bluuebunny/crossref_metadata_2025_split huggingface dataset:
Local education measures are insufficient at ensuring timely imaging in acute pancreatitis
Authors: Bhanot Kunal , Mian Areeb , Mohamed Nusbya , Dawani Aruna 
Published: December 2023

Abstract

Aims
The Royal College of Radiologists (RCR) has outlined specific criteria for imaging in acute pancreatitis. The presence of pancreatic necrosis, free intraperitoneal fluid and extensive perihepatic fat stranding is associated with worse outcome. Timely computed tomography (CT) scanning 72 to 96 hours following onset of symptoms leads to more accurate diagnosis of pancreatic necrosis. Furthermore, ultrasound examination of the gallbladder is also recommended within 24 hours of admission to demarcate cause.

Methods
Two plan-do-study-act (PDSA) cycles were run between January to October 2022 and January to September 2023 in the surgical emergency unit. 50 patients were randomly selected amongst all pancreatitis admissions for each cycle. Outcome measures were percentage of CT scans adhering to optimal timing and percentage of ultrasound scans that were carried out within the first 24 hours. Cycle 1 findings were presented locally to staff as a teaching intervention.

Results
CT scans were performed in 60% and 66% of patients in cycle 1 and 2, respectively. Of these, 39% and 70% had optimal CT scan timing during cycle 1 and 2, respectively. Furthermore, only 33% of patients had US scans performed within 24 hours of admission during both cycles.

Conclusion
The above findings suggest that local teaching interventions are inadequate at meeting the recommended standard of 95% compliance defined by the RCR. This is likely due to rotating staff, lack of knowledge and incomplete prompting when ordering imaging. Further audit with an information technology based intervention is suggested to improve compliance.
Why aren't patients having emergency laparotomy when presenting with acute surgical pathology - a single site experience
Authors: Bakrania Shiv , Manor Kristin , Capozzi Patrizia 
Published: December 2023

Abstract

Aim
To establish the documented cause for not proceeding to emergency laparotomy for the acute general surgical patient

Methods
Retrospective single site review of all emergency patients admitted over three calendar months. Identification of and further collection of data for patients that did not proceed to Emergency Laparotomy despite indicative pathology.

Results
A total of 619 emergency general surgical patients were admitted from 1st January to 31st March 2023.
39 (6.3%) patients had an Emergency Laparotomy.
17 (2.7%) patients did not proceed to laparotomy despite pathology that could indicate the need for emergency laparotomy. 100% of these patients has CT imaging to diagnose the pathology.
Of the 17 patients without laparotomy median age of 86 years (range 42 – 91 years) and 12 were female.
Two patients made the decision that they did not want to proceed with emergency laparotomy, both male (75 and 88 years old) and both were reviewed by Care of the Elderly. Relatives were also involved with decision making. Both died in hospital.
Two were managed conservatively, the decision was made by the Consultant Surgeon, both patients were female (42 and 55 years old) and both survived to discharge and at 30 days.
All remaining 13 patients had documentation of frailty as being the cause for not proceeding. Although all &gt;65 years, 4 did not see a Care of Elderly. 4 patients survived to 30 days.

Conclusion
Principles of futility in medical care are published in literature and surgeons should use these in documentation for clarification.
Outcome of emergency groin hernia repair in a district general hospital.
Authors: Hussain Muhammad Ibrar , Singh Gautam , Ghoneima Ahmed , Nasir Uzair , Prosser Mia , Peter Mark 
Published: December 2023

Abstract

Background
Tension free mesh repair is considered as gold standard technique for elective groin hernia repair. However, use of synthetic mesh remains controversial in the presence of gangrenous bowel, contaminated or infected surgical field.

Aims/ Objective
This study aimed to evaluate the outcome of emergency groin hernia repair, to assess the safety of mesh repair and explore risk factors of postoperative complications for adult patients with incarcerated groin hernia.

Methods
From April 2019 to August 2022, consecutive adult patients who underwent emergency repair for incarcerated groin hernia in our trust were retrospectively reviewed. Data was collected from electronic patient record, which includes patient demographics, type of hernia, repair (mesh/ non mesh), and the outcome in terms of early and late postoperative complications.

Results
153 patients underwent emergency groin hernia repair, of these 137 were primary and 15 recurrent. Median age was 75.5 (range 23 to 96), with male to female ratio 3:1.
80 percent cases were inguinal hernia and 20 percent femoral. 75 percent patients had mesh repair and remaining had suture repair done. Bowel resection was performed in 11 cases. Early complications were reported in 7 cases (hematoma 2, seroma 2, chronic pain 2 , recurrence 1 and infection 1) and late complications within 90 days were seen in 5 cases (recurrence, groin pain, adhesions).

Conclusions
Polypropylene mesh could be safely used in incarcerated groin hernia repair. However, suture repair is recommended when bowel resection is required. Delay in surgical repair, obesity and co-morbidities are risk factor of post-operative complications.
Referrals to a Surgical Emergency Clinic in a District General Hospital
Authors: Fitz-Gerald Alice , Pansell Karin 
Published: December 2023

Abstract

Aims
The referral pathway for the consultant-led Surgical Emergency Clinic (SEC) at our District General Hospital has no triage process. Anecdotally there are issues with inappropriate patients being booked for this clinic, taking up valuable slots and consultant time, and causing patient dissatisfaction. This was audited to see how the clinic is being utilised.

Methods
A retrospective case note review spanning 8 months looked at 250 patients seen in SEC. The origin of referrals, reason for referral, investigations, and clinic outcomes were recorded. Using this, patients were classified as ‘appropriate’ or ‘inappropriate’ for SEC.

Results
Referrals came from the following sources: 158 from general practice, 54 from the emergency department, and 38 directly from the surgical team. 58% were deemed to be appropriate referrals, while the remaining 42% were deemed inappropriate for SEC. 84 patients (33.6%) had imaging performed on the same day as their appointment, while 74 patients (30%) had investigations requested for a later date. 156 (62.4%) patients were discharged, 25 (10%) were redirected to a suitable surgical specialty outpatient clinic, and 16 (6.4%) were referred to other specialties. 10.4% had an acute surgical admission or same day CEPOD theatre, and 8.4% were listed for theatre on an elective/urgent basis.

Conclusion
This suggests SEC is not being used optimally and highlights a need to restructure the referral process. Physician Associates and Advanced Clinical Practitioners will be trained to assist consultants and triage referrals to improve patient flow, the efficiency of SEC, and hopefully the patient experience.
Pancreatitis survey of clinicians in the surgical department.
Authors: Gurung Ganga , Ali Mahmoud , Taha Ahmed , Begum Hosna , Oo Myo Kyaw , Rathore Munir 
Published: December 2023

Abstract
Pancreatitis is a common emergency presentation with acute abdomen.
A short 10 question snapshot survey about pancreatitis based on Nice guideline NG 104 and the (United Lincolnshire Hospitals NHS Trust) ULHT Trust guidelines was conducted among clinicians in the surgical department.
Survey answers were collected anonymously via google forms and paper forms. Data was analysed with Excel.
First cycle 17 responses. 2nd cycle 20 responses.
Teaching sessions were conducted; wall posters, notice letters were installed to improve the clinicians knowledge. A second cycle was conducted with the same set of questions.1st Cycle2nd CycleDefinition (88%)Definition (95%)Cause (88%)Cause (85%)Common Presentation (88%)Common Presentation (80%)Fluid management (88%)Fluid management (95%)Mortality rate (40%)Mortality rate (55%)Confirmatory test (64%)Confirmatory test (50%)Intervention (64%)Intervention (60%)Complication (70%)Complication (60%)Pain management (70%)Pain management (55%)
In conclusion, the basic idea about pancreatitis of the responders is already good which is found to be further improved even in a slightly larger sample size. The overall mortality of acute pancreatitis vs acute severe pancreatitis seems to be confused. More diverse opinions of the participants are obtained in the slightly controversial questions such as the pain management and the diagnosis.
Why the varied response? It must be acknowledged, the set of responders were a different subset as clinicians rotate in various departments. It highlights the necessity to promote education and awareness in a constant manner to provide best patient care, despite the constraints of time and workload.
A Rare Case of Fatal Necrotizing Fasciitis In An ASA Grade I Young Patient.
Authors: Mithany Reda 
Published: December 2023

Abstract
This case report presents a young adult who tragically died within 24 hours of his presentation due to severe necrotising fasciitis. The patient, initially healthy, sought medical advice from his GP for a sore throat and was prescribed amoxicillin. However, three days later, they ended up in the emergency department, critically unwell, with disseminated intravascular coagulopathy and painful left thigh with mild crepitus on examination.
A CT scan of the abdomen and pelvis with contrast revealed extensive necrotizing fasciitis in the left psoas muscle, left thigh, and left leg. Urgent surgical intervention, including left lower limb fasciotomy, laparotomy, and left above knee amputation, were performed in one session. The patient was then admitted to the intensive care unit, despite this immediate management, he succumbed to this rapidly progressive disease, experiencing sepsis and multiorgan failure.
This case highlights the importance of recognizing the symptoms of necrotising fasciitis early, even in young patients without comorbidities.
Healthcare provider cost of antimicrobial resistance in two teaching hospitals in Ghana
Authors: Otieku Evans , Kurtzhals Joergen Anders Lindholm , Fenny Ama Pokuaa , Ofori Alex Owusu , Labi Appiah-Korang , Enemark Ulrika 
Published: December 2023

Abstract
Understanding the healthcare provider costs of antimicrobial resistance (AMR) in lower-middle-income countries would motivate healthcare facilities to prioritize reducing the AMR burden. This study evaluates the extra length of stay and the associated healthcare provider costs due to AMR to estimate the potential economic benefits of AMR prevention strategies. We combined data from a parallel cohort study with administrative data from the participating hospitals. The parallel cohort study prospectively matched a cohort of patients with bloodstream infections caused by third-generation cephalosporin-resistant enterobacteria and methicillin-resistant Staphylococcus aureus (AMR cohort) with two control arms: patients infected with similar susceptible bacteria and a cohort of uninfected controls. Data collection took place from June to December 2021. We calculated the cost using aggregated micro-costing and step-down costing approaches and converted costs into purchasing power parity in international US dollars, adjusting for surviving patients, bacterial species and cost centres. We found that the AMR cohort spent a mean of 4.2 extra days (95% CI: 3.7–4.7) at Hospital 1 and 5.5 extra days (95% CI: 5.1–5.9) at Hospital 2 compared with the susceptible cohort. This corresponds to an estimated mean extra cost of $823 (95% CI: 812–863) and $946 (95% CI: US$929–US$964) per admission, respectively. For both hospitals, the estimated mean annual extra cost attributable to AMR was approximately US$650 000. The cost varies by organism and type of resistance expressed. The result calls for prioritization of interventions to mitigate the spread of AMR in Ghana.
What digital health technology types are used in mental health prevention and intervention? Review of systematic reviews for systematization of technologies
Authors: Tani Naomichi , Fujihara Hiroaki , Ishii Kenji , Kamakura Yoshiyuki , Tsunemi Mafu , Yamaguchi Chikae , Eguchi Hisashi , Imamura Kotaro , Kanamori Satoru , Kojimahara Noriko , Ebara Takeshi 
Published: December 2023

Abstract
Digital health technology has been widely applied to mental health interventions worldwide. Using digital phenotyping to identify an individual’s mental health status has become particularly important. However, many technologies other than digital phenotyping are expected to become more prevalent in the future. The systematization of these technologies is necessary to accurately identify trends in mental health interventions. However, no consensus on the technical classification of digital health technologies for mental health interventions has emerged. Thus, we conducted a review of systematic review articles on the application of digital health technologies in mental health while attempting to systematize the technology using the Delphi method. To identify technologies used in digital phenotyping and other digital technologies, we included 4 systematic review articles that met the inclusion criteria, and an additional 8 review articles, using a snowballing approach, were incorporated into the comprehensive review. Based on the review results, experts from various disciplines participated in the Delphi process and agreed on the following 11 technical categories for mental health interventions: heart rate estimation, exercise or physical activity, sleep estimation, contactless heart rate/pulse wave estimation, voice and emotion analysis, self-care/cognitive behavioral therapy/mindfulness, dietary management, psychological safety, communication robots, avatar/metaverse devices, and brain wave devices. The categories we defined intentionally included technologies that are expected to become widely used in the future. Therefore, we believe these 11 categories are socially implementable and useful for mental health interventions.
EU ETS and voluntary carbon markets: key features and current challenges
Authors: Koumpli Vassiliki 
Published: December 2023

Abstract
Carbon emissions trading constitutes an important instrument in reaching global climate goals and enhancing energy transition. This brief provides an illustration of the EU ETS and Voluntary Carbon Markets (VCMs), focusing on their main features and some of their current challenges from a regulatory point of view. Issues pertaining to systems’ linkage and carbon leakage in the framework of the EU ETS as well as ensuring the overall project quality in the framework of VCMs have to be successfully faced for such schemes to be effective. The special issues of the interaction between the EU ETS and VCM schemes and their impact on the energy sector are ultimately highlighted.
Alteration of circulating miRNAs during myocardial infarction and association with lipid levels
Authors: Ozuynuk-Ertugrul Aybike Sena , Ekici Berkay , Erkan Aycan Fahri , Coban Neslihan 
Published: December 2023

Abstract

Background
Increasing mortality and morbidity of coronary artery disease (CAD) highlight the emerging need for novel noninvasive markers such as circulating microRNAs (miRNAs).

Objective
To evaluate the circulating levels of miR-126-3p, miR-210-3p, let-7g-5p, and miR-326, and their associations with known contributors to CAD, in CAD subgroups.

Methods
We divided the cohort into 4 groups: non-CAD controls (≤30% stenosis; n = 55), and patients with stable angina pectoris (SAP; n = 48), unstable AP (UAP; n = 46), and myocardial infarction (MI; n = 36). The circulating levels of miR-126-3p, miR-210-3p, let-7g-5p, and miR-326 were determined using TaqMan Advanced miRNA Assays in serum specimens.

Results
Circulating miR-126-3p levels were lower in the MI and UAP groups, compared with the non-CAD group, whereas miR-210-3p circulating levels were lower in the MI group than others. The levels of circulating let-7g-5p were shown to be useful for distinguishing UAP from MI, and there were substantial differences in circulating let-7g-5p levels between the UAP and MI groups. Moreover, lipid levels and ratios were lower in individuals with high circulating miR-126-3p and miR-210-3p levels.

Conclusions
The study results suggest that circulating miR-126-3p, miR-210-3p, and let-7g-5p are differentiated between different clinical presentations of CAD and associated with lipid levels, which are important risk factors and determinants of CAD.
Measuring the initial-final mass relation using wide double white dwarf binaries from Gaia DR3
Authors: Hollands M A , Littlefair S P , Parsons S G 
Published: December 2023

ABSTRACT
The initial-final mass relation (IFMR) maps the masses of main-sequence stars to their white dwarf descendants. The most common approach to measure the IFMR has been to use white dwarfs in clusters. However, it has been shown that wide double white dwarfs can also be used to measure the IFMR using a Bayesian approach. We have observed a large sample of 90 Gaia double white dwarfs using FORS2 on the VLT. Considering 52 DA + DA, DA + DC, and DC + DC pairs, we applied our extended Bayesian framework to probe the IFMR in exquisite detail. Our monotonic IFMR is well constrained by our observations for initial masses of 1–5 M⊙, with the range of 1–4 M⊙ mostly constrained to a precision of 0.03 M⊙ or better. We add an important extension to the framework, using a Bayesian mixture-model to determine the IFMR robustly in the presence of systems departing from single star evolution. We find a large but uncertain outlier fraction of 59 ± 21 per cent, with outlier systems requiring an additional $0.70_{-0.22}^{+0.40}$ Gyr uncertainty in their cooling age differences. However, we find that this fraction is dominated by a few systems with massive components near 0.9 M⊙, where we are most sensitive to outliers, but are also able to establish four systems as merger candidates.
PM2.5 Concentrations of Outdoor Tobacco Smoke at Different Distances From the Smoking Source: Is There an Optimal Distance for a Designated Smoking Area?
Authors: Kim Soomin , Lee Kiyoung 
Published: December 2023

Abstract

Introduction
Many countries have enacted indoor smoke-free policies, and some have established outdoor nonsmoking areas. However, no clear standard for determining the optimal distance for these outdoor nonsmoking zones remains. This study aimed to evaluate outdoor tobacco smoke (OTS) exposure up to a distance of 21 m and to identify factors influencing OTS levels.

Methods
To assess OTS levels, PM2.5 concentrations were measured at distances of 6, 12, 15, 18, and 21 m using real-time aerosol monitors. Between August and October 2022, a total of 164 measurements were undertaken. The background PM2.5 concentration was gauged for 5 minutes before smoking commenced and then re-measured 3 minutes during smoking. OTS levels were determined by calculating the difference between the average background PM2.5 and the average PM2.5 concentrations during smoking. A one-sample t test was employed to ascertain if the OTS levels at each distance were significantly elevated compared to 0 µg/m3. Furthermore, a multiple linear regression analysis was conducted to determine the factors influencing OTS levels.

Results
The mean OTS levels recorded at all specified distances significantly surpassed 0 µg/m3. The regression analysis revealed that the OTS levels correlated significantly with distance and wind speed. Specifically, OTS levels diminished as distance expanded and wind speed reduced.

Conclusions
OTS levels, even at 21 m, were significantly greater than 0 µg/m3. Our results provide robust evidence supporting the establishment of outdoor nonsmoking zone up to 21 m.

Implications
Outdoor tobacco smoke (OTS) level was determined by PM2.5 concentration. The OTS levels significantly exceeded 0 µg/m3 at every measured distance up to 21 m. In the regression model, OTS levels notably correlated with distance and wind speed. OTS levels diminished as distance expanded and wind speed reduced.
False and missed alarms in seasonal forecasts affect individual adaptation choices
Authors: Hembach-Stunden Katharina , Vorlaufer Tobias , Engel Stefanie 
Published: December 2023

Abstract
Facing climate change, seasonal forecasts, and weather warnings are increasingly important to warn the public of the risk of extreme climate conditions. However, being confronted with inaccurate forecast systems may undermine individuals’ responsiveness in the long run. Using an online experiment, we assess how false alarm and missed alarm-prone forecast systems influence individuals’ adaptation behaviour. We show that exposure to false alarm-prone forecasts decreases investments if a warning is issued (the ‘cry-wolf effect’). Exposure to missed alarm-prone forecasts increases adaptation investments if no warning, but also if a warning has been issued. Yet, individuals exposed to both false and missed alarm-prone forecasts still adjust their adaptation investments depending on the forecasted probability of extreme climate conditions. Individuals with missed alarm-prone forecasts are, however, less sensitive to the forecasted probability if a warning has been issued. In case of low probability warnings, overshooting investments in adaptation hence becomes more likely.
Serum calprotectin correlates stronger with inflammation and disease activity in ACPA positive than ACPA negative rheumatoid arthritis
Authors: Sejersen Kristina , Weitoft Tomas , Knight Ann , Lysholm Jörgen , Larsson Anders , Rönnelid Johan 
Published: December 2023

Abstract

Objectives
The aim of the present study was to evaluate the performance of serum and SF levels of the granulocyte protein calprotectin as an inflammatory biomarker in RA patients with knee synovitis.

Methods
Seventy-six RA patients with ongoing knee synovitis were included. Data on DAS with 28 joints and their subcomponents and radiological destruction of the affected knee were collected. White blood cell count, CRP, ACPA against cyclic citrullinated peptide version 2 (anti-CCP2), IgM RF and calprotectin were analysed in parallel in circulation and in SF. Counts of polynuclear and mononuclear cells were measured in SF.

Results
Serum (S)-calprotectin correlated more strongly than SF-calprotectin with inflammatory markers and disease activity. Instead, SF-calprotectin showed a strong correlation to SF counts of white blood cells, and especially to polymorphonuclear cell counts (Spearman’s ρ = 0.72, P &lt; 0.001). S-calprotectin showed markedly stronger correlation with inflammatory markers and disease activity in ACPA positive as compared with ACPA negative RA patients; a similar difference was observed for patients with and without IgM RF.

Conclusion
The particularly strong association between circulating calprotectin and inflammation in ACPA positive RA is a new argument for a specific role for polymorphonuclear granulocytes/neutrophils in this RA subset. Measurement of calprotectin in SF does not convey any additional benefit compared with measurement in the circulation in RA patients with knee synovitis.