bluuebunny/crossref_metadata_2025 huggingface dataset:
112 Outcomes and Clinical Characteristics of COVID-19 Disease in the Frail, Elderly Population of Tayside
Authors: Shedden R , McCulloch A , Laidlaw S , Love S , McLuckie S , Jones W , Taylor J , Pennington R , Tipton C
Published: March 2021

Introduction

With advancing age, frailty, multi-morbidity and need for care, elderly patients are some of the most vulnerable to Covid-19 disease. In NHS Tayside, a dedicated Covid-19 Medicine for the Elderly (MFE) Team was formed to care for patients identified as frail and likely to benefit from comprehensive geriatric assessment.

Methods

All Covid-19 patients meeting frailty criteria1, cared for by the Covid-19 MFE Team were identified. Data on outcomes and clinical characteristics for all (140) patients admitted during the first pandemic wave (March–July 2020) was collected using electronic patient records and analysed.

Results

Patients were predominantly male (58.6%). Ages ranged from 65–99 years, with 43.6% aged ≥85 years. 82.1% had one or more of cough, fever and anosmia on admission fitting Covid-19 case definition 2. Lymphopenia was present in 92.1%. Of note, 26.5% of patients had a normal or unchanged chest x-ray report, with only 10.2% showing bilateral peripheral infiltrates. 28-day mortality was 37.1% with Covid-19 Disease listed as primary cause of death in 90.4%.

Conclusion(s)

Entering further “waves” of infection, it is vital that we understand the clinical presentation and course of Covid-19 disease in elderly patients. Our data highlights that any Covid-19 symptom, even in isolation, should raise suspicion of disease. Chest x-rays should not be used alone as a diagnostic tool. The presence of lymphopenia should raise suspicion of Covid-19 infection. In developing an understanding of how elderly patients with Covid-19 present, we can ensure early identification and initiation of appropriate infection control measures.

References

1. Healthcare Improvement Scotland. Think Frailty. 2014. http://www.healthcareimprovementscotland.org/his/idoc.ashx?docid=8abd8530-48f3-4152-bbfb-d0918b870ec9&version=-1

2. Scottish Government. Update to Coronavirus Symptoms 2020. https://www.gov.scot/news/update-to-coronavirus-symptoms
113 Improving Intravenous Fluid Therapy to Reduce the Incidence of Acute Kidney Injury in Elderly Hip Fracture Patients
Authors: McCann C , Hall A , Leow J Min , Harris A , Hafiz N , Myers K , Amin A , MacLullich A
Published: March 2021

Background

Acute kidney injury (AKI) in hip fracture patients is associated with morbidity, mortality, and increased length of stay. To avoid this our unit policy recommends maintenance crystalloid IV fluids of >62.5 mL/Hr for hip fracture patients. However, audits have shown that many patients still receive inadequate IV fluids.

Methods

Three prospective audits, each including 100 consecutive acute hip fracture patients aged >55, were completed with interventional measures employed between each cycle. Data collection points included details of IV fluid administration and pre/post-operative presence of AKI. Interventions between cycles included a revised checklist for admissions with a structured ward round tool for post-take ward round and various educational measures for Emergency Department, nursing and admitting team staff with dissemination of infographic posters, respectively.

Results

Cycle 1: 64/100 (64%) patients received adequate fluids. No significant difference in developing AKI post operatively was seen in patients given adequate fluids (2/64, 3.1%) compared to inadequate fluids (4/36, 11.1%; p = 0.107). More patients with pre-operative AKI demonstrated resolution of AKI with appropriate fluid prescription (5/6, 83.3%, vs 0/4, 0%, p < 0.05) Cycle 2: Fewer patients were prescribed adequate fluids (54/100, 54%). There was no significant difference in terms of developing AKI post operatively between patients with adequate fluids (4/54, 7.4%) or inadequate fluids (2/46, 4.3%; p = 0.52). Resolution of pre-operative AKI was similar in patients with adequate or inadequate fluid administration (4/6, 67% vs 2/2, 100%). Cycle 3: More patients received adequate fluids (79/100, 79%, p < 0.05). Patients prescribed adequate fluids were less likely to develop post-operative AKI than those receiving inadequate fluids (2/79, 2.5% vs 3/21, 14.3%; p < 0.05).

Discussion

This audit demonstrates the importance of administering appropriate IV fluid in hip fracture patients to avoid AKI. Improving coordination with Emergency Department and ward nursing/medical ward staff was a critical step in improving our unit’s adherence to policy.
114 Tackling Noise Pollution in Hospitals: A Pre-Feasibility Study
Authors: Paul N , Xyrichis A
Published: March 2021

This study aimed to better understand appropriate interventions aimed at reducing hospital ward noise and the subsequent impact this would have on inpatient experience. Service users consistently reported that noise pollution was the most detrimental factor in their recovery in hospital, principally due to its effects on sleep.

Methods

To aid usability and data collection the Richards- Campbell Sleep Questionnaire (RCSQ) was adapted into an electronic format with a sliding Likert scale using QuestionPro Software3. Qualitative patient interviews, the RCSQ and ward decibel measurements were recorded on Henry and Anne wards at St. Thomas’ Hospital, London. 20 patients were interviewed (12F, 8 M), with 3 being ultimately discounted due to severe cognitive impairment.

Results

were collated and will be presented as part of a pre-feasibility evaluation of the tools to measure patient sleep and experience of ward noise. Results: The mean of the responses from the 17 patients interviewed were calculated and graphically displayed. Of interest, 87.5% found the questionnaire straightforward to understand, but only 18.75% found it easy to complete (due to technological unfamiliarity).

Conclusion and discussion

Patients reported a consistently reported a less than optimal night’s sleep on the ward, with light sleep and increased time to fall asleep being key factors. Although visits were restricted to the “quietest” times on the ward, noise measurements consistently exceeded WHO recommendations of 40 dB. Subsequently excessive night-time noise created by other patients as well as staff was cited as the principal causes of poor sleep, with ward lighting being another cause. Results from this study have provided the justification for sound-masking technology to be trialled on inpatient wards, with the view of decreasing unpleasant ward noise and improving patient rest and recovery.
115 Multi-Disciplinary Simulation Training on Delirium
Authors: Varma S , Alston D , Shah B , Long S
Published: March 2021

Introduction

Delirium is still perceived as a “geriatric medicine competency”, despite its high prevalence across most specialties. Collective multi-disciplinary team performance in implementation of multi-component interventions is key. Simulation training incorporates the complex interplay of non-technical factors, specifically, role recognition and empowerment, inter-personal skills and teamwork that are pivotal in delivering effective delirium care.

Methods

Funding was approved by Health Education England. 2 pilot teaching sessions were arranged in the simulation ward. 3 scenarios were developed, each requiring a facilitator, an actor and three participants- a foundation-year doctor, a nurse/healthcare assistant and a therapist. Scenario 1 dealt with a patient with hypoactive delirium with focus on identification and multidisciplinary optimisation. Scenario 2 challenged participants with management of an agitated patient. Scenario 3 involved discharging a patient with resolving delirium and a reluctant relative, with emphasis on mental capacity assessment. Communication, patient risk assessment and challenging perceived role barriers were global themes. Participant feedback was captured using unstructured interviews and pre- and post-session 5-point Likert confidence scale in various learning outcomes.

Results

16 participants were included- 4 foundation year doctors, 3 therapists, 2 healthcare assistants and 7 nurses. There was an average improvement in Likert confidence scales in all measured learning outcomes. All participants would recommend the course to their colleagues (average Likert scale 4.9). Qualitative feedback appraised the course for demonstration of de-escalation communication strategies, the application of mental capacity and recognition of early discharge planning.

Conclusion

Simulation training targeted at multi-disciplinary groups is an effective way to deliver teaching on delirium. It contextualises synergistic operation of different skills and personal accountability in influencing patient management. The challenge to its potential remains its adoption as mandatory training for various disciplines involved in care of older adults and its implementation at a wider-scale, to assure cost effectiveness.
116 Impact of COVID 19 Pandemic on Hospital Care For People with Dementia—Feedback From Hospital Leads and Carers
Authors: Hood C , Morris A , Corrado O , Swanson E , Bourke L , Crawford M , Quirk A , Doxford H
Published: March 2021

Introduction

The National Audit of Dementia (NAD) is funded by the Healthcare Quality Improvement Partnership to collect data from acute general hospital in England and Wales. In June 2020 NAD circulated optional surveys to leads for dementia in acute hospitals and carers asking about the impact of the pandemic on the organisation and provision of hospital care.

Methods

Anonymous survey links were sent to hospital dementia leads directly and circulated to carers of people with dementia via social media and representative organisations. Dementia Leads’ questions included whether they and/or their team had been redeployed during the pandemic and whether wards had access to specialist services. Carers’ questions included whether patients’ needs were discussed, whether they were permitted to visit/how this was communicated, any measures to facilitate communication with their loved ones, and whether they were updated about progress and discharge.

Results

53 dementia hospital leads completed the questionnaire. 32% had been redeployed to other clinical areas during the pandemic, 45% said the same for members of the dementia team. Specialist support for people with dementia on both Covid and Non-Covid wards was significantly compromised. 32 carers completed the questionnaire. 48% were not asked about the needs of the patient they cared for, 90% not allowed to visit, 43% were not given any explanation about visiting and 48% not given support to keep in touch with their loved one.

Conclusions

Clinical priorities inevitably meant redeployment of dementia specialist staff, and changes to visiting. However, continuation of specialist support is a requirement for people with dementia admitted to hospital. Liaison with carers/families must be a priority, including facilitating remote support. Hospitals should take note of NHS guidance permitting carer visits to support a person with dementia experiencing distress.
120 Improving Delirium Recognition and Management Through In-Situ Simulation
Authors: Cheston H , Miller E , Mufti S
Published: March 2021

Introduction

Delirium is a common condition that is often associated with increased morbidity and mortality, longer hospital admission, and discharge to a residential or nursing home. By improving our ability to recognise and manage these patients we can intervene early to help reduce the likelihood of these outcomes.

Method

We organised several in-situ simulation scenarios with junior staff working on the Elderly Care Unit. The research team designed a scenario to re-create a typical delirious patient on the ward. Participants had to recognise the patient was delirious and instigate a management plan. Participants completed a pre and post-intervention questionnaire to ascertain whether they felt the simulation had improved their confidence. Additionally we performed an audit to investigate whether our intervention led to an improvement in the recognition and management of delirium in patients on the ward.

Results

The questionnaires showed an increase in participants’ confidence and knowledge when managing a delirious patient on the ward. From reviewing patient notes pre-intervention we identified that 24 patients were delirious during admission,14 of which were accurately diagnosed with delirium. The remaining 10 patients were diagnosed with “Acute Confusion”. On reviewing these 10 patients’ notes, they were all likely to have a diagnosis of delirium. Post-intervention there were 14 patients identified as delirious during their admission. All these patients were correctly documented as having delirium with no inaccurate use of terminology. The data also showed increasing use of tools such as AMTS and 4AT to diagnose delirium.

Conclusions

From the data gathered, we can see participants are better at recognising and diagnosing delirium. However, our sample sizes are too small to test statistical significance between data points. To improve the project we would include a larger sample size to determine whether the simulation produces a statistically significant improvement in confidence levels.
123 Quality Improvement Project on Completion of Respect Form in the Community At Jean Bishop Integrated Care Centre (ICC)
Authors: Mon H , Kar S , Bridge L
Published: March 2021

Background

ReSPECT (Recommendation Summary Plan for Emergency Care and Treatment) form was designed to communicate a personalized set of recommendations for a patient’s clinical care in an emergency situation and priorities over other aspects of future care. AIMS & OBJECTIVE 1)To measure ReSPECT Form completion rates at ICC and proportion of forms uploaded on the system and this compared with the published data 2 to improve performance where possible through QI process 3) Re-auditing after interventions.

Methods

All patients who attended the ICC from 1st October 2019 to 21st October 2019 were audited. Altogether 80 patients’ notes on system 1 and Lorenzo were reviewed. After initial results, interventions such as displaying the poster of salient results and recommendations in ICC clinic rooms, giving feedback to key team members were performed by the audit team.

Results

9 patients already had ReSPECT forms. From the remaining 71 patients, 57 discussions (80%) were taken place and 29 forms (41%) were completed while 28 were not for definite reasons. ReSPECT discussion was not initiated for recorded reasons in 9 cases and without reason in 5 cases. Out of 29 completed forms, 24(82%) were uploaded on the system. After the interventions, the re-audit cycle with 16 cases in which 13(94%) had ReSPECT discussions and 6 forms were completed.

Discussion

In comparison with NHS forth valley ReSPECT report, we had a better figure in completion forms (41% Vs 39%) and the number uploaded on system (82% vs 79%). After interventions, 81% had either ReSPECT forms completed or discussion which is much improved.

Conclusion

From this study, the overall improvement in performance was seen with simple interventions but further spot check QIPs and regular training sessions to team member will be essential for sustainability.
126 A Student Pilot for A Feasibility Study of the Theoretical 3S Trial (SPFT3S): GP and Ethics Committee Members Questionnaire
Authors: Brown L , Foster R , Dodd M , McCormack T
Published: March 2021

Introduction

Emerging research suggests that statin use for primary prevention in people without diabetes aged 75 and older has no benefit. This study aims to determine the feasibility of the theoretical Stop Statin Study (3S), a double-blind randomised controlled trial carried out in general practice, which would test this hypothesis. 50% of trial patients would stop taking statins for 5 years in an event driven study. The questionnaires aim to identify the attitudes of general practitioners (GPs) and ethics committee members (ECMs) regarding stopping statins for 5 years in patients aged 75 and older without diabetes or history of cardiovascular disease and their willingness to allow patients to participate in the 3S study.

Method

Questionnaires comprised of 6 questions were designed. 4 students distributed the questionnaire and it was completed by 19 GPs based at 8 practices in the North-East of England. 31 ECMs (12 expert and 19 lay) responded by email.

Results

95% of GPs who completed the survey would agree to their patients participating in the theoretical study with 47% of GPs indicating that their willingness to participate in the study is patient dependent. 95% of GPs would also consider stopping statins in this population group if sufficient research had been carried out or if the guidelines were changed. 42% of GPs have a negative attitude to prescribing statins in this population group. All the ECMs would approve the study, citing over-prescribing and polypharmacy as their reason.

Conclusions

The majority of GPs will participate in the theoretical 3S study, if their patients are willing to participate. There is already a negative perception amongst GPs towards the use of statins in elderly people without disease. The 3S study appears to be feasible from the GP and ethics perspective but would require a larger feasibility study.
132 Physical Function Comparison of Acutely Unwell COVID-Negative Older Adults Pre-Pandemic and Through-Pandemic; “Covid-Protected”
Authors: Ritchie S , Snape C , Triteos N , Vamadevan R , Olesk L , Wood C A , Jones G D , Jones J
Published: March 2021

Introduction

The risk of severe morbidity after COVID-19 infection is high in older adults (Lithander et al, 2020). Subsequent responsive UK Government guidance for older adults included self-isolation during the pandemic. It is therefore hypothesised that during the pandemic older adults are inadvertently deconditioned due to iatrogenic factors such as inactivity, social isolation, hospital-avoidance and malnutrition, and present with reduced resilience to illness and lower levels of function. The OPU continued to admit COVID-negative, or recently termed “COVID-protected”, patients throughout the pandemic. Data captured prior to, and during the COVID-19 pandemic has been compared to explore the implications on older adults, and elicit whether they are protected from the consequences of the pandemic?

Method

Demographic and physical function data (average 6 m gait-speed, Elderly Mobility Scale) were captured pre- and through-pandemic for all patients admitted to a COVID-negative OPU ward over a one month period. Ethical review was provided through local Trust governance process.

Results

Pre-pandemic 2019 (n = 67, mean(±SD) age 82.7(±8.2) years, 61%, hospital length-of-stay (LOS) 7.9(±7.3) days, hospital mortality-rate 7.2%) and through-pandemic 2020 (n = 73, 83.1(±8.3) years, 59%♀, LOS 9.0(±9.1) days, hospital mortality-rate 7.5%) data were captured during July 2019 and May 2020 respectively. There were no between-group differences in age [t(−.313) = 138, p = 0.755], gender [X2, 1 df, p = 0.782], LOS [t(0.78) = 134, p = 0.44], or hospital mortality-rate [X2 1 df, p = 0.96]. Through-pandemic patients had a significantly slower 6 m gait-speed (0.11(±0.05) m.s-1) than pre-pandemic (0.16(±0.24) m.s-1); [t(2.74) = 93, p = 0.007] and lower median (IQR) Elderly Mobility Scale (4(6 IQR) vs 9 (12 IQR) [u = 866, p = 0.015]).

Conclusion

Our data indicates this relatively short period of self-isolation might have significant implications on the physical function of older adults. The likely mechanism is iatrogenic deconditioning. Critical Public Health and policy responses are required to mitigate these unforeseen risks by deploying prehabilitative counter-measures and accurately targeted hospital and community rehabilitation.
MRI Analysis Of the Water Content Change In the Brain During Acute Ethanol Consumption Via Quantitative Water Mapping
Authors: Furtmann Johanna K , Sichtermann Thorsten , Oros-Peusquens Ana-Maria , Dekeyzer Sven , Shah Nadim J , Wiesmann Martin , Nikoubashman Omid
Published: March 2021

Aims

Alcohol consumption influences the water balance in the brain. While the impact of chronic alcohol misuse on cerebral water content has been the subject of several studies, less is known about the effects of acute alcohol misuse, with contradictory results in the literature. Therefore, we investigated the effects of acute alcohol intoxication on cerebral water content using a precise quantitative magnetic resonance imaging (MRI) sequence.

Methods

In a prospective study, we measured cerebral water content in 20 healthy volunteers before alcohol consumption and after reaching a breath alcohol concentration of 1 ‰. A quantitative MRI water mapping sequence was conducted on a clinical 3 T system. Non-alcoholic fluid input and output were documented and accounted for. Water content was assessed for whole brain, grey and white matter and more specifically for regions known to be affected by acute or chronic alcohol misuse (occipital and frontal lobes, thalamus and pons). Changes in the volume of grey and white matter as well as the whole brain were examined.

Results

Quantitative cerebral water content before and after acute alcohol consumption did not differ significantly (P ≥ 0.07), with changes often being within the range of measurement accuracy. Whole brain, white and grey matter volume did not change significantly (P ≥ 0.12).

Conclusion

The results of our study show no significant water content or volume change in the brain after recent alcohol intake in healthy volunteers. This accounts for the whole brain, grey and white matter, occipital and frontal lobes, thalamus and pons.
COVID-19 in Workplaces: Secondary Transmission
Authors: Sarti Donatella , Campanelli Tamara , Rondina Tommaso , Gasperini Beatrice
Published: March 2021

Objectives

Coronavirus disease (COVID-19) contagion at work is well studied for healthcare workers, however it is not enough assessed in other working settings. Very little is known, indeed, about the risk of COVID-19 transmission through occupational exposure in non-health working places. This study aims to describe a COVID-19 cluster among workers in an office in Italy.

Methods

This was a retrospective observational study on a cluster of COVID-19 that occurred from 20 November through 3 December 2020 in a group of six colleagues (A–F) working in the same office full time 5 days a week, 8 h a day. The workers used the following prevention measures: social distancing (desks were >1 m, 1.76–5.01 m range), plexiglas panels, hands disinfection, and use of face mask. However, they did not wear face mask when in static position sitting at their desk and they did not aerate the place frequently.

Results

The disease spread from one worker (subject A) to four (80%) of the five colleagues (subjects B–F). Only subject D was negative to COVID-19 on 14 days after last contact with subject A (20 November 2020) as confirmed by nasopharyngeal swab testing. Subject D, in particular, did not contact subject A in the 48 h before symptoms onset. COVID-19 positivity of subject A was promptly communicated to the colleagues, who started self-isolation from their relatives and none of their households were infected. COVID-19 transmission was observed only in households of subject A.

Conclusions

The rapid communication of COVID-19 positivity to the colleagues and the prompt isolation of index case’s close contacts allowed to eliminate the secondary transmission to their households. The contagion of index case’s colleagues occurred from second day before symptoms onset. Distancing of >1 m, use of plexiglass panels, sanitizing hand gel, and inconstant use of face mask may not be enough for infection prevention in closed places with poor ventilation and high occupancy.
Perception of Risk Among Aesthetic Plastic Surgeons
Authors: Sherif Rami D , Lisiecki Jeffrey , Gilman Robert H
Published: March 2021

Background

With continuous innovation in plastic surgery, new procedures are constantly being introduced. A number of these procedures are generally safe but have the potential for rare yet serious complications. Many surgeons steer clear of these procedures due to safety concerns.

Objectives

The aim of this paper was to survey the membership of The Aesthetic Society to elicit perception of risk of several novel or less mainstream procedures.

Methods

A 24-item survey was sent out to members of The Aesthetic Society. The survey focused on surgeon experience and attitude towards 3 procedures: filler rhinoplasty, gluteal augmentation with fat grafting, and submandibular gland excision.

Results

In total, 189 completed surveys were returned. Of the responders, 50%, 49%, and 89% of surgeons said they do not perform filler rhinoplasty, gluteal augmentation with fat grafting, or submandibular gland excision in their practices, respectively. The majority of those who do not perform the procedures selected “danger to the patient” as the primary concern for each of the 3 procedures. Surgeons overwhelmingly reported not learning these procedures in training. Additionally, surgeons perceive the risks of more common procedures such as abdominoplasty and breast augmentation-mastopexy to be significantly lower and more acceptable than those of the studied procedures.

Conclusions

When comparing the perceived complication rates with data published in the literature, particularly when looking at rates of serious or life-threatening complications, plastic surgeons overestimate the risks of procedures with which they are less familiar. This perception of risk, accompanied by the lack of exposure to novel techniques in training, may contribute to surgeons avoiding these procedures.
Multi-omics data integration and network-based analysis drives a multiplex drug repurposing approach to a shortlist of candidate drugs against COVID-19
Authors: Tomazou Marios , Bourdakou Marilena M , Minadakis George , Zachariou Margarita , Oulas Anastasis , Karatzas Evangelos , Loizidou Eleni M , Kakouri Andrea C , Christodoulou Christiana C , Savva Kyriaki , Zanti Maria , Onisiforou Anna , Afxenti Sotiroula , Richter Jan , Christodoulou Christina G , Kyprianou Theodoros , Kolios George , Dietis Nikolas , Spyrou George M
Published: March 2021

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is undeniably the most severe global health emergency since the 1918 Influenza outbreak. Depending on its evolutionary trajectory, the virus is expected to establish itself as an endemic infectious respiratory disease exhibiting seasonal flare-ups. Therefore, despite the unprecedented rally to reach a vaccine that can offer widespread immunization, it is equally important to reach effective prevention and treatment regimens for coronavirus disease 2019 (COVID-19). Contributing to this effort, we have curated and analyzed multi-source and multi-omics publicly available data from patients, cell lines and databases in order to fuel a multiplex computational drug repurposing approach. We devised a network-based integration of multi-omic data to prioritize the most important genes related to COVID-19 and subsequently re-rank the identified candidate drugs. Our approach resulted in a highly informed integrated drug shortlist by combining structural diversity filtering along with experts’ curation and drug–target mapping on the depicted molecular pathways. In addition to the recently proposed drugs that are already generating promising results such as dexamethasone and remdesivir, our list includes inhibitors of Src tyrosine kinase (bosutinib, dasatinib, cytarabine and saracatinib), which appear to be involved in multiple COVID-19 pathophysiological mechanisms. In addition, we highlight specific immunomodulators and anti-inflammatory drugs like dactolisib and methotrexate and inhibitors of histone deacetylase like hydroquinone and vorinostat with potential beneficial effects in their mechanisms of action. Overall, this multiplex drug repurposing approach, developed and utilized herein specifically for SARS-CoV-2, can offer a rapid mapping and drug prioritization against any pathogen-related disease.
Difference in surgical outcomes of rectal cancer by study design: meta-analyses of randomized clinical trials, case-matched studies, and cohort studies
Authors: Hoshino N , Sakamoto T , Hida K , Takahashi Y , Okada H , Obama K , Nakayama T
Published: March 2021

Background

RCTs are considered the standard in surgical research, whereas case-matched studies and propensity score matching studies are conducted as an alternative option. Both study designs have been used to investigate the potential superiority of robotic surgery over laparoscopic surgery for rectal cancer. However, no conclusion has been reached regarding whether there are differences in findings according to study design. This study aimed to examine similarities and differences in findings relating to robotic surgery for rectal cancer by study design.

Methods

A comprehensive literature search was conducted using PubMed, Scopus, and Cochrane CENTRAL to identify RCTs, case-matched studies, and cohort studies that compared robotic versus laparoscopic surgery for rectal cancer. Primary outcomes were incidence of postoperative overall complications, incidence of anastomotic leakage, and postoperative mortality. Meta-analyses were performed for each study design using a random-effects model.

Results

Fifty-nine articles were identified and reviewed. No differences were observed in incidence of anastomotic leakage, mortality, rate of positive circumferential resection margins, conversion rate, and duration of operation by study design. With respect to the incidence of postoperative overall complications and duration of hospital stay, the superiority of robotic surgery was most evident in cohort studies (risk ratio (RR) 0.83, 95 per cent c.i. 0.74 to 0.92, P < 0.001; mean difference (MD) –1.11 (95 per cent c.i. –1.86 to –0.36) days, P = 0.004; respectively), and least evident in RCTs (RR 1.12, 0.91 to 1.38, P = 0.27; MD –0.28 (–1.44 to 0.88) days, P = 0.64; respectively).

Conclusion

Results of case-matched studies were often similar to those of RCTs in terms of outcomes of robotic surgery for rectal cancer. However, case-matched studies occasionally overestimated the effects of interventions compared with RCTs.
Opportunities and challenges in partitioning the graph measure space of real-world networks
Authors: Józsa Máté , Lázár Alpár S , Lázár Zsolt I
Published: March 2021

Based on a large dataset containing thousands of real-world networks ranging from genetic, protein interaction and metabolic networks to brain, language, ecology and social networks, we search for defining structural measures of the different complex network domains (CND). We calculate 208 measures for all networks, and using a comprehensive and scrupulous workflow of statistical and machine learning methods, we investigated the limitations and possibilities of identifying the key graph measures of CNDs. Our approach managed to identify well distinguishable groups of network domains and confer their relevant features. These features turn out to be CND specific and not unique even at the level of individual CNDs. The presented methodology may be applied to other similar scenarios involving highly unbalanced and skewed datasets.
Liver-first strategy for a combined lung and liver transplant in patients with cystic fibrosis
Authors: Aburahma Khalil , Salman Jawad , Engel Bastian , Vondran Florian W R , Greer Mark , Boethig Dietmar , Siemeni Thierry , Avsar Murat , Schwerk Nicolaus , Müller Carsten , Taubert Richard , Hoeper Marius M , Welte Tobias , Wedemeyer Hans H , Richter Nicolas , Warnecke Gregor , Tudorache Igor , Haverich Axel , Kuehn Christian , Grannas Gerrit , Ius Fabio
Published: March 2021

OBJECTIVES

A combined lung and liver transplant in patients with cystic fibrosis (CF) is an uncommon procedure. The goal of this study was to compare long-term outcomes between patients with CF who underwent either a combined lung-liver or a lung-only transplant.

METHODS

This is a retrospective single-centre study of patients with CF who underwent a lung transplant between January 2005 and May 2020. Since 2006, our preference for a combined lung-liver transplant was to transplant the liver first and then the lung. Outcomes were compared using the Kaplan–Meier analysis and the log-rank test. Median follow-up was 53 (23–97) months.

RESULTS

During the study period, among 357 patients with CF who underwent a lung transplant, 14 (4%) required a lung-liver transplant whereas 343 (96%) had a lung-only transplant. Lung cold ischaemic time was longer in the lung-liver transplant group, but no patient in this group showed primary graft dysfunction at 72 h after the transplant. Prevalence of anti-human leucocyte antigen donor-specific antibodies was 7.1% vs 13.7% in the lung-liver versus the lung-only transplant group (P = 0.42). At 5 years, lung graft survival (78% vs 69%) and freedom from chronic lung allograft dysfunction (79% vs 62%) did not differ between the lung-liver versus the lung-only groups (P = 0.45 and P = 0.55, respectively). Freedom from lung biopsy-confirmed rejection was significantly higher in patients undergoing a lung-liver transplant (91% vs 50%; P = 0.027).

CONCLUSIONS

A lung-liver transplant did not impair lung graft function. The lower prevalence of donor-specific antibodies and the better freedom from lung biopsy-confirmed rejection suggest tolerogenic effects of the liver graft.
Exploring the potential of rapid evaporative ionization mass spectrometry (Intelligent Knife) for point-of-care testing in aortic surgery
Authors: Davies Hannah A. , Caamano-Gutierrez Eva , Sarsby Joscelyn , Nawaytou Omar , Harky Amer , Akhtar Riaz , Field Mark , Madine Jillian
Published: March 2021

OBJECTIVES

Many intraoperative decisions regarding the extent of thoracic aortic surgery are subjective and are based on the appearance of the aorta, perceived surgical risks and likelihood of early recurrent disease. Our objective in this work was to carry out a cross-sectional study to demonstrate that rapid evaporative ionization mass spectrometry (REIMS) of electrosurgical aerosol is able to empirically discriminate ex vivo aneurysmal human thoracic aorta from normal aorta, thus providing supportive evidence for the development of the technique as a point-of-care test guiding intraoperative surgical decision-making.

METHODS

Human aortic tissue was obtained from patients undergoing surgery for thoracic aortic aneurysms (n = 44). Normal aorta was obtained from a mixture of post-mortem and punch biopsies from patients undergoing coronary surgery (n = 13). Monopolar electrocautery was applied to samples and surgical aerosol aspirated and analysed by REIMS to produce mass spectral data.

RESULTS

Models generated from REIMS data can discriminate aneurysmal from normal aorta with accuracy and precision of 88.7% and 85.1%, respectively. In addition, further analysis investigating aneurysmal tissue from patients with bicuspid and tricuspid aortic valves was discriminated from normal tissue and each other with accuracies and precision of 93.5% and 91.4% for control, 83.8% and 76.7% for bicuspid aortic valve and 89.3% and 86.0% for tricuspid aortic valve, respectively.

CONCLUSIONS

Analysis of electrosurgical aerosol from ex vivo aortic tissue using REIMS allowed us to discriminate aneurysmal from normal aorta, supporting its development as a point-of-care test (Intelligent Knife) for guiding surgical intraoperative decision-making.
Within-stand temporal and spatial dynamics of tree neighbourhood density and species composition: even-agedvssingle-tree selection forests
Authors: Forrester David I
Published: March 2021

Tree neighbourhood conditions vary greatly through time for individual trees and throughout a forest at any given time. Therefore, many trees experience very different neighbourhood conditions to the stand mean. Although changes in stand density or species composition are often recommended to mitigate the effects of global change on forest functioning, these recommendations are often based on stand means and lack guidance on acceptable variability around the means or acceptable ranges in neighbourhood conditions. This study examined how the spatial and temporal variability in tree neighbourhood conditions varies between species and with stand structural characteristics. A trees neighbourhood, defined by all trees within a 10-m radius, was quantified in terms of basal area GN, relative height rhN (tree height divided by mean height of all trees in neighbourhood), species proportion PropN and species richness RN. Weibull functions were used to describe the frequency distributions of GN, rhN, PropN and RN within the stands. Equations were developed to describe the Weibull shape, scale and location parameters as functions of the species, stand basal area, mean tree diameter and management (even-aged vs single-tree selection forests). All of these variables significantly influenced the frequency distributions of neighbourhood characteristics. These equations can be used to show the proportion of trees experiencing significantly higher or lower values of a given characteristic than the stand mean or other threshold values relevant for management objectives. Single-tree selection forests had much greater ranges in neighbourhoods. There were also large temporal changes in tree neighbourhoods, especially in single-tree selection forests. Large trees had not experienced better neighbourhood conditions than smaller trees of approximately the same age, when considered over the long-term. Given that foresters typically consider tree neighbourhoods when marking trees for thinning, and that trees respond to tree neighbourhood conditions rather than to mean stand conditions, stand-level recommendations may be easier to transfer into practice and to interpret, when accompanied by neighbourhood-level information that indicates the distribution of neighbourhoods that actually exist within a stand.
The Genomic Architecture and Evolutionary Fates of Supergenes
Authors: Gutiérrez-Valencia Juanita , Hughes P William , Berdan Emma L , Slotte Tanja
Published: March 2021

Supergenes are genomic regions containing sets of tightly linked loci that control multi-trait phenotypic polymorphisms under balancing selection. Recent advances in genomics have uncovered significant variation in both the genomic architecture as well as the mode of origin of supergenes across diverse organismal systems. Although the role of genomic architecture for the origin of supergenes has been much discussed, differences in the genomic architecture also subsequently affect the evolutionary trajectory of supergenes and the rate of degeneration of supergene haplotypes. In this review, we synthesize recent genomic work and historical models of supergene evolution, highlighting how the genomic architecture of supergenes affects their evolutionary fate. We discuss how recent findings on classic supergenes involved in governing ant colony social form, mimicry in butterflies, and heterostyly in flowering plants relate to theoretical expectations. Furthermore, we use forward simulations to demonstrate that differences in genomic architecture affect the degeneration of supergenes. Finally, we discuss implications of the evolution of supergene haplotypes for the long-term fate of balanced polymorphisms governed by supergenes.
IX. Privilege
Authors: Munday Roderick
Published: March 2021

This chapter concerns privilege. A witness is ‘privileged’ when they may validly claim not to answer a question, or to supply information relevant to the determination of an issue in judicial proceedings. Because the effect is to deprive the tribunal of relevant evidence, powerful arguments are required for such rules. Modern law has reduced their number and scope, although this is arguably balanced by an increase in their status, which has been further enhanced by implementation of the European Convention on Human Rights (ECHR). This chapter discusses certain types of privilege: the privilege against self-incrimination, legal professional privilege, privilege for statements made without prejudice as part of an attempt to settle a dispute, and a privilege derived from the former for statements made to a conciliator.
XII. Hearsay in general
Authors: Munday Roderick
Published: March 2021

This chapter takes a look at the hearsay rule. Though it is one of the most complex and confusing of the exclusionary rules of evidence, the hearsay rule can be used as the background and foundation to understand the new statutory provisions for civil and criminal proceedings. The chapter first discusses the hearsay rule at the common law level, explaining why such an exclusionary rule was thought necessary. It also indicates the tenor of this rule's development and reform. Next, the chapter more closely examines the scope of the rule, implied assertions, res gestae, the rule against narrative, and the extent to which admissions constitute an exception to the rule.
Multi-OMICS study of a CHCHD10 variant causing ALS demonstrates metabolic rewiring and activation of endoplasmic reticulum and mitochondrial unfolded protein responses
Authors: Straub Isabella R , Weraarpachai Woranontee , Shoubridge Eric A
Published: March 2021

Mutations in CHCHD10, coding for a mitochondrial intermembrane space protein, are a rare cause of autosomal dominant amyotrophic lateral sclerosis. Mutation-specific toxic gain of function or haploinsufficiency models have been proposed to explain pathogenicity. To decipher the metabolic dysfunction associated with the haploinsufficient p.R15L variant, we integrated transcriptomic, metabolomic and proteomic data sets in patient cells subjected to an energetic stress that forces the cells to rely on oxidative phosphorylation for ATP production. Patient cells had a complex I deficiency that resulted in an increased NADH/NAD+ ratio, diminished TCA cycle activity, a reorganization of one carbon metabolism and an increased AMP/ATP ratio leading to phosphorylation of AMPK and inhibition of mTORC1. These metabolic changes activated the unfolded protein response (UPR) in the ER through the IRE1/XBP1 pathway, upregulating downstream targets including ATF3, ATF4, CHOP and EGLN3, and two cytokine markers of mitochondrial disease, GDF15 and FGF21. Activation of the mitochondrial UPR was mediated through an upregulation of the transcription factors ATF4 and ATF5, leading to increased expression of mitochondrial proteases and heat shock proteins. There was a striking transcriptional up regulation of at least seven dual specific phosphatases, associated with an almost complete dephosphorylation of JNK isoforms, suggesting a concerted deactivation of MAP kinase pathways. This study demonstrates that loss of CHCHD10 function elicits an energy deficit that activates unique responses to nutrient stress in both the mitochondria and ER, which may contribute to the selective vulnerability of motor neurons.
The Human Right to Suicide under International Law
Authors: Fellmeth Aaron , Abourahma Nourin
Published: March 2021

Suicide is a major global public health problem, but rarely is the subject viewed as a human right. With the sole exception of the European Court of Human Rights (ECtHR), no international authority has taken a strong position on whether a human right to suicide exists. Even that court’s jurisprudence goes no further than intimating that such a right falls within the scope of the human right to private life. This essay tackles the question of whether there is a human right to suicide under existing international law and, if so, what are its sources and limits. It concludes with an analysis of what obligations, both negative and positive, a right to suicide would impose on the state.
Should women receive luteal support following natural cycle frozen embryo transfer? A systematic review and meta-analysis
Authors: Mizrachi Yossi , Horowitz Eran , Ganer Herman Hadas , Farhi Jacob , Raziel Arieh , Weissman Ariel
Published: March 2021

BACKGROUND

Spontaneous ovulation during a natural menstrual cycle is frequently used for timing frozen embryo transfer (FET). Nevertheless, it remains unclear whether or not women should receive luteal phase support (LPS) following natural cycle frozen embryo transfer (NC-FET).

OBJECTIVE AND RATIONALE

The aim of this systematic review and meta-analysis was to study whether the administration of LPS improves the reproductive outcome following NC-FET.

SEARCH METHODS

We conducted a systematic search of the literature published in Medline/PubMed, Embase and the Cochrane Library, from January 2000 until December 2020. We included all original English, peer-reviewed articles, irrespective of the study design. The search strategy included keywords related to NC-FET and luteal phase support. Studies reporting the results of artificial or stimulated FET cycles were excluded.

OUTCOMES

Our systematic search generated 416 records. After screening, eight studies were included in the review and seven studies were included in the meta-analysis. Two studies (n = 858) used hCG and six studies (n = 1507) used progesterone for luteal support. Four studies were randomised controlled trials (RCTs), whereas the other four were historic cohort studies. In a meta-analysis using a random effects model, hCG administration for LPS did not increase the clinical pregnancy rate (CPR) (two studies, odds ratio (OR) 0.85, 95% CI 0.64–1.14). On the other hand, progesterone LPS was associated with a higher CPR (five studies, OR 1.48, 95% CI 1.14–1.94), and a higher live birth rate (LBR) (three studies, OR 1.67, 95% CI 1.19–2.36). The association between progesterone LPS and the LBR remained significant after excluding non-randomised studies.

WIDER IMPLICATIONS

The available evidence indicates that progesterone administration for LPS is beneficial following NC-FET. There is no evidence to support the administration of hCG for LPS in these cases. Additional large RCTs are necessary to improve the quality of evidence and validate our findings.
From the Cinema ‘Dekorator’ to the Cinema ‘Arkhitektor’: Set Design, Medium Specificity and Technology in Russian Cinema of the Silent Era.
Authors: Rees Eleanor
Published: March 2021

This article traces how understandings about the role of the cinema set designer—referred to in Russian as the khudozhnik (artist)—evolved across the 1910s and the 1920s in relation to broader artistic debates of the period. Drawing on archival material and articles published in the contemporary Russian and Soviet cinema press, it examines the changes in the cinema khudozhnik’s professional title and what these shifts in terminology reveal about differing conceptions of the scope and nature of the set designer’s role. The debate about the cinema khudozhnik related not only to the division of responsibilities among film-makers as the nascent Russian cinema industry developed and working practices became standardized. It was also connected to film-makers’ growing appreciation of cinema’s expressive potential as an art form and to how the emergent practice of cinema set design related to other creative disciplines, such as painting, the decorative arts, architecture and, from the 1920s, production art. Moreover, during the Soviet 1920s questions about the cinema khudozhnik’s role became associated with broader concerns about what it meant to be a creative practitioner working in a collaborative context and to the value ascribed to such qualities as technological expertise and versatility in early-Soviet ideology.