bluuebunny/crossref_metadata_2025_split huggingface dataset:
Graft–host coupling changes can lead to engraftment arrhythmia: a computational study
Authors: Gibbs Chelsea E. , Marchianó Silvia , Zhang Kelly , Yang Xiulan , Murry Charles E. , Boyle Patrick M. 
Published: April 2023

AbstractAfter myocardial infarction (MI), a significant portion of heart muscle is replaced with scar tissue, progressively leading to heart failure. Human pluripotent stem cell‐derived cardiomyocytes (hPSC‐CM) offer a promising option for improving cardiac function after MI. However, hPSC‐CM transplantation can lead to engraftment arrhythmia (EA). EA is a transient phenomenon arising shortly after transplantation then spontaneously resolving after a few weeks. The underlying mechanism of EA is unknown. We hypothesize that EA may be explained partially by time‐varying, spatially heterogeneous, graft–host electrical coupling. Here, we created computational slice models derived from histological images that reflect different configuration of grafts in the infarcted ventricle. We ran simulations with varying degrees of connection imposed upon the graft–host perimeter to assess how heterogeneous electrical coupling affected EA with non‐conductive scar, slow‐conducting scar and scar replaced by host myocardium. We also quantified the effect of variation in intrinsic graft conductivity. Susceptibility to EA initially increased and subsequently decreased with increasing graft–host coupling, suggesting the waxing and waning of EA is regulated by progressive increases in graft–host coupling. Different spatial distributions of graft, host and scar yielded markedly different susceptibility curves. Computationally replacing non‐conductive scar with host myocardium or slow‐conducting scar, and increasing intrinsic graft conductivity both demonstrated potential means to blunt EA vulnerability. These data show how graft location, especially relative to scar, along with its dynamic electrical coupling to host, can influence EA burden; moreover, they offer a rational base for further studies aimed to define the optimal delivery of hPSC‐CM injection.
imageKey points
Human pluripotent stem cell‐derived cardiomyocytes (hPSC‐CM) hold great cardiac regenerative potential but can also cause engraftment arrhythmias (EA).
Spatiotemporal evolution in the pattern of electrical coupling between injected hPSC‐CMs and surrounding host myocardium may explain the dynamics of EA observed in large animal models.
We conducted simulations in histology‐derived 2D slice computational models to assess the effects of heterogeneous graft–host electrical coupling on EA propensity, with or without scar tissue.
Our findings suggest spatiotemporally heterogeneous graft–host coupling can create an electrophysiological milieu that favours graft‐initiated host excitation, a surrogate metric of EA susceptibility. Removing scar from our models reduced but did not abolish the propensity for this phenomenon. Conversely, reduced intra‐graft electrical connectedness increased the incidence of graft‐initiated host excitation.
The computational framework created for this study can be used to generate new hypotheses, targeted delivery of hPSC‐CMs.
Acute exercise increases the contact between lipid droplets and mitochondria independently of obesity and type 2 diabetes
Authors: de Almeida Martin Eisemann , Ørtenblad Niels , Petersen Maria Houborg , Schjerning Ann‐Sofie Nybøle , Wentorf Emil Kleis , Jensen Kurt , Højlund Kurt , Nielsen Joachim 
Published: April 2023

AbstractIntramuscular lipid droplets (LDs) and mitochondria are essential organelles in cellular communication and metabolism, supporting local energy demands during muscle contractions. While insulin resistance impacts cellular functions and systems within the skeletal muscle, it remains unclear whether the interaction of LDs and mitochondria is affected by exercise and the role of obesity and type 2 diabetes. By employing transmission electron microscopy (TEM), we aimed to investigate the effects of 1 h of ergometry cycling on LD morphology, subcellular distribution and mitochondrial contact in skeletal muscle fibres of patients with type 2 diabetes and glucose‐tolerant lean and obese controls, matched for equal exercise intensities. Exercise did not change LD volumetric density, numerical density, profile size or subcellular distribution. However, evaluated as the magnitude of inter‐organelle contact, exercise increased the contact between LDs and mitochondria with no differences between the three groups. This effect was most profound in the subsarcolemmal space of type 1 muscle fibres, and here the absolute contact length increased on average from ∼275 to ∼420 nm. Furthermore, the absolute contact length before exercise (ranging from ∼140 to ∼430 nm) was positively associated with the fat oxidation rate during exercise. In conclusion, we showed that acute exercise did not mediate changes in the LD volume fractions, numbers or size but increased the contact between LDs and mitochondria, irrespective of obesity or type 2 diabetes. These data suggest that the increased LD–mitochondria contact with exercise is not disturbed in obesity or type 2 diabetes.
imageKey points
Type 2 diabetes is associated with altered interactivity between lipid droplets (LDs) and mitochondria in the skeletal muscle.
Physical contact between the surface of LDs and the surrounding mitochondrial network is considered favourable for fat oxidation.
We show that 1 h of acute exercise increases the length of contact between LDs and mitochondria, irrespective of obesity or type 2 diabetes.
This contact length between LDs and mitochondria is not associated with a net decrease in the LD volumetric density after the acute exercise. However, it correlates with the fat oxidation rate during exercise.
Our data establish that exercise mediates contact between LDs and the mitochondrial network and that this effect is not impaired in individuals with type 2 diabetes or obesity.
Homozygous mild beta-thalassaemia promoter transversion −71 C>T HBB:c.-121 C>T
Authors: Hassan Suha Mustafa , Alrawas Abdulhakim , Al Khanbashi Laila , Wali Yasser 
Published: April 2023

Beta-thalassaemia is one of the most common genetic disorders worldwide, which is caused by absent or decreased synthesis of beta-globin chain subunits. Beta-thalassaemias are diverse groups of disease with a wide spectrum of clinical phenotypes. The clinical phenotypes can include asymptomatic forms of beta-thalassaemia minor, intermediate and severe transfusion dependent beta-thalassaemia major. Clinical severity varies depending on the underlying β globin gene mutation. There are a number of mild β-thalassaemia gene defects that could be referred as a ‘silent carrier’. Identifying the underlying molecular defect is essential to predict phenotype severity for optimal management, tailored treatment and improved quality of life.We report the first identification of a homozygous point mutation located within the promoter region of the β‐globin gene at position −71 (C>T). The patient was a female child, who was referred to our clinic after she was found to have hypochromic microcytic anaemia with low haemoglobin (Hb) (67 g/L) and an Hb A2level at the upper limit of the normal value (3.7%). This observation is a new example of homozygous mild β-thalassaemia with a borderline Hb A2level, and illustrates a potential source of pitfall in the diagnosis of β-thalassaemia disease.
Factors affecting physicians’ attitudes towards patient-centred care: a cross-sectional survey in Beijing
Authors: Liang Haiying , Reiss Michael J , Isaacs Talia 
Published: April 2023

ObjectivesPatient-centred care has been raised as an important component in providing high-quality healthcare services. This research aims to measure physicians’ attitudes towards patient-centred care in Chinese healthcare settings and to identify the sociodemographic predictors of their attitudes using an exploratory research design.DesignA cross-sectional survey.SettingTwelve hospitals in Beijing, China.Participants1290 physicians from 12 hospitals in Beijing were invited to take part in the survey using snowball sampling methods. There was a response rate of 84% (n=1084), of which 1053 responses (82%) were valid and included in this research.MethodsThis research used a survey containing a previously validated 6-point Likert scale called ‘Chinese-revised Patient-Practitioner Orientation Scale’ (CR-PPOS). Descriptive statistics and multivariable logistic regression analyses were performed to measure participants’ attitudes and to identify the sociodemographic predictors of Chinese physicians’ attitudes towards patient-centred care.ResultsGender, professional title (ie, seniority) and hospital type influence Chinese physicians’ attitudes towards patient-centred care. Female physicians, physicians with intermediate titles and those who work in tertiary (ie, top-level) hospitals tend to have higher patient-centred attitudes (OR=1.532, 95% CI 1.160 to 2.022; OR=2.089, 95% CI 1.206 to 3.618; OR=2.198, 95% CI 1.465 to 3.297) than male physicians with other titles, and than those who work in first, secondary or private hospitals. Physicians working in non-surgical departments, those who have received training in doctor–patient communication, and those who are satisfied with their income obtained high patient-centred scores, both on the overall CR-PPOS and its two subscales.ConclusionsThis research identified sociodemographic predictors of Chinese physicians’ attitudes towards patient-centred care. The findings contribute to knowledge of factors to be considered in reforming medical education and the Chinese healthcare system to improve physician–patient relationships and provide high-quality healthcare to patients. However, these findings are exploratory in nature and require further investigation to establish their validity and generalisability.
Elderly man with mandibular pain
Authors: Lee Kevin C , Ferguson Bridget M 
Published: April 2023

Clinical introductionA 77-year-old man presented to the ED with a history of fevers, purulent drainage and right mandibular pain. He had been diagnosed with multiple myeloma 2 years previously and was receiving treatment with pamidronate. On presentation, the lower right lip and chin were anaesthetic, tooth number 31 had grade 2 mobility and a 15 mm long ulceration was present on the lingual aspect of the mandible (figure 1). Antibiotics were administered, and a maxillofacial CT without contrast was performed (figure 2).Figure 1Clinical examination revealing a 15 mm long ulceration (arrow mark) associated with the lingual aspect of tooth number 31.Figure 2CT maxillofacial (coronal) demonstrating osseous destruction (arrow mark) of the right mandibular body.QuestionWhat is your diagnosis?Odontogenic abscessBenign fibro-osseous lesionMedication-related osteonecrosis of the jaw (MRONJ)Metastatic malignancy
Paediatric shoulder injury: don’t get sucked in!
Authors: Kilgour Peter Michael , Watson Lesley , Williams Marc 
Published: April 2023

Clinical introductionA healthy 8-year-old boy presented to the ED with acute left shoulder pain. He had been playing football and his left arm was pulled by an opposition team member. He fell to the ground and landed on his left shoulder causing pain. On examination after analgesia, active and passive movement of the shoulder joint was possible in all directions but range of motion was limited by pain. There was no visible swelling or bruising throughout the shoulder girdle. A radiograph of the shoulder was obtained (figure 1).Figure 1Plain radiograph of the left shoulder.QuestionWhat radiographic finding is seen for this patient?Glenohumeral lipohaemarthrosis.Acromioclavicular joint disruption.Intra-articular gas.Intra-articular loose body.
001 Can we make the emergency department handover safer?
Authors: Tan Yok , Mansell Holly , Evans Josie , Kanani Anand , Stanhope Benjamin 
Published: April 2023

BackgroundHandover of care is one of the most perilous procedures in medicine.1The unique shift-based work in the ED, where there is a high degree of patient turnover, unpredictability and patient volume can create challenges to good quality clinician and nursing handover.The above highlights a need for an improved and standardised patient bedside handover tool for both clinicians and nurses involving and empowering patients and families. Both handover tools will cement safe continuity of information between shift changes and improved communication with patients and families.Method and resultsA standard operating procedure, flowchart and clinician’s handover tool was designed to maximise safe handover as illustrated in figure 1. The tool has been introduced into the department since June 2017. After the introduction of the tool, an evaluation survey of 30 participants across various grades of clinicians was performed.Abstract 001 Figure 1Clinicians handover toolBuilding on the success of the clinician’s handover tool; a standard operating procedure, flowchart and the first standardised nurse’s handover tool was designed as illustrated in figure 2.Abstract 001 Figure 2Nurses handover toolConclusionsFor the month of September 2017, 30 completed surveys evaluating the clinician’s handover tool was collected. 100% positive responses were received stating they found it useful. The handing over clinicians commented feeling more satisfied that ‘their patient was appropriately and safely handed over at the bed side in front of the family’.The nurse’s handover over tool was praised as nurses felt ‘happier’ with handover and more satisfied to leave shift ‘without forgetting significant patient information’.Both tools have become routine practice within the ED and are very useful adjuncts to improve patient safety within the department.Multidisciplinary handover post-shift work at the bedside has become standardised practice and improved patient safety with continuity of care with these tools. Regular ongoing audit have demonstrated that the tools are routinely used by both clinicians and nurses.ReferenceBritish Medical Association. Safe handover: safe patients. Guidance on clinical handover for clinicans and managers. London: BMA, 2004.
013 Paramedic HEART scores in the prediction of MACE and AMI. The ambulance cardiac chest pain evaluation in scotland (ACCESS) study
Authors: Cooper Jamie , Ferguson James , Donaldson Lorna , Black Kim , Davidson Elaine , Horrill Judith , Livock Kate , Lee Kuan Ken , Anand Atul , Mills Nicholas , Scott Neil 
Published: April 2023

BackgroundCardiac sounding chest pain represents about 5% of all Emergency Department (ED) attendances in the United Kingdom (UK), often via 999 ambulance.Much work has focused on the rapid distinction of the 1 in 5 patients without ST elevation on ECG, who are suffering from a non ST elevation myocardial infarction (NSTEMI). Pre-hospital translation of such work may allow improved access to specialist treatment for patients with NSTEMI and also identify a low risk population suitable for management without immediate ambulance transfer to hospital.The objective was to determine the accuracy of a wholly paramedic calculated pre-hospital HEART score to predict a 30-day Major Adverse Cardiac Event (MACE). The potential implications of pre-specified low-risk and high-risk cut offs were also to be determined.Method and resultsProspective diagnostic accuracy study in Northeast Scotland (UK) on adult (>18 yr) patients with cardiac sounding chest pain, attended by a paramedic ambulance and who had no ST elevation on initial ECG.A real time paramedic HEAR score was calculated and blood drawn for analysis with a POC cTn assay and later with both laboratory based contemporary and high-sensitivity cTn assays. Normal care then ensued and patients were followed up to 30 days for development of MACE.ConclusionsBetween Nov 2014 and April 2018, 1275 patients agreed to participate in the ambulance and 1056 later gave informed consent with 1054 completing 30 day follow up.358 patients had complete Paramedic HEART scores with all 3 assays and 969 patients with the 2 lab based assays (figure 1)Abstract 013 Figure 1Patient flow diagramSensitivities and specificities (95% CI) for the HEART scores vs MACE will be calculated and ROC curves generated. Diagnostic properties at different score cut-offs will be presented and analysis of the impact of the different cTnI assays presented.Apologies: Independent AMI adjudication due to complete next week, so no full results yet.
015 ‘I actually only come to work for the banter’: a qualitative study into contributors to emergency department care providers’ transitory emotional state
Authors: Roy Susie , Jaap Alan , Skinner Janet 
Published: April 2023

BackgroundOur affective (emotional) state has far reaching and well recognised implications relating to well-being, team-work and patient safety. The aim of this novel study was to gain an in depth understanding of factors that influence the transitory emotions of Emergency Department (ED) care providers whilst at work.Method and resultsUsing a pragmatist theoretical lens, a qualitative methodology was selected to explore staff members’ experiences of factors generating positive and negative emotions. Focus groups were facilitated with ED staff from a major acute teaching hospital in Scotland. Purposive sampling was used to recruit participants, with each group containing members of the same or similar grade and occupation. Consultant, higher specialty trainee, junior doctor and nursing focus groups were undertaken. Following transcription, data were coded and thematically analysed to arrive at key concepts.Abstract 015 Table 1Themes and representative quotesAbstract 015 Figure 1Where care provider emotion can impactConclusionsSix main themes were identified: ‘ ED team rapport’ referring to the personalities and attitudes of those working that day; ‘achievement’ with successful task completion, skill use, being thanked and constructive educational opportunities generating positive emotions and lack of this feeling generating the converse; ‘interpersonal interactions’ where the negative impact of incivility from staff or patients was highlighted; ‘equipment/infrastructure’ showcasing how frustration manifests when either fails; ‘the open and the close’ representing the impact of how the tone set in handover influences affect and finally, the self-explanatory ‘a bad day outside work can influence that inside.’This study illustrates the importance of recognising personal ‘wins’ whether that be a well-managed patient or successfully recognised teaching opportunity. It adds impetus to the campaign against incivility - reaffirming the negative effect rudeness has on affect. On a personal level, it highlights that we can take responsibility to ‘choose our own weather’ as a team member or leader in being a colleague that others enjoy working with. This may improve outcomes for all.
019 Club 18–40: why do young adults attend the emergency department? M
Authors: Muz Ahmad S , Davidson Craig 
Published: April 2023

BackgroundCrowding in the Emergency Department (ED) continues to be a challenge across the country. Recent focus has been on the increasingly complex elderly patients. However, data from the Royal Infirmary of Edinburgh (RIE) shows that over the last 10 years, attendances in young adults have doubled, whereas those in over-65s have increased by just 16%. Studies show that patients aged 18–40 are least likely to attend their GP; perhaps they see the ED as a convenient one-stop shop for 24-hour access to care. Until now, literature exploring their motivations to attend the ED has been sparse, often limited to establishing characteristics of a frequent user.Method and resultsThis project investigated the reasons for attendance to the ED in young adults aged 18–40 and their opinions of the emergency services at the RIE. A survey was conducted for three weeks where 131 patients were recruited at check-in, the waiting room and within department cubicles.Questions were based around recurrent themes of previous literature, which discussed the ideas of the ED being a convenient system to acquire medical attention at any time of day. Patients were asked about their reasons for attendance and to rate on a Likert scale a series of statements about the ED.ConclusionsOur findings show that patients aged 18–40 in fact, did not consider the ED more convenient in terms of time or location than their GP, nor did they think the ED provides better care.However once they considered their problem as urgent they did not perceive primary care as being able to accommodate this urgency. Patients therefore present to the ED as the only other option. Understanding this perspective provides potential targets for intervention, allowing patients to be seen by the right person, in the right setting, the first time.
025 Hospital interventions to improve patient flow: emergency department outcomes of an action research study
Authors: Sethi Simon , Boulind Caroline , Bruijns Stevan 
Published: April 2023

BackgroundThe Royal College of Emergency Medicine has highlighted reduced patient flow through the hospital system as a major challenge to improving emergency department flow. We describe the impact of a hospital-wide flow intervention on Yeovil District Hospital emergency department’s clinical quality indicators, in order to demonstrate the value of a whole-system approach to curb access block.Method and resultsWe followed up on an action research study that identified and intervened on several areas within the hospital that were disproportionally contributing to access block during 2016. Using a retrospective, cross-sectional design, we described the effect of the interventions on the Royal College of Emergency Medicine’s clinical quality indicators (four-hour standard, time to decision maker, seven-day unplanned re-attendance, left without being seen, ambulatory patient care and patient experience) between January 2014 and October 2018. Pearson correlation coefficient (r) was used to compare variables and linear regression was used to describe the contribution of interventions to the change in four-hour standard.Abstract 025 Figure 1ED attendance YDH vs nationalAbstract 025 Figure 2Four hour performance YDH vs nationalAbstract 025 Figure 3Time to doctor and triageConclusionsYeovil District Hospital emergency department was attended by 233,378 patients over the study period. Mean monthly attendance was 4,029 (±341) patients), mean age was 43 (±28) years and there was an equal male/female split (49/51%). The four-hour standard makes a gradual and consistent recovery from under 95% to over 95% that is not reflected in national data (r=0.09). This is despite a rising trend in emergency department attendances both for Yeovil and nationally (r=0.75). Other clinical quality indicators (except seven-day unplanned re-attendance) improved significantly. The overall regression model fit was R2=0.81; three interventions contributed significantly and a further two contributed non-significantly).The impact on clinical quality indicators reveals the significant effect of a hospital-wide flow intervention that targeted multiple causes of access block. Further research should include qualitative research to understand the facilitators and barriers to flow improvement work in emergency departments.