bluuebunny/crossref_metadata_2025 huggingface dataset:
Increased severe primary graft dysfunction in left ventricular assist device patients following united network for organ sharing allocation changes
Authors: Guo Aaron , Kotkar Kunal , Jocher Brandon , Botkin Kent W. , Britt Daniel , Fischer Irene , Masood Muhammad F. , Schilling Joel , Itoh Akinobu
Published: November 2022

Introduction

In 2018, the United Network for Organ Sharing (UNOS) implemented a new heart allocation system which prioritized patients on temporary support devices and left‐ventricular assist device (LVAD) patients with complications. These changes have the potential to impact outcomes for patients bridged to transplant with an LVAD.

Methods

We performed a retrospective study of 168 adult heart transplant recipients at our center between 2016 and 2020 evaluating post‐transplant outcomes before and after UNOS allocation changes. Donor and recipient data were retrieved from chart review and national databases. The primary outcome of this study was severe primary graft dysfunction (PGD) with secondary outcomes of 30‐day readmission, 30‐day mortality, and 1‐year mortality.

Results

Incidence of severe PGD was similar in the overall cohort before and after the changes (10% vs. 15%, respectively, p = .3) and increased in the LVAD‐bridged cohort (12% vs. 40%, respectively, p < .01). Secondary outcomes of readmission and survival were similar between all groups. Blood transfusion was predictive of severe PGD in multivariable modeling (OR 1.3 [1.11–1.59], p < .01).
An NTRK‐1‐associated soft tissue tumor showing distinctive nodules with peripheral accentuation of cellularity
Authors: Czaja Rebecca , Layng Kayla Viets , Barrett Alex , Hooper Perry , Alomari Ahmed , Warren Simon
Published: November 2022

Lipofibromatosis‐like neural tumor is a recently described entity defined by a low‐cellularity spindle cell infiltrate in the subcutaneous fat with admixed inflammatory cells. This tumor is histopathologically similar to lipofibromatosis, but unlike lipofibromatosis shows reactivity for S100 and has an NTRK‐1 kinase fusion. These lesions are locally aggressive but appear to have a negligible metastatic potential. Subsequently, a more cellular variant has been described with generally low mitotic rate. This variant also displays S100 reactivity and kinase fusions (typically involving NTRK‐1), but it has a low risk of metastasis. In this report, we describe a case that aligns with the more cellular variant of NTRK‐1 kinase fusion tumors on histopathologic, immunohistochemical, and molecular grounds, but in addition has distinctive nodules with peripheral accentuation of cellularity, reminiscent of those present in epithelioid malignant peripheral nerve sheath tumors. This latter feature is previously undescribed in NTRK kinase fusion soft tissue tumors and offers further support for the presumed neural differentiation of this neoplasm.
Large carnivore range expansion in Iberia in relation to different scenarios of permeability of human‐dominated landscapes
Authors: Pratzer Marie , Nill Leon , Kuemmerle Tobias , Zurell Damaris , Fandos Guillermo
Published: November 2022

Aim

Large carnivores are currently recolonizing parts of their historical ranges in Europe after centuries of persecution and habitat loss. Understanding the mechanisms driving these recolonizations is important for proactive conservation planning. Using the brown bear (Ursus arctos) and the Iberian lynx (Lynx pardinus) as examples, we explore where and when large carnivores are likely to expand into human‐dominated landscapes and how varying levels of resistance due to human pressure might impact this recolonization process.

Location

Iberian Peninsula.

Methods

We used ensembles of species distribution models to relate species occurrence data to climate, topography and satellite‐based land‐cover predictors at a 10 km spatial resolution. Resulting predictions of suitable habitat areas were fed into a dispersal model to simulate range expansion over the 10 time‐steps for different human pressure scenarios. Finally, we overlaid predictions with protected areas to highlight areas that are likely key for future connectivity, but where human pressures might hamper dispersal.

Results

We found widespread suitable habitat for both species (bear: 30,000 km2, lynx: 170,000 km2), yet human pressure limits potential range expansions. For brown bears, core habitats between the Cantabrian and Pyrenean populations remained unconnected despite suitable habitat in between. For lynx, we predicted higher range expansion potential, although high human pressures in southern coastal Spain negatively affected expansion potential.

Main conclusions

Our results highlight that the recolonization potential of brown bears and lynx in the Iberian Peninsula is likely more constrained by lower permeability of landscapes due to human pressure than by habitat availability, a situation likely emblematic for large carnivores in many parts of the world. More generally, our approach provides a simple tool for conservation planners and managers to identify where range expansion is likely to occur and where proactively managing to allow large carnivores to safely disperse through human‐dominated landscapes can contribute to viable large carnivore populations.
Climate change threatens the future of rain forest ringtail possums by 2050
Authors: de la Fuente Alejandro , Williams Stephen E.
Published: November 2022

Aim

The increasing frequency and intensity of extreme weather escalate the pressure of global warming on biodiversity. Globally, synergistic effects of multiple components of climate change have driven local extinctions and community collapses, raising concern about the irreversible deterioration of ecosystems. Here, we disentangle the pressure of increasing warming and frequency of extreme heatwaves on the population dynamics of tropical ringtail possums (family: Pseudocheiridae).

Location

The Australian Wet Tropics World Heritage Area.

Method

Ringtail possums' population dynamics were estimated between 1992 and 2021 using a hierarchical population model that explicitly described the state process and accounted for imperfect detection. Under our model, we propagated the estimated mechanisms governing the system by forecasting ringtails' population dynamics between 2022 and 2050. Derived from this process, we calculated the probability of absolute and quasi‐extinction using different population viability thresholds.

Results

We find a strong negative effect of climate change on population dynamics, particularly extreme heatwaves, resulting in a rapid and severe decline in ringtails' population size in the last three decades.

Main Conclusions

Forecasted increases in temperature and heatwaves threaten the collapse of rain forest ringtail possums by 2050, with populations falling below viability thresholds within three decades.
SUpporting People in extreme POverty with Rehabilitation and Therapy (SUPPORT CP): A trial among families of children with cerebral palsy in Bangladesh
Authors: Al Imam Mahmudul Hassan , Jahan Israt , Das Manik Chandra , Bashar Sk Md Kamrul , Khan Arifuzzaman , Muhit Mohammad , Power Rosalie , Akbar Delwar , Badawi Nadia , Khandaker Gulam
Published: November 2022

Aim

To test the efficacy of an integrated microfinance/livelihood and community‐based rehabilitation (IMCBR) programme in improving health‐related quality of life (HRQoL) and motor function of children with cerebral palsy (CP) and gain in social capital to their ultra‐poor families in rural Bangladesh.

Method

This was an open‐label cluster randomized control trial. Children with CP aged 5 years or under were randomly allocated to three arms; Arm A: IMCBR; Arm B: community‐based rehabilitation (CBR); and Arm C: care‐as‐usual. The CBR was modified with phone follow‐up followed by home‐based CBR at 2.5 months post‐enrolment because of the COVID‐19 pandemic. Intention‐to‐treat analysis was performed.

Results

Twenty‐four clusters constituting 251 children–primary caregivers' dyads were assigned to three arms (Arm A = 80; Arm B = 82; Arm C = 89). Between baseline and endline, the percentage mean change in the physical functioning domain of HRQoL was highest in Arm A (30.0%) with a significant mean difference between Arm A and Arm B (p = 0.015). Improvement in the mean social capital score was significantly higher in Arm A compared to Arm C (p < 0.001).

Interpretation

The findings suggest that IMCBR could improve the HRQoL of children with CP and the social capital of their ultra‐poor families. Long‐term follow‐up of the trial participants and future exploration of such interventions are essential. The integrated livelihood and CBR programme holds potential to improve health and well‐being of children with CP and their ultra‐poor families.

What this paper adds

Half of the families who received livelihoods were impacted by a cold‐wave, suggesting the need for a more disaster‐resilient livelihood asset.

The integration of livelihood with community‐based rehabilitation programme helps to improve health‐related quality of life of children with cerebral palsy and the social capital of their ultra‐poor families.
Impact of adapted bicycle riding on outcomes for children and adolescents with disabilities: A systematic review
Authors: Thevarajah Abiramy , Wallen Margaret , Imms Christine , Lonsdale Chris , Carey John J. , Froude Elspeth H.
Published: November 2022

Aim

To review the evidence for the effects of adapted bicycle riding on body structures and functions, activity, participation, and quality of life outcomes in children with disabilities, along with family‐level participation outcomes.

Method

A systematic review with searches of nine electronic databases to identify studies involving participants with a developmental disability aged 4 to 18 years who used a dynamic adapted bicycle was completed in August 2021. Risk of bias was assessed based on individual study designs. A narrative synthesis integrated the findings of the included studies. Certainty of evidence was synthesized using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Results

Ten studies were included with 234 participants. Five studies reported outcomes at the body structures and functions level, ten reported activity‐level outcomes, two reported participation‐related outcomes, and none assessed quality of life or family participation in social and recreational activities.

Interpretation

Adapted bicycle riding interventions may improve gross motor function, enhance lower‐limb muscle strength, and promote physical activity; however, certainty of evidence of effects was rated very low using GRADE. Further research is required to understand the impact of adapted bicycle riding on the participation outcomes of children and adolescents with disabilities and on family‐level participation in social and recreational activities.

What this paper adds

Adapted bicycle riding interventions may improve motor functions and physical activity.

Evidence about participation outcomes after adapted bicycle riding is limited.

Research on adapted bicycle riding interventions in natural settings is needed.
Mammillary body abnormalities and cognitive outcomes in children cooled for neonatal encephalopathy
Authors: Spencer Arthur P. C. , Lequin Maarten H. , de Vries Linda S. , Brooks Jonathan C. W. , Jary Sally , Tonks James , Cowan Frances M. , Thoresen Marianne , Chakkarapani Ela
Published: November 2022

Aim

To evaluate mammillary body abnormalities in school‐age children without cerebral palsy treated with therapeutic hypothermia for neonatal hypoxic–ischaemic encephalopathy (cases) and matched controls, and associations with cognitive outcome, hippocampal volume, and diffusivity in the mammillothalamic tract (MTT) and fornix.

Method

Mammillary body abnormalities were scored from T1‐weighted magnetic resonance imaging (MRI) in 32 cases and 35 controls (median age [interquartile range] 7 years [6 years 7 months–7 years 7 months] and 7 years 4 months [6 years 7 months–7 years 7 months] respectively). Cognition was assessed using the Wechsler Intelligence Scale for Children, Fourth Edition. Hippocampal volume (normalized by total brain volume) was measured from T1‐weighted MRI. Radial diffusivity and fractional anisotropy were measured in the MTT and fornix, from diffusion‐weighted MRI using deterministic tractography.

Results

More cases than controls had mammillary body abnormalities (34% vs 0%; p < 0.001). Cases with abnormal mammillary bodies had lower processing speed (p = 0.016) and full‐scale IQ (p = 0.028) than cases without abnormal mammillary bodies, and lower scores than controls in all cognitive domains (p < 0.05). Cases with abnormal mammillary bodies had smaller hippocampi (left p = 0.016; right p = 0.004) and increased radial diffusivity in the right MTT (p = 0.004) compared with cases without mammillary body abnormalities.

Interpretation

Cooled children with mammillary body abnormalities at school‐age have reduced cognitive scores, smaller hippocampi, and altered MTT microstructure compared with those without mammillary body abnormalities, and matched controls.

What this paper adds

Cooled children are at higher risk of mammillary body abnormalities than controls.

Abnormal mammillary bodies are associated with reduced cognitive scores and smaller hippocampi.

Abnormal mammillary bodies are associated with altered mammillothalamic tract diffusivity.
Individualized busulfan dosing improves outcomes compared to fixed‐dose administration in pre‐transplant minimal residual disease‐positive acute myeloid leukemia patients with intermediate‐risk undergoing allogeneic stem cell transplantation in CR
Authors: Klyuchnikov Evgeny , Langebrake Claudia , Badbaran Anita , Dadkhah Adrin , Massoud Radwan , Freiberger Petra , Ayuk Francis , Janson Dietlinde , Wolschke Christine , Bacher Ulrike , Kröger Nicolaus
Published: November 2022

Pre‐transplant minimal residual disease (MRD) impacts negatively on post‐transplant relapse risk in acute myeloid leukemia (AML). Therapeutic drug monitoring by calculating area under the curve (AUC) was developed to optimize busulfan (Bu) exposure. Here, we compared post‐transplant outcomes after individualized versus fixed busulfan dosage in intermediate‐risk AML who achieved CR prior to allograft focusing on pre‐transplant flow‐MRD. Eighty‐seven patients (median, 56 years) with intermediate‐risk AML and pre‐transplant flow‐MRD (“different from normal”) were included. Thirty‐two patients received individualized busulfan; 54 fixed dosages. Individualized dosage was adjusted in 25/32 patients: increased, n = 18/25 (72%); decreased: n = 7/25 (28%). After median follow‐up of 27 months, we observed lower 3‐year relapses (6%, 2%–19% vs. 35%, 23%–49% p = 0.02), improved 3‐year leukemia‐free survival (LFS) (78%, 54%–91% vs. 55%, 40%–70% p = 0.009) and − overall survival (OS) (82%, 60%–93% vs. 69%, 54%–81% p = 0.05) after individualized compared to fixed Bu. Non‐relapsed mortality (NRM) and acute graft versus host disease (GvHD) were not different. In multivariate analysis, fixed Bu showed unfavorable impact on OS (hazard ratio [HR] 4.6, p = 0.044), LFS (HR 3.6, p = 0.018) and relapses (HR 3.6, p = 0.033). Fixed Bu also had unfavorable impact on LFS (3.6, 1.1–12.6, p = 0.041) in pre‐transplant MRD‐positive patients. Individualized, AUC‐based, busulfan is associated with lower relapses in intermediate‐risk AML patients allografted in CR and may overcome pre‐transplant MRD‐positivity.
Clearance of bone marrow mast cells after hypomethylating agent and venetoclax for systemic mastocytosis associated with myeloid neoplasia
Authors: Pourhassan Hoda , Kim Young , Pullarkat Vinod
Published: November 2022

Systemic mastocytosis (SM) results from clonal proliferation of neoplastic mast cells that infiltrate bone marrow and other organs. A major subset of patients with SM has a clonally related myeloid neoplasm and the SM itself (SM‐AMN). We evaluated the efficacy of hypomethylating agent and venetoclax (HMA‐VEN) to target both the myeloid neoplasm and mast cell infiltrate in a patient with SM associated with acute myeloid leukemia arising from myelodysplastic syndrome and illustrate complete elimination of bone marrow mast cells and complete remission of MDS/AML. This case illustrates the potent activity of HMA‐VEN both against the AMN as well as the associated SM.
High expression of AP2M1 correlates with worse prognosis by regulating immune microenvironment and drug resistance to R‐CHOP in diffuse large B cell lymphoma
Authors: Liu Xindi , Zhao Xiaoli , Yang Jing , Wang Henan , Piao Yingshi , Wang Liang
Published: November 2022

Background

First‐line treatment with R‐CHOP has cured 50%–60% patients of diffuse large B cell lymphoma (DLBCL), and more than one‐third patients will eventually progressed to relapsed/refractory disease with dismal outcomes. Adaptor Related Protein Complex 2 Subunit Mu 1 (AP2M1) is required for the activity of a vacuolar ATPase and may also play an important role in regulating the intracellular trafficking and function of CTLA‐4 protein. Herein, using both public databases and our own tumor samples, we aimed to demonstrate the prognostic role of AP2M1 and the potential tumor‐promoting mechanisms in DLBCL.

Method

Using public datasets of DLBCL from both GEO and TCGA databases, we analyzed the role of AP2M1 in mediating chemoresistance to R‐CHOP and its correlation with various clinical parameters and prognosis. By using various R packages, we evaluated the role of AP2M1 on regulating tumor immune microenvironment. Moreover, tumor samples of DLBCL from Beijing TongRen Hospital were used to validate our findings by immunohistochemistry staining.

Result

Expression of AP2M1 was significantly increased in DLBCL, which was correlated with poor prognosis and a variety of clinical indicators. On the basis of enrichment analysis, it was found that AP2M1 may be related to intracellular receptor signaling pathway. Through immune analysis and drug prediction, we found that the expression of AP2M1 affected the immune environment and drug response of DLBCL, which further revealed the important role of AP2M1 in DLBCL. By analyzing 61 patients treated uniformly with R‐CHOP regimen in our center, we validated the above findings that high expression of AP2M1 correlated with inferior survival outcomes and affected sensitivity to R‐CHOP treatment.

Conclusion

Expression of AP2M1 may affect the prognosis of DLBCL patients probably by affecting the immune environment and the responses to many drugs in treating DLBCL, indicating AP2M1 as a potential therapy target in DLBCL.
Warming causes variability in SOM decomposition in N‐ and P‐fertiliser‐treated soil in a subtropical coniferous forest
Authors: Tang Yuqian , Zhang Xinyu , Wang Huimin , Meng Shengwang , Yang Fengting , Chen Fusheng , Wang Shaoqiang , Dong Qingxin , Wang Jing
Published: November 2022

Both temperature and nutrient availability have essential roles in regulating the decomposition of soil carbon (C) and nitrogen (N), the main controls on organic matter accumulation in forest ecosystems. However, there is a lack of information about how N deposition and phosphorus (P) additions might impact soil C and N decomposition rates in subtropical forests under climate warming. We measured soil organic C and N mineralisation rates and corresponding exoenzyme activities in a subtropical forest soil that had received N and/or P additions for six years in experimental conditions at a range of temperatures between 10 and 40°C. Our results showed that soil organic C and N decomposition rates were positively correlated with the activities of their corresponding enzymes, which suggests that the extracellular enzyme activities could be the main influence on soil organic matter (SOM) decomposition rates. N additions had a significant positive effect on soil organic C mineralisation and enhanced oxidase and hydrolase activities. P additions had little effect on soil organic C and N decomposition rates. These results challenge the assumptions that soil microorganisms are N‐rich and P availability restricts organic matter decomposition, and provides additional evidence that N, not P, regulates organic matter decomposition in subtropical forests. While N additions significantly influenced the soil C and N decomposition rates, they had little effect on their sensitivity to temperature. In contrast, P additions had a significant effect on the temperature sensitivities of SOM decomposition and the βG and NAG Vmax. Overall, our results show that SOM decomposition is vulnerable to both N and P additions, and both should be considered when predicting how SOM decomposition and C cycling might change under warming.

Highlights

The effect of N and/or P additions on the temperature sensitivity of SOM decomposition was explored.

N stimulated soil organic C decomposition rates and corresponding enzyme activities.

P promoted the sensitivity of SOM decomposition to temperature changes.

N and P additions could affect the stability of SOM in subtropical forests in the future.
Drug‐associated acquired hemophilia A: an analysis based on 185 cases from the WHO pharmacovigilance database
Authors: Konstantinov Konstantin , Dolladille Charles , Gillet Benjamin , Alexandre Joachim , Aouba Achille , Deshayes Samuel , Repesse Yohann
Published: November 2022

Introduction

Acquired hemophilia A (AHA) is a rare autoimmune hemorrhagic disease occurring in several underlying conditions. Drug‐associated AHA (D‐AHA) is poorly addressed nowadays.

Aim

This work aims to identify and characterize which drugs are associated with AHA using the WHO global database of reported potential effects of medicinal products (VigiBase).

Methods

First, we realized a disproportionality analysis using the information component (IC) to identify D‐AHA in VigiBase. IC compares observed‐ and expected‐values in order to find associations between drugs and adverse drug reactions (ADRs) using disproportionate Bayesian reporting. IC025 is the lower end of a 95% credibility interval for the IC. Then, we collected cases of drugs significantly associated with AHA from July 2004 to November 2021.

Results

14 drugs with IC025 > 0 were identified representing a total of 185 cases. D‐AHA occurred more frequently in men (59%) than women (41%). The median (min–max) age at onset was 75 years (8–98). The median [Q1–Q3] time to onset of D‐AHA from the start of the suspected drug was 30 days [9.5–73.75] and 10% of cases resulted in a fatality. The drugs associated with the highest IC025 (IC025 > 2) were Clopidogrel, Alemtuzumab, Omalizumab. This study retrieved for the first time three usually used drugs (3/14) that exhibit a significant pharmacovigilance signal for D‐AHA.

Conclusion

This worldwide pharmaco‐epidemiologic study updates the list of the drugs associated with AHA. The clinician should be aware of these possible severe ADR, which might require larger epidemiological and pathophysiologic studies.
Public contributors' preferences for the organization of remote public involvement meetings in health and social care: A discrete choice experiment study
Authors: Loria‐Rebolledo Luis E. , Watson Verity , Hassan Shaima , Gabbay Mark , Tahir Naheed , Hossain Muhammad , Goodall Mark , Frith Lucy
Published: November 2022

Introduction

Covid‐19 expanded the use of remote working to engage with public contributors in health and social care research. These changes have the potential to limit the ability to participate in patient and public involvement and engagement (PPIE) for some public contributors. It is therefore important to understand public contributors' preferences, so that remote working can be organized in an optimal way to encourage rather than discourage participation.

Methods

We use an economic preference elicitation tool, a discrete choice experiment (DCE), via an online survey, to estimate public contributors’ preferences for and trade‐offs between different features of remote meetings. The features were informed by previous research to include aspects of remote meetings that were relevant to public contributors and amenable to change by PPIE organizers.

Results

We found that public contributors are more likely to participate in a PPIE project involving remote meetings if they are given feedback about participation; allowed to switch their camera off during meetings and step away if/when needed; were under 2.5 h long; organized during working hours, and are chaired by a moderator who can ensure that everyone contributes. Different combinations of these features can cause estimated project participation to range from 23% to 94%. When planning PPIE and engaging public contributors, we suggest that resources are focused on training moderators and ensuring public contributors receive meeting feedback.

Discussion and Conclusion

Project resources should be allocated to maximize project participation. We provide recommendations for those who work in public involvement and organize meetings on how resources, such as time and financial support, should be allocated. These are based on the preferences of existing public contributors who have been involved in health and social care research.

Patient or Public Contribution

We had a public contributor (Naheed Tahir) as a funded coapplicant on the UKRI ESRC application and involved members of the North West Coast Applied Research Collaboration (NWC ARC) Public Advisor Forum at every stage of the project. The survey design was informed from three focus groups held with NWC ARC public contributors. The survey was further edited and improved based on the results of six one‐to‐one meetings with public contributors.
‘What price do you put on your health?’: Medical cannabis, financial toxicity and patient perspectives on medication access in advanced cancer
Authors: Olson Rebecca E. , Smith Alexandra , Good Phillip , Dudley Morgan , Gurgenci Taylan , Hardy Janet
Published: November 2022

Introduction

Following 2016 legislation permitting limited access to cannabis for research and medicinal purposes, the number of randomized clinical trials (RCTs) investigating the effectiveness of medicinal cannabis (MC) on symptom burden relief in cancer contexts has increased in Australia. This study aimed to understand the perceptions, hopes and concerns of people with advanced cancer regarding the future availability and regulation of MC in Australia.

Methods

This qualitative study draws on semistructured interviews conducted between February 2019 and October 2020 in Brisbane, Australia, as part of an MC RCT substudy. Interviews were undertaken on 48 patients with advanced cancer in palliative care eligible to participate in an MC trial (n = 26 participated in an RCT;n = 2 participated in a pilot study;n = 20 declined). Interviews included a discussion of patients' decision‐making regarding trial participation, concerns about MC and perceptions of future availability, including cost. Transcribed interviews were analysed inductively and abductively, informed by constructivist thematic analysis conventions.

Results

Overall, participants supported making MC legally accessible as a prescription‐only medication. Fear of financial toxicity, however, compromised this pathway. Steep posttrial costs of accessing MC prompted several people to decline trial participation, and others to predict—if found effective—that many would either access MC through alternative pathways or reduce their prescribed dosage to enable affordable access.

Conclusions

These findings suggest that—despite a relatively robust universal healthcare system—Australians are potentially vulnerable to and fearful of financial toxicity. Prevalent in the United States, financial toxicity occurs when disadvantaged cancer patients access necessary but expensive medications with lasting consequences: bankruptcy, ongoing anxiety and cancer worry. Interview transcripts indicate that financial fears—and the systems sustaining them—may pose a threat to RCT completion and to equitable access to legal MC. Such findings support calls for embedding qualitative substudies and community partnerships within RCTs, while also suggesting the importance of subsidisation to overcoming injustices.

Patient or Public Contribution

A patient advisory committee informed RCT design. This qualitative substudy foregrounds patients' decision‐making, perceptions and experiences.
Bereaved parents involvement in maternity hospital perinatal death review processes: ‘Nobody even thought to ask us anything’
Authors: Helps Änne , O'Donoghue Keelin , O'Connell Orla , Leitao Sara
Published: November 2022

Introduction

The death of a baby is devastating for parents, families and staff involved. Involving bereaved parents in their baby's care and in the maternity hospital perinatal death review can help parents manage their bereavement and plan for the future. In Ireland, bereaved parents generally have not been involved in this review process. The aim of our study was to assess parents' perception of how they may be appropriately involved in the maternity hospital perinatal death review in ways that benefit them and the review process itself.

Methods

Bereaved parents (n = 20) in Ireland were invited to take part in semistructured interviews. Thematic analysis was carried out on the interview transcripts.

Results

Four main themes were identified based on the participants' views and opinions on how they experienced the review process and how they feel this process may be improved. The themes reflect the journey of the parents through the different stages of the review process: Throughout process; On leaving the hospital; Interaction with the hospital ‘waiting in limbo’; Review itself. Identified subthemes highlighted essential aspects of this process and care provided to parents. For the parents, open, honest communication with staff, as well as having a key hospital contact was essential. Parents wished to provide feedback on their experience and wanted to be included in the review of their baby's death, in a way that was sensitive to their needs and the hospital's schedule.

Conclusion

A respectful, flexible system that allows bereaved parents' involvement in their baby's perinatal death review and is tailored to their needs is essential. A collaborative process between staff and parents can highlight clinical areas in need of change, enhance lessons learned, improve bereavement services and may prevent future perinatal deaths.

Public Contribution

Bereaved parents were interviewed for this study.
Development of an inflammatory bowel disease (IBD) Patient‐Reported Experience Measure (PREM): A patient‐led consensus work and ‘think aloud’ study for a quality improvement programme
Authors: Sheldon Elena M. , Lillington George , Simpson Kati , Gibson Kirsty , Chambers Lucy , D'Afflitto Manfredi , Greig Nancy , Stearn Theresa , Hind Daniel , Ainley Rachel , Winsor Gemma , Ridsdale Katie , Totton Nikki , Lobo Alan
Published: November 2022

Background

Patient‐Reported Experience Measures (PREMs) are key in improving healthcare quality, but no PREM exists for inflammatory bowel disease (IBD). This study aimed to co‐produce a PREM with IBD service users for IBD service evaluation and quality improvement programme.

Methods

A pool of 75 items was drawn from published survey instruments covering interactions with services and aspects of living with IBD. In Stage 1, during two workshops, eight expert service users reduced candidate items through a ranked‐choice voting exercise and suggested further items. During Stage 2, 18 previously uninvolved people with IBD assessed the face and content validity of the candidate items in ‘Think Aloud’ interviews. During two final workshops (Stage 3), the expert service users removed, modified and added items based on the interview findings to produce a final version of the PREM.

Results

Stage 1 generated a draft working PREM mapped to the following four domains: Patient‐Centred Care; Quality; Accessibility; Communication and Involvement. The PREM included a set of nine items created by the expert group which shifted the emphasis from ‘self‐management’ to ‘living with IBD’. Stage 2 interviews showed that comprehension of the PREM was very good, although there were concerns about the wording, IBD‐relevance and ambiguity of some items. During the final two workshops in Stage 3, the expert service users removed 7 items, modified 15 items and added seven new ones based on the interview findings, resulting in a 38‐item PREM.

Conclusions

This study demonstrates how extensive service user involvement can inform PREM development.

Patient or Public Contribution

Patients were involved as active members of the research team and as research participants to co‐produce and validate a PREM for IBD services. In Stage 1, eight expert service users (‘the expert group’) reduced candidate items for the PREM through a voting exercise and suggested new items. During Stage 2, 18 previously uninvolved people with IBD (the ‘think aloud’ participants) assessed the validity of the candidate items in ‘Think Aloud’ interviews as research participants. In Stage 3, the expert group removed, changed and added items based on the interview findings to produce a final version of the 38‐item PREM. This study shows how service user involvement can meaningfully inform PREM development.
The importance of personal documentation for patients living with long‐term illness symptoms after pituitary surgery: A Constructivist Grounded Theory study
Authors: Heckemann Birgit , Graf Tatjana , Ung Eva Jakobsson , Jakobsson Sofie , Ragnarsson Oskar , Olsson Daniel S. , Blomdahl Christina
Published: November 2022

Introduction

Despite surgical treatment, pituitary adenomas often cause long‐term illness symptoms, that profoundly impact patients' quality of life physically, psychologically and socially. Healthcare professionals often fail to recognize and discuss the ensuing problems. Personal documentation, such as symptom monitoring, reflective writing or even posts on social media, may help this patient group to manage their daily life and support communication of their care needs. Documentation strategies and the role of documentation for people with long‐term symptoms after pituitary adenoma surgery are currently unknown.

Aim

To examine the effects and strategies of documenting symptoms, activities and physical and emotional well‐being among people living with long‐term pituitary adenoma.

Methods

In this Constructivist Grounded Theory study, 12 individuals living with long‐term illness symptoms after pituitary adenoma surgery described their documentation strategies in in‐depth interviews using teleconferencing and photo‐elicitation between August and October 2020.

Results

Strategies for documentation included analogue and digital media. One core category (Exercising autonomy) and three categories describing processes (Gaining insight, Striving for control and Sharing) emerged from the analysis. These three interrelated processes become an expression of autonomy to manage life and make sense of chronic illness. Personal documentation is a flexible tool that is used more extensively in times of ill health and less in times of relative well‐being. Sharing documentation with healthcare professionals facilitated care planning and sharing with friends and family fostered emotional well‐being.

Conclusion

Personal documentation is a valuable resource for managing life after pituitary adenoma surgery. The current findings may be relevant to other chronic illnesses. Further research exploring potential tools for personal documentation is needed.

Patient or Public Contribution

We deliberately chose a Constructivist Grounded Theory approach for this interview study. Using Constructivist Grounded Theory, we gave people living with long‐term symptoms a voice, allowing them to freely speak about managing their illness in connection with personal documentation. The theoretical sampling approach enabled us to invite participants that could provide a broad overview of the landscape of personal documentation.
Randomized comparative double‐blind study assessing the difference between topically applied microbiome supporting skincare versus conventional skincare on the facial microbiome in correlation to biophysical skin parameters
Authors: Santamaria Emilia , Åkerström Ulf , Berger‐Picard Nicolas , Lataste Sylvain , Gillbro Johanna M.
Published: November 2022

Background

There are trillions of live bacteria, of around 1000 different species, living in human skin which are considered essential for the balance and barrier function of the skin. The gut microbiome has been a subject of extensive research and evidence shows that the gut flora is affected by preservatives and processed foods. In conventional skincare, preservatives are used, and this raises the question of how it affects the skin flora and its balance.

Methods

A randomized double‐blind study on 14 healthy volunteers ages 23–45 years old were advised to use microbiome‐supporting (MS) products on one cheek and benchmark (BM) products on the other cheek daily for 3 weeks. To investigate how the skin was affected, the skin microbiome was analysed using 16 S rRNA sequencing and biophysical parameters were assessed using an Antera 3D camera. Measurements were performed before and after the 3 weeks of using the products.

Results

The use of MS products for 3 weeks significantly increased the total number of reads mapped to unique bacterial species (p < 0.05) and the number of different unique species (p < 0.05). In addition, the use of MS products significantly reduced redness (p < 0.05) and improved skin texture (p < 0.01). The use of BM products showed no significant difference in any of the parameters except improved skin texture (p < 0.05). Additionally, the MS side showed a significantly improved diversity (p < 0.05) compared with the BM side. The four major phyla found were, similarly to previous findings by others, Actinobacteria, Firmicutes, Proteobacteria and Bacteroidetes. Some of the most prevalent species were Cutibacterium acnes, Staphylococcus epidermidis and Pseudonomas aeruginosa.

Conclusion

The findings of this study showed significant improvements in the microbiome and biophysical parameters within 3 weeks of using MS skincare alone, while BM skincare only gave significantly improved skin roughness. Importantly, the MS side gave a significantly improved bacterial Shannon diversity (p < 0.05) compared with the BM side. Regarding the biophysical parameters, the MS skincare gave significant improvements in several parameters compared with baseline. However, they were not yet significant when compared to using BM skincare and therefore a larger study population will be needed. Importantly, this is the first study to investigate how preservatives affect the facial microbiome in vivo and has raised a need for further investigation. These results together with further studies can lead to innovations within the cosmetic industry that promote healthier skin.
Investigation of preparation and properties of Ti3SiC2/Al2O3 multilayered composites
Authors: Chen Yingying , Ma Deli , Li Qinggang , Ji Jun , Zhang Zhenyu , Du Yuhang , Chen Sique , Yang Hailing , Wei Yulin , Shi Guopu , Pan Baocai , Wu Junyan , Wang Zhi
Published: November 2022

Ti3SiC2/Al2O3 multilayered composites were prepared by the combination of tape casting and hot pressing sintering. The slurry was produced by adjusting the amounts of each organic material, including triethyl phosphate (TEP) as a dispersion, polyvinyl butyrate (PVB) as a binder, dioctyl phthalate (DOP) as a plasticizer, and anhydrous ethanol as an organic solvent. When TEP content was 3 wt.%, PVB content was 4.5 wt.%, R‐value (DOP/PVB) was 1.4, and solid content was 38 wt.%; the cast film with a smooth surface, good flexibility, and uniform thickness was obtained after defoaming, tape casting, and drying. Three samples were prepared, namely, S1–S3. The S1 was monolithic Ti3SiC2/Al2O3 (mass ratio is 1:1) composites. S2 and S3 were Ti3SiC2/Al2O3 multilayered composites, which matrix layers were Ti3SiC2/Al2O3 composites (mass ratio is 1:1) and Al2O3, respectively, and their interface layer was Ti3SiC2. S1–S3 were also sintered at 1550°C. The bending strength of multilayered materials were lower than that of monolithic material, but the fracture toughness of multilayered materials significantly increased. Due to the introduction of Ti3SiC2 interface layer, the friction coefficient and wear rate of Ti3SiC2/Al2O3 multilayered composites were reduced by 30.7% and 33.8%, respectively, compared with monolithic material.
Nanoindentation responses near single grain boundaries in oxide ceramics
Authors: Nakamura Ryo , Masuda Hiroshi , Yoshida Hidehiro
Published: November 2022

Local mechanical responses near single grain boundaries (GBs) of 9.8 mol% Y2O3‐stabilized ZrO2 bicrystals, SrTiO3 bicrystal, and Al2O3 polycrystal were investigated by nanoindentation at room temperature to reveal single GB contributions to the mechanical properties. Contrary to the concept of the Hall–Petch strengthening, the hardness showed negligible variations among grain interiors, GB vicinities, and just on GBs in the samples. Importantly, the hardness may be underestimated owing to GB grooving in thermally etched samples. Despite the negligible change in intrinsic hardness, the transmission electron microscopy observation of the ZrO2 specimen under impressions revealed dislocation pileups at GBs. These results suggest that single GBs of oxide ceramics prevented dislocation movement but with limited strengthening contributions. This should correspond to the macroscopic Hall–Petch behaviors in oxide ceramics, where the Hall–Petch coefficients normalized by friction stress are significantly smaller than those in metals.
Characteristics of pulsed electric field cardiac ablation porcine treatment zones with a focal catheter
Authors: Verma Atul , Neal Robert , Evans John , Castellvi Quim , Vachani Armaan , Deneke Thomas , Nakagawa Hiroshi
Published: November 2022

Objectives

Pulsed electric field (PEF) therapies employ punctuated energy delivery to kill cells in a volume of tissue through mechanisms that are not dependent on thermal processes. A key component to successful cardiac ablation procedures is ensuring the generation of transmural, contiguous ablation zones, which requires in‐depth knowledge regarding treatment sizes for a given therapeutic application.

Methods

In this study, a series of acute treatments were delivered to porcine ventricles, where triphenyl tetrazolium chloride (TTC) vitality stain was used to identify treatment effect sizes for the three focal monopolar CENTAURI PEF cardiac ablation energy settings.

Results

Treatment depths were 5.7, 7.2, and 8.2 mm for the 19, 22, and 25 A energy settings, respectively. Gross pathology indicated umbral zones of hemorrhage surrounded by pale avital TTC‐negative‐negative tissue, which contrasted significantly from radiofrequency ablation (RF) controls. Histologically, treatment zones are identified by regions of contraction band necrosis and cardiomyocytolysis, which contrasted with RF control lesions composed primarily of coagulation necrosis.

Conclusions

Together, these data indicate the ability for focal monopolar PEF treatments to generate deep treatment zones in cardiac ablation without incurring the gross or histological coagulative characteristics of RF thermal lesions.
Electrocardiographic measures of repolarization heterogeneity are not predictive for Torsades de Pointes among undifferentiated patients with prolonged QTc: A case control study
Authors: Marill Keith A. , Lopez Samantha , Hark David , Spahr Jennifer , Shesh‐Muthal Ketaki , Xue Joel , Rowlandson G. Ian , Liu Shan W.
Published: November 2022

Introduction

Torsades de Pointes (TdP) is a potentially lethal polymorphic ventricular tachydysrhythmia associated with and caused by prolonged myocardial repolarization. However, prediction of TdP is challenging. We sought to determine if electrocardiographic myocardial repolarization heterogeneity is necessary and predictive of TdP.

Methods

We performed a case control study of TdP at a large urban hospital. We identified cases based on a hospital center electrocardiogram (ECG) database search for tracings from 1/2005 to 6/2019 with heart rate corrected QT (QTc) > 500, QRS < 120, and heart rate (HR) < 60, and a subsequent natural language search of electronic health records for the terms: TdP, polymorphic ventricular tachycardia, sudden cardiac death, and relevant variants. Controls were drawn in a 2:1 ratio to cases from a similar pool of ECGs, and matching for QTc, heart rate, sex, and age. We abstracted historical, laboratory, and ECG data using detailed written instructions and an electronic database. We included a second blinded data abstractor to test data abstraction and manual ECG measurement reliability. We used General Electric (GE) QT Guard software for automated repolarization measurements. We compared groups using unpaired statistics.

Results

We included 75 cases and 150 controls. The number of current QTc prolonging medications and serum electrolytes were substantially the same between the two groups. We found no significant difference in measures of QT or T wave repolarization heterogeneity.

Conclusion

Electrocardiographic repolarization heterogeneity is not greater in otherwise unselected patients with QTc prolongation who suffer TdP and does not appear predictive of TdP. However, previous observations suggest specific repolarization characteristics may be useful for defined patient subgroups at risk for TdP.
Clinical outcomes of radiofrequency catheter ablation of ventricular tachycardia in patients with hypertrophic cardiomyopathy
Authors: Garg Jalaj , Kewcharoen Jakrin , Shah Kuldeep , Turagam Mohit , Bhardwaj Rahul , Contractor Tahmeed , Mandapati Ravi , Lakkireddy Dhanunjaya
Published: November 2022

Background

Monomorphic ventricular tachycardia (VT) is rare in patients with hypertrophic cardiomyopathy (HCM), management of which is challenging. Limited data exists on the utility of catheter ablation for the treatment of VT in this population.

Objectives

We aimed to assess clinical outcomes of catheter ablation for VT in HCM patients.

Methods

A systematic search, without language restriction, using PubMed, EMBASE, SCOPUS, Google Scholar, and ClinicalTrials.gov was performed. The meta‐analysis was performed using a meta‐package for R version 4.0/RStudio version 1.2 and Freeman Tukey double arcsine method to establish the variance of raw proportions. Outcomes measured included (1) acute procedure success (defined as noninducible for clinical VT), (2) freedom from VT at follow‐up, (3) mortality.

Results

This systematic review of six studies (three from the United States and three from Japan) incorporated a total of 68 drug‐refractory HCM patients who underwent VT radiofrequency catheter ablation (mean age 57.6 ± 13.3 years, mean LVEF 45.8 ± 15.4%, 85% men, maximum septal wall thickness 17.4 ± 4.6 mm, and 32.3% with an apical aneurysm). Acute procedural success was achieved in 84.5% patients (95% confidence interval [CI]: 70.6%–95.2%) with 27.9% patients had recurrent VT requiring multiple ablations (median 1, IQR 1–3). During the follow‐up period (18.3 ± 11.7 months), the pooled incidence of freedom from recurrent VT after index procedure was 70.2% (95% CI: 51.9%–86.2%), while after the last ablation was 82.8% (95% CI: 57%–99.2%). There were two deaths during follow‐up, one from heart failure and one from SCD 0.8% (95% CI: 0%–5.8%).

Conclusion

The results of our pooled analysis demonstrated that catheter ablation for VT in HCM patients was associated with high acute procedural success, and reduced VT recurrence—findings comparable to previously published reports in other disease substrates.