bluuebunny/crossref_metadata_2025 huggingface dataset:
Detection and management of familial hypercholesterolaemia in primary care in Australia: protocol for a pragmatic cluster intervention study with pre-post intervention comparisons
Authors: Arnold-Reed Diane E , Brett Tom , Troeung Lakkhina , Vickery Alistair , Garton-Smith Jacquie , Bell Damon , Pang Jing , Grace Tegan , Bulsara Caroline , Li Ian , Bulsara Max , Watts Gerald F
Published: May 2024

Introduction

Familial hypercholesterolaemia (FH), an autosomal dominant disorder of lipid metabolism, results in accelerated onset of atherosclerosis if left untreated. Lifelong treatment with diet, lifestyle modifications and statins enable a normal lifespan for most patients. Early diagnosis is critical. This protocol trials a primary care-based model of care (MoC) to improve detection and management of FH.

Methods and analysis

Pragmatic cluster intervention study with pre-post intervention comparisons in Australian general practices. At study baseline, current FH detection practice is assessed. Medical records over 2 years are electronically scanned using a data extraction tool (TARB-Ex) to identify patients at increased risk. High-risk patients are clinically reviewed to provide definitive, phenotypic diagnosis using Dutch Lipid Clinic Network Criteria. Once an index family member with FH is identified, the primary care team undertake cascade testing of first-degree relatives to identify other patients with FH. Management guidance based on disease complexity is provided to the primary care team. Study follow-up to 12 months with TARB-Ex rerun to identify total number of new FH cases diagnosed over study period (via TARB-Ex, cascade testing and new cases presenting). At study conclusion, patient and clinical staff perceptions of enablers/barriers and suggested improvements to the approach will be examined. Resources at each stage will be traced to determine the economic implications of implementing the MoC and costed from health system perspective. Primary outcomes: increase in number of index cases clinically identified; reduction in low-density lipoprotein cholesterol of treated cases. Secondary outcomes: increase in the number of family cases detected/contacted; cost implications of the MoC.

Ethics and dissemination

Study approval by The University of Notre Dame Australia Human Research Ethics Committee Protocol ID: 0 16 067F. Registration: Australian New Zealand Clinical Trials Registry ID: 12616000630415. Information will be disseminated via research seminars, conference presentations, journal articles, media releases and community forums.

Trial registration number

Australian New Zealand Clinical Trials Registry ID 12616000630415; Pre-results.
Prostate-specific antigen (PSA) testing of men in UK general practice: a 10-year longitudinal cohort study
Authors: Young Grace J , Harrison Sean , Turner Emma L , Walsh Eleanor I , Oliver Steven E , Ben-Shlomo Yoav , Evans Simon , Lane J Athene , Neal David E , Hamdy Freddie C , Donovan Jenny L , Martin Richard M , Metcalfe Chris
Published: May 2024

Objectives

Cross-sectional studies suggest that around 6% of men undergo prostate-specific antigen (PSA) testing each year in UK general practice (GP). This longitudinal study aims to determine the cumulative testing pattern of men over a 10-year period and whether this testing can be considered equivalent to screening for prostate cancer (PCa).

Setting, participants and outcome measures

Patient-level data on PSA tests, biopsies and PCa diagnoses were obtained from the UK Clinical Practice Research Datalink (CPRD) for the years 2002 to 2011. The cumulative risks of PSA testing and of being diagnosed with PCa were estimated for the 10-year study period. Associations of a man’s age, region and index of multiple deprivation with the cumulative risk of PSA testing and PCa diagnosis were investigated. Rates of biopsy and diagnosis, following a high test result, were compared with those from the programme of PSA testing in the Prostate Testing for Cancer and Treatment (ProtecT) study.

Results

The 10-year risk of exposure to at least one PSA test in men aged 45 to 69 years in UK GP was 39.2% (95% CI 39.0 to 39.4%). The age-specific risks ranged from 25.2% for men aged 45–49 years to 53.0% for men aged 65–69 years (p for trend <0.001). For those with a PSA level ≥3, a test in UK GP was less likely to result in a biopsy (6%) and/or diagnosis of PCa (15%) compared with ProtecT study participants (85% and 34%, respectively).

Conclusion

A high proportion of men aged 45–69 years undergo PSA tests in UK GP: 39% over a 10-year period. A high proportion of these tests appear to be for the investigation of lower urinary tract symptoms and not screening for PCa.

Trial registration number

ISRCTN20141297,NCT02044172.
Randomised clinical trial of cryoballoon versus irrigated radio frequency catheter ablation for atrial fibrillation—the effect of double short versus standard exposure cryoablation duration during pulmonary vein isolation (CIRCA-DOSE): methods and rationale
Authors: Andrade Jason G , Deyell Marc W , Badra Mariano , Champagne Jean , Dubuc Marc , Leong-Sit Peter , Macle Laurent , Novak Paul , Roux Jean-Francois , Sapp John , Tang Anthony , Verma Atul , Wells George A , Khairy Paul
Published: May 2024

Introduction

Pulmonary vein isolation (PVI) is an effective therapy for paroxysmal atrial fibrillation (AF), but it has limitations. The two most significant recent advances have centred on the integration of real-time quantitative assessment of catheter contact force into focal radio frequency (RF) ablation catheters and the development of dedicated ablation tools capable of achieving PVI with a single ablation lesion (Arctic Front cryoballoon, Medtronic, Minneapolis, MN, USA). Although each of these holds promise for improving the clinical success of catheter ablation of AF, there has not been a rigorous comparison of these advanced ablation technologies. Moreover, the optimal duration of cryoablation (freezing time) has not been determined.

Methods and analysis

Patients undergoing an initial PVI procedure for paroxysmal AF will be recruited. Patients will be randomised 1:1:1 between contact-force irrigated RF ablation, short duration cryoballoon ablation (2 min applications) and standard duration cryoballoon ablation (4 min applications). The primary outcome is time to first documented AF recurrence on implantable loop recorder. With a sample size of 111 per group and a two-sided 0.025 significance level (to account for the two main comparisons), the study will have 80% power (using a log-rank test) to detect a difference of 20% between contact force RF catheter ablation and either of the two cryoballoon ablation groups. Factoring in a 4% loss to follow-up, 116 patients per group should be randomised and followed for a year (total study population of 348).

Ethics and dissemination

The study was approved by the University of British Columbia Office of Research (Services) Ethics Clinical Research Ethics Board. Results of the study will be submitted for publication in a peer-reviewed journal.

Trial registration number

NCT01913522; Pre-results
Protocol for a national prevalence study of advance care planning documentation and self-reported uptake in Australia
Authors: Ruseckaite Rasa , Detering Karen M , Evans Sue M , Perera Veronica , Walker Lynne , Sinclair Craig , Clayton Josephine M , Nolte Linda
Published: May 2024

Introduction

Advance care planning (ACP) is a process between a person, their family/carer(s) and healthcare providers that supports adults at any age or stage of health in understanding and sharing their personal values, life goals and preferences regarding future medical care. The Australian government funds a number of national initiatives aimed at increasing ACP uptake; however, there is currently no standardised Australian data on formal ACP documentation or self-reported uptake. This makes it difficult to evaluate the impact of ACP initiatives. This study aims to determine the Australian national prevalence of ACP and completion of Advance Care Directives (ACDs) in hospitals, aged care facilities and general practices. It will also explore people’s self-reported use of ACP and views about the process.

Methods and analysis

Researchers will conduct a national multicentre cross-sectional prevalence study, consisting of a record audit and surveys of people aged 65 years or more in three sectors. From 49 participating Australian organisations, 50 records will be audited (total of 2450 records). People whose records were audited, who speak English and have a decision-making capacity will also be invited to complete a survey. The primary outcome measure will be the number of people who have formal or informal ACP documentation that can be located in records within 15 min. Other outcomes will include demographics, measure of illness and functional capacity, details of ACP documentation (including type of document), location of documentation in the person’s records and whether current clinical care plans are consistent with ACP documentation. People will be surveyed, to measure self-reported interest, uptake and use of ACP/ACDs, and self-reported quality of life.

Ethics and dissemination

This protocol has been approved by the Austin Health Human Research Ethics Committee (reference HREC/17/Austin/83). Results will be submitted to international peer-reviewed journals and presented at international conferences.

Trial registration number

ACTRN12617000743369
Prevalence and trends of thinness, overweight and obesity among children and adolescents aged 3–18 years across Europe: a protocol for a systematic review and meta-analysis
Authors: Garrido-Miguel Miriam , Cavero-Redondo Iván , Álvarez-Bueno Celia , Rodriguez-Artalejo Fernando , Moreno Aznar Luis , Ruiz Jonatan R , Martinez-Vizcaino Vicente
Published: May 2024

Introduction

Increasing prevalence of both thinness and excess weight during childhood and adolescence is a significant public health issue because of short-term health consequences and long-term tracking of weight status. Monitoring weight status in Europe may serve to identify countries and regions where rates of these disorders are either slowing down or increasing to evaluate recent policies aimed at appropriate body weight, and to direct future interventions. This study protocol provides a standardised and transparent methodology to improve estimating trends of thinness, overweight and obesity in children aged 3–18 years and adolescents across the European region between 2000 and 2017.

Methods and analysis

This protocol is guided by the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) and the Cochrane Collaboration Handbook. To identify relevant studies, a search will be conducted in MEDLINE, EMBASE, Cochrane Library, CINAHL and Web of Science databases. From the selected studies, relevant references will be screened as supplemental sources. Finally, open search in websites from health institutions will be conducted to identify weight status data not published in scientific journals. Cross-sectional, follow-up studies and panel surveys reporting weight status (objectively measured height and weight) according to the International Obesity Task Force criteria, and written in English or Spanish will be included. Subgroup analyses will be carried out by gender, age, study year and country or European region.

Discussion

This study will provide a comprehensive description of weight status of children and adolescents across Europe from 2000 to 2017. The results will be disseminated in a peer-reviewed journal. This study will use data exclusively from published research or institutional literature, so institutional ethical approval is not required.

PROSPERO registration number

CRD42017056917.
Association between subjective risk perception and objective risk estimation in patients with atrial fibrillation: a cross-sectional study
Authors: Zweiker David , Zweiker Robert , Winkler Elisabeth , Roesch Konstantina , Schumacher Martin , Stepan Vinzenz , Krippl Peter , Bauer Norbert , Heine Martin , Reicht Gerhard , Zweiker Gudrun , Sprenger Martin , Watzinger Norbert
Published: May 2024

Objective

Oral anticoagulation (OAC) is state-of-the-art therapy for atrial fibrillation (AF), the most common arrhythmia worldwide. However, little is known about the perception of patients with AF and how it correlates with risk scores used by their physicians. Therefore, we correlated patients’ estimates of their own stroke and bleeding risk with the objectively predicted individual risk using CHA2DS2-VASc and HAS-BLED scores.

Design

Cross-sectional prevalence study using convenience sampling and telephone follow-up.

Settings

Eight hospital departments and one general practitioner in Austria. Patients’ perception of stroke and bleeding risk was opposed to commonly used risk scoring.

Participants

Patients with newly diagnosed AF and indication for anticoagulation.

Main outcome measures

Comparison of subjective risk perception with CHA2DS2-VASc and HAS-BLED scores showing possible discrepancies between subjective and objective risk estimation. Patients’ judgement of their own knowledge on AF and education were also correlated with accuracy of subjective risk appraisal.

Results

Ninety-one patients (age 73±11 years, 45% female) were included in this study. Subjective stroke and bleeding risk estimation did not correlate with risk scores (ρ=0.08 and ρ=0.17). The majority of patients (57%) underestimated the individual stroke risk. Patients feared stroke more than bleeding (67% vs 10%). There was no relationship between accurate perception of stroke and bleeding risks and education level. However, we found a correlation between the patients’ judgement of their own knowledge of AF and correct assessment of individual stroke risk (ρ=0.24, p=0.02). During follow-up, patients experienced the following events: death (n=5), stroke (n=2), bleeding (n=1). OAC discontinuation rate despite indication was 3%.

Conclusions

In this cross-sectional analysis of OAC-naive patients with AF, we found major differences between patients’ perceptions and physicians’ assessments of risks and benefits of OAC. To ensure shared decision-making and informed consent, more attention should be given to evidence-based and useful communication strategies.

Trial registration number

NCT03061123.
Effects of a 12-week cardiovascular rehabilitation programme on systemic inflammation and traditional coronary artery disease risk factors in patients with rheumatoid arthritis (CARDIA trial): a randomised controlled trial
Authors: Heinze-Milne Stefan , Bakowsky Volodko , Giacomantonio Nicholas , Grandy Scott A
Published: May 2024

Introduction

Patients with systemic inflammatory diseases such as rheumatoid arthritis (RA) have an increased risk of cardiovascular disease (CVD) above the baseline risk attributable to traditional CVD risk factors seen in the general population. Exercise in cardiac rehabilitation (CR) is designed specifically for high-risk primary prevention and those with established CVD. Even though the European League Against Rheumatism guidelines state that exercise is safe for individuals with RA and exercise can reduce CVD risk, patients with RA rarely participate in CR. Thus, little is known about CR’s impact on inflammatory and CVD risk in the RA population. The purpose of this trial is to determine the feasibility of a 12-week CR programme for patients with RA and whether it decreases CVD risk without exacerbating RA.

Methods and analysis

This is a randomised controlled trial whereby 60 participants with RA will be recruited and randomly assigned to either standard of care (SOC) treatment or SOC plus a 12-week CR programme (60 min of education plus two 60 min aerobic exercise sessions/week). Exercise will be performed at 60%–80% of heart rate reserve. Outcome measures (Framingham Risk Score, resting heart rate, blood pressure, blood lipids, markers of systemic inflammation (ie, interleukin (IL) 6 and tumour necrosis factor-α (TNF-α), Clinical Disease Assessment Index, Disease Activity Score-28, physical activity levels and peak cardiorespiratory fitness) will be assessed preintervention (week-0), postintervention (week-13) and 6 months postintervention.

Ethics and dissemination

Ethical approval was obtained from the Nova Scotia Health Authority Research Ethics Board. Results will be submitted for publication in an appropriate peer-reviewed journal.

Trial registration number

NCT01534871; Pre-results
Reasons for unsuccessful recruitment of children with atopic dermatitis in primary care in the Netherlands to a cohort study with an embedded pragmatic, randomised controlled open-label trial: a survey
Authors: van Halewijn Karlijn F , Bohnen Arthur M , Pasmans Suzanne G M A , Bindels Patrick J E , Elshout Gijs
Published: May 2024

Background

The Rotterdam Eczema Study was an observational cohort study with an embedded pragmatic randomised controlled open-label trial. It was conducted in children with atopic dermatitis (AD) in the Dutch primary care system. The objective of the trial was to determine whether a potent topical corticosteroid (TCS) is more effective than a low-potency TCS.

Objective

We are aiming to communicate transparently about the poor recruitment for the trial part and to explore the reasons why recruitment was weak.

Design

We used a survey to find out what patients in the cohort did when they experienced a flare-up.

Methods

Descriptive statistics were used to present the baseline characteristics of participants in the trial and the results of the survey.

Results

In total, 367 patients were included in the cohort. Of these, 32 were randomly assigned to a trial treatment; they had a median age of 4.0 years (IQR 2.0–9.8). A total of 69 of the 86 children (80.2%) who could participate in the survey responded. 39 (56.5%) suffered a flare-up during the follow-up (making them potentially eligible for inclusion in the trial). 26 out of 39 (66.7%) increased their use of an emollient and/or TCS themselves. Only 12 of the 39 (30.7%) contacted their general practitioner (GP) as instructed in the study protocol, but 8 out of these 12 did not meet the inclusion criteria for the trial.

Conclusion

The main reason why cohort participants did not take part in the trial was that they did not contact their GPs when they experienced an AD flare-up. Furthermore, the majority of patients who contacted their GPs did not match the inclusion criteria of the trial. We expect that the lessons learnt from this study will be useful when developing future studies of children with AD in primary care.
Physicians’ emotion awareness and emotion regulation training during medical education: a systematic scoping review protocol
Authors: Lange Anna , Bonvin Raphaël , Guttormsen Schär Sissel , Zambrano Sofia C
Published: May 2024

Introduction

The objective of this systematic scoping review is to identify what approaches have been implemented in medical education programmes to teach medical students the skills to identify and manage emotions that may be elicited in them during physician–patient interactions and in the clinical environment. Emotions of all involved in the clinical encounter are central to the process of clinical care. However, a gap remains addressing and teaching medical students about recognising and dealing with their own emotions.

Methods and analysis

This scoping review will follow the updated JBI (The Johanna Briggs Institute) methodology guidance for the conduct and reporting of systematic scoping reviews, and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. A search strategy was developed and applied to five databases. Terms used included medical education, medical curriculum, medical students, emotion (regulation), psychological well-being and mental health. Additionally, a grey literature and reference list search will be conducted. Two independent reviewers will first screen titles and abstracts followed by a second, full-text screening phase. Publications to be included will contain information and data about teaching approaches such as lectures, and other teaching material on physicians’ emotion awareness and emotion regulation training in medical education.

Ethics and dissemination

This study will review existing literature on emotion awareness and emotion regulation training in medical education, and a systematic scoping review does not require ethical approval. The results of this scoping review will be submitted for publication to relevant peer-reviewed journals and will be used to inform the development and implementation of training programmes and research studies aimed at preparing medical students to identify and manage their own emotions in the clinical environment.
Performance of glial fibrillary acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1) biomarkers in predicting CT scan results and neurological outcomes in children with traumatic brain injury (BRAINI-2 paediatric study): protocol of a European prospective multicentre study
Authors: Lorton Fleur , Lagares Alfonso , de la Cruz Javier , Méjan Odile , Pavlov Vladislav , Sapin Vincent , Poca Maria Antonia , Lehner Markus , Biberthaler Peter , Chauviré-Drouard Anne , Gras-Le-Guen Christèle , Scherdel Pauline
Published: May 2024

Introduction

In light of the burden of traumatic brain injury (TBI) in children and the excessive number of unnecessary CT scans still being performed, new strategies are needed to limit their use while minimising the risk of delayed diagnosis of intracranial lesions (ICLs). Identifying children at higher risk of poor outcomes would enable them to be better monitored. The use of the blood-based brain biomarkers glial fibrillar acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase-L1 (UCH-L1) could help clinicians in this decision. The overall aim of this study is to provide new knowledge regarding GFAP and UCH-L1 in order to improve TBI management in the paediatric population.

Methods and analysis

We will conduct a European, prospective, multicentre study, the BRAINI-2 paediatric study, in 20 centres in France, Spain and Switzerland with an inclusion period of 30 months for a total of 2880 children and adolescents included. To assess the performance of GFAP and UCH-L1 used separately and in combination to predict ICLs on CT scans (primary objective), 630 children less than 18 years of age with mild TBI, defined by a Glasgow Coma Scale score of 13–15 and with a CT scan will be recruited. To evaluate the potential of GFAP and UCH-L1 in predicting the prognosis after TBI (secondary objective), a further 1720 children with mild TBI but no CT scan as well as 130 children with moderate or severe TBI will be recruited. Finally, to establish age-specific reference values for GFAP and UCH-L1 (secondary objective), we will include 400 children and adolescents with no history of TBI.

Ethics and dissemination

This study has received ethics approval in all participating countries. Results from our study will be disseminated in international peer-reviewed journals. All procedures were developed in order to assure data protection and confidentiality.

Trial registration number

NCT05413499.
Exposure to needlestick injury among healthcare support staff in Greater Accra, Ghana: a cross-sectional study
Authors: Tawiah Philip Apraku , Appiah-Brempong Emmanuel , Okyere Paul , Ashinyo Mary Eyram
Published: May 2024

Objectives

This study aims to determine the prevalence and predisposing factors of a needlestick injury (NSI) among healthcare support staff in the Greater Accra region, Ghana.

Methods

An analytical cross-sectional survey was carried out from 30 January 2023 to 31 May 2023, involving 10 major health facilities. A multistage sampling method was adopted. The data analyses were performed using STATA V.15 software. χ2, Fisher’s exact and Mann-Whitney U tests were used to identify the preliminary association between the outcome variables and predisposing factors. Log-binomial regression analyses were used to confirm factors associated with NSI at a significance level of p<0.05.

Results

The study was conducted among 149 healthcare support staff. The 1-year exposure to NSI was 68 (45.6%) (95% CI (37.5% to 54.0%)). Being a healthcare assistant (APR=2.81 (95% CI 1.85 to 4.25)), being married (APR=0.39 (95% CI 0.25 to 0.63)), being a supervisor (APR=0.34 (95% CI 0.20 to 0.57)), had training on standard precaution (APR=0.27 (95% CI 0.14 to 0.57)) and non-existence of needlestick reporting system (APR=0.46 (95% CI 0.29 to 0.74)) were significantly associated with NSI.

Conclusion

The prevalence of NSI was high compared with other regional studies, and the risk factors were related to sociodemographic, behavioural and organisational factors. The study recommends guidelines that are geared towards NSI exposure among healthcare support staff.
25 Family caregiver socio-economic status, access to palliative care and patients’ place of death: a health survey for england study
Authors: Johnson Miriam , Allgar Victoria , Chen Hong , Dunn Laurie , Macleod Una , Currow David
Published: May 2024

Background

The personal impact is considerable for family caregivers at the end-of-life.

Aims

To i) describe family caregivers at the end-of-life, ii) those willing to repeat this role under similar circumstances; iii) investigate associations between caregivers’ household income, patients’ access to palliative care services (PCS) and place of patients’ death.

Methods

End-of-life caregiver questions in the Health Survey for England: had someone close to them died of a terminal illness within past 5 years?; intensity of care?; PCS accessed?; place of death?; willingness to care again?. Associations were explored using univariable analyses and multiple logistic regression.

Results

2167/8861 (25%) respondents had someone close die; 645/8861 (7.3%) provided personal care (caregivers). Younger caregiver age (≤65; OR 2.79; 95% CI 1.36, 5.74) and use of PCS (OR: 1.95, 95% CI: 1.09, 3.48) were associated with willingness to caregive again. 55% of decedents accessed PCS. PCS access reduced hospital (p<0.001), and increased home (p<0.001) deaths. Overall, respondents’ income (adjusted for PCS) was unrelated to decedents’ place of death but those with the most affluentcaregiverswereleastlikely to die at home (p=0.069).

Conclusions

Most who have provided end-of-life care for someone close would be willing to provide care again; more likely for younger caregivers and when PCS was accessed.

PCS access was associated with fewer hospital deaths and more home deaths. Decedents with more affluentcaregiverswere theleastlikely to die at home. Such caregivers are likely to be powerful patient advocates; ensuring correct understanding of goals of care is important.
40 Caring for carers: a social worker and nurse-led hospice model
Authors: Thomas Glyn , Harris Louise , Thomas Liz , Davidson Jason , Gishen Faye
Published: May 2024

Introduction

Marie Curie recognises the contribution that carers make to the support and wellbeing of those diagnosed with terminal illness.1Their 2012 report highlighted a lack of support for carers as well as the associated negative social and economic impact of caring for a dying relative. The Carers UK Report, 20142found that nearly 6000 people become carers every day, with £1.1 billion of Carers’ Allowance going unclaimed each year.

Aims

The understanding and appreciation of challenges faced by carers led to the establishment of a dedicated Carers’ Clinic at Marie Curie Hospice, Hampstead, London in April 2016. The aim was to support carers, with the focus on answering their questions and addressing their concerns.

Methods

The model was social worker and nurse-led. A modified version of the Carers Support Needs Assessment Tool (CSNAT) was used as the basis for the consultation3and a questionnaire evaluation was completed following the clinic appointment.

Results

Between April 2016 and March 2017 there were 31 consultations with 23 evaluations completed. Both quantitative and qualitative data was captured. 83% of respondents said that the clinic met their needs. Many carers requested follow-up sessions. The key themes identified were around financial advice, carers’ health needs and support with managing their relatives’ illness.

Conclusion

The Carers Clinic is now established in the hospice. Further developments include the establishment of a new service enabling carers to be referred for six sessions of pre-bereavement support, as well as a plan to implement an 8 week mindfulness programme.

References

. Marie Curie (2012)Committed to Carers; Supporting Carers of People at the End of Life, Marie Curie. pp.4-5, 7-8, 11–12

. Carers UK (2014)Need to know; Transitions in and out of Caring: The Information Challenge. Carers UK. pp.4.

. Ewing, G & Grande, G. (2013)Development of a Carer Support Needs Assessment Tool (CSNAT) for End-of-Life Care Practice at Home: A Qualitative Study. Palliative Medicine; 27 (3) pp.244–256.
5 Advance care planning for people with dementia in long term care settings: an explanatory mixed methods study of health care professionals’ and families’ perspectives
Authors: Beck Esther Ruth , McIlfatrick Sonja , Hanson Felicity
Published: May 2024

Introduction

Advance care planning is advocated for people with dementia, yet discussions with this group are rare, particularly in long-term care settings. The role of health care professionals and family are pivotal, therefore further understanding of their perspective is needed.

Aim

To examine the understanding and experience of family caregivers of people with dementia and health care professionals regarding the process of advance care planning.

Methods

Sequential explanatory mixed methods design incorporating 3 phases was adopted.

Results

All three groups had poor knowledge of advance care planning, particularly the legal aspects. Whilst health care professionals and families considered there were benefits, there were challenges to implementation in this setting. These included: concerns regarding the ability of the person with dementia to engage, the increased role of the family, a lack of context specific guidance, and a knowledge deficit regarding dementia and advance care planning.

There was widespread variations in perspectives, including when it should be implemented, who should be responsible and what it should focus on. The GP played a key role, whilst nursing staff remained on the periphery. Families were central in the decision making process, yet their ability was influenced by a limited awareness of dementia, decisional burden due to guilt and anticipatory grief, and a limited ability to reflect the wishes of the person with dementia.

Conclusions

Advance care planning for people with dementia is a complex process within nursing homes, influenced by multiple factors related to the setting, the perspectives of those involved and the context of dementia itself.
Comprehensive profiling of cancer neoantigens from aberrant RNA splicing
Authors: Wickland Daniel P , McNinch Colton , Jessen Erik , Necela Brian , Shreeder Barath , Lin Yi , Knutson Keith L , Asmann Yan W
Published: May 2024

Background

Cancer neoantigens arise from protein-altering somatic mutations in tumor and rank among the most promising next-generation immuno-oncology agents when used in combination with immune checkpoint inhibitors. We previously developed a computational framework, REAL-neo, for identification, quality control, and prioritization of both class-I and class-II human leucocyte antigen (HLA)-presented neoantigens resulting from somatic single-nucleotide mutations, small insertions and deletions, and gene fusions. In this study, we developed a new module, SPLICE-neo, to identify neoantigens from aberrant RNA transcripts from two distinct sources: (1) DNA mutations within splice sites and (2) de novo RNA aberrant splicings.

Methods

First, SPLICE-neo was used to profile all DNA splice-site mutations in 11,892 tumors from The Cancer Genome Atlas (TCGA) and identified 11 profiles of splicing donor or acceptor site gains or losses. Transcript isoforms resulting from the top seven most frequent profiles were computed using novel logic models. Second, SPLICE-neo identified de novo RNA splicing events using RNA sequencing reads mapped to novel exon junctions from either single, double, or multiple exon-skipping events. The aberrant transcripts from both sources were then ranked based on isoform expression levels and z-scores assuming that individual aberrant splicing events are rare. Finally, top-ranked novel isoforms were translated into protein, and the resulting neoepitopes were evaluated for neoantigen potential using REAL-neo. The top splicing neoantigen candidates binding to HLA-A*02:01 were validated using in vitro T2 binding assays.

Results

We identified abundant splicing neoantigens in four representative TCGA cancers: BRCA, LUAD, LUSC, and LIHC. In addition to their substantial contribution to neoantigen load, several splicing neoantigens were potent tumor antigens with stronger bindings to HLA compared with the positive control of antigens from influenza virus.

Conclusions

SPLICE-neo is the first tool to comprehensively identify and prioritize splicing neoantigens from both DNA splice-site mutations and de novo RNA aberrant splicings. There are two major advances of SPLICE-neo. First, we developed novel logic models that assemble and prioritize full-length aberrant transcripts from DNA splice-site mutations. Second, SPLICE-neo can identify exon-skipping events involving more than two exons, which account for a quarter to one-third of all skipping events.
Frequency of deployed emergency donor panel use prior to implementation of the low titre group O whole blood program
Authors: Lin Catherine Y , Hamm J D , Fisher A D , Rizzo J A , Corley J B , April M D , Schauer S G
Published: May 2024

Introduction

The US military has frequently used a ‘walking blood bank’, formally known as an ‘emergency donor panel’ (EDP) to obtain warm fresh whole blood (WFWB) which is then immediately transfused into the casualty. We describe the frequency of EDP activation by the US military.

Methods

We analysed data from 2007 to 2015 within the Department of Defense Trauma Registry for US, Coalition and US contractor casualties that received at least 1 unit of blood product within the first 24 hours and described the frequency of WFWB use.

Results

There were 3474 casualties that met inclusion, of which, 290 casualties (8%) required activation of the EDP. The highest proportion of EDP events was in 2014, whereas the highest number of EDP events was in 2011. Median injury severity scores were higher in the recipients, compared with non-EDP recipients (29 vs 20), as were proportions with serious injuries to the abdomen (43% vs 19%) and extremities (77% vs 65%). The median number of units of all blood products, except for packed red blood cells, was higher for WFWB recipients. Of the WFWB recipients, the median was 5 units (IQR 2–10) with a maximum documented 144 units. There were four documented cases of EDP recipients receiving >100 units of WFWB with only one surviving to hospital discharge. During the study period, there were a total of 3102 (3%) units of WFWB transfused among a total of 104 288 total units.

Conclusions

We found nearly 1 in 11 casualties who received blood required activation of the EDP. Blood from the EDP accounted for 3% of all units transfused. These findings will enable future mission planning and medical training, especially for units with smaller, limited blood supplies. The lessons learned here can also enable mass casualty planning in civilian settings.
No quadriceps muscle weakness following anterior quadratus lumborum block compared with placebo: a randomized, non-inferiority, blinded, volunteer trial
Authors: Tanggaard Katrine , Nielsen Martin Vedel , Holm Ulrik Heiner Ullerup , Hoffmann Balthazar Malmkjær , Bernhoff Charlotte , Andersen Christian HS , Thomassen Sophia S , Hansen Christian , Dam Mette , Poulsen Troels Dirch , Holm Pætur Mikal , Børglum Jens
Published: May 2024

Background and aims

Anterior quadratus lumborum block is a truncal block, applied in close proximity to the lumbar plexus, potentially causing lower limb weakness. This trial aimed to evaluate whether a unilateral anterior quadratus lumborum block caused quadriceps muscle weakness compared with placebo.

Methods

In this randomized, non-inferiority, triple-blind trial, 20 healthy volunteers received an active unilateral anterior quadratus lumborum block with 30 mL ropivacaine 0.75% and a placebo block on the contralateral side. Primary outcome was change in maximal quadriceps muscle strength from baseline to 60 min postblock compared with placebo. Secondary outcomes were change in single-leg 6 m timed hop test, change in Timed-Up and Go test, change in mean arterial pressure from baseline to 30 min postblock and dermatomal affection.

Results

There was no statistically significant difference in changes in maximal quadriceps muscle strength between active and placebo block; 15.88 N (95% CI −12.19 to +43.94), pnon-inf=0.003, indicating non-inferiority. Timed-Up and Go test was performed significantly faster 60 min postblock; −0.23 s (95% CI −0.38 to −0.08, p=0.005). Mean change in mean arterial pressure from baseline to 30 min postblock was 4.25 mm Hg (95% CI 0.24 to 8.26, p=0.04). Dermatome testing revealed an affection primarily of the lower abdomen (Th10-L1) with the active block.

Conclusion

In this randomized controlled trial including healthy volunteers a unilateral anterior quadratus lumborum block does not cause statistical or clinical significant motor block of the quadriceps muscle compared with placebo. When administered correctly, the block can be used for procedures where early postoperative mobilization is essential.

Trial registration number

NCT05023343.
Extended reality navigation for pain procedures: a narrative review
Authors: Cho James Sungjai , Jotwani Rohan , Chan Stephanie , Thaker Devaunsh Manish , On Jungmin Daniel , Yong R Jason , Hao David
Published: May 2024

Background

Extended reality (XR) technology, encompassing virtual reality, augmented reality, and mixed reality, has been widely studied for procedural navigation in surgical specialties. Similar to how ultrasound transformed regional anesthesia, XR has the potential to reshape how anesthesiologists and pain physicians perform procedures to relieve pain.

Objective

This narrative review examines the clinical benefits of XR for navigation in various pain procedures. It defines key terms and concepts related to XR technology and explores characteristics of procedures that are most amenable to XR-based navigation. Finally, it suggests best practices for developing XR navigation systems and discusses the role of emerging technology in the future of XR in regional anesthesia and pain medicine.

Evidence review

A search was performed across PubMed, Embase, and Cochrane Central Register of Controlled Trials for primary literature investigating the clinical benefits of XR navigation for pain procedures.

Findings

Thirteen studies using XR for procedural navigation are included. The evidence includes randomized controlled trials, retrospective studies, and case series.

Conclusions

Early randomized controlled trials show potential for XR to improve procedural efficiency, but more comprehensive research is needed to determine if there are significant clinical benefits. Case reports demonstrate XR’s utility in generating patient-specific navigation plans when difficult anatomy is encountered. Procedures that facilitate the generation and registration of XR images are most conducive to XR navigation, whereas those that rely on frequent re-imaging will continue to depend on traditional modes of navigation.
Predicting quadrupole deformation via anisotropic flow and transverse momentum spectra in isotopic $$\mathbf {{}^{128-135}_{\qquad \,54}\textrm{Xe}}$$ collisions at LHC
Authors: Pandey Saraswati , Singh B. K.
Published: May 2024

In the hydrodynamical description of heavy-ion collisions, the elliptic flow $${\textrm{v}}_{2}$$

v
2

and triangular flow $${\textrm{v}}_{3}$$

v
3

are sensitive to the quadrupole deformation $${\beta _{2}}$$

β
2

of the colliding nuclei. We produce $${\textrm{v}}_{2}$$

v
2

and $${\textrm{v}}_{3}$$

v
3

ratios qualitatively and quantitatively in most-central Xe–Xe collisions at 5.44 TeV. By employing HYDJET++ model, we study the sensitivity of anisotropic flow coefficients and mean transverse momentum to the quadrupole deformation and system-size in isotopic Xe–Xe collisions. Flow observables strongly depend on the strength of nucleon–nucleon scattering occurring in even-A and odd-A nuclei. Flow for odd-A nuclei is suppressed in comparison to flow in even-A collisions. There exists a linear inter-dependence between $${\textrm{p}}_{\textrm{T}}$$

p
T

integrated anisotropic flow and nuclear deformation. Mean transverse momentum signifies the fireball temperature in body–body and tip–tip collisions. There exists a negative linear correlation of $$\langle {\textrm{p}}_{\textrm{T}}\rangle $$

⟨

p
T

⟩

with collision system-size and a positive correlation with nuclear deformation. Flow measurements in high-energy, heavy-ion collisions using isotopic collision systems, offer a new precision tool to study nuclear structure physics. Observation of nuclear structure properties like nuclear deformation in a heavy-ion collision such as this would be very interesting.
Power-Carbon Information Management System Based on Machine Learning
Authors: Wang Ruohan , Chen Yunlong , Li Entang , Xing Hongwei , Zhang Jianhui , Li Jing
Published: May 2024

With the deepening reform of the power market and carbon market, great progress has been made in informatization. Power information may be stored in many scattered places, and it is difficult to share data between different departments or systems. This leads to fragmentation and redundancy of information and makes information exchange difficult. Blockchain can improve the reliability of Power-Carbon Management System (briefly described as PCMS for convenience) data processing. PCMS informatization has become the basis for improving the quality and efficiency of project management and maximizing the environmental and economic benefits of the project. Because the power information management system can effectively control the flow of information and resource allocation. Due to the requirement of low-carbon and stable power production, PCMS attaches great importance to the application and implementation of information in power management, but does not attach enough importance to the informatization of power production management. Therefore, this paper analyzed the current situation, characteristics and existing problems of PCMS through machine learning algorithm, then constructed the design principles, and finally proposed the optimization path of PCMS according to the principles. The information collection ability and system control ability of the optimized PCMS were better than the original PCMS. The information collection ability was 14.2% higher than the original, and the system control ability was 9.8% higher than the original. In general, both blockchain and machine learning can improve the data reliability of PCMS.
Möbius group actions in the solvable chimera model
Authors: Jaćimović Vladimir , Crnkić Aladin
Published: May 2024

We study actions of Möbius group on two sub-populations in the solvable chimera model proposed by Abrams et al. Dynamics of global variables are given by two coupled Watanabe–Strogatz systems, one for each sub-population. At the first glance, asymptotic dynamics in the model seem to be very simple. For instance, in the stable chimera state distributions of oscillators perform a simple rotation after a certain (sufficiently large) moment. However, a closer look unveils that dynamics are subtler that what can be observed from evolution of densities of oscillators’ phases. In order to gain the full picture, one needs to investigate dynamics on the transformation group that acts on these densities. Such an approach emphasizes impact of the “hidden” variable that is not visible on macroscopic level. More precisely, we demonstrate that the chimera model is an intriguing example of the classical system that exhibits the holonomy in fiber bundles of the group of Möbius transformations.
Magnetorheological fluid sedimentation characterization via laser transmittance intensity method
Authors: Zou Zhiyuan , Zhang Honghui , Wang Ning , Zhu Minghui , Pan Kexun , Zhang Dengyou
Published: May 2024

The sedimentation measurement is of significant importance when designing and synthesizing magnetorheological (MR) fluid for engineering applications. Generally, visual observation is always used to discern the mud line position but knows nothing about the concentration distribution under the mud line. The method using electromagnetic scanning is limited by the position resolution because of the height of the inductor, and the method based on thermal conductivity is time-consuming and determines the sedimentation status at a specific location.

In this paper, the sedimentation behavior is revealed by the laser transmittance intensity (LTI) method which is based on scattering when the light passes through the MR fluid, the higher the concentration and the stronger the scattering, the weaker the received light intensity. Specifically, the laser diode and the photodiode were utilized as the light source and receiver, respectively.

MR fluid samples in a series of concentrations are used to obtain the correlation between volume fraction and photodiode output voltage, and that is taken as the calibration of the sensing method. In the experiments, the scanning with height and the sensing with time are jointly employed to characterize the settling process of a specific MR fluid.
Tuning sensitivity of surface plasmon resonance gas sensor based on multilayer black phosphorous
Authors: Karki Bhishma , Trabelsi Youssef , Sarkar Partha , Pal Amrindra , Uniyal Arun
Published: May 2024

We investigated a gas sensor that makes use of the surface plasmon resonance (SPR) effect in a thick layer of gold (Au), copper (Cu), ZnO, and multilayer black phosphorous (BP). The suitability of the proposed gas sensor was investigated for a range of analyte gases recognized for their toxicity, greenhouse effect, or flammability. The proposed gas sensor obtains a maximum sensitivity of 258.77°/RIU with a remarkable full width at half maximum (FWHM) of 7.12°, detection accuracy (DA) of 0.14/°, and Figure of merit (FoM) of 36.22. The result of our enhanced numerical analysis indicates that the performance of a multilayer BP is enhanced when compared to a conventional gas sensor. As a result, using a SiO2 prism to sense different gases at a wavelength of 633[Formula: see text]nm, the suggested gas sensor may be more advantageous. Moreover, the maximum sensitivity of 374.31/RIU is obtained with a remarkable DA of 0.11° and FoM of 37.63/RIU to detect NO2 gas sensing to maintain the [Formula: see text]value. The gas sensor performance is high at different refractive indices for gas analyte (1–1.07). The performance of the proposed gas sensor is superior to that of the existing gas sensors.
Low-cost nonlocal Toffoli gate in a linear quantum network topology
Authors: Chen Huijiong , Hou Guangwu , Zhu Changhua
Published: May 2024

Although a Toffoli gate can be equivalently implemented using several single-qubit and two-qubit gates, it will consume much resource, two of which are nonlocal controlled-NOT (CNOT) gates acting on two non-adjacent nodes, especially in distributed quantum computation (DQC). We, for the first time, employ an ancillary qubit to construct a nonlocal Toffoli gate for DQC in linear network topology. The ancillary-qubit-based scheme needs fewer qubits, quantum gates, and entanglement states than that based on quantum teleportation scheme and the entanglement swapping scheme. We also analyze the performance of the three proposed schemes under different application scenarios, and present their pros and cons. Our work will help to implement DQC in noisy intermediate-scale quantum (NISQ) era.