bluuebunny/crossref_metadata_2025_split huggingface dataset:
791 The EDCO study: screening patients for unintentional carbon monoxide exposure in emergency department patients
Authors: Jarman Heather , Atkinson Richard , Baramova Desislava , Quinn Tom 
Published: June 2022

Aims/Objectives/BackgroundCarbon monoxide (CO) is the most common cause of death by poisoning worldwide. Repeated low-level exposure to CO is significant health concern leading to long-term neurological sequelae but is difficult to diagnose due to non-specific symptoms such as headache. We aimed to establish the prevalence of low-level CO poisoning in patients presenting to the ED with symptoms suggestive of CO exposure.Methods/DesignThis prospective multi-centre observational study recruited from four UK EDs between December 2018 and March 2020. Eligible patients were those with symptoms suggestive of CO poisoning including headache, flu-like symptoms and cardiac chest pain. We collected data using the RCEM endorsed ‘COMA’ questions to detect CO poisoning and measured carboxyhaemoglobin (COHb). An investigation of the home was undertaken to identify sources of CO exposure. The proportion (exact 95% confidence interval) of probable CO poisoning in each symptom group was calculated.Results/ConclusionsWe analysed data from 4190 patients. 159 (3.8%) had suspected CO poisoning based on COHb level and/or COMA questions. Prevalence was highest in patients with flu-like symptoms 14.8% (7.9, 24.4).Data linked to CO testing in the home confirmed 1 case of CO presence and 21 probable cases based on a possible CO source from gas appliances. 62% of probable cases had normal COHb level in ED and were identified using only the COMA questions. Only 7.5% of patients with raised COHb level were considered by ED clinicians to have been exposed to CO as a cause for their symptoms.This study provides evidence that ED patients with non-specific symptoms and no clear history of CO exposure are at risk from CO poisoning from faulty appliances in the home. We advocate that the COMA tool is used in conjunction with testing of COHb levels at the earliest opportunity to ensure that patients with potential CO exposure are not missed.
871 Virtual platforms for learning: balancing pandemic needs springboards future educational success
Authors: Mossad Tim 
Published: June 2022

Aims/Objectives/BackgroundThe current Covid-19 pandemic poses many unprecedented educational challenges. Virtual learning is a recognised and increasingly validated modality that has been strategically adapted to facilitate pandemic educational delivery. Balancing platform usage with fewer available face to face sessions could facilitate clinical competency development and progression for all workforce colleagues and beyond.Methods/DesignThis prospective cross-site large DGH survey, powered at an 8% margin of error with 95% confidence intervals, aimed to identify colleague perceptions of virtual learning platforms.80 colleagues (41 males, 39 females) participated in survey monkey questionnaire completion over a designated three-week period following governance approval.Demographic data was collated on job title/grade, sex, age bracket and whether the respondent currently worked in ED. Likert scale referenced statements on knowledge, confidence, utility and enjoyability were transcribed into metric data for analysis (1- strongly disagree, 2- partially disagree, 3- neither agree or disagree, 4- partially agree, 5- strongly agree).Results/ConclusionsSurvey participants at undergraduate and postgraduate levels believed virtual platforms are useful (3.80, p<0.002) and had confidence in them (3.90, p<0.001) despite face to face preferences (4.23, p<0.001). Respondents believed virtual mapping facilitated competency development and portfolio completion with high utility and system knowledge (3.68–4.08, p<0.001). Whilst preferring platform variety and pre-determined guidance, subgroup analyses showed Foundation and Core EM Trainees had highest enjoyment levels (3.85–4.88, p<0.001). Trainees preferred receiving virtual learning on one platform (4.78, p<0.001). Perceptions on needing traditional classroom teaching were neutral (3.2, p<0.01).Overall, themes relating to respondent’s perception of virtual platforms were positive. This survey provides a valid, transferable platform for developing and exploring future balanced use of virtual platforms as resources for educational progression and development.
892 Treatment variables associated with outcome in emergency department suspected sepsis
Authors: Sivayoham Narani , Blake Lesley , Tharimoopantavida Shafi , Chughtai Saad , Hussain Adil , Rhodes Andrew 
Published: June 2022

Aims/Objectives/BackgroundEarly treatment is advocated in the management of patients with suspected sepsis. We sought to understand the association between the emergency department (ED) treatments and outcome in these patients. The treatments studied were: (i) the time to antibiotics, (ii) the volume of intravenous fluid (IVF), (iii) mean arterial pressure (MAP) after 2,000 ml of IVF and (iv) the final MAP in the ED.Methods/DesignA retrospective analysis of the ED database of adult patients who met two SIRS criteria or one red flag sepsis criteria on arrival, received intravenous antibiotics for a suspected infection and admitted between February 2016 and August 2017, was performed. The primary outcome measure was all-cause in-hospital mortality. The four treatments stated above were controlled for severity of illness and subject to multivariate logistic regression and Cox proportional-hazard regression to identify independent predictors of mortality.Results/ConclusionsOf the 2,066 patients studied 272 (13.2%) died in hospital. The median time to antibiotics was 48 (Interquartile range 30–82) minutes. The time to antibiotics was an independent predictor of mortality only in those who developed refractory hypotension (RH); antibiotics administered more than 55 mins after arrival was associated with an odd-ratio (OR) for mortality of 2.75 [95% confidence interval (CI) 1.22–6.14]. The number-needed-to-treat was 4. IVF >2,000 ml (95%CI >500->2,100), except in RH, and a MAP≤66 mmHg after 2,000 mls of IVF were also independent predictors of mortality. The OR for mortality of IVF>2,000 ml in non-RH was 1.80 (95%CI 1.15–2.82); Number-needed-to-harm was 14. The OR for morality for a MAP≤66 mmHg after 2,000 ml of IVF was 3.42 (95%CI 2.10–5.57). A final MAP<75 mmHg in the ED was associated with, but not an independent predictor of mortality.Antibiotics were time-critical only in refractory hypotension. Intravenous fluids >2,000 mls in non-RH and a MAP≤66 mmHg after 2,000 ml of IVF were also independent predictors of mortality.
834 Comparative analysis of major incident triage tools in children – a UK population-based analysis
Authors: Vassallo James , Chernbumroong Saisakul , Malik Nabeela , Xu Yuanwei , Keene Damian , Gkoutos George , Lyttle Mark , Smith Jason 
Published: June 2022

Aims/Objectives/BackgroundTriage is a key principle in the effective management of major incidents. There is currently a paucity of evidence to guide the triage of children. The aim of this study was to perform a comparative analysis of nine adult and paediatric triage tools, including the novel ‘Sheffield Paediatric Triage Tool’ (SPTT), assessing their ability in identifying patients needing life-saving interventions (LSI).Methods/DesignA ten-year retrospective database review of TARN data for paediatric patients (<16years) was performed. Primary outcome was identification of patients receiving one or more LSIs from a previously defined list. Secondary outcomes included mortality and prediction of ISS>15. Primary analysis was conducted on patients with complete pre-hospital physiological data with planned secondary analyses using first recorded physiological data. Performance characteristics were evaluated using sensitivity, specificity, under and over-triage.Results15133 patients met TARN inclusion criteria. 4962 (32.8%) had complete pre-hospital physiological data and 8255 (54.5%) had complete first recorded data. Male patients predominated (69.5%), sustaining blunt trauma (95.4%) with a median ISS of 9. 875 patients (17.6%) received at least one LSI.The SPTT demonstrated the greatest sensitivity of all triage tools at identifying need for LSI (92.2%) but was associated with the highest rate of over-triage (75.0%). Both the PTT (sensitivity 34.1%) and JumpSTART (sensitivity 45.0%) performed less well at identifying LSI. By contrast, the adult MPTT-24 triage tool had the second highest sensitivity (80.8%) with tolerable rates of over-triage (70.2%).ConclusionThe SPTT and MPTT-24 outperform existing paediatric triage tools at identifying those patients requiring LSIs. This may necessitate a change in recommended practice. Further work is needed to determine the optimum method of paediatric major incident triage, but consideration should be given to simplifying major incident triage by the use of one generic tool (the MPTT-24) for adults and children.
Unfavourable intrauterine environment contributes to abnormal gut microbiome and metabolome in twins
Authors: Yang Jing , Hou Lingling , Wang Jinfeng , Xiao Liwen , Zhang Jinyang , Yin Nanlin , Yao Su , Cheng Kun , Zhang Wen , Shi Zhonghua , Wang Jing , Jiang Hai , Huang Nana , You Yanxia , Lin Mingmei , Shang Ruiyan , Wei Yuan , Zhao Yangyu , Zhao Fangqing 
Published: June 2022

ObjectiveFetal growth restriction (FGR) is a devastating pregnancy complication that increases the risk of perinatal mortality and morbidity. This study aims to determine the combined and relative effects of genetic and intrauterine environments on neonatal microbial communities and to explore selective FGR-induced gut microbiota disruption, metabolic profile disturbances and possible outcomes.DesignWe profiled and compared the gut microbial colonisation of 150 pairs of twin neonates who were classified into four groups based on their chorionicity and discordance of fetal birth weight. Gut microbiota dysbiosis and faecal metabolic alterations were determined by 16S ribosomal RNA and metagenomic sequencing and metabolomics, and the long-term effects were explored by surveys of physical and neurocognitive development conducted after 2~3 years of follow-up.ResultsAdverse intrauterine environmental factors related to selective FGR dominate genetics in their effects of elevating bacterial diversity and altering the composition of early-life gut microbiota, and this effect is positively related to the severity of selective FGR in twins. The influence of genetic factors on gut microbes diminishes in the context of selective FGR. Gut microbiota dysbiosis in twin neonates with selective FGR and faecal metabolic alterations features decreased abundances ofEnterococcusandAcinetobacterand downregulated methionine and cysteine levels. Correlation analysis indicates that the faecal cysteine level in early life is positively correlated with the physical and neurocognitive development of infants.ConclusionDysbiotic microbiota profiles and pronounced metabolic alterations are associated with selective FGR affected by adverse intrauterine environments, emphasising the possible effects of dysbiosis on long-term neurobehavioural development.
Prospective comparison of two methods for assessing sarcopenia and interobserver agreement on retrospective CT images
Authors: Dale MacLaine Thomas , Baker Oliver , Omura Miyuki , Clarke Christopher , Howell Simon J , Burke Dermot 
Published: June 2022

Abstract

Purpose of the study
To compare the relationships between two CT derived sarcopenia assessment methods, and compare their relationship with inter-rater and intrarater validations and colorectal surgical outcomes.

Study design
157 CT scans were identified across Leeds Teaching Hospitals National Health Service Trust for patients undergoing colorectal cancer surgery. 107 had body mass index data available, required to determine sarcopenia status. This work explores the relationship between sarcopenia, as measured by both total cross sectional-area (TCSA) and psoas-area (PA) and surgical outcomes. All images were assessed for inter-rater and intrarater variability for both TCSA and PA methods of sarcopenia identification. The raters included a radiologist, an anatomist and two medical students.

Results
Prevalence of sarcopenia was different when measured by PA (12.2%–22.4%) in comparison to TCSA (60.8%–70.1%). Strong correlation exists between muscle areas in both TCSA and PA measures, however, there were significant differences between methods after the application of method-specific cut-offs. There was substantial agreement for both intrarater and inter-rater comparisons for both TCSA and PA sarcopenia measures. Outcome data were available for 99/107 patients. Both TCSA and PA have poor association with adverse outcomes following colorectal surgery.

Conclusions
CT-determined sarcopenia can be identified by junior clinicians, those with anatomical understanding and radiologists. Our study identified sarcopenia to have a poor association with adverse surgical outcomes in a colorectal population. Published methods of identifying sarcopenia are not translatable to all clinical populations. Currently available cut-offs require refinement for potential confounding factors, to provide more valuable clinical information.

What is already known on this topic?

What does this study add?

How might this study affect research, practice or policy?
Cisternostomy for malignant middle cerebral artery infarction: proposed pathophysiological mechanisms and preliminary results
Authors: Cardali Salvatore Massimiliano , Caffo Maria , Caruso Gerardo , Scalia Gianluca , Gorgoglione Nicola , Conti Alfredo , Vinci Sergio Lucio , Barresi Valeria , Granata Francesca , Ricciardo Giuseppe , Garufi Giada , Raffa Giovanni , Germanò Antonino 
Published: June 2022

BackgroundThe ischaemic stroke of the territory of the middle cerebral artery represents an event burdened by high mortality and severe morbidity. The proposed medical treatments do not always prove effective. Decompressive craniectomy allows the ischaemic tissue to shift through the surgical defect rather than to the unaffected regions of the brain, thus avoiding secondary damage due to increased intracranial pressure. In this study, we propose a novel treatment for these patients characterised by surgical fenestration of the cisterns of the skull base.MethodsWe have treated 16 patients affected by malignant middle cerebral artery ischaemia and treated with cisternostomy between August 2018 and December 2019. The clinical history, neurological examination findings and neuroradiological studies (brain CT, CT angiography, MRI) were performed to diagnose stroke. Clinical examination was recorded on admission and preoperatively using the Glasgow Coma Scale and the National Institutes of Health Stroke Scale.ResultsThe study included 16 patients, 10 males and 6 females. The mean age at surgery was 60.1 years (range 19–73). Surgical procedure was performed in all patients. The patients underwent immediate postoperative CT scan and were in the early hours evaluated in sedation window. In total, we recorded two deaths (12.5%). A functional outcome between mRS 0–3, defined as favourable, was observed in 9 (64.2%) patients 9 months after discharge. A functional outcome between mRS 4–6, defined as poor, was observed in 5 (35.7%) patients 9 months after discharge.ConclusionsThe obtained clinical results appear, however, substantially overlapping to decompressive craniectomy. Cisternostomy results in a favourable functional outcome after 9 months. This proposed technique permits that the patient no longer should be undergone cranioplasty thus avoiding the possible complications related to this procedure. The results are certainly interesting but higher case numbers are needed to reach definitive conclusions.
Force probes for development and testing of different electric propulsion systems
Authors: Spethmann Alexander , Trottenberg Thomas , Kersten Holger , Hey Franz Georg , Grimaud Lou , Mazouffre Stéphane , Bock Daniel , Tajmar Martin 
Published: June 2022

AbstractDiagnostics with force probes in plumes of electric propulsion systems for spacecraft (thrusters) are presented. This contribution focuses on showing example measurements with force probes for the most common gridless ion thruster types. The gridless thrusters are investigated at typical operation modes with a force probe at fixed or variable positions in the plume. The probe measures the force on a tiny plate that is attached to a sensitive cantilever in the plume. The elastic deflection of the cantilever is measured interferometrically and translated into a proportional force. Several variants of the instrument have been developed. A HEMP thruster is investigated with a variant of the force probe that simultaneously measures two components of the force vector. With this vectorial probe, it is possible to determine the force vector acting on the probe target while moving the probe through the thruster plume. A Hall thruster is investigated with a simplified variant of the probe, which measures the force along one axis and is equipped with an additional shutter in front of the target. This allows monitoring over long periods of operation. Finally, a force probe is used as an indirect thrust balance for a FEEP thruster. In this case, the force probe can collect the entire plume.
Zero Queueing for Multi-Server Jobs
Authors: Wang Weina , Xie Qiaomin , Harchol-Balter Mor 
Published: June 2022

Cloud computing today is dominated by multi-server jobs. These are jobs that request multiple servers simultaneously and hold onto all of these servers for the duration of the job. Multi-server jobs add a lot of complexity to the traditional one-server-per-job model: an arrival might not "fit" into the available servers and might have to queue, blocking later arrivals and leaving servers idle. From a queueing perspective, almost nothing is understood about multi-server job queueing systems; even understanding the exact stability region is a very hard problem.
In this paper, we investigate a multi-server job queueing model under scaling regimes where the number of servers in the system grows. Specifically, we consider a system with multiple classes of jobs, where jobs from different classes can request different numbers of servers and have different service time distributions, and jobs are served in first-come-first-served order. The multi-server job model opens up new scaling regimes where both the number of servers that a job needs and the system load scale with the total number of servers. Within these scaling regimes, we derive the first results on stability, queueing probability, and the transient analysis of the number of jobs in the system for each class. In particular we derive sufficient conditions for zero queueing. Our analysis introduces a novel way of extracting information from the Lyapunov drift, which can be applicable to a broader scope of problems in queueing systems.
A Systematic Framework to Identify Violations of Scenario-dependent Driving Rules in Autonomous Vehicle Software
Authors: Zhang Qingzhao , Hong David Ke , Zhang Ze , Chen Qi Alfred , Mahlke Scott , Mao Z. Morley 
Published: June 2022

Safety compliance is paramount to the safe deployment of autonomous vehicle (AV) technologies in real-world transportation systems. As AVs will share road infrastructures with human drivers and pedestrians, it is an important requirement for AVs to obey standard driving rules. Existing AV software testing methods, including simulation and road testing, only check fundamental safety rules such as collision avoidance and safety distance. Scenario-dependent driving rules, including crosswalk and intersection rules, are more complicated because the expected driving behavior heavily depends on the surrounding circumstances. However, a testing framework is missing for checking scenario-dependent driving rules on various AV software.
In this paper, we design and implement a systematic framework AVChecker for identifying violations of scenario-dependent driving rules in AV software using formal methods. AVChecker represents both the code logic of AV software and driving rules in proposed formal specifications and leverages satisfiability modulo theory (SMT) solvers to identify driving rule violations. To improve the automation of systematic rule-based checking, AVChecker provides a powerful user interface for writing driving rule specifications and applies static code analysis to extract rule-related code logic from the AV software codebase. Evaluations on two open-source AV software platforms, Baidu Apollo and Autoware, uncover 19 true violations out of 28 real-world driving rules covering crosswalks, traffic lights, stop signs, and intersections. Seven of the violations can lead to severe risks of a collision with pedestrians or blocking traffic.
Enhancing Radioiodine Incorporation into Radioiodine-Refractory Thyroid Cancer with MAPK Inhibition (ERRITI): A Single-Center Prospective Two-Arm Study
Authors: Weber Manuel , Kersting David , Riemann Burkhard , Brandenburg Tim , Führer-Sakel Dagmar , Grünwald Frank , Kreissl Michael C. , Dralle Henning , Weber Frank , Schmid Kurt Werner , Herrmann Ken , Jentzen Walter , Grafe Hong , Rischpler Christoph , Theurer Sarah , Bockisch Andreas , Nagarajah James , Fendler Wolfgang P. 
Published: June 2022

Abstract

Purpose:
Restoration of iodine incorporation (redifferentiation) by MAPK inhibition was achieved in previously radioiodine-refractory, unresectable thyroid carcinoma (RR-TC). However, results were unsatisfactory in BRAFV600E-mutant (BRAF-MUT) RR-TC. Here we assess safety and efficacy of redifferentiation therapy through genotype-guided MAPK-modulation in patients with BRAF-MUT or wildtype (BRAF-WT) RR-TC.

Patients and Methods:
In this prospective single-center, two-arm phase II study, patients received trametinib (BRAF-WT) or trametinib + dabrafenib (BRAF-MUT) for 21 ± 3 days. Redifferentiation was assessed by 123I-scintigraphy. In case of restored radioiodine uptake, 124I-guided 131I therapy was performed. Primary endpoint was the redifferentiation rate. Secondary endpoints were treatment response (thyroglobulin, RECIST 1.1) and safety. Parameters predicting successful redifferentiation were assessed using a receiver operating characteristic analysis and Youden J statistic.

Results:
Redifferentiation was achieved in 7 of 20 (35%) patients, 2 of 6 (33%) in the BRAF-MUT and 5 of 14 (36%) in the BRAF-WT arm. Patients received a mean (range) activity of 300.0 (273.0–421.6) mCi for 131I therapy. Any thyroglobulin decline was seen in 57% (4/7) of the patients, RECIST 1.1 stable/partial response/progressive disease in 71% (5/7)/14% (1/7)/14% (1/7). Peak standardized uptake value (SUVpeak) &lt; 10 on 2[18F]fluoro-2-deoxy-D-glucose (FDG)-PET was associated with successful redifferentiation (P = 0.01). Transient pyrexia (grade 3) and rash (grade 4) were noted in one patient each.

Conclusions:
Genotype-guided MAPK inhibition was safe and resulted in successful redifferentiation in about one third of patients in each arm. Subsequent 131I therapy led to a thyroglobulin (Tg) decline in more than half of the treated patients. Low tumor glycolytic rate as assessed by FDG-PET is predictive of redifferentiation success.
See related commentary by Cabanillas et al., p. 4164