bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of an intra-carbonate detachment during thrusting: The variable influence of pressure solution on deformation style, Khao Khwang Fold and Thrust Belt, Thailand
Authors: Morley C.K. , Jitmahantakul S. , von Hagke C. , Warren J. , Linares F. 
Published: January 2021

Abstract
Classic detachment zones in fold and thrust belts are generally defined by a weak lithology (typically salt or shale), often accompanied by high over-pressures. This study describes an atypical detachment that occurs entirely within a relatively strong Permian carbonate lithology, deformed during the Triassic Indosinian orogeny in Thailand under late diagenetic-anchimetamorphic conditions. The key differences between stratigraphic members that led to development of a detachment zone are bedding spacing and clay content. The lower, older, unit is the Khao Yai Member (KYM), which is a dark-gray to black, well-bedded, clay-rich limestone. The upper unit, the Na Phra Lan Member (NPM), comprises more massive, medium- to light-gray, commonly recrystallized limestones and marble. The KYM displays much tighter to even isoclinal, shorter-wavelength folds than the NPM. Pressure solution played a dominant role throughout the structural development—first forming early diagenetic bedding; later tectonic pressure solution preferentially followed this bedding instead of forming axial planar cleavage. The detachment zone between the two members is transitional over tens of meters. Moving up-section, tight to isoclinal folds with steeply inclined axial surfaces are replaced by folds with low-angle axial planes, thrusts, and thrust wedging, bed-parallel shearing, and by pressure solution along bedding-parallel seams (that reduce fold amplitude). In outcrops 100–300 m long, reduction of line-length shortening on folds from &gt;50% to &lt;10% shortening upwards indicates that deformation in the NPM is being accommodated differently from the KYM, probably predominantly by shortening on longer wavelength and/or spacing folds and thrusts, given the low amount of strain observed within the NPM, which excludes widespread layer-parallel thickening.
129 Interim evaluation of a clinical educators pilot study via a multi-stakeholder online survey
Authors: Huynh Chi , Hemavathi Muniswamy , Aiello Matthew , Clancy Mike , Kennedy Brian , Knox Jane , Phillips Eloise , Terry David , Khan Aanika , Rutherford Graham , Symons Helen , Chauhan Veena , England Health Education , Tam Christina 
Published: January 2021

Aims/Objectives/BackgroundIn England, the demand for emergency care is increasing, confounded by challenges with recruitment and retention of multi-professional teams in Emergency Departments (ED). The intense working environment that clinical ED staff face is recognised as a cause of staff dissatisfaction, attrition and premature career ‘burnout.’ A new ‘shop floor’ Clinical Educator (CE) role may improve the retention and wellbeing of multi-professional ED teams. A Health Education England pilot developed and recruited CEs across 54 acute trust EDs in England, from 2017. Aston University and the Royal College of Emergency Medicine were jointly commissioned to undertake a service benefit evaluation.Methods/DesignAn online survey was circulated to CEs, learners and managers across the 54 study sites. Each group answered questions relating to experiences, opinions and reflections. Topics included impact of a CE on patient flow, confidence and competence of staff, as well as sustainability and any impact on staff wellbeing.Results/ConclusionsResults314 individuals accessed the survey and 291 eligible respondents completed it, including: 187 learners, 65 CEs and 39 ED Clinical Directors/Managers.Learners (169/187), CE (63/65) and managers (39/39) saw no change/an improvement in patient flow.100% of CEs felt that a CE in the ED improved competence and confidence of staff (88.2% of learners, 89.7% of managers).7% (61/65) of CEs and 87.2% (34/39) managers agree that CEs have improved wellbeing of staff.8% of managers (26/39) were unsure whether the CE role would be funded beyond the pilot, but 66.7% (26/39) strongly supported continuation of the CE role.ConclusionInterim evidence suggests that CEs positively impact the multi-professional ED workforce.
185 A clinical risk score to identify patients with COVID-19 at high risk of critical care admission or death: An observational cohort study
Authors: Galloway James , Sneep Ruth , Cantle Fleur , Jina Raeesa , Brookes Andrew , Reid Carole , Sugarman Leah , Norton Sam 
Published: January 2021

Aims/Objectives/BackgroundThe COVID-19 pandemic continues to escalate. There is urgent need to stratify patients. Understanding risk of deterioration will assist in admission and discharge decisions, and help selection for clinical studies to indicate where risk of therapy-related complications is justified.Methods/DesignAn observational cohort of patients acutely admitted to two London hospitals with COVID-19 and positive SARS-CoV-2 swab results was assessed. Demographic details, clinical data, comorbidities, blood parameters and chest radiograph severity scores were collected from electronic health records. Endpoints assessed were critical care admission and death. A risk score was developed to predict outcomes.Results/ConclusionsAnalyses included 1,157 patients. Older age, male sex, comorbidities, respiratory rate, oxygenation, radiographic severity, higher neutrophils, higher CRP and lower albumin at presentation predicted critical care admission and mortality. Non-white ethnicity predicted critical care admission but not death. Social deprivation was not predictive of outcome. A risk score was developed incorporating twelve characteristics: age>40, male, non-white ethnicity, oxygen saturations<93%, radiological severity score>3, neutrophil count>8.0 x109/L, CRP>40 mg/L, albumin<34 g/L, creatinine>100 µmol/L, diabetes mellitus, hypertension and chronic lung disease. Risk scores of 4 or higher corresponded to a 28-day cumulative incidence of critical care admission or death of 40.7% (95% CI: 37.1 to 44.4), versus 12.4% (95% CI: 8.2 to 16.7) for scores less than 4.ConclusionOur study identified predictors of critical care admission and death in people admitted to hospital with COVID-19. These predictors were incorporated into a risk score that will inform clinical care and stratify patients for clinical trials.
198 Current provision of general practitioner services in or alongside emergency departments in England
Authors: Brant Heather , Voss Sarah , Cooper Alison , Edwards Michelle , Price Delyth , Gaughan James , Edwards Adrian , Benger Jonathan 
Published: January 2021

Aims/Objectives/BackgroundOne approach to addressing increasing demand in emergency departments (EDs) has been the co-location of general practitioners (GPs) in or alongside the emergency department (ED), known as GPED. This approach was both advocated by the National Health Service (NHS) and supported by capital funding in 2017. However, little is known about the models of GPED that have been implemented as a result.Methods/DesignWe collected data on the model of GPED in use (if any) at 163/177 (92%) of type one EDs in England at two time points: September 2017 and December 2019. Multiple data sources were used including: on-line surveys; interviews; case study data; publicly available information. Models were classified according to an iteratively developed taxonomy as Inside/integrated, Inside/parallel, Outside/onsite, Outside/offsite.Results/ConclusionsThe proportion of EDs using GPED increased from 81% to 95% over the study period. The most common model was ‘Inside/parallel’ to the ED: 30% (44/149) in 2017, rising to 49% (78/159) in 2019. The number of Inside/integrated models dropped from 26% (38/149) to 9% (15/159). 23 sites commenced and four sites ceased GPED provision. 87% (142/163) of the EDs sampled were awarded capital funding. We identified no association between the type of GPED model adopted and the observable characteristics of EDs such as annual attendance, rurality of location and deprivation within the population served.The majority of EDs in England have now adopted GPED. The increase in Inside/parallel models and the reduction in Inside/integrated models is likely to be related to the availability of capital funding to finance structural changes to EDs so that separate GP services could be provided. Further research is required to understand the relative effectiveness of the various models of GPED identified.
109 Access to emergency health care in tiger reserves in the central Indian landscape. lessons for global emergency care
Authors: Trivedy Chet , Tate Vijaykumar , Kolhe Sheetal , Gadre Vishal , Andheria Anish 
Published: January 2021

Aims/Objectives/BackgroundForest staff working in remote locations are at high risk of life-threatening emergencies; including major trauma and snakebites. Timely access to appropriate emergency care is pivotal to life-saving treatment. This is the first study to systematically map public health facilities (PHFs) around tiger reserves (TRs) in central Indian state of Maharashtra.Methods/DesignUsing publically available data; GPS coordinates, medical staff, and services were identified for PHFs in increasing order of specialism; including Primary Healthcare Centre (PHC), Community Health Centre (CHC), Sub-district Hospital (SDH) and District Hospital (DH). GIS Network Analysis was used to identify the nearest PHFs in relation to the access points of eight TRs; and the shortest distance by road and corresponding travel time by vehicle were calculated.Results/ConclusionsOf all PHFs, 87.5% offered basic emergency care, while only 54% offered radiology services. Of all trauma beds 99.9% were placed at DH level; along with 89% of all MBBS trained doctors. Only 28.6% of TR exit points had access to emergency ambulance service based within 30 minutes.Abstract 109 Table 1Average distance and time to access the nearest PHFType of Health Facility (n=96)Average distance from a TR access point to the nearest PHF in KilometersAverage time to reach the nearest PHF in minutes by a carPHC (38.5%)12.3 ± 8.6 (0.7–39.4) 24 ±17 (1–79) CHC (26%)24.9 ±12.4 (2.5–61.6) 47 ± 25 (5–123) SDH (13.5%)42 ±15.8 (4.7–80.9) 82 ± 32 (8–162) DH (22%)65.4 ± 28.9 (11.7–137.2) 126 ± 57 (23–235) ConclusionThis study highlight the challenges of providing emergency healthcare in low- and middle-income countries and the urgent need for greater resources and infrastructure to support the delivery of emergency care for frontline forest staff in rural areas. Further work in progress to look at the provision of emergency care in remote settings.
468 Presentation of vulnerable children to ED during Lockdown: a concerning consequence of isolation
Authors: Asim Lalarukh , Jina Raeesa , Das Sreena 
Published: January 2021

Aims/Objectives/BackgroundThis study aims to evaluate changes to child safeguarding attendances to the emergency department (ED) during the lockdown period 1st of March till 31st May 2020 compared to the same time period in 2019.The COVID-19 pandemic is the defining health crisis of our time and the first time firm social restrictions have been imposed since safeguarding practices have become embedded in the NHS. The NSPCC reported a large increase in contacts but there remain concerns that vulnerable children are invisible to agencies during this time.Methods/DesignAll children (< 18 years) who attended King’s College Hospital’s ED, and were reviewed in the weekly ED safeguarding meeting were included. Data was collected from electronic patient records for different parameters.Results/ConclusionsThe total number of children presenting via ED for safeguarding review fell from 865 in 2019 to 355 for the same period in 2020. However, the proportion requiring action by the hospital safeguarding team showed a significant increase (p= 1.5 x 10-4) suggesting the severity of cases during COVID-19 is worse.The percentage of stabbings doubled (p=0.04) despite lockdown measures. This may be a contributor to the significant increase in referral to youth workers (p=8 × 10-4). The number of children attending who were considered high risk due to previous safeguarding concerns dropped by 75%.As expected, the proportion of household injuries such as accidental ingestion and burns showed a significant increase (p=0.01 and p=0.002 respectively). The proportion of children from outside of our local boroughs was surprisingly higher in 2020 (p=0.03).The findings show that the number of cases triggering a safeguarding review has dropped during lockdown and raises concerns about vulnerable children who remain hidden. The findings also suggest an increased severity of safeguarding presentations, supporting our fears that the implications of lockdown on vulnerable children is yet to be realised.
Sex differences in mapping and rhythm outcomes of a repeat atrial fibrillation ablation
Authors: Pak Hui-Nam , Park Je-Wook , Yang Song-Yi , Kim Min , Yu Hee Tae , Kim Tae-Hoon , Uhm Jae-Sun , Joung Boyoung , Lee Moon-Hyoung 
Published: January 2021

ObjectiveThe risk of procedure-related complications and rhythm outcomes differ between men and women after atrial fibrillation catheter ablation (AFCA). We evaluated whether consistent sex differences existed in mapping and rhythm outcomes in repeat ablation procedures.MethodsAmong 3282 patients in the registry, we analysed 443 consecutive patients (24.6% female, 58.5±10.3 years old, 61.5% with paroxysmal atrial fibrillation) who underwent a second AFCA. We compared the clinical factors, mapping, left atrial (LA) pressure, complications and long-term clinical recurrences after propensity score matching.ResultsLA volume index (43.1±18.6 vs 35.8±11.6 mL/m2, p<0.001) was higher, but LA dimension (40.0±6.8 vs 41.6±6.3 mm, p=0.018), LA voltage (0.94±0.55 vs 1.20±0.68 mV, p=0.002) and pericardial fat volume (89.5±43.1 vs 122.1±53.9 cm3, p<0.001) were lower in women with repeat ablation than in their male counterparts. Pulmonary vein (PV) reconnections were lower (58.7% vs 74.9%, p=0.001), but the proportion of extra-PV triggers (27.5% vs 17.0%, p=0.026) and elevated LA pulse pressures (79.7% vs 63.7%, p=0.019) was significantly higher in women than in men. There was no significant sex difference in the rate of procedure-related complications (4.6% vs 4.2%, p=0.791). During a 31-month (8–60) median follow-up, clinical recurrences were significantly higher in women after both the de novo procedure (log-rank p=0.039, antiarrhythmic drug (AAD)-free log-rank p<0.001) and the second procedure (log-rank p=0.006, AAD-free log-rank p=0.093). Female sex (HR 1.51, 95% CI 1.06 to 2.15, p=0.023), non-paroxysmal atrial fibrillation (HR 1.78, 95% CI 1.30 to 2.34, p<0.010) and extra-PV triggers (HR 1.88, 95% CI 1.28 to 2.75, p=0.001) were independently associated with clinical recurrences after repeat procedures.ConclusionsDuring repeat AFCA procedures, PV reconnections were lower in women than in men, and the existence of extra-PV triggers and an LA pressure elevation were more significant, which resulted in poor rhythm outcomes.Trial registration numberNCT02138695.
Biologic subtypes of melanoma predict survival benefit of combination anti-PD1+anti-CTLA4 immune checkpoint inhibitors versus anti-PD1 monotherapy
Authors: Rose April A N , Armstrong Susan M , Hogg David , Butler Marcus O , Saibil Samuel D , Arteaga Diana P , Pimentel Muniz Thiago , Kelly Deirdre , Ghazarian Danny , King Ian , Kamil Zaid Saeed , Ross Kendra , Spreafico Anna 
Published: January 2021

PurposeAnti-programmed cell death protein 1 (PD1)±anti-cytotoxic T-lymphocyte associated protein 4 (CTLA4) immune checkpoint inhibitors (ICIs) are standard therapeutic options for metastatic melanoma. We assessed whether biologic subtype according to primary tumor type or genomic subtype can function as predictive biomarkers for anti-PD1±anti-CTLA4 ICI in patients with advanced melanoma.MethodsWe performed a single-center retrospective cohort analysis of patients who received anti-PD1±anti-CTLA4 ICI for advanced melanoma between 2012 and 2019. Primary tumor type,BRAFandNRASmutation status, and other covariates were abstracted from chart review. Log-rank tests and multivariable Cox regression models were used to assess differences in clinical progression-free (cPFS) and overall survival (OS).ResultsWe identified 230 patients who received 249 lines of anti-PD1±anti-CTLA4 ICI for unresectable or metastatic disease. Of these patients, 74% were cutaneous, 11% mucosal, 8% unknown primary and 7% acral.BRAFandNRASmutations were identified in 35% and 28% of patients, respectively. In multivariable analyses of the entire cohort, acral or mucosal primary tumor type, >3 metastatic sites, elevated LDH were predictive of shorter cPFS and OS. Combination ICI therapy was associated with longer cPFS (HR 0.57, 95% CI 0.38 to 0.86, p=0.007) and OS (HR 0.42, 95% CI 0.28 to 0.65, p<0.001). Combination ICI was significantly associated with longer OS in unknown primary and mucosal melanoma. There was a non-significant trend toward longer OS with anti-PD1+anti-CTLA4 in cutaneous melanoma, but not in acral melanoma. In multivariable analyses, combination ICI was associated with longer OS inNRAS(HR 0.24, 95% CI 0.10 to 0.62, p=0.003, n=69) andBRAFV600E/K (HR 0.47, 95% CI 0.24 to 0.90, p=0.024, n=86) mutant melanoma but notBRAF/NRASwild-type (n=94) melanoma.ConclusionsIn our cohort, primary melanoma tumor type and genomic subtype were independent predictive markers of cPFS and OS for patients with metastatic melanoma receiving anti-PD1 ICI. Primary tumor type and genomic subtype—including NRAS—should be further evaluated in prospective clinical trials to determine their value as predictive markers. Biologic subtypes may facilitate clinical decision-making when recommending combination ICI treatment (anti-PD1±anti-CTLA4) versus anti-PD1 alone for patients with metastatic melanoma.
Preclinical PET imaging with the novel human antibody89Zr-DFO-REGN3504 sensitively detects PD-L1 expression in tumors and normal tissues
Authors: Kelly Marcus P , Makonnen Sosina , Hickey Carlos , Arnold T Cody , Giurleo Jason T , Tavaré Richard , Danton Makenzie , Granados Christian , Chatterjee Ishita , Dudgeon Drew , Retter Marc W , Ma Dangshe , Olson William C , Thurston Gavin , Kirshner Jessica R 
Published: January 2021

BackgroundProgrammed cell death protein 1/programmed death-ligand 1 (PD-1/PD-L1) blocking antibodies including cemiplimab have generated profound clinical activity across diverse cancer types. Tumorous PD-L1 expression, as assessed by immunohistochemistry (IHC), is an accepted predictive marker of response to therapy in some cancers. However, expression is often dynamic and heterogeneous, and therefore not reliably captured by IHC from tumor biopsies or archival samples. Thus, there is significant need for accurate whole-body quantification of PD-L1 levels.MethodsWe radiolabeled the novel human anti-PD-L1 antibody REGN3504 with zirconium-89 (89Zr) using the chelator p-SCN-Bn-Deferoxamine to enable non-invasive immuno-positron emission tomography (immuno-PET) of PD-L1 expression. PET imaging assessed the localization of89Zr-REGN3504 to multiple human tumor xenografts. Mice genetically humanized for PD-1 and PD-L1 were used to assess the biodistribution of89Zr-REGN3504 to normal tissues and the estimated human radiation dosimetry of89Zr-REGN3504 was also determined. Pharmacokinetics of REGN3504 was assessed in monkeys.ResultsClear localization of89Zr-REGN3504 to human tumor xenografts was observed via PET imaging and ex vivo biodistribution studies demonstrated high (fourfold to sixfold) tumor:blood ratios.89Zr-REGN3504 specifically localized to spleen and lymph nodes in the PD-1/PD-L1 humanized mice.89Zr-REGN3504 immuno-PET accurately detected a significant reduction in splenic PD-L1 positive cells following systemic treatment with clodronate liposomes. Radiation dosimetry suggested absorbed doses would be within guidelines for other89Zr radiolabeled, clinically used antibodies. Pharmacokinetics of REGN3504 was linear.ConclusionThis work supports the clinical translation of89Zr-REGN3504 immuno-PET for the assessment of PD-L1 expression. Future clinical studies will aim to investigate the utility of89Zr-REGN3504 immuno-PET for predicting and monitoring response to anti-PD-1 therapy.
Changes in emotions and perceived stress following time spent in an artistically designed multisensory environment
Authors: Cavanagh Bliss , Haracz Kirsti , Lawry Miranda , Wales Kylie , James Carole 
Published: January 2021

Self-management strategies that enhance positive emotions are considered most effective to cope with stress and maintain good mental health and well-being. An artistically designed multisensory environment, The Sensory-Art Space (SAS), was installed in a university in NSW Australia as a new self-management intervention. The design of the SAS was informed by evidence regarding the benefits of viewing art, experiencing nature and accessing sensory rooms.A pilot pre–post intervention study measured changes in affect and perceived stress in 224 participants who spent time in the SAS. Descriptive statistics were completed on the individual affective states, and paired sample t-tests were used to determine changes in Positive and Negative Affect (PANAS-X) and perceived stress (Visual Analogue Scale).The Wilcoxon signed-rank test showed that negative affect reduced, z=−10.23 (p<0.001), and positiveaffect increased, z=−2.57 (p=0.01), following spending time in the SAS. In addition, stress levels reduced after time spent in the SAS, z=−11.29 (p<0.0001).Self-management benefits were found following time in the SAS and future implications for public health and well-being are discussed.
Experimental evaluation of direct thromboaspiration efficacy according to the angle of interaction between the aspiration catheter and the clot
Authors: Bernava Gianmarco , Rosi Andrea , Boto José , Hofmeister Jeremy , Brina Olivier , Reymond Philippe , Muster Michel , Yilmaz Hasan , Kulcsar Zsolt , Carrera Emmanuel , Bouri Mohamed , Lovblad Karl-Olof , Machi Paolo 
Published: January 2021

BackgroundSuccessful direct thromboaspiration (DTA) is related to several factors such as clot consistency, size, and location. It has also been demonstrated recently that the angle of interaction (AOI) formed by the aspiration catheter and the clot is related to DTA efficacy. The aims of this study were three-fold: (a) to confirm the clinical finding that the AOI formed by the aspiration catheter and the clot influence DTA efficacy; (b) to evaluate to what extent this influence varies according to differences in clot consistency and size; and (c) to validate stent retriever thrombectomy as an effective rescue treatment after DTA failure in the presence of an unfavorable AOI.MethodsA rigid vascular phantom designed to reproduce a middle cerebral artery trifurcation anatomy with three M2 segments forming different angles with M1 and thrombus analog of different consistencies and sizes was used.ResultsDTA was highly effective for AOIs >125.5°, irrespective of thrombus analog features. However, its efficacy decreased for acute AOIs. Rescue stent retriever thrombectomy was effective in 92.6% of cases of DTA failure.ConclusionsThis in vitro study confirmed that the AOI formed by the aspiration catheter and the thrombus analog influenced DTA efficacy, with an AOI >125.5° related to an effective DTA. Stent retriever thrombectomy was an effective rescue treatment after DTA failure, even in the presence of an unfavorable AOI.