bluuebunny/crossref_metadata_2025_split huggingface dataset:
NOVEL USE OF A CHILDREN'S EMERGENCY DEPARTMENT SCORING SYSTEM AS A MARKER OF RESOURCE UTILISATION
Authors: Ronald D , Fielding P , Davies F 
Published: November 2015

Objectives & BackgroundThe Paediatric Observation Priority Score is an acuity scoring tool made of physiological, historial and subjective components. It is designed to be used in Children's urgent care settings and aids identification of both the unwell child and those children who can safely be managed in the community. As part of a programme to ensure its validity and reliability this study tested its ability to be an indicator of departmental resource utilisation.Table 1Disposition of Children presenting by POPSPOPSTotal NumberHomeRe-directed/Followed-upAdmitted029818547661–2346210301063–4196987915–663172447–82221189+11109Total93651387334MethodsSince its inception, prospective data has been collected by the Emergency Department (ED) at Leicester Royal Infirmary with regards to initial triage POPS, diagnosis and management in ED, and eventual disposition in the department. From this data, we isolated 936 presentations to ED over a small time frame. All children were aged 0–15 years. We analysed the initial POPS on presentation of these patients as a function of the investigations and interventions they went on to receive whilst in ED.ResultsPOPS scores range from 0 to 16. 298 of the 936 (31.8%) patients had an initial POPS of 0, and with 89.7% (840/936) having a POPS of 4 or less on presentation (Table 1). Grouping investigations and interventions together, patients with a POPS of 0 had on average 0.85 interventions per person. The average number of interventions per person increased in a linear fashion with increasing acuity as demonstrated by increasing POPS (Figure 1). Patients with a total POPS of 9 or above had on average 2.45 interventions per person. Chest X-ray, paracetamol and nebuliser administration, oral fluid challenge and intravenous antibiotic prescription all demonstrate a linear relationship between increased resource consumption and increasing clinical acuity.ConclusionPOPS demonstrates good correlation between acuity on presentation to the ED and the clinical requirement for investigation and intervention. This confirms the interval validity of the system although it is not suprising those children who are most unwell will require the most intervention. As POPS may provide a means of predicting likely resource consumption of children in ED at the point of assessment its utility to both senior decision makers and managers is apparent. Over time a model for resources utilisation which may aid and support service investment decisions could be developed.Figure 1CAU=Admitted, UCC=Redirected or Followed Up.
DELAYED BLEEDING IN ANTICOAGULATED PATIENTS AFTER BLUNT HEAD TRAUMA
Authors: Kuczawski M , Mason S , Teare M , Stevenson M , Goodacre S , Holmes M , Harper R , Ramlakhan S , Morris F 
Published: November 2015

Objectives & BackgroundThe AHEAD Study aimed to determine the head injury complication rate and identify risk factors associated with a poor outcome in patients taking warfarin after blunt head trauma. The presence of neurological symptoms was associated with an increased risk of adverse outcome. As delayed bleeding is of concern in this cohort of patients, we undertook exploratory analyses of those patients who re-attended the emergency department (ED) after discharge.MethodsThe study was undertaken in 33 type I EDs from October 2011 for 18-months. 3,566 adult patients taking warfarin with blunt head trauma were enrolled into the study. Anonymised patient-level data including time to CT head scan and details of any re-attendance to the ED within 10 weeks of the original episode were collected and available for 3534 patients. We examined the presentation and outcomes of those patients re-attending the ED with a related attendance.ResultsOf the 3534 patients in the study, 557 re-attended the ED of which 98 patients (2.8%) presented with a head-injury related condition, and 37 (1.1%) patients re-attended with a reason related to the original head-injury. In this patient group (median age 75.8 years; mean INR 2.59 (SD 0.82); GCS=15 86.5%): 0.54% (n=19) did not present with any neurological symptoms; 0.6% (n=21) were admitted and 0.48% (n=17) underwent CT scanning, 73.3% (n=11) of which were within 4 hours of attendance. There were significant head injury-related CT findings in 0.08% (n=3) patients; no patients underwent a neurosurgical procedure. Median number of days to re-attendance was 3 days (range 0–46 days) with length of re-attendance stay median 2 days (range 0–44 days). Neurosurgery was performed on 0.06% (n=2) patients that re-attended and 0.14% (n=5) patients died; 2 deaths were head-injury related but both patients originally presented with no symptoms and GCS=15, no CT scans were performed and the patients were not admitted.ConclusionOnly a small fraction (1.1%) of anticoagulated patients re-attended the ED after discharge from their original ED attendance for blunt head trauma. On re-attendance, 2 (0.06%) patients died due to head-injury related reasons however on their original presentation to the ED, both patients were neurologically normal. The rate of delayed complications is very low following head injury in patients on warfarin and there is no justification for admission and prolonged observation of these patients.
SPREADING INNOVATION IN CHILDREN'S EMERGENCY CARE: AN EXTERNAL PRAGMATIC VALIDATION OF THE PAEDIATRIC OBSERVATION PRIORITY SCORE
Authors: Roland D , Arshad F , Douglas A , Davies F 
Published: November 2015

Objectives & BackgroundIn paediatric emergency care the stakes are high: serious illness is uncommon but demand for urgent face-to-face medical assessment is increasing and there continue to be errors in the identification of seriously unwell children. Risk-averse strategies of referring all children of ‘potential concern’ for specialist paediatric assessment overloads an already stretched out of hours system, and leads to unnecessary hospital admissions.Scoring systems, despite being beneficial at the centre of development, often have not been shown to implement well in other settings. In a study of 20000 patients using our locally developed Paediatric Observation Priority Score (POPS) it was found a POPS >4 correlated with admission for greater than 24 hours and no patients with a POPS of 0 had a serious bacterial illness.The aim of this study was to examine the utility of POPS in Emergency Departments in the UK and determine baseline performance characteristics.MethodsPOPS was implemented in 4 emergency departments for children presenting between the ages of 0–16. Patients were managed as per local trust guidelines with POPS observations being taken prospectively at the first opportunity. Patient disposition was recorded, with participants being grouped into 4 categories: Discharged from ED, discharged but return within 7 days and admitted for less or more than 24 hours.Results3323 participants met inclusion/exclusion criteria with POPS scores ranging from 0 to 11 with a mean score 2.33 and standard deviation of 2.00.Combining data from all sites, there was a correlation between admission/discharge and POPS (R2=0.96) (figure 1). 90% of patients with a POPS 0 were discharged from the ED. 111 (3.3%) of patients re-presented. Odds ratio of readmission with POPS 5–9 against 0–4 was 2.05 (CI 1.20 to 3.52). Receiver operator curve for admission/discharge was 0.66 (CI 0.64 to 0.69).Using chi-squared models, admission/discharge for POPS 0–4 at each individual site showed no significant difference (p=0.93). However, for POPS >5 a significant difference was found (p<0.01).ConclusionIt is feasible to implement POPS into Emergency Departments and have similar peformance characteristics to the original site of development. This 'second' knowledge translation gap is often challenging to overcome and there is now evidence to support a wider health service evaluation of POPS' impact.Figure 1The Paediatric Observation Priority Score***.Figure 2Relationship between discharge rates and POPS.
INITIAL RESULTS OF THE RE-VERSE AD TRIAL: IDARUCIZUMAB REVERSES THE ANTICOAGULANT EFFECTS OF DABIGATRAN IN PATIENTS IN AN EMERGENCY SETTING OF MAJOR BLEEDING, URGENT SURGERY OR INTERVENTIONS
Authors: Pollack C , Eikelboom J , Weitz J , Reilly P , Glund S , Dubiel R , Kreuzer J , Stangier J , Wang B , Gagg J , Verhamme P , Bernstein R , Huisman M , Hylek E , Kamphuisen P , Levy J , Selke F , Steiner T , Kam C 
Published: November 2015

Objectives & BackgroundDabigatran, an oral thrombin inhibitor, is widely used for stroke prevention in atrial fibrillation. Idarucizumab, a monoclonal antibody fragment directed against dabigatran, demonstrated immediate, complete and sustained reversal of the anticoagulant effect of dabigatran, without procoagulant activity, in animal models and human volunteers.AimsTo examine the efficacy and safety of idarucizumab to rapidly reverse the anticoagulation effects of dabigatran in critical clinical situations.MethodsRE-VERSE AD is an ongoing multinational, open-label, single cohort study with a target size of up to 300 patients. It is designed to study the reversal of dabigatran's anticoagulant effect by 5 g idarucizumab given as two 2.5 g IV bolus infusions, in patients who experience life-threatening or uncontrollable bleeding (Group A) or who require emergency surgery or invasive procedure (Group B). The primary endpoint is the maximum reversal of the anticoagulant effect of dabigatran, based on central laboratory determination of the dilute thrombin time or ecarin clot time up to 4 hours after idarucizumab administration. Drug levels and other measures of dabigatran activity are also determined. Clinical outcomes, including cessation of bleeding, thrombotic events, and other safety measures, are assessed.ResultsIn the first 90 patients, idarucizumab normalized clotting tests in at least 90% of patients, an effect evident at the first measurement. There was one thrombotic event within 72 hours of idarucizumab administration in a patient whose anticoagulant therapy had not been restarted.ConclusionIdarucizumab is a promising specific reversal agent that rapidly and safely reverses dabigatran's anticoagulant effects within minutes in emergency situations that reflect real world clinical practice.
Acrylamide and Glycidamide Hemoglobin Adducts and Epithelial Ovarian Cancer: A Nested Case–Control Study in Nonsmoking Postmenopausal Women from the EPIC Cohort
Authors: Obón-Santacana Mireia , Lujan-Barroso Leila , Travis Ruth C. , Freisling Heinz , Ferrari Pietro , Severi Gianluca , Baglietto Laura , Boutron-Ruault Marie-Christine , Fortner Renée T. , Ose Jennifer , Boeing Heiner , Menéndez Virginia , Sánchez-Cantalejo Emilio , Chamosa Saioa , Castaño José María Huerta , Ardanaz Eva , Khaw Kay-Tee , Wareham Nick , Merritt Melissa A. , Gunter Marc J. , Trichopoulou Antonia , Papatesta Eleni-Maria , Klinaki Eleni , Saieva Calogero , Tagliabue Giovanna , Tumino Rosario , Sacerdote Carlotta , Mattiello Amalia , Bueno-de-Mesquita H.B. , Peeters Petra H. , Onland-Moret N. Charlotte , Idahl Annika , Lundin Eva , Weiderpass Elisabete , Vesper Hubert W. , Riboli Elio , Duell Eric J. 
Published: November 2015

AbstractBackground: Acrylamide was classified as “probably carcinogenic to humans (group 2A)” by the International Agency for Research on Cancer. Epithelial ovarian cancer (EOC) is the fourth cause of cancer mortality in women. Five epidemiological studies have evaluated the association between EOC risk and dietary acrylamide intake assessed using food frequency questionnaires, and one nested case–control study evaluated hemoglobin adducts of acrylamide (HbAA) and its metabolite glycidamide (HbGA) and EOC risk; the results of these studies were inconsistent.Methods: A nested case–control study in nonsmoking postmenopausal women (334 cases, 417 controls) was conducted within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Unconditional logistic regression models were used to estimate ORs and 95% confidence intervals (CI) for the association between HbAA, HbGA, HbAA+HbGA, and HbGA/HbAA and EOC and invasive serous EOC risk.Results: No overall associations were observed between biomarkers of acrylamide exposure analyzed in quintiles and EOC risk; however, positive associations were observed between some middle quintiles of HbGA and HbAA+HbGA. Elevated but nonstatistically significant ORs for serous EOC were observed for HbGA and HbAA+HbGA (ORQ5vsQ1, 1.91; 95% CI, 0.96–3.81 and ORQ5vsQ1, 1.90; 95% CI, 0.94–3.83, respectively); however, no linear dose–response trends were observed.Conclusion: This EPIC nested case–control study failed to observe a clear association between biomarkers of acrylamide exposure and the risk of EOC or invasive serous EOC.Impact: It is unlikely that dietary acrylamide exposure increases ovarian cancer risk; however, additional studies with larger sample size should be performed to exclude any possible association with EOC risk. Cancer Epidemiol Biomarkers Prev; 25(1); 127–34. ©2015 AACR.
N‐glycome Profile Levels Relate to Silent Brain Infarcts in a Cohort of Hypertensives
Authors: Vilar‐Bergua Andrea , Riba‐Llena Iolanda , Vanhooren Valerie , Dewaele Sylviane , Libert Claude , Penalba Anna , Montaner Joan , Delgado Pilar 
Published: November 2015

Background

Silent brain infarcts (
SBI
s) are highly prevalent in the aged population and relate to the occurrence of further stroke and dementia. Serum N‐glycome levels have been previously associated with aging and they might be related as well to the presence of
SBI
s and age‐related white matter hyperintensities.

Methods and Results

We determined the serum N‐glycome profile in a cohort study comprising 972 subjects and evaluated the relationship between N‐glycome levels and the presence and number of
SBI
s and with age‐related white matter hyperintensities grades, assessed by brain magnetic resonance imaging. Decreasing concentrations of bigalacto core‐α‐1,6‐fucosylated biantennary glycan and increasing concentrations of branching α‐1,3‐fucosylated triantennary glycan remained as independent predictors of
SBI
s (odds ratio 0.4, 95%
CI
0.3–0.7 and odds ratio 1.8, 95%
CI
1–3.2, respectively), after controlling for the presence of age and classic vascular risk factors. A similar pattern was found to be related to an increasing number of
SBI
s and white matter hyperintensities grade.

Conclusions
N‐glycome levels might be potentially useful as biomarkers for the presence of silent cerebrovascular disease.
Return to Sport Among French Alpine Skiers After an Anterior Cruciate Ligament Rupture
Authors: Haida Amal , Coulmy Nicolas , Dor Frédéric , Antero-Jacquemin Juliana , Marc Andy , Ledanois Thibaut , Tourny Claire , Rousseaux-Blanchi Marie Philippe , Chambat Pierre , Sedeaud Adrien , Toussaint Jean-François 
Published: November 2015

Background: There is little known about return to sport and performance after anterior cruciate ligament (ACL) tear in high-level alpine skiers. Purpose: To analyze the parameters that influence the return to sport and performance after an ACL tear in French alpine skiers from 1980 to 2013. Study Design: Descriptive epidemiology study. Methods: The study population included 239 male and 238 female skiers who competed on the national French alpine ski team for at least 1 season between 1980 and 2013 in the speed (downhill and super-G) and technical disciplines (giant slalom and slalom). Two groups were formed: group 1 (G1) included athletes who had sustained an ACL rupture, and group 2 (G2) included athletes who had never sustained an ACL rupture. Three performance indicators were selected: International Ski Federation (FIS) points calculation, FIS ranking, and podium finishes in the World Cup, World Championships, and Olympic Games. Results: The first-decile FIS points and international FIS ranking showed that G1 skiers obtained better performance than did G2 skiers. The mean ± SD career length of G1 skiers (men, 7.9 ± 4.7 years; women, 7.1 ± 4.1 years) was longer than that of G2 skiers (men, 4.5 ± 3.3 years; women, 4.2 ± 3.5 years). In addition, 12.8% (61 of 477) of the skiers achieved at least a podium finish during their careers: 23.0% (34 of 148) in G1 and 8.3% (27 of 329) in G2. The mean age at ACL rupture was 22.6 ± 4.1 years for men and 19.9 ± 3.5 years for women. In G1, 55 podiums were achieved before ACL rupture and 176 after in all competitions. Skiers who improved their performances after ACL rupture were significantly younger (men, 22.2 ± 3.0 years; women, 18.7 ± 2.2 years; P < .0001) at the time of injury than those showing a performance deterioration after ACL rupture (men, 25.3 ± 4.2 years; women, 22.4 ± 4.0 years). All skiers who had ACL tears continued their competitive careers after the injury. Conclusion: The overall results showed that it is possible to return to preinjury or even higher levels of performance after an ACL rupture and that age is the main element that guides postsurgical recovery.
Evaluating the Risk of a Fifth Metatarsal Stress Fracture by Measuring the Serum 25-Hydroxyvitamin D Levels
Authors: Shimasaki Yu , Nagao Masashi , Miyamori Takayuki , Aoba Yukihiro , Fukushi Norifumi , Saita Yoshitomo , Ikeda Hiroshi , Kim Sung-Gon , Nozawa Masahiko , Kaneko Kazuo , Yoshimura Masafumi 
Published: November 2015

Background: The fifth metatarsal bone is a common site of stress fractures in soccer athletes. Although several endocrine risk factors for stress fractures have been proposed, the endocrine risks for fifth metatarsal (5-MT) stress fractures have not been evaluated. Methods: To evaluate the endocrine risks of fifth metatarsal stress fractures, we conducted a cumulative case-control study. The present study included 37 athletes, of which 18 had a history of a zone 2 or zone 3 fifth metatarsal stress fracture and 19 controls. We analyzed serum 25-hydroxyvitamin D (25-OHD), serum parathyroid hormone (PTH), as well as biochemical markers of bone turnover by univariate or multivariate analyses. Results: Logistic regression analyses adjusted for multiple confounders revealed that insufficient serum 25-OHD levels less than 30 ng/mL (odds ratio [OR], 23.3), higher serum PTH levels (OR, 1.01), or higher serum bone-specific isoform of alkaline phosphatase levels (OR, 1.10) rather than serum tartrate-resistant acid phosphatase 5b were associated with statistically significantly increased odds of 5-MT stress fractures. A postestimation calculation demonstrated that 25-OHD levels of 10 and 20 ng/mL were associated with 5.1 and 2.9 times greater odds for 5-MT stress fractures, respectively. Conclusion: 25-OHD insufficiency was associated with an increased incidence of 5-MT stress fractures. This insight may be useful for intervening to prevent 5-MT stress fractures. Level of Evidence: Level III, case-control study.
Neo-epitopes emerging in the degenerative hippocampal granules of aged mice can be recognized by natural IgM auto-antibodies
Authors: Manich Gemma , Augé Elisabet , Cabezón Itsaso , Pallàs Mercè , Vilaplana Jordi , Pelegrí Carme 
Published: November 2015

Abstract
Background
Degenerative granular structures appear progressively with age in the hippocampus of most mouse strains. We recently reported that these granules contain a neo-epitope that is recognised by IgM antibodies present as contaminants in many commercial antibodies obtained from mouse ascites and mouse or rabbit serum. We hypothesise that these anti-neo-epitope IgMs are in fact natural auto-antibodies that are generated spontaneously during the foetal stage without previous contact with external antigens and whose repertoire and reactivity pattern have been determined through evolution, being remarkably stable within species and even between species.

Findings
In the present work we found that mice from the ICR-CD1, BALB/C and SAMP8 strains have anti-neo-epitope IgM antibodies in their plasma at all ages tested and even when maintained under specific opportunistic pathogen-free conditions. Moreover, we determined that these anti-neo-epitope IgMs are also present in rabbit, goat and rat serum. We also found that, in each mouse that presented hippocampal granules, the anti-neo-epitope IgMs contained in its plasma recognised the neo-epitopes in its own granules.

Conclusions
This study led to the conclusion that anti-neo-epitope IgMs are widespread natural auto-antibodies contained in the plasma of mice and other species. The presence of these natural auto-antibodies not only explains why they are frequently found as contaminants in commercial antibodies, but also paves the way for a new approach to a treatment and diagnosis of pathological brain processes based on natural IgMs and neo-epitopes.
Metric fixed point theory: a brief retrospective
Authors: Kirk William A 
Published: November 2015

AbstractThese remarks are based on a talk the writer gave at the 11th International Conference in Fixed Point Theory and Applications, held at Galatasaray University in Istanbul, Turkey, July 20-24, 2015. They represent selected thoughts on a career in research, largely devoted to metric fixed point theory, that has spanned over 50 years.
Clinical potential of gene mutations in lung cancer
Authors: Carper Miranda B. , Claudio Pier Paolo 
Published: November 2015

AbstractLung cancer is the most common cancer type worldwide and the leading cause of cancer related deaths in the United States. The majority of newly diagnosed patients present with late stage metastatic lung cancer that is inoperable and resistant to therapies. High‐throughput genomic technologies have made the identification of genetic mutations that promote lung cancer progression possible. Identification of the mutations that drive lung cancer provided new targets for non‐small cell lung cancer (NSCLC) treatment and led to the development of targeted therapies such as tyrosine kinase inhibitors that can be used to combat the molecular changes that promote cancer progression. Development of targeted therapies is not the only clinical benefit of gene analysis studies. Biomarkers identified from gene analysis can be used for early lung cancer detection, determine patient's prognosis and response to therapy, and monitor disease progression. Biomarkers can be used to identify the NSCLC patient population that would most benefit from treatment (targeted therapies or chemotherapies), providing clinicians tools that can be used to develop a personalized treatment plan. This review explores the clinical potential of NSCLC genetic studies on diagnosing and treating NSCLC.