System and method for determining triage categories

Embodiments disclosed herein provide a system, method, and computer program product for providing a triage clas- sification system. The triage classification system uses a computer model that is developed using historical patient data. The developed computer modelis applied to collected patientattributedatafromapatientinapre-hospitalsetting to generate a triage category. Based on the generated triage category, health care professionals can take desired actions, suchastransportingthepatienttoafacilitymatchingthe generated triage category.Board of Regents, University of Texas Syste

High-performance design patterns for modern Fortran

This paper presents ideas for using coordinate-free numerics in modern Fortran to achieve code flexibility in the partial differential equation (PDE) domain. We also show how Fortran, over the last few decades, has changed to become a language well-suited for state-of-the-art software development. Fortran’s new coarray distributed data structure, the language’s class mechanism, and its side-effect-free, pure procedure capability provide the scaffolding on which we implement HPC software. These features empower compilers to organize parallel computations with efficient communication. We present some programming patterns that support asynchronous evaluation of expressions comprised of parallel operations on distributed data. We implemented these patterns using coarrays and the message passing interface (MPI). We compared the codes’ complexity and performance. The MPI code is much more complex and depends on external libraries. The MPI code on Cray hardware using the Cray compiler is 1.5–2 times faster than the coarray code on the same hardware. The Intel compiler implements coarrays atop Intel’s MPI library with the result apparently being 2–2.5 times slower than manually coded MPI despite exhibiting nearly linear scaling efficiency. As compilers mature and further improvements to coarrays comes in Fortran 2015, we expect this performance gap to narrow.publishedVersio

Multidisciplinary oil spill modeling to protect coastal communities and the environment of the Eastern Mediterranean Sea

We present new mathematical and geological models to assist civil protection authorities in the mitigation of potential oil spill accidents in the Eastern Mediterranean Sea. Oil spill simulations for 19 existing offshore wells were carried out based on novel and high resolution bathymetric, meteorological, oceanographic, and geomorphological data. The simulations show a trend for east and northeast movement of oil spills into the Levantine Basin, affecting the coastal areas of Israel, Lebanon and Syria. Oil slicks will reach the coast in 1 to 20 days, driven by the action of the winds, currents and waves. By applying a qualitative analysis, seabed morphology is for the first time related to the direction of the oil slick expansion, as it is able to alter the movement of sea currents. Specifically, the direction of the major axis of the oil spills, in most of the cases examined, is oriented according to the prevailing azimuth of bathymetric features. This work suggests that oil spills in the Eastern Mediterranean Sea should be mitigated in the very few hours after their onset, and before wind and currents disperse them. We explain that protocols should be prioritized between neighboring countries to mitigate any oil spills

Further Evidence for Collimated Particle Beams from Pulsars, and Precession

We follow up on our (Radhakrishnan & Deshpande, 2001: RD01) radically different interpretation of the observed structures and morphologies in the x-ray observations of the nebulae around young pulsars (PWNe). In our general model for PWNe (RD01), originally motivated by the Chandra observations of the Vela X-ray nebula, the bright arcs, the jet-like feature and the diffuse components in such nebulae can be explained together in detail, wherein the arcs are understood as traces of the particle beams from the two magnetic poles at the shock front. We consider this as important evidence for collimated particle beams from pulsars' magnetic poles. In this paper, we discuss the variability in the features in the Vela X-ray nebula observed by Pavlov et al. (2003), and assess the relevance and implication of our model to the observations on the Crab and other remnants. Our basic picture after incorporating the signatures of free precession of the central compact object can readily account for the variability and significant asymmetries, including the bent jet-like features, in the observed morphologies. The implications of these findings are discussed.Comment: Minor revision; 12 (9+3) pages, 3 figures; To appear in Ap

Modelling of oil spills in confined maritime basins: The case for early response in the Eastern Mediterranean Sea

Oil spill models are combined with bathymetric, meteorological, oceanographic, and geomorphological data to model a series of oil spill accidents in the Eastern Mediterranean Sea. A total of 104 oil spill simulations, computed for 11 different locations in the Levantine Basin, show that oil slicks will reach the coast of Cyprus in four (4) to seven (7) days in summer conditions. Oil slick trajectories are controlled by prevailing winds and current eddies. Based on these results, we support the use of chemical dispersants in the very few hours after large accidental oil spills. As a corollary, we show shoreline susceptibility to vary depending on: a) differences in coastline morphology and exposure to wave action, b) the existence of uplifted wave-cut platforms, coastal lagoons and pools, and c) the presence of tourist and protected environmental areas. Mitigation work should take into account the relatively high susceptibility of parts of the Eastern Mediterranean

Determinants of recovery from post-COVID-19 dyspnoea: analysis of UK prospective cohorts of hospitalised COVID-19 patients and community-based controls

Background The risk factors for recovery from COVID-19 dyspnoea are poorly understood. We investigated determinants of recovery from dyspnoea in adults with COVID-19 and compared these to determinants of recovery from non-COVID-19 dyspnoea. Methods We used data from two prospective cohort studies: PHOSP-COVID (patients hospitalised between March 2020 and April 2021 with COVID-19) and COVIDENCE UK (community cohort studied over the same time period). PHOSP-COVID data were collected during hospitalisation and at 5-month and 1-year follow-up visits. COVIDENCE UK data were obtained through baseline and monthly online questionnaires. Dyspnoea was measured in both cohorts with the Medical Research Council Dyspnoea Scale. We used multivariable logistic regression to identify determinants associated with a reduction in dyspnoea between 5-month and 1-year follow-up. Findings We included 990 PHOSP-COVID and 3309 COVIDENCE UK participants. We observed higher odds of improvement between 5-month and 1-year follow-up among PHOSP-COVID participants who were younger (odds ratio 1.02 per year, 95% CI 1.01–1.03), male (1.54, 1.16–2.04), neither obese nor severely obese (1.82, 1.06–3.13 and 4.19, 2.14–8.19, respectively), had no pre-existing anxiety or depression (1.56, 1.09–2.22) or cardiovascular disease (1.33, 1.00–1.79), and shorter hospital admission (1.01 per day, 1.00–1.02). Similar associations were found in those recovering from non-COVID-19 dyspnoea, excluding age (and length of hospital admission). Interpretation Factors associated with dyspnoea recovery at 1-year post-discharge among patients hospitalised with COVID-19 were similar to those among community controls without COVID-19. Funding PHOSP-COVID is supported by a grant from the MRC-UK Research and Innovation and the Department of Health and Social Care through the National Institute for Health Research (NIHR) rapid response panel to tackle COVID-19. The views expressed in the publication are those of the author(s) and not necessarily those of the National Health Service (NHS), the NIHR or the Department of Health and Social Care. COVIDENCE UK is supported by the UK Research and Innovation, the National Institute for Health Research, and Barts Charity. The views expressed are those of the authors and not necessarily those of the funders

Genetic mechanisms of critical illness in COVID-19.

Host-mediated lung inflammation is present1, and drives mortality2, in the critical illness caused by coronavirus disease 2019 (COVID-19). Host genetic variants associated with critical illness may identify mechanistic targets for therapeutic development3. Here we report the results of the GenOMICC (Genetics Of Mortality In Critical Care) genome-wide association study in 2,244 critically ill patients with COVID-19 from 208 UK intensive care units. We have identified and replicated the following new genome-wide significant associations: on chromosome 12q24.13 (rs10735079, P = 1.65 × 10-8) in a gene cluster that encodes antiviral restriction enzyme activators (OAS1, OAS2 and OAS3); on chromosome 19p13.2 (rs74956615, P = 2.3 × 10-8) near the gene that encodes tyrosine kinase 2 (TYK2); on chromosome 19p13.3 (rs2109069, P = 3.98 ×  10-12) within the gene that encodes dipeptidyl peptidase 9 (DPP9); and on chromosome 21q22.1 (rs2236757, P = 4.99 × 10-8) in the interferon receptor gene IFNAR2. We identified potential targets for repurposing of licensed medications: using Mendelian randomization, we found evidence that low expression of IFNAR2, or high expression of TYK2, are associated with life-threatening disease; and transcriptome-wide association in lung tissue revealed that high expression of the monocyte-macrophage chemotactic receptor CCR2 is associated with severe COVID-19. Our results identify robust genetic signals relating to key host antiviral defence mechanisms and mediators of inflammatory organ damage in COVID-19. Both mechanisms may be amenable to targeted treatment with existing drugs. However, large-scale randomized clinical trials will be essential before any change to clinical practice

Whole-genome sequencing reveals host factors underlying critical COVID-19

Critical COVID-19 is caused by immune-mediated inflammatory lung injury. Host genetic variation influences the development of illness requiring critical care1 or hospitalization2–4 after infection with SARS-CoV-2. The GenOMICC (Genetics of Mortality in Critical Care) study enables the comparison of genomes from individuals who are critically ill with those of population controls to find underlying disease mechanisms. Here we use whole-genome sequencing in 7,491 critically ill individuals compared with 48,400 controls to discover and replicate 23 independent variants that significantly predispose to critical COVID-19. We identify 16 new independent associations, including variants within genes that are involved in interferon signalling (IL10RB and PLSCR1), leucocyte differentiation (BCL11A) and blood-type antigen secretor status (FUT2). Using transcriptome-wide association and colocalization to infer the effect of gene expression on disease severity, we find evidence that implicates multiple genes—including reduced expression of a membrane flippase (ATP11A), and increased expression of a mucin (MUC1)—in critical disease. Mendelian randomization provides evidence in support of causal roles for myeloid cell adhesion molecules (SELE, ICAM5 and CD209) and the coagulation factor F8, all of which are potentially druggable targets. Our results are broadly consistent with a multi-component model of COVID-19 pathophysiology, in which at least two distinct mechanisms can predispose to life-threatening disease: failure to control viral replication; or an enhanced tendency towards pulmonary inflammation and intravascular coagulation. We show that comparison between cases of critical illness and population controls is highly efficient for the detection of therapeutically relevant mechanisms of disease

EUROfusion Integrated Modelling (EU-IM) capabilities and selected physics applications

International audienceRecent developments and achievements of the EUROfusion Code Development for Integrated Modelling project (WPCD), which aim is to provide a validated integrated modelling suite for the simulation and prediction of complete plasma discharges in any tokamak, are presented. WPCD develops generic complex integrated simulations, workflows, for physics applications, using the standardized European Integrated Modelling (EU-IM) framework. Selected physics applications of EU-IM workflows are illustrated in this paper