bluuebunny/crossref_metadata_2025 huggingface dataset:
A versatile embedding medium for freeform bioprinting with multi-crosslinking methods
Authors: Li Qi , Jiang Zhuoran , Ma Liang , Yin Jun , Gao Ziqi , Shen Luqi , Yang Huayong , Cui Zhanfeng , Ye Hua , Zhou Hongzhao
Published: June 2022

Embedded freeform writing addresses the contradiction between the material printability and biocompatibility for conventional extrusion-based bioprinting. However, the existing embedding mediums have limitations concerning the restricted printing temperature window, compatibility with bioinks or crosslinkers, and difficulties on medium removal. This work demonstrates a new embedding medium to meet the above demands, which composes of hydrophobically modified hydroxypropylmethyl cellulose and Pluronic F-127. The adjustable hydrophobic and hydrophilic associations between the components permit tunable thermoresponsive rheological properties, providing a programmable printing window. These associations are hardly compromised by additives without strong hydrophilic groups, which means it is compatible with the majority of bioink choices. We use polyethylene glycol 400, a strong hydrophilic polymer, to facilitate easy medium removal. The proposed medium enables freeform writing of the millimetric complex tubular structures with great shape fidelity and cell viability. Moreover, five bioinks with up to five different crosslinking methods are patterned into arbitrary geometries in one single medium, demonstrating its potential in heterogeneous tissue regeneration. Utilizing the rheological properties of the medium, an enhanced adhesion writing method is developed to optimize the structure’s strand-to-strand adhesion. In summary, this versatile embedding medium provides excellent compatibility with multi-crosslinking methods and a tunable printing window, opening new opportunities for heterogeneous tissue regeneration.
Strategic low-cost energy investment opportunities and challenges towards achieving universal electricity access (SDG7) in forty-eight African nations
Authors: Pappis Ioannis
Published: June 2022

Strategic energy planning to achieve universal electricity access and meet the future energy needs of African nations is essential to formulate effective policy measures for climate change mitigation and adaptation. Africa cannot afford a cost-prohibiting green energy transition to achieve United Nations Sustainable Development Goal 7. In this study, I employ open-access energy models, enhanced with geospatial data, to identify least-cost power generation investment options for forty-eight African nations. Different levels of electricity consumption per capita and costs of renewables are considered across four scenarios. According to the analysis, to achieve universal electricity access by 2030 in Africa, the power generation capacity needs to increase between 211 GW–302 GW, depending on electricity consumption levels and the cost of renewables considered, leading electricity generation to rise between 6221 PJ–7527 PJ by 2030. Higher electricity generation levels lead to higher penetration of fossil fuel technologies in the power mix of Africa. Natural gas will be the dominant fossil fuel source by 2030, while the decreasing costs of renewables will lead solar to overtake hydropower. To meet the same electricity demand levels, decreasing the cost of renewables can enable a less carbon-intensive power system, although higher capacity is also needed. However, Africa is still hard to achieve its green revolution. Depending on electricity consumption levels and costs of renewables considered, grid-connected technologies are estimated to supply 85%–90% of total electricity generated in Africa in 2030, mini-grid technologies 1%–6%, and stand-alone technologies 8%–11%. Off-grid solar and hybrid mini-grid solar technologies are essential in electrifying residential areas. Higher penetration of renewable energy sources in the energy mix creates local jobs and increases cost-efficiency. The analysis demonstrates that 6.9 million to 9.6 million direct jobs, depending on the policies and renewable development levels, can be created in Africa by expanding the power sector from 2020 to 2030 across the supply chain. While increasing electricity consumption levels in Africa leads to higher total system costs, it is also estimated to create more jobs, fostering political and societal stability. Finally, the decreasing costs of renewables could further increase the penetration of renewables in the energy mix, leading to an even higher number of jobs.
Connecting the dots between urban infrastructure, well-being, livability, and equity: a data-driven approach
Authors: Das Kirti , Ramaswami Anu , Fan Yingling , Cao Jason
Published: June 2022

Developing sustainable, livable and equitable cities is a major policy goal. However, livability metrics are amorphous, emphasizing different dimensions. This paper develops a novel data-driven approach by directly surveying subjective well-being (SWB) of urban residents, alongside satisfaction with key social–ecological–infrastructural–urban correlates to inform livability and equity priorities. Our survey is novel in quantifying SWB (Cantril ladder) of urban residents and evaluating both household- and neighborhood-level correlates while addressing confounding effects of socio-demographics and personality. We propose a three-way typology of provisioning systems—foundational, consistently important and added-bonus—based on their quantitative relationship with SWB. Implemented in the Twin-Cities USA, among 21 attributes, home heating-cooling, neighborhood greenery, access to public transportation and snow removal emerged as foundational in cold Minnesota climates; home size was consistently important and satisfaction with streets an added-bonus. Assessing inequality in foundational and consistently important categories revealed disparities by income and race, informing local infrastructure priorities for livability and equity. Key insights emerged on sufficiency and sustainability.
Warm-season temperatures and emergency department visits among children with health insurance
Authors: Stowell Jennifer D , Sun Yuantong , Spangler Keith R , Milando Chad W , Bernstein Aaron , Weinberger Kate R , Sun Shengzhi , Wellenius Gregory A
Published: June 2022

High ambient temperatures have become more likely due to climate change and are linked to higher rates of heat-related illness, respiratory and cardiovascular diseases, mental health disorders, and other diseases. To date, far fewer studies have examined the effects of high temperatures on children versus adults, and studies including children have seldom been conducted on a national scale. Compared to adults, children have behavioral and physiological differences that may give them differential heat vulnerability. We acquired medical claims data from a large database of commercially insured US children aged 0–17 from May to September (warm-season) 2016–2019. Daily maximum ambient temperature and daily mean relative humidity estimates were aggregated to the county level using the Parameter-elevation Relationships on Independent Slopes dataset, and extreme heat was defined as the 95th percentile of the county-specific daily maximum temperature distribution. Using a case-crossover design and temperature lags 0–5 days, we estimated the associations between extreme heat and cause-specific emergency department visits (ED) in children aged <18 years, using the median county-specific daily maximum temperature distribution as the reference. Approximately 1.2 million ED visits in children from 2489 US counties were available during the study period. The 95th percentile of warm-season temperatures ranged from 71 °F to 112 °F (21.7 °C to 44.4 °C). Comparing 95th to the 50th percentile, extreme heat was associated with higher rates of ED visits for heat-related illness; endocrine, nutritional and metabolic diseases; and otitis media and externa, but not for all-cause admissions. Subgroup analyses suggested differences by age, with extreme heat positively associated with heat-related illness for both the 6–12 year (odds ratio [OR]: 1.34, 95% confidence interval [CI]: 1.16, 1.56) and 13–17 year age groups (OR: 1.55, 95% CI: 1.37, 1.76). Among children with health insurance across the US, days of extreme heat were associated with higher rates of healthcare utilization. These results highlight the importance of individual and population-level actions to protect children and adolescents from extreme heat, particularly in the context of continued climate change.
Joint ergodicity of Hardy field sequences
Authors: Tsinas Konstantinos
Published: June 2022

We study mean convergence of multiple ergodic averages, where the iterates arise from smooth functions of polynomial growth that belong to a Hardy field. Our results include all logarithmico-exponential functions of polynomial growth, such as the functions

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/

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,
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and

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. We show that if all non-trivial linear combinations of the functions

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, …,

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stay logarithmically away from rational polynomials, then the

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2

L^2

-limit of the ergodic averages
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exists and is equal to the product of the integrals of the functions

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, …,

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in ergodic systems, which establishes a conjecture of Frantzikinakis. Under some more general conditions on the functions

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, …,

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, we also find characteristic factors for convergence of the above averages and deduce a convergence result for weak-mixing systems.
Minimal free resolutions of differential modules
Authors: Brown Michael , Erman Daniel
Published: June 2022

We propose a notion of minimal free resolutions for differential modules, and we prove existence and uniqueness results for such resolutions. We also take the first steps toward studying the structure of minimal free resolutions of differential modules. Our main result in this direction explains a sense in which the minimal free resolution of a differential module is a deformation of the minimal free resolution of its homology; this leads to structural results that mirror classical theorems about minimal free resolutions of modules.
934 IMPROVING THE QUALITY OF FRAILTY DISCHARGE SUMMARIES THROUGH INCORPORATION OF A COMPREHENSIVE GERIATRIC ASSESSMENT
Authors: Weatherley J , Mithani P , Kaneshamoorthy M
Published: June 2022

Introduction

The CGA identifies patient needs within seven domains: cognition & mood, continence, mobility, speech and language therapy, skin integrity, social context, nutrition; has been shown to reduce admission and readmissions, and when combined with a personalised care plan, can reverse progression of frailty. We aimed to improve discharge documentation of the seven CGA domains on two elderly care wards at Southend University Hospital, within two months. At baseline, only 18% of all domains were addressed. 87% of observations were subjective, while personalised care plans addressing at risk domains were absent.

Method

Three outcomes measured included: 1. % of all domains addressed 2. % of domains with objective/measurable observations 3. % of discharge letters with personalised care plans addressing at least one domain PDSA 1 introduced CGA as a concept through teaching sessions to the frailty MDT. PDSA 2 presented a poster to provide measurable criteria for each domain. PDSA 3 created competition between wards, through light-hearted forfeit. PDSA 4 offered a checklist proforma. PDSA 5 introduced personalised care plans targeting ‘at risk’ domains.

Results

PDSA 1, 2 and 3 showed incremental improvement in all outcomes. % CGA domains addressed improved from 17% to 74%. % objective or measurable observations improved from 13% to 51%. % of letters with personalised care plans improved from 38% to 74%. PDSA 4 showed a decrease in all outcomes, although remaining above results at baseline. PDSA 5 revealed an improvement in all outcomes compared to PDSA 4.

Conclusion

Through regular interventions, including empowering the frailty MDT to value CGA, significant improvement can be achieved. Consistent teaching proved steady improvement in all outcomes, while introducing competition showed the greatest improvement. Further plans to introduce to other medical wards and to digitise the CGA pro-forma are in progress to ensure sustained improvement.
961 ‘WE CARE!’: CARE WORKERS’ SELF-PERCEIVED MEANING OF RESIDENTIAL AGED CARE WORK
Authors: Yau I S-Y , Huang S , Lee L , Lee Y , Li S , Yau S , Lai S , Law S
Published: June 2022

Introduction

Aged care workers in residential care homes of the elderly (RCHEs) are socially devalued as less skilled, low-paid, and doing ‘dirty work’. Care workers’ insider experiences with the meaning of residential aged care work are largely absent from the community and the literature.

Method

A qualitative study was conducted to examine the self-perceived meaning of work (MOW) among care workers in RCHEs in Hong Kong, an East Asian metropolis with a rapidly aging population, and unique socio-cultural meanings of elderly care. Adopting the Grounded Theory Method, in-depth interviews with 27 care workers in 6 RCHEs were conducted.

Results

Findings suggest that regardless of the job requirements of carrying out ‘dirty tasks’ and shared experiences of public devaluations, RCHE care workers find positive meanings in their work including: contributing to the greater good of helping the elderly; establishing meaningful relationships; forming a professional identity of geriatric care; achieving personal growth; ensuring job security and benefits in the aged care job market. Care workers find their work meaningful primarily because it is essential to maintain the elderly’s health and quality of life, which echoes with the Chinese cultural values of ‘accumulating fortune’ and ‘respecting the elderly’. Engaging in residential care work allows care workers to build long-term relationships with the elderly, through which they found joys and knowledge of life such as letting go. Care workers propose that geriatric care is highly skillful and professional, requiring communication, coordination, and chronic illness care skills. Care workers identify several inhibitors of attaining MOW, including heavy workloads, manpower shortage, and dehumanizing bureaucratic practices.

Conclusion

Care workers offer counter-narratives of public devaluation and reframe the meaning of care work in RCHEs. These findings have broader implications on policy, professional, and education interventions in promoting the public recognition of aged care work.

The work described in this paper was fully supported by a grant from the Research Grants Council of the Hong Kong Special Administrative Region, China (UGC/FDS16/M12/20).
996 EFFECT OF COVID-19 ON HIP FRACTURE CARE IN WALES - AN ANALYSIS OF HOW ORGANISATION OF SERVICES AFFECTED HOSPITAL LENGTH OF STAY
Authors: Probert A , Davis K , Singh I , Holleyman R , Gregson C , Johansen A
Published: June 2022

Introduction

The National Hip Fracture Database (NHFD) report that length of stay (LOS) fell (from 19.7 to 16.9 days) in the first year of the COVID-19 pandemic, as patients, families, cares, and staff in health and social care responded to this challenge. This analysis examines trends in Wales where LOS can be profiled very completely as it predominantly remains within a single health board.

Method

We used data from the NHFD www.nhfd.co.uk to define pre-pandemic LOS (in the year to 1st March 2020) and compare this with the following 18 months. We set figures for all 12 hospitals in Wales against the changes in service organisation which each reported to the NHFD's 2020 Facilities Survey, and against the local incidence of COVID-19 among their hip fracture patients.

Results

Monthly LOS fell markedly at the pandemic's onset; the national figure falling 8.3 days (from 31.2–22.9 days) between February and June 2020. Overall LOS in Wales fell by 1.6 days across the year as a whole, but this ranged from a fall of 6.3 days in one hospital to a rise of 4.5 days in another. Five hospitals reported a rise in LOS. These hospitals had either never had orthogeriatric support, or lost this to COVID-19 duties, they did not achieve the initial fall in LOS in response to the pandemic, and they reported pressures with ‘outliers’ after the first wave. Unlike other units in Wales they cited problems with workload, particularly in terms of physiotherapy.

Discussion

NHFD data provide a detailed picture of hospitals’ response to the COVID-19 pandemic, and allow us to examine service factors underpinning their resilience in the face of this challenge. More detailed work should be carried out for the 150 hospitals in England using the same sources of data.
1024 THE IMPACT OF FRAILTY ON 30-DAY MORTALITY FOLLOWING PRIMARY HIP AND KNEE ARTHROPLASTY DUE TO OSTEOARTHRITIS
Authors: Cook M J , Lunt M , Board T , O'Neill T W
Published: June 2022

Introduction

We determined the association between frailty and 30-day mortality following total hip and knee arthroplasty (THA/TKA) due to osteoarthritis and also the impact of THA/TKA on 30-day mortality compared to a control population.

Method

We used linked primary and secondary care data and Office for National Statistics mortality data. Frailty was assessed using the electronic frailty index and categorised as fit, mild, moderate, and severe frailty. The association between frailty and 30-day mortality following THA/TKA was assessed using Cox regression, adjusted for year of birth, sex, quintile of index of multiple deprivation and year of surgery. Mortality following THA/TKA was also compared to a control population who had osteoarthritis but no previous THA/TKA, matched on year of birth, sex, and quintile of index of multiple deprivation.

Results

103,563 cases who had a THA, 125,367 who had a TKA, and matched controls contributed data. Among those who had surgery, 30-day mortality increased with increasing frailty; adjusted hazard ratio (HR) (95% CI) among severely frail vs fit: following THA, 2.85 (1.84, 4.39); following TKA, 2.14 (1.29, 3.53). Compared to fit controls who did not have surgery, 30-day mortality was higher among fit people who had THA and TKA, respectively, adjusted HR 1.60 (1.15, 2.21) and 2.98 (1.81, 4.89). There was, however, no statistically significant difference in 30-day mortality among cases with mild, moderate and severe frailty compared to controls in the same frailty category.

Conclusion

Among people who had THA and TKA, 30-day mortality increased with increasing frailty. A healthy surgery (selection) effect may have impacted on the comparison of mortality among cases who had THA/TKA and controls who did not have surgery.
933 FACTORS ASSOCIATED WITH LENGTH OF STAY ON OLDER PEOPLE’S MEDICINE WARDS
Authors: Bunn J , Lewis E G , Cropp A , Baldwin  , Wilson C , Frith J , Kilsby A
Published: June 2022

Introduction

The Newcastle upon Tyne Hospitals NHS Foundation Trust’s Older People’s Medicine (OPM) department includes six inpatient wards. It was hypothesized that an increasing prevalence of inpatient frailty would be associated with increased length of stay.

Method

Data were collected on OPM wards, on a single day of February 2020 and July 2021. Demographic details, mobility, presence of delirium, resuscitation status, length of stay (LOS), and Clinical Frailty Scale (CFS) status was recorded (frailty defined as CFS score ≥ 5). Descriptive statistics and tests of significance comparing 2020 with 2021 data were performed. Independent associations with above-median LOS were analysed using binary logistic regression.

Results

There were 172 inpatients in 2020, and 160 in 2021. Median age was 84 (range 66–98 years) in 2020, and 85 (range 64–99 years) in 2021. 87 (54.4%) in 2021, and 102 (59.3%) in 2020 were female. Prevalence of pre-admission frailty was higher in 2021 (n = 143, 89.4%) compared to 2020 (n = 125, 72.7%, p < 0.0001). The prevalence of delirium was higher (n = 60, 37.5%, p < 0.0001) and fewer were independently mobile (n = 53, 33.1%, p = 0.013) in 2021 than in 2020. Nevertheless, median LOS was shorter in 2021, 9 days (range 1.0–106.9) versus 15 days (range 0.7–87.0) in 2020, p = 0.006. Being admitted from home and having a DNACPR were independent predictors of increased LOS (OR 2.4 [95% CI 1.4 to 4.0] for both), controlling for age, sex, frailty, delirium, and reduced mobility.

Conclusion

Despite the increased prevalence of frailty, delirium and reduced mobility, these factors were not associated with increased LOS. Residence at home and DNACPR were associated with above-median LOS, irrespective of the patient’s frailty, delirium or mobility status. Overall, this suggest appropriate high quality care is being delivered, despite increased pressures due to shorter LOS and higher frailty prevalence.
936 IMPROVING DELIRIUM SCREENING IN OLDER ADULTS AT THE ROYAL UNITED HOSPITAL, BATH
Authors: Cross R , Trew C , Howell K , Dyer C
Published: June 2022

Introduction

Delirium affects up to 20% of older patients within hospital and is associated with increases in mortality, length of stay, institutionalisation and accelerated cognitive decline in patients with dementia. 30% of cases are preventable. NICE therefore advocates for delirium screening on admission in the elderly and those with cognitive impairment. We aimed to determine the compliance of the RUH Bath with delirium screening. National guidelines advocate for the use of a CAM, 4AT and/or SQiD. The RUH internal policy accepts a full AMT10, AMT4 plus an assessment of alertness, 4AT or a comment from a Consultant geriatrician about the presence of delirium.

Method

Notes of 60 patients on geriatric wards were inspected for compliance with screening in the first 24 hours of the patient’s admission. Following this, we implemented education sessions for junior doctors, changed the hospital admission proformas and re-wrote the hospital guidelines for delirium to re-emphasise the need for screening. We re-screened the notes 6 months after these changes and then again at 18 months to look for longstanding change.

Results

Initially, only 25% of patients were screened according to national standards and 63% met the hospital criteria. At 6 months 52% met the national standard and 82% met the hospital policy. At 18 months 41% the national standard and 87% met the hospital standard. There was also an increase in the proportion of patients being screened for delirium via multiple different method.

Conclusion

There has been significant, long-term improvement in delirium screening at the RUH Bath. This is particularly remarkable for the hospital standard where, despite no further intervention, the figures were maintained over 18 months. Despite a slight degradation in those meeting the national standard, the proportion was still higher than pre-intervention.
957 THE USE OF IPADS AS PART OF PERSON CENTERED CARE IN A TEACHING HOSPITAL IN SINGAPORE
Authors: Oo T , Aung Z , Barrera V , Arroyo S , Lim S
Published: June 2022

The elderly patients are currently the main occupants of acute hospital beds and this trend will likely increase as the world ages. The elderly patients with cognitive issues frequently have behavioural symptoms which may be challenging for the care staff to manage, especially the staff who have not been formally trained in Gerontology. The use of restraints for this group of vulnerable patients should be discouraged as restraints can cause harmful effects.

The use of iPads as a non pharmacological strategy for managing the behavioural symptoms among the elderly in-patients with cognitive issues was effective in reducing agitation, with an improvement in mood and sundown symptoms. The patients were actively and meaningfully engaged with their iPads during therapy.

The nursing staff too, benefited from iPads as a novel therapy for their elderly in-patients with cognitive issues in providing cognitive and social stimulations, which they had no time to provide for. While the patients showed improvement in their behavioural symptoms, the nurses’ stress levels reduced with improved self-reported job satisfaction.
964 MOUTHCARE MATTERS: QI PROJECT TO IMPROVE ORAL HEALTH IN ELDERLY HOSPITAL INPATIENTS
Authors: Daniel C , Gaunt V
Published: June 2022

Background

A quality improvement (QI) project completed over four months on an elderly-care ward comprising 34 inpatients in a UK district general hospital. The QI team comprised the ward Foundation Year 1 (FY1) and Consultant, with Nursing staff consultation.

Introduction

There is evidence that oral-health in elderly people deteriorates with hospitalisation (Terezakis et al. J Clin Periodontol. 2011;38(7):628–636). Poor oral-health is associated with increased incidence of hospital-acquired infections and reduced oral intake (Kaneoka et al. Infect Control Hosp Epidemiol. 2015;36(8):899–906; Poisson et al. Gerodontology. 2016;33(2):61–168). We had no data on oral-health among our hospital inpatients, nor on nursing measures to maintain or improve it. We aimed to collect baseline data and implement ward-based improvements to oral-health assessment and care.

Method

Interventions were identified using a ‘drivers-for-change’ flow-diagram: main interventions were introduction of a mouthcare proforma (for nurse-led assessment of patient oral-health and documentation of mouthcare given), ensuring availability of mouthcare products and providing relevant ward-staff education. Two ‘Plan-Do-Study-Act’ cycles were completed; intervention implementation was staggered two-monthly, following evaluation of preceding changes’ impact. Data to measure impact of changes was collected two-monthly by the FY1 on patient oral-health (subjectively scored with assessment tool), rate of proforma completion and patient-reported completion of routine mouthcare.

Results

Over the four-month period, there were significant improvements to rates of oral-health assessment (proforma completion increased by 86%), completion of routine mouthcare (increased by 32%), and overall patient oral-health: proportion of ‘good’ or ‘excellent’ oral-health scores increased from 21% to 66%. We aim to deliver further ward-based education to maintain progress.

Conclusion

These interventions are simple, low-cost and could be implemented across many elderly-care wards. Wider adoption would improve mouthcare across larger patient-numbers, with potential benefit to both patient experience and morbidity. Ongoing education and integration of the proforma into existing ward ‘patient-care-bundles’ will promote sustained improvement.
1001 IMPACT OF THE INTRODUCTION OF ROUTINE GERIATRICIAN REVIEW FOR OLDER ADULTS UNDERGOING EMERGENCY LAPAROTOMY
Authors: Kiang J , Jegard J , Kaneshamoorthy M
Published: June 2022

Introduction

The number of older adults having emergency abdominal surgery is increasing nationally. In the last National Emergency Laparotomy Audit (NELA) report, 55% of patients were over 65 and 18% were over 80. The wide disparity in mortality rate between under- and over-65 s has persisted since data began collection in 2013. (NELA Seventh Report, 2021). There is already good evidence in Orthopaedic and Vascular surgery that Geriatrician input can improve outcomes including mortality and length of stay. We introduced a Consultant-led service to review every NELA patient aged 65 and above and review the effect on post-operative outcomes.

Method We clinically reviewed NELA qualifying patients aged ≥65 years between September 2020–September 2021. Data including Rockwood Clinical Frailty Score (CFS), NELA mortality risk prediction score, 30-day mortality and discharge destination were analysed.

Results

In total we reviewed 88 patients in 1 year. The median age was 77.5 (range 64–96) years. The median CFS was 3 (range 1–7). 23% patients had a CFS ≥5. 65% patients had a NELA score > 5% (high risk) including 30% with a NELA Score > 20%. The average NELA score was 13.8%. The overall 30-day mortality rate for our cohort was 5.8%; comprised of 10% and 4.7% for patients with a CFS ≥5 and CFS <5 respectively. On discharge, 92% of patients returned to their own home.

Conclusion

We have demonstrated routine review of NELA patients ≥65 years by a Geriatrician-led service has drastically improved outcomes. The mortality rate for both 1) Overall ≥65 (5.8%) and 2) CFS ≥5 (10%) are significantly lower than the national average of 14.6% (ELF Study, 2021) and 18.6% respectively. Importantly, most of these patients were also able to return to their own home. Further research needs to be done on assessing whether reviewing patients pre-operatively can further improve outcomes.
1003 UTILITY AND TOLERABILITY OF CSF AD BIOMARKERS IN A GERIATRICIAN-LED MEMORY SERVICE
Authors: Clancy C , Dolphin H , Kennelly S P
Published: June 2022

Introduction

People with mild cognitive symptoms often require diagnostic clarity and with the advent of disease modifying therapies for Alzheimer’s disease (ad), establishing diagnostic accuracy for amyloid and tau pathology in ad will become more clinically relevant. CSF biomarker analysis via lumbar puncture (LP) is the most accurate and cost-effective means of establishing ad pathology. Despite their clinical validation, few centres offer LP biomarker analysis, frequently citing patient intolerance and reluctance as factors. This study aimed to assess memory clinic patients’ tolerance of LP as a diagnostic tool in the work-up of memory symptoms.

Method

A consecutive sample of patients offered CSF analysis as part of their diagnostic plan in a tertiary memory service of a University Teaching Hospital were included. After clinician discussion, an LP for ad biomarker detection is offered to all patients with amnestic/non-amnestic mild cognitive impairment, or those with atypical motor-cognitive symptoms in this service.

Results

119 patients offered an LP from 2019–2020 were contacted, fifty-four (45%) of whom participated in this study. The average age was 70.1 (±7.5) years, 50% female. Forty-two (42/54, 78%) had an LP performed. More women declined an LP than men (8/12, 66%). Almost all of those who had an LP, (38/42, 90.4%) thought it yielded useful information. Side effects included mild back pain relieved with simple analgesia (11/42, 26%) and headache (3/42, 7%). There were no incidences of neurological sequelae or requirements for dural patch. Of the 12/54 (22%) who declined CSF analysis; reasons included pre-existing back pain (3/12, 25%), needle phobia (3/12, 25%), and only 2/12, (16%) declined because they did not wish to know the results.

Conclusion

This study highlights high levels of acceptance of CSF analysis when offered as part of routine care, with infrequent side effects. Most patients found the clinical information yielded was useful.
1016 USING VIDEO TELEMEDICINE FOR INPATIENT WORKING: A NOVEL APPROACH TO REMOTE WORKING DURING THE COVID-19 PANDEMIC
Authors: Green V , Joyce N
Published: June 2022

Background

Orthogeriatrics inpatient ward.

Introduction

The COVID-19 pandemic changed working patterns for many trainees. Remote telephone or video outpatient consultations became established practice, with clinically vulnerable staff able to support this provision. We adapted the use of telemedicine to provide remote clinical working for inpatient care and continued speciality training opportunities.

Method

Microsoft Teams video conferencing facilitated interaction between the specialist registrar working remotely and the on-site multidisciplinary team (MDT). Daily activities included virtual handover attendance, inpatient ward round consultations and MDT discussions. A portable computer enabled the clinician to see and interact with inpatients remotely. Access to electronic patient records facilitated timely decision making and enactment of management plans. Anonymous MDT feedback was collected via online questionnaires. This project conformed to service evaluation guidelines and ethical approval was not required.

Results

Fourteen staff members completed the feedback survey. Results were overwhelmingly positive, with 78.6% of respondents strongly agreeing that the senior doctor working remotely supported the MDT, facilitated complex clinical decision making and was beneficial to patient care. Feedback noted that some patients praised the ‘clever’ and ‘innovative’ method. Limitations included technical difficulties due to Wi-Fi connection, which contributed to communication not being as fluid as face-to-face consultations and increased ward round duration. Patient factors, namely hearing and cognitive impairment, limited the interaction that patients were able to have with the clinician via video link.

Conclusion

Video inpatient ward round consultations offer an effective opportunity for physicians to continue clinical patient-facing roles whilst working remotely. Furthermore, this minimises the impact of COVID-19 on specialty trainees, by providing continued training and assessment opportunities for individuals required to shield. This novel method affords a framework transferrable to clinicians from other hospital specialties who may be required to work remotely. Future reviews of patient and relative satisfaction with this process are required.
1048 REDUCING RISK FROM WARFARIN- A COMPLETED AUDIT CYCLE ON NICE COMPLIANCE WITH WARFARIN FOR NVAF IN HOSPITALISED OLDER PEOPLE
Authors: Lee-Johnson L , Dwivedi R
Published: June 2022

Introduction

Traditionally Warfarin has been mainly used for stroke thromboprophylaxis in patients with atrial fibrillation but direct oral anticoagulant (DOAC) are increasingly being used as they have improved safety profiles with comparable efficacy. Recent data from National Reporting and Learning System (NRLS) have discovered safety incidents related to anticoagulation, predominantly Warfarin, contributing in excess of 10% of all medication errors. National institute for clinical excellence (NICE) recommends reassessing anticoagulation choice for patients on Warfarin with poor anticoagulation control, indicated by any of the following: 1 > 2 INR values <1.5 or > 5 or 1 INR value >8, within the past 6 months 2 > Time in therapeutic range (TTR) <65% Intervention An initial retrospective audit on 50 patients on Warfarin for NVAF performed between June—September 18 showed poor compliance with NICE. We reviewed the previous 6 months INR values and recorded any significant deviations outside of the therapeutic range as per NICE. TTR over the last 6 months was calculated using the Rosendaal method. Following departmental audit presentation, a reaudit was carried out between Jan-Aug 2019 to assess improvement.

Results

Median age was 87.5 compared to 83 in the first audit. Warfarin was correctly continued in 7/38(18%) in the 1st audit which improved to 9/28 (32%) in the second. Number of patients discharged on warfarin with unstable INRs decreased significantly from 26/32 (81%) patients in the 1st audit to 10/24 (42%) in the 2nd.

Discussion

Our reaudit shows significant reduction in continuation of warfarin on discharge in patients with unstable INRs (p = 0.0043 Fisher exact test). Although, there is a trend towards improvement with NICE compliance; in general, the compliance with NICE remains poor. We suggest geriatricians to proactively review the appropriateness of warfarin prescription and to consider a DOAC in preference to Warfarin in all elderly patients.
1051 EMERGENCY PACEMAKER IMPLANTATION IN NONAGENARIANS: IMPACT OF FRAILTY ON OPERATOR DECISION-MAKING AND PATIENT OUTCOMES
Authors: Mahtani K , Parker M , Wang R B , Maclean E
Published: June 2022

Introduction

Complete heart block (CHB) is a time-critical emergency. In frail patients with CHB, the absence of test results or a comprehensive history can challenge operator decision-making; in particular, minimal data exists as to the prognostic impact of single versus dual chamber pacing in this group. In patients over 90 years of age presenting with CHB, we examined the prognostic value of parameters obtained from bedside examination, and analysed the impact of single versus dual chamber pacemakers on mortality.

Method

Data were extracted from 2016–2019. Bedside covariates were age, sex, previous cardiac surgery, atrial rhythm, LV systolic function, syncope at presentation, QRS duration, and Rockwood frailty score. Cox-proportional hazards regression examined associations with all-cause mortality and cardiac death, determined from electronic records and death certificates (adjusted HR, 95% CI).

Results

205 patients were included (age 92.3 ± 2.3 years, 45.4% male). Mortality was 13.8% at 90 days and 27.2% at 27.1 ± 16.7 months. The independent predictors of mortality were pre-procedural QRS duration >130 ms (HR 2.4 (1.4–4.1) p = 0.001), age (HR 1.07 (1.02–1.15) p = 0.004), AF (HR 2.0 (1.1–3.6) p = 0.02), and Rockwood score (HR 1.2 (1.02–2.6), p = 0.043). Sex, syncope at presentation, LV function or previous cardiac surgery did not predict mortality (all p > 0.1). In a subset of 168 patients without AF, 30 (17.8%) received single chamber pacemakers. Whilst these patients were more frail than those receiving dual chamber pacemakers (Rockwood scores: 5.2 ± 1.7 vs 4.3 ± 1.1, p = 0.025), implantation of a single chamber pacemaker was independently associated with cardiac death when adjusting for frailty and co-morbidities (HR 6 (1.4–26.4), p = 0.018).

Conclusion

Nonagenarians undergoing emergency pacemaker implantation have a reasonable prognosis. Data ascertained at the bedside can help predict survival, however—when adjusting for frailty and co-morbidities—dual chamber pacing may confer an independent mortality benefit over single chamber pacing in this group.
DrawTetrado to create layer diagrams of G4 structures
Authors: Zurkowski Michal , Zok Tomasz , Szachniuk Marta
Published: June 2022

Motivation

Quadruplexes are specific 3D structures found in nucleic acids. Due to the exceptional properties of these motifs, their exploration with the general-purpose bioinformatics methods can be problematic or insufficient. The same applies to visualizing their structure. A hand-drawn layer diagram is the most common way to represent the quadruplex anatomy. No molecular visualization software generates such a structural model based on atomic coordinates.

Results

DrawTetrado is an open-source Python program for automated visualization targeting the structures of quadruplexes and G4-helices. It generates static layer diagrams that represent structural data in a pseudo-3D perspective. The possibility to set color schemes, nucleotide labels, inter-element distances or angle of view allows for easy customization of the output drawing.

Availability and implementation

The program is available under the MIT license at https://github.com/RNApolis/drawtetrado.
Early juvenile but not mid-to-late prenatal nutrition controls puberty in heifers but neither impact adult reproductive function
Authors: Maia Tatiane S , Guimarães Higor R , Garza Viviana , Pohler Ky G , Cardoso Rodolfo C , Williams Gary L
Published: June 2022

Objectives were to test the hypothesis that pre- and post-natal nutrition in the bovine female, independently or interactively, affect age at puberty and functional characteristics of the estrous cycle of sexually mature offspring. Brangus and Braford (n = 97) beef cows bearing a female fetus were fed to achieve body condition scores of 7.5–8 (H, obese), 5.5–6 (M, moderate), or 3–3.5 (L, thin) by the start of the third trimester and maintained until parturition. Heifer offspring were weaned and fed to gain weight at either a high (H; 1 kg/day) or a low (L; 0.5 kg/day) rate between 4 and 8 months of age, then fed the same diet during a common feeding period until puberty, which resulted in compensatory growth of heifers in the L group. Heifers (n = 95) from the H postnatal diet reached puberty 2 months earlier (12 ± 0.4 months; P = 0.0002) than those from the L postnatal diet (14 ± 0.4 months). Estrous cycles of a subgroup of postpubertal heifers (n = 53) were synchronized to evaluate antral follicle count (AFC), rate of growth and size of the pre-ovulatory follicle, size of corpus luteum and ovary, endometrial thickness, and plasma concentrations of progesterone and estradiol-17β (E2). Although there was a trend for postnatal H heifers to have greater AFC and plasma concentrations of E2 compared to L heifers, neither pre- nor post-natal nutrition affected any other physiological or hormonal variables, including short-term fertility. Postnatal nutritional effects on pubertal age remained the dominant observed feature.
Myocardial brain-derived neurotrophic factor regulates cardiac bioenergetics through the transcription factor Yin Yang 1
Authors: Yang Xue , Zhang Manling , Xie Bingxian , Peng Zishan , Manning Janet R , Zimmerman Raymond , Wang Qin , Wei An-chi , Khalifa Moustafa , Reynolds Michael , Jin Jenny , Om Matthew , Zhu Guangshuo , Bedja Djahida , Jiang Hong , Jurczak Michael , Shiva Sruti , Scott Iain , O’Rourke Brian , Kass David A , Paolocci Nazareno , Feng Ning
Published: June 2022

Aims

Brain-derived neurotrophic factor (BDNF) is markedly decreased in heart failure patients. Both BDNF and its receptor, tropomyosin-related kinase receptor (TrkB), are expressed in cardiomyocytes; however, the role of myocardial BDNF signalling in cardiac pathophysiology is poorly understood. Here, we investigated the role of BDNF/TrkB signalling in cardiac stress response to exercise and pathological stress.

Methods and results

We found that myocardial BDNF expression was increased in mice with swimming exercise but decreased in a mouse heart failure model and human failing hearts. Cardiac-specific TrkB knockout (cTrkB KO) mice displayed a blunted adaptive cardiac response to exercise, with attenuated upregulation of transcription factor networks controlling mitochondrial biogenesis/metabolism, including peroxisome proliferator-activated receptor gamma coactivator 1 alpha (PGC-1α). In response to pathological stress (transaortic constriction, TAC), cTrkB KO mice showed an exacerbated heart failure progression. The downregulation of PGC-1α in cTrkB KO mice exposed to exercise or TAC resulted in decreased cardiac energetics. We further unravelled that BDNF induces PGC-1α upregulation and bioenergetics through a novel signalling pathway, the pleiotropic transcription factor Yin Yang 1.

Conclusion

Taken together, our findings suggest that myocardial BDNF plays a critical role in regulating cellular energetics in the cardiac stress response.
Intra-abdominal septic complications after ileocolic resection increases risk for endoscopic and surgical postoperative Crohn’s disease recurrence
Authors: Bachour Salam P , Shah Ravi S , Rieder Florian , Qazi Taha , Achkar Jean Paul , Philpott Jessica , Lashner Bret , Holubar Stefan D , Lightner Amy L , Barnes Edward L , Axelrad Jordan , Regueiro Miguel , Click Benjamin , Cohen Benjamin L
Published: June 2022

Background

Postoperative recurrence [POR] of Crohn’s disease following ileocolonic resection is common. The impact of immediate postoperative intra-abdominal septic complications [IASC] on endoscopic and surgical recurrence has not been elucidated.

Aims

To evaluate if IASC is associated with an increased risk for endoscopic and surgical POR.

Methods

This was a retrospective study of adult Crohn’s disease patients undergoing ileocolonic resection with primary anastomosis between 2009 and 2020. IASC was defined as anastomotic leak or intra-abdominal abscess within 90 days of the date of surgery. Multivariable logistic and Cox proportional hazard modelling were performed to assess the impact of IASC on endoscopic POR [modified Rutgeerts’ score ≥ i2b] at index postoperative ileocolonoscopy and long-term surgical recurrence.

Results

In 535 Crohn’s disease patients [median age 35 years, 22.1% active smokers, 35.7% one or more prior resection] had an ileocolonic resection with primary anastomosis. A minority of patients [N = 47; 8.8%] developed postoperative IASC. In total, 422 [78.9%] patients had one or more postoperative ileocolonoscopies, of whom 163 [38.6%] developed endoscopic POR. After adjusting for other risk factors for postoperative recurrence, postoperative IASC was associated with significantly greater odds (adjusted odds ratio [aOR]: 2.45 [1.23–4.97]; p = 0.01) and decreased time (adjusted hazards ratio [aHR]: 1.60 [1.04–2.45]; p = 0.03] to endoscopic POR. Furthermore, IASC was associated with increased risk (aOR: 2.3 [1.04–4.87] p = 0.03) and decreased survival-free time [aHR: 2.53 [1.31–4.87]; p = 0.006] for surgical recurrence.

Conclusion

IASC is associated with an increased risk for endoscopic and surgical POR of Crohn’s disease. Preoperative optimization to prevent IASC, in addition to postoperative biological prophylaxis, may help reduce the risk for endoscopic and surgical POR.
Expression Analysis in a Dispersal-Fecundity Polyphenism Identifies Growth Regulators and Effectors
Authors: Angelini David R , Steele Joshua L , Yorsz Michael C , O'Brien Devin M
Published: June 2022

Polyphenism allows organisms to respond to varying environmental conditions by adopting alternative collections of morphological traits, often leading to different reproductive strategies. In many insects, polyphenism affecting the development of flight trades dispersal ability for increased fecundity. The soapberry bug Jadera haematoloma (Hemiptera: Rhopalidae) exhibits wing polyphenism in response to juvenile nutritional resources and cohort density. Development of full-length wings and flight-capable thoracic muscles occurs more frequently in cohorts raised under low food density conditions, and these features are correlated to reduced female fecundity. Soapberry bugs represent an example of polyphenic dispersal-fecundity trade-off. Short-wing development is not sex-limited, and morphs can also differ in male fertility. We have previously shown, via a candidate gene approach, that manipulation of insulin signaling can alter the threshold for nutritional response and that changes in the activity of this pathway underlie, at least in part, differences in the polyphenic thresholds in different host-adapted populations of J. haematoloma. We now expand the examination of this system using transcriptome sequencing across a multidimensional matrix of life stage, tissue, sex, food density, and host population. We also examine the use of wing and thorax shape as factors modeling gene expression. In addition to insulin signaling, we find that components of the TOR, Hippo, Toll, and estrogen-related receptor pathways are differentially expressed in the thorax of polyphenic morphs. The transcription factor Sox14 was one of the few genes differentially expressed in the gonads of morphs, being up-regulated in ovaries. We identify two transcription factors as potential mediators of morph-specific male fertility differences. We also find that bugs respond to nutrient limitation with expression of genes linked to cuticle structure and spermatogenesis. These findings provide a broad perspective from which to view this nutrition-dependent polyphenism.