bluuebunny/crossref_metadata_2025 huggingface dataset:
Contribution of an Eastern Indochina-derived fragment to the formation of island arc systems in the Philippine Mobile Belt
Authors: Gong Lin , Hollings Pete , Zhang Yu , Tian Jing , Li Dengfeng , Berador Al Emil , Chen Huayong
Published: January 2021

The Philippine Mobile Belt is a complex plate boundary with multiple terranes in Southeast Asia, yet its early tectonic evolution is still not fully understood due to a scarcity of solid evidence. Here we report new whole rock geochemical, Sr-Nd isotopic, and zircon U-Pb-Hf isotopic data for Cretaceous-Miocene arc magmatic rocks from the Cebu and Bohol Islands, Philippine Mobile Belt. Bulk geochemical data display arc affinities with enriched large ion lithophile elements (e.g., Sr and Ba) and depleted high field strength elements (e.g., Nb, Ta, and Ti). The high positive εNd(t) (+4.6 to +9.1) values and low initial 87Sr/86Sr ratios (0.7032–0.7048) suggest that these igneous rocks were generated by partial melting of mantle wedge in an arc setting. U-Pb dating of zircons revealed Cretaceous (ca. 120–90 Ma), middle Eocene to early Oligocene (ca. 43–30 Ma), and middle Miocene (ca. 14 Ma) crystallization ages for the arc magmatism with abundant Permian-Triassic zircon xenocrysts clustering at ca. 250 Ma. The Permian-Triassic grains show dominantly negative εHf(t) values ranging from −16.2 to −6.6, which are similar to those of coeval rocks in Eastern Indochina. Combined with previous paleomagnetic studies, we propose that an Eastern Indochina-derived continental fragment was involved during the formation of arcs in the Cebu and Bohol Islands, which highlights the potential contribution of ancient continental materials in the formation of intra-oceanic arcs. This scenario does not support the previously proposed model that the Cretaceous arc in the Philippine Mobile Belt formed in the northern margin of the proto-Philippine Sea Plate and Australian margin.
Predictive study of tuberculosis incidence by time series method and Elman neural network in Kashgar, China
Authors: Zheng Yanling , Zhang Xueliang , Wang Xijiang , Wang Kai , Cui Yan
Published: January 2021

Objectives

Kashgar, located in Xinjiang, China has a high incidence of tuberculosis (TB) making prevention and control extremely difficult. In addition, there have been very few prediction studies on TB incidence here. We; therefore, considered it a high priority to do prediction analysis of TB incidence in Kashgar, and so provide a scientific reference for eventual prevention and control.

Design

Time series study.

Setting Kashgar, China

Kashgar, China.

Methods

We used a single Box-Jenkins method and a Box-Jenkins and Elman neural network (ElmanNN) hybrid method to do prediction analysis of TB incidence in Kashgar. Root mean square error (RMSE), mean absolute error (MAE) and mean absolute percentage error (MAPE) were used to measure the prediction accuracy.

Results

After careful analysis, the single autoregression (AR) (1, 2, 8) model and the AR (1, 2, 8)-ElmanNN (AR-Elman) hybrid model were established, and the optimal neurons value of the AR-Elman hybrid model is 6. In the fitting dataset, the RMSE, MAE and MAPE were 6.15, 4.33 and 0.2858, respectively, for the AR (1, 2, 8) model, and 3.78, 3.38 and 0.1837, respectively, for the AR-Elman hybrid model. In the forecasting dataset, the RMSE, MAE and MAPE were 10.88, 8.75 and 0.2029, respectively, for the AR (1, 2, 8) model, and 8.86, 7.29 and 0.2006, respectively, for the AR-Elman hybrid model.

Conclusions

Both the single AR (1, 2, 8) model and the AR-Elman model could be used to predict the TB incidence in Kashgar, but the modelling and validation scale-dependent measures (RMSE, MAE and MAPE) in the AR (1, 2, 8) model were inferior to those in the AR-Elman hybrid model, which indicated that the AR-Elman hybrid model was better than the AR (1, 2, 8) model. The Box-Jenkins and ElmanNN hybrid method therefore can be highlighted in predicting the temporal trends of TB incidence in Kashgar, which may act as the potential for far-reaching implications for prevention and control of TB.
Platelet aggregation inhibitor prescription for newly diagnosed peripheral arterial disease in the Netherlands: a cohort study
Authors: Brand Aarent RT , Houben Eline , Bezemer Irene D , Visseren Frank L J , Bots Michiel L , Herings Ron MC , de Borst Gert-Jan
Published: January 2021

Objectives

Pharmacological treatment of peripheral arterial disease (PAD) comprises of antiplatelet therapy (APT), blood pressure control and cholesterol optimisation. Guidelines provide class-I recommendations on the prescription, but there are little data on the actual prescription practices. Our study provides insight into the prescription of medication among patients with PAD in the Netherlands and reports a ‘real-world’ patient journey through primary and secondary care.

Design

We conducted a cohort study among patients newly diagnosed with PAD between 2010 and 2014.

Setting

Data were obtained from the PHARMO Database Network, a population-based network of electronic pharmacy, primary and secondary healthcare setting records in the Netherlands. The source population for this study comprised almost 1 million individuals.

Participants

‘Newly diagnosed’ was defined as a recorded International Classification of Primary Care code for PAD, a PAD-specific WCIA examination code or a diagnosis recorded as free text episode in the general practitioner records with no previous PAD diagnosis record and no prescription of P2Y12 inhibitors or aspirin the preceding year. The patient journey was defined by at least 1 year of database history and follow-up relative to the index date.

Results

Between 2010 and 2014, we identified 3677 newly diagnosed patients with PAD. Most patients (91%) were diagnosed in primary care. Almost half of all patients (49%) had no APT dispensing record. Within this group, 33% received other anticoagulant therapy (vitamin K antagonist or direct oral anticoagulant). Mono-APT was dispensed as aspirin (40% of patients) or P2Y12 inhibitors (2.5% of patients). Dual APT combining aspirin with a P2Y12 inhibitor was dispensed to 8.5% of the study population.

Conclusion

Half of all patients with newly diagnosed PAD are not treated conforming to (international) guideline recommendations on thromboembolism prevention through APT. At least 33% of all patients with newly diagnosed PAD do not receive any antithrombotic therapy. Evaluation and improvement of APT prescription and thereby improved prevention of (secondary) cardiovascular events is warranted.
General populations’ preferences for colorectal cancer screening: rationale and protocol for the discrete choice experiment in the SIGMO study
Authors: Brinkmann Melanie , Diedrich Leonie , Krauth Christian , Robra Bernt-Peter , Stahmeyer Jona Theodor , Dreier Maren
Published: January 2021

Introduction

In Germany, the organised colorectal cancer (CRC) screening programme includes the immunologic faecal occult blood test and colonoscopy. The sigmoidoscopy is recommended for individuals rejecting colonoscopy but is not included into the screening programme. To examine whether the evidence based sigmoidoscopy should be additionally offered, the first objective of this study is to evaluate the demand for sigmoidoscopy by analysing the German general populations’ preferences for CRC screening.

Methods and analysis

Preference data will be collected using a discrete choice experiment (DCE). Identification and selection of the attributes and their levels will be supported by evidence resulting from a systematic literature search and focus groups. An efficient, fractional factorial choice design will be generated. In a cross-sectional study, the DCE will be administered as a written questionnaire to a random sample of 4000 members of the statutory health insurance company in Lower Saxony (AOK Lower Saxony). Insured persons 50–60 years of age without CRC or a chronic inflammatory bowel disease will be eligible. The collected choice data will be analysed by conducting a conditional logit regression model and latent class models.

Ethics and dissemination

Ethical approval for this study was obtained from the Ethics Committee of Hannover Medical School (reference number 8671_BO_K_2019). The study results will be disseminated via conference presentations, publications in peer-reviewed journals and, to participants, the membership magazine of the AOK Lower Saxony.

Trial registration number

DRKS00019010.
Association between objectively measured body composition, sleep parameters and physical activity in preschool children: a cross-sectional study
Authors: Wyszyńska Justyna , Matłosz Piotr , Asif Muhammad , Szybisty Agnieszka , Lenik Paweł , Dereń Katarzyna , Mazur Artur , Herbert Jarosław
Published: January 2021

Objective

Associations between self-reported sleep duration and obesity indices in children are well recognised; however, there are no studies on associations between objectively measured other sleep parameters and physical activity with body composition in preschoolers. Therefore, the aim of this study was to determine the associations between sleep parameters and moderate-to-vigorous physical activity (MVPA) with body composition indices in preschoolers using objective measures.

Design

A cross-sectional study.

Participants

The study group consisted of 676 children aged 5–6 years, who were enrolled in kindergartens in the 2017/2018 school year.

Outcome measures

Sleep parameters and MVPA were measured using accelerometers for 7 days. Bioelectrical impedance analysis was used to estimate body composition.

Results

Sleep duration and sleep efficiency were inversely associated with body fat percentage (BFP) (β=−0.013 and β from –0.311 to −0.359, respectively) and body mass index (BMI) (β from −0.005 to −0.006 and from −0.105 to –0.121, respectively), and directly associated with fat-free mass (FFM) (β from 0.010 to 0.011 and from 0.245 to 0.271, respectively) and muscle mass (β from 0.012 to 0.012 and from 0.277 to 0.307, respectively) in unadjusted and adjusted models. BFP was inversely associated with MVPA and positively associated with number of awakenings and sleep periods. Number of sleep periods was inversely associated with FFM, and positively with BMI and muscle mass. Correlation matrix indicated significant correlation between BFP, FFM and muscle mass with sleep duration, sleep efficiency, number of sleep periods and MVPA.

Conclusions

Periodic assessment of sleep parameters and MVPA in relation to body composition in preschool children may be considered, especially in those who are at risk for obesity.
Timely short-term specialised palliative care service intervention for frail older people and their family carers in primary care: study protocol for a pilot randomised controlled trial
Authors: de Nooijer Kim , Pivodic Lara , Van Den Noortgate Nele , Pype Peter , Van den Block Lieve
Published: January 2021

Introduction

There is limited evidence regarding the effectiveness of timely integration of short-term specialised palliative care services for older people in primary care. Using a Theory of Change approach, we developed such an intervention, the Frailty+ intervention. We present the protocol of a pilot randomised controlled trial (RCT) with a process evaluation that aims to assess the feasibility and preliminary effectiveness of the Frailty+ intervention.

Methods and analysis

We will conduct a pilot RCT in Flanders, Belgium. Frail older people who are discharged to home from hospital will be identified and recruited. Seventy-six will be randomly assigned either to the control group (standard care) or the intervention group (Frailty+ intervention alongside standard care). Data will be collected from patients and family carers. At the core of the Frailty+ intervention is the provision of timely short-term specialised palliative care facilitated by a nurse from the specialised palliative home care service over a period of 8 weeks. We will assess feasibility in terms of recruitment, randomisation, acceptability of the intervention, retention in the programme and data completion. The primary outcome for assessing preliminary effectiveness is a mean score across five key symptoms that are amenable to change (ie, breathlessness, pain, anxiety, constipation, fatigue), measured at baseline and 8 weeks post-baseline. The process evaluation will be conducted in the intervention group only, with measurements at 8–11 weeks post-baseline to evaluate implementation, mechanisms of change and contextual factors.

Ethics and dissemination

The study has been approved by the ethics committee of University Hospital Ghent. Results will be used to inform the design of a full-scale RCT and will be published in a peer-reviewed, open access journal.

Trial registration number

ISRCTN39282347; Pre-results.
Evaluating the feasibility and acceptability of a co-design approach to developing an integrated model of care for people with multi-morbid COPD in rural Nepal: a qualitative study
Authors: Yadav Uday Narayan , Lloyd Jane , Baral Kedar Prasad , Bhatta Narendra , Mehata Suresh , Harris Mark
Published: January 2021

Objective

To understand the feasibility and acceptability of a co-design approach to developing an integrated model of healthcare for people with multi-morbid chronic obstructive pulmonary disease (COPD) in rural Nepal.

Settings

A rural setting of Nepal.

Participants

Data collection included five video recordings, five key informant interviews and observation notes from a final co-design workshop that involved a total of 68 stakeholders: persons with COPD and their family members; healthcare providers, including respiratory physicians; local community leaders; representatives from local, provincial and federal government; academics; and representatives from non-government organisations.

Primary and secondary outcome measure(s)

Feasibility and acceptability of using a co-design approach to develop an integrated model of care for people with multi-morbid COPD in rural Nepal.

Results

Our qualitative evaluation of the Hasso Plattner’s co-design process found that all stakeholders (including people with COPD/community members, primary care practitioners and local government/senior health officials) were actively engaged in and significantly contributed to the process of co-design. Four main themes were identified which determined the feasibility and acceptability of the resulting integrated model of care: engagement of stakeholders, factors contributing to the co-design, consequences of the co-design process, and challenges and opportunities learnt by the researchers and participants in the co-design process. Based on the relationship between the four main themes emerging from this research, we developed an evaluation framework to guide the co-design of a health service innovation.

Conclusion

Our study demonstrated the feasibility and acceptability of the Hasso Plattner’s co-design process. Our findings suggest that this co-design approach can be useful and acceptable
to local communities and government agencies. It enabled the meaningful contribution of a
diverse group of stakeholders in the design and delivery of health services in low-income and middle-income countries.
Development of the PriCARE classification for potentially preventable emergency department visits by ambulance: a RAND/UCLA modified Delphi study protocol
Authors: Strum Ryan P , Tavares Walter , Worster Andrew , Griffith Lauren E , Rahim Ahmad , Costa Andrew P
Published: January 2021

Introduction

Ontario ambulances are restricted from patient transportation to sub-acute levels of care when these facilities may be more suitable than emergency departments for non-emergent conditions. There is no known patient classification specifically constructed to inform ED diversion protocols and guidance for sub-acute centre transportation for primary care–like patient conditions.

Objective

To construct a novel patient classification of potentially preventable emergency department visits following transport by ambulance, and analyse patient-level characteristic associations with this classification based in Ontario secondary data.

Methods and analysis

The Primary Care–like Ambulance transports following Response for 911-Emergencies (PriCARE) patient classification will be constructed using a two-phase RAND/UCLA modified Delphi design. All experts included are physicians with relevant experience in emergency and/or primary care in Ontario. The first phase of the study will determine consensus of the expert committee on which ED interventions performed on patients with non-emergent acuities could be conducted in sub-acute healthcare centres. The second phase will assess consensus of which patient, hospital and acuity factors are most appropriate to be incorporated into a PriCARE classification. We will also investigate secondary outcomes on consensus of which ED interventions could be transferred to a paramedic context given an expanded scope of practice and patient-level characteristics of PriCARE classified individuals.

Ethics and dissemination

This study received a research ethics board exemption waiver from the Hamilton Integrated Research Ethics Board; review reference 2020-11451-GRA. Results will be submitted for publication in a peer-reviewed journal and presented at relevant conferences. The results will be shared with Ontario paramedic services and governing institutions. This study will be used to inform patient classification protocols and clinical decision tools for ambulances to transport to sub-acute healthcare centres.

Trial registration number

ISRCTN22901977.
120 NHS 24 triage of the young adult with chest pain: an analysis of patient contacts in unscheduled care
Authors: Hodgins Peter , Guthrie Bruce , McMinn Megan
Published: January 2021

Aims/Objectives/Background

Use of unscheduled care is increasing worldwide. In the UK access to services for symptoms not thought to be life-threatening is through a single telephone advice and triage service (NHS 24 in Scotland). Adults under 35 account for the largest cohort contacting this service. This study aimed to examine pathways of care in this population to inform areas for improvement to the triage process.

Methods/Design

A retrospective, population study using the Scotland-wide Urgent Care Data Mart (UCD) 2015 to 2017. The UCD links data between unscheduled care services to form Continuous Urgent Care Pathways (CUPs). CUPs for those aged 15–34 years, whose initial contact was with NHS 24 and with ‘chest pain’ recorded as the call reason. Two outcomes were examined: admission to hospital, and admission to hospital with a ‘time-critical diagnosis’ defined as an admission with a discharge diagnosis of a condition that required urgent treatment.

Abstract 120 Figure 1

Results/Conclusions

A total of 102,822 CUPs initiated by a call to NHS24 with chest pain as the call reason in the period studied. 35.1% of calls were made by people living in the most deprived 20% of postcodes. The most common CUP pathway accounted for 37.6% and was an NHS 24 call followed by an attendance at Primary Care Out of Hours. 25.4% of calls were considered not to represent an urgent care need. The most frequent ICD-10 code was ‘chest pain, unspecified’, representing 7.2% of cases with an ICD-10 code, followed by ‘asthma, unspecified’ at 7.1%. All NHS24 dispositions were strongly associated with increased odds of admission compared to self-care advice. Home-visits were associated with the greatest odds of time-critical diagnosis.

Chest pain is a symptom of concern for young people. Use of telephone triage is effective. 9060 CUPs result in a hospital admission, although many end with a non-specific diagnosis.
117 COVID-19 RCEM research summaries: taking the burden off busy clinicians
Authors: Reynard Charles , Jafar Anisa , Oliver Govind , Darbyshire Daniel , Prager Gabrielle , Naguib Mina , Carley Simon
Published: January 2021

Aims/Objectives/Background

Entering lockdown on 23rd March 2020 due to the COVID-19 pandemic marked an unprecedented period for healthcare evidence. An exponential increase in published work, pre-prints, guidelines, online information portals and more, has been overwhelming especially when combined with the ever-changing local emergency department responses to COVID-19. Many research projects were either suspended in favour of clinical work or re-routed into pandemic-oriented studies. All the while, the gap between clinical providers and a mountain of information was growing. Our team developed a strategy to deliver the most pertinent evidence to those working in emergency medicine, taking some stress out this aspect of COVID-19 working.

Methods/Design

Each week a search was conducted using PubMed of everything produced in the previous 7 days. The number of titles varied from approximately 800 to 2500. A 3 to 5 person team distilled titles and then reviewed abstracts for papers of importance and relevance to emergency medicine. Relevant and high impact journals were individually searched over the same time period. Summaries of the short-listed papers were produced and the weekly editorial team selected 5 for inclusion in the weekly RCEM Top 5 and others were combined for extra reading as part of a 2–3 weekly ‘Director’s Cut’.

Results/Conclusions

The RCEM Top 5 (at time of writing) has been run for 13 weeks. The summaries themselves were accessed by between 3000 and 6000 RCEM members/fellows each week. The work has also fed into online journal clubs and blogs (combined views of over 30,000) and has attracted interest from wider colleagues nationally and internationally to both join and even replicate the approach to other relevant areas. The positive feedback is best summarised in the following quote: ‘when I’m too mentally overcooked to do any reading on my own this helps me feel I am doing some keeping up. Please continue!’
71 Ultrasound directed reduction of Colles’ type distal radial fractures in ED (UDiReCT): a feasibility randomized controlled trial
Authors: Malik Hamza , Appelboam Andrew , Taylor Gordon , Wood Daryl , Knapp Karen
Published: January 2021

Aims/Objectives/Background

Wrist fractures are among the commonest injuries seen in the emergency department (ED). Around 25% of these injuries have Colles’ type fracture displacement and undergo manipulation in the ED. In the UK, these manipulations are typically done ‘blind’ without real time imaging and recent observational studies show that over 40% of the injuries go on to require surgical fixation (due to inadequate initial reduction or re-displacement). Point of care ultrasound has been used to guide and improve wrist fracture reductions but it’s effect on subsequent outcome is not established. We set up and ran the UK’s first randomised controlled feasibility trial comparing standard and ultrasound guided ED wrist fracture manipulations to test a definitive trial protocol, data collection and estimate recruitment rate towards a future definitive trial.

Methods/Design

We conducted a 1:1, single blind, parallel group, randomised controlled feasibility trial in two UK hospitals. Adults with Colles’ type distal radial fractures requiring manipulation in the ED were recruited by supervising emergency physicians supported by network research nurses. Participants were randomised to ultrasound directed fracture manipulation (intervention) or standard care with sham ultrasound (controls). The trial was run through Exeter Clinical Trials Unit and consent, randomisation and data collection conducted electronically in REDCap cloud. All participants were followed up at 6 weeks to record any surgical intervention and also underwent baseline and 3 month quality of life (EQ-5D-5L) and wrist function (Patient Rated Wrist Evaluation (PRWE) assessments.

Results/Conclusions

We recruited 47 patients in total, with 23 randomised to the interventional arm and 24 randomised to the control arm. We were able to follow up 100% of the patients for the 6 week follow up. Data analysis and results will be presented at the time of the conference.
292 Emergency airway management outside the operating room; a three year prospective service evaluation and quality improvement project
Authors: Horner Daniel , Daniels Benjamin , Murray Nicola , Allen Gareth , Baylis Claire
Published: January 2021

Aims/Objectives/Background

Emergency airway management outside a controlled theatre environment has been previously associated with a high rate of adverse events. Several initiatives to improve safety (such as video laryngoscopy, checklists, simulation training etc..) have been studied in isolation.

It remains unclear as to whether these interventions have been embedded in the Emergency Department (ED) and whether they offer cumulative marginal gains in safety.

Methods/Design

A prospective 3-year service evaluation delivered at a major trauma and neurosciences centre between 2016 and 2019. We designed a rolling quality improvement program to mitigate procedural airway risk through collaborative multidisciplinary team (MDT) working, education and transparent metrics.

PDSA cycles included documentary guidance (including flowcharts and checklists), high fidelity simulation training, equipment redesign, prefilled medications and mandatory reporting items (figure 1).

Abstract 292 Figure 1Abstract 292 Figure 2

Primary induction agents selected throughout the study period

Abstract 292 Figure 3

Results/Conclusions

We analysed prospectively collected data on 1181 intubation episodes outside a theatre environment over a 39 month period, of which 575 (48.7%) were performed out of hours and 635 (53.8%) were performed in the ED.

Bedside consultant presence and periprocedural checklist use both showed a sustained increase during the study period. Use of ketamine and thiopentone as primary induction agents increased and decreased, respectively (figure 2). Cricoid pressure and video laryngoscopy (VL) utilisation rates remained relatively static throughout, as did a first pass success (FPS) rate of between 83.0 to 93.5%.

Composite major complications (including sustained hypotension and/or critical hypoxia) were significantly reduced during the study period, as demonstrated via statistical process chart (SPC) mapping (figure 3).

In conclusion, we found a quality improvement program to be associated with a sustained reduction in the risk of major complications following emergency airway management. This improvement was not explained by simple direct changes in procedural care, such as the use of VL or technique changes resulting in improved FPS, but may have been influenced by unknown confounding variables.
11 External validation of the Dutch prediction model for prehospital triage of trauma patients in South West region of England, United Kingdom
Authors: Shanahan Thomas , Marincowitz Carl , Fuller Gordon , Sheldon Trevor , Quilty Fionn , Turton Emily
Published: January 2021

Aims/Objectives/Background

This is the first external validation of a European empirically derived prediction model for identifying major trauma in an unselected group of injured patients transported by ambulance in the United Kingdom.

Methods/Design

This study was an external validation of a Dutch prediction model for identifying major trauma using a retrospective cohort of injured patients who ambulance crews transported to hospitals in the South West region of England. Major trauma was defined as Injury Severity Score (ISS)>15.

Participants were patients ≥16 years with a suspected injury and transported by ambulance from February 1, 2017 to February 1, 2018. This study had a census sample of cases available to us over a one year period.

We tested the accuracy of the prediction model in terms of discrimination, calibration, clinical usefulness, sensitivity and specificity and under- and over triage rates compared to existing trauma triage practices in the South West region.

Results/Conclusions

A total of 68 698 adult patients were included in the final external validation cohort. The median age of patients was 72 (i.q.r. 46–84); 55.5% were female; and 524 (0.8%) had an ISS>15. In comparison the Dutch cohort was younger (45 years), more were male (58.3%) and more patients had an ISS>15. (8.8%) The model achieved good discrimination with a C-Statistic 0.75 (95% CI, 0.73 – 0.78). At a maximal specificity of 50% the model resulted in a sensitivity of 86%. The model improved undertriage rates at the expense of increased overtriage rates compared with routine trauma triage methods in the South West of England.

The Dutch prediction model for identifying major trauma can lower the undertriage rate to 17%, however it would increase the overtriage rate to 50% in this UK cohort. Further research is needed to determine whether the model can be practically implemented by paramedics and is cost-effective.
160 Study of shortness of breath (SOB) point-of-care biomarker panel in patients presenting with shortness of breath in emergency department
Authors: Jha Tanmay Kumar
Published: January 2021

Aim

Study of shortness of breath (SOB) point-of-care biomarker panel in patients presenting with shortness of breath in Emergency Department.

Objective

To study the sensitivity and specificity of SOB point-of-care biomarker panel in diagnosing Acute Coronary Syndrome (ACS), Heart Failure (HF) and Pulmonary Embolism (PE).

Background

Shortness of breath (SOB) is one of the commonest symptoms of patients presenting to the emergency department (ED).

The differential diagnosis of SOB is very vast, knowing the frequency and severity potential of ACS, HF and PE should be considered.

Methods/Design

165 consecutive subjects 18 or more years old, presenting to the ED due to a primary complaint of SOB were included in this prospective study.

After detailed history and thorough physical examination, the blood samples of patients included in the study were analysed using a SOB point-of-care biomarker panel (troponin I, myoglobin, CK-MB, D-dimer, and BNP at the time when patient presented with SOB within 15 minutes of patient’s visit to the ED. Thirty-day follow-up for HF, ACS and PE was performed.

The following cut offs were used for determining a positive biomarker:

myoglobin > 107 ng/mL,

CK-MB > 4.3 ng/mL,

troponin I > 0.40 ng/mL,

D-dimer > 500 ng/mL, and

BNP > 100 ng/mL.

CTCA, CTPA and 2D Echo were taken as the Gold Standard for the diagnosis of ACS, HF and PE.

Results/Conclusions

SALIENT FINDINGS

ACS:

P<0.001

Sensitivity=81.2%

Specificity=90.6%

PPV=78%

NPV=92.2%

Accuracy=87.8%

PE:

P<0.001

Sensitivity=75%

Specificity=94.6%

PPV=77.4%

NPV=93.1%

Accuracy=90.3%

HF:

P<0.001

Sensitivity=69.1%

Specificity=66.4%

PPV=50.7%

NPV=81.1%

Accuracy=67.3%

Conclusion

We conclude that there is significant correlation between SOB point-of-care biomarker panel diagnosis and final diagnosis.

In patients presenting with SOB, one of the three clinical conditions identified by the SOB point-of-care biomarker panel will lead to earlier diagnosis and initiation of specific management.
196 The effect of affect: what we teach our learners about the role of patient induced emotion in clinical reasoning in the ED and why?
Authors: Roy Susie , Skinner Janet , Jaap Alan
Published: January 2021

Aims/Objectives/Background

Few empirical studies explore the contribution of non-clinical factors to perceptions of patient difficulty in EM. Fewer have investigated what students placed in EDs learn about ‘difficult’ patients or what, if anything, clinicians teach about the topic. We looked to address this. Considering these questions is imperative: patients perceived as frustrating report lower satisfaction with their clinical encounter, experience worse health outcomes and seem to be at risk of medical error secondary to faulty clinical reasoning.

Methods/Design

With ethical approval, we undertook three interrelated, qualitative studies to conduct a case study of the undergraduate EM module delivered at Edinburgh University. In the first two, focus groups were used as the method of data collection; five clinician (n=25) and four medical student (n=21) groups were facilitated. In the third, semi-structured interviews with clinicians (n=12) were conducted. All groups/interviews were audio-recorded and transcribed. The data were analysed inductively using reflexive thematic analysis.

Results/Conclusions

Frequent attendance, demands, pre-existing relationships and unrealistic expectations contributed to perceived patient difficulty. These were modified by personal and circumstantial factors. Although rarely told, students were aware who these ‘difficult’ patients were through observing behaviours. Critically, clinicians and students alike believed frustration adversely impacted aspects of clinical reasoning. Students struggled when witnessing what they considered ‘bad’ behaviour as it contradicted their previously held ideals of how physicians should act.

It seems we teach students to try to internalise emotion yet that it is acceptable to let it negatively impact patient care. To combat this, students sought greater emotional transparency from physicians as well as advice on self-management strategies. Clinicians recognised the benefits of being candid but were afraid of being so. Contributing to this is the culture in medicine being one that mistrusts emotion. Further, both groups desired a formal curriculum addressing emotion in clinical reasoning thus suggesting one is needed.
274 Thrombotic complications in patients with COVID-19 requiring hospitalisation: a single centre prospective service evaluation
Authors: Habeichi Wadhi , Bell Jack , Khawaja Zohaib , Exley Joshua , Horner Daniel
Published: January 2021

Aims/Objectives/Background

Early experience of the coronavirus pandemic has led to concerns regarding hypercoaguability and increased rates of venous thromboembolic (VTE) disease. As a result, many centres have changed front door thromboprophylaxis risk assessment and prescribing practice. There is no clear evidence that such new approaches are safe, or improve patient outcomes.

We sought to establish the incidence of thrombotic complications in all hospitalised patients with confirmed COVID-19, at a UK thrombosis exemplar centre.

Methods/Design

A single site prospective service evaluation (Ref: S20HIP17). We identified all patients with COVID-19 who were hospitalised between 1st March and the 31st May 2020, encompassing the UK acceleration, peak and deceleration phases of the pandemic.

Standard risk assessment and weight adjusted pharmacological thromboprophylaxis were conducted in accordance with previous national and local guidelines.

We report follow up data as of the 1st July (minimum 4 weeks post diagnosis), using an established method for national VTE reporting metrics.

Results/Conclusions

A total of 528 hospitalised patients had confirmed COVID-19 during the study period, of which 74 (14.0%) were admitted to critical care. Mean age was 69.6 (SD 16.7) and the median duration of admission 7 days (IQR 16). Mortality was 35.6%.

We identified 12 VTE positive episodes at follow up, including 9 pulmonary emboli (PE) and 3 deep vein thromboses (DVT). Over 60% of PE events were isolated segmental or subsegmental thrombi, suggestive of ‘immunothrombosis’ in situ and of questionable clinical significance. VTE event rates for our population were 2.3% overall and 6.8% for those admitted to critical care.

Rates of VTE did not appear to differ from pre-pandemic levels (figure 1).

Abstract 274 Figure 1

Venous thromboembolic (VTE) events over time and proportional hospital acquired thrombosis rates(HAT)

We did not find increased rates of clinically significant VTE events in hospitalised patients with COVID-19. Our findings raise questions regarding the merits of unvalidated risk assessment tools and increased thromboprophylaxis dosing strategies in COVID-19 patients.
389 Significant impact of SARS-CoV-2 on attendances, but not acuity, in a Children’s Emergency Department
Authors: Roland Damian , Jones William
Published: January 2021

Aims/Objectives/Background

There have been anecdotal reports that delay in presenting to Children’s Emergency Departments (CED) during COVID19, combined with a reduction in more minor cases, has increased the relative acuity of children in CED.

Methods/Design

In order to determine the impact of SARS-CoV-2 on our tertiary CED we compared attendances, diagnosis at discharge, initial paediatric observation priority score (POPS) and Healthcare Resource Group (HRG) code for the months of March, April and May 2018, 2019 and 2020. POPS is a bespoke early warning-like score and is calculated between 0–16 (0 low acuity;16 high acuity) based on 8 components including vital signs and subjective observations. A large proportion of children presenting have an unrecorded or POPS 0 as they are an injury so a POPS of greater than 0 was used in analysis. A lower HRG scores indicates increased resource utilisation.

Results/Conclusions

Presentations in March, April and May 2020 fell compared with previous years with overall HRG weighting slightly increasing to 8.71 from 8.48 (2019) and 8.98 (2018) which is a clinically negligible change. There was a trend for a greater proportion of children with a POPS 0 in 2020 compared to previous years. Mean and median POPS was unchanged (table 1). Children diagnosed with an infectious disease fell by 30.5 attendances per 1000 presentations and soft tissue injuries fell by 10.0 attendances per 1000 presentations comparing 2020 and 2019. There were increases in codes relevant to specific paediatric diagnoses (croup, febrile convulsion etc.) by 11.4 attendances per 1000 presentations in the same time period and fracture/dislocations increased by 9.1 attendances per 1000 presentations.

Abstract 389 Table 1

Attendances and POPS per month and year

MonthYear of Arrival DateAttendance CountNumber of Children with a POPS >0 (%)Attendance CountMean EWSMedian EWS25th Percentile75th PercentileMarch 2018 4,123 1,682 (40.8) 4,123 5 2.00 1 3 March 2019 5,738 2,443 (42.3) 5,738 6 2.00 1 3 March 2020 3,831 1,638 (42.8) 3,831 6 2.00 1 3 April 2018 4,134 1,436 (34.7) 4,134 5 2.00 1 3 April 2019 5,159 2,066 (40.1) 5,159 5.5 2.00 1 3 April 2020 1,625 778 (47.9) 1,625 4.75 1.00 1 2 May 2018 4,594 1,515 (33.0) 4,594 6.09 2.00 1 3 May 2019 4,957 1,887 (38.1) 4,957 6.09 2.00 1 3 May 2020 2,312 937 (40.5) 2,312 5.8 1.00 1 2

While having a huge impact on childrens’ presentations to Emergency Departments there is no evidence, in our institution, of significantly elevated acuity, or a large change in case-mix, as a result of the COVID19 pandemic compared to previous years.
31 Head home: a prospective cohort study of a nurse led paediatric head injury clinical decision tool at a district general hospital
Authors: Aldridge Patrick , Castle Heather , Russell Emma , Phillips Clare , Guerrero-Luduena Richard , Rout Raj
Published: January 2021

Aims/Objectives/Background

Objectives

To assess if application of a nurse-led paediatric head injury clinical decision tool would be safe compared to current practice.

Background

>700,000 children attend UK hospitals’ each year with a head injury. Research indicates <1% undergo neurosurgical intervention. No published evidence for nurse-led discharge of paediatric head injuries exists.

Methods/Design

Methods – All paediatric (<17 years) patients with head injuries presenting to our Emergency department (ED) 1st May to 31st October 2018 were prospectively screened by a nurse using a mandated electronic ‘Head Injury Discharge At Triage’ questionnaire (HIDATq). We determined which patients underwent computed tomography (CT) brain and whether there was a clinically important intracranial injury or re-presentation to ED. The negative predictive value of the screening tool was assessed. We determined what proportion of patients could have been sent home from triage using HIDATq.

Results/Conclusions

Results - Of 1739 patients screened; 61 had CTs performed due to head injury (6 abnormal) with a CT rate of 3.5% and 2% re-presentations. Of the entire cohort, 1052 screened negative. 1 CT occurred in this group showing no abnormalities. Of those screened negative: 349/1052 (33%) had ‘no other injuries’ and 543/1052 (52%) had ‘abrasions or lacerations’. HIDATq’s negative predictive value for CT was 99.9% (95% Confidence interval (CI) 99.4–99.9%) and 100% (CI 99.0–100%) for intracranial injury. The positive predictive value of the tool was low. Five patients screened negative and re-presented within 72hrs but did not require CT imaging.

Conclusion - A negative HIDATq appears safe in our ED. Potentially 20% (349/1739) of all patients with head injuries presenting to our department could be discharged by nurses at triage with adequate safety netting advice. This increases to 50% (543/1739) if patients with lacerations or abrasions were treated and discharged at triage. A large multi-centre study is required to validate the tool.
First pass effect in patients with large vessel occlusion strokes undergoing neurothrombectomy: insights from the Trevo Retriever Registry
Authors: Jadhav Ashutosh P , Desai Shashvat M , Budzik Ronald F , Gupta Rishi , Baxter Blaise , English Joey D , Bartolini Bruno Mario , Krajina Antonin , Haussen Diogo C , Nogueira Raul G , Liebeskind David , Veznedaroglu Erol
Published: January 2021

Background

First pass effect (FPE), defined as near-total/total reperfusion of the territory (modified Thrombolysis in Cerebral Infarction (mTICI) 2c/3) of the occluded artery after a single thrombectomy attempt (single pass), has been associated with superior safety and efficacy outcomes than in patients not experiencing FPE.

Objective

To characterize the clinical features, incidence, and predictors of FPE in the anterior and posterior circulation among patients enrolled in the Trevo Registry.

Methods

Data were analyzed from the Trevo Retriever Registry. Univariate and multivariable analyses were used to assess the relationship of patient (demographics, clinical, occlusion location, collateral grade, Alberta Stroke Program Early CT Score (ASPECTS)) and device/technique characteristics with FPE (mTICI 2c/3 after single pass).

Results

FPE was achieved in 27.8% (378/1358) of patients undergoing anterior large vessel occlusion (LVO) thrombectomy. Multivariable regression analysis identified American Society of Interventional and Therapeutic Neuroradiology (ASITN) levels 2–4, higher ASPECTS, and presence of atrial fibrillation as independent predictors of FPE in anterior LVO thrombectomy. Rates of modified Rankin Scale (mRS) score 0–2 at 90 days were higher (63.9% vs 53.5%, p<0.0006), and 90-day mortality (11.4% vs 12.8%, p=0.49) was comparable in the FPE group and non-FPE group. Rate of FPE was 23.8% (19/80) among basilar artery occlusion strokes, and outcomes were similar between FPE and non-FPE groups (mRS score 0–2, 47.4% vs 52.5%, p=0.70; mortality 26.3% vs 18.0%, p=0.43). Notably, there were no difference in outcomes in FPE versus non-FPE mTICI 2c/3 patients.

Conclusion

Twenty-eight percent of patients undergoing anterior LVO thrombectomy and 24% of patients undergoing basilar artery occlusion thrombectomy experience FPE. Independent predictors of FPE in anterior circulation LVO thrombectomy include higher ASITN levels, higher ASPECTS, and the presence of atrial fibrillation.
Review of deep learning algorithms for the automatic detection of intracranial hemorrhages on computed tomography head imaging
Authors: Yeo Melissa , Tahayori Bahman , Kok Hong Kuan , Maingard Julian , Kutaiba Numan , Russell Jeremy , Thijs Vincent , Jhamb Ashu , Chandra Ronil V , Brooks Mark , Barras Christen D. , Asadi Hamed
Published: January 2021

Artificial intelligence is a rapidly evolving field, with modern technological advances and the growth of electronic health data opening new possibilities in diagnostic radiology. In recent years, the performance of deep learning (DL) algorithms on various medical image tasks have continually improved. DL algorithms have been proposed as a tool to detect various forms of intracranial hemorrhage on non-contrast computed tomography (NCCT) of the head. In subtle, acute cases, the capacity for DL algorithm image interpretation support might improve the diagnostic yield of CT for detection of this time-critical condition, potentially expediting treatment where appropriate and improving patient outcomes. However, there are multiple challenges to DL algorithm implementation, such as the relative scarcity of labeled datasets, the difficulties in developing algorithms capable of volumetric medical image analysis, and the complex practicalities of deployment into clinical practice. This review examines the literature and the approaches taken in the development of DL algorithms for the detection of intracranial hemorrhage on NCCT head studies. Considerations in crafting such algorithms will be discussed, as well as challenges which must be overcome to ensure effective, dependable implementations as automated tools in a clinical setting.
Ten years of ranavirus research (2010–2019): an analysis of global research trends
Authors: Wirth Wytamma , Lesbarrères David , Ariel Ellen
Published: January 2021

Ranaviruses are large nucleocytoplasmic DNA viruses that infect ectothermic vertebrates. Here we report the results of a scientometric analysis of the field of ranavirology for the last 10 years. Using bibliometric tools we analyse trends, identify top publications and journals, and visualise the ranavirus collaboration landscape. The Web of Science core collection contains 545 ranavirus-related publications from 2010 to 2019, with more publications produced every year and a total of 6830 citations. Research output is primarily driven by the United States and People’s Republic of China, who together account for more than 60% of ranavirus publications. We also observed a positive correlation between the average number of co-authors on ranavirus publications and the year of publication, indicating that overall collaboration is increasing. A keyword analysis of ranavirus publications from 2010 to 2019 reveals several areas of research interest including; ecology, immunology, virology/molecular biology, genetics, ichthyology, and herpetology. While ranavirus research is conducted globally, relatively few publications have co-authors from both European and Asian countries, possibly because closer countries (geographical distance) are more likely to share co-authors. To this end, efforts should be made to foster collaborations across geopolitical and cultural boundaries, especially between countries with shared research interests as ultimately, understanding global pathogens, like ranaviruses, will require global collaboration.
T-dualization of Gödel string cosmologies via Poisson–Lie T-duality approach
Authors: Eghbali Ali , Naderi Reza , Rezaei-Aghdam Adel
Published: January 2021

Using the homogeneous Gödel spacetimes we find some new solutions for the field equations of bosonic string effective action up to first order in $$\alpha '$$

α
′

including both dilaton and axion fields. We then discuss in detail the (non-)Abelian T-dualization of Gödel string cosmologies via the Poisson–Lie (PL) T-duality approach. In studying Abelian T-duality of the models we get seven dual models in such a way that they are constructed by one-, two- and three-dimensional Abelian Lie groups acting freely on the target space manifold. The results of our study show that the Abelian T-dual models are, under some of the special conditions, self-dual; moreover, by applying the usual rules of Abelian T-duality without further corrections, we are still able to obtain two-loop solutions. We also study the Abelian T-duality of Gödel string cosmologies up to $$\alpha '$$

α
′

-corrections by using the T-duality rules at two-loop order derived by Kaloper and Meissner. Afterwards, non-Abelian duals of the Gödel spacetimes are constructed by two- and three-dimensional non-Abelian Lie groups such as $$A_2$$

A
2

, $$A_2 \oplus A_1$$

A
2

⊕

A
1

and $$SL(2, \mathbb {R})$$

S
L
(
2
,
R
)

. In this way, the PL self-duality of $$AdS_3 \times \mathbb {R}$$

A
d

S
3

×
R

space is discussed.