bluuebunny/crossref_metadata_2025 huggingface dataset:
Trunk‐dominant and classic facial pemphigus foliaceus in dogs – comparison of anti‐desmocollin‐1 and anti‐desmoglein‐1 autoantibodies and clinical presentations
Authors: Bizikova Petra , Linder Keith E. , Mamo Lisa B.
Published: June 2022

Background

Canine trunk‐dominant pemphigus foliaceus (PF) is mentioned rarely in the literature.

Hypothesis/Objectives

The goal of this study was to provide clinical description of trunk‐dominant PF and to demonstrate the prevalence of serum antikeratinocyte, anti‐desmocollin‐1 (DSC1) and anti‐desmoglein‐1 (DSG1) antibodies, and determine their diagnostic value in this particular PF phenotype.

Materials and methods

Clinically relevant information was collected from 31, 25 and 34 dogs with trunk‐dominant and facial PF and superficial pyoderma (SP), respectively. Sera from these dogs were tested for antikeratinocyte, anti‐DSC1 and anti‐DSG1 antibodies using indirect immunofluorescence on canine tissues and DSC1‐ and DSG1‐transfected cells. Sera from healthy dogs and dogs with clinically irrelevant diseases served as controls.

Results

Footpad involvement and grouped/polycyclic lesion organisation were identified as features of both PF phenotypes, and not of SP. Antikeratinocyte immunoglobulin (Ig)G was not specific for canine PF. By contrast, antigen‐specific IgG was detected only in PF sera; anti‐DSC1 IgG in 100% and 58% of dogs with facial and trunk‐dominant PF, respectively, and anti‐DSG1 IgG in 7% of dogs with trunk‐dominant PF only.

Conclusions

Trunk‐dominant PF shares DSC1 as a major autoantigen with facial PF. The ability to detect anti‐DSC1 IgG is lower in trunk‐dominant PF, yet despite the lower sensitivity, the positive predictive value and accuracy of this particular anti‐DSC1 IgG test are high. A negative test result, however, cannot exclude the diagnosis, and characteristic clinical features such as footpad involvement and/or grouped/polycyclic lesions must be considered when distinguishing trunk‐dominant PF from its most relevant differential diagnosis: SP.
The Morality of Dual Mode Camera: Catholic Theological Perspectives on Joshua Greene’s Dual Process Theory of Moral Judgements
Authors: Opatrný Dominik
Published: June 2022

Las investigaciones recientes sobre el trasfondo neuronal de la toma de decisiones humanas llevadas a cabo por Joshua Greene desafían varias partes de la ética cristiana tradicional: el principio del doble efecto, la deontología y la ética de la virtud. El principio del doble efecto es un principio estándar utilizado en la bioética y en otros campos éticos. A veces se ilustra con dos experimentos mentales: los dilemas del tranvía (Trolley dilemma) y del puente peatonal (Footbridge dilema). Greene afirma que “desde un punto de vista psicológico, la diferencia fundamental entre el dilema del tranvía y el del puente peatonal radica en la tendencia de este último a involucrar las emociones de las personas de una manera que el primero no hace”. Además, está convencido de que la deontología de Kant no es más que la racionalización de nuestra moral tribal, mientras que la ética de la virtud es una mera descripción de la moral tribal de Aristóteles.Aunque los experimentos y posiciones de Greene se han reflejado en la ética teológica protestante, hasta ahora prácticamente no ha habido respuesta del lado de la teología moral católica. En este artículo se argumenta que los experimentos de Greene son compatibles con la tradición moral católica. Por una parte, no conducen necesariamente a subvertir la doctrina del doble efecto ni la ética deontológica. La distinción medios/efectos secundarios, que es la esencia del principio del doble efecto, puede estar condicionada evolutivamente, pero esto solo significaría que forma parte de nuestra naturaleza.De manera similar, el utilitarismo propuesto por Greene no es más imparcial que el juicio deontológico “intuitivo”. De hecho, a menudo se espera que el análisis utilitario sea tan imparcial como el libre mercado, pero los mercados libres no siempre son tan libres como los economistas liberales quieren hacernos creer. Por otra parte, la investigación de Greene puede ayudar a entender mejor ciertos aspectos de nuestra tradición, especialmente la necesidad de una opción preferencial por los pobres y la búsqueda de la verdad a través del diálogo.
A Six Degrees-of-Freedom Soft Robotic Joint With Tilt-Arranged Origami Actuator
Authors: Liu Sicong , Liu Jianhui , Zou Kehan , Wang Xiaocheng , Fang Zhonggui , Yi Juan , Wang Zheng
Published: June 2022

Soft manipulators attract increasing interest in robotic applications involving the unstructured environment and human-robot interaction. The majority of the soft manipulator with fluidic actuators consists of joints that are constructed by parallel actuators, achieving rotation and extension. The inability to output twisting and lateral translations concurrently in the joints hinders the applications of such soft manipulators that require dexterous manipulation. In this work, the tilted actuator soft robotic (TASR) joint with 6DOF mobility, i.e., three rotations and three translations, is studied by kinematic modeling, simulations, and experiments. The 6DOF joint has a lightweight (74.8 g) due to the implementation of soft origami actuators (SOA) and soft-rigid structure. The investigation on the characteristics of the 4-joint assembly recorded maximum in-plane translations over a 70 mm range (70% of its diameter), axial translation over 50 mm (27% of its length), and rotations over 120 deg in all three directions. Kinematic modeling and FEM simulations have been carried out on the mechanical behaviors of the joint. A soft manipulator has been produced to verify the practicality of the joint in constructing the soft robotic systems, with the repetitive accuracy and movements demonstrated in an application scenario. The 6DOF TASR joint showed the potential to be implemented in constructing dexterous and lightweight soft robotic systems, with mass-production readiness.
An Inconsistency Fault Diagnosis Method for Lithium-Ion Cells in the Battery Pack Based on Piecewise Dimensionality Reduction and Outlier Identification
Authors: Wang Lujun , Hu Zhili , Tian Aina , Chang Chun , Wu Minghu
Published: June 2022

The inconsistency of cells in the battery pack is one of the main causes of battery failure. In practical applications, the terminal voltage is an important parameter that is easy to obtain and can characterize the inconsistency of cells. In this paper, a fault diagnosis method based on piecewise dimensionality reduction and outlier identification is proposed according to the voltage inconsistency of cells in the battery pack. This method uses a piecewise aggregate approximation (PAA) algorithm with a shift factor to reduce the dimension of the cell voltage time series, after which a deletion mechanism is designed based on the clustering algorithm and outlier identification to calculate the clustering quality after deleting each cell, reflecting the deviate degree of each cell. In addition, a safety management strategy is designed based on the Z-score method, and an abnormality coefficient is set to evaluate the inconsistency of cells. The effectiveness of the proposed diagnosis method is verified by monitoring the voltage data of two real-world electric vehicles. The verification results show that the method can not only detect the inconsistency before the failure of the faulty cell in the battery pack in advance, but also reduce the risk of computational explosion caused by the voltage time series and accurately locate the faulty cell.
Screening of ETO2-GLIS2–induced Super Enhancers identifies targetable cooperative dependencies in acute megakaryoblastic leukemia
Authors: Benbarche Salima , Lopez Cécile K. , Salataj Eralda , Aid Zakia , Thirant Cécile , Laiguillon Marie-Charlotte , Lecourt Séverine , Belloucif Yannis , Vaganay Camille , Antonini Marion , Hu Jiang , da Silva Babinet Alexandra , Ndiaye-Lobry Delphine , Pardieu Bryann , Petit Arnaud , Puissant Alexandre , Chaumeil Julie , Mercher Thomas , Lobry Camille
Published: June 2022

Super Enhancers (SEs) are clusters of regulatory elements associated with cell identity and disease. However, whether these elements are induced by oncogenes and can regulate gene modules cooperating for cancer cell transformation or maintenance remains elusive. To address this question, we conducted a genome-wide CRISPRi-based screening of SEs in ETO2-GLIS2
+
acute megakaryoblastic leukemia. This approach revealed SEs essential for leukemic cell growth and survival that are induced by ETO2-GLIS2 expression. In particular, we identified a de novo SE specific of this leukemia subtype and regulating expression of tyrosine kinase–associated receptors
KIT
and
PDGFRA
. Combined expression of these two receptors was required for leukemic cell growth, and CRISPRi-mediated inhibition of this SE or treatment with tyrosine kinase inhibitors impaired progression of leukemia in vivo in patient-derived xenografts experiments. Our results show that fusion oncogenes, such as ETO2-GLIS2, can induce activation of SEs regulating essential gene modules synergizing for leukemia progression.
Identifying legitimacy: Experimental evidence on compliance with authority
Authors: Dickson Eric S. , Gordon Sanford C. , Huber Gregory A.
Published: June 2022

To what extent do individuals’ perceptions of legitimacy affect their intrinsic motivations to comply with an authority? Answering this question has critical implications for law enforcement but is challenging because actions or institutions that affect intrinsic motivations typically also affect extrinsic, material ones. To disentangle these, we propose an experimental approach that separately identifies the effect of an authority’s costly action to improve enforcement fairness on citizen behavior through both intrinsic and extrinsic channels. In experiment 1, the authority’s simple attempt to institute fairer enforcement increases prosocial behavior by 10 to 12 percentage points via the intrinsic channel. A follow-up experiment demonstrates that this is not motivated by citizen attempts to “pay back” authorities. Our findings provide causally credible evidence that an authority’s actions can directly shape citizens’ behavior by enhancing her legitimacy and have important implications in policy domains where this conflicts with other incentives.
Political coherence and certainty as drivers of interpersonal liking over and above similarity
Authors: Zimmerman Federico , Garbulsky Gerry , Ariely Dan , Sigman Mariano , Navajas Joaquin
Published: June 2022

Affective polarization and political segregation have become a serious threat to democratic societies. One standard explanation for these phenomena is that people like and prefer interacting with similar others. However, similarity may not be the only driver of interpersonal liking in the political domain, and other factors, yet to be uncovered, could play an important role. Here, we hypothesized that beyond the effect of similarity, people show greater preference for individuals with politically coherent and confident opinions. To test this idea, we performed two behavioral studies consisting of one-shot face-to-face pairwise interactions. We found that people with ambiguous or ambivalent views were nonreciprocally attracted to confident and coherent ingroups. A third experimental study confirmed that politically coherent and confident profiles are rated as more attractive than targets with ambiguous or ambivalent opinions. Overall, these findings unfold the key drivers of the affability between people who discuss politics.
A cholesterol analog stabilizes the human β
2
-adrenergic receptor nonlinearly with temperature
Authors: Serdiuk Tetiana , Manna Moutusi , Zhang Cheng , Mari Stefania A. , Kulig Waldemar , Pluhackova Kristyna , Kobilka Brian K. , Vattulainen Ilpo , Müller Daniel J.
Published: June 2022

In cell membranes, G protein–coupled receptors (GPCRs) interact with cholesterol, which modulates their assembly, stability, and conformation. Previous studies have shown how cholesterol modulates the structural properties of GPCRs at ambient temperature. Here, we characterized the mechanical, kinetic, and energetic properties of the human β
2
-adrenergic receptor (β
2
AR) in the presence and absence of the cholesterol analog cholesteryl hemisuccinate (CHS) at room temperature (25°C), at physiological temperature (37°C), and at high temperature (42°C). We found that CHS stabilized various structural regions of β
2
AR differentially, which changed nonlinearly with temperature. Thereby, the strongest effects were observed for structural regions that are important for receptor signaling. Moreover, at 37°C, but not at 25° or 42°C, CHS caused β
2
AR to increase and stabilize conformational substates to adopt to basal activity. These findings indicate that the nonlinear, temperature-dependent action of CHS in modulating the structural and functional properties of this GPCR is optimized for 37°C.
Making memories, one at a time
Authors: Wong Wei
Published: June 2022

The chemokine receptor CCR5 restricts the time period during which memories can be contextually linked.
DNA Repair Factor Poly(ADP-Ribose) Polymerase 1 Is a Proviral Factor in Hepatitis B Virus Covalently Closed Circular DNA Formation
Authors: Chen Yingshan , Yao Yongxuan , Zhao Kaitao , Liu Canyu , Yuan Yifei , Sun Hao , Huang Dan , Zheng Yi , Zhou Yuan , Chen Jizheng , Wang Yun , Wu Chunchen , Zhang Bixiang , Guan Yujuan , Li Feng , Pei Rongjuan , Chen Xinwen
Published: June 2022

The biogenesis and eradication of HBV cccDNA have been a research priority in recent years. In this study, we identified the DNA repair factor PARP1 as a host factor required for the HBV
de novo
cccDNA formation.
A one-million-year isotope record from siderites formed in modern ferruginous sediments
Authors: Vuillemin Aurèle , Mayr Christoph , Schuessler Jan A. , Friese André , Bauer Kohen W. , Lücke Andreas , Heuer Verena B. , Glombitza Clemens , Henny Cynthia , von Blanckenburg Friedhelm , Russell James M. , Bijaksana Satria , Vogel Hendrik , Crowe Sean A. , Kallmeyer Jens
Published: June 2022

Ancient iron formations hold important records of environmental conditions during the Precambrian eons. Reconstructions of past oceanic systems require investigation of modern ferruginous analogs to disentangle water column and diagenetic signals recorded in iron-bearing minerals. We analyzed oxygen, iron, and carbon isotopes in siderite, a ferrous carbonate phase commonly used as an environmental proxy, from a 100-m-long record spanning a 1 Ma depositional history in ferruginous Lake Towuti, Indonesia. Combining bulk sediment and pore water geochemistry, we traced processes controlling siderite isotope signatures. We show that siderite oxygen isotope compositions (δ18O) reflect in-lake hydrological and depositional conditions. Low iron isotope values (δ56Fe) record water column oxygenation events over geological timescales, with minor diagenetic partitioning of Fe isotopes by microbial iron reduction after deposition. The carbon isotope compositions (δ13C) reflect the incorporation of biogenic HCO3–, which is consistent with sediment organic matter remineralization lasting over ca. 200 ka after burial. Positive δ13C excursions indicate an increased production of biogenic methane that escaped the sediment during low lake levels. Diffusion across the sediment–water interface during initial formation of siderites tends to align the isotope signatures of bottom waters to those of pore waters. As microbial reduction of ferric iron and oxidation of organic matter proceed and saturate pore water conditions with respect to siderite, overgrowth on nuclei partially mutes the environmental signal inherited from past bottom waters over ca. 1 Ma. Because high depositional fluxes of ferric iron and organic matter in early oceans would have promoted similar microbial processes in ferruginous deposits prior to lithification, the environmental record contained in siderite grains can successively integrate depositional and early diagenetic signals over short geological timescales.
Holocene Evolution of the Western Louisiana–Texas Coast, USA: Response to Sea-Level Rise and Climate Change
Authors: Anderson John B. , Wallace Davin J. , Rodriguez Antonio B. , Simms Alexander R. , Milliken Kristy T.
Published: June 2022

Global sea-level rise increased during the twentieth century from 1.5 to 3.0 mm/yr and is expected to at least double over the next few decades. The Western Louisiana and Texas coast is especially vulnerable to sea-level rise due to low gradients, high subsidence, and depleted sediment supply. This Memoir describes the regional response of coastal environments to variable rates of sea-level rise and sediment supply during Holocene to modern time. It is based on results from more than six decades of research focused on coastal and nearshore stratigraphic records. The results are a wake-up call for those who underestimate the potential magnitude of coastal change over decadal to centennial time scales, with dramatic changes caused by accelerated sea-level rise and diminished sediment supply.
‘Miliary metastasis’ in a child with papillary thyroid cancer
Authors: Gie Andre , Schubert Pawel , Conradie Wilhelmina , Goussard Pierre
Published: June 2022

Lung disease with diffuse nodules has a broad differential diagnosis. We present a case of childhood papillary thyroid carcinoma with diffuse lung metastases in which the diagnosis was delayed due to fact that the diffuse nodules were considered to be pathognomonic of miliary tuberculosis. Diffuse nodular lung disease in children requires a careful diagnostic approach. The role of multidisciplinary involvement in these rare cases is invaluable.
Religiosity as a potential mediator for violence in childhood and adulthood: results from a Brazilian nationally representative survey
Authors: Gonçalves Juliane Piasseschi de Bernardin , Lucchetti Giancarlo , Latorre Maria do Rosario Dias , Laranjeira Ronaldo , Vallada Homero
Published: June 2022

Objectives

Although previous studies have investigated the role of religiosity in violence outcomes, there is a lack of studies including this aspect as a mediator for violence in childhood and adulthood. This study aimed to investigate the relationship between religiosity and violence in childhood, as well as the possible mediating role of religiosity between suffering violence in childhood and suffering and/or perpetrating violence in adulthood.

Design

Cross-sectional population-based study carried out from November 2011 to March 2012.

Setting

Face-to-face surveys (at participants’ homes) were performed in a Brazilian nationally representative sample.

Participants

A total of 3378 adults (aged 19 years and above) were included.

Primary and secondary outcomes measures

The association between suffering violence in childhood and religiosity, and the mediating role of religiosity between childhood and adulthood violence were analysed using logistic regression models.

Results

Religiosity was associated with childhood violence, showing that those who suffered less violence in childhood were more religious in adulthood and considered religion more important in their lives. However, while there was a significant association between suffering violence during childhood and suffering and/or perpetrating violence in adulthood, religiosity did not mediate this relationship.

Conclusions

Although religious individuals self-reported less violence suffered in childhood, religiosity did not show evidence of being a potential mediator for childhood and adulthood violence (experienced and/or perpetrated). These results could help researchers explore this phenomenon, and aid health professionals and managers when proposing future interventions.
Effectiveness of interventions for dry eye: a protocol for an overview of systematic reviews
Authors: McCann Paul , Kruoch Zanna , Qureshi Riaz , Li Tianjing
Published: June 2022

Introduction

Dry eye is a leading cause of ocular morbidity and economic and societal burden for patients and healthcare systems. There are several treatment options available for dry eye and high-quality systematic reviews synthesise the evidence for their effectiveness and potential harms.

Methods and analysis

We will search the Cochrane Eyes and Vision US satellite (CEV@US) database of eyes and vision systematic reviews for systematic reviews on interventions for dry eye. CEV@US conducted an initial search of PubMed and Embase to populate the CEV@US database of eyes and vision systematic reviews in 2007, which was updated most recently in August 2021. We will search the database for systematic reviews published since 1 January 2016 because systematic reviews more than 5 years are unlikely to be up to date. We will consider Cochrane and non-Cochrane systematic reviews eligible for inclusion. Two authors will independently screen articles. We will include studies that evaluate interventions for dry eye and/or meibomian gland dysfunction with no restriction on types of participants or review language. We will select reliable systematic reviews (ie, those meeting pre-established methodological criteria) for inclusion, assessed by one investigator and verified by a second investigator. We will extract ratings of the certainty of evidence from within each review. We will report the degree of overlap for systematic reviews that answer similar questions and include overlapping primary studies. We will present results of the overview in alignment with guidelines in the Cochrane Handbook of Systematic Reviews of Interventions (Online Chapter 5: Overviews of Reviews), the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, and an overview of reviews quality and transparency checklist. The anticipated start and completion dates for this overview are 1 May 2021 and 30 April 2022, respectively.

Ethics and dissemination

This overview will not require the approval of an Ethics Committee because it will use published studies. We will publish results in a peer-reviewed journal.

PROSPERO registration number

CRD42021279880.
Designing an online intervention for adults with addictive eating: a qualitative integrated knowledge translation approach
Authors: Leary Mark , Pursey Kirrilly , Verdejo-García Antonio , Skinner Janelle , Whatnall Megan C , Hay Phillipa , Collins Clare , Baker Amanda L , Burrows Tracy
Published: June 2022

Introduction

Codesign is a meaningful end-user engagement in research design. The integrated knowledge translation (IKT) framework involves adopting a collaborative research approach to produce and apply knowledge to address real-world needs, resulting in useful and useable recommendations that will more likely be applied in policy and practice. In the field of food addiction (FA), there are limited treatment options that have been reported to show improvements in FA symptoms.

Objectives

The primary aim of this paper is to describe the step-by-step codesign and refinement of a complex intervention delivered via telehealth for adults with FA using an IKT approach. The secondary aim is to describe our intervention in detail according to the TIDieR checklist.

Design

This study applies the IKT process and describes the codesign and refinement of an intervention through a series of online meetings, workshops and interviews.

Participants

This study included researchers, clinicians, consumers and health professionals.

Primary outcome measure

The primary outcome was a refined intervention for use in adults with symptoms of FA for a research trial.

Results

A total of six female health professionals and five consumers (n=4 female) with lived overeating experience participated in two interviews lasting 60 min each. This process resulted in the identification of eight barriers and three facilitators to providing and receiving treatment for FA, eight components needed or missing from current treatments, telehealth as a feasible delivery platform, and refinement of key elements to ensure the intervention met the needs of both health professionals and possible patients.

Conclusion

Using an IKT approach allowed for a range of viewpoints and enabled multiple professions and disciplines to engage in a semiformalised way to bring expertise to formulate a possible intervention for FA. Mapping the intervention plan to the TIDieR checklist for complex interventions, allowed for detailed description of the intervention and the identification of a number of areas that needed to be refined before development of the finalised intervention protocol.
Association between maternal infertility treatment and child neurodevelopment: findings from the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study in Miyagi and Iwate Prefectures, Japan
Authors: Noda Aoi , Ishikuro Mami , Obara Taku , Murakami Keiko , Ueno Fumihiko , Matsuzaki Fumiko , Onuma Tomomi , Watanabe Zen , Shiga Naomi , Iwama Noriyuki , Hirotaka Hamada , Otsuka Tatsui , Tachibana Masahito , Tomita Hiroaki , Saito Masatoshi , Sugawara Junichi , Kure Shigeo , Yaegashi Nobuo , Kuriyama Shinichi
Published: June 2022

Objectives

This study aimed to examine the association between infertility treatment and neurodevelopment in children at 2 and 3.5 years of age.

Design

Prospective cohort study.

Setting and participants

The study population consisted of mother–child pairs who participated in the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study in Miyagi and Iwate Prefectures, Japan. Pregnant women were recruited in obstetric clinics or hospitals and their children were followed up by the questionnaire.

Outcome measures

The children’s neurodevelopmental outcomes were assessed at 2 and 3.5 years of age using the Ages and Stages Questionnaire, third edition (ASQ-3), which consists of questions on five developmental domains. We performed a multivariate logistic regression analysis of the association between infertility treatment (including ovulation induction (OI), artificial insemination with husband’s sperm (AIH) and assisted reproductive technology (ART)) and the clinical range of ASQ-3.

Results

Of 9655 mother–child pairs, 273 (2.8%) and 487 (5.0%) were conceived through OI/AIH and ART, respectively. The odds of having developmental delays at 2 years of age were higher in children conceived through OI/AIH (OR, 1.36; 95% CI 1.00 to 1.85) and ART (OR, 1.36; 95% CI 1.07 to 1.72) than in those conceived naturally. Additionally, OI/AIH and ART were significantly associated with communication (OR, 1.93; 95% CI 1.25 to 2.98) and gross motor (OR, 1.50; 95% CI 1.08 to 2.09) delays, respectively. There were no statistically significant differences in the odds of having developmental delays at 3.5 years of age in children conceived through OI/AIH (OR, 1.13; 95% CI 0.79 to 1.61) and ART (OR, 1.03; 95% CI 0.78 to 1.37).

Conclusion

In this study, we found a significant association between infertility treatment and children’s neurodevelopment at 2 years of age, whereas no statistically significant differences were found at 3.5 years of age.
Prevalence and factors associated with symptoms of depression, anxiety and stress among traffic police officers in Kathmandu, Nepal: a cross-sectional survey
Authors: Yadav Binita , KC Anil , Bhusal Sandesh , Pradhan Pranil Man Singh
Published: June 2022

Objective

This study aimed to assess the prevalence of depression, anxiety and stress, associated factors and stress-coping strategies among traffic police officers in Kathmandu, Nepal.

Design

Cross-sectional survey.

Setting

Kathmandu Valley, Nepal.

Participants

A total of 300 traffic police officers working under the different traffic units of Kathmandu Valley for at least 6 months were recruited via a simple random sampling procedure.

Primary outcome measures

State of depression, anxiety and stress among traffic police officers based on the Depression, Anxiety and Stress Scale.

Secondary outcome measures

Coping strategies under stressful conditions based on the Coping Orientation to Problems Experienced Inventory (Brief-COPE) tool.

Results

Altogether 124 (41.3%) traffic police officers had symptoms of depression, 141 (47%) had anxiety symptoms and 132 (44%) had symptoms of stress. Smoking was significantly associated with an increased likelihood of experiencing symptoms of depression (adjusted OR (AOR): 10.7, 95% CI: 4.8 to 23.6), anxiety (AOR: 7.1, 95% CI: 3.4 to 14.9) and stress (AOR: 6.8, 95% CI: 3.3 to 14.1). Similarly, longer working hours was significantly associated with higher odds of experiencing symptoms of depression (AOR: 3.4, 95% CI: 1.8 to 6.4), anxiety (AOR: 2.3, 95% CI: 1.3 to 3.9) and stress (AOR: 1.9, 95% CI: 1.1 to 3.4), and lack of physical exercise was associated with an increased likelihood of exhibiting depressive symptoms (AOR: 2.3, 95% CI: 1.1 to 4.7). Participants in this study used positive coping strategies more than negative coping strategies.

Conclusion

Our study found a high prevalence of depression, anxiety and stress symptoms among traffic police officers in Kathmandu Valley, Nepal. Smoking and longer working hours were associated with an increased likelihood of experiencing symptoms of depression, anxiety and stress, and lack of physical exercise was associated with an increased likelihood of depressive symptoms.
965 Accuracy of emergency (999) telephone triage for predicting adverse outcomes in suspected COVID-19: an observational cohort study
Authors: Marincowitz Carl , Bath Peter , Hasan Madina , Stone Tony , Campbell Richard , Pilberry Richard , Turner Janette , Thomas Benjamin , Goodacre Steve
Published: June 2022

Aims/Objectives/Background

In the first wave of the pandemic some ambulance services received three times their usual number of 999 calls. The increase was mostly due to calls from patients with respiratory symptoms. Call handlers must rapidly decide whether patients need an emergency face-to-face assessment or could access non-emergency services.

We assess accuracy of emergency telephone triage in identifying patients with suspected COVID-19 infection who need an ambulance response and identify factors which affect triage accuracy.

Methods/Design

An observational cohort study of adults who contacted 999 emergency telephone services provided by Yorkshire Ambulance Service between the 18thMarch 2020 and 29thJune 2020 with symptoms indicating possible COVID-19 infection was completed. Callers were linked to ONS death registrations and routine health care data collected by NHS Digital.

The accuracy of triage outcome (ambulance dispatch versus telephone advice) was assessed for death or organ support 30 days from first contact. Multi-variable logistic regression was used to identify factors associated with risk of false negative or false positive triage.

Results/Conclusions

Of the 12, 655 callers, 11.1% experienced the primary outcomes. An ambulance was dispatched to 84.2% of callers. The decision to dispatch an ambulance achieved 95% sensitivity (95% CI: 93.7 to 96.1%) and 17.2% specificity (95% 16.5% to 17.9%) for adverse outcomes. Where an ambulance was not dispatched, patients had a 3.5% (2.8 to 4.4%) of subsequent deterioration. Of patients that received an ambulance only 57% were subsequently conveyed to hospital. Multivariable logistic regression modelling found false negative assessment was associated with younger age and female sex and false positive assessment was associated with malignancy, immunosuppression, respiratory and cardiovascular comorbidities.

Emergency telephone triage of patients with suspected COVID-19 achieved a high sensitivity to serious adverse outcomes. Further research is required to identify ways specificity of triage could be improved to reduce unnecessary ambulance dispatch.
1078 The prognostic accuracy of neutrophil-lymphocyte ratio in COVID-19 patients
Authors: Eid Mustafa
Published: June 2022

Aims/Objectives/Background

COVID-19 is a newly emerging pandemic viral disease. Multiple management guidelines were introduced; nevertheless, their efficacy is still under debate. Thus, the presences of prognostic factors are essential for predicting which patients will need more invasive treatments.

The study aims to investigate the prognostic accuracy of neutrophil-lymphocyte ratio in COVID-19 infection.

Methods/Design

This is a prospective study done in Al-Ain Hospital in the United Arab Emirates. All the Covid-19 patients presenting to the hospital were enrolled over one month from 20/3 to 20/4/2020. We gathered information about their age, sex, mode of transmission and calculated their Neutrophils/Lymphocytes ratio (NLR) from the first complete blood picture on admission. We divided the patients into two groups: those aged 50 years and above and those aged less than 50 years. We chose the best NLR cut-off value based on the Youden index and receiver operating characteristic (ROC) curve analysis. The target endpoint was the presence or absence of intensive care unit (ICU) admission.

Results/Conclusions

The study revealed that 48 patients (14%) needed ICU admission, while 296 patients (86%) were admitted to a ward or quarantine facilities. When the patient‘s age was > 50, and NLR was ≥ 3.10, it showed a sensitivity of 95.24% and a specificity of 92.86% for predicting the need for ICU admission. When NLR was ≥ 4.21, and the patient‘s age was < 50, the sensitivity and specificity were 70.3% and 93.7%, respectively.

NLR proved to be highly specific and sensitive in helping to identify patients who need more invasive care among people over 50 years of age with COVID-19. Additionally, it can be used as a ruling out gadget for low-risk patients among people under 50 years old.
774 Survey to investigate the current use of pre-hospital blood product by air ambulance services in the United Kingdom
Authors: Mercer James
Published: June 2022

Aims/Objectives/Background

It is thought that administering pre-hospital blood products (PHBP) in traumatic haemorrhagic shock can increase survival. The resuscitation with Pre-Hospital Blood Products (RePHILL trial) was a multi-centre, randomised controlled trial of pre-hospital blood product administration versus standard care for traumatic haemorrhage designed to answer this question. In 2016 less than half of all air ambulance services (AAS) in the United Kingdom (UK) carried PHBP. In 2019 this number had increased to 18/22 AAS. The aim of this survey was to review the current use of PHBP by AAS in the UK prior to publication of the RePHILL trial.

Methods/Design

On the 21stApril 2021, all UK AAS were emailed using the contact address published on their website with a standardised email asking about their current use of PHBP. AAS who did not reply were followed up with a second email three weeks later. Complete non-responders had their websites searched for blood product terms to see if the service reported their use.

Results/Conclusions

17 out of 22 AAS replied to the survey. Information was extracted from a further three AAS websites. 17 AAS reported carrying packed red blood cells, seven carried fresh frozen plasma, six carried Lyoplas, two carried fibrinogen and one carried Beriplex. No AAS reported carrying platelets. Two AAS reported not carrying any PHBP.

In 2016 less than half of UK ASS carried PHBP, now almost every service is adopting their use. To have widespread practice changes such as this over the last five years demonstrates how quickly the field of pre-hospital emergency medicine is evolving. Carrying PHBP brings a cost to services and risk to patients. If the RePHILL trial fails to demonstrate an outcome benefit from PHBP once published, it will be interesting to see whether AAS continue to employ a PHBP model for traumatic haemorrhage resuscitation.
803 Characteristics of patients with COVID-19 undergoing CT pulmonary angiography in the emergency department: a retrospective observational study
Authors: Rogers Annabel , Brend Jonathan , Pitt Dominic , Parker Amelia
Published: June 2022

Aims/Objectives/Background

The shared features of pulmonary embolism (PE) and COVID-19 create a diagnostic challenge for Emergency Departments. Raised D-dimer and CRP are predictive of PE, critical illness and mortality from COVID-19, however guidelines state there is insufficient evidence to recommend that biomarkers be used to guide practice to diagnose PE. This retrospective observational study analyses characteristics and biomarkers of patients with COVID-19 undergoing CT pulmonary angiography (CTPA) in the Emergency Department. The aim is to establish whether there is a role for D-dimer, CRP and Wells’ score to risk stratify patients with COVID-19 to guide CTPA imaging and enable early diagnosis of PE.

Methods/Design

CTPA scans requested by two London Emergency Departments in April 2020, December 2020-February 2021 were identified.Inclusion:COVID-19 positive by PCR or radiographic appearances. Patient records screened to identify: gender, age, days since symptom onset, D-dimer and CRP.Exclusion:>30 days symptoms, chronic PE, already receiving anticoagulation or insufficient data. Wells’ scores calculated for patients diagnosed with PE.

Results/Conclusions

468 patients were included, with 47 diagnosed with PE on CTPA (prevalence=10%). D-dimer (ng/ml) is significantly higher in patients with PE compared to no PE (median 6154; IQR 2455-12092 v med 1221; IQR 787-2350, p<0.05). Odds ratio for PE with D-dimer ≥1000 compared to D-dimer <1000 = 26.8 (95% confidence interval: 3.66–196.29). Diagnostic testing: sensitivity 97.87%, specificity 36.82%, PPV 14.74%, NPV 99.36%. Mean Wells’ score in patients with PE=4 (3–7.5), with 53% (n=25) having a Wells’ score of 4 or less (’PE unlikely’).

D-dimer has a strong NPV for PE at values less than 1000ng/ml in the COVID-19 population, and therefore may have a role in ruling out PE and reducing CTPA scans in the Emergency Department. The Wells’ criteria, if used according to NICE guidance, would not indicate CTPA and potentially lead to delayed diagnosis in this patient group.
875 Does fibrinogen concentrate improve outcomes in major traumatic haemorrhage? A systematic review
Authors: Bentley David , Bentley Alena , Brundage Susan , Rappoport Jacqueline
Published: June 2022

Background

Acute traumatic coagulopathy (ATC) is present in a quarter of severely injured patients and is associated with worse outcomes.(1–3) Fibrinogen is the first clotting protein to become deficient in ATC and there is a suggestion that supplementary fibrinogen may improve outcomes in these patients.(1, 4, 5) This review aimed to explore the efficacy and safety profile of fibrinogen concentrate (FC) administration to patients suffering from traumatic haemorrhage.

Methods

A comprehensive search of Medline, Embase and the Cochrane Library databases was performed. Studies were included if they compared FC administration with a suitable comparator group in adults suffering from traumatic haemorrhage. Only randomised controlled trials, quasi-experimental or cohort studies were included at the screening stage. Included papers were analysed by narrative review.

Results

271 studies were identified and screened of which 8 were included. Mortality data was conflicting and of poor overall quality. Four of the studies reported a survival benefit with FC administration,(6–9) one reported a higher ICU mortality,(10) and the remaining studies found no significant difference relative to the comparators.(11, 12) All studies exploring the effect of FC on plasma fibrinogen levels found a significant increase to normal levels in the FC group at 2 hours post intervention.(11–13) One study demonstrated that this effect lasted for twelve hours after receiving FC.(11) There was no increase in the incidence of thromboembolic events in patients treated with FC compared to standard care.

Conclusion

FC is effective at reversing hypofibrinogenaemia in the setting of ATC and does not appear to increase the risk of thromboembolic events. Mortality data remains conflicted and of poor overall quality, therefore it is unclear if these affects correspond to improved clinical outcomes. Randomised controlled trials adequately powered to detect a mortality difference are recommended before the clinical efficacy of FC in traumatic haemorrhage can be established.
808 Changing nature of major trauma from 2000 to 2019 in England and Wales: observational registry study
Authors: Shanahan Thomas , Tomkins Michael , Bouamra Omar , Edwards Antoinette , Kumar Dhushy Surendra , Coats Timothy , Lecky Fiona
Published: June 2022

Aims/Objectives/Background

Low energy transfer mechanisms – predominately falls from a standing height – have been identified as the most prevalent cause of major trauma in higher-income countries. This study examines the epidemiological trends in major trauma in England and Wales between 2000 – 2019, incorporating changes in mechanism of injury, imaging practices, case ascertainment and national demographic shifts. In addition, changes in the whole cohort of major trauma patients and differences between patients who suffered high energy and low energy mechanism of injury are described.

Methods/Design

A retrospective observational cohort study was conducted using Trauma Audit and Research Network (TARN) data. Patients with an injury severity score (ISS) >15 admitted to hospital in England and Wales between 1 January 2000 to 31 December 2019 were included. The primary outcome was the temporal trend in the proportion of major trauma sustained through low energy transfer, and its association with imaging practices, case ascertainment and demographic changes.

Results/Conclusions

241,484 participants were included in the analysis, of which 96,833 were classified as low energy. Low energy trauma accounted for 12.5% in 2000 (n = 373), rising to 52.6% (n=16,087) in 2019. Over the same period the proportion of patients receiving CT imaging increased from 20.7% (n=676) to 88.9% (n=27,174). TARN hospital membership doubled from 96 to 179 hospitals, and the annual mean numbers of cases per hospital per annum increased sixfold from 31 to 174. Case ascertainment improved from 42% in 2008 to 95% in 2019. Significant differences were observed in the demographics, injury patterns, presenting physiology, care pathways, and outcomes between the high and low energy cohorts.

Changes in imaging and reporting practices have revealed a previously hidden burden of injury resulting from low energy transfer mechanisms. It is essential that future research recognises this distinct cohort and investigates how trauma systems can be changed to optimise outcomes.
1048 Incidence of hyperoxia in traumatically injured patients receiving pre-hospital emergency anaesthesia: a 5-year retrospective analysis
Authors: Leitch Patricia , Hudson Anthony , Griggs Jo , Avest Ewoud ter , Stolmeiger Renate , Lyon Richard
Published: June 2022

Aims/Objectives/Background

Previous studies have demonstrated an association between hyperoxia and increased mortality in various patient conditions. In the present study, we aim to investigate the incidence of hyperoxia in trauma patients receiving PHEA, and we aim to determine factors that may help guide prehospital oxygen administration.

Methods/Design

A retrospective cohort study was performed of all patients who received PHEA by a single helicopter emergency medical service (HEMS) service between 1 October 2014 and 1 May 2019 and who were subsequently transferred to one major trauma centre (MTC). Patient and treatment factors were collected from the electronic patient records of the HEMS service and the hospital. Hyperoxia was defined as a PaO2 >16, based on the first arterial blood gas analysis upon arrival to hospital.

Results/Conclusions

On presentation to the MTC, the majority of the patients (90/147, 61,2%) had severe hyperoxia, 30 patients (20.4%) had mild hyperoxia, 26 patients (19.7%) had normoxia, and 1 patient (0.7%) had hypoxia. The median [IQR] PaO2in the first ABGA after HEMS handover was 36.7 [18.5–52.2] kPa, with a range of 7.0–86.0 kPa. SpO2 readings before handover were independently associated with presence of hyperoxia. An SpO2 ≥97% was associated with significantly increased odds of hyperoxia (OR 3.99 [1.58–10.08], and had a sensitivity of 86.7 [79.1–92.4]%, specificity of 37.9 [20.7–57.8]%, positive predictive value of 84.5 [70.2–87.9]% and a negative predictive value of 42.3 [27.4–58.7]% for presence of hyperoxemia.

HEMS oxygenation strategies are effective; trauma patients who have undergone PHEA often have a profound hyperoxemia upon arrival in hospital. In the prehospital setting where ABGA is not readily available, target SpO2 of 94–98% as recommended in BTS Guidelines should guide FiO2 titration to reduce risk of tissue hyperoxia. Predeparture checklists should include an agreed system to adjust FiO2 according to a patient’s SpO2 rather than fixed concentration.
947 The ‘silent video’ as a training aid for emergency department major incident management
Authors: Paranamana Supathum , Roland Damian , Coats Tim
Published: June 2022

Aims/Objectives/Background

There is a specific need to refresh knowledge of and update Major Incident Protocols (MIP) but a department may have less than one Major Incident (MI) every 5 years.

As part of our department’s COVID-19 pandemic response, a ‘silent movie’ of PPE donning-and-doffing techniques was played on large screens in the background during clinical handovers. We theorised that this technique might be effective in training ED staff on the MIP.

Methods/Design

We created a seven-minute silent video about our MIP using volunteer actors from ED Doctors, Nurses, and Ancillary Healthcare Staff. Brief captions describing key aspects of the MIP were overlaid on video clips and images.

The video was played on a continuous loop on wall mounted TVs for six continuous weeks, located within the handover room used by all ED staff members.

A questionnaire was sent out to all staff in ED to assess how the video’s content improved understanding of the MIP. The design of the questionnaire was based on the Moore’s Expanded Education Outcome Model.

Abstract 947 Table 1Moore’s Outcomes FrameworkMeasure/QuestionResponseLEVEL 1
ParticipationParticipation in questionnaire95 responses out of 851 staff.Have you seen the ED major Incident video in the Handover Room?67% of respondents had seen the training video (90% of these watched the whole video).LEVEL 2
SatisfactionI was satisfied with the format, delivery and content of the video.70% were satisfied with the format of the videoI found the content of the video useful.84% thought the content usefulLEVEL 3A
Learning: Declarative KnowledgeI know how the ED is organised in a Major Incident.Before 25%, After 66%.LEVEL 3B
Learning: Procedural KnowledgeI know what to do in a major incident.Before 35%, After 67%I could locate the Major Incident tray in each area of the ED.Before 28%, After 53%.I would be able to perform well in a Major Incident.Before 40%, After increased to 69%

Results/Conclusions

64 of the respondents viewed the video. From the cohort, 70% were satisfied with the format of the video and 84% believed the content to be useful. Using the Moore’s outcome model there was an increase in 62.1% of the declarative knowledge post viewing, and a 47.8% increase in the confidence of knowing what to do in a MI. The confidence in being able to locate the MIP tray and perform well in a MI had also increased by 47.2% and 42.02% respectively.

The repeated silent video format was an effective teaching tool, as reflected in all aspects of Moore’s model; majority of respondents showed improved confidence in all aspects of the MIP. Background training videos could form part of ED training, especially for topics which are not included in formal training programs.