bluuebunny/crossref_metadata_2025 huggingface dataset:
122 A Medication Self-Management Intervention to Improve Medication Adherence for Older People with Multimorbidity: A Pilot Trial
Authors: Yang C , Hui Z , Zhu S , Wang X , Tang G , Lee D T F
Published: March 2021

Introduction

Medication self-management support has been recognised as an essential element in primary health care to promote medication adherence and health outcomes for older people with chronic conditions. A patient-centred intervention empowering patients and supporting medication self-management activities could benefit older people. This pilot study tested a newly developed medication self-management intervention for improving medication adherence among older people with multimorbidity.

Method

This was a two-arm randomised controlled trial. Older people with multimorbidity were recruited from a community healthcare centre in Changsha, China. Participants were randomly allocated to either a control group receiving usual care (n = 14), or to an intervention group receiving three face-to-face medication self-management sessions and two follow-up phone calls over six weeks, targeting behavioural determinants of adherence from the Information-Motivation-Behavioural skills model (n = 14). Feasibility was assessed through recruitment and retention rates, outcome measures collection, and intervention implementation. Follow-up data were measured at six weeks after baseline using patient-reported outcomes including medication adherence, medication self-management capabilities, treatment experiences, and quality of life. Preliminary effectiveness of the intervention was explored using generalised estimating equations.

Results

Of the 72 approached participants, 28 (38.89%) were eligible for study participation. In the intervention group, 13 participants (92.86%) completed follow-up and 10 (71.42%) completed all intervention sessions. Ten participants (71.42%) in the control group completed follow-up. The intervention was found to be acceptable by participants and the intervention nurse. Comparing with the control group, participants in the intervention group showed significant improvements in medication adherence (β = 0.26, 95%CI 0.12, 0.40, P < 0.001), medication knowledge (β = 4.43, 95%CI 1.11, 7.75, P = 0.009), and perceived necessity of medications (β = −2.84, 95%CI -5.67, −0.01, P = 0.049) at follow-up.

Conclusions

The nurse-led medication self-management intervention is feasible and acceptable among older people with multimorbidity. Preliminary results showed that the intervention may improve patients’ medication knowledge and beliefs and thus lead to improved adherence.
127 A Student Pilot For A Feasibility Study of the Theoretical 3S Trial (SPFT3S): Patient Questionnaire and Demographics
Authors: Foster R , Dodd M , Brown L , Awonaya K , McCormack T
Published: March 2021

Introduction

There is conflicting evidence on the benefit of statins for primary prevention of cardiovascular disease (CVD) in non-diabetics over 75. Emerging evidence shows they may be ineffective, yet current guidance supports their use in those up to 85. The objectives of this study were to assess patients’ understanding of statins, willingness to participate in a theoretical randomised controlled trial (RCT), where they would be randomised to stop their statin and to compare the trial population with national data.

Methods

The survey took place in 8 GP practices with 4 students involved in questionnaire distribution. A patient search identified those over 75 and on a statin. Patients were excluded if they had a history of CVD or diabetes. 36 patients were identified and completed questionnaires, 5 were removed because they reported exclusion criteria. Demographic data was compared to the UK population from the 2011 census.

Results

Of 31 participants, 71% understood why they took statins, most were unconcerned about side effects and only 1 patient stopped statins due to the media. Opinions on the theoretical “stopping statins trial” were varied. 35% of people responded positively. 29% would not want to take part and 36% of people were unsure. Comparison of our trial population against the national population shows that 903,505 people would be eligible for a UK trial.

Conclusions

The purpose of this exercise was to see if patients would be willing to participate in a trial where 50% stopped taking their statin. Approximately a third said yes and only a third said no. As there are nearly a million people in this population, it suggests a fully funded, larger-scale feasibility study of this theoretical randomised control trial is warranted.
128 Prevalence of Older People Presenting Acutely to A Regional Spine Unit
Authors: Tarawneh A M , Sadanandan N , Salem K MI , Sahota O
Published: March 2021

Background

With ageing demographics, the number of older people is expected to rise exponentially over the next decade. With increasing numbers, the numbers of patients presenting to hospital will also increase. These patients have significant underlying comorbidities and thus further surgical interventions are more challenging.

Objective

To investigate the incidence of all in-patient referrals to the Nottingham Regional Spinal unit for patients aged 70 years and above over a 30-month period.

Methods

A retrospective 30-month review (Jan 2017-Aug 2019) of the clinical records of all in-patients’ referrals to the regional spinal unit (catchment population 4.5 million) for patients aged 70 years and above was undertaken. Patient demographics, co-morbidities, cause of referral, treatment modality (conservative vs. surgical), length of hospital stay, discharge destination (home vs. rehab) and mortality rates were collected and analysed.

Results

A total of 677 (Male: 335, Female: 342) in-patients’ referrals for patients aged 70 years and above were received. The mean age at presentation was 82.3 (±7.48) years. Trauma (low & high energy) was the most common cause of inpatient referrals (n = 448; 66.2%). Low energy trauma (insufficiency) fractures contributed to more than half of the total referrals (n = 256). Spondylodiscitis was the least common cause of referral (n = 34; 5%). Five-hundred forty-five patients were treated conservatively (80.5%). Average length of hospital stay was 16.7 days (range:1–282 days). Eighty-one of the discharged patients (13.5%) were transferred to rehabilitation after discharge, and the over-all 30-day mortality rate was 11.5% (n = 78).

Conclusion

Frail older people represent a significant workload to the regional spine unit. Adapting an ortho-geriatric model of care as with hip fracture care may be the optimal model of service delivery to improve outcomes for this patients group.
133 Incidence of Imaging Confirmed Stroke and Thrombotic Events in Older Adults with Severe COVID-19 Infection
Authors: Hickmott L , Jeyarajah C , Logarajah S , Webber A , Epstein D , Qureshi S , Penge J
Published: March 2021

During the initial phase of the response to COVID-19, concern was raised regarding a potential link with increased risk of stroke. We aimed to explore the incidence of stroke and thrombotic events within our local population with COVID-19 infection who required admission to the Intensive Care Unit (ICU).

Methods

Retrospective analysis of 57 consecutive patients with a diagnosis of COVID-19 infection admitted to Barnet General Hospital ICU between 6th March and 26th April 2020. Cases were reviewed to establish whether there had been imaging (CT or MRI) confirmed ischaemic stroke, intra-cerebral haemorrhage (ICH), venous sinus thrombosis (VST) or other thrombotic event, including pulmonary embolism (PE). Data was collected on baseline characteristics and blood tests including D-Dimer levels. Statistical analysis was performed using two-tailed t-test and Fischer’s exact test (FET). Findings: Nineteen patients (33%) were age 65 years or older (mean age 69, range 65 to 74 years) and of these 2 patients (10.5%) had imaging confirmed acute ischaemic stroke. In those under 65 (mean age 54, range 29–64 years) there was one confirmed ICH and one VST. The incidence of PE was 21% in both groups. Survival was significantly lower in the age 65 or older group (26.3% versus 63.2%, p = 0.0119 (FET)). Peak recorded D-Dimer levels also appeared to be significantly higher in the age 65 or older group (p = 0.0003, 95% CI 13068.89 to 39858.68).

Conclusions and limitations

These findings highlight the importance of awareness of risk of thrombotic events, including acute stroke, in older adults with severe Covid-19 infection. It is possible that the incidence of stroke was underestimated, including due to challenges identifying clinical signs of acute stroke and safely obtaining imaging in this population. Further, ideally prospective, studies are required to more clearly elucidate the degree of association between COVID-19 infection and stroke and VST.
135 A Quality Improvement Project Aimed to Reduce the Number of Patients on Bournville Ward Suffering with Constipation
Authors: Vasudev A , Mohamed I , Jacques H , Nicolson P
Published: March 2021

Introduction

Constipation is exceedingly common on geriatric wards, with 20–50% prevalence. It is associated with complications; including pain, delirium and obstruction. Laxatives, often considered the solution, introduce their own side effects and increase polypharmacy especially in elderly populations. Queen Elizabeth Hospital Birmingham guidelines advocate use of conservative measures, including adequate fluid and fibre intake and increasing exercise, to prevent and treat constipation prior to use of laxatives. However, we had observed that these methods were frequently underutilised, and cause of constipation was rarely considered. We aimed to reduce the prevalence of inpatient constipation and associated complications through the introduction of teaching sessions and multidisciplinary team (MDT) discussions, focusing on staff and patient education on the recognition and conservative managements of constipation.

Method

We audited notes weekly for the recognition of constipation, appropriate bowel examination, use of conservative management including patient education and any complications. Baseline data was collected from Bournville Ward over 4 weeks (n = 44), after which, teaching sessions for all regular ward staff and weekly MDT discussion for patients recognised as constipated were introduced. Patients having not opened bowels for >2 days were targeted for early simple non-laxative interventions. A further 4-week cycle of data was collected (n = 43).

Results

Constipation was recognised in 57% of patients studied, of which 64% developed constipation during inpatient stay and 20% experienced associated complications. The introduction of teaching session and MDT reviews increased patient education, cause recognition and non-laxative methods use by 19%, 27% and 30% respectively. Constipation developed during inpatient stay and associated complications decreased by 6% and 4% respectively.

Conclusion

Despite increased patient education, cause recognition and utilisation of conservative non-laxative approaches, only a small impact was made in reducing inpatient constipation prevalence and associated complications occurring.
136 Readmissions to Hospital Following A Decision to Eat and Drink with Acknowledged Risk with Support From the Forward Care Bundle
Authors: Soar N , Birns J , Sommerville P , Lang A , Fitzgerald A , Archer S
Published: March 2021

Introduction

The FORWARD care bundle (Feeding via the Oral Route With Acknowledged Risk of Deterioration) is used to support patients with dysphagia eating and drinking with acknowledged risk (EDAR) at our Trust. Key aims of FORWARD include improving advanced care planning (ACP) and avoiding unnecessary readmissions. This study aimed to determine the incidence of EDAR related readmissions (RR-EDAR) after FORWARD, and the effects of ACP and discharge location.

Methods

Retrospective review of all patients supported by FORWARD during admissions between January 2018 and December 2019. Data were collected on number and reasons for in-Trust hospital readmissions 6 months post-discharge, preferred place of care ACPs in event of EDAR related deterioration and discharge destination. Readmission reasons were classified as RR-EDAR (e.g. chest infection, reduced oral intake) and no relation to EDAR. Means (SD) and percentages are presented with comparisons using Fishers Exact Test.

Results

316 patients were included; mean (SD) age 81(12). 64% (n = 202) of patients were discharged alive, 36% (n = 114) were alive at 6 months. 38% of live discharges (n = 75) were readmitted and 52% (n = 39) of these patients were RR-EDAR. Mean (SD) RR-EDAR number was 11, and 18% (n = 7) of patients had RR-EDAR >1 (range 1–5). RR-EDAR was only 7% (n = 4) in patients wishing to remain at home vs 25% (n = 33) in those without a documented place of care (p < 0.01). RR-EDAR was 23% (n = 29) in patients discharged to a private home vs 10% (n = 6) discharged to nursing/care homes (p < 0.05).

Conclusions

The majority of FORWARD patients are not readmitted. RR-EDAR comprises half of all readmitted patients and some have multiple admissions. Fewer patients with ACPs were RR-EDAR suggesting these are effective. Most patients RR-EDAR were from private homes, suggesting residential care may provide more support. Further work includes increasing ACPs, supporting patients with multiple RR-EDAR and those discharged to private homes.
Abolition’s Afterlives
Authors: Insko Jeffrey , Stancliff Michael , DeLombard Jeannine Marie , James Joy , Fielder Brigitte , James Jennifer C , Goddu Teresa A
Published: March 2021

The positioning of movements for social and political change as forms of postemancipation abolition democracy has a long history. Abolition has been the watchword under which initiatives proceed to eradicate the death penalty, human trafficking, nuclear weapons, the hegemony of Wall Street, prisons, police, the deportation of immigrants, and more. The essays in this forum examine nineteenth-century abolitionism’s complicated legacy through the prism of contemporary frameworks and agitations for justice and social transformation. The working papers reflect vital ongoing debates about abolition’s afterlives while meditating upon a series of pressing current concerns: migrant justice, the humanitarian rhetoric of some anti-racist initiatives, the activism of Erica Garner following the murder by police of her father, the racialization of madness and violence, the prison-abolition movement, and climate activism. By addressing the mobilization of rhetorics of slavery and abolition in our own vexed political moment, the contributors reveal that to think abolition now is necessarily to rethink abolition then.
Thorne Lay: RAS Gold Medallist 2021
Authors: Johnson Paul , Lay Thorne
Published: March 2021

An influential leader in the seismological community, Lay was awarded this year's geophysics Gold Medal for his outstanding work in seismological analysis
GPDBN: deep bilinear network integrating both genomic data and pathological images for breast cancer prognosis prediction
Authors: Wang Zhiqin , Li Ruiqing , Wang Minghui , Li Ao
Published: March 2021

Motivation

Breast cancer is a very heterogeneous disease and there is an urgent need to design computational methods that can accurately predict the prognosis of breast cancer for appropriate therapeutic regime. Recently, deep learning-based methods have achieved great success in prognosis prediction, but many of them directly combine features from different modalities that may ignore the complex inter-modality relations. In addition, existing deep learning-based methods do not take intra-modality relations into consideration that are also beneficial to prognosis prediction. Therefore, it is of great importance to develop a deep learning-based method that can take advantage of the complementary information between intra-modality and inter-modality by integrating data from different modalities for more accurate prognosis prediction of breast cancer.

Results

We present a novel unified framework named genomic and pathological deep bilinear network (GPDBN) for prognosis prediction of breast cancer by effectively integrating both genomic data and pathological images. In GPDBN, an inter-modality bilinear feature encoding module is proposed to model complex inter-modality relations for fully exploiting intrinsic relationship of the features across different modalities. Meanwhile, intra-modality relations that are also beneficial to prognosis prediction, are captured by two intra-modality bilinear feature encoding modules. Moreover, to take advantage of the complementary information between inter-modality and intra-modality relations, GPDBN further combines the inter- and intra-modality bilinear features by using a multi-layer deep neural network for final prognosis prediction. Comprehensive experiment results demonstrate that the proposed GPDBN significantly improves the performance of breast cancer prognosis prediction and compares favorably with existing methods.

Availabilityand implementation

GPDBN is freely available at https://github.com/isfj/GPDBN.

Supplementary information

Supplementary data are available at Bioinformatics online.
Association of transport time with adverse outcome in paediatric trauma
Authors: Träff Helen , Hagander Lars , Salö Martin
Published: March 2021

Background

It is unclear how the length of prehospital transport time affects outcome in paediatric trauma. This study evaluated the association of transport time from alarm to arrival at hospital with adverse outcome in paediatric trauma patients in Sweden.

Methods

This was a retrospective study based on prospectively collected data from the Swedish trauma registry between 2012 and 2019 of children less than 18 years with major trauma (New Injury Severity Score (NISS) greater than 15). The primary outcome was 30-day mortality, and secondary outcomes were emergency interventions (e.g., chest tube or laparotomy) and low functional outcome (Glasgow Outcome Scale 2–3). Primary exposure was transport time from alarm to arrival at hospital. Co-variables in multivariable regressions were gender, age, ASA score before injury, injury intention, dominant injury type, NISS, Glasgow Coma Scale score, prehospital competence and hospital level.

Results

Among 597 patients, 30-day mortality was 9.8 per cent, emergency interventions were performed in 34.7 per cent and low functional outcome was registered in 15.9 per cent. Median transport time was 51 (i.q.r. 37–68) minutes. After adjustment for patient, injury and hospital characteristics, no association between longer transport time and 30-day mortality, frequency of emergency interventions or lower functional outcome could be found. Treatment at a university hospital was associated with a lower risk for 30-day mortality (odds ratio 0.23 (95 per cent c.i. 0.08 to 0.68), P = 0.008).

Conclusion

Longer transport time after major paediatric trauma was not associated with adverse outcome. Hence, it seems that longer transport distances should not be an obstacle against centralization of paediatric trauma care. Further studies should focus on the role of prehospital competence and other transport-associated parameters and their association with adverse outcome.
Linked Social–Communication Dimensions and Connectivity in Functional Brain Networks in Autism Spectrum Disorder
Authors: Xiao Jinming , Chen Huafu , Shan Xiaolong , He Changchun , Li Ya , Guo Xiaonan , Chen Heng , Liao Wei , Uddin Lucina Q , Duan Xujun
Published: March 2021

Much recent attention has been directed toward elucidating the structure of social interaction–communication dimensions and whether and how these symptom dimensions coalesce with each other in individuals with autism spectrum disorder (ASD). However, the underlying neurobiological basis of these symptom dimensions is unknown, especially the association of social interaction and communication dimensions with brain networks. Here, we proposed a method of whole-brain network-based regression to identify the functional networks linked to these symptom dimensions in a large sample of children with ASD. Connectome-based predictive modeling (CPM) was established to explore neurobiological evidence that supports the merging of communication and social interaction deficits into one symptom dimension (social/communication deficits). Results showed that the default mode network plays a core role in communication and social interaction dimensions. A primary sensory perceptual network mainly contributed to communication deficits, and high-level cognitive networks mainly contributed to social interaction deficits. CPM revealed that the functional networks associated with these symptom dimensions can predict the merged dimension of social/communication deficits. These findings delineate a link between brain functional networks and symptom dimensions for social interaction and communication and further provide neurobiological evidence supporting the merging of communication and social interaction deficits into one symptom dimension.
Stepwise regression of non-culprit lipid-rich plaque observed using serial near-infrared spectroscopy–intravascular ultrasound and optical coherence tomographic measurements after aggressive cholesterol-lowering treatment: a case report
Authors: Takahashi Norihito , Dohi Tomotaka , Endo Hirohisa , Okazaki Shinya
Published: March 2021

Background

Lipid-rich plaques (LRP) in the non-culprit lesions (NCL) in patients with the acute coronary syndrome may trigger lesion-related, adverse cardiovascular events. Aggressive lipid-lowering therapy may stabilize LRP; however, the times of stabilization remain undefined.

Case summary

A 60-year-old man presented with unstable angina. Coronary angiography revealed a severely stenotic lesion (culprit lesion) in the left descending artery, and another non-obstructive lesion in the distal left main trunk artery. Near-infrared spectroscopy (NIRS) imaging showed LRP with a maximum lipid core burden index (LCBI)4mm of 422. Optical coherence tomographic (OCT) imaging showed the vulnerable plaque as a thin cap fibroatheroma with a thickness of 50 µm. We prescribed aggressive lipid-lowering treatment with a proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor, and serially observed this lesion for 24 months. The NIRS imaging showed that the LCBI gradually decreased over time (max LCBI4mm of 422, 417, 318, 265, and 106 conducted at index percutaneous coronary intervention, 3, 8, 12, and 24 months, respectively). As plaque regression and stabilization of high-risk LRP were observed, we promptly discontinued treatment with the PCSK9i inhibitor.

Discussion

During the long-term, 24-month, follow-up using serial NIRS–IVUS imaging, we observed the gradual decrease in LCBI over time, due to aggressive lipid-lowering therapy. Compared with the lowering of low-density lipoprotein cholesterol, the stabilization of vulnerable plaques may require longer times of about 2 years. Evaluation of NCL-related adverse cardiac events by serial intravascular imaging over time, using NIRS–IVUS or OCT, may be warranted in such cases.
Dynamics of transposable elements in recently diverged fungal pathogens: lineage-specific transposable element content and efficiency of genome defenses
Authors: Lorrain Cécile , Feurtey Alice , Möller Mareike , Haueisen Janine , Stukenbrock Eva
Published: March 2021

Transposable elements (TEs) impact genome plasticity, architecture, and evolution in fungal plant pathogens. The wide range of TE content observed in fungal genomes reflects diverse efficacy of host-genome defense mechanisms that can counter-balance TE expansion and spread. Closely related species can harbor drastically different TE repertoires. The evolution of fungal effectors, which are crucial determinants of pathogenicity, has been linked to the activity of TEs in pathogen genomes. Here, we describe how TEs have shaped genome evolution of the fungal wheat pathogen Zymoseptoria tritici and four closely related species. We compared de novo TE annotations and repeat-induced point mutation signatures in 26 genomes from the Zymoseptoria species-complex. Then, we assessed the relative insertion ages of TEs using a comparative genomics approach. Finally, we explored the impact of TE insertions on genome architecture and plasticity. The 26 genomes of Zymoseptoria species reflect different TE dynamics with a majority of recent insertions. TEs associate with accessory genome compartments, with chromosomal rearrangements, with gene presence/absence variation, and with effectors in all Zymoseptoria species. We find that the extent of RIP-like signatures varies among Z. tritici genomes compared to genomes of the sister species. The detection of a reduction of RIP-like signatures and TE recent insertions in Z. tritici reflects ongoing but still moderate TE mobility.
Global mantle flow retrodictions for the early Cenozoic using an adjoint method: evolving dynamic topographies, deep mantle structures, flow trajectories and sublithospheric stresses
Authors: Ghelichkhan S , Bunge H-P , Oeser J
Published: March 2021

During the Cenozoic, the Earth experienced multiple first-order geological events that are likely mantle flow related. These include the termination of large-scale marine inundation in North America in the Palaeocene, the late Tertiary rise of Africa relative to other continents and the long-wavelength tilting of Australia since the late Cretaceous, which occurred when the continent approached the southeast Asia subduction systems on its northward passage from Antartica. Here we explore a suite of eight high-resolution, compressible, global mantle flow retrodictions going back to 50 Ma, using an adoint method with $\approx$670 million finite elements. These retrodictions show for the first time that these events emerge jointly as part of global Cenozoic mantle flow histories. Our retrodictions involve the dynamic effects from an upper mantle low-viscosity zone, assimilate a past plate-motion model for the tangential surface velocity field, probe the influence of two different present-day mantle state estimates derived from seismic tomography, and acknowledge the rheological uncertainties of dynamic Earth models by taking in four different realizations for the radial mantle viscosity profile, two of which were published previously. We find the retrodicted mantle flow histories are sensitive to the present-day mantle state estimate and the rheological properties of the Earth model, meaning that this input information is testable with inferences gleaned from the geological record. For a deep mantle viscosity of $1.7\times 10^{22}$ Pa s and a purely thermal interpretation of seismic structure, lower mantle flow velocities exceed 7 cm yr–1 in some regions, meaning they are difficult to reconcile with the existence of a hotspot reference frame. Conversely, a deep mantle viscosity of $10^{23}$ Pa s yields modest flow velocities (< 3 cm yr–1 ) and stability of deep mantle heterogeneity for much of the retrodiction time, albeit at the expense that African uplift is delayed into the latest Neogene. Retrodictions allow one to track material back in time from any given sampling location, making them potentially useful, for example, to geochemical studies. Our results call for improved estimates on non-isostatic vertical motion of the Earth’s surface—provided, for instance, by basin analysis, seismic stratigraphy, landform studies, thermochronological data or the sedimentation record—to constrain the recent mantle flow history and suggest that mantle flow retrodictions may yield synergies across different Earth science disciplines.
VII. Character in general
Authors: Munday Roderick
Published: March 2021

This chapter examines the evidence of the character of parties, witnesses, and third parties. Evidence of character has never been a model of coherence or clarity either at common law or under statute. It is complex, both in the connotation and means of proof of the concept of character, and in the variety of contexts in which it arises. The concept embraces both disposition, commonly described as propensity, to act in a relevant way, and sometimes the means of proof of such relevant disposition, either through reputation, the expressed belief of others of the subject's disposition, or of acts of the subject from which such disposition may be inferred. It may be relevant in any form of proceedings, and at any stage of a trial.
XIII. Hearsay in civil proceedings
Authors: Munday Roderick
Published: March 2021

This chapter discusses the hearsay rule in the context of civil proceedings. It begins with a consideration of Section 1 of the Civil Evidence Act 1995 (CEA). Doubts have been raised as to whether the Act is compatible with the ECHR, and on any basis, there are procedural differences between the methods of adducing different forms of hearsay under the provisions of the act. Consideration of the effect of the act in changing the law thus constitutes the first, and more important, section of this chapter. The chapter then turns to how the provisions of the act indicate that some of the existing rules relating to the admissibility of hearsay in civil proceedings remain in force.
XIV. Hearsay in criminal proceedings
Authors: Munday Roderick
Published: March 2021

This chapter considers hearsay in light of the Criminal Justice Act 2003. It first discusses the relevant provisions of the act before turning to the rules relating to confessions. Along with confessions, the chapter also takes a look at the evidential value of inferences from the accused's silence. In relation to both, the chapter considers the Codes of Practice relating to different aspects of police investigation, which often form a component in the exercise of the judge's discretion to exclude evidence. In addition, the chapter examines the reforms made to the law of hearsay, including the basic policy of the reform, the general exception, special exceptions for business documents and previous statements of witnesses, the impact of discretion, and provisions relating to the authenticity and weight of hearsay.
XVI. Proof of frequently recurring matters
Authors: Munday Roderick
Published: March 2021

This chapter describes different ways in which evidence may be given of certain matters that frequently have to be proved in litigation. Proof of foreign law, identity, birth, death, age, marriage and legitimacy, judgments, convictions, and other orders of the court are discussed here. With foreign law, the general rule is that it must be proved by an expert witness. For questions of identification, the question of evidence becomes more complicated, with the chapter exploring direct, circumstantial, and presumptive evidence in relation to identity. After a brief look into birth, death, age, marriage, and legitimacy, the chapter finally turns to the proof of judgments and convictions.
Differences in prevalence of multiple paternity in the spiny spider crabMaja brachydactylain two localities that differ in female fecundity, fishing intensity, and management measures
Authors: Rodríguez-Pena E , Verísimo P , Tully O , Fernández L , Martínez-Lage A
Published: March 2021

Many marine species are under high fishing pressure, which can cause alterations in their mating systems and the structure of their populations. The spiny spider crab Maja brachydactyla is a commercial decapod on the east Atlantic coast. In Galicia, the most exploited region in Spain, the landing of ovigerous females is prohibited, favouring exploitation focused on males. The removal of males, especially the largest ones, may lead to sperm limitation and a reduction in the average size over generations. In these cases, polyandry can work as a mechanism to protect females against sperm limitation and to increase genetic diversity and effective population size. This study analyses the multiple paternity in M. brachydactyla in two localities that differ in female fecundity, fishing intensity, and management measures. Our results showed multiple paternity in this species for the first time, with a moderate bias between sires. However, the frequency of multiple paternity was almost seven times higher in the intensely exploited Golfo Ártabro (NW Spain; 69%) than in Carna (W Ireland; 10%), where exploitation levels and female fecundity are lower.
Implementing an emergency department pharmacy service and its effect on medication safety
Authors: Sinopoulou Vassiliki , Rutter Paul , Price Gareth , Heald Victoria , Kaba Suhail , Kwok Jon
Published: March 2021

Objectives

This service innovation project examined the effect an Emergency Department (ED) pharmacy service had on medication-related safety markers.

Methods

A pre-test/post-test design captured medication-related safety markers on admission data at ward level after patients had been seen in the ED. The markers were, medication omitted, incorrect medicines prescribed and the number of incorrect doses or frequency of doses.

Key findings

All three safety markers saw reductions. Mean (SD) medications omitted were reduced from 2.19 (±3.01) to 0.48 (±1.3), incorrect medication from 0.35 (±1.11) to 0.08 (±0.36) and the number of incorrect doses or frequency of doses from 0.38 (±0.69) to 0.13 (±0.38) per patient. All differences were statistically significant (P = 0.00).

Conclusions

The service reduced medication error and the findings allowed a permanent pharmacy service to be introduced.
Utilizing a health information exchange to facilitate COVID-19 VA primary care follow-up for Veterans diagnosed in the community
Authors: Sherman Rachel L , Judon Kimberly M , Koufacos Nicholas S , Guerrero Aquino Vivian M , Raphael Shaniqua M , Hollander Judith T , Boockvar Kenneth S
Published: March 2021

The use of alerts from the Bronx RHIO, a health information exchange (HIE) to identify James J. Peters VAMC patients diagnosed with COVID-19 in the community was described to facilitate COVID-19 VA primary care follow-up. COVID-19 hospitalization and testing alerts were delivered on a Bronx RHIO facility report. VA COVID-19 follow-up care by telephone and video was guided by local COVID-19 clinical pathways, electronic health record (EHR) templates, and tracking through a database. VA received 180 RHIO alerts for 111 unique patients, and 88 had positive non-VA testing from March to June 2020. 41% of the 88 had non-VA admissions and 23% died. 63% received VA primary care follow-up of COVID-19 symptoms documented by custom EHR templates. The HIE identified 11% of the facility COVID-19 patients. HIE alerts can be used to identify facility COVID-19 patients diagnosed in the community and facilitate follow-up by their VA primary care teams.
PhageDx™ E. coli O157:H7 Assay in Ground Beef Level 3 Modification to Add 375 g Beef Trim and New Method Procedure for 25 g Ground Beef: AOAC Performance Tested MethodSM 081601
Authors: Erickson Stephen , Gil Jose , Nguyen Minh
Published: March 2021

Background

ThePhageDx™ E. coli O157:H7 Assay originally required a 5 h enrichment period and a 10 mL test sample for 25 g ground beef. The proposed method modifications seek to include beef trim (375 g) matrix and a new method procedure for 25 g ground beef comprised of 6–7 h enrichment and 1 mL test sample.

Objective

To validate the method modifications for PhageDx E. coli O157:H7 Assay to include beef trim (375 g) matrix and modify enrichment time and test sample size for 25 g ground beef.

Method

For both matrixes, pre-warmed tryptic soya broth (TSB; 42 ± 1°C) was added in a 3:1 (media:sample size) ratio, blended, and enriched for 9–10 h (beef trim, 375 g) or 6 h (ground beef, 25 g) at 42 ± 1°C. One milliliter samples were transferred to a microfuge tube, centrifuged, and the supernatant removed. The pellet was resuspended in 0.2 mL of TSB and phage reagent was added. Samples were incubated for 2 h at 37 ± 1°C. After infection, the sample was centrifuged, and 150 µl of the supernatant was transferred to a 96-well plate. Then, lysis buffer and luciferase substrate were added and the sample read on a luminometer to determine the presence or absence of E. coli O157:H7.

Results

No significant differences were found between the PhageDx E. coli O157:H7 Assay method modifications and the U.S. Department of Agriculture Food Safety and Inspection Service (FSIS) Microbiology Laboratory Guidebook (MLG) reference method.

Conclusions

The independent study demonstrated that the PhageDx E. coli O157:H7 Assay method modifications meet the qualifications for Performance Tested Method SM status.

Highlights

The PhageDx E. coli O157:H7 Assay is a rapid detection method capable of detecting E. coli O157:H7 in 25 g ground beef and 375 g beef trim samples in as little as 8.5 h and 11.5 h total turn around time, respectively.
Neurofibroma in the Breast: Diagnosis and Management Considerations
Authors: Yin Chen , Porembka Jessica H , Hwang Helena , Hayes Jody C
Published: March 2021

Neurofibroma (NF) of the breast is an uncommon benign entity that occurs sporadically or in association with neurofibromatosis type 1 (NF1). Sporadic NF of the breast is very rare and can present at any age. Neurofibroma of the breast associated with NF1 is more common. Neurofibroma commonly presents as oval, circumscribed masses that overlap with many benign entities. The histopathologic diagnosis of NF of the breast can present a management dilemma for the breast radiologist. An NF that is not associated with NF1 has good post-resection prognosis if superficial, sporadic, and solitary. However, NF of the breast diagnosed in an otherwise healthy patient should prompt evaluation for NF1 and formal genetic risk assessment. Patients diagnosed with NF1 have a higher lifetime risk for developing breast cancer and therefore may benefit from both initiating screening mammography at a younger age and supplemental screening MRI.
Predictors of Malignancy in Patients With Indeterminate Biliary Strictures and Atypical Biliary Cytology: Results From Retrospective Cohort Study
Authors: Alali Ali , Moris Maria , Martel Myriam , Streutker Catherine , Cirocco Maria , Mosko Jeffrey , Kortan Paul , Barkun Alan , May Gary R
Published: March 2021

Background

Atypical cellular features are commonly encountered in patients with indeterminate biliary strictures, which are nondiagnostic of malignancy yet cannot rule it out. This study aims to identify clinical features that could discriminate patients with indeterminate biliary strictures and atypical biliary cytology who may harbor underlying malignancy.

Methods

All patients with an indeterminate biliary stricture and an atypical brush cytology obtained during endoscopic brushings were identified in a large tertiary-care center. Demographical information, clinical data and the final pathological diagnosis were collected. The study cohort was divided based on the final diagnosis into benign and malignant groups. Descriptive and multivariable analyses were performed.

Results

A total of 151 patients were included in the analysis. Of these, 62.9% were males with mean age of 61.7 ± 16.4 years. Overall, there was an almost equal distribution of patients in the benign and malignant groups. Older age (≥65 years), jaundice, weight loss, intrahepatic biliary and pancreatic duct dilation, double-duct sign and presence of a mass were associated with malignancy in the univariate analysis. However, only older age (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.00 to 1.03), jaundice (OR 3.33, 95% CI 1.11 to 9.98) and presence of a mass (OR 12.10, 95% CI 4.94 to 29.67) were significantly associated with malignancy in the multivariate analysis. High CA19-9 was associated with malignancy only in patients with primary sclerosing cholangitis.

Conclusion

In patients with indeterminate biliary stricture and atypical brush cytology, older age, jaundice and presence of a mass are significant predictors of malignancy. Patients with such characteristics need prompt evaluation to rule out underlying malignancy.
Negative Rapid Serological Tests in an HIV-Infected Infant: A Call for Improved Inpatient Provider-Initiated Testing and Counseling Beginning With Breastfeeding Mothers
Authors: Lisboa Anselmo , Thorp Marguerite , Lambo Luisa , Chaúque Sílvia , Elias Beatriz , Domingos Celina , Macassa Eugénia , Buck W Chris
Published: March 2021

Rapid serological tests are unreliable for the diagnosis of HIV exposure and infection in infants. This case reports an HIV-infected infant with a delayed diagnosis due to multiple negative serological tests, highlighting the importance of maternal testing for provider-initiated testing and counseling in hospitalized infants.
Arguing with Digital History: Patterns of Historical Interpretation
Authors: Robertson Stephen , Mullen Lincoln
Published: March 2021

Digital history has only rarely created interpretative or argumentative scholarship that contributes back to disciplinary understandings of the past. The reasons for this are varied: digital historians have often preferred to create scholarship for public audiences, or they have pursued forms of scholarship which do not lend themselves to explicit interpretation. But we contend that digital historians have not had sufficient models of patterns of historical argumentation compatible with digital historical research. In this introduction, we read the articles by Rachel Midura and Leonardo Barleta that appear in this special section, and a series of other articles, in order to show the patterns of historical argumentation that digital historians can pursue. A companion website features versions of the articles by Midura and Barleta, as well as eight additional previously published articles, annotated by their authors to highlight how they developed their historical arguments so they can serve as models for argumentative digital history.
Questionnaire Complexity, Rest Period, and Response Likelihood in Establishment Surveys
Authors: Rodhouse Joseph , Wilson Tyler , Ridolfo Heather
Published: March 2021

Response burden has been a concern in survey research for some time. One area of concern is the negative impact that response burden can have on response rates. In an effort to mitigate negative impacts on response rates, survey research organizations try to minimize the burden respondents are exposed to and maximize the likelihood of response. Many organizations also try to be mindful of the role burden may play in respondents’ likelihood to participate in future surveys by implementing rest periods or survey holidays. Recently, new evidence from a study of cross-sectional household surveys provided an interesting lens to examine burden. The evidence demonstrated that those sampled in two independent surveys are more likely to respond to the second survey if the first survey was more difficult to complete, and that this effect was not significantly influenced by the rest period in between the two surveys. These findings are compelling, and since the mechanisms influencing response in household and establishment surveys differ in important ways, a similar examination in an establishment survey context is warranted. To accomplish this, data are used from the National Agricultural Statistics Service. Overall, our research finds that prior survey features such as questionnaire complexity (or burden), prior response disposition and rest period are significantly associated with response to subsequent surveys. We also find that sample units first receiving a more complex questionnaire have significantly higher probabilities of response to a subsequent survey than do those receiving a simpler questionnaire first. The findings in this paper have implications for nonresponse adjustments and identification of subgroups for adaptive design data collection.
Stat Laboratory Interventions to Improve Patient Management in the Emergency Department and Resource Expenditure: A 10-Year Study
Authors: Salinas Maria , Flores Emilio , López Garrigós Maite , Blasco Alvaro , Diaz Elena , Leiva-Salinas Carlos
Published: March 2021

Objective

To illustrate the changes in stat laboratory procedures over a 10 year period.

Materials and Methods

We implemented 5 different interventions: reporting total bilirubin through the icteric index, replacing total proteins for albumin, reporting albumin-adjusted calcium in hyper- or hypocalcemia, using lipase as a first marker and amylase-selected scenario, and measuring magnesium in hypocalcemia, hypokalemia, or high lipase values.

Results

Only 9.9% of total bilirubin that was requested was measured, which resulted in savings of $22,492.83. There were 30,036 albumin tests measured, and $15,625.18 was saved replacing total protein. There was $41,374.38 spent to measure lipase and amylase; the difference in costs from the lipase establishment was $16,929.62. Finally, $382.30 was spent for magnesium: 717 magnesium levels were measured given hypocalcemia or hypokalemia (42.8% hypomagnesemia), and 123 tests were added because of high lipase (35% hypomagnesemia). Overall, $53,374.15 was saved.

Conclusion

Progressive changes in stat laboratory procedures resulted in more efficient resources expenditures.
Q/F: The Texts of King Lear
Authors: Salkeld Duncan
Published: March 2021

This article argues that dictation in the printing house may account for many of the variants between the 1608 Quarto and the 1623 Folio texts of King Lear. It further argues that the ground-work for this view was established by a series of prior critical studies—including those by Chambers, Greg, Duthie, Walker, and Stone—which shared a belief that the quarto was a reported text. It also proposes that a manuscript very much like F, but without its theatrical cuts, lies behind the Quarto. A long-standing assumption that the Folio version is somehow derived from the Quarto is shown to be unsafe. The implications of this argument are that Shakespeare did not revise King Lear, and that relatively few of the variants in the Quarto can be authorial.
The Library of James Marsh, DD (1593-?1645), with ‘Shackspeers playes’ and ‘Donnes Poem’
Authors: Higgins Ben
Published: March 2021

This essay provides a case study of an otherwise-unknown clerical library from the 1640s that includes a copy of a Shakespeare folio alongside a few other literary works, including John Donne's Poems (1633). The essay offers a biography of the library's owner, a sketch of the library as a whole, and concludes by considering the unusual status of the Shakespeare folio in this collection. An appendix transcribes the inventory in which the library is catalogued. In this collection of around 200 books, the Shakespeare folio was the sole book of drama (either vernacular or classical). James Marsh is thus an outlier in what we know about early folio-ownership and the discovery of his library expands our understanding of the contexts in which Shakespeare was owned and read.
Sylvanus Morgan’s Library: Books for an Aspirational Heraldic Painter
Authors: Hughes Frances Rothwell
Published: March 2021

This article analyses an unpublished manuscript in Cambridge University Library belonging to the arms-painter and author Sylvanus Morgan (1620–1693), which contains two iterations of a library list, one beginning in 1646 and the other in 1653. The notebook also features drafts for Morgan's subsequent publications, indicating the intersection between his reading and writing habits. His library is usually only discussed in relation to that of Robert Boyle, because the remains of both men's libraries were inextricably muddled together in a joint book auction after Morgan's death. Here, the Painter-Stainer's book collection is considered in its own right, showing his (unsuccessful) attempts to elevate the status of heraldic knowledge through reference to contemporary colour theory, astronomy and philosophy. An annotated transcription of Morgan's 1653 list of printed books is included in an appendix.