bluuebunny/crossref_metadata_2025_split huggingface dataset:
215 Current management of moderate/severe traumatic pneumothoraces: a survey of emergency clinicians
Authors: Carlton Edward , Watkins Millie , Avery Pascale 
Published: January 2021

Aims/Objectives/BackgroundTraumatic pneumothoraces are present in one-fifth of multiple trauma victims. Traditional teaching mandates the insertion of a chest drain in the majority of cases. However, recent retrospective observational evidence suggests a trend towards conservative management. The aim of this survey was to understand the current emergency medicine (EM) practice in placing chest drains for the management of moderate/severe traumatic pneumothoraces.Methods/DesignThis scoping survey was developed through expert consensus. To achieve face validity, clinical sensibility testing was performed using a pilot survey (with user feedback). There were 14 pilot-phase respondents. The survey was then modified to achieve content validity. The survey was sent electronically to senior EM doctors in 15 sites internationally, and involved six clinical/imaging vignettes asking ‘how likely are you to insert an intercostal chest drain to manage the pneumothorax in ED?’. A five-point response was available from very unlikely to very likely. All pneumothroraces were >1 cm on imaging, but mechanism, physiology and need for ventilation varied.Results/ConclusionsOf a potential 409 respondents, 141 responses were received (34% response rate). Respondents had a range of clinical experience, with the majority qualified more than 10 years (median; 19 years).For 5/6 cases chest drain insertion was likely or very likely in >50% of responses, ranging from 52% for a non-compromised 1 cm pneumothorax in a ventilated patient to 98% for a tension pneumothorax on chest x-ray. Chest drain insertion was unlikely or very unlikely (62% of responses) in one case; an 86-year-old female on rivaroxaban with moderate respiratory compromise (respiratory rate 30 min-1) and a 2 cm pneumothorax.There is a broad range of clinical practice involving both conservative and invasive strategies in the treatment of moderate/severe traumatic pneumothoraces. There is clinical equipoise for interventional trials to determine the optimal management strategy for this patient group.
203 Finding voices: young people’s experiences of the emergency department
Authors: Keating Liza , Wilson Sarah , Hill Jonathan , Dainty Jack 
Published: January 2021

Aims/Objectives/BackgroundSelf-harm among adolescents is a major concern both because it gives rise to considerable distress and disruption in young people’s lives and it commonly recurs. There are currently wide variations in the care of this group of patients and it is widely reported that their experience in the emergency department is poor. Young people who have self-harmed may differ from others attending the ED and we need to know more about these differences to inform ED care and potential improvements. The aim of this study was to establish the needs and expectations among children and young people in the ED and to increase the understanding of the specific needs of adolescents who self-harm through comparison with another patient group in the ED.Methods/DesignWe undertook a case-control study with adolescents attending for suspected fractures serving as the control group. Adolescents and their guardians were each given a questionnaire pack on arrival in ED, and again at least 2 hours later, thus capturing their expectations and pre-existing characteristics, and their experience. Trained research assistants were present in the ED seven days a week and covered 10 am till 10 pm. The study commenced in July 2019 and terminated early in March 2020 at the onset of the COVID 19 pandemic.Results/ConclusionsYoung people who had self-harmed had significantly higher mean dissatisfaction scores than those with suspected fractures. They also had higher mean levels of emotional and interpersonal difficulties and these were associated with higher dissatisfaction scores. This is the first case-control study to show that dissatisfaction with the ED is at least partly a function of the particular mental health problems suffered by adolescents who self-harm. This in turn provides initial clues to the particular needs of this group of patients in whom the current management is widely reported as inadequate.
480 The prognostic value of D-dimer for COVID-19 outcomes
Authors: Killeen Peter , Trivedy Chet , Paradise Dave , Coughlan Evan 
Published: January 2021

Aims/Objectives/BackgroundThe diagnosis and management of COVID-19 has presented a novel challenge in the emergency department (ED). Early and sensitive predictors of outcome are needed to improve management of COVID-19 patients. Recent evidence has suggested a role for a COVID-19 associated pro-thrombotic coagulopathy as part of the underlying pathology. The aim was to evaluate the prognostic utility of D-dimer as a biomarker predictive of outcome in COVID-19 patients.Methods/DesignWe retrospectively analysed data for 326 cases of confirmed COVID-19 presenting to our ED at the Royal Sussex County Hospital in Brighton between 13th March and 17th June 2020. During this period 2687 attendances were triaged to the ‘red’ COVID-19 zone with symptoms suspicious for COVID-19, amongst whom 326 admissions were confirmed to have COVID-19 by CT, chest x-radiograph or PCR swab. D-dimers were measured in ED for 265/326. Peak D-dimer measured during admission was collected to evaluate deteriorations subsequent to admission. Receiver-operating characteristic curves were used to determine an optimal cutoff for discrimination.Results/ConclusionsD-Dimer elevation >0.5µg/mL was seen in 93.5% of admitted patients with confirmed COVID-19. Multivariable logistic regression suggested that age >75 (OR=3.01 95% CI 1.65–5.49 p=0.0003) and D-dimer (measured in ED) >1.25µg/mL (OR=2.06 95% CI 1.08–3.93 p=0.0276) were associated with increased mortality. D-dimer measured in ED predicted mortality with sensitivity of 76.5% and specificity of 41.3%. The D-dimer rose by >1.00 for 30/265 patients subsequent to admission of whom 8/30 (26.7%) died (all mortality 16%) and 11/30 (36.7%) were escalated to intensive care. Peak D-dimer measured during admission >3.2µg/mL predicted hospital mortality with 50% sensitivity and 72.4% specificity (OR=2.16 95% CI 1.16–3.99 p=0.0145).The results of this study support the growing argument that a raised D-dimer may play an important role as a prognostic marker in patients with COVID-19, perhaps indicative of a pro-thrombotic coagulopathy within the underlying pathology.
396 Team Time: an online strategy of storytelling as part of reflective practice to improve staff wellbeing within a paediatric emergency department during the coronavirus pandemic
Authors: Wijedoru Lalith , Potier Jo , Durand Charlotte , Evans Nicola 
Published: January 2021

Aims/Objectives/BackgroundTeam Time was developed by the Point of Care Foundation in response to the coronavirus pandemic. It is a 45-minute reflective practice using storytelling. It provides an opportunity for people taking part to share recent experiences of their work in health and social care, focusing on participants’ emotional and social response to their work. Unlike Schwartz Rounds, the audience is restricted in numbers (maximum 30), is drawn from a single department of a healthcare site rather than from across the organisation, is run and facilitated using virtual platforms, and relays stories from the recent (not distant) past.Methods/DesignTwo facilitators already trained in delivering Schwartz Rounds (one PEM consultant from the department plus one Trust clinical psychologist) were given additional specific training for running Team Time in March 2020.Six sessions between April and July 2020 were held. The formats of these sessions were as per guidance set by the Point of Care Foundation (UK).A theme for each session was set in advance, with two storytellers invited and prepared in advance by the two facilitators.Two storytellers related a five minute story each uninterrupted, followed by a facilitated discussion with the audience to share their own experiences and/or resonances to the stories told.Standardised web surveys designed by the Point of Care Foundation designed to collate both quantitative an qualitative feedback were distributed by E-mail to all participants the same day.Results/ConclusionsSurvey respondents n=4085% strongly agreed that Team Time would help them work better with colleagues.90% plan to attend Team Time again.95% would recommend Team Time to colleagues.92.5% felt that the sessions overall were either excellent or exceptional.Qualitative feedback themes included: not feeling alone; the benefits of hearing perspectives of different roles; and the advantages of sharing honest feelings in a boundaried, reflective space.
366 The ED young person’s wellbeing guide – a novel approach to psychosocial risk assessing children and young people in the emergency department
Authors: Fraser Lauren , Al-Asadi Ayia 
Published: January 2021

Aims/Objectives/BackgroundThe 2019/20 RCEM National QIP ‘Care of Children in the ED’ recommends use of a recognised tool (eg HEEADSSS) to psychosocial risk assess 12–17 year olds seen in the ED. Northwick Park’s ED team collaborated with the Young Harrow Foundation (YHF), a local charitable organisation, to coproduce the ED Young Person’s Wellbeing Guide with the aim of addressing this standard whilst also meeting the needs of ED staff and the children and young people (CYP) that we care for.Methods/DesignYHF’s Change Champions, a dynamic group of local 15–25 year olds with lived experience of areas such as youth violence and mental health, worked with the ED team and fed back that they wouldn’t necessarily expect (or welcome) ED staff enquiring about such personal topics (particularly if presenting with an unrelated issue) but valued access to reliable support and advice for themselves or their peers. ED staff, similarly, often felt awkward approaching such sensitive subjects with CYP if the presentation was with a seemingly unrelated complaint or when departmental pressures prohibited development of a meaningful doctor-patient rapport. The Wellbeing Guide was therefore coproduced to provide CYP with links to trusted sources of support (based on the HEEADSSS categories) as well as allowing the ED clinician to broach such conversations by asking whether any issues raised in the Guide resonated with the young person and whether further support or advice was required.Abstract 366 Figure 1Results/ConclusionsThe Wellbeing Guide will be piloted, and offered to all 12–17yo’s attending the ED, in the next few weeks. Using an iterative approach the document will be further developed through feedback from CYP. We are also developing a complementary document containing links to resources for parents concerned about their child. We aspire to an online version of both documents, accessible via the Trust’s website, in the next few months.
402 ‘TAP it’: trainee led initiative to reduce unnecessary blood testing in a paediatric emergency department
Authors: Magnusen Eliza , Maduemem Kene , Shafiq Ayesha , Crankshaw Daniel , Mekki Habab , Sridhar Arani 
Published: January 2021

Aims/Objectives/BackgroundUnnecessary blood testing in the paediatric emergency department (PED) is a potential starting point for diagnostic dilemma, anxiety to families and increased healthcare costs. We hypothesized that a significant number of blood tests are performed instinctively rather than clinically indicated. This stimulated a quality improvement initiative to enlighten trainees on the utility of blood tests while aiming to enhance clinical decision making.Methods/DesignChildren presenting to the acute care team in a tertiary PED who had blood tests over a 2-week period in April 2019 were enrolled. Blood tests requested were interpreted in line with presenting features and clinical impression. Following implementation of changes (posters, QI champions, educational sessions), a repeat analysis was done over a 2-week period in October 2019.Results/ConclusionsOne hundred and one children in the first cycle were enrolled. Blood testing analysis revealed that 70%, 47%, and 32% had liver bloods, bone profile, and clotting testing done, respectively. Over half of these blood tests had no clear clinical indication. The yield of the tests performed without clinical indication was 0%. Case vignettes were attempted by trainees and ANPs to evaluate their attitudes to blood test requests. Number of requested blood tests not clinically indicated was lower than anticipated; probably explained by self-thought processes. Blood tests performed on 100 children in the second cycle demonstrated a significant reduction in tests done without clear clinical indication. Liver bloods, clotting screen, bone profile tests were performed on 40%, 24% and 27% respectively in the second cycle.The utility of blood tests may be an under recognised subject in paediatric training which needs addressing. This project typified positive impact of culture change via QI champions and educational sessions. Implementation of such changes is sustainable with an estimated savings of at least £500/month.
156 Prehospital determinants of successful resuscitation after traumatic and non-traumatic out-of-hospital cardiac arrest
Authors: Barnard Ed , Sandbach Daniel , Nicholls Tracy , Wilson Alastair , Ercole Ari 
Published: January 2021

Aims/Objectives/BackgroundOut-of-hospital cardiac arrest (OHCA) is prevalent in the UK. Reported survival is lower than in countries with comparable healthcare systems; a better understanding of outcome determinants may identify areas for improvement. Aim: to compare differential determinants of survival to hospital admission and survival to hospital discharge for traumatic (TCA) and non-traumatic cardiac arrest (NCTA).Methods/DesignAn analysis of 9109 OHCA in East of England between 1 January 2015 and 31 July 2017. Univariate descriptives and multivariable analysis were used to understand the determinants of survival for NTCA and TCA. Two Utstein outcome variables were used: survival to hospital admission and hospital discharge. Data reported as number (percentage), number (percentage (95% CI)) and median (IQR) as appropriate. Continuous data have been analysed with a Mann-Whitney U test, and categorical data have been analysed with a χ2 test. Analyses were performed using the R statistical programming language.Results/ConclusionsThe incidence of OHCA was 55.1 per 100 000 population/year. The overall survival to hospital admission was 27.6% (95%CI 26.7% to 28.6%) and the overall survival to discharge was 7.9% (95%CI 7.3% to 8.5%). Survival to hospital admission and survival to hospital discharge were both greater in the NTCA group compared with the TCA group: 27.9% vs 19.3% p=0.001, and 8.0% vs 3.8% p=0.012 respectively.Determinants of NTCA and TCA survival were different, and varied according to the outcome examined. In NTCA, bystander cardiopulmonary resuscitation (CPR) was associated with survival at discharge but not at admission, and the likelihood of bystander-CPR was dependent on geographical socioeconomic status.NTCA and TCA are clinically distinct entities with different predictors for outcome and should be reported separately. Determinants of survival to hospital admission and discharge differ in a way that likely reflects the determinants of neurological injury. Bystander CPR public engagement may be best focused in more deprived areas.
Computerised patient-specific prediction of the recovery profile of upper limb capacity within stroke services: the next step
Authors: Selles Ruud W , Andrinopoulou Eleni-Rosalina , Nijland Rinske H , van der Vliet Rick , Slaman Jorrit , van Wegen Erwin EH , Rizopoulos Dimitris , Ribbers Gerard M , Meskers Carel GM , Kwakkel Gert 
Published: January 2021

IntroductionPredicting upper limb capacity recovery is important to set treatment goals, select therapies and plan discharge. We introduce a prediction model of the patient-specific profile of upper limb capacity recovery up to 6 months poststroke by incorporating all serially assessed clinical information from patients.MethodsModel input was recovery profile of 450 patients with a first-ever ischaemic hemispheric stroke measured using the Action Research Arm Test (ARAT). Subjects received at least three assessment sessions, starting within the first week until 6 months poststroke. We developed mixed-effects models that are able to deal with one or multiple measurements per subject, measured at non-fixed time points. The prediction accuracy of the different models was established by a fivefold cross-validation procedure.ResultsA model with only ARAT time course, finger extension and shoulder abduction performed as good as models with more covariates. For the final model, cross-validation prediction errors at 6 months poststroke decreased as the number of measurements per subject increased, from a median error of 8.4 points on the ARAT (Q1–Q3:1.7–28.1) when one measurement early poststroke was used, to 2.3 (Q1–Q3:1–7.2) for seven measurements. An online version of the recovery model was developed that can be linked to data acquisition environments.ConclusionOur innovative dynamic model can predict real-time, patient-specific upper limb capacity recovery profiles up to 6 months poststroke. The model can use all available serially assessed data in a flexible way, creating a prediction at any desired moment poststroke, stand-alone or linked with an electronic health record system.
Pretreatment of aged mice with retinoic acid supports alveolar regeneration via upregulation of reciprocal PDGFA signalling
Authors: Gokey Jason J , Snowball John , Green Jenna , Waltamath Marion , Spinney Jillian J , Black Katharine E , Hariri Lida P , Xu Yan , Perl Anne Karina 
Published: January 2021

Objectives
Idiopathic pulmonary fibrosis (IPF) primarily affects the aged population and is characterised by failure of alveolar regeneration, leading to loss of alveolar type 1 (AT1) cells. Aged mouse models of lung repair have demonstrated that regeneration fails with increased age. Mouse and rat lung repair models have shown retinoic acid (RA) treatment can restore alveolar regeneration. Herein, we seek to determine the signalling mechanisms that become activated on RA treatment prior to injury, which support alveolar differentiation.

Design
Partial pneumonectomy lung injury model and next-generation sequencing of sorted cell populations were used to uncover molecular targets regulating alveolar repair. In vitro organoids generated from epithelial cells of mouse or patient with IPF co-cultured with young, aged or RA-pretreated murine fibroblasts were used to test potential targets.

Main outcome measurements
Known alveolar epithelial cell differentiation markers, including HOPX and AGER for AT1 cells, were used to assess outcome of treatments.

Results
Gene expression analysis of sorted fibroblasts and epithelial cells isolated from lungs of young, aged and RA-pretreated aged mice predicted increased platelet-derived growth factor subunit A (PDGFA) signalling that coincided with regeneration and alveolar epithelial differentiation. Addition of PDGFA induced AT1 and AT2 differentiation in both mouse and human IPF lung organoids generated with aged fibroblasts, and PDGFA monoclonal antibody blocked AT1 cell differentiation in organoids generated with young murine fibroblasts.

Conclusions
Our data support the concept that RA indirectly induces reciprocal PDGFA signalling, which activates regenerative fibroblasts that support alveolar epithelial cell differentiation and repair, providing a potential therapeutic strategy to influence the pathogenesis of IPF.
Reconstructing effective Lagrangians embedding residual family symmetries
Authors: Bernigaud Jordan , de Medeiros Varzielas Ivo , Talbert Jim 
Published: January 2021

AbstractWe consider effective Lagrangians which, after electroweak- and family-symmetry breaking, yield fermionic mass matrices and/or other flavoured couplings exhibiting residual family symmetries (RFS). Thinking from the bottom up, these RFS intimately link ultraviolet (UV) Beyond-the-Standard Model (BSM) physics to infrared flavour phenomenology without direct reference to any (potentially unfalsifiable) UV dynamics. While this discussion is typically performed at the level of RFS group generators and the UV flavour groups they can close, we now also focus on the RFS-implied shape of the low-energy mass/coupling matrices. We then show how this information can be used to algorithmically guide the reconstruction of an effective Lagrangian, thereby forming top-down models realizing the typical bottom-up phenomenological conclusions. As a first application we take results from scans of finite groups capable of controlling (through their RFS) CKM or PMNS mixing within the SM alone. We then extend this to recently studied scenarios where RFS also control special patterns of leptoquark couplings, thus providing proof-in-principle completions for such ‘Simplified Models of Flavourful Leptoquarks.’
A review of the gas and liquid phase interactions in low-temperature plasma jets used for biomedical applications
Authors: Morabit Youssef , Hasan Mohammad I. , Whalley Richard D. , Robert Eric , Modic Martina , Walsh James L. 
Published: January 2021

AbstractAtmospheric pressure plasma jets generated using noble gases have been the focus of intense investigation for over 2 decades due to their unique physicochemical properties and their suitability for treating living tissues to elicit a controlled biological response. Such devices enable the generation of a non-equilibrium plasma to be spatially separated from its downstream point of application, simultaneously providing inherent safety, stability and reactivity. Underpinning key plasma mediated biological applications are the reactive oxygen and nitrogen species (RONS) created when molecular gases interact with the noble gas plasma, yielding a complex yet highly reactive chemical mixture. The interplay between the plasma physics, fluid dynamics and plasma chemistry ultimately dictates the chemical composition of the RONS arriving at a biological target. This contribution reviews recent developments in understanding of the interplay between the flowing plasma, the quiescent background and a biological target to promote the development of future plasma medical therapies.Graphical abstract