SAT0130 TREAT-TO-TARGET STRATEGY OF >8.000 PATIENTS WITH EARLY RHEUMATOID ARTHRITIS: DOES SMOKING AFFECT ACHIEVEMENT OF REMISSION ON METHOTREXATE AND TIME TO START OF FIRST BIOLOGIC? RESULTS FROM THE NATIONWIDE DANISH DANBIO REGISTRY

Background:

Smoking is a known risk factor for rheumatoid arthritis (RA). It is largely unknown whether smoking has any impact on disease activity and treatment outcomes (e.g. achieving remission on methotrexate and time to first biological disease modifying anti-rheumatic treatments (bDMARD)) in early RA with a modern treat-to-target strategy.

Objectives:

To explore if smoking was associated with treatment outcomes in newly diagnosed patients with RA starting first conventional synthetic (cs)DMARDs in routine care.

Methods:

Observational cohort study. Adult patients with RA starting first csDMARD during year 2010-2018 were identified in the Danish nationwide quality registry, DANBIO. Smoking status (current/never/previous) upon start of csDMARD (=baseline), disease activity, 1-year treatment outcomes and bDMARD treatment were retrieved from DANBIO. Data were censored Oct 2019.

Impact of smoking status was explored for the following outcomes: 1) median baseline disease activity baseline, 2) remission at 1-year (logistic regression analyses), 3) time to first bDMARD (Cox-regression analyses). Regression analyses were adjusted for gender and age.

Results:

Among 9515 patients, 8647 (91%) had available smoking status (Current 23%/never 50%/previous 27%) and were included. Baseline disease activity was independent of smoking status (Table 1). First line csDMARD was methotrexate in 91% of patients. Compared to never smokers, the current smokers were more often men, younger and sero-positive for IgM-RF and anti-CCP.

Table 1.

Patient characteristics and disease activity at baseline and 1 year stratified by smoking status. Numbers are medians (IQR) unless otherwise stated.

Smoking statusCurrentNeverPreviousBaselinePatient numbers, N200743082332Age, yrs58 (49-66)61 (48-71)62 (52-70)Female, %627163IgM-RF positive, %715465Anti-CCP positive, %715365DAS284.4 (3.4-5.3)4.4 (3.4-5.3)4.3 (3.3-5.3)CDAI18.7 (11.7-27.3)18.4 (10.9-27.4)18.5 (10.4-27.6)VAS patient global, mm60 (35-81)55 (30-77)55 (31-78)1 yearPatient number, N179338372053DAS282.6 (1.9-3.7)2.3 (1.7-3.4)2.5 (1.8-3.4)CDAI6.4 (2.8-12.5)4.9 (1.8-10.3)5.4 (2-10.8)DAS28-remission, %495753CDAI-remission, %273533VAS patient global, mm37 (14-67)29 (10-57)30 (11-58)

DAS28-response: DAS28(CRP)≤2.6; CDAI-remission: CDAI≤2.8

Never and previous smokers had higher odds of remission at 1 year’s follow-up compared to current smokers. In adjusted Cox regression analyses, baseline smoking was associated with shorter time to start of first bDMARD (Table 2).

Table 2.

Impact of baseline smoking status on treatment outcomes

ComparisonOdds Ratio (95% CI)pDAS28-remission 1 yr, yes vs. no*Never vs. current smoker1.43 (1.27;1.62)<0.001Previous vs. current1.14 (0.99;1.30)0.07CDAI remission 1 yr, yes vs. no*Never vs. current1.53 (1.34;1.75)<0.001Previous vs. current1.29 (1.11;1.50)<0.001ComparisonHazard Ratio (95% CI)pStart of bDMARD duringfollow-up**Never vs current smoker0.85 (0.76;0.96)0.006Previous vs. current1.05 (0.93;1.19)0.4

*Logistic regression analyses (adjusted for gender and age)

** Cox regression analyses (adjusted for gender and age)

Conclusion:

In this observational study of >8000 patients with RA starting a first csDMARD, current smoking was associated with lower odds of achieving remission on methotrexate and higher chance of having started bMDARD compared to never smokers. Seropositivity may be an intermediate variable. Further analyses are planned to study impact of comorbidities and other confounding factors.

Acknowledgments :

Thank you to all patients and departments who contribute to the DANBIO registry

Disclosure of Interests: :

Bente Glintborg Grant/research support from: Grants from Pfizer, Biogen and Abbvie, Oliver Hendricks Grant/research support from: Pfizer, MSD, Ada Colic Consultant of: Advisory board Sanofi, Hanne Merete Lindegaard: None declared, Rabiah Ahmed: None declared, Anne Gitte Loft Grant/research support from: Novartis, Consultant of: AbbVie, MSD, Novartis, Pfizer and UCB, Speakers bureau: AbbVie, MSD, Novartis, Pfizer and UCB, Gina Kollerup Speakers bureau: Eli Lilly, Marlene Andersen: None declared, Jolanta Grydehøj: None declared, Johnny Raun: None declared, Toke Thorgrimsen: None declared, Kasper Mortensen: None declared, Line Uhrenholt Speakers bureau: Abbvie, Eli Lilly and Novartis (not related to the submitted work), Dorte Jensen: None declared, Iben Ruge Grant/research support from: Novo Nordisk Foundation, Maren Kalisz: None declared, Kamilla Danebod: None declared, Niels Lomborg: None declared, Niels Steen Krogh: None declared, Merete L. Hetland Grant/research support from: BMS, MSD, AbbVie, Roche, Novartis, Biogen and Pfizer, Consultant of: Eli Lilly, Speakers bureau: Orion Pharma, Biogen, Pfizer, CellTrion, Merck and Samsung Bioepis

Antenatal testing for anaemia, HIV and syphilis in Indonesia - a health systems analysis of low coverage

BACKGROUND

Adverse pregnancy outcomes can be prevented through the early detection and treatment of anaemia, HIV and syphilis during the antenatal period. Rates of testing for anaemia, HIV and syphilis among women attending antenatal services in Indonesia are low, despite its mandate in national guidelines and international policy.

METHODS

Midwife-held antenatal care records for 2015 from 8 villages in 2 sub-districts within Cianjur district were reviewed, alongside the available sub-district Puskesmas (Community Health Centre) maternity and laboratory records. We conducted four focus group discussions with kaders (community health workers) (n = 16) and midwives (n = 9), and 13 semi-structured interviews with laboratory and counselling, public sector maternity and HIV management and relevant non-governmental organisation staff. Participants were recruited from village, sub-district, district and national level as relevant to role.

RESULTS

We were unable to find a single recorded result of antenatal testing for HIV, syphilis or anaemia in the village (566 women) or Puskesmas records (2816 women) for 2015. Laboratory records did not specifically identify antenatal women. Participants described conducting and reporting testing in a largely ad hoc manner; relying on referral to health facilities based on clinical suspicion or separate non-maternity voluntary counselling and testing programs. Participants recognized significant systematic challenges with key differences between the more acceptable (and reportedly more often implemented) haemoglobin testing and the less acceptable (and barely implemented) HIV and syphilis testing. However, a clear need for leadership and accountability emerged as an important factor for prioritizing antenatal testing and addressing these testing gaps.

CONCLUSIONS

Practical solutions such as revised registers, availability of point-of-care tests and capacity building of field staff will therefore need to be accompanied by both funding and political will to coordinate, prioritize and be accountable for testing in pregnancy.

Graphene Oxide Loaded Hydrogel for Enhanced Wound Healing in Diabetic Patients

Chronic wound or slow healing of a wound is one of the serious complications in diabetic patients. The decrease in the proliferation and migration of cells such as keratinocytes and fibroblasts is the major reason for the development of such chronic wounds in a diabetic patient. Therefore, designing a wound dressing patch using a biodegradable hydrogel, which can provide a sustained release/delivery of active agents that can support cell proliferation and cell migration, will be highly beneficial for promoting diabetic wound healing. Multiple evidences from both in-vitro and in-vivo studies have shown that graphene oxide (GO) and reduced graphene oxide promote wound healing by promoting migration and proliferation of keratinocyte cells. In addition, GO possesses angiogenic property. Gelatin methacrylate (GelMA) based hydrogels display excellent hydrophilic properties due to the presence of hydrophilic amino, amido, carboxyl, and hydroxyl groups in the polymer chains, which gives them highly porous, soft and flexible structure. In this work, we report the development of hydrogel dressing incorporated with GO to improve wound healing by increasing the proliferation and migration of cells.

Reactive Nitrogen Species Releasing Hydrogel for Enhanced Wound Healing

Poor proliferation and migration of fibroblast, keratinocyte and endothelial cells delays the wound healing in diabetic patients and results into chronicity of wounds. Slow or decreased formation of blood vessels is another issue that increases the chronicity of non-healing wounds. These chronic wounds turn into an ulcer that may lead to limb amputation. Recently, nitric oxide (NO) has emerged as a potential agent for accelerating cell migration and proliferation to enhance wound healing. It increases the expression of necessary angiogenic growth factors which stimulates the proliferation and migration of major cell types involved in wound repair. Here we report the synthesis of chitosan (CS), polyvinyl alcohol (PVA) and a NO donor S-nitroso-N-acetyl-DL-penicillamine (SNAP) to enhance the wound healing activities in chronic wounds. A three-fold increase in the proliferation of 3T3 cells was observed with NO-releasing CS-PVA hydrogels. In vitro cell migration assay demonstrated a four-fold faster migration of cells to the scratched area compared to the control group. The results depict that the use of CS-PVA hydrogel impregnated with the NO donor (SNAP) can be a promising material for promoting cell migration and subsequent accelerated healing of the chronic wounds in burns and diabetic patients.

A High-Performing Plasma Metabolite Panel for Early-Stage Lung Cancer Detection

The objective of this research is to use metabolomic techniques to discover and validate plasma metabolite biomarkers for the diagnosis of early-stage non-small cell lung cancer (NSCLC). The study included plasma samples from 156 patients with biopsy-confirmed NSCLC along with age and gender-matched plasma samples from 60 healthy controls. A fully quantitative targeted mass spectrometry (MS) analysis (targeting 138 metabolites) was performed on all samples. The sample set was split into a discovery set and validation set. Metabolite concentration data, clinical data, and smoking history were used to determine optimal sets of biomarkers and optimal regression models for identifying different stages of NSCLC using the discovery sets. The same biomarkers and regression models were used and assessed on the validation models. Univariate and multivariate statistical analysis identified β-hydroxybutyric acid, LysoPC 20:3, PC ae C40:6, citric acid, and fumaric acid as being significantly different between healthy controls and stage I/II NSCLC. Robust predictive models with areas under the curve (AUC) > 0.9 were developed and validated using these metabolites and other, easily measured clinical data for detecting different stages of NSCLC. This study successfully identified and validated a simple, high-performing, metabolite-based test for detecting early stage (I/II) NSCLC patients in plasma. While promising, further validation on larger and more diverse cohorts is still required.

Abstract TP21: Safety of Cangrelor in Emergency Endovascular Stroke Recanalization, a Single Center Experience

Introduction: Optimal antiplatelet regimen post-emergent stenting in acute stroke remains challenging among patients at high-risk for thrombosis and/or hemorrhage, especially after tPA. We describe our preliminary experience with cangrelor, an immediate acting IV P2Y12 receptor inhibitor with rapid onset and clearance.

Methods: Retrospective cross-sectional study of mechanical thrombectomy (MER) patients requiring urgent stenting(0-48h). Patients treated with cangrelor were compared to those treated with other antiplatelets.

Results: Nine cangrelor patients were compared to twelve patients treated with other antiplatelets. Pre- and post-treatment measures were similar overall (Table).

Conclusions: Cangrelor may be a safe alternative to current antiplatelets used in immediate perioperative period post-MER and urgent stenting, including tPA patients and those at high-risk for malignant cerebral edema or hemorrhagic transformation. Additional studies are required to confirm or refute our observations.

Structure and Rheological Properties of Bovine Aortic Heart Valve and Pericardium Tissue: Implications in Bioprosthetic and Tissue-Engineered Heart Valves

Heart valve (HV) diseases are among the leading causes of cardiac failure and deaths. Of the various HV diseases, damaged HV leaflets are among the primary culprits. In many cases, impaired HV restoration is not always possible, and the replacement of valves becomes necessary. Bioprosthetic HVs have been used for the replacement of the diseased valves, which is obtained from the sources of bovine and porcine origin, while tissue-engineered heart valves (TEHV) have emerged as a promising future solution. The bioprosthetic valves are prone to become calcified, and thus they last for only ten to fifteen years. The adequate understanding of the correlations between the biomechanics and rheological properties of native HV tissues can enable us to improve the durability of the bioprosthetic HV as well as help in the development of tissue-engineered heart valves (TEHV). In this study, the structural and rheological properties of native bovine aortic HV and pericardium tissues were investigated. The microstructures of the tissues were investigated using scanning electron microscopy, while the rheological properties were studied using oscillatory shear measurement and creep test. The reported results provide significant insights into the correlations between the microstructure and viscoelastic properties of the bovine aortic HV and pericardium tissues.

Reduced Graphene Oxide Incorporated GelMA Hydrogel Promotes Angiogenesis For Wound Healing Applications

PURPOSE

Non-healing or slow healing chronic wounds are among serious complications of diabetes that eventually result in amputation of limbs and increased morbidities and mortalities. Chronic diabetic wounds show reduced blood vessel formation (lack of angiogenesis), inadequate cell proliferation and poor cell migration near wounds. In this paper, we report the development of a hydrogel-based novel wound dressing material loaded with reduced graphene oxide (rGO) to promote cell proliferation, cell migration and angiogenesis for wound healing applications.

METHODS

Gelatin-methacryloyl (GelMA) based hydrogels loaded with different concentrations of rGO were fabricated by UV crosslinking. Morphological and physical characterizations (porosity, degradation, and swelling) of rGO incorporated GelMA hydrogel was performed. In vitro cell proliferation, cell viability and cell migration potential of the hydrogels were analyzed by MTT assay, live/dead staining, and wound healing scratch assay respectively. Finally, in vivo chicken embryo angiogenesis (CEO) testing was performed to evaluate the angiogenic potential of the prepared hydrogel.

RESULTS

The experimental results showed that the developed hydrogel possessed enough porosity and exudate-absorbing capacity. The biocompatibility of prepared hydrogel on three different cell lines (3T3 fibroblasts, EA.hy926 endothelial cells, and HaCaT keratinocytes) was confirmed by in vitro cell culture studies (live/dead assay). The GelMA hydrogel containing 0.002% w/w rGO considerably increased the proliferation and migration of cells as evident from MTT assay and wound healing scratch assay. Furthermore, rGO impregnated GelMA hydrogel significantly enhanced the angiogenesis in the chick embryo model.

CONCLUSION

The positive effect of 0.002% w/w rGO impregnated GelMA hydrogels on angiogenesis, cell migration and cell proliferation suggests that these formulations could be used as a functional wound healing material for the healing of chronic wounds.

Predicting Factors of Angiographic Aneurysm Occlusion after Treatment with the Woven EndoBridge Device: A Single-Center Experience with Midterm Follow-Up

BACKGROUND AND PURPOSE

Flow disruption with the Woven EndoBridge is increasingly used for the treatment of intracranial aneurysms. We examined factors leading to aneurysm occlusion and Woven EndoBridge shape change during a midterm follow-up.

MATERIALS AND METHODS

Patients with a minimum 12-month angiographic follow-up were included. Through a univariate and multivariate analysis, independent predictors of adequate occlusion (Raymond-Roy 1/Raymond-Roy 2) and Woven EndoBridge shape change (decrease of the height of the device) were assessed.

RESULTS

Eighty-six patients/aneurysms were included. The aneurysm mean size was 5.5 mm (range, 3-11.5 mm). The most common locations were the MCA (43/86 = 50%), basilar tip (13/86 = 15.1%), and anterior communicating artery (12/86 = 14%). Twenty-one patients (21/86 = 24%) had acute SAH. Immediate and long-term Raymond-Roy 1/Raymond-Roy 2 occlusion rates were 49% (42/86) and 80% (68/86), respectively. Woven EndoBridge shape change was detected among 22% (19/86) of cases. At binary logistic regression, wide ostium (≥4 mm) (OR = 0.2; 95% CI, 0.01-1; P = .04) and regular aneurysm morphology (OR = 5.9; 95% CI, 1.4-24; P = .01) were independent factors of incomplete and adequate aneurysm occlusion, respectively. In addition, irregular morphology (OR = 5.4; 95%CI, 1.4-19; P = .01) and a wide ostium (OR = 9.8; 95% CI, 1.6-60; P = .03) significantly increased the probability of the Woven EndoBridge shape change. Decrease of the Woven EndoBridge height was more common among incompletely occluded aneurysms (6/12 = 50% versus 13/74 = 17.5%), but it was not an independent prognosticator of occlusion at the multivariate model.

CONCLUSIONS

The likelihood of good occlusion was 5 times lower in the presence of a wide ostium, whereas aneurysms with regular morphology were 6 times more likely to be occluded. Woven EndoBridge shape modification was strongly influenced by the aneurysm shape and ostium size, and it was not independently associated with the angiographic occlusion.

Phenolic contents-based assessment of therapeutic potential of Syzygium cumini leaves extract

Syzygium cumini (S. cumini) is an evergreen tropical plant that is well recognized for its therapeutic potential of common diseases. In this study, the therapeutic potential and biomedical application of S. cumini are assessed in vitro and in vivo to find its effectiveness for different complications. The methanolic crude extract of S. cumini leaves were screened for total phenolic and flavonoid content. In vitro, the DPPH scavenging assay, XTT assay, prothrombin and activated partial thromboplastin time were used to assess antioxidant, cytoprotective and thrombolytic activity of the S. cumini extract, respectively. The anti-inflammatory potential and the analgesic activity of the S. cumini extract were analyzed in rabbits by the Carrageenan induced paw edema method and the writhing method, respectively. Phytochemical analysis showed the presence of considerable amounts of total phenolic (369.75 ± 17.9 mg GAE/g) and flavonoid (75.8 ± 5.3 mgRE/g) content in the S. cumini extract. The DPPH assay demonstrated a higher antioxidant potential (IC-50 value of 133 μg/ml), which was comparable to the IC-50 of ascorbic acid (122.4 μg/ml). Moreover, the S. cumini extract showed a dose dependent cytoprotective effect against H₂O₂ treated bone marrow mesenchymal stem cells (BM-MSCs). S. cumini also possesses significant anticoagulant activity with a prothrombin time of 28.3 ± 1.8 seconds vs 15.8 ± 0.2 seconds of control, p<0.05. The leaf extract also demonstrated an analgesic effect in rabbits as indicated by the decrease in writhing (12.2 ± 1.7 control vs. 3.7 ± 0.6 treated) and anti-inflammatory activity in rabbits paw with a protection against inflammation of 64.1 ± 2.4%. Our findings suggest that the methanolic extract of S. cumini leaves has antioxidant, cytoprotective, anticoagulant, analgesic and anti-inflammatory properties, and therefore, can be applied for treating cardiovascular diseases and cancers.

Canadian Hospital and Home Visiting Nurses' Attitudes Toward Families in Transitional Care: A Descriptive Comparative Study

Despite the key role that hospital and home care nurses have in supporting family carers in transitional care, there is limited comparative information on their attitudes toward supporting family carers during care transitions. As part of a larger research project, we conducted a descriptive comparative study using a cross-sectional survey. Canadian nurses (105 hospital, 34 home visiting) completed a demographic questionnaire and the Families' Importance in Nursing Care-Nurses' Attitudes (FINC-NA) measurement tool. There were no statistically significant differences between hospital and home visiting nurses' attitudes, which were positive about including families in care. Nurses who reported having a workplace philosophy or general approach to the care of family held more positive attitudes toward families than those who did not. This is important because positive attitudes are often linked to better communication with family carers and thus, better patient and carer outcomes. To our knowledge, only one Canadian master's thesis has used this tool. Thus, this research furthers understanding of nurse attitudes within a Canadian context. Furthermore, this article adds to the literature by including suggestions for future research that are based in social psychological theories. Interdisciplinary knowledge can help pre- and postlicensure clinicians in advanced family nursing to better lever barriers and facilitators within family nursing practice.

Wearable Real-Time Heart Attack Detection and Warning System to Reduce Road Accidents

Heart attack is one of the leading causes of human death worldwide. Every year, about 610,000 people die of heart attack in the United States alone-that is one in every four deaths-but there are well understood early symptoms of heart attack that could be used to greatly help in saving many lives and minimizing damages by detecting and reporting at an early stage. On the other hand, every year, about 2.35 million people get injured or disabled from road accidents. Unexpectedly, many of these fatal accidents happen due to the heart attack of drivers that leads to the loss of control of the vehicle. The current work proposes the development of a wearable system for real-time detection and warning of heart attacks in drivers, which could be enormously helpful in reducing road accidents. The system consists of two subsystems that communicate wirelessly using Bluetooth technology, namely, a wearable sensor subsystem and an intelligent heart attack detection and warning subsystem. The sensor subsystem records the electrical activity of the heart from the chest area to produce electrocardiogram (ECG) trace and send that to the other portable decision-making subsystem where the symptoms of heart attack are detected. We evaluated the performance of dry electrodes and different electrode configurations and measured overall power consumption of the system. Linear classification and several machine algorithms were trained and tested for real-time application. It was observed that the linear classification algorithm was not able to detect heart attack in noisy data, whereas the support vector machine (SVM) algorithm with polynomial kernel with extended time-frequency features using extended modified B-distribution (EMBD) showed highest accuracy and was able to detect 97.4% and 96.3% of ST-elevation myocardial infarction (STEMI) and non-ST-elevation MI (NSTEMI), respectively. The proposed system can therefore help in reducing the loss of lives from the growing number of road accidents all over the world.

Treatment of Wide-Neck Intracranial Aneurysms with the Woven EndoBridge Device Associated with Stenting: A Single-Center Experience

BACKGROUND AND PURPOSE

The intrasaccular flow disruptor, the Woven EndoBridge device, is increasingly used for the treatment of wide-neck intracranial aneurysms. Due to unfavorable anatomy, additional stent placement is sometimes required to avoid Woven EndoBridge protrusion into bifurcation branches. We report our experience with the Woven EndoBridge associated with stent placement for the treatment of complex intracranial aneurysms.

MATERIALS AND METHODS

Patients with aneurysms treated with the Woven EndoBridge Single-Layer plus stent placement were evaluated retrospectively with prospectively maintained data. The technical feasibility, procedural complications, aneurysm occlusion, and clinical outcome were studied.

RESULTS

Seventeen patients and aneurysms treated with the Woven EndoBridge plus stent placement were included. The mean aneurysm size was 7 ± 3.1 mm. Aneurysm locations were the following: MCA (10 patients), anterior communicating artery (3 patients), basilar tip (3 patients), and posterior communicating artery (1 patient). Two lesions were ruptured and treated in the acute phase. The Woven EndoBridge and stent placement were successfully delivered in all cases. There were no permanent/major complications. Among the 2 patients with SAH, minor and completely reversible in-stent thrombosis occurred during treatment. An asymptomatic occlusion of the angular artery with a distal nonbifurcation aneurysm was discovered during the angiographic follow-up. Long-term (10.4 months) angiographic complete (Raymond-Roy I) and near-complete (Raymond-Roy II) occlusion was obtained in 11 (69%) and 2 (12.5%) aneurysms, respectively. The mean sizes of aneurysms showing Raymond-Roy I/Raymond-Roy II and Raymond-Roy III occlusion were 5.5 ± 2.1 mm and 10 ± 1 mm, respectively (P = .003). The mean fluoroscopy time was 35 ± 14 minutes.

CONCLUSIONS

Aneurysm embolization with the Woven EndoBridge device associated with stent placement appears technically feasible and effective for the treatment of lesions with unfavorable anatomy. In our study, this strategy was relatively safe with a low rate of relevant procedure-related adverse events.

Portable System for Monitoring and Controlling Driver Behavior and the Use of a Mobile Phone While Driving

There is an utmost requirement for technology to control a driver’s phone while driving, which will prevent the driver from being distracted and thus saving the driver’s and passenger’s lives. Information from recent studies has shown that 70% of the young and aware drivers are used to texting while driving. There are many different technologies used to control mobile phones while driving, including electronic device control, global positioning system (GPS), on-board diagnostics (OBD)-II-based devices, mobile phone applications or apps, etc. These devices acquire the vehicle information such as the car speed and use the information to control the driver’s phone such as preventing them from making or receiving calls at specific speed limits. The information from the devices is interfaced via Bluetooth and can later be used to control mobile phone applications. The main aim of this paper is to propose the design of a portable system for monitoring the use of a mobile phone while driving and for controlling a driver’s mobile phone, if necessary, when the vehicle reaches a specific speed limit (>10 km/h). A paper-based self-reported questionnaire survey was carried out among 600 teenage drivers from different nationalities to see the driving behavior of young drivers in Qatar. Finally, a mobile application was developed to monitor the mobile usage of a driver and an OBD-II module-based portable system was designed to acquire data from the vehicle to identify drivers’ behavior with respect to phone usage, sudden lane changes, and abrupt breaking/sharp speeding. This information was used in a mobile application to control the driver’s mobile usage as well as to report the driving behavior while driving. The application of such a system can significantly improve drivers’ behavior all over the world.