximal seminal vesicles (PSV), bladder, and rectum. Weighted functions incorporating the CART and BRT results were used to calculate a score of individual tumor and organ at risk image feature alignment (FASTV_OAR). Scaled and weighted FASTV_OAR were then used to calculate a score of overall treatment compliance (FASglobal) for a given CBCT‐planning CT registration. The FASTV_OAR were assessed for sensitivity, specificity, and predictive power. FASglobal thresholds indicative of high, medium, or low overall treatment plan compliance were determined using coefficients from multiple linear regression analysis. Results Thirty‐two participants completed the prostate CBCT‐IGRT survey. While responses demonstrated consensus of practice for preferential ranking of planning CT and CBCT match features in the presence of deformation and rotation, variation existed in the specified thresholds for observed v

Purpose To describe a Bayesian network (BN) and complementary visualization tool that aim to support decision‐making during online cone‐beam computed tomography (CBCT)‐based image‐guided radiotherapy (IGRT) for prostate cancer patients. Methods The BN was created to represent relationships between observed prostate, proximal seminal vesicle (PSV), bladder and rectum volume variations, an image feature alignment score (FASTV_OAR), delivered dose, and treatment plan compliance (TPC). Variables influencing tumor volume (TV) targeting accuracy such as intrafraction motion, and contouring and couch shift errors were also represented. A score of overall TPC (FASglobal) and factors such as image quality were used to inform the BN output node providing advice about proceeding with treatment. The BN was quantified using conditional probabilities generated from published studies, FASTV_OAR/global modeling, and a survey of IGRT decision‐making practices. A new IGRT visualization tool (IGRTREV), in the form of Mollweide projection plots, was developed to provide a global summary of residual errors after online CBCT‐planning CT registration. Sensitivity and scenario analyses were undertaken to evaluate the performance of the BN and the relative influence of the network variables on TPC and the decision to proceed with treatment. The IGRTREV plots were evaluated in conjunction with the BN scenario testing, using additional test data generated from retrospective CBCT‐planning CT soft‐tissue registrations for 13/36 patients whose data were used in the FASTV_OAR/global modeling. Results Modeling of the TV targeting errors resulted in a very low probability of corrected distances between the CBCT and planning CT prostate or PSV volumes being within their thresholds. Strength of influence evaluation with and without the BN TV targeting error nodes indicated that rectum‐ and bladder‐related network v

Introduction We evaluated the predictive value of sonographic and clinical variables in the diagnosis of acute appendicitis in children using decision tree modelling. Methods Data pooled from two prior studies in the same population of children referred for ultrasound examination of suspected acute appendicitis. Ultrasound and clinical variables were collated and compared with patient records. Decision tree algorithms were used to model data to identify highly discriminatory variables. Receiver operative characteristic (ROC) curve analyses were performed on different models of appendiceal diameter criteria. Results There were 687 examinations included. Diameter modelling indicated that categorical assessment – below 6 mm as negative, diameters between 6 and 8 mm equivocal for appendicitis and above 8 mm positive – was more accurate (AUROC = 0.921) than the most accurate binary cut‐off (7 mm, AUROC = 0.886). Decision tree analysis supported categorical diameter criteria, demonstrated that the presence of echogenic mesentery was an important variable and showed that common blood test results can be complementary discriminators of ultrasound findings. Discussion The use of a binary appendiceal diameter cut‐off was less accurate than a three‐category model. Absence of peri‐appendiceal mesentery inflammation is an important negative predictor of appendicitis in children, even without direct visualisation of the appendix.

There is growing concern around the use of organophosphate esters (OPEs) due to their suspected reproductive toxicity, carcinogenicity, and neurotoxicity. OPEs are used as flame retardants and plasticizers, and due to their extensive application in consumer products, are found globally in the indoor environment. Early life exposure to OPEs is an important risk factor for children's health, but poorly understood. To study age and sex trends of OPE exposures in infants and young children, we collected, pooled, and analysed urine samples from children aged 0–5 years from Queensland, Australia for 9 parent OPEs and 11 metabolites. Individual urine samples (n = 400) were stratified by age and sex, and combined into 20 pools. Three individual breast milk samples were also analysed to provide a preliminary estimate on the contribution of breast milk to the intake of OPEs. Bis(1-chloroisopropyl) phosphate (BCIPP), 1-hydroxy-2-propyl bis(1-chloro-2-propyl) phosphate (BCIPHIPP), bis(1,3-dichloroisopropyl) phosphate (BDCIPP), dibutyl phosphate (DBP), diphenyl phosphate (DPHP), bis(2-butoxyethyl) phosphate (BBOEP), bis(2-butoxyethyl) 3-hydroxyl-2-butoxyethyl phosphate (3OH-TBOEP), and bis(2-butoxyethyl) hydroxyethyl phosphate (BBOEHEP) were detected in all urine samples, followed by bis(methylphenyl) phosphate (80%), and bis(2-ethylhexyl) phosphate (BEHP, 20%), and bis(2-chloroethyl) phosphate (BCEP, 15%). Concentrations of tris(2-chloroethyl) phosphate (TCEP), BCEP, tris(2-ethylhexyl) phosphate (TEHP), and DBP decreased with age, while bis(methylphenyl) phosphate (BMPP) increased with age. Significantly higher concentrations of DPHP (p = 0.039), and significantly lower concentrations of TEHP (p = 0.006) were found in female samples compared to males. The estimated daily intakes (EDIs) via breastfeeding, were 4.6, 26 and 76 ng/kg/day for TCEP, TBP and TEHP, respectively, and were higher than that via air and dust, suggesting higher exposure through consumption of breast milk.

Purpose or Case Report: The purpose of this educational exhibit poster is to increase the awareness of stump appendicitis using two case examples. Stump appendicitis is rare, with sixty-one cases identified in the literature between 1945 and 2005. Of the two common techniques of appendicectomy, ligation and invagination, the former can leave a residual stump with a potential lumen for the pathophysiological process of appendicitis to recur. Remnant stump lengths of greater than 5 mm are considered to have a higher risk of leading to stump appendicitis, acting as a potential reservoir for a faecolith. Whilst ultrasound has been commonly used to diagnose acute appendicitis for over 30 years, its utility in preoperative identification of stump appendicitis in patients postappendicectomy has only been documented more recently. Traditional sonographic criteria for diagnosing acute appendicitis have been applied to the appendiceal stump, with a transverse diameter greater than 6 mm, non-compressibility and wall hyperaemia all being concerning for stump appendicitis. Secondary sonographic signs of acute appendicitis, such as echogenic peri-appendiceal mesentery, can also indicate stump inflammation. Two case examples are presented, both in patients who are nine years old. One patient had surgically confirmed stump appendicitis. The second had sonographic features of stump appendicitis which settled with antibiotics without requiring surgery. Inflammation of the base or stump of a surgically removed appendix is an uncommon, and likely under-recognised condition in both children and adults. The majority of cases have had previous open appendicectomy, which is in contrast to a theory that laparascopic surgery is a potential factor in incomplete removal of the appendix due to poor visualisation of the appendiceal base. Both methods of appendicectomy, ligation or invagination, have been associated with stump appendicitis. Suspicion of the condition and prompt diagnosis can pote

Sediment samples collected over a 3-year period from Brisbane River, Australia, were analysed for fifteen (15) polycyclic aromatic hydrocarbons (PAHs). The total PAH concentrations varied from 148 to 3079 ng/g with a mean concentration of 849±646 ng/g. The study revealed that PAH input into the river was primarily dominated by pyrogenic sources as evidenced by the predominance of the high molecular weight (HMW) PAHs. Temporal variations of PAHs can be linked to the level of urbanization, with continuous input of combustion related PAHs in the commercial area of the river. Inherent deficiencies in using a single source identification/apportionment approach were overcome by using diagnostic ratios, principal component analysis/absolute principal component scores (PCA/APCS) and positive matrix factorization (PMF). Both PCA/APCS and PMF resolved four (4) identical factors or sources of PAH, namely: gasoline emissions, diesel emissions, biomass burning and natural gas combustion. Diagnostic ratios, PCA/APCS and PMF analysis indicated that vehicular emissions were the principal sources especially within the lower section of the river while biomass burning had moderate contribution. The distribution, temporal trend and source apportionment suggest the containment of industrial-derived sources of PAH in the river. From an ecological point of view, the risk posed by PAHs in the Brisbane River sediment is low. Nevertheless, when the investigated sites were ranked using multi-criteria decision making methods (MCDM) the commercial stratum was the most contaminated. Assessment of potential risks posed by incidental dermal exposure to PAHs revealed some degree of cancer risk, especially to children.