bluuebunny/crossref_metadata_2025 huggingface dataset:
1065 Exposing the Incidence of Ileus in Pelvic and Acetabular Fractures: A Retrospective Case Analysis
Authors: Ward A , Ahmed R , Adedeji J , McGregor-Riley J
Published: October 2021

Background

Paralytic ileus is a temporary inhibition of gastrointestinal mobility in the absence of mechanical obstruction. Ileus has previously been observed in up to 40% of patients undergoing bowel surgery, leading to increased morbidity and length of stay. Pelvic and acetabular fractures are often caused by high energy trauma and are associated with a risk of visceral injury. This is the first study to report the incidence of and risk factors for ileus following admission with pelvic and/or acetabular fractures.

Method

All patients over the age of 16 presenting to a major trauma centre throughout 2019 were included. Data included patient demographics, injury pattern, fracture management and presence of ileus. Previous studies identified patients as having ileus if they failed to tolerate an oral diet and open their bowels for more than three days (GI-2). Analysis assessed risk factors for ileus as well as its effect on length of stay.

Results

An incidence of ileus of 40.35% was observed in the 57 included patients. Ileus was three times more common in patients with a diagnosis of diabetes mellitus (p = 0.56) and 2.5 times more common in the presence of an open pelvic/acetabular fracture (p = 0.73). Length of stay was significantly longer in patients under 65 years identified as having ileus (p = 0.046). Gender, age, opiate use, fracture management and surgical approach were not identified as risk factors.

Conclusions

The authors have identified the essentiality of early risk factor identification and hope to encourage further research to create a prognostic tool.
590 Influence of Hospital Characteristics on Patient Outcomes Following Cancer Surgery: An International, Mixed Methods Study Across 66 Countries
Authors: Knight S , Weiser T , Pius R , Harrison E ,   GlobalSurg Collaborative
Published: October 2021

Aim

Early death after cancer surgery is higher in low- and middle-income settings, yet the impact of hospital characteristics on early postoperative outcomes following cancer surgery worldwide are unknown.

Method

A mixed-methods analysis was performed using data from the GlobalSurg 3 study, a multicentre, international prospective cohort study of patients who underwent surgery for breast, gastric or colorectal cancer. The primary outcomes were 30-day mortality and major complication rates. Hierarchical clustering identified distinct hospital characteristics to create a facility capacity framework. Adjusted outcomes were determined after accounting for patient characteristics and country-income group.

Results

Hospital-level data were available for 9685 patients across 238 hospitals. The facility capacity framework consisted of seven distinct hospital resources and processes: presence of CT scan, postoperative recovery area, critical care facilities, opioid analgesia availability, oncologist, pathology and radiotherapy services. While complication rates were similar across hospitals with varying facility capacities, hospitals with five or less capacities (116 hospitals, 2251 patients) had increased mortality (aOR 1.67, 95% CI 1.13-2.48; P = 0.010). After adjustment for case-mix and country income group, patients undergoing surgery for gastric and colorectal cancer in hospitals with reduced capacities had higher mortality (6.2 vs. 4.0%; P < 0.001), predominantly explained by limited capacity to rescue following the development of major complications (61.3 vs. 72.1%; P < 0.001).

Conclusions

Hospitals with certain system capacities achieve better outcomes following cancer surgery, independent of country-income group. For cancers amenable to surgical treatment, national cancer care plans should include both surgical capacity building and concurrent hospital facility development to maximise reductions in cancer-associated mortality.
644 Comparing the Use of Skin Clips and Tissue Adhesive in Wound Management After Renal Transplantation
Authors: Caine M , Bannon A , Moinuddin Z
Published: October 2021

Introduction

Wound closure and dressing choice is a decision largely impacted by factors including surgeon preference and unit standard. This service improvement project aimed to assess the difference between skin clips, the current unit standard, and a tissue adhesive (Liquiband) after renal transplantation.

Method

Data was collected retrospectively from July 2020 onwards. Outcome measures included the incidence of surgical site infections (SSI), cost, and nursing preference. Forty transplanted patients were selected, comprising the first twenty patients with skin clips and the first twenty patients with tissue adhesive. Medical notes and GP records were reviewed for any documented SSI or antibiotic prescription within six weeks of transplantation. A cost analysis was performed. Additionally, an online survey was distributed to nursing staff using Likert scales in response to a series of statements about wound care.

Results

There were no documented SSIs in either group, and no patients commenced antibiotics for a wound infection. On average, there was a 45% cost saving when using tissue adhesive compared to skin clips and additional wound dressings. 100% of nurses strongly agreed or agreed that wound care was easier with tissue adhesive, and 93% agreed that considerably more time is spent on wound care for patients with skin clips.

Conclusions

These results suggest that tissue adhesive offers comparable incidence of SSIs compared with skin clips. Furthermore, tissue adhesive is cheaper, more time-efficient, and preferred by nursing staff in post-operative wound care.
40 Cattle-Related Trauma: A 5 Year Retrospective Review in An Adult Major Trauma Centre
Authors: Rhind J H , Quinn D , Cosbey L , Mobley D , Britton I , Lim J
Published: October 2021

Aim

Bovine injuries are a common and significant cause of trauma, often requiring admission and operative treatment. We review all bovine related injuries over five years, both emergency and GP referrals at an adult major trauma centre in England.

Method

Retrospective evaluation was undertaken using keywords through radiology referrals and hospital admissions speciality databases. Demographics were collected as well as the mechanism and the situation of injury; trauma scores were calculated using: Injury Severity Score (ISS) and Probability of Survival (Ps19).

Results

Sixty-seven patients were identified retrospectively over 5 years, 44 emergency patients (including 23 major traumas) and 23 GP referrals. Combined (Emergency & GP) mean age 52 years old. 67% male. Mean ISS 11. Most common combined mechanism of injury, kicked (n = 23). In emergency patients, trampling injuries were most common. 86% of the trampled patients were major traumas. Indirect injuries mainly involved farm gates (92%). 73% of bull-related injuries were major traumas. In emergency patients’ fractures were the most common primary injury (n = 20), upper limb followed by spine. In GP, soft tissue injuries were the most common. 70% of the emergency referrals required admission and 50% operations. Only one GP referral required an operation. Two patients had a Ps19 score <90. There were two mortalities.

Conclusions

Cattle related injuries are a significant cause of severe morbidity and mortality. They are under-reported. Patterns of injury are similar to high velocity road traffic collisions and bull-related injuries or trampling in particular, should alert the clinician to more significant trauma.
89 Do Corticosteroid and Local Anaesthetic Hip Injections Administered Proximal or Distal to The Zona Orbicularis Have an Effect on Patient Satisfaction?
Authors: Watts A , Watkinson W , Shaw D
Published: October 2021

Aim

Pubofemoral and ischiofemoral ligaments blend to make zona orbicularis. Zonaorbicularis has been suggested to force fluid from peripheral compartment to central compartment in unidirectional flow. This study aims to assess whether injection of corticosteroid with local anaesthetic injected either proximal or distal to the zona orbicularis has effect on patient satisfaction.

Method

This retrospective study investigated consecutive patients undergoing ultrasound guided hip injections at a single centre in the UK between November 2018 and March 2019. Patients were identified using IMPAX© picture archiving and communications system. Radiographs were assessed to see if radiopaque dye and therefore corticosteroid and local anaesthetic had been injected proximal or distal to the zona orbicularis. Clinic letters were accessed on the electronic patient record and we recorded whether patients had pain relief at 24 hours and 2 weeks following hip injection.

Results

133 Patients were identified during the study period, of which 40 were included. At 24 hours post-injection 72% of patients were satisfied and 28% were unsatisfied, for which there was 76% and 70% satisfaction for proximal and distal injections respectively (p = 0.63). At 2 weeks post-injection 45% of patients were satisfied and 55% of patients unsatisfied, for which there was 47% and 44% satisfaction for proximal and distal injections respectively (p = 0.9).

Conclusions

Overall patient satisfaction is high following hip corticosteroid and local anaesthetic injection. No difference was found between injections proximal and distal to the zona orbicularis. Further research is needed to quantify the association between proximal and distal injections.
111 The Systemic Effects of Intra-Articular Steroid Injections- Should COVID-19 Change Our Practice?
Authors: Shah S , Raut S , Conyers R , Ahmed S
Published: October 2021

Aim

The COVID-19 pandemic prompted us to review and often suspend services, while patients continue to suffer with painful musculoskeletal conditions. The diagnostic and therapeutic value of intra-articular corticosteroid injections (IACSI) cannot be denied. Current BOA guidelines advise giving the lowest effective dose for inflammatory arthritis and limit use in osteoarthritis to patients with high levels of pain and disability. We aimed to evaluate the literature pertaining to the use of IACSI and the potential systemic immunosuppressive effects.

Method

We searched Medline, using the terms “systemic effects of intra-articular steroid” and “clinical course of Coronavirus infection in patients with steroid use”, between 1997 and 2020.

Results

No studies specifically looked at the systemic effects of intra-articular steroids in the presence of COVID-19 infection; however, four studies were identified which concluded that intra-articular steroid injections resulted in sufficient systemic absorption to cause suppression of the hypothalamic-pituitary-adrenal axis and endogenous cortisol production. These effects are dose dependent and are more common in patients with inflammatory joint diseases. A further four RCT’s, including one systematic review, showed that suppressed cortisol concentration was associated with a significant increase in mortality.

Conclusions

There is a lack of evidence in relation to the use of intra-articular steroids in COVID-19. However, evidence suggests that intra-articular steroids can result in systemic absorption and suppression of endogenous cortisol production thus increasing the potential risk of complications of COVID-19. We therefore support cautious use of low dose steroid injections in patients with inflammatory arthritis, where no alternative treatment is available.
142 Surgical Treatment of Chronic Femoral and Tibial Osteomyelitis: A Scoping Review
Authors: Lau E , Arshad Z , Aslam A , Thahir A , Krkovic M
Published: October 2021

Aim

The management of osteomyelitis, an inflammatory process of the bone that causes destruction and necrosis, is complex, and many authors report different techniques. This scoping review aims to identify and summarise literature on the management of chronic femoral and tibial osteomyelitis to further the reader’s understanding of potential management strategies and thereby explore areas for further research.

Method

The Joanna Briggs Institute methodological framework was used. PubMed, EMBASE, MEDLINE, Emcare and CINAHL searches were conducted for articles reporting the management of chronic osteomyelitis of the femur and tibia. Two reviewers independently screened the title/abstract and full text against the pre-defined criteria.

Results

Altogether, 1223 articles were identified and 52 were finally included. Various management strategies were reported, and the main principles shared across these strategies included antibiotic therapy, removal of infected tissue and management of dead-space. 75.45% of patients presented with stage III or IV disease, using the Cierny-Mader classification. The most commonly isolated organism was Staphylococcus aureus. The proportion of patients who achieved remission without recurrences during follow-up period ranged between 59.3% - 100.0%.

Conclusions

Excellent outcomes, in terms of remission and lack of recurrence, were reported in the majority of studies. It is clear that specific patient and treatment-related factors may affect outcomes but further high-level research such as randomized control trials are required to investigate this further.
149 Reducing Complications and Improving Outcomes Following Total Hip Arthroplasty
Authors: Al-Zubaidy M , Monem M , Hallett C , Ganesh D , Sarraf K , Bhattacharya R , Lewis A
Published: October 2021

Aim

Neck of femur (NOF) fractures are increasing, and the need to improve mobility and reduce complications whilst improving discharge time is an ongoing challenge. Hip fracture fixation and arthroplasty are essential in improving pain and mobility. NOF patients often undergo a fascia iliaca block (FIB) to improve outcomes. Guay J’s Cochrane systematic review confirms that FIBs reduce pain pre and postoperatively, decrease hospital-acquired pneumonia risk and improve mobility. Patients on anticoagulants are typically refused bedside blocks, however we are unsure if they truly impact adverse outcomes in FIBs for NOF patients.

Method

A retrospective observational study was undertaken to assess complication rates in 53 NOF patients who had a FIB at St Mary’s Hospital between 07/01/2020 and 26/06/2020. Patients whose NOF was the result of an inpatient fall were excluded. Pre-existing anticoagulant and antiplatelet use were noted, as were the A&E admission blood coagulation results. Local complications which may have arisen post-FIB were closely screened for in documentation until the patient’s discharge date.

Results

There were no local complications in all 53 patients. Interestingly, one patient had a documented thigh haematoma pre-nerve block, but did not have any evolution of the haematoma and achieved good pain relief from the block.

Conclusions

FIBs appear to be a safe and effective analgesic tool in the perioperative NOF patient and use has been reported to reduce early complications in those who undergo hip fracture treatment. We aim to implement these findings and increase the rate of nerve block procedures in NOF fractures.
216 Fix or Replace: Is Internal Fixation Still A Viable Option in The Elderly with Un-Displaced Intracapsular Femoral Neck Fractures?
Authors: Morris R , Krishna A , Hamid H , Chawda M , Mumtaz H
Published: October 2021

Aim

The treatment of impacted or un-displaced femoral neck fractures in the elderly osteoporotic patient is still largely debated, with arthroplasty versus internal fixation two surgical options1. Our aim was to retrospectively review patients over the age of 80 with un-displaced intracapsular hip fractures who had undergone internal fixation and assess their rate of mortality and revision surgery.

Method

We conducted a retrospective review of all patients with femoral neck fractures over a 4-year period between January 2015 to December 2018. We refined this to only patients over the age of 80 with un-displaced intracapsular femoral neck fractures fixed with cannulated screws. We noted their mental and mobility status, their follow-up attendance over 3 years, their mortality and rate of revision surgery.

Results

There were a total of 1232 femoral neck fractures in a 4-year period. Of these, 37 were >80 with un-displaced intracapsular femoral neck fractures, with 23 fixed with cannulated screws and 14 with a Dynamic Hip Screw. Mean age – 85, M:F (1:4.75). All patients were either Garden Classification Type I or II. 4% had cognitive impairment. All patients were independently mobile. 83% were followed up for 3 years, with 1 patient (4%) undergoing revision surgery 3 years following cannulated screw fixation. The 30-day mortality rate was 5%.

Conclusions

The treatment choice for un-displaced intracapsular femoral neck fractures in the elderly remains debateable. Our retrospective review shows that the rate of re-operation is low in patients who have undergone fixation with cannulated screws and so this remains a viable option.
352 Did the Discontinuation of Pulse-Lavage Have A Detrimental Effect on The Quality of Hip Hemiarthroplasties Performed During the First COVID-19 Wave?
Authors: Sharma D , Spacey K , Sharma V
Published: October 2021

Introduction

The standard of practice for performing hip hemiarthroplasty is to thoroughly wash and dry the femur with pulse-lavage. With the COVID-19 pandemic we were issued with guidance to minimise Aerosol Generating Procedures (AGPs) and discontinued the use of pulse lavage. Instead, we used a bladder syringe to wash the femoral canal.

Method

We retrospectively assessed 100 post-operative radiographs following hemiarthroplasties for neck of femur fractures. We used the Barrack classification to assess the bone cement mantle which is an indicator of aseptic loosening. We assessed 50 radiographs pre-covid (using pulse lavage) and 50 radiographs during covid (without pulse lavage).

Results

Pre-COVID-19, 30% of hemiarthroplasties were deemed as being ‘at risk’. During COVID-19, 64% of hips were deemed as being ‘at risk’. This represents an absolute increase of 34%.

Conclusions

This forced service change had a detrimental effect on the quality of the bone cement mantle following hip hemiarthroplasty. We recommend following these patients up at 2 years to assess for signs of aseptic loosening. In future pandemics, we recommend carefully weighing up the dangers of using AGPs against the detriment in patient outcomes likely to be experienced.
399 Complex Limb Injuries – Limb Salvage vs Amputation: An Overview of the Factors Influencing Decision-Making and Outcomes
Authors: Jamal S , Sheeraz A
Published: October 2021

Aim

Complex limb injuries usually comprise of a combination of osseous, soft tissue, vascular and neural damage, necessitating prompt and accurate initial examination and decision-making to maximise optimal patient outcomes. We present the factors affecting the decision-making as well as the outcomes following primary limb amputation or salvage of complex extremity injuries, with an emphasis on the various scoring systems present that endeavour to offer prognostic and therapeutic guidance to orthopaedic surgeons.

Method

We performed the literature search on PubMed and Embase, and collated the relevant data comprising of demographics, injury, scoring system, primary and secondary outcome metrics and complications.

Results

Many scoring systems, each with variable factors, have been proposed to predict limb salvage vs amputation in complex extremity injury (MESS, PSI, LSI, NISSSA, HFS-97), however the landmark LEAP trial concluded in its final analysis that they could not validate them. Whilst the scores were useful in predicting limb salvage, they were inaccurate and unreliable in predicting amputation with low sensitivities

Conclusions

Many scoring systems attempt to provide guidance regarding decision-making in limb salvage vs primary amputation, however the LEAP study has shown poor predictive standards of these systems. As such, there is no gold standard algorithmic approach or scoring system when making this difficult decision – instead, the poor predictors of limb salvage have been identified, and the surgeons need to be judicious and make a joint decision considering these variables and other patient factors (social, economic, and psychological status).
414 Informed Consent for Neck of Femur Fracture Surgery During the Covid-19 Pandemic: An Evidence-Based Approach
Authors: Cuthbert R , Ferguson D , Kayani B , Haque S , Ali A , Parkar A , Bates P , Vemulapalli K
Published: October 2021

Background

Surgical intervention for neck of femur fractures continues to be prioritised during the Covid-19 pandemic. However, there remains a lack of clarity for clinicians during the consent process. This study quantifies additional perioperative risks for Covid-19 positive patients undergoing neck of femur fracture surgery and establishes an evidence-based framework for facilitating informed consent during the Covid-19 pandemic.

Method

259 patients undergoing neck of femur fracture surgery in four hospitals at the epicentre of the United Kingdom’s first wave of Covid-19 were recruited. 51 patients were positive for Covid-19. Predefined outcomes were recorded in a 30-day postoperative period.

Results

Odds of intensive care admission were 4.64 times higher (95% CI 1.59-13.50, p = 0.005) and odds of 30-day mortality were 3 times higher (95% CI 1.22-7.40, p = 0.02) in Covid-19 positive patients. 74.5% of Covid-19 positive patients suffered post-operative complications. 35.3% of Covid-19 positive patients developed lower respiratory tract infection with 13.7% progressing to acute respiratory distress syndrome. 9.8% of Covid-19 positive patients experienced symptomatic thromboembolic events with a 3.9% incidence of pulmonary emboli.

Conclusions

The implications of Covid-19 on the informed consent process for neck of femur fracture surgery are profound. Covid-19 positive patients should be consented for increased risk of postoperative complications (including lower respiratory tract infection, acute respiratory distress syndrome and thromboembolic events), longer inpatient stay, increased frequency of intensive care admission and higher risk of mortality.
519 Outcomes of Management with Ilizarov Frames in Bone Infection: An Observational Study
Authors: Marshall C , Butler J
Published: October 2021

Aim

The successful treatment and eradication of bone infection requires a multifaceted approach and may recur even after excision if resultant bone void is not managed effectively. This paper aims to review the clinical effectiveness of antibiotic-impregnated bone void filler and current empirical antibiotic guidelines.

Method

We report a retrospective study of 18 patients with chronic osteomyelitis following injury or surgery managed via Ilizarov Ring Fixator (IRF). All patients were managed by IRF stabilisation procedures with debridement, microbiological sampling, and bone void filling with antibiotic-impregnated biocomposite material, in addition to culture-specific systemic antimicrobial therapy.

Results

Patients were followed up for a mean of 15.9 months. Infection was eradicated in 94.1% of patients in a grossly comorbid demographic. Comorbidities associated with increased risk of osteomyelitis were noted in 72.2% of patients. Anaerobic bacteria were identified in culture for four (22.2%) of the 18 patients.

Conclusions

We detected a higher than suspected growth of anaerobes in our samples, suggesting the need for metronidazole in empirical antibiotic treatment. This study would suggest that the use of STIMULAN® may be preferable in this National Health Service from a cost-effect perspective, as our results are comparable to those using other bone void fillers.
565 Predictors of Single Versus Multi-Level Lumbar Spinal Fusion: A Retrospective Cohort Study
Authors: Wong J , Baliga S
Published: October 2021

Aim

Degenerative spine disease (DSD) of the lumbar spine is a common disorder among the aging population in the world, with a substantial humanistic and economic burden. Although lumbar spinal fusion is currently the mainstay surgical management of DSD, surgery is also associated with adjacent segment disease due to the modification of spinal biomechanics. Therefore, it is important to identify potential risk factors of DSD in order to prevent progressive deterioration and provide early intervention before the surgical option is absolutely necessary.

Method

Adult patients who underwent posterior lumbar spinal fusion from 2006-2016 were identified via OPCS-4codes. Smoking status, weight, age of operation, gender, diagnosis of ischaemic heart disease (IHD) were obtained via TrakCare®. The degree of deprivation was extrapolated using the Scottish Index of Multiple Deprivation (SIMD) 2020 quintile score. Data were analysed using logistic regression.

Results

In total, 313 met inclusion criteria and had data available, of which 205 and 108 patients underwent single and multi-level lumbar fusion respectively. Within the study population, 66.8% (206) and 33.2% (104) were female and male. Adjusted for all outcome measures, age of operation achieved statistical significance (p = 0.040). There was a 1.021-fold increase in risk of multi-level spinal fusion with each additional year of age. Weight was approaching statistical significance (p = 0.068).

Conclusions

Lumbar spinal health declines over time, but some patients experience more progressive deterioration. While some components of the spine are irreparable, early prescription of regimented exercise programs may strengthen spinal musculature to maintain a healthy sagittal balance, particularly in older, overweight, female patients.
A novel predictor of ACE2-binding ability among betacoronaviruses
Authors: Dixson Jamie D , Azad Rajeev K
Published: October 2021

Background

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in ~4.8 million deaths worldwide as of this writing. Almost all conceivable aspects of SARS-CoV-2 have been explored since the virus began spreading in the human population. Despite numerous proposals, it is still unclear how and when the virus gained the ability to efficiently bind to and infect human cells. In an effort to understand the evolution of receptor binding domain (RBD) of the spike protein of SARS-CoV-2, and specifically, how the ability of RBD to bind to angiotensin-converting enzyme 2 receptor (ACE2) of humans evolved in coronaviruses, we have applied an alignment-free technique to infer functional relatedness among betacoronaviruses. This technique, concurrently being optimized for identifying novel prions, was adapted to gain new insights into coronavirus evolution, specifically in the context of the ongoing COVID-19 pandemic. Novel methods for predicting the capacity for coronaviruses, in general, to infect human cells are urgently needed.

Methodology

proposed method utilizes physicochemical properties of amino acids to develop fully dynamic waveform representations of proteins that encode both the amino acid content and the context of amino acids. These waveforms are then subjected to dynamic time warping (DTW) and distance evaluation to develop a distance metric that is relatively less sensitive to variation in sequence length and primary amino acid composition.

Results and Conclusions

Using our proposed method, we show that in contrast to alignment-based maximum likelihood (ML) and neighbor-joining (NJ) phylogenetic analyses, all bat betacoronavirus spike protein RBDs known to bind to the ACE2 receptor are found within a single physicochemical cluster. Further, other RBDs within that cluster are from pangolin coronaviruses, two of which have already been shown to bind to ACE2 while the others are suspected, yet unverified ACE2 binding domains. This finding is important because both severe acute respiratory syndrome coronavirus (SARS-CoV) and SARS-CoV-2 use the host ACE2 receptor for cell entry. Surveillance for coronaviruses belonging to this cluster could potentially guide efforts to stifle or curtail potential and/or early zoonotic outbreaks with their associated deaths and financial devastation.

Lay Summary

Robust methods for predicting human ACE2 receptor binding by the spike protein of coronaviruses are needed for the early detection of zoonotic coronaviruses and biosurveillance to prevent future outbreaks. Here we present a new waveform-based approach that utilizes the physicochemical properties of amino acids to determine the propensity of betacoronaviruses to infect humans. Comparison with the established phylogenetic methods demonstrates the usefulness of this new approach in the biosurveillance of coronaviruses.
“You Still Want to Go Lots of Places”: Exploring Walking Interviews in Research With Older Migrants
Authors: Lőrinc Magdolna , Kilkey Majella , Ryan Louise , Tawodzera Obert
Published: October 2021

Background and Objectives

Walking interviews have become prevalent in social sciences; however, their use in research with older people is limited. This article offers a reflexive account of our ethical and methodological choices and practices while conducting walking interviews with older migrants, and considers the potential of this method in researching migrants’ aging in place.

Research Design and Methods

The study had a longitudinal, multisited (London and Yorkshire), qualitatively driven multimethod research design. In 2018–2019, in-depth interviews were conducted with 45 older migrants originally from the Caribbean, Ireland, and Poland, followed by walking interviews with a subsample of 9 participants 6–12 months later. The majority of participants were older than 80 years.

Results

Our study demonstrated that walking interviews are a promising method to explore in depth a variety of relevant issues including older migrants’ mobility, and health and well-being; navigating places through everyday activities; interactions with local neighborhoods over time; and the meanings associated with such experiences. Through direct exposure to the physicality of places, walking interviews can elicit rich and complex data that would be difficult to collect through other methods.

Discussion and Implications

Conducting walking interviews with older migrants has unique thematic potential. However, a range of ethical and practical challenges need to be considered, including a risk to revealing participants’ identities and adopting an ethics-in-practice approach. The method has some limitations, especially with less-mobile participants. Implications for researchers, policymakers, and practitioners are suggested.
Comment on ‘Evidence for a large strike-slip component during the 1960 Chilean earthquake’ by H. Kanamori, L. Rivera and S. Lambotte
Authors: Savage J C
Published: October 2021

Based on numerous studies of the relevant geodetic data, a low-angle thrusting mechanism has been assigned to the 1960 Chile earthquake. Kanamori, Rivera and Lambotte recently suggested that a component of dextral slip comparable to the thrusting be included in the mechanism to satisfy long-period, teleseismic observations. The absence of geodetic evidence for that huge strike-slip component is the subject of this comment. The geodetic data are largely measurements of coseismic uplift associated with the earthquake but include eight measurements of the coseismic change in shear strain. Because strike-slip produces relatively little uplift except near the end points of the rupture, identification of that strike-slip component in the geodetic data depends upon the measured, shear-strain change. I consider elastic, half-space models of oblique slip on the plate interface possibly supplemented by simultaneous dextral slip on the nearby, intra-arc Liquiñe-Ofqui Fault Zone. Slip is assumed to be uniform along strike. The best fits to the geodetic data for these models furnish little evidence for strike-slip on those structures. To satisfy the long-period, teleseismic data, Kanamori et al. proposed six examples, each of which requires a large amount of dextral slip. Because the long-period, teleseismic data do not define the slip distributions, I have used the best fits of those examples to the geodetic data to define those distributions. The large thrusting near the deformation front required by those slip distributions implies large uplift there, contrary to the uplift inferred from the inversion of tsunami data. However, an acceptable fit to the geodetic data and the tsunami data for the six examples suggested by Kanamori et al. can be obtained if the seismic moments specified by them are reduced by a factor ∼1.8, a factor within the uncertainties in estimating seismic moments of the 1960 Chile earthquake. The presence of strike-slip in those reduced-moment examples despite the lack of geodetic evidence for strike-slip is due to a remarkable coincidence that requires careful balancing of contributions from the shallower (depths < 70 km) coseismic sources against those from the deeper coseismic sources to nullify the geodetic evidence for strike-slip. Such balancing is possible, but it is remarkable that the balancing is so nearly perfect that it nullifies the geodetic evidence for strike-slip and thereby confounds the interpretation of the geodetic data.
Analytical Performance and Quality Indicators of Fully Automated Immunoassays for sFlt-1 and PlGF
Authors: Higgins Victoria , Ma Liyan , Ragosnig Bonny Lem , Melamed Nir , Hladunewich Michelle , James Tim , Leite Joao , Rozmanc Mary , Barrett Jon , Zaltz Arthur , Yip Paul M , Fu Lei
Published: October 2021

Background

The ratio of the antiangiogenic factor, soluble fms-like tyrosine kinase 1 (sFlt-1), to the proangiogenic factor, placental growth factor (PlGF), is associated with increased risk of preeclampsia. Here, we describe an analytical evaluation of the Elecsys sFlt-1 and PlGF assays at the first North American site in which they were clinically implemented.

Methods

The analytical evaluation included short- and long-term imprecision, method comparison, accuracy, linearity, sample stability, limit of quantification verification, and measurement uncertainty. Quality indicators were also evaluated, including turnaround time and repeat test frequency.

Results

Short-term (13-day) and long-term (12-month) imprecision for sFlt-1 and PlGF were <4% CV. Method comparison (n = 40) between Roche cobas e602 and e411 exhibited r > 0.99 and bias <10%. sFlt-1/PlGF ratio rule-out cutoffs (≤33 and ≤38) and rule-in cutoffs (>38, >85, and >110) exhibited negative percent agreement and positive percent agreement of 100%, respectively (n = 40). During the first 12 months, 257 orders were placed, repeat test frequency was 17.5%, mean time between repeat orders was 23 days, and 72.0% of results were reported within 2 h from sample receipt when quality control was run continuously.

Conclusions

We describe analytical performance parameters and quality indicators of the Elecsys sFlt-1 and PlGF assays, which was the first North American clinical laboratory site to implement these assays in support of the institution’s high-risk obstetrical unit.
A Farnese acquisition: Ribera, Genovesino and other paintings and bronzes from Governor Carlo Luzzi’s collection
Authors: Cocconi Giulia
Published: October 2021

This article focuses on the works of art – bronzes and paintings – listed in an inventory of 1655 detailing the collection of Carlo Luzzi, governor of Piacenza. This document has enabled the identification of a hitherto unpublished acquisition by Ranuccio II Farnese (1630–1694), and the tracing of many of Luzzi’s objects in the Farnese inventories drafted in Parma in 1680 and 1708. It also allows us to identify a number of bronzes and to offer some observations concerning the patronage of paintings attributed to artists such as Jusepe de Ribera, Bartolomeo Schedoni and Luigi Miradori.
Effects of Trans-ancestry Schizophrenia Risk Gene Polymorphisms on Working Memory and Underlying Brain Mechanisms
Authors: Su Yanyan , Zhang Qiumei , Zhao Wan , Chen Xiongying , Li Yang , Du Boqi , Deng Xiaoxiang , Ji Feng , Dong Qi , Chen Chuansheng , Li Jun
Published: October 2021

One of the main goals of the new generation of antipsychotics is to improve cognitive functions of schizophrenia patients, which makes it necessary to identify genes related to not only schizophrenia but also its cognitive impairments. Starting with 58 trans-ancestry risk variants found in a genome-wide association study of Chinese schizophrenia patients, we conducted two studies with four samples to systematically examine these variants’ potential roles in working memory. Study 1 was a behavioral study (Sample I included 510 healthy volunteers who completed the n-back, dot-pattern expectancy [DPX], delayed match-to-sample [DMS], and spatial span tasks; Sample II included 819 healthy volunteers and 893 schizophrenia patients who completed the n-back and DPX tasks). Study 2 was an fMRI study (Sample III included 163 healthy volunteers and 52 schizophrenia patients, who were scanned with fMRI during an n-back task; and Sample IV included 89 healthy volunteers, who were scanned during a spatial span task). Sample I identified rs11210892 as the only SNP that was associated with performance on multiple tasks (n-back, DPX, and DMS) after Bonferroni correction. Sample II replicated this association on the n-back task and the DPX task. FMRI data showed that the risk allele “G” of rs11210892 was associated with an increased activation within the right dorsolateral prefrontal cortex (Sample III) and the bilateral striatum (Sample IV). We conclude that rs11210892 is significantly associated with working memory and its neural underpinnings, so the genes near this SNP might be potential gene targets for treating cognitive impairment associated with schizophrenia.
Children's Behavior and Maternal Parenting Stress in Young Children With Sex Chromosome Trisomies
Authors: Lorini Alessandra , Zampini Laura , Silibello Gaia , Dall'Ara Francesca , Rigamonti Claudia , Ajmone Paola Francesca , Monti Federico , Lalatta Faustina , Costantino Maria Antonella , Vizziello Paola Giovanna
Published: October 2021

Objective:

Children and adolescents with sex chromosome trisomies (SCTs) usually show a higher frequency of behavioral problems than typically developing (TD) children. However, little is known about the presence of behavioral issues in toddlers with SCT. This study aimed at investigating their behavioral profile in the second year of life and its impact on maternal stress.

Method:

Participants were 87 children ranging in age from 18 to 26 months: 63 children with SCTs (all diagnosed prenatally) and 24 TD children. Their psychomotor and language development and their behavioral profile were assessed. In addition, the level of maternal parenting stress was evaluated.

Results:

Both psychomotor and language development were significantly lower in children with SCTs than in TD children. Conversely, no significantly greater behavioral problems emerged in children with SCTs. However, a significantly higher level of parenting stress related to a dysfunctional interaction with the child emerged in the mothers of children with SCTs. In this population, maternal stress seemed positively related to their children's emotional problems and pervasive disorders and negatively related to their children's psychomotor and linguistic competence.

Conclusion:

Although no significant behavioral issues emerged in the second year of life, the relationships found between children's behavioral profiles and maternal parenting stress highlight the importance of prenatal counseling and support groups for parents of children with SCTs. This might help them recognize the first signs of behavioral problems and become aware of their influence on parenting stress.
In-silico investigation of umami peptides with receptor T1R1/T1R3 for the discovering potential targets: A combined modeling approach
Authors: Wang Wenli , Cui Zhiyong , Ning Menghua , Zhou Tianxing , Liu Yuan
Published: October 2021

Umami, providing amino acids/peptides for animal growth, represents one of the major attractive taste modalities. The biochemical and umami properties of peptide are both important for scientific research and food industry. In this study, we did the sequence analysis of 205 umami peptides with 2-18 amino acids, sought the active sites of umami peptides by quantum chemical simulations and investigated their recognition residues with receptor T1R1/T1R3 by molecular docking. The results showed the peptides with 2-3 amino acids accounting for 44% of the total umami peptides. Residues D and E are the key active sites no matter where they in peptides (N-terminal, C-terminal or middle), when umami peptides contain D/E residues. N69, D147, R151, A170, S172, S276 and R277 residues in T1R1 receptor were deem to the key residues binding umami peptides. Finally, a powerful decision rule for umami peptides was proposed to predict potential umami peptides, which was convenient, time saving and efficiently.
Decoding of human identity by computer vision and neuronal vision
Authors: Zhang Yipeng , Aghajan Zahra M. , Ison Matias , Lu Qiujing , Tang Hanlin , Kalender Guldamla , Monsoor Tonmoy , Zheng Jie , Kreiman Gabriel , Roychowdhury Vwani , Fried Itzhak
Published: October 2021

Extracting meaning from a dynamic and variable flow of incoming information is a major goal of both natural and artificial intelligence. Computer vision (CV) guided by deep learning (DL) has made significant strides in recognizing a specific identity despite highly variable attributes1,2. This is the same challenge faced by the nervous system and partially addressed by the concept cells—neurons exhibiting selective firing in response to specific persons/places, described in the human medial temporal lobe (MTL)3–6. Yet, access to neurons representing a particular concept is limited due to these neurons’ sparse coding. It is conceivable, however, that the information required for such decoding is present in relatively small neuronal populations. To evaluate how well neuronal populations encode identity information in natural settings, we recorded neuronal activity from multiple brain regions of nine neurosurgical epilepsy patients implanted with depth electrodes, while the subjects watched an episode of the TV series “24”. We implemented DL models that used the time-varying population neural data as inputs and decoded the visual presence of the main characters in each frame. Before training and testing the DL models, we devised a minimally supervised CV algorithm (with comparable performance against manually-labelled data7) to detect and label all the important characters in each frame. This methodology allowed us to compare “computer vision” with “neuronal vision”—footprints associated with each character present in the activity of a subset of neurons—and identify the brain regions that contributed to this decoding process. We then tested the DL models during a recognition memory task following movie viewing where subjects were asked to recognize clip segments from the presented episode. DL model activations were not only modulated by the presence of the corresponding characters but also by participants’ subjective memory of whether they had seen the clip segment, and by the associative strengths of the characters in the narrative plot. The described approach can offer novel ways to probe the representation of concepts in time-evolving dynamic behavioral tasks. Further, the results suggest that the information required to robustly decode concepts is present in the population activity of only tens of neurons even in brain regions beyond MTL.
Climate shapes flowering periods across plant communities
Authors: Stephens Ruby E. , Sauquet Hervé , Guerin Greg R. , Jiang Mingkai , Falster Daniel , Gallagher Rachael V.
Published: October 2021

Aim

Climate shapes the composition and function of plant communities globally, but it remains unclear how this influence extends to floral traits. Flowering phenology, or the time period in which a species flowers, has well-studied relationships with climatic signals at the species level but has rarely been explored at a cross-community and continental scale. Here, we characterise the distribution of flowering periods (months of flowering) across continental plant communities encompassing six biomes, and determine the influence of climate on community flowering period lengths.

Location

Australia

Taxon

Flowering plants

Methods

We combined plant composition and abundance data from 629 standardised floristic surveys (AusPlots) with data on flowering period from the AusTraits database and additional primary literature for 2,983 species. We assessed abundance-weighted community mean flowering periods across biomes and tested their relationship with climatic annual means and the predictability of climate conditions using regression models.

Results

Combined, temperature and precipitation (annual mean and predictability) explain 29% of variation in continental community flowering period. Plant communities with higher mean temperatures and lower mean precipitation have longer mean flowering periods. Moreover, plant communities in climates with predictable temperatures and, to a lesser extent, predictable precipitation have shorter mean flowering periods. Flowering period varies by biome, being longest in deserts and shortest in alpine and montane communities. For instance, desert communities experience low and unpredictable precipitation and high, unpredictable temperatures and have longer mean flowering periods, with desert species typically flowering at any time of year in response to rain.

Main conclusions

Our findings demonstrate the role of current climate conditions in shaping flowering periods across biomes, with implications under climate change. Shifts in flowering periods across climatic gradients reflect changes in plant strategies, affecting patterns of plant growth and reproduction as well as the availability of floral resources across the landscape.
Elevated transcriptional pausing of RNA polymerase II underlies acquired resistance to radiotherapy
Authors: Liu Honglu , Yu Chunhong , Zhang Na , Meng Yang , Huang Canhua , Hu Chunhong , Chen Fang , Xiao Zhiqiang , Zhang Zhuohua , Shao Hao , Yuan Kai
Published: October 2021

As the mainstay modality for many malignancies, particularly inoperable solid tumors such as nasopharyngeal carcinoma (NPC), ionizing radiation (IR) induces a variety of lesions in genomic DNA, evoking a multipronged DNA damage response to interrupt many cellular processes including transcription. The turbulence in transcription, depending on the nature of DNA lesions, encompasses local blockage of RNA polymerase II (RNAPII) near the damage sites, as well as a less understood genome-wide alteration. How the transcriptional change influences the effectiveness of radiotherapy remains unclear. Using a panel of NPC and lung cancer cell lines, we observe increased phosphorylation at serine 5 (pS5) of the RNAPII after IR, indicating an accumulation of paused RNAPII. Remarkably, a similar increase of pS5 is seen in IR-resistant cells. ChIP-seq analysis of RNAPII distribution confirms this increased pausing both in IR-treated and IR-resistant NPC cells, notably on genes involved in radiation response and cell cycle. Accordingly, many of these genes show downregulated transcripts abundance in IR-resistant cells, and individual knockdown some of them such as TP53 and NEK7 endows NPC cells with varying degrees of IR-resistance. Decreasing pS5 of RNAPII and hence tuning down transcriptional pausing by inhibiting CDK7 reverses IR-resistance both in cell culture and xenograft models. Our results therefore uncover an unexpected link between elevated transcriptional pausing and IR-resistance. Given the recurrent NPC tissues display a steady increase in pS5 compared to the paired primary tissues, we suggest that CDK7 inhibitors can be used in combination with radiotherapy to increase sensitivity and thwart resistance.