bluuebunny/crossref_metadata_2025_split huggingface dataset:
THE IMPACT OF PHYSICIAN LED PRE-HOSPITAL CARE ON MAJOR TRAUMA MORTALITY IN CAMBRIDGESHIRE: AN OBSERVATIONAL CROSS-SECTIONAL ANALYSIS
Authors: Ragab H , Mackenzie R 
Published: November 2016

BackgroundAfter decades of neglect, trauma service development in England has begun, but has focused on the in-hospital phase of the trauma care pathway, with a lack of national consensus on what constitutes the best pre-hospital care.Objectives(1) To perform an empirical analysis of a five year regional dataset to ascertain the relationship between physician led pre-hospital care and major trauma mortality, and interpret these results in the context of existing literature on the topic.(2) To analyse the epidemiology of trauma and trauma related deaths in the UK context, and comparing and contrasting these findings with historical cohorts.MethodsImpact of physician led care was analysed through multivariate logistic regression of a 5-year regional dataset, the Cambridgeshire Trauma Audit Research Project database. This multi-agency database is unique in that it is the first trauma database to have validated 100% case ascertainment, including pre-hospital data and pre-hospital deaths.ResultsThere were 775 patients who sustained major trauma within this cohort. The overall mortality rate was 58%. Physicians responded to 48% and non-physician led care was delivered for 52% of cases.Young adults, especially males, continue to be at highest risk for trauma, and road traffic accidents continue to be the most prevalent mechanism of injury.Upon multivariate logistic regression physician led pre-hospital care was associated with a significant reduction in major trauma mortality [OR]=0.47 (95% Confidence Interval 0.23 to 0.96; p=0.038). Subgroup analysis of ‘survivors to hospital’ revealed a greater effect size [OR]=0.30 (95% Confidence Interval 0.13 to 0.68; p=0.004).A different distribution of frequency of death per day (figure 1) along with the shift in magnitude and certainty of effect size from entire cohort to ‘survivors to hospital’ cohort analysis, is predicted by our theoretical understanding of trauma related deaths. The ‘secondary peak’ in the bimodal distribution of trauma deaths could be limited through improved pre-hospital care.ConclusionThis empirical analysis of the first complete case ascertainment trauma dataset to include pre-hospital and in-hospital phases of trauma care, supports the hypothesis that physician led pre-hospital care reduces mortality from major trauma.Figure 1Time course of Trauma Mortality
EMERGENCY DEPARTMENT RE-ATTENDANCES AND TREATMENT MODIFICATIONS IN YOUNG CHILDREN WITH UNCOMPLICATED COMMUNITY-ACQUIRED PNEUMONIA: A PERUKI STUDY
Authors: Bielicki J , Sharland M , Lyttle M , Hartshorn S , Petrie J 
Published: November 2016

Objectives & BackgroundData on the rate of antibiotic retreatment in children with uncomplicated community-acquired pneumonia (CAP) are lacking. We conducted a service evaluation of CAP management to review assumptions for a large UK-based trial planning to recruit children with CAP in emergency departments (EDs). The primary endpoint for the trial is the need for antibiotic retreatment, and the retreatment rate was estimated to be 5% on the basis of non-UK literature.MethodsTwenty-six EDs from Paediatric Emergency Research in the United Kingdom & Ireland (PERUKI) recorded data on the management of 1–5 year old children presenting with lower respiratory tract infection (LRTI) who were treated with antibiotics after visiting the ED. Data were collected over a 4 week period, and information was collected on any reattendance for four weeks after the index visit on all children whether they were immediately discharged from ED, or admitted to inpatient wards. Data were descriptively analyzed to identify re-attendances and antibiotic retreatment. Retreatment was defined as modification of on-going antibiotic therapy or prescription of a new antibiotic treatment course after the initial course had been completed.ResultsIn total, 936 patients (56% males) were included. Of these, 651 (70%) were discharged from the ED, while 285 (30%) were admitted. Of 651 immediately discharged patients, 97 (16%) had ≥1 re-attendance to the ED: 56 (9%) re-attended because of LRTI symptoms, and 28 (4%) were re-treated with antibiotics with treatment modification in 21 patients, and a new antibiotic prescription in 7 children. Of 285 admitted patients, 41 (15%) had ≥1 ED re-attendance, 29 (10%) re-attended because of LRTI symptoms, and 15 (5%) were re-treated with antibiotics. On-going antibiotic therapy was modified in only 5 patients, and new antibiotic treatment was prescribed to the remaining 10 patients. The overall re-attendance rate was 15% (138/936), the LRTI-related re-attendance rate was 9% (85/936), but the antibiotic re-treatment rate was lower at 5% (43/936, 26 modifications, 17 new prescriptions).ConclusionAmong 1–5 year-olds, representations to ED within 4 weeks of an index visit for CAP were frequent, but only 1 in 20 was retreated with antibiotics. The antibiotic retreatment rate of 5% was the same as the estimates informing trial design.
DEVELOPMENT OF A HIGH-RESOLUTION INFRARED THERMOGRAPHIC IMAGING METHOD AS A DIAGNOSTIC TOOL FOR ACUTE UNDIFFERENTIATED LIMP IN YOUNG CHILDREN.
Authors: Owen R , Ramlakhan S , Burke D , Saatchi R 
Published: November 2016

Objectives & BackgroundAcute limp is a common presenting complaint in the paediatric emergency department. There are a number of possible causes of acute limp, ranging from the minor, such as traumatic injury, to more severe conditions, such as infection or malignancy. In young children, these causes are not always easily distinguished, even with the use of radiological imaging and laboratory investigations. With this pilot study, we aimed to develop an infrared thermographic imaging technique for use as a diagnostic aid in the diagnosis and monitoring of acute undifferentiated limp in young children. Therefore, the objectives of this study were to critically evaluate the effectiveness of thermal imaging in this context, whilst developing an appropriate protocol for an emergency environment.MethodsFollowing NHS ethics approval, 30 children were recruited from the Sheffield Children's Hospital ED. The participants were divided into groups based on diagnosis. Using an infrared camera, the lower limbs of the participants were imaged to record the skin surface temperature of both the affected side and unaffected side. Using predefined Regions of Interest (locations of thermographic measurement on the leg), any temperature difference between the two legs of each subject was recorded and the ability to isolate the specific region affected by injury was assessed.ResultsIn all Regions of Interest assessed, the median temperature reading for the affected side was higher than that of the unaffected side. The ability of infrared thermography to isolate the specific region affected was evident on an individual basis, with particular case studies showing promise. The small sample size recruited for each group meant that tests of significant difference need to be interpreted in this context and further research is required to form clinically meaningful conclusions.ConclusionThis pilot study has highlighted a number of potential avenues for future research into the use of thermographic imaging in an emergency setting. Repeating a similar study with a larger sample size will allow more credence to be given to the tests of significant difference. This study indicated that thermal imaging shows promise as an additional tool in the diagnosis and monitoring of acute undifferentiated limp in young children.
A QUALITATIVE FEASIBILITY STUDY TO INFORM FLUIDS IN SHOCK (FISH) – A PILOT RANDOMISED CONTROLLED TRIAL OF FLUID BOLUS THERAPY IN SEPTIC SHOCK
Authors: O'Hara C , Woolfall K , Canter R , Mouncey P , Rowan K , Lyttle M , Peters M , Inwald D , Nadel S 
Published: November 2016

Objectives & BackgroundThere is increasing evidence that fluid overload may be associated with harm in paediatric critical illness. Fluids in Shock (FiSH) is a combined feasibility and pilot randomised controlled trial (RCT) to determine if restrictive fluid bolus therapy (10 ml/kg) is more beneficial than current recommended fluid bolus therapy (20 ml/kg) in the resuscitation of children with presumed septic shock. This qualitative feasibility study aims to explore: acceptability of the proposed pilot RCT, including the prospect of research without prior consent (RWPC); other potential barriers to conduct of the pilot RCT; participant information; parental decision-making; and patient-centred outcome measures.MethodsQualitative interview study involving 21 parents (18 mothers, 3 fathers, 7 were bereaved) with children admitted to a UK emergency department with presumed septic shock in the last three years.ResultsAll parents would have provided permission for the use of their child's data in the FiSh pilot RCT. The majority of parents were unfamiliar with RWPC, yet supported its use in FiSh and in other RCTs aiming to help improve treatments for critically ill children. Parents were concerned about the change from currently recommended treatment; yet were reassured by an explanation of the current evidence base, fluid bolus therapy and monitoring procedures. Parents made recommendations about the timing of the discussion regarding permission for use of data and the patient information materials. Bereaved parents stated that recruiters should not attempt to discuss the RCT immediately after a child's death, but supported a personalised postal ‘opt out’ approach to RWPC for FiSh. Parents prioritised outcome measures such as survival, time in hospital, time spent on machines and time to their child ‘looking or behaving more like themselves’.ConclusionOur qualitative feasibility study findings support the proposed FiSh pilot RCT, including the use of RWPC, amongst parents whose child has experienced septic shock. Our findings will inform the FiSh RCT including selection of a patient centred outcome measure, as well as inform development of participant information materials and site initiation training.
ANNUAL ACUTE HOSPITAL COST OF PAEDIATRIC HEAD INJURY IN AUSTRALIA – A PAEDIATRIC RESEARCH IN EMERGENCY DEPARTMENTS INTERNATIONAL COLLABORATIVE (PREDICT) STUDY
Authors: Cheek JA , Lyttle M , Oakley E , Babl F , Borland M , Dalziel K , Kanal GN , Phillips N , Gilhotra Y , Kochar A , Dalton S , McCaskill M , Furyk J , Neutze J , Dalziel SR 
Published: November 2016

Objectives & BackgroundChildren with head injuries (HIs) frequently present to acute care settings. Most injuries are mild, but a small portion of patients have clinically significant intracranial injuries. An attempt to estimate the cost of paediatric HIs using prospectively collected data has never been attempted in Australia. We aimed to estimate the total cost paediatric HI in Australia and provide an understanding of the costs associated with different causative and presentation factors.MethodsThe study was embedded in a prospective observational study of 20,255 children <18 years designed to validate three published clinical decision rules. Each patient's hospital presentation was micro-costed and then extrapolated to an annualised Australia-wide figure using Australian Independent Hospital Pricing Authority data.ResultsThere were 109,729 cases of HI in children aged 0–18 years across Australia in the fiscal year 2012–2013 (1.67% of total emergency presentations). The average cost of each HI was $1348.21 [95%CI: 1173.02 to 1523.40]. The total cost of HI in Australia was $147.94 million [95% CI: 128.71 to 167.17]. Regression and generalized linear models both demonstrate that motor vehicle accidents (MVAs) and non-accidental injury (NAI) are the most significant drivers of cost, as are injuries presenting with vomiting, seizure and loss of consciousness greater than 5 minutes.ConclusionPaediatric head injury represents a significant cost to the Australian healthcare system. Efforts to reduce the main drivers of cost–MVAs and NAI – may reduce this.
A rare and unusual cause of mammographic calcification in the breast
Authors: Robinson Andrew , Shaaban Abeer M 
Published: November 2016

Clinical questionA 45-year-old woman is found, on family history screening, to have calcification within the upper outer quadrant of her right breast. A diagnostic mammotome biopsy was performed. Review the interactive digital slide and consider your diagnosis and appropriate management.What is your diagnosis?Collagenous spherulosisFlat epithelial atypia with psammomatous calcificationLiesegang rings with lactational changesParasitic infectionSpheroid type amyloid
Randomised comparison of drug-eluting versus bare-metal stenting in patients with non-ST elevation myocardial infarction
Authors: Remkes Wouter S , Badings Erik A , Hermanides Renicus S , Rasoul Saman , Dambrink Jan-Henk E , Koopmans Petra C , The Salem HK , Ottervanger Jan Paul , Gosselink A T Marcel , Hoorntje Jan CA , Suryapranata Harry , van 't Hof Arnoud WJ 
Published: November 2016

ObjectiveThe superiority of drug-eluting stents (DES) over bare-metal stents (BMS) in patients with ST elevation myocardial infarction (STEMI) is well studied; however, randomised data in patients with non-ST elevation myocardial infarction (NSTEMI) are lacking. The objective of this study was to investigate whether stenting with everolimus-eluting stents (EES) safely reduces restenosis in patients with NSTEMI as compared to BMS.MethodsELISA-3 patients were asked to participate in the angiographic substudy and were randomised to DE (Xience V) or BM (Vision) stenting (ELISA-3 group). The primary end point was minimal luminal diameter (MLD) at 9-month follow-up angiography. In addition, 296 patients with NSTEMI who were excluded or did not want to participate in the ELISA-3 trial (RELI group) were randomised to DE or BM stenting and underwent clinical follow-up only (major adverse cardiac events (MACE), stent thrombosis (ST)). A pooled analysis was performed to assess an effect on clinical outcome.Results178 of 540 ELISA-3 patients participated in the angiographic substudy. MLD at 9 months angiography was 2.37±0.63 mm (DES) versus 1.84±0.62 mm (BMS), p<0.001. Binary restenosis occurred in 1.9% in the DES group versus 16.7% in the BMS group (RR 0.11, 95% CI 0.02 to 0.84, p=0.007). In the pooled analysis, the incidence of MACE, target vessel revascularisation and ST at 2 years follow-up in the DES versus BMS group was 12.5% versus 16.0% (p=0.28), 4.0% versus 10.4% (p=0.009) and 1.3% versus 3.0% (p=0.34), respectively.ConclusionsIn patients with NSTEMI, use of EES is safe and decreases both angiographic and clinical restenosis as compared to BMShttp://www.isrctn.com/search?q=39230163.Trial registration number39230163; Post-results.
CHILD WELFARE POLICY REFORM IN CHINA: HISTORICAL MILESTONES AND CURRENT EVALUATIONS
Authors: ZHU WENJUN JUNE , CHEUNG MONIT , LEUNG PATRICK 
Published: November 2016

Policy milestones from 1962 to 2015 highlight China's child welfare policy development in terms of its major implementation eras, characteristics, strengths, and limitations in policy enforcement. This review captures information from government and NGO reports published in the past four decades since the formalization of the one-child policy in China. In the 1960s, as population control was determined an urgent national priority, China's central government started to examine child developmental needs as a way to alert the public about future family issues. Since then, China's child welfare policy development has been characterized by an economy-driven, government-operated, localized, and healthy-child-focused system. The applicability of the public welfare laws in China has been in line with its policy focus on child protection and ending poverty. Policy reform guidelines are proposed to focus on promoting child and family welfare. 中國兒童福利政策於1962年至2015年期間的發展里程碑，是一份分析兒童福利政策的最佳資料，解釋了兒童福利政策在中國的階段性實施，以及每個階段制定的兒童福利政策的特點和利弊。這篇論文收集并分析了從一孩政策頒布伊始至今四十餘載的政府公報和非政府組織的報告。在20世紀60年代，中國中央政府將控制人口的急劇增長定位為社會發展的當務之急，並開始研究兒童發展的需求，以提升對未來家庭問題的警覺性。從此，中國的兒童福利政策的發展凸顯出經濟驅動的、政府運作的、地區差異化的、強調兒童健康成長環境重要性的特點。中國社會公共福利政策的立法呼應了中國兒童福利政策中保護兒童和消除貧困這一中心思想。政府部門在日後編寫政策改革的導論時，必須提出如何推進兒童和家庭福利政策的完善
The diversification of granitoids and plate tectonic implications at the Archaean–Proterozoic boundary in the Bundelkhand Craton, Central India
Authors: Batuk Joshi Kumar , Bhattacharjee Joyeeta , Rai Gargi , Halla Jaana , Ahmad Talat , Kurhila Matti , Heilimo Esa , Choudhary Ashwini Kumar 
Published: November 2016

Abstract
The Bundelkhand Craton in Central India holds a large Archaean granitoid complex consisting of cores of TTG (tonalite–trondhjemite–granodiorite) gneisses of island arc or oceanic origin surrounded by abundant younger high-K calc-alkaline granitoids. Major and trace element groupings and ion probe U–Pb zircon datings of the groups show a time gap of 130 Ma between the main formation episodes of the TTGs (3.5/3.3–2.7 Ga) and the emplacement of the first high-K granitoids (2.57–2.54 Ga). Based on their geochemical diversity, the high-K calc-alkaline granitoids can be divided into low-silica high-magnesium (LSHM) granitoids such as sanukitoids and Closepet-type granitoids, and high-silica low-magnesium (HSLM) monzogranites with low-HREE and low-Eu subgroups. The former group points to mantle or mixed mantle and crustal sources, and the latter to pure crustal sources. All the varieties of the high-K granitoids formed within a narrow time span, which indicates large-scale partial melting and fluid activity in the mantle and crust, possibly resulting from a slab breakoff or delamination at the margin of an Archaean TTG continent.

Supplementary material:
Major and trace element concentrations and U-Pb results of granitoids from the Bundelkhand Craton are available at
https://doi.org/10.6084/m9.figshare.c.3576377
Confidence in the curve: Establishing instantaneous cost mapping techniques using bilateral ankle exoskeletons
Authors: Koller Jeffrey R. , Gates Deanna H. , Ferris Daniel P. , Remy C. David 
Published: November 2016

Lower extremity robotic prostheses and exoskeletons can require tuning a large number of control parameters on a subject-specific basis to reduce users’ metabolic power during locomotion. We refer to the functional relationship between control parameter configurations and users’ metabolic power as the metabolic cost landscape. Standard practice for estimating a metabolic cost landscape, and thus identifying optimal parameter configurations, is to vary control parameters while measuring steady-state metabolic power during walking. This approach is time consuming, tedious, and inefficient. We have developed an instantaneous cost mapping analysis that allows for an estimate of the metabolic cost landscape without the explicit need for steady-state measurements. Here we present novel methods to quantify the confidence in an estimated metabolic cost landscape, allowing for an objective subject-specific comparison of protocols regardless of which metabolic analysis is used. We validated these techniques by estimating metabolic cost landscapes for healthy subjects walking with bilateral robotic ankle exoskeletons using a standard practice protocol and two innovative protocols that use an instantaneous cost mapping analysis. All cost landscapes were a function of the devices’ actuation timing. Results showed that for this device a protocol using an instantaneous cost mapping analysis could accurately identify optimal parameter configurations in 20 min, where the standard practice protocol required 42 min. Additionally, using an instantaneous cost mapping analysis with the standard practice’s parameter exploration significantly improved fit confidence. These methods could greatly improve real-time optimization of robotic assistive devices or studies focused on biomechanical manipulations of locomotion.NEW & NOTEWORTHY We are presenting novel subject-specific metabolic cost landscape confidence analyses. These confidence analyses can greatly improve experimental design, intersubject analysis, and the comparison of landscape mapping protocols. We validated these methods by mapping subject-specific metabolic cost landscapes using bilateral ankle exoskeletons and are presenting the first full study using instantaneous cost mapping techniques to optimally tune an assistive robotic device.
The effect of obesity on the contractile performance of isolated mouse soleus, EDL, and diaphragm muscles
Authors: Tallis Jason , Hill Cameron , James Rob S. , Cox Val M. , Seebacher Frank 
Published: November 2016

Obesity affects the major metabolic and cellular processes involved in skeletal muscle contractility. Surprisingly, the effect of obesity on isolated skeletal muscle performance remains unresolved. The present study is the first to examine the muscle-specific changes in contractility following dietary-induced obesity using an isolated muscle work-loop (WL) model that more closely represents in vivo muscle performance. Following 16-wk high-calorific feeding, soleus (SOL), extensor digitorum longus (EDL), and diaphragm (DIA) were isolated from female (CD-1) mice, and contractile performance was compared against a lean control group. Obese SOL produced greater isometric force; however, isometric stress (force per unit muscle area), absolute WL power, and normalized WL power (watts per kilogram muscle mass) were unaffected. Maximal isometric force and absolute WL power of the EDL were similar between groups. For both EDL and DIA, isometric stress and normalized WL power were reduced in the obese groups. Obesity caused a significant reduction in fatigue resistance in all cases. Our findings demonstrate a muscle-specific reduction in contractile performance and muscle quality that is likely related to in vivo mechanical role, fiber type, and metabolic profile, which may in part be related to changes in myosin heavy chain expression and AMP-activated protein kinase activity. These results infer that, beyond the additional requirement of moving a larger body mass, functional performance and quality of life may be further limited by poor muscle function in obese individuals. As such, a reduction in muscle performance may be a substantial contributor to the negative cycle of obesity.NEW & NOTEWORTHY The effect of obesity on isolated muscle function is surprisingly underresearched. The present study is the first to examine the effects of obesity on isolated muscle performance using a method that more closely represents real-world muscle function. This work uniquely establishes a muscle-specific profile of mechanical changes in relation to underpinning mechanisms. These findings may be important to understanding the negative cycle of obesity and in designing interventions for improving weight status.