Equitable inclusion of diverse populations in oncology clinical trials: deterrents and drivers

The burden of cancer exerts a disproportionate impact across different regions and population subsets. Disease-specific attributes, coupled with genetic and socioeconomic factors, significantly influence cancer treatment outcomes. Precision oncology promises the development of safe and effective options for specific ethnic phenotypes and clinicodemographic profiles. Currently, clinical trials are concentrated in resource-rich geographies with younger, healthier, white, educated, and empowered populations. Vulnerable and marginalized people are often deprived of opportunities to participate in clinical trials. Despite consistent endeavors by regulators, industry, and other stakeholders, factors including diversity in trial regulations and patient and provider-related cultural, logistic, and operational barriers limit the inclusiveness of clinical trials. Understanding and addressing these constraints by collaborative actions involving regulatory initiatives, industry, patient advocacy groups, community engagement in a culturally sensitive manner, and designing and promoting decentralized clinical trials are vital to establishing a clinical research ecosystem that promotes equity in the representation of population subgroups.

A retrospective multicentre clinical study on management of isolated splenic vein thrombosis: risks and benefits of anticoagulation

INTRODUCTION

Isolated splenic vein thrombosis (iSVT) is a common complication of pancreatic disease. Whilst patients remain asymptomatic, there is a risk of sinistral portal hypertension and subsequent bleeding from gastric varices if recanalisation does not occur. There is wide variation of iSVT treatment, even within single centres. We report outcomes of iSVT from tertiary referral hepatobiliary and pancreatic (HPB) units including the impact of anticoagulation on recanalisation rates and subsequent variceal bleeding risk.

METHODS

A retrospective cohort study including all patients diagnosed with iSVT on contrast-enhanced CT scan abdomen and pelvis between 2011 and 2019 from two institutions. Patients with both SVT and portal vein thrombosis at diagnosis and isolated splenic vein thrombosis secondary to malignancy were excluded. The outcomes of anticoagulation, recanalisation rates, risk of bleeding and progression to portal vein thrombosis were examined using CT scan abdomen and pelvis with contrast.

RESULTS

Ninety-eight patients with iSVT were included, of which 39 patients received anticoagulation (40%). The most common cause of iSVT was acute pancreatitis n = 88 (90%). The recanalisation rate in the anticoagulation group was 46% vs 15% in patients receiving no anticoagulation (p = 0.0008, OR = 4.7, 95% CI 1.775 to 11.72). Upper abdominal vascular collaterals (demonstrated on CT scan angiography) were significantly less amongst patients who received anticoagulation treatment (p = 0.03, OR = 0.4, 95% CI 0.1736 to 0.9288). The overall rate of upper GI variceal-related bleeding was 3% (n = 3/98) and it was independent of anticoagulation treatment. Two of the patients received therapeutic anticoagulation.

CONCLUSION

The current data supports that therapeutic anticoagulation is associated with a statistically significant increase in recanalisation rates of the splenic vein, with a subsequent reduction in radiological left-sided portal hypertension. However, all patients had a very low risk of variceal bleeding regardless of anticoagulation. The findings from this retrospective study should merit further investigation in large-scale randomised clinical trials.

Limitations of antifungal prophylaxis in preventing invasive Candida surgical site infections after liver transplant surgery

Invasive primary Candida surgical site infections (IP-SSIs) are a common complication of liver transplantation, and targeted antifungal prophylaxis is an efficient strategy to limit their occurrence. We performed a retrospective single-center cohort study among adult single liver transplant recipients at Duke University Hospital in the period between 1 January 2015 and 31 December 2020. The study aimed to determine the rate of Candida IP-SSI according to the peri-transplant antifungal prophylaxis received. Of 470 adult single liver transplant recipients, 53 (11.3%) received micafungin prophylaxis, 100 (21.3%) received fluconazole prophylaxis, and 317 (67.4%) did not receive systemic antifungal prophylaxis in the peri-transplant period. Ten Candida IP-SSIs occurred among 5 of 53 (9.4%) micafungin recipients, 1 of 100 (1.0%) fluconazole recipients, and 4 of 317 (1.3%) recipients who did not receive antifungal prophylaxis. Our study highlights the limitations of antifungal prophylaxis in preventing invasive Candida IP-SSI after liver transplant surgery. We hypothesize that pathogen, host, and pharmacokinetic-related factors contributed to the occurrence of Candida IP-SSI despite antifungal prophylaxis. Our study reinforces the need for a risk-based, multi-pronged approach to fungal prevention, including targeted antifungal administration in patients with risks for invasive candidiasis and close monitoring, especially among patients with surgically complex procedures, with timely control of surgical leaks.

A new portable field rotational viscometer for high-temperature melts

Mounted on top of furnaces, laboratory viscometers can be used for the rheological characterization of high temperature melts, such as molten rocks (lava). However, there are no instruments capable of measuring the viscosity of large volumes of high temperature melts outside the laboratory at, for example, active lava flows on volcanoes or at industrial sites. In this article, we describe a new instrument designed to be easy to operate, highly mobile, and capable of measuring the viscosity of high temperature liquids and suspensions (<1350 °C). The device consists of a torque sensor mounted in line with a stainless-steel shear vane that is immersed in the melt and driven by a motor that rotates the shear vane. In addition, a thermocouple placed between the blades of the shear vane measures the temperature of the melt at the measurement location. An onboard microcomputer records torque, rotation rate, and temperature simultaneously and in real time, thus enabling the characterization of the rheological flow curve of the material as a function of temperature and strain rate. The instrument is calibrated using viscosity standards at low temperatures (20-60 °C) and over a wide range of stress (30-3870 Pa), strain rate (0.1-27.9 s-1), and viscosity (10-650 Pa s). High temperature tests were performed in large scale experiments within ∼25 l of lava at temperatures between 1000 and 1350 °C to validate the system's performance for future use in natural lava flows. This portable field viscometer was primarily designed to measure the viscosity of geological melts at their relevant temperatures and in their natural state on the flanks of volcanoes, but it could also be used for industrial purposes and beyond.

Comparative Effectiveness of Integrated Peer Support and Clinical Staffing Models for Community-Based Residential Mental Health Rehabilitation: A Prospective Observational Study

This observational study compared the outcomes of consumers receiving community-based residential mental health rehabilitation support in Australia under a clinical staffing model and an integrated staffing model where Peer Support Workers are the majority component of the staffing profile. Reliable and clinically significant (RCS) change between admission and discharge in functional and clinical assessment measures were compared for consumers receiving care under the clinical (n = 52) and integrated (n = 93) staffing models. Covariate analyses examined the impact of known confounders on the outcomes of the staffing model groups. No statistically significant differences in RCS improvement were identified between the staffing models. However, logistic regression modelling showed that consumers admitted under the integrated staffing model were more likely to experience reliable improvement in general psychiatric symptoms and social functioning. The findings support the clinical and integrated staffing models achieving at least equivalent outcomes for community-based residential rehabilitation services consumers.

A68 HOW REAL ARE YOUR SURVEY RESPONDENTS? IDENTIFYING FRAUDULENT RESPONDENTS IN ONLINE SURVEYS – A CASE EXAMPLE IN INFLAMMATORY BOWEL DISEASE (IBD)

Background

Social media and online surveys are commonly used to recruit and collect data from patients and physicians about GI diseases – they are efficient, convenient, and less resource intensive compared to traditional recruitment approaches and paper surveys. However, online data fraud is increasing and difficult to identify. Online data fraud can include intentional duplicate responses/straight-lining/inattention, bots/malicious software, and professional survey takers who provide fraudulent responses to meet study eligibility.

Purpose

1) Illustrate challenges of identifying fraudulent respondents through an algorithm and verification process we developed for our survey in IBD. 2) Demonstrate potential impact of fraudulent respondents on data and results.

Method

Online survey of Canadian adults (>18 years) with IBD about healthcare processes for managing IBD hosted using Qualtrics. Recruitment was done in clinic and online (mailing lists, social media). A $25 giftcard was offered for participation due to low response after 3 months in field, after which a large influx of ‘respondents’ occurred. Most were fraudulent although not obvious at first. To mitigate further fraudulent responses, we added the following to our survey: reCAPTCHA score, repeated question (year of IBD diagnosis), duplicate ID score, fraud score and honeypot question.

Our algorithm to identify fraudulent responses included 13 binary ‘red flag’ variables: age <18 years, year of diagnosis < year of birth, 2 different year of diagnosis, invalid postal code, survey duration <10 minutes, survey duration 10-15 minutes, suspicious comments for open text questions (x2), duplicate email, suspicious email, duplicate ID score ≥30, fraud score ≥30, and failed honeypot question. These variables were used to generate a fraudulent response score (range: 0-13; 13=most likely fraudulent). ‘Respondents’ with scores >3 were categorized as likely fraudulent. Respondents with scores ≤3 were reviewed individually. Respondents flagged as likely real or unsure were emailed and asked to verify their age; those who correctly verified age were considered likely real and included in the final sample.

Result(s)

Of the 4334 ‘respondents’ who started the survey, based on fraudulent response score we identified 75% (n=3258) as likely fraudulent, 17% (n=727) as unsure and 8% (n=349) as likely real. After age verification, 76% (n=3297) were considered likely fraudulent, 14% (n=592) remained unsure, 10% (n=442) were considered likely real, and <1% (n=3) were duplicates of likely real respondents.

Conclusion(s)

Despite convenience, social media and online surveys can be prone to fraudulent responses, especially when incentives are offered. We developed an algorithm and verification process to identify fraudulent responses using an IBD survey example. Given that only 10% of the full sample was considered likely real, researchers using social media and online surveys should carefully examine data for fraudulent responses and apply strategies to mitigate risks.

Please acknowledge all funding agencies by checking the applicable boxes below

CCC

Disclosure of Interest

None Declared

Transitions from pediatric to adult rheumatology care for juvenile idiopathic arthritis: a patient led qualitative study

Background

Juvenile idiopathic arthritis (JIA) is a childhood autoimmune disease that causes swelling and pain in at least one joint. Young people with JIA experience symptoms that persist into adulthood, and thus will undergo a transition including the o transfer of care from a pediatric rheumatologist an adult rheumatologist. Missing from the literature is research that centres the transition experience of young people with JIA in Canada. This goal of this patient-led research was to explore the experience young people with JIA through the process of transition.

Methods

Qualitative study using the Patient and Community Engaged Research (PaCER) approach. Trained patient-researchers conducted three focus groups using the Set, Collect and Reflect PaCER process. Participants, recruited via purposive and snowball sampling using research/personal networks and social media, were young people with JIA in Canada between 18 and 28 years who had experienced with the process of transition to adult care. Recordings were transcribed verbatim. Patient researchers individually coded overlapping sections of the data, and thematic analysis was conducted.

Results

In total, nine individuals participated in one or more focus groups. Three themes were identified, with sub-themes: preparedness for transition (readiness for the transfer of care, developing self-advocacy skills), continuity and breadth of care (changing relationships, culture shock, new responsibilities), need for support (social support, mental health support, and ongoing support needs – beyond the transfer of care. Peer support was a connecting concept in the support sub-themes. Transition was more than a change in primary physician but also a change in the care model and breadth of care provided, which was challenging for young people especially if they had insufficient information.

Conclusions

Transition from pediatric to adult care in rheumatology is a significant period for young people living with JIA, and this patient-led study provided insight into the experience from the perspective of young people with JIA which is critical to informing the development of supports for patients through the process. Patients, caregivers, pediatric and adult rheumatologists and members of the multi-disciplinary care team need to collaborate in terms of resources preparing for transfer, and support throughout the transition process to ensure a successful transition process.

A gamification-based intervention to encourage active travel

Purpose

‘Beat the Street’ is a community-wide intervention which aims to increase active travel by turning an area into a 6-week game. Residents earn points and prizes by walking and cycling and tapping a smartcard on RFID readers called ‘Beat Boxes’ placed on lampposts at half-mile intervals. To-date, over 1 million people have taken part in the intervention, however, the impact of the program on adult active travel is yet to be explored.

Methods

In Autumn 2019, Beat the Street was delivered throughout the London Borough of Hounslow. Prior, and immediately following the intervention, residents were invited to complete a self-report questionnaire (Sport England Active Lives Survey-SF) to assess changes in physical activity. Time-stamp data generated through Beat Box activity provided an objective measure of intervention engagement and a traffic survey camera was used to measure the number of cars travelling along 1 target road between 1-week pre- and 1-week post-intervention.

Results

28,219 people took part in the six-week game. Between pre- and post-intervention there was 7% decrease in adults reporting less than 30mins of activity per week and a 13% rise in adults reporting 150+ mins (n = 346, p &lt; 0.01). Beat box data ascertained that 25% of total taps at all Beat Boxes were made between 08:00-08:59am and a further 28% were made between 3:00-3:59pm, typical travel to school/work periods. Further, traffic camera data showed that between the week before and week following Beat the Street, 1199 and 705 fewer cars and 130 and 36 fewer vans were observed travelling along Cambridge Road between 07:00-09:30am and 2:00-4:30pm, respectively.

Conclusions

These data sources, in combination, suggest gamification may be an encouraging approach to increasing levels of active travel at a community-wide level.

Key messages

• Gamification based intervention increases physical activity.

• Gamification encourages active travel to school and work.

183 Improving Documentation of Antibiotic Prophylaxis and Anticoagulation in Vascular Surgery Operation Notes at a Tertiary Centre: A Quality Improvement Project

Aim

Operation notes have important medico-legal implications and should follow the Good Surgical Practice framework to enable continuity of care.

The aim of this quality improvement project was to determine adherence of vascular surgery operation notes to the Good Surgical Practice framework at a tertiary vascular centre, identify areas of improvement and introduce sustainable change to improve patient care.

Method

Two Plan-Do-Study-Act cycles were enacted. A prospective audit was conducted over September 2021 to identify areas of improvement in documentation. The first intervention that was introduced was electronic patient records (EPR). The second intervention introduced was departmental education via posters, regular educational sessions, and presentations.

Results

The prospective audit of 31 operations over September 2021 identified antibiotic prophylaxis was only recorded in 4/31 (13%) and post-operative anticoagulation in 21/31 (68%). A retrospective audit of 28 operations over October 2021 after the introduction of EPR demonstrated improved documentation of antibiotic prophylaxis (16/28, 57%) but no improvement in post-operative anticoagulation documentation (17/28, 61%). Departmental education improved the documentation of antibiotic prophylaxis (18/30, 60%) and post-operative anticoagulation (22/30, 73%).

Conclusions

We have demonstrated that EPR and departmental education can improve operation note documentation and patient care. Next steps include designing vascular surgery proformas to further improve documentation.

App-based intervention for cardiovascular and diabetes risk awareness and prevention

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Centre for Primary Health Care and Equity, University of New South WalesAustralian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation

Background

Cardiovascular disease and type 2 diabetes mellitus are highly prevalent worldwide. They have similar risk factors, and people with diabetes have a two- to threefold increased risk of myocardial infarction and stroke. Many of the risk factors are lifestyle related. Hence, behaviour change interventions have the potential to decrease the risk for cardiovascular disease and type 2 diabetes mellitus.

Purpose

We aimed to develop and evaluate an app-based intervention for the primary prevention of cardiovascular disease and type 2 diabetes mellitus.

Methods

We developed our app using the methodology by Tombor and colleagues for the development of digital behaviour change interventions. We used the Behaviour Change Wheel and embedded 12 behaviour change techniques. The three core modules of the app consisted of i) risk scores for 5-year cardiovascular disease and type 2 diabetes mellitus; ii) goal setting and tracking functions for smoking, alcohol intake, diet, and physical activity; and iii) education about the diseases and risk factors. With the app prototype, we conducted usability testing via an iterative approach. We interviewed the participants and used their feedback to improve the app design. Next, we conducted a feasibility study with the new version to assess whether participants would use the app over three months. We were interested in drop-out from the intervention, adherence to app use, and usability of the app. We received ethics approval for both studies and written consent from all participants.

Results

The usability testing consisted of two rounds. For each round, we had five participants who were on average 57 years old. In the first round, three participants experienced a technical error that stopped them from completing the registration. From those who were able to register, five rated the app as above average according to the System Usability Scale. Overall, the participants found the app easy to use and indicated that they were interested to use it frequently. We included some additional features based on the preferences of the participants in the usability testing. For the feasibility study, we recruited 47 participants aged 45 years and older who were free of cardiovascular disease and type 2 diabetes mellitus at baseline, with a balanced distribution of age (45-64 years and ≥65 years) and gender. From those participants, four withdrew from the study immediately after providing consent and the remainder continued using the app for varying periods of time.

Conclusions

We ensured that the app is based on the theory of behaviour change and scientific evidence. We used a stepwise approach to improve the app design and to test the feasibility of the intervention. The next step will be to develop a framework for a larger trial that implements the intervention into the existing healthcare setting and investigates its effectiveness.

179 Using QIP to Create a Structured Teaching Programme to Improve Confidence in Basic Surgical Topics in Foundation Year 1 Doctors

Aim

We aim to create a new, structured teaching programme to help fill in knowledge gaps in newly qualified doctors, who have rotated into General Surgery.

Method

We ran the programme over three four-month periods.

Prior to each rotation, we used a survey to assess multiple aspects: prior experience of surgical teaching, overall feeling of preparedness and confidence. We also asked for a self-evaluation on the doctor's confidence for specific basic surgical topics, on a 5-point scale. We asked for suggestion topics that doctors found difficult or lacked confidence in. We used this information to create a curriculum for the programme.

We then reassessed these variables at the end of the cycle, using the information to plan and implement the next cycle.

Results

During the first cycle, we made no significant difference in any area. Experiencing significant barriers to attendance, organisation, and interaction with the survey. We used this first cycle to identify these barriers and address them for the second cycle.

These changes led to a significant improvement in attendance, feedback from sessions and interaction with the questionnaires. We saw a 3-fold increase in attendance to sessions on average.

After the second cycle, there was an overall improvement of confidence in all basic surgical topics. There was an increase in the number of doctors considering a career in surgery.

Conclusions

This teaching programme has led to an improvement in junior doctors’ confidence in basic surgical topics. Repeated PDSA cycles are allowing continuous improvement and change to maximise exposure to surgical teaching and training.

Comparison of scattered entrance skin dose burden in MSCT, CBCT, and X-ray for suspected scaphoid injury: Regional dose measurements in a phantom model

INTRODUCTION

Scaphoid radiography has poor sensitivity for acute fracture detection and often requires repeat delayed imaging. Although magnetic resonance (MR) imaging is considered the gold standard, computed tomography (CT) is often used as an alternative due to ease of access. Cone-Beam CT (CBCT) offers equivalent diagnostic efficacy to Multi Slice CT (MSCT) at reduced dose. We aimed to establish the difference in scattered dose between modalities for scaphoid imaging.

METHODS

Anatomical regional entrance surface dose measurements were taken at 3 regions on an anthropomorphic torso phantom positioned as a patient to a wrist phantom undergoing scaphoid imaging for three modalities (CBCT, MSCT, four-view projection radiography). Exposure factors were based on audit of clinical exposures. Each dose measurement was repeated three times per anatomical region, modality, exposure setting and projection.

RESULTS

Under unpaired T-test CBCT gave significantly lower mean dose at the neck (1.64 vs 18 mGy), chest (2.78 vs 8.01) and abdomen (1.288 vs 2.93) than MSCT (p < .0001). However CBCT had significantly higher mean dose than four-view radiography at the neck, chest and abdomen (0.031, 0.035, and 0.021 mGy) (p < .0001).

CONCLUSION

CBCT of the wrist carries a significantly higher scattered radiation dose to the neck, chest and abdomen than four view scaphoid radiography, but significantly lower scattered dose than MSCT of the wrist of equivalent diagnostic value.

IMPLICATIONS FOR PRACTICE

The use of CBCT for scaphoid injury carries significantly lower scattered dose to radio-sensitive structures investigated here than equivalent MSCT, and may be of greater use as an early cross-sectional investigation for suspected scaphoid fracture.

The College of Radiographers Research Strategy for the next five years

This article outlines the updated College of Radiographers (CoR) Research Strategy. This new research strategy will shape the approach to research from the radiography profession over the next five years. This will apply to all the profession and is aspirational and future thinking. The updated research strategy is the fifth research strategy presented by the CoR. Over the last five years, there have been considerable developments within healthcare and healthcare research. As this article is being written we are still in the middle of a global pandemic (Covid-19) which has influenced all our lives. However, despite the challenges of the last year, we are in a stronger position as a profession with more radiographers working towards and gaining masters and doctoral level qualifications. There are more radiographers working in clinical academic roles and there has been further development of radiographers coordinating and delivering research as well as becoming research leaders. This updated research strategy supports the radiography profession in delivering research-based practice over the next five years offering a framework within which radiographers can develop.

"There's always something else": Patient perspectives on improving the implementation of obesity guidelines in general practice

OBJECTIVES

The prevalence of obesity in Australia is rising. National guidelines for the management of overweight and obesity exist but our previous work demonstrates poor implementation of key elements in general practice. The aim of this study was to describe patient perspectives on the implementation of obesity guidelines in general practice.

METHODS

Qualitative study of 40 people living with obesity (PwO) who were recruited through general practices in Melbourne, Australia. PwO had a recorded BMI in the overweight range or above (>25), had attended a consultation in the last 6 months and had a diagnosis of at least one of the following: diabetes, kidney disease, hyperlipidemia, hypertension, or cardiovascular disease. Semi-structured telephone interviews were conducted with patients. Interviews were audio-recorded, transcribed verbatim and analysed thematically.

RESULTS

While a strong general practitioner (GP)-patient relationship enabled conversation to occur about weight management there was uncertainty as to whether patients or GPs should broach the topic of weight. Patients described complacency regarding their weight and often being unprepared to take up GP advice. Other health issues were felt to take precedence, and patients described inconsistent provision of information and resources to assist them in tackling their weight problems.

CONCLUSIONS

It is imperative to take into account patient perspectives on obesity management in general practice in order to improve health outcomes. This study provides valuable insights into how PwO can be better managed. Interventions should also include strategies to help patients maintain motivation in making lifestyle changes to support healthy weight loss.

1211 Assessing the Accuracy of a Dry-EEG Headband for Measuring Brain Activity, Heart Rate, Breathing and Automatic Sleep Staging

Introduction

The development of new sleep study devices, adapted for daily use, is necessary for diagnosis of sleep disorders. However, this requires to be both suitable for daily use and capable of recording accurate electrophysiological data. This study assesses the signal acquisition of a comfortable sleep headband, using dry electrodes, and the performance of its automatic sleep staging algorithms compared to the gold-standard clinical PSG scored by 4 sleep experts.

Methods

42 participants slept at a sleep center wearing both the Dreem headband (DH) and a PSG simultaneously. We measured 1) the EEG signal similarity between both devices, 2) heart rate, breathing frequency and respiration rate variability (RRV) agreement, and 3) the performance of the headband automatic sleep scoring compared to PSG sleep experts manual scoring.

Results

Results demonstrate a strong correlation between the EEG signals acquired by the headband and those from the PSG, and the signals acquired by the headband enable monitoring of alpha (r= 0.75 ± 0.11), beta (r= 0.74 ± 0.14), delta (r = 0.78 ± 0.16), and theta (r = 0.63 ± 0.15) frequencies during sleep. The mean absolute error for heart rate, breathing frequency, and RRV was 2.2 ± 0.8 bpm, 0.3 ± 0.2 cpm and 3.1 ± 0.4 %, respectively. Automatic Sleep Staging reached an overall accuracy of 84.1 ± 7.5% (F1 score: 83.0 ± 8.4) for the headband to be compared with an average of 86.4 ± 5.5% (F1 score: 86.5 ± 5.5) for the 4 sleep experts.

Conclusion

These results demonstrate the capacity of the headband to both precisely monitor sleep-related physiological signals and process them accurately into sleep stages. This device paves the way for high-quality, large-scale, longitudinal sleep studies.

Support

This Study has been supported by Dreem sas.

1210 Development Of An Auditory Neurofeedback During Sleep Onset Process

Introduction

Biofeedback is proposed as an alternative method to help patients with insomnia reducing their anxiety. Some studies have shown that auditory neurofeedback can be effective at reducing sleep-onset latency. However, the AASM sleep stage classification only describes the sleep-onset as a binary state (i.e. wake or N1) which makes it not adapted for neurofeedback. We introduced a simple 4-stages classification for sleep-onset, on 10 seconds EEG epoch. The aim of this study was to develop an automatic method to detect these stages, and an online algorithm embedded in the Dreem headband (DH) that adapted the auditory feedback based on the current stage.

Methods

Fourteen subjects underwent an overnight PSG monitoring, from which the first sleep-onset period was extracted. We defined the simple 4-stages classification for sleep-onset on 10 seconds EEG epoch as following: SO1) &gt; 75% of the epoch covered by alpha frequencies SO2) between 25% and 50% of the window covered with alpha frequencies, SO3) Alpha frequencies covered less than 25% and theta frequencies covered less than 30% of the epoch, and SO4) Theta frequency covered more than 30% of the epoch. For the manual scoring, 4 sleep scorers have been given the instructions and a Q&A session after scoring the first two records. For the algorithm, a sound triggering algorithm was linked to a neural network trained on the scored data, to dynamically adapt the sound to the sleep-onset stage.

Results

The scorers reached an average agreement of 68 + 15% over all the records. The neural network reached an accuracy of 68%. Per state the accuracy was: 71 ± 32% (S1), 52 ± 22% (S2), 54 ± 23% (S3), 79 ± 21% (S4). The automatic neurofeedback was able to adapt sound stimulations in real-time based on stages and was well perceived among first testers.

Conclusion

The results of this preliminary work show that we can reach a higher agreement by reducing the epoch duration and use this classification to produce automatic biofeedback during the sleep onset period. Further studies using a data-driven method should be conducted.

Support

This study supported by Dreem sas.

0616 Validation of a Sleep Headband for Detecting Obstructive Sleep Apnea

Introduction

Polysomnography (PSG) is the gold-standard to diagnose obstructive sleep apnea (OSA). OSA severity diagnosis is defined by the apnea-hypopnea index (AHI) defined as the number of apnea and hypopnea events measured per hour of sleep. The Dreem2 headband (DH) is a self-administered, easy to use device that measure EEG, breathing frequency, heart rate and sound at-home. In our study, we assessed the performance of the DH to automatically detects OSA compared to 3 sleep’s experts scoring on PSG.

Methods

41 subjects (8 females, 42.6 ± 13.7 y.o.) having a suspicion of OSA performed a night at-home wearing both a PSG and the DH. Each PSG record was scored for apnea and hypopnea events by 3 independent trained sleep experts following AASM guidelines. The deep learning approach DOSED, was trained on the DH signals using the manual apnea scoring. 10-fold cross-validation was used to provide predictions for each of the 41 subjects with the DH.

Results

We observed an average AHI expert’s scoring of 13.6 ± 10.1 CI[10.5, 16.5] compared to 12.9 ± 10.3 CI[9.6, 15.8] for the DH. Both, the correlation between the 3 scorers (r= 0.88, p &lt; 0.001) and the DH and the scorers (r=0.79, p&lt; 0.001) were significant. The specificity and sensitivity to detect mild OSA (AHI ≤ 5) was 84.4 % and 96.4 % for the DH and 86.5 % and 86.0% for the scorers.

Conclusion

The results show that the DH using deep learning can detect OSA with an accuracy similar to the sleep experts. The use of DH paves the way for longitudinal monitoring of patients with a suspicion of OSA and its accessibility could lead to better screening of the general population.

Support

This Study has been supported by Dreem sas.

BCAT-induced autophagy regulates Aβ load through an interdependence of redox state and PKC phosphorylation-implications in Alzheimer's disease

Leucine, nutrient signal and substrate for the branched chain aminotransferase (BCAT) activates the mechanistic target of rapamycin (mTORC1) and regulates autophagic flux, mechanisms implicated in the pathogenesis of neurodegenerative conditions such as Alzheimer's disease (AD). BCAT is upregulated in AD, where a moonlighting role, imparted through its redox-active CXXC motif, has been suggested. Here we demonstrate that the redox state of BCAT signals differential phosphorylation by protein kinase C (PKC) regulating the trafficking of cellular pools of BCAT. We show inter-dependence of BCAT expression and proteins associated with the P13K/Akt/mTORC1 and autophagy signalling pathways. In response to insulin or an increase in ROS, BCATc is trafficked to the membrane and docks via palmitoylation, which is associated with BCATc-induced autophagy through PKC phosphorylation. In response to increased levels of BCATc, as observed in AD, amyloid β (Aβ) levels accumulate due to a shift in autophagic flux. This effect was diminished when incubated with leucine, indicating that dietary levels of amino acids show promise in regulating Aβ load. Together these findings show that increased BCATc expression, reported in human AD brain, will affect autophagy and Aβ load through the interdependence of its redox-regulated phosphorylation offering a novel target to address AD pathology.

High prevalence of albuminuria amongst people who inject drugs: A cross-sectional study

Albuminuria is a key biomarker for cardiovascular disease and chronic kidney disease. Our study aimed to describe the prevalence of albuminuria amongst people who inject drugs in London and to test any potential associations with demographic characteristics, past diagnoses, and drug preparation and administration practices. We carried out a cross-sectional survey amongst people who use drugs in London. The main outcome measure was any albuminuria including both microalbuminuria and macroalbuminuria. Three-hundred and sixteen samples were tested by local laboratory services. Our study initially employed point-of-care testing methods but this resulted in a high number of false positives. Our findings suggest the prevalence of albuminuria amongst PWID is twice that of the general population at 19% (95%CI 15.3–24.0%). Risk factors associated with albuminuria were HIV (aOR 4.11 [95% CI 1.37–12.38]); followed by overuse of acidifier for dissolving brown heroin prior to injection (aOR 2.10 [95% CI 1.04–4.22]). Albuminuria is high amongst people who inject drugs compared to the general population suggesting the presence of increased cardiovascular and renal pathologies. This is the first study to demonstrate an association with acidifier overuse. Dehydration may be common amongst this population and may affect the diagnostic accuracy of point-of-care testing for albuminuria.

Circulating tumor DNA as a potential marker of adjuvant chemotherapy benefit following surgery for localized pancreatic cancer

BACKGROUND

In early-stage pancreatic cancer, there are currently no biomarkers to guide selection of therapeutic options. This prospective biomarker trial evaluated the feasibility and potential clinical utility of circulating tumor DNA (ctDNA) analysis to inform adjuvant therapy decision making.

MATERIALS AND METHODS

Patients considered by the multidisciplinary team to have resectable pancreatic adenocarcinoma were enrolled. Pre- and post-operative samples for ctDNA analysis were collected. PCR-based-SafeSeqS assays were used to identify mutations at codon 12, 13 and 61 of KRAS in the primary pancreatic tumor and to detect ctDNA. Results of ctDNA analysis were correlated with CA19-9, recurrence-free and overall survival (OS). Patient management was per standard of care, blinded to ctDNA data.

RESULTS

Of 112 patients consented pre-operatively, 81 (72%) underwent resection. KRAS mutations were identified in 91% (38/42) of available tumor samples. Of available plasma samples (N = 42), KRAS mutated ctDNA was detected in 62% (23/37) pre-operative and 37% (13/35) post-operative cases. At a median follow-up of 38.4 months, ctDNA detection in the pre-operative setting was associated with inferior recurrence-free survival (RFS) [hazard ratio (HR) 4.1; P = 0.002)] and OS (HR 4.1; P = 0.015). Detectable ctDNA following curative intent resection was associated with inferior RFS (HR 5.4; P < 0.0001) and OS (HR 4.0; P = 0.003). Recurrence occurred in 13/13 (100%) patients with detectable ctDNA post-operatively, including in seven that received gemcitabine-based adjuvant chemotherapy.

CONCLUSION

ctDNA studies in localized pancreatic cancer are challenging, with a substantial number of patients not able to undergo resection, not having sufficient tumor tissue for analysis or not completing per protocol sample collection. ctDNA analysis, pre- and/or post-surgery, is a promising prognostic marker. Studies of ctDNA guided therapy are justified, including of treatment intensification strategies for patients with detectable ctDNA post-operatively who appear at very high risk of recurrence despite gemcitabine-based adjuvant therapy.

Characteristics and clinical assessment of antibiotic delivery by chitosan sponge in the high-risk diabetic foot: a case series

OBJECTIVE

The local delivery of antimicrobials is attractive for a number of reasons. Chitosan, a biodegradable polysaccharide sponge material, has been proposed as medium to deliver antibiotics directly to wounds. In this report we evaluate the safety and practicality of antimicrobial delivery via chitosan sponge.

METHOD

We present the clinical course and systemic absorption characteristics of three cases of people with diabetic foot wounds treated with antibiotic soaked chitosan sponge (Sentrex BioSponge, Bionova Medical, Germantown, TN). The antibiotic sponge was made by reconstituting 1.2g tobramycin or 100mg doxycycline in 10-15ml saline and saturating the sponge with the solution. The sponge was then applied to the wounds. Serum levels of each respective antibiotic were evaluated after application. Additional in vitro studies were conducted evaluating elution of antibiotics from the chitosan sponge at established minimum inhibitory concentrations (MIC) for Staphylococcus aureus over 28 days.

RESULTS

No patient experienced adverse local or systemic effects due to the sponge treatment. The measured serum levels applied antibiotics remained far less than established minimums after intravenous therapy. Each patient required further treatment, however local infection or contamination resolved during the course of their hospital stay after the chitosan/antibiotic application.

CONCLUSION

The use of antibiotic-impregnated chitosan sponges appears a safe and effective mechanism of local delivery of antimicrobials in wounds. Future studies and clinical trials are ongoing to confirm these results and to guide clinical applications.

"90% of the time, it's not just weight": General practitioner and practice staff perspectives regarding the barriers and enablers to obesity guideline implementation

OBJECTIVE

To identify the views of GPs and general practice staff regarding barriers and enablers to implementation of obesity guideline recommendations in general practice.

METHODS

Twenty general practitioners (GPs) and 18 practice staff from inner-eastern Melbourne, Australia, participated in semi-structured telephone interviews. The interview schedule was informed by the Theoretical Domains Framework (TDF). Interviews were audio-recorded, transcribed verbatim and underwent thematic analysis.

RESULTS

Participants lacked familiarity with and knowledge of the NHMRC obesity guidelines. Barriers and enablers were predominantly related to five theoretical domains: (1) environmental context and resources, (2) knowledge, (3) emotion, (4) beliefs about consequences, and (5) motivation and goals. Time pressures in consultations, costs for the patient, reluctance to add to patient burden particularly in those with comorbidities such as mental health issues, lack of awareness about services to refer patients to and GPs' fear of embarrassing patients and losing them were significant barriers. Enablers included having a strong doctor-patient relationship and a sense of responsibility to the patient to address weight.

CONCLUSIONS

Obesity guidelines and policy makers need to better engage with issues of multimorbidity, socioeconomic disadvantage and workforce issues if recommendations are to be widely adopted in general practice. Tasksharing, teamwork and technology are potential solutions to some of the barriers. Patient perspectives and approaches to being able to overcome stigma and legitimise obesity management in primary care consultations could also assist.

A Type 1 Diabetes Genetic Risk Score Predicts Progression of Islet Autoimmunity and Development of Type 1 Diabetes in Individuals at Risk

OBJECTIVE

We tested the ability of a type 1 diabetes (T1D) genetic risk score (GRS) to predict progression of islet autoimmunity and T1D in at-risk individuals.

RESEARCH DESIGN AND METHODS

We studied the 1,244 TrialNet Pathway to Prevention study participants (T1D patients' relatives without diabetes and with one or more positive autoantibodies) who were genotyped with Illumina ImmunoChip (median [range] age at initial autoantibody determination 11.1 years [1.2-51.8], 48% male, 80.5% non-Hispanic white, median follow-up 5.4 years). Of 291 participants with a single positive autoantibody at screening, 157 converted to multiple autoantibody positivity and 55 developed diabetes. Of 953 participants with multiple positive autoantibodies at screening, 419 developed diabetes. We calculated the T1D GRS from 30 T1D-associated single nucleotide polymorphisms. We used multivariable Cox regression models, time-dependent receiver operating characteristic curves, and area under the curve (AUC) measures to evaluate prognostic utility of T1D GRS, age, sex, Diabetes Prevention Trial-Type 1 (DPT-1) Risk Score, positive autoantibody number or type, HLA DR3/DR4-DQ8 status, and race/ethnicity. We used recursive partitioning analyses to identify cut points in continuous variables.

RESULTS

Higher T1D GRS significantly increased the rate of progression to T1D adjusting for DPT-1 Risk Score, age, number of positive autoantibodies, sex, and ethnicity (hazard ratio [HR] 1.29 for a 0.05 increase, 95% CI 1.06-1.6; P = 0.011). Progression to T1D was best predicted by a combined model with GRS, number of positive autoantibodies, DPT-1 Risk Score, and age (7-year time-integrated AUC = 0.79, 5-year AUC = 0.73). Higher GRS was significantly associated with increased progression rate from single to multiple positive autoantibodies after adjusting for age, autoantibody type, ethnicity, and sex (HR 2.27 for GRS >0.295, 95% CI 1.47-3.51; P = 0.0002).

CONCLUSIONS

The T1D GRS independently predicts progression to T1D and improves prediction along T1D stages in autoantibody-positive relatives.