Multi-site Assessment Research Articles

Developmental changes in the endorsement of psychotic-like experiences from middle childhood through young adulthood

BackgroundChildren tend to endorse psychotic-like experiences (PLEs) at higher rates than adults, although little is known about how specific symptom endorsement changes across the span of development. Here we take an observational approach to examine trends in PLE endorsement by age in two non-clinical samples: one of school-aged children and another of late adolescents and early adults. MethodsProdromal Questionnaire-Brief (child and adult versions) responses were investigated in individuals ages 9–13 (n = 11865) and 16–24 (n = 3209) from the Adolescent Brain and Cognitive Development Study (ABCD) and the Multisite Assessment of Psychosis-risk Study (MAP), respectively. Item-level endorsement and distressing item frequencies were examined by age throughout both cohorts. ResultsUnusual perceptual experiences were generally endorsed more heavily in childhood, while other PLEs were endorsed in adolescents and adults up to 4.8 times more frequently than in children. Additionally, certain experiences were endorsed by as many as 73 percent of the older sample. ConclusionsConsiderations for the measurement of PLEs in childhood and adolescence are underscored. Findings from these two samples provide a window into the course of these PLEs and may serve as a scaffold for future research investigating normative versus risk-related experiences during development.

New data-based analysis tool for functioning of natural flood management measures reveals multi-site time-variable effectiveness

Temporary storage areas (TSAs) are a type of Natural Flood Management measure or nature-based solution that can provide additional storage during flood events by intercepting and attenuating surface runoff. Pressures on land use and an increase in climate change induced storms means there is a need to create additional storage within multifunctional rural landscapes. Implementation of small-scale TSAs is slowly gaining momentum, but practitioners still require further evidence on their functioning during different storm events. Here we present the TSA Drainage Rate Analysis tool (TSA-DRA tool), a novel data-based mechanistic method that only requires rainfall and TSA water level data to describe individual TSA drainage rates. We developed and then used the TSA-DRA tool to perform a multi-site assessment of different TSAs, allowing comparisons of TSA functioning across different types or time-variable factors. TSA design and outlet were found to be the dominant controls on drainage rates when the feature is full. Meanwhile, time-variable differences in functioning were more evident at lower water levels, when soil infiltration was the main TSA outflow. Results from a modelling experiment using observed time-variable TSA drainage rates suggested that these can impact the TSAs flood mitigation effectiveness. Specifically, for a particular event, soil conditions of a TSA in NE Scotland were more effective during spring than winter in attenuating surface runoff. Understanding spatial and temporal differences in TSA drainage rates will help optimise existing and future TSA designs, ensuring small-scale headwater TSAs are successfully integrated within rural catchments to mitigate an increasing exposure to hydrological extremes.

Multi-site assessment of soil nitrogen stocks across temperate forests under different thinning intensities, recovery times, and site conditions

Increasing research interests have been paid to understand the factors controlling soil nitrogen (N) stocks under diverse environmental conditions and forest thinning regimes. This study investigated soil N stocks across 13 temperate forests, each of which received three thinning intensities (unthinned control, 15–30 %, and 30–50 % basal area removals) under varying pre-treatment conditions (altitude, slope, soil pH, soil moisture, stand age, stand density, diameter at breast height, and tree height). The total N stored in the forest floor (L, F, and H layers) and mineral soils (0–10, 10–20, and 20–30 cm) was determined 1, 4, and 7 years after thinning. Given the various site conditions and thinning regimes, a standardized effect size was used to analyze the influences of thinning on N stocks. The N stocks (Mg N ha−1) of the forest floor and at 0–10, 10–20, and 20–30 cm mineral soil depths were 0.02–0.46, 0.32–3.21, 0.29–3.03, and 0.25–2.54 across all studied forests, respectively. The averaged effect sizes indicated decrease in forest floor N stocks and increase in mineral soil N stocks under thinning due to the reduced litterfall and eventual input of thinning residues. Thinning intensity negatively affected the effect sizes for the N stocks (P < 0.05), suggesting that excessively heavy thinning may be inappropriate for retaining forest soil N. However, multimodel inference showed that soil pH (relative importance = 1.00) and stand age (relative importance = 0.42) had the largest influence on the effect sizes for forest floor and mineral soil N stocks. This pattern suggests that the effects of thinning on soil N stocks might vary with pre-treatment conditions, even more than thinning intensities and recovery time; therefore, thinning to manage forest soil N should consider pre-treatment environmental conditions in addition to thinning regime.

Multisite assessment of reproducibility in high‐content cell migration imaging data

High‐content image‐based cell phenotyping provides fundamental insights into a broad variety of life science disciplines. Striving for accurate conclusions and meaningful impact demands high reproducibility standards, with particular relevance for high‐quality open‐access data sharing and meta‐analysis. However, the sources and degree of biological and technical variability, and thus the reproducibility and usefulness of meta‐analysis of results from live‐cell microscopy, have not been systematically investigated. Here, using high‐content data describing features of cell migration and morphology, we determine the sources of variability across different scales, including between laboratories, persons, experiments, technical repeats, cells, and time points. Significant technical variability occurred between laboratories and, to lesser extent, between persons, providing low value to direct meta‐analysis on the data from different laboratories. However, batch effect removal markedly improved the possibility to combine image‐based datasets of perturbation experiments. Thus, reproducible quantitative high‐content cell image analysis of perturbation effects and meta‐analysis depend on standardized procedures combined with batch correction.

Multisite Assessment of Optical Genome Mapping for Analysis of Structural Variants in Constitutional Postnatal Cases

This study compares optical genome mapping (OGM) performed at multiple sites with current standard-of-care (SOC) methods used in clinical cytogenetics. This study included 50 negative controls and 359 samples from individuals (patients) with suspected genetic conditions referred for cytogenetic testing. OGM was performed using the Saphyr system and Bionano Access software version 1.7. Structural variants, including copy number variants, aneuploidy, and regions of homozygosity, were detected and classified according to American College of Medical Genetics and Genomics guidelines. Repeated expansions in FMR1 and contractions in facioscapulohumeral dystrophy 1 were also analyzed. OGM results were compared with SOC for technical concordance, clinical classification concordance, intrasite and intersite reproducibility, and ability to provide additional, clinically relevant information. Across five testing sites, 98.8% (404/409) of samples yielded successful OGM data for analysis and interpretation. Overall, technical concordance for OGM to detect previously reported SOC results was 99.5% (399/401). The blinded analysis and variant classification agreement between SOC and OGM was 97.6% (364/373). Replicate analysis of 130 structural variations was 100% concordant. On the basis of this demonstration of the analytic validity and clinical utility of OGM by this multisite assessment, the authors recommend this technology as an alternative to existing SOC tests for rapid detection and diagnosis in postnatal constitutional disorders.

A Multisite Assessment of Inpatient Safety Event Rates During the Coronavirus Disease 2019 Pandemic

To date, there has been a notable lack of peer-reviewed or publicly available data documenting rates of hospital quality outcomes and patient safety events during the coronavirus disease 2019 pandemic era. The dearth of evidence is perhaps related to the US health care system triaging resources toward patient care and away from reporting and research and also reflects that data used in publicly reported hospital quality rankings and ratings typically lag 2-5 years. At our institution, a learning health system assessment is underway to evaluate how patient safety was affected by the pandemic. Here we share and discuss early findings, noting the limitations of self-reported safety event reporting, and suggest the need for further widespread investigations at other US hospitals. During the 2-year study period from January 1, 2020, through December 31, 2021 across 3 large US academic medical centers at our institution, we documented an overall rate of 25.8 safety events per 1000 inpatient days. The rate of events meeting “harm” criteria was 12.4 per 1000 inpatient days, the rate of nonharm events was 11.1 per 1000 inpatient days, and the fall rate was 2.3 per 1000 inpatient days. This descriptive exploratory analysis suggests that patient safety event rates at our institution did not increase over the course of the pandemic. However, increasing health care worker absences were nonlinearly and strongly associated with patient safety event rates, which raises questions regarding the mechanisms by which patient safety event rates may be affected by staff absences during pandemic peaks.

A Multisite Assessment of Saudi Bachelor Nursing Students' Perceptions of Clinical Competence and Learning Environments: A Multivariate Conceptual Model Testing.

Background: It is thought that students’ perceptions of educational and clinical learning environments improve the effectiveness of curricula and professional standards. It is essential to examine the educational and clinical learning environments in which nursing students learn, as well as how nursing students evaluate particular factors of these environments. Objectives: The objectives of this study were to (1) identify nursing students’ perceptions on professional competence and learning environments in the classroom and clinical settings and (2) test a hypothetical model of variables that influence and predict students’ perceptions of learning environments and professional competencies. Methods: The study employed a descriptive cross-sectional methodological design. Five hundred and eighteen undergraduate nursing students were recruited from three Saudi Arabian universities using a convenient sampling technique. Using valid and reliable self-reported questionnaires, including the Dundee Ready Educational Environment Measure (DREEM), the modified Clinical Learning Environment Inventory (CLEI), and the Nurse Professional Competence Scale-Short (NPCS-SF), data were collected. Results: Perceptions of professional competence and learning environments were positive among nursing students. With satisfactory fit indices, the final model found that students’ perceptions of clinical competence were significantly predicted by their perceptions of the clinical environment (B = 0.43, p < 0.001), students’ perceptions of university environments (B = 0.29, p < 0.001), ward type (B = 0.12, p < 0.001), and students’ year of study (B = 0.11, p < 0.001). The students’ perceptions of clinical environments were significantly predicted by their perceptions of the university environment (B = 0.31, p < 0.001), gender (B = 0.13, p < 0.001), students’ year of study (B = 0.12, p < 0.001), and ward type (B = 0.11, p < 0.001). Moreover, the students’ perceptions of the university environment were significantly predicted by gender (B = 0.11, p < 0.001) and length of training (B = 0.12, p < 0.001). Conclusions: A range of factors might influence students’ perceptions of their professional competence and learning environments. Improving the learning environments and clinical experiences of students could enhance their clinical competence. This study’s findings provide evidence for how to enhance the learning environments in the classroom and clinical settings in order to improve students’ clinical competence, which will ultimately result in better patient outcomes. It is a top priority for nursing educators all around the world to improve classroom and clinical learning settings that foster students’ learning and professional competencies.

“I’m concerned”: A multi-site assessment of emergency medicine resident speaking up behaviors

Introduction According to the Institute of Medicine, 98,000 annual deaths are caused by preventable errors. Speaking up about patient safety or professionalism concerns when they arise allows medical staff to move from bystanders to active participants in the prevention of patient harm. This study assesses the current climate around speaking up for patient safety and unprofessional behavior by Emergency Medicine (EM) resident physicians and compares it to previously published data from other specialties. Methods A multi-site, descriptive, cross-sectional design was utilized based on previously published Speaking Up Climate Safety and Professionalism Scales. EM residents at 3 programs in the United States were surveyed, and their responses were compared to previously published responses from other specialties. Results 102 residents from 3 EM residency programs responded to the survey, yielding a response rate of 54.3%. Responses on the survey fell close to the neutral response (3 on a 5-point Likert scale) on all measures, indicating opportunity for improvement. However, EM responses were significantly more favorable than responses from other specialties on several questions. Conclusion This assessment demonstrates room for improvement on speaking up behaviors among EM residents but also suggests that unique features of EM may contribute to a relatively more positive speaking up climate compared to other specialties, which may inform strategies to increase speaking up behaviors. For example, deliberate practice of situations requiring strong teamwork and strategies to reduce traditional hierarchies may help emulate the climate that tends to occur organically in EM.

Multi-site assessment of the potential of fine resolution red-edge vegetation indices for estimating gross primary production

Gross primary production (GPP) models driven by fine resolution remote sensing data characterize the spatial and temporal heterogeneities in plant photosynthesis, which is largely dependent on biome-specific maximum photosynthetic capacity. The red-edge reflectance, sensitive to leaf chlorophyll content, is a good proxy of maximum photosynthetic capacity. More importantly, studies show that the red-edge reflectance-related chlorophyll content index (CIr) multiplied by the incident photosynthetic active radiation (PARin) strongly correlates to GPP estimated at carbon flux towers (GPPflux). Yet, to the best of our knowledge, there is no systematic study investigating the general relationship between fine spatial resolution CIr and GPP among biomes and the relationship between CIr and maximum photosynthetic capacity in GPP models. To provide an overview on incorporating space-borne CIr into a GPP model, we applied fine resolution Sentinel-2-derived CIr and GPPflux over 57 flux sites representative of 10 biomes. We investigated the relationship between CIr and GPPflux, and the spatio-temporal relationship between CIr and ecosystem maximum photosynthetic capacity indicated by the potential ecosystem light use efficiency (LUEpot). We also evaluated the relationship between other five vegetation indices (VIs) and GPPflux. Results showed that the CIr multiplied by PARin has a higher agreement (R2 > 0.5) with GPP than other VIs. A universal relationship exists between the CIr multiplied by PARin and GPP, except for forest biomes. The CIr also strongly (R2 > 0.5) relates to the LUEpot during the peak of the growing season. The CIr has a low spatial variance (CV = 0.25) among biomes, highlighting that CIr can be a proxy of maximum photosynthetic capacity in GPP models that do not require biome-dependent coefficients. This study provides insight for incorporating CIr into GPP models and better quantifying global terrestrial photosynthesis.

UAV-Based Hyperspectral Monitoring Using Push-Broom and Snapshot Sensors: A Multisite Assessment for Precision Viticulture Applications.

Hyperspectral aerial imagery is becoming increasingly available due to both technology evolution and a somewhat affordable price tag. However, selecting a proper UAV + hyperspectral sensor combo to use in specific contexts is still challenging and lacks proper documental support. While selecting an UAV is more straightforward as it mostly relates with sensor compatibility, autonomy, reliability and cost, a hyperspectral sensor has much more to be considered. This note provides an assessment of two hyperspectral sensors (push-broom and snapshot) regarding practicality and suitability, within a precision viticulture context. The aim is to provide researchers, agronomists, winegrowers and UAV pilots with dependable data collection protocols and methods, enabling them to achieve faster processing techniques and helping to integrate multiple data sources. Furthermore, both the benefits and drawbacks of using each technology within a precision viticulture context are also highlighted. Hyperspectral sensors, UAVs, flight operations, and the processing methodology for each imaging type’ datasets are presented through a qualitative and quantitative analysis. For this purpose, four vineyards in two countries were selected as case studies. This supports the extrapolation of both advantages and issues related with the two types of hyperspectral sensors used, in different contexts. Sensors’ performance was compared through the evaluation of field operations complexity, processing time and qualitative accuracy of the results, namely the quality of the generated hyperspectral mosaics. The results shown an overall excellent geometrical quality, with no distortions or overlapping faults for both technologies, using the proposed mosaicking process and reconstruction. By resorting to the multi-site assessment, the qualitative and quantitative exchange of information throughout the UAV hyperspectral community is facilitated. In addition, all the major benefits and drawbacks of each hyperspectral sensor regarding its operation and data features are identified. Lastly, the operational complexity in the context of precision agriculture is also presented.

Multisite assessment of the impact of cell-free DNA-based screening for rare autosomal aneuploidies on pregnancy management and outcomes.

Cell-free (cf) DNA screening is a noninvasive prenatal screening approach that is typically used to screen for common fetal trisomies, with optional screening for sex chromosomal aneuploidies and fetal sex. Genome-wide cfDNA screening can screen for a wide variety of additional anomalies, including rare autosomal aneuploidies (RAAs) and copy number variants. Here, we describe a multi-cohort, global retrospective study that looked at the clinical outcomes of cases with a high-risk cfDNA screening result for a RAA. Our study cohort included a total of 109 cases from five different sites, with diagnostic outcome information available for 68% (74/109) of patients. Based on confirmatory diagnostic testing, we found a concordance rate of 20.3% for presence of a RAA (15/74) in our study population. Pregnancy outcome was also available for 77% (84/109) of cases in our cohort. Many of the patients experienced adverse pregnancy outcomes, including intrauterine fetal demise, fetal growth restriction, and preterm birth. These adverse outcomes were observed both in patients with fetal or placental confirmation of the presence of a RAA, as well as patients that did not undergo fetal and/or placental diagnostic testing. In addition, we have proposed some suggestions for pregnancy management and counseling considerations for situations where a RAA is noted on a cfDNA screen. In conclusion, our study has shown that genome-wide cfDNA screening for the presence of rare autosomal aneuploidies can be beneficial for both patients and their healthcare practitioners. This can provide a possible explanation for an adverse pregnancy outcome or result in a change in pregnancy management, such as increased monitoring for adverse outcomes.

Protocol for a mixed-methods and multi-site assessment of the implementation process and outcomes of a new community-based frailty programme

BackgroundFrailty is increasing in prevalence internationally with population ageing. Frailty can be managed or even reversed through community-based interventions delivered by a multi-disciplinary team of professionals, but to varying degrees of success. However, many of these care models’ implementation insights are contextual and may not be applicable in different cultural contexts. The Geriatric Service Hub (GSH) is a novel frailty care model in Singapore that focuses on identifying and managing frailty in the community. It includes key components of frailty care such as comprehensive geriatric assessments, care coordination and the assembly of a multi-disciplinary team. This study aims to gain insights into the factors influencing the development and implementation of the GSH. We also aim to determine the programme’s effectiveness through patient-reported health-related outcomes. Finally, we will conduct a healthcare utilisation and cost analysis using a propensity score-matched comparator group.MethodsWe will adopt a mixed-methods approach that includes a qualitative evaluation among key stakeholders and participants in the programme, through in-depth interviews and focus group discussions. The main topics covered include factors that affected the development and implementation of each programme, operations and other contextual factors that influenced implementation outcomes. The quantitative evaluation monitors each programme’s care process through quality indicators. It also includes a multiple-time point survey study to compare programme participants’ pre- and post- outcomes on patient engagement, healthcare services experiences, health status and quality of life, caregiver burden and societal costs. A retrospective cohort study will compare healthcare and cost utilisation between participants of the programme and a propensity score-matched comparator group.DiscussionThe GSH sites share a common goal to increase the accessibility of essential services to frail older adults and provide comprehensive care. This evaluation study will provide invaluable insights into both the process and outcomes of the GSH and inform the design of similar programmes targeting frail older adults.Trial RegistrationClinicalTrials.gov Identifier NCT04866316. Date of Registration April 26, 2021. Retrospectively registered.

Multisite assessment of emergency medicine resident knowledge of evidence-based medicine as measured by the Fresno Test of Evidence-Based Medicine.

Evidence-based medicine (EBM) is the application of scientific evidence while treating a patient. To date, however, there is very little evidence describing how residents in emergency medicine understand and incorporate EBM into practice. The aim of this study was to determine EBM theoretical and quantitative knowledge in emergency medicine residents in community hospital-based training programs. A sample of emergency medicine residents from nine hospitals was enrolled to complete a cross-sectional assessment of EBM skills from April 2021 through June 2021. Performance on the Fresno Test of Evidence-Based Medicine (FTEBM) was assessed utilizing descriptive statistics, t tests, and one-way analysis of variance. A total of 50.8% (124/244) of current emergency medicine residents completed the FTEBM during the study period. No significant difference on FTEBM scores was noted between the different types of medical degrees (DO vs. MD) (p=0.511), holding an advanced research degree (p=0.117), or between each postgraduate year of training (p=0.356). The mean score of those residents who rated their knowledge of EBM as average or higher was 36.0% (32.8-39.1%). The mean score of those residents who rated their programs as having an "average" or higher institutional focus on EBM was 34.9% (32.2-37.6%). Participating emergency medicine residents show an incomplete understanding of EBM both in theory and applied computations despite rating themselves as having an average understanding. Emergency medicine residencies would be well suited to implement a standardized EBM curriculum that focuses on longitudinal reinforcement of key concepts needed for the practicing physician.

Multisite assessment of the impact of a prenatal testing educational App on patient knowledge and preparedness for prenatal testing decision making

In this study, we wanted to assess the impact of the use of a patient educational app on patient knowledge about noninvasive prenatal testing (NIPT) and preparedness for prenatal screening decision-making. A randomized control study was carried out at three international sites between January 2019 and October 2020. Study participants completed a pre-consultation survey and post-consultation survey to assess knowledge, satisfaction, and preparedness for prenatal screening consultation. Providers completed a post-consultation survey. In the control arm, the pre-consultation survey was completed prior to consultation with their prenatal care provider. In the intervention arm, the pre-consultation survey was completed after using the app but prior to consultation with their prenatal care provider. Mean knowledge scores in the 203 participants using the app were significantly higher pre-consultation (p < 0.001) and post-consultation (p < 0.005) than those not using the app. Higher pre-consultation knowledge scores in the intervention group were observed at all sites. Most (86%) app users stated they were “Satisfied” or “Very Satisfied” with it as a tool. Providers rated the intervention group as more prepared than controls (p = 0.027); provider assessment of knowledge was not significantly different (p = 0.073). This study shows that clinical implementation of a patient educational app in a real-world setting was feasible, acceptable to pregnant people, and positively impacted patient knowledge.

A Multi-Site Assessment of Anesthetic Overdose, Hypothermic Shock, and Electrical Stunning as Methods of Euthanasia for Zebrafish (Danio rerio) Embryos and Larvae.

Simple SummaryZebrafish (Danio rerio) younger than five days post fertilization are not protected by legislation, and protocols for their euthanasia are poorly explored. In the present paper, we assess the euthanasic efficacy of anesthetic overdose, hypothermic shock, and electrical stunning on zebrafish at <12 h post fertilization, and 1 and 4 days post fertilization utilizing laboratories in different countries. Based on the survival/recovery rates 24 h after treatment, the most effective methods were an overdose with either clove oil or lidocaine with ethanol, and electrical stunning. For the oldest larvae, signs of aversion during treatment demonstrated that all the tested anesthetics, except lidocaine, induced aversive behavior. Therefore, the most suited anesthetic treatment was lidocaine hydrochloride, 1 g/L, buffered with 2 g/L of sodium bicarbonate and mixed with 50 mL/L of ethanol. Electrical stunning also euthanized embryos and larvae efficiently and without signs of aversion; this method is new and needs further assessment in other laboratories to draw firm conclusions.Euthanasia in zebrafish (Danio rerio) younger than 5 days post fertilization (dpf) is poorly described in the literature, and standardized protocols are lacking, most likely because larvae not capable of independent feeding are often not protected under national legislations. We assessed the euthanasia efficacy in laboratories in different countries of a one hour anesthetic overdose immersion with buffered lidocaine hydrochloride (1 g/L, with or without 50 mL/L of ethanol), buffered tricaine (1 g/L), clove oil (0.1%), benzocaine (1 g/L), or 2-phenoxyethanol (3 mL/L), as well as the efficacy of hypothermic shock (one hour immersion) and electrical stunning (for one minute), on zebrafish at <12 h post fertilization (hpf), 24 hpf, and 4 dpf. Based on the survival/recovery rates 24 h after treatment, the most effective methods were clove oil, lidocaine with ethanol, and electrical stunning. For 4 dpf larvae, signs of aversion during treatment demonstrated that all anesthetics, except lidocaine, induced aversive behavior. Therefore, the most suited euthanasic treatment was lidocaine hydrochloride 1 g/L, buffered with 2 g/L of sodium bicarbonate and mixed with 50 mL/L of ethanol, which euthanized both embryos and larvae in an efficient and stress-free manner. Electrical stunning also euthanized embryos and larvae efficiently and without signs of aversion; this method needs further assessment in other laboratories to draw firm conclusions.

Limited effect of wood ash application on soil quality as indicated by a multisite assessment of soil organic matter attributes

AbstractIn Canada, the combustion of forest biomass for bioenergy production has been increasing with an associated increase in residual wood ash. Wood ash is typically landfilled as waste but there is growing interest in applying wood ash to the soils of commercial forests. Ideally, wood ash supplies nutrients that may have been removed through biomass harvesting, increases soil pH, which improves nutrient availability, and potentially improves site productivity, but there is also potential for detrimental effects, such as toxicity, that impair soil functions. The objective of this study was to investigate the effects of wood ash application on soil organic matter attributes at eight experimental sites across Canada that are examining the effects of wood ash application on site fertility, productivity, and soil biodiversity. Wood ash application had an effect on total carbon (TC) and total nitrogen, microbial biomass carbon (MBC), hot water extractable carbon (HWEC), mineralizable C, sand size C, and HWEC and MBC normalized to TC, but changes were typically restricted to single sites or differed in their direction, that is, positive or negative. Based on the limited and inconsistent effects of ash on established indictors of soil quality measured in this study, there does not appear to be any advantageous or detrimental effects of adding wood ash to forest soil quality.

Development and Multisite Assessment of a Novel Shoulder Motion Joint Simulator

Multiple biomechanical shoulder simulators have been described in the literature, with a trend toward increasing complexity to better simulate clinical scenarios. Our objective was to develop an advanced, novel shoulder joint simulator and compare outcomes at two separate institutions, for a typical shoulder joint motion simulation. Identical shoulder simulators were developed & deployed at both institutions. Eight cadaveric upper extremities were tested by simulating actively controlled, arm elevation in the plane of the scapula for two sequential test conditions (intact and nondestructive simulated cuff-tear), each repeated for a total of five trials. Muscle forces and joint translations were recorded for both conditions. The intact condition was repeated following simulated cuff-tear to assess effect of testing order. Statistical analyses were aimed at assessing repeatability and reproducibility of results within specimens, between specimens, and between institutions. The highest average forces were observed for the middle deltoid (233N or 32.5% body weight (BW)), followed by infraspinatus (99.0N), and posterior deltoid (93.7N) muscles. Differentiation between test conditions was unhindered by variability between repeated trials. Data from testing repeated over time, and between the two institutions were not significantly different. The novel shoulder simulator produced repeatable results with low trial-to-trial variation and outcomes were comparable between the two institutions. The results demonstrated a consistent response in muscle forces and humeral translation for the simulated rotator cuff tear condition. Such advanced shoulder simulators could thus be used for evaluating and optimizing surgical interventions and implant strategies.

OC05.06: Multisite assessment of the impact of a prenatal testing educational app on patient knowledge and preparedness for prenatal testing decision making

OC05.06: Multisite assessment of the impact of a prenatal testing educational app on patient knowledge and preparedness for prenatal testing decision making

Multi-site assessment of rapid, point-of-care antigen testing for the diagnosis of SARS-CoV-2 infection in a low-prevalence setting: A validation and implementation study

BackgroundIn Australia, COVID-19 diagnosis relies on RT-PCR testing which is relatively costly and time-consuming. To date, few studies have assessed the performance and implementation of rapid antigen-based SARS-CoV-2 testing in a setting with a low prevalence of COVID-19 infections, such as Australia. MethodsThis study recruited participants presenting for COVID-19 testing at three Melbourne metropolitan hospitals during a period of low COVID-19 prevalence. The Abbott PanBioTM COVID-19 Ag point-of-care test was performed alongside RT-PCR. In addition, participants with COVID-19 notified to the Victorian Government were invited to provide additional swabs to aid validation. Implementation challenges were also documented. FindingsThe specificity of the Abbott PanBioTM COVID-19 Ag test was 99.96% (95% CI 99.73 - 100%). Sensitivity amongst participants with RT-PCR-confirmed infection was dependent upon the duration of symptoms reported, ranging from 77.3% (duration 1 to 33 days) to 100% in those within seven days of symptom onset. A range of implementation challenges were identified which may inform future COVID-19 testing strategies in a low prevalence setting. InterpretationGiven the high specificity, antigen-based tests may be most useful in rapidly triaging public health and hospital resources while expediting confirmatory RT-PCR testing. Considering the limitations in test sensitivity and the potential for rapid transmission in susceptible populations, particularly in hospital settings, careful consideration is required for implementation of antigen testing in a low prevalence setting. FundingThis work was funded by the Victorian Department of Health and Human Services. The funder was not involved in data analysis or manuscript preparation.

Multi-Site Assessment of Rapid, Point-of-Care Antigen Testing for the Diagnosis of SARS-CoV-2 Infection in a Low-Prevalence Setting: A Validation and Implementation Study

Background: In Australia, COVID-19 diagnosis relies on RT-PCR testing which is relatively costly and time-consuming. To date, no studies have assessed the performance and implementation of rapid antigen-based SARS-CoV-2 testing in a setting with a low prevalence of COVID-19 infections, such as Australia. Methods: This study recruited participants presenting for COVID-19 testing at three Melbourne metropolitan hospitals during a period of low COVID-19 prevalence. The Abbott PanBioTM COVID-19 Ag point-of-care test was performed alongside RT-PCR. In addition, participants with COVID-19 notified to the Victorian Government were invited to provide additional swabs to aid validation. Implementation challenges were also documented. Findings: The specificity of the Abbott PanBioTM COVID-19 Ag test was 99.96% (95% CI 99.73 - 100%). Sensitivity amongst participants with RT-PCR-confirmed infection was dependent upon the duration of symptoms reported, ranging from 78.9% (duration 1 to 33 days) to 100% in those within 7 days of symptom onset. A range of implementation challenges were identified which may inform future COVID-19 testing strategies in a low prevalence setting. Interpretation: Given the high specificity, antigen-based tests may be most useful in rapidly triaging public health and hospital resources while expediting confirmatory RT-PCR testing. Considering the limitations in test sensitivity and the potential for rapid transmission in susceptible populations, particularly in hospital settings, careful consideration is required for implementation of antigen testing in a low prevalence setting. Funding: This work was funded by the Victorian Department of Health and Human Services. The funder was not involved in data analysis or manuscript preparation.Declaration of Interests: All authors: no conflicts.Ethics Approval Statement: Ethics review and study approval was provided by Monash Health Human Research and Ethics Committee (RES-20-0000-678A) and local Governance approval was provided by Melbourne Health and Austin Health Offices for Research.