bluuebunny/crossref_metadata_2025 huggingface dataset:
Hemiarthroplasty or Total Hip Arthroplasty for the Treatment of a Displaced Intracapsular Fracture in Active Elderly Patients
Authors: Janahan Thayaparan Anthony , Singh Ashok , Al-Obaidi Bilal , Strachan Robin K. , Spicer Dominic
Published: June 2024

The treatment of displaced intracapsular neck of femur fractures in elderly patients with hemiarthroplasty or total hip arthroplasty has been contended over the years with advantages and disadvantages for each operation in the immediate instance and the subsequent months to years. However, debates arise as to which procedure is superior in the longer term. This chapter presents data suggesting that at twelve years postoperatively there is no significance between the two procedures in modified Harris Hip Scores (for functionality), mortality, rate of revision surgery, and complications in the two studied groups. Limitations consisted of the only complications recorded after discharge were dislocation and revision surgery. Only 20% of the patients were included in the final analysis at final follow-up. Consequently, the authors concluded that patients over the age of 70 years should be considered for a faster cemented hip hemiarthroplasty rather than a total hip replacement.
Should Acute Scaphoid Fractures Be Fixed?
Authors: Panagiotidou Anna , Elvey Mike
Published: June 2024

This is a prospective randomized controlled trial reporting on outcomes of eighty-eight minimally displaced or undisplaced waist of scaphoid fractures treated with either early surgical fixation or cast immobilization. The authors looked at the rate of union and the effects of treatment on pain, tenderness, grip strength, range of motion, and Patient Evaluation Measure scores at different time intervals spanning over a year. The results of the study suggest that apart from better union rates, all other potential benefits of surgery are transient, and nonunions can be successfully fixed at a later date. Cast immobilization is effective in achieving union, and therefore early fixation could lead to overtreatment of a large proportion of fractures.
A Controlled Trial of Arthroscopic Knee Surgery versus Placebo for Osteoarthritis
Authors: Maheswaran Tim , Sugand Kapil , Sarraf Khaled M.
Published: June 2024

Arthroscopic knee surgery for osteoarthritis has been commonplace for several decades, and what this study aimed to do was to determine the efficacy of arthroscopic knee surgery against a sham surgery (placebo) by means of a randomized controlled trial. One hundred and eighty patients and the assessors were blinded to the group they were assigned to, and the patients were followed up at regular intervals for up to 2 years. At each time point, the patients were assessed for pain and function. The results demonstrated no significant improvement in pain or function between the treatment and placebo group. Thus, the results of this study proved to be both significant and controversial at the time.
Long-Term Survivorship of the Hip Following Operatively Treated Acetabular Fracture
Authors: Martin Alexander , Abdul-Jabar Hani B.
Published: June 2024

This seminal study from one of the godfathers of hip surgery represents the largest and longest series of patients demonstrating the likelihood of a successful outcome following open reduction and internal fixation of a displaced acetabular fracture. It highlights that with appropriate and skilled management, patients can expect a “survival” of their native hip joint in 79% at 20 years without progressing to THR. It also highlights the fact that 50% of all treatment failures occurred within the first 2 years postinjury. The publication provides valuable prognostic information to help guide decision-making using the normogram, postoperative follow-up, and patient counseling regarding their long-term outlook. The inclusion of a novel tool to help predict the likelihood of early treatment failure will be of great interest and value to clinicians treating these complex injuries. This is a level two study from California, USA.
Cemented or Uncemented Hemiarthroplasty for Displaced Intracapsular Fractures of the Hip
Authors: Ghafur Asim , Osborne Andrew , Holloway Ian
Published: June 2024

This study compares treatment options for displaced intracapsular neck of femur fractures. A randomized controlled trial of 400 patients was undertaken to determine whether there was any difference in the outcome between cemented polished tapered or uncemented Furlong hydroxyapatite-coated hemiarthroplasty techniques. There were 273 women and 127 men with a mean age of 84.2 years (60–102) in the cemented group and 85.3 years (58–98) in the uncemented group. They were assessed for functional outcome, hip movements, limb shortening, and pain scores at two, three, six, nine, and twelve months after the injury. The main finding was better recovery with respect to mobility in patients treated with a cemented prosthesis. There was no difference in residual pain or mortality.
Comparison of Adverse Outcomes after Total Knee versus Unicompartmental Knee Replacements
Authors: Popat Ravi , Ghosh Subhajit , Nathwani Dinesh
Published: June 2024

The aim of this study was to compare the rates of adverse outcomes after total knee replacement (TKR) and unicompartmental/unicondylar knee replacement (UKR) with large data sets. The outcomes from the National Joint Registry for England and Wales, Hospital Episode Statistics, and the Office for National Statistics were reviewed. There were 25 334 UKR episodes identified, which were matched to 75 996 TKRs on the basis of propensity score. UKRs had a higher rate of revision and reoperation than TKRs at eight years. Length of stay, complications, and rates of readmission were all higher for TKR than for UKR.
Randomized Trial of Reamed and Unreamed Intramedullary Nailing of Tibial Shaft Fractures
Authors: Kwok Iris H. Y. , Bates Peter
Published: June 2024

A multicenter randomized controlled trial of 1226 patients with tibial shaft fractures was conducted across 29 centers in Canada, comparing reoperation and complication rates between reamed and unreamed intramedullary nailing. It showed that reoperation rates were lower in the reamed group for closed fractures. In open fractures, there was no significant difference between reamed and unreamed groups. The overall reoperation rate in this study was 4.6%. There were significantly more deaths in the reamed compared to the unreamed group; however, the deaths were unrelated to the intramedullary nailing procedure itself.
Isolated Medial Patellofemoral Repair Does Not Improve Patient Outcomes or Decrease the Rate of Patella Redislocation
Authors: Boutong Sara , Sugand Kapil , Ahmad Mudassar
Published: June 2024

The purpose of this study was to evaluate the effect of surgical repair of the medial patellofemoral ligament (MPFL) onto the adductor tubercle in patients with primary dislocation of the patella. Eighty patients underwent diagnostic arthroscopy before being randomized to surgical repair of the MPFL or nonoperative management. Patients were monitored for recurrent patella dislocation. Their scores from the Kujala score and Knee injury and Osteoarthritis Outcome Score were recorded. The redislocation rate and outcome scores showed no significant difference between both groups. Therefore, delayed isolated primary repair of the MPFL using anchor-based reattachment does not decrease the risk of redislocation, nor does it improve clinical outcomes.
Arthroscopic Subacromial Decompression for Subacromial Shoulder Pain (CSAW)
Authors: Nabil Fanous Rafik , Gooding Ben
Published: June 2024

Shoulder pain is a significant burden on the healthcare system, of which the most common presentation is impingement syndrome. Arthroscopic subacromial decompression to free the passage of the rotator cuff tendons in the subacromial space is a commonly performed orthopaedic procedure to address this. This large randomized study assessed the effectiveness of this procedure and has suggested that there is no benefit over diagnostic arthroscopy alone or no treatment. It would seem, therefore, that some patients may improve without surgical intervention. However, there remains contention as to the role for subacromial decompression in some cases.
Compartment Monitoring in Tibial Fractures
Authors: Merchant Irfan , Sugand Kapil , Paul Murphy John
Published: June 2024

The study observing for compartment monitoring of tibial fractures was designed to test the hypothesis of whether decompression should be performed when compartmental tissue pressure rises to within 30 mmHg of diastolic blood pressure. This study reviewed 116 patients with tibial diaphyseal fractures over two years and seven months. Continuous monitoring on anterior compartment pressures was performed over a twenty-four-hour period. The results of this study showed that no cases of compartment syndrome were missed when using a differential pressure of 30 mmHg. It was recommended that fasciotomies should be performed at this pressure limit.
Pain in People with Substance Use Disorder
Authors: Hetherington Lucy , Farnham Christopher
Published: June 2024

This case describes a person, Lydia, with substance use disorder and severe multiple disadvantages. The case discusses the role of palliative care services (hospital, community, and hospice inpatient care) in addressing Lydia’s symptoms and supporting her complex needs. Methadone medication-assisted treatment (MAT) and buprenorphine MAT use alongside other opioids is explained. Managing the prescription and storage of controlled drugs for people with substance use disorder is explored. The palliative care community has evolved over the last 50 years to support the symptom control needs of people with non-malignant life limiting or life-threatening conditions. People who use substances are no different in this respect—however, the hidden nature of their ‘needs’ and often challenging circumstances, make it easy for them to be forgotten.
Cancer Cachexia
Authors: Ison Lucy , Laird Barry , Skipworth Richard
Published: June 2024

This case examines the diagnosis and management of cachexia in patients with cancer. It explores the nature of cachexia and effects on the patient’s nutrition and function mediated by inflammation. The definition, diagnosis, and multimodal and multidisciplinary management of cachexia will be reviewed. Prehabilitation prior to definitive oncological treatment, nutritional, and pharmacological interventions will be discussed. Changes in management when a person is reaching the end of their life will be explored. This information is illustrated via a case discussion of a patient with a pancreatic malignancy and includes input from experts in the field.
Depression in Life-limiting Illness
Authors: Wood Felicity , Price Annabel
Published: June 2024

This case examines the importance of recognizing, assessing, and effectively managing depression at the end of life. Depression is common in palliative populations, yet it is frequently underdetected and undertreated. Identifying depression is important because effective management can improve quality of life and relationships with others. Screening tools can be useful to recognize depressive symptoms amongst feelings of grief, sadness, and the biological symptoms relating to poor physical health. A bio-psycho-social approach is important for management. Medication and non-pharmacological treatments have been shown to be effective. When starting antidepressants, it is important to review frequently for side effects and effectiveness and titrate to a therapeutic dose as quickly as is safely possible.
Hoarding and Associated Disorders
Authors: Bhamra Manraj , Ismail Khalida
Published: June 2024

This case outlines a case of hoarding in a woman with a new cancer diagnosis and depressive illness. The case considers the differential between hoarding as part of the presentation of underlying psychiatric illness and primary hoarding disorder, the importance of comprehensive assessment and the challenges of effective management, particularly as older people are more resistant to treatment. Whilst cognitive and behavioural techniques (CBT) have been shown to be effective in hoarding, current treatments are not as robust as for other psychiatric disorders. Technology-supported hoarding interventions, cognitive rehabilitation treatment, compassion-focused therapy, motivational interviewing, and harm reduction have all shown promise. Treatment effects with antidepressants may not be sufficient. The use of novel agents, such as stimulants and cognitive enhancers, or augmentation of psychological therapies with medications, may be future options. Further studies and more effective treatments are required for this disabling condition.
Frailty and Multiple Long-Term Conditions
Authors: Dewhurst Felicity , Nicholson Caroline
Published: June 2024

‘Frailty and Multiple Long-term Conditions’ examines a case of an older woman with complex health and social needs relating to multiple long-term conditions and her personal circumstances. The ageing population, together with associated high rates of frailty and MLTC, is arguably the biggest problem currently facing the health system. People with frailty and MLTC have high rates of morbidity, mortality and poor quality of life. Despite their high levels of need, which frequently escalate as the end-of-life approaches, people with MLTC and frailty often have poor access to palliative care. Family members are left to care for relatives without adequate support. Appropriate models of palliative care are urgently required; ensure realistic medicine provision, reduce non-beneficial hospital visits and admissions, and ensure the appropriate coordination of care. Multidisciplinary interspecialty-working (including palliative, geriatric, and primary care services) is key.
Diabetes Management at the End of Life
Authors: Mann Jaspal Kaur , Lumb Alastair
Published: June 2024

This case considers the case of a 44-year-old man with type 1 diabetes with adenocarcinoma of the distal sigmoid colon and explores the complexities of safe diabetes management in the context of life-limiting illness. In this case, the patient stopped his insulin treatment prior to admission to hospital for symptom relief, as his glucose readings had been in range at home without it and there were no further systemic anticancer treatment options available. His insulin was reinstated due to concerns about the risk of diabetic ketoacidosis, then withdrawn again after hypoglycaemia developed. The relationship between diabetes and cancer is discussed, as are the reasons for the change in his insulin requirement. Current guidelines for the treatment of diabetes at the end of life are presented.
Spiritual Care
Authors: Maan Sarah , Gray Alice , Goodhead Andrew
Published: June 2024

Spiritual care explores how to address spiritual needs at the end of life, which may include religious needs, and the value of doing this in palliative care. It is an essential part of a holistic assessment and impacts significantly on the patient’s experience. Looking beyond the scope of organized religion, spiritual care examines the different ways patients perceive and experience spirituality. It looks at how our own spirituality can influence the rapport and connections made with our patients and how we can help them meet their spiritual needs and manage any spiritual pain or distress. Listening to our patients and engaging with those important to them is crucial in ensuring this aspect of their care has been addressed.
Supportive Care and Survivorship
Authors: Datta-Paulin Lara , Warren Mark , Berman Richard
Published: June 2024

‘Supportive care and survivorship’ examines a case of narcotic bowel syndrome in the context of a patient who has had curative cancer treatment. It reviews specific short- and long-term effects of cancer treatments, including post-chemotherapy rheumatism and side effects from pelvic radiotherapy. It also considers both the immediate and long-term effects of opioid therapy such as endocrine and immune dysfunction, opioid-induced hyperalgesia, and opioid-induced bowel dysfunction (OIBD). The evidence base for the management of OIBD is examined. It reviews the pathophysiology and management of narcotic bowel syndrome. Lastly, it considers the role that supportive care can have in managing patients throughout their cancer journey and outlines the future development of supportive care within the UK.
Treatment Escalation Plans
Authors: Lewis-Williams Gemma , Taubert Mark
Published: June 2024

This case explores the current literature surrounding the use of Treatment Escalation Plans (TEPs) and Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) discussions and decision-making in clinical practice. Paper-based forms carry significant risks. Therefore, it is important to plan for central electronic patient records and repositories, that hold information about DNACPR forms and other advance or future care planning statements and can highlight where a person has a lasting power of attorney for health and welfare. The electronic records need to be available as read versions for all providers, including paramedics, hospital staff, 999 or 111 call handlers, primary care, out-of-hours services, etc. They need to be editable, when, for instance, a patient’s situation changes, or when a decision is revoked or temporarily suspended. The ability to audit records is essential.
Withdrawal of Treatment
Authors: Senders-Galloway Simeon , Gorringe Anna
Published: June 2024

This case examines the key clinical, ethical, legal considerations in withdrawing life-sustaining treatment in patients having or lacking capacity. The case explores the withdrawal of clinically assisted nutrition and hydration (CANH) in a community patient with a prolonged disorder of consciousness (PDOC). The core principles apply to the withdrawal of any life-sustaining treatment in any clinical scenario and are outlined in a stepwise structure. Learning points explored in detail include justifications for withdrawing treatment, legal case precedent, ethical considerations, and key medicolegal principles such as advance decision to refuse treatment (ADRT), independent mental capacity advocate (IMCA), and lasting power of attorney (LPA).
Kidney Transplantation with Transplant Phases
Authors: Puttarajappa Chethan M. , Mohan Sumit
Published: June 2024

Kidney transplantation offers a great opportunity to improve an end-stage kidney disease (ESKD) patient’s quality of life and mortality risk. Long-term success however requires overcoming several challenges along the post-transplant journey. These challenges vary with time after transplant and often require a multifaceted approach to ensure that recipients obtain optimal care leading to substantial benefit from their transplantation. This chapter will highlight key challenges faced by patients and healthcare providers as they navigate these different post-transplant phases, which we have demarcated here as early, middle, and late phases. The chapter will highlight immunological, medical, and social factors that pose a risk for poor graft and patient outcomes and discuss opportunities for mitigating these risks and thus improving long-term outcome.
Immunological and Nonimmunological Factors Affecting Kidney Transplant Outcomes
Authors: Sood Puneet , Gill John
Published: June 2024

Allograft failure adds significant health and financial burden to the patient and healthcare system and is the fifth leading cause of dialysis initiation in the United States. Patients who initiate dialysis after transplant failure have high morbidity and mortality. Repeat transplantation is clearly the best treatment, but is available to only a minority of patients who suffer allograft failure. Repeat transplant recipients have inferior outcomes compared to primary transplant recipients, in part due to higher levels of. Patient death with a functioning allograft is often premature, and only a minority of transplant recipients live a normal life expectancy. Traditionally allosensitization factors contributing to allograft failure have been separated from factors contributing to patient death. However, because these factors are often intertwined, this chapter provides a holistic overview of the nonimmunological and immunologic factors contributing to both allograft failure and patient death.
Short-Term and Late T-Cell-Mediated Rejection after Kidney Transplantation
Authors: Mehta Rajil B. , Naesens Maarten
Published: June 2024

Alloimmune T cell responses are central in the pathogenesis of rejection. T cells are activated by exposure to alloantigens followed by expansion of T cell clones, differentiation into effector cells, and migration into the graft, leading to tissue destruction. From the early days of kidney transplantation, this immune infiltration into the graft was recognized as rejection, even prior to the development of a classification system of rejection. Over the years, this understanding has evolved as has the recognition of the prognostic implications of varying severity of rejection. This chapter provides details of T-cell-medicated rejection (TCMR) including historical perspective, classification, clinical features, current management and its shortcomings, as well as future directions.
Cardiovascular Disease and Metabolic Complications after Kidney Transplantation
Authors: Lin Chien-Jung , Lentine Krista L. , Sharif Adnan
Published: June 2024

Cardiovascular disease (CVD) remains the leading cause of death for people with chronic kidney disease with or without kidney transplant and accounts for 30% of post-transplant hospitalizations and one-third of deaths in kidney transplant recipients. Among all renal replacement therapy options, kidney transplantation is the best option to reduce long-term cardiovascular risk in comparison to remaining on dialysis. However, death with a functioning graft is the leading cause of late allograft loss and CVD remains one of the leading causes of death post-transplantation. This may relate to progression of pretransplantation CVD or development of de novo disease post-transplantation, influenced by the milieu of immunosuppression contributing to cardiometabolic risk burden. To improve long-term outcomes further after kidney transplantation, reducing the morbidity and/or mortality associated with CVD is a priority for transplant professionals. This chapter reviews the range of metabolic complications and CVD observed for kidney transplant candidates and recipients.
Late Post-Transplant Infections
Authors: John George T. , Khanna Rajiv
Published: June 2024

Transplant recipients with kidney disease, especially those who have diabetes and liver disease, have lower immunity and are at a higher risk for post-transplant infections while receiving maintenance immunosuppression. Cancer, infections, and cardiovascular diseases are known to negatively impact kidney transplant outcomes. However, due to marked improvements in medical management and preventive strategies, there has been a decline in mortality from infectious complications after transplantation. Infectious complications account for 19% of deaths in kidney transplantation recipients, with a standardized incidence ratio of 7.8 compared with matched general population in Australia and New Zealand. Risk factors of infections include T-cell-depleting therapy, deceased donor transplantation, older age, diabetes, female sex, and marginalized individual. However, death related to infection accounts for over 50% of deaths among kidney transplant recipients in the developing world. This chapter discusses various infections with viral, fungal, and mycobacterial organisms in kidney transplant recipients.
Social Determinants Impacting Transplant Outcomes
Authors: Sharma Akhil , Hart Allyson
Published: June 2024

While the transplant community celebrates improvements in long-term kidney allograft outcomes, research and policy is increasingly focused on further improving long-term patient and graft outcomes. In addition, frustrations remain regarding the persistence of gaps in outcomes based on socioeconomic factors and other social determinants of health (SDoH). While research and advancements in medical factors, such as improved immunosuppression, cancer treatments, and cardiovascular disease management, are all critical to achieving this goal, SDoH, which are one of the largest contributors to poor outcomes, are less well studied by the transplant research community. This chapter reviews the SDoH, describes how they impact kidney transplant (KT) recipient outcomes, and discuss strategies and additional research priorities to realize the full promise of better KT outcomes for patients with kidney disease.
Simultaneous Liver and Kidney Transplantation
Authors: Molinari Michele , Dunn Ty B.
Published: June 2024

This chapter provides a thorough examination of Simultaneous Liver and Kidney Transplantation (SLKT), offering insights into its historical evolution, patient selection criteria, modern immunosuppression protocols, and identified research gaps. With the increasing number of patients requiring SLKT, particularly post the incorporation of the Model for End-Stage Liver Disease (MELD), it becomes imperative for transplant specialists to stay abreast of the most recent literature in this field and recognize areas where current evidence falls short. This chapter serves as a succinct resource for transplant professionals seeking a comprehensive analysis of recent advances for informed decision-making.
1
Authors: Cohen Lewis
Published: June 2024

The reader is introduced to Dan Winter, with emphasis on the experience he had with his own father who died from complications related to dementia. The dementias are explored from a research perspective, including Alzheimer’s disease, which affects more than 6.7 million people aged 65 and older living in the United States. The chapter also explores the question of how people with dementia develop their symptoms and how they die, including the position that those suffering with dementia should be able to choose when and how to die, with opinions gathered from experts in ethics, theology, and members of various medical organizations.
5
Authors: Cohen Lewis
Published: June 2024

This chapter explores the social and economic forces that influence how patients who are diagnosed with a dementia will process and live with the disease. Studies are analyzed that explore the differences between how white physicians and patients react to a dementia diagnosis versus people of color, particularly Black Americans. Furthermore, the experience of jurisdictions with permissive approaches to physician-hastened death suggests that those who advocate for and actively pursue this option tend to cluster demographically in privileged social groups, prompting some to describe them as “the three W’s: white, wealthy and well-educated.” Dan’s privileged social status and sexual orientation are explored, and the chapter introduces the reader to a traumatic experience in Dan’s life that had powerful and long-lasting effects.
10
Authors: Cohen Lewis
Published: June 2024

This chapter explores the terminology around the right-to-die movement. In particular, words that are fraught with negative meaning, such as “suicide” and “euthanasia,” are examined and their use dissected. The history of these words, including their clinical meanings, is also explored. The moral quandaries associated with interviewing a person as they actively create a plan to hasten death are also addressed and examined. Last, the chapter explores how people suffering with a dementia deal with issues around timing, and how important it is for them to find the right moment to end their suffering.
11
Authors: Cohen Lewis
Published: June 2024

Medical aid in dying is now legally authorized in 11 jurisdictions within the United States of America. Unlike a number of other countries around the world that have enacted death with dignity laws, the American legislation largely exempts people with dementias because of issues related to terminality and capacity, as well as its lack of attention to suffering. The chapter also explores how ementia often takes years to manifest its varied symptoms, during which time suffering may become unbearable. This may be difficult to determine because in addition to the cognitive and memory impairments, patients often develop aphasias and cannot express the circumstances of their individual situations. The chapter also clarifies the difference between capacity and competency, and it concludes with a further discussion of clinical suicides in the context of dementia. The latter are often impulsive, violent, and rely on firearms. An assisted suicide is described that has tragically fractured a family and led to a 20-year prison sentence.
12
Authors: Cohen Lewis
Published: June 2024

The reader is introduced to the first discussion of voluntarily stopping eating and drinking (VSED) as a means of hastening death. Then the chapter discusses Dan’s rationale in choosing to instead take a lethal overdose of a drug cocktail over other death-hastening methods. The principle medication he intended to rely upon is the antidepressant Amitriptyline, for which he had no difficulty obtaining a prescription. A more detailed history of the Hemlock Society and how it evolved, which was first introduced in Chapter 7, is given. Other organizations that provide assistance or support for voluntary dying and death with dignity are introduced. The reader learns more about how Dan formulated his plan to overdose.
15
Authors: Cohen Lewis
Published: June 2024

New symptoms exhibited by Dan are explored in this chapter, such as the deterioration of his language skills, and odd mannerisms that are identified by his husband. The chapter also explores Dan’s thoughts about the manner and timing of his death and how these change as circumstances evolve. The question of what the trigger should be, a date or a specific symptom, for beginning the death-hastening process is explored. Some of Dan’s most traumatic symptoms of dementia are addressed. They include a new experience of getting lost and the beginning of auditory hallucinations. These symptoms are addressed in a larger conversation around nature of either physical or existential suffering.
16
Authors: Cohen Lewis
Published: June 2024

Further civil unrest continues to wrack the city of Portland in the form of more than 100 consecutive nights of disturbances, demonstrators marching throughout the city and targeting different police buildings. Massive wildfires add to the tension. The readers learn of, and read, a letter that Dan’s husband composes and sends to Dan’s ex-wife and children. Experts from palliative care, neuropalliative care, and psychiatry weigh in on a discussion of dignity and the “authentic self” versus the “new” personality that a dementia or terminal illness may bring about. The concept of anosognosia, or the inability of neurological patients to recognize their own impairments, is introduced. So, too, are the related terms of apathy and denial.
21
Authors: Cohen Lewis
Published: June 2024

This chapter explores what happens when family members intervene in Dan’s plan to hasten his death. These interventions include visits from police officers, the local suicide prevention office, and adult protective services. The reality of “DIY” suicides is broached, along with issues tied to communication and management of friends’ and family members’ expectations and worries. Legal questions and concerns around death-accelerating measures are addressed. Cases are discussed where people were declared mentally incompetent or were targeted by law enforcement officials in efforts to prevent their hastening their own deaths. Dan and John become paranoid as to what may happen next.
23
Authors: Cohen Lewis
Published: June 2024

This chapter explores the complicated interplay between Alzheimer’s, death-with-dignity laws, voluntarily stopping eating and drinking (VSED), and qualifying for hospice. The chapter focuses on Dan’s decision to begin VSED. Experts weigh in on their experiences with VSED and give their own conflicting opinions when presented with Dan’s case. VSED, and the symptoms people experience because of it, are delineated. Space is given to identify the complicated personal and professional feelings experts have about VSED. A recent statement has concluded that “VSED provides an opportunity to achieve a relatively peaceful, personally controlled death for patients seeking an escape from the prospect of unacceptable suffering or deterioration in their present condition or foreseeable future.
28
Authors: Cohen Lewis
Published: June 2024

This chapter details the interviews that the author continues to conduct with Dan’s husband every 2 weeks, then monthly, and then every 6 weeks after Dan’s demise. These occurred over the following 3 years, and they offered an opportunity to attend to the complex impact of caregiving. The reader learns more about what happened after Dan’s death, and how the relationships with family members continued to develop. The author explores the events of the 9 months that led up to Dan’s death, and how their meaning evolved with the passage of time. Grief and mourning are explored, with the reader receiving an intimate view to the process experienced by Dan’s husband.
30
Authors: Cohen Lewis
Published: June 2024

During the next 2 years, Dan’s widower resumed feeling more creative and energetic, but his grief over Dan’s loss continued. John and the author both continue to ruminate on Dan’s end and whether he had a good death. This question is studied from different vantages. Likewise, several other individuals with dementias who foreshortened their lives are named, such as Cody Sontag. She was able to take advantage of recent amendments to US MAiD statutes; by initiating VSED, Cody qualified under the Oregon law as being “terminal.” More people will wish to discuss these issues because dementia is superseding cancer as the most feared illness of privileged societies that value individual patient autonomy.
Worth a Shot: Experience and Lessons From an Unsuccessful Pediatric Immunization Quality Improvement Effort in a Large Health System During the COVID-19 Pandemic
Authors: Howard Bailey , Gorman Gregory
Published: June 2024

Introduction

During the coronavirus disease of 2019 (COVID-19) pandemic, routine childhood immunization rates dropped dramatically across the world, and the Military Health System (MHS) was no exception. In the MHS, which is a large, universally covered, low-to-no-cost health system, the immunization rates with the measles, mumps, and rubella (MMR) vaccine remain below the rate necessary to prevent community transmission of measles. We aimed to improve childhood immunization rates in the MHS with an expansive quality improvement project.

Materials and Methods

Measles, mumps, and rubella immunization rates served as proxy outcome measures for routine immunization rates tracked by the Center for Disease Control multi-immunization combination measures. The tracked measure was the percentage of 16- to 18-month olds and 6-year olds who had received MMR #1 and MMR #2, respectively. Various countermeasures were implemented throughout the study period, and standard quality improvement analyses informed the effect of countermeasures.

Results

By January 2023, the percentage of 16- to 18-month olds and 6-year olds who had received MMR #1 and MMR #2 was 85% and 91%, respectively, with no positive shift in immunization rates despite various countermeasures introduced during the study period. For reference, the MMR immunization rates of commercial health maintenance organization and commercial preferred provider organization for 24-month-old populations were 92% and 90.3%, respectively. On chart review, the most common cause for under-immunization (55%) was vaccine abandonment. MMR #1 rates rose to 92% in 24-month olds.

Conclusions

Measles, mumps, and rubella immunization rates within the MHS remained below commercial health system rates and below public health standards required for herd immunity despite various countermeasures throughout the COVID-19 pandemic. Immunization rates increased with age, suggesting that children within the MHS eventually catch up despite potential barriers.
Pichia kudriavzevii (Candida krusei): A systematic review to inform the World Health Organisation priority list of fungal pathogens
Authors: Nguyen Thi Anh , Kim Hannah Yejin , Stocker Sophie , Kidd Sarah , Alastruey-Izquierdo Ana , Dao Aiken , Harrison Thomas , Wahyuningsih Retno , Rickerts Volker , Perfect John , Denning David W , Nucci Marcio , Cassini Alessandro , Beardsley Justin , Gigante Valeria , Sati Hatim , Morrissey C Orla , Alffenaar Jan-Willem
Published: June 2024

In response to the growing global threat of fungal infections, in 2020 the World Health Organisation (WHO) established an Expert Group to identify priority fungi and develop the first WHO fungal priority pathogen list (FPPL). The aim of this systematic review was to evaluate the features and global impact of invasive infections caused by Pichia kudriavzevii (formerly known as Candida krusei). PubMed and Web of Science were used to identify studies published between 1 January 2011 and 18 February 2021 reporting on the criteria of mortality, morbidity (defined as hospitalisation and length of stay), drug resistance, preventability, yearly incidence, and distribution/emergence. Overall, 33 studies were evaluated. Mortality rates of up to 67% in adults were reported. Despite the intrinsic resistance of P. kudriavzevii to fluconazole with decreased susceptibility to amphotericin B, resistance (or non-wild-type rate) to other azoles and echinocandins was low, ranging between 0 and 5%. Risk factors for developing P. kudriavzevii infections included low birth weight, prior use of antibiotics/antifungals, and an underlying diagnosis of gastrointestinal disease or cancer. The incidence of infections caused by P. kudriavzevii is generally low (∼5% of all Candida-like blood isolates) and stable over the 10-year timeframe, although additional surveillance data are needed. Strategies targeting the identified risk factors for developing P. kudriavzevii infections should be developed and tested for effectiveness and feasibility of implementation. Studies presenting data on epidemiology and susceptibility of P. kudriavzevii were scarce, especially in low- and middle-income countries (LMICs). Thus, global surveillance systems are required to monitor the incidence, susceptibility, and morbidity of P. kudriavzevii invasive infections to inform diagnosis and treatment. Timely species-level identification and susceptibility testing should be conducted to reduce the high mortality and limit the spread of P. kudriavzevii in healthcare facilities.
Classification of Fermi gamma-ray bursts based on machine learning
Authors: Zhu Si-Yuan , Sun Wan-Peng , Ma Da-Ling , Zhang Fu-Wen
Published: June 2024

Gamma-ray bursts (GRBs) are typically classified into long and short GRBs based on their durations. However, there is a significant overlapping in the duration distributions of these two categories. In this paper, we apply the unsupervised dimensionality reduction algorithm called t-SNE and UMAP to classify 2061 Fermi GRBs based on four observed quantities: duration, peak energy, fluence, and peak flux. The map results of t-SNE and UMAP show a clear division of these GRBs into two clusters. We mark the two clusters as GRBs-I and GRBs-II, and find that all GRBs associated with supernovae are classified as GRBs-II. It includes the peculiar short GRB 200826A, which was confirmed to originate from the death of a massive star. Furthermore, except for two extreme events GRB 211211A and GRB 230307A, all GRBs associated with kilonovae fall into GRBs-I population. By comparing to the traditional classification of short and long GRBs, the distribution of durations for GRBs-I and GRBs-II do not have a fixed boundary. We find that more than 10 per cent of GRBs-I have a duration greater than 2 s, while approximately 1 per cent of GRBs-II have a duration shorter than 2 s.
On the origin of polar planets around single stars
Authors: Chen Cheng , Baronett Stanley A , Nixon C J , Martin Rebecca G
Published: June 2024

The Rossiter–McLaughlin effect measures the misalignment between a planet’s orbital plane and its host star’s rotation plane. Around 10 per cent of planets exhibit misalignments in the approximate range 80°–125°, with their origin remaining a mystery. On the other hand, large misalignments may be common in eccentric circumbinary systems due to misaligned discs undergoing polar alignment. If the binary subsequently merges, a polar circumbinary disc – along with any planets that form within it – may remain inclined near 90$^{\circ }$ to the merged star’s rotation. To test this hypothesis, we present N-body simulations of the evolution of a polar circumbinary debris disc comprised of test particles around an eccentric binary during a binary merger that is induced by tidal dissipation. After the merger, the disc particles remain on near-polar orbits. Interaction of the binary with the polar-aligned gas disc may be required to bring the binary to the small separations that trigger the merger by tides. Our findings imply that planets forming in discs that are polar-aligned to the orbit of a high-eccentricity binary may, following the merger of the binary, provide a possible origin for the population of near-polar planets around single stars.
The wave-like disc oscillations of mono-age stellar populations in the Solar neighbourhood from Gaia DR3
Authors: Wang Tao , Chen Bing-Qiu , Lian Jian-Hui , Xiang Mao-Sheng , Liu Xiao-Wei
Published: June 2024

The North–South asymmetry in the number density and bulk velocity of stars in the Solar neighbourhood provides valuable insights into the formation and evolution of the Milky Way disc. Our objective is to investigate the wave-like disc oscillations of mono-age stellar populations in the Solar neighbourhood using data from Gaia Data Release 3. We have selected a comprehensive sample of main-sequence turn-off stars. The ages of these stars can be accurately determined using isochrone fitting methods. Our findings indicate that the North–South density and mean vertical velocity asymmetries remain consistent across all age groups. The uniformity of perturbations across all subsamples suggests that all populations are responding to the same external influence, which likely affects them irrespective of their age. Moreover, the fact that these perturbations appear consistently implies they could be either ongoing or recent. Regarding vertical velocity dispersions, we observe that older stars exhibit larger dispersions.
Rapid Adaptation and Interspecific Introgression in the North American Crop Pest Helicoverpa zea
Authors: North Henry L , Fu Zhen , Metz Richard , Stull Matt A , Johnson Charles D , Shirley Xanthe , Crumley Kate , Reisig Dominic , Kerns David L , Gilligan Todd , Walsh Tom , Jiggins Chris D , Sword Gregory A
Published: June 2024

Insect crop pests threaten global food security. This threat is amplified through the spread of nonnative species and through adaptation of native pests to control measures. Adaptations such as pesticide resistance can result from selection on variation within a population, or through gene flow from another population. We investigate these processes in an economically important noctuid crop pest, Helicoverpa zea, which has evolved resistance to a wide range of pesticides. Its sister species Helicoverpa armigera, first detected as an invasive species in Brazil in 2013, introduced the pyrethroid-resistance gene CYP337B3 to South American H. zea via adaptive introgression. To understand whether this could contribute to pesticide resistance in North America, we sequenced 237 H. zea genomes across 10 sample sites. We report H. armigera introgression into the North American H. zea population. Two individuals sampled in Texas in 2019 carry H. armigera haplotypes in a 4 Mbp region containing CYP337B3. Next, we identify signatures of selection in the panmictic population of nonadmixed H. zea, identifying a selective sweep at a second cytochrome P450 gene: CYP333B3. We estimate that its derived allele conferred a ∼5% fitness advantage and show that this estimate explains independently observed rare nonsynonymous CYP333B3 mutations approaching fixation over a ∼20-year period. We also detect putative signatures of selection at a kinesin gene associated with Bt resistance. Overall, we document two mechanisms of rapid adaptation: the introduction of fitness-enhancing alleles through interspecific introgression, and selection on intraspecific variation.
Powerful QTL mapping and favorable allele mining in an all-in-one population: a case study of heading date
Authors: Wang Pengfei , Yang Ying , Li Daoyang , Yu Zhichao , zhang Bo , Zhou Xiangchun , Xiong Lizhong , Zhang Jianwei , Wang Lei , Xing Yongzhong
Published: June 2024

The multiparent advanced generation intercross (MAGIC) population is characterized with great potentials in power and resolution of quantitative trait locus (QTL) mapping, but single nucleotide polymorphism (SNP)-based GWAS does not fully reach its potential. In this study, a MAGIC population of 1021 lines was developed from four Xian and four Geng varieties from five subgroups of rice. A total of 44 000 genes showed functional polymorphisms among eight parents, including frameshift variations or premature stop codon variations, which provides the potential to map almost all genes of the MAGIC population. Principal component analysis results showed that the MAGIC population had a weak population structure. A high-density bin map of 24 414 bins was constructed. Segregation distortion occurred in the regions possessing the genes underlying genetic incompatibility and gamete development. SNP-based association analysis and bin-based linkage analysis identified 25 significant loci and 47 QTLs for heading date, including 14 known heading date genes. The mapping resolution of genes is dependent on genetic effects with offset distances of <55 kb for major effect genes and <123 kb for moderate effect genes. Four causal variants and noncoding structure variants were identified to be associated with heading date. Three to four types of alleles with strong, intermediate, weak, and no genetic effects were identified from eight parents, providing flexibility for the improvement of rice heading date. In most cases, japonica rice carries weak alleles, and indica rice carries strong alleles and nonfunctional alleles. These results confirm that the MAGIC population provides the exceptional opportunity to detect QTLs, and its use is encouraged for mapping genes and mining favorable alleles for breeding.