bluuebunny/crossref_metadata_2025_split huggingface dataset:
02 Leveraging paramedic data to investigate the effect of COVID-19 on community opioid overdoses
Authors: Smith J Chris , Burr Wesley 
Published: August 2021

BackgroundOpioid overdoses in Canada have shown dramatic increases over recent years, despite significant investments in harm reduction. Most community monitoring currently relies on emergency department and coroner data. Our team has previously shown that paramedic data can be a useful addition to the current metrics as paramedics regularly interact with opioid overdose patients. This study examines paramedic data to investigate the changes to community opioid overdoses in the era of COVID-19 to better support our strategic partners in their battle against the opioid crisis.MethodsThe electronic ambulance call report database of Peterborough Paramedics (Ontario, Canada) was examined. De-identified records for patients from 2017-2020 with documented problem codes of ‘Opioid Overdose’ were extracted. Patients receiving paramedic naloxone were also included. The data was cleaned and analysed, and incomplete records were removed. Statistical models including chi-squared tests of goodness-of-fit and post hoc pairwise t-tests were applied to the data. Ethics approval for this study was granted by the Trent University’s Research Ethics Board.Results788 opioid overdoses were identified out of 72,737 patients. There were 263 opioid overdoses found in 2020 representing 1.4% patients, a significant increase from 2017-2019 (p value: 0.006). The proportion of patients receiving paramedic naloxone was significantly increased from previous years (p value: 0.005) while bystander naloxone administration was significantly decreased (p value 0.002). Age, gender, and pick-up location types were not significantly different between 2020 and previous years.ConclusionDespite reduced overall call volumes in 2020, paramedics observed an increase in opioid overdoses. The increase in paramedic naloxone administration and decrease in bystander naloxone administration may indicate changes in usage practices of community opioid users or an instability in the drug supply. These factors must be considered in future opioid harm reduction strategies and public health COVID-19 containment measures.
PP29 Improving buckle up in EMS study (iBEST)
Authors: Thavaravej Maneeporn , Rojanasarntikul Dhanadol 
Published: August 2021

BackgroundAccording to NHTSA (National Highway Traffic Safety Administration), data collected from 1992-2011 showed that 84 percent of EMS provider was not restrained while working; increasing the severity of injury when an ambulance crashes or abruptly stop.ObjectivesTo increase the awareness of EMS providers focusing on safety belt usage during their work.MethodThe study design is a prospective study including fifteen of physicians, nurses, paramedics, ambulance driver, and nurse aid from King Chulalongkorn Memorial Hospital, whom went on duty from April to October 2020. The collected data includes demographic data, occupation and its safety, reasons for not using seat belt. The data related to seat belt usage collected were then described and analysed by Mixed-effects Poisson Regression method and interpreted as Incident Rate Ratio (IRR) with 95% confidence interval (95% CI) and p-value.Result3 out of 15 (20%) did not use seat belt in the period before warning stickers were posted in the ambulance. When compared to 1 month after warning stickers were posted, the number of sample using seatbelt while working/travelling in the ambulance elevated to 11 out of 15 (73.33%) [IRR (95%CI) =3.66 (95% CI: 1.02, 13.13), p = 0.046].While at 3 months and 6 months, 10 out of 15 (66.77%) and 6 out of 15 (40%) still adhere to seat belt use, respectively. There is no statistical significance with the rate of seatbelt usage comparing between one, three, and six months after the warning stickers were posted. The most common reason for not using seatbelt is 1) seat cover covering the seatbelt 2) obstructing work 3) cannot reach equipment.ConclusionWarning stickers posted in the ambulance can increase awareness for seatbelt use of King Chulalongkorn Hospital’s EMS personnel while working.
PP35 The acceptability and safety of video triage for ambulance service patients and clinicians during the covid-19 pandemic: a service evaluation
Authors: Bell Fiona , Pilbery Richard , Connell Rob , Fletcher Dean , Leatherland Tracy , Cottrell Linda , Webster Peter 
Published: August 2021

IntroductionIn response to anticipated challenges with urgent and emergency healthcare delivery during the early part of the COVID-19 pandemic, Yorkshire Ambulance Service NHS Trust (YAS) introduced video call technology to supplement remote triage and ‘hear and treat’ consultations as a pilot project in the Emergency Operations Centre (EOC). We aimed to investigate patient and staff acceptability of video triage, and the safety of the decision-making process.MethodsThis service evaluation utilised a mixture of routine 999 call and bespoke data collection from participating clinicians who logged calls they both attempted and undertook. We sent postal surveys to a group of patients who were recipients of a video triage.ResultsBetween 27th March 2020 and 25th August 2020 clinicians documented 1073 video triage calls. A successful video triage call was achieved in 641 (59.7%) of cases. Clinical staff reported that video triage improved clinical assessment and decision making compared to telephone alone, and found the technology accessible for patients. Patients who received a video triage call and responded to the survey (40/201, 19.9%) viewed the technology, the ambulance staff and the care planning favourably.Callers receiving video triage that ended with a disposition of ‘hear and treat’, had a lower rate of re-contacting the service within 24 hours compared to callers that received clinical support desk telephone triage alone (16/212, 7.5% vs 2508/14349, 17.5% respectively.)ConclusionIn this single NHS Ambulance Trust evaluation, the use of video triage for low acuity calls appeared to be safe, with low rates of recontact and high levels of patient and clinician satisfaction compared to standard telephone triage. However, video triage is not always appropriate or acceptable to patients and technical issues were not uncommon.
PP40 Pre-hospital and emergency department analgesia for paediatric trauma – a survey of UK trauma centres and ambulance services supports consideration of alternatives such as ketamine
Authors: Fish David , Bell Fiona , O’Connell Clare , Walker Alison , Evans Laura , Ramlakhan Shammi 
Published: August 2021

BackgroundStudies have found that pre-hospital and emergency department (ED) analgesia for children is sub-optimal. In the pre-hospital setting, barriers include limited parenteral routes, education or clinical experience and practice legislation restricting the use of opioids by paramedics. Ketamine is safe and effective with multiple administration routes. It is not bound by the controlled drugs limitations in the pre-hospital setting, and is familiar to pre-hospital and ED practitioners.MethodsQuestionnaires were sent to all UK Ambulance Service Medical Directors and Paediatric Major Trauma Centres to establish current use of parenteral analgesics, and acceptability of alternatives in pre-hospital care such as ketamine. Descriptive analysis was undertaken.ResultsIntranasal opiates were the first line parenteral analgesics in injured children in all EDs. Frequent shortages of IN diamorphine resulted in more variability of second line choices, with 40% opting for another opioid. 96% of EDs would support the use of ketamine by pre-hospital clinicians, although concerns regarding inappropriate (IV) use and use by technician crews were raised. Most ED clinicians were unaware of the limited analgesic choices available to paramedics, with many suggesting alternative opiates as well as ketamine.All ambulance service directors recognised the need for alternative analgesics being made available. Without legislative changes, inhaled/IN agents or oral opiates were the only current options. All services were supportive of research to explore the use of ketamine by paramedics for injured children.ConclusionsThere is support for the addition of IN ketamine into paramedics’ repertoire of analgesics and recognition of potential benefit. However, there is a lack of experience and evidence around its use, thus warranting research to consider the impact on analgesic timeliness, adequacy and effectiveness. An analgesia ‘system of care’ which integrates pre- and in-hospital practice would be facilitated by the use of medicines effective in managing pain and familiar to practitioners in both settings.
Fluid challenge and balloon occlusion testing in patients with atrial septal defects
Authors: D’Alto Michele , Constantine Andrew , Chessa Massimo , Santoro Giuseppe , Gaio Gianpiero , Giordano Mario , Romeo Emanuele , Argiento Paola , Wacker Julie , D’Aiello Angelo Fabio , Sarubbi Berardo , Russo Maria Giovanna , Naeije Robert , Golino Paolo , Dimopoulos Konstantinos 
Published: August 2021

IntroductionCareful, stepwise assessment is required in all patients with atrial septal defect (ASD) to exclude pulmonary vascular or left ventricular (LV) disease. Fluid challenge and balloon occlusion may unmask LV disease and post-capillary pulmonary hypertension, but their role in the evaluation of patients with ‘operable’ ASDs is not well established.MethodsWe conducted a prospective study in three Italian specialist centres between 2018 and 2020. Patients selected for percutaneous ASD closure underwent assessment at baseline and after fluid challenge, balloon occlusion and both.ResultsFifty patients (46 (38.2, 57.8) years, 72% female) were included. All had a shunt fraction >1.5, pulmonary vascular resistance (PVR) <5 Wood Units (WU) and pulmonary arterial wedge pressure (PAWP) <15 mm Hg. Individuals with a PVR ≥2 WU at baseline (higher PVR group) were older, more symptomatic, with a higher baseline systemic vascular resistance (SVR) than the lower PVR group (all p<0.0001). Individuals with a higher PVR experienced smaller increases in pulmonary blood flow following fluid challenge (0.3 (0.1, 0.5) vs 2.0 (1.5, 2.8) L/min, p<0.0001). Balloon occlusion led to a more marked fall in SVR (p<0.0001) and a larger increase in systemic blood flow (p=0.024) in the higher PVR group. No difference was observed in PAWP following fluid challenge and/or balloon occlusion between groups; four (8%) patients reached a PAWP ≥18 mm Hg following the addition of fluid challenge to balloon occlusion testing.ConclusionsIn adults with ASD without overt LV disease, even small rises in PVR may have significant implications on cardiovascular haemodynamics. Fluid challenge may provide additional information to balloon occlusion in this setting.
Health conditions and the risk of home injury in French adults: results from a prospective study of the MAVIE cohort
Authors: Rojas Castro Madelyn Yiseth , Avalos Marta , Contrand Benjamin , Dupuy Marion , Sztal-Kutas Catherine , Orriols Ludivine , Lagarde Emmanuel 
Published: August 2021

BackgroundHome injury (HI) is a significant cause of mortality and morbidity in adults of all ages. Health conditions significantly impact HI among old adults, but little is known for other adults.Study designProspective cohort study.ObjectiveWe assessed the associations between health-related factors and HI’s risk in a French study, the MAVIE (Mutualistes pour la recherche contre les Accidents de la VIE courante) cohort.MethodsPoisson mixed models were fitted using health-related data information (diseases, treatments and disabilities) at baseline and the number of injuries prospectively recorded during the follow-up, adjusting for significant sociodemographics and exposure to a range of home activities. Attributable fractions were estimated based on risk ratio (RR) estimations measured in the fully adjusted models.ResultsA total of 6146 dwelling adults aged 15 or older were followed up for 5.1 years on average. Vertigo or dizziness (RR=2.36, 95% CI 1.06 to 5.01) and sciatica or back pain (RR=1.49, 95% CI 1.08 to 2.05) were independently associated with an increased risk of HI. These two groups of conditions showed the most significant associations among people aged 15–49, whereas musculoskeletal diseases other than rachialgias and arthropathies were the most significant health-related risk factor in people aged 50 and older. Sciatica or back pain represented the highest burden of HIs in overall adults (8%) and among people aged 15–49 (12%).ConclusionOur results suggest that adults with musculoskeletal disorders and vertigo or dizziness symptoms have a higher risk of HI, regardless of age.
Evaluating a smartphone application to increase the quantity and improve the quality of supervised practice driving
Authors: Ehsani Johnathon P , Weast Rebecca , Chirles Theresa , Hellinger Andrew , Shields Wendy , Yenokyan Gayane , Igusa Takeru 
Published: August 2021

BackgroundThe learner stage of graduated driver licensing (GDL), when teenagers are supervised by an adult driver, represents an opportunity to develop skills that could confer a safety benefit during their years of independent driving. This paper describes the design of a teenage driving study, which aims to evaluate the impact of a smartphone application, the ‘DrivingApp,’ to increase the quantity and improve the quality of supervised practice driving.MethodsThis longitudinal intervention study of teenage drivers and a parent/guardian spans the final 6 months of the learner licence and the first year of independent driving. Participants will be assigned to experimental or control groups using block allocation. Parent–teenage dyads assigned to the intervention arm will receive information about their practice driving via a smartphone application, including miles driven and total drive time. Baseline and monthly surveys will be administered to both experimental and control participants to measure the outcome measures during the learner stage: (1) practice driving amount, (2) consistency and (3) variety. Outcomes during independent driving are (1) self-reported number of attempts at the driving test and (2) number of crashes during the first year of independent driving.DiscussionImproving the quality of teenagers’ supervised practice driving is an unmet research need. This study will contribute to the evidence about what can be done during the learner period of GDL to maximise teenage drivers’ safety during the first years of independent driving, when crash risk is highest.
Leveraging data science to enhance suicide prevention research: a literature review
Authors: Wulz Avital Rachelle , Law Royal , Wang Jing , Wolkin Amy Funk 
Published: August 2021

ObjectiveThe purpose of this research is to identify how data science is applied in suicide prevention literature, describe the current landscape of this literature and highlight areas where data science may be useful for future injury prevention research.DesignWe conducted a literature review of injury prevention and data science in April 2020 and January 2021 in three databases.MethodsFor the included 99 articles, we extracted the following: (1) author(s) and year; (2) title; (3) study approach (4) reason for applying data science method; (5) data science method type; (6) study description; (7) data source and (8) focus on a disproportionately affected population.ResultsResults showed the literature on data science and suicide more than doubled from 2019 to 2020, with articles with individual-level approaches more prevalent than population-level approaches. Most population-level articles applied data science methods to describe (n=10) outcomes, while most individual-level articles identified risk factors (n=27). Machine learning was the most common data science method applied in the studies (n=48). A wide array of data sources was used for suicide research, with most articles (n=45) using social media and web-based behaviour data. Eleven studies demonstrated the value of applying data science to suicide prevention literature for disproportionately affected groups.ConclusionData science techniques proved to be effective tools in describing suicidal thoughts or behaviour, identifying individual risk factors and predicting outcomes. Future research should focus on identifying how data science can be applied in other injury-related topics.
Hypermethylation of CD19 promoter enables antigen-negative escape to CART-19 in vivo and in vitro
Authors: Ledererova Aneta , Dostalova Lenka , Kozlova Veronika , Peschelova Helena , Ladungova Adriana , Culen Martin , Loja Tomas , Verner Jan , Pospisilova Sarka , Smida Michal , Mancikova Veronika 
Published: August 2021

BackgroundAnti-CD19 chimeric antigen receptor T cells (CART-19) frequently induce remissions in hemato-oncological patients with recurred and/or refractory B-cell tumors. However, malignant cells sometimes escape the immunotherapeutic targeting by CD19 gene mutations, alternative splicing or lineage switch, commonly causing lack of CD19 expression on the surface of neoplastic cells. We assumed that, in addition to the known mechanisms, other means could act on CD19 to drive antigen-negative relapse.MethodsHerein, we studied the mechanism of antigen loss in an in vivo CD19-negative recurrence model of chronic lymphocytic leukemia (CLL) to CART-19, established using NOD-scid IL2Rgnull mice and HG3 cell line. We validated our findings in vitro in immortalized B-cell lines and primary CLL cells.ResultsIn our in vivo CLL recurrence model, up to 70% of CART-19-treated mice eventually recurred with CD19-negative disease weeks after initial positive response. We found that the lack of CD19 expression was caused by promoter DNA hypermethylation. Importantly, the expression loss was partially reversible by treatment with a demethylating agent. Moreover, this escape mechanism was common for 3 B-cell immortalized lines as well as primary CLL cells, as assessed by in vitro coculture experiments.ConclusionsEpigenetically driven antigen escape could represent a novel, yet at least partially reversible, means of CD19 loss to CART-19 in B-cell tumors.
Integrated analysis of a phase 2 study of cemiplimab in advanced cutaneous squamous cell carcinoma: extended follow-up of outcomes and quality of life analysis
Authors: Rischin Danny , Khushalani Nikhil I , Schmults Chrysalyne D , Guminski Alexander , Chang Anne Lynn S , Lewis Karl D , Lim Annette M , Hernandez-Aya Leonel , Hughes Brett G M , Schadendorf Dirk , Hauschild Axel , Thai Alesha A , Stankevich Elizabeth , Booth Jocelyn , Yoo Suk-Young , Li Siyu , Chen Zhen , Okoye Emmanuel , Chen Chieh-I , Mastey Vera , Sasane Medha , Lowy Israel , Fury Matthew G , Migden Michael R 
Published: August 2021

BackgroundTo provide pooled longer term data from three groups of a phase 2 study of cemiplimab in patients with advanced cutaneous squamous cell carcinoma (CSCC), and to determine duration of response (DOR) and impact on quality of life (QoL).MethodsPatients received cemiplimab 3 mg/kg every 2 weeks (group 1, metastatic CSCC [mCSCC], n=59; group 2, locally advanced CSCC, n=78) or cemiplimab 350 mg every 3 weeks (group 3, mCSCC, n=56). Primary endpoint was objective response rate (ORR) per independent central review (ICR). QoL was repeatedly measured at day 1 of each treatment cycle (groups 1 and 2: 8 weeks; group 3: 9 weeks).ResultsMedian duration of follow-up was 15.7 months. Overall, ORR per ICR was 46.1% (95% CI: 38.9% to 53.4%). Complete response (CR) rates were 20.3%, 12.8%, and 16.1% for groups 1, 2, and 3, respectively. Median time to CR was 11.2 months. Among patients with partial response or CR, the estimated proportion of patients with ongoing response at 12 months from the first objective response was 87.8% (95% CI: 78.5% to 93.3%), with median DOR not reached. Kaplan-Meier estimated probability of overall survival (OS) was 73.3% (95% CI: 66.1% to 79.2%) at 24 months, with median OS not reached. Global Health Status (GHS)/QoL improvements were observed as early as cycle 2 and were significantly improved and durable until last assessment. Kaplan-Meier estimate of median time to first clinically meaningful improvement for pain was 2.1 (95% CI: 2.0 to 3.7) months and was significantly improved in responders versus non-responders (p<0.0001).ConclusionsThis is the largest (n=193) clinical dataset for a programmed cell death-1 inhibitor against advanced CSCC, confirming the sustained substantial clinical activity of cemiplimab in these patients, including new findings of improved CR rates over time, increasing DOR, and durable pain control and GHS/QoL improvement.Trial registration numberClinicalTrials.gov Registry (NCT02760498), https://clinicaltrialsgov/ct2/show/NCT02760498.
Using angiographic parametric imaging-derived radiomics features to predict complications and embolization outcomes of intracranial aneurysms treated by pipeline embolization devices
Authors: Liang Fei , Ma Chao , Zhu Haoyu , Liu Lian , Liang Shikai , Jiang Peng , Zhang Yupeng , Jiang Chuhan 
Published: August 2021

BackgroundPipeline embolization devices (PEDs) have gained widespread popularity in the treatment of intracranial aneurysms (IAs). However, precise predictors of treatment outcomes are still lacking. This study aimed to use angiographic parametric imaging (API)-derived radiomics features to explore whether biomarkers extracted from immediate postprocedural digital subtraction angiography (DSA) were associated with complications and embolization outcomes of IAs treated with PED without adjunctive coils.MethodsRadiomic features were extracted from postprocedural DSA by API, and radiomics feature selection and radiomics score calculation were performed by the least absolute shrinkage and selection operator (LASSO) logistic regression. Angiographic findings and clinical characteristics were screened using stepwise multivariable logistic regression analysis to identify significant variables for predicting the complication endpoint. Radiomics feature selection and radiomics risk score (RadRS) calculations were performed by LASSO Cox regression. Univariate and multivariate Cox regression analyses were used to identify significant predictors for the occlusion endpoint.ResultsWe screened 281 observations for complications and 235 observations for embolization outcomes from IAs treated in our center using PED between June 2015 and July 2020. Multivariate regression analysis showed association of the radiomics score (p<0.01) and hypertension (p=0.04) with complications. RadRS (p<0.01), symptoms (p<0.01), and age (p=0.03) were predictors of embolization outcomes. Kaplan-Meier analysis revealed that symptomatic patients (p<0.01) and those with off-label IAs (p=0.03) had shorter intervals to complete occlusion.ConclusionsBiomarkers extracted from immediate postprocedural DSA by API could be potential indicators for assessing treatment outcomes of IAs treated by PED without adjunctive coils.