Managing the risks associated with technological disruption in the road transport system: a control structure modelling approach

Road transport is experiencing disruptive change from new first-of-a-kind technologies. While such technologies offer safety and operational benefits, they also pose new risks. It is critical to proactively identify risks during the design, development and testing of new technologies. The Systems Theoretic Accident Model and Processes (STAMP) method analyses the dynamic structure in place to manage safety risks. This study applied STAMP to develop a control structure model for emerging technologies in the Australian road transport system and identified control gaps. The control structure shows the actors responsible for managing risks associated with first-of-a-kind technologies and the existing control and feedback mechanisms. Gaps identified related to controls (e.g. legislation) and feedback mechanisms (e.g. monitoring for behavioural adaptation). The study provides an example of how STAMP can be used to identify control structure gaps requiring attention to support the safe introduction of new technologies.

Forecasting emergent risks in advanced AI systems: an analysis of a future road transport management system

Artificial Intelligence (AI) is being increasingly implemented within road transport systems worldwide. Next generation of AI, Artificial General Intelligence (AGI) is imminent, and is anticipated to be more powerful than current AI. AGI systems will have a broad range of abilities and be able to perform multiple cognitive tasks akin to humans that will likely produce many expected benefits, but also potential risks. This study applied the EAST Broken Links approach to forecast the functioning of an AGI system tasked with managing a road transport system and identify potential risks. In total, 363 risks were identified that could have adverse impacts on the stated goals of safety, efficiency, environmental sustainability, and economic performance of the road system. Further, risks beyond the stated goals were identified; removal from human control, mismanaging public relations, and self-preservation. A diverse set of systemic controls will be required when designing, implementing, and operating future advanced technologies.Practitioner summary: This study demonstrated the utility of HFE methods for formally considering risks associated with the design, implementation, and operation of future technologies. This study has implications for AGI research, design, and development to ensure safe and ethical AGI implementation.

Protocolized screening and detection of occult alcohol use before and after liver transplant: Lessons learned from a quality improvement initiative

INTRODUCTION

Detection of alcohol (ETOH) use with biomarkers provides an opportunity to intervene and treat patients with alcohol use disorder before and after liver transplant (LT). We describe our center's experience using urine ethyl glucuronide (EtG) and serum phosphatidylethanol (PEth) in alcohol screening protocols.

METHODS

Single-center, retrospective review of patients presenting for LT evaluation, patients waitlisted for LT for alcohol-associated liver disease (ALD), and patients who received a LT for ALD over a 12-month period, from October 1, 2019 through September 30, 2020. Patients were followed from waitlisting to LT, or for up to 12 months post-LT. We monitored protocol adherence to screening for ETOH use- defined as completion of all possible tests over the follow-up period- at the initial LT visit, while on the LT waitlist and after LT.

RESULTS

During the study period, 227 patients were evaluated for LT (median age 57 years, 58% male, 78% white, 54.2% ALD). Thirty-one patients with ALD were placed on the waitlist, and 38 patients underwent LT for ALD during this time period. Protocolized adherence to screening for alcohol use was higher for PEth for all LT evaluation patients (191 [84.1%] vs. 146 [67%] eligible patients, p < .001), in patients with ALD waitlisted for LT (22 [71%] vs. 14 (48%] eligible patients, p = .04) and after LT for ALD, 20 (33 [86.8%] vs. 20 [52.6%] eligible patients, p < .01). Few patients with a positive test in any group completed chemical dependency treatment.

CONCLUSIONS

When screening for ETOH use in pre- and post-LT patients, protocol adherence is higher using PEth compared to EtG. While protocolized biomarker screening can detect recurrent ETOH use in this population, engagement of patients into chemical dependency treatment remains challenging.

Hydrogel dressings for donor sites of split-thickness skin grafts

BACKGROUND

Donor site wounds of split-thickness skin grafts can be a major cause of morbidity. Choosing the appropriate dressing for these wounds is crucial to successful healing. Various types of dressing are available, including hydrogel dressings. A review of current evidence is required to guide clinical decision-making on the choice of dressing for the treatment of donor sites of split-thickness skin grafts.

OBJECTIVES

To assess the effects of hydrogel dressings on donor site wounds following split-thickness skin grafts for wound healing.

SEARCH METHODS

In July 2022 we searched the Cochrane Wounds Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL EBSCO Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses, and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication, or study setting.

SELECTION CRITERIA

Randomised controlled trials (RCTs) comparing hydrogel dressings with other types of dressing, topical treatments or no dressing, or with different types of hydrogel dressings in managing donor site wounds irrespective of language and publication status.

DATA COLLECTION AND ANALYSIS

Two review authors independently carried out data extraction, risk of bias assessment using the Cochrane risk of bias tool, RoB 1, and quality assessment according to GRADE methodology.

MAIN RESULTS

We included two studies (162 participants) in this review. One study with three arms and 101 participants (15 months' duration) was conducted in a children's hospital, and compared hydrogel dressings in the form of Sorbact with Algisite, an alginate dressing and Cuticerin, a smooth acetate gauze impregnated with water-repellent ointment. Another study with two arms and 61 participants (19 months' duration) was conducted in three surgery departments and compared an octenidine-containing hydrogel dressing with an identical non-antimicrobial hydrogel dressing. We identified no studies that compared hydrogel dressings with another therapy such as a topical agent (a topical agent is a cream, an ointment or a solution that is applied directly to the wound), or no dressing, or a combination of hydrogel dressings and another therapy versus another therapy alone. Both studies were at high risk of attrition bias and the second study was also at unclear risk of selection bias. Amorphous hydrogel dressings versus other types of dressings Amorphous hydrogel dressings may increase time to wound healing when compared with alginate (mean difference (MD) 1.67 days, 95% confidence interval (CI) 0.56 to 2.78; 1 study, 69 participants; low-certainty evidence) or Cuticerin dressings (MD 1.67 days, 95% CI 0.55 to 2.79; 1 study, 68 participants; low-certainty evidence). The effect of amorphous hydrogel dressings compared with other types of dressings is uncertain for pain at the donor site and wound complications, including scarring and itching (very low-certainty evidence). No adverse events were reported in any of the groups. The study did not report health-related quality of life or wound infection. Octenidine-based hydrogel dressing versus octenidine-free hydrogel dressing The effect of octenidine-based hydrogel dressings versus octenidine-free hydrogel dressings is uncertain for time to wound healing (MD 0.40, 95% CI 0.28 to 0.52; 1 study, 41 participants) and wound infection, as the certainty of the evidence is very low. The certainty of the evidence is also very low for adverse events, with two participants in the intervention group and one participant in the comparison group reporting adverse events (risk ratio (RR) 0.58, 95% CI 0.06 to 5.89; 1 study, 41 participants). The study did not report donor site pain, health-related quality of life, or wound complications.

AUTHORS' CONCLUSIONS

There is insufficient evidence to determine the effect of hydrogel dressings on donor site wounds of split thickness skin grafts compared with other types of dressings. There is a need for adequately powered and well-designed RCTs, with adequate sample sizes, types of populations and subgroups, types of interventions, and outcomes, that compare hydrogel dressings with other treatment options in the treatment of donor site wounds of split-thickness skin grafts.

Examining factors for the adoption of silvopastoral agroforestry in the Colombian Amazon

Current land use systems in the Amazon largely consist of extensive conventional productivist livestock operations that drive deforestation. Silvopastoral systems (SPS) support a transition to low carbon production if they intensify in sympathy with the needs of biophysical and socio-economic contexts. SPS have been promoted for decades as an alternative livestock production system but widespread uptake has yet to be seen. We provide a schema of associating factors for adoption of SPS based on past literature in tropical agriculture and apply this to a bespoke survey of 172 farms in the Caquetá region of the Colombian Amazon. We find a number of factors which do not apply to this region and argue for a context specific approach. The impact of managing increased market access and opportunities for SPS producers are crucial to avoiding additional deforestation. Further understanding of the underlying antecedents of common factors, such as perceptions of silvopastoral systems, would reduce the risk of perverse policy outcomes.

Haemostatic resuscitation in practice: a descriptive analysis of blood products administered during Operation HERRICK, Afghanistan

INTRODUCTION

Life-threatening haemorrhage is the leading cause of potentially survivable injury in battlefield casualties. During Operation HERRICK (Afghanistan), mortality rates improved year on year due to a number of advances in trauma care, including haemostatic resuscitation. Blood transfusion practice has not previously been reported in detail during this period.

METHODS

A retrospective analysis of blood transfusion at the UK role 3 medical treatment facility (MTF) at Camp Bastion between March 2006 and September 2014 was performed. Data were extracted from two sources: the UK Joint Theatre Trauma Registry (JTTR) and the newly established Deployed Blood Transfusion Database (DBTD).

RESULTS

3840 casualties were transfused 72 138 units of blood and blood products. 2709 adult casualties (71%) were fully linked with JTTR data and were transfused a total of 59 842 units. Casualties received between 1 unit and 264 units of blood product with a median of 13 units per patient. Casualties wounded by explosion required almost twice the volume of blood product transfusion as those wounded by small arms fire or in a motor vehicle collision (18 units, 9 units, and 10 units, respectively). More than half of blood products were transfused within the first 2 hours following arrival at the MTF. There was a trend towards balanced resuscitation with more equal ratios of blood and blood products being used over time.

CONCLUSION

This study has defined the epidemiology of blood transfusion practice during Operation HERRICK. The DBTD is the largest combined trauma database of its kind. It will ensure that lessons learnt during this period are defined and not forgotten; it should also allow further research questions to be answered in this important area of resuscitation practice.

Does believing something to be fiction allow a form of moral licencing or a 'fictive pass' in understanding others' actions?

Introduction

The human capacity to engage with fictional worlds raises important psychological questions about the mechanisms that make this possible. Of particular interest is whether people respond differently to fictional stories compared to factual ones in terms of how immersed they become and how they view the characters involved and their actions. It has been suggested that fiction provides us with a 'fictive pass' that allows us to evaluate in a more balanced, detached way the morality of a character's behaviour.

Methods

We use a randomised controlled experimental design to test this.

Results and discussion

We show that, although knowing whether a substantial film clip is fact or fiction does not affect how engaged with ('transported' by) a troubling story an observer becomes, it does grant them a 'fictive pass' to empathise with a moral transgressor. However, a fictive pass does not override the capacity to judge the causes of a character's moral transgression (at least as indexed by a causal attribution task).

A comparison of perceived image quality between computer display monitors and augmented reality smart glasses

INTRODUCTION

Augmented-reality (AR) smart glasses provide an alternative to standard computer display monitors (CDM). AR smart glasses may provide an opportunity to improve visualisation during fluoroscopy and interventional radiology (IR) procedures when there can be difficulty in viewing intra-procedural images on a CDM. The aim of this study was to evaluate radiographer perception of image quality (IQ) when comparing CDM and AR smart glasses.

METHODS

38 radiographers attending an international congress evaluated ten fluoroscopic-guided surgery and IR images on both a CDM (1920 × 1200 pixels) and a set of Epson Moverio BT-40 AR smart glasses (1920 × 1080 pixels). Participants provided oral responses to pre-defined IQ questions generated by study researchers. Summative IQ scores for each participant/image were compared between CDM and AR smart glasses.

RESULTS

Of the 38 participants, the mean age was 39 ± 1 years. 23 (60.5%) participants required corrective glasses. In terms of generalisability, participants were from 12 different countries, the majority (n = 9, 23.7%) from the United Kingdom. For eight out of ten images, the AR smart glasses demonstrated a statistically significant increase in perceived IQ (median [IQR] 2.0 [-1.0 to 7.0] points) when compared to the CDM.

CONCLUSION

AR smart glasses appear to show improvements in perceived IQ when compared to a CDM. AR smart glasses could provide an option for improving the experiences of radiographers involved in image-guided procedures and should be subject to further clinical evaluations.

IMPLICATIONS FOR PRACTICE

Opportunities exist to improve perceived IQ for radiographers when reviewing fluoroscopy and IR images. AR smart glasses should be further evaluated as a potential opportunity to improve practice when visual attention is split between positioning equipment and image review.

Diet and irritable bowel syndrome: an update from a UK consensus meeting

There has been a renewed interest in the role of dietary therapies to manage irritable bowel syndrome (IBS), with diet high on the agenda for patients. Currently, interest has focussed on the use of traditional dietary advice (TDA), a gluten-free diet (GFD) and the low FODMAP diet (LFD). A consensus meeting was held to assess the role of these dietary therapies in IBS, in Sheffield, United Kingdom.Evidence for TDA is from case control studies and clinical experience. Randomised controlled trials (RCT) have demonstrated the benefit of soluble fibre in IBS. No studies have assessed TDA in comparison to a habitual or sham diet. There have been a number of RCTs demonstrating the efficacy of a GFD at short-term follow-up, with a lack of long-term outcomes. Whilst gluten may lead to symptom generation in IBS, other components of wheat may also play an important role, with recent interest in the role of fructans, wheat germ agglutinins, as well as alpha amylase trypsin inhibitors. There is good evidence for the use of a LFD at short-term follow-up, with emerging evidence demonstrating its efficacy at long-term follow-up. There is overlap between the LFD and GFD with IBS patients self-initiating gluten or wheat reduction as part of their LFD. Currently, there is a lack of evidence to suggest superiority of one diet over another, although TDA is more acceptable to patients.In view of this evidence, our consensus group recommends that dietary therapies for IBS should be offered by dietitians who first assess dietary triggers and then tailor the intervention according to patient choice. Given the lack of dietetic services, novel approaches such as employing group clinics and online webinars may maximise capacity and accessibility for patients. Further research is also required to assess the comparative efficacy of dietary therapies to other management strategies available to manage IBS.

Randomized controlled trials in patients with COVID-19: a systematic review and critical appraisal

OBJECTIVES

This study aimed to describe the prevalence of risks of bias in randomized trials of therapeutic interventions for COVID-19.

METHODS

Systematic review and risk of bias assessment performed by two independent reviewers of a random sample of 40 randomized trials of therapeutic interventions for moderate-severe COVID-19. We used the RoB 2.0 tool to assess the risk of bias, which evaluates bias under five domains as well as an overall assessment of each trial as high or low risk of bias.

RESULTS

Of the 40 included trials, 19 (47%) were at high risk of bias, and this was particularly frequent in trials from low-middle income countries (11/14, 79%). Potential deviations to intended interventions (i.e., control participants accessing experimental treatments) were considered a potential source of bias in some studies (14, 35%), as was the risk due to selective reporting of results (6, 15%). The randomization process was considered at low risk of bias in most studies (34, 95%), as were missing data (36, 90%) and measurement of the outcome (35, 87%).

CONCLUSION

Many randomized trials evaluating COVID-19 interventions are at risk of bias, particularly those conducted in low-middle income countries. Biases are mostly due to deviations from intended interventions and partly due to the selection of reported results. The use of placebo control and publicly available protocol can mitigate many of these risks.

Feedback based on health advice via tracing bracelet and smartphone in the management of blood pressure among hypertensive patients: A community-based RCT trial in Chongqing, China

BACKGROUND

Lifestyle interventions have been recognized as a line of treatment for noncommunicable diseases. This study aimed to evaluate a bespoke mHealth approach to deliver personalized feedback to improve blood pressure and weight for hypertensive patients in community settings.

METHODS

A total of 307 participants, 50 from each community, were expected to be in the intervention or control group. A professional health facilitator was assigned for each of the 6 communities. The primary outcomes of the study are the reduction in blood pressure and weight at baseline and postintervention.

RESULTS

Of 307 recruited, 192 participants (62.5%) completed the study (intervention: 104 and control: 88). There was no difference in attrition rates between the 2 groups (33.5% vs 41.9%, P = .291). After 6 month of intensive feedback intervention through the mHealth approach, patients had better blood pressure (133.4 ± 15.3 vs 139.7 ± 16.0) compared with control.

CONCLUSIONS

People who were adherent to the intervention demonstrated a clinical benefit in weight and blood pressure.

Positioning for acute respiratory distress in hospitalised infants and children

BACKGROUND

Acute respiratory distress syndrome (ARDS) is a significant cause of hospitalisation and death in young children. Positioning and mechanical ventilation have been regularly used to reduce respiratory distress and improve oxygenation in hospitalised patients. Due to the association of prone positioning (lying on the abdomen) with sudden infant death syndrome (SIDS) within the first six months, it is recommended that young infants be placed on their back (supine). However, prone positioning may be a non-invasive way of increasing oxygenation in individuals with acute respiratory distress, and offers a more significant survival advantage in those who are mechanically ventilated. There are substantial differences in respiratory mechanics between adults and infants. While the respiratory tract undergoes significant development within the first two years of life, differences in airway physiology between adults and children become less prominent by six to eight years old. However, there is a reduced risk of SIDS during artificial ventilation in hospitalised infants. Thus, an updated review focusing on positioning for infants and young children with ARDS is warranted. This is an update of a review published in 2005, 2009, and 2012.

OBJECTIVES

To compare the effects of different body positions in hospitalised infants and children with acute respiratory distress syndrome aged between four weeks and 16 years.

SEARCH METHODS

We searched CENTRAL, which contains the Acute Respiratory Infections Group's Specialised Register, MEDLINE, Embase, and CINAHL from January 2004 to July 2021.

SELECTION CRITERIA

Randomised controlled trials (RCTs) or quasi-RCTs comparing two or more positions for the management of infants and children hospitalised with ARDS.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data from each study. We resolved differences by consensus, or referred to a third contributor to arbitrate. We analysed bivariate outcomes using an odds ratio (OR) and 95% confidence interval (CI). We analysed continuous outcomes using a mean difference (MD) and 95% CI. We used a fixed-effect model, unless heterogeneity was significant (I² statistic > 50%), when we used a random-effects model.

MAIN RESULTS

We included six trials: four cross-over trials, and two parallel randomised trials, with 198 participants aged between 4 weeks and 16 years, all but 15 of whom were mechanically ventilated. Four trials compared prone to supine positions. One trial compared the prone position to good-lung dependent (where the person lies on the side of the healthy lung, e.g. if the right lung was healthy, they were made to lie on the right side), and independent (or non-good-lung independent, where the person lies on the opposite side to the healthy lung, e.g. if the right lung was healthy, they were made to lie on the left side) position. One trial compared good-lung independent to good-lung dependent positions. When the prone (with ventilators) and supine positions were compared, there was no information on episodes of apnoea or mortality due to respiratory events. There was no conclusive result in oxygen saturation (SaO_2; MD 0.40 mmHg, 95% CI -1.22 to 2.66; 1 trial, 30 participants; very low certainty evidence); blood gases, PCO₂ (MD 3.0 mmHg, 95% CI -1.93 to 7.93; 1 trial, 99 participants; low certainty evidence), or PO₂ (MD 2 mmHg, 95% CI -5.29 to 9.29; 1 trial, 99 participants; low certainty evidence); or lung function (PaO₂/FiO₂ ratio; MD 28.16 mmHg, 95% CI -9.92 to 66.24; 2 trials, 121 participants; very low certainty evidence). However, there was an improvement in oxygenation index (FiO₂% X M_PAW/ PaO₂) with prone positioning in both the parallel trials (MD -2.42, 95% CI -3.60 to -1.25; 2 trials, 121 participants; very low certainty evidence), and the cross-over study (MD -8.13, 95% CI -15.01 to -1.25; 1 study, 20 participants). Derived indices of respiratory mechanics, such as tidal volume, respiratory rate, and positive end-expiratory pressure (PEEP) were reported. There was an apparent decrease in tidal volume between prone and supine groups in a parallel study (MD -0.60, 95% CI -1.05 to -0.15; 1 study, 84 participants; very low certainty evidence). When prone and supine positions were compared in a cross-over study, there were no conclusive results in respiratory compliance (MD 0.07, 95% CI -0.10 to 0.24; 1 study, 10 participants); changes in PEEP (MD -0.70 cm H₂O, 95% CI -2.72 to 1.32; 1 study, 10 participants); or resistance (MD -0.00, 95% CI -0.05 to 0.04; 1 study, 10 participants). One study reported adverse events. There were no conclusive results for potential harm between groups in extubation (OR 0.57, 95% CI 0.13 to 2.54; 1 trial, 102 participants; very low certainty evidence); obstructions of the endotracheal tube (OR 5.20, 95% CI 0.24 to 111.09; 1 trial, 102 participants; very low certainty evidence); pressure ulcers (OR 1.00, 95% CI 0.41 to 2.44; 1 trial, 102 participants; very low certainty evidence); and hypercapnia (high levels of arterial carbon dioxide; OR 3.06, 95% CI 0.12 to 76.88; 1 trial, 102 participants; very low certainty evidence). One study (50 participants) compared supine positions to good-lung dependent and independent positions. There was no conclusive evidence that PaO₂ was different between supine and good-lung dependent positioning (MD 3.44 mm Hg, 95% CI -23.12 to 30.00; 1 trial, 25 participants; very low certainty evidence). There was also no conclusive evidence for supine position and good-lung independent positioning (MD -2.78 mmHg, 95% CI -28.84, 23.28; 25 participants; very low certainty evidence); or between good-lung dependent and independent positioning (MD 6.22, 95% CI -21.25 to 33.69; 1 trial, 25 participants; very low certainty evidence). As most trials did not describe how possible biases were addressed, the potential for bias in these findings is unclear.

AUTHORS' CONCLUSIONS

Although included studies suggest that prone positioning may offer some advantage, there was little evidence to make definitive recommendations. There appears to be low certainty evidence that positioning improves oxygenation in mechanically ventilated children with ARDS. Due to the increased risk of SIDS with prone positioning and lung injury with artificial ventilation, it is recommended that hospitalised infants and children should only be placed in this position while under continuous cardiorespiratory monitoring.

OP0223 DISTINGUISHING OSTEOARTHRITIS AND RHEUMATOID ARTHRITIS SYNOVIUM WITH MACHINE LEARNING USING AUTOMATED CELL DENSITY AND PATHOLOGIST SCORES

Background

Joint damage in the knee can be severe in both rheumatoid arthritis (RA) and osteoarthritis (OA) such that total knee replacement (TKR) is often the only management option. Pathological assessment of the extent or type of synovial tissue inflammation from joint explants or biopsies can be useful. However, an ongoing challenge in using semi-quantitative assessments of synovitis is the disagreement between human pathologist scores of the same sample. We previously developed and validated a computer vision algorithm to automatically count each cell nucleus in an H&E-stained synovial whole slide image and yield a value of cell density, defined as mean nuclei count per mm2 of tissue1.

Objectives

We sought to develop methods to distinguish OA from RA based on machine learning analysis of histologic features on H&E-stained synovial tissue samples.

Methods

We measured 14 pathologist-scored histology features (137 RA and 152 OA patients) and computer vision quantified cell density (60 RA and 147 OA patients) in H&E stained synovial tissue samples from total knee replacement arthroplasty explants. A random forest model was trained using disease state (OA vs RA) as classifier and histology features and/or cell density as inputs, and feature importance scores for the model were calculated.

Results

Synovium from patients with RA exhibited increased lymphocytic inflammation, lining hyperplasia, neutrophils, detritus, plasma cells, Russell bodies, binucleate plasma cells, sub-lining giant cells, synovial lining giant cells, and fibrin (all p<0.001), while synovium from patients with OA had increased mast cells and fibrosis (both p<0.001). Fourteen pathologist-scored features allowed for discrimination between RA and OA samples, producing a macro-averaged area under the receiver operating curve (AUC) of 0.85. This discriminatory ability was comparable to that of the computer vision score of cell density alone (AUC = 0.88). Combining the pathologist scores with the cell density metric improved the discriminatory power of the model (AUC = 0.91). The three most important features in this combined model were mast cells followed by cell density and fibrosis (Figure 1). AUC values for each individual feature are provided in Table 1. The optimal cell density threshold to distinguish RA from OA synovium was 3,400 cells per mm2, which yielded a sensitivity of 0.82 and specificity of 0.82.

Table 1.

Area under receiver operating characteristic curves (AUC) of the synovial features in distinguishing RA and OA patients

FeatureAUCAutomated Cell Density0.88Fibrosis0.84Mast cells0.80Lining hyperplasia0.78Lymphocytic inflammation0.69Fibrin0.68Plasma cells0.66Detritus0.64Binucleate plasma cells0.60Neutrophils0.60Synovial giant cells0.58Sub-lining giant cells0.57Russell bodies0.56Germinal centers0.51Mucoid change0.50Figure 1.

Importance of synovial features in distinguishing RA and OA synovium

Feature importance scores for supervised machine learning model including all 14 pathology scores and the computer vision-generated cell density.

Conclusion

H&E-stained images of RA and OA TKR explant synovium are distinct. We identified cell density, mast cells and fibrosis as the three most important features for making this distinction, with RA being characterized by increased cell density, low mast cells, and low fibrosis. Cell density greater than 3400 per mm2 of tissue yields a sensitivity of 0.82 and a specificity of 0.82 for distinguishing RA from OA. In the future, this can have clinical and research applications as this technique removes the requirement for subjective selection of a certain field of interest, is reproducible, and is scalable as it does not require technical expertise of a pathologist.

References

[1]Guan S, Mehta B…Orange DE. Rheumatoid Arthritis Synovial Inflammation Quantification Using Computer Vision. ACR Open Rheumatology. 2022 Jan 10;acr2.11381.

Acknowledgements

This work was supported by the C. Ronald MacKenzie Young Scientist Endowment Award, the Leon Lowenstein Foundation, and the Kellen Scholar Award supported by the Anna Marie and Stephen Kellen Foundation Total Knee Improvement Program.

Disclosure of Interests

Bella Mehta Paid instructor for: Novartis, Susan Goodman Consultant of: UCB, Grant/research support from: Novartis, Edward DiCarlo: None declared, Deanna Jannat-Khah Shareholder of: AstraZeneca, Cytodyn, and Walgreens, J. Alex Gibbons: None declared, Miguel Otero Consultant of: Regeneron Pharmaceuticals, Grant/research support from: Tissue Genesis, Laura Donlin Speakers bureau: Stryker, Consultant of: Stryker, Grant/research support from: Karius, Inc, Tania Pannellini: None declared, William Robinson: None declared, Peter Sculco Consultant of: Intellijoint Surgical, DePuy Synthes, Lima Corporate, Zimmer Biomet, and EOS Imaging, Grant/research support from: Intellijoint Surgical and Zimmer Biomet, Mark Figgie Shareholder of: HS2, Mekanika, and Wishbone, Consultant of: Lima and Wishbone, Jose Rodriguez Consultant of: ConforMIS, Medacta, Exactech, Inc, and Smith & Nephew, Grant/research support from: DePuy, Exactech, Inc, and Smith & Nephew, Jessica Kirschmann: None declared, James Thompson: None declared, David Slater: None declared, Damon Frezza: None declared, Zhenxing Xu: None declared, Fei Wang: None declared, Dana Orange: None declared

Identifying and addressing conflicting results across multiple discordant systematic reviews on the same question: protocol for a replication study of the Jadad algorithm

INTRODUCTION

An increasing growth of systematic reviews (SRs) presents notable challenges for decision-makers seeking to answer clinical questions. In 1997, an algorithm was created by Jadad to assess discordance in results across SRs on the same question. Our study aims to (1) replicate assessments done in a sample of studies using the Jadad algorithm to determine if the same SR would have been chosen, (2) evaluate the Jadad algorithm in terms of utility, efficiency and comprehensiveness, and (3) describe how authors address discordance in results across multiple SRs.

METHODS AND ANALYSIS

We will use a database of 1218 overviews (2000-2020) created from a bibliometric study as the basis of our search for studies assessing discordance (called discordant reviews). This bibliometric study searched MEDLINE (Ovid), Epistemonikos and Cochrane Database of Systematic Reviews for overviews. We will include any study using Jadad (1997) or another method to assess discordance. The first 30 studies screened at the full-text stage by two independent reviewers will be included. We will replicate the authors' Jadad assessments. We will compare our outcomes qualitatively and evaluate the differences between our Jadad assessment of discordance and the authors' assessment.

ETHICS AND DISSEMINATION

No ethics approval was required as no human subjects were involved. In addition to publishing in an open-access journal, we will disseminate evidence summaries through formal and informal conferences, academic websites, and across social media platforms. This is the first study to comprehensively evaluate and replicate Jadad algorithm assessments of discordance across multiple SRs.

An audit of acute respiratory antibiotic prescribing in COPD patients during the COVID-19 pandemic

Introduction

Coronavirus-2 is the virus responsible for the COVID-19 pandemic. People with certain risk factors, such as having chronic obstructive pulmonary disease (COPD) may be more likely to develop complications. Research has identified that ~7% of patients with COVID-19 have a bacterial infection, however antibiotic prescribing rates have been found to vary from 38% to 72% (1,2). Primary care is estimated to make up 75% of antibiotic prescribing and was therefore a key target to evaluate whether antimicrobial stewardship principles were being followed during the COVID-19 pandemic.

Aim

To audit the adherence of antibiotic prescribing in people with COPD during the COVID-19 pandemic across a primary care network (PCN) in England against national and local guidelines.

Methods

The management of patients with COPD should follow NICE Guideline (NG) 114, NG168 and the local formulary. Three audit standards were created: 1) 100% of COPD patients should not be started on prophylactic antibiotics to reduce risk from COVID-19; 2) 100% of COPD patients should not be prescribed antibiotics for COVID-19 symptoms; 3) 90% of antibiotic prescription regimens should adhere to local and national guidelines. Prescribing data was collected from 12 practices linked to the PCN. Data of patients who had COPD, were prescribed an antibiotic, and had an indication for the antibiotic between 01/03/20 and the 30/06/20 were extracted and transferred into an anonymised spreadsheet. A total of 1088 data points were extracted. Random stratified sampling provided 300 data points for analysis, ensuring each GP surgery was represented proportionally; the required sample size to determine significance was 291. For each practice, the total number of antibiotics prescribed to COPD patients between March-June 2019 and March-June 2020 was extracted. Descriptive statistics were used to determine antibiotic prescribing adherence and overall rates of prescribing. Inferential statistics were used to compare rates of prescribing pre-vs-during the pandemic.

Results

Antibiotics were not prescribed for any patient for prophylaxis against COVID-19 (100% adherence to criteria 1). Two patients were prescribed antibiotics for ‘suspected disease caused by COVID-19’ (99.4% adherence to criteria 2). In only 28.7% of cases, the antibiotic was prescribed in line with the national and local guidelines (criteria 3). In most cases, treatment duration was the main reason for poor adherence, with longer courses of antibiotics being prescribed (7 rather than 5 days). Prescribing rates did not change significantly in 2020 compared to 2019 (1134 antibiotic prescriptions vs 1029 antibiotic prescriptions; p&gt;0.05).

Conclusion

The audit was successful in determining that the COVID-19 pandemic did not significantly affect antibiotic prescribing rates across the PCN for people with COPD. Adherence to NICE and local guidelines was low, specifically concerning the duration of antibiotic treatment. This highlights an area for improvement; to ensure healthcare professionals across the PCN prescribe in-line with antimicrobial stewardship principles. Extracted data was limited to antibiotic prescribing and could have been expanded to include steroids to provide a fuller audit of prescribing in COPD exacerbations. A re-audit may be beneficial since the publication of NG191.

References

(1) Lansbury L, Lim B, Baskaran V, Lim WS. Co-infections in people with COVID-19: a systematic review and meta-analysis. J Infect. 2020 Aug;81(2):266-275.

(2) Seaton RA, Gibbons CL, Cooper L, Malcolm W, McKinney R, Dundas S, Griffith D, Jeffreys D, Hamilton K, Choo-Kang B, Brittain S, Guthrie D, Sneddon J. Survey of antibiotic and antifungal prescribing in patients with suspected and confirmed COVID-19 in Scottish hospitals. J Infect. 2020 Dec;81(6):952-960.

The effect of an augmented reality educational tool on the motivation towards learning in pharmacy students: an evaluative survey

Introduction

Within the context of education, motivation relates to the desire students possess to engage in their learning environment. This quality is vital in determining the effort an individual expresses towards their learning and the desire they have to achieve higher academic performances (1). Educational technologies, particularly digital technologies, have long been used in post-secondary education to increase collaboration, critical thinking and motivation among students (2). The advancements in technology have led to the creation of novel augmented reality (AR) educational tools, however they have not been widely implemented or researched with the education of pharmacy students in the United Kingdom.

Aim

To identify changes of pharmacy students’ self-reported intrinsic motivation towards learning after using the ‘Pharma Compounds AR’ (PCAR) educational tool.

Methods

The PCAR tool was an image-based educational AR mobile application – it displayed 3-D models and animations of complex molecules when unique target images were scanned with the mobile’s camera. 118 stage two undergraduate Pharmacy students from a University in England were approached through cohort emails that contained a link to an online consent form and pre-intervention questionnaire. Participants were required to complete the pre-questionnaire before they received the PCAR tool for at least two months. Students were informed that they could use the tool to accommodate their learning in any way they felt appropriate. Once the intervention period ended, participants completed an online post-questionnaire. Changes in self-reported intrinsic motivation were determined with the use of adapted Intrinsic Motivation Inventory (IMI) Likert scale questions. The pre-questionnaire focused on motivation towards learning using conventional methods and their perceived usefulness, whereas the post-questionnaire focused on motivation towards learning with the PCAR tool and its perceived usefulness. Descriptive and inferential statistical analyses were conducted on the IMI adapted Likert scales.

Results

A total of 68 (57.6% rr) undergraduate Pharmacy students completed the pre-questionnaire. The majority were aged 18-21(82.4%), female (70.6%) and domestic (94.1%). The post-questionnaire was completed by 30 students (44.1% rr), mainly aged 18-21 (83.3%), female (70%), and domestic (86.7%). Participants ranked their agreement to each Likert statement from 1 (not true at all) to 7 (very true). Mean agreement motivation scores were increased after the use of the PCAR tool (pre-3.88 vs post-5.15), as were the mean agreement scores of the learning tools’ perceived usefulness (pre-4.69 vs post-5.29). Dependant T-tests performed on responses of students who completed both questionnaires revealed a significant increase in students’ mean pre- and post-intervention motivation towards learning scores (p=0.000). No significance was calculated between the mean pre-and post-agreement usefulness scores (p&gt;0.05).

Conclusion

Incorporating the PCAR tool into the education of stage two Pharmacy students significantly increased their reported motivation towards learning when compared to conventional methods, it was also reported as being a more useful learning tool. The drop in post-questionnaire responses has to be acknowledge as a limitation as well as not explicitly knowing how students used the PCAR tool in their studies. Nevertheless, the incorporation of AR into schools of Pharmacy could provide students and tutors more engaging teaching and learning experiences.

References

(1) Budiman R. Developing Learning Media Based on Augmented Reality (AR) to Improve Learning Motivation. J Educ Teach Learn. 2016 Sep;1(2):89–94. Available from: https://www.learntechlib.org/p/209026

(2) Martin F, Polly D, Coles S, Wang C. Examining higher education faculty use of current digital technologies: Importance, competence, and motivation. Int J Teach Learn High Educ. 2020;32(1):73–86.

Patient perceptions of clinical pharmacists in general practice

Introduction

As a result of changes in the demands and pressures on the NHS, the role of the pharmacist has advanced from purely dispensing and compounding medicines to a more clinical and patient-centred approach to care (1). Since 2015, NHS England set a target of recruiting practice-based pharmacists into 20% of practices by 2020-2021 as a way of reducing these pressures (2). Conducting evaluations of clinical pharmacists in individual practices is essential for role integration and evolution.

Aim

To explore patient perceptions of clinical pharmacists across three general practices.

Methods

A paper-based questionnaire consisting of open and closed questions was used to gather patient perceptions on the role of a clinical pharmacist and their consultation experiences. Participants included patients over the age of 18 who had attended a face-to-face appointment with a clinical pharmacist from one of three general practice surgeries in England between November and December 2019. The clinical pharmacists were used as a gateway to recruit participants; post-consultation, the pharmacist asked patients if they would complete a questionnaire. Patients were provided with an information sheet and consent form prior to completion of the questionnaire. The questionnaire was anonymous. Data were analysed using descriptive statistics and content analysis.

Results

A total of 39 participants completed the questionnaire. Most participants were elderly (28%) and female (64%). The primary reason for the consultations was due to an acute illness (79%), and the most common outcome was the supply of a prescription (83%). Patients were predominantly unfamiliar with the role of a clinical pharmacist (56%) and 31% of patients reportedly thought their appointment had been with a doctor. All patients were positive about their experience and reported they would “be more than happy to see a pharmacist in the future” and that the role was “a very necessary addition to the practice”. All patients reported that their consultation was the same (51%) or better than they have had with a doctor (49%). Patients commented on the pharmacists’ consultation skills, making statements such as [they] “listened to me”, “asked me questions”, “were really good at explaining” and “spoke in a way I understood”. Clinical pharmacists were reported as being “very professional” and knowledgeable as “[they] knew more about my medication [than the doctor] and prescribed me something to help”. Patients reported that they would recommend the clinical pharmacist to their family and friends when seeking an appointment.

Conclusion

This research highlights patient acceptance towards consultations with a clinical pharmacist and reinforces the competence of pharmacists to undertake this role. A key finding related to the effective consultation skills of the pharmacists and involving the patients in their care. The number of patients who participated limits the generalisability of the findings, and the patient responses may have been a reaction to the individual clinical pharmacists rather than their thoughts on the role overall. Increased publicity and patient education of the role of a clinical pharmacist may promote a greater integration into the multidisciplinary team.

References

(1) Robertson R, Wenzel L, Thompson J, Charles A. Understanding NHS financial pressures. How are they affecting patient care. 2017. The Kings Fund. https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/Understanding%20NHS%20financial%20pressures%20-%20full%20report.pdf

(2) NHS England 2016. General Practice Forward View. https://www.england.nhs.uk/wp-content/uploads/2016/04/gpfv.pdf

712 EVALUATING AN ‘ACUTE FRAILTY TEAM’ MODEL OF CARE IN IMPROVING OUTCOMES FOR PATIENTS WITH FRAILTY ACUTELY ADMITTED TO HOSPITAL

Introduction

In frailty, Comprehensive geriatric assessment (CGA) has benefit in improving patient outcomes, including hospital readmissions and institutionalisation. We looked to evaluate the effectiveness of our newly initiated multi-disciplinary, acute frailty team (AFT) in improving acute care. This team works on the Acute Medical Unit (AMU), delivering early CGA alongside the existing acute medical care.

Methods

The AFT initially targeted identification of frailty using the Rockwood clinical frailty score (CFS) through local quality improvement work. A standard operating procedure, encompassing CGA for all patients with frailty (define as a CFS 5 to 8 or, 4 with a frailty syndrome) was introduced. This assessment was additional to usual acute medical care. The impact was measured by retrospective case note review of 100 AMU admissions with frailty prior to the team being in post (Jan-March 2020) with a subsequent 100 patients seen by the AFT (March–April 2021). The 2 groups were matched for age, gender, frailty scores and pre-admission residence. These 2 cohorts were compared against key performance indices.

Results

The mean age of patients in the Pre and post AFT cohorts were 85 years and 84 years respectively with an average CFS of 6. The identification and documentation of frailty improved in the AFT intervention cohort from 31% to 100% and screening for delirium with 4AT improved from 27% to 91%. The number of patients in the AFT cohort discharged directly from AMU increased from 5% to 14% with the average length of in-patient stay reducing from 10.2 days to 7.8 days. Thirty day remission fell from 23% to 16% in the AFT cohort, and the number of patients discharge to new 24 hour care declined from 21% to 9%.

Conclusion

Our AFT alongside existing acute medical care improved outcomes including, frailty identification, delirium screening, length of stay, re-admissions and institutionalisation.

Temporal trends of perfluoroalkyl substances in an Australian wastewater treatment plant: A ten-year retrospective investigation

Per- and poly-fluoroalkyl substances (PFAS) are a problematic group of chemicals used in various industrial and household products. They have been extensively detected in wastewater as a result of day-to-day product usage. Due to concerns about their safety, voluntary and regulatory action to limit the manufacture and use of some individual PFAS has occurred since the year 2000. The impact that this intervention has had on the use and potential exposure of Australians has not been measured. Wastewater serves as a powerful tool to assess the chemical use or consumption patterns of a population over time. We accessed a ten-year wastewater archiving program to conduct a temporal analysis of PFAS trends in an urban Australian population between the years 2010 and 2020. Results showed a decline in the concentrations for most PFAS, and a change in the PFAS profile from perfluorosulfonic acids and long-chain perfluorocarboxylic acids, to the short-chain perfluorocarboxylic acids and PFOS-replacement degradation products such as 5:3 FTCA. Intermittent pulses of PFAS that were significantly higher than 'background' levels (i.e., representing the PFAS input from primarily households) were observed, suggesting continuing industrial PFAS input within the wastewater catchment. This study highlights the long-term consequences of the diffuse use of persistent chemicals in products, and their ability to continue to enter the wastewater stream for decades.

Site Readiness Framework to Improve Health System Preparedness for a Potential New Alzheimer’s Disease Treatment Paradigm

New therapies that address the underlying pathophysiology of Alzheimer’s Disease (AD), coupled with the growth of the AD population, will transform the AD care pathway and present significant challenges to health systems. We explored real-world challenges health systems may face in delivering potential new AD therapies with diverse stakeholders. Key challenges in care included integrating primary care providers into assessment and management, availability of memory care specialists, understanding payment and coverage issues and training mid-level providers to help coordinate care and serve as a shared resource across the system. This input informed a novel Site Readiness Framework for AD, comprising self-assessment exercises to identify health system capabilities and gaps and a framework of core strategies and responsive tools to help prepare to integrate new AD therapies. These resources may help health systems improve readiness to modify care pathways to integrate new therapies for AD.

902 Safe Elective & Emergency Surgery During the COVID-19 Crisis: Experience of a Large Tertiary Centre During the First Wave of the Pandemic

Aim

In addition to a reduction in elective surgery, the COVID-19 pandemic has been associated with concerning rates of post-operative mortality in COVID-19 patients highlighting the threat of nosocomial transmission. Relocation of elective patients into a protected cold wing of a tertiary centre, vigilant testing and staff test, and trace were implemented to address these issues.

Method

Retrospective analysis of 5069 consecutive patients who underwent procedures in theatre from 11/03/20 – 08/09/20 was performed. Comparison of numbers of procedures was compared with the same study dates in 2019. Detailed analysis of nosocomial transmission of COVID-19 and mortality was performed using patient notes and death certificates.

Results

5854 procedures were performed in 2020 compared with 13219 in 2019, representing a reduction of 55.7%. The overall mortality in 2020 was 2.7% (135/5069). COVID-19 negative mortality was 2.36% (119/5033). 74 patients tested positive for COVID-19 at any time (1.3%); mortality amongst patients who tested positive seven days pre- to 30 days post-procedure was 5.4% (4/74). Nosocomial transmission rate was 0.27% in elective admissions (10/3773) and 0.97% in acute admissions (20/2052).

Conclusions

The first wave of the pandemic has predictably caused a significant reduction in elective activity. Our hospital infection prevention measures have kept nosocomial transmission rates low, particularly for elective admissions. We have observed lower rates of post-operative mortality in COVID-19 patients than published in other centres. Continuation of surgical services is important for patient outcomes, and essential for training the surgeons of tomorrow.

A qualitative analysis of stakeholder experiences with Registered Reports Funding Partnerships

Background: Registered Reports (RRs) could be a way to increase the quality of scientific research and literature, such as by reducing publication bias and increasing the rigour of study designs. These potential benefits have led to Registered Report funding partnerships (RRFPs or partnerships for short) between research funders and academic journals who collaborate to encourage researchers to publish RRs. In this study we investigated the research question: "What are the experiences of the stakeholders (authors, reviewers, journal editors, funders) in the various partnership models?". Our companion paper addresses a related, but separate, research question. Methods: We conducted a thematic analysis of 32 semi-structured interviews with stakeholders (funders, editors, authors, reviewers, matchmakers) from six partnerships. Results: Interviewees had highly variable perceptions and experiences, reflecting the complex and nuanced impacts of partnerships. We identified 6 themes: "Importance of communication with authors and reviewers", "Influence on study design", "Appropriateness of partners", "Potential to reduce publication bias", "Impact on reviewer workload", and "Insufficient evidence". Conclusions: This was the first investigation into these novel initiatives. We hope that our findings can benefit and shape current and future partnerships.

Evaluating Registered Reports Funding Partnerships: a feasibility study

Background: We studied a novel initiative – Registered Reports Funding Partnerships (RRFPs) – whereby research funders and journals partner in order to integrate their procedures for funding applications and Registered Reports submissions into one process. We investigated the feasibility of conducting a randomised controlled trial (RCT) of the impact of RRFPs on (1) research quality and (2) the efficiency of the research process, from funding to publication. Methods: We conducted 32 semi-structured interviews and follow-up questionnaires with stakeholders (funders, editors, authors, and reviewers) across six different RRFPs. Results: A RCT of RRFPs appears to be feasible in principle. The partnership concept seems worthwhile to pursue further and is adaptable to the needs of various funders and publishers, and across disciplines. Three primary outcomes of interest should be measurable, and participant randomisation could conceivably be done in a number of ways. In practice, however, the current volume of submissions going through existing partnerships is too low to support a full trial.   Conclusions: Although a RCT of RRFPs is conceptually feasible, it will only be possible if organisations are willing to form new partnerships, scale up existing ones, and incorporate a trial (i.e., randomisation) into these partnerships.

OP0280-PARE A MINDFULNESS PROGRAM DOSING STUDY TO EVALUATE IMPROVEMENT IN EMOTIONAL DISTRESS AMONG PEOPLE WITH RHEUMATIC DISEASE

Background:

Mindfulness-based interventions for chronic pain and emotional distress have increased in popularity as complementary therapies among people living with rheumatic and musculoskeletal disease (RMD).1,2 Despite growing evidence that mindfulness meditation reduces pain and anxiety associated with RMD, more research is needed to specify the optimal duration of mindfulness training necessary to be effective for short- and long-term benefit.

Objectives:

To evaluate and compare the effectiveness of full-length versus brief mindfulness training programs for improving anxiety among people living with RMD.

Methods:

Adult US participants (pts) within the ArthritisPower registry were invited to participate in the Healthy Mind Healthy You study comparing the effectiveness of two online mindfulness training programs of different lengths accessed via the MoodNetwork platform. The full-length mindfulness based cognitive therapy program lasted 8 weeks, while the brief evidence-based mindfulness program lasted 3 weeks. Pts were randomized to one of the two programs and completed assessments every two weeks during the program and then every four weeks during the 12-week follow-up period. Assessments included World Health Organization-Five Well-Being Index (WHO-5), Five Facet Mindfulness Questionnaire (FFMQ), Perceived Stress Scale (PSS), and two measures of emotional distress, PROMIS Short Forms for Anxiety and Depression. Analyses compared demographic characteristics and assessment scores by program length.

Results:

324 pts completed assessments at baseline and 70 pts completed them at week 8, an attrition rate of 78% in each of the program arms. The majority of pts were female, White, with 67% between the ages of 45-64 years. No statistically significant differences were observed at baseline between participants randomized to each of the two programs, and in their assessment scores at week 8 (Table 1); PROMIS Anxiety and Depression scores improved from baseline to week 8 for pts in both programs (Figure 1). Overall, mean (SD) PROMIS Depression scores improved from 58.4 (7.7) at baseline to 55.4 (7.2) at week 8 (p=0.018), a meaningfully important difference, among the 70 pts reporting scores at both time points.

Table 1.

Assessment Scores at Baseline and Week 8, Mean (SD)

BaselineWeek 8All (n=324)8-week course (n=163)3-week course (n=161)p-valueAll (n=70)8-week course (n=35)3-week course (n=35)p-valueWHO-5 b10.6 (4.9)10.4 (4.8)10.9 (5.0)0.37812.0 (5.1)12.5 (5.5)11.6 (4.7)0.488FFMQ c42.7 (6.1)42.7 (6.1)42.7 (6.1)0.93239.2 (5.7)38.9 (6.1)39.4 (5.3)0.741PSS d18.7 (7.5)19.2 (6.8)18.3 (8.2)0.30416.6 (7.3)15.7 (7.8)17.6 (6.8)0.291PROMIS Depression e56.5 (8.3)57.3 (8.0)55.7 (8.6)0.09755.1 (8.5)54.8 (9.3)55.5 (7.8)0.735PROMIS Anxiety f58.7 (8.2)59.0 (8.2)58.4 (8.1)0.47055.4 (7.2)54.6 (7.4)56.1 (7.1)0.404

a denotes use of Fisher’s Exact Test b Range 0 (worse) to 25 (better), c Range 3 (worse) to 15 (better), d Range 0 (better) to 40 (worse), e Range 24.7 (better) to 63.5 (worse), f Range 25.7 (better) to 62.0 (worse)

Conclusion:

People living with RMD who are part of a real-world US registry are willing to participate in an online mindfulness training program study, but may require additional support to remain engaged and adherent throughout the program and to participate to study conclusion. Participation in a mindfulness training program, whether full-length or brief, appears to improve symptoms of emotional distress among people with RMD.

References:

[1]Zhou, B. et al. Comp. Ther. in Clin. Prac. 2020; 39:1-7

[2]Reiner, K. et al. Pain Medicine. 2013; 14(2): 230-242

Acknowledgements:

The authors would like to thank ArthritisPower members for participating in the study, and the Healthy Mind Healthy You study team at Massachusetts General Hospital (see MoodNetwork.org) for leading it. The study was funded by the Patient-Centered Outcomes Research Institute (XPPRN-1512-33786).

Disclosure of Interests:

Julia Thompson: None declared, Nupur Parikh: None declared, Kelly Gavigan: None declared, Shilpa Venkatachalam: None declared, W. Benjamin Nowell Grant/research support from: Full-time employee of Global Healthy Living Foundation, an independent nonprofit organization, which has received funding to conduct research; Principal Investigator for studies with grant support from AbbVie, Amgen and Eli Lilly.

Dancing for Parkinson's: A Gateway for Connectedness to Peers and Social Assurance

The first-year student experience in college is a crucial time for personal and professional development, especially for students entering science, technology, education, and mathematics (STEM) disciplines. Unfortunately, it is also the time when students most commonly leave STEM, largely due to disconnection from faculty and peers. The Freshman Research Initiative (FRI) is a program that introduces first-year undergraduates to research in a variety of fields. The program has shown positive outcomes for student success and retention in STEM fields. However, it has not been demonstrated whether this program can increase social connectedness and assurance, potentially contributing to students' longer-term retention in STEM. In this pilot study, we measured social connectedness/assurance among students before and after a 16-week course in neurophysiology. We found that combined scores of social connectedness and assurance significantly increased by the end of the course. We also found that individual constructs of social connectedness and assurance significantly increased. Furthermore, the majority of students from FRI were retained in STEM fields. We plan future studies to include collection of longitudinal data and measures to identify additional reasons that the FRI increased these positive outcomes among our student participants.

Water quality sampling methods may bias evaluations of watershed management practices

Accurate measurement of the discharge of total suspended solids (TSS) from watersheds is complicated by the extreme temporal variability of suspended solid concentrations during periods of high stream flow. Consequently, TSS loads estimated from data collected at different temporal frequencies may differ in accuracy and precision. Moreover, there remains a need for optimal sampling methods which yield the highest possible accuracy for the least effort. We investigated the effect of sampling frequency on estimations of TSS loads and retention within a restored stream in Maryland, USA. We found that coarser temporal sampling methods can lead to erroneous conclusions of restoration efficacy with poor accuracy and precision in estimates of sediment retention. Additionally, we synthesized 28 years of continuous turbidity-based TSS data from Europe and North America to assess the effect of sampling frequency. Our synthesis suggests that flow-paced composite sampling may be the most accurate and precise sampling method. This method is also economical, requiring analysis of only one sample per week. Thus, the flow-paced method may be a potential solution to economize and standardize water quality monitoring.

An optical neural chip for implementing complex-valued neural network

Complex-valued neural networks have many advantages over their real-valued counterparts. Conventional digital electronic computing platforms are incapable of executing truly complex-valued representations and operations. In contrast, optical computing platforms that encode information in both phase and magnitude can execute complex arithmetic by optical interference, offering significantly enhanced computational speed and energy efficiency. However, to date, most demonstrations of optical neural networks still only utilize conventional real-valued frameworks that are designed for digital computers, forfeiting many of the advantages of optical computing such as efficient complex-valued operations. In this article, we highlight an optical neural chip (ONC) that implements truly complex-valued neural networks. We benchmark the performance of our complex-valued ONC in four settings: simple Boolean tasks, species classification of an Iris dataset, classifying nonlinear datasets (Circle and Spiral), and handwriting recognition. Strong learning capabilities (i.e., high accuracy, fast convergence and the capability to construct nonlinear decision boundaries) are achieved by our complex-valued ONC compared to its real-valued counterpart.

Allogeneic hematopoietic stem cell transplantation for advanced mycosis fungoides and Sézary syndrome. An updated experience of the Lymphoma Working Party of the European Society for Blood and Marrow Transplantation

BACKGROUND

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potentially curative treatment option in advanced-stage mycosis fungoides (MF) and Sézary syndrome (SS). This study presents an updated analysis of the initial experience of the Lymphoma Working Party of the European Society for Blood and Marrow Transplantation (EBMT) describing the outcomes after allo-HSCT for MF and SS, with special emphasis on the impact of the use of unrelated donors (URD).

METHODS AND PATIENTS

Eligible for this study were patients with advanced-stage MF or SS who underwent a first allo-HSCT from matched HLA-identical related or URD between January/1997 and December/2011. Sixty patients have been previously reported.

RESULTS

113 patients were included [77 MF (68%)]; 61 (54%) were in complete or partial remission, 86 (76%) received reduced-intensity protocols and 44 (39%) an URD allo-HSCT. With a median follow up for surviving patients of 73 months, allo-HSCT resulted in an estimated overall survival (OS) of 38% at 5 years, and a progression-free survival (PFS) of 26% at 5 years. Multivariate analysis demonstrated that advanced-phase disease (complete remission/partial remission >3, primary refractory or relapse/progression in patients that had received 3 or more lines of systemic treatment prior to transplant or the number of treatment lines was not known), a short interval between diagnosis and transplant (<18 months) were independent adverse prognostic factors for PFS; advanced-phase disease and the use of URDs were independent adverse prognostic factors for OS.

CONCLUSIONS

This extended series supports that allo-HSCT is able to effectively rescue over one third of the population of patients with advanced-stage MF/SS. High relapse rate is still the major cause of failure and needs to be improved with better strategies before and after transplant. The negative impact of URD is a matter of concern and needs to be further elucidated in future studies.

Characteristics of L-PRP preparations for treating Achilles tendon rupture within the PATH-2 study

Platelet-rich plasma (PRP) is an autologous preparation that has been claimed to improve healing and mechanobiological properties of tendons both in vitro and in vivo. In this sub-study from the PATH-2 (PRP in Achilles Tendon Healing-2) trial, we report the cellular and growth factor content and quality of the Leukocyte-rich PRP (L-PRP) (N = 103) prepared using a standardized commercial preparation method across 19 different UK centers. Baseline whole blood cell counts (red cells, leukocyte and platelets) demonstrated that the two groups were well-matched. L-PRP analysis gave a mean platelet count of 852.6 x 10⁹/L (SD 438.96), a mean leukocyte cell count of 15.13 x 10⁹/L (SD 10.28) and a mean red blood cell count of 0.91 x 10¹²/L (SD 1.49). The activation status of the L-PRP gave either low or high expression levels of the degranulation marker CD62p before and after ex-vivo platelet activation respectively. TGF-β, VEGF, PDGF, IGF and FGFb mean concentrations were 131.92 ng/ml, 0.98 ng/ml, 55.34 ng/ml, 78.2 ng/ml and 111.0 pg/ml respectively with expected correlations with both platelet and leukocyte counts. While PATH-2 results demonstrated that there was no evidence L-PRP is effective for improving clinical outcomes at 24 weeks after Achilles tendon rupture, our findings support that the majority of L-PRP properties were within the method specification and performance.

Index matching in multilayered organic waveguides

Index matching of guided modes in birefringent multilayered organic waveguides opens new prospects for the design of mode coupling and mode switching devices. We demonstrate index matching of guided modes in two multilayered structures, in (a) a PTCDA-Alq3-PTCDA three-layer and (b) a PTCDA-Alq3 effective medium multilayer waveguide. The optical waveguides were grown on a Pyrex substrate by organic molecular beam deposition. The occurrence of index matching was investigated both experimentally by measuring the effective refractive index dispersion of transverse electric and magnetic modes using the m-line technique and theoretically by modelling the index dispersion with a transfer matrix algorithm.