bluuebunny/crossref_metadata_2025 huggingface dataset:
Small-molecule metabolome identifies potential therapeutic targets against COVID-19
Authors: Bennet Sean , Kaufmann Martin , Takami Kaede , Sjaarda Calvin , Douchant Katya , Moslinger Emily , Wong Henry , Reed David E. , Ellis Anne K. , Vanner Stephen , Colautti Robert I. , Sheth Prameet M.
Published: June 2022

Respiratory viruses are transmitted and acquired via the nasal mucosa, and thereby may influence the nasal metabolome composed of biochemical products produced by both host cells and microbes. Studies of the nasal metabolome demonstrate virus-specific changes that sometimes correlate with viral load and disease severity. Here, we evaluate the nasopharyngeal metabolome of COVID-19 infected individuals and report several small molecules that may be used as potential therapeutic targets. Specimens were tested by qRT-PCR with target primers for three viruses: Influenza A (INFA), respiratory syncytial virus (RSV), and SARS-CoV-2, along with unaffected controls. The nasopharyngeal metabolome was characterized using an LC–MS/MS-based screening kit capable of quantifying 141 analytes. A machine learning model identified 28 discriminating analytes and correctly categorized patients with a viral infection with an accuracy of 96% (R2 = 0.771, Q2 = 0.72). A second model identified 5 analytes to differentiate COVID19-infected patients from those with INFA or RSV with an accuracy of 85% (R2 = 0.442, Q2 = 0.301). Specifically, Lysophosphatidylcholines-a-C18:2 (LysoPCaC18:2) concentration was significantly increased in COVID19 patients (P < 0.0001), whereas beta-hydroxybutyric acid, Methionine sulfoxide, succinic acid, and carnosine concentrations were significantly decreased (P < 0.0001). This study demonstrates that COVID19 infection results in a unique nasopharyngeal metabolomic signature with carnosine and LysoPCaC18:2 as potential therapeutic targets.
Ceramides are early responders in metabolic syndrome development in rhesus monkeys
Authors: Smith Alex B. , Schill Jonah P. , Gordillo Ruth , Gustafson Grace E. , Rhoads Timothy W. , Burhans Maggie S. , Broman Aimee T. , Colman Ricki J. , Scherer Philipp E. , Anderson Rozalyn M.
Published: June 2022

Metabolic syndrome increases risk of complicating co-morbidities. Current clinical indicators reflect established metabolic impairment, preventing earlier intervention strategies. Here we show that circulating sphingolipids are altered in the very early stages of insulin resistance development. The study involved 16 paired overweight but healthy monkeys, one-half of which spontaneously developed metabolic syndrome over the course of 2 years. Importantly, animals did not differ in adiposity and were euglycemic throughout the study period. Using mass spectrometry, circulating sphingolipids, including ceramides and sphingomyelins, were detected and quantified for healthy and impaired animals at both time points. At time of diagnosis, several ceramides were significantly different between healthy and impaired animals. Correlation analysis revealed differences in the interactions among ceramides in impaired animals at diagnosis and pre-diagnosis when animals were clinically indistinguishable from controls. Furthermore, correlations between ceramides and early-stage markers of insulin resistance, diacylglycerols and non-esterified fatty acids, were distinct for healthy and impaired states. Regression analysis identifies coordinated changes in lipid handling across lipid classes as animals progress from healthy to insulin resistant. Correlations between ceramides and the adipose-derived adipokine adiponectin were apparent in healthy animals but not in the metabolically impaired animals, even in advance of loss in insulin sensitivity. These data suggest that circulating ceramides are clinically relevant in identifying disease risk independent of differences in adiposity, and may be important in devising preventative strategies.
A pilot meta-analysis on self-reported efficacy of neurofeedback for adolescents and adults with ADHD
Authors: Fan Hsin-Yi , Sun Cheuk-Kwan , Cheng Yu-Shian , Chung Weilun , Tzang Ruu‐Fen , Chiu Hsien‐Jane , Ho Chun-Ning , Hung Kuo-Chuan
Published: June 2022

Self-reported effectiveness of electroencephalogram-based neurofeedback (EEG-NF) against the core symptoms of attention-deficit hyperactivity disorder (ADHD) in adolescents/adults remains unclear. We searched PubMed, Embase, ClinicalKey, Cochrane CENTRAL, ScienceDirect, Web of Science, and ClinicalTrials.gov from inception to August 2021 for randomized clinical trials (RCTs) of EEG-NF with self-reported ADHD symptom ratings. Comparators included participants on waitlist/treatment as usual (TAU) or receiving other interventions. Of the 279 participants (mean age = 23.48; range: 6–60) in five eligible RCTs, 183 received EEG-NF treatment. Forest plot demonstrated no difference in inattention (SMD = −0.11, 95% CI −0.39–0.18, p = 0.46), total score (SMD = −0.08, 95% CI −0.36–0.2, p = 0.56), and hyperactivity/impulsivity (SMD = 0.01, 95% CI −0.23–0.25, p = 0.91) between EEG-NF and comparison groups. Nevertheless, compared with waitlist/TAU, EEG-NF showed better improvement in inattention (SMD = −0.48, 95% CI −0.9–−0.06, p = 0.03) but not hyperactivity/impulsivity (SMD = −0.03, 95% CI −0.45–0.38, p = 0.87). Follow-up 6–12 months demonstrated no difference in inattention (SMD = −0.01, 95% CI −0.41–0.38, p = 0.94), total score (SMD = 0.22, 95% CI −0.08–0.52, p = 0.15), and hyperactivity/impulsivity (SMD = −0.01, 95% CI −0.27–0.26, p = 0.96) between the two groups. Dropout rate also showed no difference (RR = 1.05, 95% CI 0.82–1.33, p = 0.72). Our results support EEG-NF for improving inattention in adolescents/young adults, although its effectiveness against hyperactivity/impulsivity remains inconclusive.
An integrative pan-cancer analysis of molecular characteristics and oncogenic role of mitochondrial creatine kinase 1A (CKMT1A) in human tumors
Authors: Yang Mengjie , Liu Shuna , Xiong Yue , Zhao Jingxin , Deng Wenbin
Published: June 2022

In recent years, several studies have suggested that mitochondrial creatine kinase 1A (CKMT1A) plays a key role in various cancer types. However, there is still a lack of systematic understanding of the contribution of CKMT1A in different types of cancer. Therefore, this study aims to explore the potential role of CKMT1A in human tumors. Firstly, we evaluated the expression level of CKMT1A in 33 types of tumors. Secondly, we used the GEPIA2 and Kaplan–Meier plotter to explore the relationship between CKMT1A expression and survival prognosis. Furthermore, the genetic alterations of CKMT1A were analyzed by the cBioPortal web. In addition, we performed immune infiltration analysis and gene enrichment pathway analysis. CKMT1A was highly expressed in most types of cancers and there was a significant correlation between CKMT1A expression and the prognosis of patients for certain tumors. Non-Small Cell Lung Cancer cases with altered CKMT1A showed a poorer overall survival. CKMT1A expression was negatively correlated with the infiltration of cancer-associated fibroblasts in most tumors. We also found that its expression was negatively associated with CD8+ T-cell infiltration in several tumors. Furthermore, enrichment analysis revealed that “Glycolysis/ Gluconeogenesis” and “metabolic pathways” functions were involved in the functional mechanism of CKMT1A. Taken together, our studies will provide a relatively clear and integrative understanding of the role of CKMT1A across different tumors. All these findings will lay a solid foundation for further molecular assays of CKMT1A in tumorigenesis and provide the rationale for developing novel therapeutic strategies.
In vivocharacterization of electroactive biofilms inside porous electrodes with MR Imaging
Authors: Häuser Luca , Erben Johannes , Pillot Guillaume , Kerzenmacher Sven , Dreher Wolfgang , Küstermann Ekkehard
Published: June 2022

The use of magnetic resonance imaging can contribute to a better understanding of limiting processes occurring in electroactive biofilms especially inside opaque porous electrodes.
Novel family of bis-pyrazole coordination complexes as potent antibacterial and antifungal agents
Authors: Draoui Youssef , Radi Smaail , Tanan Amine , Oulmidi Afaf , Miras Haralampos N. , Benabbes Redouane , Ouahhoudo Sabir , Mamri Samira , Rotaru Aurelian , Garcia Yann
Published: June 2022

A new pyrazole ligand L and four coordination complexes were synthesized and characterized by different spectroscopic methods. These were found to be promising antibacterial and antifungal agents.
HollowBox: An anchor‐free UAV detection method
Authors: Liu Shanliang , Qu Jingyi , Wu Renbiao
Published: June 2022

Unmanned aerial vehicles (UAV) “black flight” incidents cause serious security risks and economic losses to airports. Additionally, existing UAV detection methods are mainly radar technology at airports. Whereas, it is unable to correctly identify the number of UAVs and visualise their size, which undoubtedly poses a serious security risk. Accordingly, an anchor‐free UAV detection method HollowBox is proposed to supplement radar detection equipment for the airport “black flight” problem. It is inspired by the FoveaBox object detection method, the object detection feature layers are reset and the allocation ratio of positive and negative samples in the training phase are redefined, the HollowBox UAV detection is proposed according to the multi‐size characteristics. Extensive experiments show that, the approach achieves 90.1% AP, 6% false detection rate and 17.2 FPS inference speed, which accomplished a satisfactory performance, as verified by the real‐shot data collected of an airport in Tianjin. This work is of great significance for the application in airport UAV detection.
RAG‐Net: ResNet‐50 attention gate network for accurate iris segmentation
Authors: Wei Yinyin , Zeng Aijun , Zhang Xiangyang , Huang Huijie
Published: June 2022

Iris segmentation is an important step in the process of iris recognition. Iris images collected under non‐cooperative conditions always contain various noise, which is a challenge for iris segmentation. Most U‐Net‐based methods have made great achievements in iris segmentation. However, this architecture lacks of focusing on target structures of varying shapes, and robustness in segmenting objects with significant shape variations. In this paper, we propose RAG‐Net: an efficient iris segmentation method based on deep learning. In contrast to many previous convolutional neural network (CNN)‐based iris segmentation methods, we adopted the attention gate (AG) mechanism and ResNet‐50 in the U‐Net architecture to improve iris segmentation accuracy, the AG module was included in the skip connection part of the RAG‐Net architecture to further identify salient feature regions and prune feature responses, which preserve only the activations relevant to the required information, and the ResNet‐50 module was used to improve the robustness of the segmentation performance. Using this model, efficient iris segmentation in a non‐cooperative environment can be realized. The proposed method was trained and evaluated using the CASIA.v4‐distance, CASIA.v4‐thousand, UBIRIS.v2, and MICHE‐I databases. From the view of the segmentation results, the proposed RAG‐Net is one of effective architecture in iris segmentation methods.
FishNet: Fish visual recognition with one stage multi‐task learning
Authors: Chen Ziwen , Cao Lijie , Wang Qihua , Cai Yu
Published: June 2022

The use of computer vision for fish monitoring in aquaculture fisheries has gained importance. It is crucial to obtain the object box, instance mask and landmarks of the fish to determine their status. There are well‐established methods to achieve these tasks, but running them in a serial sequence is inefficient and complex. A multi‐tasking framework is proposed that can implement the above three tasks in parallel, FishNet. Unlike other multi‐tasking frameworks that use one encoder with multiple decoders, the authors use only one encoder and one decoder to achieve multi‐tasking fusion and can be trained end‐to‐end. A multi‐task dataset for fish is produced to validate the framework. It achieved the best speed‐accuracy balance on object detection (a 95.3% box AP), instance segmentation (a 53.9% mask AP) and pose recognition (95.1% OKS AP), and reached real‐time inference speed (66.3 FPS) on the NVIDIA Tesla V100.
Multi‐model fusion approach for electromagnetic inverse scattering problems
Authors: Zhu Dong , Zhao Qiang , Yang Lixia , Bo Yong , Chen Wei
Published: June 2022

In this paper, a novel deep learning (DL) approach is developed to solve the electromagnetic inverse scattering (EMIS) problems. Many challenges, such as ill‐posedness, high computational cost, and strong non‐linearity, are encountered when solving the EMIS problems. To surmount these difficulties, a multi‐model fusion convolutional neural network architecture is proposed, termed here as Amplitude‐Phase scheme. To the best of our knowledge, it is the first time that the multi‐model fusion DL approach is employed to solve the EMIS problems. Amplitude data and phase data of the measured scattering data are applied to train the proposed scheme. Furthermore, we compare APs with three different training schemes, including Amplitude‐Only scheme, and Phase‐Only scheme, and Complex‐Value scheme. The performance of the proposed DL schemes has been validated by numerical simulations. The results demonstrate that the proposed multi‐model fusion approach outperforms other DL schemes in terms of accuracy and is able to achieve a better performance in reconstructing homogeneous and heterogeneous scatterers.
Extremely low speed performance research of the speed sensorless vector controlled induction motor drive system
Authors: Guo Yongbao , Wang Haixia , Su Tao
Published: June 2022

This paper proposes a new full‐order adaptive observer algorithm to overcome the instability of speed sensorless vector control system of induction motor at low speed, especially at extremely low speed. The algorithm consists of the improved feedback matrix algorithm and the improved speed adaptive law algorithm. By establishing an observer state error equation considering the non‐linear voltage error of the inverter and the stator resistance voltage drop, a feedback matrix was designed to reduce the effect of inverter's non‐linear voltage error and stator resistance voltage drop on speed estimation. Meanwhile, this paper improves the traditional adaptive law. The basic idea is to add compensation amount equivalent to the non‐linear voltage error, and the compensation amount is adaptive to the running speed and load to improve the motor speed estimation accuracy at low speed. Extensive experimental tests have been carried out to evaluate the performance of the proposed algorithm using a 2.2 kW induction motor experimental platform. The experimental results show that the algorithm presented in this paper can guarantee the stable operation of the motor under the rated‐load and 180% rated‐load at low, extremely low and 0 speed with good dynamic and static characteristics.
Spannungsfeld endoskopische Resektionsverfahren bei GEP-NET // Endoscopic resection for GEP-NET
Authors: Ehlken Hanno , Younis Fadi , Wolter Stefan , Schrader Jörg
Published: June 2022

Neuroendokrine Tumoren des Verdauungstraktes (GEP-NET) sind eine seltene Tumorentität, die häufig als Zufallsbefund diagnostiziert werden. Ein großer Teil dieser Zufallsdiagnosen wird im
Rahmen einer endoskopischen Untersuchung gestellt. Während die vollständige Entfernung des Tumors im Sinne einer kurativen chirurgischen Resektion nach onkologischen Kriterien das
Standardvorgehen für lokalisierte Tumorerkrankungen ist, kann bei kleinen Tumoren ohne Hinweis und Risiko für eine lymphogene Metastasierung eine endoskopische Abtragung in gleicher
Intention erfolgen. Während dies für Magen-, Duodenum- und Rektum-NET der Standard ist, sollten NET des Jejunums und Ileums aufgrund der hohen Metastasierungsrate trotz geringer Tumorgröße
regelhaft nicht endoskopisch angegangen werden. Die Grenze für eine endoskopische Resektion ergibt sich sowohl durch die technische Machbarkeit im Sinne des Erreichens einer R0-Resektion,
der erwarteten Komplikationen im Sinne von Blutung und Perforationen als auch durch das vermutete Risiko für eine lymphogene Metastasierung. Generell wird eine endoskopische Resektion bei
Befunden < 1 cm regelhaft empfohlen, da sowohl die gute technische Machbarkeit als auch das geringe Metastasierungsrisiko für eine endoskopische Resektion sprechen. Bei allen Befunden
über 2 cm Größe sind sowohl die technischen Erfolgsaussichten so niedrig als auch das Metastasierungsrisiko so hoch, dass in dieser Situation regelhaft ein chirurgisches Vorgehen erfolgen
sollte. Es bleibt somit ein Graubereich bei der Tumorgröße zwischen 1 und 2 cm, wo sowohl endoskopische, aber auch chirurgische Resektionsverfahren sinnvoll eingesetzt werden können.
Zunehmend kommen auch gemeinsame Eingriffe im Sinne eines endoskopisch-laparoskopischen Rendezvous-Verfahrens zum Einsatz – insbesondere im Duodenum bieten sich diese Eingriffe an, um eine
minimale Resektion mit größtmöglicher R0-Erfolgsrate und niedriger Perforationsrate zu erreichen.
The detection of buried nanopillar based on electrostatic force microscopy simulation
Authors: Luo Yongzhen , Lin Guocong , Ding Xidong , Su Tao
Published: June 2022

Based on electrostatic force microscopy (EFM), the image of nano-objects buried below the surface was numerically simulated by using COMSOL Multiphysics® software. The shape and the approximate size of the buried pillar could be obtained from the simulated EFM images. It was demonstrated that the detection of the buried nanopillar based on EFM was feasible. When the image data measured by EFM were used as the input data for comparison with the simulated data, the three unknowns (relative dielectric constant εr,p, buried depth d, and side length l) of the buried pillar could be obtained. In this paper, the simulated EFM image data were used as the input data. The accurate values of εr,p, d, and l of the buried nanopillar could be obtained by comparing the input data with the data simulated with other known parameters. The results showed that EFM was a good candidate as a kind of three dimensional nanoscale tomographic technique. It could map the physical properties of buried nanomaterials, which are relevant to modern integrated circuits.
Circadian protection against bacterial skin infection by epidermal CXCL14-mediated innate immunity
Authors: Tsujihana Kojiro , Tanegashima Kosuke , Santo Yasuko , Yamada Hiroyuki , Akazawa Sota , Nakao Ryuta , Tominaga Keiko , Saito Risa , Nishito Yasumasa , Hata Ryu-Ichiro , Nakamura Tomonori , Murai Iori , Kono Yuka , Sugawa Maho , Tanioka Miki , Egawa Gyohei , Doi Masao , Isa Tadashi , Kabashima Kenji , Hara Takahiko , Okamura Hitoshi
Published: June 2022

The epidermis is the outermost layer of the skin and the body’s primary barrier to external pathogens; however, the early epidermal immune response remains to be mechanistically understood. We show that the chemokine CXCL14, produced by epidermal keratinocytes, exhibits robust circadian fluctuations and initiates innate immunity. Clearance of the skin pathogen
Staphylococcus aureus
in nocturnal mice was associated with CXCL14 expression, which was high during subjective daytime and low at night. In contrast, in marmosets, a diurnal primate, circadian CXCL14 expression was reversed. Rhythmically expressed CXCL14 binds to
S. aureus
DNA and induces inflammatory cytokine production by activating Toll-like receptor (TLR)9-dependent innate pathways in dendritic cells and macrophages underneath the epidermis. CXCL14 also promoted phagocytosis by macrophages in a TLR9-independent manner. These data indicate that circadian production of the epidermal chemokine CXCL14 rhythmically suppresses skin bacterial proliferation in mammals by activating the innate immune system.
Live analysis of position-effect variegation in
Drosophila
reveals different modes of action for HP1a and Su(var)3-9
Authors: Bughio Farah J. , Maggert Keith A.
Published: June 2022

Position-effect variegation (PEV) results from the juxtaposition of euchromatic and heterochromatic components of eukaryotic genomes, silencing genes near the new euchromatin/heterochromatin junctions. Silencing is itself heritable through S phase, giving rise to distinctive random patterns of cell clones expressing the genes intermixed with clones in which the genes are silenced. Much of what we know about epigenetic inheritance in the soma stems from work on PEV aimed at identifying the components of the silencing machinery and its mechanism of inheritance. The roles of two central gene activities—the
Su
(
var
)
3-9
–encoded histone H3–lysine-9 methyltransferase and the
Su
(
var
)
205
-encoded methyl-H3–lysine-9 binding protein heterochromatin protein 1 (HP1a)—have been inferred from terminal phenotypes, leaving considerable gaps in understanding of how PEV behaves through development. Here, we investigate the PEV phenotypes of
Su
(
var
)
3-9
and
Su
(
var
)
205
mutations in live developing tissues. We discovered that mutation in
Su
(
var
)
205
compromises the initial establishment of PEV in early embryogenesis. Later gains of heterochromatin-induced gene silencing are possible but are unstable and lost rapidly. In contrast, a strain with mutation in
Su
(
var
)
3-9
exhibits robust silencing early in development but fails to maintain it through subsequent cell divisions. Our analyses show that, while the terminal phenotypes of these mutations may appear identical, they have arrived at them through different developmental trajectories. We discuss how our findings expand and clarify existing models for epigenetic inheritance of heterochromatin-induced gene silencing.
Translators’ ideology in Shakespeare’sOthello
Authors: Alowais Fatima A. , Abdulla Adnan K.
Published: June 2022

The phenomenon that this study seeks to investigate is viewed in many different ways by scholars of Translation Studies. Sometimes, it is seen as “mediation”, or “intervention” and other times, it is seen as sheer “manipulation”, however, these terms all seem to describe the shifts that are found in the target-text, reflecting an ideology not found in the source text. The significance of these kinds of shifts, lies in the fact that they serve to either endorse or resist prevalent ideologies among the audience of the target culture. Applying Teun van Dijk’s multidisciplinary socio-cognitive approach of the ‘ideological square’ (1998; 2011) as well asHatim & Mason’s (2005)model of the degrees of translators’ mediation, this paper explores how discriminatory ideologies such as racism, misogyny and xenophobia are dealt with in the process of translating Shakespeare’sOthello.
“It is still light outside”
Authors: Hui Isaac
Published: June 2022

In the film adaptation ofLust, Caution, the importance of sex is apparent. This is not necessarily the case inSe, Jie. In Eileen Chang’s story, there is an interconnection between sex, death, and a ring. This relationship is portrayed differently in Julia Lovell’sLust, Caution. Viewing Eileen Chang as world literature reveals similarities and differences betweenSe, JieandLust, Cautionand their different thematic emphases. This article explores how the imageries of the ring, sex, and death are interrelated. The transaction involving the ring in Chang’s text is similar to a sexual transaction. Analyzing the difference between the source and the target texts reveals how Lovell places a “heavier” emphasis on women’s bodies, suggesting the suppression women suffer in a patriarchal society. While the thematic importance of death is also present inLust, Caution, it is brought out by the notion of foreignness and undecipherability.
Translating to hegemonize
Authors: Emam Abbas
Published: June 2022

Among the diverse varieties of translation, one is institutional translation, i.e., a type of translation done
either in or for a particular institution. In contemporary Iran after the victory of the Islamic Revolution of 1979, a large
number of social, religious, political, cultural, and artistic works have been translated from Persian into a long array of other
languages within such a framework. The implementation of such trans-national projects has involved hundreds of translators/
interpreters, allocation of billions of dollars, and making use of a wide network of international publishers and distributors.
Numerous motives could be enumerated for such undertakings; however, the effects of such endeavors appear not to have been
addressed in Translation Studies as yet. This research aims at pinpointing the mechanisms of such institutions, in particular
relying on concepts such as ideology, hegemony and translational discourse-propagating network to contribute to evaluation of such
a phenomenon. To this end, 11 Iranian post-revolutionary institutions with translational agendas were identified, demonstrated to
have been following double objectives across the world; ideological identity-based discourse to propagate Islamic revolutionary
Shia inclinations as well as to support consolidate the hegemony of the Islamic Republic of Iran.
Does maternity during sports career jeopardize future athletic success in elite marathon runners?
Authors: Forstmann Nicolas , Meignié Alice , De Larochelambert Quentin , Duncombe Stephanie , Schaal Karine , Maître Carole , Toussaint Jean‐François , Antero Juliana
Published: June 2022

The impact of maternity (Mat) on subsequent athletic performance is not well known. This study aims to investigate the impact of maternity among elite marathoners on their overall performance progression. For each runner listed in the top 150 female marathoners, who had experienced a mid‐career maternity, performance development was reconstituted throughout the career. Maternity data and career break time span (Ttotal) were collected from publicly available informations. Performances were modelled according to the known age‐performance relationship and the impact of maternity was added into the model. Linear mixed effect model was used to study the influence of maternity on the overall career. Among this sample, 37 runners had at least 1 child during her career. Among them, 14 had 2 children. Eleven runners (29.72%) made their personal best performance before Mat, which occurred at an average age of 28.40 ± 4.00 years. Twenty‐six runners (70.28%) establish their best performances after Mat, at an average age of 32.20 ± 4.28. The age‐performance relationship model explains 92% of the performance variability during the career's progression. When age is considered, maternity does not have significant impact on performance development. World's most competitive marathoners can still perform at their best level after pregnancy. The ability to return and surpass previous performance level is influenced by the age at which pregnancy occurs, relative to the age of peak performance during career development.

Highlights

Mid‐career maternity does not have a significant impact on overall progression in high level runners, who return to official races.

The ability to return and surpass previous performance level is influenced by the age at which pregnancy occurs, relative to the age of peak performance.

Age is the variable that explains most of performance progression, independently of mid‐career maternity occurrence(s).
953 PREVIOUS SARS-COV2 INFECTION, AGE AND FRAILTY PREDICT 6-MONTH BNT162B2 VACCINE-INDUCED ANTIBODY TITRE IN NURSING HOME RESIDENTS
Authors: Dyer A , Noonan C , Pierpoint R , Leonard A , Boran G , Brady G , Fallon A , O'Farrelly C , Bourke N , Kennelly
Published: June 2022

Introduction

Older nursing home residents are the population at greatest risk of morbidity and mortality from SARS-CoV-2 infection. No studies have examined the determinants of long-term antibody responses post-vaccination in this group.

Method

Longitudinal cohort study in residents of 5 nursing homes assessed prior to vaccination and at both 5-weeks and 6-months post SARS-CoV2 vaccine (BNT162b2). Comprehensive clinical assessment was performed, including assessment for comorbidity, frailty (NH-FRAIL) and SARS-CoV-2 infection history. Serum Nucleocapsid and Anti-Spike Receptor Binding Domain (RBD) antibodies were analysed at all timepoints and an in vitro Angiotensin Converting Enzyme (ACE2) Receptor-Spike RBD neutralisation assay used to assess serum neutralisation capacity.

Results

Of 86 participants (81.1 ± 10.8 years; 65% female), just-under half (45.4%; 39/86) had evidence of previous SARS-CoV-2 infection. All participants demonstrated a significant antibody response to vaccination at 5-weeks and a significant decline in this response by 6-months. SARS-CoV-2 infection history was the strongest predictor of antibody titre (log-transformed) at both 5-weeks (β: 3.00; 95% CI [Confidence Interval]: 2.32, 3.70; p < 0.001) and 6-months (β: 3.59; 95% CI: 2.89, 4.28; p < 0.001). Independent of SARS-CoV-2 infection history, both age in years (β: -0.05; 95% CI: −0.08, −0.02; p < 0.001) and frailty (β: -0.22; 95% CI: −0.33, −0.11; p < 0.001) were associated with a lower antibody titre at 6-months. Antibody titres at both 5-weeks and 6-months significantly correlated with in vitro neutralisation capacity.

Conclusion and Implications

In older nursing home residents, SARS-CoV-2 infection history was the strongest predictor of anti-spike antibody titres at 6-months, whilst age and frailty were independently associated with lower titres at 6-months. Antibody titres significantly correlated with in vitro neutralisation capacity. Whilst older SARS-CoV-2 naïve nursing home residents may be particularly vulnerable to breakthrough SARS-CoV-2 infection, the relationship between antibody titres, SARS-CoV-2 infection and clinical outcomes remains to be fully elucidated in this cohort.
983 LEARNING FROM THE EXPERIENCES OF NURSES IN CARE HOMES DURING COVID-19 (THRIVE STUDY): STEERING THE SHIP THROUGH THE STORM
Authors: Birt L , Lane K , Corner J , Sanderson K , Deakins A , Bunn D
Published: June 2022

Background

Nurses practising in older people’s care homes are often the only trained nurse on shift, undertaking leadership roles while also supporting residents with complex clinical needs. The study aimed to explore Nursing and Midwifery Council (NMC)-registered nurses’ experiences of working in older people’s care homes during the COVID-19 pandemic.

Method

Recruitment used direct contact with care homes, social media and links provided by national partners, then purposive sampling for age, gender, type of care home and location. Data collected through one-to-one on-line interviews using a topic guide developed collaboratively with care home nurses, focusing on how COVID-19 impacted on nurses’ resilience and mental well-being. Data were analysed thematically.

Results

18 nurses interviewed between March–July 2021: female 16, majority aged between 46–55 years; mean time registered with NMC 19 years (range 18 months-45 years); one had not nursed residents with COVID-19. Preliminary findings indicate that nurses developed enhanced clinical skills, which increased their professional standing. Many nurses were in leadership roles responsible for processing and sharing rapidly-changing guidance, making judgements on how to manage infection risk within the home. Nurses reported balancing information-assimilation and reporting with providing direct care due to staff shortages. All nurses provided emotional support to other staff. They sought support from their peers, namely nurses inside and outside their workplace. As leaders, many of the nurses spoke about the emotional impact of having to manage relatives’ expectations and make decisions on whether a relative could be with a dying resident.

Conclusion

Understanding the types of support that might best increase resilience and well-being for nurses in care homes now and in the future is essential to maintain a healthy, stable workforce. Support for nurses will likely benefit other care workers either directly through wider roll-out, or indirectly through improved well-being of the nurse leaders.
979 FACTORS THAT INFLUENCE OLDER ADULTS’ PARTICIPATION IN PHYSICAL ACTIVITY: A SYSTEMATIC REVIEW OF QUALITATIVE STUDIES
Authors: Meredith S J , Cox N , Ibrahim K , Higson J , McNiff J , Mitchell  , Rutherford M , Wijayendran A , Shenkin  , Kilgour A , Lim S E R
Published: June 2022

Introduction

Despite the myriad advantages associated with physical activity (PA), older adults are often insufficiently active to maximise health benefits. Understanding factors that influence engagement in PA will support practitioners in providing well-designed interventions for older people. Our aim was to review the qualitative evidence exploring the factors affecting older adult’s engagement in PA.

Method

Four electronic databases were searched: CINAHL, Embase, MEDLINE and PsycINFO. Inclusion criteria were community-dwelling older adults (≥70 years), and studies including qualitative method. Exclusion criteria were studies examining a single disease group, individuals with cognitive impairment, care home residents, and PA interventions. The Critical Appraisal Skills Programme (CASP) checklist was used to assess methodological rigour. Framework synthesis using the COM-B model was applied to analyse data, and the GRADE-CERQual approach was used to assess confidence in findings. (PROSPERO: CRD42021160503).

Results

Twenty-one studies were included in the review. Participants (N = 3,955; mean age 78.9 years) included 64% female and 36% male older adults. Most studies were methodologically rigorous (17/21 scored ≥8 CASP). We identified 32 themes mapped against the COM-B framework (16 high confidence). Older adult’s perceived capability was influenced by their functional capacity, illness symptoms and perceived risk of injury from PA. PA was motivated by identifying as an ‘exerciser’, health gains and positive emotions (e.g. enjoyment), while negative sensations reduced motivation (e.g. pain). Opportunity was impacted by the weather, the environment ‘fit’, and the availability of social interaction during PA. Moreover, social opportunity was impacted by socio-cultural ageing stereotypes and discourses, influencing older adults’ PA through media outlets, social norms, and self-stigma.

Conclusion

The review found a complex web of interacting factors that influenced older people’s PA between the sub-domains of capability, motivation, and opportunity. Future initiatives to increase PA in older adults should focus on social influences, environmental barriers, and physical limitations.
1069 ESSENTIAL FRAILTY TOOLSET AS A PREDICTOR OF PROLONGED LENGTH OF STAY AND DISCHARGE DESTINATION AFTER TRANSCATHETER AORTIC VALVE IMPLANTATION
Authors: Patel N , Teh W , Omoniyi O , Martin W , Weir-McCall J , D’Errico L , O’Sullivan M , Davies W , Costopoulos C , Costanzo P
Published: June 2022

Introduction

Frailty is associated with poor outcomes following transcatheter aortic valve implantation (TAVI). Rockwood is the widely used score for this population. In a recent trial, a more objective score, the Essential Frailty Toolset (EFT) outperformed Rockwood’s in predicting mortality and disability 1-year post-TAVI. Whether it predicts in-hospital length of stay (LOS) and discharge destination post-TAVI remains unclear.

Method

A cohort of patients undergoing TAVI for aortic stenosis was recruited, demographic characteristics collected, and frailty assessed with EFT and Rockwood scores. Primary outcomes were LOS post-TAVI, categorised as ‘not prolonged’ (≤2 days) or ‘prolonged’ (>2 days) and discharge destination, characterised as ‘home’ or ‘non-home’.

Results

86 patients were recruited, with median age 82 years (IQR 78–86). 54% were male. EFT identified 35% and Rockwood 11% as frail. 19% were cognitively impaired. 5 chair rises were completed by 70%, with 30% managing under 15 seconds. Median haemoglobin was 121 g/L (IQR 109.5–136). Median albumin was 36 g/L (IQR 33–39). 84% of procedures were transfemoral. 20% had moderate–severe left ventricular systolic dysfunction. Median LOS post-TAVI was 2 days (IQR 2–5). 94% were discharged home, 6% to referring local hospital or rehabilitation centre. 46% were NYHA class III-IV. A model for prolonged LOS including comorbidities, showed frailty determined by EFT (OR 4.80, CI 95% 1.52–15.2, p = 0.008) but not Rockwood (OR 5.00, CI 95% 0.865–29.0, p = 0.072) was the only significant independent predictor for prolonged LOS. A model adjusting for comorbidities also showed EFT to be an independent predictor for non-home discharge destination of borderline significance (OR 2.57 CI 95% 0.994–6.66, p = 0.051) but Rockwood was not (OR 1.38 CI95% 0.485–3.91, p = 0.548).

Conclusion

In a real-world elderly population, EFT score was a stronger, more independent predictor of prolonged LOS and non-home discharge post-TAVI, than Rockwood’s. EFT would be an effective pre-operative assessment tool for LOS and discharge destination for TAVI.
911 EVALUATION OF TYPE/LOCATION OF CLINIC APPOINTMENTS IN OLDER PERSONS SERVICES PARKINSON DISEASE PATIENTS IN RURAL EAST SUFFOLK
Authors: Blows S , Thapa A , Lae-Phyo W
Published: June 2022

Introduction

We have 262 patients under the care of older persons movement disorders service in East Suffolk, whom due to a combination of retirement and COVID pandemic hadn’t seen a consultant for their follow up in up to 18 months. There are the facilities to see patients closer to their homes with satellite outpatient clinics in Eye, Stowmarket, Felixstowe and Aldeburgh, and via telephone and video consultation. We found that 137 of these patients live in rural areas closer to these satellite clinics. An opportunity was sensed to tailor the future service to the preferences of our patients, with the aim of improving experience and satisfaction.

Method

We sent a postal survey to these 137 patients asking them about the importance of having one responsible consultant, the type and location of their appointment.

Results

We sent a postal survey to these 137 patients, we received 81 Reponses. 91% of respondents ranked it either important, quite important or very important that they see the same consultant. It was the 1st preference to be seen at a local healthcare facility with 71% of patients choosing this as their first choice versus 22% for Ipswich hospital. 7% had a 1st preference of telephone appointment. 0 patients had a 1st choice preference of video conference it was the least favourable preference for 52% of respondents.

Conclusion

Our cohort of patients place a high value on continuity of care and would prefer to be seen at a community clinic that is closer to home. These preferences have been discussed with PDUK and CCG and have informed how we deliver our service as of August 2021 with all patients having a locality based clinic and named consultant. Our results are at odds with the ethos of NHSX [1] and the drive to see patients virtually.
951 SETTING UP A GERIATRIC LIAISON SERVICE WITHIN UROLOGY IN A DISTRICT GENERAL HOSPITAL
Authors: Alexander H , Manning J
Published: June 2022

Introduction

One might refer to urologists as the ‘hidden providers’ of geriatric care, ultimately sought out by many geriatric patients. POPS, the Peri-Operative care of Older People’s Service started at Guys Hospital in London is often quoted as the gold standard for liaison services. Having set up liaison services in Orthopaedics and General Surgery in my previous job, an exciting opportunity arose after the first COVID—19 wave when I found my new office directly under the Urology Assessment Unit.

Method

A Geriatric Urology liaison service was set up by a Consultant Geriatrician with SpR support. One hour per week was agreed within the department to pilot the service. By May 2021 the service had been running for 8 months. During this period 30 patients had been seen (36 patient visits).

Results

The patient’s mean age was 82 years. The advice given included: O Stopping medication (7 cases) O Recommending iron infusions instead of tablets (5 cases) O Adjusting analgesia (4 cases) O Ordering brain imaging (3 cases) Commonly there was the recognition of the need for palliative care in this frail population. There have been complex cases: O A gentleman with a large perinephric bleed. O A young man with seizures and cognitive issues following renal stones. O A patient with post-operative rhabdomyolysis following nephrectomy. Pre-operative assessments have now been started as part of enhanced care: O Two cystectomy patients (one ward/one telephone) O Two TURBT patients (one with low sodium).

Conclusion

Staff feedback has been excellent especially linking to the Palliative Care Team. We presented our data at the Urology governance meeting in September 2021 and again received excellent feedback. The urology staff have felt increasingly supported. Data collection has helped build a business case for two Consultant posts in surgical liaison.
955 ANALYSIS OF RANDOMISED CONTROLLED TRIAL SERIOUS ADVERSE EVENT RATES AS A MARKER OF TRIAL REPRESENTATIVENESS
Authors: Hanlon P , Butterly E , Shah A V , Hannigan L J , Wild S H , Guthrie B , Mair F , Dias S , Welton N J , McAllister D A
Published: June 2022

Introduction

The applicability of randomised controlled trials of pharmacological agents to older people with frailty/multimorbidity is often uncertain, due to concerns that trials are not representative. However, assessing trial representativeness is challenging and complex. We explore an approach assessing trial representativeness by comparing rates of trial Serious Adverse Events (SAEs: most of which reflect hospitalisations/deaths) to rates of hospitalisation/death in routine care (which, in a trial setting, would be SAEs be definition).

Method

We identified 483 trials (n = 636,267) from clinicaltrials.gov across 21 index conditions. A routine care comparison was identified from SAIL databank (n = 2.3 M). SAIL data were used to derive the expected rate of hospitalisations/deaths by age, sex and index condition. We then calculated the expected number of SAEs for each trial compared to the observed number of SAEs (observed/expected SAE ratio). We then re-calculated the observed/expected SAE ratio additionally accounting for comorbidity count in 125 trials for which we accessed individual participant data.

Results

For 12/21 index conditions the observed/expected SAE ratio was <1, indicating fewer SAEs in trials than expected given community rates of hospitalisations and deaths. A further 6/21 had point estimates <1 but the 95% CI included the null. The median observed/expected SAE ratio was 0.60 (95% CI 0.56–0.65; COPD) and the interquartile range was 0.44 (0.34–0.55; Parkinson’s disease) to 0.88 (0.59–1.33; IBD). Higher comorbidity count was associated with SAEs and hospitalisations/deaths across index conditions. For most trials, the observed/expected ratio was attenuated but remained <1 after additionally accounting for comorbidity count.

Conclusion

Trial participants experience fewer SAEs than expected based on age/sex/condition specific hospitalisation/death rates in routine care, confirming the predicted lack of representativeness. This difference is only partially explained by differences in multimorbidity. Assessing observed/expected SAE may help assess applicability of trial findings to older populations in whom multimorbidity and frailty are common.
965 INTEGRATED CARE HOME OWNERSHIP AND FINANCIAL VULNERABILITY
Authors: Dolphin H , Lynch A , McNally D , Keating J , Doyle M , Domsa M , Kennelly P
Published: June 2022

Introduction

Lack of home ownership is associated higher rates of mental and physical ill-health and death1. According to longitudinal data in Ireland, 92% of persons aged 75 and over own their homes outright with approximately 8% living in rented accommodation2. We sought to compare characteristics of a cohort of patients open to our Integrated Care for Older Persons (ICOP) team with this national Irish dataset.

Method

A convenience sample of 50 patients reviewed by the ICOP team in a University Teaching Hospital was analysed. Data was anonymised and stored via encrypted key. Analysis was performed using SPSS v.27.

Results

The average age was 82.5 (±8.1) with 70% women in the sample. There was a lower prevalence of home ownership in this group of patients than the national norm (66% vs 92%) ie 34% were living in rental accommodation, majority Local Authorities. Those living in Local Authority accommodation had lower overall time spent in full time education than those who owned their own home (9.3 ± 3.1 vs 11.5 ± 3.3 p = 0.013), they were more likely to require external assistance with finances (54.5% v 88.2% p = 0.026) and less likely to have a Will (63.6% vs 35.2% p = NS) or EPOA (33.3% vs 23.5% p = 0.053) established. There was no significant difference in age, CFS, MMSE, Waterlow or polypharmacy rates between these groups.

Discussion

This report highlights a divergence between community dwelling older adults referred to ICOP teams and national standard data. Targeted social work interventions should be operationalised to assist financially vulnerable older adults. 1: Marmot M, Geddes I, Bloomer E, Allen J, Goldblatt P. The health impacts of cold homes and fuel poverty. London: Friends of the Earth. 2011. 2: Orr, J, Scarlett S, Donoghue, O, McGarrigle, C. Housing conditions of Ireland’s older population. Implications for physical and mental health, 2016. Available from https://tilda.tcd.ie/publications/reports/pdf/Report_HousingConditions.pdf
969 ACUTE FRAILTY MODEL: A DISTRICT GENERAL HOSPITAL EXPERIENCE OF DELIVERING COMPREHENSIVE GERIATRIC ASSESSMENT
Authors: Budihal D , Andrews S , Settle S , Alexander H , Haslam S
Published: June 2022

Introduction

Under the NHS Long Term Plan1, every hospital with a Type 1 Emergency Department (ED) has been asked to provide Acute Frailty Services for at least 70 hours a week. We have adopted a liaison model to ensure Comprehensive Geriatric Assessment at the front door. The Frailty Team now includes two Frailty Practitioners, a Specialist Registrar based in ED and the Acute Medical Unit (AMU) with Consultant Physician of the Week support.

Method

The team attend multi-disciplinary meetings in ED and AMU on a daily basis. Frail patients are reviewed and Comprehensive Geriatric Assessments are undertaken together with appropriate signposting. The aim being, to enhance the care of frail patients at the earliest opportunity.

Results

High bed utilisation comes at a cost and a longer length of stay (LOS) is associated with an increased risk of deconditioning. Since introducing incremental changes to our working model, the average LOS of patients on AMU has been reduced from a mean of 1.33 days to 0.82 days. This represents a 38.3% reduction from September 2020 to August 2021. This reduction has been sustained, while 30-day readmission rates have not increased. Feedback has been very positive from all the other teams involved.

Conclusion

Our service has established a more positive working culture to efficiently manage frail patients. The AMU team now feel empowered to make patient-centric decisions regarding patient flow and discharges. Since this data was analysed we have implemented a further change to help enhance the care of frail patients. A list of appropriate patients is emailed to the hospital site team every afternoon to aid getting the right patients into the right beds. The impact of LOS on the frailty wards will then be reviewed following this introduction.

Reference

1. nhs-long-term-plan-june-2019.pdf (longtermplan.nhs.uk).