A Novel System for the Device-Based Measurement of Physical Activity, Sedentary Behavior, and Sleep (Motus): Usability Evaluation

BACKGROUND

Device-based measurements of physical behavior, using the current methods, place a large burden on participants. The Motus system could reduce this burden by removing the necessity for in-person meetings, replacing diaries written on paper with digital diaries, and increasing the automation of feedback generation.

OBJECTIVE

This study aims to describe the development of the Motus system and evaluate its potential to reduce participant burden in a two-phase usability evaluation.

METHODS

Motus was developed around (1) a thigh-worn accelerometer with Bluetooth data transfer; (2) a smartphone app containing an attachment guide, a digital diary, and facilitating automated data transfer; (3) a cloud infrastructure for data storage; (4) an analysis software to generate feedback for participants; and (5) a web-based app for administrators. We recruited 19 adults with a mean age of 45 (SD 11; range 27-63) years, of which 11 were female, to assist in the two-phase evaluation of Motus. A total of 7 participants evaluated the usability of mockups for a smartphone app in phase 1. Participants interacted with the app while thinking aloud, and any issues raised were classified as critical, serious, or minor by observers. This information was used to create an improved and functional smartphone app for evaluation in phase 2. A total of 12 participants completed a 7-day free-living measurement with Motus in phase 2. On day 1, participants attempted 20 system-related tasks under observation, including registration on the study web page, reading the information letter, downloading and navigating the smartphone app, attaching an accelerometer on the thigh, and completing a diary entry for both work and sleep hours. Task completion success and any issues encountered were noted by the observer. On completion of the 7-day measurement, participants provided a rating from 0 to 100 on the System Usability Scale and participated in a semistructured interview aimed at understanding their experience in more detail.

RESULTS

The task completion rate for the 20 tasks was 100% for 13 tasks, >80% for 4 tasks, and <50% for 3 tasks. The average rating of system usability was 86 on a 0-100 scale. Thematic analysis indicated that participants perceived the system as easy to use and remember, and subjectively pleasing overall. Participants with shift work reported difficulty with entering sleep hours, and 66% (8/12) of the participants experienced slow data transfer between the app and the cloud infrastructure. Finally, a few participants desired a greater degree of detail in the generated feedback.

CONCLUSIONS

Our two-phase usability evaluation indicated that the overall usability of the Motus system is high in free-living. Issues around the system's slow data transfer, participants with atypical work shifts, and the degree of automation and detail of generated feedback should be addressed in future iterations of the Motus system.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/35697.

Development and performance of a sleep estimation algorithm using a single accelerometer placed on the thigh: an evaluation against polysomnography

Accelerometers placed on the thigh provide accurate measures of daily physical activity types, postures and sedentary behaviours, over 24 h and across consecutive days. However, the ability to estimate sleep duration or quality from thigh-worn accelerometers is uncertain and has not been evaluated in comparison with the 'gold-standard' measurement of sleep polysomnography. This study aimed to develop an algorithm for sleep estimation using the raw data from a thigh-worn accelerometer and to evaluate it in comparison with polysomnography. The algorithm was developed and optimised on a dataset consisting of 23 single-night polysomnography recordings, collected in a laboratory, from 15 asymptomatic adults. This optimised algorithm was then applied to a separate evaluation dataset, in which, 71 adult males (mean [SD] age 57 [11] years, height 181 [6] cm, weight 82 [13] kg) wore ambulatory polysomnography equipment and a thigh-worn accelerometer, simultaneously, whilst sleeping at home. Compared with polysomnography, the algorithm had a sensitivity of 0.84 and a specificity of 0.55 when estimating sleep periods. Sleep intervals were underestimated by 21 min (130 min, Limits of Agreement Range [LoAR]). Total sleep time was underestimated by 32 min (233 min LoAR). Our results evaluate the performance of a new algorithm for estimating sleep and outline the limitations. Based on these results, we conclude that a single device can provide estimates of the sleep interval and total sleep time with sufficient accuracy for the measurement of daily physical activity, sedentary behaviour, and sleep, on a group level in free-living settings.

Effect of a "feedback prompt" from a disinfection tracking system on portable medical equipment disinfection

BACKGROUND

Portable medical equipment (PME) may contribute to transmission of multidrug-resistant organisms without proper disinfection. We studied whether a Disinfection Tracking System (DTS) with feedback prompt, attached to PME, can increase the frequency of PME disinfection.

METHODS

DTS devices were placed on 10 workstations-on-wheels (WOWs) and 5 vitals machine (VM). After a 25 day "screen-off" period, the DTS device screens were turned on to display the number of hours since the last recorded disinfection event for a 42 day period. We used a Bayesian multilevel zero-inflated negative binomial model to compare the number of events in the display "screen-off" to the "screen-on" period.

RESULTS

During the "screen-off" period, there were 1.26 and 0.49 mean disinfection events and during the "screen-on" period, there were 1.76 and 0.50 mean disinfection events for WOWs and VM, respectively, per day. The model estimated mean events per device per day in the the "screen-on" period for WOW's were 1.32 (1.10 - 1.57) times greater than those in the "screen-off" period and the "screen-on" period for VM devices was 1.37 (0.89 - 2.01) times greater than those in the "screen-off" period.

CONCLUSIONS

The rate of disinfection events for WOWs increased following the implementation of the DTS feedback prompt.

4 HIGH-PROTEIN, HIGH-CALORIE ICE-CREAM PRESCRIPTION IN AN ORTHOGERIATRIC INPATIENT POPULATION

Background

At a major trauma centre in the South of Ireland, all older adults admitted with hip and other fragility fractures are co-managed by the Orthopaedic & Orthogeriatric services with an average of over 500 hip fractures a year. A recent publication by described improving calcium and protein intake by using dairy foods as a readily accessible intervention that reduces the risk of falls and fractures in aged care residents. Foods used included cheese, yoghurt and milk being described as “low cost” and “palatable”. Other dairy alternatives such as ice-cream are not used as not protein or calcium rich. In Ireland high calorie-high protein ice-cream is widely available (10g protein, 220 kcal/100g serving).

Methods

A point prevalence survey relating to the preference of calcium and/or protein rich food ‘snacks’ was completed on 20 inpatients in hospital with a hip or other fragility fracture.

Survey Questions: (1) Would an additional calcium and/or protein rich food snack be acceptable to you?; (2) Which food snack would you prefer: a serving of milk, cheese, yogurt, or ice-cream?; (3) What time would you prefer to eat an additional snack? Morning, afternoon, or evening?

Results

The majority of participants (95%; 19/20) replied an additional snack would be acceptable. With reference to snack preference: 35% (7/20) would prefer a serving of yoghurt, 30% (6/20) ice-cream, 25% (5/20) cheese and only 10% (2/20) would prefer milk. The majority said they would prefer to be offered a snack in the afternoon (55%; 11/20).

Conclusion

Our inpatient population would benefit from the addition of such snacks to optimise recovery and bone health. Patient preference needs to inform any dietary or menu modifications. Following our survey, in addition to calcium and vitamin D supplementation, high-protein high-calorie ice-cream is offered and prescribed to patients if eating less than 50% of their energy dense meals.

106 MORTALITY FOLLOWING HIP FRACTURE AMONG NURSING HOME RESIDENTS

Background

Little is known about mortality following hip fracture among Nursing Home (NH) residents. Prognostic data is important to guide management, including osteoporosis treatment.

Methods

We conducted a retrospective cohort study of all patients admitted to an Irish tertiary hospital from NHs with hip fracture during the years 2017-2020 inclusive. Mortality was assessed at 90, 180 and 365 days (one-year) following admission.

Results

One patient was lost to follow up, leaving 233 in the analysis group. 147 were female. Mean age was 85. All-cause mortality was 18.03% at 90 days, 27.04% at 180 days and 37.34% at one year. One-Year Mortality (OYM) was 34.01% among females and 43.02% among males. Among those aged 90 or over, OYM was 45.59% (31/68), being 65.22% (15/23) among males and 35.56% (16/45) among females. In those aged 75 or over, OYM was 39.9% (81/203), being 48.57% (34/70) among males and 35.34% (47/133) among females. In those aged under 75, OYM was 20% (6/30). OYM was 42.31% (11/26) among those who could mobilise independently before fracture, 37.23% (51/137) among those requiring an aid, 33.9% (20/59) among those requiring assistance, and 45.45% (5/11) among those unable to mobilise. 62 Rockwood Clinical Frailty Scales (CFS) were recorded (median score 7, range 5-9). OYM was 0% (0/4) for CFS 5, 50% (8/16) for CFS 6, 31.43% (11/35) for CFS 7, 80% (4/5) for CFS 8 and 100% (0/2) for CFS 9.

Conclusion

Mortality among NH residents following hip fracture was highest in older males. While mobility before fracture was a poor predictor of mortality, CFS showed promise among a smaller sample size.

280 PERCEIVED NEED FOR A CLINICAL ETHICS SUPPORT SERVICE AT AN IRISH UNIVERSITY HOSPITAL

Background

Ethics are the set of moral principles that guide a person’s behaviour. Ethical issues are a key component of healthcare and frequently arise in the management of hospitalized older patients. To improve decision-making and reduce burden on individual hospital staff, Clinical Ethics Support Services (CESS) have been widely-integrated into care pathways internationally. However, the need for CESS has received little attention in Irish hospitals.

Methods

A cross-sectional analysis of the ethical situation and CESS readiness at a tertiary hospital in Ireland was collected from July-October 2021 and in February 2022 via hard copies and online collection (SurveyMonkey). Both clinical (medicine, nursing other patient care role) and non-clinical (administrative, clerical, ICT, HR, general support staff and management) staff participated. Descriptive statistics were assessed taking the valid percentages, mean 5-item Likert scores and Friedman Test mean rank for ten ranked statements.

Results

In total, 199 people (13% response rate) completed the survey. Staff were largely (76%) clinical and the majority were qualified &gt;10 years (57%). In all, 78% reported that ethical issues arise in the role (83% clinical staff, 59% non-clinical staff). Most (63%) were unsure who to contact about ethical concerns, instead seeking informal advice from colleagues (&gt;90%). The majority of participants were interested in additional ethical training, especially on decision-making capacity (mean interest 4.18 out of 5), strategies for working with challenging patient/family situations (4.07 out of 5) and end-of-life care (4.06 out of 5). Out of ten options assessed, participants preferenced the development of a formal clinical ethics committee over education and training or the provision of educational materials.

Conclusion

Ethical issues commonly arise when caring for older hospitalized patients. This study found a perceived need and widespread interest in additional education as well as formal approaches to develop a hospital-based CESS, centred around a formal committee structure.

The Surveillance of Physical Activity, Sedentary Behavior, and Sleep: Protocol for the Development and Feasibility Evaluation of a Novel Measurement System

BACKGROUND

There is increasing recognition of the need for more comprehensive surveillance data, including information on physical activity of all intensities, sedentary behavior, and sleep. However, meeting this need poses significant challenges for current surveillance systems, which are mainly reliant on self-report.

OBJECTIVE

The primary objective of this project is to develop and evaluate the feasibility of a sensor-based system for use in the surveillance of physical activity, sedentary behavior, and sleep (SurPASS) at a national level in Denmark.

METHODS

The SurPASS project involves an international, multidisciplinary team of researchers collaborating with an industrial partner. The SurPASS system consists of (1) a thigh-worn accelerometer with Bluetooth connectivity, (2) a smartphone app, (3) an integrated back end, facilitating the automated upload, analysis, storage, and provision of individualized feedback in a manner compliant with European Union regulations on data privacy, and (4) an administrator web interface (web application) to monitor progress. The system development and evaluation will be performed in 3 phases. These phases will include gathering user input and specifications (phase 1), the iterative development, evaluation, and refinement of the system (phase 2), and the feasibility evaluation (phase 3).

RESULTS

The project started in September 2020 and completed phase 2 in February 2022. Phase 3 began in March 2022 and results will be made available in 2023.

CONCLUSIONS

If feasible, the SurPASS system could be a catalyst toward large-scale, sensor-based surveillance of physical activity, sedentary behavior, and sleep. It could also be adapted for cohort and interventional research, thus contributing to the generation of evidence for both interventions and public health policies and recommendations.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/35697.

32 SIMULATION-BASED EDUCATION FOR ACUTE STROKE

Background

Acute stroke requires efficient multi-disciplinary collaboration to deliver time-sensitive treatment in a prompt and effective manner. The European Stroke Organization (ESO) recommends simulation-based education (SBE) for stroke care. Studies have shown SBE improves door-to-needle times, which predict better patient outcomes.

SimStars was a competition, run by the National Doctors Training and Planning leads for the South-SouthWest Hospitals Group, to develop in-situ SBE scenarios.

We developed a SBE program for acute stroke in an Irish teaching hospital.

Methods

Medical doctors and nursing staff are included in the SBE scenario as candidates/target learners. Patients are played by role-players. Anonymised data and neuroimaging from real patients is utilized to maximize fidelity to real life. Other participants, such as paramedics, can be included to facilitate scenarios as required.

Candidates are briefed before each scenario. Clear learning objectives are set. All participants are provided with a script outlining their roles. Candidates are appraised using standard evaluation forms. A de-brief is undertaken to reinforce learning objectives.

Results

We qualified for the final of SimStars by establishing a SBE program for acute stroke, including a video of a simulated scenario that can be utilized for demonstration purposes. 100% of candidates who have participated in the SBE program so far have stated that it made a valuable contribution to their learning in the field of stroke care.

Conclusion

Stroke has been described as an exemplar of how SBE may benefit training along an entire clinical pathway. Scenarios can be adapted to cover an endless variety of stroke-related situations. SBE has been shown to improve hyper-acute clinical pathway performance and outcomes.

Frontline Nurse Feedback During the Development of a System to Track Cleaning of Portable Medical Equipment

As part of the development and testing of an innovative technology for tracking disinfection of portable medical equipment, end-user feedback was obtained during an initial trial on two acute care hospital units. The disinfection tracking device was installed on the computers-on-wheels and vital signs machines. Each device had the capability of detecting a cleaning event, reporting the event to an online database, and displaying the time since last cleaning event on a visual display. End-user feedback regarding functionality, usefulness of information provided, and impact on workflow was obtained by survey and facilitated group discussions. Seventeen frontline nurses completed the anonymous survey, and 22 participated in the facilitated group discussions. End users found the system functionally easy to use and the information about time since last cleaning useful and reported minimum disruption of workflow. Functionality of the system was confirmed by consistency between recorded and self-reported cleaning patterns. Managers found the data on cleaning of portable medical equipment helpful in validating compliance with hospital equipment cleaning policy. Frontline staff expressed appreciation for technology that helps them and improves outcomes but also discussed concerns about the potential for technology that creates extra work and disruption in the busy frontline nursing care delivery environment. Nurses were appreciative of opportunities to provide feedback and input into efforts to develop and introduce technology. Recorded cleaning events coincided with self-reported equipment cleaning patterns and illustrated that the device efficiently collects information deemed useful by the end user.

The politics of COVID-19 on the island of Ireland

Background

Political systems are the means through which the science of public health achieves its objectives. This is a qualitative study of public health policies for COVID-19 in Northern Ireland and the Republic of Ireland that seeks to establish if inter-jurisdictional commitments have led to co-ordination and co-operation on the island of Ireland.

Methods

10 indicators from the OxCGRT codebook directed data collection with directed qualitative content analysis supporting comprehensive reading of policy documents. Cross-case and within-case analysis of policy alignment and divergence across ten OxCGRT indicators was undertaken.

Results

Closing Schools Republic of Ireland: 12th March 2020 Northern Ireland: 23rd March 2020; Workplace Closing - Republic of Ireland: 12th and 15th March and 24th March 2020. Northern Ireland: 20th March 2020 followed by mandatory closure on 28th March 2020. Cancelling events and mass gatherings (St Patrick's Day, 17th March)-Republic of Ireland: 9th March 2020-Northern Ireland: 9th March 2020;Lockdown/Shelter-in-place policies. Republic of Ireland: 27th March 2020- Northern Ireland: 28th March 2020; Restrictions on Internal Movement Republic of Ireland: 27th March 2020 Northern Ireland: 28th March 2020. Physical Distancing Measures -Republic of Ireland: 2-metres 24th March 2020 Northern Ireland: 2 metres 23rd March 2020. Mandatory Face Masks in Enclosed Spaces-Republic of Ireland: 10th August 2020 -Northern Ireland: 10th August 2020.

Conclusions

The historical and constitutional politics of the island of Ireland is the obstacle to an all-island response to COVID-19 and this has almost certainly been compounded by Brexit. Defying the odds, however, this study has demonstrated substantial public health policy alignment brought about through ongoing dialogue and co-operation between the health administrations in each jurisdiction.

Key messages

Historical and constitutional politics of the island of Ireland is the obstacle to an all-island response to COVID-19. Even pandemics cannot overcome realpolitik.

Number of steps and systolic blood pressure: Do work and leisure matter?

The number of steps per day influences blood pressure and health. However, the association between steps at work and leisure and blood pressure is unknown. Thus, we aimed to investigate the association between the domain‐specific number of steps and systolic blood pressure. A thigh‐worn accelerometer was used to measure the steps of 694 workers over 1–5 consecutive days, separated into work and leisure domains using a self‐reported diary. We linearly regressed steps at work, leisure and total day against systolic blood pressure, adjusting for age, sex, body mass index, smoking, and antihypertensive medication. Additionally, we stratified the analyses on job type (blue‐collar or white‐collar). The results of this cross‐sectional analysis indicated a beneficial association between the number of steps (per 2000‐step interval) and systolic blood pressure for the total day (−0.5 mmHg; −1.0 to −0.8, 95% CI, p < 0.05) and work (−0.9 mmHg; −1.5 to −0.4, 95% CI, p < 0.05), but not for leisure (+0.1 mmHg; −0.7 to 0.9, 95% CI, p = 0.75). Blue‐collar workers took almost twice as many steps at work (9143 ± SD3837) as white‐collar workers (5863 ± SD3565) and, after stratification on job type, we observed a beneficial association between the number of steps at work and systolic blood pressure among blue‐collar workers (−1.1 mmHg; −1.7 to −0.4, 95% CI, p < 0.05), but not for white‐collar workers (−0.3 mmHg; −1.7 to 1.1, 95% CI, p = 0.7). These findings indicate that the number of steps at work, particularly among blue‐collar workers, is beneficially associated with systolic blood pressure. Such findings support the potential of work (re)design to promote walking to improve blood pressure.

Accelerometer-Measured Physical Activity at Work and Need for Recovery: A Compositional Analysis of Cross-sectional Data

Objectives

Previous research has shown strong associations between occupational physical activity (OPA) and need for recovery (NFR). However this research has only utilized self-reported measures of OPA which may be biased. Thus, there is a need for investigating if the previously documented association between self-reported OPA and NFR can be found when using technical measures of OPA. There is also the need to investigate whether older workers are particularly susceptible to increased NFR, since age-related declines in physical capacity mean that it is likely these workers will have a higher NFR for a given physical activity. The aim of this study was to investigate the association between technically measured OPA and NFR, and whether this relationship is modified by age.

Methods

This study utilized data from the Danish Physical Activity Cohort with Objective Measurements cohort—comprising Danish workers (n = 840) from the cleaning, manufacturing, and transportation sectors. OPA was measured by accelerometers attached to the thigh and upper back for at least one work day and classified into four physical behaviour categories (sedentary, standing, light, or moderate/vigorous). NFR was measured using a shortened version of the Danish NFR scale. Analysis was conducted using linear regression and isotemporal substitution analyses for compositional data.

Results

The overall association between OPA and NFR was statistically significant in the unadjusted model (P < 0.001), but not when adjusted for age, sex, occupation, and shift work (P = 0.166). Isotemporal substitution showed small but significant reductions in NFR when increasing sedentary time relative to other behaviours (adjusted: ΔNFR = −0.010 [−0.019; −0.001]). There were no significant interactions between age and OPA (P = 0.409).

Conclusions

This study found significant associations between OPA and NFR, but the effect sizes were small. Reallocating 30 min to sedentary behaviours from other behaviours was associated with a reduced NFR, but the effect size may not be practically relevant. Moreover, no clear modifying effects of age were identified.

The effects of walking speed and mobile phone use on the walking dynamics of young adults

Walking while using a mobile phone has been shown to affect the walking dynamics of young adults. However, this has only been investigated using treadmill walking at a fixed walking speed. In this study, the dynamics of over ground walking were investigated using lower trunk acceleration measured over 12 consecutive trials, following differing walking speed and mobile phone use instructions. Higher walking speed significantly increased the proportion of acceleration along the vertical measurement axis, while decreasing the proportion of acceleration along the anteroposterior axis (p < 0.001). Moreover, higher walking speed also resulted in increased sample entropy along all measurement axes (p < 0.05). When walking while texting, the maximum Lyapunov exponent increased along the anteroposterior and vertical measurement axes (p < 0.05), while sample entropy decreased significantly along the vertical axis (p < 0.001). Walking speed and mobile phone use both affect the walking dynamics of young adults. Walking while texting appears to produce a reduction in local dynamic stability and an increase in regularity, however, caution is required when interpreting the extent of this task effect, since walking speed also affected walking dynamics.

100. Effect of Disinfection Tracking System on Cleaning Events of Portable Medical Equipment

Background

Portable Medical Equipment (PME) can play a vital role in transmission of multidrug-resistant organisms. Cleaning PME is challenging and protocols vary by institution. Tracking of PME cleaning events is usually performed manually and demonstration of compliance with protocols is difficult. We studied a Disinfection Tracking Systems (DTS) to understand its potential role in tracking disinfection events of PME and whether its implementation led to improvement in the number of cleaning events. The DTS device was designed to automatically register several types of disinfection events and could be set to display time since last disinfected on the screen.

Methods

For a 25-day period, a single acute care unit received a DTS device with the display screen off but with the ability to detect and log disinfection events in a database from a disinfectant wipe. After the 25-day screen-off period the DTS units screen was turned on to display the number of hours since the last recorded disinfection event (Figure 1) for a 42-day period. DTS devices were placed on 10 computer-on-wheels (COW) and 5 vitals machine (VM). An interrupted time series analysis, using a Bayesian model compared the number of events in the display screen-off to the screen-on period.

Disinfection Tracking System with Screen-off and Screen-on

Results

During the 25-day screen-off period, there were a total of 345 events captured with 61 events on VM and 284 on COWs averaging 0.49 and 1.26 cleaning events for VM and COWs respectively per day. During the 42-day screen-on period, there were 845 total disinfection events with 104 events on VM and 741 events on COWs with 0.50 and 1.76 mean events for VM and COWs respectively per day. The mean events per device per day in the screen-on period for COW’s were 1.32 (1.10 – 1.57) times greater than those in the screen-off Period. The mean events per device per day in the screen-on period for VM devices was 1.37 (0.89 – 2.01) times greater than those in the screen-off period.

Conclusion

Disinfection events for COWs and VMs were found to be above the local policy requirements. Implementation of a DTS device was able to increase the rate of disinfection events for COWs potentially due to the prompt on the screen. Additionally, it captured disinfection events successfully on the database demonstrating its effective to be a tool for demonstration of compliance.

Disclosures

Mark Stibich, PhD MHS, Xenex Disinfection Services, Inc (Board Member, Employee) Sarah Simmons, DrPH, Xenex Disinfection Services (Employee, Shareholder) Chetan Jinadatha, MD, MPH, AHRQ (Research Grant or Support)Department of Veterans Affairs (Other Financial or Material Support, Owner: Department of Veterans Affairs. Licensed to: Xenex Disinfection System, San Antonio, TX)Inventor (Other Financial or Material Support, Methods for organizing the disinfection of one or more items contaminated with biological agents)NiH/NINR (Research Grant or Support)NSF (Research Grant or Support)Xenex Healthcare Services (Research Grant or Support)

818. Healthcare Worker Feedback Regarding the Implementation of a New Disinfection Tracking System

Background

Tracking of disinfection of portable medical equipment (PME) and demonstration of compliance with PME disinfection policies can be difficult to demonstrate. A Disinfection Tracking System (DTS) was implemented in our hospital to assess the impact of such a system on the disinfection events of PME and its ability to capture disinfection events. The DTS system improved the total disinfection events as well as disinfection events on commonly used items such as Computer-on-wheels (COWs) and vitals machine (VM) (Figures 1 & 2). Here we present a summary of healthcare workers’ (HCWs) opinions about the implementation of the DTS system in their routine work flow.

Image of DTS Mounted on a Computer-on-Wheel

Methods

The study was conducted on two medical-surgical acute care units in Temple, TX Veterans Affairs hospital. The DTS devices were equipped with sensors to detect moisture events corresponding to disinfection. A display on the device indicated the last time the PME was disinfected. Opinions were obtained after the 10-week study period through a survey and facilitated group discussions between frontline HCWs and managers who had encountered the DTS during their daily work routine. The survey measured level of agreement with 13 items on a Likert-type scale system ranging from one (least agreement) to ten (most agreement).

Disinfection Tracking System with Screen Displaying Time Since Last Disinfection

Results

A total of 17 surveys were completed. The lowest mean agreement score was 5.1 for the statement - the DTS system display corresponds to a real disinfection of the equipment and the highest mean agreement scores included - the DTS system was easy to understand and follow and the DTS system can easily be adopted in my routine workflow. Lastly, - the DTS system helped improve the disinfection of my COW and the DTS system will improve patient outcomes corresponded to agreement score means of 8.1 and 7.9, respectively. In the group discussions, all the involved groups of healthcare workers expressed agreement in the ease of use of the system and minimal disruption in workflow.

Conclusion

Our survey and interview results indicate that most of the HCWs who interacted with the device had a positive interaction with the device. They stated the DTS system helped serve as an indicator about the last disinfection event. They also noted the system integrated well into their workflow without any disruption or additional workload.

Disclosures

Sarah Simmons, DrPH, Xenex Disinfection Services (Employee, Shareholder) Mark Stibich, PhD MHS, Xenex Disinfection Services, Inc (Board Member, Employee) Chetan Jinadatha, MD, MPH, AHRQ (Research Grant or Support)Department of Veterans Affairs (Other Financial or Material Support, Owner: Department of Veterans Affairs. Licensed to: Xenex Disinfection System, San Antonio, TX)Inventor (Other Financial or Material Support, Methods for organizing the disinfection of one or more items contaminated with biological agents)NiH/NINR (Research Grant or Support)NSF (Research Grant or Support)Xenex Healthcare Services (Research Grant or Support)

821. Portable Medical Equipment Disinfection: How often does it occur?

Background

Portable Medical Equipment (PME) are routinely used by healthcare workers (HCWs). Transmission of healthcare-acquired infections has been attributed to PME. Our institution policy requires at least once daily PME disinfection. Automated tracking of disinfection events by Disinfection Tracking System (DTS) makes routine monitoring possible. We tested the device to see if it could provide accurate information about disinfection practices and patterns, as well as be used to accurately monitor compliance with policy.

Methods

Data obtained from DTS devices on PME from 2 acute care wards over a 25-day period was obtained. DTS devices record disinfection events and are automatically stored for monitoring. DTS was placed on 10 computer-on-wheels (COWs) and 5 vitals machine (VMs) on both the wards. One ward received DTS with “Screen-on” feedback displaying the time since last disinfection event, and one unit had no display on the screen (screen-off). The number of recorded events was summed over the 25-day period and sorted by time of day to determine the pattern of events over a typical 24-hour period. Minute “0” indicates start of each monitoring period in a 24-hour cycle and corresponds to 12 midnight (Figure 1).

Results

A total of 421 moisture events were recorded for the screen-on and 345 for the screen-off, during the 25-day implementation period. The highest number of events occurred between 6am and 7am, with 69 moisture events recorded in the screen-on group and 75 events were recorded for the screen-off group. Further, 37 events were recorded in the screen-on group and 43 events in the screen-off group between 2pm and 3pm. Between 6pm and 7pm the screen-on group showed 52 moisture events and 32 events for the screen-off group. Figures 1 shows the three peaks corresponding with a spike in disinfection events.

Conclusion

The pattern of disinfection events over 24 hours demonstrate that most events occurred regularly at certain times in the day. These time points correspond with higher volumes of disinfection happening at the beginning of shift changes for nursing. It also demonstrated that disinfection rates were higher than the policy recommended once a day PME disinfection. DTS has the potential to continuously record & report data related of disinfection events on PME in healthcare settings.

Disclosures

Chetan Jinadatha, MD, MPH, AHRQ (Research Grant or Support)Department of Veterans Affairs (Other Financial or Material Support, Owner: Department of Veterans Affairs. Licensed to: Xenex Disinfection System, San Antonio, TX)Inventor (Other Financial or Material Support, Methods for organizing the disinfection of one or more items contaminated with biological agents)NiH/NINR (Research Grant or Support)NSF (Research Grant or Support)Xenex Healthcare Services (Research Grant or Support) Mark Stibich, PhD MHS, Xenex Disinfection Services, Inc (Board Member, Employee) Sarah Simmons, DrPH, Xenex Disinfection Services (Employee, Shareholder)

Cardiorespiratory fitness, occupational aerobic workload and age: workplace measurements among blue-collar workers

BACKGROUND

The knowledge, from laboratory studies dating back to the 1950s on the importance of the association between cardiorespiratory fitness and aerobic workload for workers health, is fundamental for promoting sustainable healthy employability among ageing blue-collar workers today. However, the association between cardiorespiratory fitness and aerobic workload has not yet been documented during daily work, and we do not know if it applies to the normal work of blue-collar workers in different age groups. We aim to investigate the association between cardiorespiratory fitness and aerobic workload among blue-collar workers using measurements of 24-h heart rate collected over consecutive working days.

METHODS

We analyzed baseline cardiorespiratory fitness, assessed using a sub-maximal cycle ergometer test, and 1-4 days of 24-h heart rate measurement from 497 blue-collar workers participating in the DPHACTO study. We investigated the association between cardiorespiratory fitness and aerobic workload defined as the average percentage of heart rate reserve (%HRR), maximum %HRR and the duration time spent at a high HRR (> 30%) during working hours. The association was assessed using multivariate linear regression models adjusted for age, sex, self-rated health, shift-work, prescription medication and occupation, as well as for different age strata.

RESULTS

Higher cardiorespiratory fitness was significantly associated with decreased mean %HRR -0.32 [95% CI -0.39 to -0.25], maximum %HRR -0.35 [95% CI -0.45 to -0.25] and time spent at  ≥ 30% HRR; -1.8% [95% CI -2.2 to -1.5%]. These associations were evident across age groups, with slightly stronger associations for workers aged 46-51 (total range 18-68).

CONCLUSIONS

Higher cardiorespiratory fitness was associated with the decreased aerobic workload during normal work across all age groups and levels of work intensity. Our findings highlight the importance of cardiorespiratory fitness when considering the workload and its relevance in the promotion of healthy sustainable employment.

Zero problems with compositional data of physical behaviors: a comparison of three zero replacement methods

BACKGROUND

Researchers applying compositional data analysis to time-use data (e.g., time spent in physical behaviors) often face the problem of zeros, that is, recordings of zero time spent in any of the studied behaviors. Zeros hinder the application of compositional data analysis because the analysis is based on log-ratios. One way to overcome this challenge is to replace the zeros with sensible small values. The aim of this study was to compare the performance of three existing replacement methods used within physical behavior time-use epidemiology: simple replacement, multiplicative replacement, and log-ratio expectation-maximization (lrEM) algorithm. Moreover, we assessed the consequence of choosing replacement values higher than the lowest observed value for a given behavior.

METHOD

Using a complete dataset based on accelerometer data from 1310 Danish adults as reference, multiple datasets were simulated across six scenarios of zeros (5-30% zeros in 5% increments). Moreover, four examples were produced based on real data, in which, 10 and 20% zeros were imposed and replaced using a replacement value of 0.5 min, 65% of the observation threshold, or an estimated value below the observation threshold. For the simulation study and the examples, the zeros were replaced using the three replacement methods and the degree of distortion introduced was assessed by comparison with the complete dataset.

RESULTS

The lrEM method outperformed the other replacement methods as it had the smallest influence on the structure of relative variation of the datasets. Both the simple and multiplicative replacements introduced higher distortion, particularly in scenarios with more than 10% zeros; although the latter, like the lrEM, does preserve the ratios between behaviors with no zeros. The examples revealed that replacing zeros with a value higher than the observation threshold severely affected the structure of relative variation.

CONCLUSIONS

Given our findings, we encourage the use of replacement methods that preserve the relative structure of physical behavior data, as achieved by the multiplicative and lrEM replacements, and to avoid simple replacement. Moreover, we do not recommend replacing zeros with values higher than the lowest observed value for a behavior.

Light-intensity physical activity derived from count or activity types is differently associated with adiposity markers

Aim

The aim of this study was to compare the association between count‐ and activity type–based definitions of light‐intensity physical activity (LIPA) and adiposity markers.

Methods

A total of 516 Danish workers participated in 1‐4 days of hip‐ and thigh‐based accelerometer measurements. Three definitions of average daily time spent in LIPA were derived: LIPA (1) time spent between 100 and 2029 CPM, LIPA (2) time spent moving and slow walking, and LIPA (3) time spent moving, walking slow, and standing. Adiposity markers were body mass index (BMI), body fat percentage, and waist circumference. The cross‐sectional association between the three LIPA definitions and adiposity markers was analyzed and interpreted using compositional regression models followed by reallocation of time between LIPA, moderate‐to‐vigorous physical activity (MVPA), and sedentary behavior (SB), respectively.

Results

The geometric means of daily time (min/day) spent in LIPA 1, LIPA 2, and LIPA 3 were 326, 102, and 274, respectively. We found the direction and strength of the association between the relative importance of daily time spent in LIPA and the adiposity markers to depend on the LIPA definition. For example, reallocating 30 minutes from MVPA to LIPA 1, LIPA 2 and LIPA 3 were associated with a 2.97 (95% CI: 0.68; 5.27), −0.71 (95% CI: −1.43; 0.02), and −0.45 (95% CI: −1.01; 0.11) difference in BMI, respectively.

Conclusion

Our findings highlight the need for caution when comparing results from studies using different definitions of LIPA.

Predictors of in-hospital mortality post hip fracture in Ireland 2013-2017

Background

Hip fractures are associated with considerable mortality, morbidity and healthcare expenditure. There are approximately 3,500 hip fractures in Ireland per annum with this figure set to increase considerably over the coming years due to the ageing population. Internationally, mortality following hip fracture is approximately 10% at 1 month and 30% at 1 year, with less than half of survivors regaining their preoperative level of function. The authors aimed to identify the determinants of in-hospital mortality post hip fracture in the Republic of Ireland 2013-2017, with specific reference to the Irish Hip Fracture Standards.

Methods

A secondary analysis of 15,603 patients in the Irish hip fracture database was conducted.

Results

31% (n = 4,769) were male and 69% (n = 10,807) were female. Mean age for males was 75 years (SD 13.5) and 79 years for females (SD 10.5). The largest proportion of hip fractures occurred in the 80-89 age category, with 72.3% (n = 4,600) of these being female. Median in-hospital mortality was 4.7% (n = 711) (Range 2.7-6.2). Univariate logistic regression revealed 11 statistically significant predictors of in-hospital mortality; however, only 4 remained statistically significant on multivariate analysis [mobilised day of/after surgery (OR 1.46, 95% CI 1.25-1.70, p &lt; 0.000), pre-fracture mobility (OR 0.84, 95% CI 0.79-0.89, p &lt; 0.000), gender (OR 0.56, 95% CI 0.41-0.76, p &lt; 0.000) and age (OR 1.05, 95% CI 1.03-1.06, p &lt; 0.000)].

Conclusions

Older males with poor pre-fracture mobility who were not mobilised the day of/after surgery had the highest risk of in-hospital mortality. The ability to be mobilised on the day of/after surgery is a good composite measure of both patient and organisational factors in hip fracture care. This research supports the inclusion of mobilisation on the day of/after surgery as a new formal best practice standard.

Key messages

Patients not mobilised on the day of/after surgery are 46% more likely to die in hospital. In-hospital mortality of 4.7% in Ireland is comparable internationally. None of the IHFSs significantly influenced in-hospital mortality after multivariate analysis, but may well affect other outcomes such as ability to return home.

Comparison of physical behavior estimates from three different thigh-worn accelerometers brands: a proof-of-concept for the Prospective Physical Activity, Sitting, and Sleep consortium (ProPASS)

Background

Pooling data from thigh-worn accelerometers across multiple studies has great potential to advance evidence on the health benefits of physical activity. This requires harmonization of information on body postures, physical activity types, volumes and time patterns across different brands of devices. The aim of this study is to compare the physical behavior estimates provided by three different brands of thigh-worn accelerometers.

Methods

Twenty participants volunteered for a 7-day free-living measurement. Three accelerometers - ActiGraph GT3X+, Axivity AX3 and ActivPAL Micro4 - were randomly placed in a vertical line on the midsection of the right thigh. Raw data from each accelerometer was processed and classified into 8 physical activities and postures using the Acti4 software. Absolute differences between estimates and the respective coefficient of variation (CV) were calculated.

Results

We observed very minor differences between physical behavior estimates from three different accelerometer brands. When averaged over 24 h (1,440 min), the absolute difference (CV) between accelerometers were: 1.2 mins (0.001) for lying/sitting, 3.4 mins (0.02) for standing, 3.5 mins (0.06) for moving, 1.9 mins (0.03) for walking, 0.1 mins (0.19) for running, 1.2 mins (0.19) for stair climbing, 1.9 mins (0.07) for cycling. Moreover, there was an average absolute difference of 282 steps (0.03) per 24 h.

Conclusions

Physical behaviors were classified with negligible difference between the accelerometer brands. These results support harmonization of data from different thigh-worn accelerometers across multiple cohorts when analyzed in an identical manner.

Electronic supplementary material

The online version of this article (10.1186/s12966-019-0835-0) contains supplementary material, which is available to authorized users.

The effects of mobile phone use on walking: a dual task study

OBJECTIVES

The aim of this study was to examine the effects of walking at different speeds while using a mobile phone on spatiotemporal stride parameters among young adults. Ten participants (7 male, 3 female; age = 24.7 ± 4.4 years, mean ± 1SD) completed 12 walking trials. Trials consisted of tasks performed at both normal and fast walking speeds-walking only, walking while texting, and walking while talking on a mobile phone. Gait velocity, stride length, cadence, and double support time were computed using data from accelerometers on either shoe.

RESULTS

The effects of distracted walking were not significantly larger when performed at a self-selected fast walking speed compared with a normal walking speed. However, walking while texting produced significant decreases in gait velocity, stride length, and cadence, with a significant increase in double support time at both walking speeds. Moreover texting increased the size of the relative variability of walking, observed through a significant increase in the coefficient of variation of cadence, stride length, and double support time. The observed changes may be suggestive of compromised balance when walking while texting regardless of walking speed. This may place the individual at a greater risk of, slips, trips and falls.

Named data networking

Named Data Networking (NDN) is one of five projects funded by the U.S. National Science Foundation under its Future Internet Architecture Program. NDN has its roots in an earlier project, Content-Centric Networking (CCN), which Van Jacobson first publicly presented in 2006. The NDN project investigates Jacobson's proposed evolution from today's host-centric network architecture (IP) to a data-centric network architecture (NDN). This conceptually simple shift has far-reaching implications for how we design, develop, deploy, and use networks and applications. We describe the motivation and vision of this new architecture, and its basic components and operations. We also provide a snapshot of its current design, development status, and research challenges. More information about the project, including prototype implementations, publications, and annual reports, is available on named-data.net.

Identifying the superior measure of rapid fibrosis for predicting premature cirrhosis after liver transplantation for hepatitis C

BACKGROUND

Hepatitis C virus (HCV) recurrence post liver transplant is universal, with a subgroup of patients developing rapid hepatic fibrosis. Various clinical definitions of rapid fibrosis (RF) have been used to identify risks for rapid progression, but their comparability and efficacy at predicting adverse outcomes has not been determined.

METHODS

Retrospective data analysis was conducted on 100 adult patients with HCV who underwent liver transplantation at a single center. We measured year 1 fibrosis progression (RF defined as METAVIR F score ≥ 1 at 1-year liver biopsy), time to METAVIR F2-stage fibrosis, and fibrosis rate (calculated using liver biopsies graded by METAVIR scoring F0-4; fibrosis rate = fibrosis stage/year post transplant). RF was defined as ≥ 0.5 units/year.

RESULTS

Multivariate analysis revealed that donor age and peak HCV viral load were significant risks for RF, when fibrosis rate was used to define RF. Advanced donor age was a risk for rapid progression to F2-stage fibrosis, whereas genotype 2 or 3 HCV infection was protective. Fibrosis rate had the strongest correlation with time to cirrhosis development (P < 0.0001, r = -0.76) and was the most accurate predictor of rapid graft cirrhosis (P < 0.0001, area under the curve 0.979, sensitivity 100%, specificity 94%).

CONCLUSION

Different measures of RF progression identify different risks for RF and are not directly comparable. Fibrosis rate was the most accurate predictor of rapid graft cirrhosis.

Post-liver transplantation multicentric Castleman disease treated with valganciclovir and weaning of immunosuppression

Multicentric Castleman disease is a lymphoproliferative disorder which when seen in the setting of HIV/AIDS is often associated with human herpes virus 8 (HHV-8) infection. We describe the case of a HIV-negative man who developed HHV-8-associated multicentric Castleman disease 11 years after liver transplantation. The patient presented with fevers and weight loss. Physical examination revealed enlarged cervical, axillary and inguinal lymph nodes. Widespread lymphadenopathy was confirmed on computed tomography (CT) scanning. Histology of an enlarged lymph node showed a polymorphous infiltrate with mature plasma cells, plasmacytoid lymphocytes and occasional blasts within the cortex and paracortex. The diagnosis of Castleman disease was confirmed by the finding of numerous HHV-8-immunopositive cells around the regressed lymph node follicles and the detection of HHV-8 on plasma PCR. Although the conventional treatment for this condition has been combination chemotherapy, in the post-transplant context it was decided to treat the patient with valganciclovir and cessation of immunosuppression. His symptoms resolved rapidly and repeat plasma PCR done 3 months after starting treatment was negative for HHV-8. A follow-up CT scan showed a dramatic reduction in the size and amount of lymphadenopathy. After 15 months of treatment, he remains well with no evidence of graft dysfunction or rejection.

Intravascular large B cell lymphoma: an elusive cause of pyrexia of unknown origin diagnosed postmortem

Intravascular large B cell lymphoma (IVLBCL) is a rare cause of pyrexia of unknown origin. Because of its protean clinical manifestations, diagnosis is elusive and is often made postmortem. We report here a case of IVLBCL that evaded diagnosis despite multiple investigations in vivo for pyrexia of unknown origin over a 5&#x2010;month period.

Safety and Effectiveness of Telemedicine for Neurology Outpatients

Background and Aims

Patients often wait many months to see a neurologist for the first time. With the introduction of targets for maximum waiting times there is a need for novel approaches. Real time telemedicine by videolink (VL) is one such method and we aimed to replicate this in Aberdeen.

Methods

Patients were seen by VL by two Irish-based neurologists, one experienced in telemedicine, the other not. A senior trainee neurologist present with some of the patients validated the telemedicine diagnosis and management with his own face-to-face (FF) assessment. Satisfaction was assessed by questionnaires. Numbers requiring investigations and review were recorded as were representations to neurology over six months.

Results

Forty-four patients were seen. Satisfaction was higher and review rates were similar to previous cohorts seen by FF and VL. There was no difference between the two neurologists. There was complete diagnostic agreement between the VL and FF neurologists. There was a diagnostic change in a single patient after six months follow-up.

Conclusion

Neurology consultation using VL is safe and effective as well as acceptable, and the necessary skills were acquired rapidly by a telemedicine-naive neurologist. Telemedicine using VL can contribute to waiting list reduction, and is likely to be most useful in rural areas.

Malayamycin, a new streptomycete antifungal compound, specifically inhibits sporulation of Stagonospora nodorum (Berk) Castell and Germano, the cause of wheat glume blotch disease

BACKGROUND

Malayamycin is a novel perhydrofuropyran C-nucleoside isolated from Streptomyces malaysiensis that shows promising antifungal activity, fully controlling a range of diseases when applied to plants at 100 microg mL(-1). The goal of this study was to determine the mode of action.

RESULTS

Malayamycin exhibited in vitro antifungal activity against Stagonospora nodorum (Berk) Castell & Germano, the cause of stagonospora nodorum blotch of wheat. Growth in liquid minimum medium was merely delayed at 50 microg mL(-1), but sporulation was suppressed by more than 50% by 10 microg mL(-1) of malayamycin. When applied to wheat seedlings 36 h prior to infection, 10 microg mL(-1) of malayamycin reduced lesion size and significantly reduced pycnidiation to only 5% of the non-treated level. A transcription factor gene, Mrg1 (malayamycin response gene) whose expression was upregulated by application of malayamycin, was identified. Both Mrg1 knockout and overexpression strains were created. These strains were fully pathogenic, suggesting that the expression of Mrg1 did not affect pathogenicity. Interestingly, a strain that expressed Mrg1 50 times more than wild type showed a significant reduction in sporulation. However, all the tested knockout and overexpression strains retained sensitivity to malayamycin.

CONCLUSIONS

Malayamycin is a new type of antifungal compound that acts primarily by inhibiting sporulation. Although Mrg1 may be involved in the sporulation process, it is not the major contributor for sporulation inhibition caused by malayamycin treatment.

The future in your pocket

There is a growing sentiment among academics in computing that a shift to multicore processors in commodity computers will demand that all programmers become parallel programmers. This is because future general-purpose processors are not likely to improve the performance of a single thread of execution; instead, the presence of multiple processor cores on a CPU will improve the performance of groups of threads. In this article, I argue that there is another trend underway, namely integration, which will have a greater near-term impact on developers of system software and applications. This integration, and its likely impact on general-purpose computers, is clearly illustrated in the architecture of modern mobile phones

Supercharging planetlab

In recent years, overlay networks have become an important vehicle for delivering Internet applications. Overlay network nodes are typically implemented using general purpose servers or clusters. We investigate the performance benefits of more integrated architectures, combining general-purpose servers with high performance Network Processor (NP) subsystems. We focus on PlanetLab as our experimental context and report on the design and evaluation of an experimental PlanetLab platform capable of much higher levels of performance than typical system configurations. To make it easier for users to port applications, the system supports a fast path/slow path application structure that facilitates the mapping of the most performance-critical parts of an application onto an NP subsystem, while allowing the more complex control and exception-handling to be implemented within the programmer-friendly environment provided by conventional servers. We report on implementations of two sample applications, an IPv4 router, and a forwarding application for the Internet Indirection Infrastructure. We demonstrate an 80x improvement in packet processing rates and comparable reductions in latency.

Ring-Modified Analogues and Molecular Dynamics Studies To Probe the Requirements for Fungicidal Activities of Malayamycin A and Its N-Nucleoside Variants

The importance of functional group orientations and the integrity of the bicyclic perhydrofuran core of malayamycin A and two equally active N-nucleoside analogues as fungicides were investigated. Two analogues 10 and 11, representing a THP-truncated and a bicyclic aza-variant, were synthesized and found to be inactive. Molecular dynamics studies on malayamycin A and analogues were performed to highlight the importance of properly orientating the urea and methyl ether groups.

WITHDRAWN: Prophylactic corticosteroids for preterm birth

BACKGROUND

Respiratory distress syndrome is a serious complication of prematurity causing significant immediate and long-term mortality and morbidity.

OBJECTIVES

The objective of this review was to assess the effects of corticosteroids administered to pregnant women to accelerate fetal lung maturity prior to preterm delivery.

SEARCH STRATEGY

The Cochrane Pregnancy and Childbirth Group trials register was searched.

SELECTION CRITERIA

Randomised and quasi-randomised trials of corticosteroid drugs capable of crossing the placenta compared with placebo or no treatment in women expected to deliver preterm as a result of either spontaneous preterm labour, prelabour rupture of the membranes preterm, or elective preterm delivery.

DATA COLLECTION AND ANALYSIS

Eligibility and trial quality were assessed by one reviewer.

MAIN RESULTS

Eighteen trials including data on over 3700 babies were included. Antenatal administration of 24 milligrams of betamethasone, of 24 milligrams of dexamethasone, or two grams of hydrocortisone to women expected to give birth preterm was associated with a significant reduction in mortality (odds ratio 0.60, 95% confidence interval 0.48 to 0.75), respiratory distress syndrome (odds ratio 0.53, 95% confidence interval 0.44 to 0.63) and intraventricular haemorrhage in preterm infants. These benefits extended to a broad range of gestational ages and were not limited by gender or race. No adverse consequences of prophylactic corticosteroids for preterm birth have been identified.

AUTHORS' CONCLUSIONS

Corticosteroids given prior to preterm birth (as a result of either preterm labour or elective preterm delivery) are effective in preventing respiratory distress syndrome and neonatal mortality. However there is not enough evidence to evaluate the use of repeated doses of corticosteroids in women who remain undelivered, but who are at continued risk of preterm birth.(This abstract has been prepared centrally.).

WITHDRAWN: Interventions for preventing or improving the outcome of delivery at or beyond term

BACKGROUND

Perinatal mortality and morbidity is increased in pregnancies of more than 42 weeks that are otherwise low risk.

OBJECTIVES

The objective of this review was to assess the effects of interventions aimed at either reducing the incidence or improving the outcome of post-term pregnancy.

SEARCH STRATEGY

The Cochrane Pregnancy and Childbirth Group trials register was searched.

SELECTION CRITERIA

Randomised and quasi-randomised trials of interventions involving the intention to induce labour at a specified gestational age.

DATA COLLECTION AND ANALYSIS

Eligibility and trial quality were assessed by one reviewer. Study authors were contacted for additional information.

MAIN RESULTS

Twenty-six trials of variable quality were included. There were four trials of routine early pregnancy ultrasound, two of nipple stimulation, nineteen of routine versus selective induction of labour and one of antenatal fetal monitoring. Routine early pregnancy ultrasound reduced the incidence of post-term pregnancy (odds ratio 0.68, 95% confidence interval 0.57 to 0.82). Breast and nipple stimulation at term did not affect the incidence of post-term pregnancy (odds ratio 0.52, 95% confidence interval 0.28 to 0.96). Routine induction of labour reduced perinatal mortality (odds ratio 0.20, 95% confidence interval 0.06 to 0.70). This benefit is due to the effect of induction of labour after 41 weeks. Routine induction of labour had no effect on caesarean section.

AUTHORS' CONCLUSIONS

Routine early pregnancy ultrasound examination and subsequent adjustment of delivery date appear to reduce the incidence of post-term pregnancy. Routine induction of labour after 41 weeks gestation appears to reduce perinatal mortality. There is not enough evidence to evaluate the effects of breast and nipple stimulation, or tests of fetal wellbeing.(This abstract has been prepared centrally.).

Algorithms to accelerate multiple regular expressions matching for deep packet inspection

There is a growing demand for network devices capable of examining the content of data packets in order to improve network security and provide application-specific services. Most high performance systems that perform deep packet inspection implement simple string matching algorithms to match packets against a large, but finite set of strings. owever, there is growing interest in the use of regular expression-based pattern matching, since regular expressions offer superior expressive power and flexibility. Deterministic finite automata (DFA) representations are typically used to implement regular expressions. However, DFA representations of regular expression sets arising in network applications require large amounts of memory, limiting their practical application.In this paper, we introduce a new representation for regular expressions, called the Delayed Input DFA (D 2 FA), which substantially reduces space equirements as compared to a DFA. A D 2 FA is constructed by transforming a DFA via incrementally replacing several transitions of the automaton with a single default transition. Our approach dramatically reduces the number of distinct transitions between states. For a collection of regular expressions drawn from current commercial and academic systems, a D2FA representation reduces transitions by more than 95%. Given the substantially reduced space equirements, we describe an efficient architecture that can perform deep packet inspection at multi-gigabit rates. Our architecture uses multiple on-chip memories in such a way that each remains uniformly occupied and accessed over a short duration, thus effectively distributing the load and enabling high throughput. Our architecture can provide ostffective packet content scanning at OC-192 rates with memory requirements that are consistent with current ASIC technology.