A proposed Diagnostic AI System for Robot-Assisted Triage ("DAISY") is under development to support Emergency Department ("ED") triage following increasing reports of overcrowding and shortage of staff in ED care experienced within National Health Service, England ("NHS") but also globally. DAISY aims to reduce ED patient wait times and medical practitioner overload. The objective of this study was to explore NHS health practitioners' perspectives and attitudes towards the future use of AI-supported technologies in ED triage. Between July and August 2022 a qualitative-exploratory research study was conducted to collect and capture the perceptions and attitudes of nine NHS healthcare practitioners to better understand the challenges and benefits of a DAISY deployment. The study was based on a thematic analysis of semi-structured interviews. The study involved qualitative data analysis of the interviewees' responses. Audio-recordings were transcribed verbatim, and notes included into data documents. The transcripts were coded line-by-line, and data were organised into themes and sub-themes. Both inductive and deductive approaches to thematic analysis were used to analyse such data. Based on a qualitative analysis of coded interviews with the practitioners, responses were categorised into broad main thematic-types, namely: trust; current practice; social, legal, ethical, and cultural concerns; and empathetic practice. Sub-themes were identified for each main theme. Further quantitative analyses explored the vocabulary and sentiments of the participants when talking generally about NHS ED practices compared to discussing DAISY. Limitations include a small sample size and the requirement that research participants imagine a prototype AI-supported system still under development. The expectation is that such a system would work alongside the practitioner. Findings can be generalisable to other healthcare AI-supported systems and to other domains. This study highlights the benefits and challenges for an AI-supported triage healthcare solution. The study shows that most NHS ED practitioners interviewed were positive about such adoption. Benefits cited were a reduction in patient wait times in the ED, assistance in the streamlining of the triage process, support in calling for appropriate diagnostics and for further patient examination, and identification of those very unwell and requiring more immediate and urgent attention. Words used to describe the system were that DAISY is a "good idea", "help", helpful, "easier", "value", and "accurate". Our study demonstrates that trust in the system is a significant driver of use and a potential barrier to adoption. Participants emphasised social, legal, ethical, and cultural considerations and barriers to DAISY adoption and the importance of empathy and non-verbal cues in patient interactions. Findings demonstrate how DAISY might support and augment human medical performance in ED care, and provide an understanding of attitudinal barriers and considerations for the development and implementation of future triage AI-supported systems.

Abstract Objective To compare neurodevelopmental outcomes at 18–24 months corrected age (CA) for preterm infants who had hemoglobin levels < 120 gm/l versus those with hemoglobin level ≥ 120 gm/l at birth.Methods We included infants of ≤ 28 weeks gestational age (GA) born between January 2009 and June 2018. The primary outcome was neurodevelopmental impairment (NDI) at 18–24 months. Multivariable logistic regression was applied to determine the association.Results Of the 2351 eligible neonates, 351 (14.9%) had hemoglobin levels < 120 gm/L at birth. Of the 2113 surviving infants, 1534 (72.5%) underwent developmental follow-up at 18 to 24 months CA. There was no statistically significant difference in ND outcomes between the two groups. The composite outcome of death or NDI was significantly higher in the low hemoglobin group.Conclusion In preterm infants ≤ 28 weeks GA, initial hemoglobin < 120 gm/L at birth was not associated with neurodevelopmental impairment at 18–24 months CA among survivors.

IntroductionThis study examines mothers' complementary feeding (CF) knowledge and practices for children aged 6–24 months, highlighting links to adverse health outcomes and childhood malnutrition from both delayed and early CF initiation (before six months). MethodsA community-based cross-sectional study collected data from 422 mothers through multistage sampling. A pre-tested structured questionnaire was used and analyzed with SPSS software version 20.0, employing descriptive and inferential statistics. Chi-square tests assessed associations at a 95 % confidence interval, with a P < 0.05 signifying statistical significance. ResultsApproximately 66.8 % of mothers initiated breastfeeding within an hour after childbirth, with 71.1 % knowledgeable about 'breastfeeding and hand washing' prior to breastfeeding. Around 64.5 % introduced liquids, and 58.8 % gave semi-solid food to their children before six months. About 41.9 % initiated CF at the recommended age. Associations were observed between maternal education and knowledge of dietary diversification. The study also found a connection between CF-related information and timely CF initiation. ConclusionsInsufficient knowledge of infant and child feeding practices necessitates nutritional education for mothers through effective communication packages to promote proper feeding practices.

Plant growth and greening in response to light require the synthesis of photosynthetic pigments such as chlorophylls and carotenoids, which are derived from isoprenoid precursors. In Arabidopsis, the pseudo-etiolated-in-light phenotype is caused by the overexpression of repressor of photosynthetic genes 2 (RPGE2), which regulates chlorophyll synthesis and photosynthetic genes. We investigated a homologous protein in the Russian dandelion (Taraxacum koksaghyz) to determine its influence on the rich isoprenoid network in this species, using a combination of in silico analysis, gene overexpression, transcriptomics and metabolic profiling. Homology-based screening revealed a gene designated pseudo-etiolated-in-light-like (TkPEL-like), and in silico analysis identified a light-responsive G-box element in its promoter. TkPEL-like overexpression in dandelion plants and other systems reduced the levels of chlorophylls and carotenoids, but this was ameliorated by the mutation of one or both conserved cysteine residues. Comparative transcriptomics in dandelions overexpressing TkPEL-like showed that genes responsible for the synthesis of isoprenoid precursors and chlorophyll were downregulated, probably explaining the observed pale green leaf phenotype. In contrast, genes responsible for carotenoid synthesis were upregulated, possibly in response to feedback signaling. The evaluation of additional differentially expressed genes revealed interactions between pathways. We propose that TkPEL-like negatively regulates chlorophyll- and photosynthesis-related genes in a light-dependent manner, which appears to be conserved across species. Our data will inform future studies addressing the regulation of leaf isoprenoid biosynthesis and photomorphogenesis and could be used in future breeding strategies to optimize selected plant isoprenoid profiles and generate suitable plant-based production platforms.

The North East and Yorkshire Liver Nurse Network (NEYLNN) was created in 2020 by a group of liver nurses in collaboration with a pharmaceutical company. Originally intended to plug the gaps of the lone Clinical Nurse Specialists (CNS) working in liver care; it quickly developed as a forum to facilitate the sharing of expertise, service development, professional support and ultimately improving care to a vulnerable patient group.Collaboration with Pharma enabled the identification of CNS’s within the locality. Covid-19 lockdowns dictated the use of online meetings; these lasted around 30 minutes and were held quarterly. Invites and topics for discussion were distributed via email, with links for those unable to attend to submit queries. Meetings provided an open forum to discuss issues such as service challenges, and offered a vital opportunity to celebrate achievements. The inaugural face-to-face meeting in Summer 2022 was a full day event attended by ~20 Hepatology CNS. Meetings continued bi-annually with the support of the initial Pharma team. Content is decided by the NEYLNN with a focus on aspects of liver care relevant to all. Presentations are provided by a variety of speakers, including members of the network, enabling a safe forum to gain experience in this way. Topics such as palliative care, day case paracentesis, community non-alcohol related liver disease (NAFLD) pathways, and a patient story were amongst those presented. Attendance by managers and matrons is encouraged to raise awareness of liver care and the struggles encountered with service delivery.Approximately 35 liver nurses have joined the network. In addition to attending face-to-face and online meetings, members are regularly in contact via email. The network provides the opportunity to discuss clinical and service issues, ideas for improvement, sharing practices and pathways to facilitate consistent and coordinated regional practices. The network is invaluable in its original concept for lone workers accessing peer support. Members report benefits including improved professional development, increased confidence and enhanced well-being. The network identified scientific writing and communication as a specific learning need; therefore, an additional result is the production of this abstract by a subgroup of the network.Networking is integral to nursing; supporting professional advancement, enabling the dissemination of expertise between peers, in addition to providing a supportive forum to share experiences. The benefits are widespread and vary between individuals. The NEYLNN hopes to inspire CNS networks in other regions, and therefore contribute to supporting liver nurses nationally.

Abstract Aims Deep Infiltrating Endometriosis (DIE) surgery is complex &amp; the interventions involving multi-specialties can be unpredictable. Frequently it depends on the extent of the bowel/bladder involvement. We aim to study the role of MRI in predicting such involvement &amp; in pre-operative multidisciplinary planning of DIE surgery. Methods All consecutive patients between Jan 2021 &amp; Dec 2022 who underwent MRI scan &amp; subsequent DIE surgery in an accredited endometriosis center were included. Correlation was studied especially with reference to the bowel/bladder involvement between MRI findings &amp; operative interventions. Results A total of 19 patients were included. Mean age of the patients was 41.83 years (range 27-55 years). Five out of 19 (26%) &amp; 2 of 19 (10%) patients showed measurable (length &amp; depth) endometrial deposits rather than adhesions/endometrial scarring on MRI in bowel (rectum &amp;/or sigmoid) &amp; bladder wall respectively. Two patients had anterior resection and primary anastomosis and 6 had either shaving or disc excision of the bowel wall. Both patients with bladder wall involvement required full thickness resection of bladder wall. The sensitivity, specificity and positive &amp; negative predictive values of MRI depicting the extent of bowel and bladder intervention were 71%, 90%, 90% &amp; 69% respectively. Conclusion MRI helps predict the extent of DIE surgery &amp; facilitates pre-operative planning of multi-specialty approach. Specific volume categorization of the measurable deposits may influence the nature of bowel/bladder surgery (resection vs shaving). A large scale multicenter prospective study would be useful for further evaluation.

Abstract Electronic advice and guidance (A&amp;G) was implemented in our trust in April 2016. Referrals to this service steadily increased with weekly requests up to 313 (average 261) in 2022. We noticed that, increasingly, requests were being sent from allied health professionals or junior medical staff often for quite rudimentary dermatology. A survey was constructed to understand who is using our service, their level of dermatology training, whether there is discussion prior to sending A&amp;G and to examine user satisfaction. A survey link comprising 16 questions was attached to A&amp;G replies within a 12-week period from October 2022. In total, 144 responses were received. Most responders were regular users of the service, with 20% sending over six requests a month. Of those responding, 94 were fully trained general practitioners (GPs), with the others a mix of junior doctors, nurses and allied health professionals. Only 27.8% of referrers had discussed the case within primary care prior to sending the request; this included one-third of non-GPs. Levels of formal dermatology training among requestors are low, with 10.4% stating they have no formal dermatology training and 35.4% having training only within primary care. Eighty-five per cent stated they would like more dermatology training. Our department has developed online management guidelines for use in primary care. While 75.7% of those responding were aware of these guidelines, only 30.3% looked at these prior to sending the A&amp;G request. Most requesters found the A&amp;G process very easy, and 99.3% felt they received a satisfactory A&amp;G response. Only 28.4% of requests were converted to a referral. Additional comments from the responders were universally positive with the service repeatedly described as ‘excellent’. We have created an easy-to-use, valued and quick service, but this creates extra work within secondary care if cases are not discussed locally before requesting specialist input. Many may not have been referred to secondary care prior to electronic A&amp;G being established. We will discuss the issues this presents and ways we can address this to ensure we are providing the optimal A&amp;G service for those who really need it.