Simulating diluted bitumen spills in boreal lake limnocorrals - part 2: Factors affecting the physical characteristics and submergence of diluted bitumen

We examined the fate and behaviour of diluted bitumen (dilbit) as it weathered for 70 days in freshwater limnocorrals (10 m diameter × 1.5 m depth) installed in a boreal lake to simulate dilbit spills in a natural aquatic environment. We added seven different dilbit spill volumes, ranging from 1.5 to 180 L, resulting in oil-to-water ratios between 1:71,000 (v/v, %) and 1:500 (v/v, %). Volatile hydrocarbons in the dilbit slick decreased rapidly after the dilbit was spilled on the water's surface, and dilbit density and viscosity significantly increased (>1 g mL^-1 and >5,000,000 mPa s, respectively). Dilbit sank to the bottom sediments in all treatments, and the time to sinking was positively correlated with spill volume. The lowest dilbit treatment began to sink on day 12, whereas the highest dilbit treatment sank on day 31. Dilbit submerged when its density surpassed the density of freshwater (>0.999 g mL^-1), with wind, rain, and other factors contributing to dilbit sinking by promoting the break-up of the surface slick. This experiment improves our ability to predict dilbit's aquatic fate and behaviour, and its tendency to sink in a boreal lake. Our findings should be considered in future pipeline risk assessments to ensure the protection of these important aquatic systems.

Associations between intraoperative and post-anesthesia care unit hypotension and surgical ward hypotension

STUDY OBJECTIVE

To test whether patients who experience hypotension in the post-anesthesia care unit or during surgery are most likely to experience hypotension on surgical wards.

DESIGN

A prediction study using data from two randomized controlled trials.

SETTING

Operating room, post-anesthesia care unit, and surgical ward.

PATIENTS

550 adult patients having abdominal surgery with ASA physical status I-IV.

INTERVENTIONS

Blood pressure measurement per routine intraoperatively, and with continuous non-invasive monitoring postoperatively.

MEASUREMENTS

The primary predictors were minimum mean arterial pressure (<60, <65, <70 and < 80 mmHg) and minimum systolic blood pressure (<70, <75, <80, <85 mmHg) in the post-anesthesia care unit. The secondary predictors were intraoperative minimum blood pressures with the same thresholds as the primary ones. Our outcome was ward hypotension defined as mean pressure < 70 mmHg or systolic pressure < 85 mmHg. A threshold was considered clinically useful if both sensitivity and specificity exceeded 0.75.

MAIN RESULTS

Minimum mean and systolic pressures in the post-anesthesia care unit similarly predicted ward mean or systolic hypotension, with the areas under the curves near 0.74. The best performing threshold was mean pressure < 80 mmHg in the post-anesthesia care unit which had a sensitivity of 0.41 (95% confidence interval [CI], 0.35, 0.47) and specificity of 0.91 (95% CI, 0.87, 0.94) for ward mean pressure < 70 mmHg and a sensitivity of 0.44 (95% CI, 0.37, 0.51) and specificity of 0.88 (95% CI, 0.84, 0.91) for ward systolic pressure < 85 mmHg. The areas under the curves using intraoperative hypotension to predict ward hypotension were roughly similar at about 0.60, with correspondingly low sensitivity and specificity.

CONCLUSIONS

Intraoperative hypotension poorly predicted ward hypotension. Pressures in the post-anesthesia care unit were more predictive, but the combination of sensitivity and specificity remained poor. Unless far better predictors are identified, all surgical inpatients should be considered at risk for postoperative hypotension.

Comparison between mephentermine and ondansetron for the prevention of post spinal hypotension: a prospective randomized trial

Background and Aims: Spinal anesthesia is a technique often associated with side effects like hypotension and bradycardia. Recent studies have shown that the use of ondansetron leads to a decreased incidence of hypotension induced by spinal anesthesia. This prospective, randomized, controlled, double-blind study was done to compare the efficacy of the prophylactic use of intravenous (IV) ondansetron and mephentermine on post-spinal hypotension. Methods: A total of 130 patients were randomly allocated to one of two groups: Group O received 4 mg IV ondansetron and Group M received 6 mg of IV mephentermine. All patients received spinal anesthesia using 3 mL of 0.5% hyperbaric bupivacaine. Assessment of blood pressure and heart rate (HR) was done for 30 minutes after spinal anesthesia was performed. Quantitative data were analyzed using ANOVA tests and qualitative data were analyzed using the Chi-square tests. Results: Both groups were comparable regarding demographic data. Mean arterial blood pressure (MAP) in Group O was lower than Group M at 5 to 25 minutes and difference of MAP between the two groups was > 20% of baseline values (p < 0.05). HR was comparable between groups. No statistically significant differences were seen in side effects between the two groups. Conclusion: Our study shows that the preemptive use of both ondansetron and mephentermine significantly decreases the incidence of post-spinal hypotension.

COVID-19-related state-wise racial and ethnic disparities across the USA: an observational study based on publicly available data from The COVID Tracking Project

OBJECTIVE

To evaluate COVID-19 infection and mortality disparities in ethnic and racial subgroups in a state-wise manner across the USA.

METHODS

Publicly available data from The COVID Tracking Project at The Atlantic were accessed between 9 September 2020 and 14 September 2020. For each state and the District of Columbia, % infection, % death, and % population proportion for subgroups of race (African American/black (AA/black), Asian, American Indian or Alaska Native (AI/AN), and white) and ethnicity (Hispanic/Latino, non-Hispanic) were recorded. Crude and normalised disparity estimates were generated for COVID-19 infection (CDI and NDI) and mortality (CDM and NDM), computed as absolute and relative difference between % infection or % mortality and % population proportion per state. Choropleth map display was created as thematic representation proportionate to CDI, NDI, CDM and NDM.

RESULTS

The Hispanic population had a median of 158% higher COVID-19 infection relative to their % population proportion (median 158%, IQR 100%-200%). This was followed by AA, with 50% higher COVID-19 infection relative to their % population proportion (median 50%, IQR 25%-100%). The AA population had the most disproportionate mortality, with a median of 46% higher mortality than the % population proportion (median 46%, IQR 18%-66%). Disproportionate impact of COVID-19 was also seen in AI/AN and Asian populations, with 100% excess infections than the % population proportion seen in nine states for AI/AN and seven states for Asian populations. There was no disproportionate impact in the white population in any state.

CONCLUSIONS

There are racial/ethnic disparities in COVID-19 infection/mortality, with distinct state-wise patterns across the USA based on racial/ethnic composition. There were missing and inconsistently reported racial/ethnic data in many states. This underscores the need for standardised reporting, attention to specific regional patterns, adequate resource allocation and addressing the underlying social determinants of health adversely affecting chronically marginalised groups.

POS0125 CALCULATING RISK OF HAND OSTEOARTHRITIS PROGRESSION AT TEN YEARS THROUGH A PREDICTION MODEL

Background:

Hand osteoarthritis (OA) is a chronic, progressive disease, commonly affecting middle aged women. OA at the interphalangeal joints (IPJs) or the thumb base are considered different disease subsets (1). Few studies have investigated individual risk factors for IPJ OA progression (2). Prediction models can be used to calculate overall disease risk from multiple risk factors. This can guide prevention and treatment options.

Objectives:

Develop and internally validate a prediction model for IPJ OA progression.

Methods:

Data from the Chingford 1000 Women Study (Chingford Study), the largest population-based cohort worldwide assessing hand OA, was used. It is representative of the middle-aged female population in the United Kingdom (3). At baseline, 1,003 women aged 45 to 64 years’ old were recruited, and 693 measurements taken. Hand radiographs were taken at baseline and after ten years, read using the Kellgren-Lawrence (KL) atlas (inter-observer correlation: ≥0.7 (4)).

For the current study, participants must have had OA (KL ≥2 in ≥1 IPJ) on baseline hand radiographs. Participants with KL 4 in all 16 IPJs at baseline were excluded. Risk factors from the Chingford Study at baseline were selected by biological plausibility, literature evidence (2), and hand surgeons‘ consensus (5): age (years), occupation (manual versus non manual), OA in ≥1 thumb base (KL ≥2 versus KL<2), body mass index (BMI) (kg/m2), family history of hand OA (yes versus no). The outcome was defined on an ordinal scale for the number of IPJs (up to >5 IPJs) with OA progression (increase by KL ≥1), at ten years’.

The prediction model was developed using a penalized proportional odds logistic regression. Odds ratios (95% confidence intervals) were reported for each risk factor. The model was internally validated using 2,000 bootstrap iterations. Model performance was assessed for discrimination (C-statistic), and calibration (C-slope). 3.5% of data was missing, and complete case analysis was used.

Results:

699 women had baseline hand radiographs: 38 were unreadable, 459 had no IPJ OA. Seven participants had missing data (occupation: 5, BMI: 1, family history: 1) and were excluded. 195 participants were included this study. Median age at baseline was 59 (interquartile range: 8) years.

181 (92.8%) participants had OA progression at 10 years (Figure 1). Thumb base OA (odds ratio: 1.32 (0.93 to 1.88)) was most strongly associated with IPJ OA progression (Table 1). C-statistic was 0.57, and calibration slope was 1.38 for the optimism-corrected model.

Table 1.

Odds ratios for risk factors

Risk factorOdds ratio (95% confidence interval)Age (years)1.02 (0.99 to 1.06)Occupation (manual versus non manual)0.88 (0.60 to 1.29)Thumb base OA (Kellgren-Lawrence grade ≥2 versus <2)1.32 (0.93 to 1.88)Family history of hand OA (yes versus no)1.03 (0.72 to 1.45)Body mass index (kg/m2)1.04 (0.99 to 1.09)

OA: Osteoarthritis

Conclusion:

More stringent cut-offs for OA progression would be clinically useful. It was only weakly possible to predict which participants with IPJ OA would progress. This suggests that other risk factors, such as gender, ethnicity and genetics, may be predominant.

Figure 1.

Hand interphalangeal joints with osteoarthritis progression (Kellgren-Lawrence grade ≥1) at 10 years’ follow up

References:

[1]Kloppenburg M, et al. Research in hand osteoarthritis: time for reappraisal and demand for new strategies. Ann Rheum Dis. 2007;66(9):1157-61.

[2]Shah K, et al. Risk factors for the progression of finger interphalangeal joint osteoarthritis: a systematic review. Rheumatol Int. 2020;40(11):1781-1792.

[3]Hart DJ, Spector TD. The relationship of obesity, fat distribution and osteoarthritis in women in the general population: the Chingford Study. J Rheumatol. 1993;20:331-335.

[4]Hart DJ, et al. Reliability and reproducibility of grading radiographs for osteoarthritis of the hand. Br J Rheum. 1993;32:S1.

[5]Shah K, et al. Delphi consensus of risk factors for development and progression of finger interphalangeal joint osteoarthritis. J Hand Surg Eur Vol. 2019;44(10):1089-1090.

Acknowledgements:

We would like to thank all of the participants of The Chingford 1000 Women Study, Professor Tim Spector, Dr Deborah Hart, Dr Alan Hakim, Maxine Daniels, Alison Turner, James van Santen and Julie Damnjanovic for their time and dedication.

Disclosure of Interests:

Karishma Shah: None declared, Garrett Bullock: None declared, Alan Silman: None declared, Dominic Furniss: None declared, Nigel Arden Consultant of: Receives personal fees from Pfizer/Lily for consultancy outside the scope of this work, Grant/research support from: Receives grant from Merck outside the scope of this work, Gary Collins: None declared

Impurity toroidal rotation profile measurement using upgraded high-resolution visible spectroscopic diagnostic on ADITYA-U tokamak

A high-resolution spectroscopic diagnostic for the measurement of spatial profiles of impurity ion toroidal rotation velocities on the ADITYA-U tokamak has been upgraded to cover the complete plasma minor radius. Earlier, the coverage of diagnostics toward the plasma edge was restricted due to the placement of collection optics on the tangential port outside the vacuum vessel. The coverage of the full plasma minor radius, from 0 to 24 cm, has been achieved using the newly designed and developed collection optics that have seven lines of sight to view the tokamak plasma mounted inside a customized re-entrant view port which is installed in the shadow of the limiter inside the vacuum vessel. The upgraded diagnostic also includes a faster charged coupled device detector with a smaller pixel size for the detection of a small wavelength shift. The complete spatial profile has been measured using the Doppler shifted passive change exchange spectral line at 529.0 nm from the C⁵⁺ ion. In this article, we present the collection optics' design, installation, calibration, and results obtained using the upgraded diagnostic.

Burden of arrhythmia in hospitalized patients with cannabis use related disorders: analysis of 2016-2018 national inpatient sample

Funding Acknowledgements

Type of funding sources: None.

Introduction

Cannabis is being more widely use as a recreational substance worldwide. There have been case reports and systematic review describing the association of cannabis use and cardiac arrhythmia (1).

Purpose

We sought out to measure the prevalence of different types of cardiac arrhythmia in hospitalizations associated with cannabis use disorder.

Methods

We queried January 2016 to December 2018 National Inpatient Sample (NIS) databases to identify adult (≥18 yrs) hospitalizations in the US with a diagnosis of cannabis use related disorders. Patients with an associated diagnosis of arrhythmias were also identified based on appropriate ICD-10 CM codes. We used the Chi-square test to evaluate the differences between binary or categorical variables, and Student’s t-test for continuous variables. Multivariate logistic regression was used in outcomes analysis to adjust for potential hospital and patient-level confounders (age, sex, race, diabetes, heart failure, chronic kidney disease, anemia, obesity, elixhauser co-morbidity index, hospital location, teaching status, bed size, income status and others). The discharge weights provided in the databases were used to calculate the national estimates. STATA 16.1 software was used to perform all statistical analysis.

Results

We identified 2,457,544 hospitalizations associated with cannabis use related disorders across three years. Of which, 187,825 (7.6%) were associated with any arrhythmia. We found that atrial fibrillation was the most associated arrhythmia. The complete list of types of arrhythmia and their prevalence are described in Figure-1. Patients with arrhythmia group were older (mean age 50.5 vs 38.3 yrs; P &lt; 0.01) and had higher co-morbidity (% of &gt;3 Elixhauser comorbidity score 94.1% vs 60.6%; P &lt; 0.01). After adjusting for patient and hospital-level confounders, we observed arrhythmia group was associated with higher odds of in-hospital mortality compared to the group without arrhythmia [Odds Ratio (OR): 4.5 (4.09 – 5.00); P &lt; 0.01]. We also observed statistically significant increase in hospitalization length of stay due to the status of any arrhythmia [5.7 vs 5.1 days; P &lt; 0.01].

Conclusion

The prevalence of Afib is high in hospitalizations associated with cannabis use. Hospitalizations associated with cannabis use disorder and any arrhythmia are associated with higher in-hospital mortality and LOS. Therefore, all electrocardiograms should be scrutinized in hospitalized cannabis users. However, further prospective studies are necessary to endorse our study results. Abstract Figure.

Vitamin D supplementation, COVID-19 and disease severity: a meta-analysis

OBJECTIVE

Current meta-analysis aims to understand the effect of oral supplementation of vitamin D on intensive care unit (ICU) requirement and mortality in hospitalized COVID-19 patients.

METHODS

Databases PubMed, preprint servers, and google scholar were searched from December 2019 to December 2020. Authors searched for the articles assessing role of vitamin D supplementation on COVID-19. Cochrane RevMan tool was used for quantitative assessment of the data, where heterogeneity was assessed using I2 and Q statistics and data was expressed using odds ratio with 95% confidence interval.

RESULTS

Final meta-analysis involved pooled data of 532 hospitalized patients (189 on vitamin D supplementation and 343 on usual care/placebo) of COVID-19 from three studies (Two randomized controlled trials, one retrospective case-control study). Statistically (p<0.0001) lower ICU requirement was observed in patients with vitamin D supplementation as compared to patients without supplementations (odds ratio: 0.36; 95% CI: 0.210-0.626). However, it suffered from significant heterogeneity, which reduced after sensitivity analysis. In case of mortality, vitamin D supplements has comparable findings with placebo treatment/usual care (odds ratio: 0.93; 95% CI: 0.413-2.113; p=0.87). The studies did not show any publication bias and had fair quality score. Subgroup analysis could not be performed due to limited number of studies and hence dose and duration dependent effect of vitamin D could not be evaluated.

CONCLUSIONS

Although the current meta-analysis findings indicate potential role of vitamin D in improving COVID-19 severity in hospitalized patients, more robust data from randomized controlled trials are needed to substantiate its effects on mortality.

Burden of dementia in atrial fibrillation hospitalizations- analysis of national inpatient sample 2016-2018

Funding Acknowledgements

Type of funding sources: None.

Introduction

Atrial fibrillation is a common disorder in the elderly population and a known risk factor for stroke and dementia.

Purpose

 To study the burden of dementia in Afib hospitalizations and identify the predictors of in-hospital mortality in Afib with dementia hospitalizations.

Methods

We queried January 2016 to December 2018 National Inpatient Sample (NIS) to identify adult (≥18 yrs) hospitalizations with a primary diagnosis of Afib. Hospitalizations of Afib with dementia was compared with Afib without dementia. We used the Chi-square test for differences between categorical variables, and Student’s t-test for continuous variables. Multivariate logistic regression was used in outcomes analysis to adjust for potential hospital and patient-level confounders.

Results

 We identified 1,236,540 weighted Afib hospitalizations across three years. Of which, 79,405 (6.4%) of them were associated with dementia. Afib with dementia hospitalizations were associated with older age (mean age 83.2 vs 70.0 yrs; P &lt; 0.01), higher rate of chronic Afib (15.3% vs 7.5%; P &lt; 0.01), higher rate of comorbidity (% of &gt;3 Elixhauser comorbidity score 91.8% vs 83.6%; P &lt; 0.01). After adjusting for patient and hospital-level characteristics, we observed that Afib with dementia hospitalizations was associated with higher odds of in-hospital mortality compared to Afib without dementia [Odds Ratio (OR): 1.6 (1.4 – 1.9); P &lt; 0.01]. We also observed statistically significant association with increased LOS [4.7 vs 3.2 days; P &lt; 0.01], repeated falls [OR: 2.8 (2.5 – 3.1); P &lt; 0.01] and protein calorie malnutrition [OR: 1.9 (1.7 – 2.0); P &lt; 0.01] in Afib with dementia group.

Conclusion

Afib with dementia hospitalizations are not only associated with higher mortality, but they are also associated with higher repeated fall rates, and skilled nursing facility discharge dispositions. Co-morbidities like hypertension, CKD, obesity, HFrEF, HFpEF, OSA are associated with higher in-hospital mortality. Our study findings emphasize the burden of dementia in Afib hospitalizations and the need for prevention of poor outcomes in this population.

Obesity paradox in HFrEF hospitalizations: analysis of national inpatient sample 2016-2018

Funding Acknowledgements

Type of funding sources: None.

Introduction

Obesity is a common and known risk factor for many cardiovascular diseases. Prior studies on chronic systolic heart failure have demonstrated that obesity is inversely associated with mortality, the so-called obesity paradox.

Purpose

 To study the phenomenon of obesity paradox in HFrEF hospitalizations

Methods

We queried January 2016 to December 2018 National Inpatient Sample (NIS) to identify adult (≥18 yrs) hospitalizations with a primary diagnosis of HFrEF. Patients with an associated diagnosis of obesity and higher BMI were also identified based on appropriate ICD-10 CM codes. We used the Chi-square test to evaluate the differences between binary or categorical variables, and Student’s t-test for continuous variables. Multivariate logistic regression was used in outcomes analysis to adjust for potential hospital and patient-level confounders.

Results

 We identified 639,944 weighted HFrEF hospitalizations across three years. Of which, 130,949 (20.4%) of them were associated with obesity. HFrEF with obesity hospitalizations were associated with younger age (mean age 62.0 vs 70.7 yrs; P &lt; 0.01), lesser CAD (55% vs 61%; P &lt; 0.01), higher rate of comorbidity (% of &gt;3 Elixhauser comorbidity score 99.2% vs 94.1%; P &lt; 0.01) and higher Medicaid primary payer (18.2% vs 12.7%, P &lt; 0.01). After adjusting for patient and hospital-level characteristics, we observe statistically significant difference in odds of in-hospital mortality when HFrEF with obesity hospitalizations was compared to HFrEF without obesity [Odds Ratio (OR): 1.1 (0.8 – 1.5); P = 0.52]. We observed statistically significant association with increased LOS [6.0 vs 5.3 days; P &lt; 0.01], increased total hospitalization charges [US$ 61524 vs 55677; P &lt; 0.01] and decreased coronary catheterizations [OR: 0.7 (0.5 – 0.9); P = 0.01] in HFrEF with obesity group compared to HFrEF without obesity.

Conclusion

In this retrospective cohort of hospitalized patients with HFrEF, higher BMI and obesity was not associated with in-hospital mortality. However, it was associated with longer LOS and higher total hospitalization charges. HFrEF with obesity hospitalizations are associated with lesser left coronary catheterizations. This may be explained by lesser burden of CAD in this patient population.

338 Biceps Metastasis Presenting as A Presumed Abscess in Patient with An Undiagnosed Non-Small Cell Lung Cancer - An Unusual Presentation

Lung cancer is the most common cancer worldwide and has highest cancer mortality. Around 50% of cases present with metastasis, however skeletal muscle metastasis is rarely reported.

In this case we describe a fifty-nine-year-old male patient who presented complaining of fever and a mass on the distal biceps and proximal forearm over a five-month period, with no reported improvement despite debridement and antibiotics spanning three presentations to the emergency department. Subsequent biopsy at various anatomical sites showed adenocarcinoma, later identified as metastatic from a primary non squamous-cell lung cancer (NSCLC).

Metastases from lung cancer are more commonly limited to liver and adrenal glands. Presentation of such a mass in skeletal muscle would raise suspicion for the more-commonly seen soft-tissue sarcoma or hemangiomas. This case illustrates a rare example of lung cancer metastatic to skeletal muscle, more specifically, the biceps. Presentation of the mass was also unique in its morphology of an abscess with purulent discharge, raising the importance of cytology and suspicion for malignancy in an abscess unresponsive to antibiotics.

Non-small cell lung cancer can present with skeletal metastasis. A work-up of a mass or abscess of the muscle should include the possibility of soft tissue metastasis.

535 Private Trauma Lists: A Pragmatic Panacea During This Pandemic

Introduction

COVID-19 has disrupted the efficiency of hospitals nationwide. Ambulant trauma surgery was minimised to reduce risk of contracting COVID-19. Operating capacity significantly reduced and surgical training dramatically curtailed. Locally, a private hospital has been utilised as a green site with consultant-lead trauma lists. Our aim is to review the safety and efficiency of this service.

Method

Patients underwent pre-assessment, COVID-19 swabs and 7 days isolation pre and post-op. Staff also underwent swabbing. Prospectively data was gathered for all patients operated on at this site from 12/05/2020 to 20/08/2020. Records reviewed for readmission, complications and COVID status. A satisfaction questionnaire was sent to trainees who operated at this site.

Results

79 operations were completed during this period. 50 male and 29 female, average age 49, average ASA 2. No complications or COVID-19 infections were recorded. Mean time to theatre was 18 days. Delays to theatre led to 2 complications. 87% of trainees felt training was maintained.

Conclusions

Establishing a green site enabled efficient and safe management whilst still facilitating surgical training. This requires clear guidelines for staff and patients. We believe this model can help trauma service provision as the pandemic evolves.

Observations of visible argon line emissions and its spatial profile from Aditya-U tokamak plasma

The spectroscopic studies of medium and high Z impurities have been the subject of interest in fusion research due to their role in mitigating plasma disruption and reducing heat load on the plasma facing components. Line emissions from these impurities provide the rotation velocity and ion temperature measurements along with the understanding of the overall impurity behavior in plasma. In the Aditya-U tokamak, the spatially resolved Ar II line emissions have been observed using a high resolution multi-track spectroscopic diagnostic consisting of a 1 m Czerny-Turner spectrometer coupled with a charge coupled device (CCD) detector using seven lines of sight viewing plasma tangentially along the toroidal direction. The spatially resolved Ar II lines at 458.96 nm have been observed. The singly ionized Ar emission peaks at the radial location of ρ = 0.8 of the plasma having a minor radius of 25 cm. Moreover, a 0.5 m UV-visible spectrometer coupled with a CCD detector and having a line of sight passing through the plasma midplane from the radial port was used to record visible Ar survey spectra within the 670-810 nm wavelength range, and all these lines have been identified for further analysis.

P36: SOMATIC SYMPTOM DISORDER (SSD) AND ABDOMINAL PAIN: INCREASED OPIOID PRESCRIBING IN SURGICAL PATIENTS

Introduction

Undifferentiated pain, and pain out of proportion of diagnosed pathology are sources of frustration to clinician and patient. SSD is a DSM-V diagnosis that has consolidated the previous diagnoses of psychogenic pain. It is a health anxiety condition, where sufferers experience multiple somatic symptoms which cause anxiety and distress. This anxiety results in frequent ED and GP presentations, extensive investigations, and increased opioid prescription. However, opioids do little to alleviate symptoms. Treatment should focus on underlying anxiety and depression.

Population studies show SSD prevalence to be 15-20%, however SSD has never been studied in the surgical population. We hypothesized that the rates of SSD in the surgical population reflects that in primary care, and that SSD sufferers are more likely to be prescribed opioid analgesia.

Method

Adult patients admitted with abdominal pain of any non-traumatic aetiology to the Acute General Surgical Unit at a major tertiary hospital are being screened for SSD using the PHQ-15 questionnaire, and opioid prescription is being recorded.

Result

400 participants have been recruited with a total SSD prevalence of 20%. Opioid prescribing rises sharply with SSD diagnosis. The average opioid prescription appears to be 3 times higher in patients with SSD compared to those without.

Conclusion

Our data confirms an SSD prevalence of 20% in the surgical population. This is associated with increased opioid prescription. Early recognition of SSD and implementation of appropriate treatment could reduce hospital presentations, admissions and opioid prescription. We will continue recruitment to 800 participants by March 2020.

Take-home message

SSD is common in all populations, and results in increased hospital presentations, admissions and opioid prescription. Early recognition and implementation of appropriate treatment may reduce healthcare burden, improve patient outcomes, and reduce opioid prescription.

Psychiatric impact of mobile usage on medical student life: Ringxiety, nomophobia, and sleep

Introduction

The usage of mobile phones has seen exponential growth worldwide.^1,2 While college students use mobile applications for educational purposes, the reports of adverse health problems are emerging.^3,4

Objectives

Investigate the impact of mobile usage patterns on the life of medical students and its association with psychiatric effects concerning ringxiety and nomophobia.

Methods

Data was collected from the 300 medical students of Ashwini Rural Medical College of India through a survey for this cross-sectional study. Chi-square (χ2) was used for statistics that revealed association, mobile phone usage patterns, including time spent before sleep, in classrooms or clinics, and frequency of update checks.

Results

A significant association was found between time spent on mobile before sleep and duration of sleep, and mobile usage in classrooms or clinics and psychological effects (p<0.0001). Significant association observed between mobile use in classes or clinics and the frequency of update checks, and the frequency of update checks and psychological effects (p<0.0001). About 78% of participants distracted in self-study due to mobile. Updates checked every 10 minutes by 14.7%, every hourly by 43%, and during breaks by 42.3%. Mobile low network caused anxiety (13.3%) and irritability (67.3%). About 41.7% of students couldn’t abstain from mobile use for a day. Every student used the mobile phone averagely for 24 minutes before they went to sleep.

Conclusions

Our study results highlight the prevalence of ringxiety and nomophobia in medical school students. With the surging dependency on mobile phones and technology, we need to cautiously monitor its adverse effects on psychology and psychiatric conditions.

Impact of “national suicide prevention week” on digital awareness of suicide prevention : an insight from google trends

Introduction

Every year in the month of September, National Suicide Prevention Week is celebrated. The goal of suicide prevention week is to inform the public about suicide prevention, primarily the warning signs of suicide. However, the impact of this month on the general population is unknown. The Google trends show how frequent web searches have been performed for a particular search-term, which provide an approximation of the people’s interest.

Objectives

To evaluate public interest in suicide prevention by analyzing the google trends of “Suicide Prevention” search-term.

Methods

We estimated the interest in such topics by running the google trends data of the last decade by using the filter [Search Term:“Suicide Prevention”, Locations: “United States” and Time Ranges “ 2010 to 2020”].

Results

During this specific interval, people have searched “Suicide Prevention” most frequently during the month of September (month of National Suicide Prevention week). Conversely, in the other months, interest in “suicide prevention” fluctuated between little to none. The only other time people have shown interest in Suicide prevention, other than the month of September, was with suicide news in the media, such as the death of a celebrity by suicide, or suicide-related TV shows. [Figure]

Conclusions

Although it is not definitive, it gives some idea that National Suicide Prevention week has a considerable impact on population interest. Since we did not observe sufficient public interest in other months, there should be frequent and systematic efforts to spread suicide prevention awareness among the general population.

Barriers in managing psychiatric disorders in athletes

Introduction

Athletes have participated in sports and physical exercise for several decades as a coping strategy to alleviate mental health and behavioral issues. The increasing prevalence of psychiatric disorders among athletes attributed to the failure of its appropriate management.

Objectives

Our goal is to identify barriers in diagnosing and treating psychiatric problems among sportspersons to educate clinicians about the potential risk factors for athletes’ mental health disorders to provide optimal medical care.

Methods

We examined MeSH terms “Athletes,” “Sports,” “Risk Factors,” “Diagnosis,” and “Patient Care Management,” in the context of “Mental Health,” “Mental Disorders,” “sports psychiatry,” and “diagnostic barriers.” We included 23 studies per the PRISMA guidelines, searching Medline, PubMed, PubMed Central, and PsychInfo databases until August 2020.

Results

Barriers managing psychiatric disorders in athletes are overtraining syndrome, compensatory training, idolizing, negative coping mechanisms, social stigma, injuries, and performance-enhancing supplements usage. Other factors attributed to diagnostic barriers are general perceptions, age, racial and gender disparities, poor health services, interpersonal issues, patient-therapist relationships, sense of entitlement, control or confidentiality problems, and lack of quality preventative measures. Risk factors are injuries, sports type, doping, substance abuse, lifestyle, failures in achievement, eating disorders, and maladaptive coping mechanisms.

Conclusions

These barriers in psychiatric care have adversely impacted the mental health of sportspersons. Athletes have deviated from their careers and lost valuable periods of their lives due to inadequate attention to sports psychiatry aspects, such as cognitive health services, inclusive sports management measures, diagnostic and treatment approaches, reliable mental health services, and public awareness programs.

Mental health impact of covid on athletes

Introduction

The coronavirus pandemic continues to impact all aspects of the daily life of the public worldwide. With decreased economic activity, the sports industry faces significant challenges of maintaining athletes’ mental health while seeking the best strategies for eventual return to sports competition.

Objectives

We aim to evaluate COVID-19 related factors impacting on the mental health of athletes and provide appropriate management steps.

Methods

We examined MeSH terms “Athletes,” “Sports,” “COVID-19,” in the context of “Mental Health,” “Mental Disorders,” “Behavioral Medicine,” “Risk Factors.” We identified seven studies for the qualitative synthesis per the PRISMA guidelines, searching Medline, PubMed, PubMed Central, and PsychInfo databases until July 2020.

Results

The pandemic has negatively impacted athletes’ mental wellbeing due to decreased physical activities, limited resources, fears, and delays or cancellations of the sporting event. The negative psychological impact on athletes is due to self-isolation measures leading to worries of less preparedness for the lockdown, reduced physical activity, loss of competitive advantages, fear of being infected, social isolation, and loneliness. During this period, athletes struggled to maintain baseline routine and engaged in excessive calorie intake, eating low-quality food, substance use, and sleep disruption. It has caused anxiety, depression, PTSD, and mood disorder at varying degrees of severity in athletes.

Conclusions

Limited resources during a pandemic have caused adverse mental impact on athletes. We recommend improving physical activity through confined or virtual training programs with colleagues. A collaborative approach is required by clinicians, psychologists, coaches, sports organizations, government bodies to limit the pandemic’s mental health impact.