bluuebunny/crossref_metadata_2025 huggingface dataset:
DS25 Complications after skin surgery
Authors: Sarto Rubiana , Balagopalan Anitha , Naseem Saadia , Sanapala Josephine , Pynn Emma
Published: June 2024

Dermatological surgery is associated with a low incidence of postprocedural complications (Amici JM, Rogues AM, Lasheras A et al. A prospective study of the incidence of complications associated with dermatological surgery. Br J Dermatol 2005; 153: 967–71). However, they can have a significant impact on healing, patient experience and cosmetic outcome. Our aim was to assess our incidence of postprocedural complications and to review associated risk factors, potentially enabling us to improve clinical practice and patient outcomes. Over a 2-week period in December 2023, all patients undergoing excision with primary closure, at any surgical site, were invited to take part. Twelve operators across three outpatient locations recorded operative details and gave out information sheets. Patients were surveyed 2 weeks after surgery through an online form or by phone regarding bleeding, antibiotic requirement, dehiscence and other issues. Case records were reviewed to obtain demographics and details of medications. In total 78 patients agreed to participate, of whom 70 responded to the survey: 71% were above 65 years old, and 51% were male. Thirteen patients (19%) reported postprocedural complications, most of whom (77%) were above the age of 65 years. The face was the most frequent site (38%). Bleeding was the most common complication, seen in seven participants (10%); only one was anticoagulated and four were treated for postoperative infection, which may have been the primary issue. Two experienced slight bleeding, whereas five (7%) needed further medical input. Five (71% of those with a bleed) had a recorded history of increased alcohol consumption, compared with 14% of those who did not bleed. Fifteen patients (21%) received prophylactic antibiotics, and five different individuals (7%) required postprocedural antibiotics in the community. Interestingly, four of these five (80%) reported concurrent bleeding. Dehiscence was described by five patients (7%), 23% of whom were smokers. Six patients were recorded as having ulcerated lesions, four of whom were given prophylactic antibiotics; of the other two, one developed dehiscence and one infection. Our study identified bleeding as the most common postprocedural complication, with significant events in 7%. The most frequent documented risk factor was not anticoagulation as expected but alcohol intake; however, high use of antibiotics in this group suggests association with or primary diagnosis of infection. Limited by our relatively small sample size, we would like to expand this study to a larger group to further explore the clinical significance of these risk factors. We advocate continuing to educate patients regarding risk of bleeding postprocedure, with awareness of the potential effect of alcohol.
DP19 Intraepithelial metastatic melanoma mimicking gastric signet ring adenocarcinoma in situ
Authors: Wong Jo-Yve , Carless Jonathan , Holte Kristofer , Houghton Joe , Kelly Paul
Published: June 2024

Melanoma is the most common tumour to metastasize to the gastrointestinal tract. We present an exceptionally rare case of metastatic melanoma presenting as a gastric metastasis with atypical endoscopic findings and subtle histological findings mimicking signet ring adenocarcinoma in situ and neuroendocrine cell hyperplasia. A 78-year-old patient with a remote past history of pT2b acral lentiginous melanoma of the great toe was referred to gastroenterology with weight loss and anorexia. An oesophagogastroduodenoscopy (OGD) demonstrated focal thickening of the gastric folds. Biopsy from the thickened area demonstrated a focally confluent, lentiginous intraepithelial proliferation of cytologically bland, amelanotic, small cells that was confined to gastric glands. These cells were suspected to be melanocytic in nature because of the presence of periglandular mild melanin incontinence. The melanocytes stained strongly with SOX10, S100, HMB45, melan-A and PRAME immunohistochemistry. Despite examination at levels there was no lamina propria invasion or nodule formation. Given the patient’s clinical history a diagnosis of metastatic melanoma was favoured over a primary gastric melanoma. Soon after OGD the patient developed dyspnoea. A computed tomography (CT) scan demonstrated bilateral pulmonary emboli with thrombus extending from the renal vein into the vena cava. This also demonstrated lytic lesions in the T12 and L1 vertebra and para-aortic lymphadenopathy, both of which were fluorodeoxyglucose avid on positive emission tomography (PET) CT. No gastric lesion was identified on PET CT. Metastatic melanoma presenting as a gastric intraepithelial lesion is incredibly rare, and to our knowledge this is only the second such reported case. However, this is the first case to be examined with a negative PET CT scan, demonstrating a lack of sensitivity of radiological investigations in identifying metastatic melanoma with this growth pattern. This in situ pattern of metastasis to the stomach is potentially more common than previously recognized and is deserving of wider attention.
PA24 Concomitant Crohn disease and scurvy: an unusual presentation revealing nutritional challenges
Authors: Pacheco Matheus Alves , Sarto Rubiana , Lima Fernanda Ramos Paes , Wegner Christine Aparecida , Rosa Ariel Cordova , Di Giunta Funchal Gabriella , Martini Athos
Published: June 2024

This case report presents a 15-year-old boy newly diagnosed with Crohn disease (CD), currently under treatment with prednisone and azathioprine. The patient was admitted to the hospital due to diffuse abdominal pain, diarrhoea and fever. Remarkably, after 5 days of hospitalization, he developed purpuric lesions on his wrists, abdomen and lower limbs. Dermoscopic examination of the cutaneous petechiae revealed an intriguing finding: whitish hair follicles exhibiting a distinctive ‘corkscrew’ hair pattern surrounded by a haemorrhagic violaceous halo. This dermoscopic profile strongly suggested the presence of scurvy. Histological analysis provided further insight, demonstrating perifollicular haemorrhage and interstitial extravasation of red blood cells. While nutritional deficiencies are commonly linked to CD, vitamin C deficiency is less frequently identified and reported, despite its prevalence. The challenge lies in the potential overlap of symptoms between active CD and scurvy, making the diagnosis of vitamin C deficiency more elusive in patients with CD. This case underscores the importance of considering vitamin C deficiency in the differential diagnosis of cutaneous manifestations in individuals with CD. Clinicians should be vigilant in identifying such nutritional deficiencies to ensure timely intervention and prevent complications associated with scurvy.
PA33 Mosaic KRAS mutation associated with epidermal naevus and somatic limb overgrowth
Authors: Thu-Ta Flora , Bajwa Dalvir Singh , Leech Suzanne , Dubois Anna , Wilson Brian
Published: June 2024

Mosaic KRAS variants are recognized to cause a range of features including somatic overgrowth, lymphatic and vascular malformations and other anomalies. We present a child with a mosaic variant in this gene and discuss the phenotype of this condition. A 2-year-old boy was noted at birth to have an extensive keratinocytic epidermal naevus and swelling of the left lower limb. The child was born after an uncomplicated pregnancy to unrelated parents. No anomalies had been detected prenatally. The naevus was large, affecting the left side of the body with a central demarcation down the midline of his chest to the left groin. The naevus continued down the volar aspect of the left arm onto the palm of the hand. The left lower limb was hypertrophic throughout, with nonpitting oedema. The perfusion and movement of the limb appeared normal. An infantile haemangioma was noted on the lower back, and later a deeper haemangioma of the anterior neck; neither required treatment. The left testis was undescended initially, with subsequent overgrowth of the skin of the penis and scrotum. Investigations soon after birth revealed a cystic dysplastic left kidney. A magnetic resonance imaging scan of the brain was normal. Initial genetic analysis was performed on blood. Diagnostic testing for a panel of genes associated with segmental overgrowth (R110) detected no pathogenic variant. The mosaic skin disorders deep sequencing panel (R327) showed no pathogenic variant using DNA extracted from blood. This panel was subsequently repeated on DNA extracted from skin, and a mosaic pathogenic KRAS variant c.35G>A, p.Gly12Asp was identified in 30% of next-generation sequencing reads. Mosaic RASopathies affect genes involved in the RAS–mitogen-activated protein kinase signalling pathway. Phenotypes of mosaic RASopathies are often distinct from their germline counterparts. The c.35G>A variant seen in our patient is widely reported, and leads to constitutive overactivation and increased signal transduction in downstream pathways. Epidermal naevi, both keratinocytic and sebaceous, are a common finding resulting from mosaic RAS mutations. Good developmental progress was made; milestones were generally met and although the leg remained enlarged due to lymphatic overgrowth, he was able to walk. No neurological symptoms have been noted, and the eyes have been checked with no anomalies found. The kidneys will be kept under review, as renal tumours have been reported in patients with mosaic KRAS variants. Our patient highlights aspects of the phenotype of a mosaic KRAS variant and adds to the growing knowledge of these conditions.
BI31 Pembrolizumab-induced scleroderma in a patient with nonsmall cell lung cancer
Authors: Kunnumpurath Anamika , Gjorgjievska-Marsh Vesna
Published: June 2024

We present the case of a 59-year-old woman with locally advanced metastatic adenocarcinoma of the lung, who developed skin tightening and thickening following a course of treatment with pembrolizumab. She was commenced on pembrolizumab in September 2021, and in July 2023 she developed the skin changes in the neck, shoulders, stomach and thighs with associated pain, as well as areas of colour change and restriction of movement. Clinical presentation combined with subsequent histopathological confirmation led to a diagnosis of scleroderma. Following a failed trial of high-dose prednisolone, methotrexate was started with beneficial effect. This case highlights that scleroderma is a rare skin-related adverse event that can occur with immune checkpoint inhibitors.
Global Health DermatologyOral presentationsGD01 Comparative efficacy of Mycobacterium indicus pranii and bacille Calmette–Guérin as immunotherapeutic adjuncts in multibacillary leprosy: a clinical and molecular randomized controlled trial
Authors: Jain Sejal , Chhabra Seema , Dogra Sunil , Yadav Rakesh , Chatterjee Debajyoti , Narang Tarun
Published: June 2024

Immunotherapy may be a useful tool in the management of leprosy, especially in highly bacillated patients because of immunological memory. This open-label randomized controlled trial assessed changes in the molecular viability assay (esxA and hsp18 transcript expression) and serology (anti-ND-O-BSA levels) in patients with multibacillary leprosy treated with multibacillary multidrug therapy (MB-MDT) with Mycobacterium indicus pranii (MIP) vaccine or MB-MDT with bacille Calmette–Guérin (BCG) vaccine. Secondary outcomes were changes in histopathological parameters (granuloma fraction and bacillary index of the granuloma), differences in the incidences of type 1 and type 2 lepra reactions, and incidence of immunotherapy-associated adverse drugs reactions among the two groups. The study included 40 patients with multibacillary leprosy randomized into the MIP + MB-MDT and BCG + MB-MDT groups. Thirty patients (15 in each group) completed the 12-month follow-up. Molecular viability assays based on esxA and hsp18 transcript expression, and anti-NO-O-BSA levels were measured in 23 of 30 patients (13 in the MIP group and 10 in the BCG group). In the MIP group, 77% of patients (10 of 13) and in the BCG group, 50% (5 of 10) showed decreased esxA (P = 0.09) and hsp18 transcript expression (P = 0.4). The median decrease in bacteriological index was 1 (interquartile range 0–2) in the MIP group and 1 (interquartile range 0–1) in the BCG group (P = 0.9). A decrease in IgM anti-ND-O-BSA levels was seen in 77% of patients (10 of 13) in the MIP group and 80% (8 of 10) in the BCG group (P = 0.9). Histopathological upgrading was noted in 85% of patients (11 of 13) in the MIP group and 90% (9 of 10) in the BCG group (P = 0.3). Most of the patients had clinical improvement (26 of 30, 87%), which was comparable between the two groups (P = 0.5). None of these patients had primary drug resistance to the first-line MDT drugs. Two patients in the MIP group (13%) and five in the BCG group (33%) had reactional episodes, but only one had an increase in disability. The adverse effect profiles of both vaccines were similar, the majority being injection-site reactions. BCG was associated with neuritis in two patients (12%). This study demonstrates the usefulness of immunotherapy in reducing bacillary viability, improving histopathological and serological markers, and potentially preventing lepra reactions and associated disability. The comparability of MIP and BCG is noteworthy, especially considering BCG’s wider availability and lower cost. The use of molecular viability assays and anti-ND-O-BSA enzyme-linked immunosorbent assay as diagnostic and predictive tools for reactions and/or relapse could advance future research in leprosy.
BT31 The dermatology department without walls: how teledermatology unmasks unmet need in coastal ‘deserts of provision’
Authors: Farooki Roopa , Halpern Saul
Published: June 2024

Dermatology departments actively use digital solutions to provide services remotely, particularly to supplement overbooked face-to-face clinics. In coastal areas, there are additional challenges regarding provision of access to dermatology, with few centres offering dermatology appointments, and with patients not always having the means to travel. This paper discusses how the teledermatology service in one of the coastal ‘deserts of provision’ both widens access to secondary care and unmasks unmet need in these communities. The methods used involve direct comparison of the number of dermatology referrals from primary care, both before the establishment of the teledermatology service and afterwards. The teledermatology service examined has been established in coastal locations, offering photography and dermoscopic images of lesions, submitted with a standardized patient history form. The main focus of the service is to identify skin cancers and provide reassurance of benign lesions, without recourse to 2-week-wait appointments, although other skin conditions suitable for general clinics are also referred. Interestingly, the results show that the teledermatology service has had no impact on mitigating traditional referrals to routine or 2-week-wait clinics, which have continued to increase, on average by 18% in the 2-year period ending January 2024, across 24 surgeries in the region. For one surgery located in one of the most isolated areas, weekly referrals have increased by 142%, representing an increase from three to seven referrals per week. This centre also made an additional eight referrals to teledermatology per week, mainly for single lesions that general practitioners felt did not merit the 2 week wait, but that required timely dermatological opinion. Of 97 referrals examined across a 12-week period (November 2023 to January 2024), five lesions were listed directly for surgical excision, eight for biopsy and eight for further clinical evaluation. It seems evident that in providing this additional path of access, the teledermatology service has unmasked an unmet need in the coastal community. It offers a ‘dermatology department without walls’, where expert secondary care advice with consultant insight can be obtained locally, and surgical follow-up or further clinical management can be organized directly by the advising dermatology team. Further study is needed to confirm that this increased access also leads to improved patient outcomes, which is predicated on appropriate referrals to teledermatology by primary care, and assessment of the diagnostic accuracy of teledermatology compared with traditional in-person clinics. The hope is that effective dermatology specialty care is being brought to the patient more directly in coastal communities than has previously been possible.
BT38 Patient satisfaction of teledermoscopy service in a UK university health board: a service evaluation
Authors: Hughes Anna , Abbott Rachel
Published: June 2024

Around 20 000 teledermatology referrals are reviewed by dermatology consultants in our UK university health board each year, including urgent suspected cancer referrals. More recently, an additional ‘teledermoscopy service’ was introduced so that dermatology consultants can request dermoscopy photos – in addition to standard clinical photos – for remote review. With the rising incidence of skin cancer in the UK, and a backlog of referrals created by the COVID-19 pandemic, the demand for access to dermatological care heightens the need for teledermatology services, including teledermoscopy. This service evaluation sought to evaluate the patient satisfaction of the new teledermoscopy service. Over 3 weeks, patient satisfaction of the teledermoscopy service was assessed via a 14-question survey that was developed and piloted in a neighbouring health board. The survey was offered to patients after their appointment in the medical illustration teledermoscopy clinic. Waiting times, hospital accessibility, preappointment information and appointment experience were evaluated using Likert scaling, a five-point scale using the terms; ‘strongly agree’, ‘agree’, ‘don’t know’, ‘disagree’ and ‘strongly disagree’. Overall experience was assessed on a scale of 1–10, and the final question of the survey allowed for free writing of any comments the participants had. In total, 100 patients (mean age 55 years, range 16–90; 42% male) responded to the survey. Overall, 84 of 100 respondents replied to the question asking them to rate their overall experience from 1 to 10: 83 of 84 (99%) rated the service ≥ 8 out of 10, and 62 of 84 (74%) respondents rated the service 10 out of 10. With regards to patient experiences of the appointment, the responses were very positive: 98 of 100 respondents (98%) ‘agreed’ or ‘strongly agreed’ that the procedure was clearly explained to them, and 99% of respondents ‘agreed’ or ‘strongly agreed’ that the photographer acted professionally, and the photographic environment was appropriate. Contrastingly, the responses regarding the preappointment information were less positive: 35 of 99 patients (35%) ‘disagreed’ or ‘strongly disagreed’ that they were given sufficient information about the teledermatology service prior to their appointment. Importantly, 9 of the 100 (9%) reported that they thought their appointment was to see a dermatologist, not a medical photographer. In total, 85 of 100 patients (85%) agreed that the hospital was easy to attend, while 6 of the 100 (6%) expressed a preference for a closer hospital. Finally, 18 of the 100 respondents answered the open-ended ‘further comments’ question. The written feedback provided was mostly positive. The majority of patients were highly satisfied with the teledermoscopy service; however, over one-third felt that more information was needed prior to their appointment.
‘When you do not feel comfortable in your skin, you cannot get out of it’; a qualitative interview study exploring psychosocial impact and coping strategies among patients with prurigo nodularis
Authors: Schielein Louisa , Ziehfreund Stefanie , Biedermann Tilo , Zink Alexander
Published: June 2024

Prurigo nodularis (PN) is a disease associated with severe chronic pruritus and therefore causes a substantial impact on quality of life. This study aimed to explore the psychosocial burden of PN and the coping mechanisms employed by affected individuals to manage symptoms associated with the condition. In summary, patients reported a profound impact on various aspects of their lives, including mental wellbeing, relationships, self-perception, leisure activities, occupation, sleep patterns and clothing choices. Further, the disease led to social avoidance and isolation in patients.
Social Workers’ Perceptions of the Nature of Child Neglect: A Systematic Literature Review
Authors: Gibbs Jennifer , Coughlan Barry , Morgan Tessa , Mikushnica Arbenita , Phippard Samantha , Crozier-Roche Francesca , Drayak Taliah , Graham David , Smith Jack , Duschinsky Robbie
Published: June 2024

Neglect is the most common form of child maltreatment in the UK and the USA. This article reviews research about how child neglect is perceived by social workers. We conducted a systematic review and identified fifty relevant studies, using a range of methodologies, published since the 1989 Children Act. The themes were identified iteratively and synthesised using a narrative method. The review found that despite evidence that neglect is associated with several adverse outcomes, neglect is a lower priority for social work intervention compared to other forms of maltreatment. This is particularly true for emotional neglect and neglect of older children. The review found that social workers conceptualise poverty and neglect as being distinctly different and try to address poverty through practical, non-punitive interventions. However, assessments could better recognise how deprivation exacerbates other risk factors for neglect. The review found a lack of knowledge about perceptions of neglect in adolescents and children with a disability and about the threshold for intervention when neglect is cumulative. Practice may be improved by better recognising and addressing the societal context to neglect allegations and the risk of long-term harm. Achieving this may have resource and training implications.
Putaminal dopamine modulates movement motivation in Parkinson’s disease
Authors: Banwinkler Magdalena , Dzialas Verena , Rigoux Lionel , Asendorf Adrian L , Theis Hendrik , Giehl Kathrin , Tittgemeyer Marc , Hoenig Merle C , van Eimeren Thilo
Published: June 2024

The relative inability to produce effortful movements is the most specific motor sign of Parkinson’s disease, which is primarily characterized by loss of dopaminergic terminals in the putamen. The motor motivation hypothesis suggests that this motor deficit may not reflect a deficiency in motor control per se, but a deficiency in cost-benefit considerations for motor effort. For the first time, we investigated the quantitative effect of dopamine depletion on the motivation of motor effort in Parkinson’s disease.

A total of 21 early-stage, unmedicated patients with Parkinson’s disease and 26 healthy controls were included. An incentivized force task was used to capture the amount of effort participants were willing to invest for different monetary incentive levels and dopamine transporter depletion in the bilateral putamen was assessed.

Our results demonstrate that patients with Parkinson’s disease applied significantly less grip force than healthy controls, especially for low incentive levels. Congruously, decrease of motor effort with greater loss of putaminal dopaminergic terminals was most pronounced for low incentive levels. This signifies that putaminal dopamine is most critical to motor effort when the trade-off with the benefit is poor.

Taken together, we provide direct evidence that the reduction of effortful movements in Parkinson’s disease depends on motivation and that this effect is associated with putaminal dopaminergic degeneration.
Identification of angiogenesis-related genes and molecular subtypes for psoriasis based on random forest algorithm
Authors: Zhang Meng-Jie , Xue Ting-Ting , Fei Xiao-Ya , Zhang Ying , Luo Ying , Ru Yi , Jiang Jing-Si , Song Jian-Kun , Kuai Le , Luo Yue , Wang Rui-Ping , Li Bin
Published: June 2024

Psoriasis is a chronic immune-mediated recurrent skin disease causing systemic damage. Increased angiogenesis has been reported to participate in the progression of psoriasis. However, angiogenesis-related genes (ARGs) in psoriasis have not been systematically elucidated. Therefore, we aim to identify potential biomarkers and subtypes using two algorithmsr. Transcriptome sequencing data of patients with psoriasis were obtained, in which differentially expressed genes were assessed by principal component analysis. A diagnostic model was developed using random forest algorithm and validated by receiver operating characteristic (ROC) curves. Subsequently, we performed consensus clustering to calculate angiogenesis-associated molecular subtypes of psoriasis. Additionally, a correlation analysis was conducted between ARGs and immune cell infiltration. Finally, validation of potential ARG genes was performed by quantitative real-time PCR (qRT-PCR). We identified 29 differentially expressed ARGs, including 13 increased and 16 decreased. Ten ARGs, CXCL8, ANG, EGF, HTATIP2, ANGPTL4, TNFSF12, RHOB, PML, FOXO4, and EMCN were subsequently sifted by the diagnostic model based on a random forest algorithm. Analysis of the ROC curve (area under the curve [AUC] = 1.0) indicated high diagnostic performance in internal validation. The correlation analysis suggested that CXCL8 has a high positive correlation with neutrophil (R =0.8, P < 0.0001) and interleukins pathway (R = 0.79, P < 0.0001). Furthermore, two ARG-mediated subtypes were obtained, indicating potential heterogeneity. Finally, the qRT-PCR demonstrated that the mRNA expression levels of CXCL8 and ANGPTL4 were elevated in psoriasis patients, with a reduced expression of EMCN observed. The current paper indicated potential ARG-related biomarkers of psoriasis, including CXCL8, ANGPTL4, and EMCN, with two molecular subtypes.
Simultaneous cortical, subcortical, and brainstem mapping of sensory activation
Authors: Reddy Neha A , Clements Rebecca G , Brooks Jonathan C W , Bright Molly G
Published: June 2024

Nonpainful tactile sensory stimuli are processed in the cortex, subcortex, and brainstem. Recent functional magnetic resonance imaging studies have highlighted the value of whole-brain, systems-level investigation for examining sensory processing. However, whole-brain functional magnetic resonance imaging studies are uncommon, in part due to challenges with signal to noise when studying the brainstem. Furthermore, differentiation of small sensory brainstem structures such as the cuneate and gracile nuclei necessitates high-resolution imaging. To address this gap in systems-level sensory investigation, we employed a whole-brain, multi-echo functional magnetic resonance imaging acquisition at 3T with multi-echo independent component analysis denoising and brainstem-specific modeling to enable detection of activation across the entire sensory system. In healthy participants, we examined patterns of activity in response to nonpainful brushing of the right hand, left hand, and right foot (n = 10 per location), and found the expected lateralization, with distinct cortical and subcortical responses for upper and lower limb stimulation. At the brainstem level, we differentiated the adjacent cuneate and gracile nuclei, corresponding to hand and foot stimulation respectively. Our findings demonstrate that simultaneous cortical, subcortical, and brainstem mapping at 3T could be a key tool to understand the sensory system in both healthy individuals and clinical cohorts with sensory deficits.
Prevalence, awareness, treatment, and control of hypertension in community-dwelling older adults with chronic kidney disease: the Irish longitudinal study on ageing
Authors: Browne Leonard D , Alamin Mohammed Y , Miri Hamid H , Hall Robert , Tandan Meera , Sexton Donal , Stack Austin G
Published: June 2024

Background

Hypertension is highly prevalent in chronic kidney disease (CKD), posing a significant but modifiable risk for adverse clinical outcomes. This study explored the prevalence, awareness, treatment, and control of hypertension in older Irish adults with CKD.

Methods

Data were analysed from participants in Wave 1 of The Irish Longitudinal Study on Ageing (TILDA) who were aged 50 years and older. CKD was defined as eGFR <60 ml/min/1.72 m2, hypertension defined as systolic blood pressure (SBP) ≥140 mmHg and/or diastolic blood pressure (DBP) ≥90 mmHg and/or self-reported use of antihypertensive medication. Participant awareness and treatment of hypertension was based on self-report and SBP/DBP <140/90 mmHg. Multivariable logistic regression examined relationships with awareness, treatment, and control of hypertension expressed as adjusted odds ratios.

Results

Prevalence of hypertension was significantly higher in participants with CKD than without (81.9% vs 59.7%, P < .001). Among hypertensive individuals, 70.1% (95% CI: 65.8–74.1) were aware, 83.5% (95% CI 80.0–86.6) were on treatment, yet blood pressure control <140/90 mmHg and SBP <120 mmHg were achieved in only 49.3% (CI 44.0–54.7%) and 17.9% (CI 14.4–22.1), respectively. In multivariable analysis, advancing age 1.05 (CI 1.01–1.10), obesity 6.23 (CI 2.51–15.5), diabetes 5.78 (CI 1.55–21.5), and cardiovascular disease 9.89 (CI 3.27–29.9) were associated with higher odds of treatment, while cardiovascular disease 2.35 (CI 1.39–3.99) and combination antihypertensive therapy 1.76 (CI 1.03–3.01) were associated with blood pressure control.

Conclusion

The prevalence of hypertension is substantial in older Irish adults with CKD; however, control is poor. Approximately, one-third of participants were unaware of their hypertensive status and approximately one-fifth were untreated.
Interdependent security games in the Stackelberg style: how first-mover advantage impacts free riding and security (under-)investment
Authors: Huang Ziyuan , Naghizadeh Parinaz , Liu Mingyan
Published: June 2024

Network games are commonly used to capture the strategic interactions among interconnected agents in simultaneous moves. The agents’ actions in a Nash equilibrium must take into account the mutual dependencies connecting them, which is typically obtained by solving a set of fixed point equations. Stackelberg games, on the other hand, model the sequential moves between agents that are categorized as leaders and followers. The corresponding solution concept, the subgame perfect equilibrium, is typically obtained using backward induction. Both game forms enjoy very wide use in the (cyber)security literature, the network game often as a template to study security investment and externality—also referred to as the interdependent security games—and the Stackelberg game as a formalism to model a variety of attacker–defender scenarios. In this study, we examine a model that combines both types of strategic reasoning: the interdependency as well as sequential moves. Specifically, we consider a scenario with a network of interconnected first movers (firms or defenders, whose security efforts and practices collectively determine the security posture of the eco-system) and one or more second movers, the attacker(s), who determine how much effort to exert on attacking the many potential targets. This gives rise to an equilibrium concept that embodies both types of equilibria mentioned above. We will examine how its existence and uniqueness conditions differ from that for a standard network game. Of particular interest are comparisons between the two game forms in terms of effort exerted by the defender(s) and the attacker(s), respectively, and the free-riding behavior among the defenders.
Reliability of single-lead electrocardiogram interpretation to detect atrial fibrillation: insights from the SAFER feasibility study
Authors: Hibbitt Katie , Brimicombe James , Cowie Martin R , Dymond Andrew , Freedman Ben , Griffin Simon J , Hobbs F D R ichard , Lindén Hannah Clair , Lip Gregory Y H , Mant Jonathan , McManus Richard J , Pandiaraja Madhumitha , Williams Kate , Charlton Peter H
Published: June 2024

Aims

Single-lead electrocardiograms (ECGs) can be recorded using widely available devices such as smartwatches and handheld ECG recorders. Such devices have been approved for atrial fibrillation (AF) detection. However, little evidence exists on the reliability of single-lead ECG interpretation. We aimed to assess the level of agreement on detection of AF by independent cardiologists interpreting single-lead ECGs and to identify factors influencing agreement.

Methods and results

In a population-based AF screening study, adults aged ≥65 years old recorded four single-lead ECGs per day for 1–4 weeks using a handheld ECG recorder. Electrocardiograms showing signs of possible AF were identified by a nurse, aided by an automated algorithm. These were reviewed by two independent cardiologists who assigned participant- and ECG-level diagnoses. Inter-rater reliability of AF diagnosis was calculated using linear weighted Cohen’s kappa (κw). Out of 2141 participants and 162 515 ECGs, only 1843 ECGs from 185 participants were reviewed by both cardiologists. Agreement was moderate: κw = 0.48 (95% confidence interval, 0.37–0.58) at participant level and κw = 0.58 (0.53–0.62) at ECG level. At participant level, agreement was associated with the number of adequate-quality ECGs recorded, with higher agreement in participants who recorded at least 67 adequate-quality ECGs. At ECG level, agreement was associated with ECG quality and whether ECGs exhibited algorithm-identified possible AF.

Conclusion

Inter-rater reliability of AF diagnosis from single-lead ECGs was found to be moderate in older adults. Strategies to improve reliability might include participant and cardiologist training and designing AF detection programmes to obtain sufficient ECGs for reliable diagnoses.
Chronic Kidney Disease Is Associated With Increased All-Cause Mortality Risk Among Older Black Adults
Authors: Cobb Ryon J , Thorpe Roland J , Norris Keith N
Published: June 2024

Background and Objectives

Older patients diagnosed with chronic kidney disease (CKD) have a higher risk of all-cause mortality than the general population. However, there is limited information available on how CKD relates to all-cause mortality among Black adults in the United States. We aimed to investigate how CKD relates to all-cause mortality risk among older Black adults.

Research Design and Methods

This study draws on a subsample of self-identified Black participants (N = 1 393) from the Health and Retirement Study ages 52 to 96 who completed the anthropomorphic and biomarker supplement in 2006/2008. Our measure of CKD derives from serum cystatin C-based using dried blood spots, and all-cause mortality derives from the National Death Index and a key informant within the household from 2006 to 2019.

Results

Twenty-nine percent of respondents died during the study period, whereas 31% had CKD. The mean age of the entire sample is 64.52. Results from our Cox proportional hazards models showed that CKD was independently associated with an increased risk of death from all causes among older Black participants in a model that adjusted for demographics, behavioral, clinical, and health characteristics.

Discussion and Implications

Results from our study confirm that CKD is associated with increased risk of death from all causes among older Black adults. Future studies should examine whether changes in CKD over time relate to all-cause mortality risk among older Black adults.
The influence of crisis on policy formulation: the case of alcohol regulation in South Africa during COVID-19 (2020–21)
Authors: Hargovan Mumta , London Leslie , Orgill Marsha
Published: June 2024

This study contributes to a neglected aspect of health policy analysis: policy formulation processes. Context is central to the policy cycle, yet the influence of crises on policy formulation is underrepresented in the health policy literature in low- and middle-income countries (LMICs). This paper analyses a detailed case study of how the COVID-19 crisis influenced policy formulation processes for the regulation of alcohol in South Africa, as part of COVID-19 control measures, in 2020 and 2021. It provides a picture of the policy context, specifically considering the extent to which the crisis influenced the position and power of actors, and policy content. Qualitative data were collected from nine key informant interviews and 127 documents. Data were analysed using thematic content analysis. A policy formulation conceptual framework was applied as a lens to describe complex policy formulation processes. The study revealed that the perceived urgency of the pandemic prompted a heightened sense of awareness of alcohol-related trauma as a known, preventable threat to public health system capacity. This enabled a high degree of innovation among decision-makers in the generation of alternative alcohol policy content. Within the context of uncertainty, epistemic and experiential policy learning drove rapid, adaptive cycles of policy formulation, demonstrating the importance of historical and emerging public health evidence in crisis-driven decision-making. Within the context of centralization and limited opportunities for stakeholder participation, non-state actors mobilized to influence policy through the public arena. The paper concludes that crisis-driven policy formulation processes are shaped by abrupt redistributions of power among policy actors and the dynamic interplay of evolving economic, political and public health priorities. Understanding the complexity of the local policy context may allow actors to navigate opportunities for public health-oriented alcohol policy reforms in South Africa and other LMICs.
The first 100 years of the ICES Journal of Marine Science
Authors: Anderson Emory D
Published: June 2024

To celebrate the centenary of the ICES Journal of Marine Science in 2026, this article takes a retrospective look at what transpired with the Journal during those 100 years. Beginning with the original intent of the publication, its subsequent transformation is chronicled from being a French-titled journal focussing mainly on northeast Atlantic topics with three issues per volume to its present status as a well-known and highly rated publication 9–10 issues per year featuring papers from around the world addressing the full range of marine science investigations. The publication, subscriptions, and distribution of the Journal were initially handled by Danish firms, but were later contracted to major publishing companies such as Academic Press and Oxford University Press, the current publisher. Brief commentaries are provided of the nine individuals who have served as editor or editor-in-chief of the Journal throughout its 100-year history, as well as some who have served as assisting editors or editorial assistants in the ICES Secretariat. The management and promotion of the Journal by ICES are also reviewed.
Thrombomodulin Improves Cognitive Deficits in Heat-Stressed Mice
Authors: Lin Cheng-Hsien , Tang Ling-Yu , Wang Lin-Yu , Chang Ching-Ping
Published: June 2024

Background

Thrombomodulin (TM) exerts anticoagulant and anti-inflammatory effects to improve the survival of patients with septic shock. Heat stroke resembles septic shock in many aspects. We tested whether TM would improve cognitive deficits and related causative factors in heat-stressed (HS) mice.

Methods

Adult male mice were exposed to HS (33°C for 2 hours daily for 7 consecutive days) to induce cognitive deficits. Recombinant human soluble TM (1 mg/kg, i.p.) was administered immediately after the first HS trial and then once daily for 7 consecutive days. We performed the Y-maze, novel objective recognition, and passive avoidance tests to evaluate cognitive function. Plasma levels of lipopolysaccharide (LPS), high-mobility group box 1 (HMGB1), coagulation parameters, and both plasma and tissue levels of inflammatory and oxidative stress markers were biochemically measured. The duodenum and hippocampus sections were immunohistochemically stained. The intestinal and blood-brain barrier permeability were determined.

Results

Compared with controls, HS mice treated with TM had lesser extents of cognitive deficits, exacerbated stress reactions, gut barrier disruption, endotoxemia, blood-brain barrier disruption, and inflammatory, oxidative, and coagulatory injury to heart, duodenum, and hippocampal tissues, and increased plasma HMGB1. In addition to reducing cognitive deficits, TM therapy alleviated all the abovementioned complications in heat-stressed mice.

Conclusions

The findings suggest that HS can lead to exacerbated stress reactions, endotoxemia, gut barrier disruption, blood-brain barrier disruption, hippocampal inflammation, coagulopathy, and oxidative stress, which may act as causative factors for cognitive deficits. TM, an anti-inflammatory, antioxidant, and anti-coagulatory agent, inhibited heat stress-induced cognitive deficits in mice.
Risk Factors for Recurrent Urinary Tract Infections Among Women in a Large Integrated Health Care Organization in the United States
Authors: Ackerson Bradley K , Tartof Sara Y , Chen Lie H , Contreras Richard , Reyes Iris Anne C , Ku Jennifer H , Pellegrini Michele , Schmidt Johannes E , Bruxvoort Katia J
Published: June 2024

Background

Urinary tract infections (UTIs) occur commonly and often recur. However, recent data on the epidemiology of recurrent UTI (rUTI) are scarce.

Methods

Between 1 January 2016 and 31 December 2020, index uncomplicated UTIs (uUTIs) from office, emergency department, hospital, and virtual care settings were identified from the electronic health records of women at Kaiser Permanente Southern California. We defined rUTI as ≥3 UTIs within 365 days or ≥2 UTIs within 180 days. We determined the proportion of women with cystitis index uUTI who had rUTI, and we examined factors associated with rUTIs using modified multivariable Poisson regression.

Results

Among 374 171 women with cystitis index uUTI, 54 318 (14.5%) had rUTI. A higher proportion of women with rUTI vs those without rUTI were aged 18 to 27 or ≥78 years at index uUTI (19.7% vs 18.7% and 9.0% vs 6.0%, respectively), were immunocompromised, or had a positive urine culture result at index uUTI. In multivariable analyses, characteristics associated with rUTI included younger or older age (48–57 vs 18–27 years: adjusted risk ratio [aRR], 0.83 [95% CI, .80–.85]; ≥78 vs 18–27 years: aRR, 1.07 [95% CI, 1.03–1.11]), Charlson Comorbidity Index (≥3 vs 0: aRR, 1.12 [95% CI, 1.08–1.17]), and diabetes mellitus (aRR, 1.07 [95% CI, 1.04–1.10]). More frequent prior-year outpatient and emergency department encounters, oral antibiotic and oral contraceptive prescriptions, positive culture result at index uUTI, and antibiotic-resistant organisms were also associated with increased risk of rUTI.

Conclusions

The high risk of rUTI among women with cystitis is concerning, especially given previous reports of increasing UTI incidence. Current assessment of the epidemiology of rUTI may guide the development of preventive interventions against UTI.
The Politics of Punishment: Why Dictators Join the International Criminal Court
Authors: Johns Leslie , Parente Francesca
Published: June 2024

Scholars commonly argue that international law and organizations promote democracy by helping dictators to credibly commit to accountability, individual rights, and transparency. Yet dictators routinely join treaties and international organizations without transitioning to democracy. International law and organizations can generate asymmetric costs for domestic actors because international rules often apply to both governments and non-state actors, yet dictators can limit how these rules are upheld at the domestic and international level. We argue that dictators are most likely to join such treaties and international organizations when they face strong domestic political competition. We illustrate our argument using the International Criminal Court (ICC), which has extensive powers to prosecute individuals for international crimes, including crimes against humanity, genocide, and war crimes. We show that ICC investigations and prosecutions have become a tool for incumbent dictators to target their domestic opponents. We examine the implications of our theory for multiple outcome variables, including the decision to join the ICC, violence, and the survival of dictators in power. Our evidence suggests that dictators are most likely to join the ICC when they face strong political opponents and are subsequently less likely to commit violence and more likely to survive in office.
Validation of a New Liquid Asymmetric-Electrode Plasma Optical Emission Spectroscopy (LAEP-OES) Method for Measurement of Total Mercury in Tuna
Authors: Takagi Hidenori , Shibuta Yoshiaki , Yamashita Michiaki
Published: June 2024

Background

Mercury intake is caused by eating seafood, such as tuna and other predatory fish species. To reduce the health risks of mercury intake, it is necessary to continuously measure and monitor mercury concentrations at fish farms and markets. We have developed a compact system that can detect multiple heavy metals by liquid asymmetric-electrode plasma optical emission spectroscopy (LAEP-OES).

Objective

The validity of the LAEP-OES method for total mercury levels was evaluated using standard solutions, certified substances, and specimens of bluefin tuna and other fish species.

Methods

All specimens were dissolved in 4 M lithium hydroxide solution and then dispensed into a sample reservoir well of the single-use measurement reagent pack. Total mercury levels were automatically measured within 15 min of placement into the dedicated equipment. A total of 102 fish specimens, classified into 10 fish species, were evaluated using the new method and the results were compared to those obtained from validated analytical methods.

Results

LOD (0.02 mg/kg), LOQ (0.07 mg/kg), repeatability (4.0%), intermediate precision (9.8%), and trueness (recoveries 107%) of the proposed method were within satisfactory limits for total mercury levels in fish. Additionally, when using various fish species, the method had a strong positive correlation with the results of cold-vapor atomic absorption spectrometry (CV-AAS, the official method) with Spearman rs = 0.984.

Conclusion

The LAEP-OES method can be used for measuring total mercury levels in bluefin tuna. Total mercury measurement using this new method has the potential to be applied to other fish species.

Highlights

Total mercury levels in fish were measured using our unique analysis system. Pacific bluefin tuna, southern bluefin tuna, and Atlantic bluefin tuna distributed in the Japanese market were analyzed for total mercury in their wild and farmed fish varieties.