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We present progress in utilizing a machine learning (ML) assisted optimization framework to study the trends in a parameter space defined by spectrally shaped, high-intensity, petawatt-class (8 J, 45 fs) laser pulses interacting with solid targets and give the first simulation-based overview of predicted trends. A neural network (NN) incorporating uncertainty quantification is trained to predict the number of hot electrons generated by the laser–target interaction as a function of pulse shaping parameters. The predictions of this NN serve as the basis function for a Bayesian optimization framework to navigate this space. For post-experimental evaluation, we compare two separate neural network (NN) models. One is based solely on data from experiments, and the other is trained only on ensemble particle-in-cell simulations. Reviewing the predicted and observed trends across the experiment-capable laser parameter search space, we find that both ML models predict a maximal increase in hot electron generation at a level of approximately 12%–18%; however, no statistically significant enhancement was observed in experiments. On direct comparison of the NN models, the average discrepancy is 8.5%, with a maximum of 30%. Since shot-to-shot fluctuations in experiments affect the observations, we evaluate the behavior of our optimization framework by performing virtual experiments that vary the number of repeated observations and the noise levels. Here, we discuss the implications of such a framework for future autonomous exploration platforms in high-repetition-rate experiments. [ABSTRACT FROM AUTHOR]

Background Hybrid theatres facilitate higher quality angiography and simultaneous employment of open and endovascular techniques. We compared treatment approaches and radiation exposure following hybrid theatre introduction in January 2016. Methods 6-year retrospective review of all aortic interventions (January 2015 - March 2021) at a single tertiary vascular unit, from a prospective operative database. 'Pre-hybrid' cases in traditional theatres were compared to those in the 'post-hybrid' period (hybrid and traditional theatres). Results From 3885 vascular procedures, there were 184 aortic cases in the pre-hybrid period and 886 post-hybrid (hybrid theatre n=539, traditional theatres n=369). Proportionally, endovascular procedures increased from 61% (pre-hybrid) to 97% (new hybrid theatre) (p < 0.05). Of the cases in traditional theatres, post hybrid introduction; 94% (347) open and 6% (22) endovascular or combined. 212 (40%) of all endovascular cases in the hybrid setting were complex (TEVAR, FEVAR, BEVAR & ChEVAR/ChEVAS). The average FEVAR DAP vastly reduced following hybrid introduction (403 vs 233 (Gy cm²) (p<0.005)). Conclusion The ratio of interventions clearly define a drive towards aortic endovascular approaches. Hybrid theatres facilitate a wider range of techniques for aortic procedures and significantly reduces radiation dosing in complex FEVAR. [ABSTRACT FROM AUTHOR]

Abstract Background Asthma is a common chronic respiratory inflammatory disease that adversely affects patients’ quality of life (QoL) and overall well-being. When asthma is not adequately controlled, there is a higher risk of exacerbations and hospitalizations, thereby increasing the direct and indirect costs associated with the treatment and productivity loss. Overreliance on SABA and underutilization of ICS in the management of asthma can result in suboptimal treatment and poor asthma control. Patients who visit the emergency department are more likely to have poorly controlled asthma. Ensuring that these patients are provided with an evidence-based treatment plan during discharge can help reduce the risk of future exacerbations and consequently reduce the burden on the UAE healthcare system. Methods A joint task force comprising experts from the Emirates Society of Emergency Medicine (ESEM) and Emirates Thoracic Society (ETS) reviewed published evidence and updated guidelines in asthma management to optimize the post-discharge recommendations. Results The ESEM-ETS experts’ joint task force has developed a step-by-step plan for emergency department/hospital discharge, which is based on the GINA 2023 guideline recommendations and the medications available in the UAE. By adhering to this structured plan, emergency department physicians can play a crucial role in improving asthma care, long-term patient outcomes, and the utilization of healthcare resources. Conclusions Prioritizing patient education and ensuring patients are equipped with the best-suited asthma treatment plans prior to discharge can help ED physicians improve patient outcomes and reduce healthcare resource utilization in UAE hospitals.

Computer models of intense, laser-driven ion acceleration require expensive particle-in-cell simulations that may struggle to capture all the multi-scale, multi-dimensional physics involved at reasonable costs. Explored is an approach to ameliorate this deficiency using a multi-fidelity framework that can incorporate physical trends and phenomena at different levels. As the basis for this study, an ensemble of approximately 8000 1D simulations was generated to buttress separate ensembles of hundreds of higher fidelity 1D and 2D simulations. Using transfer learning with deep neural networks, one can reproduce the results of more complex physics at a much lower cost. The networks trained in this fashion can, in turn, act as surrogate models for the simulations themselves, allowing for quick and efficient exploration of the parameter space of interest. Standard figures-of-merit were used as benchmarks such as the hot electron temperature, peak ion energy, conversion efficiency, and so on. We can rapidly identify and explore under what conditions differing fidelities become an important effect and search for outliers in feature space. [ABSTRACT FROM AUTHOR]

Oral cavity structures receive abundant perfusion from the branches of the external carotid artery. Although hemorrhage is a common complication of oral cancer, bleeding from a cancerous mouth can be a devastating event in the emergency department. Lingual artery embolization is a minimally invasive interventional radiology procedure that has rarely been reported in the literature. This case involves a patient with tongue cancer who experienced massive oral bleeding leading to cardiac arrest. Fortunately, the patient was successfully resuscitated, and spontaneous circulation was restored. Diagnostic angiography confirmed the presence of pseudoaneurysm in the lingual artery. Ultimately, bleeding was definitively controlled through bilateral lingual artery embolization. This case underscores the critical importance of a multidisciplinary approach involving emergency physicians, otolaryngologists, and interventional radiologists in managing complex vascular lesions in the head and neck. Furthermore, it contributes to the growing body of evidence supporting the use of embolization techniques as a valuable tool in the management of vascular lesions in the head and neck region.

Background: The non-vitamin K antagonist oral anticoagulants (NOACs) have become the mainstay anticoagulation therapy for patients requiring oral anticoagulants (OACs) in the Gulf Council Cooperation (GCC) countries. The frequency of NOAC-associated major bleeding is expected to increase in the Emergency Department (ED). Nonetheless, we still lack local guidelines and recommendations for bleeding management in the region. The present Delphi-based consensus aims to establish a standardized and evidence-based clinical care pathway for managing NOAC-associated major bleeding in the Kingdom of Saudi Arabia (KSA) and the United Arab Emirates (UAE). Methods: We adopted a three-step modified Delphi method to develop evidence-based recommendations through two voting rounds and an advisory meeting between the two rounds. A panel of 11 experts from the KSA and UAE participated in the consensus development. Results: Twenty-eight statements reached the consensus level. These statements addressed key aspects of managing major bleeding events associated with NOACs, including the increased use of NOAC in clinical practice, clinical care pathways, and treatment options. Conclusion: The present Delphi consensus provides evidence-based recommendations and protocols for the management of NOAC-associated bleeding in the region. Patients with major NOAC-induced bleeding should be referred to a well-equipped ED with standardized management protocols. A multidisciplinary approach is recommended for establishing the association between NOAC use and major bleeding. Treating physicians should have prompt access to specific reversal agents to optimize patient outcomes. Real-world evidence and national guidelines are needed to aid all stakeholders involved in NOAC-induced bleeding management.