Single Entry Point Research Articles

How We Did Bone Marrow Transplants amidst the COVID19 Pandemic

IntroductionCOVID19 is the most heard name for the last six months, and the situation seems to worsen now. This pandemic has created significant stress on the healthcare system. Most of the resources are being diverted to COVID care, and care of non-COVID patients is compromised. As haematologists dealing with frail immune-compromised patients, challenges we are facing are staff attrition, near-empty blood banks, less intensive care beds, the chance of our patients getting infected with COVID during the hospital stay, fear of donors being asymptomatic COVID carriers to mention a few. In this situation, we have tried to formulate a practical approach for doing bone marrow transplants, which we have been following for the last few months at our centre.Our Transplant ProtocolInitially we tried to postpone transplants. But as the COVID situation was becoming a chronic one, we formulated our ways to start transplants. Amidst lockdown, we successfully completed Autografts in myeloma and Lymphoma. We also started Allogeneic transplants including haplo-identical transplant for acute leukemia.In this hour of need, we had to strike a balance in transplant management. We tried to be practical in our decision-making skills at this hour of need. Being students of science, it was time to show practicality in ordering tests, therapy, and transfusions to the patient. Due to lockdown and general panic, the stocks in Blood Banks were at an all-time low. So transfusions and donor arrangements were be dealt judiciously.The hospital was divided into COVID and NON-COVID zones. All patients with fever and respiratory symptoms go directly to the COVID zone and get examined and tested by physicians with proper PPE as per WHO protocol.Even there are no symptoms of COVID like dry cough, fever, and throat pain, the patients entering NON-COVID also will be screened by a general physician at the single point of entry with proper protection and then patient with one attendee was allowed to come to transplant outpatient department. This helped us reduce risk to the medical professional and other patients waiting in a specialty department like ours.We had a detailed discussion about the pros and cons with patient and attendee. We admitted them in a separate block and got tested for COVID19 RTPCR. The patient had HRCT thorax to check for early radiological signs of COVID19. The blood parameters which serve as prognostic markers for COVID were checked alongside to double confirm false negativity of tests.The donor was made to stay as attendee for the patient. We shifted them inside transplant unit and observed for a week to rule out COVID symptoms. Radiological investigations were done before starting procedure. Minimal physical interaction was established and in Myeloma and Lymphoma autograft, we did around 20% dose reduction of conditioning regimen drugs. For allograft, no drug dose modification was done. The threshold for antibiotic stewardship was kept very low and high end antibiotics like Colistin / Fosfomycin were initiated early. We collected single donor platelets and kept stocks ready to avoid exposure to multiple random donors. The blood bank also was very careful in selecting donors after a thorough screening for symptoms of COVID19. Once engrafted, they were discharged early and kept on follow-up mostly by tele-consultation. The personal visits were kept to a minimum of once in four weeks. From first lockdown to date of submission, we completed nine bone marrow transplants at our centre which included three AML haplo-identical transplants.ConclusionPostponing transplant is not feasible in all situations, as few of our refractory diseases will ultimately relapse and transplant becomes the only live saving procedure. As we wait for the situation to better, the normal functioning of hospitals may take some more time.These above are the methods we are following in our MIOT hospital at Chennai, India the city which has got around 100,000 COVID19 cases during submission. Our advice is where ever feasible, we should try to stick to time tested conventional protocols. The above protocols may be useful temporarily till the COVID crisis is over.Reference 1.Willian J. Care of hematology patients in a COVID‐19 epidemic. British Journal of Hematology, 2020.2.Dholaria, Savani B.N. How do we plan hematopoietic cell transplant and cellular therapy with the looming COVID‐19 threat? British Journal of Haematology, 2020.https://doi.org/10.1111/bjh.16597DisclosuresNo relevant conflicts of interest to declare.

INFRASTRUCTURE MODEL FOR A SECURE VIRTUAL ENVIRONMENT FOR INFORMATION INTERACTION BETWEEN SCIENTIFIC AND EDUCATIONAL ORGANIZATION

The article describes the construction of a basic display model in the information space of the organizational and technical association of subjects of information interaction in the implementation of joint projects and solving common problems. Some aspects of the construction of a set-theoretic model of the infrastructure of a secure virtual environment (SVE) of information interaction of scientific and educational organizations are considered. The basis of the infrastructure level of the SVE is a network of corporate portals, for which the model describes the relationship between network entities and rules of information interaction. The key element of information interaction is the portal, which is considered as a set of interconnected resources (access objects) that have a hierarchical tree structure of subordination. Multiple portal users (access subjects) are united through domain groups in a network structure that implements mechanisms of trust between domain groups, as well as one-time authorization and a single entry point to the portal network by implementing a single user session. The basic model presented in the article is the basis of a generalized model of the protected virtual environment of information interaction in general.

An Archival Repository of Archival Repositories: integrating metadata in Archives Portal Europe

Since 2009, in parallel with the creation of national or local research portals, countries around Europe have started to design a system to integrate these online allowing to access Europe’s archival heritage through one single entry point. In 2012, after three years of research, Archives Portal Europe (APE) opened up to all institutions holding archival material about Europe. Today, the portal enables new types of digital archival research, freed from geographical limitations and based on cross-country comparison and multilingualism. At the same time, establishing a common basis for the central services of the portal to allow for the searching, processing, and displaying of the archival material of thousands of institutions comes with important technical (as well as political) challenges. This paper presents challenges and solutions adopted by Archives Portal Europe as a multi-level international aggregator.

Putting UK research within reach

Putting UK research within reach

Predicting the Ideal Ventricular Freehand Pass Trajectory Using Osirix Software and the Role of Occipital Shape Variations

Cannulation of lateral ventricles via a posterior approach is a common neurosurgical procedure. It is often believed that a single entry and fiducial point applies to all. No importance is given to skull shape variations, which can lead to wrong shunt positions and revisions. A virtual-reality study was conducted to find the ideal entry point, ideal forehead fiducial point, and ideal angulation of the ventricular catheter and variations in these with changes in skull shapes. Fifty human cadaveric skulls were used to measure anteroposterior (AP) diameter and width and to classify shape of skulls into 4 types. Hydrocephalus (100 cases) and normal magnetic resonance images (50 cases) were studied from a PACS (Picture Archiving and Communication System) database. An Osirix DICOM Viewer (3.9.4) was used to reconstruct the images and estimate the ideal, 90°, and midline shunt trajectory and correlate the same with AP/width ratios and skull shapes. Contrary to popular practice, the vertical distance from the inion for ideal trajectory placement was <6 cm and >4 cm in all shapes and ratio groups for hydrocephalus and nonhydrocephalus cases, respectively. As the AP/width ratio increases, the fiducial needs to be placed at a higher distance from the nasion and the distance of the entry point also increased from the inion. A rounder or more dolichocephalic skull dictates a 90° approach to be better, especially as the first pass. No magical external entry point uniformly applicable for all cases exists. Hence, there is a need to classify skulls according to shapes/ratios and to use a tailored approach for a freehand pass to cannulate the ventricles.

Lacrimal Gland Botulinum Toxin Injection Versus Simple Glandular Needling: Histopathological and Electron Microscopic Evidence and Potential Clinical Implications.

To investigate the histopathological and ultrastructural changes in the lacrimal glands (LGs) of rabbits following either botulinum toxin (BTX) injection or simple glandular needling. Twenty-four LGs of 24 eyes of 12 healthy New Zealand white rabbits were included in the study. Of these, 4 LGs of 4 eyes of 2 rabbits were used as controls. In the intervention group, all the right LG received 5 U in 0.1 ml of BTX-A (Botox, Allergan, Dublin, Ireland) and the left LG received simple glandular needling under general anesthesia. The BTX-A was injected directly into the LG via the transconjunctival route under direct visualization. For simple needling, 5 LG passes were made through a single-entry point using a 29-gauge needle mounted on an empty tuberculin syringe. The rabbits did not receive any postoperative medications other than lubricants. The rabbits were sacrificed at 8 weeks and the 20 treated and 4 control LG's were retrieved for histopathological and transmission electron microscopic (TEM) analysis as per standard protocols. In comparison to the control LG samples, both the treated groups showed pathological changes, which were more pronounced in the simple needling group. The BTX-A-treated LGs showed mild to moderate acinar atrophy, few degenerating acini and patchy chronic inflammatory infiltrates with thick hyalinized collagen within the glandular stroma. TEM analysis showed the cytosol of few acinar cells to contain vacuoles and autophagosomes with marginal chromatin condensation of the nucleus and an eccentric nucleolus. The LGs treated with simple needling showed marked pathological changes which include moderate to severe, focal, and diffuse acinar atrophy, dense stromal fibrosis, inflammatory infiltrates, and peri-vasculitis. TEM analysis showed focal disorganized acinar morphology, loss of intra-acinar and ductal architecture, and needle track zones with surrounding fibrotic areas. Histopathological and ultrastructural changes were noted in the LGs treated with BTX-A and simple glandular needling. Simple needling of the LG has the prospect to be an effective and cheaper alternative to BTX-A.

HEP Analyses on Dynamically Allocated Opportunistic Computing Resources

The current experiments in high energy physics (HEP) have a huge data rate. To convert the measured data, an enormous number of computing resources is needed and will further increase with upgraded and newer experiments. To fulfill the ever-growing demand the allocation of additional, potentially only temporary available non-HEP dedicated resources is important. These so-called opportunistic resources cannot only be used for analyses in general but are also well-suited to cover the typical unpredictable peak demands for computing resources. For both use cases, the temporary availability of the opportunistic resources requires a dynamic allocation, integration, and management, while their heterogeneity requires optimization to maintain high resource utilization by allocating best matching resources. To find the best matching resources which should be allocated is challenging due to the unpredictable submission behavior as well as an ever-changing mixture of workflows with different requirements.Instead of predicting the best matching resource, we base our decisions on the utilization of resources. For this reason, we are developing the resource manager TARDIS (Transparent Adaptive Resource Dynamic Integration System) which manages and dynamically requests or releases resources. The decision of how many resources TARDIS has to request is implemented in COBalD (COBald - The Opportunistic Balancing Daemon) to ensure further allocation of well-used resources while reducing the amount of insufficiently used ones. TARDIS allocates and manages resources from various resource providers such as HPC centers or commercial and public clouds while ensuring a dynamic allocation and efficient utilization of these heterogeneous opportunistic resources.Furthermore, TARDIS integrates the allocated opportunistic resources into one overlay batch system which provides a single point of entry for all users. In order to provide the dedicated HEP software environment, we use virtualization and container technologies.In this contribution, we give an overview of the dynamic integration of opportunistic resources via TARDIS/COBalD in our HEP institute as well as how user analyses benefit from these additional resources.

The impact of single windows on trade

AbstractThis paper is the first that quantifies the impact of single windows (SWs) on international trade globally. SWs function as a single point of entry and exit of the goods traded internationally and are therefore intended to facilitate trade. Using a structural gravity model for a panel of 176 countries from 1995 to 2017, we apply a log–log and a Poisson pseudo‐maximum‐likelihood estimator (PPML) with multidimensional fixed effects to evaluate the extent to which export and import flows vary depending on whether or not countries have operational SWs. The main results from the linearised gravity model suggest that total trade between two countries with functioning SWs increases by about 37%, of which 23 corresponds to exports and 14 to imports. The result from the PPML estimation also indicates a positive and significant effect, which is however much smaller in magnitude.

Integrated physical and mental healthcare: an overview of models and their evaluation findings.

Comorbid physical and mental health problems are common across the age spectrum. However, services addressing these health concerns are typically siloed and disconnected. Over the past 2 decades efforts have been made to design integrated services to address the physical and mental health needs of the population but little is known about the characteristics of effective integrated care models. The aim of the review was to map the design of integrated care initiatives/models and to describe how the models were evaluated and their evaluation findings. Using a scoping review methodology, quantitative and qualitative evidence was systematically considered. To identify studies, Medline, PubMed, PsychINFO, CINAHL were searched for the period from 2003 to 2018, and reference lists of included studies and review articles were examined. The current review identified 43 studies, describing 37 models of integrated physical and mental healthcare. Although modest in terms of evaluation design, it is evident that models are well received by consumers and providers, increase service access, and improve physical and mental health outcomes. Key characteristics of models include shared information technology, financial integration, a single-entry point, colocated care, multidisciplinary teams, multidisciplinary meetings, care coordination, joint treatment plan, joint treatment, joint assessment/joint assessment document, agreed referral criteria and person-centred care. Although mostly modest in term of research design, models were well received by consumers and providers, increased service access and improved physical and mental health outcomes. There was no clear evidence regarding whether models of integrated care are cost neutral, increase or reduce costs. Future research is needed to identify the elements of integrated care that are associated with outcomes, measure cost implications and identify the experiences and priorities of consumers and clinicians.

ELECTRONIC RESOURCES AS ONE OF THE ELEMENTS OF FORMATION AND PROGRESS OF THE COMPANY'S CORPORATE CULTURE

Introduction. In the conditions of transformation of market relations, the theories defining laws of formation of an effective, motivated command that allows each of us to be successful also change. Given that companies are increasingly shifting the focus towards intensive development, which involves increasing efficiency without changing the staff, which is why managers are increasingly asking themselves to create a fruitful atmosphere in the company, which will be perceived and shared by all employees. Without proper attention to the aspect of corporate culture from the beginning there will be no guidelines that determine the development of the company, and hence the guidelines necessary for the proper selection of employees. The purpose of the article is to analyze the role of electronic resources in the establishment and development of information space and, accordingly, the corporate culture of the company. Results. The article describes the general characteristics of the concept of "corporate culture". The role of the corporate portal in the formation of the internal information space and its functional activity is considered. It is established that the internal corporate portal is necessary, contrary to the existing opinion, not only for large companies. Even in small companies, such a resource can significantly increase the efficiency of employees due to the fact that it performs a number of important functions: 1. Information. A single-entry point and convenient navigation of information will allow employees to quickly find the data they need. 2. Communicative. The corporate portal allows employees to discuss work issues via a forum or chat. 3. Learning function. Thanks to a special section on corporate culture and the history of the company, it will be much easier for new employees to get used to the work. On the portal you can organize online training, which will save time and train the company's employees without leaving the workplace. 4. Planning function. The corporate portal also allows you to assign tasks and monitor the progress of their implementation. Conclusions. At this stage of development, the company's use of the corporate portal is not an innovation, but is one of the mandatory elements to ensure its competitiveness. After all, in addition to the obvious information function of the portal, it provides the formation of new competencies or their development in employees of the enterprise, which is crucial in the development of the company. In addition, the corporate portal is a mandatory element in the formation of employee loyalty to the company and its corporate culture in general. Keywords: corporate culture, corporate portal, motivation, loyalty.

A Steerable Neuroendoscopic Instrument Using Compliant Contact-Aided Joints and Monolithic Articulation

AbstractThis work presents the design of an articulate neuroendoscopic instrument (ANI), a handheld tool for use in minimally invasive neurosurgery. The instrument consists of a handle and a steerable tube-shaft with a distal end-effector. The design aims to increase the reach of surgeons operating through narrow channels within the center of the brain when approaching multiple targets from a single incision point. The steerable tube-shaft consists of a 1.6- mm notch-tube compliant joint mechanism augmented with contact-aids modeled after a gear geometry. The contact-aid geometry aims to address the performance tradeoff between stiffness, range-of-motion (RoM), and joint compactness for millimeter-scale notched-tube joints; it increases blocking force without sacrificing RoM. Finite element modeling (FEM) was used to refine design features, and the joint stiffness and RoM are assessed experimentally for three prototypes. The joint is incorporated into a tube-shaft instrument, and the assembled tool's stiffness properties are characterized. The prototype was then assessed in a validated neurosurgical simulator. An individual 1.24-mm outer-diameter notch-tube compliant joint with gear contact-aids is capable of 30 deg maximum bending and can sustain a 0.55 N blocking force with 0.5 mm displacement. A functional instrument shaft with a 15.5- mm-long articulating section was constructed from three joints in series with an external flexible stainless-steel sheath. It achieves a 6.7-mm bending radius at 75 deg maximum bending angle. In preclinical testing with an endoscopic third ventriculostomy and endoscopic tumor biopsy (ETV-ETB) simulator, the tool successfully completes the biopsy and fenestration maneuvers from a single burr-hole entry point. The ANI prototype uses contact-aid geometry incorporated into a compliant nitinol notched-tube joint to produce an articulate biopsy instrument for minimally invasive neurosurgical applications.

DSNetwork: An Integrative Approach to Visualize Predictions of Variants' Deleteriousness.

One of the most challenging tasks of the post-genome-wide association studies (GWAS) research era is the identification of functional variants among those associated with a trait for an observed GWAS signal. Several methods have been developed to evaluate the potential functional implications of genetic variants. Each of these tools has its own scoring system, which forces users to become acquainted with each approach to interpret their results. From an awareness of the amount of work needed to analyze and integrate results for a single locus, we proposed a flexible and versatile approach designed to help the prioritization of variants by aggregating the predictions of their potential functional implications. This approach has been made available through a graphical user interface called DSNetwork, which acts as a single point of entry to almost 60 reference predictors for both coding and non-coding variants and displays predictions in an easy-to-interpret visualization. We confirmed the usefulness of our methodology by successfully identifying functional variants in four breast cancer and nine schizophrenia susceptibility loci.

IADVL Position Statement and Recommendations on Post Lockdown Dermatology Practice Amidst the Covid -19 Pandemic (IADVL Academy and IADVL Executive Committee).

IADVL Position Statement and Recommendations on Post Lockdown Dermatology Practice Amidst the Covid -19 Pandemic (IADVL Academy and IADVL Executive Committee).

ACTRIS and its Aerosol Remote Sensing Component

The Aerosol, Clouds and Trace Gases Research Infrastructure ACTRIS is currently being developed with support from more than 20 countries and more than 100 research-performing organizations in Europe. The pan-European distributed research infrastructure shall provide data and services related to short-lived atmospheric constituents to facilitate high-quality Earth system research in the long term (over at least 20 years). While some of the activities are already in place, ACTRIS functionality will be further ramped up until full operation in 2025. The observation of aerosol, clouds and reactive trace gases with in-situ and remote-sensing techniques in ACTRIS is supported by six Topical Centres, which are responsible for common standards and quality assurance. Free and open virtual access to ACTRIS data is provided by the Data Centre. International users will also have physical access to ACTRIS observatories, atmospheric simulation chambers and mobile platforms as well as remote or physical access to calibration services, digital services and training. Access provision is organized through a single-entry point by the Head Office. In this contribution, the general principles and structure of ACTRIS are introduced, and the observational component related to aerosol remote sensing, which builds on the heritage of the European Aerosol Research Lidar Network (EARLINET) and the European part of the Aerosol Robotic Network (AERONET-Europe), is explained in more detail.

Analytical determination of atypical quantized resistances in graphene p-n junctions

A mathematical approach is introduced for predicting quantized resistances in graphene p-n junction devices that utilize more than a single entry and exit point for electron flow. Depending on the configuration of an arbitrary number of terminals, electrical measurements yield nonconventional, fractional multiples of the typical quantized Hall resistance at the ν=2 plateau (RH≈ 12906 Ω) and take the form: abRH. This theoretical formulation is independent of material, and applications to other material systems that exhibit quantum Hall behaviors are to be expected. Furthermore, this formulation is supported with experimental data from graphene devices with multiple source and drain terminals.

The ICTBioMed NCIP Hub: Cancer research in a science gateway consortium

ICTBioMed, the International Consortium for Technology in Biomedicine is a consortium for biomedical collaborative research and the consortium partners believe in decentralization and democratization of science. The consortium works on strategies to develop ready-to-use research initiatives bridging the gap between research, implementation and ready-to-use science. The consortium has identified real science use cases with the help of the collaborative partners to get access of shared data and methods using the principles of science gateways. ICTBioMed has set up an NCIP Hub instance based upon the HUBzero framework and started using it for community research activities. It is an environment for scientific collaboration where researchers can access and take advantage of a variety of resources shared by others. The NCIP Hub supports members with shared access to data, tools, and standards across the cancer research community. Cancer researchers, in principle, have access to a wide range of data and software tools but in practice, however, they make limited use of these resources. Barriers that restrict access include the need to install software locally, inconsistent user interfaces, security concerns and poor documentation. ICTBioMed is developing a cancer science gateway that will greatly simplify analysis in cancer imaging research by offering a single point of entry and a unified interface for multiple tools, databases, and image repositories widely used by the community. The consortium aims at borderless research with a common goal to solve real life biomedical problems by facilitating collaborative research.

Provenance of Bengal Shelf Sediments: 1. Mineralogy and Geochemistry of Silt

This article illustrates a multi-technique frontier approach for the provenance study of silt-size sediments. The mineralogical composition of low-density and heavy-mineral fractions of four samples of fine to very coarse silt deposited on the Bengal shelf was analyzed separately for six different grain-size classes by combining grain counting under an optical microscope, Raman spectroscopy, and X-ray diffraction. The geochemical composition was determined on both bulk-sediment samples and on their &lt;5-μm classes. Such a “multiple-window” approach allowed capturing the full mineralogical information contained in each sample, as well as the size-dependent intra-sample variability of all compositional parameters. The comparison between grain-size distributions obtained by different methods highlighted a notable fallacy of laser granulometry, which markedly overestimated the size of the finest mode represented by fine silt and clay. As a test case, we chose to investigate sediments of the Bengal shelf, where detritus is fed from the Meghna estuary, formed by the joint Ganga and Brahmaputra Rivers and representing the largest single entry point of sediment in the world’s oceans. The studied samples show the typical fingerprint of orogenic detritus produced by focused erosion of collision orogens. Bengal shelf silt is characterized by a feldspatho-quartzose (F-Q) composition with a Q/F ratio decreasing from 3.0 to 1.7 with increasing grain size, plagioclase prevailing over K-feldspar, and rich transparent-heavy-mineral assemblages including mainly amphibole with epidote, and minor garnet and pyroxene. Such a detrital signature compares very closely with Brahmaputra suspended load, but mineralogical and geochemical parameters, including the anomalous decrease of the Q/F ratio with increasing grain size, consistently indicate more significant Ganga contribution for cohesive fine silt. The accurate quantitative characterization of different size fractions of Bengal shelf sediments represents an essential step to allow comparison of compositional signatures characterizing different segments of this huge source-to-sink system, from fluvial and deltaic sediments of the Himalayan foreland basin and Bengal shelf to the Bengal Fan.

Method and Apparatus for the Automated Delivery of Continuous Neural Stem Cell Trails Into the Spinal Cord of Small and Large Animals.

Immature neurons can extend processes after transplantation in adult animals. Neuronal relays can form between injected neural stem cells (NSCs) and surviving neurons, possibly improving recovery after spinal cord injury (SCI). Cell delivery methods of single or multiple bolus injections of concentrated cell suspensions thus far tested in preclinical and clinical experiments are suboptimal for new tract formation. Nonuniform injectate dispersal is often seen due to gravitational cell settling and clumping. Multiple injections have additive risks of hemorrhage, parenchymal damage, and cellular reflux and require additional surgical exposure. The deposition of multiply delivered cells boluses may be uneven and discontinuous. To develop an injection apparatus and methodology to deliver continuous cellular trails bridging spinal cord lesions. We improved the uniformity of cellular trails by formulating NSCs in hyaluronic acid. The TrailmakerTM stereotaxic injection device was automatized to extend a shape memory needle from a single-entry point in the spinal cord longitudinal axis to "pioneer" a new trail space and then retract while depositing an hyaluronic acid-NSC suspension. We conducted testing in a collagen spinal models, and animal testing using human NSCs (hNSCs) in rats and minipigs. Continuous surviving trails of hNSCs within rat and minipig naive spinal cords were 12 and 40 mm in length. hNSC trails were delivered across semi-acute contusion injuries in rats. Transplanted hNSCs survived and were able to differentiate into neural lineage cells and astrocytes. The TrailmakerTM creates longitudinal cellular trails spanning multiple levels from a single-entry point. This may enhance the ability of therapeutics to promote functional relays after SCI.

CN90 - Unplanned emergency department use by people receiving ambulatory anti-cancer agents with potential febrile neutropenia

BackgroundRecent advances in cancer therapies have resulted in a greater number of people receiving chemotherapy in ambulatory care settings worldwide. In Spain emergency departments, is the single point of entry to acute inpatient services, and therefore play a pivotal role in the immediate management of chemotherapy complications. This study set out to explore ED use by ambulatory patients receiving anti-cancer agents in febrile neutropenia episodes. Data will contribute to service innovation for optimal patient care and health service efficiency. MethodsA 12 month retrospective observational study of unplanned ED presentation by patients within 30 days of receiving anti-cancer therapy for a range of cancer diagnoses. ResultsThe preliminary main results are the following. There were 382 ED presentations of chemotherapy related FN in cancer patients and a sample of 170 were selected in regards to a 30-day frame between the FN episode and the chemotherapy administration. The most common diagnoses were breast (33/170; 19.4%); bowel (32/170; 18.8%) and genitourinary cancers (30/170; 17.6%). A total of 145 (145/170; 85.2%) were given a triage level III and the rest (25/170; 14.7%) a triage level II. ConclusionsThere is still some important data to exploit such as median time from triage to medical attention and median time from triage to antibiotic, which will allow the researchers to establish the percentage of compliance with evidence based guidelines. As reported in international literature the compliance is challenging in a busy and unpredictable ED setting. Therefore it will be interesting to measure our compliance rates and explore opportunities to further improve adherence to evidence-based guidelines and aim for better clinical outcomes in case our results correlate with current literature. Legal entity responsible for the studyEthic Committee Hospital Clinic Barcelona. FundingHas not received any funding. DisclosureThe author has declared no conflicts of interest.

Advanced Package Design: Inter-Domain Design Methodologies

Abstract Just as we transitioned from simplistic lead frames to large ball grid arrays decades ago, we find ourselves again at another inflection point in design. Originally a derivative of PCB design, IC package design finds itself straddling both PCB-style design and traditional IC design. Dimensions have shrunk to place IC package design squarely in the same design dimensions as integrated circuits. Likewise, with Moore's law rapidly losing steam to support SoC's as a system integration vehicle, advanced package technologies have been asked to fill the system enablement gap. We now see advanced packaging technologies with silicon content as the system enabler in 2.5D, 3D and fanout wafer-level packaging. Because of the silicon and small geometries, IC design flows and signoff mechanisms are being used to design the next-generation of packaged systems. Package design now finds itself in the forefront of system-level design enablement. Where once system aggregation was done in a SoC at the silicon level, packaging is being used to build a system from technology-optimized die from each functional area (memory, processing, and interfaces). Silicon is no longer just a substrate material for IC manufacturing but a “package” substrate and functional integration vehicle. As such, package design teams find themselves adding IC-based design flows and methodologies. Package designers must look to the IC tools for routing, DRC, and signoff capabilities. Designers are looking for next-generation EDA tools to support these new integration and design challenges, including LVS-like validation checks and IC-based design rules. Rather than transitioning the design team from traditional packaging tools to IC tools entirely, we propose that users can leverage complete design flows that merge the best-in-class capabilities from each of their respective design domains. Is this regard, the best-in-class capabilities can remain in their respective domains, and a design flow can be created that relies on tight integration between both domains. These flows can also leverage a single point of entry for design capture and system level management. Flows based on the system management tool and the appropriate features in each of the domains can be created that enable and optimize complex designs that meet physical, signal integrity, cost and performance requirements. We will describe how capabilities can be leveraged from both domains in a tightly coupled flow, overseen by a design system-management tool, to address the challenges of advanced-technology and silicon-based system.