Median Response Time Research Articles

Implementing hospital-based peer recovery support services for substance use disorder

ABSTRACT Background The rise in drug overdose deaths in the United States necessitates novel approaches to reduce harms. In response, peer recovery support services for substance use disorder have been implemented in clinical and community settings in several states. Objectives This descriptive analysis aimed to describe the implementation of hospital-based peer recovery support services for substance use disorder. Methods We describe the implementation of the Peer Recovery Program, which delivers recovery support services 24 hours a day, seven days a week, for patients with substance use disorder in emergency departments and inpatient settings across 20 hospitals. We report program, patient, and referral characteristics and program process measures. Results From 2016 to 2019, Recovery Specialists received referrals during 30,263 patient visits. In 2019, 65.4% (n = 7,564) of patients were male. Across three subsamples of referrals, patient acceptance of continued recovery support services ranged from 74.8% to 83.0%. At affiliated hospitals in 2019, the median response time from referral to Recovery Specialist arrival at patient bedside was eight minutes (interquartile range = 4–16), and the median duration of initial bedside consultation was 35 minutes (interquartile range = 25–45). In 2019, Recovery Specialists and Patient Navigators attempted 113,442 follow-up contacts, and patients accepted 4,696 referrals provided by Patient Navigators to substance use disorder treatment and other medical, social, and recovery services and supports. Conclusions This study describes peer recovery support services for substance use disorder delivered in emergency departments and inpatient settings. Evidence of improved patient outcomes is needed prior to widespread adoption.

Abstract 148: A Machine Learning-based Dispatch Rule for Drone-delivered Defibrillators

Introduction: Drone-delivered defibrillators may reduce response time for out-of-hospital cardiac arrest (OHCA). However, an optimal dispatch rule is not yet known. Methods: We identified all suspected OHCAs in Peel Region, Ontario, Canada from Jan. 2014 to Dec. 2019. We trained a neural network model to predict emergency medical services (EMS) response times using OHCA location, distance from responding ambulance, day of week and time of day. Instead of least-squares loss, our model optimized a loss function that penalized weighted errors in the dispatch decision (type I/II error). Assuming drones were deployed from three bases in the region, we calculated drone response time to each suspected OHCA using real drone specifications. Our dispatch rule dispatched a drone when its calculated response time was shorter than the predicted EMS response time. Response time was calculated as the minimum of the drone and EMS response times. The performance of our dispatch rule was compared on out-of-sample OHCAs using 5-fold cross validation to the baseline cases of (1) no drones, and (2) drone dispatch to every suspected OHCA. Statistical analysis on the median response times was performed using a right-tailed sign test. Results: We identified 4774 suspected OHCAs with a median historical EMS response time of 6.0 minutes. Using our dispatch rule, median response time was significantly shorter at 3.9 minutes (P<0.001). Drones were dispatched to 3803 cases (79.7%) and of those, drone response was faster than EMS in 3076 cases (80.9%). When the drone was not dispatched, it would have been slower than EMS in 856 cases (88.1%). Sending a drone to every suspected OHCA resulted in an identical median response time of 3.9 minutes (P<0.001), with drones arriving before EMS in 3191 cases (66.8%). Conclusion: A machine learning-based dispatch rule can achieve similar response times as a policy that dispatches a drone to all suspected OHCAs, while dispatching drones less frequently.

Cidofovir, a Choice for Salvage Treatment of CMV Infection in the Patients with Haploidentical Hematopoitic Stem Cell Transplantation

Cidofovir (CDV) is a nucleotide analogue with broad antiviral activity and has been approved for the treatment of cytomegalovirus (CMV) retinitis in patients with acquired immunodeficiency syndrome. Data on the use of CDV for anti-CMV treatment in the patients with haploidentical hematopoietic stem cell transplantation (haplo-HSCT) is rare. In this study, 31 (defined as CDV-second line treatment, ST group) out of 101 (conventional treatment, CT group) haplo-HSCT recipients with CMV infection being front-line treated with intravenous ganciclovir (GCV) or foscarnet (FSC) between the year 2017 and 2019, failed or intolerated to the preemptive antiviral therapy, and were switched to CDV therapy. Also, another 9 (CDV-front line treatment, FT group) patients with CMV infection were preemptively treated with CDV. CDV was used at a dose of 5 mg/kg per week until CMV-DNA negative twice with quantification polymerase chain reaction (qPCR) detection or disease progression. 23/28(82.1%) patients achieved treatment response with a median response time of 9(2-23) days and 20/28(71.8%) obtained complete response (CR) in CDV-ST group. While 6/8(75.0%) acquired CR with a median time of 6 (4-25) days in CDV-FT group. Higher response rate was seen in CDV treatment groups, though not significantly different, when being compared with those in CT groups (66/95(69.5%), 7 (2-34) days, 65(68.4%, respectively, all P-value >0.05). Also, there was not statistical difference in CMV-related mortality among the three groups (P-value >0.05). With a median follow-up of 10 (1-28) months, cumulatively 8/22(36.3%) patients experienced CMV reactivation in CDV-ST group, while 23/62(37.0%) happened in CT group, there was not significant difference (P>0.05). Whereas none with CMV recurrence was observed in the CDV-FT group. CDV-related toxicities were recorded in a total of 13/40 (32.5%) patients, shown as 7(17.5%) with I~II° gastrointestinal side effects, 6(15%) presenting reversible nephrotoxicity. Taking together, salvage treatment with CDV shows no worse efficacy than ganciclovir or foscarnet does in the front line treatment of CMV infection in haplo-HSCT recipients. Also, CDV-related toxicity is tolerated. Keywords: cidofovir, CMV infection, haplo-hematopoietic stem cell transplantation, efficacy, safety Disclosures No relevant conflicts of interest to declare.

Disparities between Rural and Urban Areas of the Central Region of Saudi Arabia in the Utilization and Time-Centeredness of Emergency Medical Services.

The purpose of this study was to explore differences in characteristics of missions dispatched by Emergency Medical Services (EMS) between rural and urban areas of Riyadh province in Saudi Arabia (SA). It also aimed at identifying weaknesses related to utilization and Response Time (RT). The study retrospectively evaluated 146,639 completed missions in 2018 by measuring the utilization rate in rural and urban areas. The study shows there are six times more ambulance crews available for rural areas compared to urban. There were 22.1 missions per 1000 urban inhabitants and 11.2 missions per 1000 in rural areas. The median RT for high urgent trauma cases was 20.2 min in rural compared to 15.2 min in urban areas (p < 0.001). In urban areas, the median RT for high urgent medical cases was 16.1 min, while it was 15.2 min for high urgent trauma cases. Around 62.3% of emergency cases in urban and 56.5% in rural areas were responded to within 20.00 min. Women utilized EMS less frequently. The RT was increased in urban areas compared to previous studies. The RT in the central region of SA has been identified as equal, or less than 20.00 min in 62.4% of all emergency cases. To further improve adherence to the 20′ target, reorganizing the lowest urgent cases in the rural areas seems necessary.

Association between prehospital time and outcome of trauma patients in 4 Asian countries: A cross-national, multicenter cohort study.

Whether rapid transportation can benefit patients with trauma remains controversial. We determined the association between prehospital time and outcome to explore the concept of the "golden hour" for injured patients. We conducted a retrospective cohort study of trauma patients transported from the scene to hospitals by emergency medical service (EMS) from January 1, 2016, to November 30, 2018, using data from the Pan-Asia Trauma Outcomes Study (PATOS) database. Prehospital time intervals were categorized into response time (RT), scene to hospital time (SH), and total prehospital time (TPT). The outcomes were 30-day mortality and functional status at hospital discharge. Multivariable logistic regression was used to investigate the association of prehospital time and outcomes to adjust for factors including age, sex, mechanism and type of injury, Injury Severity Score (ISS), Revised Trauma Score (RTS), and prehospital interventions. Overall, 24,365 patients from 4 countries (645 patients from Japan, 16,476 patients from Korea, 5,358 patients from Malaysia, and 1,886 patients from Taiwan) were included in the analysis. Among included patients, the median age was 45 years (lower quartile [Q1]-upper quartile [Q3]: 25-62), and 15,498 (63.6%) patients were male. Median (Q1-Q3) RT, SH, and TPT were 20 (Q1-Q3: 12-39), 21 (Q1-Q3: 16-29), and 47 (Q1-Q3: 32-60) minutes, respectively. In all, 280 patients (1.1%) died within 30 days after injury. Prehospital time intervals were not associated with 30-day mortality. The adjusted odds ratios (aORs) per 10 minutes of RT, SH, and TPT were 0.99 (95% CI 0.92-1.06, p = 0.740), 1.08 (95% CI 1.00-1.17, p = 0.065), and 1.03 (95% CI 0.98-1.09, p = 0.236), respectively. However, long prehospital time was detrimental to functional survival. The aORs of RT, SH, and TPT per 10-minute delay were 1.06 (95% CI 1.04-1.08, p < 0.001), 1.05 (95% CI 1.01-1.08, p = 0.007), and 1.06 (95% CI 1.04-1.08, p < 0.001), respectively. The key limitation of our study is the missing data inherent to the retrospective design. Another major limitation is the aggregate nature of the data from different countries and unaccounted confounders such as in-hospital management. Longer prehospital time was not associated with an increased risk of 30-day mortality, but it may be associated with increased risk of poor functional outcomes in injured patients. This finding supports the concept of the "golden hour" for trauma patients during prehospital care in the countries studied.

Initial treatment of seizures in children in an emergency department in rural Japan

ObjectiveAlthough the initial treatment of childhood seizures is important, treatment within an appropriate time window is often difficult in resource-limited areas. This study examined childhood seizure treatment in a rural area in Japan. MethodsWe retrospectively investigated children presenting to Nakatsugawa Municipal General Hospital emergency department between 2015 and 2018. From the hospital database, we identified children who were diagnosed with seizures, epilepsy, or acute infectious encephalitis/encephalopathy or were given benzodiazepines. We considered etiology, seizure duration, and treatment according to the specialties of the doctors providing initial care. ResultsWe extracted 236 seizure events: 40 initially treated by pediatricians, 16 by a mobile doctor team, and 180 by other doctors. Twenty patients had continuous seizures for longer than 5 min on admission. Two were treated by pediatricians at presentation; it took 4 and 7 min after arrival to stop the seizures. Four were treated by a mobile team, and 14 by other doctors; the median response times were 11.5 (range 3–47) and 19 (range 5–60) min, respectively. All patients treated by pediatricians or mobile doctor teams received intravenous or intramuscular diazepam, whereas 50% of those treated by other doctors initially received diazepam suppositories. In three of the 20 events, establishing intravenous access was difficult. SignificanceIn rural Japan, many children with seizures are initially treated by doctors other than pediatricians or emergency physicians, and they require a longer time to achieve seizure cessation. Non-intravenous benzodiazepine formulas, which have not yet been approved in Japan, would be helpful.

ICT-driven improvement of interprofessional collaboration between a rural clinic and nursing home: A mixed method

Rural shortages of medical resources inhibit interprofessional collaboration, and nursing home patient care is difficult due to constant need of resources. We investigate the effectiveness of information computer technology (ICT) in facilitating collaboration between medical and care professionals. A concurrent mixed method analyzed ICT's effects on collaboration between physicians and nursing home staff , using a two-month prospective cohort study . Staff used an ICT-based information-sharing system. Direct content analysis was used on the shared information. Additionally, one-on-one interviews with physicians and nurses were analyzed using thematic analysis. In total, 40 patients (average age 88) participated. Half had conditions shared using the ICT system. Information was shared 140 times, median response time was 80.5 min. Common contents related to terminal care (physicians) and vital signs (nursing home staff). Thematic analysis revealed four themes: seamless collaboration, security, time-saving, and accustomation. ICT increases efficiency of interprofessional collaboration and security for nurses and care workers. To promote ICT, continual usage and facilitation of veteran nurses overcoming their technological difficulties is required. • ICT systems shown to help interprofessional collaboration among rural medical staff. • Efficient information sharing leads to reduced anxiety for nursing home nurses. • Access to information overcomes rural issues of dispersed medical resources. • Older nurses and physicians may struggle with the use of new ICT systems.

Timing of response to venetoclax combination treatment in older patients with acute myeloid leukemia.

7531 Background: Venetoclax (Ven) has synergistic activity with hypomethylating agents (eg, azacitidine [Aza] or decitabine [Dec]) or low-dose cytarabine (LDAC). These Ven-based combinations have demonstrated rapid median response times. This analysis describes the rapidity and likelihood of response to Ven treatments, and its associated characteristics, in older patients with newly diagnosed acute myeloid leukemia (AML). Methods: Included are data from two open-label trials of Ven, at label recommended doses, in combination with Aza, Dec (NCT02203773; phase 1b), or low-dose cytarabine (NCT02287233; phase 1/2) in newly diagnosed patients with AML. Patients were classified based on CR/CRi timing: within 2 cycles of therapy, after 2 cycles, or never achieving CR/CRi. Within each group, baseline and post-baseline characteristics were evaluated to determine impact on response timing. The percentage of patients in each category and duration of response (DOR) in each category were also evaluated. Results: Data cutoff was August 2018. Of 197 patients, 42% (n = 83) had CR/CRi in ≤2 cycles, 22% (n = 44) had CR/CRi in &gt; 2 cycles, and 36% (n = 70) did not achieve CR/CRi. Median DOR was 21.2 mos. (95% CI 14.1-NR) for ≤2 cycle responders and 8.1 mos. (95% CI 5.3-14.9) for &gt; 2 cycle responders. Baseline characteristics are shown in the Table. Patients with baseline IDH1/2 mutation were more likely to have CR/CRi in ≤2 cycles, while those with secondary AML and no response by the end of cycle 2 were more likely to never achieve CR/CRi. Of the patients who achieved CR/CRi after 2 cycles of therapy, 43% (19/44) achieved MLFS within the first two cycles. Of those who never achieved CR/CRi, 17% (12/70) of patients achieved MLFS within 2 cycles. In depth regression analyses of factors predictive of response, including analysis of biomarkers, will be available upon presentation. Conclusions: Over 1/3rd of patients that achieved CR/CRi on Ven combination therapy within these two studies required more than 2 cycles of treatment. Therefore, prior to discontinuing therapy for nonresponders, it is critical to assess key predictive patient characteristics. Clinical trial information: NCT02203773 and NCT02287233 . [Table: see text]

Stereotactic Ablative radiation therapy (SABR) for cardiac arrhythmia: A new therapeutic option?

Stereotactic ablative radiation therapy (SABR) is used in non-oncologic indications, recently even for cardiac arrhythmias. Thus, aim of this analysis is to review preclinical, early clinical evidences and future direction of the latter new treatment approach. A collection of available data regarding SABR and cardiac arrhythmias was made, by Pubmed research and 2 independent researchers, including preclinical and clinical data. A review of ongoing trials was conducted on ClinicalTrials.gov. Preclinical research conducted in animal models showed that a safe and effective noninvasive treatment approach for cardiac arrhythmias could be represented by SABR with a median time of response around 2-3months. The treatment dose plays a crucial role: the atrioventricular node would seem more radiosensitive than the other cardiac electric zones. Clinical data, such as published case series, case reports and early prospective studies, have already suggested the feasibility, efficacy and safety of SABR (25Gy in one session) for refractory ventricular arrhythmias. Considering the ongoing trials of SABR and new technological improvements in radiotherapy (e.g. hybrid magnetic resonance) and in arrhythmias noninvasive mapping systems, the future analyses will improve the reliability of those preliminary results.

SUN-018 No Difference in Breastfeeding Rates in Women with Polycystic Ovary Syndrome

No Difference in Breastfeeding Rates in Women with Polycystic Ovary Syndrome Objective: Women with PCOS have increased rates of obesity and gestational weight gain compared to women without PCOS, factors which are associated with decreased breastfeeding (BF). Thus, our objective was to evaluate if women with PCOS were less likely to initiate BF. Design: Cross-sectional analysis of participants in the PRAMS (Pregnancy Risk Assessment Monitoring System) dataset, a national questionnaire from the Centers for Disease Control (CDC) sent to postpartum mothers 2–9 months after delivery. PCOS status and BF were by self-report. Logistic regression was used to assess odds of ever BF. Length of BF was assessed using Cox proportional hazards with right censoring for women who were still BF at the time of follow-up. PRAMS complex survey design was accounted for. Results: PCOS status was available for 14 states. Median response time was 3.7 months postpartum. Data from 16,036 participants were included which represents 855,302 women due to sample weights. 6.6% of women reported having PCOS and 83.8% reported ever BF. Compared to women with a normal BMI, women who were overweight or obese had decreased odds of BF (OR: 0.7, 95% CI: 0.6–0.9, P=0.01; OR: 0.6, 95% CI: 0.5–0.7, P<0.001 respectively); however, PCOS was not associated with BF (OR: 1.1, 95% CI: 0.9–1.3, P=0.6). In multivariate analysis, women with PCOS still were at no decreased odds of BF after adjusting for age, BMI, race, ethnicity, infertility treatment, and delivery factors (ORadj:1.1; 95% CI: 0.8–1.4; P=0.6). Variables associated with decreased odds of BF included: overweight/obesity, age ≤ 19 yrs (vs. 25–29), Black race, smoking, undesired pregnancy intent, gestational age ≤27 wks, and prior live birth. Variables associated with increased BF included: age 30–39 yrs, hospital stay 1–2 days (vs. 3–5), Hispanic ethnicity, and ≥ 3 life stressors. In multivariable Cox models, women with PCOS did not have a shorter length of BF (HRadj: 0.9, 95% CI: 0.8–1.1, P=0.3). Conclusion: Given the rise of the national rates of obesity and clear maternal and neonatal benefits to breastfeeding, understanding the predictors of BF success is paramount. In this national survey, women with PCOS were at no decreased odds of BF, despite confirming the association between overweight/obesity and decreased BF. However, our data still supports the clinical relevance of carefully targeting women with PCOS for BF education due to the association of PCOS with increased BMI. Additional prospective studies are needed to fully understand the association between PCOS and BF.

Efficacy and safety of ruxolitinib in the salvage treatment of chronic graft versus-host disease

Objective: To investigate the efficacy and safety of low-dose Ruxolitinib in the treatment of patients with chronic graft-versus-host disease (cGVHD) and refractory to the first-line and/or second-line drugs after allogeneic hematopoietic stem cell transplantation. Methods: The clinical data was retrospectively analyzed of patients diagnosed with cGVHD in Anhui Provincial Hospital from July 9, 2018 to May 23, 2019. They were refractory to first-line and second-line drugs and were given a low-dose of Ruxolitinib (a dose of 5 mg twice daily if body weight ≥ 25 kg and 2.5 mg twice daily if body weight<25 kg). There was 2.5 mg reduction per week or every two weeks if the condition improved until withdrawal. The efficacy and safety of Ruxolitinib were retrospectively analyzed weekly or biweekly. If the condition improved, the dosage would be reduced by 2.5 mg weekly or biweekly until discontinuance. Results: A total of 47 patients were included in the study,and the median time of taking Ruxolitinib was 55 (21-154) days. The median time of taking effect was 14(7-28) days. The overall response rate was 87.2% (41/47). The complete response rate was 63.8% (30/47) and the partial response rate was 23.4%(11/47). Among them, 13 cases were mild and the overall response rate was 100%(13/13). Twenty one cases were moderate and the overall response rate was 90.5%(19/21). Thirteen cases were severe and the overall response rate was 69.2%(9/13). The highest overall response rate of all organs the was 100% in the gastrointestinal tract (7/7), and it was 95.8%(23/24) for the skin, 83.3%(5/6) for the liver and 76.9%(10/13) for the lung. The highest rate of complete organ response was 95.8% for skin. Eight patients (17%) developed cytopenia, of which 2(4.2%) were with a decrease of 3-4 degree hemoglobin. Recrudescence of cytomegalovirus occurred in 3 patients (6.4%). After withdrawal of Ruxolitinib, 6 patients (12.7%) had recurrence of cGVHD. The median time to relapse was 35.5(7-90) days. All of their conditions were improved after addition of Ruxolitinib. The median time of response was 7(5-14) days. The median follow-up was 208(33-412) days. Three patients(6.4%) died, and all of them died of severe pulmonary infection. Three patients (6.4%) had relapse of primary disease. The 6-month overall survival rate was 95.7%. Conclusion: Low-dose Ruxolitinib has good efficacy and safety in the treatment of cGVHD.

65 Fourteen Years of Worldwide Teleconsultation Support for Burn Patient Care

Abstract Introduction The onset of hostilities in 2003 in Iraq generated large numbers of burned combat casualties and civilians, but most U.S. deployed providers are inexperienced in burn care. To help address this gap, the U.S. military established a Burn Teleconsultation (BTC) program in 2005. The BTC was one of 21 specialty TC programs. We reviewed this experience. Methods TC was a store-and-forward system based on e mail. BTC was one of the earliest TC programs established (Jan 2005). Users accessed BTC by sending an e mail (often with photos) to burntrauma.consult.army@mail.mil. This reached a group of Burn Center providers, as well as the overall TC program manager (PM). The PM ensured a timely response and documented resolution. BTC was publicized in numerous educational and other materials. Other TCs included Dermatology (Derm, Apr 2004), Ophthalmology (Jul 2004), and Infectious Diseases (ID, Jan 2005). Results TC program as a whole. The TC program was active for 176 months. 3766 providers requested TCs; 14763 TCs were completed; and at least 333 patient evacuations were prevented and 775 were facilitated. The median response time (RT) was 2 hours, 57 min. RT was &amp;lt; = 1 hour in 26.3% of cases, and &amp;lt; = 24 hours in 96.4%. Leading programs were Derm (5616 patients, 38.0%), Orthopedics (1428, 9.7%), and ID (1103, 7.5%). TC was transitioned to another platform in Jan 2019. BTC program. BTC provided 197 (1.3%) TCs. Peak years were among the peak war years: fiscal years 2006 (24 patients), 2008 (32), and 2009 (34). Location of the requesting provider included Iraq (95 consultations, 48.2%), Afghanistan (56, 28.4%), and the continental US (20, 10.2%). The affiliation of the patient was predominantly non-combatant (76 patients, 38.6%), U.S. Army (37, 18.7%), and U.S. Marine Corps (12, 6.1%). The median RT was faster than for the overall TC program at 1 hour, 25 min. RT was &amp;lt; = 1 hour in 45.4% of cases, and &amp;lt; =24 hours in 98.3%. Conclusions TC took advantage of the availability of e mail to most deployed providers; it did not depend on wide-band video-teleconferencing, which was not available. Like the leading TC program (Derm), BTC relied on digital photos to enhance communication. BTC achieved a faster RT than the TC as a whole, making it appropriate for rapid, if non-immediate, consultation. The fact that non-combatants constituted the largest group of BTC patients represents the role of civilians with burns on the battlefield. It argues for more training in burn care, to include care well past initial resuscitation, for those who deploy. Applicability of Research to Practice Asynchronous teleconsultation should be considered for non-emergent burn care support.

Baseline Assessment of the Importance of Contributions from Regional Seismic Networks to the Pacific Tsunami Warning Center’s Operations

Abstract The Pacific Tsunami Warning Center’s (PTWC’s) core mission consists in saving lives and minimizing property damage through the issuance of timely, effective tsunami warnings and threat messages. For this purpose, the center relies primarily not only on the analysis of near-real-time seismic data streams provided by established networks such as the Global Seismic Network (GSN), but also by an increasing number of stations contributed by regional seismic networks (RSNs) from around the world. We used theoretical computations of the detection time of the first arriving P wave as a proxy to highlight the areas where RSN contributions have the greatest operational impact. To this goal, the P-wave detection times computed for the GSN provided a baseline to isolate the contribution of the RSN in the form of spatially distributed detection time gains. Inspection of the resulting global maps reveals detection time gains of more than 3 m for Hawaii, Alaska, the east and west coasts of the United States, South America, New Zealand, the southwest Pacific, Australia, and the Sunda arc. Despite higher density of GSN baseline stations across the U.S. west coast and the eastern Caribbean, contributions from RSNs result in detection time gains of more than 2 m. These gains in earthquake detection speed correlate well with the continuous increase in the number of stations ingested into the PTWC system and the gradual reduction of the operational median response time to under 6 m from origin during the last 5 yr. These results allow us to conclude that fulfillment of the PTWC’s international and domestic tsunami warning responsibilities critically depends on the support of the RSNs contributing data to PTWC’s daily operations.

Organ responses with daratumumab therapy in previously treated AL amyloidosis

AbstractImmunoglobulin light chain amyloidosis (AL amyloidosis) involves deposition of abnormally folded light chains into a wide range of tissues causing organ dysfunction, including in the heart and kidney. Daratumumab, a CD38-targeted antibody, has recently demonstrated efficacy in producing hematologic responses in previously treated disease. However, data on survival outcomes and organ responses to daratumumab are lacking. Seventy-two patients with previously treated AL amyloidosis who received daratumumab monotherapy with dexamethasone were retrospectively evaluated. With a median follow-up of 27 months, 2-year overall survival (OS) was 86.9% (median OS, not reached) and 2-year time-to-next treatment or death (TTNT)–free survival was 62% (median TTNT, not reached). Forty of 52 evaluable patients achieved a hematologic response (77%), with >60% of patients achieving a very good partial response or better; median time-to-hematologic response was 1 month. Fifty-seven patients (79%) had cardiac involvement, and 55% of evaluable patients achieved a cardiac response, with a median response time of 3.2 months among responders. Cardiac responses were associated with an improvement in OS, with landmark analysis for cardiac responses at 3 months trending toward statistical significance (100% vs 55% at 30 months, P = .051). Forty-seven patients (65%) had renal involvement, and 52% of evaluable patients achieved a renal response, with a median response time of 6 months among responders; there was no significant difference in OS between renal responders and nonresponders. This study demonstrates that daratumumab is highly effective in the treatment of previously treated AL amyloidosis, and a significant proportion of patients can achieve deep hematologic responses, as well as improvements in organ function.

Global positioning system alerted volunteer first responders arrive before emergency medical services in more than four out of five emergency calls

AimTo evaluate response rates for volunteer first responders (VFRs) activated by use of a smartphone GPS-tracking system and to compare response times of VFRs with those of emergency medical services (EMS). Furthermore, to evaluate 30-day-survival after out-of-hospital cardiac arrest (OHCA) on a rural island. MethodsSince 2012 a GPS-tracking system has been used on a rural island to activate VFRs during all emergency calls requesting an EMS. When activated, three VFRs were recruited and given distinct roles, including collection of the nearest automatic external defibrillator (AED). We retrospectively investigated EMS response data from April 2012 to December 2017. These were matched with VFR response times from the GPS-tracking system. The 30-day survival in OHCA patients was also assessed. ResultsIn 2266 of 2662 emergency calls (85%) at least one VFR arrived to the site before EMS. Median response times for VFRs (n = 2662) was 4:46 min:sec (IQR 3:16–6:52) compared with 10:13 min:sec (6:14–13:41) for EMS (p < 0.0001). A total of 17 OHCAs took place in public locations and 65 in residential areas. Thirty-day survival in these were 24% and 15%, respectively. ConclusionUse of a smartphone GPS-tracking system to dispatch VFRs ensures that in more than four of five cases, a VFR arrives to the site before EMS. Response times for VFRs were also found to be lower than EMS response times. Finally, the 30-day survival of OHCA patients in a rural area, based on these results, surpass our expectations.

Journal response types and times: the outcomes of manuscripts finalised for submission by the University of the Free State School of Medicine medical editor, South Africa.

Introductionhealth professionals are involved in research as researchers themselves and as supervisors to undergraduate and postgraduate students. Authors may have unrealistic expectations regarding journal submission and review processes. The study aimed to describe journal response types and times for manuscripts finalised for submission by the University of the Free State School of Medicine medical editor.Methodsthis descriptive cohort study with an analytical component included all manuscripts finalised for submission to accredited journals by the medical editor, 2014-2017. Excel spreadsheets capturing all stages of the manuscript process were used to confidentially note information regarding submission and subsequent journal responses.Resultsninety-five manuscripts were submitted to 72 peer-reviewed accredited journals. The total number of submissions was 163. Only 46 (48.4%) manuscripts were accepted by the first journals submitted to. Rejected submissions (n=82) had a median journal response time of 15.5 days (range 0-381 days), with a third being sent for review. Nine manuscripts were accepted with no revisions needed. Accepted submissions (n=72) had a median of one round of revision (range 0-4 rounds), and a median time of 119.5 days (range 0-674 days) from submission to final acceptance.Conclusionwithin our setting, half of first submissions were unsuccessful, but rejection usually occurred rapidly. Acceptance for publication occurred at a median time of 4 months after one round of revision. If health professionals were made aware of expected outcomes and response times, it may prevent authors from falling victim to the publication practices of predatory journals.

Mitigating Bottlenecks in Wide Area Data Analytics via Machine Learning

Over the past decade, we have witnessed exponential growth in the density (petabyte-level) and breadth (across geo-distributed datacenters) of data distribution. It becomes increasingly challenging but imperative to minimize the response times of data analytic queries over multiple geo-distributed datacenters. However, existing scheduling-based solutions have largely been motivated by pre-established mantras (e.g., bandwidth scarcity). Without data-driven insights into performance bottlenecks <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">at runtime</i> , schedulers might blindly assign tasks to workers that are suffering from unidentified bottlenecks. In this paper, we present <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Lube</i> , a system framework that minimizes query response times by detecting and mitigating bottlenecks at runtime. Lube monitors geo-distributed data analytic queries in real-time, detects potential bottlenecks, and mitigates them with a bottleneck-aware scheduling policy. Our preliminary experiments on a real-world prototype across Amazon EC2 regions have shown that Lube can detect bottlenecks with over 90 percent accuracy, and reduce the median query response time by up to 33 percent compared to Spark's built-in locality-based scheduler.

Analysis of a Decentralised Digital Token Architecture for Public Transport

Digitisation is often viewed as beneficial to a user. Where originally people would physically have to identify to a service, pay for a ticket in cash, or go into a library to access a book, people can now achieve all of this through a click of a button. While these actions may seem functionally identical to their analogue counterparts, they come with one important difference. Namely, in the digital case, a user's actions are automatically recorded. The recording of user's interactions presents a problem because this information can be used outside the control of the person whom it concerns. This issue is only exacerbated by the centralisation of these aforementioned services' authentication mechanisms permitting the collection of even more data. This work aims to motivate the need and establish the feasibility for the application of a privacy-enhancing digital token management service to public transit. A proof-of-concept implementation of the Decentralised Digital Identity Architecture proposed by Goodell and Aste is developed. This implementation was optimised for the public transport use case. Finally, its performance is tested in a local environment to better understand the technical challenges and assess such a system's technical feasibility in a production setting. It was observed that for loads between 1 and 5 requests per second the proof-of-concept performs within acceptable limits with a maximum median response time of 334 milliseconds. Above 5 requests per second response times drastically increase due to hardware bottlenecks. It was concluded that the demonstrated throughput and latency shows that the system can feasibly compete with solutions currently in use. Yet, further work is needed to demonstrate these performance characteristics in an environment similar to that experienced in production.

Testing a Potential Marker of Attention for the Diagnosis of Functional Movement Disorders

Background: The diagnosis of Functional Movement Disorders (FMD) mostly relies on clinical expertise, with a paucity of confirmatory tests available. More objective markers are needed. We determine whether an in-clinic attention task can aid in diagnosis. Methods: A single-site study comparing subjects with FMD, essential tremor (ET), and healthy controls (HC). Subjects completed a modified Stroop Interference task and standardized questionnaires assessing mood symptoms. Level of disability was estimated by modified Rankin Score (mRS). The primary endpoint was the difference in error rate and response time on the Stroop between groups. Data was analyzed using Wilcoxon test or Fisher’s exact test. Results: 50 subjects were screened and 35 recruited (12 FMD, 11 ET, and 12 HC). No significant differences were seen in task performance between groups, although the FMD group made the most errors and had the longest median response time. Significant between-group differences were found in reported symptom severity and health concerns, despite a similar mRS between FMD and ET groups. Discussion: A modified Stroop task was not able to distinguish with significance between FMD, ET, and HC. Self-reported questionnaire responses showed significant differences with higher prevalence of depression and anxiety and greater perceived disability in patients with FMD despite similar mRS.

An observational study of missing data inquiry from randomized trial authors showed a poor response

Background and ObjectivesThe quality of evidence from a meta-analysis might be affected by poor or inadequate reporting of individual randomized controlled trials (RCTs). The results of data request from authors have not been investigated to date. Aim of this study was to quantify these results and propose a bundle of actions for improvement of data retrieval. Study Design and SettingAfter completion of a feasibility trial, the authors of 116 RCTs selected for inclusion in 4 meta-analyses and network meta-analyses were contacted via email to check abstracted data from their studies and/or provide missing data. Univariable and multivariable analyses were performed to investigate the association of response rate with predefined characteristics, including time interval between publication of the RCT and the date of contact, role of the contact author as corresponding author, the number of participating centers, the source of contact email address and risk of bias assessments. ResultsThe response rate to the primary email invitation was 31.1% (median response time 0 days, interquartile range [IQR]: 0-1). Of the authors who did not respond to the primary invitation, 31.2% responded to the reminder (median response time 1 day, IQR: 0-3). Despite an overall response rate of 41%, both confirmation of data accuracy and supplementation of missing data were provided for 9 RCTs only (7.8%). No association was found between lack of response and predefined characteristics on univariable and multivariable analyses. ConclusionDespite a fair response rate, contacting authors of RCTs to check abstracted data and complete missing items yielded a very low rate of task completion. These findings highlight the importance of endorsing a data-sharing culture among researchers. The role of alternative incentives is yet to be investigated.