bluuebunny/crossref_metadata_2025_split huggingface dataset:
161 Analysis of an ambulatory care pathway for patients with COVID-19 utilising remote pulse oximetry
Authors: Kyriakides Jonathon , Khani Aria , Kelly Charlotte , Coleman Reginald 
Published: January 2021

Aims/Objectives/BackgroundThe safe discharge of COVID-19 patients from the emergency department (ED) is difficult due to uncertainties surrounding the trajectory of the disease course. The infectivity of COVID-19 also limits follow-up options. A novel pathway consisting of home pulse oximetry with telephone follow-up was created to facilitate safe discharge from the ED of a London district general hospital. The primary objective was to utilise home pulse oximetry to prevent hospital admission. The secondary objective was to identify those requiring further care or investigation.Methods/DesignAdult patients with confirmed or suspected COVID-19 with oxygen saturations of between 90–94% who were otherwise suitable for discharge were identified. These patients were discharged from the ED with a pulse oximeter. Oxygen saturations were measured three times a day for seven days. Patients received a structured telephone consultation on days two, five and seven post-discharge from the ED, and a decision was made as to whether further clinical assessment in the ED was necessary.Results/ConclusionsOf the twenty patients discharged on the pathway, 85% avoided hospital admission, whilst 15% were re-assessed and subsequently admitted to hospital. 20% of patients required re-assessment in the ED but did not require admission.Home pulse oximetry with telephone follow-up was used to prevent hospital admission in a considerable proportion of patients who would have otherwise been admitted in the absence of this pathway. Telephone follow-up effectively identified patients who required further clinical assessment. Increasing age, the presence of co-morbidities, and pulmonary infiltrates on chest radiograph were more common in the cohort who required re-assessment. This study demonstrates the potential for safe ambulation of a subgroup of patients with COVID-19, whilst identifying practical inclusion criteria which could be replicated in ambulatory units across the UK.
127 Fascia iliaca block in the emergency department-a quality improvement project, queen elizabeth hospital Birmingham
Authors: Browne Catherine , Hosein Riad , Jellinek Alistair 
Published: January 2021

Aims/Objectives/BackgroundFractured neck of femur is a common presentation and is associated with high rates of morbidity and mortality. RCEM Best Practice specifies that Fascia Iliaca Block should be available in Emergency Departments as part of the pain management strategy.AimsImprove compliance with RCEM guidance for safe administration, documentation and post-procedure monitoring following FIB.Employ QIP methodology to create a FIB protocol.Empower the junior SHO workforce to gain competence in FIB administration through structured teaching.Improve understanding of post-block monitoring in nursing and medical staff.Methods/DesignData collection identified the number of blocks administered to those presenting with fractured neck of femur in November 2019. Documentation and post-procedure monitoring were evaluated.Interventions were piloted in January 2020. These were: pre-made block packs, a block checklist sticker incorporating post-procedure monitoring chart and laminated ‘quick prompt’ guide.Nurse champions facilitated MDT teaching sessions and junior SHOs were empowered to gain competence in block administration through teaching sessions.Retrospective data from January 2020 was compared to November 2019, allowing us to establish the efficacy of changes.Abstract 127 Figure 1Results/ConclusionsOctober 2019 results demonstrated 59% of patients received a FIB, this increased to 78% in January 2020. Pre-intervention, 45% of patients had the correct dose of local anaesthetic. This increased to 79% post-intervention. Initially, documentation was correct in just 5% of cases, improving to 59% after re-auditing.Feedback from teaching sessions was positive with nursing staff better understanding the need for post-procedure monitoring. SHOs gained increased confidence delivering FIBs, freeing up senior doctors for other tasks.The new protocol has improved the administration of FIBs with better post-procedure care and standardised dosing of local anaesthetic. Interventions are embedded in departmental practice; this will be re-audited in 6 months. Following the transition to e-noting we are developing an electronic template to translate these successes onto the new system.
393 Reducing plastic waste in Paeds ED
Authors: Young Rona , Russell Fiona 
Published: January 2021

Aims/Objectives/BackgroundVenepuncture and PVC insertion are common procedures in Children’s ED and often include blood cultures. Opening a universal dressing pack (udp) including a plastic tray, sterile swabs, gloves and 2 plastic sterile field drapes (sfd) is common practice. Our department was making a huge spend on udp’s. We aimed to determine if this was necessary and if we could reduce our plastic waste.Methods/DesignA sample of 8 doctors across all grades demonstrated their set up for both procedures. We replaced udp in the IV trollies with x2 sfd pack (sfdp). Information was disseminated via weekly staff brief. Trollies are restocked each night using attached flashcards which were updated appropriately. The use and costs of dressing packs in ED was determined for April-June 2019. We planned to compare this for April-June 2020.Results/ConclusionsAll clinicians were opening a dressing pack for procedures but 87.5% only used the sfd and swabs. 100% discarded gloves due to inappropriate size and 100% discarded the tray. All staff adopted the new equipment with no problems identified. 3500 udps were being used in dept in 3 months. Udp v sfdp per item costs 32p v 8p, weight 65 g v 30 g. Due to CoVID-19 pandemic the number of ED attendances significantly reduced therefore costs were based on 2019 usage. In 3 months switching from udp to sfd would save £840 and 122.5 kg of refuse weight. Volumes of stocks were reduced from 0.05 m2 to 0.01 m2 for 50 udp v 50 sfdp which aids storage and restocking of IV trollies releasing staff time.We demonstrated a significant reduction in unnecessary plastic waste while also reducing costs and need for storage and restocking whilst maintaining safe practice. This has been rolled out in the neighbouring Clinical Decision Unit with anticipation of being a permanent change in both areas.
In situ immunogenic clearance induced by a combination of photodynamic therapy and rho-kinase inhibition sensitizes immune checkpoint blockade response to elicit systemic antitumor immunity against intraocular melanoma and its metastasis
Authors: Kim Seohyun , Kim Seong A , Nam Gi-Hoon , Hong Yeonsun , Kim Gi Beom , Choi Yoonjeong , Lee Seokyoung , Cho Yuri , Kwon Minsu , Jeong Cherlhyun , Kim Sehoon , Kim In-San 
Published: January 2021

BackgroundUveal melanoma (UM) is the most frequent intraocular malignancy and is resistant to immunotherapy. Nearly 50% of patients with UM develop metastatic disease, and the overall survival outcome remains very poor. Therefore, a treatment regimen that simultaneously targets primary UM and prevents metastasis is needed. Here, we suggest an immunotherapeutic strategy for UM involving a combination of local photodynamic therapy (PDT), rho-kinase (ROCK) inhibitor, and PD-1/PD-L1 immune checkpoint blockade.MethodsThe antitumor efficacy and immune response of monotreatment or combinational treatment were evaluated in B16F10-bearing syngeneic mouse models. Abscopal antitumor immune responses induced by triple-combinational treatment were validated in syngeneic bilateral B16F10 models. After each treatment, the immune profiles and functional examinations were assessed in tumors and tumor draining lymph nodes by flow cytometry, ELISA, and immunofluorescence assays. In orthotopic intraocular melanoma models, the location of the immune infiltrate in the tumor microenvironment (TME) was evaluated after each treatment by multiplex immunohistochemistry and metastatic nodules were monitored.ResultsPDT with Ce6-embedded nanophotosensitizer (FIC-PDT) elicited immunogenic cell death and stimulated antigen-presenting cells. In situ immunogenic clearance induced by a combination of FIC-PDT with ripasudil, a clinically approved ROCK inhibitor, stimulated antigen-presenting cells, which in turn primed tumor-specific cytotoxic T cells. Moreover, local immunogenic clearance sensitized PD-1/PD-L1 immune checkpoint blockade responses to reconstruct the TME immune phenotypes of cold tumors into hot tumors, resulting in recruitment of robust cytotoxic CD8+T cells in the TME, propagation of systemic antitumor immunity to mediate abscopal effects, and prolonged survival. In an immune-privileged orthotopic intraocular melanoma model, even low-dose FIC-PDT and ripasudil combined with anti-PD-L1 antibody reduced the primary tumor burden and prevented metastasis.ConclusionsA combination of localized FIC-PDT and a ROCK inhibitor exerted a cancer vaccine-like function. Immunogenic clearance led to the trafficking of CD8+T cells into the primary tumor site and sensitized the immune checkpoint blockade response to evoke systemic antitumor immunity to inhibit metastasis, one of the major challenges in UM therapy. Thus, immunogenic clearance induced by FIC-PDT and ROCK inhibitor combined with anti-PD-L1 antibody could be a potent immunotherapeutic strategy for UM.
Intracellular homocysteine metabolites in SLE: plasma S-adenosylhomocysteine correlates with coronary plaque burden
Authors: Stojan George , Li Jessica , Liu Tian , Kane Maureen A , Petri Michelle A 
Published: January 2021

Background and aimsWe hypothesised that intracellular homocysteine and homocysteine metabolite levels in patients with SLE are disproportionately elevated compared with the levels seen in healthy subjects and that they are independently associated with coronary plaque in SLE.MethodsA liquid chromatography–tandem mass spectrometry absolute quantification assay was used for the determination of six analytes in both plasma and peripheral blood mononuclear cells (PBMCs): homocysteine (Hcy), S-adenosylmethionine (SAM), S-adenosylhomocysteine (SAH), methionine (Met), cystathionine (Cysta) and 5-methyltetrahydrofolate (5m-THF). We then compared intracellular (PBMC) and extracellular (plasma) Hcy and Hcy metabolite (SAM, SAH, Met, Cysta and 5m-THF) concentrations in 10 patients with SLE and in 10 age, sex and ethnicity matched controls. Subjects with a history of diabetes mellitus, cardiovascular disease, hypertension, alcohol consumption in excess of 3 units per day, anaemia, renal insufficiency (serum creatinine >1.5 mg/dL) and pregnancy were excluded. All patients with SLE had two coronary CT angiography studies as screening for occult coronary atherosclerotic disease.ResultsPlasma from patients with SLE had higher levels of Hcy (p<0.0001), SAH (p<0.05), SAM (p<0.001) and lower levels of Met (p<0.05) and Cysta (p<0.001) compared with controls. PBMC intracellular concentrations from patients with SLE had higher levels of Cysta (p<0.05), SAH (p<0.05), SAM (p<0.001) and lower levels of 5m-THF (p<0.001). Plasma SAH showed a positive correlation with total coronary plaque, calcified plaque and non-calcified plaque (p<0.05).ConclusionIntracellular concentrations of Hcy metabolites were significantly different between patients with SLE and controls, despite similar intracellular Hcy levels. Plasma SAH was positively correlated with total coronary plaque, calcified plaque and non-calcified plaque.
Optimal thresholds to predict long-term outcome after complete endovascular recanalization in acute anterior ischemic stroke
Authors: Neuberger Ulf , Vollmuth Philipp , Nagel Simon , Schönenberger Silvia , Weyland Charlotte Sabine , Gumbinger Christoph , Ringleb Peter Arthur , Bendszus Martin , Pfaff Johannes Alex Rolf , Möhlenbruch Markus Alfred 
Published: January 2021

BackgroundDespite complete endovascular recanalization, a significant percentage of patients with acute anterior stroke do not achieve a good clinical outcome. We analyzed optimal thresholds of relevant parameters to discern functional independence after successful endovascular recanalization and test their predictive performance.MethodsPatients with acute anterior ischemic stroke undergoing endovascular treatment between April 2015 and November 2019 were retrospectively analyzed. Only patients with premorbid modified Rankin Scale (mRS) score <3 and complete recanalization (modified Thrombolysis In Cerebral Infarction 2c/3) were included. Optimal thresholds of the most important variables predicting functional independence (mRS 0–2 after 90 days) were calculated using receiver operating characteristic curves and their predictive performance was tested in an independent dataset using machine learning algorithms.ResultsOverall, 371 patients met the inclusion criteria. Optimal thresholds for the overall most important variables to predict functional independence were (1) National Institutes of Health Stroke Scale (NIHSS) score ≤5 after 24 hours (area under the curve (AUC) 0.88 (95% CI 0.84 to 0.92)); (2) Alberta Stroke Program Early CT Score (ASPECTS) ≥7 on follow-up CT (AUC 0.72 (95% CI 0.68 to 0.77)); and (3) change in NIHSS score ≥8 after 24 hours (AUC 0.70 (95% CI 0.65 to 0.74)). The performance of these thresholds to predict a good outcome using machine learning in the independent dataset was evaluated for (1) NIHSS score ≤5 after 24 hours (AUC 0.76 (95% CI 0.71 to 0.81)); (2) follow-up ASPECTS ≥7 (AUC 0.64 (95% CI 0.58 to 0.70)); (3) change in NIHSS score ≥8 after 24 hours (AUC 0.61 (95% CI 0.55 to 0.67)); and (4) the combination of all three parameters (AUC 0.84 (95% CI 0.80 to 0.88)).ConclusionsAfter complete recanalization in acute anterior circulation ischemic stroke, a good long-term outcome could be accurately predicted reaching NIHSS score ≤5 after 24 hours.
Quantified health and cost effects of faster endovascular treatment for large vessel ischemic stroke patients in the Netherlands
Authors: van Voorst Henk , Kunz Wolfgang G , van den Berg Lucie A , Kappelhof Manon , Pinckaers Floor M E , Goyal Mayank , Hunink Myriam G M , Emmer Bart J , Mulder Maxim J H L , Dippel Diederik W J , Coutinho Jonathan M , Marquering Henk A , Boogaarts Hieronymus D , van der Lugt Aad , van Zwam Wim H , Roos Yvo B W E M , Buskens Erik , Dijkgraaf Marcel G W , Majoie Charles B L M 
Published: January 2021

BackgroundThe effectiveness of endovascular treatment (EVT) for large vessel occlusion (LVO) stroke severely depends on time to treatment. However, it remains unclear what the value of faster treatment is in the years after index stroke. The aim of this study was to quantify the value of faster EVT in terms of health and healthcare costs for the Dutch LVO stroke population.MethodsA Markov model was used to simulate 5-year follow-up functional outcome, measured with the modified Rankin Scale (mRS), of 69-year-old LVO patients. Post-treatment mRS was extracted from the MR CLEAN Registry (n=2892): costs per unit of time and Quality-Adjusted Life Years (QALYs) per mRS sub-score were retrieved from follow-up data of the MR CLEAN trial (n=500). Net Monetary Benefit (NMB) at a willingness to pay of €80 000 per QALY was reported as primary outcome, and secondary outcome measures were days of disability-free life gained and costs.ResultsEVT administered 1 min faster resulted in a median NMB of €309 (IQR: 226;389), 1.3 days of additional disability-free life (IQR: 1.0;1.6), while cumulative costs remained largely unchanged (median: -€15, IQR: −65;33) over a 5-year follow-up period. As costs over the follow-up period remained stable while QALYs decreased with longer time to treatment, which this results in a near-linear decrease of NMB. Since patients with faster EVT lived longer, they incurred more healthcare costs.ConclusionOne-minute faster EVT increases QALYs while cumulative costs remain largely unaffected. Therefore, faster EVT provides better value of care at no extra healthcare costs.
Older age, comorbidity, glucocorticoid use and disease activity are risk factors for COVID-19 hospitalisation in patients with inflammatory rheumatic and musculoskeletal diseases
Authors: Hasseli Rebecca , Mueller-Ladner Ulf , Hoyer Bimba F , Krause Andreas , Lorenz Hanns-Martin , Pfeil Alexander , Richter Jutta , Schäfer Martin , Schmeiser Tim , Strangfeld Anja , Schulze-Koops Hendrik , Voll Reinhard E , Specker Christof , Regierer Anne Constanze 
Published: January 2021

IntroductionWhether patients with inflammatory rheumatic and musculoskeletal diseases (RMD) are at higher risk to develop severe courses of COVID-19 has not been fully elucidated. Aim of this analysis was to describe patients with RMD according to their COVID-19 severity and to identify risk factors for hospitalisation.MethodsPatients with RMD with PCR confirmed SARS-CoV-2 infection reported to the German COVID-19 registry from 30 March to 1 November 2020 were evaluated. Multivariable logistic regression was used to estimate ORs for hospitalisation due to COVID-19.ResultsData from 468 patients with RMD with SARS-CoV-2 infection were reported. Most frequent diagnosis was rheumatoid arthritis, RA (48%). 29% of the patients were hospitalised, 5.5% needed ventilation. 19 patients died. Multivariable analysis showed that age >65 years (OR 2.24; 95% CI 1.12 to 4.47), but even more>75 years (OR 3.94; 95% CI 1.86 to 8.32), cardiovascular disease (CVD; OR 3.36; 95% CI 1.5 to 7.55), interstitial lung disease/chronic obstructive pulmonary disease (ILD/COPD) (OR 2.79; 95% CI 1.2 to 6.49), chronic kidney disease (OR 2.96; 95% CI 1.16 to 7.5), moderate/high RMD disease activity (OR 1.96; 95% CI 1.02 to 3.76) and treatment with glucocorticoids (GCs) in dosages >5 mg/day (OR 3.67; 95% CI 1.49 to 9.05) were associated with higher odds of hospitalisation. Spondyloarthritis patients showed a smaller risk of hospitalisation compared with RA (OR 0.46; 95% CI 0.23 to 0.91).ConclusionAge was a major risk factor for hospitalisation as well as comorbidities such as CVD, ILD/COPD, chronic kidney disease and current or prior treatment with GCs. Moderate to high RMD disease activity was also an independent risk factor for hospitalisation, underlining the importance of continuing adequate RMD treatment during the pandemic.
Equation of motion truncation scheme based on partial orthogonalization
Authors: Catalano Francesco , Nilsson Johan 
Published: January 2021

Abstract
We introduce a general scheme to consistently truncate equations of motion for Green’s functions. Our scheme is guaranteed to generate physical Green’s functions with real excitation energies and positive spectral weights. There are free parameters in our scheme akin to mean field parameters that may be determined to get as good an approximation to the physics as possible. As a test case we apply our scheme to a two-pole approximation for the 2D Hubbard model. At half-filling we find an insulating solution with several interesting properties: it has low expectation value of the energy and it gives upper and lower Hubbard bands with the full non-interacting bandwidth in the large U limit. Away from half-filling, in particular in the intermediate interaction regime, our scheme allows for several different phases with different number of Fermi surfaces and topologies.

Graphic abstract
The Higgs field and the Jordan Brans Dicke cosmology
Authors: Dunya Onder , Akant Levent , Arik Metin , Kardas Yelda , Sahin Selale , Tok Tarik 
Published: January 2021

AbstractWe investigate a field theoretical approach to the Jordan–Brans–Dicke (JBD) theory extended with a particular potential term on a cosmological background by starting with the motivation that the Higgs field and the scale factor of the universe are related. Based on this relation, it is possible to come up with mathematically equivalent but two different interpretations. From one point of view while the universe is static, the masses of the elementary particles change with time. The other one, which we stick with throughout the manuscript, is that while the universe is expanding, particle masses are constant. Thus, a coupled Lagrangian density of the JBD field and the scale factor (the Higgs field), which exhibit a massive particle and a linearly expanding space in zeroth order respectively, is obtained. By performing a coordinate transformation in the field space for the reduced JBD action whose kinetic part is nonlinear sigma model, the Lagrangian of two scalar fields can be written as uncoupled for the Higgs mechanism. After this transformation, as a result of spontaneous symmetry breaking, the time dependent vacuum expectation value (vev) of the Higgs field and the Higgs bosons which are the particles corresponding to quantized oscillation modes about the vacuum, are found.
From high temporal resolution to synthetically enhanced radiometric resolution: insights from Night Thermal Gradient results
Authors: Piroddi L. 
Published: January 2021

AbstractElectromagnetic emissions in thermal infrared bands are an important research topic on pre-earthquake studies. Satellite thermal data have been investigated by many independent research groups looking for their anomalous behaviour before main earthquake's occurrences. Among them, geosynchronous satellite data are reported as less prone to artefacts during data processing. In this work, the Night Thermal Gradient (NTG) algorithm is presented, which has been specifically proposed for geostationary thermal infrared data processing. NTG method relies on the exploitation of high temporal resolution data to find coherent low frequency components of a hypothetical precursory signal of seismic activity. In this paper, the method is presented by giving details about the applied procedures, steps, theoretical assumptions and results obtained during the studies of L'Aquila 2009 earthquake and the seismic activity of Central Italy and Sardinia.
Online Thread and Data Mapping Using a Sharing-Aware Memory Management Unit
Authors: Cruz Eduardo H. M. , Diener Matthias , Pilla Laércio L. , Navaux Philippe O. A. 
Published: January 2021

Current and future architectures rely on thread-level parallelism to sustain performance growth. These architectures have introduced a complex memory hierarchy, consisting of several cores organized hierarchically with multiple cache levels and NUMA nodes. These memory hierarchies can have an impact on the performance and energy efficiency of parallel applications as the importance of memory access locality is increased. In order to improve locality, the analysis of the memory access behavior of parallel applications is critical for mapping threads and data. Nevertheless, most previous work relies on indirect information about the memory accesses, or does not combine thread and data mapping, resulting in less accurate mappings.
In this paper, we propose the Sharing-Aware Memory Management Unit (SAMMU), an extension to the memory management unit that allows it to detect the memory access behavior in hardware. With this information, the operating system can perform online mapping without any previous knowledge about the behavior of the application. In the evaluation with a wide range of parallel applications (NAS Parallel Benchmarks and PARSEC Benchmark Suite), performance was improved by up to 35.7% (10.0% on average) and energy efficiency was improved by up to 11.9% (4.1% on average). These improvements happened due to a substantial reduction of cache misses and interconnection traffic.