bluuebunny/crossref_metadata_2025_split huggingface dataset:
Designing quantum multi-category classifier from the perspective of brain processing information
Authors: Ding Xiaodong , Xu Jinchen , Song Zhihui , Hou Yifan , Shan Zheng 
Published: August 2024

Abstract
In the field of machine learning, the multi-category classification problem plays a crucial role. Solving the problem has a profound impact on driving the innovation and development of machine learning techniques and addressing complex problems in the real world. In recent years, researchers have begun to focus on utilizing quantum computing to solve the multi-category classification problem. Some studies have shown that the process of processing information in the brain may be related to quantum phenomena, with different brain regions having neurons with different structures. Inspired by this, we design a quantum multi-category classifier model from this perspective for the first time. The model employs a heterogeneous population of quantum neural networks (QNNs) to simulate the cooperative work of multiple different brain regions. When processing information, these heterogeneous clusters of QNNs allow for simultaneous execution on different quantum computers, thus simulating the brain’s ability to utilize multiple brain regions working in concert to maintain the robustness of the model. By setting the number of heterogeneous QNN clusters and parameterizing the number of stacks of unit layers in the quantum circuit, the model demonstrates excellent scalability in dealing with different types of data and different numbers of classes in the classification problem. Based on the attention mechanism of the brain, we integrate the processing results of heterogeneous QNN clusters to achieve high accuracy in classification. Finally, we conducted classification simulation experiments on different datasets. The results show that our method exhibits strong robustness and scalability. Among them, on different subsets of the MNIST dataset, its classification accuracy improves by up to about 5% compared to other quantum multiclassification algorithms. This result becomes the state-of-the-art simulation result for quantum classification models and exceeds the performance of classical classifiers with a considerable number of trainable parameters on some subsets of the MNIST dataset.
Broadening the scope of anthropogenic influence in extreme event attribution
Authors: Jézéquel Aglaé , Bastos Ana , Faranda Davide , Kimutai Joyce , Le Grix Natacha , Wilson Anna M , Rufat Samuel , Shepherd Theodore G , Stuart-Smith Rupert F , Van Loon Anne F , Bevacqua Emanuele , D’Andrea Fabio , Lehner Flavio , Lloyd Elisabeth A , Moemken Julia , Ramos Alexandre M , Sippel Sebastian , Zscheischler Jakob 
Published: August 2024

Abstract
As extreme event attribution (EEA) matures, explaining the impacts of extreme events has risen to be a key focus for attribution scientists. Studies of this type usually assess the contribution of anthropogenic climate change to observed impacts. Other scientific communities have developed tools to assess how human activities influence impacts of extreme weather events on ecosystems and societies. For example, the disaster risk reduction (DRR) community analyses how the structure of human societies affects exposure, vulnerability, and ultimately the impacts of extreme weather events, with less attention to the role of anthropogenic climate change. In this perspective, we argue that adapting current practice in EEA to also consider other causal factors in attribution of extreme weather impacts would provide richer and more comprehensive insight into the causes of disasters. To this end, we propose a framework for EEA that would generate a more complete picture of human influences on impacts and bridge the gap between the EEA and DRR communities. We provide illustrations for five case studies: the 2021–2022 Kenyan drought; the 2013–2015 marine heatwave in the northeast Pacific; the 2017 forest fires in Portugal; Acqua Alta (flooding) events in Venice and evaluation of the efficiency of the Experimental Electromechanical Module, an ensemble of mobile barriers that can be activated to mitigate the influx of seawater in the city; and California droughts and the Forecast Informed Reservoir Operations system as an adaptation strategy.
Generalized Propensity Score Methods to Assess CKD-Associated Physiologic Factors and Risk of Kidney Failure in the Chronic Renal Insufficiency Cohort (CRIC) Study
Authors: Scialla Julia J , Mallawaarachchi Indika , Illenberger Nicholas , Brookhart M Alan , Isakova Tamara , Mitra Nandita , Ma Jennie Z ,   the CRIC Study Investigators
Published: August 2024

Abstract
Epidemiologic studies have identified many biochemical risk factors for chronic kidney disease (CKD) progression that are correlates of kidney function, termed here ‘CKD-associated physiologic factors’. Uncertainty remains if these factors are risk factors or risk markers accounting for aspects of kidney function not otherwise captured. We aimed to use flexible machine learning, a dynamic covariate history including kidney function informative markers, and generalized propensity score (GPS) weighting, to better control confounding for such exposures. We studied 3,052 adults with CKD in the Chronic Renal Insufficiency Cohort Study. We established a 2-year run-in period and assembled 90 variables that characterize variability and trends of selected CKD-associated physiologic factors and confounders. Using SuperLearner, we created a GPS for each CKD-associated physiologic factor and performed GPS-weighted Cox regressions. For context, we also evaluated results from traditional multivariable Cox proportional hazards models as in prior studies. Similar to traditional approaches, bicarbonate, calcium, potassium, hemoglobin, and PTH were each associated with risk of kidney failure using GPS weighting. The GPS approach detected non-linear associations in many factors, some of which were not detected with traditional models. We conclude that many associations between CKD-associated physiologic factors and kidney outcomes remain strong after GPS weighting.
Bimodal pattern of allometric scaling along grapevine shoots
Authors: Haj-Yahya Alaa , Sorek Yonatan , Hochberg Uri , Ohana-Levi Noa , Zait Yotam , Shtein Ilana 
Published: August 2024

Abstract

Background and Aims
Each branch internode, with the organs growing on it, can be seen as a single morphological phytomer subunit made of structurally and functionally interrelated components. However, allometric relationships between the anatomy and morphology of these subunits remain unclear, particularly in the axial context. The aim of this study was to address this knowledge gap by measuring morpho-anatomical parameters and their allometric relationships along grapevine shoots.

Methods
To facilitate comparison, shoot length was normalized, and a relative position index was calculated for each internode, ranging from zero at the base to one at the apex. Scaling relationships between morpho-anatomical parameters along the axis were developed and validated by statistical modelling.

Key Results
Most morpho-anatomical parameters displayed an axial behaviour of increasing then decreasing in size from base to apex, with the exception of shoot diameter and shoot vessel density. A relative position index of 0.2 acted as the data turning point for most variables analysed. During the first phase (relative position index of &lt;0.2), the traits of the phytomer organs are uncoupled and show weak allometric correlation, and during the second phase the traits exhibit strong allometric relationships.

Conclusions
Our findings suggest that allometric relationships along grapevine shoots are not constant; they exhibit a bimodal pattern, possibly influenced by seasonal temperatures. This work could aid in managing productivity shifts in agricultural and natural systems under global climate change and adds to basic knowledge of differentiation and development of growth units in plants.
75 Audit of Pain Control in Surgical Inpatients
Authors: Jodlowski G , Joyce D 
Published: August 2024

Abstract

Introduction
Pain is a significant feature in surgical patients and is complicated by multiple underlying mechanisms and co-morbidities. Optimal pain control is an important feature of care as prolonged pain can impair quality of life, reduce mobility, healing, delay hospital discharge and cause detrimental pathophysiological changes. The aim of audit is to assess the quality of pain control including side effects of analgesics in surgical inpatients at Lincoln County Hospital NHS Trust.

Method
Prospective review of patients and their clinical records was undertaken in 50 surgical inpatients and repeated in 54 patients following a departmental educational presentation. Outcomes were measured against the WHO analgesic ladder and NICE 147 guideline.

Results
Pain was managed adequately in 30% patients in the first cycle and in 46% the second cycle. Prescribing habits were inadequate in 30% of patient’s vs 16% of patients in the first cycle. Prophylactic laxatives were prescribed in 100% of eligible patients in the second cycle, and anti-emetics were offered to 92% in the first cohort vs 82% in the second. Overall, it can be seen that changeover of staff affects the prescribing habits which should be unique for all surgical inpatients.

Conclusions
Pain management of surgical patients has improved following a departmental intervention. However, measures to address pain and opiate side effects should be continued with involvement of the entire team including nurses, clinicians and pain team practitioners.
380 Audit of the Management of Suspected Ureteric Colic in Barnet Hospital Emergency Department
Authors: Dighero I , Ahmad S 
Published: August 2024

Abstract

Aim
Ureteric colic is a common presentation to the Emergency Department (ED) causing significant morbidity and socio-economic burden for both the patient and healthcare provider. Prompt diagnosis and symptom control aims to improve the patient experience and facilitate treatment. Our aim was to audit management within our department based on BAUS/NICE guidelines.

Method
We performed a retrospective review of 100 consecutive patients presenting to our ED with suspected ureteric colic who had a CT-KUB. Data was collected based on BAUS/NICE guidelines for management of suspected ureteric colic.

Results
98% of patients had a CT-KUB performed within 14 hours of arrival in the ED with average time to CT-KUB of 4hrs 50mins. 22% of patients had an obstructive ureteric stone identified. Of these, 45% had a stone &lt;4.9mm, and 55% had a stone &gt;5mm. 75% of patients with a stone identified were referred to the renal stone MDT and 45% had a repeat CT-KUB requested. 52% of patients received analgesia in the ED, with most patients receiving oral paracetamol with an average time to administration of any analgesia from triage of 3hrs 26mins. 51% of patients had their calcium measured and 4% urate measured.

Conclusions
This audit demonstrates excellence in performance in terms of diagnostic imaging for suspected ureteric colic within our department. However, we identify a need to improve appropriate analgesia administration and diagnostic work up in terms of biochemistry relevant to stone pathology through education and pathway review. A second cycle of audit is currently being completed to review these interventions.
513 A Clinical Audit on the Use of Red Cell Transfusions in a DGH’s Trauma and Orthopaedics Ward
Authors: Qamar A , Fung A 
Published: August 2024

Abstract

Aim
To compare the practice of prescribing, administering, and monitoring transfusions, with the current local Trust guidelines in order to determine the proportion of inappropriate blood transfusions especially in times of regional and national shortage of blood products

Method
For a six-week period in 2022, numerous endpoints were measured, reflecting the specifications of the Trust guideline. Based on the results from this initial data, a teaching session was conducted to create awareness of the Trust guideline amongst all rotational doctors. A subsequent re-audit was conducted to determine the effectiveness of the intervention. Following data analysis, further suggestions were discussed and implemented.

Results
Prior to intervention, 34 units were transfused across 16 patients with the mean age being 81.88 years. Post-teaching session, 11 units were transfused with the mean age being 79.58 years. 26.4% units were transfused for active haemorrhage, none were due to major haemorrhage, compared to 18.2% for active haemorrhage post-teaching session. 73.5% transfusions were inappropriate, defined as transfusions conducted in those who did not meet the haemoglobin level (Hb) threshold stated in the guideline. This significantly reduced post-teaching session to 45.5%. Transfusion-associated circulatory overload assessment was completed in 58.8%, improving to 90.9% post-intervention.

Conclusions
Simple measures such as an induction booklet highlighting the Trust’s blood transfusion guideline ensured rotational doctors were aware of the local protocol, preventing a significant proportion of inappropriate red cell transfusions.
830 Intra-Operative Tourniquet Use in Orthopaedic Surgery: How Tight Is Too Tight?
Authors: Mills R , Sohail Z 
Published: August 2024

Abstract

Aim
Tourniquets are regularly used in Orthopaedic surgery as an effective means of ensuring a clear, 'bloodless' operating field. However, knowledge concerning the implementation of this commonly used appliance is infrequently tested. Our objective was to design a survey to assess the current level of knowledge surrounding the safe use of intra-operative tourniquets in Orthopaedic surgery.

Method
A survey was constructed using Google Forms, with standards comparable to BOAST Guidelines, and disseminated to Orthopaedic team members at one single centre, district general hospital. Anonymised results were collected.

Results
22 responses were collected: 36.4%(8) from consultants, 22.7% (5) from Registrars, 22.7% (5) from scrub team members and 9.1% (2) responses from SHO's. 9.1% rated their level of confidence in safe tourniquet use as '1' ('Not confident') on the Likert scale, 36.4% rated a '4', whilst 22.7% rated themselves '5' ('Very Confident'). However, despite confidence levels, only just over half (54.5%) were aware of any guidelines available concerning tourniquet use. Half correctly answered that the tourniquet should encompass more than half of limb diameter. The majority of respondents (81.8%) correctly selected the ideal tourniquet pressure (above/in relation to systolic blood pressure) required for children. However, respondents were less confident in their selection of tourniquet pressures for adults. 63.6% selected the correct recommended upper limit for ischaemic tourniquet time whilst 22.7% recommended that audible reminders be given after this every 10 minute.

Conclusions
The mixed variety of survey responses demonstrates that there is still clear room for improvement in the safe management of tourniquets.
1034 Adherence to VTE Assessment and Re-Assessment for General Surgery Inpatients
Authors: Patel S , Abbasova A , Jacob P A , Moussa R , Ihedioha U 
Published: August 2024

Abstract

Aim
To identify compliance with mandatory VTE assessment on admission and its re-assessment for General surgery (GS) inpatients at a District General Hospital.

Method
All adult patients (≥18 years) admitted under the General Surgery department from 21/08/2023 to 25/08/2023 were included. Patients admitted due to long stays following elective surgery with any operative approach were also included. The patient’s VTE assessment charts were reviewed for 24 hours. This was done to identify if an assessment was completed within 14 hours of admission and reassessment after 24 hours.

Results
40 patients were included in the audit.
Admission Assessment ResultsN=24/40 did not have a tick in either 'no contraindication' or 'contraindication' boxesN=11/24 did not have any tick in 'risk factors’ or bleeding risk' boxesN=20/40 had no documentation of date, time, name, or signature
24hr Later Assessment ResultsN=6/40 patient had re-assessment100% of patients who had reassessment had either 'continue' or 'change' ticked

Conclusions
Venous thromboembolism (VTE) is a frequent disease affecting more than 1 in 12 individuals during their lifetime. VTE is associated with long-term complications such as recurrence, post-thrombotic, and post-pulmonary embolism syndrome. Despite VTE prophylaxis being administered for patients, documentation of risk factors and contraindications for VTE prophylaxis administration was poor. The worst performing areas were VTE re-assessment 24 hrs after admission and indicating if there is 'no contraindication' or 'contraindication' to VTE-prophylaxis on admission. It is important to stay vigilant and check the assessment during ward rounds. Adherence to VTE assessment still needs to be studied at a later date.
1279 Compliance of Countess of Chester Hospital with the Getting It Right First Time (GIRFT) Guidance on Cauda Equina Syndrome
Authors: Jabr Y , Ghodke A , Beattie S , Thonse R , Naikoti K 
Published: August 2024

Abstract

Aim
Ensure timely investigations for suspected Cauda Equina Syndrome (CES) at the Countess of Chester Hospital align with GIRFT's National Suspected CES Pathway (February 2023).

Method
Retrospective audit collecting data on A&E attendances with a referred suspected cauda equina syndrome between 01/09/2022 and 31/01/2023 (pre-GIRFT guidance). 36 patients were collected and narrowed down to 27 following adherences to inclusion criteria (incl. exclusion of medical inpatients with symptoms of CES who had scans done during their stay). Data collection parameters included: [1] Time of presenting to A&E. [2] Significant neurological deficit / red flags of CES on exam. [3] Time and amount on post-void bladder scan. [4] Time of MRI request. [5] Time of MRI completion. [6] Confirmed CES on scan. [7] Transfer and further management in neurosurgery centre.

Results
Of 26 admissions (one was transferred to regional neurosurgical centre before local review), 21 showed CES signs. Mean time from MRI request to completion was 4.67 days. Only six had timely MRI completion within 4 hours, with nine patients confirming CES. Six patients were transferred to the neurosurgical centre.

Conclusions
Significant MRI delays, some over 24 hours, stem from A&E challenges such as understaffing and prolonged wait times. Delays occur when the neurosurgical centre advises next-day scans. Recommendations include radiology adherence to GIRFT guidance and discussing introducing additional dedicated MSK radiologists and collaborating with A&E to streamline reviews for suspected CES. Thorough documentation is emphasised. Further review is recommended post-implementation to assess improvements in compliance with MRI requesting and scan completion timelines.
365 Completion Mastectomy After Wide Local Excision (Wle) and Sentinel Lymph Node Biopsy (Slnb) for Ductal Carcinoma Insitu (Dcis), Local Data from the Countess of Chester Hospital
Authors: Abdelmageed A , Hargreaves A , Ooi J , Harding-Mackean C , Seward J , Marikakis N 
Published: August 2024

Abstract

Aim
We looked at patients undergoing SLNB at time of completion mastectomy for DCIS to identify the incidence of microinvasion, invasive carcinoma and positive SLNB following completion mastectomy for DCIS.

Method
Retrospective study on a cohort group of patients who underwent completion mastectomy after WLE for DCIS for positive or close margins in the period from January 2010 to December 2021. Exclusion criteria were invasive cancer or microinvasion identified on the WLE specimen, previous ipsilateral breast cancer and recurrent cases who underwent upfront mastectomy after previous WLE for DCIS. The main limitation of the study was the limited number of cases that fit the inclusion criteria of the study in a single institution.

Results
Total 30 cases were identified that fit the inclusion criteria of the study. SLNB was performed in 25 cases (17 cases with completion mastectomy and 8 cases with WLE). Only 5 cases, did not have SLNB.
None of the studied cases showed microinvasion or invasive cancer in the final pathology in the mastectomy specimen. None of the SLNB performed was positive.

Conclusions
In view of the final mastectomy specimen showing no microinvasion or invasive cancer, combined with all SLNB results being negative, it can be posited that a significant portion of the abnormality had already been sampled in the prior WLE. Therefore, the routine use of SLNB during completion mastectomy is questionable. We would like to continue this audit prospectively and collaborate with our joint screening unit to obtain more meaningful results to support change in local practise.
446 Cor-Triatriatum Dexter: An Incidental Finding in an Adult with Rheumatic Heart Disease
Authors: Thomas R J , Jha G 
Published: August 2024

Abstract

Introduction
Cor-triatriatum dexter (CTD) is an extremely rare congenital anomaly, accounting for 0.025% of congenital heart defects. It typically presents in childhood; however this case describes incidental finding of CTD in an asymptomatic 49-year old male with rheumatic heart disease.

Case Presentation
A 49-year-old male presented with 2–3-month history of exertional dyspnea (NYHA grade II), orthopnea, pedal edema, and occasional palpitations. He had a prior diagnosis of rheumatic heart disease with severe mitral regurgitation. Examination revealed elevated jugular venous pressure, bilateral basal crepitations, soft S1, pansystolic murmur in mitral area, loud non-palpable S2, and right ventricular heave. Investigations showed right ventricular hypertrophy with strain on ECG, severe mitral and tricuspid regurgitation on echo, and CTD characterized by a membrane dividing the right atrium into two chambers with an 8.6mm defect. Coronary angiography revealed atherosclerotic disease. Right heart structures were otherwise normal with no pulmonary artery stenosis or Ebstein anomaly. The CTD was likely present since birth but non-obstructive, allowing the patient to remain asymptomatic until presenting with sequelae of longstanding mitral regurgitation.
Treatment and Outcome: The patient underwent MVR, TR and resection of the CTD membrane. Post-operative echo showed normally functioning prosthetic mitral valve, mild TR and no residual CTD membrane. The patient was discharged in stable condition on warfarin.

Conclusion
CTD may remain undiagnosed well into adulthood due to non-obstructive membranous anatomy. Incidental diagnosis prompted successful surgical resection alongside repair of symptomatic valvular disease. Clinicians should have high index of suspicion for detecting rare congenital anomalies in adults with acquired heart disease.