bluuebunny/crossref_metadata_2025_split huggingface dataset:
025 Management and outcomes of febrile infants
Authors: Hare M , Burke D , Rimmer C 
Published: September 2011

Objectives and BackgroundOne of the new Emergency Department (ED) clinical quality indicators (CQIs) defines febrile infants as “high risk” patients requiring consultant “sign-off” prior to discharge. A service evaluation of the management and outcomes of febrile infants attending our ED in 2010 was undertaken in order to determine how our department would have complied with this CQI.MethodsThe sample population was identified and data collected retrospectively using the department's electronic database. Of those, 100 patients discharged but not initially seen by a consultant were randomly selected and had their case notes reviewed.Results1137 febrile infants attended the ED and 8% were re-attendances (Abstract 025 figure 1). 75% attended outside of normal working hours, of which 22% attended at night, when a consultant is not routinely on site (Abstract 025 figure 2). 78% of the infants were discharged, 22% were admitted, and only an estimated 6% of those discharged were “signed-off” by a consultant. The majority of febrile infants were seen by an SHO (Abstract 025 figure 3). 2.5% were well, 93% had a minor illness, 3.6% had a serious illness and in 0.9% the diagnosis was unknown. None of the patients died.Abstract 025 Figure 1SCMED activity in 2010.Abstract 025 Figure 2Time of attendance.Abstract 025 Figure 3Grade of ED officer doing initial assessment.ConclusionFebrile infants represent a significant proportion of our ED attendances (2.5%). A high proportion of febrile infants re-attend, and few are signed off by a consultant prior to discharge. The majority of febrile infants have minor illnesses. This service evaluation would suggest that the threshold for defining high-risk should be reviewed, possibly to include other clinical signs/symptoms in the definition, or to reduce the defined age to <6 months. Otherwise significant changes to ED consultant working patterns are likely to be required in order to increase the number of patients in this high-risk group achieving consultant “sign-off”.
026 Retrospective study of eye swabs sent from the emergency department of the Royal Hospital for Sick Children, Glasgow
Authors: Wallace M , Russell F 
Published: September 2011

Objectives and BackgroundConjunctivitis is a common presentation to both adult and paediatric emergency departments. A Cochrane review updated in 2007 demonstrated an improvement in symptoms with administration of topical antibiotics in adult patients with suspected bacterial conjunctivitis and suggested that empirical topical antibiotic use was appropriate. This study aimed to determine if swabbing the eyes of children with conjunctivitis changed clinical practice.MethodsThe microbiology department retrospectively identified all eye swabs received for investigation from the emergency department of the Royal Hospital for Sick Children, Glasgow over the course of 1 year.Results233 patient episodes of suspected conjunctivitis generated a total of 300 swabs. 240 swabs were sent to bacteriology and 60 to virology. The age range was 7 days to 12 years, of which 71% were under 2 years. Of the bacteriology swabs, 139/240 (57.9%) were positive and 101/240 (42.1%) were negative. 8 positive swabs grew two organisms. All pathogens identified were sensitive to Chloramphenicol, which is first line topical treatment for suspected bacterial conjunctivitis in this department. 16 pathogens were identified by PCR: 7 Chlamydia, 6 Adenovirus and 3 HSV. 29 swabs were sent from children under 1 month of age. Of these, 24.1% were positive for Chlamydia.ConclusionResults of bacteriology swabs in suspected conjunctivitis do not change clinical practice. Virology eyes swabs should be sent in neonates with conjunctivitis or patients with suspected HSV. Significant processing costs and staff time dealing with results can be saved.
029 Clinical decision rules for children with minor head injury: a systematic review
Authors: Pickering A , Harnan S , Fitzgerald P , Pandor A , Goodacre S 
Published: September 2011

Objectives and BackgroundClinical decision rules aid clinicians with the management of head injured patients. This study aimed to identify clinical decision rules for children with minor head injury and compare their diagnostic accuracy for detection of intracranial injury (ICI) and injury requiring neurosurgical intervention (NSI).MethodsRelevant studies were identified by an electronic search of key databases. Papers in English were included with a cohort of at least 20 children suffering minor head injury (GCS 13–15). Studies of a decision rule derived to identify patients at risk of ICI or NSI had to include a proportion of the cohort undergoing imaging. Study quality was assessed using the QUADAS checklist.Results16 publications, representing 14 cohorts, with 79 740 patients were included. Only four rules were tested in more than one cohort. Of the validated rules the paediatric emergency care applied research network (PECARN) rule was most consistent (sensitivity 98%; specificity 58%). For neurosurgical injury all had high sensitivity (98–100%) but the children's head injury algorithm for the prediction of important clinical events (CHALICE) rule had the highest specificity (86%) in its derivation cohort. The positive predictive value (PPV) for each rule were calculated. Of the large cohorts studied (>10 000 subjects) CHALICE had PPV of 5.4% compared with 2.0% for PECARN for ICI. For NSI the PPV calculated were 4.2% and 0.4% respectively.ConclusionOf the current decision rules for minor head injury the PECARN rule appears the best for children and infants, with the largest cohort, highest sensitivity and acceptable specificity for clinically significant ICI. Application of this rule in the UK would probably result in an unacceptably high rate of CT scans per injury, and continued use of the CHALICE- based NICE guidelines represents an appropriate alternative.
003 Whole Body CT scanning for severe blunt multitrauma: analysis of the TARN database 2005–2010
Authors: Hunt P , Lecky F , Bouamra O 
Published: September 2011

Objectives and BackgroundsThere is growing evidence to recommend the use of “Whole Body” CT (WBCT) scanning in the early management of severe blunt multitrauma patients. A recent study [Lancet2009;373:1455–61] reported a survival advantage with WBCT compared to a non-WBCT approach. We present the results of our analysis of a large retrospective case series taken from the Trauma Audit and Research Network (TARN) database.MethodsWe utilised retrospective, multicentre data of severe blunt multitrauma (ISS >15) direct ED admissions aged >15 years recorded in the UK TARN database to compare survival at 30 days between two groups of patients: (1) those who underwent WBCT scans, and (2) those who received a focused CT scan approach as part of their initial management in the Emergency Department. A total of 12 792 cases were included in the final dataset.Results2822 (22%) of 12 792 cases underwent WBCT from the ED. The median ISS for the WBCT group was 22 (IQR 14–33) compared to 16 (IQR 9–25) for the focused CT group. The calculated crude mortality rate for the WBCT group was 10.1% compared to 8.7% in the focused CT group (p=0.0124). Multivariate analysis with adjustments for potential confounding factors demonstrated an OR of 1.313 (95% CI 1.083 to 1.592, p=0.006) in favour of survival in the WBCT group.ConclusionsDespite the crude mortality rates appearing to demonstrate a poorer outcome in the WBCT group, correcting for confounding factors revealed an around 30% improvement in survival for the WBCT group. However, when also correcting for the potential effect of clustering, the benefit of WBCT is less clear, with an around 20% improvement in survival and a lower level of significance (p=0.084). Overall, the results of our investigation appear to suggest a potential survival benefit from the use of WBCT in severe blunt multitrauma.
030 Multi-centre study of the emergency management of allergic reactions and anaphylaxis
Authors: Helin H , Perkin M , Gumm R 
Published: September 2011

Objectives and BackgroundThe Royal College of Paediatrics and Child Health (RCPCH) recently published its care pathway for anaphylaxis incorporating an algorithm with the stages of ideal care and a set of competences required to diagnose, treat and optimally manage anaphylaxis. In order to assess current practice we investigated the quality of documented assessment and treatment of paediatric allergies in Accident and Emergency (A&E).MethodsRetrospective case review of children presenting with allergic reactions to A&E at two large teaching hospitals during 1 year.ResultsTotal number of cases included was 187 (96 hospital A, 15% severe, 91 hospital B, 12% severe). Urticaria, angiooedema and pruritus were the main presenting symptoms. Enquiry of previous allergies was not recorded in 31%/38% (A/B) of cases. Recording of ABCD assessment of all and the most severe reactions (systemic symptoms) varied between hospitals (Abstract 030 table 1). Types of medications used were similar with antihistamines (55%/67% A/B), steroids (26%/38% A/B) and bronchodilators (4% both) being the main treatments. Number of admissions (to paediatric assessment unit and wards) differed 16%/5% (A/B). Both hospitals had low recorded referral rates to allergy clinic (8%/11% A/B) and allergen avoidance advice (8%/12% A/B). Medication on discharge was given to 29%/59% (A/B), mainly antihistamines.ConclusionThe RCPCH care pathway sets best practice. While we reviewed written notes which may not fully reflect actual consultations, current practice would appear to be falling significantly short of the ideal care proposed.
004 Does the use of the A&E theatre reflect the demise in the surgical skills of the emergency physician?
Authors: Cooper J , Hannah J , Brown W 
Published: September 2011

Objectives and BackgroundsThe College of Emergency Medicine has evolved from the Casualty Surgeons Association formed in 1967. At that time most of the expertise in the Accident and Emergency (A&E) Department was surgical and consequently many Departments had an operating theatre in which to carry out a variety of procedures. From this background the specialty of Emergency Medicine (EM) has arisen and developed. Many Departments no longer use, or have lost, their theatre as the workload and expertise has become more medical in nature. However, sound basic surgical skills are very important to the modern Emergency Physician and many feel these are still best taught in theatre. To date the Emergency Department of Aberdeen Royal Infirmary (ARI) has retained the use of its theatre and therefore to the training opportunity it provides. This study aimed to evaluate the number and type of cases passing through this facility to study trends and to evaluate what the future may be for the A&E theatre.MethodsThis was a retrospective cohort study of the A&E theatre usage in ARI, a large teaching hospital in the North East of Scotland from 1995 to 2010. Cases were identified from theatre log books, relevant demographics extracted and analysed.ResultsA total of 8785 procedures were performed during the study period of which the most common were fracture manipulation, abscess drainage and foreign body removal. There was a steady decline in theatre usage: 1078 cases in 1995; 828 cases in 2000; 368 cases in 2005 and only 214 cases in 2010. The reduction was most dramatic in the number of wrist fractures manipulated and in the number of perianal and pilonidal abscess operated on.ConclusionsUse of the A&E theatre is reducing. The reasons for this are complex and include: changing surgical practices; reduced anaesthetic presence in remote sites within the hospital and, most importantly, the change in the skill mix of the staff in the Emergency Department. Sound General Surgical and Orthopaedic basic surgical skills are valuable to the Emergency Physician but experience in these specialties is no longer required in EM training. Thought should be given to whether these skills could be learnt in the A&E theatre before such facilities disappear completely.
Comparison of unscheduled re-attendance and contraception at discharge, among women having the final stage of early medical abortion at home and those remaining in hospital
Authors: Astle Hannah , Cameron Sharon T , Johnstone Anne 
Published: September 2011

IntroductionThroughout Great Britain, increasing numbers of women having an early medical abortion are choosing to go home soon after administration of misoprostol, to expel the pregnancy at home (early medical discharge, EMD), rather than remain upon the hospital premises (day case). However, data are lacking on how this impacts upon an abortion service in terms of unscheduled re-attendance rates and contraception provision at discharge.MethodsA retrospective audit was carried out of women undergoing medical abortion (up to 64 days' gestation) over 9 months at a National Health Service hospital in Scotland, to determine (1) unscheduled re-attendance rates within 6 weeks of the procedure for an abortion-related complication and (2) method of contraception provided at discharge.ResultsOver the audit period 1128 women had an early medical abortion of whom 590 (52%) chose EMD. There was no significant difference in unscheduled re-attendance rates between EMD (n=23, 4%) and day case groups (n=20, 4%). There was no significant difference in the proportion of women in each group who left hospital with an effective method of contraception (n=362, 61% andn=355, 60% for EMD and day case groups, respectively).ConclusionsWomen undergoing early medical abortion who choose to expel the pregnancy at home are no more likely to re-attend hospital with a post-abortal complication and are just as likely to receive effective contraception than those who remain on hospital premises.
Cell-Cycle Regulator Cks1 Promotes Hepatocellular Carcinoma by Supporting NF-κB–Dependent Expression of Interleukin-8
Authors: Lee Eun-Kyoung , Kim Dae-Ghon , Kim Jang-Seong , Yoon Yeup 
Published: September 2011

AbstractThe cell-cycle regulator Cks1 has recently been implicated in Skp2-mediated ubiquitination of the tumor suppressor protein p27. In this article, we report that Cks1 exerts a Skp2-independent regulation of NF-κB that promotes interleukin-8 (IL-8) expression, which is critical to hepatocellular carcinoma (HCC) growth. Cks1 was upregulated frequently in human HCC tissues and cell lines. Cks1 knockdown in HCC cells elevated p27 levels and decreased tumorigenicity in a manner that was also associated with a strong downregulation of IL-8 expression. IL-8 downregulation was not phenocopied by either RNAi-mediated knockdown of Skp2 or ectopic overexpression of p27. However, attenuation of IL-8 expression itself was sufficient to blunt HCC growth. Mechanistic investigations revealed that IL-8 was controlled at a transcriptional level by Cks1 targeting of the NF-κB regulator IκBα, which led to NF-κB activation and IL-8 expression, through a p27-independent regulation of IκB kinase complex components. Collectively, our findings support the hypothesis that Cks1 supports hepatocarcinogenesis by NF-κB–mediated regulation of IL-8 expression, broadening the function of Cks1 in cancer beyond its role as a Skp2 cofactor in p27 ubiquitination. Cancer Res; 71(21); 6827–35. ©2011 AACR.
On the Road to Combinations of Targeted Therapies: PPM1H Phosphatase as a Suppressor of Trastuzumab Resistance
Authors: Aceto Nicola , Bentires-Alj Mohamed 
Published: September 2011

AbstractLee-Hoeflich and colleagues use RNA interference screening to identify the serine/threonine phosphatase PPM1H as an inhibitor of trastuzumab resistance in vitro. This finding extends the molecular portrait of trastuzumab-resistant cells and provides a rationale when searching for potential therapeutic targets among regulators of PPM1H and/or its substrates. Cancer Discovery; 1(4): 285–6. ©2011 AACR.Commentary on Lee-Hoeflich et al., p. 326.
Interactions of Diabatic Heating in Convective Superbursts with Energy Conversion Processes in the Genesis of Cape Verde Hurricanes from African Easterly Waves
Authors: Ross Robert S. , Krishnamurti T. N. , Pattnaik S. 
Published: September 2011

Abstract
This paper defines a mechanism for the genesis of tropical cyclones from African easterly waves (AEWs) over the eastern Atlantic, the so-called Cape Verde storms. Convective “superbursts” produce strong diabatic heating, which then strengthens the African easterly jet (AEJ), leading to enhanced barotropic energy conversions, which occur at the critical developmental stages of the system.
Diabatic heating is calculated using the Ertel isentropic potential vorticity (IPV) equation, while energy conversions are determined using energy equations first derived by Lorenz. The genesis mechanism is developed from studying Hurricane Bill (2009), as well as Tropical Storm Debby, Hurricane Helene, and a nondeveloping AEW, all from the 2006 NASA African Monsoon Multidisciplinary Analysis (NAMMA) field experiment, using the NCEP Final (FNL) analyses and the Advanced Research Weather Research and Forecasting model (WRF-ARW) simulations.
A striking and singular maximum in the diabatic heating due to the convective superburst is shown to precede by 24–36 h a pronounced maximum in positive barotropic energy conversion, which is demonstrated to occur simultaneously with the strengthening of the AEJ. The maximum in barotropic energy conversion is documented to occur in the developmental stages of the system, typically in the depression or early storm stages.
A physical mechanism is developed to explain how a mesoscale convective superburst can lead subsequently to an enhanced synoptic-scale AEJ over the eastern Atlantic, an enhanced jet that is critical to the genesis mechanism.
The findings agree with cited idealized studies by other investigators who found that moist AEWs grow 3 times stronger than dry waves as a result of faster AEJ development and larger barotropic energy conversions.
Characteristics of the Near-Surface Boundary Layer within a Mountain Valley during Winter
Authors: Helgason Warren , Pomeroy John W. 
Published: September 2011

AbstractWithin mountainous regions, estimating the exchange of sensible heat and water vapor between the surface and the atmosphere is an important but inexact endeavor. Measurements of the turbulence characteristics of the near-surface boundary layer in complex mountain terrain are relatively scarce, leading to considerable uncertainty in the application of flux-gradient techniques for estimating the surface turbulent heat and mass fluxes. An investigation of the near-surface boundary layer within a 7-ha snow-covered forest clearing was conducted in the Kananaskis River valley, located within the Canadian Rocky Mountains. The homogeneous measurement site was characterized as being relatively calm and sheltered; the wind exhibited considerable unsteadiness, however. Frequent wind gusts were observed to transport turbulent energy into the clearing, affecting the rate of energy transfer at the snow surface. The resulting boundary layer within the clearing exhibited perturbations introduced by the surrounding topography and land surface discontinuities. The measured momentum flux did not scale with the local aerodynamic roughness and mean wind speed profile, but rather was reflective of the larger-scale topographical disturbances. The intermittent nature of the flux-generating processes was evident in the turbulence spectra and cospectra where the peak energy was shifted to lower frequencies as compared with those observed in more homogeneous flat terrain. The contribution of intermittent events was studied using quadrant analysis, which revealed that 50% of the sensible and latent heat fluxes was contributed from motions that occupied less than 6% of the time. These results highlight the need for caution while estimating the turbulent heat and mass fluxes in mountain regions.
Comparing Twentieth- and Twenty-First-Century Patterns of Interannual Precipitation Variability over the Western United States and Northern Mexico*
Authors: Ruff Tyler W. , Kushnir Yochanan , Seager Richard 
Published: September 2011

Abstract
The ability of coupled climate models to simulate the patterns of interannual precipitation variability over the western half of the United States and northern Mexico is investigated by applying principal component analysis to observations and model output. Global Precipitation Climatology Centre (GPCC) observations are compared to the pooled twentieth-century warm- and cold-season precipitation averages simulated by five coupled global climate models included in the Intergovernmental Panel on Climate Change Fourth Assessment Report. The pooled model spatial structures (EOFs) closely match those of the GPCC observations for both halves of the year. Additionally, the twenty-first-century model pooled EOFs are almost identical in spatial extent and amplitude to their twentieth-century counterparts. Thus, the spatial characteristics of large-scale precipitation variability in the western United States are not projected to change in the twenty-first century. When global observed and modeled seasonally averaged sea surface temperature anomalies are correlated with the time series corresponding to the three leading EOFs to discern sources of each mode of precipitation variability, a pattern reminiscent of El Niño is found to be the only significant association. The spatial structures of variability also appear independent of the model-predicted precipitation trend over the twenty-first century, indicating that the mechanisms responsible for the trend are different from those associated with interannual variability. The results of this study lend confidence in the pooled model predictions of seasonal precipitation patterns, and they suggest that future changes will primarily result from the contribution of the mean trend over which statistically stationary interannual variability is superimposed.
‘Religion,’ ‘the Secular’ and the Critical Study of Religion
Authors: Engler Steven 
Published: September 2011

This essay critically engages Timothy Fitzgerald’s Discourse on Civility and Barbarity (2007), arguing that it takes an important step beyond Fitzgerald’s first book, The Ideology of Religious Studies ( 2000 ), in diagnosing a current malaise of the academic study of religion and in modelling a way past this malaise. Highlighting this valuable aspect of the book, I argue, requires correcting certain problems with its argument. Specifically, there is a tension between two overarching goals: writing “a critical history of ‘religion’ as a category,” and criticizing “modern discourses on generic religion.” Once these genealogical and critical projects are brought into more effective alignment, the book models an approach where a properly critical study of religion begins with a contingently and strategically theorized domain of ‘religion’ and explores its relation to other domains—not only ‘the secular.’ Cet essai reconsidère d’un œil critique le livre Discourse on Civility and Barbarity (2007), de Timothy Fitzgerald. Il soutien qu’il donne un pas important au-delà du premier livre de Fitzgerald, The Ideology of Religious Studies ( 2000 ), dans les faits de diagnostiquer une malaise actuelle de l’étude des religions et de modeler une piste alternative. Pourtant, pour accentuer cet aspect important du livre, on doit corriger des problèmes logiques avec son argument. Spécialement, il y a une tension problématique entre les deux buts du livre : l’écriture « d’une histoire critique de ‘religion’ comme une catégorie »; et la critique « des discours modernes sur la religion générique ». Dès que ces projets généalogiques et critiques sont apportés dans une meilleure alignement, le livre modèle une approche de grande valeur : c’est le travail d’une étude proprement critique du concept ‘de religion’ de le suivre où il mène, et d’analyser ses relations avec des autres concepts.