Triage Management Research Articles

Near-infrared responsive gold nanorods for highly sensitive colorimetric and photothermal lateral flow immuno-detection of SARS-CoV-2.

The highly infectious characteristics of coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), highlight the necessity of sensitive and rapid nucleocapsid (N) protein-based antigen testing for early triage and epidemic management. In this study, a colorimetric and photothermal dual-mode lateral flow immunoassay (LFIA) platform for the rapid and sensitive detection of the SARS-CoV-2 N protein was developed based on gold nanorods (GNRs), which possessed tunable local surface plasma resonance (LSPR) absorption peaks from UV-visible to near-infrared (NIR). The LSPR peak was adjusted to match the NIR emission laser 808 nm by controlling the length-to-diameter ratio, which could maximize the photothermal conversion efficiency and achieve photothermal detection signal amplification. Qualitative detection of SARS-CoV-2 N protein was achieved by observing the strip color, and the limit of detection was 2 ng mL-1, while that for photothermal detection was 0.096 ng mL-1. Artificial saliva samples spiked with the N protein were analyzed with the recoveries ranging from 84.38% to 107.72%. The intra-assay and inter-assay coefficients of variation were 6.76% and 10.39%, respectively. We further evaluated the reliability of this platform by detecting 40 clinical samples collected from nasal swabs, and the results matched well with that of nucleic acid detection (87.5%). This method shows great promise in early disease diagnosis and screening.

Sublobar Resection, Stereotactic Body Radiation Therapy, and Percutaneous Ablation Provide Comparable Outcomes for Lung Metastasis-Directed Therapy

BackgroundProlonged survival of patients with metastatic disease has furthered interest in metastasis-directed therapy (MDT). Research QuestionThere is a paucity of data comparing lung MDT modalities. Do outcomes among sub-lobar resection (SLR), stereotactic body radiation therapy (SBRT), and percutaneous ablation (PA) for lung metastases vary in terms of local control and survival? Study Design and MethodsMedical records of patients undergoing lung MDT at a single cancer center between January 2015 and December 2020 were reviewed. Overall survival (OS), local progression (LP), and toxicity outcomes were collected. Patient and lesion characteristics were used to generate multivariable models with propensity weighted analysis. ResultsLung MDT courses (644 total: 243 SLR, 274 SBRT, 127 PA) delivered to 511 patients were included with a median follow-up of 22 months. There were 47 LP events in 45 patients, and 159 patients had died. Two-year OS and LP were 80.3%, 63.3%, 83.8% and 9.6%, 4.1%, 11.7% for SLR, SBRT, and PA, respectively. Lesion size per 1 cm was associated with worse OS (hazard ratio [HR] 1.24, p=0.003) and LP (HR 1.50, p<0.001). There was no difference in OS by modality. Relative to SLR, there was no difference in risk of LP with PA, although SBRT was associated with a decreased risk (HR 0.26, p=0.023). Rates of severe toxicity were low (2.1-2.6%) and not different among groups. InterpretationThe current study performs a propensity weighted analysis of SLR, SBRT, and PA and shows no impact of lung MDT modality on OS. Given excellent local control across MDT options, a multidisciplinary approach is beneficial for patient triage and longitudinal management.

CreCENT: Creatinine and Chloride based Electrochemical Non-faradaic renal health mapping Technology

In this work, we propose a novel biosensing scheme to enable the stratification of kidney diseases based on severity and progression for timely triage and efficient management. Here, using Creatinine and Chloride as target analytes for the biosensor, we have discussed an arbitrary three-class stratification mapping renal health for Chronic Kidney Disease (CKD) management. Our method is fully quantitative, fast (<5 min turn-around time), and can work with any combination of disease biomarkers to categorize diseases by subtypes and severity. At its core, the biosensor relies on electrochemical impedance spectroscopy to transduce subtle changes at the input Creatinine and Chloride levels in a drop of neat, unprocessed urine. It can operate over a wide dynamic range of 0.15-5 mg/mL for Creatinine and 15-105 mM for Chloride. Further, as proof of concept, the biosensing scheme utilizes a simple Support Vector Machine-based supervised machine learning model for 3-state output disease state classification (corresponding to low, medium, and high disease severity) with a 97.96% accuracy. This scheme is versatile and can be extended to more complex scenarios with more biomarker input stimuli for improved diagnostics and precision therapy for other chronic urological diseases.

Perceptions and concerns of emergency medicine practitioners about artificial intelligence in emergency triage management during the pandemic: a national survey-based study.

There have been continuous discussions over the ethics of using AI in healthcare. We sought to identify the ethical issues and viewpoints of Turkish emergency care doctors about the use of AI during epidemic triage. Ten emergency specialists were initially enlisted for this project, and their responses to open-ended questions about the ethical issues surrounding AI in the emergency room provided valuable information. A 15-question survey was created based on their input and was refined through a pilot test with 15 emergency specialty doctors. Following that, the updated survey was sent to emergency specialists via email, social media, and private email distribution. 167 emergency medicine specialists participated in the study, with an average age of 38.22 years and 6.79 years of professional experience. The majority agreed that AI could benefit patients (54.50%) and healthcare professionals (70.06%) in emergency department triage during pandemics. Regarding responsibility, 63.47% believed in shared responsibility between emergency medicine specialists and AI manufacturers/programmers for complications. Additionally, 79.04% of participants agreed that the responsibility for complications in AI applications varies depending on the nature of the complication. Concerns about privacy were expressed by 20.36% regarding deep learning-based applications, while 61.68% believed that anonymity protected privacy. Additionally, 70.66% of participants believed that AI systems would be as sensitive as humans in terms of non-discrimination. The potential advantages of deploying AI programs in emergency department triage during pandemics for patients and healthcare providers were acknowledged by emergency medicine doctors in Turkey. Nevertheless, they expressed notable ethical concerns related to the responsibility and accountability aspects of utilizing AI systems in this context.

Chromosome classification via deep learning and its application to patients with structural abnormalities of chromosomes

Background and objectiveKaryotyping is an important technique in cytogenetic practice for the early diagnosis of genetic diseases. Clinical karyotyping is tedious, time-consuming, and error-prone. The objective of our study was to develop a single-stage deep convolutional neural networks (DCNN)-based model to automatically classify normal and abnormal chromosomes in an end-to-end manner. MethodsWe analyzed 2,424 normal chromosomes and 544 abnormal chromosomes. A preliminary support vector machine (SVM) model was developed to evaluate the basic recognition performance on the dataset. A DCNN-based model was then proposed to process the same dataset. ResultsBy utilizing the SVM model, the classification accuracy of 24 normal chromosomes was 86.01 %. The 32 types of normal and abnormal chromosomes got an accuracy of 85.37 %. The accuracy of the DCNN-based model performing the 24 normal chromosomal classification was 91.75 %. The accuracy of the 32 type classification was 87.76 %. To differentiate eight common structural abnormalities, we obtained accuracies that ranged from 90.84 % to 100 %, and the values of the AUC ranged from 91.81 % to 100 %. ConclusionsOur proposed DCNN-based model effectively performed the karyotype classification in an end-to-end manner. It had the competence to be used as a prediction tool for abnormal karyotype detection and screening in genetic diagnosis without initial feature extraction. We believe our work is meaningful for genetic triage management to lower the cost in clinical practice.

The telephone nursing dialogue process: an integrative review

BackgroundTelephone nursing involves triage, advice, and care management provided by a nurse over the telephone. The telephone nursing dialogue process has been used clinically in telephone nursing in Sweden for several years to structure the communication and ensure a safe assessment and advice. Studies are needed to determine whether there is sufficient scientific evidence to support the method.AimTo describe the scientific basis of the phases of the telephone nursing dialogue process.DesignThis was an integrative review.MethodsThe literature searches were performed in August 2023, in the PubMed, CINAHL, Cochrane Database of Systematic Reviews and SwePUB databases. Sixty-two articles were included. Data was sorted deductively according to the five phases of the telephone nursing dialogue process and categorized inductively to form subcategories describing the content of each phase.ResultAll five phases in the telephone nursing dialogue process were supported by a range of articles (n = 32–50): Opening (n = 32), Listening (n = 45), Analysing (n = 50), Motivating (n = 48), and Ending (n = 35). During the opening of the call, the nurse presents herself, welcomes the caller and establishes a caring relationship. In the listening phase, the nurse invites the caller to tell their story, listens actively and confirms understanding. During the analyzing phase, the nurse gathers, assesses, and verifies information. In the motivating phase, the nurse reaches a final assessment, informs the caller, gives advice and creates a mutual agreement and understanding while supporting the caller. Ultimately, the nurse ends the call after checking for mutual agreement and understanding, giving safety-net advice, deciding on whether to keep monitoring the caller and rounding off the call.ConclusionThe phases of the telephone nursing dialogue process as described in the scientific literature are well aligned with the theoretical descriptions of the telephone nursing dialogue process.

Our experience of cut throat injury at a tertiary care center during COVID-19 pandemic

Background: Cut throat injury is a least commonly attempted method of suicide or homicide. Neck injury may be suicidal, homicidal or accidental depending upon the etiology. Hesitation mark around the wound is favor of suicidal attempt and without hesitation mark is a rare possibility of suicidal attempt. Methods: This is a retrospective study carried out over period of one year, between April 2020 to March 2021, in a tertiary care center of north central India, during Covid-19 pandemic before the second wave. Results: Total 37 cases were attended; incidence was more common in male than female (34:3). Most commonly involved age group was 21 to 30 years, most of the patients belonged to rural background and manual workers. Homicide was the most common cause of injury and mostly under the influence of alcohol. Conclusions: Young males belonging to lower socioeconomic status and rural background were most common victims of cut throat injury in our study, homicide being the most common causative factor. Life of the patients can be saved with less morbidity and mortality by the means of good triage management and early intervention.

Metabolomics and transcriptomics based multi-omics integration reveals radiation-induced altered pathway networking and underlying mechanism

Recent advancement in integrated multi-omics has significantly contributed to many areas of the biomedical field. Radiation research has also grasped uprising omics technologies in biomarker identification to aid in triage management. Herein, we have used a combinatorial multi-omics approach based on transcriptomics together with metabolomics and lipidomics of blood from murine exposed to 1 Gy (LD) and 7.5 Gy (HD) of total-body irradiation (TBI) for a comprehensive understanding of biological processes through integrated pathways and networking. Both omics displayed demarcation of HD group from controls using multivariate analysis. Dysregulated amino acids, various PC, PE and carnitine were observed along with many dysregulated genes (Nos2, Hmgcs2, Oxct2a, etc.). Joint-Pathway Analysis and STITCH interaction showed radiation exposure resulted in changes in amino acid, carbohydrate, lipid, nucleotide, and fatty acid metabolism. Elicited immune response was also observed by Gene Ontology. BioPAN has predicted Elovl5, Elovl6 and Fads2 for fatty acid pathways, only in HD group. Collectively, the combined omics approach facilitated a better understanding of processes uncovering metabolic pathways. Presumably, this is the first in radiation metabolomics that utilized an integrated omics approach following TBI in mice. Our work showed that omics integration could be a valuable tool for better comprehending the mechanism as well as molecular interactions.

The effect of computer-based decision support system on emergency department triage: Non-randomised controlled trial

BackgroundDeciding on triage in emergency departments is difficult and requires comprehensive knowledge and experience. PurposeThis study was conducted to evaluate the effect of a “computer-based emergency department triage decision support system (DSS),“ which was designed and integrated into the hospital information management system, on triage decision accuracy and triage duration by using real patient data. MethodsSingle-group, pretest–posttest non-randomised clinical trial. The study was conducted with the real data of patients who had been triaged in the adult emergency department of a university hospital. The pretest was applied between July 16 and September 16, 2019, and the post-test on September 1 and October 31, 2020. In the pre-test and post-test phases of the study, triage decision accuracy rates, and triage duration were evaluated. In the post-test phase, Emergency Triage Decision Support System (ETDSS) was prepared with a rule-based decision trees method using the Emergency Severity Index Version 4 and The Australasian Triage Scale and was integrated into the hospital information management system. The effect of the developed ETDSS was evaluated. The mean, standard deviation, frequency and percentage values were calculated for the descriptive characteristics. Independent samples t-test, analysis of variance, Sidak paired comparison, and Bonferroni tests were applied. ResultsThe effect of the computer-based emergency triage DSS on triage management was tested based on the data of 16,409 patients in the pretest phase and 7,765 patients in the posttest phase. While the accuracy rate of nurses' triage decisions was 57.8% in the pretest, it was found to increase to 64.9% in the posttest. The mean duration of triage was 1.47 ± 0.72 in the pretest and 1.79 ± 0.85 min in the posttest. ConclusionsThe DSS increased triage decision accuracy independently of professional and triage experience and brought the triage duration closer to the time recommended in the literature. Clinically, this is associated with patient safety, quality improvement processes, and professional accountability.

Abstract P354: Leveraging Electronic Health Records For Quality Improvement Among Patients With Markedly Elevated Blood Pressure

Introduction: Electronic health records (EHR) can improve quality of care for patients with markedly elevated blood pressure (BP). This study aimed to develop EHR-based computable algorithms to identify barriers to BP control and enhance triage and patient management. Methods: We conducted a retrospective analysis using EHR data from Yale New Haven Health System (YNHHS) employees and their dependents. Patients with markedly elevated BP had ≥2 outpatient BP readings ≥160/100 mmHg within a 180-day period. We assessed 3-month follow-up visits after BP elevation, along with the proportions of patients prescribed antihypertensives, filled prescriptions, and self-reported adherence using EHR data sources. Results: The study included 46,361 adult patients, with a mean age of 45.7 (14.5) years; 65% were female, 59% were White, and 17% were Black. Among them, 1,437 (3.3%) had markedly elevated BP, and 880 (1.9%) had consecutive markedly elevated BP readings. Among patients with markedly elevated BP, 626 (43.6%) had follow-up visits with relevant specialties within 3 months after the BP elevation. Moreover, 970 (67.5%) patients had antihypertensive prescriptions, of whom 927 (95.6%) filled their prescriptions, and among those who filled prescriptions, 806 (87.2%) reported taking the medications. Black patients were more likely to receive antihypertensive prescriptions but less likely to fill them or report taking medications (Figure). Conclusion: This study demonstrates the potential of EHR data and computable algorithms to enhance patient triage, interventions, and resource allocation for effective BP reduction among YNHHS employees.

Plasma Glial Fibrillary Acidic Protein and N-Terminal Pro B-Type Natriuretic Peptide: Potential Biomarkers to Differentiate Ischemic and Hemorrhagic Stroke.

Acute stroke management is critically time-sensitive and challenging. Blood-based biomarkers that can differentiate acute ischemic stroke (IS) from hemorrhagic stroke (HS) can greatly facilitate triage and early management. Admission blood samples obtained within 6 h of stroke symptom onset were analyzed in a derivation/validation design. GFAP, N-FL, NT-proBNP, copeptin, neutrophils (%), NLR, and platelet counts were assessed in the derivation cohort. The informative markers and the derived cutoff values were evaluated in the validation cohort. GFAP > 703 pg/mL showed a PPV of 76.9% and NPV of 95.8% for differentiating HS from IS. Multiple logistic regression analysis showed that GFAP and NT-proBNP were independent variables associated with IS and HS differentiation. Furthermore, applying a combined cutoff (GFAP > 703 pg/mL and NT-proBNP ≤ 125 pg/mL) for HS detection increased the PPV in both the derivation and validation cohorts (93.3% and 100%, respectively). GFAP and NT-proBNP levels were validated as informative blood biomarkers in the differentiation of IS and HS and using a combination of GFAP and NT-proBNP is suggested as a feasible strategy to differentiate stroke subtypes in the hyperacute phase of stroke.

P07 Quality improvement project of acute referrals to the on-call dermatology service

Abstract With dermatology services now integrating neural networks and artificial intelligence into departments, the importance of technology to streamline services has been timely in light of the increased influx of referrals needing remote reviews from both community and secondary care. We performed a department quality improvement project to compare referrals made to the on-call dermatology service, Dudley Group NHS trust, during September 2019 and September 2020 against the ‘COVID-19: Clinical guidelines for the management of dermatology patients remotely’. Data were collected from telephone, paper and email referrals made in September 2019 and 2020. Referral data including patient demographics, nature and urgency of referrals, diagnosis, availability of medical photography and follow-up arrangements was collated on a Microsoft Excel Proforma. Of 74 total referrals (35 in 2019; 39 in 2020), hospital referrals in September 2020 (92%, n = 36) largely outweighed GP referrals (8%, n = 3). Urgent referrals made by hospital departments rose from 17% (n = 5 of 29) in September 2019 to 53% (n = 19 of 36) in September 2020. Medical photography, often essential for triage and diagnosis, was available only at the time of referral in 8.6% (n = 3) of cases in 2019 and 48.7% (n = 19) in 2020. The rise may be explained by an increased dependence on remote services. With current pressures placing greater demand on resources, there is a need for online referral systems. Moving away from emails, letters and phone calls ensures a less user-dependent interface. Medical photography can be implemented as an integral feature of referral. Online systems facilitate triage and remote management in keeping with dermatological guidelines.

Poor outcomes in patients with sepsis undergoing emergency laparotomy and laparoscopy are attenuated by faster time to care measures.

Emergency laparotomy and laparoscopy (EmLap) are amongst the commonest surgical procedures, with high prevalence of sepsis and hence poorer outcomes. However, whether time taken to receive care influences outcomes in patients requiring antibiotics for suspected infection remains largely unexplored. The aim of this work was to determine whether (1) time to care contributes to outcome differences between patients with and without suspected infection and (2) its impact on outcomes only amongst those with suspected infection. Clinical information was retrospectively obtained from the 2017-2018 Emergency Laparotomy and Laparoscopic Scottish Audit (ELLSA). Time to care referred to six temporal variables describing radiological investigation, anaesthetic triage and surgical management. Outcome measures [mortality, readmission, hospital death, postoperative destination and length of stay (LoS)] were compared using adjusted and unadjusted regression analyses to determine whether the outcome differences could be explained by faster or slower time to care. Amongst 2243 EmLap patients [median age 65 years (interquartile range 51-75 years), 51.1% female], 892 (39.77%) received antibiotics for suspected infection. Although patients with suspected infection had faster time to care (all p ≤ 0.001) and worse outcomes compared with those who did not, outcome differences were not statistically significant when accounted for time (all p > 0.050). Amongst those who received antibiotics, faster time to care was also associated with decreased risk of postoperative intensive care unit (ICU) stay and shorter LoS (all p < 0.050). Worse outcomes associated with infection in EmLap patients were attenuated by faster time to care, which additionally reduced the LoS and ICU stay risk amongst those with suspected infection.

Acute Pancreatitis In Type 2 Diabetes Mellitus With Multiple Stones In The Cystic Ductus

&lt;p&gt;&lt;strong&gt;Introduction:&lt;/strong&gt; Severe upper abdominal pain is one of the symptoms of acute pancreatitis that often occurs in other diseases, such as peptic ulcer, acute hepatitis, cholangitis, and cholecystitis. Gallstone-induced acute pancreatitis has considerable morbidity and mortality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Case illustration:&lt;/strong&gt; A 50-year-old man came to the ED with a chief complaint of severe abdominal pain in the upper abdomen, VAS 8-9. His past medical history was unknown. On arrival, blood pressure was 141/102 mmHg, pulse was 98x/minute, and temperature was 36.4ºC. CT Scan of the abdomen showed pancreatitis and multiple stones in the cystic duct. Amylase and lipase serum results were 1897U/L and &amp;gt;3000 U/L.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion:&lt;/strong&gt; In acute pancreatitis caused by gallstones, stones usually get stuck in the branches of the pancreaticobiliary duct. Obstruction at this location causes reflux of bile into the pancreatic duct. Smaller gallstones are more likely to induce pancreatitis because they migrate more easily between bile ducts. This patient was suspected of having a previously unknown history of DM, which contributed to the patient's worsening condition.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; Early management and treatment of triage, fluid resuscitation, and detection of local or systemic complications are essential. In pancreatitis due to gallstones, decisions about the need and timing of procedural intervention are critical. &lt;/p&gt;

Paper-Based Vertical Flow Immunoassay for the Point-of-Care Multiplex Detection of Radiation Dosimetry Genes

In a nuclear or radiological incident, first responders must quickly and accurately measure radiation exposure among civilians as medical countermeasures are radiation dose-dependent and time-sensitive. Although several approaches have been explored to measure absorbed radiation dose, there is an important need to develop point-of-care (POC) bioassay devices that can be used immediately to triage thousands of individuals potentially exposed to radiation. Here we present a proof-of-concept study showing the use of a paper-based vertical flow immunoassay (VFI) to detect radiation dosimetry genes. Using labeled primers during amplification and a multiplex membrane, our results showed that the nucleic acid VFI can simultaneously detect two biodosimetry genes, CDKN1A and DDB2, as well as one housekeeping gene MRPS5. The assay demonstrated good linearity and precision with an inter- and intra-assay coefficient of variance <20% and <10%, respectively. Moreover, the assay showed its ability to discriminate non-irradiated controls (0 Gy) from irradiated samples (1 + 2 Gy) with an overall sensitivity of 62.5% and specificity of 100% (AUC = 0.8672, 95% CI: 0.723–1.000; p = 0.004). Interestingly, the gene combination also showed a dose-dependent response for 0, 1, and 2 Gy, similar to data obtained by real-time PCR benchmark. These preliminary results suggest that a VFI platform can be used to detect simultaneously multiple genes that can be then quantified, thus offering a new approach for a POC biodosimetry assay that could be rapidly deployed on-site to test a large population and help triage and medical management after radiological event.

Associations between emergency call stroke triage and pre-hospital delay, primary hospital admission, and acute reperfusion treatment among early comers with acute ischemic stroke

To investigate the association between the Emergency Medical Service dispatcher’s initial stroke triage and prehospital stroke management, primary admission to hospitals offering revascularization treatment, prehospital time delay, and rate of acute revascularization. In an observational cohort study, patients with acute ischemic stroke (AIS) in Denmark (2017–2018) were included if the emergency call to the Emergency Medical Dispatch Center (EMDC) was made within three hours after symptom onset. Among 3546 included AIS patients, the EMS dispatcher identified 74.6% (95% confidence interval (CI) 73.1–76.0) correctly as stroke. EMS dispatcher stroke recognition was associated with a higher rate of primary admission to a hospital offering revascularization treatment (85.8 versus 74.5%); producing an adjusted risk difference (RD) of 11.1% (95% CI 7.8; 14.3) and a higher rate of revascularization treatment (49.6 versus 41.6%) with an adjusted RD of 8.4% (95% CI 4.6; 12.2). We adjusted for sex, age, previous stroke or transient ischemic attack, and stroke severity. EMDC stroke recognition was associated with shorter prehospital delay. For all AIS patients, the adjusted difference was − 33.2 min (95% CI − 44.4; − 22.0). Among patients receiving acute revascularization treatment (n = 1687), the adjusted difference was -12.6 min (95% CI − 18.9; − 6.3). Stroke recognition by the EMS dispatcher was associated with a higher probability of primary admission to a hospital offering acute stroke treatment, and subsequently with a higher rate of acute revascularization treatment, and with an overall reduction in prehospital delay.

Establishment of ex vivo calibration curve for X-ray induced “dicentric + ring” and micronuclei in human peripheral lymphocytes for biodosimetry during radiological emergencies, and validation with dose blinded samples

In the modern developing society, application of radiation has increased extensively. With significant improvement in the radiation protection practices, exposure to human could be minimized substantially, but cannot be avoided completely. Assessment of exposure is essential for regulatory decision and medical management as applicable. Until now, cytogenetic changes have served as surrogate marker of radiation exposure and have been extensively employed for biological dose estimation of various planned and unplanned exposures. Dicentric Chromosomal Aberration (DCA) is radiation specific and is considered as gold standard, micronucleus is not very specific to radiation and is considered as an alternative method for biodosimetry. In this study dose response curves were generated for X-ray induced “dicentric + ring” and micronuclei, in lymphocytes of three healthy volunteers [2 females (age 22, 23 years) and 1 male (24 year)]. The blood samples were irradiated with X-ray using LINAC (energy 6 MV, dose rate 6 Gy/min), in the dose range of 0–5Gy. Irradiated blood samples were cultured and processed to harvest metaphases, as per standard procedures recommended by International Atomic Energy Agency. Pooled data obtained from all the three volunteers, were in agreement with Poisson distribution for “dicentric + ring”, however over dispersion was observed for micronuclei. Data (“dicentric + ring” and micronuclei) were fitted by linear quadratic model of the expression YC + αD + βD2 using Dose Estimate software, version 5.2. The data fit has resulted in linear coefficient α = 0.0006 (±0.0068) “dicentric + ring” cell−1 Gy−1 and quadratic coefficient β = 0.0619 (±0.0043) “dicentric + ring” cell−1 Gy−2 for “dicentric + ring” and linear coefficient α = 0.0459 ± (0.0038) micronuclei cell−1 Gy−1 and quadratic coefficient β = 0.0185 ± (0.0010) micronuclei cell−1 Gy−2 for micronuclei, respectively. Background frequencies for “dicentric + ring” and micronuclei were 0.0006 ± 0.0004 and 0.0077 ± 0.0012 cell−1, respectively. Established curves were validated, by reconstructing the doses of 8 dose blinded samples (4 by DCA and 4 by CBMN) using coefficients generated here. Estimated doses were within the variation of 0.9–16% for “dicentric + ring” and 21.7–31.2% for micronuclei respectively. These established curves have potential to be employed for biodosimetry of occupational, clinical and accidental exposures, for initial triage and medical management.

Managing Canadian freshwater fisheries: persistent challenges and emerging opportunities

Freshwater fisheries and biodiversity have substantial economic, socio-cultural, and ecological value, but face severe and mounting anthropogenic threats. Canada's freshwater fisheries are not exempt from this, and provide excellent opportunities to better understand these overlooked and undervalued systems. Using expert and chain-referral sampling, we surveyed practitioners from across Canada about the management of freshwater fisheries. We used a mixed methods approach to identify and describe in detail many important aspects of the above processes, including 10 persistent and innate challenges in (1) bureaucratic sprawl, (2) lack of priority, (3) scope, (4) competing interests, (5) political inconstancy, (6) socio-ecological complexity, (7) limited tools, (8) geographies and scale, (9) reactivity, and (10) intersectoral frictions. Many of these challenges defy conventional problem solving (e.g., advocacy, basic science), leading to chronic incapacity and triage management in some freshwater fisheries. We highlight opportunities to increase management capacity, using innovation where conventional solutions fall short (e.g., using novel technologies to increase management scope). Achieving sustainability in Canadian freshwater fisheries will require ingenuity and supportive contributions beyond those that currently exist.

A triage sepsis alert indicator set based on logit analysis

Sepsis is a complication of bacterial, mycotic, or viral infections that can lead to serious consequences and even death if not promptly treated. It affects millions of people in the world every year. Early identification is essential for the patient; accordingly, adequate triage management is required during the initial hours.We propose a new set of prognostic factors for the early identification of the severity of sepsis in emergency departments. Our proposal can improve patient management and survival chances with respect to the actual tests used in emergency units. We utilize a logistic regression model based on a study's mortality rate and survival outcomes based on many variables readily available during the triage. We employ a post-stratified balancing procedure to enhance the predictive capacity of our model.

Application of a Pre-examination and Triage of Children in Fever Clinics to Prevent and Control the Epidemic of Infectious Diseases

Background: The global spread of coronavirus disease 2019 (COVID-19) has reached pandemic proportions. Attempts to control its spread have included a range of early screening and triage measures developed in several nations and areas. Objectives: This study aimed to determine how to prioritize pediatric fever patients to limit the time they had to wait for a consultation and, therefore, the potential of worsening and crises under the burden of COVID-19. Methods: The triage and emergency care process of children in the Fever Clinic of Children’s Hospital of Zhejiang University School of Medicine, Zhejiang, China, within 2019 - 2020 included flow charts, guidance signs, publicity materials, noon and night articulation, and emergency calls. To enhance the management of pre-consultation and triage, the incidence of adverse event injuries was tallied, and satisfaction surveys were conducted. The prevalence of infectious diseases was characterized by demographic and seasonal factors, and the chi-square test was employed to test for differences between groups. Results: From January 2019 to December 2020, four peak periods were observed in each year, namely February, July, September, and December in 2019 and March, June, September, and December in 2020. The peak of common respiratory virus infection was seasonal; however, a significant increase (χ2 = 52.17; P &lt; 0.001) in the case of patients who needed emergency care was observed secondary to fever. The patients within the age range of 1 - 3 years were more in need of emergency care than any other age group (54.70%; 99/181). The most common disease requiring emergency care was febrile convulsions (55.2%). No infectious diseases were missed or underreported during the study period, and no medical personnel was infected. Conclusions: An effective pre-consultation assessment and triage management system and streamlined workflow are of great importance in safeguarding acute patients while preventing infectious diseases.