Varicella-zoster virus (VZV) is the etiologic agent of varicella (chickenpox) and herpes zoster (shingles) infections commonly involving skin, mucous membranes, and less frequently the central nervous system. Traditional methods for the laboratory diagnosis of these infections are time-consuming, labor-intensive, and often insensitive. ABSTRACT Varicella-zoster virus (VZV) is the etiologic agent of varicella (chickenpox) and herpes zoster (shingles) infections commonly involving skin, mucous membranes, and less frequently the central nervous system. Traditional methods for the laboratory diagnosis of these infections are time-consuming, labor-intensive, and often insensitive. As such, these tests are being replaced by more sensitive and rapid molecular methods. This study evaluated the performance of two different molecular assays, the Simplexa VZV Direct and Simplexa VZV Swab Direct, to detect VZV DNA in cerebrospinal fluid (CSF) and lesion-swab specimens, respectively. The Simplexa VZV Direct and Simplexa VZV Swab Direct assays were compared against individual composite reference methods that varied depending on the sample cohort examined. A total of 883 CSF and 452 cutaneous and mucocutaneous prospective, retrospective, and contrived specimens were evaluated in this multicenter study. The results of this study showed that the Simplexa assays demonstrated near perfect agreement (k = 0.98) compared to the composite reference methods for the detection of VZV in CSF and lesion swab specimens. A further comparison between the standard of care molecular assays employed at the site of specimen collection and the Simplexa assays demonstrated excellent agreement (k = 1.0). The Simplexa assays offer rapid and reliable alternatives for the detection of VZV in certain clinical specimens without the need for nucleic acid extraction.

The vertical transmission of group B Streptococcus (GBS) strains causing neonatal sepsis is one of the leading reasons for neonatal mortality worldwide. The gold standard for GBS detection is enriched culture with or without the aid of chromogenic agars. Given the high risk for morbidity and mortality in this population, high assay sensitivity is required to prevent the personal and economic costs of GBS disease. Nucleic acid amplification tests (NAATs) allow for objective determination of GBS colonization with a sensitivity and a specificity higher than those of traditional culture methods. In this study, we determined the analytical and clinical performance of the Aries GBS assay compared to those of the enrichment culture method, biochemical identification, and the NAATs used at the study sites. Remnant Lim broth samples were used to perform the Aries assay and reference testing. Upon first testing using enriched culture as the reference standard, the Aries GBS assay identified GBS with a 96.1% sensitivity (95% confidence interval [CI], 91.2 to 98.7%) and a 91.4% specificity (95% CI, 88.8 to 93.6%). The test performed with 100% positive agreement (95% CI, 83.2 to 100%) compared to the results of the BD Max GBS assay and 98.0% positive agreement (95% CI, 89.2 to 99.9%) compared to the results of the Cepheid Xpert GBS LB test. Repeatability and reproducibility were maintained in intra-and interlaboratory testing, regardless of the instrument, module, or user who performed the test. The Aries GBS assay can be set up in less than 5 min and produces results in 2 h. The easy setup, with minimal hands-on time, and high assay sensitivity and specificity make this a useful testing option for GBS screening in prepartum women.

body: Radiation therapy continues to play an essential role in the primary management of breast cancer. Following lumpectomy radiation therapy to the intact breast using a conventional course of radiation treatment over 5–7 weeks has been broadly embraced as an acceptable standard of care for decades. More recently, moderate whole breast hypofractionation over 3–4 weeks has evolved as an acceptable alternative. Data supporting whole breast hypofractionation, ongoing trials and evolving data, current guidelines and controversies regarding whole breast hypofractionation will be presented. The use of hypofractionation in the management of regional lymphatics will also be presented and discussed. Data supporting alternative approaches to whole breast irradiation, including post lumpectomy partial breast irradiation and intra-operative partial breast irradiation, and partial breast re-irradiation for local recurrence will be presented and discussed. Finally the use of proton beam in the management of breast cancer, controversies and ongoing trials will be presented and discussed. Learning objectives: To inform the participant of established and evolving data, ongoing trials, issues and controversies in the radiation management of breast cancer with a focus on hypofractionation, partial breast irradiation and proton beam therapy. Sunday 22 October 2017, 0830–1030, Concurrent Session: Head and Neck Temporomandibular joint imaging review R Bessell-Browne and A Whyte Perth Radiological Clinic, Subiaco, Western Australia, Australia, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia Abstract: The presentation will highlight current temporomandibular joint imaging techniques and provide examples of common pathologies encountered in clinical practice. CT and MRI being the main imaging modalities will be covered and relevant cases will be presented, some with arthroscopic correlation. Learning objective: To improve radiologist reporting and understanding of TMJ disorders and to expose radiology trainees to imaging not commonly seen during training. The presentation will highlight current temporomandibular joint imaging techniques and provide examples of common pathologies encountered in clinical practice. CT and MRI being the main imaging modalities will be covered and relevant cases will be presented, some with arthroscopic correlation. Learning objective: To improve radiologist reporting and understanding of TMJ disorders and to expose radiology trainees to imaging not commonly seen during training. Editorial material and organisation © 2017 The Royal Australian and New Zealand College of Radiologists. Copyright of individual abstracts remains with the authors. Oral Presentations 125 Jo ur na l o f M ed ic al Im ag in g an d Ra di at io n O nc ol og y Common pathology of the sinuses

Objectives The objective of this study was to evaluate the cobas ® HSV 1 and HSV 2 Test using clinician-collected swab specimens from external anogenital lesions as part of a large multicenter clinical trial. Methods Two swabs were collected from patients with possible HSV infection at 8 geographically diverse sites. The first swab was used for the Quidel Lyra™ Direct HSV 1+2/VZV on the Cepheid SmartCycler II System and the second for the cobas ® HSV 1 and 2 Test. The Quidel Lyra™ Direct HSV 1+2/VZV test was performed at a reference laboratory and the cobas ® HSV 1 and HSV 2 Test was performed at 3 sites. Discrepant analysis included HSV culture using the ELVIS ® HSV ID and D³ Typing Test, a second FDA-cleared nucleic acid amplification test (BD ProbeTec TM Herpes Simplex viruses [HSV 1 and 2] Q x Amplified DNA Assays) and Sanger sequencing. The sensitivity and specificity were calculated by comparing cobas ® HSV 1 and HSV 2 Test results with the Quidel Lyra™ Direct HSV 1+2/VZV test following discrepant analysis using the majority result from the three comparator tests. Results There were 229 HSV positive subjects, with 73 HSV-1 (44 female, 29 male) and 157 HSV-2 (78 female, 79 male) positive subjects, among 409 evaluable participants (205 female, 204 male). The sensitivity and specificity of the cobas ® HSV 1 and HSV 2 Test compared to the Quidel Lyra™ Direct HSV 1+2/VZV following discrepant analysis for HSV-1 was 98.6% (72/73) and 97.0% (326/336), respectively, and for HSV-2 was 100% (157/157) and 92.9% (234/252), respectively. Conclusion The cobas ® HSV 1 and 2 Test, on the automated cobas ® 4800 system, displayed excellent performance compared Quidel Lyra™ Direct HSV 1+2/VZV Test combined with discrepant analysis. The test is highly suitable to detect HSV in clinician-collected anogenital swab specimens from patients with suspected HSV infection. Disclosure of interest This clinical trial study was supported by Roche Molecular Diagnostics.

Introduction Diagnosis of anogenital herpes is definitively established by testing anogenital lesion specimens from symptomatic patients by culture or molecular methods. The objective of this study was to evaluate the cobas® HSV 1 and HSV 2 Test using clinician-collected swab specimens from external anogenital lesions as part of a large multicenter clinical trial conducted in the United States of America. Methods Two swabs were collected from patients with possible HSV infection at 8 geographically diverse sites. The first swab was used for culture by the ELVIS® HSV ID and D³ Typing Test (Diagnostic Hybrids, Inc., Athens, OH) and PCR followed by Sanger sequencing for HSV-1 and HSV-2. The second swab was for the cobas® HSV 1 and 2 Test. Sensitivity and specificity were calculated compared to the combined results of culture and Sanger sequencing using the “any positive rule”. The positive (PPA) and negative percent agreement (NPA) were calculated compared with culture. Results There were 243 HSV positive subjects, with 84 HSV-1 (51 female, 33 male) and 167 HSV-2 (85 female, 82 male) positive subjects, among 408 evaluable participants (205 female, 203 male). The sensitivity and specificity of the cobas® HSV 1 and HSV 2 Test compared the Reference Method for HSV-1 was 92.9% (78/84) and 98.8% (320/324), respectively, and for HSV-2 was 97.0% (162/167) and 94.6% (228/241), respectively. The PPA and NPA of the cobas® HSV 1 and HSV 2 Test compared to the culture for HSV-1 was 100% (67/67) and 93.9% (199/212), respectively, and for HSV-2 was 99.2% (128/129) and 83.2% (232/279), respectively. Conclusion The cobas® HSV 1 and 2 Test displayed excellent performance compared to the combined results of culture and Sanger sequencing. The test is highly suitable to detect HSV in clinician-collected anogenital swab specimens from patients with suspected HSV infection. Disclosure of interest statement This clinical trial study was supported by Roche Molecular Diagnostics.

Young people with problematic alcohol and other drug (AOD) use are often referred to residential treatment. Subsequent mortality rates among this high-risk group is not known. This study estimates mortality rates and determines causes of death amongst young people referred to residential treatment in Sydney, Australia.Retrospective data linkage study. Data of young people (13–18 years) referred to a residential treatment service 2001–2015 (n = 3256) linked with Australian death registration data, and followed up to 16 years (2001–2016).Mortality rates (CMRs) and standardised mortality ratios (SMRs, age-, gender-, calendar-year-adjusted) calculated using population mortality rates. Causes of death were analysed using ICD-10 codes for AOD-induced, AOD as contributory and non-AOD related causes.During follow-up of the cohort (28,838 person-years), 63 people died (71.4 % males; 48 % Indigenous; median age at death = 21.9 years; median follow-up = 5.1years), with 76 % dying before aged 25 years. Overall mortality (SMR = 4.91, 95 % CI: 3.8−6.2; CMR = 2.18/1000 person-years, 95 % CI: 1.7−2.8) was significantly higher than age-gender-matched general population, particularly in females (SMR = 9.55; males: SMR = 4.11; RR: 2.3, 95 % CI: 1.3–4.1). SMRs were not significantly different between treatment groups (SMRs>5.5) and non-attend group (SMR = 3.7) (p = 0.359). Two-thirds of deaths involved AOD, with AOD-induced deaths comprising 42 % and AOD as contributory for 22 % deaths. Overdose, mainly opioids (including opiates), suicide, and transport accidents were major causes of deaths.Very high mortality rates, particularly among females, and the high incidence of overdose and suicide emphasise early screening for those at high-risk, targeted and culturally appropriate interventions, and maximised continuing after-care accessible to young people.

This study investigated the stability of genetic and environmental effects on the common liability to alcohol, tobacco, and cannabis dependence across adolescence and young adulthood. DSM-IV symptom counts from 2,361 adolescents were obtained using a structured diagnostic interview. Several sex-limited longitudinal common pathway models were used to examine gender differences in the magnitude of additive genetic (A), shared environment, and non-shared environmental effects over time. Model fitting indicated limited gender differences. Among older adolescents (i.e., age > 14), the heritability of the latent trait was estimated at 0.43 (0.05, 0.94) during the first wave and 0.63 (0.21, 0.83) during the second wave of assessment. A common genetic factor could account for genetic influences at both assessments, as well as the majority of the stability of SAV over time [rA = 1.00 (0.55, 1.00)]. These results suggest that early genetic factors continue to play a key role at later developmental stages.

Past studies highlight a narrowing gender gap and the existence of a shared etiology across substances of abuse; however, few have tested developmental models using longitudinal data. We present data on developmental trends of alcohol, tobacco, and marijuana use, abuse and dependence assessed during adolescence and young adulthood in a community-based Colorado twin sample of 1733 respondents through self-report questionnaires and structured psychiatric interviews. Additionally, we report on the rates of multiple substance use and disorders at each developmental stage, and the likelihood of a substance use disorder (SUD; i.e., abuse or dependence) diagnosis in young adulthood based on adolescent drug involvement. Most notably, we evaluate whether the pattern of multiple substance use and disorders and likelihood ratios across substances support a model of generalized risk. Lastly, we evaluate whether the ranked magnitudes of substance-specific risk match the addiction liability ranking. Substance use and SUDs are developmental phenomena, which increase from adolescence to young adulthood with few and inconsistent gender differences. Adolescents and young adults are not specialized users, but rather tend to use or abuse multiple substances increasingly with age. Risk analyses indicated that progression toward a SUD for any substance was increased with prior involvement with any of the three substances during adolescence. Despite the high prevalence of alcohol use, tobacco posed the greatest substance-specific risk for developing subsequent problems. Our data also confirm either a generalized risk or correlated risk factors for early onset substance use and subsequent development of SUDs.