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1. Relationship between molecular pathogen detection and clinical disease in febrile children across Europe: a multicentre, prospective observational studyResearch in context

Author

Priyen Shah, Marie Voice, Leonides Calvo-Bado, Irene Rivero-Calle, Sophie Morris, Ruud Nijman, Claire Broderick, Tisham De, Irini Eleftheriou, Rachel Galassini, Aakash Khanijau, Laura Kolberg, Mojca Kolnik, Aleksandra Rudzate, Manfred G. Sagmeister, Nina A. Schweintzger, Fatou Secka, Clare Thakker, Fabian van der Velden, Clementien Vermont, Katarina Vincek, Philipp K.A. Agyeman, Aubrey J. Cunnington, Ronald De Groot, Marieke Emonts, Katy Fidler, Taco W. Kuijpers, Marine Mommert-Tripon, Karen Brengel-Pesce, Francois Mallet, Henriette Moll, Stéphane Paulus, Marko Pokorn, Andrew Pollard, Luregn J. Schlapbach, Ching-Fen Shen, Maria Tsolia, Effua Usuf, Michiel van der Flier, Ulrich von Both, Shunmay Yeung, Dace Zavadska, Werner Zenz, Victoria Wright, Enitan D. Carrol, Myrsini Kaforou, Federico Martinon-Torres, Colin Fink, Michael Levin, Jethro Herberg, Irene Rivero Calle, Manfred Sagmeister, Nina Schweintzger, Fabian Van der Velden, Taco Kuijpers, Michiel Van der Flier, Ulrich Von Both, Lucas Baumard, Evangelos Bellos, Lachlan Coin, Giselle D'Souza, Dominic Habgood-Coote, Shea Hamilton, Cllive Hoggart, Sara Hourmat, Heather Jackson, Naomi Lin, Stephanie Menikou, Samuel Nichols, Ivonne Pena Paz, Oliver Powell, Ortensia Vito, Clare Wilson, Amina Abdulla, Ladan Ali, Sarah Darnell, Rikke Jorgensen, Ian Maconochie, Sobia Mustafa, Salina Persand, Ben Walsh, Molly Stevens, Nayoung Kim, Eunjung Kim, Benjamin Pierce, Julia Dudley, Vivien Richmond, Emma Tavliavini, Ching-Chuan Liu, Shih-Min Wang, Fernando Álves González, Cristina Balo Farto, Ruth Barral-Arca, María Barreiro Castro, Xabier Bello, Mirian Ben García, Sandra Carnota, Miriam Cebey-López, María José Curras-Tuala, Carlos Durán Suárez, Luisa García Vicente, Alberto Gómez-Carballa, Jose Gómez Rial, Pilar Leboráns Iglesias, Nazareth Martinón-Torres, José María Martinón Sánchez, Belén Mosquera Pérez, Jacobo Pardo-Seco, Lidia Piñeiro Rodríguez, Sara Pischedda, Sara Ray Vázquez, Carmen Rodríguez-Tenreiro, Lorenzo Redondo-Collazo, Miguel Sadiki Ora, Antonio Sallas, Sonia Serén Fernández, Cristina Serén Trasorras, Marisol Vilas Iglesias, Anda Balode, Arta Bãrdzdina, Dãrta Deksne, Dace Gardovska, Dagne Grãvele, Ilze Grope, Anija Meiere, Ieve Nokalna, Jana Pavãre, Zanda Pučuka, Katrīna Selecka, Dace Svile, Urzula Nora Urbãne, Kalifa Bojang, Syed M.A. Zaman, Suzanne Anderson, Anna Roca, Isatou Sarr, Momodou Saidykhan, Saffiatou Darboe, Samba Ceesay, Umberto D'alessandro, Dorine M. Borensztajn, Nienke N. Hagedoorn, Chantal Tal, Joany Zachariasse, W. Dik, Christoph Aebi, Christoph Berger, Verena Wyss, Mariama Usman, Eric Giannoni, Martin Stocker, Klara M. Posfay-Barbe, Ulrich Heininger, Sara Bernhard-Stirnemann, Anita Niederer-Loher, Christian Kahlert, Giancarlo Natalucci, Christa Relly, Thomas Riedel, Elizabeth Cocklin, Rebecca Jennings, Joanne Johnson, Simon Leigh, Karen Newall, Sam Romaine, Maria Tambouratzi, Antonis Marmarinos, Marietta Xagorari, Kelly Syggelou, Nikos Spyridis, Jennifer Blackmore, Rebekah Harrison, Benno Kohlmaier, Daniela S. Kohlfürst, Christoph Zurl, Alexander Binder, Susanne Hösele, Manuel Leitner, Lena Pölz, Glorija Rajic, Sebastian Bauchinger, Hinrich Baumgart, Martin Benesch, Astrid Ceolotto, Ernst Eber, Siegfried Gallisti, Gunther Gores, Harald Haidl, Almuthe Hauer, Christa Hude, Markus Keldorfer, Larissa Krenn, Heidemarie Pilch, Andreas Pfleger, Klaus Pfurtscheller, Gudrun Nordberg, Tobias Niedrist, Siegfried Rödl, Andrea Skrabl-Baumgartner, Matthias Sperl, Laura Stampfer, Volker Strenger, Holger Till, Andreas Trobisch, Sabine Löffler, Juan Emmanuel Dewez, Martin Hibberd, David Bath, Alec Miners, Elizabeth Fitchett, Catherine Wedderburn, Anne Meierford, Baptiste Leurent, Marien I. De Jonge, Koen van Aerde, Wynand Alkema, Bryan van den Broek, Jolein Gloerich, Alain J. Van Gool, Stefanie Henriet, Martijn Huijnen, Ria Philipsen, Esther Willems, G.P.J.M. Gerrits, M. Van Leur, J. Heidema, L. De Haan, C.J. Miedema, C. Neeleman, C.C. Obihara, G.A. Tramper-Stranders, Rama Kandasamy, Michael J. Carter, Daniel O'Connor, Sagida Bibi, Dominic F. Kelly, Meeru Gurung, Stephen Throson, Imran Ansari, David R. Murdoch, Shrijana Shrestha, Zoe Oliver, Emma Lim, Lucille Valentine, Karen Allen, Kathryn Bell, Adora Chan, Stephen Crulley, Kirsty Devine, Daniel Fabian, Sharon King, Paul McAlinden, Sam McDonald, Anne McDonell, Alisa Pickering, Evelyn Thomson, Amanda Wood, Diane Wallia, Phil Woodsford, Frances Baxter, Ashley Bell, Mathew Rhodes, Rachel Agbeko, Christine Mackerness, Bryan Baas, Lieke Kloosterhuis, Wilma Oosthoek, Tasnim Arif, Joshua Bennet, Kalvin Collings, Ilona Van der Giessen, Alex Martin, Aqeela Rashid, Emily Rowlands, Joshua Soon, Gabriella De Vries, Mike Martin, Ravi Mistry, Manuela Zwerenz, Judith Buschbeck, Christoph Bidlingmaier, Vera Binder, Katharina Danhauser, Nikolaus Haas, Matthias Griese, Matthias Kappler, Eberhard Lurz, Georg Muench, Karl Reiter, Carola Schoen, Alexandre Pachot, Marine Mommert, Tina Plankar Srovin, Natalija Bahovec, Petra Prunk, Veronika Osterman, Tanja Avramoska, Ilse Jongerius, J.M. van den Berg, D. Schonenberg, A.M. Barendregt, D. Pajkrt, M. van der Kuip, A.M. van Furth, Evelien Sprenkeler, Judith Zandstra, G. van Mierlo, and J. Geissler

Subjects
Molecular diagnostics, Diagnostic, Febrile illness, Infectious disease, Bacterial, Viral, Public aspects of medicine, RA1-1270
Abstract

Summary: Background: The PERFORM study aimed to understand causes of febrile childhood illness by comparing molecular pathogen detection with current clinical practice. Methods: Febrile children and controls were recruited on presentation to hospital in 9 European countries 2016–2020. Each child was assigned a standardized diagnostic category based on retrospective review of local clinical and microbiological data. Subsequently, centralised molecular tests (CMTs) for 19 respiratory and 27 blood pathogens were performed. Findings: Of 4611 febrile children, 643 (14%) were classified as definite bacterial infection (DB), 491 (11%) as definite viral infection (DV), and 3477 (75%) had uncertain aetiology. 1061 controls without infection were recruited. CMTs detected blood bacteria more frequently in DB than DV cases for N. meningitidis (OR: 3.37, 95% CI: 1.92–5.99), S. pneumoniae (OR: 3.89, 95% CI: 2.07–7.59), Group A streptococcus (OR 2.73, 95% CI 1.13–6.09) and E. coli (OR 2.7, 95% CI 1.02–6.71). Respiratory viruses were more common in febrile children than controls, but only influenza A (OR 0.24, 95% CI 0.11–0.46), influenza B (OR 0.12, 95% CI 0.02–0.37) and RSV (OR 0.16, 95% CI: 0.06–0.36) were less common in DB than DV cases. Of 16 blood viruses, enterovirus (OR 0.43, 95% CI 0.23–0.72) and EBV (OR 0.71, 95% CI 0.56–0.90) were detected less often in DB than DV cases. Combined local diagnostics and CMTs respectively detected blood viruses and respiratory viruses in 360 (56%) and 161 (25%) of DB cases, and virus detection ruled-out bacterial infection poorly, with predictive values of 0.64 and 0.68 respectively. Interpretation: Most febrile children cannot be conclusively defined as having bacterial or viral infection when molecular tests supplement conventional approaches. Viruses are detected in most patients with bacterial infections, and the clinical value of individual pathogen detection in determining treatment is low. New approaches are needed to help determine which febrile children require antibiotics. Funding: EU Horizon 2020 grant 668303.

Published
2023
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2. Impact of infection on proteome-wide glycosylation revealed by distinct signatures for bacterial and viral pathogens

Author

Esther Willems, Jolein Gloerich, Anouk Suppers, Michiel van der Flier, Lambert P. van den Heuvel, Nicole van de Kar, Ria H.L.A. Philipsen, Maurice van Dael, Myrsini Kaforou, Victoria J. Wright, Jethro A. Herberg, Federico Martinon Torres, Michael Levin, Ronald de Groot, Alain J. van Gool, Dirk J. Lefeber, Hans J.C.T. Wessels, Marien I. de Jonge, Amina Abdulla, Christoph Aebi, Koen van Aerde, Rachel Agbeko, Philipp Agyeman, Umberto D’alessandro, Ladan Ali, Wynand Alkema, Karen Allen, Fernando Álvez González, Suzanne Anderson, Imran Ansari, Tasnim Araf, Tanja Avramoska, Bryan Baas, Natalija Bahovec, Cristina Balo Farto, Anda Balode, A.M. Barendregt, Ruth Barral-Arca, María Barreiro Castro, Arta Bārzdiņa, David Bath, Sebastian Bauchinger, Lucas Baumard, Hinrich Baumgart, Frances Baxter, Ashley Bell, Kathryn Bell, Xabier Bello, Evangelos Bellos, Martin Benesch, Mirian Ben García, Joshua Bennet, Christoph Berger, J.M. van den Berg, Sara Bernhard-Stirnemann, Sagida Bibi, Christoph Bidlingmaier, Alexander Binder, Vera Binder, Kalifa Bojang, Dorine M. Borensztajn, Ulrich von Both, Karen Brengel-Pesce, Bryan van den Broek, Judith Buschbeck, Leo Calvo-Bado, Sandra Carnota, Enitan D. Carrol, Michael J. Carter, Miriam Cebey-López, Samba Ceesay, Astrid Ceolotto, Adora Chan, Elizabeth Cocklin, Kalvin Collings, Stephen Crulley, Aubrey Cunnington, María José Curras-Tuala, Katharina Danhauser, Saffiatou Darboe, Sarah Darnell, Tisham De, Dārta Deksne, Kirsty Devine, Juan Emmanuel Dewez, Julia Dudley, Carlos Durán Suárez, Ernst Eber, Irini Eleftheriou, Marieke Emonts, Daniel Fabian, Tobias Feuchtinger, Katy Fidler, Colin Fink, A.M. van Furth, Rachel Galassini, Siegfried Gallistl, Luisa García Vicente, Dace Gardovska, J. Geissler, G.P.J.M. Gerrits, Eric Giannoni, Ilona van der Giessen, Alberto Gómez-Carballa, Jose Gómez Rial, Gunther Gores, Dagne Grāvele, Matthias Griese, Ilze Grope, Meeru Gurung, L. de Haan, Nikolaus Haas, Dominic Habgood-Coote, Nienke N. Hagedoorn, Harald Haidl, Shea Hamilton, Almuthe Hauer, J. Heidema, Ulrich Heininger, Stefanie Henriet, Jethro Herberg, Clive Hoggart, Susanne Hösele, Sara Hourmat, Christa Hude, Martijn Huijnen, Heather Jackson, Rebecca Jennings, Joanne Johnston, Ilse Jongerius, Rikke Jorgensen, Christian Kahlert, Rama Kandasamy, Matthias Kappler, Julia Keil, Markus Keldorfer, Dominic F. Kell, Eunjung Kim, Sharon King, Lieke Kloosterhuis, Daniela S. Kohlfürst, Benno Kohlmaier, Laura Kolberg, Mojca Kolnik, Larissa Krenn, Taco Kuijpers, M. van der Kuip, Pilar Leboráns Iglesias, Simon Leigh, Manuel Leitner, M. van Leur, Emma Lim, Naomi Lin, Ching-Chuan Liu, Sabine Löffler, Eberhard Lurz, Ian Maconochie, Christine Mackerness, François Mallet, Federico Martinón-Torres, Antonis Marmarinos, Alex Martin, Mike Martin, José María Martinón Sánchez, Nazareth Martinón-Torres, Paul McAlinden, Anne McDonnell, Sam McDonald, C.J. Miedema, Anija Meiere, Stephanie Menikou, G. van Mierlo, Alec Miners, Ravi Mistry, Henriëtte A. Moll, Marine Mommert, Belén Mosquera Pérez, David R. Murdoch, Sobia Mustafa, Giancarlo Natalucci, C. Neeleman, Karen Newall, Samuel Nichols, Tobias Niedrist, Anita Niederer-Loher, Ruud Nijman, Ieva Nokalna, Urzula Nora Urbāne, Gudrun Nordberg, C.C. Obihara, Daniel O'Connor, Wilma Oosthoek, Veronika Osterman, Alexandre Pachot, D. Pajkrt, Jacobo Pardo-Seco, Stéphane Paulus, Jana Pavāre, Ivonne Pena Paz, Salina Persand, Andreas Pfleger, Klaus Pfurtscheller, Ria Philipsen, Ailsa Pickering, Benjamin Pierce, Heidemarie Pilch, Lidia Piñeiro Rodríguez, Sara Pischedda, Tina Plankar Srovin, Marko Pokorn, Andrew J. Pollard, Lena Pölz, Klara M. Posfay-Barbe, Petra Prunk, Zanda Pučuka, Glorija Rajic, Aqeela Rashid, Lorenzo Redondo-Collazo, Christa Relly, Irene Rivero Calle, Sara Rey Vázquez, Mathew Rhodes, Vivien Richmond, Thomas Riedel, Anna RocaIsatou Sarr, Siegfried Rödl, Carmen Rodríguez-Tenreiro, Sam Romaine, Emily Rowlands, Miguel Sadiki Ora, Manfred G. Sagmeister, Momodou Saidykhan, Antonio Salas, Luregn J. Schlapbach, D. Schonenberg, Fatou Secka, Katrīna Selecka, Sonia Serén Fernández, Cristina Serén Trasorras, Priyen Shah, Ching-Fen Shen, Shrijana Shrestha, Aleksandra Sidorova, Andrea Skrabl-Baumgartner, Giselle D’Souza, Matthias Sperl, Evelien Sprenkeler, Nina A. Schweintzger, Laura Stampfer, Molly Stevens, Martin Stocker, Volker Strenger, Dace Svile, Kelly Syggelou, Maria Tambouratzi, Chantal Tan, Emma Tavliavini, Evelyn Thomson, Stephen Thorson, Holger Till, G.A. Tramper-Stranders, Andreas Trobisch, Maria Tsolia, Effua Usuf, Lucille Valentine, Clementien L. Vermont, Marisol Vilas Iglesias, Katarina Vincek, Marie Voice, Gabriella de Vries, Diane Wallia, Shih-Min Wang, Clare Wilson, Amanda Wood, Phil Woodsford, Victoria Wright, Marietta Xagorari, Shunmay Yeung, Joany Zachariasse, Dace Zavadska, Syed M.A. Zaman, Judith Zandstra, Werner Zenz, Christoph Zurl, and Manuela Zwerenz

Subjects
Health sciences, Glycobiology, Immunology, Glycomics, Science
Abstract

Summary: Mechanisms of infection and pathogenesis have predominantly been studied based on differential gene or protein expression. Less is known about posttranslational modifications, which are essential for protein functional diversity. We applied an innovative glycoproteomics method to study the systemic proteome-wide glycosylation in response to infection. The protein site-specific glycosylation was characterized in plasma derived from well-defined controls and patients. We found 3862 unique features, of which we identified 463 distinct intact glycopeptides, that could be mapped to more than 30 different proteins. Statistical analyses were used to derive a glycopeptide signature that enabled significant differentiation between patients with a bacterial or viral infection. Furthermore, supported by a machine learning algorithm, we demonstrated the ability to identify the causative pathogens based on the distinctive host blood plasma glycopeptide signatures. These results illustrate that glycoproteomics holds enormous potential as an innovative approach to improve the interpretation of relevant biological changes in response to infection.

Published
2023
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3. Spectral action approach to higher derivative gravity

Author

Ravi Mistry, Aleksandr Pinzul, and Lesław Rachwał

Subjects
Astrophysics, QB460-466, Nuclear and particle physics. Atomic energy. Radioactivity, QC770-798
Abstract

Abstract We study the spectral action approach to higher derivative gravity. The work focuses on the classical aspects. We derive the complete and simplified form of the purely gravitational action up to the 6-derivative terms. We also derive the equivalent forms of the action, which might prove useful in different applications, namely Riemann– and Weyl–dominated representations. The spectral action provides a rather rigid structure of the higher derivative part of the theory. We discuss the possible consequences of this rigidness. As one of the applications, we check whether the conformal backgrounds are preferred in some way on the classical level, with the conclusion that at this level, there is no obvious reason for such a preference, the space $$S^1 \times S^3$$ S1×S3 studied in earlier works being a special case. Some other possible properties of the higher derivative gravity given by the spectral action are briefly discussed.

Published
2020
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4. Can quantitative MRI be used in the clinical setting to quantify the impact of intra-articular glucocorticoid injection on synovial disease activity in juvenile idiopathic arthritis?

Author

Joshua L. Bennett, Amanda Wood, Nicola Smith, Ravi Mistry, Karen Allen, Sharmila Jandial, John D. Tuckett, S. Claire Gowdy, Helen E. Foster, Flora McErlane, and Kieren G. Hollingsworth

Subjects
Juvenile idiopathic arthritis, Disease activity assessment, Quantitative MRI, Synovitis, Synovial volume, Intra-articular glucocorticoid injection, Pediatrics, RJ1-570, Diseases of the musculoskeletal system, RC925-935
Abstract

Abstract Background Juvenile idiopathic arthritis (JIA), the most common chronic rheumatic disease of childhood, is characterised by synovitis. Clinical assessments of synovitis are imperfect, relying on composite and indirect measures of disease activity including clinician-reported measures, patient-reported measures and blood markers. Contrast-enhanced MRI is a more sensitive synovitis assessment technique but clinical utility is currently limited by availability and inter-observer variation. Improved quantitative MRI techniques may enable future development of more stringent MRI-defined remission criteria. The objective of this study was to determine the utility and feasibility of quantitative MRI measurement of synovial volume and vascularity in JIA before and twelve weeks after intra-articular glucocorticoid injection (IAGI) of the knee and to assess the acceptability of MRI to participating families. Methods Children and young people with JIA and a new episode of knee synovitis requiring IAGI were recruited from the Great North Children’s Hospital in Newcastle upon Tyne. Quantitative contrast-enhanced MRI was performed prior to and twelve weeks after IAGI, in addition to standard clinical assessment tools, including the three-variable clinical juvenile arthritis disease activity score (cJADAS) and active joint count. Results Eleven young people (5 male, median age 13 years, range 7–16) with JIA knee flare were recruited and 10 completed follow-up assessment. Following IAGI, the median (interquartile range) cJADAS improved from 8.5 (2.7) to 1.6 (3.9), whilst the median synovial volume improved from 38.5cm3 (82.1cm3) to 0.0cm3 (0.2cm3). Six patients presented with frank synovitis outside normal limits on routine MRI reporting. A further three had baseline MRI reports within normal limits but the quantitative measurements identified measurable synovial uptake. Post-IAGI quantitative measurements highlighted significant improvements in 9 patients. Conclusions IAGI led to a marked reduction in synovial volume, with quantitative MRI identifying more patients with an improved synovial volume than routine qualitative clinical reporting. Improvements in cJADAS scores were more variable with the patient/parent global assessment component contributing most to the scores. Further work is indicated, exploring the utility of quantitative MRI in the assessment of less accessible joints and comparing the impact of different treatment modalities.

Published
2019
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5. Hawking radiation power equations for black holes

Author

Ravi Mistry, Sudhaker Upadhyay, Ahmed Farag Ali, and Mir Faizal

Subjects
Nuclear and particle physics. Atomic energy. Radioactivity, QC770-798
Abstract

We derive the Hawking radiation power equations for black holes in asymptotically flat, asymptotically Anti-de Sitter (AdS) and asymptotically de Sitter (dS) black holes. This is done by using the greybody factor for these black holes. We observe that the radiation power equation for asymptotically flat black holes, corresponding to greybody factor at low frequency, depends on both the Hawking temperature and the horizon radius. However, for the greybody factors at asymptotic frequency, it only depends on the Hawking temperature. We also obtain the power equation for asymptotically AdS black holes both below and above the critical frequency. The radiation power equation for at asymptotic frequency is same for both Schwarzschild AdS and Reissner–Nordström AdS solutions and only depends on the Hawking temperature. We also discuss the power equation for asymptotically dS black holes at low frequency, for both even or odd dimensions.

Published
2017
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6. Plasma membrane preassociation drives β-arrestin coupling to receptors and activation

Author

Jak Grimes, Zsombor Koszegi, Yann Lanoiselée, Tamara Miljus, Shannon L. O’Brien, Tomasz M. Stepniewski, Brian Medel-Lacruz, Mithu Baidya, Maria Makarova, Ravi Mistry, Joëlle Goulding, Julia Drube, Carsten Hoffmann, Dylan M. Owen, Arun K. Shukla, Jana Selent, Stephen J. Hill, and Davide Calebiro

Subjects
General Biochemistry, Genetics and Molecular Biology, Article
Abstract

β-arrestin plays a key role in G protein-coupled receptor (GPCR) signaling and desensitization. Despite recent structural advances, the mechanisms that govern receptor-β-arrestin interactions at the plasma membrane of living cells remain elusive. Here, we combine single-molecule microscopy with molecular dynamics simulations to dissect the complex sequence of events involved in β-arrestin interactions with both receptors and the lipid bilayer. Unexpectedly, our results reveal that β-arrestin spontaneously inserts into the lipid bilayer and transiently interacts with receptors via lateral diffusion on the plasma membrane. Moreover, they indicate that, following receptor interaction, the plasma membrane stabilizes β-arrestin in a longer-lived, membrane-bound state, allowing it to diffuse to clathrin-coated pits separately from the activating receptor. These results expand our current understanding of β-arrestin function at the plasma membrane, revealing a critical role for β-arrestin preassociation with the lipid bilayer in facilitating its interactions with receptors and subsequent activation.

Published
2023

7. Traumatic Injury to Both Atrioventricular Valves

Author

David Sidebotham, Richella-Lea Falland, Miriam Wheeler, and Ravi Mistry

Subjects
Atrioventricular valve, medicine.medical_specialty, business.industry, Doppler Dilemmas, Multimodality Imaging, Traumatic mitral regurgitation, General Medicine, Atrioventricular valve injury, Blunt cardiac injury, Traumatic injury, Echocardiography, Internal medicine, Traumatic tricuspid regurgitation, medicine, Cardiology, business, ComputingMethodologies_COMPUTERGRAPHICS
Abstract

Graphical abstract, Highlights • BCI encompasses a spectrum of cardiac injuries. • BCI should be considered in all patients with major thoracoabdominal trauma. • TEE is an excellent imaging method for evaluating BCI, including atrioventricular valve injury.

Published
2021
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8. A survey of self-reported use of cricoid pressure amongst Australian and New Zealand anaesthetists: Attitudes and practice

Author

Ravi Mistry, James Broadbent, Chris Badenhorst, and Daniel Frei

Subjects
medicine.medical_specialty, medicine.medical_treatment, Critical Care and Intensive Care Medicine, Cricoid Cartilage, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, Surveys and Questionnaires, medicine, Humans, In patient, Cricoid pressure, Response rate (survey), Potential impact, business.industry, Australia, 030208 emergency & critical care medicine, Rapid sequence induction, Clinical trial, Anesthesiology and Pain Medicine, Increased risk, Attitude, Family medicine, Anesthetists, Airway management, Self Report, business, New Zealand
Abstract

We conducted a survey of Australian and New Zealand anaesthetists designed to quantify self-reported use of cricoid pressure (CP) in patients presumed to be at risk of gastric regurgitation, and to ascertain the underlying justifications used to support individual practice. We aimed to identify the perceived benefits and harms associated with the use of CP and to explore the potential impact of medicolegal concerns on clinical decision-making. We also sought to ascertain the views of Australian and New Zealand anaesthetists on whether recommendations relating to CP should be included in airway management guidelines. We designed an electronic survey comprised of 15 questions that was emailed to 981 randomly selected Fellows of the Australian and New Zealand College of Anaesthetists (ANZCA) by the ANZCA Clinical Trials Network on behalf of the investigators. We received responses from 348 invitees (response rate 35.5%). Of the 348 respondents, 267 (76.9%) indicated that they would routinely use CP for patients determined to be at increased risk of gastric regurgitation. When asked whether participants believed the use of CP reduces the risk of gastric regurgitation, 39.8% indicated yes, 23.8% believed no and 36.3% were unsure. Of the respondents who indicated that they routinely performed CP, 159/267 (60%) indicated that concerns over the potential medicolegal consequences of omitting CP in a patient who subsequently aspirates was one of the main reasons for using CP. The majority (224/337; 66%) of respondents believed that recommendations about the use of CP in airway management guidelines should include individual practitioner judgement, while only 55/337 (16%) respondents believed that routine CP should be advocated in contemporary emergency airway management guidelines.

Published
2021
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9. Multimetric Finsler Geometry

Author

Carvalho, Patrícia, Landri, Cristian, Ravi Mistry, and Pinzul, Aleksandr

Subjects
High Energy Physics - Theory, Nuclear and High Energy Physics, High Energy Physics - Theory (hep-th), FOS: Physical sciences, Astronomy and Astrophysics, Mathematical Physics (math-ph), General Relativity and Quantum Cosmology (gr-qc), Mathematical Physics, General Relativity and Quantum Cosmology, Atomic and Molecular Physics, and Optics
Abstract

Motivated in part by the bi-gravity approach to massive gravity, we introduce and study the multimetric Finsler geometry. For the case of an arbitrary number of dimensions, we study some general properties of the geometry in terms of its Riemannian ingredients, while in the 2-dimensional case, we derive all the Cartan equations as well as explicitly find the Holmes-Thompson measure., Comment: 27 pages

Published
2022
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10. Intubation Practices and Adverse Peri-intubation Events in Critically Ill Patients From 29 Countries

Author

Russotto V., Myatra S. N., Laffey J. G., Tassistro E., Antolini L., Bauer P., Lascarrou J. B., Szuldrzynski K., Camporota L., Pelosi P., Sorbello M., Higgs A., Greif R., Putensen C., Agvald-Ohman C., Chalkias A., Bokums K., Brewster D., Rossi E., Fumagalli R., Pesenti A., Foti G., Bellani G., Hazem Abdelkarem Ahmed, Neill K J Adhikari, Kehari Agrawal, Nipun Agrawal, Hernan Aguirre-Bermeo, Christina Agvald-Öhman, Meraj Ahmad, Samareh Ajami, Shazia N Akhtar, Adnan Alghamdi, Abdulmueti Alhadi, Syed M Ali, Mohd N Ali, Anita Alias, Ghaleb Almekhlafi, Julio Alonso, Diana Alvarez Montenegro, Rubina Aman, Matthew Anstey, Irene Aragão, Eleni Arnaoutoglou, Elie Azoulay, Laura Baccari, Nishanth Baliga, Ramya Ballekatte Manjunath, Shrirang Bamane, Anna Bandert, Roland Bartholdy, Marta Basto, Vera Baturova, Philippe R Bauer, Agrippino Bellissima, Vladislav Belsky, Prashant Bendre, Annalisa Benini, Sebastien Besset, Mahuya Bhattacharyya, Piotr Bielanski, Luca Bigatello, Florence Boissier, Kristaps Bokums, Elisa Boni, Iwona Bonney, David Bowen, Alexandre Boyer, Luca Brazzi, David Brewster, Lina Broman, Alexander Browne, Cedric Bruel, Yannick Brunin, Guillermo Bugedo, Italo Calamai, Patricia Campos, Federico G Canavosio, Iacopo Cappellini, Marco Cascella, Nuno Catorze, Athanasios Chalkias, Benoit Champigneulle, Juhi Chandwani, Anne Chao, Satish Chaurasia, Rajesh Chawla, Aakanksha Chawla, Olivia Cheetham, Frank Chemouni, Lee Chew Kiok, Jung-Yien Chien, Timothy Chimunda, Ching-Tang Chiu, Fernando Chiumiento, Nai-Kuan Chou, Nicolas Chudeau, Sandra Colica, Gwenhael Colin, Jean-Michel Constantin, Damien Contou, Andrea Cortegiani, Paulo F Costa, Vasco Costa, Andrea Costamagna, Antonella Cotoia, Andrea N Cracchiolo, Petra Crone, Rui P Cunha, Renata Curić Radivojević, Amit Das, Sampat Dash, Gennaro De Pascale, Silvia De Rosa, Lorenzo Del Sorbo, Valentina Della Torre, Barbara Di Caprio, Raffaele Di Fenza, Ida Di Giacinto, Aikaterini Dimitropoulou, Marcel Dudda, Christopher Edmunds, Stefan F Ehrentraut, Nadia El-Fellah, Muhammed Elhadi, Ahmed Elhadi, Patricia Escudero-Acha, Missael Espinoza, Clelia Esposito, Fabrizio Fabretti, Daniel G Fein, Massimo Ferluga, Marco Fernandes, Alexis Ferre, Janet Ferrier, Marek Flaksa, Fernando Flores, Jesus Flores Gonzalez, Xavier E Fonseca Fuentes, Roland Francis, Daniela G Franco, Pawel Franczyk, Jean-Pierre Frat, Mikhail Furman, Maurizio Fusari, Piotr Galkin, Alice Gallo de Moraes, Renato Gammaldi, Maria F García Aguilera, Eugenio Garofalo, Tomasz Gaszynski, Jonathan Gatward, Mohamed Ghula, Angelo Giacomucci, Ilaria Giovannini, Kingsly Gnanadurai, Thomas Godet, Alberto Goffi, Gemma Goma Fernandez, Maria Gonzalez, Daira González, Alejandro González-Castro, Kadarapura N Gopalakrishna, Eric Gottesman, Alexandre Gros, Christophe Guervilly, Christophe Guitton, Manish Gupta, Kulbhusahn Gupta, Tarikul Hamid, Olfa Hamzaoui, Katrin Hannesdottir, Shahnaz Hasan, Mozaffer Hossain, Sazzad Hossein, Sami Hraiech, Chun-Kai Huang, Cameron Hypes, Soad Imhmed Alkhumsi, Motiul Islam, Muhamad A Ismail, Višnja Ivančan, Sophie Jacquier, Bharat Jagiasi, Nikhilesh Jain, Muhamad Fadhil Hadi Jamaluddin, Milosz Jankowski, Deepak Jeswani, Deepti Jeswani, Simant Jha, Laura Jones, Benjamin Jones, Mathieu Jozwiak, Aleksandra Jumić, Oliver Kamp, Ilias Karametos, Alexey Karelov, Panagiotis Katsoulis, David A Kaufman, Shuchi Kaushik, Callum T Kaye, Subba R Kesavarapu, Ala Khaled, Hapiz Khalidah, Akram Khan, Sudhir Khunteta, Detlef Kindgen-Milles, Sara V Korula, Amol Kothekar, Salman S Koul, Ditte Krog, Shih-Chi Ku, Mira Kuellmar, Lu-Cheng Kuo, Swarna D Kuragayala, Aikaterini Kyparissi, Gonzalo Labarca, John G Laffey, Jaya Lalwani, Antonio Landaverde, Jean-Baptiste Lascarrou, Andres Laserna, Chien-Chang Lee, Stephane Legriel, Andrew Lehr, Tiago Leonor, Yongxing Li, Anna Lisa Licciardi, Edward Litton, Vladimir Lomivorotov, Federico Longhini, Claudia L Lopez Nava, Luis R Loza Gallardo, Ramona Lungu, Annalisa Luzi, Wuhua Ma, Marat Magomedov, Alexandros Makris, Harish Mallapura Maheshwarappa, Tommaso Maraffi, Maria E Marcelli, Karim Mariano, Nathalie Marin, Nadezhda Marova, Maelle Martin, Mayra Martinez Gonzalez, Emilio Maseda, Fiore Mastroianni, Marijana Matas, Dubier Matos, Jessica G Maugeri, Mohd Z Mazlan, Melanie Meersch, Ranjan Meher, Tasneem H Mehesry, Maria Meirik, Armand Mekontso Dessap, Kwabena Mensah, Emmanuelle Mercier, Pavel Michalek, Abhirup Midya, Slobodan Mihaljević, Adrien Mirouse, Prasanna Mishra, Ravi Mistry, Mate Moguš, Norbaniza Mohd Nordin, Noryani Mohd Samat, Luca Montini, Giorgia Montrucchio, Valeria Moro, Diego Morocho Tutillo, Jarrod Mosier, Sircar Mrinal, Wojciech Mudyna, Grégoire Muller, Kartik Munta, Satheesh Munusamy, Stefania Musso, Stefano Muttini, Ismail Nahla Irtiza, Evi Nakou, Amit Narkhede, Joseph Nates, Moana R Nespoli, Francesca Nespoli, Artem Nikitenko, Carla Nogueira, Ross O'Grady, Yewande E Odeyemi, Annika Ohlsson, Alberto Orsello, Vijayanand Palaniswamy, Daniela M Palma, Salvatore Palmese, Jesus N Pantoja Leal, Eleni Papandreou, Metaxia Papanikolaou, Matteo Parotto, Mayur Patel, Mario Pavlek, Niccolò Pedrotti, Ngu Pei Hwa, Lorella Pelagalli, Miryam Pérez Ruiz, Elin Persson, Athanasia Petsiou, Angelo Pezzi, Sam Philip, Francois Philippard, Mariusz Piegat, Sébastien Pili-Floury, Riccardo Pinciroli, Marcia Pinto, Gael Piton, Gaetan Plantefeve, Caroline Pouplet, Sofia Pouriki, Andrea Pradella, Kumar Prashant, Christian Putensen, Alice Quayle, Lua Rahmani, Ian Randall, Banambar Ray, Adrian Regli, Syed T Reza, Jean Damien Ricard, Ivano Riva, Oriol Roca, Roberto Rona, Jon Rosell, Rebecca Rowley, Sheng-Yuan Ruan, Kay Rumschuessel, Annalisa Rundo, Pierpaolo Russo, Vincenzo Russotto, Samir Sahu, Gabriele Sales, Charlotte Salmon-Gandonnière, Nandyelly San Juan Roman, Luis Sánchez-Hurtado, Benjamin J Sandefur, Manel Santafe, Lida Santoro, Rhik Sanyal, Lakshmikanthcharan Saravanabavan, Bhagyesh Shah, Mehul Shah, Ming-Hann Shin, Monica Silva, Shannon Simpson, Ayush Sinah, Atul K Singh, Dinesh K Singh, Nitesh Singh, Lalit Singh, Lukasz Skowronski, Miguel A Sosa, Savino Spadaro, Martin Spangfors, Jesper Sperber, Rosario Spina, Anand Srivastava, Andrew Steel, Alejandro Suarez de la Rica, Singh Sujeet Kumar, Omprakash Sundrani, Nilu Sunil, Bharadwaj Suparna, Manimala R Surath, Yadullah Syed, Tamas Szakmany, Benjamin Sztrymf, Alexis Tabah, Stefano Tarantino, Maria Tileli, Hugo Tirape-Castro, Otoniel Toledo-Salinas, Jacopo Tramarin, Dimitrios Tsiftsis, Iva Tucić, Jose A Tutillo León, Lorenzo Tutino, Vijay N Tyagi, Kyriaki Vagdatli, Sneha Varkey, Maria M Vera, Magnus Von Seth, Carl Wahlstrom, Wan Mohd N Wan Hassan, Wan N Wan Ismail, Kuo-Chuan Wang, Hadrien Winiszewski, Jiayan Wu, Lun Wu, Yu-Chang Yeh, Paul Young, Gianluca Zani, Jonathan Zarka, Dawn Zhao, Diane Zlotnik, Russotto, V, Myatra, S, Laffey, J, Tassistro, E, Antolini, L, Bauer, P, Lascarrou, J, Szuldrzynski, K, Camporota, L, Pelosi, P, Sorbello, M, Higgs, A, Greif, R, Putensen, C, Agvald-Öhman, C, Chalkias, A, Bokums, K, Brewster, D, Rossi, E, Fumagalli, R, Pesenti, A, Foti, G, Bellani, G, Russotto V., Myatra S.N., Laffey J.G., Tassistro E., Antolini L., Bauer P., Lascarrou J.B., Szuldrzynski K., Camporota L., Pelosi P., Sorbello M., Higgs A., Greif R., Putensen C., Agvald-Ohman C., Chalkias A., Bokums K., Brewster D., Rossi E., Fumagalli R., Pesenti A., Foti G., Bellani G., and Hazem Abdelkarem Ahmed, Neill K J Adhikari, Kehari Agrawal, Nipun Agrawal, Hernan Aguirre-Bermeo, Christina Agvald-Öhman, Meraj Ahmad, Samareh Ajami, Shazia N Akhtar, Adnan Alghamdi, Abdulmueti Alhadi, Syed M Ali, Mohd N Ali, Anita Alias, Ghaleb Almekhlafi, Julio Alonso, Diana Alvarez Montenegro, Rubina Aman, Matthew Anstey, Irene Aragão, Eleni Arnaoutoglou, Elie Azoulay, Laura Baccari, Nishanth Baliga, Ramya Ballekatte Manjunath, Shrirang Bamane, Anna Bandert, Roland Bartholdy, Marta Basto, Vera Baturova, Philippe R Bauer, Agrippino Bellissima, Vladislav Belsky, Prashant Bendre, Annalisa Benini, Sebastien Besset, Mahuya Bhattacharyya, Piotr Bielanski, Luca Bigatello, Florence Boissier, Kristaps Bokums, Elisa Boni, Iwona Bonney, David Bowen, Alexandre Boyer, Luca Brazzi, David Brewster, Lina Broman, Alexander Browne, Cedric Bruel, Yannick Brunin, Guillermo Bugedo, Italo Calamai, Patricia Campos, Federico G Canavosio, Iacopo Cappellini, Marco Cascella, Nuno Catorze, Athanasios Chalkias, Benoit Champigneulle, Juhi Chandwani, Anne Chao, Satish Chaurasia, Rajesh Chawla, Aakanksha Chawla, Olivia Cheetham, Frank Chemouni, Lee Chew Kiok, Jung-Yien Chien, Timothy Chimunda, Ching-Tang Chiu, Fernando Chiumiento, Nai-Kuan Chou, Nicolas Chudeau, Sandra Colica, Gwenhael Colin, Jean-Michel Constantin, Damien Contou, Andrea Cortegiani, Paulo F Costa, Vasco Costa, Andrea Costamagna, Antonella Cotoia, Andrea N Cracchiolo, Petra Crone, Rui P Cunha, Renata Curić Radivojević, Amit Das, Sampat Dash, Gennaro De Pascale, Silvia De Rosa, Lorenzo Del Sorbo, Valentina Della Torre, Barbara Di Caprio, Raffaele Di Fenza, Ida Di Giacinto, Aikaterini Dimitropoulou, Marcel Dudda, Christopher Edmunds, Stefan F Ehrentraut, Nadia El-Fellah, Muhammed Elhadi, Ahmed Elhadi, Patricia Escudero-Acha, Missael Espinoza, Clelia Esposito, Fabrizio Fabretti, Daniel G Fein, Massimo Ferluga, Marco Fernandes, Alexis Ferre, Janet Ferrier, Marek Flaksa, Fernando Flores, Jesus Flores Gonzalez, Xavier E Fonseca Fuentes, Roland Francis, Daniela G Franco, Pawel Franczyk, Jean-Pierre Frat, Mikhail Furman, Maurizio Fusari, Piotr Galkin, Alice Gallo de Moraes, Renato Gammaldi, Maria F García Aguilera, Eugenio Garofalo, Tomasz Gaszynski, Jonathan Gatward, Mohamed Ghula, Angelo Giacomucci, Ilaria Giovannini, Kingsly Gnanadurai, Thomas Godet, Alberto Goffi, Gemma Goma Fernandez, Maria Gonzalez, Daira González, Alejandro González-Castro, Kadarapura N Gopalakrishna, Eric Gottesman, Alexandre Gros, Christophe Guervilly, Christophe Guitton, Manish Gupta, Kulbhusahn Gupta, Tarikul Hamid, Olfa Hamzaoui, Katrin Hannesdottir, Shahnaz Hasan, Mozaffer Hossain, Sazzad Hossein, Sami Hraiech, Chun-Kai Huang, Cameron Hypes, Soad Imhmed Alkhumsi, Motiul Islam, Muhamad A Ismail, Višnja Ivančan, Sophie Jacquier, Bharat Jagiasi, Nikhilesh Jain, Muhamad Fadhil Hadi Jamaluddin, Milosz Jankowski, Deepak Jeswani, Deepti Jeswani, Simant Jha, Laura Jones, Benjamin Jones, Mathieu Jozwiak, Aleksandra Jumić, Oliver Kamp, Ilias Karametos, Alexey Karelov, Panagiotis Katsoulis, David A Kaufman, Shuchi Kaushik, Callum T Kaye, Subba R Kesavarapu, Ala Khaled, Hapiz Khalidah, Akram Khan, Sudhir Khunteta, Detlef Kindgen-Milles, Sara V Korula, Amol Kothekar, Salman S Koul, Ditte Krog, Shih-Chi Ku, Mira Kuellmar, Lu-Cheng Kuo, Swarna D Kuragayala, Aikaterini Kyparissi, Gonzalo Labarca, John G Laffey, Jaya Lalwani, Antonio Landaverde, Jean-Baptiste Lascarrou, Andres Laserna, Chien-Chang Lee, Stephane Legriel, Andrew Lehr, Tiago Leonor, Yongxing Li, Anna Lisa Licciardi, Edward Litton, Vladimir Lomivorotov, Federico Longhini, Claudia L Lopez Nava, Luis R Loza Gallardo, Ramona Lungu, Annalisa Luzi, Wuhua Ma, Marat Magomedov, Alexandros Makris, Harish Mallapura Maheshwarappa, Tommaso Maraffi, Maria E Marcelli, Karim Mariano, Nathalie Marin, Nadezhda Marova, Maelle Martin, Mayra Martinez Gonzalez, Emilio Maseda, Fiore Mastroianni, Marijana Matas, Dubier Matos, Jessica G Maugeri, Mohd Z Mazlan, Melanie Meersch, Ranjan Meher, Tasneem H Mehesry, Maria Meirik, Armand Mekontso Dessap, Kwabena Mensah, Emmanuelle Mercier, Pavel Michalek, Abhirup Midya, Slobodan Mihaljević, Adrien Mirouse, Prasanna Mishra, Ravi Mistry, Mate Moguš, Norbaniza Mohd Nordin, Noryani Mohd Samat, Luca Montini, Giorgia Montrucchio, Valeria Moro, Diego Morocho Tutillo, Jarrod Mosier, Sircar Mrinal, Wojciech Mudyna, Grégoire Muller, Kartik Munta, Satheesh Munusamy, Stefania Musso, Stefano Muttini, Ismail Nahla Irtiza, Evi Nakou, Amit Narkhede, Joseph Nates, Moana R Nespoli, Francesca Nespoli, Artem Nikitenko, Carla Nogueira, Ross O'Grady, Yewande E Odeyemi, Annika Ohlsson, Alberto Orsello, Vijayanand Palaniswamy, Daniela M Palma, Salvatore Palmese, Jesus N Pantoja Leal, Eleni Papandreou, Metaxia Papanikolaou, Matteo Parotto, Mayur Patel, Mario Pavlek, Niccolò Pedrotti, Ngu Pei Hwa, Lorella Pelagalli, Miryam Pérez Ruiz, Elin Persson, Athanasia Petsiou, Angelo Pezzi, Sam Philip, Francois Philippard, Mariusz Piegat, Sébastien Pili-Floury, Riccardo Pinciroli, Marcia Pinto, Gael Piton, Gaetan Plantefeve, Caroline Pouplet, Sofia Pouriki, Andrea Pradella, Kumar Prashant, Christian Putensen, Alice Quayle, Lua Rahmani, Ian Randall, Banambar Ray, Adrian Regli, Syed T Reza, Jean Damien Ricard, Ivano Riva, Oriol Roca, Roberto Rona, Jon Rosell, Rebecca Rowley, Sheng-Yuan Ruan, Kay Rumschuessel, Annalisa Rundo, Pierpaolo Russo, Vincenzo Russotto, Samir Sahu, Gabriele Sales, Charlotte Salmon-Gandonnière, Nandyelly San Juan Roman, Luis Sánchez-Hurtado, Benjamin J Sandefur, Manel Santafe, Lida Santoro, Rhik Sanyal, Lakshmikanthcharan Saravanabavan, Bhagyesh Shah, Mehul Shah, Ming-Hann Shin, Monica Silva, Shannon Simpson, Ayush Sinah, Atul K Singh, Dinesh K Singh, Nitesh Singh, Lalit Singh, Lukasz Skowronski, Miguel A Sosa, Savino Spadaro, Martin Spangfors, Jesper Sperber, Rosario Spina, Anand Srivastava, Andrew Steel, Alejandro Suarez de la Rica, Singh Sujeet Kumar, Omprakash Sundrani, Nilu Sunil, Bharadwaj Suparna, Manimala R Surath, Yadullah Syed, Tamas Szakmany, Benjamin Sztrymf, Alexis Tabah, Stefano Tarantino, Maria Tileli, Hugo Tirape-Castro, Otoniel Toledo-Salinas, Jacopo Tramarin, Dimitrios Tsiftsis, Iva Tucić, Jose A Tutillo León, Lorenzo Tutino, Vijay N Tyagi, Kyriaki Vagdatli, Sneha Varkey, Maria M Vera, Magnus Von Seth, Carl Wahlstrom, Wan Mohd N Wan Hassan, Wan N Wan Ismail, Kuo-Chuan Wang, Hadrien Winiszewski, Jiayan Wu, Lun Wu, Yu-Chang Yeh, Paul Young, Gianluca Zani, Jonathan Zarka, Dawn Zhao, Diane Zlotnik

Subjects
Male, medicine.medical_specialty, Critical Illness, medicine.medical_treatment, Aged, Female, Heart Arrest, Humans, Hypotension, Hypoxia, Intensive Care Units, Intubation, Intratracheal, Logistic Models, Medical Errors, Middle Aged, Prospective Studies, Respiration, Artificial, Respiratory Insufficiency, Vasoconstrictor Agents, 01 natural sciences, NO, tracheal intubation, adverse peri-intubation events, 03 medical and health sciences, 0302 clinical medicine, Interquartile range, Intensive care, Settore MED/41 - ANESTESIOLOGIA, Medicine, Intubation, Intubation, Critical Care, 030212 general & internal medicine, 0101 mathematics, 610 Medicine & health, Prospective cohort study, business.industry, Respiration, 010102 general mathematics, Tracheal intubation, General Medicine, Intratracheal, Intubation procedure, Respiratory failure, Artificial, Emergency medicine, Airway management, business
Abstract

Importance: Tracheal intubation is one of the most commonly performed and high-risk interventions in critically ill patients. Limited information is available on adverse peri-intubation events. Objective: To evaluate the incidence and nature of adverse peri-intubation events and to assess current practice of intubation in critically ill patients. Design, Setting, and Participants: The International Observational Study to Understand the Impact and Best Practices of Airway Management in Critically Ill Patients (INTUBE) study was an international, multicenter, prospective cohort study involving consecutive critically ill patients undergoing tracheal intubation in the intensive care units (ICUs), emergency departments, and wards, from October 1, 2018, to July 31, 2019 (August 28, 2019, was the final follow-up) in a convenience sample of 197 sites from 29 countries across 5 continents. Exposures: Tracheal intubation. Main Outcomes and Measures: The primary outcome was the incidence of major adverse peri-intubation events defined as at least 1 of the following events occurring within 30 minutes from the start of the intubation procedure: cardiovascular instability (either: systolic pressure 30 minutes, new or increase need of vasopressors or fluid bolus >15 mL/kg), severe hypoxemia (peripheral oxygen saturation

Published
2021

12. G143(P) A qualitative audit of paediatric patients and carers’ experiences of urgent and emergency care

Author

Emma Lim, Ravi Mistry, D Schenk, L Valentine, and P Bowater

Subjects
medicine.medical_specialty, Data collection, business.industry, Emotional safety, media_common.quotation_subject, Qualitative property, Audit, Unit (housing), Nursing, Feeling, Acute care, Medicine, business, Paediatric patients, media_common
Abstract

Aims Attending the paediatric emergency department (PED) and acute assessment units can be a daunting and stressful experience for patients and carers. We aimed to evaluate their experience of PED and acute assessment unit visits. Methods Data was captured using the validated RCPCH Patient Reported Experience Measure (PREM) for urgent and emergency care. This questionnaire was initially given out in 2013 and again in 2019 and included the views of patients, if over 8 years old, and/or carers. Completion of forms was voluntary and anonymised. In 2019 all respondents were offered the opportunity to take part in semi-structured interviews to explore their experiences in detail. Interviewees completed a questionnaire prior to the interview where they ranked the elements they most valued with regards to urgent care visits. This was used to scaffold the interview. Data was collected by 2 researchers, who transcribed verbatim, and by participants’ written reports. In 2019 data was collected over a three-week period. All data collection and analyses were carried out by individuals independent from the clinical team. Qualitative data was thematically analysed by four researchers. This was the second part of an audit cycle. Results In 2019 51 (18 involving patients) responses to the PREM questionnaire were collected and 12 interviews (4 involving patients) took place (20–30 minutes long). The majority described ED experience positively. From the PREM questionnaire key strengths included addressing pain in a timely manner and safety netting. Areas that need improvement include updates when waiting and advice on when to resume normal activities. From the interviews, communication and safety were identified as priorities. The provision of detailed information in a timely manner was highly valued, alongside feeling listened to by staff. Safety had three dimensions: physical, clinical and psychological/emotional. Waiting times and environmental factors also were valued but were less than other factors above. Conclusions Communication is highly valued, but improvements are required to provide contemporaneous information. This is congruent with existing literature highlighting parent disempowerment in acute care settings and underlining the importance of timely updates. Good communication improved carers’ feelings of psychological and emotional safety.

Published
2020
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13. Spectral action approach to higher derivative gravity

Author

Aleksandr Pinzul, Ravi Mistry, and Leslaw Rachwal

Subjects
High Energy Physics - Theory, Gravity (chemistry), Physics and Astronomy (miscellaneous), FOS: Physical sciences, lcsh:Astrophysics, Conformal map, General Relativity and Quantum Cosmology (gr-qc), Space (mathematics), 01 natural sciences, General Relativity and Quantum Cosmology, Gravitation, symbols.namesake, Theoretical physics, lcsh:QB460-466, 0103 physical sciences, lcsh:Nuclear and particle physics. Atomic energy. Radioactivity, Special case, 010306 general physics, Engineering (miscellaneous), Preference (economics), Mathematical Physics, Physics, 010308 nuclear & particles physics, Mathematical Physics (math-ph), Action (physics), Riemann hypothesis, High Energy Physics - Theory (hep-th), symbols, lcsh:QC770-798
Abstract

We study the spectral action approach to higher derivative gravity. The work focuses on the classical aspects. We derive the complete and simplified form of the purely gravitational action up to the 6-derivative terms. We also derive the equivalent forms of the action, which might prove useful in different applications, namely Riemann- and Weyl-dominated representations. The spectral action provides a rather rigid structure of the higher derivative part of the theory. We discuss the possible consequences of this rigidness. As one of the applications, we check whether the conformal backgrounds are preferred in some way on the classical level, with the conclusion that at this level, there is no obvious reason for such a preference, the space $S^1 \times S^3$ studied in earlier works being a special case. Some other possible properties of the higher derivative gravity given by the spectral action are briefly discussed., typos and small mistakes corrected, references added, journal version

Published
2020

14. 172 Utility, feasibility and acceptability of quantitative MRI in children with juvenile idiopathic arthritis

Author

Helen E. Foster, Karen Allen, Ravi Mistry, Sharmila Jandial, Kieren G. Hollingsworth, Flora McErlane, Amanda Wood, Clare Gowdy, Nicola Smith, Joshua L Bennett, and John M Tuckett

Subjects
medicine.medical_specialty, Rheumatology, medicine.diagnostic_test, business.industry, Medicine, Juvenile, Arthritis, Pharmacology (medical), Magnetic resonance imaging, Radiology, business, medicine.disease
Published
2019
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15. Peer-assisted learning: filling the gaps in basic science education for preclinical medical students

Author

Ravi Mistry, Julian Lim, Shantal Deepak, Yezen Sammaraiee, Liora Wittner, and Gareth Lim

Subjects
Students, Medical, 020205 medical informatics, Physiology, Basic science, education, 02 engineering and technology, Peer Group, Education, Likert scale, Cohort Studies, 03 medical and health sciences, Peer assisted learning, 0302 clinical medicine, Surveys and Questionnaires, ComputingMilieux_COMPUTERSANDEDUCATION, 0202 electrical engineering, electronic engineering, information engineering, Mathematics education, Humans, Medicine, 030212 general & internal medicine, Curriculum, Medical education, business.industry, Peer group, Problem-Based Learning, General Medicine, Problem-based learning, Clinical training, Program Design Language, business, Education, Medical, Undergraduate
Abstract

In contrast to peer-assisted learning (PAL) in clinical training, there is scant literature on the efficacy of PAL during basic medical sciences teaching for preclinical students. A group of senior medical students aimed to design and deliver clinically oriented small-group tutorials after every module in the preclinical curriculum at a United Kingdom medical school. Twenty tutorials were delivered by senior students throughout the year to first- and second-year students. A baseline questionnaire was delivered to inform the development of the program followed by an end-point questionnaire the next year ( n = 122). Quizzes were administered before and after five separate tutorials to assess changes in mean student scores. Additionally, each tutorial was evaluated via a questionnaire for participants ( n = 949). All five posttutorial quizzes showed a significant improvement in mean student score ( P < 0.05). Questionnaires showed students found the program to be relevant and useful for revision purposes and appreciated how tutorials contextualized basic science to clinical medicine. Students appreciated the interactive nature of the sessions and found receiving personalized feedback about their learning and consolidating information with someone familiar with the material to be useful. With the inclusion of the program, students felt there were now an adequate number of tutorials during the year. In conclusion, this study shows that senior medical students can design and deliver a program that adds value to the mostly lecture-based formal preclinical curriculum. We hope that our study can prompt further work to explore the effect of PAL on the teaching of basic sciences during preclinical studies.

Published
2016
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16. G472 Young people’s views on accessing and using personal records for research purposes

Author

Emma Lim, Rachel S. Agbeko, M Walsh, L Wilson, Marieke Emonts, and Ravi Mistry

Subjects
Courtesy, Distrust, Participation bias, business.industry, media_common.quotation_subject, Ethnic group, Public relations, Transparency (behavior), Focus group, Accountability, Public trust, Medicine, business, media_common
Abstract

Aim Modernisation of records, coupled with advances in informatics, is making analyses of electronic records an increasingly rich source for researchers to help form evidence-based policy and treatments. We aimed to review the public’s views on health research from electronic records and databases, with a focus on children and young people (CYP). Method A literature search on the public’s perceptions of research from health records, data linkage, and acceptability of different modes of consent. Two focus groups using semi–structured discussions, to explore young people’s perceptions of access to healthcare data, were held with our Young Person’s Advisory Group. YPAG consists of 30 12–17 year–olds from diverse socio–economic and ethnic backgrounds. Results Published research is primarily in adults. There is widespread unawareness and misunderstanding of research using health records. The public wish to be informed when their data is used for research as a matter of courtesy and to allow control of their participation. Opt-in consent was preferred. Opt-out consent is deemed potentially acceptable, with some studies demonstrating increased acceptability when participation bias is explained. Only one study explored CYP’s views (17–19 year-olds). This broadly mirrored adults’ views, including attitudes towards opt-out consent. No studies were found involving younger adolescents. Our focus groups highlighted young peoples’ strong sense of ownership of their data and desire to be informed. Acceptability of access to data varies depending on exactly what is being used, by whom and for what purpose. A high degree of precision and flexibility in permission-granting was desired, alluding to dynamic consent. A distrust in the security of their data co-existed with a misunderstanding of the protection anonymization provides. Conclusion CYP are clear in their desire for active engagement when it comes to using their data for research and show appreciation for balancing one’s privacy against the ‘greater good’ for society. Further work is needed to explore how best to inform CYP of data use, allow informed participation, tackle misconceptions and maximise their partnership in this type of research. This is required to increase researchers’ transparency and accountability with the public and maintain public trust in clinical research.

Published
2018
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17. Chaffers Park redevelopment in Wellington - An analysis

Author

Ravi Mistry

Subjects
Geography, National museum, Redevelopment, Geography, Planning and Development, Media studies, General Earth and Planetary Sciences, Context (language use), Archaeology
Abstract

This article discusses the redevelopment of a significant area of Wellington city's waterfront, centred on the Chaffers Park district between the national museum, Te Papa Tongarewa, and Oriental Bay. This site is now being transformed into Waitangi Park. The analysis seeks to determine whether or not the redevelopment will be successful, by assessing the wider context of the issue and evaluating the perspectives of stakeholders.

Published
2005
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18. Gravitational Collapse in Gravity's Rainbow

Author

Ahmed Farag Ali, Mir Faizal, Ravi Mistry, and Barun Majumder

Subjects
Physics, Gravity (chemistry), Physics and Astronomy (miscellaneous), Horizon, Astrophysics::High Energy Astrophysical Phenomena, FOS: Physical sciences, Rainbow, Mechanics, General Relativity and Quantum Cosmology (gr-qc), General Relativity and Quantum Cosmology, Black hole, Position (vector), Gravitational collapse, Particle, Falling (sensation)
Abstract

In this paper, we will analyze the gravitational collapse in the framework of gravity's rainbow. We will demonstrate that the position of the horizon for a particle inside the black hole depends on the energy of that particle. It will also be observe that the position of the horizon for a particle falling radially into the black hole also depends on its energy. Thus, it is possible for a particle coming from outside to interact with a particle inside the black, and take some information outside the black hole. This is because for both these particles the position of horizon is different. So, even though the particle from inside the black hole is in its own horizon, it is not in the horizon of the particle coming from outside. Thus, we will demonstrate that in gravity's rainbow information can get out of a black hole., Comment: accepted in Int. J. Geom. Methods Mod. Phys

Published
2015
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