bluuebunny/crossref_metadata_2025 huggingface dataset:
TP8.2.22 Mind the Gap: Overcoming the disruption of surgical teaching during COVID-19 redeployment
Authors: Habsha Osama Al , Murphy Katherine , Aly Mohamed , Khan Adil , Younis Firas
Published: October 2021

Aims

Due to the pandemic, surgical FY1s in our trust were re-deployed to cover medical patients. In addition to cancellation of surgery-specific teaching, there was less time spent by FY1s with senior surgical colleagues during the normal working day. Our FY1s appeared less confident in managing unwell surgical patients, and there was dissatisfaction for both FY1s and seniors.

This project aimed to identify the particular areas of concern and deliver a tailored teaching session.

Methods

Surgical FY1s and SpRs were surveyed. We received 10 (83%) FY1 responses and 5 (42%) SpR responses. Management of common surgical presentations, routine administrative and clerical tasks were identified as areas of need. A teaching session was delivered via online conferencing software and uploaded to a video sharing website where it could be viewed at a later date. Seven of 12 (58%) surgical FY1s attended live and completed a post-teaching session feedback survey.

Results

Seven (100%) FY1s rated the session ‘very useful’, and a majority found the ‘common surgical presentations’ section of most value. All respondents felt more confident with both clerking surgical patients and administrative tasks following the refresher session.

Conclusions

This project demonstrated the need for additional training sessions to compensate for loss of opportunities due to re-deployment. Utilising remote teaching proved an acceptable alternative to previous in-person options. The tailored refresher session successfully improved confidence in target areas and should be delivered routinely.
TP8.2.23 Surgical education in low resource settings
Authors: Pye Jonathan
Published: October 2021

Aims

To help build medical capacity in low resource settings.

Methods

I researched and worked with two organisations, Médecins Sans Frontières (MSF) and Mercy Ships. I worked with Mercy Ships in collaboration with ASGBI

Results

MSF is a humanitarian organisation. Although MSF works in low resource settings, it is not developmental and therefore education was not part of its brief. I completed 2x 2 month missions with MSF, in Central African Republic and Chad.

Mercy Ships is a developmental organisation. I worked with Mercy Ships, in four countries, to help deliver a total of 10 skills courses and 5 Training the Trainers courses which had been set up in collaboration with ASGBI. The first time was with a UK surgical trainee under this scheme.

French was the working language in each setting.

Conclusions

There is a real and pressing need for basic surgical education in most low resource settings. Teaching with Mercy Ships is a good vehicle for teaching essential surgical skills locally and training local trainers to continue the process. It is also a good opportunity for providing a supervised introduction to working in a low resource setting for those trainees who wish to become involved in humanitarian work.
TP9.2.1Evaluating the incidence, the predictors and the outcomes of patients with negative appendicectomy
Authors: Noureldin Khaled , Elkhouly Mohamed , Shah Heer , HatimAli AliAsgar , Ayantunde Bolu , Ayantunde Abraham
Published: October 2021

Introduction

Negative appendicectomy (NA) is still a major issue following appendicectomy. We evaluated the rate and predictors of negative appendicectomy in a cohort.

Patients and Methods

Data of patients who underwent emergency appendicectomies over a year was collected and analysed. The absence of inflammation and/or other significant pathology in the appendix was considered negative by standard definition. A stricter definition of NA was the absence of inflammatory cells in the appendix. Negative appendicectomy rate (NAR) was calculated using the standard criteria (NAR-SDC) and the strict criteria (NAR-STC).

Results

372 patients were included, 179 males and 193 females with a median age of 27 (5-94) years. Median duration of symptoms and waiting time to surgery were 2 days and 1 day respectively. The mean admission WBC and CRP were 12,600 (3000-38000)/mm3 and 66.9 (1-323) mg/L respectively. Laparoscopic appendicectomy was performed in 93.5% of patients with a conversion rate of 4.6%.

NAR-SDC was 10.2% and NAR-STC was 25.8%. NAR was significantly higher in females than males (39.4% versus 11.1%; p-value 0.0001). Patients with NA were younger (p-value 0.0001), had lower mean total WBC (p-value 0.014) and CRP (p-value 0.0001) on admission. Independent predictors of negative appendicectomy are female gender, duration of symptoms more than 3 days, and lower total WBC.

Conclusion

NA is still a major problem in the management of patients with acute right lower abdominal pain. Our NAR compared favourably with reported rates. Female gender, symptoms duration more than 3 days, lower WBC are independent predictors of NA.
TP9.2.2Evaluating the Outcomes of anal squamous cell carcinoma (ASCC) with curative intent- a 10-year experience
Authors: Ayantunde Abraham , Noureldin Khaled , Hq Hafizul , Edison Daniel , Praveen Bandipalyam
Published: October 2021

Background

Our 10-year experience with radical treatment of patients with ASCC.

Patients and Method

Data of patients with ASCC treated with curative intent were analysed between January 2011 and December 2019. Patients underwent the standard workup, treated and followed up accordingly. The outcome measures were response to radical chemoradiotherapy, recurrent disease, disease-free and overall survival.

Results

117 patients were diagnosed with anal cancer. 26 ASCC patients palliatively treated, adenocarcinoma(11), melanoma(1), Paget disease(1) and carcinoid(1) were excluded. Median age of included patients was 65(38-90) years with a male to female ratio of 1:1.9. Three patients were HIV positive and 52% of the patients had AIN of varying degree of dysplasia. AJCC stages were I(16), II(18), IIIA(19), IIIB(9) and IV(15). 88.3%%(68/77) of the patients had radical chemoradiotherapy while 9 patients with tumours ≤2cm underwent wide local excision. 92.6%(63/68) of the patients treated with radical chemoradiotherapy had complete response while 7.4%(5/77) had partial response. Four patients with incomplete response underwent salvage APER. 13%(10/77) of the patients developed recurrent disease.

Mean survival time was 99.82(95% CI 88.87-110.77) months with 5-year overall survival rate of 78.0%. The mean disease-free survival time was 111.82(95% CI 102.38-121;26) months. 75.3%(58/77) of the patients were alive at the end of the study with an overall mortality rate was 24.7% and disease-specific mortality was 15.6%.

Conclusion

ASCC responds well to radical chemoradiotherapy with favourable outcome but locoregional failure and distant metastases are still issues.
TP9.2.3Laparoscopic Cholecystectomy with Intraoperative Cholangiogram and Antegrade Biliary Stenting in Acute Gall Stone Pancreatitis: A Cohort Study
Authors: Brown Rory , Cowie Jonathan , Saedon Mahmud , Rate Anthony
Published: October 2021

Aims

To demonstrate feasibility and efficacy of laparoscopic cholecystectomy (LC), intraoperative (IOC) and antegrade biliary stenting (ABS) as compared to selective pre-operative biliary investigation and intervention in acute gallstone pancreatitis (AGP).

Methods

A cohort study was performed comparing patients who had IOC+/-ABS during LC versus those who had only LC in the treatment of AGP. 74 consecutive AGP patients were included in this study from January 2016 to October 2018. All patients were included in a prospective database with follow-up for one year.

Results

47 (64.5%) patients underwent IOC during LC (7 required ABS insertion), with a mean age 51 years (SEM: 2.7), 72.3% were female. The median admission bilirubin was 24 (IQR:14-54). The average number of ERCP and MRCP per patient was 0.30 and 0.15 respectively.

27 (36.5%) patients underwent LC with selective pre-operative biliary investigation with a mean age 48 years (SEM: 2.9), 66.7% were female. The median admission bilirubin was 27 (IQR:14-48). The average number of ERCP and MRCP per patient was 0.41 and 0.52 respectively.

Discussion

In our pilot study comparing LC with IOC versus LC with selective pre-operative biliary investigation we demonstrate that, there is marked reduction in biliary investigations required in IOC group. Length of hospital admissions and rate of post-operative complications were comparable. An analytic study with a larger cohort may demonstrate further seniority of IOC.
TP9.2.27A closed loop audit looking at the use of a checklist in surgical ward rounds to improve ward round documentation. Can we improve patient safety?
Authors: Liao Christopher , Sheaff Emma , Wilkins Harry
Published: October 2021

Aims

To assess if surgical ward rounds would improve through the use of a peri-operative ward round checklist in the clinical notes.

Method

We performed a closed loop audit with a different novel ward round checklist in each audit, the second made from improving the first, based on feedback. We looked at checklist utilisation, and the quality of documentation in notes. We compared the quality of documentation in notes with the checklist, to notes without the checklist. The data was then collated and analysed. Standards from the Royal College of Physicians’ “Ward Rounds in Medicine”.

Results

In the first audit, our sample was 68, in the second, our sample was 64. With the use of a checklist (M = 67%, SD = 22%) ward round documentation was significantly better than without the checklist (M = 26%, SD = 10%), t(64)=8.85, p<.00001. Ward documentation was especially improved regarding fluid balance, analgesia, and assessing physiotherapy needs. The second version of the checklist (M = 56%, SD = 28%) was used significantly more than the first checklist (M = 13%, SD = 22%), t(75)=7.59, p<.00001.

Conclusions

With the growing role of clinical notes as legal documents, handover tools, and pillars of care planning, and the move to use electronic patient record systems, improving the quality of documentation is imperative. This study shows that a systematic checklist significantly improves ward round documentation, and so can improve clinical care. We will follow-up this study with a third audit, focusing on patient satisfaction and determining reduction in harm caused to patients with a ward round checklist.
TP10.1.7New Minor Surgical Set as a way to improve surgical efficiency during COVID-19 pandemic
Authors: Eiben Inez , Bahadori Darab Payam , Eiben Paola , Syed Mobinulla
Published: October 2021

Aims

Large number of paediatric plastic surgical procedures were identified in Evelina Hospital during COVID-19 pandemic as not requiring large conventional surgical operative sets that can contain at average 35 instruments. Large sets are more expensive, take longer preparation time due to instrument counting and as a consequence take more total operating time. Furthermore, more instruments need to be unnecessarily purchased, stored and cleaned post procedure.

Simple paediatric plastic surgery procedures including nailbed repair or laceration repair require limited and largely replicating operative instrument set. We have therefore introduced Small Minor Plastic Surgical set (MS) containing only 10 instruments. We audited its effectiveness and introduced a revised version of the set as per feedback, permanently arranged into theatre operative set collection.

Methods

MS set was introduced and used at senior surgeons discursion for paediatric plastic surgical procedures. Feedback was gathered from the surgeon and scrub nurse via specially designed questionnaire at post operation and theatre team debrief. Suggested alterations were implemented and New Minor Surgical (NMS) set was introduced and re-audited using revised questionnaire.

Results

61% of surgeons and 89% of scrub personnel thought MS set contained everything that was needed for the case. Following revision 91% of surgeons and 95% of scrub nurses thought NMS set contained all necessary equipment for the operation.

Conclusions

NMS set introduced into daily surgical practice in Evelina Hospital theatres improved overall staff satisfaction when considering both surgeon and nursing staff. It provided cost- and time-effective operative set now vastly used across surgical specialities.
TP10.1.9End Colostomy Formation: Change in Practice during the Covid-19 Pandemic
Authors: Farrow E Z , Cook T A
Published: October 2021

Aim

Intercollegiate guidance favoured the increased stoma formation during the early phases of the Covid-19 pandemic due to uncertainty around the availability of critical care beds and peri-operative impact of SARS-CoV-2. This study assessed the impact the Covid-19 pandemic and changing guidance had on end colostomy formation.

Methods

Data were reviewed from a prospectively collected database on the number of end colostomies formed over a 10-month period from 1st March to 31st December 2020. Comparison was made with the same period in 2019. Details were confirmed using clinical letters.

Results

There was an overall 11.5% increase in the number of end colostomies formed in the in the same 10-month period in 2020 compared with 2019 (87 vs 78). The increase in end colostomy formation was most marked in the 3-month period of March to May, with 36.8% more end colostomies formed in 2020 than in 2019 (26 vs 19). The number of end colostomies formed in the remaining 7-month period of June to December was similar in the two years (61 vs 59).

Conclusions

There was a change in surgical practice in favour of stoma formation, which peaked in the period of March to May 2020. This coincided with a time of maximum uncertainty surrounding the Covid-19 pandemic and changing intercollegiate guidance. The change in practice has implications for patients longer term and may impact on the service in the post-Covid recovery period with patients requesting reversal procedures.
TP10.2.5Investigating the impact of early COVID-19 policies on Emergency Surgical service at a District General Hospital
Authors: Lunt Adam , Hanger Joseph , Bush Alex , Christopoulos Petros , Munro Alicia , Keatley Ben
Published: October 2021

Aims

On the 23rd March 2020, the UK introduced measures to curb the spread of coronavirus disease 19 (COVID-19). We aimed to investigate the impact of government and Royal College measures on the acute surgical take.

Materials and Methods

Retrospective analysis was performed for patients referred to the acute surgical take between 2nd March 2020 and 5th April 2020. Data were analysed in two groups; ‘pre-COVID measures’ cohort (prior to 23rd March 2020) and ‘post-COVID measures’ cohort (on or after 23rd March 2020). Demographics, Early Warning Score (EWS) at referral, blood results, radiological investigations, antibiotic use, diagnosis, operative and outcome data were compared.

Results

465 patient referrals were included. Mean admissions per day reduced by 39.9% (p = 0.01) in the post-COVID measures’ cohort compared with the pre-COVID measures cohort. Disease severity increased, with white cell count (WCC) increasing by 14% (p = 0.02) and C-reactive protein (CRP) by 34% (p = 0.04). Laparoscopic procedures decreased by 86.4% (p < 0.01). The proportion of admissions requiring operative management showed no significant change, with 26% in pre-COVID measures verse 23% in post- COVID measures (p = 0.91). Short term morbidity, mortality and length of stay outcomes also demonstrated no significant change.

Conclusion

Fewer patients were referred following the implementation of government and Royal College guidance, however these patients demonstrated greater disease severity. Guidance likely modified patients help seeking behaviours and delayed presentation time. Surgeons demonstrated good compliance to Royal College guidance by reducing laparoscopic procedures, however operative management rates remained constant.
TP10.2.9The effect of COVID-19 on Breast clinic follow ups – a change in future practice?
Authors: Norman Carol , Ragad Lilia , Nagarajakumar Anupama , Khan Maryam Alam , Uhercik Michal , Kasem Abdul
Published: October 2021

Aims

Prior to March 2020, at Princess Royal University Hospital (PRUH), Kings College NHS Foundation Trust, almost daily face to face benign/malignant breast clinic follow ups occurred. On March 23rd 2020 the UK went into official COVID-19 pandemic lockdown. The effect on elective follow up practice was swift with cancellation, triaging and replacement of face-to-face by telephonic/virtual consultations.

We compared the change of follow up pattern, pre and post COVID-19. Could this effect the future of consultations at PRUH?

Methods

A comparison of all patients attending PRUH breast unit outpatients in January 2020 (preCOVID-19) for follow up, with those attending in April 2020 (postCOVID-19).

Data collection from clinic lists and electronic patient records, with Excel version 16 analysis.

Results

343 patient follow up consultations 01/2020. 53 patient follow up consultations 04/2020.

Malignant cases: January 65%, April 60%

Benign/B3 cases: January 35%, April 20%

Summary follow up types.

Conclusions

Impact of COVID has been widespread in our practice. Our results show a significant reduction in face-to-face appointments, to allow social distancing. Further evaluation of this model will show its sustainability. Patient satisfaction will have to be assessed, with a view to a full move to video/telephone consultation where indicated.
MRI-derived g-ratio and lesion severity in newly diagnosed multiple sclerosis
Authors: York Elizabeth N , Martin Sarah-Jane , Meijboom Rozanna , Thrippleton Michael J , Bastin Mark E , Carter Edwin , Overell James , Connick Peter , Chandran Siddharthan , Waldman Adam D , Hunt David P J ,   Future-MS Consortium, Akula Amit , Artal Javier Carod , Baranzini Sergio , Barret Fiona , Bastin Mark , Batchelor Christine , Beswick Emily , Brown Fraser , Chandran Siddharthan , Chang Jessie , Chen Yingdi , Colville Shuna , Connick Peter , Cranley Denise , Dakin Rachel , Dhillon Baljean , Elliot Elizabeth , Finlayson James , Foley Peter , Glasmacher Stella , Grossart Angus , Haagenrud Haane , Hafezi Katarzyna , Harrison Emily , Harroud Adil , Hathorn Sara , Hopkins Tracey , Hunt David , Hutchinson Aidan , Jayprakash Kiran , Justin Matt , Kampaite Agniete , Kearns Patrick , Kennedy Gwen , Kleynhans Michaela , Kwong Julian Ng Kee , Larraz Juan , Love Kathryn , Lyle Dawn , MacDonald James , MacDougall Niall , Macfarlane Lesley , Maclennan Beverly , Maclean Alan , MacLeod Margaret Ann , Macleod Nicola , Mahad Don , Martin Sarah Jane , McMahon Lynn , Megson Ian , Meijboom Rozanna , Mollison Daisy , Monaghan Mary , Murphy Lee , Murray Katy , Newton Judith , O’Riordan Jonathan , Perry David , Quigley Suzanne , Scotson Adam , Stenson Amy , Thrippleton Michael , Hernandez Maria Valdez , Waldman Adam , Weaver Christine , Webb Stewart , Weller Belinda , Williams Anna , Wiseman Stewart , Wong Charis , Wong Michael , York Elizabeth
Published: October 2021

Myelin loss is associated with axonal damage in established multiple sclerosis. This relationship is challenging to study in vivo in early disease. Here, we ask whether myelin loss is associated with axonal damage at diagnosis by combining non-invasive neuroimaging and blood biomarkers. We performed quantitative microstructural MRI and single-molecule ELISA plasma neurofilament measurement in 73 patients with newly diagnosed, immunotherapy naïve relapsing–remitting multiple sclerosis. Myelin integrity was evaluated using aggregate g-ratios, derived from magnetization transfer saturation and neurite orientation dispersion and density imaging diffusion data. We found significantly higher g-ratios within cerebral white matter lesions (suggesting myelin loss) compared with normal-appearing white matter (0.61 versus 0.57, difference 0.036, 95% CI: 0.029–0.043, P < 0.001). Lesion volume (Spearman’s rho rs= 0.38, P < 0.001) and g-ratio (rs= 0.24, P < 0.05) correlated independently with plasma neurofilament. In patients with substantial lesion load (n = 38), those with higher g-ratio (defined as greater than median) were more likely to have abnormally elevated plasma neurofilament than those with normal g-ratio (defined as less than median) [11/23 (48%) versus 2/15 (13%), P < 0.05]. These data suggest that, even at multiple sclerosis diagnosis, reduced myelin integrity is associated with axonal damage. MRI-derived g-ratio may provide useful additional information regarding lesion severity and help to identify individuals with a high degree of axonal damage at disease onset.
Surgical outcomes of two different reconstruction routes for esophagectomy in esophageal cancer patients: a meta-analysis
Authors: Yan Dongqing , Zheng Hongjie , Wang Peijie , Yin Yin , Zhang Qiwei , Zhang Liang , Liang Hongsen , Shi Donglei , Hu Liu , Fan Haiyang , Wang Zhaojun , Zeng FeiFei , Zhang Junhang , Li Yun
Published: October 2021

To evaluate the effects of two different reconstruction routes (the posterior mediastinal route (PR) and the retrosternal route (RR)) on the surgical outcomes of patients after esophagectomy for esophageal carcinoma. PubMed, Embase, Web of Science and Scopus were searched from database inception to March 2021. Randomized controlled trials (RCTs) and case–control trials on the surgical outcomes of patients undergoing esophagectomy via one of the two routes were included. RevMan 5.3 software was used for the meta-analysis. In total, 19 studies were included, 8 were RCTs and 11 were case–control studies. The meta-analysis showed that among the case–control trials, the PR had reduced rates of anastomotic leakage [odds ratio (OR) = 0.56, 95% confidence interval (CI) (0.43, 0.74), P < 0.01]. In addition, it had reduced rates of anastomotic stenosis [OR = 0.42, 95% CI (0.30, 0.59), P < 0.01] and pulmonary complications [OR = 0.63, 95% CI (0.47, 0.84), P < 0.01]. However, there was no significant difference in cardiac complications [RCTs, relative risk (RR) = 0.57, 95% CI (0.29, 1.11), P = 0.10; case–control trials, OR = 1.06, 95% CI (0.70, 1.62), P = 0.78] or postoperative mortality [RCTs, RR = 0.47, 95% CI (0.19, 1.16), P = 0.10; case–control trials, OR = 0.68, 95% CI (0.32, 1.44), P = 0.31]. Compared with the RR, the PR had reduced rates of anastomotic leakage, anastomotic stenosis and pulmonary complications.
Heterogeneity in the transcriptional response of the human pathogen Aspergillus fumigatus to the antifungal agent caspofungin
Authors: Colabardini Ana Cristina , Wang Fang , Dong Zhiqiang , Pardeshi Lakhansing , Rocha Marina Campos , Costa Jonas Henrique , dos Reis Thaila Fernanda , Brown Alec , Jaber Qais Z , Fridman Micha , Fill Taicia , Rokas Antonis , Malavazi Iran , Wong Koon Ho , Goldman Gustavo Henrique
Published: October 2021

Aspergillus fumigatus is the main causative agent of invasive pulmonary aspergillosis (IPA), a severe disease that affects immunosuppressed patients worldwide. The fungistatic drug caspofungin (CSP) is the second line of therapy against IPA but has increasingly been used against clinical strains that are resistant to azoles, the first line antifungal therapy. In high concentrations, CSP induces a tolerance phenotype with partial reestablishment of fungal growth called CSP paradoxical effect (CPE), resulting from a change in the composition of the cell wall. An increasing number of studies has shown that different isolates of A. fumigatus exhibit phenotypic heterogeneity, including heterogeneity in their CPE response. To gain insights into the underlying molecular mechanisms of CPE response heterogeneity, we analyzed the transcriptomes of two A. fumigatus reference strains, Af293 and CEA17, exposed to low and high CSP concentrations. We found that there is a core transcriptional response that involves genes related to cell wall remodeling processes, mitochondrial function, transmembrane transport, and amino acid and ergosterol metabolism, and a variable response related to secondary metabolite (SM) biosynthesis and iron homeostasis. Specifically, we show here that the overexpression of a SM pathway that works as an iron chelator extinguishes the CPE in both backgrounds, whereas iron depletion is detrimental for the CPE in Af293 but not in CEA17. We next investigated the function of the transcription factor CrzA, whose deletion was previously shown to result in heterogeneity in the CPE response of the Af293 and CEA17 strains. We found that CrzA constitutively binds to and modulates the expression of several genes related to processes involved in CSP tolerance and that crzA deletion differentially impacts the SM production and growth of Af293 and CEA17. As opposed to the ΔcrzACEA17 mutant, the ΔcrzAAf293 mutant fails to activate cell wall remodeling genes upon CSP exposure, which most likely severely affects its macrostructure and extinguishes its CPE. This study describes how heterogeneity in the response to an antifungal agent between A. fumigatus strains stems from heterogeneity in the function of a transcription factor and its downstream target genes.
Visual Impairment and Risk of Dementia in 2 Population-Based Prospective Cohorts: UK Biobank and EPIC-Norfolk
Authors: Littlejohns Thomas J , Hayat Shabina , Luben Robert , Brayne Carol , Conroy Megan , Foster Paul J , Khawaja Anthony P , Kuźma Elżbieta
Published: October 2021

Visual impairment has emerged as a potential modifiable risk factor for dementia. However, there is a lack of large studies with objective measures of vision and with more than 10 years of follow-up. We investigated whether visual impairment is associated with an increased risk of incident dementia in UK Biobank and European Prospective Investigation into Cancer in Norfolk (EPIC-Norfolk). In both cohorts, visual acuity was measured using a “logarithm of the minimum angle of resolution” (LogMAR) chart and categorized as no (≤0.30 LogMAR), mild (>0.3 to ≤0.50 LogMAR), and moderate to severe (>0.50 LogMAR) impairment. Dementia was ascertained through linkage to electronic medical records. After restricting to those aged ≥60 years, without prevalent dementia and with eye measures available, the analytic samples consisted of 62 206 UK Biobank and 7 337 EPIC-Norfolk participants, respectively. In UK Biobank and EPIC-Norfolk, respectively, 1 113 and 517 participants developed dementia over 11 and 15 years of follow-up. Using multivariable Cox proportional-hazards models, the hazard ratios for mild and moderate to severe visual impairment were 1.26 (95% confidence interval [CI]: 0.92–1.72) and 2.16 (95% CI: 1.37–3.40), in UK Biobank, and 1.05 (95% CI: 0.72–1.53) and 1.93 (95% CI: 1.05–3.56) in EPIC-Norfolk, compared to no visual impairment. When excluding participants censored within 5 years of follow-up or with prevalent poor or fair self-reported health, the direction of the associations remained similar for moderate impairment but was not statistically significant. Our findings suggest visual impairment might be a promising target for dementia prevention; however, the possibility of reverse causation cannot be excluded.
Clinical Study of Mesenchymal Stem/Stromal Cell Therapy for the Treatment of Frailty: A Proposed Experimental Design for Therapeutic and Mechanistic Investigation
Authors: Hoang Duc M , Nguyen Kien T , Hoang Van T , Dao Lan T M , Bui Hang T , Ho Thanh T K , Nguyen Thuy T P , Ngo Anh T L , Nguyen Hoa K , Thanh Liem Nguyen
Published: October 2021

Frailty, a specific condition of increased vulnerability and reduced general health associated with aging in older people, is an emerging problem worldwide with major implications for clinical practice and public health. Recent preclinical and clinical studies have supported the safety of mesenchymal stem/stromal cells (MSCs) in the treatment of frailty. Comprehensive study is needed to assess the interrelationship between the condition of frailty and the effects of MSC-based therapy. This randomized controlled phase I/II trial aims to investigate the safety and potential therapeutic efficacy of the allogeneic administration of umbilical cord-derived MSCs (UC-MSCs) in combination with the standard treatment for frailty in Vietnam. Moreover, this study describes the rationales, study designs, methodologies, and analytical strategies currently employed in stem cell research and clinical studies. The primary outcome measures will include the incidences of prespecified administration-associated adverse events and serious adverse events. The potential efficacy will be evaluated based on improvements in frailty conditions (including those determined through a physical examination, patient-reported outcomes, quality of life, immune markers of frailty, metabolism analysis, and cytokine markers from patient plasma). This clinical trial and stem cell analysis associated with patient sampling at different time points aim to identify and characterize the potential effects of UC-MSCs on improving frailty based on the stem cell quality, cytokine/growth factor secretion profiles of UC-MSCs, cellular senescence, and metabolic analysis of patient CD3+ cells providing fundamental knowledge for designing and implementing research strategies in future studies.

Clinical Trials Registration Number: NCT04919135
Communicative Resilience of First-Generation College Students During the COVID-19 Pandemic
Authors: Scharp Kristina M , Wang Tiffany R , Wolfe Brooke H
Published: October 2021

As U.S. higher education institutions closed their campuses and transitioned to online education due to the high risk for COVID-19 transmission, first-generation college students (FGS) were particularly susceptible to multiple stressors. Findings from a sample of 44 participants reveal seven resilience triggers, four resilience processes, and three relationships between resilience processes and triggers. Based on these findings, we advance the communication theory of resilience by establishing the ways triggers can be structural, emergent, and overlapping and by theorizing resilience processes as both enduring and time-bound/contingent. We also employ a new qualitative method, thematic co-occurrence analysis, to illuminate the relationships between the resilience triggers and processes. Practical applications for higher education administrators, teaching instructors, and student support professionals are described.
Implementing a digital system for contact tracing and case investigation during COVID-19 pandemic in San Francisco: a qualitative study
Authors: Burgess Hailey , Gutierrez-Mock Luis , Ho Yun-Xian , Moghadassi Michelle , Lesh Neal , Krueger Elizabeth , Reid Michael
Published: October 2021

During the COVID-19 pandemic, many health jurisdictions deployed digital informatics systems to support “manual” case investigation and contact tracing (CICT). This case study evaluates the implementation and use of a digital information system through the experiences of CICT workers in the City and County of San Francisco (CCSF). We conducted semi-structured, 90-min interviews with a sample of the CCSF CICT workforce (n = 37). Participants also completed standardized assessments of the digital system using the System Usability Scale (SUS). Qualitative analyses highlighted (1) the importance of digital tools to ensure rapid onboarding and effective data capture in a public health emergency; (2) the use of digital systems to support culturally sensitive care; and (3) the role of digitals tools in building supportive work environments. The mean SUS score was 70/100 (SD = 17), indicating relative ease of use. In summary, the analysis highlights the importance of digital tools to support manual CICT in the COVID-19 response.
Effects of dietary inclusion of Radix Bupleuri extract on the growth performance, and ultrastructural changes and apoptosis of lung epithelial cells in broilers exposed to atmospheric ammonia
Authors: Bai Shiping , Peng Xi , Wu Caimei , Cai Tong , Liu Jiangfeng , Shu Gang
Published: October 2021

To explore whether Radix Bupleuri extract (RBE) could protect lung injury of broilers under ammonia (NH3) exposure, 360 one-d-old male broilers were randomly allocated to four groups of six replicates each in a 2 × 2 factorial design with two diets (the basal diet [control; CON] and the basal diet supplemented with RBE [RB]) and two air conditions (normal condition [<2 ppm of NH3; NOR] and NH3 exposure [70 ppm of NH3; NH70]). The RB diet contained 80 mg saikosaponins/kg diet. On day 7, the lung tissues were collected and the lung epithelial cells (LEC) were isolated. Our experimental results showed that the NH3 exposure decreased body weight gain and feed intake irrespective of dietary treatments during days 1 to 7. However, the RBE addition decreased feed consumption to body weight gain ratio in broilers under NH70 conditions. In the LEC of CON-fed broilers under NH70 conditions, Golgi stacks showed the dilation of cisternaes and reduced secretory vesicles, mitochondria enlarged, the inner membrane of mitochondria became obscure, and the cristae of mitochondria ruptured, whereas only a mild enlargement of Golgi cisternaes and the part rupture of mitochondrial cristaes occurred in the LEC of RB-fed broilers under NH70 conditions. The NH3 exposure increased malondialdehyde (MDA) level, but decreased total antioxidant capacity (T-AOC) in the lungs of CON-fed broilers. However, the RBE addition decreased MDA level and increased T-AOC in the lungs of broilers under NH70 conditions. Simultaneously, the NH3 exposure increased apoptotic rate (AR), mitochondrial membrane potential (MMP), and reactive oxygen species (ROS) level in the isolated LEC of CON-fed broilers. The RBE addition decreased AR, MMP, and ROS in the isolated LEC of broilers under NH70 condition. Besides, the NH3 exposure increased mRNA expression of B-cell lymphoma-2 associated X protein (BAX), caspase-3, and tumor necrosis factor α (TNF-α), but increased interferon γ (IFN-γ) mRNA abundance in the lungs of CON-fed broilers. The RBE supplement decreased mRNA levels of BAX, caspase-3, and TNF-α, but increased IFN-γ, interleukin (IL)-4, and IL-17 mRNA levels in the lungs of broilers under NH70 conditions. These results indicated that dietary RBE addition alleviated NH3 exposure-induced intercellular ultrastructural damage via mitochondrial apoptotic pathway, possibly due to RBE-induced increase of antioxidant capacity and immunomodulatory function in the lungs of broilers under NH3 exposure.
Common Bubble Detection in Large Dimensional Financial Systems
Authors: Chen Ye , Phillips Peter C B , Shi Shuping
Published: October 2021

Price bubbles in multiple assets are sometimes nearly coincident in occurrence. Such near-coincidence is strongly suggestive of co-movement in the associated asset prices and is likely driven by certain factors that are latent in the financial or economic system with common effects across several markets. Can we detect the presence of such common factors at the early stages of their emergence? To answer this question, we build a factor model that includes I(1), mildly explosive, and stationary factors to capture normal, exuberant, and collapsing phases in such phenomena. The I(1) factor models the primary driving force of market fundamentals. The explosive and stationary factors model latent forces that underlie the formation and destruction of asset price bubbles, which typically exist only for subperiods of the sample. The article provides an algorithm for testing the presence of and date-stamping the origination and termination of price bubbles determined by latent factors in a large-dimensional system embodying many markets. Asymptotics of the bubble test statistic are given under the null of no common bubbles and the alternative of a common bubble across these markets. We prove the consistency of a factor bubble detection process for the origination and termination dates of the common bubble. Simulations show good finite sample performance of the testing algorithm in terms of its successful detection rates. Our methods are applied to real estate markets covering eighty-nine major cities in China over the period January 2005 to December 2008. Results suggest the presence of a common bubble episode in what are known as China’s Tier 1 and Tier 2 cities from June 2007 to February 2008. There is also a common bubble episode in Tier 3 cities but of shorter duration.
Lysine biofortification of crops to promote sustained human health in the 21st century
Authors: Yang Qingqing , Zhao Dongsheng , Zhang Chuangquan , Sreenivasulu Nese , Sun Samuel Sai-Ming , Liu Qiaoquan
Published: October 2021

Crop biofortification is pivotal in preventing malnutrition, with lysine considered the main limiting essential amino acid (EAA) required to maintain human health. Lysine deficiency is predominant in developing countries where cereal crops are the staple food, highlighting the need for efforts aimed at enriching the staple diet through lysine biofortification. Successful modification of aspartate kinase (AK) and dihydrodipicolinate synthase (DHDPS) feedback inhibition has been used to enrich lysine in transgenic rice plants without yield penalty, while increases in the lysine content of quality protein maize have been achieved via marker-assisted selection. Here, we reviewed the lysine metabolic pathway and proposed the use of metabolic engineering targets as the preferred option for fortification of lysine in crops. Use of gene editing technologies to translate the findings and engineer lysine catabolism is thus a pioneering step forward.
A systematic review of adaptations and effectiveness of scaled-up nutrition interventions
Authors: Sutherland Rachel L , Jackson Jacklyn K , Lane Cassandra , McCrabb Sam , Nathan Nicole K , Yoong Sze Lin , Lum Melanie , Byaruhanga Judith , McLaughlin Matthew , Brown Alison , Milat Andrew J , Bauman Adrian E , Wolfenden Luke
Published: October 2021

Context

Public health nutrition interventions shown to be effective under optimal research conditions need to be scaled up and implemented in real-world settings.

Objectives

The primary aim for this review was to assess the effectiveness of scaled-up public health nutrition interventions with proven efficacy, as examined in a randomized controlled trial. Secondary objectives were to: 1) determine if the effect size of scaled-up interventions were comparable to the prescale effect, and; 2) identify any adaptations made during the scale-up process.

Data sources

Six electronic databases were searched and field experts contacted.

Study selection

An intervention was considered scaled up if it was delivered on a larger scale than a preceding randomized controlled trial (“prescale”) in which a significant intervention effect (P ≤ 0.05) was reported on a measure of nutrition.

Data extraction

Two reviewers independently performed screening and data extraction. Effect size differences between prescale and scaled-up interventions were quantified. Adaptations to scale-up studies were coded according to the Adaptome model.

Results

Ten scaled-up nutrition interventions were identified. The effect size difference between prescale trials and scaled-up studies ranged from –32.2% to 222% (median, 50%). All studies made adaptations between prescale to scaled-up interventions.

Conclusion

The effects of nutrition interventions implemented at scale typically were half that achieved in prior efficacy trials. Identifying effective scale-up strategies and methods to support retainment of the original prescale effect size is urgently needed to inform public health policy.

Systematic Review Registration

PROSPERO registration no.CRD42020149267.
Mycobacterium Avium Complex Infection as a Rare Cause of Cerebral Mass Lesion and IRIS in a Patient with AIDS: Case Report and Review of the Literature
Authors: Lane-Donovan Courtney , Bainbridge Emma , Szumowski John , Kerkhoff Andrew D , Peluso Michael J
Published: October 2021

A patient with advanced HIV/AIDS presented with a brain abscess. While brain biopsy culture and pathology were unrevealing, universal broad-range PCR (uPCR) demonstrated Mycobacterium avium complex (MAC). We review the clinicopathologic characteristics of MAC brain abscesses and highlight the effectiveness of uPCR as a diagnostic tool in partially-treated infections.
19 Anxiolysis for laceration repair in children: A survey of pediatric emergency providers in Canada
Authors: Kumar Kriti , Ali Samina , Sabhaney Vikram , Trottier Evelyne D , Drendel Amy , Shah Amit , Bhatt Maala , Poonai Naveen
Published: October 2021

Primary Subject area

Emergency Medicine - Paediatric

Background

Laceration repair accounts for half of procedures performed in pediatric emergency departments. Although commonly used, topical anesthetics do little to alleviate emotional distress, particularly in young children. Intranasal midazolam is frequently used but is not consistently effective. Intranasal dexmedetomidine (IND) is a new and potentially effective anxiolytic but clinical uptake is limited by a lack of pediatric data.

Objectives

Our objective was to understand pediatric emergency providers’ willingness, preferences, and perceived barriers surrounding anxiolysis for laceration repair in children, to inform the design of a future clinical trial of IND.

Design/Methods

This was an online survey of Canadian pediatric emergency providers listed in the Pediatric Emergency Research Canada database. The survey was developed according to published guidelines and featured a vignette of a 3-year-old distressed child requiring laceration repair. It was hosted on the Research Electronic Data Capture platform in English and French, and was disseminated from September to December 2020. The primary outcome was the proportion of respondents that would provide anxiolysis. Secondary outcomes included perceived barriers to IND use. Data were reported using summary statistics.

Results

The response rate was 155/225 (68.9%), of which 98/141 (70%) were Royal College accredited pediatric emergency physicians. For 129/147 (88%) of respondents, 80-100% of their patients were children. 123/146 (84%) had > 6 years independent practice experience and 126/146 (86%) performed > 4 laceration repairs per month. 127/148 (86%) believed that > 25% of children experienced distress significant enough to require physical restraint during laceration repair. 116/148 (78%) indicated they would provide anxiolysis, mainly as intranasal benzodiazepines, such as midazolam (100/109, 92%). 95/148 (64%) indicated that they would consider IND if evidence suggested it was effective. Common perceived barriers included inadequate personal (114/145, 79%) and nursing (109/145, 75%) experience with IND, and lack of formulary access to IND (60/145, 41%).

Conclusion

Most pediatric emergency providers believe that laceration repair in a young child is distressing and would provide anxiolysis. Most providers would consider IND if there was evidence of benefit, suggesting that favourable findings from a clinical trial would have good clinical uptake.
20 Adolescent and caregiver perspectives on living with a limb fracture: A qualitative study
Authors: Bharadia Manisha , Golden-Plotnik Stevi , van Manen Michael , Sivakumar Mithra , Drendel Amy , Poonai Naveen , Moir Mackenzie , Ali Samina
Published: October 2021

Primary Subject area

Emergency Medicine - Paediatric

Background

Fractures occur in up to half of children by age 16 years. After initial emergency care for a fracture, function is universally impaired in children, and impacts extend to the immediate family. Knowledge of expected functional limitations is key to providing proper discharge instructions and anticipatory guidance to families.

Objectives

Our study objectives were to understand: 1) how adolescents (12-17 years) describe the functional impact of fractures on their lives; 2) how adolescents’ reports of their experiences compare to those of their caregivers; and 3) the impact of the fracture on the family unit.

Design/Methods

We conducted individual, semi-structured interviews from June 2019 to November 2020 with adolescents and their caregivers, 7-14 days following their initial visit to a pediatric emergency department. We utilized qualitative content analysis methodology. Recruitment proceeded until thematic saturation was achieved. Coding and analysis were concurrent with recruitment and interviews. A secondary coder reviewed 40% of the transcripts, and the coding team met regularly to discuss the coding framework and key themes. The interview script was modified in an iterative process, to reflect emerging themes.

Results

We completed a total of 29 interviews. The most commonly affected functions were: a) showering and hygiene (which required the most caregiver support); b) sleep variability (due to pain and cast-related discomfort); and c) exclusion from sports/activities. Many adolescents experienced disruptions to social activities and gatherings. Adolescents valued independence and often chose to take more time to complete a task to preserve this, regardless of inconvenience. Both adolescents and caregivers reported feelings of frustration as a result of day-to-day impacts imposed by the injury. Generally, caregivers’ perspectives were in keeping with the experiences that adolescents described for themselves. Notable family impacts included what we described as ‘sibling burden’ or conflicts that arose when a sibling had to take on extra chores/tasks.

Conclusion

These themes highlight an opportunity to better tailor discharge instructions for adolescents with fractures. Key messages include: 1) expect pain and impaired sleep, especially in the first few days; 2) allow extra time to complete tasks independently, especially for grooming and hygiene; 3) consider family impact, especially sibling burden; 4) prepare for changes in activities and social dynamics; and 5) frustration is normal, for both adolescents and caregivers. Future work can focus on developing a novel, family-informed tool to assess functional outcomes following injury.