bluuebunny/crossref_metadata_2025 huggingface dataset:
The Circadian Response to Evening Light Spectra in Early Childhood: Preliminary Insights
Authors: Hartstein Lauren E. , Wright Kenneth P. , Diniz Behn Cecilia , Stowe Shelby R. , LeBourgeois Monique K.
Published: January 2025

Although the sensitivity of the circadian system to the characteristics of light (e.g., biological timing, intensity, duration, spectrum) has been well studied in adults, data in early childhood remain limited. Utilizing a crossover, within-subjects design, we examined differences in the circadian response to evening light exposure at two different correlated color temperatures (CCT) in preschool-aged children. Healthy, good sleeping children ( n = 10, 3.0-5.9 years) completed two 10-day protocols. In each protocol, after maintaining a stable sleep schedule for 7 days, a 3-day in-home dim-light circadian assessment was performed. On the first and third evenings of the in-home protocol, dim-light melatonin onset (DLMO) was assessed. On the second evening, children received a 1-h light exposure of 20 lux from either 2700 K (low CCT) or 5000 K (high CCT) (~9 and ~16 melanopic equivalent daylight illuminance (mEDI lux), respectively) centered around their habitual bedtime. Children received the remaining light condition during their second protocol, with the order counterbalanced across participants. Salivary melatonin was collected to compute melatonin suppression and circadian phase shift resulting from each experimental light condition. Melatonin suppression across the 1-h light stimulus was significantly greater during exposure to the high CCT light ( M = 56.3%, SD = 19.25%) than during the low CCT light ( M = 23.90%, SD = 41.06%). Both light conditions resulted in marked delays of circadian timing, but only a small difference ( d = −0.25) was observed in the delay between the 5000 K ( M = 35.3 min, SD = 34.3 min) and 2700 K ( M = 26.7 min, SD = 15.9 min) conditions. Together, these findings add to a growing literature demonstrating high responsivity of the circadian clock to evening light exposure in early childhood and provide preliminary evidence of melatonin suppression sensitivity to differences in light spectrum in preschool-aged children.
The (Mis)Informed Consent and The Forgotten Doctor-Patient Relationship
Authors: Baeke John L.
Published: January 2025

The simple informed consent and a strong doctor-patient relationship may be the surgeon’s best tools for avoidance of malpractice claims, yet this powerful duo continues to receive little attention by our educators. This institutional oversight results in hugely inflated insurance premiums and needless heartache for surgeons and patients/families alike. What constitutes the standard of care for a proper elective surgical informed consent, plus a few pearls on the doctor-patient relationship shall be presented.
Purposeful Pathways: An Integrative Career Development Intervention for Vocational, Mental Health, and Substance Use Recovery
Authors: Stevenson Brian J. , Reed Cheyenne , Falcón Amanda , Hunt Taylor , Kathawalla Ummul-Kiram , Mueller Lisa , McNary Kelley , Wilkins Sarah , Blustein David
Published: January 2025

Veterans who are unemployed and living with mental health or substance use conditions are in need of integrative interventions that support their career development, mental wellness, and sobriety. However, career development interventions are often developed and implemented separate from mental health services. This paper introduces a novel intervention that supports career development of veterans with mental health and substance use concerns: Purposeful Pathways. This paper presents the results from three phases of intervention development: (1) retreats with clinical and vocational psychology experts ( n = 13) to develop the theoretical mechanisms of Purposeful Pathways, (2) focus groups with Veterans Health Affairs vocational counselors ( n = 6) who provide employment services to veterans with mental health conditions, and (3) an open trial in which veterans with mental health conditions ( n = 10) received Purposeful Pathways and provided feedback. Descriptions of the iterative processes of developing the Purposeful Pathways intervention are presented as a model for developing vocational interventions.
MAFA-Uformer: Multi-attention and dual-branch feature aggregation U-shaped transformer for sparse-view CT reconstruction
Authors: Zhang Xuan , Fang Chenyun , Qiao Zhiwei
Published: January 2025

Background

Although computed tomography (CT) is widely employed in disease detection, X-ray radiation may pose a risk to the health of patients. Reducing the projection views is a common method, however, the reconstructed images often suffer from streak artifacts.

Purpose

In previous related works, it can be found that the convolutional neural network (CNN) is proficient in extracting local features, while the Transformer is adept at capturing global information. To suppress streak artifacts for sparse-view CT, this study aims to develop a method that combines the advantages of CNN and Transformer.

Methods

In this paper, we propose a Multi-Attention and Dual-Branch Feature Aggregation U-shaped Transformer network (MAFA-Uformer), which consists of two branches: CNN and Transformer. Firstly, with a coordinate attention mechanism, the Transformer branch can capture the overall structure and orientation information to provide a global context understanding of the image under reconstruction. Secondly, the CNN branch focuses on extracting crucial local features of images through channel spatial attention, thus enhancing detail recognition capabilities. Finally, through a feature fusion module, the global information from the Transformer and the local features from the CNN are integrated effectively.

Results

Experimental results demonstrate that our method achieves outstanding performance in terms of peak signal-to-noise ratio (PSNR), structural similarity (SSIM), and root mean square error (RMSE). Compared with Restormer, our model achieves significant improvements: PSNR increases by 0.76 dB, SSIM improves by 0.44%, and RMSE decreases by 8.55%.

Conclusion

Our method not only effectively suppresses artifacts but also better preserves details and features, thereby providing robust support for accurate diagnosis of CT images.
A case of acquired syphilis in an infant through mouth-to-mouth transmission of prechewed food
Authors: Feng Sen , Zhu Qing , Ren Mingyuan , Miao Guoying , Zhang Guoqiang
Published: January 2025

Background

Patients with syphilis are the only source of infection, which can be transmitted through sexual contact and mother-to-child and blood transmission, and rarely through contaminants. The clinical manifestations of syphilis are complex and variable, and can be easily misdiagnosed. This article reports a case of syphilis in a child with “psoriasis”-like lesions who was fed pre-chewed food.

Case presentation

An 18-month-old girl presented with mung bean to peanut-sized erythema and papules scattered on both lower limbs and perianal area; some of the erythema was covered with scales, with clear boundaries and no fusion. The case was misdiagnosed as “psoriasis” in the local hospital until the child and her mother tested positive for syphilis in the outpatient clinic of our hospital. The girl’s mother had a habit of chewing food in her mouth before feeding it to her child.

Conclusions

Consumption of food chewed by a person with syphilis can lead to infection, and attention should be paid to the possible ways and means of being infected.
The limits to growth(ism) in ChatGPT—corpus assisted discourse studies in AI-generated texts
Authors: Szczepanik Radosław Jan
Published: January 2025

The release of ChatGPT in 2022 has caused many concerns about the unpredictable consequences of popular AI usage in education, business, and other areas of human life. Some media have speculated about the adverse effects of AI on human communication, discourse, and even cognition, although the scholarly evidence to either confirm or dismiss such claims is very limited. In order to bridge this knowledge gap, the following article was designed as a corpus-assisted study of discourse in ChatGPT-generated texts, making it one of the first inquiries into AI discourse to date. The study analyzes the growthist bias in ChatGPT (4o version) and a possible methodology of reliable detection and measurement of bias in AI using corpus tools. Two differently composed corpora of the responses of ChatGPT in the semantic domain of the economy are studied quantitatively through the generation and statistical comparison of word frequency lists, keywords, and other measures. This procedure serves to objectify the qualitative analysis data, as well as to outline the size and range of bias. The results of the critical analysis of AI discourse and biases is treated as the crucial ground for any global discussion of AI impact on human discourse, as well as for the speculation on the ideological stance of the source information used for the initial training of the chatbot.
Marcello Malpighi (1628–1694): His life, discoveries and struggles with the detractors of microscopic anatomy
Authors: Nicosia Roberto F
Published: January 2025

Marcello Malpighi is widely recognized as the founder of microscopic anatomy. His seminal discoveries of the pulmonary alveoli, blood capillaries, and renal glomeruli revolutionized existing medical knowledge, earning him fame and international recognition. He discovered the respiratory system of insects and described, for the first time, their excretory apparatus. He laid the foundations of modern embryology by characterizing the early stages of organ development in the chick embryo and was among the first to study the anatomy and biology of plants. Malpighi also faced family challenges, including his younger brother's involvement in a homicide, and relentless attacks by followers of traditional medicine. The purpose of this paper is to revisit Malpighi's extraordinary life and works, focusing on his struggles with detractors, who questioned the usefulness of his microscopic observations and resisted the new ideas of modern medicine.
Efficacy of Menstrual Leave in the Workplace: Law and the Changing Discourse on Gender in India
Authors: Bhandari Asha
Published: January 2025

This paper contextualises the ongoing debate in India on menstrual leave and the need to integrate physiological differences into workplace policies. The effort has been to analyse different physiological constitutions in the workforce, various menstruation experiences, and current inequitable workplace policies and legal provisions. Also provided is an explanation of menstruation from the perspectives of Ayurveda and allopathy, as well as a presentation of medico-legal opinions. The impact policies have on workforce participation is examined in addition to the basic arguments associated with the debate. They are supplemented by the responses of employers and employees in the organised and unorganised sectors in India. Based on this analysis, some measures are suggested for inclusion in leave policies in both the organised and the unorganised sectors in India with the aim of achieving gender equity and gender diversity; they may also be appropriate in other countries that have similar cultural contexts and labour laws.
Peliosis hepatis and hepatic fibrosis in a dog infected with multiple Bartonella species
Authors: Robveille Cynthia , Atkinson Cody , Cowart Jerry , Maggi Ricardo G. , Narurkar Neelesh , Breitschwerdt Edward B.
Published: January 2025

A 13-y-old, spayed female dog had regenerative anemia, lymphopenia, hypoalbuminemia, and elevated hepatic biochemical parameters. Liver biopsy revealed hepatic peliosis (hepatic sinusoidal angiectasis), frequently associated with perisinusoidal fibrosis. The dog was seroreactive to Bartonella antigens by indirect fluorescent antibody assays, and quantitative PCR from blood identified Bartonella vinsonii subsp. berkhoffii genotype II. The dog was euthanized 9 mo later because of acute decompensation. Autopsy revealed icteric adipose tissues, end-stage liver, and abdominal effusion. Microscopically, there was marked mixed-cell chronic hepatitis with hepatocellular loss, nodular hepatocellular regeneration, and capillary proliferation. Retrospective molecular testing documented B. koehlerae and B. rochalimae DNA in the dog’s blood at 2 or more times during liver disease progression. B. koehlerae DNA was also amplified and sequenced from the autopsy sample of liver. Our case emphasizes that Bartonella infection may be associated with hepatic peliosis and end-stage liver in dogs and expands the spectrum of Bartonella species that potentially play a role in canine hepatic diseases.
Palliative Medicine Consultation Reduces Readmission Significantly in Certain Diagnoses: A Retrospective Analysis
Authors: Depew Carissa N. , Wood Michelle , Walden Jason , Stevens Amanda , Williamson Michaela , Peshin Supriya , McDonald Eric , Rashid Saima , Baumrucker Steven J.
Published: January 2025

Hospital readmissions within 30 days are a significant concern due to their negative impact on patient outcomes and healthcare system costs.1 This retrospective study explores the impact of palliative medicine consultation on reducing readmission rates for patients with severe, life-limiting illnesses. Real-world data from a 21-hospital system was analyzed for six specific diagnoses, including heart failure, sepsis, pneumonia, and chronic obstructive pulmonary disease. The study found a statistically significant reduction in readmissions for patients with sepsis, pneumonia, heart failure and (to a lesser extent) stroke who received palliative medicine consultation compared to those who did not. The findings suggest that palliative medicine consultation for these patients leads to reduced readmission and implies potential improved quality outcomes and cost savings. This study highlights the potential of palliative medicine as a multifactorial approach to reduce readmissions and potentially improve patient outcomes in the future.
Exploring Cortical Interneurons in Substance Use Disorder: From Mechanisms to Therapeutic Perspectives
Authors: Shi Sai , Chen Tianzhen , Su Hang , Zhao Min
Published: January 2025

Interneurons (INs) play a crucial role in the regulation of neural activity within the medial prefrontal cortex (mPFC), a brain region critically involved in executive functions and behavioral control. In recent preclinical studies, dysregulation of INs in the mPFC has been implicated in the pathophysiology of substance use disorder, characterized by vulnerability to chronic drug use. Here, we explore the diversity of mPFC INs and their connectivity and roles in vulnerability to addiction. We also discuss how these INs change over time with drug exposure. Finally, we focus on noninvasive brain stimulation as a therapeutic approach for targeting INs in substance use disorder, highlighting its potential to restore neural circuits.
The accuracy of a patient-specific femoral planning and delivery system for total hip arthroplasty
Authors: Jennings Jason M , Jones Tristan , Madurawe Chameka S , Pierrepont Jim , Abila Paula , Dennis Douglas A
Published: January 2025

Introduction:

A primary objective when performing a total hip arthroplasty (THA) is to restore hip biomechanics in accordance with a chosen surgical plan. The aim of this study was to assess the accuracy of a 3D-printed patient-specific guide for delivering a planned femoral osteotomy for both a posterior and an anterior approach.

Methodology:

40 patients (20 anterior and 20 posterior) scheduled for THA received a preoperative work-up allowing for patient-specific implant sizing and positioning. Following surgeon confirmation, a patient-specific guide was designed and printed, enabling the desired osteotomy to be executed. Achieved osteotomies were assessed using commercially available software platforms. Planning accuracy was also assessed using both the planning platform as well as more traditional 2D-templating techniques.

Results:

The mean deviation between the planned and achieved osteotomy level was −0.6 mm (range −4.1–6.4 mm). 95% of the achieved osteotomy levels were within 3 mm of the plan for both the posterior and anterior approach groups. 70% of the Optimized Positioning System (OPS) planned femoral components were the exact size as planned versus 25% of the 2D-planned components. 98% of the OPS planned femoral components were within 1 size of plan versus 58% for the 2D-planned components. No sizing accuracy difference was observed between planning approaches ( p = 0.70).

Conclusions:

A patient-specific osteotomy guide can be a simple and accurate method to reproduce a planned femoral neck resection through an anterior or posterior approach. Further, 3D planning appears to more accurately predict femoral sizing in THA than more conventional 2D methods.
Zuyderland Hip Inference for Survival and Lifetime Expectancy (ZHISLE) following hip fracture surgery: validation of the model that demonstrated good predictive power
Authors: Vesseur Maud A M , Quaedvlieg Lars , Schotanus Martijn G M , Most Jasper , Bouwman Lee H , van Vugt Raoul , Boonen Bert
Published: January 2025

Purpose:

Proximal femoral fractures are common within the elderly population and are associated with a high risk of mortality and reduced quality of life. Hemiarthroplasty or osteosynthesis (extramedullary or intramedullary) is the primary treatment option for these fractures. However, within this fragile patient population many comorbidities, among others dementia, are seen. Therefore, predicting patients with a high mortality risk after surgery may lead to adopting alternative treatment options with less risks. This paper proposes a new model to distinguish patients with high postoperative mortality risk with adequate follow-up time in combination with a wide set of useful and available variables.

Methods:

Patients treated with hemiarthroplasty or osteosynthesis for proximal femoral fractures were studied, with a follow-up period of 6 months. Patients who died within this follow-up period were compared to survivors, and predicting variables were assessed in logistic regression: The Zuyderland Hip Inference for Survival and Lifetime Expectancy (ZHISLE). The model was validated internally against a held-out dataset. Furthermore, the model performance was compared against the Almelo Hip Fracture Score (AHFS) on the same sample.

Results:

Out of 2463 patients undergoing surgical treatment for proximal femoral fractures, 415 (16.8%) died within 183 days. Predictors for early mortality included old age, male sex, high heartbeat, KATZ-ADL and GFI scores, C-reactive protein and urea concentrations and low albumin concentration. Our model showed satisfactory predictive and discriminatory power (ROC curve = 0.81). Internal validation was good (ROC in validation dataset = 0.81), and better than the AHFS (ROC = 0.57).

Conclusions:

The ZHISLE model demonstrates good predictive power concerning mortality risk for old patients with a proximal femoral fracture. The model could benefit patients by indicating if a conservative, non-invasive policy might be a better option for those patients.
A non-systematic overview review of self-focused emotion regulation in autistic individuals through the lens of the extended process model
Authors: Cai Ru Ying , Samson Andrea C
Published: January 2025

Difficulties regulating emotions have been coined as inherent to autism, possibly even presenting a core difficulty of autism. While several models of emotion regulation have been proposed in the past, in this targeted review article, we aim to map emotion regulation difficulties in autistic individuals within the framework of the extended process model of emotion regulation. This model can be considered the most comprehensive one currently incorporating not only different emotion regulation strategy groups but also different stages and processes involved in successful self-focused emotion regulation. Within this model, we will identify areas and domains as specifically impacted by autistic individuals. We will also outline gaps in the literature and provide suggestions for future research that can help deepen our understanding of the emotion regulation processes of autistic individuals. The ultimate goal is to develop specific support programs that address specific emotion regulation mechanisms, providing a much more individualized support approach.

Lay abstract

What do we already know about emotion regulation in autism? We know that many autistic children, youth, and adults experience difficulties regulating emotions. Existing research has focused mainly on the differences in emotion regulation capabilities between autistic and non-autistic individuals, the relationships between autistic traits and emotion regulation, and how emotion regulation relates to other outcomes, such as social skills and mental health. What does this paper add? We want to take a new approach to review the existing emotion regulation research through the lens of a specific theoretical model: the extended process model of emotion regulation. Professor James Gross developed this model. It consists of four emotion regulation phases: identification, selection, implementation, and monitoring. Our review revealed specific areas within these emotion regulation phases that could significantly impact the emotion regulation experiences of autistic individuals. We also outline the gaps in the research and propose avenues for future investigation. Implications for practice By deepening our understanding of emotion regulation in autistic individuals through the proposed future research, researchers and clinicians can pave the way for the development of tailored support programs. These programs will directly target specific emotion regulation mechanisms, offering a much-needed individualized support approach.
Theories of mind and trauma after war in Uganda
Authors: Williams Lars , Luhrmann Tanya Marie
Published: January 2025

After years of armed conflict in northern Uganda, many local people have turned to Evangelical churches for help with healing and recovery. We observe that the healing practices in these churches encourage particular notions of what the mind is, how the mind works and whether it is bounded or porous to the outside world. In the traditional cultural setting in which these people grew to adulthood, many accept that vengeance can attack supernaturally from without. Based on ethnographic research conducted in the region between 2015 and 2025, this article argues that these new ideas about mind (broadly conceived) may help some community members recover (to some extent) from traumatic experiences arising from the armed conflict by modeling trauma as not supernatural, and modeling the mind as protected by God from attack. Learning a new way of understanding the mind and its boundaries with the outside world—e.g., as more closed and bounded—and learning to practice a certain amount of control over this boundary, may have a significant effect on the experiences of mental distress This argument contributes to debates on anthropology of mind, and on the way local theories of mind may shape mental experience.
Chinese medicine as a cure for gayness: Satire as countercultural resistance against heteronormative symbolic violence in digital public sphere
Authors: He Renyi , Chang Jiang
Published: January 2025

One significant outcome of the heteronormative symbolic violence experienced by Chinese gay people is their symbolic erasure from public discourse. Such symbolic violence is sustained by state-sponsored heteronormative ideology, adding to the weight gender minorities have to bear under non-authoritarian political contexts. Since late 2025, a novel form of resistance has gained popularity wherein gay people post and widely circulate videos that mockingly boast the idea of taking traditional Chinese medicine to “cure” their deviant sexuality on Douyin, the Chinese version of TikTok. This study discusses how Chinese gay people use satire to make themselves, their critique of state propaganda for traditional Chinese medicine, and disdain for heteronormative culture visible in the highly censored digital environment, thereby countering the symbolic violence that silences the gay community in public life. The analysis also invites reflection on the role and impact of satire as a tool of digital resistance.
The association of high-density lipoprotein cargo proteins with brain volume in older adults in the Atherosclerosis Risk in Communities (ARIC)
Authors: Li Danni , An Binchong , Men Lu , Glittenberg Matthew , Lutsey Pamela L , Mielke Michelle M , Yu Fang , Hoogeveen Ron C , Gottesman Rebecca , Zhang Lin , Meyer Michelle , Sullivan Kevin , Zantek Nicole , Alonso Alvaro , Walker Keenan A
Published: January 2025

Background

High-density lipoprotein (HDL) modulates the blood-brain barrier and cerebrovascular integrity, likely influencing the risk of Alzheimer's disease (AD), neurodegeneration, and cognitive decline.

Objective

This study aims to identify HDL protein cargo associated with brain amyloid deposition and brain volume in regions vulnerable to AD pathology in older adults.

Methods

HDL was separated from the plasma of 65 non-demented participants of the Atherosclerosis Risk in Communities (ARIC) study using a fast protein liquid chromatography method. HDL cargo proteins were measured using a label-free, untargeted proteomic method based on mass spectrometry and data-independent acquisition. Linear regression with multiple imputations assessed the associations between each HDL cargo protein (log2-transformed) and brain amyloid deposition or temporal-parietal meta-ROI volume, adjusting for covariates.

Results

The mean (SD) age of the participants was 76.3 (5.4) years old, 53.8% (35/65) female, 30.8% (20/65) black, and 28.1% (18/64, 1 missing) APOE4 carriers. We found few HDL cargo proteins associated with brain amyloid deposition and considerably more HDL cargo proteins associated with temporal-parietal meta-ROI volume. Two HDL cargo proteins mostly associated with temporoparietal meta-ROI volume were fibrinogen B (FGB) and plasminogen (PLG). A doubling of FGB in HDL was associated with a greater temporoparietal meta-ROI volume of 1638 mm3 (95% CI [688, 2589]). In comparison, a doubling of PLG in HDL was associated with a lower temporoparietal meta-ROI of 2025 mm3 (95% CI [-3669, −1034]).

Conclusions

This study suggests that HDL cargo proteins associated with temporal-parietal meta-ROI volume are involved in complement and coagulation pathways.
Unveiling neural activity changes in mild cognitive impairment using microstate analysis and machine learning
Authors: Wu Xiaotian , Liu Yanli , Che Jiajun , Cheng Nan , Wen Dong , Liu Haining , Dong Xianling
Published: January 2025

Background

Mild cognitive impairment (MCI) is recognized as a condition that may increase the risk of developing Alzheimer's disease (AD). Understanding the neural correlates of MCI is crucial for elucidating its pathophysiology and developing effective interventions. Electroencephalogram (EEG) microstates, reflecting brain activity changes, have shown promise in MCI research. However, current approaches often lack comprehensive characterization of the complex neural dynamics associated with MCI.

Objective

This study aims to investigate neurophysiological changes associated with MCI using a comprehensive set of microstate features, including traditional temporal features and entropy measures.

Methods

Resting-state EEG data were collected from 69 MCI patients and healthy controls (HC). Microstate analysis was performed to extract conventional features (duration, coverage) and entropy measures. Statistical analysis, principal component analysis (PCA), and machine learning (ML) techniques were employed to evaluate neurophysiological patterns associated with MCI.

Results

MCI displayed altered microstate dynamics, with significantly longer coverage and duration in Microstate C but shorter in Microstates A, B, and D compared to HCs. PCA revealed two principal components, primarily composed of microstate dynamics and entropy measures, explaining over 75% of the variance. ML models achieved high accuracy in distinguishing MCI patterns.

Conclusions

Our comprehensive analysis of EEG microstate features provides new insights into neurophysiological changes associated with MCI, highlighting the potential of EEG microstates for investigating complex neural changes in cognitive decline.
Medications and cognitive decline in Alzheimer's disease: Cohort cluster analysis of 15,428 patients
Authors: Grau-Jurado Pol , Mostafaei Shayan , Xu Hong , Mo Minjia , Petek Bojana , Kalar Irena , Naia Luana , Kele Julianna , Maioli Silvia , Pereira Joana B , Eriksdotter Maria , Chatterjee Saikat , Garcia-Ptacek Sara
Published: January 2025

Background

Medications for comorbid conditions may affect cognition in Alzheimer's disease (AD).

Objective

To explore the association between common medications and cognition, measured with the Mini-Mental State Examination.

Methods

Cohort study including persons with AD from the Swedish Registry for Cognitive/Dementia Disorders (SveDem). Medications were included if they were used by ≥5% of patients (26 individual drugs). Each follow-up was analyzed independently by performing 100 Monte-Carlo simulations of two steps each 1) k-means clustering of patients according to Mini-Mental State Examination at follow-up and its decline since previous measure, and 2) Identification of medications presenting statistically significant differences in the proportion of users in the different clusters.

Results

15,428 patients (60.38% women) were studied. Four clusters were identified. Medications associated with the best cognition cluster (relative to the worse) were atorvastatin (point estimate 1.44 95% confidence interval [1.15–1.83] at first follow-up, simvastatin (1.41 [1.11–1.78] at second follow-up), warfarin (1.56 [1.22–2.01] first follow-up), zopiclone (1.35 [1.15–1.58], and metformin (2.08 [1.35–3.33] second follow-up. Oxazepam (0.60 [0.50–0.73] first follow-up), paracetamol (0.83 [0.73–0.95] first follow-up), cyanocobalamin, felodipine and furosemide were associated with the worst cluster. Cholinesterase inhibitors were associated with the best cognition clusters, whereas memantine appeared in the worse cognition clusters, consistent with its indication in moderate to severe dementia.

Conclusions

We performed unsupervised clustering to classify patients based on their current cognition and cognitive decline from previous testing. Atorvastatin, simvastatin, warfarin, metformin, and zopiclone presented a positive and statistically significant associations with cognition, while oxazepam, cyanocobalamin, felodipine, furosemide and paracetamol, were associated with the worst cluster.
The role of mortality salience in tourism marketing messages during a global health crisis
Authors: Deng Tao , Chu Shu-Chuan , Stafford Marla R , Cheng Hong
Published: January 2025

Terror Management Theory suggests that health messages can trigger mortality thoughts, influencing consumer behavior. Two studies were conducted to explore this mortality salience effect in the context of travel marketing during a pandemic. Findings from Study 1 showed that health-focused travel ads led to more mortality thoughts and increased travel intentions. Both low and high levels of these thoughts boosted travel intentions, while moderate levels deterred them. Drawing on Protection Motivation Theory, Study 2 examined the roles of trust in destination and perceived health risk in the effects of message-induced mortality-related thoughts on travel intentions. Travel ads that evoked mortality thoughts encouraged both domestic and international travel when health risks were perceived as low, but discouraged it when risks were high. Furthermore, the findings suggest that trust in the destination can mitigate the negative effects of mortality-related thoughts. This study offers insights into consumer reactions to health-related travel ads, with both theoretical and practical implications.
AN EVIDENCE-BASED APPROACH TO PREVENTING HEALTHCARE-ASSOCIATED INFECTIONS IN THE ELDERLY -THE EPIC INITIATIVE IN ENGLAND
Authors: Pratt R
Published: January 2025

The prevalence of healthcare-associated infections (HAIs) in the NHS hospitals, community and primary care services continues unabated, increasing costs, morbidity and causing profound patient dissatisfaction. Following the introduction of healthcare governance in the NHS, the need to develop more clinically effective approaches to preventing infections has become urgent. National evidence-based guidelines are now being developed and implemented in NHS Trusts in England. The experience of developing and implementing these guidelines is described, along with other initiatives designed to enhance the evidence base for infection prevention and control.
Traveller’s diarrhoea ‘Travel broadens the mind but opens the bowels’
Authors: Welsby PD
Published: January 2025

Traveller’s diarrhoea is a common problem. This article features the daignosis and management of dirrahoea in returned travellers to the UK. Treatment is essentially fluid replacement, bed rest if there is much colic, exclusion from work in certain infections, and antibiotics in certain situations.
Adolf Hitler’s medical care
Authors: Doyle D
Published: January 2025

For the last nine years of his life Adolf Hitler, a lifelong hypochondriac had as his physician Dr Theodor Morell. Hitler's mood swings, Parkinson’s disease, gastro-intestinal symptoms, skin problems and steady decline until his suicide in 1945 are documented by reliable observers and historians, and in Morell’s diaries. The bizarre and unorthodox medications given to Hitler, often for undisclosed reasons, include topical cocaine, injected amphetamines, glucose, testosterone, estradiol, and corticosteriods. In addition, he was given a preparation made from a gun cleaner, a compound of strychnine and atropine, an extract of seminal vesicles, and numerous vitamins and ‘tonics’. It seems possible that some of Hitler’s behaviour, illnesses, and suffering can be attributed to his medical care. Whether he blindly accepted such unorthodox medications or demanded them is unclear.
A nineteenth-century Scottish medical family: the Coghills
Authors: Boyd DHA
Published: January 2025

In the nineteenth century, the Highlands of Scotland provided many people to the medical profession. One such person, Dr JGS Coghill, served in the Crimean War, was an early European doctor and traveller in China and Japan, had a brief association with Sir JY Simpson and obstetrics, and finally served the Royal National Hospital for Consumption,Ventnor, in the field of tuberculosis until his death. Four members of his family also became doctors, two of whom served overseas.
Incidence of Scottish Lyme disease appears to be related to the effects of weather on tick survival and human behaviour
Authors: Mavin S , Joss AWL , Ho-Yen DO
Published: January 2025

This paper investigates the annual variation in the Lyme disease infection rates seen in different areas of Scotland from 1999 to 2003. We suggest that the combination of a warm, wet January to March (aiding tick survival) and a dry April to July (favouring increased human exposure) explained the increased incidence of Lyme disease observed in certain years during the study period. Human behavioural changes brought about by the countryside access restrictions enforced during the Foot and Mouth disease epidemic may have had an additional influence on the incidence of Lyme disease in the East of Scotland during 2001. This paper helps in our understanding of Scottish Lyme disease.
Goat's rue – French lilac – Italian fitch – Spanish sainfoin: gallega officinalis and metformin:The Edinburgh connection
Authors: Hadden DR
Published: January 2025

The hypoglycaemic drug metformin is derived from galegine, which is found naturally in Goat’s rue (gallega officinalis). This plant is speading northwards in the UK.
Anaerobiospirillum succiniciproducens bacteraemia
Authors: Inverarity D , Ferguson M , Smith A , Thakker B , Morris J , Wade W
Published: January 2025

We describe a case of A. succiniciproducens bacteraemia in a thirty-fouryear-old man with decompensated chronic liver disease associated with a fatal outcome. A. succiniciproducens infections are rare. The organism has distinctive spiral morphology on Gram staining and unlike most other spiral bacteria, it is able to grow in blood cultures and on blood agar. It is a strict anaerobe but demonstrates metronidazole resistance. An appreciation of this resistance is necessary for an appropriate initial choice of antibiotic therapy. Often there is a poor response even to appropriate antibiotic therapy and there is a high associated mortality. A. succiniciproducens infections are considered to be zoonotic.
Per rectum: a history of enemata
Authors: Doyle D
Published: January 2025

Enemas and clysters have been administered since before recorded history, using instruments ranging from cow horns and hollowed out bamboo shoots to metal syringes to inject laxatives, herbs, opium, turpentine, tobacco, oxygen and noxious chemicals. The potentially lethal dangers are today well recognised. The rectal route, now less often used for laxative enemas is still proving useful for other medications, increasingly in suppository form.
The excoriation of Benjamin Bell: who was ‘Jonathan Dawplucker’?
Authors: Kaufman MH
Published: January 2025

Because of a perceived lack of continuity of care of the surgical patients in the Edinburgh Royal Infirmary, James Gregory, one of its managers, suggested that from 1800 a total of only six surgeons should be appointed full-time to that institution. As considerable animosity existed between Gregory and John Bell, a senior Edinburgh teacher and surgeon, a pamphlet that was extremely hostile to his activities was posted in prominent locations throughout Edinburgh. While the author was named as ‘Jonathan Dawplucker’ it was speculated that Gregory, or one of his close associates, was its real author. The contents of a second Dawplucker pamphlet, in the same style, but probably written by John Bell, was subsequently published. This was extremely hostile to Benjamin Bell, one of Gregory’s close surgical colleagues. While much distress was caused at that time, the real authors of these pamphlets are unlikely ever to be established.
Update on musculoskeletal ultrasonography
Authors: Keen HI , Brown AK , Wakefield RJ , Conaghan PG
Published: January 2025

Rheumatologists are increasingly utilising MUS in both the research setting and in clinical practice. Factors such as improvements in image quality and decreasing cost of machines have made MUS more accessible in the routine clinical care setting.

Musculoskeletal ultrasonography is an attractive tool, as it is portable and can be used in the outpatient clinic, allowing multiple joints to be imaged in a single visit. In contrast to conventional radiography, it allows multiplanar imaging of soft tissue structures, such as tendons and synovium, as well as providing information about articular integrity. As MUS does not require ionising radiation or contrast agents, it can be used repeatedly to monitor temporal changes. However, as with all imaging techniques, there are technical limitations which, to some extent,may vary between machines; access to some joints may be limited, and the quality of image obtained may depend on the size of joint and the frequency of the MUS transducer employed.

Whilst MUS shows much promise in aiding and optimising the practice of rheumatology, there is still a relative paucity of evidence to fully demonstrate the utility of MUS. In addition, a number of practical issues need addressing. These include educational aspects relating to the competence of physicians performing MUS, confirming MUS definitions of pathology, establishing validity and reliability, and further understanding the utility of this modality in managing rheumatological diseases. Work is underway to address many of these issues.
Ambulatory investigation and treatment of patients with suspected pulmonary embolism: a retrospective review of one year’s experience
Authors: Rowlinson JS , Deagle J , Roseveare CD
Published: January 2025

The objective of this study was to establish the feasibility and safety of managing suspected and proven PE without overnight in-patient stay and was designed as a retrospective review of experience. The study took place at the AMU, Southampton General Hospital, Southampton, England. The participants were consecutive patients between October 2002 and 2003 with clinical features suggesting PE, requiring diagnostic imaging, and who fulfilled pre-defined community management criteria. The main outcome measures were anticoagulation complications, 30-day re-admission, PE within six months, and death any time following presentation. The results were as follows: 133 patients were identified, 22 of whom were treated in the community for PE without significant complications. Eight 30-day re-admissions were all in the ‘PE excluded’ group. One re-admission may have related to anticoagulant therapy. Five patients (4%) died during follow up. No deaths could be attributed to premature discharge or management in the community. The study concluded that selected patients with suspected and proven PE may be managed in the community within a carefully defined protocol, although larger studies are required to confirm the safety of this approach.
Medical education symposium 2005
Authors: Dhaun N
Published: January 2025

This symposium addressed a number of pertinent issues relating to this increasingly important aspect of medicine. Topics ranged from medical student selection to changes in specialist training and were presented by key players in the field.
Mukden Medical College (1911–1949): an outpost of Edinburgh medicine in northeast China. Part 1: 1882–1917; building the foundations and opening the College
Authors: Crawford DS
Published: January 2025

Scottish physician Dugald Christie, an 1881 licentiate of both the RCPE and the RCSEd, was the first medical missionary sent to China by the United Presbyterian Church of Scotland. He commenced practice in the city of Mukden (Shenyang) in Manchuria in 1883. In 1892 he started to train student assistants and in 1911 founded the Mukden Medical College (Fengtian yi ke da xue). Edinburgh-trained physicians and surgeons largely staffed this college, the first Western medical school in Manchuria.
Acute renal failure in severe falciparum malaria patients in an intensive care unit in Malaysia
Authors: Koh KH , Tan Cl , Chew PH
Published: January 2025

Objectives: Identify the risk factors and the clinical impact of ARF in patients with severe falciparum malaria.

Method: Intensive care unit cases of severe falciparum malaria of Sarawak General Hospital were analysed.

Results: Out of 40 cases of severe falciparum malaria, 19 developed ARF. Patients with ARF were older (p=0·030), had higher AST (p=0·014), higher unconjugated bilirubin (p=0·041), and lower globulin (p=0·015). Aspartate transaminase level positively correlated with creatinine and urea level (log AST and urea: r=0·464, p=0·004; log AST and log creatinine: r=0·430, p=0·008); while unconjugated bilirubin level positively correlated with creatinine level with geometric transformation (r=0·402, p=0·020). Patients with ARF have higher mortality (p=0·004),and more failing organs (p = 0·0003). Patients with ARF that died had a higher number of organs failing compared with those that survived (p=0·043). Among patients with total parasite count of >300,000/µL, those patients treated with dialysis, haemofiltration or exchange transfusion developed less organ failure (p=0·050). Logistic regression with adjustment for age and malarial complications identified ARF to be the major predictor of mortality.

Conclusions: 1) Patients with severe falciparum malaria who developed ARF have higher rate of haemolysis, more organs failing and higher mortality rate. 2) Dialysis, haemofiltration or exchange transfusion may reduced the rate of organ failure among patients with parasite count >300000/µL.
Mercury – answering some of the current controversies about it
Authors: Wood DM , Dargan PI , Jones AL
Published: January 2025

Recently there has been a lot of interest in the medical and lay press concerning exposure to mercury and its potential toxic effects. Mercury is a naturally occurring metallic element, which can be found as Hg or inorganic and organic salts. In this article we will review the risks of exposure and toxicity of each of the forms of mercury, including some of the current guidance concerning the risks of mercury toxicity from eating fish, dental amalgam and vaccinations containing mercury (thiomersal) preservatives.
Carotid endarterectomy and angioplasty in Scotland: reaching a Scottish view
Authors: Kane I , Dennis MS
Published: January 2025

The timing of carotid endarterectomy in patients with symptomatic carotid stenosis is vital if it is to provide maximum benefit to patients. Throughout Scotland there are delays in referring patients to neurovascular clinics and on to surgery, where indicated. Evidence suggests that in those patients with symptomatic carotid stenosis, greater than 70%, surgery should ideally be performed within two weeks. In order to reduce delays to surgery (where appropriate) there needs to be an improvement in the organisation of services so that rapid assessment of high-risk patients can be made.
A woman with hidden charm needles
Authors: Teo SK
Published: January 2025

A 69-year-old Indonesian woman was discovered incidentally to have multiple fine small needles in the head and chest. They are known as charm needles, or ‘susuks’ in the Malay language, and are worn in the body as talismans. Inserting charm needles is encountered mainly in Southeast Asia and is related to traditional Malay beliefs, though the wearers also include Chinese and Indians.The needles do not cause pain or swelling and and are not visible externally. They should be left alone unless they lead to infection or interfere with surgical procedures or radiotherapy on the face and neck.
HIV – what the general physician needs to know
Authors: France AJ
Published: January 2025

The global spread of HIV infection over the past 25 years presents new challenges to physicians. HIV produces multi-system disease and can present to primary care physicians or to any hospital specialist department. In the twentyfirst century, HIV has joined syphilis in the differential diagnoses for many illnesses. This article is aimed at the general physician and describes the common features of HIV infection. The key points to note are: epidemiology; clinical features of opportunistic infections, tumours, and neurological disease; when to test for HIV; benefits of treatment; and complications of treatment. Throughout this article I have avoided the expression ‘AIDS’ because it means different things to different people. The North American definition is based on laboratory evidence of immunodeficiency but the European definition is based on historical clinical features which are often independent of immunodeficiency. I prefer to speak of HIV and its spectrum of clinical disease.
Slate grey pigmentation due to minocycline therapy
Authors: Gallipoli P , MTJ Leach
Published: January 2025

We describe a 77-year-old man who attended our department for investigations of sideropenia who incidentally was noted to have patches of slate grey skin pigmentation. The patient had been treated for folliculitis affecting his scalp for several years with minocycline. Appearances were suggestive of minocycline-induced pigmentation. We discuss the incidence, pathogenesis, clinical appearances and treatment of minocycline-induced pigmentation and suggest that in most instances of skin infections the use of tetracyclines is preferable.
Hypnosis and the management of patients with refractory irritable bowel syndrome
Authors: Ford MJ , Dobbin A
Published: January 2025

This review summarises the rationale, methodology and clinical evidence supporting the efficacy of hypnotherapy in patients with refractory IBS. Data sources used included English language articles published between 1966 and 2006, retrieved by a keyword search of biomedical electronic databases limited to Medline, Embase and the Cochrane Library. Only randomised controlled trials of the use of hypnotherapy in patients with refractory IBS were included in the review.