bluuebunny/crossref_metadata_2025 huggingface dataset:
The dynamic floor of Yellowstone Lake, Wyoming, USA: The last 14 k.y. of hydrothermal explosions, venting, doming, and faulting
Authors: Morgan L.A. , Shanks W.C.P. , Pierce K.L. , Iverson N. , Schiller C.M. , Brown S.R. , Zahajska P. , Cartier R. , Cash R.W. , Best J.L. , Whitlock C. , Fritz S. , Benzel W. , Lowers H. , Lovalvo D.A. , Licciardi J.M.
Published: June 2022

Hydrothermal explosions are significant potential hazards in Yellowstone National Park, Wyoming, USA. The northern Yellowstone Lake area hosts the three largest hydrothermal explosion craters known on Earth empowered by the highest heat flow values in Yellowstone and active seismicity and deformation. Geological and geochemical studies of eighteen sublacustrine cores provide the first detailed synthesis of the age, sedimentary facies, and origin of multiple hydrothermal explosion deposits. New tephrochronology and radiocarbon results provide a four-dimensional view of recent geologic activity since recession at ca. 15–14.5 ka of the >1-km-thick Pinedale ice sheet.

The sedimentary record in Yellowstone Lake contains multiple hydrothermal explosion deposits ranging in age from ca. 13 ka to ~1860 CE. Hydrothermal explosions require a sudden drop in pressure resulting in rapid expansion of high-temperature fluids causing fragmentation, ejection, and crater formation; explosions may be initiated by seismicity, faulting, deformation, or rapid lake-level changes. Fallout and transport of ejecta produces distinct facies of subaqueous hydrothermal explosion deposits. Yellowstone hydrothermal systems are characterized by alkaline-Cl and/or vapor-dominated fluids that, respectively, produce alteration dominated by silica-smectite-chlorite or by kaolinite. Alkaline-Cl liquids flash to steam during hydrothermal explosions, producing much more energetic events than simple vapor expansion in vapor-dominated systems. Two enormous explosion events in Yellowstone Lake were triggered quite differently: Elliott’s Crater explosion resulted from a major seismic event (8 ka) that ruptured an impervious hydrothermal dome, whereas the Mary Bay explosion (13 ka) was triggered by a sudden drop in lake level stimulated by a seismic event, tsunami, and outlet channel erosion.
Nanosized Modification of the Silicon Surface by the Method of Focused Ion Beams
Authors: Kots I. N. , Polyakova V. V. , Morozova Yu. V. , Kolomiytsev A. S. , Klimin V. S. , Ageev O. A.
Published: June 2022

This paper presents the results of experimental studies of the modes of formation of nanosized structures on the surface of a silicon substrate by the method of focused ion beams (FIB). The regularities of the effect of the ion beam current, accelerating voltage, and radiation dose on the surface morphology of nanoscale structures are determined. The modes under which the effects of implantation swelling (structure height up to 3 nm) and etching (structure depth up to 8 nm) manifest themselves are determined. The average roughness of the resulting structures varies from 0.13 to 0.24 nm. The results can be used in the development of technology for manufacturing instrument structures in nanoelectronics and nanophotonics.
Diagnosis and management of primary vulvar adenocarcinoma of mammary gland type: report of two distinct cases
Authors: Morais Mariana , Vaz Silva Joao , Tavares Mariana Vide
Published: June 2022

Adenocarcinoma of mammary gland type (AMGT) of the vulva is extremely rare and its aetiopathogenesis is not fully understood. Low incidence is partly responsible for the lack of guidelines for patient management. Here, two cases of postmenopausal patients diagnosed with AMGT with different therapeutical approaches are reported. Histopathological patterns are considered essential for diagnosis. The triple-negative immunohistochemical (IHC) profile of one of the cases represented a diagnostic challenge. Interestingly, it presented an immunophenotypical profile similar to triple-negative breast cancers, supporting the molecular similarities between vulvar AMGT and breast carcinomas. Surgical procedures include radical vulvectomy or radical local excision. Lymphatic involvement may be assessed by sentinel lymph node biopsy or lymphadenectomy. Adjuvant treatment was dependent on the IHC profile and disease staging. Although both cases had similar features on clinical examination, pathological and molecular characteristics and treatment approach were distinct. That illustrates the diagnostic and therapeutical challenge of this rare entity.
Inborn error of metabolism precipitated by COVID-19: challenges in the absence of an expanded newborn screening as state health programmes
Authors: Olety Priyanka , Safwan Gundyadka Moideen , Shenoy Rathika Damodara
Published: June 2022

Inborn errors of metabolism constitute a differential diagnosis in infants presenting with encephalopathy in developing countries where expanded newborn screening is not a state health programme. Acute neurological presentation with encephalopathy is documented in paediatric COVID-19. The pandemic has also altered parents' healthcare-seeking behaviour, leading to delays in emergency care. We illustrate the challenges faced in diagnosing and managing an 18-month-old child who presented with acute metabolic crisis due to methylmalonic acidaemia on the background of the COVID-19 pandemic. We discuss the current global status of expanded newborn screening services for inborn error of metabolism and the impact of the pandemic on the healthcare of children.
Use of continuous glucose monitor as a motivational device for lifestyle modifications to improve glycaemic control in patients with type 2 diabetes treated with non-insulin therapies
Authors: Farhan Hisham Ahmed , Bukhari Khulood , Grewal Navneet , Devarasetty Sranita , Munir Kashif
Published: June 2022

The efficacy of continuous glucose monitors (CGM) to improve glycaemic control in individuals on intensive insulin therapy (basal and prandial) has been well established in several studies; however, there is limited evidence on its usage and efficacy in patients with type 2 diabetes (T2D) who are on non-insulin therapies. Lifestyle modifications and glucose monitoring are essential components of the management of T2D. We report a case that demonstrates the impact of CGM use as an effective tool for patient education and motivation to implement and adhere to lifestyle modifications in improving glycaemic control in a patient with long-standing poorly controlled T2D who was on oral glucose-lowering medications. CGM use is associated with high level of patient satisfaction which can improve quality of life and has the potential to reduce long-term complications related to poor glycaemic control. These observations emphasise the need to broaden the use of CGM in this patient population.
IgA vasculitis with severe renal manifestation
Authors: Marques Dias Joana , Ferreira Marta Azevedo , Grilo Ana , Gonçalves Fernando Martos
Published: June 2022

IgA vasculitis is a rare systemic vasculitis in adults, frequently more severe than in paediatric age. It manifests with cutaneous, articular, gastrointestinal and renal involvement.

We present a case of a man in his 40s diagnosed with IgA vasculitis with cutaneous, joint, gastrointestinal and renal disease. Significant proteinuria and renal biopsy findings demonstrating crescentic glomerulonephritis led to the onset of early immunosuppression with corticoid and cyclophosphamide. This case report reflects a case of more severe renal impairment due to IgA vasculitis with good outcome with the chosen therapy. The findings in the renal biopsy after treatment supported the good response to the chosen immunosuppression.
Intermittent left bundle branch block with septal flash and postural orthostatic tachycardia syndrome in a young woman with long COVID-19
Authors: Kitsou Vasiliki , Blomberg Bjørn , Lunde Torbjørn , Saeed Sahrai
Published: June 2022

The emerging entity, long COVID -19 is characterised by long-lasting dyspnoea, fatigue, cognitive dysfunction and other symptoms. Cardiac involvement manifested as conduction abnormalities, left ventricle mechanical dyssynchrony, dyspnoea, palpitation and postural orthostatic tachycardia syndrome (POTS) are common in long COVID-19. The direct viral damage to the myocardium or immune-mediated inflammation are postulated mechanisms. A woman in her forties presented with a 2-month history of chest pain, functional dyspnoea, palpitation and an episode of syncope after having been home-isolated for mild COVID infection. During clinical workup, a clustering of ECG and echocardiographic abnormalities including left bundle branch block, septal flash, and presystolic wave on spectral Doppler echocardiography, and POTS were detected. The echocardiographic findings together with POTS and persistent dyspnoea indicated the presence of a long COVID-19 state. The prevalence and clinical significance of these finding, as well as the impact on long-term prognosis, should be investigated in future studies.
Phantosmia and psychogenic non-epileptic seizures in a patient with burning mouth syndrome suffering from severe depression
Authors: Grignoli Nicola , La Spina Alberto , Gabutti Luca
Published: June 2022

Burning mouth syndrome (BMS) is a rare but serious medical condition with important psychiatric comorbidity and specific psychological correlates. Psychopathology related with BMS represents a real challenge for clinical decision-making. In this case, depression is the leading psychiatric diagnosis associated with patient’s BMS somatic pain and is driven by anxiety and a dissociative functioning. Facing a complex psychosomatic symptomatology, we offer new clinical perspectives for the screening of psychological traits of BMS. Moreover, we highlight the need to foster interdisciplinarity to improve differential diagnosis and defining an optimal care path. This case report stimulates a reflection on management challenges for the consultation–liaison psychiatry and shows the importance of a person-centred approach when communicating the diagnosis.
Rare and complicated functional posterior mediastinal paraganglioma
Authors: SenthilKumar Gopika , Rokkas Chris K , Sheinin Yuri M , Linsky Paul L
Published: June 2022

Functional mediastinal paragangliomas (PGs) are rare, catecholamine-secreting tumours. Surgical resection is the preferred treatment, but it can be complicated by catecholamine-related symptoms, involvement of cardiac structures and/or tumour supply from major blood vessels. We report a case of a man in his 30s with a subcarinal functional PG complicated by all three factors. The PG had arterial supplies from the right coronary and bronchial arteries, with mass effect on the left atrium. Given the high risk of intraoperative bleeding, catecholamine surges and injury to right coronary artery, we attempted a minimally invasive strategy that incorporates best practices from the few published cases on functional PGs. We show that a multidisciplinary approach involving alpha/beta blockade, preoperative embolisation of tumour blood supply, robotic-assisted tumour mobilisation and, if needed, open resection with cardiopulmonary bypass can be a safe strategy in the treatment of functional mediastinal paragangliomas adherent to cardiac structures.
Why are women still leaving academic medicine? A qualitative study within a London Medical School
Authors: Salem Victoria , Hirani Dhruti , Lloyd Clare , Regan Lesley , Peters Christopher J
Published: June 2022

Objectives

To identify factors that influenced women who chose to leave academic medicine.

Design and main outcome measures

Independent consultants led a focus group of women in medicine who had left academia after completion of their postgraduate research degree at Imperial College London Faculty of Medicine. Thematic analysis was performed on the transcribed conversations.

Participants and setting

Nine women physicians who completed a postgraduate degree (MD or PhD) at a large London Medical School and Academic Health Sciences Centre, Imperial College London, but did not go on to pursue a career in academic medicine.

Results

Influences to leave clinical academia were summarised under eight themes—career intentions, supervisor support, institutional human resources support, inclusivity, work–life balance, expectations, mentors and role models, and pregnancy and maternity leave.

Conclusion

The women in our focus group reported several factors contributing to their decision to leave clinical academia, which included lack of mentoring tailored to specific needs, low levels of acceptance for flexible working to help meet parental responsibilities and perceived explicit gender biases. We summarise the multiple targeted strategies that Imperial College London has implemented to promote retention of women in academic medicine, although more research needs to be done to ascertain the most effective interventions.
Pairing regression and configurational analysis in health services research: modelling outcomes in an observational cohort using a split-sample design
Authors: Miech Edward J , Perkins Anthony J , Zhang Ying , Myers Laura J , Sico Jason J , Daggy Joanne , Bravata Dawn M
Published: June 2022

Background

Configurational methods are increasingly being used in health services research.

Objectives

To use configurational analysis and logistic regression within a single data set to compare results from the two methods.

Design

Secondary analysis of an observational cohort; a split-sample design involved randomly dividing patients into training and validation samples.

Participants and setting

Patients who had a transient ischaemic attack (TIA) in US Department of Veterans Affairs hospitals.

Measures

The patient outcome was the combined endpoint of all-cause mortality or recurrent ischaemic stroke within 1 year post-TIA. The quality-of-care outcome was the without-fail rate (proportion of patients who received all processes for which they were eligible, among seven processes).

Results

For the recurrent stroke or death outcome, configurational analysis yielded a three-pathway model identifying a set of (validation sample) patients where the prevalence was 15.0% (83/552), substantially higher than the overall sample prevalence of 11.0% (relative difference, 36%). The configurational model had a sensitivity (coverage) of 84.7% and specificity of 40.6%. The logistic regression model identified six factors associated with the combined endpoint (c-statistic, 0.632; sensitivity, 63.3%; specificity, 63.1%). None of these factors were elements of the configurational model. For the quality outcome, configurational analysis yielded a single-pathway model identifying a set of (validation sample) patients where the without-fail rate was 64.3% (231/359), nearly twice the overall sample prevalence (33.7%). The configurational model had a sensitivity (coverage) of 77.3% and specificity of 78.2%. The logistic regression model identified seven factors associated with the without-fail rate (c-statistic, 0.822; sensitivity, 80.3%; specificity, 84.2%). Two of these factors were also identified in the configurational analysis.

Conclusions

Configurational analysis and logistic regression represent different methods that can enhance our understanding of a data set when paired together. Configurational models optimise sensitivity with relatively few conditions. Logistic regression models discriminate cases from controls and provided inferential relationships between outcomes and independent variables.
819 What can you teach in 15 minutes? A pilot study of ‘just-in-time’ teaching in a paediatric emergency department
Authors: Tomlinson Patrick
Published: June 2022

Aims/Objectives/Background

The Emergency Department (ED) is a busy environment due to shift patterns and high acuity, which can make arranging formal teaching sessions difficult. We proposed daily ’15-minute Hot Topic Teaching’ sessions with feedback questionnaires used to evaluate these. The aim of this study was to assess the effectiveness of daily ’15-minute Hot Topic Teaching’ sessions in a Paediatric Emergency Department.

Methods/Design

A daily teaching programme was designed and implemented in a busy tertiary Paediatric Emergency Department. The teaching sessions were performed for 15 minutes at 1 pm on Monday to Friday for all clinical ED staff members. Following each teaching session, participants completed a feedback questionnaire to evaluate the teaching session. This assessed the ‘overall rating of the teaching session’, ‘change in confidence in application of knowledge’, and ‘the rating of how appropriate the length of the teaching session was’.

Results/Conclusions

Overall, 200 questionnaire feedbacks were completed. The average rating for the teaching sessions was 9.07/10 (0 being ‘very poor’ and 10 being ‘excellent’). The participants’ confidence in application of knowledge improved on average from 5.44/10 before the session to 8.04/10 following it (0 being ‘no confidence’ and 10 being ‘very confident’). The teaching session length was reported as ‘about right’ by 92%, with 8% stating they were either ‘too long’ or ‘too short’. ED clinical staff attending included doctors (47.5%), Advanced Nurse Practitioners (19.5%), nursing staff (12%), Physician Associates (9.5%), Health Case Assistants (3%), and ‘other’ members including medical students, nursing students and paramedic students (8.5%).

This study shows that daily 15-minute teaching sessions are an effective way of delivering teaching in a busy Paediatric Emergency Department to a wide variety of clinical staff. The sessions have improved confidence and knowledge in a variety of topics and are an appropriate length of time, making them ideal for use in Emergency Departments.
787 Evaluation of the role of anal tone and perianal sensation examination in the assessment of suspected cauda equina syndrome
Authors: Lopez Carlos Curtis , Berg Andrew , Clayton Bethan , Siddique Irfan , Carrasco Roberto , Horner Daniel , Angus Michelle
Published: June 2022

Aims/Objectives/Background

Cauda equina syndrome (CES) can present with a varied constellation of clinical signs and symptoms, which together with the time sensitive nature of the condition and risk of catastrophic clinical outcome, presents a significant challenge to those assessing patients with this suspected diagnosis. Anal tone is commonly tested during initial assessment using a digital rectal examination (DRE). This study aims to evaluate the diagnostic value of anal tone and perianal sensation assessment in patients with suspected CES and report modern prevalence data on CES within a neurosciences centre.

Methods/Design

Consecutive patients with suspected CES presenting over a three-year period to the Emergency Department (ED) of a busy tertiary centre were included in the study. History and examination findings, documented in the ED notes, were assessed and these variables were correlated with the presence or absence of cauda equina compression on subsequent magnetic resonance imaging (MRI).

Results/Conclusions

Out of 1005 patients with suspected CES, 117 (11.6%) had MRI confirmed cauda equina compression (MRI +ve CES). 35% of MRI +ve patients and 31% of MRI -ve patients had reduced anal tone. Using univariate and multivariable logistic regression analyses, no associations were found between abnormal anal tone and MRI +ve CES for patients of all ages. The univariate logistic regression analysis identified altered perianal sensation to be significantly associated with MRI +ve CES in patients ≤ 42 years old. This association was no longer present when an adjusted multivariable logistic regression was performed.

The prevalence of MRI +ve CES was 11.6%. Our findings suggest that the clinical finding of reduced anal tone has no demonstrable diagnostic value for those with suspected CES, either in itself or in combination with other clinical findings. Further studies are needed to confirm the diagnostic efficacy of assessing perianal sensation in this context.
1148 Harnessing a student network to support validation of the patient reported experience measure for over 65s attending the ED (PREM-ED 65+): Initial findings from a novel collaborative project
Authors: Graham Blair , Smith Jason , Nelmes Pam , Latour Jos
Published: June 2022

Aims/Objectives/Background

PREM-ED 65+ is an 83-item patient experience questionnaire for over-65s attending the ED. The final development stage will confirm psychometric properties in the real-world. Following recent successes of trainee-led collaborative studies, intercalated Urgent/Emergency Care students (University of Plymouth) were invited to participate in this study as student site investigators (SSIs).

We aim to outline this collaborative project and report challenges and successes encountered so far.

Methods/Design

A cross-sectional study was designed to administer PREM-ED 65+ to eligible patients upon discharge. Students were invited to review the protocol/SSI role at outset. Senior faculty agreed to their participation; timetable conflicts were avoided. NHS and University ethics were obtained.

Thirty- two students within 19 EDs volunteered to become SSIs (64% of the cohort). All underwent training. Existing mentors were co-recruited as site PIs. Commencement—planned January 2021—was delayed until Mid-May due to administrative reasons.

Results

Data collection is ongoing. Currently, twenty-two SSIs across 16 sites have recruited 272 participants in five weeks (median= 16 patients/site(R3—45); 10 accruals/SSI(R2—20)). Completion of all 83-items is near- perfect (97.8%). Sixty-four (23.5%) participants consented to a retest survey.

Average respondent age is 77 years (R65—100) with more females (58.6%). No differences in arrival mode or complaint type has been observed. Participant LOS is commonly >4 hours (51.3%) with very few treated within an hour (3.3%).

Per-item analysis will commence once the minimum sample (300) is achieved. Redundant items will be excluded; structural and criterion validity, and test- retest reliability will be assessed for remaining items.

Student feedback will be sought to evaluate the SSI role.

Conclusions

The student network has made an essential contribution. The efficiency of the collaborative model has mitigated significant commencement delay. Concerns such as conflicts with the academic programme have been allayed through involving students and faculty in design, and proactively arranging supervision and communication.
781 Drone delivered defibrillators (The 3D Project): a simulation study
Authors: Smith Christopher M , Sheehan Anthony , Rees Nigel , Powell Carl
Published: June 2022

Aims/Objectives/Background

Cardiopulmonary resuscitation (CPR) and defibrillation can double survival from out-of-hospital cardiac arrest. Members of the public can perform both before the arrival of the ambulance service, but they currently use a public-access Automated External Defibrillator (AED) in around only 5% of out-of-hospital cardiac arrests.

There are several barriers in getting an AED to a patient’s side promptly. One means of overcoming these barriers may be to deliver AEDs using Unmanned Aerial Vehicles (‘drones’). In this study we aimed to create a technologically feasible solution for drone-delivered defibrillation, and to investigate how easily a bystander performing CPR could use a drone-delivered AED.

Methods/Design

We developed a drone capable of flying an AED and lowering it to the ground via winch between July and September 2020 and tested the mechanism in October 2020. On 9thJuly 2021, we will conduct simulated cardiac arrests in an outdoor controlled test environment. Twenty participants will find a simulated patient, call an experienced 999 call-handler from Welsh Ambulance Service NHS Trust, and start CPR. Once cardiac arrest is confirmed during the 999 call a drone will take off, reach hovering altitude and lower the AED to the ground on-scene. The call-handler will alert the participant, who will then leave the patient to retrieve and attach the AED.

Hands-off CPR time is the primary outcome. Secondary outcomes are: time taken to reach the drone, recover the AED and apply it; usability of drone-delivered AEDs (using a questionnaire adapted from the System Usability Scale); and an exploration of participant behaviours by review of audio (999 calls) and video of the simulation.

Results/Conclusions

We will determine what additional burden there is for a lone bystander after introducing a drone-delivered AED to a simulated cardiac arrest scenario. This will inform future work developing protocols for drone delivery of AEDs in clinical trials.
1074 Ottawa Ankle rules cannot be safely used to rule out ankle fractures in patients who present ≥10 days post-injury
Authors: Anderson Richard , Green Amy , Davies Rhianna , Dew Lindsey , Harrison Mark
Published: June 2022

Aims/Objectives/Background

The Ottawa ankle rules (OAR) have been validated as a highly sensitive tool to rule out ankle fractures and reduce need for radiography. However, datasets validating OAR to date have excluded patients presenting ≥10 days post-injury and there is a need to ascertain if OAR can be safely used to rule out ankle fractures in this population.

Methods/Design

Patients presenting with ankle injuries to an emergency department (ED) in England between June 2015 and November 2020 were identified retrospectively through a clinical-coding search. Patient records were used to confirm the number of days between injury and presentation; those who presented ≥10 days post-injury were included for further analysis. Data was collected from ED documentation including region of pain, bony tenderness and weight-bearing status. OAR were used to categorise patients as ‘Ottawa-positive’, ‘Ottawa-negative’ or insufficient documentation. It was recorded whether the patient underwent radiography and whether the formal radiograph report confirmed a clinically-significant fracture. Patients who didn’t undergo radiography and didn’t subsequently re-present were deemed not to have a fracture. Data collected for each patient was checked and agreed by two authors.

Results/Conclusions

6782 patients presented with ankle injuries, of which 126 patients presented ≥10 days post-injury. Of these 126 patients, 9 were Ottawa-positive, 90 were Ottawa-negative and 27 patients had insufficient documentation. 85 patients underwent radiography and 19 were found to have clinically-significant fractures. Of these fracture patients, 4 were Ottawa-positive and 15 were Ottawa-negative.

Within our dataset, OAR demonstrated a sensitivity of 21.05%, specificity 93.75%, PPV 44.40% and NPV 83.30%. Using Fishers exact test, p=0.0658. OAR demonstrate poor sensitivity and cannot be safely used to rule out ankle fractures in patients who present ≥10 days post-injury. However, due to the p-value and low power there may be a risk of type 2 error and a larger study may prove otherwise.
1107 Real-world deployment of point-of-care SARS-CoV-2 testing in the emergency department admission pathway can support the safe, accurate and rapid diagnosis of COVID-19
Authors: Gunawardena Ramith , Merrick Blair , Gettings Holly , Douthwaite Sam , Nebbia Gaia , Webber Kay , Edgeworth Jonathan , Batra Rahul , Harrison Hooi-Ling
Published: June 2022

Aims/Objectives/Background

Patients admitted to hospital via the emergency department (ED) need to be separated by SARS-CoV-2 infection status to prevent transmission. Using clinical criteria alone is not feasible due to the range of symptoms and asymptomatic spread. Turnaround time of laboratory PCR assays (~6–24 hrs) hinders patient movement through the hospital with pressure on side-rooms pending results and exposure risk if unsuspected cases are moved into bays. Lateral flow devices (LFD) can provide a rapid diagnosis and aid patient movement. This implementation study aimed to assess the accuracy and safety of LFDs within an ED during a high-prevalence period.

Methods/Design

Two rapid point-of-care tests (POCT) were introduced during December 2020: Cobas®-Liat® system (Roche Diagnostics) is a 20-minute assay comparable to laboratory PCR (in-house validation), and LFDs. Symptomatic patients with a positive LFD were cohorted on a ‘red’ ward. Asymptomatic patients with a negative result were allocated an ‘amber’ ward, pending lab PCR. Where there were discrepancies between results and symptoms; a Liat® was performed.

The LFDs were validated by PCR swabs to determine true positive and false negative (FN) rates and to minimise fallout via contact tracing. The PCR cycle threshold (CT) values were recorded to evaluate the LFD sensitivity and specificity. Results were collected between December 2020-March 2021.

Results/Conclusions

Comparing LFD with PCR results, the sensitivity and specificity were 70.7% and 99.1%. LFD FNs had higher CT values (≥25), indicating the beginning or end of infection – unlikely infectious. One period of false positives during lower prevalence revealed a faulty batch. During the study period 90% of patients left the ED with a virological diagnosis.

We conclude that POCT can aid the diagnosis of COVID-19 in the ED when combined with existing laboratory-based PCR algorithms. We demonstrate a safe and effective use of POCT in the ED which could be replicated across other centres.
750 Is higher-level trauma centre care associated with better outcomes in patients injured by low-energy trauma? A systematic review
Authors: Tonkins Michael , Bradbury Daniel , Bramley Paul , Sabir Lisa , Wilkinson Anna , Lecky Fiona
Published: June 2022

Aims/Objectives/Background

Globally, trauma is a significant cause of morbidity and mortality globally. In high-income countries the demographic of major trauma is changing. Trauma patients are becoming older, more likely to have multiple comorbidities, and are being injured by low-energy mechanisms, chiefly ground-level falls. It is unknown whether existing trauma systems are equipped for the optimum management of these patients. Therefore, a systematic review was performed to investigate the association between higher-level trauma centre care and outcomes of adult patients who were admitted to hospital due to injuries sustained following low-energy trauma.

Methods/Design

A pre-registered systematic review of all major subject databases and grey literature archives supplemented by targeted manual searching was conducted in January 2021. Where necessary study authors were contacted. In the presence of study heterogeneity a narrative synthesis was pre-specified.

Abstract 750 Box 1Level 1:capable of providing total care for every aspect of injury, from prevention to rehabilitation. Level 1 centres are responsible for providing leadership in education, research, and system planning.Level 2:capable of providing initial definitive care except for particularly complex or specialised injuries.Level 3:capable of providing prompt assessment, resuscitation, stabilisation and transfer of patients when required.Level 4:provides advanced trauma life support in remote areas where no higher level of care is available.In the United Kingdom, ‘major trauma centres’ would be equivalent to a Level 1 or 2 trauma centre, and ‘trauma units’ equivalent to a Level 3 trauma centre.

Results/Conclusions

Of 2,898 potentially eligible unique records, three observational studies were included. Overall the studies’ risk of bias was moderate-to-serious due to potential residual confounding and selection bias. All studies compared outcomes among adults injured by ground-level falls who were treated in American College of Surgeons (ACS) verified trauma centres in the USA. The studies demonstrated divergent results, with one demonstrating improved outcomes in level 3 or 4 trauma centres (Observed:Expected Mortality 0.973, 95%CI 0.971–0.975), one demonstrating improved outcomes in level 1 trauma centres (Adjusted Odds Ratio 0.71, 95%CI 0.56–0.91), and one demonstrating no difference between level 1 or 2 and level 3 or 4 trauma centre care (Adjusted Odds Ratio 0.91 (0.80–1.04).

There is currently no clear evidence for the efficacy of major trauma centres in caring for adult patients injured by a ground-level fall. Further studies at lower risk of bias and studies conducted outwith the USA are required.
Epigenetics in IBD: a conceptual framework for disease pathogenesis
Authors: G Natasha , Zilbauer Matthias
Published: June 2022

The global incidence and prevalence of paediatric inflammatory bowel disease (IBD) is increasing, with a notable emergence in developing countries with historically low rates. This suggests that environmental and epigenetic factors may play an important role in the pathogenesis and progression of IBD. Epigenetics refers to the study of biological mechanisms that result in a change of phenotype, without an change in the underlying DNA sequence. Epigenetic mechanisms drive many biological processes that occur in health, such as development and ageing, and are also implicated in disease, including cancer and other inflammatory diseases. Importantly, identification of cell-type-specific epigenetic mechanisms could lead to the identification of molecular disease subtypes allowing a personalised treatment approach. In this short review, we provide a summary of epigenetic mechanisms operative in mammals, and their potential involvement in IBD pathogenesis. Furthermore, we discuss key challenges associated with investigating epigenetics in IBD and provide potential strategies to overcome these, such as through the use of ‘omics’ and organoid technologies.
Managing inoperable pancreatic cancer: the role of the pancreaticobiliary physician
Authors: Yau Chia Chuin , Leeds John
Published: June 2022

Despite our understanding of pancreatic cancer (PC), the majority of patients with this disease are incurable. Both the incidence and mortality rates for PC have increased over the last decade. At diagnosis, the majority of patients have locally advanced PC, less than 20% of patients are eligible for potentially curative resection and approximately one-third have metastatic disease. The combination of frequent advanced presentation, low resection rates and poor responses to chemotherapy make PC one of the most lethal tumours. The treatment goals are to maintain local control, manage tumour-related morbidities and improve quality of life. Patients with inoperable PC are likely to experience significant symptoms associated with their tumour, including pancreatic insufficiency, nutritional deficiencies, pain, biliary obstruction, gastric outlet obstruction and diabetes. As a result, guidance on the management of patients with inoperable PC is critical. PC is commonly referred centrally to specialist centres particularly for surgery; however, the majority do not undergo surgical intervention and thus the importance of pancreaticobiliary physicians and endoscopists. This review will focus on the non-operative management of patients with unresectable pancreatic adenocarcinoma and review some of the issues that centralisation has contributed to.
Biological mechanisms and clinical efficacy of sulforaphane for mental disorders
Authors: Zheng Wensi , Li Xiaolong , Zhang Tianhong , Wang Jijun
Published: June 2022

Current clinical management of major mental disorders, such as autism spectrum disorder, depression and schizophrenia, is less than optimal. Recent scientific advances have indicated that deficits in oxidative and inflammation systems are extensively involved in the pathogenesis of these disorders. These findings have led to expanded considerations for treatment. Sulforaphane (SFN) is a dietary phytochemical extracted from cruciferous vegetables. It is an effective activator of the transcription factor nuclear erythroid-2 like factor-2, which can upregulate multiple antioxidants and protect neurons against various oxidative damages. On the other hand, it can also significantly reduce inflammatory response to pathological states and decrease the damage caused by the immune response via the nuclear factor-κB pathway and other pathways. In this review, we introduce the biological mechanisms of SFN and the pilot evidence from its clinical trials of major mental disorders, hoping to promote an increase in psychiatric clinical studies of SFN.
Guideline-directed medical therapy after transcatheter edge-to-edge mitral valve repair
Authors: Tanaka Tetsu , Kavsur Refik , Spieker Maximilian , Iliadis Christos , Metze Clemens , Brachtendorf Birthe M , Horn Patrick , Zachoval Christian , Sugiura Atsushi , Kelm Malte , Baldus Stephan , Nickenig Georg , Westenfeld Ralf , Pfister Roman , Becher Marc Ulrich
Published: June 2022

Objective

A sizeable proportion of patients with secondary mitral regurgitation (SMR) do not receive guideline-directed medical therapy (GDMT) for heart failure (HF). We investigated the association between the use of GDMT and mortality in patients with SMR who underwent transcatheter edge-to-edge repair (TEER).

Methods

We retrospectively analysed patients with SMR and a left ventricular ejection fraction of <50% who underwent TEER at three centres. According to current HF guidelines, GDMT was defined as triple therapy consisting of beta-blockers, renin–angiotensin system (RAS) inhibitors and mineralocorticoid receptor antagonists (MRAs). Patients were divided into two groups: GDMT and non-GDMT groups. We calculated the propensity scores and carried out inverse probability of treatment weighting (IPTW) analyses to compare 2-year mortality between the two groups.

Results

Of 463 patients, 228 (49.2%) were treated with GDMT upon discharge. IPTW-adjusted Kaplan-Meier curve showed patients with GDMT had a lower incidence of mortality than those without GDMT (19.8% vs 31.1%, p=0.011). In IPTW-adjusted Cox proportional hazards analysis, GDMT was associated with a reduced risk of 2-year mortality (HR: 0.58; 95% CI: 0.35 to 0.95; p=0.030), which was consistent among clinical subgroups. Moreover, patients with GDMT had a higher rate of left ventricular reverse remodelling at 1 year after TEER than those without GDMT.

Conclusion

GDMT, defined as triple therapy consisting of beta-blockers, RAS inhibitors and MRAs, was associated with a reduced risk of 2-year mortality after TEER for SMR. Optimisation of medical therapy is crucial to improve clinical outcomes in patients undergoing TEER for SMR.
Noticing people, discounts and non-tobacco flavours in e-cigarette ads may increase e-cigarette product appeal among non-tobacco-using young adults
Authors: Chen-Sankey Julia , Jeong Michelle , Wackowski Olivia A , Unger Jennifer B , Niederdeppe Jeff , Bernat Edward , Bansal-Travers Maansi , Moran Meghan , Kennedy Ryan David , Broun Aaron , Hacker Kiana , Choi Kelvin
Published: June 2022

Introduction

Young adults new to tobacco (including e-cigarettes) are at an increased risk of e-cigarette use after e-cigarette exposure. This study examined the association between noticing e-cigarette advertising features and perceived product appeal among non-tobacco-using young adults.

Methods

A sample of non-tobacco-using young adults (ages 18–29 years; n=1993) completed an online survey in 2021. We content analysed visible features from 12 e-cigarette ads that represented commonly used e-cigarette brands. Participants viewed the ads and clicked on the areas of the ads that drew their attention. Participants reported e-cigarette product appeal for each ad, including ad liking, product curiosity and use interest. We used generalised estimating equations to examine within-person associations between noticing specific ad features and reporting each and any type of product appeal, adjusting for noticing other features and participant characteristics.

Results

Noticing people, discounts, non-tobacco (menthol and mint/fruit) flavours, positive experience claims or product images was positively associated with having any e-cigarette product appeal. Noticing discounts or mint/fruit flavours was also positively associated with e-cigarette use interest. In contrast, noticing nicotine warnings or smoking cessation claims was negatively associated with ad liking and product curiosity.

Conclusions

Attention to several e-cigarette ad features (eg, people, discounts, non-tobacco flavours) was associated with increased e-cigarette product appeal, whereas attention to nicotine warnings and smoking cessation claims was associated with reduced appeal among non-tobacco-using young adults. Restricting appeal-promoting features while strengthening the effects of nicotine warnings and smoker-targeted claims in e-cigarette ads may potentially reduce e-cigarettes’ overall appeal among this priority population.
Can’t see the flowers for the trees: factors driving floral abundance within early-successional forests in the central Appalachian Mountains
Authors: Mathis Codey L. , McNeil Darin J. , Lee Monica R. , Grozinger Christina M. , Otto Clint R.V. , Larkin Jeffery L.
Published: June 2022

Silviculture can be a powerful tool for restoring and enhancing habitat for forest-dependent wildlife. In eastern North America, regenerating timber harvests support abundant wildflowers that provide essential forage for native pollinators. Factors driving floral resource availability within regenerating forests remain almost entirely unstudied. Recent efforts to increase the area of regenerating forests (<10 years old) through overstory removal harvest in the central Appalachian Mountains provide an opportunity to investigate the development of forest wildflower communities following canopy removal. We conducted 1208 surveys of blooming plants across 143 harvests, recording 1 525 245 flowers representing 220 taxa spanning 47 families. The number of flowers within recently harvested stands was negatively associated with fern and sapling cover but positively associated with grass and bramble ( Rubus spp.) cover. Early in the growing season, more flowers bloomed in older regenerating stands (e.g., >5 years old), but this pattern reversed by the end of the growing season. Ultimately, our study demonstrates that the abundance of flowers available to pollinators within regenerating hardwood stands varies with factors associated with advancing succession. Recognizing the potential trade-off between woody regeneration (i.e., saplings) and pollinator forage availability may benefit forest managers who intend to provide floral resources to flower-dependent wildlife like pollinators via silviculture.
Opening the Black Box of Deep Learning: Some Lessons and Take-aways
Authors: Arora Sanjeev
Published: June 2022

Deep learning has rapidly come to dominate AI and machine learning in the past decade. These successes have come despite deep learning largely being a "black box." A small subdiscipline has grown up trying to derive better understanding of the underlying mathematical properties. Via a tour d'horizon of recent theoretical analyses of deep learning in some concrete settings, we illustrate how the black box view can miss out on (or even be wrong about) special phenomena going on during training. These phenomena are also not captured by the training objective. We argue that understanding such phenomena via mathematical understanding will be crucial for enabling the full range of future applications.
SUGAR: Speeding Up GPGPU Application Resilience Estimation with Input Sizing
Authors: Yang Lishan , Nie Bin , Jog Adwait , Smirni Evgenia
Published: June 2022

As Graphics Processing Units (GPUs) are becoming a de facto solution for accelerating a wide range of applications, their reliable operation is becoming increasingly important. One of the major challenges in the domain of GPU reliability is to accurately measure GPGPU application error resilience. This challenge stems from the fact that a typical GPGPU application spawns a huge number of threads and then utilizes a large amount of potentially unreliable compute and memory resources available on the GPUs. As the number of possible fault locations can be in the billions, evaluating every fault and examining its effect on the application error resilience is impractical. Application resilience is evaluated via extensive fault injection campaigns based on sampling of an extensive fault site space. Typically, the larger the input of the GPGPU application, the longer the experimental campaign.

In this work, we devise a methodology, SUGAR (Speeding Up G PGPU Application Resilience Estimation with input sizing), that dramatically speeds up the evaluation of GPGPU application error resilience by judicious input sizing. We show how analyzing a small fraction of the input is sufficient to estimate the application resilience with high accuracy and dramatically reduce the duration of experimentation. Key to our estimation methodology is the discovery of repeating patterns as a function of the input size. Using the well-established fact that error resilience in GPGPU applications is mostly determined by the dynamic instruction (DI) count at the thread level, we discover the patterns that allow to accurately predict application error resilience for arbitrarily large inputs. For the cases that we examine in this paper, this new resilience estimation provides significant speedups (up to 1336 times) and 97.0 on the average, while keeping estimation errors to less than 1%, for details see the full version of this SIGMETRICS paper.
Federated Bandit: A Gossiping Approach
Authors: Zhu Zhaowei , Zhu Jingxuan , Liu Ji , Liu Yang
Published: June 2022

We study Federated Bandit, a decentralized Multi-Armed Bandit (MAB) problem with a set of N agents, who can only communicate their local data with neighbors described by a connected graph G. Each agent makes a sequence of decisions on selecting an arm from M candidates, yet they only have access to local and potentially biased feedback/evaluation of the true reward for each action taken. Learning only locally will lead agents to sub-optimal actions while converging to a no-regret strategy requires a collection of distributed data. Motivated by the proposal of federated learning, we aim for a solution with which agents will never share their local observations with a central entity, and will be allowed to only share a private copy of his/her own information with their neighbors. We first propose a decentralized bandit algorithm GossipUCB, which is a coupling of variants of both the classical gossiping algorithm and the celebrated Upper Confidence Bound (UCB) bandit algorithm. We show that GossipUCB successfully adapts local bandit learning into a global gossiping process for sharing information among connected agents, and achieves guaranteed regret at the order of O(max(poly(N,M) log T, poly(N,M) logλ2-1 N)) for all N agents, where λ2∈(0,1) is the second largest eigenvalue of the expected gossip matrix, which is a function of G. We then propose FedUCB, a differentially private version of GossipUCB, in which the agents preserve ε-differential privacy of their local data while achieving O(max poly(N,M)/ε log2.5 T, poly(N,M) (logλ2-1 N + log T)) regret.
Competitive Algorithms for the Online Multiple Knapsack Problem with Application to Electric Vehicle Charging
Authors: Sun Bo , Zeynali Ali , Li Tongxin , Hajiesmaili Mohammad , Wierman Adam , Tsang Danny H.K.
Published: June 2022

We introduce and study a general version of the fractional online knapsack problem with multiple knapsacks, heterogeneous constraints on which items can be assigned to which knapsack, and rate-limiting constraints on the assignment of items to knapsacks. This problem generalizes variations of the knapsack problem and of the one-way trading problem that have previously been treated separately, and additionally finds application to the real-time control of electric vehicle (EV) charging. We introduce a new algorithm that achieves a competitive ratio within an additive factor of the best achievable competitive ratios for the general problem and matches or improves upon the best-known competitive ratio for special cases in the knapsack and one-way trading literatures. Moreover, our analysis provides a novel approach to online algorithm design based on an instance-dependent primal-dual analysis that connects the identification of worst-case instances to the design of algorithms. Finally, in the full version of this paper, we illustrate the proposed algorithm via trace-based experiments of EV charging.