bluuebunny/crossref_metadata_2025_split huggingface dataset:
Craft(wo)manship, female sisterhood and myth‐(un)making in Anna Solomon's The Book of V
Authors: Gasztold Brygida , Rabinovich Irina 
Published: December 2022

AbstractTaking on the lenses of historical fiction and literary feminism, the article explores the lives of five women in an attempt to demonstrate that craft and art, female friendship and metaphoric “sisterhood,” have been the unifying force that helped women cope with patriarchal domination and dire societal pressures. Bringing together three different periods and realities: the Old Testament, the 1960s, and 2016 allows for the examination of female roles across time, with special attention paid to the problems of identity, motherhood, and gender power relations. The Jewish traditional Purim celebration (Shpil) is discussed as a major feminist event where female craft, storytelling, and sisterhood merge as a culminating and unifying element, creating a magical aura and promising consolation.
Algebra and geometry of link homology: Lecture notes from the IHES 2021 Summer School
Authors: Gorsky Eugene , Kivinen Oscar , Simental José 
Published: December 2022

AbstractThese notes cover the lectures of the first named author at 2021 IHES Summer School on “Enumerative Geometry, Physics and Representation Theory” with additional details and references. They cover the definition of Khovanov‐Rozansky triply graded homology, its basic properties and recent advances, as well as three algebro‐geometric models for link homology: braid varieties, Hilbert schemes of singular curves and affine Springer fibers, and Hilbert schemes of points on the plane.
1658 Improvement in the quality of care delivered to head injury (HI) patients presenting to the emergency department of a district general hospital
Authors: Aslam Mohammed Jamil , Malik Shahid Pervez 
Published: December 2022

Aims, Objectives and BackgroundA significant mortality and morbidity rate has been observed in patients presenting with head injuries. Delays in assessment, imaging, time critical diagnosis and management has compromised patient safety and quality of care at Walsall Manor Hospital.To roll out an effective HI pathway with the aim to ensure:-> 90% of high risk HI patients are assessed within 15 minutesGreater efficiency within the process of obtaining CT (computed tomography) imagingFinal decision making < 4 hours.Method and DesignQuality improvement methodology was employed in the form of process mapping to understand the current patient journey. SWOT (Strengths, weaknesses, opportunities and threats) analysis and driver diagrams were used to analyse the problem. Gantt chart was used to plan proposed timelines and PDSA (Plan-Do-Study-Act) cycles used to implement small changes with continued analysis. A new HI pathway was introduced which involved; a succinct thorough assessment, earlier identification of need for CT head, modifications to the requesting and transfer processes to imaging and review of the decision making processes.Abstract 1658 Figure 1Results and ConclusionData retrieval and analysis post interventions showed a reduction in time to initial ED clinician assessment from 63 minutes to 29 minutes. Percentage of CT scans performed within the hour increased from 67% to 89%. Time to CT scans being performed improved from 82 minutes to 55 minutes. These changes in turn had a significant impact on the decision to admit/discharge time which reduced from an average of 9 hours and 5 minutes to 3 hours and 40 minutes.The introduction of a HI pathway alongside other adjuvant interventions had a marked impact on the safety and quality of care, provided to head injury patients at Walsall Manor Hospital. These measures will be re-evaluated at 6–12 monthly intervals to ensure continued enhanced performance.
1739 Improving the management of paediatric angulated upper limb fractures in the emergency department
Authors: Shah Roshni , Garcia Francesca , Deylamipour Yashar , Edwards Matthew 
Published: December 2022

BackgroundUpper limb fractures are common to the Paediatric Emergency Department (PED). Most angulated and/or displaced fractures are traditionally referred to the orthopaedic team to admit for manipulation under anaesthesia (MUA). The Emergency Department (ED) believes that their manipulations and associated analgaesia are sub-optimal to those performed/given in theatre. This means a higher number of avoidable overnight paediatric admissions, long waiting times while fasting, and the theoretical risks of general anaesthesia and surgery.AimsReduce the number of hospital admissions for MUA from the PED by managing suitable upper limb fractures safely and appropriately. Encourage long-term changes in clinician readiness to manipulate suitable paediatric injuries.ObjectivesIncrease number of patients identified with upper limb fractures suitable for manipulation in PEDReduce number of patients in this cohort requiring admission to hospital for MUAMethod and DesignA Plan-Do-Study-Act methodology was implemented. Adherence to our local policy was measured, specifically: inclusion/exclusion criteria, modes of analgesia and presence of a senior Orthopaedic doctor.From October 2020 -June 2021, interventions were undertaken: a teaching package for Emergency Nurse Practitioners and doctors, posters placed in the PED, meetings with key stakeholders including the orthopaedic team and the introduction of a new departmental guideline. Data was collected between June 2021–September 2021 to see if results were maintained.Results and ConclusionResultsRate of manipulations in PED increased from 41% to 78% in the 3rd cycle; improving to 86.36% after interventions stopped. Of those manipulated in PED, 73.68% were discharged from the department. Admissions for MUA decreased from 85% to 70% in the 3rd cycle; decreasing to 36.36% after interventions stopped.The project showed success in improving management of paediatric angulated upper limb fractures. By identifying appropriate fractures, involving the senior orthopaedic team and providing adequate analgesia, admission for general anaesthesia can be avoided.
1480 The application of an age adjusted D-dimer threshold to rule out suspected venousthromboembolism (VTE) in an emergency department setting: A retrospective diagnostic cohort study
Authors: Barrett Liam , Jones Tom , Horner Daniel 
Published: December 2022

Aims, Objectives and BackgroundVenous Thromboembolic disease (VTE) poses a diagnostic challenge for clinicians in acute care. Over reliance on reference standard investigations can lead to over treatment and potential harm.We sought to evaluate the pragmatic performance and implications of using an age adjusted d-dimer (AADD) strategy to rule out VTE in patients with suspected disease attending an emergency department setting.We aimed to determine diagnostic test characteristics and assess whether this strategy would result in proportional imaging reduction and potential cost savings.Method and DesignDesignSingle centre retrospective diagnostic cohort study.All patients >50 years old evaluated for possible VTE who presented to the ED over a consecutive 12-month period between January and December 2016 with a positive D-dimer result.Clinical assessment records and reference standard imaging results were followed up by multiple independent adjudicators and coded as VTE positive or negative.ResultsDuring the study period, there were 2132 positive D-dimer results. 1236 patients received reference standard investigations. A total increase of 314/1236 (25.1%) results would have been coded as true negatives as opposed to false positive if the AADD cut off point had been applied, with 314 reference standard tests subsequently avoided.The AADD cut off had comparable sensitivity to the current cut off despite this increase in specificity; sensitivities for the diagnosis of DVT were 99.28% (95% CI 96.06–99.98%) and 97.72% for PE (95% CI 91.94% to 97.72). There were 3 potential false negative results using the AADD strategy.ConclusionIn patients with suspected VTE with a low or moderate pre-test probability, the application of AADD appears to increase the proportion of patients in which VTE can be excluded without the need for reference standard imaging. This management strategy is likely to be associated with substantial reduction in anticoagulation treatment, investigations and cost/time savings.
1522 The composite outcome fallacy in the PRIEST COVID-19 clinical prediction score
Authors: Dash Kieran , Goodacre Steve , Sutton Laura 
Published: December 2022

Aims, Objectives and BackgroundClinical prediction models are often developed using composite outcomes, based on the implicit assumption that the predictors have similar associations with each component outcome. Using an example of a clinical prediction tool for adverse outcome in suspected COVID-19, we aimed to test this assumption and determine whether using a composite outcome led to suboptimal prediction of individual elements of the composite outcome.Method and DesignWe reanalysed data from the Pandemic Respiratory Infection Emergency System Triage (PRIEST) study; data was collected from 20,891 patients attending 73 emergency departments with suspected COVID-19 and was used to develop a clinical score predicting a composite outcome of mortality or receipt of major organ support up to 30 days following attendance. In this reanalysis we created Least Absolute Shrinkage and Selection Operator (LASSO) multiple regression models to produce unrestricted prediction models for (1) the composite outcome, (2) mortality, and (3) receipt of major organ support.Results and ConclusionUnrestricted regression models had c-statistics of 0.86 (95% Confidence Interval (CI) 0.85–0.86) for mortality, 0.78 (95% CI 0.77–0.80) for receipt of major organ support, and 0.82 (95% CI 0.82–0.83) for the composite outcome. Key variables in the clinical score (increased age, reduced performance status and reduced consciousness) predicted increased risk for mortality and the composite outcome but decreased or no significant risk for receipt of major organ support. The assumption that predictors have similar associations with individual elements of a composite outcome may not hold. Clinical prediction models may incur a ‘composite outcome fallacy’ if they are driven by predicting one element of the composite outcome but used to predict another. Further research into other clinical prediction score with composite outcomes is required.
1726 Integrating established clinical scores with a novel transcriptomic severity classifier augments early risk assessment in the ED
Authors: Diehl-Wiesenecker Eva , Galtung Noa , Liesenfeld Oliver , Uhle Florian , Sweeney Timothy E , Bauer Wolfgang 
Published: December 2022

Aims, Objectives and BackgroundReliable risk assessment in patients presenting to emergency departments (ED) with suspected infection is of utmost importance to support clinical decisions. Vital sign-based scoring systems such as NEWS2 or qSOFA enable a rapid first assessment of patient urgency at triage. However, their inherent high sensitivity might drive over-utilization of healthcare resources. Our aim was to evaluate if adding the result of a transcriptomic severity classifier can synergistically improve current score-based risk assessment in the ED.Method and DesignWe performed a secondary analysis of a patient cohort (n=312) enrolled in the Charité University hospital ED (Berlin, Germany) with suspected infection and at least one vital sign alteration. The expression of 29-host mRNAs in PAXgene-stabilized whole blood was quantified using NanoString nCounter® SPRINT. The proprietary machine learning classifier IMX-SEV-3 was applied to calculate a score that falls into pre-defined interpretation bands: low/moderate/high severity. NEWS2 and qSOFA were documented on admission and combined with the classifier results to analyze the incidence of two clinical endpoints: ‘need for critical care’ (composite of need for ventilation, dialysis, and/or vasopressors) within 7d and ‘28d mortality’.Results and ConclusionAmong enrolled patients, 22 (7.1%) died and 66 (21.1%) required ICU-level care. Of patients with a high NEWS2 (≥5 points; n=184), there was a stepwise increase in mortality among the low (0%; n=0/47), medium (10.1%; n=12/119) and high (44.4% n=8/18) IMX-SEV-3 severity subgroups. A similar stratification was achieved across the low (17%), moderate (31%), and high (61%) IMX-SEV-3 subgroups for prediction of critical care. More granular risk stratification could also be confirmed when using IMX-SEV-3 in combination with high qSOFA (≥2 points; n=76): 0/10.6/50% mortality and 23.5/40.4/66% need for critical care in the low/moderate/high subgroups, respectively.In summary, the combined use of immune-based IMX-SEV-3 results for ED patients with high clinical scores allows improved prediction of mortality and the need for critical care.
1473 In patients with chest pain suspicious for ACS, is arrival by emergency ambulance associated with increased likelihood of myocardial infarction?
Authors: Murray James , Raja Edwin Amalraj , Cooper Jamie 
Published: December 2022

Aims, Objectives and BackgroundPatients commonly present to the Emergency Department (ED) with chest pain suspicious of an acute coronary syndrome (ACS). Clinical features and historical risk factors for ACS are assimilated with electrocardiographic (ECG) findings and cardiac biomarkers to assess risk, determine diagnosis and decide subsequent disposition. Many such patients arrive by ambulance but whether the mode of arrival is associated with an increased likelihood of myocardial infarction is unknown.Method and DesignAdult patients (≥16 years) presenting to Aberdeen Royal Infirmary ED with chest pain suspicious of ACS and non-diagnostic ECGs were identified from two prospectively collected cohorts. Patient demographics, known ACS risk factors at presentation, cardiac biomarker results and clinical outcomes up to 30 days were recorded. Data sets were retrospectively interrogated electronically to identify the mode of ED arrival: by ambulance, or other. The independently adjudicated primary outcome was the development of type 1 or 4 myocardial infarction or cardiac death at 30 days.Logistic regression was used to determine the association between mode of arrival and the primary outcome after adjusting for other confounds. The strength of association was reported as odds ratio (OR) and adjusted odds ratio (aOR) and its 95% confidence interval (CI).Statistical analysis was performed using SPSS v27. A p-value <0.05 was considered to be statistically significant.Results and ConclusionOf 1606 patients [mean age 62 (SD 16) years, 45% women], 1246 (78%) arrived via ambulance and 188 (12%) reached the primary outcome.After adjusting for known confounders, a statistically significant association (aOR 1.72; 95% CI 1.11 to 2.66) between ED arrival by ambulance and the development of type 1 or type 4 myocardial infarction or cardiac death at 30 days was demonstrated (table 1).Abstract 1473 Table 1Relationship of risk factors to the development of the primary outcome expressed using a Chi-square test and calculation of crude and adjusted Odds Ratios (OR) with 95% confidence intervals (CI). A P-value of <0.05 was considered statistically significant. The primary outcome was the development of a Type 1 or Type 4 myocardial infarction or cardiac death at 30 daysIn our cohort of patients with chest pain suspicious of ACS, ED arrival by ambulance correlates strongly with the development of myocardial infarction at 30 days.
1795 Beyond the default male: exploring sex differences in the acute physiological response to trauma and associated clinical outcomes
Authors: Ross Jennifer , Bocchetta Natasha , Hickey Hayden , Lindsay Charlotte , Cole Elaine 
Published: December 2022

Aims, Objectives and BackgroundFemale patients are consistently outnumbered by males in trauma studies. This introduces bias towards male physiology when developing treatments and protocols and may result in females receiving less efficacious care. Recent studies have looked at sex based differences in injury patterns and outcomes following motor vehicle collisions1 as well as TXA administration following severe injury2. In this study we aimed to describe differences between male and female patients with equivalent injury severities (as assessed by ISS), specifically looking at acute physiological responses to injury and subsequent clinical outcomes.Method and DesignWe have sex disaggregated data from over 2000 patients enrolled in the Activation of Coagulation and Inflammation in Trauma (ACIT-II) prospective cohort study (REC: 07/Q0603/29) at the Royal London Hospital. Patients are eligible for inclusion into ACIT-II if they arrive in the Emergency Department within 2 hours of injury and meet the local criteria for a trauma team activation. Blood samples are taken on admission, and physiological parameters and outcome data are collected daily for up to 28 days or until death or discharge. Injury Severity Scores (ISS) were grouped into ‘control’ (ISS 0-3), ‘mild’ (ISS 4-8), ‘moderate’ (ISS 9-15), ‘severe’ (ISS 16-25), ‘critical’ (ISS 25-35) and ‘super critical’ (ISS ≥36).Abstract 1795 Figure 1Results and ConclusionOur data showed a number of variations in physiological response between females and males of the same injury severity categories, notably in terms of depth of shock and coagulation. We also demonstrated worse 28-day survival for females compared to males in the higher injury severity groups (severe p = 0.006, critical p = <0.001). This work shows a definite requirement for further study into how sex based differences can affect presentations and outcomes in trauma.
1497 Methods to diagnose carbon monoxide exposure: A scoping review
Authors: Babu Ashik , Jarman Heather , Moss Phil , Reid Stephen 
Published: December 2022

Aims, Objectives and BackgroundCarbon-monoxide (CO) is a colourless, odourless gas produced from incomplete combustion of carbon-containing fuels. Measurement of CO levels to diagnose exposure is difficult due to its short half-life. The effects of exposure to CO range from mild symptoms, such as headache, to neurotoxicity and death.In this scoping review we aimed to establish the existing methods used in clinical practice and research to determine CO exposure and map the diagnostic cut-off values used.Method and designWe undertook a scoping review to establish methods used in clinical practice and research to measure CO exposure and to determine diagnostic thresholds in each. EMBASE, Medline and CINAHL databases were searched for published articles in English from 2002 onwards using keywords ‘carbon monoxide’, ‘poisoning’ and ‘diagnosis’. Two reviewers independently screened published abstracts for inclusion, with a third arbiter where there was lack of agreement between reviewers. Full text papers were then reviewed, and data extracted on methods used to measure CO level, diagnostic cut-off values, and whether CO exposure was from a known or unknown source.Results and ConclusionA total of 85 papers were identified meeting the inclusion and exclusion criteria. The most common methods identified for diagnosing CO exposure were measurement of carboxyhaemoglobin (COHb) in whole blood (50.5%) and CO-oximeter spectrophotometrics (20%). Diagnostic values were poorly reported and varied in non-smokers and smokers. Exhaled CO levels using breath analysers (8.2%) and ambient CO measurement (11.7%) were also documented. Diagnostic threshold values varied between 2–5% in non-smokers and 10–15% in smokers. Several methods are used in clinical practice and research to diagnose CO exposure. There is variation in the cut-off values used to make this diagnosis which is challenging for clinicians and makes comparison of research findings difficult.
1347 Systematic review of the effectiveness of advocacy interventions for adult victims of domestic violence within an emergency department setting
Authors: Basheer Mohamed Bushry , Bell Rachel , Boyle Adrian 
Published: December 2022

Aims, Objectives and BackgroundAdvocacy interventions for survivors of domestic violence is well established and supported by evidence in some community and healthcare settings. Survivors of domestic violence identified in emergency departments have important differences and it is not clear whether evidence can be applied to this population. Therefore, we conducted an inclusive systematic review of controlled studies evaluating the effectiveness of advocacy workers for adult survivors identified in emergency departments.Method and DesignWe included studies that reported primary research studies evaluating the effectiveness of advocacy workers in supporting survivors of domestic abuse conducted in emergency departments. We excluded studies that reported screening trials, interventions to increase identification of abuse by healthcare staff, studies conducted on children and studies that weren’t reported in English. The search for studies was done via the following online databases from their start dates till February 2022: PubMed/MEDLINE, Cochrane Library, CINAHL/Ebsco, EMBASE and PsycINFO. We anticipated that there would be few high quality double-blinded RCTs and aimed to include before and after studies.Abstract 1347 Table 1Results and ConclusionWe only found one randomised control trial that met our inclusion criteria, and several observational studies which were judged as too weak for inclusion. We found a non-peer reviewed study done as part of a dissertation by a UK emergency consultant, as well as an unpublished randomised controlled trial carried out as part of a PhD thesis. None of the studies we found reported harm from advocacy interventions. The cost effectiveness is uncertain, but likely to be beneficial. We are able to make a weak recommendation that advocacy interventions are likely to helpful, unlikely to be harmful but are of uncertain cost effectiveness. Future research should define meaning outcomes and controlled trials evaluating referral to advocacy are justified. Survivors of domestic violence who present to emergency departments are likely to benefit from referral to advocacy workers.
1467 Hair Tourniquet syndrome, an audit on the efficacy of depilatory creams. An analysis of 3 years of Data, showed a positive rationale for supporting the usage of depilatory cream to remove the hair
Authors: Bragg Julia , Davies Ffion 
Published: December 2022

Aims, Objectives and BackgroundPurpose of the study was to provide supporting evidence for the application of depilatory cream on a child presenting with hair tourniquet syndrome, and measure it’s efficacy and any side effects.Hair tourniquet syndrome is a rare phenonium and there are minimal evidenced based studies to support best practice on how to remove them safely.Our department has been using depilatory cream to dissolve the hair, and have audited 3 years worth of data in order to achieve a sample size large enough to show efficacy for this procedure. Sample size was still low at 22 patients, but this is representative of the rareity of the complaint.Method and DesignWith patients attending with a hair tourniquet where the skin was intact, Depilatory cream was applied to the site for 6–8 minutes according to the products instructions, then washed off thoroughly with an aim to dissolve the hair.The audit was a retrospective study of 3 years of attendances to a busy children’s Emergency department. It looked at the age of the child, site of the hair tourniquet, method used to remove the hair and any iatrogenic side effects from the method chosen. It also looked at any further care needed if removal was unsuccessful.Results and Conclusion95% of patients had the hair removed effectively within 1 hour of arrival in EDx 3 children had the hair removed manually, of which one received a small wound from a scalpel.x 18 children had depilatory cream applied, and of those 18 children it was effective in 83% 1st time. Two children required a second application and it was then successful and One went on to require removal by plastics, under a general anesthetic. It therefore 94% effective as a method of removal. Iatrogenic side effects included mild skin break down in 3 patients (16.6%).