Development of a New Triage Method to Prioritize Patients Arriving at the Emergency Room

Introduction:By prioritizing emergency patients, triage facilitates the timely provision of care to the largest possible number of patients arriving at an emergency room (ER). Previous triage methods include the Canadian and Japan Triage and Acuity Scales. Since these methods sort patients into five categories, multiple patients are often categorized into the same category. Furthermore, since these scales adopt original complex algorithms to determine the triage category, triage personnel need to be very familiar with the algorithm. Hence, a simple triage method is needed to prioritize ER patients.Aim:To develop a new triage method to prioritize patients arriving at the ER.Methods:Patients aged ≥13 years who arrived at the ER of Yodogawa Christian Hospital without being transported by ambulance between January 2016 and October 2018 were assessed. We analyzed correlations between the items included in the triage sheet and admission. We calculated risk ratios (RRs) of the items that were significantly related to admission. The RR of an item was considered its score, and the triage score was calculated by summing the individual RR scores for each patient. We performed receiver operating characteristic (ROC) analysis of admission and triage scores.Results:Among 20992 patients, 2030 patients (9.7%) were admitted to the hospital. The triage scores of all the patients ranged from 26.5 to 62.3. According to the ROC analysis, the area under the curve was 0.791 and the optimal cutoff value for the triage score was 32.7 (sensitivity: 0.74, specificity: 0.70).Discussion:Since this research was based on data from a Japanese secondary level emergency hospital in an urban area, our triage method can be adapted to the many ERs in Japan that share a similar background. The method used to develop this triage method can also be used to develop triage methods for ERs with different backgrounds.

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Covid-19 and Iraq: The exponential epidemic

JOURNAL OF CONVENTIONAL KNOWLEDGE AND HOLISTIC HEALTH ◽

10.53517/jckhh.2581-3331.422020209 ◽

2020 ◽

Vol 4 (02) ◽

pp. 1-4

Author(s):

Hayder M. Al-Kuraishy ◽

Ali I. Al-Gareeb ◽

Marta Chagas Monteiro ◽

Heiam N. Hussein

Keyword(s):

Emergency Room ◽

Close Contact ◽

Social Activities ◽

Ministry Of Health ◽

Individual Level ◽

Number Of Patients ◽

Control Response ◽

The Individual ◽

Viral Outbreak ◽

Epidemiological Parameters

The coronavirus disease 2019 (Covid-19) epidemic, which originated in Wuhan, China, has now extended to more than 200 countries and administrative regions infecting nearly 36,792,906 individuals of all ages as of 9 October 2020. Many of these articles pursue to investigate the epidemiological parameters of the disease at different locations to disseminate critical information among both modellers and policymakers for a timely control response to be implemented. Iraq has had 394,566 confirmed cases with 9,683 deaths according to the last update registration of Iraq Ministry of Health. In the infected region, despite unusual efforts to limit the movement of people at the expense of the Iraqi economy, we are dealing with an even greater fear that the number of patients who present to the emergency room will become much greater than the system can cope with. Finally, our analysis tends to suggest that measures to reduce transmission should certainly be implemented, as our government did on March 9, by inhibiting people’s movement and social activities, unless strictly required. The most effective way to contain this viral outbreak in Iraq is probably to avoid close contact at the individual level and social meetings.

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An attempt to construct the individual model of daily facial skin temperature using variational autoencoder

Artificial Life and Robotics ◽

10.1007/s10015-021-00699-7 ◽

2021 ◽

Author(s):

Ayaka Masaki ◽

Kent Nagumo ◽

Yuki Iwashita ◽

Kosuke Oiwa ◽

Akio Nozawa

Keyword(s):

Skin Temperature ◽

Normal State ◽

Roc Analysis ◽

Daily Life ◽

Area Under The Curve ◽

Facial Skin ◽

Individual Model ◽

Variational Autoencoder ◽

Auc Value ◽

The Individual

AbstractFacial skin temperature (FST) has also gained prominence as an indicator for detecting anomalies such as fever due to the COVID-19. When FST is used for engineering applications, it is enough to be able to recognize normal. We are also focusing on research to detect some anomaly in FST. In a previous study, it was confirmed that abnormal and normal conditions could be separated based on FST by using a variational autoencoder (VAE), a deep generative model. However, the simulations so far have been a far cry from reality. In this study, normal FST with a diurnal variation component was defined as a normal state, and a model of normal FST in daily life was individually reconstructed using VAE. Using the constructed model, the anomaly detection performance was evaluated by applying the Hotelling theory. As a result, the area under the curve (AUC) value in ROC analysis was confirmed to be 0.89 to 1.00 in two subjects.

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Integrating philosophy, policy and practice to create a just and fair health service

Journal of Medical Ethics ◽

10.1136/medethics-2020-106853 ◽

2020 ◽

Vol 46 (12) ◽

pp. 797-802 ◽

Cited By ~ 1

Author(s):

Zoe Fritz ◽

Caitríona L Cox

Keyword(s):

Policy And Practice ◽

Waiting Room ◽

Socioeconomic Groups ◽

Philosophical Framework ◽

New Challenges ◽

Principles Of Justice ◽

The Many ◽

The Individual ◽

Equity Of Access ◽

Provision Of Care

To practise ‘fairly and justly’ a clinician must balance the needs of both the many and the few: the individual patient in front of them, and the many unseen patients in the waiting room, and in the county. They must consider the immediate clinical needs of those in the present, and how their actions will impact on future patients. The good medical practice guidance ‘Make the care of your patient your first concern’ provides no guidance on how doctors should act when they care for multiple patients with conflicting needs. Moreover, conflicting needs extend far past simply those between different patients. At an organisational level, financial obligations must be balanced with clinical ones; the system must support those who work within it in a variety of roles; and, finally, in order for a healthcare service to be sustainable, the demands of current and future generations must be balanced.The central problem, we propose, is that there is no shared philosophical framework on which the provision of care or the development of health policy is based, nor is there a practical, fair and transparent process to ensure that the service is equipped to deal justly with new challenges as they emerge. Many philosophers have grappled with constructing a set of principles which would lead to a ‘good’ society which is just to different users; prominent among them is Rawls.Four important principles can be derived using a Rawlsian approach: equity of access, distributive justice, sustainability and openness. However, Rawls’ approach is sometimes considered too abstract to be applied readily to policymaking; it does not provide clear guidance for how individuals working within existing institutions can enact the principles of justice. We therefore combine the principles derived from Rawls with Scanlonian contractualism: by demanding that decisions are made in a way which cannot be ‘reasonably rejected’ by different stakeholders (including ‘trustees’ for those who cannot represent themselves), we ensure that conflicting needs are considered robustly.We demonstrate how embedding this framework would ensure just policies and fair practice. We illustrate this by using examples of how it would help prevent injustice among different socioeconomic groups, prevent intergenerational injustice and prevent injustice in a crisis, for example, as we respond to new challenges such as COVID-19.Attempts to help individual doctors practise fairly and justly throughout their professional lives are best focused at an institutional or systemic level. We propose a practical framework: combining Scanlonian contractualism with a Rawlsian approach. Adopting this framework would equip the workforce and population to contribute to fair policymaking, and would ultimately result in a healthcare system whose practice and policies—at their core—were just.

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Prognostic value of neutrophil-to-lymphocyte ratio (NLR) in intestinal neuroendocrine tumors: An analysis of the U.S. Neuroendocrine Tumor Study Group.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.694 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 694-694 ◽

Cited By ~ 1

Author(s):

Bradley A. Krasnick ◽

Jesse T Davidson ◽

Roheena Z. Panni ◽

Martha McGilvray ◽

Jorge Zarate Rodriguez ◽

...

Keyword(s):

Neuroendocrine Tumors ◽

Roc Analysis ◽

Survival Curve ◽

Univariate Analysis ◽

Area Under The Curve ◽

Study Group ◽

Ki 67 ◽

Kaplan Meier ◽

Number Of Patients ◽

Roc Area

694 Background: Intestinal neuroendocrine tumors (NETs) can often be indolent, with survival commonly exceeding 10 years. However, a subset can be more aggressive. The search for a prognostic test based on preoperative lab results would be of benefit. An elevated NLR has been found to be predictive of diminished overall survival (OS) in several cancers, and we hypothesized that this same trend would hold true for intestinal NETs. Methods: Utilizing the 8 member institutions of the retrospective U.S. NET Study Group, patients undergoing resection of intestinal NETs were included. After excluding patients undergoing emergent surgery, those with preoperative sepsis or distant mets, and those with missing neutrophil/lymphocyte lab values, 281 patients were included for analysis. The cutoff values for NLR were determined using receiver operator curve (ROC) analysis. Univariate analysis was performed based on these groups. A Kaplan-Meier survival curve was created based off optimal NLR from ROC analysis. OS was calculated as date of surgery to date of death/ last follow-up. SPSS 23.0 was used for analysis. Results: Of the 281 patients identified, 9% were appendiceal, 9% colonic, 21% duodenal, 5% rectal, and 56% jejunal/ileal. Using a NLR of >2.47, the ROC area under the curve was 0.609 ( p=0.002). Median survival for the 130 patients in the <2.47 group was 159.8 months, versus 115.63 months in the ≥2.47 group (p =0.009). When comparing the NLR <2.47 and ≥2.47 groups, mean age (57.5 vs. 59.0 years, respectively, p=0.642), ASA status (89% ASA 2 /3 in both groups, p=0.314), tumor Ki-67 status (Ki-67>3% in 30% vs. 26%, respectively, p=0.57), and post-op complications (36 vs. 42%, respectively, p=0.310) were similar between groups. A significantly greater number of patients in the NLR high group had positive lymph nodes (60 vs. 47%, p =0.002). Conclusions: For patients undergoing curative resection of intestinal NETs with no distant mets, a preoperative NLR of ≥2.47 was significantly predictive of decreased OS, with those in the elevated NLR group having an OS 3.7 years less than those in the <2.47 group. Future prospective data is warranted to further validate these findings.

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A Handbook to Eddic Poetry: Myths and Legends of Early Scandinavia, ed. Carolyne Larrington, Judy Quinn, and Brittany Schorn. Cambridge: Cambridge University Press, 2016, xii, 413 pp., 12 b/w ill.

Mediaevistik ◽

10.3726/med012018_366 ◽

2018 ◽

Vol 31 (1) ◽

pp. 366-366

Author(s):

Albrecht Classen

Keyword(s):

Old Norse ◽

Entire Volume ◽

Cambridge University ◽

Critical Studies ◽

Individual Contributions ◽

The Many ◽

The Individual ◽

Made In ◽

Scandinavian Literature

Eddic poetry constitutes one of the most important genres in Old Norse or Scandinavian literature and has been studied since the earliest time of modern-day philology. The progress we have made in that field is impressive, considering the many excellent editions and translations, not to mention the countless critical studies in monographs and articles. Nevertheless, there is always a great need to revisit, to summarize, to review, and to digest the knowledge gained so far. The present handbook intends to address all those goals and does so, to spell it out right away, exceedingly well. But in contrast to traditional concepts, the individual contributions constitute fully developed critical article, each with a specialized topic elucidating it as comprehensively as possible, and concluding with a section of notes. Those are kept very brief, but the volume rounds it all off with an inclusive, comprehensive bibliography. And there is also a very useful index at the end. At the beginning, we find, following the table of contents, a list of the contributors, unfortunately without emails, a list of translations and abbreviations of the titles of Eddic poems in the Codex Regius and then elsewhere, and a very insightful and pleasant introduction by Carolyne Larrington. She briefly introduces the genre and then summarizes the essential points made by the individual authors. The entire volume is based on the Eddic Network established by the three editors in 2012, and on two workshops held at St. John’s College, Oxford in 2013 and 2014.

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Individuality and Beyond

10.1093/oso/9780190929213.001.0001 ◽

2019 ◽

Author(s):

Benedetta Zavatta

Keyword(s):

Moral Autonomy ◽

First Line ◽

Philosophical Interpretation ◽

Individual Personality ◽

The World ◽

Regulative Ideal ◽

Personal Library ◽

The Many ◽

The Individual ◽

The Impact

Based on an analysis of the marginal markings and annotations Nietzsche made to the works of Emerson in his personal library, the book offers a philosophical interpretation of the impact on Nietzsche’s thought of his reading of these works, a reading that began when he was a schoolboy and extended to the final years of his conscious life. The many ideas and sources of inspiration that Nietzsche drew from Emerson can be organized in terms of two main lines of thought. The first line leads in the direction of the development of the individual personality, that is, the achievement of critical thinking, moral autonomy, and original self-expression. The second line of thought is the overcoming of individuality: that is to say, the need to transcend one’s own individual—and thus by definition limited—view of the world by continually confronting and engaging with visions different from one’s own and by putting into question and debating one’s own values and certainties. The image of the strong personality that Nietzsche forms thanks to his reading of Emerson ultimately takes on the appearance of a nomadic subject who is continually passing out of themselves—that is to say, abandoning their own positions and convictions—so as to undergo a constant process of evolution. In other words, the formation of the individual personality takes on the form of a regulative ideal: a goal that can never be said to have been definitively and once and for all attained.

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Comorbidity index for predicting mortality at 6 months after reperfusion therapy

Scientific Reports ◽

10.1038/s41598-021-85390-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Hyo Suk Nam ◽

Young Dae Kim ◽

Joonsang Yoo ◽

Hyungjong Park ◽

Byung Moon Kim ◽

...

Keyword(s):

Prospective Cohort ◽

Multivariate Logistic Regression Analysis ◽

Area Under The Curve ◽

Reperfusion Therapy ◽

Good Prediction ◽

Multivariate Logistic Regression ◽

Stroke Patients ◽

Number Of Patients ◽

Comorbidity Index ◽

Using Data

AbstractThe eligibility of reperfusion therapy has been expanded to increase the number of patients. However, it remains unclear the reperfusion therapy will be beneficial in stroke patients with various comorbidities. We developed a reperfusion comorbidity index for predicting 6-month mortality in patients with acute stroke receiving reperfusion therapy. The 19 comorbidities included in the Charlson comorbidity index were adopted and modified. We developed a statistical model and it was validated using data from a prospective cohort. Among 1026 patients in the retrospective nationwide reperfusion therapy registry, 845 (82.3%) had at least one comorbidity. As the number of comorbidities increased, the likelihood of mortality within 6 months also increased (p < 0.001). Six out of the 19 comorbidities were included for developing the reperfusion comorbidity index on the basis of the odds ratios in the multivariate logistic regression analysis. This index showed good prediction of 6-month mortality in the retrospective cohort (area under the curve [AUC], 0.747; 95% CI, 0.704–0.790) and in 333 patients in the prospective cohort (AUC, 0.784; 95% CI, 0.709–0.859). Consideration of comorbidities might be helpful for the prediction of the 6-month mortality in patients with acute ischemic stroke who receive reperfusion therapy.

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Serum Extracellular Vesicle-Derived circHIPK3 and circSMARCA5 Are Two Novel Diagnostic Biomarkers for Glioblastoma Multiforme

Pharmaceuticals ◽

10.3390/ph14070618 ◽

2021 ◽

Vol 14 (7) ◽

pp. 618

Author(s):

Michele Stella ◽

Luca Falzone ◽

Angela Caponnetto ◽

Giuseppe Gattuso ◽

Cristina Barbagallo ◽

...

Keyword(s):

Glioblastoma Multiforme ◽

Roc Analysis ◽

Characteristic Curve ◽

Area Under The Curve ◽

Digital Pcr ◽

Extracellular Vesicle ◽

Size Exclusion ◽

Circular Rnas ◽

Diagnostic Biomarkers ◽

Exclusion Chromatography

Glioblastoma multiforme (GBM) is the most frequent and deadly human brain cancer. Early diagnosis through non-invasive biomarkers may render GBM more easily treatable, improving the prognosis of this currently incurable disease. We suggest the use of serum extracellular vesicle (sEV)-derived circular RNAs (circRNAs) as highly stable minimally invasive diagnostic biomarkers for GBM diagnosis. EVs were isolated by size exclusion chromatography from sera of 23 GBM and 5 grade 3 glioma (GIII) patients, and 10 unaffected controls (UC). The expression of two candidate circRNAs (circSMARCA5 and circHIPK3) was assayed by droplet digital PCR. CircSMARCA5 and circHIPK3 were significantly less abundant in sEVs from GBM patients with respect to UC (fold-change (FC) of −2.15 and −1.92, respectively) and GIII (FC of −1.75 and −1.4, respectively). Receiver operating characteristic curve (ROC) analysis, based on the expression of sEV-derived circSMARCA5 and circHIPK3, allowed us to distinguish GBM from UC (area under the curve (AUC) 0.823 (0.667–0.979) and 0.855 (0.704 to 1.000), with a 95% confidence interval (CI), respectively). Multivariable ROC analysis, performed by combining the expression of sEV-derived circSMARCA5 and circHIPK3 with preoperative neutrophil to lymphocyte (NLR), platelet to lymphocyte (PLR) and lymphocyte to monocyte (LMR) ratios, three known diagnostic and prognostic GBM markers, allowed an improvement in the GBM diagnostic accuracy (AUC 0.901 (0.7912 to 1.000), 95% CI). Our data suggest sEV-derived circSMARCA5 and circHIPK3 as good diagnostic biomarkers for GBM, especially when associated with preoperative NLR, PLR and LMR.

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Entangling Lattice-Trapped Bosons with a Free Impurity: Impact on Stationary and Dynamical Properties

Entropy ◽

10.3390/e23030290 ◽

2021 ◽

Vol 23 (3) ◽

pp. 290

Author(s):

Maxim Pyzh ◽

Kevin Keiler ◽

Simeon I. Mistakidis ◽

Peter Schmelcher

Keyword(s):

Structural Changes ◽

Many Body ◽

Wide Range ◽

Entropy Measures ◽

Particle Level ◽

The Many ◽

The One ◽

Tunneling Dynamics ◽

The Individual ◽

Trapped Bosons

We address the interplay of few lattice trapped bosons interacting with an impurity atom in a box potential. For the ground state, a classification is performed based on the fidelity allowing to quantify the susceptibility of the composite system to structural changes due to the intercomponent coupling. We analyze the overall response at the many-body level and contrast it to the single-particle level. By inspecting different entropy measures we capture the degree of entanglement and intraspecies correlations for a wide range of intra- and intercomponent interactions and lattice depths. We also spatially resolve the imprint of the entanglement on the one- and two-body density distributions showcasing that it accelerates the phase separation process or acts against spatial localization for repulsive and attractive intercomponent interactions, respectively. The many-body effects on the tunneling dynamics of the individual components, resulting from their counterflow, are also discussed. The tunneling period of the impurity is very sensitive to the value of the impurity-medium coupling due to its effective dressing by the few-body medium. Our work provides implications for engineering localized structures in correlated impurity settings using species selective optical potentials.

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DeepRePath: Identifying the Prognostic Features of Early-Stage Lung Adenocarcinoma Using Multi-Scale Pathology Images and Deep Convolutional Neural Networks

Cancers ◽

10.3390/cancers13133308 ◽

2021 ◽

Vol 13 (13) ◽

pp. 3308

Author(s):

Won Sang Shim ◽

Kwangil Yim ◽

Tae-Jung Kim ◽

Yeoun Eun Sung ◽

Gyeongyun Lee ◽

...

Keyword(s):

Lung Adenocarcinoma ◽

Early Stage ◽

External Validation ◽

Area Under The Curve ◽

The Cancer Genome Atlas ◽

Deep Convolutional Neural Networks ◽

Prognostic Features ◽

Multi Scale ◽

Model Based ◽

Number Of Patients

The prognosis of patients with lung adenocarcinoma (LUAD), especially early-stage LUAD, is dependent on clinicopathological features. However, its predictive utility is limited. In this study, we developed and trained a DeepRePath model based on a deep convolutional neural network (CNN) using multi-scale pathology images to predict the prognosis of patients with early-stage LUAD. DeepRePath was pre-trained with 1067 hematoxylin and eosin-stained whole-slide images of LUAD from the Cancer Genome Atlas. DeepRePath was further trained and validated using two separate CNNs and multi-scale pathology images of 393 resected lung cancer specimens from patients with stage I and II LUAD. Of the 393 patients, 95 patients developed recurrence after surgical resection. The DeepRePath model showed average area under the curve (AUC) scores of 0.77 and 0.76 in cohort I and cohort II (external validation set), respectively. Owing to low performance, DeepRePath cannot be used as an automated tool in a clinical setting. When gradient-weighted class activation mapping was used, DeepRePath indicated the association between atypical nuclei, discohesive tumor cells, and tumor necrosis in pathology images showing recurrence. Despite the limitations associated with a relatively small number of patients, the DeepRePath model based on CNNs with transfer learning could predict recurrence after the curative resection of early-stage LUAD using multi-scale pathology images.

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