Higher Likelihood Of Survival Research Articles

Early tocilizumab treatment was associated with survival benefits in hospitalized kidney transplants with severe COVID-19 infection: A prospective cohort study

BackgroundThe potential of Tocilizumab (TCZ) in preventing the cytokine storm caused by COVID-19 infection has been observed, while the survival benefits were inconclusive in solid-organ transplant recipients. We aimed to explore whether the timing of TCZ administration holds significance in the clinical course of COVID-19 infection and identify predicative factors of TCZ efficacy. MethodsWe conducted a prospective cohort study between December 2022, and January 2023. Early TCZ use referred to administration within 6 days after symptoms onset, while late TCZ use indicated administration after 6 days. The primary endpoint was 30-day mortality. ResultsTwenty-seven kidney transplant recipients with severe COVID-19 infection were enrolled, with 10 in the early use group and 17 in the late use group. In the early use group, ferritin, lactate dehydrogenase (LDH), C-reactive protein (CRP) and brain natriuretic peptide(BNP) levels had shown significant inhibitions comparing to the late use group, and those inflammatory cytokines demonstrated a noticeable decreasing trend after TCZ administration, whereas only CRP levels decreased in the late use group. The Kaplan-Meier survival curve demonstrated that the early use group had a higher likelihood of survival (P = 0.0078). Receiver Operating Characteristic (ROC) analyses revealed that the time from symptoms to TCZ use (AUC: 0.645), LDH (AUC: 0.803), CRP (AUC: 0.787), and IL-6 (AUC: 0.725) were potential predictive factors of TCZ efficacy. TCZ use within 6 days from symptoms onset, with CRP < 73.5 mg/L, LDH < 435.5 IU/L, and IL-6 < 103.5 pg/mL, had higher survival rates (P = 0.008, P = 0.009, P < 0.001, P < 0.001). ConclusionThis study highlights the survival benefits of early TCZ use and the predicative role of cytokines levels in predicting TCZ efficacy in kidney transplant recipients with severe COVID-19 infection.

The 90-Day Risk of Hospitalization in Heart Transplant Recipients After COVID-19 Infection

BackgroundHeart transplant recipients are at a high-risk of complications from the coronavirus-2019 (COVID-19) infection. Heart transplant recipients are a special group of persistently immunosuppressed people, and COVID-19 may cause them to experience an unpredictable course of infection, with a risk of hospitalization occurring well beyond their initial infection period. The seriousness of COVID-19 disease in heart transplant recipients emphasizes how vital it is to refer patients promptly and early to specialized heart transplant centers. MethodsWe retrospectively reviewed all heart transplant recipients at a single center between March 2019 and October 2021. All recipients with positive nasopharyngeal reverse transcriptase-polymerase chain reaction tests for COVID-19 were included in this study. After IRB approval, we obtained medical records and patient data from electronic medical records. ResultsThis study followed 126 heart transplant patients from March 2019 to October 2021 of which only 49 had COVID-19 infections. The median age at infection was 58 years (49-65), with 41% female. Race distribution was as follows: 59% Caucasian and 39% African American. The median time from transplant to infection was 384 days (237-677). All infected patients had a 50% dose reduction in mycophenolate mofetil per institutional protocol. The majority of symptoms were cough, fatigue, shortness of breath, and fever. Among all patients with COVID-19, 45 (92%) were vaccinated. Of those vaccinated, 27 (60%) patients received Pfizer initial and booster doses, whereas 18 (40%) received Moderna initial and booster doses. Twelve patients (24%) were hospitalized within 90 days of infection, with only two requiring ICU level of care. The median duration of hospitalization was 5 days (4-9). Of the hospitalized patients, 11 (92%) were discharged, and 1 (8%) died in the hospital. Three of the four unvaccinated patients were hospitalized, and one died while hospitalized. The remaining 37 patients were managed as outpatients. ConclusionHeart transplant recipients have an increased risk of contracting COVID-19 and developing severe symptoms due to multiple healthcare contacts, preexisting health conditions, and weakened immune systems. Our data highlight that most vaccinated patients do not require hospitalization within 90 days of infection, and those hospitalized have a high likelihood of survival without needing ICU care.

Fabrication of 3D printed hydroxyapatite/polymeric bone scaffold

ABSTRACT Reconstruction in cases of osteoporosis or accidents often requires the use of synthetic bones or scaffolds, with hydroxyapatite standing out as a preferred material due to its biocompatibility. This study focuses on the production and characterization of hydroxyapatite-coated 3D-printed bone scaffolds. The 3D-printed structures were fabricated by blending hydroxyapatite powder, synthesized through the solution combustion technique, with a liquid photopolymer, followed by exposure to UV irradiation. The resulting hydroxyapatite/photopolymer scaffolds were characterized by a uniform distribution of fine hydroxyapatite powder on the surface. Subsequently, these scaffolds underwent coating with a hydroxyapatite slurry, experimenting with various coating and sintering conditions. Despite the decomposition of the photopolymer during the sintering process, the coated scaffold displayed an increased thickness of the infill line within the pattern, resulting in reduced void size and enhanced compressive strength. Weibull analysis of the compressive strength indicated a high likelihood of survival at 4 MPa, falling within the acceptable range for cancellous bone strength. This comprehensive study showcased the potential of hydroxyapatite-coated 3D-printed bone scaffolds with a favorable microstructure and mechanical strength, making them promising for applications in bone reconstruction.

The impact of product portfolio specialty and activeness on firm survival: evidence from the nascent drone industry

We examine the impact of product portfolio strategy on the likelihood of firm survival within the nascent unmanned aerial vehicles (UAV) or the drone industry. Using novel and representative global data on firms that operate within the domain of air platforms in the drone industry, our study captures a period of ferment in the industry as it went through significant change and began to acquire some level of stability. The results show that both portfolio specialty and activeness have a positive impact on firm survival. Specialist firms with narrow product usage or higher portfolio specialty are in an advantageous position compared to generalists with wide product usage or low portfolio specialty. They also have a higher likelihood of survival, overall. Similarly, a firm with a more active set of drones within its product portfolio also survives better. The results are consistent even after accounting for firm‐level controls and are robust to other model specifications. Our findings have important implications for firm strategy, positioning, and interaction with technology in nascent industries, especially relating to the development and deployment of new technologies and products.

Increased Survival and Symptom Relief Following Palliative Cerebrospinal Fluid Diversion for Neoplastic Leptomeningeal Disease: A Case Series and Systematic Review

INTRODUCTION: Leptomeningeal disease (LMD) indicates widespread or advanced cancer and can lead to symptomatic hydrocephalus, for which palliative cerebrospinal fluid (CSF) diversion may be indicated. METHODS: We analyzed survival and symptom relief outcomes from a 10-year period at a single institution of patients with LMD secondary to cancer, symptoms of obstructive hydrocephalus, and documented date of death. We also searched PubMed, Embase, and Web of Science from database inception until 8/20/2022, using search terms including ‘cancer’, ‘hydrocephalus’, and ‘shunt’. Preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed. RESULTS: In our series of 50 patients, 30 (60%) underwent CSF diversion surgery after LMD diagnosis with comparable median age in both surgery (58.4 ± 14.4 years) and non-surgery (57.8 ± 14.5 years) groups. Twenty-three patients (76.7%) achieved symptom relief. The surgery group lived longer after LMD diagnosis than patients in the non-surgery group (6.6 ± 6.0 vs. 1.3 ± 4.3 months, p &lt; 0.001) and had higher likelihood of survival (hazard ratio 2.49, 95% confidence interval 1.37-4.52, p = 0.002). Median survival after surgery was 2.8 ± 3.8 months. Out of 23 articles reporting outcomes for 2895 patients, 995 (34.3%) presented with LMD. Postoperative complication rates were 0-37.7% with no cases of extraneural metastases. Symptom relief rates were 50-100%. Three studies reported median survival after surgery for LMD (2-3.3 months). CONCLUSIONS: A rare entity with dismal prognosis, LMD can present as symptomatic hydrocephalus in patients with cancer. Symptom relief can be achieved with palliative surgery for permanent CSF diversion with relatively low complication rates. Prospective studies are needed to further assess outcomes and needs of this patient population.

Ethical triage in public health emergency facilities: distributive justice – a decision model

PurposeA new triage method, MBCE (Medical Bio Social Ethics), is presented with social justice, bio, and medical ethics for critical resource distribution during a pandemic. Ethical triage is a complex and challenging process that requires careful consideration of medical, social, cultural, and ethical factors to guide the decision-making process and ensure fair and transparent allocation of resources. When assigning priorities to patients, a clinician would evaluate each patient’s medical condition, age, comorbidities, and prognosis, as well as their cultural and social background and ethical factors.Design/methodology/approachA statistical analysis shows no interactions among the ethical triage factors. It implies the ethical components have no moderation effect; hence, each is independent. The result also points out that medical and bioethics may have an affinity for interactions. In such cases, there seem to be some ethical factors related to bio and medical ethics that are correlated. Therefore, the triage team should be careful in evaluating patient cases. The algorithm is explained with case histories of the selected patient. A group of triage nurses and general medical practitioners assists with the triage.FindingsThe MBCE triage algorithm aims to allocate scarce resources fairly and equitably. Another ethical principle in this triage algorithm is the principle of utility. In a pandemic, the principle of utility may require prioritizing patients with a higher likelihood of survival or requiring less medical care. The research presents a sensitivity analysis of a patient’s triage score to show the algorithm’s robustness. A weighted score of ethical factors combined with an assessment of triage factors combines multiple objectives to assign a fair triage score. These distinctive features of the algorithm are reasonably easy to implement and a new direction for the unbiased triage principle.Originality/valueThe idea is to make decisions about distributing and using scarce medical resources. Triage algorithms raise ethical issues, such as discrimination and justice, guiding medical ethics in treating patients with terminal diseases or comorbidity. One of the main ethical principles in triage algorithms is the principle of distributive justice.

Blood pressure immediately after return of spontaneous circulation is associated with increased survival on admission following out‐of‐hospital cardiac arrest

AbstractBackgroundIn patients with out‐of‐hospital cardiac arrest (OHCA), low blood pressure after return of spontaneous circulation (ROSC) can be a sign of hemodynamic instability. We aimed to investigate whether systolic blood pressure (SBP) measured immediately after ROSC is associated with survival on admission.MethodsPatients with ROSC after OHCA between 2015 and 2018 were included. The primary outcome was survival on admission. Included patients were divided into three groups based on the SBP measured at the time of ROSC: group 1 (SBP ≤90 mmHg), group 2 (SBP 90–120 mmHg), and group 3 (SBP &gt;120 mmHg). Multivariable logistic regression was used to investigate the relationship between the groups by SBP and outcomes.ResultsIn the final analysis, 519 patients were included. In the restrictive cubic spline curve, the probability of achieving survival on admission increased gradually from low SBP to approximately 120–130 mmHg, then plateaued at a higher SBP. In the multivariable logistic regression analysis, group 1 was independently associated with decreased survival on admission compared to group 2. There was no significant difference between groups 2 and 3.ConclusionsLow blood pressure (SBP ≤90 mmHg) at the time of ROSC was independently associated with a lower likelihood of survival on admission in patients with non‐traumatic OHCA. However, high blood pressure (SBP &gt;120 mmHg) was not associated with a higher likelihood of survival. These suggest that low blood pressure measured in the prehospital phase can serve as an indicator predicting the poor short‐term prognosis of patients.

Development of a prognostic signature for immune-associated genes in bladder cancer and exploring potential drug findings.

Bladder cancer, predominantly affecting men, is a prevalent malignancy of the urinary system. Although platinum-based chemotherapy has demonstrated certain enhancements in overall survival when compared to surgery alone, the efficacy of treatments is impeded by the unfavorable side effects of conventional chemotherapy medications. Nonetheless, immunotherapy exhibits potential in the treatment of bladder cancer. To create an immune-associated prognostic signature for bladder cancer, bioinformatics analyses were performed utilizing The Cancer Genome Atlas (TCGA) database in this study. By identifying differential gene expressions between the high-risk and low-risk groups, a potential therapeutic drug was predicted using the Connectivity Map database. Subsequently, the impact of this drug on the growth of T24 cells was validated through MTT assay and 3D cell culture techniques. The signature included 1 immune-associated LncRNA (NR2F1-AS1) and 16 immune-associated mRNAs (DEFB133, RBP7, PDGFRA, CGB3, PDGFD, SCG2, ADCYAP1R1, OPRL1, PGR, PSMD1, TANK, PRDX1, ADIPOR2, S100A8, AHNAK, EGFR). Based on the assessment of risk scores, the patients were classified into cohorts of low-risk and high-risk individuals. The cohort with low risk demonstrated a considerably higher likelihood of survival in comparison to the group with high risk. Furthermore, variations in immune infiltration were noted among the two categories. Cephaeline, a possible medication, was discovered by analyzing variations in gene expression. It exhibited promise in suppressing the viability and growth of T24 bladder cancer cells. The novel predictive pattern allows for efficient categorization of patients with bladder cancer, enabling focused and rigorous treatment for those expected to have a worse prognosis. The discovery of a possible curative medication establishes a basis for forthcoming immunotherapy trials in bladder cancer.

Outcomes of Transcatheter Aortic Valve Replacement in Asymptomatic or Minimally Symptomatic Aortic Stenosis

BackgroundLittle is known about the outcomes of transcatheter aortic valve replacement (TAVR) in minimally symptomatic patients. ObjectivesThe authors aimed to evaluate the outcomes of patients with minimally symptomatic severe aortic stenosis treated with TAVR in the STS/ACC TVT registry. MethodsMinimally symptomatic status was defined as a baseline Kansas City Cardiomyopathy Questionnaire overall summary score (KCCQ-OS) ≥75. Clinical and health status outcomes of TAVR in patients with severe aortic stenosis and normal left ventricular ejection fraction were compared between minimally symptomatic patients and those with moderate or severe symptoms. ResultsAmong 231,285 patients who underwent TAVR between 2015 and 2021 (median age 80.0 years [IQR: 74.0-86.0 years], 47.5% female), 20.0% were minimally symptomatic before TAVR. Survival at 1 year was higher in minimally symptomatic patients vs those with moderate or severe symptoms (adjusted HR for death: 0.70 [95% CI: 0.66-0.75]). Mean KCCQ-OS increased by 2.7 points (95% CI: 2.6-2.9 points) at 30 days and 3.8 points (95% CI: 3.6-4.0 points) at 1 year in minimally symptomatic patients compared with increases of 32.2 points (95% CI: 32.0-32.3 points) at 30 days and 34.9 points (95% CI: 34.7-35.0 points) at 1 year in more symptomatic patients. Minimally symptomatic patients had higher odds of being alive and well at 1 year (OR: 1.19 [95% CI: 1.16-1.23]). ConclusionsAlthough minimally symptomatic patients treated with TAVR experience only small improvements in health status, their overall outcomes are favorable with a higher likelihood of survival with good health status at 1 year compared with more symptomatic patients.

COVID-19 in the intensive care unit: unmasking the critical factors impacting patient survival.

In the midst of the coronavirus disease 2019 (COVID-19) pandemic, intensive care units (ICUs) around the world have been pushed to their limits as they grapple with the effects of the severe acute respiratory syndrome coronavirus 2 virus. Identifying prognostic factors that influence mortality in COVID-19 patients admitted to the ICU could offer valuable insights for clinicians seeking to prevent disease progression. A retrospective analysis was conducted on COVID-19 patients admitted to the ICU between January and September 2020. The analysis considered patient demographics, comorbidities, neurological and non-neurological symptoms, as well as laboratory markers. The multivariate logistic regression analysis aims to uncover associations between these factors and patient outcomes. Of the 387 patients included in this study, nearly half (48.5%) of the ICU patients succumbed to COVID-19. Factors that contributed to increased mortality included being 60 years of age or older, impaired consciousness, lung disease, elevated international normalized ratio (INR), and elevated blood urea nitrogen (BUN) levels. Surprisingly, symptoms such as dizziness/lightheadedness, myalgia, and headache were associated with a higher likelihood of survival. In addition, elevated D-dimer and aspartate aminotransferase (AST) levels, as well as lymphopenia, were more commonly observed in deceased patients. The study concluded that those who died in the ICU tended to be older, white, and burdened with more comorbidities and impaired consciousness. With the intriguing link between specific symptoms and survival, further research is essential to uncover the underlying pathophysiological mechanisms that influence ICU patient outcomes in the context of COVID-19.

Impacts of strategic exploitation and exploration on firms’ survival likelihood after crises: A decision-tree analysis

Whether firms can survive a major crisis is an important question for both researchers and practitioners. Ambidexterity is frequently proposed as a sound strategy to achieve best performance when firms exist in turbulent environments; however, it is unclear whether this effect is sustained in a crisis, especially an internal one. Applying configuration and dynamic capability theories, this study extends the literature and examines this question by investigating how exploitation, exploration, and ambidexterity affect firms’ survival rates after major crises. This study is based on collected annual reports of and financial data on 367 firms that encountered a major crisis over a 21-year period (2000–2020) to provide empirical evidence. We employed a decision-tree analysis method based on text mining. The results show that during a crisis, firms adopting an exploitation strategy have a higher likelihood of survival than those adopting exploration and ambidexterity. Meanwhile, in the high-tech industry, adopting an ambidexterity or an exploitation strategy is better than adopting an exploration strategy. Theoretical and practical implications are provided.

The effect of trauma advanced practice nurse programme at a Level I regional trauma centre in mainland China.

Trauma is the fifth-leading cause of death in China. Despite the establishment of the Chinese Regional Trauma Care System (CRTCS) in 2016, advanced trauma nurse practice has not been incorporated. This study aimed to identify the roles and responsibilities of trauma advanced practice nurse (APN), and to investigate the impact on patient outcomes in a Level I regional trauma centre in mainland China. A single-centre pre- and post-control design was used. The trauma APN programme was established based on multidisciplinary experts' consultation. A retrospective study was conducted on all Level I trauma patients over a period of 5 years, spanning from January 2017 to December 2021, with a sample size of 2420. The data were divided into two comparison groups: a pre-APN programme (January 2017-December 2018; n = 1112) and post-APN programme (January 2020-December 2021; n = 1308). A comparison analysis was conducted to evaluate the effectiveness of trauma APN who were integrated into the trauma care team, with a focus on patient outcomes and time-efficiency indicators. The certification of the regional Level I trauma centre resulted in a 17.63% increase in the number of trauma patients. The integration of advanced practice nurses (APN) into the trauma care system led to significant improvements in time-efficiency indicators, with the exception of advanced airway establishment time (p < 0.05). The average emergency department length of stay (LOS) decreased 21%, from 168 to 132 min (p < 0.001); additionally, the mean intensive care unit LOS decreased by nearly 1 day (p = 0.028). Trauma patients who were treated by trauma APN had a higher likelihood of survival, with an odds ratio of 1.816 (95%CI: 1.041, 3.167; p = 0.033), compared to patients who received care prior to the implementation of the trauma APN program. A trauma APN programme has the potential to enhance the quality of trauma care in the CRTCS. This study elucidates the roles and responsibilities of trauma advanced practice nurses (APN) in a Level I regional trauma centre in mainland China. Trauma care quality was significantly improved after the application of a trauma APN programme. In regions with inadequate medical resources, the utilization of advanced practice trauma nurses can enhance the quality of trauma care. In addition, trauma APN can provide a trauma nursing education programme within the regional centres as a strategy to augment the proficiency of regional trauma nursing. No patient or public contribution, the research data all from trauma data bank.

PO-05-137 ECG MORPHOLOGY IS A DETERMINANT OF SURVIVAL IN PULSELESS ELECTRICAL ACTIVITY

Sudden cardiac arrest (SCA) due to pulseless electrical activity (PEA) has a poor prognosis and identification of cases with a higher likelihood of survival could facilitate the resuscitation process. In PEA, QRS frequency and morphology can vary significantly. To investigate if the frequency and morphology of the QRS can predict survival outcomes in PEA. The study population is drawn from two prospective, community-based studies of out-of-hospital SCA in the U.S.: Oregon SUDS from the Portland, OR metro area (Pop. approx. 1 million; since 2002) and Ventura PRESTO from Ventura County CA (Pop. approx. 850,000, since 2015). In the present study, we included SCA cases resuscitated by EMS that had EMS recording of the ECG available, and PEA was the presenting rhythm. We analyzed QRS frequency, regularity, and width of the presenting PEA rhythm in a subset of 347 PEA-SCA cases (34 survivors and 313 non-survivors). The mean age of the subjects was 70.3±15.5 years and 60.2% were male. The prevalence of QRS frequency >60 bpm was 23.1% and QRS width <120 ms was 32.6%. Females were more likely to have a narrow QRS complex than males (39.9% vs. 27.8%; p=0.02) but there was no sex difference in the QRS frequency. Those with QRS frequency >60 bpm had a higher survival rate than those with QRS frequency <60 bpm (17.5% vs. 7.5%: p=0.02). In addition, cases with QRS width <120 ms had a higher survival rate in comparison to cases with QRS width >120 ms (17.7% vs. 6.0%; p=0.001). Cases with both narrow QRS complex (<120 ms) and fast frequency (>60 bpm) had the highest survival rate (10/38, 26.3%). There was no difference in the survival rate between regular and irregular rhythms. PEAs with electrical activity >60 bpm and narrow QRS complex were associated with higher survival. These results suggest that resuscitation efforts are most likely to be beneficial in PEA-SCA cases that present with a narrow and fast QRS pattern.

The Bright and Dark Sides of a Central Bank's Financial Support to Local Banks after a Natural Disaster: Evidence from the Great Kanto Earthquake, 1923 Japan

AbstractThe Great Kanto Earthquake of 1923 caused serious damage to firms and banks in Yokohama City. We explore the role of the financial support by the Bank of Japan (BoJ) through local banks in a firm's survival and recovery from the natural disaster. We find that the small‐ and medium‐sized firms (SMEs) that had a relatively large correspondent bank with a large number of bills rediscounted by BoJ had a higher likelihood of survival but lower growth after the earthquake. Liquidity supply by the central bank for recovery from a negative shock can have both positive and negative impacts.

Expression of HIF-1α and markers of angiogenesis and metabolic adaptation in molecular subtypes of breast cancer

Hypoxic zones exist in solid tumors, where oxygen levels are significantly lower than in normal tissues. Hypoxia makes chemo-radiation therapeutics less effective and renders the metastatic potential more favorable. Emerging research has found that the transcriptional expression of hypoxia-inducible factor-1alpha (HIF-1α) promotes the transcription of vascular endothelial growth factor A (VEGF-A) and Hexokinase-I (HK-I), which are associated to cellular growth, angiogenesis, and metastatic invasion in many malignancies. However, it is still unclear whether VEGFA and HK-I expression has any influence on survival based on the intrinsic subtypes of breast cancer. Their prognostic significance remains a debatable topic. In the present study, quantitative Real-time polymerase chain reaction (qRT-PCR) was employed to check the relative expression of HIF-1α, VEGF-A and HK-I. The hazard ratios (HR) of breast cancer-specific and overall mortality were calculated using Cox proportional hazards model, which were adjusted for demographic, clinicopathological, and associated molecular variables, as well as the diagnosis year. The relative mRNA expression levels of HIF-1α (p = 0.0010) and VEGFA (p = 0.0119) were significantly higher in tumor tissues. The expression of both HIF-1α (p = 0.0111) and VEGFA (p = 0.0078) was higher in the TNBC group of breast cancers, while HK-I (p = 0.0106) was higher in ER/PR-positive, HER2-negative group. HIF-1α and HK-I overexpression were associated with a higher likelihood of survival, while overexpression of VEGFA was associated with a low survival rate, although it was not statistically significant.

Computer-Aided Diagnosis System for Blood Diseases Using EfficientNet-B3 Based on a Dynamic Learning Algorithm.

The immune system's overproduction of white blood cells (WBCs) results in the most common blood cancer, leukemia. It accounts for about 25% of childhood cancers and is one of the primary causes of death worldwide. The most well-known type of leukemia found in the human bone marrow is acute lymphoblastic leukemia (ALL). It is a disease that affects the bone marrow and kills white blood cells. Better treatment and a higher likelihood of survival can be helped by early and precise cancer detection. As a result, doctors can use computer-aided diagnostic (CAD) models to detect early leukemia effectively. In this research, we proposed a classification model based on the EfficientNet-B3 convolutional neural network (CNN) model to distinguish ALL as an automated model that automatically changes the learning rate (LR). We set up a custom LR that compared the loss value and training accuracy at the beginning of each epoch. We evaluated the proposed model on the C-NMC_Leukemia dataset. The dataset was pre-processed with normalization and balancing. The proposed model was evaluated and compared with recent classifiers. The proposed model's average precision, recall, specificity, accuracy, and Disc similarity coefficient (DSC) were 98.29%, 97.83%, 97.82%, 98.31%, and 98.05%, respectively. Moreover, the proposed model was used to examine microscopic images of the blood to identify the malaria parasite. Our proposed model's average precision, recall, specificity, accuracy, and DSC were 97.69%, 97.68%, 97.67%, 97.68%, and 97.68%, respectively. Therefore, the evaluation of the proposed model showed that it is an unrivaled perceptive outcome with tuning as opposed to other ongoing existing models.

North American COVID-19 Myocardial Infarction (NACMI) Risk Score for Prediction of In-Hospital Mortality.

BackgroundIn-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI) is higher in those with COVID-19 than in those without COVID-19. The factors that predispose to this mortality rate and their relative contribution are poorly understood. This study developed a risk score inclusive of clinical variables to predict in-hospital mortality in patients with COVID-19 and STEMI.MethodsBaseline demographic, clinical, and procedural data from patients in the North American COVID-19 Myocardial Infarction registry were extracted. Univariable logistic regression was performed using candidate predictor variables, and multivariable logistic regression was performed using backward stepwise selection to identify independent predictors of in-hospital mortality. Independent predictors were assigned a weighted integer, with the sum of the integers yielding the total risk score for each patient.ResultsIn-hospital mortality occurred in 118 of 425 (28%) patients. Eight variables present at the time of STEMI diagnosis (respiratory rate of >35 breaths/min, cardiogenic shock, oxygen saturation of <93%, age of >55 ​years, infiltrates on chest x-ray, kidney disease, diabetes, and dyspnea) were assigned a weighted integer. In-hospital mortality increased exponentially with increasing integer risk score (Cochran-Armitage χ2, P ​< ​.001), and the model demonstrated good discriminative power (c-statistic ​= ​0.81) and calibration (Hosmer-Lemeshow, P ​= ​.40). The increasing risk score was strongly associated with in-hospital mortality (3.6%-60% mortality for low-risk and very high–risk score categories, respectively).ConclusionsThe risk of in-hospital mortality in patients with COVID-19 and STEMI can be accurately predicted and discriminated using readily available clinical information.

Identifying cardiac activity using focused ultrasound in non-shockable arrests

Background: Each year, around 60 000 people in the UK experience an out-of-hospital cardiac arrest. The introduction of additional diagnostic tools such as focused cardiac ultrasound (FoCUS) aids assessment and management of patients at the point of care. The Resuscitation Council guidance recommends its use where possible. Method: A systematic literature search was undertaken of two databases, PubMed and Science Direct primarily to identify literature relevant to the use of ultrasound in medical cardiac arrests where the prevailing cardiac rhythm was non-shockable. Results: A total of 10 papers were included in the review out of 242 identified from the search. Across all papers, three themes were identified: prognostication, identification of reversible causes and true pulseless electrical activity (PEA) versus pseudo PEA. Conclusion: The evidence shows there is an association between cardiac activity identified with FoCUS and an increase in return of spontaneous circulation (ROSC) rates. The effect of FoCUS for improving survival is not statistically significant; however, there is a higher likelihood of survival because of its ability to aid decision making. Patients with cardiac motion identified by FoCUS had higher ROSC rates than those without. Although the data suggest that the presence of cardiac activity is highly associated with ROSC, there is little literature surrounding long-term outcomes of patients, so the ability of FoCUS to determine survival cannot be confirmed.

1597 Navigating the Morality of Postponing Urgent Cancer Surgery in The Covid-19 Pandemic

Abstract Introduction The Covid-19 pandemic presents challenges of unparalleled magnitude to healthcare resource allocation. Many cancer operations have been postponed due to reduced staff, bed and ICU availability, potentially allowing incurable disease progression. The five-year survival rate for stage 1 bowel cancer is 91%; stage 2, 84%1, yet some studies suggest the mortality rate of ventilated Covid-19 patients is 50-88%2,3,4,5. Many ethical documents attempt to guide just resource allocation for ICU, however, Covid-19 presents a greater conundrum. If resource allocation occurs on the basis of acute medical need it is preferential to Covid-19 care, and at what cost is this to those with potentially curable cancer? How can we navigate pandemic pressures to be as just as we can? Method Literature review and application of ethical theories including utilitarianism, deontology and a Rawlsian approach. Results Utilitarianism argues that allocating scarce resources to those likely to gain minimal benefit, whilst removing benefit from those with a higher likelihood of survival would not be for the greater good. Doctors, however, tend to practise in a more deontological way; that is in the best interests of the patient in front of them. Rawl’s thought experiment allows us to wear a ‘veil of ignorance’ to consider the fairest decision for any undefined individual. Conclusions Covid-19 has forced unprecedented moral dilemmas; these do not just extend to patients requiring ventilators, but those in need of curative surgery. An understanding of ethical principles and a multidisciplinary approach to decision-making should encompass the consideration of outcomes of oncological surgical intervention.

For the Love of Alma, Black Hopes Matter.

For the Love of Alma, Black Hopes Matter.