bluuebunny/crossref_metadata_2025_split huggingface dataset:
PP21 Can paramedics correctly recognise cardiac arrhythmias and does recency of training have an impact?
Authors: Sharp Alex 
Published: September 2017

BackgroundParamedics increasingly utilise alternative care pathways and direct referrals to reduce Emergency Department admissions. The National Institute of Clinical Effectiveness (NICE) Transient Loss of Consciousness (TLoC) guidelines are one such example, with questions previously raised on the ability of paramedics to identify the arrhythmias. Studies identify that paramedics can safely recognise ST segment Myocardial Infarctions, however there remains a lack of evidence around arrhythmia recognition. This study aims to identify if paramedics can identify key arrhythmias and whether the recency of training impacts on recognition.MethodA quasi-experimental methodology was adopted for the study using a bespoke website. Paramedics were shown 20 12-lead ECGs of key arrhythmias. Each ECG appeared on the screen for a maximum of 60 s. During this time the paramedic was directed to identify the arrhythmia within a free text box, before proceeding to the next arrhythmia.Results356 paramedics consented into the study with 230 completing the study. The majority completing the study were standard paramedics [73.04%, n=168], with alternate paramedic roles such as critical care paramedics and paramedic practitioners making up the remainder The mean recognition rate was 47.03% [95% CI 43.82–50.22] with individual paramedics ranging from 10% to 95% and a median recognition rate of 45%. Recognition of individual arrhythmias ranged from 94.78% [95% CI 91.91–97.65] for Atrial Flutter to 3.91% [95% CI 1.4–6.42] for Prolonged QTc. No statistical difference was demonstrated between participants who had received training within the past two years and those who had not (47.96% vs. 46.19%, p=0.59).ConclusionThis study identified a wide variation in the ability of paramedics to recognise arrhythmias with no obvious patterns identified. The results of the study indicate that the current lack of arrhythmia recognition within paramedic training and curriculum guidance needs to be addressed.
PP24 The transient ischaemic attack 999 emergency referral (tier) feasibility trial: development of a complex intervention
Authors: Rees Nigel , Ali Khalid , Bulger Jenna , Dewar Richard , Edwards Adrian , Evans Bridie , Evans Lyn , Ford Gary , Hampton Chelsey , John Roger , Jones Charlene , Moore Chris , Porter Alison , Pryce Alan , Representative Lay , Quinn Tom , Seagrove Anne , Snooks Helen , Watkins Alan , Whitman Shirley 
Published: September 2017

BackgroundTransient Ischaemic Attack (TIA) is a neurologic event with symptom resolution within 24 hours. Early specialist assessment of TIA reduces risk of stroke and death. NICE (2008) recommends patients with TIA are seen in specialist clinics within 24 hours (if high risk) and seven days (if low risk).We aimed to develop a complex intervention for patients with low risk TIA presenting to the emergency ambulance service. The intervention was then to be used in the TIER feasibility trial, in line with the MRC guidance on staged development and evaluation of complex interventions.MethodsWe conducted three interrelated activities to produce the TIER intervention:Survey of UK Ambulance Services (n=13) to gather information about TIA pathways already in useScoping review of literature describing prehospital care of patients with TIASynthesis of data and definition of the intervention by specialist panel of: paramedics; ED and stroke consultants; service users; ambulance service managers.ResultsThe panel defined the TIER intervention to include:Protocol for paramedics to assess patients presenting with TIA and identify and refer low risk patients for prompt (<7 day) specialist review at TIA clinicPatient Group Directive and information pack to allow paramedic administration of aspirin to patients left at home with referral to TIA clinicReferral process via clinical desk in ambulance control roomTraining package for paramedicsAgreement with TIA clinic service provider to ensure rapid review of referred patientsConclusionWe followed MRC guidance to develop a clinical intervention which assesses and refers low risk TIA patients requesting 999 care. We will test feasibility of implementing and evaluating this in the TIER feasibility trial. We will then develop a fully powered randomised multicentre trial, if findings indicate this is appropriate.
PP29 Exploring factors increasing paramedics’ likelihood of administering analgesia in pre-hospital pain: cross sectional study (explain)
Authors: Asghar Zahid , Niroshan Siriwardena A , Phung Viet-Hai , Lord Bill , Foster Theresa , Pocock Helen , Williams Julia , Snooks Helen 
Published: September 2017

BackgroundParamedics play an important role in reducing pain in patients calling an ambulance. We aimed to identify how patient factors (age, sex), clinical condition and paramedic factors (sex, role seniority) affected pain treatment and outcomes.MethodsWe used a cross sectional design using routine retrospective data a one-week sample of all 999 ambulance attendances in two large regional UK ambulance services for all patients aged 18 years or over where pain was identified in people requiring primary transport to hospital. Exclusion criteria patients with a Glasgow Coma Scale score below 13, or patients not attended by a paramedic.We used a multilevel design, using a regression model to investigate which factors were independently associated with administration of analgesia and reduction in pain, taking into account confounders including patient demographics and other variables. Analysis was performed with Stata.ResultsWe collected data on 9574 patients (service 1, 2; n=3344, 6230 respectively) including 4911 (51.3%) male and 4524 (47.3%) females (1.5% missing). Initial pain score was not recorded in 42.4% (4063/9574). The multilevel model suggested that the factors associated with use of strong opiates (morphine intravenously or orally) was a pain score of 7 or above, patient age 50–64 years and suspected fractured neck of femur. Reduction in pain score of 2 or more points was significant whatever the initial pain score and associated with age 50–84 years. There was no association between use of strong opiate analgesic or reduction in pain score and sex of patient and/or sex of paramedic or crew member.ConclusionOur initial analysis showed a high level of non-recording of pain scores. There was no association between use of strong opiate analgesics or reduction in pain score of 2 points or more with patient sex or crew sex or paramedic skill level.
PP30 Rapid analgesia for prehospital hip disruption (rapid: feasibility study progress)
Authors: Bulger Jenna , Seagrove Anne , Snooks Helen , Evans Bridie , Fegan Greg , Ford Simon , Pallister Ian , Guy Katy , Brown Alan , Jones Sian , Keen Leigh , Khanom Ashrafunnesa , Rees Nigel 
Published: September 2017

BackgroundAdequate pain relief at the scene of injury and during transport to hospital is a major challenge in all acute traumas, especially for those with hip fractures, whose injuries are difficult to immobilise and whose long-term outcomes may be adversely affected by administration of opiate analgesics. Fascia Iliaca Compartment Block (FICB) is a procedure routinely undertaken by clinicians in emergency departments for hip fracture patients, but use by paramedics at the scene of emergency calls, is not yet evaluated. We report on study progress following six months of patient recruitment.MethodsWe undertook a randomised controlled feasibility trial using novel audited scratchcard randomisation to allocate eligible patients to FICB or usual care. FICB is only administered to patients without contraindications. The primary measureable outcome is health related quality of life, measured using SF-12 at 1 and 6 months. Secondary outcome measures include mobility scores at 6 months (using Rivermead Mobility Index); patient satisfaction; pain scores; patient safety and length of hospital stay. Interviews and focus groups will be used to understand acceptability of FICB to patients and paramedics. We will also assess the accuracy of paramedic hip fracture recognition (using sensitivity and positive predictive value as indicators).ResultsWe have developedparamedic pathway to assess patients for hip fracture and FICBparamedic training package, delivered by Consultant Anaesthetistrandomisation scratchcardsTo date we have recruited 19 paramedics; 10 are fully trained and recruiting patients, the remainder are being trained. Twenty-two patients have been randomised and 16 have consented to follow-up.DiscussionThis study will enable us to recommend whether to undertake a definitive multi-centre randomised controlled trial of FICB by paramedics for hip fracture and the procedure is effective for patients and worthwhile for the NHS.
Retrospective UK multicentre study of the pregnancy outcomes of women with a Fontan repair
Authors: Cauldwell Matthew , Steer Philip J , Bonner Samantha , Asghar Omar , Swan Lorna , Hodson Kenneth , Head Catherine E G , Jakes Adam Daniel , Walker Nicola , Simpson Margaret , Bolger Aidan P , Siddiqui Farah , English Katherine M , Maudlin Lucy , Abraham Dilip , Sands Andrew J , Mohan Aarthi R , Curtis Stephanie L , Coats Louise , Johnson Mark R 
Published: September 2017

BackgroundThe population of women of childbearing age palliated with a Fontan repair is increasing. The aim of this study was to describe the progress of pregnancy and its outcome in a cohort of patients with a Fontan circulation in the UK.MethodsA retrospective study of women with a Fontan circulation delivering between January 2005 and November 2016 in 10 specialist adult congenital heart disease centres in the UK.Results50 women had 124 pregnancies, resulting in 68 (54.8%) miscarriages, 2 terminations of pregnancy, 1 intrauterine death (at 30 weeks), 53 (42.7%) live births and 4 neonatal deaths. Cardiac complications in pregnancies with a live birth included heart failure (n=7, 13.5%), arrhythmia (n=6, 11.3%) and pulmonary embolism (n=1, 1.9%). Very low baseline maternal oxygen saturations at first obstetric review were associated with miscarriage. All eight women with saturations of less than 85% miscarried, compared with 60 of 116 (51.7%) who had baseline saturations of ≥85% (p=0.008). Obstetric and neonatal complications were common: preterm delivery (n=39, 72.2%), small for gestational age (<10th percentile, n=30, 55.6%; <5th centile, n=19, 35.2%) and postpartum haemorrhage (n=23, 42.6%). There were no maternal deaths in the study period.ConclusionWomen with a Fontan circulation have a high rate of miscarriage and, even if pregnancy progresses to a viable gestational age, a high rate of obstetric and neonatal complications.
Health-related quality of life and depression among participants in the Sjögren’s International Collaborative Clinical Alliance registry
Authors: Chou Annie , Gonzales John A , Daniels Troy E , Criswell Lindsey A , Shiboski Stephen C , Shiboski Caroline H 
Published: September 2017

ObjectiveTo examine health-related quality of life (HRQoL) and depression among participants in an international Sjögren’s syndrome (SS) registry, comparing those with and without SS.MethodsCross-sectional study of participants in the Sjögren’s International Collaborative Clinical Alliance (SICCA) registry. The 2016 American College of Rheumatology/European League Against Rheumatism SS classification criteria were used to determine disease status. HRQoL was assessed using the Short Form 12, version 2 Health Survey to derive scores for physical component summary (PCS) and mental component summary (MCS). Depression was assessed using the 9-Item Patient Health Questionnaire. Multivariate linear and logistic regression analyses were performed to identify predictors of HRQoL and depression while controlling for potential confounders.ResultsAmong 2401 SICCA participants who had symptoms of dry eyes and dry mouth, 1051 had SS (44%) and 1350 did not (56%). After controlling for confounders, when compared with non-SS participants, those with SS had better PCS (p<0.001, β=2.43, 95% CI 1.57 to 3.29), MCS (p=0.002, β=1.37, 95% CI 0.50 to 2.23) and lower adjusted odds of depression (p<0.001, OR 0.67, 95% CI 0.55 to 0.81). Other significant predictors of HRQoL and depression included employment, country of residence and use of medication with anticholinergic effect or for management of SS-related signs and symptoms.ConclusionOur results suggest that among symptomatic patients, having a diagnosis of SS may be associated with better emotional and psychological well-being compared with patients without a diagnosis. Having a definitive diagnosis of SS may encourage patients to obtain a better understanding of their disease and have coping mechanisms in place to better manage their symptoms.
Correlating abdominal pain and intra-abdominal injury in patients with blunt abdominal trauma
Authors: Neeki Michael M , Hendy Dylan , Dong Fanglong , Toy Jake , Jones Kevin , Kuhnen Keasha , Yuen Ho Wang , Lux Pamela , Sin Arnold , Kwong Eugene , Wong David 
Published: September 2017

BackgroundA thorough history and physical examination in patients with blunt abdominal trauma (BAT) is important to safely exclude clinically significant intra-abdominal injury (IAI). We seek to evaluate a correlation between self-reported abdominal pain, abdominal tenderness on examination and IAI discovered on CT or during exploratory laparotomy.MethodsThis retrospective analysis assessed patients with BAT ≥13 years old who arrived to the emergency department following BAT during the 23-month study period. Upon arrival, the trauma team examined all patients. Only those who underwent an abdominal and pelvic CT scan were included. Patients were excluded if they were unable to communicate or lacked documentation, had obvious evidence of extra-abdominal distracting injuries, had a positive drug or alcohol screen, had a Glasgow Coma Scale ≤13, or had a positive pregnancy screening. The primary objective was to assess the agreement between self-reported abdominal pain and abdominal tenderness on examination and IAI noted on CT or during exploratory laparotomy.ResultsAmong the 594 patients included in the final analysis, 73.1% (n=434) had no self-reported abdominal pain, 64.0% (n=384) had no abdominal tenderness on examination, and 22.2% (n=132) had positive CT findings suggestive of IAI. Among the 352 patients who had no self-reported abdominal pain and no abdominal tenderness on examination, a significant number of positive CT scan results (14%, n=50) were still recorded. Furthermore, a small but clinically significant portion of these 50 patients underwent exploratory laparotomy (1.1%, n=4). All four of these patients ultimately underwent a splenectomy and all were completed on hospital day one.ConclusionLack of abdominal pain and tenderness in patients with BAT with non-distracting injuries was associated with a small portion of patients who underwent a splenectomy. Patients with BAT without abdominal pain or tenderness may need a period of observation or CT scan to rule out IAI prior to discharge home.Level of evidenceLevel III, therapeutic/care management.
Soft Statistics with Respect to Utility and Application to Human Trafficking
Authors: Acharjee Santanu , Mordeson John N. 
Published: September 2017

It is well known that statistics deals with quantitative analysis. Thus, there is a lack of approach to do quantitative analysis in the presence of qualitative attributes. Soft set theory has the freedom to deal with attributes, [0, 1], etc. along with quantity. Thus, we introduce some fundamental ideas of soft statistics. Here, soft mean, soft standard deviation, soft coefficient of variation, soft correlation coefficient are introduced and some theorems are proved with respect to utility. Utility theory provides an analysis of choice behavior. As an application of our notions and results, we find soft correlation coefficients between vulnerability and government responses of various regions across the world. The data from “The Global Slavery Index 2016” are considered for application purposes.
Enhanced interlaminar excitation or reduced superficial layer inhibition in neocortex generates different spike-and-wave-like electrographic events in vitro
Authors: Hall Stephen P. , Traub Roger D. , Adams Natalie E. , Cunningham Mark O. , Schofield Ian , Jenkins Alistair J. , Whittington Miles A. 
Published: September 2017

Acute in vitro models have revealed a great deal of information about mechanisms underlying many types of epileptiform activity. However, few examples exist that shed light on spike-and-wave (SpW) patterns of pathological activity. SpW are seen in many epilepsy syndromes, both generalized and focal, and manifest across the entire age spectrum. They are heterogeneous in terms of their severity, symptom burden, and apparent anatomical origin (thalamic, neocortical, or both), but any relationship between this heterogeneity and underlying pathology remains elusive. In this study we demonstrate that physiological delta-frequency rhythms act as an effective substrate to permit modeling of SpW of cortical origin and may help to address this issue. For a starting point of delta activity, multiple subtypes of SpW could be modeled computationally and experimentally by either enhancing the magnitude of excitatory synaptic events ascending from neocortical layer 5 to layers 2/3 or selectively modifying superficial layer GABAergic inhibition. The former generated SpW containing multiple field spikes with long interspike intervals, whereas the latter generated SpW with short-interval multiple field spikes. Both types had different laminar origins and each disrupted interlaminar cortical dynamics in a different manner. A small number of examples of human recordings from patients with different diagnoses revealed SpW subtypes with the same temporal signatures, suggesting that detailed quantification of the pattern of spikes in SpW discharges may be a useful indicator of disparate underlying epileptogenic pathologies.NEW & NOTEWORTHY Spike-and-wave-type discharges (SpW) are a common feature in many epilepsies. Their electrographic manifestation is highly varied, as are available genetic clues to associated underlying pathology. Using computational and in vitro models, we demonstrate that distinct subtypes of SpW are generated by lamina-selective disinhibition or enhanced interlaminar excitation. These subtypes could be detected in at least some noninvasive patient recordings, suggesting more detailed analysis of SpW may be useful in determining clinical pathology.
CRISPR Genome-Wide Screening Identifies Dependence on the Proteasome Subunit PSMC6 for Bortezomib Sensitivity in Multiple Myeloma
Authors: Shi Chang-Xin , Kortüm K. Martin , Zhu Yuan Xiao , Bruins Laura A. , Jedlowski Patrick , Votruba Patrick G. , Luo Moulun , Stewart Robert A. , Ahmann Jonathan , Braggio Esteban , Stewart A. Keith 
Published: September 2017

Abstract
Bortezomib is highly effective in the treatment of multiple myeloma; however, emergent drug resistance is common. Consequently, we employed CRISPR targeting 19,052 human genes to identify unbiased targets that contribute to bortezomib resistance. Specifically, we engineered an RPMI8226 multiple myeloma cell line to express Cas9 infected by lentiviral vector CRISPR library and cultured derived cells in doses of bortezomib lethal to parental cells. Sequencing was performed on surviving cells to identify inactivated genes responsible for drug resistance. From two independent whole-genome screens, we selected 31 candidate genes and constructed a second CRISPR sgRNA library, specifically targeting each of these 31 genes with four sgRNAs. After secondary screening for bortezomib resistance, the top 20 “resistance” genes were selected for individual validation. Of these 20 targets, the proteasome regulatory subunit PSMC6 was the only gene validated to reproducibly confer bortezomib resistance. We confirmed that inhibition of chymotrypsin-like proteasome activity by bortezomib was significantly reduced in cells lacking PSMC6. We individually investigated other members of the PSMC group (PSMC1 to 5) and found that deficiency in each of those subunits also imparts bortezomib resistance. We found 36 mutations in 19S proteasome subunits out of 895 patients in the IA10 release of the CoMMpass study (https://themmrf.org). Our findings demonstrate that the PSMC6 subunit is the most prominent target required for bortezomib sensitivity in multiple myeloma cells and should be examined in drug-refractory populations. Mol Cancer Ther; 16(12); 2862–70. ©2017 AACR.
Pathway-Enriched Gene Signature Associated with 53BP1 Response to PARP Inhibition in Triple-Negative Breast Cancer
Authors: Hassan Saima , Esch Amanda , Liby Tiera , Gray Joe W. , Heiser Laura M. 
Published: September 2017

Abstract
Effective treatment of patients with triple-negative (ER-negative, PR-negative, HER2-negative) breast cancer remains a challenge. Although PARP inhibitors are being evaluated in clinical trials, biomarkers are needed to identify patients who will most benefit from anti-PARP therapy. We determined the responses of three PARP inhibitors (veliparib, olaparib, and talazoparib) in a panel of eight triple-negative breast cancer cell lines. Therapeutic responses and cellular phenotypes were elucidated using high-content imaging and quantitative immunofluorescence to assess markers of DNA damage (53BP1) and apoptosis (cleaved PARP). We determined the pharmacodynamic changes as percentage of cells positive for 53BP1, mean number of 53BP1 foci per cell, and percentage of cells positive for cleaved PARP. Inspired by traditional dose–response measures of cell viability, an EC50 value was calculated for each cellular phenotype and each PARP inhibitor. The EC50 values for both 53BP1 metrics strongly correlated with IC50 values for each PARP inhibitor. Pathway enrichment analysis identified a set of DNA repair and cell cycle–associated genes that were associated with 53BP1 response following PARP inhibition. The overall accuracy of our 63 gene set in predicting response to olaparib in seven breast cancer patient-derived xenograft tumors was 86%. In triple-negative breast cancer patients who had not received anti-PARP therapy, the predicted response rate of our gene signature was 45%. These results indicate that 53BP1 is a biomarker of response to anti-PARP therapy in the laboratory, and our DNA damage response gene signature may be used to identify patients who are most likely to respond to PARP inhibition. Mol Cancer Ther; 16(12); 2892–901. ©2017 AACR.
A volta da Cobra Canoa: em busca de uma antropologia indígena
Authors: Barreto João Paulo Lima , Santos Gilton Mendes dos 
Published: September 2017

Este texto, escrito a quatro mãos, trata do processo das Políticas Afirmativas no Programa de Pós-Graduação em Antropologia da Universidade Federal do Amazonas (UFAM). Ele descreve o enfrentamento dos desafios e o desenvolvimento de um exercício de reflexividade na busca de uma antropologia indígena.