Screening for obstructive sleep apnea with novel hybrid acoustic smartphone app technology.

BACKGROUND: Obstructive sleep apnea (OSA) has a high prevalence, with an estimated 425 million adults with apnea hypopnea index (AHI) of ≥15 events/hour, and is significantly underdiagnosed. This presents a significant pain point for both the sufferers, and for healthcare systems, particularly in a post COVID-19 pandemic world. As such, it presents an opportunity for new technologies that can enable screening in both developing and developed countries. In this work, the performance of a non-contact OSA screener App that can run on both Apple and Android smartphones is presented. METHODS: The subtle breathing patterns of a person in bed can be measured via a smartphone using the "Firefly" app technology platform [and underpinning software development kit (SDK)], which utilizes advanced digital signal processing (DSP) technology and artificial intelligence (AI) algorithms to identify detailed sleep stages, respiration rate, snoring, and OSA patterns. The smartphone is simply placed adjacent to the subject, such as on a bedside table, night stand or shelf, during the sleep session. The system was trained on a set of 128 overnights recorded at a sleep laboratory, where volunteers underwent simultaneous full polysomnography (PSG), and "Firefly" smartphone app analysis. A separate independent test set of 120 recordings was collected across a range of Apple iOS and Android smartphones, and withheld for performance evaluation by a different team. An operating point tuned for mid-sensitivity (i.e., balancing sensitivity and specificity) was chosen for the screener. RESULTS: The performance on the test set is comparable to ambulatory OSA screeners, and other smartphone screening apps, with a sensitivity of 88.3% and specificity of 80.0% [with receiver operating characteristic (ROC) area under the curve (AUC) of 0.92], for a clinical threshold for the AHI of ≥15 events/hour of detected sleep time. CONCLUSIONS: The "Firefly" app based sensing technology offers the potential to significantly lower the barrier of entry to OSA screening, as no hardware (other than the user's personal smartphone) is required. Additionally, multi-night analysis is possible in the home environment, without requiring the wearing of a portable PSG or other home sleep test (HST).

Not all biofluids are created equal: chewing over salivary diagnostics and the epigenome.

PURPOSE: This article describes progress to date in the characterization of the salivary epigenome and considers the importance of previous work in the salivary microbiome, proteome, endocrine analytes, genome, and transcriptome. METHODS: PubMed and Web of Science were used to extensively search the existing literature (original research and reviews) related to salivary diagnostics and biomarker development, of which 125 studies were examined. This article was derived from the most relevant 74 sources highlighting the recent state of the evolving field of salivary epigenomics and contributing significantly to the foundational work in saliva-based research. FINDINGS: Validation of any new saliva-based diagnostic or analyte will require comparison to previously accepted standards established in blood. Careful attention to the collection, processing, and analysis of salivary analytes is critical for the development and implementation of newer applications that include genomic, transcriptomic, and epigenomic markers. All these factors must be integrated into initial study design. IMPLICATIONS: This commentary highlights the appeal of the salivary epigenome for translational applications and its utility in future studies of development and the interface among environment, disease, and health.

Growing up or growing old? Cellular aging linked with testosterone reactivity to stress in youth.

BACKGROUND: Given the established relation between testosterone and aging in older adults, we tested whether buccal telomere length (TL), an established cellular biomarker of aging, was associated with testosterone levels in youth. METHODS: Children, mean age 10.2 years, were recruited from the greater New Orleans area, and salivary testosterone was measured diurnally and during an acute stressor. Buccal TL was measured using monochrome multiplex quantitative real-time polymerase chain reaction. Testosterone and TL data were available on 77 individuals. The association between buccal TL and testosterone was tested using multivariate generalized estimating equations to account for clustering of children within families. RESULTS: Greater peak testosterone levels (ß = -0.87, P < 0.01) and slower recovery (ß = -0.56, P < 0.01) and reactivity (ß = -1.22, P < 0.01) following a social stressor were significantly associated with shorter buccal TL after controlling for parental age at conception, child age, sex, sociodemographic factors and puberty. No association was initially present between diurnal measurements of testosterone or morning basal testosterone levels and buccal TL. Sex significantly moderated the relation between testosterone reactivity and buccal TL. CONCLUSIONS: The association between testosterone and buccal TL supports gonadal maturation as a developmentally sensitive biomarker of aging within youth. As stress levels of testosterone were significantly associated with buccal TL, these findings are consistent with the growing literature linking stress exposure and accelerated maturation. The lack of association of diurnal testosterone or morning basal levels with buccal TL bolsters the notion of a shared stress-related maturational mechanism between cellular stress and the hypothalamic pituitary gonadal axis. These data provide novel evidence supporting the interaction of aging, physiologic stress and cellular processes as an underlying mechanism linking negative health outcomes and early life stress.

A holistic perspective of patients' lives post-Ilizarov external fixation.

BACKGROUND: The Ilizarov external fixator (IEF) is used in the treatment of complicated fractures with severe soft tissue damage. Despite advantages of being minimally invasive and allowing early weight-bearing, the IEF has limitations, including size, treatment duration and crucial pin-site care. Many patients showed enormous resilience despite the devastating effects of their injuries. Our aim was to assess the value of IEF treatment for trauma patients with a focus on their quality of life. METHODS: A postal survey was administered to 89 patients treated with an IEF at a level 1 trauma centre between January 2000 and June 2009. An SF-12 health survey was incorporated to measure quality of life. SPSS 18.0 was used for statistical analysis of the data. RESULTS: The response rate was 73%. The majority of patients (77%) were treated with IEF for primary fractures. The median duration in IEF was 174 days (56-614 days). The SF-12 mean mental component score was 51 (16-66) and the mean physical component score was 38 (16-57) at the time of survey. The mental component score was similar to that of a normal population but the physical component score was markedly below. A total of 96.8% respondents were satisfied with the IEF treatment and 91.7% reported that under the same circumstances they would have the same treatment again. CONCLUSIONS: Patient's quality of life scores correlated directly with their injury severity and pre-existing conditions. They were not negatively affected by IEF treatment itself. High quality of life scores (non-physical) were achieved with IEF treatment.

Decontamination of laundry at low temperature with CuWB50, a novel copper-based biocidal compound.

BACKGROUND: Traditional laundry decontamination relies on thermal disinfection that degrades textiles. We investigated the ability of a novel copper-based biocidal compound, CuWB50, to assist in the decontamination of swatches purposely contaminated with Staphylococcus aureus and Acinetobacter during "real-life" low-temperature machine washing with and without 2 commercial detergents. METHODS: Contaminated and noncontaminated swatches were attached to ballast sheets and washed in cold water for 15 minutes in an industrial Electrolux machine. We assessed colony-forming units (cfu) on the swatches and in the postwash water. RESULTS: Low-temperature machine washing produced only partial reductions in viable methicillin-resistant Staphylococcus aureus and Acinetobacter calcoaceticus baumannii counts on swatches and resulted in cross contamination of other swatches in the same wash. Washing with CuWB50 alone at high concentration (100 mg/L), however, resulted in superior decontamination compared with water alone, whereas washing with a combination of detergent and CuWB50 at low concentration (5 mg/L) yielded synergistic and complete decontamination of swatches and postwash water. CONCLUSION: Our results show highly effective laundry decontamination using CuWB50 with detergent at low temperature and are timely both in terms of rising energy costs and textile degradation issues.

A comparison of the antibacterial efficacy and cytotoxicity to cultured human skin cells of 7 commercial hand rubs and Xgel, a new copper-based biocidal hand rub.

BACKGROUND: Hand cleanliness is important in hospital infection control, but skin irritation from frequent alcohol-based hand rub use reduces compliance. We have compared a new copper biocide/Aloe vera-based biocidal hand rub (Xgel) with 7 commercially available hand rubs. METHODS: Hand rubs were cultured with human skin cells for 24 hours after which cytotoxicity was assessed using the sulforhodamine B assay. The EN 12054 bacterial suspension test protocol was used to assess biocidal activity of 2 of the least cytotoxic hand rubs (Xgel and Purell). RESULTS: Hand rubs had 50% cytotoxic concentrations ranging from >10% to <0.1% vol/vol. In the EN12054 assay, Xgel reduced colony forming units (CFU) by >10(8) with methicillin-resistant Staphylococcus aureus (MRSA) and Acinetobacter in 1 minute, whereas Purell only reduced CFU by 10(4) and 10(5), respectively. Purell was ineffective against C difficile spores, whereas Xgel produced a 3 x 10(3) reduction in CFU. CONCLUSION: The hand rubs had a wide range of cytotoxicity values for human skin cells, with Xgel being the least cytotoxic to human skin cells. In the EN 12054 bacterial suspension test, Xgel was more effective than Purell against all organisms tested. It should be noted that these in vitro results may not translate into clinical differences.

Three novel highly charged copper-based biocides: safety and efficacy against healthcare-associated organisms.

OBJECTIVES: We investigated three novel highly charged copper-based inorganic biocidal formulations for their activity against organisms highly relevant to healthcare-associated infection. METHODS: The three copper-based formulations were tested: (i) against clinical isolates of methicillin-resistant Staphylococcus aureus (MRSA), Legionella pneumophila, Acinetobacter calcoaceticus/baumannii (ACCB), glycopeptide-resistant Enterococcus and spores of Clostridium difficile in time-kill assays; (ii) for their ability to decontaminate ultramicrofibre (UMF) cloths; and (iii) for their cytotoxicity to human skin and intestinal epithelial cells. RESULTS: All three copper-based formulations were potently biocidal down to concentrations of 1 ppm for both stationary- and log-phase organisms, and they were all active against C. difficile spores. At 150 ppm, they achieved a complete (>6 log10) kill of MRSA and ACCB mostly within 1 h. This biocidal activity was not achieved by copper sulphate or the inorganic binders used in the formulations. All three copper-based formulations completely decontaminated UMF cloths containing MRSA, ACCB or C. difficile spores, suggesting that any of these copper-based formulations would be highly beneficial in the healthcare environment. All three copper-based formulations and copper sulphate were not cytotoxic to human epithelial cells up to concentrations of 100-200 ppm. CONCLUSIONS: All three of the novel copper-based biocidal formulations, but not their components (copper sulphate and inorganic binders), have potent activity against organisms highly relevant to healthcare-associated infections.

Sideswipe injuries to the elbow in Western Australia.

OBJECTIVE: To examine the conditions leading to sideswipe injury of the upper limb in motor vehicle accidents and to highlight the severity of these injuries. DESIGN AND SETTING: Prospective study of upper-limb sideswipe injuries in patients admitted to Royal Perth Hospital, Western Australia, between August 2003 and January 2005. PARTICIPANTS: Eleven patients sustaining sideswipe injuries to the upper limb. MAIN OUTCOME MEASURES: Accident pattern, type of injury, surgical management, complications, and functional and employment implications. RESULTS: Ten patients required open reduction and internal fixation for open fractures of the humerus, ulna and radius, and nine underwent additional surgical procedures including nerve, artery and tendon repair, and free flaps and split-skin grafting. The injury severity scores ranged from 9 to 25. The severity of injuries led to extensive functional deficits in eight patients, affecting employment prospects in seven. CONCLUSION: Appropriate educational programs, legislation and improvements in traffic conditions, especially in rural areas, as well as changes in current car design, could contribute to preventing these devastating and complex injuries.

Guidelines for the laboratory diagnosis and susceptibility testing of methicillin-resistant Staphylococcus aureus (MRSA).

These evidence-based guidelines have been produced after a literature review of the laboratory diagnosis and susceptibility testing of methicillin-resistant Staphylococcus aureus (MRSA). We have considered the detection of MRSA in screening samples and the detection of reduced susceptibility to glycopeptides in S. aureus. Recommendations are given for the identification of S. aureus and for suitable methods of susceptibility testing and screening for MRSA and for S. aureus with reduced susceptibility to glycopeptides. These guidelines indicate what tests should be used but not when the tests are applicable, as aspects of this are dealt with in guidelines on control of MRSA. There are currently several developments in screening media and molecular methods. It is likely that some of our recommendations will require modification as the new methods become available.

The theory and practice of bloodless surgery.

The application of blood conservation strategies to minimise or avoid allogeneic blood transfusion is seen internationally as a desirable objective. Bloodless surgery is a relatively new practice that facilitates that goal. However, the concept is either poorly understood or evokes negative connotations. Bloodless surgery is a term that has evolved in the medical literature to refer to a peri-operative team approach to avoid allogeneic transfusion and improve patient outcomes. Starting as an advocacy in the early 1960s, it has now grown into a serious practice being embraced by internationally respected clinicians and institutions. Central to its success is a coordinated multidisciplinary approach. It encompasses the peri-operative period with surgeons, anaesthetists, haematologists, intensivists, pathologists, transfusion specialists, pharmacists, technicians, and operating room and ward nurses utilising combinations of the numerous blood conservation techniques and transfusion alternatives now available. A comprehensive monograph on the subject of bloodless surgery along with detailed coverage of risks and benefits of each modality (some modalities are discussed in more detail elsewhere in this issue) is beyond the scope of this article. Accordingly, a brief overview of the history, theory and practice of bloodless surgery is presented, along with the clinical and institutional management requirements.