bluuebunny/crossref_metadata_2025_split huggingface dataset:
1673 Environmental leadership and the ‘green’ ED
Authors: Steley Zoe , Robertson Sandy , Farley Martin 
Published: December 2022

Aims, Objectives and BackgroundThe climate crisis is the biggest health threat facing humanity and healthcare accounts for approximately 5% of the UK’s carbon footprint. To address this, the NHS has set the ambitious target of achieving net-zero emissions by 2040. This raises the question as to how emergency departments – sites of resource-intensive clinical activity – can be engaged appropriately on environmental sustainability. Can a standardised approach be developed to hasten and consolidate efforts? To test this, we developed the GreenED framework. The aim was to trial a set of actionable criteria that could be implemented by any ED seeking to measure and reduce impacts, and increase staff engagement. It is designed to be easy to implement in the context of the emergency care crisis, and administered by RCEM. To our knowledge, this is the first framework in the world specifically designed for use in EDs.Method and DesignThe framework is modelled on UCL’s successful LEAF programme for sustainable laboratories. Criteria were drafted based on a review of literature in healthcare sustainability relevant to emergency care, and structured into bronze, silver and gold levels based on anticipated feasibility. ED staff in 8 departments across England were then recruited to pilot bronze level. Following an induction session, participants were engaged via monthly meetings, providing updates on progress and sharing approaches and challenges. Verbal feedback and written submissions were collected.Results and ConclusionSites attempted as many actions as possible; most achieved at least 3 criteria. Identified obstacles were lack of senior support, guidance on how to implement changes, and time for sustainability work. Through both measurable impacts and qualitative feedback, this pilot has shown a clear demand for reducing environmental impacts, but significant challenges impeding progress. To continue leading in this we need to ensure senior buy-in and dedicate resources towards improving the sustainability of everyday departmental practices.
1435 Anaphylaxis case note review – a retrospective observational study
Authors: Tilbury Nicholas , Tabner Andrew , Johnson Graham 
Published: December 2022

Aims, Objectives and BackgroundAnaphylaxis is seen relatively frequently in the emergency department, and if not managed promptly and appropriately, is associated with significant morbidity and mortality. Often patients are admitted for extended periods of observation due to fears that they may develop a biphasic reaction. NICE has recently updated its guidelines on this but acknowledges the sparsity of research investigating the appropriate length of the observation period. The purpose of this study was to identify the frequency of biphasic reactions and what period of observation would be sufficient for patients following attendance with anaphylaxis.Method and DesignThis was a retrospective observational study which looked at the presentation, treatment and outcomes of patients presenting to Royal Derby Hospital emergency department with anaphylaxis over the last 10 years. The patients were identified from clinical coding completed at the time of discharge and the information was attained from a combination of electronic and paper notes. We defined a biphasic reaction as a recurrence of anaphylaxis without re-exposure to an allergen following a complete resolution of symptoms and normalisation of observations.Results and ConclusionA total of 377 patients were identified as presenting with anaphylaxis from the discharge coding. After case note review, 346 of these were concluded to have been true anaphylaxis (examples of those excluded were hereditary angioedema and ACE-inhibitor related angioedema). 321 (93%) were given intra-muscular adrenaline at some point and 244 (70%) were admitted to hospital for further treatment or observation. Of the 346 cases included in the study only 5 (1.4%) met the criteria for a biphasic reaction. Interestingly, 1 patient was responsible for 3 of those 5 attendances. The results of our study strongly suggest that the risk of a biphasic reaction is significantly less than previously thought and that admission for prolonged observation may be unnecessary in the majority of cases.
1357 Patient-reported outcome measure for older people living with frailty receiving acute care (PROM-OPAC): a programme of development and field-testing
Authors: Oppen James van , Coats Timothy , Conroy Simon , Valderas Jose M , Mackintosh Nicola 
Published: December 2022

Aims, Objectives and BackgroundAcute healthcare outcomes for older people living with frailty are not meaningfully measured using only service delivery metrics (time targets) or broad outcomes (mortality). This programme developed and field-tested a novel Patient Reported Outcome Measure (PROM).Method and Design1: To define important healthcare goals, interviews were conducted with older people living with frailty during acute care.2: A systematic review searched for measures previously used for older people with frailty in acute settings. These measures were appraised for content validity with lay collaborators and patient participants.3: Some areas identified in [1] had no existing measures, so novel questions were devised, improved, and reduced using co-creation and cognitive interviews with lay collaborators and patient participants.4: The resulting questions were field-tested for feasibility and psychometric performance with a multi-site cohort of patients.Results and Conclusion1: Acute healthcare outcome goals were classified under Autonomy (information, security, control) and Function (physical, psychosocial, symptom relief).2: Four existing sets of questions measuring Function were identified. EQ-5D provided the best compromise between reliability and burden.3: There were no existing measures of Autonomy, so seven novel questions were developed and scaled.4: When Function and Autonomy questions were tested in 128 patients, median completion time was 12 minutes and most participants required researcher assistance. Mean inter-item correlation for novel items was 0.28 with adequate response distribution. Exploratory factor analysis (Table 1) indicated a three-factor structure (RMSEA, 0.043) with good internal consistency (Cronbach’s alpha, 0.73. Range for subscales, 0.62–0.77). 35% returned a post-discharge retest.Abstract 1357 Table 1PROM-OPAC items and structure of factors. Responses used a five-level scale (agree strongly, agree, neither agree nor disagree, disagree, disagree strongly)SummaryFrom patient interviews, the PROM-OPAC was developed to measure Autonomy (seven novel questions) and Function (EQ5D). In-hospital and follow-up collection appeared feasible, although users required support to overcome accessibility barriers. Validation in multi-site cohorts is ongoing. Potential future applications include system-level metrics, service-level quality improvement, and patient-level shared decision-making.
1502 Geospatial visualisation of emergency department attendance rates and their associations with deprivation and non-urgent attendances
Authors: Sutton-Klein Joanna , Lewis Jen , Shephard Neil , Campbell Ric , Stone Tony , O’Keeffe Colin , Mason Suzanne 
Published: December 2022

Aims, Objectives and BackgroundAttendances at emergency departments in England continue to increase above the capacity of the urgent and emergency care system. There is significant variability in the rates of attendance at emergency departments across different localities. The aim of this study is to model the association of deprivation and non-urgent attendances with locality-based emergency department attendance rates. The secondary aim is to create an interactive data visualisation tool to engage stakeholders, clinicians, and the public with the research.Method and DesignWe undertook a retrospective, observational study using routinely collected emergency department attendance data from Yorkshire and the Humber (population 5.4 million) between January 2013 and March 2017. We calculated average annual age and sex standardised attendance rates at emergency departments for small localities known as lower layer super output areas.The association between emergency department attendance rates, deprivation and non-urgent attendances was examined using multivariable linear and logistic regression models, which were adjusted for travel time to the nearest emergency department.The data was visualised to create an interactive choropleth map using R.Abstract 1502 Figure 1Screenshot of interactive data visualisation tool showing age and sex standardised annual emergency department attendance rates in Yorkshire and the HumberResults and ConclusionThe analytical sample included 6,389,383 attendances across 2,880 localities, with a median age and sex standardised annual emergency department attendance rate of 308 per 1000 population (interquartile range 130).The fully adjusted linear regression model was significant (Adjusted R2 = 0.648, F (7, 2872)=757, p<0.001 ). Higher locality-based emergency department attendance rates were significantly predicted by each increasing decile of deprivation (β =14.8, p=0.002), each minute less of travel time to the emergency department (β = 7.86, p<0.001) and each percent greater proportion of low acuity attendances (β = 8.61, p<0.001).A large proportion of the variability in emergency department attendance rates in different geographical areas can be explained by deprivation levels and proportion of non-urgent attendances. This provides an opportunity for targeted interventions to reduce emergency department attendances.
1358 The association between major trauma centre care and outcomes of adult patients injured by low falls in England and Wales
Authors: Tonkins Michael , Bouamra Omar , Lecky Fiona 
Published: December 2022

Aims, Objectives and BackgroundDisability and death due to low falls is increasing worldwide and disproportionately affects older adults. Current trauma systems were not designed to suit the needs of these patients. This study assessed the effectiveness of major trauma centre care in adult patients injured by low falls.Method and DesignData were obtained from the Trauma Audit and Research Network on adult (age >16 years) patients injured by falls from <2 metres between 2017–2019 in England and Wales. Binary logistic regression and Cox Regression were used to control for casemix. 30-day survival, length of hospital stay and discharge destination were compared between major trauma centres (MTCs) and trauma units or local emergency hospitals (TU/LEHs).Results and Conclusion127,334 patients were included of whom 27.6% attended an MTC. The median age was 79.4 years (IQR 64.5–87.2 years), and 74.2% of patients were aged >65 years. MTC care was not associated with improved 30-day survival (adjusted odds ratio [AOR] 0.91, 95% CI 0.87–0.96). Transferred patients had a significant impact upon the results. After excluding transferred patients, the AOR for survival in MTCs was 1.056 (95% CI 1.001–1.113). The association between improved survival and MTC care was greatest in patients who suffered major trauma (AOR 1.126, 95% CI 1.044–1.215) and was absent in patients aged >65 (AOR 1.038, 95% CI 0.982–1.097).TU/LEH care is at least as effective as MTC care due to the facility for secondary transfer from TU/LEHs to MTCs. In patients who are not transferred, MTCs are associated with greater odds of 30-day survival in the whole cohort and in the most severely injured patients. Future research must determine the optimum means of identifying patients in need of higher-level care, the components of care which improve patient outcomes, and develop patient-focused outcomes which reflect the characteristics and priorities of contemporary trauma patients.
1338 The babies kept coming and coming – Emergency department infant attendances from 2019–2021. A nation-wide electronic health records study
Authors: Aldridge Patrick , Wyatt Steve , Ross Samantha , Narayanan Sankara , Zuccolo Luisa 
Published: December 2022

Aims, Objectives and BackgroundIn 2020 limited evidence suggested increased emergency department (ED) attendances for infants in England, associated with feeding problems. We examined the frequency and distribution of infant feeding-related attendances (IFA) at EDs before and during the SARS-CoV2 pandemic.Method and DesignAll attendances at 48 major EDs (England) in two 50-week periods before and during the COVID-19 pandemic: period 1, 2 April 2019 to 10 March 2020 and period 2, 1 April 2020 to 10 March 2021. Anonymised datasets were obtained from the National Commissioning Data Repository across all age groups, with an infant defined as <1year.We estimated the change in frequency of ED presentations by age group and diagnosis before and after the SARS-CoV2 pandemic began in England. We compared changes in the frequency of attendances of IFP by infant age, sex, ethnicity, deprivation, rurality, arrival mode, arrival time, acuity, mother’s age, gravidity and mental health, birth length of stay, attendance duration and disposal (admission or discharge). IFA was classified as feeding problems, neonatal jaundice and gastro-oesophageal reflux.Abstract 1338 Figure 1Results and ConclusionWhilst total ED attendances fell by 16.7% (95% CI -16.8% to -16.6%), infant attendances increased for feeding problems (+7.5% 95% CI 2.3% to 13.0%), neonatal jaundice (+12.8%, 95% CI 3.3% to 23.3%) and gastro-oesophageal reflux (+9.7%, 95% CI 4.4% to 15.2%). These increases were more pronounced amongst first babies (+22.4%, 95% CI 13.1% to 32.5%) and brief hospital stay after birth (0–1 days, +20.1%, 95% CI 14.8% to 25.7%). Our analysis suggests many of these attendances were low acuity. Taken together, IFA presentations (figure 1) increased by 8.9% (95% CI 5.4% to 12.5%) in 2020–21.ED attendances reduced dramatically and systematically with the COVID-19 pandemic, but infant feeding-related attendances increased. This implies growth in the unmet needs of infants and identifies future target groups for health policy.
1396 Prednisolone for Bell’s Palsy in children: A randomised, double-blind, placebo-controlled, Multicentre Trial
Authors: Babl Franz , Herd David , Borland Meredith , Kochar Amit , Lawton Ben , Hort Jason , West Adam , George Shane , Zhang Michael , Velusamy Karthik , Dalziel Stuart 
Published: December 2022

Aims, Objectives and BackgroundCorticosteroids can be used to treat idiopathic facial paralysis (Bell’s palsy) in children, but their effectiveness is uncertain.AimsTo determine if prednisolone improves recovery of children with Bell’s palsy at one month.Method and DesignDouble-blind, placebo-controlled, randomised, trial of prednisolone in children presenting to ED with Bell’s palsy.1Patients 6 months to <18 years, recruited <72 hours after symptom onset, were randomly assigned to receive 10 days of treatment with oral prednisolone (1 mg/kg) or placebo. The primary outcome: complete recovery of facial function at 1 month on the House-Brackmann scale.2Secondary outcomes: facial function, adverse events and pain to 6 months.Results and ConclusionBetween October 2015 to August 2020, 187 children were randomised (94 to prednisolone and 93 to placebo) and included in the intention-to-treat analysis. At 1 month, the proportions of patients who had recovered facial function were 49% (n=43/87) in the prednisolone group compared with 57% (n=50/87) in the placebo group (risk difference -8.1%, 95% CI -22.8 to 6.7; adjusted odds ratio [aOR] 0.7, 95% CI 0.4 to 1.3). At 6 months these proportion were 99% (n=77/78) for prednisolone and 93% (n=76/82) for placebo respectively (risk difference 6.0%, 95% CI -0.1 to 12.2; aOR 3.0 95% CI 0.5 to 17.7) (figure 1). There were no serious adverse events and little evidence for group differences in secondary outcomes.Abstract 1396 Figure 1In children with Bell’s palsy the vast majority recover without treatment. The study does not provide evidence that early treatment with prednisolone improves complete recovery.ReferencesSullivan F, Swan I, Donna P, Morrison J, Smith B, McKinstry B,et al. Early treatment with prednisolone or acyclovir in bell’s palsy.N Eng J Med2007;357(16):1598–607.House JW, Brackmann DE. Facial nerve grading system.Otolaryngol Head Neck Surg. 1985;93(2):146–7.
Facing Our Ancestors
Authors: Hochadel Oliver 
Published: December 2022

Abstract
Paleoartists reconstruct hominids for museums, popular science magazines and other media as three-dimensional sculptures or two-dimensional images. This paper describes the practices and the self-understanding of half a dozen paleoartists, in part based on interviews. It will ask the following questions: How does one become a paleoartist, what skills and what knowledge are required? How are reconstructions of Australopithecines and Neanderthals actually manufactured? How do paleoartists deal with the notorious gaps in the fossil record? The claim for scientific rigor, the artist’s quest for creativity and the market forces, demanding visually attractive representations of early humans, are in constant tension. The paper analyses how paleoartists, paleoanthropologists (advisors) and museum curators (sponsors) interact and negotiate contested issues. It will argue that these reconstructions of hominids shape not only the perception of our ancestors of the general public but also influence the knowledge production of the human origin researchers themselves.
Iron Induces Resistance Against the Rice Blast Fungus Magnaporthe oryzae Through Potentiation of Immune Responses
Authors: Sánchez-Sanuy Ferran , Mateluna-Cuadra Roberto , Tomita Keisuke , Okada Kazunori , Sacchi Gian Attilio , Campo Sonia , San Segundo Blanca 
Published: December 2022

AbstractIron is an essential nutrient required for plant growth and development. The availability of iron might also influence disease resistance in plants. However, the molecular mechanisms involved in the plant response to iron availability and immunity have been investigated separately from each other. In this work, we found that exposure of rice plants to high iron enhances resistance to infection by the fungal pathogenMagnaporthe oryzae, the causal agent of blast disease. RNA-Seq analysis revealed that blast resistance in iron-treated rice plants was associated with superinduction of defense-related genes during pathogen infection, includingPathogenesis-Relatedgenes. The expression level of genes involved in the biosynthesis of phytoalexins, both diterpene phytoalexins and the flavonoid phytoalexin sakuranetin, was also higher in iron-treated plants compared with control plants, which correlated well with increased levels of phytoalexins in these plants duringM. oryzaeinfection. Upon pathogen infection, lipid peroxidation was also higher in iron-treated plants compared with non-treated plants. We also show thatM. oryzaeinfection modulates the expression of genes that play a pivotal role in the maintenance of iron homeostasis. Histochemical analysis ofM. oryzae-infected leaves revealed colocalization of iron and reactive oxygen species in cells located in the vicinity of fungal penetration sites (e.g. appressoria) in rice plants that have been exposed to iron. Together these findings support that ferroptosis plays a role in the response of iron-treated rice plants to infection by virulentM. oryzae.Understanding interconnected regulations between iron signaling and immune signaling in rice holds great potential for developing novel strategies to improve blast resistance in rice.
Lateral dorsal infundibular approach: an alternative option for the safe completion of difficult laparoscopic cholecystectomy
Authors: Song Juxian , Chen Jian , Zheng Shuguo 
Published: December 2022

Abstract
Background
Difficult laparoscopic cholecystectomy (LC) due to acute cholecystitis (AC) increases the risk of bile duct injuries and postoperative complications. Here, we added the lateral dorsal infundibular approach as an initial surgical maneuver during LC to improve outcomes.

Methods
We describe the detailed technical procedure of the lateral dorsal infundibular approach in patients with AC resulting in difficult LC. This technique was developed after nearly 10 years of experience in laparoscopic surgery, and has been routinely used in the past 5 years. We also retrospectively analyzed the perioperative data for 469 patients with difficult LC.

Results
A total of 469 patients with AC received difficult LC between July 2016 and June 2021, of which 438 (93.4%) performed a lateral dorsal infundibular approach. Sixty-four patients (13.6%) had variations of the hepatic bile duct and cystic duct according to preoperative magnetic resonance cholangiopancreatography, 438 patients (93.4%) received elective surgery, 31 (6.6%) received emergency surgery, and 10 (2.1%) underwent conversion. There was no postoperative bile leaks and no bile duct injuries in the described technique.

Conclusion
During difficult LC, the critical view of safety can be gradually achieved by changing the surgical approach to achieve cholecystectomy.
Novel compound heterozygous mutations of MTHFR Gene in a Chinese family with homocystinuria due to MTHFR deficiency
Authors: Lu Yitong , Zhao Shaozhi , He Xiaohui , Yang Hua , Wang Xiaolei , Miao Chen , Liu Hongwei , Zhang Xinwen 
Published: December 2022

Abstract
Background
Homocystinuria due to methylenetetrahydrofolate reductase (MTHFR) deficiency is a rare autosomal recessive disorder. The purpose of this study is to expand the mutation site of the MTHFR gene and provide genetic counseling for this family.

Methods
A couple came to our hospital for pre-pregnancy genetic counseling. We collected the family history and detailed clinical information, then performed whole-exome sequencing, and analyzed the pathogenicity of the candidate mutations.

Results
We found that the father of the proband had homocystinuria, the proband and his brother had low blood methionine levels at birth, and the brain MRI showed brain dysplasia. The third fetus was found to have a broadened triangle of the bilateral ventricle at 19 weeks of pregnancy. The compound heterozygous variants of c.602 A > C (p.His201Pro) and c.1316T > C (p.Leu439Pro) of the MTHFR gene in the first three fetuses were found by whole-exome sequencing. The heterozygous c.602 A > C variant of the MTHFR gene is a novel missense variant that has been submitted to the ClinVar with Variation ID 992,662.

Conclusion
In consideration of the clinical phenotype, family history, and result of genetic testing, we speculated that both patients may have homocystinuria due to MTHFR deficiency. Homocystinuria due to MTHFR deficiency caused by compound heterozygous mutations composed of the MTHFR gene in this family may be associated with cerebral atrophy and cerebral dysplasia. The novel compound heterozygous mutations broaden the mutation spectrum of the MTHFR gene and enhance the application of genetic counseling and carrier screening in rare diseases.