bluuebunny/crossref_metadata_2025 huggingface dataset:
825 DEVELOPMENT OF THE ANTICHOLINERGIC MEDICATION INDEX (ACMI)
Authors: Best K , Alderson S , Alldred D , Bonnet L , Buchan I , Butters O , Farrin A , Foy R , Johnson O , McInerney C , Mehdizadeh D , Lawton T , Lawton R , Rodgers S , Teale E , Walker L , West R , Young B , Pirmohamed M , Clegg A
Published: March 2022

Introduction

Medications with Anticholinergic (AC) properties, are prescribed to treat a range of conditions. Older people are increasingly likely to be prescribed multiple AC medications, but are also more likely to experience unwanted adverse effects, such as falls and delirium. The risks of adverse outcomes increase with the number and potency of AC medications prescribed. The aim of this study was to use a prognostic modelling approach to develop an AC Medication Index (ACMI) that identifies patients at high risk of AC medication side effects.

Methods

The prognostic model was developed using data on patients aged 65–95 years, registered with a general practice contributing data to ‘Connected Bradford’ in 2019. A Time-dependent Cox model was fitted, with hospital admission for delirium or falls as the composite outcome and AC medications, age, sex and important clinical factors (e.g. dementia, arthritis, urinary incontinence) as predictors. Concordance and Negalkerke’s R2 derived from five-fold cross-validation were used to assess model performance.

Results

There were 151,604 patients included in the study, of whom 47,035 (31.0%) were prescribed ≥1 AC medication during 2019. Codeine, Prednisolone, Furosemide and Amitriptyline were most commonly prescribed with 7.4%, 4.0%, 3.8% and 3.1% of patients prescribed these medications at least once in 2019, respectively. During 2019, 6,078 (4.0%) patients experienced a hospital admission with delirium or a fall, with the rate being increased in those prescribed ≥1 AC medication during 2019 (4.8% vs 3.7%; p < 0.001). The prognostic model yielded a discrimination statistic of 0.86 with an R2 of 0.1.

Conclusion

The model used to develop the ACMI shows good discrimination. External validation will soon be performed using data from the SAIL databank and the ACMI will be further developed as a tool for use in primary care.
658 THE RISK OF ANTICOAGULATION IN ELDERLY FALLERS WITH ATRIAL FIBRILLATION: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Sarathy P P , Cruces F
Published: March 2022

Introduction

Anticoagulation of elderly patients with Atrial Fibrillation (AF) and falls remains a domain of contention amongst clinicians. There is limited evidence to guide long-term anticoagulation decision in such patients. We performed a systematic-review and meta-analysis to guide anticoagulation decision.

Methods

We conducted a prospectively registered systematic-review and meta-analysis (PROSPERO: CRD42021228661). Studies investigating patients >65 years of age anticoagulated for AF at risk of falls were included. Outcomes included were stroke/systemic embolism (SSE), CNS bleeds, major non-CNS bleeds, and mortality. CENTRAL, MEDLINE, PsycINFO, CINAHL, DARE, Web of science and Scopus were searched. Two authors performed paper inclusion/exclusion, data extraction, risk of bias and GRADE assessment. Data was pooled quantitatively using random-effects models and expressed as Odds Ratio (OR) and 95% Confidence Intervals (95%CI).

Results

Nine studies were included and five were combined quantitatively. Studies had low to moderate risk of bias. Anticoagulated fallers were at higher risk of SSE (OR = 1.73, 95%CI:1.21–2.47, p = 0.003), CNS bleeds (OR = 1.67, 95%CI:1.25–2.23, p < 0.001), major bleeds (OR = 1.87, 95%CI:1.66–2.11, p < 0.001) and mortality (OR = 1.96, 95%CI:1.71–2.25, p < 0.001) compared to anticoagulated non-fallers. Anticoagulated fallers were at higher risk of major bleeds compared to fallers not on anticoagulation (OR = 1.69, 95%CI:1.03–2.77, p = 0.04). However, there was no statistically significant difference in SSE, CNS bleeds or mortality. In fallers, Direct Oral Anticoagulants (DOACs) have lower risk of CNS bleeds (OR = 0.19, 95%CI:0.09–0.041, p < 0.001) and major bleeds (OR = 0.78, 95%CI:0.60–1.01, p = 0.06) compared to warfarin. There was no statistically significant difference in SSE or mortality between the anticoagulants.

Conclusion: (s)

Falling on anticoagulation is associated with increased risk of complications. However, only risk of major non-CNS bleeds increases when anticoagulating fallers. In fallers, DOACs appear safer than warfarin for bleeding complications. There remains paucity of evidence about anticoagulation in fallers (GRADE certainty = very low—moderate). Further evidence is needed to help clinicians and patients regarding anticoagulation.
676 OPTIMISING ENGAGEMENT OF OLDER ADULTS IN AN ONLINE PHYSICAL ACTIVITY PROGRAMME TO IMPROVE COGNITION: A QUALITATIVE STUDY
Authors: Ritchie S , Lawrence V , Jones J , Corbett A
Published: March 2022

Introduction

Maintaining physical activity is a modifiable risk factor for cognitive impairment. However, despite numerous public health interventions, older adults do not routinely meet activity guidelines. Online interventions offer an alternative means of engaging with this group. The role of an online intervention holds particular value in the context of a global pandemic where people have become accustomed to digital living. Furthermore, such an intervention negates barriers frequently faced by older adults in attending face to face interventions, whilst providing an economically viable option. This study explored the factors which maximise engagement in an online programme to promote physical activity.

Methods

A qualitative study was conducted with adults aged 50 and over. Individual were recruited through the online UK PROTECT study cohort. Four focus groups (n = 21) examined key contributors to engagement with a digital programme to promote physical activity. Iterative Categorization was utilised to identify categories and themes of the focus group data. Semi-structured interviews were subsequently conducted (n = 5) whereby participants were asked to comment on a concept-stage online intervention.

Results

Four major themes emerged from the focus group data: interaction at the fore, incentives as foundations, fitting around me and identity is critical. The semi-structured interviews identified further key areas of programme acceptability and specific needs for enhancing engagement.

Conclusions

Older adults are open to using digital physical activity programmes, with the recent COVID-19 pandemic driving an appetite for online delivery. Any intervention must be tailored to individual usability preferences and take account of the fitness, health and lifestyle needs specific to older adults. Furthermore, the conceptual-stage intervention used in this study was found to be acceptable, with key changes needed to maximise engagement.
684 LONG-TERM CONDITIONS, MULTIMORBIDITY, LIFESTYLE FACTORS AND GRIP STRENGTH CHANGE OVER 9 YEARS IN 44,315 UK BIOBANK PARTICIPANTS
Authors: Hurst C , Murray J C , Granic A , Hillman S J , Cooper R , Sayer A A , Robinson S M , Dodds R M
Published: March 2022

Introduction

Weak grip strength is associated with a range of adverse health outcomes, and an accelerated decline in grip strength confers an even greater risk. To date there has been limited research into the factors associated with change in grip strength in mid-life. Using data from UK Biobank our aim was to investigate the associations of long-term conditions (LTCs), multimorbidity and lifestyle factors with patterns of change in grip strength.

Methods

We used data from 44,315 UK Biobank participants with grip strength measured at baseline (2006–10) and a subsequent study visit around nine years later. At baseline, participants’ LTCs were self-reported and categorised against a hierarchy. Multimorbidity was characterised by the number of LTC categories present (0, 1, 2 and 3+). Lifestyle factors (body mass index (BMI), smoking, diet and physical activity) were also assessed. Change in grip strength was grouped into four patterns: decline, stable low, stable high or reference (no change or increase) and used as the outcome in multinomial logistic regression models.

Results

Most LTC categories were associated with adverse patterns of change in grip strength (stable low and/or decline): for example, musculoskeletal/trauma conditions were associated with an increased risk of the stable low pattern (Relative Risk Ratio [RRR] = 1.63; 95% Confidence Interval [CI] 1.49–1.79). Multimorbidity and lifestyle factors had independent associations with grip strength change: those with 3+ categories of LTCs were more likely to experience decline in grip strength (RRR = 1.18;95% CI 1.08–1.28) compared to those with no LTCs. Low physical activity was associated with adverse patterns of grip strength, while raised BMI had divergent associations (both the decline and stable high patterns of grip strength change).

Conclusion

Individuals living with multimorbidity and those with lifestyle risk factors such as low physical activity are at increased risk of loss of strength over time.
799 FRAILTY MATTERS PROJECT
Authors: Duffy F J R , Papadopolou C , Barrie J , Hendry A , Andrew M , Martin J
Published: March 2022

Introduction

Preventing and managing frailty is a new area for many community practitioners yet frailty specific education remains limited. We aimed to understand and strengthen the capability of District Nurses (DNs) in leading personalised care for older people with frailty.

Methods

We conducted a participatory action research (PAR) study with DNs in one Scottish NHS Board area. Phase 1 involved three focus groups (n = 17); one one-to-one interviews; and collection of baseline team dynamics questionnaires (n = 10). Evidence from phase 1 informed co-design of an educational framework, delivered in Phase 2 as a combined coaching and educational programme through small group learning, web based coaching and bite sized online education. Interactive sessions were supported by a person-centred coach and 2 older citizen ‘co-coaches’ to bring the experience of people affected by frailty. In Phase 3 we analysed participant feedback and assessed transferability to other disciplines and to health and care settings across the UK.

Results

At baseline, DNs did not perceive frailty as a long term condition. They identified a need for help to understand the concept of frailty and to build skills and confidence in delivering community interventions. Participants embraced the coaching and educational intervention and valued the opportunity for dialogue with peers and citizen co-coaches about what really matters to patients, families and professionals. Our survey of other disciplines and teams highlighted this educational programme is both relevant and transferable.

Conclusion

Through co-design we developed a contextually sensitive programme that makes sense of frailty in the reality of both community professionals and people living with frailty. Combining technical knowledge and relational skills-building with peer support and coaching helps prepare DNs to lead interprofessional teams caring for people living with frailty. The educational framework and combined coaching and educational package are highly applicable to interdisciplinary teams in other community settings.
660 PHYSIOTHERAPISTS PERCEPTIONS OF MECHANISMS FOR OBSERVED VARIATION IN PRACTICE DURING EARLY POSTOPERATIVE PHASE AFTER HIP FRACTURE
Authors: Volkmer B , Sadler E , Lambe K , Martin F C , Ayis S , Beaupre L , Cameron I D , Gregson C L , Johansen A , Kristensen M T , Magaziner J , Sackley C , Smith T O , Sobolev B
Published: March 2022

Objective

To explore physiotherapists’ perceptions of mechanisms to explain observed variation in early postoperative practice after hip fracture surgery demonstrated in a national audit.

Methods

A qualitative semi-structured interview study of 21 physiotherapists working on orthopaedic wards at 7 hospitals with different durations of physiotherapy during a recent audit. Thematic analysis of interviews drawing on Normalisation Process Theory to aid interpretation of findings.

Results

Four themes were identified: achieving protocolised and personalised care; patient and carer engagement; multidisciplinary team engagement across the care continuum; and strategies for service improvement. Most expressed variation from protocol was legitimate when driven by what is deemed clinically appropriate for a given patient. This tailored approach was deemed essential to optimise patient and carer engagement. Participants reported inconsistent degrees of engagement from the multidisciplinary team attributing this to competing workload priorities, interpreting ‘postoperative physiotherapy’ as a single professional activity rather than a care delivery approach, plus lack of integration between hospital and community care. All participants recognised changes needed at both structural and process levels to improve their services.

Conclusion

Physiotherapists highlighted an inherent conflict between their intention to deliver protocolised care while allowing for an individual patient-tailored approach. This conflict has implications for how audit results should be interpreted, how future clinical guidelines are written, and how physiotherapists are trained. Physiotherapists also described additional factors explaining variation in practice which may be addressed through increased engagement of the multidisciplinary team and resources for additional staffing and advanced clinical roles.
670 FACTORS ASSOCIATED WITH MORTALITY IN MULTI-ETHNIC HOSPITALISED COVID PATIENTS
Authors: Omotade I , Bennett M , Chitson S , Asiedu F , Harrington B , Patel M
Published: March 2022

Introduction

Whilst most patients during the COVID pandemic made an uneventful recovery, there was a significant minority in whom the disease was severe and unfortunately fatal. This survey aims to evaluate independent risk factors for those who died of COVID compared to survivors and to identify any markers for improvement in future management.

Methods

Medical records of all COVID patients admitted to two multi-ethnic, inner city acute district general hospitals over a 6-week period in 2020 were examined. Data collected included demographic details, medical comorbidities, and type of ward where they received care. Multivariable analysis using stepwise backward logistic regression was conducted to examine independent risk factors for those who died from COVID compared to survivors.

Results

Of 951 patients admitted with COVID, 284 died[30%]. Compared to survivors(n = 667), univariate analyses revealed COVID deaths were associated with increasing age[mean(CI): 79.3(77.9–80.7)vs64.7(63.4–66.0);P < 0.001], Black African [16.2%vs11.7%;p < 0.001] & South-Asian [12%vs9.1%;p < 0.001] ethnicity, Hypertension [64.4%vs49.5%;p < 0.001], Chronic Heart Disease(CHD)[40.1%vs20.7%;p < 0.001], Chronic Respiratory Disease [17.6%vs12.0%;p = 0.02] Chronic Kidney Disease [18%vs11.1%;p = 0.004], Chronic Neurological Disease 43.3%vs23.7%;p < 0.001]. Gender, Diabetes, asthma, obesity, Chronic Liver Disease and immunosuppression (disease or treatment related) were not associated with increasing mortality. Death rates between those in general wards vs intensive care were comparable[4.7%vs2.5%;p = 0.1]. Multivariable analyses showed age 60–70 [OR 2.3], age > 70 [OR 6.5], Black Caribbean [OR 1.6], and CHD [1.5] were independent risk factors for COVID deaths.

Discussion

This large multi-ethnic study showed that age > 60, Black Caribbean, and chronic heart disease were independent risk factors for COVID deaths. This study provides valuable information on independent prognostic implications for COVID, which can be used in future interventional studies aiming to improve COVID outcomes or in audits of clinical practice.
671 DEMOGRAPHIC VARIABILITY IN MORTALITY FROM COVID DURING THE TWO SURGES
Authors: Patel M , Umasankar U , Aitken E
Published: March 2022

Introduction

COVID-19 resulted in significant mortality over the last several months. This survey aims to evaluate demographic differences between those hospitalised patients who died of COVID during the first surge [until 31/08/2020] and those who died during the second [01/09/2020–15/03/2021].

Methods

Data was obtained for all patients admitted with COVID during the two pandemic surges at two multi-ethnic,inner-city district general hospitals. Univariate and multivariable analyses [stepwise backward logistic regression] were conducted to evaluate mortality as per patient demographics, length of stay, and whether patients had been managed in critical care.

Results

1013 [21.5%] of 4,707 patients died during this period. Mortality was significantly lower during the second wave,compared to first i.e. 18.5% [632/2784]vs29.5% [381/901];39% reduction [P < 0.001]. This reduction was observed across all ages, gender, ethnic subgroups, and both sites. Advancing age was associated with significant mortality at all times with no differences between the two waves. 77% of all deaths occurred in patient>70. There were fewer deaths among those<50 during the second wave compared to first [7vs12]. Reduction in mortality during second wave was noted across all ethnic sub-groups. However,significantly greater reduction was observed in Black African [54.6%],South-Asian [47.3%],Black Caribbean [44.4%],and East-Asian [44.2%] groups, compared to white subgroup [34.2%]. Majority of patients who died were managed on general medical wards during both waves [n = 824,81.3%]. For patients who spent time in critical care, there were no significant differences in mortality [30.6vs33.7%,p = ns]. There were no differences in terms of length of hospital stay between the two waves. Multivariable analyses showed that Black African [OR 0.47,95%CI 0.27–0.82] was independently associated with lesser mortality during second wave.

Discussion

This large survey has described demographic differences in mortality between the two surges. Lower mortality rates during second wave may be due to better treatment modalities, greater awareness of infection prevention and control,and possibly vaccination. This survey indicates greater psychological support may be required for healthcare workers on general medical wards who looked after greater proportion of COVID deaths.
771 LET’S TALK ABOUT RESUS. DO WE DO IT? WHO DOES IT? WHAT ARE THE OUTCOMES?
Authors: Gilmore S , Murray S , Taylor S , Ninan S
Published: March 2022

Introduction

Discussing preferences around cardiopulmonary resuscitation (CPR) is recommended to patients who wish to discuss this, or where there is foreseeable risk of life-threatening clinical deterioration. Our team felt that we discussed this routinely for our inpatients but wished to investigate how we did this, when we did this, why decisions were made and who led these discussions.

Methods

We retrospectively reviewed the electronic patient notes of 118 patients recently discharged from elderly medicine between February and November 2020 and recorded demographic details, co-morbidities and outcomes of discussions regarding resuscitation.

Results

100/118 patients had a RESPECT form documenting preferences. Of these 100 patients, 97% had a DNACPR recommendation, 2 had a ‘for resuscitation’ recommendation and one was undecided. 69% of patients had their preferences recorded during the current admission. 43% of discussions were led by a tier 1/2 doctor. 21% of discussions were led by a tier 3 doctor. 23% of discussions were led by a consultant. It was unclear who had led the discussion 13% of the time. 29/97 patients had a DNACPR due to their wishes. 16/97 patients had a DNACPR based on clinical grounds that it would not succeed. 33/97 patients had a DNACPR on the grounds that burden outweighed risks and they had capacity In 19/97 patients the reason for DNACPR was not clearly documented. There were 6 discussions where there was distress or disagreement—all of the discussions resulted in DNACPR recommendation 1 patient had a DNACPR reversed during their admission and none were reversed afterwards.

Conclusion

Systematically discussing preferences around resuscitation is feasible and rarely results in distress. The majority of patients have a recommendation for DNACPR and discussions are led by ‘junior’ doctors.
778 THE IMPACT OF MUSCULOSKELETAL CONDITIONS AND FRAILTY ON THE ABILITY TO SELF-CARE OR BE IN RECEIPT OF CARE: A STUDY OF COMMUNITY-
Authors: Bevilacqua G , Laskou F , Jameson K , Fuggle N , Cooper C , Dennison E M , Patel H P
Published: March 2022

Introduction

Musculoskeletal conditions (MSC) and frailty lead to a significant burden of disease in later life. Living independently remains the aim of older adults but ability to self-care or access care at home may hamper this. Our aim was to consider whether MSC (osteoporosis, sarcopenia, osteoarthritis) and frailty were associated with ability to self-care or influence access to formal/informal care among community-dwelling older adults.

Methods

Participants were recruited from an established cohort study of community-dwelling adults in the UK. Osteoporosis was assessed using Dual-energy X-ray Absorptiometry. Sarcopenia was assessed using EWSGOP2 criteria. Osteoarthritis of the hand, hip or knee was defined by clinical examination. Frailty was assessed using Fried criteria. Ability to self-care and access to formal/informal care were self-reported.

Results

443 men and women (median age 75.5 [IQR 73.5–77.9] years) participated. Osteoporosis affected (n = 74) 21.4% of participants, (n = 115) 26.8% had osteoarthritis, (n = 30) 8.6% had sarcopenia, and (n = 33) 7.6% were identified as frail. Most participants (n = 402 [90.7%]) reported no problems with self-care. Identical proportions of participants received informal (n = 53 [12%]) and formal (n = 53 [12%]) care at home in the previous year. Reporting difficulties with self-care was associated with clinical osteoarthritis (OR 3.48, 95% CI 1.63–7.43, p = 0.001) and frailty (5.29, 2.12–13.2, p < 0.001), but not with osteoporosis or sarcopenia. Receiving informal care at home in the past year was associated with osteoarthritis (2.56, 1.28–5.14, p = 0.008), the coexistence of two or more MSC (6.50, 1.66–25.39, p = 0.007), and frailty (6.25, 2.59–15.08, p < 0.001), but not with osteoporosis or sarcopenia alone. None of the conditions were associated with receiving formal care.

Conclusion

MSC are associated with informal receipt of care. Presence of two or more MSC convey similar informal care requirements to those living with frailty. Early assessment and management of MSC and frailty in clinical practice may reduce need for care and preserve independence.
802 CONCURRENT PATHOLOGIES OBSERVED IN OLDER ADULTS WITH COVID-19 INFECTION
Authors: Murphy C , Hartop K , Aggrey K , Bilan J , Lumsden J , Colquhoun K , Quinn T
Published: March 2022

Introduction

This study aimed to look at the effect of frailty and multi morbidity on short-term outcomes in patients diagnosed with COVID-19 in a hospital setting, looking specifically at the variety of concurrent pathologies diagnosed during their admission and how these affected the course of their illness and mortality.

Methods

The study took place at Glasgow Royal Infirmary. We retrospectively collected data from 280 patients who were admitted to the medicine for the elderly department between the 1st October and 1st December 2020 and diagnosed with COVID-19.

Results

In this cohort, 65% of older adults in hospital with COVID-19 had their admissions complicated by concurrent pathologies; most commonly delirium, acute kidney injury and pulmonary embolism, also increasing mortality in this group. It was also found that 39% of patients in this group had co-pathologies that were not necessarily associated with COVID-19 disease, for example AKI, AF and stroke/TIA. 35% of older adults in this group had no concurrent medical diagnoses during their admission, however this did not correlate with reduced mortality in this group.

Conclusion

The data highlights the vulnerability of older adults with COVID-19 infection making them more susceptible to concurrent disease and contributing to further morbidity and mortality. We also found a large number of patients had co-pathologies not associated with COVID-19 disease, highlighting the importance of considering other diagnoses in frail elderly patients.
811 DELIRIUM IN COVID-19: COMMON AND CLINICALLY SIGNIFICANT: EXPERIENCES FROM THE NIGHTINGALE HOSPITAL EXETER
Authors: Reed W , Fearnley C , Tregarthen A , Hubbard J , Griffiths J , Whitehead T , Hacon J , Anning L
Published: March 2022

Background

Delirium is an independent predictor of mortality in patients admitted with community-acquired pneumonia (Pieralli, 2014), but significance and incidence in Covid-19 infection has not been established. The Nightingale Hospital Exeter (NHE) as a multidisciplinary team model, managed 242 patients with Covid-19 from November 2020 to February 2021. This study identifies the delirium incidence, outcome, premorbid function and demographics of this cohort.

Methods

Electronic records were retrospectively reviewed for keywords ‘Delirium’, ‘Hyperactive’, ‘Hypoactive’, ‘Confused’ and ‘Muddled’. Patients were categorised as Hyperactive, Hypoactive or Confused/non-specified. Prior functional support (independent, package of care, residential or nursing care) and presence of pre-established neurological conditions (including dementia) were noted.

Results

242 patients were included, average age 84 years (range 59–102). Of these patients, 130 (54%) developed delirium (29 (22%) hyperactive, 37 (28%) hypoactive, 2 (1%) mixed and 62 (48%) ‘confused’/non-specified). Of those with delirium, 56 (43%) were previously living independently and 51 (39%) were living at home with a package of care. 60 (46%) of those diagnosed had no pre-existing neurological condition, 32% had underlying dementia. There were 37 deaths at NHE (mortality 15%), 73% of these patients had delirium during their admission compared to 50% of those who survived.

Conclusions

Over half this cohort developed delirium, a high proportion of whom had been living independently prior to admission with no pre-existing neurological condition, emphasising how common delirium is in patients with Covid-19. In a comparable cohort with pneumonia (mean age 82 years, range 65–99) 25% developed delirium, and it was an independent predictor of in-hospital mortality (Pieralli, 2014). The fact that 73% of all patients who died developed delirium suggests it may have important prognostic implications, and both this and the high incidence indicate further work is required to fully understand how to prevent and manage delirium in Covid-19.
GraphGONet: a self-explaining neural network encapsulating the Gene Ontology graph for phenotype prediction on gene expression
Authors: Bourgeais Victoria , Zehraoui Farida , Hanczar Blaise
Published: March 2022

Motivation

Medical care is becoming more and more specific to patients’ needs due to the increased availability of omics data. The application to these data of sophisticated machine learning models, in particular deep learning (DL), can improve the field of precision medicine. However, their use in clinics is limited as their predictions are not accompanied by an explanation. The production of accurate and intelligible predictions can benefit from the inclusion of domain knowledge. Therefore, knowledge-based DL models appear to be a promising solution.

Results

In this article, we propose GraphGONet, where the Gene Ontology is encapsulated in the hidden layers of a new self-explaining neural network. Each neuron in the layers represents a biological concept, combining the gene expression profile of a patient and the information from its neighboring neurons. The experiments described in the article confirm that our model not only performs as accurately as the state-of-the-art (non-explainable ones) but also automatically produces stable and intelligible explanations composed of the biological concepts with the highest contribution. This feature allows experts to use our tool in a medical setting.

Availability and implementation

GraphGONet is freely available at https://forge.ibisc.univ-evry.fr/vbourgeais/GraphGONet.git. The microarray dataset is accessible from the ArrayExpress database under the identifier E-MTAB-3732. The TCGA datasets can be downloaded from the Genomic Data Commons (GDC) data portal.

Supplementary information

Supplementary data are available at Bioinformatics online.
Antibiotics versus placebo in adults with CT-confirmed uncomplicated acute appendicitis (APPAC III): randomized double-blind superiority trial
Authors: Salminen Paulina , Sippola Suvi , Haijanen Jussi , Nordström Pia , Rantanen Tuomo , Rautio Tero , Sallinen Ville , Löyttyniemi Eliisa , Hurme Saija , Tammilehto Ville , Laukkarinen Johanna , Savolainen Heini , Meriläinen Sanna , Leppäniemi Ari , Grönroos Juha
Published: March 2022

Background

Non-operative management of uncomplicated acute appendicitis is an option, but omission of antibiotics from the regimen has not been tested.

Methods

A double-blind, placebo-controlled, superiority RCT in adults with CT-confirmed uncomplicated acute appendicitis was designed to compare placebo with antibiotics (intravenous ertapenem followed by oral levofloxacin and metronidazole). The primary endpoint was treatment success (resolution resulting in discharge without appendicectomy within 10 days); secondary outcomes included pain scores, complications, hospital stay, and return to work.

Results

From May 2017 to September 2020, 72 patients with a mean(s.d.) age of 37.5 (11.1) years were recruited at five hospitals. Six were excluded after randomization (5 early consent withdrawals, 1 randomization protocol violation), 35 were assigned to receive antibiotics, and 31 to receive placebo. Enrolment challenges (including hospital pharmacy resources in an acute-care surgery setting) meant that only the lowest sample size of three predefined scenarios was achieved. The 10-day treatment success rate was 87 (95 per cent c.i. 75 to 99) per cent for placebo and 97 (92 to 100) per cent for antibiotics. This clinical difference of 10 (90 per cent c.i. −0.9 to 21) per cent was not statistically different for the primary outcome (1-sided P = 0.142), and secondary outcomes were similar.

Conclusion

The lack of antibiotic superiority statistically suggests that a non-inferiority trial against placebo is warranted in adults with CT-confirmed mild appendicitis. Registration number: EudraCT 2015-003634-26 (https://eudract.ema.europa.eu/eudract-web/index.faces), NCT03234296 (http://www.clinicaltrials.gov).
SARS-CoV-2 in Exhaled Aerosol Particles from COVID-19 Cases and Its Association to Household Transmission
Authors: Alsved Malin , Nygren David , Thuresson Sara , Medstrand Patrik , Fraenkel Carl Johan , Löndahl Jakob
Published: March 2022

Background

Coronavirus disease 2019 (COVID-19) transmission via exhaled aerosol particles has been considered an important route for the spread of infection, especially during super-spreading events involving loud talking or singing. However, no study has previously linked measurements of viral aerosol emissions to transmission rates.

Methods

During February–March 2021, COVID-19 cases that were close to symptom onset were visited with a mobile laboratory for collection of exhaled aerosol particles during breathing, talking, and singing, respectively, and of nasopharyngeal and saliva samples. Aerosol samples were collected using a BioSpot-VIVAS and a NIOSH bc-251 2-stage cyclone, and all samples were analyzed by RT-qPCR for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA detection. We compared transmission rates between households with aerosol-positive and aerosol-negative index cases.

Results

SARS-CoV-2 RNA was detected in at least 1 aerosol sample from 19 of 38 (50%) included cases. The odds ratio (OR) of finding positive aerosol samples decreased with each day from symptom onset (OR 0.55, 95 confidence interval [CI] .30–1.0, P = .049). The highest number of positive aerosol samples were from singing, 16 (42%), followed by talking, 11 (30%), and the least from breathing, 3 (8%). Index cases were identified for 13 households with 31 exposed contacts. Higher transmission rates were observed in households with aerosol-positive index cases, 10/16 infected (63%), compared to households with aerosol-negative index cases, 4/15 infected (27%) (χ2 test, P = .045).

Conclusions

COVID-19 cases were more likely to exhale SARS-CoV-2-containing aerosol particles close to symptom onset and during singing or talking as compared to breathing. This study supports that individuals with SARS-CoV-2 in exhaled aerosols are more likely to transmit COVID-19.
Balsalazide Exposure During the Development of Fertilizing Sperm May Be Associated With Offspring Birth Defects
Authors: Wensink Maarten J , Streett Sarah E , Damkier Per , Lindahl-Jacobsen Rune , Kjeldsen Jens , Eisenberg Michael L
Published: March 2022

Lay Summary

We report an association between balsalazide exposure during the development of fertilizing sperm and birth defects in offspring. Exposed offspring were approximately 8 times more likely to have a birth defect. There were no pre-existing reasons to suspect such a relationship, which should be confirmed in other data.
Football feminism: Global governance perspectives
Authors: Krech Michele , Weiler Joseph H H
Published: March 2022

This Symposium explores a unique and relatively understudied intersection of global law and governance, on the one hand, and gender and feminist theory, on the other—which we label “football feminism.” Football (soccer), we hazard to claim, occupies a place in the global space unlike any other cultural/economic phenomenon. Given the mass global consumption and veneration of football, it plays a particularly powerful role in shaping, validating, and entrenching gender relations far beyond the sport, all around the world. Football matters in this way, whether we like it or not, so its governance should attract scholarly feminist critique. Significantly, the primary regulator of football is a private organization headquartered in Zurich, controlling billions of dollars and a worldwide network of national football associations. The “constitution” of this organization—the FIFA Statutes—includes a prohibition on gender discrimination and, as of quite recently, commitments to promote women in football and to respect all internationally recognized human rights. However, many questions remain as to the specific meaning of these good-governance and human-rights norms in the context of football, as well as to the seriousness of the commitment to their actual implementation and the availability of mechanisms for enforcing them vis-à-vis the powerful private organizations that govern the sport. Together, these organizations embody a distinctive form of global governance that raises particular questions of legality, legitimacy, democracy, transparency, and accountability. The contributions to this Symposium consider some of these questions as they relate to gender inequality in football, both on and off the pitch.
Lockdown surgery: the impact of coronavirus disease 2019 measures on cardiac cases
Authors: Nägele Felix , Engler Clemens , Graber Michael , Remmel Nina , Hirsch Jakob , Pölzl Leo , Huber Rosalie , Schweiger Victor , Kilo Juliane , Bonaros Nikolaos , Tancevski Ivan , Grimm Michael , Gollmann-Tepeköylü Can , Holfeld Johannes
Published: March 2022

OBJECTIVES

The need to ration medical equipment and interventions during the coronavirus disease 2019 pandemic translated to an ever-lengthening wait list for surgical care. Retrospective analysis of lockdowns is of high importance to learn from the current situation for future pandemics. This monocentric study assessed the impact of lockdown periods on cardiac surgery cases and outcomes.

METHODS

The single-centre cross-sectional descriptive observational study was conducted to investigate the first lockdown period and the following post-lockdown period in comparison to the same periods during the previous 3 years at the Department of Cardiac Surgery at the Medical University of Innsbruck. Data were prospectively collected and retrospectively analysed from the department-specific quality management system. The primary objective was to compare the number of open-heart procedures between the prelockdown and the lockdown period. The secondary objectives were to analyse the characteristics and the outcomes of open-heart procedures.

RESULTS

There were no differences in patient demographics. A significant decrease of 29% in weekly surgical procedures was observed during the lockdown period. The surgical case-mix was unaffected: The numbers of aortic valve replacements, coronary artery bypass grafts, mitral valve repair or replacement procedures and others remained stable. The urgency of cases increased significantly, and the general health conditions of patients appeared to be worse. However, outcomes were unchanged.

CONCLUSIONS

By implementing a rational patient selection process, the quality of open-heart procedures was maintained even though patients who underwent surgery during lockdown were sicker and more symptomatic.
Free of choice on anterior and posterior chest tube position after lung cancer resection
Authors: Pu Qiang , Zhou Jian , Zheng Quan , Hao Jianqi , Wu Dongsheng , Zhang Ruoxi , Wang Hang , Wang Tengyong , Liu Lunxu
Published: March 2022

OBJECTIVES

The optimal location to insert a chest tube for postoperative drainage has not been identified. We performed a retrospective equivalence study to identify whether the efficiency is similar regarding anterior or posterior position of chest tube in thoracic cavity after video-assisted thoracoscopic surgery for non-small-cell lung cancer.

METHODS

A retrospective review of 4263 patients undergoing non-small-cell lung cancer resection from October 2009 to August 2019 in the Western China Lung Cancer Database was conducted. Propensity score matching was performed to balance baseline characteristics between anterior and posterior groups. Chest tube duration, drainage volume, postoperative complications and hospitalization cost were compared. Equivalence margin was defined as (−1, 1) in 95% confidence interval of the mean difference of chest tube duration.

RESULTS

After propensity score matching, we investigated 2912 patients with anterior or posterior (1456 vs 1456) chest tube location following lung cancer resection. The mean time to chest tube removal was 3.39 days in the anterior group and 3.38 days in the posterior group (P = 0.52), while the mean difference and 95% confidence interval were 0.02 (-0.17, 0.20). The mean postoperative hospital stays in 2 groups were 5.47 vs 5.24 days (anterior vs posterior, P = 0.02). No significant differences were identified regarding the drainage volume during the first 3 postoperative days, postoperative complications and hospitalization cost.

CONCLUSIONS

The comparison of clinical outcomes between anterior and posterior location of chest tube met the criteria for equivalence. For lung cancer patients undergoing video-assisted thoracoscopic surgery resection, it was free choice on anterior or posterior single-tube insertion.
Usability challenges with electronic health records (EHRs) during prerounding on pediatric inpatients
Authors: Alami Jawad , Hammonds Clare , Hensien Erin , Khraibani Jenan , Borowitz Stephen , Hellems Martha , Riggs Sara Lu
Published: March 2022

Objective

Prerounding is critical for a healthcare team to develop a shared understanding of the patient’s condition and to develop a care plan. However, the design of electronic health records (EHRs) often makes prerounding inefficient, ineffective, and time consuming. The goal of this study was to observe how residents use the EHR while prerounding to identify usability challenges associated with the design of EHRs.

Materials and Methods

Thirty residents were tasked to preround 2 pediatric patients using the think-aloud protocol. The data from the surveys, video recordings, and think-aloud comments were analyzed to identify usability issues related to EHR. The time it took for participants to complete the 6 required prerounding tasks were calculated and the pages most commonly accessed were noted.

Results

Participants spent on average 6.5 min prerounding each patient with the most time spent on checking lab results and reviewing notes. Twenty-eight distinct pages were visited by at least 2 participants, mostly due to a lack of interconnectivity between related data across pages. Usability issues with the most commonly used pages include: data overload, missing/hidden information, difficulty identifying trends, and having to conduct manual calculations.

Conclusions

We list usability issues and provide a set of recommendations to remedy these issues that include: reducing information access cost, creating a checklist, automate calculations, and standardizing notes and EHR training. Ideally, the outcome of this work will help improve EHR design to maximize the time clinicians spend interacting with and providing care to their patients.
56 Characterization of Pasture Management by Horse Operation Purposes in Florida
Authors: Vasco Carol M , Silva Liliane , Mullenix Kim , Dillard Leanne L , Wickens Carissa , Warren Lori K
Published: March 2022

Adequate pasture management can decrease costs related to supplemental feed in horse operations. However, the purpose of the horse operation may influence the level of pasture management applied. An online survey was conducted from 2018 to 2020 to evaluate if pasture management strategies used on Florida horse farms are associated with the purpose of the operation. This survey also provided inputs as needs assessment for educational programs in Florida and the Southeast United States. Survey data (n = 79 respondents) were submitted to descriptive analysis and Fisher’s exact test. Significantly associated variables were also evaluated using multiple correspondence analysis. The primary function of the operation most reported was recreational (62%), followed by training (15%), boarding (8%), breeding (6%), and other (5%). Horses were turned out onto pasture full time (24 h/d) in 57% of operations. The purpose of the operation tended to be associated with turnout practices (P = 0.08). Multiple correspondence analysis revealed that boarding- and recreational-purpose operations tended to turn horses out full time or most of the day (12 h/d), while training facilities tended to turn horses out during the night or for a short duration (~4 h/d) during the day. As for level of pasture management, pasture establishment but no maintenance was implemented by 3% of the respondents, 9% implemented pasture establishment and maintenance, 82% performed maintenance only, and 6% did not implement any pasture management. Concerning types of pasture management, pastures were overseeded by 34% of the operations, fertilized by 57%, and continuously stocked by 52%. The purpose of the operation was not associated (P > 0.05) with the level or type of pasture management strategy. Results demonstrate that pasture management practices were implemented similarly among Florida horse operations regardless of their purpose. These results illustrate an educational need to provide information and resources for horse owners aiming to improve the adoption of best pasture management strategies and decrease feeding costs.
136 Application of Ear-attached Sensor Technology (CowManager) to Detect Estrus in a Commercial Beef Cow AI Program
Authors: Weber W E , Looney C R , Rook W L
Published: March 2022

The CowManager (Agis, Harmelen, the Netherlands) ear sensor technology was developed for dairy cows in confinement and has recently been adopted for pastured beef cows. The sensors fit around the ‘840’ RFID button and houses a 3-dimensional accelerometer that registers movement of the cow’s ear. Each sensor stores up to 7 d of internal data at a time and is transmitted by solar powered routers in the pasture. The objective was to determine the effectiveness of the CowManager system’s estrus detection (ED) feature in beef cows during estrous synchronization (ES), AI, and during exposure to bulls for 60 d. Fifty 6-8 yr multiparous commercial Angus-crossbred cows with calves, were fitted with CowManager ear sensors for 14 d to allow for acclimation. Cows then underwent ES using a 6-d CO-Synch + controlled internal drug release (CIDR) protocol with AI at 72 h post CIDR + prostaglandin F2α with sexed female semen. Estrus detection was determined using breeding patches (Estrotect™, Rockway Inc., Spring Valley, WI), with estrus classified as greater than 50% of color rubbed off, and CowManager sensors with a notification to a smartphone and/or computer. The CowManager sensors were effective in determining estrus in 92% (46/50) of the synchronized cows, and the first service conception rate was 74% (37/50). CowManager sensors detected 100% (37/37), and ESTROTECT patches detected 91% (34/37) of the cows in estrus that conceived by AI. During bull exposure, CowManager detected 100% (13/13) of estrus and the natural breeding dates were confirmed by ultrasound fetal aging. ESTROTECT patches were not used during exposure to bulls. However, CowManager detected 5 of the AI pregnant cows as in estrus during the exposure to bulls. CowManager’s ED feature was highly effective in determining estrus for beef cattle and was similar to breeding patches for ED.
6 Effect of Exogenous Melatonin on the Cellular and Humoral Response of Holstein Heifer Calves During Vaccination
Authors: Martin Allie , Machado Vinicius , Crossland Whitney L
Published: March 2022

Despite rigorous vaccination protocols, calf morbidity is the primary contributor to economic loss in beef and dairy industries. Melatonin has been used as a vaccine adjuvant in many species, yet there are few studies in cattle. It was hypothesized implantation of slow-release (90-day) exogenous melatonin during vaccination could bolster cellular and humoral immune function. The objective was to evaluate the effect of exogenous melatonin on polymorphonuclear leukocyte (PMN) function and adaptive immune response in dairy calves vaccinated against a model antigen (ovalbumin). Total serum protein (TSP) was measured in Holstein heifer calves (n=60; < 3 d old) which were randomly assigned to one of four treatments: either no treatment (CON), a two-series vaccination of 0.5 mg ovalbumin on d 0 and 21 (VAC), an implantation of 24 mg melatonin on d 0 (MEL), or both melatonin and vaccine treatments (MVAC). Jugular blood was collected on days 0, 21, 42, 63, and 84 to measure PMN function and anti-ovalbumin immunoglobulin-G (IgG). Experimental design was a RCBD with repeated measures (day), a two-by-two factorial arrangement of treatments, and block was enrollment cohort. TSP was not correlated with any measurements on day 0 (r2 ≤ 0.16,P ≤ 0.23). There was a treatment by day interaction for median florescent intensity of phagocytosis where MVAC was greater than other treatments on day 42 (P =0.01). Across treatments, neutrophil oxidative burst intensity decreased after day 0 (P < 0.01) and phagocytosis intensity increased toward day 42 and decreased toward day 84 (P < 0.01). As expected, there was a treatment by day interaction (P < 0.01) were vaccinated calves developed greater anti-ovalbumin IgG over time than non-vaccinated calves, and MVAC tended (P = 0.08) to be greater than VAC on d 63. Exogenous melatonin may influence PMN function and potentially IgG response during vaccination.