bluuebunny/crossref_metadata_2025_split huggingface dataset:
006 The inter-observer reliability of head injury assessment between clinicians and parents of head injured children
Authors: Kennedy Charlotte , Oliver Govind , Body Richard 
Published: April 2023

BackgroundPaediatric head injury is common, yet 80% are mild and require no investigation or treatment. Decision-making around neuroimaging is guided by clinical decision rules. Whether parents and clinicians interpret questions within these algorithms in the same way is not known. Understanding this is fundamental for public facing algorithms and parental guidance.We aimed to determine the inter-observer reliability of Pediatric Emergency Care Applied Research Network (PECARN) head injury algorithm completion between clinicians and parents of head injured children.We conducted a prospective, observational, feasibility study. Children over 2 years old, presenting to the Royal Manchester Children’s Hospital within 24 hours of a head injury, were recruited. Children were excluded if they required immediate resuscitation or non-accidental injury was suspected. Parents were given a questionnaire to complete whilst awaiting assessment, with the PECARN criteria in lay-man’s language. Following assessment, the treating clinician completed a similar questionnaire, blinded to the parent’s answers.57 children were included. The mean age was 5.8 years (SD 4.07). The most common mechanism of injury was a fall from standing (46%), with only 6 parents reporting a dangerous mechanism. Arrival Glasgow Coma Scale (GCS) was 15/15 in 98% of children. The inter-rater reliability for individual PECARN criteria was highly variable, with kappa values ranging from −0.10 to 1.00. There was poor agreement on whether the child was alert and acting normally (K −0.10, SE 0.49) but perfect agreement on other features of altered mental state including agitation, repeated questioning and taking longer than normal to respond (all K 1.0).The high variability in agreement between clinicians and parents when assessing PECARN criteria highlights differences in how these groups evaluate head injured children. This has significant implications for public facing algorithms, such as those used by NHS 111.
007 Variability in point of care ultrasound (POCUS) practices in paediatric emergency departments in the UK & ireland; a PERUKI study
Authors: Lyttle Mark , Magnus Dan , Kanani Anand , Kehler Lisa , Parri Niccolo , Jones Sarah 
Published: April 2023

BackgroundPoint Of Care Ultrasound (POCUS) is a potentially useful addition to the technical armamentarium of PEM clinicians. Evidence is accumulating on diagnostic and procedural applications; however despite widespread use in other countries, usage patterns are not clear in our setting. Given the lack of a standardised PEM POCUS curriculum, best practice standards, and formal training courses, we aimed to determine variability in PEM POCUS practices across our PEM research network.Method and resultsThis online survey was distributed in March 2019, with content derived iteratively by the study team from existing literature and input from PERUKI members. One response was sought from each site, to describe department practices, hardware, and major enablers and obstacles. Results are presented using descriptive statistics.Conclusions59/63 (94%) sites responded, including a mix of site and department types (eg 40% tertiary hospital, 60% mixed adult/paediatric EDs, 30% major trauma centres). Almost all (90%) had access to POCUS, and 70% reported limited use by a small proportion of staff, with no named lead. Most (95%) did not have a teaching program or identified trainer. Approximately half (55%) routinely documented findings, most often in clinical notes, and most (65%) did not store images; most (68%) had no quality assurance measures. The greatest enablers of PEM POCUS were its need, funding for equipment, and clinician engagement; the greatest obstacles were availability of training courses and trainers, and time to learn and maintain skills due to service delivery needs.Whilst hardware is available in most EDs, PEM POCUS is not yet widespread, with training being the greatest obstacle. Future work exploring clinician opinions will inform whether the specialty wishes to embrace POCUS, and training course content. However, if adopted, it must be coupled with implementation of best practice standards in domains including quality assurance and governance.
008 A qualitative exploration of the factors influencing patient flow in an emergency department
Authors: Freitas Loren De , Goodacre Steve , O’Hara Rachel , Thokala Praveen , Hariharan Seetharaman 
Published: April 2023

BackgroundEmergency departments have been characterised as complex adaptive systems and patient flow is one area that affects the efficiency and quality of care in emergency departments. Complex systems may comprise complex processes but the system may still be effective if the processes have the least number of steps required to produce an outcome. Improving patient flow requires an understanding of how ED processes work. However, there is little existing qualitative literature exploring ED patient flow. This study aimed to understand the ED patient flow process and identify the factors that influence it.Multiple qualitative methods were used to explore ED patient flow in a single case study site in Trinidad and Tobago. Data was collected from May 2017 to March 2018. Non-participant observations (48 hours), observational process mapping (155 hours) and informational conversational interviews (90) were used to explore patient flow. Observational process mapping involved directly observing patient journeys across all levels of urgency. Thematic analysis was used to analyse the data.Six broad themes were identified as factors influencing ED patient flow- 1) ED organizational work processes, 2) ED design and layout, 3) Material resources within and outside the ED, 4) ED nursing staff levels, roles, skill mix and use, 5) ED non-clinical staff, 6) External clinical and non-clinical departments. Within the themes there were primary factors that influenced patient flow as well as secondary factors. The secondary factor represented the staff response to either enhance the primary factor or to compensate for limitations in the process. A conceptual model of the factors influencing ED patient flow was developed.The conceptual model of ED patient flow developed in this study can be used to systematically examine the factors influencing ED patient flow and may be used by policy and decision makers to improve patient flow.
009 Decision-analysis modelling of the effects of thromboprophylaxis for people with lower limb immobilisation for injury
Authors: Davis Sarah , Goodacre Steve , Pandor Abdullah , Horner Daniel , Stevens John , Wit Kerstin de , Hunt Beverley 
Published: April 2023

BackgroundPharmacological thromboprophylaxis reduces the risk of symptomatic venous thromboembolism (VTE) in people with lower limb immobilisation due to injury but can increase the risk of bleeding. We used decision-analytic modelling to compare the risks and benefits of thromboprophylaxis and determine the overall benefit of treatment.Method and resultsA decision-analytic model was developed to simulate the management of a cohort of people with lower limb immobilisation due to injury according to different thromboprophylaxis strategies, including thromboprophylaxis for all and thromboprophylaxis for none. Costs were estimated from the perspective of the UK National Health Service and Personal Social Services. A six-month decision tree was used to model rates of prophylaxis, VTE events (pulmonary embolism [PE], deep vein thrombosis [DVT]) and major bleeds). A Markov model with a lifetime horizon was used to extrapolate costs and QALY losses associated with chronic complications following VTE or bleeding events. The health states included within the Markov model captured the risk of post-thrombotic syndrome (PTS) following VTE and the risk of chronic thromboembolic pulmonary hypertension (CTEPH) following PE. QALYs were estimated by applying estimates of health utility to life expectancy after each of the events in the model.ConclusionsThe results suggest that the combined rate of serious acute adverse outcomes (intracranial haemorrhage [ICH], death from VTE or bleeding) would be around 1 in 4000 regardless of thromboprophylaxis use. As shown in table 1, the short-term benefits of thromboprophylaxis lie in reducing the rates of non-fatal PE, symptomatic DVT and asymptomatic DVT, with associated longer-term benefits of reduced risks of PTS and CTEPH. Overall, thromboprophylaxis is estimated to result in 0.015 additional QALYs per patient.Abstract 009 Figure 1Predicted clinical outcomes per 100,000 patients with lower limb immobilisation due to injuryOur findings suggest that the benefits of thromboprophylaxis lie in reducing long-term consequences of VTE rather than reducing the risk of acute serious adverse events.
Clinical evaluation of a deep-learning model for automatic scoring of the Alberta stroke program early CT score on non-contrast CT
Authors: Lee Seong-Joon , Park Gyuha , Kim Dohyun , Jung Sumin , Song Soohwa , Hong Ji Man , Shin Dong Hoon , Lee Jin Soo 
Published: April 2023

BackgroundAutomated measurement of the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) can support clinical decision making. Based on a deep learning algorithm, we developed an automated ASPECTS scoring system (Heuron ASPECTS) and validated its performance in a prespecified clinical trial.MethodsFor model training, we used non-contrast computed tomography images of 487 patients with acute ischemic stroke (AIS). For the clinical trial, 326 patients (87 with AIS, 56 with other acute brain diseases, and 183 with no brain disease) were enrolled. The results of Heuron ASPECTS were compared with the consensus generated by two stroke experts using the Bland–Altman agreement. A mean difference of less than 0.35 and a maximum allowed difference of less than 3.8 were considered the primary outcome target. The sensitivity and specificity of the model for the 10 regions of interest and dichotomized ASPECTS were calculated.ResultsThe Bland–Altman agreement had a mean difference of 0.03 [95% confidence interval (CI): −0.08 to 0.14], and the upper and lower limits of agreement were 2.80 [95% CI: 2.62 to 2.99] and −2.74 [95% CI: −2.92 to −2.55], respectively. For ASPECTS calculation, sensitivity and specificity to detect the early ischemic change for 10 ASPECTS regions were 62.78% [95% CI: 58.50 to 67.07] and 96.63% [95% CI: 96.18 to 97.09], respectively. Furthermore, in a dichotomized analysis (ASPECTS >4 vs. ≤4), the sensitivity and specificity were 94.01% [95% CI: 91.26 to 96.77] and 61.90% [95% CI: 47.22 to 76.59], respectively.ConclusionsThe current trial results show that Heuron ASPECTS reliably measures the ASPECTS for use in clinical practice.
Plasma biomarkers for Alzheimer’s disease: a field-test in a memory clinic
Authors: Altomare Daniele , Stampacchia Sara , Ribaldi Federica , Tomczyk Szymon , Chevalier Claire , Poulain Géraldine , Asadi Saina , Bancila Bianca , Marizzoni Moira , Martins Marta , Lathuiliere Aurelien , Scheffler Max , Ashton Nicholas J , Zetterberg Henrik , Blennow Kaj , Kern Ilse , Frias Miguel , Garibotto Valentina , Frisoni Giovanni B 
Published: April 2023

BackgroundThe key Alzheimer’s disease (AD) biomarkers are traditionally measured with techniques/exams that are either expensive (amyloid-positron emission tomography (PET) and tau-PET), invasive (cerebrospinal fluid Aβ42and p-tau181), or poorly specific (atrophy on MRI and hypometabolism on fluorodeoxyglucose-PET). Recently developed plasma biomarkers could significantly enhance the efficiency of the diagnostic pathway in memory clinics and improve patient care. This study aimed to: (1) confirm the correlations between plasma and traditional AD biomarkers, (2) assess the diagnostic accuracy of plasma biomarkers as compared with traditional biomarkers, and (3) estimate the proportion of traditional exams potentially saved thanks to the use of plasma biomarkers.MethodsParticipants were 200 patients with plasma biomarkers and at least one traditional biomarker collected within 12 months.ResultsOverall, plasma biomarkers significantly correlated with biomarkers assessed through traditional techniques: up tor=0.50 (p<0.001) among amyloid,r=0.43 (p=0.002) among tau, andr=−0.23 (p=0.001) among neurodegeneration biomarkers. Moreover, plasma biomarkers showed high accuracy in discriminating the biomarker status (normal or abnormal) determined by using traditional biomarkers: up to area under the curve (AUC)=0.87 for amyloid, AUC=0.82 for tau, and AUC=0.63 for neurodegeneration status. The use of plasma as a gateway to traditional biomarkers using cohort-specific thresholds (with 95% sensitivity and 95% specificity) could save up to 49% of amyloid, 38% of tau, and 16% of neurodegeneration biomarkers.ConclusionThe implementation of plasma biomarkers could save a remarkable proportion of more expensive traditional exams, making the diagnostic workup more cost-effective and improving patient care.
Molecules of senescent glial cells differentiate Alzheimer’s disease from ageing
Authors: Dai Linbin , Gao Feng , Wang Qiong , Lv Xinyi , Cheng Zhaozhao , Wu Yan , Chai Xianliang , Zetterberg Henrik , Blennow Kaj , Levey Allan I , Shi Jiong , Shen Yong 
Published: April 2023

BackgroundAgeing is a major risk factor for Alzheimer’s disease (AD), which is accompanied by cellular senescence and thousands of transcriptional changes in the brain.ObjectivesTo identify the biomarkers in the cerebrospinal fluid (CSF) that could help differentiate healthy ageing from neurodegenerative processes.MethodsCellular senescence and ageing-related biomarkers were assessed in primary astrocytes and postmortem brains by immunoblotting and immunohistochemistry. The biomarkers were measured in CSF samples from the China Ageing and Neurodegenerative Disorder Initiative cohort using Elisa and the multiplex Luminex platform.ResultsThe cyclin-dependent kinase inhibitors p16/p21-positive senescent cells in human postmortem brains were predominantly astrocytes and oligodendrocyte lineage cells, which accumulated in AD brains. CCL2, YKL-40, HGF, MIF, S100B, TSP2, LCN2 and serpinA3 are biomarkers closely related to human glial senescence. Moreover, we discovered that most of these molecules, which were upregulated in senescent glial cells, were significantly elevated in the AD brain. Notably, CSF YKL-40 (β=0.5412, p<0.0001) levels were markedly elevated with age in healthy older individuals, whereas HGF (β=0.2732, p=0.0001), MIF (β=0.33714, p=0.0017) and TSP2 (β=0.1996, p=0.0297) levels were more susceptible to age in older individuals with AD pathology. We revealed that YKL-40, TSP2 and serpinA3 were useful biomarkers for discriminating patients with AD from CN individuals and non-AD patients.DiscussionOur findings demonstrated the different patterns of CSF biomarkers related to senescent glial cells between normal ageing and AD, implicating these biomarkers could identify the road node in healthy path off to neurodegeneration and improve the accuracy of clinical AD diagnosis, which would help promote healthy ageing.
Unclassified clinical presentations of chronic inflammatory demyelinating polyradiculoneuropathy
Authors: Doneddu Pietro Emiliano , Akyil Houseyin , Manganelli Fiore , Briani Chiara , Cocito Dario , Benedetti Luana , Mazzeo Anna , Fazio Raffaella , Filosto Massimiliano , Cosentino Giuseppe , Di Stefano Vincenzo , Antonini Giovanni , Marfia Girolama Alessandra , Inghilleri Maurizio , Siciliano Gabriele , Clerici Angelo Maurizio , Carpo Marinella , Schenone Angelo , Luigetti Marco , Lauria Giuseppe , Matà Sabrina , Rosso Tiziana , Minicuci Giacomo Maria , Lucchetta Marta , Cavaletti Guido , Liberatore Giuseppe , Spina Emanuele , Campagnolo Marta , Peci Erdita , Germano Francesco , Gentile Luca , Strano Camilla , Cotti Piccinelli Stefano , Vegezzi Elisa , Leonardi Luca , Mataluni Giorgia , Ceccanti Marco , Schirinzi Erika , Romozzi Marina , Nobile-Orazio Eduardo 
Published: April 2023

Background
To assess the ability of the 2021 European Academy of Neurology/Peripheral Nerve Society (EAN/PNS) clinical criteria for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) to include within their classification the whole spectrum of clinical heterogeneity of the disease and to define the clinical characteristics of the unclassifiable clinical forms.

Methods
The 2021 EAN/PNS clinical criteria for CIDP were applied to 329 patients fulfilling the electrodiagnostic (and in some cases also the supportive) criteria for the diagnosis of CIDP. Clinical characteristics were reviewed for each patient not strictly fulfilling the clinical criteria (‘unclassifiable’).

Results
At study inclusion, 124 (37.5%) patients had an unclassifiable clinical presentation, including 110 (89%) with a typical CIDP-like clinical phenotype in whom some segments of the four limbs were unaffected by weakness (‘incomplete typical CIDP’), 10 (8%) with a mild distal, symmetric, sensory or sensorimotor polyneuropathy confined to the lower limbs with cranial nerve involvement (‘cranial nerve predominant CIDP’) and 4 (1%) with a symmetric sensorimotor polyneuropathy limited to the proximal and distal areas of the lower limbs (‘paraparetic CIDP’). Eighty-one (65%) patients maintained an unclassifiable presentation during the entire disease follow-up while 13 patients progressed to typical CIDP. Patients with the unclassifiable clinical forms compared with patients with typical CIDP had a milder form of CIDP, while there was no difference in the distribution patterns of demyelination.

Conclusions
A proportion of patients with CIDP do not strictly fulfil the 2021 EAN/PNS clinical criteria for diagnosis. These unclassifiable clinical phenotypes may pose diagnostic challenges and thus deserve more attention in clinical practice and research.
Area-level sociodemographic differences in tobacco availability examined with nationwide tobacco product retail licence data in Finland
Authors: Pätsi Salla-Maaria , Toikka Arho , Ollila Hanna , Ruokolainen Otto 
Published: April 2023

BackgroundDifferences in tobacco retailer density between areas by sociodemographic composition have been observed. However, little research comes from European jurisdictions and from countries with a tobacco retail licensing system. In Finland, the system consists of criteria for retailers and supervision fees.MethodsThe tobacco product retail licence data and sociodemographic data were retrieved from corresponding Finnish authorities. Area-level tobacco availability was measured as the presence of a retailer and as the number of retailers per 1000 inhabitants by postcode area. Sociodemographic indicators included median income, percentage of inhabitants in the lowest income tertile, percentage of adults with higher education and unemployment rate. Analyses were based on logistic regression and Ordinary Least Squares regression with log-transformed density.ResultsLower area-level sociodemographic composition was mainly associated with higher tobacco availability. Income was the strongest correlate of the tobacco retailer availability: areas with higher median income had lower odds of having a tobacco retailer (OR 0.54, 95% CI 0.48 to 0.61 per €1000) and lower retailer density (−4.4% per €1000, Cohen’sf=0.51). Areas with a greater proportion of people in the lowest income category had higher densities of tobacco retailers (+2.8% per percentage point, Cohen’sf=0.07). Other sociodemographic indicators showed inconsistent associations with retailer presence and density.ConclusionTobacco availability can be higher in areas with lower sociodemographic composition also in a country with a comprehensive tobacco retail licensing system and small income inequalities. Retailing policies should be further developed to reduce tobacco availability and narrow inequalities in tobacco use.
Abstract 1017: A novel blood diagnostic method for fibrolamellar hepatocellular carcinoma
Authors: Wang Ruisi , Hurley Arlene M. , Simon Sanford M. 
Published: April 2023

Abstract
Fibrolamellar hepatocellular carcinoma (FLC) is an often-lethal liver cancer affecting primarily children and young adults. The disease presents with vague symptoms, and, as a result, it is usually diagnosed at an advanced stage. Thus, there is a high recurrence rate among those who undergo surgical resection. Diagnostic tests based on scans are differentially interpreted by pathologists and radiological, and scans often miss small tumors. We are developing tests for FLC based on metabolites and nucleic acids in the blood and in the urine. We used samples from 29 FLC patients and 9 age/gender-matched healthy donors. A clinical testing lab was used to quantify the plasma for Vitamin B12, alpha-fetoprotein (AFP), estrogen (E2), and liver panel (albumin, alkaline phosphatase, alanine transaminase, aspartate transferase, creatine kinase, direct bilirubin, total bilirubin, total protein, globulin). We found no difference between FLC vs. non-FLC subjects in the liver panel tests. In addition, there is no difference between the AFP and E2 tests. Vitamin B12 levels were about 8.5 times higher (p&lt;0.05) in FLC patients compared to healthy donors. We are currently validating other protein and metabolite markers in the blood and urine, and C-reactive protein in blood and orotic acid in urine.
In nucleic acid assays, we found specific miRNAs increased in the circulation. These included: miR-122-5p, miR-514a-5p, miR-192-5p, miR-615-5p, miR-4532, miR-4322, miR-214-3p, and miR-122-3p. They were upregulated 8- to 21-fold in FLC (n= 24) vs. non-FLC patients (n=16). These results identified biomarkers and microRNAs associated with FLC tumors. The tests are currently being evaluated as part of a larger study to determine whether they can detect recurrence of disease and help assess therapeutic responses in FLC patients.
Citation Format: Ruisi Wang, Arlene M. Hurley, Sanford M. Simon. A novel blood diagnostic method for fibrolamellar hepatocellular carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1017.