bluuebunny/crossref_metadata_2025 huggingface dataset:
The Ship’s Doctor in the Royal Navy - 100 years of tradition and progress
Authors: McMenemy L , Bennett PM , Stapley SA
Published: February 2021

The changing role of the Senior Service over the past century through numerous militarily heterogeneous environments and operations has necessitated an evolution in the role of the deployed Medical Officer. However: versatility, specialist knowledge, caring for a wide and varied patient population of friendly and enemy forces, and the dual role of being an officer as well as a doctor, have remained consistent. Identifiable changes in military medical officer training, the shape of the Defence Medical Services, and modern advances in treatment and communication have evolved the Ship’s Doctor role from the pre-Second World War setting of a contracted Naval Medical Service, through growth, to a shrinking cadre again in a return to the contingency operations of today. Still, the role today remains attractive to a subset of doctors looking for something more from their medical practice; as the nature of conflict changes, so too will the role of the Ship’s Doctor. The ongoing requirement for flexibility and versatility will remain. Medical Officers will continue to meet the need to provide high quality care to their patients and, as has always been the case, will continue to be drawn to the Service’s principal appeal of an exciting world-wide role with the potential for unique experiences.
What do we need for airway management of adult casualties on the Primary Casualty Receiving Facility? A review of airway management on Role 3 Afloat
Authors: Mercer SJ , Read J , Sudheer Maj S , Risdall JE , Conor D
Published: February 2021

The Primary Casualty Receiving Facility (PCRF) of the Royal Navy (RN) is currently based on Royal Fleet Auxiliary (RFA) ARGUS and provides a functioning hospital with surgical teams and a CT scanner (Role 3) within the maritime environment. The case mix could include complex trauma, critically ill patients returning to theatre several times, as well as non-battle injury procedures. This paper describes how we have used national guidelines, evidence from recent military experience, and the Clinical Guidelines for Operations (CGOs) to review and rationalise the airway equipment that is available and that would be required for the PCRF in its current configuration, whilst maintaining capability in a deployed setting.
Abdominal hernias: a clinical review of their assessment and management in the Naval Service
Authors: Roy S , Khan M
Published: February 2021

Hernias are a relatively common occurrence in the armed forces community and may affect an individual’s fitness for duty and impact on operational capability, particularly in specialist occupations. Their early identification and management will allow appropriate treatment and minimise any impact on operational capability. This article aims to summarise the assessment and management of simple hernias and considers occupational considerations in their management for personnel serving in the Royal Navy and Royal Marines.
100 Years of British military neurosurgery: on the shoulders of giants
Authors: Roberts SAG
Published: February 2021

Death from head injuries has been a feature of conflicts throughout the world for centuries. The burden of mortality has been variously affected by the evolution in weaponry from war-hammers to explosive ordnance, the influence of armour on survivability and the changing likelihood of infection as a complicating factor. Surgery evolved from haphazard trephination to valiant, yet disjointed, neurosurgery by a variety of great historical surgeons until the Crimean War of 1853-1856. However, it was events initiated by the Great War of 1914-1918 that not only marked the development of modern neurosurgical techniques, but our approach to military surgery as a whole. Here the author describes how 100 years of conflict and the input and intertwining relationships between the 20th century’s great neurosurgeons established neurosurgery in the United Kingdom and beyond.
The early management of the burned patient in the Naval service
Authors: Rylah OJA , Smith JJ
Published: February 2021

Burns represent a perpetual threat in military combat and are a pervasive threat in the land, maritime and air arenas. Therefore, it is imperative that military clinicians are well versed in managing burns in order to ensure optimal survival and recovery. This article aims to explore the epidemiology, pathophysiology, assessment and early management of the burned patient with a focus on the austere maritime environment and current military guidance.
Meningitis in service-age personnel
Authors: Miller R , Houlberg K
Published: February 2021

The incidence of meningitis is declining in the UK population largely due to increased availability of vaccinations against the most common bacterial strains. Acute bacterial meningitis, however, is a life-threatening condition and distinguishing it from more benign causes of headache and fever is difficult in an operational environment due to limited access to diagnostic tests. Despite medical advances, the case fatality rate in the United Kingdom in adults with invasive meningococcal disease is 10.5%. Acute bacterial meningitis presents with the classical triad of fever, neck pain and altered mental state in less than half of adults, and in the initial course of the disease it frequently mimics common viral illnesses. The aim of this article is to discuss the recognition and management of meningitis with special emphasis on the deployed military environment.
Action Stations! 100 years of trauma care on maritime and amphibious operations in the Royal Navy
Authors: Osborne M , Smith JE
Published: February 2021

Over the past century trauma care within the Royal Navy (RN) has evolved; wartime experiences and military medical research have combined to allow signifi cant improvement in the care of casualties. This article describes the key maritime and amphibious operations that have seen the Royal Navy Medical Service (RNMS) deliver high levels of support to wherever the Naval Service has deployed in the last 100 years. Key advancements in which progress has led to improved outcomes for injured personnel are highlighted – the control and treatment of blood loss, wound care, and the prevention and management of organ failure with optimal resuscitation.

Historians often point out how slowly military medicine progressed for the fi rst few thousand years of its recorded history, and how quickly it has progressed in the last century. This refl ective article will show how the RNMS has been an integral part of that story, and how the lessons learnt by our predecessors have shaped our modern day doctrine surrounding trauma care.
The diagnosis and management of insomnia in the United Kingdom Armed Forces
Authors: Baker LD , Coetzee RH
Published: February 2021

Insomnia is a common condition among patients presenting to primary care facilities in both civilian and military populations. This article considers the diagnosis, management and clinical considerations of managing this condition, along with the occupational and operational considerations for the United Kingdom Armed Forces.
Surgery in an Afghan population: is pictorial consent and injury pattern recognition identification of patients appropriate?
Authors: Matheson A S , Howes R D , Midwinter M J , Lambert A W
Published: February 2021

Structured Abstract

Surgery in an Afghan population: is pictorial consent and injury pattern recognition identification of patients appropriate?

Objective

The aim of this study was to develop a safe way to obtain informed consent and ensure the correct patient was operated on in a generally poorly educated, non-English speaking Afghan patient population admitted to a military role 2 (enhanced) hospital facility.

Summary Background Data

Prior to Herrick 9, surgical consent for Afghan patients was obtained via an interpreter in the traditional manner and documented on a UK formatted consent form (MOD form 660) (group 1) with patient identification largely being the responsibility of the interpreter. Patient agreement was documented by placing a thumbprint on the form. During Herrick 9, pictorial consent and injury pattern recognition (IPR) identification of patients was introduced. The consent was written as part of the case note narrative with diagrammatic representation of the injuries and the proposed surgery, which was explained by the interpreter (Group 2).

Methods

We compared the consent and identification process for ten consecutive patients from each group. Each method of consent was examined for documentary evidence of the procedure, patient identification and method of patient agreement. The senior Afghan interpreter was asked for his personal views on the benefit or otherwise of the pictorial consent.

Results

For group 1, each of the nine MOD form 660s were completed in English by the operating surgeon and included details of the procedure. Seven had been signed by the interpreter. Each had a thumbprint on the form but there was no name or date alongside it. There was no way of confirming that the thumbprint was that of a particular patient.

For group 2, pictorial consent was documented in the narrative with specific documentation of the injury pattern of that patient. Confirmation of consent and patient identification by IPR was by the operating surgeon.

Conclusions

When possible, informed consent is required for all patients undergoing surgery in line with Department of Health guidelines. The use of pictorial consent and IPR identification, as part of patient documentation, would appear to be superior in this particular environment.
Maritime Pre-Hospital Emergency Care Primary Retrieval Team – Operational Considerations
Authors: Newman D
Published: February 2021

This article examines the non clinical skills and training required for effective maritime pre-hospital emergency care provision within a Role Two Afloat facility, allowing for a Primary Retrieval Team to be deployed in support of boarding operations. The provision of pre-hospital emergency care and sending a retrieval team forward has been trialled in various forms. In 2010 and 2011 a R2A team was deployed aboard RFA FORT VICTORIA. This included a Primary Retrieval Team consisting of an Emergency Nurse Specialist, a Medical Assistant which can be enhanced when required by an Emergency Care or Anaesthetic Consultant. This differs from the land operations support provided by the airborne Medical Emergency Response Team (MERT) as the maritime environment requires a bespoke solution for casualty retrieval as the method of deployment and the type of casualties and their locations may be more varied, requiring greater flexibility of approach.
Chronic Fatigue Syndrome in the UK Armed Forces
Authors: LeQ Blackadder-Coward J C , Perry S
Published: February 2021

Chronic Fatigue Syndrome (CFS) is a debilitating condition that can have a significant impact on the lives of patients and those who care for them. In the UK Armed Forces this condition can also have a marked impact on a patient’s career and their ability to function in the deployed environment. In this article the recognition and management of CFS will be discussed, as well as the occupational considerations within the UK Armed Forces.
The primary care diagnosis and management of social phobia and its relevance in the UK Armed Forces
Authors: Dubif JR , Coetzee RH
Published: February 2021

Social phobia can be a distressing anxiety disorder that in the clinical experience of the authors may be under-recognised in the UK Armed Forces. In this article we consider the diagnosis and management of social phobia. We also discuss the occupational and operational considerations for the military environment.
Pre-hospital, Maritime In-Transit Care from a Role 2 Afloat Platform
Authors: Whalley L , Smith S
Published: February 2021

Maritime In-Transit Care (MITC) is a new concept to allow the provision of pre-hospital care in the maritime environment within Role 2 Afloat (R2A) teams. This article describes the experiences of an Emergency Medicine nurse and a Medical Assistant who made up the MITC team on the recent R2A exercise on RFA CARDIGAN BAY. As well as describing their personal experiences, the concept of the MITC team is introduced and their role within R2A outlined.
Emergency Medicine in Role 2 Afloat
Authors: Doherty S , Gilbert S , Henning D C W
Published: February 2021

The Emergency Medicine aspects of care are described from recent experience of exercising a Role 2 Afloat team on board RFA CARDIGAN BAY. Lessons learned specific to this platform are outlined, as well as the more general issues of delivering Emergency Medicine in the maritime environment.
Critical care on Role 2 Afloat: a nursing perspective
Authors: Robinson L , Norrie W
Published: February 2021

The experience of two specialist nurses providing critical care on board RFA CARDIGAN BAY during a recent Role 2 Afloat exercise is described. In addition, the lessons learned are discussed and the limitations of critical care provision at sea in the Role 2 Afloat team are outlined.
The sensitivity of pre-hospital and in-hospital tools for the identification of major trauma patients presenting to a major trauma centre.
Authors: Potter D , Kehoe A , Smith JE
Published: February 2021

The identification of major trauma patients before arrival in hospital allows the activation of an appropriate trauma response. The Wessex triage tool (WTT) uses a combination of anatomical injury assessment and physiological criteria to identify patients with major trauma suitable for triage direct to a major trauma centre (MTC), and has been adopted by the South-West Peninsula Trauma Network (PTN). A retrospective database review, using the Trauma Audit Research Network (TARN) database, was undertaken to identify a population of patients presenting to Derriford Hospital with an injury severity score (ISS) > 15. The WTT was then applied to this population to identify the sensitivity of the tool. The sensitivity of the WTT at identifying patients with an ISS>15 was 53%. One of the reasons for this finding was that elderly patients who are defined as having major trauma due to the nature of their injuries, but who did not have a mechanism to suggest they had sustained major trauma (such as a fall from standing height), were not identified by these triage tools. The implications of this are discussed.
Bilateral chemical eye injury resulting from airbag deployment
Authors: Welch J F
Published: February 2021

A case report highlighting an unusual cause of a chemical injury and an explanation of the basic initial management of chemical eye injuries: relevant to all Armed Forces medical personnel.
Safety of the APOLLO Onyx delivery microcatheter for embolization of brain arteriovenous malformations: results from a prospective post-market study
Authors: Meyers Philip M , Fifi Johanna T. , Cockroft Kevin M. , Miller Timothy R. , Given Curtis A. , Zomorodi Ali R. , Jagadeesan Bharathi D. , Mokin Maxim , Kan Peter , Yao Tom L. , Diaz Orlando , Huddle Daniel , Bellon Richard J. , Seinfeld Joshua , Polifka Adam J , Fiorella David , Chitale Rohan V. , Kvamme Peter , Morrow Jay T. , Singer Justin , Wakhloo Ajay K. , Puri Ajit S. , Deshmukh Vivek R. , Hanel Ricardo A. , Gonzalez L. Fernando , Woo Henry H. , Aziz-Sultan Mohammad Ali
Published: February 2021

Background

Catheter retention and difficulty in retrieval have been observed during embolization of brain arteriovenous malformations (bAVMs) with the Onyx liquid embolic system (Onyx). The Apollo Onyx delivery microcatheter (Apollo) is a single lumen catheter designed for controlled delivery of Onyx into the neurovasculature, with a detachable distal tip to aid catheter retrieval. This study evaluates the safety of the Apollo for delivery of Onyx during embolization of bAVMs.

Methods

This was a prospective, non-randomized, single-arm, multicenter, post-market study of patients with a bAVM who underwent Onyx embolization with the Apollo between May 2015 and February 2018. The primary endpoint was any catheter-related adverse event (AE) at 30 days, such as unintentional tip detachment or malfunction with clinical sequelae, or retained catheter. Procedure-related AEs (untoward medical occurrence, disease, injury, or clinical signs) and serious AEs (life threatening illness or injury, permanent physiological impairment, hospitalization, or requiring intervention) were also recorded.

Results

A total of 112 patients were enrolled (mean age 44.1±17.6 years, 56.3% men), and 201 Apollo devices were used in 142 embolization procedures. The mean Spetzler–Martin grade was 2.38. The primary endpoint was not observed (0/112, 0%). The catheter tip detached during 83 (58.5%) procedures, of which 2 (2.4%) were unintentional and did not result in clinical sequelae. At 30 days, procedure related AEs occurred in 26 (23.2%) patients, and procedure-related serious AEs in 12 (10.7%). At 12 months, there were 3 (2.7%) mortalities, including 2 (1.8%) neurological deaths, none of which were device-related.

Conclusion

This study demonstrates the safety of Apollo for Onyx embolization of bAVMs.

Clinical trial registration

CNCT02378883.
Duration of symptomatic stroke and successful reperfusion with endovascular thrombectomy for anterior circulation large vessel occlusive stroke
Authors: de Havenon Adam , Alexander Matthew D , Nogueira Raul G , Haussen Diogo C , Castonguay Alicia C , Linfante Italo , Johnson Michael Austin , Nguyen Thanh N , Mokin Maxim , Zaidat Osama O
Published: February 2021

Background

It has been reported that longer time intervals from stroke onset to endovascular therapy are associated with lower rates of successful reperfusion in acute ischemic stroke patients with large vessel occlusion. However, procedural variables and potential mechanisms of this association have not been fully elucidated.

Methods

We performed a secondary analysis of individual patient data from the North American Solitaire Stent Retriever Acute Stroke (NASA) and Trevo Stent-Retriever Acute Stroke (TRACK) registries. We included patients with occlusion of the internal carotid artery or middle cerebral artery (M1 and M2 segments) who were treated by mechanical thrombectomy within 24 hours of last known normal. The primary outcome was reperfusion, defined as a Thrombolysis In Cerebral Infarction (TICI) score ≥2b. The secondary outcome was reperfusion on the first pass. The primary predictor was duration of symptomatic stroke, defined as time from last known normal to time of final pass. Adjusted logistic regression models were utilized to determine associations between variables and outcome.

Results

We included 506 patients, of which 401 (79.3%) achieved successful reperfusion (TICI 2b/3). The mean (SD) duration of symptomatic stroke was 6.8 (3.5) hours and in the adjusted logistic regression model the duration of symptomatic stroke was associated with reperfusion (OR 0.90, 95% CI 0.84 to 0.96) and reperfusion on the first pass (OR 0.89, 95% CI 0.83 to 0.95). In that model, the predicted probability of reperfusion was 88% (95% CI 0.83 to 0.92) at 1 hour, 81% (95% CI 0.78 to 0.84) at 6 hours, 70% (95% CI 0.63 to 0.77) at 12 hours, and 42% (95% CI 0.17 to 0.67) at 24 hours (ptrend=0.001). Reperfused patients were significantly younger, more likely to be male, and to have had a balloon guide catheter used during the procedure.

Conclusion

In a real-world cohort of acute ischemic stroke patients with anterior circulation occlusion treated with endovascular therapy, longer duration of symptomatic stroke is associated with lower rates of successful reperfusion and reperfusion on the first pass.
Daring discourse: should acute pain medicine be a stand-alone service?
Authors: Missair Andres , Visan Alexandru , Ivie Ryan , Gebhard Ralf E , Rivoli Stephen , Woodworth Glenn
Published: February 2021

Acute pain medicine (APM) has been incorporated into healthcare systems in varied manners with some practices implementing a stand-alone acute pain service (APS) staffed by consultants who are not simultaneously providing care in the operating room (OR). In contrast, other practices have developed a concurrent OR-APS model where there is no independent team beyond the intraoperative care providers. There are theoretical advantages of each approach primarily with respect to patient outcomes and financial cost, and there is little evidence to instruct best practice. In this daring discourse, we present two opposing perspectives on whether or not APM should be a stand-alone service. While evidence to guide best practice is limited, our goal is to encourage discussion of the varied APS practice models and research into their impact on outcomes and costs.
Long-term safety and efficacy of sirukumab for patients with rheumatoid arthritis who previously received sirukumab in randomised controlled trials (SIRROUND-LTE)
Authors: Aletaha Daniel , Bingham Clifton O , Karpouzas George Athanasios , Takeuchi Tsutomu , Thorne Carter , Bili Androniki , Agarwal Prasheen , Hsu Benjamin , Rao Ravi , Brown Kurt , Tanaka Yoshiya
Published: February 2021

Objective

Interleukin (IL)-6 is a pleiotropic cytokine involved in the pathophysiology of rheumatoid arthritis (RA). Sirukumab is a human monoclonal antibody that binds to IL-6 with high affinity and specificity.

Methods

This long-term extension (LTE) study of the SIRROUND-D and SIRROUND-T studies assessed long-term safety and efficacy of sirukumab in adults with moderate-to-severe RA refractory to conventional disease-modifying antirheumatic drug therapy or antitumor necrosis factor agents. Patients received sirukumab 100 mg subcutaneously (SC) every 2 weeks (q2w) or sirukumab 50 mg SC every 4 weeks (q4w).

Results

1820 patients enrolled in the LTE; median exposure was 2.34 and 2.07 years in sirukumab 50 mg q4w and 100 mg q2w groups, respectively. Adverse events (AEs) occurred in similar proportions between groups, with the exception of major adverse cardiovascular events (MACE), which were more common in the 50 mg q4w versus 100 mg q2w group (2.2% vs 1.0%), and injection-site reactions, more common in the 100 mg q2w group versus 50 mg q4w group (7.5% vs 3.7%). The most common serious AEs were infections (10% of the patients); 32 (1.8%) patients died during the study (primarily from serious infection and MACE). Malignancies were reported in 24 (1.3%) patients. Gastrointestinal perforations, hepatobiliary abnormalities and changes in laboratory parameters were rare. Reductions in RA signs and symptoms and improvements in physical function were maintained throughout the LTE.

Conclusions

The safety profile of sirukumab in the LTE remained consistent with that reported in SIRROUND-D and SIRROUND-T and efficacy was maintained.

Trial registration number

NCT01856309.
Significant flow velocity reduction at the intracranial aneurysm neck after endovascular treatment leads to favourable angiographic outcome: a prospective study
Authors: Tian Zhongbin , Liu Jian , Kumar Jay , Li Wenqiang , Zhang Yisen , Zhang Ying , Wang Kun , Wang Shengzhang , Ren Zeguang , Yang Xinjian
Published: February 2021

Background

With widely usage of flow diverter in intracranial aneurysm treatment, some previously used predictors may not be effective in evaluating the recurrence risk. We aimed to comprehensively re-evaluate the predictors of intracranial aneurysm outcome with various endovascular treatment methods and devices.

Methods

This is a prospective registered study. We analysed 6-month and 18-month follow-up angiographic data from the prospective study. Data on patient demographics, aneurysm morphology and type of treatment were recorded. Patient-specific haemodynamic simulations were performed. An unfavourable angiographic outcome was defined as recurrence of aneurysm in cases with coiling or stent-assisted coiling, patency of aneurysm in cases with flow diverters or retreatment during follow-up.

Results

In total, 165 patients (177 intracranial aneurysms) with at least one angiographic follow-up data were analysed. For the short-term (6-month) results, after univariate analysis, the demographic, morphological and treatment-related factors did not achieve significantly statistical differences. The reduction ratio (RR) of velocity at aneurysm neck after embolisation was significantly lower in the unfavourable angiographic group than the favourable angiographic outcome group (p=0.002). After the Cox regression analysis, the RR of velocity at aneurysm neck was the only independent factor associated with favourable angiographic outcome (OR 0.028; p=0.001) and had an acceptable area under the curve (0.714) with a clear cut-off value (46.14%). Similarly, for the analysis of midterm (18-month) results, the RR of velocity at the aneurysm neck was the only independent significant factor for the unfavourable angiographic outcome (OR 0.050; p=0.017). The area under the curve was 0.754 and the cut-off value was 48.20%.

Conclusions

The haemodynamics showed an independent effect on angiographic follow-up results and may provide helpful suggestions for clinical practice in the future.
Smoking influences outcome in patients who had thrombolysed ischaemic stroke: the ENCHANTED study
Authors: Sun Lingli , Song Lili , Yang Jie , Lindley Richard I , Robinson Thompson , Lavados Pablo M , Delcourt Candice , Arima Hisatomi , Ovbiagele Bruce , Chalmers John , Anderson Craig S , Wang Xia
Published: February 2021

Background and purpose

As studies vary in defining the prognostic significance of smoking in acute ischaemic stroke (AIS), we aimed to determine the relation of smoking and key outcomes in patient participants who had thrombolysed AIS of the international quasi-factorial randomised Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED).

Methods

Post-hoc analyses of ENCHANTED, an international quasi-factorial randomised evaluation of intravenous alteplase-dose comparison and levels of blood pressure control in patients who had thrombolysed AIS. Multivariable logistic regression models with inverse probability of treatment weighting (IPTW) propensity scores were used to determine associations of self-reported smoking status and clinical outcomes, according to 90-day modified Rankin Scale (mRS) scores and symptomatic intracerebral haemorrhage (sICH).

Results

Of 4540 patients who had an AIS, there were 1008 (22.2%) current smokers who were younger and predominantly male, with more comorbidities of hypertension, coronary artery disease, atrial fibrillation and diabetes mellitus, and greater baseline neurological impairment, compared with non-smokers. In univariate analysis, current smokers had a higher likelihood of a favourable shift in mRS scores (OR 0.88, 95% CI 0.77 to 0.99; p=0.038) but this association reversed in a fully adjusted model with IPTW (adjusted OR 1.15, 95% CI 1.04 to 1.28; p=0.009). A similar trend was also apparent for dichotomised poor outcome (mRS scores 2–6: OR 1.18, 95% CI 1.05 to 1.33; p=0.007), but not with the risk of sICH across standard criteria.

Conclusion

Smoking predicts poor functional recovery in patients who had thrombolysed AIS.

Trial registration number

NCT01422616.
Lower risk of subarachnoid haemorrhage in diabetes: a nationwide population-based cohort study
Authors: Kim Jang Hoon , Jeon Jimin , Kim Jinkwon
Published: February 2021

Background and purpose

Diabetes mellitus (DM) is a common metabolic disorder with increased risk of cardiovascular and cerebrovascular complications. However, its relationship with risk of subarachnoid haemorrhage (SAH), the most devastating form of stroke, remains controversial.

Methods

To evaluate the relationship between DM and risk of SAH, we performed a retrospective cohort study using a nationwide, population‐based, health screening database in Korea. We included participants without history of stroke who underwent a nationwide health screening programme between 2003 and 2004. Primary outcome was occurrence of SAH. Participants were followed up until development of SAH or December 2015. Multivariate Cox proportional hazards regression analysis was performed with adjustments for age, sex, systolic blood pressure, total cholesterol, body mass index, physical activity, smoking status, alcohol habit, household income and treatment with antihypertensive agents and statins.

Results

Among 421 768 study participants, prevalence of DM was 9.6%. During a mean follow-up period of 11.6±1.9 years, 1039 patients developed SAH. Presence of DM was significantly associated with decreased risk of SAH (adjusted HR 0.68; 95% CI 0.53 to 0.86; p<0.001). Elevated level of fasting blood glucose was also negatively associated with risk of SAH (adjusted HR per 1 mmol/L increase 0.90; 95% CI 0.86 to 0.95; p<0.001).

Conclusion

DM and elevated level of fasting blood glucose were inversely associated with risk of SAH. Further studies may elucidate the possibly protective, pathophysiological role played by hyperglycaemia in patients at risk of SAH.
Deep learning for automatically predicting early haematoma expansion in Chinese patients
Authors: Zhong Jia-wei , Jin Yu-jia , Song Zai-jun , Lin Bo , Lu Xiao-hui , Chen Fang , Tong Lu-sha
Published: February 2021

Background and purpose

Early haematoma expansion is determinative in predicting outcome of intracerebral haemorrhage (ICH) patients. The aims of this study are to develop a novel prediction model for haematoma expansion by applying deep learning model and validate its prediction accuracy.

Methods

Data of this study were obtained from a prospectively enrolled cohort of patients with primary supratentorial ICH from our centre. We developed a deep learning model to predict haematoma expansion and compared its performance with conventional non-contrast CT (NCCT) markers. To evaluate the predictability of this model, it was also compared with a logistic regression model based on haematoma volume or the BAT score.

Results

A total of 266 patients were finally included for analysis, and 74 (27.8%) of them experienced early haematoma expansion. The deep learning model exhibited highest C statistic as 0.80, compared with 0.64, 0.65, 0.51, 0.58 and 0.55 for hypodensities, black hole sign, blend sign, fluid level and irregular shape, respectively. While the C statistics for swirl sign (0.70; p=0.211) and heterogenous density (0.70; p=0.141) were not significantly higher than that of the deep learning model. Moreover, the predictive value for the deep learning model was significantly superior to that of the logistic model of haematoma volume (0.62; p=0.042) and the BAT score (0.65; p=0.042).

Conclusions

Compared with the conventional NCCT markers and BAT predictive model, the deep learning algorithm showed superiority for predicting early haematoma expansion in ICH patients.
Patterns of antidepressant therapy and clinical outcomes among ischaemic stroke survivors
Authors: Etherton Mark R , Shah Shreyansh , Haolin Xu , Xian Ying , Maisch Lesley , Hannah Deidre , Lindholm Brianna , Lytle Barbara , Thomas Laine , Smith Eric E , Fonarow Gregg C , Schwamm Lee H , Bhatt Deepak L , Hernandez Adrian F , O'Brien Emily C
Published: February 2021

Background and purpose

Depression is common after stroke and is often treated with antidepressant medications (AD). ADs have also been hypothesised to improve stroke recovery, although recent randomised trials were neutral. We investigated the patterns of in-hospital AD initiation after ischaemic stroke and association with clinical and readmission outcomes.

Methods

All Medicare fee-for-service beneficiaries aged 65 or older hospitalised for ischaemic stroke in participating Get With The Guidelines-Stroke hospitals between April and December 2014 were eligible for this analysis. Outcome measures included days alive and not in a healthcare institution (home time), all-cause mortality and readmission within 1-year postdischarge. Propensity score (PS)-adjusted logistic regression models were used to evaluate the associations between AD use and each outcome measure. We also compared outcomes in patients prescribed selective serotonin reuptake inhibitors (SSRIs) AD versus those prescribed non-SSRI ADs.

Results

Of 21 805 AD naïve patients included in this analysis, 1835 (8.4%) were started on an AD at discharge. Patients started on an AD had higher rates of depression and prior ischaemic stroke, presented with higher admission National Institutes of Health Stroke Scale score and were less likely to be discharged home. Similarly, patients started on an SSRI had lower rates of discharge to home. Adjusting for stroke severity, patients started on an AD had worse all-cause mortality, all-cause readmission, major adverse cardiac events, readmission for depression and decreased home-time. However, AD use was also associated with an increased risk for the sepsis, a falsification endpoint, suggesting the presence of residual confounding.

Conclusions

Patients with ischaemic stroke initiated on AD therapy are at increased risk of poor clinical outcomes and readmission even after PS adjustment, suggesting that poststroke depression requiring medication is a poor prognostic sign. Further research is needed to explore the reasons why depression is associated with worse outcome, and whether AD treatment modifies this risk or not.
Ionic liquid immobilized Cu(I)–hydrazone–triphenylphosphine complex: an easily recyclable catalytic system for Suzuki and Heck cross couplings
Authors: Ramakrishna Dileep
Published: February 2021

A highly efficient, reusable, catalytic system of Heck and Suzuki cross-coupling reactions was observed for an inexpensive copper complex dispersed in ethyl-methyl imidazolium hexafluorophosphate medium, [EMIM]PF6. The reaction conditions were optimized by studying the effects of temperature, catalyst concentration, solvent, and time. This method functions for a variety of substrates towards the cross-coupling reactions. Most notably, the catalyst – ionic liquid mixture was easily recoverable and reused six times without much loss in the catalytic activity, causing a notably very low impact on the environment.
Priority order recognition method of module redesign for the CNC machine tool product family to improve green performance
Authors: Liu Shihao , Zheng Wei
Published: February 2021

To solve the sequencing problem of module redesign in the greening process of a CNC machine tool product family, a priority order recognition method based on the fuzzy analytic hierarchy process (FAHP) and grey relational analysis (GRA) was proposed. A hierarchical model of the functional modules of the CNC machine tool product family was constructed, and the types of functional modules were divided. The generality coefficient of the functional modules was proposed to reflect the influence of the module types on the redesign priority order. A green performance evaluation indicator system for module instances of the CNC machine tool product family was built, based on which a life cycle-oriented green performance priority order recognition method was established. FAHP and GRA were utilized to evaluate the green performance of module instances. Then, the priority order of module redesign can be determined by the ratio of the green performance evaluation value to the generality coefficient. The feasibility and effectiveness of the proposed priority order recognition method were verified by an applied case of module green redesign sequencing of the gantry machine tool product family. The application case showed that the proposed priority-order recognition method based on FAHP and GRA provides a scientific basis for companies to carry out the greening improvement project of the gantry machine tool product family.
Graph Orientation with Edge Modifications
Authors: Asahiro Yuichi , Jansson Jesper , Miyano Eiji , Ono Hirotaka , Sandhya T. P.
Published: February 2021

The goal of an outdegree-constrained edge-modification problem is to find a spanning subgraph or supergraph [Formula: see text] of an input undirected graph [Formula: see text] such that either: (Type I) the number of edges in [Formula: see text] is minimized or maximized and [Formula: see text] can be oriented to satisfy some specified constraints on the vertices’ resulting outdegrees; or: (Type II) among all subgraphs or supergraphs of [Formula: see text] that can be constructed by deleting or inserting a fixed number of edges, [Formula: see text] admits an orientation optimizing some objective involving the vertices’ outdegrees. This paper introduces eight new outdegree-constrained edge-modification problems related to load balancing called (Type I) MIN-DEL-MAX, MIN-INS-MIN, MAX-INS-MAX, and MAX-DEL-MIN and (Type II) [Formula: see text]-DEL-MAX, [Formula: see text]-INS-MIN, [Formula: see text]-INS-MAX, and [Formula: see text]-DEL-MIN. In each of the eight problems, the input is a graph and the goal is to delete or insert edges so that the resulting graph has an orientation in which the maximum outdegree (taken over all vertices) is small or the minimum outdegree is large. We first present a framework that provides algorithms for solving all eight problems in polynomial time on unweighted graphs. Next we investigate the inapproximability of the edge-weighted versions of the problems, and design polynomial-time algorithms for six of the problems on edge-weighted trees.
LOCC protocols with bounded width per round optimize convex functions
Authors: Leung Debbie , Winter Andreas , Yu Nengkun
Published: February 2021

We start with the task of discriminating finitely many multipartite quantum states using LOCC protocols, with the goal to optimize the probability of correctly identifying the state. We provide two different methods to show that finitely many measurement outcomes in every step are sufficient for approaching the optimal probability of discrimination. In the first method, each measurement of an optimal LOCC protocol, applied to a [Formula: see text]-dimensional local system, is replaced by one with at most [Formula: see text] outcomes, without changing the probability of success. In the second method, we decompose any LOCC protocol into a convex combination of a number of “slim protocols” in which each measurement applied to a [Formula: see text]-dimensional local system has at most [Formula: see text] outcomes. To maximize any convex functions in LOCC (including the probability of state discrimination or fidelity of state transformation), an optimal protocol can be replaced by the best slim protocol in the convex decomposition without using shared randomness.

For either method, the bound on the number of outcomes per measurement is independent of the global dimension, the number of parties, the depth of the protocol, how deep the measurement is located, and applies to LOCC protocols with infinite rounds, and the “measurement compression” can be done “top-down” — independent of later operations in the LOCC protocol. The second method can be generalized to implement LOCC instruments with finitely many classical outcomes: if the instrument has [Formula: see text] coarse-grained final measurement outcomes, global input dimension [Formula: see text] and global output dimension [Formula: see text] for [Formula: see text] conditioned on the [Formula: see text]th outcome, then one can obtain the instrument as a convex combination of no more than [Formula: see text] slim protocols; that is, [Formula: see text] bits of shared randomness suffice.
Dynamics of a neutrally buoyant circular particle moving in a parallel double-lid-driven square cavity
Authors: Hu Junjie
Published: February 2021

The motion of a neutrally buoyant circular particle in a parallel double-lid-driven square cavity is studied with the lattice Boltzmann method. To understand, predict and control the motion of the circular particle, the effects of the initial position and particle size are studied. If the circular particle is placed at the centerline of the square cavity, at the steady state, it is confined at the bottom left corner, otherwise, the circular particle is stabilized at the 8-like trajectory, which is created by both the inertia of the circular particle and the confinement of the boundaries of the square cavity. The effect of the particle size on the motion of the circular particle is obvious, with the increase of the particle size, the confinement of the boundaries of the square cavity becomes stronger, and the 8-like trajectory shrinks toward the center. Furthermore, if the particle size is large enough, the centrifugal motion of the circular particle becomes weaker, and the circular particle cannot cross the centerline of the square cavity.
Passages
Authors: Groce Alex
Published: February 2021

Henry Petroski's The Pencil is one of Henry Petroski's many, always both scholarly and literary, and, most importantly, always engaging, books on engineering theory, practice, and history. For the software engineer, the pencil has a special place; while software engineers are not, particularly more than anyone else, pencil- users these days, we do have a special emphasis on sketching and the development of engineering tools, and one major thread of Petroski's history of the art of pencil-making is the use of pencils as an essential tool for engineers.
The 8th International Workshop on Realizing Artificial Intelligence Synergies in Software Engineering
Authors: Yoo Shin , Aleti Aldeida , Turhan Burak , Minku Leandro L. , Miranskyy Andriy , Meriçli Çetin
Published: February 2021

The International Workshop on Realizing Arti cial Intelligence Synergies in Software Engineering (RAISE) aims to present the state of the art in the crossover between Software Engineering and Arti cial Intelligence. This workshop explored not only the appli- cation of AI techniques to SE problems but also the application of SE techniques to AI problems. Software has become critical for realizing functions central to our society. For example, software is essential for nancial and transport systems, energy generation and distribution systems, and safety-critical medical applications. Software development costs trillions of dollars each year yet, still, many of our software engineering methods remain mostly man- ual. If we can improve software production by smarter AI-based methods, even by small margins, then this would improve a crit- ical component of the international infrastructure, while freeing up tens of billions of dollars for other tasks.
Security and Privacy Requirements for the Internet of Things
Authors: Alhirabi Nada , Rana Omer , Perera Charith
Published: February 2021

The design and development process for internet of things (IoT) applications is more complicated than that for desktop, mobile, or web applications. First, IoT applications require both software and hardware to work together across many different types of nodes with different capabilities under different conditions. Second, IoT application development involves different types of software engineers such as desktop, web, embedded, and mobile to work together. Furthermore, non-software engineering personnel such as business analysts are also involved in the design process. In addition to the complexity of having multiple software engineering specialists cooperating to merge different hardware and software components together, the development process requires different software and hardware stacks to be integrated together (e.g., different stacks from different companies such as Microsoft Azure and IBM Bluemix). Due to the above complexities, non-functional requirements (such as security and privacy, which are highly important in the context of the IoT) tend to be ignored or treated as though they are less important in the IoT application development process. This article reviews techniques, methods, and tools to support security and privacy requirements in existing non-IoT application designs, enabling their use and integration into IoT applications. This article primarily focuses on design notations, models, and languages that facilitate capturing non-functional requirements (i.e., security and privacy). Our goal is not only to analyse, compare, and consolidate the empirical research but also to appreciate their findings and discuss their applicability for the IoT.
Information Reuse and Stochastic Search
Authors: Kinneer Cody , Garlan David , Le Goues Claire
Published: February 2021

Many software systems operate in environments of change and uncertainty. Techniques for self-adaptation allow these systems to automatically respond to environmental changes, yet they do not handle changes to the adaptive system itself, such as the addition or removal of adaptation tactics. Instead, changes in a self-adaptive system often require a human planner to redo an expensive planning process to allow the system to continue satisfying its quality requirements under different conditions; automated techniques must replan from scratch. We propose to address this problem by reusing prior planning knowledge to adapt to unexpected situations. We present a planner based on genetic programming that reuses existing plans and evaluate this planner on two case-study systems: a cloud-based web server and a team of autonomous aircraft. While reusing material in genetic algorithms has been recently applied successfully in the area of automated program repair, we find that naively reusing existing plans for self-
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planning can actually result in a utility loss. Furthermore, we propose a series of techniques to lower the costs of reuse, allowing genetic techniques to leverage existing information to improve utility when replanning for unexpected changes, and we find that coarsely shaped search-spaces present profitable opportunities for reuse.
Mild stimulatory effect of a probiotic mix on bone mass when treatment is initiated 1.5 weeks after ovariectomy in mice
Authors: Ohlsson Claes , Lawenius Lina , Andersson Annica , Gustafsson Karin , Wu Jianyao , Lagerquist Marie , Movérare-Skrtic Sofia , Islander Ulrika , Sjögren Klara
Published: February 2021

The probiotic L. mix exerted a mild stimulatory effect on trabecular and cortical bone width when treatment is initiated 1.5 wk after ovariectomy in mice. This effect was associated with effects on bone-protecting regulatory T-cells. The results suggest that L. mix may exert beneficial effects on bone mass when treatment is started after ovariectomy.
Cleavage state of γENaC in mouse and rat kidneys
Authors: Frindt Gustavo , Shi Shujie , Kleyman Thomas R. , Palmer Lawrence G.
Published: February 2021

We have identified the major aldosterone-dependent cleaved form of the γENaC subunit in the kidney as a twice-cleaved peptide. This form appears to be identical in size with a subunit cleaved in vitro by the extracellular protease CAP1 (prostasin). In the absence of reducing agents, it has an overall molecular mass less than that of the intact subunit, consistent with the excision of an inhibitory domain.