bluuebunny/crossref_metadata_2025 huggingface dataset:
1066 INCREASING CONFIDENCE OF FOUNDATION DOCTORS IN MAKING AND DISCUSSING ESCALATION DECISIONS
Authors: Morrison F , Duffty A , Meney C , Paterson E , Warner V
Published: June 2022

Introduction

The Covid-19 pandemic has resulted in renewed emphasis on escalation decisions and discussions, often conducted by junior doctors without any training. Our local Foundation Year (FY) teaching does not address these topics. The distress caused by poor communication regarding escalation is well recognised. Our goal was to improve FY doctors’ confidence in this area and consequently improve quality of patient care.

Method

In PDSA cycle one, email questionnaires established a lack of confidence amongst FY1 doctors. This cycle resulted in the design of a one-hour workshop by middle-grade trainees interested in geriatrics or acute medicine. This workshop included an interactive teaching session, followed by demonstrative and participant role play. Feedback from the first workshop closed cycle two. In cycle three, a subsequent workshop was amended according to feedback. Workshop participants completed anonymous feedback, rating the impact on their confidence.

Results

Thirteen FY1 doctors responded positively to the initial questionnaire, with nine able to attend a workshop. Pre- and post-workshop questionnaires asked respondents to rate their confidence from 1 (low) to 5 (high). Comparison demonstrated an increase in confidence making decisions from an average of 1.8 to 3.7 and discussing decisions with patients from 2 to 3.1. Qualitative feedback emphasised benefit from participant role play and the need for longer workshops.

Conclusion

Our project highlighted the need and desire for FY training in making and discussing escalation decisions. A one-hour workshop increased confidence in this group, though we acknowledge this is a surrogate marker of improved care. Workshop uptake was limited by a small local FY1 cohort, leave and clinical commitments. Though convenient, a one-hour session did not provide adequate time to realise full benefit. We hope to address these issues by integrating longer sessions into the protected teaching for all FY doctors in our health board.
1067 IMPROVING STOOL CHART DOCUMENTATION ON A CARE OF THE ELDERLY WARD
Authors: Adiotomre M , Zuraw N , Leadley A , Athavale N V
Published: June 2022

Introduction

Constipation is a common and often overlooked problem with potentially serious consequences, including patient discomfort, urinary retention, delirium and bowel obstruction. These consequences can lead to prolonged hospital stay, increased healthcare costs and increased morbidity and mortality. Accurate stool chart documentation is an essential part of basic care that helps prevent this. The aim of the project was to increase daily stool chart documentation, including stool type, to 70% on a care of the elderly ward in a medium-sized district general hospital.

Method

We created a proforma to review each patients’ stool chart from the previous 24 hours. Daily data was collected by measuring the number of correctly completed stool charts on the ward. Initial baseline data showed an average daily completion rate of 24%. We tested 3 separate interventions over a 6 week period using Plan-Do-Study-Act (PDSA) methodology: Intervention 1- Increase staff awareness about stool charts via email, posters and at handovers Intervention 2- Complete stool charts every time routine observations are performed Intervention 3- Complete online stool charts.

Results

All interventions led to an improvement in the average daily stool chart completion rate. Intervention 1 caused the most significant improvement with the average daily stool chart completion rate increasing to 77%. Intervention 2 was the least successful change, with an average daily stool chart completion rate of 39%. Intervention 3 had an average daily stool chart completion rate of 64%.

Conclusion

Simple interventions like staff education and prompts to help culture and behaviour change led to a significant improvement in stool chart documentation rates. Paper documentation (intervention 1) fared better than online documentation (intervention 3) most likely due to the former requiring fewer processes to complete. Intense monitoring and documentation (intervention 2) was unsuccessful and was perceived to be burdensome.
1068 QIP ASSESSING ROUTINE RECORDING OF OVERNIGHT VITAL SIGNS (OVS) AND OVERNIGHT MEDICATIONS ADMINISTRATIONS (OMARS) IN ELDERLY CARE
Authors: Rizvi S , McNeela N , Masood I , Akinlade O , Ajaja O , Cole M
Published: June 2022

Introduction

Poor sleep is experienced by up to half of hospital inpatients1, associated with poor cognition, weak immunity, hypertension and increased mortality2. Recent studies recommend fewer sleep interruptions through targeted reductions in routine recording of overnight vital signs (OVS) and overnight medication administrations (OMARS) 3. The following standards were agreed at New Cross Hospital for audit (expected compliance 90%); 1. Routine OVS for stable patients shouldn’t be done overnight (2,200 pm to 0600 am). 2. Routine OMARS shouldn’t be undertaken overnight. These were derived after scrutinizing following; NICE CG1034 and QS635, NSF (Department of health)-4.256, RCP Acute care toolkit 37, CG508.

Method

Retrospective data recorded over 10 days in May and August 2021 from electronic records which included 61 elderly patients in 1st and 53 in 2nd audit cycle. Exclusion was Early Warning Score ≥ 3. We also ran night shift surveys to observe staff perceptions, completed online.

Results

OVS recording showed poor compliance of 0% and 3.77%. OMARS were done in less than half of patients but improved in subsequent audit cycle to about in 1/3rd of patients (77.35% compliance). No patient became unwell or required escalation of care. The estimated time spent on these interventions was 2.5 hours/week or 30 days in 1 calendar year. Almost all survey participants agreed to stop OVS while 66.6% of them agreed to stop OMARS in both cycles. 39.39% in 1st cycle believed that this strategy can cause harm and this misperception was reduced to 22.22% in subsequent cycle.

Conclusion

Our QIP advocates for rationalizing interventions and ensuring we only complete interventions where clinically relevant9. It showed improvement in reducing OMARS but success in stopping OVS couldn’t be fully translated in true spirits, possibly due to common misperceptions which will be further addressed in subsequent audit cycles.
1072 BARRIERS AND MOTIVATORS TO UNDERTAKING PHYSICAL ACTIVITY IN ADULTS ≥ 70—A SYSTEMATIC REVIEW OF THE QUANTITATIVE LITERATURE
Authors: Rutherford M J , Higson J M F , McNiff J A , Mitchell S , Wijayendran A , Lim S E R , Shenkin S D , Kilgour A H M
Published: June 2022

Background

Physical activity (PA) has multiple important benefits for older adults, but many do not undertake the recommended amount. This systematic review examined the quantitative literature detailing barriers and motivators to PA in older adults: a concurrent qualitative review is underway. Previous reviews investigated younger age groups or specific diseases.

Method

We included adults ≥70 years, observational studies and baseline data for randomised controlled trials (RCTs); we excluded studies of specific disease groups, care home residents, and rates of cognitive impairment above population norms. We searched Medline, Embase, CINAHL and PsycINFO on 25th February 2020. We assessed risk-of-bias using ROBANS. We undertook a narrative review; meta-analysis was not possible. The protocol was registered on PROSPERO (CRD42021160503).

Results

We identified 35 papers (24 cross-sectional studies, eight prospective cohort studies, two studies of baseline data from RCTs and one mixed method study); n = 26,264 subjects, median age 77.7 years (range 70–101) and median percentage female 62.1% (range 0–100). Quality assessment identified low risk-of-bias overall, except two studies were identified as having a high risk-of-bias for one section (confounding variables). The most cited barriers were physical health (N = 14 studies), environmental factors (N = 12), fear of falls (N = 7) and lack of interest (N = 4). Other barriers identified were lack of company (N = 1) and urine leakage (in women) (N = 1). Key motivating factors included social aspects of PA (N = 8), intrinsic/psychological (e.g. self-determination, future orientation) (N = 8), health (e.g. doctor’s advice) (N = 7) and environmental (e.g. nearby green space) (N = 4).

Discussion

This review identified key barriers and motivators to PA in older adults. There is a lack of evidence for the oldest old. These findings should be used to create trials of suitable interventions which enable older adults to take up and maintain recommended levels of PA. The wide range of factors we identified indicates an individualised approach may be best.
1074 QUALITY IMPROVEMENT PROJECT AIMED TO REDUCE THE AVERAGE NUMBER OF PATIENTS DEVELOPING CONSTIPATION ON BOURNVILLE WARD IN QEHB
Authors: Vasudev A , Baachaa S , Meakin P , Mohamed I , Nicolson P
Published: June 2022

Introduction

Constipation is an overlooked but frequent problem in elderly patients on geriatrics wards. The prevalence in inpatients aged over 65 years is estimated at about 50%.There are many reasons for this: reduced oral intake due to illness, delirium, immobility, and constipating drugs. If constipation is addressed correctly, we can reduce the rate of unpleasant complications and prolonged hospital stay by increasing awareness of non-laxative methods to be advocated initially to avoid worsening poly-pharmacy with side effects. Queen Elizabeth Hospital Birmingham guidelines advocates use of conservative measures. However these methods can be frequently underutilized and cause of constipation rarely considered to treat. We aimed to identify the barriers to our outcome by tackling lack of awareness, utilization of non-laxative method DRE prior to rapid relief. This included teaching sessions, MDT, posters, introducing constipation booklets.

Method

We used prospective data collection with a standardized questionnaire having a mix of descriptive and quantitative questions based on SMART Aims for the project. This was carried out once a week on alternate beds. Baseline data n44,2ndcycle n44,3rd cycle n43,4thcycle n42.With each cycle we used following interventions to improve constipation prevalence in Bournville ward i.e. individually educate patient/staff during ward rounds, MDT presentations, improve documentation of constipation causes, addition of separate educational posters for staff/patients,identification of at risk patients. Introduced Patient information booklet with documented discussion on hospital online record system.

Results

Following interventions from 1st-4th cycle inpatient constipation prevalence was reduced by 13%,Increased consideration of cause by 38%, significant increase in education by 65%,Increased use of non-laxative approach by 35%,Increased rates of DRE by 35%,reduced use of x-ray prior to DRE by 8.3%,reductions in complication rate by 9%.

Conclusion

Despite increased education, cause consideration, utilization of conservative non-laxative approaches, introduction of new constipation booklet in welcome pack to all new patients a small impact was made in reducing inpatient constipation prevalence and associated complications occurring.
1078 AUDIT TO IMPROVE APPLICATION OF THE MENTAL CAPACITY ACT ON GERIATRIC WARDS
Authors: Chan J , Mifsud R W , Ashton C , Shah K
Published: June 2022

Introduction

The Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) are put in place to protect the rights of capacitous patients to make decisions, and in those not deemed to have capacity, the latter ensures that any restrictions are in the patient’s best interests, are appropriate and proportionate. The objective of this audit was to assess whether these tools were being appropriately employed across the four Complex Medical Units (CMU) in the John Radcliffe Hospital, in a patient population in which dementia and delirium are prevalent.

Method

Audit of patient records on CMU wards (first cycle on 15/8/21 n = 74, second cycle on 31/10/21 (n = 74) before and after presentation of the initial audit results. All inpatients were assessed for: AMTS, completion of a MCA (for those with AMTS<8, or an AMTS not done as too unwell), DoLs applications if indicated. Across the wards, baseline patient characteristics and demographics were equal. In the first audit, there were only 16% patients (6) with an MCA out of a possible 38 patients who fulfilled the criteria and out of these, and 2 had a DOLS (5%). After training, involving a presentation given by us about the findings of our audit, together with high level discussions between consultants and registrars, there were 43% patients with an MCA (15 patients), and 14% had appropriate DOLS (5 patients), out of 35 patients. This therefore shows clear improvement in the situation on our wards.

Conclusion

This audit has improved the recognition of patients in whom a capacity assessment is required and the documentation of a MCA being done. Going forward, we suggest all geriatric medicine wards should discuss and audit MCA and DOLS to ensure patients’ rights are suitably protected.
1079 USE OF AN ADVANCE CARE PLAN CHECKLIST TO IMPROVE COMMUNICATION AND ASSESSMENT OF THE IMPACT ON HOSPITAL READMISSIONS
Authors: Adams G , Woodcock J , Barradell V , Pennells D , Narramore R
Published: June 2022

Introduction

Advance care planning (ACP) is a vital part of holistic and person-centred care. It allows formalising of an individual’s wishes and best interests, and avoids unnecessary or unwanted interventions including, potentially, hospital admissions. It is crucial that any decisions or recommendations are communicated to all relevant healthcare professionals to ensure peoples’ wishes are upheld. We developed this project to review and improve documentation and communication on discharge when a decision had been made to limit care to the community and avoid admission.

Method

A checklist was developed comprising 11 criteria to be documented in the discharge letter and actions to disseminate information including; updating the ReSPECT form and alerting the hospital frailty and community out of hours teams. We carried out a closed loop audit of patients where admission should be avoided and reviewed discharge letters against the criteria. Where patients were readmitted we reviewed the notes to determine whether the admission was appropriate.

Results

We compared patients discharged between February 2020–February 2021 and then from March–September 2021. 161 and 27 patients were identified respectively. Average age was 84.6 and 87.3 years respectively. In cohort 2 48.1% of patients were readmitted, up from 8.7% during the previous cycle. 33% of admissions in cohort 2 and 38.9% of readmissions in cohort 1 were deemed appropriate. Documentation improved in 10 of the 11 criteria. Average length of stay for readmissions was reduced from 16.7 to 5.7 days.

Conclusion

As evidenced by our study utilising a checklist has improved documentation and dissemination of ACPs to the Community. This did not lead to a reduction in hospital admissions but this may have been skewed by factors relating to the Covid-19 pandemic. We did find a significant reduction in length of stay for those subsequently readmitted.
Update on Immune Mechanisms in Hypertension
Authors: Navaneethabalakrishnan Shobana , Smith Hannah L , Arenaz Cristina M , Goodlett Bethany L , McDermott Justin G , Mitchell Brett M
Published: June 2022

The contribution of immune cells in the initiation and maintenance of hypertension is undeniable. Several studies have established the association between hypertension, inflammation, and immune cells from the innate and adaptive immune systems. Here, we provide an update to our 2017 American Journal of Hypertension review on the overview of the cellular immune responses involved in hypertension. Further, we discuss the activation of immune cells and their contribution to the pathogenesis of hypertension in different in vivo models. We also highlight existing gaps in the field of hypertension that need attention. The main goal of this review is to provide a knowledge base for translational research to develop therapeutic strategies that can improve cardiovascular health in humans.
An Ecological Study of COVID-19 Infection Rates within the UK Food and Drink Processing Industry
Authors: Mueller William , Loh Miranda , Fletcher Tony , Rhodes Sarah , Pembrey Lucy , Pearce Neil , van Tongeren Martie
Published: June 2022

Objectives

Food processing facilities represent critical infrastructure that have stayed open during much of the COVID-19 pandemic. Understanding the burden of COVID-19 in this sector is thus important to help reduce the potential for workplace infection in future outbreaks.

Methods

We undertook a workplace survey in the UK food and drink processing sector and collected information on workplace size, characteristics (e.g. temperature, ventilation), and experience with COVID-19 (e.g. numbers of positive cases). For each site, we calculated COVID-19 case rates per month per 1000 workers. We performed an ecological analysis using negative binomial regression to assess the association between COVID-19 rates and workplace and local risk factors.

Results

Respondents from 33 companies including 66 individual sites completed the survey. COVID-19 cases were reported from the start of the pandemic up to June 2021. Respondents represented a range of industry subgroups, including grain milling/storage (n = 16), manufacture of malt (n = 14), manufacture of prepared meals (n = 12), manufacture of beverages (n = 8), distilling (n = 5), manufacture of baked goods (n = 5), and other (n = 6), with a total of 15 563 workers across all sites. Average monthly case rates per 1000 workers ranged from 0.9 in distilling to 6.1 in grain milling/storage. Incidence rate ratios were partially attenuated after adjusting for several local and workplace factors, though risks for one subgroup (grain milling/storage) remained elevated. Certain local and workplace characteristics were related to higher infection rates, such as higher deprivation (5 km only), a lower proportion of remote workers, lower proportion of workers in close proximity, and higher numbers of workers overall.

Conclusions

Our analysis suggests some heterogeneity in the rates of COVID-19 across sectors of the UK food and drink processing industry. Infection rates were associated with deprivation, the proportions of remote workers and workers in close proximity, and the number of workers.
Incorporating the Osseous Genioplasty Into Rejuvenation of the Lower Face
Authors: Dekker Paige K , Slamin Robert P , Charipova Karina , Harbour Patrick W , Talbet Joseph H , Abdel Azim Sara , Baker Stephen B
Published: June 2022

Background

The chin plays a critical role in the shape, projection, and soft tissue support of the lower face. Osseous genioplasty is a powerful tool in facial rejuvenation as it allows for optimal control of the resulting chin dimensions and improvement in submental and submandibular laxity. Osseous genioplasty can be used alone or in combination with other facial rejuvenation procedures to achieve an optimal result.

Objectives

The aim of this study was to present the senior author’s approach to skeletal analysis of the lower facial third and propose an algorithm that can be used to optimize skeletal support of the overlying soft tissue laxity while maintaining an aesthetic facial shape and proportion of the chin.

Methods

All patients undergoing cosmetic osseous genioplasty for soft tissue rejuvenation of the lower face and/or perioral region with the senior author between 2010 and 2021 were retrospectively reviewed. Complications, including infection, numbness, and prolonged ecchymosis, were recorded.

Results

A total of 37 patients underwent cosmetic osseous genioplasty. The average age of the cohort was 44.5 years. Twenty-six patients (70.3%) were female. Eleven patients (29.7%) underwent genioplasty alone. In addition to genioplasty, 8 patients (21.6%) underwent orthognathic surgery, 5 patients (13.5%) underwent platysmaplasty and liposuction, and 2 patients (5.4%) underwent facelift. The authors propose an algorithm to guide evaluation of the lower facial third to help determine the possible role of osseous genioplasty for facial rejuvenation based on each patient’s unique facial characteristics.

Conclusions

In properly selected patients, osseous genioplasty can improve lower facial projection, submandibular laxity, and perioral soft tissue support while also optimizing facial shape and proportion.

Level of Evidence: 4
Sensory experience selectively reorganizes the late component of evoked responses
Authors: Bermudez-Contreras Edgar , Schjetnan Andrea Gomez-Palacio , Luczak Artur , Mohajerani Majid H
Published: June 2022

In response to sensory stimulation, the cortex exhibits an early transient response followed by late and slower activation. Recent studies suggest that the early component represents features of the stimulus while the late component is associated with stimulus perception. Although very informative, these studies only focus on the amplitude of the evoked responses to study its relationship with sensory perception. In this work, we expand upon the study of how patterns of evoked and spontaneous activity are modified by experience at the mesoscale level using voltage and extracellular glutamate transient recordings over widespread regions of mouse dorsal neocortex. We find that repeated tactile or auditory stimulation selectively modifies the spatiotemporal patterns of cortical activity, mainly of the late evoked response in anesthetized mice injected with amphetamine and also in awake mice. This modification lasted up to 60 min and results in an increase in the amplitude of the late response after repeated stimulation and in an increase in the similarity between the spatiotemporal patterns of the late early evoked response. This similarity increase occurs only for the evoked responses of the sensory modality that received the repeated stimulation. Thus, this selective long-lasting spatiotemporal modification of the cortical activity patterns might provide evidence that evoked responses are a cortex-wide phenomenon. This work opens new questions about how perception-related cortical activity changes with sensory experience across the cortex.
A core–periphery framework for understanding the place of Latin America in the global architecture of finance
Authors: Cerpa Vielma Nicole , Dymski Gary
Published: June 2022

This paper contributes to the understanding of subordinate financialisation in emerging and developing economies by setting out a novel core–periphery framework that elucidates the place of Latin America in the global architecture of finance. This framework builds on the centre–periphery financial model of uneven regional credit and economic growth, originally proposed by Victoria Chick and Sheila Dow in 1988. In the era of deregulated financial flows and market-based credit, the core–periphery relationship has become a three-level hierarchical system, in which Latin American nations occupy a subordinate place. The key drivers of this structural shift within these nations have been the liberalisation of cross-border financial flows and investment, the deregulation of banking and the adoption of private pension systems. These drivers’ adoption can be traced to both push and pull factors: specifically, recurrent financial crises requiring external intervention (especially by the International Monetary Fund (IMF)), and the possibility of engaging with the financial instruments and megabanks driving the globalisation of finance. Participating in this hierarchical system has required importing elements of the financial architecture that evolved in the 1980s in advanced economies and has also arguably deepened this region’s financial dependency and vulnerability.
Impacts and implications for the post-COVID city: the case of Toronto
Authors: Brail Shauna , Kleinman Mark
Published: June 2022

Since the onset of COVID-19, scholars have questioned whether the pandemic will alter the fundamentals propelling the growth of global cities. Using a case study of Toronto, the paper examines and analyses changes impacting the city because of the pandemic, with a focus on work, mobility and housing. In assessing pandemic-related disruption, it outlines the experiences of the early phases of recovery and expectations of continued uncertainty. Moving through and beyond COVID-19, Toronto appears unlikely to move up the rankings of global cities. The city’s status as a second-tier global city is an enduring competitive advantage, likely to persist post-COVID.
Relevance of pre-existing anaemia for patients admitted for acute coronary syndrome to an intensive care unit: a retrospective cohort analysis of 7418 patients
Authors: Wischmann Patricia , Bruno Raphael Romano , Wernly Bernhard , Wolff Georg , Afzal Shazia , Rezar Richard , Cramer Mareike , Heramvand Nadia , Kelm Malte , Jung Christian
Published: June 2022

Aims

Patients with acute coronary syndrome (ACS) frequently suffer from anaemia, but its role in patients admitted to an intensive care unit (ICU) is unclear. This analysis evaluates the prognostic relevance of different degrees of anaemia and their specific impact on disease severity and the outcome in critically ill ACS patients.

Methods and results

and results The multi-centre electronic Intensive Care Unit Collaborative Research Database was used, and all patients admitted with ACS were included in a retrospective analysis. Anaemia and its degrees were defined according to the criteria by the World Health Organization. A multi-level logistic regression analysis was used to fit three sequential regression models for the binary primary outcome of hospital mortality. A total of 7418 patients were included; 3437 patients (46%) had anaemia on admission. Patients with anaemia were significantly older [61 (53–70) vs. 70 (61–78) years, P < 0.001], more often female (P < 0.001), and required an increased rate of vasopressor use (P < 0.001) and mechanical ventilation (P < 0.001). With the higher Sequential organ failure assessment score (1 vs. 2; P < 0.001) and Acute Physiology And Chronic Health Evaluation (35 vs. 47; P < 0.001) scores, a higher degree of anaemia was associated with prolonged ICU stay (2 vs. 5 days, P < 0.001). Even patients with mild anaemia needed significantly from more intensive treatment and suffered worse outcome. Intensive care unit and hospital mortality were inversely associated with haemoglobin levels.

Conclusion

Nearly half of critically ill patients with ACS suffer from anaemia, which is associated with increased illness severity, complex ICU procedures, and mortality—even in mild anaemia. Haemoglobin on admission is an independent factor for adverse outcome.
The use of antibiotics in acute oral health patients presenting at public dental clinics in the Western Sydney region
Authors: Nguyen Stephanie , Ahmed Lamis , Villarosa Amy , George Ajesh , Yaacoub Albert
Published: June 2022

Background

There is a limited need for antibiotics when treating oral health problems, yet they are often prescribed, increasing risk of antimicrobial resistance (AMR). With AMR a threat to public health, the objectives of this study were to assess the frequency, suitability, and factors associated with antibiotic prescriptions for acute dental problems across Greater Western Sydney public dental clinics.

Methods

Patients’ reason for attending, details of any antibiotics use, and the treating dental practitioner’s clinical examination and diagnosis were compared to current prescribing guidelines, and logistic regression was used to identify predictors of antibiotic prescription.

Results

In all, 1,071 patients participated in the study, and 15.9% reported to using antibiotics for their dental problem. Over three-quarters obtained the antibiotics from their general medical practitioner (GMP). A high prevalence of antibiotics were not indicated for the patient’s complaint (71.8%) including for those with a history of extraction, pain, or intraoral swelling, who had significantly higher odds of antibiotic prescription (OR > 9). The antibiotic type prescribed was generally suitable.

Conclusions

In summary, the data suggest that the majority of antibiotics were inappropriately prescribed for the patient’s dental complaints and there is a need for interventions to improve compliance with antibiotic prescribing guidelines.
A Decade of GigaScience: GigaDB and the Open Data Movement
Authors: Armit Chris , Tuli Mary Ann , Hunter Christopher I
Published: June 2022

The increasingly multidisciplinary nature of scientific research necessitates a need for Open Data repositories that can archive data in support of publications in scientific journals. Recognising this need, even before GigaScience launched in 2012, GigaDB was already in place and taking data for a year before (making it 11 this year). Since GigaDB launched, there has been a consistent growth in this resource in terms of data volume, data discoverability and data re-use. In this commentary, we provide a retrospective of key changes over the last decade, and the role of Data Curation in enhancing the user experience. Furthermore we explore a much needed emphasis on enabling researchers to interact with and explore datasets prior to data download.
A decade of GigaScience: A perspective on conservation genetics
Authors: O'Brien Stephen J
Published: June 2022

Wide interest in species conservation is young. To many it began early in 1903 when Teddy Roosevelt and John Muir set up a camp under the Grizzly Giant in the Mariposa Grove of California's Yosemite Valley. Over three days they decided to broaden the US National Park footprint across the USA. Conservationists were inspired in the coming decades by the writings of wildlife conservation pioneers—Osa Johnson (I Married Adventure), Karen Blixen (Out of Africa) and Rachel Carson (The Silent Spring). Countless crusaders developed a passion for preserving dwindling species in those early days, yet none of these conservation advocates mentioned the word genetics, let alone genomics. The genome sequencing projects that have followed on from these have brought in an enormous amount of data, including whole genome sequences for thousands of non-human species, both individual and population wide. This huge resource has revolutionized conservation genetics, bringing in ways to assess the health of at-risk populations, devise genetic-driven breeding strategies, and other means to attempt to preserve the over 1 million species (and growing) under threat today.
A Serum Biomarker Panel Can Accurately Identify Mucosal Ulcers in Patients With Crohn’s Disease
Authors: Holmer Ariela K , Boland Brigid S , Singh Siddharth , Neill Jennifer , Le Helen , Miralles Ara , Collins Angelina E , Sandborn William J , Dulai Parambir S
Published: June 2022

Background

The Endoscopic Healing Index (EHI) is a serum biomarker panel that can predict endoscopic inflammation in Crohn’s disease (CD).

Methods

Paired serum samples with endoscopies from adult patients participating in a prospective biobank (June 2014 to December 2018) were analyzed post hoc. Diagnostic performance for EHI was assessed against the individual parameters of the Simple Endoscopic Score for CD using previously identified cutoffs. Confounders for EHI performance were identified using logistic regression.

Results

A total of 205 CD patients were included (50% male, median age 37 years). An EHI of 20 points was sensitive for ruling out any ulcers (85%; 95% confidence interval [CI], 77%-91%) and large (5-20 mm) or very large (>20 mm) ulcers (93%; 95% CI, 84%-97%). An EHI of 50 points was specific for ruling in any ulcers (86%; 95% CI, 76%-92%) and large or very large ulcers (87%; 95% CI, 79%-92%). After accounting for total extent of inflamed mucosa, strictures, and disease location, each 20-point increase in EHI was associated with a 1.7-fold increased probability for the presence of large or very large ulcers (adjusted odds ratio, 1.7; 95% CI, 1.1-2.6).

Conclusions

The EHI was independently associated with ulcer size and accurately identified large or very large ulcers. A cutoff of 50 points can reliably rule in mucosal ulcers and allow for treatment adjustment. A cutoff of 20 points can reliably rule out mucosal ulcers and signal completion of treatment adjustment algorithms.
Decomposable Product Systems Associated to Non-stationary Poisson Processes
Authors: Shanmugasundaram Sundar
Published: June 2022

Let $P$ be a closed convex cone in $\mathbb {R}^{d}$, which we assume is pointed and spanning, i.e, $P \cap -P=\{0\}$ and $P-P=\mathbb {R}^{d}$. We demonstrate that, when $d \geq 2$, in contrast to the one-parameter situation, Poisson processes on $\mathbb {R}^{d}$, with intensity measure absolutely continuous with respect to the Lebesgue measure, restricted to $P$-invariant closed subsets, provide us with a source of examples of decomposable $E_0$-semigroups that are not always CCR flows.
The Frobenius Characteristic of the Orlik–Terao Algebra of Type A
Authors: Pagaria Roberto
Published: June 2022

We provide a new virtual description of the symmetric group action on the cohomology of ordered configuration space on $SU_2$ up to translations. We use this formula to prove the Moseley–Proudfoot–Young conjecture. As a consequence we obtain the graded Frobenius character of the Orlik–Terao algebra of type $A_n$.
Metaphors in Neo-Confucian Korean philosophy
Authors: Kim Hannah H
Published: June 2022

A metaphor is an effective way to show how something is to be conceived. In this article, I look at two Neo-Confucian Korean philosophical contexts—the Four-Seven debate and Book of the Imperial Pivot—and suggest that metaphors are philosophically expedient in two further contexts: when both intellect and emotion must be addressed; and when the aim of philosophizing is to produce behavioral change. Because Neo-Confucians had a conception of the mind that closely connected it to the heart (心 xin), metaphor’s empathy-inducing and perspective-giving capacities made it an especially helpful mode of philosophizing in the history of Korean philosophy.
Morphometrics of the Tropical Bed Bug (Hemiptera: Cimicidae) From Cape Coast, Ghana
Authors: Deku Godwin , Combey Rofela , Doggett Stephen L
Published: June 2022

Bed bugs, Cimex lectularius (L.) (Hemiptera: Cimicidae) and Cimex hemipterus (F.), have become established worldwide in recent years largely due to the development of insecticide resistance. However, limited attention has been given to ongoing morphological and macroevolutionary changes within the species and their populations, which could have implications for their control. Here, we evaluated whether bed bugs of the species C. hemipterus inhabiting different communities in Cape Coast, Ghana are undergoing segregation, which could lead to possible speciation. We also aimed to provide a morphometric description of all nymphal stages. Nine-bed bug populations of C. hemipterus were field-collected in Cape Coast and were subjected to geometric morphometric analysis. The multivariate parameters applied distinguished various populations from each of the locations, indicating the presence of morphologically distinct subpopulations of C. hemipterus. Shape-based segregation and shape changes associated with the insect pronotum (which is an important taxonomic character in the Cimicidae) were evident across the populations. Through this comparative study of C. hemipterus, we showed that possible subpopulations of this bed bug are being spread from Ghana. The nymphal stages (first–fifth) of C. hemipterus were distinguished by the length of the last three antennal segment and pronota width; such information contributes to the taxonomic knowledge of the species.
Targeted Next-Generation Sequencing Reveals Divergent Clonal Evolution in Components of Composite Pleomorphic Xanthoastrocytoma-Ganglioglioma
Authors: Lucas Calixto-Hope G , Davidson Christian J , Alashari Mouied , Putnam Angelica R , Whipple Nicholas S , Bruggers Carol S , Mendez Joe S , Cheshier Samuel H , Walker Jeffrey B , Ramani Biswarathan , Cadwell Cathryn R , Sullivan Daniel V , Lu Rufei , Mirchia Kanish , Van Ziffle Jessica , Devine Patrick , Goldschmidt Ezequiel , Hervey-Jumper Shawn L , Gupta Nalin , Oberheim Bush Nancy Ann , Raleigh David R , Bollen Andrew , Tihan Tarik , Pekmezci Melike , Solomon David A , Phillips Joanna J , Perry Arie
Published: June 2022

Composite pleomorphic xanthoastrocytoma-ganglioglioma (PXA-GG) is an extremely rare central nervous system neoplasm with 2 distinct but intermingled components. Whether this tumor represents a “collision tumor” of separate neoplasms or a monoclonal neoplasm with divergent evolution is poorly understood. Clinicopathologic studies and capture-based next generation sequencing were performed on extracted DNA from all available PXA-GG at 2 medical centers. Five PXA-GG were diagnosed in 1 male and 4 female patients ranging from 13 to 25 years in age. Four arose within the cerebral hemispheres; 1 presented in the cerebellar vermis. DNA was sufficient for analysis in 4 PXA components and 3 GG components. Four paired PXA and GG components harbored BRAF p.V600E hotspot mutations. The 4 sequenced PXA components demonstrated CDKN2A homozygous deletion by sequencing with loss of p16 (protein product of CDKN2A) expression by immunohistochemistry, which was intact in all assessed GG components. The PXA components also demonstrated more frequent copy number alterations relative to paired GG components. In one PXA-GG, shared chromosomal copy number alterations were identified in both components. Our findings support divergent evolution of the PXA and GG components from a common BRAF p.V600E-mutant precursor lesion, with additional acquisition of CDKN2A homozygous deletion in the PXA component as is typically seen in conventional PXA.
Everyday Leadership Can Be Life Changing
Authors: Olsen Meredith L , Blyth Dana M
Published: June 2022

Serving as a flight surgeon after intern year marks an interesting time in a young medical officer’s career. It provides an opportunity for leadership and development for those we serve with in operational settings. This piece demonstrates how small, daily investments in others by leaders can dramatically change a life’s trajectory.
Insights into diet-associated oxidative pathomechanisms in inflammatory bowel disease and protective effects of functional amino acids
Authors: Ji Yun , Yang Ying , Sun Shiqiang , Dai Zhaolai , Ren Fazheng , Wu Zhenlong
Published: June 2022

There has been a substantial rise in the incidence and prevalence of clinical patients presenting with inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis. Accumulating evidence has corroborated the view that dietary factors (particularly diets with high levels of saturated fat or sugar) are involved in the development and progression of IBD, which is predominately associated with changes in the composition of the gut microbiota and an increase in the generation of reactive oxygen species. Notably, the ecological imbalance of the gut microbiome exacerbates oxidative stress and inflammatory responses, leading to perturbations of the intestinal redox balance and immunity, as well as mucosal integrity. Recent findings have revealed that functional amino acids, including L-glutamine, glycine, L-arginine, L-histidine, L-tryptophan, and hydroxyproline, are effectively implicated in the maintenance of intestinal redox and immune homeostasis. These amino acids and their metabolites have oxygen free-radical scavenging and inflammation-relieving properties, and they participate in modulation of the microbial community and the metabolites in the gut. The principal focus of this article is a review of recent advances in the oxidative pathomechanisms of IBD development and progression in relation to dietary factors, with a particular emphasis on the redox and signal transduction mechanisms of host cells in response to unbalanced diets and enterobacteria. In addition, an update on current understanding of the protective effects of functional amino acids against IBD, together with the underlying mechanisms for this protection, have been provided.
Disparities in Electronic Patient Health Portal Use During Pregnancy According to Race, Ethnicity, and Language [A311]
Authors: Grimaldi Carolina Gomez , Delaney Tessa , Garrison Etoi
Published: June 2022

INTRODUCTION:

Use of electronic patient health portals (EMR-PHP) was stressed during the first year of the COVID-19 pandemic as an important vehicle for equitable access to healthcare information. Disparate use of the EMR-PHP according to race, age, ethnicity, and insurance status has been reported. Less is known about disparities associated with EMR-PHP use in pregnancy. Further, the effect of the COVID-19 pandemic on EMR-PHP utilization according to race/ethnicity is unclear.

METHODS:

Institutional review board approval was obtained through Vanderbilt University Medical Center. A retrospective cohort study of patients who delivered and received prenatal care between 2018 and October 2021 was performed. Demographic and EMR-PHP activation/use data were stratified by race, ethnicity, and language. Differences in EMR-PHP registration/use in 2019 and in 2020, during the first year of the COVID-19 pandemic, were determined according to race, ethnicity, and primary language.

RESULTS:

In 2019-2020, an average of 4,400 patients delivered and self-identified as: White (54%), Black (17%), Hispanic (17%), English language (EL) (80%), and Spanish language (SL) (20%). EMR-PHP registration/use increased in 2020 for all patients. EMR-PHP registration increased more in Hispanic (44% increase 2020 vs 2019) and SL (54% increase 2020 vs 2019) patients compared to White and EL patients (P<.05). Despite significant gains in 2020, Hispanic and SL patients were less likely to register/use the EMR-PHP compared to White and EL patients at the time of delivery (P<.01).

CONCLUSION:

Significant disparities in EMR-PHP registration and use were identified in pregnancy. The patient, provider, and digital health access factors underlying low rates of EMR-PHP use in underserved populations require further investigation.
Effect of Menopause on Genital Human Papillomavirus Infection and the Microbiota in a Hispanic Cohort [A320]
Authors: Reguero-Cadilla Laura , Dominicci-Maura Anelisse , Godoy-Vitorino Filipa , Romaguera Josefina
Published: June 2022

INTRODUCTION:

Genital human papillomavirus (HPV) infections are very commonly diagnosed sexually transmitted infections. High-risk HPV types are strongly linked to cervical cancer. The composition of the cervicovaginal microbiota in menopausal and non-menopausal Hispanic people and its relation to HPV infection has not been thoroughly studied. Preliminary data from our group have shown that these changes are also observed in non-menopausal women who are HPV positive and those with high-grade lesion. The association of HPV with the microbiota in menopausal Hispanic women remains unknown. Hence, we hypothesize that menopause creates an environment favorable for HPV infection due to changes associated with the vaginal microbiota.

METHODS:

Cervical swabs were obtained from 330 women (75 menopausal and 255 non-menopausal women) who visited colposcopy clinics in San Juan, Puerto Rico, after patients' consent, as part of an institutional review board–approved study (#1050114). A questionnaire accompanied collection of samples. Genomic DNA was extracted from swabs for 16S rDNA amplification and HPV genotyping (PR Science Technology and Research Trust #2020-00112).

RESULTS:

Analysis revealed that non-menopausal women have higher HPV infection rates than menopausal women (77.25% vs. 60%, respectively), with similar rates of high-risk HPV (43.13% vs 40%, respectively). Menopausal women have higher alpha diversity and lower abundances of Lactobacillus.

CONCLUSION:

Preliminary data show that even though menopausal women have higher diversity, this does not seem to affect HPV infection rates. Nonetheless, it is important to further develop study models to better relate microbial communities and specific HPV infection types to prevent cervical disease.
Medication Management of Early Pregnancy Loss: The Impact of the U.S. Food and Drug Administration Risk Evaluation and Mitigation Strategy [A289]
Authors: Neill Sara , Goldberg Alisa , Janiak Elizabeth
Published: June 2022

INTRODUCTION:

Early pregnancy loss (EPL) occurs in 1 million U.S. patients annually. Mifepristone pretreatment for medication management increases efficacy but requires compliance with the U.S. Food and Drug Administration Risk Evaluation and Mitigation Strategy (REMS) program. This study examined how REMS influences mifepristone use for EPL among obstetrician–gynecologists (ob-gyns) in Massachusetts.

METHODS:

This mixed methods study included in-depth qualitative interviews focused on EPL management analyzed under a thematic analysis framework using multiple coders and a consensus method. Qualitative data informed development of a survey fielded among all ob-gyns in Massachusetts identified through the American Medical Association Physician Masterfile. The Partners IRB deemed this study exempt.

RESULTS:

Nearly all interviewees (17 of 19, 89%) listed the REMS as a barrier to mifepristone use. Barriers included belief that the REMS indicated mifepristone was not available to general ob-gyns, lack of pharmacy dispensing, and concerns about signing the required prescriber agreement. The REMS sometimes gave hospital or pharmacy leadership the impression that mifepristone is dangerous, prolonging protocol development and implementation. A total of 197 physicians responded to a subsequent survey. Of those, 37% did not offer mifepristone for EPL, and 40% were not or only somewhat familiar with mifepristone's REMS program. Among those who reported on barriers to mifepristone use (n=57), the most common was uncertainty with how to comply with the REMS (53%); 73% reported that removing these regulations would help them use mifepristone for EPL.

CONCLUSION:

The FDA REMS program for mifepristone impedes evidence-based medication management of EPL. Removing the REMS would improve access to this best practice.