bluuebunny/crossref_metadata_2025_split huggingface dataset:
875 Does fibrinogen concentrate improve outcomes in major traumatic haemorrhage? A systematic review
Authors: Bentley David , Bentley Alena , Brundage Susan , Rappoport Jacqueline 
Published: June 2022

BackgroundAcute traumatic coagulopathy (ATC) is present in a quarter of severely injured patients and is associated with worse outcomes.(1–3) Fibrinogen is the first clotting protein to become deficient in ATC and there is a suggestion that supplementary fibrinogen may improve outcomes in these patients.(1, 4, 5) This review aimed to explore the efficacy and safety profile of fibrinogen concentrate (FC) administration to patients suffering from traumatic haemorrhage.MethodsA comprehensive search of Medline, Embase and the Cochrane Library databases was performed. Studies were included if they compared FC administration with a suitable comparator group in adults suffering from traumatic haemorrhage. Only randomised controlled trials, quasi-experimental or cohort studies were included at the screening stage. Included papers were analysed by narrative review.Results271 studies were identified and screened of which 8 were included. Mortality data was conflicting and of poor overall quality. Four of the studies reported a survival benefit with FC administration,(6–9) one reported a higher ICU mortality,(10) and the remaining studies found no significant difference relative to the comparators.(11, 12) All studies exploring the effect of FC on plasma fibrinogen levels found a significant increase to normal levels in the FC group at 2 hours post intervention.(11–13) One study demonstrated that this effect lasted for twelve hours after receiving FC.(11) There was no increase in the incidence of thromboembolic events in patients treated with FC compared to standard care.ConclusionFC is effective at reversing hypofibrinogenaemia in the setting of ATC and does not appear to increase the risk of thromboembolic events. Mortality data remains conflicted and of poor overall quality, therefore it is unclear if these affects correspond to improved clinical outcomes. Randomised controlled trials adequately powered to detect a mortality difference are recommended before the clinical efficacy of FC in traumatic haemorrhage can be established.
808 Changing nature of major trauma from 2000 to 2019 in England and Wales: observational registry study
Authors: Shanahan Thomas , Tomkins Michael , Bouamra Omar , Edwards Antoinette , Kumar Dhushy Surendra , Coats Timothy , Lecky Fiona 
Published: June 2022

Aims/Objectives/BackgroundLow energy transfer mechanisms – predominately falls from a standing height – have been identified as the most prevalent cause of major trauma in higher-income countries. This study examines the epidemiological trends in major trauma in England and Wales between 2000 – 2019, incorporating changes in mechanism of injury, imaging practices, case ascertainment and national demographic shifts. In addition, changes in the whole cohort of major trauma patients and differences between patients who suffered high energy and low energy mechanism of injury are described.Methods/DesignA retrospective observational cohort study was conducted using Trauma Audit and Research Network (TARN) data. Patients with an injury severity score (ISS) >15 admitted to hospital in England and Wales between 1 January 2000 to 31 December 2019 were included. The primary outcome was the temporal trend in the proportion of major trauma sustained through low energy transfer, and its association with imaging practices, case ascertainment and demographic changes.Results/Conclusions241,484 participants were included in the analysis, of which 96,833 were classified as low energy. Low energy trauma accounted for 12.5% in 2000 (n = 373), rising to 52.6% (n=16,087) in 2019. Over the same period the proportion of patients receiving CT imaging increased from 20.7% (n=676) to 88.9% (n=27,174). TARN hospital membership doubled from 96 to 179 hospitals, and the annual mean numbers of cases per hospital per annum increased sixfold from 31 to 174. Case ascertainment improved from 42% in 2008 to 95% in 2019. Significant differences were observed in the demographics, injury patterns, presenting physiology, care pathways, and outcomes between the high and low energy cohorts.Changes in imaging and reporting practices have revealed a previously hidden burden of injury resulting from low energy transfer mechanisms. It is essential that future research recognises this distinct cohort and investigates how trauma systems can be changed to optimise outcomes.
1048 Incidence of hyperoxia in traumatically injured patients receiving pre-hospital emergency anaesthesia: a 5-year retrospective analysis
Authors: Leitch Patricia , Hudson Anthony , Griggs Jo , Avest Ewoud ter , Stolmeiger Renate , Lyon Richard 
Published: June 2022

Aims/Objectives/BackgroundPrevious studies have demonstrated an association between hyperoxia and increased mortality in various patient conditions. In the present study, we aim to investigate the incidence of hyperoxia in trauma patients receiving PHEA, and we aim to determine factors that may help guide prehospital oxygen administration.Methods/DesignA retrospective cohort study was performed of all patients who received PHEA by a single helicopter emergency medical service (HEMS) service between 1 October 2014 and 1 May 2019 and who were subsequently transferred to one major trauma centre (MTC). Patient and treatment factors were collected from the electronic patient records of the HEMS service and the hospital. Hyperoxia was defined as a PaO2 >16, based on the first arterial blood gas analysis upon arrival to hospital.Results/ConclusionsOn presentation to the MTC, the majority of the patients (90/147, 61,2%) had severe hyperoxia, 30 patients (20.4%) had mild hyperoxia, 26 patients (19.7%) had normoxia, and 1 patient (0.7%) had hypoxia. The median [IQR] PaO2in the first ABGA after HEMS handover was 36.7 [18.5–52.2] kPa, with a range of 7.0–86.0 kPa. SpO2 readings before handover were independently associated with presence of hyperoxia. An SpO2 ≥97% was associated with significantly increased odds of hyperoxia (OR 3.99 [1.58–10.08], and had a sensitivity of 86.7 [79.1–92.4]%, specificity of 37.9 [20.7–57.8]%, positive predictive value of 84.5 [70.2–87.9]% and a negative predictive value of 42.3 [27.4–58.7]% for presence of hyperoxemia.HEMS oxygenation strategies are effective; trauma patients who have undergone PHEA often have a profound hyperoxemia upon arrival in hospital. In the prehospital setting where ABGA is not readily available, target SpO2 of 94–98% as recommended in BTS Guidelines should guide FiO2 titration to reduce risk of tissue hyperoxia. Predeparture checklists should include an agreed system to adjust FiO2 according to a patient’s SpO2 rather than fixed concentration.
947 The ‘silent video’ as a training aid for emergency department major incident management
Authors: Paranamana Supathum , Roland Damian , Coats Tim 
Published: June 2022

Aims/Objectives/BackgroundThere is a specific need to refresh knowledge of and update Major Incident Protocols (MIP) but a department may have less than one Major Incident (MI) every 5 years.As part of our department’s COVID-19 pandemic response, a ‘silent movie’ of PPE donning-and-doffing techniques was played on large screens in the background during clinical handovers. We theorised that this technique might be effective in training ED staff on the MIP.Methods/DesignWe created a seven-minute silent video about our MIP using volunteer actors from ED Doctors, Nurses, and Ancillary Healthcare Staff. Brief captions describing key aspects of the MIP were overlaid on video clips and images.The video was played on a continuous loop on wall mounted TVs for six continuous weeks, located within the handover room used by all ED staff members.A questionnaire was sent out to all staff in ED to assess how the video’s content improved understanding of the MIP. The design of the questionnaire was based on the Moore’s Expanded Education Outcome Model.Abstract 947 Table 1Moore’s Outcomes FrameworkMeasure/QuestionResponseLEVEL 1ParticipationParticipation in questionnaire95 responses out of 851 staff.Have you seen the ED major Incident video in the Handover Room?67% of respondents had seen the training video (90% of these watched the whole video).LEVEL 2SatisfactionI was satisfied with the format, delivery and content of the video.70% were satisfied with the format of the videoI found the content of the video useful.84% thought the content usefulLEVEL 3ALearning: Declarative KnowledgeI know how the ED is organised in a Major Incident.Before 25%, After 66%.LEVEL 3BLearning: Procedural KnowledgeI know what to do in a major incident.Before 35%, After 67%I could locate the Major Incident tray in each area of the ED.Before 28%, After 53%.I would be able to perform well in a Major Incident.Before 40%, After increased to 69%Results/Conclusions64 of the respondents viewed the video. From the cohort, 70% were satisfied with the format of the video and 84% believed the content to be useful. Using the Moore’s outcome model there was an increase in 62.1% of the declarative knowledge post viewing, and a 47.8% increase in the confidence of knowing what to do in a MI. The confidence in being able to locate the MIP tray and perform well in a MI had also increased by 47.2% and 42.02% respectively.The repeated silent video format was an effective teaching tool, as reflected in all aspects of Moore’s model; majority of respondents showed improved confidence in all aspects of the MIP. Background training videos could form part of ED training, especially for topics which are not included in formal training programs.
822 Mortality in adolescent trauma: a comparison of children’s, mixed and adult major trauma centres
Authors: Evans Jordan , Murch Hannah , Begley Roisin , Roland Damian , Lyttle Mark , Bouamra Omar , Mullen Stephen 
Published: June 2022

Aims/Objectives/BackgroundWe aimed to compare adolescent mortality rates between different types of major trauma centre (MTC or level 1; adult, children’s and mixed).Methods/DesignData were obtained from TARN (Trauma Audit Research Network) from English sites over a 6-year period (2012–2018), with adolescence defined as 10–24.99 years. Results are presented using descriptive statistics. Patient characteristics were compared using the Kruskal-Wallis test with Dunn’s post-hoc analysis for pairwise comparison and χ2test for categorical variables.Results/Conclusions21 033 cases met inclusion criteria. Trauma-related 30-day crude mortality rates by MTC type were 2.5% (children’s), 4.4% (mixed) and 4.9% (adult). Logistic regression accounting for injury severity, mechanism of injury, physiological parameters and ‘hospital ID’, resulted in adjusted odds of mortality of 2.41 (95% CI 1.31 to 4.43; p=0.005) and 1.85 (95% CI 1.03 to 3.35; p=0.041) in adult and mixed MTCs, respectively when compared with children’s MTCs. In three subgroup analyses the same trend was noted. In adolescents aged 14–17.99 years old, those managed in a children’s MTC had the lowest mortality rate at 2.5%, compared with 4.9% in adult MTCs and 4.4% in mixed MTCs (no statistical difference between children’s and mixed). In cases of major trauma (Injury Severity Score >15) the adjusted odds of mortality were also greater in the mixed and adult MTC groups when compared with the children’s MTC. Median length of stay (LoS) and intensive care unit LoS were comparable for all MTC types. Patients managed in children’s MTCs were less likely to have a CT scan (46.2% vs 62.8% mixed vs 64% adult).Children’s MTC have lower crude and adjusted 30-day mortality rates for adolescent trauma. Further research is required in this field to identify the factors that may have influenced these findings.
853 Mission to mars: using story art to ease anxiety and improve empathy in a children’s emergency department (CED)
Authors: Leanage Navin , Netto Esther , Acheson Jonathan 
Published: June 2022

Aims/Objectives/BackgroundWhilst working in CED one of the most significant challenges has been effective communication with parents and children of all ages. These difficulties can lead to an unclear understanding of a child’s management plan, and specifically its individual steps. This can produce undue anxiety for both parent and child. We decided to focus on creating a tool, to help navigate parents and children through a ketamine reduction of a broken limb. The aims of the digital learning intervention would be to improve patient experience by reducing stress and anxiety and educating them on the plan as it is put into place. This would be in keeping with the Department of Health’s framework for technology enhanced learning as it aims to improve patient outcomes, safety and experience.Methods/DesignWe produced a narrated video story using hand drawn artwork, cartoon effects and video making software plus an optional e-book for parents to read to their children to give a more familiar voice to an already anxious child. The video drew from multiple educational theories and evidence in multimedia education to design an initial protoype. Initially this was specifically for an infant journey through Minor Injuries requiring a ketamine reduction for a bendy limb. Following feedback, the project is being adapted to different journeys ahead of user testing.Results/ConclusionsEvaluation at multiple levels is presently ongoing and is showing positive feedback however further work is required to fully evaluate this project.This can overall help both parent and child in an environment they are otherwise unfamiliar with and during a potentially distressing time. The project opens the doors to multiple designs for both inclusivity and diversity. Furthermore, this can be adapted by different departments and different hospitals keeping the patient at the centre of care.
Magma: A Ground-Truth Fuzzing Benchmark
Authors: Hazimeh Ahmad , Herrera Adrian , Payer Mathias 
Published: June 2022

High scalability and low running costs have made fuzz testing the de facto standard for discovering software bugs. Fuzzing techniques are constantly being improved in a race to build the ultimate bug-finding tool. However, while fuzzing excels at finding bugs in the wild, evaluating and comparing fuzzer performance is challenging due to the lack of metrics and benchmarks. For example, crash count---perhaps the most commonly-used performance metric---is inaccurate due to imperfections in deduplication techniques. Additionally, the lack of a unified set of targets results in ad hoc evaluations that hinder fair comparison.
We tackle these problems by developing Magma, a ground-truth fuzzing benchmark that enables uniform fuzzer evaluation and comparison. By introducing real bugs into real software, Magma allows for the realistic evaluation of fuzzers against a broad set of targets. By instrumenting these bugs, Magma also enables the collection of bug-centric performance metrics independent of the fuzzer. Magma is an open benchmark consisting of seven targets that perform a variety of input manipulations and complex computations, presenting a challenge to state-of-the-art fuzzers.
We evaluate seven widely-used mutation-based fuzzers (AFL, AFLFast, AFL++, FairFuzz, MOpt-AFL, honggfuzz, and SymCC-AFL) against Magma over 200,000 CPU-hours. Based on the number of bugs reached, triggered, and detected, we draw conclusions about the fuzzers' exploration and detection capabilities. This provides insight into fuzzer performance evaluation, highlighting the importance of ground truth in performing more accurate and meaningful evaluations.
On Private Peering Agreements between Content and Access Providers: A Contractual Equilibrium Analysis
Authors: Wang Xin , Ma Richard T.B. 
Published: June 2022

Driven by the rapid growth of content traffic and the demand for service quality, Internet content providers (CPs) have started to bypass transit providers and connect with access providers directly via private peering agreements. This peering relationship often raises disputes, e.g., Netflix vs. Comcast, and is not well understood. In this paper, we build a peering contract model and propose the concept of contractual equilibrium, based on which we study the formation and evolution of peering contracts. By using market data, we emulate the strategic peering behavior of providers and shed light on the understanding of private peering~agreements.
We reveal that the superiority and market dominance of providers primarily determine their peering strategies. We show that 1) superior providers tend to engage in peering more aggressively, and 2) non-dominant CPs' optimal peering strategies are negatively correlated due to market cannibalism, while the dominant CP often behaves oppositely. Our findings help explain phenomena such as why Netflix and Comcast signed the first peering contract, and reason whether private peering contracts will strengthen in future.
Mean Waiting Time in Large-Scale and Critically Loaded Power of d Load Balancing Systems
Authors: Hellemans Tim , Van Houdt Benny 
Published: June 2022

Mean field models are a popular tool used to analyse load balancing policies. In some exceptional cases the waiting time distribution of the mean field limit has an explicit form. In other cases it can be computed as the solution of a differential equation or a recursive relation. In our paper [6] we study the limit of the mean waiting time E[W&955;] as the arrival rate &955; approaches 1 for a number of load balancing policies when job sizes are exponential with mean 1 (i.e. when the system gets close to instability). As E[W_&955;] diverges to infinity, we scale with -log(1-&955;) and present a method to compute the limit lim&955;-> 1- -E[W&955;]/log(1-&955;). We show that this limit has a surprisingly simple form for the load balancing algorithms considered.
In addition, we propose an alternate scaling -log(p&955;) instead of -log(1-&955;), where p&955; is adapted to the policy at hand. This scaling allows us to obtain good approximations of the mean waiting time when &955; is close to one or zero.
Nudge: Stochastically Improving upon FCFS
Authors: Grosof Isaac , Yang Kunhe , Scully Ziv , Harchol-Balter Mor 
Published: June 2022

The First-Come First-Served (FCFS) scheduling policy is the most popular scheduling algorithm used in practice. Furthermore, its usage is theoretically validated: for light-tailed job size distributions, FCFS has weakly optimal asymptotic tail of response time. But what if we don't just care about the asymptotic tail? What if we also care about the 99th percentile of response time, or the fraction of jobs that complete in under one second? Is FCFS still best? Outside of the asymptotic regime, only loose bounds on the tail of FCFS are known, and optimality is completely open.
In this paper, we introduce a new policy, Nudge, which is the first policy to provably stochastically improve upon FCFS. We prove that Nudge simultaneously improves upon FCFS at every point along the tail, for light-tailed job size distributions. As a result, Nudge outperforms FCFS for every moment and every percentile of response time. Moreover, Nudge provides a multiplicative improvement over FCFS in the asymptotic tail. This resolves a long-standing open problem by showing that, counter to previous conjecture, FCFS is not strongly asymptotically optimal.
This paper represents an abridged version of [2].
SADPonzi: Detecting and Characterizing Ponzi Schemes in Ethereum Smart Contracts
Authors: Chen Weimin , Li Xinran , Sui Yuting , He Ningyu , Wang Haoyu , Wu Lei , Luo Xiapu 
Published: June 2022

Ponzi schemes are financial scams that lure users under the promise of high profits. With the prosperity of Bitcoin and blockchain technologies, there has been growing anecdotal evidence that this classic fraud has emerged in the blockchain ecosystem. Existing studies have proposed machine-learning based approaches for detecting Ponzi schemes. However, these state-of-the-art approaches face several major limitations, including lacking interpretability, high false positive rates and the weak robustness to evasion techniques, These limitations mean that existing real-world methods for detecting Ponzi schemes are ineffective.
In this paper, we propose SADPonzi, a semantic-aware detection approach for identifying Ponzi schemes in Ethereum smart contracts. Specifically, we propose a heuristic-guided symbolic execution technique to identify investor-related transfer behaviors and the distribution strategies adopted. Experimental result on a well-labelled benchmark suggests that SADPonzi can achieve 100% precision and recall, outperforming all existing machine-learning based techniques. We further apply SADPonzi to all 3.4 million smart contracts deployed by EOAs in Ethereum and identify 835 Ponzi scheme contracts, with over 17 million US Dollars invested by victims. Our observations confirm the urgency of identifying and mitigating Ponzi schemes in the blockchain ecosystem.
Growth Series of the Braid Monoid
M

B

5

in Band Generators
Authors: Khan Muhammad Haleem , Iqbal Zaffar 
Published: June 2022

Growth series is an important invariant associated with group or monoid which classifies all the words of group or monoid. Therefore, the growth series of braid monoids and Hecke algebras in Artin’s generators is presented in many scholarly published articles. The growth series of braid monoids

M

B

3

and

M

B

4

in band generators is known. In this work, we compute the complete presentation of braid monoid

M

B

5

in band generators by solving all the ambiguities of

M

B

5

. The words on the left-hand of each relation are reducible words, and the words on the right-hand side are canonical words. We partially find the growth series

Q

∗

5

of reducible words. Then, we construct a linear system for canonical words of

M

B

5

in band presentation and compute the corresponding growth series. We also find the growth rate of growth series of

M

B

5

in band generators.
Perfil clínico e demográfico dos pacientes com dor músculo-esquelética crônica acompanhados nos três níveis de atendimento de saúde de Sorocaba
Authors: Martinez José Eduardo , Macedo Ana Carolina , Pinheiro Daniel Faria de Campos , Novato Fernando Correa , Jorge Caio Marcelo , Teixeira Danielle Trevisani 
Published: June 2022

O objetivo desse estudo é determinar o perfil demográfico e clínico dos pacientes dor crônica. Avaliou-se 150 pessoas no Centro de Saúde Escola (CSE) (50), na Policlínica Municipal de Sorocaba (50) e no Conjunto Hospitalar de Sorocaba (CHS) (50). Observou-se forte predominância do sexo feminino nas três unidades avaliadas (CSE - 74%; POLICLÍNICA - 66%; CHS - 80%). Em relação a idade houve um predomínio da faixa acima dos 60 anos no CSE (50%) e da faixa entre 41 e 60 anos na Policlínica (52%) e CHS (50%). Quanto à distribuição articular, houve um predomínio da dor oligoarticular no CSE (60%) e de distribuição poliarticular no CHS (60%). Na Policlínica a maioria das queixas se concentrou na coluna vertebral (52%), No CSE (40%) um maior número de pacientes referiu desconhecer um diagnóstico estabelecido em relação aos pacientes da Policlínica (20%) e do CHS (16%).Observa-se, maior continuidade no tratamento no CHS em relação ao CSE e Policlínica. No CSE 28% dos pacientes referiam manter tratamento contínuo em comparação com 74% na POLICLÍNICA e 92% no CHS. Nas agudizações, os pacientes do CSE tomam remédio por conta própria em sua maioria, enquanto que grande parte dos pacientes da Policlínica e do CHS tomam remédio conforme orientação médica. Concluí - se que as unidades secundárias e terciárias de atendimento público a saúde estão aptas a atender casos de maior complexidade e, portanto, em número insuficiente para atender a demanda.