Extended Reality Head-Mounted Displays Are Likely to Pose a Significant Risk in Medical Settings While Current Classification Remains as Non-Critical

Extended reality (XR) devices, including virtual and augmented reality head-mounted displays (HMDs), are increasingly utilised within healthcare to provide clinical interventions and education. Currently, XR devices are utilised to assist in reducing pain and improving psychological outcomes for immunocompromised patients in intensive care units, palliative care environments and surgical theatres. However, there is a paucity of research on the risks of infection from such devices in healthcare settings. Identify existing literature providing insights into the infection control risk XR HMDs pose within healthcare facilities and the efficacy of current infection control and cleaning procedures. Three databases (PubMed, Embase and CINAHL) in addition to Google Scholar were systematically searched. A total of seven studies were identified for this review. Microorganisms, including pathogenic bacteria (e.g., Staphylococcus aureus and Pseudomonas aeruginosa), were found to be present on XR HMDs. Published cleaning and infection control protocols designed to disinfect XR HMDs and protect users were heterogeneous in nature. Current cleaning protocols displayed varying levels of efficacy with microbial load affected by multiple factors, including time in use, number of users and XR HMD design features. In healthcare settings, fitting XR HMDs harbouring microorganisms near biological and mucosal entry points presents an infection control risk. An urgent revision of the Spaulding classification is required to ensure flexibility that allows for these devices to be reclassified from 'Non-critical' to 'Semi-Critical' depending on the healthcare setting and patient population (surgery, immunocompromised, burns, etc.). This review identified evidence supporting the presence of microorganisms on XR HMDs. Due to the potential for HMDs to contact mucosal entry points, devices must be re-considered within the Spaulding classification as 'Semi-critical'. The existence of microbial contaminated XR HMDs in high-risk medical settings such as operating wards, intensive care units, emergency departments, labour and delivery wards and clinical areas with immunosuppressed patients requires urgent attention. Public health authorities have a duty of care to develop revised guidelines or new recommendations to ensure efficient sanitation of such devices.

Do mobile phone surfaces carry SARS-CoV-2 virus? A systematic review warranting the inclusion of a "6th" moment of hand hygiene in healthcare

BACKGROUND

Mobile phones, used in billions throughout the world, are high-touch devices subject to a dynamic contamination of microorganisms and rarely considered as an important fomite to sanitise systematically. The emergence of SARS-CoV-2 resulted in the COVID-19 pandemic, arguably the most impactful pandemic of the 21st century with millions of deaths and disruption of all facets of modern life globally.

AIM

To perform a systematic review of the literature exploring SARS-CoV-2 presence as a contaminant on mobile phones.

METHODS

A systematic search (PubMed and Google Scholar) of literature was undertaken from December 2019 to March 2023 identifying English language studies. Studies included in this review specifically identified or tested for the contamination of the SARS-CoV-2 virus or genome on mobile phones while studies testing for SARS-COV-2 in environments and/or other fomites samples than but not mobile phones were excluded.

RESULTS

A total of 15 studies with reports of SARS-CoV-2 contamination on mobile phones between 2020 and 2023 were included. Amongst all studies, which encompassed ten countries, 511 mobile phones were evaluated for the presence of SARS-CoV-2 contamination and 45% (231/511) were positive for SARS-CoV-2. All studies were conducted in the hospital setting and two studies performed additional testing in residential isolation rooms and a patient's house. Four studies (3 in 2020 and one in 2021) reported 0% contamination while two other studies (in 2020 and 2022) reported 100% of mobile phone contamination with SARS-COV-2. All other studies report mobile phones positive for the virus within a range of 4-77%.

CONCLUSION

A total of 45% of mobile phones are contaminated with SARS-CoV-2 virus. These devices might be an important fomite vector for viral dissemination worldwide. Competent health authorities are advised/recommended to start a global implementation of mobile phone decontamination by introducing regulations and protocols in public health and health care settings such as the 6th moment of hand washing.

Biomedical doctoral students' research practices when facing dilemmas: two vignette-based randomized control trials

Our aim was to describe the research practices of doctoral students facing a dilemma to research integrity and to assess the impact of inappropriate research environments, i.e. exposure to (a) a post-doctoral researcher who committed a Detrimental Research Practice (DRP) in a similar situation and (b) a supervisor who did not oppose the DRP. We conducted two 2-arm, parallel-group randomized controlled trials. We created 10 vignettes describing a realistic dilemma with two alternative courses of action (good practice versus DRP). 630 PhD students were randomized through an online system to a vignette (a) with (n = 151) or without (n = 164) exposure to a post-doctoral researcher; (b) with (n = 155) or without (n = 160) exposure to a supervisor. The primary outcome was a score from - 5 to + 5, where positive scores indicated the choice of DRP and negative scores indicated good practice. Overall, 37% of unexposed participants chose to commit DRP with important variation across vignettes (minimum 10%; maximum 66%). The mean difference [95%CI] was 0.17 [- 0.65 to 0.99;], p = 0.65 when exposed to the post-doctoral researcher, and 0.79 [- 0.38; 1.94], p = 0.16, when exposed to the supervisor. In conclusion, we did not find evidence of an impact of postdoctoral researchers and supervisors on student research practices.Trial registration: NCT04263805, NCT04263506 (registration date 11 February 2020).

Ultraviolet-C-Based Mobile Phone Sanitisation for Global Public Health and Infection Control

INTRODUCTION

Mobile phones act as fomites that pose a global public health risk of disseminating microorganisms, including highly pathogenic strains possessing antimicrobial resistances. The use of ultraviolet-C (UV-C) to sanitise mobile phones presents an alternative means to complement basic hand hygiene to prevent the cross-contamination and dissemination of microorganisms between hands and mobile phones.

AIM

This study aimed to evaluate the germicidal efficacy of the Glissner CleanPhone UV-C phone sanitiser (Glissner) device.

METHODS

Two experimental trials were performed for the evaluation of the CleanPhone (Glissner). The first was a controlled trial, where the germicidal efficacy of the CleanPhone was evaluated against six different microorganism species that were inoculated onto mobile phones. The second was a field trial evaluating the germicidal efficacy of the CleanPhone on 100 volunteer mobile phones. Efficacy was determined based on colony counts of microorganisms on Columbia sheep blood agar before and after UV-C treatment.

RESULTS

In the controlled trial, reduction in growth was observed for all microorganisms after UV-C treatment with ST131 Escherichia coli showing the highest growth reduction at 4 log10 CFU/mL followed by C. albicans and ATCC E. coli at 3 log10 CFU/mL. An overall reduction in microorganism growth after UV-C treatment was also observed for the field trial, with an average growth reduction of 84.4% and 93.6% in colony counts at 24 h and 48 h post-incubation, respectively.

CONCLUSION

The findings demonstrated the capability of the CleanPhone (Glissner) to rapidly sanitise mobile phones, thereby providing a means to reduce the potential dissemination of microorganisms, including highly pathogenic strains with antimicrobial resistance.

Mobile phones as fomites for pathogenic microbes: A cross-sectional survey of perceptions and sanitization habits of health care workers in Dubai, United Arab Emirates

BACKGROUNDS

In 2022, smartphone use continues to expand with the number of smartphone subscriptions surpassing 6 billion and forecasted to grow to 7.5 billion by 2026. The necessity of these 'high touch' devices as essential tools in professional healthcare settings carries great risks of cross-contamination between mobile phones and hands. Current research emphasises mobile phones as fomites enhancing the risk of nosocomial disease dissemination as phone sanitisation is often overlooked. To assess and report via a large-scale E-survey the handling practices and the use of phones by healthcare workers.

METHODS

A total of 377 healthcare workers (HCWs) participated in this study to fill in an E-survey online consisting of 14 questions (including categorical, ordinal, and numerical data). Analysis of categorical data used non-parametric techniques such as Pearson's chi-squared test.

RESULTS

During an 8-h shift, 92.8% (n/N = 350/377) use their phone at work with 84.6% (n/N = 319/377) considering mobile phones as an essential tool for their job. Almost all HCWs who participated in this survey believe their mobile phones could potentially harbour microorganisms (97.1%; n/N = 366/377). Fifty-seven respondents (15.1%) indicated that they use their phones while wearing gloves and 10.3% (n/N = 39/377) have never cleaned their phones. The majority of respondents (89.3%; n/N = 337/377) agreed that contaminated mobile phones could contribute to dissemination of SARS-CoV-2.

CONCLUSION

Mobile phone use is now almost universal and indispensable in healthcare. Medical staff believe mobile phones can act as fomites with a potential risk for dissemination of microbes including SARS-COV-2. There is an urgent call for the incorporation of mobile phone sanitisation in infection prevention protocol. Studies on the use of ultraviolet-C based phone sanitation devices in health care settings are needed.

Healthcare Derived Smart Watches and Mobile Phones are Contaminated Niches to Multidrug Resistant and Highly Virulent Microbes

Background

As high touch wearable devices, the potential for microbial contamination of smart watches is high. In this study, microbial contamination of smart watches of healthcare workers (HCWs) was assessed and compared to the individual’s mobile phone and hands.

Methods

This study was part of a larger point prevalence survey of microbial contamination of mobile phones of HCWs at the emergency unit of a tertiary care facility. Swabs from smart watches, mobile phones and hands were obtained from four HCWs with dual ownership of these digital devices. Bacterial culture was carried out for all samples and those from smart watches and mobile phones were further assessed using shotgun metagenomic sequencing.

Results

Majority of the participants were females (n/N = 3/4; 75%). Although they all use their digital devices at work and believe that these devices could harbour microbes, cleaning in the preceding 24 hours was reported by one individual. Predominant organisms identified on bacterial culture were multidrug resistant Staphylococcus hominis and Staphylococcus epidermidis. At least one organism identified from the hands was also detected on all mobile phones and two smart watches. Shotgun metagenomics analysis demonstrated greater microbial number and diversity on mobile phones compared to smart watches. All devices had high signatures of Pseudomonas aeruginosa and associated bacteriophages and antibiotic resistance genes. Almost half of the antibiotic resistance genes (n/N = 35/75;46.6%) were present on all devices and majority were related to efflux pumps. Of the 201 virulence factor genes (VFG) identified, majority (n/N = 148/201;73%) were associated with P. aeruginosa with 96% (n/N = 142/148) present on smart watches and mobile phones.

Conclusion

This first report on microbial contamination of smart watches using metagenomics next generation sequencing showed similar pattern of contamination with microbes, VFG and antibiotic resistance genes across digital devices. Further studies on microbial contamination of wearable digital devices are urgently needed.

Metagenomic Sequencing and Reverse Transcriptase PCR Reveal That Mobile Phones and Environmental Surfaces Are Reservoirs of Multidrug-Resistant Superbugs and SARS-CoV-2

Background

Mobile phones of healthcare workers (HCWs) can act as fomites in the dissemination of microbes. This study was carried out to investigate microbial contamination of mobile phones of HCWs and environmental samples from the hospital unit using a combination of phenotypic and molecular methods.

Methods

This point prevalence survey was carried out at the Emergency unit of a tertiary care facility. The emergency unit has two zones, a general zone for non-COVID-19 patients and a dedicated COVID-19 zone for confirmed or suspected COVID-19 patients. Swabs were obtained from the mobile phones of HCWs in both zones for bacterial culture and shotgun metagenomic analysis. Metagenomic sequencing of pooled environmental swabs was conducted. RT-PCR for SARS-CoV-2 detection was carried out.

Results

Bacteria contamination on culture was detected from 33 (94.2%) mobile phones with a preponderance of Staphylococcus epidermidis (n/N = 18/35), Staphylococcus hominis (n/N = 13/35), and Staphylococcus haemolyticus (n/N = 7/35). Two methicillin-sensitive and three methicillin-resistant Staphylococcus aureus, and one pan-drug-resistant carbapenemase producer Acinetobacter baumannii were detected. Shotgun metagenomic analysis showed high signature of Pseudomonas aeruginosa in mobile phone and environmental samples with preponderance of P. aeruginosa bacteriophages. Malassezia and Aspergillus spp. were the predominant fungi detected. Fourteen mobile phones and one environmental sample harbored protists. P. aeruginosa antimicrobial resistance genes mostly encoding for efflux pump systems were detected. The P. aeruginosa virulent factor genes detected were related to motility, adherence, aggregation, and biofilms. One mobile phone from the COVID-19 zone (n/N = 1/5; 20%) had positive SARS-CoV-2 detection while all other phone and environmental samples were negative.

Conclusion

The findings demonstrate that mobile phones of HCWs are fomites for potentially pathogenic and highly drug-resistant microbes. The presence of these microbes on the mobile phones and hospital environmental surfaces is a concern as it poses a risk of pathogen transfer to patients and dissemination into the community.

Metastatic melanoma to the ovary in pregnancy: A case report

•

Metastatic melanoma to the ovary is uncommon and can occur years after initial diagnosis.

•

Ovarian metastatic melanoma can mimic various benign lesions on imaging and clinical history is key.

•

If any suspicion in pregnancy, placenta should be evaluated due to possibility of transplacental transmission.

Metastatic melanoma to the ovary is an uncommon presentation. We report a case of metastatic melanoma to the ovary that presented as a growing left adnexal mass during pregnancy and was thought to be benign by imaging and frozen section pathology. Here we discuss the challenges in radiologic and pathologic diagnosis, as well as considerations for the mother and newborn.

Laminar airflow versus turbulent airflow in simulated total hip arthroplasty: measurements of colony-forming units, particles, and energy consumption

BACKGROUND

The optimal type of ventilation in operating theatres for joint arthroplasty has been debated for decades. Recently, the World Health Organization changed its recommendations based on articles that have since been criticized. The economic and environmental impact of ventilation is also currently an important research topic but has not been well investigated.

AIM

To compare how large, high-volume, laminar airflow (LAF) and turbulent airflow (TAF) ventilation systems perform during standardized simulated total hip arthroplasty (THA), as they pertain to colony-forming units (cfu), particle counts, and energy consumption.

METHODS

Two identical operating theatres were used to perform simulated THA. The only difference was that one was equipped with LAF and the other with TAF. Cfu and particles were collected from key points in the operating theatre, and energy was measured for each simulation. Thirty-two simulations were done in total.

FINDINGS

LAF had significantly reduced cfu and particle count when compared with TAF, at both 100% and 50% air influx. Furthermore, it was shown that lowering the air influx by 50% in LAF did not significantly affect cfu or particles, although reducing the fresh air influx from 100% to 50% significantly lowered the energy consumption. Most simulations in TAF did not meet the cleanroom requirements.

CONCLUSION

Cfu were significantly lower in LAF at both 100% and 50% air influx. It is possible to reduce fresh air influx in LAF operating theatres by 50%, significantly reducing energy consumption, while still maintaining cfu and particle counts below the ISO classification threshold required for THA surgery.

Mobile phones of paediatric hospital staff are never cleaned and commonly used in toilets with implications for healthcare nosocomial diseases

An ever-increasing number of medical staff use mobile phones as a work aid, yet this may pose nosocomial diseases. To assess and report via a survey the handling practices and the use of phones by paediatric wards healthcare workers. 165 paediatric healthcare workers and staff filled in a questionnaire consisting of 14 questions (including categorical, ordinal and numerical data). Analysis of categorical data used non-parametric techniques such as the Chi-squared test. Although 98% of respondents (165 in total) report that their phones may be contaminated, 56% have never cleaned their devices. Of the respondents that clean their devices, 10% (17/165) had done so with alcohol swabs or disinfectant within that day or week; and an additional 12% respondents (20/165) within that month. Of concern, 52% (86/165) of the respondents use their phones in the bathroom, emphasising the unhygienic environments in which mobile phones/smartphones are constantly used. Disinfecting phones is a practice that only a minority of healthcare workers undertake appropriately. Mobile phones, present in billions globally, are therefore Trojan Horses if contaminated with microbes and potentially contributing to the spread and propagation of micro-organisms as per the rapid spread of SARS-CoV-2 virus in the world.

The role of mobile phones as a possible pathway for pathogen movement, a cross-sectional microbial analysis

INTRODUCTION

Mobile phones are used the world over, including in healthcare settings. This study aimed to investigate the viable microbial colonisation of mobile phones used by healthcare personnel.

METHODS

Swabs collected on the same day from 30 mobile phones belonging to healthcare workers from three separate paediatric wards of an Australian hospital were cultured on five types of agar plate, then colonies from each phone were pooled, extracted and sequenced by shotgun metagenomics. Questionnaires completed by staff whose phones were sampled assisted in the analysis and interpretation of results.

RESULTS AND DISCUSSION

All phones sampled cultured viable bacteria. Overall, 399 bacterial operational taxonomic units were identified from 30 phones, with 1432 cumulative hits. Among these were 58 recognised human pathogenic and commensal bacteria (37 Gram-negative, 21 Gram-positive). The total number of virulence factor genes detected was 347, with 1258 cumulative hits. Antibiotic resistance genes (ARGs) were detected on all sampled phones and overall, 133 ARGs were detected with 520 cumulative hits. The most important classes of ARGs detected encoded resistance to beta-lactam, aminoglycoside and macrolide antibiotics and efflux pump mediated resistance mechanisms.

CONCLUSION

Mobile phones carry viable bacterial pathogens and may act as fomites by contaminating the hands of their users and indirectly providing a transmission pathway for hospital-acquired infections and dissemination of antibiotic resistance. Further research is needed, but meanwhile adding touching mobile phones to the five moments of hand hygiene is a simple infection control strategy worth considering in hospital and community settings. Additionally, the implementation of practical and effective guidelines to decontaminate mobile phone devices would likely be beneficial to the hospital population and community at large.

OP0157-HPR CHANGES IN PAIN AND HAND FUNCTION AFTER MULTIMODAL OCCUPATIONAL THERAPY AND/OR SURGERY IN PATIENTS WITH CARPOMETACARPAL OSTEOARTHRITIS

Background:

Carpometacarpal osteoarthritis (CMC1 OA) is a subset of hand OA, often leading to pain and functional limitations. The EULAR recommends conservative treatment as first-line management, and a recent study showed significant short-term effect of multimodal occupational therapy on pain and hand function in patients referred to surgical consultation1. However, long-term results are lacking.

Objectives:

To explore the long-term effect of multimodal occupational therapy on pain and hand function in patients with CMC1 OA, and to assess the differences between those undergoing surgery or not in the two groups.

Methods:

This project presents secondary analyses of a multicentre RCT. Patients referred by their general practitioner to surgical consultation due to CMC1 OA at three Norwegian hospitals from 2013-2015 were eligible. During the waiting period between referral and surgical consultation, 180 patients were randomized to usual care (information, n=90) or a 3-month multimodal occupational therapy intervention (patient education, hand exercises, orthoses and assistive devices, n=90). Patients were assessed at baseline, and 4 (before surgical consultation), 18 and 24 months. Pain at rest was assessed using a 11-point numeric rating scale, and hand function was self-reported with the MAP-Hand (1-4, 1=no problem). The long-term within- and between-group differences on pain and hand function were assessed using repeated measure ANOVA. Sub-analyses were done among those undergoing surgery or not in the two groups. P-value <0.05.

Results:

163 patients (63 (8) years, 81% women) were included in the analyses. Both groups showed a significant reduction in pain and improvement in hand function over time (p<0.001), with a significant between-group difference for pain (F (1, 161) = 8.56, p = 0.004), in favour of the intervention group, but not hand function.

After 2 years, 22 patients had undergone surgery in the intervention group vs 29 in the control group. No significant difference over time were found in pain or hand function between those undergoing surgery or not in the two groups. However, at the time of the surgical consultation, significantly higher pain (Figure 1) and poorer hand function were reported among those later undergoing surgery in the control group (p≤0.001). Surgery did not lead to further improvement in pain and hand function in the intervention group.

Figure 1.

Between-group difference on pain over a 2-year period. The control group is marked in light grey and the intervention group in black. Those who underwent surgery are marked with dotted lines, while those who did not are marked with solid lines (n=163)

Conclusion:

The results showed that the positive effect of multimodal occupational therapy on pain and hand function persisted over the 2-year period, however, no significant between-groups difference over time was found. No significant between-group differences were found when dividing into sub-groups, however, those later undergoing surgery in the control group scored significantly worse on pain and hand function at the time of surgical consultation. The results may imply that patients who would benefit from surgery were identified, and that surgery does not give an additional benefit in patients who have received multimodal occupational therapy. This needs to be further investigated.

References:

[1]Tveter AT, Østerås N, Nossum R, Eide REM, Klokkeide Å, Hoegh Matre K, et al. Short-term effects of occupational therapy on hand function and pain in patients with carpometacarpal osteoarthritis: secondary analyses from a randomized controlled trial. Arthritis care & research. 2020:10.1002/acr.24543

Acknowledgements:

We would like to acknowledge Øyvor Andreassen for her contribution throughout the project as a patient representative.

Disclosure of Interests:

None declared

Simple cardiovascular risk stratification using anthropometric measures instead of serum cholesterol. The MORGAM Prospective Cohort Project

Background

Body composition predicts cardiovascular outcomes, but it is uncertain whether anthropometric measures can replace the more expensive serum total cholesterol for cardiovascular risk stratification in low resource settings.

Purpose

The purpose of the study was to compare the additive prognostic ability of serum total cholesterol with that of body mass index (BMI), waist/hip ratio (WHR), and estimated fat mass (EFM, calculated using a validated prediction equation), individually and combined.

Methods

We used data from the MORGAM (MONICA, Risk, Genetics, Archiving, and Monograph) Prospective Cohort Project, an international pooling of cardiovascular cohorts, to determine the relationship between anthropometric measures, serum cholesterol, and cardiovascular events, using multivariable Cox proportional-hazards regression analysis. We further investigated the ability of these measures to enhance prognostication beyond a simpler prediction model, consisting of age, sex, smoking status, systolic blood pressures, and country, using comparison of area under the receiver operating characteristics curve (AUCROC) derived from binary logistic regression models. The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of death from coronary heart disease, myocardial infarction, or stroke.

Results

The study population consisted of 52,188 apparently healthy subjects (56.3% men) aged 47±12 years ranging from 20 to 84, derived from 37 European cohorts, with baseline between 1982–2002 all followed for 10 years during which MACE occurred in 2465 (4.7%) subjects. All anthropometric measures (BMI: hazard ratio (HR) 1.04 [95% confidence interval (CI): 1.03–1.05] per kg/m2; WHR: HR 7.5 [4.0–14.0] per unit; EFM: HR 1.02 [1.01–1.02] per kg) as well as serum total cholesterol (HR 1.20 [1.16–1.24] per mmol/l) were significantly associated with MACE (P&lt;0.001 for all), independently of age, sex, smoking status, systolic blood pressures, and country. The addition of serum cholesterol significantly improved the predictive ability of the simple model (AUCROC 0.818 vs. 0.814, P&lt;0.001), as did the combination of WHR, BMI, and EFM (AUCROC 0.817 vs. 0.814, P=0.004). When assessed individually, BMI (AUCROC 0.816 vs. 0.814, P=0.004) and WHR (AUCROC 0.815 vs. 0.814, P=0.02) improved model performance, while EFM narrowly missed significance (AUCROC 0.815 vs. 0.814, P=0.06). There was no significant difference in the predictive ability of a model including serum cholesterol versus that including all three anthropometric measures (AUCROC 0.818 vs. 0.817, P=0.13). The figure shows the pertinent areas under the ROC curve in predicting MACE.

Conclusion

In this large population-based cohort study, the addition of a combination of anthropometric measures, i.e. BMI, WHR, and EFM, raised the predictive ability of a simple prognostic model comparable to that obtained by the addition of serum total cholesterol.

Figure 1

Funding Acknowledgement

Type of funding source: None

FRI0635-HPR PATIENTS’ MOTIVATION AND GOALS FOR THUMB CARPOMETACARPAL OSTEOARTHRITIS SURGERY

Background:

Osteoarthritis (OA) in the thumb carpometacarpal joint (CMCJ) is a prevalent disease which may lead to structural damage, severe pain and functional limitations, but for which there is yet no cure. Evidence-based treatment recommendations state that all patients with hand OA should be offered patient education, hand exercises, and provision of assistive devices and orthoses. Pharmacological therapy is recommended as a symptom relieving supplement. The main indication for CMCJ surgery is pain and poor function, and such surgery should be considered only when other treatment has proven insufficient in relieving pain (1). Previous research has shown that high motivation is a significant predictor for deciding to undergo CMCJ surgery (2), but there is little knowledge regarding which factors that motivates patients for undergoing such surgery.

Objectives:

The objective of this study was to explore patient goals and motivation for surgery, and factors characterizing patients highly motivated for surgery.

Methods:

This cross-sectional study included 180 patients referred from their general practitioner for CMCJ surgical consultation. Goals for surgery were collected with an open-ended question and analysed by linking the content of each goal to domains in the International Classification of Functioning, Disability and Health coding system. Motivation for surgery was rated with a Numeric Rating Scale (NRS, 0-10, 0=no motivation). Activity limitations was self-reported using the Measure of Activity Performance of the Hand (MAP-Hand, score 1 to 4, 1=no activity problems) and the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH; score 0-100, 0=no disability). Factors that characterized patients highly motivated for surgery (NRS≥8) were explored with multivariate regression analyses.

Results:

Mean age of participants was 63 years (SD 7.6) and 142 (79%) were women. The most common goals for surgery were to reduce pain and improve arm and hand use. Fifty-six (31%) of the patients were characterized as highly motivated for surgery. High motivation for surgery was strongly associated with more activity limitations (MAP-Hand; (OR 4.00, p=0.008)), living alone (OR 3.18, p=0.007) and a young age (OR 0.94, p=0.002).

Conclusion:

Decisions on CMCJ OA surgery should be based on assessment and discussion of patients’ life situation, hand pain, activity limitations and motivation and goals for surgery. According to the EULAR recommendations, previously received conservative and pharmacological treatment should also be evaluated.

References:

[1] Kloppenburg, M., et al. (2018). “2018 update of the EULAR recommendations for the management of hand osteoarthritis.” Ann Rheum Dis. 0; 1-9

[2] Gravas, E. M. H., et al. (2019). “Non-pharmacological treatment gap preceding surgical consultation in thumb carpometacarpal osteoarthritis - a cross-sectional study.” BMC Musculoskelet Disord 20(1): 180.

Disclosure of Interests:

None declared

OP0152-HPR A COST-UTILITY ANALYSIS OF MULTIMODAL OCCUPATIONAL THERAPY IN PATIENTS WITH THUMB BASE OSTEOARTHRITIS

Background:

Patient education, hand exercises, and use of assistive devices and orthoses are regarded as first-line treatment for patients with hand osteoarthritis (OA) (1), however there is limited evidence for the cost-effectiveness of such treatment.

Objectives:

The objective of this study is to assess the cost-utility of a multimodal occupational therapy treatment delivered in the waiting period before surgical consultation in patients with thumb base OA compared to usual care.

Methods:

This study presents an economic evaluation assessing the difference in health care use and quality-of-life during a 24-month period in a Norwegian multicenter randomized controlled trial. All patients referred to surgical consultation due to thumb base OA at three departments of rheumatology between 2013 and 2015 were eligible for inclusion. In total, 180 patients were included and randomized to a control group or a multimodal occupational therapy group (90 patients in each group). During the waiting period between referral and actual surgical consultation, the control group continued with usual care which was staying on the waiting list and receiving information on hand OA. The intervention group got information on hand OA, ergonomic principles and use of assistive devices, and they were instructed in home-based hand exercises and received a day and a night orthosis. The intervention group was instructed to use the orthoses and assistive devices as much as possible and perform home exercises three times per week for 12 weeks. The patients were assessed at baseline and after 4, 18 and 24 months. The within-trial economic analysis reports the incremental cost-effectiveness ratio (ICER) reflecting the between-group difference in incremental cost per adjusted life years (QALY) over 24 months. A generic health-related quality of life questionnaire, the EuroQol 5 Dimension, was used to calculate the QALYs at baseline, 4, 18 and 24 months. Costs were collected from different sources, taking a health care perspective; The occupation therapist reported the number of consultations related to the intervention; surgical procedure and post-operative follow-up were collected from patients’ journals; and additional consumption of primary and specialist health care was self-reported by the patient. Sensitivity analyses were performed. The results are presented in a cost-effectiveness plane using bootstrapping. Willingness-to-pay threshold is set to be € 27 500 linked to the severity of this condition.

Results:

The mean age of the included patients was 63 years (SD 7.6) and 79% were women. There was a total between-group difference in QALYs of 0.07 utilities after 24 months, in favour of the intervention group. Operations constituted the main costs with 22 operations in the intervention group compared to 33 in the control group. The between-group difference in costs due to health care consumption was estimated to € 500 in favour of the intervention group (Figure 1).

Conclusion:

The results in this within-trial analysis indicate that multimodal occupational therapy in the waiting period before surgical consultation compared to usual care is a cost-effective alternative taking a health care perspective.

References:

[1]Kloppenburg, M., et al. (2018). “2018 update of the EULAR recommendations for the management of hand osteoarthritis.”Ann Rheum Dis.

Disclosure of Interests:

None declared

0451 Fully Automatic Detection of Sleep Disordered Breathing Events

Introduction

Evaluation of sleep apnea involves manual annotation of Polysomnography (PSG) file, a time-consuming process subject to interscorer variations. The DOSED algorithm has been shown to be helpful in detecting Central Sleep Apnea (CSA), Obstructive Sleep Apnea (OSA), and Hypopnea when merged into a single event type. This work uses a modified version of DOSED capable of detecting each event type separately.

Methods

The network consists of 3 blocks of 1D convolutional layers followed by 6 blocks of 2D convolutional layers. The network has 2 classification layers, one determines the probability of each class, and the other determines the start and duration time of the event with the highest probability. Four channels from nasal and mouth airflow and position of abdomen and thorax are used as input to the model. The model was trained using 2800 PSG from 4 different cohorts (MESA, MROS, SSC, WSC) and tested on 70 PSG, which have been scored by six technicians (Stanford, U Penn, St Louis).

Results

On an event by event basis, model F1-scores versus a weighted consensus score based on 6 technicians were 0.60 for OSA, 0.43 for CSA, and 0.34 for Hypopnea. Average F1-scores for the 6 technicians were 0.48 (std 0.04) for OSA, 0.29 (std 0.145) for CSA, and 0.54 (std 0.183) for Hypopnea, indicating that the model functions better on an event-by-event basis than an average technician. Correlations between indices/hr for central apnea, obstructive apnea, and hypopnea indicate excellent correlations for apneas, but poor correlation for hypopnea. We are now adding the snoring channel to explore if predictions can be improved.

Conclusion

The result shows that deep learning-based models can detect respiratory events with an accuracy similar to technicians. The poor agreement between technicians from different universities indicates that we need better definitions of hypopnea.

Support

 

1208 Sleep Stage Prediction And Sleep Disordered Breathing Detection Using Raw Actigraphy And Photoplethysmography From Wearable Consumer Device

Introduction

Wearable, multisensory consumer devices that estimate sleep are prevalent and hold great potential. Most validated actigraphic prediction studies of sleep stages (SS) have only used low resolution (30 sec) data and the Cole-Kripke algorithm. Other algorithms are often proprietary and not accessible or validated. We present an automatic, data-driven deep learning algorithm that process raw actigraphy (ACC) and photoplethysmography (PPG) using a low-cost consumer device at high (25Hz) and low resolution to predict SS and to detect sleep disordered breathing (SDB) events.

Methods

Our automatic, data-driven algorithm is a deep neural network trained and evaluated to predict SS and SDB events on 236 recordings of ACC data from a wrist-worn accelerometer and PPG data from the overlapping PSG. The network was tested on raw ACC and PPG data, which was collected at 25 Hz using the HUAMI Arc2 wristband from 39 participants that underwent a nocturnal polysomnography (PSG).

Results

Overall accuracy (Acc), recall (Re), specificity (Sp), and kappa (κ) per subject on the test dataset the prediction of wake, NREM, REM was Acc=76.6%, Re=72.4%, Sp=78.0%, kappa=0.42. On average, we found a 7 % higher performance using the raw sensor data as input instead of processed, low resolution inputs. PPG was especially useful for REM detection. The network assigned 55.6% of patients to the correct SDB severity group when using an apnea-hypopnea index above 15.

Conclusion

Current results show that SS prediction is significantly improved when using the raw sensor data; it indicates that the system holds promise as a potential pervasive monitoring device for patients with chronic sleep disorders. In contrast the system did not show potential as a sleep apnea screening tool. Additional studies are ongoing to examine the effects of pathology such as sleep apnea and periodic leg movement on SS prediction.

Support

Technical University of Denmark; University of Copenhagen, Copenhagen Center for Health Technology, Klarman Family Foundation.

Mobile phones represent a pathway for microbial transmission: A scoping review

BACKGROUND

Mobile phones have become an integral part of modern society. As possible breeding grounds for microbial organisms, these constitute a potential global public health risk for microbial transmission.

OBJECTIVE

Scoping review of literature examining microbial's presence on mobile phones in both health care (HC) and community settings.

METHODS

A search (PubMed&GoogleScholar) was conducted from January 2005-December 2019 to identify English language studies. Studies were included if samples from mobile phones were tested for bacteria, fungi, and/or viruses; and if the sampling was carried out in any HC setting, and/or within the general community. Any other studies exploring mobile phones that did not identify specific microorganisms were excluded.

RESULTS

A total of 56 studies were included (from 24 countries). Most studies identified the presence of bacteria (54/56), while 16 studies reported the presence of fungi. One study focused solely on RNA viruses. Staphylococcus aureus, and Coagulase-Negative Staphylococci were the most numerous identified organisms present on mobile phones. These two species and Escherichia coli were present in over a third of studies both in HC and community samples. Methicillin-resistant S. aureus, Acinetobacter sp., and Bacillus sp. were present in over a third of the studies in HC settings.

CONCLUSIONS

While this scoping review of literature regarding microbial identification on mobile phones in HC and community settings did not directly address the issue of SARS-CoV-2 responsible for COVID-19, this work exposes the possible role of mobile phones as a 'Trojan horse' contributing to the transmission of microbial infections in epidemics and pandemics.

Correction to: High-throughput method for ear phenotyping and kernel weight estimation in maize using ear digital imaging

[This corrects the article DOI: 10.1186/s13007-018-0317-4.].

Use of test accuracy study design labels in NICE's diagnostic guidance

BACKGROUND

A variety of study designs are available to evaluate the accuracy of tests, but the terms used to describe these designs seem to lack clarity and standardization. We investigated if this was the case in the diagnostic guidance of the National Institute of Care and Health Excellence (NICE), an influential source of advice on the value of tests.

OBJECTIVES

To describe the range of study design terms and labels used to distinguish study designs in NICE Diagnostic Guidance and the underlying evidence reports.

METHODS

We carefully examined all NICE Diagnostic Guidance that has been developed from inception in 2011 until 2018 and the corresponding diagnostic assessment reports that summarized the evidence, focusing on guidance where tests were considered for diagnosis. We abstracted labels used to describe study designs and investigated what labels were used when studies were weighted differently because of their design (in terms of validity of evidence), in relevant sections. We made a descriptive analysis to assess the range of labels and also categorized labels by design features.

RESULTS

From a total of 36 pieces of guidance, 20 (56%) were eligible and 17 (47%) were included in our analysis. We identified 53 unique design labels, of which 19 (36%) were specific to diagnostic test accuracy designs. These referred to a total of 12 study design features. Labels were used in assigning different weights to studies in seven of the reports (41%) but never in the guidance documents.

CONCLUSION

Our study confirms a lack of clarity and standardization of test accuracy study design terms. There seems to be scope to reduce and harmonize the number of terms and still capture the design features that were deemed influential by those compiling the evidence reports. This should help decision makers in quickly identifying subgroups of included studies that should be weighted differently because their designs are more susceptible to bias.

Extended evaluation of urinary multi-biomarker analyses of mycotoxins in Swedish adults and children

Biomarker-based methods are being more and more used to assess dietary exposure of mycotoxins in a population. The aim of the present study was to perform an extended analysis of urinary multiple mycotoxin levels and associations with background characteristics and food groups. Exposure assessment calculations were performed on three urine mycotoxins as described below and the probable daily intake (PDI) was compared with the established tolerable daily intake (TDI) to uncover potential exposure risks. The study population consisted of 250 adults and 50 school children in grade five from two surveys conducted by the Swedish National Food Agency. Six mycotoxins (deoxynivalenol (DON), zearalenone (ZEA), fumonisin B1 (FB1), fumonisin B2 (FB2), ochratoxin A (OTA), and nivalenol (NIV) and four metabolites (deepoxy-deoxynivalenol (DOM-1), aflatoxin M1 (AFM1), α-zearalenol (α-ZOL) and β-zearalenol (β-ZOL) were measured by an ultra-performance liquid chromatography tandem mass spectrometry based method (LC-MS/MS). OTA and DON were the most commonly occurring mycotoxins in urine of both adults and children, 51 and 63%, respectively in adults and 96 and 94%, respectively in children. A positive correlation was found between urinary NIV and total cereal consumption among adults. ZEA, α-ZOL, β-ZOL and FB2 were significantly higher in females than males (P<0.01 for all). Adjusted OTA levels were inversely correlated with income in men. In children, the percentage DOM-1 positive samples were much higher compared to adults, 76 and 8% respectively, indicating a higher capacity to detoxify DON. The small sample size among children made it difficult to study associations between urine mycotoxins levels and food group intake. All PDI estimates [DON (with and without DOM-1), ZEA (with and without α-ZOL and β-ZOL) and FB1] were below the TDI values except for DON exposure in adults, as reported previously, 1.3% of the volunteers were above the TDI.

Supply and demand: How does variation in atmospheric oxygen during development affect insect tracheal and mitochondrial networks?

Atmospheric oxygen is one of the most important atmospheric component for all terrestrial organisms. Variation in atmospheric oxygen has wide ranging effects on animal physiology, development, and evolution. This variation in oxygen has the potential to affect both respiratory systems (the supply side) and mitochondrial networks (the demand side) in animals. Insect respiratory systems supplying oxygen to tissues in the gas phase through blind ended tracheal systems are particularly susceptible to this variation. While the large conducting tracheae have previously been shown to respond developmentally to changes in rearing oxygen, the effect of oxygen on the tracheolar network has been relatively unexplored, especially in adult insects. Similarly, mitochondrial networks that meet energy demand in insects and other animals are dynamic and their enzyme activities have been shown to vary in the presence of oxygen. These two systems together should be under selective pressure to meet the aerobic metabolic requirements of insects. To test this hypothesis, we reared Mito-YFP Drosophila under three different oxygen concentrations hypoxia (12%), normoxia (21%), and hyperoxia (31%) and imaged their tracheolar and mitochondrial networks within their flight muscle using confocal microscopy. In terms of oxygen supply, hypoxia increased mean (mid-length) tracheolar diameters, tracheolar tip diameters, the number of tracheoles per main branch and affected tracheal branching patterns, while the opposite was observed in hyperoxia. In terms of oxygen demand, hypoxia increased mitochondrial investment and mitochondrial to tracheolar volume ratios; while the opposite was observed in hyperoxia. Generally, hypoxia had a stronger effect on both systems than hyperoxia. These results show that insects are capable of developmentally changing investment in both their supply and demand networks to increase overall fitness.

High-throughput method for ear phenotyping and kernel weight estimation in maize using ear digital imaging

BACKGROUND

Grain yield, ear and kernel attributes can assist to understand the performance of maize plant under different environmental conditions and can be used in the variety development process to address farmer's preferences. These parameters are however still laborious and expensive to measure.

RESULTS

A low-cost ear digital imaging method was developed that provides estimates of ear and kernel attributes i.e., ear number and size, kernel number and size as well as kernel weight from photos of ears harvested from field trial plots. The image processing method uses a script that runs in a batch mode on ImageJ; an open source software. Kernel weight was estimated using the total kernel number derived from the number of kernels visible on the image and the average kernel size. Data showed a good agreement in terms of accuracy and precision between ground truth measurements and data generated through image processing. Broad-sense heritability of the estimated parameters was in the range or higher than that for measured grain weight. Limitation of the method for kernel weight estimation is discussed.

CONCLUSION

The method developed in this work provides an opportunity to significantly reduce the cost of selection in the breeding process, especially for resource constrained crop improvement programs and can be used to learn more about the genetic bases of grain yield determinants.

Experimental mould growth and mycotoxin diffusion in different food items

Isolates of Penicillium commune, Penicillium crustosum, Penicillium expansum, Penicillium roqueforti and Aspergillus versicolor, were inoculated on different food items (hard cheese, crème fraiche, tomato purée, apple and blueberry jam) and incubated at 15 °C for 14 days at 50% relative humidity (RH). After incubation the food samples were divided into 3 subsamples; A was 0-2 cm from the surface and including the fungal colony, subsample B was 2-4 cm and subsample C was the rest from >4 cm from the surface. The subsamples were analysed with a multianalyte method capable of identifying more than several hundreds of fungal metabolites. The outcome showed that mouldy food can contain a cocktail of bioactive secondary metabolites including mycotoxins and sometimes at high concentrations. Measurements of the diffusion of fungal metabolites from the colony on the surface (layer A) into the food (layer B and C) showed that the fungal metabolites do not diffuse more than 2 cm into the inner core of the hard cheese. On the other hand in more liquid foods, such as crème fraiche, fruit jams and tomato purée, the toxins diffused quite readily throughout the entire food sample. The levels of patulin found in the apple jam indicate that the tolerable daily intake for patulin may easily be exceeded even if the mouldy layer A is removed. This limited study calls for more similar studies to be performed to give risk managers a sound basis for advice to consumers.

Total hip arthroplasty following failure of core decompression and tantalum rod implantation

AIMS

One method of femoral head preservation following avascular necrosis (AVN) is core decompression and insertion of a tantalum rod. However, there may be a high failure rate associated with this procedure. The purpose of this study was to document the clinical and radiological outcomes following total hip arthroplasty (THA) subsequent to failed tantalum rod insertion.

PATIENTS AND METHODS

A total of 37 failed tantalum rods requiring total hip arthroplasty were identified from a prospective database. There were 21 hips in 21 patients (12 men and nine women, mean age 37 years, 18 to 53) meeting minimum two year clinical and radiographic follow-up whose THAs were carried out between November 2002 and April 2013 (mean time between tantalum rod implantation and conversion to a THA was 26 months, 6 to 72). These were matched by age and gender to individuals (12 men, nine women, mean age 40 years, 18 to 58) receiving THA for AVN without prior tantalum rod insertion.

RESULTS

There were no functional outcome differences between the two groups. Tantalum residue was identified on all post-operative radiographs in the tantalum group. Linear wear rates were comparable between groups with no evidence of catastrophic wear in either group.

CONCLUSION

In the short term, tantalum rod implantation does not demonstrate an adverse effect on subsequent total joint replacement surgery. There is however, a high rate of retained tantalum debris on post-operative radiographs and thus there is an unknown risk of accelerated articular wear necessitating longer term study. Cite this article: Bone Joint J 2016;98-B:1175-9.

Genetic structure of West Greenland populations of lumpfish Cyclopterus lumpus

In this study, 11 microsatellite markers were used to determine the structure of West Greenlandic lumpfish Cyclopterus lumpus populations across six spawning locations spanning >1500 km and compared with neighbouring populations in Canada and Iceland. To evaluate whether data allow for identification of origin of C. lumpus in Greenlandic waters, genetic assignment analysis was performed for 86 C. lumpus sampled on a feeding migration. Significant structuring with isolation by distance was observed in the West Greenland samples and two major subpopulations, north and south, were suggested. Based on F_ST values, closer relationships were observed between Greenland and Canada, than Greenland and Iceland. Surprisingly, the North Greenland population showed more similarities with Canadian samples, than did the geographically closer south-west Greenland population. Origin could be assigned for a high proportion of non-spawning fish and demonstrated a marked east-west spatial separation of fish of Greenlandic and Icelandic genotypes.

Unmanned aerial platform-based multi-spectral imaging for field phenotyping of maize

BACKGROUND

Recent developments in unmanned aerial platforms (UAP) have provided research opportunities in assessing land allocation and crop physiological traits, including response to abiotic and biotic stresses. UAP-based remote sensing can be used to rapidly and cost-effectively phenotype large numbers of plots and field trials in a dynamic way using time series. This is anticipated to have tremendous implications for progress in crop genetic improvement.

RESULTS

We present the use of a UAP equipped with sensors for multispectral imaging in spatial field variability assessment and phenotyping for low-nitrogen (low-N) stress tolerance in maize. Multispectral aerial images were used to (1) characterize experimental fields for spatial soil-nitrogen variability and (2) derive indices for crop performance under low-N stress. Overall, results showed that the aerial platform enables to effectively characterize spatial field variation and assess crop performance under low-N stress. The Normalized Difference Vegetation Index (NDVI) data derived from spectral imaging presented a strong correlation with ground-measured NDVI, crop senescence index and grain yield.

CONCLUSION

This work suggests that the aerial sensing platform designed for phenotyping studies has the potential to effectively assist in crop genetic improvement against abiotic stresses like low-N provided that sensors have enough resolution for plot level data collection. Limitations and future potential uses are also discussed.

Anaesthesia-Related Haemodynamic Complications in Williams Syndrome Patients: A Review of One Institution's Experience

Williams syndrome is a genetic disorder associated with cardiac pathology, including supravalvular aortic stenosis and coronary artery stenosis. Sudden cardiac death has been reported in the perioperative period and attributed to cardiovascular pathology. In this retrospective audit, case note and anaesthetic records were reviewed for all confirmed Williams syndrome patients who had received an anaesthetic in our institution between July 1974 and November 2009. There were a total of 108 anaesthetics administered in 29 patients. Twelve of the anaesthetics (11.1%) were associated with cardiac complications including cardiac arrest in two cases (1.85%). Of the two cardiac arrests, one patient died within the first 24 hours postanaesthetic and the other patient survived, giving an overall mortality of 0.9% (3.4%). We conclude that Williams syndrome confers a significant anaesthetic risk, which should be recognised and considered by clinicians planning procedures requiring general anaesthesia.

Biomonitoring study of deoxynivalenol exposure and association with typical cereal consumption in Swedish adults

Deoxynivalenol (DON) is a mycotoxin of the trichothecene family commonly found in cereals infested with different Fusarium species. DON acts primarily on the gastrointestinal and immune system and is suspected to be an underlying agent causing several outbreaks of gastrointestinal disorder among humans, which prompts studies of human exposure and estimations of intake among populations. However, assessing human exposure to mycotoxins is associated with several difficulties. Therefore, a study was undertaken among adults (18-80 years) in a subgroup of Riksmaten, the Swedish national survey investigating dietary habits, examining both the association between urinary DON concentration and dietary intake of cereals, and estimations of daily DON intake. The results indicate that exposure to DON is common among Swedish adults, as this mycotoxin was detected in 292 out of 326 urine samples (90%) at levels ranging from non-detectable to 65.8 ng DON/ml urine with a median level of 2.9 ng/ml. Furthermore, urinary DON (ng/mg creatinine) was associated with intake (g/day) of total cereal grain as well as whole grain. Urinary DON was also significantly associated with breakfast cereals and porridge consumption (P<0.05). Estimated DON intake in this study ranged between 2.5 and 5,443 ng/kg body weight (bw). 1% of the individuals had estimated intakes above the group provisional maximum tolerable daily intake (PMTDI; 1 μg/kg), whereas the mean and median intakes of 159 and 84 ng DON/kg bw, respectively, were considerably below the PMTDI. Along with the toxicological profile of DON, no serious health implications are to be expected for the majority of Swedish adults, although a potential health concern remains for some high cereal consumers. In conclusion, biomonitoring could prove to be a valuable tool for observing DON exposure among populations.

Perspectives on the development of antioxidant antiepileptogenic agents

Epilepsy is a chronic disorder of abnormal electrical activity in the brain characterized by recurrent unprovoked seizures. Currently used pharmaceutical agents do not treat the underlying disease process, and a significant proportion of epileptic patients are refractory to current therapies. Therefore there is a strong need for additional therapeutic agents, especially those that address the underlying disease process of epileptogenesis. The redox potential of cells is maintained by an appropriate balance between pro- and anti-oxidative molecules; oxidative stress and increases in toxic reactive oxygen species occur when this balance shifts towards oxidation. Neural tissues are especially sensitive to oxygen levels, and oxidative stress is thought to be involved in epileptogenesis. Increases in reactive oxygen species occur in response to sustained neuronal electrical activity and seizures. Therefore antioxidants have been suggested as therapeutic design strategies for the treatment and modulation of epilepsy. This minireview focuses on several key antioxidants and agents involved in defending against oxidative stress that may be targets for new antiepileptogenic drug design, including directacting antioxidants, Nrf2-activating agents, and prolyl-4-hydroxylase inhibitors. A description of the necessary physicochemical properties and a summary of animal models that are thought to be useful for developing antiepileptogenic agents are presented.