Study on the Comparison of Three Typical Gas Flow Standards for Calibrating Low Gas Flowmeter

A gas flowmeter for measuring low flow rate has been widely used in the field of medical, health, environmental protection, energy industry, aerospace, etc. To against Covid-2019, the requirement on the low flow rate has been increasing dramatically. At present, the typical standard devices for calibrating low gas flowmeter mainly include standard bell provers of gas flow, standard piston provers of low gas flow and standard laminar of low gas flow. Different measuring principles are adopted among these typical standard devices. To ensure the consistency of these typical standard devices, a comparison test is performed. The standard devices used in the comparison are of the same accuracy grade, with an extended uncertainty of 0.2%(k=2). The piston-type gas flow calibrator of grade 1.0 is selected as the transfer standard, and three flow points with high flow rate, medium flow rate and low flow rate are selected for test. The consistency of measurement results is evaluated by normalized deviation En. The comparison results are acceptable which show that three typical standard devices are accurate and reliable. © FLOMEKO 2022.All rights reserved

Efficient Centroid Based Distance Monitoring System Using Deep Learning

COVID-19 virus spread very rapidly if we come in contact to the other person who is infected, this was treated as acute pandemic. As per the data available at WHO more than 663 million infected cases reported and 6.7 million deaths are confirmed worldwide till Dec, 2022. On the basis of this big reported number, we can say that ignorance can cause harm to the people worldwide. Most of the people are vaccinated now but as per standard guideline of WHO social distancing is best practiced to avoid spreading of COVID-19 variants. This is difficult to monitor manually by analyzing the persons live cameras feed. Therefore, there is a need to develop an automated Artificial Intelligence based System that detects and track humans for monitoring. To accomplish this task, many deep learning models have been proposed to calculate distance among each pair of human objects detected in each frame. This paper presents an efficient deep learning monitoring system by considering distance as well as velocity of the object detected to avoid each frame processing to improve the computation complexity in term of frames/second. The detected human object closer to some allowed limit (1m) marked by red color and all other object marked with green color. The comparison of with and without direction consideration is presented and average efficiency found 20.08 FPS (frame/Second) and 22.98 FPS respectively, which is 14.44% faster as well as preserve the accuracy of detection. © 2023 IEEE.

A holistic tunnel safety concept for a 20-year-old tunnel upgrade to an ADR "Category A” tunnel

Following the elaboration of a Tunnel Safety Documentation for the T4 tunnel, several deviations from the European and national Standards were identified. Moreover, due the tunnels' special characteristics and its ageing equipment, the rehabilitation plan had not only to upgrade the level of safety to "Category A” as per the ADR agreement, but also to perform heavy maintenance works and provide sustainable solutions for the tunnel operations and the local community. The construction methodology poses significant challenges in the operation and the construction. Therefore, special provisions, technical and operational, were required in order for the transport of heavy and dangerous goods vehicles to be allowed in the tunnel during construction. The Covid pandemic and the geopolitical conditions (Ukraine war), seem to negatively affect the projects' duration and financing. With a budget of more than €20M, it is the first tunnel upgrade project of this magnitude and complexity in Greece, that sets the basis as refence for future tunnel upgrades. © 2023 The Author(s).

EFFECTS OF DMARD TREATMENT ON SARS-CoV-2 mRNA VACCINATION IN PATIENTS WITH SYSTEMIC AUTOIMMUNE RHEUMATIC DISEASE: A MATCHED, PROSPECTIVE COHORT STUDY

BackgroundPatients suffering from systemic autoimmune rheumatic disease (SARD) display poor antibody development after two doses of mRNA vaccinations leaving these patients with only limited humoral protection against severe SARS-CoV-2 disease courses. Of key interest is the effect of conventional synthetic (csDMARD) and biological/ targeted drugs (b/tsDMARDs) disease modifying antirheumatic drugs on the time of protection.ObjectivesTo compare antibody titer development in patients with vasculitis and connective tissue disease (CTD) with healthy controls 6 months after two mRNA vaccinations and after third immunization. To analyze factors, that affect the velocity of titer decline, well as qualitative humoral response.MethodsPatients with SARD were enrolled and matched for gender and age with healthy control subjects (HC) and the humoral response after 6 months to two doses of mRNA vaccine BNT162b2 in terms of SARS-COV-2 antibody titer was assessed. In addition to binding antibody units (BAU) we also analyzed neutralizing antibodies. Patients receiving B-cell depleting therapy and those with prior SARS-CoV-2 infection (via detection of nucleocapsid antibodies) were excluded. Differences between two groups were calculated with Wilcoxon signed-rank test.ResultsA total of 53 patients with SARD (42 patients suffering from connective tissue disease and 11 with vasculitis respectively) and 73 HC were analysed. Interestingly only patients receiving a combination therapy of different csDMARDs/ b/tsDMARDs demonstrated diminished antibody titers 6 months after two doses of mRNA vaccine (p-value p-value<0,001), whereas patients receiving only csDMARD as monotherapy displayed comparable antibody levels to healthy controls. This effect was equalized after a third booster vaccination (p-value=0,13). Concerning disease entities, patients with vasculitis seemed to have lower BAU than HC (p-value<0,05) and patients suffering from CTD. After third vaccination both patient groups had lower antibody levels than HC (vasculitis: p-value <0,0001;CTD: p-value p-value<0,01). Lower antibody levels before third vaccination correlated with lower antibodies after third immunization.ConclusionPatients with autoimmune rheumatic diseases undergoing combination therapy may be more vulnerable to SARS-CoV-2 infection, due to reduced antibody levels 6 months following two doses of mRNA vaccine. Our data strongly recommends antibody measurements in patients receiving combination therapy and individualized earlier booster vaccination.Figure 1.Anti-SARS-Cov-2 S antibody titers. A: Antibody titers measured 6 months after two doses of mRNA vaccination in patients with connective tissue disease, vasculitis and healthy controls. B, Antibody levels according to disease entity. AB: antibody;BAU: binding antibody unit;CTD: connective tissue disease;HC: healthy control;mono: disease modifying anti-rheumatic drug monotherapy;combination: combination therapy of disease modifying anti-rheumatic drugs;RBD: receptor binding domain;[Figure omitted. See PDF]Table 1.Demographic parameters and therapy of study participants.SARD (n=53)HC (n=73)Age, mean (standard deviation)53.55 (±14.04)51.27 (±14.07)Female45 (84.9%)47 (64.4%)Connective tissue disease42 (79%)Vasculitis11 (21%)csDMARD or b/tsDMARD monotherapy22 (41%)csDMARD and/or b/tsDMARD combination therapy13 (25%)No therapy18 (34%)Methotrexate8 (15%)Mycophenolate mofetil10 (19%)Hydroxychloroquine17 (32%)Azathioprine8 (15%)Belimumab3 (6%)Tocilizumab3 (6%)Glucocorticoid dose 1. vaccination, mean (standard deviation)2.8 (±10.8)Glucocorticoid dose 2. vaccination, mean (standard deviation)2.6 (±10.7)SARD: Systemic autoimmune rheumatic disease, HC: Healthy controls, csDMARD: conventional synthetic disease modifying antirheumatic drugs and b/tsDMARD: biological/ targeted drugs disease modifying antirheumatic drugsREFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsElisabeth Simader Speakers bureau: Lilly, Thomas Deimel: None declared, Felix Kartnig: None declared, Selma Tobudic: None declared, Helmuth Hasla her Grant/research support from: Glock Health, BlueSky Immunotherapies and Neutrolis, Thomas Maria Karonitsch: None declared, Daniel Mrak: None declared, Thomas Nothnagl: None declared, Thomas Perkmann: None declared, Helga Lechner-Radner: None declared, Judith Sautner: None declared, Florian Winkler: None declared, Heinz Burgmann Speakers bureau: speaker fees from Shionogi, Pfizer, MSD, Paid instructor for: advisory boards for Valneva, MSD, Gilead, Consultant of: consulting fees from MSD, Pfizer, Takeda, Gilead, Daniel Aletaha Speakers bureau: other from Abbvie, Amgen, Lilly, Merck, Novartis, Pfizer, Roche, Sandoz, Grant/research support from: grants from Abbvie, Amgen, Lilly, Novartis, Roche, SoBi, Sanofi, Stefan Winkler: None declared, Stephan Blüml Speakers bureau: personal fees from Abbvie, personal fees from Novartis, Peter Mandl Speakers bureau: reports speaker fees from AbbVie, Janssen and Novartis, Grant/research support from: research grants from AbbVie, BMS, Novartis, Janssen, MSD and UCB.

VALIDITY AND RELIABILITY OF MEASUREMENT OF PERIPHERAL OXYGEN SATURATION DURING THE 6-MINUTE WALK TEST IN PATIENTS WITH SYSTEMIC SCLEROSIS

BackgroundThe 6-Minute Walk Test (6MWT) is a standardised method routinely used to screen for and monitor interstitiel lunge disease and/or pulmonary arterial hypertension in patients with systemic sclerosis (SSc). Studies shows that esaturations during the 6MWT are associated with severity of pulmonary manifestations in patients with SSc [1]. Digital sensors are commonly used to measure peripheral oxygen saturation (SpO2) during the 6MWT. However, digital-based sensors may have important limitations in patients with SSc due to disease-related microangiopathy, Raynaud's phenomenon, sclerodactyly and motion artifacts during the 6MWT [2]. Sensors located at more central body positions may therefore be more accurate as these as less prone to Raynaud attacks.ObjectivesTo determine the validity and re-test reliability of peripheral oxygen saturation measured at the finger, forehead, and ear during the 6MWT in patients with SSc.Methods82 patients with SSc had an arterial line placed while performing the 6MWT. Peripheral oxygen saturation was simultaneously measured by finger, forehead, and earlobe sensors and compared to the arterial oxygen saturation (SaO2) measured before and after the 6MWT. 40 patients repeated the 6MWT one week later. We used Bland-Altman plots to display the agreement between SpO2 and SaO2, and between the minimal SpO2 (minSpO2) one week apart. The intraclass correlation coefficient (ICC, 95% confidence interval 95% CI]) for repeated measurement of minSpO2 was calculated.ResultsThe mean difference (SpO2 - SaO2, ± standard deviation [SD]) after the 6MWT was –3.3% (±4.82), 0.15% (±1.55), and 1.36% (±1.93) for the finger, forehead, and earlobe, respectively (Table 1).The finger minSpO2 also demonstrated the poorest re-test reliability: The mean difference in minSpO2 (visit2-visit1, ±SD) was 1.28% (±5.3), 0.74% (±4.36) and –1.10% (±2.87),). The ICC (95% CI) showed good agreement using the ear and forehead probe (ICCear = 0.89 [0.80;0.94];ICCforehead = 0.88 [0.60;0.87]), while a modest reliability was found using the finger probe (ICCfinger = 0.65 [0.43;0.80]).ConclusionPeripheral oxygen saturation should be measured using either the earlobe or forehead during the 6MWT in patients with SSc.References[1]Villalba, W. O. et al. Six-minute walk test for the evaluation of pulmonary disease severity in scleroderma patients. Chest 131, 217–222 (2007).[2]Pathania, Y. S. Alternatives for erroneous finger probe pulse oximetry in systemic sclerosis patients during COVID-19 pandemic. Rheumatol. Int. 41, 2243–2244 (2021).Table 1.Validity and re-test reliability of peripheral oxygen during the 6MWT (n= 82)Finger probeForehead probeEar probeMean difference SpO2 - SaO2  Mean difference pre-test (+/-SD)–0.68% (±1.88)0.13% (±1.26)1.54% (±0.69)  Mean difference post--test (+/-SD)–3.30% (±4.82)0.15% (±1.55)1.36% (±1.93)Mean difference of the minSpO2 (visit2-visit1)  Mean difference (±SD)1.28% (±5.3)0.74% (±4.36)1.10% (±2.87)Abbreviations: SpO2, Peripheral oxygen saturation;SaO2, Arterial oxygen saturation;SD, Standard deviation.Acknowledgements:NIL.Disclosure of InterestsAmanda Lynggaard Riis: None declared, Esben Naeser Paid instructor for: Boehringer Ingelheim Denmark, Katja Thorup Aaen: None declared, Henrik Hovgaard: None declared, Peter Juhl-Olsen: None declared, Elisabeth Bendstrup Speakers bureau: Hoffman-la-Roche.Boehringer Ingelheim.Glaxo Smith Kleine.Daichii Sankyo, Klaus Soendergaard Speakers bureau: Boehringer Ingelheim, Consultant of: Boehringer Ingelheim, Grant/research support from: Boehringer Ingelheim.

Introduction

Individualised employment relations formed a key pillar of the shift to neoliberal economic policy in the 1980s, complementing other dimensions of orthodoxy deployed across governments, public administrations and central banks in the same time. In the neoliberal narrative, market forces would ‘naturally' and justly compensate labour for its contribution to productivity, like any other input to production. Consequently, redistributive institutions empowering workers to win more adequate wages and conditions (through minimum wages, Awards, unionisation, and collective bargaining) were dramatically eroded, or discarded entirely. Combined with welfare state retrenchment, this restructuring of labour market policy increased the pressure on people to sell their labour, and under terms over which workers wielded little influence. Since then, forms of insecure, non-standard work have proliferated globally, and employment relations have been increasingly individualised. Now, most workers in Anglo-Saxon market economies, and a growing proportion of workers in European and Nordic nations, rely on individual contract instruments (underpinned only by minimum wage floors typically far below living wage benchmarks) to set the terms and conditions of employment. Wages have stagnated, the share of GDP going to workers has declined, and inequality and poverty (even among employed people) has intensified. More recently, after years of this employer-friendly hegemony in workplace relations, successive crises (first the GFC and then the COVID-19 pandemic) have more obviously shattered traditional expectations of a natural linkage between economic growth and workers' living standards.After a generation of experience with this individualised model of employment relations, and with the human costs of that approach becoming ever-more obvious, there is renewed concern with reimagining policies and structures which could support improvements in job quality, stability, and compensation. Important policy dialogue and innovation is now occurring in many industrial countries, in response to the negative consequences of neoliberal labour market policies. In those conversations, institutions like collective bargaining have returned to centre stage.

Stabilise, balance and adjust—Framing the early years transitions of children whose parents work non‐standard hours

This study examined talk by parents about the early years transitions of their children (n = 7) in the context of parental non‐standard working hours and Finnish early childhood education and care (ECEC) services. Parents were interviewed at three time points: when their child was aged one, four, five or six years (a total of 21 interviews). The third interview was conducted during the COVID‐19 pandemic. This article focuses on the children's ECEC transitions and the interpretative frames used by parents when talking about their work and childcare. The frames used by the parents to discuss the children's transitions were stabilising the children's lives, balancing between staying at home and attending ECEC and adjusting to norms and rules. The diversity of families' experiences and their children's transitions during the early years should be considered when developing family policy and ECEC services. [ FROM AUTHOR] Copyright of International Journal of Social Welfare is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Upskilling haematological services for WGS and germline assessments through a regional skin biopsy training programme

NHS England Genomics introduced whole genome sequencing (WGS) with standard-of- care (SoC) genetic testing for haemato-oncology patients who meet eligibility criteria, including patients with acute leukaemia across all ages, and exhausted SoC testing. Alongside, the role of germline mutations in haematological cancers is becoming increasingly recognised. DNA samples are required from the malignant cells (somatic sample) via a bone marrow aspirate, and from non-malignant cells (germline sample) for comparator analysis. Skin biopsy is considered the gold-standard tissue to provide a source of fibroblast DNA for germline analysis. Performing skin punch biopsies is not within the traditional skillset for haematology teams and upskilling is necessary to deliver WGS/germline testing safely, independently and sustainably. A teaching programme was designed and piloted by the dermatology and haematology teams in Sheffield and delivered throughout the NHS trusts in North East & Yorkshire Genomic Laboratory Hub. The training programme consisted of a 90-min session, slides, video and practical biopsy on pork belly or synthetic skin, designed to teach up to six students at one time. To disseminate best practice, the standard operating procedure and patient information used routinely in Sheffield were shared, to be adapted for local service delivery. From January 2021 to December 2022, 136 haematology staff from 11 hospitals, including 34 consultants, 41 registrars, 34 nurses and 8 physician associates, across the NEY GLH region completed the skin biopsy training programme. Feedback from the course was outstanding, with consistently high scores in all categories. Practical components of the course were especially valued;98.6% (71/72) trainees scored the practical element of the programme a top score of 5 out of 5, highlighting that despite the challenges of delivering face-to- face teaching due to COVID-19, teaching of practical skills was highly valued;training in this way could not have been replicated virtually. Costs of the programme have been approximately 16 000, including consultant input and teaching/educational materials. Recent support has been provided by a separately funded Genomic Nurse Practitioner (GNP), with succession planning for the GNP to take over leadership from the consultant dermatologist. Plans are in place to use the remaining budget to disseminate the programme nationally. Our training programme has shown that skin biopsy can be formally embedded into training for haematology consultants, trainees, nursing team, and physician associates. Delivery of training can be effective and affordable across regional GLHs with appropriate leadership and inter-speciality coordination, and ultimately sustainable with specialist nursing staff, including GNPs.

Evaluation of Lung Ultrasound in Assessment of Critically Ill patients in Respiratory Intensive Care Unit

Reaching a proper diagnosis for critically ill patients is like collecting pieces of puzzle and bed side lung ultrasound (LUS) becomes a crucial piece complementary to clinical and laboratory pieces. It is a bed side, real time tool for diagnosis of patients in ICU who are critical to be transferred to radiology unit especially in Covid-19 pandemic with risk of infection transmission. The aim was to evaluate the accuracy of lung ultrasound in assessment of critically ill patients admitted to Respiratory Intensive Care Unit (RICU), moreover to assess its diagnostic performance in different pulmonary diseases as compared to the gold standard approach accordingly. This observational prospective (cross sectional) study with a total 183 patients who met the inclusion criteria,were selected from patients admitted at the RICU;Chest Department, Zagazig University Hospitals, during the period from September 2019 to September 2021. LUS examination was performed to diagnose the different pulmonary diseases causing RF. All cases were examined by LUS on admission. From a total 183 patients, 111 patients 60.7% were males and 72 patients 39.3% were females, with a mean age of 56+/-12.77 years, 130 patients were breathing spontaneously received conservative management with O2 therapy, 32 patients needed NIV while 21 patients needed IMV with ETT. Exacerbated COPD was the most common disease finally diagnosed followed by bacterial pneumonia, exacerbated ILD, post Covid-19 fibrosis and pulmonary embolism in32, 29,27, 19 and 11 patients respectively with corresponding diagnostic accuracy of LUS 97.3%, AUC=0.943, 93.9% (AUC=0.922), 96.7%(AUC=0.920), 97.8%, AUC=0.895, and 97.8% respectively, while Covid-19 pneumonia was the final diagnosis in 8 patients with LUS diagnostic accuracy of 97.8% (AUC=0.869) with no statistical significant difference p-value=0.818 with bacterial pneumonia in distribution of US profiles. A profile was the commonest detected US profile among the studied patients followed by B profile, C profile, A/B profile and A' profile in 37.2%, 24.6%, 15.8% 4.9%, and 3.8% of cases respectively. Bed side LUS has a reliable, valuable diagnostic performance when integrated with clinical and laboratory data for the diagnosis of most pulmonary diseases in RICU.Copyright © 2023, Colegio de Farmaceuticos de la Provincia de Buenos Aires. All rights reserved.

GDM diagnosis criteria: Standard and Covid-19 criteria

Aim: Standard diagnosis of gestational diabetes (GDM) is based on the Oral Glucose Tolerance test (OGTT). During the Covid-19 outbreak, due to Covid restrictions, criteria were modified i.e Fasting Blood Glucose >=5.3 and/ or HbA1c >= 39 for diagnosis of GDM. After the lifting of the Covid restrictions, the standard criteria were reimplemented and on analyzing the data, it was highlighted that some of the patients could have tested negative for GDM based on Covid Criteria. Method(s): We analyzed the data of 43 patients based on standard criteria (OGTT and HbA1c) after Covid restrictions, with the following results. Result(s): 11/43(28%) patients who were diagnosed on the basis of standard criteria could have been missed based on Covid criteria. Out of 11 deliveries, 2 babies with weight above 4 kg. There were no admissions to NICU. One patient had postpartum hemorrhage with 670 mL of blood loss. Conclusion(s): This was a retrospective study in which we analyzed the data of 45 pregnant females diagnosed with GDM based on testing using the Covid criteria and compared this to 43 pregnant females who were diagnosed with GDM on the basis of OGTT based on GOLD standard NICE criteria. In addition, we also examined maternal and obstetric outcomes in both groups such as the mode of delivery, the baby's birth weight, the incidence of shoulder dystocia, mean blood loss (MBL), and NICU admission. We understand that Covid GDM diagnosis was a necessity of time. In this study, we want to learn what could have been missed with that diagnostic criteria. For future pandemics, we need to revise our diagnostic criteria to avoid the risk of underdiagnosing GDM and associated complications.

Impact of Covid 19 Pandemic on Elective Rectal Cancer Surgery - Single Institution Experience

Introduction: Surgical treatment of rectal cancer depends on clinical stage, size and location of primary tumor. A sphincter preserving technique such as low anterior resection (LAR) is the preferred method if negative distal margin can be achieved. If an adequate distal margin cannot be obtained, an abdominoperineal resection (APR) is required. A proctosigmoidectomy (Hartmann's procedure) is performed in patients with potentially curable obstructing rectal cancer after neoadjuvant chemoradiotherapy, or as a palliative treatment for locally advanced rectal cancer. Aim(s): The aim of this retrospective study was to investigate the impact of COVID 19 pandemic on the number and type of surgeries performed for the treatment of rectal cancer in UHC Zagreb, Department of Surgery. Material(s) and Method(s): Collected data were extracted from medical records of the patients who underwent surgery at the Department of Surgery from 1st of January 2016 to 31st of December 2022 with prior Ethics Committee approval. Total of 688 patients were included. Retrospective analysis of number and type of surgery was done consecutively by years for the period of interest. Result(s): In 2016 total of 75 patients underwent elective surgery for rectal cancer. LAR was performed in 64% (N=48) of patients, Hartmann's procedure in 20% (N=15), and APR in 16% (N=12). In 2017, 94 surgeries were performed. LAR accounted for 64% (N=60), Hartmann's procedure 17% (N=16), and APR 19% (N=18). In 2018, 115 surgeries were performed. LAR accounted for 69% (N=79), Hartmann's procedure 10% (N=12), and APR 21% (N=24). In 2019, 80 surgeries were performed. LAR accounted for 67% (N=54), Hartmann's procedure 9% (N=80), and APR 24%. In 2020, 78 surgeries were performed. LAR accounted for 59% (N=46), Hartmann's procedure 14% (N=11), and APR 27% (N=21). In 2021, 124 surgeries were performed. LAR accounted for 66% (N=82), Hartmann's procedure 14% (N=17), and APR 20% (N=25). In 2022, 122 surgeries were performed. LAR accounted for 64% (N=78), Hartmann's procedure 15% (N=18), and APR 21% (N=26). Conclusion(s): Our results show steady growth in numbers of performed surgeries in the years prior to the pandemic, with exception of the year 2019 when our department underwent organizational changes. In 2020, significant decrease in number of surgeries was observed as a result of restrictive epidemiological measures established to reduce the spread of COVID 19 infection. COVID 19 pandemic measures also resulted in delayed diagnosis and treatment of rectal cancer which is indirectly shown through the increasing share of Hartmann's procedure. In the years following the relaxation of measures, significant increase in number of performed surgeries that exceeded all the pre-pandemic years was recorded. Constant elevated share of Hartmann's procedure was noted as possible consequence of post COVID delay in diagnosis and confirmation of rectal cancer in more advanced stages of disease.

COVID-19 IN PATIENTS WITH INFLAMMATORY ARTHRITIS IN THE VINSCHGAU VALLEY IN SOUTH TYROL

BackgroundFor patients with autoimmune rheumatic diseases, the Covid-19 pandemic carried some implications in addition to those faced by the general population. In particular, the question whether these patients are at increased risk of contracting Covid-19 or have an unfavourable disease course has been and is a matter of concern.In autumn 2020, the population of the Vinschgau valley in South Tyrol, northern Italy was still largely spared from infection with SARS-CoV-2. Accordingly, incidence of the disease in the upcoming winter was anticipated to be high.ObjectivesThis prospective observational study aimed at characterizing Covid-19 infections in a population of patients with inflammatory arthritis (IA) residing in the Vinschgau valley. The study was conceived as companion project to an analogously designed prospective cohort study in the general population of the Vinschgau valley, the CHRIS Covid-19 study.MethodsBetween september and december 2020, IA patients (i.e. previously diagnosed rheumatoid arthritis [RA], psoriatic arthritis [PsA] or peripheral spondyloarthritis [SpA]) residing in the Vinschgau valley (n=394 based on national healthcare system database) were contacted. Those who consented to participate in the study underwent a clinical baseline visit including TJC, SJC, VAS and assessment of RAID, PsAID9 or BASDAI (range 0-10, respectively). In addition, a Covid-19 screening questionnaire was administered. Then, active and/or past infection with SARS-CoV-2 were determined by nasopharyneal swab (PCR) and serum antibody test. In positively tested subjects, Covid-19 disease severity was graded according to WHO criteria (range 0-8, with 0 = no evidence of infection and 8 = death). Patients were followed-up with regular telephone interviews including Covid-19 screening questionnaire and RAID/PsAID/BASDAI for up to 12 months.Results111 patients (72 RA, 29 PsA, 10 SpA) were enrolled (see Table 1 for demographics and comorbidities).A total number of 19 PCR-confirmed SARS-CoV-2 infections in 17 patients (10 RA, 7 PsA) were observed. Mean ± standard deviation 7-day incidence (incident cases/study population) was 0.003 ± 0.007.Fatigue, fever, anosmia and sore throat (present in 57.9%, 47.4%, 42.1% and 36.8% of infections, respectively) were the most frequent symptoms. Median (min-max) disease severity was 2 [1-4]. Two infections led to hospitalization, in one case oxygen supply was necessary. Four infections were asymptomatic (Figure 1).One patient died during follow-up due to pre-existing non-small cell lung cancer.Median absolute difference between post- and pre-infection disease activity was 0.4 and -0.8 for RAID and PsAID, respectively (both markedly below the minimal clinically important difference of 3 and 3.6 points, respectively).ConclusionIncidence of Covid-19 in the analysed cohort of patients with IA was low. Symptoms and comorbidities of SARS-CoV-2-positive IA patients reflected those known from the general population. Covid-19 seemed to have no relevant impact on IA disease activity. Comparison of these preliminary data with those of the general population is planned.Figure 1.Spectrum of clinical symptoms reported by study patients during infection with SARS-CoV-2[Figure omitted. See PDF]Table 1.Demographic data and selected comorbidities of study patients. Age and body mass index (BMI) are given in means ± standard deviation, female sex and comorbidities are given in n (% of column totals).TotalSARS-CoV-2 positiveHospitalized111172Age at inclusion (years)59.7 ± 9.462.5 ± 10.076.3 ± 9.0BMI at inclusion (kg/m2)27.9 ± 17.126.1 ± 3.330.5 ± 1.6Female sex76 (68.5)10 (58.8)1 (50)Active smokers22 (19.8)1 (5.9)0 (0)Arterial hypertension44 (39.6)8 (47.1)2 (50)Diabetes mellitus4 (3.6)1 (5.9)1 (50)Hyperlipidemia27 (24.3)2 (11.8)1 (50)Cardiac arrhythmias12 (10.8)2 (11.8)1 (50)History of cancer5 (4.5)1 (5.9)0 (0)Chronic bronchitis4 (3.6)1 (5.9)0 (0)Asthma3 (2.7%)0 (0)0 (0)Hospitalized in previous 12 months21 (18.9)3 (17.6)0 (0)Surgery with general anaesthesia in previous 12 months11 (9.9)2 (11.8)0 (0)Ack owledgementsThe authors thank Elena Cannavò and the CHRIS study team, whose support was of invaluable importance for the conduction of the study.Disclosure of InterestsNone Declared.

A quality improvement project regarding family communication within critical care

Introduction: Communication is central to high quality critical care (CC)1 and caring for family members is integral to the care of critically ill patients. Communication within the CC frequently does not meet families' needs,2 impacts informed decisions making3 and can result in psychological morbidity for patients and their families.4 During the COVID-19 pandemic communication was challenging with restricted family visiting. As part of our recovery strategy we aim to ensure that frequent, high quality communication remains a key aspect of critical care. There is currently no guidance relating to the frequency of family communication within critical care. Objective(s): Our aim was to review the frequency of family communication during CC admissions admission and to develop our own internal standards. Method(s): A retrospective audit was conducted of 110 admissions to Guys and St Thomas' CC from November 2021 - February 202. We reviewed all routine family discussions documented in the medical notes. Data regarding the patient's length of stay, time to first communication from admission, frequency of communication throughout admission and grade of clinician leading the communication was collected. Family discussion regarding adverse incidents and admissions less than 24hrs were excluded. If multiple communications occurred on the same day, the most senior communication was included. To complement the audit a short survey of the consultants, regarding expectations and standards of practice of family communication was completed. Result(s): 99 patients were included within the audit and 13 responses to the survey (34% response). The mean length of stay for all patients was 14 days for survivors and 16.5 days for those who died. 32% of patients received a document family communication within 24hrs of admission, 34% did not have a documented communication within 72 hours of admission. 58.3% of consultants felt a family update should happen within 24hrs of admission and 84.7% of consultants reported that families should be updated once every 3 days. On average families received a documented family communication every 5.5 days of a CC admission. When focusing just on patients who died there was an increase in the frequency of communication to once every 3 days. 23% of all documented family discussions were consultant led with the number rising to 44% in non-survivors. The audit also showed that the longer a patient stayed within critical care the less frequently a family communication became. The survey indicated that the two biggest barriers to family communication is time pressures and appropriate space. Conclusion(s): We demonstrated that documented family communication was less frequent than expected. To ensure that family commination remains a key component of CC within our department we have adopted or own internal standard of providing families with an update once every 3 days. We are exploring the role of communication facilitators5 and seeking patient/family feedback also to improve family communication further.

Comparison of Diagnostic Accuracy of CRP Versus Ferritin in COVID Patients as a Marker of Severity of Disease Taking who Severity Classification as Gold Standard

Objective: To determine the diagnostic accuracy of elevated C reactive protein (CRP) and ferritin in predicting severe Covid-19 infection using the World Health Organization's (WHO) Covid-19 severity classification as gold standard. Study Design: Descriptive study. Place and Duration of Study: This study was conducted at the Pak Emirates Military Hospital, Rawalpindi, from January 1st 2021 till April 30th 2021. Ethical review committee's (ERC) approval was taken and good clinical practice guidelines were followed. Material(s) and Method(s): Baseline blood samples were sent to the hospital laboratory for the measurement of C reactive protein and ferritin levels. PCR was taken as gold standard for the diagnosis of Corona virus disease. Patients were classified into severe and non-severe categories using WHO classification of severity. Sensitivity, specificity, diagnostic accuracy, negative predictive value and positive predictive value were calculated for elevated CRP and ferritin. Result(s): There were 65 (57.5%) patients who had severe Covid-19 disease and 48 (42.5%) patients who had non-severe Covid-19 disease. Among the patients with severe Covid-19, 57 (87.7%) had elevated CRP levels, and 50 (76.9%) patients had elevated ferritin levels. Testing ferritin levels, against the severity of Covid-19 patients, there was a sensitivity of 76.9%, specificity of 79.2%, positive predictive value (PPV) of 83.3%, negative predictive value (NPV) of 71.7% and diagnostic accuracy of 77.8%. Testing CRP levels, there was a sensitivity of 87.7%, specificity of 85.4%, PPV of 89.1%, NPV of 83.6% and diagnostic accuracy of 86.7%. Conclusion(s): The results from our study show that CRP has a slightly improved diagnostic accuracy as compared to ferritin. However, both these markers have value in the prediction of severity of Covid-19 infection.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.

Observational study of peripheral skin temperature changes following spinal anaesthesia for caesarean delivery

Introduction: Effective spinal anaesthesia for caesarean delivery (CD) is assumed to cause bilateral sympathetic blockade with increased feet skin temperature due to vasodilatation [1]. There has been no published study of peripheral skin temperature measurements during spinal anaesthesia for CD. Our study investigated foot skin temperature changes as spinal anaesthesia was established. Method(s): A single centre, prospective observational study with ethics committee approval (IRAS No. 263967). With informed consent, 60 healthy parturients, 37-42 weeks' gestation with singleton pregnancy scheduled for category 4 CD with spinal anaesthesia were recruited. Standard spinal anaesthesia used 0.5% hyperbaric bupivacaine and diamorphine with IV Phenylephrine and fluids. Skin temperature was measured on the dorsum of both feet with Covidien Mon-a-Therm© skin thermistor sensors prior to intrathecal injection and every minute after until completion of surgery. Theatre room temperature and ambient temperature under surgical drapes were recorded. Two controls were recruited. Result(s): All participants had successful spinal anaesthesia. The Figure shows mean (95% CI) skin temperature changes of both feet of participants during spinal anaesthesia and for controls. The maximum rate of skin temperature increase occurred 5-12 minutes after spinal injection with temperature change plateauing after 30 mins. The mean temperature range was 5.54degreeC (min = 29.7degreeC;max = 35.2degreeC). Discussion(s): This study characterises for the first time the peripheral temperature changes in the feet that occur with sympathetic block after spinal anaesthesia in parturients. Increased bilateral foot skin temperatures occur within 10 minutes of spinal injection. This may be useful for determining successful spinal anaesthesia for CD in addition to other assessments [2]. The insights may be useful for assessing epidural analgesia. The study was supported by an OAA research grant. Data collected by ROAR group.Copyright © 2023 Elsevier Ltd

A Comparative Analysis of IoT Protocols for Resource Constraint Devices and Networks

Communication standards and protocols are detrimental to the success of any Internet of Things (IoT) system or application. Selecting a communication standard and a suitable middleware or messaging protocol for IoT connectivity is challenging due to the heterogeneous resource-constrained IoT devices and their messaging requirements. Recently, several messaging/middleware protocols in the IoT field were developed and adopted in the industry. However, to date, there is no specific messaging protocol that can support all messaging use cases and fulfil the overall requirements of IoT systems. Therefore, it is critical to understand the application layer messaging and communication protocols of IoT systems to identify the most appropriate protocol that could fit and be applied in various contexts. This paper provides a comparative analysis of the MQTT, CoAP, and AMQP messaging protocols including their security. © 2022 ACM.

IoT enabled Covid Standard Operating Procedure system

COVID-19, is caused by the transmission of SARS-CoV-2 through direct or indirect contact with infected people though respiratory droplets has transitioned from a pandemic to an endemic but is still regarded as active by WHO. Restrictions and lockdowns were lifted as the situation became endemic, but the previous measures had to be kept in place. By developing a module that includes temperature monitoring, face mask detection, a non-contact sanitizer dispenser, and door automation that operates based on the number of individuals inside a closed area in order to maintain social distance, our project aims to incorporate these precautions into our everyday language. As a part of making the new normal easily adaptable, we also introduce a webpagebased reservation system, which wm essentially display the current count and also help in reducing the waiting periods. © 2023 IEEE.

Towards gold standard care for peripartum women admitted to general intensive care units

Introduction: Critically-ill obstetric patients admitted to general intensive care units (ICU) are a rare and unique population for whom excellent care is essential to prevent devastating physical and psychological morbidity. Admissions are often unanticipated and can present challenges to obstetric and intensive care MDTs. 2018 Enhanced Maternal Care (EMC) Guidelines provide standards for caring for these women, and the 2022 Ockenden review exposed the association of peripartum ICU admission with undertreated psychological trauma and a desire for individualised debriefing [1,2]. We audited the care of obstetric admissions to general ICUs in our quaternary centre. We sought evidence of psychological morbidity to improve follow-up pathways in line with 2022 Ockenden actions. Method(s): Retrospective online case note review of maternity admissions to general ICUs between 1/1/2021-1/1/2022 compared to EMC audit standards. Exclusion criteria: <22/40 gestation, >6/52 postpartum and admissions to our level 2 labour ward high dependency unit. Result(s): 25 patients were admitted to general ICUs over 12 months. Median age was 35-39 years, mean parity was 1. The commonest indication was obstetric haemorrhage (n = 10). 15 of 25 patients required level 3 care, median length of stay was 1.5 days. Documentation of daily obstetric MDT ward round was variable, as was mother-baby contact. 0 of 25 women were seen in obstetric anaesthesia clinic after discharge, only 1 received outpatient ICU follow-up. 50% of postnatal admissions (n = 14) had documentation of significant psychological distress. In response a local checklist was developed with key colleagues to support collaborative working and standardise quality care. It includes automatic referral into obstetric anaesthesia clinic and access to a novel perinatal mental health service. Discussion(s): A peripartum admission to ICU is highly likely to be experienced as traumatic [2]. The incidence of obstetric ICU admissions may increase in the context of greater clinical complexity of the UK pregnant population and COVID-19, whilst the non-anaesthetic ICU workforce may have little obstetric training. Obstetric anaesthetists are therefore uniquely skilled to facilitate quality resuscitation and referral to ICU, but gold-standard holistic care extends beyond admission. We believe regular audit and dedicated local care pathways which incorporate proactive debriefing and psychological health can improve the care of this important group of women.Copyright © 2023 Elsevier Ltd

Match Performance Statistics Related to Winning of Chinese Super League Under Different Match Stages

This paper aims to determine relationships between 160 matches statistics and the match results in two match stages of 2020 CSL under the COVID-19 pandemic prevention and control. A team's winning probability was evaluated by a two-standard-deviation increase in the value of each variable. The smallest worthwhile change was used to evaluate nonclinical magnitude-based inferences. The results showed that for group round robin stage, nine match statistics had clearly positive effects on the probability of winning (Shot, Shot on Target, Shot from Set Piece, Cross Accuracy, Counterattack, Won Challenge, Tackle Gaining, HIR Distance in BP, Sprinting Distance in BP), two had obviously negative effects (Distance Covered in Penalty Area, Sprinting Distance Out of BP), other twenty-three statistics had either trivial or unclear effects. While for the knockout stage, the effects of nine match statistics (Pass Accuracy, Forward Pass Accuracy, Delivery into Attacking Third, Delivery into Penalty Area, Dribble into Attacking Third, Corner, Foul Committed, Yellow Card, Distance Covered in Attacking Third) turned to clearly positive, the effects of Won Challenge, Cross Accuracy turned to trivial and clearly negative, respectively. Coaches and players should take these different aspects into account when planning practices and competitions for their teams. © 2023 SPIE.

Assistance tools for the evaluation of machine learning algorithm performance: The decision tree-based tools developed by the Medical Imaging and Data Resource Center (MIDRC) Technology Development Project (TDP) 3c effort

MIDRC was created to facilitate machine learning research for tasks including early detection, diagnosis, prognosis, and assessment of treatment response related to the COVID-19 pandemic and beyond. The purpose of the Technology Development Project (TDP) 3c is to create resources to assist researchers in evaluating the performance of their machine learning algorithms. An interactive decision tree has been developed, organized by the type of task that the machine learning algorithm is being trained to perform. The user can select information such as: (a) the type of task, (b) the nature of the reference standard, and (c) the type of the algorithm output. Based on the user responses, they can obtain recommendations regarding appropriate performance evaluation approaches and metrics, including literature references, short video tutorials, and links to available software. Five tasks have been identified for the decision tree: (a) classification, (b) detection/localization, (c) segmentation, (d) time-to-event analysis, and (e) estimation. As an example, the classification branch of the decision tree includes binary and multi-class classification tasks and provides suggestions for methods and metrics as well as software recommendations, and literature references for situations where the algorithm produces either binary or non-binary (e.g., continuous) output and for reference standards with negligible or non-negligible variability and unreliability. The decision tree has been made publicly available on the MIDRC website to assist researchers in conducting task-specific performance evaluations, including classification, detection/localization, segmentation, estimation, and time-to-event tasks. © COPYRIGHT SPIE. Downloading of the is permitted for personal use only.