bluuebunny/crossref_metadata_2025 huggingface dataset:
Profile of Vertebral Fracture Cases in the First Full Year of an ANP led Fracture Liaison Service
Authors: Steen Georgina , Fallon Nessa , Maher Niamh , O'Carroll Claire , Caraher Jennifer , Byrne Lisa , McCarroll Kevin , Lannon Rosaleen
Published: September 2024

Background

A specialist osteoporosis and bone health service was founded in 2003 in our institution. It see’s a range of patients from providing DXA alone to giving specialist opinion on complex cases. The Irish Fracture Liaison Service Database (FLS-DB) commenced in 2020 and aims to target those who’ve just fractured with the aim of reducing risk of further imminent fracture by screening for osteoporosis and initiating bone protection measures.

Methods

Cases of vertebral fracture screened by our FLS ANP were extracted from the FLS database. Case finding for vertebral fracture remains dependent on referral to the service.

Results

We screened 53 patients with vertebral fractures through our FLS in 2023. 64% female, 36% male. Median age 81 years; range 56-99 yrs. Of these 32 (60%) were inpatients with 2 inpatient falls. 17 (32%) were on osteoporosis treatment. We noted 25 (47%) with previous fragility fracture including 9 (17%) with previous vertebral fracture – just over half of these i.e. 5 patients were on bone protection treatment. After FLS assessment of those on treatment 10 were changed to denosumab, 2 to teriparatide, one continued oral bisphosphonate by choice, rest changed to IV zoledronic acid. Those newly started on treatment a range of PO and IV Bisphosphonate, teriparatide and denosumab was recommended depending on patient factors. One declined. All were prescribed vitamin D +/- calcium supplements.

Conclusion

The UK FLS-DB estimated that the number of ‘clinical’ vertebral fractures roughly equates to that of hip fractures, so this denominator has been used for the Irish FLS-DB. This would correlate with our service assessing 29% of expected clinical vertebral fractures in 2023. Appointment of a dedicated ANP for fracture liaison has streamlined bone health assessment for acute fractures attending our hospital. Further work on case finding needed to ensure we are assessing all patients at increased risk of further fracture.
Managing End of Life Needs of Frail, Older Adults in the Community: The Role of a Hospital-Based Community Outreach Team
Authors: Alcock Megan , Hayes Mary , O'Sullivan Catherine , O'Connor Kieran
Published: September 2024

Background

Our current healthcare systems are designed around periods of acute illness and are ill equipped to meet the needs of multimorbid and frail adults with worsening mobility, cognition and function. According to The Irish Longitudinal Study on Aging (TILDA), Ireland has a high proportion of hospital deaths, indicating inadequate community and home care supports. Recognizing patients who are likely to benefit from supportive and palliative approaches with a goal to die at home can be done using a combination of tools and based on advanced care planning discussions.

Methods

In 2021, our Department for Older Persons Services allocated a team consisting of a Registrar and Advanced Nurse Practitioner in Frailty to form an outreach service. Inpatients who appear nearing end of life who have expressed wishes to avoid further hospitalization and to die at home are identified during their admission. Home visits allow for a holistic assessment and family members are given the opportunity to ask questions. We provide education on end of life, trying to anticipate needs and often see patients and families through periods of deterioration until they stabilize again in a ‘new normal’ or begin the process of active dying. We communicate with Public Health Nurses, General Practitioners and the Community Palliative Care Team.

Results

Families and carers supporting loved ones who wish to avoid further hospitalization and die at home benefit from combined medical and nursing support & specialist expertise the team brings.

Conclusion

Addressing end of life for multimorbid patients living with severe frailty is a global challenge. Hospital admission is an ideal time to begin conversations regarding goals of care and initiate advanced care planning. The outreach team work together with hospital and community colleagues to the common goal of following patients’ wishes at end of life.
Vestibular Assessment In Patients With Self-Reported Dizziness And A History Of Falls
Authors: Merrick Catherine , Alexander Marie , O'Malley Tom
Published: September 2024

Background

World Falls Guidelines recommend that any patient with a history of falls and reporting dizziness should be screened for Benign Paroxysmal Positional Vertigo (BPPV) (Montero-Odasso et al.,2022). Diagnosing and treating BPPV in particular has been shown to reduce the incidence of falls in older adults, however, it is widely underdiagnosed (Li et al., 2023). This audit explored compliance with falls guidelines in a day hospital setting where falls work up assessments take place on older patients (75 years and older). It aimed to identify reasons why vestibular assessments may not have been undertaken and establish methods to improve compliance with the undertaking of vestibular assessments where indicated.

Methods

A retrospective chart was undertaken for patients who attended a day hospital service for older adults between January and April 2023. A Microsoft excel sheet was used to track data. All data was anonymised and stored on a password encrypted HSE networked drive accessed in the day hospital.

Results

A total of 97 charts were reviewed, with 31 patients reporting to have experienced dizziness with falls. For 33% of those patients (n=10), a vestibular screen was not carried out. For 7 out of 10 of these patients a screen was not carried out due to insufficient staff training in the area, with one patient not having been referred to physiotherapy, also secondary to insufficient staff training.

Conclusion

Facilitating adequate access to training in vestibular rehab for healthcare professionals is an essential part of ensuring BPPV and other vestibular disorders are diagnosed and treated in patients with self-reported dizziness and falls. Training as part of undergraduate degrees could be considered to ensure BPPV is diagnosed and treated in a timely manner. Additional staff training was provided in the day hospital setting in question and a re-audit of vestibular screening will take place in summer 2024.
An Evaluation Of Time To Review And Brain Imaging Of Inpatient Strokes: Are We Too Slow When Patients Are FAST?
Authors: Ryan Maeve , Yun John Paul , Adnan Muhammad , Thomas Niju , Moffatt Una , Hickey Paula , O'Malley Grainne
Published: September 2024

Background

Evidence shows that in-patient strokes are more difficult to recognise and treat, often leading to poorer outcomes. There is a recognised delay from symptom onset to stroke alert. 1 The most recent stroke guidelines recommend a time from recognition to imaging of <1hour for acute stroke.

Methods

We used the stroke database in our centre to identify our acute inpatient strokes over a one-year period from January 2023 to January 2024. The number of patients included was 9. We looked at time from first documented recognition of symptoms to medical review. We also looked at time from review to brain imaging. This information was collected using our database which records time-of-onset of symptoms and our local imaging system.

Results

Of the 9 patients identified 5 had symptoms recognised and documented by ward staff prior to medical review. The average time from recognition of symptoms to review was 2 hours and 26 mins. The shortest time to review was 35 mins and the longest was 8 hrs and 45 mins. For the remaining 4 patients, the first documentation of symptoms was the initial medical review. Three patients had initial brain imaging in under 1hour. One patient had brain imaging within 75 minutes. The remaining 5 patients waited between 5 and 7 hours for initial imaging.

Conclusion

Of the 9 acute inpatient strokes identified, average time to review from onset of symptoms was 2 hours and 26 mins. Thirty percent (N=3) received initial brain imaging within 1hour. These results highlight the significant challenge of inpatient stroke management as described in the literature. 1 One intervention identified is the introduction of a stroke alert bleep. After the introduction of this measure, we hope to re-evaluate our times.

Reference

1. Identifying Best Practices to Improve Evaluation and Management of In-Hospital Stroke: From the American Heart Association. https://www.ahajournals.org/doi/10.1161/STR.0000000000000402.
Bouncing Back: Hospital Reliance On Transitional Care Beds – A Disservice To Patients? A Review Of Readmission Rates
Authors: Higgins Meave , Ramjohn Joshua , Chan Kei Yen , Hanrahan Caoimhe , Gorey David , Cashen Aoife , Martin Niamh , Cormican Niamh , Small Cliona , Robinson Stephanie , Canavan Michelle , Costello Maria
Published: September 2024

Background

The Health Service Executive (HSE) developed an Urgent and Emergency Care (UEC) Operational Plan in 2023. One UEC action was an aim to transfer “clinically appropriate” patients to alternative care settings e.g. Transitional Care Beds (TCBs) to relieve pressure caused by high occupancy rates in acute hospitals. Inclusion criteria for TCB use is ill defined and we sought to evaluate their usage.

Methods

Retrospective analysis of characteristics and readmission rates (RAR) of patients discharged from a tertiary hospital to TCB from Oct 1st, 2023 - Jan 1st, 2024.

Results

158 patients were discharged from hospital to TCBs. 49% (n=77) were female, mean [SD] age 77.82 [10.09] years. The median length of stay (LOS) was 15 days. 50% (n=79) were discharged from surgical services, 40.5% (n=64) from medical teams, 8% (n=13) from oncology services, 7% (n=11) from geriatric medicine and 1% (n=2) from ED. 27% (n=43) had a “fall” documented as their discharge diagnosis. 32% (n=51) of patients were readmitted within 90 days, 11% (n=18) within 30 days and 4% (n=6) within 14 days. 30% (n=15) were readmitted directly from TCB. Average time between discharge and readmission was 44.7 days. Median LOS on readmission was 10 (IQR 15.5 days). 9% (n=14) had an eventual discharge to long term care (LTC) either from a subsequent admission or transitioned directly from TCB. 6% (n=10) of patients died.

Conclusion

Of those readmitted, one third were directly from TCBs suggesting discharge to TCB may have been premature and patient selection inappropriate subsequently resulting costly readmissions. Although interventions are needed to relieve capacity pressure in hospitals, greater emphasis needs to be placed on access for patients to designated rehabilitation programmes. We should aim to support older adults following acute hospital admissions by carrying out comprehensive geriatric assessment to maximise independence and reduce likelihood of hospital readmission or transition to LTC.
An Examination of EOL Trajectories and Audit of EOL Documentation In Patients Admitted Under the Department for Older Persons Services
Authors: Alcock Megan , Stanley Eve , McGrath Keith , O'Caoimh Ronan , Maloney Elizabeth , Timmons Suzanne , O'Sullivan Catherine , O'Connor Kieran
Published: September 2024

Background

End of Life Care is a core element of care provided in acute hospitals, with 44% of Irish deaths taking place in the hospital setting. Our audit looks at the quality of documentation around end of life for older patients and looks to characterize these hospitalized patients’ terminal life stages.

Methods

Inclusion criteria were patients over the age of 65 who died under the care of the Department for Older Persons Services in 2023 utilizing a retrospective chart review. The Oxford Audit Assessment Tool for Care of the Dying was used to evaluate end of life documentation for patients recognized as dying in the acute hospital setting using a 1–5-point scale. The hospital courses of patients who died were characterized along one of six in-hospital courses: (1) acutely unwell, (2) end stage organ failure, (3) dwindling trajectory, (4) unexpected cardiac arrest, (5) admission with known specialist palliative care needs, and (6) combination of medical complexity and high dependency. Data points included Clinical Frailty Score and NecPal Score, as well as length of hospital stay, length of dying and specialist palliative care input.

Results

Greater than 90% of patients under the Department for Older Persons service had satisfactory, good or excellent documentation around end-of-life care. One-third of patients who died under the service were acutely unwell, one-fifth of the patients who died in hospital followed a dwindling trajectory, and 15% of patients were admitted with known indication and need for specialist palliative care. Approximately 10% of patients who died suffered an unexpected cardiac arrest.

Conclusion

Overall, documentation at end of life was quite good and specialist palliative care services were frequently involved. Older patients frequently experience a complex interplay of high dependency, medical complexity and palliative care needs at end of life, highlighting the need for skilled serious illness communication.
Establishing a Specialist Physiotherapy service with a Regional Specialist Memory Clinic
Authors: Kimmage Evelyn , O'Dowd Seán , Kennelly Seán
Published: September 2024

Background

Patients with complex motor-cognitive syndromes (E.g. Dementia with Lewy Bodies, Corticobasal syndrome, Progressive Supranuclear Palsy and Huntington’s disease) present with a wide variety of symptoms. Accordingly, these patients have traditionally been managed under different services from Neurology-led movement disorder clinics to age-related services, without dedicated access to specialist physiotherapy input. Recognising this, the Model of Care for Dementia in Ireland recommended that all regional specialist memory services (RSMC) should have a dedicated Clinical Specialist Physiotherapist. The aim of this study was to provide an overview of clinic activity in the first six months of operation.

Methods

Physiotherapy referrals were collected from September 2023 to March 2024. Referral details were captured using Microsoft Excel and included patient demographics, reason for referral, diagnosis and previous physiotherapy input. Following triage of referrals, patients were placed in one of the following three care pathways:

Results

63 referrals were generated. Of these, 15 patients were referred for pre-diagnostic assessment, 46 were referred for rehabilitation, and 2 were referred for secondary prevention. Of those referred for rehabilitation; 18 patients had a diagnosis of DLB, 27 had another form of atypical Parkinsonism, 1 patient had HD. 22 patients had previous physiotherapy input.

Conclusion

This is the first specialist physiotherapy service in Ireland within a RSMC. This presents a challenge as there is no specific physiotherapy care pathway established for this service elsewhere, but also opportunity for service development and innovation. This overview will help with strategic and service planning and enables KPIs to be established to ensure patients receive a quality service.
Acute Bed Avoidance, Direct Admissions from Frailty at the Front Door to Rehabilitation Beds in Partnership with the ICPOP Team
Authors: Dowling Ciara , Dineen Sal , Coogan Mary , Purcell Roisin
Published: September 2024

Background

A key priority outlined in the Programme for Government is to support older people to live in dignity and independence in their own home. In line with the Slainte care vision for easier access of Right Care, Right Place and Right Time Clontarf Hospital have developed a pathway with the ICPOP Team/ FITT Team admitting patients directly from the front door of the acute hospital into a more appropriate environment, thus avoiding Acute Hospital admission or admitting directly from the community thus avoiding the Emergency Department presentation. The patients are over 65 years of age with multi comorbidities and complexities.

Methods

Both pathways have been developed and embedded. The ICPOP Consultant Geriatrician and the Patient Flow Teams in both Clontarf Hospital and the Mater Hospital collaborated to establish a seamless FITT to Rehab pathway which is person centred. At least 1 Rehabilitation bed is offered by Clontarf Hospital to the FITT ED Team 5 days a week Monday- Friday. An electronic communication group was instated to refer patients directly from the Emergency Department MMUH to Clontarf Hospital. The Comprehensive Geriatric Assessment Tool is utilised to refer and handover all patients. The data is collected on Clontarf Hospital Electronic Dash Board since the introduction of the service including:

Results

Since the start of the service mid-2022, 174 patients have been admitted saving acute hospital bed days. The MLOS is 22 days and ALOS is 27 bed days. Over 72% of patients are discharged directly home. There has been significant positive feedback from patients and families.

Conclusion

The establishment of a direct admission pathway from the Emergency Department and the community to a rehabilitation hospital has demonstrated positive patient outcomes and overall benefits to the healthcare system.
“Into the Abyss” – Exploring Healthcare Professionals Experience of Transitions of Care from Stroke Early Supported Discharge Services in Ireland
Authors: Shine Niamh , McDonough Suzanne
Published: September 2024

Background

Early Supported Discharge (ESD) is a key component of the stroke rehabilitation pathway. Evidence suggests that ongoing needs persist for people with stroke at the end of ESD, however little is known about the transition from ESD to other services. As such, the aim of this study was to explore healthcare professionals’ (HCPs) experiences of transitions of care from ESD services, in the Republic of Ireland. This was achieved through the following objectives: 1) Discussion of HCPs experience of transition from ESD, including ongoing needs of people with stroke and referral pathway utilisation; 2) Exploration of barriers and facilitators to ESD transition; 3) Discussion of potential solutions to barriers experienced.

Methods

A qualitative descriptive design was implemented using semi-structured interviews with HCPs working in ESD. Interviews took place online from November 2023 to January 2024 and were audio and video recorded and transcribed, via Microsoft Teams. Analysis of interview transcripts utilised an inductive coding approach through implementation of Braun and Clarke’s six step approach to thematic analysis.

Results

Nine HCPs took part in this study. A variety of ongoing needs and current referral pathways were described. Three key themes were identified: 1) “Into the Abyss”: Lack of a coordinated care pathway after ESD, 2) Role of communication and integrated information sharing in transition of care from ESD and 3) Facilitating care transition from ESD: current practices and future solutions.

Conclusion

This study highlights that at present, services in Ireland appear insufficient to cater to the ongoing needs of people with stroke after ESD. The roll out of community neurorehabilitation teams nationally and developing integrated communication systems are key areas for development, which warrant consideration by relevant stakeholders in order to optimise patient-centred care for this cohort.
Longitudinal Frailty Transitions in Adults Aging with Intellectual Disability
Authors: McFeely Aoife , McCarron Mary , Romero-Ortuno Roman , Connolly Eimear , McCallion Philip , Fitzpatrick Darren , Kennelly Sean
Published: September 2024

Background

Adults with Intellectual Disability (ID) are a vulnerable population, experiencing high rates of polypharmacy and multimorbidity, and experiencing early mortality. Lifelong functional and intellectual disability can complicate frailty measurement. To date, no studies have examined long term frailty transitions in this complex group. The aim of this study was to examine longitudinal frailty transitions, with the hope of distinguishing frailty from disability.

Methods

This study was conducted using The Intellectual Disability Supplement to the Irish Longitudinal Study of Aging (IDS-TILDA). It followed 745 adults with ID across 4 waves of data collection between 2010 and 2021. Frailty was measured at each wave using an ID-specific Frailty Index. Scores were classified into the following states: Non-Frail, Pre-Frail, Frail, Missing and Dead. Transitions are demonstrated visually using alluvial plots, created using the ggalluvial package in R. Multistate Markov Modelling was used to calculate transition probabilities between states across subsequent waves.

Results

Frailty transitions were common across the 4 waves. Both positive (decreasing frailty) and negative (increasing frailty) transitions were seen. There was a 6.8% probability of transitioning from Frail to Pre-Frail, and a 10.5% probability of transitioning from Pre-Frail to Non-Frail. The probabilities of negative transitions were higher than positive transitions. The probability of transitioning to death was higher in higher frailty states: Non-Frail = 2.6%, Pre-Frail = 5.1%, Frail = 19.3%. Compared to the general population, positive transitions were less likely.

Conclusion

This is the first study to demonstrate transitions in frailty states in adults with ID. To date, singe time-point studies of frailty in ID have faced the struggle of distinguishing frailty from underlying disability. For adults with ID, lifelong disability is expected to be relatively static. The dynamism captured here points to frailty as a distinct entity experienced by this group. Efforts are needed to better manage frailty in this vulnerable cohort.
A Pathway for Advance Care Planning Co-Developed by Service Users and Interdisciplinary Healthcare Professionals in Older Persons Mental Health
Authors: Allen Jennifer , Donnelly Sarah , Murphy Sinéad , Morton Sarah
Published: September 2024

Background

Advance Care Planning (ACP) has been recognised as an effective mechanism for decision-making, maintaining autonomy, and ensuring that end-of-life care is aligned with an individual’s will and preference. However, healthcare professional's (HCPs) lack of confidence and knowledge has been cited as a barrier to practice. Furthermore, there are currently no widely accepted guidelines for ACP in health service settings (Barnett et al., 2024[1]). A key aim of the second stage of a three-stage action research study was to co-design a pathway to support ACP practice in a Mental Health Service for Older Persons.

Reference

[1] Barnett, M.D., Bennett-Leleux, L.J. & Guillory, L.A. (2024) End-of-life treatment preferences and ACP among older adults, Death Studies, 48:2, 95-102.

Methods

The pathway was developed through cooperative inquiry (CI), a collaborative research approach. The CI group involved three service users (one with dementia family carer experience), and six interdisciplinary HCPs coming together as co-subjects and co-researchers. Five in-person CI meetings were convened.

Results

The CI group co-developed a person-centred pathway encompassing a tiered approach to ACP, which would be a source of guidance and support for service users, family carers and HCPs. Key components include training and education for HCPs to enhance confidence and skills; a Padlet online platform to host resources for service users and family carers; and facilitated interventions based on the individual needs of service users, including potentially additional accompanying documentation to capture mental health needs. An interdisciplinary approach to facilitating ACP engagement, with social work taking a lead role was also suggested.

Conclusion

The pathway was identified as an effective approach to embedding ACP practice in older persons mental health, through a tiered person-centred framework catering to the needs of both service users, and the training needs of staff. The pathway is proposed as potentially adaptable to other older persons services to support ACP engagement.
Evaluation of Staff Views of the Rapid Assistance with Frailty Team, It’s Perceived Clinical Effectiveness and Potential Areas for Development
Authors: Walsh Erica , Bambrick Padraig , Doyle Marie , Prendergast Ann , Walsh Anna Doherty , O'Flatharta Tomas
Published: September 2024

Background

The Rapid Assistance with Frailty Team (RAFT) has been operating within our local hospital since 2021. This novel multidisciplinary service aims to support frail older adults during hospital admission, by conducting focused comprehensive geriatric assessments, and providing bespoke support to their primary team. One method of evaluating the impact of the service has been to seek regular feedback from other staff, to guide continuous quality improvement regarding our approach.

Methods

This service evaluation was registered with the Quality and Patient Safety department locally in January 2024. An online questionnaire was developed to seek feedback from colleagues who would have experience of the service, with a link distributed via email to relevant staff members. Data collection took place over an eight-week period.

Results

In total, 69 responses from staff were received, and analysed thematically. They demonstrated high degrees of staff satisfaction, with over 76% either agreeing or strongly agreeing that ‘RAFT is a valuable service’. A further 69% of respondents felt that ‘RAFT is helpful in supporting discharge’. The most common expectations were for the team to assist with frailty assessment; support discharge planning; offer MDT input; provide follow-up care; and conduct education. Staff felt the service could be improved through refining the medical input role; provision of an ED service; increased staffing; expanding the discharge planning role; development of referral pathways; and improved communication.

Conclusion

Following presentation of these findings at our departmental teaching, a service development plan was agreed. This includes organising a focused internal rapid improvement event, with RAFT staff utilising the feedback from this service evaluation to identify how the service can be improved, as well as identifying key performance indicators to evaluate this progress. We will repeat this service evaluation in 6 months’ time, to assess if these interventions have made a meaningful impact.
Relationship Between Lifestyle Factors and Accelerometery Based Motion Capture Analysis During An Active Stand In Healthy Older Adults
Authors: Mockler Toni , Knight Silvin , Hartley Peter , Connolly Emma , Xue Feng , Duggan Eoin , Romero-Ortuno Roman
Published: September 2024

Background

One in three individuals aged over 65 and one in two individuals over 80 experience falls in a year. As the population ages, preventing balance issues and falls among healthy older adults becomes increasingly critical. As the population ages, preventing balance issues and falls among healthy older adults becomes increasingly critical. We hypothesized that individuals may display distinct patterns of micro-movement during this test, undetectable to the naked eye but identifiable using motion capture technology.

Methods

Participants aged 50 years and older were recruited from a local healthy ageing group. Participants underwent an Active Stand (AS) test, consisting of lying down for 10 minutes followed by standing up as quickly as possible and remaining motionless for 3 minutes. During the test, participants wore an accelerometer Participants underwent an Active Stand (AS) test, consisting of lying down for 10 minutes followed by standing up as quickly as possible and remaining motionless for 3 minutes, during the test, participants wore an accelerometer. Computations were carried out on the signals for all remaining participants. Computations were carried out on the signals for all remaining participants.

Results

31 participants were initially recruited, with 26 ultimately included after data quality checks. The mean age was 70.5 ± 5.4 years, with 85% being women A lower BMI was found to be significantly associated with a higher MI values a lower BMI was found to be significantly associated with a higher MI values across all three phases of the active stand test across all three phases of the test.

Conclusion

These findings underscore the potential role of modifiable lifestyle factors, like maintaining a healthy BMI and avoiding smoking, in mitigating early balance problems in older adults.
UK Transients 2024
Authors: Starling Rhaana
Published: September 2024

Organiser Rhaana Starling summarises a meeting that reflected the breadth and depth of the UK Transient community
Efficacy and safety of biologics and small-molecule inhibitors in treating genital psoriasis: a systematic review of randomized controlled trials
Authors: Lai Chien-Cheng , Shao Shih-Chieh , Tsai Ethan T K , Chi Ching-Chi
Published: September 2024

While there have been many studies on the treatments for psoriasis, the evidence on the treatments for genital psoriasis is limited even though this type of psoriasis has a considerable impact on affected patients’ quality of life and sexual function. This systematic review summarizes the current evidence on biologics and small-molecule inhibitors in the treatment of genital psoriasis.
The influence of the BCS in European computing
Authors: Ashill M C
Published: September 2024

At a conference of European university vice-chancellors, when the question of curricula, lengths of courses and the like were discussed, it was flatly stated by one of the staff of the European Economic Commission that these were matters specifically reserved for the Commission, and that neither the universities nor any professional bodies have any status under the Treaty of Rome in connection with them. Although this is a somewhat legalistic point of view, and probably would not be totally endorsed by the Council of Ministers, nevertheless it serves to illustrate one of the reasons why every university teacher and professional in the enlarged Common Market must take the new situation seriously.
The IT86 Committee: after-Alvey programmers
Authors: Owen Kenneth
Published: September 2024

Last November the IT86 Committee chaired by Sir Austin Bide published its report on what should follow the present five-year Alvey programme of advanced information technology research, which is due to end next year. This article by Kenneth Owen presents the viewpoint of the committee, as indicated in the report, on the thinking behind their recommendations for a billion-pound after-Alvey programme. We hope to print the response of Mr Geoffrey Partie, Minister of State tor industry and Information Technology, in a future Viewpoint article.
Unix as an office system
Authors: Lansdown John , Selway Michael
Published: September 2024

AT & T’s Bell Laboratories’ Unix system has both its detractors and its defenders: certainly it is complex and rather daunting to the uninitiated; but, to those in the know, it is uniquely powerful and expressive. Because of its complications, it is not the sort of software that one would normally want to let loose on an unsuspecting company as the basis of its administration system. But if the office is largely populated by computer scientists and other experienced computer users, a properly tuned version of Unix – together with some ad hoc programs – can be exactly the right tool. System Simulation Ltd is a company of this computer-orientated sort and, almost since its inception, has used Unix not only to underpin its technical programming but also for its management information, word processing, electronic mail, and general administrative work. Similar small companies looking towards setting-up computer-based administrative systems might be interested in our experience.
Securing and surviving top management involvement
Authors: Virgo Philip
Published: September 2024

Few of those who call for ‘top management involvement’ in office automation projects have thought through the implications. Most senior managers take traditional office automation for granted as a topic which no more merits special consideration than the telephone network or the plumbing. Where they do not the result of personal involvement may not be what the OA expert wanted.
Communicating with the politicians
Authors: Newell Roy
Published: September 2024

Founded in 1981 and based on its predecessor - the Parliamentary Computer Forum - the Parliamentary Information Technology Committee (PITCOM) has played an increasingly important role in influencing the directions of Parliament’s IT awareness and policy. It is an All-Party Committee of both Houses of Parliament and a Registered Parliamentary group and is recognised as the UK’s foremost arena for the discussion of public policy issues generated by IT.
Detailed analysis of electrogram peak frequency to guide ventricular tachycardia substrate mapping
Authors: Mayer Joseph , Al-Sheikhli Jaffar , Niespialowska-Steuden Maria , Patchett Ian , Winter James , Siang Rafaella , Lellouche Nicolas , Manoharan Karthick , Phan Thanh Trung , Calvo Justo Juliá , Porta-Sánchez Andreu , Roca-Luque Ivo , Silberbauer John , Dhanjal Tarvinder
Published: September 2024

Aims

Differentiating near-field (NF) and far-field (FF) electrograms (EGMs) is crucial in identifying critical arrhythmogenic substrate during ventricular tachycardia (VT) ablation. A novel algorithm annotates NF-fractionated signals enabling EGM peak frequency (PF) determination using wavelet transformation. This study evaluated the algorithms’ effectiveness in identifying critical components of the VT circuit during substrate mapping.

Methods and results

A multicentre, international cohort undergoing VT ablation was investigated. VT activation maps were used to demarcate the isthmus zone (IZ). Offline analysis was performed to evaluate the diagnostic performance of low-voltage area (LVA) PF substrate mapping. A total of 30 patients encompassing 198 935 EGMs were included. The IZ PF was significantly higher in sinus rhythm (SR) compared to right ventricular paced (RVp) substrate maps (234 Hz (195–294) vs. 197 Hz (166–220); P = 0.010). Compared to LVA PF, the IZ PF was significantly higher in both SR and RVp substrate maps (area under curve, AUC: 0.74 and 0.70, respectively). The LVA PF threshold of ≥200 Hz was optimal in SR maps (sensitivity 69%; specificity 64%) and RVp maps (sensitivity 60%; specificity 64%) in identifying the VT isthmus. In amiodarone-treated patients (n = 20), the SR substrate map IZ PF was significantly lower (222 Hz (186–257) vs. 303 Hz (244–375), P = 0.009) compared to amiodarone-naïve patients (n = 10). The ≥200 Hz LVA PF threshold resulted in an 80% freedom from VT with a trend towards reduced ablation lesions and radiofrequency times.

Conclusion

LVA PF substrate mapping identifies critical components of the VT circuit with an optimal threshold of ≥200 Hz. Isthmus PF is influenced by chronic amiodarone therapy with lower values observed during RV pacing.
Does Varying the Order of Sexual Orientation Response Categories Change Population Estimates? Findings from a Nationally Representative Study of U.S. Adults
Authors: Hansen Christopher , Christian Leah M , Fordyce Erin , David Bryn
Published: September 2024

Conventional wisdom for general population research suggests that nominal response categories be ordered by population prevalence. Current best practice in sexual orientation measurement represents an exception, with lesbian or gay recommended as the first response category, followed by the second, but most selected category, straight, that is, not lesbian or gay. Although prior research has shown that there can be differences in response distributions by response ordering, there has been a dearth of empirical work to investigate the potential of such context effects in sexual orientation measurement. To address this gap, we surveyed U.S. adults aged 18+ in 2022 using a nationally representative, probability-based household panel (n = 2,099) where panelists were asked “Which of the following best represents how you think of yourself?” with response categories lesbian or gay; straight, that is, not lesbian or gay; bisexual; something else; and I don’t know the answer. Panelists were randomly assigned to one of two groups. The control group was asked the standard ordering lesbian or gay followed by straight, that is, not lesbian or gay. The treatment group was asked straight, that is, not lesbian or gay followed by lesbian or gay. The order of the remaining responses was the same for both groups. Results do not show a significant relationship between response order and sexual orientation but suggest additional research with a larger sample would be useful. Compared to the lesbian/gay first group, the straight first group showed a significant decrease in proportion for don’t know responses. Differences in proportions for the remaining responses were not significant. Young adulthood was predictive of don’t know responses in both groups, indicating that don’t know responses may capture sexual fluidity, change, or uncertainty in addition to potential satisficing. Findings demonstrate that reordering response categories by population prevalence may improve data quality by decreasing item nonresponse.
Seeing Like a Fixer
Authors: Schwedler Jillian , Chomiak Laryssa
Published: September 2024

“Seeing Like a Fixer” examines the practical and ethical consideration that arise when conducting scholarly work through short research stunts in environments unfamiliar to the researcher and by employing fixers and translators to make that research possible. The chapter examines what it means to “outsource knowledge production” and provides both caution and guidance to those considering these practices. It also discusses how fixing impacts the type and substance of the scholarship that is produced. While the work does not suggest that there is never a place for using fixers, this chapter outlines a wide range of fixing practices and their potential pitfalls. Most importantly, the chapter calls for ethical practices not only in the relationship with the fixers themselves, but in providing full transparency in one’s scholarship about when fixers have been employed and in what precise ways.
MOF-encapsulated copper-doped carbon dots nanozymes with excellent biological activity promote diabetes wound healing
Authors: Dai Sheng , Jiang Lang , Liu Luying , Su Zhaogui , Yao Li , Yang Ping , Huang Nan
Published: September 2024

Poor wound healing in diabetics is primarily caused by persistently high levels of inflammation and recurrent bacterial infections. The catalytic therapy technique based on nanozyme medicine has emerged as a beacon of hope for patients with diabetic wounds. However, the use of a single-atom nanozyme may still have limitations, including nanozyme burst release, immunological clearance and insufficient antibacterial activity. To address the aforementioned problems, we provide a new nano-catalytic therapeutic agent for diabetic skin ulcers that incorporates a single-atom nanozyme with high antioxidant activity into a metal–organic framework (ZIF-Cu/C-dots). First, a Cu single-atom nanozyme supported by ultra-small carbon dots (Cu/C-dots) with high antioxidant activity was created. A nanozyme-integrated metal–organic framework was then created, utilizing Cu/C-dots as ligands and Zn2+ as the core metal. Cu/C-dots have good oxidase-like activity, shielding the biological system from ROS damage and reducing the expression of TNF-α and IL-1β. Zn2+ also has good antibacterial activity (the antibacterial rate was more than 90%). This integrated technique prevents nanozyme aggregation, improves nanozyme biocompatibility, slows down the breakdown of ZIF and allows for the regulated release of Cu/C-dots and Zn2+ as needed. Finally, in vivo studies have shown that ZIF-Cu/C-dots can effectively alleviate inflammation at the site of diabetic wounds, accelerate vascular regeneration, promote collagen deposition and enhance tissue remodeling, serving as a novel nano-catalytic platform for the treatment of wounds that are difficult to heal.
Real-world outcomes of a dedicated fast-track polymyalgia rheumatica clinic
Authors: Cowley Sharon , Harkins Patricia , Kirby Colm , Conway Richard , Kane David
Published: September 2024

Objectives

To examine the clinical impact of a fast-track PMR clinic to enable early diagnosis and treatment, and to define both patient and disease characteristics in newly diagnosed PMR.

Methods

Primary care physicians were invited to refer patients with new PMR to our fast-track clinic. Referral criteria included new onset shoulder or pelvic girdle pain and/or stiffness with elevated inflammatory markers in patients over 50 years. All patients were seen within 72 h of referral. Patients with a rheumatology diagnosis of PMR had an US of their temporal and axillary arteries.

Results

172 patients were referred from primary care over 12 months. 39% of patients referred with suspected PMR had an alternative diagnosis for which PMR regimen glucocorticoids was inappropriate. 55% of the non-PMR diagnoses were other inflammatory rheumatological conditions requiring follow-up. Only 20% of patients referred from primary care already on glucocorticoids were commenced on bone protection. PMR patients were comorbid, with a mean of 2.5 other conditions. 75% of PMR patients experienced a glucocorticoid-related adverse event in the first 12 months of treatment. 17% of patients with new PMR had US features of subclinical GCA.

Conclusion

The commencement of glucocorticoid therapy should be deferred until after specialist evaluation to enable an accurate clinical diagnosis. A delay in treatment can only realistically be avoided if general practitioners have access to a fast-track PMR clinic. We believe that rheumatologists should consider establishing fast-track PMR clinics and this study provides a strong case for and a template to support this practice innovation.
Involvement of interferon γ-producing mast cells in immune responses against melanocytes in vitiligo requires MrgX2 activation
Authors: Liao Zhikai , Yao Yunzhu , Dong Bingqi , Le Yue , Luo Longfei , Miao Fang , Jiang Shan , Lei Tiechi
Published: September 2024

Background:

Increasing evidence indicates that oxidative stress and interferon γ (IFNγ)-driven cellular immune responses are responsible for the pathogenesis of vitiligo. However, the connection between oxidative stress and the local production of IFNγ in early vitiligo remains unexplored. The aim of this study was to identify the mechanism underlying the production of IFNγ by mast cells and its impact on vitiligo pathogenesis.

Methods:

Skin specimens from the central, marginal, and perilesional skin areas of active vitiligo lesions were collected to characterize changes of mast cells, CD8+ T cells, and IFNγ-producing cells. Cell supernatants from hydrogen peroxide (H2O2)-treated keratinocytes (KCs) were harvested to measure levels of soluble stem cell factor (sSCF) and matrix metalloproteinase (MMP)-9. A murine vitiligo model was established using Mas-related G protein-coupled receptor-B2 (MrgB2, mouse ortholog of human MrgX2) conditional knockout (MrgB2−/−) mice to investigate IFNγ production and inflammatory cell infiltrations in tail skin following the challenge with tyrosinase-related protein (Tyrp)-2 180 peptide. Potential interactions between the Tyrp-2 180 peptide and MrgX2 were predicted using molecular docking. The siRNAs targeting MrgX2 and the calcineurin inhibitor FK506 were also used to examine the signaling pathways involved in mast cell activation.

Results:

IFNγ-producing mast cells were closely aligned with the recruitment of CD8+ T cells in the early phase of vitiligo skin. sSCF released by KCs through stress-enhanced MMP9-dependent proteolytic cleavage recruited mast cells into sites of inflamed skin (Perilesion vs. lesion, 13.00 ± 4.00/HPF vs. 26.60 ± 5.72/HPF, P <0.05). Moreover, IFNγ-producing mast cells were also observed in mouse tail skin following challenge with Tyrp-2 180 (0 h vs. 48 h post-recall, 0.00 ± 0.00/HPF vs. 3.80 ± 1.92/HPF, P <0.05). The IFNγ+ mast cell and CD8+ T cell counts were lower in the skin of MrgB2−/−mice than in those of wild-type mice (WT vs. KO 48 h post-recall, 4.20 ± 0.84/HPF vs. 0.80 ± 0.84/HPF, P <0.05).

Conclusion:

Mast cells activated by MrgX2 serve as a local IFNγ producer that bridges between innate and adaptive immune responses against MCs in early vitiligo. Targeting MrgX2-mediated mast cell activation may represent a new strategy for treating vitiligo.
Temporal change in minimum mortality temperature under changing climate: A multicountry multicommunity observational study spanning 1986–2015
Authors: Yang Daewon , Hashizume Masahiro , Tobías Aurelio , Honda Yasushi , Roye Dominic , Oh Jaemin , Dang Tran Ngoc , Kim Yoonhee , Abrutzky Rosana , Guo Yuming , Tong Shilu , Coelho Micheline de Sousa Zanotti Stagliorio , Saldiva Paulo Hilario Nascimento , Lavigne Eric , Correa Patricia Matus , Ortega Nicolás Valdés , Osorio Samuel , Kyselý Jan , Urban Aleš , Orru Hans , Indermitte Ene , Jaakkola Jouni , Ryti Niilo , Pascal Mathilde , Huber Veronika , Schneider Alexandra , Katsouyanni Klea , Analitis Antonis , Entezari Alireza , Mayvaneh Fatemeh , Goodman Patrick , Zeka Ariana , Michelozzi Paola , de’Donato Francesca , Alahmad Barrak , Diaz Magali Hurtado , la Cruz Valencia César De , Overcenco Ala , Houthuijs Danny , Ameling Caroline , Rao Shilpa , Nunes Baltazar , Madureira Joana , Holo-bâc Iulian Horia , Scovronick Noah , Acquaotta Fiorella , Kim Ho , Lee Whanhee , Íñiguez Carmen , Forsberg Bertil , Vicedo-Cabrera Ana Maria , Ragettli Martina S. , Guo Yue-Liang Leon , Pan Shih Chun , Li Shanshan , Sera Francesco , Zanobetti Antonella , Schwartz Joel , Armstrong Ben , Gasparrini Antonio , Chung Yeonseung
Published: September 2024

Background:

The minimum mortality temperature (MMT) or MMT percentile (MMTP) is an indicator of population susceptibility to nonoptimum temperatures. MMT and MMTP change over time; however, the changing directions show region-wide heterogeneity. We examined the heterogeneity of temporal changes in MMT and MMTP across multiple communities and in multiple countries.

Methods:

Daily time-series data for mortality and ambient mean temperature for 699 communities in 34 countries spanning 1986–2015 were analyzed using a two-stage meta-analysis. First, a quasi-Poisson regression was employed to estimate MMT and MMTP for each community during the designated subperiods. Second, we pooled the community-specific temporally varying estimates using mixed-effects meta-regressions to examine temporal changes in MMT and MMTP in the entire study population, as well as by climate zone, geographical region, and country.

Results:

Temporal increases in MMT and MMTP from 19.5 °C (17.9, 21.1) to 20.3 °C (18.5, 22.0) and from the 74.5 (68.3, 80.6) to 75.0 (71.0, 78.9) percentiles in the entire population were found, respectively. Temporal change was significantly heterogeneous across geographical regions (P < 0.001). Temporal increases in MMT were observed in East Asia (linear slope [LS] = 0.91, P = 0.02) and South-East Asia (LS = 0.62, P = 0.05), whereas a temporal decrease in MMT was observed in South Europe (LS = −0.46, P = 0.05). MMTP decreased temporally in North Europe (LS = −3.45, P = 0.02) and South Europe (LS = −2.86, P = 0.05).

Conclusions:

The temporal change in MMT or MMTP was largely heterogeneous. Population susceptibility in terms of optimum temperature may have changed under a warming climate, albeit with large region-dependent variations.