Evidence update for the treatment of anaphylaxis

The Resuscitation Council UK has updated its Guideline for healthcare providers on the Emergency treatment of anaphylaxis. As part of this process, an evidence review was undertaken by the Guideline Working Group, using an internationally-accepted approach for adoption, adaptation, and de novo guideline development based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence to decision (EtD) framework, referred to as GRADE-ADOLOPMENT. A number of significant changes have been made, which will be reflected in the updated Guideline. These include: emphasis on repeating intramuscular adrenaline doses after 5 min if symptoms of anaphylaxis do not resolve; corticosteroids (e.g. hydrocortisone) no longer being routinely recommended for the emergency treatment of anaphylaxis; interventions for reactions which are refractory to initial treatment with adrenaline; a recommendation against the use of antihistamines for the acute management of anaphylaxis; and guidance relating to the duration of observation following anaphylaxis, and timing of discharge

Review and prospects for autonomous observing systems in vessels of opportunity

This paper focuses on the state of the art on Autonomous Observing Systems (AOS) used in Vessels of Opportunity (VOO) for collecting in situ atmospheric, oceanic and biogeochemical data. The designation Vessels of Opportunity includes all kinds of ships, even if not having scientific goals, which may carry proper devices that autonomously measure environmental variables. These vessels can be merchant, military, research, cruise liners, fishing, ferries, or even private yachts or sailing boats. The use of AOS can provide the opportunity for highly refined oceanographic data and improved derived data estimation, for local, regional or global scales studies. However, making the collected information accessible, both for scientific and technical purposes, provides a challenge in data management and analysis, which must, above all, ensure trusted useful data to the stakeholders. An overall review of the systems implemented is presented. This includes the definition of objectives, the recruitment of vessels and a review on the installation of proper acquisition devices; the selection and collection of Essential Oceanic Variables (EOV); the mechanisms for transmitting the information, and the quality control analysis and dissemination of data. The present and future capabilities of VOO for measuring EOV, within the Portuguese context are referred.PTDC/CTA-AMB/31141/2017 - MAR-01.04.02-FEAMP-0002 - UIDB/UIDP/00134/2020 - UIDB/04326/2020info:eu-repo/semantics/publishedVersio

The integration of structural mechanics into microstructure solidification modelling

In situ structural mechanics are an often neglected area when modelling alloy microstructure during solidification, despite the existence of practical examples and studies which seem to indicate that the interaction between thermal or mechanical stresses and microstructure can have a significant impact on its evolution and hence the final properties at a macroscopic level. A bespoke structural mechanics solver using the finite volume method has been developed to solve the linear elasticity equations, with design choices being made to facilitate the coupling of this solver to run in situ with an existing solidification model. The accuracy of the structural mechanics solver is verified against an analytic solution and initial results from a fully coupled system are presented which demonstrate in a fundamental example that the interaction between structural mechanics and a solidifying dendrite can lead to a significant change in growth behaviour

Modulating Meltpool Dynamics and Microstructure using Thermoelectric Magnetohydrodynamics in Additive Manufacturing

Meltpool modulation in Selective Laser Remelting Additive Manufacturing via an oscillating magnetic field generates Thermoelectric Magnetohydrodynamics (TEMHD) flow. Numerical predictions show that the resulting microstructure can be significantly altered. A multi-scale numerical model captures the meso-scale melt pool dynamics coupled to microscale solidification showing the microstructure evolution and solute redistribution. The results highlight the complex interaction of the various physical phenomena and also show the method's potential to disrupt the epitaxial growth defect. The model predictions are supported by preliminary experimental results that demonstrate the dependency of the melt pool depth on magnetic field orientation. The results highlight how a time-dependent field has the potential to provide an independent control mechanism to tailor microstructures

What the future holds for social media data analysis

The dramatic rise in the use of Social Media (SM) platforms such as Facebook and Twitter provide access to an unprecedented amount of user data. Users may post reviews on products and services they bought, write about their interests, share ideas or give their opinions and views on political issues. There is a growing interest in the analysis of SM data from organisations for detecting new trends, obtaining user opinions on their products and services or finding out about their online reputations. A recent research trend in SM analysis is making predictions based on sentiment analysis of SM. Often indicators of historic SM data are represented as time series and correlated with a variety of real world phenomena like the outcome of elections, the development of financial indicators, box office revenue and disease outbreaks. This paper examines the current state of research in the area of SM mining and predictive analysis and gives an overview of the analysis methods using opinion mining and machine learning techniques

International Variations in Surgical Morbidity and Mortality Post Gynaecological Oncology Surgery: A Global Gynaecological Oncology Surgical Outcomes Collaborative Led Study (GO SOAR1)

Gynaecological malignancies affect women in low and middle income countries (LMICs) at disproportionately higher rates compared with high income countries (HICs) with little known about variations in access, quality, and outcomes in global cancer care. Our study aims to evaluate international variation in post-operative morbidity and mortality following gynaecological oncology surgery between HIC and LMIC settings. Study design consisted of a multicentre, international prospective cohort study of women undergoing surgery for gynaecological malignancies (NCT04579861). Multilevel logistic regression determined relationships within three-level nested-models of patients within hospitals/countries. We enrolled 1820 patients from 73 hospitals in 27 countries. Minor morbidity (Clavien-Dindo I-II) was 26.5% (178/672) and 26.5% (267/1009), whilst major morbidity (Clavien-Dindo III-V) was 8.2% (55/672) and 7% (71/1009) for LMICs/HICs, respectively. Higher minor morbidity was associated with pre-operative mechanical bowel preparation (OR = 1.474, 95%CI = 1.054-2.061, p = 0.023), longer surgeries (OR = 1.253, 95%CI = 1.066-1.472, p = 0.006), greater blood loss (OR = 1.274, 95%CI = 1.081-1.502, p = 0.004). Higher major morbidity was associated with longer surgeries (OR = 1.37, 95%CI = 1.128-1.664, p = 0.002), greater blood loss (OR = 1.398, 95%CI = 1.175-1.664, p ≤ 0.001), and seniority of lead surgeon, with junior surgeons three times more likely to have a major complication (OR = 2.982, 95%CI = 1.509-5.894, p = 0.002). Of all surgeries, 50% versus 25% were performed by junior surgeons in LMICs/HICs, respectively. We conclude that LMICs and HICs were associated with similar post-operative major morbidity. Capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention

Adult Advanced Life Support 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations

This 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations for advanced life support includes updates on multiple advanced life support topics addressed with 3 different types of reviews. Topics were prioritized on the basis of both recent interest within the resuscitation community and the amount of new evidence available since any previous review. Systematic reviews addressed higher-priority topics, and included double-sequential defibrillation, intravenous versus intraosseous route for drug administration during cardiac arrest, point-of-care echocardiography for intra-arrest prognostication, cardiac arrest caused by pulmonary embolism, postresuscitation oxygenation and ventilation, prophylactic antibiotics after resuscitation, postresuscitation seizure prophylaxis and treatment, and neuroprognostication. New or updated treatment recommendations on these topics are presented. Scoping reviews were conducted for anticipatory charging and monitoring of physiological parameters during cardiopulmonary resuscitation. Topics for which systematic reviews and new Consensuses on Science With Treatment Recommendations were completed since 2015 are also summarized here. All remaining topics reviewed were addressed with evidence updates to identify any new evidence and to help determine which topics should be the highest priority for systematic reviews in the next 1 to 2 years.Peer reviewe

Incidence and outcome of in-hospital cardiac arrest in the United Kingdom National Cardiac Arrest Audit

Objective To report the incidence, characteristics and outcome of adult in-hospital cardiac arrest in the United Kingdom (UK) National Cardiac Arrest Audit database. Methods A prospectively defined analysis of the UK National Cardiac Arrest Audit (NCAA) database. 144 acute hospitals contributed data relating to 22,628 patients aged 16 years or over receiving chest compressions and/or defibrillation and attended by a hospital-based resuscitation team in response to a 2222 call. The main outcome measures were incidence of adult in-hospital cardiac arrest and survival to hospital discharge. Results The overall incidence of adult in-hospital cardiac arrest was 1.6 per 1000 hospital admissions with a median across hospitals of 1.5 (interquartile range 1.2–2.2). Incidence varied seasonally, peaking in winter. Overall unadjusted survival to hospital discharge was 18.4%. The presenting rhythm was shockable (ventricular fibrillation or pulseless ventricular tachycardia) in 16.9% and non-shockable (asystole or pulseless electrical activity) in 72.3%; rates of survival to hospital discharge associated with these rhythms were 49.0% and 10.5%, respectively, but varied substantially across hospitals. Conclusions These first results from the NCAA database describing the current incidence and outcome of adult in-hospital cardiac arrest in UK hospitals will serve as a benchmark from which to assess the future impact of changes in service delivery, organisation and treatment for in-hospital cardiac arrest

Development and validation of risk models to predict outcomes following in-hospital cardiac arrest attended by a hospital-based resuscitation team

Aim The National Cardiac Arrest Audit (NCAA) is the UK national clinical audit for in-hospital cardiac arrest. To make fair comparisons among health care providers, clinical indicators require case mix adjustment using a validated risk model. The aim of this study was to develop and validate risk models to predict outcomes following in-hospital cardiac arrest attended by a hospital-based resuscitation team in UK hospitals. Methods Risk models for two outcomes—return of spontaneous circulation (ROSC) for greater than 20 min and survival to hospital discharge—were developed and validated using data for in-hospital cardiac arrests between April 2011 and March 2013. For each outcome, a full model was fitted and then simplified by testing for non-linearity, combining categories and stepwise reduction. Finally, interactions between predictors were considered. Models were assessed for discrimination, calibration and accuracy. Results 22,479 in-hospital cardiac arrests in 143 hospitals were included (14,688 development, 7791 validation). The final risk model for ROSC > 20 min included: age (non-linear), sex, prior length of stay in hospital, reason for attendance, location of arrest, presenting rhythm, and interactions between presenting rhythm and location of arrest. The model for hospital survival included the same predictors, excluding sex. Both models had acceptable performance across the range of measures, although discrimination for hospital mortality exceeded that for ROSC > 20 min (c index 0.81 versus 0.72). Conclusions Validated risk models for ROSC > 20 min and hospital survival following in-hospital cardiac arrest have been developed. These models will strengthen comparative reporting in NCAA and support local quality improvement