bluuebunny/crossref_metadata_2025_split huggingface dataset:
PB2 Improving handovers in the emergency department
Authors: Delport M 
Published: March 2012

Objectives and BackgroundTransitions in patient care pose a significant risk to patient safety, because they can lead to discontinuity of patient care and adverse events due to information loss during handover or unnecessary delays as a result of poor handover.The goals of our project were to:Create a standardised process and documentation for doctor-to-doctor handover in our Emergency Department (ED).Improve handover as an educational experience for registrars.Shorten the duration of handover without compromising quality of information.MethodsSetting: Urban district ED with 40 000 presentations annually.Development of best practice handover process:Handover processes were audited using video and direct observation by the Handover Improvement Team. Data collected included times, information quality and documentation. Staff and patient surveys were undertaken. Best practice was defined by literature review, multidisciplinary collaboration and consumer input. Handover process and forms were compiled into a new handover policy.Implementation:The new policy was presented at educational meetings, circulated to staff via email and advertised by poster in the ED and handover room.Re-audit:Handover audit by Handover Improvement Team was repeated. Patient handover forms were reviewed. Staff survey was undertaken.Analysis:Descriptive statistics were used to analyse data.ResultsThe development phase took 7 months and resulted in our “SHARE the CARE Plan”, which will be presented. Implementation occurred over 3 weeks. Post-implementation audit showed improvement in documentation, increased multidisciplinary collaboration and teaching. A staff survey showed that the majority of doctors surveyed agreed that the new process was appropriate and helpful. Other results will be presented.ConclusionsDevelopment of a new best practice policy with a multidisciplinary team takes time. The new handover process is supported by the majority of staff and has resulted in improved documentation, collaboration and teaching.
PB3 Head injury: a system of rapid referral
Authors: Geddes L , Wright K , Clarke S 
Published: March 2012

Objectives and BackgroundTo develop a streamlined referral pathway for isolated head injuries in Trauma Units. Severe head injury (ISS >15) is a major problem in the UK. For 2010, TARN data shows 21 192 submissions, of these 7521 had an ISS >15 and 5086 were AIS 3+ in the head. Current recommendations are that all patients' GCS <9 are taken to a Major Trauma Centre giving rapid access to Neurosurgery and improving outcome. The development of integrated trauma systems is addressing this but despite the presence of primary bypass in the pre-hospital arena, under-triaged patients arrive in Trauma Units. These need rapid referral by secondary “hot” transfer protocols. The system works well for patients with polytrauma; however isolated head injuries are still not being transferred rapidly.MethodsSix months of data in the TARN report (February 2011) was reviewed for all patients ISS >15. Outcome at 3 and 30 days, discussions with Neurosurgeons, and subsequent transfers were determined. Time to CT was compared for all ISS >15, those meeting NICE head injury guidelines, and isolated head injury patients.Results60% of ISS >15 patients were isolated head injuries. 29% died within 30 days, 26% within 3 days. 74% of all patients were discussed with the neurosurgeons (82% of isolated head injuries) and 13% transferred. Median time to CT was 2.2 h (IQR 1.2–12.1) for all, 2.2 h (1.2–5.95) if meeting NICE guidelines and 1.8 h (1.1–7.5) for isolated head injuries.ConclusionsThe major barriers to referral seem to be time to CT scanning and the level of “gate-keeping” at neurosurgical level. We believe the simplified neurosurgical referral pathway will give our isolated head injury patients the same rapid referral as our polytrauma patients.
PB4 Left before treatment-do patients know best?
Authors: Harper L , Collum N 
Published: March 2012

Objective and BackgroundThe percentage of patients who leave the Emergency Department (ED) before clinical assessment is one of the ED Quality Indicators. A rate of >5% is considered as a marker of potential risk, of overcrowding and long waits to be seen. The study objective is to establish our Left Before Treatment (LBT) rate and to review data trends in order that potential risks are identified.MethodsA retrospective ED notes review from the Ulster Hospital ED during May and June 2011. The ED notes of all patients who did not wait for assessment were collected and hand-reviewed by the authors.ResultsThere were 13 939 patient attendances to the ED during the 2-month study period. The Male: Female ratio was 0.9:1; mean age was 41 years, and 3305 (23%) were admitted to hospital. 342 (2.5%) patients LBT. Patients who LBT had a M: F ratio of 1.2:1; mean age of 34 years; and attended in the following pattern: 174 (51%) at the weekend; 90 (26%) on Monday or Tuesday (our busiest days). 171 (50%) attended when there was no ED Consultant present; 30 (9%) when there was also no middle grade. The LBT could be grouped into broad case-categories: Minor injury (22.8%), Medical (18.4%), Paediatric (13.2%), Head injuries (10.5%), atraumatic musculoskeletal (8.5%), Surgical (6.7%), unknown (5.8%). Mean time to triage was 21 min, 43 (12.5%) left before triage. 50 (14.6%) had investigations performed. 19 (38%) were abnormal; 1 (0.2%) patient required recall. 12 (3.5%) patients re-attended during the 2 months, some on multiple occasions.ConclusionThe Ulster ED LBT rate for May/June 2011 was 2.5%, meeting the QI standard. Detailed review reveals that the rates of re-attending and of significant pathology are insignificant (both <0.1% total attendances). We confirm that when the LBT rate is low detailed review is unnecessary, as clinical risk is insignificant. We will re-audit this topic locally.
PB6 Antimicrobial stewardship education and effect on prescribing in the emergency department of an irish teaching hospital: Abstract PB6 Table 1
Authors: Foley S , James K , Fitzpatrick F 
Published: March 2012

Objectives and BackgroundCareful selection of antimicrobials is imperative in preventing adverse events and resistant organisms. Guidelines and their availability encourage appropriate prescribing. In our centre, the microbiology team present bi-annually in the Emergency Department (ED) on topics related to the prudent use of antibiotics. This audit aimed to assess compliance with hospital antimicrobial guidelines in medical patients admitted via the ED.MethodA prospective audit was conducted from 01 September 2010 to 30 September 2010. All medical patients were eligible to be included. Data were extracted from patients' notes and drug Kardexes. The audit identified members of staff involved in prescribing antibiotics and their respective compliance with current antimicrobial guidelines as published by the Microbiology Department.Results101 medical patients (52 female, 49 male) were included (mean age 65 years). Nine (8.9%) patients did not have an “allergy status” documented. The majority of antimicrobials were prescribed by ED senior house officers (SHOs) and registrars (69.3%). Medical SHOs or registrars prescribed in 28 (27.7%) cases and in 3 (2.9%) patients, the prescriber was unidentified. The rates of compliance with antimicrobial guidelines are detailed in Abstract PB6 table 1. 147 antibiotics were prescribed and 22 different conditions were listed as the indication for therapy.Abstract PB6 Table 1Appropriateness of antimicrobial prescriptionsPrescriberPrescription compliant with guidelinesED doctor, n=105Yes=83 (79%)No=22 (21%)Medical doctor, n=39Yes=16 (41%)No=23 (59%)Unknown, n=3Yes=0No=3 (100%)ConclusionBi-annual education sessions regarding antimicrobial prescribing provided by the Microbiology Department for ED SHOs and registrars are well attended with positive feedback. This audit demonstrated that ED staff were most likely to adhere to guidelines when prescribing (79% compliance). Medical SHOs and registrars showed reduced compliance and may benefit from similar dedicated education sessions.
PB7 Does more mean less? The impact of increased consultant numbers on ED admission rates
Authors: Hewitt D , Jennings P , Clements M 
Published: March 2012

Objectives and BackgroundThe College of Emergency Medicine has recommended an expansion of the consultant workforce; this is intended to improve patient care, patient safety, cost efficiency and further the development of emergency care.1 The aim of this study was to see if admission rates have reduced in the Airedale General Hospital Emergency Department since the addition of 2 consultants, a total of 6, in April 2011.MethodWeekly data was collected from Airedale General Hospital Emergency Department between January 2010–July 2011, consisting of number of admissions, whether they were classified as major or minor injury and total number of attendances. Weekly admission rates for April–July 2010 and December-March 2011 were compared separately with April–July 2011 using an unpaired T-Test.ResultsThere was a statistical difference between admissions rates for December–March 11 and April–July 11 (p≤0.0001) but not between April–July 10 and April–July 11 (p=0.0657). For total attendance and percentage of major admissions respectively April–July 10 had 18 842 and 41.1%, December–March 11 had 17 353 and 41.6% and April–Jul 11 had 18 937 and 45.9%.ConclusionsApril–July 11 had lower mean admission rates than both April–July 10 and December–March 11, although this was only statistically significant for December–March 11. April–July 11 also had a greater number of attendances and a higher percentage of high tariff patients. These two factors could explain why the admission rate was not statistically significant when compared to April–July 10. However, it is unknown whether the HRG tariffs correlate well with clinical complexity or need for admission. Limitations of this study are the relatively short time periods analysed, changes to practice, such as new clinical guidelines, have not been taken into account, and these results alone cannot prove causality between decreased admission rates and consultant numbers.
PB9 Development of a critical appraisal tool for emergency department quality indicators
Authors: Jones P 
Published: March 2012

Objectives and BackgroundRecently the usefulness of time targets for Emergency Department (ED) length of stay as a quality indicator has been questioned, and there has been a call to use more clinically orientated indicators. However there is uncertainty about which markers should be used and to date indicator selection has been largely by expert opinion. The aim of this study was to develop an objective tool which can be used to critically appraise candidate indicators of quality of care in the ED.MethodsA search of websites of EQUATOR network, CASP, Cochrane Effective Practice, EPIQ, NHS, RAND, TJC and NIH was conducted, along with structured searches in Medline, Embase and CInAHL and communication with experts in the field. Potential tools were compared using an evidence table.ResultsThirty two potential tools were identified. All considered some aspects of the validity and the technical properties of indicators to a lesser or greater extent. All were based on “Level five” evidence. There were differences in terminology and completeness of the tools. Only one was ED specific and none had a closing summary reflecting the final recommendation about whether the indicator under investigation should be used. An “ED Quality Indicator Critical Appraisal Tool” was developed, using elements of the existing tools, with provision to consider the value of the indicator both within the ED and as a marker of whole system quality of care.ConclusionAn “ED Quality Indicator Critical Appraisal Tool” (ED QICAT) has been developed. If validated, this may be used by clinicians and health policy makers to objectively evaluate and compare ED based candidate quality of care indicators prior to their adoption and implementation.
Gender, Sexuality, and Power in Early China: The Changing Biographies of Lord Ling of Wei and Lady Nanzi
Authors: Milburn Olivia 
Published: March 2012

AbstractTowards the end of his life, Lord Ling of Wei (r. 534-493 BCE) effectively abdicated in favor of his wife, Lady Nanzi. Such a transfer of power seems to have been unique in Zhou dynasty China, and these events were discussed at some length in ancient historical and philosophical texts. Throughout the imperial era scholars and commentators continued to study Lord Ling and Lady Nanzi, producing a considerable body of research which reflects changing attitudes to the nature of ruler's rights and authority, and which also documents responses to the couple's apparent rejection of accepted social and gender roles. Although their actions were often portrayed positively in early Chinese texts, the overwhelming majority of scholars who studied their biographies in the imperial era were hostile to the concept of a woman taking control of the government of a state. The tension between the accounts found in ancient texts and subsequent scholarship is the subject of this paper.
Liability for Suicide in Qing Law on Account of Filthy Words
Authors: MacCormack Geoffrey 
Published: March 2012

AbstractThis essay examines the Qing legislation enacted in the course of the eighteenth century to impose punishments on men who used 'filthy language' towards a woman, so driving her to commit suicide. In addition, the decisions of the Board of Punishments, interpreting this legislation, are discussed. Essentially, three distinct offences are to be identified: (i) tiaoxi or the use of words expressing a desire to have sexual intercourse (punished capitally), (ii) xiexia or the use of words of commonplace abuse without sexual invitation (punished with exile), and (iii) xixue or the use of words of mockery or ridicule, disclosing an intention to humiliate or shame a woman (punished capitally). Some observations are also made on the relationship between the legislation and the concept of chastity.
The Yaochi ji and three Daoist Priestess-Poets in Tang China
Authors: Jia Jinhua 
Published: March 2012

AbstractThis article examines the only extant compilation of Tang dynasty women's poetry, the Yaochi xinyong ji (Collection of new songs from Turquoise Pond), fragments of which have been rediscovered among the Dunhuang manuscripts in Russian library holdings. The study first discusses the compilation, contents, and poets of this collection, and then focuses on the works of three Daoist priestess-poets, Li Jilan, Yuan Chun, and Cui Zhongrong whose writings form the major part of this anthology. It investigates their poetry and reviews relevant sources to conduct a comprehensive examination of the lives and poems of the three poets, and concludes that they represented a new stage in the development of Chinese women's poetry.
An Assemblage of Salamanders in the Southern Appalachian Mountains: Competitive and Predatory Behavior
Authors: Jaeger Robert , Gabor Caitlin , Wilbur Henry 
Published: March 2012

Abstract
We conducted behavioral experiments to determine how competition and predation may affect an assemblage of salamanders that meet at and cross forest to aquatic ecotones. At Mountain Lake Biological Station, southwestern Virginia, USA, adults of four abundant species interact at the forest to stream ecotone. Plethodon einereus and the larger P. glutinosus inhabit the forest floor up to the edges of streams while Desmognathus fuscus and Eurycea eirrigera forage from the edges of streams onto the forest floor. Our six laboratory experiments yielded predictions as to how these species affect each others' distributions and abundances in the natural habitats. Previous studies showed that adults of P. cine reus are territorial intraspecifically and toward same-size juveniles of P. glutinosus. In our experiment, territorial residents of P. einereus did not act aggressively toward intruding adults of P. glutinosus and the latter species was neither aggressive nor predatory toward P. einereus. The two species were equally benign in a second experiment when the roles of resident and intruder were reversed. Thus, we predict that the adults of these two species do not influence each others' distributions on the forest floor.
Tick Defense Strategies in Bison: The Role of Grooming and Hair Coat
Authors: Mooring Michael , Samuel William 
Published: March 2012

AbstractGrooming behaviour, and its effectiveness in controlling infestation by the winter tick (Dermacentor albipictus), was studied for plains bison (Bison bison bison) in Elk Island National Park, Alberta, Canada from October 1995 through June 1996. Bison had few ticks (mean, 133 ticks per animal; 0.009 ticks per cm2), particularly in comparison with smaller sympatric cervids (moose, Alees alees; elk, Cervus elaphus; and white-tailed deer, Odocoileus virginianus), suggesting that tick defense in bison is highly effective. Bison performed grooming or grooming-like behaviours (oral grooming, scratching, rubbing, and wallowing) at a high rate during October, when winter tick larvae were blood feeding, but groomed very little from November to April, when nymphal and adult ticks predominated. Grooming in October probably removed many larval ticks while they were still unattached and traversing the body surface in search of an attachment site. Because bison groomed at the highest rate during the larval feeding period, when they were subjected to the lowest intensity of tick stimulation, grooming in bison appears to be centrally programmed rather than stimulus driven. This might be the only time ticks are vulnerable to grooming activity because bison have an extremely thick hair coat (a morphological adaptation to extreme cold), which probably serves as a physical barrier to infestation by ticks. The tightly packed mat of primary hairs at the skin surface (the highest density of primary hairs among bovids) likely forced larval ticks to traverse much of the body surface on top of the hair coat, making them vulnerable to being removed through licking and other grooming activity. Little grooming throughout late autumn and winter (November-March) corresponded to the period of coldest temperatures and snow on the ground, and was probably due to the bison's 'thermal inertia' strategy of energy conservation in which physical activity is minimized during the times of greatest cold stress, when forage is least available and of poorest quality. Newly born bison calves, 2 months old or younger, delivered 15-20 times more oral grooming per hour and 6 times more episodes per bout than did adult cows. This result is in accordance with the prediction of the body size principle of the programmed grooming hypothesis, which maintains that smaller animals should groom more frequently in order to maintain fewer ticks. Programmed grooming, which removes most larval ticks before they can attach, and the physical barrier of the dense hair coat, are proposed as the major reasons that bison host few D. albipictus.
Olfactory Recognition of Urine Signals in Dominance Fights Between Male Lobster, Homarus Americanus
Authors: Karavanich Christa , Atema Jelle 
Published: March 2012

Abstract
The maintenance of dominance hierarchies in the American lobster (Homarus americanus) is based on recognition of the dominant animal by the loser of a recent fight. It is hypothesized that chemical signals are the basis of this recognition. Adult male lobsters were paired for initial boxing matches between unfamiliar animals. The same pairs were re-matched for 3 more consecutive fights. In the first experiment, treatment animals had their primary olfactory receptor cells of the lateral and medial antennules lesioned before fights 2-4 and control animals received sham lesions. The durations of fights 2-4 for control pairs were significantly shorter than the durations of fights between lesioned animals. In the second experiment, male pairs were again allowed to establish a dominance relationship in a first fight. During second fights, urine release by both animals was prevented by the use of catheters in treatment animals while control pairs wore sham catheters. Again, durations of the second fights of control animals were significantly shorter than those of treatment animals. Together, these experiments indicate that urine-carried chemical signals, perceived by the antennules, reduce the duration and aggression of male dominance fights on subsequent days because the loser of the first fight backs off almost immediately when he smells the urine of the known dominant.
Effects of Food Preference on Scatter-Hoarding by Kangaroo Rats (Dipodomys Merriami)
Authors: Leaver Lisa , Daly Martin 
Published: March 2012

Abstract
Two laboratory studies were conducted to determine whether Merriam's kangaroo rats invest greater effort in the caching of a more preferred food. As predicted, more of the preferred food was cached and yet the individual caches were smaller. The second experiment showed wider dispersion of the preferred food, and these caches were placed further away from the source. These findings imply that investment in protecting food from pilferage is adjusted in relation to the animal's evaluation of that food.
The Territory Defense Function of Song in Song Sparrows: A Test with the Speaker Occupation Design
Authors: Nowicki Stephen , Searcy William , Hughes Melissa 
Published: March 2012

Abstract
Territory defense is considered one of the primary functions of bird song, but this hypothesis has been directly tested in only a few cases. We used the speaker replacement method to ask whether song functions as a 'keep out' signal in song sparrows, a species for which there is considerable evidence supporting a mate attraction and stimulation function of song, but only indirect evidence that song functions as a signal to other males. We removed 11 matched pairs of male song sparrows from their territories, replacing one male of each matched pair with loudspeakers broadcasting that male's song (the 'experimental' territory) while leaving the other male's territory silent (the 'control' territory). In all cases in which encroachments or takeovers occurred, these occurred first (or solely) on the control territory of a matched pair, supporting the hypothesis that song functions in territory defense in this species. The incidence of intrusions on control territories was very low, however, posing difficulties for the interpretation of speaker replacement experiments designed to ask more specific questions about how song functions in male-male aggressive competition.