bluuebunny/crossref_metadata_2025 huggingface dataset:
2836 Age differences in efficacy of newer glucose lowering treatments for type 2 diabetes
Authors: Hanlon P , Butterly E , Wei L , Wightman H , Almazam SAM , Alsallumi K , Crowther J , McChrystal R , Rennison H , Hughes K , Lewsey J , Lindsay R , McGurnaghan S , Petrie J , Tomlinson LA , Wild S , Adler A , Sattar N , Phillippo DM , Dias S , Welton NJ , McAllister DA
Published: January 2025

Background

Newer glucose-lowering agents for type 2 diabetes (sodium glucose cotransporter 2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor analogues (GLP1ra) and dipeptidyl peptidase-4 inhibitors (DPP4i)) improve hyperglycaemia and SGLT2i and GLP1ra reduce the risk of major adverse cardiovascular events (MACE). It is not clear whether the efficacy of these agents varies by age.

Methods

We searched Medline and Embase, plus clinical trial registries, for randomised controlled trials of SGLT2i, GLP1ra and DPP4i, versus placebo or active comparator, in adults with type 2 diabetes. Outcomes: HbA1c and MACE. Where IPD were available, we modelled age-treatment interactions for each trial. Otherwise, we assessed age distributions along with results from aggregate trial data. IPD and aggregate findings were combined in a Bayesian network meta-analysis to assess whether the efficacy differed by age.

Results

We identified 616 eligible trials (604 reporting HbA1c, 23 reporting MACE) and obtained IPD for 75 trials (6 reporting MACE). Mean age was 59.0 (10.7) years and 64.0 (8.6) in HbA1c and MACE trials, respectively. SGLT2i reduced HbA1c by 0.5–1.0% overall compared to placebo. This reduction versus placebo was attenuated in older participants (change in HbA1c 0.25 percentage-points less for 75-year-olds compared to 45-year-olds). SGLT2i showed greater relative efficacy in MACE risk reduction among older than younger people. This finding was sensitive to the exclusion of one of the IPD MACE trials, however, in all sensitivity analyses, SGLT2i were either as efficacious or more efficacious in older participants. There was no consistent difference in efficacy by age for GLP1ra or DPP4i for HbA1c or MACE.

Conclusion

Newer glucose-lowering drugs are efficacious across age and sex groups. SGLT2i are more cardioprotective in older than younger people despite smaller HbA1c reductions. Age alone should not be a barrier to treatments with proven cardiovascular benefit providing they are well tolerated align with patient priorities.
2504 Barriers perceived by medical students when considering a career in geriatric medicine
Authors: Fisher G , True S
Published: January 2025

Introduction

Despite the UK’s increasing life expectancy, and increase in the elderly population, there is an overwhelming lack of Geriatricians in the UK; as of 2022, there is only 1 consultant Geriatrician per 8031 individuals over the age of 65 (BGS, 2023). To meet the complex care needs of this population, there must be a focus on increasing the interest that doctors have towards Geriatric Medicine, with the overall aim being to recruit more doctors into the speciality.

Method

The aim of this review was to investigate what factors medical students perceive as barriers to pursuing a career in Geriatric Medicine and then, from identifying these, generate a set of comprehensive suggestions as to how to tackle these barriers at a medical school level to increase the interest and ultimately uptake of Geriatric Medicine. The qualitative review contains literature published between 2003 and 2023 accessed using MedLine.

Results

Six themes were identified in answering our question: (a) high emotional burden, (b) caring for patients with complex needs, (c) negative preconceptions of non-clinical factors (prestige, salary, career progression), (d) negative influence of clinical educators, (e) lack of intellectual stimulation and (f) lack of exposure to the speciality and the elderly.

Conclusion

The barriers perceived by medical students when considering Geriatrics as a speciality are complex and multifaceted; these barriers must be tackled promptly in order to secure the next generation of Geriatricians. We suggest that this work can be used as a foundation for further qualitative studies with UK medical students to investigate barriers that are specific to UK students. From this, interventional courses designed to increase Geriatric Medicine uptake could be developed to strengthen the UK Geriatric Medicine workforce.
2789 Patient navigator coordination of transitions for older adults with fractures: family caregiver experiences
Authors: Hanson N , Skerry L , O’Keefe K , Freeze T , Nguyen C , Somal R , Faig K , Jarrett P
Published: January 2025

Introduction

Fall-related injuries such as fractures are on the rise as the older adult population grows in New Brunswick, Canada. These injuries can lead to hospitalisation and transitions in care that are complicated for patients and families. The objective was to investigate the impact of patient navigators (PNs) working alongside the healthcare team on patient and family experiences, as compared to the usual standard of care (SOC), for adults aged 65 and older admitted with a fracture to an Orthopaedic Unit at one hospital in New Brunswick.

Methods

A concurrent embedded mixed methods design, in which the quantitative randomised control trial had an embedded qualitative component. The results for the family caregiver qualitative component, which used an interpretive description approach, are presented.

Results

Semi-structured interviews were conducted and thematically analysed for 15 family caregivers (8 PN group, 7 SOC group). The SOC caregivers, six women and one man, had a mean age of 64.6 years (SD = 6.9 years). The mean age of the 8 women in the PN group was 61.3 years (SD = 10.1). All participants in both SOC and PN groups self-reported their ethnicity as white. Thematic analysis found that SOC group caregivers discussed patients relying on support from family and friends throughout their care journey, whereas caregivers in the PN group predominantly discussed finding PNs supportive and helpful. Both groups discussed the ongoing stress that they felt throughout the care journey of the patient for which they cared for; however, for the PN group this topic was less prevalent.

Conclusions

This study provides an understanding of the positive impacts a patient navigator can have on older adult inpatient care and transitions in care. Patient Navigators were shown to be helpful to families, particularly those of patients with higher care needs and fewer family supports.
2792 Hospital outcomes following hip fracture in older adults: does frailty matter?
Authors: Steeves A , Shanks J , Flewelling A , Faig K , Bohnsack A , Benjamin S , MacLellan C , Gionet S , Wagg J , Dutton D , McGibbon CA , Jarrett P
Published: January 2025

Objectives

Older adults hospitalised with a hip fracture are at risk for adverse health outcomes depending on their level of frailty. This study examined how frailty levels prior to admission impacted length of stay (LOS), requirement for alternative level of care (ALC), returning home post-discharge, and mortality.

Methods

A random sample was generated from all hip fracture patients aged 65 and older admitted to a Level One Trauma Centre in New Brunswick, Canada from 2015–2019. This sample had their frailty level determined retrospectively using the Pictorial Fit-Frail Scale and the patients’ hospital electronic health record.

Results

Our study included 189 patients (mean age: 83.2 ± 8.2, 73.0% female), representing 91 not frail to mildly frail (48.2%; NF-MF), 32 moderately frail (16.9%; ModF), and 66 severely frail (34.9%; SF) patients. The ModF patients had a longer LOS (median: 20.0 days, IQR = 22.5) compared to NF-MF patients (median: 11.0 days, IQR = 10.0, p = 0.039, Kruskal-Wallis test) and SF patients (median: 8 days, IQR = 5.5, p < 0.0001, Kruskal-Wallis test). More ModF patients (56.3%) required an ALC stay in acute care compared to NF-MF (30.8%) and SF (28.8%) patients (p = 0.016, Chi-square test). More SF patients (28.8%) died in hospital or within six months post-discharge compared to NF-MF (8.8%) patients (p = 0.005, Chi-square test). Logistic regression revealed that both NF-MF (OR = 8.11, 95% CI: [3.12–21.06], p < 0.001) and ModF (OR = 5.18, 95% CI: [0.85–0.95], p = 0.007) patients had greater odds of returning home compared to SF patients when accounting for sex, age, and time to surgery.

Conclusions

A patient’s level of frailty prior to hospital admission impacts various health outcomes following a hip fracture and may provide helpful information for guiding treatment as well as discussions about health care.
2787 Supporting older ethnic minority groups in Brighton and hove to engage with research through digital means
Authors: Coleman L , Mensah E , Mukhopadhyay R , Ali K
Published: January 2025

Introduction

People from ethnic minorities are 1.5 times less likely to use digital technology. Within Brighton and Hove, 2021 Census reports that 26.1% described themselves as non-White-British categorised as other White (11.5%), Mixed Race (4.8%), Asian (3.7%), Black (2.0%), Chinese (1.1%), Arab (1.1%), and Other (2.0%). The aim of the project was to understand the lived experience of older ethnic minority adults in Brighton and Hove with digital technology, and how this experience affects their potential engagement with research.

Methods

Older people from ethnic minorities were identified through Brighton and Hove Health Watch, Bridging Change, Sussex Interpreting Services, and Black and Minority Ethnic Partnership. Using a mixed-methods approach, focus group and one-to-one meetings were held with 22 people, exploring their digital literacy, using a Likert scale, and preferences for research engagement using digital means. Meetings were transcribed and thematic analysis was undertaken.

Results

The group average age was 71.6 years. Six identified as male, 16 as female, and confidence with digital technology averaged 3/5 (5 representing high confidence). Variation of digital skills was observed, with older age and language barriers limiting digital access. Digital technology was used for social, transactional and health purposes (booking GP appointments, receiving test results, and GP consultations). Trust and confidence in the research team enhanced the group’s likelihood to engage digitally. Explaining the research in their own language would be an incentive. Younger family members can help explain digital elements. Offering choice of digital alongside traditional methods was important. There was a preference for initial research conversations to be in person. Willingness to engage is higher when the research topic is common in their community or they are personally affected.

Conclusions

Older people from ethnic minorities in Brighton and Hove are willing to engage in research using digital means if tailored to their social circumstances.
2793 Virtual wards for people with frailty—evidence to think anew?
Authors: Westby M , Ijaz S , Savović J , McLeod H , Dawson S , Welsh  , Le Roux H , Walsh N , Bradley N
Published: January 2025

Introduction

Increasing prevalence of people living with frailty is a key challenge to healthcare providers. One solution may be virtual wards (VWs). Our research sought to: examine different frailty VW models; and determine how, why and under what circumstances VWs may work effectively. During our early research, NHS England (NHSE) started roll-out of short-term VWs intended to treat acute patients with frailty crises at home instead of hospital. We expected our work to inform NHSE policy, especially how to ‘do’ VWs better.

Methods

We conducted a rapid realist review of frailty VWs, searching published and grey literature for evidence on multidisciplinary VWs based in the UK, using a literature-based definition of VWs. Information on how and why VWs might ‘work’ was extracted and synthesised iteratively into context-mechanism-outcome configurations (CMOCs). Throughout we engaged closely with clinicians and patient/public contributors. The iterative nature of the realist review led to emerging understanding.

Results

From 28 documents, we identified two VW models: longer-term, proactive care wards admitting patients at high risk of a frailty crisis; and short-term reactive care wards for people experiencing a frailty crisis. Using evidence from both models, we generated 12 CMOCs, under three themes. First, building blocks for effective VW operation (e.g. common standards agreements, information sharing, a multidisciplinary team planning patient care remotely). Second, how the VW delivers the frailty pathway (e.g. patient selection, assessment, proactive care). Third, Patient/Caregiver empowerment. Mechanisms included motivating professionals (e.g. a ‘team-of-teams’); buy-in; building relationships: professionals, patients and caregivers. VWs should be set within frailty management guidance, and a whole-system approach to care is needed. For sustainability of VWs, proactive care for people at high risk of a frailty crisis should be provided.

Conclusions

This review has implications for optimal implementation and sustainability of frailty VWs, through proactive care and a whole system approach.
2886 Video-based patient Records for Supporting Care Delivery for older adults with frailty: the Isla for frailty feasibility study
Authors: Averill P , Lear R , Odedra R , Long S , Taylor A , Charville P-J , Fernandes J , Nwobilo U , Ollivierre-Harris T , Ellis S , Mayer EK
Published: January 2025

Introduction

Written documentation and verbal handovers can be ineffective at communicating the specifics of frail, older patients’ complex functional abilities and support needs. Video-recordings of individual patients may help to convey a patient’s condition in a more nuanced, objective way, potentially improving safety at care transitions. The Isla platform interfaces with electronic health record systems, allowing care providers to capture video-recordings during patient care. We evaluated the acceptability, feasibility, and potential effectiveness of video-based patient records (the Isla platform) for supporting the care of older frail inpatients within the acute hospital setting and at care transitions.

Method

Over a three-month pilot period, a non-randomised, mixed-methods feasibility study of video-based patient records (alongside usual care) was conducted within three elderly medicine wards of a large acute hospital in England. Patient and public involvement and engagement (PPIE) was central to study design and implementation. Participant enrolment figures; semi-structured interview data; and video capture and view metrics were examined within an embedded process evaluation, appraising intervention acceptability among patients, carers, and ward staff; barriers and facilitators to intervention implementation; and perceived intervention impacts.

Results

The study enrolled 57 ward staff and 29 patients (56.9%); one patient withdrew. Enrolment figures and early interview analyses indicate apparent acceptability of video-based patient records to patients and carers. Intervention barriers (e.g. patient pain), facilitators (e.g. staff-patient rapport) and potential intervention impacts (e.g. improved person-centred care, team communication) were identified. Modal use-cases for video-recordings were to document patients’ transfers (n = 16), mobility (n = 13), and eating/drinking supports (n = 3); however, view metrics suggested limited engagement with videos once captured.

Conclusion(s)

Preliminary findings indicate the acceptability and feasibility of video-based patient records, although several implementation considerations warrant address. Perceived intervention impacts (e.g. improved person-centred care) were promising; although greater engagement with videos is a probable precondition to demonstrating efficacy in future research.
2788 Exercise trainers as key enablers in the remote delivery of dementia prevention interventions in the homes of older adults
Authors: Tranchant CC , Gallibois M , Handrigan G , Omar H , Yetman L , Haché J , Faig K , Jarrett P , Bohnsack A , McGibbon CA
Published: January 2025

Introduction

Social support for physical activity is important for engaging older adults in physically active lifestyles. Few studies examined the impact of individual exercise trainers (IETs) in the context of dementia prevention interventions with physical activity. We aimed to assess the contributions of IETs in the remote delivery of a home-based dementia prevention program combining physical exercise and cognitive training targeting older adults at risk for dementia.

Methods

Convergent mixed-method analysis was conducted using data from SYNERGIC@Home, a feasibility study of a 16-week intervention that included one-on-one supervised physical exercise (3 sessions/week) fully delivered through Zoom. Quantitative data consisted of descriptive statistics, measures of adherence, participants’ preference and satisfaction. Qualitative interviews centred on participants’ experience and motivation were conducted post-intervention.

Results

Of the 60 participants randomised to one of four intervention arms (mean age 68.9, 76.7% female), 52 completed the interventions with high overall adherence (87.5%). Pre-intervention, participants expressed a clear preference for cognitive interventions, but post-intervention preference shifted to exercise. IETs (n = 21) were part-time research assistants, each assigned to one participant after completing CSEP Certified Personal Trainer® or Clinical Exercise Physiologist™ certification as part of their training. One full-time Lead IET coordinated and supervised the other trainers. IETs worked the closest with study participants, also working closely with study coordinator and with study physician for adverse event monitoring. Interviewed participants (n = 15) often described the positive relationships that developed with their IET. Trainers were instrumental in participants’ motivation and enjoyment, personalising the sessions and addressing technological issues. Satisfaction rates with IETs (n = 54 exit survey respondents) were high.

Conclusions

Exercise trainers played crucial roles that extended beyond the supervision of exercise sessions and contributed to participant engagement in the interventions. Access to these allied health professionals should be featured more prominently in strategies/programs promoting active lifestyles among older adults.
2830 A systematic review of the association between ethnicity and frailty prevalence, incidence, trajectories and risks
Authors: Khan M , Nicholl B , Macdonald S , Hanlon P
Published: January 2025

Background

Ethnic variations in frailty are poorly understood. This systematic review examined ethnic variations in frailty prevalence, incidence and trajectories; associations between frailty and sociodemographic/lifestyle risk-factors; and health-related outcomes of pre-frailty and frailty.

Methods

We searched four electronic databases from 2000 to April 2023 using terms for ethnicity and frailty. Inclusion criteria: observational studies assessing frailty in adults ≥18 years from community-based settings, including care homes; ethnicity defined by race, country of birth, language, ancestry, or culture. We supplemented searches with manual citation and reference list searches. Primary outcomes: prevalence, incidence, and transitions of frailty. Secondary outcomes: factors associated with frailty and health-related outcomes (e.g. falls, hospital admissions, mortality). Two reviewers independently screened all articles; conflicts were resolved by a third reviewer.

Results

We included 80 studies, representing data from 13 countries plus two multi-national samples from 15 European and 10 Asian countries, respectively. Across settings, frailty prevalence was higher in minority groups (including Black or Hispanic people in USA, South Asian or Black people in UK, Moroccan or Surinamese in the Netherlands, ‘non-white’ groups in South America, Māori in New Zealand, and non-Han groups in China) compared to majority groups (White in most settings, or Han in studies in China). Ethnic differences appear sensitive to methods used to measure frailty. Two US-based studies found that ethnic differences were independent of sociodemographic differences. Six studies from USA or UK showed that Black and South-Asian people, respectively, had higher frailty incidence or more rapid frailty progression. There were no significant differences in mortality risk of frailty between ethnic groups.

Conclusion

Ethnic variation in frailty prevalence and dynamics persist across multiple settings, with minority groups adversely impacted. Future research should seek to explain ethnic differences in frailty measurement. Interventions targeting frailty need to take account of structural inequalities faced by minority groups.
2844 ‘You are as frail as your arteries’—exploring the correlation between frailty, and chronological and vascular age parameters
Authors: Mukhopadhyay R , Mensah E , Kirkham F-A , Shwe PS , Ali K , Rajkumar C
Published: January 2025

Introduction

Thomas Sydenham, English physician stated, ‘a man is as old as his arteries’. Chronological age has been noted to correlate strongly with vascular/biological age. However, little is known about how chronological and vascular parameters of ageing, correlate with frailty. In this study, we sought to study the correlations between frailty, chronological age and parameters of vascular ageing.

Methods

Data from two studies with participants aged ≥60 years investigating the associations between Cytomegalovirus infection and frailty indices and vascular parameters were included. Two hundred and sixty community dwelling adults were enrolled in both studies. Vascular parameters were measured by cardio-ankle vascular index (CAVI) using VaSera VS-2000® and pulse wave velocity-PWV (carotid-femoral and carotid-radial) using COMPLIOR®. Hand grip strength (HGS) and Charlson co-morbidity index (CCI) were measured for clinical frailty data. Patients were excluded if they had malignancy, were on active treatment for cancer or were unable to give consent.

Results

There were 260 study participants, (mean age ± SD; 72 ± 8 years), with gender distribution M:F (50:50). Chronological age strongly correlated positively with vascular ageing parameters such as CAVI (r = 0.6, p < 0.001) and cf-PWV (r = 0.5, p < 0.01). Similarly, chronological age correlated positively with CCI (r = 0.7, p˂0.001) and negatively with HGS (r = − 0.3, p˂0.001). Vascular ageing as measured by CAVI (estimated CAVI age) correlated positively with CCI (r = 0.5, p < 0.01) and negatively with HGS (r = −0.2, p = 0.01). Other measures of vascular ageing such as cf-PWV positively correlated with CCI (r = 0.4, p < 0.01) and negatively with HGS (r = − 0.1, p = 0.09).

Conclusion

Clinical frailty parameters correlate strongly with measures of vascular ageing and chronological age. Vascular ageing is a strong independent predictor of frailty.
2660 Drug classes associated with geriatric readmissions: the canary in a coal mine
Authors: Loh KY , Tay L
Published: January 2025

Introduction

Older adults are at increased risks of drug-related problems, contributed by increasing incidence of multimorbidity with age, and the consequent polypharmacy. We aim to investigate the drug classes associated with 30-day readmissions in hospitalised older adults.

Method

We prospectively studied patients aged 65 years and above admitted to a general medical department in Sengkang General Hospital, Singapore, between October 2018 and January 2020. Medication lists were obtained from electronic medical records at admission. Unplanned readmission within 30 days of discharge was tracked through the hospital’s electronic health records. Medications were classified according to the World Health Organisation’s Anatomical Therapeutic Chemical classification system. Univariate logistic regression was performed for the association of drug classes with 30-day readmission.

Results

We recruited 1507 consecutive admissions with follow-up data. 30-day readmission occurred in 331 patients (22.0%). Greater length of stay, higher comorbidity burden, hospitalisation in the year preceding index admission, frailty and polypharmacy were more commonly observed among patients who were readmitted within 30 days of discharge. Admission diagnoses associated with 30-day readmission include infections, fluid overload, acute coronary events and constipation. Drg classes associated with a higher risk of 30-day readmission include drugs for acid-related disorder (OR = 1.62, 95%CI 1.27–2.07), drugs for constipation (OR = 1.96, 95%CI 1.41–2.73), antithrombotic agents (OR = 1.40, 95%CI 1.09–1.79), antianaemic preparations (OR = 2.22, 95%CI 1.68–2.91), cardiac therapy (OR = 1.70, 95%CI 1.23–2.34), diuretics (OR = 1.41, 95%CI 1.04–1.90), beta-blocking agents (OR = 1.55, 95%CI 1.21–1.99) and analgesics (OR = 1.56, 95%CI 1.02–2.39).

Conclusion

Drg classes associated with 30-day geriatric readmissions include drugs for acid-related disorder, constipation, antithrombotic agents, antianaemic preparations, cardiac therapy, diuretics, beta-blocking agents and analgesics. Patients on the above drug classes should herald a higher index of scrutiny during admissions and necessitate closer follow-up upon discharge.
2855 Dementia in elderly individuals with depression: a systematic review and Meta-analysis of longitudinal studies (2013–2024)
Authors: da Costa Galvão PE , de Sousa Romeiro AM , de Souza GLC Branco , Prudente TP , Dias EMV , Nogueira TE , Silveira EA
Published: January 2025

Introduction

With population ageing comes challenges like dementia, prompting the urgent identification of risk factors and its associations with other psychiatric disorders. This review aims to explore the connection between depression and the onset of mild cognitive impairment (MCI) or dementia through recent literature analysis.

Methods

Systematic review and meta-analysis, following PRISMA recommendations, with studies from 2013 onwards. The search strategy ‘Depression’ AND ‘Dementia’ AND ‘Aged’ was employed in the Cochrane, Embase, LILACS, PubMed, Scopus, and Scielo databases. Cohort studies in Portuguese, English, or Spanish were included, while reviews or clinical trials were excluded. The meta-analysis was conducted using RevMan software, employing unadjusted OR effect measures for exposure in the Forest Plot graph. Study heterogeneity was calculated using the I2 statistic, with a cutoff point of >75% indicating high heterogeneity.

Results

The search strategy identified 3394 articles, screened by title and abstract. Of these, 187 were fully read, and 26 were included in the review. The most used tool for assessing depressive symptoms was the Geriatric Depression Scale (38.4%), while the Mini-Mental State Examination was the most frequently used tool for assessing symptoms of MCI and dementia (26.9%). The quantitative analysis included 14 studies evaluating dementia and 8 studies evaluating MCI. The likelihood of older adults with depression developing dementia was 1.75 times higher than in the non-depressed population (OR = 1.75; 95% CI 1.46–2.11). Additionally, a twofold increase in the likelihood of developing MCI was found in depressed older adults (OR = 2.03; 95% CI 1.44–2.88). All analyses revealed high heterogeneity.

Conclusion

Depression was found to be associated with higher likelihood of developing MCI or dementia in older adults. Understanding this complex relationship with new studies and reviews is crucial for developing targeted interventions and improving the prognosis for individuals affected by both conditions.
2763 Process evaluation of the BASIL+ trial: addressing low mood among older people
Authors: Bosanquet K , Newbronner E , Coventry P , Shearsmith L , Littlewood E , Bailey D , Henry A , Burke L , Ryde E , McMillan D , Ekers D , Gilbody S , Chew-Graham CA
Published: January 2025

Introduction

During the COVID-19 pandemic, older adults were at risk of being socially isolated or experiencing loneliness, increasing the risk of depression. We adapted the delivery of Behavioural Activation (BA), an effective evidence-based intervention for depression in older adults and people with multiple long-term conditions (LTCs), so it could be delivered remotely under COVID-19 restrictions.

Method

The qualitative study was nested within the BASIL+ definitive randomised controlled trial (https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(23)00238-6/fulltext). Semi-structured telephone interviews were conducted with 24 older adults, two caregivers and 16 BASIL Support Workers (BSWs). They were digitally recorded and transcribed professionally. Data were analysed thematically using constant comparison.

Results

Conclusion

Findings suggest a BASIL+ style intervention should become more widely available for older adults with LTCs and low mood, given its positive impact on most participants and its remote delivery by non-specialist practitioners.
Improving care in elderly neurosurgery initiative guideline on management of chronic subdural haematoma in older people-relevance for the geriatrician
Authors: Rickard Frances , Cox Anthony , Willliams Adam , Mortimer Alex , Wigfield Crispin , Shipway David
Published: January 2025

Chronic subdural haematoma (cSDH) is a common subtype of traumatic brain injury, typically affecting older people living with frailty and multimorbidity. Until now, no published guideline has existed internationally to guide management, perhaps explaining why the care of the older cSDH patient varies between neurosurgical centres.

The Improving Care in Elderly Neurosurgery Initiative guideline is the first guideline dedicated to the care of patients with cSDH across the entire patient pathway, from initial presentation through to rehabilitation and discharge after surgery. It includes specific recommendations for those patients not requiring surgery who, in the UK, are mostly managed in satellite hospitals away from the tertiary neurosurgical centre. It therefore has relevance to clinicians across the entire UK and also potentially to a broader international audience.

In this guideline commentary we summarise the key points for geriatricians and those allied specialties such as acute medicine who deliver care to a large proportion of patients with cSDH.

We discuss issues and limitations relating to guideline development, in particular in the rapidly evolving field of Middle Meningeal Artery Embolisation. We also comment on factors which may influence guideline implementation and future service development. Finally we call for some form of national registry in older people sustaining SDH, which may need to be supported by financial incentives to drive investment in services for this historically neglected patient group.
Comparison of trends in CPS reports of child maltreatment and child maltreatment-related mortality across time, place and race/ethnicity
Authors: Goitom Saron , Neumann Krista , Veazie Stephanie , Farkas Kriszta , Ahern Jennifer , Mason Susan M , Riddell Corinne A
Published: January 2025

Background: Child maltreatment is a persistent public health problem in the United States. Child Protective Services (CPS) data are the de facto data source for child maltreatment surveillance, despite these data’s established limitations. Maltreatment-related mortality could be a complementary source of child maltreatment surveillance data.

Methods: We calculated trends over time, and patterns across state and by race/ethnicity, comparing child maltreatment report rates to child maltreatment-related mortality rates, between 2005 and 2020.

Results: These two measures of maltreatment show different time trends and patterns by state and race/ethnicity. Time trends in maltreatment-related mortality decreased slightly across the study period for all racial/ethnic groups, while maltreatment report rates increased, particularly for Non-Hispanic Black children. Reports and mortality data revealed very different pictures of which states had the highest and lowest maltreatment rates, overall and by race/ethnicity. Only 14 states had report and mortality rates in the same tertile, with less alignment when stratified by race/ethnicity.

Discussion: Patterns in child maltreatment report rates and death rates do not align. Future work should consider additional sources of data to improve maltreatment surveillance. These findings highlight the need to identify a valid and consistent approach to capture patterns of maltreatment in the United States.
A comprehensive benchmarking for evaluating TCR embeddings in modeling TCR-epitope interactions
Authors: Feng Xikang , Huo Miaozhe , Li He , Yang Yongze , Jiang Yuepeng , He Liang , Cheng Li Shuai
Published: January 2025

The complexity of T cell receptor (TCR) sequences, particularly within the complementarity-determining region 3 (CDR3), requires efficient embedding methods for applying machine learning to immunology. While various TCR CDR3 embedding strategies have been proposed, the absence of their systematic evaluations created perplexity in the community. Here, we extracted CDR3 embedding models from 19 existing methods and benchmarked these models with four curated datasets by accessing their impact on the performance of TCR downstream tasks, including TCR-epitope binding affinity prediction, epitope-specific TCR identification, TCR clustering, and visualization analysis. We assessed these models utilizing eight downstream classifiers and five downstream clustering methods, with the performance measured by a diverse range of metrics for precision, robustness, and usability. Overall, handcrafted embeddings outperformed data-driven ones in modeling TCR-epitope interactions. To further refine our comparative findings, we developed an all-in-one TCR CDR3 embedding package comprising all evaluated embedding models. This package will assist users in easily selecting suitable embedding models for their data.
Novel genetic insight for psoriasis: integrative genome-wide analyses in 863 080 individuals and proteome-wide Mendelian randomization
Authors: Liu Shunying , Li Lingfei , Liang Yi , Tan Yang , Wang Xiaoyu , Feng Yanhai , Chen Nian , Lei Xia
Published: January 2025

Psoriasis affects a significant proportion of the worldwide population and causes an extremely heavy psychological and physical burden. The existing therapeutic schemes have many deficiencies such as limited efficacies and various side effects. Therefore, novel ways of treating psoriasis are urgently needed. A large-scale meta-analysis of psoriasis genome-wide association studies (GWAS) totaling 20 105 cases and 842 975 controls was conducted. Based on the GWAS results, Mendelian randomization (MR) analyses were then performed on three cis-protein quantitative trait loci (pQTL) data in blood. Furthermore, druggability verification and mouse knock-out models were utilized to explore the clinical value of screened proteins. We identified 42 genome-wide significant psoriasis risk variants (P < 5 × 10−8), of which 33 were previously unreported. MR analyses unveiled 19 unique circulating proteins that were associated with psoriasis, among which only AIF1, FCGR3A, NEU1, HSPA1A, TNXB, and ABO were the potential proteins that interacted with psoriasis risk after being analyzed with high evidence of colocalization (PP.H4 > 0.9). In addition, AIF1, FCGR3A, and HSPA1A have been finally determined to be feasible therapeutic targets for psoriasis after being confirmed by druggability verification and specific mouse knock-out models. This large-scale GWAS meta-analysis identified 33 new variants for psoriasis. This study announced that AIF1, FCGR3, and HSPA1A were the unexplored but material variants of psoriasis, thus providing novel and valuable targets for psoriasis treatment and broadening new orientation of drug development for psoriasis.
Criminology, Conspiracy Theories and Theorizing Conspiracy
Authors: Kindynis Theo
Published: January 2025

This article challenges criminologists to adopt a more critical orientation to conspiracy theories. The first part of the article suggests that a moral panic over conspiracy theories has given rise to a conspiracy theory research agenda that has pathologized and criminalized conspiracy theories. The second part of the article argues that although conspiracies are important sociological and political phenomena, the term ‘conspiracy theory’ functions to stigmatize certain narratives. The article traces the origins of conspiracy denial in the social sciences. The final part of the article argues that criminologists should take conspiracy theories seriously and seek to investigate conspiracies. If popular conspiracy theories about elite wrongdoing are invalid, criminologists should develop better explanations of how and why conspiracies take place, as well as who conspires and to what ends. The article outlines some existing concepts and approaches that criminologists might utilize to this end.
In/visibilities
Authors: George Jain Abhimanyu
Published: January 2025

In Drones and International Law, Rebecca Mignot-Mahdavi describes and explains how drones, war and law interact with and shape each other in the context of counterterrorism. Mignot-Mahdavi’s argument is rich, incisive and provocative. It makes a significant contribution not only to the literature on drones and international law but also to the literature on international law and technology and legal theory. This review essay highlights and problematizes three significant choices (or exclusions) that shape Mignot-Mahdavi’s argument – her conceptualization of technological agency, of legal argumentation and change and of the novelty of the transnational jihadist threat.
Investigation of a static source model for non-seismic tsunamis using waveform inversion: a case study of the 2018 Anak Krakatau event
Authors: Yatimantoro Tatok , Yamanaka Yusuke , Gusman Aditya Riadi , Tanioka Yuichiro , Ratnasari Rinda Nita , Karnawati Dwikorita
Published: January 2025

This study investigates the effectiveness of inversion methods using tsunami waveforms to analyse volcanic tsunami sources, which are a type of non-seismic tsunami source. We focused on the 2018 Anak Krakatau tsunami triggered by a volcanic eruption. This study developed a static initial sea surface displacement model based on tsunami waveform inversion with data recorded at tide gauge stations using a Gaussian-shaped sea surface displacement for the unit source. A key characteristic of our model is that all initial velocity components of the tsunami were zero. We tested 12 scenarios for accuracy to determine the most plausible sea surface displacement. The optimal displacement model reasonably reproduced the observed tsunami waveforms. The calculated water volume at the initial sea surface displacement was reasonably consistent with the total collapse volume of the Anak Krakatau eruption by magnitude. These findings suggest that our approach to developing a static source model can effectively apply to non-seismic tsunami events. Although this approach offers simplified tsunami source modelling for tsunami estimation during volcanic eruptions with complex source dynamics, further validation is required for its application to other non-seismic tsunami events.
A political economy analysis of health policymaking in Nigeria: the genesis of the 2014 National Health Act
Authors: Chukwuma Julia Ngozi , Obi Felix Abrahams
Published: January 2025

This article explores the ideologies, interests, and institutions affecting health policymaking in Nigeria, and the role of the private sector therein. It covers the period from the late-1950s, the years leading up to independence, to 2014, when the country enacted its first-ever law to govern its healthcare system. The National Health Act (NHAct) was adopted after a decade of preparation and civil society-driven advocacy, making the objective of universal health coverage (UHC) explicit. However, in its final version, the NHAct earmarked only a small share of public funds for UHC, solidifying the country’s reliance on private healthcare and out-of-pocket payments. To examine the specific set of ideologies, interests, and institutions defining Nigeria’s pathway toward UHC and the contribution of the private sector, we adopted the political economy framework, situating the genesis of the 2014 NHAct within the broader political and economic context of Nigeria’s health system reform process since the 1950s. Drawing on qualitative data collected during interviews and focus groups, we found that the deep entrenchment of private-sector healthcare in Nigeria is the result of a path-dependent process. This implies that Nigeria’s current reliance on the private sector is influenced by historical patterns, competing interests, and institutional practices that have reinforced the role of private actors over time. We identified three major explanatory factors that have shaped health policymaking in Nigeria. First, since the 1980s, the ideology that private healthcare is the solution to an underfunded and underperforming public healthcare system has been reinforced by leading international organizations. Second, private actors in Nigeria have been in a strong position to influence health policymaking since independence. Third, Nigeria’s challenging socio-economic context and the limitations of its federal governance structure have fostered a general level of public distrust in the capacity of the public sector to provide quality healthcare.
Key informants’ views on the benefits, planning and implementation of workplace oral health promotion programme
Authors: Bakri Noor Nazahiah , Thomson W M , Broadbent Jonathan M , Smith Moira B
Published: January 2025

This study aimed to explore key informants’ views on the potential benefits of workplace oral health promotion (WOHP) among the aged care workforce and identified factors associated with the planning and implementation of such activities. The study interviewed members of key organizations associated with the aged care workforce, including oral health and health professionals, government and non-governmental organizations, aged care providers, unions and other worker support organizations in semi-structured interviews. Interviews were audio-recorded, transcribed verbatim and analysed thematically. Fourteen (of 17 invited) key informants participated. Promoting oral health among those working in the aged care sector is perceived to have advantages for staff oral health and psychological and mental well-being, and potentially has a ‘flow-on effect’ on the organization’s productivity, operation and human and financial resources. Six factors that can act as facilitators or barriers to WOHP planning and implementation were identified: (i) organization structure, needs, priorities, and higher management contribution; (ii) resources (funding, facilities, human and time capacity); (iii) collaborators; (iv) individual or target audience; (v) communication; and (vi) sustainability of the programme. The study concluded that WOHP in the aged care sector is possible and likely has benefits for staff and the organizations involved. Consideration should be given to identifying and addressing the factors that influence the development and implementation of WOHP programmes. Good organization, support of management, availability of funding, support from collaborators and consideration of individual needs are needed to have a successful, sustainable WOHP programme that meets the needs of the aged care workforce.
Microgrid cooperative scheduling optimization based on quality of service constraint and deep Q-network algorithm
Authors: Zhou Jie , Lu Rong
Published: January 2025

This paper proposes a quality of service Cloud Workflow Firefly Algorithm (CWFA), which considers dynamic priorities. Whenever the algorithm experiences a new state–action pair, this experience is recorded as part of the training data. Genetic algorithm (GA) is introduced to optimize the initial parameters of deep Q-network (DQN). Through GA, a better initial weight can be found, so as to improve the estimation of Q-value, making the overall workflow scheduling more efficient. The simulation results show that, compared with other methods, CWFA–GA–DQN can effectively improve the efficiency of microgrid cooperative scheduling.
General practice antibiotic prescriptions attributable to respiratory syncytial virus by age and antibiotic class: an ecological analysis of the English population
Authors: Miller Lucy , Beaney Thomas , Hope Russell , Cunningham Mark , Robotham Julie V , Pouwels Koen B , Costelloe Cèire E
Published: January 2025

Background

Respiratory syncytial virus (RSV) may contribute to a substantial volume of antibiotic prescriptions in primary care. However, data on the type of antibiotics prescribed for such infections are only available for children <5 years in the UK. Understanding the contribution of RSV to antibiotic prescribing would facilitate predicting the impact of RSV preventative measures on antibiotic use and resistance. The objective of this study was to estimate the proportion of antibiotic prescriptions in English general practice attributable to RSV by age and antibiotic class.

Methods

Generalized additive models examined associations between weekly counts of general practice antibiotic prescriptions and laboratory-confirmed respiratory infections from 2015 to 2018, adjusting for temperature, practice holidays and remaining seasonal confounders. We used general practice records from the Clinical Practice Research Datalink and microbiology tests for RSV, influenza, rhinovirus, adenovirus, parainfluenza, human metapneumovirus, Mycoplasma pneumoniae and Streptococcus pneumoniae from England’s Second Generation Surveillance System.

Results

An estimated 2.1% of antibiotics were attributable to RSV, equating to an average of 640 000 prescriptions annually. Of these, adults ≥75 years contributed to the greatest volume, with an annual average of 149 078 (95% credible interval: 93 733–206 045). Infants 6–23 months had the highest average annual rate at 6580 prescriptions per 100 000 individuals (95% credible interval: 4522–8651). Most RSV-attributable antibiotic prescriptions were penicillins, macrolides or tetracyclines. Adults ≥65 years had a wider range of antibiotic classes associated with RSV compared with younger age groups.

Conclusions

Interventions to reduce the burden of RSV, particularly in older adults, could complement current strategies to reduce antibiotic use in England.