bluuebunny/crossref_metadata_2025_split huggingface dataset:
FALLS FROM BUILDINGS IN THE PAEDIATRIC POPULATION
Authors: Haq H , Fanous R , Clark M , Parikh A 
Published: November 2016

Objectives & BackgroundApproximately 4,000 children under the age of 15 are injured falling from windows in the UK. Ten of the children die and an unknown number suffer serious injuries. This study highlights a number of temporal, demographic and socio-economic risk factors for this mechanism of injury. The study also identifies potential strategies to reduce the number of falls from windows.MethodsThis retrospective study of paediatric patients utilised the Barts Health Trust Paediatric Trauma database. Initially, all patients under 16 years of age, who presented with a fall from a height (window, roof or balcony) between 2010 and 2015 were included. This was followed by a short phone survey that was conducted to find out more about safety measures at the location and housing circumstances.Results93 patients presented with falls from a height during the study period. Two (2.15%) of these children died. Boys were twice as likely as girls to fall and 88 (94.6%) were accidents. There was a seasonal pattern with 61% of falls occurring in the summer months. 78 (83.87%) of children with falls from buildings required admission to hospital, with a mean length of stay of 3.37 days. 10.5% of children required admission to the Paediatric Critical Care Unit and 11% required emergency surgery. 53% of patients sustained limb fractures and 42% head injuries. 12% of those patients contacted by telephone survey were experiencing long term health problems. The majority (72.5%) of falls occurred in neighbourhoods ranked within the 30% most deprived in the country. Only 12% of the households represented in this study had functioning safety locks. 12% of those children who fell from windows had a pre-existing diagnosis of autism.ConclusionThis study quantifies the impact the falling from windows had on individual children, their families and the broader healthcare system. This study also suggest that window locks are extremely effective at reducing falls and should be evaluated as a public health intervention. Furthermore, the disproportionately high number of autistic child that falls from windows should prompt an urgent review to ensure these vulnerable children are living in a safe environment.
USING IN SITU SIMULATION TO GET PAEDIATRIC CODE RED RIGHT
Authors: Anpananthar A , Parikh A , Galea J 
Published: November 2016

Objectives & BackgroundA paediatric code red (massive haemorrhage) call is rare but when it does happen, it needs to be performed correctly. In our major trauma centre, our adult emergency department (ED) teams have regular code red calls and have thus fine-tuned the process. We used a series of in-situ high-fidelity simulation to improve how we practically managed a paediatric code red in our ED.MethodsA paediatric code red trauma scenario was delivered using high-fidelity simulation. 3 sessions were delivered over 9 months in our paediatric ED with immediate debriefing of the team and observers.ResultsThere were >20 members of the multidisciplinary team (MDT) at each session. The key concerns identified from debriefing were acted upon. These included.▸ Communication: problems in the bleep system were identified. One key change is that the radiology registrar now holds a bleep to attend these calls. There is poor network coverage in the hospital for mobile phones and there is now an on-going discussion about the need for more portable phones. The team members on the switchboard list were identified and amended to be specific for a paediatric call.▸ Team work: aide memoires with key tasks for each of the paediatric trauma team member were adapted from the adult cards▸ Equipment: a mobile paediatric code red trolley was commissioned by the anaesthetic team to address the repeated questions about which trauma lines were available for younger children.▸ Training: gaps in knowledge for the MDT were acted upon, including increased frequency of Belmont training for the paediatric nurses. The general paediatric doctors now have a trauma specific workshop to understand their roles and trauma terminology included in their regular teaching program.▸ Major issues were reported via our DATIX system which helped efficiently deliver on some of the changes. Action and learning points were communicated with the leads for all the relevant departments via email. Debriefing sessions also gave the MDT an opportunity to identify different members of the team and open doors for other discussions.ConclusionThe simulation and debriefing sessions were key to identifying gaps and in improving the process of managing a paediatric code red by our trauma teams. We worked successfully with our simulation department and these sessions have been set up to continue running to ensure all new teams will benefit from managing this rare event and to continue to fine-tune the process.
WHO ARE OUR ‘CODE-RED’ KIDS? – A URBAN MAJOR TRAUMA CENTRE'S EXPERIENCE OF MAJOR HAEMORRHAGE IN INJURED CHILDREN
Authors: Randhawa H , Edwards MA , Cantle F 
Published: November 2016

Objectives & BackgroundMajor trauma in children, while being relatively uncommon, is still a principal cause of preventable death with severe haemorrhage being one of the main responsible reasons. ‘Major haemorrhage protocols’ (known in our institution as a ‘Code Red’) have been widely introduced in order to make large amounts of blood products available quickly. Most protocols, including the 'Code Red' involve adaptations for paediatrics. The ratio of blood products is 1:1 packed red blood cells (PRBCs) to Fresh Frozen Plasma (FFP) mirroring the adult literature that has evidence of improved outcomes.The objective was to investigate the incidence, demographics, physiology and outcomes of the children triggering a ‘Code Red’ protocol.MethodsAll ‘code red’ activations for children (all those ≤18 years) from 1st Jan 2010 to 31st Dec 2015 were identified then resuscitation room records and computer databases were scrutinised.Results1104 children presented during this period as 'trauma call' pre-alerts with only 36 children triggered the ‘Code Red’ protocol (3%). 31 actually received blood with 5 receiving products from prehospital teams.The age distribution was unsurprisingly skewed towards older age groups (median 17 years, mean 15.4 years) and predominantly male 89%. Only 3 cases were under 12.28 (78%) had penetrating trauma of which 4 were gun shot wounds.4 arrived in traumatic cardiac arrest (100% mortality) and were given the most blood products. Of the other patients, only 25% were hypotensive and only 47% were tachycardic.Low haemoglobin, deranged clotting or both were seen in 27 cases, with worsening coagulation in 13 patients post transfusion.5 children (18%) of patients receiving more than one unit of PRBCs, had a 1:1* ratio of PRBC:FFP. *(permitted to be a difference of 1 unit only)25 cases were taken direct to theatre with an overall mortality of 25%, with 2 deaths in the emergency department, 4 in theatre and 3 later in critical care.ConclusionThe most common paediatric case to trigger a major haemorrhage protocol at our intitution (72%) is a teenage male with penetrating trauma. 'Code Red' calls for smaller children or those sustaining blunt trauma are extremely rare.The data supports the caution that vital signs are poor indicators of hypovolaemia and, despite the protocols, it is still difficult to ensure recommended ratios of blood to plasma are administered.
A PRE-HOSPITAL ANALYSIS OF PAEDIATRIC MAJOR TRAUMA IN THE GREATER DUBLIN AREA
Authors: Kelly O , O'Reilly M , Collins NC 
Published: November 2016

Objectives & BackgroundThe provision of both Paediatric and Trauma care in Ireland is undergoing reconfiguration with the formation of a National Children's Hospital (NCH) and Major Trauma Centres and Networks. This will result in the amalgamation of three paediatric emergency departments (EDs) in Dublin into one centralised ED and two satellite centres.Ambulance care in the Greater Dublin Area is provided by Dublin Fire Brigade (DFB) and the National Ambulance Service (NAS).Central to service design and provision is an understanding of demand and patient centred factors. This study aims to study the burden of major paediatric trauma in the Greater Dublin Area as served by DFB in order to inform policy and strategic healthcare planning.MethodsData from DFB was analysed to determine the incidence of major paediatric trauma in the Dublin area in 2014. ‘Major Trauma’ was defined as a trauma where the attending paramedics placed the receiving ED on ‘standby’. The incident locations were mapped using Central Statistics Office small areas. Data was analysed to determine the median travel time and range to the receiving ED and the proposed NCH, diurnal variation, and the mechanism of injury.ResultsDFB responded to 58 paediatric Major Traumas in 2014. Paediatric trauma was focused in suburban areas (Image 1).The median (range) travel time to the current 3 hospitals was 10 mins 15 secs (2'38”–32'12”), this was estimated to change to 18 mins (6'–35') with the opening of a single NCH.12% of cases occurred between the night time hours of 22:00–07:30.Burns equated for the majority (34.5%) of the incidents, with traffic accidents and falls both accounting for 20.7% (Image 2).ConclusionThe low incidence of paediatric Major Trauma documented in the Greater Dublin Area may reflect the lack of both NAS data and predetermined hospital pre-alert criteria for Major Trauma.Information pertaining to location and timing is vital to hospital staffing procedures and specialty service provision, allowing strategic planning according to likely demand. An awareness of the mechanism of injury of paediatric patients can guide the need for specialist services.The change from the current paediatric service to that of one centralised ED would result in an estimated median increase of 7.75 mins in transit time.It is envisaged that this data can in strategic planning of healthcare provision, particularly at this pivotal moment of reconfiguration in Ireland.Figure 1Figure 2
NON-ACCIDENTAL INJURY: AN IMPORTANT CAUSE OF PAEDIATRIC MAJOR TRAUMA
Authors: Parry N , Goldsworthy L , Melsom S , Fryer J , Haythornthwaite G 
Published: November 2016

Objectives & BackgroundTo establish the number of major trauma patients attending Bristol Royal Hospital for Children's Emergency Department with child protection concerns and suspected non- accidental injury (NAI). To identify the difference in injury patterns of children with suspected NAI versus accidentally injured children. NAI is an important cause of paediatric major trauma. There is a lack of research on NAI as a cause for paediatric major trauma. Results from national Trauma Audit & Research Network (TARN) data suggest that children with NAI have increased Injury Severity (ISS) and a higher mortality rate. According to TARN data in 2012, 10.1% of children with major trauma were <2 years old with NAI.MethodsAll paediatric major trauma patients from 27/04/14- 26/12/14 were included. Electronic case-notes were reviewed. Information collected included: Injury Severity Score; mechanism of injury; injuries sustained; child protection documentation; imaging; disposal and outcome.Results122 Paediatric major trauma patients presented to ED and were included. 40 patients were secondary transfers. There was a weak positively skewed relationship between age and ISS. Mechanisms of injury were diverse. Commonest accidental injuries sustained were head, limb and abdominal/pelvic injuries. Child protection concerns were raised in 31 of the cases. 13 of these children had suspected NAI. Of these, there were 9 isolated injuries that included: 7 head injuries, 1 rectal perforation and 1 perineal tear. The remainder of cases involved severe multi-system trauma: 2 head injuries, 1 abdominal injury, 2 limb injuries, 3 chest injuries and 1 spinal injury. Non-ambulant children underwent the greatest proportion of CT heads compared to older children. 7/9 children in the suspected NAI group with head injuries were under 1-year-old. 9% all children were <2 years old with suspected NAI. Community Paediatricians were involved all suspected NAI cases.ConclusionThe findings of this study support previous TARN data, which suggests that NAI is a common cause of major trauma. Injury patterns are different in this group compared to accidental injury with increased proportion of head injuries, especially amongst the non-ambulant children.Figure 1Figure 2Figure 3Figure 4
Whole-genome profiling helps to classify phyllodes tumours of the breast
Authors: Laé Marick , La Rosa Philippe , Mandel Jonas , Reyal Fabien , Hupé Philippe , Terrier Philippe , Couturier Jérôme 
Published: November 2016

AimsThe aim of this study was to analyse a series of borderline and malignant phyllodes tumours (PTs) of the breast by whole-genome profiling to identify genomic markers that could help to recognise potentially malignant tumours within borderline tumours.MethodsWe evaluated the genetic imbalances of a series of 53 PTs (30 borderline, 23 malignant) using the Human CNV370 BeadChip microarray (Illumina), containing 370 000 SNP markers and correlate this alterations with clinicopathological features.ResultsForty-five PTs (85%) showed chromosome copy number variations (CNVs). Twenty PTs (37%) showed five or more chromosomal imbalances (8/30 borderline (27%) and 12/23 malignant (52%)). The large-scale genetic changes associated with malignant were+7p (9/23), +1q (8/23), −10p (8/23), −13q14 (7/23), +8q (6/23) and +10q (6/23) and borderline were+1q (13/30), −13q14 (9/30), −6q (8/30) and −10p (8/30). Losses in 9p21.3, encompassingCDKN2A/Bgene, were present in three tumours (malignant), whereas deletions of 13q, with a minimal region in 13q14.2 encompassing theRB1gene, were found in 9/30 borderline and 7/28 malignant tumours. High-level amplifications were seen in eight tumours (seven malignant and one borderline): in 7p in three tumours (includingEGFRin two), 7q31.2 (includingTFECandMET), 8q24.21 (includingMYC) and 8q23.3 (includingCSMD3) in one tumour each.ConclusionsWhole-genome profiling by SNP arrays in PTs leads to identify a high number of CNV, gains of 7p and 8q, losses of 13q and 10, losses in 9p21.3 (CDKN2A/B) and the presence of amplifications, especially involvingEGFR, as markers of potentially malignant tumours.
Is a detailed grading of villous atrophy necessary for the diagnosis of enteropathy?
Authors: Biagi Federico , Vattiato Claudia , Burrone Marco , Schiepatti Annalisa , Agazzi Simona , Maiorano Gregorio , Luinetti Ombretta , Alvisi Costanza , Klersy Catherine , Corazza Gino Roberto 
Published: November 2016

AimsThe utility of the 7 level Marsh–Oberhuber classification of mucosal damage in patients with coeliac disease has recently been criticised. Analysis of duodenal biopsies with dissecting microscopy is an unsophisticated method that, however, provides useful information in cases of frank villous atrophy. In the last 15 years, we have always analysed duodenal biopsies with dissecting microscopy before sending them to the pathology department for histology. If the results of dissecting microscopy and traditional histology were comparable, we feel that would be strong evidence that grading of the histological lesion would be unnecessary if not pointless in the everyday diagnosis of enteropathies.MethodsThe clinical notes of all 2075 patients undergoing duodenal biopsy between September 1999 and June 2015 were retrospectively analysed. Results of duodenal mucosal evaluation with both dissecting microscopy and traditional histology were collected and statistically compared.ResultsThe κ statistics showed a substantial agreement of the two methods (κ statistics 0.78). Sensitivity of dissecting microscopy for detection of severe villous atrophy was 85.1% (95% CI 81.2% to 88.5%) and specificity was 95% (95% CI 93.8% to 96%).ConclusionsAlthough dissecting microscopy is an unsophisticated method that obviously cannot substitute traditional histology, our results suggest that in everyday clinical practice, the diagnosis of coeliac disease and other flat enteropathies does not require grading of villous atrophy.
Flat-detector computed tomography PBV map in the evaluation of presurgical embolization for hypervascular brain tumors
Authors: Wen Li-Li , Zhang Xin , Zhang Qing-Rong , Wu Qi , Chen Shu-Juan , Deng Jin-Long , Huang Kaiyi , Wang Han-Dong 
Published: November 2016

BackgroundPreoperative embolization of hypervascular brain tumors is frequently used to minimize intraoperative bleeding.ObjectiveTo explore the efficacy of embolization using flat-detector CT (FDCT) parenchymal blood volume (PBV) maps before and after the intervention.Materials and methodsTwenty-five patients with hypervascular brain tumors prospectively received pre- and postprocedural FDCT PBV scans using a biplane system under a protocol approved by the institutional research ethics committee. Semiquantitative analysis, based on region of interest measurements of the pre- and post-embolization PBV maps, operating time, and blood loss, was performed to assess the feasibility of PBV maps in detecting the perfusion deficit and to evaluate the efficacy of embolization.ResultsPreoperative embolization was successful in 18 patients. The relative PBV decreased significantly from 3.98±1.41 before embolization to 2.10±2.00 after embolization. Seventeen patients underwent surgical removal of tumors 24 hours after embolization. The post-embolic tumor perfusion index correlated significantly with blood loss (ρ=0.55) and operating time (ρ=0.60).ConclusionsFDCT PBV mapping is a useful method for evaluating the perfusion of hypervascular brain tumors and the efficacy of embolization. It can be used as a supplement to CT perfusion, MRI, and DSA in the evaluation of tumor embolization.
The Barrel stent: new treatment option for stent-assisted coiling of wide-necked bifurcation aneurysms—results of a single-center study
Authors: Mühl-Benninghaus Ruben , Simgen Andreas , Reith Wolfgang , Yilmaz Umut 
Published: November 2016

PurposeThe Barrel stent is a laser cut stent designed for stent-assisted coil embolization of wide-necked bifurcation or branch aneurysms with a single device, with the purpose of lowering the metal-to-artery ratio and its inherent risk of thromboembolic complications of multiple stents. We report our early experiences with this device in 17 patients in this retrospective single-center analysis.Materials and methods17 consecutive patients who underwent stent-assisted coil embolization of wide-necked bifurcation aneurysms with the Barrel stent were retrospectively identified. We analyzed the feasibility of successful deployment and post-treatment angiographic results. Adverse events, clinical outcome, and angiographic follow-up results were also analyzed.ResultsAneurysms were located in the internal carotid artery (n=3), the middle cerebral artery (n=9), the anterior communicating artery (n=3), and the basilar artery (n=2). In the immediate post-treatment angiography, adequate occlusion (neck remnant or total occlusion) was observed in 16/17 (94.1%) of aneurysms. One patient experienced a transient ischemic attack. No permanent neurologic deficits were observed. 13/17 (76.5%) patients underwent short-term follow-up angiography after 3 months, all of which showed adequate occlusion of the aneurysm.ConclusionsIn this small retrospective single-center analysis we show that stent-assisted coiling with the Barrel stent is a safe and effective option for the endovascular treatment of intracranial wide-necked bifurcation aneurysms.
Performance of the reinforced right abutment slope of Zipingpu Dam during magnitude 8.0 earthquake, Wenchuan, China
Authors: Ren Aiwu , Wang Yujie , Chen Zuyu , Song Yangang , Sun Ping 
Published: November 2016

On 12 May 2008, an earthquake of magnitude 8.0 on the Richter scale occurred at Wenchuan in China. Zipingpu dam also experienced the earthquake. The maximum ground acceleration near the top of the 156 m high rockfill dam exceeded 2
g
. The right dam abutment slope, which accommodates all the discharge facilities, remained intact after this severe earthquake. However, the natural slopes on the opposite side of the reservoir were severely damaged. It has been found that the reinforcement provided by more than 1000 prestressed cables in the right abutment slope helped to stabilize it. Measurements from multipoint extensometers and load cells installed in the slope showed that there were sudden changes in displacement and stress during the earthquake. This is clear evidence that reinforcement with anchored cables can be successfully used to stabilize a slope.
Effect of increased and maintained frequency of speed endurance training on performance and muscle adaptations in runners
Authors: Skovgaard Casper , Almquist Nicki Winfield , Bangsbo Jens 
Published: November 2016

The aim of the study was, in runners accustomed to speed endurance training (SET), to examine the effect of increased and maintained frequency of SET on performance and muscular adaptations. After familiarization (FAM) to SET, 18 male ( n = 14) and female ( n = 4) runners (V̇o2max: 57.3 ± 3.4 ml/min; means ± SD) completed 20 sessions of maintained low-frequency (LF; every fourth day; n = 7) or high-frequency (HF; every second day; n = 11) SET. Before FAM as well as before and after an intervention period (INT), subjects completed a series of running tests and a biopsy from m. vastus lateralis was collected. Ten-kilometer performance improved ( P < 0.05) ~3.5% during FAM with no further change during INT. Time to exhaustion at 90% vV̇o2max was 15 and 22% longer ( P < 0.05) during FAM and a further 12 and 16% longer ( P < 0.05) during INT in HF and LF, respectively. During FAM, muscle expression of NHE1 and maximal activity of citrate synthase (CS) and phosphofructokinase (PFK) increased ( P < 0.05), running economy (RE) improved ( P < 0.05), and V̇o2max was unchanged. During INT, both HF and LF increased ( P < 0.05) muscle expression of NKAβ1, whereas maximal activity of CS and PFK, RE, and V̇o2max were unchanged. Furthermore, during INT, muscle expression of FXYD1 and SERCA1, and FXYD1 activity increased ( P < 0.05) in HF, while muscle expression of SERCA2 decreased ( P < 0.05) in LF. Thus increased or maintained frequency of SET leads to further improvements in short-term exercise capacity, but not in 10-km running performance. The better short-term exercise capacity may be associated with elevated expression of muscle proteins related to Na+/K+ transportation and Ca2+ reuptake. NEW & NOTEWORTHY Ten speed endurance training (SET) sessions improved short-term exercise capacity and 10-km performance, which was followed by further improved short-term exercise capacity, but unchanged 10-km performance after 20 SET sessions performed with either high frequency (4 per 8 days) or continued low frequency (2 per 8 days) in trained runners. The further gain in short-term exercise capacity was associated with changes in muscle expression of proteins of importance for the development of fatigue.